text:
|Classification and external resources
Human blood from a case of iron-deficiency anemia
|med/132 emerg/808 emerg/734
Anemia (/əˈniːmiə/; also spelled anaemia and anæmia); is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood.[1][2] Anemia may also be diagnosed where there is decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency. The name is derived from Ancient Greek: ἀναιμία anaimia, meaning lack of blood, from ἀν- an-, "not" + αἷμα haima, "blood". Because hemoglobin (found inside RBCs) normally carries oxygen from the lungs to the capillaries, anemia leads to hypoxia (lack of oxygen) in organs. Since all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences.
Anemia is the most common disorder of the blood. The several kinds of anemia are produced by a variety of underlying causes. It can be classified in a variety of ways, based on the morphology of RBCs, underlying etiologic mechanisms, and discernible clinical spectra, to mention a few. The three main classes include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive blood cell destruction (hemolysis) or deficient red blood cell production (ineffective hematopoiesis).
Of the two major approaches to diagnosis, the "kinetic" approach involves evaluating production, destruction and loss,[3] and the "morphologic" approach groups anemia by red blood cell size. The morphologic approach uses a quickly available and low-cost lab test as its starting point (the MCV), although this test can lack sensitivity and specificity in many diseases.[4] On the other hand, focusing early on the question of production may allow the clinician to expose cases more rapidly where multiple causes of anemia coexist.
- 1 Signs and symptoms
- 2 Causes
- 3 Diagnosis
- 4 Treatments
- 5 References
- 6 External links
Signs and symptoms[edit]
Anemia goes undetected in many people, and symptoms can be minor or vague. The signs and symptoms can be related to the underlying cause or the anemia itself.
Most commonly, people with anemia report feelings of weakness, or fatigue, general malaise, and sometimes poor concentration. They may also report dyspnea (shortness of breath) on exertion. In very severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing cardiac output. The patient may have symptoms related to this, such as palpitations, angina (if pre-existing heart disease is present), intermittent claudication of the legs, and symptoms of heart failure.
On examination, the signs exhibited may include pallor (pale skin, mucosal linings, conjunctiva and nail beds, but this is not a reliable sign. There may be signs of specific causes of anemia, e.g., koilonychia (in iron deficiency), jaundice (when anemia results from abnormal break down of red blood cells — in hemolytic anemia), bone deformities (found in thalassemia major) or leg ulcers (seen in sickle-cell disease).
In severe anemia, there may be signs of a hyperdynamic circulation: tachycardia (a fast heart rate), bounding pulse, flow murmurs, and cardiac ventricular hypertrophy (enlargement). There may be signs of heart failure.
Pica, the consumption of non-food items such as ice, but also paper, wax, or grass, and even hair or dirt, may be a symptom of iron deficiency, although it occurs often in those who have normal levels of hemoglobin.
Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced scholastic performance in children of school age. Restless legs syndrome is more common in those with iron-deficiency anemia.
Broadly, causes of anemia may be classified as impaired red blood cell (RBC) production, increased RBC destruction (hemolytic anemias), blood loss and fluid overload (hypervolemia). Several of these may interplay to cause anemia eventually. Indeed, the most common cause of anemia is blood loss, but this usually does not cause any lasting symptoms unless a relatively impaired RBC production develops, in turn most commonly by iron deficiency.[6] (See Iron deficiency anemia)
Impaired production[edit]
- Disturbance of proliferation and differentiation of stem cells
- Pure red cell aplasia[7]
- Aplastic anemia[7] affects all kinds of blood cells. Fanconi anemia is a hereditary disorder or defect featuring aplastic anemia and various other abnormalities.
- Anemia of renal failure[7] by insufficient erythropoietin production
- Anemia of endocrine disorders
- Disturbance of proliferation and maturation of erythroblasts
- Pernicious anemia[7] is a form of megaloblastic anemia due to vitamin B12 deficiency dependent on impaired absorption of vitamin B12. Lack of dietary B12 causes non-pernicious megaloblastic anemia
- Anemia of folic acid deficiency,[7] as with vitamin B12, causes megaloblastic anemia
- Anemia of prematurity, by diminished erythropoietin response to declining hematocrit levels, combined with blood loss from laboratory testing, generally occurs in premature infants at two to six weeks of age.
- Iron deficiency anemia, resulting in deficient heme synthesis[7]
- Thalassemias, causing deficient globin synthesis[7]
- Congenital dyserythropoietic anemias, causing ineffective erythropoiesis
- Anemia of renal failure[7] (also causing stem cell dysfunction)
- Other mechanisms of impaired RBC production
- Myelophthisic anemia[7] or myelophthisis is a severe type of anemia resulting from the replacement of bone marrow by other materials, such as malignant tumors or granulomas.
- Myelodysplastic syndrome[7]
- anemia of chronic inflammation[7]
Increased destruction[edit]
Anemias of increased red blood cell destruction are generally classified as hemolytic anemias. These are generally featuring jaundice and elevated lactate dehydrogenase levels.
- Intrinsic (intracorpuscular) abnormalities[7] cause premature destruction. All of these, except paroxysmal nocturnal hemoglobinuria, are hereditary genetic disorders.[8]
- Hereditary spherocytosis[7] is a hereditary defect that results in defects in the RBC cell membrane, causing the erythrocytes to be sequestered and destroyed by the spleen.
- Hereditary elliptocytosis[7] is another defect in membrane skeleton proteins.
- Abetalipoproteinemia,[7] causing defects in membrane lipids
- Enzyme deficiencies
- Pyruvate kinase and hexokinase deficiencies,[7] causing defect glycolysis
- Glucose-6-phosphate dehydrogenase deficiency and glutathione synthetase deficiency,[7] causing increased oxidative stress
- Hemoglobinopathies
- Sickle cell anemia[7]
- Hemoglobinopathies causing unstable hemoglobins[7]
- Paroxysmal nocturnal hemoglobinuria[7]
- Extrinsic (extracorpuscular) abnormalities
- Antibody-mediated
- Warm autoimmune hemolytic anemia is caused by autoimmune attack against red blood cells, primarily by IgG. It is the most common of the autoimmune hemolytic diseases.[9] It can be idiopathic, that is, without any known cause, drug-associated or secondary to another disease such as systemic lupus erythematosus, or a malignancy, such as chronic lymphocytic leukemia.[10][10]
- Cold agglutinin hemolytic anemia is primarily mediated by IgM. It can be idiopathic[11] or result from an underlying condition.
- Rh disease,[7] one of the causes of hemolytic disease of the newborn
- Transfusion reaction to blood transfusions[7]
- Mechanical trauma to red cells
- Microangiopathic hemolytic anemias, including thrombotic thrombocytopenic purpura and disseminated intravascular coagulation[7]
- Infections, including malaria[7]
- Heart surgery
- Haemodialysis
- Antibody-mediated
Blood loss[edit]
- Anemia of prematurity from frequent blood sampling for laboratory testing, combined with insufficient RBC production
- Trauma[7] or surgery, causing acute blood loss
- Gastrointestinal tract lesions,[7] causing either acute bleeds (e.g. variceal lesions, peptic ulcers or chronic blood loss (e.g. angiodysplasia)
- Gynecologic disturbances,[7] also generally causing chronic blood loss
- From menstruation, mostly among young women or older women who have fibroids
Fluid overload[edit]
Fluid overload (hypervolemia) causes decreased hemoglobin concentration and apparent anemia:
- General causes of hypervolemia include excessive sodium or fluid intake, sodium or water retention and fluid shift into the intravascular space.[12]
- Anemia of pregnancy is induced by blood volume expansion experienced in pregnancy.
Anemia is typically diagnosed on a complete blood count. Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry, which is an important tool in distinguishing between the causes of anemia. Examination of a stained blood smear using a microscope can also be helpful, and it is sometimes a necessity in regions of the world where automated analysis is less accessible.
In modern counters, four parameters (RBC count, hemoglobin concentration, MCV and RDW) are measured, allowing others (hematocrit, MCH and MCHC) to be calculated, and compared to values adjusted for age and sex. Some counters estimate hematocrit from direct measurements.
|Age or gender group
|Hb threshold (g/dl)
|Hb threshold (mmol/l)
|Children (0.5–5.0 yrs)
|Children (5–12 yrs)
|Teens (12–15 yrs)
|Women, non-pregnant (>15yrs)
|Women, pregnant
|Men (>15yrs)
Reticulocyte counts, and the "kinetic" approach to anemia, have become more common than in the past in the large medical centers of the United States and some other wealthy nations, in part because some automatic counters now have the capacity to include reticulocyte counts. A reticulocyte count is a quantitative measure of the bone marrow's production of new red blood cells. The reticulocyte production index is a calculation of the ratio between the level of anemia and the extent to which the reticulocyte count has risen in response. If the degree of anemia is significant, even a "normal" reticulocyte count actually may reflect an inadequate response.
If an automated count is not available, a reticulocyte count can be done manually following special staining of the blood film. In manual examination, activity of the bone marrow can also be gauged qualitatively by subtle changes in the numbers and the morphology of young RBCs by examination under a microscope. Newly formed RBCs are usually slightly larger than older RBCs and show polychromasia. Even where the source of blood loss is obvious, evaluation of erythropoiesis can help assess whether the bone marrow will be able to compensate for the loss, and at what rate.
When the cause is not obvious, clinicians use other tests, such as: ESR, ferritin, serum iron, transferrin, RBC folate level, serum vitamin B12, hemoglobin electrophoresis, renal function tests (e.g. serum creatinine) although the tests will depend on the clinical hypothesis that is being investigated.
When the diagnosis remains difficult, a bone marrow examination allows direct examination of the precursors to red cells, although is rarely used as is painful, invasive and is hence reserved for cases where severe pathology needs to be determined or excluded.
Red blood cell size[edit]
In the morphological approach, anemia is classified by the size of red blood cells; this is either done automatically or on microscopic examination of a peripheral blood smear. The size is reflected in the mean corpuscular volume (MCV). If the cells are smaller than normal (under 80 fl), the anemia is said to be microcytic; if they are normal size (80–100 fl), normocytic; and if they are larger than normal (over 100 fl), the anemia is classified as macrocytic. This scheme quickly exposes some of the most common causes of anemia; for instance, a microcytic anemia is often the result of iron deficiency. In clinical workup, the MCV will be one of the first pieces of information available, so even among clinicians who consider the "kinetic" approach more useful philosophically, morphology will remain an important element of classification and diagnosis.
Limitations of MCV include cases where the underlying cause is due to a combination of factors - such as iron deficiency (a cause of microcytosis) and vitamin B12 deficiency (a cause of macrocytosis) where the net result can be normocytic cells.
Production vs. destruction or loss[edit]
The "kinetic" approach to anemia yields arguably the most clinically relevant classification of anemia. This classification depends on evaluation of several hematological parameters, particularly the blood reticulocyte (precursor of mature RBCs) count. This then yields the classification of defects by decreased RBC production versus increased RBC destruction and/or loss. Clinical signs of loss or destruction include abnormal peripheral blood smear with signs of hemolysis; elevated LDH suggesting cell destruction; or clinical signs of bleeding, such as guaiac-positive stool, radiographic findings, or frank bleeding.
The following is a simplified schematic of this approach:
* For instance, sickle cell anemia with superimposed iron deficiency; chronic gastric bleeding with B12 and folate deficiency; and other instances of anemia with more than one cause.
** Confirm by repeating reticulocyte count: ongoing combination of low reticulocyte production index, normal MCV and hemolysis or loss may be seen in bone marrow failure or anemia of chronic disease, with superimposed or related hemolysis or blood loss.
Here is a schematic representation of how to consider anemia with MCV as the starting point:
|Reticulocyte production index shows inadequate production response to anemia.
|Reticulocyte production index shows appropriate response to anemia = ongoing hemolysis or blood loss without RBC production problem.
|No clinical findings consistent with hemolysis or blood loss: pure disorder of production.
|Clinical findings and abnormal MCV: hemolysis or loss and chronic disorder of production*.
|Clinical findings and normal MCV= acute hemolysis or loss without adequate time for bone marrow production to compensate**.
|Macrocytic anemia (MCV>100)
|Normocytic anemia (80<MCV<100)
|Microcytic anemia (MCV<80)
|Macrocytic anemia (MCV>100)
|Normocytic anemia (MCV 80–100)
|Microcytic anemia (MCV<80)
|High reticulocyte count
|Low reticulocyte count
Other characteristics visible on the peripheral smear may provide valuable clues about a more specific diagnosis; for example, abnormal white blood cells may point to a cause in the bone marrow.
Microcytic anemia is primarily a result of hemoglobin synthesis failure/insufficiency, which could be caused by several etiologies:
- Heme synthesis defect
- Iron deficiency anemia (microcytosis is not always present)
- Anemia of chronic disease (more commonly presenting as normocytic anemia)
- Globin synthesis defect
- Alpha-, and beta-thalassemia
- HbE syndrome
- HbC syndrome
- Various other unstable hemoglobin diseases
- Sideroblastic defect
- Hereditary sideroblastic anemia
- Acquired sideroblastic anemia, including lead toxicity
- Reversible sideroblastic anemia
Iron deficiency anemia is the most common type of anemia overall and it has many causes. RBCs often appear hypochromic (paler than usual) and microcytic (smaller than usual) when viewed with a microscope.
- Iron deficiency anemia is due to insufficient dietary intake or absorption of iron to meet the body's needs. Infants, toddlers, and pregnant women have higher than average needs. Increased iron intake is also needed to offset blood losses due to digestive tract issues, frequent blood donations, or heavy menstrual periods.[14] Iron is an essential part of hemoglobin, and low iron levels result in decreased incorporation of hemoglobin into red blood cells. In the United States, 12% of all women of childbearing age have iron deficiency, compared with only 2% of adult men. The incidence is as high as 20% among African American and Mexican American women.[15] Studies have shown iron deficiency without anemia causes poor school performance and lower IQ in teenage girls, although this may be due to socioeconomic factors.[16][17] Iron deficiency is the most prevalent deficiency state on a worldwide basis. It is sometimes the cause of abnormal fissuring of the angular (corner) sections of the lips (angular stomatitis).
- In the United States, the most common cause of iron deficiency is bleeding or blood loss, usually from the gastrointestinal tract. Fecal occult blood testing, upper endoscopy and lower endoscopy should be performed to identify bleeding lesions. In older men and women, the chances are higher that bleeding from the gastrointestinal tract could be due to colon polyps or colorectal cancer.
- Worldwide, the most common cause of iron deficiency anemia is parasitic infestation (hookworms, amebiasis, schistosomiasis and whipworms).[18]
The Mentzer index (mean cell volume divided by the RBC count) predicts whether microcytic anaemia may be due to iron deficiency or thallasemia, although it requires confirmation.[citation needed]
- Megaloblastic anemia, the most common cause of macrocytic anemia, is due to a deficiency of either vitamin B12, folic acid, or both. Deficiency in folate and/or vitamin B12 can be due either to inadequate intake or insufficient absorption. Folate deficiency normally does not produce neurological symptoms, while B12 deficiency does.
- Pernicious anemia is caused by a lack of intrinsic factor, which is required to absorb vitamin B12 from food. A lack of intrinsic factor may arise from an autoimmune condition targeting the parietal cells (atrophic gastritis) that produce intrinsic factor or against intrinsic factor itself. These lead to poor absorption of vitamin B12.
- Macrocytic anemia can also be caused by removal of the functional portion of the stomach, such as during gastric bypass surgery, leading to reduced vitamin B12/folate absorption. Therefore, one must always be aware of anemia following this procedure.
- Hypothyroidism
- Alcoholism commonly causes a macrocytosis, although not specifically anemia. Other types of liver disease can also cause macrocytosis.
- Drugs such as Methotrexate, zidovudine, and other substances may inhibit DNA replication such as heavy metals (e.g. Lead)
Macrocytic anemia can be further divided into "megaloblastic anemia" or "nonmegaloblastic macrocytic anemia". The cause of megaloblastic anemia is primarily a failure of DNA synthesis with preserved RNA synthesis, which results in restricted cell division of the progenitor cells. The megaloblastic anemias often present with neutrophil hypersegmentation (six to 10 lobes). The nonmegaloblastic macrocytic anemias have different etiologies (i.e. unimpaired DNA globin synthesis,) which occur, for example, in alcoholism.
In addition to the nonspecific symptoms of anemia, specific features of vitamin B12 deficiency include peripheral neuropathy and subacute combined degeneration of the cord with resulting balance difficulties from posterior column spinal cord pathology.[19] Other features may include a smooth, red tongue and glossitis.
The treatment for vitamin B12-deficient anemia was first devised by William Murphy, who bled dogs to make them anemic, and then fed them various substances to see what (if anything) would make them healthy again. He discovered that ingesting large amounts of liver seemed to cure the disease. George Minot and George Whipple then set about to isolate the curative substance chemically and ultimately were able to isolate the vitamin B12 from the liver. All three shared the 1934 Nobel Prize in Medicine.[20]
Normocytic anemia occurs when the overall hemoglobin levels are decreased, but the red blood cell size (mean corpuscular volume) remains normal. Causes include:
- Acute blood loss
- Anemia of chronic disease
- Aplastic anemia (bone marrow failure)
- Hemolytic anemia
A dimorphic appearance on a peripheral blood smear occurs when there are two simultaneous populations of red blood cells, typically of different size and hemoglobin content (this last feature affecting the color of the red blood cell on a stained peripheral blood smear). For example, a person recently transfused for iron deficiency would have small, pale, iron deficient red blood cells (RBCs) and the donor RBCs of normal size and color. Similarly, a person transfused for severe folate or vitamin B12 deficiency would have two cell populations, but, in this case, the patient's RBCs would be larger and paler than the donor's RBCs. A person with sideroblastic anemia (a defect in heme synthesis, commonly caused by alcoholism, but also drugs/toxins, nutritional deficiencies, a few acquired and rare congenital diseases) can have a dimorphic smear from the sideroblastic anemia alone. Evidence for multiple causes appears with an elevated RBC distribution width (RDW), indicating a wider-than-normal range of red cell sizes, also seen in common nutritional anemia.
Heinz body anemia[edit]
Heinz bodies form in the cytoplasm of RBCs and appear as small dark dots under the microscope. Heinz body anemia has many causes, and some forms can be drug-induced. It is triggered in cats by eating onions[21] or acetaminophen (paracetamol). It can be triggered in dogs by ingesting onions or zinc, and in horses by ingesting dry red maple leaves.
Hyperanemia is a severe form of anemia, in which the hematocrit is below 10%.
Refractory anemia[edit]
Refractory anemia, an anemia which does not respond to treatment,[22] is often seen secondary to myelodysplastic syndromes.[23]
Iron deficiency anemia may also be refractory as a clinical manifestation of gastrointestinal problems which disrupt iron absorption or cause occult bleeding. [24]
Treatments for anemia depend on severity and cause.
Oral iron[edit]
Nutritional iron deficiency is common in developing nations. An estimated two-thirds of children and of women of childbearing age in most developing nations are estimated to suffer from iron deficiency; one-third of them have the more severe form of the disorder, anemia.[25] Iron deficiency from nutritional causes is rare in men and postmenopausal women. The diagnosis of iron deficiency mandates a search for potential sources of loss, such as gastrointestinal bleeding from ulcers or colon cancer. Mild to moderate iron-deficiency anemia is treated by oral iron supplementation with ferrous sulfate, ferrous fumarate, or ferrous gluconate. When taking iron supplements, stomach upset and/or darkening of the feces are commonly experienced. The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed. Vitamin C aids in the body's ability to absorb iron, so taking oral iron supplements with orange juice is of benefit.
In anemias of chronic disease, associated with chemotherapy, or associated with renal disease, some clinicians prescribe recombinant erythropoietin or epoetin alfa, to stimulate RBC production, although since there is also concurrent iron deficiency and inflammation present, parenteral iron is advised to be taken concurrently.[26]
Injectable iron[edit]
In cases where oral iron has either proven ineffective, would be too slow (for example, pre-operatively) or where absorption is impeded (for example in cases of inflammation), parenteral iron can be used. The body can absorb up to 6 mg iron daily from the gastrointestinal tract. In many cases the patient has a deficit of over 1,000 mg of iron which would require several months to replace. This can be given concurrently with erythropoietin to ensure sufficient iron for increased rates of erythropoiesis.
Blood transfusions[edit]
In those with coronary artery disease who are not actively bleeding blood transfusions are only recommended when the hemoglobin is below 70 or 80 g/L.[27] Transfusing earlier does not improve survival.[28]
Four randomized, controlled clinical trials have been conducted to evaluate aggressive versus conservative transfusion strategies in critically ill patients. All four of these studies failed to find a benefit with more aggressive transfusion strategies.[29][30][31][32] And more recent studies have shown that transfusing patients worsens outcome. This is further substantiated by guidelines increasingly advising that transfusions should only be undertaken in cases of cardiovascular instability.[33]
In addition, at least two retrospective studies have shown increases in adverse clinical outcomes in critically ill patients who underwent more aggressive transfusion strategies.[34][35]
Hyperbaric oxygen[edit]
Treatment of exceptional blood loss (anemia) is recognized as an indication for hyperbaric oxygen (HBO) by the Undersea and Hyperbaric Medical Society.[36][37] The use of HBO is indicated when oxygen delivery to tissue is not sufficient in patients who cannot be given blood transfusions for medical or religious reasons. HBO may be used for medical reasons when threat of blood product incompatibility or concern for transmissible disease are factors.[36] The beliefs of some religions (ex: Jehovah's Witnesses) may require they use the HBO method.[36] A 2005 review of the use of HBO in severe anemia found all publications reported positive results.[38]
Vitamin supplements given orally (folic acid or vitamin B12) or intramuscularly (vitamin B12) will replace specific deficiencies.
Erythropoiesis-stimulating agent[edit]
The motive for the administration of an erythropoiesis-stimulating agent (ESA) is to maintain hemoglobin at the lowest level that both minimizes transfusions and meets the individual persons needs.[39] They should not be used for mild or moderate anemia.[28] They are not recommended in people with chronic kidney disease unless hemoglobin levels are less than 10 g/dL or they have symptoms of anemia. Their use should be along with parenteral iron.[39][40]
- ^ MedicineNet.com --> Definition of Anemia Last Editorial Review: 12/9/2000 8:31:00 AM
- ^ merriam-webster dictionary --> anemia Retrieved on May 25, 2009
- ^ "eMedicine – Anemia, Chronic : Article by Fredrick M Abrahamian, DO, FACEP". Emedicine.com. 2009-12-07. Retrieved 2010-08-24.
- ^ Frank H. Wians et al, Am J Clin Pathol 2001;115:112-118
- ^ eMedicineHealth > anemia article Author: Saimak T. Nabili, MD, MPH. Editor: Melissa Conrad Stöppler, MD. Last Editorial Review: 12/9/2008. Retrieved on 4 April 2009
- ^ National Heart Lung and Blood Institute > What Causes Anemia? Retrieved on June 9, 2010
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa Table 12-1 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology. Philadelphia: Saunders. ISBN 1-4160-2973-7. 8th edition.
- ^ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. p. 432 ISBN 978-1-4160-2973-1
- ^ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. p. 637. ISBN 0-7216-0187-1.
- ^ a b AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA)[dead link] By J.L. Jenkins. The Regional Cancer Center. 2001
- ^ Berentsen S, Beiske K, Tjønnfjord GE (October 2007). "Primary chronic cold agglutinin disease: An update on pathogenesis, clinical features and therapy". Hematology 12 (5): 361–70. doi:10.1080/10245330701445392. PMC 2409172. PMID 17891600.
- ^ Page 62 (Fluid imbalances) in: Portable Fluids and Electrolytes (Portable Series). Hagerstwon, MD: Lippincott Williams & Wilkins. 2007. ISBN 1-58255-678-4.
- ^ World Health Organization (2008). Worldwide prevalence of anaemia 1993–2005. Geneva: World Health Organization. ISBN 978-92-4-159665-7. Archived from the original on 12 March 2009. Retrieved 2009-03-25.
- ^ Recommendations to Prevent and Control Iron Deficiency in the United States MMWR 1998;47 (No. RR-3) p. 5
- ^ "Iron Deficiency --- United States, 1999--2000". MMWR 51 (40): 897–899. October 11, 2002. Retrieved 21 April 2012.
- ^ Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG (2001). "Iron Deficiency and Cognitive Achievement Among School-Aged Children and Adolescents in the United States". Pediatrics 107 (6): 1381–1386. doi:10.1542/peds.107.6.1381. PMID 11389261.
- ^ Grantham-McGregor S, Ani C (2001). "Iron-Deficiency Anemia: Reexamining the Nature and Magnitude of the Public Health Problem". J Nutr 131 (2): 649S–668S. PMID 11160596.
- ^ "Iron Deficiency Anaemia: Assessment, Prevention, and Control: A guide for programme managers" (PDF). Retrieved 2010-08-24.
- ^ eMedicine – Vitamin B-12 Associated Neurological Diseases : Article by Niranjan N Singh, MD, DM, DNB July 18, 2006
- ^ "Physiology or Medicine 1934 – Presentation Speech". Nobelprize.org. 1934-12-10. Archived from the original on 28 August 2010. Retrieved 2010-08-24.
- ^ "Onions are Toxic to Cats". Peteducation.com. Archived from the original on 3 September 2010. Retrieved 2010-08-24.
- ^ "MedTerms Definition: Refractory Anemia". Medterms.com. 2011-04-27. Retrieved 2011-10-31.
- ^ "Good Source for later". Atlasgeneticsoncology.org. Retrieved 2011-10-31.
- ^ Mody RJ, Brown PI, Wechsler DS (February 2003). "Refractory iron deficiency anemia as the primary clinical manifestation of celiac disease". J. Pediatr. Hematol. Oncol. 25 (2): 169–72. doi:10.1097/00043426-200302000-00018. PMID 12571473.
- ^ West CE (November 1996). "Strategies to control nutritional anemia". Am. J. Clin. Nutr. 64 (5): 789–90. PMID 8901803.
- ^ http://guidance.nice.org.uk/CG114/Guidance/pdf/English
- ^ Amir Qaseem (Dec 3, 2013). "Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians". Annals of Internal Medicine. doi:10.7326/0003-4819-159-11-201312030-00009.
- ^ a b Kansagara, D; Dyer, E; Englander, H; Fu, R; Freeman, M; Kagen, D (Dec 3, 2013). "Treatment of anemia in patients with heart disease: a systematic review.". Annals of internal medicine 159 (11): 746–57. PMID 24297191.
- ^ Hébert PC, Wells G, Blajchman MA et al. (1999). "A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group". N. Engl. J. Med. 340 (6): 409–17. doi:10.1056/NEJM199902113400601. PMID 9971864.
- ^ Bush RL, Pevec WC, Holcroft JW (1997). "A prospective, randomized trial limiting perioperative red blood cell transfusions in vascular patients". Am. J. Surg. 174 (2): 143–8. doi:10.1016/S0002-9610(97)00073-1. PMID 9293831.
- ^ Bracey AW, Radovancevic R, Riggs SA et al. (1999). "Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome". Transfusion 39 (10): 1070–7. doi:10.1046/j.1537-2995.1999.39101070.x. PMID 10532600.
- ^ McIntyre LA, Fergusson DA, Hutchison JS et al. (2006). "Effect of a liberal versus restrictive transfusion strategy on mortality in patients with moderate to severe head injury". Neurocritical care 5 (1): 4–9. doi:10.1385/NCC:5:1:4. PMID 16960287.
- ^ Goddard, A. F.; James, M. W.; McIntyre, A. S.; Scott, B. B.; British Society of Gastroenterology (2011). "Guidelines for the management of iron deficiency anaemia". Gut 60 (10): 1309–1316. doi:10.1136/gut.2010.228874. PMID 21561874.
- ^ Corwin HL, Gettinger A, Pearl RG et al. (2004). "The CRIT Study: Anemia and blood transfusion in the critically ill—current clinical practice in the United States". Crit. Care Med. 32 (1): 39–52. doi:10.1097/01.CCM.0000104112.34142.79. PMID 14707558.
- ^ Vincent, JL; Baron, JF; Reinhart, K et al. (2002). "Anemia and blood transfusion in critically ill patients". JAMA 288 (12): 1499–507. doi:10.1001/jama.288.12.1499. PMID 12243637.
- ^ a b c Undersea and Hyperbaric Medical Society. "Exceptional Blood Loss — Anemia". Retrieved 2008-05-19.[dead link]
- ^ Hart GB, Lennon PA, Strauss MB. (1987). "Hyperbaric oxygen in exceptional acute blood-loss anemia". J. Hyperbaric Med 2 (4): 205–210. Retrieved 2008-05-19.
- ^ Van Meter KW (2005). "A systematic review of the application of hyperbaric oxygen in the treatment of severe anemia: an evidence-based approach". Undersea Hyperb Med 32 (1): 61–83. PMID 15796315. Retrieved 2008-05-19.
- ^ a b Aapro, M. S.; Link, H. (1 May 2008). "September 2007 Update on EORTC Guidelines and Anemia Management with Erythropoiesis-Stimulating Agents". The Oncologist 13 (Supplement 3): 33–36. doi:10.1634/theoncologist.13-S3-33.
- ^ American Society of Nephrology, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Society of Nephrology), retrieved August 17, 2012
External links[edit]
- National Anemia Action Council (USA)
- Anemia - Lab Tests Online


text:
QT certainly did not steal dialogue or characters in that case, but he definitely used the scene in the Leone movie as a template to create the mood & tension he wanted in IG. He took something, but I can't call it stealing in any traditional way.
What's the old expression... good artists steal, great artists make it their own?
Franco Nero Insists Quentin Tarantino Will Be In His Western 'The Angel, The Brute, And The Wise' > The Playlist
Way back at the beginning of the year, there was a bit of excitement and confusion when legendary Italian actor Franco Nero said he was making a spaghetti western with Quentin Tarantino titled "The Angel, the Brute and the Wise." Many assumed the latter was directing the film—which Nero said would also star Keith Carradine and Treat Williams—however it soon transpired that Tarantino was directing a spaghetti western of sorts, "Django Unchained," and that "The Angel, the Brute and the Wise" was something else entirely. Anyway, as talk of Tarantino's slavery vengeance pic heated up, everyone pretty much forgot about Nero's project but he still insists it's happening and that Tarantino will play a small role in it.
"I made him sign a letter of intent saying that he would do the movie," Nero recently told Box Office Magazine (via /Film). "I am sure that very soon we will do it."
Kevin Costner Joining Quentin Tarantino's 'Django Unchained' | /Film
With this and Superman Costner's getting some nice gigs.
Samuel L. Jackson to Star in Quentin Tarantino's 'Django Unchained' | The Wrap Movies
Not a surprise, but still good news, if you ask me.The movie is described as a spaghetti western, but it's an especially violent one. Django is a slave who is freed by a bounty hunter who kills -- instead of merely capturing -- the outlaws he searches for. The bounty hunter, a German dentist, befriends Django and helps him free his wife from a vile plantation owner, Candie.
Jackson will play Stephen, a sadistic slave in Candie's home.
Thank God you saved me the trouble of finding this buried thread...
DJANGO UNCHAINED Chains Up A DEADWOOD STAR (And Sam Jackson) | CHUD.com
Deadwood ain't a bad pot for Tarantino to pull from for his upcoming Southern, Django Unchained. He might be doing just that if the negotiations go through and Gerald McRaney joins the cast in an unknown role. The famously short-lived HBO show isn't the only program that McRaney has been a part of, as he's appeared in major series for decades, going all the way back to Gunsmoke where he appeared as the final gun-fighting guest star.
I wish there was more information to communicate, but the casting isn't entirely official and there's no suggestion of the part he would fill. Had I read the script like everyone and their dog's intern, I could hazard a guess, but I'm hoping to enjoy this one untainted like the rest of you.
DJANGO Unchains Costner, Needs A New Sickeningly Evil Slave-Driver | CHUD.com
Bad decision by Costner. QT oughtta give Michael Keaton a call.

subset: commoncrawl


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Hello All,
Im really looking for help, as we have been unable to come up with a solution for this problem.
It seems that as soon as we run our outdoor sprinkler system, the tub runs yellow water. We close the valve to the sprinkler system, and the water clears up. Open the valve, and run the sprinklers, and it becomes yellow again.
We thought that it may be a back-siphonage problem, so we replaced the PVB valve for backflow prevention. Still yellow water. We thought that we may not have installed it high enough, so re-installed it well over the 12" minimum recommended. Still yellow water.
It seems that once we open the main valve to the outside sprinklers the water is still ok. Once we actually run the sprinklers (the heads pop up), is when the water starts to turn yellow.
Any thoughts would be greatly appreciated. Im at wits end...
Thanks in advance...


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Jewelry >I W Marks Jewelers
3841 Bellaire Blvd, Houston, TX | Directions 7702529.705924 -95.437972
M-W, Friday, and Saturday 10am-6pm, Thursday 10am-9pm, Closed on Sunday
Neighborhoods: Southside Place
If I could give them 10 stars I would. The most friendly and compassionate group of people I have ever had the pleasure of working with.
They listened to what me and my husband needed for our wedding rings and delivered with exact precision.
It is a family owned business and they treat you like family when you walk in the door. They have everything you need for any occasion. All my special jewelry items will come from the Marks brothers!!
What a lifesaver! – I needed a gift for my anniversary night, last minute shopping that I forgot to do very attentive to my needs, great service, friendly and fun! Made my purchase easy!
I will return soon for the next anniversary and b-day gift!
Wonderful Service Wonderful merchandise = satisfied wife – I W Marks is a first class store! Friendly associates, wonderful owners, and beautiful merchandise. My husband and I went in looking to upgrade my wedding ring. Daniel Marks spent time with us helping us find my perfect stone and setting. Never once did I feel rushed, or in a hurry. Daniel was patient and kind and walked me through all the steps to getting the ring that fit my style and budget.
August 13, 2011 – I was told about this jewelry store by a friend. This store has the best selection of diamond rings/settings I have ever seen, and I went to many stores in Houston. The staff is very professional and informational. I had a wonderful experience and will be back. They also mounted my diamond in a new setting and resized the ring while I waited. David Holtorf was my salesman and was excellent.
Great Selection and Excellent Service – I was in the store the other day and had a set budget. I told the sales person right away what I had to spend and that I wanted an elegant necklace to wear to an event I was attending. They showed me a variety of necklaces all within my budget. I could not be more pleased. I was treated with respect, even though my budget was not very large. I found a necklace that makes me feel beautiful and will definitely be back.
Great Customer Service – I'm taking a trip next week and was in need of an everyday, versitle watch, that would travel well, affordable, and fashionable. A tall order! I was lucky, both Brad and Daniel Marks helped me to get exactly what I was looking for. I really appreciate the time they took with me to go over all of my options. I could not be any happier.
Avoid This Place!!! – After purchasing a gold TAG Heuer watch ($1,400) from IW Marks, I returned the next day to have it re-sized. The watch repairman said there was a problem with the bracelet because he couldn't remove a link without damaging the bracelet. I suggested replacing the bracelet. I observed as he took it to the manager (owner's son) who, with brute force, twisted the link to remove it. Sure enough, he bent another link and chipped off a 2mm piece of the gold plating from the adjacent link. I pointed out to the repairman that the manager had damaged the bracelet (which cost $250 to replace). The watch repairman walked back to point it out to the manager -- who then denied it. The repairman, obviously not wanting to lose his job said there was nothing he could do. When I confronted the manager, IW Marks' son, he again denied it -- even though he knew I was watching him do it. He claimed the damage was already there. I went to a reputable jewelry store and paid $250 to replace the bracelet.
I will ** NEVER ** shop at IW Marks jewelry store again. If you choose to, please remember that you were warned.
Excellent Place To Shop – I recently bought my husband some cuff links. I did not have a very large budget, but knew I wanted to get him something unique and nice. I told the owner, Brad Marks, what my budget was and he found these beautiful Scott Kay cuff links for my husband. My husband loves them. I would definitely recommend this store.
Waste of time – I agree fully. I W Marks staff showed no interest in waiting on us. There are much better jewelry stores with better selections and pricing than I W Marks. We went to another store and had our wedding rings designed and made there.
Do not waste your time going to I W Marks.
A Fantastic Place – A year ago my husband suprised me with a beautiful pendant for Mother's Day. One of the designers at I W Marks helped him to create his idea and it is absolutely beautiful and I receive so many compliments on it. The bale has come off a couple of times and when I return to the store to have it repaired I am treated very professionally and taken care of with politeness. I love going to this store and if I see a ring or a piece of jewelery I would like to look at closer, even though I am not going to purchase it. they seem to have no problem taking it from the case so I can look at it or even try it on. Whenever I want to purchase a quality piece of jewelery in the future this will be the store I will go to. Perhaps they may be a little higher in price but they have quality merchandise, employees who are very knowledgeable plus they also have great sales. Thank you I W Marks for being a great place to shop.
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Availability: Holiday Inn Parramatta
Please enter your travel dates.
Standard Room
- 1 bed
Standard Room, 1 King Bed, Accessible, Non Smoking
- 1 king
Superior Room, 2 Double Beds, Non Smoking
- 2 double
Standard Room, 2 Single Beds, Non Smoking
- 2 single
4.5-star luxury hotel in Parramatta with an outdoor pool
Situated in the city center, this luxury hotel is close to Westfield Parramatta Shopping Centre, Queens Wharf Reserve, and Parramatta Park. Also nearby are Parramatta Heritage Centre and Riverside Theatres.
Hotel Features
In addition to a restaurant, Holiday Inn Parramatta features an outdoor pool. Other amenities include a bar/lounge and 24-hour room service.
Room Amenities
LCD televisions come with satellite channels. Guestrooms also feature iPod docking stations, refrigerators, and wireless Internet access (surcharge).Information missing or incorrect? Tell us!
Holiday Inn Parramatta Amenities
- General
In addition to an outdoor pool, Holiday Inn Parramatta provides a spa tub and a fitness center. The hotel offers a restaurant. A bar/lounge is on site where guests can unwind with a drink. High-speed wireless Internet access is available for a surcharge.
This 4.5-star property offers access to a business center, audiovisual equipment, and small meeting rooms. Event facilities measuring 2830 square feet (263 square meters) include conference/meeting rooms, a ballroom, and banquet facilities. This luxury hotel also offers multilingual staff, coffee/tea in the lobby, and complimentary newspapers in the lobby.
Holiday Inn Parramatta is a smoke-free property.
- Fitness facilities
- Number of buildings/towers - 1
- Fireplace in lobby
- Parking nearby
- Room service (24 hours)
- Covered parking (surcharge)
- Street parking (metered)
- Babysitting or childcare (surcharge)
- Parking nearby (surcharge)
- Meeting facilities size (meters) - 263
- Number of meeting/conference rooms - 7
- Designated smoking areas
- Meeting facilities size (feet) - 2830
- Ballroom(s)
- Smoke-free property
- 24-hour front desk
- Air-conditioned public areas
- Total number of rooms - 181
- Audiovisual equipment
- Number of floors - 6
- Self parking (surcharge)
- Banquet facilities
- Bar/lounge
- Business center
- Business services
- Coffee/tea in lobby
- Complimentary newspapers in lobby
- Multiple large conference rooms
- Currency exchange
- Dry cleaning/laundry service
- Elevator/lift
- Event catering
- Express check-out
- Luggage storage
- Medical assistance available
- Multiple small meeting rooms
- Multilingual staff
- Secure parking
- Restaurant
- Safe-deposit box at front desk
- Spa tub
- Swimming pool - outdoor
- Breakfast available (surcharge)
- Television in lobby
- Tour assistance
- Wedding services
- Wireless Internet access - surcharge
- Internet
Available in all rooms: Wireless Internet access (surcharge)
Available in some public areas: Wireless Internet access - surcharge
- Parking
Covered parking (surcharge), Secure parking, Self parking (surcharge), Street parking (metered), Parking nearby, Parking nearby (surcharge)
- Room Amenities
- Private bathroom
- Rollaway/extra beds available
- iPod docking station
- Connecting / adjoining rooms available
- Cribs/infant beds (complimentary)
- Pay movies
- Blackout drapes/curtains
- Air conditioning
- Complimentary newspaper
- Climate control
- Direct-dial phone
- Refrigerator
- Minibar
- Coffee/tea maker
- Daily housekeeping
- Complimentary toiletries
- Hair dryer
- Shower/tub combination
- In-room childcare (surcharge)
- Satellite TV service
- Iron/ironing board
- Desk
- In-room safe
- Wireless Internet access (surcharge)
- Dining
Buffet breakfasts are available for a surcharge and are served each morning between 6:30 AM and 10 AM.
Twenty One Fifty - This restaurant specializes in international cuisine and serves breakfast, lunch, dinner, and light fare. Guests can enjoy drinks at the bar. A children's menu is available.
The Lobby Bar - This bar specializes in international cuisine and serves light fare only.
In-room dining choices include breakfast, lunch, dinner, and late night fare, available from 24-hour room service.
- Recreation
An outdoor pool and a spa tub are on site. Other recreational amenities include a fitness center.
The recreational activities listed below are available either on site or nearby; fees may apply.
- Running track/path nearby
- Playground nearby
- Swimming on site
- Accessibility
To make requests for specific accessibility needs, complete the "Special or Accessibility Requests" section of "Trip Preferences" when you book your hotel.
- Accessible path of travel
- Accessible bathroom
- Roll-in shower
- In-room accessibility
Holiday Inn Parramatta Policies & Fees
- Check-in
Minimum check-in age is 18
Check-in time starts at 2 PM
- Check-out
Check-out time is 11 AM
- Payment types
Accepted at this hotel: American Express, Diners Club, MasterCard, Visa
- General
Extra-person charges may apply and vary depending on hotel policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
- Fees
- The following fees and deposits are charged by the property at time of service, check-in, or check-out.
The above list may not be comprehensive. Fees and deposits may not include tax and are subject to change.
- Breakfast fee: AUD 26.95 per person (approximately)
- Fee for in-room wireless Internet: AUD 12.95 (rates may vary)
- Fee for wireless Internet in public areas: AUD 12.95 (rates may vary)
- Self parking fee: AUD 10 per night
- Additional Details
The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation.
National Rating
- Details
Official Australia STAR Rating provided by AAA Tourism Pty Ltd
AAA Tourism Pty Ltd assigns an official STAR Rating for accommodations in Australia. This Hotel property is rated 4.5 stars.


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Slangin that crack. : Westerns » Read
Novel by sam316547
Ryain is having an unusually good day, from the minute she wakes up things go the way they're meant to. She even passes her math finals. When her best friend Megan invites her to attend a passing through fair, it seems like the perfect opportunity to celebrate. But something goes horribly wrong. People end up dead. Creatures they thought only existed in horror movies and books slaughter friends and neighbors before their eyes.
Novel by Whitlinger
The day everything ends, Earth has visitors. They are bizzare, startling, otherworldly beings, yet strangely similar to the human race. Evelyn, Noel and Alice are three teenagers from a summer camp, spending the weekend at a water park when catastrophe strikes. Soon they find themselves tangled in the mystery of the aliens and the purpose of their arrival on Earth.
Short Story by Ateo en la Trinchera
The benefit of the doubt is a beautiful gift.
Other by everafterdarling
The first chapter will be the rules for the contest and the second chapter will involve the winners, and so on (: ENJOY !


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By Frances Frei and Anne Morriss
Do you have the guts to disappoint customers? Many businesses don't -- and lose money kowtowing to demands. Great companies dare to make profitable tradeoffs rivals won't risk, argue the authors. For example, despite its rock-bottom interest rates on savings accounts, Commerce Bank (CBSH) saw deposits rise in 2012. Why? It keeps many branches open seven days a week -- a perk patrons love.
Having a hard time getting top talent? Become a good spy and send mash notes to your rivals' top employees.


text: Nature's Wishes Birthday Cards - Current Catalog Shopping Cart: 0 items Sign up for exclusive email promotions Checks Address Labels Greeting Cards Easter Cards Mother's Day Cards Baby Cards Select-A-Card Birthday Cards Friendship Cards Get Well Cards Sympathy Cards Thank You Cards Wedding and Anniversary Cards Halloween Cards Thanksgiving Cards Christmas Cards Greeting Card Value Packs Valentine's Day Cards Holidays and Events Gift Ideas Personalized Gifts For Your Home Stationery Personalized Stationery Calendars Home Office Wrapping Paper Photo Gift Center Dollar Deals Sale Home > Greeting Cards > Birthday Cards << Previous Next >> Nature's WishesBirthday Cards Wish recipients the best birthday ever with these amazing photographic cards depicting sand, sea, sky, and the green leaves of nature. White envelopes. 5" x 7".8-card set; 2 of each designClick "More Info" to view sentiments. More Info... Product Code Product Description Qty Price 605772 Nature's Wishes Birthday Cards $4.99 NOTE: To avoid errors, please do not refresh this page or hit the back button while we process your order. 42 Zig-Zag Gift Bag Set Was: $12.99Now: $6.49 Greeting CardOrganizer Box Was: $2.99 - $12.99Now: $1.99 - $12.99 Ladybug Stickers Was: $3.99Now: $3.49 Tropical Dreams File Folders Was: $8.99Now: $4.49 Home|Featured Merchants|Tips|Contact Us|Privacy & Security|Site Map|1-800-848-2848|Request Free Catalog © 1998, 2014 Current USA, Inc.


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The Anthrax Mysteryby Opinion Staff
Seven and a half years ago, photo editor Robert Stevens died of anthrax in Palm Beach County. He was the first victim of the attacks that later hit Washington and New York. The government has closed the case, and today a federal judge urged the government to settle the lawsuit from Mr. Stevens' widow.
Judge Daniel T.K. Hurley is right that the government has a poor case, having concluded that scientist Bruce Ivins let the anthrax get out of Fort Detrick in Maryland. But Mr. Ivins killed himself, and never admitted anything. Some of his friends doubt his guilt. Even if he did it, we don't know how we did it. If the case settles, we never will.
Ms. Stevens deserves justice. The public deserves answers. The widow may get her money, but the public may never get a fully closed case.
Tags: Anthrax, Anthrax attacks, Bruce Ivins, Robert Stevens


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I wish I were triplets
I wish I could cover at least three games Friday night.
GMC Boys
Attention: Elmbrook Retirees and Alumni
The Elmbrook Education Foundation (formerly the Lancer-Spartan Scholarship Foundation) has established a new Alumni page on their web site to help connect retirees and alumni to Elmbrook news and events that may be of interest to them! The EEF now maintains a list of reunion contacts on behalf of the Elmbrook School District. Please email the Foundation at firstname.lastname@example.com with the name and email of the primary contact(s) for your class so that we can make sure that our records are up to date. Don't forget to 'like' the Foundation on facebook at www.facebook.com/EEFWI and subscribe to the EEF Newsletter on the Foundation's web site to stay up to date on information of interest to Elmbrook Alumni and Retirees.
Alumni planning to attend the Foundation's Winter Social 2012 "Casino Royale" at the Wilson Center on March 3rd are encouraged to note what school and year they graduated so that we can help them connect at the event.
BRANDO is our little black and part white cat. we got him at the human society locally about 3 or more years ago. i never had a pet before so was a bit aprehensive. he is a gem. i feed him often and change his litter. he loves to play games with me. sometimes he does not. he is a move star having his picture taken quite often, and he poses. He wakes us up each day to remind us he needs attention. he sleeps a lot, all over the house which he thinks he owns. he does not cause trouble or get into things, except for an empty grocery bag or an empty box. he thinks life is all about fun. maybe he is right !
My wife adores Brando and is very caring with him. pretty neat. women are like that. love and affection.
HAWS Receives New Year's Fiesta from Taco John's
A great Waukesha eatery has really brightened up the New Year for HAWS!
For the second year in a row, HAWS has received a generous donation from Taco John's of Waukesha. The downtown restaurant recently presented the shelter with a check for $1,992.00, the result of their December "Nachos Navidad" promotion and sales of Christmas ornaments at the store at 317 N. Grand Ave.
Taco John's Unit General Manager Dusty Stiefel noted, "The entire crew at Taco John's worked very hard to make all the customers aware that we were raising money for HAWS. Our customers were a huge part of raising this money this year – we couldn't have done it without them!"
"We are honored to receive this amazing donation from Taco John's," said Lynn Olenik, HAWS' Executive Director. "Support like this from our community means so much to us – and we have enjoyed all of our associations with Dusty and her staff. They are great friends to HAWS!"
(Pictured receiving the check at the HAWS' shelter are Dusty Stiefel of Taco John's and Jessica Pinkos of HAWS, joined by several HAWS adoptable pets.)
Get YOUR business involved in the HAWS cause: Learn more about community partnerships and events to support HAWS' shelter at hawspets.org!
By the way - World Spay Day is 3 short weeks away. Help save lives through HAWS' Spay-Neuter Initiative Program (SNIP). Sponsor-A-Spay, purchase a t-shirt, enter the pet photo contest - all sorts of things can help! Visit our SNIP webpage to be a part of it!
February is a Special Month
Yes, February is a special month.
1. February 12 is the birthday of President Abraham Lincoln. President Lincoln is the historical icon of American history. His wisdom and decisions are precious.
Rest in Peace, dear Jim Garvens
Oh, what horrible news.
I don't even know if it's made it to BrookfieldNOW yet, but 3rd District Alderman Jim Garvens is gone.
A look at Woodland/GMC races
So many things to write about and not enough time...
- Brookfield Central boys (8-3) whipped Wisconsin Lutheran to snap a 3-game losing streak. Central faces Brookfield East, Tosa East and Sussex Hamilton to close out the year. First-place West Allis Central (9-2) plays MUHS, Menomonee Falls at home and Brook East on the road.
- Tosa East boys (7-4) need a minor miracle to get a share of the title. They finish with West Allis Hale at home, Brook Central on the road and MUHS at home.
- Eisenhower boys (11-3) are a game behind Whitnall (12-2) and with games against South Milwaukee, at Whitnall and Tosa West left. Whitnall plays at Tosa West, Ike and at Greenfield. The Lions won't be getting any help.
- New Berlin West boys (11-4) lost a HUGE, HUGE, HUGE game at St. Thomas More on Tuesday and fell a game behind in the loss column to More and Pewaukee, both 11-3. West finishes at Cudahy, Shorewood and Brown Deer, all winnable, but it might not matter. More plays at Shorewood, at Brown Deer, Cudahy and the big one - at Pewaukee). The Pirates play St. Francis, at Cudahy, at Shorewood and then More. Pirates have the easiest schedule.
- Eisenhower girls (13-0) have won 35 conference games in a row. They will clinch an outright title when they beat South Milwaukee Friday. They play Whitnall, Tosa West and Greendale in conference after that, but have a tough non-conference vs. Milwaukee Vincent (12-2) to end the year. They also play Mukwonago (10-5) in a NC game.
- New Berlin West girls (11-3) like the boys trails the leading Pewaukee and Cudahy (11-2) by one game in the loss column. The girls play Cudahy in a HUGE game on Friday at home, play two conference games on the road (Shorewood, Brown Deer, 6-21 combined). Pewaukee plays St. Francis, at Cudahy, at Shorewood and then More.
It should be fun.
"Conservavite alternative to Barack Obama" Rick Santorum wins 3!
What a night for Republican candidate Rick Santorum--he swept all 3 primaries in Minnesota, Missouri, and Colorado. And what is even more remarkable, he did this on a shoestring. Mitt Romney's millions (and I have nothing against wealthy people) and Newt Gingrich's millionaire backing didn't seem to matter. Rick Santorum still managed to pull ahead. Santorum has won 4 states--3 caucuses and 1 primary in Missouri, the most of any candidate so far.
It is easy to see why Newt fell from favor, given his sour grapes comments lately, plus, he wasn't on the Missouri primary ballot. But Romney's fall? Romney came in 3rd in Minnesota. "Romney should have had the advantage in both Colorado and Minnesota, which he carried in the 2008 Republican presidential primaries. He awaited the returns Tuesday night in Colorado, where he spent most of the past week campaigning." At the end of the night, Santorum came in with 40% of the vote to Romney's 35%!
True, voter turnout wasn't as high as 2008, but..."Romney won fewer voters than he did in 2008, signaling that he hasn't been able to hold onto those who turned out to pull the lever for him last time. In Minnesota in 2008 he won nearly 26,000 voters in the caucuses, while on Tuesday he won fewer than 10,000. In Missouri's primary his take dropped from 172,329 votes to just 63,826. And in Colorado's caucuses he won more than 33,000 votes last time but fell 10,000 votes shy of that this year." Even in Mormon friendly Nevada, Romney's total was 25% less than his 2008 total.
Given that Romney has run before, if we compare this 2012 election cycle to 1980's, Romney's lackluster numbers should be cause for pause. In 1976, Reagan ran again for president and lost the nomination to Gerald Ford. It was at the convention, where Reagan delivered the speech for Ford, that the party realized they nominated the wrong man. Ford lost and we got Jimmy Carter instead.
So given that many of us felt (myself included) that we chose the wrong man in John McCain and would have preferred Mitt Romney, wouldn't we expect Romney to distinguish himself this go round? Instead, it seems Romney is fizzling out.
It is still early in the game, especially in this unusual election cycle where anything seems possible, but it would seem Rick Santorum is finally hitting his stride. Maybe people are finally bothering to ferret out what each candidate actually stands for.
In any event, it is refreshing to hear a candidate state what so desperately needs to be said, " 'I don't stand here to claim to be the conservative alternative to Mitt Romney,' [Santorum] said. 'I stand here to be the conservative alternative to Barack Obama.' "
A big AMEN to that.
Delegate Scorecard: Remember, 1,144 delegates are needed for the GOP nomination. Delegate estimates :Romney 86, Santorum 38+, Gingrich 29. According to RNC rules, early primary delegates should be awarded proportionately too, but in Florida, they were all given to Romney. Missouri's were non-binding and will be awarded in future.
State by State Primary Results
Behind the numbers: Romney's Tuesday disaster
No Shire, but a mosque is on the next Plan Commission schedule
The email just came with the Plan Commission schedule for Monday, February 13th. Once again, the anticipated expansion of The Shire subdivision is no where to be found.
There is a mosque is proposed at 16650 and 16730 Pheasant Drive. That's off Calhoun by the train tracks. Ever had to pick up a lunch box at the school bus lot? Then you'll know the general location.
Elm Grove Brewer fan a finalist in MLB Fan Cave promotion
Elm Grove Milwaukee Brewer fan Kurt Peter is looking for votes in the MLB Fan Cave promotions.
After reviewing more than 22,000 entries, Major League Baseball revealed Peter as one the top 50 fans vying to be a contestant in the 2012 MLB Fan Cave.
The voting runs through Wednesday. Fans can view video submissions from all 50 applicants on MLBFanCave.com and vote for their favorites. The 50 men and women include fans from across the U.S. and Canada.
"I decided to do it after I was watching the MLB Network one day and saw the commercial advertising the 'Best summer of your baseball life.' I've been trying to break into the MLB job market, but it's extremely tough, so I thought I'd give it a shot."
Peter turned in a two-minute video describing their favorite baseball moment and why you'd be the most entertaining baseball fan. It also had two 500 word essays with a few options.
"I chose to write about who I'd most like to meet/interview in the Fan Cave and what young star I thought would most likely win a Cy Young. I linked some previous sports writing I had done and that's that."
In 2012, the MLB Fan Cave will return to the 15,000 square foot location at 4th Street and Broadway in the heart of New York City's Greenwich Village that was formerly the home of Tower Records.
The MLB Fan Cave is currently being redesigned to feature new technology and interactive elements.
The MLB Fan Cave is a unique event space mixing baseball with music, popular culture, media, interactive technology and art.
Supported by MLB Advanced Media, it also serves as a content factory providing baseball fans with a constant flow of online video and conversation via social media. The MLB Fan Cave has more than a quarter of a million combined followers on Facebook (http://www.facebook.com/mlbfancave) and Twitter (@MLBFanCave). The MLB Fan Cave features products and services provided by nearly 50 companies.
Major League Baseball will select 30 finalists based on fan voting, quality of the original submissions, and the ability of the contestants to generate buzz and interest in their campaigns. The 30 finalists will earn a trip to Spring Training in Arizona at the end of February, where they will compete in a variety of challenges to determine the final group of contestants.
These winners will begin the season in the MLB Fan Cave with the goal of watching all 2,430 MLB games on a large wall of big screen Sony televisions while chronicling their experiences online through videos, blogs, and social media.
Along the way, they will compete with one another over the course of the season in a series of challenges, with fans online helping decide who gets to stay in the Fan Cave and who gets eliminated with one eventual winner crowned before the end of the World Series.
Good luck, Kurt.
'Understanding Fossil Evidence' Tuesday, Feb. 14, 2012
No doubt about it, fossils are a fascinating, tangible glimpse into the past. They are like snapshots in time. How much time? That depends on your world view. (Click here if all 4 photos don't appear)
Concordia University professor Dr. Gary Locklair will explore the topic "Understanding Fossil Evidence" at 7pm on Tuesday, February 14th, at Concordia in the Lakeshore Room--Info & directions. His "presentation will focus on the different interpretive frameworks used by scientists in evaluating fossil evidence."
"Creationary and evolutionary scientists study the exact same evidence, the fossils, yet come to radically different conclusions about the origin of life on earth."
Differing conclusions were never more evident to me than while listening to the Park Ranger at Dinosaur National Monument last April: He explained how 1 inch of sediment depth equaled X millions of years* in the Fossil Quarry, yet the huge fossilized dinosaur bones, entombed in the hill, were cemented in a span of sediment about 15-20 feet tall! Click for picture Some of the bones were random, others were from one animal, which points to some cataclysmic event.
In fact, at Fossil Butte National Monument, they even have a display case titled CATASTROPHE to show that some sudden disaster accounted for these fish all dying at the same time. It would also account for the sudden death of the fish in the first photo, who never got to enjoy his dinner.
Another case shows how fish trails, (the curved traces or trails a swimming fish fin leaves on the lake bottom) became fossilized in a sudden covering of mud. (Click on the picture to see the curvy trails.)
Creationists would say Noah's flood was the catastrophe.
I have heard Dr. Locklair before; he is a great speaker. It should be a very interesting evening. (The Creation Science Society of Milwaukee will be holding a short Annual Meeting and Election of Officers just prior to Dr. Locklair's presentation at 6:45pm.)
Upcoming events: The great debate! Can Science Point to God? hosted by the Lutheran Student Fellowship at UWM's Student Union, Wisconsin Room -3rd floor, on Tuesday, March 6, 2012, 6:30pm. Concordia University's Dr. Mengue will debate UWM's Dr. Bristow.
Entropy and the Origin of Life, Dr. Bruce Holman, Tuesday, March 27th, 7:30 pm, at Wisconsin Lutheran High School on 84th and Bluemound Rd., in the Cafeteria, doors of school open at 7 PM
February, 2012
Open House Success!
What a wonderful Open House! All of the hard work and dedication offered by all who were involved to help make this year's event a success was amazing. We would like to take this opportunity to thank:
- the teachers for their preparation and being on hand to meet and greet all the visitors to their classrooms;
- Kris Dries for all her helpful assistance with the registration process;
- the many volunteers (parents and students who: spoke at mass, greeted, toured, displayed extra-curricular activities and offered refreshments to the visitors of our school;
- the maintenance staff for providing and setting up all the needed equipment and furniture, for shoveling, plowing and salting the sidewalks and parking lot;
- to the Boy Scouts who prepared and served a delicious pancake breakfast;
- to Jennifer Svastisalee for the architectural drawing of our new K3 classroom
- a SPECIAL thank you to the Open House Planning Committee (Margaret Thew, Molly Berens, Nora Mihm and Joanna McQuide) for their valuable input and time involved in planning this very special event.
East High School had a lock down today
A good source sent me this email, which I'm happy to share:
Lewiston, Scheel doing good job with New Berlin West teams
I wanted to just take a second and tip my hat to the New Berlin West boys and girls basketball teams.
The boys - coached by Jeff Lewiston - are 13-4 in the Woodland Conference Blue Division - and 16-5 overall with a bye this week before the seeding meetings on Saturday. The Vikings play Brown Deer at home in the finale on Wednesday next week.
Wisconsin Senate mining bill took wrong turn, now better
Wisconsin's Assembly passed AB 426, a Iron Mining Bill, in January. It essentially was designed to speed up the expensive, long drawn out 3-year DNR approval process to a 360 day maximum permit deadline.
Wisconsin's Senate came up with their version earlier this week, however, theirs was far worse than the long, drawn out process we presently have. Among other bad stipulations, it added a new $2 per ton tax on top of the present 15% of net proceeds tax. Since the mine would produce from 8 to 16 million tons a year, that new stipulation would cost the mining company from $16 - $32 million dollars of additional expense. So that Senate version of the the good Assembly Bill 426 would be far worse than the unfavorable process we currently have in Wisconsin.
Thankfully, many Wisconsinites contacted their State Senators, urging them to support mining in Wisconsin and not vote for this terrible Senate version, with its unfriendly business taxes and regulations. So many people called and emailed that Senate Majority Leader Scott Fitzgerald disbanded the Senate mining committee, scrapped the Senate version, and sent the clean, better AB 426 Assembly version to the Joint Finance Committee, which will send it directly to the Senate floor.
So people, you made the difference. We are still not out of the woods though because the Assembly version can still be amended in the Senate. They can still add on the poison-pill provisions, but at least this way, those promoting those bad ideas will be known and each Senator will have to take a stand if they are for or against mining jobs in Wisconsin.
Just how unfavorable is Wisconsin for mining companies to do business here? Here is a little test:
What do Zimbabwe, The Congo (DRC), India, Bolivia, Honduras and Wisconsin have in common? They rank among the top 10 bottom scorers of 79 locations throughout the world--Antarctica excepted--friendly to the mining industry.
The Fraser Institute surveyed the opinions of mining executives, exploration managers and mining consultants from around the world and found Wisconsin scored the worst in Environmental Regulations and 2nd worst, only to Hugo Chavez' Venezuela, for "Uncertainty concerning the administration, interpretation, and enforcement of existing regulations". (Click link and scroll down to look at graphs)
How did this happen to Wisconsin? We're the Badger State. Badgers because they dig and burrow!
Wisconsin, with our flag depicting a miner standing to the right of the shield and sailor to the left, state products representing the state's major industries adorning the shield and badger on top: "In four sections surrounding the shield are representations of the states main industries: Agriculture, mining, manufacturing and navigation. The cornucopia and pile of lead represent farm products and minerals. (My emphasis)
Wisconsin needs jobs. Not just in Ashland County, where Gogebic Taconite or G Tac proposes this new iron mine, but in the surrounding area where peripheral businesses will hire to support the minors and their families. Lake Superior shipping will also benefit from this new mine, as will Joy Global and Caterpillar in the Milwaukee area.
AB 426 is just a bill to speed up the DNR approval process. The DNR would still need to study the issue and decree their yea or nay on the project. Unlike other mining, iron mining does not use cyanide or other polluting acids to remove the metals from the ores. Iron mining uses magnets to separate the ferrous material from the stone. Even environmentally conscious Minnesota and Michigan both have iron mines in their states.
At this point Wisconsin's State Senate does not have the votes to pass AB 426 and Republicans are being blamed for its failure to pass. But we do have 16 Democrat State Senators in Madison. Where are they on this bill?
Mining jobs are nearly always UNION jobs. For all the whining how Gov. Walker and Republicans are against Unions and Union workers, why are the Democrats allowed to vote against AB 426, which would help 600+ people* to obtain new Union jobs, not to mention the estimated 4,000 other jobs this mine would generate, without so much as a murmur?
Don't people living in Democrat Senate districts want good paying jobs too?
The Republicans, who make up a slim majority of one vote in the Senate, could vote this bill in. But Republican Dale Schultz of the 17th District, is being Dale Schultzie again; he is opposing this bill. There are probably some other Republicans who are wimpy on this bill too. Our area Senators, Leah Vukmir and Rich Zipperer are in favor of AB 426.
The only way we are going to improve the employment climate and increase state revenues here in Wisconsin is to approve projects such as this G Tac mine.
Contact your State Senator, even if they are Democrats! Let them know you support mining and bringing good jobs to Wisconsin. If the Senator is a Democrat, urge them to support these Union jobs.
Also, contact Democrat Robert Jauch of the 25th District, where the mine would be located. His district has a higher unemployment rate than the rest of the state. Ask him to help the people of his district get good paying Union jobs, that can't be outsourced, since the iron ore is here!
Hope Judge Nelson Phillips prevails on Tuesday, Feb. 21, 2012: Primary Election Milwaukee County
Voter ID is now in effect, so do remember to bring it to the polls if you live in a municipality holding a primary election tomorrow.
All of Milwaukee County will be voting for Branch 17 Judge in the primary. Judge Nelson Phillips is the Conservative in that race. His website is judgenelsonphillips.com but clicking that link gave me a Bandwidth Limit Exceeded message and suggested trying again later.
The following is from my fellow Conservative blogger, Randy Melchert:
"Tomorrow is the Nonpartisan Primary Election. Most of Waukesha County does not have a primary (except for a Western Waukesha County municipal judge race), but Milwaukee County and many other areas do.
"The areas below are having primaries where there are identified conservative candidates:
Remember April 3rd is our spring election for nonpartisan races such as alderman, school board, and county supervisors and also our Presidential Primary!.
Haute Taco, I loved you well
Somewhere to the top right of this page is the news that Jake is putting burgers in place of his easy Mexican restaurant.
I am both sad and delighted. You see, the Haute Taco I loved so well had really taken a tumble the last few times I'd gone.
Non-Partisan Elections
The upcoming elections for Alderman/women are NON-PARTISAN.
There are basically 2 types of elections in Wisconsin. Partisan and Non-Paritsan.
Pres. Obama, GOP not 'licking their chops', but we'll all be licking our wounds
Yesterday, the President referenced one newspaper's lead story, that gasoline prices were on the rise and Republicans were "licking their chops", in an effort to deflect any responsibility over gasoline's unprecedented price increases.
Then he went on to say, They [Republicans] are already dusting off their 3 point plan for $2 gas... Step 1 is to drill, and step 2 is to drill, and then step 3 is to keep drilling, something he has been thwarting every chance he gets.
Sadly, the President believes higher energy prices will encourage us to adopt his greener energy initiatives such as algae or whatever, though "the president admitted, no one actually knows how to turn algae (or a million other things) into motor fuel".
Obama also touted higher fuel standard regulations as a way to help us out of our gasoline shortage. Maybe he should urge the EPA and Congress to rescind the ethanol mandates? That would increase fuel efficiency by what, 10%? (He must have forgotten to mention proper tire inflation this time.)
He bragged that the U.S. was producing more domestic oil than ever, inferring that is why we need to turn to green energy, but failed to mention that higher production level was from the Bakken Shield oil shale fields in North Dakota and other oil rich areas on private property. (In other words, no thanks to his oppressive oil policies.) No mention of how he has rejected approving Canada's Keystone oil pipeline, which would help us "build an energy-independent North America".
No, this is the same man who in January of 2008 said under my plan, under a cap and trade system, electricity prices would "necessarily skyrocket". Clearly, he doesn't mind higher energy prices.
High gasoline prices hurt the very people who can least afford them: the unemployed, the under-employed, large families, lower to middle class people, areas dependent on tourism, and businesses in general.
The one saving grace of this recession was at least gas prices were low. But now what little disposable income these people have will go into their gas tanks. Discretionary spending will go down. Vacation plans will be cut back.
We'll all be licking our wounds with high gas prices. True, there isn't much we can do about it right now, but what about in the next decade? Algae research will not help; Drill, Baby, Drill and Keystone would. Remember that when you cast your ballot in November.
More Reading:
Krauthammer MOCKS Obama's Algae Energy Plan
Barack 'All of the Above' Obama
Obama Vows to 'Double Down' on Green Investments Despite Solyndra and Volt Flop
Playoffs getting underway...
To say I picked the wrong time to get sick is an understatement.
I am on the sidelines right now with Cellulitis in my left ear, which is often caused by a bacterial infection. My left ear looks like I went through 10 rounds with Mike Tyson (before he bit it off). I was so sick that JR Radcliffe stepped in for me to cover the Tosa East-Tosa West game last night.


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Kelly Rowland
53 Songs
About Kelly Rowland
Kelendria Trene Rowland (born February 11, 1981) is an American R&B singer, songwriter, dancer, actress, and five-time Grammy award winner who rose to fame as one of the founding members of the very successful R&B girl group Destiny's Child. After a series of commercially successful releases with the group and a worldwide number-one success with rapper Nelly and their Grammy-winning single "Dilemma", Rowland released her debut solo album Simply Deep in 2002. The album became a commercial success, eventually selling more than 2.5 million copies woldwide, and garnered three more or less successful singles.[2] Rowland's often-delayed second album, Ms. Kelly was released June 25, 2007 in Europe and July 3, 2007 in the United States. So far, the album has spawned the top 5 single "Like This", a collaboration with rapper Eve, as well as the Snoop Dogg-collaboration "Ghetto" and the international single "Work." With the upcoming 2008 re-release of Ms. Kelly, Rowland is set to release a n ... Read More
Career Started: 1992
Official Website: http://kellyrowland.com
Tags: r&b, pop, dance, solo, soul,


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Anaheim, Calif. - January 30, 2013 - GBC Motorsports kicked off the 2013 WORCS Racing Series with some remarkable finishes in some of the most challenging conditions imaginable for a west coast race.
After months of off-season preparations, GBC racers headed to Canyon MX in Peoria, AZ for the opening round of the 2013 WORCS ATV/SXS Season. There was a solid turnout in every class despite the adverse conditions as more than an inch of rain dumped on the course before racing was scheduled to begin. After a short delay to perform track maintenance and some rerouting, the racing commenced and the season was underway.
More than 20 drivers turned out for the SXS Pro race, and GBC claimed 3 of the top-10 positions among a very competitive group of racers. Leading the way was Wesley Barker with a 4th place finish and 5th Overall, followed by Tommy Scranton with a 7th place class finish and 9th place Overall. Tim Wyatt joined them with an 8th place effort and rounded out the top-10 Overall. Andrew Berry and John Pacheco stuck it out for 17th and 19th, respectively.
Title contender RJ Anderson had his Mongrel equipped RZR running in third place before having to drop out due to an electrical issue. Anderson and Guthrie Jr. did combine to give GBC two of the top three qualifying times, both on the new Kanati Mongrels.
Nolan Remlinger was the sole GBC pilot in the SXS 850 class and put together a 5th place finish aboard his new Mongrels, which was good enough for 7th Overall among 850, 700 & 600 racers.
ATV Racing
On the ATV side of things GBC had several riders compete in multiple class races, notching a few more top-10 class finishes for GBC Motorsports. In addition to opening the WORCS season, these ATV racers had the chance to break in their new and improved cross-country tires from GBC Motorsports, running XC-Racer rears (formerly Race Rex) and XC-Master fronts (formerly X-Rex).
Brian Sirevaag put together a 6th place run in the Pro-Am class, and also raced to an 8th place finish in the Prod A class. Cody Mitchell finished 8th in the Pro-Am race and 12th in the Prod A battle. Jose Mendoza finished 14th in the Pro-Am and also landed in 6th place in the Open A race.
It was an exciting if not unusual opening to the 2013 WORCS season, and GBC Motorsports looks forward to putting their tires and racers up against some of the toughest competition and courses in coming rounds. GBC Motorsports is offering over $75,000 in GBC Bucks contingency throughout the 2013 WORCS season. See full rules and download the forms [here].
WORCS ATV/SXS returns February 8-10 with the second round at Buffalo Bills in Primm, NV. Visit www.gbcmotorsports.com for a look at their full lineup of ATV and SXS tires, and follow them on Facebook and Twitter to get the latest product and racing updates.
About GBC Motorsports: GBC Motorsports has been building ATV tires for over 30 years. Manufactured under the Greenball name initially, in 1995, GBC Motorsports was formed to focus on bringing to the ATV and Powersports market performance tires for every riding style. GBC Motorsport's passion is to provide the highest quality, best value, and most innovative performance tires to the Powersports enthusiast.


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Our interview with cancer patient Joseph F. Durocher, PhD, in the March/April 2002 issue, page 22, elicited the following responses.
Dear Dr. Joe, Thanks for making such an excellent Web site (orbit.unh.edu/cancer) on cancer treatment. I work with the American Academy of Pediatrics and saw your site listed in my Medical Meetings magazine. I wish we had something similar for children to use because I think many of them suffer greatly from not knowing what is going to happen to them during their examinations and treatment. Your Web site was great (a few typos, but that just makes you more human!). If you know of any sites like yours for kids, I'd really be glad to learn of them.
What you did took a lot of courage and creativity. I think you will be helping so many people to better understand what the process is. While it is still frightening, it's so much better to face such exams and treatments head on rather than creating an even more frightening scenario that may be way off base. Also, your good advice about what is painful or difficult will make it easier for folks to prepare themselves for the tougher aspects of treatment.
I am recommending that we put a link to your site [on our Web site] for parents and older children and their doctors. Thank you for sharing this most personal and courageous part of your life. You are still a wonderful teacher!
Beverly Busher
Executive Director
California Chapter 1
American Academy Of Pediatrics
San Rafael, Calif.
Dear Dr. Durocher, What a wonderful Web site. With your permission, we would like to add a link to it from our Web site. What a really excellent introduction to dealing with cancer.
Priscilla Savary
Executive Director
Colorectal Cancer Network
Kensington, Md.


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The first two are long-discontinued "Reliance Commercial Line" toilets, and the 713 is I think the Carusoe, all with 2" flush valves. Last spec sheets I found on the first ones were from 1997.
Come on to the 21st Century! Terry indicates that the basic Drake, with readily-available parts and a great flush with the 3" flush valve, is something he considers commercial grade. I think I saw where he just put a bunch of them in his local church (look at the end of the CST744 owner reviews). It comes in an ADA height version and a right-handle if you need them at the job site. CST744SL or CST744EL for the ADA-height and add an "R" to the model for a right-handle.
Last edited by wjcandee; 09-09-2012 at 07:05 PM.
Great! If you want to buy local, I would look off the Toto supplier locator I linked to above.
Last edited by Terry; 09-10-2012 at 10:31 AM.
We generally don't talk about online sources here, but you'll see what i mean if you google the model number. look at colonial white as well as cotton when you find the site. colonial is closer to current AS white.
OK, I understand. But this is a replacement for a 1979 Kohler lowboy, not AS.
Yep. No problem. 5 1/2" between post holes. As to AS, I was just identifying the difference between the two whites.
Last edited by wjcandee; 09-10-2012 at 01:06 PM.
I should probably start another thread to ask this, but how do you decide between a closed front and open front seat?
You generally see an open front seat in public restrooms...it enables 'drips' to go onto the porcelain rather than run under and on the seat, and provides a little more room for the male anatomy.
Jim DeBruycker
Important note - I'm not a pro
Retired Defense Industry Engineer; Schluter 2.5-day Workshop Completed 2013, 2014
Is that why hospitals do it? I'm asking because the clients are elderly and are trying to stay out of nursing homes.
It's easier to keep the seat clean.
Jim DeBruycker
Important note - I'm not a pro
Retired Defense Industry Engineer; Schluter 2.5-day Workshop Completed 2013, 2014
Terry has indicated that the relevant Toto seat really fits the bowl of the Drake very nicely; it's comfortable and aesthetically-pleasing.
In our house, we had recently replaced the plastic seats on several toilets with the wooden Mayfair (Bemis) slow-close seats with the EZ-detach feature, and I just moved them to our two new Drakes (one round, one elongated). To us, they seem to fit fine, and the family really likes them, but we seem to like the hard seat. Guess it's just what we're used to; it's not a money issue, we just like 'em. But they do "fit" in any way that's noticeable, although they don't fit the contours of the toilet exactly like the Toto seat, I think.
I found my Toto toilet at National Builders Supply, Austell GA, delivered to my door in SoCal in 5 days for $100 less than at a local discount plumbing supply. They actually packed the original cartons in bigger boxes surrounded by packing peanuts foamed in place with expanding foam.
Edit: apparently there is something on this forum that prevents posting their url, so I guess I cant do it.
Last edited by brucet99; 09-11-2012 at 06:55 PM.
Hey, Charles2, I did a little open-seat research for you and was intrigued at the compliments that the open-front, commercial-grade Toto SC134 seat seems to get from folks who had bought it for home. It's one of the ones noted by Toto on the spec sheet for the CST744S. If you look at the customer reviews at the major housewares merchants' web sites, they're almost unanimous that this is one nice seat.
Edit: By sheer coincidence, after I posted this earlier, a family member allowed as how the Toto SS114 seat on our Carlyle II had "broken". I assumed it had just slipped on a loose attachment bolt. Nope -- one side had come apart, apparently from significant torsion (don't ask). So I took the thing off the toilet, disassembled and reassembled it and reattached it...good as new. However, in doing so I just have to say that every piece is really nice, solid, heavy plastic or metal, an interesting and solid design, and it just exudes quality. Apparently, this is a newer design of the SS114 where they have kept the model number, because I saw lots of bitching on one seller's web site about how the seat shipped didn't match the photo on the site or the SS114 that had come on their old toilet, and posted their own photos to prove it. Indeed, my 114, which came with the toilet, is different from the old product photo but exactly what the seller was selling. (People were actually sending it back saying that the wrong product was in the box, even though the box had the right number. The perils of significantly-redesigning something and giving it the same model number, I guess, but if I were the merchant I would be pissed at the manufacturer for causing all this tsouris.) Regardless, my point is that the current SS114 seems to be a very nice closed-front seat.
Last edited by wjcandee; 09-11-2012 at 09:26 PM.


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Submitted via Letter
Truly Nolen of America Announces West Palm Beach Branch Manager Promotion
Truly Nolen of America, Inc., the largest family-owned pest control company in the United States, is pleased to announce the promotion of Arthur Pegler to branch manager of the company's West Palm Beach branch. Having begun the manager-in-training program in … Continue reading
Truly Nolen Joins the Fountain Hills Community
Company announces new branch in this tight-knit suburb outside Scottsdale WHAT: Fountain Hills residents, rejoice! Truly Nolen, the largest family-owned pest control company in America, is moving in. With the support of the Fountain Hills Chamber of Commerce, the new … Continue reading
Watch Your Step for Scorpions Frightening Pest may be Southwest's Public Enemy No. 1
One of the most infamous of pests, the scorpion is one of the most difficult to eliminate. They spend most of their time tucked away in cracks or crevices and are even found in children's sand boxes. Although scorpions are … Continue reading
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ZIPs Served by Truly Nolen of Lehigh:
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Posts Tagged 'Matt Wells'
No. 67: Utah State
By Paul Myerberg // Jul 3, 2012
From 1998-2010, a lifetime in this sport, there may not have been a worse program in college football: Utah State went 43-106 over this 13-year span, never winning more than five games and winning a combined 15 games from 2003-8. It was never, ever pretty; it was always ugly, or very, very often ugly. But Gary Andersen never lost faith, it seems, and after watching his teams make subtle progress from 2009-10 he led Utah State into bowl play last fall after a 14-year absence. Not that it was easy. And not that this past season didn't have the fan base reaching for antacids: just as six losses came by a combined 26 points, Utah State's total margin of victory over its five-game winning streak to end the regular season was only 19 points. It was never easy. But the road to perennial success is pocked with these sort of stumbles, often of the self-inflicted variety. The key is for the Aggies to take these life lessons and run with them, beginning in 2012 and moving beyond — from one conference, the WAC, to another, the Mountain West. The best news? Now that Andersen has tattooed a Utah State logo somewhere on his person, he's not going anywhere. Right?


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New formula equals higher ACT scores
A new formula for calculating average ACT scores in Colorado led the state and School District 51 each to set records this year for highest average ACT score in the 10 years the Colorado…
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