New to all this
neck. What started out as a small bump on dec 7th, has turned into this in that short length of time. Neck dissection scheduled for this coming frday. I am pretty frightened
by this whole thing but I know that GOD will take care of me. Please bear with me as I am new to this kind of thing and I am a two finger typist. Any help any of you could give me
would be greatly appreciated. This seems like the place I need to be for help and
encouragement.
Comments
-
Stevenl
Hi buddy I know the feeling of being a little frighten when you hear the word Cancer, especially when the doctor is tell it to you. Just to let you know there is hope and there are many of us here who have lived through cancer treatment more then once. You have a great start by putting your faith in God first, He will lead you to the right doctors and the right treatment, Just believe and keep positive.
Do you know what type of cancer you have, it will help to know as there are many others here who can give you guidance.
Take care my friend may the God of our fathers keep you in his care, God bless0 -
HondoHondo said:Stevenl
Hi buddy I know the feeling of being a little frighten when you hear the word Cancer, especially when the doctor is tell it to you. Just to let you know there is hope and there are many of us here who have lived through cancer treatment more then once. You have a great start by putting your faith in God first, He will lead you to the right doctors and the right treatment, Just believe and keep positive.
Do you know what type of cancer you have, it will help to know as there are many others here who can give you guidance.
Take care my friend may the God of our fathers keep you in his care, God bless
All that I know is
Hondo
All that I know is Squamous cell carcinoma. I think I have a great doc though he is not
wasting any time. The referral process is what frustrates me the most. Have a busy week
next week. By the way, thank you for responding. I know this site will help me very much.0 -
PreparationsHondo said:Stevenl
You are right, there is a lot of help here on CSN, I will be looking forward to your post.
I pray that God will watch over you while you are in his work shop
Stevenl- I would advise you to get everything in order for the path ahead. As I've stated many times, I did not, and suffered a lot more than I had to at the end of my week #1.
You mention neck dissection. To be followed by Radiation? Or Chemo?
Ask your Onco/ENT Drs. if they've found the Primary (the core source of the C).
If you are to get both C&R treatment- and the treatment will impact your ability to eat- will you need a feeding tube?
Get the prescriptions for any possible medicines needed filled, and be very active along these lines with your Drs. Don't hesitate to ask them what you need to do, and what they can do to help you thru this.
Please keep us informed, and don't hesitate to ask us questions. We are here to help.
Believe.
kcass0 -
prepKent Cass said:Preparations
Stevenl- I would advise you to get everything in order for the path ahead. As I've stated many times, I did not, and suffered a lot more than I had to at the end of my week #1.
You mention neck dissection. To be followed by Radiation? Or Chemo?
Ask your Onco/ENT Drs. if they've found the Primary (the core source of the C).
If you are to get both C&R treatment- and the treatment will impact your ability to eat- will you need a feeding tube?
Get the prescriptions for any possible medicines needed filled, and be very active along these lines with your Drs. Don't hesitate to ask them what you need to do, and what they can do to help you thru this.
Please keep us informed, and don't hesitate to ask us questions. We are here to help.
Believe.
kcass
Hi kent
Thanks for your response. Here is what I know thus far; unknown primary now. That WILL
be found this Friday. Unknown what the treatments will be but my ent said that this is
stage 4 and said that rad and chemo would follow. Have not met with either doc yet. I go for more scans tommorow and my pre op also. I meet with dentist thursday. I do not know what questions to ask so that is what I need help with, i.e. the feeding tube and things like that. What is a PET scan? My scans tomorrow are chest and abdomen. Do I need to ask for more? I look forward to your posts also to help me through this mess. The whole thing is probably my fault as I have smoked for 40 yrs and I do like my beer. Don't get me wrong,
I am not condemning my self just wanted you to know a little history. God is greater than this and he is going to take care of me!!!!!0 -
Steven,stevenl said:prep
Hi kent
Thanks for your response. Here is what I know thus far; unknown primary now. That WILL
be found this Friday. Unknown what the treatments will be but my ent said that this is
stage 4 and said that rad and chemo would follow. Have not met with either doc yet. I go for more scans tommorow and my pre op also. I meet with dentist thursday. I do not know what questions to ask so that is what I need help with, i.e. the feeding tube and things like that. What is a PET scan? My scans tomorrow are chest and abdomen. Do I need to ask for more? I look forward to your posts also to help me through this mess. The whole thing is probably my fault as I have smoked for 40 yrs and I do like my beer. Don't get me wrong,
I am not condemning my self just wanted you to know a little history. God is greater than this and he is going to take care of me!!!!!
Kent touched on allot of good points. May I suggest that you either take a notepad or another person along with you this week as allot of information will be thrown at you.
I would also like to suggest a Peg Tube up front before your Radiation and Chemo. I did not have Chemo. 30 Treatments of IMRT Radiation. The sores in my mouth and throat were pretty big, between the size of a nickel or quarter. Eating will be a big issue and you will need all the calories and nutrition you can get in yourself during all this time. My Peg Tube was inserted during my Surgery for Base of Tongue Cancer and Neck Disection.
My Best to You and Everyone Here0 -
Welcome Steven:) You came to
Welcome Steven:) You came to the right place:) All, or most of you questions you have you will be able to find here. And with tons of support!
Cindy0 -
Peg tubeMarineE5 said:Steven,
Kent touched on allot of good points. May I suggest that you either take a notepad or another person along with you this week as allot of information will be thrown at you.
I would also like to suggest a Peg Tube up front before your Radiation and Chemo. I did not have Chemo. 30 Treatments of IMRT Radiation. The sores in my mouth and throat were pretty big, between the size of a nickel or quarter. Eating will be a big issue and you will need all the calories and nutrition you can get in yourself during all this time. My Peg Tube was inserted during my Surgery for Base of Tongue Cancer and Neck Disection.
My Best to You and Everyone Here
Hi Marine E5
I have a son-in-law that is army E5. Thanks for your post. This feeding tube thing
scares me. I believe you when you say it was a good thing and I will definitely inquire
about it. Like I said, I do not know what the treatments will be yet. If you don't mind me asking, what was the neck dissection like? Judging from the size of the mass, I am pretty sure that mine will be radical. I can't tell you all how much your posts are helping me.
I hope you don't mind me adding you as my friends. THANK YOU ALL SO MUCH.
Steve0 -
fishinfishingirl said:Welcome Steven:) You came to
Welcome Steven:) You came to the right place:) All, or most of you questions you have you will be able to find here. And with tons of support!
Cindy
Hi Cindy
Can't wait to go crappie fishing again after all this is over!!!!!Thanks for your post.
Steve0 -
Your sister in law
Loves you very much Stephen. WE will get through this together as a family and you will be a testimony to hundreds of people as a cancer survivor and to the power of God. Satan will be behind us and God will lead us forward!!!0 -
sister in lawtxparadise50 said:Your sister in law
Loves you very much Stephen. WE will get through this together as a family and you will be a testimony to hundreds of people as a cancer survivor and to the power of God. Satan will be behind us and God will lead us forward!!!
Hi sweetheart. You bet we will make it. No doubt no question. Failure is not an option.
Love ya
Steve0 -
Hey, Stevestevenl said:Peg tube
Hi Marine E5
I have a son-in-law that is army E5. Thanks for your post. This feeding tube thing
scares me. I believe you when you say it was a good thing and I will definitely inquire
about it. Like I said, I do not know what the treatments will be yet. If you don't mind me asking, what was the neck dissection like? Judging from the size of the mass, I am pretty sure that mine will be radical. I can't tell you all how much your posts are helping me.
I hope you don't mind me adding you as my friends. THANK YOU ALL SO MUCH.
Steve
You didn't say if you're also going to get chemo and/or radiation. If you're getting radiation, don't be scared of the PEG (feeding tube): The PEG is your friend.
I don't understand why doctors don't just require their patients to get a PEG before they embark on this treatment. My doctors were very no-nonsense about it: They told me in no uncertain terms that I was to get the PEG put in before my treatment began.
In retrospect, that made sense. You don't want to go through the hassle of having the PEG put in when you're run down and physically and emotionally stressed from rads and chemo.
I went from 195 pounds to 155 pounds during my treatment, and I don't know what I would have done without the PEG. Starved, probably.
As for the dissection, three months after my chemo and radiation ended, I had to have a modified radical neck dissection. The surgery wasn't so bad -- heck, you're under general anesthesia anyway, so you don't notice it -- and the recovery wasn't bad. I spent two nights in the hospital after surgery. There was pain the first day, but meds knocked that back pretty well. The weird thing is, while you're under they implant a tube in your neck. It drains fluid into a little bag at the end of the tube. You have to empty the bag periodically, measure what comes out of the bag and keep track of it. Once the drainage subsides to a certain level, you can have the tube taken out. It took me close to a week. My surgeon also did a very good job on my neck. I wasn't left disfigured, but if you look closely at my neck you can see that something happened there.
In neck dissections there is a danger of nerve damage and shoulder problems. I'm sure your doc has or will go through all that with you. My shoulder came through just fine, but I did suffer a bit of damage to a nerve on the side of my face. If I open my mouth as wide as I can, the right side of my mouth doesn't open quite as wide as the left side. My smile's also a little lopsided. But hey, if that's the worst thing that I get out of Stage III tonsil cancer, I've been blessed.
You've come to the right place for information and support. We've all been through or are going through what you're facing. Please keep us informed.
--Jim in Delaware0 -
Steven,stevenl said:Peg tube
Hi Marine E5
I have a son-in-law that is army E5. Thanks for your post. This feeding tube thing
scares me. I believe you when you say it was a good thing and I will definitely inquire
about it. Like I said, I do not know what the treatments will be yet. If you don't mind me asking, what was the neck dissection like? Judging from the size of the mass, I am pretty sure that mine will be radical. I can't tell you all how much your posts are helping me.
I hope you don't mind me adding you as my friends. THANK YOU ALL SO MUCH.
Steve
Please thank your son-in-law for his service to our Country. I had the Radical Neck Disection. Had roughly 30 lymphnodes removed as well as the SCM muscle. I had 1/3 of my tongue removed, a tracheotomy, and the Peg Tube.
I can honestly say that I was not in any pain after the Surgery. Of course they had me on a drip for a day and a half. Then regular pain meds. Once I got home. I basically took over the counter pain med's. I was Blessed from above and a wonderful Surgeon. I had no choice as to whether I would have the Peg Tube because of the Thracheotomy. The Peg Tube can be alittle uncomfortable if you bang it or sleep on it, not clean it as instructed, but is a life saver. Yo will do fine with it if you decide to get it. It is better to get it before the Radiation and Chemo as you will be run down during that time and to go under another procedure at that time will be taxing.
As I mentioned, I had the Radical Neck Disection. It was several weeks after my final Radiation treatment that my neck and face reacted to swelling and stiffness. I questioned my Radiation Oncologist and found out that I was experiencing Lymphodema, the back up of fluids in the Lymphnode system. I was sent to a Cancer Physical Therapist and she showed me what I needed to do in order to fix the problem by doing a gently massage and stretching when needed. Just a extra little thing to add to my day, but it is all good.
I'm not that familiar with this site as I have recently come back after forgetting I was here in 2005, Duh. If there is anyway we can send private messages, I'll give you my phone number or you send me yours whatever works and I'll try to answwer as many questions as possible.
I was fortunate when I found out I had this. A neighbor that I really didn't know too well came up and knocked on my door one night and told me another neighbor had told him of my cancer. He had Tonsil cancer 7 years prior to my cancer and explained what more than likely was going to happen to me. He was spot on, so I wasn't in the dark about everything. He is now 12 years out from his last treatment and works full time. He was roughly your age (37) when he got his cancer.
This board is here for questions and answers, so ask away and someone will answer. I don't mind you adding me to your friend's list. We are all bonded together here whether we ever met in person or not. My thoughts and Prayers are with each and everyone here daily.
My Best to You and Everyone Here0 -
Chemo and raddelnative said:Hey, Steve
You didn't say if you're also going to get chemo and/or radiation. If you're getting radiation, don't be scared of the PEG (feeding tube): The PEG is your friend.
I don't understand why doctors don't just require their patients to get a PEG before they embark on this treatment. My doctors were very no-nonsense about it: They told me in no uncertain terms that I was to get the PEG put in before my treatment began.
In retrospect, that made sense. You don't want to go through the hassle of having the PEG put in when you're run down and physically and emotionally stressed from rads and chemo.
I went from 195 pounds to 155 pounds during my treatment, and I don't know what I would have done without the PEG. Starved, probably.
As for the dissection, three months after my chemo and radiation ended, I had to have a modified radical neck dissection. The surgery wasn't so bad -- heck, you're under general anesthesia anyway, so you don't notice it -- and the recovery wasn't bad. I spent two nights in the hospital after surgery. There was pain the first day, but meds knocked that back pretty well. The weird thing is, while you're under they implant a tube in your neck. It drains fluid into a little bag at the end of the tube. You have to empty the bag periodically, measure what comes out of the bag and keep track of it. Once the drainage subsides to a certain level, you can have the tube taken out. It took me close to a week. My surgeon also did a very good job on my neck. I wasn't left disfigured, but if you look closely at my neck you can see that something happened there.
In neck dissections there is a danger of nerve damage and shoulder problems. I'm sure your doc has or will go through all that with you. My shoulder came through just fine, but I did suffer a bit of damage to a nerve on the side of my face. If I open my mouth as wide as I can, the right side of my mouth doesn't open quite as wide as the left side. My smile's also a little lopsided. But hey, if that's the worst thing that I get out of Stage III tonsil cancer, I've been blessed.
You've come to the right place for information and support. We've all been through or are going through what you're facing. Please keep us informed.
--Jim in Delaware
Hi Jim
Thanks for the great info. It seems that everyone is different in the steps that are taken.
I first went to my Primary, then had a scan of the mass and then to the ENT. Oh Yea, one week wasted taking antibiotics, then the referral then the scan, then another referral, then the ENT on Fri the 8th. He actually told me he was 95% sure it was cancer then. went for a needle biopsy and back to see him last Friday. I guess because the mass is so obvious
he has chosen the neck dissection first to remove it and find the source. The ENT told me that Chemo and rad would follow all of this. I can tell you that this thing on my neck is angry. But it doesn't know who it is dealing with!!! So, with all that being said, I get great comfort in knowing that the peg will be my friend,and getting to talk to you all about this seemingly hard road I am about to travel down. Keep the great posts coming because they are helping me tremendously. Thanks to everyone!!!
Steve0 -
private messageMarineE5 said:Steven,
Please thank your son-in-law for his service to our Country. I had the Radical Neck Disection. Had roughly 30 lymphnodes removed as well as the SCM muscle. I had 1/3 of my tongue removed, a tracheotomy, and the Peg Tube.
I can honestly say that I was not in any pain after the Surgery. Of course they had me on a drip for a day and a half. Then regular pain meds. Once I got home. I basically took over the counter pain med's. I was Blessed from above and a wonderful Surgeon. I had no choice as to whether I would have the Peg Tube because of the Thracheotomy. The Peg Tube can be alittle uncomfortable if you bang it or sleep on it, not clean it as instructed, but is a life saver. Yo will do fine with it if you decide to get it. It is better to get it before the Radiation and Chemo as you will be run down during that time and to go under another procedure at that time will be taxing.
As I mentioned, I had the Radical Neck Disection. It was several weeks after my final Radiation treatment that my neck and face reacted to swelling and stiffness. I questioned my Radiation Oncologist and found out that I was experiencing Lymphodema, the back up of fluids in the Lymphnode system. I was sent to a Cancer Physical Therapist and she showed me what I needed to do in order to fix the problem by doing a gently massage and stretching when needed. Just a extra little thing to add to my day, but it is all good.
I'm not that familiar with this site as I have recently come back after forgetting I was here in 2005, Duh. If there is anyway we can send private messages, I'll give you my phone number or you send me yours whatever works and I'll try to answwer as many questions as possible.
I was fortunate when I found out I had this. A neighbor that I really didn't know too well came up and knocked on my door one night and told me another neighbor had told him of my cancer. He had Tonsil cancer 7 years prior to my cancer and explained what more than likely was going to happen to me. He was spot on, so I wasn't in the dark about everything. He is now 12 years out from his last treatment and works full time. He was roughly your age (37) when he got his cancer.
This board is here for questions and answers, so ask away and someone will answer. I don't mind you adding me to your friend's list. We are all bonded together here whether we ever met in person or not. My thoughts and Prayers are with each and everyone here daily.
My Best to You and Everyone Here
Hi MarineE5
We can post private messages and I just found out how. You go to the home page and go to the middle blue box "Connect and Communicate", my daughter is typing this so she's much faster (yes I am, he's sloooow), then you click on "CSN email", click on "Write a New Message" then either type in the screen name of the person you want to send a message to or click on "My Friends" and you can pick from your friend list. That way we can communicate privately.
For everyone else reading this, I know there are some sensitive things that each one of us go through personally that we can communicate privately better, so please no one stop posting me and helping me.
Thanks Marine for the offer and I look forward to hearing from you.
Steve
P.S. She figured all this out. She's a good girl.0 -
Hi Steve,stevenl said:sister in law
Hi sweetheart. You bet we will make it. No doubt no question. Failure is not an option.
Love ya
Steve
Welcome to this
Hi Steve,
Welcome to this very supportive place. Almost everyone posting here has been carry me through
as they will you to. Their support and compassion are never ending.
I was diagnosed with Squamous Cell with an unknown primary which started with a swollen right lymph node in my neck. Even after the PET scan they don't know the primary. So far the lymph node and both tonsils have been removed. I just had all my teeth removed and waiting for them to heal enough so that the radiation can begin. Due to pre-existing neuropathy in my legs and hands the doctors chose to use Erbitux instead of chemo which could greatly increase the neuropathy.
My prayers are with you Steve and so are everyone else's here.
Chefdaddy0 -
welcmeChefdaddy said:Hi Steve,
Welcome to this
Hi Steve,
Welcome to this very supportive place. Almost everyone posting here has been carry me through
as they will you to. Their support and compassion are never ending.
I was diagnosed with Squamous Cell with an unknown primary which started with a swollen right lymph node in my neck. Even after the PET scan they don't know the primary. So far the lymph node and both tonsils have been removed. I just had all my teeth removed and waiting for them to heal enough so that the radiation can begin. Due to pre-existing neuropathy in my legs and hands the doctors chose to use Erbitux instead of chemo which could greatly increase the neuropathy.
My prayers are with you Steve and so are everyone else's here.
Chefdaddy
Hey chefdaddy
Thank you so much for the encouragement. Having been on here for about 20 hrs now, I can truly see the compassion and I am blessed to have been led here by the lord. Keep me posted on how things are going and I will lift you and everyone else up in prayer! God bless
Steve0 -
PEG and Pet, etc.stevenl said:sister in law
Hi sweetheart. You bet we will make it. No doubt no question. Failure is not an option.
Love ya
Steve
Jim's post is correct, if your Dr. advises that you may have trouble eating. All is pending the results, of course, of your Op, and the Pet. I've had my PEG for a year, as well as the Port. The best advice is to have them put in before the C&R before treatment begins. Only an Outpatient Op for me. Got all my nutrition thru the tube for 7 consecutive weeks, and still lost over 17% of my body weight. And, getting the Port and feeding tube is no big deal- only a nuissance that you may end-up regarding as a critical necessity. Seems ugly, but the tube is no big deal.
As for the Pet- a scanning open-MRI style. First, they shoot a combination of sugar water and radioactive isotopes into you, then you lay there for some 45 minutes letting the stuff work it's way thru your body, then you have the scan done. And, afterwards, you drink a lotta water to help flush your system. Simple as that.
I had no neck dissection, so I cannot speak of such. Route my Drs. took was to just kill the C with full head and neck Rad, and Cisplatin and Flourouracil chemo.
The suggestion to write down the questions is good advice- it is what I did long ago.
What C&R are you gonna put me thru? How wide-spread do you think the C is?
Side-effects to treatment?
Chances of survival, and any lasting physical changes?
What prescrips should I have lined-up at the start of treatment?
Should I get a PEG; and, if so, who do I contact about the formula that will be my food?
What should I be doing now- gargle with salt water and baking soda?
(If you are experiencing sleep/emotional problems)What help can you prescribe to help me deal with this?
Will the pain get bad, and what will you give me to help me endure it all?
There's more I, and others, can help you with when you know more about your treatment specifics. We, here, are all positive when it comes to the C= we are all proof that one can survive it, as we have. It is no easy road, steven, but modern med does make that road passable. You must always be open with your Onco and ENT about difficulty you are having. You may come to know your own infamous skull mask, for instance. Not fun. Most of us keep our's. MY BEST ADVICE is to only think positive- keep your focus on the successful end of treatment we all have come to find, and know for a fact that you will get there. If you are one of Faith, then this is a good time to ask for the Lord's help. Footprints in the sand, Steven- many of us know that we are Witness to that in our live's. Bottom-line: believe you can get thru this to a victorious end, and you will. All of us have, and so will you.
Believe.
kcass0 -
BelieveKent Cass said:PEG and Pet, etc.
Jim's post is correct, if your Dr. advises that you may have trouble eating. All is pending the results, of course, of your Op, and the Pet. I've had my PEG for a year, as well as the Port. The best advice is to have them put in before the C&R before treatment begins. Only an Outpatient Op for me. Got all my nutrition thru the tube for 7 consecutive weeks, and still lost over 17% of my body weight. And, getting the Port and feeding tube is no big deal- only a nuissance that you may end-up regarding as a critical necessity. Seems ugly, but the tube is no big deal.
As for the Pet- a scanning open-MRI style. First, they shoot a combination of sugar water and radioactive isotopes into you, then you lay there for some 45 minutes letting the stuff work it's way thru your body, then you have the scan done. And, afterwards, you drink a lotta water to help flush your system. Simple as that.
I had no neck dissection, so I cannot speak of such. Route my Drs. took was to just kill the C with full head and neck Rad, and Cisplatin and Flourouracil chemo.
The suggestion to write down the questions is good advice- it is what I did long ago.
What C&R are you gonna put me thru? How wide-spread do you think the C is?
Side-effects to treatment?
Chances of survival, and any lasting physical changes?
What prescrips should I have lined-up at the start of treatment?
Should I get a PEG; and, if so, who do I contact about the formula that will be my food?
What should I be doing now- gargle with salt water and baking soda?
(If you are experiencing sleep/emotional problems)What help can you prescribe to help me deal with this?
Will the pain get bad, and what will you give me to help me endure it all?
There's more I, and others, can help you with when you know more about your treatment specifics. We, here, are all positive when it comes to the C= we are all proof that one can survive it, as we have. It is no easy road, steven, but modern med does make that road passable. You must always be open with your Onco and ENT about difficulty you are having. You may come to know your own infamous skull mask, for instance. Not fun. Most of us keep our's. MY BEST ADVICE is to only think positive- keep your focus on the successful end of treatment we all have come to find, and know for a fact that you will get there. If you are one of Faith, then this is a good time to ask for the Lord's help. Footprints in the sand, Steven- many of us know that we are Witness to that in our live's. Bottom-line: believe you can get thru this to a victorious end, and you will. All of us have, and so will you.
Believe.
kcass
HI Kent
Thanks so much, yes I do believe and I am counting on Him for strength, guidance,and full recovery and healing. Keep me in your prayers as I will for you. Heard just a little about the skull mask, sounds like another thing I,m not going to like too much. It's okay though
I have a wonderful wife and kids (not kids anymore) that are really helping me, and now I have a lot of new friends to help me too!!!. Thank you all so much my prayers are with you all.
Steve0 -
Starting Radiationstevenl said:Believe
HI Kent
Thanks so much, yes I do believe and I am counting on Him for strength, guidance,and full recovery and healing. Keep me in your prayers as I will for you. Heard just a little about the skull mask, sounds like another thing I,m not going to like too much. It's okay though
I have a wonderful wife and kids (not kids anymore) that are really helping me, and now I have a lot of new friends to help me too!!!. Thank you all so much my prayers are with you all.
Steve
Steve,
Hoping for all the best for you.
I got my mask made last Tuesday. It wasn't fun, but it was doable - not as bad as I'd feared. Oddly enough, the technicians talked to me during part of process, and, of course, I tried to nod my head a few times. I just kept telling myself that I was OK, and able to breathe just fine. Some people imagine themselves somewhere else during the mask-molding procedure (and treatments), some try to meditate, some practice visualization, some listen to music they've selected (ask your dr or technicians what you can do - I can't have headphones, but they will play a CD or radio for me).
I also have a PEG (dr. just said "you're going to need it - you should get it while you're doing well, and are not malnourished"); it's another thing I don't like, but it's doable. I can eat orally, and I just started doing tube feedings to add calories to my day and make sure my body can tolerate the formula. I'll start radiation in a week if all goes according to plan.
A couple of people have made the comment "We do what we have to so that we can do what we want to". Sounds like you've got plenty of motivation to really apply yourself, and do the things you have to do. I look forward to hearing about your successes.
All the best,
- Pam0
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