Forms Of Exercises For Senior Citizens According To A Personal Trainer West Hollywood

<div style='font-style:italic;' class='uawbyline'>By Brandon Watkins</div><br /><br /> <div class='uawarticle'>There are a growing number of senior citizens at West Hollywood. With the advancement of modern medicine, the life span of a person is increasing over the past years. With the aid of medical procedures such as angioplasty, heart bypass procedures, and now stem cell procedures, people are living longer and healthier. It's important though to remain active even when you are sixty years old and above. This could also help you have a longer life. Listed here are the different exercises a senior citizen can safely do with the guidance of a personal trainer West Hollywood:<br /> <br /> Chair exercises<br /> <br /> These chair exercises are targeted to maintain the suppleness of the leg muscles. If senior citizens would just remain inactive, their leg muscles would weaken and shorten over a period of time. It would cause them a great deal of discomfort, such as cramping.<br /> <br /> Arms can be exercised also without having to do the actual swimming. Arm lifts and leg lifts are enough to make the heart rate of a senior citizen get faster. Plus it is enjoyable and best done with group of friends. This is one exercise a personal trainer West Hollywood would recommend for a senior citizen.<br /> <br /> Walking<br /> <br /> If a senior citizen is still able to do short walks, then it is a good form of an aerobic activity. It increases their heart rate and reduces the risk of cardiovascular diseases. A cane may be used to aid in walking and in balancing.<br /> <br /> Chair exercises<br /> <br /> These chair exercises are targeted to maintain the suppleness of the leg muscles. If senior citizens would just remain inactive, their leg muscles would weaken and shorten over a period of time. It would cause them a great deal of discomfort, such as cramping.<br /> <br /> Arms can be exercised also without having to do the actual swimming. Arm lifts and leg lifts are enough to make the heart rate of a senior citizen get faster. Plus it is enjoyable and best done with group of friends. This is one exercise a personal trainer West Hollywood would recommend for a senior citizen.<br /> <br /> Dancing<br /> <br /> Senior citizens can engage in light dance activities. Personal trainers can be their partners so they can be guided very well and avoid the risk of slipping or falling.<br /> <br /> Stretching exercises<br /> <br /> A personal trainer West Hollywood will recommend senior citizens to perform stretching exercises for flexibility. This is a good way of decreasing the stiffness of muscles brought about by old age. It is a very light and very relaxing form of a physical activity.<br /> <br /> Weight lifting<br /> <br /> There are many lightweight dumbbells available in the market suitable for the use of senior citizens. There are also rubber band substitute in case one is not comfortable lifting weights. This exercise should be carefully guided by a highly qualified fitness trainer to avoid muscle tear and bone breakage among seniors. Lifting light weights is good for strengthening and balance.<br /> <br /> A personal trainer West Hollywood would strongly recommend senior citizens to remain active for as long as they can. There are limitations though, and it is advised to get a medical permission first to test if a senior citizen is still able to perform light aerobic and weight lifting workouts.<br /> <br /> </div><br /> <div class='uawresource'><br /> <div style='font-style:italic;' class='uawabout'><br /> About the Author:<br /> </div><br /> <div class='uawlinks'>Getting in good shape with <a href="https://plus.google.com/100349319569853932791/about">personal trainer in West Hollywood</a> not just enhances your figure but also your overall health also. The rewards which one can obtain from <a href="http://www.theperfectworkout.com/personal-trainer-west-hollywood/">personal trainer West Hollywood</a> are limitless.</div><br /> </div><br />

Forms Of Exercises For Senior Citizens According To A Personal Trainer West Hollywood

By Brandon Watkins There are a growing number of senior citizens at West Hollywood. With the advancement of modern medicine, the life sp...

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Tips To Keep Yourself To A Slender Figure

<div style='font-style:italic;' class='uawbyline'>By George Till</div><br /><br /> <div class='uawarticle'>It is pretty much obvious that a lot of us not just in the US are obese and overweight. The statistics are alarming to say the least. There are a lot of available options on how you can actually lose excess fat however not all of these are true. The topic about weight loss is not new to many however the topic with regards to keeping the lost weight seems to be ignored.<br /> <br /> So what do you need to learn about keeping your healthy weight?<br /> <br /> The first thing that you need to keep in mind is the source of your excess weight. Be thoroughly knowledgeable about the factors that lead to putting on excess weight, and how to stop the progress of those unhealthy habits.<br /> <br /> Think beforehand that the weight loss process will have positive results. You lost the weight; you know you can keep it off. Be sure you do all there is you can do to keep your leaner body. It is merely just prolonging your habit when you were trying to lose weight in order to keep your weight.<br /> <br /> This is actually something that many people in the US find difficult to achieve. You have reduced your weight and thus achieved a sexier and leaner body. Now is not the time let loose and forget what got you there. Try to come up with a daily program that you'll follow until it becomes a habit.<br /> <br /> Get hold of a specific or certain weight standard that you can keep. Do not let your weight get above those standards. Try to check out your weight every week. If you see that the maximum weight standard is almost reached you will need to opt for reducing the amount of food that you are taking in.<br /> <br /> A good way to keep your sugar level low is by taking in supplements or foods rich in glycemic index. It actually protects you against two harmful elements. These are high sugar levels from too much sugar intake and low blood sugar level for inadequate amount of sugar in the body. In addition, you will know what foods you can eat safely and still maintain your present weight.<br /> <br /> Keep that sugar and white bread out of your diet. Now is not t he time to get back into those habits. You already fee good about yourself. Don't think that since you've already lost weight that you already have an excuse to eating anything that you want which includes the fattening foods, If you do, you won't be able to notice that you're fat again due to the habit.<br /> <br /> If you didn't when you were losing weight, do so now and avoid processed foods. These junk and artificial foods provide harmful effects in the body and tends to initiate weight gain.<br /> <br /> Make sure that your food is rich in fiber which is good for weight loss and never ever skip a meal.<br /> <br /> You will need to steer clear of those unwanted foods. Its pretty obvious what these foods are. These are the foods that rich in fat that brings about fattening.<br /> <br /> If you will pay attention to the above items, you will not only lose that weight but keep it off permanently. Self-confidence will be one that you're sure to achieve and you'll have a better approach in life. If you need help- try one of the new weight loss programs like weight watchers online. These people will help you with the hardest part of losing weight which is the preparation in weight loss.<br /> <br /> </div><br /> <div class='uawresource'><br /> <div style='font-style:italic;' class='uawabout'><br /> About the Author:<br /> </div><br /> <div class='uawlinks'>The author is a contributor to <a href="http://bestfoodie.weebly.com">foodie blog</a> the site talks about how people prepare food today . Should you desire to learn more about <a href="http://bestfoodie.weebly.com/1/post/2013/05/what-is-the-reason-behind-bw3-not-publishing-their-health-information.html">health information of foods</a> we can help.</div><br /> </div><br />

Tips To Keep Yourself To A Slender Figure

By George Till It is pretty much obvious that a lot of us not just in the US are obese and overweight. The statistics are alarming to sa...

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Cardio Training With The Personal Trainer Lafayette

<div style='font-style:italic;' class='uawbyline'>By Jackie Johnson</div><br /><br /> <div class='uawarticle'>There are many areas of exercising that should be taken note of if you are aiming to have a good and well-covered exercise session. Everybody has a different body, each with its own unique characteristics and needs, and therefore much consideration must be given as to what kind of exercise routines you must undergo yourself.<br /> <br /> One of the most common and important types of workout is the cardio workout. It comes in many shapes and forms and can give a person all sorts of healthy and helpful benefits. As there is such a large variety of them, outside advice will be needed to make sure that you choose only the best techniques that are suited for your situation. In times like these, a personal trainer Lafayette is an undoubtedly valuable commodity.<br /> <br /> The Benefits Of Cardio Training<br /> <br /> Cardio exercises are well known for their multi-functional ability to give you the extra push when it comes to your workouts. As any personal trainer Lafayette, California can tell you, a proper workout must contain a good amount of cardio exercises, even if you are aiming for body building. No matter what you seek to improve about your body, cardio exercises help you in a variety of ways, including:<br /> <br /> * Improving your body's overall health<br /> <br /> Cardiovascular exercises are well-known for their ability to increase your heart rate. A personal trainer Lafayette, California will help you understand the importance of this, as the increased pumping of your heart in turn increases the flow of blood throughout your body. Cardio exercises give your body a healthy oxygenizing experience.<br /> <br /> * Helping you lose weight<br /> <br /> Weight loss is another well-loved benefit of performing cardio exercises. As the loss of weight is characterized by the burning of large amounts of calories, any exercise enthusiast will find that cardio exercises help push them forward in a weight loss regime. The many variations and styles of cardiovascular techniques allow for a good choice of how many calories you can lose at a time, while making sure that you never get bored.<br /> <br /> * Improving your body's overall health<br /> <br /> Cardiovascular exercises are well-known for their ability to increase your heart rate. A personal trainer Lafayette, California will help you understand the importance of this, as the increased pumping of your heart in turn increases the flow of blood throughout your body. Cardio exercises give your body a healthy oxygenizing experience.<br /> <br /> Why Choose Someone From Lafayette<br /> <br /> Having a personal trainer Lafayette to help you in your routine to good physical fitness is one of the most effective ways for you to achieve any workout goals. Lafayette is a city that is well-known for its high class athletic clubs which are specialized areas that are available to every one of all shapes and walks of life. These clubs are excellent for their ability to give any workout enthusiast a great look in the world of exercise, while at the same time providing enough opportunities and help to keep even the least exercise prone person interested.<br /> <br /> </div><br /> <div class='uawresource'><br /> <div style='font-style:italic;' class='uawabout'><br /> About the Author:<br /> </div><br /> <div class='uawlinks'>Becoming in good shape with the aid of <a href="http://www.theperfectworkout.com/personal-trainer-lafayette/">Personal Trainer Lafayette</a> not only enhances your own entire body but furthermore your health too. The huge benefits that one can receive from <a href="http://www.theperfectworkout.com/personal-trainer-cupertino/">Personal Trainer Cupertino</a> are endless.</div><br /> </div><br />

Cardio Training With The Personal Trainer Lafayette

By Jackie Johnson There are many areas of exercising that should be taken note of if you are aiming to have a good and well-covered exer...

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An Effective Weight Loss Program According To A Personal Trainer Sunnyvale

<div style='font-style:italic;' class='uawbyline'>By Jackie Johnson</div><br /><br /> <div class='uawarticle'>Sunnyvale is a beautiful city in California. There are many outdoor activities to be enjoyed because of its sunny but cool weather. Nonetheless, Sunnyvale offers a lot of good food, particularly seafood due to its close proximity to the bay area. Regardless whether you indulge in meat or seafood, too much could cause a weight increase, which in turn can lead to diseases due to an unfit lifestyle. You should do something to counteract this.<br /> <br /> A personal trainer Sunnyvale is equipped with the right knowledge on the proper way to lose weight through exercise and a proper diet. It is recommended to hire a fitness instructor because too much workout could be harmful to your health, particularly if you're doing it the wrong way.<br /> <br /> At the same time, dieting should be guided accordingly in order to prevent a sudden drop in weight. A good and effective diet will not deprive you from receiving the important nutrients necessary for a normal body function.<br /> <br /> Aerobic exercises<br /> <br /> Increasing your heart rate will make you lose calories. The harder your heart works, the more number of calories you lose in an exercise session. There are various forms of aerobic exercises available in and out of the gym. A personal trainer Sunnyvale can recommend what form of aerobic exercise is good and enjoyable for you. Any form of activity must be fun in order for you not to lose interest in it. You must be guided along the way to maximize the results and prevent injuries from happening.<br /> <br /> He is knowledgeable on the proper food combination to help you through the day without consuming too much calories. He can measure your height and then base the right amount of weight that you need to maintain in accordance to how tall you are. There are so many types of diets around, and a personal trainer will help you select the right one that is proven to be safe and effective.<br /> <br /> Concomitant with an aerobic exercise, lifting heavy weights will also help you lose calories. The more body mass you have, the more calories you can lose, even at rest period. Ask a personal trainer Sunnyvale to design a weight-lifting program based on your capabilities and health condition. He will guide you to prevent injuries by incorrectly lifting heavy objects. He will teach you the proper form. Even senior citizens can lift light weights under the direct supervision of a personal trainer.<br /> <br /> Diet<br /> <br /> Anaerobic exercise<br /> <br /> Concomitant with an aerobic exercise, lifting heavy weights will also help you lose calories. The more body mass you have, the more calories you can lose, even at rest period. Ask a personal trainer Sunnyvale to design a weight-lifting program based on your capabilities and health condition. He will guide you to prevent injuries by incorrectly lifting heavy objects. He will teach you the proper form. Even senior citizens can lift light weights under the direct supervision of a personal trainer.<br /> <br /> Losing weight is never easy especially in a place where there's an abundance of food. It takes discipline and perseverance to maintain an ideal body weight. A personal trainer Sunnyvale is going to help you achieve your goal with the healthy combination of exercise and diet.<br /> <br /> </div><br /> <div class='uawresource'><br /> <div style='font-style:italic;' class='uawabout'><br /> About the Author:<br /> </div><br /> <div class='uawlinks'>Being in excellent shape by using the help of <a href="http://www.theperfectworkout.com/personal-trainer-sunnyvale/">Personal Trainer Camarillo</a> not just enhances your own physique but furthermore your well being too. The benefits that one can get from <a href="http://www.theperfectworkout.com/personal-trainer-camarillo/">Personal Trainer Sunnyvale</a> are endless.</div><br /> </div><br />

An Effective Weight Loss Program According To A Personal Trainer Sunnyvale

By Jackie Johnson Sunnyvale is a beautiful city in California. There are many outdoor activities to be enjoyed because of its sunny but ...

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What To Ask The Personal Trainer Thousand Oaks

<div style='font-style:italic;' class='uawbyline'>By Dee C. Williams</div><br /><br /> <div class='uawarticle'>Thousand Oaks is among the cities that encompass the Ventura County in the state of California. The city is found in the north western region of the greater Los Angeles area. In 2006, the city was hailed by Money magazine as one of the best cities to live in all over the United States.<br /> <br /> In addition, a 2013 survey has also demonstrated that Thousand Oaks is one of the richest cities in the US. Given this fact, you can say that lots of people in the place can definitely afford to hire even the most expensive personal trainer Thousand Oaks. If you're among the residents there who are searching for a trainer that you can train with, here are the things that you need to ask a trainer before you decide to hire him for the job.<br /> <br /> * Ask Their Experiences<br /> <br /> When meeting up with the trainer for the first time, it is a good idea to ask them about their experiences. Furthermore, ask for their certifications and know which organization they are affiliated with. Asking these questions will help give you an idea of how they are as a trainer.<br /> <br /> * Ask What You Can Expect<br /> <br /> When meeting up with the trainer for the first time, it is a good idea to ask them about their experiences. Furthermore, ask for their certifications and know which organization they are affiliated with. Asking these questions will help give you an idea of how they are as a trainer.<br /> <br /> * Ask For Some Nutrition Advice<br /> <br /> The personal trainer Thousand Oaks that you will hire should also have knowledge about the proper nutrition and diet. Therefore, ask him if he can give you some advice when it comes to proper nutrition. Although trainers are there to assist you with exercising, they should be able to tell you what foods to eat and which ones to avoid so you can be sure that your fitness training will really turn out effective. You may be able to work out regularly, but if you do not watch what you eat, then you'll still not going to achieve your fitness goals successfully.<br /> <br /> You can ask some of your friends who have tried working out with a trainer about the price that they paid or you can go online and do research about this. If the trainer will charge you more than what you are expected to pay, then try to negotiate the price.<br /> <br /> The most important topic that you must discuss with the personal trainer Thousand Oaks is the rate of his services. Before you go on looking for a trainer to train with, you should already have an idea in mind as to how much you will be willing to pay for a trainer.<br /> <br /> You can ask some of your friends who have tried working out with a trainer about the price that they paid or you can go online and do research about this. If the trainer will charge you more than what you are expected to pay, then try to negotiate the price.<br /> <br /> So these are the things that you should ask a personal trainer Thousand Oaks before you decide to hire him. Keep these things in mind so you'll successfully achieve your fitness goals fast.<br /> <br /> </div><br /> <div class='uawresource'><br /> <div style='font-style:italic;' class='uawabout'><br /> About the Author:<br /> </div><br /> <div class='uawlinks'>Getting in great shape with the aid of <a href="http://www.theperfectworkout.com/personal-trainer-thousand-oaks/">Personal Trainer San Jose</a> not just enhances your own entire body but also your health too. The advantages that one can receive from <a href="http://www.theperfectworkout.com/personal-trainer-san-jose/">Personal Trainer Thousand Oaks</a> are limitless.</div><br /> </div><br />

What To Ask The Personal Trainer Thousand Oaks

By Dee C. Williams Thousand Oaks is among the cities that encompass the Ventura County in the state of California. The city is found in ...

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The Gulf Between Doctors and Nurse Practitioners - NYTimes.com

<div id="well" style="color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: normal; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px; -webkit-text-stroke-width: 0px; "><div align="left"><div class="entry-content"><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Not long ago, I attended a meeting on the future of primary care. Most of the physicians in the room knew one another, so the discussion, while serious, remained relaxed.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Toward the end of the hour, one of the physicians who had been mostly silent cleared his throat and raised his hand to speak. The other physicians smiled in acknowledgment as their colleague stood up.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">"Nurse practitioners," he said. "Maybe we need more nurse practitioners in primary care."</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Smiles faded, faces froze and the room fell silent. An outraged doctor, the color in his face rising, stood to bellow at his impertinent colleague. Others joined the fray and side arguments erupted in the back of the room. A couple of people raised their hands to try to bring the meeting back to order, but it was too late.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">The physician had mentioned the unmentionable.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">I remembered the discord and chaos of that meeting when I read a <a href="http://www.nejm.org/doi/full/10.1056/NEJMsa1212938" style="color: rgb(0, 0, 102); text-decoration: none;">recent study in The New England Journal of Medicine</a> of nurses' and physicians' opinions about primary care providers.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">For several years now, health care experts have been issuing warnings about an impending severe <a href="http://well.blogs.nytimes.com/2012/12/20/where-have-all-the-primary-care-doctors-gone/]" style="color: rgb(0, 0, 102); text-decoration: none;">shortfall of primary care physicians</a>. Policy makers have suggested that nurse practitioners, nurses who have completed graduate-level studies and up to 700 additional hours of <a href="http://www.nejm.org/doi/full/10.1056/NEJMhpr1301084" style="color: rgb(0, 0, 102); text-decoration: none;">supervised clinical work</a>, could fill the gap.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Already, many of these advanced-practice nurses work as their patients' principal provider. They make diagnoses, prescribe medications and order and perform diagnostic tests. And since they are reimbursed less than physicians, policy makers are quick to point out, increasing the number of nurse practitioners could lower health care costs.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">If only it were that easy.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Three years ago, a <a href="http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx" style="color: rgb(0, 0, 102); text-decoration: none;">national panel of experts recommended</a> that nurses be able to practice "to the full extent of their education and training," leading medical teams and practices, admitting patients to hospitals and being paid at the same rate as physicians for the same work. But physician organizations opposed many of the specific suggestions, citing a lack of data or well-designed studies to <a href="http://www.cmss.org/uploadedFiles/Site/CMSS_Policies/IOM%20FON%20Report%20CMSS%20Response.pdf" style="color: rgb(0, 0, 102); text-decoration: none;">support the recommendations.</a></font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">In an <a href="http://www.rwjf.org/content/dam/farm/reports/program_results_reports/2013/rwjf403637" style="color: rgb(0, 0, 102); text-decoration: none;">effort to build consensus</a>, the Robert Wood Johnson Foundation then invited a dozen leaders from national physician and nursing groups to discuss their differences. The hope was that face-to-face discussions would help physicians and nurses understand one another better and see beyond the highly charged and emotional rhetoric. The approach worked, at least initially; after three meetings, the group drafted a report filled with suggestions for reconciling many of the differences.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">But an <a href="http://www.napnap.org/Files/Section%203%20-%20pages%2061%20to%2095.pdf" style="color: rgb(0, 0, 102); text-decoration: none;">early confidential draft </a>was leaked to the American Medical Association, a group that had not been invited to participate, and the A.M.A. immediately expressed its opposition to the report.<a href="http://www.nejm.org/doi/full/10.1056/NEJMhpr1301084" style="color: rgb(0, 0, 102); text-decoration: none;">Soon after</a>, three of the participating medical organizations — the American Academy of Family Physicians, the American Osteopathic Association and the American Academy of Pediatrics — withdrew their support, and the effort to bring physicians and nurse practitioners together and complete the report collapsed.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Nonetheless, many health care experts remained confident, believing that the large professional organizations had grown out of touch with grass-roots-level health care providers. The guilds might oppose one another, but every day in medical practices, clinics and hospitals across the country, physicians and nurse practitioners were working side by side without bickering. Surely, the experts reasoned, providers who knew and liked one another would be receptive to trying new ways of working together.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Wrong.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Analyzing questionnaires completed by almost 1,000 physicians and nurse practitioners, researchers did find that almost all of the doctors and nurses believed that nurse practitioners should be able to practice to the full extent of their training and that their inclusion in primary care would improve the timeliness of and access to care.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">But the agreement ended there. Nurse practitioners believed that they could lead primary care practices and admit patients to a hospital and that they deserved to earn the same amount as doctors for the same work. The physicians disagreed. Many of the doctors said that they provided higher-quality care than their nursing counterparts and that increasing the number of nurse practitioners in primary care would not necessarily improve safety, effectiveness, equity or quality.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">A third of the doctors went so far as to state that nurse practitioners would have a detrimental effect on the safety and effectiveness of care.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">"These are not just professional differences," said Karen Donelan, the lead author of the study and a senior scientist at the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston. "This is an interplanetary gulf," she said, echoing a point in an <a href="http://www.nejm.org/doi/full/10.1056/NEJMe1303343" style="color: rgb(0, 0, 102); text-decoration: none;">editorial that accompanied her study</a>.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">The findings bode poorly for future policy efforts, since physicians are unlikely to support efforts to increase the responsibilities and numbers of advanced-practice nurses in primary care. And most nurse practitioners are unlikely to support any proposals to expand their roles that do not include equal pay for equal work.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Peter I. Buerhaus, senior author of the study and a professor of nursing at Vanderbilt University Medical Center in Nashville, <a href="http://www.gao.gov/about/hcac/nat_hcwc.html" style="color: rgb(0, 0, 102); text-decoration: none;">is chairman of a commission</a> created almost three years ago under the Affordable Care Act to address health care work force issues. But his group has yet to convene because a divided Congress has not approved White House <a href="http://www.nytimes.com/2013/02/25/health/health-care-panel-lacking-budget-is-left-waiting.html" style="color: rgb(0, 0, 102); text-decoration: none;">requests for funding</a>.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">"We're running out of time on these issues," Dr. Buerhaus said. "If the staffing differences remain unresolved, we are just going to cause harm to the public."</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">Still, by providing a clearer picture of the extent of these professional differences, the study should help future efforts. "It's too easy to say that everyone should just get along," Dr. Donelan said. "These arguments touch on the whole nature of these professions, their core values and how they define themselves."</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; "><font class="Apple-style-span" face="'Helvetica Neue'">"It's like when family members are warring over a sick patient," she added. "We need first to acknowledge the others' position and the full extent of our differences before we can reach any kind of resolution."</font></div></div></div></div><font class="Apple-style-span" face="'Helvetica Neue'"><br><a href="http://well.blogs.nytimes.com/2013/06/27/the-gulf-between-doctors-and-nurse-practitioners/?pagewanted=print">http://well.blogs.nytimes.com/2013/06/27/the-gulf-between-doctors-and-nurse-practitioners/?pagewanted=print</a> </font>

The Gulf Between Doctors and Nurse Practitioners - NYTimes.com

Not long ago, I attended a meeting on the future of primary care. Most of the physicians in the room knew one another, so the discussion, wh...

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Medical Procedures May Be Useless, or Worse - NYTimes.com

<div id="well" style="color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: normal; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px; -webkit-text-stroke-width: 0px; " class=""><div align="left" class=""><div class="entry-content"><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><font class="Apple-style-span" face="'Helvetica Neue'">We usually assume that new medical procedures and drugs are adopted because they are better. But a new analysis has found that many new techniques and medicines are either no more effective than the old ones, or worse. Moreover, many doctors persist in using practices that have been shown to be useless or harmful.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><font class="Apple-style-span" face="'Helvetica Neue'">Scientists reviewed each issue of The New England Journal of Medicine from 2001 through 2010 and found 363 studies examining an established clinical practice. In 146 of them, the currently used drug or procedure was found to be either no better, or even worse, than the one previously used. The report <a href="http://download.journals.elsevierhealth.com/pdfs/journals/0025-6196/PIIS0025619613004059.pdf" style="color: rgb(0, 0, 102); text-decoration: none;" class="">appears in the August issue of Mayo Clinic Proceedings</a>.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><font class="Apple-style-span" face="'Helvetica Neue'">More than 40 percent of established practices studied were found to be ineffective or harmful, 38 percent beneficial, and the remaining 22 percent unknown. Among the practices found to be ineffective or harmful were the routine use of hormone therapy in postmenopausal women; high-dose chemotherapy and stem cell transplant, a complex and expensive treatment for breast cancer that was found to be no better than conventional chemotherapy; and intensive glucose lowering in Type 2 diabetes patients in intensive care, which not only failed to reduce cardiovascular events but actually increased mortality.</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><font class="Apple-style-span" face="'Helvetica Neue'">In some instances, doctors routinely refused to give beneficial therapies despite a lack of evidence that they were harmful. Vaccines were unnecessarily withheld from multiple sclerosis patients in the belief that they increased flare-ups; women with lupus were denied oral contraceptives for fear they increased the severity of the disease; and epidural anesthesia was delayed during childbirth on the theory it increased the rate of Caesarean sections. Yet good studies showed that none of these fears was justified..</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><font class="Apple-style-span" face="'Helvetica Neue'">"Contradicted practices don't disappear immediately," said the lead author, Dr. Vinay Prasad. "There's an inertia, a 10-year period of time when the contradicted procedure continues to be practiced."</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><font class="Apple-style-span" face="'Helvetica Neue'">Dr. William E. Boden, chief of medicine at the Stratton VA Medical Center in Albany, who was not involved in the work, found the study useful and provocative. "It's challenging us to look at things we've done and attempt to find whether there's evidence to support their use," he said. "There's going to be increasing pressure to come forward with making sure that the health care dollars we're allocating are being well utilized."</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><font class="Apple-style-span" face="'Helvetica Neue'">Dr. Prasad, chief fellow in medical oncology at the National Cancer Institute, said that new medical appliances present a special problem. "Devices are particularly bad because they can be approved if they're similar to ones already on the market," he said. He cited as an example the Swan-Ganz catheter, a device threaded into the heart to monitor heart function and blood flow. It gives accurate information, Dr. Prasad said, "but that information doesn't help. We continue to introduce new catheters all the time, lacking good evidence that they work. This is a tremendous waste of resources."</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><font class="Apple-style-span" face="'Helvetica Neue'">Often doctors persist with procedures that lack evidence because they seem to make sense, Dr. Prasad said. "They all sound good if you talk about the mechanisms," he said. "You have cholesterol-clogged arteries, it makes sense that if you open them up it will help. But when that was studied, it didn't improve survival."</font></div><div style="color: rgb(51, 51, 51); margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><font class="Apple-style-span" face="'Helvetica Neue'">Patients, too, like to talk about mechanisms, Dr. Prasad added. "They tend to gravitate toward the nuts and bolts — what does it do, how does it work?" he said. "But the real question is: Does it work? What evidence is there that it does what you say it does? What trials show that it actually works? You shouldn't ask how does it work, but whether it works at all."</font></div></div></div></div><font class="Apple-style-span" face="'Helvetica Neue'"><br class=""><a href="http://well.blogs.nytimes.com/2013/07/26/medical-procedures-may-be-useless-or-worse/?pagewanted=print&_r=0">http://well.blogs.nytimes.com/2013/07/26/medical-procedures-may-be-useless-or-worse/?pagewanted=print&_r=0</a> </font>

Medical Procedures May Be Useless, or Worse - NYTimes.com

We usually assume that new medical procedures and drugs are adopted because they are better. But a new analysis has found that many new tech...

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Today's Teamster News 7.27.13

<a href="http://www.teamster.org/content/chicagoland-families-stand-striking-funeral-directors-transfer-services-alternative-funeral" rel="nofollow">Chicagoland Families Stand With Striking Teamster Funeral Directors, Transfer Services to Alternative Funeral Homes</a>  IBT ...Families throughout Chicagoland are supporting striking funeral directors and drivers by refusing to cross picket lines and transferring their funeral services to worker-friendly funeral homes...<br /><a href="http://www.teamster.org/content/brotherhood-locomotive-engineers-and-trainmen-encouraged-actions-canadian-rail-safety-0" rel="nofollow">Brotherhood of Locomotive Engineers and Trainmen Encouraged By Actions of Canadian Rail Safety Regulator</a>  BLET   ...The following is the official statement from Dennis R. Pierce, National President of the Brotherhood of Locomotive Engineers and Trainmen in response to media inquiries regarding the BLET’s reaction to the July 23 Emergency Directive issued by Transport Canada...<br /><a href="http://www.live5news.com/story/22920339/dd2-renews-contract-with-durham-school-services" rel="nofollow">DD2 renews contract with Durham School Services</a>  WCSC-5 News   ...Dorchester District 2 has renewed its contract with Durham School Services, the company which provides transportation for its students. The workers are represented by Teamsters Local 509...<br /><a href="http://www.wchstv.com/newsroom/eyewitness/130726_17864.shtml" rel="nofollow">Teamsters Picket In WV To Support Tenn. Members</a>  WCHS-8 News   ...Members of the Teamsters union are picketing in West Virginia in support of their union brothers in Tennessee. Picketers set up shop outside the Cummins Crosspoint plant in Cross Lanes Friday morning. See the video <a href="http://www.wchstv.com/newsroom/eyewitness/130726_17864.shtml" rel="nofollow">here</a>...<br /><a href="http://www.ufcw.org/2013/07/24/ufcw-locals-21-367-and-the-teamsters-stand-together-for-fair-grocery-contract/" rel="nofollow">UFCW Locals 21, 367 and the Teamsters Stand Together for Fair Grocery Contract</a>  UFCW   ...30,000  members of UFCW Locals 21 and 367 and Teamsters Local 38 in Washington state are covered by contracts at grocers Albertsons, Safeway, Fred Meyer and Quality Food Centers and other local independent stores that are up for bargaining this year. As the companies propose the elimination of healthcare, cuts to pay, and denied paid sick days, the union members have responded with more solidarity than ever...<br /><a href="http://uk.reuters.com/article/2013/07/26/uk-usa-ubs-settlement-idUKBRE96P0DV20130726">Banks shiver as UBS swallows $885 million U.S. fine</a>  Reuters   ...UBS will pay $885 million (574.8 million pounds) in a settlement with a U.S. regulator over allegations the Swiss bank misrepresented mortgage-backed bonds during the housing bubble, paving the way for billions more to be paid by other banks...<br /><a href="http://dealbook.nytimes.com/2013/07/26/sac-capital-is-arraigned-on-a-raft-of-criminal-charges/?_r=1">SAC Capital Is Arraigned on a Raft of Criminal Charges</a>  New York Times   ...the firm was arraigned on a raft of criminal insider trading charges, making it the first large American company to face an indictment in more than a decade. Prosecutors on Thursday announced the case against SAC, run by the billionaire Steven A. Cohen, calling it a “veritable magnet of market cheaters...”<br /><a href="http://www.washingtonpost.com/business/economy/fast-food-workers-planning-to-expand-protests-in-7-cities/2013/07/24/b02031d8-f488-11e2-9434-60440856fadf_story.html">Fast-food workers’ pay protests pick up steam</a>  Washington Post   ...Supporters of a fledgling movement for better pay for fast-food and other poorly paid employees are hoping for a major boost next week when thousands of low-wage workers are expected to walk off their jobs in seven U.S. cities. On Monday, workers are planning to stage one-day strikes at some of the nation’s best known and most profitable fast-food restaurants, including KFC, Wendy’s, Burger King and McDonald’s...<br /><a href="http://seattletimes.com/html/localnews/2021474715_wagetheftxml.html" rel="nofollow">Seattle fast-food workers file wage-theft complaints</a>  Seattle Times   ...Fast-food workers announced the filing of wage-theft complaints against some local restaurants Thursday, as part of an effort to spotlight what some say is an epidemic problem for low-wage workers...<br /><a href="http://host.madison.com/news/local/writers/jessica_vanegeren/solidarity-sing-along-crowd-grows-as-arrests-continue-at-wisconsin/article_cbd3dc63-c23f-5cc3-8901-2166614f10b5.html?comment_form=true">Solidarity Sing Along crowd grows as arrests continue at Wisconsin Capitol</a>  The Cap Times   ...Arrests of protesters continued for the third straight day Friday at the state Capitol, suggesting a renewed effort by Gov. Scott Walker’s administration to silence the ad-hoc “Solidarity Sing Along” group is doing little to stop the daily event...<br /><a href="http://www.jsonline.com/news/opinion/in-walker-era-unions-are-essential-b9961548z1-216954971.html" rel="nofollow">In Scott Walker era, unions are essential</a> (opinion)  Milwaukee Journal-Sentinel   ...Contrary to the notion in the Journal Sentinel July 23 editorial that Act 10 means public employee unions "lost many of their reasons for being," Wisconsin's lagging economy since Act 10 underscores exactly why these unions are needed more than ever...<br /><a href="http://www.nytimes.com/2013/07/26/us/labor-leaders-seek-government-aid-for-detroit.html?_r=0" rel="nofollow">Labor Leaders Seek Government Aid for Detroit</a>   New York Times ...Top leaders of the A.F.L.-C.I.O. on Thursday called on President Obama and the Congress to offer an immediate financial infusion to Detroit, which last week became the largest American city ever to file for bankruptcy...<br /><a href="http://www.detroitnews.com/article/20130718/METRO01/307180103">Creditors to fight Detroit insolvency claim</a>  Detroit News   ...“pension funds, unions and unsecured bondholders would receive, in some cases, as little as 10 cents on the dollar” while Bank of American and UBS will get 75 cents...<br /><a href="http://www.salon.com/2013/07/26/north_carolina_approves_nations_most_restrictive_voter_suppression_law_partner/">North Carolina approves nation’s most restrictive voter suppression law</a>  Salon   ...the North Carolina state legislature approved a radical voter suppression bill on a party line vote. The measure, easily the most extreme anti-voter bill passed by any state since the Jim Crow era, now heads to Republican Governor Pat McCrory for his signature. Court challenges — many of them — will most assuredly follow...<br /><a href="http://tv.msnbc.com/2013/07/25/florida-can-continue-purging-voters/" rel="nofollow">Florida can continue purging voters</a>  MSNBC   ...More fallout from the Supreme Court’s ruling on the Voting Rights Act came this week as a Federal Appeals court dismissed a lawsuit brought last year that tried to block a Florida voter purge...<br /><a href="http://www.nytimes.com/2013/07/26/world/asia/obama-and-vietnams-leader-pledge-deeper-ties.html?_r=0" rel="nofollow">Obama and Vietnam’s Leader Pledge Deeper Ties</a>  New York Times   ...Bearing a copy of a letter from Ho Chi Minh to Harry S. Truman, the president of Vietnam met President Obama on Thursday and pledged to deepen trade and military ties with the United States even as they tangled over human rights...<br /><a href="http://nation.time.com/2013/07/26/why-a-train-crash-like-spains-is-unlikely-in-the-u-s/" rel="nofollow">Why a Train Crash like Spain’s is Unlikely To Happen in the U.S.</a>  Time   ...The train that <a href="http://www.cnn.com/2013/07/25/world/europe/spain-train-crash/">derailed</a> and killed at least 80 people and injured 178 Wednesday night is a harrowing reminder of what can go wrong at high speeds. But experts say that U.S. riders have little to fear from the rails...<br /><a href="http://www.sctimes.com/article/20130725/NEWS01/307250054/Governor-candidate-seeks-overhaul-public-unions?nclick_check=1" rel="nofollow">Gubernatorial candidate seeks to overhaul public-sector unions</a>  St. Cloud Times   ...Minnesota State Sen. Dave Thompson roused conservative support and drew unions’ ire last year with his sponsorship of a so-called “right-to-work” constitutional amendment...<br /><a href="http://wtax.com/local/illinois-unions-call-for-investigation/" rel="nofollow">Illinois Unions Call for Investigation</a>  WTAX News Radio   ...Unions are calling for an investigation into whether business leaders tried to persuade credit agencies to lower Illinois’ bond rating...<br /><a href="http://www.jckonline.com/2013/07/25/rhode-island-bars-criminal-history-questions-on-job-applications" rel="nofollow">Rhode Island Bars Criminal History Questions on Job Applications</a>  JCK Online   ...A new Rhode Island law will prevent employers in the state from asking prospective employees about their criminal history on job applications...<br /><a href="http://blogs.citypaper.com/index.php/2013/07/david-simon-urges-tribune-co-not-to-sell-the-sun-to-koch-brothers/" rel="nofollow">David Simon urges Tribune Co. not to sell the Sun to Koch brothers</a>  City Paper   ...David Simon, who spent 13 years as a reporter for the Baltimore Sun before creating The Wire and Treme, has lent his voice to a campaign urging the Sun‘s owners, the Chicago-based Tribune Company, not to sell the paper to the oil-company heirs and right-wing activists Charles and David Koch...

Today's Teamster News 7.27.13

Chicagoland Families Stand With Striking Teamster Funeral Directors, Transfer Services to Alternative Funeral Homes   IBT ...Families thr...

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7 Exercises For Flat Abs

<div dir="ltr" style="text-align: left;" trbidi="on"><h1 style="text-align: center;"><span style="color: #3d85c6;"><span style="font-size: x-large;">7 Exercises For Flat Abs:</span></span></h1><div style="text-align: justify;"><span style="font-size: x-large;">For flat Abs, you start with a list of exercises beneficial. These 7 exercises not only work your core from the sides, front, back, but they are also adjustable to any level.</span><br /><div style="text-align: center;"><span style="font-size: x-large;"><img alt="7 Exercises For Flat Abs" border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg-hWrNPE0t7uQ-CHK3_wgzULzxIRoxP8r0IcoZOaixP8Xb2AYSx9_6bzIg1kSCHpATEltgm59p8zK30_zXLhJtqD0Qzr-FWO1UxE2tQdmKDeQmLSQplfso216l0Pb2rlKzzVQuDPNcZo/s640/7+Exercises+For+Flat+Abs.jpg" title="7 Exercises For Flat Abs" width="426" /> </span></div></div><h1 style="text-align: center;"><span style="font-size: x-large;"> </span></h1><br /><center><script type="text/javascript"><!-- google_ad_client = "ca-pub-5028478688240504"; /* LargeInPost_waysforweightloss_300-600 */ google_ad_slot = "6695176472"; google_ad_width = 300; google_ad_height = 600; //--></script><script src="http://pagead2.googlesyndication.com/pagead/show_ads.js" type="text/javascript"></script><br /><br /></center><div><span style="font-size: x-large;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="text-align: center;"><span style="font-size: x-large;"><br /></span></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><span style="font-size: x-large;"><br /></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: x-large;"><b>Pass The Block</b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><img border="0" height="452" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP_dcAV9xu2RxSHxrty209M03RIzdR1dg5OJeprJW4gknOsRE6J7T4-cAaPSVOZanL9ktCtQk10_AsRoulAQlQ4xpmQ2QUv1-x91qQmemgf1ziWmOeLTSDElITOyOEXJUSTs0yjkmba6o/s640/Pass+The+Block.jpg" width="640" /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: x-large;"><b>Semi-Downward Dog</b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><img border="0" height="454" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3OL3Ubuvpr7ke-flpSwXNjvw4WadZ63WfrBgjDX1_G4_yNBi-Pvrc16XlGavZQXGY-2ADRDiqdgi7kVfWNhPlcZgS2DdYxOYemzlJ9BO2H7tK8BARDNkgicve2QJAQJE9sWMAjoNF1Ic/s640/Semi-Downward+Dog.jpg" width="640" /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: x-large;"><b>Knee Tuck</b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><img border="0" height="454" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi39djqwihCXaji8AFHDvyllB-ufRvx7aOtEodm_rgYeFfUUvFGOcxUIoYy8SCYbB-J-chy1o228OtgqpiwWc9EovkSer_TBIpiOWyxzp0cirrcEW5vqYGQYnmOliOu8hSGMSaP-xBIblE/s640/Knee+Tuck.jpg" width="640" /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: x-large;"><b>Knee Curl</b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><img border="0" height="454" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_-Xs5Js3QWzcPia44az4hVFqhRSIFVoWfZJwp5CtZWDBfOq5WOHCuQum0QzreU0BJ7hX1fpgMDjwf6EZJj4mVB4tJnrnM7McTD-01jLecMCv-u4exVrQCbUl1h3HFqREIUnJg8k1fQbE/s640/Knee+Curl.jpg" width="640" /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="color: #741b47; font-size: x-large;"><b>Touch The Sky</b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><img border="0" height="454" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgydJ4mtFHzwdvKG06VEPYv-F8PAgV0Emm_zAq6QiWzBqqyspnX6E9ytRg1bJXcAX04j6Gtje8vGtJJocGgiHjNkZi07z52rgbScFG3JeLAYBS0J1X9jw-7XU2MskgkHwZAXS_wJt-N6zc/s640/Touch+The+Sky.jpg" width="640" /></b></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: x-large;"><b>Lumberjacks</b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><img border="0" height="454" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4TlvjrEBVr_eyGuIF35Q6RdzWeCPHIys-uKL5Lm0uE6ss2RZkB2kwx5XT3cdjY_HaSv4kvugXHpeif-K52Mm9BDJ7NblrwLLRcqrOEFVvsuu3wUO0koFpv3Q3jSE4xnUrCdGol9isZhQ/s640/Lumberjacks.jpg" width="640" /></b></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: x-large;"><b>Sit-ups</b></span></div><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><img border="0" height="454" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo4ZlLkZlN9hGa0rTWNsQeLTV_uSE_W5_5kq3i-kft1ETW8vAn_RmcPRVxMnIy7HVNhMuhyQ_Qu37-YuQZy2r3Lo-RjZ2Rv6v_malH-sLRAfZ2rQCY19s-t3Ks0bpcsGJhedc2eIjhP5w/s640/Sit-ups.jpg" width="640" /></b></span></div><br /><center><script type="text/javascript"><!-- google_ad_client = "ca-pub-5028478688240504"; /* AdSense in Post */ google_ad_slot = "6975892477"; google_ad_width = 336; google_ad_height = 280; //--></script><script src="http://pagead2.googlesyndication.com/pagead/show_ads.js" type="text/javascript"></script><br /><br /></center><div style="text-align: center;"><span style="color: #741b47; font-size: large;"><b><br /></b></span></div><div style="text-align: center;"><br /></div></div>

Exercises Flat Abs 7 Exercises For Flat Abs

7 Exercises For Flat Abs: For flat Abs, you start with a list of exercises beneficial. These 7 exercises not only work your core from the ...

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Matt Said, Jay Said...8"

<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2xNN0vBpOatYfLccfWronYgpNyGkAGWa7d8-EAeRwiiYoCKacCXXiR5iT519KiEiA2tr_vJ-ELYEyxg_I0IKGvLvpiN5MgJRNTtluAnGcKMSG8x1MbCpOQ5rWycZGQUytATptYnK7IDE/s1600/Sexting+Sexy+Nude.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2xNN0vBpOatYfLccfWronYgpNyGkAGWa7d8-EAeRwiiYoCKacCXXiR5iT519KiEiA2tr_vJ-ELYEyxg_I0IKGvLvpiN5MgJRNTtluAnGcKMSG8x1MbCpOQ5rWycZGQUytATptYnK7IDE/s400/Sexting+Sexy+Nude.jpg" width="400" /></a></div>Matt sextings.  Jay sextings.  You feel uncomfortable.<br /><br />Matt:  You have reached Matty-Boy, state your business.<br />Jay:  What are you wearing?<br />Matt:  Nothing but the see-through veneer of a thousand regrets.<br />Jay:  Thaaaaaat…issssssssss…HOT!!<br />Matt:  IKR?<br /><br />Jay:  It’s a line that Anthony Weiner only dreams that he could come up with.<br />Matt:  Pffffffft.  Amateur.<br />Jay:  So…I guess there really isn’t any way around it, is there?<br />Matt:  Nope.<br /><br />Jay and Matt:  Hmmmmm?<br /><br />Jay:  Nope.<br /><br />Matt and Jay:  This Sunday is going to be the <a href="http://www.blogtalkradio.com/im-with-stupid/2013/07/28/sexy-sexting-show" target="_blank"><span style="color: blue;">Sexy Sexting Show on IWS Radio!!</span></a><br /><br />Matt:  We can talk about Weinergate.<br />Jay:  Talk about famous people in the past and what they would have been sexting.<br />Matt:  Describe how you and I have NO idea what sexting, cyber sex, and, peni---<br />Jay:  Or what stalking is all about!!<br />Matt:  Word.<br /><br />Jay:  I bet Rev. Moneymaker has a few negative thoughts on this sexting thing.<br />Matt:  Oh I bet he does, and I am certain that Paul Piatt feels esoteric about it.<br />Jay:  Isn’t he always esoteric about everything?<br />Matt:  Maybe.<br /><br />Jay:  Alright then…Sexy Sexting it is.<br />Matt:  We are getting so good at this.<br />Jay:  IKR?  We could just phone this shit in.<br />Matt:  Well we do.<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0FPGjmWiqsnzmTKrBUTYfAAhi13Qj-RW3gc0ZDh17AMcvcP_NNE1z5KNucTc5GLzBba4p7fxMJYCDkHUUxqEruT-iGjEoHrkdqHnLcZdRvM0L8h28OIcT9Vy9CgO-IfpGCgoLnW5QzlI/s1600/IWS+Nuclear.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0FPGjmWiqsnzmTKrBUTYfAAhi13Qj-RW3gc0ZDh17AMcvcP_NNE1z5KNucTc5GLzBba4p7fxMJYCDkHUUxqEruT-iGjEoHrkdqHnLcZdRvM0L8h28OIcT9Vy9CgO-IfpGCgoLnW5QzlI/s320/IWS+Nuclear.jpg" width="320" /></a>Jay:  Ah…Yeah I guess we do.<br /><br />Matt:  Well my good man we are ready.  Enjoy your baked chicken this evening.<br />Jay:  I will and enjoy your hot dogs, or…should I call them weiners?<br />Matt:  You should.<br />Jay:  I just did.<br />Matt:  I guess you did, in that case...Good Night!!<br />Jay:  Nightie Night!!<br /><br />Catch Jay, Matt, and the entire IWS Radio crew<a href="http://www.blogtalkradio.com/im-with-stupid/2013/07/28/sexy-sexting-show" target="_blank"> <span style="color: blue;">LIVE</span></a> this Sunday from Noon-2 PM ET on Blog Talk Radio.<br /><br />To listen LIVE you can click below and/or call-in LIVE at 661.244.9852<br /><br /><a href="http://www.blogtalkradio.com/im-with-stupid/2013/07/28/sexy-sexting-show" target="_blank"><span style="color: blue;">Sexy Sexting on IWS Radio</span></a></div>

Matt Said, Jay Said...8"

Matt sextings.  Jay sextings.  You feel uncomfortable. Matt:  You have reached Matty-Boy, state your business. Jay:  What are you wearing? M...

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Summer escape to Big Meadows

<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7cDA7bHM1v_HnYP56b7L-rPK9FF4si-IHLK8CrJVv84Ir3yCeHtyxgX04CT3HQI4SS5WwG4GwhV4OMDQvfV24sOjrXJu7RRbjOCq8CH_To53nZcjtbsFum3JpCUlCQjXZgUQsVAbtL5zD/s1600/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7cDA7bHM1v_HnYP56b7L-rPK9FF4si-IHLK8CrJVv84Ir3yCeHtyxgX04CT3HQI4SS5WwG4GwhV4OMDQvfV24sOjrXJu7RRbjOCq8CH_To53nZcjtbsFum3JpCUlCQjXZgUQsVAbtL5zD/s400/1.jpg" width="400" /></a></div><div style="text-align: center;"><a href="http://www.nps.gov/shen">Shenandoah National Park </a>... this black bear crossed the Skyline Drive in front of us on Friday, stopped to look, and then disappeared into the underbrush. I only had time to snap one quick blurry photo through the windshield. The speed limit is 35 ... the Park requests that drivers observe it because a record number of bear cubs, deer, and other wildlife have been killed by vehicles.</div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE-Vb4rnx7kgyHE0AxaSUkXYQX-vKOPdQguMixFjOldC7X1IVIEq2vPle5gDRJ-_QgW4jhTpmFWTGnYmSNtl1abTQRJ44gOLFYCRu_a3htE92wJucS9PVnsrJtQm3bOlYAudO_w7PABgDV/s1600/17.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE-Vb4rnx7kgyHE0AxaSUkXYQX-vKOPdQguMixFjOldC7X1IVIEq2vPle5gDRJ-_QgW4jhTpmFWTGnYmSNtl1abTQRJ44gOLFYCRu_a3htE92wJucS9PVnsrJtQm3bOlYAudO_w7PABgDV/s400/17.jpg" width="400" /></a></div><div style="text-align: center;">We had decided to take advantage of the cooler temps and low humidity from a cold front that passed through western Virginia. Our destination was Big Meadows picnic ground and the surrounding area. The "big meadow" is behind the sign. When I was a kid, temporary overflow parking was in the field for those who arrived late after the campground was full. Today it is burned periodically to keep it open as it has been for centuries.</div><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjMxDub40imTL0HgnfNiEATg132i9RAWiE7UdGpvGwPB6XAOYcyY9pNfk1apt0uoFFKecj_YpPJqFtH5Rs0J4QpGfFwAkeFaw5aS7z8SQawGH1p6Y-QScHxTHTaiWZQmkC_bASBGE4Nqxz/s1600/2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjMxDub40imTL0HgnfNiEATg132i9RAWiE7UdGpvGwPB6XAOYcyY9pNfk1apt0uoFFKecj_YpPJqFtH5Rs0J4QpGfFwAkeFaw5aS7z8SQawGH1p6Y-QScHxTHTaiWZQmkC_bASBGE4Nqxz/s400/2.jpg" width="400" /></a></div><div style="text-align: center;">The Blue Ridge Mountains ... layers of historic scenery.</div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi33Y3HJfBNAlLqek82dSpGb8WRGqMszdp2wq-ZS6rX1N2VHVCzkGWvQbQJDAdPJ4MRk9bQ0XCa67drH28lUWiXcSZGvOwDyMbChJ3dhoN1mtPMAEeYywKW_jJXuNPwbPs57pPAW6Gam-uM/s1600/3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="252" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi33Y3HJfBNAlLqek82dSpGb8WRGqMszdp2wq-ZS6rX1N2VHVCzkGWvQbQJDAdPJ4MRk9bQ0XCa67drH28lUWiXcSZGvOwDyMbChJ3dhoN1mtPMAEeYywKW_jJXuNPwbPs57pPAW6Gam-uM/s400/3.jpg" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5lF2DQ9s_iNZREidz55ivxWctMV9QeJbC04T7LnLLzMldv6GTJPUd382BvKY-anpb78iY47mvSH4BLYioY2SUibx8kV5fl0E-Onyibz21yBk-01I10z4YfhmusryN5AXf5essc3CaDpFL/s1600/4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5lF2DQ9s_iNZREidz55ivxWctMV9QeJbC04T7LnLLzMldv6GTJPUd382BvKY-anpb78iY47mvSH4BLYioY2SUibx8kV5fl0E-Onyibz21yBk-01I10z4YfhmusryN5AXf5essc3CaDpFL/s400/4.jpg" width="400" /></a></div><div style="text-align: center;">Wildflowers were in abundance as were butterflies.</div><div class="separator" style="clear: both; text-align: center;"></div><br /><div class="separator" style="clear: both; text-align: center;"></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGwjUfV-BnLRCCTAUY8mv_SH_4cqnFRRmjMzXM3Wb_LJgtEr-_cvbl7Kl2AzbUuCRIMN-rmKoQH1gys_RwrfhgZNiN3xt21Q-5N7PvFXa6tOx5qBZuedPQ0B0muhvGP5OvqRPaaOaQcdRh/s1600/9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="315" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGwjUfV-BnLRCCTAUY8mv_SH_4cqnFRRmjMzXM3Wb_LJgtEr-_cvbl7Kl2AzbUuCRIMN-rmKoQH1gys_RwrfhgZNiN3xt21Q-5N7PvFXa6tOx5qBZuedPQ0B0muhvGP5OvqRPaaOaQcdRh/s400/9.jpg" width="400" /></a></div><div style="text-align: center;">The trail invites to explore the big meadow. On a July day with temps in the 60s and low humidity, it was perfect.</div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNqHsLEK7mNWdEfn8-26RyAjPUmN_yh2bmD0f9m4BUUBurgtFkyxP3SX7w-LJGAe-EqTTzKREpPTpA7cYMOdqFVezNMobPnD1dKlxwGAg-GOPRy2StWjM8xfnEGCJu0en0Kw9LLN0FAFe0/s1600/10.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNqHsLEK7mNWdEfn8-26RyAjPUmN_yh2bmD0f9m4BUUBurgtFkyxP3SX7w-LJGAe-EqTTzKREpPTpA7cYMOdqFVezNMobPnD1dKlxwGAg-GOPRy2StWjM8xfnEGCJu0en0Kw9LLN0FAFe0/s400/10.jpg" width="400" /></a></div><div style="text-align: center;"><a href="http://usparks.about.com/od/shenandoa1/qt/Dark-Hollow-Falls.htm">Dark Hollow Falls</a> was a favorite trail with my family while growing up when our destination was the falls and coolness deep in the forest on warm summer days.</div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVnssRtp6hbdR3QS_zSpGT7r_WcdvNLJY6gLISmaoCoSMhWxgGYiqyxBiQBjElLrlBJFmjKzkAMw4FNQElOvzkLSVEM5BmWu6XG8oqE1ST-VRKFJmTGX2geiV0JWx9-suOHue3ibA2QG2W/s1600/11.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVnssRtp6hbdR3QS_zSpGT7r_WcdvNLJY6gLISmaoCoSMhWxgGYiqyxBiQBjElLrlBJFmjKzkAMw4FNQElOvzkLSVEM5BmWu6XG8oqE1ST-VRKFJmTGX2geiV0JWx9-suOHue3ibA2QG2W/s400/11.jpg" width="400" /></a></div><div style="text-align: center;">From the Byrd Visitor Center, there's a great view of the big meadow. Follow the seasons from the <a href="http://www.nps.gov/common/commonspot/customcf/webcam/dsp_webcam_image.cfm?webCamURL=http://www.nps.gov/webcams-shen/bvc_800.jpg&refreshRate=60&title=7C9B93D2819B8E7B53C42E&width=800&height=450&altText=7C9B93D2819B8E7B53C42EC7BA1CBF7C479FE93BDBA8DEA19AEF3083AB03C97FDBE8D78E9689DB3CC99D030094DE9B948851B05D505CFF898652A7D0F947B5998906999393B88EC6929DCAA69697869517BE98BD9FDEE9AF9AA8A9A47082AE9D&description=7C9B93D2819B8E7B53C42EC7BA1CBF7C479FF57489EE83F0B1BD1D97F925905BD6BBE8938A928F10DED33400888A9289C756B65C5C15C281D375A089AD7CE19E9547D8C9AFB18388BD92DAA09891C7B7569A90A09A93A5D9A3BBBCA632CB99DA4119F670F0DFDA9085EF5607&256919">webcam at this location</a>.</div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4GSXuPjeFz-dnaRYJiLaHqh97mZp8pXmnYSjQ_M-hr9exFroWfNe5GmrjWPYHfDpSKBnWKPbcgswOBlqXkbNqbxA6NJfOAPGakk5J0bsW7PVY0ve-iA_yJRK-rgzD7jlwhQ8j1mLtiEAG/s1600/12.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4GSXuPjeFz-dnaRYJiLaHqh97mZp8pXmnYSjQ_M-hr9exFroWfNe5GmrjWPYHfDpSKBnWKPbcgswOBlqXkbNqbxA6NJfOAPGakk5J0bsW7PVY0ve-iA_yJRK-rgzD7jlwhQ8j1mLtiEAG/s400/12.jpg" width="400" /></a></div><div style="text-align: center;">Busy butterflies.</div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQfnG-fqkQm36RWGGZpSSZeCpK8OFEzoi8AQj8CoiEZqYmXcrMXUshejVJTGlkv6AIwYE0haUKT4fc4GF7q8p6sYZ-PgDGSika6BFd6PIXWyf3zspdji-JbZD9aZz1IvfDxd2DSDssysaS/s1600/13.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQfnG-fqkQm36RWGGZpSSZeCpK8OFEzoi8AQj8CoiEZqYmXcrMXUshejVJTGlkv6AIwYE0haUKT4fc4GF7q8p6sYZ-PgDGSika6BFd6PIXWyf3zspdji-JbZD9aZz1IvfDxd2DSDssysaS/s400/13.jpg" width="400" /></a></div><div style="text-align: center;">Water in a rock ... this intrigued me as a kid.</div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLlwrjAG3o_0vgoGr_MQOvWi9InUrXq55itN_21eIeSJiJVWfT6xErmZJ63F5okWmQ30oAmyKZMbRhd4p3ft4wFgWZ18RwAhoK2qU3KJMfrZPx7WfPEzDD7XjnOAdPeGWP6wOJ5OSznZrK/s1600/14.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLlwrjAG3o_0vgoGr_MQOvWi9InUrXq55itN_21eIeSJiJVWfT6xErmZJ63F5okWmQ30oAmyKZMbRhd4p3ft4wFgWZ18RwAhoK2qU3KJMfrZPx7WfPEzDD7XjnOAdPeGWP6wOJ5OSznZrK/s400/14.jpg" width="300" /></a></div><div style="text-align: center;">Alone on a trail in the quiet woods.</div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpAoE1apWVo-bYqCw7hqxoQukBUuq5TW7kT4qhvxnYmzMp-Tui6fjVdOPo0ydeFfHGHIRbi2Xg8CaZbWzrZi7MbCUPP1dCpwQK4e1JjEk8XxLRJRK_M-dvSdClESEZ7KtiSW88NKVI5jJ4/s1600/15.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpAoE1apWVo-bYqCw7hqxoQukBUuq5TW7kT4qhvxnYmzMp-Tui6fjVdOPo0ydeFfHGHIRbi2Xg8CaZbWzrZi7MbCUPP1dCpwQK4e1JjEk8XxLRJRK_M-dvSdClESEZ7KtiSW88NKVI5jJ4/s400/15.jpg" width="400" /></a></div><div style="text-align: center;"><a href="http://www.goshenandoah.com/Big-Meadows-Lodge.aspx">Big Meadows Lodge </a>where my parents honeymooned as young twenty-somethings. I never tire of its rustic wood-and-stone architecture, views from the terrace, walking its hallways, and thinking of my parents when they were just kids. My dad absolutely loved these mountains and passed along that love to me. They began taking me camping at Big Meadows when I was one, making many, many happy memories of spending time in Shenandoah National Park.</div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYFQGxGy1JgsJtA-zNP2KcVEOpB-nDv6iZERajHck70qTX6HdXhthGvQvQPx1zVVPMEiq0bpZnfPcHBDTLqjzutZ0UCf_TPCHaTZKvYQ9jER_HWJUZDnmafwoQ08tW6cmhgiY-OtZGGMTx/s1600/16.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYFQGxGy1JgsJtA-zNP2KcVEOpB-nDv6iZERajHck70qTX6HdXhthGvQvQPx1zVVPMEiq0bpZnfPcHBDTLqjzutZ0UCf_TPCHaTZKvYQ9jER_HWJUZDnmafwoQ08tW6cmhgiY-OtZGGMTx/s400/16.jpg" width="400" /></a></div><div style="text-align: center;">The sign says it all. The running joke was always that, as campers headed to the evening amphitheater program, the resident bears headed to the campground. How do you scare away a bear from the camp site? Bang on a pot with a big spoon. We never had any problems but definitely didn't take chances ... no food in tents, and coolers were kept safely in vehicles. Fun times!</div><br />Photos by Lynn R. Mitchell<br />Big Meadows, Shenandoah National Park<br />July 26, 2013

Big Meadows Blue Ridge Mountains Shenandoah National Park Skyline Drive tourism Virginia Is For Lovers Wildlife Summer escape to Big Meadows

Shenandoah National Park ... this black bear crossed the Skyline Drive in front of us on Friday, stopped to look, and then disappeared into ...

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HTC Desire 600 dual made entry in Indian market with new feature of dual sim in its class.

<div dir="ltr" style="text-align: left;" trbidi="on"><div dir="ltr" style="text-align: left;" trbidi="on"><span style="font-family: inherit;"><br /></span><span style="font-family: inherit;">HTC launched his model Desire 600 dual in Indian market to compete Google’s nexus 7, Sony Xperia, Micromax canvas 4 and Samsung Galaxy 4. This model launched in Taiwan last week and got a warm welcome from the people. </span><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><img border="0" height="255" src="http://4.bp.blogspot.com/-kztAl05EJgY/UfMm6lU8inI/AAAAAAAAAGE/nZPwU8ZJKc8/s400/htc-desire-600-f1-1.png" style="margin-left: auto; margin-right: auto;" width="400" /></td></tr><tr><td class="tr-caption" style="text-align: center;">Source htc.com</td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-kztAl05EJgY/UfMm6lU8inI/AAAAAAAAAGE/nZPwU8ZJKc8/s1600/htc-desire-600-f1-1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: inherit;"></span></a></div><div style="text-align: center;">        </div><h4 style="text-align: left;"><span style="font-family: inherit;">About hTC Desire 600 dual.</span></h4><span style="font-family: inherit;">This model is running on most popular OS of 4.1 Jelly Bean Platform. To get speed power, it have a processor of 1.2gHZ quad-core processor. Display is 4.7 inch with screen resolution of 950-by-540 pixel. If you looking for space then it have 8</span>GB<span style="font-family: inherit;"> </span>on-board<span style="font-family: inherit;"> memory with </span>support<span style="font-family: inherit;"> of 16GB SD card, beyond that 25GB Drop box storage.</span><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-qxayhJCpDGE/UfMnZu5PSLI/AAAAAAAAAGM/jBdugLCpn-8/s1600/htc-desire-600-f2-1.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="255" src="http://4.bp.blogspot.com/-qxayhJCpDGE/UfMnZu5PSLI/AAAAAAAAAGM/jBdugLCpn-8/s400/htc-desire-600-f2-1.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Source:  htc.com</td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"><span style="font-family: inherit;"></span></div>                                                          <br /><span style="font-family: inherit;">Connectivity options are like 2G, 3G, Bluetooth 4.0 and micro USB features will help you to connect with your friend any time. Battery will also </span>support<span style="font-family: inherit;"> you in this work with power of 1860mAh. Dual front stereo speaker gives you a better felling of music.</span><br /><span style="font-family: inherit;"></span><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-uV46oSystY0/UfMnslymrdI/AAAAAAAAAGU/UReFR5uYbgA/s1600/htc-desire-600-f4-1.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="255" src="http://2.bp.blogspot.com/-uV46oSystY0/UfMnslymrdI/AAAAAAAAAGU/UReFR5uYbgA/s400/htc-desire-600-f4-1.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">source htc.com</td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"><span style="font-family: inherit;"></span></div>                                           <span style="font-family: inherit;">                                            </span><br /><span style="font-family: inherit;"><br /></span><span style="font-family: inherit;"><br /></span><span style="font-family: inherit;">For capture your movements clearly, 8</span>MP<span style="font-family: inherit;"> rear camera is available with LED flash and 1.6MP front camera.</span><br /><div class="separator" style="clear: both; font-family: inherit; text-align: center;"><a href="http://1.bp.blogspot.com/-dNVIZoT-RV8/UfMoQJmSSnI/AAAAAAAAAGg/qMX5LYK4w3g/s1600/htc-desire-600-f3-1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="255" src="http://1.bp.blogspot.com/-dNVIZoT-RV8/UfMoQJmSSnI/AAAAAAAAAGg/qMX5LYK4w3g/s400/htc-desire-600-f3-1.png" width="400" /></a></div><br />                                             source htc<br /><div>This all you can get in  Rs. 26,860 in India. <br /><br /><div style="background-color: white; color: #222222; font-family: arial, sans-serif; font-size: 13px;"><br /></div></div></div><div class="separator" style="clear: both; text-align: left;"><a href="https://plus.google.com/100638775997274345522" rel="author">Anil Swami</a></div></div>

android dual sim HTC-Phone jelly bean price HTC Desire 600 dual made entry in Indian market with new feature of dual sim in its class.

HTC launched his model Desire 600 dual in Indian market to compete Google’s nexus 7, Sony Xperia, Micromax canvas 4 and Samsung Galaxy 4. Th...

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Has Carl June Found a Key to Fighting Cancer? | Philadelphia magazine

What's your full name?<br /><br>Where are you?<br /><br>What month is it?<br /><br>What day of the week is it?<br /><br><br /><br>Walter Keller tried to speak, but no words came out, only a dry rasp. The man asking the questions had dark, close-cropped gray hair and a kind, level gaze.<br /><br><br /><br>Eventually the man left the room. Walt wriggled up in his bed. Someone put a hand on his shoulder and pressed him gently back into the mattress.<br /><br><br /><br>Walt—tall and rawboned, with marbly green eyes and muscles hardened by a lifetime of physical labor—tried to elevate himself. An earsplitting noise went off. A nurse came running in and told him to get back down. When she left, Walt found that the nurses had clipped an alarm to his bed that would alert them whenever he tried to get up. He ripped it off and threw it to the ground.<br /><br><br /><br>The man was back:<br /><br><br /><br>What's your full name?<br /><br>Where are you?<br /><br>What month is it?<br /><br>What day of the week is it?<br /><br><br /><br>Walt had to get out of this room. He had a baseball game to coach, over at the ball field in Upland, California. The Upland Pony Giants were waiting for him. Michael was waiting, the skinny kid with the cannon arm, and Cody, the kid who could steal two bases on one pitch. The game was starting in five minutes—didn't anyone understand that?<br /><br><br /><br>Walt glanced to his side and saw his 19-year-old son, Dustin. Dustin was here, thank God. Dustin would listen.<br /><br><br /><br>"Dustin, get my shoes," Walt croaked. "Dustin, I have to get out of here. I'll give you a ride on the boat."<br /><br><br /><br>Walt knew his boat was right outside the door of the room—the wakeboard boat he drove every year up and down Lake Mohave in Nevada, giving water-ski rides to his grandkids. His boat was right here at the hospital. If he could only make it out of the bed, to the door, he could climb into the boat and drive it back to his house.<br /><br><br /><br>Dustin shook his head: broad shoulders, soft voice, cherubic face, dark brown hair.<br /><br><br /><br>"Dustin," Walt said, eyes soaked with confusion, "you are infuriating me."<br /><br><br /><br> <br /><br>Walt wasn't in California, as he thought. He was 2,700 miles east, in Philadelphia, where he'd come to be a guinea pig in a test of a new kind of cancer treatment. Leukemia had invaded his bone marrow and spread like a stain through his lymph nodes; the traditional options, including chemo and radiation, had failed. He was 58, and his body groaned with tumors potentially weighing as much as seven pounds. Walt needed something radically different if he was going to live. And the treatment he'd been given a few days ago was certainly that.<br /><br><br /><br>Over the past several years, a couple of hundred mice had received it, but Walt was only the seventh adult human. (Six men had preceded him, as well as a six-year-old girl.) The treatment wasn't a chemo drug, and it wasn't a vaccine. Instead, doctors at the University of Pennsylvania had tried to make Walt's own body the drug. In an approach known as gene therapy, they'd taken his own immune cells, modified them to give them new powers, and injected them back into his blood.<br /><br><br /><br>Gene therapy represents a break from the medical past. Like open-heart surgery, antibiotics and low-cost medical imaging, it's a "disruptive" technology capable of changing the way doctors do business. It could transform how we treat many types of cancers in people of all ages—if it can be made to work. But that's the problem. Before this trial at Penn—a Phase 1 trial, the earliest possible human test of a new treatment—gene therapy had scarcely worked in cancer, anywhere in the world. A typical gene-therapy experiment in cancer was as exciting as a sip of warm tea. Nothing happened, good or bad. In other kinds of gene-therapy trials, there had been tragedies: At Penn in 1999, in a trial run by doctors unrelated to the team treating Walt, a teenager with an inherited liver disease had died after a gene-therapy infusion sparked a runaway reaction.<br /><br><br /><br>But Walt's doctors had done things differently than past scientists. Their approach was original and new. And, incredibly, they'd already succeeded in making tumors vanish in a few of the patients who'd come before Walt. Using their custom technology, the Penn physicians had jolted two cancer-riddled men into sudden apparent remission—an outcome dramatic enough to earn mentions on TV news and a write-up in the New York Times. In September 2011, the paper described Penn's work as "a turning point in the long struggle to develop effective gene therapies against cancer."<br /><br><br /><br>But now, eight months later, at the Hospital of the University of Pennsylvania, something dramatic was happening inside Walter Keller's body—a riot of cells and signals. His blood pressure had crashed, so doctors had pumped him full of fluid to raise it, and the fluid had blown up his neck like a balloon. Socks were wrapped around his bloated legs to help with blood circulation. His kidneys were failing. He shook at times with "the rigors," excruciating full-body shivers that made his whole body feel the way his heart would if he had just run up a huge hill.<br /><br><br /><br>Scientists don't talk about "curing" cancer. A cure is the hope so great, so seemingly out of reach, that it must never be invoked. They've built a wall around the word. Still, the Penn researchers—as careful as they were, as professionally sober and skeptical—couldn't help but wonder: Was their small experiment the start of something that could one day affect thousands, tens of thousands, more? Was it revealing a secret about the human body that could point the way to treatments for other cancers, not just leukemia? There was no way to know until they gathered more data. They needed to show that the therapy was safe. And they needed to prove that the early patients—the men whose tumors they'd blasted away—weren't flukes.<br /><br><br /><br>Which is why so much now depended on Walter Keller. If Walt's condition improved and his tumors diminished, the trial would move forward, and the potential of the Penn therapy—the result of a decades-long quest of scientific passion and discovery—would continue to grow. But if he suffered harm, Penn would have to pause the trial and maybe stop it altogether. Then everything would spiral down. Other scientists would argue that gene therapy was a dead end. Funding would dry up; research would wither. The Penn doctors might never get another chance to prove the merits of their idea, and we might all lose out. It had taken 20 years to get to this point, and it could all be over in the space of a few moments.<br /><br><br /><br> <br /><br>1996, Bethesda, Maryland<br /><br><br /><br>Captain Carl June had a way of making science seem almost mischievous—something in the curl of his lip, the folding of his hands in his lap. He was an intense character even by the standards of the U.S. Navy medical community, which tended to attract driven personalities. He'd played football as a younger man. He was 42 now and ran ultra-marathons; his calves were like titanium rods.<br /><br><br /><br>He directed a research lab on a Navy medical campus. The main goal of his lab was to make the human immune system do things it hadn't evolved to do. Improve it. "Put it on steroids," he liked to say.<br /><br><br /><br>June had a tinkerer's temperament, a fascination with inventing tools to make new kinds of inventions possible. Some of this he had absorbed from his father, a chemical engineer in the San Francisco Bay area. As a kid, June planned to go into science, but then the Vietnam War came, he enlisted in 1971 and received a congressional appointment to Annapolis. He trained for a time as a sailor on a nuclear sub. "Very cool technology," June would later recall. "And then the war was over, so they said, 'You don't have to do this stuff. You can go to medical school.' So I did that, and it was cool." After med school, the Navy sent June to Seattle to learn how to perform bone-marrow transplants. If there ever was a radiation leak on a sub, the Navy would need doctors to give the sailors new immune systems, which is essentially what a bone-marrow transplant does. The procedure saves lives, but at considerable risk; it's estimated to kill one in five. June saw heroic transformations as well as tragic deaths.<br /><br><br /><br>Now, in his Bethesda lab, June mostly studied HIV, the virus that causes AIDS. It was another lens for looking at the immune system, its powers and limitations. HIV is so insidious because it infects the very immune cells, called "T cells," that would normally kill it. June wanted to know everything about T cells. But it was hard to study them, because it was hard to grow them in the lab. So June created a better way. Working with a quiet, meticulous researcher named Bruce Levine, June discovered that he could coat artificial beads with proteins that mimicked the natural cells that normally coax T cells to divide. The beads, round and about half the size of a cell, were made partly of iron; when you wanted to use the T cells that had grown, you just passed the cells and beads over a magnet. The beads got stuck on the magnet, and the cells flowed through.<br /><br><br /><br>June enjoyed his work at the Navy, and peers across the country respected his creativity—"a real genius," Laurence Cooper, an immunologist at the University of Texas MD Anderson Cancer Center, calls him—but by 1996, he'd begun to feel restless. The Navy only funded research into infectious diseases like HIV, and he wanted to study cancer. His wife, Cynthia, had recently been diagnosed with ovarian cancer. They had three kids in high school and college. June wanted to use what he'd learned about the immune system to tackle the disease. And more than that, he wanted to find a way to get his ideas out of the lab and into the wider world of suffering and need.<br /><br><br /><br>June retired from the Navy in 1996. For the next three years, he continued working in the same lab as a civilian, employed by a foundation, while caring for his wife as she endured chemo. "I learned a lot about being on the other side of a bed," June says, "and what it's like going through the ups and downs of cancer therapy. I had no idea of the impact."<br /><br><br /><br>In 1999, Penn offered June a prestigious appointment at its medical school. It was the chance he'd been waiting for. He moved to Philly, bringing Levine with him, and launched a new lab to translate basic science into drugs that could be commercialized, including cancer drugs. Meanwhile, Levine began to build a pilot facility that could produce drugs and vaccines in small batches: the Clinical Cell and Vaccine Production Facility. It was like a biotech company in miniature. In 2005, Levine scaled it up, moving into a warren of renovated lab space in a hospital building off Spruce Street.<br /><br><br /><br>Some of its first creations were custom cancer vaccines for the benefit of June's wife. "She wanted to go for the home run," June recalls. She wanted to see her kids grow up. He was sympathetic, of course; in her place, he'd have wanted the same. But in talking to some of his colleagues about risk, June came to realize that not everyone would. "Some people are not risk-takers at all," he says. For the first time in his career, June was forced to think about what it really meant, on a human level, to become a guinea pig in a cutting-edge medical trial—or to turn down that chance. What's more rational? To fight, or to accept your fate with grace?<br /><br><br /><br>The vaccines didn't work well enough to save Cynthia June. After five years of treatment, including two bone-marrow transplants, she died in 2001.<br /><br><br /><br> <br /><br>1996, Upland, California<br /><br><br /><br>Robin was on the phone. She was down at nearby Ralphs supermarket, where she worked checkout. The union had brought one of those mobile health vans to the store. Walt should come get a physical exam, she said. Why not? It was free.<br /><br><br /><br>To humor his wife, Walt drove to Ralphs and climbed into the van. He gave a sample of his blood. A few days later, he picked up the phone. "There's something wrong with your blood," a voice said. "We're praying for you."<br /><br><br /><br>Leukemia. Walt, it turned out, had the most common type: chronic lymphocytic leukemia, or CLL. Walt had always worried he might get cancer one day—his father had died of non-Hodgkin's lymphoma, and Walt had spent decades sucking down wood-stain fumes in his job as a cabinet refinisher—but still, the diagnosis felt like an ambush. At 43, he was scared of losing everything he'd built. He'd come so far from the little house in neighboring Montclair, where he'd grown up poor and afraid.<br /><br><br /><br>One day when Walt was 14, his stepfather burst through the door, carrying a gun. He told Walt not to move. He grabbed Walt's mother around the waist and pushed her out into the side yard. Walt heard a gunshot, then two more. He went into the yard. His stepfather and mother were both splayed out on the ground. The man had shot her, then shot himself. Walt stood there in shock. His mother was bleeding from her nose and ears. He went back into the house, got a pillow from his room, and put it under her head.<br /><br><br /><br>After the murder-suicide, Walt's birth father moved back in. An alcoholic painting contractor, he was too drunk to work. He made Walt ride his bicycle to the liquor store to fetch whiskey. The eldest boy of six siblings, Walt had to drop out of school at age 16 to support his brothers and sisters.<br /><br><br /><br>So his current prosperity, 30 years later, struck him as faintly miraculous. Two grown daughters, Chelle and Shawna. A three-year-old son, Dustin, whose birth had leveled him with a joy so intense, he didn't know what he'd done to deserve it. A spacious house with a courtyard and palm trees in Upland, just 15 minutes from Montclair but a world away, where Walt ran his own cabinet business and coached youth baseball. Walt wanted to see Dustin grow up; he wanted to see Chelle and Shawna start families of their own. He told his oncologist, Linda Bosserman, that he'd try anything.<br /><br><br /><br>After monitoring his cancer for two years, Bosserman started Walt on chemo in 1998. Up to three times a week, three weeks a month, Walt sat in a recliner as poison poured into him. One day he came home from a chemo treatment and Dustin was there, looking up at him. Dustin's dark brown hair was only thickening as Walt's was falling out. "Dad," he said, "if you die, how am I going to talk to you?"<br /><br><br /><br>The chemo was preparation for a course of full-body radiation, which crisped Walt's skin and left his mouth so full of blisters that he needed morphine to dull the pain. After that came a stem-cell transplant, a procedure in which blood is drawn from the body and spun in a centrifuge to extract pure stem cells, which can generate new, healthy bone marrow cells. Then, after chemo and radiation wipe out the bulk of the cancer, the stem cells are injected back into the veins.<br /><br><br /><br>The stem-cell transplant, in 1999, bought Walt five and a half years of remission. He built a rudimentary batting cage in his backyard and worked with Dustin there, sitting on an overturned milk crate in the cage and tossing his son dozens of underhanded pitches. When the cancer returned, in 2005, Walt went through the whole procedure again: more chemo, more radiation, a second stem-cell transplant. "That's like going to hell twice," he says.<br /><br><br /><br>It worked, until it didn't.<br /><br><br /><br>In 2010, when Walt was just shy of 57, he began to feel abnormally tired and weak. He knew what it meant. Eventually he went in for some blood work. The next time he saw Dr. Bosserman, in August, she spoke to Walt in a tone he'd never heard before.<br /><br><br /><br>His cancer was back again. And there were no good options left. A third stem-cell transplant wasn't in the cards. None of his family members were a genetic match for a bone-marrow transplant. All Walt could do was place himself on a waiting list to receive a transplant from a stranger. In the meantime, Bosserman would start him on a third course of chemo and hope for the best.<br /><br><br /><br>Almost immediately after starting on the drugs, Walt sensed that he had reached the end.<br /><br><br /><br>Meanwhile, his sandy-haired daughter Chelle, a birthing consultant at a local hospital, started talking to him about heaven. She had a family of her own now, and was raising her children to know Jesus. "Heaven is real," she'd say, "and we know how to get there. We'll see each other again."<br /><br><br /><br>Walt had never been much for church. But he thought about his love for his daughter, that feeling so powerful you can't put it into words, and he thought about how God knows when you're low and what's in your heart, and suddenly it all made sense: He is using my love for my daughter to reach me. He is using Chelle as a vehicle.<br /><br><br /><br>He tried not to be afraid. He climbed into his van every day and went to work. In the van, he listened to Vin Scully call the Dodgers games on the radio, marveling at how Vinny could make you see the action in your head: every pitch, every hit and stolen base, a game of seemingly infinite complexity mastered and mapped.<br /><br><br /><br>One day, Walt was finishing up some French doors by the pool of a client when the man of the house rushed out, eyes aflame. "Walt, Walt," the man said, "there's a lady on TV, and they say they have a cure for what you have."<br /><br><br /><br>"Ah, there's no cure for what I have," Walt mumbled, and went back to work.<br /><br><br /><br>When he got home that night, he turned on the evening news. The newscaster started talking about leukemia.<br /><br><br /><br>Walt's cell phone lit up.<br /><br><br /><br> <br /><br>2004, Philadelphia<br /><br><br /><br>T cells. Carl June had an idea for a new kind of cancer treatment involving T cells, those building blocks of the immune system.<br /><br><br /><br>In their natural state, T cells usually aren't able to kill tumor cells, partly because they can't latch on strongly enough. But June was fascinated by scientific papers showing it was possible to change this. A few researchers—first an Israeli named Zelig Eshhar in the '80s, then other investigators around the world—had discovered that you could force a T cell to stick to a tumor cell and kill it. To pull this off, you built an "engineered T cell"—a T cell never before seen in nature. You altered the T cell's genetic blueprint by injecting a new gene into the cell. The new gene would tell it to build a new molecular limb. The limb, called a "chimeric antigen receptor," would sit partly inside the cell and partly outside, and it could send signals either in or out. One signal it could send was: kill. Another was: replicate.<br /><br><br /><br>June loved this approach. So elegant. Put the immune system on steroids. What if you could train the body to fight cancer on its own? What if, instead of replacing a patient's immune system (as in a bone-marrow transplant) or pumping him full of poison (chemo), you could just borrow some cells, tweak them, and infuse them back into the patient? In theory, the engineered cells would stay alive in the blood, replenishing themselves, killing any tumors that recurred. It occurred to June that one infusion could last a lifetime.<br /><br><br /><br>He was also excited by the flexibility of engineered T cells. Normally, a drug for one kind of cancer couldn't ever work on another kind; you had to start over from scratch. But here, since you were starting with a T cell and adding a limb, you only had to change the shape of the limb. You could snap a new piece on the end, like a LEGO, that fit into a molecule on the surface of a breast-cancer cell, or a pancreatic-cancer cell, or whatever kind of cancer you wanted to attack.<br /><br><br /><br>June and Levine had actually tested engineered T cells before, in patients with HIV. The cells hadn't cured anyone, though they did improve immune-system function. But June wondered if the cells could work in cancer. Around 2003, he started discussing a cancer trial with a few colleagues at Penn, including Levine and an oncologist, David Porter. Porter ran the bone-marrow transplant program at Penn, and he was passionate about investigating new treatments. Together, the men decided to work toward a test of engineered T cells in patients suffering from a certain family of leukemias, including chronic lymphocytic leukemia.<br /><br><br /><br>In 2004, June and Porter won a $1 million grant from a small foundation, the Alliance for Cancer Gene Therapy, created by two parents whose daughter-in-law had died of breast cancer. It was enough to get started. But before they could make much progress, scientific opinion shifted against them. By 2006 and 2007, teams at other universities had run their own trials of engineered T cells in cancer patients. Invariably, the cells didn't replicate well and simply died in the blood. In one trial, they only lasted a day. The cells had no effect. They didn't work. The whole idea was starting to seem like a bust.<br /><br><br /><br>This is a story about science. But science is performed by people, and people are fallible, and people are stubborn. Carl June had seen before how a field could get it wrong. Back in med school, he used to lift weights pretty seriously. Some of the guys in his gym started experimenting with anabolic steroids. June saw them suddenly zoom from benching 220 pounds to a superhuman 320. The stuff obviously worked. But when June looked up steroids in his med-school textbook, it said that they were bogus; they only appeared to work because they made your muscles retain water. It wasn't until decades later, when juiced-up sluggers like Barry Bonds ruled the ballparks, that sc ience acknowledged steroids really could build muscle.<br /><br><br /><br>Even as others sprinted away from engineered T cells, June ran toward them. He couldn't shake a sense that they were so beautiful, they had to work. The concept was sound; only the execution was lacking. It was a matter of getting the details right.<br /><br><br /><br>June thought he and his team at Penn could succeed where others had failed. They had a few advantages. One was a better way of growing T cells—the June/Levine system of magnetic beads, developed at the Navy. Another advantage was a custom "vector," a sort of molecular truck for hauling new genes into a T cell. Other teams had built their trucks out of parts from viruses that cause leukemia in mice. Penn's truck was more efficient, because its researchers had made the bold decision to build it out of HIV. HIV works by squirting its genes into T cells. Nothing on Earth is better at this task. Why not exploit it? In the lab, a researcher named Michael Milone, along with others on June's team, had snipped away at the virus, removing the dangerous parts—the ones that let it multiply and cause AIDS—while keeping the basic chassis.<br /><br><br /><br>Penn had a set of unique tools, then. And the doctors used those tools to create and test various shapes of molecular limbs that no one else had tried. They injected their custom T cells into mice that had been genetically modified to accept human cells. By 2007, after testing several varieties of cells, Milone had identified one that seemed to work best, and was able to show that it could cure leukemia in mice.<br /><br><br /><br>Of course, scientists can cure a lot of diseases in mice that they can't cure in people. It's far easier and cheaper to do mouse trials than human trials. The first human-sized batch of vector—40 liters, filtered down to less than a shot glass's worth of slightly opaque fluid for use in the trial—would cost $300,000 to make. The problem now was getting the money to scale up from mice to humans, which meant finding a funder who believed in the idea.<br /><br><br /><br>No one just hands money to scientists. They have to fight for it. It turned out that the main funder of cancer research in the U.S., the National Institutes of Health, didn't want to pick up the check. Influential scientists there didn't think engineered T cells could ever work. June reached out to a few drug companies, but they were no help, either. Big Pharma didn't see a way to make money; the therapy was too different, too logistically demanding.<br /><br><br /><br>In 2008, the economy crashed, and June struggled to find money to pay his postdocs and lab assistants. He considered canceling the trial. Eventually, though, he managed to patch together funds to make the first batch of vector. It was enough for three patients.<br /><br><br /><br> <br /><br>2010, Philadelphia<br /><br><br /><br>They could feel the cancer through his skin—acorn-sized nodules of tumor in the lymph nodes under his arms. He was Bill Ludwig, a 65-year-old retired corrections officer from New Jersey. He'd come to Philly to be Patient No. 1.<br /><br><br /><br>At HUP, nurses hooked him up to an "apheresis" machine, which spun his blood in a centrifuge, separating his red cells and platelets from his T cells. The T cells then traveled to Levine's Clinical Cell and Vaccine Production Facility, which was full of biosafety cabinets and scales and flasks, and refrigerators named after characters from The Simpsons: the Otto Fridge and the Maggie Fridge, along with the Krusty Freezer. Levine and his technicians added the magnetic beads and the vector to Ludwig's T cells and put the cells in a nutrient medium that provided everything they needed to divide and grow. At this point, the mixture was the color of Earl Grey tea. The cells sat in a bag for the first few days, then were placed on a machine that rocked them gently to promote further growth. Then a magnet removed the beads, and the cells were frozen to preserve them while Levine and his team performed quality-control tests required by the FDA. After the tests were complete, the frozen bag of cells—about three ounces' worth, or a quarter-can of soda—was taken down to Bill Ludwig's bedside (a journey that involved rides on two elevators) and warmed in a water bath. Then a nurse hung the bag on a pole and connected it to an IV line. The fluid flowed into Ludwig.<br /><br><br /><br>Five days later, his temperature spiked.<br /><br><br /><br>David Porter studied a chest scan to try to figure out what was going on. He saw that Ludwig's lungs looked like they had pneumonia, which is common in CLL patients. The doctors treated it with antibiotics, and it went away. But Ludwig's fever only increased. Over the next few weeks, he grew sicker and sicker, quaking with chills, sweating with fevers. The doctors worried that maybe he was suffering from something called cytokine release syndrome, an immune system overreaction that had killed patients in other trials. Soon Porter and the other Penn doctors were dealing with end-of-life issues, like whether to put Ludwig on a respirator. Ludwig's wife called the whole family to the hospital, fearing he would die.<br /><br><br /><br>In all the commotion, no one thought to look at the patient's tumors. It wasn't until Day 21 that an intern tried to palpate the lumps under Ludwig's arms—and couldn't find them.<br /><br><br /><br>Ludwig began to feel better. His blood counts improved; his fevers subsided. On Day 30, the team performed a battery of tests, including a CAT scan. When P orter looked at the scan, he couldn't see any evidence of cancer. Then the team extracted some bone marrow and analyzed the cells several different ways. The first two tests showed no tumor. The third and most sensitive test showed less than one tumor cell in several hundred thousand, which more than met the definition of a complete clinical response.<br /><br><br /><br>Carl June thought it had to be a mistake. He asked for another bone-marrow biopsy, and for the tests to be repeated. The results of the second tests were the same: no cancer. If Ludwig still had the disease—and he might—it was beyond the current ability of medical science to detect.<br /><br><br /><br>The doctors obviously took this as good news, but it wasn't as dramatic a moment for them as you might think. Medical investigators working on new kinds of treatments tend not to expect wild success. "We've all been involved in new approaches in treatments where the first patient, it's miraculous, and then you treat nine people and it doesn't work again," Porter says. Besides, it didn't make sense to celebrate when they didn't yet know what was going on. All the team had was a suspicion—a rough hypothesis about what was happening inside Bill Ludwig's body.<br /><br><br /><br>Sometimes when doctors give chemo drugs to patients who have never had chemo before, large quantities of tumor cells die and crack open all at once, releasing high levels of toxic junk into the blood: chemicals that mess with heart rhythms and cause other dangerous problems, as well as uric acid, which clogs the kidneys. This is called tumor lysis syndrome. Porter and June hoped that tumor lysis was the cause of Ludwig's fevers, because if it was, it meant that the T cells were working; they were killing Ludwig's tumors. But if it was indeed tumor lysis, it was a kind never seen before. Usually, symptoms of tumor lysis occur within a day or two of treatment. Ludwig hadn't gotten sick until Day 5.<br /><br><br /><br>The Penn doctors went on to treat their second patient, who responded much as Ludwig had, with severe flu-like symptoms that swelled and ebbed; follow-up tests revealed that much, but not all, of the patient's cancer had been eliminated. Two successes were better than one, but two could still be a fluke; two could be an accident. It wasn't until the doctors treated Patient No. 3, a 64-year-old Bucks County man named Douglas Olson, that they got a clear picture of what they were achieving.<br /><br><br /><br>Olson, a scientist himself and a longtime patient of Porter's, had come into the trial with three pounds of tumors in his body. The tumors had proven resistant to all other therapies, and he didn't want to try a bone-marrow transplant. "If you survive it," Olson says, "you may not be cured, and you can't do it again. So this trial was a chance to beat this thing."<br /><br><br /><br>Something was different about Olson, something that made him a particularly useful test case: His T cells hadn't grown well in the lab. The team could only give him one one-hundredth of the dose of T cells given to the first patient. It was such a low dose that some colleagues at Penn didn't think it was ethical to treat the patient at all. Says Porter, "There were people who were going to insist he sign a consent that he knows this is futile. And we just argued, 'We don't know that.'"<br /><br><br /><br>The team won the argument and went ahead with the infusion. Fourteen days later, Olson woke up with fevers and chills. He called Porter, who told him to come in for some tests. "Now I had a sense of what was going on," Porter says. "That this was, in fact, good news."<br /><br><br /><br>Over the next week, Olson felt nauseated and suffered from diarrhea; he couldn't eat. (As the doctors would later discover, what was making the patients feel like they had the worst flu of their lives was cytokine release syndrome.) On the evening of Day 21, Porter was walking across the Penn campus when he got a text message on his pager. It was a series of lab results on Olson.<br /><br><br /><br>June got the results the next morning in his office. He scanned through columns of numbers, mouth agape. One of his colleagues, Michael Kalos, had spent years designing a series of ultra-precise assays to measure the activity of T cells in the blood, and now Kalos's assays were telling an incredible story. On Day Five, there had been almost no engineered T cells in the patient's body. By Day 18, there were billions. They had multiplied a thousand-fold from the original tiny dose. Almost every T cell in the patient's body was one of Penn's special genetic creatures. The patient was growing the drug in his body.<br /><br><br /><br>What's more, the lab results painted a picture of cataclysm in Olson's blood. As the T cells grew exponentially, the patient's kidneys had begun to shut down, and all sorts of chemicals associated with tumor lysis syndrome were wreaking havoc. It was really happening, all of it—cell growth, tumor death—exactly as the team had intended.<br /><br><br /><br>Two days later, Olson's bone-marrow biopsy came back clean. Three days after that, doctors discharged him from the hospital, an apparently healthy man. "I was absolutely cancer-free," Olson says. "I gotta tell you, every time I say that, it just gives me the shivers." The day he left the hospital, Olson drove to Maryland with his wife, to the Annapolis Boat Show, and bought an 18-foot sailboat.<br /><br><br /><br>The temptation was to say that pounds of tumors had "melted away," but melting implied a gentle process, and what had happened to the tumors was more violent than that. They'd been either torn to shreds directly by T cells that acted like serial killers, moving from one tumor cell to the next, slashing membranes and spilling innards, or they'd been destroyed by enzymes secreted by the T cells.<br /><br><br /><br>In follow-up tests six months later, the team would find high levels of engineered T cells still alive in Olson's blood. And no detectable tumors.<br /><br><br /><br> <br /><br>It was ingrained in them, through their training, to resist celebration. After June and his colleagues got the initial results for Olson, they thought about all the things they still didn't know. Why, exactly, had the therapy worked so well? Was it the particular structure of the engineered cells? Was it the way they'd grown the cells, using the body as a sort of bioreactor? Was cancer still lurking below the threshold of detection?<br /><br><br /><br>They knew it would take years to answer these questions. They also knew that "something unprecedented had happened," June says. The responsible thing to do with such data is to publish it and let other scientists take a look, and that's exactly what the Penn doctors did. They submitted papers to two prestigious journals, the New England Journal of Medicine and Science Translational Medicine, and as the papers circulated, scientists quickly recognized their significance—especially the handful of researchers who, like June, had always believed that this approach could work. "The Penn trial was definitely a turning point," says Michel Sadelain, a researcher at Memorial Sloan-Kettering Cancer Center who has made important contributions to the study of engineered T cells. "In the first three patients Carl treated, two of them showed a very dramatic response. It couldn't be any more dramatic. They had large tumor burdens that essentially vanished." Laurence Cooper at MD Anderson describes the transformation of the initial patients as "a sort of Lazarus moment."<br /><br><br /><br>Lazarus moment or no, there were still scientists who didn't buy that Penn was onto something big. The argument for skepticism rested less on science than logistics. Penn was a small operation—a boutique. Sure, they could treat three patients, but what about 300, or 3,000? Penn hadn't shown it could even begin to meet the need. Maybe the therapy was inherently impractical.<br /><br><br /><br>No one was more painfully aware of Penn's limitations than David Porter. In late 2011 and early 2012, after news of the breakthrough spread from the scientific literature into media around the world, more than 5,000 emails flooded into Penn, begging for access to the trial. "She is our first-born and only girl," went a typical letter from a mother and father hoping to get treatment for their daughter with leukemia. "We both love her very very much."<br /><br><br /><br>Porter read these letters with anguish. He knew Penn only had the capacity to treat seven or eight more people over the next year. Besides, the therapy was still so new. He didn't know all the side effects yet. It wouldn't be responsible to throw the trial open to more than a few.<br /><br><br /><br>How do you explain the need for scientific caution to the parent of a dying child?<br /><br><br /><br>Here is what Porter ended up telling people: "We're doing this as fast as we can."<br /><br><br /><br> <br /><br>Walt got into the trial because his family fought for him. It's really that simple.<br /><br><br /><br>Penn had set up an online application for the trial. Walt wasn't good with computers, so his eldest sister, Nancy Nelson, a woman in her early 60s with dirty-blond hair and glasses, filled out the form and hit SEND.<br /><br><br /><br>Nancy and Walt had always been extremely close; they'd bonded as kids in Montclair, relying on each other to process the trauma of their mother's murder. Nancy had already decided that if Walt got into the trial, she would leave California to be at his side for however long it took. Walt's wife, Robin, couldn't do it. Their relationship had lately become rocky; besides, she had to stay at her job to keep Walt's health insurance current.<br /><br><br /><br>Nancy received a brief email response from Penn—a form letter. Then, nothing. "We figured out pretty quickly that it was just going into a black hole," she recalls.<br /><br><br /><br>Eventually, after two weeks of calls and prayers, Walt's daughter Chelle connected with a researcher who worked for David Porter. They spoke for half an hour. "He explained to me that it was very high-risk," Chelle remembers. "That my father could die. The new cells could eat up his whole body." She asked the researcher a question: If it were his father, what would he do? According to Chelle, the man said, "Oooooh. I don't know."<br /><br><br /><br>Chelle didn't hesitate: Her father had made his wishes clear. She set up an appointment for Walt to meet Porter.<br /><br><br /><br>Walt and Nancy flew to Philadelphia for the meeting in November 2011. "If you let me into the trial," Walt told Porter, "I promise I'll be the best patient you've ever had. I promise I'll make it." Porter took this as a good sign; an early-stage medical trial demands "some incredible amount of optimism" on the part of the patient. It also boded well that Nancy was here, wearing a silver necklace that said CURE WALT. Porter didn't commit, though. He told them how difficult the journey would be. A bone-marrow transplant was the tried-and-true option.<br /><br><br /><br>Walt said no. He wanted this.<br /><br><br /><br>Porter agreed to run blood tests to see if Walt's cells would respond to the vector. In March 2012, Walt got the call: He was in.<br /><br><br /><br>The next few months were among the most agonizing of his life. His health began to fluctuate, because his leukemia was progressing. Doctors at Penn requested extra tests. Next, Penn ran out of vector—they'd used up their first two batches on the first six patients—and he had to wait for a new batch to be ready. He had to cool his heels. By now, he and Nancy had left California and come to the Philly area in anticipation of Walt's infusion. They were staying in Cheltenham, in a free hotel for cancer patients and their caregivers called Hope Lodge, run by the drug company AstraZeneca. They ate their meals in a communal dining room, chatting with the other patients about the Phillies.<br /><br><br /><br>Then, in April 2012, Penn suddenly suspended the trial. They'd begun treating their first child patient, Emma Whitehead, a six-year-old girl who suffered from acute lymphoblastic leukemia, a disease similar to CLL. After Emma received her dose of T cells, her body's immune system had revved up, releasing cytokines that caused fever, nausea, hypoxia (low oxygen) and low blood pressure. Doctors decided to administer an anti-cytokine agent called tocilizumab. They paused the trial to make sure she'd be okay.<br /><br><br /><br>When Emma recovered, the trial resumed. Walt finally received his infusion of T cells on Tuesday, May 15th. Chelle couldn't be there, so she texted Nancy a prayer to read out loud:<br /><br><br /><br>Father God, we ask for your blessing on these cells. Let this blessing flow right from you to Walt. May these cells be of You, Lord. May they heal, restore and give life. …<br /><br><br /><br> <br /><br>The first night, Walt spiked a fever.<br /><br><br /><br>This was unexpected. Previous patients had taken five to 14 days to get sick. The doctors tested Walt's blood. What they found surprised them: By Day 3, Walt had higher than expected levels of engineered T cells in his blood. His bioreactor was churning with astonishing speed.<br /><br><br /><br>Walt started feeling better over the next few days. He even penned some coaching advice for his players in an online journal Nancy had been maintaining:<br /><br><br /><br>Wyatt, remember to pick up the target early and on your fastball make sure to keep your hand behind the ball.<br /><br><br /><br>Alec, don't worry about your speed. Your strength is hitting your spots and changing speed of pitches.…<br /><br><br /><br>On the morning of the sixth day after infusion, Nancy woke up in Hope Lodge and checked on Walt. Walt wouldn't get out of bed. He seemed more tired than ever. Nancy couldn't get him to eat or to drink much water. She called Porter, who said to bring him to the hospital right away. When they arrived, a nurse tried to get blood from Walt but couldn't find a vein. His blood pressure had crashed. Doctors rolled him into the emergency room.<br /><br><br /><br>From here on in, Walt's memories are fuzzy. He has a particular way of characterizing this lost time: "I fell into the ditch."<br /><br><br /><br>His kids came to Philly when they heard he was worsening. Chelle arrived on the night of Wednesday, May 23rd; Shawna and Dustin came the next day on a red-eye flight, sprinting from the airport to a cab and from the cab to the hospital. "I thought I was coming to say goodbye," says Shawna, a 38-year-old with curly hair who works in an orthodontist office in California. When she finally got to Walt's room, she had to step back and take a minute to compose herself. It was mostly his eyes: They looked like they were bleeding.<br /><br><br /><br>The kids slept fitfully in chairs next to their father's bed. They chatted with the nurses caring for Walt and looked forward to the twice-daily visits from Dr. Porter, whose archetypically calm bedside manner helped reassure them that Walt would be okay. Porter had seen many of Walt's symptoms crop up in previous patients, and by now he had a better sense of how to deal with them. He knew he could tamp down the activity of the T cells by administering tocilizumab, the anti-cytokine agent. What he didn't know was this: By suppressing the T cells, would he also prevent them from killing Walt's tumors?<br /><br><br /><br>When Porter asked Walt if he wanted the anti-cytokine agent, Walt shook his head vigorously: He didn't want to risk stopping the beneficial part of the reaction.<br /><br><br /><br>Let these puppies work, Walt thought.<br /><br><br /><br> <br /><br>By Friday night, though, 10 days after infusion, Walt was no longer able to make decisions for himself. He started babbling to his sister and his children about Elvis Presley. He told them he had to get out of his bed.<br /><br><br /><br>Porter talked to Chelle and Nancy, and they all agreed that even though it might reduce the efficacy of the T cells, they shouldn't wait any longer to administer the agent. The staff gave it to Walt, then moved him into the intensive-care unit.<br /><br><br /><br>The scariest moment for Walt's family came a short time later, around 10 on Saturday night, when Walt started to repeat the same phrase over and over. "I need to go," he said, a faraway look in his eyes. "I need to go. I see the white wedding." To Dustin, it was like something out of a movie: His father was telling him that he could see the light, that he was sick of fighting and he wanted to die.<br /><br><br /><br>Chelle said, "That's okay, Dad. You can go." She'd miss him if he died, of course, but the way Chelle saw it, God was in control, not the family. If God wanted to take Walt, that was His will.<br /><br><br /><br>"No!" Shawna screamed.<br /><br><br /><br>Dustin began to cry. "No, Dad, don't go."<br /><br><br /><br>Dustin held his father's hand. Walt gripped back, tightly. Then he let go.<br /><br><br /><br>This is it, Dustin thought.<br /><br><br /><br>But then Walt opened his eyes.<br /><br><br /><br>He did that a few more times, gripping and letting go, gripping and letting go. Finally, he slept.<br /><br><br /><br>The next morning, when Walt woke up, his family thought he looked better. It seemed like he had regained his voice and some of his vigor. The anti-cytokine agent was working. Over the next few days, Walt's physical state continued to improve. His thinking was still muddled, though, which meant that things got harder for the family, not easier, because now Walt could actually pull himself up onto the rails of his bed in an attempt to escape. Nancy and the kids took turns playing prison guard. They would lie on top of him, hug him close, just to keep him down. There was a rope above Walt's bed attached to a hook that the nurses could use to hoist him up. At one point, Walt grabbed onto the rope with both hands like it was a water-ski line and said to the nurses, "Hit it," which is the signal a water-skier gives to the speedboat driver to start the engines.<br /><br><br /><br>Then, over the next several days, Walt was moved to a regular hospital room and started to climb out of the ditch. Nancy had taken to playing Motown music on her iPad. One day she noticed Walt humming along to "You've Really Got a Hold on Me":<br /><br><br /><br>I don't like you, but I love you. …<br /><br>Don't wanna kiss you, but I need to.<br /><br><br /><br>Another time, Walt elevated himself on the side of the bed and started jiggling. A nurse asked him what he was doing. "Shaking my booty," Walt said, and sang: Shake shake shake, shake shake shake your booo-tay.<br /><br><br /><br>The day they really knew Walt was back, though, was the day Dr. Porter walked into the room to ask the four questions—<br /><br><br /><br>What's your full name?<br /><br>Where are you?<br /><br>What month is it?<br /><br>What day of the week is it?<br /><br><br /><br>—and Walt answered them before Porter could even speak: "I'm Walter Robert Keller, I'm at the Hospital of the University of Pennsylvania, it's May, and today's Thursday."<br /><br><br /><br>"That was awesome, Walt," Porter said.<br /><br><br /><br>Soon Walt got out of bed, moseying through the hallways with a walker. Around that time, on June 5th, Porter took a sample of Walt's bone marrow to check on the status of his cancer. The lab report came back six days later, on June 11th. Accompanied by several staffers, Porter came to Walt's room to give him and Nancy the news.<br /><br><br /><br>The doctors clustered around Walt. "All of us were trying not to jump up and down," Porter recalls.<br /><br><br /><br>Before the trial, 90 percent of Walt's bone marrow cells had been cancerous. Now, doctors couldn't find any trace of the disease, Porter said. They still had to do more tests. But Walt appeared to be in complete remission. Up to seven pounds of tumor, obliterated, gone.<br /><br><br /><br>"His eyes were, like, lit up," Walt recalls of Porter. "When someone tells you you have cancer, and then when someone tells you you don't have any—oh, it was like a monkey just jumped off my back."<br /><br><br /><br> <br /><br>Walt stayed in the hospital for a few more days, working with a physical therapist to regain strength in his atrophied muscles. He and Nancy moved back to Hope Lodge for a time, then returned home to California in July.<br /><br><br /><br>Meanwhile, in Philly, the Penn team went on to treat adult patients No. 8, 9 and 10, as well as a second child, for a total of 12. (One of the patients in the second trio—4, 5 and 6—had a partial response to the therapy, while two others saw no effect on their cancer; another adult among the first 12 patients also did not respond.)<br /><br><br /><br>Last December, at a medical conference in Atlanta, the team presented its results to a rapt audience. The data boiled down to this: Nine out of the 12 patients, including both of the children, had responded to the therapy. Nine out of 12 had grown the engineered T cells in their bodies. Nine out of 12 had experienced some degree of tumor lysis syndrome and had seen their tumors vanish, either partially or completely.<br /><br><br /><br>Even more encouraging were the follow-up data on the two early cases of compete remission—patients No. 1, Bill Ludwig, and No. 3, Douglas Olson.<br /><br><br /><br>One big question all along has been the durability of the T cells. How long will they stay alive in the blood? Months? Years? Will cancer return in these patients? Doctors don't know. "I don't think we've proven that we've cured anyone," Porter says. Still, when Ludwig and Olson returned to Philly for their two-year checkups in the fall of 2012, they told doctors they felt great. The team checked their blood. The T cells were still alive, two years after infusion. Cancer undetectable.<br /><br><br /><br>"I think of these guys as the first astronauts, right?" says Levine. "They didn't know what they were getting into. They signed up for something, and it's wonderful to see how it's turned out."<br /><br><br /><br>"I mean, I thought it might work," June says, "but I didn't think it would work as well as it did."<br /><br><br /><br> <br /><br>Science is incremental. It's a slow and global grind, a steady accumulation of facts wrested from failure. But every once in a while, there really is a leap, and a small group of people can change how thousands think about the possibilities.<br /><br><br /><br>Carl June argued for years that engineered T cells could work, without much to show for it. But thanks to the trial, people are starting to listen. Even Big Pharma wants in.<br /><br><br /><br>For months, Penn has been working with the Swiss pharmaceutical giant Novartis, which manufactures the cancer drug Gleevec and the ADHD drug Ritalin, among others. According to the terms of a deal struck last year, Novartis will soon construct a new building on the Penn campus, the Center for Advanced Cellular Therapies, where Penn researchers will partner with scientists from Novartis to develop the T-cell technology.<br /><br><br /><br>Pharmaceutical companies have collaborated with universities before, but never to address the unique challenges that lie ahead for this particular drug. Novartis will help Penn learn more about the inner workings of the therapy so they can better channel and control it, hopefully sparing future patients ordeals like Walt's. It will pay for the costly Phase 2 and Phase 3 trials required to win FDA approval. It will help test the technology in other kinds of cancers: June and his team now have trials in the planning stages for mesothelioma (a lung-lining cancer); pancreatic, brain, prostate, breast and ovarian cancers; and other blood cancers. And for the first time, a pharmaceutical company will design a manufacturing system that takes blood from the patient, modifies it in the lab, and gives it back to the patient. The biggest challenge here isn't proving that the drug works; the biggest challenge is making it.<br /><br><br /><br>These days, Carl June spends a lot of time thinking about biology on an industrial scale—the unsexy details of cell cultures and workflows in the factory he wants to build. But when he's not thinking about the very large, he marvels at the very small. At the power of the Penn trial, given its size. A few well-described cases "can really change the whole field," he says. A couple of brave men. Two kids. That's all. And look.<br /><br><br /><br> <br /><br>2012, West Covina, California<br /><br><br /><br>"Nice and easy, okay?" Walt tells the starting pitcher of his Upland Underdogs, a 13-year-old named J.J. with orange sunglasses. It's a bright October Sunday, and Walt is in the bullpen with J.J. before a game. "You struck out nine guys on this team last time," Walt says. "Okay, remember, you're like a tree falling in the forest, okay? Don't overthrow." A spindly arm wheels around, and the ball smacks into the catcher's glove. "Good, J.J."<br /><br><br /><br>The opponents, West Covina, are batting first. Walt jogs out onto the field and takes up his position as first-base coach. He can jog now. He can stand in the sun and shout at the kids in the dugout to stop goofing around and pay attention to the pitcher's moves.<br /><br><br /><br>It's been three months since Walt came home from Philadelphia. His kidneys aren't quite back to 100 percent. When he goes out in public, he sometimes wears one of his painting masks to protect his immune system, and from time to time his feet go numb and he has trouble pressing the gas pedal on his truck. Yet he can feel his body coming back. There are days when he wakes up clear-headed, when he's full of weird energy and he wanders around confused until it suddenly occurs to him: This is what it feels like to be healthy. A year ago, Walt had given up planning for a future he didn't think would ever come, but now he's thinking about expanding his wood-fin ishing bu siness. He's even started to wonder, half seriously, about scoring his ultimate dream job: pitching coach for a minor—and eventually major—league baseball team. Decades of coaching experience under his belt—why not?<br /><br><br /><br>Walt's kids are here today, Dustin and Shawna and Chelle, watching in the stands, telling stories about the trial.<br /><br><br /><br>"It's an indescribable feeling, finding out his bone marrow is clean," Dustin says, gazing out at the diamond. "It's surreal. It's still surreal. I'm in disbelief."<br /><br><br /><br>West Covina cycles through three pitchers in four innings. The game finally tips in the fifth, when Walt's team explodes for 15 runs. The rally-capper is a home run that sails well over the second fence in center field.<br /><br><br /><br>Final score: 22-5, Upland. A football score. Walt shakes his head. He tucks his chin into his neck and smiles. Then he jogs across the diamond with the kids to shake hands with the vanquished. <br /><br><br /><br><a href="http://www.phillymag.com/articles/carl-june-key-fighting-cancer/">http://www.phillymag.com/articles/carl-june-key-fighting-cancer/</a>

Has Carl June Found a Key to Fighting Cancer? | Philadelphia magazine

What's your full name? Where are you? What month is it? What day of the week is it? Walter Keller tried to speak, but no words came out,...

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