Recent Posts
Topic: RE: What Happened To Me? (Alcoholism)
I was truthful in my answers but I don't remember when I did his questionairre there being anything about addiction in it. My paperwork was done in 2005 I believe so he may not have had anything in there about it then. I know I was truthful in my psych eval and the psych did not consider it an addiction because it was so short-lived and I quit immediatly after I stopped working.
But researching online I have found that many people end up with severe addictions (sex/drugs/alcohol) who did not have a serious addiction pre-op. Aside from the obvious food-addiction.
I am doing so much better and have not even thought about drinking once since that night I quit. I think I am going to be fine. The depression over what happened is just about gone and things are looking so much better.
But researching online I have found that many people end up with severe addictions (sex/drugs/alcohol) who did not have a serious addiction pre-op. Aside from the obvious food-addiction.
I am doing so much better and have not even thought about drinking once since that night I quit. I think I am going to be fine. The depression over what happened is just about gone and things are looking so much better.
Weight 5 Years Ago (2002): 275.0 -- 50.3 BMI
Pre-Consult (7/05/07): 400.12 pounds -- 73.2 BMI
Surgery Day (8/15/07): 369.8 -- 67.6 BMI
Past Weight (09/30/08): 205.0 -- 37.5 BMI
Current Weight (01/08/09): 190.0 -- 34.7 BMI
Check Out My Profile for Pics & Blog
Pre-Consult (7/05/07): 400.12 pounds -- 73.2 BMI
Surgery Day (8/15/07): 369.8 -- 67.6 BMI
Past Weight (09/30/08): 205.0 -- 37.5 BMI
Current Weight (01/08/09): 190.0 -- 34.7 BMI
Check Out My Profile for Pics & Blog
Topic: RE: extremely elevated liver enzymes. Too much supplements?
Thanks Wendy. I've been all over the internet and came up with all the same stuff. My doctor is aware that most of what I take is processed by the liver but we don't have any other options. I saw her yesterday and she told me that they have come to the consensus that it was a virus that attacked my liver. She told me she had several other cases just like mine. My enzymes are now completely normal again which surprised them. I will go from weekly to monthly checks now for a while to make sure. I just got my hospital bill for 4 days, ugg!!! On a side note, they had changed my clonopin to xanax and I had a horrible reaction to it, I became extremely manic for days. It was a nightmare, lol. I'll never touch that stuff again. Good to hear from you.
Topic: RE: extremely elevated liver enzymes. Too much supplements?
I also had elevated liver enzymes.
When my enzyme levels finally go so high that my PCP was worried enough to send me the the specialist (my levels were just 2 - 3 x normal & nowhere near your 20 x normal levels you are having), I immediately started researching everything that could cause elevated liver enzymes to see if I could just stop something I might be doing and get my levels back down to normal without going through a bunch of expensive tests.
I did about 2 months of research before deciding the most likely culprit in my case was either a: my Lexapro or b: Splenda. I stopped both and waited about a month to 6 weeks later to get my labs redrawn. They were still elevated.
I ended up getting all the tests done. I had my liver palpatated, ultrasounded and MRI'd. It feels/looks/etc completely normal on the inside & out. The specialist could not tell me why the enzyme levels were elevated, so they finally decided just to monitor the liver to see if it ever changes or begins to look funny/damaged/etc.
I wasn't satisfied with that. My thinking was and is that a normal healthy liver does not release enzymes into the blood at higher than normal levels for no reason. The liver ALWAYS releases enzymes into the blood - but it does so at certain levels. If the liver releases MORE than it is supposed to, logic dictates that there IS a reason. I was determined to find it.
I did about 2 months of research on my own regarding elevated liver enzymes. (Y'all know my motto. Be proactive about your own health or no one else will.) I discovered many interesting things tha may interest you.
1. Elevated liver enzymes immediately following WLS (or any abdominal surgery) is common since often times the surgeons move the liver out of the way and "clamp" it to the side while they work on whatever it is they are in your abdomen to do. The elevated enzymes typically go back down to normal within 48 hours or so. No worries.
2. Elevated liver enzymes farther out from WLS are not COMMON, but they do occur. The bad thing (and the good thing) about elevated liver enyzmes in WLS post-ops it that, most of the time, doctors/specialists can find no reason for the enzymes to be elevated. This is bad because something is causing the elevated liver enzymes. But this is good because the liver is usually always normal despite the enzyme levels.
3. Vitamins can cause elevated liver enzymes, but typically not when taken at normal levels. If I'm reading the doses right above, they shouldn't be the culprit.
4. Medications can definitely cause elevated liver enzymes. …PAUSE HERE FOR A MOMENT SO I CAN TELL YOU FRIGHTENING DRUG INFO… Savella can cause elevated liver enzymes. (see http://www.drugs.com/pro/savella.html)
Tramadol (Ultram) can cause elevated liver enzymes.
(see http://opioids.com/tramadol/prescribe.html) Clonopin can cause elevated liver enzymes. (see http://www.drugs.com/ppa/clonazepam.html) Lasix can cause elevated liver enzymes. (see http://www.drugs.com/sfx/lasix-side-effects.html) I honestly cannot believe the audacity of your DR to put you on all those at the same time. Most of those meds should NOT be taken together! WTF was he thinking? I’m sorry but he could have killed you which those drug combinations. I suspect that the nausea, bloated feeling and stabbing pain in your abdomen that sent you to the ER had NOTHING to do w/ the elevated liver enzymes and EVERYTHING to do with the pharmacological nightmare you have been subjected to. Holy crap honey! I’m surprised you’re still with us. Is he/she still your DR? I hope not! Unless there is no other choice and you & your DR have carefully weighed the risks and decided that the risk of NOT taking them together outweighs the risk of taking them together, you should never combine: Tramadol & Celexa (or any SSRI), OR Tramadol & Savella (or any SSRI, SSNI, etc) OR Celexa & Savella (two or more agents that impact serotonin, etc). It is also not recommended if there is a suitable alternative, to do the following combinations: Klonopin & Tramadol, OR Klonopin & Celexa. Please read this: http://www.drugs.com/interactions-check.php?drug_list=2221-0 ,679-335,703-357,3101-13615 Not only do you have all the combination issues that may have caused your abdominal distress, but all that medicine is probably overloading your liver. The liver is what detoxes all the medicines (and any alcohol) your body consumes and your DR had you on all that? Wow. Just wow. You need to see a DR who can detox your body ASAP. If it was me, I would honestly go see a DR and ask if you can go off ALL meds for a while if they believe you’ll be safe off all of them, then slowly add back just the ones they really think you NEED after monitoring you for a few months. That may not CURE whatever is ailing your liver, but it CERTAINLY can’t hurt it. …MOVING BACK ON TO… 5. Splenda is made by taking a sugar molecule, removing the carbon portion of the atom and inserting chlorine in its place. Splenda has been shown to cause elevated liver enzymes in some people – especially in larger doses. So if you do a lot of sugar free stuff, it could contribute (not likely to CAUSE all by itself, but could contribute to) elevated liver enzymes. 6. I whole-heartedly believe (and my research supports) that too much protein can cause elevated liver enzymes. There have been no studies done on WLS post-ops in regards to elevated liver enzymes in relation to increase protein intake. When I asked my specialist about decreasing my protein intake to “solve" my elevated liver enzymes, he had no clue what I was talking about. But by then, I had probably done more research on the subject than he had… who knows. I found lots of research online where BODY BUILDERS frequently get elevated liver enzymes with no physical manifestation of liver abnormality or damage AND no physiological reason for the elevation (no sickness/disease causing it). The body builders are often advised to decrease or stop their protein supplements AND THE LIVER ENZYMES GO BACK TO NORMAL. There is also the China Study to consider. (The China Study is the only study ever done on human starvation.) The China Study showed that humans who consumed higher animal protein intake had increased incidences of liver cancer than those humans who consumed lower animal protein. (Increased intake of vegetable protein does not produce the same results.) So something happens to our liver when we eat high protein diets. Maybe it makes it work harder. Or maybe animal proteins are just harder to filter toxins from than vegetable proteins. The reason(s) for the increased incidences of liver cancer was not given (probably because they didn’t know). But the fact remains that there is that increased risk. There is also the simple fact that the body must put the liver to work whenever it gets protein simply because of the processes our bodies must go through when we ingest protein. When we eat food, the body has to break apart that food into the good stuff it can use and the “waste". Most of us remember that from biology, etc. There are 2 forms of protein waste – those that contain nitrogen and those that do not. 80 % of the nitrogen-containing portion of this waste is urea. Urea is made in the liver (then excreted via the kidneys obviously). So the more protein you eat, the harder your liver has to work making urea so it can pass it on to the kidneys to get rid of it. So when you look at the facts: Higher animal protein intake has been proven to lead to a higher probability of liver cancer. Body builders who take protein supplements often develop increased liver enzymes. These increased levels fall back to normal after cessation of the protein supplements. Protein must be digested whi*****ludes getting rid of the waste – the majority of which much be formed in the liver. It’s obvious that a higher protein intake definitely CAN lead to elevated liver enzymes. My elevated liver enzymes really worried me. I didn’t want to sit back & wait for the liver to become damaged to take further action on finding out what was causing the levels. (The liver is the biggest organ in the human body. I didn’t want to mess around with this!) My liver enzymes are now normal. This is what I did to get mine back to normal. 1. I cut out most of the Splenda from my diet. I don’t eat it at all anymore unless I’m chewing sugar free gum that happens to have it in it. I don’t eat hardly any sugar free candy, sweets, etc in an attempt to keep my Splenda intake to a bare minimum. 2. I went off Lexapro. Although rare, it can cause increase liver enzymes. I am currently not on any anxiety medication even though I probably need to be. When I go to the doctor for my next check-up, I may go back on something – but it will be something different that I have researched completely and has been shown to have no impact on liver enzymes. (It will be hard but not impossible to find one.) 3. I decreased my protein intake down about 20 grams per day. As far out as we are, there is really no need to supplement at all – especially more than once a day. (Two scoops of protein in your morning drink then protein bars a time or two later in the day plus meat is a LOT more protein than you need.) Dr. Baker recommends 20 – 30 % calories from fat. He used to recommend 60 grams of protein per day, but I heard he recommends 80 grams per day now. The body simply starts shutting down without enough carbs, so you need carbs too. I eat about 1550 calories per day. I usually stay around 45 grams of fat, about 170 – 180 carbs and about 120 grams of protein. Those are approximations. I’ve done that for 6 months. My levels have returned to normal. Good luck. I miss you all. Wen
When my enzyme levels finally go so high that my PCP was worried enough to send me the the specialist (my levels were just 2 - 3 x normal & nowhere near your 20 x normal levels you are having), I immediately started researching everything that could cause elevated liver enzymes to see if I could just stop something I might be doing and get my levels back down to normal without going through a bunch of expensive tests.
I did about 2 months of research before deciding the most likely culprit in my case was either a: my Lexapro or b: Splenda. I stopped both and waited about a month to 6 weeks later to get my labs redrawn. They were still elevated.
I ended up getting all the tests done. I had my liver palpatated, ultrasounded and MRI'd. It feels/looks/etc completely normal on the inside & out. The specialist could not tell me why the enzyme levels were elevated, so they finally decided just to monitor the liver to see if it ever changes or begins to look funny/damaged/etc.
I wasn't satisfied with that. My thinking was and is that a normal healthy liver does not release enzymes into the blood at higher than normal levels for no reason. The liver ALWAYS releases enzymes into the blood - but it does so at certain levels. If the liver releases MORE than it is supposed to, logic dictates that there IS a reason. I was determined to find it.
I did about 2 months of research on my own regarding elevated liver enzymes. (Y'all know my motto. Be proactive about your own health or no one else will.) I discovered many interesting things tha may interest you.
1. Elevated liver enzymes immediately following WLS (or any abdominal surgery) is common since often times the surgeons move the liver out of the way and "clamp" it to the side while they work on whatever it is they are in your abdomen to do. The elevated enzymes typically go back down to normal within 48 hours or so. No worries.
2. Elevated liver enzymes farther out from WLS are not COMMON, but they do occur. The bad thing (and the good thing) about elevated liver enyzmes in WLS post-ops it that, most of the time, doctors/specialists can find no reason for the enzymes to be elevated. This is bad because something is causing the elevated liver enzymes. But this is good because the liver is usually always normal despite the enzyme levels.
3. Vitamins can cause elevated liver enzymes, but typically not when taken at normal levels. If I'm reading the doses right above, they shouldn't be the culprit.
4. Medications can definitely cause elevated liver enzymes. …PAUSE HERE FOR A MOMENT SO I CAN TELL YOU FRIGHTENING DRUG INFO… Savella can cause elevated liver enzymes. (see http://www.drugs.com/pro/savella.html)
Tramadol (Ultram) can cause elevated liver enzymes.
(see http://opioids.com/tramadol/prescribe.html) Clonopin can cause elevated liver enzymes. (see http://www.drugs.com/ppa/clonazepam.html) Lasix can cause elevated liver enzymes. (see http://www.drugs.com/sfx/lasix-side-effects.html) I honestly cannot believe the audacity of your DR to put you on all those at the same time. Most of those meds should NOT be taken together! WTF was he thinking? I’m sorry but he could have killed you which those drug combinations. I suspect that the nausea, bloated feeling and stabbing pain in your abdomen that sent you to the ER had NOTHING to do w/ the elevated liver enzymes and EVERYTHING to do with the pharmacological nightmare you have been subjected to. Holy crap honey! I’m surprised you’re still with us. Is he/she still your DR? I hope not! Unless there is no other choice and you & your DR have carefully weighed the risks and decided that the risk of NOT taking them together outweighs the risk of taking them together, you should never combine: Tramadol & Celexa (or any SSRI), OR Tramadol & Savella (or any SSRI, SSNI, etc) OR Celexa & Savella (two or more agents that impact serotonin, etc). It is also not recommended if there is a suitable alternative, to do the following combinations: Klonopin & Tramadol, OR Klonopin & Celexa. Please read this: http://www.drugs.com/interactions-check.php?drug_list=2221-0 ,679-335,703-357,3101-13615 Not only do you have all the combination issues that may have caused your abdominal distress, but all that medicine is probably overloading your liver. The liver is what detoxes all the medicines (and any alcohol) your body consumes and your DR had you on all that? Wow. Just wow. You need to see a DR who can detox your body ASAP. If it was me, I would honestly go see a DR and ask if you can go off ALL meds for a while if they believe you’ll be safe off all of them, then slowly add back just the ones they really think you NEED after monitoring you for a few months. That may not CURE whatever is ailing your liver, but it CERTAINLY can’t hurt it. …MOVING BACK ON TO… 5. Splenda is made by taking a sugar molecule, removing the carbon portion of the atom and inserting chlorine in its place. Splenda has been shown to cause elevated liver enzymes in some people – especially in larger doses. So if you do a lot of sugar free stuff, it could contribute (not likely to CAUSE all by itself, but could contribute to) elevated liver enzymes. 6. I whole-heartedly believe (and my research supports) that too much protein can cause elevated liver enzymes. There have been no studies done on WLS post-ops in regards to elevated liver enzymes in relation to increase protein intake. When I asked my specialist about decreasing my protein intake to “solve" my elevated liver enzymes, he had no clue what I was talking about. But by then, I had probably done more research on the subject than he had… who knows. I found lots of research online where BODY BUILDERS frequently get elevated liver enzymes with no physical manifestation of liver abnormality or damage AND no physiological reason for the elevation (no sickness/disease causing it). The body builders are often advised to decrease or stop their protein supplements AND THE LIVER ENZYMES GO BACK TO NORMAL. There is also the China Study to consider. (The China Study is the only study ever done on human starvation.) The China Study showed that humans who consumed higher animal protein intake had increased incidences of liver cancer than those humans who consumed lower animal protein. (Increased intake of vegetable protein does not produce the same results.) So something happens to our liver when we eat high protein diets. Maybe it makes it work harder. Or maybe animal proteins are just harder to filter toxins from than vegetable proteins. The reason(s) for the increased incidences of liver cancer was not given (probably because they didn’t know). But the fact remains that there is that increased risk. There is also the simple fact that the body must put the liver to work whenever it gets protein simply because of the processes our bodies must go through when we ingest protein. When we eat food, the body has to break apart that food into the good stuff it can use and the “waste". Most of us remember that from biology, etc. There are 2 forms of protein waste – those that contain nitrogen and those that do not. 80 % of the nitrogen-containing portion of this waste is urea. Urea is made in the liver (then excreted via the kidneys obviously). So the more protein you eat, the harder your liver has to work making urea so it can pass it on to the kidneys to get rid of it. So when you look at the facts: Higher animal protein intake has been proven to lead to a higher probability of liver cancer. Body builders who take protein supplements often develop increased liver enzymes. These increased levels fall back to normal after cessation of the protein supplements. Protein must be digested whi*****ludes getting rid of the waste – the majority of which much be formed in the liver. It’s obvious that a higher protein intake definitely CAN lead to elevated liver enzymes. My elevated liver enzymes really worried me. I didn’t want to sit back & wait for the liver to become damaged to take further action on finding out what was causing the levels. (The liver is the biggest organ in the human body. I didn’t want to mess around with this!) My liver enzymes are now normal. This is what I did to get mine back to normal. 1. I cut out most of the Splenda from my diet. I don’t eat it at all anymore unless I’m chewing sugar free gum that happens to have it in it. I don’t eat hardly any sugar free candy, sweets, etc in an attempt to keep my Splenda intake to a bare minimum. 2. I went off Lexapro. Although rare, it can cause increase liver enzymes. I am currently not on any anxiety medication even though I probably need to be. When I go to the doctor for my next check-up, I may go back on something – but it will be something different that I have researched completely and has been shown to have no impact on liver enzymes. (It will be hard but not impossible to find one.) 3. I decreased my protein intake down about 20 grams per day. As far out as we are, there is really no need to supplement at all – especially more than once a day. (Two scoops of protein in your morning drink then protein bars a time or two later in the day plus meat is a LOT more protein than you need.) Dr. Baker recommends 20 – 30 % calories from fat. He used to recommend 60 grams of protein per day, but I heard he recommends 80 grams per day now. The body simply starts shutting down without enough carbs, so you need carbs too. I eat about 1550 calories per day. I usually stay around 45 grams of fat, about 170 – 180 carbs and about 120 grams of protein. Those are approximations. I’ve done that for 6 months. My levels have returned to normal. Good luck. I miss you all. Wen
Topic: RE: What Happened To Me? (Alcoholism)
Wow. I've been MIA for so long. I had no idea you were having troubles and I hope it gets better soon.
Most surgeons won't do WLS on anyone who has any history of addiction. It's in Dr. Baker's questionnaire I know. I'm surprised he agreed to operate on you (assuming you were truthful in your answers to your questionnaire). Although some WL surgeons will do WLS on a former addict if the prospective patient attends counciling first and the councelor agrees that the patient won't be likely to have transfer addiction issues.
I know you said you never really considered yourself a food addict pre-op. I've seen some people on this forum and just out in the real world that believe that about themselves. But I really think MOST people who have WLS (or who just get as heavy as most of us were) have SOME sort of food addiction.
I know I did. I look back at the quantity of food I ate - and many times, the quality of food I ate - and I have NO doubts that I was a food addict.
So really, in my opinion, MOST of us are addicts. We are (or were in our case) addicted to food. I do understand most surgeon's reluctance to operate on someone with a history of addiction (because the history of addiction would make that person more likely to pick up that addiction again whenever their food addiction is taken from them). So I get the logic I guess.
But I really think you can beat this. I don't think you are "doomed" all your life to addiction problems. I do think addictive tendencies run in families and I do think some people are definately more prone to addiction than others. But I do not believe ANYONE is "doomed" to addiction unless they allow themselves to be.
Do what you have to do to get healthy again. You can do it.
Miss you all.
Wen
Most surgeons won't do WLS on anyone who has any history of addiction. It's in Dr. Baker's questionnaire I know. I'm surprised he agreed to operate on you (assuming you were truthful in your answers to your questionnaire). Although some WL surgeons will do WLS on a former addict if the prospective patient attends counciling first and the councelor agrees that the patient won't be likely to have transfer addiction issues.
I know you said you never really considered yourself a food addict pre-op. I've seen some people on this forum and just out in the real world that believe that about themselves. But I really think MOST people who have WLS (or who just get as heavy as most of us were) have SOME sort of food addiction.
I know I did. I look back at the quantity of food I ate - and many times, the quality of food I ate - and I have NO doubts that I was a food addict.
So really, in my opinion, MOST of us are addicts. We are (or were in our case) addicted to food. I do understand most surgeon's reluctance to operate on someone with a history of addiction (because the history of addiction would make that person more likely to pick up that addiction again whenever their food addiction is taken from them). So I get the logic I guess.
But I really think you can beat this. I don't think you are "doomed" all your life to addiction problems. I do think addictive tendencies run in families and I do think some people are definately more prone to addiction than others. But I do not believe ANYONE is "doomed" to addiction unless they allow themselves to be.
Do what you have to do to get healthy again. You can do it.
Miss you all.
Wen
Topic: RE: New to Little Rock area
Hello,
I am in SW Little Rock, and awaiting for my insurance approval for surgery. I as well am looking for support to help me thru to a healtheir lifestyle. Maybe we can all meet and get together an be each others additional support too into our new journey and lifestyle.
I am in SW Little Rock, and awaiting for my insurance approval for surgery. I as well am looking for support to help me thru to a healtheir lifestyle. Maybe we can all meet and get together an be each others additional support too into our new journey and lifestyle.
Topic: RE: New to Little Rock area
Hello! I am starting the process of getting the DS. I would love to meet up with you.
Kristen
Kristen
Topic: RE: Lap Band Plication Combo Procedure
I don't know if anyone in LR does that surgery, you would just need to call around. But I do know that Baptist Hosp in LR is a Centers of Excellence. I had to wait over 2 years for my surgery because of waiting for a COE. Baptist was the first in the state, I think Vincents may be one now as well.
Try googling some weight loss surgery Dr's in the areas and check out their websites. A few in LR I know of that do WLS surgery of different types is Dr. Baker, Dr. Gibbs and Dr. Wellborn.
Here is ObesityHelps list of surgeons in our state. I hope this helps.
http://www.obesityhelp.com/find/bariatric-surgeon/AR/more/
Try googling some weight loss surgery Dr's in the areas and check out their websites. A few in LR I know of that do WLS surgery of different types is Dr. Baker, Dr. Gibbs and Dr. Wellborn.
Here is ObesityHelps list of surgeons in our state. I hope this helps.
http://www.obesityhelp.com/find/bariatric-surgeon/AR/more/
Weight 5 Years Ago (2002): 275.0 -- 50.3 BMI
Pre-Consult (7/05/07): 400.12 pounds -- 73.2 BMI
Surgery Day (8/15/07): 369.8 -- 67.6 BMI
Past Weight (09/30/08): 205.0 -- 37.5 BMI
Current Weight (01/08/09): 190.0 -- 34.7 BMI
Check Out My Profile for Pics & Blog
Pre-Consult (7/05/07): 400.12 pounds -- 73.2 BMI
Surgery Day (8/15/07): 369.8 -- 67.6 BMI
Past Weight (09/30/08): 205.0 -- 37.5 BMI
Current Weight (01/08/09): 190.0 -- 34.7 BMI
Check Out My Profile for Pics & Blog
Topic: RE: What Happened To Me? (Alcoholism)
Thanks for the words of encouragement Sybyl and Janine. Janine what you said about your friend really scared me. Because I was very lucky that I had not killed myself doing this and that what Ive had checked so far (insides) seem to be in good condition. I won't know about the rest (gall bladder, pouch, etc..****il I can manage to get back into Dr. Baker's office, if I have not been written off for non-compliant, and if I have, I am going to beg and cry to let me back.
Weight 5 Years Ago (2002): 275.0 -- 50.3 BMI
Pre-Consult (7/05/07): 400.12 pounds -- 73.2 BMI
Surgery Day (8/15/07): 369.8 -- 67.6 BMI
Past Weight (09/30/08): 205.0 -- 37.5 BMI
Current Weight (01/08/09): 190.0 -- 34.7 BMI
Check Out My Profile for Pics & Blog
Pre-Consult (7/05/07): 400.12 pounds -- 73.2 BMI
Surgery Day (8/15/07): 369.8 -- 67.6 BMI
Past Weight (09/30/08): 205.0 -- 37.5 BMI
Current Weight (01/08/09): 190.0 -- 34.7 BMI
Check Out My Profile for Pics & Blog
Topic: RE: What Happened To Me? (Alcoholism)
WOW, I am so happy you are seeking help, that is the first step! I am in Newport and had RNY June 30, 2003. I was 409 now I stay between 165-175 just to tell you a little bit about me. I find A LOT of people who have had the surgery go to alcohol or something! A very good friend died a year ago yesterday due to alcohol :( She to had the surgery it only took her 1 year her organs shut down. If you ever need someone to chat with I would be Glad to talk or even meet up with you. PLEASE take care and I will be praying for you.
Janine Engler
Janine Engler