text:
|Publication number
|Publication type
|Application number
|Publication date
|Oct 4, 2011
|Filing date
|Sep 3, 2008
|Priority date
|Mar 5, 2007
|Fee status
|Also published as
|Publication number
|Ebrahim Versi
|Original Assignee
|Ebrahim Versi
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (4), Referenced by (4), Classifications (17), Legal Events (2)
|External Links: USPTO, USPTO Assignment, Espacenet
This application claims priority of U.S. Application No. 60/779,010, filed Mar. 3, 2006.
The present invention relates to a method and device for treating functional bladder disorders and related disorders in women by administering a therapeutic composition to the trigone of the bladder through the vagina.
The bladder functions to store urine and at appropriate times under voluntary control to void urine and hence empty to completion in an efficient and timely manner. The storage and voiding functions of the bladder are under neural control. The innervation of the bladder is primarily autonomic with the parasympathetic system thought to dominate during voiding and the sympathetic system dominating during the storage phase. However the innervation of the bladder is complex and many of the mechanisms of storage and voiding are poorly understood. In particular there is much local interplay of complex neuronally active molecules especially related to the sensory mechanisms.
Functional disorders of the bladder interfere with the normal storage or voiding functions. Many of the functional disorders of the bladder can be treated pharmacologically. Most treatments of functional disorders are systemic with the resultant adverse effect due to pharmacological action in other body systems. Local therapy has been carried out by injection into structures of the bladder by direct visualization of the internal structure of the bladder through a cystoscope. While this method allows accurate anatomic placement of the therapeutic agent, it does require expertise in cystoscopy, consequently limiting the number of healthcare providers who can administer this type of therapy.
Local therapy would be preferred as it would avoid adverse events from distal systems at risk from systemic therapy and would allow the use of therapeutic agents that would otherwise be toxic if administered systemically. The neuronal supply to the bladder is profuse at the neck of the bladder, near the region known as the trigone. Consequently, this is an ideal site for local administration of therapeutic agents. However, local administration of drug to the bladder has been limited by the need to use a cystoscope. To date, the trigone has not been accessed via the vagina for the purposes of pharmacological treatment. The present invention provides a novel method and device for accessing the trigone for local application of therapeutic compounds to the bladder.
The present invention provides a method of treating a functional disorder of the urinary bladder of a female patient comprising administering a therapeutically effective amount of a compound for treating the disorder through the vaginal wall of the patient into the trigone of the urinary bladder. In a preferred embodiment, the administration is by injection through the vaginal wall with at least one needle. In another preferred embodiment, infection is done with a plurality of needles.
The present invention also provides a device for delivering a fluid into the trigone of the urinary bladder comprising an array of needles in fluid-receiving connection with a reservoir. The needles in the array are of a sufficient length to extend through the vaginal wall into the trigone. The needles are in fluid receiving connection to a reservoir, which may contain any therapeutic compound of choice. The reservoir may be adjacent to the needle array. Alternatively, the reservoir may be connected to the needle array by a conduit, such as a catheter, so that the reservoir may remain outside the body of the patient while the needle array is placed within the vagina.
The present invention provides a method for treating functional disorders of the urinary bladder in women comprising administering a therapeutically effective compound into the trigone of the urinary bladder, which is anatomically adjacent and intimate to the vagina. The therapeutic compound is administered through the vagina wall into the trigone.
Functional disorders of the bladder include urinary incontinence, overactive bladder, unstable bladder, detrusor instability, detrusor over activity, detrusor hyperreflexia, urethral instability syndromes, interstitial cystitis, sensory urgency, painful bladder syndrome, radiation cystitis, detrusor hyporeflexia and detrusor sphincter dyssynergia and urinary retention. Symptoms of these conditions may include urinary incontinence, urinary urgency, urinary frequency, nocturia or noctural urinary frequency, urinary retention, voiding difficulty, difficulty in initiating a urinary stream, bladder pain, bladder pressure, intermittent urinary stream, poor urinary flow, postmicturition dribbling, and incomplete emptying.
Therapeutically effective compounds useful in the present invention include, without limitation, neurotoxins such as botulinum toxin or modifications of such molecules, muscarinic receptor antagonists, muscarinic receptor agonists spasmolytics, antidepressants, adrenoreceptor alpha antagonists, adrenoreceptor alpha agonists, adrenoreceptor beta antagonists, adrenoreceptor beta agonists, adrenoreceptor beta-3 agonists, cyclo-oxygenase inhibitors, vanilloid receptor agonists, vanilloid receptor antagonists, purinergic receptor antagonists, purinergic receptor agonists, tachykinin receptor agonists, tachykinin receptor antgonists, vasoactive peptide receptor agonists, vasoactive peptide receptor antagonists, opioid receptor agonists, opioid receptor antagonists, and compounds that enhance or inhibit or modulate nitric oxide synthesis.
The two primary functions of the bladder, namely storage and voiding, are mechanistically in many ways opposite to each other. As such, drugs used to treat these functional disorders may also have opposite actions. Therefore for one condition an antagonist would be used whereas its agonist would be used for its opposite function. An example of this is overactive bladder and detrusor hypotonia. For the former an antimuscarinic agent would be used while for the latter, a muscarinic agonist would be used.
A therapeutically effective amount of the drug is the dosage sufficient to exhibit activity for at least one week, more preferably one month, most preferably for approximately 6 to 8 months or longer. Dosing can be single dosage or cumulative (serial dosing), and can be readily determined by one skilled in the art. Drug can be delivered serially (i.e., one time per month, one time per every six months) so that the therapeutic effect can be optimized and maintained. Such a dosage schedule is readily determined by one skilled in the art based on, e.g., patient size and the condition to be treated, and will depend on many factors, including the drug selected, the condition to be treated, the severity of the disease, and other variables.
Therapeutic compounds may be administered individually, or may be administered in combination with other therapeutic compounds to treat one or even more than one disorder simultaneously. When administered in accordance with the methods and device of the present invention, such combinations of therapeutic compounds enable treatment of a single or multiple bladder disorders in a single procedure and with fewer visits to a health care provider.
Botulinum toxin has been used to inhibit release of neurotransmitter from the nerve terminals. Some studies advocate its use in patients with detrusor hyperreflexia, the goal being to paralyze the bladder and allow clean intermittent self catheterization (CISC) to be employed for bladder emptying. The paralysis is achieved by injecting all over the bladder, sparing the trigone based on the theoretical notion that a trigonal injection may impair ureteric emptying. This degree of morbidity necessitating the use of CISC is acceptable in patients with detrusor hyperreflexia. Similar regimens have been advocated for the treatment of overactive bladder but using a lower dose of botulinum toxin to reduce the urinary retention rate. However, for this less serious condition, any degree of retention or increase in post void residual urine volume is unacceptable as this can lead to additional clinical problems such as an increased susceptibility to urinary tract infection. Injecting all over the bladder results in paralysis of the detrusor muscle even when voiding is required. There is a growing body of evidence suggesting that overactive bladder has its etiology in the afferent arm of the neural control of bladder function. If this is correct, then paralysis of the detrusor muscle is not a logical therapeutic approach. Most of the sensory afferents to the bladder traverse through the trigone and the trigone plays no significant role during bladder emptying. Limiting the injections to the trigone is more logical as it would remove voiding dysfunction as a side effect of therapy.
The use of the neurotoxins is especially amenable to administration in accordance with present invention because of their long-lasting inhibition of synaptic function, preferably greater than one week, more preferably greater than one month, most preferably six to eight months or longer. Such neurotoxins can include, for example, capsaicin, resinoferatoxin, a-bungotoxin, terodotoxin and botulinum toxin. Botulinum toxin has in the past been injected into the bladder via the cystoscope. The technique of the present invention utilizing a needle patch does not require cystoscopy and therefore considerably reduces the complexity of and the degree of expertise required for the procedure.
The toxin can also be used in any pharmaceutically acceptable form supplied by any manufacturer. The dosages can be given as a single dose, or as divided doses, for example, divided over the course of four weeks. The treatment can be repeated as necessary determined by recurrence of symptoms. The drug may be administered in any pharmaceutically acceptable formulation such as a liquid, a suspension, or a solution.
The aforementioned methods of treatment should be particularly useful for the long-term control of functional disorders of the bladder, e.g., overactive bladder or interstitial cystitis. Furthermore, the methods of the instant invention provide for control of functional disorders of the bladder, e.g., overactive bladder and related conditions, in a highly selective manner, without the potential side effects and treatment failures associated with current treatment modalities.
Anatomically, the bladder consists of two regions. Its lower region contains the trigone, a triangular area whose upper vertices on the right and left are marked by the entry points of the respective ureters, which transport urine into the bladder from the kidneys. The third, more forward vertex of the trigone is the point at which the urethra exits the bladder. The size, shape and relationship of the bladder to surrounding structures vary with its urine content. Because it is essentially fixed by endopelvic fascia to the underlying vaginal wall, the position of the trigone of the bladder changes little in its relationship to the vagina as the bladder fills with urine. However, as the bladder fills, its remaining distensible portion, the fundus, can rises from the pelvis, protruding into the abdominal cavity when the bladder is maximally distended.
The bladder is innervated by the autonomic nervous system, the sympathetic drive predominating during bladder filling and the parasympathetic system during bladder emptying. Sensations from the bladder to the spinal cord and brain usually run with the branches of the sympathetic nerves. The parasympathetic innervation of the bladder provides motor stimuli to the bladder (detrusor) muscle and, when activated by voluntary or involuntary control, cause contraction of the detrusor and possibly relaxation of the sphincter muscles of the urethra, thereby promoting the expulsion of urine from the bladder. In contrast, the sympathetic innervation inhibits contraction of the detrusor and promotes contraction of the urinary sphincters, restricting the excretion of urine.
The trigone contains a higher concentration of nerves relative to the rest of the bladder wall. The trigone thus provides an ideal site for localized administration of therapeutic compounds to the bladder.
The present invention provides a method for treating a functional disorder of the urinary bladder whereby the compound is delivered into the urinary bladder trigone through the vaginal wall. In a preferred embodiment, the compound is injected into the trigone through at least one needle inserted through the vaginal wall. In another preferred embodiment, the compound is injected into the trigone through a plurality of needles inserted through the vaginal wall.
Microneedle arrays or patches have been developed for various uses in drug administration and biological sample collection. The use of microneedle arrays is well-known for the transmembrane administration of drugs. Microneedles have been developed to enable transdermal delivery of drugs without pain or bleeding, due to the shortness of the needles which do not extend deep enough into the skin to contact nerves or capillaries. The needle array of the present invention is larger than the microneedle arrays previously disclosed but similar manufacturing techniques could be used or modified for the present invention. Needle arrays of the present invention may be manufactured by any of various well-known methods, such as injection molding, masking and etching techniques, or laser etching techniques. (See, e.g., Proceedings of SPIE—Volume 4936; Nano- and Microtechnology: Materials, Processes, Packaging, and Systems, Dinesh K. Sood, Ajay P. Malshe, Ryutaro Maeda, Editors, November 2002, pp. 113-118. See also, for example, U.S. Pat. No. 7,132,054. These publications are hereby incorporated by reference into the present application.)
The present invention provides a device for delivering a fluid into the trigone of the urinary bladder comprising an array of needles in fluid-receiving connection with a reservoir. In a preferred embodiment, the needle array is substantially triangular, corresponding to the shape of the trigone.
In a preferred embodiment, the array of needles comprises a plurality of needles of varying length within range of about 2-20 millimeters, to account for the different thickness of the anterior vaginal wall in different women, in fluid-receiving connection with a reservoir.
In another embodiment the needles in the array in any one device have substantially the same length. Several different devices each with a different length of needle are available for use with different patients. The physician determines the appropriate device to use on an individual patient by measuring (sizing) the thickness of the vaginal-bladder wall beneath the trigonal urothelium. If the needle length is too long, the tip would perforate through the urothelial lining and the therapeutic compound would be injected into the lumen of the bladder. Depending on the therapeutic agent being administered, this might result in ineffective or undesirable effects but with some agents (eg: botulinum toxin), it could still have a therapeutic effect.
In another embodiment the needles in the array in any one device have substantially the same length but greater than that required. The actual length of the needles that are exposed prior to application could be adjusted by peeling off the appropriate number of protective layers after the patient has been sized (
In another embodiment, the device further comprises a conduit connecting the array of needles and the reservoir. The conduit is of any suitable length sufficient to allow for the reservoir to remain outside of the patient's body, for ease of manipulation by the physician. In a preferred embodiment, the conduit can be of varying length within the range of 2-30 centimeters in length. In another preferred embodiment the reservoir could be directly connected to the device without the need for a conduit.
In another embodiment the connection of the conduit to the needle patch can be molded fused and the conduit could be molded fused to the reservoir. The reservoir would be pre-loaded with the therapeutic agent and the whole sterilized and maintained so in a sealed sterile pack prior to opening immediately before the procedure.
In another embodiment the conduit would be detachable from the needle patch and from the reservoir or syringe containing the therapeutic agent. This would allow the needle patch to be used for a variety of therapeutic agents.
In another embodiment the connection from the conduit to the needle patch could be fused but the connection from the reservoir or syringe containing the therapeutic agent could be detachable.
In another embodiment the connection from the conduit to the needle patch could be detachable but the connection from the reservoir or syringe containing the therapeutic agent could be fused.
In another embodiment the needle patch is connect directly to a syringe or similar deliver mechanism. In this way once the patch is position in place the therapeutic agent can be injected into the trigone by pressure on the plunger of the syringe.
In another embodiment, the conduit further comprises a one-way valve which permits the flow of fluid from the reservoir to the array of microneedles and prevents flow from the array to the reservoir.
The present invention further provides a kit which comprises a Foley catheter and a substantially triangular array of microneedles in fluid-receiving connection with a reservoir.
The whole package could be prepared and sterilized and contained in a sterile package prior to use or it could be sterilized immediately prior to use. The therapeutic agent could be packed with the kit or dispensed separately.
The distance between the mucosal lining of the anterior vaginal wall and the urothelium overlying the bladder trigone may vary between individuals. This distance can be measured in cadavers but the measurements may not reflect the in vivo situation because of post mortem changes. At surgery such measurements can be made but the area is often infiltrated with saline, local anesthetic or a vasoconstrictor agent or other fluid prior to the anterior vaginal wall to aid dissection. These maneuvers would also distort the tissue revealing inaccurate measurements. The distance between the mucosal lining of the anterior vaginal wall and the urothelium overlying the bladder trigone may be accurately measured by trans-vaginal ultrasound scanning. Such data has not been published but extensive anecdotal reports by experts in the area agree that this distance is about 7 mm. However there is individual patient variation. The vaginal mucosa thins with age and is thinner in post-menopausal women who do not receive estrogen therapy but the average thickness is about 3 mm. The bladder wall at the trigone is about 3.5 mm thick but has been shown to be slightly thicker in patients with detrusor instability. Thus distance between the external vaginal mucosa and the internal trigonal urothelium is about 8 mm in women with detrusor instability. Such small intra-patient variations do not make a material difference to the method of use of this invention, but sizing of this distance may be of clinical utility and hence is incorporated in embodiments of the invention.
Sizing can be done in a variety of ways but one technique is with the use a needle fixed to an empty syringe that is inserted perpendicular to the vaginal wall at the level of the trigone. For this technique to be performed, the bladder needs to contain a minimal amount of urine. As the needle is slowly pushed through the vaginal wall, suction is applied to the syringe. As soon as urine is seen to flow into the syringe, the needle is withdrawn slightly until the urine flow stops. As the thickness of the vaginal-bladder wall complex at the level of the trigone may vary between individuals, this technique can be used to determine the length of the needle required to penetrate to the trigonal sub-urothelium. The physician then marks the needle at the point at which it enters the vaginal wall. This may be done, for example, by sliding a site marker up the shaft of the needle until it rests next to the vaginal wall. In another technique the physician places his/her finger on the shaft of the needle with the tip of the finger at the point where the needle enters the vaginal wall. In this manner, once the needle is withdrawn, the length of the needle required to reach the sub-urothelium at the level of the trigone can be determined. This can then be used to choose the appropriate device for that individual patient.
In another embodiment, sizing could be performed by using the needle array patch itself. The needle array patch can be appropriately sited and fluid can be injected through a syringe attached to the patch in place of a reservoir or via a conduit. Based on the pressure required to inject the fluid, someone practiced in the art would be able to judge if the needles are too long and protruding into the bladder lumen. To aid with the pressure assessment, a simple manometer or gauge could be attached to the conduit to measure the pressure as fluid is pushed through the needles in the patch. If the needles are deemed to be too long for that particular patient, a patch with a shorter needle array is used.
In one embodiment of the invention, the needle array lengths are substantially the same, measuring any length in excess of that required to penetrate to the sub-urothelium of the trigone, but short enough so as not to extend into the bladder cavity itself.
In a preferred embodiment this would be between 2 and 20 millimeters. The needle array may be constructed and packaged so that the needles pierce through several separate layers of soft pliable protective material of uniform thickness. As shown in
Once the appropriate patch and needle size has been determined, the patch is applied to the anterior vaginal wall at the level of the trigone as determined by the location of the Foley balloon (see
Prior to insertion of a needle(s) into the trigone for sizing or injection of therapeutic agent(s), the area could be anesthetized with a local anesthetic such as lidocaine as this part of the bladder is particularly sensitive. In another embodiment, the needle array patch itself is used to infiltrate the trigone with a local anesthetic prior to injecting the therapeutic agent. The technique for the anesthetic injection would be similar to that for injecting the therapeutic agent, using a ready filled reservoir or a syringe filled with the local anesthetic such as lidocaine.
In the method of the invention, the area of the vaginal wall adjacent to the trigone (13) may be located by use of a Foley catheter (17) inserted into the urethra (14). The Foley catheter (17) has a balloon (18) at its distal end. With the catheter balloon (18) inflated, the catheter is gently withdrawn until its movement is arrested as the balloon abuts against the bladder neck, as shown in
After the area of the vagina (15) adjacent to the trigone (13) is thus located, a therapeutic compound may be administered through the vaginal wall into the trigone (13). Therapeutic compound may be administered by any means which enables the compound to traverse the vaginal wall and contact the trigone. In one embodiment, therapeutic compound may be injected through the vaginal by use of a needle and syringe. In another embodiment of the invention, a needle array (19) having a plurality of needles (21), as shown in
Various means may be employed to transfer fluid containing therapeutic compound from the reservoir. Expulsion of fluid may be effected by, for example, mechanical compression of the reservoir, electronic metering, vacuum, and other well known means. Any of various devices may be adapted to function in the present invention, such as, for example, a syringe, pump, or a compressible bulb. Operation of the means for expelling fluid may be controlled by various mechanisms, for example, mechanical or electronic.
The foregoing description of the invention is exemplary for purposes of illustration and explanation. It will be apparent to those skilled in the art that changes and modifications are possible without departing from the spirit and scope of the invention. All of the various publications cited herein are hereby incorporated by reference.
|Cited Patent
|Filing date
|Publication date
|Oct 7, 1993
|Oct 11, 1994
|Bavaria Medizin Technologie Gmbh
|Plural needle injection catheter
|Jan 25, 1995
|May 12, 1998
|Iotek, Inc.
|Delivering an agent to an organ
|Sep 28, 1999
|Feb 17, 2004
|Novasys Medical, Inc.
|Treatment of urinary incontinence and other disorders by application of energy and drugs
|Aug 7, 2006
|Feb 15, 2007
|Alexander Melamud
|Method, system and device for delivering a substance to tissue
|Citing Patent
|Filing date
|Publication date
|Apr 2, 2012
|Oct 4, 2012
|modeRNA Therapeutics
|Delivery and formulation of engineered nucleic acids
|Jul 26, 2012
|Jan 31, 2013
|Dan Sachs
|Apparatus and methods to modulate pelvic nervous tissue
|Jul 26, 2012
|Jan 31, 2013
|Dan Sachs
|Apparatus and methods to modulate pelvic nervous tissue
|Mar 13, 2014
|Oct 2, 2014
|Moderna Therapeutics, Inc.
|Long-lived polynucleotide molecules
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|May 10, 2012
Owner name: VERSI GROUP, LLC, NEW JERSEY
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:VERSI, EBRAHIM;REEL/FRAME:028186/0765
Effective date: 20120423
|Apr 1, 2015
|Fee payment
Year of fee payment: 4


text:
Young jazz giants throw down gauntlet to the world's best
MAXINE MCKEW: The Montreux Jazz Festival in Switzerland and the North Sea Festival in the Netherlands are two of the best and certainly most prestigious jazz gatherings in the world.
They set the standard each year.
So if you're 16, live in a country town and have to travel many hours to rehearsals, playing at one of these glittering festivals is, for most, a dream.
But not for 21 determined school students for whom music is a passion.
Though most of them face major school exams in a few months, the excellence of their ensemble has seen them play their way into their dream.
Right now, they're in Europe, playing with the world's best.
Justin Murphy spent time with them before they left:
(Band plays 'Fascinating Rhythm')
JUSTIN MURPHY: Their average age is 16.
They travel hundreds of kilometres to rehearse together, but only every now and then.
And they've just flown out of Sydney to play at two of the world's top jazz festivals, beating hundreds of international bands in the process.
JOHN BENSON, BAND MANAGER: The original aim was to go to Montreux in Switzerland for their jazz festival, because it was a name that everybody knew, and then we were offered the option to put in an audition tape for North Sea Jazz Festival in The Hague.
And out of 600 bands worldwide that were auditioning for that, we were one of 12, as far as I've been told, so, I mean, that's just stunning.
ANTONY GULLICK, CONDUCTOR: I think what surprises the Europeans and the Americans is a band coming out of what they see as a backwater like Australia that can play like these guys, and when they're so young, usually pretty much knocks their socks off.
JUSTIN MURPHY: From government schools up and down the NSW coast, they started their sporadic rehearsals only five months ago.
JOHN BENSON: We just run weekend rehearsals once a month or during school holidays and they come down, 10 hours each way sometimes, just to come and play with the band, which is a credit to them.
JUSTIN MURPHY: What, they make their own way down?
JOHN BENSON: Yeah.
GREG BELL, GUITARIST: And I've had to travel back and forth, yeah.
JUSTIN MURPHY: Has it been hard?
GREG BELL: It's very tiring.
JUSTIN MURPHY: But well worth it.
One month ago, James Morrison, no less, gave the band his seal of approval by sharing the stage with an obviously impressed and excited bunch.
JOHN BENSON: James communicated that, you know, it was a great experience for him as well as all the kids.
BROOKE McCLYMONT, VOCALIST: (Sings) # Well, it's a marvellous night for a moon dance With the stars up above in your eyes A fantabulous time to make romance Beneath the cover of October skies...#
JUSTIN MURPHY: The band's vocalist, Brooke McClymont, is from Grafton, a country singer who is partly remaking herself in the jazz mould, but only partly.
How did you amend or modify a country style to big band singing? What did you do?
BROOKE McCLYMONT: You'll probably see this tonight. I haven't.
I actually sing jazz but with my country...I just sing. Like, I'm doing what I normally do, but just in a jazz style.
It's kind of different. It's a different kind of...
JUSTIN MURPHY: But it fits?
BROOKE McCLYMONT: Oh, yeah, it does. It's different.
It's really unique, what I've heard.
So I'm just like, OK.
ANTONY GULLICK: These guys are really hungry.
They really want to do this, you know, more than anything.
If you look at the commitment and the sacrifice a lot of these kids have made, they...you know, it's really special and you can keep milking them for more and more and more and they just give more.
I'd say a fair percentage of these guys will become musicians in some form, like either professional musicians or teachers or something like that.
JUSTIN MURPHY: So music's in their blood, but the enjoyment of it is as well.
Not just the money?
ANTONY GULLICK: Oh, absolutely. Who does it for the money? (Laughs) Yeah.
Transcripts on this website are created by an independent transcription service. The ABC does not warrant the accuracy of the transcripts.
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text:
Avastar 88W8897
News about Avastar 88W8897.
Marvell announces wireless combo chip with NFC
January 8th, 2014
Chip maker Marvell has introduced a new quad-radio wireless combo chip for mobile devices that includes support for NFC, Bluetooth 4.1, 1×1 802.11ac WiFi and FM radio. The Avastar 88W8887 is designed to provide "a… More
Xbox One ships with NFC chip
November 25th, 2013
Microsoft's new Xbox One entertainment system includes support for NFC functionality, via a Marvell Avastar 88W8897 combo chip that also incorporates Bluetooth 4.0 and WiFi, an iFixit teardown of the new console has revealed. Microsoft has not made any announcements regarding the Xbox One's NFC capabilities and it is not yet clear how or if the computing giant plans to use the technology.
Marvell adds NFC WiFi chip
June 13th, 2012
Chip maker Marvell has launched the Avastar 88W889, the first chip to include support for both 802.11ac WiFi and NFC. First announced at this year's Mobile World Congress, the new chip is designed to be built into Ultrabooks, tablets, gaming consoles and smart TVs.


text:
The Best and Worst Places to Grocery Shop, And Why They're All Getting Better
There's a new winner, in a new ranking of shopper satisfaction with their grocery stores.
There's a new winner, in a new ranking of shopper satisfaction with their grocery stores.
From battling coupon criminals, to fraudsters fighting back… from policy changes, to coupons' plummeting popularity – these were the top Coupons in the News stories of 2016.
Publix announces the end of double coupons in the Atlanta and Jacksonville divisions.
After attempting to restrict a deal that provided up to $20 in overage, Publix gives up and decides to allow it.
A store coupon, sale and instant rebate combo provides a massive amount of overage for some shoppers – until their stores put a stop to it.
A new analysis reveals the best grocery store in each state – and some are not what you might expect.
Ahold and Delhaize, the owners of Stop & Shop, Giant, Hannaford and Food Lion, sell 86 stores ahead of their merger.
A new survey of the best and worst grocery stores finds that nearly all of them are getting worse.
Wegmans announces plans to expand into North Carolina, setting up an epic battle with another beloved grocery store, Publix.
Publix quietly announces it will no longer double coupons in many stores that previously offered them.


text:
To order church goods, please complete the order form here:CLICK
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Visitation Epitrachelia
I offer a wide variety of brocades and colors of this very useful item. I recommend that every priest has a visitation
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Antiodoron bags
Cotton, machine-embroidered bag for transporting antidoron.
Price: $8 plus $2 shipping (designs vary)


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text: Politics 24 May 2010 Miliband the feminist Front-runner meets female Labour MPs, promises "systematic" changes to political culture. Sign up for our weekly email * Print HTML David Miliband, the front-runner for the Labour leadership, with 38 declared supporters in the Commons, has met with female Labour MPs -- about a third of the parliamentary party -- and delivered a passionate speech in which he talked about the influence of "strong women" in his life. In the speech he said: One of the key planks of my campaign will be to look at the systemic issues preventing women from entering politics and break down those barriers so that women see it as a job for them, a job which suits their lifestyle and their ambitions. I am lucky to be surrounded by a number of strong women in my life: my mother, my wife and key political advisers. They all tell me the same thing -- that we need a new kind of politics which promotes, supports and challenges women from the grass roots up. Only then will we see a change at the top. › Why Labour leadership will have to do better on immigration James Macintyre is political correspondent for the New Statesman. Subscribe from just £1 per issue More Related articles Two referendums have revived the Tories and undone Labour What kind of Christian is Theresa May? Tim Farron sacks former MP David Ward


text: Culture 9 October 2012 Preview: PAD London International art and design fair opens tomorrow Sign up for our weekly email * Print HTML To complete the London art fair trinity (which also includes Frieze and Moniker), PAD will set up shop in Mayfair's Berkeley Square this week, exhibiting the very best in modern art, design, photography, jewellery and tribal art. Sixty participating galleries from Europe, the USA and Asia will present some of the most coveted and iconic contemporary pieces from around the world. The fair, originally launched in Hanover Square as DesignArt London and returning for the sixth time this year, will also feature a new PAD Prize, to be awarded to a UK-based designer under 35 years old. "This prestigious Prize brings together the incredible talent that designers in this country have to offer and the aspiration of PAD London to promote that talent," says architect and designer Nigel Coates, President of the Jury. "Although the UK has some of the best and most competitive art and design colleges, we don't always have the industry to match it." Four major American dealers (Castelli Gallery, L&M Arts, Skarstedt Gallery and Paul Kasmin Gallery) will come together to produce a panorama of Pop Art, focusing in particular on the ever-popular stars of the movement, Andy Warhol and Roy Lichtenstein. The Galeria Mayoral d'Art (Barcelona) are bringing Jean-Michel Basquiat's Untitled – The Origin of Cotton, never before seen in Europe, and the Galerie Thomas (Munich) will exhibit the astonishing Les deux femmes à l'oiseau by Fernand Léger, symbolic of the artist's turn from cubism to a more figural style incorporated thick bands of colour. Notable in particular for its emphasis upon objects and interiors, PAD is a stylish fair which flourishes particularly in its attention to niche pursuits, decorative and tribal arts, while cultivating modern masters which comfortably rival its competitors. Appropriately housed in a Mayfair interior, the sleek fair will place innovation above all, displaying the winner of this year's Prize in the foyer. Tickets are £20 and can be purchased by clicking the below link. PAD London will run from 10 – 14 October. › Osborne has taken the "dot communism" fetish to another level Inside the PAD Pavilion. Photograph: PAD London. Philip Maughan is a freelance writer in Berlin and a former Assistant Editor at the New Statesman. Subscribe from just £1 per issue More Related articles Upon Remembering Westminster Bridge The special relationship How the ravages of the Great Depression gave American painters a purpose


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In all the Lions Fever excitement earlier Thursday, I neglected to give ample attention to another, oh, kind-of-important facet of our ESPN.com 2011 season preview.
Jeffri Chadiha and I have the Green Bay Packers repeating as champions in a little game known as the Super Bowl.
Maybe I was trying to avoid making waves within the division, but frankly I'm surprised there weren't more people on the Packers' bandwagon. I wonder if some voters were influenced by the relative difficulty of repeating and failed to accept the youth, balance and momentum of the Packers as currently constituted.
The fact is that three teams have repeated as champions in the so-called salary-cap era that began in 1993, most recently the 2004 and 2005 New England Patriots. It's impossible to predict the ebb and flow of a season, but as I wrote in the preview, the Packers have the ingredients you look for when evaluating a team's championship chances.
Indeed, ESPN's Merril Hoge says in the video that the Packers are "going to have to petition for 14 guys on the field, they have so much talent." That's a good start.
Below are the thoughts of the five panelists who determined the Packers' status as the consensus No. 1 pick in the NFC North.
Kevin Seifert: The Packers have brought back most of the nucleus from the Super Bowl team and have multiple replacements for those who have departed. Led by one of the game's top QBs in Aaron Rodgers, they are poised for an extended period of success.
John Clayton: While it's hard to repeat as Super Bowl winners, the Packers look like champions on paper. The roster is healthier and deeper than the one that beat Pittsburgh last season.
Adam Schefter: If Rodgers stays healthy all season, it's hard to see how the Packers wouldn't be competing for a second straight title.
Jeffri Chadiha: They won a Super Bowl with an assortment of key players on injured reserve. Imagine what they'll do when completely healthy.
Ashley Fox: The Super Bowl champs lost a few players in free agency, but they got healthy in the offseason. Rodgers could be the league's MVP this season.


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Posts Tagged travel
Sunday Column (428)
Posted by Volker Ballueder in Sunday Column on March 12, 2017
Another week. More travel. It seems as if the weeks just blur into one and I spend two days a week in a different place. I don't mind, being away for a night, taking the Easyjet 'bus' from Gatwick to Europe. A 430 wake up call followed by a quick exercise routine, a meditation session, a shower and a ride to the airport. Then an almost two hour delay due to air traffic control strikes in France – I was on my way to Madrid. Those delays are annoying. Having just endured almost 12 months of conductor strikes on Southern Rail, I have no sympathy with anyone striking whatsoever. I keep saying it over and over again, I am thankful for the opportunities given to me in my life and wouldn't want to jeopardise them due to strike actions or anything stupid like that. So I have little understanding for someone who would go to their employer and say 'if you don't do this, then we strike'. There are enough people out there that would take jobs and make it happen. Something I am missing?
Yes, there is an argument that if we didn't have the unions, companies would do whatever they wish. They wouldn't I don't think. Companies have a keen interest in making their employees happy. To work with them, to empower them, to make work a nice thing to do. Maybe I am wearing some pink glasses here or something, but companies who are 'abusive' to their employees will not succeed. I cannot see that happen. Maybe I am listening to too many American podcasts suggesting that we are all in it together. That we can determine our destiny and people around us want to help us. We must be under that anticipation that an employer doesn't want you to fail and want to do the utmost to make you happy and successful. After all they are spending money on you and your career. Mine does, and I am grateful for it.
Working in different places is critical. I love seeing the local teams, connecting and understanding the local challenges. Each market is unique, each view is different. Listen to their needs. It widens my horizon and gives me a chance to review what we are doing in HQ and whether we can change things, adopt some local practises, to improve things overall and to help moving the company forward. I enjoy that and believe it adds a lot of value to the company. I have another two weeks of travel ahead of me. Speaking at a conference in Germany which is tricky and challenging as it is a new corporate deck with a translation into German. I will master it and actually I am excited about it. Just in case I fly out the night before 😉 Then Sweden. Then I shall have a couple of weeks in the office before a family break over Easter. No flying then. As much as it is nice to travel, it is not glamorous and it does tire you out. At least I keep up my exercise routine and healthy eating (most of the time). Yet this week I felt a bit drained. The weather is to blame I guess?!
Further to travel this week I read an article in the FT about citizenships and Brexit. You can read it in detail yet the main take away for me was that if you lived here for long enough – and that is uninterrupted – you can continue to live here post Brexit. Or it should be fairly easy to get a passport/citizenship. Or you leave. I am not judging whether that is fair or not, but what I am saying is that if you have lived here long enough there is nothing you should fear. So why did I get the citizenship? Because I wanted to ensure I can stay and be with my family, plus I feel more British these days than German anyway. I don't have plans to leave this country other than with my family and then we all would be foreigners elsewhere, on the same passport. That's really it. I wanted to do it years ago but didn't want to spend the money on it. Now I could and did it. The necessity felt slightly bigger of course. Anyway, this should all be done by next week.
If you feel I write too much about work, then please let me know. I just realised I wrote all about Brexit, travel and work without writing about work or family. If that makes sense? I love management studies, and I love work. That's what I do and I enjoy it. Even my taxi driver said that, if he won the lottery, he would continue working. So would I, there is no way I could sit on my bum long enough doing nothing. I'd go up the walls. So I used the flight delay to catch up on some work, prepare a presentation, write part of this blog and think about life. I also caught up on some sleep mid air and arrived refreshed. Kind of anyway 😃
The remainder of the week was nice. It is nice to see trains running on time most of the time. It makes a huge difference to both my mood and my state of happiness. Plus the Friday 'pale ale express' session with the neighbours. Then I took the wife out for a meal on Saturday. Nothing fancy, just a very nice Thai place, a good chat and some 'us time'. There is never enough of that once you got children. We are getting better in carving date nights out of our schedule, more than we used to. Then again the kids are getting older. Life becomes easier from a logistical point of view. Attitude, tantrums and questions and demands are the same pain as before, just different. Growing up I suppose 😃 Yes, I wouldn't want it any other way!
I hope all is well with you and yours.
From our little corner of the world, I wish you lots of love and happiness.
Have an amazing week ahead, and please share this blog if you like it.
Sunday Column (382)
Posted by Volker Ballueder in Sunday Column on April 24, 2016
Last week started on Sunday when I flew to Germany. I piggy-backed a long overdue trip onto a trip to some clients in Frankfurt. Frankfurt is not only a pain to fly to (Heathrow only), there aren't that many companies in our industry. It has been 18 months since I have been and stayed one day this time to then train it to Düsseldorf. Germany is very scattered when it comes to big cities and there are important people in each one of them. I guess it keeps it interesting.
A bit of travel is essential to cover ground in Germany. One of the few countries without a centralised city for media, not like Paris/France, Milan/Italy, Madrid/Spain and of course London/UK. My next trip to Germany is Berlin in a few weeks time. That again will be from Gatwick, which is a lot easier. It seems that Easyjet changed their flight plan and doesn't fly to some cities I need to go to. That means a long taxi drive to Heathrow.
On the note of train travel in Germany: my annual travel card from Hassocks to London, which I renewed this week, costs more than a travel card to use the train all over Germany for a year. On first sight my ticket seems like a rip off. Discussing it with people, it seems that Germany subsidises train travel and given you pay almost double on tax, this explains how it works. Guess every country has its pros and cons.
I seem to hate flying out on a Sunday. It seems like I am cheating on family time but luckily this happens only a couple of times a year. Particularly as I got a good engagement going with the boys, playing chess and doing homework. We had a fantastic weekend.
However the meetings we had were awesome. The industry is very responsive to our solutions and we are pivoting. It is nice to see we offer innovation in a crowded market space and drive business forward. What is not to like?
My Hilton in Dusseldorf was a bit unliked by me. We got to a personal chat with the Operational head and a make good. Actually curious to meet him in person now 😉 He seems very much switched on. Next time. First unhappy Hilton stay so far. That's a better track record in comparison to IHG. Let's see how the next three Hilton stays stack up. Being away from home you want to have a good bed and a good service, a good place to stay and most of all, value for money. When staying in a very low frill hotel the other day, it ticked all the boxes. Yet, it didn't come at the price tag of a Hilton. Same is true when we travel, as a family we go into a Premier Inn for the night. Anyway….I keep you posted, no doubt.
Overall it was a very successful trip. Definitely worth while with some very challenging and good discussions with industry leaders. Just the way I like it.
Work is very interesting at the moment. We are, as a company, innovating a lot around cross device data points. That and us playing in the biggest offline silo, TV, and the most engaging online silo, Social, leads to some interesting developments. It's going to be exciting over the next few months.
My wife ran another race. I am very proud of her. She managed to hit her anticipated time. She also signed up to more runs. I am a bit afraid I would get addicted if I start signing up to races. Hence I am still refusing to join races but the one in July running a 24 hour relay race over the distance of 10K. Despite my exercises I seem to be putting on weight. Not a lot to be honest but it seems to be creeping up. So this week I have done a few more runs than normal. 30K and 45 minutes Cross Trainer. That resulted in the weight being down again but I was exhausted on Friday.
For the matter of weight I need to look into my diet again. A few client lunches and boozing sessions with lots of finger food and crisps seem to take its toll. That of course is fair enough so I shall try to cut down on those wasted calories of nuts and crisps. Also I am wondering if this high fat diet, having a ham and cheese omelette every morning, is the best idea. I guess I need to do more research. If you look up athletes's diets they eat 'normal' with focus on veggies, carbs prior to events and fruit as well as protein. Yet they never mention chocolate, cashew nuts or crisps as part of their diet 🙂
You only live once I guess 🙂
I am buzzing this week. Overall. The challenge is our bathroom. The tiles just don't seem to be on there right. Uneven in any of the three directions. The builder keeps trying. I am hopeful we get there in the end. Quite a stressful experience. But for now, it was weekend. Time to chill.
Last but not least I decided to grow a beard this week, then took it off again. I just don't seem to be able to decide on the right look. And the right itch. The right format of beard. Off again for now….we shall see.
The joys of life. Hope yours is going well.
Best wishes,
Sunday Column (370)
Posted by Volker Ballueder in Sunday Column on January 31, 2016
I start this blogpost in the air. My second flight of the year. I am in a Fokker, a KLM Cityhopper, from Dusseldorf to Amsterdam. I just spend two great days meeting clients in Germany and now I am heading to another meeting in Amsterdam, flying back on Friday night.
I miss the family. At time of travel I spoke to the wife twice but hadn't managed to speak to the kids. Busy. When I landed I managed FaceTime at Amsterdam airport. It isn't easy but they don't know any different. Also I am not gone for too long. Not that often. We trying really hard to balance life and work. Life really is what we balance. And in the end I managed an earlier flight home, surprising them to be home for dinner.
It is fun and seeing it in any other way doesn't make sense. Whilst one hotel wasn't up to the 'Ballueder standards', the ride there was. I managed to catch a Tesla. It was futuristic. It was amazing to sit in that car. That feeling was like being in the future already. Wow. That reminds me that we are still looking at cars. The Skoda Superb was thrown in the mix and surprisingly the Mazda CX-5, a mini SUV, which could kind of be a nice family car. Test drives to follow in a few weeks time. Interesting development, as I didn't think there were that many cars out there that could host us, as the price level we are looking at.
As always I am working late nights when on the road, exercising early mornings despite my cold. I love pushing boundaries. Over 100K run this month! I am confident that in 2016 things are soaring to the next level. This is true for various aspects of my life. We should finish the house renovation, have a first package holiday with the family, career, fitness, engagement with kids, personal confidence and strengths in multiple ways. Life is awesome.
I want to give more. I want to make more happen. And I will. 2016 is a pivotal point I think. Ask me again in a few months time. Or 2 years from now looking back. Connecting the dots. Contributing to that is village life and us getting more engaged in the local community. My wife is a member of one of the running clubs and we went to their annual party. That was fun, and fascinating to see how popular running and exercising got. Great!
I am grateful. I am appreciative. What you don't appreciate, depreciates. Tony Robbins. Stop to smell the roses, live the moment, work hard, play hard. You can probably tell I am on fire. But that is it. I am so knackered at the weekends, but I am on fire. Not sure that makes sense but I am pushing boundaries and then rest up for the coming week. Yet, weekends are great. Playing chess with the eldest, cuddles and reading with the little one. We are having lots of fun!
Last but not least there are two more decisions this week. Firstly, after a non successful 4 weeks but 2 weeks long dry January, there will be more periods of less alcohol. However, I want to worry less about my alcohol consumption and don't believe, given the statistics, that I have to. Hence I stop counting my alcohol intake. Whilst I always said that if you monitor things, that you can improve on them, I don't have to improve on it. I had some really interesting chats about it, and I am done with counting alcohol, I don't need to anymore I believe. It makes me more paranoid than it is helping me to count everything. Similar is true for food calorie intake. I did that for a few monthlong periods but haven't done it for a while as I am quite aware of what I am eating. So I will stop counting and simplifying life a bit more.
And the second decision is to change my supermarket. I move away from Tesco as we complained about their ongoing quality issues. However, when the delivery truck was 2 hours late we complained properly. Yet when discussing the issues with a customer representative, she only saw the delay of the van as the issue and, despite us mentioning it in emails and in conversations, she was oblivious to everything else we complained about over the last few months. They didn't see the bigger picture of us changing. Result: I let go. I cannot hold on to Tesco and went back to Ocado. For now anyway 🙂
My best thing this week? Coming home of course. Cuddles from the kids. Being super productive late night and up early in the gym. When I am achieving. When I am disconnecting. Fire and ice. I love those extremes as much as I hate them. And yet I am not complaining.
A lot of thoughts this week were around my chosen life and industry. What do we do and why. And I am happy. I am in a sweet spot I like to believe within our small world.
Then I stop and smell the roses. Say thanks. Meditate on what life is all about and hug my sons.
Have a great week.
Love and Kindness.
Sunday Column (359)
Posted by Volker Ballueder in Sunday Column on November 15, 2015
What a gloomy Sunday. Saturday was so dark and cold, we put the fire on all day – it is nice and relaxing, calming yet it should be either a bit lighter or a bit colder – this weather just really sits in between autumn and winter. And it is wet. Yet, despite all that my wife did a 10K run today. Well done you!
The week was full of travel, yet it was actually very pleasant. I left the UK Monday evening to go to a conference in Hamburg. Easyjet seems to have a winter schedule, where they fly evenings rather than early mornings. So I got away for three nights. I prefer early morning but hey, all about being organised.
The conference was amazing. Of course it was because I was speaking but really it was because there was a room of people interested in cross device tracking and the break down of silos: offline/online. I do really like what I do. I love my job (and not only saying that), as we are able to connect offline to online marketing, targeted advertising. So this conference went down as a treat, getting to know lots of different view points within the industry.
I also managed to do a 10K run in the dark. Given it was a bit windy and misty, it was a fun run. I managed to do a personal best with an average of around 4:52 per kilometre which is quite good. Really enjoy pushing myself to get fit for my challenge next year. However, maybe I overdid it a bit doing it that early before the conference. Never mind. It felt awesome at the time.
Then I met lots of interesting people. Old university friends from within the industry, old friends, industry friends who I knew since 2006 and so on. Online and Digital marketing is such a small industry. And everyone knows everyone and knows someone who worked with some mate….
Overall a fantastic week. Yet, again, I was away from the family. Packing my suitcase with lots of German sweets works to get the love from the kids, but the sweets still don't replace me when I am away. They need and want me to be at home. Finding that balance is still difficult and being able to switch off from work when being home. I am working on it and yet was very happy to be home on Thursday night. I missed them too! And my wife of course.
A new rule sees me to stop being on my phone during the weekends and really engaging with them. We are playing UNO, paw patrol, and mock about.
Friday was another busy day in the office before a well deserved, if I may say so, weekend. At the weekend we met some friends and I got a long overdue sports massage, trying to sort out a sore back thanks to my chiropractor. I was a success. We met friends but due to the weather just sat around really, chatting and catching up whilst the kids were playing.
I am very proud of my wife, I have to say. The 10K now, and her ambition to run a half marathon next year. I love her and she is an inspiration for myself, the boys and many of her friends to get fit, stay healthy and look stunning 🙂 Well done!
That sums up another week. Writing this whilst sitting at the airport waiting for my flight….I don't mind travelling, as the best part is coming home. At least that is true for non holiday flights 😉
Have a fantastic week,
Sunday Column (314)
Posted by Volker Ballueder in Sunday Column on March 15, 2015
Is it Friday yet?
The week started with me wanting to order some shoes from Marks. After they apologised for their mistake, I got a voucher I wanted to put towards some new shoes. The order was marked as despatched and I was hoping to get it this week. An email, a call and a few more annoyed days later, no shoes as once of a sudden they were out of stock. After they were sent? Never mind, back in stock in a few weeks time….
Now, the official week started with work in Hamburg. The red eye to Hamburg on Monday morning, meetings, preparation, work, long evenings, a conference, more long hours in the hotel room, abrupt changes, more meetings, networking and so on. You get the picture. Just a normal business trip. Great to connect to the online industry in Germany again, meeting old and familiar faces. It has been a good and successful trip, and that is great. I arrived home rather tired on Wednesday night yet somewhat satisfied with the progress.
Travel is a lot at the moment and probably I am living through the busiest Q1 of my career. Not ever do I remember a quarter being that full on from Monday after Christmas to the end of March. It is a good sign. Recovery of the global crisis, an interest in TV Data and TV Sync. I am very excited about the space I am working in, gladly contributing to the strategy and direction for our product in Europe.
So things are good. The family is good too. Speaking to so many people that week I haven't seen for a long time; it is good to connect, see what familiar faces are up to and how we can cooperate. It is a small industry, many friends and good camaraderie. I so enjoy the space I am working in and cannot repeat it often enough. This must be better than any other industry. It just has to be. And, I am allowed to be part of it too!
Enough about work, really 😉 Then again I saw the family too little this week. I miss them when I travel and I look forward to a week in London next week. It has been busy but Easter in sight, there is a break to look forward to. My camera lens from my iPhone broke a while ago. I figured something wasn't right and then remembered my youngest throwing it down the stairs and me dropping it quite a few times. Luckily I am due an upgrade sometime soon…in July 🙁 And there was mother's day. Hurray!
My weight training, physio and exercise along with my weight loss is going well. If we are connected on Facebook you know that I lost just over a stone (7 kg) since Christmas. How did I do that? I foremost started drinking less. I even managed the conferences and networking in Germany without alcohol as they kindly provide alcohol free beer. Not drinking when travelling is kind of hard but possible. I run 2 times 10K a week. This is to keep fit rather than losing weight. So the key are two things: one is to do weight training 4 times a week and then to eat less overall. No snacking on nuts and chocolate unless you have a bad day. Chocolate is a treat now really. Then no more nuts and seeds during the day but bananas. I eat up to 5 bananas a day. Whilst lunch is normal, yet no bread (another key to weight loss), I eat little at night: cracker-bread/Ryvita with humous, an egg or two, some olives or gherkins. That means I have enough energy during the day, I am not hungry at night and won't put on weight. With less alcohol consumption one doesn't have to worry about the amount of food one eats, as there isn't the need to fill the stomach lining before a night out.
Let me know if you have any questions or need advice. I still need to learn to eat a bit more about food for when I am travelling or I am at conferences, to not fall over 😉 But overall I am doing well and will continue the above routine. It is all about habit and making it work, a bit of will power and consistency. But don't beat yourself up, something I tend to do and get all fussy about what to eat. Particularly not eating bread is difficult.
Now that's all for the week. May you have a fantastic week ahead. I am sure I will, only travelling my usual 3 hour commute per day. With Monday being my wfh day, so will be able to catch up of this rather eventful week.
Have a good one.
Sunday Column (312)
Posted by Volker Ballueder in Sunday Column on March 1, 2015
Two months into the new year. It has been a busy start with an acceleration towards end of Q1. I just came back from a trip just to go on to another, then another, a bigger pitch and an exciting conference plus another trip. Wow, the next few weeks will be busy. Good busy.
I enjoy the travel, and have written about it at lengths. They are a bit of an escape and an opportunity to carve out disconnected time. Disconnected time you usually don't take, as I feel like I am constantly connected, 5 am to 8 pm. That is wrong, no question, and I will deal with that over the next few months. It affects my sleep and downtime, however I have big goals for self improvement this year. Losing weight, changing my diet, running up the South Downs are part of a bigger picture. And I started. 9.9K up the South Downs, down to almost 90kg from 95 at Christmas. Dropping chocolate, snacking and disconnecting more often is next.
The main challenge I have at the moment is tiredness. Whether this is the 5 ams catching up with me or the vivid dreams, the disconnectedness or some other stressful things in the back of my mind, I am not sure. Getting 7 hours of sleep should surely be enough, yet the animated, vivid dreams are what seem to crack me up. No nightmares but processing things way down my past history. I believe there is a certain stress factor with challenging times across my life.
What I mean by that is manifold. The above mentioned travel and associated business at work cause a strain of course. Don't get me wrong, it is good and I enjoy it, but life is coming with some challenges. I have some challenges outside work I don't want to discuss here, but it never pours, it rains. Life is good though, with those precious moments; and we should never forget that, I get reminded when going to bed and seeing the little ones' blanket off, when you pull it back over their tiny bodies, hugging them, and enjoying the moment to feel so close to them. To be able to teach them gratitude and to challenge the status quo. To build their own vision yet pursue their dreams, regardless of money. I want to be able to support them to do that.
Those moment you can perish. Enjoy the hugs, and hug them a bit more. Sharing the love. When you, out of the ordinary, take their warm milk to their bed in the morning. When they wake up and smile at you. The smile saying that, I love you dad, and thanks for me being able to stretch in bed and drink my warm milk whilst waking up. The love you feel. The satisfaction you get from them being able to have some special moments. Small things in life.
And when you set up the first computer profile for your son to use the computer. And you explain him what a profile is. And you ask him to find out about which games he plays in school, and what he likes to do at home on a computer. They are growing up so fast. My parents always said you have to be 12 to use the computer. But things change of course, technology and exposure to it accelerates dramatically. Mad.
The ever accelerating spiral of technology advancements. The connective-ness and strain, faster moving world, pressure to perform, reply to emails quicker and deal with more in shorter time.
That is it for the week. My WordPress doesn't show me the visual editor, just the html one, so the post might look out of order.
Love and Kindness.
Sunday Column (311)
Posted by Volker Ballueder in Sunday Column on February 22, 2015
I started my week with some travelling. Frankfurt this time, just in time for "Rosenmontag", the night of carnival in Germany. Neither my client partner nor I had this on the radar yet we managed to get three great meetings out of it. I also flew with a small airplane from City Airport and enjoyed the more "elite style" flying experience. This wasn't because it wasn't Easyjet, I love my Easyjet, but more because it seemed to be more intimate, 2 seats each side of the gangway, closer to the sky somewhat and faster. The City….
Once I arrived in my hotel, I realised the higher standard leads to the hotel being a bit more complicated. The computer system, the room service, the housekeeping…..oh dear, I am just made for simpler things sometimes. That includes simply customer service, like Marks, but that is now all solved too. Just a shame you need to kick a fuss to get attention 🙁
In the hotel, I got all those things for comfort I don't need, and I miss those simple things I am used to, like decaf instant coffee. Working in start ups for most of my life, being brought up on modest pleasures. Yet it was a great stay for one night and I didn't end up in a hotel in the red light district, so that's a bonus. That's what could happen when you are working with external booking agencies that don't know the country 😉
I enjoy travel, and believe that you should feel comfortable when you stay away from home. It is a burden to you and the family. However, I am still a big advocate of spending a night or two away from the family sometimes. It makes your heart grow fonder as they say, but it also gets you and your partner some 'me time'. I usually get more work done and write more posts, work on presentations etc. Shutting off the screens when travelling seems to be harder than at home, as you are out of your routine. Your weight bench is replaced by "own resistance" exercises unless you got a gym in the hotel you are staying at. Soon, I am contemplating of taking my running shoes. All depends on the length of the stay.
This week I finished another book on Steve Jobs and Apple. Working off a Mac now on a daily basis for two years, I couldn't go back to any other system. It just works. I am waiting to upgrade my iPhone as the battery life on mine is appalling, and I am contemplating of replacing my iPad sometime this year to upgrade after about three years. Hmm, we shall see. I used it mainly as a kindle and for mind mapping, then as a laptop replacement at home. I could do all I do there on my laptop but if you are in confined spaces on a plane or train, you end up preferring a smaller device. Decisions decisions.
Whilst this week has been a bit of a roller coaster ride too, I will write a more detailed post about some other developments later this month. All is well, and sometimes we just have to be very grateful for what we have. I have experienced a deeper connection to my loved ones recently and a an urge to spend more quality time with the boys. I feel like time becomes so precious if you start thinking about it.
Overall it was a good week. Work has been busy too. I have been thinking a lot, laughing a lot and continued with my framework of "no drinking days" and exercising despite travelling. Or at least in moderation, and that is a good thing Food wise, I managed to order a kid's portion without chips to keep off the weight. No need to eat a big meal before bed, is there? Just by being more aware of what you drink and eat, you can keep a healthy and balanced lifestyle without the need to overeat, put on weight and ultimately being unhealthy and unfit.
I also managed my first 9.5K run outside (my calves and shins are still hurting from the hill up to the South Downs) in 54 minutes. For a first time this isn't too bad. For me, 2015 is about positive change. Better healthy diet, better exercise, outside running, more quality time with the family, more balance at work. I am making progress on most points.
We need to enjoy life, yet in moderation and balancing the good and bad days, without beating ourselves up.
With these thoughts, have a great week.
Sunday Column (292)
Posted by Volker Ballueder in Sunday Column on October 12, 2014
I start writing this post enjoying yet again the best bacon sandwich at Gatwick airport, at Apostrophe in the South terminal. Maybe not in line with my healthy eating ambitions, it serves as a treat for the 5 am start, the 4.15 am alarm. I will be back here the coming week.
This time it was a bit worse as C was up at night, having nightmares. We have been exposing him to dogs almost on an excessive basis to secure utmost preparation for the arrival of Rosie. I will update on that below. As a parent having to do manipulative work with your five year old is fine yet not if it is forced and needs to be done quickly. Never mind, things will work out at the end. I am actually a bit chuffed that my NLP and personal development work has had such a great impact on my son. A bit of anchoring and positive reinforcement, a role play and his fear of dogs was cured 🙂
After my trip to Turkey last week, I was in Zurich for a day, and will be going to Milan next week. I enjoy it somewhat but it is tiring and exhausting. I have done little exercise due to some restrictions from the cold. I also got some tape that hopefully will improve my pain when running. Fingers crossed. I did some stationary biking, the weather was far from pleasant this week. On Saturday the changing weather put me in a right pickly mood. Not good and not happy.
I couldn't even say it was a busy week. Busy enough yet not crazy busy until Friday afternoon of course. I had two solid days in the office being able to catch up on lots of things and almost getting on top of everything – as if that is ever going to happen…..being able to let go and take a step back sometime also helps. Having support at home, someone to fall back on helps too.
Anyway, the highlight was the visit to Rosie, our German Shorthaired Pointer. It was a bit up in the air whether we would get her due to C's fear of dogs but with my work and his brave effort to face different dogs this week, the breeder was happy. C even jumped on a trampoline with a Vizla this week and totally lost his fear of dogs. We cannot wait for her arrival next weekend which is going to be so good.
I dog proofed the fence and gates this weekend, we went shopping on Amazon and Pets at Home and make sure everything is set for Rosie's arrival. We cannot wait. The kids are very excited and so are we. Whilst the last few weeks I was wondering how cute a dog could really be, the puppies at 7 weeks are just adorable! Seriously, they are amazing. I got all soft 😉
It was also nice to have my cousin over for the weekend. She is really good with the boys and good to us too. Whilst I was in Zurich myself I didn't have time to buy chocolate. She did 🙂 Again, this is going against the healthy eating regime but how couldn't you 😉 Swiss chocolate is heaven. And an extra pair of eyes to watch the kids is nice too.
A mixed bag of feelings this week. Mixed weather. Yet it all worked out at the end. Another two weeks before I have half term off to really work with Rosie. You can just see her loving me already, I even ordered an extra bag of treats 😉
Have a great week yourselves, enjoy what is left of the Indian Summer, rain and winter are slowly taking over.
Sunday Column (290)
Posted by Volker Ballueder in Sunday Column on September 28, 2014
A week that starts off with a headache, a 5K run with lots of muscle pain and a temperature drop of 5-10 degrees is not a good week, or at least not a good start of the week. Whether it was the weekend where I overdid my exercise or the amount of chocolate and sweets I ate at the kids party, I do not know. Yet something triggered a typical Monday which turned out to get worse as the day went on. Of course the week changed to the better and I got used to the rather nice autumn weather and went on another trip. But this weekend, I felt it again – so maybe I just need a break 🙁
This week I went to Paris for a night and a day to visit a few clients. As this gets published I finish packing my things for a trip to Istanbul. I have never been to Istanbul in my life, so I am very excited to go. A few years back I went to Egypt realising that I will see the pyramids. Being on work travel schedules doesn't mean you are doing some sight seeing. Having said that, I went to Iceland before and my wife was annoyed that I saw Iceland and Egypt/Kairo before she did. Now I also see Istanbul. I am not into travelling as much as my wife, I just do my job, but that's where we differ I suppose. Maybe that is why I am quite happy staying at home with a dog at the weekend, putting my feet up and enjoying "being home". Istanbul of course is different. I will report back next week of course.
What else happened this week? I think there are a few things transport wise worth mentioning. I was on the train towards Gatwick when the train stopped. Then we heard someone got hit by a train. Lucky for us it was behind us and with some delay we managed to get to Gatwick. I did get a bit stressed and was glad I didn't travel the other direction that night. Bad enough for the person that got hit, it is a bit of pot luck tbh to sometimes make your journey home. At Gatwick I got served an undercooked chicken at Jamie's Italian. Fancied some superfood salad and ended up with an awful meal. Not great to travel sometimes. The view of course, as of my earlier post, was amazing.
Anyway, things are good overall. One never has enough time for the family it seems and weekends are too short. I caught up with a uni friend and another good friend this week. I have another few people I need to call. I spoke to my granny for her 94th Birthday. I am lucky, all my grandparents reached the age of 90+. Maybe a good omen. None woke up at 5 am to run 10 K, then worked all day and commuted for 3 hours per day. Life seems as if it is in the fast lane at the moment. I like that though.
I know the next few weeks will be busy. I wouldn't want to have it any other way. I couldn't to be honest. But I am learning a lot too. Prioritising, time management, letting go. All those passionate topics I am writing about over at tidWOWs. It is as if I am fine tuning a bit.
It is good to know that in a few weeks time, probably around mid December, things will slow down. When the dog and I will be having a cuddle with the boys under the Christmas tree and watch the fire, when we think that we are so grateful for what we have. And, that next year we take more time for each other. And this will repeat for another few years. Why I think that? Because I believe that is how it is. Life is living in extremes, on both ends. And I am truly blessed with it.
Love living!


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11 Days Post-Op and my Left Breast is very sore and much more swollen than my right breast. I'm a little concerned.
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Doctor Answers 11
Pain after breast augment
Whenever there is significant unilateral pain, in my opinion, that is an indication to reach out to your plastic surgeon who should evaluate you and determine the cause. It could be muscular but, just as well, could reflect a hematoma or other issue. I am not a fan of self-treatment (ie-massage) unless directed to do so by your surgeon.
Early post op, some advices:
Thanks for sharing your concerns with us.
In my practice, after performing a BA I recommend to my patients to limit the movement of the arms for two weeks. After that, you can move your arms taking care and always with common sense. In this regard, it's not advisable to carry heavy weights to prevent the implant out of position, and allow the formation of the physiological capsule around the implant, also to avoid pain and breast swelling.
Kind regards
Pain in breast
If you are having severe pain, then you should be checked out in person. Best of luck with your results.
Web reference: https://www.stevenwallachmd.com/breast/breast-augmentation/
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11 Days Post-Op and my Left Breast is very sore and much more swollen than my right breast. I'm a little concerned.
You are going to see the difference just after the procedure. However it is necessary to wait for some time in order to see the final result. After the breast lifting operation, recovery period depends on your physical status, age, general health and condition mainly. Operation itself does not take too long therefore you receive a mild anesthesia. Since the anesthesia that you receive is mild; you will not have problems associated with anesthetic agents after the operation. This is especially important and can be achieved with only a team of plastic surgeons like we have. After the operation you will be advised to wear a corset in order to reduce the edema. You can start to do your daily activities just after the operations but we do not advise you heavy lifting, running or activities that require excess physical activity. The more you rest, the faster your recovery will be
Assymetry of breasts 11 days post op
You should not have that significant of a difference as you are describing. I would recommend you see you surgeon before the 5 days especially if things are getting worse or not improving at all. It may just be the muscle being different on that side but you should be checked.
11 Days Post-Op and my Left Breast is very sore and much more swollen than my right breast. I'm a little concerned.
Pain and swelling and feeling of tightness on one side after breast augmentation can be a sign of hematoma or bleeding. I suggest that you see your surgeon for an exam and not wait 5 days.
Web reference: http://www.bostonplasticsurgeryspecialists.com/services/breast-surgery/breast-augmentation/
Breast swelling and asymmetry after BA.
Unless you had asymmetry of your breasts before surgery, you should not have marked asymmetry of your breasts after surgery. This combined with more pain on that side raises the concern of a hematoma in your breast. You should see your surgeon sooner, not later for an evaluation.
Swelling and pain
Hello and thank you for your question. Its unfortunate you are feeling this discomfort. I always tell my patients that if they feel like something is not right then they should call me or the office. Unless its something that sounds completely normal, I usually have them come into the office just so I can evaluate them myself and give us both peace of mind. Asymmetric swelling and pain can be very normal after surgery but it depends on the extent. If they are significantly different in regards to swelling and pain then a concern would be for possible hematoma. I dont think you should wait 5 days. I think its best you, at the least, call your plastic surgeon and express your concerns with them but I definitely think they should know about it. Congrats on your new breasts!I hope this helps.
Ankur Mehta MD
Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery
I appreciate your question.
Right now, you are very early on in the post op recovery period. It will take 3-6 months for you to feel comfortable having implants in your body and for them to settle. This time allows for you to physically and psychologically adapt to your new body image. There are many variables that contribute to a breast augmentation's final result. Preop size and shape, IMF location, location of the implants and type of implant. Patients heal at different rates and each breast will sometimes heal at a different rate. Rest, relax, recover and heal. Express your concerns to your surgeon so he/she can examine you. Then reassess final result at 6 months.
The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
Best of luck!
Dr. Schwartz
Board Certified Plastic Surgeon
Web reference: http://beverlyhillsbreastandbodyinstitute.com
Breast Augmentation - Post Op Swelling?
Thank you for your question and photos. You are still very early in the post-operative period. It typically takes 3 - 6 months for the swelling to subside and and implants to settle into proper position. The breasts may swell asymmetrically. Please discuss your concerns with your board certified plastic surgeon. Also, make sure you follow all of your plastic surgeons post-operative instructions regarding level of physical activity and use of a support bra. Hope this helps and good luck with your recovery.
Web reference: http://www.rottmanplasticsurgery.com/before-after-breast-augmentation-baltimore/
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.