Archive for the ‘Health Care Reform’ Category

LungCACXR

Not really mine, but I thought it looked good. Thanks Wikipedia. I’ll post the real X-ray when I get it from my doctor.

That we had actually gotten to the hospital at the designated time made me a little nervous. Jessie and I hadn’t been on time for anything in thirty years, so the mere fact that we had arrived on the dot — at five-thirty in the morning, no less — reminded me how serious the next few hours would be.

The Kaiser pre-op area was an enormous, fluorescent-lighted room with at least 15 bed-cubicles situated along its perimeter. By my count, ten of these little cubicles were now occupied. In just a few minutes ten souls in various states of disrepair, including your narrator, Russell S. Buchanan, would be cut open and — if all went as planned — repaired.

While we waited for them to come wheel me to the operating room Jess posed an interesting question.

“Hey, how do you think they make sure they’re working on the right — I mean, the correct — side?”

Hmmm. The confusing way she asked her question, with the homonymic “right,” made the question all the more compelling. My left side was the target, of course. But how would the surgical team know that for sure before they started carving me up?

As I began planning my escape, my surgeon, Dr. Yakoub, entered the cubicle, introduced himself to Jess then signed his name under my left armpit with a black Sharpie. Whew.

______________

Let’s back up a little, though. What brought me to this world of scalpels, gurneys and black Sharpies began in January with a persistent variation in my body temperature, including a slight fever. There was also a bit of a worry about the weight I’d been losing for about a year and a half. Even though I had shed about 30 lbs. over six months, the weight loss was somewhat more explainable and less concerning for a few reasons. We had purposely been eating smaller portions to lose weight over much of that time — Jess had lost weight too. Also, I had been walking my dogs religiously at 4:30 every day for up to an hour, up and down the calorie-burning hills around my house. Not to mention, I’m about to turn 64. If my dad’s “spindly shanks” — as my mom called dad’s legs during his autumnal years — were any indication, losing weight is just something male Buchanans do when they get old. There was also the comfort in knowing that my Anthem/Blue Cross doctor, who was aware of my weight loss, had given me a clean bill of health just two months before, after giving me a complete check-up that included a chest X-ray. Oops.

But the temperature fluctuation was another matter. I’d wake up many mornings with my thermometer reading 100. An hour later, back to my normal low of 97.7. Two hours later, 96.7. Then back up to 101. No cough, no shortness of breath, no other symptoms at all. I even bought a snazzy new digital thermometer to be sure the problem wasn’t in my analog one, which had probably been handed down through ten generations of Buchanans. I went to see my new GP at Kaiser, Dr. Slingenberg.

Based on my fevers and what the chest X-ray indicated was some wispiness in the lower lobe of my left lung, Dr. Slingenberg figured I had managed to develop a bit of pneumonia there. So the doc wrote a prescription for antibiotics and I went home.

As you might have guessed by now, that was not the end of the story. Dr. Slingenberg called a few days later.

“Hello, Mr. Buchanan. It’s probably nothing to worry about, but remember that wispiness in your chest pictures?”

“Uh-huh?”

“Well, I’d like you to have another chest X-ray. Something about that wispiness looked unusual.”

Unexplained weight loss, mystery fevers, lifelong smoker of cigarettes… I had hoped to live my entire life without hearing the words “you,” “chest,” “X-ray” and “unusual” uttered in one sentence by my doctor. But Dr. Slingenberg had just scuttled that hope.

Even with my cancer indicators, though, the chance of me actually having lung cancer was remote. No cough, no malaise, no cancer markers in my blood tests. Not to mention, nobody in my family — grandparents, parents or sister — had developed any type of cancer during their long lives. Cancer does not like my DNA, I kept telling Jess and myself… again and again.

In fact, the first time cancer seemed like a real possibility to me was right after my second chest X-ray. It was something about the way the tech spoke to me before and after the session — the way he said “good luck” after he’d had time to look at the pictures. Not only had there been a subtle change in the way he spoke, but his tone and transition sounded vaguely familiar. Then I remembered — it was the same way Dr. Slingenberg sounded during his last call about the wispiness. Both of these guys’ voices had become more intimate and personal — more careful and compassionate.

The second X-ray again showed signs of trouble in my left lung’s lower lobe and proved to be the healthcare equivalent of the umpire yelling, “play ball.” Batteries of tests were ordered — blood tests, breathing tests, CAT-scan — and, of course, my first bronchoscopy.

Imagine a colonoscopy. Now, imagine a little higher. Rather than inserting a camera in your rectum to examine your bowels, the camera goes into your mouth then down into your lungs. In my case, the bronchoscopy confirmed what the CAT-scan had indicated — and what my doctors had suspected — a mass about the size of a pecan was growing inside the bronchus of my left lung.

As an inveterate body abuser — eat-what-I-want, smoker, ex-dope fiend, former touring rock-and-roller (and all the sleepless nights and debauchery that suggests) — I believe it is a minor miracle that I had, until now, never experienced ill health of any sort, let alone serious ill health. In other words, I am a very grateful guy who would be the last person on earth to shake his fist at the sky and shout “Why me, lord?” I know darned well why. But at the same time I must admit that all this talk of cancer and diseased lungs was beginning to put me in a philosophical mood. I began thinking of shortcuts I might take that would complete the album I’ve been working on for the last three years. I mean, dying with 14 almost-finished songs trapped in my computer would have made me very cranky in the afterlife. I found myself reviewing my life a lot and began worrying about Jess worrying about me. Hell, I even worried about my dogs, and how distraught they would be — however briefly (squirrel!) — if the cancer killed me.

As it turned out, my morbid musings were unnecessary. Though they couldn’t be sure without biopsy — and biopsy of the mass would not be possible until its removal — Dr Yakoub and my pulmonologist, Dr. Drucker, were both confident that mine was a rare, slow growing, non-metastasizing (in my case) type of cancer known as a carcinoid, a type of growth that until recently was not even considered a cancer. Apparently, I had picked the right kind of tumor.

However, it did have to be cut out of my body. The date of my deliverance was set for April 14.

_____________

A few minutes after Dr. Yakoub signed the correct side of my chest, my anesthesiologist, Dr. Chung, peeked in and introduced herself. I sat on the gurney marveling at all the activity going on around me.

“Honey, I know it’s idiotic, but I can’t help feeling guilty about all this,” I said to Jess.

“Guilty about what?” answered a male voice on my right. It was Dr. Yakoub, whom I thought had left the cubicle but was only hidden by a computer cart.

Great, I thought. Not only was my surgeon about to be subjected to my useless guilt rant, but he also probably thought I had just called him “honey.”

“Well, here I am with lung cancer brought on by stupid life choices — namely smoking — and now I’m blithely expecting all these people to snap to and come to my rescue. It just feels wrong and irresponsible and unfair. Hell, I don’t even have any pain… ”

Dr. Yakoub cut me off as he continued typing away at the computer. “Oh, your carcinoid has nothing to do with smoking,” he said. “We’re not really sure why carcinoids occur.”

That’s the last thing I remember before partially regaining consciousness in the recovery room. According to Jess, I was fairly miserable when I awoke – lots of shallow breathing and grimacing. I remember being wheeled through the halls to my hospital room, where apparently, I insisted upon placing my oxygen mask on my forehead.

My four-hour surgery had been successful. My growth — or “friend,” as Dr. Drucker called it, was biopsied immediately after it was removed and turned out, in fact, to be a carcinoid — a blessed little carcinoid. Dr. Yakoub also found a touch of pneumonia in my lower lobe behind the mass, just as Dr. Slingenberg had surmised.

The six-inch gauze pad and two drainage tubes under my left armpit told me that the simpler, less invasive thorasocopic procedure that Dr. Yakoub had hoped to employ, which would have left me with two tiny holes and a much shorter hospital stay, had not been an option. Dr. Yakoub explained to me later that my tumor’s proximity to a major artery required him to go in the old fashioned way — through my ribs.

I spent four days in one of the many rooms of the post-op wing of Kaiser Panorama City, the same hospital that took my tonsils 50 years ago – my only other surgery and hospital stay. Sadly, they were in the process of tearing down the actual building of my tonsilectomy, but I got to see its gutted shell from a fourth floor window every day during my doctor-prescribed walk around the wing.

In just four days the post-op staff at Panorama took my already good opinion of Kaiser and put it in the stratosphere. Nurses, kitchen staff, on-call doctors, housekeeping — every single person I dealt with during my stay — was professional, upbeat, caring, smart and pleasant to be around. I now have an appreciation for nurses that borders on worship. These gals and guys on the fourth floor were constantly busy with patient medications, bathroom assistance, assorted emergencies, etc., but always came to my room right away when I hit that button. They even walked the floor with me the first couple of days. One of my fondest memories will be my petite Philippine/American nurse and me strolling down the corridor, belting out old Chi-lites and Commodores hits (she belted, I kind of grunted and winced), while I guided my IV tree with one hand and valiantly tried with the other to keep my butt from peeking out through my half-open hospital gown.

As a sworn enemy of America’s health-as-commodity, private insurer-based system and Anthem/Blue Cross survivor, I can’t believe I am now going to sing the praises of a health insurance company, but here I go: Ever since I joined Kaiser Permanente in December I have been in various stages of awe and admiration. The past month, with all my appointments, tests and such has only intensified my appreciation of this behemoth org.

I’m new at Kaiser so I’m still trying to figure out what makes this company so good at its job while others continue to fail so miserably. Of course, Kaiser’s one-stop shopping, with labs, diagnostics and doctors of all specialties located in one place is a godsend. With Anthem I’d still be waiting for my first X-ray, which, if approved, would likely be conducted at an imaging center twenty miles away at rush hour. Also, I assume one big reason my doctors Slingenberg, Drucker and Yakoub have been so clear and patient with me and so expert with my case is that with Kaiser handling the administration, traffic, marketing and other non-medical duties doctors traditionally loathe, Kaiser doctors are free to be healers. Well-informed healers, at that; according to my Internet research, doctors are often flummoxed by the very uncommon carcinoid. Not my Kaiser doctors, though. They were all on the carcinoid trail well before the bronchoscopy pictures all but confirmed the theory.

Overall, Kaiser seems to have hit upon a magical formula of super-efficient, digitally-driven healthcare administration combined with absolutely top-level employees. The computers take care of the pain-in-the-butt-but-important stuff, such as parking (digital readout of available spaces and their location) and blood-test traffic (take a bakery-type number at lab entrance and wait for your number to be called. I’ve yet to wait longer than 20 minutes, usually far less time). The employees take care of the actual healing and support duties along with their job of representing the organization to the patient and making the patient feel valued.

________

Well, I am home now. My carcinoid is probably in a landfill somewhere or may still be in Panorama City, getting to know my tonsils. I feel surprisingly good, considering that just nine days ago the good Dr. Yakoub opened me up, bent my ribs out of the way, cut through a few centimeters of my muscle, adipose and lung tissue and then sewed me shut.

At the risk of diminishing the wonderful sympathy I’ve been getting from Jess and the few others who knew about this thing, I must confess that the pain has been curiously minimal. Minus the hours after the procedure, which I really don’t remember very well, and the occasional attention-getting tweak from my drainage tubes, which were removed before I was discharged, the discomfort has really been much closer to annoying than excruciating. Granted, I was taking Percocet every four hours with an occasional shot of Dilaudid for four days, but even so I expected the pain to be much worse.

I’m glad it wasn’t.

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Impressionistic rendering of health insurers' profits

The new rules on health coverage are causing fibrillation in the microscopic hearts of health insurance giants Cigna, Aetna and United Health.

Apparently, stipulations in the new federal health law—including prohibitions on dropping policyholders when they get sick and refusing insurance to kids with preexisting conditions—will adversely affect insurers’ “medical loss ratio,” the percentage of each premium dollar pried out of insurers’ clutches to be used for actual healthcare.

A recent story by Robert T. Garrett of the Dallas Morning News puts it all in perspective.

In the article, former Aetna and Cigna executive Wendell Potter tells an illustrative tale of just how important this medical loss ratio is. According to Potter, Aetna had a problem a “few years ago when it announced that its medical loss ratio had inched up from slightly above 78 percent to a little bit more than 79 percent. The investors were so upset about that incremental change, the stock price dropped 20 percent on that one single day.”

Over the last 15 years, the industry has managed to drop, deny, lie, steal and cheat their healthcare costs down 15%, causing jubilation in the boardrooms, and industry profits to inflate like an engorged tick.

Having to divert money from the important things–executive compensation, bonuses and dividends–to things like medicine and healing has filled industry CEOs with dread; Wall Street does not like trimmer ticks.

*

I must be going deaf and blind. I know there are hordes of angry Americans out in the streets, carrying pitchforks and torches, screaming at the top of their lungs for an end to a healthcare system that determines its success by how little healthcare it delivers… I just can’t see them.

 

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Like hyenas culling an injured wildebeest from the herd, health insurers are ganging up on single policyholders—the ones without group clout or protection—and demanding premium increases large enough to cause cardiac arrest in their healthiest policyholders.

That the industry continues to gouge Americans is not news. But doing it so boldly during a time when people can barely afford to stay in their homes, let alone pay their current health insurance premiums, would seem to be playing unnecessarily with fire. It could actually stir up grass roots passions, and revive the currently moribund national health insurance debate–something I’m sure the health insurance suits would rather put off for another millennium or two.

Where’s their concern about public opinion?  WellPoint / Anthem demanding a 39% increase in Californians’ premiums after boasting record profits in 2009 should have approximately the same marketing value as Toyota choosing “Caveat Emptor” as a new advertising slogan.

This kind of behavior pisses people off, and pissed-off people are unpredictable people. They just might start thinking, “hey, if this industry is unethical enough to do this to us during one of the worst recessions in history, maybe they were lying to us about Obamacare “death panels,” socialism and National Health waiting lines in England. Maybe this Public Option thing isn’t such a bad idea after all.”

Could it be that WellPoint and the others believe they have so completely torpedoed health insurance reform with their misleading TV spots and astro-turf protests that they feel public opinion is no longer something to worry about?

I’m betting they’re wrong. Though the insurers still have plenty of legislators in their pockets, politicians do need votes. When policyholders in Maine, Oregon, Kansas and California start having to choose between eating and health insurance—they’ll want someone to blame.

These premium hikes should remind voters who the true boogeyman is in our health care crisis. Politician friends of WellPoint / Anthem and the others had better start looking for new friends — if they’d like to stay in office, that is.

For a look at the health care reform debate set to music, check out my video “All-American Suckers”

When a lawmaker is found to have a few thousand ill-gained bucks stashed behind packages of Ore-Ida hash browns and a half-eaten pint of Cherry Garcia in his freezer at home, we call it bribery.”

When Democratic lawmakers take money from private health insurers, and then proceed to fight their own party, president and constituents by trying to undermine, hijack, maim, and vaporize the only hope we have of making American health care more Hippocratic than plutocratic – we call it “politics.”

Of course, this is nothing new.  Politicians throughout history have been on the take in varying degrees of legality.  From 54 B.C – when every single candidate for Roman consulship was indicted on charges of bribery – to Boss Tweed’s Tammany Machine, to Representative Jefferson’s Frigidaire, the violation of public trust in exchange for money has been the engorged leech on the body politic.  But as the cost of modern American campaigning continues to soar (and the idea of meaningful campaign finance reform has become a quaint artifact of a bygone era), the once discreet tit-for-tat collusion between “special interests” and our leaders has oozed from the smoke-filled back rooms of yesteryear into a full-blown yard sale of political influence and favor.  By now, selling votes to the highest corporate bidder is no doubt a rider on American legislators’ oaths of office.

But, as commonplace as the ownership of our elected officials has become, the positions on the “public option” taken by the House Blue Dogs and centrist-conservative Democrats in the Senate are – even by today’s standards – nauseating in their blatant toadyism, shining the brightest spotlight yet on the Turkish bazaar we call the United States Government.

One would think the numbers alone would be enough to scare the Blue Dogs and Democratic Senators like Ben Nelson, Mary Landrieu, Evan Bayh and Blanche Lincoln into line.  Recent polls show that most Americans continue to believe a strong, non-triggered, public option is a good idea.  Among Democrats and health professionals the pro-public option numbers are overwhelming.  One can only imagine how Democratic doctors feel about it.  Yet, these lawmakers have tried to crush the public option at every turn.  To be fair, a few of these centrist-conservatives may have a little honest-though-misguided ideology prompting their party apostasy, and it’s true that Landrieu will soon be facing a tough re-election in her conservative Louisiana.  But she needs Democratic votes and the party’s good will.  She is – despite all recent evidence to the contrary – a Democrat.  Civil rights groups have been airing TV ads pressing her on the issue, and unions are following suit with letter-writing campaigns.  If she and her fellow flies in the ointment continue in their current direction, the Mark of Cain shall be upon them, friendless in the party and at the polls.

What could possibly make these folks behave in such a seemingly politically self-destructive way?  What could make them side with the universally loathed health insurance industry – the industry that views their customers as medicine-grubbing pests?  Will the half-million Landrieu’s gotten from insurance and health sectors, the million Nelson has received, the million and a half tossed to Bayh, and the nearly two million heaped upon Lincoln buy enough TV time to overcome the party alienation and livid voters created by their obstruction?  They must think so.

Then, there’s the morality – the decency of it all.  Thanks to Rep. Alan Grayson and a recent Harvard study (http://www.ajph.org/first_look.shtml), it is now widely known that 45,000 Americans per year die because of lack of health insurance.  That’s die – as in spouses and children left to grieve, or parents left to endure what psychologists cite as the most profoundly excruciating experience life can dish out to a human psyche.  Why?  Because they could not afford–or were denied access to–the care that might have detected that tiny tumor long before it became inoperable, or that irregular heartbeat that eventually killed an otherwise healthy little kid.  And, if 45,000 of us are dying of “lack of insurance,” and related causes, like suddenly discovered “preexisting conditions” and “denied experimental procedures,” how many of us are being blinded and crippled by the same conditions?

For many voters, this takes the public option issue out of the political realm and plants it firmly in personal, deeply-felt territory.  The Blue Dogs’ in-boxes must be exploding with emails asking, “Are you really going to sit there with an American flag pinned to your lapel while you condemn Americans to death for being sick or poor?”  “Yes,” is their implied answer, as they continue to sideswipe hope into a ditch.  Surely, they must realize all the television time in the world will not erase the sense of betrayal these voters are feeling, or the blame these lawmakers will share if the public option goes up in smoke or turns out to be a combination of the spineless, industry-friendly versions currently being spewed by the Senate and the House.

Maybe they just don’t get it.  Maybe they’re looking at the public option as just another bit of politics, to be wheeled and dealt with as their corporate sponsors see fit.  It wouldn’t be too surprising.  When “Independent” Joe Lieberman announced his plan to join the planned Republican filibuster, the TV news reporter explained matter-of-factly that Senator Lieberman has a number of private health insurers based in his state – as if it’s understood that a senator-host to large insurance corporations is somehow required to hold American’s health hostage to please his guests.

Or maybe there’s something larger going on here.   For the first time in a long time, our government is considering a move that could deeply affect the bottom line of one of the wealthiest industries in the world.  CEOs in every sector must be watching the public option debate like slave owners fearing an uprising.  The Corporate Word has gone out to lawmakers everywhere: “Hey, if we can’t trust you on this health care thing, what’s gonna happen when my defense, energy, finance or transportation bill comes up before you guys?  Are you gonna go Grayson and Kucinich on us?”

The implied threat of having his corporate spigots not only turned off, but also opened wide for his more “trustworthy” opponent in the next election, puts the poodle right back in the yard; that is, if the poodle was even thinking about jumping the fence in the first place.

Obama is wrong when he downplays the public option as a mere “sliver” of overall health care reform.  It is the centerpiece, and he knows it.  A government-run insurance option is the only way – short of a politically unattainable single-payer, European-type system – to help make health care more affordable and accessible to Americans.  But more importantly, it has become a crucible in American politics.  The implementation of a real public option will show that reports of our democracy’s demise have been somewhat premature.

Now that we’ve seen congress’ embarrassing, whittled down versions of the plan, it is clear Obama’s influence and veto power – along with lawmakers who actually use their office to help Americans – are our last and only hope.  Will the oligarchy emerge triumphant, once again?   Or will Obama use the power we gave him and start effecting real change, making the adoption of the public option an historic bellwether that saved our lives and our government – when the common good went up against some of the wealthiest, most powerful corporations in the world, and despite their propaganda, their staged “grassroots” protests, their TV ads and the tireless efforts of their very own politicians – the American people won.

For a look at political bribery and health care–set to music (sample): “All-American Suckers”

Dear Max,

I know it’s been a while since we last spoke, but that doesn’t mean I haven’t been thinking about you.  In fact, I’ve been thinking about you a lot lately.

Max, I’m gonna get straight to the point.  Lately, there’s been a lot of ugly talk connecting your attempt to torpedo the public option with the millions of dollars you’ve gotten from health insurance honchos.

People see conspiracy in everything these days; have they never heard of coincidence?

But, you’ve got to admit; to those who don’t know the honorable Max Baucus, as I do, your position does emit a certain aroma.  Frankly, it makes you look a lot like one of those corporate poodles we used to point and laugh at in the congressional cafeteria.  Now, I know you called a “moratorium” on any further health sector donations to the Max Baucus campaign, and that was good – but a wee bit late, I’m afraid.  People recognize four million over five years can buy a shitload of influence, and your recent attitude toward the public option and health care reform in general is scorching many a nostril.

As you know, Montanans are among the least health insurance-covered folks in the country.  Hell, out of sheer desperation, Republicans in your state are calling for the public option.  So I’m sure you’re aware that your high profile and adamant objection to it could make life very difficult for you during your next campaign, no matter how much TV time your health industry money buys.

The national scene is even worse. Your party’s leadership and an overwhelming majority of Democratic voters are ape-wild for this option.  Unless you count the remedial class on the other side of the aisle, you and the Blue Doggerels sit alone like lepers at a fashion show.  And now with Obama’s pledge to keep his plan deficit neutral, the rug has been pulled out from the only almost-credible reason you had for objecting to the public option in the first place.

In fact, I was hoping you might have used Obama’s speech as an aha moment – an opportunity to publicly change your mind.  Instead, a few days later you released your committee’s counter proposal, which if enacted would not only put the public option out to pasture and squeeze the middle class like an empty tube of toothpaste, but would also do for private health insurers what HIV did for the latex industry.

Hell, I’m even starting to think something’s up, Max- ha ha.

All quid pro quo aside, guy, you and I both know a government-run health insurance option is the only way to get your pals at Aetna and United to stop the wholesale ripping-off and selective killing and maiming of our countrymen.  The Max I know, cares about stuff like this.  And though you benefit mightily from their dollars, your innate decency must be wreaking havoc on your sleep and that ulcer of yours.

But, don’t despair, my friend; I’ve got a plan.

Remember back in 2002 when you rented your support to the financial sector, and helped make filing personal bankruptcy for Americans more difficult than getting gold at the Olympics?  Or when you voted to lift what was left of those pesky regulations on Wall Street?

How much were you paid for your “help?”  Four million over ten years.  Ten years, Max!  You gave them the green light to own people for life, and greased the way for the investment boys to reap a windfall while destroying our economy in the bargain.  And all you got was a crummy four hundred thousand a year!

You were severely chumped, my friend, and you know it.

And, how about the NRA?  You vote to give Americans their constitutionally guaranteed right to shoot armor-piercing rounds at deer and Kevlar-wearing javelinas, and what do you get in return?  A lousy fifteen grand.  This is madness, kiddo.  These guys are worth zillions!

As the chairman of the Senate Finance Committee, there are plenty of industries champing at the bit to develop a “stronger relationship” with you.  Energy, telecommunications, defense, transportation, your old pals in finance – the list is endless.  Sure, some of your votes on your new clients’ behalf may stir up a little controversy from time to time, but nothing like this public option landmine your health “friends” have placed neatly in your path.

You’ve given them enough already.  It’s time to scrape them off of your wingtips, and open yourself up to some real dough.

As your folks used to say, “You can have your cake and eat it too.”

Just call a press conference and say something like, “Upon further study, I now believe an efficient, government-run health insurance choice (don’t say “public option”) can be cost-effective, and is in the best interest of Americans.”

With those few words, Mercenary Max becomes a statesman.  You might even get Olympia Snow to go along with you, who knows?

Sure, there will be many nasty calls from health care lobbyists, but what do you care?  You don’t need them. As chairman of the Senate Finance Committee, you’re alpha-poodle.

Anyhow, I hope I didn’t come on too strong with this thing.  And I’m sure you know that I’m only looking out for your welfare, old chum.  By the way, I know you’re a busy boy of late, but if you’re not doing anything tonight, stop by the house. We’re having a little get-together with some friends from Exxon.  I’m sure they’d be happy to see you.

Take care,

Russ Buchanan