Merry holidays

Mom sitting with the choir at the Christmas event.

Tom, Scotty and I went out to First United Methodist to hear the choir last Sunday night. Mom has been back to choir practice for the last couple of months and was able to participate in the Christmas event! It was more than an event really - there was a professional cellist, concert singer, band and two solo rock guitarists, full drum set, baby grand piano...I couldn't think of anything that was missing. The choir director even picked up a set of bongos during one of the songs and he even managed to pull of a couple of solos as well.

Mom came over to our house on Christmas Eve for dinner - Ethan and Scotty were there as well and Tom's mom Anne also joined us. We opened gifts that night and then lounged around on Christmas Day. It was a nice holiday and nice to think about having a good year in 2015.

Great outlook for rest of 2014

Mom had a check up visit with Dr. Porubin on Friday and all signs point to good for the rest of this year. Her CA125 has dropped to 6.5 and the rest of her counts are good as well. She can finish out the rest of this year on a good note and not have to look to any more chemo hopefully for a while.

Mom has returned to her church choir and is singing in the big Christmas event coming up (should be a feature since the new sanctuary at First United Methodist was completed this year) and she and some friends went out Friday night to see the Holiday Pops at the Mark. We ventured out shopping on Saturday and hit one of our favorite places in Atkinson and then headed to downtown Geneseo to check out some of the new shops there.

Thanksgiving is at my house this year and she always makes her famous cranberry sauce (with fresh cranberries) which I look forward to each year. Usually there are plenty leftovers so that I can have cranberry sauce every morning for breakfast for a week.

We are definitely going to enjoy the holidays!

Mesothelia Awareness Day, Sept. 26

Since starting this blog for mom back in 2009, my sole intent was to just keep my family updated…however, I have had the chance to correspond with many other cancer bloggers who are either survivors, or support someone who is living with cancer. There are many stories and there are thousands of people out there with cancer – ovarian, uterine, liver, lung, pancreatic – you name it. Someone has been affected by cancer. Just this last year, my boss lost both his mother and father to cancer, and over the summer my in-laws lost a loved one to a cancerous brain tumor.

Cameron, Lily and Heather Von St. James

This blog has also given me opportunities to connect with other families affected by cancer. One family I’ve been in contact with - Heather and Cameron Von St. James - asked if I would help spread awareness about annual Mesothelioma Awareness Day, Friday, Sept. 26. Heather Von St. James was diagnosed with pleural mesothelioma at the age of 36 shortly after giving birth to her daughter Lily and was only given 15 months to live. After the diagnosis, most mesothelioma patients are only given about 10 months to live. Fortunately, the cancer was caught early and Heather was able to have a procedure done that involved removing her right lung. Because of that life saving surgery, Heather can call herself an 8-year survivor…and each year she looks forward to tacking on another number.

We know the main cause of Mesothelioma: asbestos. I’ve always known about asbestos, and I work around asbestos-laden areas every day (it is contained). I’m continually amazed at how such a ubiquitous material was widely used back in “my” day - the 70's - and was once used in consumer products that included household items such as toasters and hair dryers.

You could still be using a toaster that has asbestos in it.

The most unfortunate part is that asbestos can reside in the body for YEARS and mesothelioma will lie dormant in the body for 20-50 years after someone is exposed to asbestos. And, just like with Ovarian Cancer, the symptoms of Mesothelioma are subtle and can be misinterpreted or all too frequently ignored or dismissed by people who are inclined to attribute them to common every day ailments: chronic cough, back pain, shortness of breath.

I feel that if I can help spread awareness about cancer, then someone else can also add their voice to the collective and hopefully we can prompt people to pay attention to their body and know the signs before a cancer gets out of control. Some cancers are preventable and can be eradicated if caught early. 

Heather has a great story – www.mesothelioma.com/heather - and it encourages me that there are many stories of hope out there just like Heather's and my mom's. It is Heather and her husband Cameron’s mission to reach out and ask people to spread the message about mesothelioma awareness to prevent this from happening to another family.

And if the unavoidable happens, then sharing information about other cancer success stories can give people hope. As I have learned with my mom's story, hope can mean all the difference.

UPDATE: Here are some additional links about Mesothelioma awareness sent to me by another blog reader! 

• https://mesothelioma.net/mesothelioma-awareness-day/
• https://mesothelioma.net/mesothelioma/ 

Happy Birthday!

Mom and me at the McCann/Brewick reunion summer 2014.

Today mom turns 76! We (the fam - Tom, me, Scotty, girlfriend Stephanie, Ethan, girlfriend Andrea) took her out to dinner at Pinnacle Country Club on Saturday to celebrate. Mom had a big plate full of pork chops, sweet potato fries and side plate of fruit. She almost made it through the whole meal except she had to take one chop home.

We are thankful that there is a lot to celebrate again this year. She made it through a few chemo sessions and Dr. Porubcin feels she's good enough to coast for awhile, so we can look forward to the holidays and not have to worry about chemo sessions, side effects, etc.

Happy Birthday Mom!

Doxil free September

Teal Toes!

Mom did not have a chemo treatment yesterday – Dr. Porubcin decided to hold her off for now as her blood counts were good. The CA 125 crept up a little to 10, but that’s not a big jump and we are used to it going up and down a little.

Mom will get her blood counts done every 4 weeks and Dr. Porubcin will see her in 12 weeks to review things and see where she goes from there. If she needs another treatment of Doxil, she can get one as she has not reached that cap. Mom had an EKG done last week and that came back normal, so it looks like the Doxil hasn’t had too much of an effect on the heart tissue.

Today mom is going to get a routine scan so that Dr. P can check on her lymph nodes and see if there are any changes in size. 

Overall mom feels pretty good (aside from a broken rib - minor slip and fall not serious) and having a chemo-free September will give her good cause to celebrate her birthday on the 15th! Haven't talked to her about any plans but if we do a get together I will let everyone know. 

Meanwhile my toes are teal for September’s Ovarian Cancer Awareness month! I know cousin Gayle painted her toes as well! Hopefully we will see more toes! 

Chemo day

Mom and little Miles. 

Mom and I had a whirlwind weekend traveling to Indiana for Jeramy's wedding. Despite the 5 1/2 hour (each way) car ride mom wasn't too worse for wear... even though we missed the wedding because of the time zone.

We still were able to visit with everyone and mom enjoyed seeing Aunt Ruth and Uncle Bernie along with Greg, Demara and kids. We met little baby Aurora and got a few snapshots in while she sat still for a half a second. Miles and Camden kept us entertained at the reception. Jeramy and his new wife Megan are a cute couple and their friends were hilarious.

Today is a chemo day - mom will go back in next week for an EKG so they can check her heart muscle. As she is getting to the threshold level of the Doxil, they need to keep a check to make sure Doxil hasn't damaged the heart tissue too much. Once she gets to the Doxil max then I guess they will look to see what other cancer drugs are a good fit for her type of cancer.

Summertime reunion

Mom has been a little more fatigued than usual after chemo treatments this time around, but last week she had a pretty good week. Dr. Porubcin gave her the clear to go back to choir so that makes things a little better. Her feet are pretty raw and she has to keep them on ice sometimes, but she's keeping up with it so they look the way they look. That is one of the side effects of Doxil and something to deal with.

It has been a busy June. Weekend before last we went to Iowa City for a wedding - good friends Bill and Nancy Craig's grandson Brandon married his high school sweetheart at the Old Capitol. The Craig's and lived right "up the hill" from us when we lived in the Hazelwoods, and mom and Nancy have been friends for ages. Bill and dad were friends as well and their entire family stepped up quite a bit after dad died. They are usually the first ones I call if I need to talk to them about mom.

Then last weekend was the McCann/Brewick Family Reunion was at the Ottawa Lions Club park. There were a handful of us there and it was a nice day to spend in the park. Mom's cousin Virgil's cousin David (from the Brewick side) was in town with his wife Kay from Colorado. The other usual McCann suspects were there - Peggy and Ron, Aunt Carol, Aunt Rosemary & Uncle Steve, Alaina, Baby Rayland and myself. It was nice to see cousin Janie (Brewick) and her girls Carly and Gracie as well as cousin Melissa (Brewick) ((haven't seen her in years now she has a family!)) and then distant? cousin Scott (I think he's a cousin from some branch of the family) and his mom Beth. They are from a McCann but I always forget if it's Mabel or Mildred.

I just saw Linda and Sonny a couple of weeks ago as they came to Rock Island for a festival, so it was like we were old friends.

In July mom and I are heading to Indiana for cousin Jeremy's wedding. We are both looking forward to that as we haven't met Greg and Demara's little girl Aurora. Mom couldn't get enough of the twins the last time they were around and she is looking forward to being around the little tikes.

If things go well for the rest of the summer she may look into a couple of trips here and there. Why not?

Chemo reschedule

Mom was scheduled to have another dose of Doxil today, however Dr. Porubcin thought that it was best to reschedule it for next Tuesday. Mom's CA125 was great - (8!) - however she is coming to a point where she is reaching the maximum amount of Doxil that she can have.

Apparently there is a "lifetime maximum dose" (I learn something new each time it seems) for the amount of Doxil mom can have put in her body before it starts doing damage to her heart. Often I forget that chemo drugs are designed to kill - and yes they kill cancers but the chemo drugs also do damage to tissues that aren't cancerous. So the long and the short of it is that she is approaching that "lifetime max." Dr. Porubcin wants to stretch out this timeframe as much as possible so that Mom can get the most benefit out of the drug.

Dr. Porubcin is very happy with the results from the last two doses. Mom's CA125 has dropped considerably. Unfortunately the side effects (like her blistering feet) are happening just as fast as well. Her feet were bothering her a lot over the weekend as the heat and humidity intensifies the rash. The good part is that she isn't really having to many other issues.

So mom will have her third Doxil dose next Tuesday, and then in July she is going to try and schedule it so that it can be done after nephew Jeremy's wedding. We have a wedding to go to later in June as well so if we can get through this wedding season she should be sitting good for the rest of the year!

Second treatment

Mom made it through the second treatment yesterday without a hitch. There wasn't any doubt really, but we will just have to keep watch over how the side effects go since her feet are already blistering and cracking.

The nurse said her CA125 was down to 29 - a HUGE DROP. As excited as mom was to hear that, we both hope that the CA125 stays down through the rest of her treatments. As of now Dr. Porubcin wants her to have at least 7 which will take her through October.

The best part of the day a surprise from Chad. He decided to come to the Quad Cities for a few days, so he and Scotty drove out to Geneseo to pick mom up for chemo. She was surprised and happy to have some time with two out of the three grandsons at least. It is really hard to get all three of them in the same place at the same time now that they are adults, so we will take what we can get.

Chemo rescheduled

Mom didn't get her chemo treatment today after all. After meeting with Dr. Porubcin he felt that she needed another week before getting another treatment, so she will go in next Tuesday again.

Her port area is still very tender and putting a needle in would be very uncomfortable. And she has already started getting blisters on her feet (they never really healed after her previous Doxil treatment) and they are very inflamed at times. She can put ice packs on them to cool it down a little, but her feet are already a mess. Cream will also help somewhat. I brought her two new jars of Udderly Smooth so she is set for a couple of weeks at least.

Dr. Porubcin is also going to reduce the Doxil dosage slightly - from 40 ml to 30 ml. He feels that should be a good mix to attack the cancer yet reduce her side effects a little. We won't know until we get into the treatments more, but Dr. P. is concerned that her feet are showing the signs already.

She did get some good news from the lung doctor though - she won't need to see him again as her lungs have healed properly. The spot where the doctor put the chest tube in will be quite sore for a while though. It still bothers her and probably will for the next few weeks.

Mom, Rosemary and Carol having a chat at the wedding.

On a lighter note mom had a busy weekend - we went to a family wedding in Ottawa. My cousin Alaina's son David married his girlfriend of two years (or so give or take I think) Katie. The wedding ceremony was wonderful and the colors Katie chose were very cool - her "inspiration piece" was the colors of a peacock feather and everything was done in those hues of green, blue, purple with black accent. Great concept.

So we ate a lot of food (mom did put on a few pounds thankfully when she weighed in this morning) and danced (not mom) and then went to Ransom church Sunday morning. It was a fun weekend and mom enjoyed being around family. We had a nice surprise and saw some old neighbors from Hazelwood who were at the wedding - the Sowers. Turns out they are the bride's Aunt and Uncle. Small crazy world. It was fun to see them and mom got a kick out of Bob's usual demeanor to her "What are you doing here?" and "Who invited you?" Of course mom gave it right back to him - that is the way that it goes.

Happy Easter

A great day for Easter - fantastic church service and message at First UMC in Geneseo; mom was feeling good; a killer brunch at Pinnacle and the weather was beautiful to boot.

We felt very blessed. She is looking forward to the family wedding affair this coming Saturday. Cousin Alaina has forewarned us: "Make sure you bring your dancing shoes!"

Still trying to get mom the hang of doing a selfie.

World Ovarian Cancer Day

Once again, May 8 is World Ovarian Cancer Day. Last year was the first year for the event, and I think it has built some awareness about Ovarian Cancer, but we can always use more awareness. At this point, that is the best defense against the disease - knowing the symptoms, knowing your body and taking the time to be aware of what is going on with your body. 

As my mom knows, the symptoms are subtle and can be too easily confused with other body ailments. I have signed a pledge to share awareness on May 8 - it's easy to sign up and easy to spread the word, whether it's talking to people, using a blog or putting something on Facebook. 

Sign the pledge >>

Restful evening

Mom had some good periods of sleep last night and this morning said she was feeling rested. It makes all the difference in the world to be at home. 

Today she isn't going to do much, and Scotty is going to head out to her condo later this a.m. and make sure she doesn't do what she says she's not going to do! 

Home finally

The hospital released mom right before lunch so she has been home since about 1:00 p.m. and doing fine. She has a few follow up appointments next week with the pulmonary doctor and then a reschedule with the surgeon who put the port in her chest as she missed that follow up yesterday.

She is happy to be home! Thanks to everyone for the well-wishes and prayers! Her lungs are both expanded and the Physician Assistant said this morning that there is no detection of pneumothorax issues from what they could see on the x-ray.

Mom is a little fatigued but overall feeling good and pain-free. I'll be keeping an eye on her, and Scotty is planning on helping her out in the next few days as well. Mom also has some great neighbors who will be keeping their eye out - so mom knows she has to behave herself!

Going home!

The nurses wheeled mom down for another x-ray bright and early this morning for one more look at the lungs. The report was good, and the doctors said that mom can go home this afternoon. They also took her off the oxygen.

She is feeling much better this morning and looking forward to getting out of the hospital! I'm thinking that they will release her after lunch.

They didn't give her too many restrictions either - she just needs to be mindful of lifting, etc. She will have a few follow up appointments next week. We need to get the weight back on her (she is down to 95 pounds) so that will be a priority - food! I'm sure we'll be doing some Culver runs... and Geneseo has a new Casey's now. I still haven't tried their pizza so that will be on the list too.

Busy afternoon

Flower garden on the window sill.

Mom had a busy afternoon. The morning x-ray results were good, so the doctor took the GARDEN HOSE out of her right lung much to mom's relief. Her pain level went down dramatically after that.

She sat in the chair for awhile and ate lunch, and then had her mind on getting back to bed and taking a nap when my friend Kathy stopped by to say hello and how's it going... etc. About 10 minutes later someone announced that it was time for another x-ray and that her "transport" was ready (for the last couple of days they have been bringing the x-ray machine to her in the room; but since the tube was out of her chest that was out of the question now and mom had to go to the x-ray machine). So they put her on a cart and wheeled her down to the basement - I went along as I wasn't too trusting of the "transporter"(there's another story there). After the joy ride to the basement mom was looking forward to a nap, but the Physical Therapist said it was time to walk the hall.

Somewhere between the afternoon activities we set off a few alarms because I thought I could just help mom to the restroom instead of calling a nurse. I didn't know they had a bed sensor attached to her as well, so when her bum left the bed, a REALLY LOUD alarm went off. After I got the IV cart situated with all of the cords I turned around and the whole floor of doctors and nurses were standing in the doorway.

Mom finally got her nap though.

I'm hopeful that someone will come in tonight and have the most recent x-ray results. If they are good then she could be going home tomorrow, maybe. That's not confirmed. There was a short conversation earlier about whether or not mom was going to need someone to check on her at home. I'm sure we'll talk more about that tomorrow.

The good news is that she is feeling much better today!

Good night's sleep

Mom had a good night's sleep last night thankfully. The "garden hose" (that is what she calls it) in the side of her chest is uncomfortable, but the nurses have been on top of it and have helped mom manage the pain. Mom did get up and do a little walk down the hall yesterday so hopefully she can get some more activity in today.

The nurses did an xray again this a.m. so hopefully those results will be good. Dr. Porubcin was in early to check on her and I think that he was happy with her progress.

If the xray looks good maybe they will take the garden hose out this afternoon. Then she may be able to go home tomorrow. It always seems like this is all a big waiting game but the doctors and nurses want to make sure that mom heals properly (as we all do!) so we will wait.

To be continued...

Improvement

Today has been an up and down day. The nurses clamped the pleural-vac (the thing that has the tube going into her lung) to see if mom's lung could maintain the respiratory functions. She did fine with breathing, but the tube coming out of her lung is still painful and making her very uncomfortable.

She ate very well today otherwise - better than yesterday.

The nurses took an xray of her chest of 5:30p and the results were pretty good - there was some change in her right lung...not fully expanded but better than Friday; the left lung is the same. So they are going to keep the clamp on the vac and see how she does through the night, and then take another xray in the morning. If the results are good on that xray then they will take the tube out of her chest and see how she does from there. The nurses and doctor seem to be hopeful.

But in mom's words "you better be sure my lung is good before you take the tube out because you are not putting another tube in my chest again." That is how bad it hurt and mom is not one to complain really.

Mom received some flowers today and my sister in law Lisa came by for a visit. Chad called her from Chicago and she was happy to talk to him for a bit. She has been getting calls on her cell phone too so that seems to make the day go better. Hopefully she will get a good night's sleep tonight and have good results in the morning tomorrow. She wants to go home.

Anniversary day

As good as the afternoon was yesterday, mom had a tougher time as the evening wore on. The pain from the chest tube was irritating and making it hard for her to sleep, but I think that after a while she eventually got a good 4 hour doze down. 

She ate a good breakfast this morning (half her oatmeal) and she looks perky-er but there is a little bit of pain still in the chest tube area still. Dr. Porubcin has not been in yet. 

Barb and Harry, circa 1963

Today is a bittersweet day - it's mom and dad's anniversary. Aunt Ruth and I deduced last night that they were married in 1963 (because Ruth wore the same dress to the wedding and prom??). So that's 51 years. 

It is really ironic because mom is at the hospital where dad passed in 1989. 

Barb and Harry were quite a snappy couple in the day. I think dad must of wore the same suit for years but mom was always very fashionable. I'll try and look for some more photos. 

Private room with a view

The nurses moved mom to a private room this afternoon because all of her tubes and attachments were getting to be a issue every time she had to use the restroom and having a double room just meant more obstacles. So she is now in room 773. The nurses and doctors and staff have been really outstanding here and have made mom very comfortable, and that's comforting to me!

She had a good afternoon overall, and ate a good dinner. Mom will be here for a couple more days at least.

Nancy and Bill Craig stopped by today and so did Pastor Chris. Scotty also stayed for a little while this afternoon and Tom will be the first one in the room tomorrow morning again with coffee (that she can't have) so hopefully tomorrow will be a better day yet.

Back to the hospital...

Mom started to have a problem mid-week, commenting that she was short-of-breath and just overall fatigued. Her voice also sounded raspy and I thought maybe she was coming down with some sort of chest cold or something. She also said her left hurt as well... wasn't sure what to make of that either. 

She talked with Dr. Porubcin's office yesterday morning, and they thought there was a great concern, so I took her over to the Dr office yesterday afternoon, and long story short (after tests - scans, EKG etc) they found that her right lung was 50% collapsed and the left lung was also showing some stress due to some small holes in her lungs. Pneumothorax. (Read more here >> http://www.webmd.com/lung/tc/collapsed-lung-pneumothorax-topic-overview )

Right away they took her into the emergency room (Unity Point Trinity Moline) ((Dr. Porubcin's office is in the same hospital)) and put a tube in her right lung and hooked her up to a machine to re-inflate the lung. They also put her on oxygen, which will help the lungs heal. 

They took her over to Unity Point Trinity West in Rock Island where she is going to be staying for a few days. Dr. Porubcin wanted her in the QC to keep a watch on her. She is in room 790 on the seventh floor. 

Last night was a struggle as she was in a lot of pain (from the chest tube) and they gave her quite a bit of morphine and vicodin to get control of it. I think everything kicked in at about 10:30 p.m. She slept on and off throughout the night, and has been sleeping most of the morning. 

At this point, she will have the chest tube until her lung re-inflates and not sure what the timeframe is on that. A couple more days at least. 

Chemo day - Round Four

It was kind of comforting to be back in the Trinity Cancer Center Chemo room today. Most of the same nurses are still there - Carrie, Tracy and Marty - and they all know mom and were happy to see her (in a bittersweet way). They take great care of mom and all of the cancer patients. The room was full today, and that makes it fun because you get to meet people and hear their stories if they want to talk. The nurses are always great to family members and have always made me feel welcome and make sure that I can squeeze my chair next to mom's.

Mom was tired today - she didn't sleep very well at all last night - the bandaged area around the new port was not comfortable. I think the tape was irritating her skin a bit. The surgeon also left the needle in the port yesterday (so the nurses wouldn't have to re-access it today) and so that was uncomfortable as well. There were a combination of things that was just making it not easy for mom to sleep. Luckily she caught a couple of cat naps.

Overall mom's chemo session was about 2 1/2 hour total. The nurses gave her a mixed bag of 2 nausea meds and a steroid to start, and then put on the Doxil bag after that. Not sure if she will see any side effects right away since she has had this drug before. Her feet haven't been the same since the last time, and are not healed quite fully as it is, so I expect that she will have some blisters reappear in the next couple of months.

All in all the day went well.

She goes to Dr. Atwell for a check-in next week and get the stitches out of her chest. I'm hoping that we can hear about the cyst-thing that they took out of her neck by the end of this week.

Surgery successful, ready for chemo tomorrow

Flowers from the staff at Hammond Henry.

Mom made it through the port-installation surgery this morning just fine. Dr. Atwell ended up putting it on the right side of her chest...he had mentioned maybe putting it back on the left side again before they took her into surgery, but it didn't work out that way.

Dr. Atwell also removed a lump from the right side of her neck. Not really sure what it is, and the nurses sent it to the pathology lab so they can analyze it. Dr. Atwell didn't seem to be concerned about it and mom was glad it was out as it had been bothersome. It had been there since last summer so they decided to give her a 2-for-1 on the surgical procedures today.

They should have the results in a couple of days.

Other than some soreness, mom will be ready for her first dose of chemo tomorrow.

Chemo, round 4 with Doxil

Yesterday Dr. Porubcin shared Thursday's scan results with mom. Apparently there is quite a bit of growth in her lymph nodes compared to her last scan. Compound that with her elevated CA125 and therefore she will be starting chemo on April 1.

Dr. P recommends doing Doxil again. She will be on a 4 week schedule and will have it for the next several months. There is not a concern that the drug will run out - one of the head nurses in the office said the company straightened out all of the distribution issues.

The worst side effect of the Doxil is how it wears down her skin tissue - so the areas where there is a lot of friction (feet, hands) need a lot of care. She still has issues from the Doxil from the last round she had a couple of years ago, so I don't know if this round will be worse or the same. The "Udderly Smooth" cream seems to help a lot - so if everyone wants to start sending her some tubes that would be great! She also needs to wear a lot of sunscreen as the Doxil makes her skin very sensitive to the sun.

Mom is also going to have another chest port put in on March 31. Even though she just had her other one removed in December, she wants to go that route and not have a pic line in her arm. The surgeon (Dr. Atwell at Hammond Henry) can put it in the right side of her chest and make it work.

Mom is down about the whole scenario as she was hoping to get through the summer but Dr. Porubcin feels that the sooner she starts on the chemo regimen, the better. The cancer is being a little more active than he would prefer, so it's best to nip it in the bud now. Keeping the cancer down is the priority!

Three month check-in

Mom had an appointment with Dr. Porubcin last Thursday and also had her normal blood work done the week before. Her CA125 has shot up quite a bit (to over 100) and they had her do another test just to check and confirm. The second test also came back with the CA125 at 118, so Mom is scheduled for a scan next week. Dr. Porubcin wants to see if it shows anything (a growth..?...) and then he will determine what to do from there.

We knew at some point that Mom would have to go back on chemo - hence the check up appointments to keep tabs on the cancer and catch it before it gets carried away again. The cancer is always there and we know that, so we just have to keep it down...which shouldn't be hard to do. Mom had a nice long stretch without a chemo regimen for the last year - two years actually - and the unfortunate part is that we knew that eventually chemo would be in the picture again.