Fibro, HGH and DHEA...

You mean you're STILL looking for what's going wrong?

I know I keep going on and on on about Human Growth Hormone "Deficiency" (I have trouble with the term but that will have to keep for another post).  You may very well be thinking, "here we go again," but there really is good reason to go on about HGH today!  Last night on twitter I happened to mention that blood work from the visit to the endocrinologist was slowly trickling in. Yawza!  My doctors and I are in a bit of a surprised state.

Fortunately, my thyroid tests are thus far all normal.  That is, the thyroid medication and dosage seem to be working a treat.  So it looks like THAT seems to be under control though to be perfectly honest with you, I personally have a problem with all thyroid testing and its accuracy.  (Another post, folks!)  But be that as it may, we need to look elsewhere for what the REAL problems may be and today we have two clues as to what may be causing me to feel as sick as I did back in 2001, if, that is, it's not the worst I've ever felt.  Period.

My doctor checked for a hormone called DHEA (Dehydroepiandrosterone).  This is not new territory for me. For those who aren't familiar with DHEA, this is a hormone that both men and women make and is released by the adrenal glands, located above each kidney.  This hormone is necessary for many bodily functions including resistance to infection, muscle toning and energy level.  In the past, I've actually been low in my DHEA level and have had to take supplements to get my levels where they should be. 

DHEA levels can actually fluctuate based on pain levels, nutrition, sleep and the presence of other diseases. Consequently, the levels should be taken (in the form of a blood test) periodically, some even advise every month or two.  (If we tested me every month or so for everything, I'd have no blood left, so we do so only about every year or so!)  Normally, DHEA levels decline with age - isn't that often the case?  Sigh!  In the past few years my DHEA levels have been pretty much spot on (hallelujah! Something that's right with moi!).  However, my most recent test shows that my level is about a third of what it should be.  (What luck!)  My doctor will be prescribing DHEA in pill form - again - to be taken once a day and we should be set on that front.  To tell you the truth, I've never felt much of a difference in taking the DHEA, but it makes the guys so happy that I just let them get their jollies with me when they can.  (Did that sound improper?  I assure you it wasn't meant to be anything but amusing!  I get my jollies where I can as well!)

However, the part that HAS intrigued me is that in taking my most recent blood work we checked out my HGH levels again, just for "fun," and there we were in for a surprise! (See previous links to HGH posts here, here, and here.)  

To be boringly accurate, one doesn't actually check for hormone levels but for by-product levels of IGF-1 (Insulin-dependent growth factor 1).  This chemical has a very long half-life so a random blood test will give the doctor a good idea of how much growth hormone has been released from the pituitary gland in the brain over the last few days.  As we age we make less and less growth hormone: this is normal.  However, as Bennett described in the literature beginning back in 1992, HGH levels in people with fibro are all too often low and in 1995 Bennett showed that growth hormone injections improved the quality of life for his fibro patients.  However, because adult growth hormone deficiency is thought to be rare, expensive and hard to obtain, doctors do not check levels of IGF-1.  Because they do not see cases of growth hormone deficiency the concept that it is rare in adults got solidified in physicians' minds, further complicating a convoluted history. (Understatement!)

OK, time to take a step back for a moment in order to understand the whole myth, "secrecy" and even legend of the whole HGH issue, though in very "Cliff Notes" style.  The whole issue became muddled when abuses began with the misuse of HGH.  In children, who indeed DO need HGH in enormous amounts in order to grow, etc, the hormone was suddenly abused by some doctors and parents who had children who did NOT have HGH deficiency but because they wanted their children to become better athletes and thus the whole system got out of whack.  Further complicating the system was when ADULTS wanted to look younger and abused the hormone for cosmetic reasons.  Do we even need to go into the abuses on behalf of adult athletes?  

The government tried to control the abuses of the hormone and imposed controls which the insurance companies took advantage of, thus making a cluster you-know-what.  When I was diagnosed with HGH deficiency in 1999 it took two YEARS for HGH to be approved on behalf of all agencies involved and we could not buy any for love or money, even though I was lying in the hospital dying with all of my organs shutting down when, finally, the HGH was shipped to us via courier.  It's still very difficult to get HGH (not available in a pharmacy but only each month, still via courier, after a call for a delivery time, date and place each and EVERY month! Talk about restrictions!).  HGH is still very difficult to obtain with lots of testing needed to "satisfy" all the powers-that-be, although much easier to obtain than back in 2001.  Now you have the back story in a nutshell, though trust me, a book could be written on this alone.

Back to today...

I just learned that my most recent IGF-1 level had dropped from a normal value about six months ago to a much lower level now.  This is quite unheard of.  We normally go to my endocrinologist to make sure that my IGF-1 level is not too high since as I age, we need to keep the level at the number that someone my age would need and NOT any higher.  Now here we are, stunned to find ourselves with a much lower number than what we ever could have imagined.

This is also surprising because my dose of HGH had not changed for many years, since 2001, in fact.  The last time my levels were taken was in September.  What could have happened to change a number so quickly or even to change it at all?

There are several possibilities that come to mind:

• Although my pneumonia was probably developing earlier, it wasn't diagnosed until October 11.  The pneumonia may have weakened me and made me more prone to develop a lower hormone level.
• At about the same time, I had my gall bladder and stones removed.  This is major surgery (as I found out the hard way!) and is a major stress on the body.
• The holidays certainly didn't help my general health.
• The remodeling and redecorating (which seems to be a permanent state of affairs here in this house) has most definitely not helped.
• We've gone from a family which has had embarrassingly great health (except for MOI - must give that caveat again!) to a family with embarrassingly BAD health with each family member undergoing major surgery in the last year and a half.  Talk about stress and worry!

At any rate, I include this info because again, I really want people out there to realize that DHEA and HGH levels are so important and frequently problematic in fibro.  Please do yourself a favor and talk to your doctors about this if you have unexplained fatigue, low stamina and muscle weakness.  Also, a deficiency of these hormones can make you flabby (as I can attest!) and unable to lose weight, no matter how much you try (again, I can attest!  Sadly!).  Again, previous posts go into other aspects of lack of HGH (see search box if need be).

I don't know that we've found my Red October in the Hunt for it (see previous posts on that) but at least we have one small explanation for my recent deterioration. We just need to see if this is yet another red herring or the real deal.

As always, hoping that everyone's feeling their best, only better.  Ciao and paka.



(Did you enjoy this post? Please subscribe to my blog and you'll never miss another one again. It's easy: follow the directions on the upper right-hand corner of this page. And BTW: I'll never sell, share or rent your contact information. I don't even know where to find it, so fear not: it's a firm promise!)

Friday Tidbits: Depressed/Not Depressed?

Yesterday in an email to my BFF I admitted that I thought I was depressed.  That's a huge admission for me since I put a lot of work into NOT being depressed.  

However, looking over some of the posts I've written lately, along with some research on the state of the flu "epidemic" we're experiencing, I suddenly realized that I wasn't depressed as much as I was just really sick. What I thought was just some sort of awful bug we've all been fighting, has most likely been the flu instead, the real McCoy.  In fact, it's probably been more than just one episode of the flu.

Well, it was the flu on top of the cellulitis, which would make sense, because who knows which came first, the cellulitis or the flu?  Regardless, whatever got into my system resulted because of an already weakened state, and that's on top of the already weakened state of the CFIDS/CFS/ME and fibro, plus my severe insomnia that's gone into stratospheric heights.  Am I making sense?  I know, you really do need a score card around here.

What started my "depression" is that I couldn't take the cellulitis (wow! that did a lot of damage!) on top of the hypothyroidism I was trying to get a handle on.  In the flu epidemic post I wrote last Friday (link) I alluded to the fact that we would basically have to put a halt to "The Hunt for Red October" until flu season was over. This is the plan I've dubbed as the hunt and mystery of the new-awful-mysterious-thing-that's-happened-to-me-that-we-need-to-find, but instead get red herrings thrown at us.  (Whew. Do you see why I need a code?) In other words, my plan to go on the offensive had been thwarted and it was just too much for the Pollyanna side of me.  (Hey! You think it's EASY to be positive???)

BUT!  Yes!  BUT!  And it's a good BUT! 

Yesterday's news gave me heart.  According to what I can piece together from various news sources it appears that:

• there is a good chance that the flu season has peaked in a few states.  Whew. That sounded wonderful.  Caution is being reported right and left, as it should be.  Furthermore, we still need to watch what we touch, where we go, all the things I mentioned in the flu post.  But this is wonderful news, the best I've heard in quite a while.
• there is a good chance that we only have six weeks of this junk ahead of us, which takes us to the end of February.  I liken this bit of news to labor.  What was so awful about labor?  It was that you didn't know when in the world that baby of yours would finally decide to enter the world and put you out of your misery.  Having what is a type of time frame is NOT to be underestimated!   I can handle six more weeks of vigilance and wait to resume "The Hunt for Red October."
• there have been three strains of the flu out there, not one.  NOW I understand that I may have had all three versions at one point or another.  Looking at the symptoms was reassuring.  I hadn't been fighting the same thing over and over again.  And no wonder the pain meds weren't working.  Once I have an explanation I can handle most things.  I'm just so glad that I take a daily anti-viral which my rheumy/immunologist recommended and GP prescribed and I've been a fanatic about taking the anti-viral for about the last five or so years.  How much worse could things have been?  MUCH, from what I've been told by said doctors.

As soon as my surgeon gives me the OK to return to whatever MY normal is, I can't wait to start sterilizing the house.  I have got to find the steamer and start in on washing those areas I'm exposed to, including the kitchen areas where germs and viruses may be lurking despite all attempts (on hubby's part) to eradicate.

Furthermore - and how I hope I'm not jinxing myself! - I've made another list for the weekend and hubs looks like he's gung-ho.  I certainly hope that nothing happens to HIM between now and then to make this plan go kaput.  I mean, I REALLY need to get something done in the house.  Accomplishing anything will put me in a better state of mind.

So, I see that I'm not depressed as much as sad and frustrated.  Or at least that's my story and I'm sticking to it!

And in the meanwhile, I hope everyone is feeling THEIR best, only better, and staying away from all those nasties out there.  Take care and take precautions.  Ciao and paka!

Six weeks?  Yeehaw!!!

(Did you enjoy this post?  Please subscribe to my blog and you'll never miss another one again. It's easy: follow the directions on the upper right-hand corner of this page. And BTW: I'll never sell, share or rent your contact information. I don't even know where to find it, so fear not: it's a firm promise!)

Zebras Rather Than Horses?

"Have courage for the great sorrows of life and patience for the small ones; and when you have laboriously accomplished your daily task, go to sleep in peace."           ~Victor Hugo 

Yesterday and the day before (Christmas and Christmas Eve, respectively) turned out to be a bit of a surprise, and not just an "Oh! surprise?"  but a  completely out-of-the blue surprise.  At least it was for me, the person who has the dreaded CFDIS/ME/CFS and fibro with a list of complications that reads almost as long as a Victor Hugo novel.  (Which reminds me that I do want to add a page to this blog where I actually list the symptoms of CFIDS/etc and fibromylagia, the symptoms I have, as well as those I've managed to miraculously escape thus far.)

But first, on with what I have at hand.  I've written about red herrings and the major military operation which I've now dubbed "The Hunt for Red October" (see link).  There I explain that I know that I have "something new majorly wrong with me," the condensed version here.  Finally, my GP and rheumy are now trying to get down to the bottom of it all, scheduling in specialists from other fields, but what slows us all down are these red herring which are constantly being thrown in the way.  My GP and rheumy, I believe, as well as even the ER docs, are starting to look for zebras and not horses, so to speak.  Things are just too strange, too weird, too unexplainable, but very annoyingly THERE. 

Like most of my family, I've been fighting a particularly nasty strain of a GI bug for the past year or so.  OK, perhaps they're not fighting a bug every other day, like I am, but they are fighting it regularly nonetheless. It's the warm winters, I tell you.  Well, that and the "fact" that someone had to have stepped on a mirror and broken it: it's the only reasonable explanation for our cruddy streak of bad health, I tell you!  We have definitely become frequent fliers to the ER and even for hospitalizations. 

Since a couple of weeks ago and the visit my GP and then my surgeon the following week, I've known in the back of my mind that I wouldn't be able to do any cooking or baking of the Christmas Eve Dinner, my favorite day and meal of the year.  Worse, I wouldn't even be up to sitting in the kitchen to command  instruct hubs and daughter as to what needs to be done, explaining the details that are kept out quite unintentionally (Ha!).

You need to understand that Christmas Eve dinner is absolutely sacred.  It's the day with the meal which as a child we were not to eat anything at all until the first Star in the Sky stood out.  (Luckily, we were not on Daylight Savings Time!)  Then, since we were still observing the Advent lent, the 13 traditional food on the Christmas Eve table were vegan.  Some of these foods were made only once or twice a year, so there was a real specialness towards Christmas Eve.  I was always most certainly interested in the food than in the gifts which would arrive the next day.  Better yet, we ended up celebrating two (yes, you heard me, TWO!) Christmases, one on December 25 when we would get the majority of our gifts (and awful gifts they were: dominos, cheap plastic comb and mirror vanity set or pj's and socks).  We were definitely poor.  Then on Russian/Ukrainian Christmas Eve and Day, we were able to repeat the whole kit and caboodle on January 6th and 7th with our Godparents and Grandparents giving us presents on Eastern Orthodox Christmas and all the foods were served once more for Christmas Eve and Christmas Day, the latter with meat, dairy, etc.

Since I've been married (to a Catholic) we've made compromises.  We do the whole kit and caboodle Christmas Eve food, most of which hubs won't even try to taste because he is THAT picky an eater.  As a consequence, we've always had to make a few compromises on which foods would be on the table so that he and my picky kids would have something to "enjoy."

And I am such a Christmas fanatic!  Not only do I cook and bake most years, decorate the house to within an inch of its life (though as elegantly as possible) and then on top of it all.... Well, I had a large dining room table custom-made which will seat 14 people quite comfortably, as well as Christmas China that will serve about 40 people, all so that the kids would never even think of not coming home for Christmas.   Christmas is MAJOR around here!

Well, as they say, "man plans, God laughs."  As much as I've always wanted those kids of mine to never even consider for a moment that they won't come home for Christmas with their spouses and vast numbers of children, the joke's been on me.  Elder son is always living in some most inconvenient corner of the world thinking he's some sort of reincarnated Indiana Jones, but for the fish farming community - or perhaps it's Crocodile Dundee?  Who knows?  He's not around much any longer.  Child #3 has his own thing that he does and that leaves daughter of mine to make it home for the meals.   However, I swear, half the time I think she does so only because she wants to figure out the little secrets of the recipes served for when her time comes.  

So, why am I going on and on about this?   It's because I want you to understand the magnitude of what happened on the day before Christmas Eve.  I was sicker than any proverbial barnyard dog and my daughter had tears in her eyes from seeing me just that sick - actually, since she's seen me almost dying how many times, those tears really freaked me out!  My neuropathy was spreading and painful, most of my hand from last year's surgery was swollen and four of the fingers were now numb, pain moving from my gallbladder surgery sites to other parts of my body and returning, I was experiencing  migraines and body migraines, the list went on and on.  We huddled up together (between unpleasant runs - hubs carrying me - to the other room when necessary) trying to figure out if an ER visit was necessary.  The pain was off the chart, there was new stuff I'd never felt before, and I must have looked like death warmed over.  (And I definitely didn't want to go with chipped nail polish!  Priorities, ladies!)  I finally decided against going, not wanting the nasty "invisible" illness treatment that usually happens when coming into an ER with anything less than an ax through your head.  Funny, I actually saw that once, and the guy was sitting out in waiting room...truly!  (But I digress!)

On Christmas Eve I felt somewhat better (the usual pattern now going on for months) but I finally had to make a "mature decision."  I called hubs up from the kitchen.  Oh my yes, I guess he does indeed love me if he and my daughter spent two days cooking food that they wouldn't for the most part be eating!  (Although that could be a guilty mind and/or seeing how pathetic I looked and sounded.... now those are reason that I do NOT like!)  At any rate he  and #1 daughter came into the room and I told them that there was no way that I'd be able to get down the stairs and then sit at the table eating.  We would have to eat in our bedroom and keep me in bed.  The relief on their face was priceless.  The burden removed from my shoulders was almost miraculous.  

We ended up having a wonderful dinner, laughing, joking and having a very low-key dinner, though with Christmas China, of course.  But what a sacrifice on my part!  We almost never eat in our dining room.  I have a special tablecloth and napkins just for Christmas Eve and then a selection for Christmas Day.  We had to skip the beautiful table centerpiece we'd ordered for the first time in years and not able to look at the Christmas tree which I was finally able to help decorate a little bit - although I managed to break three very special ornaments, plus a foot-tall Christmas angel, cracking her porcelain wings.  Worse, I know that had anyone else done this, I would have been as angry as a hornet whom a crazy person'd had the nerve to disturb.  Yep, it was definitely time to get  back to bed for me.

By Christmas day I couldn't get out of bed either.  We had dinner in my bedroom again.  However, by 3AM, I was so sick that we ended up calling an ambulance to get me to the ER.  There, testing was done and though everything came back more or less "normal," (high BP for me at almost 150 over whatever, up from it's usual 70/50 lately and temp 98.6, up from my usual 95.5).  They did a CT scan with the dye and found that I was "clean" of whatever.  However, they discovered "atelectasis," a partially collapsed part of one of my lung lobes, not surprising with the gallbladder surgery, the pneumonia and perhaps even the "newly-diagnosed" hypothyroidism.  Thank goodness we'll be seeing my endocrinologist in a just a couple of weeks.  To see him will be like preparing for a grad school exam.  I need to write everything out as coherently as possible, in brief bullet points as to what the newest developments have been and then the prioritization I believe is needed, to then be compared to what HE actually thinks.  I swear, I think 5 eight-hour days would not be over-doing it, but alas, I'll have only about an hour.  

A slightly funny thing happened today as I was leaving the ER today.  The ER physician (whom I've never seen before) was almost apologetic that he couldn't find more that was conclusively wrong with me, number-wise, so that he could have admitted me to the hospital.  It as a strange moment because I've not gotten this sort of "feeling" or "hinting" in at least 20 plus years.  He was about my age which would put him into that, "Golden Era" of physicians as far as I'm concerned.  There was something about his being that felt as if he was pretty certain that I shouldn't be going home but up to one of the floors where real workups could be done... something that no longer happens in our era.  It was a very bittersweet fraction of a second, but it was there, and it gave me a glimmer of hope: someone BELIEVED! 

And so, going back to Victor Hugo's quote, appropriate, given yesterday's release of the movie version of "Les Miz".  Unfortunately, I'm too sick to go see the movie, but I read the book back in 8th grade and loved every minute of it, and have been lucky enough to have seen the stage production a few times.  I do think I've always had it in me to think that it would serve me well to show courage for the great sorrows in my life, while showing patience for the small things, though in full-disclosure, patience has always been a downfall of mine, no matter how much I've worked on that alone.  However, and unfortunately, as a CFIDS/etc and fibro, I have trouble going to sleep at all, a little bit of spoilage in the ointment, no matter how virtuously I may I act.  

And finally, next year I'm ordering a tiny tree for my bedroom as well.  If we get stuck eating any Christmas dinners in our bedroom again, I want a tiny tree nearby that I can see while eating all the wonderful food.  

And so, as always, I hope all are feeling their very best, only better.  I hope that those who celebrated Christmas had a truly special one.  Ciao and paka!

Friday Tidbits: Medicine 21st Century Style

The Offensive

It's been an awfully odd week. I finally felt well enough to go and see my GP.  It was a long appointment as we made plans as to how to attack a "new" problem I'm having.  This is the latest development in what I call the "something new is majorly wrong with me" problem that I've been concerned about for about two years now. We've been distracted from this hunt because of a few red herrings that got in the way, among them the compartment syndrome surgery, pneumonia, gallbladder surgery and abnormal mammogram.  We talked and planned as if it were all a military operation, deciding which specialists I need to see.  Before, it's been, "see this specialist to put out this fire, another one to put out another fire."  However, we all now realize that we need to actively go on the offensive.  Putting out fires is no longer acceptable.  Because of the military feel of strategic planning, as well as well as the red herrings, my mind thinks of this as "The Hunt For Red October."  It is just so much easier to give it a code name because "the figuring out what new majorly new huge problem is" is just a wee bit overly-worded.

Part of me is happy that we appear to now start planning by going on the offensive by making appointments. On the other hand, the realistic part of me is a bit anxious because I know that no matter how much I plan it all out, no matter how many appointments are made with doctors who have carved out times in their schedules to accommodate me (calling in favors) I will end up having to cancel some appointments - and that is not just embarrassing, but it also makes me feel like a second-class citizen.  For example, I'd made numerous appointments with my gastroenterologist and over the last two years I've had to cancel each of about five appointments at the last minute. I become so sick that were the house on fire, I wouldn't be able to allow anyone to haul me out of it.  The pain is just so bad that I can't allow anyone to be in the same room with me, much less touch me.   How does one ever explain this sort of pain, exhaustion, brain depletion, nerve sensitivity, and so forth that is the legacy of CFIDS/ME/CFS and/or fibromyalgia?

So, this is one huge problem. As optimistic as I am, the rational, practical voice in me says, "this I have GOT to see!" as in "how in the world am I going to be able to see all these doctors?" I need to see about five or six specialists at this point, PLUS get my breast biopsy.  Huh?  Really?  Seriously?  Good grief, I'm still recovering from the gallbladder surgery.

In the end, my GP, hubs and I did cover some of the realities of being ill in the 21st century.

• We lamented the fact that one can no longer be admitted to the hospital and have all the consultants come to see you. We remember the days when all tests could be run during your hospitalization, all in one big fell swoop.  Back in the day, the consultants would run into each other in the hospital cafeteria, the X-ray room, or corridors if they couldn't manage a brainstorming session. What now takes months and months to accomplish could take a week or less if it were done with a hospitalization.
• We lamented the fact that acute health problems like saving the life of a shooting victim or a liver transplant is done so well, but chronic medical problems are woefully badly done.  Everything is so wrong!  I had great care when I had my compartment surgery but because of my CFIDS/ME/CFS, fibromyalgia, insomnia, migraines, I could not make it to the hand therapy I needed, once released from the hospital.  The plastic surgeon could not understand that if he wanted me to have several months worth of tri-weekly sessions, they needed to be done at my home.  I couldn't begin to explain to him that even if someone came to the house I might not be able to handle talking to a hand therapist, much less have him touch me!   Forget the fact that all my organs had fluid around them (anasarka) and the urine in my bag was brown because the tissue from all my organs were breaking down (rhabdomyolysis).  Forget that I needed two blood transfusions to stay alive.  Forget that I had renal failure and pancreatitis. They STILL wanted me in the office and felt I was being difficult and non-compliant in regards to hand therapy.  (Note: I was released from the hospital too early and THAT'S why I ended up with the almost fatal conditions, rushed to another hospital less than 24 hours after coming home... in what world is THAT cost-effective?)

Yet when we said we'd pay privately for any hand therapy at home, the surgeon's office said that at-home therapy was "not in accordance with our business plans."  (Oh boy! Hubs still sees red every time he thinks about the hypocrisy and rigid thinking.)  Twelves months on, I have severe nerve damage and the inflammation in my hand is often not helped by anti-inflammatories. Oh those spoiled prima donna plastic surgeons.  You didn't see Dr. Hunk General Surgeon acting this way with my gallbladder.

• And finally: we think we have a large chunk of the falling problem solved.  Perhaps you recall that I'd spent quite a bit of time passing out and crawling about, not being able to walk even the six feet between the bathroom and my bed without hubby's help.  It turns out that the muscle relaxer I need was changed to the generic and THAT was a great deal of the problem.  The scary part was also how LONG it took to clear the generic muscle relaxer out of my system.  I'm back to my name brand muscle relaxer and after six weeks, the falls are almost gone.   I do have trouble walking around but much of that is due to the gallbladder surgery and whatever this new "Hunt for Red October" is about.

The day after seeing my GP was more difficult than I've had to undergo in ages.  I see that after going to see my GP a couple of years ago and describing that I'd developed a new pain, he thought that my pain was just like any other.  Because of the stress of the visit (and the side visit to the mall for new glasses) I ended up in the ER with the surprise diagnosis of gallstones less than 48 hours later.  After seeing my surgeon on election day, plus taking the time to vote and run up to TJMaxx, I ended up so sick that I was in the ER just two days later.  After this latest visit to my GP, within 24 hours I ended up calling hubs at work and having a melt-down because the pain was so bad, but I couldn't endure even the thought of another ER visit, knowing how I would be treated for an "invisible illness." 

So, I want to know, how, exactly, will I survive all these visits to specialists without being killed in the long run?  I wouldn't think that under the circumstances, a hospitalization would be stretching it.  But alas, the hospitalization for a good workup in order to get everyone on the same page and to establish what is going on has gone the way of the doctor's house call.  I think a large part of the population out there with "invisible" illnesses knows exactly what I mean. Yes?  Comments welcome, as always.

And that's it for the week.  I hope everyone has a truly great weekend, feeling their very best, only better. Ciao and paka!