Help me before I read another fifty articles on kidney disease!

[skg]

Hi, All --

Just kidding about needing help! I'm beyond help. (Learning is how I cope.)

I'm relatively new to kidney problems, but I've been diabetic for several years and control it with multiple daily injections of insulin. Unfortunately, between diabetes and hypertension and maybe some NSAIDs, my kidneys have gone from just fine a little over a year ago (serum creatinine of 1.0), to 1.4 this past summer, to 2.4 in November. I was referred to a nephrologist, and they did a bunch of tests between November and February. Except for the serum creatinine (which fluctuated 2.4, 2.3, 2.5), things looked pretty good -- I was hoping to hear I didn't need to see the nephrologist again for three months instead of monthly. Everything seemed to be stable, but my serum creatinine went to 3.4 in March (GFR of 19 for me).That was when the doctor told me to start learning about kidney replacement options. I go back on Friday for the first visit since then to see whether things have gotten worse or not.

So, I've been worrying and obsessing and learning everything I can about kidney disease. Seems like an unusually rapid decline in GFR, so far as I can tell.

So, that's my "kidney" history. As for the rest -- well, I'm a professor teaching computer game design, which I think is about the coolest job possible. I live in an old Victorian house which is just two blocks from campus, so I almost always walk to work. (Even when we're having a blizzard in April, as is the case right now.) Besides computers and games, I also like reading and mathematics, and dogs, hiking, guitar, bicycling, and lots more besides (such as my wife and daughers!).

Did I mention I'm obsessively learning about kidney disease? Then remember I'm a Ph.D., computer expert, and love to read. Gack!

Oh -- I did have good news today -- no sign of diabetic retinopathy at my eye exam. Woo-hoo!

cheers,
skg

a mad professor from "south" dakota

[Bill Peckham]

Welcome - there is no end of things to read. I think this book from the Medical Education Institute is a great resource Help I need Dialysis


They also operate Kidney School web site and Home Dialysis Central. So yeah, lots to read ... not to mention the 454,448 Posts in 27,705 Topics by 8028 Members here on IHD.

[boswife]

welcome and you sound like a wonderful life loven man   You have come to a great place for info.  It seems that you may still be in a place where if you got your diet right, ya might just fight this thing off for a while.  Theres so much to ask, so much to know, and i wish you well.  Looks like Bill has got ya started in the right direction so read read read and join in here with real life others in like situations.    and all the best to you   

[Henry P Snicklesnorter]

.

[MooseMom]

SKG, make it easier on yourself and first look over the three resources cited by Bill Peckham.  I have been obsessing over renal issues for 9 years now, and I can promise that those sources are the very best for a newly diagnosed renal patient who may be facing dialysis.  Since you are a Ph.D, a computer expert and you love to read, I can see you finding all kinds of awful stuff about renal disease/failure.  It will scare you stupid, I can virtually guarantee, so edit what you read.  All of the info you find online will not apply to you.  Read through all of the thousands of my posts, and you will see what I mean.  I am/have been what you do not want to become!  LOL!

[Henry P Snicklesnorter]

.

[MooseMom]

Oh, Henry P, that's so kind of you.  You've gone and made me shed a tear.

[cariad]

skg

There is always room for another member eager to learn. I also cope with stress through research, so I get that. Know thy enemy and all that.

Coolest job in the world is in computer games? We may have to agree to disagree on that one.

Congrats on the non-existent retinopathy. You sound like you've got the attitude to get you through whatever the future has in store for you. Your decline is not slow, but not especially rapid, either. GFR 19 is just on the border of full-on renal failure and it could stay right where it is for years and years or things could unexpectedly improve or you could be starting dialysis imminently. Usually, it's impossible to predict. Exciting, huh? 

I look forward to reading more of your delightful posts.   

[MaryD]

Welcome, skg!       

With all your reading I hope you are aware that foggy brain will probably creep up on you before you get to start dialysis.  In your line of work, foggy brain would not be the most desirable acquisition.  It goes away with dialysis - at least mine did with a vengeance.  If it happens to you - don't panic.

Once again - welcome

[Poppylicious]

  skg!

[skg]

Welcome - there is no end of things to read. I think this book from the Medical Education Institute is a great resource Help I need Dialysis


They also operate Kidney School web site and Home Dialysis Central. So yeah, lots to read ... not to mention the 454,448 Posts in 27,705 Topics by 8028 Members here on IHD.

Thanks for the suggestions, Bill! I've already run into Kidney School and found it a great resource so far. I've read some materials from homedialysis.org as well, also good stuff. I haven't gotten ahold of "Help I need Dialysis", other than the downloadable sample chapter, but I'm planning to. And I've only read a few hundred fo the 400,000+ posts here -- so I've got lots of homework left to do!

cheers!
skg

[skg]

SKG, make it easier on yourself and first look over the three resources cited by Bill Peckham.  I have been obsessing over renal issues for 9 years now, and I can promise that those sources are the very best for a newly diagnosed renal patient who may be facing dialysis.  Since you are a Ph.D, a computer expert and you love to read, I can see you finding all kinds of awful stuff about renal disease/failure.  It will scare you stupid, I can virtually guarantee, so edit what you read.  All of the info you find online will not apply to you.  Read through all of the thousands of my posts, and you will see what I mean.  I am/have been what you do not want to become!  LOL!

Thanks for the suggestions. You are certainly correct about finding all sorts of of awful stuff. I don't know about it scaring me stupid, though. I was already scared! (Probably already stupid, too. )  I'm not sure, but I think it helps me -- sort of an optimistic pessimism? If I know the worst, then whatever happens won't be any worse than that and will probably be better. I do edit what I read though (when I need to), and I do keep telling myself that there are all sorts of reasons why things may be better for me than much of what I read.

I'll have to try to read through your posts so I can understand your advice better.

cheers,
skg

[skg]

skg

There is always room for another member eager to learn. I also cope with stress through research, so I get that. Know thy enemy and all that.

Coolest job in the world is in computer games? We may have to agree to disagree on that one.

Congrats on the non-existent retinopathy. You sound like you've got the attitude to get you through whatever the future has in store for you. Your decline is not slow, but not especially rapid, either. GFR 19 is just on the border of full-on renal failure and it could stay right where it is for years and years or things could unexpectedly improve or you could be starting dialysis imminently. Usually, it's impossible to predict. Exciting, huh? 

I look forward to reading more of your delightful posts. 

So what is the coolest job in the world then? (not sure I'll agree, but I want to hear about other candidates!)

And the "impossible to predict" is starting to sink in. What I've most wanted to know is what's going to happen and when. And I suppose why, as well. I've learned lots about the what, and diabetes&hypertension seem to cover the why fairly well.

But I'm still doing a little bit of grasping at straws -- maybe there is some cause that I can do something about. I know my GFR decline isn't especially rapid in general - but it seems so for the descriptions of CKD/DKD. So maybe there is something else going on that could still be fixed? Probably not, but even if there isn't, it seems like the more I can understand exactly what is happening to me, the better I'm going to be able to deal with it. Does that make sense?

cheers,
skg

[skg]

Welcome, skg!       

With all your reading I hope you are aware that foggy brain will probably creep up on you before you get to start dialysis.  In your line of work, foggy brain would not be the most desirable acquisition.  It goes away with dialysis - at least mine did with a vengeance.  If it happens to you - don't panic.

Once again - welcome

Yes, I've come across mentions of brain fog and it is something I find particularly worrisome. There are lots of symptoms I am not having, but this one seems to have gotten a bit of a grip. Is there a medical term used for this? Most of the accounts I've read have been anecdotal from fellow patients.

On the plus side, no one outside my own head will ever know -- since I've *always* been the stereotypical absent-minded professor.

cheers,
skg

[skg]

Thanks everyone for the welcomes and suggestions!

I am very glad to find an active site. When I first came across IHD, I visited the news page and saw the last update as March 14th, 2009. So I thought the site was moribund.
Checked it out again a week or so later after finding mentions elsewhere suggesting it was still going strong. Nice to find that there is lots of life!

cheers,
skg

[MooseMom]

Please do not read all 7000 of my posts.  That was supposed to be a joke.

I understand the idea of learning and research being an effective coping mechanism.  It is my mechanism of choice.  I regularly check in on websites that are more geared to nephrologists and renal fellows.

http://renalfellow.blogspot.com/
http://www.thekidneydoctor.org/

A great site that serves as sort of a clearinghouse for up to date research and information is RenalWeb.
http://www.renalweb.com/

I myself never had "brain fog", but I was lucky enough to have a pre-emptive tx and never had to go on dialysis.  My mother, however, spent 5 years on D; her kidneys failed for an entirely different reason than mine.  She was in her late 70s at the time, so my experience/impressions of dialysis came from watching her.  I had to keep reminding myself that I was a different sort of patient than she was; this is something you will have to keep in mind, too, as you read through posts here on IHD.  Renal failure has many causes.  Many people on dialysis have co-morbidities that make dialysis a truly traumatizing experience.  Still others are in generally pretty good shape other than having renal failure, and they cope much better with dialysis.  And please be mindful of the fact that people come onto this site to vent and to describe problems.  I think Henry P is the only one who regularly extols the virtues of dialysis, and thank God for that, otherwise we'd all be in a funk!

Good dialysis will help you deal with "brain fog".  The one salient fact that you should come away with after reading through all of these resources is that more frequent dialysis will keep you in better health.  And when you think about it, it makes sense.  Normal kidneys work every second of every day.  If your kidneys are no longer functioning, and if you are on dialysis for only 3-4 hours, three days a week, well, imagine only being able to urinate 3-4 hours, three days a week.  Do the math.

One last thing about "brain fog".  Many people find dialysis overwhelming.  Not only do people have to cope with illness and being on a machine, but they also have to deal with a system that is for-profit and that is rarely "patient centered" as a result of the profit motive.  Many find their clinics to be wonderful and the nurses/techs to be lovely and helpful.  But many clinics are not so well run, and patients have to cope with THAT on top of everything else.  No wonder so many dialysis patients experience brain fog; not only are they not getting adequate dialysis, but their brains are filled with of the other bureaucratic crap.  Imagine having to deal with Medicare stuff on top of everything else!

The only way you will get more dialysis if you are here in the US is to do it yourself, at home.  It sounds like you are generally healthy enough to do that, so explore that option first.  The Home Dialysis link that Bill gave you is a great start.  One awful aspect of chronic illness is the realization that you've lost so much control over your life and your body.  Take as much control as you can.  Home dialysis can help you do that.  If, after careful consideration, you do not feel home dialysis is for you, that's OK.  You can always change your mind.

Diabetes and hypertension are the two most common causes of renal failure.  If you want to protect and preserve the renal function you have left, it makes sense to control those two conditions.  Are your diabetes and bp under control?

Have you yet consulted with a renal dietician?  With an egfr of 19, it is imperative that you do so.  Make this your priority, now.  You will be surprised by how many "healthy" foods are injurious to people with severe CKD/ESRD.

We are here to help.  Please feel free to ask any questions.  The people on this site are experienced, informative, compassionate and eager to assist.  Welcome to our community.

[amanda100wilson]

Welcome.  I second what Bill says about Kidney school and home dialysis central.  I would say that they should be your first port of call and then maybe re-visit here after to find out the anecdotal information.  We are on the whole a positive bunch, but like anyone with a chronic illness we have our good and bad days and I would hate you to turn tail and run!

[cariad]

So what is the coolest job in the world then? (not sure I'll agree, but I want to hear about other candidates!)

Why, social science researcher of course!
(I would have also accepted "vineyard owner" or "playwright".)

Ask my husband and he would probably say "fast, expensive car tester" (which is a small part of his job).

Or we could consult my son (age 10) and he would probably say "football midfielder who is occasionally called upon to demonstrate paragliding technique".

And finally, there is my other son (age 6) and he would undoubtedly respond "street dancing animal rescuer".

So, you've got some options. (And I have to admit, your profession would place second in a photo finish with either of my children, and quite possibly my husband!)

And the "impossible to predict" is starting to sink in. What I've most wanted to know is what's going to happen and when. And I suppose why, as well. I've learned lots about the what, and diabetes&hypertension seem to cover the why fairly well.

I remember in preparing for kidney failure the second time that it was all a great big puzzle and I did not know where to start. First question to consider: transplant, yes or no? If no, then that is a whole other learning curve that you won't be on and you can put your energies elsewhere. If yes, you are below GFR 20, start the listing process.
In terms of preparing for dialysis, which you will need to do at this point whether you also go for a transplant or not, pick your modality (PD or hemo) and then you will know where to go from there. As for the exact moment that you will either need dialysis or transplant, that is the great unknown in this. I was told dialysis can wait to be initiated until my GFR went below 10 (it never did) or until I just felt awful. So, really, much of this is down to you determining if you feel bad enough to start or not. It doesn't sound like you do at the moment, so that's great.

But I'm still doing a little bit of grasping at straws -- maybe there is some cause that I can do something about. I know my GFR decline isn't especially rapid in general - but it seems so for the descriptions of CKD/DKD. So maybe there is something else going on that could still be fixed? Probably not, but even if there isn't, it seems like the more I can understand exactly what is happening to me, the better I'm going to be able to deal with it. Does that make sense?

Right! Now I see what you are saying. Yes, this is a very good point, makes perfect sense. Your decline should not be compared to the whole of people in kidney failure but instead to others with your condition. If your glucose and blood pressure are always in good range, then I can see why you feel that something else might be afoot. I don't have diabetes, but quite a few members do, so perhaps they have thoughts about whether this all sounds familiar or not. I'm assuming you're type II? If any place will have the answers or suggestions you seek, it's here, so do stick around.

[skg]

Please do not read all 7000 of my posts.  That was supposed to be a joke.

Darn! I thought I had plenty of light reading for the summer. Now I'll have to find something else.

Thanks for the links. Yes -- I've been reading articles from medical journals of various sorts, standards of practice, and so on. These look promising!

... And please be mindful of the fact that people come onto this site to vent and to describe problems.  I think Henry P is the only one who regularly extols the virtues of dialysis, and thank God for that, otherwise we'd all be in a funk!

Of course -- I understand that people come to vent and describe problems. One of the reasons I think this place is vital -- other sources aimed at patients tend to not mention or gloss over problems (and there's never enough detail, anyway). Maybe people tend to take the virtues of dialysis for granted? Looking at it from the perspective of not-quite-there yet, I'm awfully glad it exists as an alternative.

Good dialysis will help you deal with "brain fog".  The one salient fact that you should come away with after reading through all of these resources is that more frequent dialysis will keep you in better health.  And when you think about it, it makes sense.  Normal kidneys work every second of every day.  If your kidneys are no longer functioning, and if you are on dialysis for only 3-4 hours, three days a week, well, imagine only being able to urinate 3-4 hours, three days a week.  Do the math.

Yes -- seems fairly obvious. I'm hoping for a pre-emptive transplant, but if that doesn't work out, I'm thinking home hemodialysis looks most promising. (Or self-cannulation if I end up doing in-center.)

One last thing about "brain fog".  Many people find dialysis overwhelming.  Not only do people have to cope with illness and being on a machine, but they also have to deal with a system that is for-profit and that is rarely "patient centered" as a result of the profit motive.  Many find their clinics to be wonderful and the nurses/techs to be lovely and helpful.  But many clinics are not so well run, and patients have to cope with THAT on top of everything else.  No wonder so many dialysis patients experience brain fog; not only are they not getting adequate dialysis, but their brains are filled with of the other bureaucratic crap.  Imagine having to deal with Medicare stuff on top of everything else!

I live in a small town in South Dakota, the middle of nowhere, or next door to it -- but just two blocks from where the local, not-for-profit dialysis center is. I've visited it already, and imagine it would be fairly comfortable. But the thought of traveling and ending up in some random center terrifies me.

The only way you will get more dialysis if you are here in the US is to do it yourself, at home.  It sounds like you are generally healthy enough to do that, so explore that option first.  The Home Dialysis link that Bill gave you is a great start.  One awful aspect of chronic illness is the realization that you've lost so much control over your life and your body.  Take as much control as you can.  Home dialysis can help you do that.  If, after careful consideration, you do not feel home dialysis is for you, that's OK.  You can always change your mind.

Diabetes and hypertension are the two most common causes of renal failure.  If you want to protect and preserve the renal function you have left, it makes sense to control those two conditions.  Are your diabetes and bp under control?

Have you yet consulted with a renal dietician?  With an egfr of 19, it is imperative that you do so.  Make this your priority, now.  You will be surprised by how many "healthy" foods are injurious to people with severe CKD/ESRD.

Diabetes is in good shape. I've gradually been adopting a lower  and lower carb diet, and that, along with frequent testing and multiple daily injections are doing the trick. I'm somewhat dreading that I may have to deal with a nutritionist biased against low-carb diets, though. The ADA diet they recommended when I was first diagnosed would have killed me (or killed me faster), I think.

We are here to help.  Please feel free to ask any questions.  The people on this site are experienced, informative, compassionate and eager to assist.  Welcome to our community.

Thanks again! I'd love any feedback on home hemodialysis and/or self-cannulation.

Get to visit the nephrologist tomorrow (no, later today), and see what my numbers are this month.

cheers,
skg

[skg]

So what is the coolest job in the world then? (not sure I'll agree, but I want to hear about other candidates!)

Why, social science researcher of course!
(I would have also accepted "vineyard owner" or "playwright".)

Ah. I can see that. But the social science research option would depend on what the research topic was though. So ... ?

Ask my husband and he would probably say "fast, expensive car tester" (which is a small part of his job).

Or we could consult my son (age 10) and he would probably say "football midfielder who is occasionally called upon to demonstrate paragliding technique".

And finally, there is my other son (age 6) and he would undoubtedly respond "street dancing animal rescuer".

So, you've got some options. (And I have to admit, your profession would place second in a photo finish with either of my children, and quite possibly my husband!)

Good choices!

I remember in preparing for kidney failure the second time that it was all a great big puzzle and I did not know where to start. First question to consider: transplant, yes or no? If no, then that is a whole other learning curve that you won't be on and you can put your energies elsewhere. If yes, you are below GFR 20, start the listing process.

Hoping for a pre-emptive transplant. But won't know until lots of screening tests are done. Got a packet from one of the two nearby transplant centers today. How on earth do you choose between centers? (Assuming you live close enough to more than one to have a choice.)

In terms of preparing for dialysis, which you will need to do at this point whether you also go for a transplant or not, pick your modality (PD or hemo) and then you will know where to go from there. As for the exact moment that you will either need dialysis or transplant, that is the great unknown in this. I was told dialysis can wait to be initiated until my GFR went below 10 (it never did) or until I just felt awful. So, really, much of this is down to you determining if you feel bad enough to start or not. It doesn't sound like you do at the moment, so that's great.

I don't feel particularly bad yet. It's mostly just fatique, which has crept up on me so far.

The school I teach at has been shut down for the past two days due to a blizzard that went through, so I caught up on my sleep a bit. And I get tomorrow off, so I can have a colonoscopy and then it's the weekend. Practically a vacation!

I get to see the nephrologist tomorrow late afternoon (go in for the colonoscopy at 7am, Yuck!) -- so hoping that he his schedule isn't messed up due to the blizzard. I *really* don't want to wait longer to hear how my numbers are doing.

cheers,
skg

[MooseMom]

skg, you're a smart man who loves to do his research, so you probably know this already, but I'd feel like I'd be letting you down if I don't make this point clearer...

A RENAL dietician is a particularly valuable resource to anyone who has severe renal impairment ALONG with diabetes.  A renal dietician who has a diabetic patient will not be anti-low carb diet, but WILL be anti-potassium and anti-phosphorus.  Severely damaged kidneys do not adequately filter these two minerals from the blood.  A molecule of potassium is too large to fit through the glomeruli, and a molecule of phosphorus is too "twisty".

Potassium is an electrolyte, so too much (or too little) potassium interferes with the electrical signals to the heart.  Remember Karen Carpenter?  She didn't die of anorexia specifically; she died of a heart attack brought on by too little potassium.  So, a renal dietician will tell you to avoid foods high in K, such as bananas, avocados and plenty of other foods that are great for healthy people.

Too much phosphorus can result in a parallell rise in calcium in the blood.  Too much phos results in a leeching of calcium from the bones into the blood.  This calcium can be transported through the bloodstream to settle in soft tissue.  Imagine having boney bits of calcium deposits in your eyeballs.

In none of your postings have I seen mention of either of these two minerals, and this worries me.

I apologize if you already know all of this!

[cariad]

So what is the coolest job in the world then? (not sure I'll agree, but I want to hear about other candidates!)

Why, social science researcher of course!
(I would have also accepted "vineyard owner" or "playwright".)

Ah. I can see that. But the social science research option would depend on what the research topic was though. So ... ?

Oh, I like the heavy stuff to be sure. Right now I have a major decision to make - continue toward my Ph.D by studying members of this very population (people in organ failure seeking transplant, as one prof stated, I'm the ultimate insider) or skip the myriad hassles of academia and just write a book that no one will read on that same topic, or do what I'm doing now and just spend all my time dealing with the everyday minutiae of life and let time slip away from me.
I have been involved in various projects, none of them light, and I guess I like it that way. I love analyzing cultures, would love to study populations in Africa. Ethical considerations aside, one of my favourites is the Milgram study. It taught us so much about people's response to authority, but you'd never be able to conduct those studies now. (Probably not a bad thing.)

Hoping for a pre-emptive transplant. But won't know until lots of screening tests are done. Got a packet from one of the two nearby transplant centers today. How on earth do you choose between centers?

I really, really, REALLY want to answer this question but I don't want to get into it in the Intro forum since we're really not supposed to. Would you mind creating a new topic in the transplant section? Burying these crucial questions in your intro will mean that you'll probably only get my opinion (the *best* opinion, I'll grant you, but hey, you might not realize this as you'll have nothing to compare it to). I think picking your transplant center wisely is of the utmost importance. And if you're willing to name names, someone here may have experience with one or both hospitals and you can get the inside dirt.

'Yuck' is an enormous understatement when it comes to colonoscopies.... and having to be anywhere at all by 7AM! Best of luck with it!

[skg]

Potassium ... phosphorus ...

In none of your postings have I seen mention of either of these two minerals, and this worries me.

I apologize if you already know all of this!

Just getting started learning about it all. Don't remember my numbers for those, but they were all in the reference range for the lab. Is it a mistake to think they are OK, for now?

Is there an order you would prioritize learning about them? (considering I've also got to learn more protein and sodium)?

cheers,
skg

[MooseMom]

If your K and phos are within normal range, are they on the high end of "normal"?  It was not long after my egfr dropped below 20 that I had to start taking binders, and well before that, I had to start really watching my K.  So, if these values are within normal range now, keep a very close eye on them.  Can you tell us what those values are?  What do your latest labs say?  Even though you don't remember offhand, can you get that information?  You may find it useful to keep copies of all of your labs so that you can see any trends that are developing.

Dietary protein makes the kidneys work harder, so pre-D patients are told to keep the intake of animal protein to 3oz a day or less.  Avoid sodium wherever you can.  The best way to do this is to avoid commerically processed foods.  Anything from the deli and anything in a can should be avoided.

Davita's website has a lot of good information about the pre-renal diet.

I think I'd prioritize potassium first, then phosphorus, but they are both very important.  High serum postassium can have more immediate adverse affects.

[skg]

...
Oh, I like the heavy stuff to be sure. Right now I have a major decision to make - continue toward my Ph.D by studying members of this very population (people in organ failure seeking transplant, as one prof stated, I'm the ultimate insider) or skip the myriad hassles of academia and just write a book that no one will read on that same topic, or do what I'm doing now and just spend all my time dealing with the everyday minutiae of life and let time slip away from me.
I have been involved in various projects, none of them light, and I guess I like it that way. I love analyzing cultures, would love to study populations in Africa. Ethical considerations aside, one of my favourites is the Milgram study. It taught us so much about people's response to authority, but you'd never be able to conduct those studies now. (Probably not a bad thing.)

Heavy stuff is definitely interesting, and I think this very population is quite interesting, too. Not sure about the Ph.D. versus book versus minutiae, though. They all have their attractions, and drawbacks. What would you do with a Ph.D. if you got one? (That you couldn't do without one?)

Hoping for a pre-emptive transplant. But won't know until lots of screening tests are done. Got a packet from one of the two nearby transplant centers today. How on earth do you choose between centers?

I really, really, REALLY want to answer this question but I don't want to get into it in the Intro forum since we're really not supposed to. Would you mind creating a new topic in the transplant section?

Done.

...
'Yuck' is an enormous understatement when it comes to colonoscopies.... and having to be anywhere at all by 7AM! Best of luck with it!

Colonoscopy was early, but not too bad otherwise. Except whatever anesthetic they gave me made me cough the whole time and I've got a sore throat now as a result. The results were good -- everything clear -- so it should be a while before I need one again.

Then saw the nephrologist later in the day -- my creatinine is slightly better, but he said it was time to get in touch with a transplant center regardless. So, which one is a question to resolve quickly.

cheers,
skg