text:
Sign into our member site to view your information online.Forget your username or password? Not registered? Register here
ethambutol (generic name)
It is used to treat tuberculosis (TB)
(e THAM byoo tole)
Table of Contents
Top Learning Centers(Recursos en Español)
What is this medicine?ETHAMBUTOL (e THAM byoo tole) is used to treat tuberculosis (TB). This medicine is never used alone, but always with another medicine.
What should I tell my health care provider before I take this medicine?They need to know if you have any of these conditions:
How should I use this medicine?Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Take this medicine with or without food. Take your doses at regular intervals. Do not take your medicine more often than directed. For your therapy to work as well as possible, take each dose exactly as prescribed. Do not skip doses or stop your medicine even if you feel better. Skipping doses may make the TB resistant to this medicine and other medicines. Do not stop taking except on your doctor's advice.
Contact your pediatrician or health care professional regarding the use of this medicine in children. While this drug may be prescribed for children as young as 13 years of age for selected conditions, precautions do apply.
What if I miss a dose?If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.
What may interact with this medicine?
What should I watch for while using this medicine?Visit your doctor for regular check ups. Tell your doctor or healthcare professional if your symptoms do not start to get better or if they get worse.
Tell your doctor or health care professional right away if you have any change in your eyesight.
Do not take any medicines that contain aluminum for 4 hours before or after you take this medicine.
What side effects may I notice from receiving this medicine?Side effects that you should report to your doctor or health care professional as soon as possible:
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
Where should I keep my medicine?Keep out of the reach of children.
Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Throw away any unused medicine after the expiration date.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.


text:
Effectiveness of a Decision Support System in Improving the Diagnosis and Screening Rate of Breast Cancer
Recruitment status was: Recruiting
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Clinical decision support has been shown to improve the performance of screening tests; however, few studies have documented direct clinical benefit resulting from the increased screening promoted by clinical decision support systems.
The purpose of this study was to determine if a standards-based, sophisticated decision support system could not only promote additional breast cancer screening, but also detect significantly more breast cancer
|Breast Cancer
|Other: SEBASTIAN Clinical Decision Support System (CDSS)
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
|Official Title:
|Effectiveness of a Decision Support System in Improving the Diagnosis and Screening Rate of Breast Cancer
- Number of participants with new Breast Neoplasms Diagnosis (Incident cases) [ Time Frame: 18 month ]New Breast Neoplasms Diagnosis (Incident cases from biopsy reports). Breast Neoplasms are stored in the institutional Clinical Data Repository. The diagnosis are automatically codified using a terminology server that use SNOMED-CT as reference terminology
- Number of patient with breast cancer screening due that received the order to perform the study (mammography) [ Time Frame: 18 month ]Number of patient with breast cancer screening due that received the order to perform the study (mammography). This information will be record through the clinical data repository every time that a provider order a screening test to each of the patients involve in the study
|Estimated Enrollment:
|Study Start Date:
|November 2009
|Estimated Study Completion Date:
|June 2012
|Primary Completion Date:
|June 2011 (Final data collection date for primary outcome measure)
|Assigned Interventions
Experimental: Electronic Reminder
alert from SEBASTIAN decision support system
Other: SEBASTIAN Clinical Decision Support System (CDSS)
SEBASTIAN is an example of a clinical decision support technology that supports the latest, service-based architectural approach to CDSS implementation. Developed at Duke University, SEBASTIAN is a clinical decision support Web service whose interface is now the basis of the HL7 Decision Support Service draft standard SEBASTIAN places a standardized interface in front of clinical decision support knowledge modules and makes only limited demands on how relevant patient data are collected or on how decision support inferences are communicated to end-users
|No Intervention: control
Detailed Description:
Breast cancer is the most common female cancer. In the United States, the second most common cause of cancer death in women, and the main cause of death in women ages 45 to 55 years old. The U.S. Preventive Services Task Force recommends screening mammography, with or without clinical breast examination, every one to two years among women aged 50 to 69 years old.
Recent research has shown that health care delivered in industrialized nations often falls short of optimal, evidence based care. US adults receive only about half of recommended care. To address these deficiencies in care, health-care organizations are increasingly turning to clinical decision support systems. A clinical decision-support system is any computer program designed to help health-care professionals to make clinical decisions. In a sense, any computer system that deals with clinical data or knowledge is intended to provide decision support.
Examples include manual or computer based systems that attach care reminders to the charts of patients needing specific preventive care services and computerized physician order entry systems that provide patient-specific recommendations as part of the order entry process. Such systems have been shown to improve prescribing practices, reduce serious medication errors, enhance the delivery of preventive care services, and improve adherence to recommended care standards.
The aim of this study is to show the efficacy of a decision-support system as a strategy for improving the performance of the mammography care process and the detection of significantly more breast cancer.
|Ages Eligible for Study:
|50 Years to 69 Years (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Women between 50 and 69 years old
Exclusion Criteria:
- Breast Neoplasms
- Bilateral mastectomy
- Disabled Persons
Please refer to this study by its ClinicalTrials.gov identifier: NCT01336257
|Hospital Italiano de Buenos Aires
|Buenos Aires, Argentina, 1209
|Contact: Ana M Gomez, MD 541149590200 ext 5398 email@example.com
|Principal Investigator:
|Damian A Borbolla, MD
|Hospital Italiano de Buenos Aires
|Responsible Party:
|Damian Borbolla, MD, Hospital Italiano de Buenos Aires
|ClinicalTrials.gov Identifier:
|NCT01336257 History of Changes
|Other Study ID Numbers:
|Study First Received:
|April 14, 2011
|Last Updated:
|April 13, 2012
Keywords provided by Damian Borbolla, Hospital Italiano de Buenos Aires:
Decision Support Techniques
Electronic Health Records
Reminder Systems
Early Detection of Cancer
Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Breast Diseases
Skin Diseases
ClinicalTrials.gov processed this record on September 21, 2017

subset: commoncrawl


text:
Sign into our member site to view your information online.Forget your username or password? Not registered? Register here
urea topical (generic name)
Mectalyte (brand name)
It is used to soften thick, rough, or dry skin caused by certain skin conditions
(yoo REE uh)
Table of Contents
Top Learning Centers(Recursos en Español)
What is this medicine?UREA (yoo REE uh) is used to soften thick, rough, or dry skin caused by certain skin conditions. It is also used to soften and remove damaged or diseased nails without surgery.
What should I tell my health care provider before I take this medicine?They need to know if you have any of these conditions:
How should I use this medicine?This medicine is for external use only. Do not take by mouth. Follow the directions on the label. Apply a thin film to the affected area. The moisturizing effect may be better if this medicine is applied while the skin is still damp after washing or bathing. If applying to the nails, cover to protect the surrounding area. Apply generously to the affected nail. Let it dry uncovered or cover with an adhesive bandage or gauze secured with tape. The treated nail can be removed after several days. On exposure to air the nail bed hardens within 12 to 36 hours. Apply with caution to the face or on broken skin. Do not get this medicine in or near the eyes, lips or other areas of sensitive skin.
Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
What if I miss a dose?If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.
What may interact with this medicine?Interactions are not expected. Do not use any other skin products on the affected area without telling your doctor or health care professional.
What should I watch for while using this medicine?Tell your doctor or health care professional if your symptoms do not improve.
What side effects may I notice from receiving this medicine?Side effects that you should report to your doctor or health care professional as soon as possible:
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
Where should I keep my medicine?Keep out of the reach of children.
Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Keep in a well closed container. Throw away any unused medicine after the expiration date.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.


text:
Currently HTMLayout is installed and works on more than 6,700,000 PCs in various software products of various companies.
This means that almost 43 thousands users per day download and install HTMLayout based products.
HTMLayout uses its own lightweight HTML rendering engine which gives your applications:
HtmLayout helps you to:
HtmLayout is a "native" window class implementation and is distributed in binary form as native Windows DLL (dynamic load library).
HTMLayout does not use any heavy component technologies this is why its startup time is just zero. And couple words about its light weight. .... well, not words just numbers:
These numbers were taken while browsing the Complexspiral Redux page (basic HTML and CSS level 1) in Microsoft Internet Explorer, Mozilla Firefox and HTMLayout (browser.exe).
Numbers are not precise - they just give you rough estimation of what to expect.
Actually such comparisons are not exactly fair to be honest. HTMLayout designed to be an embeddable component. So we have different priorities in our engine design therefore different optimization targets.


text:
Media Briefing: Fairfax County Gang Prevention Summit
Fairfax County Office of Public
12000 Government Center Parkway, Suite 551
Fairfax, VA 22035-0065
Feb. 22 , 2005
Media Briefing: Fairfax County Gang Prevention Summit
The Fairfax County Coordinating Council on Gang Prevention invites members of the media to attend a briefing regarding gang prevention, intervention and suppression.
DATE: Friday, Feb. 25, 2005
TIME: 10 a.m. – 10:30 a.m.
PLACE: Government Center, Room 232, 12000 Government Center Parkway, Fairfax, Va. Briefing will occur immediately after the PowerPoint presentation of a gang prevention model.
WHO: Fairfax County Board of Supervisors Chairman Gerald E. Connolly; Fairfax County Public Schools Superintendent Jack Dale, Ph.D., and Fairfax County Police Chief David Rohrer, will be available for comment.
For more information, please contact the Office of Public Affairs at 703-324-3187, TTY 711.


text:
Planning The Us101 Loop & Olympia National Park
Posted 13 July 2008 - 10:01 PM
I have lived in the Northwest most of the past 40 years, and have never taken the full loop! In fact, I have only seen the Olympic Mountains from a distance, never from inside the Park! I have never been in the Park. I guess its that thing about the grass is always greener somewhere else.
Well, I think we will do the loop soon at least if our dog sitter (his former master, and my son) arrives next week to watch ole Bo, the now homebound Malamute Wonder Dog. Believe it or not, a deer actually laid down within 100 feet of him today, and neither he nor the deer seemed to care. He is just too old (13), and the deer too confident to care, I guess. The ole boy is sleeping beside the chair as I write.
Becky has made several suggestions on the chat this evening as to places to see. But perhaps there are others here who have been to the Park or around the loop. Any advice?
I am thinking this will be just a few days, maybe no more than two, maybe three. The whole loop is two lanes, with just a few miles exception. We have traveled the area between Olympia and Port Angeles, and between Olympia and Forks, but never connected the dots, so to speak.
As usual, we will make a report, perhaps even in transit depending on time and WiFi connections.
Keep the Show on the Road!
Posted 13 July 2008 - 10:22 PM
I'll bet that's one beautiful route!
Posted 14 July 2008 - 03:17 AM
Since you're going next week, you can clear a path for me and give me some up-to-date pointers. Sounds like I ought to ask Becky for some pointers, too. (Sorry I missed last night's chat.) I had intended to inquire about a hookup somewhere so you could buy me a cup of coffee. I'll be leaving Silverdale sometime on the 4th of August so might be somewhere around Hoquiam on the 5th. I'm guessing that's the closest point (unless you break down in Humptulips and I catch up with you on the road).
Posted 14 July 2008 - 01:15 PM
You must post copious photos, Dave!
Posted 14 July 2008 - 02:06 PM
You must post copious photos, Dave!
It is nice country. The road is actually quite rural in character. You pass along the Hood Canal, which I think was cut by glaciers, then you can detour into Port Townsend for one of Americas premier Victorian towns, then up to Fort Worden where Officer and a gentleman was filmed.
Back on 101 you head toward Olympic National Park, and Port Angeles where the ferry goes over to Victoria BC. We cant go because our passports have lapsed. But there is plenty to see in the USA. For the first time in my life, we will actually drive into Olympic National Park! We would have goon sooner but I had to wait to be eligible for my Golden Age Pass. Having reached a golden age some years ago, it is now time to use the pass.
I havent been between Port Angeles and Forks, but there is Neah Bay and the Olympia Rain Forest to see. Then down the Washington Coast for several miles, perhaps into the lodge at Lake Quinault for lunch, and back through the former mill and lumber towns of Hoquiam and Aberdeen.
It can be done in a single day, but I think we will do at least two, and perhaps three.
And we will do lots of photos as usual.
Im just keeping my fingers crossed that our dog sitter keeps his promise and doesnt cop out on us.
Keep the Show on the Road!
Posted 14 July 2008 - 02:55 PM
Since you're going next week, you can clear a path for me and give me some up-to-date pointers. Sounds like I ought to ask Becky for some pointers, too. (Sorry I missed last night's chat.) I had intended to inquire about a hookup somewhere so you could buy me a cup of coffee. I'll be leaving Silverdale sometime on the 4th of August so might be somewhere around Hoquiam on the 5th. I'm guessing that's the closest point (unless you break down in Humptulips and I catch up with you on the road).
Well, great minds run in the same loops! BTW, I wasnt planning to clear a path for you .but I can give folks along the route advance warning!
Not having been west of Port Angeles myself, I dont know whether 101 or 112 would be preferred. In fact, I havent given the route between Port Angeles and Forks much attention yet, but I hope to before I leave. And I can certainly report back.
I wrote the post to Mobilene before I saw your post, so you might want to scan it.
From your closest point note, Im assuming that you plan to continue on down 101 to Astoria and not go through Olympia.
A hook up in Hoquiam may be problematic in that you may find yourself substantial influenced by interests or traffic. We had dinner guests who arrived an hour and a half late Saturday because they took the loop and misjudged time.
When youre in Silverdale, send me an e-mail and lets see what our respective plans are. If a hookup looks good, then you could give me a call when you leave Kalaloch, as your travel time (about 1.5 2 hours) and mine to Hoquiam will be roughly the same.
Keep the Show on the Road!
Posted 14 July 2008 - 05:03 PM
Maybe that is more appropriate.
I certainly don't know and believe I went for 112 to stay near the water and to pick up the Crescent Beach area. I intentionally routed through there for some reason or another. I then routed back to 101 at WA-113. You mentioned Neah Bay in your response to mobilene. If you mean the town, that's a place that neither my route or US-101 gets to. I've been to Port Angeles once specifically for the ferry and recall that I really enjoyed the drive (from somewhere around SeaTac) and that it was very green.
Yep. I plan to stay on 101 to Leggett, CA, then take CA-1 on to San Francisco. It's around 1100 miles and I've got six days to cover it. Seven elapsed days but I intend to spend one day seeing that Columbia River I've heard so much about.
Hopefully we can tune things to allow at least a brief hello somewhere.
Posted 14 July 2008 - 06:29 PM
I certainly don't know and believe I went for 112 to stay near the water and to pick up the Crescent Beach area. I intentionally routed through there for some reason or another. I then routed back to 101 at WA-113. You mentioned Neah Bay in your response to mobilene. If you mean the town, that's a place that neither my route or US-101 gets to. I've been to Port Angeles once specifically for the ferry and recall that I really enjoyed the drive (from somewhere around SeaTac) and that it was very green.
Yep. I plan to stay on 101 to Leggett, CA, then take CA-1 on to San Francisco. It's around 1100 miles and I've got six days to cover it. Seven elapsed days but I intend to spend one day seeing that Columbia River I've heard so much about.
Hopefully we can tune things to allow at least a brief hello somewhere.
Green it is! It is so green and tree studded you may very well get tired of tall things with leaves or needles!
On the other hand, I think it is nearly impossible not to enjoy the coast and environs. And on a clear day, the Columbia River George is absolutely awesome. You will not see the falls at their best because it will be mid summer, but they will not disappoint you in any event. If you imagine the great floods out of Lake Missoula carving the sheer walls on the south side, you will enjoy them even more.
I will try to limit my unsolicited advice, but I will offer a few thoughts.
101 south of Aberdeen goes mostly through the woods. Long Beach is a busy tourist town, and you can visit Ilwaco and Cape Disappointment if you are a Lewis and Clark fan. Astoria can be quaint, and the ride to Portland is pleasant. The vast majority of that is along two lanes.
I would get on the old Columbia River Highway at Troutdale and cross the two old bridges, but you can also enter the old road via Corbert, and miss the bridges. I would go at least as far east as the Bonneville Dam (which means some freeway), if you have not viewed a big dam. You could go further east and pick up the old road again and see the part tourists dont usually visit, but that may be further than you want to travel off your 101 route.
The Oregon Coast and some of the towns along 101 are among the best in the country. Your normal instincts will lead you to nice places. Obviously look for the older parts of towns down by the waterfront or at the entrance to a bay or river estuary. Most of the time the newer sections of towns along the highway are better left for another trip.
Sheila and I enjoy staying in Yachats on the Oregon Coast because it is small and quaint and there are several nice beach front motels and at least a restaurant or two with the waves crashing almost in your lap viewed though the big windows. But there are so many nice places, that is just one.
Eureka is interesting in the old town area. Roadhound will be just getting back from his trip and should have some fresh insights to share about that area.
Definitely lets see if we can do hook up as you fly by.
Keep the Show on the Road!
Posted 14 July 2008 - 09:14 PM
Your advice is unsolicited only because I hadn't gotten around to asking. It is all appreciated.
I've plotted the CRH from Troutdale to just past The Dalles with hope that I can do that during one day's sun light. You can probably help me out on the area just west of the Hood River Bridge. The CRH is shown as riding I-84 while (a possibly 2-lane) US-30 runs along its south side. Is there any advantage or disadvantage to picking up US-30 here?
I didn't mean to trick you into giving advice in a thread in which you asked for advice yourself but I do appreciate it.
Posted 14 July 2008 - 10:51 PM
I've plotted the CRH from Troutdale to just past The Dalles with hope that I can do that during one day's sun light. You can probably help me out on the area just west of the Hood River Bridge. The CRH is shown as riding I-84 while (a possibly 2-lane) US-30 runs along its south side. Is there any advantage or disadvantage to picking up US-30 here?
I didn't mean to trick you into giving advice in a thread in which you asked for advice yourself but I do appreciate it.
The old Columbia River Highway is closed to autos between Hood River and Mosier. You could hike it and walk through the historic Twin Tunnels, but you dont have the time anyway.
If you might go as far as The Dalles, the drive between Mosier and The Dalles has some spectacular views, and the Rowena loops. And it is much less traveled than the western section. I would definitely make time to take it if I could.
I posted some material from along that segment some time ago
After you leave Bonneville Dam you will be on freeway for some distance. A stop at Cascade Locks will give you a view of the locks built around the turn of the century to bypass rapids that hindered riverboat traffic. Then I would pull off at Mosier to pick up the old highway again.
Im guessing you will be there mid week so I dont think you will have great problems with crowds. The biggest problem may be with parking, because the parking areas were not designed to handle the level of interest the old road is getting. But Im thinking you may just get more exercise walking a little further.
Going west to east, and assuming you start in Troutdale, you cant miss the old bridges, but you might miss Chanticleer Point (Womens Forum State Park). Dont!
But rather than me giving you a blow by blow, go to the site below and print out the excellent material there, or load it on your hard disk on your laptop.
Go to the Nomination for National Historical Landmark and start about page 17 in the first document
These are the nomination for National Historic Landmark and include a mile by mile (more like a foot by foot) description and terrific historical material.
Hope this helps!
I should add, as you might expect, I have a ton of old maps and guides for the Columbia River Highway, including a 1926 volume designer builder Samuel Lancaster published. The highway is so well documented, I doubt that my stuff would add anything at all, but if time permits I may post a few items that may be less frequently cited, and which you may see on your visit.
Maybe I should also note that the old highway is also part of the Old Oregon Trail Highway so you get two for one!
Keep the Show on the Road!
Posted 18 July 2008 - 02:51 PM
I have lived out here for 30 years and have always wanted to take that trip, but never have. Please do take lots of pics!
Posted 18 July 2008 - 03:18 PM
I have lived out here for 30 years and have always wanted to take that trip, but never have. Please do take lots of pics!
Yah, tell me about it! It is kind of amazing that we often dont visit what is next door! For example, I have never been up to Mt St Helens! Some of the mountain came to me years ago, at least some of it settled on my lawn, etc! But I have never driven up to see the results of that blast close up.
I was hoping to do a trip this week around the Olympic Peninsula, but the weather forecast has been for clouds along the western shores all day long, even though it clears inland in the afternoon. I am waiting until the beaches are at least partly sunny for some photos.
I have been looking at photos on Google Earth. Some are quite spectacular, especially the mountains, lakes, and sea shore. The rain forest is also pretty, but living basically at the southeast corner of the peninsula, I feel I have seen and live with enough rain forest already!
I definitely will take photos when I go.
Keep the Show on the Road!
Posted 18 July 2008 - 04:26 PM
It sure would be sad to read "I have lived in the Northwest most of the past 41 years, and have never taken the full loop! I almost did once but I heard that it might be cloudy"
Posted 18 July 2008 - 05:09 PM
Yah, I can see the tears streaming down your cheeks from here!
I should have added that the weather forecast for Sunday and Monday looks promising, with only 55% cloud cover offshore both afternoons.
I only have the one deadline; I have to sound the warning before you make your pilgamage out here!
Seriously, I am hoping the summer weather pattern will give you a clear day for your visit. I have been looking at the National Weather Service graphic forecast, which is.. well, graphic and quite good. Just about every day, the clouds cover the coast and the peninsula, with a big opening in the grey over the center of Olympic NP. Then the clouds burn off in the afternoon, out to the coastline, but not out to sea. Sunday and Monday, the clouds retreat offshore, which is what Im looking for.
Keep the Show on the Road!
Posted 18 July 2008 - 06:46 PM
Better not let those unsuspecting good folks down
I know of clouds in the northwest. My first visit to Seattle was for business. Another fellow and I flew in, spent the night at a motel somewhere between the airport and Seattle, then drove into downtown the next morning. At the end of the day, we returned to the motel. After a pleasant night, it was back to the city the following day. But, at day's end, as we headed back to the motel, we really thought we were lost for awhile. Right in front of us was this huge mountain that was impossible to ignore. Mount Rainier had been completely hidden by clouds during the first day and a half we were there.
As for the upcoming trip, I'm resisting getting too organized but I'm kind of concerned about the availability of spontaneous and affordable lodging. You mentioned Quinault Lodge in the context of a lunch stop for you and Sheila so I took a look at it and it seems like a possibility for my first night's roost. Any thoughts on the Lodge as an overnight or on the general availability of motels along the route? I've noted your recommendation of Yachats but my first thought is that it's at an awkward point for me since I'm thinking in terms of a place where I can spend the night before and the night after a Columbia River Highway drive. I'm hoping that Roadhound will have some up to the minute input on places further south.
Posted 18 July 2008 - 07:55 PM
I think there are three choices of where to stay that would be viable for you, assuming you get out of Silverdale say around 8 or 9AM. I would look at Forks as having the most motels, and probably the more economical .but it wouldnt be my first choice.
I would look first at Kalaloch. It overlooks the water, and has a nice restaurant. You will need reservations, and a full wallet as overnights start around $150. But it would be worth the bucks, if you can get in. And their cancellation policy is three days in advance. Lake Quinault Lodge would be my second choice....mainly because it is on a lake, not the ocean. The amenities equal Kalaloch. Kalaloch or Lake Quinault will not disappoint. other than your wallet. Check their web sites. You can make reservations on line. They are run by the same company.
As for your next day (day two), let me make a few observations. I will assume you are planning to drive down 101 to Astoria then come east along the Columbia River through Portland (or via Longview) to pick up the Historic Columbia River Highway (HCRH). If you did that, it would not make sense to return to Astoria, because you would be backtracking along road you had been on. In that scenario you would be wise to skirt Portland and get to the Oregon coast via McMinnville.
The northern Oregon Coast is very nice, but more developed than the southern section. There are more condos and commercial tourist attractions north because they can be more easily reached from Portland. So I personally prefer the coast south of Lincoln City (Lincoln City itself is touristy, if you want that).
So Alternate one for day two is to go down 101 to Astoria, along the Columbia River eastbound, through Portland (or via Longview), and stay along the Columbia River near the HCRH. If it were me I would get east of Troutdale, maybe to Cascade Locks. There is a nice Best Western there. Or as far east as Hood River where there are lots of choices.
Alternative 2 for day two would be to cut over on US12 or State 6 to I5, then down to pick up the HCRH. Frankly that would be my choice. It is shorter (about 40 miles), has some lovely scenery and small towns, and saves time (maybe 2 hours) so you get to spend it on the two lanes of the HCRH. And if you hate the freeway, you could follow some of the old Pacific Highway .but Im thinking the HCRH is the objective. The downside is you miss Astoria.
Whether alternative one or two, I would hit the Oregon Coast at, or south of Lincoln City on day three.
Ill let you digest those thoughts, and please ask any questions that you think I might be able to answer.
Keep the Show on the Road
Posted 19 July 2008 - 07:37 AM
I had the same thoughts as you about backtracking to Astoria. I picked US-26 over US-30 because there would be less of it but I think what I'm hearing is that, if I'm going to miss coast, Astoria or Cannon Beach to Lincoln City is a good coast to miss. So I'm now thinking about getting to the HCRH on US-26 (a.k.a., incidentally, the Sunset Highway although not because of the setting sun) and back to the coast through McMinnville as you suggest. I looked at I-5 to US-20 but it saves little time, involves an expressway, and misses Lincoln City. I'm guessing that lodging should be plentiful around Portland for Tuesday and Wednesday nights.
The same cannot be said for Saturday night lodging as I approach San Francisco. Most of what I've found is either AbE (Available but Exorbitant) or AbF (Affordable but Full). I suspect I'll book something in advance for Saturday and maybe Friday to avoid last minute on site shopping in a seller's market.
Referencing your response to my direct email, I assure you that an ocean (or lake or river) view is not worth $100. The Quinault River Inn is an improvement but Aberdeen prices would probably be even better. It's an hour beyond Quinault which might be pushing that first day but I generally have more timing problems on the last days than on the first. It's those thoughts that kept me from already booking in Quinault.
Big thanks for the advice (and I'm not done asking:-).
Posted 19 July 2008 - 12:39 PM
Referencing your response to my direct email, I assure you that an ocean (or lake or river) view is not worth $100. The Quinault River Inn is an improvement but Aberdeen prices would probably be even better. It's an hour beyond Quinault which might be pushing that first day but I generally have more timing problems on the last days than on the first. It's those thoughts that kept me from already booking in Quinault.
Big thanks for the advice (and I'm not done asking:-).
Sounds like your plans are starting to jell. I agree that the Kalaloch or Lake Quinault Lodges are best if you are going to spend some time there. It is too expensive for just a bed and place to shave.
Taking US26 from the coast didnt occur to me, but it is a good plan, and should avoid some Portland area traffic as well. We dont use it because it angles the wrong way for our purposes, but it should serve you well coming in from US101.
We had a reunion with friends a couple of years ago near Astoria, so I probably have some shots around here, and plenty of advice Trouble is you will be just driving through so you will need to be selective.
Lets wait until we get closer to your travel dates to see if and where a cup of coffee might work. I might prefer connecting along the Historic Columbia River Highway (HCRH) instead of Aberdeen. It is a longer drive to get down to the HCRH from Olympia, but I (or Sheila and I) might make it a day excursion. It is about a 1.5-2 hour drive to Troutdale from our place, so if I knew the day, we could probably work out the details while you are in transit to meet there or further east
Sheila went with a friend to Sequim (which is on your Olympic Peninsula route) yesterday for the Lavender Festival, and reported the area to be in full bloom. The weather there was great and the Olympic Mountains were as spectacular as ever. Im hoping she and I can do the loop the last weekend in July. I may also do all or part tomorrow or Monday, if the coastal weather is favorable for photos.
Speaking of weather, the summer pattern is typical for western coastal areas, with the potential for morning clouds clearing to sunshine before mid day. Sometimes that applies to the Columbia River, perhaps as far west as the HCRH. The vistas of the Columbia will be spectacular in the sunshine, so watch the weather patterns on your laptop. I find the National Weather Service site to be a real asset on the road.
My son, who now lives in Coos Bay on the Oregon Coast, will be here Tuesday (7/22). I will ask him to provide a report as well.
As you plan, Im thinking you will enjoy a stay in Cascade Locks or Hood River more than one in Portland, Troutdale, or The Dalles. The former are quaint and charming, with Hood River having a variety of sights, quaint downtown, and young wind surfer crowd, and Cascade Locks having a nice park and the locks on the river with the Bridge of the Gods in the background.
Enough rambling .
Keep the Show on the Road!
Posted 19 July 2008 - 06:31 PM
Your comments on Cascade Locks and Hood River really clicked. I'm guessing that the Best Western there is the one you mentioned earlier. Their rates aren't bargain basement but they're reasonable. Even the "river view" rooms aren't outrageous but by foregoing the premium view, I might almost pay for a tank of gas. So I'm just about sold on making that my Tuesday & Wednesday night home. Getting there from Quinault River shouldn't be a problem (especially if I'm not spending time chit-chatting with someone over coffee in Aberdeen ) and even if the last hour or two is after sundown it doesn't matter - it's expressway! On Wednesday morning, I'll backtrack to Troutdale to pick up the beginning of the HCRH and can time things to meet you there or somewhere else along the highway.
With Wednesday night at Cascade Locks, your earlier suggestion of Yachats becomes a possible Thursday night stop. Any specific recommendations? Actually, Lincoln City and points up to an hour or so south are possibilities.
Over lunch I reread the "Oh, Columbia" article from AR V III N 3. Of course it got me even more psyched about the trip but I realized that it was (something I bet you don't hear often:-) "before your time". The article, by David J. Sell, is quite good and the Rowena Loops are on the cover. There is also a 1 to 101 article by Thomas on Sol Duc Hot Springs and that made me think of you because the Springs are less than 10 miles south of US-101 west of Port Angeles. It's an area where I'm planning on being north of 101 on WA-112 so I doubt I'll go for it. The road is really skinny in DeLorme plus you may take 112, too, but thought I'd mention it. I'd be glad to pass on more details if you'd like. Looks like the issue is still available in case you're short on HCRH information.
Posted 19 July 2008 - 09:23 PM
But I absolutely deny expertise, and any drive will certainly reveal much that I have missed or forgotten. Besides I have never traveled it as a passenger, other than when I was perhaps eight or nine. So should we connect and do a short tour, it will still be a new experience for me.
The section between Troutdale and Cascade Locks is the primary tourist section and contains all the waterfalls the highway is famous for. It is also the most busy now that heritage travel is catching on. Being there mid week will be to your advantage. I seldom have traveled the HCRH at peak season, so I am a little concerned with parking at prime sites.
I wouldnt wait until Wednesday to do the section between Troutdale and Cascade Locks. The warm late afternoon sun, low in the sky, illuminating the Columbia River will take your breath away. And even a dusk visit will be spectacular, as the lights on the Crown Point circle are illuminated. ( And if there is a parking problem, it will be less in the late afternoon.) Then if you do backtrack to Troutdale Wednesday for another run, you will see it in a different light.
My point is, two runs at different times of day will be well rewarded.
The run between Mosier and The Dalles is entirely different. Even though you are practically at sea level through the entire Columbia River Gorge, you actually cross the Cascade Mountains in the process, and the climate changes dramatically on the east side. The mountains drain the clouds of rain, and the east side is much dryer, and at this time of year golden in contrast to the lush green on the west side.
The advantage of the east side is that it is more open, and the views less restricted by big trees. You will note on the west side that some of the vistas and scenes in 1916-1926 photos are obscured by trees. Not so on the east side. But no waterfalls, and not many bridges and viaducts grace the east side.
A thought just occurred to me. If you are thinking you will backtrack from The Dalles to Cascade Locks for Wednesday evening, consider instead backtracking to Hood River, then going over the shoulder of spectacular Mt Hood, and spending the night at Timberline Lodge or along US26 further west. The road is good, and has much to recommend it. It is a good and beautify mountain road, and you will be practically top of Mt Hood something you wont see up close and personal in Ohio! And it is real northwest mountain country!
Check that one out. It would still be possible to hook up, but I would follow you to Hood River. Then we could take one car between Hood River and The Dalles. We would pick my car up at Hood River on the return as you headed for the mountain. Boy, including Mt Hood would be a real bonus!
Enough rambling
Keep the Show on the Road!
0 user(s) are reading this topic
0 members, 0 guests, 0 anonymous users


text:
Will Venable homered and drove in three runs, Robbie Erlin pitched six effective innings in his return to the majors and the San Diego Padres avoided a three-game sweep with a 5-1 win over the Arizona Diamondbacks on Wednesday night.
Venable drove in the first of the Padres' two runs off Wade Miley (9-9) in the first inning and gave them a cushion with a two-run homer in the eighth. He's hitting .390 with eight homers in August and has an eight-game hitting streak.
Jesus Guzman also homered and had two RBIs for the Padres. Erlin (2-2) was sharp after being called up from Triple-A Tucson, holding the Diamondbacks to a run and six hits.
Willie Bloomquist had three hits, drove in a run and made some tough plays at shortstop in his first game off the disabled list for Arizona, which had its five-game home winning streak end.
The series finale was relatively quiet after Tuesday's wild game of lead changes, hits (26) and lineup shuffling, including a major league-record five different third basemen used by the Padres.
Erlin had a lot to do with it after being called up to take the rotation spot of Edinson Volquez, who was designated for assignment on Saturday.
The young left-hander struggled in his last appearance with the Padres, allowing four runs in four innings in a loss to Washington on July 7.
Erlin had pitched well before that, though, and was good early to start his fourth stint in the majors, working around a couple of baserunners in the third and fourth innings.
Erlin got himself into a little trouble in the sixth, when he walked Eric Chavez with two outs and gave up a single to Aaron Hill. Bloomquist, who had been out since being hit on the left hand by a pitch on July 26, followed with a single to right to cut San Diego's lead to 2-1.
Miley has been good since the start of July, going 5-1 with a 2.26 ERA in 10 starts. He wasn't particularly fortunate over his previous three starts, earning three straight no-decisions despite allowing seven earned runs in 21 innings.
Miley's tough luck continued.
He struggled early against the Padres, giving up a leadoff single to Chris Denorfia, a run-scoring double to Venable and a run-scoring single to Guzman to fall behind 2-0 in the first inning.
The left-hander worked through three baserunners in the second inning before settling into a rhythm. He allowed two runs on seven hits and walked five, but didn't get much support to lose for the first time in seven home starts.
The Padres padded their lead with the homers by Venable and Guzman off Heath Bell in the eighth inning.
NOTES: Diamondbacks 1B Paul Goldschmidt was given the night off after 47 straight starts. ... Arizona RHP Will Harris, outfielder/baserunning coordinator Joel Youngblood and Padres OF Carlos Quentin all shared a birthday on Wednesday. Quentin, on the DL since Aug. 10, will have surgery on his right knee and is done for the season. ... Arizona has Thursday off before opening a three-game series at San Francisco. RHP Randall Delgado, who will start the opener, is 3-1 with a 3.83 ERA his last seven starts. ... San Diego also has Thursday off before LHP Erick Stults faces LHP Hyun-Jin Ryu in the opener of a three-game series against the Dodgers.


text:
FiltersShow / Hide
- All Events
- Rock & Pop
- Acoustic
- Alternative
- Americana
- Indie
- Metal
- Pop
- Punk
- Rock
- Rock & Roll
- Tribute Bands
- Dance & Urban
- Ambient
- Electronic
- Experimental
- Hip-Hop
- Reggae
- Modern RnB
- Ska
- Jazz, Blues & Soul
- Big Band
- Blues
- Classic RnB
- Easy Listening
- Gospel
- Jazz
- Soul
- Swing
- Folk, Roots & World
- Celtic
- Country
- Folk
- Latin
- World
- Classical
- Brass
- Choral
- Classical
- Decades
- 50s
- 60s
- 70s
- 80s
- 90s
- Comedy
- Theatre & Arts
- Shows & Events
- Cinema
- Festivals
- All Tickets
- My Tracked Artists
- Latest Tickets
- Free Events
- Special Tickets
- Disabled Access Venues
- Festival Offers
- Anywhere In The UK
- Location: Anywhere in the UK
Radius: ... miles
Get an alert when new Machine Head dates are announced
American metal outfit packed with brutality and fearsome energy and a sound 'as raw and heavy as possible'. The live show is packed with intense power and an undeniable bond with their audience. They've released six amazing albums in a career that spans more than a decade, securing their legacy as a legendary act.
See more info at machinehead1.com
Machine Head Tour Dates
Track Machine Head
- You are tracking Machine Head
Fans of this artist also track:
- Receive email as soon as new tour dates are announced
- 1,382,365 fans now rely on Ents24 alerts
- Alerts are free and always will be!
- We never share details with 3rd parties
No current UK tour dates for Machine Head
Alert me when new Machine Head tour dates are announced...
You are tracking Machine Head.
We will email you as soon as UK tour dates are announced.
- Be the first to know about new Machine Head tour dates
- Alerts are free always will be
- We hate spam and will never share your email address with anyone else
- 1,382,365 fans now rely on Ents24 to track their favourite artists and venues
Puttour dates on your web site
- Customisable, flexible tour date widget
- Super quick set-up, get the code here
News and Announcements RSS feed
No current news or announcements.
Have Your Say
- Read the full review and 15 more
If you're thinking of going to see them prepare to get pushed around a lot! beth.brophy
Have you seen Machine Head? Write a review
Fans who like 'Machine Head' also like:
Do you represent Machine Head, or are you a member of their promotional team? Click here to claim this page


text:
SWIRLING winds and torrential rain are battering Bolton this afternoon – and the Met Office has issed a "red" warning for the North West.
The most severe warning available to the Met Office was issued ahead of anticipated gusts of up to 100mph.
Bolton Council has announced that it is in a "state of readiness" after hearing of the severe inclement weather forecast during the afternoon and evening.
A window has been blown out of the Bamboogy bar in Bradshawgate, shattering on the pavement outside.
It is not thought that anyone was hurt by the incident, although a police cordon is currently in place outside the bar.
A road sign has been uprooted in Junction Road West in Lostock, while shoppers and pedestrians in the town centre have been drenched and buffeted by the winds.
Although the worst winds are expected to hit more coastal regions, people are being advised to alter their travel arrangements.
Red weather warnings are very rare, usually occuring only once or twice a year, with the Met Office only issuing them if there is a "risk to life".
People are also being urged to be aware of the risks posed by falling trees, structural damage to property and loss of power.
Drivers on the M60 are also currently experiencing problems because of the winds.
Traffic is very slow clockwise between junction 8 at Carrington and junction 12 at the Eccles Interchange, with matrix signs set to 50mph.
There are also long delays in both directions on Barton Bridge between junction 10 and the Trafford Centre and junction 11 at Barton.
A Met Office spokesman said: "During this afternoon a swathe of exceptionally strong winds is expected to affect western parts of Wales and then some northwestern parts of England this evening.
"The public should take action to alter their travel arrangements during this spell of storm force winds."
More updates will appear here as they happen. Have you been affected by the wind? Contact us on 01204 537270 or firstname.lastname@example.com


text:
How Are Brain and Spinal Cord Tumors in Adults Diagnosed?
Brain and spinal cord tumors are usually found because of signs or symptoms a person is having. If a tumor is suspected, tests will be needed to confirm the diagnosis.
Medical history and physical exam
If signs or symptoms suggest you might have a brain or spinal cord tumor, your doctor will get a complete medical history, focusing on your symptoms and when they began. The doctor will also do a neurologic exam to check your brain and spinal cord function. It tests reflexes, muscle strength, vision, eye and mouth movement, coordination, balance, alertness, and other functions.
If the results of the exam are abnormal, your doctor may refer you to a neurologist (a doctor who specializes in medical treatment of nervous system diseases) or a neurosurgeon (a doctor who specializes in surgical treatment of nervous system diseases), who will do a more detailed neurologic exam or other tests.
Imaging tests
Your doctor may order one or more imaging tests. These tests use x-rays, strong magnets, or radioactive substances to create pictures of the brain and spinal cord. The pictures may be looked at by doctors specializing in this field (neurosurgeons, neurologists, and neuroradiologists) as well as by your primary doctor.
Magnetic resonance imaging (MRI) and computed tomography (CT) scans are used most often for brain diseases. These scans will show a brain tumor, if one is present, in almost all cases. Doctors can often also get an idea about what type of tumor it might be, based on how it looks on the scan and where it is in the brain.
Magnetic resonance imaging (MRI) scan
MRI scans are very good for looking at the brain and spinal cord and are considered the best way to look for tumors in these areas. The images they provide are usually more detailed than those from CT scans (described below). But they do not image the bones of the skull as well as CT scans and therefore may not show the effects of tumors on the skull.
MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. A contrast material called gadolinium may be injected into a vein before the scan to help see details better.
MRI scans can take a long time — often up to an hour. You may have to lie on a table that slides inside a narrow tube, which can be confining and might upset people with a fear of enclosed spaces. Newer, open MRI machines can sometimes be used instead, but they might result in less detailed images and can't be used in all cases. The machine also makes buzzing and clicking noises that you may find disturbing. Some people might need medicine to help them relax for the test.
Magnetic resonance angiography (MRA): This special form of MRI may be done to look at the blood vessels in the brain. This can be very useful before surgery to help the surgeon plan an operation.
Magnetic resonance spectroscopy (MRS): This test is like an MRI, except that it measures radio wave interactions with different chemicals in the brain. MRS highlights some features of brain tumors that are not clearly seen by MRI. It creates graph-like results called spectra (although basic images can also be created). This might give clues as to the type of tumor, but in most cases a biopsy of the tumor is still needed to get an accurate diagnosis. MRS can also be used after treatment to help determine if an area that still looks abnormal on another test is remaining tumor or if it is more likely to be scar tissue.
Magnetic resonance perfusion: For this test, also known as perfusion MRI, a contrast dye is injected quickly into a vein. A special type of MR image is then obtained to look at the amount of blood going through different parts of the brain and tumor. Tumors often have a bigger blood supply than normal areas of the brain. A faster growing tumor may need more blood.
Perfusion MRI can give doctors an idea of the best place to take a biopsy. It can also be used after treatment to help determine if an area that still looks abnormal is remaining tumor or if it is more likely to be scar tissue.
Functional MRI (fMRI): This newer type of MRI looks for tiny blood flow changes in an active part of the brain. It can be used to determine what part of the brain handles a function such as speech, thought, sensation, or movement. Doctors can use this to determine which parts of the brain to avoid when planning surgery or radiation therapy.
This test is similar to a standard MRI, except that you will be asked to do specific tasks (such as answering simple questions or moving your fingers) while the scans are being done.
Computed tomography (CT) scan
The CT scan is an x-ray test that produces detailed cross-sectional images of your brain and spinal cord (or other parts of the body). Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures as it rotates around you while you lie on a table. A computer then combines these pictures into images of slices of the body. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body.
CT scans are not used as often as MRI scans when looking at brain or spinal cord tumors, but they can be useful in some cases. They may be used if MRI is not an option (such as in people who are very overweight or people who have a fear of enclosed spaces). CT scans also show greater detail of the bone structures near the tumor.
Before the scan, you may get an injection of a contrast dye through an IV (intravenous) line. This helps better outline any tumors that are present. The contrast may cause some flushing (a feeling of warmth, especially in the face). Some people are allergic and get hives. Rarely, people have more serious reactions like trouble breathing or low blood pressure. Be sure to tell the doctor if you have any allergies or if you ever had a reaction to any contrast material used for x-rays.
A CT scanner has been described as a large donut, with a narrow table that slides in and out of the middle opening. You need to lie still on the table while the scan is being done. Some people feel a bit confined by the ring while the pictures are being taken, although it is not as narrow as an MRI tube.
CT angiography (CTA): For this test, you are injected with a contrast material through an IV line while you are in the CT scanner. The scan creates detailed images of the blood vessels in the brain, which can help doctors plan surgery. CT angiography can provide better details of the blood vessels in and around a tumor than MR angiography in some cases.
Positron emission tomography (PET) scan
For this test, a radioactive substance (usually a type of sugar known as FDG) is injected into the blood. The amount of radioactivity used is very low and passes out of the body within a day or so. Because tumor cells in the body grow quickly, they absorb larger amounts of the sugar than most other cells. After about an hour, you are moved onto a table in the PET scanner. You lie on the table for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body. The picture is not as detailed as a CT or MRI scan, but it can provide helpful information about whether abnormal areas seen on other tests (such as MRIs) are likely to be tumors or not.
This test is also useful after treatment to help determine if an area that still looks abnormal on an MRI scan is remaining tumor or if it is more likely to be scar tissue. Any remaining tumor will show up on the PET scan, while scar tissue will not.
Chest x-ray
A chest x-ray may be done to look for tumors in the lungs if a tumor is found in the brain, because in adults most tumors in the brain have actually started in another organ (most often the lung) and then spread to the brain. This test can be done in a doctor's office, in an outpatient radiology center, or in a hospital.
For this test, a special dye is injected into blood vessels near the tumor, and the area is then viewed with x-rays. This helps doctors look at the blood supply of a tumor.
This test is not done much for brain or spinal cord tumors anymore, as it has largely been replaced by other tests that can look at blood vessels, such as computerized tomographic angiography (CTA) or magnetic resonance angiography (MRA).
Rarely, an angiogram may be used as part of the treatment for certain brain tumors. It is done as a first step of a procedure called embolization, in which the radiologist injects tiny particles into the blood vessels feeding the tumor to block them and make it easier to remove the tumor.
Brain or spinal cord tumor biopsy
Imaging tests such as MRI and CT scans may show an abnormal area that is likely to be a brain or spinal cord tumor. But most often these scans can't tell exactly what type of tumor it is. This can only be done by removing some of the tumor tissue in a procedure called a biopsy. A biopsy may be done as a procedure on its own, or it may be part of surgery to treat the tumor.
Once the tissue is removed, it is looked at under a microscope by a pathologist (a doctor specializing in diagnosis of diseases by lab tests). Sometimes it might need to be looked at by a neuropathologist, a pathologist who specializes in nervous system diseases. The pathologist determines if the tumor is benign or malignant (cancerous) and exactly what type of tumor it is.
Sometimes, a tumor may look so much like an astrocytoma on an MRI scan that a biopsy is not needed, especially if the tumor is in a part of the brain that would make it hard to biopsy (such as the brain stem). In rare cases a PET scan or MR spectroscopy may give enough information so that a biopsy is not needed.
There are 2 main types of biopsies for brain tumors.
Stereotactic (needle) biopsy
This type of biopsy may be used if, based on imaging tests, the risks of surgery to remove the tumor might be too high (such as with some tumors in vital areas, those deep within the brain, or other tumors that probably can't be treated with surgery) but a sample is still needed to make a diagnosis.
The patient may be asleep (under general anesthesia) or awake during the biopsy. If the patient is awake, the neurosurgeon injects a local anesthetic into areas of skin above the skull to numb them. (The skull and brain do not feel pain.)
A rigid frame may then be attached to the head. This helps make sure the surgeon is targeting the tumor precisely. An incision (cut) is made in the scalp and a small hole is drilled in the skull. An MRI or CT scan is often used along with the frame to help the neurosurgeon guide a hollow needle into the tumor to remove small pieces of tissue.
Another approach is to get an MRI or CT, use scalp markers or facial and scalp contours to create a map of the inside of the head, and then use an image-guidance system to direct the needle into the tumor. This still requires making an incision and drilling a small hole into the skull.
The removed tissue is sent to a pathologist, who looks at it under a microscope to determine what type of tumor it is. This is very important in determining the prognosis (outlook) and the best course of treatment .
Surgical or open biopsy (craniotomy)
If imaging tests show the tumor can be treated with surgery, the neurosurgeon may not do a needle biopsy. Instead, he or she may do an operation called a craniotomy (described in the Surgery for adult brain and spinal cord tumors section) to remove all or most of the tumor. (Removing most of the tumor is known as debulking.)
Small samples of the tumor are looked at right away by the pathologist while the patient is still in the operating room, for a preliminary diagnosis. This can help guide treatment, including whether further surgery should be done at that time. A final diagnosis is made within a few days in most cases.
You can read more about the kinds of tests that are done on biopsy or tissue samples in Testing Biopsy and Cytology Specimens for Cancer.
Lumbar puncture (spinal tap)
This test is used to look for cancer cells in the cerebrospinal fluid (CSF), the liquid that surrounds the brain and spinal cord. For this test, you lay on your side on a bed or exam table with your knees up near your chest. The doctor first numbs an area in the lower part of the back near the spine. A small, hollow needle is then placed between the bones of the spine to withdraw some of the fluid.
This fluid is sent to a lab to be looked at under a microscope for cancer cells. Other tests may be done on the fluid as well.
Lumbar punctures are usually very safe, but doctors have to make sure the test does not result in a large drop in pressure in the fluid, which could possibly cause serious problems. For this reason, imaging tests such as CT or MRI scans are done first.
Lumbar punctures usually aren't done to diagnose brain tumors, but they may be done to help determine the extent of a tumor by looking for cancer cells in the CSF. They are often used if a tumor has already been diagnosed as a type that can commonly spread through the CSF, such as an ependymoma. Lumbar punctures are particularly important in people with suspected brain lymphomas because often the lymphoma cells spread into the CSF.
Blood and urine tests
These lab tests rarely are part of the actual diagnosis of brain and spinal cord tumors, but they may be done to check how well the liver, kidneys, and some other organs are working. This is especially important before any planned surgery. If you are getting chemotherapy, blood tests will be done routinely to check blood counts and to see if the treatment is affecting other parts of the body.
Last Medical Review: March 5, 2014 Last Revised: January 21, 2016
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
Early Detection, Diagnosis, and Staging
- Can Brain and Spinal Cord Tumors in Adults Be Found Early?
- Signs and Symptoms of Adult Brain and Spinal Cord Tumors
- How Are Brain and Spinal Cord Tumors in Adults Diagnosed?
- How Are Brain and Spinal Cord Tumors in Adults Staged?
- Survival Rates for Selected Adult Brain and Spinal Cord Tumors
- What Should You Ask Your Doctor About Adult Brain and Spinal Cord Tumors?


text:
As young men and women leave rural communities, the current aging population continues to dwindle and younger generations move to more populated and prosperous locations.
According to the Financial Times, "an analysis of U.S. Census Bureau data by the Department of Agriculture found that although population growth in America's rural heartland has risen and fallen for decades with changes in the U.S. economy, the pace of decline accelerated in years in 2010-12. For the first time in U.S. history, the natural increase in population — total births minus deaths were alarming to offset the catastrophic loss of those migrating away to the larger metropolitans."
Rural areas have declined for decades as cities thrived, but in certain areas the rural U.S. have seen some growth. In South Dakota, where previously people left the state due to lack of economic opportunity, some are returning because of job opportunities related to the booming oil and gas sector.
That's not the case elsewhere in the rest of the Midwest and Rust Belt states that are being hit the worst, as the young flock to economic prosperity in other regions.
In contrast to the mass exodus in many rural communities, one demographic that is taking advantage of the low cost of living associated with rural communities is Hispanics.
Losing young people in their 20's and 30's has serious ramifications for the rural heartland. Young people are more likely to be the prime candidates for childbearing, and many rural regions are seeing their birthrates decline rapidly.
Many individuals who relocate to rural communities have passed the prime childbearing time in their life, which plays into rural America aging faster than the rest of the nation due to the lack of offspring being brought up in these communities. This fuels negative economic consequences from the quick egress of old rural America.


text:
Topic: New supplemental drink might help...
In August of 2007, my husband Richard began feeling ill. It took until December 20 and five specialists to finally diagnose his condition (another long story in itself). He is now two and a half years post-Whipple surgery for stage 2a (just barely) distal cholangiocarcinoma with no lymph node involvement. His surgery by Dr. Jason Fleming at M D Anderson Cancer Center in Houston went very well, but he did develop a severely inflamed pancreas afterwards which necessitated a longer hospital stay and a second drain being inserted post-surgery. The surgery was performed January 15, 2008, and due to the complication and the toll it took on him, his reduced-level chemo and radiation therapies did not begin until the end of May. He received chemo both by IV and orally (the oral was Xeloda) and then continued Xeloda through the radiation treatments. He tolerated both very well, with only a mild case of becoming susceptible to cold temps and tingling in the tips of his fingers at the very end of the chemo. He did well throughout the radiation treatments as well, though by the end he was beginning to be tired. His last five treatments had to be delayed by the onset of Hurricane Ike when it hit the area in September 2008 and shut the hospital's non-essential services down for a few days. Therefore his last few treatments hit him harder than they normally would have, but the effect was mostly to make him extremely tired for a couple of months. He began recovering soon after that with a steady progress and gradual weight gain. By August 2009 he had gained 10 lbs. back of the 85 he had lost since the onset of the disease two years earlier. He had been overweight, and didn't want to gain all of it back, but he finally looked healthy again. Then he developed a pseudo-cyst on what is left of his pancreas, which caused some bleeding and pressing on his stomach. He had to have two units of blood transfused over Labor Day weekend and lost his appetite for about a month, making him lose the weight he had gained. The pseudo-cyst was surrounded by swollen blood vessels and could not be drained. We had to wait and let his body take care of it by itself. It took a few months, but it did; however, he has had trouble putting on any weight since then. He has struggled just to gain even one pound. Twice since then, we have also had to deal with a pocket of infected fluids collecting at the site of the scar on his pancreas left by the pseudo-cyst. Each of these episodes has also destroyed his appetite, though it has returned.
I relate this chronology of events in order for you survivors and co-survivors to have an understanding of where we are. While we don't feel we have to deal with the cancer again (statistically, as I'm sure you are all aware of, if it doesn't come back in two years, it probably won't again), the aftereffects of the Whipple surgery itself are another matter. Richard is not one of those people that has problems with dairy post-surgery, but he has not been able to tolerate Ensure or Boost supplemental drinks. He has not been able to handle much fat at all in his diet, so it's been a struggle to find nutrition-rich, low-fat foods that he likes and can eat. He does take replacement enzymes. He is back at work, and unable to eat several meals during the day as most sites recommend. So you can imagine that he has some symptoms of malabsorbtion, bordering on malnutrition, even with taking vitamin supplements. These episodes of infection affecting his appetite have only aggravated the issue. Luckily, the surgeon told us last week of a new supplemental drink called Enlive! that has just come out. It is fortified like Ensure or Boost, but is based in fruit juice instead of milk, and is more easily tolerated. Think extra-fortified Gatorade in apple and berry flavors. It isn't available here at any stores, but the company that makes it (Abbot Laboratories) ships. We just got our shipment yesterday, and my husband has found that he actually LIKES it!! That's good, considering the surgeon told him he has to look at it like medicine and down two a day for the foreseeable future!
I know that two days isn't much to base anything on, but believe me when I say that it's more encouraging than anything else we've tried. I just wanted to let others who are struggling like we are know about the product so that it might help.


text:
On-Air Challenge: You'll be given a series of categories. For each one, name something in the category beginning with each of the letters of the word "robin." For example, given the category "two-syllable boys' names," the answers could be "Roger," "Omar," "Barry," "Isaac" and "Neville."
Last Week's Challenge: Name the capital of a country that, when said out loud, sounds like a three-word phrase. This phrase might describe the reason why the police did not catch a barefoot thief. What is the capital, and what is the reason?
Answer: The capital is Port-au-Prince, and the reason is "poor toe prints."
Winner: Jeanne Grace of Fairport, N.Y.
Next Week's Challenge from listener Gary Witkin of Newark, Del.: Using only the six letters of the name "Bronte," repeating them as often as necessary, spell a familiar six-word phrase. What is it?
If you know the answer to next week's challenge, submit it here. Listeners who submit correct answers win a chance to play the on-air puzzle. Important: Include a phone number where we can reach you Thursday at 3 p.m. Eastern.
This is WEEKEND EDITION from NPR News. I'm Rachel Martin. Get those synapses firing, folks, because it is time for the puzzle.
MARTIN: Let's start with last week's challenge from the puzzle editor of the New York Times and WEEKEND EDITION's puzzle master Will Shortz.
WILL SHORTZ, BYLINE: Name the capital of a country that, when said out loud, sounds like a three-word phrase. And this phrase might describe the reason why the police did not catch a barefoot thief. What is the capital and what is the reason?
MARTIN: Well, about 420 of you figured out the answer. And our randomly selected winner this week is Jeanne Grace of Fairport, New York. Congratulations, Jeanne.
JEANNE GRACE: Thank you, Rachel.
MARTIN: OK. So, what was the answer to last week's challenge?
GRACE: The answer was Port-au-Prince, Haiti, which can also be pronounced Porto Prince.
MARTIN: Nicely done. This was a hard puzzle. I mean, how long did this take you to figure out?
GRACE: I was still working on it till Thursday morning. I was running all the three-syllable capitals I could think of and not getting anywhere. And then my husband reminded me it was a barefoot person. And so I started looking for anything with a toe, and that got me to where I needed to be.
MARTIN: So, a little shout-out to your husband for his helpful hints.
GRACE: Yes, indeed.
MARTIN: And what do you do in Fairport?
GRACE: I am a retired as a professor in a school of nursing.
MARTIN: And now have a little more time for puzzles, I imagine.
GRACE: I always managed even when I was working full-time.
MARTIN: Good for you. OK. Before we continue, let's welcome the puzzle editor of The New York Times and WEEKEND EDITION's puzzle master Will Shortz. Good morning, Will.
SHORTZ: Good morning, Rachel. And congratulations, Jeanne. That was a tough one.
GRACE: Thank you. And good morning, Will.
SHORTZ: And a lot of people were working on Mogadishu, because that ends in the syllable shoe. But you were right. You concentrated on the toe.
MARTIN: So, OK. What do you have in store for us today, Will? More world capital puns?
SHORTZ: Something different we haven't done in a while. It's a game of categories. It's based on the word robin, as in the spring bird. I'm going to give you a series of categories. For each one, name something in the category beginning with each of the letters R-O-B-I and N. For example, if the category were two-syllable boy's names, you might say Roger, Omar, Barry, Isaac and Neville.
MARTIN: Wow.
GRACE: Well, I think we can do this, Rachel.
MARTIN: Really? You're positive? OK. I like your attitude, Jeanne, I like your attitude. Let's try it, Will. Take it away.
SHORTZ: All right. Your first category is chemical elements.
GRACE: Chemical elements. Well, we get radium, boron, iodine, nitrogen and oxygen.
SHORTZ: Oxygen. So fast. Nice job.
MARTIN: Jeanne, you don't even need me. Are you kidding?
GRACE: Oh, yes, I will.
SHORTZ: Your second category is islands.
GRACE: Islands. Bahamas, Oahu, Nihau, which is...
SHORTZ: Nihau, really?
GRACE: ...the island off Kauai. That's the forbidden island in Hawaii.
SHORTZ: OK. Also New Guinea, Newfoundland would have worked.
SHORTZ: All you need R and I.
GRACE: R and I. Well, there's Rhode Island but it's not really an island.
SHORTZ: Yeah, I won't count that one.
MARTIN: Yeah.
GRACE: OK. Rarotonga.
SHORTZ: OK. Well, you're impressing me here. My answers were Rhodes, the Isle of Rhodes and Reunion or Reunion, however that's pronounced. In Polynesia.
GRACE: We still have an I to go, Rachel.
MARTIN: OK. All right. I...
MARTIN: I suppose Indonesia doesn't count 'cause...
GRACE: Iceland.
SHORTZ: Iceland does it. Ireland and Ios would have worked. All right. Nice job. Your next category is Major League Baseball team names.
GRACE: Oh, dear. Well, let's try Red Sox, Orioles. Rachel, I'm going to need some help here.
MARTIN: Are the Brewers are baseball team.
SHORTZ: Brewers, yes. Also, the Braves and Blue Jays.
GRACE: And then the Indians. And the Nationals.
SHORTZ: Nationals, so good. And your last category is things you might see in a hospital.
GRACE: In a hospital. OK. Operating rooms should be O. Neonatal intensive care units would give us the N. The I is going to be intensive care units.
SHORTZ: All right. You could have said nurse for N. OK. And you need R and B again.
GRACE: I need R and B. Respirators.
SHORTZ: And the B is the easiest one. Where do...
GRACE: Beds.
SHORTZ: The beds, yes.
MARTIN: The beds. Wow, great job, Jeanne. Really. That was extraordinary. For playing our puzzle today, you'll get a WEEKEND EDITION lapel pin as well as puzzle books and games. And you can read all about it at NPR.org/Puzzle. And, Jeanne, before we let you go, tell us what public radio station you listen to.
GRACE: We are members of both WXXI in Rochester and WRVO, which is Watertown-Oswego-Syracuse and points a bit to the east.
MARTIN: Great, double membership. Love to hear. Jeanne Grace of Fairport, New York. Thanks so much for playing the puzzle this week, Jeanne.
GRACE: Now, it was fun.
MARTIN: OK, Will, what do you have for us next week?
SHORTZ: Yes, the challenge comes from listener Gary Witkin of Newark, Delaware. Take the name Bronte, B-R-O-N-T-E, using only these six letters, repeating them as often as necessary, spell a familiar six-word phrase. What is it?
So again, the name Bronte, use only these six letters but repeat them as often as necessary, spell a familiar six-word phrase. What is it?
MARTIN: OK, When you have the answer, go to our website, npr.org/puzzle and click on the Submit Your Answer link - just one entry per person, please. And our deadline for entries is Thursday, May 10th at 3 P.M. Eastern Time. Please include a phone number where we can reach you at about that time. And if you are the winner we'll give you a call, and you'll get to play on the air with the puzzle editor of The New York Times and WEEKEND EDITION's puzzle-master, Will Shortz.
Thanks, Will.
SHORTZ: Thanks, Rachel.
MARTIN: Author Julia Alvarez has been straddling two worlds for a long time. She was born in New York City but raised in the Dominican Republic. And that personal experience, being of two places, has shaped much of her writing. A couple of her most celebrated works of fiction are "How the Garcia Girls Lost Their Accents" and "In the Time of the Butterflies." Both stories address issues of belonging and cultural identity.
Her newest book though is a memoir. It's called "A Wedding in Haiti." And again, Alvarez writes about place and culture, but this time she's the outsider looking in; trying to make sense of a country so close to her but so foreign.
Author Julia Alvarez joins us from Middlebury College in Middlebury, Vermont.
Ms. Alvarez, thanks so much for being with us.
JULIA ALVAREZ: Thank you for inviting me.
MARTIN: So, this story begins with a promise that you and your husband made to a young Haitian man named Piti. Describe that promise.
ALVAREZ: Well, he was a young boy, as many Haitians come across the border undocumented to work in the Dominican Republic. And he showed up at this farm project that my husband Bill and I have in the Dominican Republic. And he looked so young and I felt like, oh, my gosh, he should be with his mother. So I declared myself his distant mother.
And so, you know, we would go down to Alta Gracia - that's the name of the farm project. And nights after supper we would sit around and sing and talk. And one night, he just seemed so forlorn and sad, you know, just a boy far from home. And so, to cheer him up, I told him that I could see that in his future he would meet the love of his life and get married. And he just kind of giggled.
And I said no. No. No, no, no. You have to believe me, Piti. One day you're going to get married to this love of your life. And you know what? I'm going to be at the wedding and I'm the godmother. OK, fast forward eight years later. We get a call in Vermont. Piti is getting married - are we coming to the wedding? So we decided we made a promise, we're going to keep it.
MARTIN: We should note that this trip you made was before the devastating earthquake in Haiti in January 2010. You made this trip in 2009.
ALVAREZ: Originally, I didn't set out to write a book about this journey. But when the earthquake happened, I took out the journal as a way of being close to a Haiti that wasn't being shown on the news. The richest, warmest culture; lots of solidarity, lots of community hanging in there together, which are things that they're rich in, and that maybe we have lost.
But I needed one story, one little point of light. And so, in reading the journal was when I said, well, maybe there's a story to tell here.
MARTIN: I want to ask you about the earthquake in a moment. But first, you and your husband attend the wedding. But your return journey takes a little bit of a twist when Piti asks you if you will take him and his new wife and baby out of Haiti into the Dominican Republic. He has papers. They don't. Did you consider saying no? You knew this was going to be risky.
ALVAREZ: He didn't ask if he could go back with us. He just said he was.
MARTIN: So, after a lot of wrangling and negotiating you managed to get Piti and his family back into the Dominican Republic. Time passes. When the earthquake happened, where were you?
ALVAREZ: I was in Vermont, and when I turned on the news, I realized it was really bad. And it was overwhelming, overwhelming. So that very evening, I called Piti and...
MARTIN: We should say he was living in the Dominican Republic.
ALVAREZ: Oh, he was living in the Dominican Republic, yes, with Eseline, his wife and his little girl, Ludy. And they couldn't reach family. They didn't know what had happened. Basically, they needed to go back and see that their families were all right.
MARTIN: You decide that you need to take them. Why?
ALVAREZ: So I guess - I don't know. They're like our kids now. You're not going to put your kid on the back of a pickup with a baby.
ALVAREZ: You're going to go. So it just felt like something we would do in solidarity. We weren't in Port-au-Prince. We weren't volunteering at a hospital. But maybe we could just be with one young Haitian and his wife and kid and their family. It was I guess - I don't know. These movements of the heart, how do you explain them?
MARTIN: If you wanted to focus on Haiti as a country, why not address it in ways that you have other issues in your writing? Why put yourself in it? Why make it this memoir?
ALVAREZ: Why tell it this way? I'm just following this friendship. It's the story of a friendship. And it's just one friendship. Haiti is a big country, it has many problems, there's a lot of people there. But, you know, there's a wonderful haiku that I love by the Japanese poet Issa, and he says: I look in the dragonfly's eye and I see the mountains over my shoulder.
That sometimes through the lens of one little story, one friendship, you really can talk about the bigger problems. The story finds the form that best fits it.
MARTIN: Author Julia Alvarez, her new memoir is called "A Wedding in Haiti." She spoke with us from the studios at Middlebury College in Middlebury, Vermont.
Julia, thanks so much.
ALVAREZ: Thank you for having me.
MARTIN: The people of Okemah, Oklahoma, the birthplace of Woody Guthrie, have another musical native son to call their own. His name is John Fullbright.
JOHN FULLBRIGHT: (Singing) Six long days, seven day he rest. It's said there's one sure way humans can be best to give them wine and song, fire and lust. When it all goes wrong, I'm the man to trust. And now...
MARTIN: He's all of 24 years old but he sounds like an old soul, making music with hints of folk, country and the blues. I spoke with John Fullbright recently about his debut studio album. It's called "From the Ground Up." You're listening to the album's first track, "Gawd Above." And on it, Fulbright sings from God's perspective, which he admits is pretty, well...
FULLBRIGHT: Bold.
MARTIN: Bold is the right word, I would say.
FULLBRIGHT: Yeah, it was an interesting song to write. I wanted there to be kind of a sense of humor, you know, it was God with a gold tooth in his smile. You know?
FULLBRIGHT: (Singing) ...swinger's ball if you don't know my name, oh well. You think it's hot down there in July. I've got the means and a kitchen to fry. And then you all...
MARTIN: There are a number of tracks on this album with Biblical references in the song title or the lyrics. Did you grow up in a particularly religious household?
FULLBRIGHT: Yeah, I did. I grew up with a lot of questions that couldn't really seem to be answered. You know, why we're here? Did some higher power make all of this? Did he make me? And songwriting is kind of your own voice, your strongest voice, that you can use to ask yourself those questions.
MARTIN: You were born and raised in Okemah, Oklahoma. What's it like there?
FULLBRIGHT: I actually live in kind of an outskirt of Okemah in a little town called Bearden. But I went to school in Okemah. And Bearden is too small to have a post office. All my letters say Okemah, so it's just easier...
FULLBRIGHT: ...to say that. But it's a very, very small place. And it seems I think is when dad's side kind of settled there and had a little farm, about 80 acres. That's where I live now. The little farmhouse that I was raised in until I was about nine, that's where the title came from, "From the Ground Up." It was - every song on this record was written in that house. And I was also kind of written in that house.
FULLBRIGHT: (Singing) I've got diamonds in my backyard. Well, they grow just like weeds. You'll come and gather them in bundles. Take all that you need. But save the flowers there for me, dear. Take the diamonds for your greed, 'cause the flowers don't grow like weeds...
MARTIN: So, you're just 24 and I'm sure you've heard this before. But you do sing with this kind of depth that would appear to come from someone who has a few more years under their belt; someone who's kind of lived through a lot of setbacks and heartbreak. Is that you, have you gone through a lot of that?
FULLBRIGHT: Well, you know, I don't have many friends.
FULLBRIGHT: No, it's - it comes from locking yourself in a room and thinking about things for a really long time.
FULLBRIGHT: But I don't know...
MARTIN: Is that what you do? You lock yourself in a room and just kind of sit for a while?
FULLBRIGHT: I did that. In my teen years I definitely did that. I locked myself in a room and played the guitar and really just brooded about it for...
FULLBRIGHT: ...for a really long time. I've been a piano player since I was a child, 5 and 6. And I can remember sitting at a piano and just of figuring out that a minor chord means sad and an upbeat song means happy.
FULLBRIGHT: And, you know, you can explain it all without having to really say anything.
FULLBRIGHT: (Singing) Memory is a river. It winds and it changes. It cries when it's happy. It smiles when it's blue...
MARTIN: John Fullbright, his debut album is called "From the Ground Up." He joined us from member station KUT in Austin, Texas.
John, thanks so much for talking with us.
FULLBRIGHT: It was a pleasure talking to you, Rachel. Thank you.
FULLBRIGHT: (Singing) One, two, three...
MARTIN: And you can hear more of John Fullbright's music on npr.org.
This is WEEKEND EDITION from NPR News. I'm Rachel Martin. Transcript provided by NPR, Copyright National Public Radio.


text:
EL SEGUNDO -- Time passed in the last 48 hours. Lakers general manager Mitch Kupchak listened, asked questions and provided feedback.
On and on the process went in the Lakers' exit interviews in which players such as Kobe Bryant, Dwight Howard and Pau Gasol analyzed the 2012-13 season. That once-hyped campaign ended in a tireless list of injuries and a first-round sweep at the hands of the San Antonio Spurs.
So Kupchak's work to restore the Lakers to championship greatness again has just begun.
"When you lose, everything is in play," Kupchak said Tuesday at the Lakers' practice facility in El Segundo.
Lakers reflect on the '12-13 season: PAINTER: No easy solutions for aging, ailing Lakers | Bonsignore on Dwight Howard | Painter on Pau Gasol | Medina on Kobe Bryant | Painter on Mike D'Antoni | Medina on Mitch Kupchak | Inside the Lakers blog | Photos: Lakers season highs and lows | Exit interview photos
Once July 1 hits, the Lakers' most pressing item on the agenda involves Dwight Howard.
He would earn $117.9 million with a five-year deal if he signs with the Lakers. He would receive $87.9 million over four years if he goes elsewhere.
""I want to do what's best for myself to make me happy," Howard said. "I want to get away from everything and focus on me and make the best decision for me.
"That's not happening today."
Kobe Bryant said, "it's very important" Howard returns to the Lakers. Bryant even plans to talk to him at his Newport Beach residence to convince him.
"Los Angeles is the perfect spot for him to assert himself, to put his foot down and have his career really take off," Bryant said. "There's no greater place for centers to play than here in Los Angeles."
Kupchak paused for seven seconds before offering "it's hard for me to say" on Howard's intentions. Kupchak later said he felt "hopeful" and "optimistic" Howard will stay.
"We didn't spend a lot of time saying what the city doesn't have to offer or what the organization doesn't have to offer," Kupchak said. "He does like living here. That's why I'm optimistic.
"If there's something we're lacking, I don't know what it is."
Kupchak said he will stay patient with Howard.
"If he says he needs some time, then we'll give him some time." Kupchak said. "But the sooner the better for everyone."
The Lakers have uncertainties beyond Howard. Will the Lakers keep Pau Gasol?
"Everybody is in play whether it's Pau or anybody else," Kupchak said.
"We'll look for ways to improve the team."
Kupchak said it's "in play" for the Lakers keeping Howard and Gasol.
Bryant said he vouched for Gasol to Kupchak and argued "we need him to get to where we need to go." Bryant and Gasol teamed for two NBA championships in 2009 and 2010.
Gasol said Kupchak offered him no assurances.
"I prefer to stay, but I'm prepared if I'm not," Gasol said. "I feel like I belong to the Lakers."
The Lakers boast a $100 million payroll and an extra $30 million in luxury taxes. The Lakers would owe another $85 million with the same budget next season because of a tax increase stemming from the NBA's labor deal outlined in 2011.
Between July 10-16, the Lakers could use the amnesty provision on one of four candidates, including Bryant, ($30.5 million), Gasol ($19.3 million), Metta World Peace ($7.7 million) or Steve Blake ($4 million).
"Can I refer this to Mark Cuban?" Kupchak joked. "He's our amnesty expert."
The Dallas Mavericks owner suggested the Lakers use the amnesty provision on Bryant. The Lakers won't do that because of his obvious skill set and the public relations. Using it on Blake wouldn't yield the Lakers many savings.
But the Lakers could waive Gasol or let World Peace go if he exercises his $7.7 million player option.
"I'm still trying to get over the Cookie Monster thing," Kupchak said, laughing at World Peace's attire during his exit meeting. "I liked the shirt."
Kupchak only sounded certain on Lakers coach Mike D'Antoni staying. He has two guaranteed years worth $8 million left on his contract.
"Mike was flexible and listened to the players, maybe too flexible at times," Kupchak said. "He worked with the veteran's and they figured it out.
Still, Kupchak has a busy offseason littered with uncertainties. Bryant advocated the Lakers acquire players who have "length, speed and athleticism." D'Antoni openly wished for more "rangy, perimeter players."
Such variables hinge on Howard's future.
"This a place where I think he should be," Kupchak said. "We have a great legacy and great history of great players in this city. He certainly fits the mold.
"But I don't want to get ahead of the game and take anything for granted."