Hiatal hernia + 3 fractured vertebrae = pain/fear for life

[teddog]

41 minutes ago, sailorjon said:

UPDATE:  

I will add to this little by little, I'm exhausted.  I went to Penang, Malaysia hoping to get SOMETHING done that would improve my situation as almost six months later and lots of my little money spent on tests, doctors, hospitals and medication and no treatment!  No improvement.  Still day and night pain and discomfort.   Now, however, in addition to 3 fractured vertebrae and a hiatal hernia I can add Heart disease.  Let me explain.

 

The gastro doctor in Penang said it was a bad idea to operate on hernia now because a: i am so weak with breathing problems that it would be dangerous to go under anesthetic.   b:  he didn't think the hernia had anything to do with the breathing problem, but thinks its the heart.

 

I explained that two weeks ago, I had gone to thai hospital and done a complete heart check and they said heart is ok.  He said still, get another opinion.

I saw cardiologist there.  He said did the thai hosp do the most important test?  blood flow to test for blockage, ie angiogram.    no, they didn't.  he said I should.  ok.  but at that hospital it is $1300 u.s.

 

I find another hosp with a machine like a ctscanner just for angiogram and go there.  It is also about $400.  They do a pre-test which is a calcium in the blood check with the machine and it reveals i have a lot of C.  so the machine cannot be used because it wouldn't show the images correctly.  I would need a normal angiogram.  However, the doctor, who was the best doctor I've seen yet, suggested that the calcium pretty much indicated a heart blood vessel blockage which was probably the reason for the shortness of breath.  He said I should get the angiogram later to confirm.

 

However, he could begin prescribing medications that he would prescribe if it is true.  So, while this is not a happy result, I now am aware that I PROBABLY have heart disease problems, there does seem to be progress in getting an actual fing diagnosis from the med community.  And some medication that represents a possible treatment that might have a positive impact.

 

 

 

Shoot,   $1300,just seen a quote for 3200 baht for angiogram   8 hour stay  india

[sailorjon]

Really!  Do you have that info?  Sounds good.  I keep getting prices doubled and tripled here in BKK.

[teddog]

9 minutes ago, sailorjon said:

Really!  Do you have that info?  Sounds good.  I keep getting prices doubled and tripled here in BKK.

 

Been looking at your thread a while now, yes could have saved you a bundle, did not want to upset Sheryl .  India was the place you should have sailed to...again whatever you think or thought or wanted   just google it  but put India into quote    That procedure you want  angiewhatever google it with India in quote   starts 3200 ...average price  7000 baht   keep to Calcutta  nearest to BKK       get short visa  the doc will give you covering letter for overstay

[Sheryl]

To conclusively diagnose this, you would need the angiogram and it is customary, if blockage is found, to do a stent placement at the same time. 

 

Medications will at best reduce the symptoms but not correct the blockage and, if it is present, you are at high risk of a heart attack.

 

Angiogram plus stent placement if done at Chulalongkhorn will cost about 150-180K, more if multiple stents are needed. I previously recommended the cardiologist Prpf. Taworn  Suithichaiyakul to you; in addition to weekly hours at Sukhumvit Hospital he can be seen at Chula (and for possible angiogram/stent, you'd want to use Chula, way too expensive at a private hospital).

 

 

[lopburi3]

As said the angiogram is basic cost but if any blockage more than about 70% will likely require angioplasty and stents to keep open and that will increase cost at least 10x with cheapest options/you can save a bit using bare stents rather than medicated (both upfront and with later medications) but it is very expensive as stents cost a lot.  But they can make a world of difference.

[teddog]

These figures are in Rupees,just halve them for baht.    stents not inc. but i know they were mass producing them there for general public and better ones are available.

 

  Do not know where to start with your ailments, but perhaps general hospital (something like Christian hospital Calcutta) and start from there

Angioplasty in Kolkata (with Cost).htm

[Sheryl]

He should start with a good intervention cardiogist, be it in Thailand or India or wherever.

[teddog]

Hello Sailor,  

       Not heard from you for a bit,.   hope your boat has not sunk!  Sailorjon i did look around other cities Bangalore is a cheap place for hospitals too,   supposedly 20 world class heart hospitals  (Chennai has 25)as well as cheaper airfares, nothing there actually except endless hospitals, I'll put up an option if you do not mind...

Angioplasty in Bangalore - Google Searchaaaaa.htm

Angioplasty & Stents - Cost, best Hospitals and more.htm

 

If you tell them there is a hole in your boat and flat broke, compromise  I got 50% off an op there in India a couple of months ago , world class too, but I'm sure they loaded price to get knocked down (and no boat)

 

Yes are rupees, halve them for baht

[sailorjon]

Hi all.  Still afloat! And I so appreciate all the good and helpful comments, Shiela, Teddog and Lopburi.

 

I think India seems like a good choice.  I've given BKK a chance and they saw an ATM machine who could die in the street for all they cared if I didn't have the colorful paper to hand over.  [hey, I know it's not just here but... galling I spend everything I have here... ] And no treatments just more tests, inconclusive, and more referrals for more consultations.  If I continue I think they would have me see as many consultants as possible and load me with medicines! and I don't think they talk to one another so they really seem incompetent to treat wholistically what is happening with me! because it is more than one thing, multiple conditions.  I need Dr. House and instead I'm paying top bkk dollar for Doctor Who!  Who went to medical school?  Who graduated in the bottom 50%? Who has enough experience and training to save me rather than kill me? 

 

So, I found this place right away.  Very close to bkk as you say.  http://desunhospital.com/angiography.php     

 

But, I have another option and I want to ask the advice of my forum helpers [that's you guys]...

 

I still think there is a chance to get the health insurance I purchased last month to pay for these costs.   That would solve a lot. Let me explain the situation, and maybe someone has an idea.  Because if they will pay, I could go to Bumrungrad or another top facility for treatment here.

 

The issue is Pre-existing conditions.  When I applied for this insurance with Pacific Cross I told them about the fractured vertebrae, hiatel hernia, and hypertension diagnosis.  So these are not covered.  But,, 

 

In one of the documents,  under EXCLUSIONS, it includes this:

 

'Investigation and treatment of hypertension. The consequences of hypertension, such as heart attacks and strokes are covered under the policy.'
 

So, perhaps, this means the insurance will cover the angiogram and any and all necessary treatment after that for a heart condition including angioplasty, bypass surgery etc..  you know, the lifesaving, necessary procedures I, and most of us cannot afford.

 

What do you think?  And then what, should I go to a hospital like Bum... and exhibit my hard to breathe condition and ask for them to help diagnosis it?  Giving them the Malaysia doctor report...  Of course this time I would try to be sure they would pay before incurring costs.  I'm so tired of thai hospitals lying to me and then I'm stuck with the bill.  I had them check with insurance before the heart check a few weeks ago, told them confirm first.  Seemed to be confirmed but at cashier, no.  I had to pay.  This is some of the crappiest treatment, I've seen mafia organizations in films that are less heavy handed in their blackmail.

 

And how to get this covered in full and not just under OPD which is only 2500/day?  Ayaah now I have a headache.  I need another consultation.

 

Ok, I need to stop now.  Or I will rant and become short of breath and I don't have any expat rant coverage. yet.    cofefe. 

 

I will check out your links, Teddog.  Thanks for the info Lopburi and Shiela.  180k or more from my pocket would mean saving a year or more, if I still have energy to work.  So, I must light candles at the local temple and look for another way.    Update soon.  Thanks!

[Sheryl]

From the wording of the policy you describe it is possible the angiogram (and stent if indicated) would be covered. However as it is a new policy they will give the claim extra scrutiny and if they find that you had symptoms suggestive of heart disease prior to getting the policy that could be an issue.

 

It should be possible to find out in advance by going through the pre-approval process.

 

 

[jpinx]

Just a quickie to say that you really really need to clear the bowels movements.  You might be passing some softer stools but still have a concreted-in blockage.  It might take an excessive amount of laxative, and diet is so very important now.  Drink gallons/litres of water, fruit-juice, non-fizzy, not chilled, minimum 3 litres per day, preferably 5.  Yes - not chilled and not fizzy.  Plain old bottled water at room temperature is best.

 

Then get the standard blood tests for myeloma done by someone who actually knows what they're talking about. Ask the professional questions about their experience and the number of patients currently under their care.  You need to diagnose your doctors qualifications to treat you before he lays a finger on you, so do some reading on the non-sponsored health websites like the Macmillan trust in UK.  bloodwise.org.uk  Falling on your ass might have been the best thing that happened to you - inspiring you to get early enough tests to make myeloma more readily controllable -- if that's what you have.  Early blood test are not conclusive, but the results will be used in many ways. 

 

Pain control is tricky, since everyone has different levels of tolerance, and it depends if it's a pain you can locate, or if it is all-over pain like you've been tumbled down the street under an artic. It also depends what the local pharmacy has on offer.  Even paracetamol varies considerably by brand names and price, with the better results not always being the top-of-the-range price-wise.  Stay away from anything too fancy like tramadol - they mess your kidneys (and head).  You might be able to get something called "Longtec Oxydonon" which will stay working on your system for around 12 hours, and reacts well with paracetamol. 

 

Good luck - I won't go into too many details on a public forum, but sufficient to say that I know this road :)  Feel free to pm me for the gory details.

 

 

[Scott]

A post has been reported and removed.  

[sailorjon]

thanks Shiela. I guess I just have to go to the hospital and try to see if it's approved.  And thanks for that info jpinx, very helpful also.  I will follow up.  I continue to believe there is definitely some core problem involving bowels , intestines etc..  abdomen continues always bloated and hard and uncomfortable whether eat or not.  And movements not good, it seems I'm I obviously am stuffed up with crap but ignored by all the doctors so far.. I'll keep trying

[sailorjon]

Anyone know what was the removed post?

[Flustered]

4 hours ago, sailorjon said:

Anyone know what was the removed post?

Welcome to the club. You will never know.I think that Iris Dement sums it up.

 

Let the Mystery Be

 

https://www.youtube.com/results?search_query=iris+dement+let+the+mystery+be

[sailorjon]

Ha! Thanks flustered.  I think you're right.  Iris has the good philosophy for life.  But,,, I can't help wondering...

Good version of that song with Natalie Merchant and David Byrne:  

 

[sailorjon]

UPDATE:

 

jpinx was suggesting Laxido.  See if it clears out a blockage.  

 

I researched Laxido.  I was prescribed Forlax 10g which seems to be the same. I have been taking it for a number of weeks with some results but weak not very productive, as they say.

 

The interesting info on drug site for me is:

 

The faecal impaction diagnosis should be confirmed by appropriate physical or radiological examination of the rectum and abdomen.

 

If patients develop any symptoms indicating shifts of fluids/electrolytes (e.g. oedema, shortness of breath, increasing fatigue, dehydration, cardiac failure) Laxido Orange should be stopped immediately and electrolytes measured and any abnormality should be treated appropriately.

 

well, my most recent severe crisis involves all those except no cardiac failure yet.    I wonder if the forlax is responsible for the shortness of breath, et al?   This is nuts.  I could really use professional care.  Its driving me crazy. 

 

So, perhaps I should find out how to get my electrolytes measured so I can have this abnormality treated appropriately.

 

[Sheryl]

If I am not mistaken your complaints of shortness f breath well predate this medication.

 

In addition, the electrolyte disturbance mentioned occurs only when there has been a lot of watery diarrhea in response to the medication, which you do not report.

[sailorjon]

 

My BM's are usually watery diarrhea to semi watery.

 

I'll have to check my timeline and when I started Forlax exactly but, I've had SOME shortness of breath since the start of this.. but..  not very strong in effect and not very often... it changed dramatically in character when, ?  about a month ago now i think, time is squirrely, i have to take better notes with dates I guess, but..  this is ridiculously overwhelming.  

 

Oh, here's a positive change I can report!  The pitted edema has lessened dramatically.  Feet are no longer ballooning everyday and night.  Using the usual modern scientific method we patients have... [ I will take a guess] perhaps it's because of the new medication I have been taking from the heart doctor in Malaysia.

 

If that's not it?  I'll win the lottery and then hire a doctor to tell me.  In the meantime, perhaps massive doses of gin will help the pain.  I think experimentation is in order.

[teddog]

Just now, sailorjon said:

 

My BM's are usually watery diarrhea to semi watery.

 

I'll have to check my timeline and when I started Forlax exactly but, I've had SOME shortness of breath since the start of this.. but..  not very strong in effect and not very often... it changed dramatically in character when, ?  about a month ago now i think, time is squirrely, i have to take better notes with dates I guess, but..  this is ridiculously overwhelming.  

 

Oh, here's a positive change I can report!  The pitted edema has lessened dramatically.  Feet are no longer ballooning everyday and night.  Using the usual modern scientific method we patients have... [ I will take a guess] perhaps it's because of the new medication I have been taking from the heart doctor in Malaysia.

 

If that's not it?  I'll win the lottery and then hire a doctor to tell me.  In the meantime, perhaps massive doses of gin will help the pain.  I think experimentation is in order.

7

Hello again Sailor,  

       AS the title you originally put up 'fear of life' it should read 'fear of a good crap '    Just that sailor   completely forgot I had prostate op a few months ago,(smooth as silk) but doc said I would rip all his good work out if I was constipated, r so I bought from fascino a bulb shaped plastic holder with whatever liquid was in it and a 4 inch tapered plastic tit is attached, if not ambidextrous, then you sit on it and body weight takes into your anus and squirts the substance up the pipe, works wonders Sailorjon, anyway long story short I only used it once and still plenty left, if you PM me I'll send it to you   , no money wanted...

     I figure my problems were connected with diet...years ago lived in Parker AZ , middle of the desert stuff, steak and eggs every morning, then a sail down the Colorado sat on the butt compounding it all...moved to Flagstaff and stopped the steak and eggs (and diet) now can shit through the eye of a needle

  

[jpinx]

38 minutes ago, sailorjon said:

 

My BM's are usually watery diarrhea to semi watery.

 

I'll have to check my timeline and when I started Forlax exactly but, I've had SOME shortness of breath since the start of this.. but..  not very strong in effect and not very often... it changed dramatically in character when, ?  about a month ago now i think, time is squirrely, i have to take better notes with dates I guess, but..  this is ridiculously overwhelming.  

 

Oh, here's a positive change I can report!  The pitted edema has lessened dramatically.  Feet are no longer ballooning everyday and night.  Using the usual modern scientific method we patients have... [ I will take a guess] perhaps it's because of the new medication I have been taking from the heart doctor in Malaysia.

 

If that's not it?  I'll win the lottery and then hire a doctor to tell me.  In the meantime, perhaps massive doses of gin will help the pain.  I think experimentation is in order.

The "instructions" written on medications are necessarily broad-reaching and really a cya for the manufacturer.  Without proper consultation you are experimenting -- for every patient there is a different solution.  Having said that -- semi-liquid movements can easily pass a serious hard blockage.  Mix-n-match-ing the various doctors recommendations is haphazard - to say the least.  You run are serious risk of clashing side-effects.  Focus on the really basic essentials.   Plain water - lots of it, exercise, especially walking, maximum sitting time 20 minutes at a time,  light diet - no meat, bread, eggs etc - stick to fish, green vegetables, fruits. 

 

Until you sort out your bowels you can not really know what else is happening.  A bad, long-term blockage affects everything - blood counts, pain levels, brain function, etc, etc. 

[Sheryl]

He is taking opioid pain killers for his back problem, and this is likely the main reason for the intractable constipation,

[Patsycat]

Syrup of Figs works wonders for constipation.

[teddog]

Ahoy there Sailor,

 

    Hope you feel better now..yes we have some things in common  sailing and our waste management systems...you having a dump, me? having a piss...but the doc raked me out recently and now can piss for the planet,I miss the bowl constantly, have the bleach on standby, comes out of now like a fire hose, piss on the dog sometimes when caught short too, god it's one powerful jet, after years of a dribble.  

                 sorry, you are having probs tho, I'll send you the device I have got, you never know..sat there having a dump and next minute up to your armpits in shit...but heaven sent in essence.

 

   Have a good one sailerjon         just found out the device with the 4 inch tit on it is about 38 baht

[jpinx]

19 hours ago, Sheryl said:

He is taking opioid pain killers for his back problem, and this is likely the main reason for the intractable constipation,

Indeed - but diet can help a lot with bowels.  It's a tricky balancing act between the painkillers and clearing the blockage.  From my own experience it was better to suffer a few days reduced painkillers and seriously tackle the blockage.  In my case Laxido at maximum permitted dosage did the trick, but it's not a happy couple of days.  Once the bowels are cleared then painkillers will not upset a good diet -- and the other issues can be addressed. 

 

It has to be said that tackling multiple issues is tricky even when there's a team of medics in the loop -- doing it on your own is very hit-and-miss, hence my suggestion that he clears one thing at a time where possible, before getting caught up in the confusion of the various side effects of other medications. 

 

 

[teddog]

How are things, sailor?   not heard from you for a bit, hope the fear of death or whatever has not turned into it, yes septic shock or whatever connected to the overly bodily containment of shit.

  We all have our probs  sailor..me?  I'm only half the man I was , after prostate op I fear I'm firing blanks, God help me!!, I would never had the op if I had known, the GWP (great wet patch) is now missing just after the vinegar stroke, I hate it, going back to the doc and see if he can do something about it, the John Henry was always an important part of life here in Thailand,... US/ UK forgot about its use with those  huge asses hanging out of their pants

  Anyway please do not forget the power of prayer Sailorjon, if it can move mountains it sure can move those bowels of yours

[sailorjon]

No, teddog… 'grateful for a good crap' .. You know, you don't appreciate things so much as when they are gone.. And that includes…

 

Re, the enema option, perhaps I should try.  I know it sounds strange but when it was suggested before I didn't act on it because with my 3 fractured vertebrae and bending, twisting , reaching,  or sometimes even just walking results in intense, stabbing back pain and I couldn't imagine how I could do this 'procedure'.  [although, and I just can't stop my mind from going there… ha,, I'd say the hospitals have perfected their abilities in this regard. ]

 

I'm sure diet is involved, I take responsibility for decades of bad choices and mistreating my body.  Now, I would just like to survive these ongoing crises, stop the pain, get real diagnosis, and try to reverse the conditions as much as possible for the duration.   I can change diet and lifestyle but if I am to continue day after week after month a walking bag of pain, weakness, discomfort, and incapacitation almost room bound as my muscles atrophy with no real help or treatment from the medical professionals while the last of my money goes to them then I might as well go out with wine, cheese, porkfat, cake and a song.

 

Lastly, there is something strange about this condition that seems more than just constipation.  Sheila is right,  this has dragged on for so many months I've had to use pain pills and that surely has contributed to the constipation.  But since I had the fall and the stomach hernia, the whole abdomen is hard and bloated and uncomfortable all the time.  I mean like being pregnant.. I've been constipated before it's never been like this.  Even when I don't eat.  And then I can eat only tiny bit and feel so full.  One doctor said he thought there was air in the abdomen, but offered no solution.  AND,, whenever I mention this painful condition I'm told the hiatal hernia, in their experience, has nothing to do with this but.. No diagnosis or treatment offered. 

 

Perhaps I need to try to get an Endoscopy and a colonoscopy to find out more information and discover if there is a blockage because I'm just getting pills and lifestyle change advice that ignores the crisis/pain aspect and is impossible to do!   Standard boilerplate from 'im a doctor 101' textbook like :  'Get plenty of exercise'  [err , but now,, I have this possible heart condition so a 10 minute walk leaves me gasping..weak as a kitten and almost feint at times.. How exactly does one exercise…?]  or 'eat smaller meals but more of them 4 or 5 times a day'  [er,, but if I eat a small bowl of soup I'm full all day, and my abdomen is like a rock  because nothing passes!!!  And, it would have to be snacks because I don't have the energy to cook up 4, 5 dishes a day or go out to eat ,,, see above re: heart condition.

 

And what about the fact that I have been taking laxitives now for over 5 months!  Everything I read says this is not good.  Obviously, I need a competent doctor/medical team to manage my case but don't so it's a mess.

 

Prostate operation that went smoothly?  Good to hear a success story.

 

Jpinx is correct, I think, that things have been made worse by my getting different meds from different doctors and mixing them, it’s a mess.  

 

Patsycat… Syrup of figs? Ok,  I will try it. Where can I get it.

 

And teddog … sounds like you have a very powerful evacuation system now! Ha!  My back pain changes weekly up and down and recently its better, so I might be able to do this.  I may try to buy one but.. No no I can't imagine being successful without boo coo pain in back..  Im as weak as kitten.. Ayyahhh   I don't know maybe

 

Jinpx - ok, I might try that.  I'm about out of pain pills now, and I've been trying to use them much less.  The forlax I have is the same as the laximo I think but I usually take one packet.   I will try hold off on pills and then drink down about 8 packets at once and maybe bust the dam and have at least one of problems solved.

 

Teddog, that sounds difficult:  post-op prostate op [ha.  Say that 5 times fast ]  russian roulette with no bullets in the chamber!   It's another sore issue with me, John Henry was driven into hibernation from the beginning of this sad saga of mine, as basically one pleasure after another has been taken away.  It's very humbling.  Prayer helps, and I practice meditation and buddhist chanting and study and learn all I can from this in terms of living in the now, being grateful for what still works, and slowing down, being forced to focus on serious health issues and be practical, assertive.    But, come on this began in december last year.. Jeez

 

Good news is the swelling is gone, thanks I think to the pills from malaysia cardiologist whose function the webpage said is to allow the salt not to be retained causing edema for patients with conditions like congestive heart failure..  And this week, I can walk longer without feeling I will collapse and getting very short of breath.  I don't know why, perhaps the meds from malaysia doctor, taken them more than two weeks now.  I don't know if it will last or get better or change back, everyday/week its different.

 

And.. My next move.  I still need to consider the 'heart issue'  the latest most serious news and get the diagnosis confirmed with an Angiogram to see what's what.. Will I need angioplasty, etc..  And for any of this, I must get the insurance I now have to pay because I can't afford it.  And I believe they should…

 

 

So, tomorrow I have an appointment at the hospital, Vejthani, where went to have the 'comprehensive' heart check done before going to Malaysia [ See season 4, episode 27 'insurance denies payment even though Jon had the hospital call first'.. A real tearjerker ]

 

As we all remember, our patsy, I mean hero, Jon limped to the hospital complaining of serious shortness of breath, weakness, and swelling legs and feet.  Cardiologist did blood test, xray, and echocardiogram declaring heart looks good.  It's not the heart causing the breath problem.   What is then?  No answer.  But.. You should see lung specialist for tests and also diabetes doctor.    And here are some  pills.

 

 

Then, I went to malaysia saw other cardiologist who asked: did they do 'angiogram'  the most important test, which shows your blood vessels, if they are blocked it would cause those symptoms and its serious.  A high tech test confirmed too much calcium in blood and the cardiologist there said that shows him I have a blockage and that is the cause of the breath problem.  However, I should confirm it with angiogram.  He then prescribed pills as if there was a blockage.

 

So, I will go to see the same doctor here in bkk, Vejthani that said it's not the heart, show him the new results, and try to get an angiogram done and paid for by insurance.

 

Should be a barrel of fun tomorrow morning.  After that, I can make decisions on how to get mri for back problem and I will try to blow out my colon with laxitives!  May the force be with me.  Wish me luck! 

[teddog]

You are making far too much of this, We all have HH  , yes mines big, ..probably bigger than yours,  number vertebrae 3 and 5 kaput, I'm a lot older than you and still living and breathing.

 

  Stop all medical visits in Thailand,they will thrash you on price,  visa,and air ticket Calcutta   , cheapish hotel, (near a pub)  (Tripadvisor)   following morning local taxi,about800 baht from 8am to4 pm  he will take you all over,  smallish hospital, tell them your problem    Every procedure here will be expensive, there cheap, but ask prices first, Flexi return air ticket.

 

 Stop walking   swim

[Sheryl]

While I agree his emphasis on the hiatal hernia is likely misplaced, I don't think he is making too much of a potential cardiac problem. That needs to be investigated. OP I continue to suggest you see the cardiologist I recommended previously rather than taking pot luck with random one.

 

Normally a stress test would be done to help determine if an angiogram - which is invasive and comparatiovely expensive - is indicated. Your back problems rule that out but there is a "chemical stress test" that can be used in such instances.

 

You may run into issues with the insurance company simply because coronary artery disease does not develop quickly and you took out the policy recently. They will look critically at your medical records in terms of how long you have had the shortness of breath for.

[lopburi3]

Having taken the chemical stress test at Bangkok Hospital last year prior to cancer surgery can say it is not unpleasant at all (and I did find treadmill very unpleasant).  It is marginally invasive as they must carefully add chemical to your blood while monitoring - believe I had two RN's as well as doctor present during procedure.  It also required scheduling (although I had without full normal fasting due an opening becoming available while I was at hospital).

 

Agree getting cardio checked should be a priority - getting arteries cleared can make a huge difference in how one feels if there actually are issues.  Been there too.