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The Triangle of Knowledge and its importance to doctor.  In reality, the pyramid of knowledge should play a major role in every decision you make, regardless of your vocation or lot in life.

The apex of the pyramid represents what you know.  As it turns out, no matter how smart or well educated you are, what you know accounts for a small percentage of all knowledge.

The midsection of the pyramid represents what you know that you don’t know. I know that I don’t know how to fly a jet.  I know that I don’t know how to insert an electrical conduit in a person’s brain.  Knowing what you don’t know is essential if you want both to avoid problems and find someone to fix them.  When I referred you to a specialist, it was because that individual’s job was to know about the things I didn’t know about and then to diagnose and treat those problems when necessary.

The third (largest) section of the pyramid of knowledge represents what you don’t know that you don’t know.  What you don’t know that you don’t know is what can hurt you the worst.  What I did my entire life was to “PRACTICE” medicine.  Delivering medical care has always been referred to as “THE PRACTICE OF MEDICAL CARE,” in recognition of the fact that there is much that we don’t know about the human condition and disease.  Over the last 40 years, my job has been to increase my knowledge and decrease the “I don’t know that I don’t know” portion of the pyramid.

Now for a true story.  I’ve been having trouble getting in and out of bed.  I’ve tried multiple interventions, including buying a new bed, all without success.  Renee is great at doing research and showed me a floor to ceiling bar that she thought would work.  I, a man of infinite wisdom, told her it wouldn’t work.  Further, I told her it would probably ruin both the floor and ceiling.  She, in her infinite wisdom, ordered it anyway.  Brian, my brother-in-law, and Abe, my brother from another mother, installed my pole yesterday.

Again, I was confident that a floor to ceiling pole by my bed would not help me (and that Renee certainly wasn’t going to take up pole dancing).  I was wrong!  The pole helped.  Time to eat crow! “Sorry for underestimating you.”  [Realistically, I was partially right; Renee is not going to do any pole dancing.]

Knowing what you don’t know and who knows it can save you a lot of grief.  As I grow older, the things I don’t know are becoming more plentiful.  Luckily, I have a brilliant wife whose job in life is caring for me.  Her knowledge base compliments mine, filling in the gaps.

I know I’m risking my membership in the Society of Men by admitting that my wife is right, but she is (and often).

Here’s your joke of the day:

Annoyed by the professor of anatomy who liked to tell “naughty” stories during class, a group of female students decided that the next time he started to tell one, they would all rise and leave the room in protest. The professor, however, got wind of their scheme just before class the following day, so he bided his time. Then, halfway through the lecture, he began. “They say there is quite a shortage of prostitutes in France.” The girls looked at one another, arose and started for the door. “Young ladies,” said the professor with a broad smile, “the next plane doesn’t leave till tomorrow afternoon.”

Usually, words come easy, spilling onto the pages I will publish. Originally, my articles were designed to teach individuals how to be better patients and how to care for themselves. I addressed current medical controversies and treatment protocols, as well as the importance of having a functional medical family. Eight years ago, I started on meds for Parkinson’s and everything changed.  My articles became more personal, giving my readers a front row seat from which they could witness the effects of chronic illness on the lives of those dealing with such devastation. While my original articles were meant to help my patients take better care of themselves, my recent articles should help the families of their chronically ill loved one better understand and care for their charge.

I have become more pessimistic and essentially capitulated to Parkinson’s.  In my role as a doc, I found that the patients that give up (such as myself,) don’t do very well.  In my case, every time I allow a smidgeon of optimism to sneak into my life, I find myself facing new source of pain and suffering.   It’s as if I have a roulette wheel with body parts instead of numbers.  Every morning I spin the wheel.  Whatever body part I land on is the one that will bother me today.

I Facetime with my brother every day and every day I see the benefit of hard work and healthy attitude.  I’ve started to write about my brother multiple times and find that doing him justice is beyond my capability.  Nonetheless, I’ll try.  Alan, in many ways, is my opposite.  He worked out in a gym while I worked out in the refrigerator. When he was faced with a debilitating stroke, he refused to capitulate, fighting to get the use of his leg and arm back.  I replayed images of my grandfather and father’s Parkinson’s, buried my head in the sand, and refused to admit that my foe was attacking or that there was something I could do to slow the disease process.  The list goes on.

I’ve always looked up to my older brother, but never really told him how I felt.  There wasn’t anything he couldn’t do.  As a rule, what disability you have at the end of the first post stroke year is what you are left with.  Not my brother! He continues to gain function by battling through physical therapy and refusing to give in to his losses.  He works at lifting my spirits while I write depressing articles and slide further into my disability.  I must embarrass him.

I failed to mention him or Martha, my other sister from another mother, in my last article.  Writing at 3 am is probably not a good idea. They are coming to see me at great personal peril.  Their major risk is that I take the wind out of his sail with my attitude. Traveling by car from Tennessee is not going to be easy. Not having your own chair, bed, and bathroom poses new problems. Our recent trip to Disney reminded me how difficult life can be when away from your usual abode.  Like Renee, Martha has become responsible for everything!  The packing and trip preparations Alan and I used to do have now fallen on our wives. They have become superwomen caregivers.  Frankly, I’m wearing Renee out.

I love my brother and sister.  Unfortunately, we lived our lives miles apart and never traveled together or spent much social time together.  Those who read my blog know I advise against playing the “would’a, could’a, should’a game”; but waiting until you are ill to see each other is insane.

It’s a pity that there are no do overs.  If you could play the “would’a, could’a, should’a game,” I would follow my own advice, spend more time with family, stress less, eat better, and exercise.  Oh, well.

Maybe there is a God however the devastation caused by war makes me wonder.  As many of you know, I’m having a deep brain stimulator (DBS) implanted in my brain on the 23^rd of this month.  What you may not know is how scared I am! I shouldn’t be.  I practiced medicine for close to 40 years and have done or seen it all.  Years ago, I assisted my local neurosurgeon in a case of traumatic brain injury and even bored holes in a child’s skull.  She did great, as did the other patients I assisted with.   Even though our tools were primitive compared to today’s tools, our patients did well.

Nonetheless, I’m scared.  I worry about having a stroke or bleed.  I worry about becoming even more of a burden on my wife than I am today.  It may surprise you, but I worry about worsening and NOT dying.  I do not want to be a burden to my family or linger in a nursing home. Realistically, DB is going to help or it’s not going to help; and I’ll deal with whatever comes my way.

Just in case I don’t survive the surgery, I’m having a going away party over the next few weeks.  My family is trickling in from Virginia, New Jersey, and Georgia.  I have been blessed with two childhood friends/brothers.  I talk to them frequently and both had reasons why they couldn’t be here.  Internet hugs are just not as good as real hugs, but they would just have to do.

Maybe there is a God, and maybe He/She/or whatever pronoun you choose to use was looking after me today and recognized how badly I need an Abe hug.  Abe was scheduled to fly into Charlotte today and make a connection to his flight to the Virgin Islands.  Apparently, a bank of fog rolled in, closing the airport, and causing Abe’s plane to circle long enough to miss his connection. Yep, you guessed it. Abe and Linda are spending the night; and, having been able to hug them and tell them I loved them has alleviated many of my fears and concerns.

There is a Yiddish word, B’Shert, that translates to “meant to be.” What was unfortunate for Abe and Linda turned out to be a blessing for Renee and me.  I’ll drive them to the airport tomorrow knowing that their layover here was B’Shert no matter what happens in the OR.

Ripped off and pissed!  Embarrassed! Guilty! Ashamed! Trapped! Taken advantage of! Scared! These are some of the emotions I’m dealing with tonight!  Let me explain.  My Parkinson’s is getting worse rapidly.  I “freeze” meaning that my legs won’t obey my brain’s command.  It’s like I’m cemented to the floor.  It lasts a variable amount of time and can be embarrassing.  Imagine you have to go to the bathroom (really bad) and you freeze half the way there. Oops!

Now imagine that there is a new formulation of a very old medication that can help.  Rather than swallow a pill, you inhale its contents; and, within 10-20 minutes, the freezing goes away (for 2-3 hours).  What would you be willing to pay for it?  Would you believe that my copay for this new formulation of an old compound is $1240.00 dollars for 60 capsules.  Yep, $1240 for less than 1 month of medication.  Now you understand why I feel ripped off! 

Let’s talk about the other emotions:

1.  Embarrassed – I was a paid consultant to Pharma for many years.  I sat on several national physician/Pharma boards and fought for lower prices for meds, less TV advertising, and better access to medications for those who couldn’t pay for it.  I’m embarrassed to say I accomplished nothing and may have actually added to the cost of pharmaceuticals (they paid us well).
2. Guilty- Yep, I was paid well.  Afterall, my opinions were valuable.  I thought Pharma were the good guys and was proud to work with them. In time, I learned how wrong I was.  They are in the business of making a profit and they are very good at it!  Unfortunately, there are no limits to the amount they can charge; and the sick and elderly either pay or die.
3. Ashamed – I should have realized who I was dealing with earlier.  I gave out a lot of samples and those samples led to the prescribing of “brand named” products at inflated prices.  Samples cost society a lot of money!  Generics save money.  They also don’t advertise, don’t hire physician consultants and don’t have a fleet of sales reps pushing their products.
4. Trapped – I either pay $1200 plus or wet myself.  By the way, adult diapers are expensive as well.  Yes, the company that makes my new medication offers discount coupons.  Did you know that Medicare does not allow seniors (covered by Medicare) to use any discount programs?  Yep, you heard me right.  When your government talks about controlling the cost of medications, I laugh. Not only have they failed to control Pharma, but they’ve guaranteed that retired elders have to pay the full, inflated cost of their medications.  By doing so, they have guaranteed that Pharma will thrive for many years to come.
5. Taken advantage of – I think this emotion is self-explanatory.  Why hasn’t Congress done something about the price gouging policies of Pharma?  Pharma is one of the largest contributors to political campaigns; and, rather than count on drug reps to sell their goods, they fund lobbyists!
6. Scared – Do the math. The cost of living with Parkinson’s just went up between $14,880 to $30,000 a year for just one of my many medications. Diapers are not that expensive after all!

Anyone want to bet on Biden tackling Pharma?   If so, let me know.  I could use the money.

Here’s your joke for the day:

There was an old guy who took suppositories as a medication daily. One day he went to a restaurant with his wife, she said, “What is a suppository doing in your ear.” The old man says, “OH! Now I know where my hearing aids are!”

You know you’re an old man when your wife says “HONEY” in that special way and you’re disappointed that she wants sex rather than to let you know dinner is ready.

You know you’re an old man when every time you hear water running you have a sudden urge to pee.

You know you’re an old man when you aim at the toilet and hit everything but the toilet.

You know you’re an old man when you know where every bathroom between home and wherever you are going is located.

You know you’re an old man when you pee before leaving the house and again in 20 minutes.

You know you’re an old man when you hear the name Starbucks and you think, “They have a clean men’s room.”

You know you’re an old man when your wife says, “Let’s stop at Bed Bath and Beyond and you think, “bathroom to right of front door.”

You know you’re an old man when having fun means taking a nap.

You know you’re an old man when you pass on making love in favor of an extra nap.

You know you’re an old man when making love takes 30 seconds and goes like this: “Honey, I love you.” ” I love you too, now go to sleep.”

You know you’re an old man when your neighbor complains that your snoring is keeping him awake.

You know you’re an old man when you put on your CPAP mask and night guard and pretend that your call sign is Maverick.

You know you’re an old man when you can’t find anything without the help of your wife, and that includes your penis.

You know you’re an old man when you can’t remember your best friend’s name, and neither can he.

You know you’re an old man when your shirt looks like a culinary record of everything you’ve eaten this week.

You know you’re an old man when you brag about the dump you had this morning.

You know you’re an old man when you worry about not having a dump this morning.

You know you’re an old man when you can’t figure out how to turn the sink on in the men’s room or get the towel dispenser to give you a towel but your grandson can.

You know you’re an old man when farts seem to just appear out of nowhere and you don’t give a shit.

You know you’re an old man when you actually give a little shit with the leaking fart.

You know you’re an old man when you are afraid to laugh because you might pee.

You know you’re an old man when your bucket list has been replaced by a fuck-it list.

You know you’re an old man when every time you open a book and start reading, you fall asleep.

I know I’m an old man when I fall asleep 3 times while writing this blog.

And finally, you know you’re an old man when a happy ending is a good night’s sleep!

Here’s your daily joke:

Tom, Mike and Johnny are sitting around the breakfast table having coffee.

Tom says, “Oy, life’s a bitch.  I wake up every morning and sit on the throne for an hour, straining to take a dump.  All I get are these little rat turds.  It’s miserable being constipated.”

Mike says, “I don’t have any problem taking a dump. However, it takes me an hour to piss.  Start, stop, dribble and repeat.”

Johnny says, “I don’t have any problems taking a dump or peeing.  I just do both an hour before I wake up!”

I was watching a movie last night in which the hero seriously upsets his lover.  In his apology, he states, “I didn’t know what I didn’t know.”  What a powerful statement!  We live in a world where everybody is an expert.  People surf the internet, assimilate what they read and then go out and regurgitate their knowledge in the form of strongly stated opinions disguised as fact.

Since their opinions carry truths backed up by Google searches, they stand by them and freely share them with whomever will listen.  Since everyone is an expert and everyone assimilates his/her set of facts, conversations can become quite heated and deteriorate into arguments as each expert is sure he/she is right.  The result is our society becomes more polarized than ever.

The most important lesson of my career as a doctor was entitled, “The Pyramid of Knowledge”. At the top of the pyramid, occupying the smallest part of the triangle, is what you know. The next portion of the triangle is what you know that you don’t know. At the base, occupying the largest part of the triangle, is what you don’t know that you don’t know.  It’s what you don’t know that you don’t know is the segment that is most likely to hurt you and others.

One of the goals in life is to increase what you know.  It’s the primary purpose of education.  I had thousands of hours of study and lectures under my belt prior to practicing medicine (augmented by 38 years of practicing medicine).  Despite my MD degree and knowledge base, there are things associated with new vaccines that I don’t know that I don’t know.  In time, I’ll learn more as more vaccine is given.  One of many examples is:  when the measles vaccine was approved for use, there were things we didn’t know about it.  Now, after years of use, I can tell you everything about it.  I can say the same thing about all my vaccines. During my career, I can only remember one vaccine that was withdrawn from the market after initial approval.

“I didn’t know what I didn’t know” is a powerful statement!  The next time you find yourself in a conversation that is heating up, hit the pause button and ask yourself, “Do you know what you don’t know (does he/she know what they don’t know?”  The next time you find yourself believing that you are an internet expert in law, medicine, politics, etc., remind yourself that you probably don’t know what you don’t know and guard against the unknown as best you can.  You have a right to your opinion!  Your opinion is important.  Don’t forget that your opinion may not be fact.  Consider that there may be things you don’t know about the subject you’re discussing.  When it comes to medical facts, rely on your doctor.  A good doc knows what she/he doesn’t know and knows where to find it.

Here’s your joke for the day:

A man wonders if having relations on the Sabbath is a sin because he is not sure if doing so is work or play, so he goes to a priest and asks for his opinion on this question. After consulting the Bible, the priest says, “My son, after doing exhaustive research, I am positive that sleeping together is work and is therefore not permitted on Sundays.” The man thinks: “What does a priest know about having relations?” So, he goes to a minister who, after all, is a married man and experienced in this matter. He queries the minister and receives the same reply. Sexual relations is work and therefore not for the Sabbath! Not pleased with the reply, he seeks out a Rabbi, a man of thousands of years of tradition and knowledge. The Rabbi ponders the question, then states, “My son, it is definitely play.” The man replies, “Rabbi, how can you be so sure when so many others tell me it’s work?” “Because, my son,” said the Rabbi drily, “if having relations was work, my wife would have the maid do it.”

https://www.ba-bamail.com/jokes/religion-jokes/?jokeid=1411

What happened to sandboxes?  When I was a kid, my neighbor had a large sandbox and we played in the sand for years. Occasionally, we would start at 8 a.m. and quit when our moms called us in for dinner.  We dug tunnels and built roads with our Tonka trucks.  As we grew older, the sandbox became a war zone.  We had an army of plastic warriors protected by tanks, troop carriers and planes.  Of course, we built model planes, trucks, ships, etc.  In our teens, loaded with M80s and cherry bombs, we had a blast blowing it all up.

Sandboxes were easy to build and inexpensive.  We played outside; and, instead of having gigabytes of memory and computer-generated images, we used our own brains and creativity.  What happened to sandboxes? What happened to playing outside?  What happened to using our own creative minds?

Obviously, computer games have captured and taken our children hostage.  They still play outside but their “outside” is inside a computer screen or television screen.  Their parents try to limit their screen time and get them involved in outside activities.  Limiting their screen time usually leads to a fight.

My parents never tried to limit my time in the sandbox.  Quite the contrary, my mom would say, “Why don’t you go over to Harris’s house and play in the sandbox.”  I gladly went out.  I’ve got to admit, I often fought coming home at dinner time.  Like all kids, I bargain for “just a few more minutes.”

I was pleased to see sandboxes are still sold and that Amazon has a large selection.  Now, I just have to convince today’s parents that playing in the sand is preferable to playing with an iPad.

Did you have a sandbox?  Do you have fond memories of playing in the sand?  Do your children or grandchildren have sandboxes?  If you didn’t have a sandbox, did you build sandcastles at the beach?

Here’s today joke:

A married couple is lying in bed.

The wife leans over and says, “I want you to say dirty things before we start”. So, the man starts to caress her neck and whispers to her. “Living room, Bathroom, Kitchen”.

Are you old and hard of hearing?  Is your vision decreasing with age?  Do you have any other handicaps? If you’ve answered any of the above questions with a yes, then keep reading.

By law, there are handicapped parking, handicapped equipped bathrooms, hotel rooms, entrances and exits from buildings, etc.  Handicapped accommodations make my life much easier and safer.  I am thankful that Congress has recognized the handicapped’s need for help and provided it.

Today, I want to propose that the handicapped laws be expanded to cover one additional area.  Today, I called the customer service line of a major insurance company.  The phone was answered by a soft- spoken agent, speaking rapidly in broken English.  I had a lot of trouble understanding what he was saying.  My end of the conversation was, “Could you please repeat that?”  “Can you speak up?” “I can’t hear you!”  “Is there someone who speaks English?”  “Can you spell that word for me?”

Typically, Customer Service refers me to an internet site where I am bombarded with screens designed to setup my account and password protection.  Then there are forms made up of a number of fill in the blank questions and free type boxes.  God forbid if you don’t have email.  Without email access, you end up trying to communicate with another individual speaking broken English. You are really up the creek if you speak in broken English.

           Unfortunately, my typing skills have diminished with age, arthritis and Parkinson’s.  Usually, I go to the Customer Service internet site prior calling and call only if I can’t resolve the problem online or it is too confusing to be navigated.

Now imagine you’ve called Customer Service and are at the first choice point: dial one for English or3 dial two for Spanish.  My proposal is to add a third option: dial three if you are hard of hearing. Pushing number three would take you to a panel of customer service agents who specialize in communicating with the hearing impaired. Other disabilities could be addressed on the internet by employing programs designed for those with visual handicaps.

If you agree with my basic premise, share this article with your family, friends, and congressional representatives.  Until the laws change, politely ask to speak to a native speaker (interpreter). 

Here’s today’s joke:

A police officer pulls over an elderly couple He walks up to the driver’s side window and asks the husband for his license and registration. The wife, hard of hearing, asks “What?! What did he say to you?” The husband replies, “He wants my license!”

The officer asks him if he knew how fast he was going.

The wife yells “What?! What did he say to you?”

The husband yells back, He says I was speeding!”

As the officer looks at the license, he notices they’re from Ohio and says, “You know, I used to live in Ohio. Worst place ever. I was seeing this woman there, and it was just miserable. She would never shut up, couldn’t cook worth shit, constantly belittled me, and the sex was just awful.”

The old lady once again yells, “What?! What did he say to you?”

The husband yells back, “He said you two used to date!”

I’ve been working on my diet for months; and, unfortunately, I’ve had very little success.  In “Diets and Other Unnatural Acts,” which I wrote years ago, I explained why I preferred refining your own diet as opposed to conforming to someone else’s diet plan.  I was right, at least in my case.  Conforming to a “canned” diet has proven unsuccessful for me.  I was also wrong.  Refining my own diet has failed, as well.

I stated yesterday, I’ve been using food as an antidepressant.  I’ve been using food to fill the long hours of an otherwise boring retirement.  I realized that since retirement, I’ve been on a pity diet.  My pity diet has led to a fifty-pound weight gain.  Obesity sucks.

Three weeks ago, I decided I needed a radical change in my diet and some major behavioral changes.  I’ve done well!  I’ve lost 9 pounds on a modified keto diet.  Keto has not been easy.  I’ve spent a lifetime limiting fat ingestion despite the fact that I love cooking and eating fats. I haven’t abandoned my ideal, defined and refined, life diet; I’ve just put it off until I’ve lost a total of 25 pounds.

Striving to stay within the guidelines for a Keto Diet, I’ve sampled many foods that I’ve not eaten in the past.  I’ve also thrown out more food than I ever have.  One of the secrets of the Keto Diet is that many of the “Keto friendly” foods taste so bad that you want to spit them out.  While the internet will tell you that Aldi’s Keto friendly bread is the best, I’ll tell you that it is solidified sand and cardboard.  Remember, qualifying terms such as “the best” are all relative.  The best poop is still poop!  The Keto ice cream I just bought is probably made from poop.  It is a zero-calorie product (since I won’t eat it).

Obviously, to achieve permanent weight loss, I’ll have to find answers to depression, boredom, and pity.  I’ll also need to resume my Wellthy Diet, eating healthy food in appropriate quantities.  This is going to be a long-term project.

Today’s joke came out of the mouth of my 4-year-old granddaughter’s boyfriend’s mouth. 

“Mommy, is my butt-hole a poop copier?”

Which led to my asking: “Why do people hate poop jokes?  Because they kinda stink.”

The number of my friends who suffer with depression is staggering.  The number of my former colleagues (physicians) who are depressed is also staggering!  I find myself wondering whether this is a new phenomenon or tied to Covid, politics and the media’s new role (BREAKING NEWS scrolling across our TV and computers every 15 minutes).  Whatever the cause, depression should be treated aggressively.  Unfortunately, most depressed individuals will neither admit to depression nor treat it.

Are you depressed?  I once asked a patient that very question.  Her answer was an emphatic, “NO!”  She had all the signs of depression as well as a multitude of depressing problems, yet she appeared angry that I would suggest such a diagnosis.  Her response was a typical one.  Depression is accompanied by an ancient stigma.  Admitting to depression is like admitting to a character flaw or weakness.  A diagnosis of depression can have a significant, negative impact on your career and inter-personal relationships. This particular patient was deeply entrenched in her denial.  I gave her a choice.  “Mrs P., your choice is to be depressed or insane.  Your story is so sad that it depresses me.  If you are not depressed, then you must be insane.  Any sane person I know would be depressed given your circumstances.”   She chose the diagnosis of depression and eventually accepted treatment.  (She’s doing well.)

As a physician, I can tell you that once you’ve gotten a patient to accept a diagnosis of depression, you then have to get them to accept therapy (medication, counseling, etc.)  Making the diagnosis is fairly simple.  Getting the patient to accept the diagnosis is difficult.  Getting the patient to accept help and treatment is nearly impossible.

When my doc told me I was depressed my response was, “DUH!”  Hurdle number one was easy, diagnosis made and accepted.  When she offered pills and counseling, she hit a wall. I was already on a shitload of pills with a host of side effects.  Further, I explained that I had spent 30 years counseling patients and didn’t think counseling was going to be worthwhile.  Ultimately, I gave in and started on meds and in counseling. I ended teaching the counselor.  The meds I agreed to take did not help.

What I’ve found is the best antidepressant in the world is time spent with my grandchildren and their parents.  Second best is cruising North Carolina country roads on sunny days in a convertible.  Third best on my list is eating.  Unfortunately, the side effects of eating are weight gain and obesity which then lead to more depression (in my case, anyway).  Certainly, treating the underlying disease would be helpful (if successful).  Parkinson’s is a mean adversary.  Fourth on my list of non-medicinal therapies is watching my garden grow.

In March, I’m scheduled for DBS (neurosurgery) in a final attempt to slow the ravages of Parkinson’s.  My garden guru will plant my vegetable garden and tend to it while I recover.  Renee will drive me around with the top down while I recover.  Luckily, she’s a racecar driver, taking curves at max speed and making every excursion an exciting experience.

If you are depressed, talk to your doc.  Certainly, meds and counseling can help.  What works for me may not work for you and what failed me may help you.  The important thing is being open to help.

Here’s today’s joke:

I was having issues in my personal and professional life. I hated everyone. I was on the brink of a mental breakdown and depression. I decided to see a therapist about it. The therapist suggested that I should write letters to the people I hate and then burn them. I must admit I feel much better…

But now I don’t know what to do with the letters.