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Support Taronga
Taronga needs on-going assistance to continue our work For The Wild. You can join a very special group of our most committed supporters.
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- Nintendo
- © 2014 Nintendo. Games are property of their respective owners.
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Cartoon Violence
A best-selling Nintendo classic, bringing 14 tough matches of knockouts and ultimate glory!
Original Release Date: August 1990
As young boxer Little Mac, players have a once-in-a-lifetime chance to battle the big guys of the World Video Boxing Association circuit. Take them on one by one, starting with skinny Glass Joe. Battle up through King Hippo and all the way to the WVBA Champion himself. Players use their best jabs, hooks, and power uppercuts to knock out opponents but must also dodge jaw-breaking blows by paying attention to subtle changes in their foe's body position. With great graphics, addictive action, and a touch of humor, this game will keep players entertained for hours!
Get caught up in the tractor beam of this arcade classic!

subset: commoncrawl


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Did a sketchy picture RP with my buddy KP (his art is awesomecool go look), with my character Mimi and his Randal! It was a very sad story. :C
1:13 am • 4 April 2012 • 2 notes
art She was an off-duty Guardian Angel he was a ghost who gets one vacation day a year to show up somewhere It was never meant to be guys. It was a sad ending I really liked it though very poignant And I got to use Mimi again! God I created her when I was like 14 or so damn old angel


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Was Tupac really killed off in 1996? Rihanna doesn't seem to think so with the current photo of her hugging the singer.Rihanna, who is due to play at the Barclaycard Wireless Festival on the 8th July 2012 at Hyde Pak in London showed off her latest photos of her with the hologram of the singer which was shown at Coachella music festival this year.
Wireless Festival has announced a further 22 acts on the 2014 line-up including Tinie Tempah, Robin Thicke and Sean Paul.
Wireless festival have announced J. Cole, 2 Chainz, Knife Party and more as the latest acts on their 2014 line-up.
Wireless festival announce Kanye West, Drake and Bruno Mars as the headline acts for the now two site festival.


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Teacher resources and professional development across the curriculum
Teacher professional development and classroom resources across the curriculum
Notes for Session 10, Grades 6-8
Notes 1: This session focuses on developing algebraic thinking in the grades 6-8 classroom. We'll consider the mathematics content of the previous sessions and its relation to the mathematics you teach in your own classrooms. We'll explore how algebraic thinking develops at your grade level by analyzing mathematical tasks appropriate for the grades 6-8 classroom. We'll also look at lessons from existing curriculum materials and critique them in relation to how students are asked to demonstrate their thinking and in relation to how the mathematics reveals algebraic thinking.
Part A Notes:
Classroom Video
Part B Notes:
An Example for Developing Algebraic Thinking
Part C Notes:
Patterns That Illustrate Algebraic Thinking
Part D Notes:
More Problems That Illustrate Algebraic Thinking
Part E Notes:
Critiquing Student Lessons
Begin the session by reviewing the mathematics content in the previous nine sessions: patterns, functions, linearity, proportional reasoning, nonlinear functions, and algebraic structure. You may want to think about one big idea in each of these topics.
Homework Review
Groups: Discuss any questions about the homework.
<< back to Session 10, Grades 6-8 index
Learning Math Home | Algebra Home | Glossary | Map | ©
Session 10, Grades 6-8: Index | Notes | Solutions | Video
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Nottingham EM Airport Donington Park M1 Hotel
Travelodge Nottingham EM Airport Donington Park M1 Hotel
|Price per room per night
|Double Room
|Flexible rate (Cancel up until noon on the date of arrival)
Important information
This hotel will be undergoing a makeover from 6th January 2014 to 31st January 2014. During the makeover we will keep any disruption and inconvenience to a minimum.
About this hotel
Located just outside the city, the Nottingham EM Airport Donington Park M1 Hotel offers a convenient place to stay for those wanting to be close to the airport. At only 2.5 miles from East Midlands Airport, its external location offers a quiet place to stay whilst still offering easy access to the city of Nottingham, which is found 12 miles away.
The more external location also means guests can explore the wider countryside, making it especially suited for family holidays. Snibstone Discovery Park (12 miles) is the perfect site for young intrepid explorers whilst Twycross Zoo (15 miles) offers a fun day out for kids and adults alike, with numerous exotic animals to see. For history fans, the stunning Elvaston Castle is only 10 miles away.
Useful Information
Guests should be aware that there are no ground floor rooms at this hotel, but there is a lift to all floors.
Transport links near Nottingham EM Airport
Places to visit in and around Nottingham EM Airport
Directions supplied by Travelodge
From M1 travelling northbound.
Take junction 23A exit which is signposted for East Midlands Airport and the A453. Travelodge is situated in the MOTO Services.
Travelling southbound on the M1.
Take junction 24 exit and follow signs for East Midlands Airport. Follow signs to the Moto Services area. Travelodge is situated inside the main MOTO building.
From The A42 : Go to where A42 merges with M1, then take exit at junction 23A on M1 and follow signs for MOTO Services area.
Plan your journey
Parking details
The car park adjoining the hotel is owned by Moto and operated on their behalf by CP Plus. All Travelodge customers travelling by motor vehicle must enter their vehicle registration number into the console at hotel reception when checking in. This will ensure free parking for the duration of your stay. Failure to do so may result in an administration fee of £15. Travelodge Hotels Ltd will not be liable for any fines incurred. Travelodge customers do not need to pay and display.
Calls cost 10 pence per minute from a standard BT landline. Calls from other networks and mobiles may vary. Bookings made through the Central Reservations call centre are subject to a non-refundable booking fee of £2.50 per call.
Our Most Flexible Rate
These rates are still great value, but offer the most freedom to change bookings. Bookings are fully flexible and can be cancelled up until 12 noon on the day of arrival
Our Best Rate
This is a saver rate. This rate is Non refundable. You can amend them up to 21 days before arrival for a £5 fee.
Twin Occupancy
Please note that the sofa bed/pull out bed in the room will be made up before your arrival.


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Skies this afternoon have been a pleasant mix of clouds and sun with temperatures making their way into the upper 60s.
A weak, moisture-starved cold front will work through this afternoon and early evening with nothing more than a brief increase in cloud cover.
The weekend looks very nice with sunshine both Saturday and Easter Sunday. Highs on Saturday should touch the 70 degree mark while on Sunday we should see mid/upper 70s. Rain returns to the forecast on Tuesday. Easter Sunday: Partly cloudy with a cool low of 45 degrees and a high of 75 degrees.
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310 Broadway
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It's Packapalooza time at N.C. State University! Thousands of people packed Hillsborough Street for one of State's biggest celebrations.
There was plenty of food and fun for the whole family. Bouncy houses and bungee jumps filled the kid zone. Local restaurants and businesses had booths set up along the street.
It also gave students a chance to check out all the programs N.C. State has to offer. Athletes and coaches signed autographs and took pictures with fans.
Country music star and state student Scotty McCreery performed live with head football coach Dave Doeren and Chancellor Randy Woodson. There were two stages set up for live music.
The highlight of the even, in our opinion anyway, was our very own Pam Saulsby and The Reel Deep Band who added some funk to the party.
Born in California but growing up in South Carolina, Jonathan Rodriguez joined WNCN in June 2013 as a digital journalist. More>>


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Recruiting Recap: Men's Power 100
Geoff Shannon - 8/15/2008
IL is taking a look back this week at the summer that was, leading up to the release of our annual recruiting issue next week. Yesterday, we looked at the top rising senior classes for both men and women. Today features the best junior players in the land and Friday will wrap up with the release of the Power 100 men's recruits, Top 25 women's recruits and the Top 10 classes for both genders heading into their first college season.
More depth, more speed, more stick skills. Building Inside Lacrosse's Power 100 boys lacrosse recruits entails sifting through prepared lists, awards, film, phone calls and personal analysis before making our selections. Painstaking? Definitely. Tedious? Most certainly. An awesome exercise to help preview the future of college lacrosse while sparking discussion? You bet, and that's what makes it worthwhile. This year's Power 100 is again chock full of talent, hailing from hotbeds and hinterlands, all ready to dive headfirst into the college game. Now, these aren't the only recruits heading to college this fall; however, this list offers a steady baseline of top rookies who we think will make headway for their respective programs either this year or in the ensuing seasons.
1. Steele Stanwick
Attack, Loyola-Blakefield, Md. Virginia
2. Tyler Fiorito
Goal, McDonogh, Md. Princeton
3. Chad Wiedmaier
Defense, Delbarton, N.J. Princeton
4. Jeff Cohen
Attack, Syosset, N.Y. Harvard
5. Matt MacKrides
Attack, Malvern Prep, Pa. Penn State
6. C.J. Costabile
Defense/LSM, New Fairfield, Conn. Duke
7. Chris Bocklet
Attack, John Jay, N.Y. Virginia
8. Tom Palasek
Attack, Rocky Point, N.Y. Johns Hopkins
9. Kevin Drew
Midfield, John Jay, N.Y. Syracuse
10. Steven Rastivo
Goal, Ward Melville, N.Y. Penn State
11. Peter Borror
Defense, Haverford School, Pa. Virginia
12. Keenan Ochwat
Defense, Farmingdale, N.Y. Ohio State
13. Mike Shakespeare
Midfield, The Governor's Academy, Mass. Maryland
14. Mark Staines
Defense, Severn, Md. North Carolina
15. Joe Cummings
Attack, Loyola-Blakefield, Md. Maryland
16. Daniel DiMaria
Defense, Half Hollow Hills West, N.Y. Harvard
17. Robert Rotanz
Midfield, Fairfield Prep, Conn. Duke
18. Conrad Ridgway
Midfield, La Salle, Pa. Penn State
19. Mike Chanenchuk
Midfield, St. Anthony's, N.Y. Princeton
20. Bobby Smith
Defense, Lawrenceville, N.J. Notre Dame
21. Joe Resetarits
Attack, Hamburg, N.Y. Albany
22. Francis McDonough
Midfield, Garden City, N.Y. Georgetown
23. Jonathan Meyers
Defense, Greenwich, Conn. Princeton
24. Damon Edwards
Midfield, Brewster Academy, N.H. Denver
25. Owen Blye
Attack, Downingtown East, Pa. Maryland
26. Will Fields
Midfield, Notre Dame Academy, Va. Navy
27. Colby Wilson
Attack, Western Reserve Academy, Ohio Georgetown
28. John Cunningham
Defense, Fairfield Prep, Conn. Princeton
29. Tim Rommel
Midfield, Henninger, N.Y. Rutgers
30. Rob Grimm
Midfield, Carthage, N.Y. UMBC
31. Jake Bernhardt
Midfield, Lake Brantley, Fla. Maryland
32. Mark Matthews
Attack, Whitby, Ont. Denver
33. Spenser Parnell
Midfield, Fairfield Prep, Conn. Syracuse
34. Chris Layne
Midfield, Malvern Prep, Pa. North Carolina
35. Sean Rogers
Attack, Holy Trinity, N.Y. Notre Dame
36. Peter Coleman
Attack, Chatham, N.J. Navy
37. Rob Fortunato
Goal, Montclair Kimberly, N.J. Virginia
38. Mike Grossman
Attack, Landon, Md. Princeton
39. Joe Fontanesi
Midfield, Brother Rice, Mich. Maryland
40. Roy Lang
Midfield, St. Ignatius Prep, Calif. Cornell
41. Greyson Konkel
Midfield, Regis Jesuit, Colo. Denver
42. Dan Savage
Attack, Garden City, N.Y. Penn
43. Grant Oliver
Defense, Upper Arlington, Ohio Maryland
44. Wyatt Melzer
Defense, St. Andrew's, Fla. Virginia
45. Alex Capretta
Attack, St. Ignatius Prep, Calif. Princeton
46. Hunter Rodgers
Attack, Brophy Prep, Ariz. Johns Hopkins
47. Joe Bonanni
Defense, St. Mary's, Md. Ohio State
48. Charlie McComas
Defense, Boys' Latin, Md. North Carolina
49. Mike Flanagan
Defense, Georgetown Prep, Md. Princeton
50. John Paul Dalton
Midfield, St. Mary's, Md. Loyola
51. Casey Rich
Attack, Amherst Central, N.Y. Syracuse
52. Jarrid Puzes
Defense, Adlai Stevenson, Ill. Virginia
53. Ryan Barber
Attack, West Genesee, N.Y. Syracuse
54. Matt Lamon
Attack, St. Mary's, Md. Towson
55. Jim Dunster
Midfield, Greenwich, Conn. North Carolina
56. Jeff Muscatello
Midfield, The Governor's School, MA North Carolina
57. Alex Gannett
Midfield, Downingtown East, Pa. Penn State
58. Eric Keppeler
Midfield, Dulaney, Md. Notre Dame
59. Kevin Lalley
Midfield, Orchard Park, N.Y. Towson
60. Steven Burke
Goal, Bullis School, Md. Johns Hopkins
61. Zach Angel
Attack, St. Mary-Ryken, Md. Georgetown
62. Luke Cometti
Midfield, West Genesee, N.Y. Albany
63. Marshall Burkhart
Midfield, Dublin Jerome, Ohio Johns Hopkins
64. Nick Gantsoudes
Midfield, Avon Old Farms, Conn. Bucknell
65. Henry Van Wagenberg
Midfield, Georgetown Prep, Md. Georgetown
66. Andrew Wascavage
Goal, St. Mary's-Ryken, Md. Towson
67. Dave Hamlin
Defense, New Hartford, N.Y. Syracuse
68. Travis Lyons
Defense, Farmingdale, N.Y. Albany
69. Mike Diehl
Attack, Hunterdon Central, N.J. Rutgers
70. John Conneely
Attack, Half Hollow Hills West, N.Y. Penn
71. Andrew Blasko
Defense, Seton Hall Prep, N.J. Johns Hopkins
72. Mike DeNapoli
Midfield, Lynbrook, N.Y. Hofstra
73. Tyler Kimball
Midfield, Gilman School, Md. Navy
74. Jay Mann
Midfield, Dulaney, Md. Navy
75. CT Fisher
Goal, Landon, Md. Georgetown
76. Craig Sullivan
Defense, Duxbury, Mass. Maryland
77. Brock Sorensen
Defense, Peterborough, Ont. Ohio State
78. Dylan Koontz
Attack, Montclair, N.Y. Syracuse
79. Justin Annunziato
Midfield, Rocky Point, N.Y. Syracuse
80. Kevin Hover
Attack, Montgomery, NJ Rutgers
81. Nolan Hickey
Goal, Chaminade, N.Y. Navy
82. Alex Gajic
Attack, British Columbia, Can. Denver
83. Pat Schmitz
Defense, Georgetown Prep, Md. Georgetown
84. C-Jay Engelke
Attack, Farmingdale, N.Y. Georgetown
85. Sean Maguire
Attack, Calvert Hall, Md. Towson
86. Andrew Van Valkenburg
Midfield, Garden City, N.Y. Bucknell
87. David Miller
Midfield, Notre Dame Academy, Va. Maryland
88. Will Mangan
Midfield, Columbia, N.J. Rutgers
89. Tyler Granelli
Midfield, John Jay, N.Y. Syracuse
90. Justin Hummel
Defense, Downingtown East, Pa. Drexel
91. Matt Gibson
Attack, Chaminade, N.Y. Yale
92. Mike Sawyer
Attack, Charlotte Catholic, N.C. Loyola
93. Robert Koger
Defense, Brewster Academy, N.H. Georgetown
94. Matt Conte
Midfield, Malvern Prep, Pa. North Carolina
95. Steve D'Amario
Attack, Niskayuna, N.Y. UMass
96. Andrew Gvozden
Goal, Severna Park, Md. Hofstra
97. Cliff Larkin
Attack, St. Paul's, Md. Princeton
98.Mike Rogers
Defense, DeMatha, Md. Notre Dame
99. Adam Donahue
Attack, Upper Arlington, Ohio Georgetown
100. Nick Beattie
Attack, Worthington Kilbourne, Ohio Notre Dame


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10, rue Saint-Antoine
Quebec, QC G1K 4C9
Quebec City
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CAN$31 to CAN$50
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Panache Details
Dining Style:
Fine Dining
(418) 692-1022
Hours of Operation:
Breakfast: Monday - Friday: 6:30am - 10:30am, Saturday & Sunday: 7:00am - 11:00am; Lunch: Wednesday - Friday: 12:00pm - 2:00pm; Dinner: Nightly: 6:00pm - 10:00pm
Payment Options:
AMEX, Diners Club, MasterCard, Visa
Dress Code:
Business Casual
Accepts Walk-Ins:
Additional Details:
Banquet/Private Rooms, Beer, Late Night, Patio/Outdoor Dining, Wine
Getting there
Hotel Parking
A word from Panache
In July 2004, the Auberge Saint-Antoine opened a restaurant called Panache. This name reflects the elegance and distinction of an establishment that has rapidly gained an enviable reputation as one of the city's finest restaurants. In the first year, Panache won the city's Best New Restaurant award.
Panache's dining room is located in the 19th century Hunt maritime warehouse, a building distinguished by its stone walls and massive wood beams. The menu is traditional French Canadian cuisine 'with a twist'.
Foodspotting photos
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Awards voted by OpenTable diners
Diners' Choice Winner
Best Overall
Diners' Choice Winner
Best Ambiance
Diners' Choice Winner
Diner Reviews
Great food. The wine pairings
were a bit over prized compared to the food. The toilet on second floor (one room was over frequented and could have been cleaned during the evening. The food was outstanding and compensated for everything."
Dined on 3/21/2014
No detail is overlooked. Service
was personal and excellent. Beautiful restaurant!"
Dined on 3/14/2014
Delicious food, a table by the
fireplace and fine wine always results in a wonderful evening. Attentive but not obtrusive, the staff was welcoming, knowledgeable and helpful. Despite entertaining a large party upstairs, we never felt hurried or ignored. The menu offered a number of interesting dishes in every category, and, after a long trip, it was a relief to just walk downstairs from our room for a relaxing evening with fois gras by the fire."
Dined on 2/27/2014
Be sure to ask for Yann, the
sommelier, to pair wines with the food. He is excellent as is the rest of the staff. A real gem in Quebec!"
Dined on 3/6/2014
We are very please to have had our
family brauch at this very nice location. We recommand this restaurant to all."
Dined on 3/2/2014
Attentive service. Sommelier was
willing to suggest less expensive alternative than his first choice. Good bilingual service. Offered English or French menu. Staff explained food well in either language. Food on signature menu was interesting. Right quantities for the number of courses. Uniformly well prepared, presented and served. Give yourself at least two to three hours to enjoy this experience. Beautiful setting in restored 18th-century building."
Dined on 2/28/2014
Everything about Panache is a
delight to the senses. The ambience, decor, comfort and food all create an experience one will want to repeat again soon. Such a great spot indeed!"
Dined on 2/26/2014
Positives: great service, a
beautiful dining room, tasty food. Unfortunately, ultimately neither the food nor the wine was as good as the prices would have you believe. $300+ for two people sharing one bottle of decent wine, no cocktails, with appetizers, mains and one dessert? No, for that price the food needs to be spectacular, not just tasty."
Dined on 2/21/2014
We had a great dinner after a long
drive. I would definitely come back."
Dined on 2/20/2014
We dined on Valentine's night with
a set menu and were treated to an absolutely amazing gastronomic delight. All told we had 9 courses of varying sizes all of which flowed one into the other beautifully. These were complimented by a specially selected drinks menu which changed with every course to accompany each new dish. The atmosphere was excellent within a stunning dining room in an old warehouse revitalised. Very attentive staff who were always on hand to ensure the experience was as enjoyable as possible. Great all round."
Dined on 2/14/2014
We were in Quebec for our 25th
wedding anniversary and couldn't have picked a more wonderful place for a romantic night out. The food was simply fabulous...the staff was very attentive and engaging...and the restaurant itself was lovely stone, wood and warm lighting. PERFECT! PARFAIT MERCI"
Dined on 2/16/2014
Panache was fantastic, food was
amazing, great service and what a beautiful building and location."
Dined on 2/17/2014
We had a wonderful time with
fabulous food and service."
Dined on 2/17/2014
Panache is a gem of a place. The
setting, a 17th century storehouse has been beautifully preserved. The service is excellent and so is the food - chef uses local/seasonal produce, but the attention to detail and depth of flavour is spectacular."
Dined on 2/16/2014
Panache was everything we had
hoped it would be. Amazing food, service and atmosphere. Waitstaff was experienced, friendly and helpful. The food was amazing! This restaurant is expensive but we felt it was worth every penny."
Dined on 2/9/2014
Had an absolutely delicious
dinner, just perfect for the special occasion that we were celebrating. We went with the Chef's Menu and the classic wine pairing. The each wine chosen complimented the course perfectly. The food was presented in a very appealing manner and the delectable portions were just right. The serving staff were very gracious and happy to speak in both French and English. The venue is a beautifully restored heritage building. It was a very memorable evening and we are so pleased we went. It is expensive but a wonderful treat for a special occasion. Should we find ourselves in Quebec again, we would definitely go back."
Dined on 2/9/2014
Absolutely loved the ambience, the
service was top-rated and the food among the best we've ever enjoyed."
Dined on 2/10/2014
My friends and I were in the area
skiing and wanted to have dinner at a nice restaurant. My wife found Panache online. It's located on the base of the river in a hotel. The location is beautiful. My friend had a birthday coming up and his wife wanted a bottle of wine waiting for him. The staff had an amazing wine selected based on what we were looking for and a card done with a message from her at our request. The food was amazing. They have traditional french meals cooked with a modern concept in mind. Everything was perfect. The prices were very reasonable for such a quality restaurant in a tourist area. I will be going there again when I return to Quebec City."
Dined on 2/4/2014
Ambience was terrific. Food
expensive but only average. The lamb chop was fatty and difficult to cut. The service was very good."
Dined on 1/23/2014
This restaurant is exceptionally
beautiful and every detail is well thought out. The service was beyond compare and the food, exceptional. It is very pricy, however, about $100 per person for food alone. But, well worth it."
Dined on 1/10/2014
Expected more for à Relais et
Châteaux. The brunch was ordinary. No more to say."
Dined on 1/19/2014
Notre plat principale n'etait pas
ce a quoi on s'attendait. Une viande qui baigne dans une sauce ne goute Que la sauce filet angus entoure d'oignon et une Cote d'agneau dans un jus. Les entrees et les desserts Etait parcontre tred reussi a notre avis"
Dined on 1/6/2014
The Pananche is the most romantic
restaurant in Québec city. Ande the food is délicious. The sommelier is also very good."
Dined on 1/6/2014
Soup to nuts this restaurant is
fantastic. It was the best meal during our stay in Quebec!"
Dined on 12/26/2013
We had a spectacular meal at
Panache on our recent trip to Quebec for New Year's. We (my husband, step-daughter and son-in-law) were all staying at the Auberge St. Antoine and had just arrived after a long drive. Nothing could be more comforting or welcoming than Panache, where the beautifully lit space and calm atmosphere enveloped us. We all had the tasting menu with classic wine pairings, and the food was beautifully prepared and presented. I loved getting extras, like the amuse bouche, and we were given an extra small plate of gorgeous turnips. (Yes, you read that right. :-) The fois gras was just perfect - not too much - and the scallops were amazing. The service was very attentive, but not overbearing. A "must"!"
Dined on 12/28/2013
It was my birthday and since we
were in Qc City, we thought of going big with Panache. Located in a splendid hotel (Auberge Saint-Antoine), the Tasting Menu was an obvious choice, and nothing was hidden in terms of cost. We knew it would be expensive. The overall experience was amazing: the portions were good but not gigantic, which enables enough appetite for all services. We also chose the optional wines tasting that can come with it, and all of them were very interesting. I was secretly hoping for a few more drops in my glass, but again, it was standard ounces, so I cannot complain. In the end, though, for what we had, the bill was about 15% too much from what we would be willing to pay. And coming from Montreal, we know our food value."
Dined on 1/1/2014
Prices are too high for the
quality of the food. Food is OK, but not at the level the prices would suggest."
Dined on 1/1/2014
My husband and I visited Quebec
and stayed at the St. Antoine for several nights. We had dinner at Panache on our 20th anniversary which was absolutely outstanding in every way. The only comment I would make is that we asked for a romantic and quiet table and were put upstairs. I don't think that the upstairs has the ambiance that the downstairs has. Nonetheless we thoroughly enjoyed it. What's more, we had breakfast at Panache every morning, since we were staying there, and they were the most wonderful breakfasts that either of us have ever had. The French toast and the crepes, in particular were just superb and we still talk about them today, months later."
Dined on 10/10/2013
We ate at Panache on a Sunday
night in late December. The restaurant is in an old Quebec City house (stone walls, exposed wooden rafters etc) but has been done up with sophisticated lighting and décor. When we were there, it was cold and snowy outside, and the fire inside was beautiful. The food, wines, and service we all excellent, but that is what we expected from this tier of restaurant, located in a Relais and Chateaux inn. Why not a fifth star for food or service? We'd hoped to be surprised with one of those culinary revelations you come across from time to time in fine restaurants, but found that although there was certainly nothing amiss with our meal, Panache missed out on the spark we were looking for."
Dined on 12/29/2013
Went with my parents during our
Christmas vacation and dinner was wonderful. Our waitress forgot about us at one point and one of our sides. But every dish was delicious and the setting is very cozy, especially next to the fireplace."
Dined on 12/26/2013
The starter (paté) was very
insepid - no taste. The duck as a main was very good and so was the pasta with trufle. The dessert was "undefinable" with no concrete identifiable taste except for the part that had some ice cream. The service was quite cold (stiff?) but attentive. the room was very cozy and comfortable with the beautiful modern fireplace in the centre. I would reccommend the place for the main dishes only and the cozy, appealing atmosphere."
Dined on 12/26/2013
we went here for Christmas dinner.
limited choices of the menu. we had the sommelier choose a wine pairing, and it wasnt very good. the service was cordial, not nearly as friendly or attentive as we found at other top restaurants in Quebec, and in fact not as good as we had in lower priced establishments in Montreal and Quebec city. classic indicators that their high ratings have gone to their heads or they have been reading their own press clippings, and the overall quality has declined. pass up Panache and go to Le Patriarche which is more deserving of the number one rating in Quebec."
Dined on 12/25/2013
Une ambiance chaleureuse et un
excellent service! Très bonne cuisine."
Dined on 12/26/2013
We picked this place for dinner
based on their extensive wine list as we had wanted to try the Canadian Ice wines & they did not disappoint. With a superb wine list & very knowledgeable staff they not only delivered on the wine front but served a extraordinary locally sourced gastronomical fare. A definite must for food & wine lovers visiting Quebec."
Dined on 12/17/2013
Tout était parfait, le service et
le repas! Délicieux brunch sur assiette! Fin et délicat Merci à toute l'équipe!"
Dined on 12/15/2013
Menu Signature was amazing... each
dish a fantastic experience with the appropriate wine accomoanying... the dining experience we hoped for our wedding anniversary... Thank You, it was memorable !"
Dined on 12/6/2013
We have a wonderful corner table
in this beautiful restaurant. The service was impeccable and the food was as well. Very enjoyable evening with my husband."
Dined on 12/6/2013
The room is quietly beautiful with
exposed brick walls and large windows and soothing and generous amounts of wood. The service is attentive and non-pretentious, and the food is divine. My wife and I shared the mushroom ravioli and then she relished the rack and saddle of lamb and I enjoy the monkfish. Truly a gem of a place and one that deserves repeat visits."
Dined on 12/2/2013
Very good service and a "somelier"
with lot`s of interesting comments about history of wine. Very warm reception. I love that restaurant."
Dined on 12/1/2013
A splendid experience. Great for
walking or short taxi rides. Only one disappointment - the Arctic Char on Saturday night was not as fresh as expected of such a fine restaurant. The breakfasts were excellent, The service was top notch and very friendly."
Dined on 11/30/2013
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According to the Higher Health Institute, studies show that Italian girls are irresponsibly using alcohol.
"Among 11 to 15-year old girls we see an average number of consumers remarkably higher than the overall Italian female average—three times more than adult women," said Emanuele Scafato, head of the National Alcohol Observatory.
In addition to young girls drinking, studies have also shown that more Italian women are not only drinking outside of mealtimes but also drinking to become intoxicated.
Recently, a 14-year-old girl in Rome was rushed to the hospital from an alcoholic coma after a night of drinking. With binge drinking increasing, Italy has passed new measures including zero tolerance for drivers and stricter enforcements with nightlife.
Read the full article in ANSA.


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Falling Into the Fire
A Psychiatrist's Encounters with the Mind in Crisis
Christine Montross - Author
Hardcover | $25.95 | add to cart | view cart
ISBN 9781594203930 | 256 pages | 01 Aug 2013 | The Penguin Press | 9.25 x 6.25in
Additional Formats:
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- eBook - ePub eBook: $12.99
Summary of Falling Into the Fire Summary of Falling Into the Fire Reviews for Falling Into the Fire An Excerpt from Falling Into the Fire
Falling Into the Fire is psychiatrist Christine Montross's thoughtful investigation of the gripping patient encounters that have challenged and deepened her practice. The majority of the patients Montross treats in Falling Into the Fire are seen in the locked inpatient wards of a psychiatric hospital; all are in moments of profound crisis. We meet a young woman who habitually commits self-injury, having ingested light bulbs, a box of nails, and a steak knife, among other objects. Her repeated visits to the hospital incite the frustration of the staff, leading Montross to examine how emotion can interfere with proper care. A recent college graduate, dressed in a tunic and declaring that love emanates from everything around him, is brought to the ER by his concerned girlfriend. Is it ecstasy or psychosis? What legal ability do doctors have to hospitalize—and sometimes medicate—a patient against his will? A new mother is admitted with incessant visions of harming her child. Is she psychotic and a danger or does she suffer from obsessive thoughts? Her course of treatment—and her child's future—depends upon whether she receives the correct diagnosis.
Each case study presents its own line of inquiry, leading Montross to seek relevant psychiatric knowledge from diverse sources. A doctor of uncommon curiosity and compassion, Montross discovers lessons in medieval dancing plagues, in leading forensic and neurological research, and in moments from her own life. Beautifully written, deeply felt, Falling Into the Fire brings us inside the doctor's mind, illuminating the grave human costs of mental illness as well as the challenges of diagnosis and treatment.
Throughout, Montross confronts the larger question of psychiatry: What is to be done when a patient's experiences cannot be accounted for, or helped, by what contemporary medicine knows about the brain? When all else fails, Montross finds, what remains is the capacity to abide, to sit with the desperate in their darkest moments. At once rigorous and meditative, Falling Into the Fire is an intimate portrait of psychiatry, allowing the reader to witness the humanity of the practice and the enduring mysteries of the mind
Pauline W. Chen, M.D., The New York Times:
"Thought-provoking…Dr. Montross, an award-winning poet before attending medical school, is passionate about her work and her patients' plight…She addresses these issues with intelligence; and by deftly intertwining her patients' stories with historical facts, current research and ethical quandaries, she presents a moving and nuanced picture of the psychiatric patient and doctor relationship, and a riveting and thought-provoking look at mental health care."
Los Angeles Times:
"Thoughtful and deeply compassionate…[Falling Into the Fire] is a fluid meditation on the limits of medicine and how Montross learned to care for 'people nearly all of whom are in profound moments of crisis.'…This is not a doctor puzzling clues together like some real-world Dr. House; this is a doctor struggling to sit with the uncomfortable questions that arise when medicine doesn't have any answers."
The New Yorker:
"Montross explores the practical, emotional, and philosophical challenges of working with patients whose illnesses of the mind are often intractable and deeply disturbing."
The Washington Post:
"[Falling Into the Fire] draws a troubling but illuminating picture of what it's like to be locked into unrelenting emotional and mental chaos…Montross does want to illustrate the 'messy, unsatisfying, nonconforming human mind,' but this is also her story—and the story of all those whose mission it is to comprehend and treat these perplexing illnesses…Montross inserts herself, along with her partner and two children, into the book, with powerful effect. Parenting and caring for patients have quite a bit in common, she explains, including love, frustration, ineptitude—and of course fear…Other details of Montross's full and joyous family life serve to accentuate the humanity she brings to her work."
Providence Journal:
"Writing with elegance and a sharp-eyed for detail a novelist might envy, Montross brings us examples of minds that, in her words, are 'standing at the edge,' if not already singed by the fire…Rare are such gripping accounts of the difficulties of treating mental disorders…I applaud the compassion and empathy she brings to what arguably is health-care's most difficult specialty…Montross writes first and foremost as a person, as someone with a lively intellect and authentic emotions. She cares deeply about her patients. For these reasons, Falling Into the Fire is a significant book for anyone who has been touched directly or indirectly by passing or permanent disorders of the mind (and is that not pretty much everyone?)… [A] powerful book."
Daily Beast:
"Falling Into the Fire is as good an account of the labyrinth of mental health care as you're likely to read. [Montross's] work in critical care psychiatric settings is the source material, and she launches from discussions of clients into larger questions about the nature of psychiatry and of mental health. Montross writes beautifully about the deep-seated illnesses that challenge therapist and psychiatrists."
Kirkus Reviews:
"A sympathetic portrait of seriously ill patients that could guide future practitioners on the art of helping, if not always healing, the sick."
Publisher's Weekly:
"…[Montross's] intriguing analysis is anchored by the humble and empathetic voice of a psychiatrist working in a field wherein 'every diagnosis is an act of faith.'"
Shelf Awareness:
"Montross is pragmatic and compassionate in her attempts to understand the complexities of each individual's neurosis, intertwining research into early medical and psychiatric practices with reflections on her family as she searches for a medical treatment that will be effective—and that her patients will be willing to follow. Empathetic and informative, Falling into the Fire is a fascinating look into the convoluted world of psychiatry and mental illness."
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Pick your 23 men to go to World Cup with England
The only place to watch the race for the title live
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More from Sky Sports
Manchester United boss David Moyes has played down reports concerning England international Danny Welbeck.
Gary Neville says Danny Welbeck is the man to provide Man Utd the 'different edge' they need.
Manchester United striker Danny Welbeck admits he is baffled by the team's current poor form.
Manchester United striker Danny Welbeck has been challenged to rack up 20 goals by his manager David Moyes.
David Moyes expects Wayne Rooney to return for Manchester United's next game after he missed the 1-0 win at Norwich.
Manchester United forward Danny Welbeck insists he has always been prepared to work hard on improving his game.
Manchester Utd boss David Moyes has revealed Danny Welbeck is doing extra training in a bid to make more of an impact.
Jay Rodriguez is in line for his England debut after Michael Carrick and Danny Welbeck pulled out of the squad.
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Manchester United strikers Robin van Persie and Danny Welbeck picked up knocks during the 3-2 defeat to Yokohama.
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Jimenez makes European Tour history
Spain's Miguel Angel Jimenez on Sunday became the oldest winner in European Tour history.
Only seven weeks away from his 49th birthday, Jimenez took the UBS Hong Kong Open for a third time with a one-stroke victory over Swede Fredrik Andersson Hed.
The former Ryder Cup player's 19th Tour title - and 12th since he turned 40 - came without a single bogey in his last 54 holes.
He finished with a 65 for 15 under par, Andersson Hed's 64 having an agonising climax when a 12-foot birdie attempt on the last dribbled down the slope and lipped out.
Australian Marcus Fraser was third and joint fourth came Ireland's Peter Lawrie, Scot Stephen Gallacher and 19-year-old Italian Matteo Manassero, last week's Singapore Open champion.
New Zealander Michael Campbell, joint overnight leader with Jimenez, fell away to joint eighth.
With a cigar in one hand and glass of red wine in the other, the 48-year-old Spaniard toasted his victory. This was his third win at the event - all since he turned 40.
"It's always an honour to make records and I hope it's not the last one," said the Malaga golfer, nine months older than Ireland's Des Smyth was when he lifted the 2001 Madeira Islands Open.
"I really love this place. You have to control the ball very well - it's not a matter of distance - and I played very solid all through the week."
With 19 Tour victories now there are only 10 players who have ever won more on the circuit than the former caddie, who turned professional in 1982 and had to wait a decade for his first success.
He was Seve Ballesteros's vice-captain at the 1997 Ryder Cup, went on to win four caps and in September was one of Jose Maria Olazabal's assistants for the victory in Chicago.
Campbell was hoping for a first win in seven years, but after an opening birdie he fell back and a double bogey six on the 18th for a 72 dropped him to joint eighth.
And when Andersson Hed missed his birdie shot, it meant Jimenez's eight closing pars were good enough to give him the £208,084 first prize with a 15 under par aggregate of 265. He has almost £16million in career earnings as a result.
He birdied the long third, then took control with four more in a row from the seventh.
The third of them was the most impressive, a five-wood approach to Fanling's hardest hole finishing only two feet from the flag.
Third place went to Australian Marcus Fraser, while joint fourth were Ireland's Peter Lawrie, Scot Stephen Gallacher and 19-year-old Italian Matteo Manassero.
"I think it was probably the best I've ever played under pressure when you're in this situation and you can win a tournament. But unfortunately I couldn't get it all the way there, but close," said Andersson Hed, according to the Asian Tour.
"It was a pity I couldn't get one of the putts on the last two holes to put a little bit more pressure on Miguel on the last hole. He did fantastic, though so all credit to Miguel," added the Swede.
Having climbed to the top of the merit rankings with his finish, Fraser described his week in Hong Kong as one of his best after having to endure an indifferent form of late.
"I felt like I played pretty ordinary the last three weeks. And then my coach came up this week and turned my game around straightaway. It's nice to be able to do that on the course, as well, and have a really good week. I couldn't be happier," said Fraser.
A week on from his third Tour victory at the Singapore Open Manassero was right in the thick of things until a six at the long 13th and he dropped another shot at the last to finish four back.
The event also brought joy and agony for those fighting to keep their Tour cards.
The agony belonged to Welshman Rhys Davies, who had to stay 119th on the money list to avoid a return to the qualifying school, but came only 51st and slipped to 120th when Australian Andrew Dodt, having dropped five shots on the front nine, birdied three of the last six.
It lifted Dodt from 122nd to 117th, put England's Richard Bland 118th and South African Tjaart Van der Walt 119th a mere £83 ahead of Davies.
Bland, who came 69th, and Van der Walt, who missed the cut, were not safe, though. There was still the South African Open to come later in the day before the issue was decided.


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Tuesday, June 1st, 2010
Complete Obituary
Maverick Fishbaugh
Maverick James Fishbaugh, infant son of Travis and Jennifer Fishbaugh, St. Marys, died May 28, 2010, at Joint Township District Memorial Hospital in St. Marys.
He was born May 28, 2010, at the hospital.
He is survived by his parents; a stepsister, Alaina Fishbaugh, St. Marys; grandparents Eddie and Doris Fishbaugh and Connie and Joe McPheron, all of Celina, and Richard and Linda Wessel, St. Marys.
Services are 7 p.m. Wednesday at Cisco Funeral Home in St. Marys, the Rev. Jim Sweigert officiating.
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Condolences can be left at www.ciscofuneralhome.com.
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Wednesday, April 23
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Wondering if there is anyone else here whose child/loved one has lymphoblastic lymphoma? Thanks!
Hi, and welcome to these boards. It's a place none of us ever wanted to be, but it is a great place for advice and support, so I'm glad you found it.
My daughter has a different T-cell lymphoma, Anaplastic Large Cell Lymphoma. Many of the parents here have children with Acute Lymphoblastic Leukemia - as I understand it, very very similar with similar treatment. (has to do with the percentage of blasts in the bone marrow?)
I'm sure you'll find lots of caregivers here who can help.
Just wanted to say welcome, and let you know you aren't alone.
Thank you for the welcome. Emma's lymphoma caused a mass in her chest that collapsed her windpipe. She was on the ventilator for 2 1/2 weeks. This is how she was diagnosed. The doctors told us that they only see 2 children a year come in with lymphoblastic lymphoma (at St. Jude). But they said not catching until its at this point was not uncommon. I guess I really want to hear someone else's story, and how they dealt with this. Compare notes, you know?
My son, Joey, was diagnosed with high risk T-Cell Acute Lympohoblastic Leukemia, not Lymphoma, in August of 2008, but he also had a large mass in his chest. It was a mass of cells not a turmor. His was on his breastbone and delayed inserting a broviac line for 3 days b/c they were afraid that his chest would cave in while he was unconscious. He had 12 different i.v's done those first 3 days. Joey presented with a wbc of 336,000 which peaked at 364,000 in the PICU. Miraculously, he was sent to the regular hemonc floor the day after his broviac was placed and went into remission 3 days later. He was in the hospital for about 11 days. He has been hospitalized twice since for 4 days each time. That first year he only went to school a handfull of times but had a Home/Hospital teacher. This last year he made it to school about 60% of the time.
Joey started long term maintenance May of 2009 and is scheduled, God willing, to go off treatment Dec. of 2011. To be honest, I can never remember the name of his protocal but I can look it up if you'd like. He is being treated at Children's National Medical Center in Washington, DC and had his radiation at Univ. of Md Medical Center.
We don't do CaringBridge but here's the link to his Team Joey site if you'd like to join and read the early messages. I only post about once a month now, but was on several times a day the first few weeks and several times a week for months after that. https://lls.lotsahelpinghands.com/c/606630/
Thank you, and I will read them. I don't know why (maybe we all feel this way?) but I want to hear EVERYONE's story! LOL
Hello, My Dauaghter has Acute Lymphoblastic Lymphoma. Not unlike your story. She was diagnosed the day before her second birthday. She had been treated for pneumonia for 3 weeks prior to diagnosis. She had a huge tumor in her chest that had collapsed both lungs. The day they started chemotherapy she was breathing on 1/4 of one lung. They said the tumor was the size of a football. We have completed 8 months of intensive chemo and hopefully starts maintenance tomorrow, which she stays on for 2 years. Hope things are traveling ok for you.
I know of 2 families whose children (teens) had the same lymphoma - both presented with large tumors in the chest, as your daughter did. I can't tell you much about their day to day experiences - one is a family at our hospital, and another is someone I've met recently and they've mostly been a great source of encouragement because their son is 4 years in remission and doing wonderfully.
That is wonderful to hear--someone being off treatment and doing well. I long for that day (as we all do!)
Welcome, and so sorry you have to be here. My son has T-cell Acute lymphoblastic leukemia. We don't know anyone with t-cell lymphoma. Not sure how similar the treatment is. We spent our first week in the PICU also. Patrik had a WBC of 456,000 and needed apheresis to lower it. We are now 21 months into treatment with 19 months left to go. We are on the COG AALL 0434 protocol. I hope treatment is going well. Best of luck
Mom to Patrik dx T-cell ALL 11/17/08
I'm not sure what Emma's wbc count was at diagnosis. In fact, I don't know if they ever even told us. I know that they protocol she is on is the same they use at St. jude for treating ALL. It is protocol 16, ALL standard risk. It appears no one else who's answered has used it? Hmmm. Maybe I'm wrong!
My son, Noah (age 7) was diagnosed with T-cell lymphoblastic lymphoma-stage IV in October 08. He was CNS positive at diagnosis. We are on protocol COG 5971 Arm B1. He also had 9 days of cranial radiation since he was CNS positive. We are 2 1/2 months till OT. Feel free to ask me any question.
Alaina Jacobs
www.caringbridge/visit/noahjacobs (just started his caringbridge site a couple months ago)
Stage 4? A doctor told me when I asked that they don't stage this. I will have to ask again. He was not Emma's doctor, just a doctor checking in on her while we were in ICU. Thank you, and I will deff be visiting your site!
I'm not sure about the staging. I was told that it was either stage 3 or stage 4 because of where the tumor was (in the chest), but her spinal fluid and bone marrow were both clear. So that meant that she didn't have to have as many bone marrow aspirates or any radiation, although they still did spinal procedures where they injected her spinal fluid with chemo.
Her white blood count at time of diagnosis was 15,000. No where near what the ALL kids are.
I do not know the name of the protocol, only that it is the standard protocol used by ACOG (?) for ALL. A period of induction, followeed by consolidation, then interim maintenance then re-induction/re-consolidation, and then maintenance. A 2 yeear protocol (because she is a girl). The drugs used: vincristine, cytarabine (ARA-C), cyclophosphomide, methotrexate (injected into spine), high-dose methotrexate (done in-patient), methotrexate (tablets during maintenance), mercaptopurine, steroids, thiaguanine. Hmmm. I am probably missing something, but that is what I remember off the top of my head. The doctors gave me a sheet of paper which outlined the days and what she was having on what days for each stage of treatment. Very involved.
We were very blessed in that Grace handled the chemo very well. The first month was hardest, then she started to feel better. The second hardest part was re-induction/re-consolidation. At one point, she was having platelet transfusions every other day. She had an anaphylactic reaction to the first transfusion, which was terrifying, but that was really the only rough patch through the 2 years. Right now we have 2 kids in our clinic who have had serious reactions to the methotrexate.
My daughter was diagnosed with acute t-cell lymphoblastic lymphoma 2 years ago when she was 6 years old. She JUST finished her treatment on August 1st, and we go in for an out-of-treatment conference with her care team this Wednesday. She is now 8 years old. I am happy to share with you anything about her treatment. I know how it is to feel like you're the only one out there with this same diagnosis. In 2 years, I only found 2 other kids with this: one was a boy who was ending treatment up north, and one is a 3 year old boy who has just begun treatment in Alabama. Thankfully, it appears to be a rare one, but sometimes it is nice to compare notes with someone who is going through the exact same thing.
My daughter's caringbridge site is www.caringbridge.org/visit/graciefloyd
That is wonderful! I am so encouraged to hear this kind of news! I will check out your site, and email you with any questions. Thankyou so much for answering!
My son was T cell lymphoblastic lymphoma, this disease is the same exact malignancy as T cell ALL, the only difference is with the lymphoma it presents in the lymph system and not the peripheral blood like ALL. These kids usually present with a completely normal CBC at diagnosis versus the ALL kids present with high white counts. This disease has a better prognosis when it presents above the diaphragm versus below the diaphragm. I'm not sure as to why, I suspect because there are less lymph nodes in that area to be involved. Many times you will hear this referred to as T cell LBL/ALL. Often Dr.'s would refer to my son as T cell ALL patient because they are the same malignancies. My son relapsed in the CNS and required a stem cell transplant at that time we went to MD Anderson in Texas because they are the leaders in leukemia's and lymphoma once there my son was treated in the leukemia department instead of the lymphoma department because they considered it leukemia. The protocols are usually identical to the ALL kids and rightfully so since it is the same malignancy. With most lymphoma kids their bone marrow is usually clean. The T cell portion of this lymphoma is what makes it so aggressive, but because it is so aggressive it usually responds well to treatment. Very important, is that if it is a male they require 3 years of treatment versus a girl who only requires two because males have a higher relapse rate. Kids tend to fair better with this disease than the young adults, again I am not sure why, but overall young adults fall in a poorer prognostic group for most cancers. Of course if you are not being treated at a major cancer center than I would recommend you go to one. We considered St. Jude's for my son's transplant. All in all the odds are good, the treatment is tough but you can get through it. Today my son will be 5 years since diagnosis and 4 years post transplant, he is now 25, and if you met him you would never guess he was ever so ill. I wanted to just chime in and let you know that you will be going through the same treatment as the ALL kids and therefore will have much in common with them.
God Speed,
Thank yo so much for responding. It is so encouraging to hear the GOOD stories, as I'm sure you know! I appreciate all information. We are currently at St. Jude. And I am happy that your son is doing so very well.
Katie Clark
St. Jude's, then there's no need to say you are in good hands. I hope all goes well for you.....
My daughter, Madeline, was 4 when she was diagnosed. She had a slight cough which progressed to slightly raspy breathing. We got a chest x-ray and could see her mediastinal mass. She is now 2 years off chemo and is doing fabulously. She has had no late term effects, so far, with the exception of an anxiety problem that manifests itself once in a while. She is a happy, healthy almost 9 year old with a bunch of newly curly hair, it's nearly as long as it was when it all fell out.
They didn't stage her but according to my research she's stage 3. She didn't have CNS involvement.
This sounds like Emma's symptoms, except we got no x-ray. I wish we had caught it before hand. I am glad that your daughter is doing well. I believe that Emma would be staged at 3 also, based on research I've done. She also has no CSF involvement. Thanks for sharing!
My 7 year old daughter Kathryn was diagnosed with T-cell Acute lymphoblastic leukemia in Sept of 09 with a WBC of 750,000 and a mass in her chest.... She has gone through the last year of chemo so good with minimal side effects. Now we're just getting ready to fight a new battle..... last week she was dignosed withT-cell lymphoblastic lymphoma. Even with this set back, Kathryn has done so well with everything. Check out her story on her caringbridge site
Good luck with your journey.
My 14yrs son has Precursor T cell Lymphoblastic Lymphoma Stage 3...
Just read about MRD in ALL.....Do we have the MRD in LBL also,,,,
Came across http://resources.metapress.com/pdf-preview.axd?code=t625844186g7n1l0&size=largest
Has anyone done these tests......
Can we lymphoblastic Lymphoma parents get counted in this fourm and do research on LBL also.......
My son was diagnosed with T-cell lymphoblastic lymphoma on Dec 25, 2010. He is currently in IM on COG study 434. His mediastinal mass was enormous (13x13 cm) but no bone marrow or CNS involvement. His mass is mostly gone - only a small piece remained on day 30 (1x1.5 cm) which the doctor believes is really just a bunch of dead cells which should be re-absorbed by his body soon. He is being treated at Lucille Packard Children's Hospital (Stanford). He had a MRD measurement taken at diagnosis which came out clean down to their detection limit, which I believe was .01%. They took fluid from his lung and were able to see that he does not have the Philadelphia mutation, but they weren't able to get a full cytogenetic report. They said that the cells weren't dividing, so they couldn't tell me much more. They didn't seem to worry about his staging, just his risk assessment, which was standard. When I pressed them, they said probably stage II.
The below is St Judes staging-
The lymphoma is in only one place, either as a single tumor not in lymph nodes or in lymph nodes in one part of the body (the neck, groin, underarm, etc.). The lymphoma is not in the chest or abdomen.
Stage II lymphomas are not in the chest, and one of the following applies:
For stage III lymphomas, one of the following applies:
The lymphoma is in the central nervous system (brain or spinal cord) or the bone marrow when it is first found. (If more than 25% of the bone marrow is abnormal cells, the cancer is classified as leukemia instead of lymphoma.).
Incase the BM and CNS is not involved it has to be below stage 4.....My son had the same...but stage 3 as it was in many lymphnodes.....in mediastnum and one node in cervical......also it was both above and below the diaphragm,,,,
As per my undersytanding in Remission MRD shall be done....to check whether relapse can happen or not.....not at dx
This sounds just like my son's experience so far (diagnosed Aug 2011), right down to the very small bit left on day 30. He is on COG 0434 too, but his arm gets HD MTX. I was surprised to see that your Dr said little chance of relapse. I'd love to hear that! Our Dr just says everything is looking very good. Gavin is labeled as High Risk, only due to the fact that his pediatrician had him on steroids (prednislone) for 3 weeks on and off before he was diagnosed. She thought he just had athsma. His only symptom was incredibly loud breathing (on inhale) at night. After knowing the pre-curser symptoms, I remembered that he was also complaining of an itchy back at night a few months before diagnosis. What type of side effects has your son had to the chemo so far?
Thanks for posting that! I never saw a lymphoma-specific staging chart. It looks like my son must be stage III since his lymphoma started in the chest. In his case, the CT scan didn't show other nodes involved, but that isn't a very sensitive test. You can certainly have minor lymph node involvement that doesn't show up on a CT scan, so I'll never know for sure.
I understand what you mean about MRD. I think that there is another word that Is should have used that is more appropriate, something like "Minimum Disseminated Disease" MDD for the sensitive testing done at diagnosis to see how far the disease has progressed. The same testing done after some treatment is called MRD, to look for disease that is "residual" after the treatment. They use the same techniques for both and I've seen the terms used almost interchangably in the literature. The COG study kids get the MDD done at diagnosis. I suspect that the data is collected so they can do retrospective analysis at some point.
My 6 y/o son was dx'd Oct '10 with Pre-T Acute Lymphoblastic Leukemia. He presented with swollen lymphnodes in his neck and then one in his armpit. He also had a huge mediastinal mass which caused wheezing and shortness of breath. When they put the chest tube in and drained off a liter of fluid they were able to give a preliminary diagnosis of pre-T. It was not until a few days later that they did the BM and LP they classified it as the leukemia (68% blasts in the BM) he also had a fairly normal CBC at diagnosis but was CNS positive (1 blast in the entire CSF sample). He is on a slightly modified 0434 protocol. You can read more about his dx on the My Story of his caringbridge site if you would like.
My son was dx in Dec 2008 w/T-Cell ALL (cousin to the T-Cell Acute Lympho Lymphoma). As someone else stated basically the difference is whether its made it in the blood and elevated the WBCs as ALL patients have. Aidan had a mediastinal mass that was huge. The shadow that showed on the Xrax was enormous. His neck lymph nodes were huge as well (one was almost baseball size), he also had enlarged adenoids and tonsils at time of dx. The couldn't put in any central lines in chest/arms due to the swelling of the mass, recovery from his biopsy and tubes that he had put in in his ears at the same time.
It took them a long time to figure out what he had because when his neck nodes started to swell, he was first given antibiotics. Then when that wasn't helping they did a CBC and all was within normal range. It wasn't until the day before his biopsy that he even started acting sick. He had a hard time breathing and his stomach hurt (enlarged pancreas and spleen we later discovered). It was very noisy and I knew his tonsils and adenoids were starting to swell too. They really thought it was some nasty virus at first because nothing else was showing up. He was checked for Mono, CMV, TB but all checked out negative. Then after not coming out of the anthesia properly they did a CBC and noticed things not right and later got dx and we discovered everything that wasn't right in his little body. He was initally negative for CNS involvement but they found a couple of WBCs on the cytospin. His WBC count was in the 300Ks (don't know # of blasts but it was high) and he was rushed to the PICU at Children's Hospital where he was dx w/Tcell ALL (initially they weren't sure if it was lymphoma or leukemia (and exactly what type but considering the mass in his chest and high counts I'm pretty sure they had a good idea before the results even came back) but treatment was basically the same) He spent about a week there and he immediately went into remission and didn't have any blasts in his BM at day 14 or so. He had some cranial radiation due to his having an intermediate risk but is now in his last year of LTM. I like to think of it as 3 more cycles So far there haven't been any long term effects (hoping it stays this way). His counts have been so stable that they've just started adjusting his meds a bit to get his ANC a little lower but they aren't concerned w/it too much. Kids grow and meds need to be adjusted so now they are just trying to find the right mix w/o crashing his counts too low. They are doing it pretty slowly.
Good luck to your child. I know its hard to find others out there w/the Tcell lymphoma dx but I am pretty sure treatment is fairly similar to Tcell ALL.
My son Has T-Cell Lymphoblastic Lymphoma, he too had a large mass in his chest that went misdiagnosed for months. We were fortunate enough to have caught it before his windpipe collapsed, but it was close. We caught his cancer due to a lump that showed up in his neck, we went back and forth with the pediatrician for weeks and finally they sent us to a surgeon who removed it and discovered it was cancer. I still remember April 22, 2010 sitting in the Oncologist's office hearing her say that my child has cancer, something I would never have thought I would ever hear. We went for tests on April 23 (CT scan) and a April 24th we did a PET scan, went to dinner and by the time we got home we had a message from our doctor telling us that we had to check into the hospital immediately that he had a large mass in his chest 9cm (I think, basically the size of his fist and same size as his heart) that was leaning on his windpipe and his heart. We started chemo that night. It has been a year now, my son is in remission and doing well. There were some really scary times, but he pulled thorough and is slowly returning to his normal self. Please let me know if you have any questions about anything! Best wishes and we will keep you in our prayers.
TLBL misdiagnosed with my son as well. He also had a small bluish lump under his skin (about the size of agrain of rice). It was on the back of his neck, to the right of his spine. What was the lump on your son's neck like? Our Dr's say that his lump is unrelated- a clogged pore or benign cyst. It still concerns me.
I had this idea that if I had paid VERY close attention to my son, perhaps I could have caught it earlier. I told our oncologist that 1 month before he was diagnosed, my son said "My heart hurts" . At the time, he had just eaten a HUGE meal, so I figured it was heartburn, gave him some TUms and told him not to eat so much next time! Oh, I told the doctor, if only I had listened to him! The oncologists said, you know, it probably was heartburn....this disease has a VERY rapid onset and it is unlikely that you could have caught it much earlier. Well, that made me feel a tiny bit better.
The side effects that come to mind are significant nausea to the point of hospitalization for dehydration (especially during IM!), fatigue and vincristine related walking problems. Of course, he lost almost all of his hair (he was never cueball bald), his eyelashes and his eyebrows. He also becomes diabetic when he is on steroids, so that we have to do frequent monitoring and I give him injections of 2 kinds of insultin up to 5 times a day.He is on a chemo hold in LTM right now because his platelets are just under 50K and his ANC is 200.
Not sure what lump you mean - perhaps that was another kid? I think Balkan's son had a lump in his neck area. My son didn't have any obviously swollen lymph nodes.
TLBLmom, I can not believe it! My son also complained of "pain when I breath in, right here on my heart"!! I also gave him some antacids and brought him to the Dr. This was about 3-4 months before he was diagnosed.
Late April- Chest pain and tiny lump on the back of his neck. Dr. @ clinic on Ft. Bragg says, "It is probably clogged pore. We just don't see skin cancer in kids this young." Dr. ordered chest x-ray, which was clear.
July 3- Louder breathing at dinner, I gave him Musinex
July 6- No improvement with Musinex. Dr. gave us an inhaler and chest x-ray. Also my son was blowing less than 40% on test for athsma. Tech said probably upper airway, NOT athsma.
July 13- Breathing so loud while sleeping that it could be heard in next room. Chest pulling in on inhale. Brought to ER. Son said he felt fine and no symptoms when awake. Dr. said "We can not do anything. It stops when you wake him up, so just wake him up. I can't give you a cancer diagnosis in the ER!" ***this was almost 1 month BEFORE he was diagnosed***
July 14- Chest x-ray showed few small shadows, attributed to "athsma", given steroids. (he would improve slightly on steroids, then get worse as soon as he was off them)
July 15-August 4 - Dr's seem to think I am just nuts. Sent to ENT from camera down nose- clear to vocal chords. Given rounds of steroids, antibiotics, antihisamine, inhaler... nothing makes it go away. Dr. wants to do sleep study "sometime soon". Given pediatric pulmonology appoinment for AUG 30!
I begged for sooner appt. Got one for August 4th.in Chapel Hill.
August 4- Admitted THAT DAY at Chapel Hill. X-rays, TB test, MRI, CT, and talk of possible NHL diagnosis.
I was diagnosed with T-cell Lymphoblastic Lymphoma when i was 15... i had just finished freshman year in high school. I have a history of asthma so when I started to be short of breath from walking up stairs, we just assumed it was that... then when i breathed in it felt like a sharp pain in my left lung... right by my heart.... I also had a slight cough, and a low grade fever of 99.8 for a month before it was diagnosed. . I was treated for bronchitis and it seemed to be better, but then we got a call from the guy who took an x-ray of my chest (to see if my cough and trouble breathing was pneumonia) and he said my aorta was kinked and i should get a CT scan done. that resulted in my cancer being found... i am now 19 and I have been off of chemo since January 2, 2011. but what gets me is we think we KNOW the cause of my cancer. I was pre-diagnosed with an anxiety disorder when i was around eight or nine so one night when i found a rather large ant crawling around under the covers of my bed in my room i flipped. this was almost exactly 6 weeks before i was diagnosed. i found the RAID ant and roach spray under the sink and went to town in my room. i sprayed the walls, the floor, my bed, everything. i didn't notice the "warning: toxic, may cause some lymphomas" in small print on the back. i slept in that room every night after and up until i was diagnosed. the doctor said my cancer was just about 6 weeks old at stage III. I kinda wanted to sue but there was a warning right there, and i had other things (like beating cancer) to worry about.
What I have seen ALL children have MRD on day 8 and 29 which becomes a prognostic factor.....For TLBL there is only one study I came across.... http://jco.ascopubs.org/content/27/21/3533.full
1) Are TLBL children getting done this MRD.....Is this feasable with TLBL kids..where bone marrow is not involved.....what sample is required...where it happens ....and what is the cost invoved...Pl find out what ever u can on this....
2)Does your protocol has cranial radition 12gy....Are you getting this done....
Pl do inform what you oncs say on above 2 issues...
For us the symptoms were only back ache.....that too not severe.....
CT and next day PET gave us this data....... an mediastnal mass 10cm ...bone marrow is clean on dx 11jan 2011...pelural fluid also had maligant cells on presentation.....also cervical had a small 1cm lymph node.........
Now this node was on the left side of neck and not visible externally........After PET revealed the node on neck for 1-2 days on close observation we could say it is a swollen Lymph......That also went away before I could notice it after becoming aware.....
All going fine only relapse is a topic which I am unable to find how frequently/why this happens.........
Was reading these details to find LBL delayed response
Oh, it is I'm so proud I'm gushing!
Wow - you two are naturals in front of the camera! I cried when I saw it. I am so impressed that you held it together in front of a camera to tell your difficult story. We aren't at St Judes, but I can see that it's such a good cause. I know I would make the WORST spokesperson ever because you'd only hear me blubbering.
My son was diagnosed with T-cell lymphoblastic lymphoma at 2.5 years old in November 2011. He also presented with a large mass the size of a nerf football compressing his lung. Looking back, I feel like he displayed symptoms months before diagnosis, but our oncologist said it is such a fast growing cancer that it was most likely there less than a month.
I haven't met any other parents of children with this cancer... Everyone has ALL.
Just got on this LLS discussion board tonight for first time and not really sure how they work, but I am "Excited" to see a few others with his cancer.
How is Emma doing?


text:
1. There are now just nine shopping days left until Christmas.
2. My lady the blonde is strung out tighter than a banjo string.
She's out there somewhere (take your pick: Dillard's, T. J. Max, Couch's) amongst all of you, which means I am in the midst of hanging on and saving our marriage. An old bit of advice on how you do that fits like a wet glove this time of the year:
"The key to a successful marriage is keep your mouth shut and your pocketbook open."
'Course it's not always that easy, especially when (after being gone all day) she pulls her truck (mini-van) into the carport, honks the horn, calls me on her cell phone (just to be sure), and says:
"I need some help out here!"
She always arrives in the middle of Wheel of Fortune and I never know who won the big pot at the end or how much.
Anyway, I "rock" my way out of my Archie Bunker recliner, and head for the carport. Her truck (mini-van) is sitting low on the rear axle. It's remindful of a bootlegger heading down the mountain to town with a few gallons of the white (recipe).
(In the spirit of the season, please don't ask me how I know about THAT!)
Anyway, you can bake a small pone of cornbread while you're unloading the blonde's truck (mini-van). Well, you're right. That's stretching it a bit ... but not by much. Mostly what I'm doing here is being very up front about "the season to be jolly."
I'm not doing all that badly there, either.
We are now into the 21st day of the nation's Number One Shopping Season and there hasn't been (as of yet) one single shouting match between me and the blonde ("keep your mouth shut"). In addition to still being head-over-heels in love with her, divorce is expensive and murder gets you a seat in the electric chair. All that helps keep the mouth zipped.
All kidding aside, a truth is she is most amazing at this time of the year. Among other things:
1. She's out there shopping for no less than eight people ... one son, one daughter-in-law, three grandsons, two granddaughters-in-law, and for me, too. There is also a scattering of nieces and nephews she bestows a bit on.
2. If at home, she's up in her "barn" wrapping all that stuff. The place looks like a minefield at the moment, but she's recording who and what on index cards (that's to be sure she doesn't slight anybody). Ribbons, boxes, bags, and Scotch tape abound.
3. She also goes about "picking up the house," cooking a bit, and talking on the phone for hours with Susie (the daughter-in-law) about a menu for our Christmas Eve dinner. I thought that was booked solid when Riley, number one grandson, called from McCalla saying "Poppa, I want your cornbread and field peas with slaw for supper." That, at the moment, is about the only bone of contention at the house. The blonde has loftier plans.
Oh, did I mention the tree is up and decorated? She and a young lady by the name of Courtney Noah did that over the span of three days.
She's a wonder.
And, for some reason, my memory harkens back to my grandmother, Hattie Cook Smith.
She bore nine kids (eight boys and a girl), kept a big old house in order, kept clothes washed and ironed, milked cows, had a big garden and, in her spare time, went to the fields with a cotton sack over her shoulder.
All that without electricity or running water. Light was a kerosene lamp, water came from a hole in the ground.
When I look around at all the blonde has wrought since Thanksgiving, it comes to me she would match up very well with my grandmother if she had lived in those days and hard times.
She's a wonder ... and come next Thanksgiving I'm going to tell her exactly that and give thanks for her being in my world.
One more thing ...
Columns do not always go in the direction intended. Sometimes you start out a bit on the cutesy side, but then wander into a message that really is important ... at least for yourself if not for others.
George Smith can be reached at 256-239-5286 or email: firstname.lastname@example.com