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ID 2016-2224 Job Location US-WA-Seattle Posted Date 2/19/2016 More information about this job: Overview: At Accolade, we?re transforming the way people experience healthcare. We believe that conventional approaches are failing American families, and reject the notion that5/28/2016 Seattle, WA Save This Job
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Product Apply now Posted: July 6, 2016 Full-Time Atlanta, GA, United States The Customer Experience Quality Manager leads the Allconnect quality assurance and customer satisfaction functions. Additionally this resource acts as an internal consultant to the product, operations7/21/2016 Atlanta, GA Save This Job


text:
The Best Thing About You Test
Their result for The Best Thing About You Test ...
Humility is your strongest virtue. You are humble.
Humility is the defining characteristic of an unpretentious and modest person, someone who does not think that he or she is better or more important than others. And you? When you do the right thing, you're doing it for all the right reasons. All 7 virtues are a part of you, but your humility runs deepest.
It is likely you're a quiet type. But if not, then you just have dark, secret side that loves to give.
Humble famous people: JD Salinger, Isaac Newton, Harry Potter (pre-puberty)
Your raw relative scores follow. 0% is low, and 100% is perfect, nearly impossible. Note that I pitted the virtues against each other, so in some way these are relative scores. It's impossible to score high on all of them, and a low score on one is just relatively low compared to the other virtues.
60% Compassion
44% Intelligence
75% Humility
56% Honesty
0% Discipline
29% Courage
42% Passion
Their Analysis (Vertical line = Average)
They scored 60% on Compassion, higher than 73% of your peers.
They scored 44% on Intelligence, higher than 38% of your peers.
They scored 75% on Humility, higher than 86% of your peers.
They scored 56% on Honesty, higher than 40% of your peers.
They scored 0% on Discipline, higher than 3% of your peers.
They scored 29% on Courage, higher than 27% of your peers.
They scored 42% on Passion, higher than 36% of your peers.
All possible test results
Passion is an intense emotion that compels feeling, enthusiasm, or desire for anything, and that often requires action. Get that? Requires action. It's very lik... Read more
Courage, also known as bravery, will and fortitude, is the ability to confront fear, pain, risk, danger, and all that. "P... Read more
Discipline is the act of enduring that which you don't dig ("the shit"), even though you could be doing something else more fun, because the shit is better for you in the long run.... Read more
Honesty is the human quality of communicating and acting truthfully. This includes listening, and any action in the human reperto... Read more
Humility is the defining characteristic of an unpretentious and modest person, someone who does not think that he or she is bette... Read more
Compassion is the most human of the virtues. And you? Your heart has limits far beyond normal levels empathy, and your capacity for feeling the world's pain is boundless.&nbs... Read more
Intelligence (also called intellect) is an umbrella term used to describe a property of the mind that encompasses many related abilities, such as the capacities to... Read more
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Talib Kweli sits down with HardKnock TV to discuss his first influence in Hip-Hop, how he came up with his new album title, his feelings on MTV's hottest MC list, and more.
Nick Cannon Shares Bruised Spoken Word Inspired By Dallas Police Shootings
Stream Jarren Benton's "Slow Motion Vol. 2" Project
Backed By Cardo Production, Hardo Knows How To "Represent"
DJ Esco and Future Team Up For OJ Simpson-Inspired "Juice" Video
Copyright © 2015 Boi-1da.net. All rights reserved.


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By Dale Gillard
Open the Mac App Store to buy and download apps.
Work faster with Pages, Keynote, Numbers and now iBooks Author.
Don't wait for an app to launch and open a document you've just used. Instead choose Token's icon from your Mac's menu bar and open a recent iWork or iBooks Author document.
• Quickly access your personal iWork templates from Token's menu.
• Choose Apple-designed templates for iBooks Author and your personal templates from Token's menu
Still using OS X Snow Leopard and want to Auto Save your documents? Token will save your iWork documents automatically at regular intervals.
NB Feature not available on OS X Lion and newer.
• Download AppleScripts to automate your work and trigger them from Token's menu.
• Visit the Token Extras web page to download more than 20 sample AppleScripts to customise for your own tasks.
• Requires an iWork app (Pages, Keynote, Numbers) or iBooks Author.
• Compatible with OS X 10.6 and newer.
NB Token adds an icon to the right side of the Mac menu bar and does not use a Dock icon. The Mac App Store will put the Token icon in your Dock but you can safely remove it.
iWork, Keynote, Numbers, Pages and iBooks Author are trademarks of Apple Inc.
What's New in Version 1.3.1
* Fixed bug where Auto Save repeated too frequently if using Snow Leopard (OS X 10.6)
- ฿99.00
- Category: Productivity
- Updated: 15 June 2012
- Version: 1.3.1
- Size: 0.4 MB
- Languages: English, Dutch, French, German, Italian, Portuguese
- Developer: Dale Gillard
- © 2015 Dale Gillard
Compatibility: OS X 10.6 or later


text:
West Country Travel
A look at what's happening on the roads, trains, and planes.
A look at what's happening on the roads, trains, and planes.
Fifteen million motorists are expected to hit the roads roads this Easter Bank holiday weekend with the AA issuing a warning that the worst traffic jams will be for drivers travelling to the south west.
Roadworks have been removed from parts of the M5 to help the Easter getaway - but major work on the M4 will continue, with queues already building around Bristol, especially going towards junction 19.
It's looking like a damp night tonight and then tomorrow morning won't be good either. Through the week the picture stays varied.
It's a mild and wet night coming up with a wet morning ahead...and the weather looks like staying like that for the next few days.
A Gloucester couple were left shocked after a banana plant that's never looked like flowering in its 20 years suddenly produced fruit.


text:
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text:
tag:blogger.com,1999:blog-87687482016-07-23T12:19:40.573-05:00Life (and death)...My life as a Malaysian doctor in the United States.vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-88134643690296068162016-07-23T07:04:00.000-05:002016-07-23T07:04:20.147-05:00CGMS
About 20% of my diabetes patients have type 1. And as any patient or physician will know, this can be more challenging than type 2 in many ways- for one a person is completely dependent on exogenous insulin to survive. For some, this insulin-glucose-meal-exercise relationship can be very precarious and brittle.

And to make things worse, over time, many lose their protective senses and have hypoglycemia unawareness. Not being able to rely on symptoms to warn you of low glucose- palpitations, tremors, sweating. The first sign of low sugars might very well be loss of consciousness and a seizure.

Many of my patients try their best- they test their glucose all day. They carry glucose tablets, glucagon at home and at work, medic-alert ID. But sometimes, that might not be enough.

Last month, I lost perhaps my 5th patient in the 8 years I've been here to hypoglycemia. Mr F. was a 52 year old man with very brittle diabetes. He was prone to episodes of diabetic ketoacidosis or hypoglycemia, and was a frequent visitor to the emergency department. It was clear that he would benefit from having closer monitoring with a continuous glucose monitoring system (CGMS). However, these things are very pricey, and while it might be partially covered by some insurance, there is still a huge cost to patients. And his insurance unfortunately did not cover this.

One morning his wife came home and found him unconscious in the living room, drooling and having some twitches. She called 911 and have him a glucagon shot. When EMS arrived, his glucose was 23 mg/dL. He was brought to the hospital, but despite treatment, did not regain consciously. The neurologist felt that he suffered irreversible anoxic/metabolic brain injury. He passed away a week later, in hospice care. I felt his family's pain, after having been his doctor for 7 years, and seeing him struggle.

And so, thinking about him, and many other patients like him, yesterday marked a big step for continuous glucose monitoring devices.

The FDA advisory panel recommended allowing Dexcom to change its label- from a device meant to be used to supplement glucometer data, to a a nonadjunctive use.

The concern has always been if measuring glucose continuously from interstitial fluid, is accurate enough to be relied on for insulin dosing, versus blood glucose. And the truth is, when the earlier generations of CGMS came out they were unreliable, and a hassle to use. I remember seeing a few during training and thinking, "Who would pay to use this?".

This has evolved to very sleek, reliable (somewhat) and frankly, life-saving devices. And they are not too uncomfortable- I wore one for a few weeks to get a sense of how it feels.

The major hurdle for many is cost; and though it might be covered by insurance, there is still a significant out of pocket cost. In addition, Medicare does not cover these at all, so for my older patients, this is not a viable option. One reason has been it was felt to be "experimental".

If the FDA grants it full approval, it would mean they acknowledge that though it's not a perfect device, it's good enough to not have to prick your finger 4-6 times a day to get glucose data (you still need to do so twice a day for calibration). And hopefully, this will lead to eventual change- better coverage by insurors and more accessibility for patients.

Sadly, this will not come at least for a year I'd imagine- it takes time for insurance companies to change their policies. And it will come too late for Mr. F. But I hope this will make a difference for many others.
vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-810086916193480772016-07-13T07:19:00.003-05:002016-07-13T07:19:25.061-05:00Dumb...
Bell

Get it? Dumb Bell.

Ok, this is a geek post.

As you probably already know, I like space. No, I'm not claustrophobic- but I like all that is related to astronomy.

I'm a Trekkie. I'm a Star Wars fan. All manner of Sci-fi.

One of my favorite books is Stephen Hawking's A Brief History of Time (now, how's THAT for a bedtime story?).

Anyway, I've had my telescope for several years. It's a 4" Celestron Maksutov Cassegrain scope with computerized goto altazimuth mount. I love it. It's given me hours of viewing pleasure. But the mount has always been limiting me to solar system photography- while it tracks the stars, it does not rotate along Earth's axis.

So this year, with the blessings of the wife, I upgraded to an 8" scope with an equatorial mount. And took a deeper (much more expensive) step into astrophotography.

Meet Big Brother....

I still have much much more to learn about deep space objects. But I was particularly proud of this one.

This was a picture of the Dumb Bell Nebula, or M27. A planetary nebula 1360 light-years away in the constellation Vulpecula. So the light took over 1000 years to hit the camera's sensors.

It was a 20-minute stacked picture at ISO 800.

Sleeping 4 hours that night and feeding the mosquitoes in the backyard was worth it.

More to come in the future.
vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-88887339459426842122016-06-27T20:43:00.001-05:002016-07-13T06:58:07.538-05:00Bedtime Stories
So last night, as I was putting the girls to sleep, they asked for a bedtime story.

"Something about a Princess!", Ava gushed. After all, it's princess everything, these days.

So I told them the story of the princess who lived on a mountain, who ate too much candy and developed diabetes, and how Prince Metformin came to her rescue, and along with diet and exercise, lowered her blood sugars from 200 to 100 mg/dL and saved her from the clutches of neuropathy, retinopathy and nephropathy, and they lived happily ever after.

Something tells me someday they're going to take away my Daddy License. I'm gonna need to work on my bedtime stories 😜.

vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-43617233602441194562016-06-19T08:04:00.002-05:002016-06-19T08:04:36.873-05:00Happy Father's Day

Happy Father's Day!

Thank you. For all the sacrifices you have made. Things that I never understood as a child- why you'd spend so much time at work (to ensure your family was provided for), why I got spanked (when I was up to no good), why you pushed me when I wanted to give up. For your love, support and quiet strength, and for being the role model you are.

Being a parent changes one's perspective, doesn't it? I see things a bit differently now. Like how noisy babies on a plane don't bother me anymore (if anything else, I give them a look of empathy). You look at not just the beauty of the world, but the hidden dangers that may hurt your child. You avoid taking unnecessary risks, to keep your kids safe. You get excited over not cars, but over cute kiddie dresses, or nail paint colors, or stick-on earrings. Your TV spends most of its time tuned in to NickJr or Disney.

You're convinced that your greatest achievement in this world, is having those kids in your life. And part of you fears the inevitable day, then your kids leave home and start their own journeys into the real world, and you can only hope that you gave them a good enough of life's roadmap to make the right choices.

To all the dads, granddads, dads-to-be: Happy Father's Day!
vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-3661725605994870282016-06-07T07:02:00.001-05:002016-06-07T07:02:08.414-05:008th Anniversary

In the blink of an eye, it's been 8 years.

2 kids, 2 dogs, 5 cars, 2 cities and 3 jobs later.

Though I look nothing like that picture anymore. I've aged significantly while my forehead has, ahem, grown upwards (ie am balding), while my wife has only grown more beautiful, wise and graceful over the years.

Happy Anniversary, honey!

To many more to come!
vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-35942393809799807612016-05-30T20:21:00.001-05:002016-05-30T20:51:22.038-05:00Of Expirations and Best Before Dates...
Question: Is it safe to consume ikan bilis that expired 4 years ago, or sambal paste from 3 years ago, or rendang mix that expired in 2011?

Affirmative. Affirmative. Affirmative.

As with other few (precious) weekends when I get to play the role of bachelor, when my wife is away visiting family, or at some medical conference, I turn to my vices. And in some ways I wish I could say my life was exciting enough to have secret sex orgies, or drunken escapades, or spending the night in the 'lokap' when I'm a free man, no, what I really do is cook.

As in cook Malaysian food that my kids, wife, neighbors and American friends consider to be more pungent than fermented gym socks.

And because I can't usually cook certain aromatic, spicy dishes, I hoard racks and racks of Malaysian spices. If you're a Malaysian expat living in abroad, you know what I mean. That pack of Bak Kut Teh spices or Rendang paste is more precious than my left arm.

So when you hoard stuff that you don't usually get to use, the inevitable happens. They expire. But who in their right minds would throw away otherwise perfectly 'good' food and spices from the Motherland??

After all, expiration dates are a government conspiracy. I tell my wife that nothing vacuum packed/frozen ever goes bad.

This weekend, with the missus being away at Boston with one of the girls, I took the opportunity to make Nasi Lemak.

My wife would rather inhale the air in a small sauna with a dozen flatulent sumo wrestlers than to smell ikan bilis. And with my kid having a peanut allergy, this is a no-no in our household. But with me being semi-alone this week, the timing was perfect.

Except I then noted the print on the packets. April 2012 for the ikan bilis. Ogos 2013 for the sambal paste, and Feb 2011 for the rendang spices.

For a moment, I thought about tossing them and not risking it. For all of 2 seconds.

But then I realized I already have my last will and testament and trust all written up. And life insurance policy in place. And my retirement portfolio has done quite well so far. So the family would be OK without me should shit happen. Literally.

And so, voila:

Nasi Lemak with sambal ikan bilis, ayam rendang, satay sauce. 8 hours later, I'm still alive and kicking. No gastronomic catastrophe yet. I haven't gone blind yet.

Except Ava was getting worried for me, seeing how much I was sweating. The beads of sweat was literally dripping off my head.

In retrospect, perhaps making a spicy dish on a warm 30C day wasn't the best time. But man, it was worth it. And perhaps speaking as someone who hasn't tried it, but there is no way some orgy would be more satisfying that a spicy nasi lemak meal.

Or can it?
vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-7883889839062322202016-05-29T20:09:00.000-05:002016-05-30T20:16:42.386-05:00On The Mend
Thanks for the well wishes. The trooper she is, she seems to be on the mend steadily. She had her "permanent" cast placed the other day, And being smaller, and below-elbow, it's proving to be more comfortable. And she was actually excited to be given several choices for color- she picked tie-dye.

The pain is completely gone. Gone enough that we have to keep reminding her to not do anything too physical. After all, my greatest nightmare is to need an ORIF.

And yes, that's a hula hoop she's holding- but that's about all we're letting her do. No slides, climbing, trampolines.

She was initially unsure of how her schoolmates would react. I have to remind myself that they grow so fast- and now she's already to the point where she cares about what others think.

But when she learnt that she could customize the cast, this gave her something to look forward too.

And so, daddy hot-glued some crystals on it. And because she's always wanted to be a superhero, I put a Batman patch on her sling.

Now she's all set to take on the world. Just don't be breaking any more bones!
vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-11871495785059575942016-05-22T17:01:00.001-05:002016-05-22T17:13:55.048-05:00Poor Alli
It's one thing being the doctor.

It's a totally different thing being a father.

I learnt this the hard way a few days ago. Allison had learnt how to use the monkey bars at school, and so wanted to show us she could do it.

Inevitably, when you wage a battle with gravity, gravity always wins. And so she fell, and suffered a distal radial fracture.

While it was not life threatening, it breaks the heart, seeing her cry, and knowing even before the X-rays that the radius was fractured. After all, there was an obvious body deformity.

The X-rays and fluoro told us all we needed to know.

I've seen perhaps 20-30 fracture reductions during medical school and residency. Not a whole lot, since my career path was destined for a nonsurgical route. While I've always felt for the patient in pain, I've never experienced anything like this.

Seeing your own daughter, in so much pain, in so much fear, looking at the foreign white lights of the ER. Seeing the strangers in white coats (not something she is used to, since neither mom nor dad wear white coats to work), poking and prodding.

And then, despite the sedation and pain medication, seeing the orthopedic surgeon reducing the displaced fracture. Despite the sedation, she was somewhat whimpering. And it was sickening, nauseating even, to see your child's distal forearm manhandled, and twisted in abnormal ways to reduce and reposition the fractured fragments. I'm glad I sent my wife and other child out- even I could not keep my eyes dry.

Thankfully, that did not last too long. And so, after a 4 hour ER visit, she went home. With a cast that she will wear for the next 2 months, right into summer vacation, right into her birthday.

She's not happy that she has to miss swim class, or skip gymnastics, or riding her bike, or jumping on the trampoline. But she's being a trouper so far. And perhaps even finding things to look forward to, like how she wants to decorate her cast, or her sling.

Hopefully, this will all be over soon.

But it has me thinking wondering if playsets with monkey bars are secretly sold by companies owned by the American Orthopaedic Association?

vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-73914968557816729272016-05-17T22:04:00.001-05:002016-05-17T22:04:23.720-05:005 Years

I can't believe it has been 5 years since you left us.
How time flies, my friend. In those 5 years, the world continues to revolve but yet, our precious moments and memories of you become frozen forever.
Down here, much has changed. I've become more cynical, jaded, tired and aged. We now have two girls- you met the older one in your last weeks, remember? She's now in kindergarten, while the other is in preschool.
I miss our conversations; truth is with work and life as a parent, it's hard to form bonds like those we had, when we were relatively young and carefree, and it's hard to find a confidante to fill your shoes. I miss those sessions we would have over a meal, or Halo, complaining about work or life (usually it's me, with your patiently listening). Now, I like to imagine that when all is not well, somewhere up there you're still listening...
I sometimes think about the unfairness of life; of why someone like you would be taken away so soon, so young. Truth be told, I've asked myself many times in the past- why a man like you? Why not someone like me? After all, you'd leave a bigger mark in this world than I ever would. Or maybe that was the point- to teach the rest of us who have much to learn, how to life live and make the most of things.
I remember the time when you told us that you decided to not carry on with chemotherapy. Being the oncologist you were, you knew the odds even before treatment began. And you knew when you had had enough, and you wanted to just make the most of your time. We both knew the implications of your decision, which was why we made that last minute trip back to Malaysia.
And I'm sure you knew, as I did, when we had dinner at that food court that evening in Penang, that that would be the last time we would ever see each other, at least in this world. Yet, in your usual quite demeanor, you seemed a bit embarrassed when Kris and I gave you our goodbye hugs. You were at peace and perhaps more ready to move on- but we certainly weren't.
You carried yourself with more strength and grace than I ever will know. You never once asked, "Why Me?". And did I ever share with you how I actually met the wife of one of your patients here; someone who was bitter and angry and had trouble accepting his diagnosis, until he found out that his oncologist had stage 4 esophageal cancer, and yet carried on in peace? His wife told me that you gave him newfound peace, that when he finally lost his battle, he was no longer angry.

Buddy- my best friend and confidante, my partner in crime during those 6 years at WFMC, my room-mate, my Best Man, my brother, my Halo teammate.

5 years ago, the world lost a wonderful man, brother, son, husband, oncologist. And yet, you remain near to those whose lives you've touched, never to be forgotten.

I miss you, buddy. Till we meet again someday... here's a toast to you. I'm sure you and our pal Gene are living it up there.

vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-32170286719704314412016-04-16T06:46:00.000-05:002016-04-16T06:46:13.391-05:00
Ok, I admit it.

I've gotten lazy.

It's been 3 weeks since my last post.

Therein lies the issue. Maybe life has gotten to be too mundane. Or busy with the kids. Or perhaps I'm just blissfully happy and have no need to vent out on my blog anymore . After all, I think that was one of the drivers for my posts:
Complaining about work.
Complaining about being homesick.
And perhaps most of all, complaining about being single (hoping that a girl would fall in love with me reading my blogs!)

It's interesting, a bit embarrassing, and maybe envy-inducing, reading my old posts, those going back 10 years ago when I was a trainee, working at the Mothership under the supervision of the Medical Gods, and seeing all those super-rare cases. Then coming home to a small rented house, hanging out with our community of Malaysian/Singaporean friends. I had a lot more free time then at night, and perhaps a lot of brain-juice and flowing creativity (hah).

I admit I've neglected this. For some reason, I just have less to say. I can't help but notice though I'm not the only one. Many of the blogs I used to follow (still sometimes check it out) are kinda like mine. Lapsed, infrequent entries. Or perhaps stopped completely. Are blogs fads that have passed, perhaps superseded by the newer social media platforms? After all, I vent and share so much more easily on Facebook, and at least I know the people there a bit better. I haven't yet caught up with Twitter or some of the other stuff out there, and it makes me feel old saying that.

Anyway, I'll still continue to update this with boring, mundane stuff. And the way life is right now, much of it will probably be of my most priceless possessions- my girls (wife included). I'm not even sure if I have any real readers anymore, beside those spambots- feel free to drop me a line if there are real people out there.

Happy weekend.
vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-25906915570795955892016-03-23T13:52:00.002-05:002016-03-23T13:52:14.117-05:0015 years
The wife and I were talking last night, when our university days came up.

And I started off wanting to say that it wasn't that long ago that I was in university.

Until I actually stopped to count, and realized to my horror:

I have been a doctor for 15 years.

FIFTEEN.

15 years ago, I had those letters M and D added to my professional/academic name. Be it a blessing or a curse, it's been with me since.

Holy cow- did the 15 years just whizzed by. After all, between that day (graduation) and now, I've done clinical teaching at IMU in Bukit Jalil, completed my residency in internal medicine at WFMC, followed by 3 years of fellowship in endocrinology, gotten married (twice- but to the same girl thankfully!)(in the USA and Malaysia, lah!), had 2 kids, and have been in practice for 8 years.

It's true what they say about time flying. But it's also interesting to note how I've changed professionally. Sadly enough. After all, ask any keen medical student, and they'll tell you they're going to change the world and help everyone. But somehow along the way, you get jaded, numbed and burnt out from the harsh realities of medicine in the USA: the complexities of health insurance and the skyrocketing cost of care and medications, the greed you sometimes see from industry, the bureaucracy, the lawyers and administrators. And yes, sometimes the patients too- when they argue and fight or are simply indifferent.

But, life goes on. We do what we can. Perhaps less of a spring in our steps, but we have after all taken that oath, and it's one I intend to keep. And the few guiding principles I try to live by:

The needs of the patient come first

Primum non nocere

I wonder where I'll be in the next 15 years?
vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-3054972389189027602016-03-06T07:28:00.001-06:002016-03-06T08:08:17.401-06:00Disney Cruise, Part 2
Ok, this is a bit of an outdated post, but I've been busy (and lazy).

We got back from our 2nd Disney cruise a couple of weeks ago. Again, we sailed on the magnificent Disney Dream ship. It was no surprise that Cruise Critics awarded the Dream the 2016 Cruisers' Choice award.

We went on this cruise with family last year. And this year, it was a long-overdue reunion with friends from my medical residency days, including one from Malaysia.

The last time we all met up, there was only 1 child amongst us.

Now, well, the picture speaks for itself.

The last time this group got together, it was 2004!

This time, we took the 5 day/4 night cruise to the Bahamas (we did 3 nights the last time). And like the last time, we had a blast. There is always much to do on the ship- plenty of activities for the children: a huge playroom with free child watch, with enough stuff that I had fun there too (I mean,come on, they had a mock up of the Millenium Falcon!!) and the kids spent hours there. Meals were provided in the playroom if the kids wanted to stay, and adults get a "wave" phone that allowed them to text you if your child wanted to be picked up. But the one thing I was surprised by the first time, was the amount of activities to keep the adults occupied. Sports bars, jazz bars, karaoke, games,gym, adults-only pool. And this time, at last knowing the layout of the better, we were able to explore much more compared to the last time.

The first day was spent sailing from Port Canaveral to Nassau, Bahamas.It was a quick overnight sail, with the ship getting into port in the morning. The kids wanted to stay in the playroom so the wife and I were able to explore the island on our own a bit. We got to sample some pretty good rum cake. And the straw market is an easy 5 minute walk from the port- plenty of nice little souvenirs you can get; and they're always open to haggling (I wish I brought my mom!).

We left port that evening, and sailed towards perhaps what is the most amazing part- Disney's private Bahamian island, Castaway Cay. We arrived at about 8AM the following day. It's a smallish island, only about 4 km2- but large enough to give the cruisers plenty of space to have fun and explore. Pick your activities- the two family beaches including one with water slides, the adults only beach, cabanas for rent, water sports, kids' play areas, snorkelling, biking, character meeting. Of all the activities, my wife had to sign us up for the Castaway Cay 5 km run! I suppose it was a good way to burn calories from the amazing food.

Truth be told, the February waters were a bit too cold for me (though the air temp was comfortable). That didn't stop the hordes of swimmers though. After saying farewell to the island, we sailed off- day 4 was spent a sea- and this was the difference between the 3 and 4 night cruise. This was actually a nice welcome- it turned out to be a relaxing day as you didn't have to rush and get everyone ready to disembark for activities. So we just replenished our Vitamin D, laying on the deck on the bow of the ship, and hung out with the other adults in the group.

We got back to port about 6AM the following day. After an early breakfast, we disembarked early at about 8AM to do some exploring in Orlando. All in all, it was another great cruise, and it was especially nice to see some old friends.

Would I sail Disney again? Hell, yes. Maybe not next year as the budget probably won't allow, but in a couple of years, perhaps.
If you're planning to do Disney, some words of advice:

If you want to explore the pool, choose an early boarding time

You'll need to pack a daybag, as your luggage will be brought to your room only many hours after you board. Obviously, you'll need swim gear if you intend to use the pool while waiting around- but it's a good idea to actually be wearing your swim suits under your clothes when you board. The last cruise, there was a long line for the ladies' restroom so the girls had to wait to get their suits on

You'll have a choice of first or 2nd dining for meals- with younger kids, I'd say the first dining is best- you get to have your dinner and catch the shows after that. And the shows were excellent- don't miss them

Consider using travel agency for booking. We used Dreams Unlimited- fares were the same as the Disney website, but very helpful agent, and they give freebies, as well as onboard credit ($100 this time, and $250 the last cruise- so it's really a rebate).

Plenty of websites with room suggestions- check it out. Very helpful times. We got a deluxe verandah room with balcony- on the port side of deck 8. I thought this was a great location. Port side is where they dock on Castaway Cay; but if you want a view of the beach from your room, then pick starboard.

I think this changes depending on wind conditions- but the two times we sailed with them the fireworks on Pirate Night was towards starboard, so not visible from our room.

Alcohol is pricey. Yet, they allow you to hand carry alcohol onboard if you wish- check out the website for limits.

If you have young kids, bring their pirate/princess costumes- great photo ops for Christmas cards.

Likewise, if you intend to give the girls a treat and send them to the Bibbidy-Bobbity Boutique, dress them up in their princess dress and then take them there- you'll save a huge bundle having them do the hair package only, but yet they'll already be in their dress. They'll feel like real princesses for a few days!

vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-23535180509957985022016-02-14T14:29:00.003-06:002016-02-14T14:29:33.437-06:00Happy Valentine's Day!I saw this on FB today. Sorry, the endocrine geek in me could not resist.

Happy Valentine's Day!
vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-47614687528529890202016-02-13T05:47:00.001-06:002016-02-13T06:04:59.064-06:00John Cena
One of my patients broke his leg the other day. A 27 year old man with type 1 diabetes who also has cognitive disabilities. Had a hypoglycemic episode and fell down a flight of stairs and unfortunately fractured his right tibia. I saw him a few days after his surgery, and he was in some pain, and crying because he wanted to go home to his bed.

He happens to be a a huge fan of WWE. This was obvious in the years I have seen him in clinic- he would always come in his WWE cap. To him, John Cena was God himself. And so, yesterday, I dropped by his hospital room to drop this off.

Sometimes, it's fun to get to know your patients. Despite all the frustrations of this job, perhaps the greatest joy is getting to know your patients and feeling like you're a part of their lives. He was still yearning to go home, and was still in some pain, but the smile he flashed when he saw this was priceless. The nurses later told me they hadn't seem him eat so well since he was admitted (though not necessarily a good thing with his diabetes :) )

Ava even drew him a picture/get well soon message. Note the bleeding from the right leg.

vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-41388118800131829652016-02-07T15:04:00.001-06:002016-02-07T15:04:15.041-06:00Happy New Year!

Happy Chinese New Year!

Another year, another CNY.

Can't believe it's already 2016. And can't believe it's another CNY. Well, it's not hard to forget living in the relatively culturally secluded Midwest, where there isn't much festivities.

Year of the Monkey. None of my kids are monkeys, though they certainly act like one sometimes. However, my late Ah Kong was a monkey. Until his final years when he was showing some dementia, he was always soft-spoken, gentle, and serious; not the kind of personality the horoscope would suggest.

This is always the time of year when I yearn for home (yes, this is home now, but you know what I mean) the most. When you get a flood of memories, the traditions your family has. The things you'd do, even if you didn't understand why. Traditions you know will die with you, as you plant your new roots in a different land, on which you will make new traditions for your kids to pass on- but not the kind of traditions you grew up with. Bittersweet, but alas, to be expected raising kids here.

However, the standing plan currently, if budget and time permit, is for the family to spend Chinese New Year 2017 in Malaysia. It's ambitious, and with Allison in school now, we'll have to take her out. And the ticket prices will be horribly expensive. But it's important to me that my children at least see and experience a Malaysian Chinese New Year with my parents at least once, so that they'll somewhat understand what their daddy did during his version of 'Christmas'. Thankfully, my wife understands this is important to me. And so, 2017, we'll be there.

In the meantime, here's wishing all you readers, family, friends, loved ones, a Happy and Prosperous New Year, and may the Year of the Monkey be filled with silly laughter and happy memories.
vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-57057946580725817572016-02-04T05:57:00.002-06:002016-02-04T05:57:50.929-06:00Sick Day
I took my first sick day this week.

I just couldn't take it anymore- my head was pounding, I had a runny nose and congestion, and a sore throat. And so I asked the clinic to cancel my afternoon.

It was my first sick day in 14 months.

Strangely enough, there was no pride that it's been that long since I last called in sick.

Instead, I felt horrible for a few reasons.

For one, I felt an immense sense of guilt because I knew that would be pissing a long line of patients off. Patients who have waited 2-3 months to see me, especially the very-anxious new consults for a variety of issues they or their PCP felt was urgent and hormonal. And so, to cancel would mean rescheduling and waiting another few months. Who would not be miffed?

The second reason that I felt bad though, was just the sheer madness of the situation itself. I'm not proud that I have a 'clean' record of not taking time off for illness. Instead, I'm ashamed of it. I'm perplexed that we function in a world where either patients or doctors see it wrong, to be ill and to take time off for themselves. We see it unforgivable to make a patient reschedule- the very people who are often themselves on sick leaves to come see the doctor. And yet, for some stupid reason, we think so highly of ourselves that we think our immune system is s resistant to influenza, parainfluenza, rhinovirus, coronovirus, strep or whatever else germs are out there. Perhaps the M.D. degree hanging on my office wall had antimicrobial properties. But no; we are human too, and we do get sick. So why do we find it so difficult, why does the system make it so difficult, for us to acknowledge that, that often we go to work if we are ill, if we think it's mild and not too infectious?

Indeed, I posted something on my blog years ago- results of a survey asking if people preferred their sick doctor to still see them knowing that they might be infectious, or have their doctor reschedule the appointment and wait another few months to see them?

The results- most polled that they still preferred to see the sick doctor.
vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-38661635869402818532016-01-19T19:47:00.001-06:002016-01-19T20:40:52.949-06:00When Breath Becomes Air

After waiting a few weeks for this, I finally received it yesterday.

When Breath Becomes Air, a book by Dr. Paul Kalanithi, a Stanford trained neurosurgeon who was diagnosed with metastatic lung cancer during his residency.

The first part of the novel is about his early years, and his foray into the world of medicine. He shares his experiences during residency, and having gone though this myself, at many levels this hit close to home.
The 2nd part is about his struggles after his diagnosis. As a doctor and surgeon. As a husband, And later on, as a father. This too, hit close to home.

It was an easy read. It was a difficult read. It was a good read.

I couldn't put it down- and so I began reading the book at 6:30PM, and finished it at 10:45PM. By the end, I was a mess. I was quietly crying in bed as my wife and kids slept.

For one, this brought back all kinds of memories, experiences I have always been ashamed of, but could relate to. I remember the torture, the sheer exhaustion, as an intern. I remember the times when I could not take it any more, and had to go into the bathroom during rounds to just sit down and cry for a few more minutes, before I could go on with work again. We all start off human, but the truth is the training kills off part of the soul, part of the human side. Paul shares a story of how his colleague wished a patient had metastatic pancreatic cancer just so his Whipple's would be cancelled, and she could get some much needed rest; of how when she realized what she was thinking, she just broke down in shame. I can certainly relate to that. No matter how we try not to lose our humanity, sometimes you are so beyond exhausted that you think the unthinkable. I remember having had those days; when the nurse calls to tell you that your patient died overnight- the first thought that comes is that of gratitude, so that you have one less patient to round on, and you get perhaps another 15 minutes of precious sleep. I remember having that exact reaction- moments thinking that, that I started to cry uncontrollably in the oncall room because of the sheer shame I felt, even having that thought cross my mind. No, I've never ever told anyone those thoughts, until now. In a way, I'm relieved that I wasn't the only one cruel enough to think that, and I'm glad that was a phase of my training that is well behind me.

The 2nd part was difficult for me to read too, for obvious reasons. We've all lost patients, family, loved ones. And the person that obvious comes to mind was Buddy. After all, he could have written a book like this. Indeed, a now-stalled dream of mine once was to write a book about him- and though I have a few stories in my hard drive, the momentum is lost and the stories will instead be committed to the heart and mind. Anyway, this could have been his story though perhaps being a medical oncologist and not neurosurgeon, perhaps the work-related stories less dramatic. And instead of Stanford, we were at the other premier medical center. And instead of lung cancer, it was high grade adenocarcinoma of the distal esophagus. Paul died at 36; Buddy at 32. And though I would have loved to share his story on print, the reality is the stories will die with us, those of us who had the privilege of knowing him, and spending those last few precious years with him.

I remember how he broke the news about his cancer. I remember the chemotherapy sessions, the many hospital admissions for intolerable emesis and dehydration. I remember the discussions we had about sperm banking before the chemotherapy would kill his chances of fathering offspring. I remember being in awe of his apparent strength, his peace, despite the unfairness of having an uncurable cancer, with a dismal prognosis that as a cancer specialist he was only too aware of. I remember when Buddy asked me if he should marry his sweetheart, knowing very well that he would make her a widow. I remember asking myself, asking God, why him? Why Buddy, who was such a talented, wonderful human being? I remember asking the obvious: Why not me? It's a question I sometimes ponder still. Why him, and not me? He would have made such a positive difference in so many lives. Buddy was such a better human being, a doctor, than I would ever be. God, I miss him; but reading Paul Kalanithi's books brought back a flood of memories of my friend. And in a way, it was comforting reading Paul's words as it seemed to give me some insight into Buddy's psyche.

This would be the last I'd ever see him alive. We both knew; it was pretty obvious the way we said our goodbyes. He passed away a months after we visited him.

It's a good book. It was a real tearjerker for me. And perhaps in part because I am now a husband and father, it was particularly poignant that the book was completed posthumously by his wife because he took a turn for the worse unexpectedly. It made me think about how things would have been if I was in his shoes, at this stage of my life.

Ultimately, it's a book about faith, strength and love. I'd highly recommend it.

vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-36093072786272127372016-01-09T16:10:00.002-06:002016-01-09T16:10:54.023-06:00Why You Shouldn't Let Your Kids Play with Siri

So a word of caution to you parents out there with iPhones. The girls like to take our phones and talk to Siri. They find it hilarious that she can actually talk to them. They love to say things like "Call me Cinderella" etc. It's kinda cute actually.

I didn't think much of it, until I got this work-related email.

Addressed to Pretty Princess.

Obviously, this is visible only to the receipient- but I guffawed when I saw it.

I think I'll keep the nickname.

vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-51317328559747996752015-12-30T21:58:00.003-06:002015-12-30T21:58:53.405-06:00The Force Awakens
OK, I had to blog about this, right?

Whaddaya think? OMG, right?

I was blown away. Granted, I'm a scifi geek and I love Star Trek and Star Wars, and know enough about them that I wasn't going to be like that girl who went to the Star Wars opening night wearing a Starfleet uniform.

But geekiness and blind loyalty aside, it was a great show. Much better than the previous 3, with no stupid characters like Jar Jar, or corny lines. It was new and foreign enough to feel like a new movie, but yet had enough connections to keep it in the Star Wars family. And it doesn't leave you hanging completely as Episode 5, but does leave you in a bit of suspense at the end.

My goosebumps came out and hairs stood up on the back of my neck when the Star Wars theme came on. And it was a bonus that my 5 year old is into it too, and jumped up and smiled ear to ear when the show started.

The lightsabers. The X-wings. Millenium Falcon. The banshee-like screams of the TIE fighters. OMG OMG. I'm hyperventilating.

It was a great movie, and it's going to be a long wait till Episode 8. I'm not going to give away any of the plot- just go watch it and expect to have a great time. I know I will, for the 2nd time.
vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-39399710901711364842015-12-19T05:33:00.001-06:002015-12-30T21:47:49.605-06:00Perspectives
So the 5 year old hands me this. A picture she drew for daddy:

I was like, erm, thank you.

But how to you respond to your daughter who draws you that? All I could think was, maybe she's old enough that I shouldn't shower in front of her anymore.

I innocently ask her. "What did you draw?"

"I drew a giraffe for you, daddy. Can't you tell?"

Oooooooooo.

I guess I had my head in the gutter. Now I see it.
vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-14013452411041400482015-12-05T06:28:00.000-06:002015-12-05T06:40:45.472-06:00Ornaments

We put our tree up last weekend. And though there was a time I would have liked to have a uniform, clean, coordinated tree, in the recent years I've learnt to appreciate my wife's family tradition of getting trinkets and ornaments from events, people, places and adding them to the tree; putting them up certainly evokes certain memories.

Take this angel. A simple crystal angel sitting on a bell. I've had this for over 10 years now, but I remember where it came from. It was a nice gesture from a patient I was seeing in the hospital, who had a prolonged stay because of complications from a diabetic ulcer that ultimately led to his foot being amputated. He wasn't happy at the prospect of being in the hospital, but he was particularly disappointed that he couldn't take his wife out for their 50th wedding anniversary. And so I bought them a cake and brought it to them (ironic since I was dosing his insulin!). He was appreciative enough, and knew I happened to have to round for Christmas that year, and gave me this. He called me his personal angel- not something many patients say to me since many see us as the doctors who put them on insulin shots.

That was many years ago, and though I've forgotten his name, I still remember which part of the hospital his room was, and our interactions.

As I look at our tree, it's also now beginning to be filled with ornaments related to our girls, or trips we've taken. Never mind that it's not a uniform color- I'll take my memory-laden tree with its ornaments.

vagushttp://firstname.lastname@example.com:blogger.com,1999:blog-8768748.post-90888494623419723402015-11-23T06:19:00.001-06:002015-11-23T06:21:41.435-06:00A Hypogonadism ConsultI had an interesting consult the other day. Again, one of the many, hordes in fact, of men coming in for a testosterone prescription. And I admit I'm jaded and I've begun the stereotype. This was the classical young man, meathead type with biceps bigger than a treetrunk. He could have been a body double for the incredible hulk. Proud that he bench presses 200 lbs.
And yet, feels that he needs to be on testosterone. Admits he 'juices' up frequently too (a word I learnt not too long ago) with crazy shit he was getting from his gym- androgens, to which they often add aromatase inhibitors to prevent gynecomastia, and HCG to prevent the resultant testicular shrinkage. What a crazy world.

Anyway, like many before him, this chap refuses to accept that his blood test showed his testosterone to be normal. And so he was here for some 'medical testosterone'.

"I'm young. I should be on the higher range of normal!".

They all say that. Never mind that the total T was in the 600s already.

And he was most convinced of this for two reasons. That he has peaked with his weightlifting. And that he has 'erectile dysfunction'.

As an endocrinologist, I do go into a bit of detail when taking a history of ED. So I asked him what that meant to him. He was very concerned because a few years ago he could have sex about 5 times. And now it's only about twice.

A. SINGLE. DAY.

Talk about feeling inferior. This chap's definition of normal was having sexual intercourse 5 times a day. And he is concerned that he is now only interested or able to do it 2 times a day.

I wasn't sure if I should laugh, cry, hit my head on the wall, or go on my knees and kowtow to him. 5 times a day??? Teach this padawan, O Master.

I was professional and held my composure. And did all I could to explain to him the normal endocrine physiology of the reproductive system, the risks of unnecessary testosterone use and the medical guidelines. I'm pretty sure he left unconvinced.

In the meantime, I feel like I need to go to the gym more.
vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-14404536344776447672015-11-17T21:22:00.001-06:002015-11-23T06:06:51.821-06:00The Nonbelievers
I have to admit, I have an inherent bias.

And how it came to this I don't know. After all, I hated Evidence-Based Medicine (EBM) in medical school. I had a bully of a mentor, a lab-based cardiac physiologist with minimal people skills, who bluntly told me, "Your question was so stupid I'm not even going to try to answer it...." (digression: I'm not a model teacher- but I swore I would never speak to a student/resident like that ever. Words do scar). Anyway, I spent all of medical school fearing the word 'research', and hating everything EBM.

I went into residency with the same sentiments, feeling stupid, ignorant and inferior when you are in the company of the world's medical greats. The world-famous researcher clinicians whom patients travel the world over to see. Classmates who compare not only how many publications you have but what impact factor the journal that accepted your manuscript carried.

Research. Ugh.

And then something kinda slowly happened. After all, you do get brainwashed training at the same institution for six years. And not that I consider myself a brilliant researcher, but at least I learnt some of the ropes. I learnt what it takes to write a paper, analyze a study, even perform experiments (I got to play with human orbital fibroblasts, yay!). And I popped my publication cherry. And became a scientist. I still consider myself one- after all, a doctor is a person of science, and as dynamic as science can be, we too need to evolve and learn, don't we? And so, it's interesting how I went from that hater of EBM in 1999, to one who looks at The Evidence, to guide his clinical judgments. Not only the conclusions of the study, but also to try to pick apart the study to see if he agrees with the findings. After all, the goal of an author is to get the study published, and one often learns to present the data in the most compelling way; so you can't always take things at face value. And so, yes, I'm a believer of EBM, I think we all should be.

That being said, I've realize that the world doesn't see things that way. For some, EBM remains a bad word, one that is controlled by Big Pharma who makes things up to fool doctors and ultimately patients, all in the name of making money. And I've realized that once a person chooses to not believe, there is no amount of data you present that will be accepted, that they always will view things with a generous serving of skepticism. That big pharma bought you/CDC/FDA over- never mind that the basic concept of EBM is that you learn to critically appraise and make your own decisions.

This is perhaps more worrisome when the person you're trying to convince is a medical professional. I ran into this situation when discussing a case with a surgeon, when he (in my opinion) was over treating a patient with an unjustified therapy based on an unproven diagnostic test (which incidentally enough, is something he owns too).

And so sometimes, there is only so much you can do. And sometimes, you just have to take a step back, and agree to disagree. But secretly you hope the patient takes your side, because the data really doesn't show that that treatment is necessary.
vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-52920658276909373092015-11-01T06:11:00.000-06:002015-11-01T19:59:06.858-06:00Patient Satisfaction
There is much talk about the importance of patient satisfaction. Of how some hospitals and physicians are reimbursed in part based on how satisfied patients are, the much-hated Press-Ganey surveys. After all, we do want our patients satisfied, don't we?

Do we?

Proponents say, patients are clients, customers. Keeping them happy should be a priority.

But is this truly the relationship physicians and patients should have? After all, in situations like this, the 'customer' isn't always right; the patient doesn't have the background knowledge to know that's best for him or her. Studies have shown that higher patient satisfaction is associated with more adverse outcomes.

I'm sure this is a struggle all physicians across all specialties face. I hear this coming from ER and primary care colleagues of how patients leave disappointed if they are not prescribed antibiotics for a viral syndrome, or opiates for pain.

This week alone I encountered three situations myself where patients left obviously disappointed and upset.

Two patients with no background of thyroid problems who were upset because I would not prescribe thyroid hormone treatment for their fatigue and inability to lose weight despite claiming to be on a diet and exercising. One already had a TSH that was undetectable while on exogenous Levothyroxine, refusing to discontinue treatment.
Another patient, a woman, who left upset because I would not prescribe Testosterone treatment for her dry skin! Because according to her extensive research (on Google) skin dryness if from Testosterone deficiency; after all if a person makes too much, you get oily skin, acne, right?

I have to say, a part of me blames the referring physician. It gets my blood boiling, wondering where how the heck these people got their medical degrees. It's not surprising that a patient leaves unhappily, when your GP promises that this hormone specialist will fix your problems, and gives you the impression that your troubles are indeed from a hormonal imbalance. And then you wait 2 months to see this person, who then says no to treatment but bills you for the visit.

So, no. I do wish to try to satisfy my patients, but my view is a patient is not a customer in the classic sense; he/she does not have the medical background to really know what's best for his or her health.

As how my patient ominously ended my session with her after I counselled her on the risks of unnecessary hormonal treatment: "I'd rather have a stroke than continue to be fat..."

Is this going to be the future of healthcare?

vagushttp://email@example.com:blogger.com,1999:blog-8768748.post-29598970317880214312015-10-11T02:27:00.001-05:002015-10-11T02:41:11.519-05:00Farewell, my Malaysia
My flight out departs in a few hours. And truth be told, I miss my wife and kids terribly, and a large part of me can't wait to see them.

Another part will miss what will always be one of my homes- Malaysia.

And I find myself doing what I usually do in the days preceding my departure. I try to capture as much as I can, to bring the memories back with me. This usually means my shooting of random pictures.

Such as the beautiful chaos of the pasar malam.

Or how motorcycles snake in and out of traffic, often carrying little kids, or sometimes even 3!

I'll miss the KL skyline. Even if it was haze and smog-covered this trip. But thankfully, this night when I was up there for dinner, it cleared up enough for me to snap this picture.

My mom found it amusing when she saw me take this picture. It was just a reminder of simpler times. And it was something I wanted to show my family- they are so used to getting coconut milk from packs that one never wonders about how we get the milk. The girls have never seen a machine like this.

Yes, it's all random stuff. But it's the weird, simple, random stuff that makes Malaysia truly Malaysia. I've had a busy week- giving lectures to 3 groups in 3 different states (all pro bono, mind you). The last group I met with were medical students early in their careers. Asking me the age-old question- should I go overseas to study/specialize?

Well, it's a difficult, subjective question to answer. There will be goods and bads. But the one bad will be, you will be leaving a culture, a people, a language, a cuisine, a climate that is so familiar and near and dear to you, to live in a foreign land. No doubt with time, that land becomes home as it has for me, but some things will always remain foreign. And so, you will make sacrifices, and when it's your time, you may find yourself doing as I do- taking pictures of quaint coconut graters because it reminds you of your childhood.

Farewell, Malaysia. You have not lost your charm, though many of us abroad worry about your future. Here's to hoping that the Rakyat will rise up above the disease and rot emanating from her politicians and bigots, and bring her glory days of peace and harmony and muhibbah back.
vagushttp://email@example.com


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|Rob Reiner
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|Corey Feldman, Jerry O'Connell, Kiefer Sutherland, Casey Siemaszko, Gary Riley, Bradley Gregg, Jason Oliver, Marshall Bell, Frances Lee McCain, Bruce Kirby, William Bronder, Scott Beach, Richard Dreyfuss, John Cusack, Madeleine Swift, Popeye, Geanette Bobst, Art Burke
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the subtitles wont switch off . I am not happy with this dvd.Published 5 days ago by dennis halliday
My parents used to call me Vern, I now know why. I've watched this movie on repeat some nights and I just cannot shake my love for this film. Read morePublished 2 months ago by Nathan
Awesome film...you will cry. Order tissues at the same time ha haPublished 2 months ago by Chris B.
Love this film, one of the true greats, I am now becoming an old man and still LOVE this film to pieces, a reminder of my childhood before www and game sytems took over, happy days... Read morePublished 2 months ago by AnonymousDrone
I feel bad giving it 1 star as its a fantastic movie, but I just want people to know the picture quality is terrible, this is not a HD remaster it looks more like a transfer from a... Read morePublished 2 months ago by MrGreen


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Veterans of Foreign Wars (VFW), Post 8545, Smithfield VA
Veteran in Need BBQ Fundraiser
Requirements and names we have so far.
29 July for Pre-set Up 1630 hrs: Tony Jackson, Brian Mullery, Joe Lupton, Jim Phillips, James Hartman, Dan Wilson, if I missed anyone simply show up anyway.
30 July for Set Up Cookers and Start Butts, 0300 hrs: Tim Shumaker, Chris Garrrett
30 July for Set Up of all remaining Items, 0730 hrs: Chris Garrett, Dan Wilson, James Hartman, George Perez, Ed Mortimer
30 July for Chop BBQ, Mix sauce and start Fryers for fries, 0900 hrs: Mike Eggleston, Eddie Rowland, Lynn Moran, Herb DeGroft, Howard Hinnant, Les Byrge, Fries is Tom Harper, Brian Mullery
30 July, 1000 hrs for Cashier; Marsha Oliver, Jack Pittman, for Prepping food Dan Wilson, Jim Phillips, Rick Sheldon.
If you can assist to serve the food and beverages, please let Jim Phillips know so we can split labor to make this happen. Or, for all those willing to assist in setting up tents etc day before the actual event, please go directly to TRU-Value on 29 July, 1600 hrs onward.
Bruce Fischer
Post 8545


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How cute is Poochi?
Her current rating is 4.59 out of 5 with 27 vote(s).
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Neutering dogs and cats – Pet tip 111
When it comes to neutering cats and dogs, many veterinarians will tell you that their male customers are often reluctant to have their male pets neutered. When the veterinarian asks why, the answer is focused on them putting themselves in …
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My name is poochi, I am a westie! I am always hyper and never wanna stop playing. I love my mommy and daddy, they spoil me with lots of love! I love to sleep in my crate and never do my business inside. I love my mommy's cooking, she makes me homemade food! I am just a happy dog...along with my brother prince. He's annoying sometimes but he make me laugh when im bored!


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The Legend of Michigan (Myths, Legends, Fairy and Folktales) Hardcover – March 21, 2006
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Syria fighting spills over into Israel; UN calls for restraint
Jerusalem: Israel for the first time fired a warning missile on Syria since the 1973 Yom Kippur War, breaking a long standing ceasefire and drawing itself into the ongoing bloody fight between President Bashar Assad`s regime forces and the rebels in the strife-torn country.
Israel Defence Forces (IDF) said they fired the missile as a warning shot yesterday after a stray mortar from Syria hit a military post in the Golan Heights.
The errant shell marked the fourth time in just over a week that the infighting from Syria has spilled into Israel.
"IDF forces fired warning shots and relayed a message to the Syrian forces via the United Nations that warns against additional fire. Additional fire will prompt a quick response," a statement from the Israeli army said.
No injuries or damage were reported.
Following the threat of escalation, UN chief Ban Ki-moon appealed to Israel and Syria to ease tensions on their disputed Golan Heights frontier.
"The secretary general is deeply concerned by the potential for escalation," said the UN spokesman Martin Nesirky.
"He calls for the utmost restraint" and urges both sides to uphold the 1974 accord which set up a ceasefire line and demilitarised zone patrolled by UN forces.
Syria and Israel must halt "firing of any kind" across the ceasefire line.
The missile fired by the IDF was an advanced Tammuz missile, an electro-optic missile that is based on Spike long-range missile technology developed by Rafael Advanced Defence Systems.
IDF sources said that it was likely that the mortar attack on Golan Heights was the result of the ongoing clashes between the Syrian army and rebel forces, and that "Israel was not intentionally targeted".
IDF spokesman Brigadier-General Yoav Mordechai said that the army`s decision to retaliate, which was authorised by Chief of Staff Benny Gantz, had taken into account the fact that during the last two months, eight such events were recorded, including mortar and light-artillery fire as well as today`s mortar hit.
"We also notified the UN of the incident and repeated the warning given to Syria, that the IDF will not tolerate any fire on Israel. We will be monitoring the situation to see if the message was received," Mordechai said.
The Israeli army filed a written complaint with UN forces (UNDOF), which also has an Indian contingent, which is enforcing the ceasefire in the Golan Heights.
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Puppy of the Day: Tusk
Tusk is a 6-year-old-male cocker spaniel and is ready to be adopted at Little Shelter Animal Rescue and Adoption Center in Huntington. If interested, please call the shelter at 631-638-8770. (Credit: Newsday / Jessica Rotkiewicz)
DNC 2016 Day 2 recap Bill Clinton: Hillary's 'the best darn changemaker' Hillary Clinton wins nomination, New York delegates react Gov. Andrew M. Cuomo speaks about Bernie Sanders Black Lives Matter protest: 'Don't vote for Hillary' Hillary Clinton nominated Sanders makes Clinton the Democratic Party's nominee Michelle Obama takes a dig at Trump: 'When they go low, we go high' Bernie Sanders addresses NY delegation breakfast Newsday reporter: 'Unconventional start' to first day of DNC Convention DNC in Philadelphia: Day One recap Demi Lovato performs at the DNC


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Guru3D Rig of the Month - July 2016
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Powered by Intel's P67 chipset, we'll review that stunning looking P67A-UD4 Sandy bridge ready motherboard. A motherboard that is using a 12+2 phases design cooled by passive grey heatsinks. Of course features like SATA 6G and USB 3 are available as well, and guess what, the board supports SLI and Crossfire, albeit in a x8:x8 configuration. Read article
« MSI P67-GD65 motherboard review · Gigabyte P67A-UD4 review · Enermax Modu82+ II 625W PSU review »


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State prosecutor Gerrie Nel has listed 30 points in his application for leave to appeal Oscar Pistorius's 6-year sentence for murder.
Vuyo Mvoko, who penned an article detailing the bullying and intimidation at the SABC, is taking the public broadcaster to court.
A 32-year-old constable was gunned down while he was responding to a business burglary alarm at a local bank in Hartbeesfontein.
The Hawks' have arrested an alleged fake tax practitioner for fraud amounting to R691 000.
A 20-year-old dad was gunned down metres from his home in Scottsdene, Kraaifontein.
SABC rebel Vuyo Mvoko will turn to the high court to order the broadcaster to put him back on air after he spoke out against censorship.
Two murder and rape suspects have been arrested in the North West after being on the run since December.
The National Prosecuting Authority has filed court papers setting out the reasons for its appeal against the sentence handed down to Oscar Pistorius.
Suspended Wentworth police captain, Larry Heslop, was sentenced to 15 years in jail for attempted murder and possession of ...
The ANC Women's League says the National Prosecuting Authority's decision to appeal the six-year handed down to Oscar Pistorius ...
Corporal punishment complaints at a Limpopo school are to be addressed after a pupil took pictures of a teacher beating pupils with a piece of piping.
Reeva Steenkamp's parents have voiced support for the State's decision to appeal Oscar Pistorius's six-year jail sentence for her murder.
Durban City has denied it owes its bus operator R132 million - and instead claimed Tansnat has not fulfilled its own obligations ...
Senior journalists who were dismissed by the SABC have vowed to fight for freedom of expression and a better working environment.
A police officer lied and must be charged in connection with the death of Gerdo Karelse who was found dead in holding cells, Ipid has found.


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You try to do a good thing, but someone always has to come around and say there's a down side. In this case, the good thing is AB 32, also known as California's greenhouse gas emission reduction law, and the potential down side is one that could generate a lot of bad publicity.
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There's twenty eight of these?
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4 for potential.
Move a few joints change some facial expressions.


text: Stayed here for 2 weeks for a business trip. Overall it's an OK property but I would not stay here again. The Lobby: The breakfast area is here. It's a pretty small breakfast area, if there is a tour bus around forget it, there will be a line for everything and line for coffee as well. There are papers in... More


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