Tuesday, April 29, 2014

Confusion


This July Richard and I will have been married ten years.  This August will mark nine years since we started trying to have a baby.  I never imagined this is where I would be nine years later…childless. We tried on our own at first.  After about six months, our OBGYN put me on Clomid.  I had very little response, so he did a sperm test on Richard.  He finally told me that he was referring us to a specialist in Birmingham.  Several tests later, we were ready for our first cycle. My response was not great, and the day of the IUI they discovered that something had drastically impacted Richard’s sperm count in a very short amount of time.  The doctor said that my chances didn’t look good, but sometimes miracles happen, so she went ahead with the IUI.  Of course, it didn’t work. 

Richard went to see a doctor who discovered that he had a varicose vein and had to have surgery…a varicocelectomy.  He went to specialists, and we waited.  The stress was so much on me that I said that we should just take a break, so we took a break for five years.  Knowing that we were going to have to spend lots of money on something that wasn’t definite was hard for me to wrap my brain around.  I took time to study God’s word and read and memorize every piece of scripture that I could find that pertained to our situation.  I started a Bible study/support group at church called Hannah’s Hope.  I wanted to reach out to other women who were going through the same thing.  I met some great women, increased my faith, and drew closer to God. It also gave me time to get my mind off everything.  God could make me pregnant without medicine.  He’s the great physician, so we stopped seeing doctors and tried on our own for five years, but it didn’t work.  I knew we needed to go back to the doctor, but I couldn’t bring myself to face it.  Finally, a dear friend gave us $500 and told us to make an appointment, so we did.

We started that first summer and did two IUI’s.  It was all we could do because I just couldn’t miss work.  We kept toying around with my meds, but neither response was ideal, and the IUI’s didn’t work.  Nine months later, we decided to try two more IUI’s.  We tried different meds, but my response wasn’t ideal.  Neither IUI worked.  It was at that point that we decided that I would have to continue throughout the year.  We had to be more aggressive.  I had recently turned thirty-six, and time wasn’t on my side.  The doctor and I decided that he should do exploratory surgery to make sure there wasn’t anything going on internally.  I had my surgery in October.  There were no problems.  I had a couple of polyps and such a mild case of endometriosis that it was barely stage I.  He lasered out what he found and cleaned me up.  He said that there was nothing going on internally that would keep me from conceiving. 

I was ready for my first treatment in November.  When I went in for my ultrasound, the nurse found a 4 cm cyst.  I had to take birth control pills for a month.  I went in at the beginning of January for my next treatment.  A sweet friend had sold me two boxes of Gonil F that she had leftover from her treatments.  It just felt like a God thing, medicine was placed in my lap.  However, it didn’t work.  Since the beginning of our journey, I’ve tried to keep a positive outlook on things, keeping the faith, but for some reason, I felt very depressed after that failed IUI.  I didn’t understand, and I felt so certain it would work, yet I had the worse response I’ve ever had. I’m resilient, so I bounced back after a couple of weeks, ready to go through it all over again. 

Then the greatest miracle of all happened.  A very dear friend from Dothan gave me all of her leftover meds from her previous cycles.  She gave me thousands of dollars worth of meds.  What a God thing!  I was so excited.  God had truly blessed us.  I went in for my ultrasound to get ready for my next cycle (it was on my birthday), and I had another cyst, almost as large as the last one.  I had to wait again.  This time I decided to stay on the birth control for a couple of extra weeks so I could visit with my family during Spring Break. After Spring Break, I went in for my ultrasound.  I still had a cyst, but it was too small to be concerned about.  I was ready for my cycle.  I just knew that this would be the one.  God had sent that medicine to me through a sweet friend.  I had the best response I’ve ever had.  It was a God thing. I just knew that this was the time I would finally get pregnant.  It was a done deal. 

After nine years and approximately 108 failed pregnancy attempts, you’d think that I would be used to it.  It’s hard to tell if you are pregnant while being on all these meds.  The progesterone pills you take mimic pregnancy symptoms/period symptoms, the typical stuff like cramping, bloating, sore boobs.  So, on Thursday, April 24th, I knew something was wrong when I woke up that day and all symptoms were gone and zits covered my face.  Then I began spotting like I do every single time.  It was at that moment that I knew I wasn’t pregnant, just like all the other times. That night, I lay in bed crying.  I didn’t want Richard to know, so I hid it from him.  He kept asking me why my nose was stopped up, but he had no clue that I was crying and hurting and angry.

Depression is not what I felt this time.  I was angry at God.  I felt let down.  Why? Why did you let me get my hopes up?  Why did you send medicine to me only for it not to work?  Why did you let me have my best results ever only to find out that I’m not pregnant?  Why does your word say that with faith the size of a mustard seed, you can move mountains?  I have faith, at least mustard-size faith.  Why does your word say that nothing is impossible with God, yet this seems to be an impossible feat?  Why did you say you would give me the desires of my heart?  Why? WHY? WHY!!!!!! Do you hear my prayers?  Do you hear the people praying for me?  Do you even care?

I know those sound like horribly selfish things to say, but I am human.  Even though I know God hears my prayers and cares, I was hurting…am hurting.  I was ready to quit and throw in the towel.  Richard and I sat and talked about what to do.  The money is running out.  The stress and frustration are unbearable.  Maybe we should just quit. 

As I scanned through Twitter and Facebook, it seemed that every post I saw was aimed at me:  “Just because you can’t see it yet, doesn’t mean it’s not on its way.”  “Get your fire back.  It’s not over until God says it’s over.  Start believing again.  Start dreaming again.  Start pursuing what God put in your heart.”  Okay, God, I get your point.  It’s not time for me to give up.  Every single time I think it’s time to quit, something tells me not to.

I’m not angry at God anymore, but I still don’t understand.  But, in the wise words of Steven Curtis Chapman, “God is God and I am not.” I don’t always get his plan.  I don’t understand why he has allowed us to go through this.  All I know is that I have to keep on going and trusting him.  There has to be some reason for all of this, and one day soon I will know that reason.  Sometimes I get depressed, sometimes I get angry with God, sometimes I question God, sometimes I feel like I’m losing my faith in God; but don’t worry.   There is nothing wrong with my relationship with Christ.  I am human, but in my heart of hearts, I hear the voice of reason (the Holy Spirit), and I snap out of my funk.  

It is no secret that my insurance is maxed out, no more drug coverage.  I can do one more IUI, and then insurance won’t cover those anymore.  They only cover eight of them.  Richard and I can afford to do about three more treatments and that is it.  After that, I don’t know what we will do.  Maybe we can find some money or maybe we’ll have to take out a loan and try to adopt, if that’s even an option.  I don’t know if you can get a loan for that.  I don’t know anymore.  Right now I’m stressed about the storm damage to my house and figuring out how to pay the deductible and worried about what insurance will or will not pay for.  Trying to figure out how to pay for that and how to pay for fertility treatments at the same time is a nightmare.

Here I go again.  I’ll spend the month of May on birth control, trying to shrink that stupid cyst that won’t go away.  I’ll repeat my yearly tests, the ones that test me for every disease known to man.  Then I’ll meet with the doctor and proceed with the next plan, which will probably include outrageously expensive meds.  It’s just another waiting game.

There comes a point when you’ve said all that you can say to God.  There is nothing left.  I’ve prayed every prayer.  I’ve walked in faith.  I’ve begged and pleaded.  He knows.  Just pray for us.  There has to be something good just around the corner.  There just has to be.

Friday, April 4, 2014

The Waiting Game

I've been quiet for a while, not because anything is particularly wrong. I've
just been very busy, so let me take this time to get you all caught up.  I went to the doctor on my
birthday, February 21st, excited and ready to start my next cycle. When they did
my ultrasound, they found another 4cm cyst. I didn't even get upset. I just
shook my head and left, prepared to wait it out again. They put me on birth
control in the hopes of shrinking the cyst.

I've been playing the waiting game. I was on birth control for about five/six weeks
so I could get through Spring Break without having to go to the doctor, and that was probably the greatest decision I've made.  I needed a break.  I needed to get refreshed and rejuvenated, and seeing my family and going to the beach was just what I needed. Sometimes you just have to step away from it all for just a while. 

 I had to get the birth control out of my system and start my period before I could go back to the doctor, so I finally went back to the doctor today to do my ultrasound. Everything was fine; however, I still have a very small cyst on my right ovary. It just doesn't seem to want to go away, but it was so small that it doesn't matter. I can still start my meds and continue on with my next cycle.

I'm not going to get into specific dates, just because I would like to have some type of privacy.  I don't want people to ask me when I'm taking my pregnancy test and if I'm pregnant.  Sharing that news with everyone and people actually being surprised would be an absolute thrill for me, so I don't want to ruin that by telling people too much, but just know that I will be starting a new cycle of meds this month and will then have an IUI. I will have to wait two weeks and take a pregnancy test.

I really need your prayers. Pray specifically that I respond very well to this medicine, and thank God for replenishing my eggs when you pray. Pray for me to have a stress-free month. It is no secret that I have been really stressed out this year. Stress is not helpful when trying to get pregnant. Pray that things will go smoothly for me at work. Also, please pray that I will stop having cysts. Most importantly, pray that I get pregnant this time, and thank God for answering my prayers. 

I have peace.  I always do.  I know that God is in control.  He wouldn't bring me this far to leave me empty handed.  He has placed people in our life who have blessed us financially, people who have blessed us with thousands of dollars in medicine, and people who have prayed for us without end.  There is a reason for all of this.  I don't always understand why we've had to deal with infertility, but one day all the puzzle pieces will fit, and I will see God's perfect plan and how it all came together.

Thanks for your prayers and support,

Shatisa

Saturday, February 8, 2014

I Can See Clearly Now. The Rain Is Gone.

In the two weeks since my last blog, things have changed.  I was really feeling down, but I have been reminded of God's love for me in a tremendous way. Countless people have sent me cards, texts, messages, and have even approached me with a hug telling me how they've been praying for me. I can't express to you how much that means to me.

As I sat in the doctor's office this past week, I noticed a woman who is there often when I am. She was crying and is always crying every time I see her there. I felt compassion for her, because I know what she feels like, but I also hurt for her because I could see the hopelessness in her eyes. Sure, I have days when I'm down and depressed, but I've never lost hope. I can't imagine going through infertility without knowing Christ or not having faith or hope in him. I'm not saying that she doesn't know Christ. I'm just saying that I was reminded of that when I looked at her. Without faith in God's ability and the hope that things will get better and I will be pregnant, I couldn't make it.

Everywhere I look I see reminders of God's goodness. Richard's car broke down a couple of days after my last blog. The old adage "When it rains, it pours" was running through my head. The repair was only $1100, which might not be too much to some, but to those who are spending thousands on medical treatments, it can be a huge burden. But, God made a way for us to pay for it. When we started back doing fertility treatments, we were fundraising pretty heavily. We raised around $1,000, which was a huge blessing, but the money stopped coming in. However, as I stepped back and took a look, I realized that God was answering my prayers but in a different way than I had expected. First, we didn't have to spend nearly as much money on our last treatment because a friend sold us her leftover meds for $200. Recently, another friend of mine donated all of her leftover meds. We are talking about six boxes of Follistim, not to mention the progesterone, Menopure, and supplements she sent me as well. She saved us over a thousand dollars, and my parents are coming to see me in a little over a week, so they can bring me the meds. My eyes were opened, and I realized that he hears my prayers and is answering them.

Interestingly enough, the medicine she donated to me is exactly what my doctor decided to put me on for this next round. Coincidence? I think not. We discussed my previous cycles and talked about the best way to make my body respond. He joked that my ovaries don't like him. He also talked about how I just don't have as many eggs as a 36 year old should have. Some people might have been upset by that news, but I just kept thinking, "Is that all you've got? That's a piece of cake for God. I'll ask God to replenish my eggs, and that's that. I mean, come on! He turned water into wine, made the blind to see, raised the dead. This is nothing." I'm not phased by that at all. Don't worry though. The doctor is not ready to throw in the towel. He's just trying different concoctions of medicine that will make my ovaries respond. There are women a lot older than I am with much fewer eggs still getting pregnant through fertility treatments.

I will try another round at the end of the month. Pray that my new meds will work and I will have a great response. Pray for eggs, eggs, and more eggs. Hold on! Don't go overboard. I don't need sextuplets. I'm just aiming for one, possibly two babies. I just need it to work. I need good news, no setbacks. Please pray for my sweet friend who donated her meds to me. She finds out next week if she is pregnant, and I pray that God blesses her just like she blessed us.

Thank you for all of your prayers and support. They mean the world to us. When you pray for us, don't forget to praise God for what he is doing in our lives. He wouldn't bring us this far to leave us empty handed. There is something wonderful just around the bend.

Sunday, January 26, 2014

Transparency

This has been a really rough semester. We did two failed cycles this summer and decided to meet with the doctor in September to come up with a plan.  He agreed that exploratory surgery would be a great option for me.  I had my surgery in October, and I got a good report.  There was absolutely nothing in there that would keep me from conceiving.  He cleaned up a few things, and I was ready to go with our first cycle since August.  When November rolled around, I went in for my baseline ultrasound to check and make sure everything was okay, and they discovered a large 4 cm cyst.  That meant that I had to wait another month to try a cycle. 

I finally was able to do one at the beginning of January.  We were very optimistic and hopeful, because the doctor was trying to be more aggressive.  We bought some medicine from a friend who had two leftover (unused) boxes of our medicine that she sold to us at a very cheap price. The doctor put me on the highest dosage of straight injectable drugs that I've ever taken.  In the past, I've taken straight injectable drugs at a lower dosage and didn't do well. Then we started mixing my drugs with a pill called Femara.  I actually was doing fairly well on it.  This time we decided to push my body and take a much higher dosage with no Femara.  I was devastated to find out that I only produced one mature follicle on the drugs. 

Many of you may not understand how these drugs work.  They stimulate your follicles.  Follicles have to be a certain size to be considered mature.  If they are 1.8 or higher in size, they are considered mature and able to produce a mature egg.  That doesn't ensure that it will produce a mature egg.  It just means that it can.  These drugs cause you to produce more follicles.  The more follicles, the better chance you have at producing one or more mature eggs. I had about five follicles.  All were 1.4 or smaller.  I only had one that was 1.8 and mature.  That is an extremely bad response. My last two cycles, when I was taking Femara, I had at least three mature follicles.  I was expecting to have several mature follicles with such a high dosage of drugs.  That was not the case. 

Now that you've had your tutorial on human reproductive technology, let me tell you where I am now.  I'm not very good at talking and communicating verbally, but I like to write.  I communicate better when I write. I've just gone through the horrible two-week wait.  My pregnancy test is Tuesday.  They will make me go and take the test even though I already know I'm not pregnant.  I've been spotting for days, and I finally started my period today, cramps and all.  And before you all try to tell me that there is a chance that I'm pregnant, I'm not.  I'm positive.  I know my body.  When you go through these treatments, you know everything about your body. I have an appointment with the doctor on Feb. 6th to discuss my treatment options and which medication concoction he would like to try next.

The bottom line is this:  I am not doing well.  I normally bounce back very well and am positive and full of hope and faith, but this time, I am not.  I have been in a deep funk, maybe even depression, since I found out that my response was so horrible.  I can't seem to get over it.  I know it's the devil. I know I have to have faith and trust God.  I talked to a friend the other day, one of the few who actually gets what I'm going through.  She had a great analogy for how I'm feeling:  "I used to describe it as feeling like I was pushing a bus full of people uphill alone."  That's exactly what it feels like.  I'm worn down.  I'm tired, tired of disappointment.  It's a deep emotional tired, where you have nothing left to pray about and nothing left to say to God.  It's all been said. I'm all prayed out. 

Not many people get what I'm talking about.  Consider yourself blessed.  I really don't want to hear the cliche responses.  I know that you mean well.  It's easy for people to say those things when your faith isn't being tested.  Not everyone has been through times so hard they just break you down.  Sometimes your world stops and life brings you to your knees.  People who haven't gone through life-altering circumstances or depression or disappointment on such an awful level just don't get how to console me. As my friend told me, "You just reach the point where there are no words of comfort or advice that anyone could offer that bring you one ounce of peace."

I don't need a lecture on faith.  I've memorized every scripture that pertains to my situation.  I know what his word says.  It doesn't mean that I don't have faith.  I'm just going through a hard time right now.  Please don't be like Job's so-called friends in the Bible and point out all the things I'm doing wrong.  Instead, right now, I need friends like the ones in the story of the paraplegic man in the Bible, ones who lowered their friend through the roof and put him at the feet of Jesus.  I need friends who are willing to stand in the gap for me and pray.  I don't have much left right now.

Please try and understand what I'm going through.  I'm not bubbly and happy right now.  I'm quiet most days. I'm trying my hardest.  I want to cry and give up and throw in the towel, but I know that isn't what I need to do. I need friends who understand.  I need to have some fun and get all of this off my mind. I normally just focus all of my attention on school.  I stay in my room and work and come home and work.  Work keeps my mind off things somewhat.  However, right now, work isn't helping much either.  It seems to be making it worse.  In the wise words of Shakespeare, "with what I most enjoy contented least."  That's how I feel.  I'm not content with anything at the moment.

I am going to skip a cycle this time and wait until the end of February.  I just need a break so I can get caught up at school.  I really don't need to miss right now.  Plus, I need to meet with the doctor, so I really don't feel like rushing around to get in another cycle.  I'll try again at the end of the month once we've established a game plan. 

Thanks for your prayers and understanding.

Shatisa

Thursday, December 5, 2013

Great Post-Op

Now that I've completely healed from my surgery, I'm ready to start treatments. I was supposed to start my first round the week of Thanksgiving. I had everything planned, medicine and all, and I was ready to go. I got to the doctor's office to do my baselines and have an ultrasound, and they found a 4cm cyst on my ovary. Great!! That's really all I could say. You can't do treatments with a large cyst. They told me I'd have to wait another month. I was so disappointed. I cried all the way home. They had no explanation for why I had a cyst. I had surgery the month before, so there were no drugs in my system to cause a cyst. It just popped up on its own. I've never had cysts, so it was a bit odd. To top it off, they made me take birth control pills to shrink it, which totally defeats the purpose.

Today was my post-op appointment. Because if you remember, I missed my appointment on November 5th. I somehow got in my head that the appt. was the 22nd. Then they couldn't get me in until today. So I had surgery on October 25th and couldn't see the doctor again until December 5th. I think that's one reason why my failed cycle last month upset me so much. I had two setbacks in a row. Anyway, my appt. went really well. We talked about my surgery, and he reassured me that he found absolutely nothing to be concerned about. He said he only found two small lesions of endometriosis, so it was very minor, and the polyps were benign.

We had a great conversation, and I told my doctor that if he thought IVF was the answer, I would prepare myself for it and accept it, but if he thought there was hope through IUI, I wanted to continue. He assured me that he's not ready for IVF yet. He reminded me that I'm not old. I always feel like a clock is ticking furiously, but he said, "You're only 36. You aren't old yet. If you were older, we might try some other options." I know 36 seems older to most, but in the world of fertility clinics that see people in their forties, I'm still young.

He said that we've been so careful with my treatments, not wanting to cause multiples or a risky pregnancy, but he agreed that now is the time to get aggressive. I agreed and mentioned to him that a friend recently said to me, "God already knows how many children he is going to give you, so just go for it." That statement resonated with me and was just a reminder that God's got this under control. He went on to say that he doesn't know what my threshold is or how many eggs I can actually produce because we've never pushed my limits. And, IVF couldn't even be an option until we discover my limits.  He said that there is nothing wrong with me internally, and looking back at my previous cycles, I've responded very well to the drugs. I produce eggs. It's just that I have to wait for that perfect one, and according to him, increasing my dosage only heightens my chance of producing more eggs and heightens my chance of a pregnancy.

With that being said, I will begin taking some supplements that can help with egg production. It's a cocktail of hormones and vitamins. I'll take those for the next month. When I come back from Christmas, I will start my next cycle, and I will be taking a high dosage of straight injectable drugs. Pray I don't have quintuplets or something. Also, if I act weird over the course of the next two months, just remember that I have multiple drugs pumping through my body, and my hormones are on a roller coaster ride.

It's all good though. I'm healthy and blessed, and God is in control. Richard and I will be parents very soon. That I can promise you. Please continue to keep us both in your prayers. I've included the link to our fundraising site. All of this costs quite a bit of money. God is faithful and always makes a way. Thanks for all of your love and support http://www.youcaring.com/medical-fundraiser/our-journey-to-parenthood/50742




Saturday, November 16, 2013

Healthy and Blessed

Most of you know that I had exploratory surgery on October 25th. I wanted to do that before we continued with any treatments. I appreciate all of your prayers and kind words. My surgery went really well. The doctor didn't find much at all, but that was exactly what I prayed for. He found a little bit of endometriosis. I know most people freak when they hear ENDOMETRIOSIS. However, it's really very common, and a lot of women have a little bit, and it never impacts their ability to conceive at all. It's the more severe cases that cause issues. It is rated on a scale of 1-4. Mine was barely stage one, so it's really no big deal. He lasered it all out.  He also did a D&C to remove some excess endometrial tissue. He found a few polyps and removed those as well. He said that it was all very common and nothing to worry about and that he was just mainly cleaning things up.

Now that all of that has been done and we know all my plumbing works properly, we will be proceeding with fertility treatments. Within the next month, we will do another round of treatments with an increased dosage of medicine. It's hard to do treatments during the holidays, but you do what you have to do. I would appreciate your prayers that my treatments won't impact my holiday travels. You all know that my family is down in Dothan, and I really don't want to cut my visits short.

I like to keep you all updated, because so many of you are praying for us. Thank you to all who have contributed towards our fundraising efforts. Thanks to you, we have been able to pay off almost all of our treatments from the summer. We can start anew this next month.

We still covet your prayers. Please pray that the treatments work, and we will have our baby soon. Please pray that we will be able to afford the treatments. God is so good, and I know he has his arms wrapped around us. I know our baby is on its way. Also pray that I won't have to miss so much work. It is so hard to plan for subs, and the amount of work I have to do after being absent is stressful. I found that out firsthand after missing a week of work because of my surgery. Plus, teachers don't have tons of sick days, and I need mine for maternity leave.

Thanks again for your love and support.

Shatisa

Thursday, September 19, 2013

Feeling Blessed

I know that I've been horrible about updating my blog, but it's been a little hectic around here. I found out August 27th that I wasn't pregnant, so even though both cycles were the best ones I've ever had, I failed to achieve pregnancy. I would've posted a blog, but honestly, I've been so busy adjusting to the new school year and this ridiculous eight-period day. It has truly been a nightmare and very stressful. The good news is that it's kept my mind off all this fertility stuff. Plus, I wanted to wait until I met with our doctor before I posted any updates.

Richard and I had to take a day off today to have a video conference. That may not seem like something you would need to take a day off for, but I always end up waiting forever to see the doctor, and today was no exception. They were running behind as usual. We had a nice appointment. Dr. Allemand said that I responded the best that I ever have. They definitely found the perfect dose and combination of meds. He literally said that he was baffled as to why I'm not pregnant. They've gone down the list checking for every possible reason, but I don't have any conditions.

He gave us two options. First, we can do a cycle with a really high dose of meds. However, I've tried to avoid that because of the increased chances of multiples. Second, he said we could do exploratory surgery to rule out anything internal that hasn't shown up in tests.  I chose the second option. I just feel like we should rule out everything before we spend more money. I told him about a sweet friend who has two unused boxes of our meds and offered to sell them to me at a very low price, which is truly a blessing. So, if he decides after the surgery that he still wants to do an increased dosage, we have the meds.

No one wants to have surgery. I hate missing school with all that is within me, but it is what it is. I will have surgery in October. I don't know the dates yet. The surgical nurse should call sometime this week or next to schedule it. I will have it done at Brookwood Medical Center in Birmingham. It will be outpatient surgery, and I will be able to go home that evening. He said it normally takes 4-5 days to recover, depending on what has to be done. If he finds excessive endometrial tissue, he will do a D&C and remove it, and if he finds any endometriosis, he will go ahead and laser it. Those procedures could cause recovery to be a little longer. He will do laparoscopy and hysteroscopy, which are very common.

Honestly, I'm fine with it. I said we would be aggressive this year and do whatever we have to do to get pregnant, and that is exactly what we are doing. God is in control, and I know I'm having a baby. I was reminded recently that God loves me, I will have a baby sooner than I think, and God wants my life and my story to be a blessing and a testimony for him and his glory. I truly believe those things.

God has already blessed us. Richard got an extra part-time job, and I started teaching voice/piano lessons from home. Those extra jobs have helped out tremendously. A sweet friend offered us her unused meds for only $200. You have no idea how much that saves us. And, despite having to wait today, they felt sorry for the wait and didn't charge us. Those are all great financial blessings. Fertility treatments are expensive, but God is making a way.

Thank you all for your prayers and kind words. It means so much to us. Continue to pray for us. Pray that the surgery goes smoothly and there are no serious issues.