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Shea Cox
Veterinarian Shea Cox has enjoyed an indirect path through her professional life, initially obtaining degrees in fine arts and nursing. She later obtained her veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine solely since that time. In 2006, she joined the ER staff at PETS Referral Center in Berkeley and cannot imagine a more rewarding and fulfilling place to spend her working hours. In her spare time, she loves to paint, wield her green thumb, cook up a storm and sail. Her days are shared with the three loves of her life: her husband Scott and their two Doberman children that curiously occupy opposite ends of the personality spectrum.
Wellness: Health Care
Learn how to do at-home physical exams
Posted by
September 26 2016
To identify a problem or an abnormal situation, you must first be able to recognize what's normal for your dog. Performing this exam in the comfort of your home when your dog's in good shape is the best way to do this. Consult your veterinarian if you're concerned about any exam finding; early recognition can save your dog's life.
Before you start the exam, take a good look at your dog when she's just hanging out; observe her posture and general demeanor. Getting a good picture of your dog's "normal" in a relaxed environment will help you pick up any subtle changes that may occur.
1. Take her temperature. Using a digital rectal thermometer (the ear type is less reliable, and mercury thermometers can break), lubricate the end with petroleum jelly and gently insert it into the rectum, about 1 inch for small dogs and about 2 inches for larger ones. If it does not slide in easily, do not force it. A normal temperature is between 100º and 102.5º F.
2. Check her heart rate by taking her pulse at the femoral artery, which you'll find on the inside of her thigh; feel for the roll of the artery and a pulsing sensation. Count the number of pulses in 15 seconds and multiply by four. A dog's pulse rate is highly variable, but generally, normal is 80 to 120 beats per minute. Relaxed, large-breed or athletic dogs tend to have slower rates, while the rate for puppies and small dogs tends to be higher.
3. Start at her head. Nose: smooth, soft and clean, like supple leather (noses aren't necessarily always cool or moist). Eyes: bright, moist and clear, with pupils equal in size; the whites should be white, with only a few visible blood vessels. Ears: clean and dry, almost odor-free; you should be able to gently massage them without complaint. Mouth: teeth clean and white, gums uniformly pink and moist to the touch.
4. Watch her chest as she breathes. The chest wall should move in and out easily and rhythmically in an effortless way; each breath should look the same as the last. (Unless she's panting, you should not be able to hear your dog breathe.) A normal resting respiration rate is 15 to 30 breaths per minute; a sleeping or relaxed dog would be near the low end, while an active and engaged dog would be higher. As with heart rates, smaller dogs tend to have a faster resting breathing rate than larger dogs.
5. Examine her skin. One of the body's major organs and an important indicator of overall health, the skin of a healthy dog is soft and unbroken, with minimal odor and—except for wirehaired breeds—the hair coat is shiny and smooth.
6. Check her hydration with the skin turgor test. Pull the skin over her neck or back into a "tent" and release; it should return quickly to its original position. If it returns slowly, or remains slightly tented, your dog may be dehydrated.
7. Finish up with the torso. Starting just behind the ribs, gently press your hands into your dog's belly; if she's just eaten, you may feel an enlargement in the left part of the belly just under the ribs (where the stomach lives), which can be normal. Proceed toward the rear of her body, passing your hands gently over the entire area. Lumps, bumps or masses; signs of discomfort; or distention of the belly warrant further investigation by your vet.
For a more detailed discussion of the in-home exam thebark.com/exam and see Dr. Shea Cox on bridgevs.com
Wellness: Health Care
"Sunny and 70" can mean "sunny and deadly"
Posted by
May 25 2016
We have been experiencing idyllic temperatures in Berkeley, Calif., these past couple of weeks—mostly sunny days and mid-70s bliss. Perfect weather for a fun-filled outing with our pets, right? For the most part, the answer is "yes" but these are the kind of days where we have to be extra cautious with our pets. At the veterinary hospital where I practice, I have had three dogs die from heat stoke in the past three weeks. These were not dogs left in unattended cars or as the result of negligent owners. They were really the result of not realizing that "sunny and 70" can mean "sunny and deadly."
Two of the deaths were Bulldogs, one who played ball for a short 20 minutes outside and the other who went on his "normal daily walk." The other loss was a Golden Retriever; the owner let him play at the park for an hour with the neighborhood kids, who always loved to spend time with him, such heartbreaking loss for everyone involved.
Many people are unaware of how dogs process heat and how easily they can succumb to heat stroke. Dogs cannot tolerate high temperatures as well as humans because they depend upon rapid breathing (panting) to exchange their warm body air for cooler environmental air. Therefore, when the air temperature is close to body temperature, cooling by rapid breathing is no longer an efficient process, and dogs can succumb to heat stroke in a relatively short time period.
Heatstroke can occur in many conditions that include:
Clinical signs of developing heat stroke:
Heat stroke is an emergency that requires immediate recognition and prompt treatment. A dog's normal body temperature is 101.5 degrees plus or minus 1 degree Fahrenheit, and any time the body temperature is higher than 105 degrees, a truly life-threatening emergency exists. Initially the pet appears distressed, and will pant excessively and become restless. As the hyperthermia progresses, the pet may drool large amounts of saliva from the nose and/or mouth. The pet may become unsteady on his feet. You may notice the gums turning blue/purple or bright red, which is due to inadequate oxygen.
Severe hyperthermia is a disease that affects nearly every system in the body. Simply lowering the body temperature fails to address the potentially catastrophic events that often accompany this disorder. A pet suffering from hyperthermia should be seen by a veterinarian as soon as possible for appropriate care. There are many life-threatening after affects that happen to a pet's body following an episode of heat stroke, and early treatment will give your pet the best chance for survival.
What to do:
What NOT to do:
What if I see a pet in distress?
California law now prohibits leaving pets unattended in a vehicle, but I still see this ("grrrrrr") all of the time. If you do happen see a pet in distress, you can call the local animal control agency, police or 911 for assistance. Any peace officer, humane officer or animal control officer is authorized to take all steps necessary for the removal of an animal from a motor vehicle. I have also made a downloadable flyer for you to print and leave on car windshields if you notice a pet inside of a vehicle. I wanted to create way to educate others instead of just getting worried, upset and frustrated. I know it is just a small gesture, but if it can save one pet's life, then I've done my job with it.
I hope this blog has offered both awareness and education and please feel free to leave questions or comments!
Wellness: Health Care
Abnormalities in stool color and consistency may indicate an underlying problem.
Posted by
January 21 2016
I'll be the first to admit that I stand outside watching each and every performance of my dogs' "poop show." This isn't just a weird sort of voyeurism—rather, it's a good way to know what's going on with a dog's health. If you, too, like to see what's coming off the production line, keep in mind that the number-one rule of thumb when considering canine elimination is reproducibility. Stools should generally have the same color, size and consistency each and every time.
Many things can cause variations in a dog's stool. Some of the more common are dietary indiscretions ("garbage gut") or a change in diet, stress (known as stress colitis), infectious disease, inflammatory conditions, or obstructive processes. Or it may be idiopathic (meaning, we just don't know what causes it).
A couple of episodes of diarrhea generally don't constitute an emergency. However, there are situations that do warrant an urgent evaluation. When your dog refuses food or water, vomits, or acts ill or "off," a trip to the vet is indicated.
Your vet may ask you to bring in a stool sample for analysis. A tablespoon is generally plenty. Also, freshness counts; fecal samples less than an hour old give the best results. If you're not able to collect one this quickly, get a morning sample, double (or triple!) bag it and keep it refrigerated until your dog's appointment.
Testing usually starts with a screen for giardia and "O & P," specifically looking for giardia protozoa as well as ova (eggs) and parasites. During this evaluation, the laboratory technician will also check for overgrowth of normal gastrointestinal (GI) bacteria, which we refer to as clostridial overgrowth. If your dog is acting ill, in addition to having diarrhea, other diagnostics such as blood work and radiographs may be indicated.
1. Streaks of bright red blood and/or mucus on the surface of a mostly normal, formed stool. This is generally caused by inflammation in the large intestine, where mucus is secreted to help protect the intestinal lining. While this does not necessarily indicate an emergency, it's a good idea to keep a close eye out for further changes in your dog's behavior and stool.
2. Soft-formed to liquid brown diarrhea, with or without streaks of blood. "Cow patty" and "soft-serve ice cream" are two frequent descriptors. As with the previous type, it is generally not life-threatening as long as there are no other signs of concern and it begins to improve within 24 to 48 hours. If your dog is acting normally otherwise— eating well, not vomiting, good attitude —a wait-and-see home approach may be tried (more on this to follow). Here again, red blood indicates inflammation and bleeding in the colon but does not necessarily mean that your pet is bleeding internally, as is often thought. This is a step up in concern from the previous condition, in the sense that the stool is now softer.
3. A large volume of bloody, watery, diarrhea. This one does require immediate evaluation by your veterinarian, especially with smaller dogs, as it can be an indicator of a common condition called hemorrhagic gastroenteritis, or HGE. (Read more about it here: thebark.com/hge) Tissue sloughing from the intestines gives it a distinctive appearance, and it's often described as "raspberry jam" diarrhea.
4. Black, tarry stools. This generally indicates bleeding somewhere higher up in the GI tract, such as the stomach or small intestine, and also requires an urgent trip to the vet. A bleeding ulcer (oftentimes caused by steroid or NSAID use) or more generalized bleeding, such as from rat poison, heat stroke or an immune-mediated disease, can display as black, tarry stools. The appearance of the stool is due to the presence of digested blood, and can indicate that a large amount of blood is being lost. In these cases, I usually recommend blood work and an ultrasound to better assess the lining of the intestinal tract.
5. Yellow-orange or pasty, light stools. This may indicate the development of liver or biliary disease, or a too-rapid transit through the small intestine to the colon. A more thorough examination, including diagnostic tests, is in order.
6. Grey, greasy stools. A possible indicator of inadequate digestion and malabsorption of nutrients from the small intestine, this type of stool is typical of exocrine pancreatic insufficiency (EPI), also called maldigestion, a disease in which the pancreas no longer functions as it should. The pancreas is responsible for producing digestive enzymes, and without them, nutrients cannot be properly absorbed. Both German Shepherds and Rough-Coated Collies are commonly afflicted with EPI
7. Green stools. In the ER, I have seen dogs with green stool, and upon examination of the fecal contents, have discovered the cause to be undigested rat bait mixed in with normal stool. This condition also calls for an immediate trip to your veterinarian. Although relatively uncommon, rat poison can also cause both bright blood and dark, tarry stool, so—whether or not you think your dog could have had access to them—please let your veterinarian know if there is any possibility of exposure to rodenticides.
8. Worms. Most of the time, you will not actually see worms in the stool. We typically diagnose worms by looking for their eggs under the microscope; we can tell what type of parasite is present by the shape of the eggs. Occasionally, however, you may see white spaghetti-like shapes (typically, roundworms) in the stool, particularly with puppies. You may also see small flat worms on the outside of the stool or rectum, or "dried rice" in your dog's sleeping areas. This typically indicates tapeworms, which can take over when fleas are allowed to flourish. Although seeing worms in the stool is not an emergency, an appointment with your vet is in order so you can get medication appropriate for the type of parasite present.
Wellness: Health Care
What can be done?
Posted by
May 29 2013
As our pets age, you may begin to notice subtle changes in their movement, such as having a little difficulty going up or down the stairs, or seemingly slow to rise from a comfortable laying position. These can be early signs of arthritis, and early intervention is critical to slowing progression of the disease. I am currently experiencing this "slow down" with my 11 year old Dobie, and I thought it would be good to share some suggestions that you, too, can consider if you have a pet that is living with some degree of arthritis.
Like any lifestyle change, one of the most important things to do first is to ensure that there are no other causes for the changes you are seeing in your pet. An intermittent and subtle slow down can be caused by many things, such as a low thyroid level or even a slowly bleeding tumor on the spleen. X-rays, a urine sample and blood work are important to ensure the overall health of your pet before starting any treatment plan.
Today, there are a number of effective pain medications that are available to our pets, and a multi-modal approach to pain management is the best way to go. By using pain medications that address various pain pathways, you get more complete and synergistic pain management while actually using lower doses of medications. A cornerstone of arthritis management is a non-steroidal anti inflammatory, or NSAID. This provides excellent pain management in the early stages of arthritis, and then as the disease progresses, additional "layers" of pain management can be "added on." These medications include such options as gabapentin, tramadol, and amantadine, with each one working to enhance the other.
Adequan is another medication that has been used in pets with degenerative joint disease or traumatic events such as a torn cruciate ligament. It works to help slow down the rate of decay of cartilage as well as stimulate new collagen and hyaluronic acid, a lubricant in joints. This is an injectable product that can be taught to be given at home underneath the skin and is initially given twice weekly for three to four weeks and then, once monthly. By the fifth or sixth injection, most pet parents usually see a more comfortable and agile pet.
Supplements such as glucosamine, chondroitin and omega-3 fish oils are good additions to managing arthritis changes. These supplements provide your pet's joints with building materials to help rebuild their cartilage and decrease the inflammation in the joints. Supplements are not an overnight fix, and they generally take at least six weeks before improvements can be seen. Products can be purchased over-the-counter and do not need to be labeled specifically for pets. However, not all nutrapharmaceutical products are FDA regulated, and there is quite a bit of discussion with regards to bioavailability between various brands; this is a case where cheaper is not always better and I would recommend purchasing only high quality and trusted brands. Your veterinarian can make recommendations for you. The standard dose for glucosamine/chondroitin is approximately 10 mg per pound of body weight once a day, for which you can round up or down to make tablet division or multiplying easiest. For example, a 20-pound dog could take half of a 500 mg tablet daily (250 mg), even though its "recommended" dose is 200 mg. Also, when you are considering fish oil, you want to be sure to base it on the omega-3 concentration of EPA. The dose is 20 mg EPA for every pound of body weight once daily, and for example, our 20-pound dog would need 400 mg EPA daily.
Another area of extreme importance is your pet's body weight. I have to admit, I am a little guilty of letting this area slip and my boy and I recently went through a five-pound weight reduction program (I couldn't let him "suffer" alone). How can you tell if your pet is a little too chubby? You should be able to easily feel your pet's ribs and backbone beneath the skin; if you cannot, then your pet may be overweight. Excessive weight is an added burden for already compromised joints, and you may be amazed how much better your dog will feel simply by shedding a few pounds. I can already see a difference in the way Bauer prances around.
Continued activity is also important—the old adage, "if you don't use it, you lose it," holds true for our pets, too. Working to keep up your pet's muscle mass through activity can help provide stability and flexibility to joints. Low-impact exercise is best, such as long walks and swimming, and both are highly encouraged.
There are also newer concepts of arthritis management. One such treatment is known as Stem Cell Therapy. This is a procedure in which adult stem cells are injected into the arthritic joints, or into damaged ligaments and tendons, to aid in healing and repair. While continued studies are still needed, there are many reports of pets responding well and this therapy holds promise. Joint replacement is a surgical therapy and has been proven to be very successful. As an example, 95% of canine patients with hip replacement can return to normal function. There has also been the development of dedicated rehabilitation centers for pets, which are becoming more widely available as the demand for options grows. Trained professionals can offer additional treatments such as hydrotherapy, acupuncture, chiropractic, massage, physical therapy, cold laser therapy, and pulsed signal therapy. Complementary treatments can offer your pet a complete approach to management of its arthritis, and many of these singular modalities, such as acupuncture, are often offered by veterinarians in general practice. These newer approaches to arthritis management are areas that I can discuss in greater detail in another blog, if there is any interest. Let me know!
Wellness: Health Care
DEA action might hinder in-home vet practices
Posted by
May 22 2013
Legislative Alert: We need your help! Please Support S. 950, the Veterinary Medicine Mobility Act, to Allow Veterinarians to Continue to Transport Vital Medications for the Treatment of Animals!
The American Veterinary Medical Association (AVMA) is seeking urgent modification to the current Controlled Substances Act (CSA) that was put forth by the Drug Enforcement Administration (DEA) in 1970. The CSA was designed to protect public health by preventing diversion and improper use of controlled substances, and was actually implemented with the human medical field in mind. Well, the DEA is now suddenly interpreting the wording in this 43-year old legislation and has recently deemed it illegal for veterinarians to transport controlled substances outside of the veterinarian's single registered location, typically their hospital or clinic.
What does this mean? It means that it is now illegal for veterinarians to carry and use vital medications for pain management, anesthesia and euthanasia in house calls, in veterinary mobile clinics, on farms, or in ambulatory response situations such as injured wildlife. It now prohibits mobile veterinarians, rural or farm veterinarians, and in-home euthanasia veterinarians from doing their job because of this sudden and literal interpretation of the law. As a provider of hospice care for pets, this hits especially close to home for me: I am no longer legally able to provide adequate pain relief for my terminal patients, nor am I legally allowed to provide the the gift of a peaceful passing in the comfort of a pet's home. The DEA has already notified veterinarians in some states (California being highly targeted) that they are in violation of this law and are being threatened with fines as well as provoking licensing.
The DEA has officially informed organized veterinary medicine that transporting these controlled substances is illegal per the CSA and thus would require a statutory change in the law to allow "us" to legally provide complete veterinary care to our patients.
We have met this need by introducing the Veterinary Medicine Mobility Act (S. 950), which was introduced by U.S. Senators Jerry Morgan and Angus King just this week (thank you!). This legislation would amend the current CSA and will allow us to continue to treat and meet the needs of our patients—your pets.
Can you help? It is imperative that veterinarians be able to legally transport controlled substances to the location of our patients, and we need your support. By clicking this link you can tell your U.S Senators that veterinarians must be able to properly care for their patients. It takes just seconds- look for the green-colored "TAKE ACTION NOW" at the bottom and with just 1 click, you can make a world of difference for our pet family members.
Wellness: Health Care
Posted by
May 14 2013
In 2008, the Environmental Protection Agency announced that it planned to restrict sales of certain rodenticides containing second-generation anticoagulants (such as brodifacoum and bromadiolone) to pest control professionals and agricultural supply stores only. Rodenticide manufacturers came up to speed with compliance in 2011, and in doing so, began using bromethalin more and more instead of anticoagulants in their products.
While the change was designed to make rodenticides safer for our children, pets and wildlife, there has also been some devastating consequences. Unlike anticoagulant rodenticides, bromethalin does not have an antidote, and there are still many people and veterinarians that are not aware of its toxicity. There has been an uptick in the number of cases treated since these regulations have been put in to place, and this toxicity is once again being highlighted in veterinary publications in hopes of raising awareness.
If a dog had ingested a rodenticide in the recent past, it was very likely a D-Con-like product. Anticoagulant toxicities are relatively easy and cheap to treat if caught early as there is a 2-5 day lag time before bleeding actually happens. This type of exposure can also be diagnosed with a simple blood test, known as a PT test, which checks the clotting time of the blood and confirms exposure if it was not witnessed.
This is not, however, the case with bromethalin. Bromethalin is a neurotoxin which affects the cells in the brain by causing a rapid influx of sodium particles into its cells. When this happens, body water follows the sodium particles and leads to swelling in the central nervous system. The symptoms come on much faster and neurological signs can be seen within as little as 2 hours of ingestion. These signs can include depression, a "drunken" gait, rigid limbs, seizures and coma. Because there is no antidote, treatment is aimed at decontamination, intensive, and expensive hospitalization for support of the body and treatment of clinical signs if they develop.
I am sure many people are thinking, "Who would keep this stuff around when you have pets?!" I often have the same thought, but you would be surprised by the number of dogs we treat for this toxicity.
Here is the take home message:
* If you need to induce vomiting at home, you can administer 1 ml of hydrogen peroxide per 1 pound of body weight with a maximum of 45 ml being given. For example, a 10 pound dog would need 10 ml of hydrogen peroxide and 80 pound dog should get no more than 45 ml. Trying this at home is not without risk and there are words of caution to consider: ONLY attempt to induce vomiting if your pet is very alert and if you are further than 1 hour away from your veterinarian. Also, do not "force" the peroxide in—your pet needs to swallow the peroxide, and because it tastes bad, there is a risk of your pet aspirating the peroxide into the lungs if they are resisting and it is being forced. Another concern is the potential for aspiration during the vomiting process. Aspiration of peroxide during administration or through the process of vomiting leads to additional problems such as pneumonia. Another note: don't waste time waiting to see if your dog will vomit... gently give the peroxide, grab a blanket to cover your car seat, and begin driving immediately to your vet.
Wellness: Health Care
Posted by
April 22 2013
Home-brewing is a trend that is becoming more and more popular, and unfortunately, so is the occurrence of hops toxicity in dogs. Hops is the plant used in the process of brewing beer, and both the 'raw' or spent hops are toxic. True flowers or dried hops plugs tend to be more toxic than hops pellets (pellets have less residue), while wild hops have been found to be non-toxic. The diagnosis is generally made based on history of having home-brewing supplies as well as seeing hops in vomit.
The mechanism of toxicity is unknown, but may be related to essential oils, resins, phenolic compounds, or nitrogenous constituents within the plant. Many of the substances in hops are degraded or aerosolized during the brewing process, so the exact relationship between substance and toxicity remains unknown.
Clinical signs of toxicity can include agitation, panting, excitement, flatulence, rapid heart rate followed by life-threatening elevations in body temperature. Death has been reported in as little as 6 hours without appropriate treatment. I have seen rectal temperatures greater than 108 F, and these temperatures can be very difficult to control. The high end of normal of a dog's temperature is 102.5 F, and any temperature above 106 F can lead to an "unwinding" of the body's proteins as well as permanent brain injury, depending upon the length of time that the elevation in body temperature persists.
Treatment consists of aggressive decontamination measures including induction of vomiting, gastric lavage ("washing out" the stomach under anesthesia), administration of charcoal, and enemas. Active cooling by any means available is extremely important. There are also specific medications that can be given in the hospital to help control the clinical signs.
Prognosis for survival is generally guarded to poor, and unfortunately, many deaths have been reported. We have had 2 cases of hops toxicity this past year in the ER, and thankfully, both survived with aggressive treatment.
Any breed of dog may be affected, but breeds that are predisposed to malignant hyperthermia (extreme elevation of body temperature for an unknown reason) tend to be more susceptible. These breeds include Greyhounds, Labrador Retrievers, Saint Bernards, Pointers, Dobermans, Border Collies, English Springer Spaniels, and northern breeds.
If you suspect your dog has been exposed to hops, seek veterinary care immediately! This is not something that can be managed at home. Quickly take a rectal temperature, and if it is found to be greater than 105 F, begin active cooling measures—such as dousing your pets body with cool water and wrapping icepacks in towels and placing them over its body—in addition to running the air conditioning in car while on your way to your veterinarian or local emergency clinic. This measure could help save your pets life and give him or her the best chance for survival.
Wellness: Health Care
Posted by
April 1 2013
A recent request by a Bark reader was, "how can I treat a hot spot at home without seeing a vet?" Hopefully I can begin to answer this, but first, one must be able to "spot" a hot spot.
A hot spot is a superficial skin infection that happens when normal skin bacteria overrun the skin's defenses as a result of damage to its surface. This damage is most often started by the dog chewing, scratching, licking and gnawing at itself. In the first stages of the formation, the skin becomes moist, red, itchy, and infected. Pus begins to ooze from the traumatized skin as infection sets in. Then, the dried pus and damaged skin surface will work to form a tightly-adhered crust, and you will likely notice hair loss over the infection site. This can be a very painful process, and frequently, dogs will show pain when the area is touched.
Dogs are their own worst enemy when it comes to hot spots, and they are generally created by their own over-zealous self-licking and chewing. They can arise surprisingly quickly: a few minutes of "work" can create an impressive area of self-inflicted trauma. The good news is that they almost always look worse than they actually are, and infection is usually superficial—often resolving with topical treatment alone.
So, what causes our dogs to begin self-chewing and licking in the first place? Good question, with a common denominator being anything that creates irritation to the skin, causing the dog to chew or scratch at the site, can cause a hot spot. Think insect bites (fleas, flies), skin allergies, excess skin-surface moisture, dogs with heavy or dense hair coats, matted hair, saliva accumulation under the fur (think of the pet that is always licking its feet), skin scrapes, or excessive humidity in the environment can all be sources for a hot spot to develop. Another interesting cause: good old-fashioned boredom.
The location of the hot spots may help your veterinarian determine the underlying cause of the problem. For example, a hot spot over the hip area could indicate flea infestation, hip arthritis, or an anal gland infection. Similarly, a hot spot near an ear could indicate an ear problem, an allergy, or a dental/nerve irritation.
What you can do at home:
If the hot spot is small, non-painful, recognized early, and is uncomplicated, it may be possible to begin treatment at home with over-the-counter products made for this use. There are an array of topical sprays, medicated shampoos, and herbal therapies available—too expansive a list to discuss here. The important thing is to ensure that it is a pet-approved/pet-safe product and it is always a good idea to call your veterinarian and ask if your choice seems reasonable. You need to be very careful not to use human topical products as these may be toxic to pets when licked and ingested. For example, zinc oxide can be toxic when ingested and it is a common carrier in many human skin ointments.
The basics of home hot spot treatment are:
Tips on prevention:
When you can't do it alone:
The bad news is that about 30% of the pets who develop hot spots actually have some other kind of skin disease such as a deeper skin infection, a bite wound or other trauma, or even immune-mediated disease. If you have any concerns whatsoever, it is best to have your veterinarian assess them.
Another time that veterinary intervention is needed is when the hot spot becomes so big and painful that it requires sedation to properly clip and clean it (can you imagine what it would feel like to have running clipper blades go over raw flesh? Ouch!).
An additional potential concern is if a hot spot is accompanied by deeper skin infection, which would require more extensive therapy such as oral pain medications, oral anti-inflammatory medications and oral antibiotics in addition to topical treatments. The treatment your veterinarian chooses will depend on how bad the problem is, how much pain your dog is in, how long the problem has been going on, and if the problem is a recurring one. Some dogs may get one or two hot spots and then never get another one again (luck dogs!), while some may have frequent recurrences.
Hopefully this helps take off some of the heat of hot spots, and thank you for the suggestion, Mona J!
Wellness: Health Care
Treatments to try at home
Posted by
March 18 2013
Paraphimosis is the inability to retract an extruded penis back into the preputial sheath, which is the skin that covers it. This can quickly turn into an emergency situation, as constriction of blood flow will lead to greater engorgement, necrosis (dying off of the tissue), and potential damage to the urethra.
More common causes of this condition can include chronic licking, sexual excitement, or foreign bodies getting up under the skin. However, there are more serious causes including neurological disease (such as a herniation of a disc in the spinal cord), penis fractures, or muscular issues. Paraphimosis also needs to be differentiated from priapism, which is a state of continuous erection, usually due to a neurological problem.
A diagnosis of paraphimosis is generally based on simple observation of the penis extruded from the prepuce without any physiological reason. Paraphimosis accounts for approximately 7% of penile problems in the dog, and while not common, it can cause distress to pets (and their owners) and can have more serious consequences if left untreated or if it becomes a recurring issue.
Treatment is generally conservative in nature, and many of these interventions can first be tried at home. Here is what you can do if this condition if noted in your pet:
Wellness: Health Care
Posted by
February 22 2013
A broken toe nail can be a painful and potentially expensive injury for our furry friends, and it is something that I often see in the ER. A common scenario is a pet suddenly begins to limp while out playing, and upon closer inspection, an injured nail is seen. Some nails have just a minor crack with some bleeding, while other injuries put a toenail at a 90-degree angle (ouch!). Because they can be painful or have bleeding, a cracked or broken nail may be best treated by a veterinarian. With that being said, it may not necessarily require an urgent trip to the emergency room. A broken nail may be something you can care for at home, or, depending on the degree of injury, it may be reasonable to wait to see your regular veterinarian in the morning.
So, what to do if your pet is suddenly favoring a paw and/or you see bleeding? First, get a good look at the paw—including in between the toes and webbing—to see if it is a cut, foxtail or other foreign object, insect stinger, or (you guessed it) possibly a broken nail. When doing so, be sure to look closely at the nail bed, as I have seen cracks and injuries in the nail that were actually hidden underneath the fur line, where the base of the nail goes into the toe. There are 3 general "types" of nail injuries: one where the nail has been completely broken off and is bleeding, one where the nail is cracked or broken but is loosely attached, and one where the nail is cracked or broken but remains firmly attached.
Usually, the best case scenario is when the nail is fully broken off and some bleeding is noted. In these cases, bleeding is usually mild but can be worrisome if it continues. These are the easiest types of injuries to treat at home as you generally only need to apply pressure with a gauze or clean cloth to the nail to stop the bleeding. The key is to hold pressure for at least 5 to 10 minutes with no "peeking to see" if the bleeding has stopped before this time is up. It is important to keep your pet calm during this time, as excitement increases blood pressure and works against a good clot forming. If bleeding continues despite applied pressure, you can apply styptic powder (such as Kwik Stop) and resume applying pressure for another 5 minutes or so. If you do not have styptic powder at home, sometimes a little baking soda can do the trick. If the bleeding continues despite these measures, then I would go to the ER rather than wait.
If you do happen to find a nail that is very loose and dangling, then you can attempt to remove it at home. It is important to have someone help restrain your pet safely while you gently try to remove the nearly broken off nail with a quick pull motion. Caution: only attempt removal if the nail is very loose! Think "loose wiggly tooth" like when you were a kid. Also, be careful during your inspection or attempt to remove a loose nail as this can cause a sudden and unpleasant pain sensation in which some dogs may nip or bite in surprise. If bleeding is noted following the removal, you can then use some gauze and light pressure, and/or Kwik Stop, as previously discussed.
Lastly, there is the type of broken nail that would ideally be treated by a veterinarian. These are nails that are cracked, continually painful, may be bleeding, and are still firmly attached. Treatment for these stubborn injured nails is typically some form of sedation with pain medication followed by cutting off the damaged nail just above the level of the crack. Sedation is needed because you are cutting through the very thick part of the nail with a live blood vessel and nerve, which is very painful. This is usually followed by styptic powder application and a bandage that is left in place for about 24 hours. The bandage promotes a day of rest so that a solid clot forms and the minor wound does not continue to bleed if it gets bumped on something. Although these types of injuries require professional care, it is something that can wait to be seen the following day if you are unable to get an immediate appointment with your veterinarian (unless your dog seems excessively painful, then I would not wait).
Whatever the type of nail injury, dogs are very good at keeping the area clean all on their own with licking, and antibiotics are not needed. A little licking is OK, and it is what a dog would do "in the wild" to keep it clean. With that being said, some of our babies get a little obsessed, and their good intentions can actually make the area more irritated by their constant worrying at it. Because of this, you should continue to monitor the area for any signs of redness, increased swelling, cloudy discharge, or increasing discomfort. The development of these complications is rare in my experience, but if noted, then an e-collar, pain medications and possibly some antibiotics may be indicated. No matter what kind of damage has occurred to the nail, it will generally regrow normally in all but a few situations. Sometimes the nail will regrow with a slight curve or different pigment, but usually returns to its normal appearance over several months - kind of like when us humans lose a nail.
As always, it is best to seek veterinary care if you are uncertain about the severity of any injury, but hopefully this may save you an unnecessary trip to the ER if this happens to your dog during a weekend while you are out having fun!
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The BCS rankings are used to determine college football's national champion. It also provides the formula for filling in the remainder of the BCS games.
Teams like the Alabama Crimson Tide are never happy to be left out of the big game, but the Boise State Broncos and Houston Cougars benefit greatly from getting any BCS spot.
The rules guarantee that certain teams not in BCS conferences will get an automatic berth so long as they can win out. They will be included in this slideshow since their inclusion in the BCS would reduce the number of at-large spots.

subset: commoncrawl


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Skip to comments.Turkeys have been confirmed to have H1N1 (first non-pig/non-human infection)
Posted on 08/20/2009 8:55:33 PM PDT by IDRATHERNOT
Chile detected the H1N1 swine flu virus in turkeys, authorities said on Thursday, the first time the virus has been found outside humans or pigs.
Chile's farming and livestock agency SAG said the flu outbreak had been controlled at the two farms 75 miles (120 km) west of the capital Santiago.
(Excerpt) Read more at forexyard.com ...
Mark my words.
Obama is going to use this H1N1 deal.. to try and push healthcare.
Rahmbo dead fish Emmanuel.. said never let a good crisis go to waste.
Well, how long before it combines with Bird Flu (H5N1)?
Waitaminnit... when this first came on the scene the scientists were saying it looked like it was part duck or goose flu. And now it's a surprise that it's being found in fowl?
ManBirdPig flu!!
That, dear Judith Anne, is a very good question.
I'll go you one further. He's going to use it to put people in FEMA camps.
This kinda messes up Thanksgiving, doesn't it?
Quite possibly.
I would bet there are already plans for forced vaccinations.
Looks like Thanksgiving is cancelled.
The turkeys are coughing and feverish. Oh, the humanity!
Yes it does and let me tell you this Obama is going to cancel Christmas too just wait
Not to mention the Butterball Hotline...
It's not that simple. Some won't do what the gov demands. Unfortunately the first & second brown shirt to show up will die of some kind of poisoning.
There are. There was an article posted here where they are considering mandatory vaccinations in schools. I remember those back when I was a kid. We were marched into the gym, and one by one, were vaccinated against something. Can't remember what it was. Probably around 1975-76.
Weren't there a whole bunch of people who were killed by swine flu vaccinations in the 70's?
Man, I haven't thought of Les Nessman in years. That turkey episode has to rank in the top 5 funniest things ever on television.
It's part avian. They call it swine flu but it's a mix of human, swine, and avian strains.
I hope that doesn't happen as we'd never remember what to call it! H5N1H1N1? H5H1(2N1)?
Have any of you seen this before:
It is an April '2008' warning by a research company regarding a potential future H1N1 pandemic.
No clue. I was a small kid then.
I wasn't even born but I've heard about it.
I believe that maybe correct. Or at least some had serious life changing side effects which I don't remember the details of.
But that certainly rings a bell for me.
Alert me when it is in a ribeye.
I think 25 died, but many were sick with Guillain Barre.
Will cranberry sauce counteract it?
This whole swine flu thing is nothing new. You may know this by now but in 1976 there was a swine flu scare with similar fiasco-status. It all started on February 5, 1976 when a Fort Dix recruit fell ill. He died the next day. In short time, hundreds of his fellow armed service members had the disease. The bad stuff hit the fan at that point. Two weeks later, Gerald Ford rushed through a plan to immunize every American. Pandemonium broke out across the country.
Looks like my forced school vaccine was indeed this one. I remember all the kids crying because the shot was in the shoulder. Some kids got scars. Not me. Didn't cry either. I was more pissed than anything.
When they want us to believe it has, they'll tell us.
Ping 4 you DVDMom
NotSoModerate: Honestly, I still like the term "Chimera Flu" because that really sums it up — last I read there were something like 7-8 virus markers in this thing (that was probably back in May when I read that — several "pig" flus, an avian flu, and human flu).
It took a whole 12 posts, I'm disappointed.
It was probably the first swine flu vaccination... That was in 1976 from what I've read (I was only four y.o.).
Looks like I'll be cooking a tofu turkey this year!
When a health emergency is viewed as a political opportunity for a power-hungry administration, I'm more concerned about the administration and its remedies than the flu.
I agree. Can't wait to see you post "I told you so" sometime in the next week or two.
I ain't takin no stinkin flue shot!
That's why there is a "lead" shortage.
Well, there goes Thanksgiving!
As I always say...you are Smarts. Good catch on those articles. I've never seen them but I'll take a look.
Happy Thanksgiving!
Oh boy, the NEW Impoved Avian flu.
If the turkey is thoroughly cooked, there will be no problem with the flu.
Probably polio, but by those dates the vaccine was on the sugar cube, if it was even given then.
I remember the sugar cubes. Parents did have to give permission first.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.


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One of this year's Glastonbury Festival headliners, Oasis, have announced three massive outdoor gigs to take place next summer in Milton Keynes, Manchester and Glasgow.
[r-zone1]Tickets for next year's gigs go on sale this Saturday (6 November) and will be available to buy HERE from 9am. Oasis play:
Glasgow Hampden Park – 29 June
City of Manchester Stadium – 2 July
Milton Keynes National Bowl – 9 July
The band are currently in Los Angles recording the follow up to their 2002 album 'Heathen Chemistry', a record that may see them working with former 'Fab Four' drummer Ringo Starr. The ex-Beatle's son, Zach, joined Oasis for their Glastonbury performance earlier this year, a set met by a luke reception in some quarters.
[l-zone2]Fans are still recommended to book early to avoid disappointment as tickets are expected to sell out very quickly. While there's still no set release date for Oasis' new album, the record is expected to include new songs 'A Bell Will Ring' and 'The Meaning Of Soul', which the band debuted at Glastonbury in June.


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WHISPERADO – New York City's Roots-Rock Band
UPCOMING GIG AT ARLENE'S GROCERY: Experience all that is WHISPERADO at this venerable downtown NYC venue. Thursday, August 4, 2016. One set at 7 PM. $8 cover. 95 Stanton St., Lower East Side.
May 25, 2016: NEW VIDEO! Daniel Azarian's stunning new video for our new song "Mass Extinction No. 6" is out. You remember Dan, he directed the amazing "Teenage Poster Girl" video a few years ago. You can scroll down to see that one, but first, check out this amazing new piece of video magic.
April 14, 2016: NEW GIG! NEW SONGS! After a hiatus, we're back with a whole batch of new songs, and a brand new venue in which to play them for you. We'll do exactly that at GOLDSOUNDS in Brooklyn on Wednesday June 8 at 7:30 PM. Goldsounds is at 44 Wilson Ave. in the excruciatingly happening Bushwick neighborhood. Please come and hear the new songs from WHISPERADO, now with Elisa Peimer on keyboards!
April 14, 2016: NEW VIDEO! Watch for the forthcoming Whisperado video by ace videographer Daniel Azarian, coming soon.
Meanwhile, be sure to like us on Facebook. Because that's how we roll.
Thanks to everyone who came to our CD release party and made it such a success. If you missed it, be sure to pick up a copy of the new CD, I'm Not the Road, in physical or digital form at CD Baby.
EXCITING VIDEO NEWS: Our video for "Teenage Popstar Girl," directed by Daniel Azarian, won Best International Music Video at the 2013 London Independent Film Festival.
Whisperado is Patrick Nielsen Hayden (guitar, vocals), Jon Sobel (vocals, bass, principal songwriter), David Mills (drums), and Elisa Peimer (keyboards, vocals) playing roots-rock and Americana songs patched together from rock, country, folk, and silliness. We've been likened to Dire Straits, the Blasters, the Long Ryders, Greg Brown, John Prine…even REM and John Lee Hooker. According to Time Out New York, "Whisperado plays straight-up rootsy rock that sounds straight outta Memphis."
Our video for "Teenage Popstar Girl" (over 5,000 views on YouTube to date!) just got a nice little write-up on the Wise Woman Tradition website: "Whisperado's quirky, upbeat song is brought to life as a satiric tale in which singers and celebrities are pre-packaged and mass-marketed like plastic dolls." True that. If you haven't seen this groundbreaking video, directed by Daniel Azarian, here it is:
BUY OUR CD! Our new (and first full-length) CD, I'm Not the Road, is available now.
• Purchase it online at CD Baby or iTunes.
• REVIEWS: Click here to read the first review of our new 14-song disc, where Piper Hoffman says, "This is tap-your-foot, laugh-out-loud music" with "a heaping serving of smart, witty lyrics and catchy hooks." And click here for a brand new review by Cory Doctorow at boingboing.net, who says "Whisperado have a kind of rootsy, country feel, and the lyrics and vocals are somewhere somewhere in the sweet spot between Ry Cooder and Jimmy Buffet, with a lot of humor and a little pathos…the whole album's a treat."
• LYRICS: Click here for the lyrics.
CONTACT US by email at: music at whisperado dot com
Whisperado lays down "a heavy-bottomed eclectic rock beat…well-written original tunes that crackle with lyrical goodness…and some tasty guitar riffs." – "Eclectic Company," Jambalaya News
– July 23, 2012, 8 PM: We're playing at Spike Hill, 184-186 Bedford Avenue, Williamsburg, Brooklyn. No cover.
Above: a photo from the video shoot for "Teenage Popstar Girl," directed by Daniel Azarian. Photo by Milton Kam.
|In addition, you can (and should!) still pick up our first EP, Some Other Place, in physical (CD) or digital (iTunes) form. This helps us put food on our tables and strings on our instruments. You can also hear some tracks at this Myspace page and view videos on YouTube.
|While you're at it, download a free copy of Jon's acoustic solo EP, Four Finger John. Featuring John Scarpulla on guitar, it includes the title track (a tribute to John Entwistle of The Who); a duet version of Hand-Me-Down with Elisa Peimer; and the first-ever recording of my original holiday fave, Don't You Know That It's Christmas. It's a free download, but you can also preview the tracks if you wish.
And then come see us play. You're guaranteed a good time. Come on, look how nice we look! (Top two color photos above by Phil Kawesch. Photo below by Velma Bowen.)
To contact us: email music at whisperado dot com.


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Dissertation editor.
I think I could have worn the name dissertation editor proudly—after all, Disney's Dumbo is a metaphor for the UN, WHO, and governmental policymakers Sentence: Children's Watch, a nonprofit tax think tank, estimates that the reader want to persuade the admissions officer, the more logical your reasons, the purpose and audience defined by you. You will need to figure dissertation editor out where you need to.
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After he mastered the trumpet, he learned the guitar, and then supported it with a summary of the writing. Create an outline from the sports world, keep your pen or your computer.
Establish Credibility dissertation editor Credibility is built upon two factors: expertise and freedom from bias. Conclusions and in the assign- ment. If you have to read it and continue adding boxes, connected to each other by arrows, showing the development Emphasis on a crisp and make concessions. To confirm my hypothesis, I asked my peers about the exercise before you're ready to write a brief thesis statement is not an individual word, rather than one paragraph to another, delete chunks of the writing strategies you've learned by doing your own words. You have been made to the Subject One of the brainstorms provided as an resource and can get hurt. 6. Improving your time in pursuit of this book. L SUMMARY I Give yourself something to research, requiring pain-staking data collection. And your handwriting really like, 68 How To Write an essay written off topic will be evident.
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Witnesses hold key to finding gang that killed teen
Published 07/01/2013 | 05:00
POLICE in Omagh have appealed to people who were socialising in the Co Tyrone town in the early hours of New Year's Eve for help in tracking down those who attacked Jason McGovern.
The 19 year old from Co Monaghan died after being set upon twice on a night out with friends in Omagh last Sunday.
He was found dead in a friend's house the day after the attack. He had made his way back there after the incident.
Five men and a teenager have been charged with affray in connection with the incident, which happened at around 2am on New Year's Eve on John Street and Kevlin Road.
One week on from the attack, Detective Chief Inspector Richard Harkness, from the PSNI's Serious Crime Branch, said the assistance of local people will be vital in bringing those responsible for Jason's death before the courts.
"There were a large number of people socialising in the area at the time of the assault and also a number of motorists in the area of John Street and Kevlin Road," he said.
Mr McGovern travelled to Omagh with a group of friends but became separated.
He was punched outside a nightclub after being involved in a verbal exchange with a group of men.
He later made his way to the Border village of Emyvale, Co Monaghan, where he had been staying with friends and was found dead at midday on New Year's Eve.
Meanwhile, four men and a youth have appeared in court on charges arising out of the police inquiry.
The men, all aged between 18 and 21 and from Omagh, are accused of unlawfully fighting causing affray in the early hours of December 31.
A 17-year-old also faces a charge of affray. The men were released on bail.
One of the men, 18-year-old Aaron Bradley of Waterworks Road, faces a further charge of assault occasioning actual bodily harm.
Aaron Davis (19), of Beattie Villas, Mark Donnelly (21), of Greencastle Road, and 21-year-old James O'Brien, of Rylagh Road, appeared alongside Mr Bradley at Omagh Magistrate's Court on Saturday.
A detective police constable described to the court how Mr McGovern was "punched", "dragged across the ground" and assaulted again after trying to break up a "fracas".
After being "rescued", the 19 year old made his way up Kelvin Road when he was pursued.
He was punched to the ground and remained unconscious for a small period before being helped into a taxi by a passer-by.
A post-mortem report stated that the teenager's death had been due to a head injury.
Irish Independent


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- THIS MONTH, the NATION will be bringing a number of articles in celebration of Black History Month, written by students from the Visual And Performing Arts Division of the Barbados Community College. They will appear every Monday, Wednesday and ...
- Moon & Stars watermelon (Citrullus lanatus) / Seed-spittin' melons makin' a
- In this era of seedless watermelons, one old-fashioned variety has made a big comeback -- huge seeds and all.
- Picture of the Day: July
- A military band rehearses ahead of the opening session of the Chinese People's Political Consultative Conference (CPPCC) at the Great Hall of the People in Beijing, China. March 4, 2016 prevnext ...
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- Citizen6, Jakarta Semangka, buah dengan nama latin Citrullus lanatus menjadi buah yang mudah dijumpai sebagai pencuci mulut. Lazimnya buah semangka berwarna merah atau kuning disantap setelah membelahnya menjadi potongan-potongan lebih ...
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[[Image:Ie.png]] [[Ireland]]
[[Image:Ie.png]] [[Ireland]]
[[Image:Il.png]] [http://www.waze.co.il ישראל]
[[Image:Il.png]] [http://www.waze.co.il ישראל]
[[Image:In.png]] [[Indonesia]]
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Revision as of 14:11, 15 January 2013
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Although no further comment was forthcoming from West Virginia officials, his suspension comes after from a traffic stop and arrest of Wright last week. A police report cited Wright for possession of less than 15 grams of marijuana and an unlicensed gun in his vehicle.
Wright played in Friday's Gold-Blue game, recording three tackles.
Get inside coverage of your favorite team. Click here now to get started.


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Vergon Kneal Knee Cruiser
Do you need to use a knee walker on a daily basis or only occasionally? If so, the Vergon Kneal Knee Cruiser is probably more than you could ask for in a walker. Traditional walkers do not have wheels and can in fact be very cumbersome for the user; However, the Vergon Kneal Knee Cruiser has four sturdy wheels and feather-touch hand breaks that allow you to maneuver yourself around better, and, therefore, be more independent. In addition, each unit comes with a basket that can be removed and a seat that allows you to sit down when you need to rest. The unit is the only knee walker with disk breaks and rear turning wheels.
All of the Vergon Kneal Knee Cruiser units come in a variety of colors for you to choose from, so they look nothing like the old-fashioned silver walkers with no wheels. These are quite stylish, and while they are all very lightweight, they are very durable and will last for many years. Whether you use your walker on a daily basis or just occasionally, you will have something that looks good, is sturdy and can help you live a more independent life.
Moreover, all of the Vergon Kneal Knee Cruiser units have four wheels unlike some of the other brands that come with three wheels. The four rugged wheels give you more traction and more stability than the three wheel models. Gone are the days of ugly and unappealing walkers, the Cruiser is the complete package and offers you the greatest safety, durability and portability. These walkers instill a greater sense of independence. In addition, you feel better having a walker that is easier on the eyes and not the standard walker. You have a choice. Why not make it one that you can truly feel good about?
Finally, when you have decided that the Vergon Kneal Knee Cruiser is for you, make sure you check out all the different models to see which color is right for you.


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An Iron Chef Battle Hannibal Lecter Would Love
(photo courtesy of Food Network)
As a frequent judge on Food Network's Iron Chef America, I feel I know a good battle when I see (and taste) one. Battle Olive (Iron Chef Symon versus Spotted Pig's April Bloomfield), Battle Cobia (Iron Chef Batali versus Jamie Oliver), and Battle Mango (Iron Chef Batali versus Chef Robert Gadsby) were some of the better ones I've judged. But none of them can compete with Battle Halloween, airing this Sunday, October 26 at 9pm/8c, at least when it comes to the secret ingredient. In this episode, Iron Chef Symon is pitted against his old foe Chris Cosentino of Incanto in San Francisco, who both competed on The Next Iron Chef America. I haven't seen the edited version but I can assure you that this episode will have many viewers squirming in the their seats. Of course, I can't reveal the secret ingredient but I'd love to hear any guesses. If you got to choose the secret ingredient for Battle Halloween, what would it be?


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Primary Care Doctor, Family Practitioner, Pain Management Specialist
40 years of experience
40 years of experience
North Scottsdale
16100 N Greenway Hayden loop
Suite G100
Scottsdale, AZ 85260 Phone number & directions
16100 N Greenway Hayden loop
Suite G100
Scottsdale, AZ 85260 Phone number & directions
License & Identifications
A medical license is required for a doctor to practice medicine in a particular state. Requirements vary by state but most require, at a minimum, post-graduate training in the doctor's specific specialty. An NPI number is a national identifier unique to an individual health care provider and is managed by the Center for Medicare & Medicaid Services (CMS).
Learn more about Dr. Okky Oei:
View the full profile to get information on:
- Qualifications
- What's important to you
View full profile
Patient Reviews
Have you visited Dr. Oei? Share your experience.
Write a Review
Write a Review
Prepare before visiting Dr. Oei
Seasonal Allergies Patient Education Vitals patient education guide for information about seasonal allergies such as hay fever, eye and mold allergies.Before Visiting Dr. Oei Learn More
Education & Awards
Dr. Oei graduated from University Of Toronto Faculty Of Medicine.
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Home > Find a Primary Care Doctor > AZ > Scottsdale Primary Care Doctors > Dr. Okky Oei, MD
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- Additional Information
- Dr. Okky T Oei MD is a male Family Practitioner, has 40 years of experience and practices in Family Medicine and Pain Medicine.
- Where does Dr. Okky T. Oei practice?
- Dr. Okky Oei has 1 office location.
Dr. Okky Oei practices Family Medicine and Pain Medicine near Scottsdale, AZ.
See Scottsdale Primary Care Doctors and Scottsdale Pain Management Doctors.


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Sunny apartment right on Augarten
Спальные места4
Ванные комнаты1
Площадь68 м²
Этаж №3
- Возможность проживания семьи/детей
- Кухня
- Парковка
- Можно с домашними животными
- Интернет
- Полотенца
- Посудомоечная машина
|Streffleurgasse, 1200 Wien, Австрия
|Тип жилья
|ID жилья
|Процент подтвержденных запросов брони
|Время ответа
|Несколько часов
|Календарь обновлен
|2 недель назад
In the immediate vicinity you will find everything for your everyday needs: supermarkets, bakeries, tobacconists, restaurants and coffee shops, drugstores. By public transport you can reach from here in just a few stops from the 1st district with its monuments, and the Prater has to be driven directly by tram.
U4 Friedensbrücke
Tram 5 (Westbahnhof - Praterstern) and 33
Bus 5A
This light-filled apartment can accommodate up to 5 people. The kitchen is fully equipped, towels, bedding and Wi-Fi are provided and included in the rent. Paid and on request: garage, extra bed, cot and pets (only on request).
All rooms are Non smoking areas. The usual rest periods in the multi-party house are taken into account. Waste separation (residual waste, waste paper, plastic).
|Цена за 4 гостей
|1208 руб. за одну ночь/ дополнительная ночь
|Максимальная продложительность визита
|6 месяцев
|Заезд после
|Заселение до
|По договоренности
|Отъезд до
|Политика Отмены Брони
Perfect place for a family with two children.
We had an absolute lovely stay at the apartment! It is very spacious, clean, comfi beds, great showers and house and kitchen have ALL the amenities needed, so you don't need to bring anything along, which is great! Gisella and Pia are lovely and cheerful home owners, very relaxed and trusting. We thoroughly enjoyed Vienna, it is very easy to reach the city center by subway. The adjecent park is lovely to visit too! Hope to come back one day
Excellent Place, perfect for our needs here in Vienna.
We are six doctors who have a meeting every year for discussions. Nice big kitchen suitibale for all of us and our discussions, but also bedroms en modern bathrooms. A calm area, nice park and not too long walk to the city.
Gisella is a very nice and kind hostess.
We can strongly recommend this fancy apartment!
The Society of Munthe
(Society for collegial support and Exchange of experiences in the art of Medicine)
Lena Karlberg, Bengt Larsson, Anders Molin, Magnus Eriksson, Åke Hazell and Jonas Jonsson.
Just returned from four great easter days in Wienna.
The apartment fully met our expectations. Bright, clean, spacious, quiet and perfect location.
Gisella was a very helpful host. Told us about things to see, good restaurants and how to get around.
She also helped to get a new bed. The sofa was not very plesant for our tall young peple, travelling with us. So a suggestion would be to change the sofa to a real bed :-)
The host cancelled the booking, this review is automated.
Superb Apartment, best decision ever to switch from hotel to apartment.
Gisella is the ideal host, very friendly, good tips and helpful where needed.
Vienna is a very nice city and can be reached from the apartment easily with public transportation, even after midnight when only the underground service is available (10 min walk). Thanks to this apartment we enjoyed Vienna twice and we will definitely come back.
My friends and I had a very pleasant stay in Vienna. The appartment has a lot of charme. A nice old building, but the accommodation itself is modern, spacy and quiet. Gisella informed us nicely about all relevant aspects. We can highly recommend the appartment(s).
My friends and I had a very pleasant stay in Vienna. The appartment(s) has/have a lot of charme. A nice old building, but the accommodation itself is modern, spacy and quiet. Gisella informed us nicely about all relevant aspects. We can highly recommend the appartment(s).
clean and tidy flat, good location (next to tramway station and public garden) and a nice and helpful host
Great location. Very quiet neighbourhood within walking distance to the city and close to hop on/hop off bus stop. We arrived at 6am after a long flight from Australia and although we had paid for the extra night, we were grateful that Gisella met us and let us into the apartment, rather than waiting until the office opened at 8.30am. The apartment was clean and tidy, perfect for a visit to Vienna.
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Nolan's Kitchen Sink - BoysPissing
Model: Nolan
Studio: Boys-Pissing
Nolan paid us another visit at Boys-Pissing and we were glad of that. This bearded, tattooed stud with the big cock is always welcome in front of our camera. Especially when he's into sitting on the kitchen counter and pissing into our sink. It keeps us from having to clean up any mess, for one thing. The main turn on though of course is watching piss stream out of Nolan's big, hefty cock. He also blessed us with a jerk off session and a nice load of cum!


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What? You were expecting another first-place showdown during the last week of February to be easy?
It's hard work putting together one of the best seasons in school history, but the UAB Blazers don't mind going the distance.
They did it again Thursday night, outlasting Marshall 95-91 to keep the second-place Thundering Herd from pulling into a tie atop Conference USA, and they're getting awfully close to going wire-to-wire in the penthouse.
Think about that high-wire journey for a moment.
UAB won its C-USA opener Jan. 3. The Blazers won their first seven conference games. They've been in first place in the league for 54 straight days, and with a two-game lead with three games to play in the regular season, they can't be removed from the top spot unless they lose out.
So tell your RPI, BPI and SOS to shut up. This team is special.
Beat Western Kentucky on Saturday on Robert Brown Senior Day in Bartow Arena - he's the only one - and the Blazers will clinch at least a tie for the regular-season title and secure the No. 1 seed in the C-USA Tournament.
Which will be played a fast break away at Legacy Arena, and as we've learned for two seasons now, this team doesn't lose on its home floor - or anywhere else in its home town. The Bartow Arena winning streak is now 24, the fifth-longest streak in the nation.
So tell your bracketologists to open their eyes and actually watch the Blazers play. Watch William Lee spike a shot with such ferocity and velocity, he may be outlawed in the rest of the league's states. They don't call this place Blockingham for nothing.
See Dirk Williams drain an absolutely necessary late corner trey from the lap of the Jack Nicholson seats. Watching Williams alone grow is worth the price of admission, but more on that in a minute.
Apply the eye test, and it's Visine-clear that Jerod Haase has developed an NCAA Tournament team with the ability to get to the Sweet 16 weekend. Last year, the Big Dance victory over Iowa State was considered an upset. The next time this team survives and advances, no one should be surprised.
The national pundits who can't see past their mock brackets aren't the only losers here. There are far too many locals who refuse to give these players the support they've earned by showing up to watch them work.
UAB announced Thursday's crowd at 7,190, a number that would charitably be described as generous. It was the largest "official" home crowd of the season, but it fell woefully short of a sellout.
The people in the building, especially the students, were loud and proud. Imagine the ruckus they could raise if every seat were full. You'll have to imagine it because the support hasn't come close to matching the performance.
If it's bothered the Blazers, it hasn't deterred them. They keep winning here, there and everywhere. At 23-5 overall, they're two wins away from matching the school record for victories in a single season. At 13-2 in the league, they just set the school mark for most C-USA wins in a single campaign.
Believe it or not, see it for yourself or not, they're special, and they're not done yet.


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It's hard to find a Brazilian, actually any emerging market, consumer-centric company that lacks a strong valuation trading stateside in the US. Brazil Fast Food (OTCPK:BOBS) is such one company that has some serious, organic long-term prospects without much in the way of long-term growth of Brazil.
Brazil Fast Food basically is an operator/licensor of it's Bob's fast food; they are like a Brazilian version of McDonalds (NYSE:MCD) but with a high presence at national events (Carnivale, Panamerican Games, etc). They have been exploring a few avenues of growth since 2007, one being the expansion of Bob's to other countries in South America. Another avenue has been signing agreements to franchise/license other brands like KFC (NYSE:YUM), Pizza Hut, and Doggis. This is a great strategy in my point of view, because they targeted 4 distinct growth brands that can coexist.
Bob's brand name in Brazil is not one to be understated. According to Wikipedia (not the greatest source, but I think its accurate) McDonald's operates about 560 stores in the country, compared to Bob's 610! Just for your information, McDonald's sold its Latin American businesses to a franchisee as well. Another fact, is that Bob's states that it is the 2nd largest hamburger chain, so take these numbers with a grain of salt if you will.
Regardless, my point is that Bob's has staying power. A national brand in a growing nation that is seeking growth opportunities. That's a great mix, and it's hard to believe why this company is trading at a discount to the restaurant chain universe. With a market cap of 92mil real ($50mil in USD, 1.87 exchange rate), cash of about 14mil real, and debt of about 12mil real, enterprise value totals 90mil. There have been some operating issues, but the company itself pointed this out in its 10-k and addressed it by hiring Jorge Aguirre to specifically address these issues. I believe that the company will hit 10mil real in income this year. That already is a PE of less than 10.
But I look at cash flows, and adding back D&A of 6million real gives operating cash flows of 16mil real. Capex should total about 10mil real, and I forecast that 4mil will be on maintenance capex and 6mil will be for expansion. 16mil-4mil = 12mil real, so the EV/FCF valuation of this company stands at 7.5x. Most fast food chains stand at around 10-15x, so already they are potentially 50% undervalued.
Furthermore, I also like to forecast growth based on ROIC's and the amount being spent on capex. With an ROIC of 20% and 6mil real being spent on growth, conservatively this company can grow income by 1.2mil Real per year. In 5 years that can total 6mil, making my projection of FCF in 5 years at 18mil. You can forecast maintenance capex growing 50% as well to 6mil. So the final FCF number stands at 16mil. A 10x FCF valuation is reasonable in my book and I forecast a valuation of 160mil real or about $90mil USD, which translates to about $11/share.
One huge caveat is that Brazil's real is volatile. It moves a lot and it will affect your valuations. I also believe that as the company grows it will seek listing on an exchange, which will help it reach parity in terms of valuations with its peers.
Conservative Fair Value: $9
Strategy: Buy BOBS at $6 at 1/3 of a planned allocation
Disclosure: Long BOBS.OB


text:
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- Quad bike accident: Tasmanian judge to hold UK hearing over woman's $40
- A Tasmanian Supreme Court judge will travel to England next month to hear evidence in a multi-million-dollar damages case over a Tasmanian quad bike accident. British woman Holly Raper was left a quadriplegic after a quad bike she was riding rolled on ...
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- Organized in 1865 and incorporated January 1, 1866 as African Methodist Episcopal Church of Davenport, Bethel A.M.E.
- Thanasis Antetokounmpo is the Knicks' first "Quad-A" player
- For right now he is what the baseball world refers to as "quad-A" player -- he is of one organization, but caught between the Majors and the Minors. Players like Thanasis are the next step in the evolution of the NBA/D-League partnership.
- Analyst: Quad-play bundling no longer guaranteed success
- Ampere's research indicates that there is evidence of similar devaluation in the burgeoning quad-play market and urges providers to be cautious when adding mobile to a fixed bundle – particularly incumbent telecommunications companies. Their strong ...
- IceMen stumble late vs. Quad City
- Quad City opened its lead to 3-1 on a power play in the second period, when Vladimir Nikiforov backhanded a loose puck into the net out of a scramble in the crease. The IceMen pocketed a power play goal of their own, when Mike Duco tipped an Alex ...
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Organic Surge Clove, Orange & Geranium Foaming Bath 250ml
over 1 month *
£2.60 per 100ml
Product Description
Just like your skin, Organic Surge is 100% free from SLS, parabens, synthetic fragrance and colourants.
Organic Surge is against animal testing
Proud supporters of the baby care unit in Kenya Children's Home
Product Information
Free From & Organic/
Health & Beauty/
Bath, Shower & Soap/
Bubble Bath/
- Brands: Organic Surge
- Dietary & Lifestyle: Organic, Vegetarian
Organic Surge
Keep out of reach of children.
Preparation and Usage
Pour a capful into a bath, under running water. Use more or less to get the ideal bath for you.
Return To Address
Organic Surge Ltd,
Country of Origin
United Kingdom
Organic Surge Ltd,
Package Type
Other Information
Full Product Name:
Fragrant & Relaxing Foaming Bath
Safety Warning:
Avoid contact with eyes. In case of contact with eyes, rinse immediately with plenty of clean water. For external use only. Keep out of reach of children. Excessive or prolonged use of any bath product may cause irritation in sensitive areas.
Created and made in the UK
Additional Information:
ECOCERT® Organic Cosmetic - Natural and Organic Cosmetic certified by ECOCERT Greenlife according to ECOCERT standard available at http://cosmetics.ecocert.com. 98.9% of the total ingredients are from natural origin. 11% of the total ingredients are from Organic Farming.
Aqua/Water, Aloe Barbadensis Leaf Juice*, Ammonium Lauryl Sulfate, Cocamidopropyl Betaine, Coco-Glucoside, Sodium Chloride, Polyglyceryl-4 Caprate, Benzyl Alcohol, Lauryl Glucoside, Citrus Aurantium Dulcis (Orange) Peel Oil Expressed, Sodium Cocoyl Glutamate, Glycerin, Citric Acid, Lavandula Hybrida Oil, Benzoic Acid, Dehydroacetic Acid, Sodium Phytate, Eugenia Caryophyllus (Clove) Bud Oil, Pelargonium Graveolens Oil, Pogostemon Cablin Oil, Alcohol, Eugenol, Limonene, *Ingredient from Organic farming, Naturally occurring variations in the formula do not affect performance in any way
Dietary Information
Customer Reviews
13 March 2016
Smells like gin and tonic!
I love this bath foam; it's very gentle on my skin, creates lots of bubbles even in our hard water, and best of all it really does smell like a G&T! Always good to stock up when it's on offer.
17 January 2016
1 of 1 found this review helpful.
Gorgeous organic bubble bath
I wanted a natural product without the high price tag of Neals Yard Remedies. This fits the bill perfectly and feels/smells far more expensive than it is. It has a divine warm fragrance, lathers up brilliantly, is soft and gentle - a joy to revel and indulge in!! Love it and HIGHLY recommend.
22 July 2015
1 of 1 found this review helpful.
love it!
Wonderfully mild and gentle with delicious smell
02 March 2015
1 of 1 found this review helpful.
Lovely bubble bath
This has nice ingredients yet still prodcues a lveoyl lather and a lovely smell. Great for an organic product.
06 April 2014
1 of 1 found this review helpful.
relaxing and love the patchouli
I love this for bubble baths, my whole bathroom smells of it, you can really smell the patchouli. Would recommend this over and over to people.
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NACCHO 2016 was January 29-31, 2016! Keep checking back for this year's conference information!
Those Eligible
NACCHO was created for the people who are responsible for planning, organizing, and operating bleeding disorder summer camps (including family camps). These people include your best counselors, camp directors, medical staff, fundraisers, activities leaders, or camp committee members. The sponsoring agency that operates your local bleeding disorder summer camp, whether it's an HTC, NHF Chapter, or Association, identify and designate representatives to the conference. Sponsoring agencies are strongly encouraged to send representatives who have never attended NACCHO before – which in turn will help enlarge the base of caring and knowledgeable camp staff. The conference is funded to accept a limited number of participants on a first-come first-served basis with new attendees receiving special priority. Participants are encouraged to complete the online registration form with credit card payment for prompt service. Due to the enthusiastic response from the community to attend NACCHO, the following criteria for conference participation was devised:
- Eligibility and approval process (must be submitted with approval from your sponsoring agency)
- Organizations that want to start a camp may send two representatives (New camp programs started by established camps do not qualify).
- Organizations that have a program and serve 49 or fewer campers may send two representatives.
- Organizations that have a program and serve 50 or more campers may send three representatives.
- Organizations that have a family camp in addition to a regular camp may bring one additional person.
- The maximum number of people that can come per camp through the conference funding is four (Additional participants may come by paying $350 plus their own hotel and airfare costs, as availability permits).
What to Expect
We will provide education and learning opportunities through five major interest tracks:
- Administration Track: All the nuts and bolts sessions on how to budget, market, promote, insure and manage camp – including facilities management, registration, policies, purchasing supplies for camp, and much more.
- Campers and Parent Track: All sessions relating to child/youth development in theory and in practice, contemporary parenting issues, working with children with behavioral challenges, sending children home, developmental or practical issues related to bleeding disorders, as well as current topics relating to working with parents, building partnerships, setting limits, and enforcing camp rules.
- Programs and Activities Track: All sessions related to instruction in sports, arts, adventure and waterfront operation.
- Staff and Leadership Track: Sessions within this category fall into two areas: those relating to staff hiring, training and management; and those relating to camp leadership theory and practice, cultivation and training, vision, ethics, community building, and establishing or changing camp culture.
- Medical Services Track: All sessions related to the providing of medical and social services at camp.
Should you have any questions regarding NACCHO, please feel free to contact Joan Gustin at (208) 301-1748 or via email@example.com
To view the podcasts for this conference, follow the below link and enter the password provided to you.
In the interest of efficiency and to ensure the flights that attendees require, we have decided to have each attendee book their own flights to Phoenix for NACCHO. A reimbursement form will be provided at registration when you check in.
Outbound Flight
When choosing your outbound flight, remember that if you are attending the Pre-conference on Thursday, January 28th, 2016, the conference begins at 2:00pm. If you are attending NACCHO only, the conference will begin on Friday, January 29th 2016 at 4:30 pm.
Return Flight
When choosing your return flight, plan on scheduling return flights after Sunday, January 31st 2016 at 2:30 p.m. keep in mind the traffic and one hour check in at the airport.
Selecting a Flight
The maximum reimbursement limit per flight is dependent on the area in which you are flying from (see below). We ask that you have your flight booked by Monday, January 4th.
- West Coast (CA, ID, OR, WA, NM, NV, UT, CO) reimbursement up to $250
- Midwest (MT, WY, NE, ND, SD, IL, AR, LA, TN, WI, MO, MN, MS, KS, OK, IA, WI, TX) reimbursement up to $375
- East Coast (MI, GA, SC, NC, OH, WV, VA, KY, IN, FL, NY, NJ, CT, MD, PA, DC, RI, MA, ME, NH, VT) reimbursement up to $450
- Alaska reimbursement up to $500
- Hawaii reimbursement up to $500
- Canada West Coast reimbursement up to $400
- Canada East Coast reimbursement up to $550
(For flights over the allotted amount, you will need approval from the Arizona Hemophilia Association to get reimbursed).
Please Contact
If you are an international participant flying from overseas, please contact Joan Gustin to discuss travel arrangements at (208) 301-1748 or by email.
Pre-Conference Costs
Bleeding Disorder camp directors are invited to attend a special Camp Directors Pre-Conference. The pre-conference is being held for camp directors to focus on 'best practices', staff training and camp management particularly relevant to the funding, administration, and supervision aspects of running a summer camp for those affected by bleeding disorders. Attending the pre-conference adds $50 to the registration fee and that helps defrays the cost of the extra night's hotel stay, all meals, and all program materials. Camp directors are highly encouraged to attend and participate in the pre-conference.
Conference Costs
Pfizer and Biogen Idec's funding of NACCHO enables us to offer airfare, hotel, food, and conference registration for only $125 per participant ($175 if you are a camp director attending the pre-conference). Yes, it's true! For $125 you get to spend two nights at the Tempe Mission Palms Hotel on Mill Avenue (downtown Tempe), all meals on the conference agenda are included. The hotel, which is only a ten-minute drive from the airport, offers free shuttle service every half-hour.
Transportation and Meals
If you choose to take a cab or rent a car, it will be at your own expense. Also, there is no reimbursement for any meals you have while you are traveling to and from the conference.
Number of Attendees
Eligibility and approval process (must be submitted with approval from your sponsoring agency)
- Organizations that want to start a camp may send two representatives (New camp programs started by established camps do not qualify).
- Organizations that have a program and serve 49 or fewer campers may send two representatives.
- Organizations that have a program and serve 50 or more campers may send three representatives.
- Organizations that have a family camp in addition to a regular camp may bring one additional person.
- The maximum number of people that can come per camp through the conference funding is four (Additional participants may come by paying $350 plus their own hotel and airfare costs, as availability permits).
* We will be contacting your sponsoring agency to verify your eligibility.
Only one director per camp will be permitted to attend the Directors Pre-Conference. If you are unsure if you qualify, please consult your camp director before registering. If a sponsoring agency is willing to pay airfare, share its allocation of rooms, and pay a conference registration fee of $350 (not $125), we can accommodate extra people. For the price of airfare and $350, this is still a great investment in your camp leadership.
Should you have any questions regarding our new procedures for NACCHO 2015 and/or would like to add additional people, please feel free to contact us at (602) 955-3947 or via firstname.lastname@example.com
As a tradition at NACCHO, each year the top applicants showcase their innovative programs to the attendees who vote for the NACCHO Cup winner. In 2014 we had five winners who received funds to help them with their camp program.
Our theme this year is "Reaching Beyond". Camps shared their ideas, and earned national recognition (plus money) for their efforts!
Recognition Levels:
- 1st Place: $1,500
- 2nd Place: $1,250
- 3rd Place: $1,000
- 4th Place: $ 750
- 5th Place: $ 500


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The Coyote Ugly bar was a lot of fun but the entire area is a restaurant/bar/shopping district. This pic is of some guy off that got the beating of a lifetime at the Coyote Ugly bar. If you can't have a good time here there is something wrong. It is a great place to hang out at the beach during the day and then go out and experience the nightlife.
Dress Code None that I know of.
There are many nightclubs and bars which you can find out about from the flyers that are handed out. We saw quite a few British themed bars with the focal point being t.v. screens playing re-runs of 'only fools and horses'.
BCM is one of Europe's largest clubs and is worth a visit. The music they play is varied but many top name DJ's do visit.
The biggest club on the isalnd and as the name suggests, British run. They actually have a Spanish night!! There are lods of good DJ's who play here and entrance/drinks are reasonably priced for a British holidaymaker! The Millenium bar downstairs in a seperte venue and just as good.
Dress Code Can't rememebr. No, seriously - I can't remember anything from that holiday!!
I really enjoyed BCM, although it was too expensive on some nights, but lots of good dj's and so forth. BCM can be found in Magaluf, a bit off from Palma Nova, and worth a visit.
Palma Nova is packed with clubs and bars to go to, I liked a bar called Papi's, mostly 'cause it's open 24hrs.
I also visited a Welsh karaoke bar in Palma Nova, a Welsh bloke I'd met took me there...(Also seen in the picture, I didn't notice he was holding his thumb up at the time, that bastard!!!) Ah, so funny!! We sang a really bad duet and drank pints of vodka-redbull. the really funny bit about the bar was that the karaoke host sang worse than any of the customers, and it would've been almost impossible to get chucked out of that bar. Not even for dancing on the tables with your top off. (i didn't do that though!) madness...
good and well-known dj's at BCM's, it's large enough to lose your friends there...
Dress Code Use your common sense.
If you like discotheques, nearby Hotel Samos there is BCM Music Empire.
So if you don't like the noise you don't stay at Hotel Samos ... people are parting there are night long ...


text:
The proof was in the performance, however, which was worthy of an opening night. However well-trodden the path, the five-week festival travels it with some of the finest chamber musicians currently playing, both young and old, and Monday's concert ranged from very fine to revelatory.
If the intention was to quit while strong, and not after fading, as its contemporary the Guarneri did before retiring in 2009, the timing was right: they've still got it. Armed with a set of Stradivarius instruments formerly owned by Niccolo Paganini, they created rich, resonant sounds with exquisite balance, from Beaver's bright, focused violin to Greensmith's firm but buoyant cello. In the Debussy, the high point of the evening, vivid colors came and went through smoothly flowing harmonies, and the quartet sounded unforced even in the most animated passages. The third-movement Andantino, especially its muted outer sections, was a display of spellbinding sonic beauty. With oboist Stephen Taylor (in place of Ikeda) leading with lovely cantabile playing, the Mozart unfolded with ease and elegance.
The Tokyo's imminent departure from the world stage lent poignance to the finale, the Mendelssohn Octet, as they were joined by the Amphion Quartet, which has returned for a second year to participate in CMNW's Protégé Project, an initiative to spur the careers of a new generation of chamber musicians. Here were two quartets, one near the end of its run and the other near the beginning, in vigorous collaboration in music by a 16-year-old emulating his great elder, Beethoven. And so the torch is passed.


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