You are currently browsing the tag archive for the ‘biopsy’ tag.
Mark and I sat around for a long time last night trying to figure out exactly what to hope will come out of today. Wishing for everything to “be okay” doesn’t quite cut it, nor does my usual “I hope the worst is behind us.” We need some specifics here.
We’ve settled on four scenarios, two likely and two highly unlikely. Of course, there may be one or ten other possibilities that haven’t yet crossed our minds, but we do have a well of experience for how these things work.
The two most realistic possibilities are that we clearly see the lesion and 1) are able to easily reach it with a needle biopsy or 2) aren’t able to reach it. The first is obviously the most desirable. Then we could schedule a biopsy and get real information. At that point, we know exactly what to wish for: that the “thing” is not cancer. And not only not cancer, but defined with certainty as something else so we don’t even have to worry about it. Then we’d finally pop open that champagne. If we’re unable to reach it with a needle biopsy, I think the next step would be to watch and wait, with repeat scans. I don’t think any of us (parents or doctors) believe that the need to know outweighs the risk of surgery. If it grows or changes on repeat scans (probably monthly), then we could justify going in surgically since growth almost always equals cancer.
The two unlikely scenarios fall on opposite ends of the good-bad spectrum. One is that the “thing” has disappeared. I know that sounds like the best option, but it would also raise many questions, like what was it saw last week and where the hell did it go? I imagine we would also end up with more frequent repeat scans if that was the case, to make sure it doesn’t magically reappear. The worst possibility would be that it’s grown considerably since last week, forcing us into quicker action (since growth equals cancer).
So, for all of you who’ve sent me lovely messages saying you’re wishing, hoping and praying for us today, now you have a specific request to send out into the universe: That we can easily reach it with a needle biopsy and that’s it’s ultimately defined as something other than cancer.
Okay … got it? Now get busy.
One of the features on WordPress allows me to see which pages on my blog people visit and each day, there are at least several (presumably new) visitors who read the “About Krissy” page. So I just looked at it and, wow, that sure can’t help anyone! It actually says, in those few brief paragraphs, that Austin has “been in remission since March 2008.” Humph. I wish.
So, for the sake of any newcomers (or any confused old-timers), I’m going to give the Cliff’s Notes version of the past two-plus years, divided into three rounds.
Round One began on July 30, 2007 when Austin was diagnosed with bilateral Wilms’ tumor, cancer in both his kidneys. His treatment lasted eight months and included four abdominal surgeries, the removal of his entire right kidney and 40% of his left, and twenty weeks of chemotherapy. The details of that round are summarized on the Austin’s Story page, which is a seriously shortened version of what I wrote on his Carepage between August 2007 and March 2008. Excerpts from those months can be found interspersed throughout this blog as well, especially in this post.
Round Two coincided with the launch of this blog and took place in March and April of 2009. After thirteen glorious cancer-free months, a CT scan revealed a new mass floating in his left abdominal cavity (not in the kidney itself). A biopsy confirmed that it was indeed a Wilms’ tumor and we were left reeling, certain that his cancer had recurred. The tumor was removed in yet another major surgery after which we learned that it was actually an old tumor, and instead of a dreaded recurrence, this episode was labeled the much vaguer (but much better) “residual cancer.” The whole thing lasted a mere three weeks and we suddenly found ourselves back where we’d started.
There was another intermittent event between Rounds Two and Three: In October and November of 2009, we began watching yet another shadow, worried that it might be cancer and necessitate the removal of that left kidney. We thought we had resolved the issue when, lo and behold, the shadow changed drastically which brings us to the present, Round Three.
Round Three officially began in December with the decision to go in and attempt to remove this new tumor while also hoping to salvage what remained of the kidney. I won’t go into all the nitty gritties because they’re posted here throughout December, but the surgery was successful in terms of the kidney but not so much in terms of what it showed us about the cancer. Austin had indeed relapsed, his cancer was back and more vicious than ever. After some gut-wrenching back and forth decisions about whether or not keep the kidney, Austin began another protocol of chemo and radiation, which we are currently partway through.
It’s all here, in a crazy and jumbled fashion. These posts are filled with good news and great news, bad news and horrible news. There is hope and laughter and tears and fear and love and lots and lots of living.
Oh, how I wanted to be surprised. I wanted to be shocked, disbelieving: “What?! Really? It shrunk? It disappeared? It can do that??”
But no, I was not surprised. It was as we had thought. And as we had feared.
This little mass has doubled in size, from 1 centimeter in diameter to 2, in the past three weeks. That pretty much does it for us, that’s about as certain as they come. We’re still going to do a needle biopsy before scheduling surgery, just to be positive sure, but it would be pretty shocking if this wasn’t a cancerous tumor. There’s really nothing else that it could be.
We’ll try to schedule a biopsy for later this week, which requires a two-nght stay, one for pre-hydration and one for observation in case it causes excess bleeding in the kidney. Then, assuming that proves that this is indeed cancer, we would schedule a surgery for the following week to remove that tough little kidney.
Oh, that kidney. I am mourning that kidney already. It has surprised and impressed us all over the past two years and I really wanted to see how far it could go, how many years its can-do, no-quit attitude would give us. And now, we will take it out before it ever has the chance to prove all it is capable of.
We’re still calm, strangely so. Numb, I guess. Not surprised, which helps. This has been a long time coming. That whole October dilemma about the cystic lesion prepared us for this, let us wrap our heads around the idea of dialysis and transplant, made us really contemplate what might lie ahead of us.
Back in March, when that new tumor appeared and we thought his cancer had recurred, that time was shocking. That knocked the wind out of us, sent us reeling, spinning out of control. We had so firmly believed it was over, we had so firmly believed we were sfae. And we weren’t. But that episode taught us a lot. We’ve been on our toes ever since. And so today, we are not surprised.
Oh, how I wanted to be surprised.
I find it sort of funny, or at least ironic, that all of us (you out there as well as me and Mark) are feeling such joy and relief after Monday’s meeting. It’s almost as if we think, “Oh thank God, that’s over with,” when in reality, whatever was inside Austin’s body last week is still there today. He still might have cancer. Or not.
We do feel good. Enormously relieved. Even though the facts didn’t change, even though no one looked at the slides and said, “Oh wait, now we know what it is,” even though everything remains the same, it sure doesn’t feel that way. Just to have the prospect of surgeries and dialysis no longer looming over our heads (for today, at least) is a huge gift.
But, as promised, here are the nitty gritty details we learned in our Monday conversation, all of which fed into our decision.
You may remember that we thought our next step would be to do a needle biopsy, even knowing it may not be successfully diagnostic. Well, that was an understatement. The doctors said it had about a ten percent chance of giving us any definitive answer. Because of the “thing’s” location and because of the fact that they’d be stabbing a fluid sack and trying to draw out cells from the solid portion inside it, they thought it was sort of a waste of time. Even if it is cancer, learning that from the biopsy is unlikely. And our actions moving forward wouldn’t be impacted by the results in a major way because those results would most likely have put us back where we are now. So it was deemed an unnecessary step to take.
We also discussed the possibility of doing an open surgical biopsy, where they begin a surgery but don’t decide whether to take out the mass, or take out the kidney or just sew him back up until they’re actually inside and can biopsy a section of the shadow. If the mass grows and we do decide to operate, this is what will automatically happen anyway. But to do that now would put him at great risk. Because he’s had so many surgeries (one kidney-sparing that removed four tumors plus three surgical biopsies on that particular kidney), there’s a ton of scar tissue and adhesions that have formed. For instance, one part of the kidney has sort of suctioned on to the spleen and any surgery could severe that currently harmless connection and make the spleen bleed out and need replacing. The kidney itself could fail due to excessive blood loss because of all of the scar tissue that would need to cut through to even take a look in there. So again, at this point, it is not worth it.
Another thing, and this one is promising, is that this shadow might be a urinoma. A little pocket of pee. When they raised this as a possibility, I exclaimed, “Oh, it must be that! A pocket of pee is just so Austin!” Because there is obviously urine in the kidney (apparently just floating around in there), when they did his main surgery, they might have sewed up some pee into a little ball, called a urinoma. Ha. How do you like that for modern medicine?
That’s about it. We’re scheduling an ultrasound for next week and just keeping our fingers crossed. And we feel good.
From the mouth of my outrageously smart, not-yet six-year-old when I told him about our latest predicament with Austin: “But Mom, the real question is, How are we going to know what’s inside of him?”
Exactly Braedan, exactly.
I know a lot of you have questions too, so I will do my best here to provide a few answers. First of all, on the issue of kidney transplant: I’ve explained before that transplant can’t take place until a patient is two years cancer-free. A few of you have asked (and I’ve wondered as well) if that rule might be tweaked if a donor stepped forward and said, “I don’t really care if Austin might have cancer inside him, I’m willing to risk it and I want to give him my kidney anyway.” It’s a nice thought but the answer is a resounding no. This is a hard and fast rule with absolutely no wiggle room. In fact, the entire hospital could lose its license to perform transplants if they were to do something like that. The main reason (and it’s a good one) is that the immuno-suppressant drugs transplant recipients have to take can cause cancer to grow. Not exactly the outcome we’re looking for.
Some other things I’ve learned about kidney transplants: The most successful transplants occur when the donor is a live relative (LRD or “living related donor”). The ideal kidney comes from anyone between the ages of 18 and 35, although they’ll go as old as 50 or more with a healthy match who has no history of high blood pressure. I am automatically out of the running because of my diabetes, but we feel confident there are many family members who would step forward and be tested. The best match is determined based on a set of six tissue matches, all with a numeric score. The highest scoring kidney is the best match and therefore least likely to be rejected by Austin’s body as foreign. An unrelated donor with a high tissue match is also a fine candidate. We have quite some time (obviously) before we need to even begin that process but it’s helpful to start thinking about it.
The bummer about him needing a transplant so much earlier in his life than we’d expected is that transplanted kidneys (called “grafts”) don’t last all that long. I read last night, “Some grafts even last twenty-five years” and I thought, “Oh, great, so we can do all this again when he’s thirty?” Not to mention the risks of infection during the years of dialysis. He again is put into that high-risk category where exposure to chicken pox or pneumonia could mean hospitalization and death. And then there are all the drugs he’d have to take for the rest of his life to ensure his body continues to accept the new kidney, which surely have side effects especially when taken for so many key developmental years.
But before we get to all that, we still need to figure out what exactly to do next. We’re planning a meeting with the team of four here at UH (oncologist, surgeon, radiologist and nephrologist) so we can explore the many paths we might find ourselves on. A few of our questions include:
1) Does the fact that this mass is fluid-filled make a kidney-sparing surgery more or less likely to succeed? ie, Is it easier to get clear margins with a solid or fluid filled mass?
2) (And this one is key) If this is indeed cancer, would we up our chances of cancer-free survival if we just screw the kidney-sparing attempt and take the whole thing out? Is his cancer less likely to recur if there is no kidney for it to orignate in?
4) Can we do an open exploratory surgery where they biopsy the mass while he’s “open” before we decide whether to remove it and/or whether to remove the whole kidney?
5) If we do such a surgery and it turns out to not be cancer but the kidney fails as a result of the exploration, can we consider him cancer-free from April 2009, the last time there was proven
cancer in his body and therefore put him seven (or more) months closer to a potential transplant?
We hope to get some real answers to those questions, but know that 1) There are no guarantees and 2) With few, if any, kids who’ve ever had this type of cancer, there are few, if any, data points to use to mark our path.
In the meantime, Austin himself is totally fine. He feels normal, acts normal and is normal. We haven’t told him anything yet because it’s all too uncertain for a three-year-old’s mind to grasp. What can we say? “Austin honey, we think there might be cancer inside you and we might do a surgery in a few weeks and then some pretty awful stuff might happen to you for two years but don’t you worry about that right now.” No, we’ll just let him be while we can.
I had his first conference at school yesterday and his teacher assured me that he is doing very very well there. Her written evaluation ended with, “Austin is such a capable, respectful little man, and a positive role model for the other children. It has been beautiful to watch him manage the transition to school with greater confidence each day. Now, he relishes it with a smile on his face most of the day.” She told me to hold on to that, which I will both literally and figuratively, as a snapshot of where he is now and as a goal to which he can someday return.
Back and forth, and back and forth, and back and forth. This is a terrible position for parents to be placed in. This is a terrible decision to have to make on behalf of our child.
What’s the right answer? What will cause the least damage, to mind and to body and to spirit? What will give Austin the best possible life?
We just don’t know what to do.
I had a phone consultation yesterday with the head of surgery at St. Jude. Talking to him in person (well, not in person, but actually speaking with him) left me convinced that he and the team there do indeed know Austin’s history and are indeed making informed and careful recommendations. So that was good. But talking with him left me more confused than ever about how to proceed.
Some key points: He said he can envision few scenarios in which this “thing” could be left inside Austin indefinitely. The likelihood of it being cancer is just too high, and the risks that would pose are just too great. Of course, the fact that Austin’s cancer has never spread is reassuring but is no guarantee that it won’t decide to start spreading at any given moment. He also wondered aloud about the tumor that was removed in April that was located outside of the kidney. At the time, we thought that was good news because it meant the kidney would remain safe and untouched through yet another round of cancer. But Dr. Davidoff said that that might itself be an instance the cancer spreading. How do we not know that that particular tumor originated in the kidney along with all the others and somehow moved out into the abdominal cavity? Of course, we can never know the answer to questions like that but it does make you think.
He also said, and this has given us a small bit of hope to grasp on to, that he is comfortable attempting another kidney-sparing surgery. This means that he would try to remove the current mass without taking out the entire kidney, something the doctors here feel wouldn’t be successful and therefore wouldn’t be worth even trying. (Because that would require another surgery to remove the damaged kidney so soon after the first surgery, I guess.) Dr. Davidoff said that they have done several similar surgeries over the years, none quite like Austin’s of course, but that he is certainly hopeful and willing to at least try it. The caveat there, though, is that he would be more likely to succeed if we did it sooner rather than later, before the mass grew any larger. Another thing to think about.
Also, he did say that they’ve had children at St. Jude who were initially diagnosed with solid Wilms’ tumors but whose recurrences were cystic Wilms’ tumors. That wasn’t what I wanted to hear.
Our decision has come down to this: We leave something potentially deadly inside our child. Something that might just sit there and do nothing, or something that might sit there seeming to do nothing for months or even years before suddenly sneaking away and then reappearing somewhere else in an unbeatable, untreatable form. Or we subject him to a major surgery that is likely to result in a completely altered (and considerably less pleasant) life for two or more of his most formative years. And that maybe that major surgery removed something that proves to be completely and totally harmless and it was all for naught.
Do you see why I say this is a terrible position for parents to be placed in? A terrible decision to have to make on behalf of our child?
I think, at this moment at least, that we are leaning towards trying a needle biopsy as planned before we learned that this mass was cystic (or fluid-filled). Aftert talking with Jeff yesterday, he re-explained that we can still attempt that route but that it’s not as likely to give us definitive results. Basically, if a needle biopsy comes back indicating that this mass is indeed cancer, then that would be definitive. If it comes back indicating that it’s scar tissue, . . . well, that might mean that the one tiny part they biopsied was scar tissue with no information about the rest. So, you see, the news we would hope for (that’s it’s scar tissue) would leave us right back where we are now, not knowing what to do. The news we don’t want (that it’s cancer) would at least tell us what to do next (go in and remove the damn thing already).
Of course, I (ever hopeful) will hold on to the slim possibility that when we biopsy it, it turns out to definitively be something else entirely, something no one had yet thought of that is completely harmless. Ah, a girl can wish.
Sure beats the weather here in cool and rainy Cleveland.
So . . . St. Jude’s recommended a resection and biopsy. That means removing the “shadow” to find out exactly what it is, which in Austin’s case means removing the kidney (and you know what that means). Now, this is just a recommendation, not something we are going to do rush out and schedule. It’s also not terribly surprising, especially because, according to Jeff’s description, the doctors were reviewing dozens of cases during Wednesday’s meeting and didn’t necessarily go through Austin’s entire past history, including the two years’ worth of CT scans we sent. In fact, they didn’t even look at the recent ultrasound because their radiologist didn’t think it was “relevant.” So, ultimately, we again think they didn’t really put their full attention to this and are not all that surprised by the automatic recommendation to get as much information as possible (at all costs, as I feared).
Mark and I have decided to finally go to Nashville and meet with them in person. We want the chance to sit down at a table and really discuss all that has happened and all the options moving forward (and all their ramifications). The main guy we’d be meeting with is Dr. Green, the “Wilms’ tumor guru” who has been following along (albeit peripherally) with us since the very beginning. I think it will be much more productive for him to see Austin in the flesh (and not as a series of grey shadows on slides sent via FedEx) and for us to have a real human conversation.
There’s not a huge rush, so we’ll wait until after Halloween (obviously of great importance in a house with two little people) and probably go sometime in the next few weeks. We feel okay about this; not much has changed since yesterday after all.
And we could always use some sunshine and warmer weather . . .
The mystery of Austin’s kidney continues with no easy resolution in sight. Yesterday’s ultrasound revealed that this shadow, this mass, actually appears to be filled with fluid. Now at first glance that seems like good news because Wilms’ tumors are solid tumors. But of course, there are things to worry about that we had never heard of before.
First of all, the radiologist doesn’t think he can do a needle biopsy on it if it’s fluid-filled because he usually takes slices off of solid growths. Fine needle aspiration is a possibility, although one that often results in non-diagnosis (or even misdiagnosis) due to the small sample size. So it seems likely that we cannot find out what this thing is without removing the entire kidney and biopsying it. Which we are not willing to do. At least, not yet.
Jeff (that’s Dr Auletta, for those of you not yet on a first name basis with our oncologist) said there is a spectrum of cystic lesions that this thing might be. It could be a benign cystic nephroma (you guys should qualify for an honorary medical degree just for reading this stuff!), which is not that big a deal. It could also be a partially differentiated nephroblastoma, which falls in the intermediate danger range, sort of a non-aggressive cancer-like growth. It would appear that neither of these two options are particularly dangerous; however (big however here), in kids with two functioning kidneys who present with one of these two cysts, the typical course of treatment is to remove the entire affected kidney. Just in case. It’s really a better-safe-than-sorry approach; sort of no-harm, no-foul. Now with Austin, such an option is not really an “option,” but a last resort.
And here’s the other thing it could be, on the far end of the “spectrum of cystic lesions” I now have to worry about: it could be a cystic Wilms’ tumor. Who knew such a thing even exists, right? Yes, of course, there is another kind of Wilms’ tumor that I heard about for the very first time yesterday that is indeed fluid-filled. Great. Of course, most kids who have this type have it from the beginning. There is no research that shows that Wilms’ tumors evolve from one type to another. But (big but here) because Austin is literally one of a kind and no one has ever before had what he has (oh, what I would give for ordinary), we can’t completely rule that out.
So . . . what to do? That is the question.
The various doctors (oncologist, radiologist, surgeon, nephrologist) all think we should just watch and wait. His kidney has always had shadows, I’m not sure if I’ve made that clear to you before. Even when we have “clear” scans, there are still shadows. That little kidney has been cut into, sliced apart, manipulated and manhandled on four separate occasions. So, yes, there are shadows on it, little swirls of gray that show up on the scan. Some of them we worry about and some we don’t. We usually watch to see if they change in any way. And this one has, albeit very subtly. It’s not dramatic at all, it’s darkened a bit and shifted position slightly so it touches the border of the kidney. The doctors agree that it’s not urgent, especially considering the potential harm of trying to definitively diagnose it. St. Jude’s will review his case again next week, so we’ll see if they have any new insight into what it might be or how to treat it.
And in the meantime, we wait. And we watch. We’ll do more scans alternated with ultrasounds. My mom asked yesterday if anyone was worried about the increasing number of scans he’s been exposed to (you know, radiation) and I said, “Wow, that seems like such a luxury, to be able to worry about some secondary cancer that might appear in twenty years.” As Jeff always says, “Let’s get to twenty years first.”
A friend sent me a poem about hope the other day. It called hope a fragile thing. And in a lot of ways, it is fragile and sometimes elusive. But it’s also surprisingly strong. And we will hold on to it as long as it will hold on to us.
Thank you, yet again yet again, for the outpouring of support and well wishes coming our way. You can not possibly know how much strength we draw from all of you.
Yesterday ended with better news. Not the good news we’d been expecting on Thursday, but definitely better news.
Dr. Auletta spent a good chunk of yesterday afternoon sitting down with Austin’s nephrologist (kidney doctor), the radiologist who did the needle biopsy in March and the new head of urology who would be in charge of any surgery Austin has in the future. Together they reviewed all the past scans and weighed our options moving forward. The first, and best, thing they agreed on was that even thinking about removing the kidney based on what little we know right now would be premature. So that warrants a sigh of relief, to say the least.
The other good news is that the radiologist believes he can reasonably and safely access the mass with a needle, precluding the need for a surgical biopsy (for now, at least). This Tuesday we’ll have an out-patient ultrasound just to check whether or not the shadow is visible which would mean he could do the biopsy guided by ultrasound instead of CT. It’s not a huge deal either way but it would be nice to subject Austin to a little less radiation plus we’d only need one night in the hospital with ultrasound versus two with CT (because of the need for pre-hydration). Dr Auletta did warn us that the biopsy could give us inconclusive results, which would put us right back where we are now, but we’ll deal with that if it comes.
The bad news came from the nephrologist who said that Austin is not a candidate for peritoneal (at-home, overnight) dialysis and never will be because his peritoneum (which is what they hook up to the machine) was severed during one of his many surgeries. This means that if and when he ends up on dialysis, it will indeed be the more traditional hemodialysis requiring four-hour hospital stays every other day. Yuck, yuck and yuck. My mom assured me yet again that she would take one shift a week and that my dad could too, plus of course Mark but it is not me I’m worried about. I mean, I certainly don’t want to have to spend any more time in a hospital than I already have, but it’s Austin who shouldn’t have to sit still for four-hour stretches every other day. That has got to be a sick method of torture designed specifically for three-year-old boys. This kid does not stop moving. He doesn’t even watch TV (which is suprisingly disappointing to me!); he is go go go all the time. So I will not give up on this kidney just yet.
But right now, for today, life feels normal. The boys are none the wiser, consumed with their usual issues: what’s for dinner, whose car races faster, whose turn it is to mow the lawn with Daddy. Austin feels totally fine and we will just carry on as is until there is a reason to stop.
As we drove to the hospital on Wednesday night, Austin was asking again why we were going, finding reassurance in my endless repetition of what was to come. I told him he needed a CT scan so the doctors could look in his tummy and make sure there’s no cancer inside him. He responded with great sincerity, “But I don’t feel any can-ther inside me.”
Let’s hope he’s right again.
And then we wait and we worry and we wish some more. But we don’t exhale with relief when the good news is delivered.
Because it’s not good news that’s delivered.
There’s another shadow. Another fucking shadow. God, this is the never-ending story. This shadow is actually inside the left kidney, which is really lousy. We don’t know what it is, of course, just that it’s there. It might be scar tissue, it might be another Wilms’ tumor or it could be a nephrogenic rest (those pre-cancerous growths he had on his left kidney back in the beginning, along with two tumors). It happens to be located exactly where the biggest of the original left side tumors was before it was removed in October 2007. So it could very well be some leftover cancer cells that have grown into something new.
We’re not in crisis mode yet. But we’re tired. We’ve been through enough and we’re so very ready to be done with this stage of our lives. But we’re not done yet. Dr. Auletta is checking with the doctor who did the needle biopsy back in March to see if he could safely do one in this location. That would be the best thing because then we would get real information and know what to do next. If we can’t do a needle biopsy, we’d have to decide whether to do a surgical biopsy which would probably destroy what remains of that kidney or to wait a few months and do another scan. We are obviously willing to give up the kidney to save the child, no doubt about it, but I don’t want to take his kidney out for no good reason. So we’ll be in a bit of a quandary if we can’t get a definitive diagnosis of what this “thing” is.
I guess the best case scenario would be to do a needle biopsy and learn that the shadow is just scar tissue. The worst case is that we lose this kidney. It’s something I’ve fought against many times before but right now, it seems like a reasonable and acceptable option. Sacrifice the kidney, rid the body of cancer, save the child. We can’t keep coming back to this terrible place, scan after scan, year after year, more maybes, more tumors–let’s just get rid of it once and for all. Of course then we start down another long road–that of dialysis and transplant.
If he’s not undergoing chemo or radiation treatment (which remains unlikely), he’d be able to do at-home dialysis. I think this is called peritoneal dialysis and he would have a little “button” or plug in his belly button that we’d hook up to a machine sitting at the foot of his bed and dialize him (that verb again) over night. The rest of his life, I think, would be pretty normal. His age is not the determining factor in when he’d be eligible for transplant; it’s how long he’s been cancer-free. Which, of course, he isn’t yet so we’re talking about at least two years of dialysis before transplant.
Ugh, god, I can’t believe we’re even thinking about these things right now. We really thought we’d have ten more years before heading down this road. But this seems to be the road we’re on. And we’ll make it.
We will make it.