Archive for the 'More treatment!' Category

Tuesday…woops!

Well, the last posting may have been overdue, but I was certainly under-due for my ECP appointment.

It all got a little strange when I turned up at the accommodation yesterday, and found that no room had been booked. But it was when I arrived on the ward to be greeted with “Nice to see you, what are you doing here?” that I started to get concerned! It turned out that my appointment (which I had had to move from last Monday, had been set for next Monday! Fortunately there was a spare machine and I had the treatment anyway.

However, it didn’t all run smoothly as this morning there was a problem with the machine I was connected to, and after a bit of messing about, I was put on another one, so the process was delayed by an hour!

I had expected this to be the last session, but it seems not! As it is a while since I last saw the consultant dermatologist, I had an appointment made on conclusion of yesterday’s treatment. As I have had such a good response, I am having some more sessions, at six week intervals with a review in 4 months, which will be after another three sessions.

I was delighted to see fellow transplant patient Mark on the dermatology day unit. He has had a tough time with GvHd after his second transplant, and at the moment is on steroids to damp down his immune system, along with immuno-suppressants. Not a good state of affairs, so he is having a course of ECP as a less aggressive (and more effective) alternative. We had a long chat about the treatment – it has certainly been very beneficial for me – so I hope all goes as well for him.

Finally… I have always been interested in finding out about the various risks that have been likely to affect me, and one has been the CMV infection. One of the requirememts for my blood transfusions is that it should be CMV negative. CMV (or Cytomegalovirus) is a relatively common infection, that usually only causes problems in people that have impaired immune systems. I found an article about it in Monday’s Daily Telegraph, and with a bit of Googling, found this article which I have also added as a link.

While on the subject of common infections, another is the Epstein-Barr Virus, associated with glandular fever and possibly linked to some lymphomas. There is more information here. Although I am CMV negative, I am EBV positive, along with the majority of the population!

End of cytology discussion… Off to Chippenham this evening!

Onwards and upwards! (and I’ve just noticed – this is the 400th post!)

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Thursday… and the snow came down!

And the snow continues to make life interesting! I went over to see my sister, Anne, last night (good curry!) and left just before 10. Roads were clear, no snow. By the time I had driven to the M4 the snow was just starting and I drove past a recovery van pulling a car (on its side) out of a field; the roads were still clear, so I don’t know how long it had been there. Five miles further on in the descent down into Bath, the snow was starting to stick, and by the time I got to Box hill, I was crawling along in second gear at 15mph with uncertain traction. I got back to the hotel safely, but I didn’t leave a minute too soon.
Snow sceneThis morning there was about 4 inches of snow on the car, and the roads were ungritted. I left early and got in before there had been too much traffic to compact the snow, but several people have rung in to say that they are snowbound. The forecast isn’t good, so it will be an interesting drive back to Winchester tomorrow!

Onwards and upwards!

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Monday… again!

I was hoping to post a few more photos from Katie’s ‘Birthday bash’, but I haven’t received them yet!

My second course of ECP went well. I am getting the hang of the hospital accommodation, and decided that rather than go for an overpriced pizza, I’d get something from M&S (This is not just food…) and cook for myself. It didn’t go quite according to plan…

The starter, as I discovered after I bought it, needed to be cooked in a real oven – there is only a microwave in the accommodation kitchen. However that was no problem for the main course – a curry. Well there wouldn’t have been had I not read the “re-heat for 2 1/2 minutes” as “reheat for 22 1/2 minutes” (which would have been reasonable if it had been frozen! Fortunately I realized my error in time to salvage something (after 12 minutes) – but it wasn’t quite the gourmet experience I had hoped for!

However, there are signs that the ECP is having a positive effect. My joints don’t feel quite as stiff as they were and I think I can stretch a bit further.

Felicity cam home on Saturday after a week at Ascot – and it was off to Bournemouth on Sunday to collect all Katie’s ’stuff’ from her rented flat as the term has ended. Next year is spent at a placement, so there may be a slight storage problem…! However it is stacked in her bedroom at the moment.

But those little trials and tribulations apart, all is well!

Onwards and Upwards

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Sunday… New experiences

Yet again it has been a week since I last posted – and another busy one! Firstly I am sorry the blog hasn’t been updated, but I have had little opportunity to connect to the internet – and when I have, the server has been unavailable because of the ongoing network snags. I have now found the source of the problem! You may recall that I had thought that it was one of the network devices (a switch) that was overheating, but having removed it (for return to the suppliers under warranty) the problem happened again, and I can now point the finger at one of the computers, which may have a hard disk or motherboard problem, possibly caused by overheating. I will have to look at improving the airflow through the case but until I can sort that out, I’ll be leaving it disconnected so the rest of the network, with the webserver, can run normally.

This week saw the first ECP sessions! All quite uneventful really. I went up to St Thomas’s on Tuesday, and had the first session in the afternoon. One (large) canula is placed into the vein near the inside of my elbow, and about 125ml of blood removed and centrifuged. The white cells are separated out and the red cells returned to the body. This happens six times, and then a photo-sensitive drug called psoralen is added to the white cells which absorb it. The cells are then circulated through a tube past an ultra violet (UV) light which activates the drug and modifies the cells attributes (in a way I don’t fully understand). The cells are then returned to the body. The idea is that because only the target cells are exposed to the drug, which is activated outside the body, the side effects are significantly reduced. However one side effect is the risk of cataracts, as it does make the eyes sensitive to UV radiation, so I had to wear UV blocking goggles (like safety glasses) for nine hours after each session – I received some strange looks in a restaurant!

I stayed in a hospital room overnight (adequate but spartan – it reminded me of the flat I shared in Leeds as a student) – 6 rooms with a communal bathroom – although I was the only occupant! Next morning (Wednesday) I had session two, and then I went off to meet Felicity and Katie who had come up to London as Katie had an interview for a job placement as part of her degree course. Session 2 was uneventful – once the canula was inserted – it took two attempts.

We stayed in London that night in rather more comfort at the flat of our friends Marion and Martin. We were out for a Chinese that night, and then Thursday saw me head off to Guy’s , while Katie went for her interview. My haematology check up at Guys followed the usual pattern, although they think my Hb was 11.9, while the team at St Thomas’s claimed it was slightly better at 13.4! However, having had four needle inserted, I have a nice collection of bruises! I did get a bit more of the coursework done, all but finished. Katie’s interview went well – but she found out at the interview that it is an unpaid placement, which makes it rather undesirable!

We drove back on Thursday afternoon, I was out for dinner that night, and back at work on Friday.

Friday evening saw me driving up to Worcester for an excellent but intensive week-end of training (nice to be doing it instead of receiving it!) and I drove back home this afternoon, to finish off my coursework and email it off – which I did about 2 hours ago, just before the midnight deadline.

So another busy week! Next ECP is in two weeks, and currently planned for every two weeks for the next twelve months – which leaves my in a bit of quandary as to how to classify these posts. Certainly having treatment, although not for the original disease, and with the appointment schedule it feels a bit like ‘life on hold’ again, yet at the same time, it is part of getting my life back! Maybe all three (or four as there was a bit of ‘geek speak’ at the start).

But whatever the categories, we stay Onwards and Upwards!

(Oh yes, I passed the financial management course with 71%)

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Monday… Back to St Thomas’s

It has been a while since I posted something with the ‘More Treatment’ tag, but today saw me back at St Thomas’s at the St John’s Dermatology clinic (originally founded in 1868 – and the only postgraduate dermatology teaching facility in the country) to look at the remaining GvHd. Now I must say that in the grand scale of things, my GvHd is pretty mild – and certainly nowhere near as bad as fellow blogger John but although the majority of my skin is OK, the mucous membranes are affected, and it does flare up a bit from time to time, hence the referral.

Anyway, after a brief wait I saw the consultant, recounted my history and had an examination. The result is that there are two treatment options. The first is an ointment, Tacrolymus, which I had been prescribed before (for my mouth – but never used) which I can apply to the affected areas. If that doesn’t work, there is another, somewhat more invasive procedure, called photo pheresis. In this procedure, a canula is inserted into my vein and my blood ‘on-line’ centrifuged (a bit like the stem cell collection) and the white cells separated out. They are then treated with a photo-activated drug, then exposed to UV radiation to activate the drug, and then returned to my body. This occurs twice in two successive days, either monthly or fortnightly for up to 12 months! Hmmm! My concern is that while the GvHd is present, it shows that my immune system is fighting, but if you damp it down, does that increase the risk of the lymphoma returning? The answer was “no – there no evidence from studies to show that patients having this treatment are more likely to relapse than those that don’t”. Anyway, I don’t need to make a decision yet, and the ointment might do the trick.

As you might have guessed, I have done a little research since I came home and this link gives a little more information about GvHd and is part of a site that describes photopheresis. This link describes the photophoresis procedure.

After seeing the unit, and the obligatory wait at the hospital pharmacy, I am pleased to say that my train journey home was a lot less eventful than the last time!

Onwards and Upwards!

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Thursday… Guy’s again!

But what a difference from last time – no long faces, and new determination in the air! Perhaps that is my perception as my strength returns, but it has been a good day!

We arrived late morning, at the day unit, only to learn that we needed to go to the clinic first, for bloods and to see Linny. My blood counts have improved considerably in the last 10 days – platelets almost back in range, neutrophils back in range, and other indications are good. I am still anaemic – haemoglobin around 9.5 but I hope that will improve too.

We had a chat with Linny, and I signed the consent form, then it was off for a chest X-ray and then to the day unit for the donor lymphocyte infusion (DLI). The chest X-ray result was good and confirmed Linny’s listening – that there is now much less fluid on my lungs than before. (And certainly my breathing at night is much less ‘rattley’ than 10 days ago.)

The DLI was uneventful. The procedure starts with a dose of anti-histamine (Piriton – given as an injection.) This always makes me sleepy – and today was no exception – I just fell asleep while the cells dripped in! After that, I needed to wait a while to ensure that there were no adverse reactions, and then we left to come home. So now it is up to the lymphocytes – get to work my beauties! It will a take a while before any effects are noticed though – as much as 6 weeks, so we are in a waiting game – I’m afraid I’m going to have to ask you to keep things crossed again!

I also saw Mark today. You may remember him as a fellow patient who had his transplant at the same time as me. He has developed lumps on his neck, and was being admitted to Blundell Ward (ENT – where I was last September) for a biopsy. Mark says that he looks at the blog nearly every day – so Mark, I send you my best wishes, as I’m sure everyone else will too – stick with it and think positive, we are all with you.

And now for a few comments about my nutrition (oh no – not more, I hear you say!)

There has been a bit of banter about my diet and nutrition, but looking back over the last couple of weeks, there has been a sort of logic to my eating! When I came out of hospital, I was certainly undernourished, and the muscle wastage was quite scary. My stomach had shrunk, and the anti-biotics had interfered with my digestive tract anyway, destroying some of the useful bacteria that live there. Although I weighed 10 stone (the same as today) much of that was water where I had been re-hydrated. So I suppose concentrating on the protein (lots of bacon and eggs) made sense to get the amino acids to build up my own protein. I certainly couldn’t eat complex carbohydrates while my saliva production was low (saliva contains enzymes that start the breakdown process) but the simple carbohydrates like sugar gave me much needed energy.

Now as my digestive system is recovering (and my sense of smell is returning) I am managing more complex carbohydrates (bread, potato) and my taste for vegetables is returning. Certainly putting on 7 lbs of body mass is good, and my improved condition (wet nose?) was remarked upon today! I was being fitted up for an appointment with the dietician, but when I explained what I have been eating, I think that may not happen. Certainly the double scrambled egg and two rashers of bacon on a piece of toast made a great start to today!

And this brings me to another nutritional subject, Acai berries. Liz alerted to me to these berries (there is a link on the left – if you are using Internet Explorer, you will have to scroll down, if you have upgraded to Firefox or Opera, it will be available on the right) a few months ago, and I have been doing a bit of research into their properties.

Acai berries are native to Brazil, and have dark purple skins. Like other dark skinned berries, these have strong anti-oxidant properties, and acai berries are reputed to contain the most anti-oxidant of any berry. Anti-oxidants are good in that they are believed to mop up free oxygen radicals in the body, which is believed to contribute towards ageing.

However, the most interesting fact is that in laboratory studies at the University of Florida, the extract has been shown to have a an effect against cancer cells. Now it is a long way from a demonstration in a laboratory to a viable drug, and as far as I can tell, the results have not been repeated at any other laboratory. That isn’t to say that the effect isn’t genuine – lots of plant products exhibit pharmacological effects – Vincristine, part of the R-CHOP protocol, is synthesised from the Madagascan Periwinkle plant. Salycilic acid, found in some species of willow, is a powerful anti-inflammatory drug, which we know as aspirin, and if you ate enough apricot stone kernels, you would make yourself seriously ill with cyanide poisoning – they are pharmacologically active!

So there may be a potential benefit from eating acai berries. However, that brings two difficulties. If the berries are pharmacologically active, is it possible that they could interfere with the conventional treatments, either enhancing or reducing the effect? Certainly some other natural remedies, such as Echinacea and St John’s wort are not recommended with conventional treatment because studies have shown that there is an interference. However these studies don’t exist for acai berries.

The second concern is quality control. There are three main suppliers in the UK, each producing a range of acai berry products. One produces a juice, but there is a comment that the juice loses its anti-oxidant properties very quickly. Another produces a freeze dried extract (at £15/50 grams, or £135/lb!) for which they make generous claims, while yet another product is frozen pulp (at about £63 for 5Kg). The problem is that how do I know I am getting what I am ordering? What is the quality control? All I have are the claims of the companies, that are – as far as I can tell – unregulated. I could be buying cranberry pulp for all I know!

So for the moment I will watch the acai berry with interest, and there might come a time when I will try it – but that time is not now. But thank you Liz for bringing it to my attention!

So a long post – but I will end on the usual sign out – “Onwards and Upwards”

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Tuesday… New Hospital, New Experiences, New me?

Well, maybe not a new me, but certainly new experiences!

It has been an interesting 10 days or so, and this will be a long post, so settle down and I’ll tell you about it!

Mark was quite right when he said that I under-estimated how unwell I was. I suppose it came home to me on Sunday morning (14th) when I was thinking about getting up, and finding the prospect un-appealing, that I realised that in 24 hours I was supposed to be at Guy’s – and I just couldn’t do it. The fact that I had spent the previous two days in bed should also have alerted me to the fact that things weren’t well. There were some slightly surreal moments too – Mark said that he had visited on that Sunday, and that I looked unwell, I also had a visit from a friend, Peter – who is also our Vicar. He did arrive wearing his clerical clothes, and it was a bit of a shock to open my eyes to see this figure in black leaning over me! I did wonder where I was for a moment!

Anyway, having decided that Guy’s on Monday was out of the question, the only other option was to get me to Southampton General for some treatment, and the only realistic way was by ambulance. So an ambulance was called, but on arrival, the crew were distinctly hostile. It didn’t help that they had no knowledge of the effects of chemo, or how unwell I was. It did help that I had a letter of referral to Southampton, written by Guy’s, but we got the distinct impression that they thought we were time wasters. However that changed when they saw I was having difficulty breathing, and at that point they offered oxygen. Meanwhile I decided I needed to wash my hands. Funnily enough, I had difficulty reaching the tap, and the next thing I knew, I was on the floor of the bathroom having blacked out. I think that was the pivotal moment for the crew, and they eventually got me downstairs and into the ambulance for a trip to Southampton. The only disappointment was that we didn’t go with lights and siren!

I was admitted to A&E, and then eventually onto the ooncology ward, where they started immediate re-hydration and anti-biotics. My blood counts were a disaster – haemoglobin about 7.5, platelets 5, neutrophils about 0.1 – low enough to warrant being in isolation, and in fact after about 2 hours on the open ward, I was transferred to a side room, which was where I stayed for the rest of the week.

I was also given some pain relief for my sore mouth and I was given a cocaine mouthwash. I had had that before at Guy’s during one of my transplants, but this seemed stronger, and the relief was immediate – and just being pain free made a big difference. Once that was sorted, and I was moved into my side-room, the rest of the treatment continued – anti fungal drugs as I had a thrush infection in my mouth, loads of saline to get me re-hydrated (I must have had about 14 litres or more during the week) and lots of anti-biotics as my neutrophil count was so low. I also had a bag of platelets and three units of blood to get some semblance of blood normality back.

The week was not without its moments! I mentioned that I had the cocaine mouth wash, and that was the first of many, however I began to notice that after the mouthwash, I was becoming almost garrulous – I couldn’t stop talking and I had a real feeling of euphoria. It wasn’t until about the 5th time it happened that I realised I was on a cocaine high. The stronger solution and my damaged mucous membranes meant that I was absorbing a ‘recreational’ dose – and when I realised that, I found it quite frightening. I did have to apologise to some of the staff who I must have bored, but they found it quite amusing! I decided to stop taking it, but when I discussed it with Dr Katia, we halved the strength, and so it only had the desired effect of pain killing. Was there a little twinge of disappointment? Maybe, but the fact that the drug had such a mind altering effect really was scary. I can see how people become psychologically addicted. While discussing it with Dr Katia, I did say that I have NEVER used drugs recreationally – she smiled at me and said “Well, you have tried it now” It was an experience!

And now is the time to give a huge thank you to the medical staff on C6 ward. On the medical staff, there were Drs Katia (Registrar) and Dr Helen, who admitted me from A&E and started the treatment, and Dr Jane, who as the SHO had day to day care of me. They are all part of Professor Johnson’s team, and looked after me really well. I must also thank the nursing team, who yet again showed that it is the people that go to make a good team. I always feel a bit diffident at this stage, because there are many more nurses whose names I didn’t catch – but my thanks goes to them too. However the ones whose names I did catch include: Beatrice (who looked after me on arrival), Kevin (Charge nurse), Terry Clare, Rosie, Allison, Mel, Vicky, Sheryl, Susan and Reena – and many more. Thank you all – yet again it was a demonstration that Oncolgy nurses are a special breed. Susan was on nights during my stay and so did much to look after me at that time.

My stay lasted a lot longer than the Thursday. However I found hospital food to be difficult to eat, partly because it didn’t appeal to my suppressed appetite, and partly because although the mucous membranes started to heal, I still had a painful ulcer on my tongue that made swallowing difficult – even with the mouthwash.

However, by Saturday I was ready to leave, knowing that my nutrition would be better at home. Sadly my platelets were still low, and Dr Katia was reluctant to discharge me, however on Sunday, they had crept up a little, and although not a dramatic improvement (13 to 15) but with some misgivings, I was discharged, again with a small pharmacy stock! It was so good to be home, and to have real food cooked for me!

On Monday I had an appointment at Guy’s for a review, and we were driven up by a friend of ours – trains were banned! I had hoped that I might have some donor lymphocytes, but instead the news was not good. Basically Guy’s feel that there is little more worthwhile treatment that will make a difference, and that the future lies in palliative care. Put baldly, it means that my life expectancy is now measured in months rather than years. They are arranging for a scan to see exactly what is happening, and if the disease has been knocked back, there is the possibility of DLI, but it takes a while to act, and there is the risk that the disease will overtake it, but we shall see. There is also the possibilty of an experimental drug called Velcade, but again it is a slower acting drug, and the disease dynamics again come into play. So not good news, and “Onwards and Upwards” doesn’t seem really appropriate. All I can say is that I will try to fight this every inch of the way! (Tough old bird!) And I will keep the blog going for as long as I can.

OliviaHowever, I don’t want to end this post on a sad note, so I take great pride in introducing Olivia Ellen, who was born at 8 minutes to midnight on 15 January, weighing 7lb 3oz! She is a cutie! :) The photo was taken when she was less than 24 hours old. And perhaps looking at that photograph, maybe there is room for a little “O&U”! I will post some more photos if you wish!

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Saturday… not a good week!

I’m sorry I haven’t posted for a while. There was a milestone on Thursday, which was t+51, but also the anniversay of my admission to Guy’s for the procedure. I suppose If I had known what 12 months later would be like, I would have been disappointed, but hey-ho – I have survived another year!

So to this week – I went into work for the first three days of the week, but as the week progressed, my mouth became very sore (imagine eating stinging nettles!) and I took Thursday and Friday off – and spent most of the days in bed. (I am in bed now good old trusty laptop!)

One of the problems with the sore mouth is that it makes eating almost impossible. I do have the high calorie milk shake drinks, so I am getting some nourishment.

I am off to Guy’s again on Monday, blood checks and an echocardiogram. With a bit of luck I might get some oxygen too! I hope the GCSF will start having an effect – certainly once the neutrophils start increasing, the mucositis goes quite quickly/

So – through gritted teeth – onwards and upwards!!

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Tuesday…

And with the holiday well and truly over, it was back to work yesterday! However not without its trials and tribulations!

I had a good weekend, appetite back, feeding up a bit (helped no doubt by the steroids that are part of the treatment) but yesterday evening the other side effects of the chemo started kicking in – the tiredness, sore mouth and throat etc, and my sense of taste has taken the expected nose dive. I did go into work again today, but not for too long – enough to read e mails and to prepare for a meeting tomorrow, then it was back home to sleep for about 3 hours!

However, I have started the GCSF injections – earlier than last time – so I hope that the neutropenia nadir will be less deep and shorter lived. I did have a call from Liz at Guy’s yesterday, saying that the echocardiogram has been moved from this Thursday to next Monday, which is when I am due to have the next set of blood tests, so I don’t have to go up to London this week!

Anyway, I know what to expect from the first cycle of chemo, so I guess I shall just have to grin and bear it!

Onwards and upwards!

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Friday… t+50 (and a bit) and yesterday’s visit to Guy’s

It was an early start to get up to the Day Unit for just after 9am, for what promised (and turned out to be) a long day!

I was feeling a bit tired when I got there – to the extent that it was remarked on, and the observations showed that my blood pressure was low, and my oxygen saturation was also a bit low – next thing I was attached to an oxygen cylinder! I must say oxygen does act as a quick pick-you-up – I ought to get a bottle for home! (As an aside, I am a qualified oxygen administrator – but only for diving related conditions)

I then saw Natasha (haematology registrar) who taught me a new medical term – that I was looking “slightly grottier” than last time she saw me – on Monday! (In turn, I am delighted to report that Natasha looked as delightful as ever :) ) She also had a listen to my chest, and decided that a chest X-ray was required just to check that there was no infection present, so a porter was summoned to take me down in a wheel chair, and a smaller portable O2 cylinder tracked down, and off we trundled for the X-ray.

All this shenanigan took most of the morning, then it was a quick check with Rob (Specialist Transplant Registrar) to discuss the options. Apart from having a prescription for more antibiotics just in case there is a low level infection – although the chest X-ray was clear) we went ahead with the chemo. There has a been a response, although Rob could still feel a few nodes, so I might yet have a third cycle, although the final decision will rest on the response from this next cycle.

Once we started the chemo, it all went well. No nasties from the Rituximab, and the rest of the chemo (Vincristine, Doxyrubicin and cyclophosphamide) were all administered by Liz – one of the haematology specialist support nurses. I also had a litre of saline to make sure I was hydrated and to bring my blood pressure up.

You may remember that Liz joined the team last year, just before my transplant, and one of her projects has been to work work with other Liz (Ward Manager) to get Samaritan Ward refurbished. That is at last going ahead, starting in May, and will consist of 16 positive pressure, en-suite isolation rooms, and 3 negative pressure en-suite isolation rooms. (The negative pressure rooms are for patients with injections – the negative pressure ensures that the bugs aren’t pumped out into the atmosphere) There will also be a dedicated minor treatment area. The whole set up looks very exciting and will take about 6 months. There is an overall reduction in the number of beds, but coinciding with that, and to complement the trend towards day patient care, the day unit is likely to be expanded too!

I final escaped from the day unit at just after 4 (and thanks to Emma, who looked after me in the morning – during my ‘Grotty’ phase! – and to Louise, who made numerous cups of tea!) then it was a quick call to the pharmacy to pick up another small medicine cabinet of drugs to go with the ones to support the chemo, then home for 6:30, with, if not exactly a spring in my step, certainly feeling better than I had been that morning!

So get to work you toxic little chemicals – onwards and upwards!

(Oh yes – 12th night tomorrow – new theme on the way!)

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