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Medical Forum / Diseases and Disorders / Prostate Cancer / January 2004My LRP
My story is not as compelling as Dans, but I don't believe that the standard RP would have gone easier. Before reading the following, note that my uro had a great deal of experience, as well as statistical data indicating high %s of success. *** My surgery was 7 hours. One of the nerve bundles was sticky (this is often a bad sign). It took over an hour to free it. The initial surgery took 4 hours. I stayed in op while the uro waited for a preliminary path report. After an hour the path report came back with positive margins where the sticky nerve bundle was, and near the urethra, required removing that bundle, as well as taking another thin slice from the urethra - another 2 hours in surgery. *** Spent 2 hours in post op - it's hard to wake up after that much time under anesthesia. *** Post-op: Lots of pain. I had bladder spasms from the get go, and they were bad. Spent 3 days in the hospital, and did no walking until the 2nd day. *** JP drain: Did not come out for 10 days. After 6 days, they pulled the stitches, and tugged on it to move it: theory is drain holes were sitting right on an opening in the anastomosis, and the vacuum was sucking fluid out at a steady enough right to keep it from closing. Moved it again on the 8th day - finally drainage stopped. *** 11th day: Fever of 103+. 2 shots of antibiotics in the butt plus oral. *** Foley: Out on the 17th day. Uro insisted on a full week after JP drain removal. 17 days of hell. I hated that thing, and as the last few days ticked down, I thought I would die waiting. *** Incontinence: Bad from day one. I could squeeze and slow the flow, but it would still trickle out. Sleeping was ok, but sitting, standing, or worse, walking, was like a flood. *** Perineal pain: Severe, and needed a donut to sit for 10 weeks. This apparently affects ~10% of patients. *** I'm now at 8 months, feel great, and am down to 2-3 pads in 24 hours. On days that I am active, I use more. But since I started at 12+ a day, and *any* activity meant changing every 30-60 minutes, things are much improved. I coach youth soccer, and initially I was running to the car every 30 minutes. Now I can go 2 hours no problem. I'm anticipating that this will end, but there are of course no guarantees. I try and do 400 kegels a day. Interestingly, as bad as it was, I have *never* had any accidents. *** Impotence: Yes. I have tried shots - erection was too painful. Have used the pump. This works great, and if it is true that you "use it or lose it", then I highly recommend. I have used Viagra, Levitra, and Cialis, with little to no success, although I get better results with the pump when using these drugs. I have no side effects from any of these, other than the blue haze and being flushed from Viagra and Levitra. I had been using 100mg of V, and 20mg of L. I just went down to 50mg of V recently, and had no side effects, and actually saw some positive reaction. *** Summary: My dad had an RP 15 years ago, and told me in hindsight he would not have gone that route. But after looking at my options, and my age, I decided that was the best shot at a *cure*, and for less, long-lasting, side effects. And of course there was the LRP as an option. At this point, my PSAs are < 0.04, and there is hope on the incontince and impotence. My only advice: Buy a Harley. I had not ridden a bike in 25 years. 8 weeks after surgery, I went out and bought a new Softail, and rode it home (without the donut!). That Harley is my "Happy Thought", which as we all know, is all you need to fly. Peter Pan reformatted... My story is not as compelling as Dans, but I don't believe that the standard RP would have gone easier. Before reading the following, note that my uro had a great deal of experience, as well as statistical data indicating high %s of success. *** My surgery was 7 hours. One of the nerve bundles was sticky (this is often a bad sign). It took over an hour to free it. The initial surgery took 4 hours. I stayed in op while the uro waited for a preliminary path report. After an hour the path report came back with positive margins where the sticky nerve bundle was, and near the urethra, required removing that bundle, as well as taking another thin slice from the urethra - another 2 hours in surgery. *** Spent 2 hours in post op - it's hard to wake up after that much time under anesthesia. *** Post-op: Lots of pain. I had bladder spasms from the get go, and they were bad. Spent 3 days in the hospital, and did no walking until the 2nd day. *** JP drain: Did not come out for 10 days. After 6 days, they pulled the stitches, and tugged on it to move it: theory is drain holes were sitting right on an opening in the anastomosis, and the vacuum was sucking fluid out at a steady enough right to keep it from closing. Moved it again on the 8th day - finally drainage stopped. *** 11th day: Fever of 103+. 2 shots of antibiotics in the butt plus oral. *** Foley: Out on the 17th day. Uro insisted on a full week after JP drain removal. 17 days of hell. I hated that thing, and as the last few days ticked down, I thought I would die waiting. *** Incontinence: Bad from day one. I could squeeze and slow the flow, but it would still trickle out. Sleeping was ok, but sitting, standing, or worse, walking, was like a flood. *** Perineal pain: Severe, and needed a donut to sit for 10 weeks. This apparently affects ~10% of patients. *** I'm now at 8 months, feel great, and am down to 2-3 pads in 24 hours. On days that I am active, I use more. But since I started at 12+ a day, and *any* activity meant changing every 30-60 minutes, things are much improved. I coach youth soccer, and initially I was running to the car every 30 minutes. Now I can go 2 hours no problem. I'm anticipating that this will end, but there are of course no guarantees. I try and do 400 kegels a day. Interestingly, as bad as it was, I have *never* had any accidents. *** Impotence: Yes. I have tried shots - erection was too painful. Have used the pump. This works great, and if it is true that you "use it or lose it", then I highly recommend. I have used Viagra, Levitra, and Cialis, with little to no success, although I get better results with the pump when using these drugs. I have no side effects from any of these, other than the blue haze and being flushed from Viagra and Levitra. I had been using 100mg of V, and 20mg of L. I just went down to 50mg of V recently, and had no side effects, and actually saw some positive reaction. *** Summary: My dad had an RP 15 years ago, and told me in hindsight he would not have gone that route. But after looking at my options, and my age, I decided that was the best shot at a *cure*, and for less, long-lasting, side effects. And of course there was the LRP as an option. At this point, my PSAs are < 0.04, and there is hope on the incontince and impotence. My only advice: Buy a Harley. I had not ridden a bike in 25 years. 8 weeks after surgery, I went out and bought a new Softail, and rode it home (without the donut!). That Harley is my "Happy Thought", which as we all know, is all you need to fly. Peter Pan hi peter - what's i noticed is that through the years of different folks having different types of treatments, it boils down to one thing - the luck of the draw. boy, that is a lot to risk on a roll of a pair of dice, but that seems to best way to summarize these treatments. some guys get the LRP and never have a problem, yours was not the case. some guys get radiation and never have a problem, others are plagued with ongoing situations. some guys get RP's and never have a problem, while others would tell a story similar to yours. i happen to fall into the RP category since i had mine last april. i had my share of nightmares, but mainly from the scaring and had to have subsequent surgeries to straighten that up. the RP came off pretty much as planned, and with the usual things that one might experience. however, i was able to have erections a couple of weeks post op. and i was 99% continent after about 7 months. right now, i would say, that i'm fairly close to where i was - healthwise - a year ago, minus the prostate cancer. while i don't push the RP as the answer or any of the other treatments either. i'm posting this for the lurker who might think one way or the other on some of the treatments. but - i'm just curious - i will ask this from the other members. if someone was to walk up to you and stated that they had pca, and wanted to know what treatment they should get, what would be your answer. would you recommend your path? would you recommend another? do you see a particular path of treatment that may have more problems to watch out for that another might not have? and here is another suggestion - just as we have a check sheet for post op care that joe price is so kind to post for us (thanks joe) can we come up with a check off sheet for a person who is first dx'ed with pca? what should be on the sheet and who wants to be the keeper - joe???? we got a great team and i am thinking in terms to make it easier on the new person. he's got enough on his mind with what he just got told. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional > but - i'm just curious - i will ask this from the other members. if > someone was to walk up to you and stated that they had pca, and wanted [quoted text clipped - 3 lines] > a particular path of treatment that may have more problems to watch out > for that another might not have? My own treatment was 2 HDR brachytherapies + EBRT. Here are my recommendations: 1. Look for a clinical trial. It's a way to get excellent care, reduced or no cost and, most importantly, a way to do something that will help your son and grandson and the sons and grandsons of all your friends. I personally believe that the care I got in a clinical trial was not only very good, but somewhat ahead of the state of the art, administered by doctors who were among the best in the field. If it did no good for anyone else then, for purely selfish reasons, I think I'd still look for a clinical trial. 2. I would probably recommend implanted seeds + external beam radiation. If the Gleason was high, I would probably also recommend HT as a precursor ("neoadjuvant") therapy. I'd also recommend sending the slides for a second opinion to be sure since Gleasons are so often under reported. Here's my rationale: 1. Radiation over surgery. As near as I can tell from every clinical trial I can find, modern radiation has an equal outcome with surgery. Some people don't believe it. I do. Radiation has a quicker recovery time and less risk of complications and side effects. There can be complications and side effects for sure and they can be bad, but my understanding is that they are less common. Impotence is common. Difficulty urinating for a while is common. Incontinence is rare. Infection is rare. Blood clot is rare. If the cancer has penetrated beyond the prostate capsule, radiation may even have a better chance of a cure than surgery. With Gleason 7 or above, that becomes a serious possibility. See EBRT below. 2. Implanted seeds. Studies show that the chance of a cure is directly proportional to the amount of radiation delivered to the tumor. Implanted seeds, either low or high dose rate, can deliver more effective radiation to the tumor than EBRT for the same amount of peripheral damage (one might call them losses due to friendly fire.) The difference can be very significant. Implanted seeds takes the radiation level from adequate to overkill, which doesn't bother me when the enemy is cancer. I took high dose rate temporary seeding because that's the clinical trial I found. Low dose rate permanent seeds would also have been perfectly acceptable to me - and would have the advantage of only one hospital procedure instead of two, with a possible disadvantage of having permanent implants. 3. External beam radiation. Studies have shown that EBRT + seeds yields a higher cure rate than seeds alone. Presumably, the reason is that a significant number of men have cancer penetration outside the prostate, but still in the immediate vicinity. I've been quoted numbers ranging from 15-50%, but even at the low number I consider it worth dealing with. With surgery, we have a good, (but maybe not perfect) indication of whether cancer cells exist in the surrounding tissue. With radiation, we have less indication (MRIs and CT scans can tell us if there are significant penetrations, but small ones may not be detected.) It's best to treat the patient as if there are some there. --------------------- Now, having said all of the above, I'll also say that every cancer patient would probably do well to speak to both a surgeon and a radiation oncologist. The advantages of one treatment over another, and one type of treatment over another, are not absolutely obvious. Since all of the treatments work about the same when well done, much depends on what fits the particular patient's desires, needs and fears. For example, for me, I once had a botched surgery and was very leery of having another. When I tell someone about what I would do and why, I'll recommend the above. But I'll also tell them it was a personal decision and other very different decisions can work out better for a different person. Alan Lupron 7/03, 8/03, 12/03 > we got a great team and i am thinking in terms to make it easier on the > new person. he's got enough on his mind with what he just got told. I had RRP and had to stay in the hospital 8 days due to surgical complications. If I had it all over to do again I'd opt for RRP (RLRP wasn't avaiable to me in 2000). Of course, if I had it all to do over again, I'd get my PSA tested more often.  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Gee, great, how lucky we were to be part of the 10% with peritoneal pain. Glad that is in the past, but I still have the donut. I envy you the Harley. I got a laptop computer so i could work anywhere in the house (wife not happy with the time I spent upstairs on the ng - Heather you heartbreaker) and reclaim the desk top. Bet you are having more fun with your toy than me. Best of luck on defeating the evil twin "I's" (incontinence & impotence). I am six months out and still fighting the good battle, but no real progress to report. Thank you. David S. > My story is not as compelling as Dans, but I don't believe that the standard RP would have gone easier. Before reading the following, note that my uro had a great deal of experience, as well as statistical data indicating high %s of success. > *** My surgery was 7 hours. One of the nerve bundles was sticky (this is often a bad sign). It took over an hour to free it. The initial surgery took 4 hours. I stayed in op while the uro waited for a preliminary path report. After an hour the path report came back with positive margins where the sticky nerve bundle was, and near the urethra, required removing that bundle, as well as taking another thin slice from the urethra - another 2 hours in surgery. > *** Spent 2 hours in post op - it's hard to wake up after that much time under anesthesia. > > *** Post-op: Lots of pain. I had bladder spasms from the get go, and they were bad. Spent 3 days in the hospital, and did no walking until the 2nd day. > *** JP drain: Did not come out for 10 days. After 6 days, they pulled the stitches, and tugged on it to move it: theory is drain holes were sitting right on an opening in the anastomosis, and the vacuum was sucking fluid out at a steady enough right to keep it from closing. Moved it again on the 8th day - finally drainage stopped. > *** 11th day: Fever of 103+. 2 shots of antibiotics in the butt plus oral. > > *** Foley: Out on the 17th day. Uro insisted on a full week after JP drain removal. 17 days of hell. I hated that thing, and as the last few days ticked down, I thought I would die waiting. > *** Incontinence: Bad from day one. I could squeeze and slow the flow, but it would still trickle out. Sleeping was ok, but sitting, standing, or worse, walking, was like a flood. > *** Perineal pain: Severe, and needed a donut to sit for 10 weeks. This apparently affects ~10% of patients. > > *** I'm now at 8 months, feel great, and am down to 2-3 pads in 24 hours. On days that I am active, I use more. But since I started at 12+ a day, and *any* activity meant changing every 30-60 minutes, things are much improved. I coach youth soccer, and initially I was running to the car every 30 minutes. Now I can go 2 hours no problem. I'm anticipating that this will end, but there are of course no guarantees. I try and do 400 kegels a day. Interestingly, as bad as it was, I have *never* had any accidents. > *** Impotence: Yes. I have tried shots - erection was too painful. Have used the pump. This works great, and if it is true that you "use it or lose it", then I highly recommend. I have used Viagra, Levitra, and Cialis, with little to no success, although I get better results with the pump when using these drugs. I have no side effects from any of these, other than the blue haze and being flushed from Viagra and Levitra. I had been using 100mg of V, and 20mg of L. I just went down to 50mg of V recently, and had no side effects, and actually saw some positive reaction. > *** Summary: My dad had an RP 15 years ago, and told me in hindsight he would not have gone that route. But after looking at my options, and my age, I decided that was the best shot at a *cure*, and for less, long-lasting, side effects. And of course there was the LRP as an option. At this point, my PSAs are < 0.04, and there is hope on the incontince and impotence. > My only advice: Buy a Harley. I had not ridden a bike in 25 years. 8 weeks after surgery, I went out and bought a new Softail, and rode it home (without the donut!). > That Harley is my "Happy Thought", which as we all know, is all you need to fly. > > Peter Pan > > My only advice: Buy a Harley. I had not ridden a bike in 25 years. 8 > weeks after surgery, I went out and bought a new Softail, and rode it home > (without the donut!). What is it with men and motorcycles!!!! I left my husband with our 7 year old daughter last weekend to have some quality time together. Their tentative plans were to go shopping - my daughter loves to shop. When I asked my daughter later about their shopping excursion she informed me that they spend the entire afternoon looking at motorcycles!! And her daddy told her that he's buying a motorcycle and nobody (I guess that means me) is telling him otherwise!! We've been married for 21 years and I made my husband sell his motorcycle early in the marriage because I thought they were too dangerous and he had his children to think about - well now I guess it is time for him to think about himself! I now feel quilty I made him give up something he loved so much but I'm sure he'll make up for it!! Sandi Sandi, Men probably like all that power between their legs. Personally, I just liked being out where is no one else around me. When you're going 70 MPH on an expressway with the air hitting your face, it's almost as if you are totally alone and singularly involved with the environment on a very special level. Nothing but you, ....your thoughts, ....and the idiots trying to kill you. But, if you've ever ridden on the back of a Harley, you have some explaining to do..... Why is it that women love THAT so much? And it has to be a Harley. Hondas won't do. > > > My only advice: Buy a Harley. I had not ridden a bike in 25 years. 8 > > weeks after surgery, I went out and bought a new Softail, and rode it home [quoted text clipped - 14 lines] > > Sandi Steve, I beg to differ, my wife loved riding on the back of my gold wing. But you are right, there is nothing quite like tooling down the road at 70 - just the wind and the idiots! DanR hi dan - i love my goldwings - i have two older ones. one has the air ride which is sweet because the wife has had three back surgeries and doesn't hurt her. i had a harley and it has a romance about it. i've had a v-max - now that was power i''ve had a suzsuki mk 4 that love to live on the back wheel. but i guess i'm just getting old because i like the faring, the luxuries on the cycle and my idea of cruising is 20 - 30 on the hard surface back roads with no cars around. to come upon a patch of honeysuckle and smell it as you drive by. to see the fox looking at me. to come over the top of a hill and be greeted by a deer and it doesn't run off but as you come to a stop and just admire nature as both of two of watching each other. if i was doing 70, i would miss the beauty of what nature has to offer. like i said, maybe i'm just getting old and sitting out and watching the grass grow for a change. to me, there is nothing like to cruise on the cycle at midnight to wind down and relax before going to bed. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional I just saw this and am on the floor!! What a hoot!! Tell your wife it is a big compliment to me........at my age.......to be 'the other woman'.....LOL!! Hey.......about Buttercup. I have never had dogs but have a 17 lb. Wonder Cat who never drinks water or milk.......but we add a fair bit of water to his wet tinned food and that seems to be all he needs. The only time I ever saw him dash for the water bowl was when we fed him some curried chicken.....(VBG) But he sure loves to drink out of the tap. Go figure!! Cheers.......Heather > Gee, great, how lucky we were to be part of the 10% with peritoneal > pain. Glad that is in the past, but I still have the donut. [quoted text clipped - 9 lines] > > "peter*pan" <peter*pan@neverland.com> wrote in message news:daf497f4ae3e4f784600a4544090b757@localhost.talkaboutsupport.com... > > My story is not as compelling as Dans, but I don't believe that the > standard RP would have gone easier. Before reading the following, note that [quoted text clipped - 68 lines] > > > > Peter Pan A very useful report. Thanks. With every kind of treatment it seems that complications and unanticipated bad effects can occur. Your report may help someone see what can go wrong and get a better picture of how tough things can be. More important even than that however, your report shows that even when things get tough, they are survivable and time + determination will often win in the end. As for your final advice (about the Harley), you've hit the nail on the head. There's nothing like a bout of cancer to let you know that it's time to go out and do some of those things you've always wanted to do. Best of luck. Alan > My story is not as compelling as Dans, but I don't believe that the standard RP would have gone easier. Before reading the following, note that my uro had a great deal of experience, as well as statistical data indicating high %s of success. > *** My surgery was 7 hours. One of the nerve bundles was sticky (this is often a bad sign). It took over an hour to free it. The initial surgery took 4 hours. I stayed in op while the uro waited for a preliminary path report. After an hour the path report came back with positive margins where the sticky nerve bundle was, and near the urethra, required removing that bundle, as well as taking another thin slice from the urethra - another 2 hours in surgery. > *** Spent 2 hours in post op - it's hard to wake up after that much time under anesthesia. > > *** Post-op: Lots of pain. I had bladder spasms from the get go, and they were bad. Spent 3 days in the hospital, and did no walking until the 2nd day. > *** JP drain: Did not come out for 10 days. After 6 days, they pulled the stitches, and tugged on it to move it: theory is drain holes were sitting right on an opening in the anastomosis, and the vacuum was sucking fluid out at a steady enough right to keep it from closing. Moved it again on the 8th day - finally drainage stopped. > *** 11th day: Fever of 103+. 2 shots of antibiotics in the butt plus oral. > > *** Foley: Out on the 17th day. Uro insisted on a full week after JP drain removal. 17 days of hell. I hated that thing, and as the last few days ticked down, I thought I would die waiting. > *** Incontinence: Bad from day one. I could squeeze and slow the flow, but it would still trickle out. Sleeping was ok, but sitting, standing, or worse, walking, was like a flood. > *** Perineal pain: Severe, and needed a donut to sit for 10 weeks. This apparently affects ~10% of patients. > > *** I'm now at 8 months, feel great, and am down to 2-3 pads in 24 hours. On days that I am active, I use more. But since I started at 12+ a day, and *any* activity meant changing every 30-60 minutes, things are much improved. I coach youth soccer, and initially I was running to the car every 30 minutes. Now I can go 2 hours no problem. I'm anticipating that this will end, but there are of course no guarantees. I try and do 400 kegels a day. Interestingly, as bad as it was, I have *never* had any accidents. > *** Impotence: Yes. I have tried shots - erection was too painful. Have used the pump. This works great, and if it is true that you "use it or lose it", then I highly recommend. I have used Viagra, Levitra, and Cialis, with little to no success, although I get better results with the pump when using these drugs. I have no side effects from any of these, other than the blue haze and being flushed from Viagra and Levitra. I had been using 100mg of V, and 20mg of L. I just went down to 50mg of V recently, and had no side effects, and actually saw some positive reaction. > *** Summary: My dad had an RP 15 years ago, and told me in hindsight he would not have gone that route. But after looking at my options, and my age, I decided that was the best shot at a *cure*, and for less, long-lasting, side effects. And of course there was the LRP as an option. At this point, my PSAs are < 0.04, and there is hope on the incontince and impotence. > My only advice: Buy a Harley. I had not ridden a bike in 25 years. 8 weeks after surgery, I went out and bought a new Softail, and rode it home (without the donut!). > That Harley is my "Happy Thought", which as we all know, is all you need to fly. > > Peter Pan In article <daf497f4ae3e4f784600a4544090b757@localhost.talkaboutsupport.com>, > My only advice: Buy a Harley. I had not ridden a bike in 25 years. 8 weeks > after surgery, I went out and bought a new Softail, and rode it home (without [quoted text clipped - 4 lines] > > Peter Pan In 1977 I motorcycled to Jasper and fed the bears, well almost, then back down thru BC. I have a picture of my motorcyle sitting on the great divide. It was a memorable trip and I'll never forget it. I wish you well in your recovery. My doc says it takes up to three years for all to heal up. Dale J. SignatureEmail: dalej2@mac..com > My only advice: Buy a Harley. I had not ridden a bike in 25 years. 8 weeks after surgery, I went out and bought a new Softail, and rode it home (without the donut!). > That Harley is my "Happy Thought", which as we all know, is all you need to fly. Had a '76 Honda 750SS up until just before I moved into this condo. No place to put it and I found that I had become a fair-weather rider. Now that I'm here, I realize my garage is big enough for a bike. So, on March 29, 2011 (retirement), I'm buying a Harley. All I have to do is live that long. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 why wait ??? buy it now and enjoy it. > Had a '76 Honda 750SS up until just before I moved into this condo. No > place to put it and I found that I had become a fair-weather rider. Now > that I'm here, I realize my garage is big enough for a bike. So, on March > 29, 2011 (retirement), I'm buying a Harley. All I have to do is live that > long. I'll have the money then. You're an accountant, do the math! :-) SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 > why wait ??? buy it now and enjoy it. > [quoted text clipped - 3 lines] > > 29, 2011 (retirement), I'm buying a Harley. All I have to do is live that > > long. > ... So, on March > 29, 2011 (retirement), I'm buying a Harley. All I have to do is live that > long. Sounds like a damn good reason to stick around. > > ... So, on March > > 29, 2011 (retirement), I'm buying a Harley. All I have to do is live that > > long. > > Sounds like a damn good reason to stick around. I agree with Alan, however, if your body and your wallet can do it now; enjoy it now and have 7 more years of Harley time. There's no dress rehearsals, we only go through life one time. Tom |
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