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Because of its known benefits of decreasing stress, pain, anxiety, depression and fatigue, massage can be of great benefit to those living with cancer. Well Within offers Oncology Massage with practitioners who have a special certification in working with cancer patients. They are trained specifically to make appropriate adaptations in massage sessions according to treatment type, stage and other applicable factors. Clients who receive Oncology Massage enjoy a safe, nurturing, and compassionate session with a customized focus on either relaxation, relief from muscle pain or tension, or some combination. Some studies show patients have also experienced improved sleep and immune function, as well as nausea relief (Sat-Siri Sumler and Lorenzo Cohen, Ph.D.) As stated by the Society of Oncology Massage, this specialized work is considered an "adaptation of massage to safely nurture body, mind and spirit of anyone who is dealing with cancer. [It] can benefit cancer patients at all stages of cancer, during and after treatment, in remission, cure or at the end of life."
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Learn more about our practitioners:
Naomi Nuestadt, LMT


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Rec Fest 2015 at Paramount Ranch
October 24, 2015 @ 10:00 am - 4:00 pm
Event Navigation
Want to enjoy the Santa Monica Mountains but don't know where to start? Come out to our first RecFest and introduce the family to all sorts of fun outdoor activities! Download our 2015 RecFest poster and share with your friends and neighbors.
When: Saturday, October 24, 2015. 10 a.m. to 4 p.m.
Where: Paramount Ranch, 2903 Cornell Road, Agoura Hills, CA, 91301
Cost: Free!
Highlights include:
- hiking
- biking
- horseback riding
- 1-mile foot race*
- fishing
- camping demonstration
- rock climbing
- art making
Bring a picnic or grab lunch from a food truck.
*The one-mile foot race starts at 12 p.m. and is for kids and their families.

subset: commoncrawl


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Russell Knox may have raised a few eyebrows by picking Duncan Stewart as his partner, but that decision is no longer the big talking point when it comes to pairings for next week's World Cup of Golf in Melbourne.
Spare a thought for Lee Westwood. The Edinburgh-based player had been looking forward to making his debut in the event after being selected three months ago by the Masters champion, Danny Willett, to represent England. That's not happening now, though.
Willett withdrew at the weekend as he doesn't want to aggravate a back problem. When Chris Wood and Andy Sullivan were then announced as England's new representatives, it was thought that Westwood had pulled out as well. Nope. In short, he's been snubbed. It's no real surprise, really, that he's not a happy bunny.
"Frustrated would be one word you could use," said the 43-year-old, speaking at Jumeirah Golf Estates in Dubai on the eve of the $8 million DP World Tour Championship, which he won in its inaugural staging in 2009.
"It's not great when it all happens at the last minute, especially as I'd geared all my end-of-season plans around playing in the World Cup.
"I'm not pointing fingers, but you would have thought that, when a guy has made detailed plans and sorted out travel and everything else, he should still be in the team even when someone else has to pull out. It was a big deal for me because I've never played in the World Cup before. Whenever the chance came up in the past, I'd already committed to another event, so I made sure I cleared the decks this time. Danny nominated me back in early August, and it's something I've been really looking forward to. But the rules state the top guy on the ranking list can take whoever he wants, so there's nothing I can do about it."
Indeed, Wood is perfectly entitled to pick whoever he wanted as his partner – as Knox did with Stewart despite him being a Challenge Tour player this season – and he's gone for Sullivan because he believes that combination can come up with England's first victory in the event since 2004. "It's a bit of an awkward position to find yourself in, to be honest," admitted the lanky Bristolian, who won the BMW PGA Championship, a triumph that helped him become a Ryder Cup team-mate of Westwood's for the first time at Hazeltine. "Danny made no bones about the fact he was picking his mate, and it probably looks like I've done the same thing. But it goes a lot deeper than that. Once I told I was England's No 1 representative at the World Cup, my first thought was who can I play with who will give us the best chance of winning it? And Sully ticked all the boxes.
"We've known each other since we were playing county golf together as kids. We also played for England as amateurs together and, of course, we made our Ryder Cup debuts at the same time earlier this year. We get on great, and I think that will help a lot when you have to play two of the four rounds in foursomes. Like I said, the bottom line is that we're in it to win it. It's a huge honour to represent your country in any World Cup, and bringing home that trophy would be a career highlight for anyone.
"I can understand Lee's frustration after being named, only to be left high and dry when Danny pulled out. Maybe the rules need looking at, but I couldn't let that affect my decision. Sully and I are a different generation to Lee, and in a way this latest Ryder Cup possibly marked a changing of the guard, where guys like myself and Sully have to step up. We're both itching to get out there."
l Turkish Airlines fly daily from Edinburgh to Dubai via Istanbul with no charge for golf clubs. Check out www.turkishairlines.com for flights and prices


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The Thimble vs. The Iron
There comes a certain stupefying point in most Monopoly matches when who wins becomes less important than that someone wins, when victory matters less than simply finishing. With each roll of the dice, each movement of the tin tokens, and each exchange of meaningless colored money, the game seems to stagnate, to slow and then slow further, proceeding in ever smaller, duller increments toward an ever-less momentous conclusion. Players start making excuses to leave the table, to get up and use the bathroom, to go pop popcorn. If only something—anything—would happen. But nothing does. People just keep buying houses. Over and over they just keep passing 'go.' The temptation arises to pull a stunt—to fake a seizure and upend the board or spill Dr. Pepper down little sister's shirt—just to get the damn thing over with and return to whatever you were doing that you now realize you should have gone on doing, even if it was the laundry or the dishes.
That's how the Republican primary feels now, like a contest that might be better off abandoned than doggedly, numbingly seen through to the end, which will only leave everyone permanently annoyed. With all the high drama of two Good Humor ice cream men circling each other with water pistols, Santorum and Romney seem singularly incapable of landing the sort of telling blows that alter the momentum of a struggle. As for the prospect of damaging disclosures that might shift our perception of the candidates, good luck with that one. Have any two men in recent political history seemed less endowed with the roiling unconscious selves that bring forth at critical moments in their careers molested interns, felonious close relatives, or unacknowledged cases of Hep C? With the disappearance or marginalization of the seething, swaggering, sweaty trio of Gingrich, Cain, and Perry (even Michele Bachmann, looking back, seemed good for at least the possibility of a nasty Vicodin habit or a closeted college lesbian phase), we're left with two proclaimed observant Christians—a Catholic and a Mormon—whose faith walks seem to have never known a zig zag, let alone a stumble into a ditch. In truth, a touch of hypocrisy might look good on them, might grant them a little charisma, a bit of zing. It might also assist us in telling them apart.
Slow but steady wins the race, it's said, but only when at least one of the contestants is playing things fast and loose. When both competitors take it slow-but-steady, the race may not stop but it does cease feeling race-like. It turns into one of those ultra-super marathons that start in Alaska in the spring of one year and end in Belize in the autumn of another and whose results are of no interest to anyone except the participants themselves. Occasionally, as is happening with the primary, the race will pass through a town in the Midwest and rouse a high school to deploy its marching band or inspire a local Chrysler dealership to put out a few balloons and hold a sale, but eventually even the dogs stop showing up.
There are signs that Santorum, for one, has started to realize—whether consciously or unconsciously, who knows; it's hard to analyze the mental processes of someone with a perma-grin and clothes that look dumb and homely on purpose even though they're the clothes he's always worn and presumably believed look pretty sharp once—that just as important as beating Romney is keeping the nation awake to see him do it. To this end, he recently launched a weird TV ad of dubious pop-cultural literacy portraying his opponent as Rambo, the sinned-against Vietnam-vet turned vigilante whose story tapped pretty much the very same vein of slack-jawed populist resentment that Santorum is depending on and might not want to help his rival symbolize. The ad's ostensible message is that Romney has run amok making dirty, unfounded attacks, which are visualized as spurts of mud issuing from a gargantuan machine gun that Rambo-Romney fires from hip level at a life-sized cardboard cut-out of a grinning, unflappable Santorum. It's one of the most unwittingly truthful campaign spots that we're likely to see this year. The two-dimensional paper-Santorum, which pivots mechanically when threatened and never loses its perfect dopey composure splendidly captures the essence of the real man. As for Rambo-Romney, he's strangely lumbering-yet-agile, a triumph of advanced animatronics who's something between unsettlingly lifelike and disconcertingly hydraulic.
To keep up the daft momentum of a campaign that may now have to get along on gaffes alone if it hopes to still be in the papers by Super Tuesday, Santorum followed the ad with a remark that posthumously faulted Whitney Houston for failing to act as a role model to youth. The truth, of course, is that the addict-singer has probably saved the lives of more young reprobates by dying at 48 than Pat Boone will by living to 97. But Santorum, a pro-life, anti-contraception, pro-war, anti-immigration creationist has never been known to let reason affect his thought flow, let alone his mouth flow. Those who speak for him are equally confusing, and sometimes flat dumbfounding. Foster Friess, an evangelical business leader who emerged from a Sinclair Lewis novel last week, is a surrogate who we hope will stick around. Not only does his name suggest high office in the Benevolent and Protective Order of Elks, he's apparently versed in secret American folkways pertaining to warding off unwanted pregnancies. On Thursday, he revealed to the public that in his youth women inserted aspirin between their legs as an apparently morally neutral way of short-circuiting insemination. Friess acted as though this technique were common knowledge, and maybe among Santorum supporters it is, as are other strange forms of household Santeria. More please, sir. The Smithsonian is interested.
The late-Monopoly-game doldrums of a campaign that can't go on, but must, because those are the rules, goddamn it, we can't just quit, will summon more Foster Friess's to center stage. Also of help will be more impromptu sermons linked to the tragic lives of addled pop stars and more TV ads that compare the candidates in nonsensical but diverting ways to B-movie action heroes from thirty years ago, when the average Republican value voter last attended the cinema. With these little assists from the absurd and asinine, the process still has a chance of playing out and Obama will have an opponent sooner or later. Much, much later, is how it's starting to look.
Would someone, anyone, please knock over the board?
Walter Kirn is the author, most recently, of a memoir, "Lost in the Meritocracy." His 2001 novel "Up in the Air" is the basis for the film of the same name. His column appears every Friday.
Read more from Death Race 2012
Follow Walter on Twitter.


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Well, I made it through finals. So far only one final grade has posted. That was an A. I am still waiting for 3 more to post. Some times I think this may be the hardest part. Waiting. I feel fairly certain that of the three remaining classes I got a least one A and two B's. I am hoping though that it turns out to be two A's and one B. That would be nice.
We only have a three week break between semesters. What makes this a little bit more bearable is the fact that there are two 1 week vacations in the Spring Semester. That is a lot nicer than fall when you only get I think four or five days off the entire semester.
I am taking 6 classes next semester so those two breaks will be a good chance for me to get caught up on anything I am behind on or struggling with. I know a couple of the classes are going to be quite difficult for me, so the breaks will be nice.
Well that is it for now. More to follow soon I hope


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Carey Mulligan - SAG Awards 2010 Red Carpet
Carey Mulligan shows off a stylish red gown by Lanvin on the red carpet of the Screen Actors Guild Awards held at Los Angeles' Shrine Auditorium on Saturday (January 23).
The 24-year-old actress is up for Outstanding Performance by a Female Actor in a Leading Role for her work on An Education. The cast of Carey's film is also up for Outstanding Performance by a Cast in a Motion Picture!
Carey finished her glam look with jewels by Fred Leighton - she's wearing 19th century diamond snake pendant earrings, a diamond line bracelet and a pear-shaped diamond ring. Gorgeous!


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School's out for summer and the beach traffic is booming again here on Isle of Palms, South Carolina, as the vacationers, day trippers, and locals alike flock to the beach. There are two things people always want to know when they visit this special beach town… where should I eat and what book should I read.
For food–I recommend Long Island Cafe and Sea Biscuit Cafe. There are many fun places to dine on the island, but these are my go-to spots!


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i'm gonna need a rally to restore sobriety after this weekend...
she uses eco-friendly sex toys. she is the literal definition of a hippie.
Today's face brought to you by last night's make-up.
Have you ever straight up just taken a bite out of a block of cheese? Because it's amazing.
where's my purse there's an important taco in it
You were making dinosaur noises while jerking me off..
drunk tastebuds have low standards.
When I say rough sex, and show you scars from past encounters, pulling my hair a little IS NOT GOING TO CUT IT. And he just doesn't understand.
I made friends with a raccoon. I pet it. Like I was Pocahontas.
He was going nice and slow, then he yelled " BOONNEESTOORRMM!!!!!". I can't walk straight.
Its as if he has to do the exact opposite of what I tell him. Don't come in my eye, pfshh it's in my eye. Don't come on the cat, pfshh it's on the cat.
She recited Pi throughout ever orgasm she had....she said it was a game she likes to play...how far she gets is how she judges her lovers...I am oddly turned on by this...
woke up on my stairs with half a hot dog beside me and the last text I sent was "i make hot dog in toasTer" .
i think it would be like really awesome if scientist could genetically engineer manatees to be like the size of goldfish so i could have one in my fishbowl and be like FUCK YEAH TINY MANATEE
it appears as though my vagina has gotten the best of me again
What the fuck?


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Avon 'Ship Ahoy' Vintage Brooch & Earrings Set
Regular price $ 25.00
$ 0.00
Shipping calculated at checkout.
Avon 'Ship Ahoy' - a goldtone sailboat brooch with a dangling anchor, sails enameled in red and blue, and flying a red pennant. Matching pierced earrings are goldtone ship's wheels that repeat a smaller version of the sailboat motif. Pin measures approximately 1-3/4 x 3 inches and earrings are 1-1/8 inch in diameter. This is a vintage set from 1992, pre-owned and in excellent condition. Brooch and one earring are signed Avon. A great fun set for anybody who loves to sail!


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The feeding frenzy over Tiger Woods' tiny run-in with a fire hydrant has taken voyeurism to new depths. Where was he going at 2:25 in the morning? Why wasn't he wearing shoes? Why was his wife smashing his Cadillac Escalade's window with a nine-iron?
Prying minds apparently want to know all this and more. And the insatiable, ubiquitous media -- from the bloviating blogosphere to the cackling cable commentariat -- are all too happy to oblige.


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Favorit Bikes by Petr Novague
Petr Novague Demonstrates The Favorit Bikes Retro Bike
Petr Novague , the project leader of the highlighted work Favorit Bikes by Petr Novague explicates, It was a challenge to design bicycles and accessories for Favorit, not only because of the history and heritage of the brand. Many years had passed and the technological demands of clients have changed. All the technologies used on Favorit bicycles are chosen with high regard to reliability, low maintenance, simple manipulation, light weight and elegance. All three series have uniform level of equipment and price. The customer can then select a model of bicycle with preferred riding position or a way. .
Favorit Bikes by Petr Novague Images:
End of the article, click here to go back to previous page, or alternatively go back to Design Reviews homepage.


text: Loving Right Now by declairelegenou featuring a cashmere shawlI've grown accustomed to darker lip shades now. Somehow, it flatters my pale, sallow, wintry skin. Applied either as light stain or full-on, it is the perfect accessories and I hardly need anything else to look pulled together. These items are my everyday uniform lately; perfect for lounging at home, driving to play dates, or impromptu leaf-hunting in the park. Burberry Lip Glow in Bright Plum, Aerin Beauty Mini Lipstick in Dahlia, Chanel Joues Contraste in Rose Initiale, Black V-neck Cashmere sweater and Cropped Tweed pants (both J.Crew), London Sole Pirouette in Black Patent (here shown similar from London Rebel), Oversized Snood (my own hand knitted item, here shown similar from J.Crew), and Deborah Lippmann Modern Love on tips.


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Posts Tagged 'googleable'
Lessons for and from students
Posted by: Dr Ashley Tan on: July 10, 2015
ECG is an acronym for electrocardiogram. I had an ECG earlier this week, but it was not about my heart. I volunteered to share some thoughts at a school's Education and Career Guidance event.
As with other events which are designed so that I give, I received much in return. Here are a few of my takeaways from the event.The students were prepared with some guiding questions, but we found much of this scaffold unnecessary. When we made meaningful connections, questions and answers flowed naturally.
For me this reinforced the importance of being personable and personal as an educator.
Being personable is being approachable, having a smile that comes from deep within, and above all sounding human instead of high-and-mighty. Being personal is sharing meaningful events or stories. This sort of sharing is sincere and connects with heart and mind.
For example, when I introduced myself I mentioned that I was married to one of the teachers in the school. That naturally piqued interest and generated a Q&A game.
I also noticed all members of one group were armed with smartphones. So instead of answering the "What do you do?" and "Why do you do it?" questions the standard way, I asked the students to Google me. It was my way of showing them that:
- they should use the tools they already have,
- they could teach themselves, and
- it was important to be Googleable in a good way.
All three are important in modern work. If that is not career advice and guidance, I do not know what is.
I took the opportunity to ask different groups of students what they thought about the state of technology use in school compared to their personal lives, what games they played, and what social media tools they preferred. I will focus on their social media habits since that was the topic I discussed with all of them.
Almost without exception, the students seemed to favour Instagram. Some were on Twitter, and if they were, they preferred to keep private accounts. YouTube was also popular, but it is not really a social media platform if the behaviour is largely consumptive. Only a few had heard of or used more current tools like Snapchat, Meercat, or Periscope.
The serendipity ship sailed by because a tweep shared this the next day:
My former students r on Facebook & Twitter. My current students r on Snapchat, Instagram & Twitter (private accounts). #socmed #edtech #edsg
— Ping Kwa (@pingkwa) July 9, 2015
Her students were slightly older, but they had a similar evolutionary social media profile.
Take one or two accounts and you have anecdotes; collect more anecdotes in a disciplined way and you have data. Groups like comScore, TheNextWeb, and MindShift provide similar anecdotes and data about how teenagers use social media.
The more important question is whether teachers know and care enough that their students are on such platforms. If they do, the next question is whether teachers use appropriate strategies (read: non-LMS, non-traditional).
Students and teachers have different expectations of social media. For example, teachers seem to forget how they use social media in their own lives and resort to push strategies instead of pull.
Push strategies include making announcements, giving instructions, requiring online discussions of a certain quantity by a certain time, etc. These are pushed towards students and rely on an external locus of control (the teacher).
Pull strategies, on the other hand, originate from the students, a shared event, a common interest, or some other internal locus of control. No one has to tell them to take a photo (like the one above) and share it on Instagram, to talk about Amos Yee or Taylor Swift on Twitter, or to discuss homework on Facebook.
I let some of the students know that one of the things I do now is try to show teachers how to unlearn old habits and pick up new value systems for teaching. The secret sauce is this: Teachers have to use social media in their own lives and transfer what is good and useful to class. It is social first, not content first.
One student asked me if I could come back to her school and tell her teachers how to do that. I would love to. I can, but will the school leadership or staff developer even bother?


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Team Cameron, as my colleague James Forysth points out, are rather pleased with Obama's victory. Downing Street's finest have been pushing the idea that Barack Obama's victory speech echoed, word for word, Cameron's constant refrain that 'we are all in this together' and that the 'inherited economic mess' is slowly being overcome. Dave the Statesman, don't you know?
Obama has his admirers on the Opposition benches, as we know. The Labour Party was out in force at the two biggest victory bashes in central London last night: CNN's opulent shindig at One Mayfair and the tackier affair at the US Embassy. I spotted Mr and Mrs Harriet Harman, Chris Bryant and Austin Mitchell enjoying the jazz band at CNN's champagne and oyster soirée, while former chief whip Nick Brown and Diane Abbott, who never passes on a free drink, had to subsist on Big Macs, Bud and an Elvis impersonator at Grosvenor Square.
A few Tory backbenchers bobbed about the sea of red. I spied a less than chirpy Liam Fox in the wee hours; not even one of CNN's 'Mitt-inis' could cheer him up. If only the Romney campaign had listened harder in the 'long meeting about foreign policy, security as well as economics' that Fox had held with them! But alas, all is now lost.
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Saturday, January 17, 2009
Tamaki Int - Cook Island Solo Dance
5 comments:
- Sue said...
These gorgeous, talented kids are going to have so much confidence when they go out into the world on their own. How much time is allowed in the school week for learning andpreparing such polished cultural performances? It must be an amazing place to work and learn.
Glad to see your computer is up and running again :)
- January 20, 2009 at 2:18 AM
- NZWaikato said...
Well thanks for that Sue. Students had to prepare for the competition in their own time as to not interrupt their study... the student in this case put a lot of time into her work with her parents helping...
- January 22, 2009 at 11:23 PM
- room6 said...
awesome dancing.
Room6 has enjoyed wathching all your peformance. you were very brave to dance solo.
great performance.
- February 9, 2009 at 11:52 AM
hey everyone! i am from germany and i wonder whether someone could tell me if there is a possibility to take traditional dancing classes in the cook islands? like a 4-6 weeks programme maybe or regular classes? thanks for any ideas on schools, programmes, people who might have information on that...thanks, bye, kat
- January 8, 2010 at 12:47 PM
- Samira said...
HI Tamaki inter
WOW I loved your cook Island Solo dance keep up the great work.
- November 28, 2012 at 11:56 AM


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In 2012 Fluid Interior completed a furniture project for Riverbridge, an investment management firm in Minneapolis. Through the use of Fluid's visualization software and interactive design development, Riverbridge transformed their vision from a more traditional, closed office setting to a collaborative, open workspace. The space features access to daylight and a height adjustable workstation for each employee. The perimeter of the space is dotted with private offices and meeting spaces for employees.
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Well, it is that time of year when Papertrey Ink celebrates it's birthday. A time of new product release, fun challenges and lots of great prizes. The challenge for Day 1 was a colour challenge - you can check it out here.
These challenges are doubly so for me since we are currently doing basement renovations and my entire craft room is packed up, with many things inaccessible, yikes!!!! I have no embellishments and no access to my embossing tools, as well, where I usually take my photos is packed with furniture - so here goes.
I chose Lizzie's colour palette and came up with this card:
I was inspired by this gorgeous card created by Laura Bassen. I die cut balloons from cardstock in the colours of the pallette, sponged some ink on the left side and bottom of each to give them some shadow and added a highlight to each with a white gel pen. After adhering them to the die cut white cardstock and stamping the sentiment, I drew lines for the strings using a glitter gel pen. Popped it onto a card base with fun foam and done.
Stamps - Stylish Sentiments: Birthday (PTI)
Dies - Birthday Style (PTI), Stitched Rectangles (Lil Inkers)
Paper - Hawaiian Shores, Aqua Mist, Limeade Ice, Summer Sunrise, Berry Sorbet, Stampers Select White cardstock (PTI)
Ink - Memento Tuxedo Black, White, Glitter Jelly Roll pens (Sakura), various inks for shading
Sunday, February 7, 2016
Papertrey Ink 9th Anniversary - Day 1 Team Favourites Colour Challenge
3 comments:
Such a fun birthday card! I love the techniques you used for doing the balloons - the shading and highlighting. I'll have to remember to try this, because they really look good!ReplyDelete
So festive--great use of the colors!ReplyDelete
Love your balloon bouquet, Connie! The shading is fantastic.ReplyDelete
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How a small U.S. college logo became a $61million fashion empire... that has nothing to do with the academic institution it represents
The Daily Mail
December 29, 2011
A story featuring the link between the Franklin and Marshall clothing line (based in Italy) and our institution. more>
We grew up in a zoo!
Frederick News Post
December 22, 2011
In 1966, Richard Hahn '64 bought a zoo in Thurmont, Md. He and his wife, Mary Anne, raised their three children in a house on the zoo grounds, reminiscent of the new film We Bought A Zoo, based on a book by Benjamin Mee (portrayed in the film by Matt Damon). more>
Another Kind of College Sports
Philadelphia Inquirer
December 16, 2011
President Porterfield discusses the vital link between academics and athletics at Division III colleges. "Colleges like Franklin & Marshall, Haverford, and Wesleyan aim to further the intellectual growth of all our students in a climate of high achievement and individual responsibility. In that context, we appreciate the educational value of competitive sports and structure our athletic programs to maximize their contribution to learning." more>
Christie Nominates Attorney General for Judgeship
Philadelphia Inquirer
December 12, 2011
N.J. Gov. Chris Christie on Monday shuffled his Cabinet, nominating Attorney General Paula Dow '77 to become a Superior Court judge in Essex County and his chief counsel, Jeff Chiesa, to take her place. more>
The Swift Death of Letter Writing
The Sunday News
December 4, 2011
Constance Renfrow '12 and Eric Mellis '13, and Professor of English Patricia O'Hara, discuss the decline of letter-writing. more>
Beyond 'Glory'
New York Times
November 29, 2011
Associate Professor of History Van Gosse writes about the fraught history of black soldiers in early America. more>
KIPP Enlists UH in Graduation Program
Houston Chronicle
November 15, 2011
Franklin & Marshall is one of 10 colleges in the country to partner with the KIPP charter school chain to increase support for low-income students. more>
Walking a Mile in a Refugee's Shoes
Intelligencer Journal/Lancaster New Era
November 15, 2011
In a refugee-simulation experience during a McCaskey High School staff development event, Franklin & Marshall College students took on the roles of persecutors, resettlement workers, bureaucrats, volunteers and others whose paths the refugees crossed. more>
A Wall Street Refugee's Art Takes an Acid Look at her Old World
Philadelphia Inquirer
November 10, 2011
An exhibition of the artwork of Associate Professor of Art Virginia Maksymowicz commemorates the time she worked as a secretarial temp on Wall Street. more>
Philadelphia Boxing Legend Joe Frazier Dies
Philadelphia Inquirer
November 8, 2011
The Rev. William H. Gray '63, formerly of Bright Hope Baptist Church in Philadelphia, gave Joe Frazier odd jobs at the church when he returned from the Olympics and was struggling financially. more>
Obama Pays Attention to Keystone State
USA Today
November 8, 2011
A recent Franklin & Marshall College Poll reports, "Despite his tepid support among Pennsylvania voters, President Barack Obama continues to lead his main Republican challengers." more>
Author: 'New Middle East' Needs New Policy
Sunday News
November 5, 2011
Stephen Kinzer, former New York Times foreign correspondent, said at an event held at Franklin & Marshall, "We're at a very interesting turning point in the history of the Middle East." more>
Front Line Soldiers in the Civil Rights Movement
Intelligencer Journal/Lancaster New Era
November 4, 2011
A new exhibit at Franklin & Marshall focuses on African-American GIs in Germany. more>
New Franklin and Marshall President to Appear
WITF Smart Talk
November 1, 2011
Daniel R. Porterfield, Ph.D., discusses his vision for Franklin & Marshall College and the future of higher education. more>
Far From Home: A Bhutanese Family Settles in Lancaster
Intelligencer Journal/Lancaster New Era
October 31, 2011
Avery Bayard '11 volunteers to teach English to Bhutanese refugees who have settled in Northwest Lancaster. more>
In Our Schools: David Mostow
Reading Eagle
October 31, 2011
For David Mostow '75, teaching is a second career after spending 25 years as a recruitment professional. more>
Book Review: The Physics Book by Clifford Pickover
October 25, 2011
A book reviewer of The Physics Book says that Author Clifford Pickover '79, "ably describes each physics milestone in the span of one page. His language is conversational and extremely accessible, all without sacrificing accuracy." more>
Occupy Wall Street — For What?
Huffington Post
October 21, 2011
Robert Diggs '13 writes that Occupy Wall Street, "needs to regroup and find their mission. Once they have that, they should disseminate that mission to both their followers and detractors in one explicit message." more>
Penn Manor Grad Helps Teacher Fulfill Dream
Intelligencer Journal/Lancaster New Era
October 20, 2011
Jake Bleacher '00 invited his former high school science teacher to participate in NASA's Desert RATS (Research and Technology Studies) program. more>
From Ancient to Modern, Plays Hold Timeless Appeal at College Theaters
Intelligencer Journal/Lancaster New Era
October 20, 2011
"Electra," by Sophocles, will open with a literal Greek chorus of 12 women, one very messed-up family and questions we still ask today. Set a few years after the Trojan War in Argos, the play focuses on one extremely dysfunctional family. more>
Ancient Images of a Mother Giving Birth Found
Discovery News
October 19, 2011
A unique object was found at the Poggio Colla Fieldschool in Florence, Italy, where Franklin & Marshall students can participate in an archeological dig. The object, which could be the earliest representation of childbirth in western art, shows the head and shoulders of a baby emerging from a mother. more>
Student Curators Explore the Lives Behind the Art
Chronicle of Higher Education
October 19, 2011
The work and romance of artists William and Marguerite Zorach have captivated the imaginations of students at Franklin & Marshall College, who have produced an exhibit at the Phillips Museum entitled Zorach: Paint and Spirit. more>
The Poor Richards in Morristown…Are You Listening, Frankie?
Morristown Green
October 18, 2011
Members of the F&M A Cappella group The Poor Richards travel through their hometown Morristown, NJ, and get some feature treatment in the hometown paper. more>
New Stream Cleanup Model?
Intelligencer Journal/Lancaster New Era
October 17, 2011
Dorothy Merritts and Robert Walter, professors of geosciences, made a startling discovery that has redefined what we know about water pollution. They determined that nearly 500 mills and mill ponds from long ago had transformed much of Lancaster County's waterways into virtual lakes. more>
Bluesman Corey Harris to Play a Free Concert at F&M
Sunday News
October 15, 2011
Corey Harris, known worldwide for his diverse and unique style of Rastafarian music, will play a free concert at Franklin & Marshall on Oct. 20. more>
'Generational Spillover' Shapes her Life, Art
Sunday News
October 15, 2011
Novelist Amy Tan delivered the Hausman Lecture at F&M on Oct. 20. more>
Tests Bolster Use of Holographic Radar System
Boston Globe
October 10, 2011
Tim Bechtel, adjunct professor of geosciences, explains how holographic radar software uses the Doppler effect to distinguish fast-moving objects, like artillery shells, from distractions like explosions or sea spray. more>
Passion for the Past
The Reading Eagle
October 10, 2011
Provost Ann Steiner presented "Reading Greek Vases in Reading and Beyond" at the Reading Public Museum for the event "A Celebration of Archaeology." more>
F&M to Host Zorach Exhibit
The Sunday News
October 9, 2011
Students in Associate Professor of Art History Linda Aleci's curatorial practices class are putting the finishing touches on a substantial exhibit of the art of the Zorachs, major figures in American modernism whose work has hung in several prominent museums. more>
Downstream and Dirty
The Sunday News
October 8, 2011
Acclaimed ecologist/author Sandra Steingraber, who will give a free public talk Thursday at F&M, says the way we live causes cancer. more>
'Cream of Kohlrabi' by Floyd Skloot
Boston Globe
October 7, 2011
A book reviewer says Floyd Skloot's '69 16th book, a short story collection, is full of "graceful and understated writing." more>
Food Business Caters Toward Helping Refugees
October 7, 2011
Director of Web Content Sri Dasgupta is interviewed about Upohar, her catering service that employees refugee women living the Lancaster area. [Video] more>
Lancaster: More than Just Amish
Philadelphia Inquirer
October 7, 2011
Located about 65 miles west of Philly, downtown Lancaster is an artsy enclave of indie shops, cafes and galleries - an evolving cultural scene that delivers plenty of action for a weekend getaway. more>
Winters' Grave Brings Admirers, Concern
Intelligencer Journal/Lancaster New Era
October 7, 2011
The grave of Maj. Richard D. Winters '41, commander of the Easy Company that was made famous through the HBO mini-series "Band of Brothers," has been visited by hundreds of people from as far away as Holland and China. more>
Steve Jobs' Mantra Rooted in Buddhism: Focus and Simplicity
ABC News via Yahoo!
October 6, 2011
John Lardas Modern, assistant professor of religious studies, says the irony of Steve Jobs' spirituality was that as much as it reflected the most beautiful aspects of the products he made, those very "machines" have in some ways enslaved a generation of users. more>
New Tool Will Give Clearer Picture on College Cost
Associated Press
October 6, 2011
VP of Admissions Daniel Lugo says the net price calculator is "a good tool for parents and students of college-bound people to get a sense of what their bottom-line cost will be." more>
Books in Brief
October 5, 2011
Molecular biophysicist and inventor Clifford Pickover '79 follows his 2009 volume The Math Book with The Physics Book: From the Big Bang to Quantum Resurrection, 250 Milestones in the History of Physics. more>
Students Scrimp on Costly Books
Intelligencer Journal/Lancaster New Era
October 3, 2011
Barry Bosley, associate vice president for administration, says the college has received a lot of positive feedback about textbook renting services. more>
Colleges, Synagogues Reach Out to Jewish Students at Holidays
Intelligencer Journal/Lancaster New Era
October 1, 2011
Ralph Taber, associate dean of the college and Klehr Center director, explains what F&M does to help students celebrate Rosh Hashanah and Yom Kippur. more>
A Shot in the Arm
Sunday News
October 1, 2011
Seth Mnookin, author of "The Panic Virus: A True Story of Medicine, Science, and Fear" who comes to campus on Thursday, says that in some ways he is an advocate for vaccines, but that he feels more like an advocate for science and an advocate for truth. more>
Celebrating Frugality
Inside Higher Ed
September 30, 2011
Deborah M. Martin '72, director of special events, explains that combining inauguration with family and homecoming weekend gave President Porterfield a chance to interact with several groups of people who might not have attended a traditional inauguration weekend and engage a wider audience in service activities that made up the heart of his inauguration. more>
Franklin & Marshall College Inaugurates New President
Intelligencer Journal/Lancaster New Era
September 26, 2011
Mary Schapiro '77, chairwoman of the U.S. Securities and Exchange Commission, and many others offered high praise for President Porterfield during the ceremony when he was inaugurated as the 15th president of Franklin & Marshall College. more>
Monkeys Also Reason Through Analogy, Study Shows
Science Daily
September 24, 2011
A study carried out by co-author Roger Thompson, professor of psychology, shows that monkeys are capable of making analogies. more>
Walking the Line Between Activist and Scold
Intelligencer Journal/Lancaster New Era
September 22, 2011
Indie filmmaker of the anti-fracking documentary "Gasland" Josh Fox told a class of F&M students "If you're freaked out by this, you should be." more>
Pa. Republicans Weigh New Electoral College Plan
Talk of the Nation, NPR
September 21, 2011
G. Terry Madonna, director of the Center for Politics and Public Affairs, discusses the possible political strategies behind a proposed change to the Pa. Electoral College. more>
Apple's Mousetrap
September 20, 2011
Associate Professor of Psychology Tony Chemero devised a clever experiment to test Heidegger's concept of readiness-to-hand. more>
The Talking Cure at Work in Contemporary YA Fiction
The Millions
September 20, 2011
Adjunct Assistant Professor of English Kabi Hartman writes that, "YA novels involving teen protagonists and their therapists suggest that adolescents are vulnerable and in need of adult intervention." more>
Calculating Costs and Benefits
Inside Higher Ed
September 20, 2011
Vice President and Dean of Admission and Financial Aid Daniel R. Lugo says that the net price calculator, "is a win for the consumer, and I think long-term it's a win for institutions that actually do provide competitive financial aid." more>
F&M Chaplain Works Across Faith Lines
Intelligencer Journal/Lancaster New Era
September 17, 2011
College Chaplain Susan Minasian says, "My role is to cultivate a multi-cultural atmosphere, to foster the value of critical thinking in a liberal arts culture." more>
New Challenges to Gas Drilling
The Wall Street Journal
September 12, 2011
The Franklin & Marshall College Poll found that 66 percent of Pa. residents had a favorable opinion of the natural gas industry. more>
Glow Cat: Fluorescent Green Felines Could Help Study of HIV
The Guardian
September 11, 2011
Eric Poeschla, M.D. '80 has produced a genetically modified cat that may aid HIV research. more>
The Net Price Calculator: Financial Aid 'Game-Changer'?
The New York Times
September 9, 2011
Daniel Lugo, vice president and dean of admission and financial aid, says the net price calculator is a "game changer" for families researching colleges and gives some pointers for users. more>
University Presidents Welcome Students Back to Campus
The Washington Post
September, 2011
President Daniel R. Porterfield, Ph.D, is included in a slideshow that features college presidents who personally welcome students and their families to campus. more>
Concertante Ponders its Musical 'Mission' in its 15th Season
September 8, 2011
Doris Hall-Gulati, coordinator of F&M's Sound Horizons series and an artist-in-residence, explains why she chose Concertante to come to campus. more>
Like Former Mayors, a Statue Fades From View
New York Times
September 5, 2011
A statue of former New York City mayor Abraham De Peyster that sits on the edge of F&M campus has an unusual story. more>


text:
This was a tragic case.
A preventable case.
This woman should be alive today.
But she's not.
The anesthesiologist is still administering anesthesia.
The GI doctor is still doing colonoscopies.
The patient's family was furious when they learned what happened.
You should know that the doctors involved didn't tell her surviving family the real truth about what happened.
A lawsuit seeking money as compensation for the death of their mother.
Seeking compensation for the taking her at an early age.
Seeking compensation for the loss of their best friend and companion.
This was a close-knit family.
Mom was the cornerstone of this family.
All four lived near each other in Brooklyn.
They spent holidays together.
They spent their weekends together.
It wasn't unusual when mom told her oldest daughter that she saw blood in the toilet when going to the bathroom.
That prompted her to see a gastroenterologist.
He told mom he needed to look inside to see why she was bleeding.
It wasn't a gyn issue.
He got her worried.
It might be cancer.
It might be a polyp.
It might be a hemorrhoid.
"The way to look inside is to do a colonoscopy," he said.
Even though she was in her mid-sixties, she never had one.
He told her to follow these instructions to prepare for her colonoscopy.
She followed his instructions to the letter.
Then again, nobody likes that liquid.
She did exactly what he said to do.
The next day, she was ready.
She arrived on time.
She wouldn't feel anything.
She wouldn't remember anything.
She'll wake up feeling refreshed.
She was ready.
She was the designated driver.
Behind the scenes, she didn't know what was going on.
Here's what took almost two years to find out...
During the colonoscopy, the GI doctor inserts a small, thin, fiber-optic tube into her butt.
He looks around.
He needs to see what's in there.
If he finds polyps, he'll remove them and send them off to pathology for evaluation.
He needs to find out where the bleeding is coming from.
He's searching.
He's moving that probe further and further up her colon.
Except he got stuck.
She had a kink in her colon.
He was trying.
He kept pushing.
The anesthesia doctor heard an alarm trigger on a device used to monitor the patient's oxygenation.
It's called a pulse-oximeter.
That device triggered an alarm.
It meant one of two things...
Either the device malfunctioned or...
There was a problem with the patient getting sufficient oxygen.
He needed to know what the problem was.
He first went to look at the pulse-oximeter device and how it was hooked up.
Everything looked connected.
He reset it and waited for the oxygen levels to return to normal.
They didn't.
They were dropping.
That meant the problem was with the patient.
Nor did he know what caused this sudden drop in her oxygen levels.
Remember, he doesn't know what's going on at the other end with the GI doctor and what he encountered in her colon.
The GI doctor, still hearing the alarm, asked the anesthesiologist if everything was Ok.
He replied distantly "Yes. Her O2 sat levels are dropping. Everything's fine though."
He kept trying to push his way through the kink in the colon.
Kept trying to get the colonoscope further up so he could see what's past this kink.
The anesthesiologist now checks the patient's mouth.
He sees there's some fluid in her mouth.
The anesthesiologist decides to suction the fluid in her mouth.
He suctions the fluid around her cheek and the back of her throat.
You should know that during this colonoscopy the patient is lightly sedated.
She is given a medication known as propofol.
She's not intubated.
That's where an anesthesiologist inserts a tube down her airway in order to keep an open airway.
It protects the airway and ensures that if her airway closes down, she still has the ability to breathe.
Here's what I learned when I questioned the two doctors involved in this case...
An involuntary reaction.
It caused her to vomit.
That meant that fluid and stomach contents were now up in her mouth.
That explained why there was fluid in her mouth.
That didn't yet explain why her oxygen levels were falling.
When someone vomits stomach contents into their mouth while under anesthesia, the next thing that happens is that the patient breathes in.
Because the patient has no gag reflex while under anesthesia, they don't cough.
That gag reflex prevents liquids from entering the airway.
When you're under anesthesia, without a gag reflex, you simply breathe in whatever is in your mouth and throat.
That went right into her lungs.
When a foreign object or liquid goes into the lungs that shouldn't be there, that's known medically as pneumonia.
The action of how those stomach contents got into her mouth and then her lungs is medically known as aspiration pneumonia.
That can be life-threatening.
In this case, the anesthesiologist had no clue.
He never considered the possibility that she aspirated.
He was first worried about the machine malfunctioning rather than the patient having a medical emergency.
Rather than tell the GI doctor to STOP what he was doing while he corrected her oxygen levels, he told him to keep going.
He'd just suction out the fluid in her mouth and she'd be just fine.
Except she wasn't.
He never suctioned beyond the back of her mouth.
He should have suctioned down her throat, past her vocal cords.
The reason why her oxygen saturation levels were dropping was because she couldn't get air into her lungs.
There was fluid in her lungs.
There was stomach contents in her lungs.
Her lungs were not able to properly inflate and exchange air.
If this continues for a certain period of time, the patient will suffer brain damage.
The anesthesiologist never considered the possibility that she had aspirated.
He never figured out why her oxygen levels had dropped dangerously low.
He never learned from the GI doctor the triggering mechanism for this aspiration.
My medical expert confirmed that when he got stuck advancing the scope, he should have stopped.
Rather than risk a perforation by trying to push through, he should have abandoned the procedure.
But he didn't.
He kept going.
He didn't know why her oxygen levels had dropped.
Neither did the anesthesia doctor.
When they put the patient in the recovery room, the anesthesia doctor told the nurse to keep her head elevated.
Then he left to go administer anesthesia to another patient.
She was gasping for air.
She couldn't breathe.
There was fluid in her lungs, but he didn't know it.
Her oxygen levels did not improve.
He went on to do his next procedure.
The anesthesiologist sees the patient is having difficulty breathing.
He doesn't summon an ambulance for another 15 minutes.
There's talk of calling an ambulance immediately.
They delayed calling an ambulance.
She's not improving.
Her oxygen levels are terrible.
She's not awake.
The anesthesiologist can't wake her.
Finally, an ambulance is called.
She's taken emergently to the closest emergency room.
She's in a coma.
She can't feel anything.
She'll never awaken.
She remains in a coma over the next two days.
She deteriorates.
She suffered terrible brain damage.
All from a lack of oxygen.
All of her organs are now shutting down.
She can't survive.
All from a lack of oxygen.
How did she get such a lack of oxygen?
It all started when the GI doctor tried to push his way through the kink in the colon.
That triggered her to vomit into her mouth.
The anesthesia doctor failed to recognize the problem and tell the GI doctor who was doing the colonoscopy.
The GI doctor failed to tell the anesthesiologist he encountered a problem and would now end the procedure.
The anesthesiologist failed to recognize she had aspirated.
He failed to suction past her vocal cords to try and remove fluid contents from her lungs.
Each of the medical experts I consulted to evaluate this case were appalled.
They were furious.
They didn't understand how each of these doctors violated the basic standards of medical care.
Their miscommunications and their misunderstanding of what was going on, cumulatively and individually led them to believe she was fine.
She wasn't.
She died because of miscommunication between her GI doctor and the anesthesiologist.
She didn't have to die.
This was preventable.


text:
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text:
I would suggest to better take professional courses like Project Management, ACCA, MCSE and lot of other courses are there.
Institutes should also stop giving false education and stop money making scam playing with youngsters careers.
PS: Educators(insttutes) should keep better courses in thier institutes, which will help them grow as well help students grow rather than repeating and time wasting courses.
Edited by Limitation//Moon, 22 April 2010 - 08:48 PM.


text: By Scatterbrain From the recording titled 'Here Comes Trouble' Here is a tribute to my best friend, Hung with me since the beginning And he'll be there to the end. Talkin' Mr. Johnson and the Juice Crew. I love Mr. Johnson and the Juice Crew too, And all the girls that meet him, they love him too. 'Cause he's the baddest of the bad, hardest of the hard, Mr. Johnson is a giant, dare I call him God? Juice Crew - Dept. of Energy, The power Mr. Johnson, Johnson powers me. And all the girls keep knockin' - knockin' on my door, All those Johnson junkies want more and more. So hail Mr. Johnson and his two friends, too, Mr. Johnson super hero, Johnson and the Juice Crew. Johnson's hypnotizing and Johnson's mesmerizing... Johnson keeps me vital, Johnson keeps me strong Just like Samson had the power when his hair was long. Everybody needs a source of power, A hammer works for Thor but I got Johnson power, Every minute every hour. So darn cute a big hood with one eye, Girls can't keep their hands off of him and neither can I. Talkin' Mr. Johnson and the Juice Crew. ----------------------------------------


text:
I recently saw the movie Rashomon again. In it, a crime is described by four different participants, each of whom sees it quite differently. The Akira Kurosawa film is considered a masterpiece, in part for what it says about the human experience: We can all see the same thing, yet we can produce substantially different but equally plausible accounts of it.
This is certainly true of doctors and chronic lymphocytic leukemia. My CLL is cause for treatment with Rituxan and fludarabine, according to one doctor. It is cause for Rituxan plus cyclophosphamide, vincristine, and prednisone, according to another. Another expert weighs in with Rituxan plus chlorambucil. Three doctors say it is cause for nothing more than watch and wait, though two of them differ on how to proceed when treatment time comes. If I were to see more doctors, I would probably end up with a laundry list of treatments and no general consensus on whether to treat at all. As in Rashomon, my CLL is experienced differently by everyone who examines it.
But the subjective truth that ultimately matters here is mine. I have come to know my disease better since diagnosis, as I explained in the second part of this series on the "new normal." And I have gotten to know it even better this year. Part of my "doctor quest" has been to learn more about it, to see it through the eyes of people who are experienced at looking at it, so that I can see it better myself.
What I have learned is that I have what is called "high risk" CLL. The year 2006 brought with it news of clonal evolution, from a "normal" FISH result to deletion 11q. In an IgVH unmutated patient, which I am, this is not good news. Conflicting ZAP-70 tests performed by Quest Diagnostics have been resolved by the lab at UC San Diego, which is considered probably the most reliable place to get your ZAP-70 done: I am ZAP-70 positive.
Beyond that, I have clinical signs of progression: a slowly expanding spleen, slowly expanding lymph nodes, and a booming lymphocyte count. I may feel fine now, my hemoglobin and platelets may be in the normal range, and I may not have any "B" symptoms. But this won't last. How long it won't last is a matter of conjecture.
As I explained in the The "new normal," Part 2, I once thought, with some justification, that my disease might be, if not indolent, at least fairly cooperative. After all, I had likely had it for a decade and was still feeling good, even at Stage 2. Yet, I have now learned that the problems I am having -- acquisition of the 11q, disease progression -- are indeed consistent with having had CLL for a decade, especially in an unmutated patient. In fact, it is a wonder things didn't get worse sooner. If the statistics are to be believed, and if I were a cat, I would have used up four or five of my nine lives already.
But, as Mark Twain quotes Benjamin Disraeli as saying, "There are three kinds of lies: lies, damned lies, and statistics." I am not giving up. I am looking to refashion my hope in response to this newest "new normal," to find a realistic path to a better future. If the climb is at a steeper angle, and my heart beats a little faster, then it will only make me stronger.
Afternoon at The James
The last doctor I visited was John Byrd at the James Cancer Center at Ohio State University in Columbus. I have followed Dr. Byrd's research, and he would be on anyone's list of the top CLL doctors in the country. More importantly, if doctors were choosing which doctors they respect the most, I believe he would be very high on that list, too. Byrd, a self-described conservative when it comes to treatment, has a reputation for adhering to rigorous scientific and ethical standards in his clinical trials. I could have gone elsewhere, and had I gone a little to the south and west of Ohio, I might even have found an expert who would have promised to "cure" me through chemoimmunotherapy. (And no, I'm not talking about a fly-by-night clinic in Mexico.) But my CLL is hard enough to see -- think Rashomon again -- without adding rose-colored glasses to the equation.
And so, Marilyn and I drove 1806 miles from our house to OSU; the last few hundred yards were the hardest, since we had to find our way from the parking garage to the James, which sits at one side, slightly hidden, of a huge medical complex. It would have helped had they placed bits of cheese in various locations so we could have known if we were heading down the right corridor at any given time. But we did find it, and with half an hour to spare before my appointment was to begin.
It turns out that Dr. Byrd's floor was in mid-renovation, to the point that slips of paper with handwritten numbers tacked to the doors served to identify which exam room was which. The place was phenomenally busy and we were seen phenomenally late. I expected this, of course, and was reminded of the advice offered by a good restaurant I once visited: We take the time to prepare each meal properly, so please be patient.
Eventually my vital signs were taken, and I found that even in the halls of an enormous cancer center, the new normal has its comic moments. We have all heard of a "spit take," in which a comedian takes a drink of water and, upon hearing something surprising, spits it out. This almost happened to me when I got my temperature taken. After the thermometer was stuck in my snout, I noticed that the nurse's ID badge was emblazoned with the name "IP Freely." It took everything I had not to send the thermometer flying across the room.
After a lengthy interview with Dr. Byrd's nurse practitioner, Mollie, who knows more about CLL than most doctors I have encountered, we were ushered into an examination room to meet Dr. Byrd himself. The doctor looks a little older in person than he does in photographs, and was dressed in a striped oxford shirt, khakis, and tasseled loafers. Missing were the white coat and that usual doctor neckwear -- a stethoscope thrown jauntily about the shoulders. The one piece of medical equipment that Byrd keeps on his person is a cloth tape measure -- "hardware store issue," he says -- for measuring lymph nodes.
Dr. Byrd was personable and did his best to answer all my questions and address all my concerns. It helped that I came with an open mind for an honest opinion and that I was not shopping for news I wanted to hear. Doctors, even the experts, respond to perceived patient expectations. The more open you are, and the more relaxed -- yeah, I know, that part is not always easy -- the more you will usually get out of a visit. We got a lot accomplished during our hour, and by the time I left, I had several points to ponder:
- Unmutated 11q CLL in a person my age (49) will likely mean a stem cell transplant down the road, in my case from an unrelated donor. It's a risky therapy, but there is a 50% chance of a cure, or something close to it; a 20% chance of outright failure; and a 30% chance of complications that will eventually lead to, as the doctor put it, "badness." (For more on transplants, check this article at CLL Topics.) That said, the 11q is not reason in and of itself to jump into transplant mode right now.
- It is indeed better, as I have been surmising, to save heavy-duty chemotherapy for a pre-transplant remission and not to burn that bridge now, which would leave me with less chance of effective CLL cell reduction prior to transplant. Such "cytoreduction" is a key element in transplant success.
- In the short term, there is no reason not to continue to watch and wait. My nodes, for example, aren't nearly as big as I thought they were. The NCI Working Group guidelines for node treatment are 10 cm and most of mine are less than half that. I still feel fine, without "B" symptoms, and my platelets and hemoglobin are normal. At the point at which I start feeling fatigue, satiety (fullness) from an enlarged spleen pressing on the stomach, discomfort from nodes, night sweats, low platelets -- the usual CLL stuff -- treatment will be in the offing.
- I might be able to wait six to nine months -- or even a year or more, if the disease plateaus -- before that happens. When it does, there is no reason not to pursue a biologic approach to therapy ("immunotherapy"), either via a clinical trial or through single-agent Rituxan again. Dr. Byrd has done a dosing study of Rituxan, and thinks infusions three times a week for four weeks may be more effective than the once-a-week-for-eight-weeks that I have had. There is no guarantee that this will work, but I have responded pretty well to Rituxan in the past and it may be worth a try. (I have since been reading some Rituxan dosing studies and will post to the blog about them.)
- Dr. Byrd is not a fan of R+HDMP and he has given me pause in that department. I believe the word he used was "vehemently," as in "vehemently opposed" to my using it. Suffice it to say that a trial at OSU as part of the CLL Research Consortium led to serious problems in five of nine patients and had to be stopped early. Dr. Byrd knows that off-study R+HDMP is popular among patients, but says they are operating with very little data. In my case, were I to pick up a fungal infection from this immunosuppressive regimen, it could rule out a transplant. HDMP is, Byrd wrote in a report to my local oncologist, "associated with significant infectious risks as well as other end-organ toxicities."
- In general, Dr. Byrd is excited about some of the trials going on at OSU, including flavopiridol and Chiron-12.12, a CD 40 antibody. He does think things are progressing nicely in CLL research. "There are a lot of things happening," he said, "so I think the longer you hold out, the better you are."
Still, I get the sense from any number of experts that progress is incremental. And, alas, many clinical trials of promising agents are designed for the fludarabine-refractory. There are no silver bullets on the horizon just yet, and my disease is progressing faster than science.
It also remains a difficult case, in which I may have no choice but to take some big risks someday. My predisposition to squamous cell skin cancers makes therapy with fludarabine or Campath -- as well as a transplant -- into higher-risk propositions. (It does little good for the CLL to be knocked back if I develop systemic metastatic squamous cancers in its place.) New information about the Epstein-Barr virus and patients with a past history of full-blown infectious mononucleosis -- that's me -- makes me doubly wary of risking T-cell suppressive therapy. (Richter's Transformation doesn't sound like fun.) Dr. Byrd pointed out that CLL is a journey, and there are no doubt some challenging bridges to cross in mine.
Based on what I have learned from Dr. Byrd and from elsewhere in my travels, I now have some sort of plan, albeit one with some still-open questions:
First, I am going to have my HLA typing done and my local oncologist will do a preliminary search of the National Bone Marrow Donor Program database. (I'll write more to the blog about this experience, too.) The search results will let me know how many, if any, good matches pop up, and will give me some idea of what to expect in the future: a fairly easy time of finding a donor, or a difficult one. If it were to appear, for example, that finding a well-matched donor is likely to be impossible, I might consider a different approach to disease control.
Not all the doctors I have spoken to are fans of transplants, by the way. One commented frankly that, "in order to get the graft-versus-leukemia effect you have to put up with graft-versus-host disease, and in my experience that can be so bad that you are alive wishing you were dead."
Point taken. But in a world of hard choices, I think it is probably better to risk being alive wishing you weren't than the other way around. Not all transplant experiences are bad ones, though they have their share of unbearable moments, and it is worth the gamble to me if I have no other option.
There is, of course, another big "if" for me: My insurance company specifically excludes stem cell transplants from coverage. There are plusses to being self-employed, but finding adequate insurance coverage is not one of them. I will have to cross this bridge somehow, if and when I come to it.
Second, the longer I wait for a transplant, if my disease will allow it, the better. The procedure will only improve with time, as will, presumably, its effectiveness. So a 50% chance of success today may be a 60% chance a few years from now. I am young as these things go, and have a 10-year window before I get to the age where transplants are considered too risky to perform. In the meantime, I need to get in the best shape of my life and avoid comorbidity factors such as diabetes and heart disease that would reduce my chances of transplant success. And in keeping the transplant at bay, I need to be creative, as do my doctors, about treatment. It needs to be strong enough to keep me going, not so strong that it burns bridges I need to save. Finessing this will be tricky, and will be a challenge during the next few years. (So when is that Humax stuff going to get on the market, anyway?)
Third, I will watch and wait for awhile longer. I am unused to this -- letting the disease go further than it has gone before -- but I suppose this is part of my newest "new normal." And the shark I thought I had jumped -- single-agent Rituxan -- has now re-entered the picture. If the statistics on the more intensive Rituxan dosing schedule hold true, there is a 40% or so chance that I can get a partial remission that might last for 10 months. Hardly sterling, but it's not like there are many softball choices out there. (I will, of course, keep my eyes pealed for clinical trials of interesting alternatives.)
Beyond Rituxan, there are precious few tools readily available in the low-tox toolbox. There are lower-dose steroids, there's chlorambucil, and perhaps cyclophosphamide. (As you can see, I am grading on a curve here when I say "low tox.") If I use some of these now but save fludarabine and Campath for pre-transplant use, will that be enough to get the thorough disease clearance I will need?
Fourth, if the last couple of years have taught me anything, they have taught me this: I need to be ready, at the drop of a hat -- or the fax of a test report -- to adapt to any new "new normal" that may come up. As Roseanne Rosannadanna said, "It's always something." For example, while I am grateful to learn that having the 11q deletion does not predispose me to picking up the dreaded 17p, new information indicates that a third of unmutated patients will pick up the 17p on their own, even without treatment.
Finally, I have come to the point where I can own my CLL, all several hundred billion mutant Bucket C lymphocytes of it. There is a tendency, when one feels fine, to ignore bad news, bad test results, unimpressive response to treatment. It is only human to want to believe the best about one's situation. Coming to grips with my ever-changing new normal has been harder, in many ways, than the mechanics of learning about the disease and consulting with doctors. But being honest with myself and seeing it for what it is as best I can -- Rashomon-like -- is essential to taking the right steps to control and perhaps even conquer it.


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