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TOTAL COLECTOMY PART 30 page 12

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Posted 4/18/2010 7:29 PM (GMT 0)

Hi all,

Mother Hen just checking in from the ship.  So far so good.  Dancing is super!

I did not see if any updates from Lizzie.  Ship connection is Sooooooo slow. Hope she is hanging in.

I think you're right butterfly, surgeons know more of the heart than of the gut system.  Hope the research catches up.  Rosemary

Posted 4/18/2010 9:08 PM (GMT 0)
butterfly, doll , sweetie, please listen to Rosemary, she is right get another opinion.  Do not accept what he says at face value.  You have to get a few opinions so that you can be confident in what you are doing.  I feel so bad that his letter was so generic and so very up-setting to you.  My god some of these so called doc think they are GOD but as we all know they are not.

I like you find it very useful to research everything and anything you can on what is going on with you and go to as many doc's as you can to feel comfortable in your option.  I hope today is better than yesterday for you sweetie.  I can't even beging to imagine what your going through, but we are all here for you and we are all praying very hard for you.

If you colon is gone and he says you might lose your sm intestine also....ask some one this.  I watched a show where a lady got a cadaver lg intestine and a sm intestine at the same time and she got a lung and a kidney too I believe.  She had gone like 15 years without either and was on a feeding tube and was bone skinny.  Then she recieved the transplant and she was the first one ever and she is healthy and put on weight and is back to living life like a normal person... You could probably google or bing it, as it was the first one ever so I figured it might be on the web as everything else is..just a thought, and maybe be something like that could help you.

My heart really aches for you sweetie so take care.

Leslienono

Posted 4/18/2010 10:50 PM (GMT 0)
Hi all! Had a great weekend. Had four days off work and the weather has been absoultly beautiful. Its been close to 70 and feels so good after a long winter. I am getting very anxious to get my dirt bike out. I started it yesterday and cant wait to get back on it.

My belly has been a little more happy the past few days. I quit taking Miralax for the last couple of months and I think that is what messed it up so bad. I am not getting the bad cramping anymore. My doctor was shocked to hear that I take Miralax daily. I told him that it seems to be the norm for people who have had a colectomy, but he was just in awe. As I am to. You would think that food would just fly though us.

Judy, do you take Miralax? And are you still on the low residue diet? I am so scared of having anymore problems so I stay away from a lot of food. I just do not want to risk anything. But, I do miss salads terribly.

Well, back to work tomorrow then I think I will be able to get my bike out on Tuesday. Yeah!! Hopefully I can remember how to ride. Wish me luck!! Love you all and think of you everyday!
Posted 4/18/2010 11:10 PM (GMT 0)

Butterfly,

I think the transplantation center for small, large intestines is in Washington DC.  Wish I could remember the name of the center for you.  Maybe George Washington University Medical Center; they are on the cutting edge and are a well kept secret.  If you are still nervous; call or write.  You have nothing to lose and everything to gain.  The above story shows you what CAN be done.

I posed for some formal ship pictures in evening gowns etc and nobody would know that only 3 years ago I was so damaged I was being left to die by 10 other top US surgeons until I found my ileo surgeon.  Keep looking.  Don't settle.  You only have ONE chance.  I sure hope my one chance lasts, but Seize the Day is now my motto.

Rosemary

Posted 4/18/2010 11:19 PM (GMT 0)
Rosemary and Leslie, thank you for all of your kind words and thoughts.  I really do appreciate your thoughtfulness.  I have been having a really difficult time dealing with my feelings and depression.  I was in the hospital for a week the end of March to help me with my depression and it did do me some good, but it's still very hard for me not to worry about my upcoming surgery.  I am weepy alot.  I don't know how I am able to work, but I'm giving it my best.

Unfortunately, I don't really think that there is anyone that can give me a second opinion.  I am fortunate to have Dr. Wexner from Cleveland Clinic as my surgeon.  He is one of the best colorectal surgeons ever and trains many other colorectal surgeons each year.  I don't think there are if any other colorectal surgeons that have attempted my surgery before. 

What happened to me, just doesn't happen; however, it happened to me.  I really think that Dr. Wexner is preparing me for whatever happens and he really doesn't know how my surgery is going to turn out.  I think that he doesn't want me to get my hopes up, because this is going to be an extremely long and dangerous surgery.

I have started walking and want to get in the best shape that I can be when I have my surgery in July.  It doesn't seem so far away now.  I wish that I had a crystal ball and could tell how my life will be like if I make it thru surgery.  I'm hoping that my ileostomy goes well, because I think that I will have a break down if something bad happens.  I have been thru too much for a person and don't know how much more I can handle.  I'm really tired.

butterfly

Posted 4/18/2010 11:22 PM (GMT 0)
Rosemary, our e-mails just crossed but I'm going to look into Washington DC transplants and see what I can find..  Thanks for being so wonderful...  I really mean it.

I hope that you're having a bunch of fun, again.. We only live once and should make the most of it.!

butterfly

Posted 4/19/2010 12:45 AM (GMT 0)

Hi all,

I'm just checking in and seeing what's going on with everyone.  I have heard from Hodaya on Facebook.  She posted to my wall asking how things were going.  I sent her a message to see what's up with her.  I hope to hear back soon. 

To those of you with upcoming surgery.  Like Judy says stick to a low residue diet after surgery and don't do things you shouldn't.  Do not clean your house and do other work.  I made a mistake and was trying to clean the house too early because I am a dang neat freak.  I don't know that it had any bearing on my complications, but I'm sure it didn't help. 

I had my initial surgery October 26, 2009 and the emergency surgery on November 17, 2009.  I am finally back to work, I am walking 3 miles a day and lifting weights, and have my life back. I have no problems with going to the bathroom.  I go anywhere from 3-8 times a day.   It feels good not to blow up like a toad after I eat. 

Lizzie I hope you are improving.  You are in my prayers.

Jen

Posted 4/19/2010 2:53 AM (GMT 0)

Jen-So good to hear how well you are doing! yeah I can't wait to start working out again, even if it's just doing weights, yoga or anything!!!!  I can't run or even walk any distances because 3 summers ago I was supposed to have my knee replaced but had to have all kinds of work done on my shoulder due to a car accident, then the next summer was my colectomy and this past summer has been my kidney!  Now I have vowed to never get it fixed once this whole kidney ordeal is over; I've had enough of surgeries and hospitals.  But I'm so jealous of toned bodies because I used to be very athletic now I have like noooooo muscle tone.  Enjoy your health and I'm so glad that you have healed after all you've been through; YAY!!!!!!!

Marisa-My GI has me on the low residue diet for the rest of my life.  and yes, I too miss salads but I won't risk an obstruction.  I only take miralax maybe once a month if even then and that's only because I've eaten too much wheat or it's because of all the meds i'm on for the kidney which causes constipation. I rarely don't have a bm every day but if I don't, I'm in agony and then I need to take the miralax and it works within an hour.  I also live for my corn bags; I heat them up all the time and put them on my stomach and when I go to bed I heat them up and then pt then on my stomach & kind of wrap a pillow around them.

Something else that might help many of you with discomfort is to wear heat wraps; I wear them for the kidney pain everyday and they really help with the abdominal discomfort.  I get the ones that have a mesh wrap and you put the heat pads into the mesh, I found these work the best.

Marisa-Be careful on that dirtbike!!!!  Listen to your Mom when she's talking to you!!!!!  Don't be acting crazy!!!!LOL  Have fun and enjoy the sun!!!  Love you:)

Prayers to all,

Judy

Posted 4/19/2010 3:23 AM (GMT 0)
Marisa
Well honey as you know I have had a total colectomy and I take nothing, things do fly through as long as I have not screwed up and had dairy without my pill...OMG, what a silly girl I am..forgetting that pill for lactose..  Learned a very important lesson...I miss salads tooo.....Hope your feeling better.

Leslie

Posted 4/19/2010 4:27 AM (GMT 0)
Quick Update:

Just checking in real quick. I had an ok weekend, but was happy it wasnt in the hospital. My tube they put in is still working, but I am afraid to eat anything real substantial which isnt helping me get as strong as I can before surgery. I almost went to the ER Friday as I had another fever and was in severe pain and nausea, but my tube was still working so I just grin and beared it and tried to sleep. I slept until 5 pm the next day and felt a little better so went bowling with some friends and Adam said as soon as I do anything I just turn pale as ever....but at the same time it felt good to get out. I slept most of the day today.....I am not sure why I am so tired....I just cannot keep my eyes open. I am getting very scared for surgery as May 6 is approaching very quickly and with all the family issues and my mom is having foot surgery this wednesday so I have to help with all the kids its just stressful. I am having some reddish/yellow discharge from my stoma around the tube and it has an odor and I am wondering if its infection? I just got off my abx two days ago. I hope not....I got the lecture from my hubby and mom tonight about how frail I still look and how I need to be eating more to prepare for this surgery. I am trying, I am just so scared and like Lori a bit depressed.

Judy and Marisa I love talking to you both....thanks for all your texts. I always have my phone next to me for alarms when to empty so its nice to hear from you all. I love you all more than you will eve know. Judy I just want you to get better and I hope your doctor is right about that he thinks he can fix things. Marisa..I am worried about you on that dirtbike....I think you need to gain a few before you can lift that thing little one :)  I am glad you had such a great weekend. I love you to pieces and I swear we are all getting together....we have to...

So it was amazing, Hodaya called me from Israel....she is so sweet and speaks such good english. She was very frustrated as she had taken her pear juice before her defecography and the barium was out within 3 min and we all know this is not accurate, but she has another one scheduled with another doctor this month ( i think the 23 rd?). She is having computer issues still. She sounds sad and I feel so bad for her as she said she hets up 3 hrs before work to try and empty out and them works all day and comes home and has no life at all....I told her no pear juice for 48 hrs before the next test to get accurate results. She sounds so seet and said I sound exactly as she pictured. We talked for sometime and it was great....

Jen- So good to hear your doing so well and working out and working :) I am so happy for you.... Miss talking to you, but at least you have your life back :)

Tracy- Always worried about you......whats new with you honey????

Well I am in a lot of pain fro mthis tube and going to try some valium and norco to get some sleep before i have to be up every three hrs to empty this darn tube. It is draining the life out of me getting up so often and tomorow and the rest of the week I will be watching two 3 y/o's while my mom prepares for surgery and I take her in on wednesday. Its going to be a long week. I hope I can find the energy....I love and miss you all...

Lizzie

 

Posted 4/19/2010 7:34 AM (GMT 0)
Please help.

Hi everyone,

I know I'm probably jumping in the middle of a conversation, and I'm so sorry for doing that, but I am desperate. I had a total colectomy in November 2007 (at age 21) to treat colonic inertia. We knew before surgery that my small intestine is extremely slow. I don't have an ostomy- the end of my small intestine was connected to my rectum.

I am in agony. The motility in my small intestine has progressively deteriorated. The pain, bloating, and constipation make eating anything a nightmare. 

Has anyone found anything (supplements, medications, etc.) that works? What foods work for you, and what foods make your symptoms worse? Is a low-residue diet better than a high fiber one? Please- anything you can share with me will be greatly appreciated.

Thank you so much.

Allie

Posted 4/19/2010 1:57 PM (GMT 0)
Hi Allie,
You should probably stick to a low residue diet. I avoid high fiber foods. I don't touch lettuce, brocolli, etc. I eat white bread and avoid wheat bread, high grain products, basically the opposite of what everyone is trying to eat these days to be healthy. It is a different way of thinking for sure.

Just a few months ago I was having major problems with slow motility in my small intestine also. I had numerous scans and tests on my small intestine which all showed marked decreased motility. Things have changed since then. I really don't do anything different than what I was doing then. I think time has just helped. I do use fleet suppositories often just to get things going but don't have to use them all the time. I also use Miralax only when things do slow down which is only once in awhile.

I do have gastroparesis also which they were treating with Remeron when Regulan wasn't working. I stayed on Remeron for a couple of months but no longer take it. I just deal with it through diet. I take numerous vitamins and just stick to the low residue diet.

I know this information is probably not helpful. I don't know what kind of diet you are on, but I would definately try the low residue diet. Eating high fiber foods causes me to bloat and things slow down.

Jen
Posted 4/19/2010 3:03 PM (GMT 0)
Allie, have you tried miralax? There are several gals on here that have had total colectomies that take miralax and where it didn't work with their colons, it works great for them now. Also milk of magnesia may work too.....I agree with what Jen said....eat no fiber. Fiber has no nutritional value and you don't need it with your colon gone.

Did your doctor leave any of your colon? Do you feel constipated, or do you feel like you can't "get it out"?

I have read and researched until I am cross-eyed, and I did come across several articles that said the inertia can spread to the small intestines after the colon is removed. I am not sure how common it is though.

Tomorrow is the dreaded defogram....I am getting anxious and don't want to do it. I even briefly considered canceling my appt. but know I HAVE to just get it over with. It is just so embarassing
Do I have to drink barium too? I think I remember drinking it with the 1st defogram, but, I have had so many tests, they are running together.

My stomach is staying bloated 75% of the time now and this is a change. I used to only get bloated towards the end of the week...now, it just seems to stay that way and this has me worried. Last night, it was huge and so bloated that it came all the way up to under my boobs. Were any of ya'll like this before your total colectomy?

Is there an end in sight for me? I feel very worried because I have been told you have anismus, you have anismus, but now the doctor said, no it definitely is not anismus because my angles are normal, and my puborectalis muscle relaxes exactly as it should. Maybe I should shoot for the temporary loop ileostomy and see what happens. Decisions, decisions.....I am scared to make one not knowing what exactly is wrong with the outlet portion of it. And I am too scared to have a total colectomy not knowing if I would still have the outlet problem???????? Why do I have to have 2 problems....it would be so much easier if I only had 1.
Posted 4/19/2010 5:42 PM (GMT 0)
Hi Isabutterfly,
Have you check out your doctor on some of the online heath surveys sites such as RateMDs.com or Heaalthgrades.com ?
You may have the best doctor in the world, but he may not be the best doctor for you. You need to feel comfortable with him and feel like you can talk to him and that he will LISTEN TO YOU! You deserve it.
As much as we hate to believe it, all Doctors do not treat all patients alike. I have had doctors that I loved but someone else thought he was a quake. By the same token, I have had a doctor that was rude, short-tempered with me (actually yelled at me)--yet, I have heard many people that think this doctor hung the moon.
Posted 4/19/2010 6:18 PM (GMT 0)
Isabutterfly,
Your surgery is not for a few months--you have time to look at the options that other people on this forum have mentioned.
---TRUST YOUR GUT (no pun intended). If this doctor doesn't feel right, trust that feeling. Remember, you have time to check things out.
Posted 4/20/2010 9:16 PM (GMT 0)
Thanks, ladies.

Jen, I have been on a high fiber diet. As the motility in my small intestine slowed, I increased my fiber intake. While lots of fiber gives me pain and bloating, at least it lets me go the bathroom once a day. Low fiber foods tend to just sit in my gut, making the bloating and pain exponentially worse. Any food stimulus causes my gut to shut down (even if I drink too much water). Regardless, I am going to drastically cut back on the fiber to see if that makes any difference. Maybe the low residue diet I was on right after surgery will help.

I was on Reglan for two days a few years ago (I was 20 at the time). It worked like a charm, but I had a rare neurologic side effect called tardive dyskinesia. Scary stuff. I am very lucky that it went away; many people who have that reaction to Reglan are permanently disabled.

Answers4me2, I have tried Miralax. Prior to surgery all it did was cause tons of bloating and pain. I'm going to try it again now that I don't have a colon to see if it will work. Everything I consume just sits in my small intestine, causing more and more bloating and pain. Here's to hoping that will change.

My surgeon removed my entire colon. In his experience, patients who had a partial colectomy had no relief and had to go in for a second surgery to remove the remaining colon. You're right- inertia can spread to the small intestine; I have always had a serious small intestine dysmotility (stomach is involved to a lesser degree), so I'm not sure if that is just getting worse, or if the intertia is spreading, or both!

Allie
Posted 4/20/2010 9:19 PM (GMT 0)
So, I had the defogram today...I did NOT have to drink barium, nor did they place anything in my vagina or bladder. Hoping I don't have an enterocele???? The testers were 1 woman, 2 men, oh the joys! LOL They placed the barium in my rectum, then sat me up on the table, which at the bottom of the table was a makeshift toilet. I then had to sit there for 10 minutes due to technical difficulties, but, I felt fine and absolutely no urge.

He had me relax, then pull up like I was trying to stop escape of gas or bm's, then bare down....he said, "don't let it all out at once", I just laughed and said' "no problem". He then said, "so, you have trouble getting it started?" I said, "yes, I can't ever get it started, that is the problem". I pushed for like 3 minutes and I pushed as hard as I could. With the last defogram, I didn't push with all my might due to embarassment.....but, this time I literally almost blew my head off....HEEHEE

Nothing ever came out, NOT ONE DROP of that barium.

So, when I was done, I got dressed. They said you can leave. I said, well, I need a copy of the test for my doctor because my doctor wants to see it. They said, oh, sorry our vcr is broke and the test was NOT recorded????? WHAT THE HELL? I was almost in tears. So, they gave me 3 xray pictures for my doctor and said they would send the report to my doctor in a few days.

Do you guys think I wasted my time today having this dreaded test?

Anyway, I looked at the pictures and my rectum is obviously abnormal.....I wish I could post the pictures so ya'll could see it. It looks collapsed, curved???? Definitely not like a normal rectum that I have seen on defograms.

Just hoping the pictures are enough for my doctor to make a diagnoses????
Posted 4/20/2010 9:24 PM (GMT 0)
Allie, hoping the miralax works this time....I would take it real slow though to reduce any unpleasant side effects by starting out with a half a dose a day, then increase slowly.
Posted 4/20/2010 9:30 PM (GMT 0)
Thanks, Answers. That's the plan- start slow. And hopefully I can get myself back to the motility clinic at Mayo before too long.

I hope your doctors are able to make a solid diagnosis with the x-rays. Pardon my French, but what century is that radiology clinic operating in? A VCR?! Seriously? Nearly everyone has gone digital.
Posted 4/21/2010 1:08 AM (GMT 0)
Hi everyone,

Allie, I'm so sorry for your all your issues. You and Peltzier sure seem to have alot of common issues. Both of you are way too young to deal with so many problems.

Tracy,
Glad you had your defecogram...has the barium come out yet? I had a much harder time emptying AFTER my colectomy than I did the first time I took the test. Hopefully betweeen the xrays and the report, your doctor will get enough information.

I have a question for those who have said they have pain after eating....it's been just over a year since my surgery, and now for the first time I'm starting to have horrible pains after eating sometimes. It started about 2 weeks ago and it's happened 3 times now. Each time it's been after eating different things, once after eating some chocolate, which I've eaten many times without a problem. The second time was after eating dinner with chicken and rice....again, I've eaten that many times. Tonight I had salmon and a salad, which I've also eaten many times without a problem. The pains are sharp and last for an hour or more. Because of the miralax, I still am going to the bathroom, but the pains last for so long....any ideas what's going on?

Thanks,
Janie
Posted 4/21/2010 3:57 AM (GMT 0)
Janie....So sorry you are having pain after eating. I always have and especially in this last week. I have gotten the lecture from everyone that I am too thin going into this surgery, but I and the doctors have no explanation. Maybe your small bowel is slowing a bit and the digestion is harder causing pain, but since its new I would call your doctor just to let him know. I love you and praying for you always.

Allie- Praying for you.....I try and keep up on the site, but I am going through a lot myself. I will continue to pray for you as like, me, and Sarah (Peltz) and so many others we are too young to be going through all of this. I am here for you if you need anything.

Tracy- I got you picture and something is definatelt not right. I hope you have gotten rid of some of the barium I had to take three bottles of mag citrate and was very sick and almost caused a obstruction for me. I am very worried for you....

I was in the ER today. I have not felt right since Friday and when I woke up my whole bandage around tube, shirt, and pants were soaked with foul smelling fluid and pus like substance. I was so weak I could hardly get in the shower, but I got to the ER and my pulse was 122 and they did a CT. It did not show an abscess, but the dr said my pouch is inflamed and I may have some slight infection around the stoma. I also had very low potassium which was probably why I felt so weak. They got my pain under control as best as they could, put me on potassium daily, and more nausea neds as this week eating has been a struggle. Not good when surgery is two weeks from this Friday. I am so emotional and crying daily. I just am feeling the stress and I feel its one thing after another. The ER knows me so well...I hate it. I feel so bad. My veins are horrible so I may ask for another picc line for surgery. My mom has surgery tomorroe on her foot so I am helping her with my nephew for the next two weeks with what energy I have and its also my best friend (the one who has been distant) memorial of her best friends death three years ago. I got her a hand painted ceramic plate made special from Texas with the verse from her memorial and little things that respresent their friendship and then both their initials and bith/death date....I am trying to be ther for her, my mom, my sister, my nephew, and myself and I am tired. I hope she likes it as even though I did not have the money I figured a representation of how much I care was important and I hope she will like it.

Gilda-Thanks for calling me today. I am praying for you as you have you r gastrograffin enema tomorrow and I hope they can figure out what is going on with you. I was going to call you back but I was in the ER when you callled and have been exhausted. It meant a lot to hear your voice....I now know what you, Tracy, and Hodaya sound like and it makes me more eager to meet you all in person. My love and prayers arebeing sent your way.

I love and miss you all.

Lizzie

Posted 4/21/2010 3:57 PM (GMT 0)
Hi everyone.  I was at the hospital Monday.  I was dehydrated and they had to give me and IV.  The doctor asked me if I felt better afterwards and I said no.  I don't think that it happens that quickly!  I've been drinking gatorades and sleeping since and have had no energy.

I'm still working through my depression with my counselor.  My husband and he have been a godsend.  I know that I'll make it until surgery with their understanding and patience.  My crying has stopped and I'm just feeling numb. 

I'm so depressed that I've started hearing things.  My counselor and nurse have changed my medications and hope to improve my mood and get rid of the voices that I'm hearing.  I've been off work since Monday afternoon when I went to the hospital and am trying to take care of myself.

It is very hard to work with all of my problems happening at once.  I don't want people to feel sorry for me, but wish that they were more understanding even if they don't know what I'm going through.  Some of my co-workers have started discussing my absences from work and are just gossiping, because they have no idea of what I'm going through.

I thank heaven for all of you,

butterfly

Posted 4/21/2010 4:58 PM (GMT 0)
Lizzie....My god girl hang in there just a couple of weeks and hopefully you will feel better...your tough so hang in.

Butterfly, You hang in there too girl.  Don't worry about what ignorant people say about you at work.  Your health is of the utmost importance, so you take care of you.

People who have not walked a day in our shoes have no idea what we go through.  So stay strong and its great that you have such a loving husband...

Praying for all of you

Leslienono

Posted 4/21/2010 11:08 PM (GMT 0)
Lizzie,

I don't get the idea out of my head that the inflammation of your pouch which may also have caused the valve slippage is subsequently to your RA or connective tissue disease.

Do you feel that you still have motility issues in your small bowel since pain after eating is not normal...how does your pouch work? Have you expereinced this kind of pain immediately after the pouch surgery or did it take some time before it started?

However, if you say that you have the pain even without eating (is the type of pain after eating the same as the general pain?) I wonder if you "simply" suffer from extensive small bowel inflammation not only limited to the pouch. The pouch is a part of your small bowel so why should the inflammation be isolated to the pouch?
Bowel inflammation would indicate a seroius RA problem/connective tissue disease that has to be adressed and treated with higher dosis of steroids than with simple RA.
Posted 4/21/2010 11:23 PM (GMT 0)
Hi everyone!

Gosh.. it's been a couple months or so that I've checked in!

From briefly reading.. seems as Lizzie is still having issues? Rosemary is cruising again!

Tracey - you're finally getting the fun defecogram!

Judy, you'll be having surgery soon?

I really need to take some time and catch up! I'll be having foot surgery in a couple weeks - that may be a good time to catch up on my reading.

My colon resection was 4-1/2 months ago, and as you all know - I still ended up with issues! I had planned to ignore them.. but because I felt things were getting worse, (and honestly - think of it everyday) I went back to the doctor. Sadly, my repairs for the rectocele, and bladder (the sacralcolopexy) became "unhitched". Apparently - when The did the resection of the rectum, they had to cut the mesh that holds me up, and when they rejoined it - apparently it broke away.. at least that's the thought - they won't know until I go for yet another surgery!! My doctor said sooner than latter as the straining can cause many more issues.

I still take the Miracle MiraLax, and I do have a BM most days - which is a major improvement.. just I can't get it out without a lot of effort and my fleet! I think surgery will be in August.

I did want to say he asked me to buy a book called 'cure constipation now'. One of his patients recommended it - he wants me to try it for 3 months. Not sure if it's anything I haven't tried already.. but for $12.95 - I'll buy the book. Anyone hear of this book?

Well, glad I stopped in to say hello. I will catch up on the posts! I honestly did just try and put my trouble out of my head.. but it doesn't work when there really are issues going on!
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