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Author Topic: back to work after oats  (Read 8242 times)

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Offline JG

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Re: back to work after oats
« Reply #30 on: December 07, 2004, 12:56:31 AM »
Hi Kathy,

Was just wondering how you are doing?  I know your surgery is upcoming.  How is everything feeling?

I've been going to PT twice a week for about 8 weeks now and been feeling really good.  Each session consists of 40 minutes cardio and about 2 hours of leg work.  I was even allowed to run briefly (3x30 seconds).  I was just commenting to my PT last week that my knee hasn't felt this good since before my very first knee surgery (back in 99).  I think that jinxed me.  I went to step into the jacuzzi last Wednesday and I slipped.  My knee got hyperflexed under my body, basically my full weight on a collapsed knee.  My normal flexion is maybe 110 and it was at 135 (full flexsion) with all my weight.  I went to PT and they are worried about at a torn MCL and maybe PCL.  ACL and LCL seem fine.  In one step, I went back 3 years in terms of how my knee feels.  I am hoping it's just scar tissue breaking up.  The whole thing makes me want to laugh.  Knee is really swollen and hot again.   I was able to cycle about 30 miles yesterday, so I'm hopeful that all is okay and that it was just scar tissue breaking up.  I don't do well resting, so I am going to cycle indoors today.

Let me know how you are doing...Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline kathleenj

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Re: back to work after oats
« Reply #31 on: December 07, 2004, 04:23:27 PM »
Hi Janice,

Sorry to hear about your mishap.  Geez, just when things seemed to be getting better.   Try to look at it as just a minor setback.  Hopefully it will heal ok and then you can get right back to where you were with rehabbing the knee.  It sounds like things were going great.  I admire your persistance.  You really stick with it even when you are thrown a loop.

Anyway, my surgery it scheduled for thursday afternoon.  I'm kind of in a 'whatever' type of mood about it.  I dont really have any feelings either way about going in for another surgery.  I just want this stupid knee to feel better.

We took the kids to Disney for almost 2 weeks over Thanksgiving and the knee held up ok.  We did alot of walking (very slowly) and things were ok when we were there...swelling and pain but nothing abnormal.  Since we have gotten home the knee is protesting everything.  Sleeping, sitting, walking, stairs and even driving is killing me.  I probably did way too much when we were away and now I am paying for it.  

I am beginning to worry about the defect on my tibia as I have been having some serious bone pain which radiates down my shin.  My VMO hasnt been firing very well either, which I suppose is from the swelling...therefore, my kneecap is jumping all over the place and catching in the scar tissue.  Not very pleasant I might add.  

Boy, arent you sorry you asked how I was doing? :-/
It's been a tough couple of weeks but luckily surgery is thursday and HOPEFULLY we can take care of all this stuff once and for all.  

I'll stop complaining now.  I'm really sorry you hurt your knee again.  I was actually thinking of you the other day when I dropped a gallon of juice on my toe. ;)
How did all that play out?  Toe better now?

Take care of the knee and I will post as soon as I can after surgery on Thursday.  Thanks for the concern.

Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline JG

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Re: back to work after oats
« Reply #32 on: December 10, 2004, 08:11:49 PM »
Kathy,

How did everything go?  Were you able to speak to your surgeon after?  Please update me when you get a chance.  

Thanks for your last message.  My toe is great and I just have to roll my eyes when it comes to my knee.  I am currently in an immobilizer.  I'm trying to get the patella pressure off the trochlea.  I had 13 fairly large (12-15mm) grafts in that area that are taking their time healing.

I hope you are feeling okay.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline kathleenj

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Re: back to work after oats
« Reply #33 on: December 10, 2004, 08:26:46 PM »
Hi Janice,

Thanks for thinking about me.  I did post in the post op section but to make it short...surgery went ok.  OS removed lots of scar tissue and a really inflammed plica.  He also had to do a Chondroplastly of the MFC because I have some new cartilage defects in that area.  The worst one was right next to the Oats graft.  The original graft looks great but now there are more problems there.  I'm very discourage right now.  Os told my husband the Chondroplastly is certainly not going to fix this and that we need to address the cartilage issues soon.  Both the defects on the tibia as well as the new ones on the medial femural area.  Apparently it is quite extensive.  He wants to do whatever he can to avoid a TKR but he says it is something I will probably be dealing with in the future.  That comment kind of freaked my husband out a bit!  This is all very depressing.  I thought all this was going to be behind me after this simple clean up scope.  No such luck I suppose.

As far as this procedure goes, I'm feeling ok.  Pain is ok and I'm able to move around just fine.  Gonna try with one crutch later, just want to wait for the dizziness to subside some more.  

Thanks again for the concern, I'm doing ok physically just a bit bummed emotionally.  I hope your knee is feeling ok.  Keep me posted on that.
Kathleen  
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline JG

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Re: back to work after oats
« Reply #34 on: December 14, 2004, 01:48:24 AM »
Hi Kathy,

This is repeated under the other section.

It will be okay.   I was told after my surgery in 2001 (a simple clean-up) that I would definitely need a TKR.  I was 33 at the time.  After speaking with my OS, he did give me the option of mosaicplasty but said even mosaicplasty was not meant for a such huge defect.  Remember when it is really wide spread they can't do autograft plugs, so there is still lots of hope for you.  I never had the autograft option since I needed 5 large (12-15mm) allografts just for my MFC and 13 for the trochela.  My LFC will need probably 5-8 grafts and I have two huge defects in my lateral tib plateau.  Even with all that, I actually do well.  Like you, I battle with scar tissue/adhesion and plica problems.  They key is rehab, rehab, and patiences.  I've been battling this knee problem since late 1999.  

And yesterday I got word that when I fell last week (hyperflexed knee), I most likely tore my MCL and may have damaged the PCL in addition to tearing some meniscus and the fibrocartilage that formed on my two lat. tib plateau defects.  Also, he is most worried that I have a bone bruise from the patella jamming into my trochlear grafts.  Keep in mind my grafts are still healing at 18 months post op.  All this after commenting to my PT the day that my knee had not felt this good in 5 years.  I don't cry, but I wanted to, more out of frustration than sadness.  But, I got on the phone to the person I rehab with.  She knows me best.  I just told her that I felt like I was taking a huge step back. I spend 8 hours at PT each week.  She put it best, if you got back to "normal" once, you can do it again.  I am in a brace with limited ROM for the next 10 days and on prednisone for the bad swelling.  After that, I will start over...but hopefully not from the beginning.

Listen, I would totally encourage YOU to come up with a plan for your knee.  It is in YOUR best interest.  Use the OS and PT as sounding boards, not the decision makers.  Don't feel afraid to talk to other surgeons, especially ones that specialize in cartilage procedures.  My OS made me talk to 4 other OSs before he would undertake the mosaicplasty.  None of them had ever tried to repair such huge defects.  And two said the procedure was not meant for such a widespread problem and wouldn't do it.  

Once I really took control and developed a plan, I did well (I just had an accident that set me back a little).  My OS and PT love this attitude and wished more patients were like me.  I've done enough research into treatment options and I NEVER read about TKR.  It isn't an option.  I truely believe that I can manage the problem for the next 20 years at least (with the help of my OS and PT).   Give yourself a few weeks just to recup, then come up with a plan.  For me and the health of my knee, I MUST exercise 5 days a week and do 2 rehab sessions.  But keep in mind, I am very single (and loving it I might add).  Even though I have a very busy job, I still find time.  If you ever want to talk, please let me know and I will email you my contact information.

Kathy...it WILL be fine.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline kathleenj

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Re: back to work after oats
« Reply #35 on: December 14, 2004, 02:24:27 AM »
Janice,

Thank you for the encouragement.  I know you have been thru this and your support means alot to me.  I'm really sorry to hear about your MCL and PCL.  When are you going to stop hurting your knee ;)  I'm keeping my fingers crossed that this will only be a small setback for you.  You have seemed to come along so far since your last procedure and I would hate to see you lose so much 'steam' with your recovery.  Hang tough!

I've had a couple of days to let all this crap with my knee sink in.  I'd like to say that I'm in a better frame of mind but I really cant.  I'm still very discouraged by all this.  I have so many questions and I cant wait to see the OS on Thursday.  I also have another highly recommended knee specialist that I will be making an appointment with after I see my current OS this week.  I think its time to get another opinion or 2 or 3.  Depending on what they think, I will then go down to Boston for a consult with Dr. Minas.  He's the best around here in regard to cartilage stuff so I think that will be my best bet.  At least get a feel of what he thinks is happening here and what should be done.  
Its really scary to see how much worse my knee is since June.  The pics from the scope only showed that one defect in june and now...gosh....its really just amazing!
Not in a good way either.  How could I have done so much damage in just a short time?  Especially when I have been doing light rehab stuff the past 6 months.  Nothing high impact at all!  I guess thats where I need to start.  I have alot of questions.

As of now, the knee is feeling good.  I can walk around pretty good without the crutches.  Knee is very stiff and a bit sore but nothing too serious.  I stopped taking the heavy narcotics on Saturday and seem to be doing alright with just tylenol when I need it.  Sleeping still sucks but I suppose it will be that way for a long time coming.  

Anyway, sorry to be such a downer.  I'm trying to keep my spirits up....after all, its Christmas time and the kids need mom to be happy!!!  Thanks again for the encouragement, I truly do appreciate it.  I'll let you know what the OS says on Thursday.

Take care of yourself and try not to have any accidents for a little while...okies?
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline JG

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Re: back to work after oats
« Reply #36 on: December 15, 2004, 12:19:42 AM »
Kathy,

Minas is good.  Although I didn't talk to him directly, my surgeon did.  Minas thought my case was extreme and that the current use of mosaicplasty and other cartilage replacement techniques was not meant for such widespread damage.  I'm working on proving him wrong.  If not Minas, try Brian Cole in Chicago (and easy on the eyes).  He was great.  Also, Allan Gross in Toronto.

It's amazing how much damage can happen quickly.  When I had surgery in 1999, I had no articular cartilage damage, but in 2001, I had enough for a TKR.  It was 18 months between the two.  I've always thought that I had a low grade infection...my OS is thinking maybe that is a contributing factor.  Even the time between my big surgery and my recheck (12 months) I develped a second large lat tibial plateau defect.  And I have no alignment issues.  I'm still lucky, not joint space narrowing and I have 100% of my medial meniscus and 70% of my lateral meniscus.

I find it helpful to just have a "knee" routine.  That's what is killing me right now.  I'm basically doing nothing but trying to get all the swelling down.  I'm normally at PT M and F and have my other 4 workouts I do each week.   I'm just really mad that I was feeling awesome and I slip in the jacuzzi.  Ridiculous! I skipped the depression phase and I'm in the permanent pissed off phase.  I'm thinking if this is a 6 or 8 week recovery just to get the swelling under control that I might just have my lateral femoral chondyle grafted now.   I had planned on re-evaluating at the end of next year.  It probably needs 8 grafts.  It is actually worse than my MFC.  It was a surgery day decision to do the MFC and trochlea rather than the LFC and trochlea the first round.  I think he was worried that the area between the lateral edge of the trochlea and LFC would fall apart and he would really left trying to graft most of the lateral joint.

Let me know how you are doing...Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

brattkids2

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Re: back to work after oats
« Reply #37 on: December 18, 2004, 03:26:08 AM »
Hi Kathy,

I was wondering how you were doing and how your OS visit went. Did you make an appointment with another OS yet? I hope your spirits are better!!!

I am going to a new OS. I am gong to see Dr. Wojtys here in Ann Arbor in January. I have that ice pick pain and pain that wakes me up again. Its as bad as it was before the first surgery. Im really depressed. I think I need a new and fresh approach to treatment too. My current OS is great but I think he is frustrated with how to treat me as I am such a difficult case. I am trying like you to stay positive for the holidays. I have an 8 1/2 yr old and a 6 yr old so excited for Santa.

Hope your doing well
Paulette


Offline kathleenj

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Re: back to work after oats
« Reply #38 on: December 22, 2004, 04:15:26 PM »
Sorry I havent posted in a while.  Things have been pretty hectic.  Between the stupid knee and holidays and family issues...you know that saying 'when it rains, it pours'...its a monsoon here.  

Anyway, I did see the OS on the 9th for my follow up.  And to be honest, it was kind of worthless.  He couldnt really give me much info other than we need to wait and see how the knee plays out.  What the heck?  Basically he said that there are more defects in there, nothing is down to the bone like my original one so its basically a wait and see.  He said I will be the one to determine if something should be done about it. Depending on how it starts to feel as time goes by.  He said many people have defects that have absolutley no symptoms and that the chondroplasty may be all that was needed.  Time will tell he said.  He wants me to work hard to rehab the knee because the atrophy is pretty bad.  Once the knee is rehabbed and I start using the knee to its full potential we will be able to determine if something should be done and if so, what.

So thats the story...pretty much wait and see.  I am going to make that appointment for the 2nd opinion though.  I dont really like just sitting back and letting this ride.  My OS is great...has been great, but I think I would like to have another persons feel on it.  I will make an appointment after the holidays.

Janice,
I hope you are feeling better.  Hows the knee feeling?
I really admire your perserverance.  You seem so optimistic even when you are royally pissed off :o
Let me know what have decided....are you going to go ahead with more grafting or are you still holding off?


Paulette,
Sorry to hear that you are still having problems.  I am glad that you are going to see a new OS.  Like me, you need to get a new perspective on things.  Another set of eyes might see something the original one didnt.  At least that is what I am hoping.  Hang in there and please keep me informed.

Happy Holidays to you both!!!!
Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline JG

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Re: back to work after oats
« Reply #39 on: December 23, 2004, 07:14:54 PM »
Hi...

Kathy, I certainly understand the hectic life.  I don't have kids, but I have two high-energy, demanding dogs and a crazy job.  I hate to say this but he is right on two fronts - time will tell and some individuals have huge defect but are asymptomatic.  I have two large defects (one LFC and one (really two) on my lateral tib plateau).  Both are down to the bone, but don't really bother me that much.  Since my fall, the tib is very tender, but okay.

Again, I cannot stress enough that it up to you for the rehab.  Use your OS and PT has a sounding board, but you need to figure out what is going to make you better.  There are days that are going to be difficult, but take it in stride.  Even if my knee feels bad, I start my rehab and modify it as necessary.  In terms of a second opinion, don't mess around with that.  Go see one of the big names.  I would highly recommend either Brian Cole, William Bugbee, Tom Minas, or Allan Gross (U of Toronto).  Gross is the "grandfather" of allografting procedures, but, according to a recent lecture he gave (2004), he is no longer doing grafting on patients with bipolar defects ("kissing" lesions").  Bugbee is into allografting as well.  

Trust me I really like my OS and he is extremely gifted.  The technique he uses is not really used by anybody else.  He actually does almost as many grafting procedures as Bugbee, but it's not the forefront of his practice.  Having said that, I plan on seeing either Gross, Bugbee, or Cole for a second opinion.  Each of them is somewhat familiar with my case.  For me, I'm just curious as to what they think.   Small price to pay for great advice.

Paulette,

I haven't responded to many of your posts lately.  I certainly have some advice/opinions for you.  First, let me tell you that I'm not the "supportive" poster type.  I think that stems from not seeking emotional support from this site.  I'm much better with someone kicking me in the butt than telling me it will be okay.  I'm looking for something entirely different from this site.  You have been a great support and your words have been kind to many.  So here it goes....

From what I understand your latest procedure was on 11/11.  So doing the math you are 6 weeks post-op.  You should be on crutches.  No if ands or buts.   You should be on crutches for 8 weeks with 4 more PWB.   Read any of the articles or view any of the conference presentations from the top guys, from Steadman (grandfather of microfracture) to Gross to Bugbee to Cole.  6 weeks is minimum and 8 preferrable.    This is key to graft healing during the first 2-3 months.  Given that you have two failed procedures - one microfracture in April/May and then a synthetic graft in August/September.  Why would you not be conservative and safe given your history?  

Also, give your knee a break!  You've had 4 procedures since April.  Any cartilage repair procedure requires a very long time to heal.   You should still be healing from the microfracutre.  I will admit that I don't know how it was determined that it didn't work in the first 4 weeks.  Read info about microfracture....18 months to feel normal.  And contrary to a recent post, there are top athletes that had this procedure recently and have returned to top form. Heck it takes 8 weeks for the fibrocartilage to start filling in.  Yours was deemed failed before it had a chance to heal.

When I got my second opinions before my mosaicplasty, all said it would take 18 to 24 months for full graft healing/incorporation.  I would also start feeling better at this time.  Unless the graft fails to incorporate or the graft has poor congruence (sugeon fault), these take time to heal.  When I initially went PWB, I thought for sure my grafts failed.  I was positive.  It hurt every step.  But what do you know...18 month later, my knee felt awesome.  They were all right! Okay, so I had a little fall recently, but that's only a minor set back.  The best advice I got from both my OS and PT was, doing nothing the first 8 weeks is far far better than doing something.  Other than 8 weeks of CPM and icing, I didn't do anything.  Nothing.  I checked in with my PT every couple weeks.  

Also, don't mess around with some guy in Ann Arbor.  Drive down to Brian Cole in Chicago.  He is on the forefront of this.   And don't look for a quick fix.  There is nothing quick about these procedures.  Like I told Kathy, YOU need to come up with a plan.  If I were you, I would be back on crutches and fast.  Also, look into getting an unloader brace.  My medial compartment has alway been the problem.  The unloader brace really helped keep the pressure off the joint from 12 months to about 15 months.  I wore it full time.  I still wear it to rehab.

I hope you take this as friendly advice.  Both of you need to come up with a knee plan and be very patient.  After falling recently, I was thinking, "what the heck".  I'll just have my LFC grafted...just get it over with.  It was that immediate emotional reaction that we all get.  I was really, really mad that I worked so hard, followed good advice, had a fantastic plan...and I fall.  The knee isn't great but better.  However, after a good kick in the butt from my OS, PT and trainer (from PT), I've readjusted my plan for my knee.  I need to wait and see with how the knee responds.  So we are all in the same boat.  Please give it time.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline kathleenj

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Re: back to work after oats
« Reply #40 on: December 27, 2004, 06:55:25 PM »
Hi Janice,

Thanks for the big kick in the butt!!  I must say though, I was kind of getting there myself.  Although, kicking yourself is a bit difficult with a bad knee.
I was thinking about what you said about making a plan for myself and I've been doing that.  I have totally reversed directions for myself.  I think what you said about looking for a quick fix is pretty accurate.  I understand now and I have come to grips with the fact that this WILL be a long haul and I really need to be patient.  (which really isnt one of my strenghts)   I have come up with a plan...its basically taking one day at a time.  I have begun rehabbing and the knee is beginning to feel a bit better. So are my spirits, I'm finally taking a proactive attitute here.   I am determined to get as much strength from this knee as possible.  I will see my OS the end of January for a follow up and then that will be it for a while.  I think I need to just give it time to see how it plays out.  
In the summer I think I will re-evaluate how the knee is doing and if need be I will go see DR. Minas.   I absolutely will not have another procedure until my knee is as strong as it can get and only then if it will drastically change the way I live my life.  I think 3 procedures in 1 year is a bit much and like you said...my knee needs a break!  

So how are you doing?  Last you wrote the knee was feeling a little better but you were struggling with the swelling.  Any changes?  Are you able to get back to your routine yet?

Keep me updated.
Kathy      
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline JG

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Re: back to work after oats
« Reply #41 on: December 28, 2004, 11:06:17 PM »
Hi Kathy,

Good to hear you have a plan!  Stay on top of rehab.  My knee is okay.  The swelling is finally gone.  I took prednisone for a week.  That's the best drug.  Everything feels better.  Now that the swelling is down, I can really tell what is bothering me.  Of coarse my medial joint as well as my tibia.  The medial joint is something that bothered me from about February to September.  It finally started feeling better in October and November.  I decided it was best to start wearing my unloader brace and limit my exercise to swimming, deep water running, and maybe cycling.  The knee might need another month to settle down.  I plan on calling my OS today to get his thoughts.  I still have to shake my head at the thought that my knee was awesome for 2 months and then I slip and fall.  My trainer at PT is trying to help me not lose all the strength I gained while balancing what loads my knee can tolerate.

Good luck and keep in touch...Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

brattkids2

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Re: back to work after oats
« Reply #42 on: December 29, 2004, 12:00:53 AM »
Janice,

Thank you so much for the post and I take the advice as friendly advice!!! Thank you

I dont know if I can go to Dr. Cole with my stupid insurance. I have Blue Care Network and they are horrible about out of newtork but believe me I will surely look into it.

I plan on giving my knee a long rest before I do anything else. I really need to build my strength back up and allow the joint to heal. I need to let all the inflamation and irritation go away.

I guess my OS was just not a stickler with how much time to be on the crutches. His thing was always 4 weeks and then progress off. Could you please let me know where I can read some information on the proceedures and those conferences?

I am definately making a knee plan!! I have nothing but time and I will be patient that is for sure!!

I knew my microfractures had failed (at least that is what I was told) when I had the scope in may to clear out the debris. I had absolutely no healing and the lesions were larger and causing me lots more pain!!

Thanks Again for the help. Please feel free to give advice anytime

Hope your Christmas went well!!
Happy New Year
Paulette