Tag Archives: pulmonary hypertension

World COPD Day,2011 and the Governor’s Proclamation meet in Bremerton’s City Council TODAY

Happy World COPD Day today – 16 November 2011!   (Local recognition activity follows….and Bremerton’s Mayor Patty Lent leads the way)  Sorry, I’m running a little late.

In addition – a new lung connection in the newly completed 20-year study found that COPD patients are five times more likely to develop lung cancer than normal lung folks are.  The warning is to offer Spirometry to detect COPD in the early stages to cut cancer and COPD deaths.  The investigative paper gave the shout-out in the prestigious European Respiratory Journal.

“It comes as an exclusive investigation by GP found a lack of PCT investment in the gold standard treatment for COPD is undermining patients’ quality of life and increasing practice workload.

Around one in 100 patients with the chronic disease developed cancer, compared with one in 500 without lung impairment.

Testing the lung function of former and active smokers would identify COPD earlier, thereby improving early detection of lung cancer and improving survival chances, it found.

Lead author Yasuo Sekine, of Tokyo Women’s Medical University, said: ‘The findings from our analysis suggest that early detection of COPD in addition to lung cancer screening for these patients could be an effective detection technique for lung cancer. However, further research is still needed to determine the selection criteria for COPD and lung cancer screening.’

Monica Fletcher, chairperson of the European Lung Foundation, said millions had COPD but it was often undetected.

‘People frequently ignore the symptoms of lung disease and leave it too late before going to the doctor, she said. ‘This research highlights the need for routine lung function tests, known as spirometry, to help improve quality of life and identify other conditions that could be present.’

Professor Klaus Rabe, president of the European Respiratory Society, said ‘On World COPD Day, we would also urge European governments to improve early detection of respiratory diseases, such as COPD.’

Meanwhile, patients’ respiratory associations across Europe said governments must work harder to reduce the £28 billion annual cost of COPD.

Proposals from the European Federation of Allergy and Airways Diseases Patients’ Associations to reduce this burden include listing COPD as a warning on tobacco products, improving access to spirometry and funding research on how to avoid exacerbations.

 

http://www.gponline.com/News/article/1104308/detect-copd-cut-cancer-deaths-experts-urge/

The Better Breather’s Respiratory Support Group meets today at Harrison Silverdale -in the Rose room from 1:00pm – 3:00 pm.  Pam O’Flynn will introduce Harrison’s new Respiratory Clinical Practice Educator, Martin Robin.  I know the meeting will be informative and lively no matter the topic and hope to see you there!

http://www.harrisonmedical.org/home/calendar/4903

“We welcome any community member with asthma, emphysema, chronic bronchitis, sarcoidosis, asbestosis, pulmonary hypertension, pulmonary fibrosis and the many more lung diseases affecting our population, pediatric or adult.”

Harrison Silverdale – 1800 NW Myhre Road – Silverdale, WA 98383

Pamela O’Flynn – 360-744-6685 – respiratorycare@harrisonmedical.org

 

Today – at 5:30 pm – Bremerton’s Mayor Patty Lent makes COPD, Kitsap County and Washington State history.  She is the first mayor in Washington State to present Governor Christine Gregoire’s Proclamation declaring November 2011 State COPD Month, to my knowledge.  Her generosity in recognizing the 3rd leading cause of death in the US is precious by recognizing today, 16 November 2011 as World COPD Day!

District 3, Manette’s hard working effective and beneficial city council member, Adam Brockus will present the Proclamation to Karma Foley of Seabeck who lost both parents to COPD.  Karma’s mom had the inherited type of COPD and with her oxygen tank, went out of her way to help me with several COPD/EFFORTS public meetings we put together a few years ago.

This COPD  historic event happens at 5:30 pm in the Norm Dicks Government Building city council chambers.  I will be taking pictures for y’all and trying not to let my eyes leak. Thank you!

I will ride a recumbent trike from Evergreen Park to the NDGB or walk it instead…very cold and wet out there.

Thanks for reading… Sharon O’Hara

ALPHA-1 is coming to town and Harrison Silverdale’s BB has them!

Alpha-1 is coming to town!  Silverdale to be exact – in the Rose Room at Harrison Silverdale to be more exact – 1:00pm to 3:00pm and we are all excited.

Mark Wednesday, 21 September 2011 for Better Breather’s partnering with Alpha-1 and Free Testing for the Alpha-1, a genetic component of Emphysema (COPD)

“American Thoracic Society (ATS) Guidelines

ATS guidelines recommend testing a broad range of patients with lung conditions:1

All adults with symptomatic emphysema regardless of smoking history

All adults with symptomatic COPD regardless of smoking history

All adults with symptomatic asthma whose airflow obstruction is incompletely reversible after bronchodilator therapy

Asymptomatic patients with persistent obstruction on pulmonary function tests with identifiable risk factors (smoking, occupational exposure, etc.)

Consider testing of asymptomatic individuals with persistent airflow obstruction without risk factors (no smoking or no known occupational exposure, etc.)”

The speaker is Nancy Bartholomew, with Prolastin-C from Grifols Inc.

 

 

I have included this photo taken from ATS “Rare Lung Diseases” because seeing it broke my heart.  It shows a ‘mother and her baby poignantly illustrating the fact that young women can be the victim of rare lung diseases.”

If we do not test, we cannot know and could easily be misdiagnosed and medically treated for the wrong condition.

… taken from American Thoracic Society (ATS) online “Some of the most exciting discoveries in pulmonary medicine have come from studying rare diseases. Insights gained from uncommon lung diseases often shed light on more common lung diseases…”  http://www.thoracic.org/education/breathing-in-america/index.php

Web sites of interest

National Institutes of Health Rare Diseases Clinical Research Network

www.rarediseasesnetwork.org

Orphanet  – About Rare Diseases

www.orpha.net/consor/cgi-bin/Education_AboutRareDiseases.php?Ing=EN

LAM Foundation

www.thelamfoundation.org

Hermansky-Pudlak Syndrome Network

www.hermansky-pudlak.org

Tuberous Sclerosis Alliance

www.tsalliance.org

 

Look for a table and chairs set up and friendly Harrison folks…Joyce is the RRT Harrison volunteer Better Breathers liaison…we are lucky to have her.

Rose Room – Harrison Silverdale

1800 NW Myhre Road – Silverdale, WA 98383

Better Breathers Support Group

“Our Better Breathers support group encompasses community members and their caregivers who live with chronic respiratory disease and lung disease. Better Breathers is designed to provide support, education, networking, and tools to improve the daily lives of those living with these health conditions.

We welcome any community member with asthma, emphysema, chronic bronchitis, sarcoidosis, asbestosis, pulmonary hypertension, pulmonary fibrosis and the many more lung diseases affecting our population, pediatric or adult.

Please email or call if you will need assistance with parking at the meeting.”

Contact: Pamela O’Flynn   – 360-744-6687 – respiratorycare@harrisonmedical.org

 

If anyone needs a ride, contact me.

Thanks for reading… Sharon O’Hara

TREE OF LIFE hosts Better Breather’s Support Group Meeting on (COPD Equipment!)

Better Breathers meets tomorrow in Silverdale Harrison’s TREE OF LIFE room from 1 pm – 3 pm.

Sorry – change of topic.  Stat Home Care is bringing the different machines Lung folks use  and explain the use of each.  Example:  I’m on a BIPAP and Concentrator bleed in and not entirely sure how they work together.  Can a concentrator work without the BIPAP and how does it affect the patient?  It will be exciting to see the very latest The topic is Neuromuscular Disease, which includes Lou Gehrig Disease and a review of respiratory medications.

The speaker is Respiratory Therapist Christine Bromell.

It takes muscle to breathe and I’d like to understand how these diseases work on the body…including the Sleep Apnea and COPD progression work.  going because it takes muscles to breathe….we’re getting educated!

The fastest way to the TREE OF LIFE room is through the Labor and Delivery Baby entrance and down the long hall by the elevators.

Look for a table and chairs set up and friendly Harrison folks…Joyce is the RRT Harrison volunteer Better Breathers liaison…we are lucky to have her.

Neuromuscular Disease      COPD equipment including CPAP, BIPAP, CONCENTRATORS…

Speaker:  Respiratory Therapist Christine Bromell

Wednesday, 17 August 16, 2011

1:00pm – 3:00pm

TREE OF LIFE room – Harrison Silverdale

1800 NW Myhre Road – Silverdale, WA 98383

Better Breathers Support Group

“Our Better Breathers support group encompasses community members and their caregivers who live with chronic respiratory disease and lung disease. Better Breathers is designed to provide support, education, networking, and tools to improve the daily lives of those living with these health conditions.

We welcome any community member with asthma, emphysema, chronic bronchitis, sarcoidosis, asbestosis, pulmonary hypertension, pulmonary fibrosis and the many more lung diseases affecting our population, pediatric or adult.

Please email or call if you will need assistance with parking at the meeting.”

Contact: Pamela O’Flynn   – 360-744-6687 – respiratorycare@harrisonmedical.org

***

Thanks for reading… Sharon O’Hara

Good Sleep Health and Sleep Apnea – Tomorrow!

Good Sleep Health and Sleep Apnea

Speaker:  Jess Lackey of Pacific Pulmonary Inc.

Wednesday, 20 July 2011

1:00pm – 3:00pm

Rose Room – Harrison Silverdale

1800 NW Myhre Road – Silverdale, WA 98383

 

Better Breathers Support Group

“Our Better Breathers support group encompasses community members and their caregivers who live with chronic respiratory disease and lung disease. Better Breathers is designed to provide support, education, networking, and tools to improve the daily lives of those living with these health conditions.

 

We welcome any community member with asthma, emphysema, chronic bronchitis, sarcoidosis, asbestosis, pulmonary hypertension, pulmonary fibrosis and the many more lung diseases affecting our population, pediatric or adult.

Please email or call if you will need assistance with parking at the meeting.”

Contact: Pamela O’Flynn   – 360-744-6687 –  respiratorycare@harrisonmedical.org

****

My sleep apnea story in short form:  Some ten years ago the Sleep Study and bi-pap machine enabled me to get back into a bed after a few years of sleeping in a chair…I could not breathe lying down so had to sleep in a recliner chair…comfortable though it was, it was not a bed.

During this last year after an at home study I discovered my saturation numbers hit the basement while sleeping – bottoming out into the low 70’s.  100 is normal and nobody knew it…who knows how long that went on?

One of the questions I will be asking tomorrow:  Why don’t the c-pap or bi-pap machines monitor the patient’s blood/oxygen level during sleep to alert the doctor there is a problem.  Hint: After a length of time without oxygen, brain cells die.  http://www.nlm.nih.gov/medlineplus/ency/article/001435.htm

During sleep how low can the blood/oxygen levels go and for how long before brain cells die?  Personally, I want to hug and cherish my brain cells from a distance and keep them going as long as possible.

A sharp Harrison Medical Center ER doc caught a problem and had me put on a concentrator that gathers oxygen from the room and bleeds it into my bi-pap – leading to better sleep.  Except when the RLS bounces me right out of bed to move my legs and walk around.

Ignoring Sleep Apnea can lead to serious stuff – we need to be aware.

Tomorrow is the opportunity to ask the questions and have fun at the same time.

Refreshments!

See you Wednesday!  If anyone needs a ride, let me know.

Following are photos of my concentrator connected to the bi-pap and connected to the facemask that goes over my nose and blows air into my airway.

Some folks say the c-pap and bi-pap is too noisy.  I call it the sweet song of life.

Thanks for reading… Sharon O’Hara

Mark Mangus Tells the COPDer How to Live – EXERCISE

Pulmonologists and COPDers – take note – patients really do WANT to be educated and too many physicians are shy about encouraging patients to exercise and WHY WE MUST EXERCISE to have a life.

Following is the noted exercise guru for the COPDer, Mark W. Mangus, Sr., BSRC, RRT, RPFT, FAARC of San Antonio, TX answer to a patients question about her FEV-1 and FVC decline.  Mark’s answer was posted on my online support group, EFFORTS.  www.emphysema.net.

A gentle reminder that Mark had to move beyond traditional COPD treatment because his daughter, Kim, born with Cystic Fibrosis was not helped by traditional medicine methods for lung patients.  Kim’s only hope was to stay alive until she was old enough for a lung transplant.  She has had double lung transplants now and currently works for Vanderbilt Medical Center.

Hi _ _ _,

First, let me say that there is nothing you can do to stop the decline you

are experiencing in your FVC and FEV-1, though you CAN slow the inevitable

progression to some (unknown) degree by exercising increasingly VIGOROUSLY

as you embark on your pulmonary rehabilitation effort.

**********

Your stress testing and echo tell a story of long developing pulmonary

hypertension which has advanced with poor intervention with regard to timely

detection of hypoxemia and earlier oxygen therapy support.  Your breast

cancer bout and treatment are potentially responsible for part of what you

are currently experiencing.  Radiation treatment is notorious for triggering

a process of radiation fibrosis, though it usually happens more profoundly

in treatment of lung cancer than more superficial cancers like breast

cancer.  But, if lymph nodes under your arm were irradiated – in other words

- the radiation was applied broadly over an area larger than simply the

breast tissue, chances are that you are seeing some effect from that.  A

high-resolution CT of your lungs, maybe with enhancement, if deemed helpful,

might better illuminate the presence of fibrosis and its extent and progression.

 

Your FVC has dropped disproportionately with your FEV-1, the FVC dropping by

almost double that of the FEV-1 during the same period.  This is also

suggestive of the possibility of fibrosis.  As well, your DLCO being reduced

to around 30 % of what it should be AND the confirmed and significant

hypoxia discovered with your walking and sleeping oximetry tests correlate

with the reduced DLCO and FVC.  The reduction in FVC is yet further

suggestion of a restrictive process being combined with your obstructive

lung disease process.

**********************************

I am disappointed that your 6 minute walk was conducted as it was, but,

unfortunately, not surprised, as it is one of the most variably conducted

tests done in this area of medicine.  You SHOULD have been allowed to

continue – hypoxia detected or not – as long as you were able to AND at a

pace that YOU chose.  If monitoring was to be done, then it should have done

no more than to document the extent of changes – NOT signal a point at which

the clinician decided to stop you and THEN to totally alter the validity of

your test by setting your pace!  So, the 620 feet you walked is meaningless

to determine anything with regard to the clinical state of your disease

and the limitations it imposes upon your ability to ambulate or to

extrapolate any determination of functional adequacy.  None of that is your

fault.  It is due to the poor understanding of the test purpose and method

on the part of the clinicians.

**************************

Your sleep saturations are very telling of significant hypoxemia that is

more likely associated with your fibrosis and pulmonary hypertension.

Pulmonary hypertension aggravates hypoxia, making it worse, which in turn

makes the hypertension worse, which in turn, makes the hypoxia worse . .

You can see where that is going. That is why you bottom out so low at 78 %

during sleep.

*************************************

First, I hope that 2 liters during sleep is keeping you saturated to at

least 88 % as a bottom low point.  If you have not had a follow-up sleep

study to determine the effect/benefit of the oxygen during sleep, you should

push for it to be done.   You should ALSO be using oxygen for ALL ambulation

and exertion – and possibly more like 4 to 6 liters – as I’m doubtful that

any less will saturate you adequately to counteract your pulmonary

hypertension.   Treatment of the pulmonary hypertension should be a point of

primary focus for you and your medical team.  Oxygen, at this point is the

most powerful and effective treatment you can use to slow the inevitable

progression towards profound heart failure you can expect if the pulmonary

hypertension is not controlled a LOT better than it has been over the recent

past.  That wll likely ‘do you in’ a whole lot sooner and with much interim

misery than the combined lung disease process that has caused it.

********

It is good that you are starting a pulmonary rehab program.  I am surprised

that they don’t have a pulmonologist directing the program.  Do you know

what kind of doctor is acting/serving as their medical director?  Make the

most of it.  Push hard to learn to work against the difficulties of the

breathing symptoms that accompany your disease, especially at this point.

Don’t let the staff hold you back because of hypoxia.  Push them to give you

all the oxygen you need to be able to push yourself to the maximum.  Short of

such an effort and you will be mostly spinning your wheels.  Working hard to

breathe and overcoming the difficulties and fear it can impose upon you are

not easy.  NEVERTHELESS, working hard to breathe – even when it makes others

uncomfortable to watch you work so hard – will NOT harm you, despite what

many might opine.  It may ‘feel’ like it’s gonna kill you.  HOWEVER, it will

NOT!  It is not an easy path you must travel.  But, others have traveled the

same path.  The good news is that you still have 29 % FEV-1.  That might

creep back up to 35% with hard work.  AND, it would be worth it because that

little 5 % raw change represents a 20 % change in your overall FEV-1.

*******

If you have further questions as you go along, I am happy to try to answer

them for you.       Best Wishes,                                  Mark

 

Mark W. Mangus, Sr., BSRC, RRT, RPFT, FAARC

San Antonio, TX

************************

COPDers, a new study indicating what I have shouted about for years – recumbent cycling (trike)…

“…This study showed that an eccentric cycling protocol based on progressive increases in workload is feasible in severe COPD, with no side effects and high compliance…”

COPD. 2011 Jul 5. [Epub ahead of print]

Eccentric Cycle Exercise in Severe COPD: Feasibility of Application.

Rocha Vieira DS, Baril J, Richard R, Perrault H, Bourbeau J, Taivassalo T.

Source

Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada,1.

Abstract

Eccentric cycling may present an interesting alternative to traditional exercise rehabilitation for patients with advanced COPD, because of the low ventilatory cost associated with lengthening muscle actions. However, due to muscle damage and soreness typically associated with eccentric exercise, there has been reluctance in using this modality in clinical populations. This study assessed the feasibility of applying an eccentric cycling protocol, based on progressive muscle overload, in six severe COPD patients with the aim of minimizing side effects and maximizing compliance. Over 5 weeks, eccentric cycling power was progressively increased in all patients from a minimal 10-Watt workload to a target intensity of 60% peak oxygen consumption (attained in a concentric modality). By 5 weeks, patients were able to cycle on average at a 7-fold higher power output relative to baseline, with heart rate being maintained at ∼85% of peak. All patients complied with the protocol and presented tolerable dyspnea and leg fatigue throughout the study; muscle soreness was minimal and did not compromise increases in power; creatine kinase remained within normal range or was slightly elevated; and most patients showed a breathing reserve > 15 L.min(-1). At the target intensity, ventilation and breathing frequency during eccentric cycling were similar to concentric cycling while power was approximately five times higher (p = 0.02). This study showed that an eccentric cycling protocol based on progressive increases in workload is feasible in severe COPD, with no side effects and high compliance, thus warranting further study into its efficacy as a training intervention.”

PMID:     21728805

[PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/21728805

 

COPDers–talk to your doctors- get educated and educate them to what patients CAN DO.

Thanks for reading… Sharon O’Hara

Lung Patients Learn to Eat for Easier Breathing – Wednesday!

Harrison is doing a super job of helping us get educated and this month’s meeting is no exception.

See a video and brief glimpse of last month’s meeting on Pulmonary Function Tests with Joyce Belnap, RRT and successful Reduced Lung Surgery COPD patient Clint Halliday, there with daughter Laurie Schley.   Learn how a spirometry test is taken.  Thanks Harrison!   I also have video of other folks there and I’ll show them from time to time.

http://www.youtube.com/watch?v=bRLkUTWsKIw&feature=youtube_gdata

Harrison Medical Center’s Better Breathers Support Group Meeting Program promises to be a real eye opener and help us learn how to eat the right foods  for easier breathing , sometimes difficult for some of us to learn – “Eating to Breathe Easier.”

Taken directly from Harrison’s online Calendar of Events http://www.harrisonmedical.org/home/calendar/4891

Wednesday, May 18 – 1:00pm – 3:00pm

Better Breathers Support Group

Our Better Breathers support group encompasses community members and their caregivers who live with chronic respiratory disease and lung disease. Better Breathers is designed to provide support, education, networking, and tools to improve the daily lives of those living with these health conditions.

We welcome any community member with asthma, emphysema, chronic bronchitis, sarcoidosis, asbestosis, pulmonary hypertension, pulmonary fibrosis and the many more lung diseases affecting our population, pediatric or adult.

Please email or call if you will need assistance with parking at the meeting.

Eating to Breathe Easier.

Featured Speaker:

Leah Werner, Clinical Dietician

5/18/2011 1:00pm – 3:00pm

Rose Room, Harrison Silverdale

1800 NW Myhre Road

Silverdale, WA 98383

Contact Info

Pamela O’Flynn 360-744-6687

respiratorycare@harrisonmedical.org

If anyone needs a ride, let me know.

Thanks for reading… Sharon O’Hara

FREE Oximeter Readings and FREE Take Home Pic Flow Meter – Lung Patients Meet at the Rose Room – Harrison Silverdale

The oximeter is a wonderful aid to lung patients and Harrison’s BB meeting this month – Wednesday – will offer a spirometry reading to each of us attending.  PLUS!  Harrison’s gifted respiratory folks will teach us how to use the Pic Flow Meter AND send one home with each of us!

http://healthguide.howstuffworks.com/peak-flow-meter-picture-a.htm

Harrison and the  American Lung Association’s Better Breathers look at ALL aspects of lung disease and welcomes all of us – not just the third leading cause of death in the US, COPD (Chronic Obstructive Pulmonary Disease)  Many of us have more than one lung disease diagnosis often leading to heart disease.

If you have an oximeter, they’ll be glad to check the calibration – I’m bringing mine.

I’m also bringing a few extra copies of the Harrison spin off the Old Guy made up for me to use for daily health readings to give to my doctor – in case anyone wants one.

***

Wednesday, April 20 – 1:00pm – 3:00pm

Harrison Medical Center – Better Breathers Support Group

Our Better Breathers support group encompasses community members and their caregivers who live with chronic respiratory disease and lung disease. Better Breathers is designed to provide support, education, networking, and tools to improve the daily lives of those living with these health conditions.

We welcome any community member with asthma, emphysema, chronic bronchitis, sarcoidosis, asbestosis, pulmonary hypertension, pulmonary fibrosis and the many more lung diseases affecting our population, pediatric or adult.

Please email or call if you will need assistance with parking at the meeting.

This Support Group is held the third Wednesday of each month.

4/20/2011 1:00pm – 3:00pm

Rose Room

Harrison Silverdale

1800 NW Myhre Road

Silverdale, WA 98383

Contact Info

Pamela O’Flynn * 360-744-6685 * respiratorycare@harrisonmedical.org

If anyone needs a ride let me know.  360-337-1454

Hope to see you Wednesday….thanks for listening… Sharon O’Hara

Lung Disease Meeting Wednesday

I hope to see you on Wednesday for the next Harrison Medical Center’s Respiratory BB Support Group Program.

I’m disappointed we’re not having the meeting I’d expected with a Sleep Study M.D. doc and an explanation of … “is cycling healthier for a lung patient with right heart failure than walking.”

http://pugetsoundblogs.com/copd-and-other-stuff/2011/02/16/is-cycling-healthier-for-a-lung-patient-with-right-heart-failure-than-walking/

That said,  I’m looking forward to the topic of the newest home and portable nebulizer machines and hope new nebulizer meds are mentioned  In particular, I’d like to know what the latest nebulizer medications are and how they work in comparison to the old Albuterol.

***

Wednesday, March 16 – 1:00pm – 3:00pm

Better Breathers Support Group

Our Better Breathers support group encompasses community members and their caregivers who live with chronic respiratory disease and lung disease. Better Breathers is designed to provide support, education, networking, and tools to improve the daily lives of those living with these health conditions.

We welcome any community member with asthma, emphysema, chronic bronchitis, sarcoidosis, asbestosis, pulmonary hypertension, pulmonary fibrosis and the many more lung diseases affecting our population, pediatric or adult.

Please email or call if you will need assistance with parking at the meeting.

This Support Group is held the third Wednesday of each month.

Dates and Locations

3/16/2011

1:00pm – 3:00pm

Rose Room

Harrison Silverdale

1800 NW Myhre Road

Silverdale, WA 98383

Home Nebulizers and Medications

We have a speaker for you this month from MedEquip Homecare Company.  MedEquip is part of the Rotech family of hometown healthcare companies.  Tony Vondran will be speaking about the newest home and portable nebulizer machines.  In addition he’ll be teaching you about home nebulizer medications and meter dose inhalers and their proper use.

Please join us for our great topic and some St. Patrick day treats.

Speaker:  Tony Vondran, RRT

Registered Respiratory Therapist

MedEquip Services, INC.

Topics:  Home Nebulizers and Medication

Joyce Belnap, RRT

Supervisor

Respiratory Therapy Department

Contact Info

Pamela O’Flynn

360-744-6685

respiratorycare@harrisonmedical.org

***

If anyone needs a ride to the meeting, let me know.  See you Wednesday!

More later… Sharon O’Hara