A New York City ENT doctor deals with a variety of different conditions from performing sinus surgeries to diagnosing ear, nose & throat problems.
Throat
Herpangina: What You Need to Know
06 months ago
As the known term for a blister-like ulcer within the mouth, herpangina occurs typically in childhood. Unfortunately, being an infection, herpangina can cause other health issues – we’re here to discuss what you need to know.
What is Herpangina?
In the past, the infection has been compared to hand-foot-mouth disease since they’re both viral infections found mostly in children. As a group of viruses known to affect the gastrointestinal tract, enteroviruses are to blame for herpangina. The immune system will typically jump into action as soon as it detects an enterovirus. Since young children and infants aren’t always equipped with the right antibodies, they’re more susceptible to these viruses.
When it comes to herpangina, the main issue is its contagiousness. After spotting or hearing of an ulcer in the roof of the mouth or back of the throat, you should look to treat the symptoms and have the infection cleared as soon as possible. If left untreated, it can spread around a nursery or classroom.
Herpangina Risks
Although herpangina can affect anyone of any age, those around the age of 5 to 10 years experience it most frequently. Since it’s highly-contagious, breeding grounds can form in classrooms, camps, and other locations where children regularly congregate. In the U.S., researchers have found the problem to be most common in fall and summer.
Symptoms of Herpangina
Both for yourself and your children, some health conditions can be hard to diagnose since the symptoms are very similar to other health issues. Luckily, the signs of herpangina can be spotted and tested more easily. For example, the primary symptoms one might experience include swollen lymph glands, sudden onset of fever, neck pain, difficulty in swallowing, sore throat, loss of appetite, and a headache.
For smaller children, there may be an issue with verbal communication of symptoms, but indicators include excessive drooling or vomiting. Of course, ulcers may also be visible on the roof of the mouth or towards the back of the throat. In appearance, specialists suggest a gray color with a red border for ulcers; in the majority of cases, they clear within a week.
Herpangina is easier to diagnose in older children who have learned how to speak and communicate their symptoms. However, in younger kids, look out for vomiting and excessive drooling.
Should I Contact a Doctor?
For many, especially with worried parents, this is the key question because you want to help your child feel better but you don’t want to exaggerate what may be a small issue. Therefore, we advise contacting the doctor if a fever measures above 106 degrees (or stays for longer than usual), if there are signs of dehydration, and if mouth sores remain for longer than five days.
Herpangina Treatment
After paying a visit to your doctor, they can typically diagnose the issue with ease since the ulcers are unique in their appearance. With a simple physical examination of yourself or your child, they can see the problem while also assessing all symptoms and your medical history. With herpangina, specialized diagnostic tests aren’t required.
Regarding treatment, the goal is to reduce the symptoms while also keeping them under control in the days ahead. Depending on your age and a number of other factors – including your medical history and symptoms – doctor’s can recommend different types of treatment. A course of antibiotics won’t be especially useful since herpangina is a viral infection.
With this in mind, the first suggestion would be acetaminophen or ibuprofen. It’s crucial that the patient doesn’t take aspirin since herpangina has been linked to the potentially life-threatening Reyes disease that is associated with a severe aspirin allergy.
Elsewhere, topical anesthetics could be used to relieve any mouth pain (and sore throat), including lidocaine. Regardless of the treatment, the doctor will suggest an increased intake of liquids with a focus on water and milk; hot drinks and citrus-based beverages will worsen the symptoms. Strangely enough, many sufferers have found popsicles to ease throat issues so this could also be advised.
Preventative Measures
Finally, you might be wondering whether you can avoid this disease altogether. First and foremost, you can take preventative measure by practicing good hygiene habits. For example, all the necessary rules apply such as covering your mouth when sneezing or coughing, washing hands after using the toilet, and washing hands before meals. If you teach your children the basic hygiene rules, you’ll decrease the likelihood of them suffering from herpangina too.
If your child currently has herpangina, remember these rules when helping them to recover. Throughout the day, wash your hands and pay particular attention before and after changing diapers or dealing with mucus. Furthermore, try to keep areas of high activity clean for your child including toys, surfaces, and their beds. To avoid becoming the enemy of all other parents, we also advise keeping your child from school or day-care while recovering too. If you follow these tips, you or your child will be back to full health in no time!
Chronic Cough? Sinusitis May Be to Blame
07 months ago
Of all the things we experience in life, there are few more frustrating than a cough. At first, we hope it will last for just a couple of days before then disappearing. After several weeks, this is the time you should go to see a doctor because your body is telling you something. With coughs caused by viral infections or an upper respiratory infection should disappear within a week. Any cough that lasts longer than a week, a chronic cough, suggests an underlying health condition. Of course, this could be asthma, which is a common issue, but there’s another health problem we’re starting to learn more about as time goes on: sinusitis.
The Link Between Chronic Cough and Sinusitis
According to various ongoing studies and research, we now know that sinusitis is a bigger problem than we first thought. In fact, back in a 2005 Mayo Clinic study, at least 33% of all chronic cough sufferers were suffering from sinusitis (some form of inflammation of the sinuses). In the twelve years since then, this number has increased, but there are now solutions available.
If you’re wondering why this inflammation causes a cough, it comes from what we call ‘postnasal drip.’ Here, your sinuses will produce too much mucus to be of any use so some will drip backward into the throat and this triggers the cough reflex. In the medical world, this has a name of its own; upper airway cough syndrome (UACS). As a side effect of having sinusitis, this creates the link with your chronic cough, meaning you need to treat the sinusitis before anything else. If left untreated, the cough will keep returning time after time.
Allergic Rhinitis
While on the topic, we should also discuss allergic rhinitis (inflammation concentrated in the nose). It’s caused by allergens such as mold, pollen, and dust mites. With millions of people suffering from allergies in the US, this is now a huge issue and it just so happens that postnasal drip is a symptom of the problem. As we know, this will soon lead to a chronic cough which persists until you receive treatment.
Generally speaking, patients with sinusitis and rhinitis-related coughs experience a worsening of the symptoms when the sun goes down. Since we go to bed and lie down to get some rest, this horizontal position can cause a disruption in the throat which makes sleeping somewhat difficult. Furthermore, we normally have something else to focus on throughout the day. When we’re trying to go to bed, we tend to concentrate on the things that are preventing us from resting, and this places all the emphasis on the cough.
Seek professional treatment for a chronic cough as soon as you can, as these symptoms often point to more serious health concerns, such as asthma and sinusitis.
Treatment
As mentioned before, treating the cough alone in these situations is a little pointless because it won’t be long before postnasal drip brings it back again. Therefore, you need to consider tackling the cause of the issue which is the sinusitis.
If you’ve been experiencing the symptoms for more than 12 weeks, you’re now past the ‘acute’ phase and are progressing into the ‘chronic’ phase. At this stage, antibiotics aren’t likely to act fast enough, which is why some form of therapy may be required. Treatment options include including anti-inflammatory nasal sprays and the like. If the problem persists and starts to affect your life dramatically, you should see your doctor for a consultation for balloon sinuplasty.
How balloon sinuplasty works: after inserting a small camera into the nasal passage, a balloon is then sent up before being inflated. This inflation procedure works similarly to opening blocked arteries during heart surgery. Compared to more traditional options, this is less invasive and will only see you out-of-action for a couple of days.
From here, you can then treat the chronic cough (if it still exists) as you would a normal cough. Safe in the knowledge the postnasal drip has stopped, you can treat the cough without worrying about it returning anytime soon.
Ultimately, you know your body better than anybody else. Only you know when the cough is unusual in duration and severity. If you pay attention to the length of a cough, by marking it on the calendar, you’ll soon learn the right time to see a medical professional and find the underlying issue.
What Causes a Dry Cough?
09 months ago
by Social Media Team
in Throat
Have you had a dry cough nagging away at you for the past few weeks? At first, we attribute it to the flu or just a cough that will ‘go away soon’. As time goes on, we start to ignore it and actually grow accustomed to the cough but this is incredibly dangerous for a number of reasons. Today, we’re going to uncover these reasons and see what your cough could mean (and why you should seek medical attention).
What Is a Dry Cough?
In case you were unaware, a dry cough is any type of cough that produces no mucus or phlegm. Otherwise known as a ‘non-productive’ cough, they quickly become irritating and cause frustration. Often, they get worse at night as you lie down and this prevents a good nights’ sleep and leads to further issues – trouble concentrating at work, constant daytime fatigue, and even impacts on your personal and professional relationships.
Normal Duration of a Cough
With this in mind, how long does a “typical” cough actually last? According to most experts, a cold or flu-related cough should disappear within two weeks. Though some will be shorter and some may extend to three weeks, this is the average duration a cough lasts.
If the cough lasts for more than eight weeks, this is treated as a chronic cough and for children this lasts around four weeks. If you’ve had a dry cough that has lasted for more than eight weeks, now is the time to see the doctor – especially if it’s affecting work/school, sleep, personal life, or produces bloody phlegm.
Diagnosis
When you first visit the doctor, they’ll look into your medical history before beginning a medical examination. In this testing phase, they may take an x-ray as well as a computerized tomography (CT) scan. With a CT scan, they’ll be able to see the condition of your lungs as well as any issues that would produce a cough or issues within the sinus cavities. After this, they could also go for lung function tests, scope tests, and lab tests.
Have a dry cough that has persisted for a while? It’s best to get it diagnosed and treated as soon as possible – dry coughs can be indicative of more serious health issues.
Possible Issues
Possible diagnoses could include the following, some of which produce a dry cough:
- Asthma – First and foremost, a cough relating to asthma may come as the seasons change or after an upper respiratory tract infection. With asthma, it means there is an issue within the lungs and this leads to regular coughs, difficulty breathing, and many other side-effects. If this is the cause, you may be given an inhaler to aid with your breathing, help your lungs, and clear up the cough.
- Postnasal Drip – As the nose produces excess amounts of mucus, it can actually drip down into the throat and trigger the cough reflex. Also known as upper airway cough syndrome (UACS), it can continue for some time without treatment.
- Infections – After a bad case of the flu or an infection in the upper respiratory tract, whooping cough can form which is a bacterial infection within the airways and lungs.
- Gastroesophageal Reflux Disease (GERD) – With this issue, stomach acid can back up into the esophagus (which connects your throat and stomach). This can cause both a wet and dry cough, which causes GERD, causing further coughing, etc.
- Bronchitis – Finally, this inflammation within the bronchial tubes (airways) can cause dry coughing. Although most sufferers are or were heavy smokers, it can occur in anyone and it falls into the spectrum for chronic obstructive pulmonary disease (COPD).
- Other causes – Ultimately, these are the most common underlying problems for a dry cough but you could also be experiencing a side-effect from blood pressure drugs, cystic fibrosis, lung cancer, laryngopharyngeal reflux, and sarcoidosis.
Treatment
Ultimately, the treatment required will depend entirely on the issue found. For example, antihistamines and decongestants are common for allergies and postnasal drip while antibiotics will be the best solution for infections. Furthermore, acid blockers would be advised for acid reflux although surgery is an option for the more severe cases.
Elsewhere, cough suppressants might be issued if the doctor cannot find the reason for the cough. If the cough is preventing you from sleeping and severely affecting your life, this solution should see you through until test results are returned and the doctor can work towards a proper treatment to get you back on your feet.
If you have a dry cough that doesn’t seem to be disappearing or if you’re coughing up blood, get in contact with your doctor today and you can have the problem treated rather than living with a potentially dangerous health condition.
Swallowing Disorders and How to Treat Them
09 months ago
If you’re currently having trouble swallowing, this is known as ‘dysphagia’ and it’s actually more common than most think. Normally, the issue will come from your throat or the esophagus (this takes food and liquid from the mouth to the stomach). Furthermore, swallowing disorders can happen to people of all ages but they’re more commonly found in older generations, people with nervous system issues, and babies.
Causes of Swallowing Disorders
When it comes to the problems themselves, there are a number of different issues ranging from minor problems to serious health concerns. If it only happens once or twice, this normally suggests something small while medical attention should be sought if it happens frequently.
As a natural process, our throat muscles will actually contract as we swallow and this helps the food to be pushed down into the stomach. If there’s a problem, food and liquid will struggle to pass through the esophagus and there are two main reasons as to why you could be experiencing this failure.
Blockages
Trouble swallowing might be because of something blocking the esophagus and this is preventing anything from passing through. Swallowing disorders might stem from any of the following types of blockages:
- Esophagitis – This is where the esophagus becomes inflamed after an infection or perhaps even a pill getting stuck. For some, they also experience some form of reaction to a substance in the air or food they consume.
- Gastroesophegeal Reflux Disease (GERD) – If stomach acid manages to back right up into the esophagus, ulcers can form and this can actually lead to scars; in turn, this narrows the esophagus.
- Other Issues – Although these are the two main issues, you could also have cancerous or benign tumors within the esophagus or small sacs that form on the walls of your throat (diverticula). Finally, lymph nodes can appear on the vertebrae and push into the esophagus from the outside.
Damaged Muscles/Nerves
Secondly, the muscles and/or nerves might not be working correctly and this may come from brain injuries, stroke, orsome other health concerns.
- Nervous System – With muscular dystrophy, post-polio syndrome, Parkinson’s disease, and multiple sclerosis, these can affect the muscles and nerves.
Esophageal Spasm – At random intervals, the muscles will squeeze together and this prevents food from reaching the stomach. - Scleroderma – With the esophagus tissue, this can become hard as well as narrow. In some cases, it can also weaken the lower esophageal muscles which, in turn, causes a backup of stomach acid in the throat.
- Immune System – Finally, an issue in the immune system can cause weakness and swelling in the area.
Since swallowing disorders greatly impact your everyday life, it’s important to seek treatment for them.
Treatment
Now we know the issues that exist, how do professionals treat these swallowing disorders so you can return to your normal self? Firstly, they’ll try to locate the problem using an x-ray and various other procedures they have. If necessary, they’ll use a small camera to see the extent of the damage or even a small pressure gauge to measure your ability to swallow. Once they’ve found the cause, they can get to work on treatment and there are many different solutions depending on the cause.
- Dilation – If your esophagus has narrowed, this treatment will see a small device expand the area; this may require several sessions.
- Diet – If your diet is causing the problem, your doctor will recommend changing the foods you eat to identify the problematic ingredient.
- Exercise – As strange as It sounds, you can actually complete swallowing exercises to strengthen the muscles and allow for better swallowing.
- Endoscopy – In some situations, a blockage might cause the problem and an endoscopy can be used to remove any objects.
- Medicines – If the issue is related to heartburn, GERD, or esophagitis, some prescription medicines might be able to prevent stomach acid from getting into the esophagus. With infections, antibiotic medicines will also help the problem.
- Surgery – Finally, and this will only be done if completely necessary, surgery can remove blockages or anything else affecting the lower esophageal muscle.
Summary
There we have it, the causes and treatments for swallowing disorders. If you’ve experienced anything we’ve discussed today, we highly recommend talking to an expert as soon as possible because, left untreated, your condition will only get worse. In some rare cases, patients are left needing a feeding tube so contact an expert today and get yourself back to full fitness!
A Link Between Throat Microbes and Schizophrenia
02 years ago
Since 2007, scientists announced plans for a Human Microbiome Project to catalog the micro-organisms living in our body, and because of this project, a new body of research has had a profound influence on how such organisms affect our health. From this growing research, one study has found a possible link between throat microbes and schizophrenia, and this link could explain the etiology, that is, the causes, behind this neuropsychiatric disorder, and thus pave a way for new treatments.
In this peer-review study conducted at George Washington University in Washington, DC, and published in the journal PeerJ, researchers looked at the levels of fungi, bacteria and virus microbes in the oropharynx region of the throat. The reason for choosing this region, according to the head author Eduardo Castro-Nallar, is that the oropharynx region appears to contain different levels of oral bacteria in people with schizophrenia compared to people who don’t have the disorder. “Specifically, our analyses revealed an association between microbes such as lactic acid bacteria and schizophrenics,” he says.
A growing number of studies have demonstrated that the microbiome—the ecological community of viruses, bacteria and fungi found living on and within the human body—has recently been conntected to brain development, behavior and cognition.
Several studies published in Medical News Today and the New York Times have reported on how gut microbiome can reduce cognitive functioning and affect psychological moods and states such as anxiety and depression.
New research on our body’s microbiome—especially how it affects cognitive development and moods—is becoming more and more exciting in medicine. The link between throat bacteria and schizophrenia is one clear example of what’s happening with connecting the microbiome to health issues. Hopefully, more of this research will lead to improved sinusitis and some forms of sleep apnea.
This new study examined the complete microbiome by looking at viruses, bacteria and fungi present in 16 individuals with schizophrenia and 16 control participants. The researchers reported significant differences between the microbiome of schizophrenia patients and those of the control participants. The control participants were richer in microbe species but less even in their distribution than the participants with schizophrenia.
What this means is that evidence of the fungal species Candida dubliniensis was more evident in participants with schizophrenia, and the researchers suggested that this fungus may be connected with immune response problems. One lead researcher mentioned the importance of further and wider studies though.
“Our results suggesting a link between microbiome diversity and schizophrenia require replication and expansion to a broader number of individuals for further validation,” reports Keith Crandall, director of the Computational Biology Institute at George Washington University. He further explained, “But the results are quite intriguing and suggest potential applications of biomarkers for diagnosis of schizophrenia and important metabolic pathways associated with the disease.”
The researchers concluded that their findings were extremely important to understanding not only schizophrenia but also how our microbiome in the body affects cognitive development and other behavioral issues. Yet more research with diverse samples, such as in the gut microbiome, will be able to shed more light on the potential links between schizophrenia and these microbes.
Strep versus Sore Throat
04 years ago
by Social Media Team
in Throat
Strep versus Sore Throat: Learn the Difference Here
When school is in session, outbreaks of strep throat can be common. Determining whether this common childhood infection is actually strep or just a sore throat can be challenging. Some parents may not be sure what the differences are or how to determine when to take a child to the doctor for treatment. Here are some things to keep in mind when weighing the differences between strep versus sore throat.
To start, a sore throat is generally caused by a virus. Usually, it will manifest along with other symptoms such as sneezing and a runny nose. There is no medicine that will cure a viral infection, so it generally just has to run its course. While they may be similar, there are marked variations between a strep and a virally induced sore throat.
Strep throat is caused by a bacterial infection. It is contagious, and this is one reason it spreads so quickly, particularly among little ones. Sneezing, coughing, and inadequate handwashing are some ways the infection can be spread. Generally, an infection leading to strep throat is treated with antibiotics. Symptoms may include fever, swollen tonsils, nausea, difficulty swallowing, and white and red patches on the throat. When these symptoms present themselves, it is a good idea to call the pediatrician. A swab test can be done to determine if there is in fact a strep infection. Plenty of rest, fluids, and a course of antibiotics are generally all that is needed to have children back to a normal routine.
The question often arises as to whether a child should have their tonsils removed in cases of frequent strep infection. Research has shown that this may be advisable when infections occur more than seven times in one year, or several times in two consecutive years. Talking to your pediatrician is best when making such a decision.
Knowing the differences between strep versus sore throat can save parents an emergency visit expense, but when in doubt always consult a medical professional.
Antacids May Reduce Throat Cancer Risk
04 years ago
by Social Media Team
in Throat
Cancer Alert! Chronic Heartburn May Be an Early Warning Sign of Certain Cancer Types
We usually associate vocal cord and other throat cancers with bad habits, like smoking and alcohol abuse. Chronic heartburn, however, may be a far more accurate forerunner of these types of cancers. What did a recent study reveal to be the best way to protect yourself if you face heartburn issues regularly? Is it medication prescribed by a physician? Believe it or not, antacids may reduce throat cancer risk.
But, haven’t previous studies attempting to connect throat and larynx cancer to acid reflux proven inconclusive? While this is true, those studies were all on a very small scale and didn’t factor in many variables. The study in question is comprehensive, involving many individuals over a longer period of time. Over 1,800 people participated in the study, with approximately two thirds of those individuals serving as the control group.
The participants were surveyed to learn more about factors in their life that could result in various throat cancers, including their personal habits, family and medical histories, and certain demographic information. They also had to be tested for HPV 16 antibodies, since HPV has been linked to throat cancers and could have skewed study results.
In the end, the study revealed a 78 percent greater risk of the predicted forms of cancers for those with chronic heartburn, even if they didn’t use alcohol or cigarettes. On the other hand, those who used antacids to fight their heartburn saw a 41 percent decrease in risk. The antacid users did not take prescription drugs to fight the condition nor were they using homeopathic remedies.
While more research is needed, these initial results seem to indicate antacids may reduce throat cancer risk, particularly among high risk individuals. The study findings may also help doctors identify and screen people who are at higher risk for throat and vocal cord cancers for early intervention.
Diagnosing Vocal Problems
04 years ago
by Social Media Team
in Throat
The Difficulty in Diagnosing Voice Problems
There are many people who rely on a consistent voice to make a living. Performers need to sound the same on stage, night after night; just as they do in the recording studio, take after take. Voice actors need to sound the same in every episode they record. Television stars have to sound the same from week to week. But the arts aren’t the only jobs that require a consistent voice. Lawyers need to be able to speak convincingly and at an audible volume day after day in court. Teachers need to be heard by their classes. Public speakers also rely on their voice, and the list goes on and on. So what happens when voice issues start to occur? Diagnosing the issue quickly can be very difficult.
The fact is that there are a large number of conditions that can cause voice changes, and not all of those underlying causes are physical. True, diseases, cysts, muscle tension, or nodules may be to blame. It is also possible, however, for the voice issues to be psychological. In fact, anxiety is a frequent cause of vocal changes. So what are the keys to diagnosis?
Often, the combination of an otolaryngologist (ear, nose, and throat specialist) and a therapist will be used to make a faster diagnosis. The ear, nose, and throat doctor will look for physical damage and obstructions to the vocal chords using a stroboscopy, or other tests that measure the acoustics of the vocal chords. The therapist will probe for signs of a psychological cause of the vocal issues.
Individuals who suffer from voice problems generally need a personalized solution due to the sheer variety of potential causes of the problem. A combination of medications, surgery, or therapy may be the solution to your problem, and the key to getting your voice back to where your job needs it to be.
Hidden Acid Reflux Symptoms
04 years ago
by Social Media Team
in Throat
Little-Known Symptoms of Reflux
For many, reflux disease means bouts of uncomfortable heartburn. While this is a very common symptom closely associated with acid reflux, it is by no means the only one. Patients may not even realize they have issues with reflux because they may be unaware of the other indicators. Physicians may suggest that reflux is the cause, but the idea may be quickly rejected. The good news is that for those with acid reflux, once a diagnosis is made, there are steps that can be taken to reduce or eliminate symptoms.
The symptoms that a person may experience from reflux disease can vary according to severity of the illness and the time that has passed without treatment. Doctors would like to see an increased awareness of some of the other results patients may experience from reflux. Often, the symptoms other than heartburn are not as obvious. Here are a few of those common yet little-known symptoms of acid reflux.
Some of the most common symptoms involve the throat. Constant clearing of the throat, a feeling that something is trapped in the throat, a sore throat, and a hoarse voice can all be signs pointing to reflux. If a patient wakes up during the night with a cough, or if regurgitation happens from time to time, these could also be symptoms of reflux. Sometimes a difficulty with swallowing and an excess of phlegm are other indicators.
Many of the other results that manifest from acid reflux may not usually be associated with the illness. However, if these are experienced, even if it is in the absence of heartburn, it could be a case of untreated reflux. With drug therapy, diet changes, and weight loss, it is possible to manage or even be rid of these symptoms completely.
Information about Voice Disorders
04 years ago
A common condition that often goes undiagnosed is a voice disorder. Many simply ignore the condition or do not recognize it for what it is. Many have postulated that voice disorders are more common amongst females. This may be because of the fact that many women have jobs and responsibilities that require more time speaking each day, such as teaching, reception, law and administrative assisting. And some women are stay-at-home moms, and young children can keep conversations going all day with a simple question: Why?
What are the symptoms that reveal the beginning of a voice disorder? Don’t ignore it if you suffer from pain when you speak, have frequent sore throats, have difficulties in controlling the volume of your voice or have persistent bouts of hoarseness. You may also experience having to frequently cough or clear your throat while speaking. Smoking and frequent yelling are two habits that can both put a person at greater risk for a voice disorder and should thus be avoided.
What else can you do to help prevent a voice disorder? Be sure to drink the recommended amount of water each day. Keeping your throat moist is the best way to protect your voice. If you frequently have to speak to large groups (meetings at work, etc.), try having a PA system set up so you don’t have to strain your voice to be heard. Breathe properly and practice speaking from the diaphragm rather than straining your voice as well. Limit the intake of liquids that dry you out, such as alcohol and coffee. Finally, try not to overstrain your voice, as in shouting at concerts or sporting events.
If you start to experience symptoms of a voice disorder, don’t be afraid to see a specialist to have it checked out. Your ability to communicate is too important to ignore.
大人気 人気
This is a topic that is close to my heart... Best wishes!
Where are your contact details though?
4 years ago