Important to have advance health care directives

By Leanne Wagoner

There may come a time in your life when you become injured unexpectedly or are too sick to make health care decisions for yourself. Who do you want to make medical decisions for you? What type of life-saving measures do you want to keep you alive?

Here are a few reasons you may want to complete your advance directive today:

• An advance directive is a legal document that can speak for you, when you’re not able to speak for yourself – for example if you are in a coma. It provides written instructions regarding your medical care and life-sustaining preferences.

Leanne Wagoner

Leanne Wagoner

• It relieves your loved ones from making medical decisions for you and can reduce confusion or disagreements about the care you should receive.

• Choosing someone to act as your health care agent who will carry out your requests may be the most important part of your planning. He or she should be mature, level-headed, and comfortable with difficult conversations. It doesn’t have to be a family member and you shouldn’t pick someone because of guilt or obligation.

Here are additional considerations:

• Living wills and other advance directives aren’t just for older adults. Because sudden illness or accidents can happen at any age, all adults need advance directives.

• Your advance directive should be in writing. You can find state-specific forms online by searching “advance directives” or at websites such as the National Hospice and Palliative Care Organization. You can also obtain an advance directive at your primary care physician’s office.

• Make sure you talk about your wishes, and give copies to your family members, health care providers and health care agent. Take a copy with you if you are admitted to the hospital. You can change your decisions at any time. Be sure to tell everyone involved – family members, health care agent, and primary care provider when you make changes.

To revise your information, follow the same steps you used to create you advanced directive.

Advance directives are available in your primary care physician’s office. You may also download an advance directive. There is no cost to complete this legal document provided by each state.

Leanne Wagoner works in the marketing department for Barton Health.

 




Keeping kids home may be a healthy choice

By Michelle Feeney

Knowing when to send your student to school or daycare and when to keep him or her home can be a tough judgment call — especially in the rush of a weekday morning.

When you’re wondering how sick is too sick for school, a few general guidelines can help. Keep your child home if:

• He or she has a fever over 100 degrees measured orally or 100.4 degrees.

• Other kids could get sick from being around your child.

• He or she isn’t well enough to participate in activities, including outside recess.

• He or she requires more care than school staff can provide without compromising the safety and health of other children.

Tips for Working Parents Scheduling around a sick day for your child can be difficult. Here are a few tips when you are in a bind: Plan ahead. Make arrangements with friends or family that fill in when you can’t watch your child. Make sure they are on your child’s emergency contact list at school. Coordinate with your employer to work from home. Split the “shift” with your significant other, family, or friend.

 Scheduling around a sick day for your child can be difficult. Here are a few tips: Plan ahead. Make arrangements with friends or family that fill in when you can’t watch your child. Make sure they are on your child’s emergency contact list at school. Coordinate with your employer to work from home. Split the “shift” with your significant other, family, or friend.         — Michelle Feeney

Other symptoms that warrant a sick day include:

• Diarrhea and/or vomiting within the last 24 hours

• Abdominal pain for more than two hours, or with fever

• Red eyes with discharge or mucus

• Cough that is disruptive to your child or other students

• Strep throat, until 24 hours after beginning antibiotic treatment

• Abrupt behavior change that includes irritability, constant crying, or lethargy

• Difficulty breathing

• Mucus or blood in the stools

• Mouth sores with drooling, unless your child’s doctor has confirmed that he or she isn’t contagious

• Lice, until after the first treatment with lice shampoo.

• Rash with fever or behavior changes, until your child’s doctor has confirmed that the illness is not contagious

• Measles, until four days after the rash appears

• Chickenpox, until all lesions have crusted or dried (typically seven to ten days after the rash appears)

• Quickly spreading rash.

If your child has not received their vaccinations and develops a rash or swollen glands, consult with your provider before he or she attends school.

If you are unsure of your child’s symptoms, contact your child’s primary care provider to see if your child requires an appointment or urgent medical attention.

Michelle Feeney is a family nurse practitioner at Barton Family Medicine and Barton Pediatrics at Stateline Medical Center. 




Cancer program focuses on exercise, nutrition

By Angela Moniot

Since 2009, South Lake Tahoe resident Rick Robinson has been battling cancer. He traveled more than an hour to Truckee for chemotherapy, and 45 minutes down the hill to Carson City for radiation treatments.

While being treated in Truckee, Robinson learned of Tahoe Forest’s cancer wellness program that focused on exercise, yoga, and nutrition. Seeing the program’s benefits, Robinson knew a similar program would benefit cancer patients on the South Shore.

 Physical therapist Kelly Skelly, right, assesses Rick Robinson's balance in an "Exercise for Energy" class.

Physical therapist Kelly Skelly assesses Rick Robinson’s balance. Photo/Provided

Robinson was inspired to partner with Barton Health’s director of Rehabilitation & Sports Medicine, Alan Barichievich, to help create Barton’s Cancer Wellness Program.

As Robinson puts it, “I was a guinea pig of sorts,” as he helped pioneer the program now available to cancer patients in South Lake Tahoe.

Funded by the Barton Foundation, the free program is designed to help community members undergoing, or who have undergone, cancer treatment. Patients reach an improved state of wellness through guided exercise, yoga, meditation, and nutrition.

“When you are undergoing treatment, there are times when it is very difficult to motivate yourself to get up and move,” Robinson explains. “That is why having this program is so fantastic. I know that it has kept me stronger and has helped fight my battle better.”

Today, Robinson continues to ride his bike, take occasional hikes, and enjoy life to the fullest.

Kelly Skelly, a physical therapist with Barton Rehabilitation & Sports Medicine, leads the “Exercise for Energy” classes — a series of supervised exercise classes that incorporate strength training, stretching, breathing, balance, cardio, and wellness education.

“Exercise has been shown to improve not only a person’s ability to complete activities of daily living, but it also can help with decreasing pain and cancer-related fatigue,” Skelly explains. “I try to make the exercise class fun and as individualized to a person’s goals as possible.”

In addition to exercise, the program includes free yoga classes. Health benefits from yoga include relaxation and stress reduction. Yoga also helps improve the quality of life.

“Yoga provides a peace of mind and a way of helping you to relax versus the more physical aspects of the exercise for energy program,” Robinson states.

The program also offers free nutrition classes, which include nutritional advice, cooking tips, and recipes. Led by Barton Health’s registered dietitians, patients learn how a healthy, well-balanced diet plays a key role in overall health during cancer treatments, throughout recovery, and into long-term survivorship.

A physician referral is required to participate in Barton’s Cancer Wellness Program. As with any wellness program, it is important to consult your physician to determine if the program is right for you. If you experience abnormal symptoms associated with the program, please discontinue the wellness program and contact your physician immediately.

Interested in the Cancer Wellness Program? Call 530.543.5896 or go online.

Angela Moniot is Barton Health’s marketing specialist.




Tahoe Tails — Adoptable Pets in South Lake Tahoe

Cooper

Cooper

Cooper is a 6-year-old Labrador mix, about 55 pounds, who has lived with other dogs and children.

Cooper is blind, so he would do best in a home with another dog, preferably a mid-sized female. He is a nice boy who is a bit confused at being in the shelter. He loves to go for walks and play fetch with his favorite toy.

Cooper is neutered, microchipped, tested for heartworm, and vaccinated. He is at the El Dorado County Animal Services shelter in Meyers, along with many other dogs and cats who are waiting for their new homes.

Go to the Tahoe animal shelter’s Facebook page to see photos and descriptions of all pets at the shelter.

Call 530.573.7925 for directions, hours, and other information on adopting a pet.

For spay-neuter assistance for South Tahoe residents, go online.

— Karen Kuentz




Even today books are banned in the U.S.

By Rebecca Hersher, NPR

Banned Books Week kicked off Sunday: Each year, the American Library Association takes this week to sponsor events all over the country to talk about the books that shock, offend, and generally make Americans uncomfortable.

Violence and curse words are two of the top three reasons books get banned in the U.S.

The third reason is sexual content. For example, the “Fifty Shades of Grey” series has been frequently banned from libraries for its explicit descriptions of intercourse.

But when it comes to kids, the bar for inappropriate sexual language is much lower. In 2013, the top banned book in America was the kid’s story “Captain Underpants”. It was most frequently challenged for potty language and toilet humor.

That’s how a sex education book for children, titled “It’s Perfectly Normal”, became one of the most banned books of the past two decades. The book is meant to teach children 10 and over about sexual health, emotional health and relationships, and contains sections on puberty, pregnancy and sexual orientation.

Read the whole story




Arsonists often fit a similar profile

By Ed Pearce, KOLO-TV

Investigators say the King Fire, now burning out of control near Pollock Pines, was deliberately set and they have a suspect. Thirty-seven-year-old Wayne Huntsman has been arrested, pleading not guilty Friday to felony arson with enhancement.

Huntsman’s guilt or innocence and any possible motive will be determined by further investigation and prosecution, but arson is a crime which always leaves the rest of us with a puzzling question: Who are these people and why do they set fires?

It turns out arson investigators have developed a profile. “We will always have a percentage of people who walk among us who commit acts like this and they are extremely dangerous,” says Terry Taylor, a captain and fire investigator with the East Fork Fire Protection District in Douglas County. He’s also a founding member of the Nevada Arson Investigators Association and an arson investigation instructor at the National Fire Academy.

The crime itself often destroys evidence and without witnesses the investigation can stall, but over the years a profile of who they are looking for has emerged. “White males, under 24 years of age,” says Taylor. “They’re sort of troubled. They have difficulty keeping employment. They have difficulty maintaining social relationships. If they’re 30 to 40 of age, people would think they behave like teenagers.”

Read the whole story




Financial advisors need to understand clients

By Rodger Alan Friedman

Shocking stats continue to make news regarding America’s preparedness for retirement, including the fact that one of five citizens near retirement age have zero money put away for the golden years, according to statistics recently released from the Federal Reserve.

About 20 percent of pre-retirees have nothing stocked away, and 31 percent of the total population also has no money for retirement.

This issue is making news regularly, and financial planning for retirement advertisements have spiked in recent years, in case you haven’t noticed.

If nothing else, I hope the increased focus is lighting a fire under those who are near retirement, and I hope future generations are taking notes.

Just as the average person needs to get real with their own finances, advisors also need to get real with their clients. That means having several traits.

• Competence: When advisors are unsure of themselves, it comes through. When presented with a set of facts, new advisors may not recognize what they are dealing with, or its importance. A seasoned advisor, on the other hand, has dealt with many clients with numerous problems several times over and knows what it takes to solve a problem. That’s why I feel that an experienced financial advisor is the best answer for someone in need of retirement income and financial planning. Also, financial advisors should be very well-read, with self-imposed reading requirements. Learning new ideas and revisiting old ones keeps veteran advisors fresh.

• Empathy: What is a client going through? Advisors must have their antennae up. Tears, anger, regrets and frustration are often bound with a person’s finances. I have met very few 22-year-olds who can fully understand the struggles, worries and dreams most people experience throughout a lifetime. Advisors have to develop an approach that helps clients feel comfortable in discussing difficult matters. The client needs to understand that the advisor truly cares and is not there merely for a transaction.

• Ability to listen: “You have to have two ears and one mouth,” my mother used to say; she made it clear that I should be listening twice as much as I was talking, and that advice has served me well in my life and career. Clients come to an advisor for professional expertise, but they don’t want to be lectured. Advisors have to first listen to clients – their problems, needs and hopes – before offering a professional response. The conversation should flow easily both ways as an advisor and client get to the heart of matters in an atmosphere of mutual respect.

• Perspective and insight: Perspective and insight are like twins: wherever there is one, the other is not far behind. Planners gain perspective and insight through thousands of hours of listening, collaborating, advising and acting as a steward of the financial assets and dreams of the families they serve. You know when you’re in the presence of these “twins;” it is often said that people with both see with their intellect – they possess vision. Clients should keep their antennae up for these traits when meeting a prospective advisor. Pay attention to how he or she may, as if without effort, intelligently guide the two-way conversation.

Rodger Alan Friedman grew up working in his family’s New York City laundry, where he learned a strong work ethic – and about the type of work he didn’t want to do. After earning a degree in political science, he became a real-estate agent trainee, then performed compliance audits for a large Wall Street brokerage firm, eventually became a stock broker, and then financial advisor and wealth management professional. 




West Shore Inn oozes relaxation

No need to get out of bed to  see the sunrise from the West Shore Inn. Photos/Kathryn Reed

No need to get out of bed to see the sunrise from the West Shore Inn. Photos/Kathryn Reed

By Susan Wood

HOMEWOOD – As active as I am, I never dreamed I’d look so forward to waking up early on vacation. I also never thought I’d go to a hotel and have sitting be my favorite activity.

But a couple days at the West Shore Café and Inn isn’t just any experience – especially with a stay in the Marlette Peak suite.

This peak experience right on the lakefront starts with the sun rising. Views of Heavenly Mountain Resort runs remind us this waterfront experience is in our backyard. The many shades of pink and yellow of the shoreline seep through the morning clouds then changed in a matter of minutes, thus keeping me stationary for hours. Between the mesmerizing lapping of the waves only 20 feet out the window, a ski boat breaks the rhythm cutting across the shoreline with a water skier in tow.

Breakfast with a view.

Breakfast with a view.

If one wants to move around, there are two balconies – one with two cushy chairs and an end table for morning coffee, another with a bench. The best seated-view, though, is smack dab in front of the floor-to-ceiling living room window.

A throw blanket is carefully placed on one of the chairs in case the temperature dips. When it got nippy, we turned on either the gas fireplace in the living room or bedroom. When the sun was beating it, we’d open the two balcony doors.

The first morning, I got up to take in the different views and to await a breakfast tray of assorted muffins and orange juice that would soon arrive at the door. Coffee is made in the living room/office area.

The rooms, which are inviting all day and night, are a tastefully decorated with an alpine feel, along with beautiful walnut wood furnishings and finishing accents. Even the nightstands in the bedroom look as though someone attached a tree-round steppingstone to legs. Elegant touches may have guests never wanting to leave. Tile floors and a full-size tub add to the relaxing experience. (Suggestions: Fix the shower so it drains properly, and so water is not being wasted, and provide consistent quality towels.)

A view that never gets old.

A view that never gets old.

Cushy robes let you lounge all day in comfort. The mini fridge filled with complimentary water and sodas is a nice touch, as was a tray of glasses for water, coffee and wine.

The wine glasses are Riedel, one of the finer things in life for wine enthusiasts. When Kae noticed what type of glass it was, she immediately took it off the balcony railing where she was snapping a photo.

Old black and white photos line the walls in the hallway outside the suite and continue to dot the walls inside. In the bathroom is one of Tahoe City, just five miles north on Highway 89 from the inn. The living room shows one of fishing on the East Shore.

Forget pulling the drapes, unless you totally want to sleep in or completely seclude yourself. For us, they were up and away the whole time. After all, the view is a huge reason to be here.

Even the large wedding on the deck below where the inn hosts dinner guests provided entertainment from one of our balconies that first evening.

The water taxi beats driving.

The water taxi beats driving.

The West Shore Inn has the wedding thing down, hosting about 90 for the year. More than two-thirds of those are planned in the summer. Three fell on our recent fall weekend. (Note: Those who want access to the restaurant and quiet time at night may want to check this out ahead of time, as weddings can be quite festive into the wee hours.

Not having dinner there was no big deal on the first night. We simply added the North Lake Tahoe Express boat to our experience. In its third and final trial year, the shuttle runs from June 21 to Sept. 21 and can be used for pickups or drop-offs from five docks between Homewood and Carnelian Bay.

Through a recommendation of the West Shore Inn’s concierge Bill Gaines, we opted for the five-minute walk south on Highway 89 to Obexer’s marina to take it to Tahoe City for $10 a person, where Moe’s barbecue awaited. It’s fun and exciting to be on a motorboat on the lake. What’s nice about the shuttle is the plastic lining the bow to shield the wind — considering J.T., the skipper, cranks up the motor to travel 24 mph on the 25-minute excursion.

With his own personal experience to draw from, J.T. endorses the experience for those who simply don’t want to drive or may partake in too many cocktails. As one of the original drivers since its inception, J.T. has also done his civic duty on the water, having to rescue a stranded boater at Dollar Point.

Scallops at the West Shore Cafe.

Scallops at the West Shore Cafe.

Bikes are allowed on the boat, which can accommodate a dozen people. Crewmembers J.T. and Matt are pleasant, professional and admit they like their jobs being out on the water. This is even with a slight slowdown after Labor Day weekend and with the drought’s impact of a low water level making docking a little bit more challenging. The shuttle service funded through Placer County’s transient occupancy tax was forced to remove Captain John’s as a drop off and pickup point.

If the boat shuttle doesn’t work out for the return from Tahoe City to Homewood, there are a handful of various vehicle taxi services. After dinner, we hopped into a North Shore Checkered Taxi cab where our local driver was courteous.

When asked about the upcoming big plans from the West Shore Inn’s owner JMA Ventures that is expected to change the face of Homewood, he said he liked the idea. In particular, the prospect of the West Shore’s first major development seemed appealing to him because it would be good “for the local economy.” He also backed the underground parking structure to deter the possible eyesore that goes with a major attraction as a large hotel planned at the base of Homewood Mountain Resort.

The development planned across the street from the West Shore Café and Inn may alter the identity of the small boutique hotel, but its place under the cloak of an upcoming 180-room hotel remains to be seen.

West Shore Inn General Manager Jessica Barton said it’s “tough to compete” with an upscale resort of that size, but it sounds like the West Shore Inn is holding its own in its own niche of weddings and group events. A few weeks ago, JMA – which has owned the 14-year-old inn for five years – bought two villas on the north side of the inn as additional lodging options. One is considered lakefront, the other serves up a mountain view.

“It’s important to get something more to accommodate large groups,” Barton told Lake Tahoe News of the popularity of retreat gatherings.

The full moon provided plenty of photo ops.

The full moon provided plenty of photo ops.

The inn is evolving. Barton said much of the focus in the West Shore’s experience is on amenities. Guests can now enjoy complimentary access to paddleboards and kayaks off their dock. The inn also partnered with a motorboat vendor that will offer charters with a 10 percent discount to guests. There’s a certain charm in being able to dock their boat or yours just steps from your room.

The second day of our stay, we hauled the 17-foot canoe down to the beach – with help Gaines had arranged as concierge extraordinaire. The paddling trip was both gorgeous and challenging, as our mid-morning jaunt to Sugar Pine Point was a little too late to avoid the headwind. Despite the workout, this activity is highly recommended.

Hugging the shoreline provides an interesting architectural tour, along with glimpses of residents’ ensembles of various water toys. One home had a slide that could be attached to a boat. A few boaters cruised by, but for the most part, the trip was peaceful and quiet. One woman sitting at the end of her pier was knitting and smiled as we paddled by. This was the universal sign for, ah yes, the good life.

Water at Sugar Pine Point looks like the Caribbean.

Water at Sugar Pine Point looks like the Caribbean.

Three miles down from the inn, the water got a little rougher with more exposure to the wind, and the shoreline looked more rugged. I knew we were entering Sugar Pine Point State Park. And because I was told by an inn worker that an eagle bird’s nest is near the rock outcropping that we negotiated in the canoe, I found myself often looking overhead while trying to keep my eyes on where we were going.

We brought the canoe to the shore and walked down the beach to the large pier in front of a giant grassy area in front of the Hellman-Ehrman Mansion, a century-old-plus residence passed down from a San Francisco businessman. The California State Parks system, which bought it in 1965 from heirs, is maintained as a museum and an example of the opulence of yesteryear.

From shore-to-shore, Tahoe pioneering families have shown through chronicled history how life at the lake can be good and fulfilling. Before dinner, I glanced at the nightstand where the classic Tahoe novel “Lake of the Sky” by George Wharton sits alongside historian Mark McLaughlin’s popular “True Tales of Tahoe” series. I read all of Volume 1 while lounging at the end of the West Shore Inn pier, where a fire pit, stimulating conversation with other diners and a tray full of s’mores ingredients beckoned me on the second night of our stay.

Dinner at the West Shore Café is yet another example of the modern-day good life at Tahoe. The food is excellent, but the setting on the deck on the lakefront is untouchable. Add to that a full harvest moon and you get an experience as savory as my seared Maine scallops and Kae’s perfectly seasoned pasta.

An eclectic wine list offers varietals from Oregon to Italy and Australia to Hungary. We went with the Oveja Negra Sauvignon Blanc from Chile.

Before the delivery of our entrees, Kae joined many diners away from the table to take photos of the moon rising above the East Shore ridge. It was a picture-perfect night.

And the service was exemplary. Hoke, our waiter from Scottsdale who works in Tahoe for the summer season, was excellent, noticing every slight detail. He even fixed an uneven table, which most waiters in Tahoe would have ignored.

The West Shore Café offers two-for-one entrees in September, a nice gesture for the shoulder season. (However, I found the 20 percent mandatory gratuity a bit presumptuous, though I would have gladly given Hoke that and told him so.)

The lemon tart with wafer and strawberry sorbet and rhubarb is worth saving room for.

In the peak seasons, the West Shore Café is open for lunch and dinner, but is now open for dinners only through this month. In October, the inn is open without the restaurant. The first two weeks of November, JMA closes the whole operation for a major cleanup leading into the ski season.

——

Notes:

• West Shore Café and Inn is located on Highway 89 across from Homewood Mountain Resort, five miles south of Tahoe City.

• Rooms in the fall range from $199 to $499 a night; in winter, they can run from $399 to $549.

• For more info, go online.




Critical to take concussions seriously

By Kris Terrian

With fall and winter sport seasons upon us, concussion awareness is a timely topic. But concussions are not only a sports-related injury. A concussion can occur from a fall on the head, whiplash in a car accident, or other significant

Kris Terrian

Kris Terrian

impacts to the head or body.

A concussion, a type of traumatic brain injury, is a disturbance in brain function that occurs after an impact to the head or body causes the brain to move or violently shake.

If you or someone you know experiences a direct or indirect impact to the head or neck, consider some signs and symptoms of a concussion:

  • Headache or pressure against the head
  • Temporary loss of consciousness
  • Confusion or “foggy” feeling
  • Amnesia surrounding the incident
  • Dizziness, “seeing stars”
  • Ringing in the ears
  • Nausea, vomiting
  • Slurred speech, delayed response to questions
  • Fatigue.

Someone who experiences significant head or body impact should be safely removed from the cause of the injury, such as participation in a sport. Some symptoms of concussions may be delayed hours or days after an injury. New research from Boston Children’s Hospital suggests emotional and mental concussion symptoms last longer in children.

One of the most dangerous injuries from a concussion is second impact syndrome or SIS. SIS can happen when a second concussion or head injury occurs before the first concussion injury has recovered. Recovery can take weeks and an additional concussion during the recovery period can be fatal.

Anyone who experiences a traumatic head trauma or severe signs of a concussion should seek medical attention. Concussion patients, especially injured athletes and adventure enthusiasts, should be cleared by a physician before heading back out to play.

If the signs and symptoms discussed above increase or do not go away, see a medical provider right away. Other concerning signs and symptoms that require immediate medical attention include:

  • Weakness, numbness, or decreased coordination
  • Extreme drowsiness, concussion patient won’t wake up
  • One pupil larger than the other
  • Convulsions or seizures
  • Difficulty recognizing people or places
  • Loss of consciousness
  • Increased confusion, restlessness, or agitation

To avoid a concussion, exercise caution, prevention and knowledge. In activities with substantial contact or potential for falls, wear a helmet. In organized sports, limit contact with the head or objects that could strike the head. Coaches should teach proper mechanics for falling or colliding, such as safe approaches to tackling in football.

Be aware of your surroundings and play with caution. Note the concussion symptoms listed above and take appropriate action if a significant head or body impact occurs.

Kris Terrian is an athletic trainer with Tahoe Orthopedics and Sports Medicine. 

 




Nominations sought for Blue Ribbon Awards

Lake Tahoe South Shore Chamber of Commerce is accepting nominations for the 7th annual Blue Ribbon Awards.

The awards focus on businesses and individuals that have made significant contributions to the South Shore economy and community through their unique programs, exceptional customer service, entrepreneurship and otherwise.

The following categories are open for nominations:

Geotourism award: Providing an authentic Tahoe experience

Tourism award: Innovative program, promotion or product for visitors

Experience award: Business providing compelling and captivating experiences

Entrepreneur award: An innovative individual who assumed the risk of starting a new business

Customer service (business) award: An individual who consistently provides quality service

Customer service (public agency) award: Quality service in the not so usual places (DMV, city, county, TRPA, etc.)

Small green business (less than 100 employees) award: Business that is minimizing its impact on the environment

Large green business (more than 100 employees) award: Business that is minimizing its impact on the environment.

Nominate a business or individual by going online and click the Blue Ribbon Awards banner on the homepage. Individuals may nominate in only one category, multiple categories or all categories. The nomination period closes Oct. 10 at noon.

Winners will be announced at the 7th annual Blue Ribbon Awards on Nov. 13 at Harrah’s Lake Tahoe.