Show love

Hey all, my 36 yr old, older brother unexpectedly died of heart failure last week on Sept. 27, 2014. I loved him but I didn’t appreciate him enough. I didn’t see him often lately and when I did, I teased him (as little sisters do) but I don’t know if I told him I loved him and how much he meant to me.
So take my advice: tell the people you love, that you love them. Be there for them.

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What I said at his memorial service
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David was my brother, no David is my brother. And as his sister, I don’t think I appreciated him enough, because I took him for granted. I thought, he was always going to be there, that he was always going to tease me, that I was always going to annoy him, that he would always be there as a presence for my children. Unfortunately, I was wrong. David has taught me, through his death, that when you love somebody you need to let them know, as often as you can, be it through the words I love you, be through little gestures like hugs, kisses, punches, pinches, uh I mean hugs and kisses. And I hope that this is a lesson that he is taught you. appreciate the people in your life even if you don’t always get along with them, even if you don’t always agree with them or their lifestyle choices, even if they are the most aggravating person in the world, which David was not I was. Appreciate your loved ones be they friends or family and never treat a stranger bad because you don’t know what they’re going through.
So grieve, rage but also laugh, love and live. Live your life for you only have one.IMG_2464.JPG

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Another boy injured by infant circumcision and another boy dead because of a pain med overdose given for his circumcision

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http://www.intactamerica.org/learnmore

Newborn male circumcision is the most common surgical procedure performed in the U.S. It’s a common misconception that there are tangible health benefits to male circumcision, but the truth is no medical society in the world recommends it. This invasive procedure carries serious health risks, including infection, hemorrhage, surgical mishap, and death, as well many ethical considerations.

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Another baby dead. It’s so sad and horrible. He died from a pain med overdose. The pain meds were given to him to help him during his circumcision. Since, there is no medical reason for circumcision this baby would still be alive if he wasn’t circumcised and given pain meds.

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Penile amputation
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045722/

Albatross, garbage and the nesting grounds on Midway

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http://www.midwayjourney.com/
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http://www.neseabirds.com/Midway/laysan.htm

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http://www.upworthy.com/people-should-know-about-this-awful-thing-we-do-and-most-of-us-are-simply-unaware?c=ufb1
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The plastic plight of the albatross
http://pacificvoyagers.org/midway-atoll-the-plastic-plight-of-the-albatross

documentary follows internationally acclaimed artist Chris Jordan to investigate an environmental tragedy in this remote Pacific paradise: tens of thousands of albatrosses lie dead on the ground, bodies filled with plastic from the Pacific Garbage Patch – See more at: http://pacificvoyagers.org/midway-atoll-the-plastic-plight-of-the-albatross#sthash.piwDQtlm.dpuf

Of the 500,000 albatross chicks born here each year, about 200,000 die, mostly from dehydration or starvation. A two-year study funded by the U.S. Environmental Protection Agency showed that chicks that died from those causes had twice as much plastic in their stomachs as those that died for other reasons. Albatross scour the ocean surface for sustenance, finding all manner of plastic debris, bottle caps, lighters, combs, and minuscule photodegradated (broken down by the sun) pieces of plastic that can be mistaken for food. Hence, the birds swallow the junk, that perforates their stomach or blocks their esophagus or gizzard, leading to inability to eat, often leading to death.

– See more at: http://pacificvoyagers.org/midway-atoll-the-plastic-plight-of-the-albatross#sthash.piwDQtlm.dpuf

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http://www.doomcarousel.com/comic/laysan-albatrosses-of-midway-atoll/

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http://www.midwayjourney.com/

Your son is fine….. But these boys weren’t

http://ripe-tomato.org/2013/02/16/cock-ups-happen/

Complications during male circumcision are rare, being estimated to occur in 1 of every 500 procedures. These complications, which can be severe, include poor cosmetic outcome, bleeding, infection, injury to the penis and the removal of too much or too little skin.

Using “rare” for a 1 in 500 risk, when earlier the benefit of “avoiding the need for circumcision later in life” (about 1 in 2,000) is mentioned without qualification, is biased. The figure also applies to the best series. Less well organised services report rates up to 20%, e.g. Nigeria, click here. Since the manual is for use in developing countries the possibility of higher complication rates should be mentioned. Finally, Complications, which can be severe, include poor cosmetic outcome… is clearly designed to play down severity.

But more importantly, catastrophic complications are omitted altogether. Fully informed consent means telling people everything, however rare, which might alter the decision of a reasonable patient/parent. In gynaecology we mention the 1 in 10,000 risk of temporary colostomy after laparoscopic surgery for example. Unless we have a double standard for Africa, the complications below, which all appear elsewhere in the guide, should be mentioned. Italic text and pictures are all taken from the guide.

None of these complications are common, but they all occur. If infant circumcision programmes get rolled out widely in developing countries, it is inconceivable that everyone will read all 140 pages of the WHO manual In the real world sterilisation goes wrong, mismatched Yellen clamps get packed together, and diathermy and wrong sized Plastibells get used. Even if they don’t, infants wriggle. Parents should be told.

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pics in link at top

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Different article

http://helpingmenblog.blogspot.co.uk/2013/03/majority-of-britons-support-ban-on-male.html?m=1

in Britain (UK)

Complications are common, two boys a week are admitted to the Emergency Department in Birmingham Children’s Hospital and one boy a month comes close to death as a result of male circumcision.

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Another baby hemorrhaging… Lucky to be alive and yet supposedly the risks are worth it? How is almost dying worth it? How is almost dying because of a medically unnecessary surgery being performed on a healthy infant worth it?

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Bleeding out/ hemorrhaging

Is circumcision just a routine harmless procedure?

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Before and after images:
http://circumcisiondecisionmaker.com/circumcision-facts/before-and-after-circumcision/

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Joseph4gi
http://joseph4gi.blogspot.com/2011/06/circumcision-is-child-abuse-picture.html?m=1

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http://www.drmomma.org/2010/05/death-from-circumcision.html?m=1

So freaking sad that this happens and that the statistics on infant injury or death due to circumcision are not accurately reported.

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Oh crap!

Please prayer for this little boy!!!!!!

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I really should have stayed off of fb today. My heart aches for this family.

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Oh God, the baby died. Please pray for this family in their time of grief and heartache.

“God, bring comfort and peace. Peace is your essence. Peace is your name. Bring peace to this family who has lost their precious child in death.
We come to you, God because we know that you sorrow, and are acquainted with grief. You too have endured the loss of a child. You empathize.
We can’t help but ask, “Why?” Forgive our insistence, our confusion, even our anger. We believe that you are just, and we ache to understand how this tragic death is an expression of that justice, how it expresses your love. We also know – in our minds at least – that you seldom answer the “why?” question. We press you, but on these matters you are mostly silent.
What we ask instead is “how?” How can we move forward? How can this bring us together and not tear us apart? How can we now live under the shadow of this untimely death? Answer this prayer with your comfort and guidance.
There is no way to remove the pain. The grief is real. The only sanity is to know, to believe, in a life beyond with you, when all the scales are righted and the sufferings are made good. We trust you and your promise that while this child’s life on earth is done, his life beyond has just begun. With that release we lose him and let him go into your arms, then by faith receive in return the boundless comfort of your presence. That is all, that is enough. In Jesus.”

Read more: http://blog.beliefnet.com/prayerplainandsimple/2011/06/a-prayer-for-a-family-grieving-the-death-of-a-child.html#ixzz2N3T3e12k

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Messy pancakes and heartache

Although the below post is a funny post, please pray for the author she just lost her toddler to SIDS (awaiting autopsy to confirm).
The info about her toddlers’ passing was not on her blog but on her fb fan page.
I cannot imagine her agony and the emotional tsunami her and her family are going through. Please pray for them.

http://www.theprogressiveparent.org/2012/11/finding-zen-messy-pancakes.html?m=1

They took WAY longer than I had ever spent making pancakes- or anything, really, ever before. When we were through with our efforts, we had procured several brown, lumpy, oddly shaped wads so thick and heavy, I was pretty sure they were going to skip being eaten to put on some flannel and grab a chainsaw to finish a hard day’s work at a lumber mill. I could have said about the same for the syrup/sauce/fruit goo.

This was a giant, leaping bound away from the light, fluffy pancakes of yore. My spiced oatmeal pancakes looked and smelled like Rudolph had used the serving tray as a personal port-a-potty. (Going with the unicorns-farting-rainbows theory, I’m assuming magical reindeer poo also magically smells of cinnamon and vanilla) My not-so- abandoned reservations were screaming in my face, SEEEEE? Dude. Yuckballs. Leave the cooking to the professionals, eh? Despite the encouraging eyes of my toddler companion, I kind of wanted to cry.

“To-men ‘eesh are MESHY pancakesh!” he said between never-empty-mouthfuls. “We MADE ’em. ‘ey’re GOOD!”

With that small insight, the burden of my expectations and ego were lifted. Aiden had never had an agenda aside from wanting to spend time with me- and wanting a hot breakfast. He had enjoyed every minute of the feel of the flour mixture, the satisfaction of successfully cracking the eggs, the stickiness of the dough, the participation and the company. When it was through, he loved the outcome with no reservations and simply called them as he saw, “Messy Pancakes”… and they were the best pancakes I’ve ever tried.

What kind of wacko kills 5 yr olds?

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http://abcnews.go.com/m/story?id=17973836

A heavily armed man invaded a Newtown, Conn., elementary school today, killing his mother and 26 others, mostly children, federal and state sources tell ABC News.

http://rosemarieberger.com/2012/12/14/2-laws-could-end-sandy-hooks-forever/

The United States needs two new federal laws, which would almost guarantee an immediate, dramatic decline in gun violence:

1. A renewed ban on the sale of assault weapons. These are the weapons of choice for deranged individuals who are determined to kill. They must be banned in America forever.
Sign the petition here: http://signon.org/sign/ban-assault-weapons

2. Require all gun purchasers to undergo an instant background check. No more “cash and carry.”

Violence in China. Man stabs 22 kids.

http://m.jamaicaobserver.com/mobile/latestnews/Man-stabs-22-children-in-China

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Guggie Daily- on circumcision and its harms

AMEN AMEN AMEN! This was a Facebook status update she posted today.

Facebook post from Guggie Daily:

Do you know of a page, blog, website or other resource against circumcision started by a MAN? Feel free to link it here.

Men DO complain.
They DO acknowledge their loss.
They DO want forced circumcisions to stop.

They DO want their sons to be healthy and whole.It’s not about feeling insecure, inferior or broken.It’s about acknowledging what others have done, and taking a stand to stop the cycle.

It’s not about focusing on the hurt others had in their hearts or what they passed onto the next generation.

It’s about learning to unconditionally love your partner/yourself, to the point that you can look at the facts and still feel completely loved and accepted.

Someone forcefully circumcised you and you’re fine with it? *shrugs* That’s…FINE. It really is. Lucky you, that you don’t have a scar, or discoloration, or nerve damage, or keratinization, or a bridge on the glans, or hair pulled up onto the shaft, or ejaculation issues, or painful/dry/banging sex, or a crooked penis, or meatal stenosis. Lucky you that you weren’t one of the babies who bled to death, or choked on vomit, or had a heart attack, or got an infection after surgery and died.

You’re FINE. That’s good. You don’t have to feel bad about your body or what others did to you.

If you’re FINE, then it shouldn’t bother you to 100% oppose forcing it onto anyone else. If you don’t have bad feelings or unresolved hang ups, then freely jump up to STOP forcing it onto others.

His body, his penis, his health, his life, his sexual partner, HIS CHOICE.

Her website:
http://guggiedaly.blogspot.com/?m=1

Her Facebook page:
https://www.facebook.com/guggiedaily?ref=stream
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To avoid criticism, do nothing, say nothing, be nothing.ELBERT HUBBARD

Hermit crab

Found out sunsun the biggest hermit crab of my original purchase has died. I had sunsun for about a yr and a half. I thought he was molting but I guess the stress got to him and he died. In death they crawl out of their shells and stink.
I don’t think I’ll Tell my oldest son this time…🐚🐚🐚

Baby dies after home circumcision

http://m.bbc.co.uk/news/uk-england-manchester-20503660

Manchester baby boy ‘bled to death after circumcision’
27 November 2012 Last updated at 12:28
A four-week-old boy “bled to death” after a home circumcision carried out by a nurse, a court has heard.

Goodluck Caubergs died the day after nurse Grace Adeleye carried out the procedure without anaesthetic, Manchester Crown Court was told.

The jury heard the 66-year-old only used scissors, forceps and olive oil at an address in Chadderton, Greater Manchester in April 2010.

Mrs Adeleye denies manslaughter by gross negligence.

The court heard the medic and Goodluck’s parents are originally from Nigeria, where the circumcision of newborns is the tradition for Christian families.

‘Dangers ignored’

Mrs Adeleye, of Sarnia Court, Salford, was paid £100 to do the operation, the court was told.

It is alleged the defendant, who is also a midwife, left a “ragged” wound that bled and her post-operative care was inadequate.

The family home, where the procedure took place, is a mile and a half from Royal Oldham Hospital.

……..
The court heard up to three children a month are admitted to the Royal Manchester Children’s Hospital because of bleeding after home-based circumcisions – a danger the nurse should have been aware of.

Mrs Adeleye went to Goodluck’s home on 16 April 2010, telling his mother to fetch some olive oil and a bowl of warm water and stripping the baby to his vest, the jury was told.

‘No pain relief’

The defendant brought her “instruments” out of her handbag and dipped a pair of scissors into the water in a kidney dish.

She carried out the procedure with no anaesthetic or local pain relief before cleaning the wound with cotton wool and applied a bandage, the court heard.

Between 30 and 40 minutes after surgery, Mrs Adeleye left without making any proper checks on the patient, Mr Darbishire said.

Later, the parents found the bandage had come off the wound and there was blood in Goodluck’s nappy.

Mr Darbishire said even a small amount of blood loss is dangerous and the loss of just one sixth of a pint of blood can be fatal for a newborn.

A post-mortem examination revealed Goodluck’s death was caused by a loss of blood.

The trial continues.

7 yr old in India loses his genitalia because of a botched circumcision

http://m.timesofindia.com/india/7-year-old-loses-genitals-after-circumcision-fighting-for-life/articleshow/17330245.cms

The boy, Imran, was admitted to Sania hospital in Alwar town on November 10 for circumcision. According to sources, after the operation, some equipment was used to prevent bleeding. However, electric current accidentally passed into his private parts and the boy suffered serious injury. On November 13, the boy was referred to a private hospital in Jaipur. After investigating the case, the doctors in Jaipur advised the boy’s relatives to remove his genitals as it was necessary to save his life. The operation was conducted and his genitals were removed. Three days after the operation, the boy was again admitted to Sania hospital in Alwar.

The boy is now fighting for life while his relatives are protesting outside the hospital in Alwar.
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Imran’s uncle Fakruddin Khan said that the operation was to be completed in just 30 minutes but the doctors took four hours. “Two days after the circumcision, the doctors advised us to take the boy to Jaipur. When we took the boy to Jaipur, the doctors there immediately informed us that the boy’s private parts were completely damaged and his genitals had to be removed. After operation, we tried to admit the boy in different hospitals but no hospital admitted him. The last option for us was Sania hospital. So we brought him here back after his genitals were removed in Jaipur.”

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http://www.circleaks.org/index.php?title=Documented_Severe_Complications_of_Circumcision

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Death

A friend’s dad died last night and a few weeks ago my brother-in-law’s 18 yr old brother died.
Death is every where and it scares me. I can’t imagine losing someone that I love.
My miscarriage in 2008 devastated me ad I’d only know that entity for a couple of months.
What would I do if I lost a parent or sibling or child or husband?
Would I be numb and act like everything was ok? Would I wail and cry and waste away in bed?
How would/will I react?
Sometimes, I feel so disconnected from others and I wonder how strong my emotions for them are…..
I just pray I don’t lose anyone…..

Lives lost to circumcision

https://sites.google.com/site/completebaby/death

Lives Lost from Circumcision
by W E Martin
Most of us have played the state lottery, especially if we live in a lottery state. We all think we have a chance to win. We also play a lottery of sorts when we circumcise a child. The odds of a child dying from his circumcision injuries are at least 1,750 times greater than winning the lottery. On the long odds, we bet a dollar. On the short odds, we bet a life. We celebrate the winner of the state lottery and someone gets paid. We deny the “winner” of the circumcision lottery and an innocent life is lost. In the state lottery we all think we have a chance of winning otherwise we wouldn’t give up our hard earned money. In the circumcision lottery we deny there is a chance of “winning” and risk losing a son.

Some babies die of complications of circumcision.[1] There has been a need to assemble in one convenient location information concerning death from complications of circumcision. This page is designed to fill that need.

Deaths occur secondary to loss of blood or systemic infection from the circumcision wound.

………
Read more

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http://www.canada.com/mobile/iphone/story.html?id=cb3b8281-4134-46ba-85d3-b076072bda75&k=25810

2007
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Circumcision deaths are a legalized non-scandal …. And more

I have not read anything but this link on that page so I’m not sure of the pages biases or methods but I am posting this link.
http://mondoweiss.net/2012/06/circumcision-deaths-are-a-legalized-non-scandal.html

The author’s comment in regards to other commenters on his blog

To tokyobk, and others who question why I posted this piece:

Co-editor Philip Weiss opened the door to critical commentary about the American Jewish community broadly, on topics other than just Israel/Palestine. For example, please see his post about the ultra-Orthodox sex scandal:

link to mondoweiss.net

Phil wrote:

It struck me that night that because of the Catholic church scandal and its sequels, our society is experiencing an awakening. We are uncovering important new terrain of man’s inhumanity to man. The truth is that sexual abuse has gone on everywhere, in countless institutions where children and power intersect. The discovery of these horrors is now widespread and imperative, and it will make society better. That is why I jumped on the Ultra Orthodox story yesterday.

Couldn’t have said it better. Discovering the horrors of circumcision, and outlawing this shameful and destructive practice, will benefit society.

Why I’m focusing on the Jewish angle:
As a Jew, I feel responsible to challenge Jewish practices that are harmful. As I wrote in the article – and as the Canadian Children Right’s Council has stated – circumcision of non-consenting minors is wrong no matter what religious or cultural context. If I was a Muslim, I would be posting this article to a Muslim-originated blog, and I would link it to a video of a Muslim circumcision. But since I am a Jew, I am posting it here, on a site that criticizes aspects of the American Jewish community for the sake of bettering it!

To all commenters
As of 2:11AM PST on June 25th, not one of the seven comments thus far has expressed a drop of shock, moral outrage, or indignation at the practice of exposing infant males to death, as documented in my post. Again, the question: why is this obvious scandal such a non-scandal, not only in the American Jewish community and the mainstream media, but for readers of this blog? Are the lives of male babies truly that worthless? Why are the practices cited in this article legalized when performed on male infants, whereas these practices are illegal when performed on female infants? Shouldn’t that change, so that both males and females are protected by the law?

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Baby death after circumcision: Uganda
The death is blamed on the mother but the fact remains if the healthy child want subjected to medically unnecessary and unethical surgery the baby would not have died

http://m.allafrica.com/stories/201201240156.html/

Kasese — Grief engulfed residents of Kasese Municipality when a three-weeks old baby died after undergoing circumcision. The baby’s mother Dorah Muhindo, said she was instructed by the health workers at St. Paul’s Health Centre IV not to feed the baby from 6am since the operation was to be done at 7am but it took place at 11am.

A relative, who preferred anonymity, said the child was discharged at 5pm.

A medical source at the health centre said: “Imagine a three-week-old child spent more than eight hours without eating and no fluids were given to him, obviously his glucose levels reduced causing dehydration and eventually death.”

The parents said the child was discharged before he regained consciousness but his condition worsened when they reached home. The baby was taken back to the hospital but it was too late to save his life. However, health workers accused the mother of having breast-fed him before the recommended time.

A death certificate from the health unit reads: “The child died because of being breast-fed before he gained consciousness.” Locals wondered how a child would be discharged by a medical worker before gaining consciousness.

When contacted, the in-charge of the health centre, Dr Anthony Kiwanuka, said: “I am not at the health unit now, I am with police in the field.” The health centre administrator, the Rev. Josephat Bwaruma, said he was not briefed about the matter.

Residents have vowed to take the matter to court if the family drops the issue.

Within four months, four children have died at St. Paul’s Health Centre IV and Bishop Masereka Health Centre, after circumcision.

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http://m.thomhartmann.com/forum/2012/07/mass-circumcision-drive-africa-and-hospital-near-you-soon

Cultural bias. When studying circumcision, cultural bias must be considered:

Circumcision practices are largely culturally determined and as a result there are strong beliefs and opinions surrounding its practice. It is important to acknowledge that researchers’ personal biases and the dominant circumcision practices of their respective countries may influence their interpretation of findings.10

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The article is a bunch of crap but the commenters are on their game.

http://mblogs.discovermagazine.com/crux/2012/08/31/cut-the-penis-cut-the-risk-why-circumcision-is-a-good-choice/

Guggie Daly: How many Babies Must Die from Circumcision?

http://guggiedaly.blogspot.com/2011/08/how-many-babies-must-die-from.html?m=1

Over and over again, I hear other debaters remark that the estimated 100-200 deaths resulting from amputation of the prepuce on newborn baby boys in America are a “small number” and not something of concern. Here are examples of the comments people have posted to me:

”Even if we doubled that number, it’s still minute.”
”Everyone dies.”
”That’s only like 100 people.”
”Oh, that’s actually really safe.”
”Well, more people die in car crashes.”
”You can’t save everyone.”

Babies die every day. We all die, actually. That’s just a fact of life. What is the inherent issue with circumcision deaths? Why should a baby dying from circumcision concern us and anger us?

The current routine procedure performed on baby boys in America is recognized as medically unnecessary surgery. Even the American Academy of Pediatrics (AAP) acknowledges that any “potential benefits” are not enough to recommend routine circumcision. We’ll look at that link in a minute.

Routine circumcision is the act of taking a healthy, living, functioning baby and performing surgery without medical indication: http://www.youtube.com/watch?v=bXVFFI76ff0

The baby is not sick. The baby does not have a congenital defect. But a part of the body is removed through surgery. And some of these babies die.

In other words, all of those 100-200 deaths were 100% preventable. Every single one of those babies should be alive today. As I’ve quipped before:

“Nothing in life is 100% safe, but medically unnecessary circumcision is 100% preventable.”

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Eight thoughts to ponder (humorous)

I did NOT write this! I am merely passing it on as I found it funny

EIGHT THOUGHTS TO PONDER

Number 8

Life is sexually transmitted.

Number 7

Good health is merely the slowest possible rate at which one can die.

Number 6

Men have two emotions : Hungry and Horny. If you see a gleam in his eyes, do some baking .

Number 5

Give a person a fish and you feed them for a day. Teach a person to use the Internet and they won’t bother you for weeks, months, maybe years

Number 4

Health nuts are going to feel stupid someday, lying in the hospitals, dying of nothing.

Number 3

All of us could take a lesson from the weather. It pays no attention to criticism.

Number 2

In the 60’s, people took acid to make the world weird.

Now the world is weird and people take Prozac to make it normal.

And The Number 1 Thought

Life is like a jar of Jalapeno peppers–

what you do today, might burn your ass tomorrow.

And as someone recently said to me:
“Don’t worry about old age–it doesn’t last that long.”

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Circumcision complications

The site below is not an anti-circ site. Circumcision is not a surgery without complications…. Serious complications may be rare but if it is your child suffering it is a decision you can never take back.
Infants do not need circumcision! In almost all cases there is no medical need. In the case of medical need, doctors usually wait until the baby/child is older so that the “work area” is bigger and more developed.
Circumcision complications can kill or cause life long pain and problems.

Click the link to see the pictures of the complications.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253617/

The rate of adverse events varies widely across reports, depending on the definition chosen for a postoperative complication. In a large meta-analysis of prospective and retrospective series, Weiss et al. reported a frequency of adverse events of and for serious adverse events [14]. This can represent a significant cost in terms of utilization resources and healthcare dollars. During a five-year period at the Massachusetts General Hospital, 7.4% of all visits to a pediatric urologist were for circumcision complications. This translated to an average total cost per patient for redo procedures of $1,617 and an estimated annual cost of $137,122 to the institution [15].
For ease of discussion, adverse events following circumcision can be categorized as either early or late complications. Early complications such as: bleeding, pain, inadequate skin removal, and surgical site infection tend to be minor and quite treatable. However, postcircumcision bleeding in patients with coagulation disorders can be significant and sometimes even fatal. Other serious early complications include chordee, iatrogenic hypospadias, glanular necrosis, and glanular amputation. The latter, of course, requires prompt surgical intervention. Late complications include epidermal inclusion cysts, suture sinus tracts, chordee, inadequate skin removal resulting in redundant foreskin, penile adhesions, phimosis, buried penis, urethrocutaneous fistulae, meatitis, and meatal stenosis. These are commonly treated in an outpatient setting. Most of the aforementioned conditions are avoidable giving attention to detail and proper technique. Mayer et al. found that some subtle anatomic variations are significantly associated with late circumcision complications, including penoscrotal webbing, suprapubic fat pads, and prematurity [16].
4.1. Death
Fortunately, death from neonatal circumcision is fortunately an extremely rare occurrence. King reported a period when 500,000 consecutive circumcisions were performed in New York city without a single fatality [17]. However, a case of a misplaced Plastibell ring which caused complete meatal obstruction resulted in acute venous stasis and subsequent death from sepsis reported by the Ontario Pediatric Death Review Committee in 2007. In this situation, prompt recognition of the obstruction is critical and primary management should be immediate removal of the Plastibell ring and catheter placement [18]. There are other reports in the international literature that describe mortalities from tetanus as a result of circumcisions performed under nonsterile conditions. Bennett et al. reported that topical antibiotics could decrease this risk of neonatal tetanus 4-fold [19].
4.2. Bleeding
Bleeding is the most common complication of circumcision, with an incidence of 1% in a large retrospective review [20]. Bleeding may occur along the skin edges between sutures or from a discrete blood vessel, most commonly at the frenulum. Meticulous attention to hemostasis during an open procedure and adequate time for skin edge compression during newborn circumcisions should prevent the majority of cases although dislodging of a clot or cautery eschar can occur. The majority of postcircumcision bleeding can be controlled with application of direct pressure or careful application of silver nitrate. Rarely is wound exploration and suturing necessary. A hematologic workup is warranted only in patients who persistently bleed, or bleed significantly. In a retrospective review of the Mayo Clinic Pediatric Hemophilia database, 48 patients with a range of coagulopathies were circumcised. 21 patients had known coagulation disorders, while the remaining 27 patients were diagnosed after prolonged bleeding from their circumcision. There were 11 bleeding complications, three of which were severe and required transfusion of RBC’s for severe anemia despite preoperative factor replacement [21]. In those patients with hemophilia who must undergo circumcision, preoperative and perioperative factor replacement is a definite requirement. Fibrin glue has also been shown to decrease the amount of recombinant factor replacement needed (and the cost of treatment, as well) without significantly altering bleeding complications [22].
4.3. Infection
Due to the superb dual blood supply of the penis, wound infection occurs infrequently. In a series of 5,521 circumcisions comparing the Plastibell technique to the Gomco clamp, Gee and Ansell reported only 23 (0.4%) infections. Of those, the Plastibell group had significantly more infections, 19 versus four (P <; 0.005) [20]. All responded to a combination of topical treatment and oral antibiotic therapy. Causative organisms are usually skin flora, but due to the uniquely dirty environment of the diaper, colonic flora has also been reported. Most infections can be prevented with proper patient preparation, glove wearing and good local wound care including cleaning the penis, and application of antibiotic ointment with diaper changes [2].
Severe infections following Plastibell circumcision, including necrotizing fasciitis, have been reported as well. Several authors describe presenting signs and symptoms as erythema, induration, pain out of proportion to physical findings, coupled with tachycardia, leucocytosis, or bandemia. As in adults, this is usually a polymicrobial infection. Empiric broad spectrum antibiotics to cover Gram-negative, Gram-positive, and anaerobic organisms are essential. A suggested regimen is an aminoglycoside, nafcillin, or vancomycin and clindamycin. Prompt surgical evaluation and aggressive debridement of necrotic tissue is required [23].
4.4. Loss of Skin/Wound Dehiscence
Wound dehiscence and degloving injuries of the shaft are possible following using any of the techniques described above for neonatal circumcision. De-gloving injuries result from excess skin being drawn up into the clamp and then amputated. While, less likely, improper determination of the amount of skin to remove during free-hand circumcision may occur. Often these injuries are treated with local wound care and allowed to heal by secondary intention. There are reports of autografting the excised skin with good cosmetic result [24].
4.5. Trapped/Concealed Penis
Similarly, a concealed penis can result from overzealous removal of shaft skin coupled with a prominent suprapubic fat pad resulting in healing within the fat pad. Another consequence of this configuration is a secondary phimosis from the progressive closure of the skin over the glans penis. This can be avoided by firmly compressing the fat pad to the abdominal wall to best determine how much skin should be removed [16]. In addition, the suprapubic fat should be compressed regularly after the procedure to allow the penis to be protrude. Corrective surgery may be necessary if there is absence or significant laxity of the penoscrotal angle or penoscrotal webbing that precludes adequate protrusion of the penis.
4.6. Redundant Foreskin/Circumcision Revision (Figure 6)
Inadequate circumcision, or excess foreskin, is a fairly common indication for referral to a pediatric urologist. In a retrospective review of 476 late circumcision complications treated at Massachusetts General Hospital, 40% were for inadequate circumcision and another 5% were for phimosis requiring revision. The criteria for treatment are purely subjective and mainly cosmetic excepting those with phimosis, of course [15]. Repair is scheduled electively under general anesthesia and is best accomplished using the “free-hand” skin sleeve technique removing the redundant skin.

Figure 6

Examples of redundant skin following circumcision (a,b,c).
4.7. Preputial Adhesions/Skin Bridges (Figure 7)
Preputial adhesions often result from either inadequate lysis of natural adhesions prior to circumcision or from distal migration of the skin from a prominent suprapubic fat pad. Williams et al. report that 63% of patients presenting for circumcision revision were found to have prominent suprapubic fat pads [25]. The majority of adhesions should lyse spontaneously as the penis grows, suprapubic fat recedes, and erections become more frequent and firmer. Otherwise, lysis of preputial adhesions can be performed in the office by gently pushing away the adhesions from the glans after administering a topical anesthetic cream such as EMLA. Recurrence of these adhesions can be limited by regular compression of the suprapubic area to make the penis protrude and placement of petroleum jelly or any other such ointment. During healing, the circumferential incision can adhere to the glans and in some cases heal into an epithelialized skin bridge [2]. If thin and transparent, they can be divided in the office. However, extensive adhesions and thick skin bridges require surgical intervention. These can be divided sharply after a period of compression with a hemostat. Skin bridges accounted for nearly 30% of the late complications reported by the Massachusetts General Hospital group [15].

Figure 7

Penile adhesions (a) between the shaft skin and the glans can be manually separated while penile skin bridges (b) cannot be manually separated and need to be excised—skin bridge.
4.8. Meatitis/Meatal Stenosis (Figure 8)
In the absence of the prepuce, the erythema of the meatus commonly occurs after circumcision as a result of irritation. Meatitis is commonly a self-limited problem but can be treated by application of an antibiotic ointment and keeping the area dry. Meatal stenosis has been postulated to be a result of ligation of the frenular artery or from ammoniacal meatitis [2] and account for 26% of the late complications [15]. While the meatus may appear small, it can open adequately during voiding; this explains why most children with meatal stenosis do not present until after toilet training. Surgical treatment is indicated in the presence of symptoms such as deflection of the urine stream, dripping, dysuria, or urgency frequency from inadequate emptying. The treatment is meatotomy or meatoplasty, which can be accomplished under local anesthesia in the office or in the operating room.

Figure 8

Meatal stenosis in a 3 year old circumcised male who presented with a narrow stream.
4.9. Urethrocutaneous Fistula
Urethrocutaneous fistula is a rare complication, but nonetheless has been reported after both Plastibell and Gomco circumcisions [9]. Fistulae may present as an obvious fistulous tract or as a split urine stream. Often this is a result of compression necrosis from a retained Plastibell ring or a direct injury from incorrect placement of the Gomco clamp. Injury to the urethra during any ventral dissection can occur during a “free-hand” circumcision. Delayed flap repair can be done electively after the child's penis has grown enough for good tissue handling.
4.10. Glanular Necrosis/Glanular Amputation
Necrosis of the glans can occur as a result of cautery injury during a Gomco circumcision or from distal migration of an incorrectly sized Plastibell ring [9, 20]. Management of glans necrosis depends on its severity. Mild cases can be managed with local wound care and topical antibiotic ointment and allowing the necrotic skin to slough. Some authors report management of severe cases with suprapubic diversion and delayed urethroplasty [9]. There are rare case reports of complete necrosis of the glans and phallus in which gender reassignment was performed after multiple attempts at staged repair [20]. For this reason, the use of electrocautery is contraindicated in clamp circumcision.
Amputation of the glans occurs extremely rarely, but is a devastating complication of Mogen clamp circumcision. The Mogen clamp or shield seems uniquely susceptible to this particular injury given the surgeon's inability to directly visualize the glans prior to incising the foreskin. Sherman et al. report seven glanular reconstructions after traumatic amputations. The authors reported that minimal debridement and recovery of the amputated tissue were critical to the repair. Simple primary reanastomosis of glanular tissue was possible in 6 of 7 patients, the last patient required urethral reconstruction [26]. The patient's own tissue can remain viable up to 8 hours and used successfully for repair if adequately preserved by wrapping the tissue in moist saline gauze placed in a plastic bag and transported on ice [26].
4.11. Hypospadias
Isolated cases of iatrogenic hypospadias have been reported after the surgeon performed a ventral rather than a dorsal slit prior to initiation of circumcision [27]. It is important that the proper plane be entered for the initial lysis of adhesions so that the meatus is not inadvertently entered and then damaged.
While not technically a complication, failure to recognize a hypospadias prior to circumcision may be problematic if there is insufficient skin for subsequent repair. While most cases of hypospadias are associated with a dorsally hooded prepuce, the megameatus with intact prepuce variant will have a configuration as described in its name. Thorough physical examination is imperative prior to circumcision regardless of the method employed.

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Taken from an online forum…. Cropped to protect speaker and privacy.

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Sooo hermit crabs

So remember a while back when one of our 3 hermit crabs died, I told my boys, and we buried it. A few weeks after the burial I bought 3 small, small hermits.
About a week before our trek from TN to Florida I moved their habitat into a smaller more portable case.
Well we’ve been in FL for about 3 full weeks. At some point in the last 3-4 weeks one of the small crabs had died while buried in the substrate. I thought it may be molting so I tried to give it plenty of time, well I checked today and it was dead dead dead.
This time I did not tell the boys as they had not yet formed attachments to the new small hermits, in fact my hubs thinks I only bought 1 extra hermit do this hermit that died wont be missed by the family. However, I did bury this one and covered it with rocks to protects its “grave”….

On another note, the living hermits are enjoying all sorts of food: rabbit food, dried veg, dried fruit, crab food, cricket food, finch food….. Etc