Monthly Archives: May 2014

Trustworthy: Vaccines have earned that title

Two doses of measles-mumps-rubella vaccine will prevent measles in 99 percent of those vaccinated.

By Patsy Stinchfield, PNP

The confirmation of 83 cases of measles in Ohio this month and the recent quick diagnosis of a 19-month-old with measles in Minneapolis, Minnesota’s first case of measles this year, brought a timely reminder that the potentially deadly virus has not been eradicated and of the importance of vaccination. Having just wrapped World Immunization Week and National Infant Immunization Week, the importance of immunization is as great as ever.

In fact, the U.S. Centers for Disease Control and Prevention reported today that the 288 cases of measles in the country so far this year are the highest since 2000. The number of cases reported this year is the highest for the first five months of a year since 1994.

I worry that the numbers are a sign of growing credibility for a small band of celebrities and others who have thrown up an online smoke screen of fear of vaccines against measles, whooping cough and other common childhood diseases.

If even a relatively small percentage of Americans buy into this criticism, it would be disastrous. Measles, one of the most contagious airborne diseases, can be extremely serious, leading in rare cases to pneumonia and fatal brain infections. Infants too young to be vaccinated particularly are at risk.

We’re fortunate that the child in Minnesota, who actually had one of two measles shots and apparently contracted the disease during a visit to India, was diagnosed within minutes at Children’s – Minneapolis. Because the alert medical team picked up the symptoms so quickly, only 16 potentially exposed people had to be notified after the child was quarantined.

Three years ago, as many as 700 contacts had to be reached for some patients during an outbreak at Children’s.

What’s most frustrating is that it’s all so unnecessary.

The virus hasn’t changed all that much. It’s not like the HIV virus, constantly mutating. No; with measles the culprit purely is social – a breakdown in trust of medical experts whose longtime vaccine advocacy made measles and other common childhood infections a footnote.

Fear-mongering online vaccine critics are not winning, in a classical political sense. Thankfully, more than 90 percent of parents still trust their health care providers and nationally recommended vaccines. If they didn’t, we would see frequent headlines about deaths from measles, whooping cough and other diseases.

However, the remaining 10 percent of parents are hesitant, have vague fears and wonder who to trust. They routinely hear or read vehement vaccine bashing in social media circles, which feeds fear and denial – and new outbreaks. New York City and Orange County, Calif., currently are dealing with measles outbreaks.

Measles is so highly contagious that just passing through a clinic waiting room two hours after someone with measles has been there can expose an unvaccinated newborn, which may be devastating.

We all must protect the vulnerable in our community by forming a protective barrier of our own vaccination. That’s a simple point seemingly lost on the peddlers of myth and pseudoscience who have infected too many parents with baseless fear of vaccines that protect their own children and the community at large.

Parents should trust health care professionals who urge vaccination on schedule. At Children’s, we speak from experience. We have seen children die or become permanently impaired from vaccine-preventable disease. Ask our specialists how many unvaccinated, critically ill children they have cared for, and they would answer “too many to count.” And how many they’ve seen with severe vaccine side effect? You’ll get a blank stare, or “I don’t recall any; maybe one at most.”

We have seen children with measles on a ventilator, fighting for their lives. That’s a bitter sight when you recognize that two doses of measles-mumps-rubella vaccine will prevent measles in 99 percent of those vaccinated. There’s no contest between the benefits of vaccines and their extremely rare risks.

Before the measles vaccine was developed in the 1960s, there were 2.6 million measles-related deaths per year worldwide. In 2012, that number was down to 122,000, mostly in children younger than 5 in parts of the world where vaccines are scarce or their parents refuse to allow vaccination. The point is that we can’t afford to let our guard down in the U.S. or elsewhere. In a global society measles is a mere plane ride away for the unprotected.

The safe, effective and trustworthy action for infants, children, adolescents and adults is to get vaccinated on time for all recommended vaccine-preventable diseases.

Aside from sanitary drinking water, vaccines remain the safest, most-life-saving medical intervention we have to protect our children.

Patsy Stinchfield, PNP, is the director of Infection Prevention and Control and the Children’s Immunization Project at Children’s Hospitals and Clinics of Minnesota.

Child free of seizures after laser procedure

Jack Healy, seen with his family, including his mother, Shannon, had a rare, benign tumor called a hypothalamic hamartoma.

By Shannon Healy

Our sweet baby boy, Jack, was born Oct. 18, 2012. When he was only a few weeks old, we started noticing he was having “episodes.” His body would tense up and he would scream like he was in pain. These continued to worsen as he got older and got to the point where he would wake up with them every time he tried to go to sleep. He also began having episodes where he would appear to be laughing but still looked terrified and in pain.

For months, we sought out different specialists to try to diagnose our baby’s episodes. Finally, in April 2013, we were referred to the neuroscience program inside the St. Paul campus of Children’s Hospitals and Clinics of Minnesota. Still unsure of what his episodes were, the staff began following him closely and keeping a close eye on his other symptoms (a large head and low muscle tone).

In August 2013, Jack had an MRI on his brain. Within days, we had a diagnosis: Jack had a tumor on his hypothalamus and his “episodes” were gelastic and dacrystic seizures associated with the tumor. This time was so overwhelming for us, but we finally knew what Jack was battling.

Jack was prescribed a few different seizure medications, but his seizures continued to worsen. At the peak, he was having up to 15 seizures per day; more severe and longer in duration than when he first started having them. They were taking a toll on Jack and our family. He has two older sisters who adore him, and they would get extremely upset every time he would have one of his “fits,” as they called them.

It seemed like the seizures were affecting every aspect of Jack’s life and development. He began refusing all solid foods and would take only bottles of milk. His seizures constantly would interrupt his sleep. He was having severe delays in his gross motor development and also was falling behind in his speech. Defeat and hopelessness were setting in for us.

After watching the tumor for three months, the neurology team at Children’s was able to confirm that Jack had a rare, benign tumor called a hypothalamic hamartoma. We were told that these tumors occur in only one in 1 million people, often appearing in young children. According to Meysam Kebriaei, MD, Children’s neurosurgeon, that number could be underestimated since hypothalamic hamartomas can be missed without high-resolution MRIs.

In December, we met with Dr. Kebriaei, who discussed a new surgical procedure called Visualase, an MRI-guided, minimally invasive laser procedure. He thought Jack would be a great candidate.

Jack would be the first patient at Children’s with a hypothalamic hamartoma to undergo a Visualase procedure. We were thrilled to have this option available to us and made our decision to proceed before we left the clinic that day.

We also learned that Children’s is the only institution in the Midwest to perform Visualase ablation for hypothalamic hamartomas. Dr. Kebriaei explained that Visualase would allow him to treat Jack’s tumor in such a way that will minimize the risk and decrease his recovery time, when compared to the standard, open surgical procedure. 

Jack had seven seizures the morning of his surgery.

Jack’s surgery was scheduled for Jan. 10. He had seven seizures the morning of his surgery; a strange reassurance to us that we had made the right decision. The surgery took the entire day and we were updated by Children’s staff throughout the process. We never left the waiting room.

At the end of the day, Dr. Kebriaei told us that the surgery had gone perfectly. The tumor had been completely disconnected from Jack’s brain. We spent two nights in Children’s ICU with Jack and, amazingly, he was seizure-free.

After going home, Jack experienced an unexpected drop in his sodium level, which required a readmission to Children’s. He spent 2½ weeks in the hospital, where he continued to receive extraordinary care and, in spite of this complication, continued to be free of his debilitating seizures.

It has been almost four months since Jack’s surgery, and he has not had any seizures. It still is hard to believe, considering he had these seizures daily for 15 months. Sometimes, I still expect him to be having one when he starts laughing, but then I realize that he is laughing because he’s so happy!

Jack has been seizure-free since undergoing the Visualase treatment.

With the seizures gone, we now are able to focus on Jack’s development. He is having therapy multiple times each week, and we already are seeing progress in his eating, speech, motor skills and sleep patterns. Just within the past week, Jack has been standing, walking and pushing toys through our kitchen. We are hopeful these parts of Jack’s life only will continue to improve.

This surgery has been life changing for us. We learned later that Jack is one of only 50 people in the country who have undergone Visualase ablation for a hypothalamic hamartoma. After months of feeling grief and hopelessness, we have a renewed hope that our sweet boy is going to have a healthy and happy life. As Dr. Kebriaei told us at Jack’s last appointment, “He’s about ready to take off.”

The neuroscience program at Children’s Hospitals and Clinics of Minnesota unites hundreds of experts in a common mission. We care for more neurology patients, more brain tumor patients and more epilepsy patients than any other hospital in the region. And we do it with some of the most advanced treatments and technologies available today.

Doctor teaches patient’s third-grade class about science of sound, hearing

Leah Tygum, MD (back row, left), visited the third-grade classroom of patient Sophia Nelson (middle row, second from left) at Redtail Ridge Elementary School in Savage to talk about the science of sound and hearing.

Working together was the spark that started a fire of learning and understanding for a class of third-grade students this winter. A collaborative project between staff at the St. Paul campus of Children’s Hospitals and Clinics of Minnesota and Redtail Ridge Elementary School in Savage helped students learn about the science of sound and hearing while creating a lifelong lesson that went well beyond the typical third-grade science curriculum.

“What’s that thing in your ear?” is a question Redtail Ridge third-grade student Sophia Nelson often has heard from classmates. Diagnosed at age 6 with moderate to severe hearing loss in her left ear, Sophia has worn a hearing aid for the past two years, and it has raised questions from several curious friends during that time.

Third-grade teacher Stacy Kodada (left) takes a turn using a small stethoscope placed to Sophia Nelson’s hearing aid.

This winter, when Sophia’s classroom teacher, Stacy Kodada, introduced a science curriculum that included studying the physics of sound, Kodada and Sophia connected about inviting Sophia’s audiologist, Leah Tygum, MD, to visit with Sophia’s classmates. Dr. Tygum, affectionately referred to as “Dr. Leah” by Sophia, has helped transform Sophia’s hearing-loss journey from one that began at diagnosis with fear and concern to one that now is characterized by empowerment and confidence. Since first meeting Sophia, Dr. Tygum has helped provide Sophia with resources to help her – and fellow students – better understand what some might consider Sophia’s “disability.” When invited by Kodada to visit with the third-graders, Dr. Tygum seized the opportunity to help Sophia better educate her classmates on hearing loss and hearing aids.

Prior to the on-site visit, students shared their questions about hearing loss and hearing aids with Sophia and her teacher. Their questions were honest, at times simple, and revealing in terms of a young child’s understanding of those who suffer hearing loss. Students posed several questions, including:

  • What happens inside the ear when you can’t hear?
  • How do you get the sound from the hearing aid into the eardrum into the brain?
  • How do you make a hearing aid?
  • How do you know if you need a hearing aid?

Sophia Nelson (left) had Leah Tygum, MD, visit her third-grade classroom at Redtail Ridge Elementary School in Savage.

On the day of her visit, Dr. Tygum was greeted by a room of students buzzing with excitement and questions. She facilitated more than 90 minutes of hands-on, interactive learning about hearing. Attempting to address all questions, she talked about the science of hearing, what goes wrong with hearing loss and how hearing aids work for those who need them. Using Sophia as a teaching partner, Dr. Tygum took the lesson well beyond Q&A, leading students through a variety of engaging learning activities. Dr. Tygum made a mold of Sophia’s inner ear while the students watched, just as she would do in her office to properly fit a hearing aid. To increase involvement, she then gave students their own individual balls of molding material so they could feel how it hardens into a shape in minutes.

To help make the hearing aid even more “real world” and understandable, the children were each given the chance to use a small hearing aid stethoscope which allowed them to hear sounds in the classroom the way Sophia does when she wears her aid. The exercise proved popular. After listening, children raced back into line in hopes of getting a second chance.

The classroom learning experience helped students understand the science of sound and hearing, but for Kodada it went beyond that.

“Having Dr. Leah come to the classroom allowed the students a different insight into others with hearing disabilities,” Kodada said. “The hands-on experience and real-life demonstration is a wonderful way for students to learn and then be able to apply it to their own life situations.”

While Sophia will probably continue to get questions throughout her life about her hearing loss, she’s certain that none of this year’s classmates will ever ask again “what’s that thing in your ear?”

Photo gallery: Leah Tygum, MD, visits third-grade class at Redtail Ridge Elementary School in Savage (Photos by Michael Nelson)

 

Allergies in full swing in spring

Although allergies can develop at any age, they most commonly show up during childhood or early adulthood.

Winter exits, spring enters, and with it come irritants in the environment that can trigger allergies in children and adults.

In the U.S., more than 50 million people (1 in 5) are affected by allergies, which are caused by an overactive immune system, according to the American Academy of Pediatrics.

 

 

12 tips to help keep kids safe this summer

Wear a helmet every time you ride a bike, skateboard, scooter or use in-line skates.

Children’s has one of the busiest pediatric emergency programs in the country, with about 90,000 visits each year. We love kids here at Children’s, but we’d rather see them safe at home. With warm weather upon us, we compiled a list of basic tips, with help from our injury prevention experts, to keep kids safe all summer. Together, we can make safe simple.

For more safety tips, read about Making Safe Simple.

Sun and heat

1. On hot days, make sure kids drink plenty of water to stay hydrated.

2. Make sure kids are covered. Apply 1 ounce of sunscreen to the entire body 30 minutes before going outside. Reapply every two hours, or immediately after sweating heavily.

3. When heat and humidity are high, reduce the level of intensity of activities.

Water

4. Kids should wear life jackets at all times when they’re on boats or near bodies of water.

5. Never leave kids alone in or near a pool or open water. In open water, kids should swim with a buddy.

Fireworks

6. Don’t allow kids younger than the age of 12 to use sparklers without close adult supervision. Don’t allow them to wave sparklers or run while holding sparklers.

Playground

7. Always watch kids on a playground. Make sure the equipment is age appropriate and surfaces underneath are soft enough to absorb falls.

Lawnmowers

8. Kids younger than 16 shouldn’t be allowed to use riding mowers, and those younger than 12 shouldn’t use walk-behind mowers.

Bike and wheel-sport safety

9. Make it a rule: Wear a helmet every time you ride a bike, skateboard, scooter or use in-line skates. Skateboarders and scooter-riders should wear additional protective gear.

ATVs

10. Every rider should take a hands-on rider-safety course.

11. All kids should ride size-appropriate ATVs.

12. All riders should wear full protective gear including a helmet, chest protector, gloves and shin guards.

Five Question Friday: Mary Sachs

In honor of Cystic Fibrosis Awareness Week, this edition of Five Question Friday is about Mary Sachs, RN, CNP, who works with cystic fibrosis patients at Children’s. 

Mary Sachs, RN, CNP, has worked at Children's for about 22 years.

How long have you worked at Children’s?

I have worked at Children’s for about 22 years. I started out in the pulmonary clinic as a nurse practitioner, and I continue to work in the pulmonary field doing asthma clinics in St. Paul and coordinating the cystic fibrosis program on the Minneapolis campus. I also work 2½ days per week in the general pediatric clinic. I enjoy the variety in my job and the ability to be on both sides of the river.

How has cystic fibrosis care changed over the years? Or what advances have you seen in the way we care for pediatric cystic fibrosis patients?

One of the biggest changes that happened eight years ago was the addition of testing for cystic fibrosis on the newborn screen. Whereas before, we would diagnose most children after they had issues with frequent pneumonias or infections or were failing to thrive, we now can diagnose them shortly after birth and begin preventative medications and strategies to optimize growth and maintain lung function. We used to also hospitalize children with CF at diagnosis because they were so sick. Now we usually don’t have to hospitalize children until they are older and we provide most of our education and treatments as outpatients.

What’s one thing you want people to know about cystic fibrosis?

The main thing I would like for people to know is that there is great hope that one day we truly will find a cure. The research happening around this orphan disease is truly amazing, and Children’s is a part of this research, enrolling subjects in many observational and clinical trials. New drugs studies are actually making corrective changes at the cellular level which is very exciting.  

Parents also need to know that if their child is diagnosed with CF that they are not alone. There is a team of people at Children’s who are going to be there with them every step of the way.

Do you have a favorite memory from working at Children’s?

There are some many wonderful memories of caring for children and their families here, but one memory reminds me that when you work here at Children’s – you have to be ready for anything and truly at the top of your game. I walked into one of our patients with CF’s room on the sixth floor one day and he was watching the “Wishing Well Show” (the previous in-house studio show). Porky-Chop (the pig puppet) was having a hog-calling contest for patients and staff. Sam (my patient) insisted that we enter the contest (and how could I say no?). We did our best and then I was off to see the rest of the patients with CF on the unit. The next day when I came onto the floor, he came running out of his room yelling “Mary, Mary! We won! We won!” He was just SO excited. He is a teenager now, and when he comes to Children’s for his annual clinic visit with the team once a year, we still laugh about it.

If you could travel anywhere in the world, where would you go and why?

I would go to Italy because of the wonderful culture, food and wine.

Cities 97’s Paul Fletcher to host Baby Steps 3K

Paul Fletcher of Cities 97 will be the emcee for Baby Steps 3K walk and party, taking place on Saturday, May 31, at the Minnesota State Fairgrounds. Paul and his wife, Spencer, their family and friends will walk in honor of their daughter, Elsie, who was born with Hirschsprung’s disease and continues to receive care at Children’s. All proceeds from Baby Steps 3K will go to support the neonatal program. Learn more about or register for Baby Steps 3K.

In 2013, Paul and Spencer shared their story about Elsie and the care they received at Children’s and the Ronald McDonald House:

Photo gallery: 2013 Baby Steps 3K

Minnesota spring means ticks, health risks

Deer ticks are tiny – about the size of a pencil tip – and brown-black in color. Wood ticks are larger and do not carry Lyme disease.

Erin Fritz, RN, CNP

The snow has now melted and the temperatures are rising, allowing our energy and activities to bring us outdoors. Spring weather brings sprouting trees, blooming flowers – and creepy crawly ticks that lurk in the woods, grass and marshy areas.

Whether you are heading up north to the cabin or playing in your backyard, ticks may be present and a tick bite may occur. Due to the extreme seasonal temperature changes and high humidity, Minnesota has a lot of ticks and high rates of tick-borne illness such as Lyme disease, and the risk remains high. Lyme disease is an infection caused by bacteria that is carried by some deer ticks. Deer ticks are tiny – about the size of a pencil tip – and brown-black in color. Wood ticks are larger and do not carry Lyme disease.

Prevention

Playing outdoors increases the risk of encountering a tick, but there are ways to prevent a tick from attaching and biting. The American Academy of Pediatrics recommends the following for tick and Lyme disease prevention:

  • Cover arms and legs by wearing long-sleeved shirts and pants tucked into socks
  • Wear a hat to cover hair
  • Wear light-colored clothing in order to see ticks more clearly
  • Wear enclosed shoes, use insect repellent with DEET
  • Stay on cleared trails whenever possible
  • Routinely check for ticks immediately after coming indoors

When you find a tick

Most ticks are noticed when crawling around on clothing or skin and easily can be removed by taking it off before it attaches to the body. If a tick already has attached, removal is rather easy and should be removed as soon as possible. While prompt removal is important to decrease the risk of developing Lyme disease, be aware that most medical experts agree that the tick must be attached for at least 24-36 hours before Lyme disease is transmitted.

In order to remove the tick:

  • Simply grasp the tick with a tweezers as close to the skin as possible
  • Without squeezing the tick’s body, slowly pull the tick away from the skin
  • Clean the bitten area with soap and water
  • Apply an antiseptic ointment

Be on the lookout

After tick removal, it’s important to monitor the site for expanding redness that might suggest a “bull’s eye” rash. This particular rash can be the first and most obvious sign of Lyme disease.  The rash usually doesn’t cause other symptoms, but burning or itching is a possibility. Further examination by a health care professional is needed if there is a bull’s eye rash, headaches, chills, fever, fatigue or muscle aches. If Lyme disease is suspected, a health care professional probably will prescribe an oral antibiotic for treatment. There’s no benefit in testing for Lyme disease at the time of the tick bite; even people that become infected will not have a positive blood test until approximately two to six weeks after the infection post-tick bite. Early identification and treatment is important to reduce the risk of worsening illness.

While ticks and tick-borne illness easily can be overlooked, prevention is vital. This is the time of year to take full advantage of the long-awaited summer. Get outside and play safely.

Erin Fritz is a certified nurse practitioner at Children’s Hospitals and Clinics of Minnesota.

Five Question Friday: Bonnie Carlson-Green

Working as a neuropsychologist is a bit like being a detective for Bonnie Carlson-Green, PhD, LP. Learn more about her fascination with the brain in this week’s Five Question Friday.

When she was in high school, Bonnie Carlson-Green, PhD, LP, wanted to be a pediatrician but decided to major in psychology in college because she was fascinated with the study of brains and behavior.

How long have you worked at Children’s?

I’ve been at Children’s for 17 years – one year less than my eldest child’s age, which makes it easy to remember!

Describe your role.

I was hired to develop the neuropsychology program, specifically as it relates to supporting the hematology/oncology patients. Many children who have central nervous system (CNS) cancers or are treated with brain surgery, craniospinal radiation, or intrathecal chemotherapies can develop neurocognitive late effects – problems with attention, processing speed, memory or other difficulties that affect their development and learning capacity. We now have six neuropsychologists across both Children’s hospital campuses and see children from age 2 years to young adults into their 20s, and sometimes 30s, for neurocognitive issues related to a variety of diagnoses and conditions.

How did you decide to go into pediatrics?

In high school, I wanted to be a pediatrician but decided to major in psychology in college because I was fascinated with the study of brains and behavior (there were no neuroscience or neuropsychology programs back in those dark ages). My psychology classes were a lot more interesting than the cutthroat pre-med classes so I gave up plans for med school. Now I feel like I get the best of both worlds: I work in a hospital setting with kids but get to spend a lot more time getting to know them over the course of their assessment.

What do you love most about your job?

I love the challenge of a mystery. Families come to me with questions about why their child is struggling. I listen to their stories for clues, do my own bit of detective work through my assessment, and then present my hypotheses to the families. It’s so gratifying for parents to have an “aha” moment in your office when all of a sudden they have a better understanding of their child. It’s also wonderful to be able to follow children over time and to see them learn to read or to do better in school because of recommendations or strategies that you suggested.

What’s your favorite meal?

My absolute favorite food in the world is Tom Yum soup. It’s a Thai soup that is a little sweet, a little sour and served with rice. Every bite tastes a little bit different than the last. There is nothing better, and it cures every ill. Unfortunately, the little hole-in-the-wall restaurant in Dinkytown that made the best Tom Yum soup in the Cities closed a number of years ago, so my husband and I were forced to learn how to make it ourselves.

Kangaroo Care a tranquil experience for parent, child

Newborn Azarias has skin-to-skin contact with his mother, Veronica Engel, as part of a Kangaroo Care exercise. Thursday, May 15, is International Kangaroo Care Day.

This month, the Neonatal units in St. Paul and Minneapolis are celebrating the importance of Kangaroo Care, a technique where an infant is held skin to skin with mom or dad. Kangaroo Care promotes bonding, provides comfort for the baby and parent and has potential to improve a baby’s medical condition. In honor of International Kangaroo Care Awareness Day, a mother shares her experience holding her newborn son skin to skin.

Veronica Engel of Chippewa Falls, Wis., holds newborn son Azarias skin to skin as part of Kangaroo Care.

By Veronica Engel

My husband and I found out at my 10-week ultrasound that we were having a baby boy, but we also found out that our son, Azarias, had a birth defect called gastroschisis.

Due to his condition, doctors informed me that I wouldn’t be able to hold Azarias until after his surgery. This had me worried because I was afraid of missing out on that special bonding time that you immediately have with your newborn. When he was born, I was able to put him on my chest momentarily but then he had to be rushed off in an isolette to be prepared for his stay at the hospital until the doctors could perform the surgery he needed.  He was staying in the neonatal intensive care unit (NICU) at Children’s – St. Paul, which has private rooms. I am grateful for this because it allowed me to stay in the room with him around the clock.

I wasn’t able to hold him for the first week of his life due to his condition; however, I was able to hold his hands and feet or rub his head. After his surgery, I was able to hold him the next day. This was special because I got to hold him skin to skin; I held him for three hours straight. It was relaxing and soothing for both of us to be able to have this closeness, which we weren’t able to do at the beginning of his life. I continued to stay with Azarias in the NICU, and each day I would hold him once or twice using skin-to-skin – anywhere from an hour to three hours at a time.

The doctors told me that he was doing excellent for his condition. Not only was he gaining weight at a good pace, but he also was moving along quickly for what he was able to consume and digest.

When I’m holding Azarias skin to skin, I don’t even notice the time fly by; it’s such a relief to be able to help calm and comfort him just by this simple action. Kangaroo Care truly is a tranquil experience for parent and child and has helped us build a lasting bond with each other. I believe that being here and holding him skin to skin has made a difference in Azarias’ ability to recover and heal from this whole ordeal.