Vaping-the new hype


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Vaping is the new trend in the smoking population. What is it you ask? It is the inhalation of “vapor” that is produced by an electronic nicotine delivery system (ENDS). It has been touted to be a safer way to smoke or a means of quitting the nicotine habit. In reality, this is quite the opposite. Before FDA began regulation of the ENDS and products, it was becoming very popular among our teenage population due to the different flavors available, ease of availability, and thought process that it is harmless. National Youth Tobacco Survey found from 2011 to 2015 an increase in use from 0.6% to 5.3% in middle school and 1.5% to 16% in high school.

First and foremost, vaping is NOT harmless. The vapors emitted have many harmful substances that are dangerous to the lungs. Even if the product claims not to have nicotine, studies have found low levels of nicotine. These solutions also contain carcinogens, aldehydes, metals, volatile  organic compounds, diethylene glycol 1% (used in antifreeze), and several other hard to pronounce substances. The flavored solvents that were advertised as safe by FDA were actually approved for ingestion and were never meant to be inhaled-they are respiratory irritants.

The liquid cartridges that were first sold were not child resistant. These cartridges could contain of up to 30ml of flavored liquid with nicotine. It only takes 2ml of this liquid to be lethal to a small child!

The good news is as of 2016, FDA has better regulation on these vaping products. It is now prohibited to be sold to minors, must be labeled with ingredients and risks, and must be in child proof containers.  Due to the enticing flavors though, teenagers are likely to try and become addicted to these vaping devices. We encourage you to talk with your teenager about the risks of vaping. If anyone in your home is vaping, we implore you to keep products locked up and away from little ones who could ingest these dangerous products.


Here is the AAP policy statement on vaping.


Back to School



back to school

We hope everyone is adjusting to your back to school routine!!! This can make for an anxious few days but here are some tips that may help!

The following health and safety tips are from the American Academy of Pediatrics (AAP). Feel free to excerpt these tips or use them in their entirety in any print or broadcast story, with acknowledgment of source.

  • If your child seems nervous, remind your child that there are probably a lot of students who are uneasy about the first day of school. This may be at any age. Teachers know that students are nervous and will make an extra effort to make sure everyone feels as comfortable as possible.
  • Point out the positive aspects of starting school to create positive anticipation about the first day of class. She’ll see old friends and meet new ones. Refresh her positive memories about previous years, when she may have returned home after the first day with high spirits because she had a good time.
  • Find another child in the neighborhood with whom your student can walk to school or ride on the bus.
  • If it is a new school for your child, attend any available orientations and take an opportunity to tour the school before the first day.
  • If you feel it is needed, drive your child (or walk with her) to school and pick her up on the first day.


  • Choose a backpack with wide, padded shoulder straps and a padded back.
  • Pack light. Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back. The backpack should never weigh more than 10 to 20 percent of your child’s body weight.  Go through the pack with your child weekly, and remove unneeded items to keep it light.
  • Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles.
  • Adjust the pack so that the bottom sits at the waist.
  • If your school allows, consider a rolling backpack. This type of backpack may be a good choice for students who must tote a heavy load. Remember that rolling backpacks still must be carried up stairs, they may be difficult to roll in snow, and they may not fit in some lockers.


Review the basic rules with your student:

School Bus

  • Children should always board and exit the bus at locations that provide safe access to the bus or to the school building.
  • Remind your child to wait for the bus to stop before approaching it from the curb.
  • Make sure your child walks where she can see the bus driver (which means the driver will be able to see her, too).
  • Remind your student to look both ways to see that no other traffic is coming before crossing the street, just in case traffic does not stop as required.
  • Your child should not move around on the bus.
  • If your child’s school bus has lap/shoulder seat belts, make sure your child uses one at all times when in the bus. (If your child’s school bus does not have lap/shoulder belts, encourage the school system to buy or lease buses with lap/shoulder belts).
  • Check on the school’s policy regarding food on the bus.  Eating on the bus can present a problem for students with allergy and also lead to infestations of insects and vermin on the vehicles.
  • If your child has a chronic condition that could result in an emergency on the bus, make sure you work with the school nurse or other school health personnel to have a bus emergency plan.


  • All passengers should wear a seat belt or use an age- and size-appropriate car safety seat or booster seat.
  • Your child should ride in a car safety seat with a harness as long as possible and then ride in a belt-positioning booster seat. Your child is ready for a booster seat when she has reached the top weight or height allowed for her seat, her shoulders are above the top harness slots, or her ears have reached the top of the seat.
  • Your child should ride in a belt-positioning booster seat until the vehicle’s seat belt fits properly (usually when the child reaches about 4′ 9″ in height and is between 8 to 12 years of age). This means that the child is tall enough to sit against the vehicle seat back with her legs bent at the knees and feet hanging down and the shoulder belt lies across the middle of the chest and shoulder, not the neck or throat; the lap belt is low and snug across the thighs, not the stomach.
  • All children younger than 13 years of age should ride in the rear seat of vehicles. If you must drive more children than can fit in the rear seat (when carpooling, for example), move the front-seat passenger’s seat as far back as possible and have the child ride in a booster seat if the seat belts do not fit properly without it.
  • Remember that many crashes occur while novice teen drivers are going to and from school. You should require seat belt use, limit the number of teen passengers, and do not allow eating, drinking, cell phone conversations even when using hands-free devices or speakerphone, texting or other mobile device use to prevent driver distraction. Limit nighttime driving and driving in inclement weather. Familiarize yourself with your state’s graduated driver’s license law and consider the use of a parent-teen driver agreement to facilitate the early driving learning process. For a sample parent-teen driver agreement, see


  • Always wear a bicycle helmet, no matter how short or long the ride.
  • Ride on the right, in the same direction as auto traffic and ride in bike lanes if they are present.
  • Use appropriate hand signals.
  • Respect traffic lights and stop signs.
  • Wear bright-colored clothing to increase visibility. White or light-colored clothing and reflective gear is especially important after dark.
  • Know the “rules of the road.”

Walking to School

  • Make sure your child’s walk to school is a safe route with well-trained adult crossing guards at every intersection.
  • Identify other children in the neighborhood with whom your child can walk to school.  In neighborhoods with higher levels of traffic, consider organizing a “walking school bus,” in which an adult accompanies a group of neighborhood children walking to school.
  • Be realistic about your child’s pedestrian skills. Because small children are impulsive and less cautious around traffic, carefully consider whether or not your child is ready to walk to school without adult supervision.
  • If your children are young or are walking to a new school, walk with them or have another adult walk with them the first week or until you are sure they know the route and can do it safely.
  • Bright-colored clothing will make your child more visible to drivers.


  • Studies show that children who eat a nutritious breakfast function better. They do better in school, and have better concentration and more energy.
  • Most schools regularly send schedules of cafeteria menus home and/or have them posted on the school’s website. With this advance information, you can plan on packing lunch on the days when the main course is one your child prefers not to eat.
  • Many school districts have plans which allow you to pay for meals through an online account.  Your child will get a card to “swipe” at the register. This is a convenient way to handle school meal accounts.
  • Look into what is offered inside and outside of the cafeteria, including vending machines, a la carte, school stores, snack carts and fundraisers held during the school day.  All foods sold  during the school day must meet nutrition standards established by the US Department of Agriculture (USDA). They should stock healthy choices such as fresh fruit, low-fat dairy products, water and 100 percent fruit juice.  Learn about your child’s school wellness policy and get involved in school groups to put it into effect.
  • Each 12-ounce soft drink contains approximately 10 teaspoons of sugar and 150 calories. Drinking just one can of soda a day increases a child’s risk of obesity by 60%. Choose healthier options (such as water and appropriately sized juice and low-fat dairy products) to send in your child’s lunch.


Bullying or cyberbullying is when one child picks on another child repeatedly. Bullying can be physical, verbal, or social. It can happen at school, on the playground, on the school bus, in the neighborhood, over the Internet, or through mobile devices like cell phones.

When Your Child Is Bullied

  • Alert school officials to the problems and work with them on solutions.
  • Teach your child when and how to ask a trusted adult for help.
  • Recognize the serious nature of bullying and acknowledge your child’s feelings about being bullied.
  • Help your child learn how to respond by teaching your child how to:
    1. Look the bully in the eye.
    2. Stand tall and stay calm in a difficult situation.
    3. Walk away.
  • Teach your child how to say in a firm voice.
    1. “I don’t like what you are doing.”
    2. “Please do NOT talk to me like that.”
    3. “Why would you say that?”
  • Encourage your child to make friends with other children.
  • Support activities that interest your child.
  • Make sure an adult who knows about the bullying can watch out for your child’s safety and well-being when you cannot be there.
  • Monitor your child’s social media or texting interactions so you can identify problems before they get out of hand.

When Your Child Is the Bully

  • Be sure your child knows that bullying is never OK.
  • Set firm and consistent limits on your child’s aggressive behavior.
  • Be a positive role mode. Show children they can get what they want without teasing, threatening or hurting someone.
  • Use effective, non-physical discipline, such as loss of privileges.
  • Develop practical solutions with the school principal, teachers, , school social workers or psychologists, and parents of the children your child has bullied.

When Your Child Is a Bystander

  • Encourage your child to tell a trusted adult about the bullying. Encourage your child to join with others in telling bullies to stop.
  • Help your child support other children who may be bullied. Encourage your child to include these children in activities.


  • During early and middle childhood, youngsters need supervision. A responsible adult should be available to get them ready and off to school in the morning and supervise them after school until you return home from work.
  • If a family member will care for your child, communicate the need to follow consistent rules set by the parent regarding discipline and homework.
  • Children approaching adolescence (11- and 12-year-olds) should not come home to an empty house in the afternoon unless they show unusual maturity for their age.
  • If alternate adult supervision is not available, parents should make special efforts to supervise their children from a distance. Children should have a set time when they are expected to arrive at home and should check in with a neighbor or with a parent by telephone.
  • If you choose a commercial after-school program, inquire about the training of the staff. There should be a high staff-to-child ratio, trained persons to address health issues and emergencies, and the rooms and the playground should be safe.


  • Create an environment that is conducive to doing homework starting at a young age. Children need a consistent work space in their bedroom or another part of the home that is quiet, without distractions, and promotes study.
  • Schedule ample time for homework; build this time into choices about participation in after school activities.
  • Establish a household rule that the TV and other electronic distractions stay off during homework time.
  • Supervise computer and Internet use.
  • By high school, it’s not uncommon for teachers to ask students to submit homework electronically and perform other tasks on a computer. If your child doesn’t have access to a computer or the internet at home, work with teachers and school administration to develop appropriate accommodations.
  • Be available to answer questions and offer assistance, but never do a child’s homework for her.
  • Take steps to help alleviate eye fatigue, neck fatigue and brain fatigue while studying. It may be helpful to close the books for a few minutes, stretch, and take a break periodically when it will not be too disruptive.
  • If your child is struggling with a particular subject, speak with your child’s teacher for recommendations on how you or another person can help your child at home or at school.  . If you have concerns about the assignments your child is receiving, talk with their teacher.
  • If your child is having difficulty focusing on or completing homework, discuss this with your child’s teacher, school counselor, or health care provider.
  • For generalhomework problems that cannot be worked out with the teacher, a tutor may be considered.
  • Some children need help organizing their homework. Checklists, timers, and parental supervision can help overcome homework problems.
  • Some children may need help remembering their assignments. Work with your child and their teacher to develop an appropriate way to keep track of their assignments – such as an assignment notebook.Establish a good sleep routine. Insufficient sleep is associated with lower academic achievement in middle school, high school and college, as well as higher rates of absenteeism and tardiness. The optimal amount of sleep for most adolescents (13-18 year of age) is in the range of 8-10 hours per night.

© 2016 – American Academy of Pediatrics

Breastmilk is still the best


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If you are about to have a baby or have recently had a baby, you have had to make the big decision whether or not to breastfeed your baby. This is an easy choice for many mothers, but others may find it a difficult process, whether it be from lack of production of milk, difficulty of baby latching, or considering pumping when returning to work. We, as pediatric providers highly encourage you to breastfeed, even if it is only for those first two months of life. We even have a certified lactation consultant in our office to help our mothers succeed, which is a rare thing to find in most pediatric offices. That is how important we think this is. The antibodies your baby receives are so beneficial to their development. Breastmilk is much easier for your baby to digest as compared to formulas.

We know breastfeeding isn’t a possibility for all mothers but there are some other options besides formula. There are some moms that produce enough milk to feed multiple babies, but end up tossing it at some point because they seldom needed to dig into their stored supply. Breastmilk is GOLD!!! Consider donating your milk if you have an oversupply or obtaining your milk from a milk bank. The milk is thoroughly screened for disease and kept properly until a baby is in need of it. A great organization to look in to for this is HMBANA.

The following article is great one to describe the process of donating milk and the rigorous testing the milk is put through.

Why Moms Can and Do Donate to Human Milk Banks

Diane L. Spatz, PhD, RN-BC

|August 12, 2016In October 2015, The Children’s Hospital of Philadelphia (CHOP) opened the 18th milk bank in the United States under the umbrella of the Human Milk Banking Association of North America (HMBANA). In 2016, to date the CHOP Mothers’ Milk Bank has pasteurized and dispensed more than 13,000 ounces of milk.

Pasteurized donor milk is available from both nonprofit and for-profit organizations in the United States. Nonprofit milk banks are part of the HMBANA network and have a shared set of standardized milk-banking practices. HMBANA has an interdisciplinary board, with representatives from HMBANA milk banks as well as external board members from a variety of professions.

Milk Bank Donors

Why do mothers with extra milk donate to a human milk bank? Optimistic and altruistic motives are the primary reasons for donation to an HMBANA milk bank.

Mothers may find themselves with too much milk that they would rather not discard, and by donating their milk they are giving a tangible gift that they know will benefit other infants. They have seen the benefits of providing their milk to their own children. Mothers who are familiar with the needs of HMBANA milk banks and the infants they serve are motivated to donate their extra milk and report positive emotions and a willingness to donate again if given the opportunity. Healthcare providers can influence a mother by recommending donation of her excess milk to a HMBANA milk bank.

Some bereaved mothers also choose to become donors to HMBANA milk banks. Some mothers know during pregnancy that their infants have a fatal diagnosis, and others have infants who die after a long hospitalization. Bereaved mothers report that by donating their milk, they give meaning to their child’s life. They report that donating their milk helps in the grieving and healing process and may help them achieve a sense of closure.

The HMBANA Milk Banking Process

Mothers who wish to donate milk must go through a rigorous screening process. The first step is a verbal health screening. The mother then completes a lifestyle questionnaire related to her health, her infant’s health, and her lifestyle and dietary practices, as well as an extensive health history. A healthcare provider must complete a screening form for the mother, reporting her health status and laboratory testing from pregnancy. In addition, the infant’s healthcare provider must complete a form stating that the infant is in good health, is growing well, and is breastfeeding well.

A milk bank coordinator then reviews all of these materials and verbally confirms the information with the potential donor, who gives written consent to be a donor. At this point, donors undergo serologic testing for HIV, HTLV1, HTLV2, hepatitis A, hepatitis B, and syphilis. The cost of the laboratory testing ($200-$300) is paid by the milk bank.

Once a mother has passed all screening and her blood work is negative, she is approved to be a donor. Mothers can make a one-time donation or be repeat donors. If a mother continues to be a regular donor, the milk bank staff will follow-up regularly to ensure the mother has had no changes in her lifestyle or health.

Milk is transported to HMBANA milk banks using a variety of methods (in person drop-off, courier service, milk depots in the community, and shipping). Raw milk is stored frozen until ready to be prepared for pasteurization. Raw milk is thawed, pooled, poured, and then pasteurized, and cultured after pasteurization to ensure that there is no bacteriologic growth. After pasteurization, the milk is stored frozen. Once the milk culture comes back negative, milk can be dispensed to donor recipients.

In the United States, most HMBANA milk is donated to hospitals with neonatal intensive care units. Pasteurized donor human milk is mostly used for preterm infants or other vulnerable infants. However, some data support the use of donor milk for term infants or late preterm infants, if supplementation is required during the hospital stay. In the community setting, a prescription from a health professional is required for the milk bank to dispense pasteurized donor milk to a home.

Pasteurized donor milk from HMBANA is provided on a cost-recovery basis, causing the milk banks to charge a processing fee of $3.00-$5.00 per ounce. Insurance reimbursement varies from state to state, resulting in a cost to the hospitals or consumers.

Flu vaccine this year? Flumist not recommended.



Advisory Committee for Immunization Practices (ACIP) has recently recommended to not use Flumist this year. This statement comes after the poor outcomes of the immunization over the last 3 seasons. Many people prefer this due to ease and painless administration for their children, but we highly encourage getting the injection this year. Our office will not be carrying the Flumist this year in accordance with ACIP recommendation. Please don’t let this prevent you from getting immunized!!

The Rise and Fall of FluMist–Can the Nasal Spray Flu Vaccine Be Redeemed?

Paul A. Offit, MD

|July 01, 2016Hi. My name is Paul Offit. I’m talking to you from the Vaccine Education Center, at The Children’s Hospital of Philadelphia.

I want to talk about something that happened last Wednesday, June 22, 2016, at the meeting of the Advisory Committee for Immunization Practices (ACIP) when they made the following recommendation
[Editor’s note: The following is from a statement prepared by the ACIP on June 22]:

In light of the evidence for poor effectiveness of LAIV—the live attenuated influenza vaccine, otherwise known as FluMist—in the United States over the last three influenza seasons, for the upcoming 2016-2017 season, the ACIP makes the interim recommendation that FluMist should not be used.

How did we get here? Years ago, we preferred FluMist over the inactivated influenza vaccine, for a few reasons: (1) It worked better than the inactivated vaccine; (2) In children, it is easier to give and is often preferred; (3) It reproduces itself at the nasal mucosal surface and induces local immunity, which in theory should allow the recipient who is exposed to the natural or wild-type influenza virus to shed less virus and therefore be less contagious.

Unfortunately, over the past few years, FluMist has underperformed compared with the inactivated vaccine, reaching a new low last year when the efficacy was estimated to be 3%, a rate that was indistinguishable from placebo. Why did this happen? It is hard to know, but when you give an inactivated vaccine with 15 µg of hemagglutinin per strain into a muscle, the antigen is taken up by local lymph nodes, processed, and presented to the immune system. When you give the FluMist vaccine, you are giving live, attenuated viruses that contain nanograms, rather than micrograms, of hemagglutinin. To get an adequate immune response, those viruses need to replicate.

By definition, these viruses are not replicating well, because either prior immunity or a dominant strain is affecting their capacity to replicate. Switching from the trivalent FluMist to the quadrivalent FluMist has not been effective over the past few years, perhaps because one of the added B strains caused the other vaccine viruses to reproduce less efficiently.

These are answerable questions. For example, we can look at the shedding of these viruses. That was the case with the oral polio vaccine. In that vaccine, the type 2 virus was actually contained in larger quantities because the other two viruses were able to replicate more efficiently on the intestinal mucosal surface. This question should be answered because FluMist was an excellent vaccine and hopefully it can be redeemed.

Are your kids into Pokemon Go? Here’s some good tips to consider.





Pokemon Go is all the rage right now!!! If your kids aren’t playing, I’m sure you know or have seen someone playing. We have heard of lots of scary injuries that have occured while playing this making many leary about the game. The following article has some great tips if your kids insist on playing!

Pokémon GO Tips for Parents

Tim Locke

July 18, 2016Pokémon GO is a global phenomenon getting children and adults walking around outside with their smartphones hunting creatures.

It seems like the computer game parents have been waiting for – one you have to GO outside to use.

However, as well as encouraging healthy exercise, there are some safety concerns over children playing the game.

The NSPCC has issued advice for parents and has written to Nintendo UK saying the app “appears susceptible to being hijacked by users who wish to harm other players and as such raises fundamental child safety concerns”.

The game uses the phone’s GPS location feature to lead players to Pokémon using built-in maps.

Before the app launched in the UK, the charity says: “there have been numerous accounts of children being placed in dangerous situations because of the geo-location feature – in one instance it is reported that armed robbers lured teenagers to a particular spot using your game and in another that players are taken to a sex shop”.

Despite these concerns, millions of parents are likely to come under pressure by children wanting to play Pokémon GO, so what can be done to help kids play it safely?

Understand the Game

You’ll need to know your Poké Balls from your Pokémon Gyms to understand what kids will be doing when out playing Pokémon GO.

Pokémon are ‘pocket monsters’. They only exist inside the game – but you have to track them down in the real world outdoors. When one is spotted nearby, the app gives an alert and you use the phone’s camera to look in front of you – and the Pokémon is seen superimposed on the real life scene on the phone screen – called augmented reality.

You catch them by flicking Poké Balls at them. The captured creatures are logged in the player’s Pokédex. Once you have reached a high enough level in the game you can visit Pokémon Gyms in your area where you can train the creatures and take part in competitions. PokéStops are other places you can visit to collect items for the game.

Before letting kids out on their own with the app, join them for their first Pokémon adventure – and play along yourself if you can.

It Is Free… But…

The game is free to download and play – but there are tempting in-app purchases available to help players reach higher levels. Check the settings on your child’s phone and store account to prevent these extra charges or limit them to avoid a bill shock later. A boost of 14,500 virtual Pokécoins will set you back £79.99 in real money.

The game only works on smartphones, so be ready for pester power from children insisting they need a costly upgrade this summer.

The app also uses mobile data—so keep an eye on this mounting up and going over spending limits on your account or pay-as-you-go top ups.

Set Limits

A child will probably find a couple of Pokémon close to home, but will need to go some miles to keep finding more. Talk to children about how far you are happy for them to go while playing, and specify areas you want them to keep away from.

Keep Concentrating

You can get very immersed in the game and forget about real dangers around you. Make sure children understand road safety dangers – and make sure they concentrate near traffic and look out for physical risks, such as cliff paths.

The NSPCC says there have already been cases of children being lured into unsafe places.

Respect Boundaries

The Pokémon maps mostly follow real life pavements and paths, but the creatures can appear to tantalisingly close, but in graveyards, someone’s garden or on other private property. Make sure kids know where they can and can’t go.

Stranger Danger

At the moment Pokémon is a single player game, but PokéStops and gyms, and the location of the creatures themselves will bring people together to certain places in your area. Some of the strangers your children will meet will be other kids, but the game is also popular with adults. The NSPCC warns “you never know who they might meet”.

Theft is another risk, with reports of phones being snatched from players as they turn up at known locations in the game.

Is It Age-Appropriate?

You’ll know best whether your child is old enough to play the game and also understand the risks. Make sure younger children are accompanied by an appropriate older child or adult while playing.

Privacy Concerns

To play Pokémon GO, you’ll need an account – and the app asks for personal information, such as date of birth and email address. It is possible to opt out of some uses of this information outside of playing the game through the game’s privacy policy.

Spare Battery

Playing the game uses the phone’s screen, GPS tracking and mobile data – and that runs the battery down far quicker than normal use. So that kids can always get in touch with you when they are out and about, consider investing in a special spare battery pack to plug in if the phone goes dead. Stress that this is to keep them in touch with you – not just to extend playing time!

Safety First

When the game starts up the first screen warns players: Remember to be alert at all times. Stay aware of your surroundings. Niantic and The Pokémon Company who make the game have told players they take safety seriously.

They advise players to be aware of their surroundings especially when exploring unfamiliar places. They suggest playing with friends and family, and respect local laws and the locations visited.


NSPCC: Pokémon GO: Our open letter to Nintendo UK,

Apple App Store

Pokémon GO app game play

Niantic and The Pokémon Company

BBC News

WebMD Inside Health News: The Pokemon GO Pick-Me-Up

Vegetarian? Maybe we should!


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This is a topic that we have posted before as we saw a lot of research surfacing on the benefits of a plant based diet. Obese people with high inflammatory markers (making them suceptable to heart disease), show significant improvement in their markers after following this plant based diet. It may be worth trying for those with heart disease or even our teens with high cardiac risk!

Why is there so much Violence in the world?




It saddens me to turn on the news these days. Police officers being shot to the wars in the Middle East, there seems to be an overwhelmingly lack of good news. I have to question, “why is there so much violence?” There is not one answer to this question, but I can’t help but think the virtual world our children our constantly exposed to may contribute to this.  I look at the video games advertised and can’t believe the extensive violence portrayed! What happened to Pac-Man and Frogger? When kids spend HOURS and HOURS on these games, this becomes their reality. We as parents need to stand up and take responsibility for what we allow our kids to see and do!

I love the following article that gives parents helpful tips and how to steer our kids away from the violence. Well worth the read!