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December 2008 posts


The new hematologist seems great.   She's got an awesome personality, she's funny and warm.  It's actually more funny though - when I went in there - I am brand new never met the woman - and she says:

"You didn't have a gastric bypass or anything, right?"

LMFAO.  The nurse is all, "Read the chart."

She looked half-mortified for a moment. 

Apparently young, otherwise 'healthy' younger women make up a large portion of a hematologists caseload.  Every hematologist I meet tells me stories about people who've had gastric bypass and gotten sick.

My first hematologist basically inferred that I chose to "do this to myself" (have the bypass and get sick) when I first went with my blood level at 23.  Initially I was pissed when I heard that.  But.  I got over it.


My blood draw from the end of November was decent. 

My anemia was borderline, not so bad at all, my ferritin (long term iron stores) are always the toilet, but HCT and HGB were low normal, which is where it is all the time, even with IV iron treatment.

Everything else was actually fine aside from my low Vitamin D.  B12 was normal.  Protein normal, nothing out of range, and a full panel was drawn, as I asked - begged for.  Nothing in the panel was out of range that SHE saw.  Good.  I did not get a copy.  But, it was old.

(Though, I am going to make for DAMN SURE that the bariatric doctor I see on Friday checks every. little. detail. since I am looking for a trigger for my neurological problems.  There are many trace elements than can be tested.)

*Because, right after I wrote this?  I had a complex partial seizure.

We took a new draw, of course, and set up a iron infusion for next week.

Most Expensive Medical Treatments - Bariatric Surgery

As I sit here on December 31st, rolling over into a new health insurance plan with a fresh new deductible tomorrow, I am thinking dollars.  Last January 2008, I was inpatient at Beth Israel Medical Center after my first Grand Mal Seizure - maxing out our deductible in the first week of the month. I think it was $1,500 for that particular plan, plus 10%. Going to the doctor gets expensive around here.  (My blood draw today was $35.00)  I believe our new plan is somewhat less, because we're anticipating my health needs, but the weekly costs have got to be higher.


    Painfully Thin

"More than one-third of U.S. adults are obese, and 207,000 of them had bariatric surgery last year to reduce the size of their stomachs, a 100% increase since 1999. For people who are 100 pounds or more overweight, stomach stapling, gastric banding, or stomach bypass operations can be life-altering, and seemingly well worth the $30,000 average cost. But the risk of complications is high, many patients regain the weight, and one study estimates that it can take five to 10 years to recoup the costs through savings on drugs and other interventions."

The study follows:

Return on Investment for Bariatric Surgery

Eric A. Finkelstein, PhD, MHA; and Derek S. Brown, PhD

In this issue of the Journal, Crémieux and colleagues1 report on an analysis of the return on investment for bariatric surgery. The authors used health insurance claims data for more than 3600 patients who underwent a bariatric procedure and for a matched control group to estimate the length of time required before the procedure breaks even (return on investment period) from the insurer’s perspective. The authors find that procedure-related  costs are fully recovered after 53 months. For laparoscopic procedures, the estimated return on investment is reduced to 25 months. This article makes a nice contribution to the still sparse literature on the economics of bariatric surgery. However, 2 important and subtle points require further discussion.

First, the return on investment estimates are driven primarily by rising costs in their matched control group rather than by a reduction in costs from the bariatric sample. When the authors refer to “savings,” they are actually referring to the difference in costs between the surgery and control groups in the postsurgery period. Consider the savings that the authors report for month 19 and beyond. These are forecast to be $545 per month for the overall bariatric population and $926 per month for the laparoscopic-only sample. But in Table 1 of their article, the authors report costs for 5 months before surgery of $2443, or roughly $489 per month. Because the monthly savings figures exceed the presurgery mean costs, and dramatically so for the laparoscopic sample, the return on investment estimates seem to result from substantially higher cost increases in the control group relative to the surgery group in the postsurgery period.

Second, because of data limitations, the authors’ return on investment estimates are based on the assumption that the differential in costs between the 2 groups (ie, the savings) is constant after month 19 for the overall sample and after month 13 for the laparoscopic sample. Whether or not this assumption holds in reality will only be answered once additional follow-up data become available. If this assumption is not met or if another control group has a different cost profile, then the return on investment could be substantially increased.

To further highlight these points, the Figure herein (based on claims data from Medstat’s proprietary MarketScan database; Thomson Reuters, Ann Arbor, Michigan) provides a graphical depiction of the cost implications of bariatric surgery. The Figure shows insurance payments before and after gastric bypass surgery (payments for the month of surgery are removed because they make it more difficult to see the trends).

In the roughly 54 months after the procedure takes place (the duration that the data provide reliable estimates for), the Figure confirms that costs in the postsurgery period seem to be no less than those in the presurgery period. Although gastric bypass has been shown to reduce weight and to improve comorbidities, there are several reasons why costs are not reduced. First, we found that a few individuals experienced severe adverse events that required lengthy and expensive readmissions (EAF and DSB, unpublished data, 2008). Second, other recipients had high costs because the procedure was so successful. In several cases, individuals lost so much weight that they required subsequent surgical procedures to have excess skin removed. There was even evidence of hip and knee replacements that likely resulted from formerly obese individuals’ becoming active and realizing that the damage their excess weight caused on their joints could only be fixed through additional surgical procedures, operations that would not have been required if not for the successful weight loss resulting from the procedure. The Figure also reveals substantial variability in the monthly cost estimates, suggesting that the assumption of constant savings after month 19 (or month 13) is unlikely to hold in reality. It would be interesting to see a similar figure of the data by Crémieux et al showing monthly costs for the surgery and control samples to confirm that rising costs in the control sample are generating their return on investment estimates.

As a parting note, we would like to add some caution for insurers and other payers. If coverage decisions are predicated on achieving returns on investment as short as those presented by Crémieux et al—and an internal ex post analysis produces results that are not as favorable because a within sample analysis akin to that in the Figure is conducted or because some of the assumptions in the study by Crémieux and colleagues do not materialize—then it is likely that the decision to cover the procedure will be reversed. As a result, those who could truly benefit from the procedure would not be able to do so without paying 100% of the costs out-of-pocket. For this reason, we have counseled bariatric device manufacturers, insurers, employers, and others against focusing on return on investment as a means for making coverage decisions for bariatric procedures.

Bariatric procedures should not be held to a different standard than other medical or surgical interventions, regardless of what the return on investment might actually be. For example, no one asks to see a positive return on investment for treatment of cancer, heart disease, or diabetes mellitus, yet treatments for these conditions are covered in almost every health plan. The coverage decision should be based on whether or not the intervention can improve the condition in a cost-effective manner compared with other potential treatments. Making this determination requires information on efficacy and cost-effectiveness relative to other treatment options, but cost savings are not part of the calculus, nor should they be. To this point, when we presented the Figure herein to the chief medical officer of a private health plan, he responded that the results were as expected but that he would continue to cover bariatric procedures (although only at “Centers of Excellence”) because they represent the best available alternative for treating individuals with morbid obesity (oral communication, September 2006). We would encourage others to make a similar assessment to determine whether or not coverage is appropriate for their population, regardless of what the return on investment might actually be.

1. Crémieux PY, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M. A study on the economic effects of bariatric surgery. Am J Manag Care. 2008;14(9):589-596.

baby, it's cold outside.




We celebrated part of NY Eve by driving to the hospital for my hematology intake.  We spun out in our own driveway, and I nearly lost my mind.  But.  I wasn't canceling.  I can't miss any. more. appointments.   There was ZERO visibilty on the way there - I have never NOT seen the road like that.  WHEE.

Now... I'll brb with more in a moment.

Out of the mouth of a man.

"Those bars, are freaking awesome."

That's his review.

Supreme Protein Carb Conscious Carmel Nut Chocolate Snack Bar - Box of 9
Here's mine from a long time ago.  (This was of the 3+ ounce size bars.  Now they're available as mini-bars, 1.8 ounces.  Super.

Yes, I said something along the lines of, "I told you so!" Nobody listens to me.  Actually I said, if you read the blog you'd know that, but, said, "I can't, I'm scared to read the blog."

So I get a phone call...

From the hospital:

"Hi, it's such and such, calling to see if you'd like to reschedule your hematology appointment?"

    "Yes, absolutely."

"Well, let me see when the next available appointment is...well it looks like we have something tomorrow, but you wouldn't want that, it's New Years' Eve."

"Wait, really, I'll take it.  Can you hold it for me?  Give me an hour, I will call you back."



What on earth are we supposed to do on New Years Eve anyway?  Party?  Heh heh.  I'll be drunk on iron.  Woot-woot.


Photo credit:  http://www.flickr.com/photos/euthman/2274260085/

Reversal of Type 2 Diabetes + Cardio Improvements after WLS in teens.

Study:  http://pediatrics.aappublications.org/cgi/content/abstract/123/1/214

OBJECTIVES. Type 2 diabetes mellitus is associated with obesity, dyslipidemia, and hypertension, all well-known risk factors for cardiovascular disease. Surgical weight loss has resulted in a marked reduction of these risk factors in adults. We hypothesized that gastric bypass would improve parameters of metabolic dysfunction and cardiovascular risk in adolescents with type 2 diabetes mellitus.

PATIENTS AND METHODS. Eleven adolescents who underwent Roux-en-Y gastric bypass at 5 centers were included. Anthropometric, hemodynamic, and biochemical measures and surgical complications were analyzed. Similar measures from 67 adolescents with type 2 diabetes mellitus who were treated medically for 1 year were also analyzed.

RESULTS. Adolescents who underwent Roux-en-Y gastric bypass were extremely obese (mean BMI of 50 ± 5.9 kg/m2) with numerous cardiovascular risk factors. After surgery there was evidence of remission of type 2 diabetes mellitus in all but 1 patient. Significant improvements in BMI (–34%), fasting blood glucose (–41%), fasting insulin concentrations (–81%), hemoglobin A1c levels (7.3%–5.6%), and insulin sensitivity were also seen. There were significant improvements in serum lipid levels and blood pressure. In comparison, adolescents with type 2 diabetes mellitus who were followed during 1 year of medical treatment demonstrated stable body weight (baseline BMI: 35 ± 7.3 kg/m2; 1-year BMI: 34.9 ± 7.2 kg/m2) and no significant change in blood pressure or in diabetic medication use. Medically managed patients had significantly improved hemoglobin A1c levels over 1 year (baseline: 7.85% ± 2.3%; 1 year: 7.1% ± 2%).

CONCLUSIONS. Extremely obese diabetic adolescents experience significant weight loss and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass. Improvements in insulin resistance, β-cell function, and cardiovascular risk factors support Roux-en-Y gastric bypass as an intervention that improves the health of these adolescents. Although the long-term efficacy of Roux-en-Y gastric bypass is not known, these findings suggest that Roux-en-Y gastric bypass is an effective option for the treatment of extremely obese adolescents with type 2 diabetes mellitus.

ISS Oh Yeah RTD a la MM Cappuccino.

I poured a bottle of ISS Oh Yeah RTD Protein in my frother part of the DeLonghi.  It works well as a vanilla cappuccino.  Score. I suppose this gives back some nutrition to my daily habit. The ISS Oh Yeah in a couple cappuccinos over the day will add a serious protein punch, since I drink them anyway.  It's not entirely the same, no.  But.  You know.

Go! Diva.

My eleven year old daughter had a couple of friends over the other afternoon.  They were raiding my fridge for a snack. 

"Mom, is it okay if I give my friends something to eat, because they didn't have much lunch?"

I had warmed up an entire pack of "Whole Grain" Perdue Chicken Nuggets  (this makes them more parent-worthy) and they snarfed them down pretty quickly - apparently - someone didn't grab some and was still hungry.

"Yeah, help yourself, there's fruit in there, and this over here, and whatever in the cabinet."

I come out a bit later, and note that she didn't really take anything out. 

"What did the girls end up having?"

"Oh, just those 'Go! Diva!" Strawberries in there."

Go!  Diva!  You know.  For Divas. 

Picture 11

Dr. Garth Davis, The Expert's Guide to Weight-Loss Surgery

Garth Davis
From Amazon:

"Today, an estimated forty-four million Americans suffer from obesity. For most, the traditional prescription of “eat less, exercise more” simply doesn’t work. Thankfully, there is another option— a proven path to reclaiming quality of life, to curing diabetes and other weight-related diseases, and to living without the constant emotional and physical struggles that being obese entails.

This option is weight loss surgery. Having performed more than one thousand weight loss surgeries in his career, Dr. Garth Davis—star of the hit TLC series Big Medicine—knows, firsthand, the surgery’s ability to transform lives. In The Expert’s Guide to Weight Loss Surgery, Dr. Davis combines cutting-edge medical advice and compassionate guidance into what promises to be the definitive handbook on the topic.

The book features a user-friendly breakdown of the various types of weight loss surgeries available today (gastric bypass vs. adjustable gastric banding vs. sleeve gastrectomy); a no-nonsense guide to finding the right doctor; and words of wisdom from dozens of patients who have undergone WLS. Most important, because weight loss surgery alters the digestive tract’s size and structure, Dr. Davis lays out a complete diet and exercise plan to help ensure that readers’ success is long term. This book should be required reading for anyone seeking a permanent obesity cure.

About the Author Garth Davis, MD, is a bariatric surgeon and star of TLC’s Big Medicine. He is medical director of the Weight Management Center Program at the Methodist Hospital in Houston, Texas, and is a frequent speaker and guest lecturer across the country.

It must be done.

Last night, my mother pulls out one of her presents for XMAS to show me an app on it.  A KOI pond on her IPOD touch.  I play with it, I call it sushi.  She's showing me "how it works." 

She did not realize, I had one.  It's one of the items I was hoping would turn up soon.  I am missing THAT too.  If I had not HAD the wedding rings on my finger when I went to to the OH event when the house move happened, I might have assumed the movers ripped us off, but they had all sorts of insurance we hired a big company.  The items went missing just after we moved, when I got back.  The phone was used for a month, for "internet."  $280.00 worth.


So the unrelated reason for my post? 

I am hellbent on buying a belated Christmas present.  I've got Wal*Mart and Amazon all up in my email telling me about their post-holiday sales and I spent no money  (nada, not one cent!) on Bob or I for Christmas this year, so HERE IT IS!


I want one that SUCKS, HARD.  (Here come the porn Googlers.)  Because - this stupid one is broken to crap.  It's brand new, and broken.  Can you find my review at Wal*Mart?

PS.  Do you know there is a CASH FOR GOLD kiosk at the mall now?  Can you fucking believe it?  Is it any wonder WHY?  ANY?

Meme for you you.

Occupation: Blog Mistress.  Wah-pssh!  Otherwise, not so much.

Relationship status:  Married long time.  Ten years this coming August.  We were actually looking to plan a v-a-c-a-t-i-o-n for this occasion.  Where to?  It's got to be relatively simple, bathing-suit free (not like, NUDE, no!) and no outdoor sport on ATV's with Beth driving.  ;)

What did you eat today?

Food Item Servings Cals Fat Cholest Sodium Carbs Sugars Fiber Protein  
Silk Unsweetened Soymilk
0.25 20 1g 0mg 21mg 1g 0g 0g 2g x
1.00 2 0g 0mg 0mg 0g 0g 0g 0g x
Atkins Endulge Chocolate Coconut Bar
0.50 90 6g 0mg 38mg 10g 1g 4g 2g x
Trader Joe's Brown Rice Sushi
1.50 210 5g 0mg 795mg 41g 3g 9g 6g x
Boar's Head Picante Sharp Provolone Cheese
1.00 100 8g 25mg 250mg 1g 0g 0g 7g x
Fresh Mozzarella Mini Balls
2.00 160 12g 0mg 0mg 0g 0g 0g 10g x
Trader Joe's White Bean And Basil Hummus
1.00 60 5g 0mg 135mg 4g 0g 2g 2g x
Trader Joe's Mixed Grilled Vegetable Bruschetta
1.00 60 6g 0mg 150mg 2g 1g 0g 0g x
Papa Gino's Large Cheese Pizza, One Slice
0.75 168 5g 11mg 427mg 24g 1g 1g 8g x
Silk Unsweetened Soymilk 1.00 80 4g 0mg 85mg 4g 1g 1g 7g x
Ghiardelli Double Chocolate Brownie 0.25 48 1g 0mg 30mg 7g 5g 0g 0g x
Peanut Butter Fudge (never Fail) 1.00 96 4g 3mg 72mg 15g 13g 1g 2g x
Fitness Minutes Calories Burned Distance Heart Rate
Add your physical activity/exercise for December 28th, 2008!
Click totals for charts! Totals: 1,094 56g 39mg 2,003mg 108g 25g 19g 46g  
% of your daily value 76.47% 86.35% 12.83% 83.44% 35.92% n/a n/a 91.6%  
    Cals Fat Cholest Sodium Carbs Sugars Fiber Protein  

What do you never eat?
ALL FORMS OF seafood, typically, although whilst in Texas I tried real sushi and liked it.  If I do not know WHAT IN THE HELL IT IS - I will eat it.  And, if it happens to be tasty - mo bettah!

Complete this sentence: In my refrigerator, you can always find...
FOR ME?  Silk Unsweetened Soy Milk, varieties of cheese, turkey breast, dark chocolate, butter, bagged salad,  low carb tortillas or wraps/lavash/etc.

What is your favorite kitchen item?
My fancy knife from foodbuzz!

Where do you eat out most frequently?
HA.  That's funny.  You're kidding, right?  We don't go OUT, like EVER.  I haven't been OUT TO DINNER, like WITH MY SPOUSE - in months.  But, to answer the question?  Drive-Thru Baby!  I get a single burger - throw the bread out the window and eat it with the condiments.  :)  200 calories-ish and no guilt.

World ends tomorrow. What would you like for your last meal?
As the end is near, I want to be face down in a half gallon of Breyers Mint Chocolate Chip.

Top Twenty Unhealthiest Drinks in America

Men's Health (my not-so-secret-favorite magazine) compiles these lists to make people like me CRINGE WITH SICK DELIGHT!  Thank you Men's Health!  How many of these have YOU chugged, slugged and burped up?  I am clicking through trying to figure it out.  I'm on a roll so far - but it may be that I've been an altered freak so long - this stuff is nowhere near my radar:

Worst Hot Coffee - Starbucks Venti 2% Peppermint White Chocolate Mocha

660 calories
22 g fat (14 g saturated)
95 g sugar

Heath® Shake Large

Nutrition Facts
Serving Size 1 Serving (32 fl.oz)

Amount Per Serving
Calories 2310 Calories from Fat 970
% Daily Value*
Total Fat 108g 166%
Saturated Fat 64g 320%
Trans Fat 2.5g
Cholesterol 295mg 98%
Sodium 1560mg 65%
Total Carbohydrates 303g 101%
Dietary Fiber 2g 8%
Sugar 266g
Protein 35g
Vitamin A 60%
Vitamin C 15%
Calcium 120%
Iron 6%
Calories per gram:
Fat 9 Carbohydrate 4 Protein 4
*Percent Daily Value based on a 2,000 calorie diet. Your daily values may be different depending on your calorie needs.
2,000 2,500
Total Fat Less than 65g 80g
Saturated Fat Less than 20g 25g
Cholesterol   Less than    300mg 300mg
Sodium Less than 2,400mg      2,400mg  
Total Carbohydrate 300g 375g
Dietary Fiber 25g 30g
Allergy Data
Contains: Yes No
Tree Nuts  
Crustaceans include, crab, crayfish, lobster, and shrimp.

 reduced fat milk, heath bar crunch ice cream (cream, nonfat milk, caramel ribbon (corn syrup, sweetened condensed whole milk (milk, sugar), water, high fructose corn syrup, butter (cream, salt), propylene glycol, sodium alginate, salt, natural and artificial vanilla flavors, potassium sorbate (preservative), soy lecithin, annatto color, sodium bicarbonate, propyl paraben (preservative)) , heath® bar candy pieces [milk chocolate (sugar, cocoa butter, chocolate, nonfat milk, milk fat, lactose, soy lecithin (an emulsifier), salt, and vanillin (an artificial flavoring)), sugar, palm oil, dairy butter (milk), almonds, salt, artificial flavoring, and soy lecithin], sugar, corn syrup, toffee base (sweetened condensed whole milk, high fructose corn syrup, corn syrup, water, natural flavor, disodium phosphate, and salt), whey powder, cellulose gum, mono and diglycerides, guar gum, carrageenan, polysorbate 80), fudge topping (corn syrup, sugar, water, hydrogenated coconut oil, nonfat milk, cocoa (treated with alkali), modified corn starch, salt, sodium bicarbonate, disodium phosphate, potassium sorbate (a preservative), natural and artificial flavors, soy lecithin), jamoca ice cream (cream, nonfat milk, sugar, corn syrup, jamoca extract (coffee extract, sugar, potassium sorbate and methyl paraben (as preservatives)) whey, caramel color, cellulose gum, mono and diglycerides, carrageenan, polysorbate 80, carob bean gum, guar gum), caramel praline topping (corn syrup, sweetened condensed whole mil, water, sugar, modified food starch, butter, salt, propylene glycol, natural and artificial flavor, sodium citrate, xanthan gum, lecithin, potassium sorbate and propyl paraben as preservatives), hershey’s® heath® milk chocolate english toffee (milk chocolate (sugar, cocoa butter, chocolate, nonfat milk, milk fat, lactose, soy lecithin [an emulsifier], salt, and vanillin [an artificial flavoring]), sugar, palm oil, dairy butter (milk), almonds, salt, artificial flavoring, and soy lecithin), whipped cream (whipped cream (cream, milk, sugar, dextrose, nonfat dry milk, artificial flavor, mono & diglycerides, carrageenan, mixed tocopherols (vitamin e), to protect flavor, propellant: nitrous oxide).

A WLS Holiday Peeve. But, actually, it's all the time.

This post at a body-positive blog got me thinking about something that makes me a little twitchy. 

Disclaimer:  I write about a weight loss surgery issues, and I write A LOT food products that are aimed at the weight loss community.  But, we use them because we are ALTERED and most of us sort of have to find creative ways to work with the new guts we have.  WHICH, brings me to my holiday peeve. 

Continue reading "A WLS Holiday Peeve. But, actually, it's all the time." »

Weird year in review.

Last night I thought of a post idea while standing in the shower.  A Year In Review!  Because, well, I did not send any paper cards in the mail, partially because I was "going green," partially because I am totally unorganized, and because frankly, we do not celebrate a traditional Christmas.  Yeah, you should know this already, but I am not a church-going Christian.  I am going to hell.  I have not stepped toe into a church for the purpose other than a wedding or baptism since, um, 1994? 

We are totally in it for the presents and the goodies, we're in it for the cookies.  How can you not?  People, I ate a fucking OREO TRUFFLE last night.  Woot.  Latkes have a real draw too.   In fact, I just want all holiday themed and inspired goodies and giving gifts.

But, then I realized 2008 really sucked in many ways, but it has forced me to get creative too, as I started to write:

January 2008
Started off with Bob's reconstructive plastic surgery, lots of gooey infection, Beth's grand mal seizure, and a ten day hospital stay, then Beth lost her part time job.  Beth decides to blog as a means of a part time "job."

February 2008
Beth went out ONCE to get groceries, skidded on the ice going 15 mph in her very large truck and totaled it.  No more truck.  Insurance papers are filed.

March 2008
Lots of hypoglycemia.

April 2008
Beth is clear of seizures!  She buys a car in her OWN NAME!  She's good to go!  Brings it home.  Goes to bed.  Has a grand mal seizure in her sleep.  Cannot drive for another six months.

May 2008

June 2008
Beth tries Click.  History is made.  We have a new baby cousin.

July 2008
Bob's + Beth's plastic surgeon is fired for working under the influence.  Bob looks down at his crooked scars, goes into deep denial.

August 2008
Beth has a trial with a Continuous Glucose Monitor = FAIL.  Dog had puppies!  Beth signs on to go with Obesity Help to some events, Philadelphia, Los Angeles, and later, San Ramon.

September 2008
Preparing to move house.  Celebrate is tasted!  The Walk From Obesity.  My baby is told to shut up at a car dealership.

October 2008
Beth goes to Texas for the WLS Channel, Philly for OH and LA for OH.  Move houses about 30 minutes south, while Beth is away! 

November 2008
Another seizure.  Six more months stuck in the house from this point.

December 2008
Beth goes to San Ramon, CA for OH. 

2009 promises to be full of, promise.  I know it.  I am starting it fresh with a doctor visit on the 2nd.  If I can get the seizures out of the way, we can get things DONE around here, know what I'm saying?!  I just need to GET the kids TO PLACES.  That is a serious undertaking - and we can't get it done at this point.  I can't expect HIM to get the kids anywhere, if he's at work. 

I need a housewife.  Maybe that's the answer.  I can do everything ELSE BUT...