Awakening - Joshua Lang - The Atlantic

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><span class="smallcaps" style="font-variant: small-caps; letter-spacing: 1pt; ">Linda Campbell was </span>not quite 4 years old when her appendix burst, spilling its bacteria-rich contents throughout her abdomen. She was in severe pain, had a high fever, and wouldn't stop crying. Her parents, in a state of panic, brought her to the emergency room in Atlanta, where they lived. Knowing that Campbell's organs were beginning to fail and her heart was on the brink of shutting down, doctors rushed her into surgery.</p><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Today, removing an appendix leaves only a few droplet-size scars. But back then, in the 1960s, the procedure was much more involved. As Campbell recalls, an anesthesiologist told her to count backward from 10 while he flooded her lungs with anesthetic ether gas, allowing a surgeon to slice into her torso, cut out her earthworm-size appendix, and drain her abdomen of infectious slop, leaving behind a lengthy, longitudinal scar.</p><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The operation was successful, but not long after Campbell returned home, her mother sensed that something was wrong. The calm, precocious girl who went into the surgery was not the same one who emerged. Campbell began flinging food from her high chair. She suffered random episodes of uncontrollable vomiting. She threw violent temper tantrums during the day and had disturbing dreams at night. "They were about people being cut open, lots of blood, lots of violence," Campbell remembers. She refused to be alone, but avoided anyone outside her immediate circle. Her parents took her to physicians and therapists. None could determine the cause of her distress. When she was in eighth grade, her parents pulled her from school for rehabilitation.</p><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Over time, Campbell's most severe symptoms subsided, and she learned how to cope with those that remained. She managed to move on, become an accountant, and start a family of her own, but she wasn't cured. Her nightmares continued, and nearly anything could trigger a panic attack: car horns, sudden bright lights, wearing tight-fitting pants or snug collars, even lying flat in a bed. She explored the possibility of post-traumatic stress disorder with her therapists, but could not identify a triggering event. One clue that did eventually surface, though, hinted at a possibly traumatic experience. During a session with a hypnotherapist, Campbell remembered an image, accompanied by an acute feeling of fear, of a man looming over her.</p><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Then, one fall afternoon in 2006, four decades after her symptoms began, Campbell met an anesthesiologist at a hypnotherapy workshop. Over lunch, she found herself telling the anesthesiologist about her condition. She mentioned the appendectomy she'd had not long before everything changed.</p><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The anesthesiologist was intrigued. He told her about a phenomenon that had sometimes accompanied early gas anesthetics, particularly ether, in which patients reacted to the gas by coughing and choking, as if they were suffocating.</p><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The comment sparked something in Campbell. "I started having all these flashes," she remembers. "The flashes were me being on the table. The flashes were of the room. The flashes were of the bright lights over me." A man—the same one from her memory?—was there. At some point, the room went black. "And then I got to the place where I was on the table, and I just remember feeling terror," she says. "That's all I remember. I don't see anything. I don't feel anything. It's absolute, abject terror. And the feeling that I am dying." At that moment, Campbell realized that something had happened to her during her appendectomy, something that changed her forever. After several years of investigation, she figured it out: she had woken up on the table.</p><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">This experience is called "intraoperative recall" or "anesthesia awareness," and it's more common than you might think. Although studies diverge, most experts estimate that for every 1,000 patients who undergo general anesthesia each year in the United States, one to two will experience awareness. Patients who awake hear surgeons' small talk, the swish and stretch of organs, the suctioning of blood; they feel the probing of fingers, the yanks and tugs on innards; they smell cauterized flesh and singed hair. But because one of the first steps of surgery is to tape patients' eyes shut, they can't see. And because another common step is to paralyze patients to prevent muscle twitching, they have no way to alert doctors that they are awake.</p><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">Many of these cases are benign: vague, hazy flashbacks. But up to 70 percent of patients who experience awareness suffer long-term psychological distress, including PTSD—a rate five times higher than that of soldiers returning from Iraq and Afghanistan. Campbell now understands that this is what happened to her, although she didn't believe it at first. "The whole idea of anesthesia awareness seemed over-the-top," she told me. "It took years to begin to say, 'I think this is what happened to me.' " She describes her memories of the surgery like those from a car accident: the moments before and after are clear, but the actual event is a shadowy blur of emotion. She searched online for people with similar experiences, found a coalition of victims, and eventually traveled up the East Coast to speak with some of them. They all shared a constellation of symptoms: nightmares, fear of confinement, the inability to lie flat (many sleep in chairs), and a sense of having died and returned to life. Campbell (whose name and certain other identifying details have been changed) struggles especially with the knowledge that there is no way for her to prove that she woke up, and that many, if not most, people might not believe her. "Anesthesia awareness is an intrapersonal event," she says. "No one else sees it. No one else knows it. You're the only one."</p><p style="color: rgb(0, 0, 0); font-family: Georgia, 'times new roman', times, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">More ...</p></div><a href="http://www.theatlantic.com/magazine/archive/2013/01/awakening/309188/?single_page=true">http://www.theatlantic.com/magazine/archive/2013/01/awakening/309188/?single_page=true</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Awakening - Joshua Lang - The Atlantic

Linda Campbell was  not quite 4 years old when her appendix burst, spilling its bacteria-rich contents throughout her abdomen. She was in se...

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Good and Bad, the Little Things Add Up in Fitness - NYTimes.com

<base href="data:"><div style="color: black; text-align: left; "><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">The past year in fitness has been alternately inspiring, vexing and diverting, as my revisiting of all of the Phys Ed columns published in 2012 makes clear. Taken as a whole, the latest exercise-related science tells us that the right types and amounts of exercise will almost certainly lengthen your life,<a href="http://well.blogs.nytimes.com/2012/05/09/how-working-the-muscles-may-boost-brainpower/" style="color: rgb(102, 102, 153); text-decoration: underline; ">strengthen your brain</a>, affect <a href="http://well.blogs.nytimes.com/2012/08/01/dieting-vs-exercise-for-weight-loss/" style="color: rgb(102, 102, 153); text-decoration: underline; ">your waistline</a> and even <a href="http://well.blogs.nytimes.com/2012/02/01/exercise-as-housecleaning-for-the-body/" style="color: rgb(102, 102, 153); text-decoration: underline; ">clear debris</a> from inside your body's cells. But too much exercise, other 2012 science intimates, might have undesirable <a href="http://well.blogs.nytimes.com/2012/05/23/is-marathon-running-bad-for-the-heart/" style="color: rgb(102, 102, 153); text-decoration: underline; ">effects on your heart</a>, while <a href="http://well.blogs.nytimes.com/2012/12/05/for-athletes-risks-from-ibuprofen-use/" style="color: rgb(102, 102, 153); text-decoration: underline; ">popping painkillers</a>, <a href="http://well.blogs.nytimes.com/2012/01/25/scientists-look-at-the-dangers-of-high-heels/" style="color: rgb(102, 102, 153); text-decoration: underline; ">donning stilettos</a> and sitting and reading this column likewise have their costs.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">With New Year's exercise resolutions still fresh and hopefully unbroken on this, day two of 2013, it now seems like the perfect time to review these and other lessons of the past year in fitness science.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">First, since I am habitually both overscheduled and indolent, I was delighted to report, <a href="http://well.blogs.nytimes.com/2012/06/06/moderation-as-the-sweet-spot-for-exercise/" style="color: rgb(102, 102, 153); text-decoration: underline; ">as I did in June</a>, that the "sweet sport" for health benefits seems to come from jogging or moderately working out for only a brief period a few times a week.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">Specifically, an encouraging 2012 study of 52,656 American adults found that those who ran 1 to 20 miles per week at an average pace of about 10 or 11 minutes per mile — my leisurely jogging speed, in fact — lived longer, on average, than sedentary adults. They also lived longer than the group (admittedly small) who ran more than 20 miles per week.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">"These data certainly support the idea that more running is not needed to produce extra health and mortality benefits," Dr. Carl J. Lavie, a cardiologist in New Orleans and co-author of the study told me. "If anything," he said, "it appears that less running is associated with the best protection from mortality risk."</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">Similarly, in <a href="http://well.blogs.nytimes.com/2012/09/19/is-30-minutes-of-daily-exercise-a-sweet-spot-for-weight-loss/" style="color: rgb(102, 102, 153); text-decoration: underline; ">a study from Denmark</a> that I wrote about in September, a group of pudgy young men lost more weight after 13 weeks of exercising moderately for about 30 minutes several times a week than a separate group who worked out twice as much.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">The men who exercised the most, the study authors discovered, also subsequently ate more than the moderate exercisers.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">Even more striking, however, the vigorous exercisers subsequently sat around more each day than did the men who had exercised less, motion sensors worn by all of the volunteers showed.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">"They were fatigued," said Mads Rosenkilde, a Ph.D. candidate at the University of Copenhagen and the study's co-author.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">Meanwhile, the men who had worked out for only about 30 minutes seemed to be energized by their new routines. They stood up, walked, stretched and even bounced in place more than they once had. "It looks like they were taking the stairs now, not the elevators, and just moving around more," Mr. Rosenkilde said. "It was little things, but they add up."</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">And that idea was, in fact, perhaps the most dominant exercise-science theme of 2012: that little things add up, with both positive and pernicious effects. Another of my favorite studies of 2012 found that a <a href="http://well.blogs.nytimes.com/2012/11/14/can-housework-help-you-live-longer/" style="color: rgb(102, 102, 153); text-decoration: underline; ">mere 10 minutes of daily physical activity</a> increased life spans in adults by almost two years, even if the adults remained significantly overweight.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">But the inverse of that finding proved to be equally true: not fitting periods of activity into a person's daily life also affected life span. Perhaps the most chilling sentence that I wrote all year reported that, according to <a href="http://well.blogs.nytimes.com/2012/10/17/get-up-get-out-dont-sit/" style="color: rgb(102, 102, 153); text-decoration: underline; ">a large study of Western adults</a>, "Every single hour of television watched after the age of 25 reduces the viewer's life expectancy by 21.8 minutes."</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">I am watching much less television these days.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">But not all of the new fitness science I covered this year was quite so sobering or, to be honest, consequential. Some of the more practical studies simply validated common sense, including reports that to succeed in ball sports, <a href="http://well.blogs.nytimes.com/2012/11/28/keeping-your-eye-on-the-ball/" style="color: rgb(102, 102, 153); text-decoration: underline; ">keep your eye</a> on the ball; during hot-weather exercise, <a href="http://well.blogs.nytimes.com/2012/08/15/strategies-for-hot-weather-exercise/" style="color: rgb(102, 102, 153); text-decoration: underline; ">pour cold water</a> over your head; and, finally, on the day before a marathon, <a href="http://well.blogs.nytimes.com/2012/10/31/how-to-carbo-load-for-a-marathon/" style="color: rgb(102, 102, 153); text-decoration: underline; ">eat a lot</a>.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">But when I think about the science that has most affected how I plan my life, I return again and again to those studies showing that physical activity alters how long and how well we live. My days of heedless youth are behind me. So I won't soon forget the <a href="http://well.blogs.nytimes.com/2012/09/05/the-benefits-of-middle-age-fitness/" style="color: rgb(102, 102, 153); text-decoration: underline; ">study I wrote about in September</a> detailing how moderate, frequent physical activity in midlife can delay the onset of illness and frailty in old age. Exercise won't prevent you from aging, of course. Only death does that. But this study and others from this year underscore that staying active, even in moderate doses, dramatically improves how your aging body feels and responds.</font></p><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; "><font class="Apple-style-span" face="'Helvetica Neue'">Aging also inspired my favorite reader comment of 2012, which was posted in response to a research scientist's name. "'Dr. Head,'" the reader <a href="http://well.blogs.nytimes.com/2012/01/18/how-exercise-may-keep-alzheimers-at-bay/?comments#permid=44" style="color: rgb(102, 102, 153); text-decoration: underline; ">wrote</a>. "That shall be the name of my all-senior-citizen metal band," which, if its members gyrate and vigorously bound about like Mick Jagger on his recent tour, should ensure themselves decades in which to robustly perform.</font></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; "><font class="Apple-style-span" face="'Helvetica Neue'"><br></font></div></div><a href="http://well.blogs.nytimes.com/2013/01/02/the-little-things-add-up-in-fitness/"><font class="Apple-style-span" face="'Helvetica Neue'">http://well.blogs.nytimes.com/2013/01/02/the-little-things-add-up-in-fitness/</font></a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Good and Bad, the Little Things Add Up in Fitness - NYTimes.com

The past year in fitness has been alternately inspiring, vexing and diverting, as my revisiting of all of the Phys Ed columns published in 2...

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Skoy Cloth Review and Giveaway!

<div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqHPWbh-xrfC-UBFeykc44a25qBGgYaXesETh2fNhVeQJGEf7WnXZlI7tPd8dlURGAPqUUB_Jiy5JFOFMAimPsctsBnRXzk8CcNNuu4qiI0S8onp950fzWSGK39g6-wLw0wxZaLzOvRVU/s1600/skoy+cloths.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqHPWbh-xrfC-UBFeykc44a25qBGgYaXesETh2fNhVeQJGEf7WnXZlI7tPd8dlURGAPqUUB_Jiy5JFOFMAimPsctsBnRXzk8CcNNuu4qiI0S8onp950fzWSGK39g6-wLw0wxZaLzOvRVU/s320/skoy+cloths.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Skoy Cloth </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">All I have got to say is this is an amazing product!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><a href="http://www.skoycloth.com/index.htm">Skoy</a> cloths is an environmental stretch in cleaning cloths.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Their cloths are made from an extravagent blend of natural cotton, non toxic and free of chlorine. </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6XMje0JdK_SFQJ9X7FSDRALy5OeLocrDbNnuIFNlkUUeJDIwW7He7XcOdx51c-rC1uZl2b6-mxLdvaU3mOrGfn4aSmhabzhE_xZ6m3swECpw4YMvZgQjR9CR6OZJpXFoEkt7tmQD1MNg/s1600/skoy+cloth.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6XMje0JdK_SFQJ9X7FSDRALy5OeLocrDbNnuIFNlkUUeJDIwW7He7XcOdx51c-rC1uZl2b6-mxLdvaU3mOrGfn4aSmhabzhE_xZ6m3swECpw4YMvZgQjR9CR6OZJpXFoEkt7tmQD1MNg/s320/skoy+cloth.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Water based inks are colors are made with it's artwork designs to add fun into cleaning!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Ever feel like every time you turn around your constantly buying rolls upon rolls of paper towels?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">With Skoy cloth you don't need to because it's reusable and get this actually saves 15 rolls of paper towels!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Easy on your wallet as well too!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Did you know that Skoy Cloth company also offers a  fund raising program for schools.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I think this is a great idea!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Think this would be great for your children's school or yours? </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Check them out and fill in the form!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><a href="http://www.skoycloth.com/index_files/fundraising.htm">Fundraising </a></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Upon using wet your cloth and squeeze out all of the excess water for absorption and also can be used with your everyday household cleaners.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Dishwasher safe too!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I do Recommend microwaving it for 1-2 minutes to keep your cloths healthy and germ free and it must be wet.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Wait a minute or two before removing from microwave, don't want to burn yourself!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvLtspdsxyVI_GriGdD_wEtO2TbQjmDtweWV85gLVXMlOyevFmpVvcNJwDAwHol2MqbYeUAw13d4c9NgEzh-wZ-4PSGBtrxlqAQiEvv2PEwyeGswzgsbJPV1HlBC80H_TrwNhfzc2DBBA/s1600/wet+skoy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvLtspdsxyVI_GriGdD_wEtO2TbQjmDtweWV85gLVXMlOyevFmpVvcNJwDAwHol2MqbYeUAw13d4c9NgEzh-wZ-4PSGBtrxlqAQiEvv2PEwyeGswzgsbJPV1HlBC80H_TrwNhfzc2DBBA/s320/wet+skoy.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">After washing the dishes tonight I wet the Skoy Cloth and started wiping down the counters.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I immediately noticed a difference, unlike paper towels Skoy Cloths don't rip very easily.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">They are durable and fun to use because of the design and colors.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Cleanup is a pinch!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">So easy to use and best of all it's safe and you don't need to toss it out after one use!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh15elRuMl3t1bazUIplIrJOF9WVFZICYdFfXKPOopx7GjD-JNoiP1R_is_MBO8jcQnjag9hrDBWA7xWXVs94H-0J6du-sNgXGFXl2kf5LnNm6nyAsAb1tsRr9BzYe7EN6bWjExH8PyLs/s1600/giveaway+skoy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh15elRuMl3t1bazUIplIrJOF9WVFZICYdFfXKPOopx7GjD-JNoiP1R_is_MBO8jcQnjag9hrDBWA7xWXVs94H-0J6du-sNgXGFXl2kf5LnNm6nyAsAb1tsRr9BzYe7EN6bWjExH8PyLs/s320/giveaway+skoy.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Giveaway</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Want to win a 4 pack of Skoy Cloths?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Enter to win by telling me why you choose to go green!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Want to learn more about their products?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Check them out online here:</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><a href="https://www.facebook.com/pages/Skoy/34885431393?ref=ts&fref=ts">Face Book </a></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><a href="https://twitter.com/Skoycloth"><span style="font-family: Verdana, sans-serif;">Twitter </span></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Or you can look for them at Cost Plus, and Container Store locations! </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">The Winner is Billie Ketelsen! </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div>

Skoy Cloth Review and Giveaway!

Skoy Cloth  All I have got to say is this is an amazing product! Skoy  cloths is an environmental stretch in cleaning cloths. Their cloths a...

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Country Bob's Review and Giveaway!

<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnTt111wSBJLlb1yL4gaQE7HvojTnitIJpqvn2Mv3suv_6JXrZpvxaD7X38-HDaU4c60w-zPLUk0uh80KqVQw5-x94NcYgcvLV5hmNe-4BJAeRYA0-8S-lqsQ3CpQRg3FWsGKqn_VVjiY/s1600/Country+Bob's.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnTt111wSBJLlb1yL4gaQE7HvojTnitIJpqvn2Mv3suv_6JXrZpvxaD7X38-HDaU4c60w-zPLUk0uh80KqVQw5-x94NcYgcvLV5hmNe-4BJAeRYA0-8S-lqsQ3CpQRg3FWsGKqn_VVjiY/s320/Country+Bob's.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><u><b><br /></b></u></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><u><b><br /></b></u></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><u><b>Country Bob's All Purpose Sauce</b></u></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><u><b><br /></b></u></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">Bob Edson founder of <a href="http://www.countrybobs.com/">Country Bob's </a> sauces perfected his recipe in 1968 with the most amazing spices to give your food that extra kick it needs!</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">He then began offering the sauce as a taste test to friends and family, then began selling it in 1977.</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">Since then the product line has expanded into seasoning salt, barbecue sauce, Honey Habanero All Purpose Sauce,</span><span style="font-family: Verdana, Arial, Helvetica, sans-serif;"><span style="color: #ffefc3; font-size: 12px; line-height: 18px;"> </span><span style="font-size: 12px; line-height: 18px;">and apple chipotle  as well! </span></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">You know when a product is made with the finest ingredients and the people who made it put a lot of love into them.</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">This is a company that believes in equal partnership as a team.</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: 'Trebuchet MS', sans-serif;">You can use it on any kind of meat such as burgers, steak, chicken, pork or even dip french fries into the sauce!</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">The taste of the sauce is like no other, it can't even compare because it's that good!</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">It's not too spicy and not too sweet.</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">Just the right amount of heat.</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">Just give the bottle a little shimmy shake and pour some onto your favorite meal.</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">1. You can enter to win 2 bottles of their all purpose sauce here by telling me what you like to use all purpose sauce on! </span><br /><br /><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"></span><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;">Want an extra entry? </span><br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;" /><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"></span><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;">2. Follow my blog.</span><br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;" /><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"></span><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;">3.Then also follow me via Twitter, here. https://twitter.com/kelli_bliss </span><br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;" /><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"></span><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;">4. then </span><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;">tweet about the giveaway and make sure you use #CountryBobs </span><br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;" /><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"></span><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;">5. leave me a link here to your tweet.</span><br style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;" /><span style="background-color: white; color: #222222; font-family: Verdana, sans-serif; font-size: 13px; line-height: 18px;"><br /></span></div><div style="text-align: center;"><span style="font-family: 'Trebuchet MS', sans-serif;">Comment and share the link to the giveaway!!</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">Good Luck! </span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">Enjoy! </span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">Interested in their sauces?</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;">Check them out online!</span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><a href="https://twitter.com/countrybobs">Twitter</a></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><a href="https://www.facebook.com/CountryBobs">Face Book</a></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div><div style="text-align: center;"><br /></div>

Country Bob's Review and Giveaway!

Country Bob's All Purpose Sauce Bob Edson founder of Country Bob's  sauces perfected his recipe in 1968 with the most amazing spices...

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Soda Sparkle Review and Giveaway!

<div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhISGD8cwVhUmAXEER86Rd7Q_-IyFxvyzwCk8GtQ_KVBAZpkZkG0ruXEllAGZS04tk2UTkO7klxLG30cjeA0lBmEpEqx27dJ8aTpy0JFcHajcF-hHGO8ymN4PiY1upaJ-iv_BASIK4Ssh0/s1600/soda+sparkle.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhISGD8cwVhUmAXEER86Rd7Q_-IyFxvyzwCk8GtQ_KVBAZpkZkG0ruXEllAGZS04tk2UTkO7klxLG30cjeA0lBmEpEqx27dJ8aTpy0JFcHajcF-hHGO8ymN4PiY1upaJ-iv_BASIK4Ssh0/s320/soda+sparkle.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Soda Sparkle </u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I was sent this wonderful fizzy product to review! </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Want to enjoy soda at home without all of those extra calories?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">You can with <a href="http://www.sodasparkleusa.com/">Soda Sparkle</a>, by simply using cold tap water.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Sounds amazing doesn't it?</span><br /><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSEiLoPbGDEARPpXTXzIPfdyUTn97NCkbBwy8foJ372QwrH6acIaqVqwWsDhb0dCLNHiLklOeGbR0Q7kOOsaE6fuRxBic4b5cKJGOh084xmPbR89nte4WOD35ZeMebRLv7p4Q2qOkGt4I/s1600/soda+sparkle+nutrition.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSEiLoPbGDEARPpXTXzIPfdyUTn97NCkbBwy8foJ372QwrH6acIaqVqwWsDhb0dCLNHiLklOeGbR0Q7kOOsaE6fuRxBic4b5cKJGOh084xmPbR89nte4WOD35ZeMebRLv7p4Q2qOkGt4I/s320/soda+sparkle+nutrition.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">You can enjoy soda all over again in the comfort of your own home and the best of all it's made from water and a Soda Sparkle flavor packet.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Remember to use cold tap water because if not there will be no fizz just like any other sodas or soft drinks.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Can be used as sparkling water or soda which is awesome so you don't spend all of the extra money by buying both separately! </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">The flavors include Pineapple, Lychee, Cola Lemon, Tonic, Lemon and also apple.</span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">With just a few shakes of the bottle you will have your favorite soda in no time!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbNvQDPC7y4Sb5ccz3gpI0RBubr7wEyEkSb8DaZvAIvM2u8s9-mRhWyZPs_WsoTNiuR-c-6pDQPS0XV2du2T9WGkVv_1sFiyRm4C3Cn37aH12OieCNAZQ7LNUh02P7JChx2DYG90thF0Q/s1600/soda+sparkle+contents.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbNvQDPC7y4Sb5ccz3gpI0RBubr7wEyEkSb8DaZvAIvM2u8s9-mRhWyZPs_WsoTNiuR-c-6pDQPS0XV2du2T9WGkVv_1sFiyRm4C3Cn37aH12OieCNAZQ7LNUh02P7JChx2DYG90thF0Q/s320/soda+sparkle+contents.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">It's affordable, fun and environment friendly.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">The flavors are natural and are continually growing in market!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">It's environment friendly because it helps the reduce of the use of plastic bottles at home such as soda bottles,cans or water bottles we use to flavor ourselves. </span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTdAeh3ZpDq0aqRW52mfHGCYlzXiuxODqjVTpzdhVMkQWe2s6vx-W6kvm0QNv_nWwof_GwZirmeu-eNIbpkOa4UF9ROwcq2zT2-DsotHtzwHKdbL2hFamqxylV6zgMOHr2ot8F_geSSv4/s1600/soda+sparkle+flavors.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTdAeh3ZpDq0aqRW52mfHGCYlzXiuxODqjVTpzdhVMkQWe2s6vx-W6kvm0QNv_nWwof_GwZirmeu-eNIbpkOa4UF9ROwcq2zT2-DsotHtzwHKdbL2hFamqxylV6zgMOHr2ot8F_geSSv4/s320/soda+sparkle+flavors.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Pineapple-</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>I</u> am obsessed with all things pineapple!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">This one is my favorite.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Full of flavor, refreshing and not too sweet! </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Apple-</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I'm not too much of an apple person when it comes to drinks except for apple juice but I thought this one was actually pretty good!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">It wasn't over powering like some apple drinks are.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Lychee-</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">This one was fantastic.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Reminded me of bubble teas without the tapioca bubbles in them!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Cola-</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Tastes just like the real thing! Amazingly crisp and delicious!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Tonic-</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I love how good this is.reminds me of sparkling waters and I would usually buy them by the cases!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Now I don't need to thanks to Soda Sparkle. </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5YMTsj42aZ9o2VgBrbhN93Gq8M22dw1SvFf3z9jMM4HsFMenK1o8Kbw0JKPG1Zh4fBQdyBjwBtTUDDxhgDZ5UjBJtj5gVavxf1hk4DVOdsx4BvhfYP7JzAH_ULXKLBKg151KXnCS-MQE/s1600/soda+sparkle+directions.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5YMTsj42aZ9o2VgBrbhN93Gq8M22dw1SvFf3z9jMM4HsFMenK1o8Kbw0JKPG1Zh4fBQdyBjwBtTUDDxhgDZ5UjBJtj5gVavxf1hk4DVOdsx4BvhfYP7JzAH_ULXKLBKg151KXnCS-MQE/s320/soda+sparkle+directions.jpg" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhymUh6w-48uL6MPP7oxIxRHo2Xx_RH4D_TchBLLA7V84MTxspR-Cx-E5dRLNKCfODIZlDHogtzrQ_DS3mdj14nkDwInWrGrbetbPiGwX08AV3wkVXlEXXu4j2j-hLOAFoD9wSfPWaYD3s/s1600/soda+sparkle+directions+continued.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhymUh6w-48uL6MPP7oxIxRHo2Xx_RH4D_TchBLLA7V84MTxspR-Cx-E5dRLNKCfODIZlDHogtzrQ_DS3mdj14nkDwInWrGrbetbPiGwX08AV3wkVXlEXXu4j2j-hLOAFoD9wSfPWaYD3s/s320/soda+sparkle+directions+continued.jpg" width="240" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><br /><span style="font-family: Verdana, sans-serif;">1. Enter to win by commenting below why you think this is a great product for you? </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Want an extra entry? </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">2. Follow my blog.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">3. Want another? Then also follow me via Twitter, here. https://twitter.com/kelli_bliss </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">4. then </span><span style="font-family: Verdana, sans-serif;">tweet about the giveaway and make sure you use #SodaSparkle </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">5. leave me a link here to your tweet.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Good Luck!</span><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Interested in the process of how you turn water into soda?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Watch their video on you tube here for details! </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><a href="http://www.youtube.com/watch?feature=player_embedded&v=0CHdrsnw6Ks">http://www.youtube.com/watch?feature=player_embedded&v=0CHdrsnw6Ks</a></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Interested in learning more about their products?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">They are online and you can check them out here!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><a href="https://www.facebook.com/SodaSparkleUSA?fref=ts">Face Book</a></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div>

Soda Sparkle Review and Giveaway!

Soda Sparkle  I was sent this wonderful fizzy product to review!  Want to enjoy soda at home without all of those extra calories? You can wi...

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Imagine yourself with end-stage Alzheimer’s disease (while you can) | Full Comment | National Post

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Jean was a retired physician who was diagnosed with Alzheimer's disease just after the birth of her first great grandchild. She lived a life filled with prosperity and good health. She was adored by her family, and touched the lives of many. Jean was predeceased by her husband, Robert, her partner of 55 years.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">At the age of 87, after setting off a small fire in her kitchen, Jean moved into a retirement home. She thrived there for a number of years, taking an active role in many of the home's social events. She was an avid bridge player who could still play a wicked game despite her memory loss.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">I met Jean at the University Health Network memory clinic in Toronto, when she was brought in by her family for an assessment of memory loss. She took the diagnosis of Alzheimer's disease in stride, and never quite accepted her impairments as anything more than one would expect for her age.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">I met her again a few years later as an inpatient on the geriatric psychiatry unit at the Toronto Rehabilitation Institute, where patients with dementia associated with severe behavioural problems are assessed and treated. I barely recognized her. She was a shadow of the woman I had met a number of years ago. Along with her significant weight loss, she was incontinent of bowel and bladder and would hit, kick, scratch and bite staff that rendered her personal care.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Despite having had a number of serious falls, Jean constantly and without purpose paced the unit both day and night. She was no longer able to carry out a meaningful conversation, having lost her abilities to express and understand language. More importantly, Jean was no longer able to participate in critical health-care decisions that profoundly impacted her dignity and quality of life.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Individuals in end-stage Alzheimer's often lose their capacity to eat. Even when fed by others, they are either unable to swallow or simply refuse to consume food, as if their body is shutting down in anticipation of death.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">When it was clear that Jean was not able to attain adequate nutrition to sustain life, her family insisted upon the insertion of a feeding tube. This decision was made despite detailed explanations to the family highlighting the evidence showing that tube feedings in such situations do not prolong life. They are more likely to increase suffering.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The family also was aware that Jean would need to be constantly physically restrained in order to ensure that she would not pull the tube out.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Despite learning that starvation at the end of life is not an unpleasant experience (as we know from the reports of terminal cancer patients), they simply refused to let Jean "starve to death." Jean's life lingered on for a few more days, until she eventually succumbed to an infection, which did not respond to antibiotic treatment.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Would Jean's care have been different had she been suffering from end-stage brain cancer? Would attempts have been made to prolong her life (and, as many health-care providers would suggest, thereby prolong her suffering and death)?</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Based on my experience, I suspect her case would have unfolded differently: Most families realize that suffering at the end of life in individuals with cancer is worsened through intrusive medical interventions such as mechanical tube-feedings. Why then, do patients with dementia too often receive less compassionate care?</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Most people recognize that Alzheimer's disease affects memory. However, few appreciate that Alzheimer's disease also is one of the leading causes of death among senior citizens. While most people understand that end-stage cancer requires a palliative approach (providing comfort and compassionate care at the end of life), patients with Alzheimer's disease and related disorders often are deprived of that care.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Are the two conditions so different that the approaches should be so disparate? Not really. The inevitable outcome is the same. Therefore, the goal of providing comfort and compassion while maintaining dignity should be the same under either condition.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">There will always be those who argue that the sanctity of life demands aggressive medical intervention, no matter what the cost is to the individual whose life is being prolonged. But in the case of patients with terminal Alzheimer's disease — people who are incontinent, who are unable to communicate or comprehend, who are bedbound and can no longer recognize their family nor the world around them — attempts to extend life often do little but cruelly prolong death and suffering.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">I believe that these patients would recognize this fact were they of sound mind. Family members, care providers, ethicists and religious leaders debate such end-of-life issues. But does anyone listen to the suffering patient, even when the patients can no longer speak for themselves?</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Death is a frightening and unpleasant event, which most of us choose to ignore despite its inevitability. We may have little choice in determining how we die, whether in our sleep from a heart attack or slowly from cancer; or, like Jean, from the ravages of Alzheimer's disease. We can, however, have an enormous impact on the terms of our care as we die.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">This can be achieved by informing our families and substitute decision makers about what we would want to have done while we are still capable of making those choices. The law ensures that our wishes be respected.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Whatever your ideological and spiritual beliefs, the decision on how your life ends can and should be made by you.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">To ensure this, talk with your family about how you would like your care to be rendered in the event that you are in a terminal state, and speak to your physician about an advanced care plan. Do it now, perhaps as a New Year's resolution. Jean's example shows what can happen when those decisions are made by others.</div><div style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0.83em; margin-left: 0px; font-size: 16px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; font-family: georgia, 'times new roman', times, serif; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; "><em style="padding: 0px; margin: 0px; "><strong style="padding: 0px; margin: 0px; ">Dr. Keren is the medical director of the Toronto Rehabilitation Geriatric Rehabilitation Program and the co-director of the University Health Network Memory Clinic.</strong></em></div></div><a href="http://fullcomment.nationalpost.com/2013/01/03/ron-keren-imagine-yourself-with-end-stage-alzheimers-disease-while-you-still-can/">http://fullcomment.nationalpost.com/2013/01/03/ron-keren-imagine-yourself-with-end-stage-alzheimers-disease-while-you-still-can/</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Imagine yourself with end-stage Alzheimer’s disease (while you can) | Full Comment | National Post

Jean was a retired physician who was diagnosed with Alzheimer's disease just after the birth of her first great grandchild. She lived a ...

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Borax Review and Giveaway!

<div class="separator" style="clear: both; text-align: center;"><b><u>Giveaway Winners, please contact me!</u></b></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="background-color: white; color: #333333; font-family: Georgia, 'Times New Roman', serif; font-size: 22px; line-height: 28px; text-align: start;">Congratulations to the winners of my Borax giveaway! Contact me with your address ladies!! </span><a class="twitter-atreply pretty-link" dir="ltr" href="https://twitter.com/gummasplace" style="background-color: white; color: #7b8894; font-family: Georgia, 'Times New Roman', serif; font-size: 22px; line-height: 28px; text-align: start; text-decoration: initial;"><s style="color: #afb7be; text-decoration: initial;">@</s><b style="font-weight: normal;">gummasplace</b></a><span style="background-color: white; color: #333333; font-family: Georgia, 'Times New Roman', serif; font-size: 22px; line-height: 28px; text-align: start;"> </span><a class="twitter-atreply pretty-link" dir="ltr" href="https://twitter.com/WildOrchid985" style="background-color: white; color: #7b8894; font-family: Georgia, 'Times New Roman', serif; font-size: 22px; line-height: 28px; text-align: start; text-decoration: initial;"><s style="color: #afb7be; text-decoration: initial;">@</s><b style="font-weight: normal;">WildOrchid985</b></a><span style="background-color: white; color: #333333; font-family: Georgia, 'Times New Roman', serif; font-size: 22px; line-height: 28px; text-align: start;"></span><a class="twitter-atreply pretty-link" dir="ltr" href="https://twitter.com/Dealsfan32" style="background-color: white; color: #7b8894; font-family: Georgia, 'Times New Roman', serif; font-size: 22px; line-height: 28px; text-align: start; text-decoration: initial;"><s style="color: #afb7be; text-decoration: initial;">@</s><b style="font-weight: normal;">dealsfan32</b></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgesmm8-hqzD51uIWvE36S3yGbSnb8plI0rGdS5oLITjszdMUJBPq-nlDzOAEwwcHnYtqB8MrhDtJO81vD6PcpIL2K6N5p3a4Fl_OdlqzU1SmGIuNAsoUlaV5T7qNoGvBGg20JCUS5H30Y/s1600/borax.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgesmm8-hqzD51uIWvE36S3yGbSnb8plI0rGdS5oLITjszdMUJBPq-nlDzOAEwwcHnYtqB8MrhDtJO81vD6PcpIL2K6N5p3a4Fl_OdlqzU1SmGIuNAsoUlaV5T7qNoGvBGg20JCUS5H30Y/s320/borax.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Borax Detergent 20 mule team</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Since I'm a Purex Insider I was selected to try Borax laundry detergent and also hold a giveaway!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">What is Borax?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Borax detergent is a natural mineral that's from the earth and when removed from the ground it's dried and washed then boxed for consumers like us!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Pretty cool huh?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Also produced by the perpetual evaporation of seasonal lakes, which I never knew!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">The great thing about this product is that no chlorine or phosphates are added   in the making of this detergent.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Astonishing that even hard water affects laundry by settling on the bottom of the washer where it won't go down the drain leaving your clothes actually still dirty!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">20 Mule Team Borax naturally softens hard water protecting your detergent and the cleaning power is stronger!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Keeps stains from sticking to your clothing instead of being redistributed back onto your clothing like some other laundry detergents might do. </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">You can add a 1/2 cup of Borax 20 mule to every load along with Purex to boost it's cleaning process.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_ZlWapygtA-aA9ff_CWTxFFCN_Ym7Y4n-dJVXZ0makw8EEZ0Pz_B4HmZ0d2Fqt2vtDR8ycfVYOp64JVEjDr_wltKNNKn9w-yt7914ZV30ip6U0i1ugQSB0BdiXUUdXQyOaQdIzGs7HpU/s1600/borax+coupons.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_ZlWapygtA-aA9ff_CWTxFFCN_Ym7Y4n-dJVXZ0makw8EEZ0Pz_B4HmZ0d2Fqt2vtDR8ycfVYOp64JVEjDr_wltKNNKn9w-yt7914ZV30ip6U0i1ugQSB0BdiXUUdXQyOaQdIzGs7HpU/s320/borax+coupons.jpg" width="320" /></a></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>Story:</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">This detergent is outstanding!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">The cleaning power worked like magic.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">The stains on one of my favorite jackets came right out!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I could not believe it when I saw it.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I am so glad that I tried this detergent, and am a firm believer that detergent really does work! </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><br /><span style="font-family: Verdana, sans-serif;">1. Enter to win by telling me how do you keep your clothes looking white and good as new? </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Want an extra entry? </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">2. Follow my blog.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">3.Then also follow me via Twitter, here. https://twitter.com/kelli_bliss </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">4. then </span><span style="font-family: Verdana, sans-serif;">tweet about the giveaway and make sure you use #Borax</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">5. leave me a link here to your tweet.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Good Luck!</span></div><div style="text-align: center;"><br /><br /><br /><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><br /></div>

Borax Review and Giveaway!

Giveaway Winners, please contact me! Congratulations to the winners of my Borax giveaway! Contact me with your address ladies!!  @ gummaspla...

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Key West

Here's a few pics of KW, Duval Street.  N<br />The big red shoe gets dropped at midnight on NYE - sitting in the shoe is drag queen, Sushi!<br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjENM_F8rvLrxG5e2xXap6jv9-39Qrub6aXdWyDHTtEw-uFZM86qSH0W2g1_ROkNLMzkPHPRjzgXnCgX03U4h9awAWlAc9U2pmYGYxBxzeBQbzfGmKI5WiD9DC3948ln3WFDQXFJujG7Q_/s1600/20130101_182611.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"> <img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjENM_F8rvLrxG5e2xXap6jv9-39Qrub6aXdWyDHTtEw-uFZM86qSH0W2g1_ROkNLMzkPHPRjzgXnCgX03U4h9awAWlAc9U2pmYGYxBxzeBQbzfGmKI5WiD9DC3948ln3WFDQXFJujG7Q_/s400/20130101_182611.jpg" /> </a> </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgphjZ3Zzt-v4bZN5srg2ztw6Qj4vd6UNf4EPDpEJGyGpGOmy2dQzJtrTZhg6bBOh5Tt9LlgUxtLqB2n172I6Q5604RdiwsLur2wGZebWW2J2AYf0mL8FvuykL7PBziNYRo8dfWeSQMufwi/s1600/20130101_182603.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"> <img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgphjZ3Zzt-v4bZN5srg2ztw6Qj4vd6UNf4EPDpEJGyGpGOmy2dQzJtrTZhg6bBOh5Tt9LlgUxtLqB2n172I6Q5604RdiwsLur2wGZebWW2J2AYf0mL8FvuykL7PBziNYRo8dfWeSQMufwi/s400/20130101_182603.jpg" /> </a> </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe-wISNq0nho9w1eQZMeafa49iifVbSuR1dUurS0WxSjHB5gDWXgnY5N9I8Aea2sW_rQyXRzW8Dkn4NBXHwmeNEXqw3qcsQkluTakeWMxs8bfEXGATmSr4wvwuHIcvMUH2u7u_qx8oTKBH/s1600/20130101_182448.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"> <img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe-wISNq0nho9w1eQZMeafa49iifVbSuR1dUurS0WxSjHB5gDWXgnY5N9I8Aea2sW_rQyXRzW8Dkn4NBXHwmeNEXqw3qcsQkluTakeWMxs8bfEXGATmSr4wvwuHIcvMUH2u7u_qx8oTKBH/s400/20130101_182448.jpg" /> </a> </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7_R3Dc9Cl348zxwK1ngix5tzv9nVTXO_TW5XxuJ8i089PWrzzvdCzgAh-ETjsAOAZUPDnZvcttLN-M36ulPYpRpzczA4f-XjC4P_-GpiEnOsxgM6oZ-GS6ixXOsIhI8N_PkeHe9WR88nn/s1600/20130101_182434.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"> <img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7_R3Dc9Cl348zxwK1ngix5tzv9nVTXO_TW5XxuJ8i089PWrzzvdCzgAh-ETjsAOAZUPDnZvcttLN-M36ulPYpRpzczA4f-XjC4P_-GpiEnOsxgM6oZ-GS6ixXOsIhI8N_PkeHe9WR88nn/s400/20130101_182434.jpg" /> </a> </div>

Key West

Here's a few pics of KW, Duval Street.  N The big red shoe gets dropped at midnight on NYE - sitting in the shoe is drag queen, Sushi! ...

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Making a Case for the Medical Checkup - NYTimes.com

<base href="data:">How does it feel to learn that the bread-and-butter of what you do for patients might not actually help them?<br><br>Unsettled, to say the least. A recent analysis from The Cochrane Collaboration, an international group that reviews scientific evidence, concluded that general health checkups for adults did not help patients live longer or healthier lives.<br><br>I thought about that the other day as I worked my way through the morning appointments. Some patients were there for management of their ongoing diseases, like diabetes and hypertension. But many were there for a general checkup, often prompted by minor symptoms.<br><br>One 43-year-old man came because of shoulder pain. It took just a few minutes of questions and physical exam to attribute the pain to muscle strain from lifting weights, with the simple prescription to lay off the weights for a few weeks.<br><br>For an internist, though, this is a golden opportunity — a minor symptom gets a patient into my office, which becomes a prime opportunity to address general health. Like many healthy people, he hadn't been to a doctor in years, so there was lots to do.<br><br>I checked his blood pressure to screen for the "silent killer" of hypertension. I noticed that he hadn't had a tetanus booster in 10 years, not to mention an annual flu shot. I ordered a blood test for cholesterol. I went through his family medical history in case there were any particular diseases we should be on the lookout for.<br><br>We discussed a healthy diet and exercise. I screened for H.I.V., depression, domestic violence, smoking, and drug and alcohol abuse.<br><br>It was a lot to pack in for a visit about shoulder pain, but screening is where we get the most bang for the buck, or so we've been told. If our detailed interview uncovered one serious illness in the making, we'd be poised to treat it earlier, not later. This is the essence of primary care medicine.<br><br>So to read the new report suggesting that these exhaustive (and exhausting!) general checkups may not impact morbidity and mortality was dispiriting.<br><br>The study was a meta-analysis, in which the authors scoured the literature and came up with 16 randomized trials in which one group of patients had general checkups and the other group did not. Two-thirds of the trials, covering more than 150,000 patients, followed the patients long enough — nearly a decade — to track actual death rates.<br><br>Patients in the checkup group received many more new diagnoses; one trial found a 20 percent increase. But they did not live longer. They died from cancer and heart disease at the same rates as their peers who did not have checkups.<br><br>The visit with my patient ran well over our allotted time. The next several patients were delayed because I'd scrambled to cover all the bases that constitute general health. (The same bases, incidentally, that are being tabulated as a measure of my "quality.") But are we — as the study might suggest — wasting our collective breath here?<br><br>Certainly the study had drawbacks. By the time a trial is planned, executed, published and then later reviewed in a meta-analysis, it is of course outdated to some degree. So in some of the trials, the medical practices may not reflect what we are actually doing today. And the group that did not have checkups may have actually received a fair bit of general health screening along the way if they, like my patient, saw a doctor for a sore shoulder and walked out with a cholesterol analysis and a flu shot. Additionally, not enough data were collected to permit conclusions about the potential harms of general checkups — excess medications, harmful tests, false-positive diagnoses.<br><br>Still, it would have been nice to see a hint of a benefit for checkups in this analysis, given how much effort and time is invested in screening. We strive to practice evidence-based medicine, and if general checkups don't help our patients live healthier and longer lives, then maybe we should be focusing our resources elsewhere.<br><br>Of course it can also be argued that this analysis, like most studies, offers us only averaged data for a population of people. It does not give us specifics for an individual person. There may be certain types of patients who do benefit from check-ups, and others who may be harmed.<br><br>So I'm not – yet — telling my patients to skip checkups altogether. Certainly those in robust health need not slavishly adhere to the annual physical. In any case, it's not so much the annual "physical," but rather the "history-taking," that is critical. It's the detailed conversation that is much more likely to uncover lurking medical issues than the physical exam or blood tests.<br><br>What the meta-analysis can't quantify, of course, is the value of establishing a doctor-patient relationship before one gets sick. I feel fortunate to have been with many of my patients for years, a few for a decade or two. If you stick together long enough, you'll be there when something comes up. Treatment is immeasurably easier when it's not taking place between strangers. It's hard to place a numerical value on that.<br><br><i>Danielle Ofri is an associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review. Her most recent book is "Medicine in Translation: Journeys With My Patients."<br></i><br><a href="http://well.blogs.nytimes.com/2013/01/03/making-a-case-for-the-medical-check-up/">http://well.blogs.nytimes.com/2013/01/03/making-a-case-for-the-medical-check-up/</a><br><br>

Making a Case for the Medical Checkup - NYTimes.com

How does it feel to learn that the bread-and-butter of what you do for patients might not actually help them? Unsettled, to say the least. A...

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