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Trekking to La Danta
Two weeks ago I headed out for the last of my borrower verifications with EDESA, the microfinance institution where I've been working. All week long I anticipated my trip to Golfito, which is way down in southern Costa Rica, in the Puntarenas province. I asked my colleagues about our portfolio there and peppered them with questions like: 'Have you ever been to Golfito? How far is it from the Panamanian border? I heard it's raining hard in Golfito now, do you think it will clear up by the time we go?'
It wasn't until we were an hour into our car ride that I started talking about Golfito again, and my one colleague informed me we weren't going to Golfito. It turned out we were going to a small mountain community called La Danta instead.
This has been the story of my life here in Costa Rica: While slowly getting accustomed to hearing Spanish around me all the time, I've often been left clueless as to what is going on. It's gotten a lot better since day one at EDESA, but there are still hits and misses. I don't know how my colleagues didn't pick up on my inquisition on Golfito, though.
At any rate, I was just happy to be in the backseat of a car and NOT on a bus as we flew over the winding mountain roads. (Mountain roads are part of my fate here in Costa Rica.) Not even a 4:20am wake-up could dampen on my spirits, although the Gravol did help. My colleagues told me it would be a long drive, 6 hours each way, a feat they wanted to accomplish in a single day.
As we gained altitude along the highway, we passed through an area called Cerro de la Muerte, where the temperature dropped to what felt like 5oC. We stopped and ate a hot breakfast, which I welcomed as I shivered to keep warm. One does not think to pack warmer clothes when traveling from Canada to Costa Rica. As I sat down in the open dining area (no protection from the chilly outside air there!), I glanced up and caught the whole restaurant gaping at me. I guessed it had been a while since this tiny hamlet had witnessed an Asian person!
The rocky roads to Concepción
We continued on our long journey, and as we got closer to Concepción de Pilas (where our partner in La Danta was located), the roads became a lot rougher. Our little Toyota crossover bravely crawled over large stones along some parts; along others, the roads were composed of red dirt and you could see how tropical rains could easily wash away sections of it. My colleague jokingly told me I'd better get my visits done quickly before the weather changed: We could see big clouds threatening the clear blue skies.
It turned out that the four borrowers on our list were far more scattered around this mountain farming community than we had hoped. Judging by the fact that one six-kilometre stretch took us 45 minutes to cross, we would not be getting back to San José as early as we had hoped.
'Can't we just swap some of the borrowers for people living closer by?' my colleague asked, only half-joking. Unfortunately, that wasn't an option; the borrowers have to be randomly selected by Kiva, or it would defeat the purpose of an objective verification.
How does your garden grow?
We set off with our host, Gilbert, to meet the borrowers, our feet going squish, squish as we walked along a muddy trail. Two of them live in a quiet, beautiful little valley which may be converted into the largest dam project in all of Central America someday soon. If the project goes through, the entire community would be relocated to another area.
Finally we got to where Robert and Neojalí were working. Around us were fields of corn, ñampí (or eddoes, which are a close relative of taro), and ginger. Robert pointed out a papaya tree to me, where I could see the fruit in its early stages of growth.
Aside from corn, I'd never before seen how these things grew, and it was pretty awesome. I was especially excited to watch Neojalí pull up bunches of ginger from the ground, as I love cooking with ginger. Seeing taro was cool too, since taro is my favourite bubble tea flavour. I found out that while farmers sell taro for about 120 colones/kg (about $0.24), people buy it in the supermarket for 4,000 colones/kg ($8). Seems like they could use an app like the one my fellow Kiva Fellow Christina told me about, which lets farmers know the market price for their products.
As Gilbert, Robert, and Neojalí dug up some vegetables for us to take home, we heard an airplane flying in the distance. Robert paused in his work to gaze up at it. 'It's so beautiful,' he murmured. That moment really struck me. Here we were, three people from San José coming to appreciate the simple ways of farm life, and here was a farmer, captivated by modern technology. The contrast between our lives was stark, and yet here we were, all together and somehow connected.
Later, we enjoyed oranges that we plucked from an orange tree at Robert's house. Neojalí accompanied us back to Concepción and showed us where the corn was processed, housing 8,000 bags of corn from this year's harvest. As for their other produce, Neojalí, Robert, and some other members of the community have a business called Frutas y Raíces Tropicales Costa Rica, in which they export their products to places like the US. I asked him to send some of their delicious produce up to Canada while they were at it.
Sharing an important message
The long day was made even longer with the road conditions. But rough roads in places like La Danta are not only problematic for Kiva Fellows with weak stomachs. They would also represent a real challenge if a borrower had a loan with a regular bank. Imagine if it took you several hours to get to that bank in the nearest town. To pay off your debt, you would have to make the long trek at regular intervals, perhaps on a monthly basis. There are no other options; you can't make your payments online and there certainly isn't a local ATM you could pop into.
For any entrepreneur, the opportunity cost would be high: It would mean hours of lost labour. Farmers would have to take time away from their crops. That's where microcredit can be incredibly beneficial, providing ease of access for borrowers. Driving six kilometres to Concepción, even if it takes you 45 minutes, is still much better than the alternative of driving to the nearest town.
Microcredit also often provides greater flexibility for borrowers. Depending on the terms set out in the loan agreement, some entrepreneurs—particularly farmers—may not have to start paying back until they harvested their crops, for example in a year's time if you're a pineapple farmer. If agriculture is your livelihood, this makes perfect sense. Microcredit, at its core, is about understanding the needs of borrowers.
These are some of the things we chatted about throughout the day, and with Neojalí as we lunched on a comida típica in Concepción. Overall, it was a really fun day, and it was great to come home with an armload of fresh produce. I gave my share of the loot to Manuel, the gentleman who owns the house where I live, and my good karma was rewarded.
The best part of the trip, however, came right at the end of the day as we were getting ready to leave La Danta. As we said our goodbyes, Neojalí looked right at me and said:
'Tell Kiva lenders we say thank you. Thank you for giving people in our community the opportunity to earn an income. Because it's not for lack of hard work or motivation that they are in their current situations; it's for lack of opportunity. Kiva's loans mean a great deal to us.'
To me, that pretty much sums up what microfinance is all about, and that one word, opportunity, captures the very essence of it.


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temperature | depth | salinity | dissolved
oxygen | turbidity | pH | nutrients | chlorophyll
Nutrients, especially nitrogen and phosphorus, are key indicators of water quality in estuaries. Plants require many nutrients (e.g., carbon, nitrogen, phosphorus, oxygen, silica, magnesium, potassium, calcium, iron, zinc, copper) to grow and reproduce. Of these, nitrogen and phosphorus are the most essential for aquatic plants.
Nitrogen and phosphorus naturally enter estuarine waters when freshwater runoff passes over geologic formations rich in phosphate or nitrate, or when decomposing organic matter and wildlife waste get flushed into rivers and streams. Manmade sources of nutrients entering estuaries include sewage treatment plants, leaky septic tanks, industrial wastewater, acid rain, and fertilizer runoff from agricultural, residential and urban areas. Too much nitrogen and phosphorus acts as a pollutant in the water. This leads to explosive blooms in algae that cloud the water and deplete it of the oxygen that is critical for aquatic animals. This is called eutrophication.
Excessive nutrient concentrations have been linked to hypoxic (very low oxygen) conditions in more than 50 percent of U.S. estuaries. Under the worst conditions, the waters of an estuary can become anoxic (having no oxygen). High nutrient concentrations have also been linked to algal blooms such as red and brown tides, some of which produce harmful toxins. Nutrients are also believed to cause the growth of the potentially toxic organism Pfiesteria (USGS, 1999). Red and brown algal tides and Pfiesteria have been linked to fish and shellfish kills, and may be harmful to human health. The image below illustrates what an estuary with a healthy input of nutrients looks likelush and vibrant.
Revised April 09, 2020
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subset: commoncrawl


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Har Vokse™ Hair Spray Combo
Hair Loss Solution
Precio Anterior: 129.95€
Garantizamos el precio más bajo. Si encuentras el mismo producto a un precio menor, nosotros lo igualamos.
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Coffee beans extract has reviving and regenerating properties and helps add elasticity to the hair, prevent breakage, repair split ends and encourage healthy hair growth.
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Centella Asiatica is commonly known as centella native to wetlands in Asia. It is used in cosmetic products to treat hair loss, thicken hair and restore hair growth.
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No hay valoraciones aún.


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When you think about it, Duck Hunt is a pretty scary game. Get past the blue skies and cheery art design and that's one evil dog lurking in the bushes. Something this horror movie based on the Nintendo classic knows only too well.
The Hunt is the first of G4's promised trilogy of short horror films based on video game properties, the others to be centred on Mario and Angry Birds.
It was directed by Sam Balcomb, and runs for just over ten minutes, so it won't take too much time out of your hectic internet schedule.
The Hunt: A Dark Take On Duck Hunt - G4 Films' Epictober Film Festival Opening Selection [G4]
You can contact Luke Plunkett, the author of this post, at firstname.lastname@example.com. You can also find him on Twitter, Facebook, and lurking around our #tips page.


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Part Stores > Car Engines Store > Toyota > V6, 3 L, 2959 CC Rebuilt Engine
1993 - 1995 Toyota V6, 3 L, 2959 CC Rebuilt Engine
To read more about Car Engines Store, please visit our Information page.Toyota Engine Quality Most rebuilt Toyota engines are just that, rebuilt. Our Toyota remanufacturing line builds to IMPROVE not just REPLACE! All parts in our high quality Toyota performance engines (long blocks, short blocks, big blocks & small blocks) meet or exceed all the Toyota original specifications, and most of the time are purchased from the same suppliers who supply Toyota! All the moving parts in our Toyota remanufactured engine are NEW. Be cautious of other engine remanufactures using used, broken, re-machined or returned parts! Due to our precise re-manufacturing standard, the Toyota Engine line has achieved one of the lowest breakdown rates in the world - Below 1.5% breakdown rate We keep a large inventory of Toyota remanufactured engine blocks mostly for passenger cars, light trucks, pickups and some marine applications. Most of our Toyota engine supply is ready for instant freight. Toyota Engine Description
ALL OUR Toyota REMANUFACTURED LONG BLOCKS MEET OR EXCEED Toyota SPECIFICATIONS!
- Our entire Toyota long blocks (small or big blocks) come with cylinder heads and valve train installed. Note, you have to reuse the existing valve cover(s), timing cover, intake manifold and oil pan from your original Toyota car, truck or SUV.
- The Toyota long blocks have NEW valves, valve springs, valve keepers, push rods, rocker arms, fulcrums, lifters, camshaft, timing chain (belt), timing gears, valve guides (diamond honed), three angle seats, cam, rod and main bearings, pistons, piston rings, rod bushings when applicable, gaskets and oil pump.
- The Toyota cylinder blocks, cylinder heads, crankshafts and connecting rods are cleaned and shot peened and magnafluxed for cracks. All the Toyota motor bolt holes are tapped.
- The Toyota Cylinder blocks are bored to each piston and diamond honed to 18RMS finish. All oil galleys are hand brushed with white cleaning brushes and cylinders are hand cleaned with cleaning solution and white towels.
- Your Toyota cylinder heads have each valve guide diamond honed, seats are three angle. Following assembly, your Toyota motor heads are vacuum checked for valve seating.
- This Toyota crankshafts are ground and polished to 12RMS. Each oil galley is hand brushed with a white cleaning brush.
- All connecting rods on the Toyota block are honed.
* Price as of 04/15/2015. Actual prices may vary.


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Forehead Contouring Price, real cost
Forehead Contouring Price
|Average/As of Price
|Vienna AKH Hospital, Austria
|American Hospital Paris, France
|Aesthetic Surgery Center, Latvia
|Hospital Seven Hills, India
|Kohinoor Hospital, India
|Gizinscy Clinic, Poland
|Medipol Clinic Istanbul, Turkey
|Clinic KCM, Poland
|Skopia Clinic, Poland
|Clinic Taksim, Turkey
|American Hospital Istanbul, Turkey
|Hospital Xanit, Spain
|Clinic Center Maresme, Spain
|Medcare, Spain
|HOSPITAL Povisa, Spain
|Clinic Paloma, Spain
|Ceram Hospital, Spain
|SNS Hospital, Portugal
|Clinic Conde, Portugal
|Hospital Cuf, Portugal
|Clinic Fantozzi, Italy
|Humanitas Hospital, Italy
|Uz HOSPITAL, Belgium
|Saint-Luc Hospital, Belgium
Forehead Contouring clinic and hospitals: average price
In average the price for Forehead Contouring includes 8 services.
What services are included in the various costs of your Forehead Contouring clinic?
The Vienna General Hospital generally known as AKH, is the general hospital located in the heart of Vienna City, Austria. It is the tallest hospital building throughout the world and is also the city's university hospital, and at the same time, its the site of the Medical University of Vienna.
The Vienna General Hospital (AKH) is the biggest hospital which is made up of 5 clinical institutes, 26 hospitals, 42 specialized departments, 61 outpatient departments, 51 operating theaters, 7 postoperative wards, 21 ICU intensive care units, 2,200 beds and more than 8,800 members of staff working to satisfy patients from different parts of the world.
Different departments at AKH are listed below:
The Vienna Cancer Center is associated with other Austrian oncology hospitals in other to render high-quality assistance to patients, innovative drugs, and effective treatment plan. AKH Cancer Department is a top cancer center in the field of studying and treatment of cancer in Austria. Approx. 30,000 patients undergo treatment at the center.
Vienna General Hospital renders heart surgery to patients with any complexity in the innovative hybrid operating theatre. Surgical interventions are provided to both children and adults by specialist. Doctors at AKH make use of minimally-invasive methods to carry out surgical operations. The advantages of this method are to reduce complications and hasten a patient's recovery. Unique methods of visualization are make used of amid a heart surgery: specialists control all their movements on the screen, get MRI and CT-images in real time.
The specialists working at AKH Transplantation Department performs transplants of the abdominal cavity organs, liver, kidneys, pancreas, small intestine. AKH doctors adopt the use of robotic Da Vinci systems in order to remove organs from living donors. This method has been used only in US hospitals before. 95% success rates have been recorded for kidney transplantation at AKH.
There are 4 operating theatres, 60 beds at AKH Neurosurgery Department. Every year, doctors working in neurosurgery departments at AKH carry out approximately 10,000 procedures. The Neurosurgery Department of Vienna Hospital in Austria is equipped with special microscopic techniques for the most accurate manipulation during surgery this makes it possible to protect the brain and spinal cord from injuries amid the operation. The Department focuses in removal of tumors, cardiovascular surgery, pediatric neurosurgery, etc.
Below are the list and number of staffs working at AKH:
•Medical staff: 1584
•Pharmacists, chemists, physicists, scientific staff: 198
•Midwives: 35
•Health and nursing: 2643
•Medical, therapeutic and diagnostic health professions: 1012
•Paramedics, nursing assistance and assistance professions: 359
•Administrative and clerical staff: 1305
•Operating staff: 1199
•Other staff: 429 Close
The American Hospital of Paris, known as "l'Hôpital américain" works in accordance with the laws, regulations and principles of professional ethics and pay serious attention to the rights of our patients to their privacy. The hospital have built a coordinated integrated system of doctors, nurses, technicians and patient collaborators who work around the patient.
America Hospital also provide patients with transparent and integrated health services at a standardized quality level with the support of the clinical path, guidelines and algorithms designated by the American hospital.
The American hospital offers effective and quality health services with 33 departments, 16 private units and 671 doctors. American hospital offers current medical approaches to ethics and a safe environment. Maintaining reputation in the health sector by continuously improving the quality of health services focusing on academic values and competent staff and medical personnel.
American hospital have established a clinical road map, guidelines and algorithms to provide transparent and integrated health services at a standardized quality level to all its patients, medical and administrative systems at American hospital are constantly measured and evaluated to improve hospital systems and increase patient satisfaction and care.
In the light of its basic concepts of nursing the American hospital nurses are experts who provide the appropriate service to international quality standards by meeting patient expectations, changing patient health requirements and the needs of patients and loved ones. Patients with their holistic care approach, at American hospital, evaluation of a patient's physical, psychological, and social practices, and care for a patient with scientific evidence is based on the latest available.
Departments at America Hospital include: Allergy – Immunology, Anesthesiology and Reanimation, Audiology, Cardiology, Cardiovascular Surgery, Check Up, Clinical Laboratories, Dermatology, Ear Nose and Throat, Emergency Service, Endocrinology, Gastroenterology, General Surgery, Hematology, ICU Coronary Care, ICU Neonatal, and Infectious Diseases among others.
For nurses, be aware of their responsibilities and values of life, which is educated, ethical and conscientious is the most basic approach.
The Sister 500 nursing family at American hospital has maximized efficiency in a positive approach to the work environment, while in order to satisfy the patient's / employee's happiness and trust. They constantly seek to constantly improve their services and use cutting-edge technology and reflect such events in the services they provide. Close
The Centre of Plastic and Aesthetic Surgery is the private practice of the two Board certified plastic surgeons Dr. Janis Zarzeckis and Dr. Talivaldis Krumins. The Centre of Plastic and Aesthetic Surgery is where best quality services are provided in aesthetic, reconstructive and hand surgery.
Surgical operations carried out at Centre of Plastic and Aesthetic Surgery is listed below:
FACIAL SURGERIES: Facial plastic surgeries are one of the most effective way to employ modern methods in order to remove lines, wrinkles and grooves on the forehead, somewhere at the corners of the mouth and around the eyes which occurs as a result of the aging process of the skin. These new age methods are also utilized to enhance the contours of an aged face, to restore the firmness and youth of the facial skin and skin on the neck. Plastic surgeries done on the face include nose, ear and lip reshaping procedures, providing the opportunity for everyone to enjoy the harmony of his or her inner and outer beauty.
COSMETIC EYELID CORRECTION: the main purpose and objectives of the eyelid plastic surgeries is to eliminate visual defects resulting from the aging process or from congenital and bothersome eyelid peculiarities, which already obvious in a some categories of people at the ages of 20 to 30.
EAR RESHAPING: These type of plastic surgeries of the ears is performed purposely to improve the ear shape, to eliminate consequences resulting from trauma or congenital visual defects. During the surgery, the ear cartilage is reshaped into the desired shape and position (if the ears need to be brought closer to the head). The incision is made behind the ear where scars will not be visible.
Other surgical operations include: nose reshaping, lip reshaping, facial and neck skin rejuvenation among others.
The long-term of experience possessed by both Dr. Janis Zarzeckis and Dr. Talivaldis Krumins, their extensive knowledge and modern working methods in using the latest medical equipment provides patient with the best result and professional care on the way towards a pleasant life, coupled with a fantastic appearance and well-being. Close
SevenHills Hospital is a hospital based in India. The categories of doctors and specialists working at SevenHills Hospital are regarded as one of the best doctors in India, putting into consideration the level of experience and expertise they bring with them in their respective domains.
At SevenHills there are teams that are dedicated full time and visiting consultants whose aim and objectives is focusing on important healthcare issues and research that affect patients of irrespective of ages. The team of dedicated doctors at SevenHills Hospital is highly qualified and committed to excellence in providing a beautiful pleasing environment to ensure quality in medical care.
SevenHills Hospital is widely known for its 'Exceptional Patient Care'. Taking good care of patients and visitors is part and parcel of SevenHills Hospital. At SevenHills Hospital, the Centre of Excellence Tertiary Healthcare Model is built upon the foundation of offer quality healthcare to patients and a delightful patient care experience.
At SevenHills Hospital, the experienced and efficient patient care services' team works meticulously for 24 hours in seven 7 days to provide 'exceptional patient care'. The patient care services staff is optimally nurtured by way of adequate training, support, and encouragement to reach their potential and give their best, day after day.
Patient Services at SevenHills Hospital include:
Inpatient Services: SevenHills Hospital provides a wide range of treatment options for patients with simple and complex health conditions.
Eeasy Card: Eeasy Card Program at SevenHills Hospital assist you to become a member of a world class medical institution and be able to access a host of medical benefits at SevenHills Hospital.
Diagnostic Services: Diagnostic Services at SevenHills Hospital aid the provision of timely, cost-effective, and high quality diagnostic care to all.
Other services includes: Health Checkup Packages, Outpatient Services, Visitor Information, and Patient Voice among others.
At SevenHills Hospital, the specialties are listed below:
Centre of Excellence which deals with Cardiac Care, Neurosciences, Bone and Joint Care, Cancer Care, Nephrology and Aesthetic Clinic. Close
Kohinoor Group was established in 1961 by Dr. Manohar Josh, with a vision to grow continuously. The Group is dedicated and play a vital role in various fields such as Education, Hospitality, Real Estate and Power. With the inauguration of Kohinoor Hospital, the group took a giant leap into the Healthcare sector. Kohinoor Group philosophy is to achieve sustained and enduring excellence in every activity, by creating an atmosphere for associates, clients, dealers and shareholders for win-win alliances, and for empowerment of employees to guarantee growth.
Kohinoor Group strives to achieve its vision through:
•Ethical Business Practices
•Customer Focus
•Employee Empowerment
•Instant and Accurate Decision Making
•Continuous Learning
•Creativity and Innovation
•Result Orientation
Kohinoor Hospital is one of the best hospitals situated in India and recognized among the finest hospitals in Mumbai. Kohinoor Hospital has fortified facilities, equipped with cutting-edge technology, professional medical specialists and excellent medical equipment, making it a first-class participant in medical care. It is Asia's first LEED Platinum Certified and NABH Accredited Hospital.
Dr. Manohar Joshi, a leader whose rise from humble beginnings has inspired scores of Indians, founded the Kohinoor Group in 1961.
This multi-specialty hospital in Mumbai is centrally situated and is reachable with ease, during emergency situations, the hospital continuously plays important roles, when it comes to the great number of lives Kohinoor Hospital has saved. It is a favourite medical care hospital becomes the recognisable choice in times of illness or when healthcare is needed. Kohinoor Hospital is a one stop multi-specialty hospital in Mumbai, India, comprehensively for all your medical care needs. All the requirements for well-being, continuity and consistency for decent health are met without running between clinics and doctors to any further extent.
Kohinoor Hospital is steadfast and dedicated to providing each patient fineness service in health care with virtuous business practices, honesty & dignity. Pledging to practice high standards of healthcare through an effective quality improvement system and ensure that the patient is treated with respect, compassion and dignity in a safe environment.
Kohinoor Hospital is aiming to accommodate 500 self-sustained tertiary care beds by 2020. Close
Gizińscy Medical Centre was established in the 1990s, by Katarzyna Gizińska and Włodzisław Giziński it is a dream come true that crowns many years of hard work. More than 20 years ago, a private psychiatric office was opened, and in a short period of time a paediatric-laryngology counselling centre, complying with the first Polish regulations that allowed physicians to take up a standalone initiative. today the clinic has a vast experience of over 20 years in the non-public medical sector.
The clinic started with a single office at Sułkowskiego Street in Bielawy housing estate. In the 1990s, and relocated at Kościuszki Street in the City Centre. Thanks to progressing circumstances, the clinic was able to open there over a dozen of offices and treatment rooms.
Functioning at the very same time in the public health care, university, as well as state and local administration, all the time the clinic was striving to make the simplest and yet the most effective treatments. Employing all experiences and thoughts when relocating the Gizińscy Medical Centre to the new base at Leśna Street. The clinic is definitely a cutting-edge clinic, with several offices and counselling centres, hospital departments, treatment and operating rooms.
The clinic founders entrusted their son, Jędrzej, economist by education, with the administrative and financial management of the centre.
Gizińscy Medical Centre concentrate on a wide variety of services, expert approach for patient's convenience and well-being. All that to make each patients satisfied and contented with the clinic.
Gizińscy Medical Centre provide 81,678 number of counselling appointments in 2015, 21,433 number of counselling appointments provided by 31st,March,2016 and 4 727 number of hospitalisations provided in 2015. 1,153 Number of hospitalisations provided by 31.03.2016.
Gizińscy Medical Centre partners with other organizations such as Uniqa, Tu-zdrowie, Allainz, PZU, Saltus zdrowi. Close
Medipol University Hospital is one of the top largest private health investment located in Turkey. As a university hospital that incorporates General, Cardiovascular Surgery, Oncology and Dental hospitals, Medipol University Hospital grabs audience with its new age architecture intelligent building technology and state-of-the-art medical equipment and bears the distinction of being one of Turkey's best hospitals with a new generation of technology. Medipol University Hospital, is a new reference center in the health sector in both national and international arenas.
Medipol University Hospital has been justified as the pride of Medipol Education and Health Group in Turkey and around the globe, sequel to this, is a health complex which has JCI standards that accept patients from all over the globe. Medipol University Hospital takes strong steps forward with the big investments and advances in preventive / curative health services in order to enhance the community's quality of life.
At Medipol University Hospital, the hospital capacity has 470 beds, 133-bed Intensive Care Units (General, Coronary, CVC, Neonatal Intensive Care) all serving with an infrastructure equipped with intelligent systems and technology. Medipol University Hospital is the only hospital in Turkey that has the highest number of departments, presents patient-centered superior service approach. The hospital is also organized with a new generation of technology which has the capability of performing simultaneous operations in 25 operating rooms.
The comfort and convenience of patients is at the forefront of Medipol University Hospital. At Medipol University Hospital, both patients and their relatives are hosted in the comfort of home environment. There are 470 beds in total which also involves spacious and modern physical areas, terrace garden suites, suites and normal rooms. Patients can benefit from multimedia services such as TV, DVD, and internet among others in rooms equipped with LCD screen. A high - quality meal service is also supplied to both the patient and their relatives.
Medical Centers at Medipol University Hospital are listed below:
•Bone Marrow- Stem Cell Transplantation Center
•Hemodialysis Center
•In Vitro Fertilization (IVF) Center
•Nuclear Medicine Center
•Organ Transplantation Center
•Medical Oncology
Treatments performed at Medipol University Hospital are listed below:
•Aesthetic Plastic and Reconstructive Surgery
•Brain - Nervous System
•Cardiovascular Surgery
•Dentistry - Oral Surgery
•Ear - Nose – Throat
•General Surgery
•Infectious Diseases
•Internal Diseases
•Obstetrics - Gynecology Close
The KCM Clinic is situated in the heart of Karkonosze. It is a modern Clinic. The clinic was established in 2006 at first under the name Karkonoskie Centrum Medyczne, which is currently known as the KCM Clinic. KCM clinic begin operating in cooperation with NFZ in order to render all Patients with the highest quality of healthcare services.
In 2009 KCM clinic received the ISO 9001:2009 quality management certificate, and in 2010 the construction of the Hospital began. At the end of 2011 the highly specialized Hospital was officially opened, including a modern multimedia operating theatre, in-patient units, the 1-Day Surgery Clinic, the Rehabilitation Complex, and the Dental Clinic with the highest class equipment. For the patients KCM clinic provide a high-standard single and double rooms with bathrooms, TV, Internet and Wi-Fi.
The goal of KCM clinic is being a clinic that is friendly to both patient and children. Due to cooperation with the Sanford Health, USA, initiated in April 2012, doctors at KCM clinic expand their knowledge and medical experience.
Since the establishment of KMC Clinic, the mission of the clinic is to provide a wide-range help to its Patients and increase access to the latest achievements in medicine. The believe of KCM clinic is that with modern equipment, highly-qualified personnel and, particularly, the clinics doctor's commitment and care for its Patients, it is possible to help anybody who visits KCM Clinic.
Treatment provided at KCM clinic include:
•Weight Loss Surgery
•Spine Surgery
•Laparoscopic Surgery
•Plastic Surgery
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I am so overjoyed that this is happening in my lifetime. It will be a great moment in the history of Pakistan when Imran wins the elections IA.
I am so overjoyed that this is happening in my lifetime. It will be a great moment in the history of Pakistan when Imran wins the elections IA.
Not sure about Imran's policy of removing the military option and having a political solution through Dialogue with the terrorists tbh.
It may be good political posturing as the mood in Pakistan right now ought to be Anti - West generally, but also not sure how feasible distancing Pakistan from the US in terms of fighting the taliban, not taking aid etc.... would be.
Also then there is the question of how much power actually a civilian government can wield in Pakistan with the Military and the ISI etc.. always keen to play a political role and being quite powerful. Some of the domestic changes he has proposed are good theoretically, but he would need absolute power of the state to enforce them because the implementation part is the major issue on South Asia right now in every country, not lack of thinking or what is on paper or the statutes.
Secondly I agree with Imran that a military option should be the LAST option and not the first option.
Has there ever been a real concerted effort at talks with these guys? I am not too sure. Also it seems the US itself does not know what exactly does it want to do. After 10 years of war in Afghanistan what exactly have they achieved except for a costly US military base in Afghanistan where the military sits cozily while the rest of Afghanistan is as lawless as ever.
Imran isn't too far off from the US in terms of policy is he? . Read below
US says it's ready to talk to Taliban chief
And smalishah's avatar is the most classy one by far Jan certainly echoes the sentiments of CW
Yeah we don't crap in the first world; most of us would actually have no idea what that was emanating from Ajmal's backside. Why isn't it roses and rainbows like what happens here? PEWS's retort to Ganeshran on Daemon's picture depicting Ajmal's excreta
Imran doesn't want to distance himself from the US's friendship. He just doesn't want Pakistan involved in a war in which the US will eventually leave Pakistan a very unstable neighbour.
Ending corruption and making better use of our resources will allow us to avoid US aid, which by the way never goes to the public.
Hope Imran cuts the defence budget by a big margin. We don't need the latest defence toys at the moment. We need education, electricity, strong industry, health, etc. However it will be difficult to control the military.
Also then there is the question of the civilian government not having power to act over the army and ISI and army giving immunity to many associates who do the same. I guess though in this regard it would be a step in the positive direction.
But the US don't have to live next to the terrorists, do they? They have ended the Taliban rule and made it tougher to attack them and that's really what there first objective was, even though they failed at mostly everything else.Secondly I agree with Imran that a military option should be the LAST option and not the first option.
Has there ever been a real concerted effort at talks with these guys? I am not too sure. Also it seems the US itself does not know what exactly does it want to do. After 10 years of war in Afghanistan what exactly have they achieved except for a costly US military base in Afghanistan where the military sits cozily while the rest of Afghanistan is as lawless as ever.
Imran isn't too far off from the US in terms of policy is he? . Read below
US says it's ready to talk to Taliban chief
And then there is a difference between having talks and keeping military option open/doing operations at the same time, and removing the military option of the table and then having just talks with what are terrorists with extreme positions.
Taliban's stated aim is to spread and implement their version of Islamic rule all over the region and then the world. What do you negotiate with them with such a position? What can the Pakistani government really offer them?
It's also clear that many terrorists in the country have support from the military / ISI elements and it is only at this time, that the civilian government should push the military to break of these ties rather than hold talks with them and let them strengthen further and gain a bigger support base in the establishment, which was these guys do when you go soft on them and as a result of the War recruiting people right now ideologically won't be tough in uneducated and uninformed areas either. It may provide short term peace in Pakistan(though have adverse effects in Afghanistan and maybe India too), but in the long term being too sympathetic to what are terrorists will again only come back to haunt Pakistan.
I know the feeling amongst the Pakistani public would be that this war has made attacks there worse and they have paid a big price for their support. This is true partially as USA's conduct and execution has been poor in some regards and also selfish.
But on the other hand Pakistan can't really absolve itself and especially the Army,ISI etc.... of the blame either. It was not exactly hidden before and is even less hidden now that elements of the Pakistani state have a policy to provide support to terrorist which act outside of their borders, but are based there. Whether it be the Talibani terrorist who have a Afghan agenda or the Anti-Indian terrorist groups like LeT, JeM, Hum etc.... Even Dawood ebrahim had his daughters wedding last month IIRC Karachi in a big hotel, which was confirmed by his own group to Indian news channel.
Don't agree with a lot of what Hillary Clinton says but she made a statement in her recent tour to Pakistan last week, You cant keep snakes in your backyard and expect them to only bite your neighbor, and this is what is happening now for the past some time now and will happen again in the future if Pakistan goes soft on terrorists using it's territory right now. Not too forget it will be bad for the whole region too. History is full with such examples and even USA has faced the brunt of supporting such rebels/terrorists in the past with Al - Qaeda and 9/11 amongst other attacks. While India did it with LTTE and Indira Gandhi's support to them. When her own son Rajiv decided they were now getting too dangerous and opposed them it resulted in his life being taken.
Secondly his stated view is that if he came into power in a coalition govt then depending on his status i.e. PM or otherwise. In case he is just a junior partner he will probably not join the govt since the parties in power i.e. PPP or PML will be his enemies in any case. Secondly in case he becomes PM he will act on the charter of his party which he has been proclaiming for the last 15 years i.e. try to bring in a new independent judicial system for the first time in the history of Pakistan. That has always been his stated primary goal. Once such a system is in place there will definitely be a check on corruption whether from his party or from other parties. Not only that Imran is also in favor of importing the corruption laws from China i.e. executing people found indulging in financial impropriety above a certain level.
The Taliban neither have the support nor the resources to take over the region and the world. They are not the 3rd Reich that they are being made out to be. The max that they can do is to start suicide bombings (which they have been doing in any case).
Besides Imran brings with him two other things that no other politician does and the first of those is credibility.
The second is hope.
What better alternatives are out there? If nothing Imran brings hope to hundreds of thousands all over the Pakistan. He is seen by many as the only ray of hope. We all know that Imran might not be able to solve all of Pakistan's problems. Hell he might not even be able to solve a single problem but one thing I do know. That he will die trying.
The Taliban never intended to conquer the world. You have to understand their mentality. They only wanted a better Afghanistan free from drugs, prostitution etc. That's why they stood up (a talib is a student). Before 9/11 the US never cared for the Taliban because they were harmless. The US only came after Al Qaida. The Taliban even offered to hand over Bin Laden, which the US refused because they wanted the country. Now the Taliban are fighting for their homeland (can you really blame them for that).
And once the US leaves, the Talibs will come back into power because the Afghan government is weak and is mainly Tajik. Most of the population of Afghanistan is Pushtun and so are the Talibs. Do you really think the majority Pushtuns will support the Tajik government once US leaves. Pushtuns always support their tribe first (that's their mentality).
Once the US leaves, Pakistan will have a chance to sort itself out. At the moment the military is using this to their advantage by playing their double game with the US and Pakistani people. They are diverting the education, health and other budgets to themselves and also taking money from the US. This is what Imran is trying to sort out. That is why he wants the US gone, so that Pakistan has a chance to manage its problems. But I don't know how he will manage the ISI, however has Zardari managed it, or did Sharif manage it. We aren't voting for Imran to manage the military, we are voting for him because he is better than the rest and he will improve the situation in Pakistan.
haha.....classic quote dug up by Xuhaib
that should answer some of your questions Cevno
Last edited by smalishah84; 31-10-2011 at 10:20 AM.
A great piece from the political commentator Dr Moeen Peerzada writing in one of his columns
"Yes! I was only cautious when I wrote my last one liner...people were still gathering at Minar-e-Pakistan; but then they came from all directions,
and they came with their wives, and wives with their husbands, they came with their children and their friends, they came on their motorbikes, on cycles, on their cars and they walked, and so we know for sure that they were not in the usual government controlled buses, and they were not brought by police and patwaris and by the petty bureaucrats...they were free men and women who walked to the sprawling lawns of Minar-e-Paksitan on their free will for they believed in something...something bigger than their own lives; they wore all colors of Pakistan, they were Punjabis and Pakhtoons and Sindhis and Baluch and Kashmiris..and they showed a remarkable discipline and respect for each other...and what else was different? ...they were young and they were full of excitement and belief..unlike the rent-a crowds of usual Pakistani politicians who sullenly and listlessly listen to the demagoguery of politicians these men and women were full of enthusiasm and self-belief...the presence of large number of Pakistani women, of music, of Shahzad Roy and Strings added a dimension to this political rally that had never been seen in this country before...that was like the Latin American political scene...alive and full of belief..
What Imran said? he may not be as charismatic as Zulfiqar Ali Bhutto or as trained a speaker as Benazir Bhutto but the message he delivered, and delivered with all sincerity was more original and powerful ever heard from a politician in Pakistan since the Bhutto speeches of 1960's and 1970's....perhaps for the first time in the last 40 years a politician has emerged on the scenes of Pakistan who actually put forward a political agenda, an agenda that could be defined, understood and implemented; when he says we will get rid of the usual Patwari and thana he is laying down the vision for a progressive Pakistan...a Pakistan in which land assets could be traded without the fear of fraud...if we achieve this, or at least move in this direction, we will enter a new era of commerce....and what was refreshing was the total absence of "demagoguery", Imran did not talk of the liberation of Kashmir, usual rhetoric against India or ultimatums to America, kind of things which cannot be implemented, he talked of things that are possible...it was so fun to listen to him...it was this balanced, sophisticated political message we so wanted to hear but could never hear from these buffoons who have ruled our lives in the last 20 -30 years...
What has changed? Elections are far off, and there is many a slip twixt the cup and the lip but today a new Pakistan was born or perhaps the Pakistan of 1960's and 1970's was revisited; a Pakistan that existed before Ronald Reagon the and Gen. Zia ul Haq struck the faustian bargain against Soviet Union, the faustian bargain that lead to the collapse of the Soviet Union but left Pakistan in a perpetual crisis of the politics of personality cult, of feudals and Pirs and Sajada Nasheens..today PTI has brought forward the politics of ideas and issues and this will not only effect us but will effect the structures and power politics inside the other parties...to fight PTI they will have to change...
Lets watch it as it evolves, lets make a pledge that we will all vote in the next elections and we will demand a free fair transparent election process..we will ensure a transition of power in this country..from feudals and criminals and thugs into the hands of decent human beings, first step has been taken...."
And in The News (one of Pakistan's leading English dailies)
You had to be there to see the waves
I have covered a number of rallies in this park, which is infamous for gobbling up many a political fortunes because of its sheer size, and Sunday's rally brought back memories of BB's return from exile during Zia days. It's a ground where you bring in fifty thousand and it appears like five but Imran packed it to capacity. I leaned over to senior journalist Mujeebur Rehman Shami and asked him about the crowd and he said that in his opinion the crowd was even bigger than the last big one gathered here by late Mohtarma Benazir Bhutto. Even a close comparison would have sufficed actually but to say it could have even been bigger says it all."
Last edited by smalishah84; 31-10-2011 at 10:32 AM.
And from one of Dawn's articles
"Speaking very clearly on foreign policy, Khan stated that his party does indeed want relations and friendship with the US – BUT, on the basis of equality. He doesn't want to be America's puppet – how is that a bad thing? We won't get dollars, true, but we may manage to get some respect. He doesn't want to fight America's war – what's wrong with that? Last time I checked, we were pretty desperate to claim our sovereignty, which is impossible when our government itself allows the US to drop its missiles inside our territory. But then if that doesn't happen – who will fight the monsters we created that are blowing people up? Imran Khan thinks dialogue is the solution – so you don't agree, sure. But it's not as if military action has so far achieved too many results either – if anything it is breeding terrorism – but then again, everyone has an expert opinion these days on how to get rid of militancy, if anything Khan is entitled to his – especially when he has the courage to say all this without an entourage of feudal guards around him or a bullet-proof podium to protect him."
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By N. Aaron Troodler
Whether it emanates from world leaders or media reports, there is a barrage of public opinion chastising Israel for policies that supposedly impede the path to peace in the Middle East.
As anti-Israel sentiment is perpetuated through this misinformation, Israel is forced to contend with a degree of isolationism virtually unparalleled in its 64-year history.
In light of its rocky relationship with Israel and the anti-Israel slant it often takes, it was no surprise that the United Nations recently made headlines with yet another diatribe.
Following a six-month investigation, the Geneva-based United Nations Human Rights Council issued a pejorative report that painted Israel in an extremely unflattering light. The title of the 37-page report speaks for itself: "Report of the independent international fact-finding mission to investigate the implications of the Israeli settlements on the civil, political, economic, social and cultural rights of the Palestinian people throughout the Occupied Palestinian Territory, including East Jerusalem."
After concluding that Israel's settlements violate the Geneva Conventions, the report called for an immediate cessation of all settlement activity, lest Israel be found guilty by the International Court of committing war crimes.
"The settlements have been established and developed at the expense of violating international human rights laws and international humanitarian law," concluded the report. "Israel must, in compliance with article 49 of the Fourth Geneva Convention, cease all settlement activities without preconditions. In addition it must immediately initiate a process of withdrawal of all settlers."
The report is replete with criticisms aimed at Israel and the wording is so partial one can only suppose the UN was intent on vilifying Israel before it completed its fact-finding mission.
The report says that "[a] governmental scheme of subsidies and incentives has been put in place to encourage Jewish migrants to Israel to move to settlements and to boost settlements' economic development." It declares that the settlements "impede Palestinian access to and control over their natural resources." According to the report, "[a]ll spheres of Palestinian life are being significantly affected by a minority of settlers who are engaged in violence and intimidation with the aim of forcing Palestinians off their land."
The UN implies that Israel is involved in some grand scheme to boost the settlements and significantly impair the ability of the Palestinians to live their lives. Does the UN not comprehend that there are over a half-million Israeli citizens residing in those "settlements" – which are actually vibrant centers of commerce and culture? We are not talking about a bunch of extremists living in rundown trailers in illegal outposts but rather about respectable individuals and their cities with modern infrastructures, state of the art homes, commercial hubs and beautiful schools.
Particularly appalling was the call for Israel to "ensure adequate, effective and prompt remedy to all Palestinian victims for the harm suffered as a consequence of human rights violations that are a result of the settlements."
The UN is calling for redress for the Palestinians? Where is the call for Palestinians to cease all terrorist activities aimed at Jewish civilians? Why is the UN not demanding that Palestinians stop firing deadly rockets at Israeli cities and neighborhoods? Where is the insistence from the UN that the Palestinians officially recognize the state of Israel? How about a statement from the UN that urges Palestinians to end incitement in their schools?
While the UN assails Israel for alleged "human rights violations," it is especially curious that this purported humanitarian organization overlooks the critical role Israel plays in facilitating humanitarian aid to the Palestinians.
Just recently, the Israeli government transferred $100 million in tax revenue to the Palestinian Authority that it collected on its behalf, in light of the PA's fiscal crisis. That came in the wake of an advance of 250 million NIS in September and 180 million NIS in July in order to make certain the PA could pay its employees' salaries before the Muslim holiday of Ramadan. In addition, Israel increased the number of work permits it issues to Palestinians, bringing the total number issued to date to nearly 50,000.
Israel also goes to great lengths to ensure that Palestinians have access to quality medical care and supplies. Tons of medication and medical equipment are shipped from Israel to Gaza annually. Thousands of Palestinians travel from Gaza to Israel each year in order to receive medical treatment at Israeli medical facilities.
Over the past several years, millions of tons of food were transferred from Israel to the Palestinians in Gaza, including dairy products, meat, baby food, wheat, and fruits and vegetables.
The UN neglected to acknowledge the immense amount of aid that flows from Israel to the Palestinians – all while the Israeli government is contending with major security challenges due to the animus of its neighbors.
With the issuance of its latest report, the UN once again showed its true colors when it comes to matters pertaining to Israel. Rather than furthering its core mission by promoting peace and security, it has instead chosen to endorse discord and exacerbate an already tenuous situation in the Middle East.
Shame on the UN for this latest abdication of its diplomatic duties.
About the Author: N. Aaron Troodler, Esq., is an attorney and a principal of Paul Revere Public Relations, a public relations and political consulting firm. Visit him on the web at www.PaulReverePR.com or follow him on Twitter at http://twitter.com/troodler.
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Tuesday, August 16, 2011
Gestational Diabetes
I failed my gestational diabetes screen by two points.
For those of you not familiar with the screen, it's a test during pregnancy where you drink this horrible, sugar drink and then come in an hour later to get your blood glucose tested. Considering I was seven months pregnant, not showing, and weighed only 116 pounds, I didn't think there was any chance of my failing the test. I was so overconfident that I had some crackers right before I had the drink, to make it go down easier. (This was allowed, but probably stupid and likely pushed me over the cutoff.)
The cutoff my practice used was 135 and I had a blood sugar of 137. In some practices, a cutoff of 140 is used. And when I looked this up in research studies, in a woman of my age, race, and BMI, it is appropriate to use a cutoff of 140. Or actually, some say the screen isn't even necessary in the first place in someone like me.
Now if you fail the screen, the next step is a three hour glucose tolerance test. You come in for a fingerstick and if that's normal, they give you a huge amount of sugar, do a venous draw for blood glucose, then repeat that every hour for three hours. I did not want to do this test.
You are probably thinking to yourself, "Why is she being such a baby? It's just four blood draws." That's exactly what I'd be thinking if someone told me that story, believe me. I've had like a billion blood draws in my life and I've always thought of it as no big deal… needles don't bother me.
Except for some unknown reason, my ob/gyn practice gave the most painful blood draws known to man. Now I can deal with short-term pain, no problem, but on two separate occasions of having my blood drawn at this practice, my arm was basically incapacitated. The pain in my biceps was so bad that I was actually awakened during the night due to pain. I could barely move my arm to drive and I had bruises going all the way up to my deltoids. And the pain persisted for over a week. Both times! Their phlebotomist was obviously not the greatest.
So I wasn't thrilled by the idea of having four of these blood draws in a row at that practice. (The only other place they'd do them was at a hospital a million miles from my office.) My job involves a lot of writing and I was terrified by the idea of my arm being taken out of commission. I was literally in tears at the thought of being unable to function or sleep due to these blood draws--blood draws that I felt were basically unwarranted given the fact that it was so unlikely that I had GD. If I felt the baby were in danger, I'd have done anything, but it seemed more like this test was being done so they could cover their ass.
Anyway, I did try to keep a somewhat open mind. I felt if they had a convincing argument, I'd do the test. I went to my appointment for the 3 hour test at 8:30AM. I did the fasting fingerstick, which was 90. I asked if it would be possible to briefly speak to any OB at the practice about the test before doing it. Immediately the phlebotomy tech looked really put out, and acted like this was a ridiculous request that would take hours to fulfill.
About five minutes later, they miraculously located an OB that was between patients and she came over to talk to me. Except before I even opened my mouth, the doctor's arms were crossed and she looked really angry at me for taking up 2 minutes of her precious time.
I explained that I was a doctor, that I researched the test myself and that I knew I was extremely low risk. I explained that research showed that with someone my age, race, and weight, testing wasn't indicated at all, or at the very least, a cut-off of 140 was warranted.
Doctor: [snippily] "OUR cut-off is 135."
I then tried to explain to her about how painful the blood draw had been at that office. They clearly went through the vein both times due to the pattern of bruising. I had been awake all night in pain. And then continued to have pain for a week after both times.
Doctor: [snippily] "That's impossible."
So I guess I was lying?
At this point, all I wanted to do was run home crying. Finally, I said I would do the test in fingersticks on my left hand.
Doctor: [snippily] "Fine, so I'm documenting your refusal to do venous draws!"
The phlebotomist was kind of cold to me after that too, possibly since she was the one who gave me the two painful draws. She started ranting about how she didn't know how to document my results. I felt like I had to apologize with every single hourly fingerstick.
I don't know exactly what the doctor could have done differently. I would have preferred if she gave me an actual explanation of why it was so important for me to have the test, aside from just reiterating the cutoff. Or if she did agree with me the test was unnecessary, she could have nicely explained to me that she had to document a refusal, but admitted that I was very unlikely to get a positive result.
Anyway, three of the four fingersticks weren't even close to the cut-off. The fourth was below the cut-off, but only slightly. I was terrified the entire night that the mean doctor would call me and try to bully me into repeating the test and threaten to kick me out of the practice.
What did end up happening was that I had to call the next day (originally, they promised they'd call me, but apparently they wrote me off) and they got a different OB to speak to me. It wasn't my usual doctor, but it was one I had seen before and liked. He told me that the test was definitively negative. He didn't know what to make of the one borderline number, but said their glucometer tends to run high, and one abnormal value wasn't enough to diagnose GD anyway. He said to me, "I kind of remember from seeing you and from looking at your weight here… you're pretty tiny, aren't you? I really don't think you could have diabetes. That test was probably overkill. Just, you know, eat healthy."
(I then proceeded to not gain any weight for the next month because I was so nervous about eating carbs, and meat made me ill.)
Even though I guess it worked out in the end, the whole thing left me with a negative feeling about the practice. I felt uncomfortable coming to my visits and I imagined everyone was angry at me. Moreover, guess which OB in the practice was on call the night I went into labor?
So now that it's all over and I've given birth to an average sized baby, you can go ahead and feel free to judge me and tell me that I sacrificed my baby's health for the sake of avoiding discomfort.
19 comments:
Well,medicine being an art rather than a science when all is said and done, a practitioner should be willing and able to answer questions about cutoffs and procedure...and do it cheerfully and fully. And in my opinion, prior to the test.ReplyDelete
MOST patients that I know google the conditions that they are being tested for and know a little something - which should be a good sign; not an instance of questioning authority, but of trying to be an informed and compliant patient.
And the bad needle sticks? Just plain inexcusable if it happens on a regular basis...the one time that I had a bad stick was at a blood donation when the tech said (very unprofessionally, but I appreciated it!) "CRAP. I went through your vein. You're going to bruise up and be really sore for awhile! I'm really sorry."
I think this particular doctor just didn't have a great bedside manner. My husband met her later and thought she was very "abrupt."ReplyDelete
The needle stick thing was crazy though. I've never had such a painful blood draw and so much bruising. I would have said it was a fluke if it happened once, but then when it happened again, I felt like the tech was just terrible.
I don't see how it is "impossible" for a blood stick to hurt that bad. I have had a few rather painful ones in my time so I know it can happen (they are not giving phlebotimists a lot of training these days but that is a rant for another time). Obviously that OB had issues and maybe needs to take classes on how to improve her bedside manners.ReplyDelete
From the point of view of a non-medic who had gestational diabetes, and a long standing needlephobia and veins which "disappear", they showed very poor practise indeed. Not accepting people's fears or bad experiences and finding ways of overcoming them (including explanation as to the choices and options and why different cutoffs are used, different methods of the same procedure, different people doing it, different locations) means people are less likely to access care which could make a huge difference to health.ReplyDelete
I come from a country where care is free at point of use, and I'd have been giving strong feedback (complaining) if treated that way.
(In my case, they booked the senior phlebotomist and said they'd have one "go" at my second best vein and if they didn't get a good shot, they'd get an anaesthetist to put a line in instead. Oh, and they were quite happy with me singing campfire songs loudly to distract myself.)
I know... when I showed people my arm, a few of them told me about similar or even worse experiences.ReplyDelete
I don't think classes are enough to improve anyone's bedside manner.
From reading your previous Pap post and this one, I think you should consider finding a different Ob (if you still see the same one...). It's not fair to you, and you have rights as a patient! That Ob is the kind of doctor that gives us all a bad reputation. Geez.ReplyDelete
Dr. G: My current OB is actually a very nice lady and I like her a lot, so I wouldn't switch on the basis of not liking one doctor in the practice. Plus I hope not to need to see an OB/GYN again anytime soon and get most of my care through my PCP.ReplyDelete
- AnonymousAugust 16, 2011 at 12:08 PM
This is the kind of treatment you were subjected to, and you are a physician. Imagine if you were not?ReplyDelete
This kind of treatment is one of the reasons women choose midwives.
Anon: I can certainly now understand why women choose midwives. I was so disgusted by this experience. Plus I had to wait close to an hour for my two minute OB checks, which always felt very rushed. I selected my OB because out of all the doctors I saw during my OB checks, she was the only one who actually took time to explain things to me during our visits.ReplyDelete
If I had a midwife, I might not have had to wait an hour to push while fully dilated because the doctor was stuck in a surgery.
Fizzy, your experience sounds awful, on top of being pregnant and not just a regular patient. Sometimes things are just harder for us, pregnant people (I know you're not right now, but I am). I think I would cry if I was in your shoes. All of my tests so far have been borderline (but luckily a few points under), I am also on the skinny side, and my OB has been gracious most of the time in giving me "the benefit of the doubt." Just like that other OB doctor was who called you back about your results.ReplyDelete
That said, I also agree with you that one negative experience with a physician shouldn't necessitate going to a different practice or choosing a midwife. I think there are plenty great OB female and male doctors (and midwives), we just have to find them! :)
- AnonymousAugust 16, 2011 at 1:06 PM
With both of my pregnancies, I failed my one hour screens. I am also on the petite side (5 feet tall). I'm not sure it is fair to have me drink the same amount of glucose has a much larger person - I don't eat as much as they do (I hope). Anyway, total sympathy about the 3 hour test, having done it twice -- it sucks.ReplyDelete
I agree with other commenters: based on the last two posts, you should think about a new OB practice if you ever get pregnant again! Still, I hate to generalize, but I've met far more "toxic" docs in OB/GYN than in other specialties. I always find it odd. The majority of OB/GYNs with whom I have interacted (as a med student and through 3 full-term pregnancies) have been women, who are supposed to have better communication skills, higher pt satisfaction, etc. And they work in a field where most pts are healthy and, in the case of OB, happy to be in the office/hospital because they are pregnant or delivering. Why are they so bitter as a group? It mystifies me. Maybe some of the very pleasant OB/GYNs amongst our MiM writers can shed some light on the specialty. In truth, I loved OB/GYN--the mix of medicine and surgery, the healthy, happy pts, the continuity of care, the intensity of being a part of childbirth--and might have considered it seriously as a specialty, but was so put off by the toxicity of the residents and faculty I worked with, especially (unfortunately) the women, that I quickly ruled it out.ReplyDelete
K: Exactly... I thought I deserved the benefit of the doubt. I'd barely gained any weight in my pregnancy and I was thin to begin with. Considering I just barely failed the test (likely due to those damn crackers), it seems like it wasn't worth yelling at me over.ReplyDelete
Tempeh: This was actually the first unpleasant experience I've ever had as a patient seeing a female ob/gyn. And I've seen many... and till now, they've all been lovely. I've seen a couple of male ob/gyns who were really toxic, but this was the first female. But as a *med student* my experience was totally different. This OB reminded me of the women I worked with during my med school clerkship. And yeah, that does seem to be a common experience.
Anyway, I'm not planning any more kids, so it's not really worth switching. I'm going to see my PCP for my annuals.
First of all, let me say that the way you were treated was *not* appropriate or nice in any way, and I certainly don't support the way in which your practice physician snipped with you (maybe she was on call and 10 patients behind, maybe she was told you were refusing a test, who knows? Still, not good). However, gestational diabetes is not merely a matter of weight gain or how small you are in pregnancy. All women, to some small degree, are somewhat insulin resistant in pregnancy. Sometimes this crosses over into diabetes in pregnancy, no matter if you are 100 or 400 lbs (of course, the more risk factors, the higher possibility of developing diabetes). If you fail the test, you *should* have further screening, but one off number does not diabetes make. There is actually some good research supporting moving from a 1 hour/3 hour glucola to a 2 hour standard glucola for all. An alternative in our practice to the glucola is 2 weeks of fasting and post-prandial blood glucose monitoring to monitor trends. I happen to be the "diabetes nazi" in our practice, and was trained with a cut-off for a one hour of 130 (gasp!) More patients rule into the 3 hour test group, but when I was in my prior practice I had a heck of a lot less fetal macrosomia than in my current group, which uses the 140 cut-off. Anecdata, FWIW. You shouldn't have to be fasting for the 1 hour glucola, crackers or not, should not have made a significant difference. Big slice of chocolate cake? Maybe. :)ReplyDelete
- AnonymousAugust 16, 2011 at 7:42 PM
I completely agree with Tempeh. My best friend is an OB and I know a lot of the OB residents at the hospital I delivered at. Almost all are women, and they are the some of the bitchiest and condescending people I've ever met. It actually made me feel like I just had to check my heart/emotions at the door when I was having my baby because they were so cold, weird, and just bitchy about everything. Definitely not a "miracle of life" group and that was really frustrating and disappointing to me. Oh, and the way they talk about work/patients outside of work is truly, truly awful. God forbid if you have any complaints, are overweight, hairy, or remotely different in any way if you're delivered by one of them.ReplyDelete
Dr. Whoo: If someone had said the right things to me, I likely could have been talked into the test. I'm fairly easily influenced.ReplyDelete
However! :), I still think that the test was unwarranted. I had a BMI of 19 pre-pregnancy and only gained net 15 pounds through the entire 40 weeks. Nobody could tell I was even pregnant till 7-8 months. Can you honestly tell me even anecdotally that you've seen a woman like that deliver a macrosomic baby?
(And I DO think the crackers could have made at least a 2 point difference. An hour after the 100g glucose load, my fingerstick was only 120 :)
- AnonymousAugust 16, 2011 at 10:29 PM
I've been thinking about this post all day. While I sympathize with you, I think you might have chosen the wrong time to bring up your concerns...the day of the test. It wasn't an emergency and you could've followed a gestational diabetes diet until you discussed it with your doctor. One week wouldn't have impacted your baby's size ans since you felt so strongly about being a false positive in the first place, you could have waited. I've been there and I convinced my OB to do the 3 hour test without "wasting my time" on the 1 hour test because I have a stong family history of gestational diabetes and type 2 DM. Lucky me, the 3 hour one was negative but "barely."ReplyDelete
Gestational Diabetes is also one of my passions because it is true preventative medicine. Treating it effectively can reduce the risk of c-section, pre eclampsia and shoulder dystocia. I also have had many 'skinny' patients with gestational DM. I agree that you were not treated very nicely, but also as anonymously mentioned before me, that was probably not the best timing to discuss the matter either.ReplyDelete
Say you were in the middle of rounds and the nurse pulled you in a room to answer another doctor's patient's question. Said patient, who you didn't know from Adam, states he was refusing care and wants to ask you questions about it, how would you respond?
Anon and RH+: You make an excellent point except for 2 things:ReplyDelete
1) I had the screen done during my OB check, so my next appointment wasn't for another 3 weeks. If I waited that long, then waited to schedule the test, it would have probably been over a month before the issue (if there was one) was addressed)
2) Since I only joined the practice when I was pregnant, the practice actually refusesd to assign me a specific OB (I selected one at the end). So actually, I didn't have an OB at that point. Each visit, I just saw whatever doctor was available, and they encouraged this since there was an equal chance of getting delivered by any doctor. So there wasn't a possibility of talking to *my* doctor who knew me so well, because such a doctor didn't exist through no fault of my own. None of them knew me, really.
So given that situation, there wasn't much I could do beyond asking to speak to whatever doctor was available. Maybe this was an irritating experience for the doctor, but if it was, maybe they should have assigned pregnant women specific OBs so I could have had someone I trusted to talk to about the situation.


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TMC wrote:xBayAreaWarriorx wrote:I believe we should try and unload Jackson. Minutes will surely be a problem when Jrich returns and we'll certainly need a PF. I'll take SJax for now so long he keeps his off the court problems from becoming a distraction. Both Harrington and SJax may command for the ball more as they did at Indy, but that shouldn't be a problem so long everything pans out well.
I wouldn't make a move now (well, maybe MP for a PF... if there's someone interesting in the trading block, but that's all). Jackson was an extremely productive player for the Hawks and Spurs... He can be that player again. Also, he's a perfect fit for Nellie (and a much needed piece with J-Rich out). I've heard him in an interview and he sounded desperate to leave Indiana. I've got my doubts about him, but let's wait and see what happens before moving him.
Yes, I know that. We'll need a PF. A true PF, not a started, a backup will do. We're in trouble now that we traded away two of our PF's. Those oompa loompa lineups will surely be seen until we get a real one.


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A pair of enterprising iOS developers have created a hack that allows iPhone and iPad apps, including Facebook and YouTube, to run on the Apple TV.
The second-generation media hub is essentially an iOS device, with an iPad-style A4 chip under the hood and a modified version of iOS 5 for its operating system. You can use AirPlay to stream video from a nearby iPhone or iPad but it doesn't have its own apps (yet).
Developer Steve Troughton-Smith and tinkerer Nick "TheMudkip" worked together to build an interface and loader for apps on a jailbroken Apple TV. It uses a hack called MobileX which loads up an iPad emulator, and comes with a custom-built SpringBoard (the trusty Home Screen) that works with the Apple remote.
In the video and various screenshots on Troughton-Smith's Twitter feed we see default apps like YouTube, Safari and Maps, and third-party creations like Angry Birds, Facebook, and black-market jailbreak app store Cydia all working well. The hack automatically resizes and moves interface elements to make better use of the expanded screen real estate.
Right now the apps are controlled by a Mac Magic Trackpad, which connects up over a VNC (virtual networking computing)—but this rerouting of control can slow apps down.
Troughton-Smith says that apps can be tweaked to support the Apple TV remote and, even though he's not giving out the actual media box hack yet, he has given away the necessary libraries so developers can put remote support in their apps. "Do not attempt to submit an app to the App Store with this included," he warns.
The wily hacker hopes that his hack might nudge Apple towards building a bonafide app store for the TV box. "Remember how the unofficial iPhone apps back in '07 forced Apple's hand in creating an App Store?" he tweeted. On iPhone, jailbreakers got access to downloadable games and apps like Lights Off months before Apple opened its own iOS App Store. "I'd like Apple TV to get the same treatment."
Apple has already discussed the possibility of selling apps for the Apple TV. In September 2010, the late CEO Steve Jobs told Bloomberg Businessweek that when the time is right, Apple could open an App Store for the TV.
There are also pervasive rumours that Apple will launch a full television set with a built-in Apple TV. Industry sources told Digitimes that Apple will sell a so-called iTV in late 2012, with Samsung producing chips and Sharp providing displays. The rumoured TVs will come in "32- and 37-inch sizes initially, noted sources in the supply chain." Take all that with a massive grain of salt.


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I have several websites that I help manage. When running on my local machine (under iis7), the websites run on under a folder on my machine d:\WebRoot\TheWebsiteName and run as htt://localhost/TheWebsiteName, but when they are deployed they run as http://www.TheWebsiteName.com (also running under iis7)
Currently I am handling the path to the website resources (images, javascript, etc) via code. But I was wondering if there was a better way to handle this rather than writing specialized code in the website.