Kamis, 31 Januari 2008
Senin, 28 Januari 2008
Climate Change dan Busway
Menurut IPCC Third Assessment Report (IPCC, 2001) negara-negara berkembang di Asia umumnya sangat rentan terhadap perubahan iklim. Lebih spesifik lagi dilaporkan bahwa daerah-daerah yang berpenduduk padat yang sangat tergantung pada sumberdaya alam seperti Indonesia sangat rentan terhadap dampak yang ditimbulkan oleh perubahan iklim. Suhu udara yang meningkat secara langsung akan mempengaruhi produksi padi (makanan pokok masyarakat) serta serealia lainnya. Daerah yang padat penduduk akan rentan terhadap wabah penyakit seperti malaria dan demam berdarah. Demikian juga akibat tingginya curah hujan akan langsung berpengaruh terhadap daerah pesisir yang rendah dan padat penduduk yang secara luas akan terpengaruh oleh genangan banjir. Sebaliknya, kekeringan akan mempengaruhi daerah lahan kering dan dataran tinggi.
Sebentar lagi Indonesia akan menjadi tuan rumah penyelenggaraan Convention on Climate Change di Nusa Dua Bali, 3-14 Desember 2007. Konvensi ini merupakan lanjutan dari United Nations Framework Convention on Climate Change, yang diselenggarakan di Kyoto, Desember 1997 yang telah menghasilkan Protokol Tokyo. Protokol Kyoto sendiri adalah sebuah perjanjian internasional yang mengatur tatacara penurunan emisi Gas Rumah Kaca di atmosfir pada taraf yang tidak membahayakan kehidupan organisme dan memungkinkan terjadinya adaptasi ekosistem, sehingga dapat menjamin ketersediaan pangan dan pembangunan berkelanjutan. Melalui Protokol Kyoto, target penurunan emisi oleh negara-negara industri dapat dijadwalkan dan dilaksanakan melalui mekanisme yang transparan. Indonesia sendiri telah meratifikasi konvensi tersebut pada tanggal 1 Agustus 1994 melalui UU No. 6/1994
Usaha menurunkan emisi Gas Rumah Kaca pada sektor energi umumnya didasari pada tiga prinsip berikut, yaitu:
• Mengurangi penggunaan bahan bakar karbon.
• Meningkatkan efisiensi pembakaran
• Meminimalisir kebocoran metana (CDM Country Guide)
Di Indonesia, telah mulai dijalankan berbagai usaha-usaha mengurangi emisi Gas Rumah Kaca tersebut, salah satunya dengan pembuatan Bus Rapid Transit, yang lebih dikenal sebagai busway.
Bus rapid transit (BRT) secara definisi merupakan system transit massa dengan bus, yang mengantarkan masyarakat dengan cepat, nyaman dan murah (Wright, 2005).
Pengadaan busway ini merupakan kebijakan yang positif apabila dilihat dari sisi kesehatan, karena keberadaan busway TransJakarta dapat mengurangi nitrogen oksida sebesar 212 kg/hari (Ernst, 2005) dan mengurangi penggunaan mobil pribadi, yang berpengaruh pada pengurangan penggunaan bahan bakar minyak, juga CO2 dan CO sebagai bahan buangannya. Dari 1 Februari 2004 hingga akhir Maret 2005, busway TransJakarta dilaporkan telah mengangkut sebanyak 20.508.898 penumpang (TransJakarta.go.id).
Walaupun keberadaaan busway sangat menguntungkan, masih banyak kontradiksi dari masyarakat karena kemacetan yang diakibatkannya. Masalah itu terjadi karena perubahan jenis transportasi ini tidak dibarengi dengan pergeseran tren pilihan transportasi masyarakat dan belum adanya pengurangan alat transportasi umum lainnya. Adanya kekurangan dalam sistem busway dan belum optimalnya promosi mengenai penggunaan busway juga merupakan faktor yang sering menjadi permasalahan.
Manifestasi dari permasalahan tersebut terlihat dari penggunaan motor dan mobil pribadi masih tinggi, angkutan umum lain seperti bus dan metromini yang penggunaannya belum dikurangi ,dan masih ada beberapa kekurangan pada sistem busway, seperti kapasitas terminal busway yang tidak mencukupi kebutuhan masyarakat, hanya ada satu pintu pada sisi platform dan pelayanan yang belum efektif (Ernst 2005).
Di waktu mendatang, diharapkan keberadaan busway dapat menjadi salah satu solusi yang efektif bagi masalah kesehatan, ekonomi dan transportasi yang ada di Indonesia, juga sebagai salah satu bentuk keikutsertaan Indonesia dalam usaha menyehatkan dunia dari pemanasan global.
Ma, 11 November 2007
Minggu, 27 Januari 2008
Priceless,, *tapi kata temen Ma sih rada serem*
Hari ini Ma ga ada kerjaan, sama sekali! Tapi siapa sangka begitu Ma nonton tipi, malah ketemu sesuatu yang bikin Ma stunned banget,,
House season 3 episode 17, itu yang bikin Ma spicles abis abisan,,
Kasus kali ini tentang ibu hamil yang kena gangguan paru-paru, ginjal dan hati sekaligus,, Penyakit dari ibunya ga jelas, dan bayinya udah dicek semua kecuali paru-parunya yang belom terbentuk, juga ga ada masalah,, House curiga itu Maternal Mirror Syndrome, yang kalo ngga diapa-apain, ibunya bisa meninggal ga sampe seminggu lagi, jadi dia nyaranin buat diaborsi aja,, Sebenernya salah satu cara lainnya itu ya dilahirin aja dulu bayinya, tapi bayinya baru 21 minggu, kira kira 5 bulan kurang dikit, belom bisa dilahirin,,
Masalahnya jadi ribet gara-gara Cuddy ngotot ga ngebolehin, malah mau nambahin kortikosteroid biar paru-paru bayinya lebih cepet ngembang,, Itu bener bener maksa,,! Masalahnya kortikosteroid yang dimasukin itu lumayan banyak, dan beresiko juga buat ibunya,,
Tapi,, Itu berhasil, dan paru paru bayinya mulai ngembang,, *biar gimana, ini kan pileem,,*
Abis masalah paru-paru itu, mereka mutusin mau ngapain lagi,, Saran dari Chase yang akhirnya diterima itu ngeoperasi bayinya,, Iya, rahim ibunya di buka, terus bayinya dioperasi,, *Ma ga kebayang deh, pasti susah banget,,*
Nah, yang luar biasa keren itu waktu operasinya,, Waktu lagi operasi, *lebih tepatnya waktu House mulai make suction buat ngurangin cairan ketuban di sana* tangan bayinya nongol!! Tangan itu megang jarinya House, kaya refleks bayi sebelom 6 bulan gitu lho,, Sampe seorang House juga jadi stunned,,
Akhirnya, bayinya selesai dioperasi, semua selamat, dan House jadi sedikit lebih manusia,,
Selain event itu, yang bener bener keren banget,, Ma juga meratiin masalah House yang ga pernah nyebut bayi itu sebagai bayi, tapi fetus,, dan Cuddy yang ngotot ga mau ngeaborsi bayi itu,,
House itu ngga nganggep bayi itu manusia, at least not yet mungkin,, Dan yang kaya gitu bukannya hal yang aneh di dunia kedokteran,, Yaaaaah, ga semua dokter yang pro banget sama abortus dengan indikasi itu pasti separah House sih, tapi tetep aja, ada sedikit kesan yang lebih meremehkan keberadaan bayi itu,, *House itu udah ekstrim banget kali ya,,*
Tapi, terakhirnya House nyebut ‘baby’ lho!! He’s definitely changed!! ^o^
Kalo Cuddy, dia itu single, udah beberapa taun ini berusaha punya anak secara in vitro, tapi ga dapet dapet,, Makanya dia agak ngerasa ga rela aja kalo udah ada yang punya bayi, tapi meninggal gitu aja,,
Yah, begitulah hari Ma yang diawali dengan ke-ngga penting-an, dan diakhiri dengan ke-ngga penting-an yang seru,,
Kalo mau liat di youtube, ada di sini dan di sini nih,, Juga cerita yang rada mirip, ada di sini,,
Gastric bypass, versi bahasa inggris,, Round 1!!
Mungkin dibagi beberapa bagian nih,, Nampak panjang bahasannya,, *dan tulisan Ma sangat simpel, jadi malu,,*
Gastric bypass procedures (GBP) are any of a group of similar operations used to treat morbid obesity—the severe accumulation of excess weight as fatty tissue—and the health problems (comorbidities) it causes. Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity, not just gastric bypasses, which make up only one class of such operations.
A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower "remnant" pouch and then re-arranges the small intestine to allow both pouches to stay connected to it. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different GBP names. Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food. The resulting weight loss, typically dramatic, markedly reduces comorbidities. The death rate is reduced by up to 40%Comorbid conditions
Life-threatening health problems arise from obesity as a consequence of its mechanical or metabolic effects. These comorbidities may in turn lead to severe deterioration of health, shortened life expectancy, and lower quality of life.
Major comorbidities include:
- Atherosclerotic cardiovascular disease. Obesity is not only associated with the occurrence of hypercholesterolemia and hypertriglyceridemia, but it is also a factor in the occurrence of atherosclerosis, the deposition of fats within the walls of the blood vessels. This leads to conditions such as coronary artery disease, congestive heart failure, and "hardening of the arteries." This group of conditions is a leading cause of death in the United States.
- Diabetes mellitus type 2 occurs mostly in middle and old age, but it is up to 40 times more likely in those who are severely overweight. It is associated with ASCVD, kidney failure, blindness, nerve damage, and amputations of the extremities, and is also a leading overall cause of death in the United States. Dysmetabolic Syndrome X, a pre-diabetic condition often associated with obesity, is accompanied by elevated levels of insulin in the blood and a high incidence of early development of coronary heart disease.
- Essential hypertension or "high blood pressure", is much more common in obese individuals. It can lead to early development of ASCVD, as well as to kidney disease. Weight loss is considered to be an important feature of treatment.
- Obstructive sleep apnea (OSA) Persons with this condition tend to suffer from airway obstruction when asleep, as the muscles relax and the weight and bulk of tissues collapses the throat passages. An observer notices loud snoring, frequent periods when breathing ceases (apneas), and episodes of restlessness and partial awakening. The afflicted patient is often unaware of the nature of the problem, but may notice frequent awakening at night, dry mouth, a sense of having slept poorly, daytime drowsiness and fatigue, or inappropriate sleeping (such as at work, in meetings, or while driving). This condition has a significant associated mortality.
- Gastroesophageal reflux disease (GERD) is characterized by regurgitation (reflux) of acid and gastric contents into the esophagus, and sometimes into the back of the throat. Gastric acid and bile are very corrosive to the lining membrane of the esophagus, and cause it to become inflamed (esophagitis) and sometimes scarred (esophageal stricture). Reflux which occurs while sleeping can lead to sudden coughing and choking at night, a burning sensation in the throat (pyrosis), and inhalation of acid and stomach contents into the lungs, with the risk of hoarseness, bronchitis, pneumonia, lung abscess and lung scarring. GERD is often associated with development of asthma, and causation of asthmatic attacks, and may also be aggravated by OSA.
- Gallbladder disease is much more likely in obese individuals, being associated with formation of gallstones, usually composed of crystallized cholesterol, within the gallbladder. Although readily treatable by removal of the gallbladder (cholecystectomy), it may lead to life-threatening problems such as obstruction of the ducts from the liver, jaundice, and inflammation of the pancreas (gallstone pancreatitis).
- Liver disease is present in some degree in 90% of persons who undergo bariatric surgery, usually a manifestation of the metabolic effects of obesity on the liver. This may take the form of large fat globules within the liver cells (steatosis), chronic inflammation of the liver (steatohepatitis), and in a few instances, cirrhosis of the liver. The latter condition may lead to liver failure and the need for a liver transplant.
- Venous thromboembolic disease affects the legs, and causes swelling, thickening and discoloration of the skin, and ulceration of the skin. This condition begins with damage to the veins of the legs, associated with formation of blood clots (thrombophlebitis), often associated with an injury, a pregnancy (even use of birth-control pills or hormones), or a surgical operation. When a newly formed blood clot breaks loose, and floats through the veins to the heart and lungs, it is called a Pulmonary embolus, which may sometimes be fatal within minutes. More commonly, the blood clot remains in place locally, and heals by becoming a scar, which permanently damages the vein. Once damaged, the veins cannot fully function to return blood to the heart, and increased venous pressure in the legs causes swelling, impaired circulation in the skin, and sometimes skin breakdown. Obesity is a major risk factor in development of VTE, and may also aggravate the increased venous pressure in the legs.
- Degenerative disc disease is a progressive "wearing-out" of the cartilaginous disks between the vertebral bones of the spine. It occurs more often and earlier in life in obese persons, due to the markedly increased mechanical stress on the disks from the extra weight. Its most common sign is chronic low back pain, which may be disabling. This condition is also associated with sciatica, lumbar spondylosis, and spinal stenosis.
- Degenerative disease of the weight-bearing joints, or osteoarthritis, affecting the hips, knees, ankles and feet, occurs earlier in life, and in greater degree, in obese individuals, due to the mechanical stresses of excess weight. Joint pain, loss of mobility, and joint replacement surgery are much more likely in obese persons.
Gastric Bypass is indicated for the surgical treatment of morbid obesity, a diagnosis which is made when the patient is seriously obese, has been unable to achieve satisfactory and sustained weight loss by dietary efforts, and is suffering from co-morbid conditions which are either life-threatening or a serious impairment to the quality of life.
In the past, serious obesity was interpreted to mean weighing at least 100 pounds (45 kg) more than the "ideal body weight", an actuarially determined body weight at which one was estimated to be likely to live the longest, as determined by the life insurance industry. This criterion failed for persons of short stature.
In 1991, a Consensus Panel of physicians was sponsored by the National Institutes of Health, and its recommendations have set the current standard for consideration of surgical treatment, the body mass index (BMI). The BMI is defined as the body weight (in kilograms), divided by the square of the height (in meters). The result is expressed as a number usually between 20 and 70, in units of kilograms per square meter.
The Consensus Panel of the National Institutes of Health (NIH) recommended the following criteria for consideration of bariatric surgery, including gastric bypass procedures:
- People who have a body mass index (BMI) of 40 or higher. Or,
- People with a BMI of 35 or higher with one or more related comorbid conditions.
The Consensus Panel also emphasized the necessity of multidisciplinary care of the bariatric surgical patient, by a team of physicians and therapists, to manage associated co-morbidities, nutrition, physical activity, behavior and psychological needs. The surgical procedure is best regarded as a tool which enables the patient to alter lifestyle and eating habits, and to achieve effective and permanent management of their obesity and eating behavior.
Since 1991, major developments in the field of bariatric surgery, particularly laparoscopy, have outdated some of the conclusions of the NIH panel. In 2004, a Consensus Conference was sponsored by the American Society for Bariatric Surgery (ASBS), which updated the evidence and the conclusions of the NIH panel. This Conference, composed of physicians and scientists of many disciplines, both surgical and non-surgical, reached several conclusions, amongst which were:
- Bariatric surgery is the most effective treatment for morbid obesity
- Gastric bypass is one of four types of operations for morbid obesity.
- Laparoscopic surgery is equally effective and as safe as open surgery.
- Patients should undergo comprehensive pre-operative evaluation, and have multi-disciplinary support, for optimum outcome.
The gastric bypass, in its various forms, accounts for a large majority of the bariatric surgical procedures performed. It is estimated that 140,000 such operations were performed in the United States in 2005. An increasing number of these operations are now performed by limited access techniques, termed "laparoscopy".
Laparoscopic surgery is performed using several small incisions, or ports, one of which conveys a surgical telescope connected to a video camera, and others permit access of specialized operating instruments. The surgeon actually views his operation on a video screen. The method is also called limited access surgery, reflecting both the limitation on handling and feeling tissues, and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision — with the option of using an incision should the need arise.
The Laparoscopic Gastric Bypass, Roux-en-Y, first performed in 1993, is regarded as one of the most difficult procedures to perform by limited access techniques, but use of this method has greatly popularized the operation, with benefits which include shortened hospital stay, reduced discomfort, shorter recovery time, less scarring, and minimal risk of incisional hernia.
Essential features
The gastric bypass procedure consists in essence of:
- Creation of a small, (15–30 mL/1–2 tbsp) thumb-sized pouch from the upper stomach, accompanied by bypass of the remaining stomach (about 400 mL and variable). This restricts the volume of food which can be eaten. The stomach may simply be partitioned (typically by the use of surgical staples), or it may be totally divided into two parts (also with staplers). Total division is usually advocated, to reduce the possibility that the two parts of the stomach will heal back together ("fistulize"), negating the operation.
- Re-construction of the GI tract to enable drainage of both segments of the stomach. The technique of this reconstruction produces several variants of the operation, which differ in the lengths of small bowel used, the degree to which food absorption is affected, and the likelihood of adverse nutritional effects.
Variations of the gastric bypass
Gastric bypass, Roux en-Y (proximal)
This variant is the most commonly employed gastric bypass technique, and is by far the most commonly performed bariatric procedure in the United States. It is the operation which is least likely to result in nutritional difficulties. The small bowel is divided about 45 cm (18 in) below the lower stomach outlet, and is re-arranged into a Y-configuration, to enable outflow of food from the small upper stomach pouch, via a "Roux limb". In the proximal version, the Y-intersection is formed near the upper (proximal) end of the small bowel. The Roux limb is constructed with a length of 80 to 150 cm (30 to 60 inches), preserving most of the small bowel for absorption of nutrients. The patient experiences very rapid onset of a sense of stomach-fullness, followed by a feeling of growing satiety, or "indifference" to food, shortly after the start of a meal.
Gastric bypass, Roux en-Y (distal)
The normal small bowel is 600 to 1000 cm (20 to 33 feet) in length. As the Y-connection is moved farther down the Gastrointestinal tract, the amount of bowel capable of fully absorbing nutrients is progressively reduced, in pursuit of greater effectiveness of the operation. The Y-connection is formed much closer to the lower (distal) end of the small bowel, usually 100 to 150 cm (40 to 60 inches) from the lower end of the bowel, causing reduced absorption (mal-absorption) of food, primarily of fats and starches, but also of various minerals, and the fat-soluble vitamins. The unabsorbed fats and starches pass into the large intestine, where bacterial actions may act on them to produce irritants and malodorous gases. These increasing nutritional effects are traded for a relatively modest increase in total weight loss.
Loop Gastric bypass ("Mini-gastric bypass")
The first use of the gastric bypass, in 1967, used a loop of small bowel for re-construction, rather than a Y-construction as is prevalent today. Although simpler to create, this approach allowed bile and pancreatic enzymes from the small bowel to enter the esophagus, sometimes causing severe inflammation and ulceration of either the stomach or the lower esophagus. If a leak into the abdomen occurs, this corrosive fluid can cause severe consequences. Numerous studies show the loop reconstruction (Billroth II gastrojejunostomy) works more safely when placed low on the stomach, but can be a disaster when placed adjacent to the esophagus. Thus even today thousands of "loops" are used for general surgical procedures such as ulcer surgery, stomach cancer and injury to the stomach, but bariatric surgeons abandoned use of the construction in the 1970s, when it was recognized that its risk is not justified for weight management.
The Mini-Gastric Bypass, which uses the loop reconstruction, has been suggested as an alternative to the Roux en-Y procedure, due to the simplicity of its construction, which reduced the challenge of laparoscopic surgery. It is claimed that construction of a long tubular gastric pouch reduces the risk of inflammatory complications, and renders it as safe as the RNY technique. Most bariatric surgeons shun the procedure, and most would assert that it remains unproven and investigational in nature at this time.
Akemi Yoshimura, Beyond The Sea 10,, Lesson 1!
Lesson 1,,
Pria, Wanita, Melahirkan dan Pekerjaan,,
Klasik banget ya,, di komik seri terakhir ini Ma suka banget dialog berantemnya mereka,, Sebenernya Ma niatnya buat nulis semua dialog 9 halaman yang banyak banget tulisannya,, tapi ternyata panjang banget,, jadi Ma ambil bagian akhirnya deh,, jadi kalo mau baca semuanya beli yak,, (malah ngiklan,,)
Masalah kenapa laki laki bisa menikah dan bekerja, tapi perempuan sulit buat bisa ngedapet dua duanya,,
Hal itu memang terjadi, tapi ada juga kecurigaan mengapa perempuan ingin terus bekerja,,
contohnya karena bekerja itu menyenangkan, ingin mandiri secara ekonomi, ga mau kalah dari laki laki,selalu ingin awet muda.. Kupikir semua itu wajar, pasti semua berjuang keras untuk itu, tapi kenapa di semua alasan perempuan ingin terus bekerja walau sedah menikah nggak ada alasan “karena ingin menanggung anak dan suami?”
[Hitomi] : Kenapa perempuan harus menanggung suami??
Alasan utama laki laki bekerja adalah untuk “memberi makan anak dan istri”, umumnya laki laki yang sudah menikah dan bekerja memiliki kesadaran ini. Tapi kenapa perempuan nggak memilikinya?
Alasan gaji laki laki lebih tinggi dari perempuan karena ada tunjangan untuk anak dan istri, makanya jika ingin pekerjaan dan gaji yang sama dengan laki laki, lebih baik perempuan menempatkan tunjangan anak dan suami sebagai alasan utama, soalnya laki laki bekerja dengan alasan itu..
Penjelasan Juzou saat ditanya oleh Hitomi,,
“Jelas sekali kalau laki laki bekerja demi anak istrinya!! karena perempuan kan yang melahirkan”
Jumlah perempuan yang nggak ingin anak itu membengkak lho,, anak dinilai sebagai beban ekonomi, kejiwaan dan fisik, makanya perempuan ga mau,,
Perempuan lebih tertarik dengan kehidupan suami istri yang saling bekerja dan konsumtif. serta saling menjamin kebebasan masing masing,, akibatnya laki laki yang setuju dengan pendapat itu makin bertambah
Tapi masih ada laki laki yang berjuang demi istri karena menikah, perempuan sendiri bagaimana? ga ada yang bilang “karena menikah aku akan berjuang keras demi suami” kan?
[Hitomi] : Jelas dong, kenapa perempuan harus bekerja demi suami?? bekerja kan kewajiban laki laki!?!?
Kalau begitu, apa kewajiban perempuan?
Apa cuma laki laki yang punya kewajiban?
Yang ketiga, jawaban Juzou mengenai perkataan Hitomi,,
“Huh, laki laki hanya bisa bilang apa saja, karena mereka ga mungkin bisa melahirkan anak”
BENAR! Cuma perempuan yang bisa melahirkan anak! Seberapapun menginginkannya, Laki laki ga akan bisa!!
Bagi perempuan yang yang punya kemampuan untuk melahirkan, mungkin nggak akan mengerti perasaan laki laki yang ingin melahirkan tapi ga bisa,,
Tapi, karena itu melindungi perempuan dan anak anak menjadi kewajiban laki laki!!! Makanya laki laki bekerja!! Karena bekerja satu satunya kemampuan yang bisa dilakukan dan kunci dari nyawa itu digenggam perempuan,,
[Hitomi] : Meskipun bilang melindungi, laki laki cuma merampas kebebasan perempuan kan???
BODOH! Kamu pikir kenapa laki laki mendahulukan anak anak dan perempuan di saat bahaya? Kenapa laki laki sampai nekat mennjadi perisai dengan menyerahkan seluruh usahanya??
Itu semua karena perempuan dan anak anak berkaitan dengan nyawa selajutnya!!
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Edan banget! Ma suka banget jawabannya, jawaban Juzou bener bener keren,, dengan seluruh niat untuk melindungi istri dan anak anaknya,,
Garfield Vault
kenapa Ma pilih yang ini,, ini tanggal lahir Ma!!!
Ma benci kucing!!! kecuali Garfield,,
I DO smile for real,,
Man, what’s HIS problem??
Hahaha,, best diet, ever!!!
Hahahahahaha,, Garfield, Euuwwwy,, yet, Funny,,
Walaah,, *speechless*
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My Fave Feline
Garfield is freakin’ weird!, yet I love Garfield,, though I hate cats,,
Bener bener Suka!
Garfield, Pooky, dan boneka boneka di sekelilingnya,,!!
Later on, you can find lots of Garfield trace around this blog, especially in the Vault,, sometimes I even use Garfield’s strip in my posts,, Those nasty, mean, and funny strips inspire me A LOT!
Garfield rules!!!!
Garfield Garfield Garfield Garfield Garfield Garfield Garfield Garfield Garfield