Wednesday 11th January 2012, 11:30 AM
The waiting room from hell
Last call of the day. This was an unscheduled request to present myself to Dr Teresa Guerrero-Urbano at the Cancer Outpatients Day Clinic, which is in a much older part of Guy's Hospital than I had seen before. I made myself known to reception and we were asked to wait.
It's the biggest waiting room I have seen so far, at least the size of half a tennis court, and packed. Packed like a rural bus in South America. Jo and I found two seats between a man sitting with a piglet on his lap and and old woman with a screaming baby. The wait was interminable. The room was a constant 'hubbub' of noise, people talking, coughing, hacking, mobile phones, babies crying, kids running up & down shouting & screaming, and the ever present clucking from the crates of chickens piled in one corner.
After 45 minutes we were called in to a consulting room, I'm beginning to wonder if Dr Teresa actually exists. We met with Dr Mary Lei and one of the two medical students who's assisting her. This was very much a brief "all systems go" conversation, a catch up and a what to expect next. I queried the 'minor anomalous' blood test result from a week or so ago, 'just a blip', either something I had eaten or possibly just a blip, nothing to worry about, last blood test was fine and Kidney Test via Nuclear Medicine all OK.
Jo told them how very impressed we both were with Clinical Nursing Specialist Myleyne Frieres. Dr Lei was not surprised, she said that Myleyne is one of the very best experts they have at that sort of thing, I'm not surprised either. Jo was most impressed with her apparent ability to divert me back on subject while I'm mid anecdote. Dr Lei was surprised and asked whether that was permissible and Jo told her "Oh Yes, I just don't know how to myself - I'll have to get her to show me", "Dr Lei said, yes me too". I don't know what they were talking about.
Four days off to get used to 'pipie' and rest and then 1st Chemo on Monday.
Edited with thanks to Jo W
Tuesday, January 17, 2012
Sunday, January 15, 2012
19. Chemotherapy, part 2
Wednesday 11th January 2012, 11:30 AM
PICC line insertion
This is definitely one of those instances where having a "Jo" along for the ride really payed off. I knew that a PICC Line is a specific type of catheter and would be temporary or semi permanent, I was only half right.
Senior Staff Nurse Juan Roman introduced Jo and I to the Clinical Nursing Specialist Myleyne Frieres who's speciality would include performing this surgical procedure. The first thing she did was sit us down in a consultation room to watch a 10 minute DVD explaining about PICC lines and how patients feel about having them. Jo knew what was to come, she read all the stuff I'd been given, she knew I hadn't, she kept quiet. My ignorance was bliss.
To my dismay and a little horror PICC Lines aren't as I had thought, i.e. a larger type of butterfly needle like the ones that I have had for my CT and MRI and PET scans. I had 'not' read the notes I had been given and I had not taken on board what would be involved.
A PICC line is 45cm (18") of plastic tube, run from just inside the bicep, through a vein, and stops just before the heart. C.N.S. Myleyne showed me one, I did not smile.
The cancer Day Unit has it's own surgical room where C.N.S. Myleyne would perform the PICC Line insertion for me. I offed my shoes and top shirt but kept on my T-Shirt and everything else.
She inspected my inner arm and ran the Ultrasound scanner over it too. The image was on screen for no more than 2 seconds before she said "perfect just what I'm looking for" Wow ! that was quick "well I've done this so many of these I know exactly what I'm looking for".
She scrubbed up, donned a gown, gloves, mask and eye shield.
Next was my turn, lying on the 'bed come operating table'. She cleaned my arm three or four times, then with my arm held up, unfurled a full length surgical sheet, arm down and unfurled a second one with a cutout window. Surprisingly we are now over half way through the whole procedure.
Now the worst part, one 'jab' of local anesthetic. That was a tad 'ouchie' going in much deeper than the ones I had during my biopsy and for much longer. A minute or two later she started the insertion, I felt very little, not much more than having someone tapping their fingers on the inside of your upper arm.
One more little 'jab' of anesthetic and a quick view into the shoulder with the Ultrasound and it will all be over in another minute or two. "Did you feel that ?" It felt to me like I had been very gently touched on the arm with the very tip of a ball point pen. "Good that's exactly what it should feel like", "Right just tape this up, put a tube bandage on and were all done here". Myleyne looked up at the clock and said "just about ten minutes and we're all done now".
I had been led to expect to have the PICC Line in my left arm but because so many people instinctively 'coddle' their wounded/different feeling arm the practice is now to put the line in the dominant arm. There is a concern that as the blood flow is restricted ( due to having a tube in the vein ) and the natural tendency to 'coddle' the uncomfortable arm a blood clot is a real possibility. I was told I must use the arm as much as possible and as much as I would do normally. I asked whether it would be permissible to masturbate, Myleyne said yes, her eyes widened, her jaw dropped, and she screamed NO ! not in here, wait until you get home.
Myleyne sent me off for a chest X-Ray, like the dental X-Ray a week earlier this to is taken standing up and only takes a couple of minutes and was available to view immediately, I stood there and and was shown where my PICC Line was running through my arm, down my chest and nearly to my heart. It didn't bother me in the slightest. Back up at to see Myleyne for her assessment of the X-Ray, a big smile and a thumbs up from her and were done for the day.
I'm getting used to 'pipie' now. I can sleep pretty much normally on both sides and the dull ache has dissipated. It's very much like wearing and ill fitting watch over a small fresh bruise, occasionally uncomfortable and ever present. Bathing is a 'faff' as it mustn't get it wet due to the risk of infection.
As the PICC Line will be staying in my arm for the rest of my treatment, three or four months I'll just have to get used to it. One thing though, every now and again it does itch like hell.
Edited by Jo W, with thanks
PICC line insertion
This is definitely one of those instances where having a "Jo" along for the ride really payed off. I knew that a PICC Line is a specific type of catheter and would be temporary or semi permanent, I was only half right.
Senior Staff Nurse Juan Roman introduced Jo and I to the Clinical Nursing Specialist Myleyne Frieres who's speciality would include performing this surgical procedure. The first thing she did was sit us down in a consultation room to watch a 10 minute DVD explaining about PICC lines and how patients feel about having them. Jo knew what was to come, she read all the stuff I'd been given, she knew I hadn't, she kept quiet. My ignorance was bliss.
To my dismay and a little horror PICC Lines aren't as I had thought, i.e. a larger type of butterfly needle like the ones that I have had for my CT and MRI and PET scans. I had 'not' read the notes I had been given and I had not taken on board what would be involved.
A PICC line is 45cm (18") of plastic tube, run from just inside the bicep, through a vein, and stops just before the heart. C.N.S. Myleyne showed me one, I did not smile.
The cancer Day Unit has it's own surgical room where C.N.S. Myleyne would perform the PICC Line insertion for me. I offed my shoes and top shirt but kept on my T-Shirt and everything else.
She inspected my inner arm and ran the Ultrasound scanner over it too. The image was on screen for no more than 2 seconds before she said "perfect just what I'm looking for" Wow ! that was quick "well I've done this so many of these I know exactly what I'm looking for".
She scrubbed up, donned a gown, gloves, mask and eye shield.
Next was my turn, lying on the 'bed come operating table'. She cleaned my arm three or four times, then with my arm held up, unfurled a full length surgical sheet, arm down and unfurled a second one with a cutout window. Surprisingly we are now over half way through the whole procedure.
Now the worst part, one 'jab' of local anesthetic. That was a tad 'ouchie' going in much deeper than the ones I had during my biopsy and for much longer. A minute or two later she started the insertion, I felt very little, not much more than having someone tapping their fingers on the inside of your upper arm.
One more little 'jab' of anesthetic and a quick view into the shoulder with the Ultrasound and it will all be over in another minute or two. "Did you feel that ?" It felt to me like I had been very gently touched on the arm with the very tip of a ball point pen. "Good that's exactly what it should feel like", "Right just tape this up, put a tube bandage on and were all done here". Myleyne looked up at the clock and said "just about ten minutes and we're all done now".
I had been led to expect to have the PICC Line in my left arm but because so many people instinctively 'coddle' their wounded/different feeling arm the practice is now to put the line in the dominant arm. There is a concern that as the blood flow is restricted ( due to having a tube in the vein ) and the natural tendency to 'coddle' the uncomfortable arm a blood clot is a real possibility. I was told I must use the arm as much as possible and as much as I would do normally. I asked whether it would be permissible to masturbate, Myleyne said yes, her eyes widened, her jaw dropped, and she screamed NO ! not in here, wait until you get home.
Myleyne sent me off for a chest X-Ray, like the dental X-Ray a week earlier this to is taken standing up and only takes a couple of minutes and was available to view immediately, I stood there and and was shown where my PICC Line was running through my arm, down my chest and nearly to my heart. It didn't bother me in the slightest. Back up at to see Myleyne for her assessment of the X-Ray, a big smile and a thumbs up from her and were done for the day.
I'm getting used to 'pipie' now. I can sleep pretty much normally on both sides and the dull ache has dissipated. It's very much like wearing and ill fitting watch over a small fresh bruise, occasionally uncomfortable and ever present. Bathing is a 'faff' as it mustn't get it wet due to the risk of infection.
As the PICC Line will be staying in my arm for the rest of my treatment, three or four months I'll just have to get used to it. One thing though, every now and again it does itch like hell.
Edited by Jo W, with thanks
18. Chemotherapy, part 1
Wednesday 11th January 2012, 09:00 AM
Pre-Treatment Consultation
The cancer Day Unit ( Note, I refuse to spell cancer with a capital 'c' its doesn't deserve it ) is on the tenth floor of the tower of Guy's Hospital and has spectacular London views all round.
Jo and I were met by Senior Staff Nurse Juan Roman, and he explained everything that I could expect from the treatment and showed us around the unit/ward/facilities. Like most of the rest of the hospitals I have been in so far it all looked nearly brand new. Very quiet, restful and calming with its own surgical room, blood work room, internet cafe and facilities for making Tea & coffee etc.
At first I was a little concerned that as S.S.N. Juan was speaking english as a second language communication might become a 'tad' labored even with his excellent command of English. After I stopped interrupting him and we all got to know each other a little better everything went smoothly and became quite light hearted.
It didn't strike me as a bad place to have to spend six or eight hours in hooked up to a machine.
Edited by Jo W, with thanks
Pre-Treatment Consultation
The cancer Day Unit ( Note, I refuse to spell cancer with a capital 'c' its doesn't deserve it ) is on the tenth floor of the tower of Guy's Hospital and has spectacular London views all round.
Jo and I were met by Senior Staff Nurse Juan Roman, and he explained everything that I could expect from the treatment and showed us around the unit/ward/facilities. Like most of the rest of the hospitals I have been in so far it all looked nearly brand new. Very quiet, restful and calming with its own surgical room, blood work room, internet cafe and facilities for making Tea & coffee etc.
At first I was a little concerned that as S.S.N. Juan was speaking english as a second language communication might become a 'tad' labored even with his excellent command of English. After I stopped interrupting him and we all got to know each other a little better everything went smoothly and became quite light hearted.
It didn't strike me as a bad place to have to spend six or eight hours in hooked up to a machine.
Edited by Jo W, with thanks
17. Nutrition & Dietetics
Tuesday 10th January 2012, 03:00 PM
Grubs Up !
The fifth and final appointment of the day, phew !
With both the Chemo & RT weight loss is a serious issue. Good nourishment plays a significant role in the ability to cope with and recover from treatment. This coupled with the fact that the exposure map the RT will be working to is so precise ( one millimeter or so ) that any significant loss or gain in weight and the inevitable change in body shape that would ensue Nutrition & Dietetics are taken extremely seriously.
When Nurse Annabel called to confirm that I had received the letter for this appointment she also told me that this would be when I would meet the rest of my team. I had visions of walking into a room full of people ( remember Mr Terry telling me that all my results are reviewed by a 28 person panel ) casting my eye around the the room and saying "I suppose you are all wondering why I called you here today" There were only 3 there, the dietation ( name to follow ), Nurse Annabel and the speech therapist ( name to follow ) Imagine my disappointment.
Basically the meeting boiled down to two main issues:-
1, Eat the high calorific foods that I like. Custard, chocolate pudding, dairy, cream, cheese etc. Because I would in all likely-hood be feeling so rough & nauseous that anything to keep my weight stable would be good.
2, That I would almost certainly need to have a feeding tube ( PEG ) inserted into my stomach.
I had been warned about this feeding tube before, and frankly the idea gives me the "heebie-jeebies". But because I will be irradiated through both sides of my neck I can expect the discomfort be become so extreme as to make normal eating as good as impossible. One alternative is to have a feeding tube "UP THE NOSE" that's 'worse' not better, NO THNK YOU !
I was sure I'd be OK without it, after all I managed after my tonsillectomy, but that was just for a couple of weeks, not four, and only on the left side, not both.
As consistent good nutrition and constant body weight play such a crucial role in both treatment and recovery of Chemo & RT I think I'll just have to just 'suck it up' be a 'brave little soldier' and have the damn tube fitted.
It will be a two night stay in hospital, but now after having my PICC line inserted I'm getting used to the idea. If it means getting better quicker I'm all for it.
And on the plus side... here comes the chocolate pudding.
Edited by Jo W, with thanks
Grubs Up !
The fifth and final appointment of the day, phew !
With both the Chemo & RT weight loss is a serious issue. Good nourishment plays a significant role in the ability to cope with and recover from treatment. This coupled with the fact that the exposure map the RT will be working to is so precise ( one millimeter or so ) that any significant loss or gain in weight and the inevitable change in body shape that would ensue Nutrition & Dietetics are taken extremely seriously.
When Nurse Annabel called to confirm that I had received the letter for this appointment she also told me that this would be when I would meet the rest of my team. I had visions of walking into a room full of people ( remember Mr Terry telling me that all my results are reviewed by a 28 person panel ) casting my eye around the the room and saying "I suppose you are all wondering why I called you here today" There were only 3 there, the dietation ( name to follow ), Nurse Annabel and the speech therapist ( name to follow ) Imagine my disappointment.
Basically the meeting boiled down to two main issues:-
1, Eat the high calorific foods that I like. Custard, chocolate pudding, dairy, cream, cheese etc. Because I would in all likely-hood be feeling so rough & nauseous that anything to keep my weight stable would be good.
2, That I would almost certainly need to have a feeding tube ( PEG ) inserted into my stomach.
I had been warned about this feeding tube before, and frankly the idea gives me the "heebie-jeebies". But because I will be irradiated through both sides of my neck I can expect the discomfort be become so extreme as to make normal eating as good as impossible. One alternative is to have a feeding tube "UP THE NOSE" that's 'worse' not better, NO THNK YOU !
I was sure I'd be OK without it, after all I managed after my tonsillectomy, but that was just for a couple of weeks, not four, and only on the left side, not both.
As consistent good nutrition and constant body weight play such a crucial role in both treatment and recovery of Chemo & RT I think I'll just have to just 'suck it up' be a 'brave little soldier' and have the damn tube fitted.
It will be a two night stay in hospital, but now after having my PICC line inserted I'm getting used to the idea. If it means getting better quicker I'm all for it.
And on the plus side... here comes the chocolate pudding.
Edited by Jo W, with thanks
16. MRI Scan
Tuesday 10th January 2012, 12:00 AM
MRI Scan
Although both my appointment to have my teeth cleaned and my first return to Nuclear Medicine today were both running late, I have managed to make up the time. However now MRI Dept. are running late. I tell them that I need to get back to Nuclear Medicine for my next blood test before my appointment at Nutrition & Dietetics and they 'get a move on' with no more prompting needed.
The MRI Scan like so many others will need a contrast dye injected, I'm starting to feel like a pin cushion today. The Scanner is very similar to The PET and CT scanners that I have previously been in, but louder, much-much louder.
The sound this machine makes alternates between a pneumatic road drill and the most unimaginative, repetitive Techno beat you could possibly imagine. The funny thing is, before I got on the bed the operator asked if I'd like to listen to some music, and what would I like ? I chose "Easy Listening" I got classical, I heard bugger all.
I heard about 30 seconds of music before all the "BUZZ-BUZZ, SHUDDER-SHUDDER, BUZZ-BUZZ, BOOM-BOOM" started and about 30 seconds more when it was all over. So you have to ask yourself "what's the point ?"
Back off to Nuclear Medicine for my third and final blood draw of the day, I hope !
Edited by Jo W, with thanks
MRI Scan
Although both my appointment to have my teeth cleaned and my first return to Nuclear Medicine today were both running late, I have managed to make up the time. However now MRI Dept. are running late. I tell them that I need to get back to Nuclear Medicine for my next blood test before my appointment at Nutrition & Dietetics and they 'get a move on' with no more prompting needed.
The MRI Scan like so many others will need a contrast dye injected, I'm starting to feel like a pin cushion today. The Scanner is very similar to The PET and CT scanners that I have previously been in, but louder, much-much louder.
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The sound this machine makes alternates between a pneumatic road drill and the most unimaginative, repetitive Techno beat you could possibly imagine. The funny thing is, before I got on the bed the operator asked if I'd like to listen to some music, and what would I like ? I chose "Easy Listening" I got classical, I heard bugger all.
I heard about 30 seconds of music before all the "BUZZ-BUZZ, SHUDDER-SHUDDER, BUZZ-BUZZ, BOOM-BOOM" started and about 30 seconds more when it was all over. So you have to ask yourself "what's the point ?"
Back off to Nuclear Medicine for my third and final blood draw of the day, I hope !
Edited by Jo W, with thanks
15. Dental Hygiene
Tuesday 10th January 2012, 10:45 AM
Teeth Cleaning...
the second of five appointments this day.
During my last dental examination see Chapter 12 that I had the week previously I voiced my desire to "at some point have my teeth cleaned". Dr Mary Burke, who's care I am under at Sedation & Special Care said that if I wanted that they could do that for me before I started Chemo, and would I like them to book me an appointment ?.
Having been 45 minutes late for my first appointment with the dentist I made dam sure I was there twenty minutes before I was due for this one. Two watches, one wrist, one pocket. I didn't get in the chair until 11:15, so already running late now.
Next stop, back to Nuclear Medicine for blood samples "Two for One Deal" see chapter 13 & 14 then off for an MRI Scan.
I explain all this and then the teeth cleaning commences. After half an hour we call it quits for the day, there is still more cleaning to do, but I have other pending appointments to keep. I'll be back to the dentist in a couple of weeks time.
I return to Nuclear Medicine 15 minutes late, have a 10 minute wait and have to rush off for my next appointment the MRI Scan.
Edited by Jo W, with thanks
Teeth Cleaning...
the second of five appointments this day.
During my last dental examination see Chapter 12 that I had the week previously I voiced my desire to "at some point have my teeth cleaned". Dr Mary Burke, who's care I am under at Sedation & Special Care said that if I wanted that they could do that for me before I started Chemo, and would I like them to book me an appointment ?.
Having been 45 minutes late for my first appointment with the dentist I made dam sure I was there twenty minutes before I was due for this one. Two watches, one wrist, one pocket. I didn't get in the chair until 11:15, so already running late now.
Next stop, back to Nuclear Medicine for blood samples "Two for One Deal" see chapter 13 & 14 then off for an MRI Scan.
I explain all this and then the teeth cleaning commences. After half an hour we call it quits for the day, there is still more cleaning to do, but I have other pending appointments to keep. I'll be back to the dentist in a couple of weeks time.
I return to Nuclear Medicine 15 minutes late, have a 10 minute wait and have to rush off for my next appointment the MRI Scan.
Edited by Jo W, with thanks
14. Blood Test
Tuesday 10th January 2012, 10:00 AM
Grumpy, no! not me, her...
Today for first time I met a miserable member of hospital staff.
If you remember from 'Chapter 13, Nuclear Medicine' I need a blood test because after the first half dozen tests that I've had so far, my last one showed an anomalous result.
The Blood Test Dept. that I was sent to was overwhelmed, there were probably twenty or thirty people waiting, sitting, standing, in wheelchairs, with prams & crying babies etc.
I presented my self at the door to ask for my vials, and was told in no uncertain terms and a somewhat impatient manner to "take a number". I started to explain that... "just take a number, and wait your turn"...
I managed to explain my purpose but was met with incomprehension & obstruction "who sent you, where is your green slip, what's it for" etc. until a disembodied voice said "it's OK! he just needs his vials, i've got it... step this way".
Which way ?
Where are you ? a head with a smiling face appeared from behind a curtain and asked for my details. I told him my name and started to find my "patient and hospital numbers" but before I could finish he said "got you". He printed out the labels put the blood vials in a poly bag we bid our fare-wells, and off I went, job done...
One less needle to think about. Hooray !
Edited by Jo W, with thanks
Grumpy, no! not me, her...
Today for first time I met a miserable member of hospital staff.
If you remember from 'Chapter 13, Nuclear Medicine' I need a blood test because after the first half dozen tests that I've had so far, my last one showed an anomalous result.
The Blood Test Dept. that I was sent to was overwhelmed, there were probably twenty or thirty people waiting, sitting, standing, in wheelchairs, with prams & crying babies etc.
I presented my self at the door to ask for my vials, and was told in no uncertain terms and a somewhat impatient manner to "take a number". I started to explain that... "just take a number, and wait your turn"...
I managed to explain my purpose but was met with incomprehension & obstruction "who sent you, where is your green slip, what's it for" etc. until a disembodied voice said "it's OK! he just needs his vials, i've got it... step this way".
Which way ?
Where are you ? a head with a smiling face appeared from behind a curtain and asked for my details. I told him my name and started to find my "patient and hospital numbers" but before I could finish he said "got you". He printed out the labels put the blood vials in a poly bag we bid our fare-wells, and off I went, job done...
One less needle to think about. Hooray !
Edited by Jo W, with thanks
13. Nuclear Medicine
Tuesday 10th January 2012, 09:00 AM
Kidney Test.
Kiddelie test? yes, I said kiddelie diddle-eye ?
The Chemo therapy is somewhat "toxic" and won't be initiated unless the recipient has fully functioning kidneys that are able to clean the blood sufficiently.
The test itself is fairly simple & straight forward. A radio active tracer is injected into one arm and after a two hour wait blood is drawn for analysis from the other. Then a second blood sample is taken an hour later, and a third an hour after that. One test, four (4) needles. Oh what fun ! The three samples are analyzed and the results plotted on a graph and a determination can then be made as to the efficiency of the Kidney function, simple.
Eugenie, who would be putting the "stuff" in and taking the first sample of blood out, and I chatted. From 9:00 o'clock day one everyone has been chatty, I think it's part training ( to put patients at ease ), and part due to a genuine interest in 'who people are', 'what they do', 'and how they are getting on'. I was telling him how I felt about 'needles' and that considering how many I have had so far that you'd expect me to be more accustomed to them by now, which to some extent I am ( but still not enough for my liking, anyway ). And, that as well as the 4 he would be sticking in me, when he and I were done I had to go straight up to Blood Tests so they could have a go too.
Apparently my last Blood Test showed a slight 'anomaly' and this would need to be "pinned down" before Chemo could commence.
Eugenie said that if I went to up to 'Blood Tests' and got my "vials & their bag" he would take the samples they needed at the same time that he was taking the samples that he needed. All he needed to do was use a "Butterfly Needle" instead of the type he would use normally, it was no trouble at all, that he would be happy to do it if I wanted him to, and it would mean one less needle that day. I said "YES PLEASE !" I like Eugenie.
Kidney Test.
Kiddelie test? yes, I said kiddelie diddle-eye ?
The Chemo therapy is somewhat "toxic" and won't be initiated unless the recipient has fully functioning kidneys that are able to clean the blood sufficiently.
The test itself is fairly simple & straight forward. A radio active tracer is injected into one arm and after a two hour wait blood is drawn for analysis from the other. Then a second blood sample is taken an hour later, and a third an hour after that. One test, four (4) needles. Oh what fun ! The three samples are analyzed and the results plotted on a graph and a determination can then be made as to the efficiency of the Kidney function, simple.
Eugenie, who would be putting the "stuff" in and taking the first sample of blood out, and I chatted. From 9:00 o'clock day one everyone has been chatty, I think it's part training ( to put patients at ease ), and part due to a genuine interest in 'who people are', 'what they do', 'and how they are getting on'. I was telling him how I felt about 'needles' and that considering how many I have had so far that you'd expect me to be more accustomed to them by now, which to some extent I am ( but still not enough for my liking, anyway ). And, that as well as the 4 he would be sticking in me, when he and I were done I had to go straight up to Blood Tests so they could have a go too.
Apparently my last Blood Test showed a slight 'anomaly' and this would need to be "pinned down" before Chemo could commence.
Eugenie said that if I went to up to 'Blood Tests' and got my "vials & their bag" he would take the samples they needed at the same time that he was taking the samples that he needed. All he needed to do was use a "Butterfly Needle" instead of the type he would use normally, it was no trouble at all, that he would be happy to do it if I wanted him to, and it would mean one less needle that day. I said "YES PLEASE !" I like Eugenie.
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| National "Pin Cushion Day" ...not happy |
Edited by Jo W, with thanks
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