Intervention - RA Patient abusing meds?

[ErinENj]

Hi everyone,

I'm going to try and keep this short since I have an early day tomorrow (well, technically today) but I wanted to post this when it was fresh in my mind.

I watch a program from time to time called "Intervention" on the A&E network. Tonight's show was about a 26 year-old woman named Brooke, who is "addicted" to pain medications.

What I immediately thought when I saw the start of the show was, "who says what is too much? where is that line?"

Here's a link to A&E's site where you can find a synopsis of the show and I think maybe video also (it premiered tonight, so it might not be available right now, but I'm sure by tomorrow it'll be posted): Episode Guide for Brooke's show (http://www.aetv.com/intervention/int_episode_guide.jsp)

Please, if you have a moment, take a look at the show. I'm interested in seeing how all of you react to this show and the way they present her story.

Here's what I've gotten so far - It's 1:21am, so I'm less than halfway through it, so I won't spoil the ending -

Her story: 26 years old. The show says she has RA, but also that she has tested positive for Lyme's disease. One of the things that kind of upset me was when the producers interviewed her parents, they both said that Brooke decided that she was going to listen to her local specialists and continue under the diagnosis of RA instead of 'treating' the lymes. Her father even said something that created a sudden urge to smack him upside the head - he said that Brooke doesn't want to deal with pain and wants to get to be a 0 on the 0-10 scale.

How many of us are in that same position? I'd love to have a zero! Here's where a little of my ignorance comes in - does lyme's create very similar symptoms to RA? Also, I thought that if you aren't treated for lyme's quickly after getting infected, it doesn't go away, even with treatment. Am I wrong on that? (not sure. I remember hearing something like that, but I could be getting my facts messed up).

Here's her daily medication cocktail, according to the show: Two Oxycontin (looked like the 80mg version, but I couldn't tell for sure since I only got a quick glimpse of the pills; they were the blue ones, if that matters any. It's been awhile since I took that), 12 muscle relaxers (no specific type given), and 12 Lortab. No specific milligrams were given, but it may be possible for someone who has been on these meds to tell what size they are by seeing them.

The show does use clips to illustrate that sometimes she can't stay awake or even collapses and falls on the floor. While I know that the majority of the time, being in that state means that you are taking more than your body can handle and maybe that she's abusing them.

I just saw that in the past, her parents have taken away all of her medications and tried to detox her themselves, and even gone so far as to have her committed to a psych ward. The show took two segments to allow her parents and family to explain that she got the attention when her illness started and that she continues to get attention with her condition, like she's using her pain to get the attention she's always wanted from her father but never got.

The producers aren't helping the image of chronic pain patients - a few quotes from the show: In a statement shown on the screen - "Prescription painkillers cause more drug-overdose deaths than heroin and cocaine combined" quoted from the CDC; "Pain medicines only work for a short time and then it turns into addiction" from the intervention specialist preparing the family for the actual intervention; "She doesn't want to be in pain," said by her mother in a tone that seemed to say that that was an unrealistic expectation.

The big question to me is what is too much? Where's the line? Is it totally unrealistic to strive for little or no pain? Who makes that detemination?

This may be a totally incomplete description of the show, but I wanted to bring it to all of you to take a look at. In my opinion, it's another show promoting the negative side of pain medication without giving the other side. I hope that she gets the help that she may genuinely need, but these people aren't really thinking about the pain and what it is like to live in her body when she can't move, can't bend her knees, can't even turn the key to unlock her door because her joints are that uncomfortable.

I don't know. I could be wrong on 3/4 of this stuff. I just thought it would be interesting for all of you to see and read your reactions to it. Sorry if this post seems somewhat disjointed and rambling, but I have already taken my sleepy meds and they've started kicking in. Thanks everyone for getting this far!! I hope that you get a chance to take a look at the show and look forward to reading your impressions and opinions!

[GardeniaGirl]

I really wanted to see this, but my recorder may have not recorded it.

When I saw the previews, I was very concerned about whether this girl was on immunosuppressant medications for her RA (Enbrel, methotrexate, etc)-- those are the mainstay of RA treatment. I was doubtful that the show would even discuss that aspect of her treatment- whether she was on those meds, whether they were working at all for her, etc.

I was thinking, this show is going to sensationalize the addiction to pain meds aspect and totally gloss over the serious problems of chronic pain. I wasn't sure I would even be able to watch it because of that issue.

I wish we could get chronic pain out into the media the way a topic like addiction is.

as an aside.....

I should add-- what I wouldn't give to be able to "transfer" the feeling of being in my body to other people. Imagine being able to transfer this over to a doctor, who could feel our bodies for a few hours. Or to family members, friends, etc.....then I wonder how many times we would get comments about how we need to learn to deal with the pain better.

[brians2000]

I watched most of the show but I missed the first 7 min. I didnt hear what she actually took per day but during the show I did notice her taking quite a bit of pills. One scene she took five pills of some sort at one time and then when she was found passed out on the floor she admitted taking two extra pills that night. She was diagnosed with RA but she was also told her test came back positive for Lyme disease. They said she didnt believe those test but instead stayed with her pain meds. One time she opened a little box and it had about four different bottles of pills. I don't know if they were all pain pills because it didnt say. She did look drug out all thru the show. I was just wondering how she got all those pills. I have a certain number I can take per day and if I take too many I do without. She never mentioned running out so I guess she got them either from a doctor or someplace else. Anyway the guy at the intervention was an addiction doctor and also a pain management doctor. He told her parents she is taking the pills because of chronic pain that she needs to get thru the day. During the intervention he told her he is not there to take away her pain meds but to help her threat her pain better. He told her there were new ways and new meds to threat her pain. She is still at her 90 treatment center but they said she is doing much better controlling her pain. I know when I first went to the doctor who is treating me now he asked what i was taking. I told him 4 to 5 lortabs per day and he said he didnt like me taking those long term and suggested a long term pain med such as Oxycontin or something where I wouldn't have to take pills all during the day. Anyway that was almost six years ago and now I am on the patch. Hopefully she is on the patch or something that will control her pain better. I don't think they will cut her off because you could differently tell this girl hurt just watching her get around. I actually thought this was a pretty good show because the pain doctor told her parents and family that she needed something for pain because of her chronic pain. Brian

[simby]

the guy doing the intervention and the doc were great.

If you are going to watch it, don't read this paragraph as its a spoiler
The doc stressed to the family that the rehab will deal with both issues - severe, uncontrolled pain, and the abuse of the meds.
He really made the family look at it through Brooke's eyes.
The doc also stated that "15% of people with cp like Brooke's commit suicide".
I was glad that the doc also said "It's not like she was going out and doing heroin. This is different - she does NOT need to go to a rehab with addicts. Rather, a rehab that deals with chronic pain issues.


I don't know about the oxy's - but i take 12 vicodin a day and its not much better at pain reduction than 16 advil that i took for a year before being treated right.
If anything, i find it hard to sleep. I don't pass out on the floor. IMHO i would think its all those muscle relaxers and also that she is taking more than she lets on.

anyway, good show. I just hope i never have to appear on it.

Which makes me wonder = WHAT WOULD YOU DO IF YOU WERE BROOK WALKING INTO THAT ROOM????

sims

[Mark N]

Brian and Sims, thanks for the report on the show. It is good to hear the doctor brought up issues of CP and her need for proper pain treatment. It doesn't sounds as if they put CP in a bad light and maybe even educated some people about the need for pain medication for CP.

[cindybear]

I felt very sorry for her, she had no family support, They all just thought she was an addict,,,!!! But you could tell she was suffering,,And if they put her anywhere else but where she went,,I would have been upset..I watched the whole program..And yes, she seemed to be out of it,,I take alot of meds, but never act like that,,Allways alert. But I do not take muscle relaxers either, so I do not know how they affect a persons body,,But I would think, like most drugs, Your body gets use to them,,and they just help your pain or ?? your spasm..?? Etc...But I hope she finds the right combo that she can have somewhat a life and still have her family be supportive..But her family (imho ) was way off...Hugs, cindy

[Annie B.]

Hi all,

Long time since I posted and unfortunately, I have time to post my initial thought only. As one in recovery (successfully for the past 5+ years, one day at a time), AND with a chronic pain condition (due to my past ETOH abuse), I first viewed "Intervention" with critical and very wary eyes. I was very pleasantly surprised though and think that it is very well done; in fact; one of the best constructed and researched pieces about the beginning of the recovery process I've ever seen on television.

I agree with one of you--the interventionists are all wonderful. They are all in recovery themselves.

I believe that unless a person breaks their own anonymity, that only one recovering addict can recognize another.

Remember though, that this show is about Addiction and Recovery. (It's also about money in AE's pockets.) It is not about Chronic Pain, or Anorexia, or meth, or X, or heroin, or gambling... It is about the emotions and processes that have led those who suffer into the bowels of hell and the hope that intervention can SOMETIMES give to help a suffering addict.

The horrible statistic is that most of us will not make it. There are only 3 places for the addict (recovering or active) to end up: Jails, Institutions, or Death. I prefer Death. But I prefer to die as a sober member of society. I try to remember, to not credit this show for more than it is. It comments on addiction, not specific problems, drugs, conditions, etc...Although it may talk about these things,it is where these things get us that is the topic of the show. I believe, in reading up about this particular show, that of all the people profiled, 26 are sober since their interventions and treatments. It may not seem like much, but these 26 people, all with their unlimited potential, may have been dead by now, or may have been responsible for the deaths or injury of others if not for the loving hand of their families, and other addicts and alcoholics reaching out to them. Most of all, to speak very personally, and for myself only, I am certain that this would have been me, if not for the loving hand of God as well. I hope that this discussion continues in a positive way and without flaming.

xoxo,
Annie B.

[sandi1016]

I watched the show last night too and I may take an unpopular stance, but she was abusing her pain medication and her father also said the same thing. Admittedly, whatever her painful condition is, the RA/Lyme's or a combination of both ( yes the symptoms do mimic one another-painful, inflammed, swollen joints and the rash she developed indicate Lyme's), she repeatedly was taking more medication than she is supposed to be dosed at.
I dealt with RSD for over 7 years, was on methadone, fentanyl patches ( 3- 100 mcg patches every 48 hours) and several muscle relaxers, and breakthrough meds, and I was never, ever stoned as she was last night.
There was also commentary from her family that she sees several doctors who do NOT know what the others are prescribing for her.
I am not perfect, far from it actually, but there is a difference in taking pain medication as needed for pain and taking it as she was last night on the show.
Do I think that zero pain is unrealistic? Yes I do. I think that we all have to readjust our views of acceptable pain levels in our new lives. We all suffer from a chronic pain condition. That is a fact. It is also a fact that we may never be pain free as we were before our condition began or worsened. What we can do though is learn to work through the lower pain level days, and adjust our lives/thinking so that we can handle those lower pain days without relying on pain medication to bring it down to zero. We are never going to be the same as we were before, now we have to adjust to our new normal....I would be happy to get mine down to a 4 or even a 5......
I think when we look at our pain levels and wanting a zero, we are setting ourselves, our doctor's and our expectations of pain management too high.
Sandi

[Maggie]

I would love to have heard more from the Chronic Pain Addiction Specialists. He sounded like he understood so much more than most Pain Doctors do. Even the young lady was surprised that he had gotten through to her family and made them realize that she has to take medications for her pain.

She took many medications for the RA that she said were free samples because of poor insurance. Anti-inflammatories, etc.

She definitely was over medicated and broke all the rules as far as going to multiple doctors to get the meds. I think not being understood by her family made her even more desperate to get all she could. If they would have acknowledged that she had pain, I think she would have been more able to adapt to a more acceptable treatment method. It is in the process of being validated.

A really good program.
Maggie

[Sara1979]

ITA Maggie, well said.

I watched it a few hours ago and had to think about what I really thought of the program overall. I really wish they would have given the Pain Manage/Addictionologist more air time. I think on one end they were just showing her as an addict up until the very end when the Pain Management/Addiction Specialist was given a minute or two to explain things and tell the family she will need pain medication to control her pain.

I re-watched the initial scene were he was telling her family that she needed pain meds and they were all rolling their eyes and looking at each other at first. So there was definitely more there than was shown. They showed a total lack of understanding on their part. I don't think anyone can ever really understand what it is like unless you are a CP Patient but they were just really going with the drug addict she can be cured and just doesn't want to be approach. I also don't understand why they couldn't have provided her a chair or wheelchair so she could still be a bridesmaid at her sister's wedding.

I absolutely think she was very over-medicated but obviously in severe pain. It definitely didn't help that her family really had no understanding. They just kept saying I want the old Brooke back. "She used to be so active and a cheerleader." Well, I am sure Brooke would like the old Brooke back more than any of them. They definitely need to understand that her life has changed. She will have limitations and will never be "The Old Brooke." She could be doing a lot better on a better combination of medication and family support. When her BIL said that he can take one Vicodin and be knocked out it really showed that her family had no clue. I am lucky that my family comes from mostly medical professionals and are very supportive. If my husband and family were as cold as her family I really don't know how I would cope.

I think it had to have been the muscle relaxants that were making her so wonky or she was lying about her dosages. I saw a Specialist a few years back and his answer was to increase my muscle relaxant (Zanaflex) over and over to the point that I was literally just asleep all day and night. I have never had that kind of reaction with opiate therapy. I have an adjustment the first few days but I am not falling over and drooling with a high dose of muscle relaxant I was just in bed zonked out.

I am really happy she was able to go to a Pain Clinic so she can get a multi-dimensional support system and therapy. As well as reasonable expectations about pain control. Another thing about the program I didn't like was the show made it seem as if she was getting medication from all of these Doctors but we really don't know that. She could have just been seeing the others for PT or other modalities and receiving her pain meds from one source.

To the OP's original question, for me the dosage is too much when I can't function. A zero pain level is not ever an option. I have learned to deal with a certain level of pain in exchange for coherence.

I really think with a multi-dimensional approach and long acting medication her quality of life will greatly improve. I just hope her family realizes she will always have limitations and will never be the person she once was. If we could all only be that...

[Annie B.]

Is it not possible that this young lady is indeed an addict? Please, I don't want to get into an argument about semantics. Yes, I know all too well, the positions and definitions around addiction/dependence, and really, this thread isn't about that at all--at least the way I read it.

In fact, I really don't know what the main topic of this thread is, but I do enjoy and grow from an intelligent discussion, especially with a topic that hits me so deeply.

If Brooke continues to use medication despite negative consequences, if she doses herself, if she suffers from withdrawl when denied her DOC, if she has exhibited tolerance and the phenomenah of craving, and most importantly, if she is able to see and admit one or more of these things herself (Acceptance often comes much later.), then one might reasonable conclude that she is indeed an addict. OK, no shame in that. So, we move on.

Lack of understanding? You'd better believe it. I don't care how much book learning one has--unless one suffers from addiction themselves, and has enjoyes sobriety (not clean time, but SOBRIETY), there will always be a lack of understanding on the part of others. Don't even expect empathy. I can't fault the non-addicts who love me for not understanding. It's not their fault that they are not addicts. They are not trying to harm me by their comments. They are simply not capable of understanding what the addict feels and is motivated by. They are simply not capable.

My family too, always said, "I just want the old Annie back." Are you sure about that? The old Annie was a drunk. You just didn't know it. She was still really good at hiding it. She was still completely functional. Believe me, NOBODY wants the old Annie back. Let's try for the real Annie. Maybe just as scary, but so much more real and honest. What did everyone like so much about the "old Annie?" She was making money, she was a great mom with fabulous children, had a beautiful home, wonderful job, everything going for her. Nobody saw the hole inside her--the rot where her soul was supposed to be. Nobody saw the reason she drank.

The bottom line is, the "old Annie" was comfortable to look at. She fit in and she made her family look good. What a crock. The "old Annie?" I hope to never ever see her again. If I do, I hope that I recognize that I'm in trouble and get help soon.

My mom is like Brooke's uncle. My mom gets tipsy after half a drink. She's a normal drinker. That's how people are supposed to react to ETOH or Vicodin or whatever. Brooke, if she feels no effect after much more the normal dosage, has built up tolerance, which is one, only one symptom of addiction.

OK folks, I've really beat the dead horse way long enough. See what happens when an alkie in recovery doesn't make a daily meeting? I grab anyone available and hold them hostage. Writing this down helped me to not drink for another evening. If reading my words helped anyone at all, than that's a bonus. If reading my words pissed you off, I hope that you manage to go to bed in a better mood. You'll get a more restful nights' sleep.

God Bless Us All,

xoxo,
Annie B.
(Can't even start to proof this. It's late. I hope that they typos add to the charm here!)

[Mark N]

Annie, you have done a wonderful thing by stopping your drinking and being able to do it every day. I didn't see the show but based on what several that did see the show have said I think she could very well be an addict. But if Sara is right, it wasn't clear she was getting meds from different doctors then she might not be an addict. I think that she was trying to have zero pain is a better indication she might be an addict. We all know that our lives will never be without pain again unless we receive a miracle. I shudder to think how much meds I would have to take to be without pain. I do know I would be in bed asleep day and night to have no pain and that isn't worth it to me.

It does sound like the show brought up several different aspects of this woman's problem and use of pain meds. It is a struggle most of us deal with trying to get our families to understand. I am thankful that I haven't had to much hassle from my family although it took a while to educate my mom.

[brians2000]

The pain management doctor on the show seemed like he really understood what Brook was going thru and hopefully he will find new meds for her to try. Every few min on the show she was popping more and more pills. I know it was just television but I started to wonder how she is getting this many pills. I doubt one doctor will give any of us enough pills to make us pass out and appear out of it day after day. Sure we could get knocked out a few days during the month but then our meds would run out. That is one reason I thought she must be going to more than one doctor or she must be getting them from someone other than a doc. All of us on this forum has been through hades and back to get a doctor to prescribe us something to make us comfortable but I doubt any of us has doctors that would continue to give us bottles on top of bottles of pills each month. I would love to see a follow up show about this girl. I really hope she gets something that would keep her pain levels at a rate she could live with without the need for so many muscle relaxants. The doctor did tell her and her parents that their have been many new meds available today than they were before she got sick so I am sure he will try to help her get ahold of one of the better pain managing drugs. I kinda felt like she was chasing her pain and after a hand full of pills multiple times per day she would get sick. Brian

[GardeniaGirl]

If she has RA, then she needs to be on something to suppress her immune system and control inflammation.

Muscle relaxants and pain meds are a supplement to those meds for people with RA.

My disease is very similar to RA and there is no way my rheumatologist would rely on large quantities of muscle relaxers to treat my pain.

I hope she gets some improved medical treatment as a result of this show.

[Pike]

I have watched the program a few minutes a few times but most programming of this type is IMHO a program for ratings as normal people do not air their dirty laundry in public … I would rather watch the History Channel or other program.

However I know that when many of us begin this journey we encounter the Drs that wish to throw in everything including the kitchen sink and turn our bodies into a hit and miss toxic dump with so many drugs onboard the side effects are unmanageable.

This is a Drs responsibility if and when the patient is compliant.

I went thru this same thing 10 years ago in the beginning and it was not the opiates that would leave me passed out at this desk but the other meds added on in a vain attempt to treat nerve pain and Ambien nightly …

I fought being awake for 2-3 days … no more Ambien except for very rare occasions and my day begins when I wake and ends with 3 hours of sleep … I am never asleep at my desk anymore as I stopped fighting to live a “normal life” … I live.

We should also realize that most of us have evolved with many misdiagnoses and issues that resolved over time, this seems to be when people are new to pain and seek to control our life with meds instead of using our meds to better our life … acceptance can take a while …

In time people will either get into trouble or … learn … how to live with the correct medications and the disease itself, this is often time consuming and can take a while before we accept our life as it has evolved.

Yep I use the cane when I must be on my feet for extended periods, I ride the cart when I go into a large Wal-Mart and wait until I get things put away before I take a pill and sit down to relax … I avoid extreme pain by avoiding things that cause the pain.

I live in disabled and elderly housing so I do get to see people in all stages of their life and disease … most will learn to live with their pain and meds … some may need a little help but sadly even diabetics do not always get the education they need and simply exist until the next crisis situation arises.

I am a firm believer that most people who are in severe pain can live a good life without such issues if given the guidance and time to adapt … if a person fails they either take the wrong med, do not care or do not appreciate the opportunity they have been given.

Family members can help or hinder, few understand or bother to learn how to help the one they love, it is easier to condemn than to assist … ignorance is a mirror image of laziness in some situations.

Learning to make good lemonade when lemons are plentiful is not always easy and must be learned … to prohibit a person from learning to make lemonade can be cruel!

Pike

[sandi1016]

I recorded and watched it again last night. Her family did acknowledge that she has pain , in fact, all of her family members agreed that she does, but what they disagreed with her on , was the amount of pain medications that she was taking a day and on the diagnosis. Her mom said that when she was tested for Lyme the test came out positive but that Brooke decided not to investigate that as a possibility instead decided to continue on with the RA diagnosis. There was also a lot of discussion about the family dynamics and how Brooke felt left out and not as loved as the other siblings until her diagnosis and all of the attention it brought her.....
All of her family members said that she was seeing several different doctors, and that none of the doctors knew what the others were prescribing, and that's where the concerns about addictions were coming from.
Those samples she got from one doctor were because she has lousy insurance( could have been no insurance- noisy kids in the background LOL), according to what Brooke herself said.
I think that her family wants to help her but doesn't know how, and have gone about it the wrong way at this point, but then again, if you were her family member getting phone calls about her being passed out in broken glass or falling asleep with her head in her food, I'm sure that we would be alarmed as well.
Anyway, I hope that when they do an update that she has found effective pain medication that works for her and allows her to resume life more comfortably.
Sandi

[Sara1979]

Sandi, I agree that her family was saying she was in pain but when she entered the intervention room and her mother apologized to her Brooke was shocked. After the Pain Management Specialist spoke almost everyone apologized to her which leads me to believe they weren't being very understanding about her need for medication to control her pain. I absolutely believe she was either using a seriously bad combination of medication or was abusing. She was absolutely overmedicated. As Pike said I don't think she had come to a point of acceptance and what life as a CP'er would mean. Also, it is the same for me. It isn't the narcotics that make me forgetful, gain and lose weight rapidly, or take a nap 2 hours after I got up. It was all of the "alternate experimental meds." I am sure the program Brooke went to will teach her about Biofeedback, Meditation, Stress, how your pain increases if you don't eat a balanced diet and get as much sleep as possible. This is what she really needed, as well as medication.

As far as the Lyme diagnosis her family was saying she could get treatment and be fine and pain free but she doesn't want to. Unfortunately, the damage was done. They showed her hand and her joints were swollen and looked horrible. The progression of her disease may slow but there was obviously some damage that was not going to be reversed. Also, at the end of the show it said her Doctors could still not agree on a diagnosis.

Early on in my Pain Management I received about 10 different diagnosis and 8 ways from Sunday to treat it. All of my Specialists were in the same hospital and were contradicting each other on what I needed to be doing. It got to a point where I went to the Patient's Advocate and they all had to sit down and discuss my case. Then they basically said these are the treatments each of us has to offer pick which route you would like to go for the time being. So sure my family could have easily said "Sara, is ignoring what XYZ Doctor told her to do."

I want to be clear that I think she had a problem. I am not sure what exactly that problem was but I am glad she is getting help. I really wish they would have showed more about her case.

[911]

i will look when i have the chance BUT what i saw written sounded alot like what my ex family thought of me , they all called me an addict , abuser attention seeker , etc well i am none of the above i have psoriatic arthritis for those of you who dont know what it is it is the same as rhuamatiod but diffrent it is an auto imune disorder and my joints have alll been attacked by it , now as for my meds i am on alot of pain meds to but alot of us are i take 5 pills for b/t pain 3 doses of long acting meds and 3 doses of muscle relaxers , i also use just one doc and am on a narcotic contract and have been with the same doc's office since 1997 so they know me and have been a huge help i could not survive the pain i have without them , so it sounds an awful lot like how my EX ( blood ) family treated me , i had to disown them they didnt care , i feel bad for this woman because there is also something called psuedo addiction and perhaps this is her problem , before i got into proper pain managment that was my issue i was what my docs called a psuedo addict that didnt have proper pain meds for my pain managment so i dunno but it sounds alot like what i went thru ,,,,,,,,,,,,,, Dave ,,,,,,,aka,,,,,,,911

[alex44]

Not having seen the show, I can only say this - She needs pain control. to the poster that said a 4-5 was reasonable - I do not agree. If the doctor will work with you , a 2-3 is possible, I am proof and I am not lying on the floor or passing out. I am on around 250Mg. of moraphine Er this includes B/t and I am fully functional. if my doc only got me down to a 5 i would find another. anyway, I am glad she is getting help. from the sound and content of the posts, she needs it. but let us all remember, everyone is differant so lets not judge other people just because they are on x amount of medication. that is between them and their doctor. No one should have to live in pain but it is also true that a 0 is probobly unrealistic. quality of life is what matters, not the meds they are there to help.
Alex44