#a friend of mine posted on her facebook page about the importance of pain management in dog behavioral problems
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creekfiend · 4 months ago
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I used to get an arguments on facebook and it bit me in the ass enormously because it turns out that when you get an arguments on facebook habitually, you'll be interacting with a lot of other people who get an arguments on facebook habitually, and most of these people are deeply unpleasant and they will be super mean to you in really fucked up ways. so for a couple of years I just sort of dropped off ever interacting with anyone who said things that I did not agree with. I would just scroll past stuff or I would get upset about it privately and move on. I did not ever engage. and the last couple of weeks I've started being able to say things in response to things I don't agree with in ways that I feel lay out what my perspective is but do not get overly invested in "winning" or "proving" anything -- I will say my piece generally for the benefit of other people who might be reading the conversation and need to hear what I have to say. and then I will turn notifications off and go do something else.
anyway. wow. y'all heard about this? pretty cool shit.
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sunnytears · 7 years ago
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a definitive post of my first year of university
I’ve been meaning to write this post for some time, mainly because I wish someone told me these things before I started my post-secondary education:
ACADEMICS
- invest in a good planer, 4-month calendar, or even a whiteboard. I hung up a plain whiteboard and prioritized everything I needed to be done for the week and any deadlines for major assignments. I also had a little spot for my hours for work and any other important dates!
- Google Docs!!!! I used this for all of my notes for each class, and it’s absolutely great for notes and assignments/papers. I even have some shared documents with my friends that way we can all edit our notes (which is great if you can’t make it to class - more on this later). Another pro if using Google Docs is that if you accidentally close your browser (like I have way too many times), everything is saved and can be accessed from any device. 
-  PLEASE TRY go to all your lectures! Sit near the front and maybe get to know the people who usually sit around you, they might become a good friend and can help you out with the coursework.
- To be honest, I didn’t really do a lot of course readings. Most of the time, I didn’t even buy the textbook. It honestly really depends on the course and how heavily your professor bases the course on the textbook. I had one professor require us to get the textbook (”required” doesn’t mean necessary) because she asked us to source it in an assignment. $85 later for one of the most poorly written textbooks ever which came with something about archaeology (???), I found out that it was them, in fact, who WROTE the textbook and just wanted some extra cash. TL;DR, try to determine if a textbook is really necessary for your course, and if it is, you can probably find it online or buy it used from an upper year student 
***TIP: My university has a buyback program where you can sell your textbooks back to the school and get cold, hard cash. I bought a calculus textbook from an upper year student for $50 (new ones cost ~$200), but I ended up finding the whole thing online. I sold the hard copy back to the school and got $100!! 
-  I really haven’t used Facebook since 6th grade (lol) but it’s SO amazing for university. Almost all of my courses had a large group chat that was extremely helpful, especially for calculus. My whole class of 2021 even had a Facebook page, AND there was a popular school-wide page where people could ask anonymous questions (all of are filtered and are mostly people confessing their love for strangers and memes, it’s great). 
- It’s SO okay to expect your marks to drop. DO NOT BE AFRAID OF FAILURE. EMBRACE IT. ACCEPT IT. WORK HARDER.  I have had courses where I have failed multiple midterms and still manage to pass. You’re going to be just fine.
PERSONAL
- First-year teaches you a lot about yourself more than anything. I learned so much about how to take care of myself and about what makes me strong. 
- PLEASE make me a promise to me to look after yourself mentally and physically. I’m fortunate enough to still live comfortably at home and commute to school, so I wasn’t really eating off ramen and Tim Hortons all year (although I regularly indulged in french vanillas), but there are relatively healthy and cheap alternatives if you look for them (discount groceries stores, or stocking up if/when you go home to visit). Since I’m an undergraduate student, I get a free 12-month membership to my university’s gym and pool, however, I didn’t take much advantage of it since I was usually exhausted after all my classes (and I hate going to the gym lol). 
- One thing that I found out this year is how to start managing my mental health. I started to really struggle with stress and anxiety throughout my senior year of high school and finally started to see a naturopathic doctor (who conveniently was a short bus ride down the street from the university, three cheers for free university bus passes). We’re still trying to get all my pills and tinctures sorted out, but it’s a start. My appointments are quite costly, but there are always alternatives on campus. My campus actually has a naturopathic doctor, but I won't be switching any time soon. There is usually mental health counseling available and plenty of people to offer you help. 
- Take frequent breaks to avoid burnout. Don’t feel guilty for grabbing some food with your friends or just having a relaxing night with Netflix or listening to music; whatever makes you happy! University can be stressful, and everyone is in the same boat. My university offered great coffee night events or even de-stressing events, which was super great. TAKE CARE OF YOURSELF!
- This past December, I went through having to cut off some people I loved the most, one being my now ex-boyfriend who I had been seeing for just over 3 years. It was by far one of the most painful experiences I had to go through. Just remember that everyone and everything is prone to change, and you might feel EXTREME guilt like I did when breaking things off, but just really think everything through and give yourself time to heal. Be thankful for the learning experience and remind yourself that you can get through it, it just takes time. You might feel lonely at times like I did, but hey, I met one of the greatest people while I was slightly intoxicated at homecoming, and another while getting lost on my way to a tutorial. 
- Live a little, experience new things and new people. This is the time to do so! Go to those coffee nights, JOIN THOSE CLUBS AND TEAMS, read your school newspaper, explore the surroundings of your university and the city. There really is a place for everyone.
- Be safe at night around your campus. I had to commute home at night by myself which can get kind of spooky. I always had my phone charged (invest in a good portable charger, and keep it charged) and called a friend on my walk home from the bus stop. Some campuses, like mine, have a walk-home system where a volunteer can accompany you on your walk or commute home just so you’re safe!
- Develop a good support system. For me, that came sort of naturally. After my break up, my parents got into more of a habit of telling me that they’re proud of me, and my friends naturally rallied around me. Nothing feels better than telling your mom you passed calculus and having her hug you while you both cry tears of joy, or having your friends tell you how proud they are of you. Developing a supoprt system takes time, as does everything. People come and go, but that is no reflection of who you are. You are always going to have you, so make sure you look after yourself.
I really can’t think of much else right now, but if you’re reading this, and have any questions at all, please don’t hesitate to shoot me a message. University/college is an exciting time of life. Remember, everything you endure builds character. Best of luck kid, you’re gonna kill it. Oh, and if no one has ever told you: I’m so proud of you, I love you, keep going, you can do it.
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drferox · 7 years ago
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20 Questions with Dr Ferox #21
Looks like it’s time for another round of 20 questions and comments. I’ve tried to tag you all again, but if you asked on Anonymous I have no way of tagging you.
Anonymous said: Do you prefer treating certain animals over others? I'm friends with a few vets and I know one who's pretty much specialized in cats and another who can treat most companion animals but has a strong preference for dogs (good thing dog vet was out hiking with cat vet when cat vet's dog got a face full of porcupine quills lol) .
I do have a preference for cats, we just seem to come to a better mutual understanding, and I'm very softly spoken in person so the cats are less inclined to panic. I used to get along well treating cattle for some reason too, but I'm pretty exclusively in small animal practice these days.
Anonymous said: Does your clinic have a Facebook page? If so - how would you feel if clients posted pictures of their pets to it? My vet recently got my rat through a tough injury and I'd like to post a picture of her now that she's all healed up, but I don't know if that'd be weird or if any of them would even see it.
We love it when it happens. Happy pets with a nice comment on our Facebook page is always welcome. Sometimes we let people email us photos and we post them for us too.
Anonymous said: I know is Aus we're usually told to take injured wildlife to our local vet. Do you mind it, or should they be taken somewhere else instead?
It's perfectly fine for triage, but if somebody brings in an endangered species with a reasonably good prognosis, we'll often recommend it goes to a better equipped clinic for that species. Note very clinic has UV lights for turtles, for example.
Anonymous said: Hello, many years ago I lost my chihuahua to a broken back which I believe stemmed from him jumping onto our couches and beds so often. The experience was very traumatizing for me but now I have another chihuahua who jumps often and I don't often take him to the vet so I was wondering if it is common for smaller dogs to hurt themselves from jumping so often?
To actually break the back would be unusual, but slipping an intervertebral disc so that it prolapses up into the spine is relatively common after jumping off things in tiny dogs.
@justaphage said: I've been wondering about probiotics (this is not a question about the health of my dog, she's getting treatment). Multiple times (and with two different vets) when my dog had diarrhea they gave us a probiotic along with the dewormer or antibiotic and I've been thinking: my doctors never prescribed or suggested that when I'm sick in a similar way. Is there some difference in what we know about dog/human probiotics or is it just a difference of the culture of medicine.
It's probably more a culture of medicine than anything else, but also probiotics are kind of wishy-washy in terms of clinical evidence. There's some evidence to say they're sometimes very useful, but other times not so much. Keep in mind though that dogs are also much more likely to eat poop from other animals and so will be picking up all sorts of intestinal microflora.
Anonymous said: I came across your weed toxicity post for pets and had a question: a friend of mine recently told me he got weed extract for his anxious rescue pet (can't remember if it was a dog or cat) but prescribed by a veterinarian I didn't ask him more about it because I was too confused at the moment, knowing that weed does not have the same effects on dogs and cats as it has on people. do you think this is legit or was he bullshitting me?
It's hard to know, especially given that I have no way of knowing which country you're in, or what your laws in relation to marijuana are. Certainly there are some veterinarians working on cannabinoid extracts with known concentrations and milligram dosages, but if I was told this locally I would be extremely skeptical.
@fallowsthorn said: On the "cats don't usually get round tumors" thing - weirdly enough, our cat has a bunch of them. Our joke is that he gets a new one every time he goes to the vet, because every single time, the tech says something to the effect of "well this isn't normal for cats but...." They're just little bumps of fat, they don't grow, and he doesn't poke at them or seem in pain, but he's got like twenty of them by now and it's super weird.
It is super weird. Cats usually get inflamed fat rather than fatty tumors, but there's always somebody that does things differently.
Anonymous said: Hey Dr Ferox! I'm just asking purely out of curiosity, have you ever had a kitty patient come in with an aural hematoma?
I have once, but I can't remember whether it had been in a fight or had an ear infection, or both. We treated it surgically, the same way as a dog.
@daedricprincessxoxo said: I've decided to start as a technician before becoming a veterinarian, after a CVPM at a big-deal hospital told me how much she recommends it. After ages of financial constraints, I finally began the course to become licensed!! I'm to excited not to share!!!
That is very exciting and great to hear. Best of luck with all of it.
@insatiable-obsession said: Hi I love your blog! It's so informative and real, and I'm trying very hard to get into the vet world (unsuccessfully applied to several vet clinics and hopefully going to vet tech school next year!) I was wondering if you have any advice or opinions on zoo work/zookeeping? Also to give you a fun break from all the vet questions, do you prefer: sunset or sunrise? Camping or going to the beach? Christmas or Halloween? Pen or pencil? Sweet or savory?
I really don't do much with zoos and prefer not to analyse them too much through a veterinary lens, because I want to keep them as something fun. Like everything else in life zookeeping is possible to do very well, and possible to do very badly. You could pop across to @why-animals-do-the-thing for more zookeeping connections.
Anonymous said: I'm so annoyed right now. So ever since my friend got a dog we were trying to get them to get him fixed (her dad who's totally hyper masculine is against neutering) then they got a girl dog and refused to get her fixed (we convinced the mom but not the dad). They tried to rehome the girl earlier in the year and until tonight they've refused to get one of them fixed. Tonight the girl had 9 pups and it's the only thing that convinced them to get her fixed (after she's done nursing) They also are keeping one of the male puppies. The dogs go out on a cable because they don't have a yard. The dogs are big too they're an staff bully breed mixes.
I don't know what to tell you Anon. It's a poor situation for those animals to be in, but I can't tell you anything to make it any better, and as long as their minimum welfare standards are met, the animals can't be seized.
Anonymous said: I am considering harness training a new cat. I have only indoor cats. If I allow my new cat out in a harness will I need to do anything different for care of my indoor cats, because all the cats will be in contact together at home. My indoor cats are up to date on their rabies and distemper vaccines, do they need anything else? 
You should call your own vet about what concerns are relevant locally. You are very clearly not local to me and I cannot give you specific veterinary advice, but I suspect parasite control is going to be important for your cats.
Anonymous said:What do you do if your pet dies at home? Like with the body?
Depending on where  you are, you can have the option to bury your pet at home, or you can arrange burial or cremation either through a vet clinic or a pet crematorium directly.
Anonymous said: I have a 3.5 month old kitten and he occasionally like tries to eat litter? i use a clay bases non clumping litter and i move him away whenever he starts but like? Could there be a medical reason? Is he just weird? Were taking him to the vet soon to be neutered and im going to ask them then. Thank you!!
There is no way for me to tell whether your kitten it eating litter because it has a nutrient deficiency, an abnormal behavior or is just chewing on things with a novel texture. Hope your vet visit goes well.
Anonymous said: Hi, not sure if you can help, but figure it's worth a shot! I'm in my parasitology class and I'm having the hardest time keeping the Spinose ear tick and the ear mite straight in my head due to their extremely similar scientific names(otobius megnini and otodectes cynotis respectively) and both residing in/around an animals ears, can you offer any advice?
Sorry I don't have any advice for you, other than O. megnini being an overseas parasite and not one I have to deal with.
Anonymous said: I came across your blog while having a nasty bout of heartburn and I got to wondering: can animals suffer from acid reflux or have symptoms similar to GERD in humans? If so, do you know of any cases or treatments?
Small animals can also suffer acid reflux and subsequent oesophageal ulcers. It's particularly common in brachycephalic dogs. There are a variety of potential predisposing causes, some of which are managed medically, but some require surgery. Hiatal hernias are a good example.
@softlyfiercely said: Am curious re: your thoughts on a childhood memory. We had snails in our yard growing up (southwestern USA) and we loved them. My brother & I fed them lettuce & built them little stick-and-leaf villages. Once we brought one inside to show a family friend. He dropped it. Its shell cracked & it looked in bad shape. We were distraught and begged mom to bring it to a vet. She did not. But would a vet have been able to help? How do zoos care for endangered snails? Can snail shells be repaired?
Some clinics equipped for exotics can and will treat snails, but not very often. It's possible to repair small areas of damage to the shell, so long as the body has not been damaged and does not come into contact with any glue or compounds used.
@malted-shark said: Just wanna' say. Sardine sounds like my Basil at the vet. He has aggressive on his chart and they legitimately have to launch a liquid sedative in his mouth. I wish I was kidding. I wish he wasn't such a nightmare at the vet. He's like that at home sometimes too. Particularly, he doesn't like it when things aren't done EXACTLY to his liking and don't dare try to restrain or hell is to be paid. I just let them handle it, I get scared of him.
With cats like this, sometimes all you can and should do is sedate them for an exam. It's stressful for the cat and dangerous for the handler otherwise.
@peaceofpuregold said: As a primary human to two feral (currently not so feral with a lot of patience, training, and good luck in the mix) can confirm at least 70% of the feral cat escape phrases. All I was missing were the washing machine related ones. I might use this to make a bingo card.
If you do make a feral cat bingo card, let us know!
@hesmyboi said: Came for Trashbag, stayed because I adore animals, I like your style, and I'm having fun learning about veterinarian stuff
And we're very pleased to have you here with us. Thank you.
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kriskonfesses · 7 years ago
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Just a little change... 1/1
20 (give or take) years. That, my friends, is how long it takes for a bunch of scientists to discover the genetic issues that cause a disease and for a treatment of any kind for the disease to be released (other than just treating it symptomatically). Well, in my case. My entire life can be summed up in a similar number of years. My mom always told me that they had pinpointed the exact chromosome that was malfunctioning in people with SMA right before I was diagnosed.  Now, I finally get to do something about it. So, here I’ll keep my progress of the treatment I’ve been panicking/searching/drooling over for the past four months. A little more than a year ago Spinraza, the first ever gene therapy for SMA, was FDA approved and tomorrow I get my go at it. December 2016 I’m sitting on the bed in the guest room of my dad’s new house. It’s the day after Christmas and I have a sore throat (that eventually ended up in the ICU, save that for a later date). I’m flipping through posts on facebook when I came across a peculiar post on a rare piece of magic... well, sorta. It may be science but it seemed miraculously exciting. A drug called Spinraza which would stop the progression of my disease and was very expensive. That was of all I knew and all I wanted to know at the moment. I called each person in the house to the room one at a time and told them and none of them seemed very cheerful about it. I couldn’t understand why no one felt the way I thought I should feel. And they had a point. It wasn’t a cure. It’s almost a million dollar treatment. It’s done every four months for forever. There is no promise to gain strength. It’s a needle going into your spine. I could go on... And for us, we didn’t know much about the result, but I always held hope a little in the back of my head. I gave up and decided to wait. I heard insurance was hell to get through. Yet, my muscles have gotten weaker... My already painfull major depression just made everything suck, everything sucked. It had been sucking since my pneumonia. Nothing would change what has happened to me, but my mindset needed the change. That's when I realized I had stopped seeing my therapist since pneumonia and I really needed one. I called her back up and the results were amazing. My panic attacks have literally gone from twice a day to once a week. Then, I got the other important thing that helps with depression: Meds? No, sun. I took a cruise. I felt so relaxed and away from my troubles and it was great. I know I seem a little off track right now but stick with me here for a sec. Around this time I got an invite to a Facebook group about Spinraza. I started seeing all these wonderful stories about babies and toddlers. They were breathing without the need for support, crawling, sitting up, and walking on their own. The joy of knowing that these kids would never have to grow up going through the trials I had to was priceless. Nowhere near as many hospital visits, no missing learning important things in school like tying your shoes because you had PT, no difficult special ed bus drivers, no missing field trips or field days.The families would save some pain in the process, too. Maybe this would prevent some siblings from having to go to therapy. Maybe it would even save some marriages. I know having children with disabilities can be a heavy load for parents to carry. Although I know my own parents had their unrelated reasons for divorce, it still stung to think that my disease didn’t help the matter.  While reading and wading through emotional stories, I learned children weren’t the only ones noticing changes, even though these changes in adults were never promised. I heard stories of people who could lift a cup or open a lid. These things may seem minuscule to the vast majority of people, but they can be huge to those who have no way to care for themselves. You don’t ever understand fully until you have to ask others to do everything for you. I heard people were talking clearer. It has always been a fear of mine to lose the ability to speak clearly as it is the only form of control I really have. Just the thought of not having to lose my voice or my already weak ability to pick things up is exciting. And honestly, that right there is the reasoning behind getting this treatment. So I started. My very first step is to research as much as I possibly could. Learning about the procedure, the side effects, and the expectations is very important. I read thousands of comments and questions on the Facebook page and read as much on the official website as I could. I didn’t want to go in and be blinded by complications, so I tried to find a way out of all the problems before I even started the process. Unfortunately, for a person with panic disorder this severe, this caused a lot of stressing about things I never should have had to worry about, to begin with. I also learned every situation is vastly different. When I came across a person in the same state with the same insurance I have, who kept getting denied, I instantly thought I would be in the exact same situation. Turns out I was wrong and I spent a month worrying about it. I can always be counted on to overthink things. My next hurdle revolved around the location of the treatment. While Austin isn’t behind the times when it comes to medical facilities, it is nowhere near the largest or most medically advanced cities in Texas (Texas has 3 of the 10 largest cities in the country in it and Austin certainly isn’t one of them, even though it is the capital). Since at the time Spinraza hadn’t even been out for even a year and the cost was such a large risk, very few places were willing to administer the drug. I pretty much had two options, Dallas and Houston. I looked into Houston and found a place but they wouldn’t take my insurance (aka Government insurance) because of something called “Buy & Bill”, which pretty much means my insurance agrees to cover it as long as the hospital pays for it initially and then gets reimbursed. Obviously, it isn’t the ideal situation. Someone said that university hospitals tend to agree to “Buy & Bill” more often and one of the doctors I was told to look into was at the University of Texas Southwestern in Dallas. When I finally scheduled I had to wait about a month until my appointment. I brought the partially filled out Start form with me and was prepared to start with no idea what the wait time was. I had heard people waiting anywhere from seven months to a year. I got assigned my Family Access Manager about two weeks later. He came out for a meeting and went over everything. Most of this I had already known from my tedious research. He told me that it was my job to be proactive. Implanting myself like a thorn in the side of the doctor's office I fought for speedy results and proved myself a worthy self-advocate. After a couple of months, I received one of those annoying insurance calls where a machine says something to the effect of “blah blah blah your request for a nonformulary prescription has been approved blah blah blah.��� I was having a lot of insurance issues at the time, but the call eventually said “if you’d like to know the name of the prescription press 1″ and that is how I found out I was approved for Spinraza. There were still things to do before I could schedule. I had heard something called a Hammersmith test was required to be done by a PT to get approved, but I had been approved without it. Similarly, a CT scan was required to find an opening. The procedure is called a Lumbar Puncture. It is a process of injecting a needle between the vertebrae of the spine to pierce the neural foramen, withdraw 5cc of spinal fluid, and inject 5cc of Nusinersen, or Spinraza. Commonly people with SMA suffer from Scoliosis and require rods to be put in to straighten the spine. When this is done bone grafts are put in to help keep the spinal rods in place. This is a problem because the spaces between the vertebrae are covered by bone grafts leaving no way to directly access the neural foramen. There are multiple ways around this. They can go into the cervical spine (the neck), which is above the rods, but that can be dangerous as there are many important nerves and it is dangerously close to the Spinal cord. They can add a window. This means they perform surgery and cut a small square of bone out of the way. But, all surgeries have risks like infection or respiratory issues related to the chronic lung problems associated with SMA. Choosing the correct fix truly depends on the patient. While I called multiple times to schedule a CT scan, I was finally told that all of that would be handled the day of the first injection. The last thing to do was schedule my first procedure and prepare to make the long journey to Dallas. I don’t know what my results will be and I certainly won’t stop until I try. To be continued... Written 1/10-1/13
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writingandwands-blog · 6 years ago
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Returning to the Wand
Okay, so, it’s been a long while since I’ve done anything on this page, but I’m planning on changing that very soon. My social media presence isn’t as important as being out in the real world, but I realized a few tips from other social medias (Facebook, Instagram, Twitter, etc) needed to be addressed here. 
So! Here’s to returning to wands!
Writer’s block when it was cool painful
Writer’s block is a very unfriendly beast, yes? Though it is hard to overcome, there are many ways to do so. In fact, here are some real world tips on how to regain your creativity. 
1. Follow the comedians.
Did you know that almost all of the jokes comedians tell are from what they see, hear, and experience in the real world? Yeah, crazy right? The funniest moments in life are the moments when your family or friends are being their straight up natural selves. That’s the same way it is with writing. When you want to write an amazing scene, think back on a similar scene from your own life. If you don’t know how to write a textbook romance or the perfect date, then don’t. Nothing is better than being real and raw with your character’s emotions. Just because they don’t have real memories, don’t think that you can’t make them relatable to your audience, or yourself. Sometimes the best way to entertain is to follow what really happens. 
The example given is only a snippet of what happened when my step-brother, mother, and I all went to a doctor’s appointment when my mother had broken her ankle. The whole ordeal was actually hilarious, thinking back on it now, but I toned down the silliness to show how it could potentially be twisted into a more serious tone.
The waiting room was small, tiny even. The overstuffed chairs and once plus carpet looked out of place, and overwhelming. Her gaze landed on his, and the two shared a soft smile, the skin around their eyes crinkling with laugh lines. After a moment, another woman appeared, and the trio sat down, the first two on a yellowing faux velvet love seat, and the older woman across from them...
2. Go for a walk
Now I know, my other posts have told you to go outside and enjoy nature, but I really, truly believe that this is important, and that many people tend to forget that it’s important. So many people post pictures with gorgeous foliage and amazingly adorable animals on Facebook and Instagram. Use them to your advantage! If you’re wishing to have your readers have an image painted in their minds, use descriptive words. This example is from the time I was walking through my neighborhood, and a woman was jogging by.
There she was, sapphire orbs with tiny suns illuminating from her pupil, olive complexion drizzled with sweat, and hair that matched the auburn leaves falling from the trees around us. The tank top was seamless and midnight, it covered her soft mounds, but tightened around her slim stomach. Plum yoga pants clung to every curve of her legs, and pronounced each gentle ripple of muscle..
3. Social media itself.
There really are a lot of ridiculous people in the world. Some people prefer to never hide their crazy, while others tend to keep it behind closed doors. Among my social groups, the former tends to be more prominent. Friends of mine have been known for drama, and a couple of old acquaintances found their way into the world of drugs. Watching it all unfold on social media allowed me to write my own short story based on how drugs can tear apart families. While I do not always indulge in this sort of opportunity, I do want to note that sometimes, even the worst types of stories can be found in the real world. The example given here is only a snippet of my own personal work, and it discusses the end of a relationship due to drugs. 
 ...One last tear escaped her eye as she caught his. The pain and suffering was almost too much for her to handle. She winced and stepped out, the door falling loudly behind her. He stood there, not allowing himself to crack in her presence. However, as soon as the door was closed, the floods came. Falling to his knees, he cradled his head in his hands. After a while, he sat back on his haunches and stood up. Moving to the coffee table, he picked up a trashcan and wiped the powdered lines into it. "Goddammit."
4. Write a letter.
This has to be one of the hardest things to do on this list. I’ve written three letters to other people since I’ve been writing, and it has helped me in general. What the gist of this is, is to write a letter to someone, anyone, that has hurt you or helped you in some way, or someone that you just know. Allow yourself to be raw and real, even if it’s painful, show the pain through the words you’re conveying to the receiver of the letter. Find ways to show that you’re crying or laughing or smiling so brilliantly, you’ll have laugh lines before you’re 25. The three I wrote were to: myself, an ex, and a bully from elementary school. In that order. However, this example will be less about myself and those who have wronged me, and more about someone who has always been there for me. 
Today the wind whipped around my head, and a memory of you came crashing through my mind. It was a chilly December night, and you have me go outside and twist the antennae for our television. The Simpsons were on, and you didn’t want to miss a single moment of it. It was 7:58 PM, and you were yelling for me to come back inside, the picture was perfect, and the theme song blared from the speakers. That one moment of us having a perfectly fun Wednesday night, without fancy board games or video cameras. No money spent on a night out or a day at FunBowl will ever replace the simple lessons you managed to teach me when I was young. Happiness is found best the small moments, and though you always preached it to me, and I always heard it from others, all it took was a bit of wind to cause me to remember your love and encouragement for me as a child.
My father, who passed away when I was 12, was the main light of my life, and even now he is the only person I hope I will never let down. The snippet above is only the beginning of a new letter that I will be finishing soon. 
So please, take in the things you see around you, the moments that you enjoyed, or did not enjoy. Write that angry letter or proclamation of love. Embrace the weirdness and sadness for the world. When you learn how to do that, then you will be able to write fantastically. 
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selfpublishingnews · 8 years ago
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Today’s guest post is by novelist and reporter Rick Pullen writing on Jane Friedman’s excellent website, which we highly recommend.
After 38 agents turned down my political thriller, Naked Ambition, my friend Ron Sauder, a niche book publisher on Maryland’s Eastern Shore, urged me to try Amazon’s Kindle Scout. Kindle Scout allows Amazon customers to vote on which books they’d like to see published based on reading a few opening chapters. After a month, the books are evaluated by an Amazon editorial team, who take into consideration the number of nominations a book has received, then select some books for publication as part of Amazon’s Kindle Press program.
The logic behind Ron’s recommendation was that I was an unknown and agents give about 15 seconds of attention to query letters, so they really had no idea what I had written. After 38 rejections and only a few half-hearted responses, he asked, why not get my name out there and test the waters with readers?
I quickly learned writers must first sign a contract with Amazon, not knowing if their book will be selected. If it is, Kindle Press immediately owns both your ebook rights and your audio rights and you can’t back out of the deal. You keep only your print rights since Kindle Press doesn’t publish or distribute print books. While Kindle Press has sold a lot of ebooks, it has yet to publish its first audio book even though Amazon owns the largest audiobook company, Audible.
I’m no social media maven, but I took to Facebook and email—the extent of my social media knowledge—to urge friends and family to vote for my novel. I also had a friend re-launch my web page, which had been dormant for years, but I don’t think that helped at all with the launch.
A lot of friends and business colleagues shared my request and I ended up with 1,200 votes after the 30-day process. Kindle Press quickly picked up my novel, which meant everyone who nominated it would get a free early copy of the ebook—part of the incentive to nominate a Kindle Scout book.
I handed over my manuscript and a Kindle Press editor from Kirkus made minimal grammatical changes throughout the copy, almost all of which I accepted. It was obvious from some of her edits there was a wide generational gap between my knowledge and hers.
I was required to submit my own cover, which I had already been working on with the help of my creative director at my magazine. (I work in magazine publishing.) Creating a cover was quite a story in itself (read about it at my website). It started out looking like a romance novel, then soft porn, and—finally—after consulting with designers and marketers at a couple of publishing conferences, a real thriller novel cover. I realized I still had a lot to learn.
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I also had to coordinate the publication of the CreateSpace print-on-demand version with the publication of the Kindle Press ebook.
Finally, on May 3, Kindle Press launched Naked Ambition and I quickly became what my friend Ron describes as “one of the ninety-nine percenters.” My novel hit No. 1 on three Amazon thriller lists by May 20. I was floored. I was a complete unknown in the thriller genre and my book was suddenly—if briefly—hanging out with some of the greats who live much of their lives on that other bestseller list owned by the The New York Times.
I was immediately invited to become a member of a private Kindle Press Authors Facebook page and that’s when I began to get another education in publishing, or at least a Kindle Press publishing education.
Naked Ambition was published in Kindle Press’s second year of operation. In 2015, it published about 90 novels. By the end of 2016, Kindle Press had published a total of 218 books. Megan Muldur, the managing editor and defacto publisher, acknowledged to me that her staff was stretched thin by the middle of 2016. She was gradually adding more staff but that still didn’t keep authors’ emails from going unanswered for long periods of time. Some of mine went for months and I still have some outstanding. But being a magazine editor with a small staff of my own and working with a lot of freelance writers, I know exactly what Megan is facing. She is struggling with the same growing pains faced by any suddenly very successful business enterprise.
I have talked with her by phone and we have emailed back and forth and she has been very supportive of my book, even when I didn’t know it. One time when my sales suddenly surged, I wrote to ask why and found, after the fact, that Kindle Press had been promoting my novel. No complaints there, although it would have been nice to know ahead of time (although, frankly, I don’t know what I would have done with the information). It’s just nice not to fly blind, which is what I feel I have done ever since I decided to write a novel.
Some 185 Kindle Press authors had joined the private Facebook page by the end of 2016. I learned that many had a lot fewer nominations than I did, but were still chosen for publication. And many spoke of knowing writers who had thousands of more nominations who were turned down. It became clear that Kindle Press may use nominations as an indicator of interest, but it is like every other publisher and looks for story and quality of writing before making a decision to publish.
That of course begs the question: Why bother with the Kindle Scout nominating system at all? Is it a gimmick? It took me a while before I figured that out. But if you understand Amazon, the answer becomes obvious. Those who nominate books create a pool of initial reviewers to help promote Kindle Press ebooks when they are first published. Voters, after all, not only get a free book if they voted for a winner, they are the first to receive it. And everyone knows early reviews help sell books. So each Kindle Press “winner” has a volunteer marketing force in place from day one of publication.
But the Kindle Press business model just also happens to create new data for Amazon—the ultimate data-driven company. And this is data on some of its more engaged customers. It can use this information to track their buying habits and then market other books and products to them. It also urges them to do more reviews and thus promote more books and sales on Amazon. It’s a never-ending marketing loop and Amazon wins every time. And of course, a few writers like me get a wonderful free ride on the breaking crest of sales.
Kindle Press not only marketed my book well, but also pays well. Its royalty on domestic ebooks is 50%. Also, Kindle Press pays its authors a full royalty on all books sold through Amazon’s Kindle Unlimited subscription service. (Self-published authors are paid a variable rate based on pages read.)
Finally, by November, sales had dropped precipitously. So after seven months, I received an email from Kindle Press telling me my book would be promoted for 99 cents for the month of December. Other writers told me this usually happens after a book has been on the market for about 90 days. But at that time, my book was still selling well, so I’m sure the algorithm on my sales told Megan and her colleagues to wait on a price reduction promotion.
So in December sales again shot up. I sold more in a day than I had the entire month of November, but at 99 cents (that’s a 49-cent royalty), I wasn’t going to get rich. But at the dawn of my fiction-writing career, I’m more interested in readers finding me than making a boatload of money. The yacht can wait.
Then in mid-December, Megan offered me a fat one-time royalty to place my book in Amazon’s new Prime Readers program for the first three months of 2017. This is a new program that offers Amazon Prime customers a choice of 10 free books at a time from a list of 1,000, of which a third are turned over every month. And yet Kindle Press still pays me a royalty. It was an offer I couldn’t turn down, because thrillers were only a fraction of the books in the program. I was asked to keep the offer quiet, which I did. But I still scanned the Kindle Press authors Facebook page in search of answers about the program and learned a lesson in marketing.
Other Kindle Press authors who took part explained that the free giveaways would be counted in my novel’s Amazon sales rankings. That’s extremely important because it keeps my book visible to those who are not Amazon Prime members and are still paying for it. On Amazon, where there are more than five million ebooks, mine was again breaking into the top 1,000 in sales. But more importantly, my book was ranked in the top 15 on Amazon’s thriller novel lists right next to many New York Times best sellers.
It’s all about a book’s visibility and mine suddenly had it again. The advantage for me is not only would I get the lump sum royalty from the Prime Readers program, but I would also continue to receive royalties every month from those who were still buying my novel for $3.49. This doesn’t hurt sales of my $14.99 CreateSpace print novel either!
My friend Ron was right about making a name for myself. Last July I signed a contract with an agent who had actually read my novel and did not rely on one of his readers to send me a rejection. He had previously turned me down—not because he didn’t like my book, he said, but because he feared it would not become a breakout novel. When he found it was selling well, we got together for brunch in New York.
I now face a dilemma with my second novel, a sequel to my first and possibly one of four or more in a series. My new agent told me traditional publishers don’t want to pick up a series once it has begun. He asked two imprints right after he signed me and neither was interested despite my strong sales numbers. While he said my sales are impressive for a first-time novelist (approaching 20,000), a traditional publisher still wants to own it all—print and ebook rights to everything.
There are a lot of other authors out there just like me. We’ve done fairly well with non-traditional publishing, but we want to explore our potential. But with the publishing world changing so rapidly, is that really a smart idea? Would I be locking myself into a long-term contract with a dinosaur?
Jane Friedman noted recently that 70% of fiction is sold in ebook format and about 50% of all domestic book sales are through Amazon. How does an author ignore Amazon? Frankly, as my friend Ron has reminded me again and again, Amazon is a marketing machine. My book sales are about 97% ebook and 3% print. From an author’s view, that is the only weakness of Kindle Press. Print books are not part of their business plan and frankly I can’t blame them.
Despite my Kindle Press’s impressive record, my agent assures me he can navigate the roiling waters and changing currents of traditional publishing today, taking full advantage of all of its digital dynamics and minimizing its negative troglodyte characteristics. He’s told me while traditional publishers may have a reputation as living in another geological age, they are pretty savvy at digital sales and print marketing.
We’ll see what happens. What would you do?
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realselfblog · 6 years ago
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Costs, Consumerism, Cyber and Care, Everywhere – The 2019 Health Populi TrendCast
Today is Boxing Day and St. Stephens Day for people who celebrate Christmas, so I share this post as a holiday gift with well-wishes for you and those you love.
The tea leaves have been brewing here at THINK-Health as we prepared our 2019 forecast at the convergence of consumers, health, and technology. Here’s our trend-weaving of 4 C’s for 2019: costs, consumerism, cyber and care, everywhere…
Health care costs will continue to be a mainstream pocketbook issue for patients and caregivers, with consequences for payors, suppliers and ultimately, policymakers. Legislators inside the DC Beltway will be challenged by the newly-elected Democratic leader of House, Nancy Pelosi, and her party which has healthcare top-of-mind.
We know that a top issue driving American voters to the 2018 mid-term polls was health care, in at least two dimensions: direct costs to the voters (as patients and taxpayers); and, personal and collective concerns about losing coverage due to pre-existing conditions. More people became aware of that wonky term, taking it to heart and to the polls in 2018. Expect health care costs and access to be at least as important to U.S. voters through 2019, and on the Presidential debate stages for both Democrats and Republicans leading up to the parties’ nominees for 2020.
A key health care cost focus of Congress will target prescription drug costs. Expect pharmaceutical companies to raise prices in 2019 — “with a wink to Trump,” Bloomberg News characterized last week — prompting Congressional health care activists (particularly Democrats in the House) to come together on legislation and collaborate with President Trump on this issue which he promised would be a priority when he took office.
An example of legislation newly-crafted to hit the House floor in January 2019 comes from Elizabeth Warren (D-MA) in the form of the Affordable Drug Manufacturing Act. This bill would create a government-run drug company to produce and distribute generic medicines. In 2018, we also saw a response to high drug costs in the form of CivicaRx, a consortium of hospitals coming together to manufacture drugs in short supply at hospitals.
Employers will endeavor to artfully design consumer-directed benefit plans (CDHPs) that nudge insured workers toward healthier habits, while integrating a broader definition of wellness. There’s evidence that companies who cover health insurance are baking more financial wellness into a broader culture of health in the workplace, along with more attention to mental health. Greater awareness of the opioid epidemic, pain and financial stressors drive that trend, along with realization that student loan debt is very serious for both younger workers and, what may surprise you, Boomers who have taken on student debt on behalf of younger family members. Costs are also motivating employers to adopt telehealth coverage, en masse, and also behavioral economic designs to incentivize workers to access care in lower-cost settings like retail clinics, urgent care centers, and those Skype-type visits for care that don’t require a trip to the emergency department or bricks-and-mortar doctor’s office or hospital outpatient clinic.
Worries about health care costs, now crossing over into higher-earning households, underpins the growth of consumerism. It is difficult to behave like Rational Economic Man and Woman as a patient in the American health care labyrinth; but that doesn’t mean people aren’t exercising new muscles and choosing services delivered in newer, lower-cost sites. The retail pharmacy, for example, is a popular choice for receiving vaccines for flu and filling the childhood immunization schedule; and, the proliferation of web-based telemental health providers is providing an on-ramp for people to access behavioral health in a non-taboo, accessible mode.
We are also witnessing green shoots of understanding across the many layers of health literacy for:
Personal health financial literacy, a greater appreciation among consumers about the tax benefits of conserving funds in a health savings account, and what “coinsurance” shares mean
Digital health literacy, greater adoption of wearable tech and tracking apps, FDA-cleared devices that measure medical metrics like heart function, and people going online to sign up for health insurance
Nutrition literacy, with more clinicians prescribing food and recipes to promote self-care and healthy eating for patients and their families.
Consumerism and payor pressure will grow the landscape for care, everywhere. As employers and commercial payors support the growing use of telehealth and virtual care among insured workers and plan enrollees, so too will patients-as-consumers choose to more frequently receive care in convenient places and, increasingly, at home. The home will begin to emerge, in a pioneering phase, as our health hub. Peoples’ growing adoption of voice assistants like Alexa is already providing a platform for health assistance at home, with skills for a range of self-care like medication adherence, mental health support (say, through music and humor), and healthy recipe suggestions.
Outside of the home, I note the growth of retail health options well beyond (but including) the retail pharmacy. The grocery store is an important destination for health and wellness, along with Big Box retail, schools, church, and other community-based locations where people can create health — where we live, work, play, pray, and learn. The new “front doors of healthcare,” a term smartly coined by Oliver Wyman’s team, will emerge from combinations of stakeholders, such as the CVS + Aetna combination, Walgreens allying with Humana for primary care and Verily (Alphabet, Google) on data-driven chronic care, Cigna + Express Scripts vertical integration, Walmart’s work with a long list of health/care players, Apple branching into health clinics and hiring physicians, and Amazon reaching across the entire ecosystem to cover the landscape. This list, and other names we’ll see creating on-ramps to primary care and self-care to the consumer, will expand in 2019.
We’ll see more edgy digital technologies that speak to sex, drugs, rock ‘n roll: real life, EveryMan and -Woman issues. As I finalize my meeting agenda for CES 2019, I see more invites to developers of techs for adult “toys” (a growing category of sexual health and wellness), mental health and mindfulness, addiction and substance use, and consumer breathalyzers. One new development I find both provocative, sobering and highly useful is the SipChip, a disc roughly the size of a casino chip, which embeds a diagnostic test to check if one’s drink is spiked with common date rape drugs [e.g., Flunitrazepam aka “Roofies,” Xanax, and Diazepam (Valium), among others]. This innovation was developed by a team of college students at NC State University to help stem the college campus epidemic of drug-facilitated sexual assaults.
Investment, too, will come from unexpected places. The announcement this week of Morgan Stanley’s capital influx into Medsphere, an EHR company, is a hint of what more is to come in 2019 as an example of investors’ expanded interest in health IT and new-and-improved healthcare services and business models.
Greater attention paid to the social determinants of health, by payors (both public in Medicaid and Medicare, and in private sector benefit plans) will promote peoples’ access to care, services and social support outside of traditional, legacy healthcare nodes. This will continue to put pressure on the margins and business models of hospitals and doctors’ practices.
To more effectively manage these tight margins, health care providers will continue their use of augmented and artificial intelligence to mine data from both traditional claims and electronic health records, combined with consumer-generated data from wearable tech, surveys, and third party data sources that collect information on social determinants of health, personal finance, and retail transactions.
As consumers take on more self-care through apps, remote monitoring at home, and using social networks for health, people are also becoming more aware of these interactions creating data points. So much of these data flows aren’t covered by HIPAA. At the same time, Americans are more aware of data privacy challenges in the post-Facebook/Cambridge Analytica era, and U.S. Congress’s greater attention to Big Tech’s privacy gaffes and gaps.
Cyber-security and personal data breaches are now front-page (or -screen) news in mass media, as people live lives online and share all kinds of daily experiences with friends and family. More people have come to realize that personal information shared online isn’t seen by “just” friends and family, and can be scraped and re-purposed by third parties. Personal data, too, gets breached — notably, quite frequently, in healthcare provider organizations. It turns outs that medical breaches are quite valuable to hackers, so the frequency and severity of cyber-hacks in healthcare will be  an ongoing phenomenon in 2019.
Don’t be surprised for a major hack in or closely adjacent to healthcare to occur in 2019 that could reach the scale of the Experian breach. This would prompt Congress, driven by Democrats and moderate Republicans, to propose more stringent privacy legislation which industry will try to rebuff. It will be a wild card whether sufficient voter pressure could motivate the Congress and President to usher in a U.S.-style GDPR (the General Data Protection Regulation promulgated in the European Union).
Health Populi’s Hot Points:  There is one hot point that’s most important on Boxing Day and, truly, Everyday. That’s that love is the killer app — and our positive social connections bolster our health. May you delight and thrive in those loving touch-points in your life, and be mindful of minimizing the negative ones.
Here’s to your health, to love, loving kindness, and peace in 2019. I wish you very well…
The post Costs, Consumerism, Cyber and Care, Everywhere – The 2019 Health Populi TrendCast appeared first on HealthPopuli.com.
Costs, Consumerism, Cyber and Care, Everywhere – The 2019 Health Populi TrendCast posted first on http://dentistfortworth.blogspot.com
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pete-and-pete · 6 years ago
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Fred Hopkins (Frederick): 5 Fast Facts You Need to Know
Fred Hopkins, the Vietnam veteran husband of a well-known family and divorce lawyer in South Carolina, was identified as the man accused of shooting seven law enforcement officers in Florence, South Carolina, killing one of them.
Seven law enforcement officers were shot and one – Officer Terrence Carraway – has died after authorities say Hopkins opened fire on them near Florence, South Carolina on October 3, 2018. At about 6 p.m. that evening, the Florence County Emergency Management department said the suspect was in custody.
Fred Hopkins, who is also known as Frederick Hopkins, is 74-years-old. He is in the hospital because he fell at the scene. He is the husband of Cheryl Turner Hopkins. You can read about the life of Officer Terrence Carraway here. He was a former football coach and family man who worked in law enforcement for three decades.
A source close to investigation tells me the suspect in the shooting of 7 officers in Florence yesterday is Fred Hopkins. I’m told Hopkins remains in the hospital. Deputies say he fell yesterday at the scene. No word on his condition.
— Tonya Brown (@TonyaWPDE) October 4, 2018
Here’s what you need to know:
1. Fred Hopkins Was a Vietnam Vet Who Claimed He Suffered From Agent Orange
Fred Hopkins
In rambling posts on Facebook, Fred Hopkins indicated that he was a Vietnam veteran who was a cancer survivor, an ailment he attributed to Agent Orange exposure. A 2000 court document in an old child support case indicated that he was wounded in Vietnam. “Father was injured in the Vietnam war; his sole source of income is his disability check of $1127.00 per month,” the documents say, referring to Fred Hopkins.
In one post on Facebook, he wrote, “Today was a fantastic day! I went to the Dorn VA Hospital in Columbia, SC, and spoke with my oncologist, who gave me some very good news. My recent P.E.T. scan from the Charleston VA Hospital shows that I have no evidence of an active case of ‘b-cell lymphoma.’ Once I complete my schedule of chemo sessions, they will let me rest for several months and monitor my case with simple scans. That means — no radiation treatments in the near future. I am in remission!!! My family couldn’t be happier. Looks like I will be around for a few more years. I just might make it to my birthday in two days! The sun was shining and the powers above looked upon me with kindness.”
He wrote that he had “many things to be thankful for and life is one of those miracles. Now I can concentrate on my nine little pups and give them hope. Have a great day, one and all. Today I tried to remember those who passed on 9/11 and all those friends of mine from EMHS who crossed over much too early! Be patient, we will all be together in the far future. I miss you all very much and especially those who died 6 May 1970 on the slopes of FSB Henderson, RVN. Time magazine in the May 1970 issue it was the bloodiest firebase attack in the Army’s history. I lost more than 50 of the best brothers I ever knew my short life. They deserved better.”
He wrote about Agent Orange exposure: “Had the biggest ‘gut check’ of my life yesterday. I underwent 8.5 hours od chemo for ‘mantle cell lymphoma’ because I was exposed to heavy doses of ‘Agent Orange’ while performing combat duties with the 101st Airborne Division in Viet Nam in 1969-1970. I have been fighting this disease for five years on my own and the VA finally found out why I had pain and swollen nodules in my neck. Next chemo on June 12th. Feeling well so far, but was allergic to several meds they gave me. No pain, no gain! My eight kids are all in the house and one on the way — due about August 8th, plus or minus ten days. Updates to follow.”
2. Hopkins Was Married to Cheryl Turner Hopkins, a Prominent Attorney
Fred Hopkins
On Facebook, where he posted pictures of his family, his wife, rifles, and her Mother’s Day presents, Fred Hopkins wrote that he had studied Aerospace Engineering at Polytechnic Institute of New York University, went to Elmont Memorial Junior – Senior High School, lived in Florence, South Carolina, and was from Brooklyn, New York.
He was married to Cheryl Turner Hopkins, a well-known attorney in the Florence area. He recently posted a series of pictures of flowers and other gifts his wife received for Mother’s Day, writing, “These are pictures of my Bride’s (Cheryl Hopkins) many presents from Mother’s Day (13 May 2018) and posted on my timeline.”
On Facebook, he indicated that he had been married to Cheryl Hopkins for more than 30 years. “Today I spent several hours getting medicine for my wife of 30+ years,” he wrote in one Facebook post. “I am very proud of her and know how important good medicine is a getting it on time. I would be lost without her good cheer and great jokes and stories from the courthouse. I am about to go to dinner in Garden City, SC and hope to meet my fourth son, Jeremy, who is now attending Clemson. Since I received my doctorate from USC, he is bound and determined to tell me that Clemson (ranked #3 nationally) is the best. Well, whatever.”
3. Fred Hopkins Wrote About Rifles on Facebook
A photo on Fred Hopkins’ Facebook page.
Hopkins sometimes wrote about weaponry. “This is my rifle…….. this one is my gun. This one was built just for me and this one was for fun!” he wrote in one Facebook post.
“IT’S 12:20 HRS and the temp is over 100 deg F. Too hot for yard work. So I’ll quit for now and get ready for a long EKG because of the accident. Seth and I got our Fiat RR tire fixed and remounted in no time. We’re ahead of schedule and tonight we play Trivial Pursuit (Red Neck style) at Southern Hops in Florence. Our team has won the past three weeks, so we have quite a war chest established. Time to upgrade our meager meals into something more expensive. Feeling good. Peace to all.”
In another post, he wrote, “The day after my 70th birthday, I took my 12 year old son to my favorite rifle range in Lexington County SC for the monthly service rifle match. It showered all day and I fired my M-14 rifle by Federal Ordnance in 7.62mm NATO. The rifle is set up exactly like one I used in Viet Nam in 69-70. I scored 338-0X’s and had a blast! I have been shooting competitively since 1984 and lovin’ it. I just love the smell of gunpowder in the mornin’s. The guys at the range sang ‘Happy Birthday’ to me — gosh, it doesn’t get any better.”
4. Cheryl Hopkins Helped Fred Hopkins With a Previous Divorce
Fred Hopkins and his wife Cheryl Turner Hopkins.
A Supreme Court decision from 2000 indicated that Fred Hopkins was married before to a woman named Carol Hopkins and that Cheryl Turner Hopkins, his second wife, helped him with the divorce.
“Mother and Father were married in 1967; they divorced in May 1983,” that court case said, referring to Fred and Carol Hopkins. “They had two children: Sean, born May 26, 1972, and Fred, born December 4, 1969. Father was ordered to pay child support of $350.00 per month. In November 1986, Father was found to be $18,693.00 in arrears in his child support, and an order garnishing $432.60 per month of his military disability payments was entered.”
The court case continued: “The younger son, Sean, went to live with Father for approximately 5 months, from late April, 1990, through September, 1990. In early May 1990, Father instituted the instant action seeking custody of Sean; a hearing was held on May 13, 1990, three days prior to Sean’s 18th birthday. Father sought termination of support for his older son Fred, claiming he was over age 18 and was not entitled to post-emancipation support; Father did, however, request Mother be required to pay post-emancipation support for Sean. The family court gave Father temporary custody of Sean but required Father to continue making his child support payments pending the final hearing.”
The documents indicate: “he was represented at trial by his current wife, attorney Cheryl Turner Hopkins.”
5. Authorities Said Gunfire Was Being Shot ‘All Over’
#officerdown Police Officer Terrence Carraway, Florence Police Department (South Carolina), EOW 10/3/2018 @scflorencecity Six other officers and deputies were wounded! #rememberthefallen https://t.co/PSXdA4K1ov pic.twitter.com/joxTuwW7lk
— ODMP.org (@ODMP) October 4, 2018
Authorities said gunfire was being shot “all over.” They said officers saw fellow officers down. The way the suspect was positioned, his view of fire was several hundred yards. “So he had an advantage. The officers couldn’t get to the ones who were down.”
Initial reports had said that five officers were shot. However, later reports said as many as seven officers (four City of Florence and three Florence County sheriff’s deputies), and a 20-year-old man, were shot.
NEW INFORMATION: Four City of Florence officers were shot, three deputies were shot, and a 20 year old male was shot
A City of Florence officer has died @WBTWNews13 pic.twitter.com/AUBZt5COB6
— Teresa Galasso WBTW (@TeresaOnTV) October 3, 2018
One officer, Carraway, died in the shooting. Two of the other officers’ conditions were described as “touch and go,” according to WPDE-TV. The officer who died is a City of Florence police officer. “Carolinas Hospital System in Florence is on a temporary lock down following the shooting,” WPDE-TV reported. The station added that, according to neighbors, the initial call was for shots fired inside a home.
“****Major Update**** The active shooting situation is over and the suspect is in custody. We are asking everyone to stay away from Vintage Place as there is still an active crime investigation in progress,” the Emergency Management office wrote on Facebook.
According to WMBF-TV, three Florence County sheriff’s deputies and two city of Florence police officers were shot. A female officer was among those shot. The motive and identity of the shooter were also not yet clear. You can watch live stream video from the scene here.
Three Florence County deputies and two city officers have been shot during an active shooter incident that is in progress in Florence County, according to sheriff’s deputy Chief Glenn Kirby. pic.twitter.com/lGxIHWblmI
— M. Jennings (@RealFriscoKid) October 3, 2018
Florence County Emergency Management confirmed the incident on Twitter, writing, “Due to a high priority call in Vintage Place off of Hoffmeyer Rd in FLORENCE. There is an active shooter incident in progress at this time. We are advising everyone to stay away from this area. We have FCSO along with City PD and other first responders handling this situation.” Photos and videos captured a massive law enforcement response to the scene.
BREAKING: Report: 5 law enforcement officers shot in Florence South Carolina, Police confirm "active shooter". pic.twitter.com/Zs6HJOfxll
— Keith Esparros (@kesparros) October 3, 2018
The message was stamped “high priority” on Twitter. Gov. Henry McMaster wrote on Twitter, “This is simply devastating news from Florence. The selfless acts of bravery from the men and women in law enforcement is real, just like the power of prayer is real.”
#BREAKING: Photos from the scene of the 'active shooter' in Florence, South Carolina where 5 law enforcement officers has been shot. (Photos: @TonyaWPDE) pic.twitter.com/o01IRs2ouP
— BreakingNNow (@BreakingNNow) October 3, 2018
The Florence County, South Carolina Sheriff’s Department is located in Effingham, South Carolina. Florence is a community located about 80 miles from Columbia, South Carolina. A local high school was put in lockdown as a precautionary measure.
Due to a high priority call in Vintage Place off of Hoffmeyer Rd in FLORENCE. There is an active shooter incident in progress at this time. We are advising everyone to stay away from this area. We have FCSO along with City PD and other first responders handling this situation. pic.twitter.com/qvpYJPIAZk
— FCEMD (@FlorenceCoEMD) October 3, 2018
Representative Terry Alexander, who represents parts of Florence, released the following statement to WPDE: “It’s just a very sad situation. We have got to do something about these guns. We should also remember to be calm and let the process take place. Let’s see what our magnificent law enforcement officers come up with to make sure that our people are safe, especially our children. I am in prayer for all six families who are hurting right now, including that of the shooter.”
This post will be updated as more information is learned about the incident and about the conditions of the law enforcement officers who were shot.
source https://heavy.com/news/2018/10/fred-hopkins-frederick-cheryl-florence/
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realselfblog · 6 years ago
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Costs, Consumerism, Cyber and Care, Everywhere – The 2019 Health Populi TrendCast
Today is Boxing Day and St. Stephens Day for people who celebrate Christmas, so I share this post as a holiday gift with well-wishes for you and those you love.
The tea leaves have been brewing here at THINK-Health as we prepared our 2019 forecast at the convergence of consumers, health, and technology. Here’s our trend-weaving of 4 C’s for 2019: costs, consumerism, cyber and care, everywhere…
Health care costs will continue to be a mainstream pocketbook issue for patients and caregivers, with consequences for payors, suppliers and ultimately, policymakers. Legislators inside the DC Beltway will be challenged by the newly-elected Democratic leader of House, Nancy Pelosi, and her party which has healthcare top-of-mind.
We know that a top issue driving American voters to the 2018 mid-term polls was health care, in at least two dimensions: direct costs to the voters (as patients and taxpayers); and, personal and collective concerns about losing coverage due to pre-existing conditions. More people became aware of that wonky term, taking it to heart and to the polls in 2018. Expect health care costs and access to be at least as important to U.S. voters through 2019, and on the Presidential debate stages for both Democrats and Republicans leading up to the parties’ nominees for 2020.
A key health care cost focus of Congress will target prescription drug costs. Expect pharmaceutical companies to raise prices in 2019 — “with a wink to Trump,” Bloomberg News characterized last week — prompting Congressional health care activists (particularly Democrats in the House) to come together on legislation and collaborate with President Trump on this issue which he promised would be a priority when he took office.
An example of legislation newly-crafted to hit the House floor in January 2019 comes from Elizabeth Warren (D-MA) in the form of the Affordable Drug Manufacturing Act. This bill would create a government-run drug company to produce and distribute generic medicines. In 2018, we also saw a response to high drug costs in the form of CivicaRx, a consortium of hospitals coming together to manufacture drugs in short supply at hospitals.
Employers will endeavor to artfully design consumer-directed benefit plans (CDHPs) that nudge insured workers toward healthier habits, while integrating a broader definition of wellness. There’s evidence that companies who cover health insurance are baking more financial wellness into a broader culture of health in the workplace, along with more attention to mental health. Greater awareness of the opioid epidemic, pain and financial stressors drive that trend, along with realization that student loan debt is very serious for both younger workers and, what may surprise you, Boomers who have taken on student debt on behalf of younger family members. Costs are also motivating employers to adopt telehealth coverage, en masse, and also behavioral economic designs to incentivize workers to access care in lower-cost settings like retail clinics, urgent care centers, and those Skype-type visits for care that don’t require a trip to the emergency department or bricks-and-mortar doctor’s office or hospital outpatient clinic.
Worries about health care costs, now crossing over into higher-earning households, underpins the growth of consumerism. It is difficult to behave like Rational Economic Man and Woman as a patient in the American health care labyrinth; but that doesn’t mean people aren’t exercising new muscles and choosing services delivered in newer, lower-cost sites. The retail pharmacy, for example, is a popular choice for receiving vaccines for flu and filling the childhood immunization schedule; and, the proliferation of web-based telemental health providers is providing an on-ramp for people to access behavioral health in a non-taboo, accessible mode.
We are also witnessing green shoots of understanding across the many layers of health literacy for:
Personal health financial literacy, a greater appreciation among consumers about the tax benefits of conserving funds in a health savings account, and what “coinsurance” shares mean
Digital health literacy, greater adoption of wearable tech and tracking apps, FDA-cleared devices that measure medical metrics like heart function, and people going online to sign up for health insurance
Nutrition literacy, with more clinicians prescribing food and recipes to promote self-care and healthy eating for patients and their families.
Consumerism and payor pressure will grow the landscape for care, everywhere. As employers and commercial payors support the growing use of telehealth and virtual care among insured workers and plan enrollees, so too will patients-as-consumers choose to more frequently receive care in convenient places and, increasingly, at home. The home will begin to emerge, in a pioneering phase, as our health hub. Peoples’ growing adoption of voice assistants like Alexa is already providing a platform for health assistance at home, with skills for a range of self-care like medication adherence, mental health support (say, through music and humor), and healthy recipe suggestions.
Outside of the home, I note the growth of retail health options well beyond (but including) the retail pharmacy. The grocery store is an important destination for health and wellness, along with Big Box retail, schools, church, and other community-based locations where people can create health — where we live, work, play, pray, and learn. The new “front doors of healthcare,” a term smartly coined by Oliver Wyman’s team, will emerge from combinations of stakeholders, such as the CVS + Aetna combination, Walgreens allying with Humana for primary care and Verily (Alphabet, Google) on data-driven chronic care, Cigna + Express Scripts vertical integration, Walmart’s work with a long list of health/care players, Apple branching into health clinics and hiring physicians, and Amazon reaching across the entire ecosystem to cover the landscape. This list, and other names we’ll see creating on-ramps to primary care and self-care to the consumer, will expand in 2019.
We’ll see more edgy digital technologies that speak to sex, drugs, rock ‘n roll: real life, EveryMan and -Woman issues. As I finalize my meeting agenda for CES 2019, I see more invites to developers of techs for adult “toys” (a growing category of sexual health and wellness), mental health and mindfulness, addiction and substance use, and consumer breathalyzers. One new development I find both provocative, sobering and highly useful is the SipChip, a disc roughly the size of a casino chip, which embeds a diagnostic test to check if one’s drink is spiked with common date rape drugs [e.g., Flunitrazepam aka “Roofies,” Xanax, and Diazepam (Valium), among others]. This innovation was developed by a team of college students at NC State University to help stem the college campus epidemic of drug-facilitated sexual assaults.
Investment, too, will come from unexpected places. The announcement this week of Morgan Stanley’s capital influx into Medsphere, an EHR company, is a hint of what more is to come in 2019 as an example of investors’ expanded interest in health IT and new-and-improved healthcare services and business models.
Greater attention paid to the social determinants of health, by payors (both public in Medicaid and Medicare, and in private sector benefit plans) will promote peoples’ access to care, services and social support outside of traditional, legacy healthcare nodes. This will continue to put pressure on the margins and business models of hospitals and doctors’ practices.
To more effectively manage these tight margins, health care providers will continue their use of augmented and artificial intelligence to mine data from both traditional claims and electronic health records, combined with consumer-generated data from wearable tech, surveys, and third party data sources that collect information on social determinants of health, personal finance, and retail transactions.
As consumers take on more self-care through apps, remote monitoring at home, and using social networks for health, people are also becoming more aware of these interactions creating data points. So much of these data flows aren’t covered by HIPAA. At the same time, Americans are more aware of data privacy challenges in the post-Facebook/Cambridge Analytica era, and U.S. Congress’s greater attention to Big Tech’s privacy gaffes and gaps.
Cyber-security and personal data breaches are now front-page (or -screen) news in mass media, as people live lives online and share all kinds of daily experiences with friends and family. More people have come to realize that personal information shared online isn’t seen by “just” friends and family, and can be scraped and re-purposed by third parties. Personal data, too, gets breached — notably, quite frequently, in healthcare provider organizations. It turns outs that medical breaches are quite valuable to hackers, so the frequency and severity of cyber-hacks in healthcare will be  an ongoing phenomenon in 2019.
Don’t be surprised for a major hack in or closely adjacent to healthcare to occur in 2019 that could reach the scale of the Experian breach. This would prompt Congress, driven by Democrats and moderate Republicans, to propose more stringent privacy legislation which industry will try to rebuff. It will be a wild card whether sufficient voter pressure could motivate the Congress and President to usher in a U.S.-style GDPR (the General Data Protection Regulation promulgated in the European Union).
Health Populi’s Hot Points:  There is one hot point that’s most important on Boxing Day and, truly, Everyday. That’s that love is the killer app — and our positive social connections bolster our health. May you delight and thrive in those loving touch-points in your life, and be mindful of minimizing the negative ones.
Here’s to your health, to love, loving kindness, and peace in 2019. I wish you very well…
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