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Acid Reflux causes and Treatment

Crohn’s & Colitis UK ECWD Livestream Q&A 2019 Mar

Crohn’s & Colitis UK ECWD Livestream Q&A 2019 Mar

Evening everybody. Welcome to our
Facebook live chat with me Kathy Webb, IBD Nurse at Derriford, and … Shas Chilcott, volunteer, Lindsay, volunteer We’ve already had some questions emailed
through I think, but keep your questions coming. Yes please. Should we ask anyone if they’re receiving us? Are you receiving us? Is there anyone out there? Dani’s popped up! So Dani’s receiving us. I guess while we’re just waiting for the first question we could just give a little plug for WALK IT on Saturday 13th July. So we’d like to see you for WALK IT please and we also need volunteers. We want to get to 400 walkers and we’ve
got about 120 I think at the moment, something like that, and we want to get to about 40 or 50
volunteers and I think we’ve got about 15 so we could really do with lots more of both. And while we’re on the subject of plugging things, I’m gonna plug our Ball as well. Our 40th Anniversary Ball is on Saturday 12th October at the Crowne Plaza Hotel, so if you check our Facebook page we’ll be posting loads about it but we are already selling tickets so you want to get in soon. Shas has already got a
gown. No! I think we should mention with the Ball as well, if you’re planning on coming in
a group, if you can get 10 of you there’s a discount if you can book before the
end of July so you can get them for £40 a ticket for a table of 10 as opposed to paying the £42, so book your table! Book now! Got a question coming through. (From background) I have a question here. “I have two doses of … oh no, I don’t know how to say that word! … Adalimumab left before transferring onto a biosimilar. Have any users reported any issues with
transferring over, e.g. effectiveness of new medication or side effects?” Oh, hot topic! So Adalimumab Is that like Humira? It is the same as Humira … has recently
switched to a biosimilar, so a biosimilar just means that it’s a new …, it’s a
generic of the drug. So it’s cheaper, it saves the NHS lot money and all of the
studies that have been done have suggested that the drug is just as
effective as all the biosimilars. So Infliximab has gone over to biosimilars years ago. We’ve had no problems with that. And Humira has recently gone over to Imraldi, we’re using Imraldi, at Deriford. Other centres will use different ones. I’m not sure where that question came from, If it was a local one or not , Plymouth or not … (From background) I think it’s local, yes. Do we know what drug he’s transferring over to? (From background) It’s Exeter. Ah, Exeter. But the bottom line is that we have no
problems. No, I mean the commonest problem that a few people have had is the new
injections, the Imraldi, in a few people they been more stingy. So they
have said that the injections sting more than Humira. That’s quite a
transient short-lived thing. It doesn’t affect the efficacy of the drug so it
won’t make a difference to how effective the drug is for you but some people have
said that there’s that slight stinging. But other than that we’ve had no
problems with people switching over, apart from the logistics of …
sometimes these things like people have run out and they haven’t had the new
drug sent. That can happen quite a lot to begin with, but not from a point of view
of the effectiveness, no. So is he swapping from Humira on to something else completely or is it just a different brand? I think he said a biosimilar, yes, so it will be either Imraldi or, I think the other one’s called Amjevita. How d’you remember them all? I didn’t know if he was leaving those completely and going to Infliximab or something else … like a complete change of drug, that was all. I think it was a biosimilar … (From background) Okay another question, and keep them coming in, type in any questions that you want to, while we’re all talking. “A loved one has recently been diagnosed with Crohn’s Disease”. Abbie says Hello. Ah, hi Abbie! (From background) And Jane says Hi. Hi Jane! “I can see they are struggling with the diagnosis and I don’t know how to support them. Can you help?” Over to you two I say. It’s
difficult isn’t it … Yeah … we’ve had a few messages on this,
on this line already, in the past, in the past year actually, from people, sort of fairly young, but their girlfriend or boyfriend said can we do anything. I know for at least one of them, I’d gone back and said, you can get emotional support from Crohn’s & Colitis UK. So you can go onto the website for Crohn’s & Colitis UK and there’s a helpline you
can phone and you can chat to someone. I think you make an appointment and they
phone you back. And these are properly trained people that are very
helpful. They’ve also got loads of guides. They’ve got guides on how to support someone that you love, someone you’re living with or someone
you’re caring for, whatever. They’ve got stuff about what is Crohn’s, what is Colitis, all those kind of things so there’s lots of good useful advice up
there. Yeah, I think it’s not so much … we can’t really advise on … because
everybody’s individual so what we might class as support might be
different to them. Just, all I’d say is do your research so you know a bit
about the disease first and try to stay away from ‘Are you feeling better today?’
and, you know, ‘If you eat something different will it help’ – things like that
because they just … everybody is different with the disease so there’s nothing in
particular per person that can say well that works for everybody. Just, emotional support is basically all you can do to help. There was also something I found called Plymouth options so you can use them. It talks about people with anxiety and depression and, you know, that might be more strong
than you’re thinking but, if you start going down that road maybe it’s a good thing to stop early. But Plymouth Options is a place you can go
and get health support, counselling … Yeah we do refer quite a few patients to Plymouth Options if they’re struggling with anxiety and depression around their
disease. But like you said, Lindsay, everyone’s so individual. Some people don’t want that and other people just want … some people just want to ignore it. I think being well-versed in it really helps, understanding it. It’s amazing how many people you meet, whether relatives – their husbands, their partners, whoever, have got no idea about the illness. They’ve never read anything. They don’t come to appointments And it’s not just the disease itself, is it, they don’t understand the struggles, the daily struggles, that go with having a chronic illness. whether it be Crohn’s, Colitis, Lupus, anything. It’s draining, there are other conditions that come along with it.
It’s very invisible isn’t it. If you’ve got, you know, a physical obvious
disability, you’ve lost a leg or something, then people will know. Shas is probaby the same as well. When anyone says, no matter how you’re feeling ‘You look really well. How are you?’, ‘Fine, I’m fine’, it’s just easier. So just do some research on it so you get a basic knowledge and
and try and support them is all I can say. Depression and anxiety are a big
thing that come with it because there’s a realisation that it’s never
going away and I think that’s the big thing. It’s not something that can be cured.
Especially when people are young. It’s more common in ages 15 to 30 or
16 to 30 – I think that’s the most common age you get it – so these are young
people who are getting it and that’s gonna strike them. I’ve got this, I’m
sixteen years old, I’ve been diagnosed with this, I’ve got it for the rest of my
life, because we haven’t got a cure yet. I You’re going through a lot of stuff already when you’re a teenager – you don’t need a chronic illness as well.
The older ones that get diagnosed, it’s almost like … they call it grieving don’t they. They can’t
have the life they’ve always had. It’s gone. I know I certainly was like that for a long time. I wanted to be who I was before, and my body stopped me, and it took me a long time to get past that. So it is just, be there if they want to talk about it. Just be an ear. I think it’s good to talk about if you can. It is, definitely. (From background) Another question, but something I found that’s really helpful for bloating is peppermint tablets after meals and Emma’s asking Abbie about that. And Stephen says “I always say to fellow sufferers ‘Appreciate what you can do and don’t worry about what you can’t'”. Good philosophy! “Whatever restrictions or difficulties you have with your condition there is always something you can do to make you feel more positive.” Absolutely! That’s actually a bit of a theme for Crohn’s & Colitis UK at the moment The theme is ‘It Takes Guts’, so you can still do stuff, and they’ve been promoting a lot of stuff that people, ordinary people, have been doing extraordinary things. Not everyone has to do an extraordinary thing. Just going to work might be an extraordinary thing for a lot of people. It can be very draining! But I think Stephen’s absolutely right, make the most of what you can do. And if you’re having a bad day, don’t punish yourself. Have the bad day. Tomorrow’s another day. But peppermints after a meal? Yeah, they do a drink version of it as well – a blue tea – it’s not nice,
well, some people might like it! My sister-in-law likes peppermint. But I used to have that, if you remember, the first stricture I had terrible bloating and pain from, well, wind basically, so it did help me a bit. Oh, actually, we’ve got a question on that. I was just about to say that leads on to that question. (From background) I don’t whether to cover that question or … What have you got? Something else? (From background) Yeah, Abbie’s just said “Since starting my PIP claim my joints seem to have got worse and I’m finding it a little more difficult to walk as far as I used to. Is it worth updating my PIP claim to tell them about this? I don’t know if it would make a difference or not worth hassling them with it?” Definitely. I would. Anything that you can get in to tell them works in your favour. Definitely! Do it Abbie! And good luck! So back to wind! (From background) “I had a gastro …” why do I get these long words!? … “gastrojejunostomy” ‘gastrojejunostomy’ … that’s a new one on me! (From background) “and an ileal resection …” ‘Ileal resection’, yep. (From background) Why am I getting all the big words today?! We just like to give you a challenge. (From background) “… in August 2013 following diagnosis in March 2013. I am keeping a log of my bowel movements and diet though can’t work out any link between food intake and either the degree of belching that occurs, which can be regular through the day, or flatulence, which I seem to not be
troubled with for a while and then returns for a few days at a time. Is
there anything that I could be doing to minimize the flatulence and belching? I
do not drink fizzy drinks or alcohol. I access the gym 4 sessions a week, feel
fairly fit as a rule, slightly overweight but not massively. I take Humira twice
weekly, Azathioprine, Omeprazole, and iron daily.” Well done! So they’ve got a lot of wind … both ends by the sounds of it! He’s obviously had quite extensive surgery in 2017. Obviously without knowing the details it’s difficult to advise too much. I’m not sure if you’ve been reassessed since 2017. We tend to do blood tests and
stool samples for inflammation, and calprotectin tests, after surgery every 6 months, to give us an idea of whether people are in remission. So I’d say that’s the first thing, are you definitely in remission. Is there any
signs of active disease ‘cos that won’t help those symptoms. So discuss that with your
team. Is it local, is it Derriford? From background) No, I don’t think he is, no. Regarding the flatulence … we were just talking about this … the biggest link is fibre. Fibre and wind, fibre and flatulence, fibre and bowel motions. So if you’re somebody that’s going to the toilet quite a lot, which people often
are after a resection, then reducing fibres can really help, as can things like Imodium – that can help too. Because he says he has a good diet … yeah, he might be very healthy … but that can make you worse. Unfortunately, if you are having brown bread, if you’re having seeds, or you’re having nuts, or you’re having lots of fibre that will add horrendously to those symptoms so if you stop all that or reduce it by 70% then that should all improve. But I would
say that you need to be checked out, that you haven’t got any active Crohn’s going
on, and that you’re having regular bloods and regular calprotectin tests because
those do make a big difference. But certainly the biggest link tends to be
fibre, with all these symptoms. That’s the first thing they tell you to
stop when you have a colonoscopy isn’t it. The first thing you do is cut the fibre. I think I’ve been on the low residue diet for about 7 years! And it is very boring so people don’t want to be on it for ever but it’s worth experimenting. If it bothers you and you’re going to the loo a lot, and you’re having a lot of wetness, if you cut out all fruit and veg, even if you do it for a week, and it’s tremendously improved, then you’ve kind of got your answer. And then maybe also take a multivitamin for people that aren’t managing to have their fruit and veg. Or just go with the wind! It depends how much it’s bothering you doesnt it. (From background) Or your workmates! I mean I’m also a fan of … it might be worth him looking at type the type of iron he’s taking. If it’s tablets … Yes true, that can add to that. Kathy’s very kindly swapped me to liquid iron. I’ve had no problems since, touch wood, but tablets were crippling me. Yeah that’s a good
point. And how long have you been on iron. Have you had blood tests to
check that your iron’s now okay. If you’ve been on it for two or three months then it’s no point taking it anymore. If you’re still iron deficient you need an infusion. So all
of those things I wouldn’t know without … Oh right, so you’re not actually supposed to take iron for more than 2 or 3 months? If it’s not improving your blood, there’s no point taking it ‘cos you’re not absorbing it, and someone like that, who’s had a lot of extensive bowel surgery may not absorb iron at all so may just need an iron infusion. So he might be taking iron for nothing and it’s making him worse. Exactly. So that could be the case. And like Abbie said, peppermint tea, peppermint capsules help tremendously. I found the Buscopan has helped tremendously. What’s Buscopan? It’s like a little tablet but, basically a few years ago, I was tried, obviously at the start, to take Imodium, Loperamide, you know, and it would cause real severe abdominal pain, crippling, so I just couldn’t take it, so since having the ileostomy, I’ve had to try and slow the output, so the only thing I could do to get two to three hours sleep at a time, was to take Codeine, because I couldn’t take the Imodium. And it wasn’t until I was in town shopping one Christmas, I thought I’ve got to slow this down. I wasn’t getting into a shop before I would go again! So I went into Boots and thought I’m gonna have to take some Imodium and just deal with it, but they did one with Buscopan to reduce cramps. So I thought it’s
worth a try and it worked, so Kathy very kindly gave me a
prescription for both together to try and see if it works. It only took us 6 years! And had I not gone into Boots that day and gone ‘I’ll try that’ … Yeah lots of help out there for that sort of thing. (From background) Got a question. “Do you think probiotics help IBD sufferers?” Have you tried them? No I’ve always steered clear of them. I thought they were actually more trouble than they’re worth. The problem is, it’s how they take it, isn’t it. You said one time … Oh I hate this when it happens on a Live! … No it’s a good thing! You said, it’s alright if you’ve got the proper things but don’t get the little ones that you buy in the supermarket. Things like Actimol and Yacult, the amount in them isn’t enough. My friend who works in the lab told me that. She said that’s not enough. If you’re gonna do it, go and get the proper capsules with the high dosage of them. It’s no good drinking that … Totally agree. There is quite a lot of evidence, quite a lot of growing research, for probiotics and prebiotics in people with IBD, only
because it helps gut flora. So no-one’s saying it’s a panacea of all ills. It’s
not going to cure your Crohn’s or your Colitis but from a symptom point of view,
if you’re someone that goes to the toilet a lot, and has your bowels open a lot, you have a lot of diarrhea, they can be really helpful. But Lindsay’s right. Go to Holland & Barrett or a health food shop and get a probiotic capsule or liquid. They’re not cheap No, they’re not. But there’s very good evidence, and for IBS as well, that they’re really good for gut health, general gut health. Which is actually what those named brands that you mentioned earlier … they say that they’re really helpful but actually they’re not so helpful. There’s not enough in them. No but I think we said there’s not enough in them to mak any … And they have got a lot other things in them to make them tasty. They’re like yoghurts aren’t they. (From background) Got a message from Sharon. Hi Sharon! Hi Sharon! (From background) “Hi ladies. Just wondering if you get withdrawal symptoms coming off Azathioprine?” Oh, you shouldn’t do, no. I didn’t ‘cos I was allergic to it. But you probably went on something else didn’t you? Once I’d finished my reaction … I took Azathioprine for two weeks and got sinusitis and all sorts of horrible things. So I stopped taking that and got Mercaptopurine instead. I think she’s probably talking about long term and stopping it. You shouldn’t have any withdrawal. You
can just stop it straight. But some people, cos they’re concerned, like a bit of a safety blanket. They just want to reduce it slowly, so that’s fine as well. Yeah, I stopped it when I got that horrible rash. Remember I got that horrible rash a few years ago? Remember I was red all over? Oh yeah! I stopped taking it, because you said to me ‘You’d better stop taking that’ and I stopped taking that and I stopped taking that for several months. I was gonna say, it’s the same with all of them isn’t it, if you get bad cough or anything, or an infection, you need to stop them until that’s gone, so that’s just the same. It’s never affected me like that … I was more worried about the rash. Yeah I forgot about that. (From background) “Hello”, this is from Rhiannon. “Sadly, I’ve now developed antibodies to Humira. I’ve read on the Crohn’s & Colitis website about a new drug called Tofacitinib?” Yes. “Is this something that is/will be widely available for Colitis?” Yes, so, um, I can’t actually remember the name off the top of my head. It is brand brand-new. We’re not using it yet at Derriford but she’s right in that it is licensed. It’s a tablet, anti-TNF. So similar group of drugs to Humira,
Infliximab, Vedolizumab, all of those, and we are currently not using it at Derriford but it
is licensed so that means that, at some point in the very near future, we do hope
to be able to use it. Having said that there still are other things that we
could use for you, for Rhiannon, in all likelihood because she’s developed the
Humira antibodies. So there are still other medications we could use that are
in our pot. Maybe Ustekinumab? Ustekinumab is one of them. (From background) Jane, who asked you about the probiotics, says “Thank you very much for answering her question and Hi Lindsay and Kathy.” Is that Jane Carden? Hi Jane! Hi Jane! We must have that coffee soon … (From background) Okay, another
question that’s come in. “I’m trying to give up smoking and my GP has suggested
I take a prescription drug to help but I’m worried that it might trigger a
flare-up of my Colitis. Any advice?” (From background) Rhiannon says thank you as well for answering her question. Yeah there are prescription drugs … Champix … I think there were a couple I saw but that was … It’s the common one, isn’t it. I mean we’ve had few, not very many, few problems with people
on Champix. You know, they haven’t developed any problems with their
Colitis. I had a couple of patients that did think their colitis was flaring but
it’s really difficult to know if it’s that or not. Champix itself makes you feel sick. That’s the whole point of the tablet. Yeah, my brother was on it. After so many weeks it makes you feel sick because then you don’t want cigarettes. And it can give you some other GI [gastro-intestinal] upsets, can’t it. Yeah it can give you sort of hallucinations as well at night-times … Poor girl … or woman … or man … Not sure I like the idea of that! I mean it worked for him but … yeah … A lot of patients have said they’ve had no problems on it. Have they tried other things first. I was gonna say, when I did it I went down the route of vaping instead, and just lowered the
nicotine in that until it was down to zero. Presumably, they probably have tried other things first but they only do that … If the doctor’s talking about prescribing it then it must be someone who’s gone to the
doctor and said ‘Look I’ve tried these things. Nothing seems to work, patches, nothing seems to work.’ I think what you have to
do is just try it. I mean if you start it and you really have problems with your bowels then … Yeah, you can stop it. It’s probably worth telling your IBD nurse that you’re doing it I suppose, so you know something about it in case she/he comes in and says … Yeah, drop us an email or phone. Oh you haven’t got the number on there. No, that used to be when we had the it fancy way, with all the fancy gear. We haven’t got the fancy gear now. We’ll have to get a piece of paper and just hold it up. (From background) I’ve got a question here from Jane. “If someone has pouchitis what length of antibiotic course is used
generally?” 10 days to 2 weeks. It’s quite long for pouchitis. Can you tell us what pouchitis is? So if you’ve got an ileoanal pouch, you’ve had Ulcerative Colitis … J-pouch, isnt that what they call it as well? That’s right, yes. So you have the colon removed and then you have the pouch made … an ileoanal pouch … and occasionally people can get bouts of pouchitis, which is just inflammation within the pouch, and it’s normally treated very well with antibiotics so we normally say 10
to 14 days. But often people do get shorter courses from their GP, so give us a ring, or contact us if you’re concerned about that. We can always
advise. But it tends to be 10 days to 2 weeks. That was a fairly straightforward question wasn’t it. Thanks Jane. (Fom background) Okay we’ve got 6 minutes left, and “Where is the research in terms … Oh sorry, no I’m gonna go back because Jane’s just come back. “I’m on my second bout of pouchitis. I was recently given a 5 day course of antibiotics. I was really well on them and then finished the course and the pouchitis came back. I thought I had read that it is generally a 10-day course.” Yeah, 10 days to two weeks. I mean
give us a call, Jane, if you’re having a problem. I can have a chat with you. Ring Kathy, she can help. I’ll try! She’s back now. I’ve only had 3 days off! Seems like longer! Don’t have any more annual leave! (From background) Okay sorry … we have 5 minutes. “Where is the research in terms of new
medication and finding a cure for Crohn’s?” Yeah, that would be … wouldn’t that be lovely? Wouldn’t it just?! I think the research is, all the time for Crohn’s anyway, is moving towards consideration for stem cell transplant.
There’s now a couple of centres in the UK that are taking patients on for that.
We’ve sent 2 people there with very, very, very severe
Crohn’s for that consideration. That would actually be a cure then? It would be because your whole stem cell is being rewired, a bit like if you have cancer or leukemia … They’re quite a bit further down the line with that research in America … They are … … About 5 years down the line, so far. They’re a long way ahead of us and I would still say that it was quite a drastic move … with a lot of significant It can be quite dangerous. Absolutely! it’s not a nice thing to have your whole immune system kind of wiped out effectively and then you have to have your stem cells implanted and stuff so it’s major stuff But I think that’s the way that we
are moving and I think the genetics, as well, of Crohn’s, I think that’s also …
lots of research being done into genetic responses to certain drugs. So I think that will really help when we can tailor-make drugs to people’s genes. Yeah I
know, exactly, rich people will have … They’re doing some research in Exeter at the moment about Mercaptopurine and which people will have reactions to Azathioprine or Mercaptopurine and that’s really interesting. I think we can kind of like have a perfect
genetic fit then that will be ideal. And then obviously from the
from a drug point of view we have got newer ‘mabs’, everything is going to be
‘mabs’. Anything with a ‘mab’ on the end is gonna be the other way that they’ll
develop for Crohn’s Disease. Ulcerative Colitis is a bit different because it’s still considered a cure to have a pouch so they don’t do quite so much research into that because most people do very well on the whole with a pouch. (From background) Abbie says she is one of the ones going up to … She is one of the ones! (From background) She says that she’s pretty nervous to hear about it. Yeah it’s major stuff, it is major stuff, but
it’s not … you get a lot of support from up there and you don’t have
to go ahead with anything. Really the reason to send people there is for
people to be aware of what it entails. It’s not a commitment. It’s just good to get information. She could be a pioneer.
She could! Oh Abbie, a pioneer! How exciting! We wanna know what happens now! You’ll have to start writing a blog that we can follow. It’s quite, it’s very rigid as well, I mean they don’t accept everyone. You have to tick lots of boxes. Actually, with research, there’s loads of research going on with Crohn’s & Colitis UK so if you just go on the website … And there’s a lot on stem cell transplants. I mean you know it’s a really good thing to look up because it is fascinating. I mean they’re doing them in all areas now aren’t they, and very successfully in a lot of diseases. Big stuff. (From background) Jane says she’ll be in
contact with you guys tomorrow. Get the antibiotics ready. I’ll get the prescription organised Jane. (From background) Sorry Abbie. “What happens if it’s something I’m not keen on doing. I’ve heard there is a possibility
it can make you infertile. That scares me. If it is something I’m
going to do then I’d be happy to blog or record the progress.” That would be lovely Abbie. And no-one’s gonna push anyone. Just have a conversation with them. Yeah it’s a conversation but there are options with that anyway, so speak to them about it. Don’t worry yourself. You’re not gonna get up there and there just gonna throw you into it. You’ll have a chance to ask questions. And I can give you … if you’ve got any worries, give me a ring and I’ll have a chat with you in the next few days, but it is just like Lindsay says, it is just a conversation at this stage for a lot of people. (From background) But yeah, if you keep a blog that’d be great. We’d love to read it … Yeah we would. There are about 4 or 5 people who’ve gone up there just for a conversation so it’s worthwhile having. And you can do some shopping in
London. Think of it as a nice away day. (From background) There’s a lady I follow on Twitter, Abbie, if you message us I’ll put you in contact with her she’s from the Exeter team. I think she’s been up, or she’s on her way up, to Exeter as well and she’s on the Exeter networking team. So Abbie get in contact and I’ll check and I might be able to pass on … There’s another patient – I won’t say the name on here – but there’s another patient that has been up, has had a conversation and is having thoughts about that so I can put you in touch with him and maybe you two could chat about it. (From background) So it’s 8 o’clock, d’you want to round things up? Yeah, have we got any more questions? That was really … that seemed to go really, really quickly. It did, didn’t it! So another plug for WALK IT. Saturday 13th July. Best date of the year! Which is also Dani’s … Can we say? … Yes … 40TH BIRTHDAY! Whoooo! We’ll drink to that! Cheers Dani! We’ll be there. We’ll be there for you. So we’ll probably have a couple of bottles up there as well. If you’re volunteering … Shas will have had a couple before she gets there! No, not me! So if you’re volunteering, we’ll probably have a couple of bottles afterwards. It’s worth volunteering just for that! Saturday 13th July. Sign up now. You go on the Crohn’s & Colitis UK website and then the big thing says WALK IT and you go to Plymouth and sign up, either to walk or to volunteer. Don’t forget the kids can get their t-shirts and the dogs can get their bandanas. Cara’s got her bandana from last year. Yeah, Dizzy has as well. But you get new t-shirts this year. Yes. The t-shirts this year will be different from the ones last year so I think they’re gonna say ‘WALK IT’ on the front like this, or something like this, and on the back it’s
going to say ‘It Takes Guts’ this year, so it’ll be new. Now I was gonna volunteer, now I wanna change my mind. No! And Helpline number – 01752 439224. And none of us are going to say the email address because we can’t … it’s too long-winded. It’s alright, it’s all on our Facebook page. Thank you very much everybody. Thank you. Bye!

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