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Most people have heard of Munchausen's syndrome, a fascinating condition in which patients try to fake a condition in order to draw attention or sympathy.
There are a few syndromes that doctors need to keep in mind, some of which are quite fascinating, in which the patient tries to fool the doctor for various reasons. Here are some of those conditions, how the patients fool the docs, and how the docs avoid being fooled.
1. Drug-seekers
What are they –
In a sentence, the bane of any ER physician's existence. They're either addicted to pain meds, or obtain and fill prescriptions then sell them on the street to addicted people for a huge profit.
How they fool doctors -
Drug seekers can be very slick. I have seen a patient had another doctor vouch for them, one who wore their full police uniform, an adorable 80-year-old church organist, and even nurses and doctors ... all of whom were found to be getting prescriptions for pain medications and selling them illegally.
How doctors recognize them -
Besides being highly suspicious of any patient who asks for narcotics, some regions have databases that doctors can use to determine if a patient has filled a suspicious number of pain prescriptions. However, some drug seekers raise a lot of suspicion on their own. They'll claim to be allergic to every non-addictive type of pain medication, which is statistically unlikely. Others are just bad actors. They'll shriek and cry at the lightest touch when a doctor pokes their back to find out which part hurts… then later, the doctor will give them a friendly pat on the back, and find that the supposedly painful spot no longer seems to hurt.
2. Malingerers and Insurance Hopefuls
What are they -
A "malingerer" is defined as a person who fakes an illness with the intention of avoiding duty or work. I'll lump these in with patients who fraudulently fake or exaggerate illnesses to try and get insurance payouts.
How they fool doctors -
Malingerers will seem to have a lot of pain, and some actually are suffering from very real pain. They use this, however, to prey on a doctor's empathetic side. They can also be quite convincing actors when they demonstrate just how incapacitated they are.
How doctors recognize them –
By knowing the physical exams and anatomy very well, doctors can get suspicious if the results of a few different tests of the same joint or muscle aren't consistent. Some malingerers, though, can be fooled quite easily. Even I have had my suspicions raised with a patient who struggled to raise her arm a few inches when I asked her to demonstrate her range of motion. When I then asked her to show me how high she could raise it before her accident, she effortlessly shot her arm up high above her head!
3. Psychogenic nonepileptic seizures
What are they –
This is a term for people who appear to be having seizures, but it turns out that they are actually not suffering from epilepsy – for various reasons, they're faking the seizures.
How they fool doctors –
Anybody in a doctor's office or emergency room who is having what appears to be having a violent seizure, will obviously get the benefit of the doubt. In fact, in some cases, it is many years of investigating and giving high doses of seizure medications before a doctor realizes that the patient has been having nonepileptic seizures the whole time.
How doctors recognize them –
Research has shown that nonepileptic seizures occur more commonly in a doctor's office or waiting room, or when there is a witness around. Some medical textbooks suggest giving such patients a sugar pill or an injection of water while telling them that this medicine has been known to cause seizures, and seeing if the patient starts shaking. While this can seem deceitful, the lie isn't usually necessary: some patients still have these fake seizures even if they are told that they are being given something that can induce both real and fake seizures. Other things doctors look for are things such as where the patients bite their tongues, which is often in a different location for real and fake seizures, and the length and frequency of the seizures.
4. False comas
What are they –
Hopefully I don't need to explain what a fake coma is. I will mention though, that people fake comas for a variety of reasons. Some people with psychological conditions feel safe in a hospital, and fake a coma so they are surrounded by doctors and nurses. Others have been found to fake being knocked unconscious on a ski hill, because they can't afford a bus ticket home and would instead prefer taxpayers pay for a helicopter to fly them to the nearest city.
How they fool doctors –
By laying very, very still.
How doctors recognize them –
While there are some non-invasive tests that can be done to determine if a coma is indeed real, sometimes doctors aren't even trying to "catch" a fake coma when they do their neurological exam and find that some results don't add up. Also, patients who appear to be in a coma but resist the doctor opening their eyes, or flinching when the doctor's stethoscope swings close to their face, obviously raise suspicion. Obviously to determine legitimacy it's important the doctor knows what is normal, because strangely enough, patients with legitimate comas have been seen to do odd things such as cross and uncross their legs.
That's not to say, however, that these "fakers" don't need help. While the financial gains for drug-sellers or insurance scammers are usually based on greed alone, people who are addicted to drugs, or feign comas and seizures, can have very real and complex psychogenic conditions (to give you an idea of how complex these conditions can be, some patients may not even be aware they are faking). While they can make a doctor's work more challenging, at the end of the day all of these people do need real treatment – not with narcotics or anti-seizure medications, but with psychological counselling to determine the underlying reasons that are compelling them to fake these conditions.
Friday, September 19, 2008
When patients try to fool doctors - four interesting types of fakers
Most people have heard of Munchausen's syndrome, a fascinating condition in which patients try to fake a condition in order to draw attention or sympathy.
131 comments:
One way to detect fake unconsciousness/coma: with the patient lying on their back, hold the patient's hand about 10-15cm above their face, then let go. If the hand misses their face, they're faking. It's almost impossible to let yourself hit you in the face.
- Monday, September 22, 2008 10:55:00 AM
- healthskills said...
Hi there
I'd argue with you a bit about malingering. It's not a medical condition at all - it's simply fraud to fake a medical condition (and it's not necessarily pain) to obtain money.
Health professionals are lousy lie detectors.
And there is no way to determine whether someone's pain is 'real' or not.
So I don't think it's reasonable at all to suggest that you can test for the 'authenticity' of pain by doing the tests you describe. In fact, there is no way to test for pain - we simply need to accept that the person is describing what they experience. Leave fraud detection to the people who do this for a living: the private investigators, and let us get on with helping people with pain without trying to work out if they're real or not.
You'll do more good than harm by recommending these things for chronic pain:
- getting on and doing things
- returning to normal activity
- and minimising the use of medications
and if they're really having a hard time - send them to an interdisciplinary pain management centre.
- Thursday, September 25, 2008 10:51:00 AM
I disagree with you completely. Despite being overrun with fakers, and bullshit artists, hospitals still err on the side of the patient. However, when the case is so obvious, so blatant, and frankly so insulting as to fool even a child, we need to act to stop abuse.
To simply prescribe a narc doesn't resolve the situation. The person is still diverting it, still addicted to it, still not treating the underlying disease, or whatever. Pain is a symptom.
Don't tell me you just hand over the keys when some gandy walks in and says, "I'm in pain. I got allergies to Aspirin, Tylenol, Toradol, Ibuprofen, Nubain, Naproxyn, Motrin, Codeine, Demerol, Morphine, and Fentanyl. Only that one D- drug help. I don't remember the name. But that D something or other drug is all I can take."
Bullshit flags waving wildly in the wind.
There's nothing wrong with having a high index of suspicion. Simply handing out narcotics is poor medicine. It's not in the patient's best interest of facilitate their addiction. Treating the addiction is.
Particular in state-funded systems be it NHS or Medicare/Medicaid in the US.
- Sunday, November 23, 2008 4:23:00 PM
- neuro-transmitter said...
Very insightful opening commentary, and interesting posts in response.
I particularly note the recognition that the "faker" is commonly ill - although the illness is not the one claimed as the focus.
One interesting subgroup of "fakers" is patients with what I all "obsolescence syndrome": fundamentally, people who have become socially obsolete and who become fakers as a way to exhonerate themselves from their obsolescence. An example is the uneducated, obese, 50 y/o plumber with modest degenerative processes who has a minor back strain but then devolves into a chronic pain syndrome as a route to career change.
Sadly, while fakers seek to exploit they are commonly themselves exploited. Pain clinics (particularly those that pander to the accident claim game) are sometimes exceedingly hesitant to find any answer other than some biological construct. Other pain doctors also default to the "pain is whatever the patient says it is" in order to avoid confronting the difficult issues and to avoid the loss of business which stems from real answers. Accident claim lawyers may stand willing to attack anyone who fails to "appreciate" the "severe and permanent injury of my client". All of these purport themselves to be patient advocates. But, the real story is that the patient becomes a tool to the advocate's own economic agendas.
Often, outsiders fail to realize how much "stomach lining" the truly good doctor gives up to the pursuit of truth in these difficult patients. As reflected in the original discussion, the doctor may be maligned or even attacked for simply trying to pursue the truth.
The patient's real advocate is the provider who seeks the truth, because in the end the patient's illness does not care about anyone's preferred view of it. The illness will behave according to its truth. And, in the case of hidden addiction or psychiatric problems we know the outcome of failing to treat the real illness.
- Sunday, February 08, 2009 1:17:00 PM
Feel the blog is really insightful.
I suffer from "fakers" disorder or NEAD. It's great being told your an attention seeker because a paedophile had a good time with you many years ago.
The "fakers" stances silences victims of child abuse by shaming them into believing they are responsible for the injuries they have sustained. And, actually supports the behaviour of paedophiles. Victims are to ashamed to come forward and more children risk the same future.
Good luck in keeping your children safe. It's your conscience.
- Monday, April 13, 2009 3:24:00 PM
...forgot to mention. Just for the record.
Between 50% and 75% of psychiatric patients including those struggling with dependency issues have a history of childhood poverty, neglect,psychological, physical and sexual abuse.
Many of these drug addicts are self medicating for very legitimate reasons. It's rather unpleasant to be passed around a few paedophiles as a child, or starve for several days, watch your parents shoot up or let your alcoholic dad beat you with an iron bar.
I would just like you to reflect on your own conditioning and marvel at how you managed to become a med student. If you sit on the other side of the fence it's easy to fool yourself that anyone can do it if they work hard in school or are brighter enough.
- Monday, April 13, 2009 3:50:00 PM
- Vitum Medicinus said...
Anonymous - I'm going to stand up for myself here and take objection to be likened to one who "supports pedophiles," and I am sure my readers will agree that there is no need for me to expand upon that further.
What I will express is my genuine hope that you can find a way to treat the source of the very real pain I won't deny you are experiencing from your past emotional and physical trauma. "Self-medicating" with substances (alcohol? narcotics?) will in the end cause you more harm than good. There is help available.
I do appreciate you taking the time to comment and am always interested in seeing a good discussion take place here.
- Thursday, April 16, 2009 3:14:00 PM
I have never touched a street drug in my life, nor would I.
I was a school teacher until developing NEAD.
I spent many summers teaching children in specialist camps on the dangers of street drugs.
I witnessed children exposed to these environments firsthand. That is why I am so knowledgeable.
I did not mean to offend you and I did not mean to imply that you had direct involvement in covert activity.
I was merely pointing out that ignorance can be very damaging.
I would hope that you could reread my comment objectively.
I like a good discussion also. Thank you for your feedback.
- Monday, April 20, 2009 12:09:00 PM
Just thought I would add that reality and legitimacy are personal, social and cultural perceptions.
Bio medicine places great emphasis on the "test" to define legitimacy. Testing is a reflection of current scientific understanding - no more and no less.
There is very little scientific understanding of dissociation. It is new ground, the tests and tools have not been developed yet.
But, when science catches up these so called psychogenic or "fakers" conditions will eventually be viewed as legitimate.That's how the system works.
Biomedicine has immense cultural influence in the western world. But, as I have explained previously these influencing views of reality and legitimacy are only perceptions.
- Monday, April 20, 2009 1:54:00 PM
As a (non-pain) patient, with relatives who work in the medical field, I feel there are better approaches.
First, I think doctors should be better informed as regards to pain management. Of course, non-drug techniques (e.g. "TENS" units, etc. are often very costly and not covered by insurance). Yet, many types of pain, even subjectively reported pain, are, in fact, real and have real causes; yet, narcotics are not necessarily the best (or only) drug approach to treatment, especially for the long-term (even pain with objectively diagnosable signs).
I feel that g.p.'s (family doctors, ob-gyns, internists), should be more informed and trained on the different types of medications available for pain, and make referrals to pain management specialists when appropriate (e.g. neurologists, physiatrists--not psychiatrists-LOL!, rheumatologists, surgeons, oral surgeons/dentists, orthopedists, nephrologists, oncologists, urologists, etc.), and agree to follow-up and consult when appropriate.
Also, some patients may "appear" to be drug seeking (by asking for narcotics--even specific drugs) but may be under the impression that narcotics are the only option for their type of pain (complicating matters).
Small supplies of narcotics should be given initially, strict follow-up with medical records requests and/or pharmacy records verification releases (In addition to; and/or if medical records are not available; pain med contract agreements; thorough documentation of treatment; trained office staff to document phone calls; no early refills; thorough examinations and interviews, etc.
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Thanks for your article. I know some people like that. What are they thinking? Faking a disease just to get drugs? not good...
- Sunday, February 13, 2011 7:34:00 PM
- marimethod said...
Your article is very interesting, most people with this kind of "illnesses" are just want to draw the attention of their love ones or an addict of narcotics who wants to get prescription. Doctors in ER's are used to this kind of act, and sometimes placebos are Doctors best friend.
- Thursday, February 24, 2011 10:50:00 PM
- Dental Marketing said...
I agree.
1 can never be 2..right?
Doctors is never the same to these fakers.
I mean doctors themselves know their identity but let's give credit to those impersonators.
Avoid being a fakers, it's against the law! :)
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Please, Doctors and Medical professionals, take heed:
Arrogant Doctor Syndrome is a huge problem. I KNOW you guys are sick and tired of being explioted. I know you never want to be the one responsible for addiction.
However, the second you start judging based on their appearence will open the door to malpractice.
There is always that one you might've misjudged. I am that one.
I saw a sergeon seven months ago about a suspected breast tumor.
He basically told me he had performed so many biopsys that he was certain it couldn't be cancer at my age. He advised me to wait 6 months and return.
Six months later I saw another surgeon. It was a very agressive cancer, and it had grown 3 CM in that short amount of time.
If he had checked, I would not have needed a masectomy and chemo, and I'd have such a better prognosis.
Don't be over-skeptical, please.
- Sunday, June 03, 2012 3:58:00 PM
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I was volunteering at an Urgent Care centre this morning when we had a lady come in with a minor condition. She didn't seem pleased when the triage nurse said that there would be a 3 hour wait. She went back to her seat and five minutes later, fell to the ground and started shaking. A whole team of nurses dashed out and took care of the lady, but the triage nurse noticed that the lady would dodge her head whenever the nurse's stethescope got too close to her face as the nurse was kneeling over her. The triage nurse later explained to me that the patient was having a fake seizure to get seen by the doctors faster... I thought it was interesting to read this post after I experienced this for myself!
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- Aleksandra Musial said...
Dear author of this blog:
I'm a student of biology with chemistry.
I'm not that much of an expert in psychiatry, but I feel compelled to shed light on one of the conditions you described, which, coincidentally, I suffer from - that is PNES or psychogenic non - epileptic seizures.
I'm afraid there is something that can be called 'An Ignorant, Skeptical Doc Syndrome'. Some people consciously fake seizures to draw attention or gain financial / material reward. They often go to great lenghts in being realistic and I believe that this behavior falls into the Munchausen Syndrome cathegory.
PNES is a disorder. In contrast to what I just mentioned, it consists of seizures that are NOT voluntary NOR consciously produced. PNES emerges as means of coping with intense emotional trauma which is unconsciously pulled into the person's subconscious so they won't need to suffer. Even Freud described this event. The trauma later shows as episodes of seizing that are regarded as specifically designed to draw attention.
It's sad how people can live devoid of sympathy. I was once admitted to ER when I had a particularly tough fit of PNES and they told me three times to stop it, accused me of being an attention seeker and malingerer, knocked me out with Valium and forced me to go home. It is people like YOU that caused me and many other PNES patients to give up treatment and refuse social activity because of "faking seizures for attention".
I needed to pass my last year at home and have no friends.
I don't have the words for what the world has come to...Sorry I need to go turn off my laptop and get some fresh air :(
- Saturday, July 14, 2012 7:13:00 AM
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This is very interesting because it is true, I think that it is important that in the hospitals keep an expedient of each patient and see how many times this person reports the same disease or problem, haha.
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These ideas are just running through my head for the last 4 days. I thought I was just being judgmental to one patient I know. But after reading this article blog. Man what I am thinking is correct! She has all characteristics of 4 types mentioned above. Next plan, I might suggest to have a psyche evaluation. Thank you for a very informative and eye opener blog!
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- Wednesday, January 09, 2013 11:44:00 PM
I totally agree with you. I too have nead and makes my blood boil when i am treated like a fake. I am not aware of these seizures and normally end up in itu and this is not through my or my families choice. I am sorry i waste your time and so sorryvyou have to give me drugs but just you be careful. One of these fake seizures cumulated in me being ona life support machine for 2 weeks with a really nasty infection. I would have died had you treated me as a fake. Oh by thexway i am a doctor too. Get a grip and do your job.
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- Monday, January 28, 2013 11:19:00 PM
I would like to point out the nead is not someone faking a seizure. It is a manifistation of bottled up emotion commonly from trauma in the persons past. They have no control over there body at all and have no knowledge of the attacks. I struggle to get people to accept the diagnosis of nead and its is mis information such as this that causes it.
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Is it possible for a person to go into a coma and the doctors tell the family that the patient is dying; for that patient (who has had to have help getting out of bed for months) to get out and bed 36 hours later and ask: 'what's going on?" Was this person in a coma or were they faking it. Less than 2 hours after waking from coma, patient was allowed to go home.
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text: Jason Mraz Through The Years Category Music Photo Galleries Jason Mraz - 2003 (credit: Frederick M. Brown/Getty Images) Recording artist Jason Mraz attends the Fourth Annual Wish Night 2003 Awards dinner at the Ritz-Carlton Hotel on November 1, 2003 in Marina Del Rey, California. The event honors outstanding individuals, corporations and celebrities, while also raising funds for the Make-A-Wish Foundation. Television host Bob Goen was honored with the Celebrity Wish Granter Award. Jason Mraz - 2003 (credit: Kevin Winter/Getty Images) Musician Jason Mraz performs on "The Tonight Show with Jay Leno" at the NBC Studios on November 7, 2003 in Burbank, California. Jason Mraz - 2004 (credit: Scott Gries/Getty Images) Jason Mraz performs on stage during Music Midtown May 2, 2004 in Atlanta, Georgia. Jason Mraz - 2005 (credit: Brad Barket/Getty Images) Jason Mraz performs at Housing Works Bookstore Cafe on July 27, 2005 in New York City. Jason Mraz - 2008 (credit: Kevin Winter/Getty Images) Singer Jason Mraz arrives at Stand Up For Cancer at The Kodak Theatre on September 5, 2008 in Hollywood, California. Jason Mraz - 2009 (credit: Fran Flynn/Getty Images) Jason Mraz performs on stage during Day 5 of the Byron Bay Bluesfest at Tyagarah Tea Tree Farm on April 13, 2009 in Byron Bay, Australia. Jason Mraz - 2009 (credit: Larry Busacca/Getty Images for Songwriters Hall of Fame) Jon Bon Jovi, Rob Thomas and Jason Mraz attends the 40th Annual Songwriters Hall of Fame Ceremony at The New York Marriott Marquis on June 18, 2009 in New York City. Jason Mraz - 2010 (credit: Jason Merritt/Getty Images) Singer Jason Mraz arrives at the 52nd Annual GRAMMY Awards held at Staples Center on January 31, 2010 in Los Angeles, California. Jason Mraz - 2012 (credit: Michael Buckner/Getty Images for Bing) Singer/Songwriter Jason Mraz performs at Bing Bar presented by Intel and Asus during 2012 Park City on January 20, 2012 in Park City, Utah. Jason Mraz - 2012 (credit: Christopher Polk/Getty Images for Burton) Musician Jason Mraz at the Burton Lounge at Park City Mountain Resort on January 22, 2012 in Park City, Utah. Jason Mraz - 2012 (credit: Larry Busacca/Getty Images For The Recording Academy) Singer Jason Mraz arrives at the 2012 MusiCares Person of the Year Tribute to Paul McCartney held at the Los Angeles Convention Center on February 10, 2012 in Los Angeles, California. Jason Mraz - 2012 (credit: Theo Wargo/Getty Images) Jason Mraz performs on NBC's "Today" at Rockefeller Plaza on August 31, 2012 in New York City. Next Gallery: Sarah Shahi -- JACK's Crush Of The Week View Comments

subset: commoncrawl


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I was feeling rejected, that you were sending me away.
No no. You have been selected, not rejected. And they will give you a farewell party when you leave!
It is not rejection at all, not at all. So if you don't want to leave then I will have to select somebody else. And it is a selection because it is going to be a big place soon - forty rooms - with many people staying there permanently too. It has big grounds and is just sixty miles away from London.
It is going to become a great center, so just think about it. And be unburdened. If you feel like it, go, otherwise.


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Review: Savoir No. 2 Bed - "The Savoy"
A Year in Bed
Bed: Savoir No. 2 with Horsehair Topper
Manufacturer: Savoir Beds
Retail Price: $15,550 (queen)
May was a huge step up for us; we tried our second extreme luxury bed, the Savoir No. 2, also known as The Savoy. Completely handmade in England for each customer, Sara Kate and I slept on a medium tension model that was sprung equally for both of us (we were both invited to come try a floor model months ahead of time). Our experience? We both really liked the bed, but had different reactions to how lumpy the bed was at first (it settled a lot over the course of the month.) We agreed on one thing: this bed REALLY moves.
Savoir is a UK based company that started up in 1905 by making beds for the Savoy Hotel in London after the owner declared he wanted the best beds in town for his hotel. Prior to 1997, you could only buy these beds through the hotel, but since then the company split off and has a large presence in Europe. They only opened a US showroom, in New York City, last year.
Check out Joyce Wadler's review of the Savoir $50k bed (she only spent one night on it) here (NYTimes).
In the interest of full disclosure, the delivery of these beds is a big part of the experience, and we got the full treatment. Savoir not only delivered the bed, but threw in luxury bedding and a bottle of champagne (they said customers often buy new bedding with their beds). When we came home that night it made quite an impression. Personal, white glove delivery is standard. Not sure about the champagne. This is what we tried out:
• Sferra Giza Sateen Bedding
• Hefel Pure Silk Comforter
• Savoir Back-Sleeper Pillows
While all of this added to the experience, we quickly swapped out the sateen for our own linen sheets. They were just too slippery.
It's worth adding, however, that making a big deal out of this point of contact made a distinct impression. Not only is bed delivery a very sensitive event, it's also a huge marketing opportunity and all of the attention this bed comes with definitely adds to the personal experience.
Sleep Experience
• Excellent (but not at first)
You have to get used to this bed. For a $15k bed, we were both amazed at what a lumpy first impression it made. The horsehair topper settled big-time over our thirty days. Soft, breathable and plush with many layers of natural material, I loved falling into it at night, but it did take getting used to. Sara found the way the horsehair topper "settled" uncomfortable as it created a ridge between us at first and made her feel as if she were rolling towards the edge. This went away by the end of the month.
That said, we both slept very well after the first week, my occasional morning back pains disappeared and our body temperatures were never too hot or too cold. The sleep is very soft and deep, which I prefer, but Sara is more of a firm surface aficionado. This is important to know when choosing a bed, and the Savoir can be built for different firmnesses within the same bed.
• Amazing
The Savoir is a "bespoke" handmade bed, which means that it is built to your specifications in their factory in London. Totally traditional in build, with layers of natural materials on top of hand tied springs, this bed will rock your world if your eco-minded. If you just like well made things, you'll appreciate all the care that goes into one of these things.
From the Savoir website:
The difference between a Savoir Bed and any other will become apparent over many years of comfort. The fact that 60 hours of craftsmanship goes into one of our king size beds allows us to make best use of the finest materials. Screwing a frame together takes longer than using a pneumatic staple gun, but the time taken is reflective in their respective lives.
The materials? FSC certified knot-free pine and beech, lambswool, cotton, horsehair and steel springs. I took a lot of pics of the bed being set-up as the thing looks as good without bedding as it does dressed.
• Aspirational
This bed is a lot of money, but if actually can afford to buy one, you're likely not to feel that it's overpriced. While I'm sure there's a healthy markup in there, this is a lot of bed and you DO feel like you're lying on something that's going to get better and dearer with time. It had a totally different presence in our bedroom than most of the other beds - like a big, solid anchor in our home.
If you're big into having a great bed, really crave natural materials, this type of soft, deep sleep and don't need to buy a car or send a kid to college this year, this could be a great choice.
Can you get a Savoir for less? Yes, Savoir makes two other models that are lower in price (often bought for guest rooms!), which will allow you to dip your toes in these waters, but they're still going to run you a lot more than the typical $1-2k beds that we see most often.
Do you sleep on a Savoir bed? If yes, please let me know in the comments how it's going for you.
Bed Rankings to Date - 9.26.11
(Best overall sleep experience according to both him and her - i.e. two thumbs up)
Tie For First
1. Danny Seo Natural Care Bed by Simmons
1. NaturaLatex Tranquil
Tie for Second
2. Hastens Excelsior II
2. Savoir No. 2 Bed - "The Savoy"
3. The Keetsa Pillow Plus
4. The Biltmore Bed by C.P. Rogers
5. Encased Coil Natural Mattress by Room & Board
6. TEMPUR-Cloud Supreme with Advanced Ergo Adjustable Base
7. Embody Memory Foam Stillness Plus Bed by Sealy
8. IKEA Erfjord
Year In Bed Info
• Follow daily progress on Twitter at #yearinbed
All Year In Bed Posts
• SAVOIR No. 2 REVIEW
• Beyond the Ides of March - Bed #6 from Room & Board
• How To Get a Really Good Night's Sleep
• Preview: NaturaLatex Tranquil
• More Things I've Learned So Far
• Sealy Preview
• Ikea Preview
• What is the Right Price for a Bed?
• Some Things I've Learned So Far
• Hastens Preview
• Year in Bed: A Modest Proposal


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DVD Review: Acupressure for Natural Pain Relief in Labour
by Attilio D'Alberto
I think this DVD is a useful product for many couples expecting a new baby. It also opens up acupuncture to a wider audience and is good value at £11.99. It can be recommended to patients once they have been shown the correct pressure and point location by a qualified acupuncturist
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A newly minted MBA joins a volunteer non-profit board. Shortly after joining the board the organization experiences significant cash flow challenges. In the process of resolving this problem, much deeper issues are exposed, including long-time neglect of fiduciary responsibilities by prior and current board members, lack of basic financial and human resource controls, problems with reputation and image in the community, alienation of funders, and an executive director (ED) who tries her best to hide her performance issues from the board. The board must decide if they can continue operations and reorganize to address these weaknesses or if the agency should be closed.
learning objective:
This case was written to motivate discussion of issues related to non-profit governance. It is presented in three parts, allowing instructors to choose one or two of several possible areas of focus. These include general preparation for governance, roles and responsibilities of management versus directors, funder and media relations, human resource related management controls, and financial control mechanisms. As such, this case will be useful for courses on governance and non-profit management at the undergraduate and early MBA level.
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This case highlights the dilemma of Nicholas, an accounting executive, who must decide whether to promote a disabled employee, Paul, to a management role. Paul is a strong performer; however he is frequently required to work at home on a laptop in order to manage the symptoms of Crohn's disease. Nicholas needs to decide whether this presents a barrier to Paul's ability to take on greater degrees of responsibility. He struggles with the legal and ethical implications of his decision. The impact of his decision on the rest of his team is also considered.
learning objective:
1. To increase awareness of disability legislation and employer's legal responsibilities using an example that highlights current standards and definitions as established by the courts. 2. To foster debate about an employer's ethical obligations to disabled employees. 3. To engage in discussion about practical aspects of accommodating invisible and sporadically occurring disabilities in the workplace, with particular attention to managing coworker reactions.
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text:
Data about the village of Trippa Bella
The village of Trippa Bella is 3,80 kilometers far from the same town of Pontelandolfo to whom it belongs.
To the municipality of Pontelandolfo also belong the localities of Acqua del Campo (5,70 km), Caicchia (4,88 km), Carluni (3,09 km), Case Agnerone (2,21 km), Case Calvino (1,76 km), Case Carluni (3,09 km), Case Ciova (1,86 km), Case Fracassi (3,61 km), Case Mazzucco (2,87 km), Case Russo (2,69 km), Case Santillo (2,41 km), Case Tolla (2,07 km), Case Zingari (2,95 km), Ciarli (1,92 km), Ciccotto (2,47 km), Cocuzzo (4,58 km), Fonte Mardara (2,41 km), Giallonardo (3,33 km), Giallonardo II (2,69 km), Grotte (1,43 km), Gugliete (1,58 km), Guitto (3,59 km), Iella (1,16 km), Lena (2,37 km), Lisa (2,16 km), Lombardara (2,56 km), Longo (0,96 km), Malepara (2,55 km), Marzilongo (0,71 km), Masseria Ciccotto (2,51 km), Masseria Pericurti (1,82 km), Mezzoculo (2,05 km), Minicariello (2,74 km), Mucciacciaro (1,82 km), Perugini I (3,58 km), Perugini II (3,29 km), Pesce (2,39 km), Petrillo (0,98 km), Pianelle (2,29 km), Ponte Sorgenza (1,19 km), Pontelandolfo Scalo (2,50 km), Santa Caterina (2,42 km), Santa Maria degli Angeli (4,24 km), Santillo (2,45 km), Sorgenza (1,22 km), Spappolla (1,99 km), Sticco (4,20 km)
The number in parentheses following each village name indicate the distance between the same village and the municipality of Pontelandolfo.
The locality of Trippa Bella rises 760 meters abobe sea level.
The population of Trippa Bella counts 10 inhabitants.Please find in what follows:
- A set of photos about Trippa Bella (when available)
- Weather and weather forecast for the municipality of Pontelandolfo, to whom Trippa Bella belongs.
- Map and road map of Trippa Bella
- A selection of videos about Trippa Bella
- The latest news about Trippa Bella, the municipality of Pontelandolfo, the province of Benevento and the Campania region.


text:
Brian Wilson Teaming Up With Jeff Beck For 11th Solo Album
Monday, June 10, 2013
Brian Wilson is back with Capitol Records after a four-year layoff in which he recorded two albums for Walt Disney Records. The still untitled set is being self-produced by Wilson with contributions from Beach Boys co-founders Al Jardine and David Marks, Jeff Beck and his rhythm section, Vinnie Colaiuta and Tal Wilkenfeld -- along with members of Wilson's longtime ensemble, and studio vets Don Was and Jim Keltner. There's been no release date set for the new album, which is the followup to Wilson's 2011 collection, Songs In The Key Of Disney.
Wilson spoke about his admiration for Jeff Beck -- whom he recently appeared with at a Rock N' Roll Fantasy Camp, saying, "When I watched Jeff Beck perform 'Surf's Up' to honor me at the MusiCares Person of the Year event in 2005, I knew I had to find a way to work with him. He absolutely blew my mind and we've been friends ever since. Jeff's incredible guitar playing is exactly what I want for my new album and I'm also looking forward to performing live with him soon."
He credits the fans reaction to the Beach Boy's 50th anniversary tour last year for inspiring him to polish off some new material: "I was really moved by the fans' excitement about the Beach Boys' album and tour last year. It charged me up and my head was full of music -- I just couldn't wait to get back into the studio to let it out."
Brian Wilson spoke about his fondness for Capitol which was the home to all of the Beach Boys' legendary '60s classics: "Capitol Records is an old stomping ground place where I recorded 46 years ago. Which I thought to myself, 'Gee, what a sentimental experience it was to go back there to Studio A of Capitol. Yeah, I think the full circle is back."
Brian Wilson with Al Jardine and David Marks tour dates (subject to change):
July 20 - Atlantic City, NJ - The Grand
July 21 - Pittsburgh, PA - Stage AE
July 23 - Interlochen, MI - Kresge Auditorium
July 25 - Kettering, OH - Fraze Pavilion For The Performing Arts
July 26 - Highland Park, IL - Ravinia Festival At Ravinia Park
July 27 - Apple Valley, MN - Minnesota Zoo Amphitheater
October 20 - Los Angeles, CA - Greek Theatre
Photo Courtesy of James Minchin III
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Pumpkin Dip
When I was coming up with my Thanksgiving menu the first thing that I started on was an appetizer. I was planning the menu shortly after making the hot cheesy mushroom dip so dips were on my mind and on a whim I thought; Why not a cheesy pumpkin dip? A quick search on the web showed that not only had it been done before, but that it was quite common! This pumpkin dip is pretty simple, consisting of pumpkin puree, cream cheese, sugar and pumpkin pie spices. This pumpkin dip kind of reminds me of a pumpkin cheesecake and as a gingersnap crust is wonderful on a pumpkin cheesecake I was immediately thinking about serving the dip with gingersnap cookies. If you want to keep it a bit healthier, sliced apples also work great.
Pumpkin Dip
A sweet pumpkin pie cheesecake dip that is perfect for entertaining.
Servings: makes 4 servings
Prep Time: 5 minutes
Cook Time: 0 minutes
Total Time: 5 minutes
Printable Recipe
- 2 cups pumpkin puree
- 1 (8 ounce) package cream cheese, room temperature
- 1 cup brown sugar
- 1 teaspoon cinnamon
- 1/2 teaspoon ginger
- 1/4 teaspoon cloves
- 1/4 teaspoon nutmeg
- Mix everything, cover and chill overnight in the fridge.
Similar Recipes:
Pumpkin Pie White Hot Chocolate
Pumpkin Pie Milkshake
Pumpkin Pie French Toast
Pumpkin Pie Oatmeal
Pumpkin Hummus


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Nancy Eckerson: What is your current fitness level?
Sunday, December 30, 2012
The end of the year, and beginning of a new one – it's the perfect time to reflect on what you've accomplished and what new goals and adventures await in the future. As runners, exercise can mean less about weight control and how we look and more about how our bodies perform and finding out what we are capable of.The number one resolution on most people's lists is to get fit, and I thought it would be interesting to take a look at a myriad of fitness test standards with running components; you can look at these standards to see where you rank and use them to put in perspective your current fitness, or perhaps fuel a few new goals. While there is more to overall fitness than just running, I'll focus on only the running standards for men and women, age 35; follow the provided links at the end of the column to find your own age group and the rest of the standards.
Finally, there is what was once known as the Presidential Physical Fitness Award, created back in 1956 as a baseline for grade school children to see if they met certain fitness standards; you may remember the sit-ups and pull-ups or flexed arm hang and the beloved shuttle run and longer endurance run of up to a mile. Now known as the President's Challenge, there is both a youth and adult component.For the adult fitness test, you can enter your test results on-line andfind out your percentile score based on normative data of people in your age group. For example, a woman age 35, running the one and a half mile test in 11:30 (pace of 7:40) receives a score in the 90% percentile.To fuel a little competitive fire, you can also join the Presidential Champions Challenge where both adults and children can log activities and earn points towards awards.
Whatever running plans you have in the year ahead, the most important one to have is to keep at it – sign up for that first race of the year, or race series if that helps to motivate you through the colder months. Challenge yourself to meet faster standards, or try a longer race distance for the first time. You will reap the benefits now and in the future.
Running Notes


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Dragon Ball Z Episode 129
You are going to watch Dragon Ball Z Anime Show for free with English Subs Episode 129 Online.
if Dragon Ball Z – Episode 129 are not working, please try one of the Video Mirrors.
Upload by: chia214
Updated: November 7, 2012
You are watching Dragon Ball Z Episode 129 in High Quality English subbed. Dragon Ball Z Episode 129 is from Dragon Ball Z anime series. If you enjoyed Dragon Ball Z Episode 129 please share it with others! Please note that this Episode is hosted on a third-party video sharing website, and it is not affiliated with Chia-Anime.


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Poonam unveils Helen post...
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A threat to girls' education anywhere is a threat to progress everywhere.
USAID has helped 7,600 Nepali farmers in commercial agriculture increase their net sales by 800 percent.
Annual Calendar 2015
USAID, in partnership with a local private bank, will reach 8,100 customers via branchless mobile banking outlets in eight districts of Nepal.
A health worker treats a newborn's umbilical cord with chlorhexidine, which will prevent infection in the baby. USAID is saving newborn lives across Nepal with this treatment through a national program supported by the Grand Challenges for Development.
About Nepal
Landlocked between India and China, two rapidly changing countries, Nepal remains one of the poorest countries in the world and continues to cope with the effects of a decade-long insurgency that ended in 2006. Located in the Himalaya mountain range, the country is greatly impacted by global climate change and struggles with both water scarcity in some areas and increased flooding in others. Supporting progress toward a democratic, resilient and prosperous Nepal is a priority for U.S. development efforts.
USAID programs in Nepal seek to reinforce recent gains in peace and security, stabilize the transitional government, strengthen the delivery of essential social services, expand proven health interventions, and address the global challenges of food insecurity and climate change.
Last updated: March 30, 2015


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Free Audio Travel Guide Downloads for Smart Phones
Planning a big trip? Skip the tour guide and check out Audissey.com! You can download a guide to your iPod or Smart Phone and literally listen to an audio tour wherever you're at! The idea is to replace the old school paper guides and be able to have your own personal guide via audio. It does sound pretty cool and it's FREE!
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Carrying a toddler during pregnancy probably isn't a good idea. As your belly expands, your center of gravity shifts. This puts lot of pressure on your lower back. Also, body changes early in pregnancy can make you more prone to feeling lightheaded when you stand up. So if you reach down and lift a toddler straight up, you may feel weak or dizzy for minute or two.
This may be difficult to explain to your toddler. Be creative about strategies to keep your toddler feeling special. You can sit down and have your toddler sit on your lap for hugs, and use a stroller when you're on the go. Friends and family can help carry a sleeping toddler to bed.
If you must lift your toddler from time to time, bend your knees and try to keep your back straight. Flat shoes and back support products in pregnancy may help reduce the strain on your lower back.
In the early months, if it doesn't hurt your back, it's probably okay. Taper off after four or five months, though. Try letting your toddler sit on your lap instead and encourage him to walk with you instead of being carried.


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naturally neat. Decluttering gets down to earth. Revealing naturally warm tones and smooth wood grain, beautifully spare eucalyptus planks construct a slatted design that corrals toys, magazines, accessories and other clutter. Neat cutout handles make it easy to move room to room.
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eucalyptus large storage box. 16"Wx11.75"Dx8"H
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Timberdoodle Farm
Broccoli year round call for hours
also pick your own Basil, Chives, Garlic, Nettles, Onions, Parsley, Rosemary, Sage, Swiss chard, Tomatoes in season
|North Scituate, RI
40 mi
Tangerini's Spring Street Farm
some organic
Broccoli 9:00 a.m. to 7:00p.m. Check our ripening schedule on our website.
also pick your own Basil, Blueberries, Cantaloupe, Corn, Cucumbers, Cut Flowers, Eggplant, Garlic, Gourds, Green beans, Lettuce, Peas (snap), Peppers, Pumpkins, Radishes, Raspberries, Salad greens, Summer squash, Sunflowers, Tomatoes, Watermelons, Winter squash, Zucchini in season
|Millis, MA
68 mi
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text:
Two police officers were in Haverhill District Court yesterday — not as prosecution witnesses, but as defendants in late-night fracas during which one off-duty officer Tasered the other. Lawrence Patrolman Daron Fraser was charged with domestic assault and battery and assault on a pregnant woman outside her home in Haverhill Tuesday night. Kingston NH Patrolman Joshua Wallar, who subdued Fraser with a Taser issued by his department, was charged with assault and battery with a dangerous weapon.Read more »
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