Instructions For Setting An Athletic Works Wristwatch

Instructions for Setting an Athletic Works Wristwatch

Digital watches, like the Athletic Works wristwatch, are convenient timekeepers for today's busy lifestyle. The Athletics Works watch, which is sold at Walmart stores and online, does more than just keep time. It has several modes including the ability to set military time and a mode for lap keeping. Setting the time on your watch can be a challenge if you have misplaced the instructions. Athletics House, the manufacturer, makes several styles of watches but the instructions for setting the watches remain the same. The good news is that most digital watches can be set by following some very simple steps. Does this Spark an idea?

Instructions

1. Locate the "Lap/reset" button and hold it down for five seconds.

2. Look for the word "Set" to appear on the display screen.

3. Locate the "Mode" button and push it to change from alarm to date and month.

4. Press the "Stop/start" buttons to change the numbers.

Power Bands Wrist Exercises

As athletes and the fitness-conscious become more savvy, an increasing number have starting used power bands, also known as resistance bands, to supplement their workouts. Resistance bands are relatively cheap and portable ribbons or tubes made of flexible material, which provide increasing resistance as the material is stretched. Resistance bands are especially useful for muscle toning and working smaller muscles that require less resistance, such as the wrists.

Wrist Curl

The wrist curl is a standard wrist- and forearm-strengthening exercise that is normally done with a single dumbbell. To perform a wrist curl with a power band, begin by sitting on a bench, chair, or couch. Step on the middle of the power band with the foot corresponding to the arm that you are planning on working out, then grab the end of the band with that arm. Rest your forearm along the top of your leg, with the wrist lined up with the end of your knee, so that it can backward to full extension. With your palm facing you in a fist around the end of the band, curl it up toward your face against the resistance of the band. You may have to adjust where you are stepping on the band to get the correct resistance.

Reverse Wrist Curl

Begin the reverse wrist curl in the same position as the normal wrist curl--sit down and anchor the power band by stepping on it. Grab the end of the band and place it on top of your leg, but this time have your palm facing away from you so that you can see the back of your wrist. Starting with your drooped down in front of your kneecap, extend your wrist backward against the resistance of the power band so that your knuckles point up toward the ceiling. Lower your wrist back down and repeat the exercise. Do not use a jerky motion; the exercise should be done slowly and deliberately.

Band Stretches

Sit down on an chair with arms, and rest your arms on the armrests. if you do not have a chair with arms, rest your hands on a flat surface, or hang them just over the edge of a flat surface, with your forearms resting on the surface. Grab the resistance band with either hand, so that there are 6" of the band between the hands. Stretch the band apart so that your forearms are parallel with each other, resting on the arm rests. With palms facing down, (but still in a fist) move them inward, then outward, while keeping forearms still. The amount that your wrists are able to move side to side is small, but the band will provide resistance to work the muscles that assist with the action. When you feel fatigue, you can flip the fists over, regrip the band, and move the wrists against the resistance once more.

Post Total Gastrectomy Diet

Total gastrectomies are surgical procedures in which your stomach is removed, usually due to cancer or ulcer disease. The surgeon uses intestinal tissue to recreate a pouch that is attached to your esophagus and small intestine, enabling it to function as your stomach. The procedure may leave you with frequent heartburn, vitamin deficiencies and discomfort after eating (a condition known as dumping syndrome). Making dietary changes is crucial to living a healthy life after a total gastrectomy.

Making Changes

Your doctor may refer you to a nutritionist in order to best create an individualized plan to meet all of your dietary needs. According to the University of Maryland, Greenebaum Cancer Center, after a gastrectomy, you cannot absorb vitamin B12 from food; therefore, patients undergoing a total gastrectomy usually require vitamin B12 shots. Vitamin B12 is crucial for maintaining nerve health and healthy blood cells.

Jackson Siegelbaum Gastroenterology guidelines recommend that you eat small, frequent meals. Aim to have 5 to 6 small meals with no more than 4 ounces of fluid during the meal. This prevents food from overwhelming your small pouch and from moving too quickly through your GI (gastrointestinal) tract, enhancing your body's ability to absorb nutrients. Do not drink liquids during your meal; instead, drink 30 minutes prior to or 1 hour after your meal. After eating, rest for approximately 15 minutes to slow the food moving through your GI tract.

Anti-Dumping Diet Plan

Dumping syndrome is characterized by nausea, rapid heart rate, abdominal discomfort, diarrhea, cramping, increased perspiration and dizziness shortly after eating. Sugar often increases the symptoms as do high-fat foods and too much protein.

Jackson Siegelbaum Gastroenterology's Anti-Dumping diet recommends including all of the food groups in your diet for optimal nutrition. Consume at least 2 cups per day of dairy products that you can tolerate such as buttermilk, milk, cream soups, yogurt, cheese and low-calorie puddings. Include at least 3 servings of vegetables per day and 2 servings of fresh fruit, canned fruit or unsweetened fruit juice. Include at least 4 servings of breads such as rice, unsweetened cereal, pasta, crackers, breads, pretzels and rolls. Aim for between 5 and 6 ounces of eggs, peanut butter, poultry, beef, pork and seafood. Limit your desserts to low-calorie gelatins, popsicles and items sweetened with a sugar substitute.

After a total gastrectomy you should avoid foods such as ice cream, malted milk, milkshakes, dried fruits, sweetened fruit juice, sugary cereals, doughnuts, cake, cookies, pie, candy, regular soft drinks and anything sweetened with sugar.

Sample Menu

Breakfast: 4 ounces of unsweetened cranberry juice, 1 slice of toast with 1 teaspoon of low-calorie jelly and 1 poached egg.

Mid-morning snack: 1/2 cup of unsweetened cereal with skim milk.

Lunch: 3-ounce hamburger on a bun with ketchup, 1/2 cup of broccoli tossed with a teaspoon of butter or margarine and salt/pepper.

Mid-afternoon snack: 1 slice of bread with 1 ounce of turkey breast, 1 tbls. of mayonnaise and lettuce; 1/2 cup of low-calorie gelatin.

Dinner: 3 ounces of grilled chicken breast, 1/2 cup of steamed green beans, 1/2 cup of mashed potatoes and salt/pepper.

Nighttime snack: 1/4 cup of low-fat cottage cheese topped with 3/4 cup of fresh sliced pear.

Post Surgery Incision Infection

Post-surgery incision infection may occur with improper incision cleaning or loose dressings, that allow bacteria to reach the incision site. The surgical team will discuss reduce surgical incision infections and understand the warning signs.

Benefits of a Pre-Surgical Discussion

Before a surgical procedure, a physician will discuss surgical reasons and post-surgical expectations. The physician may perform laboratory work to confirm no current infection such as the flu, that may postpone surgery.

Signs of Infection

Patients who develop signs of infection should contact a physician. Some signs of post surgical incision infection may include swelling, redness and pain.

Patient Risks for Infections

Young surgical patients should be closely monitored by parents/guardians for infection control. Older patients can ask a trusted adult for help to reduce infection risks.

Understanding Special Instructions

Follow the physician's instructions for cleansing and managing the incision. Patients should keep the physician's office number near the home telephone to confirm any instructions.

Prevention/Solution

General tips for incision care include avoiding foreign objects such as perfumes, powders and lotions. Ask the physician about methods to reduce infections.

Post Op Recommendations For Vocal Cord Surgery

Many reasons exist for why someone might require vocal cord surgery. Two of the most common reasons are the removal of cysts and polyps. After the surgery, it is important to allow the folds in the vocal cords to heal, so you must follow post-operation instructions to avoid having the folds heal together. If that happens, you will have scar tissue and might require another surgery to correct the problem.

Pain

It is normal to have pain following any type of surgery, especially vocal cord surgery. You can expect a sore throat, along with pain and swelling at the incision site. Most doctors prescribe prescription-strength painkillers for the first 24 to 48 hours. After that, you can use ibuprofen or acetaminophen as needed for pain.

Vocalization

It is crucial to avoid any speech or making sounds for at least the first two to four days. This includes sneezing and coughing. You can sneeze and cough, but you need to avoid making any sound while doing so. To sneeze silently, press the side of your finger under your nose as you inhale silent "uh" sounds through your mouth. To prevent sound with coughing, inhale through your mouth with a soft "huh" sound, and then exhale.

Once you resume speaking, use a confidential voice, meaning you would speak at the same level as you would while sharing confidential information with someone. You will also see a speech pathologist to learn modulate your voice while easing back into speaking at a normal level. Speech therapy is an essential part of the rehabilitation process and necessary for full recovery from vocal cord surgery.

Other

Immediately after surgery, you will be on a liquid diet for a day or two. After that, you may resume a normal diet, though soft foods are best for the first week. You will be advised to sleep in whatever position is most comfortable for you. The doctor will tell you to watch for bright red bleeding or passing clots.

It is common to run a fever around 100 degrees, but report anything higher, or prolonged, to your doctor. Smokers shouldn't smoke for the first few days, because it will increase pain levels and slow healing time.

Removal Of Excess Skin After Weight Loss

The National Institutes of Health report that an estimated 133.6 million Americans are either overweight or obese. With millions of people seeking to lose weight, many find success. Typically most people lose weight through a combination of diet and exercise, although some morbidly obese individuals may undergo one of the different types of bariatric surgery. Regardless of one's method for losing weight, people who lose a large percentage of their body mass will be left with a considerable amount of excess skin, states the University of Minnesota. A person will need to undergo a surgery, to remove excess skin.

During the Procedure

After consulting with a surgeon ahead of time to discuss the nature of the surgery and where on the body the skin will need to be removed, a person can then go under the knife. According the EMedicine, the extent of the procedure will depend on how much excess skin a person has on his body. For relatively small amounts, the surgery can be done at an outpatient facility. Most people, however, have a considerable amount that should be removed and therefore it must take place in a hospital. The patient will be placed under general anesthesia, where the doctor will begin to remove folds of skins in various areas of the body, says the University of Minnesota. The areas that tend to have the largest concentration of excess skin typically are the upper arms, the neck, the stomach, the breasts, and the thighs.

Following the Procedure

While it depends on how extensive the surgery was, the patient should expect to remain in the hospital for 24 to 48 hours following the procedure, cautions EMedicine. Beyond the initial stay in the hospital, it will be weeks before regular physical activity can be resumed. After roughly a week, any remaining sutures and bandages can be removed from the body. Doctors recommend walking in order to get the body back to normal, unless the procedure involved the thighs. After several weeks of gradual reintroduction to regular activity, the patient can expect to begin to complete regular tasks as the wounds heal, says the University of Minnesota.

Risks and Results

As with any medical procedure, there are risks. The most widespread one is infection and loss of blood, says DocShop.com. Following a doctor's instructions and proper self-care can greatly diminish the possibility of complications. Most people will see a noticeable change in their appearance and so will other people. According to EMedicine, those who are slightly to moderately overweight will see better results than those who are severely obese due to scarring and the limited nature of the surgery. Severely obese individuals will normally have a longer healing time and more scarring, but will notice the greatest change, especially in their mobility.

Post Gastric Bypass Surgery Recipe Tips

The decision to go ahead with gastric bypass surgery is a big one to make for many people who are looking for a healthier weight and a fuller life. Getting the surgery done is just the first step. There are definite lifestyle changes after the surgery to achieve weight goals and maintain them for life. Recipes can be obtained from outside sources or by altering the recipes we already have of our favorite dishes. To design your own recipes, keep in mind the basic nutritional tips given by your doctor.

Nutritional Basics

To lose weight in a healthy way after gastric bypass surgery, it is important to adopt better eating habits. Sticking to a nutritious meal plan and staying away from unnecessary snacking is the basis of a post gastric bypass surgery diet. Certain nutrition guidelines must be considered when finding valid recipes.

Damaged body tissues need protein to repair the worn cells. The body doesn't store protein, so it will need to be consumed every day to fulfill the body's protein needs. Find recipes that optimize lean proteins such as eggs, poultry, fish and low-fat cottage cheese. You should be eating at least 60 grams of protein every day and at least one serving of protein with each meal.

Avoid too much sugar and fat in your recipes after gastric bypass surgery to reduce the risk of developing dumping syndrome, a condition that occurs when patients eat a diet that is high in sugar and fat. Dumping syndrome causes a rapid heart rate, nausea, diarrhea, pain in the abdomen, sweating, sleepiness and light-headedness. To avoid this, use less than 10 grams of sugar and fat in each serving of your recipes.

Sample Recipe

One recipe that incorporates all of the tips above is chicken casserole. It has 21 grams of protein and only 2.5 grams of sugar per serving. The ingredients are a cup of skinless chicken breast cut into cubes, three cups of any kind of summer pasta blend (includes shells and mixed vegetables), Campbell's Cream of Chicken Soup (use the 98 percent fat-free kind), a cup of shredded cheddar cheese, ¾ cup of water, canned mushrooms and seasonings for flavoring. If you use salt, make sure it is a salt substitute.

Start by preheating the oven to 350 degrees. While you are cooking the pasta blend (pay attention to packaging for directions), mix all the other ingredients together; save half of the cheese to sprinkle over the top of the casserole. Add the seasonings to your taste. Mix the pasta blend and the other ingredients together and pour into a casserole dish. Spread out the cheese over the top and bake for about 30 minutes.

Post Bariatric Nutrition

For individuals who are obese, bariatric surgery can be life-saving and life-changing. According to the American Society for Metabolic and Bariatric Surgery, more than 200,000 people underwent bariatric surgery in 2008. With no end to the obesity epidemic in sight, the number of people undergoing bariatric surgery is expected to increase in the coming years. Following nutritional recommendations after surgery is of utmost importance to ensure weight loss success and health in both the short and long term.

Preoperative Assessment

Before the bariatric surgery procedure, a nutritional assessment should be performed by a dietitian or physician to evaluate for any existing problems with nutrition, to identify problems that can be corrected, and to create a nutrition plan for after the surgery. In addition to checking for other diseases like heart disease and type 2 diabetes, the doctor will take weight history, results of laboratory testing, and nutritional status into consideration. The dietician or physician will also assess the patient's readiness for change, capacity for goal setting, knowledge of nutrition, psychological health and social life.

Three Months After Surgery

In the initial postoperative period (one to two days after the surgery), no solid foods can be consumed. At this time, a liquid diet is recommended, which may consist of juice, milk, broth or cooked cereal. Adequate hydration is important. After the initial liquid diet, the diet will progress to pureed foods for approximately three to four weeks. Then, a soft food diet, such as fresh fruit, cooked vegetables and ground meat, is recommended for an additional eight weeks before regular foods can be consumed.

A patient should initially start with many small meals each day and then gradually decrease the meals until a regular diet is reached. This step-by-step process ensures proper healing of the surgical site.

Throughout this process, a physician will continue monitoring for symptoms of vitamin deficiency, as this is a significant concern in the postoperative period. Bariatric surgery alters vitamin absorption and repletion, and daily multivitamins and mineral supplements are valuable in maintaining intake for optimal body function. Protein content of meals is also very important for healing.

At each visit, the physician will reinforce what she discussed in the preoperative visit, including the previously approved nutritional plan, self-care prescription and behavioral modification.

Continuing Nutritional Recommendations

Maintaining adequate nutrition is still important after the initial postoperative period. Although regular foods can be consumed, the same principles apply as in the initial stages. Drink and eat slowly to avoid complications such as nausea or vomiting. Each meal should take 30 minutes to consume. Similarly, drinking one cup of liquid should take between 30 and 60 minutes. High-fat and high-sugar foods should be avoided to minimize problems. Continue eating protein-rich meals. Don't drink liquids while eating food, and chew food to avoid blockages. Small meals are still important, as the stomach will only hold a maximum of 1 to 1.5 cups of food at a time.

Follow-up visits with the physician will continue to touch upon nutritional goals. Hydration (ideally six to eight cups of liquid daily), texture progression, vitamin/mineral levels, and meal planning and appropriate food choices will be reviewed to ensure that weight loss is maximized.

What Is The Definition Of Bariatric Surgery

Obesity puts an individual at risk for many conditions, some of which can be life threatening. These conditions include high blood pressure, diabetes, joint pain and deterioration, stroke and heart attack. Many people are able to lose weight through good diet and exercise, but some people struggle to lose weight even when they are eating right and are physically active. Some of these people may consider one of the multiple forms of bariatric surgery to treat their obesity.

Definition

Bariatric surgery can be defined as surgery that modifies the gastrointestinal tract with the purpose of decreasing calorie consumption and therefore decreasing weight. There are several different types of bariatric surgery, including malabsorptive, restrictive and mixed. In malabsorptive bariatric surgery, the primary result is the inability to absorb as many calories, vitamins and minerals. Restrictive bariatric surgery achieves weight loss by restricting the physical size of the stomach and thus restricting the number of calories consumed. Mixed bariatric surgeries are a combination of malabsorptive and restrictive bariatric surgeries.

Biliopancreatic Diversion

Biliopancreatic diversion is a rare type of malabsorptive bariatric surgery. In this procedure, part of the stomach is resected, which creates a stomach that is smaller. This smaller stomach pouch is then connected to the small intestine.

Restrictive Surgeries

The two main types of restrictive bariatric surgery performed are vertical banded gastroplasty (aka stomach stapling) and adjustable gastric band (aka lap band). In vertical banded gastroplasty, the stomach is stapled to create a prestomach pouch that is smaller. Adjustable gastric band surgery is like stomach stapling, but a band is used in place of staples. The advantage of the band over the staples is that the band can be made larger or smaller based on the needs of the individual.

Mixed Surgeries

The two main types of mixed bariatric surgery are gastric bypass and sleeve gastrectomy with duodenal switch. In gastric bypass, stapling of the stomach is done, and the intestine is rerouted to the smaller pouch that is created. In the United States, this is the most popular form of bariatric surgery. Sleeve gastrectomy is similar to biliopancreatic diversion---the size of the stomach is decreased, the stomach is disconnected from the duodenum and the stomach is then reattached about 3 feet from the colon.

Considerations

Bariatric surgery is a serious procedure despite its commonality. Complications, such as bloating, infections, leaks at the site of incision and diarrhea, frequently occur.

Postop Diet For Gastric Lap Banding

Post-Op Diet for Gastric Lap Banding

Gastric lap banding is a surgical procedure performed to help obese patients lose weight. The lap band physically reduces the amount of volume in the stomach, so that less food is consumed. A careful diet must be followed after the surgery to minimize discomfort and complications. The medical team performing the surgery will provide detailed diet instructions.

Liquid Diet

After surgery, clear liquids may be consumed for 2 to 3 days. Immediately after surgery, sucking on an ice cube is sufficient intake. Build up to sipping water and eventually other liquids such as broth. Do not drink a large volume as this can lead to vomiting which stretches the stomach. Three days after the surgery, other liquids may be introduced. Thin liquids are easier to tolerate, according to the University of California Medical Center. Skim milk, thinned protein shakes, broth and diluted juice may be consumed in addition to water. Sinai Hospital recommends drinking fluids at room temperature since cold liquids may make the stomach spasm.

Soft Foods

Approximately two weeks after surgery, soft foods may be introduced. Soft foods are easily mashed and contain no chunks, according to Sinai Hospital. Soft foods may be pureed meats and vegetables, mashed potatoes, applesauce and low fat yogurts and puddings. Foods should be chewed thoroughly until the food has the same consistency as a liquid. Hydration remains important, but liquids should not be consumed at the same time as the meal as this may cause the stomach to stretch. Drink clear liquids before and after meals to stay hydrated.

Solid Foods

Approximately five weeks after surgery, solid foods may be introduced. Solid foods should be cooked until tender and cut into small pieces when introducing back into the diet. Food should be chewed until a liquid consistency with each bite. Overcooked or rough foods (coconut, artichoke, chips and popcorn) should be avoided so that they do not get stuck by the band. Large foods like chunks of meat may not pass through the band and should not be consumed. Throughout the day, eat three small meals and chew each bite carefully.

What Is Unsupervised Probation

What Is Unsupervised Probation?

An individual who has no significant criminal record and who has been convicted of a more minor offense qualifies for unsupervised probation in many instances. Short of diversion or a suspended sentence, unsupervised probation is the least significant punishment that a court can order in a criminal case.

Barring committing a new crime or failing to comply with any conditions of probation, a defendant can make it through a term of unsupervised probation with very little to no contact with the court or the probation office.

History

Probation in the United States initially was utilized in Boston in 1841. The first statewide probation system was developed in Massachusetts in 1880. Forty years later, over 20 states in the U.S. began using probation systems in regard to criminal defendants.

By 1951 every state in the Union (as well as the federal government) utilized probation in criminal cases. Each state and the federal government rely on different levels when it comes to probation. The least severe and intrusive type of probation is unsupervised probation. Supervised probation is a midlevel form of the sentence, while intensive probation is the most restrictive.

Function

The basic function of unsupervised probation is to ensure that any penalties, educational or counseling requirements ordered by a court in a criminal case are completed. For example, oftentimes a term of supervised probation is accompanied by a requirement for the defendant to do community service, participate in some sort of educational programming or take part in counseling. Additionally, an individual on unsupervised probation is required not to breach the conditions of the probationary term not break the law while on probation.

Although a person on unsupervised probation is not obliged to meet with a probation officer during the term, there is some general oversight by the probation office from time to time to ensure that the basic requirements of the probation order are being met by the defendant.

Time Frame

A term of unsupervised probation normally is not very long in duration. Typically unsupervised probation extends for a period of six months to one year. However, under applicable law, it is possible in some cases and with certain charges for a term of unsupervised probation to extend beyond a one-year period.

Revocation

If a person on unsupervised probation fails to satisfy the terms and conditions of the probation order or commits a new crime, that individual can face the prospect of having his unsupervised probation revoked. In most instances, a probation office and companion criminal justice system take a graduated approach to revocation. By this it is meant that if the infraction is not too significant, a defendant may end up on supervised probation for the duration of his sentence.

If the offender continues to have problems satisfying the conditions of probation, he will face stiffer sanctions. In the end, it is possible for a person to end up incarcerated if he continues to fail to comply with a probation order.

Warning

Although in and of itself, unsupervised probation is not a particularly serious sentence, if a defendant finds herself facing a revocation of unsupervised probation, seeking legal advice and representation is a wise course to take. The reality is that if a probation officer elects to revoke unsupervised probation, the consequences can be serious and there is always at least some risk of incarceration.

Postoperative Patient Instructions After A Hip Arthroscopy

Total arthroscopic hip replacement---through one or two small incisions---is now commonplace. This minimally invasive procedure, during which the head of the thighbone and the hip's ball and socket are replaced, has a significantly shorter recovery time. If you have arthroscopic hip surgery, you will need to follow these post-operative instructions.

Immediately After Surgery

Eat and drink conservatively immediately following surgery, as the anesthetic may affect your digestion. You may wish to drink only clear liquids, such as ginger ale or Sprite for the first 24 hours. Also during that time period, eat only dry crackers or toast. If vomiting or nausea is severe or if you have a temperature above 101 degrees, call your doctor or the hospital. A slight fever, however, is not uncommon.

Minimize Swelling

To minimize swelling in the first 72 hours, you should elevate the affected limb. Frequently apply ice, as well, especially in the first 48 hours. Use a large zip-lock bag with ice or a large ice pack.

Care for Bandages

Your incision will have been stitched closed, then covered with bandages. These bandages should remain in place for 24 hours. It is normal for these to be tinged with blood or fluids, but if bright red blood continues despite elevation and ice, call your doctor. On the second or third day following surgery, remove the outer bandages (not any strips or stitches) and replace them with adhesive ones.

Keep Wound Dry

Keep your wound dry and clean for 48 hours following surgery. Shower by covering your wounds with plastic or take a sponge bath. On the second day you may shower with the wound exposed, but don't scrub it or submerse it in water. Avoid taking a bath or swimming in a pool for the first one to three weeks following surgery, depending on your doctor's instructions.

Follow Medication Instructions

Patients often report increased pain the second or third day after surgery. Be sure to use pain medication as directed. If it is a narcotic, be wary of driving or operating machinery when you are under its influence. In addition, ask your doctor about taking a baby aspirin daily to lower the risk of blood clotting.

Exercise

Exercise is important to post-operative care. Unless your doctor states otherwise, full weight bearing exercises are not recommended. You may use crutches, a walker or cane for balance but not to support you. For the first week, range-of-motion exercises, as well as straight leg lifts and foot extensions, are encouraged and may be started the evening of surgery. However, you are advised not to overexert yourself.

Port Of Seattle Cruise Ship Information

Set sail to Alaska from Seattle's seaport.

Seattle, Washington is located in the Pacific Northwest region of the United States. There are several major cruise lines operating from Seattle's seaport offering getaways to Alaska.

Cruise Line Selection

As of October 2010, six cruise lines offer service to Alaska from the Port of Seattle. Within the pool of cruise lines there are 12 ships setting sail through the Pacific Northwest en route to Alaska.

Cruise Packages

Cruising season lasts from April to the end of September. Cruise lines depart from Seattle to Alaska on various days of the week. Cruise packages generally offer trips ranging from seven to 14 days. Cruises can be booked online through various travel websites or your local travel agent.

Terminals and Transportation

Ships set sail from Seattle's two cruise terminals, the Bell Street Pier Cruise Terminal/Pier 66 and the Smith Cover Terminal/Pier 91. If you are arriving in Seattle via Sea-Tac airport, you can take a 15- to 30-minute taxi ride, bus or light rail from the airport to the cruise terminals. Both terminals offer rental car kiosks, 1,000 or more secure parking spaces and complementary shuttle service to and from the terminal.

Portacath Protocol

Port-a-Cath® is a medical device from Smith Medicals intended to allow repeated intravenous entry into the human system to administer nutrition, fluids and medication, as well as for sampling blood.

Port-a-Cath®

The Port-a-Cath®, the only device through which repeated intravenous access can be achieved over a long period of time, is implanted under a patient's skin. Patients live normally, and the device requires only a monthly cleaning.

Cleaning the Site

Whenever the dressings on the Port-a-Cath site are changed, the area should be cleaned with aqueous chlorhexidine gluconate solution 2 percent. If that is unavailable, a solution of 0.5 to 1 percent aqueous chlorhexidine gluconate should be used and the site allowed to air dry.

Maintaining the Site

After implantation, the catheter site should be covered with either an all-inclusive gauze dressing or a transparent polyurethane dressing, which are recommended. The former should be changed regularly and always when damp, dirty or loose. When the Port-a-Cath® site is healed, dressings can be eliminated; however, the central line should be looped to guard against pulling.

Changing Intravenous Sets

Before accessing the injection port or catheter hub, alcohol or a solution of chlorhexidine gluconate should be used to clean the port. Intravenous sets for blood should be changed every 12 hours, while sets for nutritional substances should be changed every 24 hours. Sets in use continuously need only be replaced every 72 hours.

Polyester Allergy

Polyester found in clothing can cause allergic contact dermatitis.

Polyester is a synthetic fiber that is frequently used in fabric items such as clothing, linens or swimsuits. A polyester allergy is defined as allergic contact dermatitis when the skin gets red, itchy, and swollen due to exposure to polyester, according to the American Academy of Dermatology (AAD.) Allergic contact dermatitis is similar to other types of rashes and ultimately makes self-diagnosis difficult. Therefore, it's vital for specialized physicians, such as dermatologists, to study all materials that touch the patient to identify polyester as the allergen source.

Skin Tests

Skin tests are used to identify substances that may be causing an allergic reaction. WebMD reports that there are three skin tests used to determine the allergen: scratch tests, intradermal tests and patch tests. In most cases of allergic contact dermatitis, the AAD states that patch tests are the safest and easiest way to diagnose contact allergies.

A patch test is a simple procedure that applies small amounts of the possible common allergens to the skin on strips of tape. Two days later the tape is removed. If a small red spot appears at the site of the patch, the test is deemed positive.

PPD and Textile Dye Dermatitis

Paraphenylene-diamine, or PPD, is a widely used ingredient found in permanent hair dyes. Although PPD is rarely found in clothing, other dyes found in polyester may cross-react with PPD to cause an allergic reaction. People allergic to PPD should stay away from polyester or any other synthetic fibers.

Although allergic contact dermatitis to textile dyes in polyester is not common, the true incidence remains unknown due to insufficient patch tests. Edwin K. Joe, M.D. writes in the Dermatology Online Journal that allergens specific for textile dyes are not frequently included in patch testing. He goes on to say that disperse blue 106 and 124 are both excellent screening allergies for identifying a polyester allergy.

Symptoms

Some of the more common symptoms that accompany a polyester allergy are a red rash on the legs, severe itching, hives and skin abrasions. People with eczema or sensitive skin should avoid polyester to prevent further skin irritation and discomfort.

Polyester Allergy Relief

There is currently no cure for a polyester allergy, but certain over-the-counter and prescription medications can help ease the symptoms. Antihistamines, steroid creams, frequent washing, calamine lotions, wet compresses and cool baths are all successful allergic contact dermatitis treatments.

Prevention

The best way to prevent an allergic response is to avoid any product containing polyester. This can be difficult due to the prevalence of the synthetic fiber in clothing and linens; however, plenty of other materials like cotton and silk are available as nonirritating options.

Pms Relief Through Self Hypnosis

Premenstrual Syndrome or PMS includes pain, bloating, depression and mood swings, which presents a week or two before menstruation. No one knows exactly what causes these syndromes, especially when some women experience severe symptoms while others experience only slight discomfort. Some women do not experience symptoms at all.

Pain medications and diuretics help, but another alternative solution is catching on. These days, women who want to control PMS symptoms without resorting to medication can use self-hypnosis techniques.

PMS Control

Hypnosis is deep relaxation induced by focusing on someone's voice or object, which induces relaxation like that experienced in sleep. In self-hypnosis, use of an audio or visual tape guides you into a relaxed state.

Guided induction allows you to experience hypnosis before you attempt self-hypnosis on your own; however, it is not necessary. Guided induction is a convenient tool to use when you are tired or too stressed to guide yourself, and some people prefer it because they find it easier.

An October 2001 article in the Western Journal of Medicine stated that randomized controlled studies have shown hypnosis and other relaxation techniques to help alleviate pain and reduces stress. This is not just new age stuff -- physicians and psychologists are using the mind-body connection and advising patients on relaxation techniques for stress and pain management.

Use of Imagery and Affirmation

Self-hypnosis, like meditation, induces relaxation of your body, reduces stress hormones and reduces pain by increasing endorphins, the brain chemical responsible for mood. Self-hypnosis uses visualization or imagery such as imagining yourself floating on a cloud or on some paradise island; any image you conjure up that helps you to focus on relaxation will work.

For PMS, you may induce an image of yourself on a warm and sandy beach. Imagine the waves rushing over you and with each wave that subsides, imagine the pain and stress of PMS washing away out to sea.

Using affirmations along with imagery helps to introduce new ideas about you through verbal statements. For example, you might say, 'I am a wonderful person,' or 'I handle stress well.'

Repeating affirmations will teach you to condition yourself and to learn different things about you until you begin to believe it. Affirmation helps reduce negative ideas or feelings you have. It is important however, to repeat affirmations that you do believe, at least on some level.

Self-Suggestion

Self-suggestion is like affirmations in that in a relaxed state, you can repeat words that help to focus on relaxation, such as the words calm, or serenity. When preparing for hypnosis, you should think about suggestions related to what changes you want to make. Self-suggestion comes before the affirmations because self-suggestion is telling yourself what to feel about PMS and affirmations are about you and your self-image.

Self-suggestion helps deepen the relaxation state. You may want to make a tape of suggestions because you can play the tape without hypnosis whenever you want to remain alert, such as when you are in your car.

What Is The Safest Way To Lose Weight

The safest way to lose weight is gradually, with a combination of exercise, eating less and eating healthier. No fad diet is safe. About two pounds a week is considered the optimal level of weight loss.

Drink Water

Replace most of your daily beverages with water. Water has no calories or unhealthy additives and keeps your metabolism working.

Breakfast

Eat a healthy breakfast to get energy for the day and jump-start your metabolism, which slows overnight.

Snacks

Replace junk food with a handful of nuts, which have healthy unsaturated fat and have been shown to aid weight loss, or fruit, which is also healthy and nutritious.

Carbs

Skipping carbs is not a safe way to lose weight; get carbs from whole grain breads, cereals and pastas, brown rice and oats.

Weight Training

Resistance and weight training exercises are essential to safe weight loss. When losing weight, you lose muscle mass faster than fat if you don't exercise.

Aerobic Exercise

To lose weight, you must burn more calories than you consume and aerobic exercise, such as brisk walking or jogging, is the best way to burn calories.

Platinum Vs Tungsten Wedding Bands

When it comes to tungsten versus platinum, the decision usually comes down to a man's personal choice about the weight and cost of the ring. Does this Spark an idea?

Platinum

Platinum is a rare, heavy metal that is significantly more expensive than tungsten, it's also more expensive than gold. It can scratch easily, but it never loses its white luster.

Tungsten

A steel-gray metal, tungsten is known for being incredibly lightweight and scratch resistant. It's a popular choice for men's wedding rings because it does not require polishing and it's inexpensive in comparison to platinum.

Other Metals

Besides platinum and tungsten, other common metals used in men's wedding bands are gold, titanium, stainless steel and silver.

Engraving

Tungsten rings cannot be engraved using the traditional engraving method as you can with platinum or gold. It can only be laser engraved. Tungsten rings cannot be resized.

Considerations

Men often lose their rings during activities like swimming and contact sports. Choosing a tungsten ring means less expense in replacement. In an emergency situation, platinum rings can be cut off, while tungsten rings need to be cracked into pieces using vice-like pliers.

Qualifications For Bariatric Surgery

If you are significantly overweight, and diet and exercise are not doing the trick, you may be considering weight-loss surgery. You will need to discuss this option with your doctor to determine if this procedure is right for you. As with any type of surgery, there are always risks you must carefully consider. Due to these risks, there are certain requirements established by the National Institutes of Health that may be required before you and your doctor can consider bariatric surgery.

Morbid Obesity

The main qualification to have bariatric surgery is that you have a body mass index of 40 or above. This also means that you are at least 100 lbs. overweight.

Failure or Noncompliance with Other Programs

Patients who are evaluated by a medical professional and judged to have a low chance of success with nonsurgical measures are usually considered. You may have a history of failure in established weight control programs or be reluctant to enter such a program.

You are at High Risk for Obesity-Related Diseases

If you have a high risk of life-threatening cardiopulmonary problems, Pickwickian syndrome, obesity-related cardiomyopathy, severe sleep apnea or severe diabetes mellitus, you may be a good candidate. If your obesity is severe enough that it is greatly inhibiting your lifestyle, employment, family function and ability to ambulate, surgery may be the answer.

Motivation to Change

Good candidates for this surgery should be well-informed and able to accept the risks listed below that are involved with this procedure. The patient needs to be motivated to take part in her own care, make the necessary lifestyle changes and be able and willing to participate in treatment and long-term follow-up.

You Must Understand the Risks

While most patients do well with this surgery, you need to understand that you are at risk for infections, dehiscence, leaks from staple breakdown, stomal stenosis, marginal ulcers and various pulmonary problems. Gastrointestinal leaks, deep venous thrombosis and death occur in some patients.

Plasticsurgery Cost For Lip Reduction

Many people drastically overestimate the cost of plastic surgery. Though you'll almost certainly pay in the thousands for a plastic-surgery procedure, it is very rare to have a five-digit-price tag attached to your plastic-surgery bill. Lip reduction is one of the less expensive plastic-surgery procedures because it is performed on a small area of the body and requires a relatively short-time investment by the surgeon and medical staff.

Significance

Lip-reduction surgery is a permanent procedure; the main objective of the surgery is to lessen the size of a patient's lips. If desired, the lips may also be reshaped into a more attractive shape than the current. Patients may opt to undergo surgery on both lips or simply choose to alter the larger of the two. Due to the fact that lip reduction is classified as a cosmetic procedure, it is not covered by insurance companies.

Cost

Lip-reduction surgery typically costs anywhere from $2,000-to-$4,000. However, the national average is reported to be about $3,000. Don't look for bargain-basement prices when choosing a plastic surgeon, for the ones who charge much less are often uncertified, inexperienced and will perform a botched-up job.

Considerations

According to plasticsurgery.org, when choosing a plastic surgeon, you should choose a surgeon who is certified by the American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. He or she should operate only in accredited medical centers and have at least three years of plastic-surgery experience.

Time Frame

The lip-reduction surgery itself usually lasts between one-to-two hours. Because lip reduction is an outpatient procedure, you'll have to take time off from work and possibly make arrangements for accommodations at a hotel if your procedure will be performed out of state. Recovery time is relatively short; you can expect to be back at work within three-to-seven days of the procedure.

Warning

As with all invasive plastic-surgery procedures, there is an element of risk with lip-reduction surgery. The most common side effects of lip-reduction procedures are numbness, swelling and restricted chewing and speech. When compared with other plastic-surgery procedures, these side effects are trivial. Typically, side effects will dissipate within seven days of surgery.

Minnesotacare And Medicaid

MinnesotaCare and Medical Assistance help low income residents afford health care coverage.

MinnesotaCare and Minnesota Medicaid (known as Medical Assistance or MA) are two options for low comes residents of that state who cannot get affordable health care otherwise. Each program has its own qualification guidelines that must be met.

Types

Children up to age 20, pregnant women, parents living with children under the age of 19, the disabled, seniors over age 65, the blind and those who have been diagnosed with breast or cervical cancer are all eligible for MA. Adults without children and with no more than two people in the household, pregnant women and children under age 21 and their caretakers are all eligible for MinnesotaCare.

Income

Income limits vary widely based on the coverage type, whether the applicant is applying for MA or MinnesotaCare and household size. They range from 280 percent of the Federal Poverty Level for infant under the age of two who are applying for MA to 100 percent of the FPL for non-pregnant adults applying for MA. Adults applying for MinnesotaCare must not be employed by a company who has health insurance option available and is willing to pay half of the monthly premiums.

Considerations

While Medicaid is free for qualified residents, MinnesotaCare comes with a monthly premium which is determined by an income-based sliding scale that also takes family size into consideration. There are some exceptions to this for those who are in the military or on Transitional MinnesotaCare.

Preop Procedures For Bariatric Bypass

Just as bariatric bypass surgery (sometimes called gastric surgery) is not an instant fix for weight problems, neither is the pre-operative process for the surgery instant. Several tests and consultations will need to be completed before your surgery will be scheduled and performed. Although certain consultations are necessary for everyone, additional consultations might be called for as the medical team considers the individual patient's state of health. The Mount Sinai School of Medicine's Program for Surgical Weight Loss provides a roadmap of what preoperative procedures will be needed.

Meet with the surgeon

Meet with a bariatric surgeon to discuss your health and options. According to National Institutes for Health criteria, bariatric bypass can be considered for people with a body mass index of more than 40, or more than 35 if the patient has serious medical problems, such as diabetes, obstructive sleep apnea or joint problems, that could be improved with weight loss. Several different surgical techniques have been developed and the surgeon will review your health and previous weight-loss efforts to decide which is best for you. How much weight needs to be lost is also a factor in this decision. As part of evaluating your total health picture, blood tests will be ordered. Some surgery centers request the blood testing be done before the initial meeting with the surgeon.

Meet with a nutritionist

Meeting with a nutritionist is standard procedure for bariatric bypass. Your diet will be different both before and after surgery. A nutritionist will explain what changes you'll need to make, as well as make sure you understand maintain the needed diet to maximize the benefit of the surgery. According to UpToDate.com, some patients need to lose a small amount of weight before surgery. Mount Sinai states that losing weight before surgery shrinks the liver and makes the operation safer.

Meet with a mental health professional

Both for insurance purposes and to help identify lifestyle, coping and stress issues, you will need to meet with a psychologist or psychiatrist before your surgery. A psychiatric evaluation is a standard pre-operative procedure.

Consult other specialists as the surgeon requests

Depending on what other medical conditions you may have, the surgeon may ask you to be examined by a cardiologist, sleep medicine specialist, pulmonologist or internal medicine specialist.

Start your pre-surgery diet

Follow the pre-surgery diet the nutritionist and surgeon recommend for you. Depending on the specific surgical technique selected for you and how much weight you need to lose before surgery, you will start your pre-surgical diet two weeks to three months before. The diet will be high in protein but low in fats, calories and carbohydrates. Some surgeons require a liquid protein diet for two weeks before surgery. You will also need to take vitamin supplements, avoid alcohol, stop smoking and avoid certain medications (your surgeon will tell you which ones to avoid). Mount Sinai recommends clear liquids only for two days before surgery in order to allow all solids to pass the small intestine.

The day of surgery

Starting at midnight before the surgery, you are allowed no fluid or food by mouth. You can take medications only and just a sip of water to swallow them. Your surgeon will tell you which medications to take and whether you should skip any of them on that day. Arrive at the designated time, which allows you to meet with the anesthesiologist, have an I.V. placed and be given medication to help you relax before surgery. Generally you will also be given an antibiotic and an anticoagulant to prevent infection and thrombosis.

Is Medicare Automatic When You Reach Age 65

Medicare is a federal government-managed health care program for senior citizens. Medicare consists of Part A, which provides hospitalization coverage, Part B, which covers doctor visits, and Part D, which covers prescription drugs. Part C may be chosen in place of traditional Medicare and is available from private insurers. Medicare Part A offers automatic enrollment while other parts require action by the enrollee.

Part A

You will be automatically enrolled in Medicare Part A. Coverage will begin on the first day of the month of your 65th birthday, assuming you have met the requirement of at least 40 quarters of qualified employment paying Social Security taxes. No action is required, and you will receive your Medicare card in the mail about three months before your 65th birthday. No premium payment is required for Medicare Part A enrollment.

Part B

You are eligible to enroll in Part B at the same time as you are enrolled in Part A. Because Part B is optional and requires the payment of a monthly premium, you must elect to either accept or decline the coverage. If you want Part B, you will have a seven-month window in which to enroll, and enrollment instructions will be included with your initial Medicare enrollment package. If you decline Part B, you pay a penalty if you choose to enroll at a later date.

Part C

You may carry medicare Part C, or Medicare Advantage, instead of Medicare Part A and Part B. However, you must first enroll in Part A and Part B, then select a Medicare Advantage plan from a private insurer during your initial Medicare enrollment period. You can also switch to a Medicare Advantage plan during the annual enrollment period that runs from Nov. 15 to Dec. 31 each year.

Part D

Medicare Part D, which provides prescription drug coverage, is also an optional plan that requires an additional premium. If you decide to enroll in Part D coverage, you can do so during the annual enrollment period of Nov. 15 to Dec. 31. If you are enrolled in a Medicare Advantage plan, it may is provide prescription drug coverage. You can also obtain separate prescription drug coverage from a private insurer.

Physician'S Assistant Job Requirements

A physician's assistant helps to diagnose problems and prescribe treatment.

Patients are often seen by a physician's assistant instead of a doctor in some areas, including hospitals. Physician's assistants perform a wide variety of tasks to help people regain their health. They also must meet educational and certification guidelines to do their jobs, all of which are regulated by law.

Patient Treatment

Physician's assistants put casts on injured patients.

Physician's assistants, under a doctor's supervision, perform routine examinations, record a patient's medical history and help to diagnose health issues. They sometimes also do minor treatment, including putting on a cast, putting on a splint or putting stitches in a wound. They also interpret the results of X-rays and blood work. Their duties are established according to the attending doctor and state law.

Work Schedule

The physician's assistant's schedule depends primarily on the area and the type of clinic where he works. If you work in the hospital, you will have a more varied schedule. This might include working overnight, on weekends or during early morning hours. Often, you also have to be on call in case of an emergency. If you work in a clinic, you will work approximately 40 hours during the week. This is more common in rural clinics that have set hours.

Training

The educational background for this job requires training in either a two- or four-year program. Physician's assistants take courses in family medicine, surgery, prenatal care and emergency medicine. After graduation, they must take the Physician Assistant National Certifying Examination to become eligible to practice. They must attend 100 hours of continuing education within two years to keep their certification up to date. The certification test must be retaken every six years.

Phrases For Performance Reviews

Set the tone for your employee's performance review by staying positive.

Annual performance reviews are valuable tools when used properly. But many managers and employees simply go through the motions when review time rolls around, robbing both parties of a real opportunity for interaction and instruction on work together to improve job performance.

Reviews: A Two-Way Street

No matter the frequency of reviews, the performance review process should be a two-way street. Managers should use performance reviews as a coaching mechanism and a as means for helping employees excel, while employees should use the review process as a means for growing their skills and enhancing their career paths.

Set the Right Tone

For optimal benefit, managers should set the right tone for all performance reviews. The right tone is vital whether the employees are doing a good job or a poor job. For exceptional performance, give your star workers the praise (and the rewards) they deserve. When performance is marginal, use the review process as a coaching opportunity.

When coaching a worker whose performance is unsatisfactory, couch any criticism in positive terms. This provides the worker the opportunity to improve his or her performance. Setting a negative term accomplishes nothing, and sets up a combative and unproductive climate for the balance of the performance review.

Some Handy Performance Review Phrases

Using the right phrases during performance reviews can set a positive tone while fending off potential problems.

For instance, a manager might say, "Our department counts on you to get the job done," for a worker who goes above and beyond what is expected. The manager might say, "You are a great worker, but need to focus a bit more on your attendance," for the otherwise good employee with absenteeism issues. Use phrases like, "You are a real team player" for recognizing a committed worker, and "You need to focus more on the big picture," to coach a worker who is too focused on small details to see the true scope of her job.

The Average Cost Of Liposuction & A Tummy Tuck

Liposuction surgery and tummy tucks can be time and energy saving alternatives to the drudgery's of exercise to remove stubborn excess fat. But the price of eliminating unwanted body fat while you sleep does not come cheap.

What is Liposuction?

Liposuction also referred to as lipoplasty and body contouring is an operation that uses a vacuum type device called a suction to remove body fat. Liposuction is not designed to replace diet and exercise but it can expedite the reduction of fat that fails to respond to a traditional weight reduction program.

Overall Cost of Liposuction

The cost of liposuction surgery will vary depending on how many areas of the body are treated with suction and what area of the U.S. the procedure is being performed in. The total cost of a typical three region procedure including non-surgical fees is about $8,800.

Breaking Down the Cost of Liposuction

The average cost of removing fat from the hips is $2,400, the buttocks $1,800 and the outer thigh region about $3,000. You can factor in an additional $1,600 for non-surgical fees.

Tumescent Liposuction

The most commonly used liposuction treatment is called tumescent liposuction. The procedure consists of your doctor injecting fluids (a combination of salt water and anesthetic) into the area that will be suctioned, causing it to harden and swell.

A small incision is made in the skin and a suction tube is inserted to remove the fat and fluids.

The average cost of tumescent liposuction varies depending on where in the U.S. it is performed and how many areas of the body are to be treated. The median price is about $5,000.

Tummy Tuck

A tummy tuck (abdominoplasty) can remove excess skin or fat and tighten the abdominal region that may be resistant to exercise. A tummy tuck can also erase stretch marks that frequently result during pregnancy.

Cost of Abdominoplasty

As with liposuction, the cost of a tummy tuck can range significantly depending on where in the U.S. it is to be performed and the experience level of the plastic surgeon. You can expect to pay somewhere between $3,000 and $8,500.

Additonal Cost Variables of Abdominoplasty

The cost of a tummy tuck is directly correlated to the amount of skin and fat that is to be removed. Since the procedure can be performed either in a hospital or in the surgical area of your doctor's office, the facility fee can vary considerably.

Phentermine 37 5 Directions

Your doctor may prescribe phentermine if you are having trouble losing weight.

Phentermine belongs to a class of drugs called anorectics, which are medications that cause patients to experience a reduction in appetite. Your doctor may prescribe phentermine tablets, which contain 37.5 mg of phentermine hydrochloride, on a short-term basis (three to six weeks) to help you lose weight while launching a diet and exercise program. For the best results, follow the medication's instructions for use.

Instructions

1. Take the medication three times per day, 30 minutes before a meal, after your doctor prescribes phentermine. Follow any other directions recommended by your doctor.

2. Take extended-release phentermine tablets in the morning. It is important not to crush, split or chew extended-release medications. You must swallow them whole.

3. Follow your doctor's instructions regarding adjunct diet and exercise weight-loss interventions while taking phentermine.

4. Talk to your doctor about possible side effects, including diarrhea, constipation, dry mouth, vomiting or an unpleasant taste in your mouth.These side effects will continue unless you discontinue use of phentermine.

5. Report potentially dangerous side effects to your doctor immediately. They include: Chest pain, shortness of breath, dizziness and lightheadedness, hypertension, restlessness, insomnia, tremors, heart palpitations, swollen ankles or feet and/or an inability to perform your usual activities of daily living.

6. Discontinue phentermine if you build a tolerance to its effects. Do not take increased doses of the medication to overcome this tolerance.

7. Avoid drinking alcohol while taking phentermine. Alcohol can increase the adverse side effects of the medication.

Phalloplasty Procedures

Phalloplasty Procedures

Phalloplasty is a cosmetic procedure for enhancing the penis. Phalloplasty began in the early 1990s, however many plastic surgery medical boards do not widely approve of the procedure due to it putting a normally functioning organ at risk. The most ideal candidate for phalloplasty are men who do not take blood thinners, no heart problems, old enough to weigh the risks and benefits, and ow risk of scarring.

Widening

The widening of a penis is in an effort to acquire more girth. Girth can be obtained by one of two ways during the phalloplasty. First off, fat injections into the penis will give the look and feel of more girth. This will make the penis thicker and thus, wider. For this option, it is always possible that the body will eventually absorb the fat injection--bringing you right back to where you began. The second option is a bit more invasive. Option No. 2 involves donated tissue--your own tissue or from a donor--that is grafted into the penis through incisions.

Lengthening

A penis is partially held in place by the suspensory ligament at the base of the penis. When a patient wants to lengthen the penis, the surgeon will cut the suspensory ligament, thus allowing the penis to extend further away from the body. Tissue expanders may also be added to prevent the ligament from tightening back in the future.

Glanular

An increase in the penile glan (the tip of the penis) can be obtained during the phalloplasty by two ways. Just like the widening process, a glanular increase in size is obtained by fat injections of a tissue graft. And just like the widening procedure, fat injections may be absorbed by the body in the future and tissue grafts tend to be more invasive and require more aftercare.

Cost

Phalloplasty is an elective cosmetic surgery. Therefore, the expense of this procedure most likely not be covered by your insurance company. You will be required to pay the entire amount in full, or have the total amount financed. The cost of a phalloplasty is between $9,000 and $13,000, depending upon the procedure you choose and the amount of enhancement your surgeon performs.

Recovery

The phalloplasty procedure generally takes one to three hours to perform. It is done in a hospital, and then after a few hours the patient is moved to an outpatient facility. The patient stays under outpatient care for one to three days before finally being released. Pain can be managed with medication. During the first two to three weeks patients should abstain from smoking and strenuous activity. No showers are allowed for at least one week. Sexual intercourse can resume in four to eight weeks after the phalloplasty.

Personal Success Factors

A clearly defined target will help you channel your efforts in the right direction.

Personal success factors can vary from one person to the next, but those who are successful generally share certain attributes. If you have not yet attained success, then it may seem like those who have are simply lucky -- as if such individuals were born with those attributes. However, attaining personal success is possible if you follow certain strategies.

Define Goals Clearly

Successful people have clearly defined goals that they can see with their mind's eye, like the bull's-eye of a target. If you're struggling, then make sure you first have clearly defined goals; goals that are specific and measurable will keep you on track. People who keep changing their mind about what they want to accomplish or repeatedly abandon one project only to start from scratch on a new one usually end up frustrated. A clear goal is very specific.

Make a Plan

Make a plan as to how you'll attain your goals. Make both strategic plans and tactical plans. Strategic plans take the long view and embrace what you want to accomplish, say, in one year or five years, or longer. Tactical plans contain the nitty-gritty -- all the daily activities -- of how you'll reach those long-term goals.

Act Now

Knowing a destination and get there doesn't do you any good if you don't take action. Spending too long analyzing possibilities can hold you back. So the important thing is to choose a direction and start taking steps to make it happen -- right now.

Learn from Mistakes

Successful people may seem to breeze through life, but in most cases they have had their share of failures and disappointments. However, they possess the remarkable ability to forget their mistakes and pick themselves up and keep going. Emulate that behavior. Don't dwell on something that didn't work out well for too long. Get whatever lesson you're meant to get from a "teachable moment" and move on -- quickly.

Persist

The most important personal success factor is persistence. Those who succeed are those who decide that failure is not an option and keep trying until they do succeed.

Personal Goals & Career Development

It is relaxing and empowering to work at a career that is in harmony with your personal goals.

According to the humanist psychologist Abraham Maslow, we each have a hierarchy of needs ranging from basic physiological needs, such as food, to spiritual or creative needs, which Maslow dubs "self actualization." Primary physiological needs are the most urgent, but higher needs spur us each to realize our full potential. A successful career helps us to integrate our advanced personal goals, or the urge toward self actualization, with our primary goals of providing for our basic physiological needs by earning a living.

John Holland's Career Typology

According to psychologist John Holland, career choices are based on personality types. Holland identifies six fundamental personality categories: conventional, enterprising, social, artistic, investigative and realistic. We search for careers that fit our personality types, and people whose occupations fit their personality types are most content with their work lives. For these people, career development is a natural extension of personal goals.

Social Cognitive Career Theory

According to Lent, Brown and Hackettt's Social Cognitive Career Theory, we develop personal goals and follow career paths by means of a dynamic process that involves learning skills and identifying our own proclivities, and also discovering our own aptitudes. We receive positive reinforcement for skills and activities that come naturally to us and this process enables us to develop complementary personal and career goals.

Holistic Integration of Personal Goals and Career Development

According to the Career and Personal Development Institute, an individual's career will be most successful and satisfying if it meshes gracefully with his personal goals. Integrating these two sets of priorities is not simply a matter of finding the right job, but also evolving personally and professionally with that job.

Practical Skills

Although it is important to understand your personal goals and their relationship to the process of building your career, you must also develop practical skills to find a fitting career. Résumé writing and interview skills may be antithetical to your personal and professional predilections, especially if you are creatively inclined, but they will almost certainly be essential to the process of matching your personal and career goals.

Career Development Planning

Writing a career development plan is a process that can help you to define your personal and professional goals, and understand their relationship to each other. A career development plan includes educational goals as well as personal and professional benchmarks. Even if you do not write a formal career development plan, it is useful to have an idea of how you will achieve these important steps.

Periodontal Disease Symptoms

There are two types of periodontal diseases: gingivitis and periodontitis. Periodontal means "around the tooth," so all periodontal diseases involve the gums. They are caused by bacterial infections of the gums and the resultant problems of those infections.

Gingivitis is the mildest form of periodontal disease, but if left untreated it can progress to periodontitis.

There are several types of periodontitis with varying degrees of symptom severity. The most common types are: aggressive, chronic, necrotizing and periodontitis caused by systemic disease.

Predispositions

The different types of periodontal disease are more prevalent in some populations than others.

Gingivitis can affect anyone, and it is mainly a result of insufficient oral hygiene. It can often be reversed by improving hygiene.

Aggressive periodontitis occurs in healthy individuals, generally after they have progressed past gingivitis.

Chronic periodontitis can occur at any age, but it is more common in adults.

Periodontitis caused by systemic diseases, such as diabetes and heart conditions, generally occurs during childhood.

Necrotizing periodontitis is prevalent in individuals with suppressed immune function, including those with HIV and AIDS, those suffering from malnutrition, and those with any kind of immune dysfunction.

First signs

The first signs of a periodontal disease are bleeding, red or swollen gums. This is usually an indication of gingivitis, but it can appear in the early stages of the other periodontal diseases as well. Persistent bad breath, mouth sores and receding gums are all early symptoms as well.

Plaque

Left untreated, plaque will begin to grow beneath the gum line as well as above it. You cannot see it below the gum line, but once there it causes more bacteria to form. That bacterial growth can cause the gums to come loose from the teeth, form recesses in the gums and loosen teeth. Eventually teeth may fall out or have to be removed from periodontitis.

Gum Appearance

Some diseases affect your gums' appearance. Receding gums make your teeth appear longer, as the gum line has receded away from your tooth. Necrotizing periodontitis can kill gum tissue, leaving black or grayish spots where the gum tissue has died. The gums can lose the normal triangular shape where it follows the contour between teeth. It can swell and hang lower over the teeth, and it will generally have a rounder or bulging shape. Pus may drain from the gums or pockets formed by the gums.

Alignment

Periodontal disease can affect the alignment of teeth. This will be especially noticeable if you wear dentures or partials, as they will no longer fit properly. The teeth can shift and form gaps due to the erosion of the connective tissue of the gums and the teeth. The jaw bone can also lose density, which will make teeth loose and even fall out.

Perforated Colon Symptoms

A perforation or hole in the colon wall is an immediate medical emergency. The most common causes are trauma or infection; in some cases trauma can lead to an infection. The colon is an important part of maintaining the hydration status of the body. Any symptoms associated with a perforated colon should be taken very seriously. You should seek medical attention at once, as surgical repair is often needed to save the life of someone with this condition.

Purpose of the Colon

There are actually two colons, a large colon leading to a small colon. The job of the large colon is to absorb water and minerals from ingested matter. The small colon makes and folds waste for elimination. The walls of both are made of smooth muscle to move material along the tract. The lining is made up of selectively permeable cells that allow certain substance like water to pass but prevent bacteria from entering the body

Infection

With certain conditions like ulcerative colitis, the lining of the colon is eroded in places, allowing bacteria to infiltrate the tissue. In extreme cases, the bacteria can form a pocket that abscesses and perforates the wall. This results in an open channel for the microbes of the digestive tract to move into the abdominal cavity.

Trauma

Occasionally a normal, healthy colon is injured, resulting in a perforation or tear. This can arise in many ways from an impaling injury where a foreign object moves through the body creating a hole. It also can occur when the abdomen is crushed devitalizing the tissue creating many small perforations or leaks into the abdomen.

Symptoms

A perforation of the intestine is life-threatening, and your body knows this. Symptoms are severe abdominal pain, fever, nausea and infection. There are usually significant symptoms prior to a perforation though. Abdominal pain, nausea, loss of appetite and diarrhea are all signs you should seek medical attention.

Repair

If the intestinal wall is only weakened and not truly perforated, a lot of times medication and rest can repair the damage. If the intestinal wall is perforated immediate surgical repair is the only option. Following surgery, abdominal lavage, flushing of the abdominal cavity, may be needed. Powerful antibiotics prescribed by a physician should be taken as directed. Following all post-surgical instructions is vital, as the intestinal wall is still in a weakened state.

Perfect Diet For A Pregnant Woman

Salads are a great source of good pregnancy nutrients.

When you're pregnant, good nutrition becomes even more important. Some moms-to-be panic about everything from eating sushi to sipping lattes, but in general, common sense and your obstetrician's advice should carry you through. And incorporating these essential nutrients into your pregnancy diet will help ensure your baby gets the nutrients she needs.

Folic Acid

Eat plenty fortified cereals and breads, lentils, leafy greens and fortified orange juice, all of which are rich in folic acid, a key nutrient for healthy pregnancies. Folic acid helps reduce your baby's risk of developing serious neural tube defects that lead to spine and brain damage. It also plays a role in preventing preterm labor, reducing risk of low birth weight and minimizing risks of slow fetal growth.

The American College of Obstetricians and Gynecologists (ACOG) recommends getting 600 micrograms of folic acid each day.

Calcium

Make sure your diet includes yogurt, milk, salmon and calcium-fortified orange juice to increase your calcium intake. Calcium helps your developing baby build strong bones and teeth, as well as aiding in the development of the circulatory system and nervous system.

ACOG recommends getting 1,000 milligrams of calcium each day during pregnancy.

Protein

Eat lean meats, eggs, peanut butter and tofu to be sure your body is getting enough protein. Protein helps grow and repair cells, making it an essential nutrient for your growing baby.

ACOG suggests getting at least 60 grams of protein a day while you're pregnant.

Iron

Boost your energy and your iron levels by eating plenty of lean meats, nuts, spinach and tofu. Pregnant women need nearly twice as much iron as non-pregnant women to produce enough hemoglobin for your body's pregnancy-increased blood volume. Lack of iron can also leave you feeling tired.

ACOG recommends getting 27 milligrams of iron each day while you're pregnant.

Patient Information On Pessary Change

A pessary is a plastic ring or cube that is worn inside your vagina to treat fecal or urinary incontinence or a prolapsed uterus. If you wear a pessary, you will need to change the device from time to time.

Causes

Pessaries need to be changed if you gain or lose weight, as you age, if the shape of your vagina and reproductive organs change, or if your old pessary becomes worn.

Symptoms

If you develop pressure sores or painful areas inside your vagina, you may need a new pessary. You may also need to change your pessary if your incontinence symptoms return.

Considerations

Because there is no exact way to determine the correct size or shape of pessary for each woman, you may need to try several different pessaries before finding one that fits properly.

Types of Materials

When changing your pessary, your doctor may suggest that you use a different material such as latex instead of silicone.

Prevention

In order to care for your pessary and lower the chance of changing it, wash your pessary every few days with soap and water. You should also visit your doctor every few months to have your pessary checked.

Patient Financing For Medical Bills

The expense of medical bills

Medical bills are one aspect of your personal finance that you cannot control. When a medical emergency strikes, you must seek care, and you do not have time to shop for the best bargain. Even if you have medical insurance, chances are you will still be stuck with a portion of the medical bill. When this happens, sources are available for financing your medical bills.

Medical Bill Finance Companies

Companies exist that allow you to apply for credit to finance your medical bills. This is an option only if the doctor's office or hospital where you received your care is contracted with a finance company. If it is, you may apply for credit while you are at the checkout desk. Generally you get an answer back within several minutes regarding acceptance or rejection by the finance company. If you are approved for credit, you will begin making payments based on the terms allowed by that finance company. Once you are approved, you no longer owe any money to the doctor's office or hospital. Your financial obligation is to the finance company.

Interest Rates

Credit.com states that many of these medical bill finance companies carry high interest rates. This will depend on your credit score. The primary reason for the high interest rates is that the credit is unsecured. Unsecured credit indicates that the finance company has nothing tangible to repossess if you do not meet your financial obligation.

Regular Credit Cards

Credit.com advises that if you are going to use a form of credit, it might be better to use your current, lower-interest credit card. However, Kiplinger.com cautions against this practice. It reports that the credit bureaus look more favorably on medical debt than they do credit card debt. If you pay for your medical bill with a regular credit card, you still carry the debt but the credit bureaus no longer acknowledge it as medical debt. This can adversely affect your credit score.

Home Equity Loans to Finance Medical Bills

Kiplinger.com advises against using a home equity loan to finance medical bills. If you must default on your medical bills, you are safer to not have an asset such as your house tied to that debt. The medical debt is unsecured. If you are sued for default on the medical debt, you are not likely to lose your house in the process. If the medical debt is tied to your house through a home equity loan, you could lose your house if you default on the debt.

Other Solutions for Covering Medical Expenses

Both Kiplinger.com and Credit.com offer several tips for negotiating down your out-of-pocket medical expenses. All of your leverage for negotiation depends on your debt being tied to the health care facility. Once you finance it through one of the methods outlined above, your leverage is lost. Depending on your personal financial style, you may choose to utilize one of the methods above for patient financing of medical bills, or you may choose to try your luck at negotiating your costs down to a level you can afford without financing.

Patch List For A Yamaha Mo8

According to the MIDI Manufacturers Association (MMA), the most recognized feature of general MIDI is its predefined list of sounds, or "patches." The word comes from the early days of synthesizers, when physical patch cables were plugged into various sockets to send sound signals through different effects units. Nowadays, the whole process is replicated electronically. The Yamaha MO8 GM voice list is as follows.

1 to 42

The Yamaha MO8 includes a concert grand piano patch.

1 is ConcertGnd. 2 is Rock Brite. 3 is CP 2001. 4 is Honkytonk. 5 is E.Piano 1. 6 is E.Piano 2. 7 is Harpsicord. 8 is Brite Clav. 9 is Celeste. 10 is Glocken. 11 is Music Box. 12 is Vibes. 13 is Marimba. 14 is Xylophone. 15 is TubulrBel. 16 is Dulcimar. 17 is Draw Organ. 18 is Perc Organ. 19 is Rock Organ. 20 is ChurchOrgn. 21 is Reed Organ. 22 is Accordion. 23 is Harmonica. 24 is TangoAccrd. 25 is Velo Nylon. 26 is Steel. 27 is ModernJazz. 28 is Clean. 29 is Mute. 30 is Overdrive. 31 is Distortion. 32 is Harmonics. 33 is Acoustic. 34 is FingerBass. 35 is PickBass. 36 is Fretless. 37 is SimpleSlap. 38 is FingSlp SW. 39 is SynthBass1. 40 is SynthBass2. 41 is Violin 2. 42 is Viola 2.

43 to 85

43 is Cello 2. 44 is ContraBas2. 45 is TremoloStr. 46 is Pizz. 47 is Harp. 48 is Tmpni+Cym. 49 is StereoSt1. 50 is StereoSt2. 51 is Grand Saw. 52 is SynString. 53 is Aah Choir. 54 is Ooh Choir. 55 is Syn Voice. 56 is Orch.Hit. 57 is Trumpet. 58 is Trombone2. 59 is Tuba. 60 is MuteTrpt. 61 is F.Horns. 62 is Brass Sect. 63 is SynthBrass. 64 is SoftBrs GM. 65 is Soprano. 66 is Alto Sax. 67 is TenorSax. 68 is Bari Sax. 69 is Oboe. 70 is Eng.Horn. 71 is Bassoon. 72 is Clarinet 2. 73 is Piccolo. 74 is Flute. 75 is Recorder. 76 is Panflute. 77 is Bottle. 78 is Shakuhachi. 79 is Whistle. 80 is Ocarina. 81 is Square Ld. 82 is Saw Ld. 83 is Caliop Ld. 84 is Chiff Ld. 85 is Charan Ld.

86 to 128

86 is Voice Ld. 87 is Fifth Ld. 88 is Bass&Ld. 89 is New Age. 90 is Warm Pad. 91 is Poly Synth. 92 is Choir Pad. 93 is BowedPad. 94 is Metal Pad. 95 is Halo Pad. 96 is Sweep Pad. 97 is Rain Pad. 98 is SoundTrack. 99 is Crystal. 100 is Atmosphere. 101 is Brightness. 102 is Goblin. 103 is Echoes. 104 is Sci-Fi. 105 is Sitar. 106 is Banjo. 107 is Shamisen. 108 is Koto. 109 is Kalimba. 110 is Bagpipe. 111 is Fiddle. 112 is Shehnai. 113 is Tinkerbel. 114 is Agogo. 115 is Steeldrum. 116 is Woodblock. 117 is Taikodrum. 118 is MelodicTom. 119 is Synth Drum. 120 is Rev Cymbal. 121 is Fret Noise. 122 is BreathNoiz. 123 is Seashore. 124 is Tweet. 125 is Telephone. 126 is Helicopter. 127 is Applause. 128 is Gunshot.

Parade Of Lights Ideas

Lighted boat parades provide holiday entertainment in many waterfront towns.

A Parade of Lights has become a staple of many waterfront communities' holiday seasons. The Parade commonly features a lighted boat procession through a local harbor or river, although land-based Parades of Lights also exist. Boats of all sizes are generally welcome in harbor Parades. Boat owners, yacht clubs and community organizations create colorful light displays often powered by onboard generators. More sophisticated displays are computer controlled, and feature character animation or constantly changing scenery. Does this Spark an idea?

Themed Boat Displays

Consider a themed Parade of Lights in communities with many recreational or commercial boats. Themes include holiday movie characters, traditional holiday scenes or sea creatures dressed for the holidays. Boat crews often enhance the lighted displays by dressing as characters reflecting the boat's theme. Onboard sound systems pipe holiday music as the boats slowly proceed around the parade route. Shipboard refreshments put the parade boats' crews in a festive holiday spirit.

Marine Business Competition

An active maritime business community may seize the opportunity for a friendly Parade of Lights marine business competition. Ask staff from marinas, boat maintenance firms and rigging companies to band together, with each group creating a parade entry aboard a staffer's boat. Waterfront-area restaurants and cafes represent other parade entry prospects. Offer winners' trophies, a pre-parade buffet lunch for participating crews and free publicity that helps support the city's maritime district.

Parade of Lights Benefit

Parade of Lights events provide opportunities for parade entrants, and the viewing public, to support a local charity. In Venice, Florida, for example, a registered non-profit group organizes the boat parade. The group solicits sponsors to underwrite expenses, with proceeds dedicated to youth-oriented boating activities. Sponsorship potentially offers tax benefits, if applicable. Even without these benefits, Parade of Lights organizers can support a community-based charity through event registration fees. Parade viewers can vote for favorite entries with small voluntary donations.

Business Sponsorships

Use the Parade of Lights to promote sponsoring businesses and create a cohesive city business community. In Marina del Rey, California, for example, businesses sponsor Parade of Lights banners that appear on city streets for eight weeks prior to the boat parade. Banners publicize the Parade of Lights event, and prominently display the sponsor's name, as well. This sponsorship connection showcases each business's civic pride to residents and visitors alike.

Panniculectomy Vs Tummy Tuck

Panniculectomies and tummy tucks are both major surgeries and are often confused because both procedures involve the removal of fat and both target the abdomen, but they are two very different procedures. A panniculectomy involves the removal of excess skin and fat; whereas a tummy tuck involves the removal of fat and tightening of the abdominal muscle. These procedures are often combined or performed with other abdominal surgeries.

Misconceptions

When comparing the procedures of a panniculectomy and tummy tuck, there is a significant difference between what they aim to accomplish. Most people considering these surgeries are obese, have lost a massive amount of weight, or suffer post-pregnancy issues with excessive fat centered below the belly button. A tummy tuck, like a panniculectomy, involves the removal of excess skin and fat, but during the tummy tuck procedure the abdominal muscles are tightened. A panniculectomy only removes tissue.

Candidates

Candidates for a panniculectomy may have fat extending as low as the knees, over the hips, and around the back, which pose a number of health issues. Back problems, tissue breakdown, rashes or ulcers are just a few of the conditions that panniculectomy candidates can suffer from. These conditions can make performing everyday functions such as walking, standing, or sitting very difficult. The best candidates for a panniculectomy have maintained a stable weight for at least a year and must be following a diet and exercise regimen. The ailments for tummy tuck candidates are less severe and the procedure is more often performed for aesthetic purposes. Tummy tuck candidates are in relatively good physical shape, but have excess skin or fat in the abdominal area that is resistant to exercise because the muscles have stretched beyond the point of natural resiliency.

Procedure

A tummy tuck starts with an incision across the abdomen, along the pelvis just above the pubic area. A second incision is made around the navel to loosen surrounding skin. The skin is then separated from the abdominal wall. The surgeon will then stitch the underlying abdominal muscles into a firmer position, creating a smaller waist. Excess skin and fat are removed and the remaining skin is repositioned over the abdomen and sutured into place. A new opening is then created for the navel.

In a panniculectomy, the surgeon makes two incisions. The first is a horizontal incision that runs from hip to hip where the excess fat and skin can be gently removed. The second is a vertical incision from below the sternum to the pubic area. After the removal of excess skin and fat, the remaining skin is pulled firmly and stitched together. The length of time for both these surgeries to be performed is determined on a case by case basis. On average, patients for both procedures can expect their operation to last two to five hours.

Healing

The healing process is essentially the same for both panniculectomy and tummy tuck procedures. They are both major operations, so a considerable recovery time should be expected. Patients are often fitted for a body wrap or garment post-op that has to be worn at all times. To ensure a successful recovery, your doctor should provide a complete list of postoperative instructions to follow and medication for pain and to prevent infection. Swelling, bruising and pain are experienced in the first few days and should decrease as time goes on. Patients should refrain from engaging in any physical activity for several weeks during the healing process. Stitches will generally be removed in a about week and most patients can return to normal activity in three to four weeks. It may take several months for the results of either surgery to become apparent.

Risks

Complications can occur after any major surgery, but they can also be avoided or minimized, if patients follow the doctor's orders. The risks included in both panniculectomy and tummy tuck procedures are:

Infection

Bleeding

Excessive scarring

Fluid collection (seroma) in the newly created abdominal space

Blood clots in the leg or lungs

Revision surgery

Pain Relief For Pregnant Women

A bundle of joy is often accompanied by pain.

While pregnant, you'll encounter a number of aches and pains that you've never experienced before. From a simple backache to stomach cramps and muscle contractions, you'll find that you're often plagued by pain in some form, and desperate to find a way to stop the pain. Unfortunately, while pregnant you are limited to the type of drugs that you can take, however some are safe. Besides medicine, you can find other pain relief that soothes your aching body during a transitional and stressful time in your life.

OTC Medicine

If you are the type of person who automatically reaches toward the medicine cabinet when pain hits, then you should know which types of over the counter medicines are appropriate for use by a pregnant women. While you may trust ibuprofen, aspirin or naproxen when you have pain while not pregnant, you should know that these medicines are not advised for pregnant women to take. The contain NSAID pain relievers which can be dangerous to an expecting woman. Instead, stick to acetaminophen and follow regular dosing instructions. If your pain does not subside, talk to your doctor about prescription medicines that you can potentially use.

Heat and Massage

Using heat and massage are two ways that you can avoid taking medication while you're pregnant. While very hot temperatures are generally not advised, as they can dangerously raise your core temperature, heating a bathtub or shower to 100 degrees and below is fine. Make sure that you take breaks every ten or twenty minutes to give your body a chance to cool off. A whirlpool tub can be very relaxing for back and leg pain. If you'd prefer a massage, look into a masseuse that specializes in prenatal massage. They have special tables built to accommodate a pregnant woman's growing body so that she can enjoy pain relief in comfort.

Nutritional Supplements

When pregnant, you may experience crippling leg cramps in the middle of the night, and can have lasting side effects for days afterward. This is caused by a potassium deficiency. Potassium regulates muscles contractions, which means if you are not getting enough, you can experience painful muscle spasms which most often occur in the calf muscle. Making sure to have adequate nutrition through a balanced diet and nutritional supplements is important to relieve that middle of the night pain. Your doctor might also prescribe a standalone potassium supplement to ward off that cramping. If it does happen, make sure to begin massaging your calf muscle immediately to relax the muscle so that you can go back to sleep.