Re: Adrenal Vein Sampling test

[Guest guest]

http://hyperaldo-too.blogspot.com/

|Thanks in advance for any direction you can provide --

|Best regards,

|

|

[Guest guest]

I am based in MIlwaukee. Where will this be done?Why do they want to do AVS now?Have you failed DASHing and MCB to control BP and KCE Grim MDGo to our files and look at AVS experiences. Hi -I am fairly new to the group and have been lurking for a couple of weeks. I was diagnosed with primary hyperaldosteronism (which I can finally pronounce without problem...) a couple of weeks ago. My journey to this diagnosis has been anything but straightforward, but I'm thankful to have finally been listened to.I am writing because I'm scheduled next week to have the AVS procedure (here in southeastern wi). I have been searching for layperson accounts of this, but find only a couple. Those that I have found scare the you-know-what out of me. I attempted searching your yahoo groups site for any specific info on this, but failed. Can anyone point me in the right direction, either a specific spot in the group's archives, or any first-hand experience of the procedure?Thanks in advance for any direction you can provide --Best regards,

[Guest guest]

Dr. Grim, the procedure will be done at Waukesha Memorial. After being BP 90/60 for 38 YEARS, then over the past 3+ years it’sbeen creeping up and up and up. Lately I’m around 160/120.No BP meds at this point. I have had very low K for at least thelast year, but it took about 6 visits to my primary care physician(who clearly is dumber than a box of rocks, but that’s an entirelydifferent conversation/rant) and 3 visits with cardiac symptoms to the ER to finally have a doctor to put the extremely low K(2.1 even after 80 meq of K bid) and the blood pressure businesstogether. So Dr. Elangovan did blood tests and the 24-hr urine tests and tellsme that my K is about 4 times what it should be. CT scan last weekwas inconclusive. So he tells me that next we can do one of twothings: spiro (currently 200 mg/day) and “wait and see,” or do AVS and see if we can determine the actual cause. ConsideringI’ve been feeling so lousy for 4+ years and I’m sick of it, plus the fact that we’ve met our med. ins. deductible, and that this is about the only time of year my husband isn’t travelling, it seems this isprobably the best time to do it. I have been DASHing since I started following your site here. MyBP has gotten slightly lower high 130s over 90s; but is that the DASHing or the spiro? K was at 3.1 last week, which is much betterthan it’s been since it was first measured in Dec. ’09.Your questions make me think I shouldn’t be having AVS at this point….???? Laskomslasko@... http://abrokencompass.comCompass Media, LLC From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: Wednesday, December 08, 2010 10:20 PMTo: hyperaldosteronism Cc: Clarence GrimSubject: Re: Adrenal Vein Sampling test I am based in MIlwaukee. Where will this be done? Why do they want to do AVS now? Have you failed DASHing and MCB to control BP and K CE Grim MD Go to our files and look at AVS experiences. Hi -I am fairly new to the group and have been lurking for a couple of weeks. I was diagnosed with primary hyperaldosteronism (which I can finally pronounce without problem...) a couple of weeks ago. My journey to this diagnosis has been anything but straightforward, but I'm thankful to have finally been listened to.I am writing because I'm scheduled next week to have the AVS procedure (here in southeastern wi). I have been searching for layperson accounts of this, but find only a couple. Those that I have found scare the you-know-what out of me. I attempted searching your yahoo groups site for any specific info on this, but failed. Can anyone point me in the right direction, either a specific spot in the group's archives, or any first-hand experience of the procedure?Thanks in advance for any direction you can provide --Best regards,

[Guest guest]

Oh THANK YOU! FlowerSpy’s account was the most completedescription I had read before this one. This makes me think thatresuming most of my parenting duties (I have 9-, 6-, and 4-year old girls) may be possible a couple days after the procedure,after all. J Laskomslasko@... http://abrokencompass.comCompass Media, LLC From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of StudyCircleSent: Wednesday, December 08, 2010 10:20 PMTo: hyperaldosteronism Subject: RE: Adrenal Vein Sampling test http://hyperaldo-too.blogspot.com/|Thanks in advance for any direction you can provide --|Best regards,||

[Guest guest]

With 3 kids this age might be better to replace AVS with Scintiscan:

http://www.nature.com/ki/journal/v75/n6/pdf/ki2008287a.pdf

Oh THANK YOU! FlowerSpy’s account was the most completedescription I had read before this one. This makes me think thatresuming most of my parenting duties (I have 9-, 6-, and 4-year old girls) may be possible a couple days after the procedure,after all. J

Lasko

mslasko@...

http://abrokencompass.com

Compass Media, LLC

[Guest guest]

Welcome and Thanks for your story.Take my evolution article to everyone who missed you so they can find the others they are taking care of now as well.Surely you don't want them missed for years like you have been. Trust you do not eat licorice every day.Give us your lab numbers and normal values.We recommend AVS only after spiro or Inspra and DASH have failed to contol BP and or K. Esp if no bump on imaging. Sounds like you are improing a lot. Likely due to both. You can read our DASH stories in our files as well and hope you will be able to do one.CE Grim MDDr. Grim, the procedure will be done at Waukesha Memorial. After being BP 90/60 for 38 YEARS, then over the past 3+ years it’sbeen creeping up and up and up. Lately I’m around 160/120.No BP meds at this point. I have had very low K for at least thelast year, but it took about 6 visits to my primary care physician(who clearly is dumber than a box of rocks, but that’s an entirelydifferent conversation/rant) and 3 visits with cardiac symptoms to the ER to finally have a doctor to put the extremely low K(2.1 even after 80 meq of K bid) and the blood pressure businesstogether. So Dr. Elangovan did blood tests and the 24-hr urine tests and tellsme that my K is about 4 times what it should be. CT scan last weekwas inconclusive. So he tells me that next we can do one of twothings: spiro (currently 200 mg/day) and “wait and see,” or do AVS and see if we can determine the actual cause. ConsideringI’ve been feeling so lousy for 4+ years and I’m sick of it, plus the fact that we’ve met our med. ins. deductible, and that this is about the only time of year my husband isn’t travelling, it seems this isprobably the best time to do it. I have been DASHing since I started following your site here. MyBP has gotten slightly lower high 130s over 90s; but is that the DASHing or the spiro? K was at 3.1 last week, which is much betterthan it’s been since it was first measured in Dec. ’09.Your questions make me think I shouldn’t be having AVS at this point….???? Laskomslasko@... http://abrokencompass.comCompass Media, LLC From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent: Wednesday, December 08, 2010 10:20 PMTo: hyperaldosteronism Cc: Clarence GrimSubject: Re: Adrenal Vein Sampling test I am based in MIlwaukee. Where will this be done? Why do they want to do AVS now? Have you failed DASHing and MCB to control BP and K CE Grim MD Go to our files and look at AVS experiences. Hi -I am fairly new to the group and have been lurking for a couple of weeks. I was diagnosed with primary hyperaldosteronism (which I can finally pronounce without problem...) a couple of weeks ago. My journey to this diagnosis has been anything but straightforward, but I'm thankful to have finally been listened to.I am writing because I'm scheduled next week to have the AVS procedure (here in southeastern wi). I have been searching for layperson accounts of this, but find only a couple. Those that I have found scare the you-know-what out of me. I attempted searching your yahoo groups site for any specific info on this, but failed. Can anyone point me in the right direction, either a specific spot in the group's archives, or any first-hand experience of the procedure?Thanks in advance for any direction you can provide --Best regards,

[Guest guest]

Hi ,

As the author of that hyperaldo-too account, I want to encourage you that a properly done AVS should not cause the severe pain you may have read about. When that happens, it is the result of pushing too far, and all the expert how-to articles caution strongly against that. None of the events that cause the pain are helpful to achieving correct results. They can even prevent getting correct results, although it is also possible for correct results to be achieved despite the mistakes that cause the pain. For instance, Carole / Flower-Spy got correct results despite the pain in her procedure.

There could be some lesser pain around the puncture site, but as mentioned in my story, I didn't experience even that.

I understand very well where you are, having maxed out your deductible / out-of-pocket limit and wanting to get this done before the end of the year.

I should point out (haven't yet updated my article) that both Dr. Grim and an expert at the Mayo Clinic later judged my AVS to be a failure. The numbers clearly show a failure in sampling the right adrenal vein. The radiologist refuses to admit his procedure failed and the endocrinologist is shocked and appears to be publicly on the fence, though I think that privately he now understands. The radiologist's denial may be a liability ploy but it is also very common in medicine that the worse the consequences of a failure, the more psychologically impossible it becomes for an ambitious doctor to wrap his mind around the fact that he failed. My radiologist insists his images prove the procedure succeeded. But my numbers fail both an informal " sanity sniff test " and the formal cross-check criteria published to ensure that decisions about surgery are not based on invalid comparisons between left and right. My radiologist and endocrinologist were simply not experienced enough in this procedure to recognize what the numbers were saying. In the end, it is the numbers that prove success or failure.

There is a new technique spreading in America called rapid intra-procedural cortisol assay. (I will call it RIPCA, though that is not a formal acronym.) With RIPCA, the radiologists test cortisol levels on the spot, while the catheter is inside you, so that they can be absolutely sure they are getting a valid sample from each adrenal vein, especially the right adrenal vein. Studies have shown that visual certainty is unreliable. It all comes down to those cortisol numbers, and RIPCA prevents failed AVS procedures. Right now it is in use only by early adopters, but the high AVS failure rate will surely lead it to become universal within, oh, I don't know, 5-10 years? Expert estimates say that there is a 40% failure rate with radiologists who don't do this procedure frequently. Every cost-benefit study I have seen about RIPCA concludes that the cost it adds is recouped several times over (say, about 4x) by the avoided costs of the failed procedures it prevents.

Given your short time-frame (to the end of this year), you may not have any control over whether you can get RIPCA used in your AVS. But at least talk it over with the doctors responsible for your procedure. They might be able to arrange that for you.

Alden G

Oh THANK YOU! FlowerSpy’s account was the most complete

description I had read before this one. This makes me think that

resuming most of my parenting duties (I have 9-, 6-, and 4-

year old girls) may be possible a couple days after the procedure,

after all. J

Lasko

mslasko@...

http://abrokencompass.com

Compass Media, LLC

From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of StudyCircle

Sent: Wednesday, December 08, 2010 10 :20 PM

To: hyperaldosteronism

Subject: RE: Adrenal Vein Sampling test

http://hyperaldo-too.blogspot.com/

|Thanks in advance for any direction you can provide --

|Best regards,

|

|

[Guest guest]

One other thing, :

This morning I added two more articles to hyperaldo-too.blogspot.com. I believe their content is already familiar to most members of this group from earlier emails I've contributed. Dr Grim has also commented them in that context.

Now it contains

My Adrenal Vein Sampling Experience

The Failure Of My Adrenal Vein Sampling Experience

Three Steps To Avoiding AVS Failures

as well as links to Carole's original hyperaldosteronism blog that inspired it plus two of the best articles on actually performing AVS and a link to this group. My radiologist ignored the Australian article when I provided it to him but then went on to commit the very mistake it explains how to avoid.

Best of luck. Chances are good this will be easy for you and turn out well.

AG

[Guest guest]

,

I too have been recently diagnosed with PA after years of blood

pressure problems and borderline low potassium. I decided to go ahead

with the AVS procedure because I have had problems wiht side effects

from the blood pressure medicines and would at least like to know if

I am a candidate for surgery.

I just had the AVS procedure done yesterday. I too was scared to death

of the procedure because of others experiences with them. I had a

really good experience. I had no pain during the procedure, only

a slight feeling of pressure while they were injecting the contrast

dye. I have only had very minor discomfort yesterday at the puncture

site. The pain was not even enough to need tylenol. Today I don't

really notice any pain.

I met with the radiologist before I had the procedure done and asked

a lot of questions. This was so that I felt comfortable having him do

the AVS and I could determine his knowledge level of the procedure. I

would recommend that you try to schedule an appointment to talk to

the radiologist before the procedure. They should be able to explain

the procedure in laymans terms for you.

I have 2 young children, ages 2 and 4. The day of the procedure

my husband was with me all day the day of the AVS and was there to

help with the kids last night. You won't be able to drive for 12

hours afterwards due to the pain medicines. Today I was able to take

care of both kids by myself. I cannot lift more than 10 lbs until

tomorrow so my 2yr old had to climb in his car seat, chair, etc.

himself. I can't guarantee this will be the case for you, but this

was my experience.

I hope my experience at least will let you know that the AVS

procedure can be a minimally painful pricedure.

>

> Hi -

> I am fairly new to the group and have been lurking for a couple of weeks. I

was diagnosed with primary hyperaldosteronism (which I can finally pronounce

without problem...) a couple of weeks ago. My journey to this diagnosis has

been anything but straightforward, but I'm thankful to have finally been

listened to.

>

> I am writing because I'm scheduled next week to have the AVS procedure (here

in southeastern wi). I have been searching for layperson accounts of this, but

find only a couple. Those that I have found scare the you-know-what out of me.

>

> I attempted searching your yahoo groups site for any specific info on this,

but failed. Can anyone point me in the right direction, either a specific spot

in the group's archives, or any first-hand experience of the procedure?

>

> Thanks in advance for any direction you can provide --

> Best regards,

>

>

[Guest guest]

Send us the numbers when u get them. CE grinMDTiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

,

I too have been recently diagnosed with PA after years of blood

pressure problems and borderline low potassium. I decided to go ahead

with the AVS procedure because I have had problems wiht side effects

from the blood pressure medicines and would at least like to know if

I am a candidate for surgery.

I just had the AVS procedure done yesterday. I too was scared to death

of the procedure because of others experiences with them. I had a

really good experience. I had no pain during the procedure, only

a slight feeling of pressure while they were injecting the contrast

dye. I have only had very minor discomfort yesterday at the puncture

site. The pain was not even enough to need tylenol. Today I don't

really notice any pain.

I met with the radiologist before I had the procedure done and asked

a lot of questions. This was so that I felt comfortable having him do

the AVS and I could determine his knowledge level of the procedure. I

would recommend that you try to schedule an appointment to talk to

the radiologist before the procedure. They should be able to explain

the procedure in laymans terms for you.

I have 2 young children, ages 2 and 4. The day of the procedure

my husband was with me all day the day of the AVS and was there to

help with the kids last night. You won't be able to drive for 12

hours afterwards due to the pain medicines. Today I was able to take

care of both kids by myself. I cannot lift more than 10 lbs until

tomorrow so my 2yr old had to climb in his car seat, chair, etc.

himself. I can't guarantee this will be the case for you, but this

was my experience.

I hope my experience at least will let you know that the AVS

procedure can be a minimally painful pricedure.

>

> Hi -

> I am fairly new to the group and have been lurking for a couple of weeks. I was diagnosed with primary hyperaldosteronism (which I can finally pronounce without problem...) a couple of weeks ago. My journey to this diagnosis has been anything but straightforward, but I'm thankful to have finally been listened to.

>

> I am writing because I'm scheduled next week to have the AVS procedure (here in southeastern wi). I have been searching for layperson accounts of this, but find only a couple. Those that I have found scare the you-know-what out of me.

>

> I attempted searching your yahoo groups site for any specific info on this, but failed. Can anyone point me in the right direction, either a specific spot in the group's archives, or any first-hand experience of the procedure?

>

> Thanks in advance for any direction you can provide --

> Best regards,

>

>

[Guest guest]

Good luck. Be sure that that do ACTH INfusion before sampling I am retired from MCOW. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Dr. Grim, the procedure will be done at Waukesha Memorial. After being BP 90/60 for 38 YEARS, then over the past 3+ years it’sbeen creeping up and up and up. Lately I’m around 160/120.No BP meds at this point. I have had very low K for at least thelast year, but it took about 6 visits to my primary care physician(who clearly is dumber than a box of rocks, but that’s an entirelydifferent conversation/rant) and 3 visits with cardiac symptoms to the ER to finally have a doctor to put the extremely low K(2.1 even after 80 meq of K bid) and the blood pressure businesstogether. So Dr. Elangovan did blood tests and the 24-hr urine tests and tellsme that my K is about 4 times what it should be. CT scan last weekwas inconclusive. So he tells me that next we can do one of twothings: spiro (currently 200 mg/day) and “wait and see,†or do AVS and see if we can determine the actual cause. ConsideringI’ve been feeling so lousy for 4+ years and I’m sick of it, plus the fact that we’ve met our med. ins. deductible, and that this is about the only time of year my husband isn’t travelling, it seems this isprobably the best time to do it. I have been DASHing

since I started following your site here. MyBP has gotten slightly lower high 130s over 90s; but is that the DASHing or the spiro? K was at 3.1 last week, which is much betterthan it’s been since it was first measured in Dec. ’09.Your questions make me think I shouldn’t be having AVS at this point….???? Laskomslasko@... http://abrokencompass.comCompass Media, LLC From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimSent:

Wednesday, December 08, 2010 10:20 PMTo: hyperaldosteronism Cc: Clarence GrimSubject: Re: Adrenal Vein Sampling test I am based in MIlwaukee. Where will this be done? Why do they want to do AVS now? Have you failed DASHing and MCB to control BP and K CE Grim MD Go to our files and look at AVS experiences. On Dec 8, 2010, at 8:51 PM,

wrote:Hi -I am fairly new to the group and have been lurking for a couple of weeks. I was diagnosed with primary hyperaldosteronism (which I can finally pronounce without problem...) a couple of weeks ago. My journey to this diagnosis has been anything but straightforward, but I'm thankful to have finally been listened to.I am writing because I'm scheduled next week to have the AVS procedure (here in southeastern wi). I have been searching for layperson accounts of this, but find only a couple. Those that I have found scare the you-know-what out of me. I attempted searching your yahoo groups site for any specific info on this, but failed. Can anyone point me in the right

direction, either a specific spot in the group's archives, or any first-hand experience of the procedure?Thanks in advance for any direction you can provide --Best regards,

[Guest guest]

Dear friends,

Could you please, tell me what is the title of Dr. Grim'a article that he often requires to read and how to find it?

Many thanks,

Natalia Kamneva

To: hyperaldosteronism Sent: Thu, December 9, 2010 1:59:33 PMSubject: RE: Adrenal Vein Sampling test

One other thing, :

This morning I added two more articles to hyperaldo-too.blogspot.com. I believe their content is already familiar to most members of this group from earlier emails I've contributed. Dr Grim has also commented them in that context.

Now it contains

My Adrenal Vein Sampling Experience

The Failure Of My Adrenal Vein Sampling Experience

Three Steps To Avoiding AVS Failures

as well as links to Carole's original hyperaldosteronism blog that inspired it plus two of the best articles on actually performing AVS and a link to this group. My radiologist ignored the Australian article when I provided it to him but then went on to commit the very mistake it explains how to avoid.

Best of luck. Chances are good this will be easy for you and turn out well.

AG

[Guest guest]

It is in our files and called the evolution of PATiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Dear friends,

Could you please, tell me what is the title of Dr. Grim'a article that he often requires to read and how to find it?

Many thanks,

Natalia Kamneva

To: hyperaldosteronism Sent: Thu, December 9, 2010 1:59:33 PMSubject: RE: Adrenal Vein Sampling test

One other thing, :

This morning I added two more articles to hyperaldo-too.blogspot.com. I believe their content is already familiar to most members of this group from earlier emails I've contributed. Dr Grim has also commented them in that context.

Now it contains

My Adrenal Vein Sampling Experience

The Failure Of My Adrenal Vein Sampling Experience

Three Steps To Avoiding AVS Failures

as well as links to Carole's original hyperaldosteronism blog that inspired it plus two of the best articles on actually performing AVS and a link to this group. My radiologist ignored the Australian article when I provided it to him but then went on to commit the very mistake it explains how to avoid.

Best of luck. Chances are good this will be easy for you and turn out well.

AG

[Guest guest]

,

On the left hand side of this group, there is a link that says "Files". If you click on that, you will see a link to some other group members AVS experiences. I think if you click on the link below, it should take you directly there.

http://f1.grp.yahoofs.com/v1/IDkdTRafhNiBbknr0i3KOLZTa5yaKfc3MJdsjdus3JSpPEOdoDjyCG__vBUIEUH_AHQtbnI4OLzQEbcs8-b12ha7efkEeRmk/Young_adrenal_vein_sampling_Mayo_Surgery_2004.pdf

Also, you should read Flowerspy's blog. She describes her experience with hyperaldosteronism and has an account of her AVS.

http://hyperaldosteronism.blogspot.com/search/label/Adrenal%20Vein%20Sampling%20Test

Hope this helps

Polymac

>> Hi -> I am fairly new to the group and have been lurking for a couple of weeks. I was diagnosed with primary hyperaldosteronism (which I can finally pronounce without problem...) a couple of weeks ago. My journey to this diagnosis has been anything but straightforward, but I'm thankful to have finally been listened to.> > I am writing because I'm scheduled next week to have the AVS procedure (here in southeastern wi). I have been searching for layperson accounts of this, but find only a couple. Those that I have found scare the you-know-what out of me. > > I attempted searching your yahoo groups site for any specific info on this, but failed. Can anyone point me in the right direction, either a specific spot in the group's archives, or any first-hand experience of the procedure?> > Thanks in advance for any direction you can provide --> Best regards,> >

[Guest guest]

Let us know why u are having AVS AS WE only recommend as last resort. Give us your complete story And numbers. Be certain they use ACTH. See our file on endo guidelines.Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

,

On the left hand side of this group, there is a link that says "Files". If you click on that, you will see a link to some other group members AVS experiences. I think if you click on the link below, it should take you directly there.

http://f1.grp.yahoofs.com/v1/IDkdTRafhNiBbknr0i3KOLZTa5yaKfc3MJdsjdus3JSpPEOdoDjyCG__vBUIEUH_AHQtbnI4OLzQEbcs8-b12ha7efkEeRmk/Young_adrenal_vein_sampling_Mayo_Surgery_2004.pdf

Also, you should read Flowerspy's blog. She describes her experience with hyperaldosteronism and has an account of her AVS.

http://hyperaldosteronism.blogspot.com/search/label/Adrenal%20Vein%20Sampling%20Test

Hope this helps

Polymac

>> Hi -> I am fairly new to the group and have been lurking for a couple of weeks. I was diagnosed with primary hyperaldosteronism (which I can finally pronounce without problem...) a couple of weeks ago. My journey to this diagnosis has been anything but straightforward, but I'm thankful to have finally been listened to.> > I am writing because I'm scheduled next week to have the AVS procedure (here in southeastern wi). I have been searching for layperson accounts of this, but find only a couple. Those that I have found scare the you-know-what out of me. > > I attempted searching your yahoo groups site for any specific info on this, but failed. Can anyone point me in the right direction, either a specific spot in the group's archives, or any first-hand experience of the procedure?> > Thanks in advance for any direction you can provide

--> Best regards,> >

[Guest guest]

,

On the left hand side of this group, there is a link that says "Files". If you click on that, you will see a link to some other group members AVS experiences. I think if you click on the link below, it should take you directly there.

http://f1.grp.yahoofs.com/v1/IDkdTRafhNiBbknr0i3KOLZTa5yaKfc3MJdsjdus3JSpPEOdoDjyCG__vBUIEUH_AHQtbnI4OLzQEbcs8-b12ha7efkEeRmk/Young_adrenal_vein_sampling_Mayo_Surgery_2004.pdf

Also, you should read Flowerspy's blog. She describes her experience with hyperaldosteronism and has an account of her AVS.

http://hyperaldosteronism.blogspot.com/search/label/Adrenal%20Vein%20Sampling%20Test

Hope this helps

Polymac

>> Hi -> I am fairly new to the group and have been lurking for a couple of weeks. I was diagnosed with primary hyperaldosteronism (which I can finally pronounce without problem...) a couple of weeks ago. My journey to this diagnosis has been anything but straightforward, but I'm thankful to have finally been listened to.> > I am writing because I'm scheduled next week to have the AVS procedure (here in southeastern wi). I have been searching for layperson accounts of this, but find only a couple. Those that I have found scare the you-know-what out of me. > > I attempted searching your yahoo groups site for any specific info on this, but failed. Can anyone point me in the right

direction, either a specific spot in the group's archives, or any first-hand experience of the procedure?> > Thanks in advance for any direction you can provide

--> Best regards,> >