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DEPRESSION DRUG FOR TEENSRead Now
The Saturday of Labor Day weekend, my best fiend's mom passed away --- almost three years to the day after HIS DAD passed. I was just south of St Louis at my in-laws, and had brought THE MOTORCYCLE because the rest of the family had gone up a couple days earlier.
Although there was certainly sadness for the passing of the family matriarch, ILENE, the day was really a celebration of her and Paul's life together. For instance; one of the kids (Jonah?) found an old slide projector and slides --- all of them four to five decades old. It was an incredible time watching everyone's reactions to the slides and listening to their stories.
That afternoon, Rick approached me about taking care of someone's shoulder. After working on one person, it sort of snowballed. Several people told me of chronic (long-standing) problems they had been struggling with, and I spent a couple of hours working on anyone who needed. I felt honored to be able to give something back to a few of the people who have become a second family to me. Below is an email I received from DREONA'S husband -- a law enforcement officer in PA.
Following an incident that occurred while conducting an arrest, I had severe neck and upper back pain that kept me up at night and inhibited my movements during my work day. While at a recent family function, Dr. Russ Schierling performed Scar tissue remodeling treatment on me. After the procedure, I instantly felt the pain release from my neck and upper back. That night I slept for the first time in months without waking, and I am now able go through my workday pain free. - Jeremy Breton
Fortunately, fascia is shedding its reputation as the "redheaded stepchild" of Anatomy & Physiology, and is slowly claiming its rightful place at the forefront of the study of the structure and function of the human body (HERE'S a recent example). When I talk about "function" I am speaking of things much greater than simple joint motion or tissue support. There is actually research showing that facial function is intimately related to the proper function of various organ systems, the nervous system, and even the immune system.
In fact, we are seeing that fascia is not just a tissue, but a Tissue System, which, like the nervous system, connects every part of your body to every other part of your body (HERE). This means that anything that disrupts the fascia is bad news --- potentially really bad news. The most up-to-date fascial research is showing us that FASCIAL ADHESIONS can cause the body to dysfunction in a wide variety of ways ---- ways that not only cause pain, but can cause sickness as well. Unfortunately, to the untrained practitioner, the two problems ---- Fascial Restrictions and the various systemic illnesses they are associated with ----- are all too often "seemingly unrelated problems" (HERE).
We have recently learned that fascia can contract on its own --- similar to muscle tissue (HERE). Besides this, research has shown that both stress and systemic acidity can cause fascia to go into a perpetual state of contraction. On top of all this, the fascia is also known to be embedded with nerve fibers from the Sympathetic Nerve System (FIGHT OR FLIGHT). Put all of this information together and it is not difficult to grasp that POOR DIETS, improper (or not enough) EXERCISE, HIGH STRESS LEVELS, etc can play a huge part in the development of fascial problems --- or more particularly, in the inability of many people to be able to defeat their underlying fasical injury and dysfunction (HERE).
Although most doctors are adept at convincing patients they have found the source of the pain, the research tells a much different story. I have chronicled this fact in the Blog Posts in the previous paragraph. Suffice it to say that the majority of the adult American population is walking around with disc bulges, degenerative discs, rotator cuff tears, and heaven only knows what other issues (CANCER for instance), are completely unaware because they have not yet developed pain or overt symptoms. In plain English; MRI's are not predictive of whether or not you will have back pain or how long it is going to last.
The renowned biomechanist Dr. Manohar Panjabi, who along with Dr. Augustus White wrote the classic 1990 textbook, "Clinical Biomechanics of the Spine" published a paper in the prestigious medical journal, European Spine, suggesting that we need to think about a whole new model of back pain. Dr. Schleip and his team of researchers of Germany's Ulm University Fascia Research Team verified what Dr. Panjabi was saying, going as far as stating that.......
"Subfailure injuries in spinal ligamentous tissues can lead to chronic low back via related muscle control dysfunction and resulting tissue changes including subsequent neural inflammation. Based on the positioning of the lumbar fascia and several other indicators we subsequently published a response in the same journal, in which we suggested that micro injuries in the posterior layer of the human lumbar fascia should be included in that model as a potential back pain generator."
They then backed the statement up with studies by Vermont University's famed fascia / TENSEGRITY researcher, Helen Langevin, M.D., and Nagoya University's Dr. Toru Taguchi. Their research indicates that microscopic fascial injuries can trigger an entire cascade of altered physiological responses that are thought to play a major role in the development of both acute and chronic low back pain. It seems though that most clinicians do not grasp the all-encompassing effects of injured fascia, and seem to have only a cursory understanding of what it really is, what it really does, how to asses it, and how to effectively treat it (HERE is an example concerning low back pain --- make sure you watch the 5 second videos).
Although it was terribly misunderstood and often all but ignored as unimportant, you can see from the above quote that anatomists have been discussing fascia for hundreds of years. You yourself have learned a little bit about this amazing tissue and may be starting to wonder if your pain and / or health problems might possibly be related to problems with your fascia.
"Fascia Proper" is not difficult to understand. These are the the fascial "bands" or "sheaths" that cover muscles. However, this is only the beginning of really understanding fascia. You must be aware that when you see any of these terms listed below (from Drs. Langevin & Huijing), you are almost certainly talking about fascia. This list, by the way, will help you understand why fascia is said to be the most abundant Connective Tissue in the body!
- Dense Connective Tissue (This is tissue that is made up of collagen fibers. Dense connective tissue forms strong, rope-like structures such as tendons and ligaments, as well as the lower layers of the skin.)
- Areolar Connective Tissue (These tissues hold the organs in place and attache the lower layers of the skin to deeper underlying tissues (HERE).
- Superficial Fascia (This is the fascial layer lying directly underneath the skin. It contains both Dense and Areolar Connective Tissue, as well as fat --- see previous link.)
- Deep Fascia (This is what most of us think of when we think of fascia. The Deep Fascia is often called, "Investing Fascia" and is a layer of fascia which can surround individual muscles, and divide groups of muscles into compartments. This is the dense fibrous connective tissue that interpenetrates and surrounds the muscles, bones, nerves and blood vessels of the body. It provides connection and communication in the form of ligaments, tendons, RETINACULUM, joint capsules, and septa. The Deep Fascia covers all bone (periosteum and endosteum); cartilage (perichondrium), and blood vessels (tunica externa). It also becomes highly specialized in MUSCLES (epimysium, perimysium, and endomysium) and nerves (epineurium, perineurium, and endoneurium). The high density of COLLAGEN FIBERS is what gives the Deep Fascia its strength and integrity, not to mention its elasticity. Make sure to look at it's relationship to STRETCHMARKS as well.
- Intermuscular Septa (These are the sheaths of fascia that separate individual muscles from other individual muscles that might be working opposite each other. These work in concert with the Epimysium.)
- Interosseal Membrane (Interosseous Membranes are broad and thin planes of fascia that separate certain bones from certain other bones. For instance, these fascial membranes can be found between the tibia and fibula of the lower leg, as well as between the radius and ulna of the lower arm.)
- Periosteum (This is the thin layer of membrane that is the outermost tissue of all bones. You can see it if you pick at a chicken bone.)
- Neurovascular Tract (Often called the Neurovascular Bundle, this fascial tissue surrounds and envelops nerves, arteries, veins and lymphatics that tend to travel together in the body.)
- Epimysium (This is is a layer of connective tissue, which surrounds the entire muscle like a sheath. It is composed of dense irregular connective tissue. It is continuous with fascia and other connective tissue wrappings of muscle including the endomysium, and perimysium. It is also continuous with tendons where it becomes thicker and collagenous. The epimysium also protects muscles from friction against other muscles and bones.)
- Aponeurosis (APONEUROSES are layers of flat broad tendons. They have a shiny, whitish-silvery color, are actually considered to be tendons. The primary regions with thick aponeurosis are in the abdominal area, the lower back, and in the PALM OF THE HAND and the PLANTAR FASCIA. Their primary function is to join muscles and the body parts the muscles act upon, whether it be bone or muscle.)
- Perimysium (In a muscle --- the biceps, for instance --- there are thousands of bundles of individual muscle fibers that are bound by sheaths of fasica. These fascial sheaths called Perimysium wrap groups of these muscle fibers (anywhere between 10 to 100 or more) into bundles.)
- Endomysium (This is where things get crazy. We just saw where the Perimysium surrounds bundles of muscle fibers. The Endomyisum is the fascia that ensheaths each individual muscle fiber.
Although the "Father of Osteopathy", DR ANDREW TAYLOR STILL touted fascia as being one of the most significant tissues in the body clear back in the late 1800's, there was no scientific evidence to back up his claims. Mind you; there was plenty of evidence ---- it was just that it was not in the form of double blinded, placebo controlled studies (it was "anecdotal" --- aka TESTIMONIAL). The explosion of two brand new branches of healing (Chiropractic and Osteopathy), created huge amounts of experiential evidence. However, until very recently, this type of evidence was not accepted by mainstream medicine. They wanted research, studies (RCT's), and hard empirical facts. Now that there is ample amounts of research, we find that much of it is largely ignored, despite the recent emphasis on something called "EVIDENCE-BASED MEDICINE").
And although these early practitioners ---- pioneers in the field of manipulation and body work ---- made it clear that that fascia was not just a tissue scrap left over from last week's anatomy dissection, they did not have the evidence to prove scientifically that what they were discovering with their patients was in any way connected to fascia despite the fact that very passing day brought new evidence that fascia plays a much bigger part than its obvious supporting role. Think about it, Dr. Still was touting fascia as not only the most abundant Connective Tissue in the body, but one that is intimately involved in its structure, function, neurology, immunology, and metabolism ---- well over a century before some of these things could be "proven".
Although most of the Medical Community does not take a position on this one way or another (hey, IF IT DOES NOT SHOW UP ON AN MRI, it can't be too important can it?), the current research has made it painfully obvious that practitioners can no longer look at muscles, joints, and numerous other tissues as something different and unrelated to fascia, because they are so intimately connected. According to the most current available fascial research today, we know that Fascia does far more than was ever imagined by even some of those who are "in the know". According to brilliant scientists like Harvard's Donald Ingber (M.D. Ph.D) and Dr. Tom Meyers, founder of Anatomy Trains (links provided earlier), we are becoming increasingly aware of the amazing relationship between the structural and functional integrity of the body's soft tissues. And it is fascia that seems to be the common denominator in all of this.
Although it is often difficult for people in pain to grasp the fact; local problems do not exist in isolation. The Kinetic Chain is just that ---- a chain of structure and motion. Not to sound New-Agey here, but the new breed of healers --- the successful healers of tomorrow --- will grasp the fact that science can no longer look at the body as it currently does; simply as a bunch of individual parts that are related to each other. As the great Greek philosopher Aristotle taught, the whole organism is much greater than the sum of its individual parts. We must begin to recognize the musculoskeletal system for what it is ---- an almost unfathomably complicated group of inter-related tissues, working in unison (HERE). And as we are increasingly seeing from Fascia Research, the failure of these tissues to work together in harmony, causes not only chronic pain but sickness and dis-ease.
- Renowned Endocrinologist / Neurologist, Dr. Helene Langevin (M.D.) of the University of Vermont's College of Medicine has been studying acupuncture since 1986. In a recent study she showed that new technology has made it possible to actually visualize fascia as layers slide over each other. This is done by using diagnostic ultrasound and elastography. Videos taken using this technique show unhindered movement of the Thoracolumbar Fascia in people with no back pain (these are the videos I mentioned earlier in the post). However, people with back pain typically exhibit restriction and adhesion of their Thoracolumbar Fascia.
- I have spoken at length about the fact that SCAR TISSUE is neurologically very different from normal tissue. Interestingly enough, some of this information is becoming mainstream. Dr. Alena Kobesova (M.D.) is a neurologist and physiatrist at the Rehabilitation Department of Charles University's School of Medicine, Prague, Czech Republic. According to some of her most recent work, scars that are neurologically active (father of Applied Kinesiology, Dr. George Goodheart, spoke extensively about this decades ago) can subtly alter or inhibit spinal motion. Many patients perceive this abnormal joint motion as low back pain. She has shown that pain of this nature can often be relieved by treating neurologically active scars in the abdominal and pubic region (think surgeries here; particularly C-scections). A prime example of this in our clinic can be seen HERE.
- Italian P.T. Luigi Stecco's family (his children Carla and Antonio are both M.D.'s who carry on his work), have made some incredible breakthroughs in our knowledge of fascia. Their work with fresh, unembalmed cadavers has shown that when fascia is mechanically overstressed, irritated, or immobile; the collagen matrix becomes inflamed and disorganized. The result is something they refer to as "FASCIAL DENSIFICATION" --- a thickening, FIBROSIS, and adhesed tissue. South African P.T., Willie Fourie, has shown that this process of fascial thickening and adhesion causes abnormal joint motion, abnormal muscle function, and ABNORMAL PROPRIOCEPTION. As function is impaired, motor control is lost. Fascia expert, Tom Myers (who studied with some of the heavy hitters in the bodywork field such as Dr. Ida Rolf, Dr. Moshe Feldenkrais, and Dr. Buckminster Fuller), has shown how local adhesion, tissue fibrosis, scar tissue, and restriction, cause patterns of aberrant motion that can adversely affect the whole body (see the links in this paragraph).
- Fascia is the "new" Nerve system. It allows every part of the body to communicate with every other part of the body in a manner similar to, but different than nerve conduction. Interestingly enough, nerve impulses travel between 150-175 miles per hour. However, Fascia transmits messages at approximately 750 miles per hour ---- the speed of sound in water! Expert on Fascia, Tom Myers recently stated in an interview with Susan Maier-Moul, "Fact: there are ten nerve endings in the fascia for every one nerve ending in the muscles. I'm talking about sensory nerve endings here. In the normal course of things.... your nervous system is constantly listening to your fascial system."
- Recent research by Dr. Tomasek (a cell biologist at the University of Oklahoma), Dr. Schleip (a professor at the Institute of Applied Physiology in Ulm, Germany), and others has shown that Fascia can actually contract on its own --- in similar fashion to muscles. This is not brand new information (Dr. A. Cathie in 1974), but is just starting to be embraced by the Fascia Research Community.
One more thing to be aware of. Fascia is subject to INFLAMMATION in similar fashion to most other tissues of the body. This is not simply due to overuse or injury, but any number of issues, including poor lifestyle choices. Because I don't find one in a thousand people who really grasps the importance of Systemic Inflammation's relationship to pain and ill health, I would suggest you take a look at the link if you are dealing with any sort of Chronic Pain or CHRONIC ILLNESS issues. To learn more about solving this important piece of the puzzle, HERE are some links for you. You might also be interested in taking a look at some of our TESTIMONIALS as well.
- SUPERFICIAL FASCIA: This is the fascial layer lying directly underneath the skin (HERE) that contains both Connective Tissue and fat.
- DEEP FASCIA: The Deep Fascia (sometimes referred to as 'Investing Fascia') surrounds your organs as well as muscles, dividing muscles into compartments. Deep Fascia is the tissue that ALLOWS COMMUNICATION with other tissues, sort of like having an extra nervous system. It also provides support, kind of like a spring-loaded skeletal system (HERE). It is the covering for any number of tissues, which are named according to their location.
FASCIA THAT COVERS CARTILAGE: Perichondrium
FASCIA THAT COVERS BLOOD VESSELS: Tunica Externa
FASCIA THAT COVERS MUSCLE TISSUE: Epimysium, Perimysium, and Endomysium
FASCIA THAT COVERS NERVE TISSUE: Epineurium, Perineurium, and Endoneurium
Believe me when I tell you that I barely scratched the surface (HERE). As you should be starting to see, Fascia is continuous. In other words, it is a membrane that winds its way through your entire body as it surrounds and supports any number of tissues and organs. Not surprisingly, it is the most abundant connective tissue in the body.
Why is the Fascia around the muscles so commonly injured? For one, it is an external tissue. As I have shown you before, one of the ways to cause the Fascial Adhesions that I refer to as "SCAR TISSUE" is to bang or hit a body part hard (HERE). What is far more common, however, are overstretching or tearing type injuries --- think MVA's, SPORTS INJURIES, or CONCUSSIONS here --- which can result in this same microscopic Scar Tissue. But it's the chronic overuse type of injuries that are probably the most common -- with research saying that repetitive injuries are the hardest to deal with (HERE).
Chronic, repetitive actions can lead to a build up of this Scar Tissue (some will argue that it is not really a Scar Tissue per se, but a "DENSIFICATION" of the fascia). I frankly don't care if you call it banana boat, it's dealt with in the SAME FASHION. This might be a great time to also mention that STUDY after STUDY after STUDY has shown us that INFLAMMATION always leads to Scar Tissue (HERE). Another reason that you need to understand THIS POST.
The more external "Deep Fascia" around the muscles is prone to injury not only because its external or superficial nature leaves it vulnerable to getting hit or impacted in some fashion, but because it is vulnerable to tremendous torquing or shearing forces. Think of it in terms of what happens on a merry-go-round. If you are standing in the center of a merry-go-round that is being pushed intensely, although you are spinning in a circle, there's very little force on you. However, move out toward the edge, and it's all you can do to hold on tight enough to keep yourself from flying off into space (probably the reason you don't see these relics of a bygone era anywhere anymore).
Regardless of how the adhesion of the Fascia occurs, here's the dilemma. The tissue that is arguably the single most pain-sensitive tissue in your body, CANNOT BE IMAGED via standard tests such as MRI. What does this mean to you? It means that even though you might be struggling with any number of CHRONIC PAIN SYNDROMES, don't be surprised if there's nothing to show for it as far as positive medical tests. Because of this, it is likely that you will be treated as a drug-seeker --- or given a prescription for one or more of "THE BIG FIVE" and essentially told that there is nothing more that can be done for you other than pain management. Or maybe you'll be sent to a specialist who will do the same things. Because I HAVE LIVED IT MYSELF, I feel for those of you struggling with Chronic Pain.
If you think your pain might be the result of Fascial Adhesions, you've got NOTHING TO LOSE BY SEEING IF TISSUE REMODELING COULD HELP YOU. As far as tackling some of the chief sources of inflammation is concerned, I've got that covered for you as well. HERE is a simple little post that explains how to get started.
"Spurlock ate at McDonald's restaurants three times per day, eating every item on the chain's menu at least once. He consumed an average of 5,000 calories per day (the equivalent of 9.26 Big Macs) during the experiment. As a result, the then-32-year-old Spurlock gained 24 lb, a 13% body mass increase, increased his cholesterol, and experienced mood swings, sexual dysfunction, and fat accumulation in his liver (at one point he gained 17 lbs in 12 days). It took Spurlock fourteen months to lose the weight gained from his experiment by using a diet supervised by his then-girlfriend (now ex-wife), a chef who specializes in gourmet vegan dishes."
In other words, by the end of the thirty days, Spurlock was both physically and mentally messed up. This recent study is even more shocking in it's revelation of just how fast WEIGHT GAIN and INSULIN RESISTANCE can actually occur. Have you ever been on a vacation or holiday where you lay around watching old movies or one football game after the next, while eating ample amounts of junk food (think about a Christmas break where you are snowed / iced in)? According to this latest peer-reviewed research from Dr. Guenther Boden's team from Philadelphia's Temple University, the price you will pay for a sedentary "binge" of this sort is going to be steep.
Our government's own National Academy of Medicine says that the average sedentary, middle aged male (30 to 50) should be consuming about 2,200 calories a day. In this particular study, six "healthy" men were made to lay in a hospital bed for one week, eating almost three times that number of calories (6,200 to be exact) --- mostly in the form of high carb / high fat junk (PIZZA, COOKIES, white bread, etc, etc). The results? They gained an average of eight pounds each; a bit over one pound a day --- on par with Spurlock's gain of 25 lbs in a month --- most of it as BELLY FAT.
Remember, however, that due to the totally sedentary nature of the men in this study, it's almost certain that they actually lost several pounds of muscle mass, meaning that the weight gain (all fat) was even more pronounced than it appeared. But weight gain was not the only problem revealed by this study --- not by a long shot. Make sure you are sitting down when you read this next sentence. It only took 2 days for these men to develop a resistance to the hormone Insulin (Insulin Resistance --- a part of the METABOLIC SYNDROME, which, along with HYPOGLYCEMIA, is a precursor to DIABETES). According to the authors, by day two there were, "severe systemic and adipose [fat] tissue insulin resistance in every one of six study subjects."
Along with the chemicals we collectively refer to as INFLAMMATION, oxidative stress (oxidation is what causes unprotected iron to rust) was determined to cause the biggest changes to GLUT4 --- a protein regulated by Insulin that actually transports BLOOD SUGAR --- glucose --- out of the blood and into the cells. Several studies have shown that people who lack the gene for making GLUT4 in certain parts of their brain end up with DEPRESSION and cognitive impairment ("DEMENTIA"); symptoms that certainly jibe with what we saw on Supersize Me.
The authors of this study argue that it is oxidative stress and not inflammation that first triggers the weight gain and insulin resistance. As far as I am concerned, the point is moot because not only are both essentially caused in the SAME FASHION, you deal with both dietarily the same way as well (HERE). Because this study showed that oxidative stress is involved, it would naturally follow that a DIET RICH IN ANTIOXIDANTS could be beneficial. Just remember, however, that research has shown that high doses of chemically synthesized individual antioxidants are not always the best approach. I bring this up because this is always what researchers are looking for --- some sort of chemical or drug that can be patented and sold.
Studies such as this one produce tons of hype about the potential for that "miracle product" that will solve your Diabetes (or PRE-DIABETES) without any effort on your part. You'll not need to change your diet or address the underlying Inflammation. It's the false hope of drugs and supplements --- that there is something out there WITH ZERO SIDE EFFECTS that will allow us to keep living our same old self-indulgent lifestyles, but prevent us from gaining weight or getting sick; or "cure" us when we do. Products like this are a staple of late night TV advertising.
The body and the foods we eat need to be viewed as a whole. It's why I am such a stickler for WHOLE FOODS & WHOLE FOOD SUPPLEMENTS. Prescribing people an isolated molecule can do amazing things ---- for awhile. But you upset the body's homeostasis, leading to an array of potential problems. CORTISONE is one such molecule --- ask anyone that's been on it. Amazing results; brutal side effects. If you follow medical logic, we should just be able to give folks GLUT4 and solve their Insulin Resistance problem. The problem with this approach is that according to a study published in the May, 2002 issue of the Journal of Biological Chemistry (The Insulin-Sensitive Glucose Transporter, GLUT4, Interacts Physically with Daxx), this could potentially produce deadly results. Daxx is another name for Death-Associated Protein VI --- a chemical whose purpose is, among other things, to cause pre-programmed cellular apotosis (death).
I used to simply have people do the stretches --- every half hour for three days and every hour for the next week --- after working on them. I still use the same schedule, but with the following caveat; don't overstretch. I have recently (within the past few months) had two different patients who each got nearly 100% results as far as their pain was concerned --- at least initially. The first individual for several days, and the other person for one day. They both felt things start to go south after a session of intense stretching first thing in the morning. In both cases, the pain settled back down to pre-treatment levels (one of them is significantly better).
I have also seen any number of cases of Piriformis Syndrome caused --- or at least contributed to --- by heavy duty stretching. Case in point, an email I had in my inbox this morning.
"It is my belief that I must have sustained an overuse injury of sorts because this all came about after about 4 months of partaking in crossfit classes. There was never a moment when I felt I injured myself, the symptoms just sort of started in my left hip and leg...... Two months of physical therapy with minimal relief. (I continued the stretching program at home on my own but stopped when I developed the unbearable buttocks pain.) "
How do you know if you are one of those people who are going to develop Piriformis Syndrome? That's just it; you don't. This is why I, although I still recommend stretching of the hip / piriformis area, I want folks to know that the stretches need to be less intense / more controlled. Interestingly enough, I have not found this to be the case with other areas of the body. Not sure I have ever seen anyone over-stretch their NECK or SHOULDER after we work on them. I believe that the mechanism has to do with THE NATURE OF SCAR TISSUE and the fact that by its very nature, it has a "tethering" action that can be very deep. Below is something I wrote a few years back (HERE is a recent article on the topic).
"I would liken the kind of stretching you have been doing, to trying to undo a loose knot by pulling on both ends of the rope: No matter how hard you pull, you only make the knot tighter! Sound familiar? Think about it logically; if Scar Tissue is a significant part of your problem, stretching is simply tightening the noose!"
The moral of this story is, if you are dealing with PS or hardcore myofascial tightness of the buttock / hip area, stretch but don't over-stretch. What does this really mean? Honestly, I'm not completely sure myself. Certainly, for those struggling with PS it can be a fine line. Especially for those of you who are motivated to do whatever it takes to get better (lots and lots of intense stretching) ---- especially here in America; the land of, "if a little is good, a lot must be better."
A FEW CURRENT RIVER PICSRead Now
- ANTIBOTICS ARE RELATED TO TYPE II DIABETES: "The odds ratio associating type 2 diabetes with exposure to antibiotics of any type was 1.53 [53% higher]". I read a blog with a number of physicians complaining that we can't tell from this study, whether Diabetes causes the infections, or the infections cause the Diabetes. It's a no-brainer folks --- this pathway works equally well in both directions. Just remember that SUGAR DRIVES virtually every bad outcome in your body from Dysbiosis, to Diabetes, to INFLAMMATION, to infections (HERE), to Cancer (HERE). Whether you are chronically ill, CHRONICALLY INFLAMED, struggling with Type II Diabetes, or simply needing to DROP SOME WEIGHT, the solution is similar for all (I will give it to you at the end of the post).
- THE MORE ANTIBIOTICS YOU TAKE, THE GREATER YOUR RISK OF SERIOUS HEALTH ISSUES: Please note that we are not talking here simply about "ADVERSE EVENTS". Although Antibiotics are heavily associated with adverse events such as TENDON DESTRUCTION, we are talking about the long-term consequences of using drugs that SUPPRESSES YOUR IMMUNE SYSTEM by radically altering your MICROBIOME. "A clear dose-response effect was seen with increasing cumulative load of antibiotics."
- WHAT YOU DO FOR YOUR CHILDREN TODAY, WILL AFFECT THEM DECADES FROM NOW: For two and a half decades, I have been beating the drum for doing whatever it takes to keep your children off Antibiotics (HERE). "The increased use of antibiotics in patients with type 2 diabetes was found up to 15 years before diagnosis of type 2 diabetes as well as after the diagnosis."
- ANTIBIOTICS CREATE A VICIOUS CYCLE: According to the venerable Dr. Robert Mendelssohn, few things are scarier than a sick child (HERE). Just remember that giving your children Antibiotics weakens (scratch that) DESTROYS their DEVELOPING Immune Systems. When the child gets sick again because their Immune System is compromised, said infection will once again be treated with --- you guessed it --- Antibiotics. Repeat cycle ad infinitum. What does this do? It leads to THIS LIST of problems. "Our results could support the possibility that antibiotics exposure increases type 2 diabetes risk. However, the findings may also represent an increased demand for antibiotics from increased risk of infections in patients with yet-undiagnosed diabetes." This is exactly what I was speaking about at the beginning of this post.
If you are one of those people who is dizzy from riding the MEDICAL-MERRY-GO-ROUND, let me show you an "EXIT STRATEGY". That's right, you don't have to be sick for the rest of your life. But if you don't make some radical changes for yourself and your children, that's exactly where you are headed.
ARTHRITIS SOLUTIONSRead Now
Because the problem is "INFLAMMATORY," the average MD treats the problem with what I call "THE BIG FIVE". When you click the link ant read my short post, you'll quickly realize that "EVIDENCE-BASED MEDICINE" is not nearly as 'evidence-based' as you have been led to believe. Case in point, an article by in the same issue of PPM by Dr. Elmer Pinzon (PPM Editorial Board: Tips for Treating Osteoarthritis). After asking several of the 40 members of the journal's editorial board, these are some of the solutions they suggested.
- EXERCISE: Exercise was mentioned almost ubiquitously. They specifically mentioned swimming, STRETCHING, walking, cycling, aquatic therapy, ellipticals, Yoga, Tai Chi, and others. I myself am a huge fan of RESISTANCE TRAINING (it does not have to be heavy), and would totally agree with the idea that exercise is beneficial for those suffering with Osteoarthritis (or even those simply wishing to prevent it). OVERUSE was also mentioned, and for some populations is a much bigger problem than living a sedentary lifestyle.
- PHARMACEUTICAL GRADE FISH OIL: FISH OIL was also talked about by several individuals. All stated that the dose needs to be between 2,500 - 2,700 daily milligrams of EPA+DHA (see the link). DIETARY FATS greatly modulate our Inflammation levels, with most people getting somewhere between 1/30th and 1/50th of what is recommended as far as Omega-3's are concerned.
- ADDING NATURAL ANTIOXIDANTS TO YOUR DIET: OXIDATION is a huge problem in our bodies (think of it in terms of how rust affects unprotected metal). A diet high in Antioxidants is also going to be an ANTI-INFLAMMATORY DIET; something dealt with by PPM a few years ago (not sure why this article was not mentioned today?). Things like Garlic, Circumin, Astraxanthin, and AVOIDING SUGAR were mentioned specifically.
- SUPPLEMENTS: There were several mentioned, including Glucosamine, and several Vitamins.
- COGNITIVE BEHAVIOR TREATMENT TECHNIQUES: Although I am certainly not against these, the evidence for their efficacy is iffy at best (see link below).
- COPPER BRACELET: With the advent of copper-infused clothing, this has gotten easier. Over the years, I have seen copper bracelets (some made out of copper pipe) help some people dramatically with arthritis pain.
- ELECTRIC / ELECTROMAGNETIC STIMULATION: There are many kinds of this, but one author mentioned a very specific kind, essentially telling readers that it was going to revolutionize arthritis treatment. Who knows; it might turn out to be as beneficial as COLD LASER THERAPY. However, I've been in practice far too long and heard far too many similar pitches to hold my breath.
- HOT SHOWERS: Pretty simple.
- DRINK ENOUGH WATER: Once you realize that water is the basis for lubricating your joints, you can see why it is so important.
- VISCOSUPPLEMENTATION INJECTIONS: This might be things like HA via rooster comb injections.
- BOTOX / PRP INJECTIONS / RADIO-FREQUENCY ABLATIONS: Although I occasionally see the first two things in this bullet point work (HERE and HERE), the third option above (RFA's) is rarely good. This is where the offending nerve is "burned" away by a needle heated up with radio frequencies. It's not permanent, and when the pain returns (the nerve grows back), it's usually with a vengeance.
- NSAIDS / CORTICOSTEROID INJECTIONS: Although these were mentioned by one of the authors, it was in the context of avoiding them by doing these (mostly) non-invasive "ALTERNATIVE" sorts of treatments.
Here's the rub. You have the premier journal for pain doctors providing any number of natural treatment "tips" (they even had a short article in this issue touting the benefits of acupuncture). But is this how things are really done here in America when it comes to the medical treatment of Degenerative Arthritis? Maybe in some places, but certainly not in my area --- and my guess is that it is probably not done this way in your neck of the woods either. Another example of the CHASM that exists between the average practicing physician and medical academia. Case in point, the article just before the one discussed above, called Treatment of Osteoarthritis. According to the authors....
"The American College of Rheumatology (ACR) recently revised its recommendations for treatment of osteoarthritis (OA) of the hand, hip, and knee. According to the ACR, the treatment of arthritis should include the following: Medications, Nonpharmacologic therapies, Physical or occupational therapy, Splints or joint assistive aids, Patient education and support, Weight loss, Surgery."
Although this article certainly deals with some of the same things mentioned in the first article (not nearly as many of them), the first thing mentioned is DRUGS (medications). Furthermore, it's what the article spends the majority of time discussing. And even though it's last on the list above, surgery gets just as much space as drugs. But how are these two pillars of Osteoarthritis treatment working out according to the "evidence"? That's just it --- it's not. Particularly with what we know about things like patient education (COGNITIVE THERAPY), WEIGHT LOSS, and surgery (particularly SPINAL SURGERY, which few doctors recommend any more for arthritis because it simply does not work).
For example, even though this article talks about the benefits of knee arthroscopy ("The surgeon cleans up the knee joint by removing any debris (damaged cartilage or tissue) to prevent further joint deterioration"), is this the reality of the situation? Firstly, we know that incidence of knee arthritis is exploding in America (HERE). And secondly, we know beyond the shadow of a doubt that arthroscopy for knee arthritis does not work. In fact, it actually causes arthritis (HERE). Don't get me wrong; I realize that many of you are between a rock and a hard place as far as the fact that your knee is totally shot, and might need replaced. But having your knee scoped as a solution for arthritis will actually, according to peer-review, make the problem worse!
Here is the thing you need to understand about Inflammation. You can choose deal with it two very different ways. Firstly, you can try and mop it up as your body creates it. Although this approach is valid, it does not address the massive amount of Inflammation some of your bodies are producing. This is why you should be working to dry Inflammation up at the source. NSAIDS and CORTICOSTEROID INJECTIONS are only concerned with the former. The only way you are going to stop Inflammation at the source is to radically change your lifestyle. How do you do this? THESE POSTS provide a starting point.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
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"Good" is just not good enough anymore! A modern content writer must be capable of discerning what not to do and building a strategy to keep him from falling in the numerous ...READ MORE +
The end is near! Hoards of brain-eating zombies roam through the streets chasing after their next target. Like vultures, they prey on the weak and look to devour the next ...READ MORE +
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Marketing a product is no easy feat and there are no shortcuts you can take to have a successful marketing strategy. You'll need to spend a great amount of time researching your ...READ MORE +
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More often than not, whenever you start reading about Growth Hacking, instead of learning what it is, we end up reading about "How to do it". Maybe it's just me, but I have a ...READ MORE +
Before you go all out and buy an impressive billboard on the busiest part of town, you need to develop a comprehensive plan that'll guarantee you that's the absolute best way to ...READ MORE +
I'm sure you have all heard, and maybe even said; "Content is King!" Yes, I'm sure we are all familiar with that phrase, but is it? I mean exactly what does it mean? And most ...READ MORE +

subset: commoncrawl


text:
legal assistance
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Get a Prenuptial Agreement before Your Next Marriage
by: Jeffrey Broobin
While signing a prenuptial agreement can be one of the all-time romantic turnoffs, for people heading into their second marriage, a prenuptial agreement can give the trade-off of a better relationship through the security of financial and life planning.
A prenuptial agreement is a legal contract between two people about to marry, specifying how assets will be distributed in the event of divorce or death. A prenuptial agreement is a good idea, even if you aren't rich or own a home. It saves future arguments and can even save you money.
A prenuptial agreement requires that each partner prepare an inventory of assets owned before the marriage, and it allows you to establish your separate priorities about those assets.
Even if you do nothing more than that in your prenuptial agreement, this gives children from a previous marriage a chance to have half of that property and establish what belonged to Mom or Dad before the second marriage, and it establishes what you're taking with you should you leave the marriage."
Statistically, second or third marriages are more likely to result in divorce than first-time unions. Because of this, a prenuptial agreement is an especially wise idea.
We recommend that each partner draw up a list of assets. Furthermore, for professional couples, prenuptial agreements can be the ultimate protection against all-too-common lawsuits or medical malpractice suits. You can't predict all of your life events, and prenuptial agreements are a means of keeping your own assets safe in the event of any financial problems that your spouse may experience.
Note that Legal Helper Corp. - http://www.legalhelpmate.com/prenuptial-agreement.aspx - provides an easy-to-use, quick, and economical online method for creating Prenuptial Agreement (Premarital).
|Medical Meetings Real Time Media On The Net Talk On The Net


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Our Big Bike Breakfast is becoming something of a fixture in Dumfries's cycling calendar, and we were pleased to welcome record numbers of commuters on Friday for a hot bacon roll (we do offer a vegetarian equivalent, but there were no takers …), tea or coffee, and most importantly lots of bike related chat.
Despite a slight hiccup with the roll delivery, we fed around 70 cyclists, councillors and council officials. Police Scotland provided an officer to do bike marking and give advice on keeping your bike secure from thieves. I wasn't able to talk to everyone who came, but there were many intense conversations going on, and much admiring of each others' bikes …
Ronnie Nicholson, leader of the council, showed up, as did a number of other councillors including Jeff Leaver, Colin Smyth and Archie Dryborough, and local MSP Elaine Murray (looking extremely 'cycle chic' on her bike). On the officers' side we had Alastair Speedie, Director of Planning and Environmental Services, Peter McCormack, Douglas Kirkpatrick (who gained bonus points for coming in on his day off!), and Eddie Whitefield, who was there to greet us well before 7am to make sure the parking area was clear and we could get into the building. We often complain about things the council do – after all, that's part of what we're here for – but it is encouraging to know that they are willing to provide us with space for the breakfast, and also show up and talk to people about what they'd like to see changed. If we don't tell them, after all, how else will they know?
Now we need to turn some of those conversations into real action. The bigger we are, as a campaign, the more people we can speak for, and the louder our voice will be. Everything we do in Cycling Dumfries is down to the volunteer efforts of our members. If you want to see things continue to improve for cyclists in Dumfries, then please do join us – it's just £5 a year – and help to make our voice louder.
Thank you to everyone who made it happen – the council for providing a splendid and prominent venue (and clearing out precious car-parking spaces!), our volunteer cooks and organisers, JB Houston, Greystone Rovers and Morrisons for providing the food and the means to cook it – and to the cyclists of Dumfries who came, and who also help keep the town moving, day after day!


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Car accidents take a mental and physical toll on one's body. You may have physical trauma like scrapes or bruises as proof of that injury but many experience soreness and muscle aches not always visible. You can receive treatment for this type of injury from a car accident chiropractor. Chiropractors at RxWellness are not only … Continue reading Common Car Accident Injuries That A Chiropractor Can Treat
Car accidents are traumatic for anyone, even if it's just a "fender-bender." Car accidents can cause physical, mental, and emotional trauma for victims.Even if the "fender-bender" doesn't look that bad for your car, your body may have actually absorbed most of the impact. It is not uncommon for injuries to stay hidden for a few days … Continue reading 6 Delayed Accident Symptoms
Whiplash is one of the most common injuries sustained in car accidents, and unfortunately some cases can be serious. Despite being a common car accident injury, many people do not seek treatment for it. This is typical of someone who doesn't realize until a few days after they've been injured when their neck or back … Continue reading What Should I Do For Whiplash After A Car Accident?
The human body is incredible. It is complex and intricate. Nature created our bodies to be strong, resilient and withstand various outside forces and disease. However, the average human body also has it limitations. Car accidents are extremely traumatic not only emotionally, but physically. Our bodies were not created to withstand 2000 pounds of force … Continue reading How To Treat Back Pain After A Car Accident
The severity of car accidents varies from case to case scenarios. There are many factors that contribute to the damage done to not only the car, but the human body. Speed, force of impact, direction hit, and debris all play a devastating role. The worst injuries sustained are often visible to the naked eye like … Continue reading 10 Reasons to See a Car Accident Chiropractor for Pain Relief


text:
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text:
"Today I experienced a good deal of sorrow because of a certain person, a lay person, that is. On the basis of one true thing, she said many things that were fictitious. And because they were taken to be true and spread around the whole house, when the news reached my ears, my heart felt a twinge of pain. How can one abuse the goodness of others like that?" (Diary, Notebook 3)
Gossip! We all know that gossip is wrong, and even the Bible is full of warnings about it. "A perverse man stirs up dissension, and a gossip separates close friends". (Prov. 16:28). But we often fall prey to the fact that "the words of a gossip are like choice morsels" (Prov. 26:22). In our humanity, we sometimes savor those little tidbits we hear about other's lives. And our nation's obsession with reality TV does not help – it's like one long gossip-fest!
Often it is difficult to separate sharing news with gossip, but perhaps a good rule of thumb is whether we would want the information shared if it was about us, and if we would share it in front of the person we were speaking about. St. Faustina speaks true words when she said that gossip abuses the goodness of others. If someone trusts us enough to bare their heart to us, shouldn't we hold that sacred? The spoken word holds so much promise - and it can also cause so much pain. Our words have power, and once spoken are difficult to call back.
The next time someone is whispering rumors, think back to St Faustina and the reaction she had to malicious gossip. Then try to turn the conversation around, and let your words bring goodness instead of abusing it.
St. Maria Faustina, pray for us!


text:
He said, "You're beautiful
Like a flower."
I said, "Pick me
And I'll die."
So he groped me
By the stem
And ripped me
From my life.
I blossomed
In his sun
He inhaled my scent
as it rained
I asked,
Can this last forever?
Ignoring a
Destiny, preordained.
I wilted
The next morning
And was laid
In a dirt bed.
Then my love plucked
The next Lily
And left me
For dead.


text:
In Other Words is a lively, charming, gossipy memoir of life in the publishing trenches and how one restlessly curious young woman sparked a creative awakening in a new country she chose to call home.
"We need our own dreams." —Anna Porter
When Anna Porter arrived in Canada in early 1968 with one battered suitcase, little money and a head full of dreams, she had no idea that this country would become her home for the rest of her life, or that she would play a major role in defining what it means to be Canadian. And where better to become a Canadian than at the dynamic publishing house, McClelland & Stewart, an epicentre of cultural and artistic creation in post-Expo Canada?
Anna Porter's story takes you behind the scenes into the non-stop world of Jack McClelland, the swashbuckling head of M&S whose celebrated authors—Leonard Cohen, Margaret Laurence, Pierre Berton, Peter C. Newman, Irving Layton, Margaret Atwood—dominated bestseller lists. She offers up first-hand stories of struggling young writers (often women); of prima donnas, such as Roloff Beny and Harold Town, whose excesses threatened to sink the company; of exhausted editors dealing with intemperate writers; of crazy schemes to interest Canadians in buying books. She recalls the thrilling days at the helm of the company she founded in the 1980s, when Canada's writers were suddenly front-page news. As president of Key Porter Books, she dodged lawsuits, argued with bank managers, and fought to sell Canadian authors around the world. This intriguing memoir brings to life that time in our history when—finally—the voices Canadians craved to hear were our own.
In Other Words is a love letter to Canada's authors and creative agitators who, against almost impossible odds, have sustained and advanced the nation's writing culture. Moving effortlessly from the boardrooms of Canada's elite and the halls of power in Ottawa, to the threadbare offices of idealistic young publishers and, ultimately, to her own painful yet ever-present past in Hungary, Porter offers an unforgettable insider's account of what is gained—and lost—in a lifetime of championing our stories.
"The Storyteller shows that great storytellers are both born and made. Like grandfather, like granddaughter."
"This book is like reading Anna Porter's personal diary as she chronicles -- with wit and wisdom-- the most amazing era of books and book publishing in Canadian history. Full of stories, secrets and wry observations, it turns literary legends into real people -- Atwood, Lawrence, Cohen, Purdy, Birney, the great Jack MacClelland and dozens of others are all here in these pages, struggling with their own trials and tribulations. Plus attending amazing parties! This book will make you yearn for the Golden Age of Canadian culture."
"Represents a much higher level of literary accomplishment, a worthy addition to the growing literature of displacement, and a poignant reminder that the best history is not always written by the winners."
Praise for Kasztner's Train
"Anna Porter's book on the genocide in Hungary's Jewish communities is the best book on the Holocaust by a Gentile ever written and rivals Prof. Michael Maruss' holocaust work on the subject. Anna Porter is an absolute marvel as a historian of the Nazis and the Jews in Hungary."
Praise for The Ghosts of Europe
"Porter offers a succinct, highly readable, contemporary history, interspersed with interviews with influential national figures regarding past, present and future."
"Porter manages a difficult feat—she conveys the heartbreaking innocence of childhood with an overlay of the knowledge and humour of the person she is today."
"A gripping work of popular history."
"Porter covers a dense landscape of loss, grievance, revenge and barely submerged guilt that echoes to the present day, raising troubling moral questions."
"A compelling narrative that does great justice to Kasztner's memory."
Praise for The Storyteller
"The Storyteller speaks eloquently of the uses—and misuses—of history and the power of narrative."


text:
Michael Caine is the only German officer ever to have been born in south London, so it's no wonder the Nazis have locked him up (actually it's because his Colonel Steiner doesn't approve of certain Nazi policies. Fiendishly, though, they contrive a mission for him: to lead a disparate band of renegades, Brit-haters and soldiers, parachute into England, kidnap Churchill and bring him to Berlin. At the height of the war (it's 1943). The trickiest part of the mission will be posing as Polish soliders on a training mission in Norfolk. "This operation could make The Charge Of The Light Brigade look like a sensible military exercise," utters Anthony Quayle's German admiral when planning the escapade.
Caine is joined by other familiar faces, such as Robert Duvall, as the Nazi who assigns Steiner the mission; Donald Sutherland, as a IRA soldier; Donald Pleasence as Himmler; and a pre-'Dallas' Larry Hagman as a US colonel.
A silly adaptation of Jack Higgins' silly book (scripted by Tom Mankiewicz, son of Joseph L), The Eagle Has Landed would prove to be Sturges' final film. Having already left his mark with The Great Escape and The Magnificent Seven, one presumes he didn't feel inclinded to make much of an effort. It has a certain adventure story charm, but don't expect any great drama or gravitas, it's more The Dirty Dozen than Saving Private Ryan.
Michael Caine as Col. Kurt Steiner
Donald Sutherland as Liam Devlin
Robert Duvall as Col. Max Radl
Jenny Agutter as Molly Prior
Donald Pleasence as Himmler
Anthony Quayle as Admiral Canaris
Jean Marsh as Joanna Grey
Sven-Bertil Taube as Captain von Neustadt
John Standing as Father Verecker
Judy Geeson as Pamela
Treat Williams as Captain Clark
Larry Hagman as Colonel Pitts
Alexei Jawdokimov as Corporal Kuniski
Michael Byrne as Karl
Joachim Hansen as SS-Obergruppenführer
Maurice Roeves as Major Corcoran
David Gilliam as
Jeff Conaway as Frazier
Tim Barlow as
John Barrett as Laker Armsby
production design: Peter Murton
director of photography: Anthony B. Richmond
director: John Sturges
editor: Anne V. Coates
producer: Jack Wiener
casting: Irene Lamb
producer: David Niven Jr.
location manager: Ray Freeborn
original music composer: Lalo Schifrin
sound recordist: Robin Gregory
screenplay: Tom Mankiewicz
novel: Jack Higgins
UK | 135 minutes | 1976


text:
TEXAS, USA — The number of people working from home or "super commuting" both in the Dallas metro area and nationwide has increased significantly since 2005, and workers at either extreme tend to make more money than typical commuters, according to a new report compiled by Apartment List.
The average commute time in the U.S. has remained fairly stable for decades and is currently about 26 minutes — only five minutes longer than it was in the 1980s and 90s — the study found.
But the number of "super commuters," who travel more than 90 minutes each way to work, has increased by 31.7 percent since 2005 to total 2.9 percent of the full-time working population, or 3.5 million Americans.
You can take a look at what you could earn working from home in the country's top metros by clicking here.
The number of Americans who work from home has spiked by 76 percent to 5.6 million, up from 3.2 million in 2005.
In the Dallas metro area, 1.9 percent of the workforce super commutes, an increase of 34 percent since 2005. At the other end of the spectrum, 5.3 percent of local employees work from home, an increase of 123 percent over the same time period.
The study also found that super commuters and work-from-home employees nationwide make more money than workers with an average commute.
In 2017, the median American worker employed full-time outside the home with a commute of less than 90 minutes earned $43,000 annually. The median super commuter earned $52,000 — 20.9 percent more. Those who worked from home had a wage premium of 28 percent, earning a median income of $55,000.
In Dallas, those working from home far out-earn the other groups with a median income of $78,000 compared with super commuters at $57,000 and average commuters at $50,000.
Extraction, construction, and protective services are the top super-commuting occupations. The top work-from-home occupations are in creative and technical fields.
Mathematical and engineering careers make both lists, as some in the field travel long distances to access innovation clusters while others are able to work remotely in programming and other computer fields, the study found.
The share of workers who super commute is highest on the outskirts of expensive cities including San Francisco, New York, Washington, D.C., Los Angeles and Boston, while the highest rates of working from home are found in mid-sized technology hubs including Austin, Raleigh, N.C., and Denver.


text:
McKinney-Vento Reauthorization
This update is from the National Alliance to End Homelessness.
Latest news: On May 24, Senators Jack Reed (D-RI) and Wayne Allard (R-CO) introduced S. 1518, the Community Partnership to End Homelessness Act of 2007 (CPEHA), legislation to reauthorize the McKinney-Vento Homeless Assistance Grants program.
The Alliance's analysis of this legislation is very positive. This legislation will make the McKinney program a more effective tool (one of many tools) to prevent and end homelessness. As the bill moves through Congress, we will be working with our local, state and national partners on any changes needed to improve the legislation further and ensure that it suits the needs of as many as possible.
We would like to highlight the following provisions – some new from legislation introduced in the last Congress. The legislation would:
Establish a new prevention program to serve people who have moved frequently for economic reasons, are doubled up, are about to be evicted, live in severely overcrowded housing, or otherwise live in an unstable situation that puts them at risk of homelessness;
Encourage programs that move families into permanent housing;
Enable rural communities to use funds for homeless prevention and stabilization with an application process tailored to rural communities;
Renew permanent housing programs non-competitively; and
Reward communities that get the best outcomes but in a less prescriptive way.


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Court of Appeals of Utah
January 25, 2018
Eldad Vered, Appellee,v.Tooele Hospital Corporation, Executive Medical Committee of the Medical Staff of the Mountain West Medical Center, Tracy Schaffer, and Yvonne Nielson, Appellants.
District Court, Tooele Department The Honorable Robert W.
Adkins No. 130301902
J. Drake, Mark O. Morris, and Paul W. Shakespear, Attorneys
for Appellants
R. Guelker and Janet I. Jenson, Attorneys for Appellee
David N. Mortensen authored this Opinion, in which Judges
Gregory K. Orme and Jill M. Pohlman concurred.
MORTENSEN, Judge.
In this interlocutory appeal, we address questions regarding
the invocation of the care-review privilege and the mechanics
of a privilege log in establishing the applicability of that
privilege. Twice the district court rejected Defendants'
assertion that they had established that the care-review
privilege applied. Defendants ask this court to give them a
third bite at the apple by remanding to the district court so
that they may reassert their twice-rejected arguments
regarding the care-review privilege. We decline to do so and
affirm the district court's decision.
Dr. Eldad Vered filed suit against Defendants, alleging
breach of contract, defamation, and interference with
economic relations. In February 2014, Dr. Vered served
Defendants with his first set of discovery requests. In
April, Defendants responded, setting off a string of
discovery disputes between the parties. On September 3 of
that year, Dr. Vered filed with the district court a
statement of discovery issues and asked for the court's
intervention. He specifically requested that the court order
Defendants "to produce all documents and things which
defendants agreed to produce in their responses to
Plaintiff's First Set of Requests for Production of
Documents, " "to answer all of the Interrogatories,
" and "to respond to all of the Requests for
Production of Documents."
On September 11, Defendants filed an opposition to Dr.
Vered's statement of discovery issues. They argued that
Dr. Vered's motion was moot because "Defendants are
already, and have been in the process of finalizing a
privilege log and supplemental responses with the
discoverable information and documents sought" by Dr.
Vered. They also noted that Dr. Vered's counsel had
failed to "meet and confer in person or by telephone
before filing his Statement, as [then] required by Rule
4-502(2)(A)" of the Utah Rules of Judicial
Administration, [1] but did not argue that the motion should
be denied on that basis.
The district court set the matter for hearing on October 6.
Before the hearing, but after filing their opposition,
Defendants provided Dr. Vered with a privilege log that
identified 119 documents purportedly protected by the
care-review privilege. At the hearing, the parties and the
court discussed not only the statement of discovery issues
but also the privilege log. Defendants did not argue that Dr.
Vered had failed to comply with the meet-and-confer
Defendants indicated that there was not "necessarily a
dispute as to" some of the issues raised by Dr. Vered,
but they disagreed as to the application of the care-review
privilege. Dr. Vered argued that Defendants, as the
"party asserting the privilege[, ] must provide [an] . .
. 'adequate evidentiary basis to show that the documents
were prepared specifically to be submitted for review
purposes.'" (Quoting Wilson v. IHC Hosps.,
Inc., 2012 UT 43, ¶ 115, 289 P.3d 369.) He also
claimed that Wilson stood for the proposition that a
party asserting the privilege must "submit an affidavit
or provide some witness testimony to show that the documents
that [it is] claiming as a privilege really fall within that
privilege, " which Defendants failed to do. Ultimately,
Dr. Vered asked the court to compel the production of all the
documents listed on the privilege log because Defendants had
failed to identify an evidentiary basis for claiming
privilege and thus had not "met their burden of
establishing" that the care-review privilege applied.
Defendants countered that they "read the privilege a
little . . . differently" in that they believed
"[i]t's a very broad privilege." They also
offered that they had "no problem providing an affidavit
or a witness to lay the foundation for the applicable
privilege, but this process did not allow for [them] to
provide an affidavit."
The district court concluded that "there ha[d] not been
an adequate evidentiary basis to show that the documents were
specifically prepared to be submitted for the review
purposes" and ordered "that all of the documents be
produced." Defendants asked for clarification: "As
far as the production of the care review materials, if we
provide the evidentiary basis or [are] you saying that that
door is shut[?]" The district court responded,
"That door is shut at this point, " and asked Dr.
Vered's attorney to prepare a written order.
When Dr. Vered's attorney submitted the proposed written
order, Defendants objected and filed a motion for
reconsideration. They requested that the district court
reconsider its order requiring production of the documents
for which Defendants had suggested the care-review privilege
applied. Defendants argued that "the Court did not have
the proper information before it at the hearing" because
Dr. Vered had presented a "surprise argument, "
leaving Defendants unprepared to "provide[] the proper
information before the Hearing." Defendants reasoned
that if they had been prepared to provide the district court
with the "proper information, " the court
"then would likely have followed the steps established
by other Utah courts when presented with an issue of whether
a party's care review documents are privileged."
(Citing Wilson, 2012 UT 43; Cannon v. Salt Lake
Reg'l Med. Center, Inc., 2005 UT App 352, 121 P.3d
74.) Defendants also argued that they had been unprepared to
provide an affidavit supporting their invocations of the
care-review privilege because Dr. Vered had been "lying
in wait" until the hearing to take the "secret
position" that Defendants had waived their claims of
As exhibits to their filings, Defendants attached two
documents of particular note. The first was a letter written
by Defendants' attorney in July 2014, in which he
promised that "for those documents that Defendants
withhold[] because of privilege or work product, we will
provide you with an appropriate privilege log." This
letter was sent three months before Defendants provided their
privilege log to Dr. Vered. The second exhibit was an
affidavit from the "Quality Director for Mountain West
Medical Center." In that affidavit, the Quality Director
outlined the types of documents contained in Dr. Vered's
credentialing and quality files-documents for which
Defendants had claimed the care-review privilege applied-and
represented that the documents in the files "are and
were gathered and submitted to Mountain West Medical Center
and its in-house committees specifically for review purposes
. . ., for the purpose of reducing morbidity and mortality,
and for the evaluation and improvement of health care."
The Quality Director further represented that any
"individuals who reviewed this information did so for
care review, peer review, and improvement purposes."
Around the time Defendants filed their motion for
reconsideration, the Utah Supreme Court issued its decision
in Allred v. Saunders, 2014 UT 43, 342 P.3d 204.
That decision addressed the care-review privilege; clarified
that the privilege protects "information compiled or
created during the . . . care-review process from both
discovery and receipt into evidence"; addressed
amendments to rule 26 of the Utah Rules of Civil Procedure,
along with their impact on the care-review privilege; and
explained that
in camera review is not required in all cases. Rather,
parties seeking to withhold arguably privileged material from
discovery must create a privilege log identifying each
document or item withheld from production and provide
sufficient foundational information to allow the court and
opposing parties to evaluate the validity of the claimed
Id. ¶¶ 9, 12, 28.
The parties appeared for a hearing on Defendants' motion
to reconsider in August 2015. Defendants reiterated that Dr.
Vered did not challenge the adequacy of the evidentiary basis
supporting the claim of privilege in his statement of
discovery issues but raised it for the first time at the
October 2014 hearing. They also argued that Allred
constituted a "change in the law" that warranted
reconsideration of the court's order. Specifically,
Defendants argued that under Allred, "there is
no requirement of an affidavit" and that the parties
were "only at stage one. We have provided a privilege
log to the plaintiff. The opposing party has not raised
objections to the . . . privileges asserted in that log,
" and Defendants expressed that they did not think
"the situation [was] ripe at this time for the Court to
undertake an in-camera review." Instead, Defendants
asked the court for "a couple of weeks to go back and
supplement this privilege log."
Dr. Vered responded that an objection to the privilege log
could not have been made before the October 2014 hearing
because the log had not been received until just days before
the hearing. He also argued that the problem with the
privilege log "wasn't that it wasn't accompanied
by an affidavit per se. It was really that there was nothing
on the log that provided any foundation showing why the
privilege applied." In his view, "The case law was
clear that you have to provide an adequate evidentiary basis
to show that the documents were prepared specifically to be
submitted for review purposes."
Defendants' attorney admitted several times throughout
the August hearing that the original privilege log was
deficient.[3]He acknowledged that he did not know
whether the privilege log "satisfie[d] all the
foundational requirements" set forth in Allred,
and that they could "do a better job." The court
ultimately explained that it "could not conclude and
still today cannot conclude that [the documents] are
privileged, " and, because Defendants had not
"show[n] that the documents are privileged, " the
court "affirm[ed] its prior oral ruling."
Defendants now appeal.
Defendants raise three issues for our review. They first ask
us to decide whether the district court erroneously
determined that Defendants waived their claims of privilege
by not providing a supporting affidavit with their privilege
log to lay the evidentiary foundation for the privilege.
Next, Defendants maintain the district court abused its
discretion when it ordered Defendants to produce the
requested documents, without first reviewing the documents in
camera. Finally, Defendants assert the district court ...
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CALDWELL, NJ — The Rotary Club of the Caldwells (RCC) recently donated $5,000 to the Caldwell Police Department toward the purchase of a drone for the department to provide additional security for events like the annual Rotary/Kiwanis Street Fair.
On behalf of the RCC, president Samantha Cordaro McCoy said the club is "proud to help sponsor the drone and thankful for the opportunity to support the Caldwell Police Department."
"The purchase of this drone will help the police in a wide variety of situations including providing needed security for the street fair," she said. "We knew how important it was to fund such a worthwhile project and are hopeful that it provides benefits for years to come."
Pictured above (left to right) are Caldwell Police Chief James Bongiorno, Samantha Cordaro McCoy and Paul Carelli, Caldwell Borough Administrator.
All are welcome to attend RCC meetings every Tuesday at 12:15 p.m. at the Cloverleaf in Caldwell.
Don't miss important news in your town. Click HERE to subscribe for free, or follow us on Facebook and on Twitter at @TAPWestEssex.
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FREE Downline Builder To Get Referrals And Signups
Many of us have been struggling for getting free referrals or signups of our programe to increase the earning in lesser time through referral . But failed to doing the same. If you would follow the mentioned advertising methods over here, surely you could be able to get referrals free every months. See the below which i made
Even many of us surprised having seen the list of referrals of others in bunch in their referral list or some time seeing highest referral winning notification working to specific programe. At the moment, thoughts come in mind that how the people getting referrals & signup and from where.
The answer is easy, they are advertising their programme to million of people over the internet through Email, Banner Exchange, Surfing. I don't recommend traffic exchange as it is only for website user to get visitor on their site.
Here is the list of free email and banner exchange which i am using to advertise my link to get referral, in fact not only link but also getting in return free bitcoin and commissions.
Here is the proof. This is only for one programe. There are others also.


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Saturday, January 24, 2009
Just an Update
Thursday evening, I started a run on the treadmill but had to stop at 24 minutes as a good friend drove off our driveway. We pulled her out, but I was unable to get the rest of the run in.
Last night, during our first soccer game, one of our players, Sharri, got hit in the chest with a soccer ball. It knocked her down and sent her to the hospital. She fractured a rib but as far as I know, she's fine and desirous to play next week.
During the second game, I played defense. It was a lot of fun. Two brothers from Lebanon dominated the game. Fortunately, I was on their team.
At home, we stayed up with our friends from Iowa, Leah and Elisabeth, drinking wine and eating cheese until 2am. Lots of stories from Cono, the boarding school where we used to live and work.
Marty and Leah started talking about doing Trail Mix again this April.
Two things I am not doing enough of:
1. Running
2. Studying for the WI Bar exam
3 comments:
- David Ray said...
One thing you are doing enough of:
1. Living
What does "fell off driveway" mean?
- January 24, 2009 at 9:35 PM
- Unknown said...
At the bottom of our driveway, the driveway turns and sits about 2-3 feet above the lawn as a culvert goes underneath it. Our friend turned too sharply and drove her rear wheel over the edge of the paved section. Once one wheel is over, the underside of the the car, van in this case, rests on the asphalt.
It's almost impossible to drive oneself out of such a jam.
- January 25, 2009 at 12:45 PM
- David Ray said...
Ouch. I've seen that before. Hopefully there was no damage.
- January 25, 2009 at 1:14 PM
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Nikki's Photos (5 Posts)
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I recommend Nikki to all my friends!
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Nikki is dope. She watched/walked my dog penny for two weeks while I was on vacation. She did such a great job with walks and taking her out daily. Thank you so much Nikki!
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Sanity for Service Providers
Free appointment scheduling.
Built-in payments, tips and reviews.


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|Prince, not a pirate.
Hello and Happy Halloween! Halloween is a holiday that is popular in English-speaking countries, particularly in the US. It's also becoming more and more popular in other countries like Costa Rica. It's common for people to go to parties and wear costumes to celebrate the holiday, and children go trick-or-treating, where they go from door to door in their neighborhoods to ask for candy.
I found this good, brief video that talks a bit about Halloween on History.com. It has information about customs, traditions, and history associated with Halloween. Check it out:
Also, if you click here to go to the video's page, you can also find lots of other cool videos related to Halloween.
If you are going to celebrate Halloween, have a good time and be safe! Thanks for reading!
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Overlord at Sitzman ABC
Hey! I'm Ryan Sitzman, the person in charge of Sitzman ABC. If you want to know more about me, you can check out my profile on Google or go to my personal site, RyanSitzman.com. You can also click on any of the redundant little boxes to the left and it should take you to my profiles for all kinds of social networks. Thanks!
Latest posts by Sitzman (see all)
- 2 More Books with Examples of English Second Conditional – September 29, 2018
- English Song for Learning Second Conditional: "If I Were A Boy" by Beyoncé – September 25, 2018
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- A Perfect Example of the First Conditional in English – September 19, 2018
- English Activity: Two Songs About "Wishes" – September 14, 2018


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Is there a way to define the left side of my armor as a greater/different variable than the right, the example I'm using just has "sideArmor".
Also is there a way to disable an arm?
armors: - type: STR_PERSONAL_ARMOR_UC frontArmor: 50 sideArmor: 40 # right armor = 40 leftArmorDiff: 50 # left armor = 40 + 50 = 90 rearArmor: 30 underArmor: 30
This is cool though man cheers, do you list the ruleset changes to your OXCE+ armor-wise anywhere?


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Bowker Vale and Our Ladies teaching at Climate Control exhibition
Pupils aim for Climate Control
Pupils from Bowker Vale Primary and Our Ladies High worked together to talk with and teach adults about climate change at Manchester Museum's Climate Control exhibition today. Inviting members of the public to join in with teaching activities the pupils did a wonderful job of sharing their knowledge and prompting people to think about their carbon footprints.
Well done to the pupils for conveying their knowledge and understanding, to the Museum for creating the opportunity for the session and for the participating adults for listening and engaging. A great experience all round.


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July22-24, West Jordan, Utah
This wonderful celebration of the lives of the pioneers will span three whole days filled with pageants, concerts, games, Dutch oven cook-offs, fireworks and more! Don't miss out on the youth pageant that was written by Merrill Osmond. It's sure to features some wonderful, young talent and honor all the pioneers who helped settle the Salt Lake Valley. This event is also meant to raise hearing-health awareness and benefit local deaf children in the community with the gift of better hearing.
Nauvoo Pageant - "A Tribute to Joseph Smith"
July 9–August 3, Tuesdays through Saturdays, beginning at 8:30 p.m., Nauvoo, Illinois
Narrated by Parley P. Pratt, the pageant emphasizes the prophetic mission of Joseph Smith and honors the sacrifice, faith and courage of the Saints who gave their all to build a city and a temple to their God.
Men and Women of Faith Lecture - "Iosepa: Utah's Pacific Islander Pioneers"
July 11, 7:00 p.m., Assembly Hall, Salt Lake City, Utah
From 1889 to 1917, Latter-day Saint converts from Polynesia settled in Iosepa, a remote desert colony in Utah's Skull Valley. Archaeological investigations at the town site have revealed how these pioneers from the Pacific sought to make the desert "blossom as the rose" by drawing upon their traditional cultures and their newfound faith.


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Bidfood Oman signs distributorship with Lamb Weston
Bidfood Oman (previously known as HORECA Trade) has been appointed as exclusive distributor to frozen potato product producer, Lamb Weston, in the Sultanate of Oman.
Lamb Weston has been partners with Bidfood UAE, Oman's sister company in the United Arab Emirates, since 2007.
The partnership has yielded many milestones and accomplishments, which rendered the partnership-decision an easy one for Bidfood Oman to make and created new possibilities for the potato processor's presence in the Middle East, the companies said in a release.
Commenting on the new business partnership, Bidfood Middle East chief commercial officer, Wael Al Jamil, said: "Lamb Weston is the premier potato processing brand in the world and one of the best frying companies to exist in the market. It is a top choice for many restaurants and culinary professionals, so we couldn't be more excited about our new partnership in a new market."
The partnership is part of Bidfood Oman's strategy to strengthen its product portfolio and better serve the increasing demand for frozen potato products and growth ambitions of customers in the Sultanate of Oman.
Adding to Al Jamil's comment, Lamb Weston's foodservice business leader – Middle East, Nizar Al Husseini, said: "Reflecting on our vision to be the preferred inventive potato solution provider in the Middle East, we believe that Oman is a significant market with a high potential to fuel our ambitious growth in the region and sustain our market leadership position."


text: Penelephant 0 Posted May 20, 2019 Hi there, I've been reading lots of posts on here hoping for some help but nothing seems to quite match, anyway... 1987 dt125lc mark3. Was going pretty well, now when it starts up, usually first kick, there seems to be no throttle response except for a backfire. It idles very low, maybe 500rpm. If you slowly move the throttle you can get it to sit at 2000rpm but it still bogs on giving throttle. Randomly if you keep trying the throttle the symptoms seem to disappear. Sometimes if you mess with the throttle cable it seems like it fixes the problem, but it usually comes back again. Very occasionally it will race and you have to shut it down. When its having a good spell it goes great! Things tried so far, crank seals, stator, carb rebuild, plug, also general rewiring including regulator/rectifier and all lighting. If anyone has any tips that would be great. Quote Share this post Link to post Share on other sites


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Apprenticeship Course Structure
Our Higher Level apprenticeships and Degree apprenticeships are aligned to Level 4 and Level 6 standards.
For our Digital Innovation programme, aligned to the Level 4 Software Developer Standard and the Level 6 Digital and Technology Solutions Degree Apprenticeship, we use a Foundation and BSc. Degree as the core learning component validated by the Open University.
Our new Data Analytics and Visualisation programme aligns to the Level 4 Data Analyst standard.
We have worked with industry experts to iteratively design our curriculum to ensure we equip all our apprentices with the solid foundations to become competent developers and analysts from day 1 in your role and go on to develop the beginnings of an expertise in their chosen area.
All apprentices commit to an initial two year programme beginning with our 8-week full-time Launchpad training. After that, apprentices follow a block release schedule consisting of 7 weeks at the employer and 1 week back at Ada, for the remainder of their apprenticeships. Many apprentices, in conjunction with their employer, look to extend the apprenticeship to a third year to allow the apprentice to top-up to a full Bsc. Degree Apprenticeship. In total, apprentices spend 80% of their time at their workplace and 20% in the classroom.
Digital Innovation Apprenticeship
Our Digital Innovation apprenticeship is aligned to the Level 4 Software Developer Standard. With this programme students have the option to select pathway modules focusing on either Technical, Entrepreneurial or Creative routes.
Core Modules:
- Computer Programming
- System Development Life Cycle
- Testing – Integration & Automated
- Database Systems
- Data Structure & Algorithms
- Ethics & Commercial Reasoning
- Advanced Programming
- Data Analytics & Business Insights
- Interactive User Interface Design
- Work-based Project
Optional Modules:
Technical Pathway
- Distributed Systems
- Artificial Intelligence
Entrepreneurial Pathway
- Entrepreneurship & Innovation
- Business Risk Analysis
Creative Pathway
- Web Design & Authoring
- Mobile App Development
Data Analytics & Visualisation Apprenticeship
Our Data Analytics & Visualisation apprenticeship is aligned to the Level 4 Data Analyst Standard.
Core Modules
- Essential Statistics
- Data Analysis Concepts
- Data Analysis in Practice
- IT Professional Development
- Database Systems
- Python for Data Science (I)
- Data Visualisation
- Data Warehousing
- Python for Data Science (II)
- Data Analytics & Business Insight
- Artificial Intelligence
- Work Based Project
(Optional) Year Three for Digital Innovation programme
There is an optional third year of study with Ada to top up to a full Bachelor of Science (Hons) for the Digital Innovation Programme following the same block release model.
Regulations For Validated Awards Of The Open University Ada College
Understanding our pathways:
To fit with varying skills and interests, we offer three pathways in our digital curriculum to allow for a tailored programme. These specialised pathways, chosen by the employer and apprentice, are as follows:
Technical Pathway
- To equip students to work as professionals in the field of software development, particularly in environments where competence in computer hardware, software and distributed information systems is required
- To provide an in-depth knowledge of the management, organisation and execution of large-scale software design and development activities including reuse and integration, and testing
Entrepreneurial Pathway
- To provide students with the skills, knowledge and practical experience required to respond to the challenges involved in managing, commercialising and marketing technological innovation and new business development, in various emerging technologies
- To provide an awareness and understanding of how organisations build value through the application of entrepreneurial and innovative practices
Creative Pathway
- To prepare the student to take an active role in the creation of computational systems in digital media and other areas of the software industry that require creative individuals
- To educate in the theory, technology, practice and application of computing and the development of creative digital media and/or and the development of modern computer games


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The NRA faces multiple stressors heading into November midterms while the National Teacher of the Year backed refugees in a private moment with Trump
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Bacon, Cheese and the right amount of spice! You'll love these Jalapeno Popper Bites. Just looking at the photos make me hungry. If you are looking for the perfect holiday appetizer than you really you need to look no further because these Easy Jalapeno Popper Bites are crazy good and easy to make. Your family will thank you, your guests will thank you and you'll probably want to just hoard them all for yourself. But sharing is caring, so maybe just make up a double…. or triple batch. You probably won't regret doing that and everyone will be happy. So when you are making your holiday menu, complete with holiday stuffing, the perfect sweet potato casserole and lots of holiday desserts— don't forget to add Jalapeno Popper Bites to the menu.
Jalapeno Popper Bites
• 1 Package of Bacon Cooked and Diced Up
• 4oz Cream Cheese softened
• 1/2 cup sour cream
• 1/2 cup shredded cheese
• 4 Jalapenos diced (can remove seeds to make less hot)
• Egg Roll Wrappers (can substitue won-ton wrappers)
How to Make:
1. Preheat oven to 350 degrees. Make sure to cook up your bacon until crispy, and then dice it up and set
2. For the peppers I always halve them, pull out the seeds, rinse well and then dice to make less hot. I then
dice it up and set aside.
3. In a mixing bowl, combine your sour cream, cream cheese, and then 1/2 the bacon, 1/2 the jalapenos, and 1/2 the cheese. 4. Cut your egg roll wrappers into 4 pieces, and then place in a cupcake pan. Bake them for 8 minutes, pull
out and let cool just a minute. 5. Add a dollop of the filling mixture to each egg roll. Top with a little of the jalapeno, cheese, and bacon,
and then put back into the oven for 8 more minutes.
This is one of those recipes that you'll probably just close your eyes and cherish every bite. Comfort food at its finest. If you aren't a bacon lover, feel free to skip that step. If you are a bacon lover, feel free to double the bacon. You can never have to much bacon. Or cheese for that matter. Am I right? 🙂


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DC Comics Young Men's T-Shirt - Injustice: Gods Among Us, Size: Large, Black
$9.99 $20
Enter the realm of superheroic mortal combat with this young men's video game-inspired T-shirt from DC Comics. Amazing cover artwork from Injustice: Gods Among Us comes alive with screened graphics featuring Cyborg, Wonder Woman, The Joker, The Flash, Green Lantern, Batman, Superman and Spectre to make this all-cotton tee red hot! Size: L. Color: Black. Gender: Male. Age Group: Adult.
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