Thank you, Stephanie, for this wonderful introduction. So as most of you know, I've given a lot of talks here and everywhere else, primarily related to endovascular treatment of aneurysmal disease, abdominal aortic aneurysm, thoracic aneurysm, and so on, carotid disease. But I have never given a presentation here to this audience related to this particular topic, which is chronic venous insufficiency. And I call this the forgotten part of circulation, because as you fellows know, very little is done as far as education is concerned at our institution and at many cardiology fellowship programs related to this particular problem. Those few of you that were lucky enough to rotate with us at Leachman Cardiology Associates had an opportunity to see plenty of patients with this condition and also a variety of treatment modalities that are available, including the latest technology that we have.  So as all of you know, venous pump, as far as the lower extremities are concerned, is related to muscle contraction in your lower extremities. So it's a passive type of a pump. And inspiration also helps in moving the blood flow from the lower extremities upward towards your heart. So inactivity makes this pump inefficient and all of us that are performing international procedures, international cardiologists and also surgeons are at risk of having this pump malfunction because we stand for a long period of time and do not necessarily contract our muscles on a regular basis. And therefore we are also prime candidates for chronic venous insufficiency syndrome. So here you can see a normal vein where the valves open and valves close. And that should be standard. However, when you have a dilated veins due to a variety of reasons and some of it's just inactivity and the other ones are from pressures compressing the veins above, you will get dilatation of the veins and you will have a lack of closure of the valves so you'll have actually retrograde flow or stasis that stays in the lower extremities. So obviously this condition is caused by failed venous valves. Now venous reflux in saphenous vein is most common underlying cause of painful varicose veins in the lower extremities. There are other conditions but reflux is the major cause. Hypertension can be three times above normal at the ankle level while we are standing in a calf lab. So I don't know how many of you and doesn't matter what age you are. Very frequently at the end of the day you feel a little bit of burning, tingling sensation and maybe some degree of numbness in the lower extremities and that is related to venous stasis and lack of circulation of the venous blood. The venous blood is very acidic from metabolites so a lot of lactic acid is in there and that lactic acid causes all of those symptoms. So it's a serious condition and it's almost invariably a progressive disease if you follow patients over a long period of time you will see that this disease progresses. Now how big and how prevalent is chronic venous insufficiency disease? I'm absolutely positive that a lot of you will be astonished by the numbers that I will show you. It is estimated that somewhere between 30 to 40 million in the United States suffer from symptoms of chronic venous insufficiency. However, only 1.7 million roughly seek treatment on an annual basis. So we have somewhere close to 30 or 28 million that do not receive treatment. And so they basically remain untreated and suffer with symptoms. As you can see here it can manifest itself just with varicose veins like in this particular case which is relatively mild type of a finding to a more advanced non-healing wounds in the lower extremity with infection. So it affects all age groups and I'm looking at you fellows you are not exempt from this at all. Now, another very important fact that I'm sure a lot of you are not aware of that chronic venous insufficiency is twice as common as the incidence of coronary artery disease, okay? And 10 times more common than prevalence of peripheral arterial disease in the lower extremities. So about pathophysiology of this condition related to venous hypertension. You get leukocyte trapping that do harm to those valves and the venous wall. You get release of proteolytic enzymes, destruction of cellular membrane, leakage of the plasma proteins and leakage eventually of the red blood cells and destruction of tissue. You get hemociderin and hyperpigmentation as you can see here. And then you get tissue hypoxia, dermatitis and lipodermatosclerosis and eventually ulcer formation, infection and bleeding. So this is what I would call the most advanced stage that we can see. So chronic venous insufficiency facts that a lot of us are not aware of is the most under diagnosed condition to the best of my knowledge. It is the most ignored condition and most misdiagnosed condition. What I mean by that is that some other condition is blamed for this, whether it's peripheral arterial disease or diabetes or whatever else. There are many other conditions you will see in the threshold diagnosis that can mimic this condition. It's also the most under treated medical condition that I know. The question is why? Why is this happening? Well, there is a misconception that this is just a cosmetic disorder, particularly in early stages when you see varicose veins and oral orbit of leg edema. There is so little awareness among population in general and also among healthcare providers of various specialties. And a lot of providers are unaware that in right hands with appropriate treatment, the resolution of this condition is very rewarding for our patients. And there is also a general failure to realize a link that exists between venous insufficiency and lower extremity swelling or edema, nocturnal leg cramps, restless leg syndrome and venous ulceration. There is also a failure to consider the symptoms burden and the tremendous suffering that those patients experience. And this is not to blame only us, but also to patients as well. And very frequently, you will hear from patients, well, I think it's probably related to my old age or it's probably related to my arthritis or it's probably related to my obesity and variety of other things and symptoms and diagnosis. But also the providers have the same misconception where they contribute to this condition due to some other conditions or are not able to differentiate between other conditions and this particular condition. A lot of people that restless leg syndrome is something related to a neurosis, anxiety or whatever. No, it's basically sub-conscious way of treating this condition by contracting muscles and pumping the blood upward. So, and this is one of the most common early stages of presentation of this condition. Hence, venous disease remains a major cause of preventable morbidity and mortality.  So, look at variety of things that can manifest itself as chronic venous insufficiency. Very frequently it is aching or leg or foot cramping. I have frequently encountered experience with my patients where you'll ask them a question, do you have leg cramps? And they will say no. It's the same thing if you ask your patient, do you have angina? And they don't know what angina mean. They'll say no. Do you have chest tightness or pressure? They'll say yes. So, ask all the pertinent questions that can explain patient's condition. So, they'll say no, I don't have leg cramping, but I have foot cramping, okay? Sometimes they just experience heaviness at the end of the day, pain, burning sensation, itching, tingling, swelling, numbness, restless legs. Now, about numbness, a lot of patients are misdiagnosed to have peripheral neuropathy. And actually they don't have a peripheral neuropathy. They have numbness related to chronic venous insufficiency. And if you treat chronic venous insufficiency in a lot of instances, you can relieve the symptom of numbness and many other symptoms as well. Once you are more advanced, as far as chronic venous insufficiency concerned, you get ulcers, you get thrombosis, bleeding, cellulitis and infected wounds. So, pay attention to that because it's not infrequent that the patient will present to you with both conditions, peripheral disease of the lower extremities, particularly in diabetics and also chronic venous insufficiency. And you have to be able to differentiate which one is causing the primary problems because sometimes arterial interventions are riskier and more complicated while the venous interventions might be more rewarding for certain subsets of patients that present with this problem. So, it is important therefore to remember that varicose veins is more than simple or cosmetic problem. And you can see there are a variety of categories in the COAP categories that will delineate how advanced this condition is. C6 is the most advanced condition. This will be C6, okay? You never want to get to this stage and then start treatment because this is only a palliative phase. You have to treat them very early. In this stage or this stage and then you have cure and excellent results and very rewarding results for your patient. So, what's important now, this is one of the main messages for you guys that are in fellowship program training that nearly 80% of non-healing leg wounds are related to chronic venous insufficiency, not to peripheral arterial disease. What are the risk factors for varicose veins and chronic venous insufficiency? There are many of them and I listed some of them. It's impossible to list all of them, but the most important ones as we get older, we all will get certain degree of chronic venous insufficiency and regurgitant and incompetent venous valves. Family history is a very strong factor, strong indicator and that could be due to a variety of reasons whether it's obesity, whether it's lifestyle or inactivity, whether it's incidence of May Turner syndrome that's familial and so on. If you have a prior history of DVT, almost invariably you will get a certain degree of valve deformity or destruction and you will develop a certain degree of valve insufficiency. History of phlebitis is very important. Ask your patients about it. Previous trauma of whatever kind that patient suffered from, you can also anticipate there will be certain degree of venous insufficiency. May Turner syndrome, now why we call it May Turner? There were two individuals. One was May, the other one was Turner. We'll describe it, we'll talk a little bit more about it in detail, okay? And then obesity standing occupation, we mentioned that inactivity, sedentary occupation, those secretaries that don't get up for eight hours a day, they are certainly at risk and that's why they have restless leg syndrome because they're smart. They know what helps them to relieve the discomfort. Pregnancy, of course women primarily, right? Nowadays. And for that particular reason, female gender and I have nothing against female gender but because of all of those conditions, pregnancy, birth control pills, certain degree inactivity, weight gain at all the age, all of those things will contribute to that and also May Turner syndrome as well. There are several other possible risk factors that are probably less likely to be connected with it but anyhow they certainly should be considered. When would additional diagnostic evaluation be of importance as far as differential diagnosis concern? Low back pain, sciatica, I had a lot of patients that were referred to me because they underwent back surgery and the symptoms didn't improve. And the reason for it is because the primary problem was chronic venous insufficiency and not any lumbosacral spine disc disease. The genitive joint pain, a lot of patients will have problems with arthritis, hip joint and they think it's causing all of those symptoms which is impossible related to that and actually it's chronic venous insufficiency. Fibromyalgia is difficult because those patients have all kinds of complaints. Vascularitis, also another factor, arterial ischemia, peripheral arterial disease. We talked a little bit about it. Lymphedema is a problem because a lot of patients with lymphedema will have exactly the same symptoms as swelling. So you have to be able to differentiate those things but that doesn't mean that you should not treat chronic venous insufficiency in patients that have lymphedema. You will be able to improve their symptoms that are related to chronic venous insufficiency and then you'll have to address another problem which is lymphedema. So a significant number of those will improve. Peripheral arterial disease and arthritis of various kinds. Neuropathy, okay? I mentioned peripheral neuropathy and interestingly enough, a lot of those patients will improve. So you have to make sure that you're treating proper condition. Heart failure, congestive heart failure will give you leg edema and some of those symptoms. Liver failure, hypertension, obesity, particularly morbid obesity, surgical trauma and previous injuries. All of those things play a significant role. Now let's talk a little bit about anatomy because we have to know the anatomy to be able to diagnose and to be able to treat this condition appropriately. So there are three venous systems. There is a deep venous system, there is a provisional venous system and there are perforators connect those two. When I talk to my patients, I try to explain to them in a layman terminology because it's difficult for them to explain in any other way, why are we doing certain things and what will happen? A lot of patients will worry, well doctor if you close that vein, what will happen? I'm not gonna have a good blood flow and so on. Then you have to explain to them as long as your deep venous system is working well, there shouldn't be any problem by closing or removing the superficial venous system.  I tell them if you are a skydiver and see those that well and you have a parachute and you have a spare parachute. Spare parachute has a lot of holes. You're not gonna use a spare parachute, you're gonna use your main parachute and so the superficial venous system that's inefficient or regurgitant is like a spare parachute.  And I tell them the surgeons use those superficial veins for bypass surgery in thousands and hundreds and thousands of patients and nothing bad happens. So you have to explain to them because otherwise they become very skeptical. So superficial venous system is basically you have a greater saphenous vein which is on the inner aspect of your leg and then you have a lesser saphenous vein or a smaller saphenous vein that's positioned posteriorly from the knee down to your ankle. And then you have a communicating veins between those two system and you have lateral system. Of course you have perforators that also connect the deep and superficial system. A little bit about deep veins other than what I already mentioned is that deep veins usually do not cause ulcerations in the lower extremities, okay? It's primarily due to superficial venous system problem and the perforators. So deep venous reflux will very frequently disappear after you treat the superficial venous system. Why is that? Because you decrease the flow that returns through the deep venous system. So therefore do not worry about deep venous system even though it might be incompetent at a certain degree and a lot of those patients will actually improve and the incompetence of the valves in the deep system will disappear after you treat the deep venous system. Evaluation, that's extremely important. So how do you do it? There are many different techniques that you could use. A lot of times the best is in standing position. You have to use some augmentation maneuvers like at the saphenofermal junction valve salva to see if that incompetence is occurring there. That is a must. A lot of insurance companies will not approve the procedure of any kind that you intend to do unless you have incompetence of the principal saphenofermal junction vein. And so pay attention to that. Now, so what is a reflux of significance and what is a reflux of no significance? We should have less than 0.5 seconds of a reflux. That will be physiologic type of a reflux but in a common femoral vein it's more than one second, okay? So pay attention to that. Now perforators is more than half a second. So those are the things and numbers that you have to remember because the insurance companies will require this information from you. This is something that absolutely is astonishing to all of us that are involved in this field. If you send your patients to any of the labs, vascular labs, including this our lab here, 94% of the vein disease will be missed by standard ultrasound. If you order just a venous ultrasound study, you will not get any information related to valvular incompetence, particularly related to greater saphenous, less saphenous vein or perforators. And I don't know how many of you that are practicing here have sent your patients to the peripheral vascular lab here and you'll get a report. This is a report that I get on a deep basis. No evidence of thrombophobiasis, no evidence of DVT, minimal or no valvular incompetence of the deep venous system and that's it, nothing else. So how do you know what's happening with the superficial venous system? You have to do it in a lab that is trained, technologies that are trained in doing that. 94% of labs are not trained to do that. So this is what you get in a regular lab, those two things, but you don't get nothing about greater saphenous vein reflux, less of saphenous vein reflux, accessory vein reflux or perforated vein reflux, nothing, okay, embarrassing. Now treatment options, there are a variety of treatment options available. There are conservative methods that you could use and it's almost mandated by insurance companies. They will not allow you to do any other aggressive mode of treatment until you try conservative therapy, which is compression stockings, leg elevation while you're sitting at your desk, exercise, weight reduction, very important, and analgesic as needed. So this is something that you need to document to be able to get approval from the insurance companies. Typically they will require three months of treatment. Now none of those things work on a long-term basis. They work if you achieve certain goals. For instance, compression stockings work only while you wear them, but you will not correct the problem. And in a lot of instances, this is an absolute nuisance, particularly for those high-heeled persons in the fashion type of situations where you wanna show off your beautiful legs and also because of the climate that we live in here. It's uncomfortable. So most of the patients will have a difficult time in tolerating compression stockings on long-term basis. Okay, surgical interventions that have been well-tested in the past is primarily vein stripping, which is nowadays rarely used because we have other modalities that are more rewarding and less traumatic and less aggressive. And those are the endovascular interventions. There is a thermal to mess in the ablation. I will mention about that. It's basically heat-generated ablation of the vein that you achieve by injecting to mess anesthesia, which means local anesthesia to relieve the discomfort that is generated with those particular devices. RFA ablation is one of them. Laser ablation, EVLT is another one, a variety of lasers available. And then more recently, we have been using less invasive, less aggressive and more rewarding as far as discomfort is concerned, non-thermal, non-fumicent therapies like foam, sclerotherapy with a variety of what we call detergents that are being used for that. Vertina is one of them, mocha is another one. And more recently, vena-seal, which is an acrylate that in my opinion is probably the most rewarding for a great majority of patients. This does not necessarily mean that the other modalities treatment are obsolete. Not at all, but that certainly is an option. So vein stripping, I don't know how many of you have seen that. And this has made me a little bit exaggerated, but it is a certainly aggressive procedure is typically done under general anesthesia. There are several incisions made and it's for robust individuals like Bill Godley here that's standing and observing this particular procedure. So stab fluectomy for varicositis is where you use hemostats and hooks and you tease that venous segment out as you can see. So this is done obviously with domestic anesthesia. You sometimes make 30 or 40 different stabs with 11 blade to remove those varicositis. And that is occasionally needed and useful is certainly less uncomfortable than vein stripping. And this is done again with local anesthesia. But this is sometimes the picture for stab fluectomy that you have to do. So obviously this is a gruesome type of a thing if you show this to your patient and this is what you have to do to remove all the varicositis. So that's why more pleasing less invasive modalities are becoming more and more popular. And so many of the invasive alternatives offer you faster recovery. Basically it's done typically on outpatient basis. If any of the physicians perform this type of procedures under general anesthesia in a hospital environment that is totally obsolete, totally inappropriate and they are ignoring the cost issues and they're ignoring patients benefits and that would be embarrassing to do that but it's still happening in a lot of instances even in neighboring institutions here, anyhow. So procedural details with RFA and laser procedures. RFA means radio frequency and there are several products available. It's an outpatient procedure. You use an ultrasound guided. So you better know or you have to have a good sonographer to guide you through this procedure because it cannot be done without ultrasound guidance. You can resume normal activities immediately. I tell our patients to start walking right away as much as they tolerate the same day. So that is encouraging and rewarding for the patient. I tell them for the ladies to go to Neiman Marcus first and the day like that. And it's covered by Medicare and CMS which is very important. So that is an approved procedure. So what laser radio frequency do, they basically shrivel the vein to a string, okay? And that is generated by heat by denaturating the cells in the intima and basically I tell the patients like welded vein into a string, okay? Now, so let's talk about benefits, advantages and advantages of one versus the other. Vain stripping is a useful procedure. It is successful in a lot of instances but again, it's aggressive modality. Now EVLA or radio frequency, when we look at the meta analysis in 34 randomized controlled trials is basically equivalent efficacy. That means that they are equally successful, okay? The problem with vein stripping is a blind procedure. So you're basically removing the vein without seeing how much and what segment are you moving? So sometimes there are segments that are not removed and they can eventually cause through coladoles, further problems with valuing incompetence and further symptoms. So EVLA and radio frequency and terminal ablation. So when you look at the outcomes with the radio frequency ablation, 92% success rate and occlusion at five years which is very good. 2.7% of patients have symptoms after that length of follow up. And as far as laser is concerned, one year occlusion rate is 93% which is very close to this one but there is a little bit higher instance of nerve injury. Now this is relatively low if it happens to somebody else but if it happens to you, then it's a significant problem because you could have a permanent peristasia, even weakness in that extremity if this is very aggressive. And the reason for it is the laser generates more heat and that is probably the reason. And it also depends how you treat it and where you treat it. Now meta analysis between RFA and laser because there are some proponents of laser and there are some proponents of radio frequency but we use both of them and have experience with both of them. I don't think there is a tremendous difference other than post laser you have a little bit more pain and you have more acrymosis and a little bit higher incidence of nerve injury and that's why we use it relatively infrequently. So over the last several decades to mesent thermal ablation therapies have basically replaced surgery for treatment of chronic venous insufficiency. And again, the procedure can be done in a simple setup in your office and on outpatient basis under local anesthesia. Now, what are the disadvantages of thermal ablation therapies? Because all therapies have certain disadvantages. You heard about elastic stocking disadvantages. Now let's talk about thermal ablation disadvantages. It cannot treat all venous segment due to potential nerve damage. Like you have a Fremont nerve that goes very close to the greatest saphenous vein and the further down you go below the knee, the closer they are. So when you generate a temperature of 120 or 140 degrees of centigrade you will invariably cause some damage to the nerve unless you use the mesent anesthesia which is called sailing mixed with lidocaine, bicarbonate and epinephrine. And what you're trying to do you're trying to separate or isolate the vein from the nerve but it's almost impossible to do it below the knee. So for those of us that are using RFA or laser we will go just below the knee and stop right there. So if the patient has a viral incompetence further down all the way to the ankle we have to find some other modality to treat this particular problem because we cannot safely treat this with thermal ablation therapy. There is also potential risk of skin burn and stain for superficial veins. So we try to do a variety of things to prevent that, but it's very difficult in those what we call supra-facial veins that are just underneath the skin and that should be avoided. So they all require to mesent anesthesia and again, and you have to gain experience to know how to do appropriate to mesent anesthesia and to know what is enough and what is not enough as far as to mesent anesthesia. There is a considerable amount of training required to gain proficiency for those type of treatments and there is a very frequently intra-procedural discomfort particularly with laser therapy and there is a post-procedural bruising primarily because of to mesent anesthesia and many sticks but also if you hit the vein inadvertently you will have bleeding. So there will be bruising with that and requires post-procedural compression posed for several weeks and this is particularly a nuisance in warmer climates like here and it's very difficult for some patients to do that particularly morbidly obese patients that cannot pull up their stockings or frail patients or patients that have a significant peripheral arterial disease of the lower extremities because you'll compress coladones and they'll have more symptoms. So this is why the non-to-mesent, non-thermal therapies became popular and there are a variety of what we call detergents so-called polygocanol is one of them and then there is a Sotrdecal that we use more frequently and then a variety of devices where you have nitrogen mixed with them or CO2 mixed with them or if you mix just air with it those are a variety of techniques and more recently cyanoacrylate adhesive so cyanoacrylate has been extensively used for aneurysms, brain aneurysms, AV malformations some of you have seen me using it for treatment of type 2 endolics and so on so this particular product has been well tested in the past in variety of applications and it has been proven to be safe and so we obviously have options available as far as this is concerned so non-to-mesent, non-thermal therapies have basically evolved to eliminate the risk of thermal ablation there are less needle sticks okay because you don't have to give it to mesent no sedation is required no to mesent anesthesia you can treat superfacial veins very superficial veins you can treat the whole saphenous vein either greater or lesser saphenous vein without fear to cause nerve damage and you can significantly lessen procedural and post-procedural discomfort there will be less bruising there is no reason for bruising unless you are doing something inappropriate and no risk of bleeding so for our patients we actually treat them while they are on anticoagulants and it is truly minimally invasive modality of treatment for this particular condition so vena-sil is the only one that's using cyanoacrylate that is by Metronic and as I mentioned it has been well tested there is a required technique to learn how to prevent embolization of that material by compressing the vein and obviously this has to be done under ultrasound guidance what are the results when you compare a variety of non-to-mesent therapies polydocanol, sotridechol in variety of forms or shapes and versus vena-sil as you can see vena-sil offers you excellent results as far as follow-up occlusion rates 99% of six months and 94% at 36 months if you do it appropriately which is lower than with other modalities and pretty comparable I would say to radiofrequency ablation but this one obviously can avoid certain things that can occur with radiofrequency ablation mentioning a little bit about polydocanol and vanish-2 trial results there was in this particular study risk of thrombus extension it was a femoral junction in about 4% of patients and incidence of proximal TBT in 2.6% or distal TBT in 3% and 50% of patients were treated with anticoagulants because of the concerns and potential risk with vena-sil we do not at any point of time for any patients give any anticoagulants so that is another benefit here wanted to share few patients with you that came to me for treatment of chronic venous sufficiency this is almost embarrassing to mention that this particular patient was 76-year-old vascular surgeon that totally neglected his health and care diabetes, peripheral tear disease, hypertension, hyperlipidemia and chronic venous failure and non-healing ulcers we treated this patient with venous seal from the ankle all the way up and one week after that this wound looks dramatically better it was dry and healing real well so that was certainly very rewarding now when you would look at this young lady that came to me you would say she has the most beautiful legs she could be in a glamour magazine or wherever else why would you even consider doing anything for her? there is no varicose veins and so on but she had all the classical symptoms so first we established a diagnosis she was only 27 years old that she had developed a devotee during pregnancy diagnosis of meternal syndrome was established then she had a placement of the iliac stent she had a placement of the iliac stent because of 90% residual stenosis and she was at significant risk of occluding that vein again and she had significant valvular incompetence of the greatest affinous veins bilaterally because meternal can present with your symptoms bilaterally and no problems with deep venous system and this is how it looked this leg looked at the end of the procedure so just one bandaid no elastic stocking, nothing and she flew back to Mexico the next day and this is how it looked treating both legs so venous seal procedure one stick, local anesthesia, not to medicines no sedation, no elastic stockings this is what I like this is what I call minimalist approach to treatment of any kind of condition here's another patient had a totally incompetent greatest affinous vein from the ankle all the way up okay so you treated the ankle you would use a radio frequency you would use laser you could not do that because you would run the risk of damaging the nerve a little bit about meternal syndrome because this is very important about 25% of us here in the audience have meternal syndrome and you don't know about it now 30% of female population has it and about 20% of the male population has it okay and why again I'm complaining that the females have more problems with this well because they have a different anatomy as far as pelvis is concerned the angle of the pelvis and the way the vessels bifurcate and so on so this was described by May and Turner in the etiology in 1957 on pathological specimens but we're called in 1800s last surgeon from Germany from Berlin was the first one to describe everybody knows about work of triads but very few know that actually he was the first one to describe the compression of the ilium veins so it's also called iliocaval compression syndrome or Crockett syndrome that occurs secondary to the compression of the ilium veins by overriding ilium carter it could be common, it could be external or whatever and this is how we look angiographically you see anyhow now what's important is who gets it well it is seen in more than 25% of as I mentioned healthy individuals but it can vary tremendously among patients that have a left-sided EVT so if you see a patient in your office a young patient that's very pronounced or middle-aged or all the patients pronounced veins varicose veins in the left leg only nothing on the right side consider May Turner syndrome anyhow so pay attention to this particular feature it is easily diagnosed just with a ultrasound as you can see here you can see the velocity difference you can see the compression you can see the compression here or the compression here you have a variety of other modalities with the ultrasound available to establish the diagnosis reversal of the flow collateral flow all of those things can be used and you have to make sure that you send the patient to the appropriate vascular lab that knows how to evaluate for this condition MRI and CTN geography is also very useful as you can see here you can see here clearly showing the compression it's very infrequently used you have to talk to your radiologist what are you looking for and you have to make sure it's MRV not MRA because if you order MRA they will miss the Venus phase so make sure that you inform your radiologist what are you looking for so pre and post venous seal as you can see in this patient very rewarding for venous ulcers we can use also sclerotherapy for varicose veins or greatest aphid veins that were left untreated after radiofrequency ablation we can treat telangiectasis with sclerotherapy and spider veins but the important thing is address the main problem first so it means treat the greater saphenous or lesser saphenous vein first in a lot of instances the problems with spiders and telangiectasis will disappear or improve to a significant degree but this is not a cosmetic condition I have seen patients with this type of condition actually still having symptoms or burning sensation, tingling and numbness so in a lot of instances actually it should be treated okay so what can you expect related to endovascular treatment of chronic venous insufficiency you can expect in the great majority of your patients resolution of their symptoms related to chronic venous insufficiency you can dramatically reduce the incidence of complications if you treat this early prevent DVT, venous ulcerations unnecessary hospitalization and also unnecessary antibiotic treatment you can stop a lot of medications that the patients have taken for a variety of conditions that are actually not causing this problem and your patients would be much happier if you would give them the optimal treatment for this particular condition so endovascular treatment of chronic venous insufficiency depends on your knowledge and your experience and common sense and then you gain excellence but lack of knowledge and lack of experience can lead to disastrous complications as seen here and those are my patients that will refer to me too late so knowledge ladies and gentlemen you see only what you look for and you recognize only what you know thank you very much for your attention


Alrighty, as always, let's watch the full end. There is sound. I love how exaggerated the sounds are for a tiny move, ready? This cracked me up. It's all really cute. I like it. Shouldn't have the sound here. Now, there are some nerdy things that I love about this. That's why I picked this one. There's also actually a really good animation moment. And just topic-wise, of course, I like it.  The classic NES, you got the Wii, you got the GameCube, and a Super Nintendo. And I love even just the set dressing, how it's contrasty. It's not all neat and stacked and stuff. There's a nice presentation regarding everything here. And as we go forward, yep. And to me, it's always not just Metroid 4, but also, I always say I would love a full-scale, super-expensive, super-laborate pixel art. Metroid sequel, that'd be so cool. Now, animation-wise, the only tiny thing I would say, and again, I feel weird saying all this because I am not doing some motion, so I don't feel like I'm an expert in saying anything that's also a pain to do. The only thing I would say, go back to my onion skinning here. I draw over those legs really quickly. You go forward. They're always in the same spot. It might have been cool to get a step in there. I know this is so much more work. It's already a pain in CG. So if I add my onion skinning here and draw those lines, quickly you can see the legs are always in the same position. That's a super-picky note. Again, it's already a pain to do a side step in CG, so let alone stop motion. But maybe on that turn, there could have been something where is it just kind of a test? Is it looking for something? Could have been a potential lean over for this or ready to shoot and anticipates the recoil and is ready to shoot and you have that type of thing, or maybe that type of thing here. You've got your crotchoposter here, blah, blah, blah. And then, ding, ding, when this happens, or it goes back to the cleaning, back to straight. And then when this happens, again, a bit more of that. Now, this is probably also the limitation of the toy. Only this you can do. There's probably not a way to bring that leg over straight and then move this out. I don't know.  Just visually, it would have been cool, so it's not completely stuck always there. And on the squat down, I mean, this is nice. It has a little slight lift and foot roll, what are we going to call it? This is the limitation of the toy, but it's nice. You might argue it gets a bit twinned. But then again, what else can you do? Maybe you could have done a pivot off of this. So then when this happens, that it's actually went into a turn where it's more like this. This looks like someone is taking you to the bathroom, but you know, a balanced version of this. But then you would have maybe a nice curve, that curve of the back, would be nice. This is a nice clean silhouette. Who knows if you wrote it this around, how complicated this silhouette would be. So again, is it really needed? It's nice and clean. I like it. Now the thing I really like is look at the time it takes to grab the phone. Ready? And ding ding. Oh, let me see. Boom. I love this. Just because it's not just, let me go back and bring it back out. A to B or just quick. There is a feeling of I'm going to go back there and of course the cloth conveniently disappears. But it feels like it goes up, anticipates to put the hands into a pocket right there. But then there's a hold. And it's almost like the hold of all the hands there. Now I've got to grab the phone and now I'm going to pull it out. It doesn't feel rush to me. It feels like a really nicely timed. Just that. The hold to grab and then the pull. Even that has a move in the chest over. It just feels really nice. I also like the idea that there's a hidden pocket given that this is all hard surface shell for the suit. I was like, oh, is this moment? Yeah, just, it's that pause. And to me, just those couple frames, right? What do we have here? We have one, two, three, four, five, four to five. Depending if you count this. Just that is enough to sell the idea of, yeah, just for that. I love it. That's, I know it's maybe it's a silly thing, but I love that detail. I love that moment. It really sells the whole pocket idea. And then with that pull, bringing that chest over, it's great. And again, I love the subject matter. I love all of this. This just speaks to me and, you know, I dare I say, I haven't finished these to the end, but I love these. Yeah, I'm a big fan of the game. I love this presentation. It's great. The animation is super cute. The sound is funny. And that's that. Short and sweet. And I love it.  And there's sound. The end cracked me up. So I picked it. This is one of the cute stuff in there, but I love that it freaks out and also love that the eyes get bigger. And then as it goes back in, it's not just, let me hide the back closes and then the whole bag disappears. I don't know why, but this cracked me up. But I like the set dressing too. You know, it's in place. You can see all the cutting there. It's a nicely presented composition with all the things in here. And it's cute how it moves and then reveals the face a bit. And then it goes out. And as always, the disclaimer, I don't do some motion. So I can't comment on the technique and the difficulties and all that stuff. But I just know to me it's really difficult. Whenever I have tried it way, way back. If this was animation in terms of CG and you could tweak things, blah, blah, blah, my two cents would be, it could be cute to do a turn and hold a bit, maybe even a blink. That could be interesting. Then it comes out. And then I think holding this for a couple more frames just to kind of push the idea of, you know, it's even like the pointy thing is right behind the tomato here. And you wonder, oh, it's a nice day today. What is going on? And then there's a turn and then you have that and maybe potentially pushing this where you would have to maybe, I don't know how much you could see, but bring those pupils down, maybe also a bit of a, like a hop. Again, there's always a pain because then you got to have something that keeps it in the air and then you got to paint that out. It could also be maybe on the string, like a tiny string that you just can't see for one frame. But maybe just that reaction pushing that. It could also be a, and then a twirl going in. Into that. But then that, that cracks me up. That just, I don't know why it just makes me laugh that the whole bag sits there. And maybe since this is here, obviously this would be rigged, but it could be something where you would flatten those and then on the, oh, it seems like that does happen here. I was going to say move them way up, but it seems like that happened. And there's even a trail and a track there. Maybe, yeah, that's already in there. Cause if I look at this, it's not like the perspective changes. No, no, no, that was added. So that, there you go. I was going to add that. Nope, that's there. So lots of really cute stuff. You can go more dark and have some of the Jews out here and make this more of a murder scene and some stuff here. But I don't, I think this is super cute. The idea is super cute. I mean, it's technically a horrific idea, right? But I like how it's executed. Then again, that whole bag exists makes me laugh. So yeah, short and sweet. I love all of this. And that's that for me. Let's play this one in full. Of course, there's sound. And as you can tell, it loops and here starts there. It's really great. I want to turn off the sound. I was always disclaimer. I'm not a submission animator, so I can't evaluate the technique behind it and if it's good or bad or anything. To me, this looks great.  I was a big fan when you have actually human elements and not just objects, but it still looks stop motiony. But from an animation point of view, I like that. The contrast of this, right? We're here, but it goes up and this tip is dragging. This goes up, then goes up, but then angles in a different area with a little bit of a drag with the tip there to push this down to cut this. It's called two over one frame. Of course, nicely over one frame. You see all the other cuts in there for this, but it's nice. I like the timing of this. I really like because you got that roll and then up slight hold and then drop. So watch out in real time and swing. Just that. Nice rhythm.  What is that? A fork? I wonder what this is here. Must be that light to illuminate the scene. It's moving the center. I don't know. I don't know, but I like it. And it's cute, especially how then it moves into a creature. That looks like a swan. A swan would have a long neck, but whatever. I don't know, swan. Duck. Apple duck. Swan. But it's great. But also getting the rhythm of this with a little bit of a stop, but also comes towards us. I was a big fan of using depth in a scene and not just being kind of stuck and put. So you use left and right, but also out into the scene and coming back. I think that's cool there. And then as it goes back, oh, this is frame by frame here. It was up there. It was a fork. Nicely rounded so you can get up there. And then flip over one frame back into the Apple roll. Let me see the roll in real time. I see even that it rolls and then overshoots a bit and then comes back into the same position because now I'm looping into this. And then you can play this again. It's really cool. Again, I'm not a specialist in terms of what the technique was used and what you could do better in terms of, like, good stuff, but that's really neat. If I look at the background and the folds, it seems to be all the same and given that the light, whatever it is, stays put, I would assume that these are the objects that are also moving to imply a camera move. That is my guess, my very uneducated guess. But that's that. These are short and sweet. Critiques are short and sweet. Again, not... Actually, in terms of animation and anything that I would do differently, let's pretend this was in CG. I can't really say anything. The only thing, maybe, if we are saying these are wings of a duck or a swan to me, then I would say maybe at this part it would be interesting. They do trail, but then they could have been something where maybe they go up, which would be a pain to do because these are just placed. So they would have been something where maybe you have to stick them or something for a little flap or something where you have... Let me see.  Shroom trail, shroom trail, shroom trail. So it's good that it's on threes, but it hasn't ever so slight and one, two, three, one, two, three, one, two, three. It's not a waltz. Where that is maybe even. So that could have been maybe the third run of change of timing and maybe even with a little flare with the wings to go up for some extra timing contrast and animation body pose contrast, apple contrast. And that is that. Again, that's super picky and I always feel bad for critiquing something I'm not doing that I would never be able to do that well. So I believe it at that. Again, it's a really, really cool example and a great submission. Alrighty. Another one with sound. I love it. This cracks me up. I love that one. So for those that have sound, there's a crashing, then a person screaming and then what? Something happened. Da, da, da. Let me change into superhero mode and then go over there. It's so cute. I love this, this whole setup. You got your cute backgrounds. I love this. Weird looking flying creature. It's so cute. I love this here. That's why I want to go frame by frame. What is going on? You got to stretch out on those arms. Then you got a whirlwind type of thing, stretching the eyes and then goes into war different color into that new outfit. Oh, that's cool. I like this. That's really neat. Boop into that with a, let me see here. You got the wings and then wings plus extra wings for awesomeness. Gets ready, flies off and even has this here. Again, this glamour. I don't do stop motion. I don't know. This being so sharp here. I don't know. This must be in comp. Add it as a post effect since you got transparency and all unless this has been cut out but then you have a bit of a blur as it seems. Who knows? Again, this to me seems like an out of effect but it's super cute. I love how it comes in. I do that. I so love it. It's like most Muppets have those big eyes just the mouth open. Yeah. And I like the change into what is over there. And then you have even that look before the transformation. Wall-eyed. He's ready. He means business. Even here you got a mouth change to press lips out. Let me see. Just checking. It's already so much detail. I knew it. See, there's another change here. Lots of detail here. It's great. So if I be picky and again as always saying all of these stop motion critiques it's weird for me to critique anything stop motiony because I don't do it and I would never be able to do any of this. What I would say as always say this by this clip this was CG what I would tweak color the background it does not do with the animation but color. So you have a cleaner silhouette of that leg just for clean visibility it's a bit better through here but it's nice when you see that here also nice with the lighting a bit of a rim here so maybe that could be pushed here lighting wise to see this bring that out there and then pose wise animation wise actually I didn't even see this I love this that he looks this way you have to drag here but maybe instead of having the body always up up up that's kind of the general thing that I'm seeing even through all of this and then there's the exit this is slight tilt but it still goes up I know he points or it points this way but if api-piki I would say it could be fun for the entrance to be like this eyes here could still be dragging could still be looking to the left so that this is more of a change here they could maybe a little overshoot settle there and then when you have this even go what is that a slight bigger lean it's like what did I hear not doing this I mean but for the person to go what was over there and then you can go back into this straight pose so you go from here to here into all of this but I like how this goes down down down up up in a different position so if we do onion skinning here this is the position here and you can see this position there so there is change throughout as it goes down into this so this I love that that is happening here and then the same thing there when you prepare it would be alright which I love here let the patient going over down but then it feels like that's the point it would be cool let me frame through it this is an adjustment in the hand to not go this way but imagine this would stay so onion skinning back on hold on let me turn everything off this is here that the body actually tilts and maybe the legs come together for streamlined version here wings out to exit more this way that would be kinda cool there is a change there is this into that it does come together it could be potentially closer there is also a bit of a stretch which is nice there is a lot of nice stuff again to me this is all super picky from someone who doesn't do some motion but that is that it's really fun I love the design this is really inventive I love this here and I love how the twirl stays a little bit and then we are back into this it's really cute I love it and that's that alrighty let's play this in full first what cracks me up about this is that it's like the violent best scene from among us but then you have just that and then eyes out let me turn off the sound now this is stop motion and I am not a stop motion animator I'm gonna preface this for all of these but I really like that one I think the setup is really cute I like that side hop that just in terms of how they are built what they look like you know what they are they are super cute got a little camera move as well probably in post I would assume to be less brutal but I don't see any crazy shape changes and flickering again this is like me old school stop motion all the problems that I'm thinking of it seems so clean the flickering of the camera with the lights all that's great you got your anticipation there squashed into this which is funny I like the change of style with all of this you know so you still got the the wool background here which is really cute then you got spikes coming out you can clear the Rita I like that it will bounce and super cute and then at the end yeah eyes go out and then the kinda left I like that I like that walk out little hop there like how high this goes it's really cute yeah it's short and sweet I think if that be super picky and this is weird because I don't do stop motion but maybe there's a specific reason that I'm missing why it's hopping exactly sideways it's always looking this way also with the hearts here I see my little one playing the game but I haven't played it so maybe that's a specific thing of how they get in I'm not sure but maybe what I've been looking this eyes looking this way and then with a bit of a turn that's like the only thing I would say is then you have the other one the cute reaction because it's not repeated it's not this is your position A jumps up to position B and back to A this goes from this to here with a turn down to C like a different position I think there's a lot of great contrast in terms of posing even this with that they go down this way doesn't stay in place there's just a lot of cool stuff there so short and sweet that's all I have if you like this is super cute you got sound there as well it's overall a really nice package alrighty let's play this in full there is sound there you go and there we go and it loops alright we turn off that sound and it's cute I like it I like the portal idea it's actually cute when you go and it starts to go in whoop the head already appears now looking at this again this clamor I don't I don't do stop motion so I'm not going to be able to give you any type of insightful technique it's more like I have questions given that this is like this right unless there's a light through this maybe I don't see the you know any influence here on the light this shadow feels like it's been added wait wait wait that's framed through it maybe faster framed through it there you go so that I'm assuming added in post it looks a bit cut out and these are just added and this is just a comped background in my limited knowledge of this whole setup this is my guess but I like the presentation it's nice and clean this all makes total sense it's very catchy turns with the colors that are somewhat complementary colors there as well like your red and the blue and it's cute got a little slide going backwards I know there's not much else I can say if I will it sits with CG and I would looking at just regular timing stuff and contrast and stuff like that I would probably say when the creature here surprised me with my kid's show that I used to watch back then care about the name when this falls down it might be slower on the up and then go just to have more contrast in a time so it's not up left right left right go so it's these back and forth are not so even and repeated super picky not that they're extremely even if I go it's painful to watch me do this this well let's go over here and then we have onion skinning see it's not completely even there is a change so there is contrast but as a whole I would love for it to be more like I don't drive would say more but it's something where to me even though the distance changes as you can see there I feel like with the timing I see a speed up but it just feels still even I don't know it's a weird comment to give even though it has contrast it does speed up I would love for it to be pushed in terms of the contrast where it's it might be painful it might be disorienting to go the and then maybe even what is he doing here he doesn't overshoot it could be something like that so it will overshoot there and then really slow go back in there that could be something even on the back in maybe you could do something where you hold this for a bit longer and then you go up well then you go down first little squash up for a stretch stretch into it's always a bit of a launch again, technique wise you would have to have this something on the stick back there and then comp this out do not see it I'm saying this because it would be cute to have this in the air so it's like launching itself into the hole there for this that would kind of also give us the sense of speed jumping up and then dropping into this into that super picky again I always feel weird giving some motion knots but it's a cute clip I like it it's critique, short and sweet that's all I have and yeah, I like that submission alrighty let's play this in full this time there is no sound coming in there we go now when I was watching this at first I was going wait, wait, wait, wait, wait is this like a toll booth giving out a coin or something then I'm going wait a minute he grabs this and then he throws it then it goes after like a pet thing bringing back something because it's already in its mouth or whatever you want to call this so I had to watch this a couple times I was like what am I looking at what is going on but it's cute I really like this here the transformation into really nice just that all the shapes totally work they will come, come that's why I was also slightly confused maybe too slow I'm not quite sure if I'm getting what this is supposed to be because then you would always expect if this is a dog maybe they would be instead of that side tilt they would pivot from here and the butt will go left and right like pretending it's a butt wiggle but then this is cute clearly there's something going on and excitement and then that to me is just to me at least they tip off while they throw well now they're excited and I love this here I love that it's even inside the wheels it's not just back there you can see it's in there it goes out and you can almost have a little bit of a like a drag that speed of the car pulls the thing over a little bit and then it comes back it's super cute yeah that's all thing I would say but I like seeing all the detail and again this it's not like that because I do have cars around and you know sculpting and clay something like that would be really fun to do some motion I feel like that would be really cute to do because I like the the lean there but interesting if that could be broken you know this would be obviously a toy we have to break but we're almost that tire could stay flat or flattened here like how far can you push models and tweak things but I like that it has actually all the separation between the top part the chassis here and then when the door closes that's kind of neat maybe again if this was CG I'm always again I'm not a submission animator so I can't really confidently say what you should do and do better whatever if this was CG that's my disclaimer and all of these submission critiques the excitement here it starts here goes up here goes back down here goes back up there I like the contrast of now opening this but maybe it could have been interesting too just for contrast the wheels through my onions getting here the wheels are here crackly drawn go up and be here that's fine but then lands and I was going to say more to the right which it is doing here but more as I think I think as I said in the previous critique more just pushing that idea further because technically it's there like even this here let me go back to the first up see that first up is a bit lower so there is slight contrast this one is a bit lower but it's just somewhat in the same position this one seems fairly similar and then again this one seems fairly similar so to me it feels like well we could push this by we having the royal we we're doing all the work here that if you go there but I do like this it's like change there it'll move but to go from this wheel here land here go here land here just really a big excitement maybe you start small and then as it continues the contrast gets bigger just because of the excitement and maybe this here could have because I like the it starts but why not I could be pushed continue where it actually goes back a bit and maybe even be a tricky to do but down but then the buck goes up a bit and then it goes down into like a and then then this starts into an exit maybe again I feel we're giving those notes but it's cute I like it I like this all of that I like the the wormy quality of it has an ever so slight the abyss feel if this was water but it's cute I like it yeah I mean that's that that's my strange non stop motion critique and I'll leave it at that


Hello, this video is to inform you of some changes that I'm going to be doing to my channel. As you know, if you're a regular viewer, I've been doing about 12 videos a month, three every week on different topics. And it's just been overwhelming working on those as well as answering questions. And I also want to be able to continue to make videos, but I just don't have the time right now, and the effort is just growing. So what I'm going to try, as I mentioned in a previous video, is to get more viewer support by using a website called Patreon. Now I will still be posting my videos to YouTube. All my videos will be done under a Creative Commons license. All of my code will always be under an open source license, usually a GPL license is what I prefer. So none of that will change, but what I would like to is have more interaction with you and have more time to put more quality into my videos. And I also just want to be able to do more things, different types of videos, get other people involved in my videos, and all that takes time, effort, and money. And that's where Patreon comes in. It's similar to a Kickstarter, except for it's an ongoing Kickstarter. A lot of Patreon creators, what they do is they have their Patreons, you guys, the viewers support them per video. Now I do a lot of videos, and I hope to continue doing a lot of videos. So I don't want to have to charge you per video, although you could put a cap on what you pay each month. So the way I've set it up on my Patreon site is that you can help support me on a monthly basis. I have rewards starting at $2 on up. And what this will do is give you more access to what I'm working on, as well as more of a say. You will be able to download the videos without the YouTube ads in an open-og format. You will have an option to get them early on. I'm going to start doing monthly topics, and instead of having to wait for the entire month, if you get to the reward for that, you will be able to download all the videos at the beginning of the month. You will be able to get rewards to other things, like being able to vote and have a say on what videos I'm going to create. There are rewards where we will be able to have Google Hangouts, and we'll all be able to talk if you get to that, and I'll be able to hear your input and start working on other videos and tutorials that maybe topics I didn't think of. I also really just, like I said earlier, wanted to get more people involved, wanted to get other people who are involved in computers and maybe programming languages and other hardware that I'm not familiar with, both people who are more advanced than me, so I can get information from them and maybe people who are knowledgeable on computers but maybe aren't great at programming or have questions about Linux if they aren't regular Linux user, and that way I can do videos where I talk with them, I interview them, and I can get more of a concept of maybe what beginners are looking at as far as Linux goes, but basically I want to continue what I'm doing, put more time and effort and better quality into these videos, I want to be able to get new hardware for these videos, especially hardware that I can do tutorials on, and the way this works is you'll be able to go to my Patreon site and you can choose to be a Patreon and how much you want to pay each month, and at any point you can stop, you don't have to be locked in, so if I start going around you don't like, you can change your mind, if you decide that you like the way I'm going you can always upgrade your rewards, and I also want to hear what your thoughts are as far as other rewards maybe that you'd like to see, but basically this will give me an opportunity to continue making videos, hopefully upgrade the quality of them, get some new content, some new ideas, and most importantly, interact with you guys more. As I've mentioned a number of times, I don't like the communication through YouTube comments, plus I get so many, I don't have time to answer them all. Well if you become one of my Patreons on Patreon, not only will you get regular updates on what I'm working on and what I'm doing, you will be somebody that I can make time to talk to and time to answer questions. So I just ask you to take a moment, go over to the Patreon website, look at the rewards I've set up, and seriously consider helping support my site, my videos, and allow me to continue making the videos I'm making and more. Again I want to continue, I've been doing a lot of videos every month, and I just can't afford to continue doing it the way I'm going now. If you guys have noticed over the last two years or a year and a half, I've had YouTube put ads on my videos through AdSense. Well let me tell you this, I just got paid for back in January, and the amount of money I got for the month was $166, and that's before the transfer fees, it came down to actually $161 for the month, that's 12 videos. That breaks down to an average of $13 a video. I spend a lot of time on each of these videos, some more than others, but I can't continue putting the effort for that. I need to be able to justify the effort, the time, and the money I spend on these videos, and this is the way you can do it. Again, I am not saying you have to pay, I will still be posting these videos on YouTube, they will still be under a Creative Commons license, but the people who help support will get early access, and more of a say on what's going on. But if for some reason this doesn't pan out, I might try something else, but I will try to always make videos, but if this doesn't work out, the number of videos is going to be cut dramatically, so I just hope that if you enjoy my videos, you think about going and supporting, like again, the lowest reward is $2 a month. I really hope that my videos entertain you enough and educate you enough that you can afford $2 a month to help support me, my site, my work, and my interaction with you. So I thank you so much for taking the time to watch this video. I ask that you take the time to go over and look at my Patreon site and look at the rewards and seriously consider how much my videos and my work is worth to you. I thank you so much, and as always, I hope that you have a great day.


Marines with First Combat Engineer Battalion conducted a ship-to-shore exercise on White Beach aboard Marine Corps Base Camp Pendleton, California, March 5th. The purpose of the training is to help better train us so we can be better prepared for future endeavors. This job helps support the Marine Corps by making sure that we're better trained and we can support the meth in any way we can. The Marines did really good today. They're really motivated and they knew what to do as soon as they got on the Elkac. The training involved the successful cooperation between Navy and Marine Corps forces to move vehicles from offshore to land using a landing craft air cushion or Elkac. Training, training, repetitive training. If future deployments and we get called last minute, not everybody's lost. So we know what to do, we know how to mount the equipment, load it, strap it down. So we could just take away the headache of, all right, we've never done this, we've got to train. Instead of, hey, we've already done it before, we're good to go. The Navy provides the landing zone for the Elkacs. The Marines are then directed to where they need to go. Once that is complete, the Elkac returns to the ship to load another vehicle. Reporting from Camp Pendleton, California, I'm Corporal Christopher Moore.


From Hollywood, it's time now for Edmund O'Brien as Johnny dollars Ralph Whedon again Johnny I'm glad I caught you before you left. There's almost two hours before I play leaves. It's on your mind Now the cable just came in from Manila the amount taken in the burglary is roughly $75,000 that's dollars and not pieces dollars. Yeah, they mentioned that a clerk has dropped out of sight native an American Name's Blake Daniel Blake Blake. All right. That's all so far. What's your hotel in Manila? Do you know yet? Oh, yeah, the Hotel Tondo Tondo good. I'll get word to you there if I learn anything you can use well Good luck on the trip Edmund O'Brien in another adventure of the man with the action-pact expense account America's fabulous freelance insurance investigator yours truly Johnny dollar expense account submitted by special investigator Johnny dollar to home office Columbia all-risk insurance company Hartford, Connecticut The following is an accounting of expenditures during my investigation of the Woodward Manila matter expense count item one eighteen hundred and fifty dollars airfare and incidentals between Hartford and Manila Oh Yes, these gentlemen are waiting for you. This is mr. Dollar sir. Oh, yes I'm Floyd McDonald mr. Dolemn local manager the Woodward company. Oh, how are you, sir? And this is Irving Morgan my assistant Morgan glad to meet you. I've made arrangements to have your luggage sent to your hotel Have you like to do it that way? Irving and I can drive you right in buying a star. Nice of you Well, I know it is the estate owner want to bother with the tails after a long flight like that You'll give me your luggage, sir. Oh, yeah, I'm right here. Thank you. Well, that's what I think The car is right outside. We can give you the details of the burglary on the wind He told me very little that I didn't already know the story manners one of Manila's largest hardware stores was part of the American Owned Woodward chain He had discovered the loss of the seventy five thousand dollars himself Monday morning when he'd entered his office and found the safe open Naturally, I feel very badly about it everything that can be done is being done I don't know who the main office is blaming it on but I think you'll find that Floyd and I were anything with careless We've got five years without a loss behind us to prove that and it only takes one failure to ruin a success Irving There's seventy five thousand Do I understand that it was all American currency? No, no, it was made up of pesos, too I stated the amount in dollars and cents when I reported the loss You're in the habit of keeping as much money as that in your office safe It wasn't my idea or to my liking It was because of a company rule They were worried about conditions on this side of the Pacific in order to stop banking our cash here Instead of the usual yearly transfer of our money. It has been going to the States once a month They didn't say much this time What about this clerk Dan Blake? Oh, don't get me started on him. No, there's nothing proved yet Irving What is it going to take to open your eyes, Floyd? We don't agree on just what to think about Dan, Mr. Despite of the circumstances I But I find it almost impossible to believe that Dan would do this to me could he have done it Of course he could. He had access to the office and he could have memorized the combination of the same. Yes Yes, that's true, but I Can't forget that he was a very good friend of mine. He was like a son to me Was he in any trouble that you know of or any money? I Hadn't heard of anything He's been out of sight for days now What kind of a search has been made for him? I understand that the police have been working very hard They class him as the chief suspect, too. Yes, but you've got to realize that the Philippines aren't like the states dollar It's not hard to drop out of sight here. It's a big world. I know I just watched a lot of it pass by Well, as soon as my luggage arrives and I can get into a fresh suit. I'll contact the police see what they've got Expense count item 2 350 including tip a pitcher of gimlets delivered to my room While I waited for my baggage to arrive. I relaxed in front of a window My hotel was two blocks from Manila's Great Bay in a section called El Puerto From my room. I could see enough of the Orient the native craft working the harbor to give even a common hardware store burglary an atmosphere of intrigue Expense count item 3 80 cents cab fare to police headquarters Where I was shunted into a side office to wait for the sergeant in charge of the Woodward case he finally showed up Yes, my name is Dalla.  Well, not quite. I've been hired by an insurance company to learn what I can about it What do you wish to learn from me? Well, you've made any progress You've gotten any place with your search for Dan Blake then Blake. No, I do not look for him now You don't know I have captured the teeth Who is it me? Well, no solid up You've recovered the money. You will not say where it is yet, but he will say Tomorrow, maybe what evidence do you have a sergeant? He cannot say where he was that night of the burglary Is that all he's by profession a thief he was arrested while he was robbing another store last night He speak English. Oh, yes, one of I could talk to him. Maybe he's afraid to confess to the police and Maybe I can get him to talk All right, you come with me You do not stay long only five minutes. That's good enough. Why you come here. I'll do you again What do you work? No work Get hurt in bombing. No work. You have any children see To daughter. Why do they work? Is either one work at the Woodward hardware store work in prison Both work in prison Sergeant Malva says you stole some money from the Woodward store. No You'll make it easy for yourself if you tell the truth and give up the money I don't got money If I got money then why steal five pesos from other place why? You tell police why if I got lots money why steal a little more why? Because I don't got lots money. It's good enough for me Miguel Sorry, I took a good time. You do not stay long. I think he wants to sleep What would he say to you? Well, he didn't do it How to be hand you wouldn't have caught him stealing five pesos because he wouldn't have needed it He need a kick in the head for his lying. You have any connection between him and the Woodward place He tell you he got two daughters in prison. Yeah, he lies They come out, but they do not go back to him because he's still their money The daughters of connection with Woodward's connection if we need connection with by one all right tomorrow, maybe I have an idea Sergeant Malva's philosophy reason that it was a lot easier to grill the whiz and little prisoner Then it would be to continue the search for Blake, but I left him to his own devices and cab to the Woodward store I was told that neither Floyd McDonnell nor Morgan were in but that a secretary would help me Oh, how do you do mr. Dollar? I knew that you were coming out. My name is Charlotte Page Donald's my uncle. I didn't know that he had to go out to her meter with an order for a house. It's being built there Can I help you in any way? I want to look at the office. I know where the safe were. I can show you I'll check this door first I See only entrance Mr. Dollar, I know you've been here only a little while, but have you learned anything not much, but All of it looks bad for Dan Blake Just can't believe that Dan would do a thing like this How well did you know it? Evidently not well at all. He stole the money We're the same aid found something in common working here together I've had dinner with him occasionally go to the beach Know if he was in any kind of trouble debts or anything. No, I thought he was very happy and comfortable here. He seemed to be Where's this safe now? It's under the rug You have to lift the corner the rug Did Dan Blake know where it was? Oh, yes, everybody trusted him. He'd been here for years Did he know the combination? No, I don't think so. Uncle Floyd handled the cash Could he have memorized it? Well, I don't know that either. I hadn't given it a thought I guess we didn't put the rug back Oh We got to get Blake's address from the police You happen to know what it is. Oh God it's somewhere on Samplock, I can find it on the payroll. It'll be right here. It's too easy to find him there Wouldn't it mr. Dollar? That's too easy that I might pick up a chroma to the here it is 307 Samplock 307 Sampline. Thanks Tell Mr. McDonald. I was here. Would you please and I'll be in touch tomorrow The fair biography of Dan Blake in his rooms I learned that he was born in Duluth, Minnesota 26 years ago His father wrote him occasionally that he had sailed with the merchant marine during the war and had made a few into Island trips after that Floyd McDonald had said he was a student of the Philippines And that was born out by photographs and receipts from steamer and airlines I made a list of the places he'd visited But that was all I could do for that day wasn't until the next morning that I went to police headquarters and waited again for Sergeant Malva We do very good without your help. Well, pardon me. I don't want to buddy and I just wondered if you knew that Dan Blake Spent a lot of time learning these islands Oh, do you know that he'd spent some time in San Jose on Mindoro Don Maren Duke and in Palo and Lady I did not know might pay to check those places or more to Here clear down to Mendenau the search is finished. What do you mean? Then Blake has been found he was adrift and he dug out until I was very He was taken aboard a ship and then he died. I killed him. He was shot many times What about the money? It has not been found. Not yet. Yeah, sure, but maybe tomorrow We'll return you to the second act of yours truly Johnny dollar in just a moment With winter in the wind driving becomes more hazardous every day Not as much for you in your car as for the people walking across the street or along the edges of a highway A shoe touches a tiny strip of ice Someone loses his balance falls in the wrong direction and there is sudden death Check your car carefully. Make sure your brakes are good. Make sure your tires have a heavy tread check your steering wheel Someone's life may depend upon the efficiency of your automobile upon the care of your driving Now with our star Edmond O'Brien we return you to the second act of yours truly Johnny dollar Sergeant Malva Manila police was again taking his inimitable approach to a subject believing what he wanted to believe When I asked him how he knew the body was that of Dan Blake He told me the ship captain who had picked him up said so. How did he know? The man had mentioned the name before he died That was all and it wasn't enough for me I put in a call for Floyd McDonald the Woodward Company manager. This is Johnny dollars mr. McDonald there No, he stepped out for a moment. This is shot at everything I can do. I'm calling from police headquarters They have a body down here a body picked up by a ship someplace They claim it's Dan Blake, but there wasn't any identification on him you tell mr. McDonald I want him to come and look at him Notified mr. McDonald's sergeant Malva was playing it close to his chest. Where is sergeant Malva didn't tell me where he Was going he left word that we could look at the body and he left I Name is dollar corporal see you're going. Thanks. I know this is unpleasant. We have to find out Is this Dan Blake? Yes, cover him up, please. Where do they find him a dugout canoe? someplace called Ty Abbas Bay, I think yes Ty Abbas Bay southwest of here Who found him man by the name of Kovar. He's the captain of an inter-island schooner Could we leave here? What happened do you know not first-hand shot in the back four times? It was alive for a short time after Captain Kovar pick him up. The money has not been found. I see Then there's no explanation yet Not but I know a schooner is anchored offshore just south of the Pacific River. You know what that is. Yes I'd like to talk to this Kovar. I Guess I can hire a boat to take me out there I'll drive you down to the docks As a matter of fact, I'd like to go with you. It's a good idea if you have the time. Well, I'll take the time That's my car there That's it Skipper, that's the one there the CNM. That's a little precious for a wreck like that, isn't it? Some are even worse I don't know how they stay afloat. There's somebody on deck. You Captain Kovar. I want to talk to you about the body You brought in the McDonald and Blake work for him the police sergeant would tell me is that I got the money And I better give it to him. I'll take some door. Take the chairs you two. I'll take the bonkers Now what's this all about? There's a little over $75,000 missing. You didn't have anything when I picked him up He was in a dugout canoe. That's right. Look like a moral craft to me. Oh I see what you mean. I was empty. I looked it over. How long did he live? Well 15 20 minutes Maybe not that long. I don't think taking him aboard did any good for him But I didn't know he's saying anything about the shooting nothing that I could understand. What did he say? I? Told you I couldn't understand Just some noise but you were able to understand you're beginning to sound like that police sergeant mister And I don't like it. I thought I was doing right when I brought that boy. Wait a minute captain. We don't left him there Police right now we're getting papers to search my ship and now you start I'm not making any accusations, but you were the last person to see him alive. I'm interested in what he said Well, he said Blake Blake It's all I can understand Tell you the truth. I wish I'd left him there But you know what I think what's that if he went from Manila to someplace on Tayobas Bay where he had his dugout plenty could happen It's about 60 miles You heard about our hucks our rebels.  McDonald? Well Certainly a possibility The hucks are active. I Guess there's not a chance of putting our finger on it. That's what happened not a chance All right, and let's leave that possibility until the last I Wasn't sure of captain Kovar if he was telling the truth. He was doing so without tact And if he was lying he seemed to be doing that with complete confidence I didn't bother questioning his crew I knew that sergeant Malva if he hadn't already would take care of them when he returned to search the schooner I spent the rest of the morning and part of the afternoon and routine legwork on the case and at four o'clock I got the sergeant's report. There was nothing from one end of the ship to the other end my man Look, I know it is there, but it was not found you talk to the crew. Yes I talk myself to them. They do not hear then Blake say anything The captain is the only one who hear him. What have you done with them? What is there I can do nothing I leave his ship and that is all What now what now? There is nothing now So the hooks killed him then that is all I Learned a few things about Floyd McDonald this afternoon. So He's up to his neck and debt. Did you know that? So I don't know about the Philippines, but in the States It's an old pitch to have a patsy found full of bullets, but without the missing money Do not know what you say, but maybe it looks like Dan Blake is the thief when somebody else is I haven't been able to find a reason for the kid Who have done this now I find that McDonald needed money. I did not know that It would not be wise for me to question him in Manila. Mr. McDonald is not the man to suspect He is known as a man with honor. Yeah, so I gathered that's probably why he could get so far into debt I think it would be wise at that point for me to question Floyd McDonald either I waited until his store closed that evening and until his assistant Irving Morgan had gotten to his home Mr. Morgan. Oh, hello, Mr. Tyler. I've been thinking about you. Come on in. Thanks Well, how's it going? It's hard to tell from what I hear the money is gone. Good Did McDonald tell you there? Yeah, isn't that right? Maybe I Don't make it a habit to go around switching the values of national problems But it's a cut to me that these hucks could be pretty handy people to have around. I Don't get you. Oh when a killing outside the city can't be explained any other way. It's marked off to the hucks Oh, you don't think they shot Blake. I'm not as sure of it as everybody else seems to be just what do you mean, mr. Tyler, how much did you know about McDonald's personal life? Well, I see him socially if that's what you mean. We're good friends Are you any money? It seems to me. That's a very personal question. I have to ask that kind once in a while I've learned that McDonald's a lot of money to a lot of people thousand here 1500 there loans gambling debts Heat be ruined to this became common knowledge, mr. Tyler. He loses position everything How far do you think McDonald's go to save himself?  Well, it's something to think about and kill Blake to cut No, no, he didn't you're sure that I couldn't have he's not that kind of man He might be desperate. Yes, but he'd never do a thing like that Would he be at home now? I don't think so. It's it's only seven. He usually has dinner at the club. What club? They're the merchants club Mr. Dollar, don't question him down there wait until he gets home I can count on you not to tell him I'm waiting for him. I certainly can I want to stay as far away from this thing as possible On a half later a cab dropped me in front of Floyd McDonald's home The residence at least was a picture of propriety Said in a fashionable suburb. It was with any a shot of a bellboy somewhere in the bay I followed a sidewalk across a neatly hedged lawn and halfway to the house I stopped to watch a man come out of the front door What are you doing here? Forget it. I can't what's your part in this never mind. I get you saw me. Come here. Go Here yes, I came to talk to your uncle. Is he here? No and Captain Kovar was with you.  What did he do to you? He hit me why because he's insane. He thought he had to hit me one of the money Gave it to him you gave him the money. Yes all of it every penny of it I didn't want it anymore. It's not what I mean. You were holding the money for Dan Blake for us We were in it together Kovar learned it from Dan before he died Dan kept calling for me while he was dying so this Kovar thought he could black me on me He thought I gave him the money to keep him quiet Dan and I were trying to get away from this place have a life of our own Tried I don't care what happens to me Where's the telephone through that door, but you don't have to call I'll go to the police by myself I just wanted to wait Uncle Floyd got home. I'm not worried about your personal problems Charlotte. That's not my job Kovar and that's $75,000 is all I want Not to waste a minute, but time slipped by 15 minutes on the phone 25 to get back to me never When Sergeant Malva finally arrived at the harbour police dock a boat was ready for us Come as quick as I can his ship is not the thing. I checked it. He moved out about 20 minutes ago. We go then And I We don't find him he do not get out of the way both their colleagues are right now waiting The girl she was an accomplice she held the money so if he was picked up you couldn't prove possession She's gonna meet him later. They hooked shot him. That's what Kovar told her so But they also do not kill him. What's that? Police doctor. He said bullets do not kill Blake Blake choked to death I think Kovar choked him to learn the secret. I think we could prove that sergeant You get any more speed out of this thing? Come on. Let's get inside out of the spray One of the schooner with auxiliary power is matched against a police boat With our speed and the beams from four searchlights fanning out around us We covered every possible course that Kovar could have set it took us less than 30 minutes We go outside. Show this man. We are strong I Had in front of me church is ship No, sir, then Malvary curse back The doctors works for him or not. All I can see is his weight now do not get the way We move in right now go on board. He's shouting something. How'd you have your men stop him? Come on there? He's running forward.  Now if you'll put me aboard. I'd like to find that stolen money blanket item covering hotel Transportation, etc. Item for same as item one expense account total $3940 remarks After the arrest of Charlotte Page the stolen funds were counted in front of witnesses and the amount was not as large as was Plained by McDonald. I don't know what you can do about it Everybody seems to be out after something these days yours truly Johnny dollar Johnny dollar stars Edmund O'Brien in the title role and is written by Gil Dowd with music by Wilbur Hatch Edmund O'Brien's latest picture is the Paramount Pictures production Warpad Featured in tonight's cast were Bill Conrad, Lillian Bayef, Robert Griffin, Bill Johnstone, High Everback and Jack Crushan Yours truly Johnny dollar is produced and directed by Jaime Delvalle This is Dan Cumberly inviting you to join us next week at this time when Edmund O'Brien returns as yours truly Johnny dollar You can sing it again on CBS tonight for a whole hour of fun packed music packed entertainment And maybe Dan Seymour will be calling you to solve one of the tuneful little riddle songs That lead to a chance at radio's largest cash jackpot $5,000 plus 10,000 more in wonderful prices Allendale Judy Lynn Bob Howard the Riddlers and Ray Block orchestra are on hand to sing and play the riddle tunes leading up to Dan Seymour's coast-to-coast calls Be listening again later tonight when sing it again comes along on most of these same CBS stations Now stay tuned for Von Monroe's caravan, which follows immediately on most of these same CBS stations This is CBS where you laugh with Lucille Ball and my favorite husband on Saturday nights the Columbia Broadcasting System


Here's a solar storm that erupted on August 21, 2012. It's like the one on October 14, 2014, that SOHO and other spacecraft tracked across the solar system. This kind of storm is called a coronal mass ejection, or CME for short. CMEs are billion-ton clouds of solar plasma launched by a single explosion. A typical velocity is around 300 kilometers per second. That's 186 miles per second. This 2014 CME washed over spacecraft throughout the inner solar system, including Curiosity on Mars and ESA's Rosetta orbiting comet 67P. Measuring these storms enables scientists to predict a CME's path and strength. This is important because CMEs can disrupt communications and power systems on Earth if we are not prepared.


Joe Biden and his wife Jill have visited the site of the deadly conundium collapse in Florida. They offered condolences to the families of those killed and missing. As a casualty toll climbed, 18.145 people are missing and feared trapped in the rubble. President Biden promised to look into covering the cost of the first 30 days of the rescue operation. The governor has been completely open with me after that but I think we've been able to deliver and I think there's more that we can do including I think I have the power and we'll know shortly that to be able to pick up 100% the cost from the county of the state over the first 30 days well I think I'm quite sure I can do that and so we're going to do that and there's going to be a lot you all know it because a lot of them have been through as well this could be a lot of pain and anxiety and suffering and even the need for psychological help in the days and months that follow and so we're not going anywhere thank you thank you for real hello hope you enjoyed the news please do subscribe to our youtube channel and don't forget to hit the notification button so you get notified about fresh news updates


Here's what Kumomefela is doing for Christmas. The new queen of Kwaido Kumomefela is always seen at events with her dance moves that are on steroids, but Cis is really a family-orientated person and is going to spend Christmas with those she loves. The singer and dancer told Chvissa Livee that she feels complete when she's surrounded by her loved ones and is look forward to spending time with them. Imagine if it means getting one or two lame gifts. What is the most expensive gift you've received? The most expensive gift that I received was a huge teddy bear from my dad and I was over the moon when I got it. Why is Christmas special to you? Christmas is a special day because Christ was born. I become complete and content when I'm with my family. If you receive a bad gift would you return it? I wouldn't return a bad gift because it came out of love. I will keep it and show appreciation. I've never received a bad one from family or friends. What is on your Christmas lunch menu? There has to be a lot of meat and cakes because I'm a fan of meat and cakes and desserts. Out of 10 how fat do you feel after Christmas? I feel 10 out of 10.