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Horner, Patricka,b; Blee, Karlab; Adams, Elisabetha,c
aSchool of Social and Community Medicine, University of Bristol, UK
bBristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Tower Hill, Bristol
cAquarius Population Health, London, UK
Correspondence to Dr Patrick Horner, School of Social and Community Medicine, University of Bristol, 39 Whatley Rd, Bristol BS8 2PS, UK. Tel: +44 117 928 7387; e-mail: email@example.com
Purpose of review: Mycoplasma genitalium is a sexually transmitted infection that causes significant morbidity in men and women and is a co-factor in HIV transmission. However, commercial diagnostic tests are not generally available for M. genitalium and sub-optimal treatment is often given. We review the literature on the burden of infection, how it may present in clinical practice and the effectiveness of current treatment regimens.
Recent findings: In-vivo and in-vitro data strongly suggest that M. genitalium is an important cause of urethritis, cervicitis, pelvic inflammatory disease and potentially asymptomatic proctitis. Studies now consistently demonstrate suboptimal eradication rates with the current treatment regimens recommended first line for the treatment of nongonococcal urethritis. Concurrently, there has been a rapid emergence of antibiotic resistance in M. genitalium, with macrolide resistance now appearing to be endemic in some centres, and quinolone resistance is beginning to emerge.
Summary: In the absence of specific M. genitalium diagnostic and antimicrobial resistance testing, azithromycin 1 g should not be used for the management of patients with symptomatic disease potentially caused by M. genitalium. This review offers an alternative evidence-based approach to managing such patients that should, theoretically, reduce the risk of the development of antimicrobial resistance.
Mycoplasma genitalium is an important sexually transmitted pathogen [1–3]. It is a common cause of nongonococcal urethritis (NGU) in men and cervicitis in women. It is associated with pelvic inflammatory disease (PID) and is probably causal, and potentially causes asymptomatic proctitis, although the latter is currently based only on biological plausibility (see below) [1–3,4▪▪,5▪▪]. Studies now consistently demonstrate suboptimal eradication rates with current treatment regimens of either azithromycin 1 g or doxycycline 100 mg twice daily for 7 days, with the concurrent apparently rapid emergence of antibiotic resistance in some centres (see below) [1–3,6▪▪–8▪▪,9,10,11▪▪,12,13▪▪,14,15▪]. As clinicians we remain blind to the problem, as the majority of the major commercial companies producing diagnostic bacterial sexually transmitted infection (STI) nucleic acid amplification tests (NAATs) do not currently have commercially available NAATs for M. genitalium. Two recently reported randomized controlled trials (RCTs), which began enrolling in 2006 and 2007, have demonstrated the inadequacy of current treatment regimens for M. genitalium. However, there are currently no registered RCTs to investigate the effectiveness of regimens that may be more effective (www.controlled-rials.com) [14,15▪]. Designing such trials to inform clinical practice will be complex as macrolide resistance appears to be increasing globally, with some centres having 20% or more prevalence, and quinolone resistance is beginning to emerge [1,8▪▪,9,10,11▪▪,12,13▪▪]. In addition, we have limited capability for routine diagnostic testing let alone routine antimicrobial resistance testing, which a number of experts now consider essential in order to inform local antimicrobial decision making [6▪▪,9,10,11▪▪,12,13▪▪,16]. By the time a new trial is conducted and reported, it may then be too late to implement the findings internationally given the apparent ability of M. genitalium to rapidly develop antimicrobial resistance. This happens probably as a result of the continued use of suboptimal regimens, which provide selective pressure for the emergence of resistant mutants [6▪▪,8▪▪,11▪▪,13▪▪,17,18]. In the last 2 years, various experts have called for commercially available M. genitalium NAATs, monitoring of M. genitalium antimicrobial resistance and for new antibiotic regimens, including RCTs, as they recognize the importance of antibiotic stewardship to monitor and limit the spread of infection [1–3,6▪▪,7▪▪,11▪▪,13▪▪]. In the absence of evidence from effective RCTs, we set out an alternative evidence-based approach to managing patients at increased risk for M. genitalium infection.
The epidemiology of M. genitalium has many of the features of a bacterial STI. It is more commonly detected in sexual partners of people with M. genitalium and tends to be associated with younger age groups [1,5▪▪,19–22]. People with multiple partners are at increased risk for testing M. genitalium-positive, and black ethnicity has also been associated with an increased risk, although in Europe this association is not as strong [19–24]. Community-based studies indicate that M. genitalium is present in about 2% (range 0.7–3.3%) of women in the general population under 30 years in developed nations and may be less common in men [5▪▪,19–22]. In men and women attending sexual health departments, the prevalence is between 3 and 13% [2,3,6▪▪,9,14,23,24]. Recent evidence suggests it may be more common in men who have sex with men (MSM), particularly if they are HIV-positive, than in heterosexual men with an overall prevalence rate of 2–11% [25,26,27▪,28,29▪▪]. This is probably because rectal infection with M. genitalium, which is probably sexually acquired, is detected more frequently than urethral infection in this group [25,26,27▪,28,30▪].
In asymptomatic individuals in the general population, about 2–5% of Chlamydia trachomatis-positive people are infected with M. genitalium[19–22]. Co-infection is more common in symptomatic disease [14,15▪,23,24].
A recent in-vitro study, using endocervical cell lines, demonstrated that M. gentialium can establish chronic infection [4▪▪]. At low loads, a cytopathic effect was not observed in the chronically infected cell lines but did result in the production of pro-inflammatory cytokines, which predominantly consisted of potent chemotactic and/or activating factors for phagocytes, including interleukin-8, monocyte chemotactic protein 1 and macrophage inflammatory protein 1. There was also evidence that these chronically infected cells may be more hyperresponsive to exogenous innate immune stimulation by other STIs and bacterial vaginosis. Infection is probably both intracellular and extracellular, and replication, although slow, eventually results after a number of weeks in a sufficient organism load to exert a cytopathic effect. This is consistent with clinical observations that higher loads are observed in men with symptomatic urethritis and that the incubation period before the development of disease may be longer than for C. trachomatis, which has a much shorter replication cycle of 48 h [1,24,31].
The M. genitalium adhesion genes have the ability to undergo reciprocal recombination with a family of repetitive DNA elements within the genome, which contributes to the heterogeneity of these proteins. The resulting antigenic variation probably contributes to immune evasion and the ability of M. genitalium to establish chronic infection in vivo[1]. Mycoplasmas also have a high mutation rate that is likely to rapidly generate mutants [11▪▪,18]. High-level macrolide (azithromycin) resistance is mediated by an A-to-G substitution in A2059 and A2058 residues in region V 23S of the rRNA gene [1,6▪▪,11▪▪,13▪▪]. Single mutations in the GyrA and ParC of the DNA gyrase, which are critical target sites for the fluoroquinolones, confer antimicrobial resistance to fluoroquinolones [11▪▪].
Ison [17] expressed concern about the continual use of a single agent as a first-line therapy for an infection, as it provides selective pressure for the emergence of resistant mutants. M. genitalium, a slow replicating infection both intracellularly and extracellularly, with a high mutation rate, is likely to be at increased risk of this occurring when azithromycin is administered as a single dose, which has a much longer intracellular half-life than extracellular half-life [1,4▪▪,17,18,32]. There is emerging evidence, which needs to be confirmed, that development of resistance following use of azithromycin 1 g may be more likely in individuals with higher loads who are also more likely to be symptomatic [1,4▪▪,33].
The majority of women infected with M. genitalium are probably asymptomatic. Taylor-Robinson and Jensen [1], Manhart et al.[2] and McGowin and Anderson-Smits [3] recently reviewed the association of M. genitalium with disease, concluding that it is associated with cervicitis particularly if diagnosed using a Gram-stained cervical smear, PID and probably urethritis and infertility. However, they were not unanimous in concluding that the association was causal and generally felt additional evidence was needed both in vivo and in vitro before one could conclude this [1–3]. Since then, further evidence has emerged both in vivo and in vitro[4▪▪,5▪▪,34]. A significant association with PID was observed by Bjartling et al. [5▪▪] in a case–control study, although only 4.9% of cases were infected. More recently Weisenfield et al.[34] observed prevalence of 22% in women with acute PID. A possible explanation is that M. genitalium may cause PID with milder symptoms than C. trachomatis and is underrepresented in women with severe symptoms requiring laparoscopy [5▪▪,35]. This would be consistent with the recent in-vitro data as reviewed previously [4▪▪].
Thus, young women, at risk for an STI, with a vaginal discharge, post-coital bleeding and/or abdominal pain are potentially at increased risk for M. genitalium infection. Those with cervicitis and/or PID detected on examination have about a 4–25% chance of being infected [3,5▪▪,34].
The majority of men infected with M. genitalium are probably asymptomatic. Taylor-Robinson and Jensen [1] and Manhart et al. [2] recently reviewed the association of M. genitalium with disease, concluding that it causes acute and chronic NGU and that it is associated with balanoposthitis and possibly chronic prostatitis and epididymitis. There is no association between rectal symptoms and the presence or absence of M. genitalium and we are not aware of any studies investigating whether it can cause proctitis [1,25,26], although this would seem biologically highly likely given the recent observations of McGowin et al. [4▪▪].
Thus, male patients with symptoms of a urethral discharge and/or dysuria are at increased risk for having M. genitalium infection. This risk increases further (9–31%) if urethritis is detected on a Gram-stained urethral smear [1,2,36]. Although men with symptoms of balanoposthitis and epididymoorchitis are also probably at increased risk, this probably is dependent on the presence of urethritis [1,37].
There is good biological plausibility that M. genitalium can promote the acquisition and transmission of HIV [1,38,39▪▪]. The production of pro-inflammatory cytokines by infected cells will increase the presence and activation of HIV-susceptible cells, and HIV-infected women with high burden of M. genitalium infection are more likely to shed HIV DNA that those who are M. genitalium-negative [1,39▪▪]. Mavedzenge et al. [39▪▪] in a longitudinal study recently reported a two-fold increased risk of HIV-1 acquisition among Zimbabwean and Ugandan women who were infected with M. genitalium, and attributes approximately 9% of HIV-1 acquisitions to infection with this micro-organism. This is supported by previous studies demonstrating an association of M. genitalium with HIV infection [38,40]. Before a screening and treatment programme can be introduced as part of an HIV prevention strategy in sub-Saharan Africa, Manhart [38] suggested that there needs to be an accessible and accurate diagnostic test and an accessible and effective treatment regimen. Given the association of M. genitalium with rectal infection in MSM and the biological plausibility that this will cause proctitis (see above), it would seem highly likely that M. genitalium will be a co-factor for HIV transmission in MSM, although this has not been established using a longitudinal prospective cohort study [39▪▪].
Molecular diagnostic testing for M. genitalium using a NAAT that is approved for commercial use is not currently available from most of the major diagnostic companies. As a result, M. genitalium is not tested routinely in clinical practice. However, commercial tests with good performance are beginning to become available [41,42].
Asymptomatic infection is not diagnosed in the majority of cases, as it is not tested for and symptomatic infection can be caused by several different infections, one of which is M. genitalium. Patients with symptoms and signs of NGU and PID are managed syndromically, without waiting for the results of microbiological diagnostic test results for C. trachomatis and Neisseria gonorrhoeae. The current treatment regimens for these conditions continue to focus on effective treatment for C. trachomatis, and when clinically indicated N. gonorrhoeae; however, such regimens often have poor efficacy against M. genitalium[2,43,44]. The diagnosis of cervicitis is problematic, as there are a number of essentially subjective criteria including the presence of a mucopurulent discharge and/or contact bleeding on examination and ≥30 polymorphonuclear leucocytes per high-power field on Gram stain [1,2]. Consequently, although some clinicians will treat cervicitis without waiting for results of C. trachomatis and N. gonorrhoeae, most do not, and therefore without a readily available diagnostic test women will remain untreated for M. genitalium[43,45].
The commonly used treatment regimens are given in Table 1. Studies indicate that doxycycline 100 mg twice daily for 7 days is inferior to azithromycin 1 g as a single dose with microbiological failure rates of 55–83% compared with 12–33%, although more recently microbiological failure rates of single-dose azithromycin have been reported as high as 60% [1,2,6▪▪,9,15▪,46▪]. The increasing failure rate of azithromycin is the result of preexisting, probably endemic (13–100%), macrolide resistance in the population being treated [6▪▪–8▪▪,10,11▪▪,12,13▪▪]. A recent study by Twin et al.[13▪▪] suggests that ∼50% of those who fail treatment with azithromycin 1 g may develop macrolide resistance, which is sexually transmissible [1,13▪▪,30▪]. Although it remains unproven, there is concern that the frequent use of azithromycin 1 g is the cause of the rapid emergence of macrolide resistance over the past 10 years [6▪▪–8▪▪,11▪▪,13▪▪]. An extended regimen of azithromycin 500 mg then 250 mg on 4 days is more than 95% effective, unless macrolide resistance is present, which is believed to be the reason for the reduced treatment efficacy in the study by Jernberg et al.[6▪▪,47]. A 5-day regimen is biologically more sensible than a single dose, as M. genitalium is a slow growing intracellular and extracellular micro-organism. An added advantage of this regimen is that it does not appear to induce macrolide resistance [6▪▪]. There is currently no evidence that doxycycline treatment failure is associated with the development of tetracycline resistance [12].
Ofloxacin 200 mg twice daily for 10 days is suboptimal for treatment, with it being associated with more than 50% failure rate in one study, which is consistent with data from in-vitro antimicrobial susceptibility testing [1,47]. It is possible that some of those who fail develop quinolone resistance, as this is an emerging problem [9,10,11▪▪,16]. Moxifloxacin has high in-vitro activity against M. genitalium and has more than 95% effectiveness in treatment studies [1,2]. One recent study suggests that 400 mg for 14 days may be more effective than a 7-day course [48▪]. However, oral moxifloxacin should be used with caution and reserved for treatment failures because of rare but very serious adverse hepatic reactions [6▪▪].
The recommended regimen for PID in the UK is doxycycline 100 mg twice daily for 14 days with a third-generation cephalosporin plus metronidazole to cover N. gonorrhoeae and anaerobes, respectively, or ofloxacin 400 mg twice daily for 14 days plus metronidazole if at low risk of N. gonorrhoeae[44]. The doxycycline regimen is probably associated with more than 40% failure rate for M. genitalium-positive women, but no data are available for failure rate with ofloxacin [2]. An alternative treatment regimen for PID is a third-generation cephalosporin followed by azithromycin 1 g/week for 2 weeks [43,44]. Given the pharmacokinetic and pharmacodynamic properties of azithromycin and the ability of M. genitalium to replicate extracellularly (see above), the possibility of treatment failure with the development of antimicrobial resistance is, in our opinion, a reasonable concern [32]. Indeed in the original trial, of seven M. genitalium-positive patients, one failed therapy and she was in the azithromycin treatment arm [49]. In the southwest of England, azithromycin 1 g then 500 mg once daily for 4 days can be substituted for doxycycline in women at risk for pregnancy (http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947353557). Although this regimen has not been formally evaluated in a clinical trial, experience in clinical practice has been positive and it should be effective against both Chlamydia and M. genitalium[6▪▪,31,50].
There is a high concordance of M. genitalium infection between sexual partners indicating that partner notification and treatment are required to prevent reinfection and onward transmission [1,3]. Angarius et al.[6▪▪] observed that female M. genitalium-positive patients, often identified through partner notification, had more than 90% response to azithromycin 1 g, with a prolonged course of azithromycin eradicating M. genitalium in 100%. However, Twin et al.[13▪▪] observed that azithromycin 1 g in women was also associated with treatment failure and the development of macrolide resistance.
Treatment of symptomatic, uncomplicated disease and epidemiological treatment of their partner(s) with azithromycin 1 g should be discontinued. Urgent consideration should be given to using doxycycline 100 mg twice daily for 7 days instead of single-dose azithromycin for the treatment of NGU in men and cervicitis in women, if opting to treat the latter. Available evidence from RCTs indicates that in men with NGU, clinical cure rates, in the same study, are similar with both regimens [14,15▪,43] and would be one strategy in attempting to halt the spread of M. genitalium macrolide-resistant isolates. For those who fail therapy with doxycycline, the extended regimen of azithromycin can then be used, and for those who fail this regimen moxifloxacin for 10–14 days [51]. If azithromycin is to be used first line instead of doxycycline, then we would recommend restricting prescribing to a 5-day course. This could be pragmatically implemented by using an initial 1-g single dose (instead of 500 mg) followed by 250 mg once daily for 4 days, as this contains the currently recommended 1-gram stat dose to cover Chlamydia[14,15▪,43]. This may also lead to better outcomes in those with disease caused by C. trachomatis[14,15▪,31]. The use of an accurate point of care test for C. trachomatis and N. gonorrhoeae, which is now available commercially [52], offers an alternative strategy with doxycycline being prescribed for C. trachomatis-positive patients and extended azithroymcin regimen for those who are C. trachomatis-negative [51]. Treatment of contacts should be with the same treatment regimen administered to the index case, and we would recommend that azithromycin 1 g should not be used [13▪▪].
The alternative treatment regimen for PID of a third-generation cephalosporin followed by azithromycin 1 g/week for 2 weeks should be used with caution (see above) [32,43,44,49]. For patients with persistent symptoms following treatment of complicated disease, an extended course of moxifloxacin or azithromycin should be considered.
Where diagnostic testing for M. genitalium is available, we would recommend the aforementioned antimicrobial approach should still be used, but all patients with symptomatic disease should be tested for M. genitalium and retested 3–4 weeks post-treatment. Those found to be persistently infected after treatment with azithromycin and/or moxifloxacin should have antimicrobial resistance testing undertaken and consideration should be given to monitoring this at a national level [11▪▪]. The results of this can then be used to guide patient treatment, and also inform the most appropriate first-line and second-line therapy for the local population.
The use of dual antimicrobial treatment in patients with symptomatic M. genitalium infection merits urgent evaluation in vitro in order to inform decisions about the use of these and potentially other antimicrobials in combination in vivo. Although theoretically attractive, the two current first-line agents, azithromycin 1 g and doxycycline 100 mg twice daily for 7 days, are both sub-optimal in eradicating M. genitalium[6▪▪,12,14,15▪]. Although they may be synergistic, doxycycline is bacteriostatic and its effect in combination with azithromycin is to our knowledge unknown [1,12,17,53].
Screening and treatment of asymptomatic individuals should not be undertaken unless it has been demonstrated to be cost-effective and it can be concluded that the adverse risk of treatment, primarily the generation of resistant mutants, does not outweigh the potential short-term benefits.
There is increasing evidence that M. genitalium is an important cause of symptomatic disease and that current first-line treatment regimens demonstrate suboptimal eradication rates for this micro-organism. Concurrently with increasing use of azithromycin 1 g, there has been a rapid emergence of macrolide antibiotic resistance in M. genitalium, which may now be endemic in some centres, and quinolone resistance is beginning to emerge. In the absence of specific M. genitalium diagnostic and antimicrobial resistance testing, we argue that azithromycin 1 g as a single dose should not be used for the management of patients with symptomatic disease potentially caused by M. genitalium.
P.H. has received funding from HEFC, NHS, BASHH, the Bristol University, Imperial College London, the Crown Prosecution Service, Hologic, Cepheid and Rib-x for his salary, consultancy, lectures, patents, and providing evidence; E.A. has received funding from Cepheid, Bristol University, Atlas Genetics, Pharmaxis, Intermune, the NCSP, the Office for Sexual Health, Pathway Analytics, Gilead and Hologic for consultancy and lectures; K.B., none declared.
Papers of particular interest, published within the annual period of review, have been highlighted as:
▪ of special interest
▪▪ of outstanding interest
This in-vitro study demonstrates that M. genitalium can establish long-term infection in human endocervical epithelial cells, both intracellularly and extracellularly, that results in chronic inflammatory cytokine secretion and increased responsiveness to secondary Toll-like receptor stimulation. Infectious load increases slowly over time and eventually results in a cytopathic effect.
This cross-sectional case–control study demonstrated an association between M. genitalium cervicitis and PID. This adds to the evidence that M. genitalium is likely to be causal in these conditions.
This retrospective case study demonstrates the efficacies of commonly used antibiotics for the treatment of M. genitalium. This observation has important implications for first-line antibiotic therapy for the treatment of M. genitalium and surveillance of antimicrobial resistance.
The first retrospective study in France describes macrolide resistance in M. genitalium. Ths articles suggests that surveillance to inform treatment strategies is required.
This population-based study from Greenland found a high prevalence of M. genitalium with 100% of micro-organisms having marcolide-resistant determinants.
This study determined the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium and indicated further surveillance and a review of M. genitalium management are required.
This article demonstrates the association between treatment failure and the detection of macrolide-resistant mutations and strengthens the argument for M. genitalium testing.
This is the most recent randomized controllled trial comparing the efficacy of azithromycin to doxycyline. It highlights the inadequacies of current treatment regimens for M. genitalium.
This retrospective analysis is one of few studies investigating the urogenital, anorectal and oropharyngeal prevalence of M. genitalium in MSM. This adds to our understanding of M. genitalium prevalence in this population.
This study evaluated the use of transcription-mediated amplification to detect M. genitalium in male and female rectal swabs from men and women reporting receptive anal intercourse. This provides futher evidence of the prevalence of M. genitalium in the rectum.
This article reports two cases of urethral–rectal transmission of M. genitalium in MSM. This confirms that M. genitalium is sexually transmitted in men who have sex with men.
This longitudinal study observed that women infected with M. genitalium were at increased risk for HIV-1 acquisition. This adds to the evidence that M. genitalium infection increases the risk of HIV-1 acquisition.
This subsequent analysis of the trial detailed in reference [14] assessed the association between M. genitalium and a number of variables before and after treatment including treatment regimens.
This retrospective study evaluated the M. genitalium eradication rate of several antibiotics in women with uterine cervicitis. This has implications for M. genitalium treatment strategies.
azithromycin; cervicitis; Mycoplasma genitalium; nongonococcal urethritis; pelvic inflammatory disease
© 2014 Lippincott Williams & Wilkins, Inc.
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Visiting downtown Boston with our Labrador. . . dog friendly spots anyone??
My husband and I are going to be in Boston in August for a weekend with a our beloved 9 yr old Labrador Retriever. We are staying at a super dog-friendly hotel, but we are not bringing him along to leave him in the hotel room all day. I have searched for some breakfast and even dinner spots with outdoor seating but I am not coming up with much. My husband and I love to eat good food (he loves seafood, I can take it or leave it / please keep the foie gras places out - I had enough in France to last me a lifetime!). We enjoy fine wine, yummy cocktails and cold brews. We are also big coffee drinkers. I am looking for simple to moderate scale breakfast spots and dinner spots with interesting plate options and a generally well regarded reputation for quality and service. Farm to table is always welcome! We are going to be focusing dog-tag-a-long time in and around the Boston Common area. If there other must-do places, we will have 2 dinners, 2 breakfasts and 2 lunches in Boston and we will venture outside the BC area so I will also take suggestions for just generally good local places that we shouldn't miss (with our without the pooch). Thank you for your comments and recommendations in advance!!
Can't speak to everywhere, but from our experience Cambridge is much more dog friendly than Boston. Places like Area Four and Cambridge Brewing Company are super dog friendly (and you will see lots of them there on nice days). In Boston, I feel like the South End is the most dog friendly neighborhood - I'm pretty sure they're allowed at the outdoor tables of Tremont 647 and Toro.
re: mkfisher
Thanks MK. We will definitely take a look in the South End!
People are often reluctant to mention dog friendly places in print because it will make them targets for those who don't share our love of dogs who might pressure the city powers to crack down on them.
Grant.cook is right .The Liberty Hotel has it's Yappier Hour in the "Yard" on Wednesday's and the Seaport hotel has copied this and is doing Canines and Cocktails at the same time.
For the past year we've had a lot of great food trucks hit the streets of Boston and food trucks, because they are curbside are dog friendly places to grab something delicious, pull up a stair or bench and enjoy a meal with your best bud by your side.
Here's the food truck schedule
The restored Brewer Fountain Plaza on the Boston Common is a great place to try the Clover Food Lab truck. You can get wonderful coffee nearby at the Thinking Cup on Tremont Street.
It is possible for a restaurant to be legally dog friendly. There are a bunch of places in Provincetown that have requested and been granted special permits to allow the whole family to dine on their patios. I would love to see this happen in Boston. I'm sure you saw plenty of dogs inside restaurants in France.
re: BostonZest
Agree with Penny 100%. That being said, *most* restaurants in the south end with outdoor seating allow your dog to dine with you. Some (many) require the dogs to be on the outer edge of the patio (i.e. if there is a rope or chain they are on the other side, but can still be tied from your side) It really just depends and is so arbitrary, it drives me crazy. A few we have had good experiences with:
Coppa,Garden of Eden, Tremont 647, Toro, and Stella --all in the south end..Toro is probably my favorite of the bunch. There's a new spot called "Kitchen" that has an outdoor patio too...their predecessor used to allow dogs so I'm assuming they do also.
You should check out Mike & Patty's too, in Bay Village (not far from the south end) They are a small little shop with awesome breakfast and lunch sandwiches. You can grab a couple and hopefully snag one of their small tables outside (def dog friendly) or just sit on someone's stoop and eat your sandwiches. Really good.
re: twentyoystahs
Garden of Eden: are you thinking of Stephi's on Tremont, which took over that location? GoE closed in 2008. I have no idea of Stephi's dog-friendliness.
re: Allstonian
Stephi's on Tremont is ideal for bringing the pooch - they just require them being on the outside of the small gate. They will bring a bowl of water for the dog as well.
re: Allstonian
That is so bizarre. I have no recollection of typing "Garden of Eden" -- really weird! But yes, that is Stephi's on Tremont now, and they will let you bring your dog but you need to be sitting along one of the outer tables where the ropes are.
And Picco is a good choice too and your dog can sit at any table with you (outside)
re: twentyoystahs
Kitchen is dog-friendly, while walking my dog I stopped to peruse their menu and the hostess made a point, without my asking, of letting me know they're happy to accomodate dogs on the patio. Maybe Picco in the South End, too, they have a large outdoor space and great food.
re: BostonZest
Penny, do you know of where I can find a list of these p-town restaurants? We will be there for a week in September with our dog and would love visit some of these restaurants.
For the OP, this thread (http://chowhound.chow.com/topics/780070) from last year should be quite helpful. We have an 7 year old lab, and it is always an added bonus when you can take your dog on vacation!
re: Gabatta
Gabatta, this other thread was also very helpful. It seems Boston "health laws" with regard to dogs may be just like Princeton's! At least here at some places the servers just tell you they are not allowed to touch the dogs while others follow the "tie them up off the patio" rule. That makes more sense and is more friendly than having to tie them up 10-12 feet away.
re: Gabatta
The dog park group has some of them but I know of a few more along with other dog friendly resources.
Our technique was to walk up to the host and ask for a table for two. If they had a problem with our dog joining us they are quick to say so. But, many places will just lead you to a table where they don't mind if you have your dog with you.
re: BostonZest
re: phatchris
The little side patio at Myers+Chang- great suggestion. btw, labpal, the park that runs down the center of Commonwealth Ave (Comm Ave) from the Public Garden -is very popular for dogwalking, on one of the most beautiful streets in our city. I have also seen dogs on the patio outside the cafe on the south corner of Salem St and the Greenway, in the No End.
re: opinionatedchef
the strip of green that runs down comm. ave in the back bay is properly called 'the mall". yes, a very pretty spot to sit and have a bite, or to walk the dog. boston does have leash laws.
re: phatchris
The last I heard Picco was no longer dog friendly...I guess some miserable customer dropped a dime on them one day.
re: NahantNative
I would like to thank the CH staff for removing the non-food related posts regarding whether someone likes or dislikes having a dog on a patio where they are dining. I never intended for this thread to become the debate venue for Dog Lovers vs Dog Dislikers. Thank you, LabPal
All this is all great information! I think we have a good list to at least start with and if we encounter anymore places of note while we are there, I will certainly report back!! Thank you all so much!!!
Ok so I think I have a few spots to start. But how about this - it seems like it might be easier and less chance for drama if we plan to take a picnic lunch to a park. . . since we will be North End mainly with some meandering to South End and Newbury Street, can anyone recommend a good deli or gourmet shop where we can make a nice picnic meal?
re: LabPal
south end -- formaggio.
north end -- j. pace or il panino express.
re: LabPal
Salumeria and Mercato Del Mare; North End
re: LabPal
If this visit happens to fall on a Sunday, you could also go to SoWa Sundays in the South End: http://sowasundays.com/ Besides being great dog-friendly shopping, you can go to the food trucks behind the main building and have an outdoor lunch. Supposedly a food truck just for dogs is in the works as well. I also highly recommend the dog park next to Myers and Chang - it is completely fenced and our dog loves it.
Heard from a friend that Red House in Harvard Square allows dogs in their outdoor area. Haven't been and don't own a dog, but it's worth looking into.
Monica's Mercato on Salem St. in the North End has terrific sandwiches and cold prepared foods.
What hotel are you staying at? I will be in Boston in Aug and would love to bring my puppy. I am bringing my kids to a Red sox game and am looking for a hotel that may offer dog walking or pet sitting while we are at the game. Any suggestions? Also, any recommendations as to where we can go with the puppy when we are not at the game? We will only be there for 1 night but would love to take her out with us as much as we can
re: jmsylvia
Since this is the place to talk about food. I'm going to give you some guidance that will of more helpful to others looking for good food near a pet friendly hotel.
There are a lot of Pet Friendly Hotels with good food as well. The Eliot Hotel in the Back Bau is home to Clio and Uni. Around Copley Square hotels like the Lenox and Copley Plaza, would be perfect to give you access to the Farmer's Market and food trucks as well as two great parks for picnics.
The Liberty Hotel has a bunch of popular restaurants and is close to Charles Street where you can pick up picnics at places like Savenor's, Panificio , Cafe Vanille, and the Paramount. You can walk across a footbridge and enjoy a picnic on the Charles River Esplanade. Or in the other direction you and go to the Public Garden or Boston Common.
re: BostonZest
add Copley Fairmount, which has a resident dog/mascot who wrote a book! it faces the Copley farmer's market which is there tuedays and fridays. also the Boston Seaport Hotel, down at the waterfront.
the four seasons also accepts dogs and you'd be steps from the public gardens and common.
re: jmsylvia
The Kimpton Hotels are all dog friendly and there are 2 or 3 in Boston. One near Boston Common and then 2 others. Check out www.kimptonhotels.com and search by City. Since I am the one who started the thread, I will leave the dining suggestions to others but I will post a reply once we return with where we went and what we experienced with our 4-legged furry pal in tow.
Coincidentally we were looking to go out for dinner last week and bring our dog along with us so I made a couple calls to our choices, here was the answer:
Posto Pizzeria in Somerville - OK at their outdoor seating, but they can't reserve the outdoor seating specifically.
Redd's in Rozzie - same story. We ended up going on a Friday night at 7:30pm and there was plenty of room on the patio. We didn't end up bringing the dog because someone did some dog sitting for us for the evening, but there were water bowls, the patio is enclosed so it would be a relaxing place for a dog to hang out without outside distractions/other dogs.
The problem with not being able to reserve patio seating at these places is that if I go out to dinner with friends and the dog, what are we supposed to do if we're turned away because there aren't any outdoor seats available? Kind of annoying.
Well we are back from Boston and what a great time we had!! Our dog really enjoyed the trip as well and was welcomed at several places as we wandered about. The folks at the Clover Food Truck gave him some roasted carrots that he was eyeing as my husband and I waited for our "pour over" coffee. And Stephi's on Tremont brought two bowls of water each for our dog and our friends' dog. It was one hot morning and the boys enjoyed the icey liquid! Boston Common has an offleash pilot program area. We didn't test it out, but we did see a lot of local folks with their dogs. I agree with several posters here that the South End and even parts of the Back Bay were more dog-accommodating than say Beacon Hill or the North End.
As for my husband and I, we enjoyed lunch at Neptune Oyster and Yankee Lobster Company - YLC got the higher marks for the lobster. It was fresher tasting and more tender. We enjoyed dinner at No. 9 Park and La Voile. Both were fantastic! No 9 is the most accommodating kitchen we have ever experienced. And our waitress Inez was perfectly humorous and informative. The drinks at La Voile before dinner were refreshing and different. We followed that up with cocktails at City Bar in the Lenox Hotel. A very preppy place with crafty cocktails.
For coffee we did check out Caffe Vittoria in the North End for iced coffee (excellent!) on a recommendation from a coworker who used to live in Boston. My husband got a cannoli there later in the week with some colleagues and he was very disappointed. Our last food stop before I and the pooch headed back southward was Thinking Cup on Tremont St. The coffee was fantastic, but the breakfast sandwiches were just okay. Its location right across from the Common made it an ideal quick stop for breakfast with our dog, so if we return to Boston we will likely stop there again but will skip the sandwiches.
All in all it was a great trip! We loved the feeling of the South End and the Haymarket on the edge of the North End. We regret that Prezza wasn't open, but there is always next time!
re: LabPal
so happy youall enjoyed yourselves. And all your details are most welcome; now we can pass them along to future visitors!


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Every couple of years a group with enormous talent comes on the scene and captures the hearts of hip-hop aficionados. Then something happens, usually label problems. This is followed by the creative differences within the group leading to the departure of a member or the destruction of the group as a whole. Well this time it is Little Brother in the hot seat with their well-known label issues and, to make matters worst, 9th Wonder and the remaining members decided to part ways, leaving Phonte and Rapper Big Pooh holding the mantle of the LB legacy. This had many to wonder if the group could carry on and still put out great music or would they end up in the same position as those who came before them. With the marvelous Getback, they not only prove that they still got it, but that they are better than ever.
Shockingly, the departure of 9th Wonder comes as a blessing. Not discrediting 9th Wonder in any way, but the use of different producers actually enhances the album and corrects the monotony of production they were highly criticized for on The Minstrel Show. This is not the only correction they seemed to have made since the last album. The use of skits not only serves as entertainment, but also as a great transition between tracks. On their last LP, some individual tracks were devoted to skits that were irrelevant and at times annoying, where as on Getback the skits are relatively short and only appear as an extension of a song. This clever usage of skits has not been seen since De La Soul's De La Soul Is Dead.
While listening to the album, you also become reminded of A Tribe Called Quest's Low End Theory in the way a "minor member" steps up to the plate. Big Pooh was never a terrible emcee by any account, but it is here that he has his coming out party. He seems to be more comfortable with himself where before it seemed as if he wasn't too sure and felt he had to prove it through every line he rhymed. This is most evident on one of the album's best tracks, the Mr. Porter produced "Extra Hard," where Pooh's confidence shines in verses like, "Say I'm good/ Say I'm great/Couple niggas took shots/But they both late/They both cake/Soft like a Styrofoam plate/You wanna see the camp/Better get into shape…"
As Pooh finds his groove, this is complimented by Phonte's laid back and sharp-witted flow. In fact, Phonte is a gifted emcee in his own right that has a unique way of bringing a point home in a sensitive way. A pure example is on "Dreams" where he says, "I still go to the crib and see my niggas on the corner/Pounds on their waist/Getting old/Getting round in the face/So when I hang with them/They ask me if The Minstrel Show means I'm ashamed of them…" With the departure of 9th Wonder, these two display a chemistry and camaraderie that was not as prolific on their first two LPs. When listening to them, once again you become reminded of another group with superior interaction, EPMD.
What separates this album from being put in the same category as the classics mentioned amongst others are a couple factors. One is that some of the hooks come off a little flat, best examples being the Lil' Wayne featured "Breakin' My Heart" and "When Everything Is New." Secondly, there is the whole impact factor. Although this album is great, it isn't exactly groundbreaking. Yes, the subject matter on the album and the viewpoint from which they are rhyming is refreshing, but it is not new. Plus, the group does not push the boundaries of hip-hop. It doesn't have the essential elements that would change the scope of music. By all means, this album's qualities cannot be denied. But being able to enter the same class as their older brothers, LB has just a little farther to go. – Ryan Harrison
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Administrative leave, unlike sick leave and annual leave, is not specifically mentioned in statute or regulations governing federal employee benefits. It comes from two sources: Administrative leave that is excused absence because of a natural disaster or other temporary and short-term need to be away from the workplace. Administrative leave that applies to a specific federal employee who has come under scrutiny because of misconduct or some issue related to a security clearance. If government offices shut down because of snow or an event like Hurricane Sandy, employees in the affected region will be on administrative leave with some exceptions.…
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The United Way of Central Kentucky's campaign is under way with agency directors and volunteers making presentations to potential givers at companies in our area. The difference from the last 12 years is that Susan Asher will not be at the helm.
Asher's presence will be missed during the campaign and throughout the year. She was a visible leader and immersed herself in the position. She invested many hours and countless miles into doing all she could to raise money and awareness for the United Way and its agencies.
By MARGIE HARPER
On Nov. 6, President Obama signed the new Worker, Homeownership, and Business Assistance Act of 2009 into law. This legislation extended and expanded the first-time home buyer credit.
Important essentials to know about the credit:
The following building permit information has been obtained from Hardin County Planning and Development Commission and the City of Elizabethtown Planning and Development offices. The name of the applicant, applicant's address and use of permit are listed.
Lydora Stewart, 3498 Star Mills Road, county. Use: single-family dwelling.
Earl B. and Frances J. Johnston, 206 Milimish Lane, Vine Grove. Use: addition.
Makr and Cindy Coleman, 58 Jako Circle, Elizabethtown. Use: swimming pool.
By MARTY FINLEY
ELIZABETHTOWN — The former Cott facility at North Dixie Avenue and U.S. 31W Bypass has seen a revitalization of sorts this year with its drab exterior pulled away and its walls splashed with a new sheen.
By JEFF D'ALESSIO
In the U.S. Army, most days are far from typical.
But for Staff Sgt. Kyle Puckett, last Thursday started out as "fairly routine" at Fort Hood, Texas. Puckett, 30, was just about to take a break from his duties as a mental health NCO to grab some lunch after a busy week of processing between 300 and 400 soldiers through his office.
The following civil suits are filed in Hardin County Circuit Court in Elizabethtown. Et al is a Latin abbreviation meaning "and others." Lawsuits give only one side of a disagreement and do not reflect any counterclaims and/or settlements that may have occurred since the initial suit was filed.
Ronald L. Hinkle, et al, v. Kentucky Neighborhood Bank, 1000 N. Dixie Ave., Elizabethtown. Claims breach of contract. Seeks judgment for damages; trail by jury.
The following misdemeanor and traffic violation cases are found in Hardin District Court Division I in Elizabethtown. KAPS stands for Kentucky Alternative Programs. Totals include court costs and/or public advocacy fees. Birth year is in parenthesis.
Brenda S. Barger (1973). Speeding 34 in a 25. Total $182.
Karen M. Bays (1972). Failure to wear seat belts. Total $25.
Melisha Boyd (1980). Theft by deception. Total $185.
Charles W. Breeding Jr. (1988). No license in possession. Total $144.
VINE GROVE — When Donovan Smith returned to the Vine Grove mayor's office in 2007, he did so knowing that it likely could be his last stint in public office.
In sticking to a campaign promise he made to his wife, Penny, the 70-year-old Smith won't pursue another term as mayor in 2010.
"I'm going to keep that promise,'' Smith said.
Copyright © 2014
The News-Enterprise is your source for local news, sports, events and information in Elizabethtown, KY, Hardin County and the surrounding area.


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Clearwater Beach Condo Rental Photos and Description
Condo, 0 Bedrooms, 1 Baths, (Sleeps 4)
A TRULY UNIQUE way to stay in Clearwater Beach!
This studio unit has all of the amenities a home comfortably provides with the well equipped kitchen and balcony with a slight view of the Bay of Clearwater and the on-site pool. The living area holds a flat screen TV and comfortable sofa that become a sleeper met by a classic hexagonal dining table and chairs.
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- Suitability:
- children welcome
- non smoking only


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|Twenty-two executives and employees of military and law enforcement products companies charged for violating the Foreign Corrupt Practices Act (FCPA) in foreign bribery scheme
In an international crackdown against illegal bribery in the military and law enforcement products industry, U.S. government officials and U.K. police served indictments on 22 people, as revealed in a January 19 2010 press release by the U.S. Department of Justice (DOJ).
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Instantly stream the full version of Wabi Sabi Art Style Introduction and Inspiration with Serena Barton on your computer at ArtistsNetwork.TV now!
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I really like this video because the artist offers suggestions for subjects to be used for your wabi sabi project and then takes you in studio to practice various methods and techniques. This is exactly what I was looking for ---an instructional video showing me how to do my own wabi sabi project.
As indicated in the other product review by Malinda-Ro, it is not a philosophical book. It is a practical guide.
(Posted on 5/11/2014)
(Posted on 5/11/2014)
Recently purchased this DVD after discovering how wabi-sabi most of my photographs are. I had not heard of this concept before but it fitted so well with my photographic work, finding the beauty in the cracks and crevices of nature and man made things. The weathering, rusting and aging of things. I see this as a metaphor of my life.
It was interesting to see this incorporated in the creation of an art work but I felt it could have been explored much more with less technique explanation as there are plenty of resources for that aspect.
Perhaps I was looking in the wrong place for a more philosophical emphasis instead of the brief intro and a few mentions along the way.
Still worth the look, but living in Australia I'm not sure it was worth the postage. Wish it had been a downloadable product.
(Posted on 4/20/2014)
(Posted on 4/20/2014)


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VA BBQ that isn't Rocklands or Dixie Bones
- monkeyrotica Jun 2, 2013 04:37 AM
Those are the only two off this list that I'm familiar with. Any folks had any experience with these? Worth a drive from downtown?
After reading that list, I'd be surprised if the author has actually eaten at many, or ANY, of these places that are being excessively praised. Some of them might actually be good, but that blog post smacks of compilation of comments pulled off the Internet and pasted together, possibly paid for with $ from those listed.
I've been to #'s 4, 6,9,11,14,15 and 16, and would recommend Rocklands, though it can be spotty, and the BBQ Exchange in Gordonsville, which is a nice, pretty drive from the city.
re: wayne keyser
What do you like there?
Buz and Ned's is very good for ribs and also mac n cheese, but I wouldn't get their chopped pork. It's been a long time since I've been, though.
I don't care for Pierce's, but again, it's been a while.
Hill Country is good, but is in DC. Hmmmm.
Some of the items at Harry's Smokehouse in Arlington (Pentagon City Mall) are good. There is also a new upscale BBQ place a couple of blocks away from it (behind the Costco) but I haven't tried it.
Carolina Brothers in Ashburn is good, although it doesn't have a huge selection.
Pork Barrel BBQ opened a restaurant in Alexandria. I haven't been there but have had their food at events and it is good.
You may want to check out Dizzy Pig BBQ's event calendar. They are a grilling supply store in Manassas and teach grilling classes and have a line of spice rubs but they als are a competitive grilling team--they compete in BBQ festivals, and those festivals may interest you.
re: Foodgeek
The place near Costco is called Epic Smokehouse. Not just bbq, they have steaks, etc. Swank interior. I wouldn't go back for the bbq.
Pork Barrel served me dried out, tasteless bbq. I saw them wrapping their ribs in plastic wrap, thereby steaming them inside. Yech.
re: yummmymummy
Does Pig 'n Steak still give you a ridiculous amount of fries?
bad to the bone in gainesville -- best ribs i've had in many, many years (of my quest). great slaw and potato salad, too. has really stepped up its game!
pulled pork has definitely gotten top level, too.
worth the trip.
Allman's is awful. Dry, flavorless, and chopped to the point where it's consistency is more in line with sawdust than pulled pork. Odd that Carolina Brothers in Ashburn isn't on there - speaking as a born-and-raised eastern North Carolinian, they really nail the style out there, and their sides are quite good as well!
Shaffer's BBQ Palace is a food truck in Arlington on Saturdays and some Sundays. Definitely next weekend and it looks like through November, but I'd call first.
These are the best ribs in the area, and in fact there is no 2nd place. St Louis cut. About as close as you can get to ideal here, although my guess is they use oak so it's a lighter smoke flavor than I'd prefer. Still, everything else from the texture, spiciness, and crustiness to the clean well-rendered flavor is exactly what I look for but cannot find in bbq ribs. $22 for a full rack. Only side is a cole slaw mixed with bbq sauce which I did not try.
3507 Columbia Pike
Arlington, VA 22204
(571) 969-7675
Every other Sunday
Colombia Pike Farmers Market
Corner of S. Walter Reade and Colombia Pike
Arlington, VA
re: Mississippi Snopes
Yeah, a lot of places can get the pork shoulder right but not the ribs. Shaffer's was one of the rare examples of the reverse. I will try them again soon.
There's a BBQ trailer at 340 and 50 west of Berryville, VA that has very good brisket and chopped pork. It's next to a fruit stand and a McDonalds. He's there on weekends and does the smoking on premises.
I've really enjoyed The Pit Stop lately. It's a guy with towed smokers at Gilbert's Corner (the intersection of Rt. 15 and Rt. 50 in Loudoun County in a gravel lot). He's there Saturdays and Sundays and has a nice set up- picnic tables, a tent, usually a guy selling lemonade and kettle corn. I especially liked the smoked chicken salad. His pulled pork sandwiches are really moist and flavorful. And the spicy sauce is true to its name. The ribs are popular- people were leaving with trays of them. Prices are reasonable.
re: Hobbert
I hit Pit Stop Sunday just before they closed at 5 pm, and they were out of just about everything but Rib Tips for $8. Tips tend to be a combination of meat with either chunks of bone or cartilage, so they aren't a neat and tidy meal to eat on a drive home, but I went for it and they were pretty darned good with the hot sauce giving them just a bit of heat. I will definitely come back and try a half slab soon.
Definitely worth giving these guys a try if you are out there near Aldie. The assortment of tents has added a Maine Lobster Roll truck and a local produce truck, as well.
re: Hobbert
I was tempted to get the lobster roll just to see if they got it right. I have had them both in Maine and here in Virginia and in my admittedly limited experience, they are often not as good here. But if they specialize in it maybe they do it right so it would definitely be worth a try.
I got there right at 5 pm and the couple in front of me got what looked to be a quarter slab, which may have been the last they had. They were out of pulled pork, so he seems to be doing well. I imagine in a business like that minimizing waste is pretty darned important.
re: Foodgeek
It is indeed a hike depending where you live (especially from DC) but I LOVED Carolina Brothers. Hill Country was a disappointment last time I went - the brisket was insanely salty. I know this is a bit off topic, but Kangaroo Boxing Club in Columbia Heights is turning out amazing pulled pork these days.
#1 - Checkered Pig in Martinsville - This was one of the great BBQ surprises of my life. Three years ago my wife and I had taken a barbecue tour of western North Carolina, eating at famous places like Cook's and Lexington No. 1 (Honey Monk's) in Lexington, Short Sugar's in Reidsville (huge disappointment), and Wink's in Salisbury, plus some other not-so-famous places.
So we were pretty much barbecued out by the time we headed back north to Arlington. But as we passed through Martinsville, this place (then known by the awful name of Pigs-R-Us) had a full parking lot so we couldn't pass it by.
It was tremendous, the second best barbecue of our entire week of eating barbecue (only Lexington #1 was better). There were huge BBQ competition trophies everywhere, which is not always a good sign, but in this case tournament Q turned into wonderful retail Q. Fantastic pulled pork.
#4 - Rocklands - I'm probably in a minority here, but I think Rocklands is very good barbecue, at least in the DC and Arlington locations (Alexandria has been a bit more iffy). My favorite is the brisket sandwich, which is different from Texas brisket like at City Market and Black's in the Texas Hill Country, but to me very good. It's always been a mystery to me why Rocklands has so many nay-sayers (including some people who sound pretty knowledgeable about barbecue).
#5 - Galax Smokehouse - We also hit this place on our "barbecue vacation." It's very very good, deeply smoked and nicely sauced, and a pleasant place to eat, but not national caliber like Lexington #1 or the Checkered Pig.
#8 - Dixie Bones (Woodbridge) - We only tried it once and won't go back. Very little smoke and overly sweet sauces. Basically on a par with Famous Dave's. On the plus side our Ghanaian waiter tipped us off to the superb Ghanaian restaurant Aburi Gardens in Woodbridge.
#10 - Buz & Ned's (Richmond) - After my daughter graduated from VCU, she worked at Buz & Ned's for several months, since she'd always dreamed about working in a barbecue place. Buz is a real character, perhaps not 100% on an even keel, but the barbecue is the real thing made without shortcuts. Maybe not the very top tier of barbecue places I've eaten in, but very close.
13 - Pierce's (Williamsburg, or actually right outside of Williamsburg) - Decent, I'll always stop by here if I'm driving down I-64. But it's not heavily smoked enough for my personal taste and the sauces are way way too sweet.
15 - Allman's (Fredericksburg) - Ever since my wife and I moved here in 1979, we've seen articles popping up claiming that the barbecue at Allman's was wonderful. After trying several times, we just gave up. Not only is the barbecue at Allman's not good, it's not even barbecue. I've never tasted a whiff of smoke in Allman's meat, which is dry and tasteless. It's basically a sloppy joe sandwich, without the sloppy part. The place itself is kind of neat (it's been open since 1954), but get a hamburger or grilled cheese, not the barbecue.
#16 - Alamo (Richmond) - Another superb barbecue place, probably better than Buzz & Ned's. I think these guys are also barbecue tournament people, though I'm not sure about that. Not the best of the best, but the real thing. Deeply smoked, delicious sauce, good sides.
One place that isn't mentioned that should have made the list is Cuz's Uptown Barbecue in Pounding Mill, just south of Tazewell. This isn't a typical barbecue place -- it's a full sit-down restaurant, with Asian and American and fusion cuisine. The barbecue is very good, properly smoked. However, the real star at Cuz's isn't traditional barbecue but their "smoked ribeye," a variant of barbecue. They take a whole ribeye and smoke it for only an hour, which surprisingly is enough to give it a richly smoky flavor, but obviously isn't enough to cook it at all. Then you can order your smoked ribeye cooked to order -- just imagine what you'd think "medium rare barbecue" would taste like in heaven and you've got the idea. An ambrosial quasi-barbecue dish.
re: Mississippi Snopes
Buz and Neds was wonderful at first, now it's let me down the last couple of times. I will not rush back. Son at VCU right now.
re: Mississippi Snopes
mr. alka will be happy to hear of the smoked steak at cuz's. he had his first smoked steaks in texas, and just loves them.
ate at buz and ned's last year -- pulled pork. pretty good, but not nearly as good as bad to the bone in gainesville. and bad to the bone's sampler platter is great -- pick your top three meats off the menu, plus sides. the ribs are a must.
pulled pork at rockland's is decent.
mr. snopes, have you seen this brookwood farm's bbq? harris teeter grocery store carries east carolina style pulled pork. the plastic tub is over in the prepared meats case (next to the lloyd's bbq, prepared meatballs, ready-to-eat mashed potatoes, etc). be sure and get the "original." http://brookwoodfarms.com http://chowhound.chow.com/topics/564496
by the way, at cowboy café's lee hwy location (not sure about the other one) they smoke their own pork for the pulled pork they put on their huge burger
("the barnyard"). we were actually very pleasantly surprised at the good smoky, savory flavor of the bbq on top. (they also do a very good shrimp and grits for brunch, by the way). (i see from their menu, they do smoked pork and also smoked brisket sandwiches -- see photo of menu screen shot).
on buz and ned's, was it then a concocted tale that ned had died (since you say he was fictional)?
re: alkapal
Wow, I'll try the Harris Teeter barbecue, though I'll admit it seems a little like chasing a unicorn to look for good grocery store barbecue. But anything's possible.
I've been by Cowboy Cafe maybe 5000 times and had no idea they had barbecue.
Yep, Ned is entirely fictional. He never existed, with or without teeth.
re: Mississippi Snopes
cowboy cafe has a good happy hour, too -- lots of neat beers on tap (maybe 12 on tap, more by the bottle). $3.50/pint from 3-6.
we've gotten the barnyard burger on their ½ price burger day (tuesday). mr. alka also reckons CC has the best french fries around. i tend to agree.
as to brookwood farms BBQ -- i'm anxious to see what you think!
re: Mississippi Snopes
I like the brisket at Rocklands on Wisconsin Ave. The ribs were more like jerky the one time I tried them, so I stay with the brisket.
The ribs at Black Hog in Frederick are consistently good.
Triple Crown on 211 in Luray has the best smoked pork around. Added bonus: The owner builds custom guitars in his shop around back. If he likes you and he's not too busy, he'll invite you to go back there and play a few. Great guy; outstanding barbecue.
re: flavrmeistr
I love Black Hog. I was there last summer and I was shocked and amazed to see that they serve cole slaw that is almost identical to what we have in eastern NC. Uusally you can' find that stuff anywhere outside of NC. For some reason, the rest of the world is under the impression that NC cole slaw is just shredded cabbage doused with a bunch of vinegar. I'd never even heard of something like that in 21 years spent living in Greenville, NC and Winston-Salem, NC.
re: The Big Crunch
I've had lunch at Dickey's a couple of times, brisket and pork sandwiches, and, you know, it's OK. Not great, but better than I expected from a place in the new Halstead Square development in Merrifield. The pork has a much more smokey flavor than other places of that ilk around here (thinking Red Hot and Blue and Famous Daves, both of which most BBQ hounds wouldn't consider worth eating at). The brisket has been kind of dry, not like the moist brisket at Hill Country, but Dickey's has a pretty good sauce that works well with it if you use it sparingly.
The iced tea actually tastes like tea, and they have free self-serve soft-serve vanilla ice cream(?) that's creamier and more vanilla-tasting than most. mac & cheese is OK, beans are better at Red Hot & Blue.
They need to work on their production line. Each time I've been in there, there's been maybe one or two people (though some are groups) ahead of me at the ordering station and it seems that it takes forever for them to place an order. It's not that complicated with just a few meats and sides. They have an overhead menu board that's kind of hard to sort out, but there are paper take-out menus near the door that make ordering easier if only people would look at them.
Dickey's is a chain from Texas, They have a slew of places around the US, but they're fairly new coming to this area. Any Texans here have experience with it there? I suspect that locally it's just another chain BBQ joint.


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Elizabeth and James Cynnie Leather Drawstring Backpack, Yachting Navy
For the girl on the go, this hands-free Elizabeth and James sling bag makes multitasking a breeze.
- Elizabeth and James soft grainy lambskin backpack with golden hardware.
- May be carried as shoulder bag or backpack.
- Thin shoulder straps gather drawstring top.
- Removable padded top handle; 9" drop.
- Vertical zip pocket on exterior front.
- Flat bottom structures bucket bag.
- Inside, faille lining; one zip and two open pockets.
- 12"H x 10 1/2"W x 7"D.
- Bag weighs 2lbs.
- "Cynnie" is imported.
Sold Out
Elizabeth and James' cult 'Cynnie Sling' backpack has been updated in sleek calf hair and leather . This versatile style boasts ample interior pockets, plus a zipped outer pocket to keeps your keys and cell close at hand. It has a detachable strap so you can carry it as a shoulder bag, too. Black calf hair (Cow), leather (Lamb) Drawstring top
The 'Cynnie Sling' backpack is one of Elizabeth and James' most coveted carryalls. This black leather version is finished with silver hardware and a detachable short strap. Stow your daily essentials in the roomy twill -lined interior, keeping your cellphone and keys in the front zipped pocket. Black leather (Lamb) Drawstring top Comes with dust bag
Elizabeth and James' chic textured- leather backpack is the answer to over-scheduled days. Store your keys and cards in the front zipped pocket, leaving the spacious interior free for your tablet, work documents and latest read. Adjust the straps for a closer fit, or carry it by the detachable top handle. Black textured-leather (Lamb) Drawstring top
Elizabeth and James updates its popular 'Cynnie Sling' backpack for the new season - the brick , light-brown and cream woven cotton is perfectly in tune with Pre-Fall '14's Western theme. The durable black leather base and trims add structure, and the faille -lined interior boasts a multitude of pockets for your smaller essentials. Wear it over your shoulder or carry it by the removable top handle. Multicolored woven cotton, black leather (Calf) Drawstring top
Elizabeth and James' 'Cynnie Sling' bag is an effortless way to give your favorite casual outfits a fresh spin. This design has a front zipped pocket and can be worn as a backpack or on the shoulder. Silver snake-effect leather (Cow) Drawstring top Designer color: Anthracite Comes with dust bag
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Elizabeth & James dyed lamb fur (Turkey) backpack. Lambskin leather trim; silvertone hardware. Detachable top handle; 8 1/2" drop. Thin shoulder straps gather drawstring top. Vertical zip pocket on exterior front. Inside, faille lining and zip pocket. Metal feet protect bag bottom. 13 1/2"H x 12"W x 7"D; weighs 1lb. 4oz. "Cynnie" is imported.
Lined in twill for durability and added structure, Elizabeth and James's leather 'Cynnie Sling' bag can be worn as a backpack or on the shoulder. The baby-pink hue is surprisingly versatile - wear yours with denim. Baby-pink leather (Lamb) Drawstring top
Elizabeth & James soft lambskin backpack. Polished golden hardware. Detachable top handle; 9" drop. Adjustable thin shoulder straps. Drawstring top cinches slouchy body. Vertical front zip pocket with tassel pull. Inside, fabric lining; one zip and two open pockets. 12"H x 10"W x 7"D. "Cynnie" is imported.
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According to the 'Keuzegids hbo 2014' we are the best Dutch University of Applied Sciences .
HZ's International Office members regularly travel to other countries to meet with prospective students.
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Susan's Cottages Bed and Breakfast
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- Continental Breakfast
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TripAdvisor Reviews Susan's Cottages Bed and Breakfast Alexandria
Travel Blogs from Alexandria
A hard day due to heat and lightening storms.
Saturday was both a relaxing and a stressful day. Lynne's bike would not start Friday night and a lady passing by said that her cousin owned a repair shop and might be able to help. Her cousin Chris drove to Beaumont, TX to pick up a part to repair her bike and get her back on the road. The bike was repaired and delivered by about 3 pm and by 4 pm, we were driving around Lakeshore Blvd admiring all their extensive ...
Road Trip to Texas
New Orleans to Alexandria (21/06)
Up early to pack as we didn't do it last night (we are rubbish at packing the night before, everything you go to pack you think "I might need that in the morning" so you end up just leaving it. Well that is our excuse!). Checked out and got a taxi to the Avis Rental location to pick up our Mazda 2. Decided that a Mazda 2 feels very small on American roads, now I know how Smart car drivers must feel back ...
One week to go!
... because someone thought 5:30 a.m. was a good time to fly out. But instead of sleeping I will lay their with my thoughts running 90 miles an hour - is everything packed, did I get everything done at work that I should have, am I crazy for going away for two whole weeks? Can only hope that by the time the plane lands in Honolulu, I will be able to relax, leave all my worries behind and enjoy all that Hawaii has to offer.
Made it to our campsite in Louisiana.
... three hour drive into New Orleans so we should be there by noon. Our campsite is very nice. Has water and electrical outlets right next to the picnic table and even has a shower in the bathroom. I'm a little confused about how Louisiana handles the finances of their parks because we had to drive on a dirt road to get to the park but when we got here the bathrooms were air conditioned. I'm not complaining though because with the humidity I will take any air conditioning I can ...
Day 2 - Woodworth, LA
... no hot water! Surprise of the day, we only had to pay $7/night...for the life of us, we can't figure out how the office came up with that figure. Sherry, the good person that she is, tried explaining the math, but they insisted. $14. Ok. Thanks. We like Louisiana math but I don't think I should try using it at work! ;-) Early night tonight. Long road trip tomorrow, will be gone by daybreak. Next stop, Roswell, New Mexico! Will be on the lookout for aliens!!! Thanks for ...


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Town Square
Rivals play for first time in seven years
Original post made on Feb 28, 2013
Read the full story here Web Link posted Thursday, February 28, 2013, 4:59 PM
Comments (3)
a resident of The Crossings
on Feb 28, 2013 at 6:59 pm
GO Bears!! "Class of 2000"
a resident of Waverly Park
on Mar 4, 2013 at 2:11 pm
Great to see the Voice finally cover school sports!
a resident of Whisman Station
on Mar 4, 2013 at 5:08 pm
If they have not played each other in 7 years, AND they are not even in the same conference....how can they be RIVALS???
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