Doctor dickering….

Can you dicker with your doctor?

Yesterday, my occular plastic surgeon’s nurse called me back with cost of a full lower lid fix on my eyes….mind you, I’m already sedated and cut open, and it’s the same surgeon doing just one more cosmetic adjustment that he estimated would add 30 minutes to the proceedure.

And the number is? Four thousand dollars. Four thousand uninsured dollars, that is. That means that he wants cold hard cash before he does it. I keep thinking about what I could do with an extra four thousand dollars…..and a cosmetic procedure just isn’t where I’d like it to go….it just seems so incredibly vain to me. I’ve often been accused of having had plastic surgery, and I’ve always been proud to declare a “body by God”….so this whole thing is conflicting me a bit.

So, I’m hoping to call him and tell him that I can’t handle four, but I would happily pay two thousand if he would consider doing the procedure for that…..I’m curious to see how he reacts to that. I know that medical offices dicker with insurance companies all the time, and that many procedures get reduced or even written off…..why not dicker before the fact?

The K.L.O.

Today I became an official member of the Koi Liberation Organization.

It all started a few monthsago when one of our many self-employed friends had to file bankrupcy….it’s absolutely amazing how the wind has come out of the sails of so many of our friends in this economy. Not that we don’t have our own struggles, but I am grateful to be able to make two mortgage payments in this economy (we bought my in-laws a home about 5 years ago)<—-that’s a whole other blog!!

So, when I heard that our friend’s home, which was foreclosed on weeks ago, had koi fish living in their back pond, I started to panic….with no one to feed the little darlin’s….how will they live? Keep in mind that a foot long koi averages for $150 retail, and you can understand why I was eager to rescue these little beauties, which were definitely off the immediate budget….I can’t imagine when I’d realistically feel good about spending $750 on some fish for my pond again.

My husband built us a “water feature” when we landscaped our backyard. My husband is your typical 6′8″ Texan….bigger is always better. I often feel as if our home is handicapped as far as the “altitudinally challenged” members of our family. That’s just me…..our son is 6′9″ and still growing (2 more inches, and mama’s got a new HOUSE, as far as the NBA is concerned! LOL!)<–but, that’s a whole other blog,…..

Keep in mind, that we started stocking our pond with 25 cent minnows. Guess what? tiny minnows are easily swept up in the filtration system that is needed to run our 25 foot double waterfall (photos to follow soon)

So, we tried tiny fish, and they were sucked into the filtration system, and foot-long koi were too much a risk for my pocketbook….but free foot-long koi is a horse of a whole different color!! We contemplated sneaking in in the dark of night to liberate the 3-5 koi that were in our friend’s pond, but I am not as adventurous as I used to be, and jailtime does not hold the allure it once held in my youthful mind….

But, this morning, My Honey and I awoke at our normal 3am….we tossed and turned, walked the neighborhood, and finally decided around 7:30 that today was the day to liberate the koi. I even decided on a story….that we’d only recently heard of the poor koi’s plight, and as the sensitive wife, I felt compelled to give the poor fish a proper cared for home.

So, thanks to our GPS, we arrive at the home and tip toed into the back yard. We were prepared: My husband had brought a 5 gallon bucket and a spa skimmer…..a spa skimmer is like a pool skimmer, only less than 1/2 the size….it was maybe 8 inches in diameter….

When we finally arrived at the pond, we realized that :

A) There were not 3-4 koi, as originally thought, but only one lonely gold and white butterfly koi lolly gagging in the tiny pond.

B) This koi was over a foot long, and not likely to be caught in our tiny skimmer.

But, we didn’t drive 15 miles for nothing, so I filled our 5 gallon bucket with murky pond water while my husband stirred up all the debris from the bottom of the pond desperately trying to scoop up the lonely koi. Keep in mind that we are trespassing on bank property in a very nice neighborhood, and we don’t want to draw attention to our plight.

Somehow my husband convinces me to take off my shoes and wade in the disgusting murky pond…..mind you, I can’t see my feet, and the bottom is slick and uneven. At one point, he manages to braise the fish with his skimmer, sending it in my direction. Now, a foot-long koi is stronger than you can imagine, and it took every bit of strength of my inner being not to scream……I almost fell on my rear in sheer terror when the fish tried to dart between my legs…..the water was only calf-high, b.t.w.

So, it became apparent that the skimmer isn’t going to cut it, but it is 8am on a Sunday morning, and there are no sporting good stores open. We decide to try Fred Meyer…a local one-stop-shopping place that boasts in it’s jingle “What’s on your list today? You’ll find it at Fred Meyer!”…..so we head off to the sporting goods section…..no luck….

Then I come up with a brilliant idea….why not use two basic laundry baskets? The Indians weaved baskets to catch fish, so why not use a modern version in modern times? We purchase two cheap white laundry baskets, and return to the scene of the crime.

I, of course, had to wade back into the murky waters of the friend’s pond, and my husband, of course, looked on from OUTSIDE the pond. The basket was taller than the depth of the pond, so I used it to skim the depth of the pond….I could see the pale gold and white tail in the murky waters, and instructed my husband to turn his laundry basket toward me, in order to catch the fish in between the two baskets……It took less than 2 minutes to catch the fish in this fashion, because the laundry basket was so large compared to the fish and the pond…..I was actually pretty amused with myself for coming up with the whole laundry basket idea.

Did I already mention that of 4 koi, there was one lone fish left? So it flipped into my basket, and I quickly scooped it up, handed it to my husband, and filled our 5 gallon bucket with more of the murkey water it had gotten used to as home.

Then there was the 30 minute ride home…the bucket sloshing all the way, and my and my husband high-fiving each other the whole time…..it felt great to save this poor koi, who surely would’ve died if not tended to soon.

Long story short, we liberated the poor gold and white colored butterfly koi into our pond, and my girls have already named it, aptly, Creamsicle!

The next few blogs could possibly feature photos of Creamsicle, along with stories of it’s eventual comfort in our little man-made pond.

For now, creamsicle remains a little shell shocked….he tried swimming in our pond, but it is evident that our pond is a bit larger, deeper, and definately noisier than he is used to. For now, he is content to curl up inside two concrete blocks that we placed in the pond ot hold pond plants and provide shleter from the racoons….he has rarely left in the past 8 hours…..

Damned if you do……

I just had my pre-op with anesthesia and a meeting with my eye surgeon. I left my house at 7:00am for an 8:00am meeting, only to be put off until 8:45. Then my 10:30 with the eye surgeon didn’t happen until after NOON! Tell me why a doctor’s time is so much more important than mine? Why does my cell phone alert me if my plane is more than 10 minutes behind schedule, but a doctor will never apologize for making you wait an hour in your underwear?

And the anesthesia pre-op was a joke….paperwork filled out by me with litmus-test questions like: Ever smoke? Ever do illicit drugs?

My favorite answer today was when they asked the drinking questions? Drink? (yes) How much? (1-2 drinks) How often? (OFTEN) I always tell them I’m nervous about surgery so they give me the early cocktail of happy juice. The best part was that this was all taken in by a nurse practitioner, who I know is only going to go online and check the appropriate columns in an Excel spreadsheet…..I’ve usually only had actual anesthesiologists do the pre-op anesthesia reports…..today was a first. Gotta love the big box medical centers.

Then it was off to the eye surgeon. It was not a total loss, because I got to ride on the tram that connects the two campuses of the medical center. Between the parking validation and the free tram ride, I figure I saved about 12 bucks……which will come in handy later.

My surgeon looked at me and cocked his head to one side (not a good sign). Then he measured my eyes. No change, even though they appeared to him to be a little less compressed. I still have eyes that protrude 24 mm too far forward….pretty. Then he lowers the bomb. A recommendation he’d never previously given:

“I think you may want to consider a little additional work on your under eye bags. I’m afraid if I take down the fat deposits under your eye, you will be left with too little fat between your upper cheekbone and your eye socket. He never mentioned this in any of the previous 4 appointments.

He proceeds to put a mirror in my hands and manipulate my face up and down…..illustrating the toll that the last several years of ill health have had on my face….

“As you age more, your skin will continue to sag lower, and your cheekbones will continue to protrude, and then here come the jowls….” He laughs at himself, and I just want to deck him…..Then he tells me that the extra surgery he recommends is, of course, considered elective cosmetic, and therefore not elligible for insurance or flexible spending.

“How much more?” I ask.

“I’ll have my assistant get back to you with that figure” he answers. My heart sinks. Here I thought this surgery would end my eye issues, and it turns out they may just be beginning.

He goes on to tell me that the scars that will remain at corners of my eyes the end of the surgery will be “definitely noticable for awhile, if not always…sometimes we have to go back and do ‘touch ups’ here and there.”…again these “touch ups” will be considered cosmetic and completely out-of-pocket.

By now, I am thoroughly confused about whether I should even bother……maybe it’s better to look like Barbara Bush than Riff Raff from Rocky Horror.

“Of course, you don’t have to do this surgery at all if you don’t want”…..reminding me that this is, in effect, completely elective. I can elect to look like kermit the frog, or I can elect to give into vanity, and possibly end up with a worse outcome, with no real guarantees either way.

But just last week I scratched my eyeball when I went to brush the hair out of my eyes….that is how far my eyes stick out. And my eyelids are touching most of my glasses frames….annoying to say the least.

So, so far I am full steam ahead with the surgery.

for now.

Family Reunion, Part 1

I’ve been busy organizing a family reunion….what a trip. If there is one thing I have learned over the years it is this….the more you do for people, the more they expect…..lucky me!

I feel just about 100%, just 2 and a half weeks post hysterectomy. There is only one incision that still screams at me from time to time. It hits right where all my pants hit, so I know that has something to do with it….it just won’t heal over like the others.

Now have the eye surgery to look forward to. Good thing I have the family reunion to keep my mind off things….except that the family reunion is driving me nutso! At least it’s on my husband’s side, which gives me a little room to be objective.

On the plus side, I have lost 11 pounds in 2 weeks, and only 2 of that was uterus….so I guess I can’t complain….

In My Spare Time…..

So, what does a creative stay at home mom do to keep her sanity? It’s a great question that I can’t answer for everyone. I, myself like to keep busy in order to keep from cleaning.

An interesting paradox….a housewife who hates housework. You show me a perfect house, and I’ll show you a desperate housewife with nothing better to do…..Please don’t think I’m ranking on those Martha Stewart types, I wish I could experience their thrill of monotony. For me, I just find the daily chores an exercise in the futile….especially with my messy brood…but my guess is that Rachel Ray is a bit of a slob herself. And, Oprah without all the help would be hopeless around the house.

I’ve tried to get Zen about it, I’ve tried various systems out of Better Homes and Gardens…but when my kid walks in and asks to do paper mache pigs, I immediately quit cleaning and start creating. I love the creative side of domestic sciences, like cooking and decorating….but my house is 6 bedrooms and 5 bathrooms and it’s all a bit overwhelming at times. What were we thinking when we got such a big house?

That being said, I do keep my home sanitized, especially when my littlest was awaiting her surgeries. I used to make visitors wear large bleached work shirts of my husbands, and I still have a drawer full of medical masks right by the front door in case anyone comes over with a sniffle. I HATE it when people come to my house with a cold. I find it rude for someone to come to a party knowingly sick.

So, when I want to escape housework, I find something creative to fill my time. For over a decade I produced musical reviews and planned weddings and parties for friends and clients of my husband’s. I never tried to make money at it, I just did it to keep myself away from the feather duster.

I also fell into web design accidentally, and even had an online fund raising company for small non-profits. Again, my business partner and I never made any real profit, but it was a fun distraction for awhile.

So, now my pet project is helping my friend Paul get his personalized color shampoo line launched. Paul owns a fierce little place called Blue Chair Salon. I’ll never forget the first time I sat in his chair and watched him work….he was trained at the Vidal Sassoon Academy in Australia, and his technique is flawless, as is his approach to hair color. Anyway, we’ve been developing this shampoo for over a year, and it’s finally ready to launch. Well, almost. We still need to get a good design to silkscreen on the bottles.

This is where you come in: Please look at the following samples, and tell which one is your favorite. Thanks in advance!

Now, imagine if you will these bottles filled with high pigment color….red, blue, orange, etc. and the gray ink will be metallic silver, not just gray.

Seriously?

Can someone tell me how a girl with all my health issues gets a freakin’ bladder infection on top of everything? and of course, it feels as if my uterous is falling out, but that is IMPOSSIBLE!

On a happier note, my gyno got me in quick for a test, and prescribed an antibiotic pronto, so I should be on the mend quickly…..I’l post another eye update later this week.

I can’t believe how tired my body still is….I had to cancel a client dinner tonight, and I can’t remember the last time that happened. Happily, my son filled in as my husband’s date for the evening….he’s going off to college in just a few weeks, and it’s hard to wrap my brain around that….how will he eat? Who will fold his underwear? LOL!

Difining Limitations

Well, I am doing marvelously. Woke up today and didn’t even take a pain pill. Decided to clean my grill. Spent 2 hours on it, scrubbing, steaming, etc. and then had to lay down because my cervix felt like it was screaming at me. Woke up 2 hours later, as if I’d been in a coma!! LOL!

On a happier note, my kitchen pantry moth trap seems to be working. My mother bought them for me, and I was reticent, but it’s caught at least 20 of the little suckers…..I initially got the pantry moth infestation from my local asian market, thank you Uwajimaya!!

In other good news….sometime on Wednesday, my computer got a virus. Now websites open willy-nilly, and my husband is asking me “Baby, are you looking at dating sites?” LOL! The virus has also rendered my word processor and my copy+paste useless….good times.

Recooperating

Well, I made it through the weekend, and my husband is calling me with honey dos for the day, so I must be on the mend!!

The pain is definitely negotiable, and I’m weaning myself off the oxycodone and substituting ibuprofen. Still, it hurts to sit upright for too long, and my belly has big yellow bruises that start at the belly button. My entire tummy feels itchy, like whatever is inside is healing.

The swelling is going down, which is good because I hate looking at my 2nd trimester belly! Today I’m going to hop on the elliptical for 10 minutes and do some very light upper body work with free weights….I might even go work out on our lower deck: In keeping with our Sanford and Sons roots, we have moved our home exercise equipment to our backyard lower deck. This same deck holds redwood boards from the 80’s that my husband has dragged to each of his homes (in hopes of making a picnic table one day) and patio furniture set we bought at Restoration Hardware 8 years ago. We are self-proclaimed pack rats. I’m shocked we didn’t ask to keep my uterus as a memento. I’m sure my husband could make some sort of coffee table with it. But, it is kid of fun to work out outside when the weather is sunny and not too hot, so I’m not complaining.

On the plus side, I can finally sleep on my side again. I’ve been back sleeping, which I know is better for your face, but it’s just not me……I’ve also lost 5 pounds…..do narcotics keep you from feeling hungry?

I haven’t even hit the one week mark, and I’m counting down the days when the hubby and I can re-consummate our marriage! LOL! Am I a virgin again? Do I get another honeymoon if I am?

I’m anxiously awaiting a call from the Gyno’s office. I’m really hoping he will at least call to check in with me. I’m really hoping that customer service is something he actually believes in, and not something he just pays lip service to. But, today will definitely show me whether what happened last week was a fluke or a flaw…..stay tuned.

UPDATE:

I had no sooner published this blog when the phone rang. It was my Gyno himself, back from sunny Florida and checking in to see if everything was okay. He was extremely apologetic, and couldn’t have said anything better.

He stressed that what happened was inexcusable, and urged us to write a letter to detail the events which transpired, and our level of dissatisfaction. He promised me that he would make sure that this never happened to another one of his patient’s again, and that he’d do anything to make things right with us and keep me as a patient.

I have to say, I was impressed with his earnest attitude and direct communication….

Everyone makes mistakes and has off days….very few know how to properly apologize for them.

Independence Day!!

For the past 7 years, our neighborhood has held a 4th of July celebration that has turned into quite the celebration. We start around 3 with a swim party that moves on to a kids parade, face painting, parent’s relay, BBQ, fireworks display and so on…..It’s a fun event, and each year I have one job….the grill. It is not unusual to have 50 burgers and 20 hot dogs on the grill at a time, and evidently I’m the only person in the neighborhood who can flip that many burgers without freaking out. I’m totally anal about getting the grill marks just right…..it’s just my thing.

The party is held at our neighbor’s home, because they have a pool in the back and a flat yard in the front, and I have neither. Everyone brings a side dish and we all chip in for the BBQ, etc.

So, today i woke up and started preparations for the party. My husband invited extra guests, so I wanted t make sure that there were enough side dishes to cover them, so I started early in the morning. First thing I had to do was clean the kitchen, including cleaning out my fridge because it was one of those chores I meant to do before my surgery that I didn’t get to. Now with guests bringing (possible) side dishes, I had to make room.

I was feeling fine, so I started making banana cake and potato salad. I also found a recipe for Serendipity’s frozen Hot Chocolate, so I made up a batch that would be ready to go when the kids got out of the pool. Then, of course, I had to clean the kitchen again! By now I was kind of tired, so I went down for a cat nap before I showered and got ready for the party.

By the time the party came around, I was buzzing around getting our guests drinks and running back and forth between houses trying to help with the set up of the party….all those last minute utensils, decorations, etc.

I was feeling fine, except when I walked too fast, which made my incisions whisper a bit at me. But I just kept busy while everyone marveled “Wow! I can’t believe you are moving so well! You’re amazing! Modern medicine is a miracle……etc” Everyone was chastising me to sit down and relax, and I really tried to, but that’s just not what I do well. I like being the go-to mom who hustles and bustles. I even turned on the grill and tried to BBQ, but my husband swooped in and made me sit down. “My turn” he said, which was adorable…..I honestly NEVER see him grilling. It’s a joke in my family that I grill…..but that’s a whole other blog…..

Parenting books always tell you not to criticize the new father when he picks up the baby and takes on any responsibility. That means that if the diaper is on backwards and Daddy is spoon feeding baby food to the baby’s ass, you say NOTHING….or else you are just feeding into the idea that he is useless, and he’ll never offer to help and it will be your fault…..So, I sat back and said nothing while he grilled the burgers. I sat on my hands and my tongue, and didn’t even crack a joke (which is a miracle for me). And guess what? They turned out BEAUTIFUL!! I didn’t even check the grill marks….

So, I sit and visit, and go back to my house a few times for various things (drinks, bathroom breaks, kid stuff) and I never really sit down for another 30 minutes or so. By the time I sit, the grass looks like it is spinning a bit, and I’m feeling queasy. This is why I avoided sitting for so long….I was afraid of how I’d feel when I finally did.

So, I toughed it out, feeling spacey and unsociable for the most part. This is when my husband’s ex-wife stops by, just to say hi (note that she has never lived in our neighborhood, but always manages to stop by whenever we have a function…..that’s a whole other blog!) along with a nephew I haven’t socialized with in years, and it all became a bit too “This is Your Life” for me……

So, long story short, I retired before a single firework went off, but I felt good about contributing to the party and being there for most of it. The frozen hot chocolate never got made, but it’s in the fridge ready for the next hot day as a pool treat for the kids (we actually had a cool 4th this year: overcast and threatening to rain the whole time).

And I learned that you CAN teach an old dog new tricks!! That’s what I call independence!!

My Husband is THE MAN!!

Now, I have loved my husband for over 15 years now, and he has been my rock through so many of my illnesses. Lord knows we have tested most of our wedding vows both ways in our 13 years of marriage, but yesterday my husband stepped up in a way that really made me take notice and fall in love with him all over again.

When I first visited my new gyno and scheduled surgery, I was given a choice between Vicoden and Percocet. I chose Vicoden, but I don’t know why. My step-dad is a doctor, and he suggested I get scripts for both in case I reacted to one…..I had planned on asking after surgery, but my doc never came in to check on my after my surgery (we asked our nurse, and were told he’d see me before I left.) It never happened, but we didn’t really take much notice. I was just happy to be leaving.

Yesterday I mentioned that the Vicoden was giving me a screaming headache. I called the Dr’s office and was told that Percocet was off the menu, because it was a narcotic, and therfore had to be signed for, and my doc was out of the office. He left town for a long 4th of July holiday, and could not be reached. She suggested I try the Tylenol with Codeine and see if that works.

So, my dear husband (heretofore referred to as DH) ran up to the pharmacy early morning and brought back the T3 tabs. I took two doses to give it a good effort, but it was not touching the pain. By noon it hurt to breathe, and I was not able to lay comfortably. I have a pretty high tolerance for pain, but I knew this was going to be a long weekend if T3 was all I could get.

So, at 12:30 I call the office and get an answering service. I leave a message for the on call Doctor, we’ll call her “Dr. J”. At 1:30 I call the office again and speak with the nurse, who tells me that she will call Dr. J and get back to me. I wait 3 hours (3 painful hours) and finally call the office again at 4:30 and ask for the nurse. When she gets on the line she says “I was JUST going to call you!” (yeah, right) She tells me that, unfortunately, Dr. J in on call, but NOT in the office, so she cannot write a prescription for Percocet, but I could try Darvocet if I’d like, as it was the last painkiller she could offer that was a bit stronger than the T3 my husband picked up earlier (why wouldn’t they have just given me this in the first place?)

She also pleasantly told me that if the Darvocet didn’t work, I could always go to an urgent care center and ask them to write a prescription for the Percocet……this is when I felt completely betrayed by this medical office…..Urgent Care? Are you KIDDING ME?

I tell her that I’m not really satisfied with her answer. I tell her that when we first sat down with my gyno, he explained that he was different from most other gynos in the area, and what really set him apart was the fact that he refused to be a part of the “health care juggernaut” as if it were part of the axis of evil. He had many valid points, and convinced us that having surgery out of network would be a win/win situation.

Unless of course, your surgeon leaves town the day after your surgery and there is no one around to write a pain med prescription.

I tell this nurse that I now felt as if I would’ve been better served at a hospital system, since there are unlimited numbers of physicians who at any time can cover for each other on the spot to write a prescription, and this was prime example number one. I explained to her that I did not originally want a July 2nd surgery date, and was concerned about being mobile for the 4th, and my Dr. assured me that I would be “flipping burgers and joking with neighbors”….and where was this Dr. now? Off with his family, non-responsive to the needs of his patients, and his on call assistant was clearly unwilling to make a trip into the office to write a prescription for him.

And today is Thursday, Friday is a holiday, so I was looking at a long weekend of pain. At this point, I could only take shallow breaths, as it hurt to relax my abdomen enough to let the air in. She tells me that I was “welcome to call Dr. J if I have any more problems this weekend” I explain to her that I’ve been waiting for over 4 hours for Dr. J to return my first message, as I’d called her answering service at noon. “I’m afraid you are really seeing a poor side of our public relations, and I apologize.” She quickly excused herself off the phone with the clincher salutation “mmm…..buh-bye!”

My husband walked in 2 minutes later, and I tearfully explained what I had been told. Noting that it was now 4:45, he dialed the number to the office. When the receptionist answers, he says;

“I am Beth’s husband, and I am NOT a happy camper, and I want to speak with a doctor IMMEDIATELY” within 5 minutes, there is a call from Dr. J. I hear my husband say; “Why has it taken you over 4 hours to return my wife’s phone call to you?…..That is not an acceptable answer. My wife has been in pain all day and we’ve been trying to communicate with your office, and you’ve done nothing but give us the run-around. I do NOT enjoy communicating like this, but you, ma’am have left me no choice. Now I’m going to put my wife on the phone, and you are better KISS HER ASS, do you understand me? “

Dr. J could not have been more delightful at this point. She listened attentively, and offered to run over to the NW office and write me the prescription that I requested a mere 9 hours before. She explained that she was on her way now, and my husband could get there at his leisure, as they would keep the office open until he arrived to pick up the prescription. No trip to Urgent Care required. It was an unpleasant day, and it was sad that this small boutique office was unable to deliver the “friendly medical service in a spa-like atmosphere” that it advertises in it’s TV commercials that are on Oprah everyday.

Ironically, we had just filled out our survey, and were satisfied with this medical office. I even planned to move all of my future gyno appointments here, and was going to refer many of my friends to go there….all they had to do is follow through with the services that they promised. They never mentioned that my surgeon was skipping town the next day, and I would be S.O.L. if I needed anything from then on out.

But, alls well that ends well, and my husband stepped up big time and got results. He accomplished in one phone call what I couldn’t do in 5, and that makes him my hero, not just today, but every day.

Today reminded me again of how important it is for patients to stand up for their rights and not take the triage nurse’s word as gospel, and not allow yourself to be dismissed.

It is not easy to put up with my sardonic humor and recent barrage of health scares. I wouldn’t blame him for trading me in for a newer model… But, we continue to take our vows seriously, and appreciate each other daily, and for that I am truly grateful.

Today is Independence day, but for me it is Thanksgiving. I am thankful to have such a wonderful spouse to support me, and I’m also thankful that I will not be in pain all weekend.

p.s. within 30 minutes of taking the Percocet I was taking a stroll around the block with the kids….worth all the hassle, if you ask me!!