2014 came in with a bang and won't be forgotten!

January has been a fast month, full of Mother Nature’s fury! Can you remember a winter with so much snow and so many below zero temperatures? We can only hope that once June rolls around, it behaves more like June and not June-uary!

At the beginning of the year, The Medical Foundation began an effort to be more of an educational resource for the communities we serve; because after all, we are your laboratory expert!  Through posts on Facebook and Twitter and updating blogs and our web page regularly, we hope you will learn more about various diseases, how to become healthier and the role that laboratory testing plays in each of our lives. It is our organization’s hope that you will learn from our communications and that you will you pass along information you feel is useful to your friends, co-workers or family members.

If you have logged onto our website this month, you probably learned a little more about The Medical Foundation and are now aware that January is the month for Healthy Weight Awareness, Birth Defects Awareness, National Blood Donor Appreciation Month and Thyroid Awareness. 

That’s a lot to be aware of! If you missed the original posts on our website, you can always look back at the blog to read anything that has been posted during the month.
Are there topics you think are important for others to learn about? Or topics that you want us to explore and write about? If so, you can email info@sbmf.org or post your thoughts on our Facebook or Twitter pages.

Be sure to check out our web page and other social media pages during February as The Foundation challenges the community to become healthier.  It’s a great challenge and we’ll even give you all the tools you need to be successful. We’ll also explore World Cancer Day, American Heart Month, introduce you to a pathologist and update and educate you on many other interesting topics. 

If your thyroid gland isn’t working properly, neither are you!

More than 30 million people suffer from thyroid disease and about half, 15 million, don’t realize they have it.

The thyroid can be thought of as the master gland of metabolism. The butterfly shaped gland is located in the base of the neck, just below the Adam’s apple. When the thyroid isn’t properly functioning, it affects weight, depression and energy levels.  It also affects the heart, brain, liver, kidneys and skin.  As you can imagine, if the thyroid gland isn’t working properly, then neither are you!

Dr. Jeffrey R. Garber, breaks the thyroid down into a manageable analogy by comparing the thyroid to a car engine.

A car engine sets the pace of a vehicle, just as the thyroid gland sets the pace at which your body operates. While the engine produces energy for how fast the car moves, the thyroid manufactures energy, or thyroid hormones, which prompt cells to move at a certain rate.
In order to make the vehicle run, it must have gasoline, just as the body needs fuel to be able to move.  The body doesn’t use gasoline, but rather iodine, which ends up producing two much needed hormones called thyroxine, or T4 and triiodothyronine , or T3.

Although you may have the engine and the gasoline in place, the car is unable to move along unless you press the accelerator, right? Well, the body is very similar because it also needs something to tell it how fast to go.  This master gland is located in the brain and is referred to as the Pituitary gland.  This pea-shaped master gland sends messages to the thyroid in the form of thyroid stimulating hormone, better known as TSH.  TSH levels rise and fall depending on how much of the hormone is produced. 

Someone who is battling fatigue and/ or weight issues might be experiencing symptoms of a poorly performing thyroid gland.  Although thyroid disease is predominately found in women, many men suffer from the disease, as well.  You may want to consider a thyroid evaluation if a parent, sibling or child suffers from a thyroid disease or if you have taken the prescription medications Lithium or Amiodarone.  Finally, if you have had head or neck radiation and are experiencing some of the symptoms listed above, you may also have an increased risk of thyroid disease. 

Having a blood test at The Medical Foundation that determines your TSH levels can be instrumental in diagnosing whether or not you are suffering from hyperthyroidism or hypothyroidism.  Hyperthyroidism is a condition where your thyroid is being overactive and hypothyroidism is where your thyroid is under performing and may be causing you to feel sluggish.

If you are currently taking corticosteroids, lithium, dopamine or other various thyroid medications, you will want to have your blood drawn for the test before you take your medication for the day.
The lab also offers testing which includes a T3, Free (triiodothyronine) and T4, Free (thyroxine).  These tests are essential in aiding in the diagnosis of euthyroid, hyperthyroid and hypothyroid states. 

You may notice blue paisley ribbons in the community as a way to gain awareness and advocacy for thyroid disease, because January has been noted as the month of observance.  The blue paisley was chosen to represent thyroid disease because of its resemblance to cross-sections of thyroid follicles.

To learn more about the thyroid and its functions visit the Thyroid Disease Awareness page on Facebook or the American Association of Clinical Endrocrinologists website.

Blood Donors Save Lives!

Most people don’t think of themselves as heroes. They reserve those accolades for firemen, police officers and doctors. At the Medical Foundation, blood donors are referred to as heroes.  They’re heroes because they selflessly donate blood to help others they may have never even met.

Approximately 38% of the general population is eligible to donate blood, yet of that 38%, only 5% actually donate blood. And while 5% donate blood, approximately 75% of the population will receive blood at some point in life. Those statistics are rather alarming when you think about it!

Donating blood doesn’t cost anything, it only takes about 45 minutes and you are helping to save the lives of other people. So why don’t more people donate blood?

According to a study conducted by the University of Maryland Medical Center, the number one answer is, “I don’t like or am afraid of needles; I’m afraid to give blood.” Other reasons include being too busy, no one ever asked me, I didn’t realize blood was needed and I already gave last year.  

Many times at mobile blood drives or at our donor centers, a first time donor will be scared and hesitant to donate because he or she doesn’t like needles. It’s a fear of the unknown! However, just about every first time donor is pleasantly surprised that it wasn’t nearly as bad as they anticipated and they end up being return donors. After all, the actual donation time is only 5-10 minutes with paperwork and time for juice and cookies accounting for the other 30-40 minutes.  Phlebotomists at the Medical Foundation are experienced in their field and stick anywhere from 5-25 donors each day!  So don’t be worried, you are in good hands.

Do you know what blood type you are? If you don’t, we’ll tell you!  You may have heard on the news or seen on billboards the need for O- which is a blood type the Foundation is in need of constantly.  O- is given to patients who are in need of blood in the trauma units because it can be given to anyone. 

Look at our blood compatibility chart to see which type of blood can be given to recipients.  O- is the universal donor and is in high demand, yet only 7% of the population has this type of blood. 

Blood donors are eligible to give a unit of blood every 56 days.  One misconception people have about donating blood is that a unit of blood is good for ever.  However, a unit of whole blood is only viable for transfusion up to 42 days.  Often times, especially with type O and A blood, it is often off of the shelves in a matter of days instead of weeks.

Another misconception is that people can’t donate blood if they are on medication.  There are only a handful of medications that can cause donors to be deferred and medication for high blood pressure or high cholesterol is not on that list.

We’re proud of our donors and we’re very appreciative for the time and blood that they donate at the Foundation. If you are ready to take the plunge and roll up your sleeve, visit our blood donor website and learn more about the qualifications and process.  Walk-ins are welcome at any of our locations and some mobile blood drives, but if you would like to make an appointment you may do so on the website or you may call 574.234.1157. 

 

What you should know about the Human Papillomavirus (HPV)

Did you know that cervical cancer is the second most common type of cancer in women? Or that according to the National Cervical CancerCoalition (NCCC), 12,000 women are diagnosed with cervical cancer each year and 4,000 will die? How about that the Human Papillomavirus (HPV) is found in 99% of cervical cancers?

The good news is that cervical cancer is one of the most preventable cancers.  January is cervicalhealth Awareness Month and today, we’ll take a look at HPV.

HPV is a type of virus that can cause abnormal growth (for example, warts) and other changes to cells.  Infection for a long time with certain types of HPV can cause cervical cancer.  It can also play a role in some other types of cancer such as anal, vaginal, vulvar, penile, oropharyngeal and squamous cell skin cancers.  There are over 100 types of HPV, but experts have determined that 14 of these types actually cause cervical cancer.

HPV is shared through skin to skin contact and not through bodily fluid exchange.  There are approximately 6 million new cases of HPV each year with at least 20 million people estimated as currently infected. 

The National Cervical Cancer Coalition explains that to better understand HPV and its effect on cervical cancer, visualize the cervix as soil and high risk HPV as the seed.  There are other co-factors that can increase the risk of cancer, which can be thought of as fertilizer.

 Some of the co-factors include: smoking, long-term use of oral contraceptives, a weakened immune system, power diet (lack of Vitamin A and Folic Acid), presence of other sexually transmitted infections such as Chlamydia, history of many sexual partners, sexual activity at a young age, male partners without circumcision and possibly having many children.

What the best defense against HPV? Experts are now recommending that girls around the age of 11-13, who are not yet sexually active, receive a vaccination against HPV.  The vaccination is given in three doses over six months and guards against HPV Type 16 and Type 18.  Genotyping for HPV 16 and Type 18 has proven responsible for 70% of cervical cancer worldwide.  When boys are vaccinated by a product produced by the company Gardasil® the vaccination also protects against Type 6 and Type 11 which causes about 90% of genital warts cases in men and women. The vaccination is also recommended for homosexuals as a guard against oral and anal cancers.  Approximately 30% of oral carcinomas can be attributed to HPV and HPV Type 16 has been linked to some head and neck cancers.

According to Dr. Kristen Jacobs, Director of Cytopathology and Reproductive Medicine at The Medical Foundation, “the vaccine is effective and I do encourage that girls get the vaccine ; however, it hasn’t proven effective against all carcinogenic types which means that women can still become infected with a type they’ve not been vaccinated against.”

Dr. Jacobs recommends that the best screening for women is to have Pap smears because the Pap test finds changes in the cells of the cervix that are not normal.  Around the age of 30, a woman should have a Pap test and an HPV test to establish a baseline for future testing. It isn’t recommended for women younger than 30-years-old to have an HPV test because often the body will naturally clear itself of some of the viruses.  Typically, women ages 35-55 are diagnosed with HPV.

The Medical Foundation has the capability to perform Genotyping for HPV Type 16 and Type 18 using the Roche cobas® HPV test.  The Foundation also performs testing on approximately 85,000 Pap smears each year. If you are a healthcare provider and would like more information about the Roche cobas® testing provided by the Foundation, or information about SurePath or ThinPrep Pap tests, please email info@sbmf.org or contact your marketing representative at 574.234.4176 *61214.

 

 

  

Meet Dr. Kristen Jacobs

Dr. Kristen Jacobs joined the staff of The Medical Foundation in 1988 after graduating from the University of Iowa and completing a four year residency program with the Foundation. She has lived in the area since and is married to a local family practice physician, John. Dr. Jacobs is certified by the American Board of Pathology in Anatomical and Clinical Pathology and Cytopathology.

Q: How long have you been a Pathologist at The Medical Foundation?

A: I completed my residency of four years here and then Dr. Luis Galup, who was president at the time, offered me a position about 26 years ago.

Q: How did you become interested in Cytopathology?

A: I suppose I became interested when I saw how little tissue material was needed to make a diagnosis. It is simpler than having to process intact biopsy tissue. You just put the bits of tissue and cells on a glass slide, stain it and look at it through the microscope. And then, I was also interested in the focus on women’s health with Pap tests and trying to improve that.

Q: What is a typical day for you at the Foundation?

A: I’d say I look at about 26-30 surgical cases, about 15-20 pap tests and about 5 non-gynecological cytology cases [urine, throat, and thyroid cytology etc]. I also look at abnormal blood smears and answer blood blank and other clinical questions.

  Q: Take me through the process of what happens with a Pap smear after the cells are processed for you to observe.

A: The automated analyzer works by “looking” at every cell on the slide for its nuclear configuration and DNA content. It chooses, according to its data library of millions cells, 22 of the most “abnormal” cells on the slide. We have 10 cytotechnologists who review this information and they are directed to look at those 22 selected cells first. In a normal Pap test, those 22 cells, although according to the analyzer, they were the worst cells on that particular slide, they aren’t really abnormal.

Q: So every Pap slide is reviewed by a cytotechnologist?

A: Yes. A normal Pap, where the analyzer has detected 22 fairly normal cells for the tech to peruse, is fairly straightforward when reviewed by the cytotechnologist. And then if the cells that have been flagged by the analyzer look even remotely abnormal then the techs do a full screen. They review every cell and categorize the abnormality.

Q: And how does that process continue?

A: Anything that is flagged as abnormal will be seen by a staff pathologist. So there are three layers of review: the automated analyzer, the cytotechnologist, and then a pathologist if needed.

Q: How has Reproductive Medicine changed since you became a pathologist?

A: Pap testing has improved, first through thin layer technology. The quality of the Pap test used to depend on how the doctor sampled the cervix and then smeared it onto the slide at the doctor’s office. The quality was often compromised and we had no control over it. The Thin prep system, which came on board in 1996, was a big advancement in technology. The doctor now swishes the Pap sample in a vial and then the vial is well mixed and turned into what is called monolayer preparation. Now, pathologists and technologists look at a nice, clean, single cell layer through the microscope. Abnormalities are more readily visualized. Then later, the automated analyzer was introduced about 10 years ago. It adds another layer of patient protection. It saves our techs time from looking at thousands of normal cells and targets the abnormal cells that we want to focus on. It prevents screening fatigue.

Q: How many Pap tests are looked at each year at the Foundation?

A: In 2013, there were a little over 85,000 Pap tests, which is quite a bit less than in previous years because of the change in recommendations. In contrast, in 2007 we evaluated at least 123,000 Pap tests, so the numbers have dropped significantly. On the other hand, our department has picked up HPV testing. That wasn’t really done very often ten years ago, but HPV test recommendations have become more important to patient care.

Q: What kinds of changes do you see in the future of Cytopathology?

A: Analyzing Pap test cells by Flow Cytometry is a potential technology that has been talked about for years, but it’s never happened. We do Flow Cytometry all the time on blood cells in which abnormal cells are detected by flowing them through a camera-type aperture. The cells are marked with a special stain and then they shoot through an aperture which detects the cell abnormality. Now that the Pap sample is submitted in a liquid vial preparation, we’d somehow have to tag the abnormal cells and then shoot them through the aperture to automatically detect the abnormality without the human eye being involved. But nobody’s figured out how to make that happen yet! The problem with high tech analysis of Pap samples is it can’t be used in low resource settings where most cervical cancer now persists. A manual Pap analysis can be done in the middle of Africa with only a microscope, but none of these other technologies work in low resource places. The Pap test with all its improvements has succeeded in reducing cervical cancer to very low rates in the United States, but cervical cancer is still one of the foremost killers of women in third world countries. Since technology is available to perform a rapid malaria test with a simple finger stick blood sample, it would be nice if technology could find a way to perform a simple field test for cervical cancer. I hope we’ll see that change in the next 10 or 15 years.
 
Q: Is there anything else you would like to add?

A: In terms of educating the public, I would like women to know that it’s not uncommon to have an atypical Pap test result. Atypical results account for about 3% of tests. Patients should not be unduly alarmed but should follow up appropriately. Patients should also know that HPV testing can be quite useful in directing their care.

  For Dr. Jacob’s comments on Human papillomavirus and to learn more about HPV, check our website early next week or learn more on Facebook by becoming a fan of SBMFLAB.

Birth Defects are Common, Costly and Critical

For many parents, the birth of a child is one of the happiest occasions of their lives. The new parents are ecstatic to count ten little fingers and 10 little toes and are eager to begin all the late nights with their new bouncing bundle of joy. That’s the case for the parents of roughly 4 million babies born each year.

On the other hand, every 4 ½ minutes, a child is born with a birth defect. That’s roughly 1 in every 33 babies born in the United States and birth defects remain the leading cause of infant mortality. Recently, hospital costs of children with birth defects exceeded 2.5 billion annually. Parents with a child who has Down syndrome spent 12 to 13 times the medical costs for a child without.

The National Birth Defects Prevention Network (NBDPN) is raising awareness about birth defects and screening during the month of January with the theme, “Birth defects are common, costly and critical.” Their hopes are that by sharing information about birth defects, and encouraging potential parents to make healthy lifestyle choices, the number of children born with birth defects will decrease. According to the NBDPN, various types of birth defects can occur in any family regardless of race, health history, economic status or level of education. These birth defects include: congenital heart defects, cleft lip or palate, defects of the brain, spine, bones, muscles, internal organs, or a variety of genetic syndromes such as Down syndrome.

There are some simple precautions expecting mothers can take when trying or becoming pregnant: • Consume 400 micrograms of folic acid daily • Manage chronic maternal illnesses such as diabetes, seizure disorders, or phenylketonuria (PKU) • Reach and maintain a healthy weight • Talk to a health care provider about taking any medications, both prescription and over-the-counter • Avoid alcohol, smoking, and illicit drugs • See a health care provider regularly • Avoid toxic substances at work or at home • Ensure protection against domestic violence • Know their family history and seek reproductive genetic counseling, if appropriate

While these measures are important, The Medical Foundation also offers Prenatal Risk screening tests. These blood tests measure certain substances produced by the developing fetus and placenta that are passed into the mother’s blood. The amount of these substances in the mother’s blood can help to determine the risk of certain genetic abnormalities in the developing infant. The test is typically performed between the 14th and 22nd weeks of pregnancy.

There are two Prenatal Risk screening tests performed at The Medical Foundation. The first, is referred to as Triple Marker, which measures substances called alpa-fetoprotein (AFP), estriol, and human Chorionic Gonadotropin (hCG). The other test performed at the Foundation is the Quadruple Marker. This test measures the three substances listed above, as well as inhibin-A.

The screening can determine whether or not the mother is in a high-risk group for giving birth to an infant that may have Down syndrome, open neural tube defects or Trisomy 18. While the screening is typically an indicator of risk, it is not an absolute or conclusive guarantee that the infant with be born with or without the defects.

For more information about screening provided by The Medical Foundation click here. Included in the brochure, is more information about Trisomy 18, open neural tube defects and Down syndrome.

The Blizzard of '14 Doesn't Stop Medical Foundation Employees

While students and adults watched TV in anticipation of their workplace or school closing, employees at The Medical Foundation didn’t even need to watch the closings as they scrolled across the bottom of the screen.

Instead, they knew that they would be expected to come to work. The Medical Foundation is open 24 hours a day, seven days a week, 365 days a year. In fact, an employee may even hear the voice of Cliff Claven from an episode of Cheers saying the familiar postal service creed, “Neither snow, nor rain, nor heat, nor gloom of night, stays these couriers from the swift completion of their appointed rounds.” Apparently life as a Medical Foundation is similar to that of a United States Postal Carrier!

Although many managers may have had numerous pages during the early hours from employees who were unable to make it or needed a courier to pick them up, all departments were functioning well during the morning of January 6th.

The fleet of courier vehicles was parked in a single file line in the parking lot so plows could get around them. Many of the vehicles had been brushed off, but many still had several inches of snow stacked on top. Although several local physician offices and surgi-centers were closed for the day, specimens from hospitals and other offices still needed to be gathered and brought back to the laboratory for testing. And while the specimens are usually the most precious cargo transported by the couriers, today there were employees in tow and even a few blood donors.

Each day, blood donors make their way into our Mishawaka, South Bend, Marion and Elkhart Blood Donor Centers. However, with some roads impassable and donors encouraged to stay off the road, the number of units collected have decreased tremendously.

 

Our staff at our South Bend Donor Center was ready and waiting for donors this morning at 8am and many employees who were heading to donate. Outside of our Central Lab Patient Services Center, a lone patient waited for the doors to open at 7:30am.

Although it wasn’t the case, our staff was ready to handle the masses if necessary! Employees around the building exchanged travel stories as more and more employees scanned through the employee entrance. One employee mentioned how her car had been running in the driveway for an hour and when she was ready to leave the ice was still several inches thick.

Another employee mentioned how she starts her day at 2am and her battle from Grape Road to our Lafayette office was an interesting one! She thought that as she got closer to the hospital the roads would be a little better, but that just wasn’t the case. Employees in our Manual Lab were more concerned with the possibility of our President, Dr. Tomec, buying donuts for the crew, than how they might get home or whether the temperatures were warming or turning colder.

But perhaps the Histology Department had the best attitude as they started a scorecard as to which employees would make it in. A little light humor to keep everyone going and a little incentive for employees not to make the list! One employee took a few minutes out to donate blood and was especially happy about the Blondie’s Cookies. Thanks, Steph!

Many employees remembered the Blizzard of ’78 when they trekked into work and thought of stories of how employees helped in other departments and worked extra shifts making sure laboratory testing was able to be completed.

It’s been a long time since then, and I’m sure the employees who were able to make it in today will remember their stories for years to come. The focus of providing good patient care to those in the communities we serve remains our main priority. And for the patients who braved the roads to come in and donate blood, thank you for helping us to add to our decreasing blood product supply. We are still in need of O- and A- donors please pass along the word to everyone you know!

Did you make an resolution to lose weight?

If you’ve ever struggled with your weight, you probably know better than anyone else that losing weight is one of the hardest things to do. You’ve probably tried every over-the-counter pill there is, been on the cabbage diet, the grapefruit diet, and every other fad diet that has ever been invented, right? Well, you aren’t alone.

According to the Center for Disease Control (CDC), of the adults age 18+ in Indiana, 65.9% are overweight and 29.6% are obese. That means that the overweight adults have a Body Index Mass (BMI) of over 25 and the obese adults have a BMI of over 30. If you want to figure out your BMI, click here, and enter your weight and height.

Why is this important? It’s important because January is National Healthy Weight Awareness Month. Being overweight has proven to not only cause physical harm such as increased pressure on joints, higher cholesterol and blood pressure leading to stroke or heart disease and diseases such as Type 2 diabetes, but it can also cause harm mentally, as well. Those who are overweight often struggle with a lack of self-confidence, and often feelings of despair and lack of self-discipline.

So… you know you’re overweight or obese, but you’ve tried everything and you just don’t know what to do about it, right? Well, here are some tips from various weight loss experts.

1. Make small changes. You didn’t gain 50 pounds overnight and you probably aren’t gonna lose 50 pounds overnight! Be patient and make small changes such as exchanging a bag of chips for a small 100 calorie tube of Pringles. Make a small change for the week and stick to it. You’ll feel empowered and over time, small changes will make a huge impact.

2. As with making small changes, you should make small goals. Instead of saying you need to lose 80 pounds, set a goal of losing 10 pounds. Once you have achieved losing 10 pounds, make another 10 or 15 pound goal. Celebrate by buying yourself a new shirt or another item of clothing.

3. Drink water! Water helps naturally flush out your system and really adds to weight loss. Most experts suggest drinking 6-8 glasses of water a day, but again, don’t be overwhelmed by this suggestion. If you aren’t drinking any water now or are drinking a lot of sugary soda, replace one or two glasses of pop with two glasses of water.

4. Take small steps to add some physical activity into your daily routine. Again, you don’t have to start out with a five mile jog! Instead, make a goal to do 10 sit-ups and 10 push-ups each day or walk around the block. If you aren’t exercising at all now, anything you add to your day is a step in the right direction.

The State of Indiana has also taken steps to help residents take a healthier approach to life. At their website, they offer a Community Tool Box with online courses about health and nutrition, motivational videos and interesting facts about weight issues.

If losing weight is one of your New Year’s Resolutions or you have decided to be more aware about becoming or maintaining a healthy weight, good luck! You can do it, make small goals, small changes, drink water and turn the radio up and dance around the living room like you’ve never danced before!

The Medical Foundation, Your Laboratory Expert!

Maybe you have seen The Medical Foundation logo throughout the past 100 years we’ve been in existence. Perhaps you have had some lab work completed or donated blood. But do you really understand the scope of The Medical Foundation?

Do you realize that the Foundation helps guide the care of patients in the community? Approximately 70% of medical decisions made by physicians are based on the results of lab tests. And to think, you have a regional laboratory right here in Indiana!

Although there have been some blogs under this heading, "Your Lab Matters," it is the Foundation’s hope that you will continue to follow us on social media and our blog to learn more about health matters, view information on our various departments, learn more about pathologists and use us as a resource to make knowledgeable decisions about your health. The Medical Foundation is truly, your laboratory expert!

The Foundation services physicians and hospitals in Indiana, Illinois, Ohio and Michigan. Our transportation department has couriers who drive almost 2.5 million miles a year to the facilities we serve. They carefully transport your specimens to our Central Laboratory in South Bend, where they are routed to various departments for testing.

Our pathologists are responsible for studying tissues obtained from biopsies, surgeries and other means. Unlike many other laboratories, The Medical Foundation has 22 pathologists on staff with various areas of specialties. If a pathologist wants another opinion on a case, all he or she has to do is walk down the hall to another pathologist’s office to discuss the case or share the case via the multi-head microscope. This is just one of the ways the Foundation takes pride in guiding the care of patients we serve.

While the Foundation began in 1912, our blood donor center didn’t begin our collection process until 1951. Since that time, we’ve grown from one facility to five collection sites in South Bend, Mishawaka, Elkhart, Indianapolis and Marion. And over the last two years, our blood donor recruitment department has increased its employees to a team of eight and introduced our third bloodmobile to the community in October.

As you can see, this is a very broad overview of the Foundation. But it would take pages and pages for you to learn more about all the great things we do, which is exactly why there are lots of blogs to come!