Tylenol: The Facts AND The Warnings..your experiences?

Discussion in 'Fibromyalgia Main Forum' started by RedHeadEMT, Dec 28, 2006.

  1. RedHeadEMT

    RedHeadEMT New Member

    Hi everyone! I hope that the holidays haven't been kicking your butts too hard! Thank goodness the craziness is almost over. :O)

    ANYWAYS!

    Recently, I have been noticing a lot of posts about tylenol; most especially, a lot of worried warnings about this drugs. So, I searched my medical school books and online study resources and wanted to just drop some facts out there regarding this medication!

    -Acetaminophen or paracetamol (brand name: Tylenol) belongs to a class of drugs called analgesics (or pain relievers) and antipyretics (or fever reducers).

    -Acetaminophen is mainly metabolized by the liver ... then excreted by the kidneys. Only a small portion (5–10% of a therapeutic dose) is metabolized via the [liver].

    -The oral RECOMMENDED daily dose for adults is 325mg to 650 mg every 4-6 hours. The maximum daily dose is 4 grams, or 4,000mg.

    -In humans, tyl has something called "a narrow therapeutic index" – basically,

    THE THERAPEUTIC DOSE IS CLOSE TO THE TOXIC DOSE...

    Now that being said...

    The toxic dose of tyl is HIGHLY variable.

    -In adults, single doses above 10 grams or ABOUT 10,000mg have a reasonable likelihood of causing toxicity.

    Quick definition:
    *Toxicity is a measure of the degree to which something is toxic or poisonous.
    *Many different factors go into influencing toxicity- how it is administered, time it was administered, the number of times if was given, the genetic makeup and overall health of a person, and lastly - is this an acute or chronic exposure?

    SO...

    Toxicity can also happen when multiple smaller doses within 24 hours exceed the above stated levels, or even with chronic ingestion of doses as low as 4 g/day (aka 4,000mgs), and death can occur with as little as 6 g/day (aka 6,000mgs).

    EXTRA ACETAMINOPHEN FACTOIDS:

    -unlike other common OTC pain meds such as aspirin and ibuprofen, TYL has very little anti-inflammatory properties, and so it is not a member of the class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). In RECOMMENDED doses, it does NOT irritate the lining of the stomach, affect blood coagulation as much as NSAIDs, or affect function of the kidneys.

    BASICALLY, when taken as directed, it is much safer, on the whole, than NSAIDs.

    -it's useful in managing more severe pain, allowing lower dosages of additional non-steroidal anti-inflammatory drugs (NSAIDs-like ibuprofen, aspirin, nabumentone, and even omega-3 fatty acids!!) or opioid pain meds to be used = minimizing overall side-effects.


    QUICK WARNING: In some other animals, for example cats, even small doses are toxic, as cats lack the basic physiological components to break down this med. So, please be especially extra CAREFUL with your tylenol around your kit kats!


    So, there...I hope that some of the info that I've provided has proven to be helpful for some of you. I guess the basic message that I'm trying to get across, is that TYL is no different than any other medications, OTC or RXed, in that if you take it as directed, then you should be FINE! If ya have the knowledge, there should be no excuse for stressing unneccessarily OR to not do the right/correct thing. The more knowledge you're armed with, the better, right?

    Take care!! gentle xoxoxox


    K
    [This Message was Edited on 12/29/2006]
  2. RedHeadEMT

    RedHeadEMT New Member

  3. RedHeadEMT

    RedHeadEMT New Member

    Something else that I didn't put in my original post was WHAT your experiences were with TYL and IF you have/had worries about TYL, WHY?

    Curious in Cali,

    K
  4. BethM

    BethM New Member

    My primary concern is that I take acetaminophen as generic Tylenol and in Darvocet, every day. It's a very rare day when I don't need it to keep my pain levels under control so I can function somewhat normally, whatever the heck THAT is.

    I monitor my intake of both meds, keep it to a minimum as much as possible, trying to stave off potential problems.

    Occasionally taking 4 grams a day of acetaminophen won't hurt anyone unless they have other health issues like cirrhosis of the liver. Taking the couple of grams or so I take DAILY is problematic.

    I think that being aware of the high potential for putting my liver at risk is vitally important for my future health and well being, as is taking supportive measures such as the milk thistle I've just begun taking.

    Putting any organ or organism under constant stress creates damage over time. It just makes sense to protect my liver as best I can, with the knowlege I have.

    my 2.5 cents,

    Beth.
  5. Beadlady

    Beadlady Member

    helps to keep your liver healthy--especially raw beets.
  6. RedHeadEMT

    RedHeadEMT New Member

    Thanks for your reply...

    I am actually kinda worried about my own tyl consumption, now that I have researched more. I take between 2600-3600mg on a daily basis. That really is too much and during my next doc visit (on the 12th), I will be talking to him about maybe switching my meds (is there any way to get the hydrocodone without the acetaminophen...I will be researching that) or doing SOMETHING because I want to keep my liver and kidneys!!!

    xoxo

    K

    PS-WOW! I saw your profile and am thoroughly impressed with your job! Man, your job much be so tough ANYWAYS, and to do it with the FMS at your side...You're an incredible lady, Beth!
  7. missblondi66

    missblondi66 New Member

    Hi all,
    It's been a long while since I have posted, I'm so bad!
    I hope the New Year brings health and happiness to all.

    I'm not sure how many people remember me, so I'll give a brief update. I have what they believe is Lupus, I'm going on my 4th year of agony with an unclear diagnosis. I swell enormously(my sedrate runs consistently at 85), my kidneys are failing, and just recently, I became severely anemic requiring iron infusions.

    I can't take much medicine because of my kidneys, which has slowed my treatment somewhat. I do take plaquenil, which, though it helps, doesn't end the suffering. I take anywhere between 4-6 Darvocet in a 24 hour period, just to get thru the day. I can't take anti-inflammatories, or I would...because when I did take them, they helped me enormously. I am on a diuretic to help with my blood pressure related issues due to the kidney failure, but it does not reduce the fluid levels much at all...and if they put me on a stronger one, my potassium goes too low.

    My thinking is this:I have two choices...take the Darvocet and minimalize my pain, or not take anything and make everyone around me, including myself, miserable. Frankly, the doctors have to monitor my pain medicine intake, because I will be on it the rest of my life. They can't go zipping thru the pain meds exhausting all of the sources, I am only 40. That's why I think that they don't fret too much about me taking the levels of Darvocet that I do.
    Ok, that's my two cents. Hope to hear from everyone!
  8. kjfms

    kjfms Member

    While your post is great and very informative. If I may I am going to add just a few items of interest. There are some other things to consider and be on the look out for when taking acetaminophen.

    My source is MedlinePlus -- I use in my work and have use it since I was in school so I do trust it.

    http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202001.html

    This contains is some important information about acetaminophen effects on lab tests -- anyway -- I hope you do not mind me adding to your post :)


    Check with your medical doctor or dentist:

    If you are taking this medicine to relieve pain, including arthritis pain, and the pain lasts for more than 10 days for adults or 5 days for children or if the pain gets worse, new symptoms occur, or the painful area is red or swollen.

    These could be signs of a serious condition that needs medical or dental treatment.


    If you are taking this medicine to bring down a fever, and the fever lasts for more than 3 days or returns, the fever gets worse, new symptoms occur, or redness or swelling is present.

    These could be signs of a serious condition that needs treatment.

    If you are taking this medicine for a sore throat, and the sore throat is very painful, lasts for more than 2 days, or occurs together with or is followed by fever, headache, skin rash, nausea, or vomiting.

    Check the labels of all prescription and nonprescription (over-the-counter [OTC]) medicines you now take.

    If any contain acetaminophen, check with your health care professional.

    Taking them together with this medicine may cause an overdose.

    If you will be taking more than an occasional 1 or 2 doses of acetaminophen, do not drink alcoholic beverages.

    To do so may increase the chance of liver damage, especially if you drink large amounts of alcoholic beverages regularly, if you take more acetaminophen than is recommended on the package label, or if you take it regularly for a long time.

    Taking certain other medicines together with acetaminophen may increase the chance of unwanted effects.

    The risk will depend on how much of each medicine you take every day, and on how long you take the medicines together.

    If your medical doctor or dentist directs you to take these medicines together on a regular basis, follow his or her directions carefully.

    However, do not take any of the following medicines together with acetaminophen for more than a few days unless your doctor has directed you to do so and is following your progress:

    Aspirin or other salicylates

    Diclofenac (e.g., Voltaren)

    Diflunisal (e.g., Dolobid)

    Etodolac (e.g., Lodine)

    Fenoprofen (e.g., Nalfon)

    Floctafenine (e.g., Idarac)

    Flurbiprofen, oral (e.g., Ansaid)

    Ibuprofen (e.g., Motrin)

    Indomethacin (e.g., Indocin)

    Ketoprofen (e.g., Orudis)

    Ketorolac (e.g., Toradol)

    Meclofenamate (e.g., Meclomen)

    Mefenamic acid (e.g., Ponstel)

    Nabumetone (e.g., Relafen)

    Naproxen (e.g., Naprosyn)

    Oxaprozin (e.g., Daypro)

    Phenylbutazone (e.g., Butazolidin)

    Piroxicam (e.g., Feldene)

    Sulindac (e.g., Clinoril)

    Tenoxicam (e.g., Apo-Tenoxicam)

    Tiaprofenic acid (e.g., Surgam)

    Tolmetin (e.g., Tolectin)

    Acetaminophen may interfere with the results of some medical tests.

    Before you have any medical tests, tell the person in charge if you have taken acetaminophen within the past 3 or 4 days.

    If possible, it is best to call the laboratory where the test will be done about 4 days ahead of time, to find out whether this medicine may be taken during the 3 or 4 days before the test.



    For diabetic patients:

    Acetaminophen may cause false results with some blood glucose (sugar) tests.

    If you notice any change in your test results, or if you have any questions about this possible problem, check with your health care professional.

    This is especially important if your diabetes is not well-controlled.

    For patients taking one of the products that contain caffeine in addition to acetaminophen:

    Caffeine may interfere with the results of a test that uses adenosine (e.g., Adenocard) or dipyridamole (e.g., Persantine) to help find out how well your blood is flowing through certain blood vessels.

    Therefore, you should not have any caffeine for 8 to 12 hours before the test.

    If you think that you or anyone else may have taken an overdose of acetaminophen, get emergency help at once, even if there are no signs of poisoning.

    Signs of severe poisoning may not appear for 2 to 4 days after the overdose is taken, but treatment to prevent liver damage or death must be started as soon as possible.

    Treatment started more than 24 hours after the overdose is taken may not be effective.




    Side Effects of This Medicine

    Along with its needed effects, a medicine may cause some unwanted effects.

    Although not all of these side effects may occur, if they do occur they may need medical attention.

    Check with your doctor immediately if any of the following side effects occur:

    Rare -- Yellow eyes or skin


    Symptoms of overdose --

    *Diarrhea
    *Increased sweating
    *Loss of appetite
    *Nausea or vomiting
    *Stomach cramps or pain
    *Swelling
    *Pain, or tenderness in the upper abdomen or stomach area


    Also, check with your doctor as soon as possible if any of the following side effects occur:

    Rare --

    *Bloody or black, tarry stools

    *Bloody or cloudy urine

    *Fever with or without chills (not present before treatment and not caused by the condition being treated)

    *Pain in lower back and/or side (severe and/or sharp)

    *Pinpoint red spots on skin; skin rash, hives, or itching

    *Sores, ulcers, or white spots on lips or in mouth

    *Sore throat (not present before treatment and not caused by the condition being treated)

    *Sudden decrease in amount of urine

    *Unusual bleeding or bruising

    *Unusual tiredness or weakness


    Other side effects not listed above may also occur in some patients.

    If you notice any other effects, check with your doctor.




    Brand Names

    In the U.S.—

    Aceta Elixir1
    Aceta Tablets1
    Acetaminophen Uniserts1
    Actamin1
    Actamin Extra1
    Actamin Super2
    Aminofen1
    Aminofen Max1
    Apacet Capsules1
    Apacet Elixir1
    Apacet Extra Strength Caplets1
    Apacet Extra Strength Tablets1
    Apacet, Infants'1
    Apacet Regular Strength Tablets1
    Aspirin Free Anacin Maximum Strength Caplets1
    Aspirin Free Anacin Maximum Strength Gel Caplets1
    Aspirin Free Anacin Maximum Strength Tablets1
    Aspirin-Free Excedrin Caplets2
    Banesin1
    Bayer Select Maximum Strength Headache Pain Relief Formula2
    Dapa1
    Dapa X-S1
    Datril Extra-Strength1
    Feverall, Children's1
    Feverall, Infants'1
    Feverall Junior Strength1
    Feverall Sprinkle Caps, Children's1
    Feverall Sprinkle Caps Junior Strength1
    Genapap Children's Elixir1
    Genapap Children's Tablets1
    Genapap Extra Strength Caplets1
    Genapap Extra Strength Tablets1
    Genapap, Infants'1
    Genapap Regular Strength Tablets1
    Genebs Extra Strength Caplets1
    Genebs Regular Strength Tablets1
    Genebs X-Tra1
    Liquiprin Children's Elixir1

    Liquiprin Infants' Drops1
    Neopap1
    Oraphen-PD1
    Panadol, Children's1
    Panadol, Infants'1
    Panadol Junior Strength Caplets1
    Panadol Maximum Strength Caplets1
    Panadol Maximum Strength Tablets1
    Phenaphen Caplets1
    Redutemp1
    Snaplets-FR1
    St. Joseph Aspirin-Free Fever Reducer for Children 1
    Suppap-1201
    Suppap-3251
    Suppap-6501
    Tapanol Extra Strength Caplets1
    Tapanol Extra Strength Tablets1
    Tempra1
    Tempra D.S1
    Tempra, Infants'1
    Tempra Syrup1
    Tylenol Arthritis Extended Relief
    Tylenol Children's Chewable Tablets1
    Tylenol Children's Elixir1
    Tylenol Children's Suspension Liquid1
    Tylenol Extra-Strength Adult Liquid Pain Reliever 1
    Tylenol Extra Strength Caplets1
    Tylenol Extra Strength Gelcaps1
    Tylenol Extra Strength Tablets1
    Tylenol Infants' Drops1
    Tylenol Infants' Suspension Drops1
    Tylenol Junior Strength Caplets1
    Tylenol Junior Strength Chewable Tablets1
    Tylenol Regular Strength Caplets1
    Tylenol Regular Strength Tablets1
    Valorin1
    Valorin Extra1





    In Canada—

    Abenol1
    Actimol Chewable Tablets1
    Actimol Children's Suspension1
    Actimol Infants' Suspension1
    Actimol Junior Strength Caplets1
    Anacin-31
    Anacin-3 Extra Strength1
    Apo-Acetaminophen1
    Atasol Caplets1
    Atasol Drops1
    Atasol Forte Caplets1
    Atasol Forte Tablets1
    Atasol Oral Solution1
    Atasol Tablets1
    Excedrin Caplets2
    Excedrin Extra Strength Caplets2
    Exdol1

    Exdol Strong1
    Panadol1
    Panadol Extra Strength1
    Robigesic1
    Rounox1
    Tempra Caplets1
    Tempra Chewable Tablets1
    Tempra Drops1
    Tempra Syrup1
    Tylenol Caplets1
    Tylenol Children's Chewable Tablets1
    Tylenol Drops1
    Tylenol Elixir1
    Tylenol Gelcaps1
    Tylenol Junior Strength Caplets1
    Tylenol Tablets1





    Other commonly used names are APAP; paracetamol.

    This information applies to the following medicines:

    1. Acetaminophen (a-seat-a-MIN-oh-fen)‡
    2. Acetaminophen and Caffeine (a-seat-a-MIN-oh-fen and kaf-EEN)


    Category
    Analgesic --Acetaminophen ; Acetaminophen and Caffeine
    Antipyretic --Acetaminophen; Acetaminophen and Caffeine


    Thanks,

    Karen :)




    [This Message was Edited on 12/31/2006]
  9. kirschbaum26

    kirschbaum26 New Member

    Hi:

    Just wanted to ad that I have been going to my PCP for about 10 years now. During that time I have been taking a minimum of 2000mg of advil and 1300mg of tylenol every day. She knew it, and while it kept me from needing any stronger pain meds, it has probably helped to damage my liver and/or kidneys. I always told her how much I was taking, and she would always say..."and it does not upset your stomach" and I would say that my stomach was always upset, and this did nothing more to it.

    So now that my RA has gotten out of control, many of the meds that I would most likely take, that would probably work to halt or at least slow down the destruction of my joints and damage to my internal organs, I cannot take. I have had a liver ultrasound, which fortunately did not find anything suspicious. I have the "fatty liver" that means that my liver is too busy processing all these meds and is not doing its primary job efficiently.

    So I had a hysterectomy, and had to stop all NSAIDs and tylenol for a week prior. I am still not back on them, as I am on a blood thinner due to complications with my atrial fibrillation during the surgery. So now, I am taking vicodin. I get by on 4-5 per day. I am not sure how long I am going to be able to continue to take them. My rheumatologist knows that I am tyring to balance all these different health issues, but not sure that he wants to continue to give me vicodin.

    Well, just thought I would share my experiences. I think that I would have thought more about taking so much advil. The box says, if you take it for more than 10 days to tell your doctor. I told my doctor, and thought that was all I had to do. NOT. I have to be more responsible for my health...which is tough at this stage (44 years old).

    Good luck.

    Ingrid
  10. RedHeadEMT

    RedHeadEMT New Member

    Thanks so much for sharing your ideas about the ibuprofen. After much research and thought and talking with folks on here, I will definitely be changing my med intake SOMEHOW. I am gonna try to take my 2.5 norco twice a day with a muscle relaxant and at night take a klonopin from tonight. I will see how the will work and if it does, then I will stick with it.

    I also have that doc apt on the 12th with my pain doc and hope that he will have some suggestions on what to do. I have an rx for 600mgs of ibuprofen that I take off and on ON TOP of the norco. Not often though, as I worry about the intake on top of the tyl; although, sadly, the combo really does work wonders for pain.

    Perhaps, my doc can rx hydrocodone with a motrin combo that I can alternate with the regular norco, to minimize the tyl intake.

    Thanks so much again for the suggestion. I gonna buy the milk thistle soon to support my liver.

    take care,

    K


    PS-Your Lulu is ADORABLE! My grandma had beautiful poodles all throughout her life and they were her best friends-great dogs!

    PPS-I am so impressed by your career-wow! What an amazing lady you much be! I envy your experience and knowledge and hope to be on your level in the near future! :O)
  11. RedHeadEMT

    RedHeadEMT New Member

    First of all, welcome back to the board!!!! We're very happy to have you!

    Thanks so much for sharing your experience with me. I'm sad to hear of all your health problems. Are you currently on dialysis? You know, I think one of the worst things is not having a diagnosis, but being SO sick. I really empathize with you and I will pray for you that you find a great doc who will finally give you an answer!

    You know, what you said in your answer is the SAME exact thing that I have been sayng to my mom for AGES now. She suffers from SO many debilitating chronic pain conditions (and in my opinion, undiagnosed fms also) and simply REFUSES to properly take pain meds that her doc rxes for her. It's so frustrating!! When she finally can;t take it anymore, she takes her meds and is a human being again. When she doesn't, she is a terror to be around.

    And it is completely understandable! So, what you said is my philosophy alllll the way, honey! I can either take my pain meds and be myself, fun to be around OR I can NOT take any pain meds and lie in bed or when I'm around anyone, I have a short fuse, I am aggitated, and am just counting the minutes till when I can go home and rest.

    Anyways, again, you take GOOD care of yourself ok? I will keep ya in my thoughts and prayers.

    gentle hugs,


    K
  12. RedHeadEMT

    RedHeadEMT New Member

    Thanks so much for adding your link to the thread! I, too, often use medlineplus and find it really useful and simple to read and navigate.

    I think that if anyone is taking ANY med it really is up to them to truly research that med on their own, since docs and pharmacies will only tell you a small percentage about the med.

    I like your profile very much! If that photo of somewhere by where you live? It is truly beautiful. I love your philosophy about taking control of your own healthcare and I reallllly believe in that wholeheartedly and always advocate for it, so amen to that!!

    Anyways, thanks so much, again!

    gentle hugs,

    K
  13. RedHeadEMT

    RedHeadEMT New Member

    Thank you SO much for sharing your experience and life story. I think that you are an extraordinary woman and someone that we can all learn something from. I am always amazed at how someone so afflicted with medical issues, can still work at such a demanding career...

    I'm sorry that your doc wasn't very diligent in ensuring that your liver would be ok, especially seeing that you were so upfront with her on what you were taking. Hm. Sometimes, I wonder if some docs didn't take the Hypocratic Oath or the TOTAL HYPOCRACY Oath.

    Anyways, you take good care of yourself. I hope to run into you soon again.

    gentl hugs,

    K


    PS-Your daughter is ADORABLE!
  14. kjfms

    kjfms Member

    You're welcome I have a lot of great sites in my favorites which I have used for years oh you probably know most of them -- AMA, AHIMA, CDC, FDA, WHO, CMS, WebMD, MedScape, AACE, MerckSource, Advance for HIM, etc... both are work related and for my personal research on my own health.

    I agree with you we do have to be our own advocates I often toss in interesting information which I know or find when I think it may help someone here.

    Thank you -- I just put that picture in -- it is the Glade Creek Grist Mill in Fayette County, WV at the Babcock State Park which is just down the road a piece (as we say in WV...LOL)from me. I am very lucky I live in a beautiful area.

    Yes this has been my philosophy since I began working in the medical field several years ago and having my eyes opened -- as it were.

    I am not saying it is all bad -- there are some professionals in the field who are actually there for the patients as it should but then there are some who...

    Oh well that is with any profession but it is really hard to keep the faith at times.

    Best of luck on getting your PA. I know how it is to have illness to interfere with plans. I really admire your goals it sounds like you have been working hard [I took a peek at you profile :)] I do hope you get to return to a fairly "normal" kind of life soon.

    I have had to postpone an important certification exam for the Certified Coding Specialist (CCS) which is given by the American Health Information Management Association (AHIMA) due to a pituitary macroadenoma.

    I only hope it will not be too long because it cost $385.00 and now only have around a 5 month period in which to take it and I am getting more ill...aarrgghhh!!!

    This is causing a lot of problems and some major flaring of my FMS not to mention my mind is not working too well and I just do not trust it at the moment for this exam...

    Anyway -- Happy New Year to ya,

    Karen :)
  15. RedHeadEMT

    RedHeadEMT New Member

    Hi Karen,

    I also LOVE webMD, AMA, Medscape, and I also visit Wikipedia and Drugdigest.com a lot.

    So you do medical coding, if I'm correct? That's challenging working, too. Have you found it extra difficut with your FMS symptoms?

    I live in the San Francisco Bay and I adore it here, but my husband's family is from New York and Georgia, so we have many ties to the east coast; we've always wanted to visit. Now I see that I should put WV on my list of places to see! It's beautiful and looks very greeeen, which we love!

    Thanks for the well wishes on my PA goal. I'm workin at it, even if it is at a snail's pace. I know that I will get there. Ya know, if I was able to finish my degree in 4.5 years, at the top of my class at that, get my EMT certification, and get a job almost immediately in an ambulance (not to mention working 30-50+ hrs/wk, including 24hr shifts!!), I think that I can do ANYTHING.

    I also wish YOU the very best of luck with your CCS cert exam; cert exams are always tough and never fun, but I found for all my tough exams, FLASH CARDS are the key. I swear by them, I live with them for days to weeks before any exam and I usually do VERY well. I have a feeling that you will do very well and that you will be able to get it done within the 5 month window!!!

    Anyway -- Happy New Year to YOU, too, Karen!

    K
  16. kjfms

    kjfms Member

    Thanks.

    Love flash cards couldn't have gotten through school without them...LOL

    The problem it my mind at the moment and it is getting worse. I did not proof read very well. I meant to say I am having these problems due to a pituitary tumor and that is why I am concern about the time frame.

    I just don't know what the physician's are going to do yet. I found out just before the holidays and have been having a rough time dealing with it.

    Not ask for sympathy just getting it off my chest again -- everyone here has already been so nice and are probably very sick of me and my tumor.

    Oh I like Drugdigest too great site.

    Yes I have over 2 years under my belt in hospital coding but right now I am doing some transcription part time but I applied for a job just last week that involves both coding and transcription but now I am in fear that I'll not be able to keep up due to illness.

    I am just no sure what to do.

    I hope I did not mess up this post like I did the last one.


    Thanks again,

    Karen :)
  17. abcanada

    abcanada New Member

    I recently went to a Pain Management Clinic and they wanted to take me off Percocet and put me on staight oxycodone. I take the daily maximum dose 4000mg for a long time now, and am getting concerned. They plan to switch me after Christmas. Take Care Laura