Hello to all.
Shrink Rapping is moving!
I appreciate all of you who have been faithful readers since January of 2009, and I would like to invite you to move right along with me.
You may now read all my previous entries from Shrink Rapping, and all the new content to come, at www.gregsmithmd.com. I describe this new forum as "One psychiatrist's thoughts about the world". Please feel free to sign up to get news about new posts sent directly to your mailbox, access the content via RSS through your favorite reader, and leave comments as you browse posts old and new.
I will of course leave Shrink Rapping up for now, but will no longer be adding new content here.
Have fun visiting the new place for one psychiatrist's thoughts at www.gregsmithmd.com. Happy reading!
Greg
Wednesday, March 9, 2011
Tuesday, March 8, 2011
Knee-Jerky
Sometimes I say things without thinking.
I'm sure you do too. I'm sure at the time that I'm feeling very clever or witty or funny and that everyone is hanging on my every word because I'm so wise. You get the idea. Well, not. Just not. These things that I say sometimes, they might indeed be hilarious, but at the expense of someone else. They might make me feel like I'm very funny, but only because I've pointed out something that is not funny at all to the party that is impacted by my mirth. I might feel superior or smart or talented or large and in charge, but if the things I say (or do) bring someone else to their knees in the process, well, am I really lifting myself up, or am I tearing down the race? You know, in a cosmic sense. Dig it? Oh, yes, I am ashamed to say, I have done this. In person (ouch). On Twitter (millions of potential readers? Double ouch). Other places. I have done it, and I am not proud of it.
I have used knee-jerky. I have wadded it up and put it in my mouth and felt the bite and the flavor and the spice of it. I have chewed it and felt the juice roll down my chin and wiped it on my sleeve. I have spit a little of it out on the ground. I have felt its raw flavor and then I have swallowed it, and it does not always sit on my stomach so easy, no, not at all. Sometimes it sits there for a while, it stews, it digests slowly. Hell, sometimes I feel it creeping back up, regurgitating and burning me just a little. Not enough to permanently scar, but enough to let me know that it's there.
Moron. Mental case. Touched in the head. Crazy. Wacko. Retarded. Brain dead. Idiot. Neanderthal.
Knee-jerky.
Have you chewed on any lately?
My best advice to you (and to myself)?
Spit it out.
Switch to sugar free mints.
I'm sure you do too. I'm sure at the time that I'm feeling very clever or witty or funny and that everyone is hanging on my every word because I'm so wise. You get the idea. Well, not. Just not. These things that I say sometimes, they might indeed be hilarious, but at the expense of someone else. They might make me feel like I'm very funny, but only because I've pointed out something that is not funny at all to the party that is impacted by my mirth. I might feel superior or smart or talented or large and in charge, but if the things I say (or do) bring someone else to their knees in the process, well, am I really lifting myself up, or am I tearing down the race? You know, in a cosmic sense. Dig it? Oh, yes, I am ashamed to say, I have done this. In person (ouch). On Twitter (millions of potential readers? Double ouch). Other places. I have done it, and I am not proud of it.
I have used knee-jerky. I have wadded it up and put it in my mouth and felt the bite and the flavor and the spice of it. I have chewed it and felt the juice roll down my chin and wiped it on my sleeve. I have spit a little of it out on the ground. I have felt its raw flavor and then I have swallowed it, and it does not always sit on my stomach so easy, no, not at all. Sometimes it sits there for a while, it stews, it digests slowly. Hell, sometimes I feel it creeping back up, regurgitating and burning me just a little. Not enough to permanently scar, but enough to let me know that it's there.
Moron. Mental case. Touched in the head. Crazy. Wacko. Retarded. Brain dead. Idiot. Neanderthal.
Knee-jerky.
Have you chewed on any lately?
My best advice to you (and to myself)?
Spit it out.
Switch to sugar free mints.
Sunday, March 6, 2011
When Worry Met Dally
It started about two weeks before Christmas as a feeling of tightness, cramping, and pain in my buttocks and hips.
I work primarily as a telepsychiatrist, which means that I can be sitting down for most of a sixteen hour shift seeing patients and typing notes into an electronic medical record. I thought, smart man that I am, that I was simply not getting up and stretching enough between consults, or that I was sitting in such as way that the chair was doing a number on my sciatic nerves, causing the pain and discomfort. I tried to sit in another chair for a week or two, I put a pillow underneath my bad self, then two or three pillows. I got up and tried to stretch at every opportunity, even taking to doing laps around the hallways to limber up a bit. I told myself that this would pass, that it was nothing, that I could handle it, and that I was being foolish to even worry about it. I soldiered on.
Then one morning I could barely get out of bed. The morning stiffness in my hips, legs, and knees was so bad that I had to barrel roll myself out from under the covers and onto the floor. It then took what seemed like an hour for me to stand upright and get myself into a hot shower, which was like manna from heaven on my body, which was already tired at six AM. Sitting down and putting on my socks was absolutely exhausting. I felt like a ninety year old man. It finally hit me. You are a fifty three year old man who just trained for and walked a half marathon on your birthday in October. Something is wrong with you, my friend. Something is really wrong. You need to see a doctor.
This realization, being a doctor and now knowing in my head and heart and hips that I needed to see a doctor myself, that I was about to become a patient, was disconcerting if not downright frightening. I have never really been sick. Oh, yes, I've had appendicitis and I've broken my leg sliding into second base (yeah, that was really stupid-another story for another day), but I've never had anything stop me in my tracks and keep me from putting on my socks and getting into and out of my car without outright yelps of pain. Something is wrong with you. NO! Yes. You need to see a doctor. NO! Yes, you idiot.
This was when Worry met Dally. Worry won.
I was so afraid that I might have something that would maim me for life or disable me so that someone would have to put my socks on for me or drive me around or that it would (gasp) KILL me, for God's sake, that I finally decided to make the call. I'm glad I did. I was diagnosed with a condition that, it turns out, my father also had, called polymyalgia rheumatica. It's serious enough, but it won't kill me. It's treatable, and my pain and discomfort are much better than they were three months ago. I know what this is, I know how to treat it, and I will be able to live with it. I know what to watch for in the future. If things get worse, I can deal with it. I now joke with my wife and kids that with my growing collection of medical ailments that I will get myself a silver Bat Masterson cane to walk with (and bop people on the head with when they annoy me), a nice blue handicapped sign to hang on my mirror when I can no longer walk from my car to my office, and a nice chocolate Lab to be my traveling companion when I go blind. (My black Lab Holly is much too old and set in her ways to help me out there, so I won't even ask her).
I can kid myself about this now that I can move again, but the moral of this tale is very serious. You know your body better than anyone else, including your doctor. If you develop symptoms that are serious, that last longer than a few days, that cause you discomfort or disability or impair your ability to function, please do not do what I, the wise and wonderful wizard of a doctor, did. Do not dally. Get checked out.
Thankfully, I did not have anything that would kill me if not diagnosed and treated right away.
You might not be so lucky.
I work primarily as a telepsychiatrist, which means that I can be sitting down for most of a sixteen hour shift seeing patients and typing notes into an electronic medical record. I thought, smart man that I am, that I was simply not getting up and stretching enough between consults, or that I was sitting in such as way that the chair was doing a number on my sciatic nerves, causing the pain and discomfort. I tried to sit in another chair for a week or two, I put a pillow underneath my bad self, then two or three pillows. I got up and tried to stretch at every opportunity, even taking to doing laps around the hallways to limber up a bit. I told myself that this would pass, that it was nothing, that I could handle it, and that I was being foolish to even worry about it. I soldiered on.
Then one morning I could barely get out of bed. The morning stiffness in my hips, legs, and knees was so bad that I had to barrel roll myself out from under the covers and onto the floor. It then took what seemed like an hour for me to stand upright and get myself into a hot shower, which was like manna from heaven on my body, which was already tired at six AM. Sitting down and putting on my socks was absolutely exhausting. I felt like a ninety year old man. It finally hit me. You are a fifty three year old man who just trained for and walked a half marathon on your birthday in October. Something is wrong with you, my friend. Something is really wrong. You need to see a doctor.
This realization, being a doctor and now knowing in my head and heart and hips that I needed to see a doctor myself, that I was about to become a patient, was disconcerting if not downright frightening. I have never really been sick. Oh, yes, I've had appendicitis and I've broken my leg sliding into second base (yeah, that was really stupid-another story for another day), but I've never had anything stop me in my tracks and keep me from putting on my socks and getting into and out of my car without outright yelps of pain. Something is wrong with you. NO! Yes. You need to see a doctor. NO! Yes, you idiot.
This was when Worry met Dally. Worry won.
I was so afraid that I might have something that would maim me for life or disable me so that someone would have to put my socks on for me or drive me around or that it would (gasp) KILL me, for God's sake, that I finally decided to make the call. I'm glad I did. I was diagnosed with a condition that, it turns out, my father also had, called polymyalgia rheumatica. It's serious enough, but it won't kill me. It's treatable, and my pain and discomfort are much better than they were three months ago. I know what this is, I know how to treat it, and I will be able to live with it. I know what to watch for in the future. If things get worse, I can deal with it. I now joke with my wife and kids that with my growing collection of medical ailments that I will get myself a silver Bat Masterson cane to walk with (and bop people on the head with when they annoy me), a nice blue handicapped sign to hang on my mirror when I can no longer walk from my car to my office, and a nice chocolate Lab to be my traveling companion when I go blind. (My black Lab Holly is much too old and set in her ways to help me out there, so I won't even ask her).
I can kid myself about this now that I can move again, but the moral of this tale is very serious. You know your body better than anyone else, including your doctor. If you develop symptoms that are serious, that last longer than a few days, that cause you discomfort or disability or impair your ability to function, please do not do what I, the wise and wonderful wizard of a doctor, did. Do not dally. Get checked out.
Thankfully, I did not have anything that would kill me if not diagnosed and treated right away.
You might not be so lucky.
Saturday, March 5, 2011
Losing It
As a psychiatrist, part of my job is to listen as you tell me about symptoms that bother you every day. If I can help you put these symptoms into a framework such as a syndrome or a disease, then we can work together on trying to figure out how to treat them. Often times in mental health, the best we can do is to dampen the symptoms and make them better or more tolerable because we haven't figured out exactly how to get rid of them completely yet. Frustrating for you and for me, but at least your life can be more enjoyable and you are not plagued by intense depression, debilitating manic episodes, or maddening hallucinations.
Now, we all would usually agree that getting rid of symptoms and curing disease are two admirable goals that are well worth pursuing. Much of medical school and residency training for doctors involves diagnosing, treating, and getting rid of pain, symptoms, suffering and disease. Lord knows, when I recently went to my doctor for diagnosis and treatment of severe pain that was measurably cramping my style every day, I had every expectation and confidence that he would listen to me, examine me, diagnose something, tell me about a cure, and fix me! He pretty much did that, and though I will not be cured from this syndrome, I feel much better and can go about my life with only moderate pain and discomfort.
What about psychiatric symptoms? Does the same hold true there? Well, of course, you would say! Who wants to suffer from sad mood and shyness and inability to go out of their home and hearing voices and social isolation and decreased appetite and all these other myriad symptoms that patients tell me about every day when I ask, "What brought you in to see me today?"? You would say, emphatically, that all patients with mental illness would want to be cured and rid of all their psychiatric symptoms and all their behavioral problems and all their social faux pas. You would say that, right?
Sometimes, you would be wrong.
I have started patients on antipsychotic drugs that got rid of the hallucinations that they had been plagued with since they were teens. All the voices-gone. The scary shadows on the wall-gone. The command hallucinations telling them to kill themselves-gone. But, the pretty, soft, soothing music that played in their heads when they lay down on the couch to try to sleep at three AM? Gone too. The positive affirmations that play in their heads that tell them that maybe things will be OK after all and to hang in there-gone along with the grandmother whose voices they conjure. The lithe, thin, physical body they'd had for years-gone with the weight gain that can come with medication treatment, just at the time that they feel like getting out and wearing a swim suit in public for the first time in their lives at the beach. The desire for intimacy, emotional and physical, with another human being-gone with the "bad" symptoms when the medications they take completely shut off a wakening sex drive that gets better when their mood improves, or that cruelly causes sexual dysfunction just when desire is returning.
So you see, sometimes losing symptoms and fixing syndromes and diseases is a tricky business indeed. While we very much want to help patients get better and function in life the very best they can in spite of their mental health problems, sometimes we take away the very things that help them care, connect, and cope.
This is why medicine, in spite of all the high tech and the wonders that we possess, is still an art.
Cookbook medicine is a fallacy.
Compassionate medicine is a worthy goal.
Now, we all would usually agree that getting rid of symptoms and curing disease are two admirable goals that are well worth pursuing. Much of medical school and residency training for doctors involves diagnosing, treating, and getting rid of pain, symptoms, suffering and disease. Lord knows, when I recently went to my doctor for diagnosis and treatment of severe pain that was measurably cramping my style every day, I had every expectation and confidence that he would listen to me, examine me, diagnose something, tell me about a cure, and fix me! He pretty much did that, and though I will not be cured from this syndrome, I feel much better and can go about my life with only moderate pain and discomfort.
What about psychiatric symptoms? Does the same hold true there? Well, of course, you would say! Who wants to suffer from sad mood and shyness and inability to go out of their home and hearing voices and social isolation and decreased appetite and all these other myriad symptoms that patients tell me about every day when I ask, "What brought you in to see me today?"? You would say, emphatically, that all patients with mental illness would want to be cured and rid of all their psychiatric symptoms and all their behavioral problems and all their social faux pas. You would say that, right?
Sometimes, you would be wrong.
I have started patients on antipsychotic drugs that got rid of the hallucinations that they had been plagued with since they were teens. All the voices-gone. The scary shadows on the wall-gone. The command hallucinations telling them to kill themselves-gone. But, the pretty, soft, soothing music that played in their heads when they lay down on the couch to try to sleep at three AM? Gone too. The positive affirmations that play in their heads that tell them that maybe things will be OK after all and to hang in there-gone along with the grandmother whose voices they conjure. The lithe, thin, physical body they'd had for years-gone with the weight gain that can come with medication treatment, just at the time that they feel like getting out and wearing a swim suit in public for the first time in their lives at the beach. The desire for intimacy, emotional and physical, with another human being-gone with the "bad" symptoms when the medications they take completely shut off a wakening sex drive that gets better when their mood improves, or that cruelly causes sexual dysfunction just when desire is returning.
So you see, sometimes losing symptoms and fixing syndromes and diseases is a tricky business indeed. While we very much want to help patients get better and function in life the very best they can in spite of their mental health problems, sometimes we take away the very things that help them care, connect, and cope.
This is why medicine, in spite of all the high tech and the wonders that we possess, is still an art.
Cookbook medicine is a fallacy.
Compassionate medicine is a worthy goal.
Friday, March 4, 2011
Get RID of It!
Ok.
So you like to read, yes? You read stuff for work, stuff to get the news, stuff for fun, stuff to learn more stuff. You read things on your iPad, on line, through RSS feeds, on news readers of various types, in apps. You pick up newspapers, books, magazines. Some of these are real, in that they are held in your hands, and some are "held" virtually in your device, whether it be Nook or Kindle or iPad or other. Are you getting the same feeling I'm getting? Is the ever increasing amount of information getting to be too much for your poor addled brain? Is this pile of stuff too daunting to deal with?
I have the answer for you.
Get RID of it!
Well, not literally. You really don't want to stop learning or taking things in, but there MUST be some way to filter all this stuff so that we feel that we're learning things that matter to us. Things that make our lives better. My answer, something that I'm trying to do myself and that I challenge you to do as well?
RID = Read In Detail.
I'll spot you the weekend to figure out you want to approach this, but the gist of it is this. As all of your usual information sources pour out their bounty on you today through Sunday, pick ONE topic or interesting subject that you really want to learn more about. Something that interests you, something that you need to learn more about so you can impress your girlfriend, something you need to know to do your job better. Then, let everything else take a back seat for ONE WEEK (you pick the start day) and Read In Detail about that topic. Notice that I did not say let everything else GO, but just let the other noise fade into the background for a while. The world will not end, trust me. Google it. Go to the library. Download something from the Kindle Store. Find a review article about it. Watch a movie about it. (Well, that would technically be cheating, but I like movies so I'll let it slide if you want to do this to mix things up a little).
Read In Detail. Learn. Absorb. Get the skinny. Go beyond the buzzwords and understand the nuances. Be able to explain a new concept to your spouse, your boss, or your kid. Explain it so that the other person actually understands it.
Modern life is full of information. We are being bombarded with more information in a single day than our ancestors were exposed to in their entire lives. Don't be intimidated by it all and give up.
Get RID of it. Read In Detail. Learn, Understand. Share.
We'll all be better off if you do.
So you like to read, yes? You read stuff for work, stuff to get the news, stuff for fun, stuff to learn more stuff. You read things on your iPad, on line, through RSS feeds, on news readers of various types, in apps. You pick up newspapers, books, magazines. Some of these are real, in that they are held in your hands, and some are "held" virtually in your device, whether it be Nook or Kindle or iPad or other. Are you getting the same feeling I'm getting? Is the ever increasing amount of information getting to be too much for your poor addled brain? Is this pile of stuff too daunting to deal with?
I have the answer for you.
Get RID of it!
Well, not literally. You really don't want to stop learning or taking things in, but there MUST be some way to filter all this stuff so that we feel that we're learning things that matter to us. Things that make our lives better. My answer, something that I'm trying to do myself and that I challenge you to do as well?
RID = Read In Detail.
I'll spot you the weekend to figure out you want to approach this, but the gist of it is this. As all of your usual information sources pour out their bounty on you today through Sunday, pick ONE topic or interesting subject that you really want to learn more about. Something that interests you, something that you need to learn more about so you can impress your girlfriend, something you need to know to do your job better. Then, let everything else take a back seat for ONE WEEK (you pick the start day) and Read In Detail about that topic. Notice that I did not say let everything else GO, but just let the other noise fade into the background for a while. The world will not end, trust me. Google it. Go to the library. Download something from the Kindle Store. Find a review article about it. Watch a movie about it. (Well, that would technically be cheating, but I like movies so I'll let it slide if you want to do this to mix things up a little).
Read In Detail. Learn. Absorb. Get the skinny. Go beyond the buzzwords and understand the nuances. Be able to explain a new concept to your spouse, your boss, or your kid. Explain it so that the other person actually understands it.
Modern life is full of information. We are being bombarded with more information in a single day than our ancestors were exposed to in their entire lives. Don't be intimidated by it all and give up.
Get RID of it. Read In Detail. Learn, Understand. Share.
We'll all be better off if you do.
Wednesday, March 2, 2011
Visual Communication
My online friend Bryan Vartabedian over at 33 Charts wrote a blog post on 2-18-11 about how he structures his patient interviews. Read it here. It gave me pause and got the wheels turning.
As I am interviewing you as a new patient for the first time, a lot of information is being shared (we hope!) back and forth. I ask questions, you answer, that leads to more elaboration, and on we go. The whole key to this process, of course, is to get to some kind of understandable, workable diagnosis of a problem that can then be better understood and treated, making you feel better than when you came in. That's the ultimate goal for me. I want you to leave feeling that you have learned something, gotten relief from your symptoms, or that you have a plan for tackling something that has been giving you trouble.
Bryan mentioned using a whiteboard to write things down as he explains lists of symptoms and key issues that might impact patient care. I have never thought of doing this in psychiatry, but it intrigues me. Instead of just keeping my usual notes on a clipboard to be used to type information into the electronic medical record after you leave, what if I actually got up and brainstormed with you at a whiteboard after the "formal" part of the interview was over? What if I wrote down key symptoms, possible diagnoses, and outlined potential treatment plans visually on a board so that we could both see them more clearly? It strikes me that at the end of a psychiatric diagnostic interview today, which is more like a thirty minute Board exam (pun entirely intentional) than a clinical encounter these days, that I fire an awful lot of info about disease states, medications, therapies, appointments, testing, and referrals at you than you might not be ready to hear right then. A visual aid might be helpful. There is the added bonus that I could then snap a picture of this information that we had covered and somehow get it into the EMR as well so that we can refer back to it later, reviewing and modifying what we thought about at that very first visit.
What do you think? Would a visual helper such as a whiteboard be helpful with communication in the mental health setting when you see a psychiatrist for the first time, or at follow up visits later? I'd love to hear what you think.
Thanks, Bryan, for this little nudge to my brain this morning.
As I am interviewing you as a new patient for the first time, a lot of information is being shared (we hope!) back and forth. I ask questions, you answer, that leads to more elaboration, and on we go. The whole key to this process, of course, is to get to some kind of understandable, workable diagnosis of a problem that can then be better understood and treated, making you feel better than when you came in. That's the ultimate goal for me. I want you to leave feeling that you have learned something, gotten relief from your symptoms, or that you have a plan for tackling something that has been giving you trouble.
Bryan mentioned using a whiteboard to write things down as he explains lists of symptoms and key issues that might impact patient care. I have never thought of doing this in psychiatry, but it intrigues me. Instead of just keeping my usual notes on a clipboard to be used to type information into the electronic medical record after you leave, what if I actually got up and brainstormed with you at a whiteboard after the "formal" part of the interview was over? What if I wrote down key symptoms, possible diagnoses, and outlined potential treatment plans visually on a board so that we could both see them more clearly? It strikes me that at the end of a psychiatric diagnostic interview today, which is more like a thirty minute Board exam (pun entirely intentional) than a clinical encounter these days, that I fire an awful lot of info about disease states, medications, therapies, appointments, testing, and referrals at you than you might not be ready to hear right then. A visual aid might be helpful. There is the added bonus that I could then snap a picture of this information that we had covered and somehow get it into the EMR as well so that we can refer back to it later, reviewing and modifying what we thought about at that very first visit.
What do you think? Would a visual helper such as a whiteboard be helpful with communication in the mental health setting when you see a psychiatrist for the first time, or at follow up visits later? I'd love to hear what you think.
Thanks, Bryan, for this little nudge to my brain this morning.
Tuesday, March 1, 2011
If U Kan't Spel, Peasz Dont Right
OK.
This post iz an ezy one fur me to right. I love to rite about my pet peavs, becase I am passhionate about them of corse. Lots of u luv to right. I know you do, becase I reed your stuff almost evry day. I realy lik most of it-I really do. You are onest with yur feilngs, you put yur thots rit out there for all of us to see, and you have some origenal idees that you wont us to think about.
You think thru the post, you chooze your werds karefuly, you spend a little time at the keebored, and wahla, a knew letter or blog post or artikle or editorrial is borned. It goes out to the internet and reeches millions of reeders. It makes an impack. It teaches peeple things that they never new befor. I applaud you for that.
However, my per peave is that many of you relie of things lik spell chekkers to catch the mastakes taht you mite make as you send out this good informashion. It is much easier to finnish writing, click on a buton, leeve the heavy lifting to the computter, and call it done. If it gets caught by the chekker, it's all good. If not, well, one or two mitakes wont hurt anybdy, rite?
The problem is, whether or not it's a tecknical document, a letter, a blog post, an editoreal, or even a note in a medical rekord, eventully somebody else is going to reed it adn try to understand it. The speeling and grammer mistakes that litter taht little jem of a document that you rote are going to take away from the genyous that I know is there, lerking in the back ground waiting to be transferred to the reeder.
Do me adn the rest of us a favur? Pleese, pleese, pleese, prufreed you're on work. Check the spelling. See if it flows, if it makes since, and if the words are spelled correcly. It will make reading your idees, which I am quiet sure are worth my time to reed, much more plesent.
Have a grate Tusday!
This post iz an ezy one fur me to right. I love to rite about my pet peavs, becase I am passhionate about them of corse. Lots of u luv to right. I know you do, becase I reed your stuff almost evry day. I realy lik most of it-I really do. You are onest with yur feilngs, you put yur thots rit out there for all of us to see, and you have some origenal idees that you wont us to think about.
You think thru the post, you chooze your werds karefuly, you spend a little time at the keebored, and wahla, a knew letter or blog post or artikle or editorrial is borned. It goes out to the internet and reeches millions of reeders. It makes an impack. It teaches peeple things that they never new befor. I applaud you for that.
However, my per peave is that many of you relie of things lik spell chekkers to catch the mastakes taht you mite make as you send out this good informashion. It is much easier to finnish writing, click on a buton, leeve the heavy lifting to the computter, and call it done. If it gets caught by the chekker, it's all good. If not, well, one or two mitakes wont hurt anybdy, rite?
The problem is, whether or not it's a tecknical document, a letter, a blog post, an editoreal, or even a note in a medical rekord, eventully somebody else is going to reed it adn try to understand it. The speeling and grammer mistakes that litter taht little jem of a document that you rote are going to take away from the genyous that I know is there, lerking in the back ground waiting to be transferred to the reeder.
Do me adn the rest of us a favur? Pleese, pleese, pleese, prufreed you're on work. Check the spelling. See if it flows, if it makes since, and if the words are spelled correcly. It will make reading your idees, which I am quiet sure are worth my time to reed, much more plesent.
Have a grate Tusday!
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