Sunday, December 31, 2017

Whole30

Robert and I did our first Whole30 in December.  It went well!  We weren't perfect at it - we had to eat "normal" food a few times at Christmas parties - but I think we were really successful overall.  I think I read all of Melissa Hartwig's books in advance which really helped educate me and get me on board.  Obviously, we won't implement all of her suggestions all of the time, but it's been a really good time to evaluate our eating habits.  If you are unfamiliar with Whole30, the very very very basic synopsis is eat an animal protein, vegetable, and healthy fat for three meals a day, and eat fruit at two of those meals.  Don't consume dairy, grains, or legumes.  Those aren't all the guidelines, but they're they highlights.  Here are some of our favorite recipes that we made over the month:

Dump Ranch

Lettuce Wraps

Shepherd's Pie

Breakfast Casserole

Indian Curry Chicken

Salmon and Veggies - We didn't use the sauce recipe.  We used some oil, vinegar, and coconut aminos instead.

Tomato Basil Turkey Meatloaf

Jalapeno Turkey Burgers

Green Chile Chicken

Breakfast was the hardest for me.  I like protein with my breakfast, but I really like having carbs with it as well - waffles, pancakes, bagels, etc.  I got pretty tired of eggs.  Also, basically all bacon has sugar added to it which is a bummer.  Leftovers for lunch was key.  A big dinner that filled us up so we didn't need to snack was important too.  We were surprised that we weren't overly hungry, but we were eating nourishing, filling meals.

Weight loss: Robert lost 15 pounds, and I lost 18 pounds!

Non-scale victories: Robert noticed that his acid reflux was much much better.  We both slept better.  I felt less anxious.  I fit into a pair of jeans that hadn't fit in a season. Robert brought on his belt buckle one notch. It definitely flattened my stomach more and helped with the mom pooch. I had two 24 hour stomach bugs during this month (‘‘tis the season), and I got headaches during those days, but other than that I only had one headache this month which is really good for me, and it went away within an hour of treating it which is very unusual for me. Robert’s wedding ring got quite a bit loser.

Going forward, we want to limit snacking and nighttime eating, eat less carbs and dairy, and make a conscious effort to select food that fuels our bodies.  We also want to make intentional decisions about treating ourselves instead of just eating junk food out of boredom.

Have you ever tried a Whole30?  What did you think?

Wednesday, December 27, 2017

Sarah's Upcoming Surgery

A few weeks ago I wrote about all of our health battles we've been enduring.  I'm happy to say that I've gotten a custom mouth guard to wear at night and have noticed a great decrease in my discomfort.  So thankful!

On December 15 Sarah had her renal ultrasound and VCUG.  We had to wake her up at 6:30 which wasn't great, but she got moving quickly.  She wanted to leave on her pajamas which worked just fine.  We got to the radiology department at the hospital at 7:30.  My parents met us there which was very kind.  We didn't have to wait long which I was thankful for.  Sarah, Robert, and I went back to a small, dark room for the ultrasound.  She wasn't a huge fan, but she cooperated and stayed pretty quiet.  The ultrasound tech was nice and worked pretty quickly.  He checked out her bladder and kidneys and only took about five minutes.  When he was finished we waited in a different waiting room.  Sarah wanted my mom to come back and join us.  Shocking. ;)  They're two peas in a pod!


The room for the VCUG was much larger.  We'd been in it a year and a half ago, so I knew what to expect.  There were two radiology techs that got the area ready.  They had Sarah change into a hospital gown and gave her a doll that also had a hospital gown.  She got to take it home which was sweet.  Then a pediatric nurse came in and placed the catheter and emptied her bladder.  The placement of the catheter wasn't fun but not horrific.  She's had a catheter six times so it's sort of familiar.  My mom, Robert, and I were able to hold her hands and stay close to her face to talk and reassure here.  They lowered the x-ray machine, and her torso was basically in a tunnel.  Then the radiologist came in, and they started pushing the contrast dye.  That part was a bit uncomfortable, as you can imagine.  The radiologist watched a live feed of the x-ray, and we could see the monitor as well.  He watched her ureters and kidneys as her bladder filled, and the instant the contrast dye started up her left ureter started refluxing.  I was immediately disappointed.  Honestly, I had been hoping and praying so hard for 18 months that I just thought surely something would have improved.  I knew there weren't great odds, but I just had such high hopes.  After seeing the reflux I just switched my focus to soothing Sarah and cheering her on.  The left ureter continued to reflux, and then the right one started up two.  Both backed up into her kidneys.  The left ureter is just as misshapen as before.

So then they pulled out the catheter and needed her to pee to watch the reflux as her bladder emptied.  When she'd had the last test at 7 months old they just removed the catheter and she immediately started peeing, but since she's potty trained now I knew it wouldn't be that easy.  We'd talked about it beforehand.  "Sarah, the doctor is going to ask you to do a funny thing.  He's going to ask you to pee on the bed, and it's okay to do it this one time even though it seems strange."  She'd told people for days that she was going to pee on a bed, but unsurprisingly, when the moment came she wouldn't do it.  I really do understand.  I mean, I wouldn't want to pee on myself and then lay in it on a bed.  So she got squirmy and was crying because she had a super full bladder but didn't want to pee on the bed.  The kind nurses brought out a pink bedpan and called it a princess potty.  They held it under her, and she peed immediately.  I'm not sure why they didn't offer it to begin with, but at least it worked once it was offered.  She peed, and the radiologist noted that she continued to reflux as her bladder emptied.

Once she peed we got to clean her up and get dressed.  She got sent home with a diaper for her baby and lots of band-aids.  We went to Chick-Fil-A to let her celebrate her bravery.

As a reminder, or maybe just for your information in case you haven't become a novice urologist over the last year a half (haha), when a healthy person is processing urine, it goes from the kidneys, to the ureters, to the bladder, and out of your body through the urethra.  Sarah's goes to the bladder but then goes back up the ureters and into the kidneys while your bladder fills up.  Then when she pees some urine also goes up into the kidneys.  The urologist likened the urine being back in the kidneys to being like a pond with stagnate water or a pool without any chlorine.  So obviously, that's a prime environment for an infection to occur.  So that's how Sarah gets UTI's.  It has nothing to do with external factors like wiping wrong, sitting in diaper, or peeing in the bath tub (as some people have tried to suggest to me.  Uh, thanks?) The last year and a half she's been on a medicine that doesn't prevent reflux (no medicine can), so her body has been refluxing, but the medicine has been preventing infections.

Anyway, we went home happy that Sarah had been so brave and didn't seem to be permanently traumatized from the day but also fairly disappointed that we didn't have better initial results.

Three days later on Monday, December 18 we saw the pediatric urology nurse practitioner.  Springfield doesn't have a pediatric urologist so a team comes down from the St. Louis Children's Hospital once a month.  From my understanding, the doctor comes down to do outpatient procedures, and the nurse takes the office visits.  So we've seen nurse practitioner Mary both times now.  She confirmed what we suspected - grade III for her right and grade IV for her left - just like a year and a half ago.  She said we could continue to give Sarah her medicine and wait another 12-18 months, but things most likely wouldn't have changed.  She kind of beat around the bush for a bit while I asked her questions like, "How likely is it that she'll improve?" and, "How long do people usually try to wait it out?"  Finally I just asked her, "What would you do if Sarah was your daughter?"  She was finally straightforward and said she'd have the surgery.  As a reminder, for kids with lower grade reflux like a I you often outgrow it.  Grade II can be fixed through a laparoscopic outpatient procedure called deflux.  But grades IV and V have to be fixed with a procedure called open anti-reflux surgery.  She asked if I'd like the doctor to call me later that day, and I said yes.  At the end, they had Sarah pee on a super high-tech toilet that observed her peeing and printed out a receipt with a graph showing her flow and information about her duration, quantity, and peaks.  Crazy and super cool!

The doctor called me a couple of hours later.  I was very thankful that he took time to call me and answer my questions because I know not all doctors do that.  The synopsis of the phone call is that he doesn't believe that Sarah will get better on her own, and that surgery is necessary and the only way to resolve her issue.  Robert and I feel very confident that this is the right decision for Sarah's health.  The doctor says this surgery is the gold standard for fixing VUR, and that it was a 98-99% success rate with a very low morbidity rate.

So here's what else I learned from the doctor.  The surgery will be at the St. Louis Children's Hospital on January 25.  We will go up the day before so that we can get settled and not have to make the 3.5 hour drive the same day as the surgery.  They schedule surgery in age order, so Sarah should be toward the start of the day, but we'll get the exact time the day before the surgery.  We get to be with Sarah while she gets her catheter, and then they'll take her back for the TWO HOUR surgery.  Does that seem long to anybody else?  After the surgery, the second she wakes up Robert and I get to go back and join her.  She will spend the night in the hospital and will have in the catheter overnight.  I'd imagine she'll also have an IV overnight, too, but I forgot to ask.  I'm also thinking that if she has a catheter and an IV then they won't want her walking.  How do they keep a two year old from walking?  Will she be heavily medicated?  I should have asked more questions!  They need Robert and me to spend the night in her room with her on a little pull out bed.  We're already bracing ourselves for a very long night with little sleep.  In the morning they will remove the catheter, and they will need her to go to the bathroom.  Then we'll get discharged.  The doctor said patients usually stay 24-36 hours after surgery.  I'm curious to see how miserable the drive home is.  The incision will be like a c-section incision, so I can't imagine riding in the car in a carseat is super comfortable.  He also said that Sarah's left kidney is 15% smaller than her right kidney which is pretty common for people with reflux.  Her kidneys aren't scarred at all, and both are growing proportionately, so he feels comfortable saying this is just a birth defect.  He also said that Sarah's bladder is the size of an adult's which is also common for kids with reflux.  That really makes sense because I've always thought it's impressive that Sarah can hold her bladder for six hours from time to time.

The doctor says she should be back to her normal self in a week and to expect blood in her urine for about four days.  The reason for that is because for the surgery he cuts open her bladder, removes the ureters from it, straightens them, and reattaches them in a stronger position.  He will close the incision with stitches and glue.  I need to ask, but I'm not sure if the follow-up will be in St. Louis or if we can do it when his team comes down to Springfield.

Anyway, here's our current mindset: We feel confident that this is necessary and the right decision for Sarah even though we wish this wasn't our reality.  We feel confident that this is the right doctor to do the procedure.  St. Louis Children's is a great hospital, and he's one of only 150 people in the country with his certifications.  We're sad that our daughter will have to go through being scared and being in physical pain.  We're sad that she'll have a large scar on her beautiful skin.  We're thankful for modern medicine that can prevent her from needing a kidney transplant.  We're thankful for family members who are supporting us and sharing this burden.  But I'd imagine that we're as nervous as just about anyone would be who has a two year old about to have a two hour surgery and an overnight stay in a hospital.

We would greatly appreciate your prayers.  We're praying that God would use this surgery to heal Sarah and to help her lead a healthy life, that He would keep her safe through the surgery and recovery, that God will calm our anxious hearts as we anticipate the surgery and wait through the actual procedure itself, that God would use this part of our story to bring Himself glory, and that we could be witnesses to all we encounter because of this situation.

Would you join us in doing the same?

Sunday, December 24, 2017

2017 Books

I really wanted to step up my reading in 2017, and I did it!  I didn't have a set number of books that I wanted to try to read, but I just felt like I was wasting too much of my free time watching TV or playing on my phone, and I wanted to use some of that free time in a different way.  I checked out almost all of these books from our local library.  In the past I had been intimidated walking into the library and just walking around looking for a good book.  I don't know a lot of authors' names so I never really knew where to start, and you definitely can't stroll through a library when you have a toddler with you.  So I look through a variety of lists online like "Christian books for moms" sort of a thing on Pinterest, and then added books to my request list through the library's website.  This is very convenient because I get an email when the book is ready for me, and then I just pick it up at the drive-thru window without having to get out of my car with Sarah.  Anyway, I'm not going to take the time to write a summary of all of these books, but I did want to share them with you because almost all of them were winners in my opinion.  Most of them have to do with being a mom, because, well, that's my full-time job.  Enjoy, and let me know if you end up reading any of them!

1. I'm currently watching Glee for the second time and have read a couple of the authors' books.  This is skimmable, but I also enjoyed learning a bit more about one of the actresses, Naya Rivera.


2. Say Goodbye to Survival Mode


3.  I can't say that I agree with all of Jen's political and religious perspectives, but I didn't feel like that distracted from this book.  She's such a captivating author because you really do feel like she's just sitting next to you talking.


4.  Definitely one of my favorites this year.  It gave me a good perspective on raising Sarah to be grateful by teaching her to be a contributing member of our household and family.


5.  If you enjoy Raising Grateful Kids in an Entitled World, then give Kristen Welch's other book a try, too!


6. I love Gilmore Girls, and I love Lauren Graham.  If you do too, why haven't you read this book yet?


7. Again, a book by a Glee actress.  Skimmable. :)


8. Unseen - Encouragement for fellow stay at home mommies


9.  One of my faves!  Read this one for sure!  It'll have you laughing and nodding your head in agreement through the whole book.
 

10 and 11. I want to become friends with Sally Clarkson.  Is it okay to feel like we are friends now?  She's an inspiration, and I always love reading from moms who have made it through to the "other side" and lived to tell about it.
 

12-16.  Can you tell that we're doing our first Whole30 this month?  More on that at the end of the month, but I'd strongly recommend reading these books and not just trusting Pinterest if you're wanting to do a Whole30.
 

17. Daring Greatly - Skimmable but challenges you to go for it and have big dreams


18. I read a few books on essentialism and organization this summer, and they inspired our yard sale in September.
 

19. Obviously a must-read if you like Fixer Upper or Chip and JoAnna in general!


20. More yard sale inspiration :)


21. Who doesn't need to extend some more grace to their kids?


22. I'll be honest, I don't think I finished this one.  I just couldn't get into it.


23.  This was a unique one as it was co-authored and each chapter included both authors' perspectives on a topic - a younger mom and her mentor, Sally Clarkson.  I enjoyed it!


24. I like to read financial advice from time to time just to remind myself of our financial goals and why we want to make wise financial decisions.
 

25. Another book about dreaming big and prioritizing


26. Present Over Perfect
 

27. Who hasn't felt uninvited?  Whether it's not being on the in-crowd with other cool stay at home moms, not feeling like you fit in with your old childhood/hometown friends, not being asked to be part of a group, or whatever.  Your self-worth isn't based on those things.


28. Making the most of my time
 

29. Finding Grace


30. I really liked this one!  Good daily, practical examples and tactics.
 

31-34. I got on a Ruth Soukup jag. :)

Saturday, December 23, 2017

2017 Recap

2017 is coming to a close, so I wanted to take a minute to think about this year:

In March Robert's dad, Ray, and Ray's two sisters were able to visit from Alabama.  It was fun to have all three of them here, and it was extra special since this was one of Aunt Leah's last big trips before moving to Asia.  It was also the first time for Aunt Tammy and Aunt Leah to visit us since we'd moved back to Missouri.

We continued to work on home improvement projects.  The list is never done when you're a homeowner, right?  We did a lot of yard work this fall in hopes that we'll have grass in the spring.  I think there's a good chance we're going to have success!  We have a couple of small projects left, and then there's that elusive kitchen remodel that'll probably never happen but is fun to imagine. :)

I joined Robert's sister, mom, and grandma for our fifth annual girls trip in May.  We went to Arkansas this year and had a great time!  Sarah and Robert enjoyed their time together back at home, too.

Also in May, Robert and I got to go to Louisville for a week to celebrate our fifth wedding anniversary.  Sarah spent time at our house with my parents and Robert's mom, and this was the longest time I'd ever been away from her.  We had an awesome week staying with our friends Anna and Forrest from our seminary days in NC.  We did lots of sightseeing, game playing, eating, talking, and laughing.  It was a wonderful week!

We went to Alabama at the start of July.  Sarah LOVED the beach this year!  We enjoyed getting to celebrate the 4th of July with Robert's family!

Sarah turned two in August.  Can I say that this is my favorite age so far?  I genuinely think that she went through the "Terrible Two's" from about 18-24 months old, and her being two has actually been easier compared to that (although 18-24 months was a pretty cute time, too!).  She loves doing art activities, putting on concerts, seeing friends, Minnie Mouse, anything girly, and Mittens.

Robert had a jam-packed summer as always: Serve Springfield, VBS, summer camp, mission trip to Kentucky, and a mission trip to Asia.  In January he will have been working at South Gate Baptist Church for three years as the student minister.  I'm still a stay-at-home mom and enjoy teaching the 2-3 year old Sunday School class, serving in MOPS, and serving alongside Robert in student ministry.

Merry Christmas!  We hope you had a great year!


Monday, December 4, 2017

Poor Health

I haven't known what to blog about for the last two months or so because, honestly, I've felt very "in the middle" of some tough times, and I'd been waiting to write until things were better, but it's just time to decompress a bit.  Everybody just can't wait to hear about our hard times, right?  The very short version is that in the span of 48 hours Sarah broke her toe; Robert got diagnosed with herniated discs, bulging discs, phase II disc degeneration, arthritis, and spinal stenosis; and I started having mouth and stomach pain that eventually got diagnosed as TMJ, SI joint dysfunction, and a uterine fibroid.



It's kind of a blur at this point, but in mid-October I went to urgent care with terrible stomach pain.  I was just given an antibiotic and sent on my way which was frustrating.  I ended up seeing a new OBGYN at my normal clinic because my previous doctor is in the process of retiring.  I got an ultrasound, and there was a uterine fibroid found, but this doctor diagnosed me as having an overactive bladder, and that that was what was giving me pain.  What on earth?  It just didn't make sense.  I didn't have any symptoms of an overactive bladder.  So I went to my old OBGYN that I had seen in high school and college.  She believes that the fibroid is small enough that it shouldn't be causing this much pain.  After running every test imaginable she thinks that the belt of pain that I'm experiencing in my low back, pelvic bone, and low abdomen is caused by sacroiliac joint dysfunction.  Her suggestion was to avoid picking up Sarah for two weeks which is easier said than done considering that Robert is also under doctor's orders to not pick up Sarah.  We'll see if I start feeling better soon.  But anyway, the day after I went to urgent care I had an appointment set up with my dentist because I'd been in pain ever since he gave me a filling a month before.  He said everything was totally fine and suggested getting an over the counter night guard.  I tried that for two weeks and didn't notice any improvement.  He suggested a root canal.  It just seemed extreme and too coincidental that this all happened after I got the filling.  So again, I got a second opinion from my dad's dentist.  He found excess cement on my gum line from the filling and scraped it off and gave me a deep cleaning.  I was frustrated that the original dentist wasn't willing to admit his mistake.  Unfortunately, I still didn't feel better, so this dentist suggested I see an endodontist.  I went in today and got examined and tested, and the good news is that I don't need a root canal.  The bad news is that I have TMJ which has been really magnified after having my jaw open wide for all of this dental work.  He also saw signs of abnormal wear caused by grinding my teeth and clenching my teeth while I sleep, so I'm going to be doing some exercises and massage and also getting a custom-fit night guard.  I'm really hoping for some relief.  I've been in pain from this since mid-September.

So then there's Sarah.  The day after Robert's big back episode she picked up a 10 pound dumbbell and dropped it on her left big toe.  The toenail cracked and bled a lot.  It had been over a month, and she started talking about it hurting again, so I took her to the doctor last week, and found out that she had broken it.  I was so sad, but reassured that there really isn't anything that you can do for a broken toe.  She's walking just fine.  Her toenail is also in the process of falling off.  Once it totally falls off it'll take about six months to grow back which is sad to me.  I've never lost a nail.  She's a trooper.  But while we were at the doctor for her toe I mentioned that Sarah had been coughing for a few weeks.  Turns out she had an ear infection.  She's had four ear infections in the last year, so she's going to see an ENT.  She's also never seemed to be fully healed from her clogged tear duct, so the ENT should be able to check out that too.  And she seems to get lots of lingering colds, so we're going to have him do an allergy test and assess for asthma.  I'm hoping and praying for some answers and a positive experience when we get to see the ENT.  Seeing your child hurting is just terrible.  Also, could you all be praying for Sarah's upcoming urology tests and appointment?  On December 15 she will have a renal ultrasound and voiding cystourethrogram (VCUG).  She had both of these tests a year and a half ago to officially diagnose her with vesicoureteral reflux.  The renal ultrasound isn't bad, but for the VCUG they have to insert a catheter and fill her bladder with contrast dye and watch her bladder fill and empty on an x-ray screen to test the strength and formation of the ureters.  The last time she had it done she wasn't even one yet, and she did a good job.  I just don't want her to be in pain or scared.  Then on the 18th we'll see the urologist to get her updated diagnosis.  I'll be honest and say that for the last year and a half I've been praying for a miracle.  With all of my heart I want to go in on December 18 and hear that Sarah is fully healed.  It will take a miracle.  Most kids with grade IV reflux don't grow out of it.  It just gets better enough to need a laparoscopic surgery instead of an open anti-reflux surgery.  I hate having to give her a daily prophylactic antibiotic in order to prevent UTI's.  I also hate the way I feel when people hate on antibiotics and parents who "let" their kids take antibiotics.  I want to yell at them and say, "This is the only way I was able to avoid having my seven month old daughter have open surgery and stay at a children's hospital for days!!!"  When people make sweeping generalizations about how antibiotics are overused it hurts my feelings.  I understand building up a child's immune system, but not everyone takes antibiotics just so they don't have to be in pain from an ear infection.  For some people like Sarah it is literally preventing her from needing a kidney transplant one day.  Anyway, I'll get off my soapbox.  I will just end by saying that I am thankful for this medicine that has enabled Sarah to be UTI free since the summer of 2016 after she had two that spring.



Finally, there's Robert.  Before I even met him he injured his back in high school but never took care of it.  After several years it was bad enough that, after no improvement from physical therapy and pain management, he had back surgery in September of 2012 for two herniated discs.  He had been at about 90% ever since then, but in October he picked up Sarah, and it was the straw that broke the camel's back (almost literally).  Robert was in extreme pain and went to the emergency room only to get some pain medicine.  Thankfully, I got him in with his primary care physician that same day, and he was able to get an X-Ray and an MRI to get diagnosed with herniated discs, bulging discs, disc degeneration, arthritis, and spinal stenosis.  I'll spare you the details, but basically the medical world moves way too slowly when you're in excruciating pain and can't walk or stand up straight.  For example, his original MRI was scheduled for six weeks from his doctor's appointment!  Thankfully I did lots of calling and got him in just two days later, but can you imagine waiting six weeks for an MRI so you can get a diagnosis and actually start a treatment plan?  That's nuts!  The silver lining is that our neighbor works at a physical therapy clinic owned by her father-in-law, and she got Robert in to see him quickly.  The PT has been an absolute godsend.  He has done things that other PT's have never done for Robert, and he has seen a ton of improvement.  He told Robert he thinks he can be healed without surgery.  Robert was also able to get an injection from at the spine institute, and has gotten a lot of pain relief from that.

I want to say thank you to our family, friends, and church members who have taken care of us during this time.  You lightened our load!

We obviously wouldn't have ever wanted to experience this.  It hasn't been fun to be in physical pain.  It isn't fun to get medical bills in the mail.  It isn't fun to spend hours in waiting rooms, but I'd like to leave you with an excerpt from a book a friend is letting me borrow.  It's called The Scars That Have Shaped Me by Vaneetha Rendall Risner.
Remembering Romans puts my life in perspective.  God is not surprised by disappointing news.  He knows it all beforehand and uses it to conform me into his image.  As I reflect on the situation and the character of God, my prayer changes.  I am able to say: "Though I don't understand this situation, Lord, you have brought it into my life.  Because of that, I know it is good.  And I know that you will use it - both for my good and for your glory.  I want to trust you.  Help me to do that."
Then, every time I think about the situation, I decide to seek God in it.  Rather than dwelling on the negative, I begin praying that God will use it - in my life, for others involved, to his glory.  This is not an easy prayer.  It is a deliberate choice to push worry, anger, and self-pity away.  But as I seek the Lord and keep talking to him, he enables me to take my thoughts captive.  Slowly, my sense of desperation dissipates.
Recognizing that God is going to use this trial makes me calmer.  So every time I think about the issue, rather than getting upset and anxious, I pray.  I ask God to work in the situation.  To redirect my emotions.  To help me trust him.  It's easy for me to jump to conclusions.  To think that a trying situation is going to lead to another and then another.  I often extrapolate present difficulties into the future - which is the crux of not trusting God.  Those difficulties may never present themselves, but even if they do, God's grace will be there to meet me.  Even if the worst happens, God will not fail me.
I wish I could remember these truths when problems first arise.  I needlessly worry when I could be trusting God.  I shouldn't be surprised when trials come.  The Bible says to expect them.  They train me and refine me.  They do deep work in my soul.  The reveal my character.
I do not know how this situation will end, but I do know that God brings beauty from ashes.  No matter what happens, I know he will use it for my good and his glory.  There cannot be a better ending than that; 

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