Archive for the ‘Heart Dad’ Category

Ten Feet Tall… and Bulletproof!

November 15, 2010

“People always told me be careful of what you do…” – Billie Jean (1982) Michael Jackson

Here’s a post by blogger Doctor D about growing up as a Sick Kid. Here he is writing about children living with Diabetes, so what are parents of  Cardiac Kids who just hit the teenage years supposed to do? Give them room? Lock them in their rooms? Who knows? I can promise you one thing, life will not be “normal”… after all, what is “normal” to a teenager going through puberty?

Oh, goodness what a time. The hormones are fully in control and you just don’t want to hear a word your parents say. Whatever they want, you try to do the opposite, and you feel just like the title of this post: Ten Feet Tall and Bulletproof. Throw a Heart Defect into the equation and things could get crazy.  Sick Kid? Naw, that ain’t me! I’m just like my friends, I can go where I wanna go and do what I wanna do, and never feel “sick” at all! Medication? Who needs medication? If I miss a dose that’s OK, because I don’t feel any different.

There’s a problem brewing right there. A lot of times, you don’t feel any different when your heart is causing trouble. A worsening heart can steal your energy and your stamina, but not all at once. It does it so slowly that it is hardly noticeable… and then suddenly, you realize that you can’t do what you used to do and your energy level is way down. Here’s a newsflash for our teenage CHDers: You were born with this problem and you will have it every day you live. So you’ve got to pay attention to your health… every day you live. You are right, it isn’t fair. But rather than whine and cry about it and let your Heart Defect win, why not learn how to fight it?

The teenage years are just the time when they don’t want to follow your advice, so you got to get ’em when they are kids, not teens. When they are teens, you are THE PARENT and your opinion carries very little weight. When you and your teen have a conflict concerning their illness, it might pay to follow Doctor D’s advice and have a neutral party step in. So you gotta catch ’em when they are young.

And this leads to an incredible balancing act: exactly how much do you tell a CHD child about their heart? First things first, you don’t want to scare them, but you do want to help them know that taking care of themselves is so very important. Cardiology appointments and checkups and doing all the “little things” right will help them live longer and better. But you don’t want to drop that knowledge on them all at once, or when they are too young, because they will almost certainly start looking at the other side of the coin. It’s an uncanny ability that kids seem to have. And you certainly don’t want to hang the “I’m different!” thoughts on the child – we want him or her to fit in, to be a well-balanced kid who grows into a great member of society. If you approach every new situation with an “I can’t” attitude you’re going to miss out on some wonderful life events. And we don’t want that to happen, either.

It’s almost like a valve: you have to decide how much information they can handle and open up the information faucet just enough. Not too much, and not too little. In a few years when they are older and understand more, you can open the faucet just a little bit more. And hopefully, by the time they reach the rebellious years, they understand enough to know that their health is not the place to issue a challenge to parental authority. They can make you scream, run in circles, and even pull your hair out, but those medications are not to be missed and you see your doctor when you need to. Because you have taught them how important it is.

I do not envy Heart Parents with children on the brink of puberty. Those folks deserve a medal!

Heart Defects and the 2010 Midterms

November 8, 2010

With the recent victory by the Republican Party in the 2010 midterm elections, another, larger issue looms: The Republican Party ran on the promise to repeal the Affordable Care Act and replace it with other forms of health care reform. If they can’t do that (And most likely they can not), they will refuse to fund it. And with Republicans in control of House of Representatives – where all bills that allocate money originate – this is a threat they can make good on.

This is not good news at all for Congenital Heart Defect patients. The Congenital Heart Futures Act which was once a stand alone bill, was “folded” into the Affordable Care Act. So if the Affordable Care Act is repealed, there goes the Congenital Heart Futures Act. And if it is unfunded, the Congenital Heart provisions won’t be funded either. In an ironic twist, the sections dealing with Congenital Heart research and funding never were funded to start with. We wouldn’t have lost anything, because we never had anything to start with. Just words on a piece of paper.

Tell George Washington that the Declaration of Independence is just words on a piece of paper, and let me know how that goes for you.

We can go to Washington, meet with our legislators, and request funding, but there is no guarantee. Every other worthy cause will also be in DC, trying to make sure that they get their money, too. And since we were never funded in the first place, that puts us way down on the list. After all, if we never received any money at all, there must not be much to these heart problems. If it were serious, we’d be throwing cash at it! (They don’t call it an invisible disability for nothing, folks!)

The new legislators won’t take office until January 20, 2011, so we have a little time to prepare. We can’t really prepare a strategy yet, but we can get set in our minds what we are working for.

This isn’t a party issue. It is not Republicans vs. Democrats. People of all political walks have heart defects – an unborn child’s heart begins to develop early, and often the heart is forming before the mother even knows she is pregnant. This doesn’t benefit this side or that side, it benefits people. Because a house divided cannot stand, and a house united cannot fall.

This isn’t for us. This is for our children and their children. This is for the parents who sit in the Intensive Care Unit and fear that their child’s next breath may be the last one. This is for those who have to live with medication, scars, blood draws, and the knowledge that they are different, outsiders, alone.

A lot of people believe that Conservatives and Progressives are so far apart that they can’t even order lunch together. I choose not to believe that. I think we can all work together to bring Congenital Heart Defects under control and eventually condemn them to the dustbin of history.

On the cutting edge

November 5, 2010

Do you think my child needs one of those medical information bracelets? He had Transposition of the Great Arteries but his doctor said he was fixed after his surgery.

Yes, I would certainly get a Medical Information bracelet. I personally use MedicAlert, because you aren’t limited by whatever you can squeeze onto the bracelet. MedicAlert is a little more expensive – you have to pay for both the service and the jewelry – but you can have so much more information. I don’t just have a heart defect, I’m also in Heart Failure, you can’t read my pulse, my blood pressure, or give me an injection in my left arm because of my Blalock-Taussig shunt, and I take a small bucketful of medication every day. A “bracelet” that listed all that would be as long as my arm! (just try getting it through airport security!) With the MedicAlert bracelet, you discuss your detailed health information with a nurse over the phone and your bracelet comes with a telephone number and a numerical code. If something happens and you can’t speak, emergency personnel can call the number and enter the code, and they will have instant access to all of your information. Most of their bracelets are waterproof, so you can wear them in the shower – after all, it can’t do you much good if you have passed out in the bathroom and your bracelet is lying on your bedside table.

The Medical ID bracelet is important and could save your child’s life… but that isn’t the reason for today’s post. The second part of that statement made my hair stand up: He had Transposition of the Great Arteries but his doctor said he was fixed after his surgery.

Holy cow! Read this carefully, it is very important that it be understood: A heart defect can not be fixed. The word “fixed” implies that it is good as new. It isn’t. A heart can be repaired through surgery, which means that it can be made to function – perhaps not in the normal manner, but it is functional.

It is hard to believe that there are still doctors who tell Heart Parents that their kids are “good as new!” They used to tell them that, back when I was growing up – because they didn’t know any better. There weren’t that many Cardiac Kids around, so no one really had any idea what the future held for these children. But this child had been born with a critical health problem, had survived a delicate surgery, and would get better. He or she might not have as long or as full a life as the other kids, but we had won this battle. Now go, get out there and enjoy your life! And for years that was the common practice, because kids with heart problems didn’t live as long as other children. As an example, Cardiologists at Johns Hopkins Hospital told my parents that if I needed a second operation, it would probably have to happen ten years in the future. My parents asked what kind of surgery I would need, and after a long, uncomfortable pause the doctors admitted that they didn’t know. “That operation probably hasn’t been invented yet.”

But then something totally unexpected happened: Cardiac Kids grew up! As we grew, we had more heart problems – some of them related to our original defect, and some of them new. Doctors had new tools they could use to help us out, either a new drug or a better surgery. They could do a lot more with Catheterizations, too. And while we were proving that we could grow up, doctors were discovering that those heart problems were still popping up, sometimes years after we had been “fixed.” And their thinking started to change.

Today, most Cardiologists will tell you that your child’s heart has been repaired – and he or she will always need specialized cardiac care. Their heart is misshapen, blood vessels run the wrong way, it has holes where there shouldn’t be any, and has been altered by surgery. Even after they grow up, Heart Children will always have to make allowances, take medication, go see their Cardiologist, and stay on top of their health. And they will have to do this forever – because even though their heart is functional, it isn’t normal. No it isn’t fair, but this is the way it is.

And if your Cardiologist is telling you your child is “fixed”, you seriously need to consider finding another Cardiologist. Because this one is living in the past.

And Cardiac Kids live their lives right on the cutting edge of medical science. We always have, and we always will.

Flu!

November 3, 2010

Doctor: “What’s wrong with you?”  Patient: “Flu.”  Doctor: “Looks like you crashed!” – Old Joke

Ready for Cold and Flu Season?

Colds and Flu can be rough on someone living with a Congenital Heart Defect. We tend to heal slower than others, and with our less than perfect Circulatory Systems, chest colds can be a nightmare. Whenever I catch a cold, it’s usually going to hit me harder than the next guy. The same cold that will keep him in the bed for a day could keep me in the bed for several days. That is, if I can lie down. It is liable to clog me up to the point that when I lie down, I feel as if I am drowning. Often I wind up sleeping upright in the big recliner in the living room, tucked under a blanket.

Heart parents today have a yearly debate, trying to decide how to care for their child during the winter months. Some parents just bundle them up tighter than usual, others decide that the best thing to do is to go into lockdown, rarely coming out during the winter months. My parents were of the “bundle him up” group. Not because of any instructions from my Cardiologists, but rather the lack of instructions. I was born in 1966 and most of my childhood that I can remember occurred during the 1970’s. The ’70’s were “back then” as far as Congenital Cardiology was concerned – no Pediatric Cardiologist had a good answer for most of my parent’s questions because there weren’t that many Cardiac Kids around. The usual answer was “I don’t know!” or something close to it.

I had a Cardiologist who wasn’t much on the bedside manner – a visit to his office was almost like playing hockey and continually being slammed into the walls – but he was pretty smart. He told my parents that “If you want him to be a normal child, you have to treat him as close to normal as possible.” So my folks just let me go – with limits. During winter I had on so many clothes I felt like a turtle; if I fell over there was no way I could get up. I’d just lie there and roll around on the ground. If someone at church was sick I had better not sit near them, or move as soon as I realized that they were ill. I missed a few services over the years when several people had colds, and even missed a few days of school for the same reason (which highly irritated one teacher!) But I muddled through. I caught the occasional cold and suffered through it, but that is a normal part of childhood.

I can’t say this is what you should do, only your Cardiologist can advise you on what to do during Cold and Flu Season. And be sure to ask your Cardiologist – your Primary Care doctor will have good advice, but you have a heart defect. Ask the doctor who specializes in hearts, he or she will have a better answer.

Most of the time – not always – the Flu Vaccine will be recommended for us. If you are in doubt, again – ask your Cardiologist. As a general rule we’re told to get “dead virus” vaccinations. At the current time vaccinations in the United States can be either “dead virus” or “live virus”. Live virus vaccinations have actual, living virus cells in them – they are weakened, but they are living. With a dead virus vaccination the virus has been deactivated. Even deactivated, the body still realizes that a case of the Flu is present and starts building antibodies to stop it. As far as I know, only the FluMist vaccination is a live virus formula.  Be certain to inform the person giving the vaccine that you have a chronic health condition and need the dead virus formula.

While you should always be cautious, you should never be scared to live your life!

Joshua

October 20, 2010

When Joshua Haskins passed away earlier this month there was a great deal of controversy. This post is not about Circumcision safety issues, but about a related and equally important topic.

Joshua’s mother is heartbroken – she’s supposed to be her child’s advocate, his defender, but now he’s gone and she blames herself. But I don’t – she had been a Heart Mom for seven weeks. There was a lot that Jill Haskins didn’t know, including one critical fact that I didn’t mention.

As regular readers of this blog know, I have a hernia. A hernia can be fixed with a simple operation;  when my dad had his hernia repaired it required an overnight hospital stay, but even that may not be required anymore. The average hernia can be repaired pretty easily, but mine can’t.

My Cardiologist has vetoed a hernia repair more than once, because my blood oxygenation level (the familiar PulseOx reading) is low. A Heart Healthy person will register a PulseOx of nearly 100%; but mine is normally 80 to 82%. “I don’t have any doubt we can put you to sleep,” my Cardiologist says. “The real challenge is waking you back up!”

Not only is anesthesia an issue, there’s more. “I could spend all day describing your cardiac anatomy to the operating team,” my heart doctor continues. “And I don’t know if they would understand it any better when I finished.” That’s quite a statement, considering my doctor has won several teaching awards in his career. I’m 44, and one of the open heart repairs I have had has changed greatly over the years. Another one just isn’t done anymore – there are only three places that I know you can find it: 1) in a musty old surgical textbook; 2) in the brain of a very old cardiac surgeon; and 3) in my chest.

If my hernia were to cause enough trouble that it had to be repaired, I couldn’t just have it done anywhere. I can’t run the risk of having a surgeon who has done this operation 12,759 times before and considers me just another patient, because I’m not. Because of my heart, the plan is to go to Emory University Hospital and have my hernia repaired with a Congenital Heart Surgeon in the room, just in case of trouble. Afterwards they would keep me in the Intensive Care Unit for at least 24 hours – again just in case.

I know this… and I never mentioned it to Joshua’s parents. I don’t recall them mentioning the circumcision to me before it occurred, but that doesn’t matter. I should have said “Look, with Joshua’s heart, there is never going to be a ‘simple’ medical procedure. More than likely he’ll even need antibiotics before and after he sees the dentist, so you really need to think about any kind of operation or procedure that can be avoided.”

But I didn’t say that.

We are each put on this Earth for a reason, to accomplish something. Perhaps Joshua’s task was to remind us all that when you have a Congenital Heart Defect, no medical procedure can be considered “routine.”

Your Choice (My Answer)

October 14, 2010

Yesterday I asked Funky Heart! readers the question Given a choice, would you devise a cure for Congenital Heart Defects, or prevent them? To make it a little bit more difficult I added a stipulation: Your choice would have no effect on the other group – developing a cure will not prevent new cases from occurring; preventing heart defects will not cure those who already have them.

The question generated a lot of debate and discussion (as I hoped it would). But what would I choose to do? The answer might surprise you: I’d choose to prevent Congenital Heart Defects.

Preventing all future heart defects would isolate those of us who already have them… the need for Pediatric Cardiologists would drop as would the need for surgeons with CHD repair skills. You can assume there would be the need for a number of surgeons as CHDers could easily need heart operations later in life, but perhaps not as many as before. The number of Cardiologists would also decline, slowly – there would be a need to serve the current number of patients but that would drop as the patients begin to age and no new cases occur.

Older Heart Warriors would have to increase their efforts to inform and educate younger patients and their families. Not being boastful, but this would be the perfect job for an organization that I am a member of, the Adult Congenital Heart Association (ACHA). We’re already working toward a similar goal: adolescents with a heart defect tend to fall away from good cardiac care as they reach adulthood. They no longer visit their Pediatric Cardiologist; nor have they found an Adult Congenital Cardiologist. A good percentage of them may not even realize that they need an Adult Congenital Cardiologist.

The ACHA is working to prevent this from happening, to makes sure CHDers get good care all of their lives. Currently the Bethesda 32  report outlines care guidelines for the Adult Congenital Heart Defect patient and the ACHA’s Vision 2020 Project is a program designed to provide a seamless transition path – from Pediatric Cardiologist to well-trained, competent Adult Congenital Care Cardiologist without a break in care.(Bethesda 32 may be a name you are not familiar with. Every year, experts from the American College of Cardiology meet in Bethesda, Maryland to devise proper care guidelines for a segment of cardiology. The 32nd time they met (the year 2000), they devised guidelines for the care of adults born with a Congenital Heart Defect. You may not be familiar with the name, but the Bethesda 32 Report is very important to the CHD Community. You can read a good summary by CLICKING HERE.)

In the fictitious world we’ve created – one in which all new CHDs can be prevented – older Heart Warriors would have to step forward. We’re the voice of experience, we’ve literally been there and done that. And in this brave new world, we’re a lot more important. Now, we’re going to have to be teachers – teaching the younger generation how to take care of themselves, what to do and what to avoid. And we’re going to have to help each other out, too… the number of Adult Congenital Cardiologists will also begin to drop. After all, in this world where CHDs can be prevented, why specialize in a field that in time, will no longer exist?

This will cause problems, but I believe they can be overcome. We’re all in this fight together, and as Benjamin Franklin said, “We must all hang together or surely we will hang separately.”

From Death, Life

October 5, 2010

Greater love hath no man than this, that a man lay down his life for his friends. – The Gospel of John; Chapter 15, Verse 13

I hate that he’s gone, and I hate everything about the CHD that took this perfect child from us. Nothing can replace him, and nothing will help us “get over” this. It is too much. – Comment left last night by Ewan’s mom.

Lord, yes. Nothing can replace him, and nothing should. This was a life cut much too short. It’s been a rough week in the Congenital Heart Defect (CHD) family, as at least six CHDers of all ages have passed. Always the optimist, my hope is that someone, somewhere learned something new from one these cases. And perhaps they can couple that new knowledge with what they already know and find the key that unlocks the mystery.

Older CHDers can help, too. Something has kept us going much longer than anyone predicted…what? When I shuffle off this mortal coil I plan to leave my heart to medical research. Let them poke and prod as much as they want, I won’t mind. And perhaps someone can figure out why some of us are only granted an hour upon the stage and then are heard from no more, while others seem to be here tomorrow, and tomorrow, and tomorrow.

There is a reason why that happens… what is it? We haven’t found it yet. But I live in the hope that if something – anything – is gleaned from such a sad event it will be knowledge. Even if all that is learned is what not to do, that helps bring us one step closer.

Traditions

September 29, 2010

One of my earliest memories is getting up very early in the morning and loading into the car for the long drive to see the doctors at Johns Hopkins. My parents were younger back then; with a little luck we could make the trip in one day. Just about sunrise we’d encounter a Stuckey’s Restaurant close to the North Carolina – Virgina state line. That was where we always stopped for breakfast, and the light blue roof became one of our landmarks. I looked forward to the restaurant, and the folks did too. Then one day…

…. one day, we came around the corner to find our favorite restaurant was now a pile of ashes! The only thing left, somehow, was the roof. It was pretty much intact, as if someone or something had gently removed it and set it aside before the restaurant burned, then returned it to its proper place.

Well, that’s not good. So we found breakfast somewhere else, and didn’t think anything about it until we got to Hopkins. There, we found out that my Cardiologist – arguably the best Cardiologist in the world – had left. Dr. Richard Rowe was now Head of Cardiology at a hospital in Canada.

No Stuckey’s, no doctor… these two events must be connected in some way, correct? And by the way, I am not superstitious!

I wear a pair of lucky socks whenever I have a doctor’s appointment. One day they’ll wear out, and I’ll rescue them from the trashcan. If I have to cut a small section out of the toe and stick it in my pocket, I will.

Why? At one appointment my doc looked at the EKG and his eyebrows shot up. That is never a good sign.

“You’ve developed an Atrial Fibrillation since your last appointment,” he said. Not good – A-Fib can lead to fainting or a stroke. And I was already taking Amiodarone to combat A-Fib, so apparently the Fibrillation had broken through.

“Double your Amiodarone and have an EKG test in two weeks. Have them fax us a copy. You may eventually have to have an ablation to try to knock that A-Fib down.”

Ablation – a catheter maneuvered inside of the heart with a probe on the end, designed to burn away the areas causing the out of sync heartbeats. Wonderful.

So two weeks passed, and I had the EKG done and faxed. Naturally, the EKG tech won’t even tell you the time of day, no matter how much you beg. But I got my answer that evening, when they called and told me I needed to come to the hospital for an appointment with the Electrophysiologist.

So the next week I was back, being examined by the specialist – wearing a new pair of socks. Didn’t bring that pair intentionally, just needed an extra pair and tossed them into my carry bag.

The doc hooked me up to a 12 lead EKG (the first one I had ever seen), listened with his stethoscope, and asked me several questions.

“So, how do you feel?”

“Worried about what you are going to find, but other than that, pretty good.”

“Tell me how you feel when you are having an episode.”

“Actually Doc, I can’t tell you. I don’t feel them.”

“Not at all?”

“No sir.”

He put the stethoscope back on my chest. “You are in A-Fib right now. Do you feel any different? Anything at all?”

“No sir,” I said.

He listened some more, and run another EKG. “I’m going to discuss this with your Cardiologist,” he said as he excused himself from the room.

In a few minutes he was back. “Since you don’t even feel it, and it doesn’t seem to be bothering you, I’m going to discontinue the Amiodarone. Get an EKG faxed to my office in two weeks. And if you feel light headed or more tired than usual, call me ASAP. But if it doesn’t bother you, I’m not going to medicate you for it.”

And with that we were out the door. The two-week EKG was acceptable and I felt fine, so all he told me to do was to discontinue the medication and come back for a routine checkup in one year. And ever since then, I walk into a doctor’s office wearing my lucky socks.

But I’m not superstitious…. what makes you think that? 🙂

Miracles

September 27, 2010

If only you believe in miracles, baby (like I do)
We’d get by

Miracles, Jefferson Starship (1975)

I was concerned about traffic (traffic in downtown Charleston,  South Carolina can be a nightmare; almost every street is One Way) so I intentionally planned to arrive at the Palmetto Hearts Pediatric Cardiology Reunion early. A little too early, as I was the first CHDer on the scene… oops! But the wait wasn’t long, and before I knew it the entire museum was full of Cardiac Kids and Heart Parents. The oldest CHDer I met was a 16-year-old with HLHS (I never got your Facebook Friend request, Johnathan! Try it again, please!) but most of them were under 10 years old.

When you are that young, your heart is roughly the size of your fist. Imagine operating on an organ no bigger than an infant’s fist, cutting it open to find and repair a hole that isn’t supposed to be there. Imagine finding two blood vessels that are measured in millimeters – these blood vessels are connected to the tiny heart but they are in the wrong place, and it is your job to cut them, switch them, and sew them into the tiny hole where the other vessel was.

Imagine looking into the chest of an infant with part of his heart missing. It’s supposed to be the size of a walnut, but part of it is missing, so there isn’t even that much. As my grandma used to say, “There’s not enough space in there to change your mind.” No, there isn’t enough space to change your mind – but there is plenty of room to screw up, to shatter an already broken heart, to ruin a life and a family forever.

I didn’t talk to many of the children – If you were a child, which would you rather do: talk to the adult you don’t know or play with all the cool stuff in a Children’s Museum – but I did talk to a lot of their parents. I heard tales of living in the waiting room.

Staying by the bedside.

Waiting for a miracle.

That’s what I saw at the Pediatric Cardiology Reunion I attended Saturday night… miracles. A lot of them. Walking, talking, miracles.

This place is a zoo!

August 22, 2010

Yes it is! It was designed to be!

I was recently invited to be a part of a Congenital Heart Defect (CHD) Conference scheduled to be held at Riverbanks Zoo in Columbia, South Carolina! I haven’t said anything yet because it is still in the planning stages, but they have the date set: February 26, 2011!

I accepted – the zoo is only about 70 miles from my home. So no flights, and no Baggage Claim! I’m planning to stay away from any Baggage Claim area for a little while!

This will be fun, since I haven’t been to the Zoo in quite a while. Since I was there last (escorting a church youth group in the mid 1990’s) they have added a Botanical Garden and changed a lot of the exhibits. I do hate to see that the polar bears are gone. When I was in grade school we’d take a field trip to the zoo at least once a year, and the Polar Bear exhibit featured a large pool. I’m sure the bears appreciated it, since they are a little overdressed for South Carolina. They also had an underground cavern where you could watch the Polar Bears swim around through a huge plate-glass window in the side of the pool. The cavern always seemed to be closed; they had problems with the window leaking. But I looked at a map of the Zoo and the Polar Bears have been replaced by Grizzlies. I hope they have a pool and a window, for old times sake.

I took my oldest niece to the zoo when she was young, and like a good uncle I tried to convince her that I always thought my brother (her dad) was born in the Monkey exhibit. For some reason she didn’t believe me! Just to make sure, we studied the Monkeys for quite a while but didn’t see him. She said he was at work, but I think he was hiding in the shadows.

Being serious again, the Zoo will be fun, and I’ll get to hang out with a bunch of Cardiac Kids and their parents. We’ll have a blast together…. and if you are visiting Riverbanks Zoo that day, you’ll probably never know any of us are sick kids. We’ll look like a big group just out having fun, just like so many other groups that visit the Zoo. In most cases, a CHD is an invisible disability. You can’t tell we’re sick, and for the most part we adapt well. CHDers learn at an early age that we have to do things a little differently, take it just a step slower, and pace ourselves. We don’t want to be different, but as my father says, “You play the hand you were dealt.” This is the way it is, and we deal with it.

The conference is going to be sponsored by Palmetto Hearts, and you’ll see more details as they become available. If you are a heart family in South Carolina, plan to attend!