Stairway to Bed

Jeff and I discovered that three months is about as long as we can last between his oncology appointments without our anxiety becoming unbearable.  This was the longest he has gone without seeing Dr. Porter since BMT – and the assurance provided by the many blood tests they run each visit.  Jeff, who is usually Mr. Calm, was starting to express his concern.  His worry became my own.  This allowed for some good conversations about his priorities and our goals.

No, he had no major symptoms that caused our freak-out.  He’d had a dexascan to check his bone density and there was a 10% change on one of the measurements.  A couple of the measurements showed “Significant” change.  Jeff thought of our support group friend who has moth-eaten bones from Multiple Myeloma and, well, got to thinking too much.  I assured him that Dr. Porter would “pooh-pooh” the results of the bone density test and my niece, Nurse-to-be Becky, agreed it probably wouldn’t be a great issue.

As I reassured Jeff about his bones, I began worrying about the amount of sleep he needs.  He has been working more and comes home absolutely whipped.  After a day’s work, his voice is weak and he answers questions with Mmm’s and eh’s.  He often heads directly to bed, sometimes without showering first.  I couldn’t help wondering whether it was only the physical labor that exhausted him. 

Between his Mondays and Fridays with little Rosie, Jeff managed to complete a custom staircase job - which also involved wallpaper removal, replacing trim, installing hardwood flooring and painting.  This would not have been a big job for him pre-BMT.  This time he enlisted the help of a friend for a couple of days.  After it was finished, he admitted that he might have taken on a bigger job than he ought to do these days.  In addition to the physical demands of this job and an exterior painting job he also took on, there was a fair amount of worry about what it would take for him to finish.

Tuesday he saw Dr. Porter.  His blood counts were good, with Hemoglobin hitting a new peak, 14.7.  Nurse Heather and Dr. Porter both told him that his three-year survival bodes well.  They discussed his neuropathy and Jeff said he wasn’t sure the Neurontin does any good.  Dr. Porter said to experiment, then, and drop one pill.  The results of the liver function tests were not yet available so he could expect a phone call about those.  Jeff came home a little relieved and sheepish about our unnecessary hand-wringing.

On Thursday Nurse Heather called Jeff.  He sensed that Heather was reluctant to give him the news:  a recurrence of GVHD.  He has to go back on the immunosuppressant, Cellcept, because his liver function test results were elevated.  He’ll have to have those tests run again in three weeks.  At least GVHD can be managed. 

Oh, well.  Down one Neurontin, up four Cellcepts (the dreaded empty-stomach pills).  Net change:  +3 pills. 

Gift of Life Swab and Slobber

We’ve had a beautiful weekend!  We took Rosie to the Grounds for Sculpture Friday afternoon, she and her mother helped us run a swab station yesterday for Gift of Life.  Then we drove into Philadelphia with Kerry, Theresa and Rosie to meet Kim for a Father’s Day Eve dinner.  Lovely weather!  Lovely company!

The Gift of Life swab station was at the Hamilton YMCA training day (aka Pep Rally) for 1200 camp counselors.  Jeff’s job was to address the crowd and encourage them to join the bone marrow registry.  This he needed to accomplish with only two minutes at the microphone.  That didn’t leave a lot of time for details of his story so he whittled his speech down to essentials and added a bit of competition, “Freehold is way ahead.  And Lower Bucks, you’re in my neighborhood so I want to see you at our table!”  At that point, we’d only collected DNA from eight potential donors – all from Freehold - so he was particularly clever to turn that into a game. 

We had a steady stream of people swab all morning.  Our collection team included Jeff, Theresa and Rosie (good advertisement for why Jeff is glad to be alive), Stem Cell Donor Frank, Nick Hudson from Gift of Life and me.  Often Jeff was out of sight somewhere and I eventually realized that he was carrying Rosie around the grounds, talking up Gift of Life whenever he saw that we were ready for more “customers.”

Some of the young people were embarrassed when the swabbing action caused them to slobber.  Others asked, “Is it okay if I just ate a Jolly Rancher?”  or “…had gum?”  Jeff teased the gum-chewer, “Just stick the gum in there!” but I don’t think she did.  Some people needed to tell their stories, their reasons for their willingness to join the registry: “my cousin,” “my brother,” “my niece.”  One man asked Jeff, “Can I talk to you?  I just lost my dad to AML.”  Some seemed nervous, others more committed.  We loved them all. 

Stem Cell Donor Frank’s story is a particularly good one, well-known among Gift of Life staff members.  When Nick realized who Frank was, he said, “Oh, you’re that guy!”  Frank donated at Robert Wood Johnson Hospital the day after Hurricane Sandy in a lab opened just for him – which was running on generator power.  He had to use a back door - and maybe even a secret handshake (not really).  I told Frank how nerve-wracking donation day was for us, when Jeff was without marrow, very sick and waiting for his life-saving juice.  The family of Frank’s recipient had the added concern of a hurricane and power outages.  What a nail-biter!  Sadly, Frank will never meet his recipient.  Still, he is hopeful that he will be someone’s match again.  Awesome guy!

Nicole once told us about the special blanket Gift of Life donors are given on their donation day.  The GOL staff member who sits with them during the donation brings a blanket that has been signed by each of the Gift of Life staff members, thanking them for their donation.  It was nice to hear Frank and Nick, who is also a donor, talk about their blankets with the same reverence Nicole has for hers.  Gift of Life really knows how to take care of people.   

Prayers, please, that all those who swabbed yesterday feel our gratitude and  that among the swab kits now on their way to the lab, the identity of a hero may be made known.

Then and Now

I sat at at the kitchen table loading Jeff’s pill box for the week.  When I’d plunked the last pink pill into SAT PM, I studied the contents and felt as if I had forgotten something critical.  An email exchange with Dr. Porter’s office last week confirmed that Jeff could stop his prophylactic antibiotic and antiviral medications since he has stopped taking the immunosuppressant Cellcept.  That leaves only three pills in his arsenal:  a prescription calcium for his bones, Neurontin for neuropathy and a multivitamin.

A gallon freezer bag is supposed to corral the medications that are no longer required but several bottles spill out if you try to pick up or move the bag.  Suddenly I realized that instead of stowing any more bottles in this bag, it was time to dispose of the whole kit and caboodle!  Some of this stuff is pretty toxic.   I pulled out the prednisone for GVHD – just in case, checked with Jeff to see whether he agreed it was time to toss it all (he did) and Googled “Where to dispose of medications near 19067.”  Then I thought it would be fun to take a picture of the two bags.

Jeff has been working steadily on his non-Rosie days and is approaching his third birthday, the anniversary of his BMT, on May 27th.  

May Celebrations: Rosie's first birthday, my graduation, Kerry's 30th birthday, Kim's 28th birthday and Jeff's 3rd "birthday"  (We're missing our Marine Keith who is in California.)

Three Cheers for the Caregiver

Four seats ahead of us, facing us, a thirty-ish woman rested her head her honey’s shoulder as we traveled out of Philadelphia on SEPTA.  I would have recognized the posture even if I hadn’t noticed that her beautiful bald brown head had nary a hair follicle - smoother than a shave could achieve and evidence of her endurance.  She and her good looking, curly-haired beau were adorable, sharing secrets and smiles with their foreheads never more than an inch apart. 

At their stop, they got off the train and paused at the top of the stairs that would take them to street level.  She linked her arm through his and they put their heads together again as if they’d missed each other during the 10-foot walk from the door of the train to the top of the staircase.  They laughed, she let go of his arm, he stooped slightly and she jumped on his back for the descent down the stairs.  Too cute!  Was she too tired to carry herself one step further?  Were they just enjoying themselves?  Anyway, I couldn’t help being impressed by the young man’s strength – and recognizing that we caregivers find ourselves doing… well, whatever is required.

We’d been to the White Dog Café on Sansom Street in Philly for an MDS Caregiver luncheon.  Patients were invited as well but the event was intended to focus on the caregiver.  Mary Walton, Nurse Ethicist and Director of Patient/Family Centered Care at HUP, kept our discussion focused on the role of the caregiver, our anxieties and joys.  Rochelle Ostroff-Weinberg from the MDS Foundation - and an MDS spouse herself, contributed to our discussion with her 16-year experience.  The timing of this event coincided (deliberately, as I understand it) with the one-year anniversary of her husband’s death.  Wow!  Talk about strength. 

Two of the patients represented at the table had considered or are considering bone marrow transplant.  I was glad Jeff had decided to come along with me because he was looking mighty handsome in his baby blue shirt with UV protection.  He was the picture of health!  I told him he was the poster boy for BMT and maybe helped others see that it can be a very good thing – though, admittedly, very scary.  This is exactly what Jeff sees as his contribution – sharing his story and encouraging others.  As for me, I found the discussion very helpful.  Hugs and email addresses were shared at the end of the meal.  

Jeff has had a sinus infection for three weeks and he just couldn't seem to kick it.  He took Amoxicillin for ten days and was wiped out the entire time.  We waited for our family doctor to respond to our phone calls to request an additional course of antibiotic and ultimately found it necessary to change doctors.  We're back to a practice we used years ago and since they are in the Penn Medicine system, they will have easy access to all of his BMT records.  I think it was a good move.  After three days of Azithromycin, Jeff feels a whole lot better although he has had several bouts of diarrhea.  Oh, well.  Perhaps that's the trade-off.

Prayers, please, for our new friends as they continue caring for their loved ones through ongoing treatment and treatment decisions.  Also, for Rochelle and her daughter who strive to help and support MDS families and, so, are the living legacy of husband and father, Bob.

White-kneed Jeans and Other Joys

The Leukemia & Lymphoma Society and Jefferson Cancer Center put on a very nice Blood Cancer Survivorship Conference last week.  Judy did Rosie-duty so that we could go.  Jeff thought of Rosie all day, even as he enjoyed the company of Michael and Monique, friends from our Gilda’s Club networking group.  We missed Connie and George from our group who would have appreciated the quality and quantity of food we were served.  We hope they are okay.  
 

The highlight of the conference for Jeff and me was not the keynote address on survivorship plans or the morning breakout session on BMT or the Chair Yoga class that put us in a peaceful place during the afternoon session.  It was not eating and laughing with Michael and Monique, although that was fun, too.  The highlight for us was meeting Doug Olson, Dr. Porter’s famous (to us at least) patient who’d had T-cell gene therapy about a year before Jeff’s transplant.  Doug told us that he goes for a treatment every three months for his immune system but that is no big deal.  He told us that funding for the trial stopped after his treatment and did not start up again until a year or so later. He was very fortunate to get the treatment when he did!  Here is good video news coverage of Doug and Dr. Porter:  http://www.cbsnews.com/news/new-weapon-against-cancer-comes-from-patients-own-bodies/     

More on Chair Yoga… We were told that we could remove our shoes or leave them on.  Since he didn’t know exactly what would be involved, Jeff decided to keep his neuropathetic feet protected – shoes on.  After some nice breathing, feeling the wind going around our organs, we began moving our limbs in controlled movements.  We held onto the seat of the chair and lifted our legs.  The instructor told Jeff to sit back further on the seat and then said, “Oh, you have really long legs.  You’re fine.”  Then we planted our feet on the floor and pressed our heels down, feeling each toe… Jeff interrupted the tranquility by jumping up out of his seat – Cramp!  His hamstring complained in much the same way muscle cramps wake him up in the middle of the night.  Even so, Jeff thinks he’ll try to catch a class when he goes down to Penn for his check-ups every two months.

 

At Jeff’s two-month visit at Penn’s Perelman Center on Tuesday, he talked to another patient as they waited for their labs to be drawn.  The man was a little agitated because they hadn’t called him in yet and he had a bone marrow biopsy scheduled quite soon.  Jeff asked him why he was watching the clock because they would do the biopsy whenever his labs were done.  It turns out the man was going downstairs to be sedated for it!  Jeff was impressed and thought it sounded like a really, really good idea.  His six or seven biopsies were done in the doctor’s office without so much as a valium. 

Dr. Porter gave Jeff some good news.  After many months (or maybe two years?) of weaning off the immunosuppressant (Cellcept/Mycophenolate), he can stop it altogether!  No more empty-stomach medications!  No more worries if a dose is missed!  For some patients, this day never comes.

Jeff’s lab results were posted online and I could see that most of the numbers were solidly in the middle of the standard range.  So… normal!  For the first time Nurse Heather posted his Immunoglobulins (A, G and M) and all of those measurements were, likewise, in the middle of the standard range.  I texted Jeff to summarize the excellent results and I shook my head at the length of my text, “I should have just called you.”

He texted back, “I guess the only thing wrong is to get it in my head.”

I replied, “Oh, you have that trouble, too?  I think I still worry about you too much.”

“It’s nice to have somebody worry about me.”

 

That night he held up his favorite jeans and said, “See how white the knees are?  That’s from crawling around with Rosie.”  We laughed together over his glorious white-kneed jeans.

Family Time

This might be the longest stretch we’ve gone without a blog post - almost two months.   The good news is that there is nothing much to report.  Here are some pictures worth a thousand words.  Life is good!

Keith returned from Afghanistan.  He enjoyed the Philadelphia Flower Show with us.

The "kids"

Playing Peek-a-boo

The Whole Gang

Frigid Cold, Dusty Gray

It was 16 degrees on Friday and felt like 1.  Jeff knows it.  His train home was 10 minutes, 20, 30, 40 minutes late according to the periodic updates on the arrivals/departures monitor.  Once he boarded the blessedly warm train, there were issues with power and the trip was stop-and-go.  I doubt he will take the train in bitter cold weather again.  His next appointment at the Perelman Center isn’t until April 1^st so, unless Mother Nature plays a nasty April Fool’s joke, he won’t freeze. 

Jeff saw Nurse Jackie, the transplant nurse at Dr. Porter’s office.  She hadn’t seen him in quite a long time and was glad to see him looking so well.  She reviewed last week’s breathing test and reported excellent results – one of the measurements was 98%, up from 60% pre-transplant.  His Hemoglobin was 14.7, a new high since transplant.  She gave him a new instruction from Dr. Porter: continue the Cellcept taper, drop one more pill!  That means only one night-time dose and we will once again be able to eat weekday breakfasts together!  It has seemed like such a nuisance for Jeff to take his empty-stomach pills as soon as he wakes up.  We’d have tea in bed together, then he’d eat breakfast after I’d left for work.  This has been our habit for so long that I wonder how quickly Jeff will adjust.      

Jackie likes to scold her patients.  Patients like Jeff enjoy getting her going.  He asked her whether any of his medications could be causing joint pain – shoulders, wrists and ankles (he failed to mention jaw pain).  She said, “That’s classic GVHD!  Do you do any stretches?” 

“Oh, no,” Jeff replied with the conviction of a couch potato. 

“You have to stretch!”  Jackie insisted.

“Amy and I mall-walk in cold weather.  It doesn’t hurt while I’m walking but the next couple of days my legs and feet hurt terrible.” 

“But you stretch before and after you walk, right?” Jackie asks.  Surely she could have guessed his answer.

“No.”

Jackie shook her head.  If only her patients were more diligent in following her instructions!  She called in the Physical Therapist who gave him some exercises.

The lab orders for Jeff required four vials of blood, a big lab day.  In addition to the several routine panels, another engraftment analysis was ordered.  We usually don’t get those results until his next doctor visit.  They have caused me some anxiety in the past but this time I was not overly concerned.  

Jeff told me about a new patient he saw in the waiting room.  The woman looked ill and was accompanied by a young relative wearing blue University of Pennsylvania scrubs, a nurse.  The younger woman was telling the older woman what she could expect in the lab department.  The lab door opened and “Mary!” was called.  The phlebotomist asked Mary, “How are you today?”  Jeff thought that was a question that didn’t require an answer.  Anyone could see the answer was “lousy” so he answered for her, “That’s the million dollar question.”

In other news, Jeff’s New Year’s resolutions included prioritizing some of our home improvement projects.  You might remember that during Jeff’s early recovery he took a permanent marker to the ceramic tiles on the bathroom floor to mark those that he thought he’d replace when he was up to it.  Months later I removed those X’s with toothpaste and elbow grease to avoid the questions we invariably got from guests.  When he asked me to go tile-shopping last week, I asked whether he was really ready to tackle the project which now has evolved into a near gut-job.  He assured me he was going to start it right away so off we went. 

We bought tile.  I didn’t want anything to hold up the project so immediately upon returning from the tile store, I emptied the bathroom linen closet, medicine cabinet, vanity, took pictures off the wall and even removed the toilet paper.  I figured that was a good way to say, “Construction Zone Here.”  Jeff began the demolition and turned a worrisome gray that was only partially due to the construction dust.  Tile removal wilted him.  Now I find myself worrying just a teeny bit that the project could be stalled if he doesn’t feel well.  Over breakfast this morning, I confessed to Jeff that I was relieved by this week’s excellent blood counts - on more than one level.

55 And Still Alive!

When I wished Jeff a Happy Birthday this morning he puffed out his chest and announced, “I’m 55 and still alive!”
 

Single-digit temperatures are not conducive to outdoor walks so we went mall-walking this morning.  Jeff is concerned about his lung function test later this month because he has been getting winded fairly easily.  He wanted to make sure he fit in a “work-out” this weekend.  The lung function test is done periodically to check for damage from the pre-transplant conditioning.  So far he has had good results.

We’d been discussing the empty anchor store at the mall.  Jeff was quiet for a couple of minutes and then said, “I wonder what’s next.”

“You mean, which store will occupy that space?” I asked.

“No.  What I’ll do to help Gift of Life.”

Jeff wondered aloud what he might expect next medically and, well, eventfully.  Jeff’s birthday, the New Year and his January appointment at Dr. Porter’s office have us thinking about his survival.  Right now, we decided, it seems as if he is cured - even though “there is no cure.”  It feels like “cured,” not “in remission.”  We don’t delude ourselves that things couldn’t get ugly again but we are in a pleasant place, enjoying now. 

We tossed around some ideas for a swabbing event.  Where do lots of people congregate, especially young people, who would be inclined to swab?  The Grange Fair?  A Rider event?  We can talk to Gift of Life for advice. 

We mused about the future and reflected on the past year.  It was a big year for us.  We learned the identity of Jeff’s donor in April, we became grandparents in May, Keith left for Afghanistan and Jeff started babysitting Rosie in July, we took a bucket-list trip to Bermuda in September, met Jeff’s donor in October, celebrated 34 years of marriage in November and went to Boca Raton, FL, in December at the invitation of Gift of Life.  Also in December was the third family wedding since Jeff’s transplant.  It was a very happy occasion both for the young couple and for us.  Jeff gave me much more than the one slow dance he would reluctantly grant me pre-transplant.  We danced slow, we danced fast, we danced and danced!

Kim cooked for her Dad’s birthday – a beautiful flank steak stuffed with roasted peppers, spinach and bleu cheese with beets and potatoes and, naturally, rum raisin ice cream.  We played a rousing game of Qwirkle, played with the cats and headed home.  A good day.

50 Spoons and Kinship with a Sea Turtle

First there was a spoon with a needle-eye on the handle for the stitcher, a spatula that resembled a paintbrush for the painter, syringe spoons for the nurses, a sand shovel spatula for the beach-lover, and now Swab Spoons for the Gift of Life staff members.  Jeff asked me how many spoons I thought he'd made so far.  That was easy to figure out because we started a list when it became difficult to remember which of his supporters he'd already gifted with a spoon.  We counted the names on the list.  With the seven he made for the folks at Gift of Life, there were 50 in all.  He likes to think that number 50 is the one for Jay Feinberg, founder of the Gift of Life Bone Marrow Foundation. 

With the Swab Spoons packed along with our sunscreen, we headed to the Philadelphia airport Thursday afternoon for our flight to Fort Lauderdale.  I95 was closed at Packer Avenue due to "debris on the road" according to a digital sign that warned us of a problem.  The "debris" turned out to be mangled rolls of sheet metal that had unrolled from the center like Chinese yo-yos and blocked the entire highway.  Fortunately, we had worked ample time into our schedule to allow for an extra hour of travel - or sit-still - time during which Jeff periodically quipped, "Don't they know I have an important speaking engagement?"

We traveled without further incident (we even got to keep our shoes on at the airport!) and arrived in Boca Raton on Thursday evening. Our room overlooked a plaza featuring a large, beautifully-lit Christmas tree. We went out to dinner with Tamara from Gift of Life and then turned in early.

Jeff awoke Friday morning relaxed and prepared.  We ate breakfast and strolled around the plaza.  Jeff practiced his speech a couple of times and we planned the rest of our weekend.  Finally it was time to walk to Brio Tuscan Grille for the Gift of Life holiday luncheon.
 
We met Barby with whom we'd had many email exchanges since September when she called to ask if Jeff would like to meet his donor in New Jersey.  Barby happily accepted the Swab Spoon he'd made for her and put the two extra spoons on the raffle table.  We met more staff members as they arrived and we had our caricatures drawn.  Gregg kicked off the festivities by thanking all the staff members in a humorous overview of their jobs.  This turned out to be pretty useful to us in learning a little of what is involved in recruiting donors and performing matchmaking.  Gift of Life has an office environment unlike many, I think.  Hugs and compassion are the norm and staff members know and appreciate the significance of their work for the patients and families they impact.

Jeff's speech was well received.  He talked about Nicole's inspiration for becoming a donor, her little cousin, Nicholas.  He talked about the life events and moments he has enjoyed since his bone marrow transplant: Kerry and Theresa’s wedding, cooking for Kim on her weekly school night, seeing Keith become a Marine, helping me see my parents through their end-of-life journeys and, of course, the birth of our granddaughter, Rosemary.  Jeff said, “Before, during and after these events and moments – and many more – I think of Nicole and what she did for me.”  He told the staff that he thinks about all the hands involved in his survival, including all of theirs.  He thanked them all for their generous Gift of Life.
 
Later Jeff reflected on his performance and thought he only missed one little piece - about how he and I complement each other.  At one point pre-transplant, Jeff had concerns that his transplant was delayed, not because his donor was sick but because she was chickening out.  I soothed him at the time by assuring him that his donor had probably been screened for the likelihood of her reneging. It turns out that Gift of Life asks potential donors 16 questions to be rated on a scale of 1-5 including,"How likely are you to donate stem cells," "...bone marrow?"  Of course they're looking for 5's.  Nicole probably answered 10! Thank God!

How to spend an evening after such a success?  Shopping!  Jeff had been reluctant to replace his shoes that no longer work for his neuropathetic feet because he needed to replace all of his shoes.  However, he so dreaded donning his black dress shoes for the upcoming Claus-Snyder wedding that he was willing to get new ones.  I tried to persuade him to fork over a bit more than usual in order to get what he needs - shoes that don't hurt.  I found a couple of pairs of Italian shoes at Nordstrom's that were soooo soft and very nice and would have been perfect if they were discounted by about 75%.  Fortunately, we found good, old-fashioned service at Clark's.  The salesman understood about neuropathy.  We got "dancing" shoes and walking shoes to replace the sneakers we bought hastily at the time of his transplant (he needed new, clean sneaks for his allo-cleaned room at the hospital).  Although he'd complained about those now-two-and-a-half-year-old shoes every time he put them on, he had trouble leaving them at the store to be trashed!  With a little encouragement from the salesman, Jeff surrendered.

We spent a great weekend touring Morikami Gardens and the Flagley Museum, walking the beach and enjoying great restaurants.  Sunday afternoon we headed to the airport believing we'd be home before the snow storm.  No plane arrived at the gate, though, and finally the flight was canceled.  With our two cell phones going simultaneously, we were able to book a room near the airport and wait on hold for an eternity with the airline.  No flights tomorrow, we were told.

A full day extra in Florida!  With our gift of an extra day, we visited the Gift of Life offices.  Gregg was kind enough to show us around despite the short notice.  The offices are beautiful, recently expanded to accommodate their growing organization.  Everyone was very nice to us and we repeated our thanks for their good work.

We walked along the ocean in Delray Beach and visited the Gumbo Limbo Nature Center where we saw butterflies, watched the fish in the education tanks get fed and visited the sea turtle rehab area.  As we entered the rehab center, Jeff stepped quickly to the last turtle along the row of hospital tanks.  I looked to see what had drawn his attention so quickly.  The turtle was hooked up to an IV.  Jeff was fascinated by this and wondered whether it was the "same stuff" he'd had at home post-transplant - IV fluids.  It turned out the turtle was receiving antibiotics for a lung infection.  As we left the rehab center, Jeff remarked with satisfaction, "It was certainly worth going in there."  He felt a kinship with the sick sea turtle!

More walking - along Fort Lauderdale's Las Olas Boulevard- made Jeff's feet hurt.  He wasn’t wearing his nifty new walking shoes (grr!).  The forecast threatened more snow for Philadelphia so we noted which restaurants we liked in case we were given another day in Florida.  Back at the hotel, we packed for an early morning flight and wondered whether the next snowstorm would hinder our return to Philadelphia.  It didn’t.  

Many, many thanks to Gift of Life for their hospitality and, of course, for what they do every day.  What a great bunch of people!