We had a wonderful Christmas at Mom & Dad's house this year. Mom seemed to feel better and she looked a lot better than she did when they left Kentucky last month. The picture below is taken in the new sunroom Mom & Dad had added to the house. just in time for Christmas...literally. The painters and carpet-installers were there while we were driving down Wednesday. It is beautiful and was the perfect place to eat our big meal, open gifts or just hang out together. It also kind of became a playroom for Lyla while we were there!
back: Seth, Lyla, Ashley, Kendall (holding Zoe), Alison Joy, Jesse, Jessica, Justin, Jared, Alison, Andrea, Ken front: Dad & Mom
Mom received good news the day after her MRI. The doctor so no change since the last one which was done this summer. She will see that doctor again in January. She also saw Dr. Lava, her neurologist, who feels like she is doing pretty well. She continues to have various therapists come to the house and seems to be getting up and down more easily on her own. She tripped going into Steak & Shake last week but THANKFULLY was no injured AT ALL. We are extremely glad about that. Her back pain seems to improve with some ibuprofen which makes me think it's muscular and not related to the compression fracture. She will follow up with an orthopedist soon, though.
We are all looking forward to being together for Christmas this week...Mom is especially excited, of course. Mom & Dad have been busy getting things ready for a full house for a few days.
Merry Christmas to you and your family and God Bless.
Mom is having an MRI today at 2 pm. Please pray that it looks the same or better than the last one she had which was in June. She will see Dr. Waltuck at 1 pm tomorrow to discuss the results.
Also, a Home Healthcare representative visited yesterday and evaluated Mom's needs. She is suggesting the following for mom: a nurse to come and check her blood and physical & occupational therapy. Mom is also experiencing severe back pain again and struggles to get out of bed. Once she is seated or standing, she seems to be fine but the "sitting up" causes her a lot of pain. So, a hospital bed has been ordered so that she can get up more easily. She begins physical therapy today and will also follow up with a back doctor to make sure the pain is just the kyphoplasty healing.
Mom & Dad had a smooth trip back home last weekend. Thank you for lifting them up in prayer.
After arriving home, though, Mom seemed to have some trouble finding the leg-strength to get up from a seated position. She had this problem a few times while up here in Kentucky but we always seemed to do it together. On Sunday afternoon my sister, Andrea, was able to work with Dad in getting her up but Sunday evening, she slid down to the floor of their bedroom and Dad had to call 911 to get some help with her. Three fireman came and helped her back into the bed. Needless to say we were more than a little concerned with this drastic drop in her strength.
Andrea & Dad took Mom to her appointment with Dr. Waltuck Monday afternoon. After reviewing all of the events of the past month and taking into consideration the rough weekend she had, he decided to keep her medication as it is for another two weeks. At that point, he wants to do another MRI & see her again. He believes that the fall, the surgery, the bleeding ulcer, her having been away from home, etc, could be part of her problem. He wants to see how she does once all the other stuff is out of her system and now that she is home.
Unless something changes, I will post again with her MRI results and the doctor's thoughts in two weeks.
God Bless.
p.s. I have to share a side story from today. Today Lyla told me her back was hurting and said she needed me to put a patch on it. She knew her Mimi wore a patch because her back hurt. She doesn't miss anything.
After a good week at home with us, Mom & Dad are on the road back to Georgia. Unfortunately, because of the Thanksgiving holiday week, the physical therapist was unable to visit the house but Mom had a great session with the occupational therapist. We were also visited by a nurse a couple of times which was reassuring. They tested her blood--both her hemoglobin level and sugar levels were normal.
Mom is doing well. The back procedure seemed to have worked. In the past few days, she has complained of back pain but it isn't the same as before. I think she might have a strained or pulled muscle from using different muscles to get up and down. She is using a walker...most of the time but is beginning to feel stronger. She hasn't felt like using the walker lately but I made her (that went over well with both parents) because I didn't want to risk another fall.
They left Kentucky around 11 this morning. The Occupational Therapist suggested they stop about every hour & a half so that Mom can stretch so the trip may take a little longer than the usual six hours.
I will posting more details & pictures of their visit here in Kentucky at The Martin Messenger. Here's a picture from Thanksgiving, though.
Also, Mom sees her Vasculitis specialist, Dr. Waltuck this coming Monday. I will be sure to let you know what he says. Thanks for your prayers and hope you had a wonderful Thanksgiving!
We think Mom's back pain is gone. She is able to move around much easier and isn't complaining of the pain. Also, the endoscopy yesterday looked the same as last week--they found an ulcer but it was not bleeding. They will keep her on some stomach-coating medicine until she can follow up with her GI specialist in Atlanta.
Mom was very confused all day yesterday. She knows who we are but isn't sure where she is or what's going on. It is difficult to talk to her because she rambles on about things that make no sense. The doctors/nurses say that could be due to the anesthesia. She was put under two days in a row and could still have it in her system. She is off the pain medication now so hopefully today will be a better day.
Also, Mom and Dad will be staying up here for Thanksgiving. We are moving the feast to our house so it will be easier for Mom and are looking forward to both families celebrating together. In spite of a rough year, we still have so much to be thankful for.
Yesterday morning, the found that Mom's hemoglobin leveled had dropped significantly again causing her to need 2 more pints of blood. Also, she is having another endoscopy right now so they can check to see if the ulcer is bleeding again.
As for her back surgery. Yesterday was a long day of waiting. Mom was asleep almost the entire day which was actually good because she has to keep her arm perfectly straight during the transfusions and when she was awake, she was moving all over the place and setting off the machine. I finally asked the nurse if I could push the "restart" button instead of calling him every time. He said he didn't mind doing it but then the next time I called he said "you push the button." After a while when Mom would hear the beep, she would immediately straighten her arm and say, "sorry, honey."
First we were told the surgery would be at 10am then "late morning" then 1pm then around 2pm we were told 5pm. Well, they finally started the surgery at 6:15pm. The surgeon came to see us in the waiting room around 6:45 to tell us he was done. He told us that the bone was very soft, as they suspected.
She was knocked out from the anesthesia for the rest of the night last night but Dad said she was wide awake and alert this morning but still confused. As I said, she is have an endoscopy right now. I am glad it's being done early because she hasn't eaten since Tuesday night. They are supposed to get her up at least 3 times today. The internal medicine doctor told us yesterday that their goal is to release her by the weekend. We would really like that, too, as long is she is more mobile and the GI problems are under control.
Thanks for all your prayers, well-wishes, calls and even visits. I ran into an old friend at the hospital yesterday and he said something about how that stinks that my parents are not home where "their" friends can see them. I was happy to tell him that MY friends and Seth's family have stepped in by visiting them and even sending flowers. That has meant so much to them and also to me. God is good and continues to amaze me.
They have moved her surgery from 10 to 1ish. She will be unable to eat before the surgery which would make anyone irritable. Please pray that Mom has a good day and of course, that the surgery is successful. We are hoping this procedure takes care of the pain which then causes her to get back to where she was before this fall. She has not gotten to spend much time with Lyla (the main purpose for their trip) so hopefully, she will be released soon and get a few days home with us before heading home.
Thanks for your prayers. I will be away from the computer today but will post an update when I can.
Thanks so much for praying for Mom and for your support of our family. I had kind of a rough night with Mom on Saturday. She just gets confused sometimes and isn't herself. It's hard to take. Last night, I hung out with her so Dad could do some things he needed to do online and also so he could spend some quality time with Lyla. I am thankful for the time Mom and I spent together. She had moments of confusion but not like Saturday. We watched some of her favorite shows then flipped channels and watched the last hour of Dancing with the Stars. I sat on the side of her bed and she scratched my back. I joked about lying with her in the bed and going to sleep and she thought that would be a funny joke to play on Dad when he came back. :) I did lean back with her a little while. It was a good way to end my day.
Her surgery has been scheduled for 10 am tomorrow. We are praying that this procedure is so successful that her pain actually goes away immediately. That's not unrealistic either. The sooner she gets off all the pain meds, the better.
Mom had a pretty good weekend and has been getting up and about more frequently. She is also sitting up for longer periods of time which is good. Dad spoke to Mom's vasculitis specialist in Atlanta this morning and he agrees with the neurosurgeon that surgery is the best option for Mom.
Here is an article I found that discusses Mom's compression fracture and also the surgery options.
I will let you know when the surgery has been scheduled. It is supposed to be a pretty simple procedure that "could" take away her pain immediately. The surgeon said it takes about an hour from start to finish and can actually be done as outpatient.
Mom's back seems to be feeling much better. No decision has been made about possible surgery. We are hoping the neurosurgeon here in Lexington can talk to Mom's neurologist in Atlanta before proceeding. Mom has been very confused this weekend. We aren't sure if the pain meds are to blame or if the confusion could be due to her recent steroid dose reduction.
So, it's a good thing Dad and I pushed for her to stay another day because a pain specialist was brought in and ordered another CT scan. (Apparently, the one done the evening of the fall was not of the entire back.) The new scan was done this morning and showed a "compression fracture." Can you imagine if they had released Mom two days ago?
The pain management specialist felt like pain medication and physical therapy could be affective but when we spoke to the neurosurgeon this evening, he seemed to think surgery would be a better option for Mom. He wants to see how she handles the pain meds and physical therapy over the weekend and then evaluate her again.
They tried to release Mom from the hospital yesterday because the ulcer is no longer bleeding and "that" is under control. However, she is still on LOTS of pain meds because of her back pain and can't sit up, stand or walk without feeling nauseous. Argh. So, when they said she could go home, we said, "...um, no she can't." They planned to keep her another day and would evaluated her today. They are going to do more test on her bowels today and also make sure she gets the two sessions of hard physical therapy today, too. We really want her to be able to move around more easily before we feel like we can handle things on our own. Dad is also going to ask about lessening her pain medication to see if the nausea subsides.
Mom's pretty much the same. They put her endoscopy off from this morning to this afternoon. Then had to move it to tomorrow because the doctor had to go home sick. Her back pain is under control and they plan to start physical therapy tomorrow after the endoscopy. They are giving her a transfusion later this afternoon because her hemoglobin levels are so low. My friend, Teresa (a nurse), said that a transfusion might be one of the best things for her because getting that new blood should make her feel better pretty quickly. So, pray that goes well and the endoscopy happens tomorrow.
PART 2
I was able to spend the day with Mom yesterday and Dad was able to go for a good run. Mom seemed to be doing better. I think the transfusion really helped. They did find ulcers yesterday but they were not bleeding anymore. The doctor said prilosec should prevent them from bleeding again. She was supposed to start pt yesterday but was in too much pain. She did get up a couple of times, though, so that's a start. The doctor said she could be released today but I doubt that since pt didn't get to do much yesterday. She will have pt at my house for a few days until she feels up to the trip home.
That's it for now. Sorry for not posting yesterday
They have Mom's back pain under control while they run tests on the suspected reason for her fall. She is having an endoscopy this morning to check for bleeding ulcers in stomach (most likely caused by the steroids she has been on for so long). They think the bleeding has caused her hemoglobin levels to drop which has been causing her to feel light-headed after being seated for a while. Once they get that under control, they will begin physical therapy and make her back pain the priority. Thanks for the prayers. We really do feel them and appreciate them.
Mom fell today at my house here in Kentucky. She had been seated through a whole movie and we believe she was light-headed/wobbly when she stood up and then fell. EMS came and took her to a local Ambulatory Center where they did a CT Scan and thankfully found no fractures or new damage.
Unfortunately, she still cannot sit up without severe pain so she has been transferred to a local hospital where they will keep her for physical therapy and treatment. The goal is to get her mobile again so that she is able to travel to Georgia without pain/discomfort. Once back home, she will see her specialist to try to find out why she gets these weak spells as often as she does.
Thanks for praying for Mom, Dad and our family. This has been a long year for all of us. God continues to be faithful and we know He is in control and by Mom's side every step of the way.
As of yesterday, Mom began an increased dosage of the drug Methotrexate from five pills to eight pills (four in the morning and four at night). If she is able to tolerate the increase of Methotrexate then they will begin to reduce the steroids (Prednisone). He will still have her take it every day and not do like it was reduced before. Before, it was reduced from 30 MG a day to 15 MG every other day. He thinks that her body could not take being without any for a day. The doctor considered prescribing Cyclophosphomide(Cytoxan) for Mom. It has been used in treating some Wegner's Vasculitus. But, he thinks it is too toxic for treating Mom's Vasculitus.
Mom's next appointment is scheduled for Monday Oct. 26 at 1:40. At this point, Dr. Waltuck will evaluate how she has handled the increased dosage and hopefully make a plan for reducing the steroids.
This email is my dad's summary of his conversation with Mom's Vasculitis specialist:
Dr. Waltuck called me late today. The protein, Amyloid, is not only in her blood stream but some spots are on her brain. This protein is thought to cause Alzheimer's disease. Drug company are now researching ways to reduce this protein which could reverse the Alzheimer's effect. He will present Mom's condition to a panel of doctors tomorrow without using her name. Then, Friday, he will go over slides with Dr. Hunter, who analyzed her biopsy. He has already emailed the doctor at the Cleveland clinic. This doctor in Cleveland has had some good results with Cyclophosphomide(cytoxan) in some patients but none in others. This medicine can be very toxic and you have to be very careful about what is done. But he wants to reduce the steroids as quickly as possible due to the side affects. This is mostly what I got out of our conversation. Hope this is of some help to all of you. Will not know anymore until he gets back with me.
My words now...
All of this began close to a year ago. Mom came down with the flu the day before she was supposed to get her flu shot for the season...and the rest is history. So, Dad called the doctor's office yesterday to make sure Mom could get the flu shot with everything she is on right now and the doctor said YES. Dad got his flu shot yesterday and Mom is getting hers tonight.
Below is my brother, Ken's summary of Mom's appointment with the Vasculitis specialist. He and my sister, Alison, were able to go with Mom and Dad to the appointment. They were all felt like the doctor had done his homework and were encouraged that he was going to do even more research before just "trying" something else.
Ken's Summary
Mom’s case is very rare – less than 10,000 documented cases – due to the presence of amyloid protein deposits in the blood vessels of her brain. The deposits of amyloid protein are likely the catalyst for causing Mom’s vasculitis. Mom’s body perceived the amyloid protein deposits in the blood vessels of her brain as harmful and, therefore, began to attack the deposits which resulted in the inflammation in the blood vessels (vasculitis). Consequently, the presence of the amyloid protein complicates Mom’s treatment because simply addressing the inflammation in Mom’s brain doesn’t eliminate the circumstances that caused the autoimmune reaction of Mom’s body.
The vasculitis specialist, Dr. Waltuck, which Mom met last Monday (September 14, 2009) will be consulting with other doctors to determine the best course of action regarding Mom’s medications, treatments, therapies, etc. He stated that the initial objective will be to decrease, if not eliminate entirely, Mom’s need for Prednisone (which has serious side effects after long-term use) by using different medications to control the inflammation in Mom’s brain and to at least maintain Mom’s current stable condition. Decreasing or eliminating the Prednisone should minimize some of the side effects that Mom is currently experiencing such as fatigue, weakness, irritability, loss of appetite, and weight gain – particularly around the face.
Apparently, the report following the February biopsy of Mom’s brain revealed the presence of amyloid protein but previous doctors either overlooked it or didn’t recognize its significance to Mom’s condition.
Dad's email concerning Mom's appointment with the new neurologist last Friday, August 21st:
We had a good visit with the new doctor, Neil Lava, today. He would like to possibly put Mom on another drug to work with the Methotrexate called Cyclophosphomide (cytoxan). He also said that he may recommend increasing the dosage of Methotrexate. But he wants to wait until after the appointment with Dr. Jonathan Waltuck (the Vasculitis specialist) before any change is done. He knows Dr. Waltuck and they will confer about Mom's treatment. He wants to decrease the steroids because of all the side effects. So, we are hopeful that after the next visit we will have a different plan.
We are all encouraged that both doctors will be working together--what a BRILLIANT idea! Mom's appointment with the specialist is September 14th and I will let you know more after that.
I haven't said much lately because there really hasn't been anything to say. Mom is doing pretty well. She has an appt at the end of the month with a different neurologist because Dr. K feels like she has done all she can do and wants Mom to get a 2nd opinion. Each time Dr. K has decreased Mom's steroids, we have seen a change...all of us, including Mom. So, it will be good to see what another doctor says. To be honest, I am looking more forward to hearing what the Vasculitis Specialist says when Mom sees her at the end of September.
As for how well Mom is doing, she and Dad (a longtime runner) have volunteered for several years at the Peachtree. Mom was able to do that with Dad this year and enjoyed it. She got a little tired but was able to walk back to their hotel and wait for Dad to finish the race. Later that week, they traveled up here to Kentucky for Lyla's 2nd birthday party and then just last weekend, she and Dad when to a family reunion in North Georgia. She may get tired a little easier (due to her medication, we believe) but she is still doing really well.
I will write again after her neurologist appt at the end of the month, unless something changes before then.
Thanks for continuing to pray. Have a wonderful weekend!
I have been "called out" for not posting on this blog and I would like to apologize. To be honest, there really just hasn't been much to report and I have to admit that I think that's a good thing! Mom is doing so well! She started physical therapy a few weeks ago at a different facility. She is so pleased with her therapist and is feeling more and more confident every day. She is working on her balance and control and still uses a cane. This past weekend, she was able to attend an annual event at Brenau College (her alma mater) where she reunited with several sorority sisters and friends...and even got her picture in the local paper. :) She saw her neurologist Tuesday and was once again encouraged by the appointment. I misunderstood something before...she continues to be on steroids along with the new drug, Methotrexate. However, over time, they will be decreasing the steroid dosage while increasing the other's dosage. The doctor told Mom that the swelling in her face, due to the steroids, should go down as they decrease her dosage. I was so proud of Mom's outlook as she told me "I don't mind if my face is full as long as I don't have any more seizures." She truly has had the best attitude through all of this. She is eating well, drinking only water and making every effort to do her physical therapy exercises just as she is instructed. I am looking forward to her visiting me soon so we can go to a Mother's Day Luncheon at my church. There will be so many people there that have prayed for her and will be happy to see her for the "walking miracle" that she is.
Tuesday, March 24, 2009
I am sure you will forgive the delay in posting updated information. It has been a busy week but Mom is handling it all really well. It is hard to imagine that just a week ago, she was on her way to visit her mother who was sick.
Last Wednesday, Mom saw her neurologist who felt like she is doing really well. The doctor is taking her off of the prednisone and putting her on Methotrexate which is a common treatment for vasculitis. Mom will continue to be on Keppra (anti-seizure medication) for the rest of her life. The doctor has decided that Mom will only require physical therapy.
While in the rehab center, Mom played some Wii games and loved them. So, in the name of "therapy," Mom and Dad bought one. I am sure the Wii was not created for therapy purposes but several games really are good exercises for the brain. Mom is even better at some of them than we are. We are all having fun with it and have also enjoyed creating mii characters for everyone in the family.
Grandmother's funeral Sunday was beautiful and she would have loved it. My brother, Ken, did the eulogy, truly capturing the spirit and personality of Grandmother while making us all laugh and cry.
Thank you so much for your continued prayers. We, too, are praying for you that God will bless you as well.
All 4 Kesler children: Phillip, Susan, Joyce and Gary
Joyce's mother, Margaret Kesler went to be with Jesus while she slept peacefully last night. We know she and her husband, B.A. are happy to be together again. My sister, Andrea, suggested that Grandmother was simply waiting to see Mom as they were able to have a good visit Tuesday afternoon. Grandmother was 90 and had lived a good life for the Lord. She loved her family very much and was proud of us all. We are all handling it rather well, including Mom. Our family appreciates your prayers throughout the coming days and weeks.
More news of Mom's appointment with the neurologist is to come later.
Today is the BIG day that we have all been waiting for...Mom gets to go home! It has been a long week for her. Since finding out that she only had more week at the rehab center, staying there has been that much harder. She sees her neurologist tomorrow so they can go over the plan of action.
While Mom is excited about getting to go home, her heart is also heavy for her mother. While she was in the hospital last month, her mother was in a different hospital suffering with a blockage in her gallbladder. The pressure from the blockage was relieved using a stint but Grandmother has also been diagnosed with pancreatic cancer and does not have long to live. So, Mom and Dad are going straight from the rehab center to visit with Grandmother at her home. Please pray for Mom this afternoon as she sees her mother who is quite thin and weak these days. Please also remember my grandmother in your prayers as well--pray for her to be comfortable and comforted right now.
Please pray for Mom's patience these next few days. She just really wants to go home and is struggling with depression. We have all been trying to call her through the day and give her encouragement but she just seems to have a negative attitude right now. Also, if you are a close friend, she carries her cell phone with her and I am sure she would love to hear from you.
Mom, Dad, Andrea & Ken T met with Mom's rehabilitation doctor this morning. He told them that they believe the vasculitis is a byproduct of the encephalitis (viral infection) she had last year. The immune system was attacking the lesions on her brain and also the blood vessels. She is currently on high doses of prednisone (a steroid) and will be on some sort of strong steroid for at least the next six months, at which point another MRI will be done to see how she is doing. She is also taking aricept (also used to treat alzheimer's) to help with her cognition and short-term memory. She is no longer on the anti-seizure medication as the seizure was a result of the swelling. Now that she is on steroids, the swelling/seizures shouldn't be an issue. The really good news is that she will get to go home next Tuesday. Once home, she will not require home health care as she did last time but will start outpatient therapy right away.
The doctor pointed out one big difference between last time and this time. In November, she had trouble "processing," meaning it was more difficult to make her body do what it needed to. However, this time around, he said she is perfectly fine from the neck down and has little trouble following instructions. One downfall in this is that she "thinks" she can do anything and doesn't like to be told not to. This explains why she is much more frustrated this time around--she thinks she is fine and doesn't like being treated as a child, since she is an adult. She doesn't see that she jumps from topic to topic and can't stay on one task. Her short-term memory still isn't what it should be and her order of recent events is a little off. She speaks and moves very well but will just need more work to get her cognitive abilities up to par.
Mimi became sick in October of 2008. Her symptoms were flu-like but medicine didn't seem to work because she wasn't getting any better. She went to the emergency room twice in a 6-week period. The second time she went to the ER was for a severe headache (Saturday, November 15, 2008). After an inconclusive cat scan, she was diagnosed with a migraine and sent home. By Monday morning, she was incoherent and was back at the hospital. Her MRI showed lesions on her brain and her spinal tap had signs of infection. The doctors began treating her for a brain infection with steroids. She stayed three weeks at a rehabilitation center where our family spent Thanksgiving together and was home by mid-December.
She received some in-home therapy and then went back to the rehabilitation center for some outpatient therapy. She was released from occupational therapy rather quickly and could handle most day-to-day activities. Mimi's physical therapy was going well, as was her speech therapy. In fact, she had recently been released from all therapy by her neurologist. However, she had been taken off all steroids and other medication and had regressed slightly in those few weeks. The doctor assured us that this was normal because she was "on her own" now but also stressed the importance of taking her off of steroids, as they are not intended to be taken long term.
Mimi enjoyed a nice Valentine's Day weekend with my dad but was once again incoherent Monday morning. While Dad was getting her ready to go to the hospital, she had a seizure. Her MRI showed more lesions but this time, the spinal tap showed NO signs of infection. The doctors were stumped. After much discussion, everyone agreed that a brain biopsy was the only way to effectively figure out just what was causing all of the problems. So, Friday, February 20, the brain biopsy began at 10 am and the surgeon came to talk to us around 11:45. The preliminary results looked good. The surgeon said the brain and its vessels were very swollen, leading him to believe it could be vasculitis--an inflammation of the blood vessels of the brain. If this is the case full recovery can be achieved after 6/12 months of strong steriods and other meds. Slivers of her brain were sent to 7 or 8 specialists and we expect to learn the test results tomorrow, Tuesday, March 10 in a meeting the doctor is having with Dad, Andrea and Ken (Joyce's oldest daughter and her husband).
Mimi has been back at the rehabilitation facility for a little over a week and is doing well. She is walking better and talking well, too. I don't think she fully understands why she is there again and she is definitely beyond ready to go home. I can't imagine how frustrating it all is for her. I keep trying to remind her that she is being taken care of by people who know best how to get her well quickly so that she can go home...so she should just try to be patient with them. She is such a good-natured person, I have no doubt that she IS very kind to everyone; she just vents about it to us. There's nothing wrong with that.
Dad has been so strong through all of this. It has been hard on all of us to see her so close to full recovery just a month ago...just to see her back at square one. But I know it is ten times harder on Dad. I am so blessed to have parents that love each other they way mine do. In fact, they are celebrating 44 years of marriage this summer. They have taught me so much about marriage and just what unconditional love means. I believe that this has made their love for each other grow and will continue to bring them closer together.
Thanks for caring so much about Mimi. Thanks for praying for her and for all of us. God has always been faithful and we know He will continue to be.
back: Seth, Lyla, Ashley, Kendall (holding Zoe), Alison Joy, Jesse, Jessica, Justin, Jared, Alison, Andrea, Ken
