God's Amazing Body and Science - Part 6

The Heart

I am sure this is going to be my last post in this series or matching God and science.  It is fitting to leave the most important for the last and this organ is important to us in many ways.

I was got up late today and did not take my FBS before running off to cheuch.  I have struggled the past few days of staying the course with my eating.  I have a dog who just had surgery and most likely has cancer.  I have a lot of stress still going on at work and the Christmas season is upon us - not that it brings on stress, just a lot of good eating!!! 

Straight forward warning - this will be a long post - happy reading.

What it looks like and does

The heart is a muscular organ about the size of a fist, located just behind and slightly left of the breastbone. The heart pumps blood through the network of arteries and veins called the cardiovascular system.
The heart has four chambers:

• The right atrium receives blood from the veins and pumps it to the right ventricle.
• The right ventricle receives blood from the right atrium and pumps it to the lungs, where it is loaded with oxygen.
• The left atrium receives oxygenated blood from the lungs and pumps it to the left ventricle.
• The left ventricle (the strongest chamber) pumps oxygen-rich blood to the rest of the body. The left ventricle’s vigorous contractions create our blood pressure.

The coronary arteries run along the surface of the heart and provide oxygen-rich blood to the heart muscle. A web of nerve tissue also runs through the heart, conducting the complex signals that govern contraction and relaxation. Surrounding the heart is a sac called the pericardium.

Once again I am amazed that one cannot see it took a super engineer to create such a system of moving oxygen rich life through our bodies.

Heart Conditions

There are many conditions that can effect the heart and are listed below:

Coronary artery disease: Over the years, cholesterol plaques can narrow the arteries supplying blood to the heart. The narrowed arteries are at higher risk for complete blockage from a sudden blood clot (this blockage is called a heart attack).

Stable angina pectoris: Narrowed coronary arteries cause predictable chest pain or discomfort with exertion. The blockages prevent the heart from receiving the extra oxygen needed for strenuous activity. Symptoms typically get better with rest.

Unstable angina pectoris: Chest pain or discomfort that is new, worsening, or occurs at rest. This is an emergency situation as it can precede a heart attack, serious abnormal heart rhythm, or cardiac arrest.
Myocardial infarction (heart attack): A coronary artery is suddenly blocked. Starved of oxygen, part of the heart muscle dies.

Arrhythmia (dysrhythmia): An abnormal heart rhythm due to changes in the conduction of electrical impulses through the heart. Some arrhythmias are benign, but others are life-threatening.

Congestive heart failure: The heart is either too weak or too stiff to effectively pump blood through the body. Shortness of breath and leg swelling are common symptoms.

Cardiomyopathy: A disease of heart muscle in which the heart is abnormally enlarged, thickened, and/or stiffened. As a result, the heart's ability to pump blood is weakened.

Myocarditis: Inflammation of the heart muscle, most often due to a viral infection.

Pericarditis: Inflammation of the lining of the heart (pericardium). Viral infections, kidney failure, and autoimmune conditions are common causes.

Pericardial effusion: Fluid between the lining of the heart (pericardium) and the heart itself. Often, this is due to pericarditis.

Atrial fibrillation: Abnormal electrical impulses in the atria cause an irregular heartbeat. Atrial fibrillation is one of the most common arrhythmias.

Pulmonary embolism: Typically a blood clot travels through the heart to the lungs. 

Heart valve disease: There are four heart valves, and each can develop problems. If severe, valve disease can cause congestive heart failure.

Heart murmur: An abnormal sound heard when listening to the heart with a stethoscope. Some heart murmurs are benign; others suggest heart disease.

Endocarditis: Inflammation of the inner lining or heart valves of the heart. Usually, endocarditis is due to a serious infection of the heart valves.

Mitral valve prolapse: The mitral valve is forced backward slightly after blood has passed through the valve. 

Sudden cardiac death: Death caused by a sudden loss of heart function (cardiac arrest).

Cardiac arrest: Sudden loss of heart function.

Science to the rescue as always

Science has done many good things for the heart.  There are many tests now that can be run and science has even gone so far as replacing a heart.

Tests that can be run on the heart

Electrocardiogram (ECG or EKG): A tracing of the heart’s electrical activity. Electrocardiograms can help diagnose many heart conditions.

Echocardiogram: An ultrasound of the heart. An echocardiogram provides direct viewing of any problems with the heart muscle’s pumping ability and heart valves.

Cardiac stress test: By using a treadmill or medicines, the heart is stimulated to pump to near-maximum capacity. This may identify people with coronary artery disease.

Cardiac catheterization: A catheter is inserted into the femoral artery in the groin and threaded into the coronary arteries. A doctor can then view X-ray images of the coronary arteries or any blockages and perform stenting or other procedures.

Holter monitor: If a doctor suspects an arrhythmia, a portable heart monitor can be worn. Called a Holter monitor, it records the heart's rhythm continuously for a 24 hour period.

Event monitor: If a doctor suspects an infrequent arrhythmia, a portable heart monitor called an event monitor can be worn. When you develop symptoms, you can push a button to record the heart's electrical rhythm.

The first heart replacement

On December 3, 1967, 53-year-old Lewis Washkansky receives the first human heart transplant at Groote Schuur Hospital in Cape Town, South Africa.

Washkansky, a South African grocer dying from chronic heart disease, received the transplant from Denise Darvall, a 25-year-old woman who was fatally injured in a car accident. Surgeon Christiaan Barnard, who trained at the University of Cape Town and in the United States, performed the revolutionary medical operation. The technique Barnard employed had been initially developed by a group of American researchers in the 1950s. American surgeon Norman Shumway achieved the first successful heart transplant, in a dog, at Stanford University in California in 1958.

After Washkansky's surgery, he was given drugs to suppress his immune system and keep his body from rejecting the heart. These drugs also left him susceptible to sickness, however, and 18 days later he died from double pneumonia. Despite the setback, Washkansky's new heart had functioned normally until his death.

In the 1970s, the development of better anti-rejection drugs made transplantation more viable. Dr. Barnard continued to perform heart transplant operations, and by the late 1970s many of his patients were living up to five years with their new hearts. Successful heart transplant surgery continues to be performed today, but finding appropriate donors is extremely difficult.

The heart and Love

So this thing we call a muscle and is designed to pump the very life liquid through our bodies is also associated with a feeling, and emotion, a little thing we call love.  I am a true believer that God intended this muscle to be important to us and our relationship with him.  It is also the organ that drives our relationships on earth.

Before explaining why I think this is true - let me lead you to another person who has an awesome way of stating what happened to her.  Hillary Pike has a site and the link is http://thedailylove.com/the-awe-inspiring-power-of-your-heart/ .  In her post she writes:

'One of the most powerful moments of my life was when I experienced the love within myself during my Kundalini Yoga teacher training at Golden Bridge. I was in a deep meditation when I had a profound heart opening that took over my entire being; I felt so much love exuding from my heart. It was as if my whole body became a vessel of divine love. In that instant, I felt the true intelligence and power of the heart. I knew in that moment that part of my soul’s purpose in this lifetime to is to help hold a space of love on this planet.'

Jesus gave us two new commandments and they both involved love, love one another and love our enemies.  I think God knew that along with the blood our heart pumps that we would need a special place for our "love" of one another and he placed it in the heart.  That is why he gave us our hearts.

As we move into the Christmas season, I for one need to do a reset on so many things and starting with my heart is a good step.  A reset that involves:

1. Finding and eating good heart healthy foods
2. Taking heart healthy vitamins
3. Intensifying the love in my heart for my wife, children, friends, and even my enemies
4. Strengthening my love for my God - give my heart what it wants 

I ask each of you to think about your heart and over the next year - let's get heart healthy and heart friendly and let's take care of this muscle that pumps our life energy and also brings us joy through love.

God I make one simple request today and that is you give us the ability to make these life altering changes for our heart.  And we thank you for the amazing body you have given us and for the scientist you have allowed to learn about this amazing body and help it when it is broken and needs repair.

We love you and adore you and look forward to this Christmas season for your coming and your birth.

Bob,

God's Amazing Body and Science - Part 5

 

Medicines and how they can help

Yep, you heard it here folks - I am going to give some credit to the medicines and the ones we take.  I have stated before and you can see if previous posts, I believe in medicines - I just choice to avoid them if possible.  Then I have to hope I am not doing any damage to myself.

FBS - 106 this morning.

I have to get a new blood pressure monitor - mine is broken.

Before going to far, it is Sunday and we must give thanks to our higher power for the great things we have.  But most importantly, I ask that you raise your thoughts and prayers to your higher power for diabetics everywhere.  I am lucky - I have diabetes and that is just about it.  The rest of my body functions near normal, I guess.  There are so many diabetics that have other complications and the medicines they take for their other ailments actually increase their blood sugar level.

I have also been introduced to a nice individual in the ADA community and her mother " began taking Vascepa (which controls her triglycerides and inflammation markers in her blood) but had to stop as insurance wont cover it due to the FDA's actions regarding this drug.  It was really helping with her feet.  She can hardly walk now"   She has reached out to the community to gain some support for this medicine and I have signed the pledge.  If it is in your heart - please sign the pledge at http://epadruginitiative.com/.

Thanks for the support and help of a fellow diabetic.

Two Main Body Organs

We have looked at many different aspects of blood sugar and the impact of our bodies.  We have also looked at how our bodies utilize blood sugars.  Let's take a closer look at the two main body parts that help control blood sugar levels, the liver and the pancreas.

The Live Functions

The liver has several functions:

It regulates the composition of blood, including the amounts of sugar (glucose), protein, and fat that enter the bloodstream.

It removes bilirubin, ammonia, and other toxins from the blood. (Bilirubin is a by-product of the breakdown of hemoglobin from red blood cells.)

It processes most of the nutrients absorbed by the intestines during digestion and converts those nutrients into forms that can be used by the body. The liver also stores some nutrients, such as vitamin A, iron, and other minerals.

It produces cholesterol and certain important proteins, such as albumin.

It produces clotting factors, chemicals needed to help blood clot.

It breaks down (metabolizes) alcohol and many drugs.

So the one we are most interested in is the regulation of sugar in the body.

The Pancreas Functions

The pancreas is an organ located in the abdomen. It plays an essential role in converting the food we eat into fuel for the body's cells. The pancreas has two main functions: an exocrine function that helps in digestion and an endocrine function that regulates blood sugar.

Exocrine Function: The pancreas contains exocrine glands that produce enzymes important to digestion. When food enters the stomach, these pancreatic juices are released into a system of ducts that culminate in the main pancreatic duct. The pancreatic duct joins the common bile duct to form the ampulla of Vater which is located at the first portion of the small intestine, called the duodenum. The common bile duct originates in the liver and the gallbladder and produces another important digestive juice called bile. The pancreatic juices and bile that are released into the duodenum, help the body to digest fats, carbohydrates, and proteins.

Endocrine Function: The endocrine component of the pancreas consists of islet cells that create and release important hormones directly into the bloodstream. Two of the main pancreatic hormones are insulin, which acts to lower blood sugar, and glucagon, which acts to raise blood sugar. Maintaining proper blood sugar levels is crucial to the functioning of key organs including the brain, liver, and kidneys.

Once again I have to say I am completely amazed when people think our bodies morphed from tiny cells.  A great mind had to put this together - it did not just happen and it did not formulate itself.

Medicine To The Rescue.

We know there are times our bodies just cannot work as designed - like an engine that is not tuned or has a belt problem.  We need to take care of it and send it to the mechanic.  Our body mechanics are scientist and doctors.  Thank God for them.

metForm

This is the most common medicine for diabetes.  I will focus on it today just as how science is working.

Metformin ( pronounced /mɛtˈfɔrmɨn/, met-FAWR-min; sold as Glucophage) is an oral antidiabetic drug in the biguanide class. It is the first-line drug of choice for the treatment of type 2 diabetes, in particular, in overweight and obese people and those with normal kidney function.  Its use in gestational diabetes has been limited by safety concerns. It is also used in the treatment of polycystic ovary syndrome, and has been investigated for other diseases where insulin resistance may be an important factor. Metformin works by suppressing glucose production by the liver.

First synthesized and found to reduce blood sugar in the 1920s, metformin was forgotten for the next two decades as research shifted to insulin and other antidiabetic drugs. Interest in metformin was rekindled in the late 1940s after several reports that it could reduce blood sugar levels in people, and in 1957, French physician Jean Sterne published the first clinical trial of metformin as a treatment for diabetes. It was introduced to the United Kingdom in 1958, Canada in 1972, and the United States in 1995. Metformin is now believed to be the most widely prescribed antidiabetic drug in the world; in the United States alone, more than 48 million prescriptions were filled in 2010 for its generic formulations.

New metformin combo drug

Metformin is popular as the co-ingredient in several drugs for type 2 diabetes, and a new one is now in the pipeline and on course for approval by the European Medicines Agency’s Committee for Medicinal Products for Human Use. The new drug is called Xigduo, and it represents the first time metformin (which is in the drug class biguanide) has been combined with a sodium-glucose cotransporter-2 (SGLT2) inhibitor, dapagliflozin (Forxiga). 

Science just keeps trying to get better and I appreciate them for it.

Special Medical Professionals

I could not talk about medicines without talking about my favorite pharmacist - Suzy Cohen.  Suzy is trying to do so much for us diabetics and it is not all medicine related.  She is trying to educate us on so many topics and how medicines may actually be harmful to our bodies.

I urge you to get her book and visit her on-line at http://www.dearpharmacist.com/ .  She covers how to live drug free, headaches, and many other day-to-day complications.

She is a must in your library and knowledge bank.

God grant us the ability to know our body and its different functions.  Grant us the ability to give it what it needs and what you designed it to need.  Thank you for this wonderful body and we appreciate it very much and those mechanics who help us take care of it.

Bob,

God's Amazing Body and Science - Part 4

Blood Our Life Line

I realize it is not Sunday and no I have not lost my mind – just a whole bunch of time is all I have lost. But since I have been busy and missed the most precious day of my week – Sunday; I thought I would call today Sunday and continue with Sunday’s praise to God.

So please bear with me as I post on what I had on my mind on Sunday.

Before going on too far, the prayer requests just keep coming and I appreciate them very much. I ask that you continue to pray for those devastated in the Pacific Rim and for those Americans who have lost their health insurance.

I also ask that you continue to pray for Dora; remember her and how she is a diabetic who is in a nursing home and has lost both of her legs to this horrible disease.

I am asking that you add Kathy, a resident at the same nursing home to your prayers. She has just lost her 23 year old son and does not have a spouse to help her through this troubling time. I am asking that we all step up and be her Rock and ask God to help comfort her in these troubled times.

BS – 11/17/2013 – 97
BS – 11/18/2013 – 102
BS – 11/19/2013 – 115 (crazy right - I ate badly on the weekend – why up now?)

Again this picture represents just how majestic our Maker was when putting us together and building this magnificent machine we call our bodies. Just hard for me to believe that people do not believe that a Super Being put all of this together.

I mean speaking of a well-tuned engine that just purrs when it is running right – how about that body of ours and how it uses blood as the conduit into every part of our body.

Just think of the oxygenation of our blood. In one direction it travels through the lungs to be filled with oxygen – the very basic requirement of life. Add to that the sugar that we monitor is the very source of energy. Just two natural aspects of life carried in the blood and constantly purified and enriched for our natural health.

 

If the original concept does not get to you. Just look at this picture of all the places the blood goes and the total number of arteries and veins we have in our bodies.

Think of those that are big and carry lots of blood and those tiny little capillaries in small places like our eyes.

Every piece of skin, every small aspect or your body, and every nerve in your body relies on this think we call blood – our life energy.

No wonder we diabetics learn to monitor this and take care of it. Something is wrong with our natural production and consumption of the sugar.

Try this experiment if you want to see the impact of high blood glucose on the flow of your blood. Take two classes, one empty and fill one about ¾ full of water. Then add a little red die to the class with water. Begin to pour it into the empty glass and notice how it flows without effort between the two glasses. Pour it back and forth a couple of times and just appreciate how the normal flow of blood is working.

Now take as much sugar as you can and fill the glass with the water in it all the way up. You should now have about ¾ water and ¼ sugar. Let it settle for a minute and let the sugar and water become one. Now pour the liquid from one glass to the other. Notice the thickness and how it does not flow. Now think of that thick blood trying to get into those very small capillaries in your fingers, or eyes, or toes.

Get the picture how nerve damage starts?

Science to the Rescue:

As I have stated a few times, I think God knew we needed science to take care of our bodies like we need mechanics to take care of our cars.

A1c and what it is just amazes me still. It is a 60-90 day AVERAGE of what your blood glucose level has been. AN average! Can you imagine the ingenious thinking that went into that when the master engineer designed our bodies?

Now think of the first mechanic (scientist) that came along and discovered that our bodies could do that. Then develop a test to tell us what it has been. According to WIKI:

Glycated hemoglobin (hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also HbA1c) is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the measurement.

But science did not stop there as they realized that monitoring every 60-90 days was not enough. They developed the instant measurement of blood glucose level in our blood.

In 1962, Leland Clark and Champ Lyons at the Medical College of Alabama developed the first glucose enzyme electrode. It relied on a thin layer of glucose oxidase on an oxygen of oxygen consumed by the enzyme.

Another early glucose meter was the Ames Reflectance Meter by Anton H. Clemens. It was used in American hospitals in the 1970s. A moving needle indicated the blood glucose after about a minute.

Test strips that changed color and could be read visually, without a meter, were also widely used in the 1980s. They had the added advantage that they could be cut longitudinally to save money. As meter accuracy and insurance coverage improved, they lost popularity. However, a generic version of the BM is marketed under the brand name Glucoflex-R. There is a UK Pharmaceutical company (Ambe Medical Group) who have the executive rights for distribution within the United Kingdom.

At least in North America, hospitals resisted adoption of meter glucose measurements for inpatient diabetes care for over a decade. Managers of laboratories argued that the superior accuracy of a laboratory glucose measurement outweighed the advantage of immediate availability and made meter glucose measurements unacceptable for inpatient diabetes management. Patients with diabetes and their endocrinologists eventually persuaded acceptance. Some health care policymakers still resist the idea that the society would be well advised to pay the consumables (reagents, lancets, etc.) needed.

Home glucose testing was adopted for type 2 diabetes more slowly than for type 1, and a large proportion of people with type 2 diabetes have never been instructed in home glucose testing. This has mainly come about because health authorities are reluctant to bear the cost of the test strips and lancets.

May God continue to give us scientist and medical professionals to help monitor and care for our magnificent body. May he always guide them in ways that only the Master Engineer can lead mechanics with curious minds.

Bob,

God's Amazing Body and Science - Part 3

God and Science Creating Small Miracles

For just a moment and since this is Sunday,  I ask that everyone take a moment to speak a word to their higher power about the people facing with Typhoon Haiyan. The pacific rim is being slammed by one of the worst typhoon storms in history and 10,000+ are feared dead.

While stationed in Okinawa, I faced two of these typhoons and the wind were 140 - 160.  Pretty bad storms but not as bad as this one.  With  the winds we faced, large military vehicles were blown.  We must also remember that many of these tiny islands and countries do not have the shelters or places to go.

This is devastating and we all need to pray for the victims of this terrible storm.  Thank your.

BS - 110 this morning.  Having another weekend where not really watching what I am doing as my wife come home Friday night and we had card club Saturday night.  Next week I will get better again.

BP was high at the walk on Saturday so have to check that out at the doctors.

Keeping with the direction I discussed in an earlier post, I will keep Sunday's dedicated to God and science.

What a hard working pancreas

The pancreas is just one of those amazing organs that you just know it took a lot of time, thought, and energy for a higher power like God to design.  No amount of evolution could drive this small organ's abilities to keep the body regulated.

Reprinted from Sunshine Sharing



Where is it located?The pancreas is located in the abdomen, tucked behind the stomach. It is shaped somewhat like a tadpole - fat at one end and slender at the other - and is around 25cm in length.


What does it do? The pancreas has dual roles.
1. it is an organ of the digestive system and of the endocrine (hormonal) system. Once food has been mulched and partially digested by the stomach, it is pushed into the duodenum (first part of the small intestine). The pancreas adds its own digestive juices and enzymes to the food, via a small duct attached to the duodenum. This process is said to belong to the 'exocrine pancreas'.

2. The pancreas also produces the hormone insulin, which helps to control the amount of sugar in the blood. This is the role of the 'endocrine pancreas'. 

It is this second function that hurts all diabetics - Type I and Type II.  But let's stop for a moment and say what is going on here.  Your blood is carrying the insulin and sugar to cells so they can absorb the right amount of sugar.

So to stay on top of this 24x7, the body has to have some mechanism to monitor the blood glucose level and know if more insulin is needed to control the blood glucose level.

Sometimes the pancreas does not produce enough insulin and the blood glucose levels rise.  Other times, the cells do not absorb the sugar and feel starved so they ask for more sugar and it is produced.

Think of a very smart computer constantly checking to see if the amount of sugar in the blood stream if correct.  That takes some very sophisticated technology to make that work.

For normal human beings - it works fine.  For diabetics, something is wrong and the body needs help.

Science to the rescue

There is a great article in WebMD, http://diabetes.webmd.com/features/4-new-high-tech-tools-to-help-control-diabetes  that identifies how science is building technologies to help diabetics coop with their disease.  I will cover the highlights here.

  

Each diabetic knows the true answer is to test constantly, know your sugar levels, your carbohydrate intake, and to know what fuel the body needs to function properly.

In yesterday's post, I mentioned an 11 year old girl who got on the stage to discuss her life with Type I diabetes.  Her life consisted of constant monitoring, sticking her fingers 9-10 times a day, and then adding insulin when she needed it.

She now uses technology to help manage her daily life.  She has an insulin pump and a constant blood glucose monitor hooked up.  As mentioned in WebMN, the following 4 technologies are helping diabetics make it through the day, the week, the month, the year, and through their life - 5 minutes at a time.

New Diabetes Control Tools: Continuous Glucose Monitors

Many people with diabetes lance their fingers 2 or more times a day to check glucose levels. But even with as many as 9 finger sticks a day, patients still spend less than 30 percent of the day in a normal range, Kowalski says. "It's often a teeter-totter that a person with diabetes stands on."

Now, imagine getting a glucose reading every 5 minutes. That's 288 readings in 24 hours -- or almost 100 times what one would get with 3 finger sticks a day.

Thanks to the continuous glucose monitors (CGMs), this is possible. With a CGM, the user inserts a disposable, needle-like sensor under abdominal skin. The sensor measures glucose in tissue fluid, not blood. The sensor then transmits the data every 5 minutes to a monitor.

New Diabetes Control Tools: Combination Continuous Glucose Monitor and Insulin Pump

Patients who use insulin now have another option besides stand-alone CGMs. Medtronic's MiniMed Paradigm REAL-Time is the first combination CGM and insulin pump.

"Patients can both monitor their blood glucose and administer insulin therapy through the insulin pump."

It's not an automated system; patients must still make decisions about insulin dosing. But the Juvenile Diabetes Research Foundation hailed it as a "significant step" toward one of its major research priorities: That is development of an external, artificial pancreas that could someday automatically measure glucose and deliver insulin -- much like the real thing.

New Diabetes Control Tools: Diabetes Information Management Software

Increasingly sophisticated software programs allow patients who use regular blood glucose meters to track and analyze trends, Klonoff says. Patients can download stored data from their meters onto a computer through a USB port. Then, for example, they can view charts that show what percentage of time their glucose levels were within normal ranges, as well as above or below normal.

New Diabetes Control Tools: Smaller, Hidden Insulin Pumps

When the Omnipod Insulin Management System came on the market in 2005, it signaled a new generation of pumps. These were small, disposable, worn directly on the skin, and concealed under clothing.

Continue reading below...

"It's a completely different animal. It's the size of a small half-kiwi or a small Matchbox car," says Elizabeth Vivaldi, director of marketing at Insulet Corp., maker of the Omnipod. The pump, a compact "pod," weighs only 1.2 ounces when its insulin reservoir is full.

"You can hide it. People don't need to know," says Kowalski, who wears an Omnipod. He says that many people resist conventional insulin pumps. They're typically worn on one's belt like a small cell phone, with short tubing to deliver insulin through a needle inserted under abdominal skin. Many people dislike hooking up the pump and they try to conceal the tubing.

The following picture is a good picture of how some of these modern medical miracles are hooked up:

You have to love it when science helps God help us diabetics.

God please continue to give us intelligent people who are inquisitive and want to develop modern technology to help all of us.  Thank your for those that you have given us.  Thank you for the help you brought an 11 year old girl and to help her live a better life style.

Bob,