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The fact that I am writing about running again only confirms that I have something wrong in my head. My wife agrees.

We have all grown up wearing shoes. We wear them for everything. They help us look good, protect our feet, and make us comfortable. From the time we start walking we are introduced to shoes. We adapt accordingly throughout life to be one with our shoes. Shoes are more of an extension of our body than any other piece of clothing. So, why try to take away a part of your make up?

It’s no secret that there is a big “minimalist” running trend going on. In the races I’ve been a part of over the last 4 years I’d usually see some dude running barefoot and think to myself “How can that be good for you?” There was usually only 1 person doing it so I didn’t pay much attention. However, in the last year, this minimalist mentality has gained increased popularity thanks mostly to the folks at Vibram and their FiveFingers “shoes”. I am loosely categorizing them as shoes because they go on your feet, but to me they look more like Foot Work Gloves.

I fear these "shoes" would destroy me

Other manufacturers have gotten into the concept also. My two favorite brands New Balance and Brooks have their lines called the Minimus & Green Silence. These are your more traditional shoe-looking foot covers, but are supposed to promote a barefoot feel when running. I will say both these shoes actually look like they could be comfortable, but still not sure on the hype around this whole thing and that the shoes can live up to the daily demand you place on your running shoes.

I fear I would destroy this shoe.

I am biodegradable.

Here’s a little background info on the supposed benefits of Barefoot running. Also to qualify my perspective a bit I will say that I have a degree in Exercise Science and a minor in Biology. I’m not a doctor and I don’t work in a health related setting. I now work in IT and my only connection to health & fitness is that I run, workout, & read a lot. So take my opinion it for what its worth (which is nothing short of awesome).

  • Comfort & Efficiency – They are kind of one in the same with running. The theory with Barefoot running is that it will promote runners to run/land on the balls of their feet as opposed to leading with the heel and then rolling through the toes. Its believed that this is the more “natural” way of doing things and that landing on the mid & forefoot lessen the blow to the joints as opposed to landing on the heel. Got it?
  • Increased lower leg strength. Remember that Seinfeld episode with Jimmy? Well Jimmy uses special jumping shoes that help his vert. This is similar but instead of adding to the front of a shoe, you take away from the back and emphasize landing towards the front. This will cause the calves & other lower leg muscles to build up and promote more stability in your lower leg. Also, George likes his Kung Pao spicy.

Here’s why I think its goofy:

  • Over-compensating for a lack of shoe could promote just as many or more injuries than just running with shoes. We are familiar with shoes. Unless going barefoot to work becomes socially acceptable, only then will we all get natural or minimal.
  • As a larger person (200-ish lbs) are you to tell me that I would benefit from having less cushioning to absorb shock between the ground and my foot? It wouldn’t matter where I landed on my foot, I’d be applying more direct stress to my body for sure. Its simple math really.

If someone would like to prove me wrong on this, I am all for it. I will gladly take on a challenge to try it, I am a size 14 2E. However, know that my opinions and body type are stacked against liking this and ultimately succeeding at it.

Also, I know I use a lot of bullet formatting in my writing. I am not a poet & this is the way my brain processes info.

-S

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If you read our Bios on the About Page you’ll see that I have 2 wonderful daughters. They are awesome. Emotionally unstable at times, but overall still the best kids anyone could ask for. Well their lives are about change drastically. Through mostly fault of my own we will be adding to our brood in October. I am thoroughly excited about this. However, that excitement is paired with equal amounts of anxiety & concern. Before anyone freaks out, everyone is healthy. The concern on my part is just the overall questions that come along with being a dad.

  • Is it a boy or a girl? While some people insist on finding out the sex of their kids, my wife since our first child has insisted on not finding out. We tend fly by the seat of our pants and are terrible planners for stuff like this. So being surprised in the delivery room has been a great thing for us. Also the hospital staff gets into it too because they don’t know either. That being said, with 2 girls already on land, I am a bit curious to see if I need to build a tampon closet in 10 years. +1 for gender stress
  • Is the baby healthy? I know I have absolutely no control over this. But this is the number one-ish concern for me.  I want my kid to grow up with every advantage possible and want them to be able to live a normal life. However, it weighs on my mind daily. +1 for uncontrollable factors
  • How the hell are 2 of us going to raise 3 kids? 1 kid is easy although you don’t realize how easy it is until you have number 2. Right now 2 is good. Not easy, but we can each restrain one and not worry about a surprise folding chair to the back. +1 for WWE-like interference stress
  • Please don’t be a vampire… Admittedly I have read the Twilight series. In the last book the girl has a half-vampire, half-human child. A vampire kid would be cool, but is it worth the beating she receives? Its the pregnancy issues my wife goes through that I have a hard time with. She literally gives up so much physically to have a kid it is amazing that she would want to have more than one. The daily vomiting and constant nausea to me seems unbearable, but she does it. She’s also has had preeclampsia & Bell’s Palsy with the other kids too. She amazes me at how much she is willing to go through. I just don’t want her to be in any pain. This is the other number one-ish concern. +2 for Twilight reference & wife stress
  • How can we afford it? Not that I am Scrooge McDuck and have a room of money to swim in, but planning for the future has always been on the forefront of my wife’s & my thoughts. Almost to a fault we put away money for ourselves and kids (mostly kids) leaving not much in the tank to have some extras we might want or go on vacations. We are fine with this rationale. However, I don’t know how we can keep saving & pay for another one to go to Day Care (which is in my mind a Ponzi Scheme). We could buy another (larger) house for what child care will cost us. Somehow this blog needs to start turning a profit or I will be reduced to reviewing diapers in hopes I can get them free. +1 for not having a condo in France

Okay, it really isn’t that bad, but you get the point. Also, let it be known (and if my wife decides to actually read something I write) that I am extremely happy about the new addition and wouldn’t trade any of the stress above for the end result.

-S

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I am going to continue the trend of reviewing health related products. Recently I officially claimed the self imposed title of “avid runner”. It has been about 4.5 years in the making but I have finally crossed over into almost cult-like behavior when it comes down to my running. Recently my normal runs have been lasting 4-5 miles and I am stretching my long runs out to 9 or more. I wasn’t always this into running, in fact not too long ago I despised it with every fiber of my overweight being. However I, much like Jamie, decided that being a fat dad was an overall bad thing. So about 5 years ago I took to running. I won’t bore you with my lifestyle change &  running history now, I will save that for a different post. However I want to make sure you know that I am into running more than a sane person should be.

So this Christmas, my wife bought me a new iPod Nano because up until very recently I needed music to run, and my old iPod Nano is a disaster. So after fooling around with the new Nano, I decided that I didn’t like it very much, my old iPod was still better, and I really don’t need music for running anymore. So with that realization I decided to purchase a Garmin Forerunner 305 with heart rate monitor. This was great for me since I was satisfying my inner techy-nerd and my clinical addiction to running at the same time. I now possessed the ability to track my runs, watch my heart rate, and look really cool all at the same time. I became a triple treat. Kind of like the end of the 7th Harry Potter book.

I also went with a Garmin because its Garmin Connect site syncs with a site I belong to called Earndit. Quickly, I will let you know that Earndit is a fantastic site and a great way to be rewarded for your hard work. While they are relatively new, and they are picking up reward sponsors quickly. So jump on the bandwagon. Oh its free to join also.

Unfortunately not every product can be perfect, except bacon. There are 3 issues I have identified with the Garmin Forerunner 305 that I think you should be aware of if you are considering purchasing one.

1) It takes forever to find & lock on to a damn satellite. I would say that on the average it takes 5 minutes to lock on. I find this to be a big problem especially in the cold because you have to wait and wait on the Satellites. I am pleading with you Garmin to release a firmware upgrade or something, so you can fix this. Brutal.

2) The buttons on the watch aren’t the easiest to use and it is very hard to tell if you have pushed one or not. I am glad I am not a biker because it would be dangerous to have to fiddle extra time with the watch while riding. Eyes on path.

3) The software that comes with the watch I believe was updated last in 2004. My 5 year old could produce better graphics and functionality with a marker and a blindfold. Again, Garmin please release some new software that doesn’t look so terrible.

These may seem very trite complaints because honestly I am wearing a GPS receiver on my wrist that can communicate with outer space. Its pretty incredible.

Now that that’s out of the way, I really do like this watch. I am racking up reward points like crazy, it has helped me run longer, and not be confined to any specific route that I had already mapped out. I am getting instant feedback on everything you can imagine, my pace, distance, heart rate, etc. I can actually race myself with the watch which is really cool if you are looking to set PRs without forking over serious scratch for organized races. I think overall this device has made me a better, happier, more attractive runner.

Here are some key Pros that I want to let you know about.

  1. Once a Satellite locks on, it stays on. I have not experienced any drops and that is with running through some thick woods. Also it is very accurate in terms of measuring distance.
  2. Garmin’s online workout tracking site is really good.
  3. Garmin syncs up with a lot of other sites. Earndit as mentioned above and RunKeeper are the two I use. You can also convert your run data and plot it on Google Maps.
  4. The heart monitor is awesome and you can also purchase a Foot Pod for indoor running & Pedal sensor for your bike.
  5. The Garmin support staff was extremely quick  and helpful when my watch wouldn’t power up. We solved the issue right over the phone at no cost.
  6. What else… Oh it cost less than that new iPod if you look online for it.

On our Sandwich Scale I would rate the Garmin Forerunner 305 a Muffaleta. Which if you look at their product lineup in this category is fairly accurate. And as any good review goes, if Garmin is willing to have me try out other devices or products I am more than happy to do this for them.

The iPod Nano however didn’t fair so well on the scale. I am giving it an MLT (Mutton Lettuce & Tomato). If I were to use this in a workout or running setting it would last no more than 6 months. There is no real way to protect it or sheath it from my over-active sweat glands. Also it would be nearly impossible to easily skip songs while working out. Smaller isn’t always better Apple.

-S

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Well here it is the final episode of my Prostate trilogy. Its been an epic writing journey for me as I don’t think I have written so much about 1 topic since College. I will recap just a bit but you can read the full stories here & here.

I first started with a story about how I became ill and it was discovered that I had an inflamed prostate and a UTI. The next step was to go to see a Urologist (which this post will cover). The second post was a complete breakdown of everything the normal person would need to know about their prostate, what it does, and how doctors diagnose issues with it. I think this second post was a huge success as we had a true professional give his expert opinion instead of just getting a bunch of stuff from the internets.

The Boyfriend I Never Wanted

So on with the show. We pick up the story 2 weeks after my UTI. The antibiotics had run their course and I was feeling normal again. I just had to get past this one visit and go on with my life. I met with my doctor who is highly respected in the St. Louis area. In fact there is a college with his Family’s name on it. I went over my symptoms with him and he had gotten a full write up on me from my primary care. We started with the “exam” and right away he noticed that my Prostate was still enlarged.  He also prescribed some blood work as my Prostate should have gone down in size over the past couple weeks with the infection.

Within a few days the blood results were back and my PSA level was at 4.5. Which at the time to me seemed low. My calmness was squashed in the matter of a second when I heard that for my age a PSA lower than 1 was more normal. I was then asked to come back into the office for some more testing and examining. The next test was still looking at my PSA but they wanted to know the Free:Bound ratio. Now for some reason I will never forget where I was when I received the info back from this test. It was St. Partick’s Day and I was celebrating my Irish Heritage at 10am and I think it was a Tuesday or something. I was well on my way to having a great day. Then my phone rang… The results came back with my Free PSA was at 3%. Which if you recall from Dr. Greenfield, the higher the Free PSA the better. My doctor advised that he likes to see around 20-25% Free PSA. What really makes this call really stick out in my head however, is it was the first time the “Cancer” word was mentioned. The timing was terrible.

With 2 strikes against me (Elevated PSA & Low Free PSA) my doctor was concerned. He gave another exam and the size had not gone down. He advised that the next step was to perform an ultrasound of my Prostate. He wanted to get a visual of the area, to see if there was some asymmetry and just try identify if something crazy was going on. The ultrasound was not the same as the one that was performed on my wife’s belly when she was pregnant either. In fact, to get a REALLY good look at it they had to dive in. This was the second most uncomfortable experience in my life. He looked around for what seemed like 3 hours took some pictures and went about his ANALysis. He identified some scar tissue that had been there from a previous infection (not the one I just had) and noticed my walnut was large and asymmetrical. Stirke 3.

With all the information gathered, there was but one choice (so I thought). My Doctor seemed almost certain that I had cancer. He even wrote a “Thank you” letter to my primary care. I don’t know if he was excited about the thought of a 30 year old with cancer or what… Anyway the biopsy was put on the calendar and my one visit to the Urologist had blown up into 4 visits, 2 rounds of blood work, 1 ultrasound, and now 1 biopsy.

As I said before the Ultrasound was the second most uncomfortable event in my life. The Biopsy remains number 1 and I really hope it doesn’t get trumped any time soon. If you are unfamiliar with a biopsy, they have to take small pieces of whatever is at risk, send them off to a lab, and check to see if there’s cancer. The Biopsy itself took I think about 30-45 min. They took 16 samples (4 from each region). It was painful and almost humiliating at the same time. When finished I thought the pain would be over, just a little pain here and there, nothing crazy. I was wrong. The rest of the day and the next I had to sit on one of those horseshoe-like pillows. Not to mention when I did business in the bathroom there was a lot of blood associated with it (from both ends). I will chalk that up to not asking about the side effects before i went in. Now with all the physical pain, there’s another interesting feeling going on, not knowing if you have cancer or not. That seemed to weigh on me as much as the pain.

To save the suspense, the bioposy results came back negative for cancer. Which was one of the greatest phone calls I’ve every received. So for the record, I didn’t want this to turn into a pity blog for me, I wanted to share this story with you to educate and hopefully make you a better patient. If I would have been armed with future goggles and Dr. Greenfield’s information, I don’t think I would have gone down this long painful path.

After talking with Dr. Greenfield and going over my history (with no exam +1), he has suggested that I possibly have Prostatitis, chronic swelling of the Prostate. Unfortunately, there is no real silver bullet for this and he did not suggest I take Avodart or Proscar as there are potential side effects that will hinder my baby making abilities. He suggested that I just live a healthy lifestyle, eat well, and exercise. I can live with that.

Thank you to everyone for taking some time to read this and a big thanks to Dr. Greenfield who took these posts to a new level. I hope my mission of providing you with some information & advice was successful. I think this will be the last post about wang for awhile. Til next time…

-S

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Now that you are well versed in the beginning stages of my Prostate ordeal, I think it is only fitting that we go over some important words and phrases that I will be using in the upcoming part 3 of this saga a.k.a. “The Boyfriend I Never Wanted.”

Part 2 of the PSA on PSA “The Greenfield Diaries” wasn’t originally planned at first. I was just planning on doing some research on WebMD or something to give definitions. However, it turns out a college friend of mine has made something for himself and is a Board Certified Urologist. So on a whim, and not really speaking with him formally in 10 years, I asked if he would be so kind to answer some questions for the site. He did and it was exactly what I wanted: straightforward answers with minimal amounts of conservatism. This saved me tons of research time and time figuring out how to give credit to a website. So, thank you Dr. Jason Greenfield for your professional input here. Also you should be able to tell the difference between Dr. Greenfield’s comments and mine.

So on to the show. We’ll start at the beginning. How many of you actually know what your Prostate does? I am going to bet that most of you that are under 40 know very little. Maybe general location or that your dad isn’t thrilled when he goes and gets it checked. The prostate is a gland specific to the male gender. It is located next to the bladder and envelops the urethra as it begins from the bladder neck. Its main function is to contribute secretions that compose semen and is the entry point of the the ejaculatory ducts where sperm from the vas deferens and secretions from the seminal vesicles enter. So, without this walnut shaped glad, there wouldn’t really be a Suburban FATHER Alliance.

Now that we are squared away on its location lets get more into its function. The Prostate produces PSA. PSA stands for “Prostate Specific Antigen” and its major function is to liquefy semen. It can also be found in blood and is currently used as a tumor marker for prostate cancer. Essentially, the higher the PSA level, the more in your blood. It is a better marker of prostate size but doctors use it to screen for cancer because it is still one of the best markers they have right now. Although, in truth, it is terrible in terms of specificity. It is important to know that a lot of other medical problems can cause the PSA to rise such as urinary infections. — If  I can pause, this last sentence really hits home for me and after talking to Dr. Greenfield, I wished I would have gotten a second opinion with my symptoms. Second opinions only cost a copay but could save you a huge amount of stress.

So a bit more on PSA. When PSA is measured in the blood there is a level associated with it. Now what constitutes a “normal” PSA level is a very complicated answer. A normal PSA level depends on the patient’s age, prostate size, and previous levels. For example, most laboratories give a range of 0-4.0 as normal. However, it is definitely not normal for a 30 year old to have a PSA of 3.5. A level of 5.0 may not be abnormal for a man in his 80’s. As another example, a very small prostate and a PSA of 3.5 may be concerning whereas a very large prostate and a PSA of 5 or 6 may not be. As a final example, we also look at “PSA velocity”. If your PSA one year was 3.9 and the next year was 4.1, that may not be very concerning. If it was 1.5 one year and the following year was 3.0, that can be a red flag. There are also a multitude of other tests involving PSA and it’s subtypes. It can be very confusing and one could write volumes of text about PSA itself. Perhaps the best advice is to be aware of what your PSA is and ask your urologist what, if anything, you should be doing about it.

Now, like many substances in our blood stream, PSA exists both bound and unbound to other proteins (mainly albumin). Unbound PSA is often referred to as a “free PSA”. Testing for free PSA was developed in the hopes that it would be a more specific test for identifying men who were at risk for prostate cancer. It is given as a percentage and, unlike the test for total PSA, a “lower” value is considered MORE suspicious for prostate cancer versus benign disease. However, it should be noted that the free PSA test has been somewhat disappointing as a tool for identifying higher risk patients. It certainly has not relieved us in our quest for a highly sensitive and specific test for identifying men with prostate cancer.

Finally, one very common complication with Prostates is BPH or an enlarged Prostate. The most important thing to know about an “enlarged” prostate is that a large prostate is in no way a risk for having cancer. It may lead to an elevated PSA but as  mentioned above, that does not mean cancer. An enlarged prostate can eventually cause urinary problems as the prostate grows to obstruct the flow of urine through the prostatic urethra. This is often called “BPH” which stands for “Benign Prostatic Hyperplasia”. Note the word “benign”. This is not cancer. BPH occurs in the central part of the prostate where the urine passes through. Prostate cancer usually occurs in the peripheral part of the gland.

Ok we covered the location, function, and what doctors measure in the Prostate. We can also confirm that each person’s Prostate is going to be different in size and in producing PSA. There’s no clear formula on what is going to constitute if you have cancer or not. What Dr. Greenfield does recommend is talking with your doctor briefly about whether or not you wish to be screened. If you decide that you do, the recommended age to start screening for a Caucasian male with no significant family history of prostate cancer is age 50. Men of certain ethnic backgrounds, especially men of African descent, are recommended to start at age 40 as well as men with a family history of prostate cancer.

Overwhelmed with info? Mission accomplished. I really hope you all have taken some time to read & re-read this info. Its a lot, but it is necessary to stay informed as patients and to ask the right questions when we visit with our doctors. I cannot thank Dr. Greenfield for his time on this subject. He has probably opened a Pandora’s box by being so open and thorough.

Now, for the the final post of this Trilogy I will talk about my experience when I went to the Urologist for the first time not knowing what any of this was and having some discouraging news dropped on me in the middle of a St. Patrick’s Day Parade. Thanks for reading.

-S

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At the ripe age of 32 I know more than I want to know about my Prostate than I care to. Its not a bad gland, one of the best in fact, but to have issues with it this young is not necessarily normal. The next few posts from me will delve into a very hard to reach part of my body and why something the size of a walnut can freak you out. Later in the series, we will also have a guest appearance from Jason M. Greenfield M.D., Board Certified Urologist. I’ll be asking him some questions along the lines of definitions, preventative measures, and a bunch of other stuff I wish I would have asked my doctor at the time. This is valuable information that he’s providing, and since we aren’t backed by Google yet, he’s doing this for free. So for that we are extremely grateful.

The Agitated Walnut

It was a fairly normal day. I was at work pretending to do my best, making customers happy, and counting the hours as they rolled by. Halfway through the day I noticed that I wasn’t feeling incredible well and my mediocre drive to excel was going farther downhill. I was starting to feel funny. My muscles were achy, I had a headache, lots of low back pain, and I was getting a fever. I pushed through the end of the day like all great employees but by the time I got out of the office, I was a wreck and completely sick. I went home, took some ibuprofen, and for the most part went straight into bed. I was fairly confident the fever would break and I’d be fine the next day, but I was proved wrong. That night I got up to relieve myself and I was struck with 2 things: 1) it burned like fire and 2) it didn’t all want to come out. After about 15 min in the bathroom and achieving about what i am guessing to be about 90% evacuation I went back to bed. I laid there for about a minute and it felt like I still had to go. So I went back to the bathroom. This cycle happened a few times before I could go back to sleep. When I woke up to do my morning routine, my symptoms weren’t any better and the pain was still there. If I can go off track for a second, the pain is different than if you get kicked or something down there. It was like lava was trying to escape my body through my water hole. Also, when I would “finish” the left-over lava that hadn’t escaped made an extremely uncomfortable sensation.

And we’re back… With the fever still in full force, my muscles sore, and the pain when I had to pee, I decided to call the doctor. Like most men, I am not one to frequently call or visit the doctor. Normally things work themselves out, but the trifecta of symptoms warranted at least a call. I was told to get right in there. When I arrived, I was greeted by the friendly receptionist with a slight look of disgust after seeing that a man so foul looking could exist. I made my way back to the room and met with my doctor. I was a bit hesitant to explain my symptoms in the lower half of my body to my doc, but figured that wouldn’t be fair to either of us if I didn’t. When I mentioned my symptoms down there, he broke out the rubber glove and asked me to drop my pants. Well, thats what I get for telling the truth. He did his examination which I don’t necessarily need to explain, but I can tell you there’s really only one way to reach the prostate. Luckily my doctor had done a few of these before and he could tell very quickly that my prostate was inflamed. I had an infection, most likely a Urinary Tract Infection (UTI). He prescribed me some anti-biotics and referred me down the hall to set up an appointment with his office neighbor the Urologist. I had to make an appointment 2 weeks out since the doctors wanted to have the anti-biotics run their course and the results of my exam with the Urologist weren’t skewed.

With-in 24 hours of taking the anti-biotics I was feeling better. The fever was gone, my muscles weren’t sore, no hot lava, and 100% evacuation. I am very glad I decided to tell my doctor all of my symptoms when I went in and was on the road to recovery. I just had to meet with a Urologist in a couple weeks. No biggie.

My next post will get side tracked just a little bit from the this story. I think it would be a good idea to go over some terminology before I continue on. Also Dr. Greenfield provided a ton of info and I don’t want any of it to go to waste.

So in the meantime, I will just encourage you all to be up front with your doctor. If you are embarrassed for some reason to explain any symptoms to him/her, go find a new one that you are comfortable with. An open and honest dialog with your doc should be one of the top lines of communication in your life.

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Well the SFA has been official for a little over 3 weeks now. I think we’ve explained who we are and what we want to accomplish, but we think it would be a jerk move not to tell you what’s up behind the scenes, and get some feedback about what you want to read about. We’ve had a series of articles about times and trials of a Vasectomy and there are some other man-health related items that will be coming out soon (think Prostate). We’ve also reviewed a couple products/services for our Padre Knows Best section.

Now call us lazy, but what we have decided to do (for now) is to add our “Padre Knows Best” content to the SFA blog. If you recall, PKB is the first and only limb of the SFA focusing on various product reviews so we can get free stuff. What this will do is provide a single feed for our wonderful followers (until you get annoyed with the hodge-podge format and tell us to separate it out).

So I bet you still have a lot of questions or at least I have had some inner dialog with myself:

Q. Hey man, what do you talk about your junk so much?

A. 2 reasons: 1) The movie Braveheart lied to us when Mel Gibson’s uncle said “It is our Wit that makes us Men.” Wrong. It is our wang. With out this we wouldn’t be called fathers or dudes. 2) We feel that the best way to build Street Cred is to present lots of Scrotally-Based articles out of the gate. If a guy can talk about his junk openly, he’s got nothing to hide.

Q. Do you accept donations or do public speaking?

A. No donation is too large, but an audience might be a bit too much for now unless there is a large donation.

Q. What makes you guys experts on these subjects?

A. We do not claim to be experts on anything, just 2 guys that want to help an under-served group of people on the internet.

Q What can I do to help other than give you all my money?

A. We want feedback on how we’re doing and what you want. We’ll take any constructive criticism you can throw at us, kindly tell you where to stick it, and make adjustments accordingly. Oh and one more thing, SPREAD THE WORD. Right now we are sitting at a whopping 8 followers on Facebook. We need followers to get this train moving. Thanks in advance for all your help.

That’s it. Now give us money or feedback or both.

– O & S

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