Friday, June 14, 2013

A Journey of Self Discovery

Yeah, I am going to post more in my blog, that really lasted a long time didn't it.  It must be the ADHD. 

Cancer isn't so bad or scary, at least not to me.  This time I could only handle one round of chemo (did I tell you that already?) landed in the hospital because the blood tanked, scare the doctor tanked, ambulance to the hospital because I couldn't drive myself.  Hey at least I was able to drive to the doctor's office, and get there on time.  I knew when to admit I couldn't do it.

Had surgery (did I tell you?)  They did a Whipple on me.  Took out my gallbladder, 40% of my pancreas, the duodenum, re-routed my stomach and liver and what was left of the pancreas.  Had a feeding tube I didn't use, the damn liquid food made me sick, so I stopped it and ate real food.

My son came back to Virginia to watch over me, thank you Jim, and I will always hold dear to my heart what you said as I started to pass out on the way to surgery.  I have always known that, and wonder how you have ever been able to deal with a nut job like me as a mom.

Jasmine came to Virginia for a week, and it was wonderful to see her, and I have her Dad, Jim Sr, to thank for that.

Surgery was March 13th, I was back to work part time two weeks, or was it three, after that, full time at the end of April.

Now that I may have bothered you with the same details again, on to what has been rolling around my head.

Yes, the thing with the cancer was part of the thought process for a couple of days, and then I started to realize how that since I move to Virginia, I have been on this incredible journey of self discovery.

It is amazing.  I went through a move, got a job in a field I really didn't know much about, got divorced, lost 125 pounds, dealt with cancer twice.  And all through it have been able to see the little changes that have occurred and taken place.

The biggest thing is renting space in my head to people or situations that do not belong there.  Fuss or complain about it and let it go.  Keeping it going around and around in your head does you no good, and gives them the last laugh because they are getting to you even when they aren't trying to.

One change is a trash company I changed to a few years ago that had free recycling containers.  So I got the container, and recycle.  They have the ability to crush and shift the different types of acceptable material.  If everyone could do that it would make a major change in the environment.

And yes, when people come over and toss recyclables in the wrong container I tell them and pick through the trash to put them In the recycle bin.  Right now I have two trash bags of regular trash in the can; it has been 3.5 weeks since the regular trash went out for pick up.  I am amazed at the reduction.

I also got a bunch of fake Tupperware from the dollar store, and like Jim, make several meals at once.  He will freeze them but I just make enough that I will have lunch and dinner for three or four days, then make more.  Some things don't freeze then reheat well.

Another one of the things I try to keep up with but I am bad at is when I go out to eat (last time was when Jim was home, if you don't count the lunch one day last week) take a container and put half the food in it.  Two meals for the price of one.

I'm also more OCD about dust, and I am back to vacuuming twice a week, and keeping the sink clean and wiped out.

Before Jim went back to Mississippi to finish his PHD, I went to Lowe's and bought some window boxes for the deck, and a couple pots.  Filled the window boxes with herbs, and a couple pepper plants, put some tomato plants in containers, and decided to re pot the couple of house plants I ended up with.  Since then I have added a couple flowering containers to the deck and a beautiful Avocado tree that I started from a seed, a really nice size palm tree (Ikea for ten bucks!!! it is 4.5 feet tall!), and a few other plants.  Oh yeah, and two strawberry plants too.  Forgot the lavender, I have to get more of it, it seems to help keep flying bugs away.

I need to rearrange things a bit on the deck, but it is a very serene place to sit and have coffee, or laze in the sun when it come over head.  (Yes I am sitting in my little Oasis now.)

Oh, here is another change/growth.  I decided to compost, and yes, I did my research on it.  I am lazy, and I know it, so keeping my trash to compost and taking it downstairs and hauling in to the back, yeah, it'll happen like keeping up with this blog.  Who knows maybe it will eventually, but it is a big change that I can't do right now. 

I even looked at the electric one you could keep in the kitchen, it composts dairy, meat, everything but paper.  It constantly rotates the stuff,  No odor too.  But if I am trying to reduce my "carbon footprint" doesn't that electricity count?  Grant it is suppose to run on about a dime a day, but still.  Hell, I am trying to keep the AC at 80 when it is hot and humid (if it is 90 and really humid, 80 and low humidity will feel great).  So do I really want to get an electric composter?

Yes, I am composting, but I am worm composting.  Red wigglers, and yep, the compost container is in the house.  It only smells like dirt when I open it.  The worms are doing a pretty good job and fairly quick too, and as long as the paper doesn't have staples in it or the glassine windows in the envelopes, I can add the shredded paper to the compost, napkins and paper towels too, as long as they don't have cleaning solution on them.  But I think the homemade container is better than the one I got from Amazon.  Just saying.

Speaking of cleaning, I found (again) the Heinz Cleaning Vinegar.  6% acidity, it isn't the easiest to find, but worth it.  I have no idea why I stopped using it.  Put orange peels in it to give it an orange scent.  I use it straight, on everything.  Put it in a spray bottle and go to town.  I just make sure that the spray isn't too fine of a mist, because it can irritate the throat and lungs.  Yeah, you smell vinegar, but that smell goes away, and you are left with just clean.  (Make sure to toss your rags that you clean with in the washer when you are done, or you will smell them.)

Last week I did a Spring Clean Cleaning using the vinegar instead of the usual cleaner, house was spotless, smelled clean, and best of all, the vinegar softened my hands rather than drying them out like the Mr. Clean or Pine Sol, or any of the other cleaners I have used.  (The only one I like better than the vinegar was the Orange Clean that used to be sold at Wal-Mart.  I miss that stuff, smelled like fresh squeezed oranges, and did one hell of a great job cleaning the shelter, and a bottle went a long way too.)

The whole point to this is I have changed.  Changed a lot since I left Cleveland.  I have changed for the better.  But the changes didn't happen over night, it took a while, I have been here for five years.  There have been lots of little changes that ended up being bigger changes.

And I am still changing, growing as an individual, growing as a part of the world.  There are still parts of my personality I really don't like, but I am taking baby steps on improving that.  I really do need to start a regular exercise program, not the hit or miss like I have.  Thinking about it now, I really did not like myself at all when I lived in Cleveland.  Now, I do, I even like being by  myself, and am OK with it.  I learned I don't need someone in my life to complete me, only I can complete me.  I am a work in progress.

What started all this?  Cancer.  Cancer really started me on the road to change.  Even in 2003.  It made changes.  Cancer nearly killed me three time.  But I made it, and grew from it, and changed.  Took some time, and lots of little changes but I changed and grew and I am continuing to grow.

Life is good, especially when you can sit on a deck, with ice coffee, two Pitts, know your two adult children love you just for you, can listen to the birds, cicadas and crickets in perfect evening weather.

Yes, life is good.  I hope each and every one of you make little tiny changes that bring you joy.

Wednesday, February 20, 2013

A Whore's bath, and My Hair is in the Sink.

First, let me get something off my chest.  It drives be nucking futs when people refer to either a male or female that has a different viewpoint of sex as a "hoe".  A hoe is a piece of gardening equipment, not a person with questionable sexual behaviors.

For the record, I believe that both males and females can qualify as a whore, it is not a gender specific thing.

Now that is out of my systems, let's get down to the different types of "Whore Baths".  Yes, there are a few, at least the way I look at things, and I will define each (don't worry I'm going somewhere with this).

There is what I would define as the "quickie" whore bath, which I swear more females do, why else would a woman walk out of the house stinking of perfume?  A "quickie" whore bath is when a female grabs a wash cloth, hopefully with some soap, washes her face, gives the netherworld a quick wipe or two, sprays a shit ton of perfume on, put on the make up and out the door. 

Now why do I say that it seems lots of females do this?  Just stand in line at a Starbucks in the AM, or the grocery, or just about any where.  You smell the perfume before they walk in the flipping door!!  Burns the eyes and nose. 

Ladies, that is not attractive!!  That does not make the male of the species want to get any closer to you than he would want to get to a stinking pile of steaming elephant dung.

One spray in the air, walk into it.  A light barely there scent that is attractive.  You don't have to smell it trust me it is there and others will.  It will make you more attractive.

Second type of "Whore's" Bath.  A tub full of hot water, a bar of soap, and a wash cloth.  Dip the washcloth into the tub or basin, soap it up, wash your body, dipping and rinsing and soaping with the dirty water in your tub as you go along, consequently spreading dirty soap scum water all over.  Yeah, not pleasant.

The third type of "Whore's" Bath is the microwaved, pre packaged deodorant wash clothes.  They come with eight or ten in a bag.  The instructions actually break down how to uses them.  One for your face and neck, one for your right arm and hand, one for the left, and so on.  They make sure there are two for the netherworld.  One front and one back.  But at least you feel refreshed, and your skin doesn't feel like ten layers of it was removed with the soap.

The third type of "Whore's Bath" is what I get to experience.  You see, I am hooked up to the pump, and they have a portable heart monitor on me.  In order to get a shower, I have to be disconnected from everything, and that requires a doctor's order.  Yeah, you read it, a doctor's order.

The down side of showering here is the soap.  It dries every inch of you up.  So, I'm going to pack a "Just in case Jean goes to the Hospital" Bag.  And in it make sure I have my soap, shampoo, and things that keep my skin feeling normal rather than like something stretched too thin.

So I get my "Whore's Bath" today, and when I was done I decided to use the shampoo in the little kit to wash my hair.  My head and neck have felt like the muscles are wound tighter than an over wound watch.  So I stick my head in the sink, turn the hot water on, and it felt like heaven.  I could feel the muscles starting to give a little.  So I soap up my hair, and it starts coming out in hand fulls.  I clean out the sink, and keep running the water over my head and neck, and rubbing the hair, and it keeps coming out in hand fulls.

LOTS of hair came out.  I now am sporting the splotchy bald patch look which I hate, so when I go home, which maybe tomorrow, I want to stop at a barber.  I can't walk around like this.

Oh, the Telemetry people contacted my nurse and told him my hear rate went up and is still up, so they sent him to check, and there I am drying the splotchy head.

"That is why your heart rate is up!"  Me: "Yep.  But I'm done for now."  "How long have you been washing your hair?"  Me: "About twenty minutes, I have a lot of hair to come out."  "I'll tell them."  Me: "OKAY DOKAY".

Yes, the sink was full of my hair and I had to clean it out twice.  Yes the sink was nice and clean when it was needed next.

Tuesday, February 19, 2013

No Lemon Slices for the Tea, and a moment of your time please

Nope, can't have any fresh fruit, or veggies.  So basically it all has to be nuked, cooked and dead.

I can't stand the coffee here, so I switch to tea with lemon.  Yeah no lemon.  Huh.  But they do have Mandarin Orange Slices on the menu, every time I ask for them I hear, you are not allowed fresh fruits or vegetables, I say they aren't fresh, they are canned.  They check and I get my Mandarin Oranges.

Now, I like them but it isn't so much so I can have the orange slices, it is so I can pour the syrup into the tea, which helps make it a little more tolerable since I can't have my lemon.  Yeah, I eat the oranges too.

Not sure exactly when I will get out of here, the infectious disease doctor thinks I may be able to go home soon, (he didn't define soon) but I'd have to be on antibiotics.  He was thinking oral, but since I have a port, he is of the IV preference.  Yeah, IV antibiotics at home, but he also said something about keeping me till Friday, he would talk to Dr. King and Vaughn.  Friday?? Is he out of his freaking mind?  But I am still waiting to hear from the surgeon and Dr. Vaughn.  And the consensus of the platelet issue. Hurry up and wait.

Now, I'd like to ask a huge favor from everyone.  My kid sister was diagnosed with breast cancer.  The doctor said it was early, which is a good thing.  She is terrified. The final diagnosis of the type won't be back until the biopsy comes back Friday.  He told her she would probably do surgery, radiation, but nothing is solid yet.  She is on her way to another doctor's appointment right now, she'll call me when she gets done.

I can't explain why cancer doesn't frighten me.  I don't know  how to explain it.  I know the word frightens her.

So if you would please, light a candle for her, say a prayer, send her healing thoughts.  She needs the strength.  She is scared.  Right now she is my bratty little sister who used to be a real pain at times, but she is scared and moral support is what she needs.

And if you know of any breast cancer links for help, support, whatever, I will be happy to pass them along.

Monday, February 18, 2013

Hey can I get another piece of gauze? I'm still bleeding

I'll get around to explaining the title in a bit, it is all a part of the story, the adventure if you will, and yes, I do believe I stopped bleeding, at least it hasn't soaked through yet.  Eh, whatever.

Chemo started on February 4th.  Ten whole days earlier than in 2011.  Yes on February 14th 2011 I started chemo.  Happy Valentine's Day! First day is ok, I mean it went well, by the time the six hours was done, I was tired, but ok.  Made it to wok everyday for an  hour and a half, except for Friday, just couldn't motivate, nausea, hell I couldn't even get two sips of coffee down.  But I dutifully got my ass to chemo and got my ass home.

One of the most disturbing sides effects (only one you ask?) is the fact it has affected my breathing.  What I could normally do three or four times with out a problem (get your dirty little minds out of the gutter!!!! :D) go up and down the stairs, I can't do once with out huffing and puffing for air.  I never knew how much I took the simple thing of breathing for granted. 

I spent Friday, Saturday, and Sunday in bed, except for the doing my laundry, which I didn't put away right.  It is driving me insane that it isn't put away right, and my room isn't right, and my house isn't right, I am literally going crazy over dust bunnies, and I can't help it.  A clean home makes me feel better, any way after letting you into a bit of my quirks, Monday rolls around.  I get up, huffing and a puffing, take care of the dogs, yeah I'm not making it to work.  So I let my boss know and he makes sure I get a ride to my doctor's for my Newlasta shot.

My ride home was Michelle and a stop at the grocery was on the schedule, ten quarts of orange Gatorade were on my list, along with Bob Evans Mashed potatoes and Mac and Cheese.   I waited in the car and Michelle made the run.  Two ice cream scoops of taters were wonderful, then I go crash and burn.

In the morning, Michelle comes up stairs and there I am sitting in front of the dishwasher huffing and puffing, clenching the half and half waiting for my cup of coffee.  I asked her to ask the CWO if it would be ok for me to park in the visitors parking space instead of where we normally have to park because it would make it easier.  She did and he told her to tell me just park there and he would take care of it.

So I did, and by the time I got to my desk I was so happy to be able to sit down.  But I got to work, and I made sure I got back to where I could sit when I felt it hitting a bit hard.

CWO told Michelle to move my car to the handicap spot, and he would take care of it.  I work with the best people.

But I make it through the week, feeling a bit rough, Thursday was ok, but Friday AM I knew I was in for a rough one,  down a couple of aspirin for fever, all I have to do is make it till 1 so I could get to the doctors.  By 1 I was feeling rough, but I could drive, worse by the time I got to the doctor's.  They took blood for my counts and I got to go sit in the office.  Daniel walk in and says, "Oh Honey, you look like hell!"  My response is a laugh, and "And I feel like shit."  Needless to say my numbers in the tank. Doctor wants to admit me, can you drive to the hospital?  Me, nope, not feeling like this.  When I left work I was ok to drive, but I crashed hard and fast.  I know my limits.  So, off I go in an ambulance.  I had Michelle's number scribbled down so they could call her and let her know to pick up my car, I thought I left my phone at home, turns out it was in the car.  DUH.

Admitted Friday, lots of blood taken, my arm is bruised and I look like a junkie.  (Did I mention the hair is falling out?) The doctors talk to me and tell me my blood levels, uh yeah I need transfusions.  I've had bad reactions before to them so they pretreat.  The blood transfusions go ok, and the tests come back my platelets are gone.  So a platelet transfusion is on board.

The first half of bag goes ok, then it hits. I start to shake, the first thing I reach for is the O2, and try to cover up because I start to freeze and shake, just as I try to press the call button my nurse Lisa walks in, next thing I know there are like five nurses, a doctor, and all working to get the reaction under control.  I'm running a fever, but my body is freezing, I am so cold I am shaking so hard I can't breath, I actually have to try to calm the shaking and think breathe in from the nose out through the  mouth.  They cut off the platelets, give me something for the reaction, and I start to feel warmer, so the shaking starts to subside, I stop shaking but I stay covered up, I tell them I'll peel off the layers as I feel warm enough, and as they were all taking in what had happened I started to remove layers of blankets. I scared a few people.  But the nurses are all top notch here.

Next day the Doc comes in says my platelets are still way too low and I need another transfusion.  They want to put a cocktail of Benadryl, steroid, and something else.  Run it slow, three hours, have me checked and vitals taken like every fifteen minutes to thirty.  At the first sign, tickle, or clue from me it stops, and the line gets flushed.

That was the longest, most stressful three hours.  By the time it was done, I had a tension head ache like you wouldn't believe.  Two percosets.  Helped the pain, but didn't do a thing for the tight muscles in the neck and head.  Slept like shit last night too.

Talked to the Nurse Practitioner from Dr. Vaughn's Office today, my platelets are still low and she thinks another transfusion is in order, we talked, and agreed to not do it today, and see what the counts are tomorrow, then if needed the same protocol will be used.  Seems reasonable.  I only wish the same nursing staff were on duty tomorrow.

What caused the reaction?  They can test for disease but they can't test for things the donor may have eaten that you are allergic to, or medicines.  If the donor of the platelets had Vancomyicyn or MSG for that matter.  My body reacts to what it sees as something that doesn't belong.  Not fun at all. 

Rather frightening.  But all is well at the moment.  I am stuck here another couple days.  Still have issues with one type of bacteria growing in the urinary tract, and e-coli growing in my blood.  They think the tumor is some leaching it from the intestine.   No I don't have it, but it is in my blood.  Very weird.

When they told my that I went wait, I do this, this, this and this.  The doctor laughed and said it wasn't my habits but the tumor may have found a way to leach from the bowl.  Yeah, lucky me.

That is the complete update, and I am going to see if I can get some Tylenol for this headache and hopefully get some sleep tonight.

Oh yeah the title, they took some blood to test, did the usual ball of gauze, pressure tape.  Well I soaked through the ball of gauze and had to ask for some more.  It did finally stop.

Friday, February 8, 2013

Day Four - TGIF

Didn't make it to work this AM, the nausea was nasty.  Took a second dose of Compazine and Zofran an it didn't help.  Went back to bed until I had to get up to get ready to show up for chemo.

TGIF.  Last treatment for the week.  The port will be de accessed and I will have two weeks to recover before the next cycle.  I was hoping for three, but I heard the nurse wrong.

I think the chemo is hitting a little harder/faster this time.  Which stands to reason.  I think.  I am already at the point where I want this done and over with, and it is only week one.  I need to work on my patience.

I don't know how I am going to keep it together for another 5 cycles, then surgery.  How am I going to do it?  Everyone tells me I am a pillar of strength, someone with courage.  I keep telling them I am only human, and trying to face this with as much grace and dignity as I can.  Trust me, there are days that it is really difficult.  I don't want to let people down.

I don't want to let my kids, friends and family down.  That would be the worst thing I could do.

I can't lose my sense of humor, I have to keep it sharp, but on days like today it is difficult.

Maybe Pannera potato soup today while the nausea is at bay.

Thursday, February 7, 2013

Day Three, Cycle One, Third Dance

I'm cold.  I have a vest on and a wrap and I am still cold.  May put my jacket on.

Anyway, this day is finding me puffy like the Stay Puff Marshmallow Man.  Even the ice on the eyes to reduce puffiness didn't  help. 

Since Tuesday, I have put on 9 pounds in water weight.  Can you say it is time for Lasix?  I knew you could.

The nausea is a bit worse this time around, and the fog is showing up.  As long as I am in no hurry to get the thought down or do something it works out.  Tired too after treatment, but I'm wondering if it is just because I am tired, or the nausea, I tend to want to sleep when I am nauseated. 

I thought I was on a cycle of one week of chemo and three weeks off, but looking at the list of appointments, it is one week on and two weeks off.  The next schedule is the 25th.  I'll have to double check on that.  Either way you look at it, it is still a lot of chemo.

Thoughts are drifting, time to save this as a draft and come back later.

Well it is later and I don't have any great insights to this mess.  I'm tired and I want my fresh brewed Dunkin' Doughnuts coffee from my kcup. 

Only about an hour to go, getting done a bit earlier today, tomorrow will be earlier.  Then two days to get my head together  for work.

Today isn't the most positive day, I feel run down.  Hey at least I have time to dig through the family tree when I feel up to it.

See you on the flip side.

Wednesday, February 6, 2013

The Third Time Around

Well, I was hoping to get at least a five year break in between bouts of caner, but it seems this time I only get a year. 

I have accepted the fact I will never be cancer free, I am okay with that, all I want is more than one year in between.  I'd of liked to be in better physical shape.  Year one after the huge mess was to be rest, eat, work, get a tattoo, and nothing other than enjoying life, notice I didn't mention working out?  Well I started to and figured I needed to rest from that too.

January 21 I started to feel a little bloated.  Like I was pregnant again and the kid was pushing his feet up against my ribs.  (No I am not pregnant, you have to have sex to get that way.)  The next day the bloating settled into a pain along the right side of the stomach, controllable with ibuprofen, the next day it was worse.  Thursday at 3AM I am texting my housemate, Michelle, can you bring me to the ER?

Three hours later and a CT scan later, the ER doctor came in put my bag on the floor and looked at me with the saddest face.  I knew then.  He told me to make an appointment with my oncologist ASAP.

I looked at him and laughed.  Okay, I was hoping that I wouldn't be seeing him regularly for awhile, and I was really hoping that it would be appendicitis.  Ah well, no such luck.

So the following Monday I am off to see Dr. Vaughn.  Just to hear "You are complicated, I am going to bring your case in front of the Cancer Board Wednesday to come up with a game plan."  Let me tell you something, no woman wants to hear she is complicated from a man, especially so if the man happens to be her Oncologist.

I had to go for a port study because my port isn't operating properly, you can't draw blood but you can push fluid. Turns out end of the tube is right up against the heart wall, so they cannot draw blood. Every time they try to draw blood the suction pulls the tube to the wall.  They can push fluid.  So my blood draws are through my arms.  I hate that.  I am a hard blood draw, tiny veins, lots of scarring, they roll and disappear. 

So thanks to the ER visit, and the visit with the doc and the port study, I have met my out of pocket expenses already.  The deductible is a killer, but I'll deal with that.

So the kibosh has been put on my wonderful plans for 2013.  What plans??  Well here is a short list:

1. Dating. I figured that I would start dating, hey a year of getting the clean bill of health from the doctors.

2. Two maybe three tattoos, already have the design in the head, and it all depends on cost.

Well, the third and fourth I am not going to mention.


Get your damn minds out of the gutter.  If you are a friend of mine it is in the gutter by nature.

The treatment is going to be 6 cycles, 5days per cycle, each cycle is 6 hours long.  The up side is the fact I will be going through one cycle a month, so every fourth week is chemo.  Hopefully this helps with the side effects, but with me you never know.  Feeling the nausea and head ached already, and talk about water weight gain, my face is puffy.  And this is day two!!

I refuse to go through this with a puffy face a sausage fingers, just refuse, they will have to do something about it.  And soon.

I am home for the night, started this during chemo.  Feeling like nap time, but that will translate into most of the night, and it is only 15:30, 3:30 for those who don't think 24 hour clock.


The up side, no radiation.  The tumor is too near vital organs that I need and the radiation would do more harm than good.

Someone said maybe the third time is the charm, maybe the third time will be the last time I have to kick cancer to the curb and I can live life without that shadow hanging over my head.  I can only wish, but as my Dad would say "Wish in one hand, shit in the other" translation, don't waste your life on wishes, actions make things happen.

The optimistic/pessimist in me is how I am dealing with it.  Hope for the best/expect the worst.  The best would be the cancer is gone forever, period.  The worst would be it is gone for a period of time.  Hopefully longer than a year.  Either way, it is a pretty damn good outlook.

I do need to do a will.  I think I will work on it tomorrow, and then get all those damn calls made to make sure the insurance, 401k, have the right beneficiaries and percentages.  Would be nice to have it in one place too.  Hey, better be prepared just in case. 

One side effect of this is about halfway through the chemo I start craving coffee.  Fresh brewed, plain old coffee with a bit of half and half.  Yesterday, I thought maybe Mocha from McDonald's because I don't like their coffee, yuck!!!! Tasted like sugar.  Got home pulled out the Cuisinart (out of Doughnut House Kcups) and made a cup of coffee from fresh ground beans, so tasty.  Then promptly went to bed at 6ish.  (I got home around 5).

Tonight I had to stop at the Navy Fed ATM, and right across the way is a Dunkin' Doughnuts.  So After the ATM, I drove over to the Dunkin' and got the Dunkin' Kcups (expensive little bastards) got home and brewed me a cup.  Ah perfection.

I think the chemo weeks are going to be tough, but as long as I have my Dunkin' Doughnuts Kcups I'll be alright. 

And with that let me leave you my gentle readers with this:  Coffee makes everything better, coffee understands.