Appointment for Zach, and test results for Em.

We had an early morning today.  On the happier side, we saw two hot air balloons on our way to the hospital!  It was a really neat experience for the kids!  By the time we got to the interstate, we had come fairly close to one of them, certainly closer than they had ever come before to one.

I'll start with Emily because our month has been difficult with her.  She had gotten a sinus infection just before we went for her meds two weeks ago.  We started her on antibiotics only a day or two before.  I wasn't overly worried because she was receiving her IViG that week.  Usually that would boost her immune system up enough to kick an infection.  I was surprised to see that her IgG count (immune system) was up around 700- normal.  Hmmm...  I thought that surely with a good IgG and added IViG, she would be just fine pretty quickly.  That was a Thursday and Friday hospital visit.  We also finally had the hand MRI done during that stay, though only for one hand.

By Monday she felt worse.  We went back to her pediatrician, who increased her Augmentin from 1.5 teaspoons to 2.  She also insisted that we give Emily Xopenex in her breathing chamber every six hours.  The very next day her pedi called me on my cell phone, from her cell phone, on her day off to make sure Em was doing ok.  She informed me then that her breathing was so bad that she considered sending us to the ER, but opted instead to check up on us, and ask us to start using the nebulizer.  I had lent that to my parents, so I borrowed it back from them.  Em was seen that Wednesday.  Her breathing sounded much better after 4 rounds of albuterol in the nebulizer.  Phew!  Not out of the woods yet, we were asked to bring her in on Friday for a CT scan of her sinuses.  We couldn't get a Friday appointment, but we were able to have them done on Saturday morning.  I am so glad that we did!  By this Wednesday, since she still wasn't feeling any better, I called our rheumies, wondering what we should do about her infusion the next day?  I also called our pediatrician and had them fax the CT results to our rheumies.  I had six calls to and from the hospital, between the nurses from the infusion room, to the RN that helps keep the rheumies on the same page.

The end result for this was an infusion of IV antibiotics before her Actemra.  The RN had at one point called me and said that her head was still so full that she didn't feel comfortable telling us to come in, but the doctor's ordering the antibiotic changed the game.  She also said that apparently, the roots from Emily's molars are growing into the maxilliary sinuses.  I found that to be rather interesting.  She had a CT of her sinuses a few months ago, and nothing was said about that then.  On my list of questions for next time I will have to ask if this is possibly a result of the stunted growth from her steroids.  I am assuming that her face and jaw are not growing as well as they should be, so this would make sense.  Thinking about the advice of a friend, I believe we will ask them to refer us to an endocrinologist.  (Thanks, KPM!)  I hope to have more answers on Monday when we go back to the hospital to see the ENT.  I have no clue what the answer will be to the molars getting into her sinuses.  As my husband said, that explains the pain that she has had in her jaw lately.  On the bright side, she can now feel the Actemra working.  She was wiped out, but she felt better last night.

The other thing with her is the MRI of her hands.  I was extremely happy to see that there is no joint deterioration, but there is tenosynovitis.  At least now we know why they hurt so badly so much of the time.  We received her TENS unit this week.  We will have to use this to help that.

Zach's appointment was much less complicated.  The end result with him is, while there continues to be signs of progression, there is not enough cause to change medicines.  I am happy with this.  I really do not want to try Humira, mostly because of the burn.  He is experiencing swelling in his right knee and left ankle, but not really any pain.  Occasionally his knee will hurt, but his ankles are worse.  He also has a spot in his back, but it doesn't bother him often.  However, they are not bad enough yet, which is fine with me!!!  His psoriasis isn't so bad either.  He has a spot on both elbows, and his head is starting a bit, but I also held his meds this week because he has been sick, too.  I am glad that one of them is stable.

The funny thing about having two sick kids is that, since Zach is so much more well than Emily, it is hard sometimes to remember that he is sick, too!  It would be lovely if he would hit remission.  We will never lose hope.

Little update

Our little roller coaster is rollin' along.  We went for Emily's first round of Actemra on Thursday.  She says that she doesn't really feel a difference yet, but I think that she is moving better.  We got our hopes up because I found an article that stated many kids can feel the Actemra working within a few hours.  I thought for sure that Em would be one of those kids;  usually if a medicine is going to work for her, she feels it almost immediately.  I still have high hopes that this will work- it just isn't happening as quickly as I would like.  Her hands and toes have been extremely bad, but her knees, hips, back and wrists have been kicking in as well.  She has been back on Mobic every day.  Hopefully when she goes back in two weeks, that round will help.  Actemra is a bi-weekly infusion, which is a pain, but if it works....

Last time, they had ordered labs, then later in the evening they ordered more labs.  I had seen the report from the first set, but I had not seen the report from the last set.  Not only were her inflammation counts down, her muscle enzymes were low.  For a child with Dermatomyositis that had muscle pain and active rash when those labs were drawn, a low Aldolase is weird.  I'm not arguing, mind you.  They took it twice that day.  The first time it was 4.9; the second time is was 3.2.  I still have things to research here, as soon as I can find some time.  They ran another Scleroderma panel.  Something like 62% of people with Scleroderma are negative for the antibody, so I'm not very surprised that she has so many symptoms but she's negative.  Hopefully her MCTD won't turn into full-blown Scleroderma.  We can deal much easier with just "features".

We were home on Friday when my son goes limping behind me in the kitchen.  He was trying to slide by without me noticing, but it's hard not to notice him limping.  His knee was swollen and sore.    It was feeling better by the next day, but still... His knees never bothered him before.  I am hoping it was a fluke and not new joint involvement.

And yet, through all of this I think about how happy my family is together.  I think about how we may be if it wasn't for crazy health problems.  Would we be well if we hadn't had mold in the house?  Would we get along at all if Kevin and 2/3 kids weren't sick?  I am pretty sure that I wouldn't have had the confidence in myself to go back to school.  I certainly wouldn't have the same motivation that I have.   We wouldn't be homeschooling, which I think is really cool!  And we probably wouldn't have a cute new furry member of our family.  (Even though he is a bitey little puppy, he's very loved!)  Yeah, Kevin and I have had a few rough years that I don't know how we got through, but overall I am so happy to see him come home every night.  Who would have thought some 19 years after meeting him that I would still love him?  Or even like him?  :)  Yup, he is my rock and an awesome father.  I thank God for him and the kids every day, multiple times.  I would be lost without those 4.

And of course there are always those that have it worse than us... no matter who you are or what you are going through.  I have shared on my Facebook the story of a boy named Cameron.  About a year and a half ago, Cameron began having seizures.  They couldn't get them to stop, or figure out why he was having them. I believe it was 21 days before he was stabilized, but he was left having to relearn many, many things.  There was some permanent brain damage.  He went home and began the long recovery process.  Just as he was about to "graduate" out of physical and occupational therapy, he was hit with another round.  This past Christmas morning, he began to seize violently.  This time, they had a much more difficult time figuring out how to stop his seizures.  He was on quadruple the amounts of medicines than he should be, but what else could they do?  They finally did stop the seizures.  When they went to take him off of the ventilator, his lung collapsed.  They discovered he had an infection, so he is on antibiotics and they re-intubated him.  They are weaning him off of the ventilator.  However, the doctors still have no idea why this has happened.  He has now defied the odds twice, though he's not totally out of the woods this time.  Please pray for this boy- that he recovers, that he retains his fighting spirit, that he does not give up.  Please pray for strength for him as well as his family.  He has a twin brother.  Can you imagine being that brother???  I can't.  Please pray for him and their other siblings.  I believe that boy is still alive because of the awesome power of prayer.

Another new med coming our way

This appointment went a little more like I expected last time would be.  We have three different rheumatologists working out of our clinic.  We have pretty consistently seen the one male doctor the for the past year, mostly because of the days that we have made our scheduling.  We don't play favorites- I think that they are all fantastic.  However, sometimes there are situations that I feel one really needs to see the doctor with the most experience for, or at least get a second set of eyes for. 

This past six weeks Emily just went downhill.  No, it wasn't nearly as bad as 2010 when she was too tired to roll over in bed and crawling to the bathroom, but it was the worst flare that she's had in a while as far as joints and muscles are concerned.  I am just happy that we got her throat stuff under control before this flare hit.  Every day for the past six weeks something new has hurt.  The pain in her hands- most notably her thumbs- has been the most significant.  One of our occupational therapists had ordered her new splints, and started wrapping her in KT tape to give her added support.  She has still felt pain badly enough to want to rip off her thumbs and toes.  Then her ankle, thighs, knee, shoulders, and wrists decided to kick in, with the occasional shout out from her hips.  The month was miserable for her. 

I had hoped that we would see the head doctor this time, but I didn't expect it because she has been doing a lot of research related work.  I was so thrilled to see her come our way!  I have missed her.  :)  She's just so sweet and caring.  (They all are, really.)  She agreed immediately that Orencia isn't cutting it.  We are going to give Actemra a try.  I had expected this before we started Orencia, honestly.  Actemra was first approved for the Still's Disease (SJIA) kids; recently it was proven effective and approved for poly JA kids.  Since Emily is a mix of things, I am hoping that this works well.  She should be set to start it in two weeks.

The hands are posing more than the usual concern.  We had an MRI scheduled for her hands, but they said that it would be 1 A.M.- a day and a half after the order was sent to them.  We stayed all day today waiting for it, but we just couldn't wait for them anymore.  We're already changing meds so it won't affect treatment; they just wanted to see why they are such a mess.  Our other doc says that her hands are much more scleroderma now than arthritis.  Not what I wanted to hear.  It makes sense, I know.  I would just be more comfortable thinking it was "just" arthritis.  

One thing that I found interesting through this is that her labs look awesome.  You would think that as much pain as she is in, as much stiffness as she has, as much as the rash is coming back out in her knees, elbows and around her eyes, her labs don't show it at all.  I asked the doctor if it was just because we were two weeks later on the IViG this time than usual, and he said likely so.  But one would think her labs would show it.  No elevated inflammatory markers, no elevated muscle enzymes.  Weird.  Awesome, but weird.  This is good to know for future reference.  I know that many adult rheumies assume that if your labs don't show inflammation, you don't have any. 

So, we go back in two weeks to try Actemra, and we hope that the MRI works out in the near future.  And for now, I am going to pass out in my own bed.  I have to be at work in a few hours.  I'll keep ya'll posted!

November appointments

Well, I'm not really sure where to start tonight.

We had already pretty much decided that Orencia wasn't really working for Emily, however I wasn't expecting our doctor to suggest just dropping it and hoping for the best.  Granted, we would be keeping the Rituxan, which she feels is actually helping a lot, but still...  I mulled that over for a little while, and decided that with her recent daily thumb and toe pain, that is probably not a good idea. She has told me that they sometimes hurt so badly that she wants to rip them off.  I totally love our rheumy's- ALL of them- and I think this was the first time the question seemed completely not aggressive.

The night went by uneventfully, with no visit from the doctors until just as I was about to go down the hall to take Zach to his appointment.  Just as we were starting off, one of the other rheumies came over to see us.  She asked me how I felt about dropping the Orencia, and I told her my fears about the thumbs and toes.  She told me that she was not fond of the idea, enough to have mentioned it to the head of the department.  This is part of the reason that I love our team- they actually communicate.  I like our other option much better- instead of dropping Orencia, we will spread it out to every six weeks.  She also asked when our last Prednisone decrease was.  Ummm... long enough ago that I can't remember when.  Well, permission to drop 1/2 of a milligram... granted!  :)  That had me over the moon!  I was so excited!  No, it isn't a huge drop, but it is huge to us!

So, I left our room extremely happy, expecting an easy appointment for Zach and then on to home.  Not so much.  While he looks great, our doc noticed that his toes were swollen.  And they hurt.  And his back has an arthritis spot.  Which usually means Spondylitis in a person with Psoriatic Arthritis.  So, yeah.  Not thrilled.  I was very glad that his appointment was today and not yesterday.  I like thinking our appointments over on the way home.  It's harder to think straight when they keep talking and giggling.  It just hurts your heart to hear these things.  This is not what you want for your kids.  I had really hoped that Zach's would be easier to deal with because we caught it early.  He responded so well to Enbrel at first.  I really thought that this would easy.  He's HLA-B17 positive- that is a psoriasis marker, and it often means a more mild form of arthritis, if I remember right.  I thought we were clear.  So far, it doesn't bother him too much, so it obviously isn't really bad right now.  He has complained of his back once or twice.  He complains of the feet often, and on Halloween it was the ankles.  No changes in meds yet- we are to just keep an eye out and see what happens.  We will go back in 3 months, but call if anything changes.  

On a sweeter note, we were asked by one of the rheumies if we were going to be at the Jingle Bell Walk.  :)  We don't go to that event, only because it is so cold, but I thought it was cute that they were thinking about it, especially since our walk is so far away from the hospital.  I really do love our doctors.  But I would like to put them all out of business by finding a cure, please.  Then we could all just hang out and talk medicine without actually having any medical crises ourselves.  On the bright side, we don't have to go back for six weeks.  Woot to that!    

Oh, and we got a dog!  We swore that we were NOT getting a puppy, and we were NOT getting a big dog.  You know what they say about the best laid plans, right?  We have a shepherd/ husky/ lab mix.  He is three months old.  We were both thinking that he was six months old, but no, he's three months.  His name is Brody, but I swear I may change it to Bitey.  He is definitely like a baby, and so cute!  Assuming I can get his immunizations tomorrow, we should be good to start him in training classes tomorrow!  I am so hoping.  We need to get him to stop biting, and so far the tips that we have found on YouTube are not working.  He is good with the younger kids; it's just me, Kevin and poor Ash.  He especially loves to bite Ash!  She'll be just sitting on the couch texting, and he comes up and starts biting her.  Poor kid!  PetSmart said that they can get him close to therapy dog in training.  I can't wait to start!  I'll keep ya'll posted!

Thankful

Back in 2007 before my children were diagnosed, I was a wreck.  I was extremely depressed.  Nothing in the world could make me happy.  I was crying on my way to work every day.  Yeah- every day.  Aside from trying to raise my family, I had no idea of what else to do with my life- no clear direction.  I was a mess.

After Emily was unofficially diagnosed with Juvenile Arthritis, I was lost... for a while.  I felt hopeless.  Until I stopped feeling sorry for myself and started thinking of how Emily must feel.  After all, she was the one hurting... not me!  I started researching, trying to understand this madness.  At that time, she could barely walk.  Almost every joint was affected.  Her anxieties were extremely high.  She didn't want anyone to touch her.  She couldn't sit on the floor because she couldn't get up. Her kindergarten teacher carried her around school.  Getting out of bed was a huge challenge.  She spent more time in the bath than anywhere else.  And she didn't know what it was like to spend a day out of pain.

Starting Naproxen gave her the first taste of normalacy.  Not that it was enough, mind you.  It took another 8 months to really feel what it was like to be free.  It took 7 months of Methotrexate and then starting Enbrel to help her.  Around that time, the Raynaud's started.  This and some skin tightening made her rheumy feel that perhaps she had Scleroderma.   Oddly enough, this was her good time.  This was the closest she has ever come to remission.  It lasted about a year.

This was also around the time that I realized that she really isn't mine; she was given to me, entrusted to us as parents.  We all belong to God, like it or not.  This is when I learned how to let go, and to trust.  It was pretty tough.  We faced her mortality in a way that no parent should have to.  It was also around this time that suddenly, all around me, I was finding blogs of parents whose children had brain tumors.  I didn't go out of my way looking for them;  they found me.   This helped me to see how blessed we were.  This was also around the time that the little peeps and I went back to church, the only place I can go to cry.  I felt that this was all a way of leading me back home to Him, and bringing the little ones to Him, too.  He was showing me how He was taking care of us.

Emily's diseases have helped our family in so many ways.  We went from being lost and out of touch with each other to being closer than almost any other families that we know.  No, it didn't happen overnight.  It took a lot of work and a lot of pain.  We count our blessings.  We look for the good in everything, because we know that time isn't guaranteed.  The longer she is sick, the more medicines get added to her already long list.  The longer she is sick, the more systemic effects pop up.  The throat issue really scares me.  I have heard of people that require surgery to reopen their throats.  I hope to God that it doesn't come to that.  I refuse to worry about things now until I know for sure that it needs to happen.  We go day-by-day, and we have for so long that it is just habit now.

We expect the possibility that one of the kids will be sick daily, or too tired or sore to go out.  It isn't because they don't want to go places, because they are usually disappointed when they have to miss out, or we rely on her wheelchair.  They have learned to deal with it, and enjoy the good days.  We embrace the good days, and just get through the lousy ones. I truly never know how any day will be.  She is so complex.  He isn't so much, but we need to be careful not to downplay his problems because hers are so much more severe.  I try hard not to trample on his feelings.  My sweet little man.  <3 p="p">
In the midst of this, we have met some of the most amazing families!  This has led me to having some of the coolest friends that I could ever imagine.  Some I have never actually met in person!  My Facebook friends that also have kids with similar problems have become like family.  It is so wonderful to have these people in my life... even if I rarely get the chance to chat with anyone right now!  (This, too, shall pass.)

I never thought that I would ever go to college, or even know what I wanted to do with my life.  Now I have clear direction, and I am empowered by how much I have learned through my research.   I would never have researched if first Emily, then Zachary, didn't get sick.  I have learned all about Dermatomyositis, which took me months to pronounce, as well as Lupus, Scleroderma, Raynaud's, Psoriasis, Psoriatic Arthritis, Spondylitis, and other little things.  I learned what patulous meant,  (spreading widely from a center patulous 
branches, according to Merriam Webster),  and I've learned about esophageal dysmotility and lung changes that warn of pulminary fibrosis.  As crappy as this might be, it has given me a confidence that I never before had, as well as a drive and motivation that I did not have before.  I made a vow to myself to be able to speak with the doctors on their level.  I am 95% there. I am so much stronger than I ever thought that I could be.  Ever.  And the kids?  They are way stronger than I am.
I never, EVER thought that I would be the type to homeschool my children, and yet here I am.  Granted, it is out of necessity, but still... There is no way that she could continue on in public school.  Just simply no way.  She had such a difficult time last year, but that has led to such a great adventure!  Now we have our butterfly garden, crabs and fish.  We have science everywhere!  Everything leads to learning.  I love it!!!  And we are in this together since I am also in school.  We appreciate each other and love each other like we may not have long, because you just never know.  I could get hit by a bus tomorrow.  What regrets would I have?  None.  Could you say the same thing?  Do you have your priorities straight?  Life is too short to worry about competitions and material things when it comes to family.  Drama is way over-rated.  Who needs it?  I don't have time for drama.  We are ecstatic that October wasn't spent with a long stay in the hospital for a third year in a row.  That rocks!!!  Yeah!  We are happy just to be here, just to be together.  That is what matters, and I am thankful and blessed.  Every. Single. Day.

Finally! An October spent inpatient ONLY for meds!

It was October 13, 2010 that Emily was diagnosed with Dermatomyositis, and officially diagnosed with Mixed Connective Tissue Disease.  That week, she was kept inpatient for six days for heavy-duty steroids and other meds, along with a plethora of tests to rule out other not-so-nice diseases.  It was last September 26th that she had the port placed, and it was early October when we realized she had staph in there.  That led to an almost month-long stay.  It broke her heart to have to miss the fall carnival at school and Halloween.  Granted, she was able to trick-or-treat at the hospital, but it just isn't the same.

I am happy to say that this October the bad chain was broken; we had our typical overnight for meds, then we were free to go home!  Thank you, Lord!

I didn't mention Zach again this time to our rheumy.  I believe last month was just a fast psoriasis flare, likely due to the change in weather.  He has a small spot or two, but for the most part it isn't big enough to concern us.  I'm keeping my eye out, and I know he will tell me if anything changes.  We are planning on using the Body Check Journal to see if we can establish patterns for both kids.  If you have ANYTHING that you are trying to figure out (rashes, erratic behavior, allergies, flares, etc) I strongly recommend that you try this journal, lovingly made by one of our favorite arthritis mom's.  She has discovered so much about her daughter by doing this herself, which is how she thought to make the journal!

Em's appointment went better than I thought it would.  Our rheumy was sick, and it was a bit hard to understand him over the noise and through his mask, but we decided together not to make any changes yet.  He said that studies show that Rituxan, Orencia and CellCept in combination are proven to help things like her throat issues, but it isn't something that we can do for more than a few months.  He doesn't want to backtrack before giving the combo a fair shot.  Since it's only been 2 months since she's been on CellCept, and 5 or 6 for Orencia, he wants to be patient for just a bit longer.  I'm good with that.  The biggest fear is her throat, so if this combo will help her throat the most, we will wait.  Monday and Tuesday she received her Orencia (30 mins), Rituxan (4 hours) and IViG (over 12 hours).  Wednesday is the day for her to recover from meds, and for me and Zach to recover from stress, and lack of sleep.  Poor little man has a cold, too.

It is crazy how much has changed with Em in the past month or two.  When people ask me how she's doing, I have no idea how to answer.  Here's why:  yes, the throat problem is pretty big, and scary.  However, she has been running around, trying to hoola-hoop, and she has been giggly.  Really giggly.  She sounds.... happy!  On the flip side of that, for a few weeks there she was taking 2-3 baths a day.  Usually she does that when she's hurting or stiff.  I have no idea what to make of it, but I take the running and giggling as good signs.  It's been so awesome to be home with them more!!!  I expect them both to be more giggly when we change our homeschool program.  We are just worn out from the amount of work they have around other things, like therapy.  We found a new program that I suspect will be the winner for us.  I know two families that use it and absolutely LOVE it.  They have similar situations, so I think this will work well for us.

The steroid weight has started dropping more!  She started steroids at 42 lbs. (and really under weight.)  Two months later she was 75 lbs.  Today she was 60.5!  Her clothes are falling off of her.  I had to go buy her new jeans.  She fit into her FAVORITE pair of old pre-steroid jeans!  So exciting!  I realized tonight that if she is wearing a large shirt you can't see her belly anymore.  This is helping with the activity level, I'm sure.  Oh, I am so glad!  Next month I will ask about the next decrease.  Currently she is on 3mgs a day.

Speech came into our room this morning for a consult, but she was so tired that we couldn't wake her.  Our doc wanted them to see if there was anything they could do to help her swallowing issues.  Being the skittish type, she was afraid of talking to them anyway.  I will have to psyche her up for it next month.  Another thing that was supposed to happen was an ultrasound of her hands.  This is more for the doctors benefit for now, but I suspect that it could have long-term benefits.  He is doing an informal study on ultrasound for Scleroderma hands.  I was unable to get specifics out of him, but hopefully that will also happen next month.  I would like to have the opportunity to help with some of the science involved; being a test patient is great when it's painless!  It may even help her one day.

We are talking much more formally around the house about going gluten and processed sugar-free.  We are going to try!  I expect that it will take quite some time to make the full change, but it may well be worth it.  We shall see!  I certainly want to try.  Since getting into making our own household cleaning products, I have been looking into making moisturizer, lip balm, shampoo, soap and laundry detergent.  I am hoping that this may help.  It can't hurt!  

Last thing to add is that we have a blog guest post up! The Arthritis National Research Foundation has made it their mission to highlight stories like this.  It made my day to see this made it up!  And I believe that is all.  I am so exhausted to I cannot recall anything else.  I am heading to bed.  Have a wonderful day ahead!

May I point you elsewhere for a moment?

We arthritis people stick together.  I have made some lifetime relationships because of arthritis.  It started with blogs.  I found a few different blogs around the time that I started blogging.  I really didn't know anyone else yet.  What I didn't know then was that Florida had its own little JA group going on.  Thanks to one of my favorite AF employees, I was introduced to this group.  It was really cool that people that lived near to each other could easily find each other on one page!  We started meeting up.  Sometimes by accident, sometimes at planned events.  Actually, it was one of our Florida mom's that started me blogging.

 The week that Emily was diagnosed with Dermatomyositis, I logged onto a family computer at the hospital (I wasn't expecting our first visit to the new doctors to last six days) and I found a group invite on my Facebook page.  This led to a group of JA mom's all together on one real-time forum.  This was like an epiphany.  It was just a little bit before this that I met Parker's mom.  

They go through so much.  I "met" them online first, just after Parker was diagnosed.  A few years later and we've shared tears, had our kids (and some of our other favorite families kids) play together.  The kids support each other in ways that their well friends couldn't possibly.  Parker's mom has become an even larger advocate than me.  Their walk team at this past Arthritis Foundation walk raised over $10,000, and Parker had his favorite pro baseball player come hang out with him!  

Parker's mom asked a group of us not long ago what one thing we wanted people to know about Juvenile Arthritis.  Remember, there are over 100+ forms, and when I say JA, I am also referring to Juvenile Dermatomyositis, Lupus, Scleroderma, Mixed Connective Tissue Disease, Psoriatic Arthritis, Still's Disease, etc.  With input from so many different groups, this is the list that she came up with.  This explains why I don't make plans, why we always try to see the good in everything, some of the things that we all think about, worry about, and want other people to know.  We've all said these things, but when you post them all together in one place like that.... it's powerful.  This is one of the best pieces I have personally seen.  Please check it out.