Notice board is in the main for messages from me when there is no other way to contact you.
But also a few tidbits on how we can improve our well-being without too much effort. Sometimes, everything must change.
Right now in 2020 the coronavirus is radically changing the world as we know it. The most scary part is that scientists are telling us that almost everyone will be infected by the bug within the next year or two. We now have a short window of opportunity to get our immune systems into shape and, if are in one of the high risk categories, make some radical changes to our lifestyles.
What are they? Smoking and obesity alas top the list; both are very difficult to beat, but faced with the likelihood of imminent death, is it not the time for change? It can be done. It is their affect on hypertension, blood vessels to the heart and the state of the lungs that they crucially affect.
“As far as the future is concerned, it is not a question of
foreseeing it, but of making it possible.”
- Saint Exupéry, French aviator
Whilst this is obviously vitally true for those venturing into the skies or on the seas, in these days of the coronavirus it is equally important for anyone stepping out onto the street or into a busy mall. Few things should rank more highly than maintaining a healthy lifestyle knowing that we are almost certain to be exposed to the bug in the not too distant future.
Our health should be considered an asset just as important as our home or family; anything like Covid-19 that poses a threat to our ability to earn a living and even our very life has to be weighed.
Is it time to join a walking group and make a weekly visit to a the local farmers' market for organic fruit and vegetables? Has the day come to say a firm no to colas and cookies?
Along with your chromosomes, the little people inherit our habits, the ways we deal with stress, what you eat and whether the family exercises or not.
My suspicion is that genetics gets blamed when an awful lot has been learned, rather than inherited.
I am currently treating a young woman with a host of complaints that have not responded at all to years of medical care. Despite being only twenty years of age, she has hip and groin pain, lower back and mid thoracic problems. She is also suffering from costosternal stabs, neck, jaw conditions and severe headaches. That is not very nice when you are in your early twenties.
Thirty years ago I treated her grandmother; she too had a litany of complaints.
Is this genetic? In part I would say yes. But along with the genes the young woman has inherited her grandmother's diet, exercise regime, attitude to life and a psychologist would say a lot more.
Your genes you cannot change, but you do not have to be a couch potato, and eat rubbish like your parents did. Mine both smoked and it killed them long before their time; we do have choices.
In the photograph above you can see how we have been enjoying a five-day hike along the southern Cape coast, watching the annual whale migration. Four of the party of six were around seventy-years of age.
I have today received an anguished letter by a lady who responded to a chiropractic promotion, and was consequently quite seriously injured.
The whole story raises many questions, not the least of which is why do chiropractors feel the need to have promotions? Do you ever see a surgeon promoting a special price to have your hip replaced? Have we lowered ourselves to the status of second hand salesmen? Notice board takes a hard line on the subject.
On the other hand, I have just completed a locum in Holland and the chiropractor had a promotion to get me going; the initial consultation was at a reduced rate. In this particular instance, my colleague had the sense to make it clear that at this first consultation there would be no treatment; just a history and short examination. If patients felt that there was virtue in continuing they could make a further appointment, and had a few days to weigh matters.
The fact of the matter is that all doctors of every ilk must take holidays, or suffer from burnout. With the best will in the world sometimes a locum is chosen who is something less than ideal.
My thoughts on the matter is to treat any promotion with a degree of apprehension, just as you would if seeing a second hand car advertised. As always, if it's too good to be true, then it's too good to be true.
If, when faced with a locum, your instincts are that you he or she has not heard you out properly, has not asked pertinent questions about your history, and has not examined you adequately as your normal chiropractor would have, then this notice board suggests you decline treatment, and politely leave.
Difficult sciaticas walk daily into our clinics. Notice board is just to tell you of this and that at the chiropractic help coalface.
Let us admit it; some backs are just plain difficult. Mr X has had severe pain in both legs, following a non-dermatomal pattern. He can't lift either heel off the ground; that's called paresis of the calf muscles. An MRI shows a large hernia at L5-S1. For nine months he been unable to walk. Today, after just one adjustment of L5, he walked a whole mile; so grateful, he brought me a copy of his book. Miracles we do at once, but the impossible takes a little longer. I reminded him of the 50 percent less pain rule.
I have known if for yours, but this week again it was reinforced how much more difficult a sciatica is in smokers. Whether it's the decreased oxygenation of the tissues, or the coughing, or whatever, the disc just doesn't heal. Reading the literature, orthopaedists too find it's the greatest of all the risk factors leading to failed back surgery.
I have recently been on a very long trip; forty five hours door to door from South Africa to the Dominican Republic. Four flights cramped in the cattle class, and two long drives at each end is not particularly healthy for the back or legs.
Knowing full well what a serious problem deep vein thrombosis in the calves is, I undertook a strategy to make sure I wasn't amongst the victims.
The body is made to move, not sit for long hours; whether it's low back pain or DVT, it's better to walk as much as possible when traveling; so says notice board!
I fairly regularly get emails at contact; sometimes they are urgent asking for direction and advice. I spend some time replying, and then my letter is returned. Notice board then is the only way for me to contact you.
Remember, you may have to white list my address with your service provider. Please check it and then again once more if you receive no reply.
Likewise, if you write asking for advice about this or that, please may I ask that you don't type from your mobile. Google downgrades sites written in poor grammar and I have better things to do than correct your spelling. I just won't reply, so don't waste your time writing from your smart phone; you probably will not get an answer. I have at notice board more than enough of your letters to attend to.
The crossed sciatic sign should be handled with great care; it's worth a mention at notice board.
I have a love hate relationship with the medial disc in the lumbar spine. They usually respond magically to the chiropractic adjustment; patients one week call me Dr Golden Hands.
But it still takes a full six weeks for the tear in the annulus fibrosis to heal.
When the pain abates by a half after just a few treatments and is nearly gone within a week or ten days, then it couldn't possibly have been so serious. The 50 percent rule is forgotten, the exercises neglected and there's a swift return to normal life; a relapse is almost inevitable.
A greater percentage of medial discs thus end up under the knife. One week I'm Dr Golden Hands, the next Dr Chiropractic can't fix a slipped disc, see?
So, what's that crossed sign? You do the Slump test for sciatica sitting in a normal kitchen chair. Straighten first the leg opposite to the pain; then the leg on the naughty side. Normally raising the foot on the side of pain is worse; if the straightening the opposite leg is worse, then beware. You have a medial disc; they're extremely deceitful.
For more information, type Slump test for sciatica into the Site Search.
When did you last take some leave? All work and no play makes Tom a dull boy, right? And you and me too suggests notice board.
There are still plenty of elephants in Kruger National Park; but we didn't see any rhino. Both will soon be totally poached out for their ivory and horn.
Debate rages on. Should Africa by harvesting tusks and horn and selling them to the East where the insatiable hunger continues? Banning these products has not helped one iota in saving these magnificent beasts.
These beautiful wild dogs are very rare now; there are less than 300 in the whole world. The slaughter of nature continues.
The kudu is perhaps Africa's most stunning antelope. A visit to Kruger National Park should be on your bucket list once the threat of the coronavirus is over; do it at least once in your life, no matter where you live, if you can afford it. The Rand is ever weaker, making a visit to South Africa cheaper, but it is a long flight.
Is this a surgical emergency?
One gets so proud of some patients, and none less than Mrs S. At 84 she has so much spunk; I'm proud to mention her in dispatches at notice board.
Had she been ten or more years younger, I'd have sent her straight to the neurosurgeon. Three months ago she developed a severe femoral nerve neuralgia; a pinched nerve in the back causing profound weakness in the quadriceps muscle in her right thigh and numbness down the inner lower leg. But at 84 would she survive major back surgery? I had just had a patient of similar vintage who died a week after a full knee replacement and decided I must her a fair chance with chiropractic management of this difficult condition.
Coming faithfully for chiropractic treatment, doing her back exercises with great enthusiasm and continuously exercising that quadriceps was her formula for success; initially, whilst sitting, she couldn't lift the knee at all, nor barely straighten the leg.
Yesterday, she had no pain, no numbness and complete restoration of the strength of that muscle. She still uses a stick and the walker only when she goes on a Friday to Happy Hour; just one little glass of wine. Now can she drive again?
Spend a moment with this graphic. Get it?
"Your skeleton's no longer dancing."
There are few more nasty conditions than vertigo; the world spins and you feel nauseous and may vomit; at notice board I report one such case.
A 69 year old woman consulted me yesterday, thinking that an adjustment of her neck might cure her vertigo. It all began five days previously, with no known cause. Her doctor diagnosed Benign Positional Paroxymal Vertigo and prescribed Stugeron which after four days hadn't helped in the slightest. She had no signs of a cold, sinusitis or inner ear infection.
Lying down was a nightmare and it got so bad that she started falling; a fall in the rose garden resulted in a hundred pricks.
The standard test for BPPV, known as Hallpike Dix test was strongly positive for a blockage in the right posterior semi circular canal in the inner ear. There was wild nystagmus on right rotation and extension of her neck; an uncontrolled jerking movement of the eyes.
Her blood pressure was quite normal, as was a cranial nerve examination. Reflexes were normal. She is not becoming deaf. In short there were no signs of inner ear infection, Meniere's disease or a stroke.
Research indicates that the treatment of choice is not medication, but the Epley manoeuvres. The head is turned in very specific positions to allow the crystals that have becoming deposited in one of the canals to be dislodged.
The morning she reported after the first treatment yesterday that she had the best night in six days, and had no spinning sensation on awakening, but it did start again later in the morning.
The Epleys usually need to be done on three consecutive days. Many chiropractors have attended courses, specializing in the treatment of vertigo.
If doctors are not so knowledgeable about Vertigo and up on the current research regarding the greater benefit of the Epleys, they usually prescribe Stugeron. What's astonishing is that, according to NetDoctor, in 10 percent of cases, one of the side effects of Stugeron cinnarizine is nausea. The very condition it's supposed to cure, it actually causes.
After three sessions of the Epleys she is 70% better, but still the Hallpark Dix is test is positive. Turning her head to the right and looking up still brings on the giddiness and nystagmus; instead of the Epleys which do dislodge the offending crystals but are awful, we did the home exercises of Brandt Daroff. They were much less unpleasant. She's stopped the Stugeron.
It's vital to continue with chiropractic help until serious conditions like this abate complete; I'm reminded of a patient in Holland who brought me some infamy, on television what's more; prior to starting the Epleys she had severe vertigo every time she'd turned on her left side for five years. It's all recorded in Stones in my Clog if you want to know how Bernie got onto Dutch television.
Yup, notice board is a mixed bag.
Yesterday I met a young man socially who had a double lumbar fusion done on his back 12 weeks ago. For two months he was fine; now he says he has as much pain as the day he went into hospital three months ago. He was given exercises to do, but they took 30 minutes, and he simply couldn't make the time, or so he said, having been off work for two months.
So, what's my point? If you have had a severe lower back condition, no matter what treatment you go for, it's unlikely to be a cure. That's just as true of chiropractic as surgery. Unless you go through with the tedious rehabilitation, and continue to do the exercises, a setback is almost inevitable the next time you make a wrong move.
In my experience, giving a patient a thirty minute exercise programme was also doomed to failure. In most people's busy lives they simply don't make the time.
Our exercise programme for the lower back which you'll find in the navigation bar takes less than two minutes, but initially should be done several times a day. Now nobody can say they don't have two minutes, done first thing in the morning in bed, to prevent another lower back episode.
Done faithfully these lower back exercises will save you a lot of money, much pain and the possibility of serious disablement. Do them, even if you have never had a severe back problem. I do them myself every morning; I never miss.
This next case from the clinic mentioned at notice board is quite strange. My last patient reported this evening that since starting chiropractic treatment for severe headaches from her temporomandibular jaw joint and lumbago that she has no more foot pain.
She first came for treatment some two years ago, and for some reason she never reported, and I never asked about her feet. A runner, she had a long history of severe pain in the ankle area.
Normally, I treat a lot of lower limb conditions, but she didn't know that; most people assume that chiropractors treat only the spine.
Do I have an explanation? I could mumble along about how subluxations in the spine change the biomechanics, bla di bla, but in fact I usually think of it the other way around. Fixated joints in the feet, particularly in the subtalar joint for some reason, changes the way you walk and run and has a decided knock on effect on the knees, hips and lumbar spine.
But have you heard of lower back treatment fixing lower limbs? That's a new one for me.
Newsletter number 37 is about the importance of making a correct diagnosis. Whilst medical research shows that medical doctors get it right less than half the time, it still behoves each and every one who calls himself a doctor to do his utmost to make the correct diagnosis. I doubt that chiropractors do better than that fifty percent either, though perhaps I'm wrong.
Monthly newsletter number 36 is about the reliability of xrays and the safety of ionizing radiation. You'll find it a sobering read. Roll on the days when the price of a magnetic resonance scan is little more than an xray. That alone will save a lot of lives.
So, I'm trying to reduce irradiation of patients. Yesterday we sent a lady for just three views of the neck. The inexperienced radiographer took eight views, and the patient was charged for them. It cost her double the money, and nearly three times the radiation.
When and if your chiropractor sends you for xrays, ask exactly how many views have been ordered, and even what positions can be expected.
This will irritate some chiropractors; refuse a new set of xrays in a short period of time, read months, unless he has some very good, convincing reasons why he needs more.
Bad temporal headaches radiating to the right eye
This week a case of severe daily headaches. The history (as is almost always the case) turned out to be most important. After
considerable digging, after I couldn't find much wrong with his neck, he reported that three months ago he had his wisdom teeth out under
anaesthetic. Bingo: TMJ syndrome? Yes, indeed, severe jaw joint pain
bilaterally and a very active trigger point in the Lateral Pterygoid
muscle. Ouch, the treatment hurts...
... but fortunately no signs of popping or clicking from the jaw joint. I'm expecting a good response. TMJ anatomy ...
Update: Indeed a good response. Despite the pain of the first treatment (which needed to be done only once), it was only a strain of the muscles and jaw joint.
Strong recommendation: Persuade your dentist to take your wisdom teeth out in the chair under a local anaesthetic. Over-opening of the jaw under a general anaesthetic can severely injure the disc giving life long facial pain and migraine headaches.
Very severe low back pain
Chiropractors treat severe low back pain cases on a daily basis and that's as it should be. Medicine's own research indicates that manipulation is the treatment of choice, and this notice board remains committed to that.
Medicine's research also proves convincingly that extended bed rest is about the worst treatment available.
Fancy this week: A young woman with very severe low back pain radiating to the right leg. She has recently spent a whole twelve months on her back whilst under medical care.
Today she was slightly better after the first Chiropractic adjustment. Follow with interest...
Update: Because she came very quickly after the onset of pain (her husband had a similar less severe episode that resolved quickly, so he made sure she didn't delay) and followed my slipped disc rules to the letter, she has responded very quickly and within two weeks the pain and disability had almost resolved.
Had she left it for ten days, the swelling and inflammation would have set in and it would have been far more trying, as it was last time when under medical care. The scan taken two years ago showed a "modic effect" - swelling into the bone itself which then becomes very difficult with any form of treatment.
Know you have a problem... don't delay; that's our advice at notice board.
Lower limb fractures
This may seem like a crazy analogy, but for me it's revealing. Try breaking a stick for firewood. Notice how it almost always breaks in two places, not one?
I'm not sure of the reason, but I'm sure there's a perfectly rational engineering answer.
And if you break a bone in your lower leg, ankle or foot, be sure there's also injury elsewhere. If the force of the injury is great enough to break your tibia, be sure it's done something to your knee or ankle too. Make someone checks them once the fractures have healed.
This week a lady with three fractured metatarsals in the foot. They have healed nicely under medical care, but the simultaneous injury to the subtalar joint... has been a great trial.
After only four treatments of the subtalar joint, she reports that walking has improved greatly, no more flopping gait, as she describes it, but the pain at the end of the day is still debilitating. A pharmacist, she has to stand for long hours, even longer than usual, and by the end of the day, her foot remains swollen and very painful.
Visit again for updates.
Popping your own back
Hard on the heels of Newsletter #34 on the subject of popping your own neck is an interesting case for our Notice Board of an 87-year old lady who nine months ago developed an acute RIGHT sciatica down the back of the leg to the side of the foot. When it didn't respond to PT or anti inflammatory drugs and dual antiinflammatory drugs starting affecting her tum, a friend described a technique to fix it.
Popping her own back. I'm not going to describe what she did, not because it might put chiropractors out of business! but...
Yes, the technique worked. Self manipulation of the lowermost joint in her back provided significant help for sciatica pain ...
So, if what's good for the goose is good for the gander, then what's good for the right leg must be good for the left, right? Wrong. She caused an even worse Femoral nerve neuritis down the front of her LEFT leg, and it's now been six months of medical treatment without any joy. It wakes her at 2am and she can't sleep for the rest of the night.
Fortunately she's stopped popping her own back, but can chiropractic help her? The first two consultations have been promising, but it's early days... I'll keep you posted.
Unhappily she has not responded well and is little if any improved. Off to her doctor for medical care. We'll see if that helps.
This week it's three patients who have had cervical spine surgery. Whilst I'm a believer in good surgery, it remains a risky, expensive and painful business. In my opinion spinal surgery should be the last resort. I make no apology for it; I've seen them go sour so often, and so notice board is committed to prevention; forever it remains better than a pound of cure.
The first lady who had chronic pain since childhood, without radiating arm pain. Finally, five years ago in desperation she went for a fusion. She declared this morning that it was a complete waste, and it took her a whole year to get over the surgery. Can Chiropractic cervical facet syndrome treatment above and below the surgery help? Time will tell.
The second, a man for radiating pain to the middle finger. The first surgery didn't help a jot, so he went to another surgeon who told him the previous operation was at the wrong level. The second op didn't help either, but chronic nerve pain medication is helping. Now he has an acute frozen shoulder in the same arm.
The third I'm afraid is a fubarite. A young man who had his third neck surgery two months ago. After each he has gone from bad to worse. I have declined to treat him. I don't think we can help.
Apologies for keeping adding the words notice board, but Google has dispatched this Notice Board from one of my most read pages to zero because I have to add the words notice board 18 times. Boring!
Here are a few new insights.
Chiropractors aren't only interested in your back. At least most of them. Many years ago, a patient of mine dropped dead of a heart attack, and I had been attending to his moderately sore back, but neglected the weightier matters of his weight, blood pressure, lack of exercise and presumably cholesterol. He was a dairy farmer. It came as a wake up call for the young chiropractor. We humans don't just backs. Somehow the lame excuse that all his other doctors had been lax too, didn't carry much water. I felt culpable, and was. Much worse, he was my secretary's husband. I've never forgiven myself.
It was a watershed event. A realisation that everybody who calls himself a doctor should be looking at the whole patient, seeing the big picture and not just his or her speciality. And so this notice board will also include many healthy living tips.
Healthy living tips are for you if you plan to live to a vibrant and happy eighty; it's as important on our notice board as having your subluxations adjusted. In fact, perhaps even more significant as it addresses every organ in your body.
Well, subluxations of the spine certainly can also affect all your organs, often in surprising ways; like not being able to fall pregnant.
So, Chiropractic Help has just as much about your whole health as your spine, and I make no apology for that, though some so called straights will question my bona fides.
This last month it's been an interest in omega 3. Eating foods rich in these fatty acids improves the healing of arthritic joints. There is research, but only on white mice at this stage, that they also help with Alzheimers, Parkinsons, cardiovascular disease and a host of other problems. Alopecia to Athletes's foot. I'm being sarcastic of course.
For your omega 3 look to eating fatty fish like mackerel and salmon twice a week, plus walnuts, pecan nuts and freshly ground flaxseed. Where possible, try to eat the real food rather than taking fish oil and flaxseed oil.
I do this myself, by the way. Fatty fish for dinner tonight, and three pecan nuts every day with my cereal for breakfast.
FEMORO ACETABULAR IMPINGEMENT SYNDROME
FAIS comes in two forms. CAM and Pincer. Most people suffering from the condition actually have both, but she has only the CAM deformity. As if that wasn't enough: groin pain. Very treatable with Chiropractic help.
The answer to my initial question? In my opinion the primary is in the hip. That's what set up her lower back pain. For another, more detailed and interesting case, see our Chiropractic Help newsletter # 31. See the bottom of this page.
Notice board is about the many different conditions we see in our chiropractic clinics.
How safe are anti inflammatory drugs?
It's often assumed in certain medical circles that manipulation of the cervical spine is a highly dangerous procedure. Like all medical procedures there are certain dangers, but much depends on who is doing the manipulation.
New research suggests again that manipulation of the neck should be abandoned. It's just too dangerous, but they make no mention of who is doing the manipulation.
In 2013, the minister of health in the netherlands is trying to ban cervical spine manipulation, after three patients stroked. All three were treated by physios who had learnt manipulation at a few weekend courses.
But of course that's dangerous and should be banned. Same as if I went to a few weekend courses and started to doing surgery on the cervical spine. Both require long years of training under the strictest supervision.
Research by dabbs and lauretti concludes that cervical manipulation for neck pain is much safer than the use of nsaids, by as much as a factor of several hundred times.
Nsaids, non steriodal anti inflammatories, cause a severe bleed in the gut in 1 per 1,000 persons, directly causing the death of 14,000 people per year in the united states alone.
All I can say is that I'm in my 32 year in practice, and touch wood, have never had a serious incident. During that time I must have given several hundred thousand cervical manipulations.
But it does happen; very, very rarely.
At notice board I wear two quite distinct hats, one as chiropractor and webmaster of Chiropractic Help. The other just as important to me, is as chiropractic author, Bernard Preston, love of life, gliding, carpentry, gardening, solar energy and writing novels ...
Initially, I kept the websites at Chiropractic Help and Bernard Preston quite distinct, but I'm afraid that distinction has become a little blurred.
Stones in my Clog is my third book of Chiropractic anecdotes. Follow me through the polders of Holland as I discover a whole new way of life. Can you imagine living without a car...? Stones in my Clog is only available in the ebook format on Kindle or you iPad or smartphone. Why?
"In paper, with rare exceptions, there’s a big upfront sales push, followed by either total evaporation or by years of low backlist sales. Digital isn’t like that. It's forever."
It was Eisler who shocked the publishing world recently when he turned
down a $500,000 contract from St. Martin's Press in favour of
self-publishing his eBooks. Just purchase my new book, and you'll
understand why it's win-win. Win for me, with no publisher, and win for
you, the same book, downloaded in an instant for a fifth of the price, no p&p or drive to the bookshop. Read it on your laptop, your iPhone and, as I said, on your eReader. It's only $2.99.
On the former you'll need to download the free Kindle app first.
It's no longer any secret that Dr Bernard Preston D.C. is my alter ego. If you have found this website useful, and you like my "voice", then you might enjoy my third book, but the first of my ebooks, Stones in my Clog. Chiropractic anecdotes from Holland.
Semi retirement doesn't necessarily mean sitting behind the
geraniums as the Dutch quaintly put it. It can just means more time for
other things that one has a passion for. Like this notice board has for me; helping you discover better chiropractic health.
What plans do you
have post-retirement? Retire into something, or drop dead in a couple
years from boredom. Literally, I've seen it happen so often, particular to men.
Then don't send a letter like this one that I received this morning: "What exercises must I do, and which should I avoid?"
The more details you can give the better, but at least:
SEND A CRAPPY, HASTILY WRITTEN NOTE IN POOR GRAMMAR AND YOU CAN EXPECT A CRAPPY, HASTY ANSWER! Or none at all.
Where possible, reply via the invitation on most pages.
Do you have a question? Shoot! Please include important details such as when the problem started, what increases and relieves the pain, which movements cause dizziness, for example, whether the pain radiates to all the fingers or just the thumb and forefinger, or just certain parts of the leg.
A two line question will get an answer of zero value.
About Dr Barrie Lewis DC
Click below to see contributions from other visitors.
Cracked ribs? Not rated yet
Fell over dog outside on the back porch about 2 weeks ago & hit a metal chair on the way down. I think I might have broken a rib or 2 but only been taking …
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i wonder if i will have permanent damage tot he nerves and muscles as i have had tos for about 2 years and only just diagnosed. pklease can you recommend …
Chiropractic help is increasingly being researched so you know what's anecdotal, and what's scientific.
My own interest currently is how Chiropractic can help joints outside of the spine. By applying the same principles that we use with the spine, I'm getting very good results with hips right now, for example. The hip is prone to two conditions: too much cover, Femoro Acetabular Impingement Syndrome, and too little cover of the ball (Hip Dysplasia) both of which offer much challenge to the clinician. Pain in the groin is the hallmark. Untreated, both prematurely become arthritic.
Our Healthy Living Tips remains an evergreen, very popular page. Did you know the vast, and I mean vast, benefits of eating raw honey regularly? Along with Parsley benefits, raw honey increases fertility, a wonder on burns and varicose ulcers, constipation... once again I have four beehives in my garden.
Making a compost pile may not be everybody's dream, but I've found it inordinately rewarding.
Please, please, check your email address carefully. It's very irritating to send a lengthy considered reply, only to have it returned.