Re: Ot: The dreaded antibiotic

[Guest guest]

Hi Tamara,

If this tick was attached, means he was alive at some point...

What you need to be concerned about from this tick, was first did it carry Lyme

and second, did he pass it on to you.. Only if you could answer yes to both,

would you have to be concerned about a new acute infection you would have to now

deal with along with your chronic infection you are dealing with... Not all

ticks carry Lyme and not all Lyme ticks pass on the disease, but then how do you

know?

This is what Dr. Burrascano says about new tick bites, I would presume yours was

the first, but really have now way of knowing for sure:

TICK BITES - Embedded Deer Tick With No Signs or Symptoms of Lyme (see

appendix):

Decide to treat based on the type of tick, whether it came from an endemic area,

how it was removed,

and length of attachment (anecdotally, as little as four hours of attachment can

transmit pathogens). The risk

of transmission is greater if the tick is engorged, or of it was removed

improperly allowing the tick's contents to

spill into the bite wound. High-risk bites are treated as follows (remember the

possibility of co-infection!):

1) Adults: Oral therapy for 28 days.

2) Pregnancy: Amoxicillin 1000 mg q6h for 6 weeks. Test for Babesia, Bartonella

and Ehrlichia.

Alternative: Cefuroxime axetil 1000 mg q12h for 6 weeks.

3) Young Children: Oral therapy for 28 days.

EARLY LOCALIZED - Single erythema migrans with no constitutional symptoms:

1) Adults: oral therapy- must continue until symptom and sign free for at least

one month,

with a 6 week minimum.

2) Pregnancy: 1st and 2nd trimesters: I.V. X 30 days then oral X 6 weeks

3rd trimester: Oral therapy X 6+ weeks as above.

Any trimester- test for Babesia and Ehrlichia

3) Children: oral therapy for 6+ weeks.

*Doxycycline- Adults: 200 mg bid with food; doses of up to 600 mg daily are

often

needed, as doxycycline is only effective at high blood levels. Not for children

or in

pregnancy.

If levels are too low at tolerated doses, give parenterally or change to another

drug.

Dr. B says pathogens can be transmitted in as little as 4 hours...

I guess this comes down to a judgement call on your part... Have you felt any

new symptoms you didn't have in your recent past? If no, then you may want to

take the chance and not continue the Doxy... If yes, I would continue the Doxy

for 4 - 8 weeks past the extinction of the last known symptom...

In the future, if you or anyone you know gets bitten, taking a single dose of

Doxy, 200 mg will most likely kill it off right away.

Jim

>

>

> Hello all:

>

> I'm putting a really bad week behind me as I had to go on Doxy for the new

tick I found dead but attached to my scalp. It was a little disheartening that I

had such a strong herx reaction after all of this time but I know I am still so

greatly improved.

>

> I am now feeling much better and wondering if anyone has any suggestions on

how long I should continue with the Doxy as It has now been exactly one week and

I'm ready to go back to my rife. The tick was a wood tick and could not have

been attached for more than a day or two and I started the Doxy within 72 hours.

>

> Thanks,

>

> Tamara

>

[Guest guest]

Hi Jim,

I was hoping to get of of the abx with time served. I will stick with them for

the duration.

I know its childish and I know they can prevent a new infection but my CD57 is

still in the teens and I don't want to lower my immune function even more. It

also might get sunny one day in the next couple of weeks and I don't like to

hide from the sun. I'll stop complaining as I'm feeling much better.

Thanks,

Tamara

> >

> >

> > Hello all:

> >

> > I'm putting a really bad week behind me as I had to go on Doxy for the new

tick I found dead but attached to my scalp. It was a little disheartening that I

had such a strong herx reaction after all of this time but I know I am still so

greatly improved.

> >

> > I am now feeling much better and wondering if anyone has any suggestions on

how long I should continue with the Doxy as It has now been exactly one week and

I'm ready to go back to my rife. The tick was a wood tick and could not have

been attached for more than a day or two and I started the Doxy within 72 hours.

> >

> > Thanks,

> >

> > Tamara

> >

>

[Guest guest]

Hi Tamara,

The CD-57 really isn't a reliable test... Have you caught my posts about this

test? Many LLMD's don't trust it.

If you are on Doxy, don't go out in the sun! I don't know what effects

it will have on you and when I was on Doxy I still went out in the sun, but not

supposed

to...

Well here is what it says about the sun, I guess you could spend a little time

out there with no problems... :-)

http://www.drugs.com/doxycycline.html

>>>Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds).

Doxycycline can make your skin more sensitive to sunlight and sunburn may

result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you

must be out in the sun. Do not take iron supplements, multivitamins, calcium

supplements, antacids, or laxatives within 2 hours before or after taking

doxycycline.<<<<

I just think it is best to be safe than sorry with this Doxy... Staying on it

will hopefully kill off any new infection and shouldn't set you back to much...

I always have a bottle of Doxy in the fridge, just for times like this... If you

take it quickly, one 200 mg dose should kill off any new infection. Some say

this can be taken up to 72 hrs, but I believe the quicker the better... If a

Lyme tick infects only after 4 hours (and they can), I think taking Doxy at 72

hours will not be effective...

Take care,

Jim

> > >

> > >

> > > Hello all:

> > >

> > > I'm putting a really bad week behind me as I had to go on Doxy for the new

tick I found dead but attached to my scalp. It was a little disheartening that I

had such a strong herx reaction after all of this time but I know I am still so

greatly improved.

> > >

> > > I am now feeling much better and wondering if anyone has any suggestions

on how long I should continue with the Doxy as It has now been exactly one week

and I'm ready to go back to my rife. The tick was a wood tick and could not

have been attached for more than a day or two and I started the Doxy within 72

hours.

> > >

> > > Thanks,

> > >

> > > Tamara

> > >

> >

>

[Guest guest]

Hi Jim,

I have never read anything about the cd-57 being unreliable. I just goolged it

and could not find any info regarding that. I would be interested in seeing

that because the hope always is that the test is wrong. My nuero has told me

that the bartonella could be the reason why my numbers are always low as the

bart works in your cells and turns off their immune response. It is also

possible that mycoplasma is now more powerful now that the borrelia is low and

that is why my numbers are still low.

I have tested several times over the course of 1 1/2 years and never gotten over

18.

Tamara

> > > >

> > > >

> > > > Hello all:

> > > >

> > > > I'm putting a really bad week behind me as I had to go on Doxy for the

new tick I found dead but attached to my scalp. It was a little disheartening

that I had such a strong herx reaction after all of this time but I know I am

still so greatly improved.

> > > >

> > > > I am now feeling much better and wondering if anyone has any suggestions

on how long I should continue with the Doxy as It has now been exactly one week

and I'm ready to go back to my rife. The tick was a wood tick and could not

have been attached for more than a day or two and I started the Doxy within 72

hours.

> > > >

> > > > Thanks,

> > > >

> > > > Tamara

> > > >

> > >

> >

>

[Guest guest]

Uh, sorry, but the advice you gave, Jim, about 1 dose of doxy doing the

trick--that's an IDSA fable!! It DEFINITELY doesn't work! And the doxy is not

only for the Lyme, but for the co-infections, too (but not Babesia). So stick

it out, Tamara. Better to be safe than sorry.

> > >

> > >

> > > Hello all:

> > >

> > > I'm putting a really bad week behind me as I had to go on Doxy for the new

tick I found dead but attached to my scalp. It was a little disheartening that I

had such a strong herx reaction after all of this time but I know I am still so

greatly improved.

> > >

> > > I am now feeling much better and wondering if anyone has any suggestions

on how long I should continue with the Doxy as It has now been exactly one week

and I'm ready to go back to my rife. The tick was a wood tick and could not

have been attached for more than a day or two and I started the Doxy within 72

hours.

> > >

> > > Thanks,

> > >

> > > Tamara

> > >

> >

>

[Guest guest]

Uh, sorry, but the advice you gave, Jim, about 1 dose of doxy doing the

trick--that's an IDSA fable!! It DEFINITELY doesn't work! And the doxy is not

only for the Lyme, but for the co-infections, too (but not Babesia). So stick

it out, Tamara. Better to be safe than sorry.

> > >

> > >

> > > Hello all:

> > >

> > > I'm putting a really bad week behind me as I had to go on Doxy for the new

tick I found dead but attached to my scalp. It was a little disheartening that I

had such a strong herx reaction after all of this time but I know I am still so

greatly improved.

> > >

> > > I am now feeling much better and wondering if anyone has any suggestions

on how long I should continue with the Doxy as It has now been exactly one week

and I'm ready to go back to my rife. The tick was a wood tick and could not

have been attached for more than a day or two and I started the Doxy within 72

hours.

> > >

> > > Thanks,

> > >

> > > Tamara

> > >

> >

>

[Guest guest]

Hi Gloria,

Do you have any supporting data to your claim that a single dose of Doxy given

immediately after a tick bite does not work and that it is a IDSA fable? I have

suggested this to many on and off group for family members or friends who were

bitten, in my area I have suggested this to more than 100 folks in my community

and of all that have reported back to me, not one had Lyme. In fairness, many

bitten had no clue of the kind of tick, some had their ticks tested and some

came back positive for Lyme. My wife was bitten again by a deer tick, the test

on the tick was positive for Lyme, yet one dose of Doxy given immediately after

the bite, she did not contract Lyme for a second time.

The only coinfection Doxy also may treat is Ehrlichia.

Here is a study done on this subject, a single dose of Doxy given within 72 hrs

of a tick bite and supportive studies that it does work. The only thing I take

issue with this method is the length of time the Doxy can be given, 72 hrs. as

it should be given a soon as possible.

http://content.nejm.org/cgi/content/short/345/2/79

>>>Conclusions A single 200-mg dose of doxycycline given within 72 hours after

an I. scapularis tick bite can prevent the development of Lyme disease.<<<<

http://www.aldf.com/raad.shtml

>>>SEE TICK BITE<<<<

http://www.aafp.org/afp/2004/0415/p1935.html

>>>In areas with a high incidence of Lyme disease, it may be reasonable to

administer chemoprophylaxis with a single 200-mg oral dose of doxycycline

(Vibramycin) to persons bitten by an I. scapularis nymph tick that is identified

as being at least partially engorged with blood<<<<

http://jac.oxfordjournals.org/cgi/content/abstract/dkq097v1

>>>Results: Four placebo-controlled clinical trials were included for review.

Among 1082 randomized subjects, the risk of Lyme disease in the placebo group

was 2.2% [95% confidence interval (CI), 1.2%–3.9%] compared with 0.2% (95% CI,

0.0%–1.0%) in the antibiotic-treated group. Antibiotic prophylaxis significantly

reduced the odds of developing Lyme disease compared with placebo (pooled odds

ratio = 0.084; 95% CI, 0.0020–0.57; P = 0.0037).<<<

I will continue to suggest to anyone bitten by a tick take Doxy 200 mg, then

watch for symptoms of any kind and see a doc if any show up for further

treatment. At least in my area, doctors WILL NOT treat even for early Lyme

without a positive Lyme test.

And Gloria, had you fully followed this thread, I was the person who suggested

to Tamara she remain on the Doxy for full term...

Jim

> > > >

> > > >

> > > > Hello all:

> > > >

> > > > I'm putting a really bad week behind me as I had to go on Doxy for the

new tick I found dead but attached to my scalp. It was a little disheartening

that I had such a strong herx reaction after all of this time but I know I am

still so greatly improved.

> > > >

> > > > I am now feeling much better and wondering if anyone has any suggestions

on how long I should continue with the Doxy as It has now been exactly one week

and I'm ready to go back to my rife. The tick was a wood tick and could not

have been attached for more than a day or two and I started the Doxy within 72

hours.

> > > >

> > > > Thanks,

> > > >

> > > > Tamara

> > > >

> > >

> >

>

[Guest guest]

Jim,Remember my probiotic, yogurt, scientist - I just mentioned?He went on all three antibiotics at 72 hours (so maybe a little late). Stayed on the abx for 9 months and is still very sick.  He is now rifing.

I guess he wasn't as lucky as some.  I still think it's a good idea, though.He was not bit by a tic. He's not sure what it was, he was outside and suddenly he felt like a knife had been stabbed in his back - his wife confirmed something had bit him.  I think that was on a Sat, by Mon he was at a LLMD, who took labs and put him on the abx. (His blood work came back positive).

 

Hi Gloria,

Do you have any supporting data to your claim that a single dose of Doxy given immediately after a tick bite does not work and that it is a IDSA fable? I have suggested this to many on and off group for family members or friends who were bitten, in my area I have suggested this to more than 100 folks in my community and of all that have reported back to me, not one had Lyme. In fairness, many bitten had no clue of the kind of tick, some had their ticks tested and some came back positive for Lyme. My wife was bitten again by a deer tick, the test on the tick was positive for Lyme, yet one dose of Doxy given immediately after the bite, she did not contract Lyme for a second time.

The only coinfection Doxy also may treat is Ehrlichia.

Here is a study done on this subject, a single dose of Doxy given within 72 hrs of a tick bite and supportive studies that it does work. The only thing I take issue with this method is the length of time the Doxy can be given, 72 hrs. as it should be given a soon as possible.

http://content.nejm.org/cgi/content/short/345/2/79

>>>Conclusions A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.<<<<

http://www.aldf.com/raad.shtml

>>>SEE TICK BITE<<<<

http://www.aafp.org/afp/2004/0415/p1935.html

>>>In areas with a high incidence of Lyme disease, it may be reasonable to administer chemoprophylaxis with a single 200-mg oral dose of doxycycline (Vibramycin) to persons bitten by an I. scapularis nymph tick that is identified as being at least partially engorged with blood<<<<

http://jac.oxfordjournals.org/cgi/content/abstract/dkq097v1

>>>Results: Four placebo-controlled clinical trials were included for review. Among 1082 randomized subjects, the risk of Lyme disease in the placebo group was 2.2% [95% confidence interval (CI), 1.2%–3.9%] compared with 0.2% (95% CI, 0.0%–1.0%) in the antibiotic-treated group. Antibiotic prophylaxis significantly reduced the odds of developing Lyme disease compared with placebo (pooled odds ratio = 0.084; 95% CI, 0.0020–0.57; P = 0.0037).<<<

I will continue to suggest to anyone bitten by a tick take Doxy 200 mg, then watch for symptoms of any kind and see a doc if any show up for further treatment. At least in my area, doctors WILL NOT treat even for early Lyme without a positive Lyme test.

And Gloria, had you fully followed this thread, I was the person who suggested to Tamara she remain on the Doxy for full term...

Jim

> > > >

> > > >

> > > > Hello all:

> > > >

> > > > I'm putting a really bad week behind me as I had to go on Doxy for the new tick I found dead but attached to my scalp. It was a little disheartening that I had such a strong herx reaction after all of this time but I know I am still so greatly improved.

> > > >

> > > > I am now feeling much better and wondering if anyone has any suggestions on how long I should continue with the Doxy as It has now been exactly one week and I'm ready to go back to my rife. The tick was a wood tick and could not have been attached for more than a day or two and I started the Doxy within 72 hours.

> > > >

> > > > Thanks,

> > > >

> > > > Tamara

> > > >

> > >

> >

>

[Guest guest]

Hi ,From what I've heard, there are many other vectors now besides deer ticks. It's horrible to think that any biting fly might be a carrier, but that's the truth. I know that chronic Lyme is often sero-negative, but I've got to tell ya, when a mosquito bites me, I want to kill it before it can then go bite someone else and possibly pass my disease on!Be well,Léna Jim,Remember my probiotic, yogurt, scientist - I just mentioned?He went on all three antibiotics at 72 hours (so maybe a little late). Stayed on the abx for 9 months and is still very sick. He is now rifing. I guess he wasn't as lucky as some. I still think it's a good idea, though.He was not bit by a tic. He's not sure what it was, he was outside and suddenly he felt like a knife had been stabbed in his back - his wife confirmed something had bit him. I think that was on a Sat, by Mon he was at a LLMD, who took labs and put him on the abx. (His blood work came back positive). On Thu, Apr 29, 2010 at 1:23 PM, Sunshine <jimjax2gmail> wrote: Hi Gloria, Do you have any supporting data to your claim that a single dose of Doxy given immediately after a tick bite does not work and that it is a IDSA fable? I have suggested this to many on and off group for family members or friends who were bitten, in my area I have suggested this to more than 100 folks in my community and of all that have reported back to me, not one had Lyme. In fairness, many bitten had no clue of the kind of tick, some had their ticks tested and some came back positive for Lyme. My wife was bitten again by a deer tick, the test on the tick was positive for Lyme, yet one dose of Doxy given immediately after the bite, she did not contract Lyme for a second time. The only coinfection Doxy also may treat is Ehrlichia. Here is a study done on this subject, a single dose of Doxy given within 72 hrs of a tick bite and supportive studies that it does work. The only thing I take issue with this method is the length of time the Doxy can be given, 72 hrs. as it should be given a soon as possible. http://content.nejm.org/cgi/content/short/345/2/79 >>>Conclusions A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.<<<< http://www.aldf.com/raad.shtml >>>SEE TICK BITE<<<< http://www.aafp.org/afp/2004/0415/p1935.html >>>In areas with a high incidence of Lyme disease, it may be reasonable to administer chemoprophylaxis with a single 200-mg oral dose of doxycycline (Vibramycin) to persons bitten by an I. scapularis nymph tick that is identified as being at least partially engorged with blood<<<< http://jac.oxfordjournals.org/cgi/content/abstract/dkq097v1 >>>Results: Four placebo-controlled clinical trials were included for review. Among 1082 randomized subjects, the risk of Lyme disease in the placebo group was 2.2% [95% confidence interval (CI), 1.2%–3.9%] compared with 0.2% (95% CI, 0.0%–1.0%) in the antibiotic-treated group. Antibiotic prophylaxis significantly reduced the odds of developing Lyme disease compared with placebo (pooled odds ratio = 0.084; 95% CI, 0.0020–0.57; P = 0.0037).<<< I will continue to suggest to anyone bitten by a tick take Doxy 200 mg, then watch for symptoms of any kind and see a doc if any show up for further treatment. At least in my area, doctors WILL NOT treat even for early Lyme without a positive Lyme test. And Gloria, had you fully followed this thread, I was the person who suggested to Tamara she remain on the Doxy for full term... Jim > > > > > > > > > > > > Hello all: > > > > > > > > I'm putting a really bad week behind me as I had to go on Doxy for the new tick I found dead but attached to my scalp. It was a little disheartening that I had such a strong herx reaction after all of this time but I know I am still so greatly improved. > > > > > > > > I am now feeling much better and wondering if anyone has any suggestions on how long I should continue with the Doxy as It has now been exactly one week and I'm ready to go back to my rife. The tick was a wood tick and could not have been attached for more than a day or two and I started the Doxy within 72 hours. > > > > > > > > Thanks, > > > > > > > > Tamara > > > > > > > > > >

[Guest guest]

Hi Jim,

That was not meant as a scold to you; I did read the thread and what you said

about staying the course. I just was alarmed that people might get the wrong

information from this.

The studies you quoted, esp the NEJM, and ALDF, are all completely IDSA slanted.

Take a look: did any of them do long-term follow-up on the subjects? Not

likely.

The studies showing Borrellia persisting after much more abx than that are too

numerous to mention here (I have them though). Dr. Burrascano's guidelines are

quite clear on the subject.

In addition, I got bitten again last Memorial Day. However, in spite of much

longer low-level doxy (200 mg, AND IV rocephin that I was on already), I got new

onset Bell's Palsy!! It has improved, but hasn't gone away completely.

Any LLMD worth their salt knows that the one dose of doxy absolutely isn't

sufficient. Your wife was lucky! Or had a terrific immune system. I just

would hate to have someone think that it was adequate and find out the long,

hard way that it isn't.

Gloria

> > > > >

> > > > >

> > > > > Hello all:

> > > > >

> > > > > I'm putting a really bad week behind me as I had to go on Doxy for the

new tick I found dead but attached to my scalp. It was a little disheartening

that I had such a strong herx reaction after all of this time but I know I am

still so greatly improved.

> > > > >

> > > > > I am now feeling much better and wondering if anyone has any

suggestions on how long I should continue with the Doxy as It has now been

exactly one week and I'm ready to go back to my rife. The tick was a wood tick

and could not have been attached for more than a day or two and I started the

Doxy within 72 hours.

> > > > >

> > > > > Thanks,

> > > > >

> > > > > Tamara

> > > > >

> > > >

> > >

> >

>

[Guest guest]

 ANd, of course, there are lots of other co's, too, RMSF, Tularemia, etcI haven't heard of these.  Frequencies?  Any more oddballs? :-)

[Guest guest]

I don't believe there are any sure things with the lyme. I don't think there

is enough data and what we get is so filtered to believe anything for sure. I

have a friend who went on doxy within 72 hours and she is very sick. She was

bit a couple years before me and stayed healthy until a couple of years ago.

She is now very ill and probably won't get better as she refuses any type of

alternative treatment. She doesn't do anything at all just gets sicker and

sicker. I have been unable to get through to her in any way as there seems to

be so much damage to her brain that I can't reason with her at all. She really

doesn't even seem like the same person to me and I have lyme.

I am worried about my new tick bite. I think I might be ok as it was dead. I

think it got poisoned by my dogs frontline and then tried to catch a ride with

me. I have not been able to hold down the doxy for a couple of days now.

Vomit has never been one of my symptoms so I think it is the doxy.

After I vomit I feel fine so I don't think its a bug.

Any ideas

Tamara

> > > > > >

> > > > > >

> > > > > > Hello all:

> > > > > >

> > > > > > I'm putting a really bad week behind me as I had to go on Doxy for

> > the new tick I found dead but attached to my scalp. It was a little

> > disheartening that I had such a strong herx reaction after all of this time

> > but I know I am still so greatly improved.

> > > > > >

> > > > > > I am now feeling much better and wondering if anyone has any

> > suggestions on how long I should continue with the Doxy as It has now been

> > exactly one week and I'm ready to go back to my rife. The tick was a wood

> > tick and could not have been attached for more than a day or two and I

> > started the Doxy within 72 hours.

> > > > > >

> > > > > > Thanks,

> > > > > >

> > > > > > Tamara

> > > > > >

> > > > >

> > > >

> > >

> >

> >

> >

>

[Guest guest]

Well, I was just going by what Dr. Burrascano says about Doxy, it is effective

for Lyme and Ehrlichia..

" Consider Doxycycline first in early Lyme due to concern for Ehrlichia

co-infections. " ~ Dr. Burrascano

Jim

> > > > > >

> > > > > >

> > > > > > Hello all:

> > > > > >

> > > > > > I'm putting a really bad week behind me as I had to go on Doxy for

the new tick I found dead but attached to my scalp. It was a little

disheartening that I had such a strong herx reaction after all of this time but

I know I am still so greatly improved.

> > > > > >

> > > > > > I am now feeling much better and wondering if anyone has any

suggestions on how long I should continue with the Doxy as It has now been

exactly one week and I'm ready to go back to my rife. The tick was a wood tick

and could not have been attached for more than a day or two and I started the

Doxy within 72 hours.

> > > > > >

> > > > > > Thanks,

> > > > > >

> > > > > > Tamara

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

HI Tamara,

Just remember, if you got biten by 100 ticks, only some would have Lyme and not

all of them would even pass the disease on to you... So with one tick bite, your

changes are relatively low you contracted Lyme... What you are doing now is just

a precaution and for the most part probably isn't needed for anything other than

a little insurance... But don't let your guard down, look for any symptoms that

may suggest otherwise, just in case...

Vomiting is not a symptom of Lyme... Can you take the Doxy after some food? If

so, this may help. Do take it at least 2 hrs away from other meds and supps to

ensure they will not have an affect on it.. And I think you also have to leave a

few hours away from any foods with calcium...

Take care,

Jim

> > > > > > >

> > > > > > >

> > > > > > > Hello all:

> > > > > > >

> > > > > > > I'm putting a really bad week behind me as I had to go on Doxy for

> > > the new tick I found dead but attached to my scalp. It was a little

> > > disheartening that I had such a strong herx reaction after all of this

time

> > > but I know I am still so greatly improved.

> > > > > > >

> > > > > > > I am now feeling much better and wondering if anyone has any

> > > suggestions on how long I should continue with the Doxy as It has now been

> > > exactly one week and I'm ready to go back to my rife. The tick was a wood

> > > tick and could not have been attached for more than a day or two and I

> > > started the Doxy within 72 hours.

> > > > > > >

> > > > > > > Thanks,

> > > > > > >

> > > > > > > Tamara

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> > >

> > >

> >

>