My First Comic Book by Marc Charles

10_33 AM


Hi Gang:

I published my first comic book boys and girls.

Save the reviews......its my first attempt.

Ill send you a copy free of charge (PDF) if you ask.

Its on Amazon and soon BN and elsewhere.

Pen name of course:  Charles Schulte. Get it? 

http://tinyurl.com/mk7toj7

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My top seven posts of 2014

Im now in my fifth year of blogging. Thanks to everyone who has taken the time to read what I have written—especially those who have commented. Ive learned a lot from you.

My seven most read posts of 2014 are listed below. Click on the title to read the post.

"That electric hand dryer study was bogus" was an analysis of a study that made outrageous claims about electric hand dryers and dispersal of bacteria.

"What are the residency prospects for graduates of offshore medical schools?" took a look at the realities associated with graduating from medical schools outside the 50 states and Puerto Rico.

"Preventing infection: The "bare below the elbows" rule for doctors doesnt go far enough" discussed the role of clothing in the transmission of disease and the ultimate solution to the problem.

"A medical student says to abandon the match" was my take on a proposal to do away with the residency matching program in the US. Spoiler alert: I didnt think it was a good idea.

"How to select surgical residents: The evidence" was a review of the limited evidence concerning how surgical program directors select candidates to interview and rank.

"A paper of mine was published. Did anyone read it?" spoke to the proliferation of medical journals, the likelihood that a single paper will be read, and what the future may hold.

"Health Care and the $20,000 Bruise: A different take" raised a lot of questions about a Wall Street Journal article written by a doctor who took his son to an emergency room for an 11-day-old bruise on his head.

And the all-time winner so far is this post, "Appendicitis: Diagnosis, CT Scans and Reality," which was the tenth post I ever wrote and is approaching 22,000 page views.







Best wishes to all.

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eft: 0i"

paul’s,secret,for,making,more,money,per,square,foot,by,marc,charles

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Amazing Voice Talent Seriously

Hi Gang:

If you need voice talent check this out......Im serious.....

The Best Female Voiceover Artist for Only $5 - Check it out!

http://tinyurl.com/kqdytxh



Marc Charles

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It wasnt like this in my med school

When I was a medical student, we had to practice drawing blood on our lab partners. I remember the first day we did it. One guy fainted as he was having his blood drawn, and another fainted while he was drawing someone elses blood.

Weve made a lot of progress in medical education since then. In 2015, teaching blood drawing, which is going to eventually be taken over by robots anyway, is passé.

Students are suing a Florida sonography school because they were forced to perform transvaginal ultrasounds on each other almost every week. Those who complained were allegedly told to “find another school if they did not wish to be probed” said an article in the Washington Post.

While that seems out of line, it pales in comparison to allegations lodged against a former US Army doctor who ran a company that taught battlefield medicine to soldiers and made more than $10.5 million in the process.

According to Reuters, he gave students alcohol and drugs, including ketamine, a powerful hypnotic used as an anesthetic. Sometimes alcohol and ketamine were given at the same time.

Trainees were told to insert urinary catheters into each other, and two students underwent penile nerve blocks. On another occasion, when students balked at receiving penile blocks, the doctor had the students perform a penile nerve block on him. Its not clear what a penile nerve block has to do with treating wartime casualties.

If thats not troubling enough, he supposedly ran what he called "shock labs," during which he drew blood from trainees, observed them, and gave their blood back to them.

But wait, theres more. The doctor is alleged to have had a few beers with a student and examined, manipulated, and photographed the students uncircumcised penis.

The doctors claim that his methods are standard in Virginia medical schools was refuted by experts quoted in the Reuters piece.

The Virginia Medical Board has suspended the doctors license and will hold a hearing on June 19.

And we thought sticking each other with needles was traumatic.

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Earning Money with Earn2Gether com

Welcome to Earn2Gether.com! If you?ve been searching for a legitimate way to earn money online, and are tired of misleading ?opportunities? and false hype, then welcome home.

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We want to be very clear up front what we?re about, what type of work you?ll be doing and how you receive offers. Once you establish an account, you?ll be able to log in and view a list of all available offers. Each listing includes all the information you need about the offer, including the offer description and payment amount

Mentors Will Help You Succeed!

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Are today’s surgery residents poorly trained What can be done about it

A surgical resident writes

I’m sure you have read several recent studies suggesting that current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency.

My questions for you:

1. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?

2. What should we do differently? I personally don’t feel that “more simulation activities”, which many have suggested, is an adequate solution.

Thank you for the excellent questions.

I have been out of the surgical education loop for a few years and no longer have first-hand experience, but the literature does indicate that some surgical residency graduates are not ready to practice by themselves.

In 2013, I blogged about an Annals of Surgery paper reporting as many as one third of subspecialty general surgery fellowship directors felt that about one-third of incoming fellows were deficient in several areas and unable to independently perform a laparoscopic cholecystectomy or 30 minutes of a major case unsupervised.

Click on the table to enlarge it. You can see the responses of the program directors.

This paper was criticized by some because the fellowship directors surveyed were not subspecialtists recognized by the ACGME. The implication was that fellows in these programs might not be representative of all surgical graduates. However, many of them were minimally invasive fellowship programs which continue to be highly sought after.

Does it really matter? Some general surgery graduates apparently can’t operate by themselves.

In 2011, I blogged about a paper that reported 27% of all graduating surgical residents surveyed were not confident performing surgery by themselves. That was approximately the same percentage identified by the fellowship program directors.

Regarding what can be done about the issues of confidence and traing, I agree with you about simulation. You can simulate all you want, but being alone at 2 AM with a patient who is bleeding out cannot be adequately simulated.

The American College of Surgeons created a Transition to Practice Fellowship in 2013. They later change the name from a fellowship to a program. Of course, I blogged about this too. As far as I know, not many hospitals are involved. How many graduating residents have enrolled in this fellowship program is unknown.

Henry Buchwald, a prominent senior surgeon, recently advocated establishing “open surgery” fellowships and wrote, “I submit that it would behoove our training programs to return open surgery schooling to their curricula.” However, he doesn’t explain how this could be done or where one would go to do a fellowship and open surgery.

Life imitates art. In a post last year, I cited the visionary surgeon Leo Gordon who saw it coming in 2002. He predicted the need for a "macrolaparotomy" course, and said it could be run by the newly created "American Board of Open Surgery."

The lack of confidence stems from the gradual increase in supervision of residents over the last 15 to 20 years. In yet another blog post, I pointed out that many of today’s residents rarely if ever operate independently during residency training. To realize you are on your own as a full-fledged surgeon without ever having performed a case by yourself must be frightening.

With all the ACGME regulations, medicolegal concerns, and extensive scrutiny surgeons and trainees are subjected to, I don’t see this problem going away anytime soon.

All you can do as a surgical resident is to try to scrub on as many cases as possible and take care of as many patients as you can. With luck, you may have faculty who have enough confidence in themselves to allow you some autonomy and decision making in the OR and when managing patients pre-and postoperatively.

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OR delays Whos responsible and what can be done

Every two or three years, someone, usually a hospital administrator, decides that delays in operating room turnover time need to be looked into. A committee of 20 or 30 stakeholders (love that term) is appointed and assigns someone the job of measuring the time between cases and identifying reasons for delays. In years when turnover time is not being studied, first case starting delays are on the agenda.

In my nearly 24 years as a surgical department chair, one or the other of these issues was investigated at least 10 times. We were never able to conclusively determine the exact causes of delays or solutions to the problem, and we returned to business as usual.

An article in Anesthesiology News about a paper that looked at causes of operating room delays in over 15,500 cases at a single hospital got my attention.

The number one reason for delays was that the nurses did not have the operating room ready for the patient. Nursing also was responsible for the third most common cause "preop prep (IVs, meds, etc.)."

Surgeons were the reason for the second most common problem, "notes, consent, patient marking not complete." A few more of the top 10 included surgeons running two rooms, surgeon unavailable, and my favorite, "last case ended early." I’m not sure how a case ending early causes a delay in starting the next case. Usually we are blamed for underestimating the length of time we need to do an operation.

Anesthesiologists were cited for only one of the 10 most common reasons for delays—placement of an IV line or regional block.

Not surprisingly, the study was done by anesthesiologists using data they collected.

When I expressed skepticism about this on Twitter, I was accused of implying the research was fraudulent. Not so. Some of my best friends are anesthesiologists. In fact two of my medical school roommates became anesthesiologists. Fraud is not the issue. Its a matter of perspective.

For example when the nurses investigate OR delays, the problem never seems to be nursing.

Im not saying that surgeons dont cause delays. A task force once found that one of my surgeons was late for his first case every time he operated because he had to take his kids to school.

Another surgeon would disappear between cases and was always late for his next one. No one knew where he went. Some thought he may have been calling his broker or perhaps having an affair.

Here’s what the anesthesiologist researchers may have overlooked.

In effort to avoid delays, I would often ask for an anesthesia consult on complicated inpatients booked for surgery a day or two later. On nearly every occasion, the anesthesiologist who saw the patient was not the one assigned to do the case. The consulting anesthesiologist never said a certain lab test was necessary, but in the holding room, the one who was going to put the patient to sleep said it was. A spirited discussion, phone calls, and a delay ensued.

Sometimes a day surgery patient who arrived 2 hours ahead of schedule wasnt interviewed by anesthesia until the scheduled time of the case.

Then there was my patient whose operation was postponed for 6 hours because she had a piece of hard candy in her mouth when she got to OR. The anesthesiologist said it was the equivalent of having a full stomach. Read the full story here.

Can delays be shortened by working together? A 2014 paper in the Journal of Surgical Research by a surgeon and four anesthesiologists found that “various events and organizational factors created an environment that was receptive to change.” The authors were able to decrease their general surgery OR turnaround times from 48.6 minutes to 44.8 minutes, a statistically significant (p < 0.0001) but hardly clinically important difference.

Let me hear your experiences with OR delays.

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My top seven posts of 2015

I’ve been blogging since July of 2010. Here is a list of my most viewed posts of 2015. Thank you for reading and commenting.

“How much money do journal publishers make? A lot,” a look at the highly profitable world of journal publication, was number 1. Profit margins of the top for medical publishers range from 32% to nearly 42%. It’s a good business to be in.

Next was “A shallow water blackout is a silent killer.” What can happen if you hyperventilate before swimming underwater? You might die.

“How to pick the leading physicians of the world” was a humorous take on an “honor” bestowed upon me by a company that is a little careless about choosing its candidates.

In “Narcotics addicts can sue doctors and pharmacies for ‘enabling’ them,” we learned of a ruling by West Virginia’s highest court that spells trouble for both patients and physicians.

“Antibiotics for appendicitis? No thanks” was a critique of a Finnish randomized prospective trial of antibiotics vs. surgery in uncomplicated appendicitis. I had some serious concerns about the way the study was done and interpreted.

“Do surgeons still do postop care?” was a guest post by a medical hospitalist who felt that surgeons were no longer interested in taking care of their patients after operating. It drew a number of comments.

The seventh most-read post was “So you want to be a radiologist,” written by a radiologist who I asked to respond to an email I received from a pre-med student. It was a nice discussion of the pros and cons of the specialty.

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Another reason not to rely on medical advice from the Internet

On New Years Eve, The Daily Beast published an article with suggestions about how to avoid a hangover.

Some of the tips were reasonable such as limiting yourself to one alcoholic drink per hour and maybe avoiding certain beverages like wine, bourbon, and Scotch, which contain congeners and have been associated with worse hangovers.

However, some of the advice is wrong.

The article recommends this on the day you plan to party:

6 a.m.: Rise and hydrate! Drink early and drink often. One of the main causes of a hangover is dehydration. Women should be drinking 2.7 liters per day, and men should get 3.7 liters. Thats 0.7 gallon and 0.97 gallon, respectively.

After you party, at 12 a.m.: Drink some water and get to bed. It’s your last chance of the day to hydrate, so seize it! Sip some water before your head hits the pillow, but avoid popping any anti-hangover pills.

The 6 a.m. recommendation has two important bits of misinformation. One, dehydration is probably not a major factor causing a hangover. A 2010 literature review explains that hangovers are much more complicated than most people think. From the abstract:

Markers of dehydration were not significantly related to hangover severity. Some studies report a significant correlation between blood acetaldehyde concentration and hangover severity, but most convincing is the significant relationship between immune factors and hangover severity. The latter is supported by studies showing that hangover severity may be reduced by inhibitors of prostaglandin synthesis. Several factors do not cause alcohol hangover but can aggravate its severity. These include sleep deprivation, smoking, congeners, health status, genetics and individual differences.

Two, the idea that you need to drink 8 glasses of water per day is a myth. The best plain English explanation of this appeared in the New York Times last summer.

The 12 a.m. suggestion may also be incorrect. Do you really need more water right before you try to sleep?

As the 2010 review pointed out, blocking prostaglandins by taking an anti-inflammatory drug like ibuprofen might be useful. However, a small risk of bleeding from gastric mucosal damage with the combination of alcohol and anti-inflammatory drugs is a concern.

Abstaining from alcohol or drinking it in moderation is the best way to avoid a hangover. Once you have a hangover, the best remedy is time.

A Washington Post article on the dangers of overhydration in marathon runners quotes an expert as follows: “Drink when you’re thirsty. It’s not something you have to tell your body to do.”

If you have normal kidneys and drink as much water as The Daily Beast recommends, you may avoid hangover because instead of getting drunk, you will be spending a lot of time in the bathroom peeing.

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Antibiotics for appendicitis No thanks

The long-awaited Finnish randomized controlled trial of antibiotics vs. surgery for appendicitis was just published in JAMA. Depending on your perspective, 73% of patients were successfully treated with antibiotics or 27% of patients failed antibiotics and needed surgery.

The good news is that it was a large multicenter study involving 273 patients randomized to surgery and 257 to antibiotics. Patients included in the study had uncomplicated appendicitis as diagnosed by CT scan.

The bad news is that the paper has many limitations.

Of the patients who underwent appendectomy as the primary treatment, only 15 (5.5%) had laparoscopic surgery. The authors state that open appendectomy was selected as the protocol operative technique because laparoscopic instruments may not be available worldwide and apparently many surgeons in Finland are not experienced in performing laparoscopic appendectomies.

In most Western countries, laparoscopic appendectomy is the procedure of choice. In the United States, at least 80% of all appendectomies (not just those done in patients with early or simple appendicitis) are done laparoscopically. Laparoscopic appendectomy has a much lower complication rate than open. This renders the comparison of complications of surgery (20.5%) and antibiotics (2.8%) in the Finnish randomized trial meaningless. The Finnish authors did not consider failure of antibiotic treatment a complication. Had they done so, the complication rate would have been higher for the antibiotic group.

The hospital length of stay for the surgery patients in the JAMA study was a median of three days. A paper from Texas published last year found that of 345 patients who had laparoscopic appendectomies for uncomplicated appendicitis, 88% were managed as outpatients. They spent a total of about eight hours in the hospital from admission to discharge and had a complication rate, including readmission, of 2.8%.

The antibiotic chosen for the in-hospital treatment in the JAMA study nonoperative group was ertapenem—a once-a-day drug that costs $80 per dose. How available is ertapenem in low- and middle-income countries?

The follow-up in the current paper was only one year. Is it realistic to expect that no more patients will have recurrences of appendicitis in the following years?

The inconvenience and costs of the extra hospitalization for the 27% of patients who failed antibiotic therapy were not addressed.

The stated goal of the trial was to prove the noninferiority of antibiotic therapy for appendicitis. By the authors own admission, the result failed to meet their prespecified criterion for noninferiority. In plain English, this means the trial showed antibiotic therapy is inferior to surgery for the treatment of uncomplicated acute appendicitis.

Early last year, I blogged about the potential problems with this study and said, "A randomized trial of antibiotics vs. surgery for uncomplicated appendicitis is underway in Finland. Judging from the wording of the abstract describing the trial, the authors are markedly biased toward the use of antibiotics. Despite this, lets hope it sheds some much needed light on this subject." Too bad that did not happen.

Other than Dr. Edward Livingston, a surgeon who wrote a favorable editorial accompanying the paper in JAMA, I do not know of any surgeons who would opt for antibiotics to treat appendicitis for themselves or their family members.

A more realistic randomized trial is planned by surgeons in Washington State. Until that study is published, I’ll stick with surgery for uncomplicated appendicitis.

Addendum: The spelling of ertapenem was corrected on 6/18/15.

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Business Plan Reviews by Marc Charles

10:44 AM

Hi Gang:

I reviewed a business plan and executive summary over the weekend.

Most entrepreneurs follow a "business plan template" when developing his or her own.

The problem is its almost impossible to forecast sales, profit/loss, margins, etc when you havent made the FIRST SALE.

Seasoned investors, banks, lenders and VCs RARELY read business plans --- they assign this task to lower level management.

Seasoned investors are looking for the BIG idea, actual market demand (with proof) and how a venture plans to reach an audience.

The next thing they want to know is WHEN theyll get paid, and what is the downside risk.

So....I try to put all these things in the first paragraph of plan or exectuive summary.




The King

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Review courses and board exams

Four years ago, I wrote a post called "Hints for new residents." Among my 15 tips was this: "Read, read, read. This isnt like school. You cant cram for your boards. You can’t learn 4 or 5 years’ worth of material in a one-week review course. You have to learn it as you go along."

Just published online in the journal Surgery is a paper entitled "Review courses for the American Board of Surgery certifying examination do not provide an advantage" by four officials from the board.

They surveyed new surgeons who took the certifying (oral) exam, 1067 for the first time and 329 who had previously failed the test, during the time period from October 2012 through June 2013. The overall response rate was 90%.

The pass rate for first-time takers was significantly better than that of repeaters, 82.1% and 72.6% respectively, p < 0.001; 77.9% of all examinees took a review course—76.1% were first-time takers compared to 84.6% of those repeating the exam, p = 0.002.

From the paper: "The overall CE [certifying exam] pass rate did not differ between those who did and those who did not participate in a review course (82.7% vs. 78.9%; p = 0.22)."

The results were controlled for sex, US or international med school graduate, written board exam scale scores, average written board scores over the last five years for the candidates program, and size and type of program.

The review courses were also analyzed, and the authors found that attending any one of the specific courses failed to predict passing the certifying examination. The only significant predictor of passing the certifying exam was the scale score of the candidate on the written examination.

The authors concluded: "On the basis of this survey, there was no evidence that participating in a board review course provided a benefit to passing the CE of the ABS."

The work was presented at a meeting, and the transcribed discussion was also published. The assigned discussant, Dr. Michael Nussbaum, said, "As a long-term program director, I really strongly believe that preparation for the CE is a 5-year process, not something that can be taught in a short course or crammed for."

I am pleased that the board and the discussant agree with what I said four years ago.

However, it is not clear from this paper that review courses are of no value when preparing for the written board examination. The paper said the score on the written examination correlates with passage of the oral examination. If a review course a helps candidates pass the written exam, then indirectly, a course might have a positive effect on the outcome of the oral exam.

Another problem with the paper is its failure to separate prep courses for the written and oral exams. One would not expect a course directed at the written exam, which is more of a multiple choice test about remembering facts, to help with the oral exam, which focuses on a candidate’s judgment and maturity in managing hypothetical patients.

The authors noted that only 29% of candidates for the boards in took review courses in 1990, and the courses are expensive.

Should the nearly 80% of candidates who took courses 2 years ago not have done so? Unfortunately, this paper does not conclusively answer the question.

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My blog cited in JAMA Surgery paper Progress for bloggers

About a year and a half ago, I blogged that a medical student on Twitter used a blog post of mine as evidence. In January, the Canadian Journal of Anesthesia published an article I wrote under my pseudonym called “Why I blog and tweet.”

Last month, medical blogging took another step toward legitimacy. A JAMA Surgery Viewpoint formally cited my post critiquing the Finnish randomized trial of antibiotics versus surgery for the treatment of acute appendicitis.

Here is the first page with the portion of the piece discussing what I had written in the blog post.

Click on figure to enlarge.

Here is how citation appears in the JAMA Surgery article.

If you havent read my entire post about the randomized trial, click here.

Last year I said this: “Journals may have to adapt and become more like blogs. In the future, medical information may be disseminated by blogs and comments rather than journal articles and letters to the editor.”

We have already seen prominent publications such as the New England Journal of Medicine starting online forums and the BMJ hosting blogs (at least 36 so far) and rapid responses to published papers.

The sea change in the way medical research is disseminated may be happening sooner than I thought.

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My Interview with G2A!

Photo by Photos and Designs by Piera. 

I have recently been interviewed by G2A.com. They are a global digital marketplace famous for selling game keys online at very low prices and have partnerships with famous youtubers like PewDiePie. I spoke to Julia who asked questions about my charity work with Heroes Alliance and my hobby as a cosplayer. As a company that is well known in the gaming industry for offering amazing games for the geeks they are also into charity work for children. In 2014 G2A.com, as a team of game enthusiasts joined their forces with another partner and raised over 5 million dollars for the Save the Children organization. Thanks to such actions many children were given a better start and an opportunity to be protected from harm. Check out my interview below!

Photo by Dru Phillips. 

G2A: Tell us something about yourself?

Victoria: My name is Victoria and I have been cosplaying since 2006. My day job is part time Nanny and part time Nursery School Teacher. I run my own birthday party business where I do princess parties. I also work for the non-profit volunteer group, the Heroes Alliance. I have been hired and paid throughout the years by photographers and agencies as a professional  model.

G2A: When did you start cosplaying and what inspired you?

Victoria: I began cosplaying in 2006. I was inspired by a photo of a beautiful cosplayer that my boyfriend showed me. She was at a convention in Japan and was dressed as Rikku from Final Fantasy X-2, which is one of my favorite video games. I was inspired by that photo. The composition was beautiful. The quality of the costume was stunning. She truly breathed life into the character.

G2A: Tell us about the pros and cons of being a cosplayer.

Victoria: Being a cosplayer is creatively liberating. It gives you an avenue to express yourself and your love for a character however you want. The process of putting a costume together is artistic. Its a fun and healthy hobby. Being active in the community, you meet many like minded people and make friends. The friendships formed are the best part. On the negative side, because this hobby is about being seen and photographed, you can be subjected to online bullying which includes racism, sexual harassment and other forms of bullying. Dont tolerate it because you dont deserve it. Block, delete, ban. Do whatever you have to do to flush out the negativity.

G2A: What are the key factors in choosing the best cosplay costume?

Victoria: I can say that the most impressive are those who think outside the box. Also if you bear a strong resemblance to a character, it will make a lasting impression. But theres really no rule book on how to choose the best costume. Just go for what you love and express yourself.

G2A: What is your dream cosplay?

Victoria: I want to be Iron Man!

G2A: Do you have any cosplayer friends that share the same passion for cosplaying?

Victoria: Majority of my friends are cosplayers. The friendships I have made in this community are priceless to me.

G2A: Apart from cosplaying, what are your other hobbies?

Photo by Green House Photography. 

Victoria: I am a huge doll collector. I collect Monster High, Bratz, Ever After High, Disney and Barbie dolls. I am actually more passionate about doll collecting that I am about cosplay. I mediate. Meditation is a very important part of my life.  I am the author of the Confessions of a Cosplay Girl Blog where I write articles about the Hispanic Geek Community, feature my Cosplay Galleries, conduct product reviews, convention coverage and opinion pieces.  Im a book worm and love to read. I love spending time with my two beautiful black cats.

G2A:  I know about your charity work for Heroes Alliance. Could you elaborate further on this topic?

Victoria: The Heroes Alliance is a nationwide non-profit volunteer group. We dress as superheroes and volunteer at local Childrens Hospitals and Childrens Charities that focus on the medically fragile or terminally ill. Our goal is to give them a "real life" super hero experience. The Heroes Alliance is celebrating its 10th year and we have branches all over the country. I am the coordinator for the Eastern Pennsylvania branch. I manage my team of fellow super hero volunteers and handle all of the scheduling for events. Heroes Alliance image Heroes Alliance About Heroes Alliance View on www.heroesalliance.org


G2A:  What is your greatest achievement in Cosplaying?

Photo by Dan Gregory Photography. 

Victoria: Becoming a part of the Heroes Alliance family and chartering the Eastern Pennsylvania branch. Giving back to the community and to children in need is a beautiful experience. You are bringing happiness and hope to those who need it, simply by showing up in costume and spending a few moments with kids. Its a powerful thing.

G2A:  Apart from cosplaying.. is there anything else you do professionally?

Victoria: As I stated before, I have been hired and paid to do commercial modeling. I run my own birthday party business. My day jobs are working in Early Child Hood Education. I do not consider cosplay a profession. Its not a job. Its a hobby.

G2A: I read about your serious accident in 1999, how did you deal with recovery? What advice would you give to people who found themselves in similar situations?

Victoria:  My advice would be not to give up hope. Keep working hard and surround yourself with a strong support group. Dont be afraid to ask for help. Remember that not only do you need healing psychically but mentally and emotionally.

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Overactive bladder Is it a disease

According to the Urology Care Foundation, the official foundation of the American Urological Association, 33 million Americans suffer from overactive bladder (OAB). Thats 30% of all men and 40% of all women in the United States. The foundation estimates that the actual number is much larger because many people who have overactive bladder problems are embarrassed and do not seek care.

This represents a nearly twofold increase since 2001 when a paper written said 17 million people had the problem.

Its not clear how either of the two sources cited above obtained their information.

Maybe you didnt know that there are two kinds of OAB. "Dry" is the one where the patient is able to get to the bathroom on time. "Wet" is the form that is accompanied by leakage of urine also known as the urge incontinence.

Here is something else you probably didnt know. The disease was virtually unknown before 1997.

What happened in that year?

A drug company, Pharmacia, had a drug called Detrol that they were originally going to market for the treatment of urinary incontinence. However the number of people with urinary incontinence was small. They decided to focus on people who had urinary frequency and urgency and declared that incontinence was not absolutely necessary to make the diagnosis of OAB.

As related in the book "Our Daily Meds," the drug company had to convince people who went to the restroom frequently and were previously treated with conservative measures such as restricting fluid intake and eliminating caffeine from the diet that OAB was not just an annoyance or inconvenience but a serious condition requiring professional medical care. They named it "Overactive Bladder."

A special supplement to the journal Urology in 1997 contained 30 articles about OAB, a number of which were written by doctors who were paid by Pharmacia.

Here is a graph by year for the 4803 papers listed in PubMed on the subject of OAB since the term first appeared in 1977.

Of the 69 papers written before 1997, only 7 used the term "overactive bladder."

There are now seven drugs for the treatment of OAB on the market. Consumer Reports says that none of the seven is clearly more effective than the others. The monthly cost of these drugs can be as low as $4.00 for a generic to $300 for a brand name medication.

In 2010, the website Decision Resources predicted that "the OAB drug market will increase from approximately $3 billion in 2009 to nearly $4 billion in 2019 in the United States, France, Germany, Italy, Spain, United Kingdom and Japan."

Not a bad return for treating a disease that did not even exist until 18 years ago.

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My Friends NEW App is a Must See by Marc Charles

9:04 AM

Hi Gang:

Most of you know I rarely ever say something is a MUST SEE.

Most "must see" videos are really hidden sales pitches.

Not this time.

Plus.....BTW.......I HATE deceptive, sneaky and half truth sales copy.

This one from my buddy George is different -- NOTHING to buy, just a cool video.

Im NOT an affiliate either.....

Have fun.

Marc

http://gsniper.com/blog/newvideo/

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Giving Up Work to Write My First Novel

I have decided to stop working full-time in an office prison in order to become a proper writer.

At last I will be able to share my important thoughts with a vast audience of people.
I have no need to attend some graduate course in writing, learn and study for many years and find an editor and publisher.  My brand of writing comes from the heart and soul and will be ideal for a quick Kindle or seventeen.

I plan to document this fascinating journey for the benefit of others who may be tempted to become quill men and women of their own.

Here is the diary so far:

Monday

I am not going in to work today. Have told boss to shove it. Well, I mailed in and said I had a cold.

The reason being that from today I am going to live my own life without restriction, wife permitting of course.

No more shackles of the nine to five.

I am going to work from six in the morning to three the following morning on writing my great book, and I am going to do that every day.

...

Broke off at midday after spending the morning on Facebook and stirring up a row on the forums. Wife has taken opportunity to draw up a list of jobs I can do as I am at home. Tried explaining the creative process to her, the need to channel my energy into thoughts. With hindsight that was a mistake.

Tuesday

I arose at ten and emailed the office telling them that my ‘cold’ was no better.

Logged in and have been banned from the forums. Did Facebook stuff until lunchtime. Sausages, bacon, eggs and fried bread. That would have made a great brunch but as it is midweek could only find Coco Pops in the cupboard.

Completed first page of masterpiece. Mainly a dedication to those I hold dear or owe money to. Cried briefly until wife asked if my allergy had returned.

I am sure this novel will be a winner.

Wednesday

Mailed boss. The cold I referred to earlier has turned out to be a particularly severe form of Asian flu. I am working from home which means responding to emails occasionally and drinking far too much coffee.

Time to crack on with novel. Had planned to create a first work of immediate brilliance which would shock the literary world, but after three days and one page have set sights slightly lower. Need to work on plot lines and characterisation – whatever that means. Read it on an advert for a writing course. Spent morning on Facebook.

Wife has stopped cooking for me. Says she needs to concentrate on her creative process.

Thursday

No emails from work apart from one sarcastic sounding “hope you are getting better” from the boss. I responded with some typos to make it look as though I were still suffering.

Have decided that a purely fictional book would be a challenge at this stage in my writing development.  Considering writing a travelogue based on my local area. This will need to be distinctive and own brand so it doesn’t get lumped in with all those laughably amateur writing efforts from other so called authors.

Asked for advice on Facebook.

Slept on sofa.

Friday

I spent a pleasant morning taking pictures of local interest for my travel book. Afternoon in police station answering a complaint from a busy body who accused me of stalking attractive women. I explained it was for my book and they let me go after confiscating my camera.

Text only from now on, until I can afford to buy a new camera. Thinking about doing one of those “Fifty” things – best jokes, idioms, Facebook Groups. But with a new angle. The “Forty” best somethings. Could be a winner.

My first week as a full time writer is complete. It’s been a personal journey of discovery and I feel richer as a result. Slight pain in lower back from sleeping on sofa.

Saturday

Have gone back to thinking about a novel. About a struggling writer whose wife doesn’t understand him. Spent some time thinking about this, in between a very interesting thread on Facebook.

Wondered if signing up for a pornography site in the interests of research would be helpful. Unfortunately wife has taken the good credit card with her. She is visiting her mother for a few days. Said we needed a time out while I got my head out of my ass.

Sunday

Got up at 2 in the afternoon. Spent an enjoyable hour flaming wannabe authors on Facebook. What a bunch of losers.

Bought flowers and tidied house.

Two hours on the phone persuading wife that I had returned my head to rightful place. Yes, she was right all along. No, I don’t have what it takes. Yes, I would be lost without her guidance and mentoring.

Had first shower for four days.

Wife returned home, late. Changed Facebook status back to Married.

Monday

Back to office work. Who wants to be a writer anyway.

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My personal experience Wizard World Philly 2011

Imagine my surprise and delight when I recieved an email from Wizard personally inviting me to this years Wizard World Philly/ Philadelphia Comic Con convention!
Not only was I given access to the three day event but I was also granted my own personal guest list to get my cosplay friends inside to enjoy all the glorious festivities! As if that wasnt enough and didnt make me feel like the Belle of the Ball, I was also invited to the official launch party (which sadly I was unable to attend because I was with my family) and a private party hosted by my friend, pro wrestler The Smoke. Smallville and Dukes of Hazards star John Schneider joined us for dinner and he remembered me from earlier in the day as Wonder Woman. He was very impressed with my costume when I told him my friend Candy made it for me. We had a nice chat with him over dinner. I also met actress Margot Kidder (Lois Lane) who was an absolute doll and funny as hell (she loved my costume too). After meeting Margot I posed with a fan who turned out to be Beauty and the Geek reality star Bill Lambing. I also posed with superstar artist Greg Horn.

Okay so lets talk cosplay; Friday I debuted my brand new Wonder Woman costume made by my girl Candy who has her own boutique http://www.threemusesclothing.com/   The outfit is absolutely amazing (thanks to the fans who sponsered it)! and I lost count with how many compliments I got on the costume. Everyone from celebrities to vendors to fans. One girl stopped me to tell me I was the best Wonder Woman at the show. Ive been wanting to cosplay Diana since I was a little girl spinning in the living room watching the Lynda Carter series so thank you to Candy for making my dream come true. Saturday my girlfriends and I went to the show as the Gotham City Sirens. I lost count on how many people said how "Smokin Hot" we all were. People were saying I was the best Catwoman at the show, which was very flattering. One woman marveled at my face saying I looked "Exactly like Selina!" Aside from posing for pics, converesing with Facebook, Twitter and Comic fans, friends and shopping, us ladies did a shoot with the original Batmobile.  We also did the first Cosplay Photoshoot gathering organzied by The Smoke and his friend Brian. I was a chairman for the gathering as well and it was a HUGE success; loads of cosplayers turned out! After the costume contest (where us Sirens pleased the crowd by giving them a view of our bums) we all went to dinner.

For Sundays show I decided on Black Canary, which is one of my most comfortable costumes. Catwoman is also very, very comfy. I was surprised by the Sunday crowd; in the past it was usually the slowest day with a considerable less amount of people but it was just as busy as Saturday. I expected a day of granting a lot less photo requests but I was still approached every few feet which was very cool. I only kept my jacket on for a few minutes before deciding to take it off because I was hot. Sunday we also had a second cosplay shoot where my personal favorite moment was Superboy asking if he could lift me on his shoulder. And may I add that there were many hot cosplayer men at this years show. Our second cosplay shoot was also a success and we have some big plans next year. 

Also chatted with industry friends Ken Haeser, Raven Gregory and Eric Basaldua. I got a spanking from one of them (guess who?) In closing I want to once again thank Wizard for their amazing generosity! Ive been attending the show the last 10 years and it always gets better and better. I am so grateful that they took care of all of my friends and I had an absolute blast with them! I also made tons of new friends!  Im going to leave you now with a few more of my favorite shots and some of the best cosplayers at this years event and also add that I have been cast in the next DC Comics fan film! Who will I play? Stay tuned!

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