Archive for Ease and Disease

Another insomnia update

Having once again brought my sleeplessness to the attention of the medical profession, I have been prescribed two new (to me, anyway) drugs: Elavil (amitriptyline), a tricyclic antidepressant which is occasionally prescribed off-label for insomnia, and Neurontin (gabapentin), an anti-seizure drug which has some unspecified effect on nerve pain. This is probably consistent with everyone else’s experiences: the Wonder Drug of the moment works for a while, right up until the moment when it doesn’t.

I will say that the Walgreens pill bottle, while unintuitive, is somewhat less excruciating to operate than the CVS equivalent. And speaking of CVS, CFI Care (not its real initials) is not the only insurance carrier to dump them; Tricare, provider of civilian health benefits to military and dependents, is also leaving the CVS fold.

I also discovered this evening that I am much less able to pump my own gas after a full day of work: I had to lean up against the car for almost the entirety of 13 gallons (at the scary price of $2.399). This does not happen when gassing up at noon on Saturday, as is my usual wont.

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Insomnia update

Current puzzlement: how it is that no matter what time I get to bed, I don’t seem to actually fall asleep until nearly sunrise. (Experimental range: 10:15 pm to 2:30 am.)

First possibility to be explored: 600 mg of alpha-lipoic acid is too much. I skipped it yesterday, with no discernible effect.

Next: Overdose of melatonin (10 mg). Perhaps it worked better when I was taking 5.

Last: No commercially-available sleeping pills, either over-the-counter or prescription, work for me anymore. In which case, something triggered by sleep deprivation is likely to do me in before too awfully long. I certainly can’t work like that.

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Reversal of course

For a couple of years, I’d taken alpha-lipoic acid as a supplement, mostly motivated by “Well, how can it hurt?” The American medical establishment sneers at it because “Ew, supplement!” However, apparently it’s approved in Germany for the treatment of diabetic neuropathy. When I ran out in late September and my reorder went undelivered — Amazon says it came back to them — I figured I’d see if it made any difference if I did without.

Inasmuch as I’ve been in serious decline for the last month and a half, I decided to start taking the stuff again. Maybe it will work again, if it worked the first time.

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A laugh a minute

I woke up several times before the alarm, and finally dragged myself to the bathroom about five minutes early. I completed the sink-based ablutions with the usual amount of difficulty — a rather sharp departure from vertical — and made for the shower. In my current state of disrepair, I have adopted a procedure: grab one of the two bars retrofitted to the toilet, swing one leg over, grab the windowsill and swing the other leg over.

Not today. I got halfway up and came down hard on the side of the tub. Okay, fine: both those bars are within reach, I’ll just pull myself up. Also not today. I could get a decently firm grip on those bars, but I could not lift myself to standing position, no matter how much I pulled. Finally, with one last tug, I sank to the floor, to the accompaniment of the dreaded Spew Noise that told me I’d just broken the toilet.

Naked and wet, I crawled the entire length of the hallway, about 25 feet, to get to my cell phone, and summoned 911. The EMTs couldn’t haul me up to vertical for more than fractions of a second, and finally I was shipped off to the emergency room, muttering things about “So this is my last ride” and other Darryl Downer quotes.

ER found only one thing that could have caused this: excess fluid buildup in the legs. So they shot me up with 40 mg of Lasix, waited while I passed a couple of gallons of fluid in a mere two and a half hours, and then sent me home. I could stand, though not especially well.

Extra Special Downside: There is more fluid to pass, and, of course, the toilet is broken. The usual plumber has been called.

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Running Deepika

It was expected that Deepika Padukone would become a professional badminton player, as her father was. But being a fashion model paid better, and eventually, she meandered into film, becoming one of the highest-paid actors on the Indian subcontinent. She won her second of three Filmfare awards for Goliyon Ki Raasleela Ram-Leela, a 2013 take on the old Romeo and Juliet story.

Deepika Padukone in shorts

Deepika Padukone promoting shaving cream

She does promote a lot of products, yes.

Deepika Padukone at the MTV Europe Music Awards 2016

This latter is from this past weekend at the MTV Europe Music Awards.

Deepika has been very out front about her battle with depression:

She’ll be thirty-one in early January.

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Some folks do recover

Wikipedia describes one possible cause of cauda equina syndrome:

CES can be caused by lumbar spinal stenosis, which is when the diameter of the spinal canal narrows. This could be the result of a degenerative process of the spine (such as osteoarthritis) or a developmental defect which is present at birth. In the most severe cases of spondylolisthesis cauda equina syndrome can result.

Ann Wheeler, CES suffererI know from spinal stenosis; I had some serious surgery to correct the matter. I did not, however, develop CES. Now I’m starting to wonder if maybe I should have:

A mother who was inspired by a near-death experience to get “body confident” and go on 20-mile hikes in just a bikini and boots is facing a backlash from other women.

Ann Wheeler, from Clayton-le-Woods, Lancashire, suffers from Cauda Equina syndrome — a rare spinal condition that can cause paralysis.

The 59-year-old claims that the post-op experience motivated her to take up walking and wild swimming as natural pain management as she believes it is as strong as traditional painkillers.

Surgery, you may be certain, sucks:

After undergoing a gruelling five-hour op five years ago, Ann explained she technically died after all her bodily functions shut down.

She explained: “A male nurse helped me get out of bed the following day, I said I didn’t feel very well and the next thing I was out. I remember a doctor working on my chest. When I came to he said ‘welcome back, you’re back with us’. I also remember going down a black hole — it was then my bodily functions had shut down. I turned my life around after that — it took six months to get me walking again but now I can walk 78 miles in three days.”

I’m not walking after four months. Maybe I should have had my bodily functions shut down.

(Via Interested-Participant.)

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Issue forced

I have occasionally grumbled at how CVS has handled the legacy of Target Pharmacy, but not enough to get me to change drug stores, and certainly not loudly enough to draw anyone’s attention.

Or maybe it was. Received in the mail:

Beginning January 1, 2017, CVS Pharmacy #16007 will no longer be a part of your pharmacy network. This includes all CVS-owned pharmacies and CVS pharmacies in Target stores.

Why would CFI Care (not its real initials) do this? They’ve hired something called Prime Therapeutics to run their pharmacy-benefit operation, and it turns out that they own a piece of Prime. And there’s already bad blood:

Prime Therapeutics is suing CVS Health Corp. after the drugstore chain claimed generic drug payment changes will cost it more than $100 million annually.

CVS is seeking about $19 million outside of court from Eagan [Minnesota]-based Prime, claiming the pharmacy-benefits manager violated terms of a 2007 agreement plus federal and state laws, according to a lawsuit filed [in December 2015]. Prime disputes those claims and is asking a Minnesota federal judge to rule that it did nothing wrong and doesn’t owe CVS money.

I do not comprehend, however, how it was that the eight prescriptions filled yesterday at that specific CVS location, official copays totaling $103, were turned over to me for a mere $45. Surely they’re not bidding for my non-network business.

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Vertical hold

I try awfully hard to remain upright, even though I’m starting to think that it may not be worth the bother.

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Everything in balance

And that’s the important thing, right?

(Via Steve Lackmeyer.)

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Some hard-headed research

There are minor concussions, and there are major concussions. And they tend to look exactly alike out in the field, which makes this gizmo pretty useful:

“Did your brain slow down? How do we measure that objectively?” said Dr. Nancey Tsai, the creator of the Blink Reflexometer.

She said the device can answer those questions.

In the blink of an eye, she said the device can determine if there’s been any changes to the brain’s processing abilities. CEO Mark Semler and the team at the Zucker Institute of Applied Neuroscience in Charleston helped make the invention a reality.

“The computer logs 20 parameters per eye — all these different subtleties about the blink reflex,” said Semler. Through quick air bursts, the device measures the brain’s reaction time. Unlike other technology, this provides numbers.

Right now, it has one disadvantage:

The Blink Reflexometer is currently hauled around on a cart, but eventually, they’ll make it into a handheld device to use on the sidelines at both professional and high school sports.

It’s probably pricey, but hey: sportsball.

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A shock to the system

All of a sudden, falling on my sword looks like a good option again.

Something called Tiger Neurophysiology P.C., having collected nothing from my health insurance, evidently refiled; 90 days after the date of alleged services, CFI Care (not its real initials) has decided that these are really legitimate expenses after all, but Tiger is out of network, so I have to pay the entire $7300 and change.

Apart from the fact that I don’t have $7300 and change, I don’t understand this at all. So far as I can tell, Tiger works out of Teaneck, New Jersey. I can think of no reason why they’d be here in the 405. (Duplicate names? Possible, but hardly likely.) The EOB includes five separate entries for “Diag. Medical Exam,” which would seem useless, since I was already in the hospital on the day in question, scheduled for surgery.

I left an email for the insurance guys. But I tell you, I can’t take stuff like this; all by itself, this incident has put me perilously close to suicide watch. And a life that is constantly interrupted by traumatic incidents is not, to me, a life I want to live.

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Lately I’ve been losing sleep

I know this situation entirely too well:

My buddy insomnia does nothing fun to offer up as blog fodder. He has no antics, no card tricks, no dirty jokes. He just keeps me awake.

I yawn a bit as I wiggle my rear deeper into the recliner. I close my eyes for a second, but I know I’m not yet ready to fall into the arms of Morpheus. Insomnia and I have hung out many times in the past. I know his ways. In the old days these late night sessions found me at my creative best. That part of my brain withered long ago. I have always had strange sleep patterns. Even as a boy, I often got up for thirty minutes or an hour at a time in the middle of the night. I would walk the house, go outside and sit in the warm months, read or watch TV before heading back to bed. I know it drove my parents crazy. Until I was probably thirty it was rare if I averaged more than five hours of sleep each night.

Which is about the best I can do today on weekdays.

And for what it’s worth, my weirdest dreams are about two or three orders of magnitude more interesting than anything I try to pass off as fiction.

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We got your free health care right here

However, you probably won’t like it much:

No incubators, and no cribs, in this hospital; the newborns are sleeping in cardboard boxes.

And as seemingly always with Venezuela these days, it’s actually worse than it looks:

Experts say hospitals in the cash-strapped country, which is suffering from a shortage of food and fuel, are being starved of resources.

Douglas Leon, president of the Venezuelan Medical Federation (FMV), claimed some hospitals are working with just five percent of the medical equipment that they need.

The world’s tenth-largest (as of 2014, anyway) oil producer is suffering from a shortage of fuel. How bad is it? They’re having to buy oil from those horrible Americans.

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Tabs from heck

One of my Daily Drugs is name-brand only; CFI Care (not its real initials) specifies a copay of $75 a month for it, and will presumably do so until such time as a generic version becomes available, whenever that may be. A Mumbai-based drug company announced three years ago that the FDA had granted them tentative approval for a generic, but the patent apparently doesn’t expire until 2020. In the meantime, CFI Care gets to pay $12.32 per tablet.

Ongoing bladder issues led my doctor to recommend a trial of yet another brand-name drug: he handed over three boxes of seven tablets each. It worked fairly well. There exists a generic, but distribution seems to be blocked for now, so the pharmacy duly boxed me up 90 days’ worth, with a caution from the pharm tech that “this is very expensive.” Well, yeah, I knew that:

A 2006 cost-effectiveness study found that 5 mg solifenacin had the lowest cost and highest effectiveness among anticholinergic drugs used to treat overactive bladder in the United States, with an average medical cost per successfully treated patient of $6863 per year.

This was $18.80 a tablet in 2006. It’s come down some since then; CFI Care got to fork over $9.72 a tab. Still, it’s another $75 a month out of my pocket. Fortunately, Martin Shkreli doesn’t seem to be involved.

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Ready for the beginner slope

One week of the horrid floor materials at work wore away the last of the rubber tips on the back legs of my walker. Something had to be done, and that something was this:

Pop 'N Glide Walker Skis by Essential Medical Supply

I admit to being a hair over 250 pounds, but it wasn’t that long ago I was over 350 pounds. The walker itself supports 300.

$11.90 on Amazon Prime. I bought a pair and a spare.

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The lure of a smiling beak

I suggest that it’s probably not a good idea to get romantically involved with a creature that might end up on your dinner table, whether or not there exists the potential for disease:

A recent study from the Centers for Disease Control and Prevention shows an uptick in salmonella cases due to more and more people keeping and raising chickens. How do you get salmonella from a chicken, you ask? Take a wild guess.

An alarming number of people have apparently contracted it from kissing their fine fowl companions. According to the CDC’s research, 13% of the chicken-related salmonella cases they studied from 1990 to 2014 were due, in part, to some human-on-chicken smooching.

Of the cases they studied, the CDC says, “Most contact occurred at the patients’ home, and high-risk behaviors included keeping poultry inside the house and having close contact, such as holding, snuggling, or kissing poultry.”

I admit to being occasionally distracted by nice legs. Thighs, even. But I draw the line at making kissy-face with these peckerheads.

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Checking in

Today was, apparently, the last follow-up by the surgical team following my back surgery in early July. I grumbled a bit, mostly because the robovoice calling me to remind me a couple of days ago made a point of telling me to bring a whole bunch of documentation that I knew damned well they already had. The receptionist said, yes, they did have it, but we do need you to fill out a third of a page on Current Conditions.

The doctor himself says that I probably have another month’s worth of work restrictions before they’ll be officially lifted. He did, however, seem impressed with spot-strength displays. (One such test: you raise the front of the foot, he forces it upward, and then you’re supposed to push it back to the floor. I may have scraped the guy’s knuckles.) Anyway, unless something dreadfully terrible happens fairly quickly, this book is now closed.

Downside: it was raining when I left the office, and I had to contort myself rather horribly to get into my car, something I don’t do well anyway, even when it’s dry. My right knee now hurts like a sonofabitch.

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Keeping the beat

It just might save someone’s life:

If a little irony helps save lives, St John Ambulance is all for it. CPR instructors pumped out retro tunes, including Queen’s hit “Another One Bites the Dust” and Bee Gees’ “Stayin’ Alive” in the middle of the Bridge Mall on Friday for express lessons in chest compression.

Both have the required 103 beats per minute recommended for CPR.

“‘Another One Bites the Dust’ is the tune that has resonated most but if people can remember the song because it’s quirky and, if they ever have to perform CPR, they’ll be hoping the person they’re working on doesn’t bite the dust,” St John’s Martin Wells said. “Any attempt at CPR is better than none.”

(Happened upon after reading Roger Green’s piece for Freddie Mercury’s 70th birthday.)

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Not so fast, Chubby

The UK’s National Health Service is reshuffling its priorities, and you go to the bottom of the list:

Obese people will be routinely refused operations across the NHS, health service bosses have warned, after one authority said it would limit procedures on an unprecedented scale.

Hospital leaders in North Yorkshire said that patients with a body mass index (BMI) of 30 or above — as well as smokers — will be barred from most surgery for up to a year amid increasingly desperate measures to plug a funding black hole. The restrictions will apply to standard hip and knee operations.

The decision, described by the Royal College of Surgeons as the “most severe the modern NHS has ever seen”, led to warnings that other trusts will soon be forced to follow suit and rationing will become the norm if the current funding crisis continues.

Which, of course, it will:

The restrictions echo others made by health bosses in Hertfordshire, the North West and London in the past two years, where blanket referral bans were imposed on patients on the basis of their weight.

Last month St Helens CCG in Merseyside said it was considering temporarily suspending all non-essential hospital referrals by GPs because of financial concerns.

Reports of rationing have emerged after NHS England admitted in May that its provider sector overspent by £2.45 billion in 2015-16, more than a threefold increase on the previous year.

And inevitably:

The figure, which was described as conservative by think-tanks, prompted some hospital chief executives to question the future viability of free universal healthcare.

What are the chances Her Majesty’s Government will abandon the effort? Pretty close to nil.

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Snuff ’em

This is a scary followup to yesterday’s “Time for you to move on”:

Chester Siniawski, the man who survived a forced-euthanasia attempt on his life at the Joliet Area Community Hospice, continues to regain strength after his son, Chet, managed to free him from the JACH and move him into a hospital (where medical professionals actually work, not ghouls who try to kill people who want to keep living). Chester’s being fed three times a day now and is making huge steps in his recovery. A man who was cruelly denied food and starved for over two months is being given as much to eat as he wants and is loving it! He’s regained the use of his left side and, every day that he’s receiving proper nourishment and physical therapy, he gets closer to being the person he used to be, before his stroke in April.

The reason I care so much about this man is because of how horrific what was done to him truly is: he had a non-terminal stroke that he could recover from … but his own wife (who appears to have some kind of mental illness) wanted him to die and never recover, because she didn’t want to be bothered with having a husband in a wheelchair. Being a widow sounded more fun and a better time for her than having to care for a man who needed rehabilitation to regain use of his body after a stroke. That whole “in sickness and in health” part of the wedding vows didn’t seem to register with this woman. That right there is terrible enough … but on top of it there is actually a place in Illinois where someone this despicable can take her husband and staff will go along with a plot to withhold food and water from the man in order to euthanize him against his will. Just because his wife already has a black dress picked out and wants to put the “fun” back in funeral.

And the following is here mostly for my benefit:

I just come back to the fact that life is such a precious gift. Every day, each of us ages. We’ll never be who we were at 18 or 25 or 30 or whatever. Our health deteriorates. We lose abilities. In time, we become ghosts of our former selves. As an American, I just don’t like the idea of ever giving up … and so I won’t ever give up. That’s my choice. I want to keep fighting and living for as long as I can. I hope that the people I love want that too for themselves. And if they do want to fight and keep living but staff at a facility and other actors try to kill them, you better believe I will do whatever I can to keep them alive. How sad it is that our elected officials and trusted public servants don’t feel the same way and operate under the kind of “death is better” mentality that the Soviet Union would have subscribed to.

“We’re going to take things away from you on behalf of the common good.”

Hillary, you should know, was actually talking about tax rates at the time, but I trust absolutely no contemporary politician to comprehend, let alone define, any concept like “the common good.” This is why we have death panels “end-of-life counseling.”

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Time for you to move on

I found this in a thread started by a Facebook friend:

When I lived in Massachusetts, and my health was collapsing, and I couldn’t afford to wrangle the problem, strangers would often recommend that I kill myself. It got to where I would not mention my problems with my health in public places — someone sitting nearby would always come over and angrily aggressively insist I kill myself, to cease being a burden on society. They honestly believed that’s how the system works and should work.

It matters not to me whether their belief is “honest” or not. Who died and left them in charge of logistics? Exactly. The lot of them can go straight to hell, do not pass Go, do not collect $200.

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Air biscuits under examination

Admit it, you’ve wondered yourself. Now you know:

[I]t’s impossible to say exactly how much space a generic fart takes up in the body. I can, however, tell you about the range of specific farts, as captured in scientific experiments. For instance, a 1997 study of 16 Americans found a volume-per-fart range of 17 milliliters to 375 milliliters. Imagine a bottle of nail polish — that’s a rough analogy for the volume of the daintiest of poots. Now imagine a can of soda. That’s the volume of a really big stinker. Your body is a wonderland.

Your mother, of course, is aghast.

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You’re not dying fast enough

And this sort of thing matters to insurance providers and similar types:

When someone is receiving hospice care, it usually means they’re very close to the end of their life. But what happens if that person simply refuses to die?

A woman who’s outlived her prognosis has lost hospice care for that very reason, CBS New York reports. She wasn’t supposed to still be alive, after doctors gave her less than six months to live … two years ago. But despite battling stage 4 lung cancer and chronic obstructive pulmonary disease, she’s hanging in there.

Because, you know, rules:

Medicare rules define hospice care as for the actively dying only, and “terminal” means you have less than six months to live. Now that her hospice provider has done what’s called “graduating” the woman from hospice care, she’ll have to go back to her private doctor and supplemental insurance.

I’m going to ponder that phrase “actively dying” for a while.

And while I do, I’ll think about my dad, who back in 1999 was told he had maybe six months to live.

He made it just past Christmas 2006. Then again, he was a right ornery cuss.

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The last dose

This seems like a legitimate problem to me:

[T]hen there is the “problem” with people accidentally committing suicide by taking too much of a prescription pain killer. If it’s a prescription painkiller, we know how much of the drug is in there. We aren’t talking about street corner heroin which have anywhere from zero to 100% active ingredients. If people are dying from taking too much Oxycodone, it’s either because they want to die, or they don’t know what a fatal dose is. And why is that? I’ll bet it’s because “nobody needs to know” that kind of information.

A lethal dose will probably vary from person to person. There is an FDA Black Box warning on Vicodin, but probably not the one you expect:

Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen-containing product.

They could slap that on Tylenol, and probably do.

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I suspect I’m drowning in it

And I never, ever even knew:

An international collaboration of research scientists in Australia, the United States and Sweden has identified a molecule in the blood that holds the key to identifying the cause of suicide.

“We have known for a long time that people who attempt suicide have markers of chronic inflammation in their blood and spinal fluid. Commonly used antidepressants have only limited effect because they target serotonin — the branch of tryptophan associated with happiness — rather than quinolinic acid which is the other branch of tryptophan associated with inflammation,” said Professor of Neuroscience Gilles Guillemin from the Faculty of Medicine and Health Sciences.

“Our latest research provides further evidence of the role of inflammation in a person’s mental state. It shows that suicidal patients have reduced activity of an enzyme called ACMSD which results in lower production of picolinic acid, an important molecule for brain protection. We now have a much clearer indication of the biological mechanics behind suicidal tendency.”

Because you want to know:

Brundin, L., Sellgren, CM., Lim, CK., Grit, J., Palsson, E., Landen, M., Samuelsson, M., Lundgren, C., Brundin, P., Fuchs, D., Postolache, TT., Träskman-Bendz, L., Guillemin, GJ., Erhardt, S. An enzyme in the kynurenine pathway that governs vulnerability to suicidal behavior by regulating excitotoxicity and neuroinflammation. Translational Psychiatry, 2 August 2016, doi: 10.1038 / TP.2016.133.

(Via Fark.)

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You want this, you’re on your own

Insurance companies are balking at the high prices of some drugs, so this should surprise no one:

CVS Health, the giant pharmacy benefits manager, moved Tuesday to counteract the financial impact of high-cost medications by excluding a number of drugs used to treat patients with cancer, diabetes and hepatitis C.

“We expect to remove 35 products from our standard formulary” — a list of covered products — “including 10 hyperinflationary drugs,” said CVS Health, which provides prescription benefit management services to several thousand health plans.

In some cases, higher-cost drugs are being replaced with lower-cost options, the company said.

I looked at the list [pdf], and there’s nothing particularly surprising there. They will no longer pay for brand-name Nexium, for instance, but will pay for generic esomeprazole. And one drug I’ve used before, Dymista (azelastine), previously scrubbed from the formulary, has been reinstated.

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Limbo lower now

In which I wonder how low I can go.

(Fundraiser continues.)

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Lessons from life (one in a series)

(Medical facility) + (new computer system) = two-hour delay, minimum.

In this specific instance, the new appointment handler overbooked by a factor of 1.5, maybe worse.

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Not at all perky

And I never, ever will be:

Get well soon.

Balloons and cards offer — or sometimes command — this well-meaning sentiment to patients in the hospital. Gifts of stuffed animals and flowers are showered upon people to provide comfort and cheer. But for some patients, nothing can help them feel better after leaving the operating room. Even as they recover physically, their mental health suffers as they experience sadness, fatigue or anxiety — all of which are symptoms of post-operative depression, a commonly experienced but little-known condition.

Depression following surgery is a frequent occurrence but not nearly as frequent a topic of conversation in the medical community. It can be credited to a number of physical factors after an operation, including reactions to anesthesia and narcotic painkillers, pain and discomfort, or an undetermined biological process. The type and severity of the depression can vary depending on the type of surgery performed, but according to HCPLive, post-operative depression is reported to occur more in coronary artery bypass graft (CABG) patients who smoke, are single, experienced anxiety before the surgery, have high levels of cholesterol and angina or more severe heart disease or are undergoing another CABG. Emotional triggers of post-operative depression can be credited to disappointment in the outcome of the surgery and a response to physical changes such as stitches or scars as well as resulting feelings of vulnerability and fear.

And believe me, I know from vulnerability and fear. I technically don’t have a life-threatening ailment, so far as I can tell; but the life I used to have was threatened, and now it’s evaporated.

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What was done

In case you were curious:

For the record, I had three screwy laminae plus one herniated disk. Prognosis, to me at least, seems unclear.

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