Enbrel

[Guest guest]

Thanks everyone for the support! My husband has finally convinced me that I

should do this so I have my TB test scheduled for tomorrow (my doctor won't

write the prescription until I do the test). Then I have to wait for insurance

approval. Hopefully it won't be too long before I lose my nerve....

June Dixon <juner24@...> wrote:

Me, too, a. I kept going to my doctor's office and his nurse would do it.

With winter weather coming, this just would not work. I was scared to death but

just did it and was a little embarrassed when I discovered it was very easy. My

hubby learned to do it as well so when my hands are bad, he does it for me.

Hugs

June

----- Original Message -----

From: a Papola

I too was terrified to inject myself. For the first 7 years on

Enbrel, my husband did it for me.

Then one day I decided to try it and I'm so glad I did since now I

prefer doing it myself.

I was very surprised that I hardly felt it at all.

a

On Mar 11, 2006, at 7:34 PM, eemalawyer wrote:

> ,

>

> I was absolutely terrified to inject myself, and it just wasn't a

> big deal. If you really can't do it, I'm sure you can go into the

> doctor's office and the nurse will inject you, but try it first.

> I'm thinking about trying injectable MTX now because my doc says

> that you get more drug with fewer side effects.

[Guest guest]

Thanks Kathe,

The test is done and now I'm just waiting for insurance approval, which takes a

few days. I'm actually looking forward to it now because my fingers are swollen

and I'm looking forward to getting back to the way it used to be before this big

flare/change. Thanks for the support!

Kathe Sabetzadeh <lv2ryd@...> wrote:

:

My advice is to get the test done, and give Enbrel a

try. I am on it, and it is doing so well for me, and

the injections are easy. I actually can feel in my

body when it is time for my next shot. Best of luck -

Kathe in CA

--- <jhughes_bp@...> wrote:

> a,

>

> I give you a lot of credit. My doctor suggested I

> go on Enbrel or Humira a few weeks ago and I still

> somehow cannot get over the idea that I am going to

> have to give myself injections. It's good to hear

> that it went so well. I am still trying to convince

> myself to go get that TB test and call for the

> prescription.

>

>

> >

>

>

>

>

>

[Guest guest]

, did your physician mention that you can do a washout procedure with

cholestyramine or activated charcoal to try to get the Arava out of your

system faster?

************************

" Cholestyramine given orally at a dose of 8 g three times a day for 24 hours

to three healthy volunteers decreased plasma levels of M1 by approximately

40% in 24 hours and by 49 to 65% in 48 hours.

Administration of activated charcoal (powder made into a suspension) orally

or via nasogastric tube (50 g every 6 hours for 24 hours) has been shown to

reduce plasma concentrations of the active metabolite, M1, by 37% in 24

hours and by 48% in 48 hours.

These drug elimination procedures may be repeated if clinically necessary. "

**********************

" Without the drug elimination procedure, it may take up to 2 years to reach

plasma M1 metabolite levels less than 0.02 mg/L due to individual variation

in drug clearance. "

**********************

http://www.arava.com

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Enbrel

> Thx Sue, Toni and a for the info on Enbrel.

>

> How long did it take to work? I took my first shot yesterday and

> I swear my fingers burn just a little less today I am so hoping

> that this will be my miracle drug. It really sounds like those of you on

> Enbrel love it. I would sure like to not have to take MTX cuz of the

> liver issues, or so much Prednisone and Vicodin.

>

> I'm still having a lot of stomach pain from the Arava, can only eat when

> I take pain pills. Great weight loss idea, eh? But the doc says it will

> resolve, it'll just take time cuz of the half life of Arava.

>

> a, how come you had to start MTX? Did the Enbrel become less

> effective over time?

>

> Thx,

>

>

[Guest guest]

,

I started on Arava and had no side effects but when I changed Rheummy's the

new one did not use this drug due to so many reports of sudden liver failure.

He stopped the arava and switched me to MTX pills. They made me soooo sick

it was not funny....Then I got drug induce pneumonitis. So the MTX was

stopped and Enbrel added. It worked well after the first 3-4 weeks but not

enough. I was also still working. So he added MTX injections. That seemed to

help but not enough. Finally I left my job on Short term disability and the

reduction of stress made a HUGE difference for a while. Then it seems the

drugs just were not working. I refused prednisone.

I had weight loss surgery (lap-band) and had to stop all my meds. I had a

NINE month remission after that!!! I was thrilled. When I tried to restart

the Enbrel I had bad reactions to it. So I stopped it completely and went

with no drugs cause at the same time the rheummy moved.

I don't blame you on the MTX. Its on my chart that I will NEVER take it

again due to side effects!!! I also make sure the rheummy knows...not to even

bother talking about MTX. I will NOT take it!!!!

In a message dated 4/9/2006 8:31:02 A.M. Central Daylight Time,

writes:

Date: Sat, 08 Apr 2006 14:28:30 -0600

From: <kyrik@...>

Subject: Enbrel

Thx Sue, Toni and a for the info on Enbrel.

How long did it take to work? I took my first shot yesterday and

I swear my fingers burn just a little less today I am so hoping

that this will be my miracle drug. It really sounds like those of you on

Enbrel love it. I would sure like to not have to take MTX cuz of the

liver issues, or so much Prednisone and Vicodin.

I'm still having a lot of stomach pain from the Arava, can only eat when

I take pain pills. Great weight loss idea, eh? But the doc says it will

resolve, it'll just take time cuz of the half life of Arava.

a, how come you had to start MTX? Did the Enbrel become less

effective over time?

Thx,

Toni

Independent Decorating Consultant

Home Interiors

Become a consultant today for $99 and get $500 in free merchandise!

[Guest guest]

,

Enbrel is still very effective for me, however I still have

progression of the disease so mtx was added.

Since being on Enbrel, the RA has affected my shoulders and now my

wrists. I believe it has slowed the disease down.

a

On Apr 8, 2006, at 4:28 PM, wrote:

> Thx Sue, Toni and a for the info on Enbrel.

>

> How long did it take to work? I took my first shot yesterday and

> I swear my fingers burn just a little less today I am so hoping

> that this will be my miracle drug. It really sounds like those of

> you on

> Enbrel love it. I would sure like to not have to take MTX cuz of the

> liver issues, or so much Prednisone and Vicodin.

>

> I'm still having a lot of stomach pain from the Arava, can only eat

> when

> I take pain pills. Great weight loss idea, eh? But the doc says it

> will

> resolve, it'll just take time cuz of the half life of Arava.

>

> a, how come you had to start MTX? Did the Enbrel become less

> effective over time?

>

> Thx,

>

>

[Guest guest]

, many rheumatologists do baseline x-rays (or MRIs or other imaging) so

they can periodically check for damage and see how you are doing. I'd ask

your rheumatologist why he hasn't done them.

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Enbrel

>> ,

>> Enbrel is still very effective for me, however I still have

>> progression of the disease so mtx was added.

>> Since being on Enbrel, the RA has affected my shoulders and now my

>> wrists. I believe it has slowed the disease down.

>

> Hi a,

>

> Does your RA show up on xrays or in blood tests, is that how you

> know the progression is worse? Mine doesn't (yet?) so I can only

> go on symptoms.

>

> Thx,

>

>

[Guest guest]

>

> Have any of you had success with Enbrel but had it take

> awhile?

>

>>

Hi ,

I'm on my second month of enbrel and have not had much relief from

it. It has helped my knees but my hands and elbows are still bad.

I was hoping for more relief then this and am considering quitting this

med, and alot of other things. I hope you get the relief you need.

Sorry didn't mean to make this a downer but its been a bad nite.

good luck!

aN

[Guest guest]

It was about my 3rd or 4th inj. before I noticed much iimprovement but it was a

gradual process and by the end of the 1st month there was marked improvement.

I've been on it now for almost 3 months and everything is much improved. At 2

months my CRP was down to 6.3. It had been up in the 30's and with mtx I had

seen it improve to the mid teens but could not tolerated being on the high dose

necessary to bring it on down nor could I tolerate the RA symptoms. Feeling

much better now with low dose mtx and enbrel. I've been doing light gardening

and doing Curves exercise program where for the last year I had done no

exercising and only moving as little as was absolutely necessary. I am also off

of all steriods.

<kyrik@...> wrote: > Yes, that is how RA is, one day good, one

day bad, one

> day the knees, next the wrists, etc. There is no way

> to tell from day to day, and sometimes even hour to

> hour, what is going to start hurting. That is why its

> so hard to make plans in advance.

That is one of the hardest things, I think. You'll be

cruising along (relatively speaking) and then you'll

get waylaid by symptoms and end up in bed. I hate that

Plus I took my second shot of Enbrel yesterday and don't

feel any better so I'm really worried that it won't work.

I know it can take awhile but I also know some people

feel it right away. I'm hoping that maybe it's relative.

When my first drug, Arava, wasn't working I was literally

in bed for most of the day. I still feel like crap but

I'm not in bed all day so maybe that's improvement?

I hope so And at this point, I've given up on feeling

" great " , I can even live without " good, " I'm just desperate

for " better. "

Have any of you had success with Enbrel but had it take

awhile?

Thx,

[Guest guest]

Hi :

Yes, it can take a while for the Enbrel to kick in,

unfortunately, they have not come up with a drug which

is instantaneous relief - when it does, we'll all be

on it! I think it took about a month for me to begin

to feel some improvement (I am also on Mtx, and at

that time was on 20mg weekly - now down to 10mg

because they Enbrel is helping), but have been on it

six months now and am very happy with the way my RA is

being controlled. No x-ray evidence of any erosions,

and after 8 years with RA that is great. My doctors

have always treated the RA aggressively, and I know

that is best.

Yes, I believe that your not wanting to be in bed all

day is an improvement - small steps. I will keep my

fingers crossed, and my prayers coming, that the

Enbrel will start helping you more soon. Hang in

there -

Kathe in CA

--- <kyrik@...> wrote:

>

> Plus I took my second shot of Enbrel yesterday and

> don't

> feel any better so I'm really worried that it won't

> work.

> I know it can take awhile but I also know some

> people

> feel it right away. I'm hoping that maybe it's

> relative.

> When my first drug, Arava, wasn't working I was

> literally

> in bed for most of the day. I still feel like crap

> but

> I'm not in bed all day so maybe that's improvement?

> I hope so And at this point, I've given up on

> feeling

> " great " , I can even live without " good, " I'm just

> desperate

> for " better. "

>

> Have any of you had success with Enbrel but had it

> take

> awhile?

>

> Thx,

>

>

>

>

>

>

>

Kathe

" To ride a horse is to borrow freedom. "

__________________________________________________

[Guest guest]

Hi ,I am one of the lucky ones,i felt a difference within 3

hours of taking enbrel.The fatigue lifted almost instantly,and i

felt really well by the end of the day.It lasted a while until i had

the flu jab,and that upset everything.I now take mtx and enbrel with

nsaids and i feel very well at the moment.I live for the day i am in

and it works for me a day at a time.

> >

> > Plus I took my second shot of Enbrel yesterday and

> > don't

> > feel any better so I'm really worried that it won't

> > work.

> > I know it can take awhile but I also know some

> > people

> > feel it right away. I'm hoping that maybe it's

> > relative.

> > When my first drug, Arava, wasn't working I was

> > literally

> > in bed for most of the day. I still feel like crap

> > but

> > I'm not in bed all day so maybe that's improvement?

> > I hope so And at this point, I've given up on

> > feeling

> > " great " , I can even live without " good, " I'm just

> > desperate

> > for " better. "

> >

> > Have any of you had success with Enbrel but had it

> > take

> > awhile?

> >

> > Thx,

> >

> >

> >

> >

> >

> >

> >

>

>

> Kathe

>

> " To ride a horse is to borrow freedom. "

>

>

>

> __________________________________________________

>

[Guest guest]

No, it's not caused me to gain weight. I've never heard of that as a

side effect of Enbrel. It can happen, I understand, with Prednisone.

Sue

On Thursday, April 20, 2006, at 07:23 PM, giambifan2001 wrote:

> I will be starting enbrel soon.I would like to know if it has caused

> anyone to gain weight.On top of all my other problems, I dont want to

> worry about that! thanks,

[Guest guest]

>

> I've had a good reaction to Enbrel. Just took my eighth

> shot yest. I don't have any reaction or adverse effects

> at all. Used to get a site rash but now I put a Bandaid

> on and leave it for a few days and I don't get that.

>

> It gives me more energy, although " more " is a relative

> word I'm still exhausted. (But I shouldn't complain

> because I am up and about and running errands and ferrying kids

> around for a couple of hours a day, although I'm still

> hardly working.) And it hasn't helped my

> joint pain at all. My rh says we'll give it several

> more months and then if the joint pain is still bad,

> we'll add something else.

>

> Sometimes it stings a little going in, but then I just slow

> down and the stinging stops. And it's a little sore afterwards. But

> in general, I've been amazed at how little it hurts (especially

> after hearing you all talk about Humira.)

>

> Good luck with yours

>

>

I have been on Enbrel 6 wks now and have not had any problems and I

was told to let the Enbrel set out about 45 mim and let it warm up a

bit and then it does not sting. and that works well for me I too

have alot more energy and not to much pain now. good luck to you

JANET IN IL

>

>

> I'm sorry I'm babbling, but I am curious about other people's

> reactions to the Enbrel. I think I have to start the inj this

coming

> week.

>

[Guest guest]

>

> Hi my name is . I have been on Enbrel for 3.5 months. I'm

> better, but I don't think the small benefit outweighs the risks. I

> worse before my menstrual cycle, and I'm still getting flares. I'm

> going to start on small dose of Prozac to help with the PMS. Does

> anyone have experience with Enbrel? Thanks

>

Hi

I have been on Enbrel 6 wks now and have not had any prob. as yet. sorry

that you are haveing trouble. I can say I do feel much better now that I

am on it. good luck to you, hope you find something that works for you.

Janet IN IL

[Guest guest]

,

I was on Enbrel for nine months. It really did not do much for me. Toward

the end I started having reactions to it and large red painful lumps at the

injection site. I finally stopped it.

As far as the PMS thing when I was also on prozac and over time my dose went

from 20-80 mg a day. This was before I was Dx'd with RA, OA and Fibro.

I changed docs and made lifestyle changes and most of my symptoms went away.

I stopped the prozac and was happy.

Toni

In a message dated 5/30/2006 6:29:36 P.M. Central Daylight Time,

writes:

From: " denverni " denverni@...

Date: Tue May 30, 2006 11:22am(PDT)

Subject: Enbrel

Hi my name is . I have been on Enbrel for 3.5 months. I'm

better, but I don't think the small benefit outweighs the risks. I

worse before my menstrual cycle, and I'm still getting flares. I'm

going to start on small dose of Prozac to help with the PMS. Does

anyone have experience with Enbrel? Thanks

[Guest guest]

I've been on Enbrel since it was approved in 1998. It has been wonderful

for me and I've had no problems with any side effects. It's just a shame

that these drugs affect us all differently. I am sorry you're not

getting

much benefit out of it.

a

On May 30, 2006, at 2:06 PM, denverni wrote:

> Hi my name is . I have been on Enbrel for 3.5 months. I'm

> better, but I don't think the small benefit outweighs the risks. I

> worse before my menstrual cycle, and I'm still getting flares. I'm

> going to start on small dose of Prozac to help with the PMS. Does

> anyone have experience with Enbrel? Thanks

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Hi :

I have been on a combination of Methotrexate and

Enbrel now for about six months, and have felt benefit

from this. Do you take anything other than the

Enbrel? If not, your doctor might look into combining

another medication with it like Mtx or Arava,

sometimes that helps the Enbrel to work better. I

think that this whole thing is very hormonal so it

would not be too strange to have increased flares with

your periods - I no longer have mine (thanks to the

heavens!), but it still seems like I do get hormonal

once in a while!

I am not painfree, wish that would be so, but I am in

less pain. There is always some degree of pain in

some joint, but in general my flares are less often

than they were prior to Enbrel being added.

So, if you are on Enbrel alone, please ask your doctor

about adding another med to your treatment plan and

see if that helps. Sometimes it takes a while for the

meds to kick in, but three months seems like the time

to see if something else can be added to help you.

Stay on the Enbrel, if you can, and add something.

Good luck and let us know what your doctor thinks of

this -

Kathe in CA

__________________________________________________

[Guest guest]

>

> Hi my name is . I have been on Enbrel for 3.5 months. I'm

> better, but I don't think the small benefit outweighs the risks. I

> worse before my menstrual cycle, and I'm still getting flares. I'm

> going to start on small dose of Prozac to help with the PMS. Does

> anyone have experience with Enbrel? Thanks

>

Hi , Been on Enbrel for 6 months, it's helped some but still

pain and stiffness. Bad ankles and wrists are the worst but other

joints as well. Came down with this curse (RA)in '91

In that time I really don't remember how many different drugs I've

been on, but it's been plenty.

Good luck with Enbrel, but any negitive difference in your body.....go

back to the Specialist.

[Guest guest]

Welcome,

There are a lot of are members on Enbrel, and it works well for them.

You will find plenty of support and information here. The nurse at

your doc's office will usually help you through it all. Is there

someone else that can help you with the injections for awhile? Not

long, and you will be feeling better and able to do it yourself. Good

luck, and keep us posted, Tawny

[Guest guest]

--- In , " vacation808 " <vacation808@...>

wrote:

>

> > on Monday I am going to try Enbrel. I do not

> know how I will give myself injectins because my hands are so

swollen

> and painful, but I will do just about anything to relieve some of

this

> pain and feel more " normal " . Has anyoe had relief with Enbrel?

>

Hi I have been on Enbrel two months and I think it has help some

I still have some pain Like Last night my hips were hurting but this

morning not to bad.. good luck with your Enbrel and also Welcome to

the group. you will find alot of very nice people and alot of

information. Where are you In am in IL and Have had RA about 2 yrs

and Fribo about 3yrs.so they say I think alot longer. any way

welcome to our family

Janet IN IL

[Guest guest]

--- In , " vacation808 " <vacation808@...>

wrote:

>

> Hi I am new to the group. Has anyoe had relief with Enbrel?

>

Hi-I hope a pray that enbrel is the answer for your RA. It has done

wonders for me. I have been dianosed for about 3 years. For the

first 2 years MTX did ok but then I had to add prednisone just to

junction at all. Last Christmas I was miserable using mtx and

prednisone. Decided it was time to give enbrel a try and have had

great results. I've cut the mtx back to 5 mg a week and hope to stop

it completely by the end of June. I have not used prednisone since

the end of January. I have also reduced the amt of otc ibupren and

naproxen that I'm taking. I do the shots twice (25 mgs) a week. I

still have some soreness and tenderness in my hand and pain in my

wrists and hips but feel soooooo much better and can do most thins

that I desire to do. We just come home from vacation a couple of

weeks ago and I hiked and walked for miles when back at Christmas it

was difficut to get around the house. If doing the shots is

difficult enbrel does come in a premixed version that makes giving

it easier. I does have a preservative in it and I'm told it stings

a little when taking it. It does not hurt at all with the need to

mix kind. If you have trouble I'm sure you could have a family

member or friend give it to you at first or even the nurse at the

doctor's office or maybe even someone at your pharmacy. I hope it

works for you as well as it has for me. It's given me my life back.

in Tennessee

[Guest guest]

I have been on Enbrel for about 2 1/2 years now, and it works very well

for me. I can't take methotrexate because it lowers my white blood cell

count too much. Luckily for me, the Enbrel is effective even without

the mtx. Maybe someone else could help you with the injections at

first, and hopefully the Enbrel will do so much good that your hands

will get a lot better.

Good luck.

Sue

On Thursday, June 8, 2006, at 11:03 PM, vacation808 wrote:

> Hi I am new to the group. I was diagnosed a year ago and have been on

> a mix of Liprox, methotrexate, prednisone and folic acid. They cannot

> raise me anymore on the methotrexate and do not want to to icrease the

> prednisone either, so on Monday I am going to try Enbrel. I do not

> know how I will give myself injectins because my hands are so swollen

> and painful, but I will do just about anything to relieve some of this

> pain and feel more " normal " . Has anyoe had relief with Enbrel?

>

[Guest guest]

Hi:

Welcome to the group - this is a great place to come

for support and information. I have made many friends

in the years I have been here, and the information I

have learned here has helped me to be able to talk

with my rheumy with more assurance since I have

usually always heard about whatever it is here first!

I have been on Enbrel now for 8 months, and it is

really helping me - I also take Mtx, Mobic, and Ultram

for pain. I think that you can get your shots at the

doctor's office if it is impossible for you to do them

yourself, they are tiny little bottles that I have to

fit together to mix the med up, so that might be hard

for you. Is there anybody else who might volunteer

like a family member? They are not hard to do once

you get the hang of it. Give the Enbrel at least a

month to kick in, hopefully you will feel relief even

before that, some people have felt it after the first

few shots. I truly wish you the best, and hope that

Enbrel will be of help to you. If not, there are

other meds out there, so don't despair, and keep

trying. Let us know how it goes - take care -

Kathe in CA

--- vacation808 <vacation808@...> wrote:

> Hi I am new to the group. I was diagnosed a year

> ago and have been on

> a mix of Liprox, methotrexate, prednisone and folic

> acid. They cannot

> raise me anymore on the methotrexate and do not want

> to to icrease the

> prednisone either, so on Monday I am going to try

> Enbrel. I do not

> know how I will give myself injectins because my

> hands are so swollen

> and painful, but I will do just about anything to

> relieve some of this

> pain and feel more " normal " . Has anyoe had relief

> with Enbrel?

>

>

>

>

>

>

>

>

__________________________________________________

[Guest guest]

I have been on Enbrel for over two years, and have had no adverse side

effects from it. It seems to have stopped the progression of my RA, and

I am a happy camper.

Why don't you start the Enbrel again and see what happens? If you have

bad side effects, you can always quit it again.

Sue

On Tuesday, June 13, 2006, at 10:17 AM, catmoh wrote:

> I have read all the research on

> Enbrel, the insert that comes with the drug, and my RA doctor told

> me up front that it is a high risk drug. He is a good doctor. I am

> not unhappy at all with his therapy. But I am a little afraid to

> take the Enbrel without knowing a little more about it. The

> research and the insert are all straight forward and informative,

> but I need to hear some comments from people with direct experience

> with the drug.

[Guest guest]

Thanks, .

The rheumatologist called today to tell me that my liver values are

climbng again (after initially heading back toward normal) even

though I'm off the Arava. She wanted my to decrease my Mtx dose for

the next couple of weeks to see how my liver responds. That Enbrel

better kick in if I've got to cut the Mtx!

>

> > So, , are you using the twice-weekly 25 mg Enbrel or the

> > once-weekly 50 mg? I use the 25 mg, and it doesn't sting or

feel thick.

> > I've heard that the 50 mg does sting some people, maybe

because it has

> > preservatives in it.

> >

> > I tried the 50 mg, but didn't like it because the needles

seemed very

> > dull, and it didn't seem to last all week for me. After one

month's

> > supply of the 50 mg, I went back to the 25 mg.

>

> I use the 50 once a week and even though it doesn't seem to last

all

> week, I like it. It took me about a month before I really felt it.

But

> I've been off if for a month and just took my first shot Friday

and I

> already feel a difference. Actually I didn't realize how well it

was

> working until I went off of it, I felt like I was dying and the

pain and

> fatigue and depression were almost unbearable. So, hey, any little

> improvement is good

>

>

>

[Guest guest]

Thanks, .

The rheumatologist called today to tell me that my liver values are

climbng again (after initially heading back toward normal) even

though I'm off the Arava. She wanted my to decrease my Mtx dose for

the next couple of weeks to see how my liver responds. That Enbrel

better kick in if I've got to cut the Mtx!

>

> > So, , are you using the twice-weekly 25 mg Enbrel or the

> > once-weekly 50 mg? I use the 25 mg, and it doesn't sting or

feel thick.

> > I've heard that the 50 mg does sting some people, maybe

because it has

> > preservatives in it.

> >

> > I tried the 50 mg, but didn't like it because the needles

seemed very

> > dull, and it didn't seem to last all week for me. After one

month's

> > supply of the 50 mg, I went back to the 25 mg.

>

> I use the 50 once a week and even though it doesn't seem to last

all

> week, I like it. It took me about a month before I really felt it.

But

> I've been off if for a month and just took my first shot Friday

and I

> already feel a difference. Actually I didn't realize how well it

was

> working until I went off of it, I felt like I was dying and the

pain and

> fatigue and depression were almost unbearable. So, hey, any little

> improvement is good

>

>

>