Insurance Premium Increase

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Physicians aren’t exempt from the struggles with personal health insurance coverage, affordability, denied coverage, etc.   When I finished my training and opened my practice 20 years ago I had to buy individual coverage.   All options included a rider that excluded coverage on my uterus and ovaries due to fibroid surgery during training.  So when I had my TAH & BSO a few years later, the entire cost came out of my pocket.  Fortunately, I knew how to ask for cost reductions, but still…

My husband and I are both small business individuals.   I have always carried our health insurance under my name (office).  Over the years we have gone to a health savings account with a high deductible to keep the cost reasonable.  Fortunately, we have been mostly healthy.

Last month, we received a letter from Assurant Health telling us of a policy change that includes a $75 ER visit charge.  I thought this might be their way of avoiding a policy increase, but no.  Last week I received the notice regarding an increase to our policy.  Currently, our premium is $619.76 per month plus a mandatory $100 deposit into the HSA each month. 

The notice included the “good news”  -- “Congratulation!  You’re a Healthy Discount candidate.”  To determine your eligibility for the Healthy Discount, follow these simply instructions:  1.  Answer all six questions below.  Please consider the last 12 month when answering these questions……”

• Been recommended or scheduled for surgery that has not been complete?
• Been recommended to have or is anyone contemplating infertility treatment or been treated for infertility?
• Received or been recommended to have any treatment for alcoholism, alcohol or drug abuse or addiction or mental or nervous conditions?
• Been cited for operating a moving vehicle under the influence of alcohol or drugs?
• Received a diagnosis for any serious medical condition such as heart disease, stroke, cancer, diabetes, HIV, AIDS, or any other progressive disabling condition?
• Been incapacitated or hospitalized due to an accident or illness?

The “good news” is that since we can answer no to all six of those questions, our new premium will be $761.71 per month rather than $842.87 per month.  The mandatory $100 deposit into our HSA remains the same.
A simple 23% increase rather than a 36% increase. 

Earlier this year policy increases of up to 39% in California, Indiana, etc led The House Committee on Energy and Commerce to summon the chiefs of WellPoint, UnitedHealth Group, Humana and Aetna to the Hill to answer questions.  Policy increases by other companies seem to be flying under the radar.

If you missed them, check out the posts by Shadowfax here and here on Assurant Health.

Shout Outs

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Today, April 6th, is World Physical Activity Day.  I didn’t know this before reading @DrVes’s tweet last week:  Run for your life - April 6 is World Physical Activity Day http://goo.gl/NshG

This fits right into the theme for this week’s Grand Rounds chosen by the host Dave Munger, The Daily Monthly --  Fitness and Nutrition.   You can read this week’s edition here.

Welcome to the Grand Rounds — a weekly roundup of medical and health blogging, hosted on a different blog each week. This edition is volume 6, number 28 (click here for last week’s edition).

Since this is fitness month on Daily Monthly, I asked this week’s participants to focus on nutrition and fitness where possible, and we got a great response.

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Dr. Dean, The Millionaire Nurse Blog,  is the host of the latest edition of Change of Shift (Vol 4, No 19) !   It is the April’s Fool Edition.  You can find the schedule and the COS archives at Emergiblog. (photo credit)

Kim at Emergiblog, asked me to host Vol 4, number 19 edition of Change of Shift.  On April Fool’s Day!!!

April Fool!!!!!

And for you non-nursing readers, Change of Shift is a nursing blog carnival. …….
In Honor of April Fools Day, I thought I would share quotations that use the word “Fool.”  See if you recognize any of them.

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Dr Howard Luks, The Orthopedic Posterous, gives us an interesting post:  Health Law Does Little to Curb Overuse of Care: nyt #hcr #hcsm.   The comments are an important part of this discussion.

Docs... we can step up and control costs... limiting expenses to provide a better world for our children should be all the incentive you need!

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I was pointed to this NYTimes article by @purplesque and @ctsinclair:  Helping Patients Face Death, She Fought to Live.

By the time she was 38, Dr. Desiree Pardi had become a leading practitioner in palliative care, one of the fastest-growing fields in medicine, counseling terminally ill patients on their choices.

She preached the gentle gospel of her profession, persuading patients to confront their illnesses and get their affairs in order and, above all, ensuring that their last weeks were not spent in unbearable pain. She was convinced that her own experience as a cancer survivor — the disease was first diagnosed when she was 31 — made her perfect for the job. ………….

And here’s Paul Levy’s comments on the article:  Should we let the death issue die?

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Yesterday, I caught part of the Diane Rhems show “Savior Siblings”  discussing “the medical and ethical issues of using in vitro fertilization with genetic testing to produce a baby who could be a genetic match to save the life of a sibling with a fatal illness.” 

Guests

Beth Whitehouse -- reporter for Newsday and adjunct professor of journalism at Columbia University's Graduate School of Journalism, author of the book, "The Match:"Savior Siblings" and One Family's Battle to Heal Their Daughter.

Laurie Strongin  -- founder and executive director of the Hope for Henry Foundation, author of "Saving Henry: A Mother's Journey"

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I have @sandnsurf to thank for tweeting this:  RT @velopilot Fibonacci numbers visualized. http://vimeo.com/9953368 wow, brings out my inner geek..

Nature by Numbers from Cristóbal Vila on Vimeo.

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Dr Anonymous  doesn’t seem to have a BTR show scheduled this week. 

Upcoming Dr. A Shows (9pm ET)

4/14:  Psychiatric Social Worker Brandice Schnabel
4/22: DG & Tiffany Hollums and their adoption journey

Scalp Reconstruction – an Article Review

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

The March issue of Plastic Surgery Practice has a very nice article on scalp reconstruction (full reference below). The short article is an overview of HRS (hair restoration surgery) options for massive hair loss resulting from illness or injury.

The degree of deformity generally determines the treatment choice. Advancements in HRS in the past 2 decades are significant in yielding natural and almost undetectable results. Using a combination of HRS and cosmetic and reconstructive techniques, most deformities can be treated effectively.

There are many HRS techniques available, including follicular unit transplantation (FUT), follicular unit extraction (FUE), scalp reduction, scalp flaps, and tissue expansion.

The article gives some nice tips for use of tissue expanders:

• Planning is critical. Patient/family counseling regarding temporary deformity is crucial.
• It is best to overestimate the needed expansion and choose the largest commercially available expander that fits the patient’s anatomy.
• The vertical dimension is the most important factor providing the greatest gain in flap expansion. When the distance over the expanded tissue minus the base width of the expander is equal to 120% of the defect width, the expansion is complete.
• Overexpansion even by a modest amount will increase patient safety by providing excess tissue to cover the defect, allowing closure with minimal or no tension.
• If the entire defect cannot be removed and the residual defect is significant, leave the expander in place for a second expansion.

The article also mentions Operation Restore , a charity program which matches prospective hair loss patients with volunteer ISHRS physicians to obtain hair restoration services to help restore the physical and emotional wellness of the individual. The foundation will provide financial, travel, lodging, and medical assistance to eligible patients. The ISHRS Pro Bono Program was also featured in Association Forum Magazine.

Other posts you may find interesting:
Scalp Avulsion Injuries
Eyebrow Reconstruction
Hair Transplantation

REFERENCE

Scalp Reconstruction: An Aesthetic Challenge; Plastic Surgery Practice, March 2010, pp 14-18; E. Antonio Mangubat, MD

Reconstruction of Acquired Scalp Defects: An Algorithmic Approach; Plastic & Reconstr Surg, Vol 116(4):54e-72e, September 15, 2005. Leedy, Jason E. M.D.; Janis, Jeffrey E. M.D.; Rohrich, Rod J. M.D.

Happy Easter Sunday

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

First, I’d like to wish you all a Happy Easter.  I’ll begin mine with the Community Easter Sunrise Service down at the Arkansas River front. 

Next, I’d like to say I’m not sure what happened with #320 edition of SurgeXperiences which was due today, so I’ll just give you a few links to some surgical blog posts.

Here is the catalog of past SurgeXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.

 

• A classic op-ed post over at KevinMD’s by surgeon Sid Schwab:  "No more and no less a human being than my patients"
• Dr. Bruce Campbell, Reflections in a Head Mirror, gives us this very thoughtful post:  Turning Away.
• Bongi, other things amanzi, gives us a story relating how six degrees of separation can change how patients get treated.  He has another on anatomy.
• Via TBTAM’s recommendation as I somehow missed this when it was published November 21, 2009 comes a post from MommyDoc:  And that’s the way Sue “C’s” it.
• From Aggravated DocSurg:  If they could only all be taken to Rampart Hospital
• From Michael, Medgadget comes this post:  Photo Contest Profiles Role of Science in Modern Life.  (follow the links included in the post)
  
• Kane Guthrie, Life in the Fast Lane,  gives us a lesson on Minor Injuries 001.
  
• Dr. Wes tells us about a carpenter who had his  one heart nailed and lived to tell about it.
  
•  Buckeye Surgeon gives you the answer to his weekend image.  Go check yourself.
  

 

 

Hope you enjoy your day!

Elated

Crying she says, “Dr. Bates, my right implant has deflated. Help!”

“Don’t panic. It’ll be okay.”

We review the options and risks. Fortunately, her 9 year old implants are covered by the 10 year plan.

“Dr. Bates, can I go bigger this time?”

“Yes, that’s an option.”

Smiling, “Then let’s do it.”

Wisp Scarf for Kristen

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

I made my niece Kristen a pink scarf for Christmas, but she really seemed to like mine.  So I took the left over JoJoLand Harmony wool yarn from mine and knit this scarf for her.  It is approx 10 in X 62 in.  The pattern is Wisp by Cheryl Niamath.

The Lace Ribbon pattern (the pink scarf) is free on Ravelry.

Skin Grafting in Lower Third Nasal Reconstruction

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Skin grafts for the lower third nasal defects should not be overlooked as an option.  The article listed below  (first one)reminds us that  skin grafts can give a better cosmetic results than a local flap in certain situations.  

The lower third of the nose is defined by its margins, which include the alar rims inferiorly, the nasolabial grooves laterally, and the alar groove, which forms the junction with the upper two-thirds of the nose.

Classically, the lower third of the nose is composed of six subunits: bilateral ala and soft triangles, the central tip, and columella. (photo credit)

The skin in this area is thick, richly populated with sebaceous glands, often stiff and difficult to rotate and form into local flaps.

Criteria given for selecting lower third nasal defects that can be acceptably treated with full-thickness grafts

include defect location; size smaller than 1 cm; and a partial-thickness defect with underlying dermis, subcutaneous tissue, or perichondrium.

Rather than increasing the small defect to a larger defect (whole subunit size), the authors achieved acceptable cosmetic results using full-thickness skin grafts to reconstruct lower third defects smaller than 1 cm in diameter.

Any defects larger than 1 cm were reconstructed more successfully with entire subunit reconstructions using more standard reconstruction techniques (local or adjacent flap techniques).  Defects that involve cartilage or deeper are by definition complex nasal defects that will require onlay cartilage grafting for satisfactory reconstruction.  These are not appropriate for skin grafting.

Donor site selection is important to try to match “like with like.”   Best choices include:

The senior author prefers preauricular and more preferably forehead skin for lower third nasal reconstruction. Forehead sites offer thicker skin, with a relatively sebaceous, oily texture, and they suffer the same degree of daily sun exposure and actinic damage as the lower third of the nose.

Other donor sites available to the reconstructive surgeon include the nasolabial fold, postauricular skin, and supraclavicular skin.

Poor donor site choices:

Postauricular donor sites suffer very little (if any) daily sun exposure and have much thinner skin than the nasal lobule. Therefore, they are prone to pigmentation changes and do not provide a good contour match for reconstructing the lower third of the nose.

Likewise, the skin of the supraclavicular region contains very few sebaceous elements and is often hyperpigmented before harvest.

 

Any distortion of the alar rim or obliteration of the nasolabial groove is exceedingly noticeable and difficult if not impossible to correct secondarily so care must be taken regardless of technique used in these area.

REFERENCE

Lower Third Nasal Reconstruction: When Is Skin Grafting an Appropriate Option?; Plast Reconstr Surg. 124(3):826-835, September 2009; McCluskey, Paul D.; Constantine, Fadi C.; Thornton, James F.

Nasal Reconstruction, Principles and Techniques: Multimedia; eMedicine article, August 28, 2008; Joseph Fata, MD

Nasal Reconstruction-Beyond Aesthetic Subunits: A 15-Year Review of 1334 Cases;  Plast Reconstr Surg. 2004;114:1405-1416; discussion 1417-1419; Rohrich RJ, Griffin JR, Ansari M, Beran SJ, Potter JK.

Chinese Boy with 31 Fingers and Toes

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Daily Mail ran a story recently on a Chinese boy, 6, who was born with 31 fingers and toes (15 fingers and 16 toes).  The story reporting on the child having surgery to correct the congenital anomaly.  (photo credit)

Polydactyly is a condition in which a person has more than five fingers per hand or five toes per foot.  Rarely is it more than one or two extra.  Polydactyly  occurs in approximately 1 out of every 1,000 births. Usually, only one hand is affected.

In the hand, the extra digit(s) may be located on the thumb side  (radial), the small finger side (ulnar), or in the middle (central). 

In the black population an extra finger on the little finger side (ulnar polydactyly) is most common. The most common congenital hand difference in the Asian population is an extra thumb (radial polydactyly).

Central polydactyly is inherited as an autosomal dominant condition with variable expression, meaning that it may be more or less severe from one generation to the next.

This young Chinese boy’s extra fingers were located centrally and the skin fused together (syndactyly).  This is much more rare than either radial or ulnar polydactyly.  (photos credit)

In Memory of Robert M Goldwyn, MD

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

I signed onto the Plastic and Reconstructive Surgery website this morning to look up an article and found this tribute to Robert M. Goldwyn, MD who served as Editor-in-Chief of Plastic and Reconstructive Surgery from 1979 to 2004, died on Tuesday, March 23, 2010.   I was privileged to meet him while doing my plastic surgery residency in Boston.  He and the head of my program (Dr. Gaspar Anastasi) were friends.  He was a giant in the field of plastic surgery who will be missed.

 

Please join us in remembering Dr. Goldwyn by reading his collected editorials, immortalized in the pages of PRS and gathered together in October 2004 in a special supplement.

In 2004, the supplement of editorials by Dr. Goldwyn and tributes by a few of the people who had been close to him represented a small token of appreciation. Today, the supplement will serve as an enduring tribute to a wonderful scientific journal editor, physician, role model and friend.

The supplement is complimentary and only available online at PRS.

25 Years of Selected Editorials by Robert M. Goldwyn, MD

Join PRS in the weeks and months to come for further tributes to Dr. Goldwyn.

From PRS October 2004 - Volume 114 - Issue - p v
Biographical Note:  Robert M. Goldwyn, M.D

Robert M. Goldwyn was born in Worcester, Massachusetts, in 1930. He attended Worcester Academy, Harvard College (A.B., 1952; Phi Beta Kappa, Magna cum Laude), and Harvard Medical School (M.D., 1956).

He did his internship and residency in general surgery at the Peter Bent Brigham Hospital in Boston from 1956 to 1961. During this time he was the Harvey Cushing Fellow in Surgery at the Peter Bent Brigham Hospital. In 1960, he worked with Dr. Albert Schweitzer in Lambarene, Gabon.

His plastic surgical training was at the University of Pittsburgh Medical Center from 1961 to 1963. He returned to Harvard Medical School and became Senior Surgeon at the Peter Bent Brigham Hospital and at the Beth Israel Hospital, where he was Chief of the Division of Plastic Surgery from 1972 to 1996. Since 1979, he has been the Editor of Plastic and Reconstructive Surgery and has authored or co-authored more than 300 articles and has edited several books: The Unfavorable Result in Plastic Surgery: Avoidance and Treatment (now in its third edition), Reconstructive Surgery of the Breast, Long-Term Results in Plastic and Reconstructive Surgery, and Reduction Mammaplasty.

He has written The Patient and the Plastic Surgeon (two editions) and The Operative Note, a collection of his editorials, as well as a book for the general public: Beyond Appearance: Reflections of a Plastic Surgeon. With J. Saxe as translator, he wrote an introduction to G. Baronio's Degli Innesti Animali, 1804 (On Grafting in Animals). He also wrote the introduction for the first complete English translation by J. H. Thomas of G. Tagliacozzi's De curtorum chirur-gia per insitionem, 1597 (On the Surgical Restoration of Defects by Grafting, a facsimile edition).

Dr. Goldwyn has served as President of the Massachusetts Society of Plastic Surgeons, the New England Society of Plastic Surgery, the American Association of Plastic Surgeons, which made him an Honorary Fellow, and the Harvard Medical Alumni Association.

In 1972 he founded the National Archives of Plastic Surgery, housed at Harvard Medical School, and has since served as Chairman of the Archives Committee of the Plastic Surgery Educational Foundation.

He was a founding member of Physicians for Social Responsibility and has written articles on world peace, opposition to chemical and biological warfare, and medical ethics.

He has been Visiting Professor to more than 70 institutions, universities, and hospitals in this country and abroad and is an honorary member of more than a dozen national and international societies of plastic surgery. His other awards include the Dieffenbach Medal, the Honorary Kazanjian Lectureship, Clinician of the Year of the American Association of Plastic Surgeons, and the Special Achievement Award and the Presidential Citation of the American Society of Plastic and Reconstructive Surgeons. He has received numerous recognitions for his teaching and writing.

 

More information on this amazing man:
Boston Globe Obituary
Leonardo’s Hand – Dr. Robert Goldwyn

Keeping Patients Warm Perioperatively

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Last week I read this article in the Medical Industry News written by Kaye Spector: Warm wakeup from surgery has roots with Cleveland doctor. I am impressed with this new patient gown that works with the Bair Hugger System (photo credit)

It would work well to pre-warm patients in the holding area. It would work well for facial, abdominal, or extremity surgery as shown in the photo. For chest case, perhaps it is possible to roll the gown downward covering the abdomen and legs. If not then the traditional lower-body Bair Hugger blanket could still be used.

If kept clean in the operating room, then it could be used in recovery to continue warming the patient there.

The 2006 article by Dr. Leroy Young on preventing perioperative hypothermia in plastic surgery patients is a very good article – well written, easy to read, covers the topic thoroughly. Here are the big suggestions for prevention given:

• Actively prewarm patients in preoperative area for approximately 1 hour with forced-air heating or resistive-heating blanket.
• Keep the ambient temperature of the operating room at a minimum of 73°F.
  
• Monitor core temperature throughout administration of general and regional anesthesia.
  
• Cover as much body surface area as possible with blankets or drapes to reduce radiant and convective heat loss through the skin.
  
• Actively warm patients intraoperatively with forced-air heaters or resistive-heating blanket to prevent heat loss and add heat content. Rearrange covers every time patient is repositioned to warm as much surface area as possible.
• Minimize repositioning time as much as possible so that the active warming method can be quickly continued.
  
• Warm intravenous fluids and/or infiltration fluids if large volumes are used. Warm incision irrigation fluids.
  
• Aggressively treat postoperative shivering with forced-air heater or resistive-heating blanket and consider pharmacologic intervention.

Perioperative hypothermia is associated with increased surgical site infections, slower wound healing, coagulation disorders, and increased bleeding. So it is very important to keep patients warm. It also makes them more comfortable, so improved hospital and surgeon ratings.

As the surgeon (and one with the occasional hot flash), I can tell you it is difficult to work in an OR with temperatures higher than 70°F. My fellow female colleagues (scrub nurses, circulating nurses, etc) at the surgery center I work most frequently often want the temperature even lower. It is a struggle to keep everyone happy and comfortable.

The article referenced below states

The minimum OR temperature recommended in the literature is 22°C (71.6°F), and most researchers agree that an ambient temperature of at least 23°C (73.4°F) is better. Sessler recommends an OR temperature of 25°C (77°F). One study by El-Gamal and colleagues determined that nearly all cases of perioperative hypothermia could be eliminated if OR temperatures were 26°C (79°F).

REFERENCES

Prevention of perioperative hypothermia in plastic surgery; Aesthetic Surgery Journal September 2006, Vol. 26, Issue 5, Pages 551-571; V. Leroy Young, Marla E. Watson

Shout Outs

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

Evan Falchuk, See First Blog, is this week's host of Grand Rounds.   You can read this week’s edition here.

Welcome to Grand Rounds – the health care blogosphere’s ultimate blog carnival.

This week’s version is something special.  I asked for posts only about health care reform, and I am overwhelmed by the response.  Below are the leading voices of the health care blogosphere.

It is the Mother of All Health Care Reform Blog Round-Ups.

So, evacuate the dance floor- you’re about to be infected by the sound of health care reform blogging.

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Nursing Student Chronicles  is the host of the latest edition of Change of Shift (Vol 4, No 19) ! You can find the schedule and the COS archives at Emergiblog. (photo credit)

Howdy everyone! Welcome to Change of Shift, here for the very first time! And we’ve got a mini-party here today, just as promised.

So, domo arigato! How would you feel with a New Robotic “Coworker“? He speaks to you, moves around you, and even prefers to ride the elevator alone! He’s sitting at the Man-Nurse Diaries and he’s waiting to help you lift a saline bag or fifty.

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The Patient Protection and Affordability Act was signed into law last week.  Here are the parts that go into effect immediately (or more accurately within the first year).

Small Business Tax Credits
 Offers tax credits to small businesses beginning in 2010 to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage. ….

No Pre-existing Coverage Exclusions for Children
 Prohibits health insurers from excluding coverage of pre-existing conditions for children. Effective six months after enactment, applies to all employer plans and new plans in the individual market. (This provision will apply to all people in 2014)……….

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NPR had a very interesting story (audio available) last week:  Former Bullies Share What Motivated Behavior.  Host Neal Cohen was joined by guests Aileen Dodd, education and family reporter for the Atlanta Journal Constitution and Rosalind Wiseman, author, Queen Bees and Wannabees. 

In Georgia, a young man killed himself because he could no longer endure his bullies. And in Mass., bullies left a 13-year-old paralyzed.

These cases and others like them have focused attention on bully behavior: Why do they do it, and do they change?

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 Dr. Gwenn covered the topic of bullies too:  Victims of Bullying Must Be Heard!!

You likely heard that Massachusetts is finally considering an anti-bullying law. It’s about time!

My kids have both been bullied over the years…have yours? It is one of the most challenging situations to handle in all of parenting and the dramatic increase in technology among today’s kids and teens and made bullying via technology a contributing factor. 25% of kids being bullied is too many already. 42% of kids being cyber-bullied is unthinkable…but is the estimated number being victimized via technology…….

In addition, Dr Gwenn has a series of BTR shows on the bulling topic.  Please, note part 2 & 3 are both upcoming.

Show 17: Bullys In Your Back Yard 1, Take 2! Stopping It Today!! (March 26, 2010)

Show 18: Bullying In Your Back Yard 2: Bully-Proofing Your LIfe  (April 1, 2010; 12 PM)
Show 19: Bullies In Your Back Yard 3: An Ounce of Prevention by Becoming Great Digital Citizens (April 9, 2010; 11 AM)

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I wish all of you could see the documentary aired by AETN last week on architect Fay Jones:  Sacred Spaces: The Architecture of Fay Jones.  (photo credit)

an Arkansas native who was in the first class of architecture students at the university, taught at the architecture school for 35 years and served as its first dean. In 2000, the American Institute of Architects named Jones one of the 10 most influential architects of the 20th century and recognized his Thorncrown Chapel as the fourth most significant structure of the 20th century.

You can take a virtual tour of his Thorncrown Chapel.  It is a breathtaking place.

Nestled in a woodland setting, Thorncrown Chapel rises forty-eight feet into the Ozark sky. This magnificent wooden structure contains 425 windows and over 6,000 square feet of glass. It sits atop over 100 tons of native stone and colored flagstone. The chapel's simple design and majestic beauty combine to make it what critics have called "one of the finest religious spaces of modern times."

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Another Little Quilt Swap (ALQS) 4  is now open to those who would like to participate.  For the complete rules and deadline (July 1, 2010) go here:

Unlike the ALQS3, Round 4 will allow all quilt types - traditional, modern, contemporary, art and any other designation you can think of.

All quilts should be roughly between 16"x16" and 24"x24". They do not have to be square, but the total area should be approximately the same.

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Dr Anonymous’ guests this week will be Psychiatric Social Worker Brandice Schnabel.  Come join us.

Upcoming Dr. A Shows (9pm ET)

4/22: DG & Tiffany Hollums and their adoption journey

Donating…..

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.


The earth quakes.  Haitians suffer. 
The world tweets updates, texts donations, waits anxiously wanting to do more.
The woman extends her arm willingly, squeezing a fist in gentle rhythm as the life giving blood flows.



*** Found in my blog drafts, decided to go ahead and publish it.