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lioness ring
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This clever lioness ring is handmade in Stepehn Einhorn's London workshop in solid sterling silver. This ring is fierce and a great addition to your jewellery collection.
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As seen in Cosmopolitan. January 2015 issue, page 38.
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Einhorn, Gundlach, Ackman, Jones unveil their best longs and shorts at Ira Sohn
The 19th annual Ira Sohn Investment Conference took place in New York City Monday.
MarketWatch reporters William L. Watts and Sital Patel live-blogged the series of investment calls from the who\’s who of the hedge-fund universe, including Bill Ackman, David Einhorn, Paul Tudor Jones and Jeffrey Gundlach. You can read a recap below.
- 12:04 pm
- Schedule
- by Tom Bemis
- Edit
- Add a Comment
Ira Sohn Conference speaker timeline:
Jeffrey Gundlach due up in first hour.
Bill Ackman around 3 P.M.
Paul Tudor Jones II after the bell.
MarketWatch’s Sital Patel tweeting from the conference. Doesn’t get more real time than this.
Bad pic but it’s Chris Shumway talking about the macro picture #sohn2014 pic.twitter.com/wdosV0X16E
This is a great quote from Chris Shumway: Three big issues investors face are Janet Yellen, Vladimir Putin and China–”bogey men of changes”
Chris Shumway says China’s economy is decelerating and will have to resort to stimulus. Isn’t this more or less what many experts have been predicting for a while?
Chris Shumway says China has to either stimulate or resort to currency devaluation. That’s why he’s reccommending shorting the CNH, or Chinese yuan.
Shumway’s second idea: Moody’s. Ratings and analytics are a “great business.” Basically it’s a global duopoly with Moody’s and S&P in lead role, while Fitch brings up the rear. Not many businesses have Moody’s pricing powers, while return on capital employee is “incredible” at 81%.
Moody’s and S&P enjoy a huge moat around their business, he says.
Shares of Moody’s are up 1.6% in wake of Chris Shumway’s public vote of confidence.
Jeffrey Gundlach takes stage at at Ira Sohn conference, report Bill Watts (@wlwatts).
Jeffrey Gundlach is making the bearish case for single-family housing, which he describes as “overbelieved” and “overrated.”
New home sales are “flat on their back,” while mortgage purchases have never gained traction, remaining at same level as 2010. Starts picked up but have plateaued below an annualized 1 million.
Bulls like to point to “affordability,” but notes they remain well above levels at boom. He also notes comparison suffers due to preponderance of exotic mortgages during boom.
“If affordability was so great, why was interest rate rise of last year responsible” for a big drop in sales, he asks.
If you think rates will rise again as Fed withdraws QE, that implies a pretty ugly outlook for “affordability,” he says.
Gundlach: private housing has fallen because mortgage credit fell, from write offs. #sohn2014 pic.twitter.com/uIuJlZpxHz
Where are the first-time buyers, Gundlach wonders.
Household formation is depressed and this appears to be a generational rather than a cyclical trend.
Home ownership for all age brackets is back to where it was in 1995. Meanwhile, “the kids aren’t alright,” he says, noting bleak job prospects for young adults.
Case-Shiller indicates rents will continue to rise, making it tougher for young people to save for downpayments while also struggling with student loans, he says.
Home builder stocks are having a lousy Monday after DoubleLine’s Jeffrey Gundlach presented a dim outlook on the U.S. housing market at the Ira Sohn conference.
Among his various observations were that home ownership for all age brackets is back to where it was in 1995. He also pointed out the dearth of first-time buyers and predicted that the market will remain weak on bleak job prospects and many young adults struggling with student loans. D.R. Horton Inc. slid 0.9%, PulteGroup Inc. dropped 1% and Lennar Corp. fell 1.4%. The SPDR S&P Homebuilders ETF shed 1.5%.
Laffont talks about Liberty Mobile. Says households will have increasing needs for broadband. #SOHN2014
Laffont says “broadband needs will change very quickly” with expansion of Netflix #SOHN2014 $nflx
Laffont talks possible “moon shots”, including Vodafone buying Liberty Global #SOHN2014
Shares of Liberty Global rally 2.4% while Vodafone Group shares rise 0.6%.
Laffont: $LBTYA $LBTYK 5% rev growth, 8% ebitda growth, 15% fcf growth, 25% fcf/share growth #irasohn #SOHN2014
— Insider Monkey (@insidermonkey) May 5, 2014
Here’s a chart of homebuilder ETF XHB /quotes/zigman/477673/delayed /quotes/nls/xhb XHB after Jeff Gundlach makes a bear call on single-family housing, pointing to a generation of would-be home buyers who are still renting or living at home, rather than entering the housing market.
After the remarks, Gundlach said on CNBC that “I’m really kind of surprised by how copacetic people are about the homebuilders and housing markets. If you look at the data, in recent months it’s gotten really soft.”
So Laffont sees Liberty /quotes/zigman/17863374/delayed /quotes/nls/lbtya LBTYA continuing to buy back shares with free cash flow and sees potential for M&A activity, including the possibility that Vodafone could make a play for the company. He thinks the stock could trade at $100 or more. Shares are up 2.6% at $42.38.
It’s intermission time but people are already starting to stream back into Avery Fisher Hall at Lincoln Center for Round 2. So far, we’ve heard Jeffrey Gundlach argue the short case against the SPDR S&P Homebuilders Trust, while Chris Shumway has made a bull case for Moody’s and Philippe Laffont just wrapped up a bullish argument for Liberty Media.
We’re back. Next up is Larry Robbins of Glenview Capital. Robbins did well in 2013, with his hedge fund returning a net 43%, according to Forbes, helped in part by a bullish call on hospital stocks in the runup to Obamacare.
Robbins says the playbook for 2014-15 might not look too much different than that from 2013. “Resist the temptation to think 2014 is materially different to 2013 just because the calendar has changed.
Excess cash still “exceedingly high,” Robbins said. That accounts for “activism, suggestivism” and other sources of “awareness,” he says.
But now it will be actions of management, board and engaged shareholders that will be difference between ordinary and extraordinary returns.
HMOs and Monsanto are in two of the most hated industries, he says.
While HMOs are vilified, government actually embraced managed care in effort to bend cost curve downward. They’re the only sector that’s still 18% cheaper to where they were in 2007 on a relative basis and offer cheap multiples.
The pain is in the rearview mirror for HMOs in terms of government-imposed caps on profit margins. Looking ahead, this and other headwinds turn to tailwinds in future, Robbins argues.
Laffont is found of Coatue Management and a former analyst at Tiger Management.
Laffont speaking now at #SOHN2014 . FWIW, his tech focused hedge fund is down nearly 10% this year – crushed in Q1
— Lawrence Delevingne (@ldelevingne) May 5, 2014
There’s “an alarming outbreak” of old people in America, Robbins jokes.
Seniors also like MedicareAdvantage. While profit’s been flat, it’s likely to accelerate at up to 15% “before add-ons,” he says.
Humana /quotes/zigman/229688/delayed /quotes/nls/hum HUM is best capitalized among providers, which means could take on more debt that’s cheap and buy another MedicareAdvantage provider or HMO or buy back shares. They could also outsource pharmacy benefits.
If it all comes together, Humana could see 30% to 40% growth, potentially putting it in “stratosphere.”
Robbins, who speaks very, very fast by the way, also likes Wellpoint /quotes/zigman/362231/delayed /quotes/nls/wlp WLP .
Of all the options for feeding the world that “aren’t utopian,” genetically modified organisms are the way to go, Robbins said.
Monsanto’s mon /quotes/zigman/267799/delayed /quotes/nls/mon MON “oligopoly” on seed puts it in good shape, he said, while products in pipeline are likely to add meaningfully down the road, including a Latin-American soy product.
Robbins said he’d urge Monsanto to use ample cash to leverage up and grow faster. The company needs to deploy capital like a company that enjoys near monopoly power and is sitting on lots of cash, he says.
Robbins wants $MON to use leverage: “are we asking them to do something unnatural?,” he asks — without irony. #SOHN2014
Stanley Druckenmiller takes the stage, but he’s not presenting. He’s giving a big introduction to Zach Schreiber of PointState.
He’s going to talk about oil and is urging a short position in West Texas Intermediate crude partly offset by a long position in Brent. He also hints he’s going to make the case for being long some U.S. refiners.
Schreiber has a picture of a clown car up to describe people who are long oil. #SOHN2014 #irasohn
Schreiber references Led Zepellin’s “Song Remains The Same,” noting that crude is being drilled by the same companies that have oversupplied natural gas.
He sees the crude production rate growing 1 million barrels a day for next three years, while Canadian production expands by around 300,000 barrels a day. That’s all going to make its way into supplies with or without the Keystone pipeline, he argues.
Wide spreads provided tons of incentive to move oil from the futures delivery point in Cushing, Okla, to the Gulf Coast and elsewhere. Now Gulf Coast refiners are going flat out.
Schreiber says there’s $33 billion net long WTI crude futures /quotes/zigman/2237082/realtime CLM4 . He thinks that will make for an ugly picture when everyone tries to get out.
Cushing, meanwhile, is a temporary “island of scarcity” in a sea of crude “that is rapidly filling up” he says. He sees Cushing inventories swinging to a big surplus by year-end from a current 14 million barrel deficit.
He argues that people long oil based on Cushing stocks are looking at a poor risk-reward, effectively picking up quarters in front of a dump truck.
Oil will have to go below $85 to $80 a barrel to meaningfully slow U.S. oil production growth, Schreiber says.
He says it will take “substantially lower” prices to balance the picture. Meanwhile, that means there will be a bigger “disconnect” between WTI, the U.S. benchmark, and Brent, the European benchmark.
A wider spread will favor refiners, and it’s likely to be more durable than people anticipate, he says.
Schreiber likes Valero /quotes/zigman/186158/delayed /quotes/nls/vlo VLO and Marathon Petroleum /quotes/zigman/5611608/delayed /quotes/nls/mpc MPC . There’s little prospect for new refineries to come on line, so that means the scenario should be good for incumbents.
Oil futures settled lower on the New York Mercantile Exchange, paring some of their losses in their last 15 minutes of trading.
June oil /quotes/zigman/2237082/realtime CLM4 settled at $99.48 a barrel, down 28 cents, or 0.3%.
James Grant is pitching Gazprom (!), the Russian oil giant. “Have you ever wondered what the polar opposite of Tesla Motors was?” LOL
— Downtown Josh Brown (@ReformedBroker) May 5, 2014
Back at Sohn, listening to James Grant speaking about the lack of corporate governance in Russia.
Beware of hedge-fund managers bearing gift-wrapped stock tips. Market research firm Birinyi Associates issued a cautionary warning to investors glued to the words of market wisdom at the annual Ira Sohn conference in New York. Last year’s stock picks, in aggregate, underperformed the S&P 500 /quotes/zigman/3870025/realtime SPX by 19.1%, Birinyi noted. Moreover, only three of ten names beat the market.
Grant: Talking about Gazprom, trading below composite value. Trades at $1.39 per barrel. Trades at a Putin discount, emerging market discount, lots of other discounts.
Grant notes that May 15 Ukraines elect a new president. Here’s hoping Putin doesn’t muck it up, he says.
Gazprom may or may not be a bad company. 2.5x the estimates.
James Grant of Grant’s Interest Rate Observer, citing variations on the phrase that the time to buy is when blood is running in the streets, is making the long case for Russian energy producer Gazprom /quotes/zigman/248728/realtime UK:OGZD .
He jokes that Gazprom is “Donald Sterling with a London ticker,” which we guess means there is no way but up for the shares.
“What could possibly go right,” Grant aks? Well it’s very cheap — both after taxes and “after stealing” he jokes. It trades around 48% its average price target and the yields are still cheaper if you look at asset value.
Gazprom trades at around $1.39 a barrel versus more than $17 for ExxonMobil.
So what could go right? Well, Gazprom could announce a 30-year deal to provide oil to China. It could also stop investing in low-payoff capex and could contemplate raising its dividend, he says.
Moscow might choose not to provoke new sanctions, he says. A drawn out but tense peace isn’t out of the realm of possibility.
Gazprom may or may not be a bad company, but at 2.5 times earnings, it’s imperfections would seem to be priced in, Grant concludes.
Getting ready to hear Bill Ackman next.
Speaker says “he’s not without controversy”
Ackman says he’s got 110 slides!
Fannie Mae to start it off
Ackman: What happened? He goes through the history of Fannie Mae. It became a very, very important part of the mortgage market.
Fannie and Freddie are the most important asset in the mortgage market that they have ever been.
If you compare that to other parts of the world, we are the only place that supplies 30-year fixed- interest rate mortgages, says Ackman.
Ackman says Fannie and Freddie are essential to the mortgage market in the U.S. Their core business is a phenomenal business. It’s a simple business.
Ackman: Fannie and Freddie is a very low-risk business. The financial crisis was a very rare occurrence.
All the new business they write is very competitive and they are the only ones that provide the service.
Ackman: If you look through their business, it’s got better since the financial crisis as they guarantee safer loans and as the housing market got better.
Ackman: Subprime exposure really took them out of business, that and some comments from Alan Greenspan.
Ackman points to Congress creating mini-Fannie and Freddie’s.
Problem is they have to raise about $500 million, so an enormous amount of capital and not sure if investors have appetite after what has happenened.
Worth reminding those listening to Ackman: you get 0% of Fannie, Freddie profits when you buy their stock
— Steve Goldstein (@MKTWgoldstein) May 5, 2014
Ackman: We estimate in order for a startup to work, they’d have to go from 60 basis points to 300 basis points. It would raise the mortgage costs for Americans by 50% to 60%.
With a new system, we won’t know if they will work until the next crisis.
Ackman proposes keeping Fannie and Freddie.
Force them to get rid of fixed income arbitrage and have more regulatory oversight.
They have a workforce that knows the business, a simple model, have royalty fees from every mortgage in America. They have high earnings power.
Fannie Mae /quotes/zigman/226360/delayed /quotes/nls/fnma FNMA and Freddie Mac /quotes/zigman/226335/delayed /quotes/nls/fmcc FMCC shares, both traded over-the-counter, are rallying on Ackman’s presentation. Fannie Mae is up 3% to $4.10. Freddie Mac is up 1.8% to $4.05. Both were lower before the presentation.
Ackman: I am prepared to sit down and make a deal with the government on Fannie and Freddie.
Time to get off our Fannie, he says.
Coming up: Paul Tudor Jones II. Let’s see if he makes any comments about women.
Spotted David Einhorn mingling with conference participants, wondering where his parents were.
We’re getting ready for the final session as Sohn participants gorge themselves on chips, brownies, coffee and other sundries in the crowded foyer outside the hall. Paul Tudor Jones and David Einhorn have yet to speak.
Tudor Jones “rarely” speaks publicly.
My knees are starting to give out from all the genuflecting between #BRK2014 and #Sohn2014 over the last four days. #BLANK
— Jacob Wolinsky (@JacobWolinsky) May 5, 2014
So far we’ve had “make-up sex” and “central bank Viagra” in Paul Tudor Jones’s #Sohn2014 speech. Whatever next?
— Stephen Foley (@stephenfoley) May 5, 2014
This year’s Sohn conference could be subtitled “the macro traders’ lament.”
The usually publicity-shy Paul Tudor Jones is making his first-ever Sohn presentation. The investor, like Michael Novogratz of Fortress Investment Group, is lamenting a volatility-constrained environment that makes it all the more difficult for macro traders.
He offers up a seasonal chart showing what Treasurys tend to do around the first of a series of rate hikes. “My message to bond bears is to wait till you see the whites of their eyes before you sell fixed income,” he says, noting that yields don’t tend to rise until around three months before the Fed pulls the trigger.
It’s a similar story with a bit more lead time in the euro zone and U.K., he says. Noting that some audience members probably hadn’t been born yet when the Bank of Japan last hiked, he shows that Japanese yields tend to rise around 6 months ahead of first hike.
So when is there an “actionable event?” Jones argues the time to get short is probably in April of 2015, three months ahead of the implied rate hike in July 2015.
Jones: Friday was one of the greatest days in macro trading days, we had strongest econ data in a number of years. #SOHN2014
Jones: How can you possibly think that bonds would close up on the day on Friday? #SOHN2014
Coming up next, the only woman investor in the line-up:
Mariko Gordon founder of Daruma Capital Management.
Paul Tudor Jones on why hedge funds think the Fed is wrong: Low interest rate policy is making it very hard for us to make money. #SOHN2014
— Stephen Gandel (@stephengandel) May 5, 2014
Daruma Capital Management has been in business for 19 years and is the “best kept secret on Wall Street.”
Some days I think a unicorn is easier to find than an edge in data, says Gordon.
“We’ve developed a bad case of short-term itis.”
With the growth of ETFs and index funds, there are fewer investors interested in the long-term, we have become very short-term in our thing, Gordon says.
We are playing “bingo” with our investments.
Gordon says she has 3 investment ideas – the dream big version of those investment ideas.
First one is a small cap – EFI.
So long print rolls is the way to go. The costs are all in the upfront.
Violated one of the ten commandments in business, you can’t sell razors without razor blades. You get the ink.
HB Fuller Co. (FUL) – glue you say? It’s very complicated, says Gordon.
A roll of tiolet paper has 3 types of glue, to make it work.
FUL – has been solving it’s customers problems until 2010. The firm got a new CEO Jim Owens, and started to act like an 800-pound gorilla.
13 plants were reduced to 7.
1400 people to 1000.
Culture is very important for topline growth, says Gordon.
FUL – made a tremendous amount of progress by just thinking of themselves to be another type of company, says Gordon.
Our target is $78, stock is $48, dream price is $90.
Gordon likes Pacira Pharmaceuticals $PCRX.
Gordon has a $150 price target, currently trading at $70 a share.
Dream big price is $250
Gordon likes $PCRX drug Exparel, saying products lasts up to 72 hrs to relieve post surgical pain and avoids side effects of opiods.
Final speaker is Greenlight Capital’s David Einhorn next.
David Einhorn takes the stage. Noting he’s last speaker he promises to go “way over time.”
His first slide is on a so-called bubble basket, saying he will take a “deep dive” in one of the stocks he is shorting, while not revealing the others. That stock is athenahealth /quotes/zigman/107872/delayed /quotes/nls/athn ATHN , which he says could fall 80% from its peak.
Einhorn getting a lot of laughs from the crowd.
Einhorn highlights what one analyst called a “history of disappointments,” but still quintupled in recent years despite missing top- and bottom-line estimates.
He plays a compilation of video clips of Jonathan Bush, who Einhorn describes sarcastically as “a lot of fun.” He mocks Bush’s description of the company and an enthusiastic endorsement by CNBC’s Jim Cramer.
— Wallace Witkowski (@wmwitkowski) May 5, 2014
Einhorn wants us to look at bubble stocks: Athena missed its revenue estimates in 2013 $ATHN #SOHN2014
Einhorn keeps going after athenahealth CEO Jonathan Bush.
Just because a company launches a website, it doesn’t make it an online retailer, Einhorn says. He mocks Bush’s insistence that the company is a cloud pioneer.
Athenahealth is a “business process outsider,” a company that takes mundane tasks off the plate of other companies, Einhorn says.
Einhorn seems to be ripping Morgan Stanley’s recent report on athenahealth as much as or more than athena itself. #SOHN2014
— Luciana Lopez (@Luciana_F_Lopez) May 5, 2014
Companies comparable to athenahealth have margins of around 10%.
Morgan Stanley’s estimate it will hit 30% is what “passes for conservative” in the midst of a bubble, Einhorn says.
Einhorn says $7 a share is more like it than $72 for $ATHN #SOHN2014
Einhorn says there are “serious risks” to the business model. In a bearish case, discounted-cash-flow valuation is $14 versus Morgan Stanley’s estimate of $192 or Einhorn’s “optimistic” case of $50.
Einhorn says he takes some comfort in the fact shares have already started to slide, signaling the bubble may be starting to deflate.
And that’s a wrap as the Sohn attendees file out for a cocktail reception as “Happy” blares out of the auditorium’s loudspeakers.
S&P 500, Dow end higher, halting 2-day skid; Apple tops $600: stock market live blog recap
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Tyson to Wall Street: You\’re overly optimistic
lioness ring
What we say:
This clever lioness ring is handmade in Stepehn Einhorn's London workshop in solid sterling silver. This ring is fierce and a great addition to your jewellery collection.
Cosmopolitan says:
As seen in Cosmopolitan. January 2015 issue, page 38.
Similar Products
We think you'll like
Spin the colour wheel this season
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Trousers tailor-made to flatter
Your shortcut to looking pulled-together this season
Give your fitness a boost with the latest gym gear AND it's in the sale!
Beat the chill this autumn in the layer of the season
Grazia says this dress will always be in style
Vox Studios, 1-45 Durham Street, London SE11 5JH
Stephanie and Matthew
July 15, 2017 • Dallas, TX
Everyone's heard the old adage, "When you meet the right person, you'll know." I always thought the sentiment a silly cliché; but when I met Matthew, I found I was blissfully mistaken. From the very first kiss, I knew instantaneously, viscerally, we had delved into something much deeper than I could fully grasp. It felt, simply, like home. Meant to be. Kismet. Whatever you like. Beneath the surface, our hearts and minds whispered to one another, as if a language written for two. Our similarities and differences, dancing seamlessly in tandem. It seemed as simple as tying one's shoes.
He is truly my counterpart, and I his. As we began to embark on our own journey together, there was never a moment's doubt; we had found our eternal running partner. And over the years, he has been supportive, encouraging, loving, accepting, and has always helped me strive to be a better woman, wife, and mother. I believe and hope, I have granted the same for him :).
We feel so blessed to have found one another; to see each other in our entirety, and cherish that person we have discovered. Grow together with that person. After our first five years, I feel more grateful for this amazing gift than ever. We've become closer with each passing day; learning what it means to nurture and appreciate the bond we share. And now, we are simply ecstatic that we will get to share and celebrate in that love with all those we care about. Cheers!
The ceremony will be at the wonderful church where I grew up. Afterwards, we'll head out to reception in Frisco for dancing, games, and some summertime BBQ!
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Ira Sohn Conference 2014 Einhorn, Bill Ackman, Gundlach
Since 1996, the world-renowned Ira Sohn Conference 2014 has been the premier investment forum, bringing together the world’s savviest investors to share fresh insights and strategies in support of pediatric cancer research and treatment.
ValueWalk will be covering the 19th IRA Sohn Conference 2014 produced in partnership with Bloomberg LINK – sign up for our free newsletter to ensure you do not miss our coverage . You can also find coverage via Twitter, Facebook, Linkedin, or RSS. Also see the 2014 Value Investing Conference here. Also check out our coverage of the Berkshire Hathaway conference here.
Wall Street’s best and brightest investors participate in this unique, “must attend” event to share their expertise with an audience of more than 3,000 people, comprised of portfolio managers, asset allocators and private investors. Most speakers manage large proprietary investment portfolios that have outperformed the market for many years and do not share their insights in any public forum, but they volunteer their time to the IRA Sohn Investment Conference for the benefit of the Foundation.
All contributions support the Foundation’s mission to support pediatric research and care. The 2014 IRA Sohn Investment Conference will be held at the Avery Fisher Hall, Lincoln Center, New York on the 5th of May, 2014 from 12PM to 5:30PM. ValueWalk will be providing live coverage of the event. NOTE: all blog posts, analysis, coverage etc will be linked here so you can find EVERYTHING you need in this one post via links, no need to go searching around the website.
IRA Sohn Conference 2014 Line Up:
The 2014 IRA Sohn Investment Conference always attracts the brightest stars in the value investing universe, and 2014 is no exception. Attendees at the conference will get to hear from legendary value investors and financial professionals which are listed below along with links to their presentations (which will be available as we update).
The IRA Sohn Conference 2014 schedule will be posted once it becomes available to us. (Presentation links below)
- William Ackman , Pershing Square Capital Management – Ackman Talks Fannie Mae, Freddie Mac, The First Time Publicly, see the slides from the presentation here
- Dan Ariely , Professor of Psychology & Behavioral Economics at Duke University – Dan Ariely Presentation – Ira Sohn 2014 Investment Conference
- David Einhorn, Greenlight Capital – David Einhorn Presentation At Ira Sohn: Short AthenaHealth
- Mariko Gordon , Daruma Capital Management – Mariko Gordon Presentation – Sohn 2014 Investment Conference
- James Grant , Grant’s Interest Rate Observer – James Grant Presentation – Ira Sohn 2014 Conference
- Jeffrey Gundlach , Doubleline Capital – Jeff Gundlach Presentation – Ira Sohn Conference 2014
- Paul Tudor Jones II , Tudor Investment Corporation – Paul Tudor Jones Presentation – Ira Sohn 2014
- Philippe Laffont , Coatue Management – Philippe Laffont Presentation – Ira Sohn 2014 Conference
- Michael Novogratz , Fortress Investment Group LLC (NYSE:FIG) – Michael Novogratz Presentation- Ira Sohn Conference 2014 , see the slides from the presentation here.
- Larry Robbins , Glenview Capital – Larry Robbins Presentation Ira Sohn Conference 2014
- Zach Schreiber , PointState Capital – Zach Schreiber Presentation – Ira Sohn 2014
- Chris Shumway , Shumway Capital – Chris Shumway Presentation Ira Sohn Conference 2014
UPDATE 10:34 AM EST, below is the full schedule for the speakers
Emma and William
August 26, 2017 • Arlington, VA
Bill and I met during our first week of college at the University of Massachusetts, Amherst. It was a small honors seminar, and Bill got to the classroom first. I was immediately drawn to him and was sure to sit next to him as often as possible. We even organized a few group dinners together after class. The seminar was short - only 7 sessions long. Afterwards, we went our separate ways, making different groups of friends. I was on the rowing team, which occupied the majority of my time and Bill lived on an honors engineering floor. We would see each other around campus sometimes (I may have been seeking him out sometimes, but he never noticed!), and we did not officially re-connect till sophomore year.
Labor Day weekend 2006, Bill and I returned to campus early to help with the Honors College freshman orientation. As luck would have it, I was paired with some of Bill's friends and was invited to the engineering welcome back party. There, we danced the night away.
After dating a few months, we decided to make it official on Halloween 2006. Dressed as Pippi Longstocking and the Hamburglar, we used the words boyfriend and girlfriend for the first time.
It was the first class of my mandatory honors book seminar. I was already sitting and chatting with a redhead fellow two seats down from me. All of a sudden, in through the door burst this bubbly and energetic girl who plopped down right between us. She apparently knew the other guy, but was eager to make friends. Little did I know how much the ginger thing was working for me then! In the next few months, we'd often lead a dinner crew after class, but that was about it. Over the next year, I'd run into Emma at the dining hall. Often, this was only because my friends would mutter "Hey Bill, it's that girl trying to get your attention again. Are you ignoring her or what?" In my defense, I was an oblivious doofus who couldn't pay attention to anything but my food during lunch. To her credit, she was incredibly patient and tenacious.
Third semester began and I showed up a few days early to staff new student orientation. Guess who was also on staff? Emma and I started hanging out with some mutual friends, attending a few totally alcohol-free parties. One night in early October, I had just come back from a concert when I stopped dead in the hallway. There was Emma, dressed for a night on the town, wearing a cute skirt and these killer knee-high boots, which are absolutely an essential detail of the story, honey! We were going to the same party, and we hit it off. I had come down with a cold that week and got us both sick, so we spent the next morning doing crosswords at the health clinic. Over the next few weeks we'd hang in the dorms, get meals, and just walk around campus. I had a penchant for holding her hand so tightly that I'd end up dragging her through huge puddles.
Halloween was fast approaching. Emma and I were going to a costume party together, and we realized we should probably figure out what we should tell people we were (Boyfriend and Girlfriend? Friends? or maybe "Friends, winky-face?"). Well, it was official, and we were going as Pippi Longstocking and her boyfriend, the Hamburglar. That night we went to the traditional UMass Halloween lobster dinner, the first official intro to her friends. Emma cracked a lobster tail and got lobster poop all over me, which was incredibly embarrassing for me, but seemed fair given the puddle thing.
I look back and wonder how a goofball like me ever ended up with a girl like Emma. Over the years, I've come to realize that she is just as much of a goofball as I am! Whether it's playing board games with a spirit of (un)healthy competition, reading young adult and high-fantasy novels, or just hitting up the national zoo to check out the monkeys, we know how to have a good time being ourselves. I can't wait to spend the rest of my life with her, doing more of the same!
Bill and Emma decided to get married in July 2015. While attending the gorgeous wedding of their friends Mike and Supicha, the loving and warm environment was exhilarating. We officially told each other we wanted to get married for the first time while sipping beers on a dock in New Hampshire.
Fast forward to six months later, we decided to act on our commitment to each other. Emma is allergic to some common metals, so we took months to get allergy testing and research rings. As soon as she saw a vintage emerald and diamond ring, she knew it was for her. Unfortunately, it was made of a material she was allergic to.
Bill was undeterred. He took Emma to a jewelry shop that would custom make any design. Together, we worked with the shop to make Emma's dream ring come to life.
Then, on March 24th, 2016 Bill took Emma on a gorgeous stroll around the Tidal Basin to see the Cherry Blossoms in peak bloom. Then, at the FDR memorial he got down on one knee to propose. Emma said yes immediately and was surprised to find that her friend Kate had been in the background taking pictures the entire time. We are forever grateful to her for capturing this special moment. After calling family members and friends, we all went to the W hotel for a drink with gorgeous views of the Washington Monument, and then our favorite restaurant, Founding Farmers.
Top of the Town is about half a mile from each of the hotels. It will be August - so only the brave of heart should walk as you may melt along the way. We recommend that you call a Lyft in small groups for transportation to the venue, which will cost less than $10. There is only one elevator up to the top floor where we will be dancing, so it is best to arrive in smaller groups so you can go directly up to the ceremony site without waiting.
We are happy to help with babysitting options for your little ones. There will be a group gathering and recommended sitters available for hire. Please email Emma for more details.
Join us Friday night to kick off the weekend festivities. We'll have a private room at Whitlow's with an outdoor patio and lawn games. Some drinks and food will be available. Stop by any time! When you get there, ask the hostess for Bill and Emma's reception or look for the signs.
Please join us anytime between 10-12 pm at Rhodeside Grill for brunch. The entire family is welcome! Bill and Emma will be in the hotel lobby at 9:15 am to see anyone off who can't make it to brunch.
Lindsay is the eldest in our family, and certainly a trailblazer. She is always looking out for others in her life, and her generosity often comes with a home cooked meal. Nothing is funnier than when Lindsay cracks herself up in the middle of conversations because she made a joke in her head (medium rare).
Kirby is my middle sister, and my rock. She's always there when you need her and has a knack for making you laugh at whatever situation is causing you stress. She takes the lead on music selection when we dance in the kitchen and makes sure there is cake and champagne to celebrate important things, or just on your average Tuesday.
Bailey is Bill's sister and college bound in the fall. We couldn't be more proud of her as she has grown into a strong, brilliant and beautiful woman. My how times have changed from Sundays in Mendon watching NASCAR and playing Mario Kart!
Sarah and I were roommates through most of college, when she wasn't running off to Spain. I often wish we could go back to lie in fields looking at clouds and all the other ridiculous things we had time for in college. I'm so excited for all of her world travels coming up but know I will miss her dearly on gchat during the day.
Kate and I met because she attended graduate school with Bill. We quickly hit it off over our love of games, winning those games, and being sure everyone followed by alllllll the rules. I'm so happy that she and her husband have moved to the DC area, but am seriously jealous that Bill gets to have lunch with her at work! Thanks Kate, for getting married first, and teaching me all your tricks.
Taylor is my cousin and millennial-in-chief. She's always sharing the latest trends and telling me which apps to download. A trip to NJ is not complete without a family dinner at one of our houses or a diner or a game of limeball.
Kris is my middle brother, and the most down-to-earth of the Vogt boys. He's not afraid to call it like he sees it, and he leaves me in stitches with his dry wit. Ask him about Roger Goodell's latest attempt to smear the Patriots' good name, or the yahoos that load the Christmas tree backwards on their car roof.
Mike is my youngest brother, and if I'm a bit too straight-laced, it's because I had to compensate for his free-spirited nature. We affectionately refer to Mike as our 'hippie' brother, and he's earned it. Unfortunately for him, we are not serving organic, free-range alcohol at the reception and shoes are required for entry.
Chris and I met at Virginia Tech and lived together for a year. Chris was the true lord of the tailgate, and we still get together to watch the Hokies (plus a few contentious Super Bowls). You know Chris is a great friend because he'll invite you to an 18-hole golf outing and not bring up how terrible you are at golf (until the 19 th hole).
Mikey and I met at Virginia Tech and lived together for a year with Chris. Whether it's Friday night cookouts, a pizza break during all-nighters in the lab, or late-night circuit diagrams, Mikey made undergrad 2.0 a great time. Heads up, Mikey, the venue doesn't allow Enter Sandman so get the jumping out of your system early!
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Einhorn cocktail
The choices of cocktails are limited to ones we know are actually good. If you want a huge list you can go buy a bartending book and read through a million useless foul old people drinks (the types who sit in sad, depressing jazz clubs). Our staff has already done the research (years of liver damage) and found the weird drinks that don't suck and maybe will impress your friends.
These drinks are guaranteed to:
a. Not taste awful.
b. Get you seriously messed up.
We have a rating system for these drinks based on Percocets (a codeine-like pain killer which we need to write this website).
Percocet = Somewhat drunk.
Percocets = Wasted.
Percocets = "Mmm, cah, hmm? Yah!"
Percocets = Wake up in Jail.
SMURF
7 0z Orange Juice
2 dashes Grenadine
Mixing instructions: Pour all the stuff into glass. Drink it.
RUM RUNNER
A favorite of Scott Smith! (SSmith76@aol.com) Ask him about the Tiki Bar in the Florida Keys, and how he spent the night on the roof of the Hotel afterwards. You can also ask him about "Project Greek God."
1 1/2 oz Malibu Rum
1 oz Blackberry Brandy
3-4 oz Orange Juice
3-4 oz Pineapple Juice
3-4 oz Cranberry Juice
Mixing instructions: Pour all the stuff into glass. Drink it.
Note: For the adventurous, float some 151 Rum on the top. Gains it another percocet in the ratings (this was what Mr. Smith was drinking that night)
Bahama Mama
This drink was used after we dropped acid in the Florida Keys - just before we began "Project Greek God." This is hard to explain - so we won't.
1/2 oz lemon juice
2 oz Orange Juice
2 oz Pineapple Juice
1 oz coconut rum
1/2 oz Cherry Heering
1/2 oz Grenadine
Mixing instructions: Pour all the stuff into glass. Drink it.
Long Island Iced Tea
This will get you wasted. Often much more effective on women than a "roofie."
1/2 oz Light Rum
1 oz Triple-Sec (thanks: "Man From Long Island" for the correction)
Top off with Coca-Cola
twist of lemon (or lime)
Mixing instructions: Pour all the stuff into glass. Drink it.
California Lemonade
Pleasant drink. After ten, you get a guaranteed DWI.
2 oz Blended Whiskey
juice of 1 lemon
juice of 1 Lime
1 tblsp Powdered Sugar
1/4 tsp Grenadine
Mixing instructions: Pour all the stuff into glass. Drink it.
If you drink the whole series -rating=
This is from the "Rongovian Embassy to the USA." A weird bar in Trumansburg, New York. Only a few have done this series and found their car. Generally you end up waking up on a golf course somewhere.
1. Suffering Bastard
1/2 oz Lime Juice
1 oz Ginger Ale
Mixing instructions: Pour all the stuff into glass. Drink it.
1/2 oz Lime Juice
1 oz Ginger Ale
Mixing instructions: Pour all the stuff into glass. Drink it.
1/2 oz Lime Juice
1 oz Ginger Ale
Mixing instructions: Pour all the stuff into glass. Drink it.
Zombie
There was a bar in the basement of the Plaza Hotel in NYC (Trader Vic's) that made these things at their optimal strength. You've heard of "Paint Remover. "
Well, this drink can be best described as "Prom Dress Remover!"
1/2 oz Creme De Almond
1 1/2 oz Sweet And Sour
1/2 oz Triple Sec
1 1/2 oz Orange Juice
1/2 oz rum , 151 proof
Mixing instructions: Shake all ingredients (except 151 proof rum) with ice and strain into a collins glass over ice cubes. Float the 151 proof rum on top, add a cherry (if you are that anal), and serve.
(It's 5:00am we're tired of writing, so you just get the recipe now)
Lemon Drop
1 shot Absolut Citron
Mixing instructions: Pour all the stuff into big glass with ice - pour into shot glasses.
Mudslide
Mixing instructions: Pour all the stuff into big glass with ice - pour into shot glasses.
Purple Hooter
1/2 oz chambord raspberry liqueur
Mixing instructions: Pour all the stuff into big glass with ice - pour into shot glasses.
Sex on the Beach
1 oz Triple Sec
1 oz Apple Schnapps
1 oz Peach Schnapps
1 oz Southern Comfort
2 1/2 oz Orange Juice
tblsp Grenadine syrup
Mixing instructions: Pour all the stuff into big glass with ice - pour into shot glasses.
Slippery Nipple
1 oz Bailey's Irish Cream
Mixing instructions: Pour all the stuff into big glass with ice - pour into shot glasses.
1-900-FUK-ME-UP
1/2 oz Absolut kurant
1/4 oz Grand Marnier
1/4 oz chambord raspberry liqueur
1/4 oz Midori melon liqueur
1/4 oz Malibu Rum
1/2 oz Cranberry Juice
1/4 oz Pineapple Juice
Mixing instructions: Pour all the stuff into big glass with ice - pour into shot glasses.
Einhorn cocktail
Testicular cancer used to be a brutal killer. If you were diagnosed with nonseminoma, you had to have a complete Retroperitoneal Lymph Node Dissection because it was the only thing that could possibly cure the cancer. If you had Stage III testicular cancer, little could be done. Back in 1970, about 90% of testicular cancer patients died of their disease.
The 70's brought us the success of Cisplatin which, when used in combination with other chemotherapy drugs and the appropriate use of surgery, brought the cure rate to an astounding 80%! This chemotherapy is not pleasant, but it's profound success has allowed the doctors to decrease the toxicity of all of the various testicular cancer treatments because they know that they have a chemotherapy safety net. The surgeries used have become less drastic with fewer side effects; surveillance has become an option; and the chemotherapy, which was once given continuously for two YEARS, is now limited to 9-12 weeks. Yes, it is not perfect. People still die of their disease. But it is a far better world for testicular cancer patients than it was 30 years ago.
We asked one of our world class testicular cancer experts, Dr. Craig Nichols, to provide a little more history and an explanation as to why this chemotherapy works so well.
He tells us that this is, "Literally a Nobel Prize question. I can tell you why these agents were selected, but the actual mechanisms of action and why this combination works so well in this disease and hardly at all in others is unknown. In the pre cisplatin era, there were a variety of single agents that had some small level of activity in testis cancer. It was also noted that two agents in particular, vinblastine and bleomycin, seemed to have not just additive effects but synergism."
"In 1973 here at Indiana, Dr. Einhorn recognized that cisplatin had activity in testis cancer and also that it was a perfect drug for combining with the best agents of the time. Cisplatin had dominantly nausea/vomiting and kidney toxicity whereas vinblastine had bone marrow toxicity and bleomycin had lung toxicity. He realized that these agents could be combined in full doses and give the three best agents in this disease simultaneously. Therein lies the tale, because with the addition of cisplatin the cure rate went from 10% to 80% (with the addition of adjunctive surgery as necessary.) [Editor's note: Vinblastine was replaced by Etoposide in the 1980's. It has fewer side effects and is slightly more effective.]"
"We believe these agents kill the tumor cells by crosslinking DNA, disrupting the ability to divide and also accelerating programmed cell death. The trillion dollar question is what is unique about germ cells relative to other solid tumors that allows this exquisite sensitivity. This is not well understood (at this time)."
Agents and Protocols
The chemotherapy protocols used for testicular cancer vary from country to country and even from hospital to hospital. That makes life a little more complicated, but in general, there are two accepted chemotherapy protocols for good risk testicular cancer: Either 3 cycles of BEP (Bleomycin, Etoposide, and Cisplatin) or 4 cycles of EP (Etoposide and Cisplatin). The standard protocols used in the US call for the cisplatin and etoposide to be given, inpatient or outpatient, over a period of 5 days. Some other countries and some experimenters in the US have tried to give the chemo over a period of 1-3 days, but in my opinion, they are really trying to save money more than they are trying to benefit the patient. Also, in Europe they tend to use less Etoposide per cycle.
For intermediate and poor risk germ cell tumors, the standard protocol is 4 cycles of BEP. Some institutions use a protocol called VIP (Etoposide, Ifosfamide, and Cisplatin) and/or use high dose chemo with a stem cell transplant (Carboplatin and Etoposide) to treat poor risk patients. Typically, the stem cell transplant is not used outside of a clinical trial.
Please note that Carboplatin, while related to Cisplatin, is not as effective as Cisplatin. It should never be used to treat nonseminomatous germ cell tumors except during a stem cell transplant.
No nonpulmonary visceral metastasis
No nonpulmonary visceral metastasis
Good markers (all of the following):
Nonpulmonary visceral metastasis
No nonpulmonary visceral metastasis
Intermediate markers (any of the following):
AFP 1,000-10,000 ng/mL
hCG 5,000-50,000 mIU/mL
Nonpulmonary visceral metastasis
(brain, liver, bone, etc.)
Poor markers (any of the following):
hCG >50,000 mIU/mL
AFP, alpha-fetoprotein; hCG, human chorionic gonadotropin; LDH, lactate dehydrogenase; ULN, upper limit of normal.
Adapted from International Germ Cell Cancer Collaborative Group
Some countries in Europe (particularly the UK and Germany) plus a few sites in the US are now recommending 2 cycles of adjuvant chemo for patients with high risk stage I nonseminoma. Their thought is that if they can't see the spread of cancer on CT scan, but the pathology report indicates that it is likely to have spread, then they can save the patient from surgery or excessive chemo by giving them just two cycles of BEP chemo right away. Unfortunately, neither I nor most of the experts I have talked with agree with this thinking.
- First of all, the success rate of the standard chemotherapy and surgical procedures is so high (
98%) that it would take a very large sample of people to ever prove that the 2 cycle regimen is equivalent to the existing protocol. It would take many years to get enough people to run the study, and even then, you would have to watch for many years to ensure that no one is suffering from recurrences years later.
To Chemo or Not to Chemo.
So, who needs chemo? Well, in my opinion, men with documented Stage II or III testicular cancer are candidates for chemotherapy. Some with stage II seminoma can be treated with chemotherapy or radiation. Some with Stage II nonseminoma can be treated with surgery or chemotherapy. Men with Stage III seminoma or nonseminoma and men with Stage I nonseminoma and abnormal tumor markers that have not dropped to normal (Stage IS) must be treated with chemotherapy.
Men with Stage IS and Stage II cancer should probably receive 3 cycles of BEP or four cycles of EP. Depending on the severity of the disease, most men with Stage III cancer can be also cured with one of these standard protocols. Men with advanced Stage III cancer or a mediastinal extragonadal germ cell tumor should probably get 4 cycles of BEP or investigate a clinical trial into the use of high dose chemotherapy. If there is ever any question as to how much chemo you really need, please have your doctor consult with one of our experts!
The two protocols (EP and BEP) are essentially identical in terms of cure rate. They are different in terms of length and possible side effects. The BEP protocol uses less Cisplatin and Etoposide, but uses Bleomycin. Bleomycin can cause lung fibrosis in older patients (over fifty) and can be a problem in patients with extensive lung metastases or existing lung problems. Etoposide can cause leukemia many years down the road (at the levels given during standard chemo, the risk is less than 1 percent.) and Cisplatin can cause neuropathy and hearing loss, so there is some impetus to reduce the number of cycles of these drugs. Which should YOU choose? Well, you usually won't be asked. These protocols typically vary from hospital to hospital. Memorial Sloan Kettering strongly prefers EP while Indiana University prefers BEP. If you have any concerns, please discuss them with your doctor before starting chemotherapy.
John S, one of the TC survivors on our email support list, did some research into the bleomycin question. He asked a couple of doctors about problems associated with oxygen exposure. He learned that the more Bleo you receive, the greater the risk of this pulmonary toxicity. Most doctors don't worry too much about this side effect until you're up in the 300-400 units range. His doctor recommended a MedicAlert bracelet for a year or two just in case you're knocked unconscious and they decide to put you on oxygen. However, he said that if it's life-threatening situation, it's best to get the oxygen. Ditto for oxygen masks on an airplane. If they drop down, put them on.
The other question he had concerned scuba diving. After all, you're not breathing concentrated oxygen, just compressed oxygen. He consulted with Daniel A. Nord from the DAN Medical Staff. DAN (Diver's Alert Network) is an organization dedicated to dive safety and medical issues. Daniel wrote back explaining that, "Bleomycin is a cytotoxic drug of particular importance to divers as it causes pulmonary toxicity in generally 4% of patients, usually in the form of pneumonitis/fibrosis. Even in patients with no obvious pulmonary toxicity, the lungs are sensitized to raised levels of inspired oxygen, causing an adult respiratory distress syndrome. In general, anyone who has had bleomycin should not be exposed to partial pressures of oxygen greater than 0.3 ata's, approx. 15 feet salt water on normoxic air. Sorry to have to advise that from a medical perspective, diving is not recommended. If you would like to discuss this in further detail, please feel free to contact this office directly at (919) 684-2948."
We asked Dr Nichols about the issues associated with bleomycin. He told us, "that patients who received bleomycin should always make sure that, now and forever, their doctors and anesthesiologists should be reminded about this before any surgery or sedation. I suspect the risk of O2 toxicity declines over time, but as far as I know this is unknown. I don't think any additional information need be related to medical personnel and always, if oxygen is required in a life threatening emergency (eg heart attack or respiratory arrest etc.) it should be given." We have also asked Dr Lawrence Einhorn at Indiana University about the same thing, and his position is that the a good part of bleomycin toxicity issue is overstated and the negative aura has grown over time without any medical evidence.
So there you have it: Put on the mask, sell your respirator and tanks, and buy a medical alert bracelet or necklace! Or not. Keep your eyes open. I hope to give this issue more space in the near future.
Salvage chemo. It doesn't have a nice ring to it, does it? Well, truth be told, not everyone with testicular cancer is going to be cured by the first attempt at chemotherapy. But just because the first chemo fails to cure does not mean that all is lost. Depending on the type and timing of the recurrence, many patients can still be cured of their disease.
No matter when the recurrence, be it 1 month or 10 years after chemotherapy is finished, I strongly recommend that the patient's doctor contact one of the experts on our experts list to learn about the proper way to treat the problem. There is a lot of research in this area, and new treatments are being tried all of the time. Be aware that more than one study has determined that getting treated by an expert will improve your chances for survival. The experts know what they are doing and are willing to share this information. Please make use of them. The articles and links listed below also have some good information.
This may sound stupid, but it is very important that salvage therapy is not given unless a relapse is clearly occurring and is documented by a biopsy or a clearly rising and significant levels of markers. It is not that rare for patients to be mistakenly classified as having recurrent disease based on false-positive markers or abnormal x-ray results. Some of these false-positive results may be due to a growing teratoma (which still would require surgery), pseudonodules from bleomycin-induced pulmonary disease, or elevated markers from other causes such as elevated b-HCG from marijuana usage or cross-reactivity with luteinizing hormone, or elevated AFP associated with hepatitis or liver dysfunction. Tests can and should be done to ensure that a slightly positive marker level is really due to cancer and not something else! Another cause of persistently elevated markers is a tumor sanctuary site (eg, in the testis or brain). Now, this is still cancer, but it may be treated differently than recurrent cancer in the abdomen.
Most salvage chemotherapy for testicular cancer is VeIP with or without high dose therapy, and this protocol results in 30-50% of patients being cured assuming that they are not cisplatin refractory. During this type of therapy, it is generally routine to prescribe G-CSF. Be aware that chemo may not be a solution, so it is important that you explore surgical options as well.
A Few Important Final Tips
Chemotherapy is a complicated subject. The drugs used can make you sick, typically much sicker than you felt from the cancer alone. There are many different drugs used and many different ways to use those drugs. Oncology may seem like a cookie cutter / recipe driven way to cure cancer, but it is not. Experience does count, and if your doctor does not have a lot of experience with testicular cancer, you might want to ask them review your treatment with their peers and with an expert.
Over the years, we have learned a few things about the administration of chemotherapy for testicular cancer. Discuss this information with your doctor, and make sure that both of you agree how to deal with these issues before starting chemo.
Chemotherapy usually has some effect on the immune system. With many chemotherapy protocols, it is not unusual for the oncologist to delay a cycle if a patients white count is below a certain level. This is not the case with testicular cancer. If a patient is receiving BEP, EP, or VIP, each cycle and dose of chemo should be given on schedule regardless of the white count!
For example, a patient wrote, "I was supposed to get my dose of Bleomycin today, but my white blood cell count had dropped too low. The doc is now recommending both abstaining from the bleo, and waiting an extra week to begin my next cycle in order to let the count come back up. I consulted with another Oncologist -- mine wouldn't return my calls. This other doc said that, given how low my white cell count is, he'd (pretty strongly) recommend Neupogen to boost the count."
Dr Nichols' response was, "The Bleo should be given since it doesn't really effect the white count. We always give Bleo irrespective of the white blood cell count. We don't usually add neupogen at this point since it takes several days to work, and he already is starting to recover. His next cycle should be initiated as planned irrespective of the white count. Patients are almost always recovering at that point."
I later asked Dr Nichols specifically, "Under what circumstances would you postpone the start of the next BEP cycle? Would your answer change if the protocol was VIP?" He says that, "The correct answer is very rarely for any circumstances related to myelosuppression. What we do is start virtually everyone on the correct day and watch their counts over the 5 days. If, and this is very uncommon, the white count doesn't start to rise we hold the last day of etoposide. Most everyone has a rising white count at that juncture. There is little to no evidence that holding chemotherapy until the white count reaches an arbitrary number is safer."
Finally, I asked him about the consequences of delaying a cycle. He told me that, "There is published data that delaying a cycle by more than 7 days does worsen the results. There is also data that a lower cisplatin dose intensity, measured in mg/m2/week, does worse. The standard EP dose intensity is 33 mg/m2/wk and we know that 20/mg/m2/week is worse. No one knows whether a 3 day delay is harmful, but it certainly is inconvenient to not get your chemo on time, and there is no evidence that waiting until an artificially determined number of white cells has anything to do with risk of infection. This is a very unscientific area."
I get a lot of questions about Neupogen, so I asked Dr Nichols, "What is Neupogen, and when would you use it?" He responded, "Neupogen (trade name for filgrastim or G-CSF) is a product that is used to prevent severe lowering of the white blood cell count associated with chemotherapy. It usually given by subcutaneous injection daily beginning the day after chemotherapy ends and for 7-10 days thereafter. The general recommendations for use in patients is as follows: I don't use this routinely in patients with good risk disease receiving 3 cycles of treatment. I would give it in this setting if the patient developed a fever associated with a low white count during the prior cycle of chemotherapy. We also consider it in patients with poor risk disease who are getting 4 cycles of chemotherapy and in all patients receiving salvage chemotherapy and all patients undergoing stem cell transplant. It is a very well tolerated medicine with the exception of sometimes causing bone pain from expansion of the bone marrow white cells. A similar drug (GMCSF, Leukine) is also sometimes used rather than G-CSF"
The tumor marker levels are a very important and convenient way to gauge the progress of chemotherapy. However, sometimes they go up after the first cycle. That does not mean that the chemo is not working. Dr Nichols notes that, "Sometimes there is a surge of markers with initiation of therapy, sometimes the markers are rising rapidly before and you catch it on an up phase. The practical aspect is that very rarely would I let the markers values at cycle two make me change or abandon therapy for first line treatment."
Back in the old days the treatment for testicular cancer was always done as an inpatient in the hospital. They did this so that they could constantly force fluid into the patient to ensure that there was no kidney damage. Nowadays, they've decided that this is overkill, and most people are healthy enough to take their chemo as an outpatient. Nevertheless, it is still important to drink as much as you can and to get the proper amount of fluid during the chemo infusion. Dr Nichols says that, "Most people would require a liter of normal saline before cisplatin, more with the etoposide (usually 500 cc) and a liter afterwards. So the patient should receive somewhere between 2.5 and 3 liters of fluid. Even at 500cc an hour, which is fast, this will take most of the day."
Cancer can happen to you at any time of the year. Strangely, though, a lot of doctors and hospitals will try to get you to postpone your chemo because of holidays. That is not acceptable. If you begin chemotherapy in mid November, you could get moved around all over the place due to Thanksgiving, Christmas and New Years. Don't let them get away with this. As Dr Nichols says, "We make arrangements to treat our patients through the holidays on schedule. Cancer doesn't observe Thanksgiving. "
We mentioned before that Bleomycin can cause lung damage. Given the doses used in the standard chemotherapy protocols, the odds of this happening are very low. Nevertheless, make sure that the doctors are listening to your lungs periodically to check for this, and if you are experiencing symptoms such as a cough or shortness of breath, bring this to the attention of your doctor immediately.
For more detailed information on chemotherapy and testicular cancer, please check out the following links:
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Market Watch
MarketWatchMag.com — MARKET INTELLIGENCE ON SPIRITS, WINE AND BEER
Mixology: Cachaça
Mixologists are going beyond the Caipirinha with an array of bold, fruity and aromatic cachaça cocktails.
Ahead of the 2014 World Cup in Brazil, exports of cachaça—the country’s national spirit—notably increased, according to Campari America vice president of marketing Umberto Luchini. The company owns Sagatiba cachaça, which features the unaged Pura, the aged Velha and the extra-aged Presiosa expressions. “In 2013, total export volumes for cachaça increased by just over 13 percent compared to 2012, with $16.6 million worth of cachaça exported from Brazil to other countries,” Luchini says. “The United States is Brazil’s second-largest cachaça market after Germany, with about 78,000 cases imported in 2013.”
The World Cup certainly helped expand exposure of cachaça, and as more brands become available in the U.S. market, this awareness will only continue to grow. “Cachaça used to be available only in specific pockets of the country, but now it’s expanding,” says Steve Luttman, founder of Leblon cachaça. And with the 2016 Summer Olympics set to take place in Rio de Janeiro, Luttman expects the cane sugar spirit’s recognition to increase significantly. “There are so many cachaça brands in Brazil, and I expect many of them to appear in the United States, especially as the Rio Olympics promote more interest in the country,” he adds.
Luke McKinley, digital marketing manager for Novo Fogo cachaça, concurs, noting that U.S. consumers are taking more note of Brazilian culture. “With the World Cup and the upcom ing Olympics, the country has ascended to become a major global player in recent years, and people are learning more about the Brazilian way of life,” he says. “Cachaça is an important cultural link to Brazil, and sipping a well-made cachaça drink transports you to that beautiful, tropical country.”
The most common way that cachaça is enjoyed—and what serves as consumers’ primary introduction to the spirit—is in the Caipirinha, which blends cachaça with muddled lime and sugar. “When offering even a classic Caipirinha, guests are excited,” says Mitch Einhorn, owner of the Chicago shop and bar Lush Wine & Spirits. “Imbibers are always looking for something new and different, and they also love rediscovering classic cocktails. The Caipirinha offers a traditional drink that many haven’t tried before. The cocktail boom has been great for popularizing so many unique spirits like cachaça.”
Caipirinha Craze
As Brazil gains increasing attention at a global level and the country’s national spirit has become more recognizable, mixologists are exploring cachaça’s cocktail possibilities, using the Caipirinha as a starting point to experiment and explore new drink combinations. “In recent years, the fame of Brazil’s national cock tail has spread beyond the borders of the country, and these days Caipirinhas are available in bars and restaurants from Miami and Montreal to Mumbai and Munich,” says Vivian Viana, manager at Boteco in Miami. The Brazilian restaurant and bar’s house Caipirinha ($7) is made with Tatuzinho cachaça, muddled lime and sugar.
James Watkins, beverage director for Houston-based Cordúa Restaurants, points to the Caipirinha as the cocktail that best exhibits cachaça’s unique flavors. The company operates eight Latin American venues in the Houston area. “Cachaça shows a lot of character compared to traditional rums,” Watkins says. “It’s far more intense in nature and pairs really well with high-toned citrus like lime.” The Caipirinha ($9.95) at Cordúa’s Artista restaurant features Barsol cachaça, muddled lime and sugar.
While the Caipirinha and cachaça go hand-in-hand, Leblon’s Luttman is excited to see mixologists experimenting with this simple recipe to make creative variations with seasonal, fresh flavor profiles. “The Caipirinha is usually the gateway to cachaça for many consumers, but we’re finding that mixologists use the drink as a starting point to make more elaborate fruit Caipirinhas and include unique additions like herbs,” he says. Leblon’s cocktail book, “The Art of Cachaça: Crafting Cocktails with Brazil’s Artisanal Spirit,” offers numerous variations on the classic cachaça drink: The Kumquat Ginger Caipirinha comprises Leblon, sugar, and fresh kumquats and ginger; the Cucumber Jalapeño Caipirinha blends Leblon with agave nectar and fresh English cucumber, lime and jalapeño; and the Tangerine Honey Caipirinha features Leblon, fresh tangerines, tangerine juice and honey.
Oficina Latina in New York City has a section of its cocktail menu devoted to Caipirinhas. The Classic Caipirinha ($12) features Pitú cachaça, muddled fresh lime and sugar; the Banana Ginger Jalapeño Caipirinha ($14) comprises jalapeño-infused Pitú, fresh banana purée, house-made ginger syrup, fresh lime and sugar; and the Kumquat Rosemary Caipirinha ($14) blends Avuá Amburana aged cachaça, house-made rosemary syrup, sugar, and fresh kumquats and lime.
“The current sophistication of bartenders has made a simple Caipirinha a great foundation for experimentation,” says Josh Hafer, corporate communications manager for Água Luca cachaça owner Heaven Hill Brands. “Modifying a base Caipirinha with unexpected flavors and ingredients presents a mix of the exotic with a simple, recognizable and delicious cocktail.” At The Broken Shaker in Miami, the Parcha Caipirinha ($11) features Leblon, passion fruit juice and house-made pink peppercorn reduction, while Einhorn’s Japanese Caipirinha ($10) at Lush Wine & Spirits blends Velho Barreiro aged cachaça with muddled lime, sugar and a float of Mito No Kairakuen 5-year-old plum liqueur. “Many consumers are familiar with the Caipirinha, and we love working with cachaça to teach guests how good the spirit is and help them discover new ways to enjoy it,” Einhorn says.
Craft Combinations
As a spirit distilled from cane sugar, cachaça is often compared to rum and even called “Brazilian rum,” but as Campari’s Luchini notes, the process for making cachaça is actually quite distinct. “Cachaça is unique because it’s distilled from the juice of fresh-pressed sugarcane. Most rum is made from sugarcane juice that has been cooked and caramelized prior to fermentation and distillation,” he explains. “The pure sugarcane gives cachaça a distinct herbaceous flavor with underlying grassy, vegetal notes that can change depending on where the sugarcane is grown.”
In Brazil, there are more than 40,000 cachaça distilleries, according to Novo Fogo’s McKinley, who adds that diversity within the category is vast. “All cachaças must be distilled from raw sugarcane juice, giving them a distinctly funky and fresh flavor, but regional differences in climate, terroir and production methods have a tremendous impact on how each cachaça tastes.” Novo Fogo markets four different expressions: the unaged Silver and the aged Chameleon, Tanager and Barrel-Aged variants, each exhibiting different flavor characteristics due to the barrels used and the time spent in them.
“The Caipirinha will likely continue to be the main driver of the cachaça category, but we’re beginning to see more creativity and unique combina tions,” Leblon’s Luttman says. In New York City, the Lost in Bangkok ($14) at Louie and Chan restaurant comprises Leblon, Cedilla açai liqueur, homemade spicy ginger syrup, Angostura bitters, lemon and orange juices, and cilantro leaves. And at Forrest Point bar in Brooklyn, New York, bartender Dustin Olson’s Pencil Thin Mustache ($11) features Leblon, Fernet- Branca amaro, fresh pineapple and lime juices, and a house-made mint syrup. Tiki-inspired cocktails are a natural fit for cachaça due to both the spirit’s sugarcane base—a natural partner for fresh fruits and citrus—and its earthiness, which pairs well with herbs and spices. “Cachaça adds Brazilian flair to any cocktail, especially those calling for fresh and simple ingredients, such as fruit juices and herbs,” Luchini notes. Sagatiba’s Maroon Swizzle features the Velha expression, Demerara simple syrup, fresh lime juice and homemade allspice dram.
While cachaça is commonly featured in fruity, Caipirinha-like drinks, the spirit is complex enough to stand up to bolder flavors and other spirits, as many mixologists are beginning to discover. “Cachaça definitely screams to be part of a refreshing cocktail, but recently I’ve started to see it being used in more aromatic cocktails,” says Brian Klemm, bartender at Copa d’Oro in Santa Monica, California. “This trend definitely speaks to the true vegetal and earthy characteristics of the spirit and what makes it so beautiful. The Caipirinha got cachaça through the door, so now the spirit just has to turn the corner and show that it can do more.” For Cuca Fresca cachaça, Klemm created a number of cocktails ranging from tall and refreshing to bold and bitter. His Porto Velho features Cuca Fresca with fresh lime juice, raw agave nectar, Original Combier orange liqueur and egg white, while his Rabo de Gallo blends Cuca Fresca with Cynar amaro.
“Consumers are starting to appreciate artisanal cachaças that make for great craft cocktails,” Novo Fogo’s McKinley says. “They are learning that cachaça goes far beyond the Caipirinha.” The brand’s mixology team created numerous unique craft cocktails using each of Novo Fogo’s expressions. The Wisdom in Waitsburg, inspired by mixologist Jim German, features Novo Fogo Silver, Carpano Antica Formula sweet vermouth, Cynar and fresh ginger juice; the Visible Edulis blends Novo Fogo Chameleon with B.G. Reynolds’ Passion Fruit syrup and Original Orgeat syrups, and lime and pineapple juices; the Barbosa Cocktail comprises Novo Fogo Tanager, Aperol aperitif, Combier Rouge cherry liqueur and Scrappy’s Aromatic bitters; and the Cornerstone is made with Novo Fogo Barrel- Aged cachaça, Fernet-Branca, B.G. Reynolds’ Lush Grenadine syrup and Scrappy’s Orange bitters. “In Southern Brazil, barrel-aged cachaça is the runaway favorite type of cachaça to enjoy,” McKinley explains. “We use repurposed American oak Bourbon barrels to age our cachaças, and American bartenders love using these barrel-aged expressions in classic stirred drinks.”
Classics Reimagined
As craft cocktails continue to reign at the bar, mixologists are on the lookout for new ingredients, unique flavor combinations and chances to experiment. As a lesser-known spirit, cachaça offers mixologists a way to introduce cocktail enthusiasts to new, unexpected possibilities, even by simply taking a tried-and-true recipe and using cachaça instead of the traditional spirit.
“Swapping out cachaça for the base spirit in a range of beloved cocktails creates an entirely new flavor profile, which is what today’s bartenders and drinkers are constantly looking for,” McKinley says, adding that due to the diverse range of flavors from one brand to the next, cachaça can be used in place of most spirits. “It’s funky, fresh, vegetal, bright and earthy. Cachaça cocktails create a space where people who appreciate agave spirits, cane spirits and even whiskies can all find common ground.”
Indeed, there’s now an abundance of cocktail recipes that feature cachaça swapped for the expected base spirit. Replacing the usual white rum, Sagatiba Pura cachaça is the star of the brand’s Brazilian Mojito, which also features fresh mint, sugar, lime and club soda. Leblon’s cocktail book includes a section devoted to “Twists on the Classics,” including the Brazilian Margarita, made with Leblon, Cointreau orange liqueur, lime juice and simple syrup, and the São Paulo Cosmo, comprising Leblon, Cointreau, cranberry juice and lime juice. At Lush, Einhorn’s Brazilian Bloody ($10) is made with Velho Barreiro cachaça and Twisted Spoke Bloody Mary mix.
While these cocktails all use cachaça—both unaged and aged—to replace white spirits, cachaça can also stand in the place of dark spirits like whiskies. “Spirits are not necessarily bound to long-held, rigid cocktail formulas,” McKinley says. “For example, the classic Old Fashioned is a drink blueprint that transcends the conventionally used Bourbon or rye—it can be equally enjoyed with spirits like mezcal, Pisco and certainly cachaça.” Sagatiba’s Brazilian Old Fashioned features the Velha expression, maple syrup, Angostura Orange bitters and Fee Brothers Whiskey Barrel–Aged bitters. Leblon’s Bossa Manhattan blends Maison Leblon Reserva Especial aged cachaça with Cedilla açai liqueur, agave nectar and Angostura bitters, and the brand’s Brazilian Julep features Leblon cachaça, Southern Comfort liqueur, lime juice, simple syrup and mint.
The Caipirinha will likely continue to lead as most consumers’ introduction to cachaça, but as the category grows in the U.S. market, there’s plenty of room for the spirit to find its way onto more bar menus and into more experimental cocktails. “I think you have to believe in the future of cachaça,” Heaven Hill’s Hafer says. “There is a great amount of exploration still available for bartenders. As variety within the category begins to expand here in the United States, we’ll start to see a real burst of cocktail experimentation.”
Pencil Thin Mustache
By Dustin Olson
Ingredients
- 1½ ounces Leblon cachaça;
- ¾ ounce Fernet-Branca amaro;
- 1½ ounces pineapple juice;
- ½ ounce lime juice;
- ½ ounce mint syrup 1 ;
- Mint sprig.
Combine cachaça, amaro, juices and syrup in a cocktail shaker with ice. Shake well and strain into an ice-filled Old Fashioned glass. Garnish with a sprig of mint, lightly slapped to release the aroma.
1 Combine 2 cups sugar, 2 cups water, ½ teaspoon salt and 2 cups roughly chopped mint in a saucepan. Bring to a light boil and remove from heat when sugar is dissolved. Allow to steep for 30 minutes, strain and cool.
Japanese Caipirinha
By Mitch Einhorn
Ingredients
- 2½ ounces Velho Barreiro aged cachaça;
- Splash Mito No Kairakuen 5-year-old plum liqueur;
- ½ lime, quartered;
- 1 teaspoon white sugar;
- Lime peel.
Muddle lime and sugar in the bottom of a rocks glass. Add ice and cachaça and then float liqueur on top. Garnish with a lime peel.
Zoe In Brazil
By Brian Klemm
Ingredients
- 1 ounce Cuca Fresca cachaça;
- 1 ounce St-Germain elderflower liqueur;
- Bar spoon Campari aperitif;
- 3 lime quarters;
- 1 ounce grapefruit juice;
- Lime wheel.
Squeeze limes and drop into a cocktail shaker. Add cachaça, St-Germain, Campari, grapefruit juice and ice. Shake and strain into an ice-filled rocks glass. Garnish with a lime wheel.
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