1/12 Ozy AMPS-249,+5.5-212,+6.5-267,+9-230

Status
Not open for further replies.

donaleen and Ozy

Member Since 2013
Previous http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=111700

Ozy had a bad night. Pretty certain he is having pancreatitis. His glucose has been high. Should I raise his dose again or not? Should I give him R or not?

Update: .1U R at AM+1.5 Bupe@AM+2 (dosing every 8 hrs now); his lip looks so painful from the Eosinophilic granuloma. He seems to feel pretty good after the bupe took hold.

1/12 Ozy AMPS-249,+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-267,+9-230

Update@AM+7.5 - failed subQ fluids. Got very little in him. Will try again later.

Famished today. Begging to eat all the time.
 
Re: 1/12 Ozy AMPS-249 dose? R?

i guess i'm reluctant to try the R unless I see him rising. If you test again in an hour or two and he's on his way up, we *could* try it. the fact that he's lower now than he was 6 hrs ago would make me think this isn't the right time yet to try it.

i don't think i'd raise his dose either, not when he's possibly just having a temporary flare. i think i'd hold the Lev dose and see if whatever is making him feel yucky, ie likely pancreatitis, is going to resolve later today.

let's see what others think, but that's my 2 cents worth.
 
Re: 1/12 Ozy AMPS-249 dose? R?

Shooting now.... so any advice would be for tonight or for later in the cycle. Thanks, Julie.

He had almost 13 days and I imagined his islets healing and now they are shot again.

And btw, I now wear my camping head lamp when I shoot him. Makes it so much easier to see through all that hair....
 
Re: 1/12 Ozy AMPS-249 dose? R?

on the other hand, he's had 13 days of great numbers and several dose reductions have held and only a few hours of higher numbers. :-D

it's just a blip! he'll come back down. :YMHUG:
 
Re: 1/12 Ozy AMPS-249 dose? R?

I see Ozy's +1/347. This is a perfect time for you to try the 0.1R if you want to Donaleen. You'll want to test him every hour for about the next 5 hrs so we can see what he does with it.

It takes longer than a day or two to harm the islets. I'll look to find the info for you, but it is sustained highs for several days. Like over 500. i'll find it.

do you want to try the R now?
 
Re: 1/12 Ozy AMPS-249 dose? R?

great. we might see one of three things. if he was on the rise and going higher, it might just hold him flat. it also might pull him down. it also is a very tiny starting dose that we use just in case he's very responsive, which some cats are, so it might not do much.

that's what you're going to test to find out.

from what he does, we'll learn how sensitive he is to the R.

try not to worry too much about his high numbers. look again at BK's spreadsheet - how high he was and for how long, and be encouraged that he still was able to heal and go off of insulin. :YMHUG:
 
Re: 1/12 Ozy AMPS-249 dose? R?

Things are not good at our house. This is very hard for me. To see him go backward again. I should have left him at 5.5 units and propped him up. Whatever kind of resistance he has, this is how it works. Call it what you will.
 
Re: 1/12 Ozy AMPS-249 dose? R?

oh - and i meant to add, the three cornerstones to treating pancreatitis are to treat with insulin, give him pain relief (bupe) and give subq fluids. you're doing the first two - i think i'd add the subq fluids. if you can only get 50ml at a time in him, i'd give it every day, especially when you see he's not feeling well and you suspect pancreatitis.

the only way we could get subq's in punkin was to do it while he was busy eating. we could only give it as long as there was food in his dish, so we'd give him about 3oz of food and make it soupy to last longer, then put the food down when we were all set to poke. maybe that strategy is one that would help with Ozy. you just want to separate the fluids from the insulin injection by a couple of hours and not poke in the same exact spot.
 
Re: 1/12 Ozy AMPS-249,+1-347,+2.5-283

ok, so 0.1R and he's come down 64 points in an hour. we want a nice slow drop. 50 points an hr is plenty. you might give him a little bit of regular food to slow him down a bit.
 
Re: 1/12 Ozy AMPS-249 dose? R?

Hi there ~O) :cool: ~O)

I'm just catching up here (any running a quart low on ~O) )

Like Julie advised, since this is your first time using R test every hour for 5 hours.
Then you will have your baseline which is very important and will help you in making future R dosing decisions, should you ever need to use R again.

Ozy has made great progress Donaleen, IMHO progress that would not have happened had Ozys FD been treated by his vet,

Just for some perspective -
You are just about 6 months into this. When we were 6 months in, BK had not yet seen double digits.
I would have given my eye teeth to have made such fabulous progress!

I don't know much about p-titis however it is another 'moving part' in the puzzle of Ozys treatment.
You will figure out the particular nuances of Ozys p-tits and the treatments that work best for him.
Then you will be able to fine tune things some more. It is a process.

The future is always unknown, there is no way to predict what a day will bring.
Personally, learning to find and focus on 'the bright spot' was and still is is critical to the preservation of my sanity.-
Developing this habit gave me a powerful tool to persevere in the face of all we went through with BK. . .
and all the other curve-balls life relentlessly threw our way in 2009. . .

Don't despair-
Keep Calm and Carry On - we are all behind you. :cool:
 
Re: 1/12 Ozy AMPS-249,+1-347,+2.5-283,+3.5-254

Donaleen --

One cycle of higher numbers does not mean that Ozy's pancreas is "shot." Take a look at Gabby's SS. There are times when she's doing great. And then she'll throw me yellow cycles and recently, pink cycles. And then, she gets back on track. Even though I know that from the standpoint of physiology it's not the case, I tend to think her pancreas just gets "tired." Even with cats that are pretty steadily going down the dose ladder, there are times when numbers may be higher. If you twist yourself up in knots every time you see a cycle of less than lovely numbers, you're going to be miserable and Ozy will sense your stress. If Ozy is having a less than great day, go out an do something fun or get a good night's sleep. You won't have to test all that often if you know he's sitting in yellows.

A very important point to remember is that Ozy is a cat. It's his job to be unpredictable. None of our cats read the rule book let alone follow the rules for managing feline diabetes. If they did, there wouldn't be a need for this board.
 
Re: 1/12 Ozy AMPS-249,+1-347,+2.5-283,+3.5-254

(((Donaleen)))
Lucy is having a pancratitis flare this morning too. :smile:
So I feel your pain.
You are giving him bupe and cautiously giving him R, and he will get better.
It is impossible to predict when a pancreatitis flare happens, we both caught it early and I think we did good under the circumstances.
Now we'll just have to wait for it to pass, like flu, even though it's hard on us to see our kitties suffer.
As long as we help them deal with the pain, and make sure they eat, pancreatitis will not kill them, and the flare will pass.

When Lucy's not doing well, like this morning, I tend to fuss too much.
And I'm sure Lucy senses "NG" vibes oozing out of me, and I'm afraid she might think she's doing something wrong.
So.... I usually escape to a nap.... only way I can stop myself from falling deeper into negative thinking.
I am terrible at shifting my focus and go have fun in times like this, I can't even read a book.
Good thing we are almost always sleep deprived.

Sending prayers to Ozy.
I am praying both our kitties (and Dyana's J.D. too) recover from this flare quickly.
 
Re: 1/12 Ozy AMPS-249,+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5

and now he's down to 212! looking good! we don't want to go so much R that we're yanking down numbers because that can set up a rebound cycle.

so far, so good. will watch for your 3:30 post too.
 
Re: 1/12 Ozy AMPS-249,+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5

How do you know if it is the R or the Levemir bringing him down? Or even the pancreatitis subsiding? How would you characterize his response to R? Average? Sensitive? Less sensitive?

You said we should give him 50 ml of subQs daily....just now or all the time?

Planning on doing that this afternoon. John is having a lay down now.
 
Re: 1/12 Ozy AMPS-249,+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5

it wouldn't hurt to do it all the time, but i'd especially give him fluids daily when you think he doesn't feel well. his pancreatitis seems to be the chronic kind and it'd be super if we could head off a flare-up.

a nap sounds like a perfect thing to do. it's a gray day here, add in Sunday afternoon and VOILA - nap time!

eta - let's see how the R plays out!
 
Re: 1/12 Ozy AMPS-249,+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5

Some thoughts right off the top of my head- :cool:

Interesting results; I expected more movement-

We have repeatedly seen the effect bupe has on bringing down his BGs, likely being relief from pain..

How much pain is he in today? Who knows?

Can these results be useful in gauging Ozys pain in the future? Could be. . .

When considering the results of this R trail an R dosing decisions in the future, it's very important to remember it's context.
If say, Ozy was not in pain and just heading for a garden variety bounce you wanted to take the edge off of, the same dose may have very different results.
 
Re: 1/12 Ozy+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-

Well it seems to be losing its effectiveness.

So is this an average response or not? I am not sure what you meant.

And I want ALL the thoughts, not just the ones on the top...
 
Re: 1/12 Ozy+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-

you want ALL the thoughts, eh? what if they aren't brilliant?! i'm feeling the pressure! ;-)

my thought is that he was on the rise. i think it kept him flattish when he might otherwise have gone higher. looks to me like it petered out around 4 hrs.

i guess i also think that when the same circumstance happened again, we *might* try 0.25u, but really, the goal of R isn't to pull down more than perhaps 50-100 points, so even holding flat i would call this dose, today, successful. For today, i think the 0.1u was enough. It lowered the range enough that the Lev will be able to be more effective. The disadvantage of a higher dose is that potential to cause bouncing. So maybe this did enough and a 0.25u dose trial isn't needed.

With punkin, while the R was in and out in about 4 hrs, the real benefit was in the next couple of cycles. consider that the range Ozy might have been in today could've easily been 400's, given how he was rising. of course, none of us has a crystal ball to know what would've happened if you hadn't shot the R, but you were giving it because you saw a significant rise and could predict that it was likely to continue. So now Ozy's Lev is working on a 200's range instead of what might have been a 400 range.

Punkin didn't really respond to the 0.1u dose. so i'm thinking it's a bit surprising that it did as much as it did with Ozy.
 
Re: 1/12 Ozy+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-

donaleen and Ozy said:
And I want ALL the thoughts, not just the ones on the top...
:lol: :lol: :lol: :lol:

I often fire off 'top of my head' thoughts/impressions so that I don''t risk losing them.
I've got to get dinner started right now however will be back with any further thoughts. :cool:
 
Re: 1/12 Ozy+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-

Thanks Julie and Sandy.... on the other hand, Ozy seldom goes into the 400s, and hopefully going there is not a new trend. Ozy is more likely to just get very resistant to leaving the pinks and the yellows. That has been my experience with him in this past six months, anyway.

It did look like he came down from the R, given the time frame he came down.

I understand that this stuff is an art, not a science. I get that. But I do have some questions.

You didn't want to try the R until he was pink. That was a kind of cautiousness. But, seeing how he responded, why not use it in the yellows? For example, he was 247 @AMPS. Why not use it then now that we see his reaction?

And, should I have used it when I saw that 374 in the night (that is, now that I have tried it, etc)? I understand that I would have to stay up and test, just like today.

I also understand that you have to take into consideration his nadir, which is late in the cycle. Don't want to shoot R in nadir vicinity.
 
Re: 1/12 Ozy+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-

Hi donaleen and John

Glad you had a chance to use R when there were folks around to watch and help. I actually think this was a decent response to R. As Julie said, you do not want to yank numbers down. I might be tempted to stick with the 0.1uR for a bit when you need it. I have discovered with Gracie that her response varies and I know Jill also has seen that with Alex. Sometimes it barely changes the BG. Other times, it really brings them down. What you are looking for when you use it is a very rapid rise. Does he have to go into pink? No...I've used it frequently when Gracie shot up into yellow but I look for a really rapid rise that tells me she is starting a bounce. But remember if he rises quickly but only to 250, for instance, when you give the R, it has the potential to bring him down quite a way so you must be really diligent....which you always are.

I also found the first several times I used it, Gracie would go right back up when it wore off. That appears to be what is happening to Ozy tonight for various reasons....he doesn't feel good, it busted up some of the counterregulatory hormones but not all, etc. I have also found that when it brings them down and they don't go back up, it's wise to be prepared for lower numbers the next cycle. It's as if the R opens the door and tells the levemir to get to work and do your job!!! :lol: :lol:

On the fluids.....I wouldn't give them every day. I'd only give them when he needs them. The best way for a cat to stay hydrated is to drink water on his/her own. If they need hydration support, then it should be given. But if they don't need it, you shouldn't give daily fluids. You might not be aware but 50 mls of fluid is only 10 tsps.

And, finally, I read an article that further supports what Sienne said about the pancreas needing a break. It said when numbers first come down to normal and the beta cells start to heal, they are fragile. Because they are fragile, they can stop working. So I think that the longer a kitty stays in healing numbers, the stronger the beta cells can become until they are ready to take over the job and provide endogenous insulin.

Sending many healing vines.
 
Re: 1/12 Ozy+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-

Thanks Marje. That all makes sense.

10 tsp for someone his size seems like a bit.. Ozy seldom drinks water now that he is on insulin. None of our cats drink much water now that they eat only canned food.

We really haven't come up with a great system and location for fluids. Our earlier attempt today was not successful. The spot we have been using is too low and doesn't give us good access to him. Tonight I tried setting things up at the kitchen table. I put his favorite cardboard box on the table. We put him in it. We just petted him and scratched him while keeping him in the box. Then we gave him a treat and praised him and took him out. While he was in there we worked on the logistics. I think we need to get him used to that. If we gave him fluids pretty regularly, I think we would all do better with it. We would all be used to it. None of us wants to do it, really....

Thanks for the vines.
 
Re: 1/12 Ozy+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-

my understanding is the higher the bag is in relation to the cat, the faster the flow goes. i think i heard that on here somewhere, but we did find that it seemed like it sped up the fluids when they were high.

we took a hangar, put the bag through the hook part, then hung it from an interior door. put the food bowl on the floor and one of us knelt down to poke and hold the needle while the fluids were going in.

the other person (usually me) stood up so we could see the fluid level in the bag and know when to stop. i usually held the thing that cut off the tubing and stopped the flow. DH had a paper towel in hand so that when he withdrew the needle, he would use it to catch drips.
 
Re: 1/12 Ozy+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-

No....10 tsp isn't much. Just a little bit more than 2 tbsp. Ozy is much bigger than Gus and Gus was getting 150 mls/day for a couple years. Of course he had CKD, but I've seen CKD cats who got 200 mls bid.

Have you seen our video? We bought a cat condo with a sling type of bed that comes to my chest height. We then spent $35 and bought a rolling IV stand. I think that might have been the best $35 we ever spent. With Gus at chest height and the IV stand extended, it was a really nice drop. Yes..the longer the drop, the faster it goes but it also depends on the needle size.
 
Re: 1/12 Ozy+1-347,+2.5-283,+3.5-254,+4.5-277,+5.5-212,+6.5-

I'm going to respond to this before I expand on my earlier thoughts. . . :cool:
donaleen and Ozy said:
You didn't want to try the R until he was pink. That was a kind of cautiousness. But, seeing how he responded, why not use it in the yellows? For example, he was 247 @AMPS. Why not use it then now that we see his reaction?

The short answer is I'm not convinced he needs it.

The long answer (my $0.02)is-

I believe in very prudent use of R.
The kitties whose caregivers I've shared my experiences and learnings regarding safe and appropriate use of R fall into 2 categories: Kitties like BK, who suffered from extreme insulin resistance (a condition that requires very high doses of insulin for any new folks following this) and kitties who are fighting ketones (regardless of dose.)

With regard to IAA kitties like BK and Ozy, the following 2 items stay at the very front of my mind - always:
1-The release of insulin from the antibodies can happen at inopportune times
2- When insulin sensitivity returns, it can happen quite suddenly.
3- At these times, large amounts of insulin previously bound to the antibodies may be released, so avoiding hypoglycemia is a major concern.

Sobering stuff.

There are certain low dose kitties who benefit from R, however I can’t speak to that as it’s not in my experiences.

I can say that I've seen it mis-used many times. Caregivers get caught in an endless loop of ups and downs with the waters getting so muddied the only way to know if the basal insulin dose was effective was so stop the R entirely and let the dust settle - definitely double strait-jacket stuff here - painful to wait out.

Speaking for myself only - R should be used prudently, when not doing so would place the kitty in danger, as in IAA & Acro, or in the presence of ketones
When the benefit clearly outweighs the risk. I myself would not take medicine I didn't need . :cool:
 
So you are saying R is not for Ozy? Well, I am not real pro-R. I would be happy to never use it. But what is for Ozy when he gets stuck in the yellow and pinks? How should he get out of them? I was hoping R would keep him from going up the dosing ladder.

I guess it depends on whether he comes down from where he is to normal numbers WITHOUT raising his dose. When the antibodies let go, a little R that wears off fast seems safer than a huge depot.

I feel like I am at the mad hatter's party where I am told every cat is different, you have to have history, only the last two weeks matter....

I think I need a time out.
 
I'm saying that since I've been following Ozy, I have not seen a need to use it.
I'm not saying I will always feel that way. Things change and it's important to change with the circumstances.

Coming in cold back on 12/27 (?) or so, all things considered (change in insulin, dose, the absence of ketones), I felt the best path would be to carry on with the Lev increases typical of a high dose condition until reaching a good dose.
Which Ozy did quite marvelously. :mrgreen:And along the way, it became apparent that there is a direct connection between pain and BGs for Ozy. That may not have been apparent if R was on the scene

donaleen and Ozy said:
But what is for Ozy when he gets stuck in the yellow and pinks?
I have not seen him stuck in the yellows and pinks. Looking at the past 14 days on his ss I see cool blues and greens prevailing. :mrgreen:
donaleen and Ozy said:
I was hoping R would keep him from going up the dosing ladder.
IMHO, R use for an IAA kitty is to keep kitty safe.

Also, Ozy currently has been going down the dosing ladder. . . . :mrgreen:

As important as it is to figure out when to use it, it's just as important to recognize when to stop using it, as well as when not to use it.

These are just my thoughts based on my experiences. Right or wrong, that's all I can, in good conscience, offer.
 
It just occurred to me Ozy has been (with the exception of R+5) pretty much flat yellow. . .
some say that can signal activity ahead. . . . :cool:

How is Ozy doing today? Are you able to get ahead of what I presume is greater pain than usual?
 
Okay, I need a time out. As supportive and wonderful and helpful as you have all been, this is still stressful for me. It is just very intense for me. It just is. Thanks for getting us here and celebrating our good times. Thanks for all your time and all your caring.

I will keep up my SS but I need a break from posting.

donaleen
 
You don't have to post but I have to tell you this.

You don't use R to keep from increasing the basal insulin dose. My comments here are in regard to R users in general and not those using it for IAA or DKA. But if you have to use R very much, the basal insulin dose probably needs to increase. Remember it is just a bolus.
 
You need to push harder for IAA kitties, and if it means fighting with R, then so be it.

In general, cats get reductions if the hit below 50 but with IAA cats, you need to get a couple numbers in the 40s, and even then your decrease will be in the drop amount.

From looking at Ozy's ss, the dose is rising, and it needs to be held in place. You can't let up for a second because the resistance will pull you up again.

You may need to have a sliding scale set up for your use of R; you should be considering R at ps times, especially if you are in the 300s as they are much too high.

IAA is harder to handle that acromegaly because you really need to push hard into the lower numbers, or your dose will just keep rising higher and higher.

Gayle
 
donaleen and Ozy said:
Well, I am totally confused by all the different things I've been told about IAA, about R, about Ozy.
I am too. I know everything is ultimately up to the CG, but there's a lot of conflicting info out there tonight.
 
You can tell the difference between cats who are IAA only and one who are acro or acro and IAA.
IAA cats have more of a roller coaster in their numbers..... IAA CAN be beaten, but you cannot let up on the numbers or before you know it, you will be over 10u and higher, and it's very tough to beat back IAA.

There is an IAA cat who is quite close to OTJ with his current dose at 0.5u but it was once over 10u.
It has not been easy, and it meant pushing to the 40s.... not for the weak of heart for sure.

IAA cats are like a hummingbird, flitting here and there, and you can't know for sure what they will do.
Acro cats are like semi trailers, and you can tell what they are doing because you can't move that fast with a big trailer.

If you have not been advised to have some R on hand, you have been lacking in guidance because it's helpful for your cats to have R in the toolbox for all insulin resistant cats.

One of my cats was acro only, and the other was positive for acro and IAA.

Gayle
 
Gayle, if you're going to give advice, you must spend the time and understood a cat's history first. it's clear you haven't even looked at Ozy's spreadsheet, which is critical to give advice that is safe for a cat. Advice given without context can be dangerous.
 
Gayle,

If you have not been advised to have some R on hand, you have been lacking in guidance because it's helpful for your cats to have R in the toolbox for all insulin resistant cats.

I believe Donaleen does have R on hand, and if you scroll up towards the top of the condo, she did use it on the 12th, I think for the first time. I haven't been around much since then, so not sure if she's used it again. (I don't see any notes on the SS if she has.)

Carl
 
julie & punkin (ga) said:
Gayle, if you're going to give advice, you must spend the time and understood a cat's history first. it's clear you haven't even looked at Ozy's spreadsheet, which is critical to give advice that is safe for a cat. Advice given without context can be dangerous.

Julie, please never assume.
I have looked at Ozy's ss. A few times over that past while. Why would you think I have not looked? Please clarify your odd assumption.

I do know that you don't have that much experience with caring for several insulin resistant cats, so I am hoping you can point out what words of mine are incorrect?

My words on R were directed at the 400, in the middle of the cycle, so can you point to my dangerous words please?

If Ozy is ill, as I figure from the comments column, would there be a harm to suggest TOR for that 400?
My posts are not dangerous.

Gayle
 
Several times I have lost control of Ozy's numbers when I reduced. It seems Ozy does not have a good dose. A dose is either too high and he goes low or it is not high enough and then I get what I have today.

Ozy got sick on the 11th. I believe he had pancreatitis. Not a severe attack with throwing up and diarrhea (he hasn't had one of those since I started B12) but he was escaping into sleep, lethargic, his appetite was off. I think he is past the pancreatitis but now I am left with the high numbes and how to get him down and how to keep him down because when it gets away from me, this is what happens. Pink, pink pink and the longer we go, more red. He goes red more easily these days than he used to.

I don't understand how to use R for him. Sandy said not to use R. I feel like I have to bush whack my own way for him.
 
Sorry to say that not using R for an IAA cat is weird advice.
I am unclear why you would be given that advice because the other IAA only cats I know do make good use of R.

I see Ozy's dose rising on his ss, and not much improvement, but just from caring for another IAA cat, Harley, I know that R can be useful. Harley has come down from over 10u to a current dose of 0.5u, and that's with higher numbers from a pancreatitis flare.

Once you know how YOUR cat reacts and utilizes R, it can be very useful.

Gayle
 
Blue said:
Sorry to say that not using R for an IAA cat is weird advice.
I am unclear why you would be given that advice because the other IAA only cats I know do make good use of R.
I'm sorry to bump this old condo again, but I feel a need to address this one statement.

I found this thread very confusing until I realized that the condo is from last week. Sandy's advice to not use R was spot-on at the time she wrote it. Ozy had been running in blue/green for almost two weeks, was getting reductions, the one pink number came after a delayed shot, and he came down to green again on his own in just a few hours. I wouldn't have suggested R at that point either.

A week later, Ozy's numbers have changed, but the advice was not "crazy" at the time.
 
Blue said:
Sorry to say that not using R for an IAA cat is weird advice.
I am unclear why you would be given that advice because the other IAA only cats I know do make good use of R.

I see Ozy's dose rising on his ss, and not much improvement, but just from caring for another IAA cat, Harley, I know that R can be useful. Harley has come down from over 10u to a current dose of 0.5u, and that's with higher numbers from a pancreatitis flare.

Once you know how YOUR cat reacts and utilizes R, it can be very useful.

Gayle

Yes it sure can
 
Status
Not open for further replies.
Back
Top