1 4 Included in these descriptions are patients with proximal diabetic neuropathy, truncal neuropathy, limb mononeuropathies and cranial neuropathies ( Table 1 ). Patients experience losses in sensation, balance, and walking ability, and they are at greater risk for foot ulceration and falls. One of the first symptoms diabetics with peripheral neuropathy notice is a tingling sensation in the feet or toes. It primarily affects the muscles of the thigh and pelvic girdle. However the cidpusa e-book lists the simple protocol which will make the patient fully mobile by day five. Only one article evaluated the postprandial and fasting glycemic index (n = 87), which precluded meta-analysis. Controlling your blood sugar levels is the most important part of treating diabetic amyotrophy. The main features of diabetic amyotrophy are: Weakness of the lower legs, buttocks or hip. Chokroverty S, Sander HW Muscle Nerve 1996 Aug;19(8):939-45. doi: 10.1002/(SICI)1097-4598(199608)19:8<939::AID-MUS1>3.0.CO;2-9. Assistive devices or bracing may be needed depending upon an individual’s degree and distribution Diabetic proximal neuropathy often begins so abruptly that patients can recall the exact day the symptoms began, Dr. Windebank said. It may result from a loss of blood supply to key nerves in the hips and shoulders, from the direct effect of high blood glucose levels on these nerves, or from a combination of both. Aerobic exercises, such as running or swimming, strength training exercises, functional training, and tai chi have all been shown to improve symptoms, whether by decreasing pain and neuropathic symptoms or by increasing function and nerve conduction. These symptoms, although often beginning on one side, can also spread to both sides. Medications may help with the pain. There are a number of ways that diabetes damages the nerves, all of which seem to be related to increased blood sugar levels over a long period of time. Nevertheless, various immunotherapies (eg, corticosteroids and intravenous immunoglobulin (IVIg) have been tried with subsequent improvement in symptoms. There's no quick fix here, though; the study lasted four years. It is characterized by weakness followed by wasting of pelvifemoral muscles, either unilaterally or bilaterally, with associated pain. Electromyography will tell about the denervation or affected nerve. Two out of the five included studies evaluated the muscular strength of LL (Lower Limbs) (n=116), both studies with combined exercises (resistance/balance) versus control, but we could not conduct the meta-analysis of these studies as muscle strength was evaluated in different ways. The condition tends to go on for several months but can last up to three years. Although distal symmetric polyneuropathy is most common type of diabetic neuropathy, there are many other subtypes of diabetic neuropathies which have been defined since the 1800s. Chi Ogawa T, Taguchi T, Tanaka Y, Ikeguchi K, Nakano I Intern Med 2001 Apr;40(4):349-52. doi: 10.2169/internalmedicine.40.349. AAEM case report #13: diabetic amyotrophy. Continue reading >>, DIABETIC NEUROPATHY PART 2: PROXIMAL AND ASSYMMETRIC PHENOTYPES Mamatha Pasnoor , MD, Assistant Professor, Mazen M. Dimachkie , M.D., Professor of Neurology, and Richard J. Barohn , MD, Professor and Chairman Mamatha Pasnoor, Department of Neurology, University of Kansas Medical Center, Kansas City, KS; The publisher's final edited version of this article is available at Neurol Clin See other articles in PMC that cite the published article. Such pain and subsequent weakness may be centralized on one side and gradually move on to the other side also. Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. This condition is usually seen in patients with type 2 diabetes and older adults as well. The condition may come on quickly or more slowly and usually remains asymmetrical (ie the two sides of the body are unequally affected) throughout its course. Muscles are able to burn glucose much more efficiently than fat, therefore physical therapy which … Based on the analysis, our physicians create a personalized treatment plan that can improve the symptoms. Diabetic amyotrophy belongs to the rare neuropathic complications of long term diabetes mellitus especially of the type 2. Diabetic amyotrophy is a rare complication of diabetes compared to distal symmetric polyneuropathy, but can occasionally be encountered in clinical practice, particularly as the incidence of diabetes increases. He also noted a … In most patients with peripheral neuropathy, loss of sensation is directly attributable to kind, severity, and distributed loss of these sensory receptors, nerve fibers, or neurons . Diabetic neuropathy occurs when a person's diabetes is uncontrolled, and is characterized by the malfunction of the nerves in the body. "It depends on where you're starting," says Dace L. Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle. It can also help to build up the strength in the leg muscles again, thus reduce pain and regain mobility. The first to normally occur is peripheral neuropathy . Diabetic amyotrophy is a disabling illness that is distinct from other forms of diabetic neuropathy. There are four types of Diabetes-Related Neuropathy. Continue reading >>, DIABETIC NEUROPATHY PART 2: PROXIMAL AND ASSYMMETRIC PHENOTYPES Mamatha Pasnoor , MD, Assistant Professor, Mazen M. Dimachkie , M.D., Professor of Neurology, and Richard J. Barohn , MD, Professor and Chairman Mamatha Pasnoor, Department of Neurology, University of Kansas Medical Center, Kansas City, KS; The publisher's final edited version of this article is available at Neurol Clin See other articles in PMC that cite the published article. The pain could also affect the shin and feet. The combination of the two occurrences is what causes the amyotrophy to show up and makes it so painful. The symptoms are usually asymmetrical, which means that it will only happen in one side of the body or it is not as intense in one side as it is in the other side. The condition often occurs in middle aged and elderly individuals who may not know that they suffer from diabetes. Because patients usually improve with time, physicians may underappreciate their pain and suffering. ”... only happens during pregnancy. It is … Studies on diabetic polyneuropathy patients with IVIg Pain Med. 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I enjoy looking at deciduous trees in the winter when there are no leaves to disguise their form and interesting bark. I enjoy the colors of fall. But, oh! Spring is upon us here in middle Georgia – we might even say it is half past spring - and it is truly wonderful.
It is a remarkable season with beauty and the promise of more to come in the garden. And I have to say that I have never enjoyed the season as much as I do living here on Elm Street. Of course, there may be an age factor which figures in here: Just being happy to be able to greet another spring. But the work of the eleven years we have put in here also figure in the pleasure Robert and I both derive from this place.
Words can get a bit trite when attempting to sing the glories of spring, so I’ve put together a photo essay of some of the wonders of this season here at Elm Street Gardens. There are roses, iris, evening primrose as well as vegetables and fruits. And, of course, there is the promise of the delights of the summer garden to come.


The first time I saw Alan* I assumed he was tripping on acid.
He was sitting on the steps of the coffee room. He looked out at the street quietly, except for when he would burst into laughter and sentence fragments for no apparent reason, with a wild look in his eyes. I smiled as I passed by him.
The coffee room — a casual local hangout in the small town I had just moved to — was owned by his mother, Anne, and she lived next door to it, in the same building. Alan was a regular fixture there. We learned each other’s names and I quickly understood that he hadn’t been using psychedelics that first time I saw him. Something else was going on.
A few of us would be sitting around having a relatively normal conversation when he’d gaze past everybody and hiss, “Stop it. You stop that, he’s fine. He’s fine! No. You’re crazy.” Followed by a silence, and then his distinctive guffaw. Yaheyyyo!
He had a difficult time staying present in conversations, but some days were better than others. One time he went into his typical arguing-with-nobody pattern, and when he came back to reality he said “I’m sorry, Dana. I don’t mean to be rude. There are people around me that I talk to and I know you can’t see them. I call them my distractions.”
He said it was OK to ask questions about it, which I occasionally did from that point on.
I once witnessed him struggling to use the steam wand of the espresso machine. He grew increasingly distressed as his milk failed to froth. “IT’S FUCKING BROKEN! I BROKE IT!” he shrieked, as he dumped the milk down the drain, refilled his mug, and tried over and over until the gallon was empty.
I’m no psychologist, but based on my observations and his answers to my questions, it was apparent to me that he suffered from schizophrenia.
Major symptoms include hallucinations (often hearing voices), delusions (having beliefs not shared by others), and disorganized thinking. Other symptoms include social withdrawal, decreased emotional expression, and lack of motivation. (wiki)
It seemed that Alan was constantly contending with the distractions that surrounded him. They were often malicious, telling him cruel things, casting doubt on all of his interactions, telling him that he should die.
I was fascinated and disturbed by this, so I did some more research. I watched schizophrenia simulation videos. I joined a subreddit centered on schizophrenia. I asked questions to people who had known Alan for a long time.
His family thought he suffered from “multiple personality disorder” (now known as dissociative identity disorder), a condition in which a person switches between multiple personalities that are not aware of each other. Sometimes his distractions would “possess” him and his voice would sound different, but I saw no sign of personality splitting. He was clearly having hallucinations of external characters which he struggled to distinguish from reality.
I wish I could have known him in his younger days. He’d been a child prodigy of sorts, well known for his captivating singing voice and theatrical performances. He was well-read on the classics, and highly educated.
Then he joined the Navy and went to boot camp, where he faced severe harassment and violence from the other recruits; he was a small man, and probably gay. He came home and was never quite the same. Perhaps this trauma played a role, but schizophrenia tends to claim its victims — about 0.5% of the global population — in their mid-20s regardless of what their life experiences have been so far. It might have happened anyway.
Alan would often walk back and forth on the main street between his mom’s house and his aunt’s house. He paced slowly, stiffly, looking straight ahead, his arms unmoving by his sides. He was often silent, or murmuring things — but as often as not, he’d be screaming at the top of his lungs. “FUCK YOUUU! FUCK YOUUU! NO! I’M SICK OF YOUR SHIT! LEAVE ME ALONE! I’LL FUCKING KILL YOU!”
As violent as his screams became at times, he was peaceful in his actions. I never saw him touch anybody or heard stories of him being dangerous. It was safe to walk past him on the street even in the worst of his episodes, but the tourists didn’t know this, and he had the police called on him many times. They knew him well. The whole town was familiar with him.
Alan used to live next to his mom in a manufactured home, but she converted it to a vacation rental. Sometimes he lived in a hotel room, or in another semi-assisted living situation, but would eventually be evicted under accusations of theft or disruption. Other times he would be arrested and spend time in jail, or in a psych ward, and when he came back he was quiet and sedated because they’d given him a long-lasting anti-psychotic shot. He hated this kind of medication, which made him feel not like himself.
He preferred to self-medicate — with weed and methamphetamine and I don’t know what else. Eventually the anti-psychotics would wear off and he’d be back to screaming obscenities as he paced the streets.
When he wasn’t institutionalized in some way, Alan was my neighbor. I lived in my RV in his aunt’s driveway — she was my co-worker and we got along well. Her house was on a piece of family property which had been divided into several lots. On the other side of my RV, in the backyard of another house in the next lot, was a small, run-down trailer, which lacked running water and other basic amenities. This is where Alan was allowed to live. The trailer was about 50 feet from my RV.
He was a frequent cannabis user, and one day he was asking around at the coffee room like he usually did. Nobody had any to share with him, and they seemed tired of his repetitive mooching. He walked away and I felt bad for him so I caught up with him half a block later. “Hey Alan, I don’t have any weed on me, but come over to my RV and I’ll pack a bowl for you.”
That was the first of many times that he came over to smoke. He rarely stayed longer than 5 or 10 minutes. He’d knock, saying that he just wanted to say hi, and I’d let him in. I could tell he was making an effort to ignore his distractions and have a conversation. I’d ask some question about his day, which was usually a dead end; and before too long he’d ask “hey, can I hit your pipe?” and I’d pack him a bowl, or let him try a resin hit if I didn’t have any flower. We sat in silence a lot, which was fine, then after a few minutes he’d start arguing with the people I couldn’t see. It seemed like they were trying to convince him that I was a threat or that I didn’t want him around. He’d usually get embarrassed, apologize, and leave.
I was conflicted about whether or not I should allow him to smoke with me. I knew cannabis and schizophrenia didn’t mix well. I didn’t want to hurt him, but he knew what he needed better than I did, and he was going to find it from somebody if he wanted it. If it helped him feel better, maybe it was for the best. Besides, he didn’t have many people to spend time with, so at least I could give him a peaceful place to go for 10 minutes and some non-judgmental company.
During one of his visits, when he was in his most lucid state, he looked at me with eyes full of emotion. “Dana, I wanted to say thank you because you’ve always been good to me. And I really appreciate it.”
I wish I had thought of a more meaningful response in that moment, but I probably said something like “yeah, man, of course.” It caught me a bit off guard, and made me feel warm and sad at the same time.
As much as I was glad to provide him a safe space, I’m introverted and the near-daily visits were a bit much for me. I don’t always know how to say no, especially to someone who needs so much and asks so little; how could I justify turning him away in order to maintain a slightly higher comfort level for myself?
But I left town for a couple of weeks and when I came back I told him that I couldn’t smoke him out anymore. I didn’t have any weed left, and I was trying not to smoke it myself, so I’d stored away my pipe and everything. I told him he was still welcome to come over anytime if he wanted to hang out. All of this was true, but I suspected that setting this boundary would stop him from coming over so much. He never came over again, to my memory.
But I still heard him every time he knocked on his aunt Marge’s door. She cared about him, and would say yes to as many requests as she could — Can I have a shower? Some water? Alka-Seltzer? Food? Sure, Alan, come on in. She was there for him.
Yet she didn’t always want to be. She was bad at saying no, too, and at times she felt anxious because she didn’t have the privacy she wanted in her own home. Sometimes he’d come by late at night. He’d ask for a shower and lose track of what he was doing in the bathroom for long periods of time. Sometimes she got frustrated and kicked him out.
One night I was awake at nearly midnight and I heard him shouting outside. “He’s just jacking off! He’s just jacking off! You’re fagging out!” I wasn’t sure if he’d seen motion from my RV when I was walking around, or if it was completely unrelated to me. A few hours later: “NO! You don’t just KILL PEOPLE!” I certainly hoped that debate was not in reference to me. Outbursts like these were common and woke me up at all hours of the night, but I got used to it.
He flew, alone, back to his hometown to visit his father and his old friends. Marge told him, “maybe on this trip you can leave your distractions behind”, which to me was a bit like telling an Alzheimer’s patient they should try not to forget things. From what I heard, he was arrested shortly after landing (I imagine for scaring people on the plane) and he ended up in a psych ward. He was gone for almost a month.
As much as Marge was sorry he’d run into trouble on his trip, she also dreaded the return of his screaming and the unpredictable intrusions into her home. His absence felt to her like a weight lifted — she got her personal space back, her life back.
Another time, Anne took him to be observed for a 24-hour medical analysis. The doctors said they could find nothing wrong with him mentally or physically. Maybe he managed to appear neurotypical for 24 hours, but I doubt it. I’m astounded at how this could have happened. He needed help, and not just mentally.
He complained of intense pain in his stomach, maybe ulcers, which is why he often wanted antacid. He started to look sick. Gray. Old. Stony. He was in agony inside his own body, and the world he lived in was full of evil voices.
It’s not hard to imagine how alone he must have felt. Not a single person could see the world the way he did, and few were willing to try.
One time after a particularly bad episode in Marge’s house, he stood in the driveway and screamed:
EVERYONE JUST WANTS ME TO DIE!
It chilled my blood because, in a sense, I knew he wasn’t wrong. And judging by how much worse he’d been looking, it seemed like it might happen.
Nobody was actively thinking “it’d sure be great if Alan died.” But it was heartbreaking not knowing how to help him, watching him being tormented day after day. Though we felt bad for admitting it, the times when he was institutionalized came as a relief. Someone else was watching over him. We had peace again.
I think if any of us could have lived a day in his life it would have broken us. To be surrounded by sinister apparitions, perceiving them as real, hearing them say critical, threatening things. Of course it’s hard to get in the shower when there is a monster behind the curtain. Any of us might have been yelling in the street, or self-medicating for an escape, in his position.
What is left of life when you take away all meaningful friendships, all pleasure, and even the privacy of your own mind?
There were many times when he was in distress, yelling, and I didn’t come out of my RV. I didn’t know what I could do. I’m not trained in crisis management and maybe any intervention I could have attempted would have backfired.
Maybe I was afraid that if I helped too much, he would become dependent on me and then I would be the one who had a hard time saying no. I had minimal privacy to begin with, living in an RV in a driveway, and if he’d started to come to me with every problem, any illusion of privacy would have vanished.
I didn’t have the perspective of knowing him in his youth. I only knew him for the last two years of his life. This lack of context made it harder to understand his trajectory, but it also let me see him with eyes unbiased by history.
According to Marge, he’d been spoiled growing up; the child prodigy, the popular actor. I guess he had ways of getting what we wanted. Maybe he could be manipulative.
Marge’s theory was that he’d gone to boot camp, been badly harassed and beaten up, and come home with PTSD; he fell into drugs, and maybe now he was exaggerating his problems to garner sympathy. Since he was such a good actor, he could play the role of the madman, he could speak in the weird voices, he could seem crestfallen if you didn’t comply with what he wanted. This sense of mistrust was at odds with her compassion.
Coming into his life at such a late stage, my perception of him was very different. I saw a man who of course wasn’t perfect, and didn’t have amazing coping mechanisms, but was doing his best to get through every day of mental and physical agony. What she saw as manipulation I saw as desperation.
I think Anne and Marge both understood there was a serious mental illness, but it was more comfortable for them to avoid understanding it. If they imagined he was simply acting out, being uncooperative, or perhaps the victim of addiction, they could continue to believe that this was only a hard phase for him and he might simply snap out of it. To fully accept the reality of schizophrenia would have meant coming to terms with the fact that he’d most likely never recover.
I left town for two months and in the middle of my absence I got a text from Marge.
Alan had been found dead in his trailer.
I was told that the autopsy blamed his death on an overdose of sleeping pills. I don’t know if that means it was a suicide, or if it was an accidental lethal combination with other depressants in his system.
Despite the premonitions I described earlier, this came as a shock to me, and I was shaken up for a while. He was only 38.
When I returned to town I talked with Marge about his death. Despite her sadness, it predominantly seemed like she was relieved by it, the same as when he’d been out of state. He was done hurting, he was in a better place now, and she could get on with her life.
Anne had a medium friend who told them she had talked to his spirit, and that he was happy for the first time in years, which gave them comfort.
As an atheist, that looked like an easy coping mechanism to me, a way to feel better about a situation that really has no upside. But was the sentiment wrong? His soul might not have gone anywhere better after death, but at least his tremendous suffering had ended.
Instead of a typical memorial service, a mourning parade of sorts was organized. 75 or 100 of us congregated to trace his typical route, the three blocks between his aunt’s house and his mom’s house, led by a small marching band. I stopped trying to hide the tears as they rolled down my face, both from the injustice of his life and from the intimacy of this community remembrance. After stopping at Anne’s house we proceeded to his favorite bar, where stories were told and more music was played by people who had known him for years.
I was distressed that his family seemed so happy and relieved in the wake of his death. But I had to entertain the question: When is death an acceptable solution to health problems that have no foreseeable route to recovery? How long should we expect people to fight? Where’s the balance between holding on to hope of recovery and simply putting an end to the misery?
These are the kinds of questions philosophers have disagreed about for a long time, and I don’t have any new insights to contribute.
One side of me is appalled by his obvious mistreatment. Alan was relegated to a dingy old trailer in a backyard while his mother rented out his old home to tourists, and it didn’t seem like this was strictly necessary for her own financial security, as she owned other properties and frequently enjoyed going on yoga retreats. She failed to understand his condition and connect him with the kind of help he needed. For all that she claimed to care, and all the ways she did try, Alan’s needs ultimately went neglected, and he died.
Yet I can also see it from a completely different perspective. I’m pretty close with Marge and I know that she has a compassionate heart. She did care about him. That’s why I stayed silent when she expressed her relief at his death, despite how wrong it felt. A lot of people who have his condition, and his history of drug abuse and jail time, end up abandoned by their families (and all of society) to live homeless on the street, where they are seen as the scum of the earth. While their treatment of him was not perfect, at least they were present and involved throughout all of his trials, which is more than can be said for many families.
At least in this small town, he could walk around familiar places, have interactions with people who knew him, and mostly be left alone even when he was screaming scary stuff. At least the police knew his history and could treat him more gently. At least he had a consistent place to sleep, and Marge could give him showers and meals.
So do you blame people for not doing better, or do you appreciate them for doing as much as they did?
I question my own culpability, too.
I could have sent the schizophrenia-simulation videos to his family so they would understand him better. There was nothing to stop me from cooking meals for him and bringing them over, or figuring out some activity that he liked to do and inviting him over regularly — or simply allowing him to continue smoking weed in my RV. Maybe I should have tried walking next to him in his most difficult episodes. It wouldn’t have saved his life, but it might have made things better.
Others have described a similar feeling of guilt, because we failed him as a community, because we crossed the street when we saw him coming, because we thought his suffering was inconvenient.
If that guilt drives us to ask ourselves how we can help the countless others who are still struggling around us, I think it is not misplaced.
Our community failed to find good solutions for Alan, but I don’t view that as purely our own fault. We’re part of a much bigger societal system that fails mentally ill people on a daily basis, through stigmatization, lack of awareness, and poor access to treatment. It’s not the family’s fault that an assisted living situation would have been prohibitively expensive, or that there wasn’t a better healthcare system in place to find a medication that could have worked for him.
It’s good to care for each other as much as we can, but we also need to ask more questions about the root cause of the problem.
Why do people fall through the cracks of our medical system and end up misdiagnosed for years and years?
Why does our society allow our most vulnerable people to endure homelessness, neglect, and early death instead of matching them with the housing and care programs they need?
What is it about our culture that leads Americans with schizophrenia to hear antagonistic, violent voices, while people with the same disease in other cultures tend to hear neutral or even benign voices?
As for myself, I hope that in the future I will be more willing to go out of my way to ease the pain of those around me.
I will remember Alan every time I walk down that small town’s main street. I’m glad his misery is over, but I will always wish we could have gotten our act together and helped him live a good life instead.
*All names have been changed to protect the identities involved in this true story.


I would love to connect with your further and explore all things mom life, raising readers, book love, child development and more! Please come join with me in my Facebook community, on Instagram and check out my Usborne Books and More bookstore to find the best reads for your littles.
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Long COVID Studies in Dallas, TX
A Longitudinal Study of COVID-19 Sequelae and Immunity: Baseline Findings
A substantial proportion of persons who develop COVID-19 report persistent symptoms after acute illness.
Study Identifies Four Major Subtypes of Long COVID
The study, published Dec. 1 in Nature Medicine, was the largest of its kind to examine long COVID.
Studies show long-haul COVID-19 afflicts 1 in 4 COVID-19 patients, regardless of severity
Doctors have been estimating one-quarter to one-third of COVID-19 patients become long haulers, as many patients call themselves.
Characterizing long COVID in an international cohort: 7 months of symptoms and their impact
A significant number of patients with COVID-19 experience prolonged symptoms, known as Long COVID.
Most COVID-19 patients recovered with low mortality; however, some patients experienced long-term symptoms described as “long-COVID” or “Post-COVID syndrome” (PCS).
Long COVID is an often debilitating illness that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. More than 200 symptoms have been identified with impacts on multiple organ systems.
Submit a study for review
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When I picture my mom’s hands, what do I see? I see hands that took care of me when I needed it the most. I see hands that worked to make our house a home that was comfortable and safe. And I see her diamond engagement ring that she treasured and wore every day.
I picture my father carefully choosing a ring that would look beautiful on her lovely hands. I picture him presenting the ring to her with hope in his eyes. And I picture her joyfully accepting this gift of his love.
Now that mom is gone, I treasure her engagement ring and the memory of her hand wearing that ring that was exactly her style.
But, it is not my style. I have tried it on my fingers. I have tried to love it for me. But I don’t. So it has stayed in a box. For years. Until now.
With several years of separation from the heartbreak, I am now ready to love her diamond in a new way. I am ready to honor her memory in a beautiful new piece of jewelry that will bring me joy whenever I wear it. I just don’t know what is possible. Fortunately, I know someone who does.
Meet Tara Goodman, in-house goldsmith at Henry Wilson Jewelers in Central New York. It is so difficult to trust someone with something as valuable as your mother’s diamond. Tara knows how many feelings and memories are tied up in our family heirloom jewelry. And she takes her responsibility very seriously. In addition, Tara has an amazing eye as a designer and exceptional skill creating custom jewelry.
So here I go. I shall turn over mom’s diamond to Tara and give it new life. I shall have courage and trust in her expertise. And I shall turn a ring that reminds me what I have lost, into a pendant that will forever remind me how lucky I was to have my mom for 54 years of my life. It will be a joyful pendant that honors my mom.
Think about what is in your jewelry box that could have a joyful, new life. And let it out of the box. It is time.
By: Kris Gold


© 2019 Andy.Church
CALL TO WORSHIP
God’s Spirit has been poured upon all flesh. That Spirit rests upon us like
flames of fire,
That we may be light in the world’s darkness, and warmth in the
The Spirit has been poured upon us like a mighty wind, refreshing us in
love and renewing us in strength.
And leading us to serve in love. The Spirit has been poured upon us!
Let us worship God!
PRAYER OF PRAISE
God of love and hope and peace, on this Pentecost Sunday we praise you for the
gift of your Holy Spirit which comes upon all your people. Open us to the power
of the Holy Spirit, that the boldness of your Spirit would transform us, that the
gentleness of your Spirit would lead us, that the gifts of your Spirit would be our
strength, now and always. We pray in Jesus’ name. Amen.
(refrain) Spirit, spirit of gentleness, blow through the wilderness, calling and free,Spirit,
spirit of restlessness, stir me from placidness, wind, wind on the sea.
You moved on the waters, you called to the deep,then you coaxed up the mountains
from the valleys of sleep;and over the eons you called to each thing;“Awake from your
slumbers and rise on your wings.”
You swept through the desert, you stung with the sandand you goaded your people with
a law and a land;and when they were blinded with idols and lies,then you spoke through
your prophets to open their eyes. (refrain)
You sang in a stable, you cried from a hill,then you whispered in silence when the whole
world was still;and down in the city you called once again,when you blew through your
people on the rush of the wind.
You call from tomorrow, you break ancient schemes.From the bondage of sorrow all the
captives dream dreams;our women see visions, our men clear their eyes.With bold new
decisions your people arise. (refrain)
PRAYER FOR ILLUMINATION
Spirit of the Living God
Spirit of the living God, fall afresh on me. Spirit of the living God, fall afresh on meMelt
me, mold me, fill me, use me. Spirit of the living God, fall afresh on me.
OLD TESTAMENT LESSON
NEW TESTAMENT LESSON
What Does This Mean?
AFFIRMATION OF FAITH
From a Brief Statement of Faith
We trust in God the Holy Spirit, everywhere the giver and renewer of life. The
Spirit justifies us by grace through faith, sets us free to accept ourselves and to
love God and neighbor, and binds us together with all believers in the one body
of Christ, the Church. The same Spirit who inspired the prophets and apostles
rules our faith and life in Christ through Scripture, engages us through the Word
proclaimed, claims us in the waters of baptism, feeds us with the bread of life and
the cup of salvation, and calls women and men to all
Previous Bulletins May be Found HERE


“To Develop A Love Of Reading”
Recommended Book Lists:
We are passionate about reading at Holt Farm Junior School.
We believe that being able to read is the backbone of education across all subjects as it significantly impacts one’s success in school and beyond. Reading provides endless opportunities for children to explore a wealth of worlds which exceed their own experience. It can take children into the past where they can harness an additional love of history, span countries and continents which can help develop an understanding of the geographical world and even into the future and imagined worlds which help to create a love of critical and creative thinking. The power of reading is incredible and, as a school, our desire is for children to be able to understand and take advantage of all the benefits and enjoyment reading offers. We wish to develop everyone’s attitudes towards reading as a positive and exciting experience that can be shared with friends and family. We aim for every child to harness a love of reading where they think of themselves as a reader and enjoy listening to and discussing the written word within the community. We wish for our community of readers to share and enjoy their critical and creative thinking skills which develop through this incredible past time.
We teach reading in a variety of ways at Holt Farm Junior School; this includes but is not limited to whole class teaching, close text analysis, picture inference, systematic synthetic phonics teaching, shared, peer and 1:1 reading. Furthermore, all classes have high quality texts read to them throughout the year.
Reading to the Children
Our goal is to motivate children to want to read so they will practice reading independently and become fluent readers. That happens when children enjoy reading, so we advertise the subject by reading great stories and poems. Throughout every day, class teachers will read and share high quality texts at a level which is slightly beyond their reading age. This ensures that we continue to develop their vocabulary and understanding of characters and plot beyond their reading level. It also gives them access to worlds and experiences different to their own.
At Holt Farm Junior School, Reading VIPERS are used to support children with their reading comprehension skills. VIPERS are a range of reading prompts based on the 2016 reading Content Domain Areas (CDAs) found in the National Curriculum Test Framework. Each classroom will have the Reading VIPERS displayed in the reading area of their classroom and the class teacher will make explicit links to the skill the children will be learning about. This gives all children across the school a common language to discuss their reading knowledge and understanding.
All children will be working on VIPERS during class reading, whether it is reading as a class, in a small group, or one-to-one with an adult. It would be fantastic if parents could also be referring to VIPERS when they listen to their child read at home. All children are given a VIPERS bookmark which has a range of question prompts based on each reading skill. Children and parents can use this to help ask in-depth questions. If your child loses or needs a new bookmark, please let your teacher know.
During reading sessions, children will be reading a class book which correlates with themes taught throughout each half-term’s topic - these books will change every half-term. Children will focus on a series of reading activities based from these books which focus on the content domain areas. Sometimes these reading sessions may focus on all of the content domains at once and some sessions will also focus purely on one specific domain. Children will have one session a week where inference skills are taught purely based on a picture(s) where opportunities are given to discuss: what they see; the significance of specific objects or expressions; and discuss what could have led up to the moment we see in the picture. Children will be given at least one thirty-minute free reading session a week where they are encouraged to read their own or a school book for pleasure. This is to ensure children have the opportunity to develop their love of reading without the constraints of a comprehension question-and-answer style in other sessions. Children will be listened to by an adult every week in a small group setting. Additionally, children will be listened to by an adult on a 1-1 basis at least once every two weeks, with follow up comprehension and vocabulary tasks. The sessions are organised as follows:
Developing Readers (Year 3)
Upon entry in the Autumn term, Year 3s are assessed on their Systematic Synthetic Phonics (SSP) knowledge. Children are put into ability groups based on their needs and are reviewed continuously (see SSP section for more information). During this time, VIPERS skills are taught in some English lessons and in some instances, in additional reading sessions so all children are introduced to the VIPERS style. For those children who do not need additional phonics support, they will follow VIPERS sessions upon entry in their ability group. As the school year continues, more Year 3 children will be having daily VIPERS sessions and less will be having phonics sessions. In the VIPERS sessions, children will complete two reading tasks each week, with adult support time with both the teacher and teaching assistant, which require a written response and focus upon comprehension using the VIPERS approach. The evidence from these sessions will be collected to inform next steps. Children will also have one session in which they are able to read for pleasure, one session where they have a discussion about a picture(s) and one SSP session where the children continue to develop and maintain their phonics skills.
Fluent Readers (Year 4, Year 5, Year 6)
The children will have five sessions throughout the week, which they will rotate around. Two of the sessions will be VIPERS reading domain questions based on the class text. This will have the dual purpose of children reading and absorbing the text, as well as orally rehearsing answers to key questions linked to a VIPERS focus. They will then work with a teacher to discuss the key questions and unknown vocabulary that has arisen from their reading. One session will be picture inference based and there will be one session where children will free read. The fifth and final session is an opportunity for children to revisit particular learning from any of the previous sessions within the week and will change weekly based on children’s needs. It could be an additional VIPERS, picture inference, free reading or even an assessment session.
VIPERS can be used on any text that a child is reading, as well as on pictures, picture books and films. When any adult is listening to a child read, all they have to do is think of questions about the book/picture/film that cover all of the VIPERS, and there are great examples below of how you can create your own questions using the following question openers.
Systematic Synthetic Phonics (SSP)
All children’s phonics ability is assessed when they join us in Year 3 and are put into ability groups to reflect their needs. Read, Write, Inc. is the main phonics scheme followed and children are continuously assessed on their understanding. For those identified as needing additional support, Lexia interventions are offered where children receive individualised and teacher-directed personalised learning through adaptive and engaging online activities. Children are able to access this at home to further enhance their learning. For those children who do not need additional phonics support upon entry follow the VIPERS sessions in their ability groups.
Marking & Feedback
Feedback and marking should be completed, where possible, within the lesson. All marking and feedback is given in line with our marking and feedback policy where successes are highlighted and next steps provided for children to action.
Teachers will use their professional judgement to determine whether a child is working within age-related expectations, above or below at the end of each half-term. They will base their judgements on Target Tracker statements such as how well a child is reading phonetically, changes of intonation to reflect the mood of what is being said, discussion based on what has been read, and verbal and written answers based on VIPERS. In addition to the aforementioned formative assessment, there will also be a range of summative assessments which will be conducted through NFER and other tests each half-term. The two of these combined will be used to officially assess children and identify next steps.
Pupils will enjoy reading and will be inspired by fiction and non-fiction across the curriculum.
· Pupils will have a wide vocabulary and learn new literary devices that they use within their own speech and writing.
· Pupils of all abilities will be challenged so that they can achieve not only a good reading and comprehension level, but also a deeper understanding of literary devices authors use across all genres.
· Pupils will leave school with a wealth of high level vocabulary and an appreciation for books.
· Parents and carers will have a good understanding of how they can support reading at home, and contribute regularly to homework
· The % of pupils working at ARE within each year group will be at least in line with national averages.
· The % of pupils working at Greater Depth within each year group will be at least in line with national averages
· There will be no significant gaps in the progress of different groups of pupils (e.g. disadvantaged vs non-disadvantaged).


Remember that old school companion that always hung somewhere around you. That innocent smiling face that always looked at you with kind eyes, full of hope love and compassion. Remember that all comforting embrace, those words slowly rolled into your ears. The familiar touch. The everlasting scent of someone that lasts just a while longer than it should. Remember feeling oddly familiar in a place you’ve never been before. Our senses play games that our minds can comprehend. It is a language not spoken, only felt.
Scarves are crowns draped around necks. They are the least functional yet most important garment in your wardrobe, serving perhaps the only purpose of lighting up your outfit with the beauty and art. Scarves are canvases to your face. They are the frames of your portrait and cradles of your chin. They are your familiar friend. Their hug is their loving embrace. Their scent lingers a while after you’ve left the room. Woven in textures that sing songs of passion, art and beauty. Fitting into your purse or nonchalantly draped around your shoulders, scarves are quiet reminders of the woman you are. They are silent announcements of style and loud symbols of comfort, wellness and prosperity.
-Team Pashtush India


Let’s face it: I’m scared, scared and frozen. First, I guess, I’m afraid for myself … the old primitive urge for survival. It’s getting so I live every moment with terrible intensity. Last night, driving back from Boston, I lay back in the car and let the colored lights come at me, the music from the radio, the reflection of the guy driving. It all flowed over me with a screaming ache of pain… remember, remember, this is now, and now, and now. Live it, feel it, cling to it. I want to become acutely aware of all I’ve taken for granted. When you feel that this may be the good-bye, the last time, it hits you harder.
Sylvia Plath, The Unabridged Journals of Sylvia Plath (via viviling)


Torrential downpour. What. The. Fuck.
Really? Isn’t it June? Boston, $#&^@!!! New England weather.
I try to figure my way to work. Charliecards, I still know how to work them. Train or bus? Which will it be? Let’s go for bus; it’ll be quicker.
Big mistake. Traffic was bad, but not as bad as Manila or Bangkok so I’m not even going to complain. I watch the numbers on the clock at the front of the bus. Minutes after minutes after minutes passed. I stood, of course, soaked on a crowded bus filled with wet people. I couldn’t even enjoy the view out the rain-covered windows of the 1 bus. All I could think of; the day can’t get any worse than this.
I walk straight to the office, sheepishly stared at the bosses. Over an hour late, my first day back.
Michael, my travel partner/former-roommate/co-worker/friend forever, just as late as I was shakes his disapproval at me; soaking wet, disheveled. But there was that smirk. Nothing really changes.
I work through my shift. Easy. I don’t bother remembering the new people that were introduced to me. Are you kidding? I get caught up with the gossip. Who broke up. Who got together. Who quit. Who got fired. Say what? Guy came to work drunk then walked out with a guests’ credit card? Fantastic. What else?
Close to midnight and I get phased.
The end of the night finally came and that’s when it really began. Everyone’s going to the party, right? Hurried nods, and shouts of confirmation from across halls as most everyone rushes through the final details of the last minute things to do. Fuckin’ sidework. If you don’t already understand, you never will. I hurriedly paint my face, threw off my uniform, undid my pony, and make my way over to the bar. I’d never been here before. It looked cute. Mini-bar it was called. How perfect. One section was closed off for our use, but we overflowed every which way. The waitress kept the Martini’s in my hand coming. I meet new people. I see the old ones. Everyone was mad, mad drunk, mad rolling, mad high, mad happy. There was a theme, but I didn’t get the memo. Most everyone at least paid attention to it and at least half of them stuck to the black and white dress code.
There he was, the belle of the ball. Phillips had a black vest and a short black veil. He goes and he comes. Center of attention and he’s loving it.
I keep mostly quiet, stick with my favorite people. The music’s good, the drinks even better. Six months I hadn’t been with this crowd. I think I must have forgotten. I feel almost a stranger, but not quite. Everyone knew me, but did they? Then there’s that whole thing with Michael. Maybe be doesn’t feel weird. But I do. That confession was brutal. Vulnerability is not something I’m comfortable with. Thank all the gods for the liquid miracle in my hand. Thank god, there’s always too many of us. Eye-contact with him was practically impossible.
Who was I staying with tonight? Melissa, wasn’t it? She’d been disappearing now and again, screaming about her keys.
“She had too much vodka,” Lohan explains. Nothing further.
Night was young, I’ll figure out where I’m staying when the time comes. Boston felt fresh from the rain. I step out for a quick smoke and meet interesting new characters. Conversations move from and about tattoos, work shit and Florida. Of course. I had stopped paying attention to the words and I didn’t notice most had gone back inside. I stared at the wet asphalt, the blurred glimmer of lights, the twinkling of streetlamps. Small groups of people, walk up and down. Lost in their own little worlds, having their own fun. Every now and then, drunken obscenities are screamed. God, I love this city. A group of my friends, stumble out of the bar, and down into the club in the basement next door. Loud, laughing, obnoxious. The best people you’ll ever meet.
When the music stopped, I grab a ride with Melissa’s roommate and I meet his girlfriend. But I apparently we’d already met before. We drive down Storrow Drive, right along the river, I look at the dark, peaceful shimmering water and I get a message; Melissa went home with another friend. I guess, I’ll have her bed for myself.


Repeat infections of the sinuses treated with antibiotics about 4 or more times year is called Recurrent Acute Rhinosinusitis. When and how extensive surgery might be for this entity is controversial. This condition can be treated with ongoing observation and medical management or surgery. It’s not unreasonable to follow such patients and determine if they truly have recurrent acute sinusitis as their history suggests. Dr. Khetarpal conducted research on a small number of such patients examining their CT scans during an acute infection and their results with balloon sinuplasty. This research was summarized in five presentations at the International Meeting of Rhinology in Chicago, June 5-9.


Ain’t it something when everything falls apart? The ground you build upon determines if you’ll fall. It’s slow motion as I watch it from the hall all come undone. It’s the past that leaves you on the floor.
" I’m in love with the parts of you that have the power to completely destroy me "


A special thank you to Mandi Gerwig and Sarah Brown
for your donations to our Easter Party!
Have a blessed Spring Break! Happy Easter!!
See you Monday, April 4!
Our school Literature Fair is on Tuesday, September 25 . Grandparent's Day will be on Friday, September 28 ! There will be ...


The Convergence Insufficiency Treatment Trial (CITT) was a National Eye Institute funded nationwide study that compared various treatments for convergence insufficiency, the most common eye muscle disorder.
The study involved pediatric optometrists and ophthalmologists, and Dr. Gallaway was the Principal Investigator at one of the sites, the Pennsylvania College of Optometry at Salus University. The study results published in 2008 showed that the most effective treatment for convergence insufficiency is office based vision therapy, which is the treatment offered at our office. Home based treatments were no more effective than placebo therapy.
CITT is the most extensive scientific study of vision therapy done to date.
Children in the study who were successfully treated were followed for a year and the results showed that the improvements were long lasting. Children who were successful also showed improvement in academic behaviors such as completing homework and classroom work, as well as attention span and willingness to read.
A Cochrane Review of evidence based treatment for convergence insufficiency reviewed numerous studies and concluded that office based vision therapy is the best treatment. Also, the recent CITT-ART also showed that vision therapy is much more effective than placebo in improving the signs and symptoms of convergence insufficiency.
COVD is the College of Optometrists in Vision Development, the professional organization that board certifies optometrists in vision therapy. COVD has compiled extensive bibliographies of research on vision therapy, vision and learning, vision-based reading problems, and brain injury/concussion.
Clinical Practice Guidelines from the American Optometric Association detail the research support for the care of patients with amblyopia, strabismus, learning-related vision problems, and accommodative and vergence dysfunction.


Emily Dickenson once wrote:
I never saw the moor,
I never saw the sea:
Yet know I how the heather looks,
And what a wave must be.
I never spoke with God,
Nor visited in heaven;
Yet certain am I of the spot
As if the chart were given.
When I would recite that, it was unfathomable to me that someone should have never smelled the salty, briny air of a coastline or not have heard the rush and crash of waves upon the shore.
I am completely enamored with the ocean and her offerings. I am simply grateful to live close to these waters.
~ A day at El Matador Beach this past December.


I offer professional writing
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“Tim’s writing skills coupled with an understanding of business goals makes Tim a great person to work with. He always contributes to key objectives in meaningful ways. A real team player, creative, and insightful.”
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“Tim was an incredible mentor to me in refining my novel. He offered countless recommendations concerning content, style, and in the format my manuscript. He also offered sound advice about approaching agents and publishers in a professional manner. His extraordinary patience in working with me was most evident by his immediate responses to my barrage of emails, always asking for ever more advice and information. I highly recommend Tim as a knowledgeable resource for anyone fortunate enough to benefit from his expertise.”
– Jerry Miller, Owner, Find-it Fast Books
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A Difference in Values Â The House of Wang Lung rose in one generation from a family of poor farmers to a wealthy respected house in the novel The Good Earth by Pearl Buck. The dramatic change in social status causes the sons of Wang Lung to have different views and values from their father. His different treatment of each son also shapes each character. Although part of the same family the charachters demonstrate a difference in values. The father values the land, the youngest son values regognition, the middle son values wealth, and the eldest son values respect. Â As a result of his impoverished upbringing, Wang Lung values the land more than anything else. His obsession with the land causes him to neglect his family. The youngest son receives no attention and Wang Lung's plan to have him work the land disturbs him and makes him feel like a peasant. He feels that he has to prove that he is as great as his brothers and leaves the family to join the army. The middle son watches as his inheritance passes from his father's hand into the hand of his eldest son, and complains that his share is always too small. He wants to save the families money. The eldest son receives more attention and is given more than the other two sons and wants to be respected as a great family. Â Â The eldest son receives more attention and is given more than the other two sons and wants to be respected as a great family. Wang Lung is proud of his first born son, Nung En, and gives him more than his other two sons. One example is when Wang Lung becomes distressed because he cannot read the contracts he is signing and does not want to sign a bad deal. He hopes that sending the elder son to school to learn how to read will solve this problem. The elder son is no longer needed in the fields, because Wang Lung can now afford men to work the land. However, he ignores sending his other children to school until later. Â The eldest son's greatest desire is to have his family viewed as a great house. His wife, the daughter of the grain merchant Lui, Boggs 2 grew up in a rich house, she is accustomed to wealth and respect from others, and contributes to her husband's desire. He takes Wang Lung's silver bit by bit to mend up the old House of Hwang.
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