A poll of some sorts...do you go for your "annual"?

[Melissa in Australia]

for a pap smear every 2-4 years

 

I had my first mammogram a few months back. I plan to have another one next year as I can still feel the lump

 

 

[Audrey]

I go every year, but I live in Canada and that is covered for me.  I feel the preventative care and the peace of mind is worth the few moments of discomfort for the tests.

 

ETA:  For tests: every year I get the blood, urine and stool tests. The pap smear is every 2 years and I'm not at the age recommended for mammograms yet, but I'll have those on whatever schedule is recommended.

[TeacherZee]

Recommendation here is for every 2-3 years so that is what I do :)

[creekland]

The problem with not wanting to be treated for anything is that if you ever do get any kind of disease, you'll end up being treated for it anyway, because you won't want to suffer and you won't want to die. But the treatment is usually a lot easier when a problem is discovered at an early stage, rather than when you're already very sick.

 

 

 

For many people - probably a majority - this is most likely true, but there are some of us where it doesn't fit.

 

I am far, far, far more likely to take a "Bucket List" stance than a "treat at all costs - or even moderate measures" stance.  Cost isn't even a factor here as it ends up being free.  I'm just not afraid of death (even at an early age) and would actually prefer it to growing old with "issues."  I've seen far too many older folks with a quality of life that doesn't interest me.  I'm happy for them if they want it, but I don't want it for myself.  All that is involved with many treatments isn't all that appealing either.

 

So, not knowing and enjoying life while one can IS my preference.  When the disease (or whatever) gets bad enough that one knows something is wrong, then doing what one can (Bucket List style) while letting the disease (hopefully) end things more quickly "fits" me better.

 

I am actually dealing with this now - sort of - not with "annuals," but with a benign brain tumor they found 2 months ago.  It affects my eyesight and some days I get a bit of pressure with an occasional headache.  In reality?  It doesn't affect much of life and I'm ok with it.  My preference would be to let it stay and enjoy life...  Almost everyone else around me disagrees... so... it's being treated with radiation.  Perhaps that will get rid of it.  Perhaps not.  It could make things worse.  A close friend/co-worker had a similar thing happen with her mom.  The radiation stopped the tumor, but very soon afterward she got leukemia.  Last year she died from that - and it wasn't pretty.  She didn't get extra years - she got worse years (18 months with leukemia).  My co-worker firmly believes it would have been better to leave the tumor alone.

 

Sometimes I really wonder why I'm bowing to peer pressure to treat mine...  I end up reminding myself that I'm not afraid to die and que sera, sera.  Treating it is appeasing my relatives and friends.  However, should "I" end up with leukemia (or whatever) from it, it's not getting treated...  Instead, I'll enjoy whatever time I can until the end.  If the treatment ends up working and things improve - then others will have been right, but it's not a certain thing.  It's a gamble.

 

And in the meantime I regret making that first appt to find out what was wrong with my eyesight... it's just not that bad comparatively.  Catching it earlier would not have changed anything.  In the last two months it hasn't grown or changed significantly.  Knowing about it has only scared the bejeebers out of my family/friends and changed life in that manner - not what I consider "good" changes except, perhaps, to get some to stop and smell the roses more rather than living life like it has no end.

 

IMO it's important to do what one can to stay healthy (exercise, eating reasonably well - while still allowing enjoyment of food, watching for signs of things that can be improved, keeping up on certain vaccs, etc), but when it comes to the major stuff, life is a gamble and what one opts to do with it 100% depends upon their preferences/mindset.  I have no desire to spend my "last" years (whenever they may be) in doctors offices and/or hospitals.  I'd rather hike/travel until I can't anymore, then perhaps check out wheelchair access to other places.  The most I might agree to would be pain meds.

 

To each our own.  The "trouble" comes when we believe the fallacy that all are like "us."

 

[MrsJewelsRae]

34 yrs old and between having my 3 kids (11, 9, 5), having endometriosis and PCOS, 3 miscarriages, and countless infertility appointments, tests and procedures I've seen a specialist far more often then once a year since I married at 20. Besides my female issues I also have severe asthma that I visit my doctor for regularly to renew prescriptions and because I usually end up sick enough to need an extra prescription for breathing issues.

[Guest]

No.

 

When I was dating, I was able to get STD tests done without having to see a doctor, which may not have been the best financial decision in the world, but I have enough problems with eye doctors and dentists without some random stranger deciding to "put me on the pill" before giving me permission to have an HIV test.

 

I'm 50ish and celibate at the moment, but still bleeding irregularly.

[Jean in Newcastle]

I go every year, but I live in Canada and that is covered for me.  I feel the preventative care and the peace of mind is worth the few moments of discomfort for the tests.

 

ETA:  For tests: every year I get the blood, urine and stool tests. The pap smear is every 2 years and I'm not at the age recommended for mammograms yet, but I'll have those on whatever schedule is recommended.

It is covered for many people in the US too.  I don't have to pay for mine.  It is 100% covered under my insurance.  (Pre ACA and I think post ACA too.)

[G5052]

Covered 100%, and I've always found it valuable.  Our doctor is very well-educated on alternative medicine, and has really helped us both figure out approaches to some of our middle-age issues.  I also always get a mammogram.

[Cindy in FL.]

Usually I go every year. Now with the new guidelines I will beat a mammogram every year and the rest every 2-3 years.

[marbel]

I have yearly mammograms; regardless of changing recommendations; since I had my kids late in life (over 40 for both) I am considered higher risk for breast cancer though there is no history in my family.  I get paps every few years, not often.  I have a pelvic exam every year as that is one way ovarian cancer may be detected; again I am in higher-risk because of late pregnancies (though being on BCP for many years may have given protection against that).  

 

 

[dancer67]

I always wondered that myself. Why such a difference between countries?

[AlmiraGulch]

I used to go every year.  Actually, sometimes twice a year.  I had bad paps basically every time they did them.  Colposcopy after colposcopy, year after year.  

 

Then I had a hysterectomy.

 

No more uterus, no more cervix, no more problems.  

 

I should still go, but I haven't been for an annual since they removed the offending part late in 2011.  I should probably go this year. 

[Stratford]

Yearly.  Also have a normal physical yearly.  

[Jean in Newcastle]

I don't mean I don't want to be treated for a serious disease.  I mean I don't want to take cholesterol lowing drugs or blood pressure pills, or whatever other pills they give for stuff like that.  So if I go for blood work and they tell my cholesterol is elevated, I'm not going to take pills for it.  So why bother going for something like that?

 

 

Because it allows you to adjust your diet in order to help manage both your cholesterol and your blood pressure.  It allows you to do these things before you have a heart attack, which is not painless and is not always fatal and can severely impact your life.  

[SweetMissMagnolia]

yea I do go every year....Every year that I have had insurance that covered it,I have gone for an annual "check up" since I was about 19 or so.....

[Jean in Newcastle]

Well and adjust my diet.  What is there to adjust?  I think I'm eating generally very healthfully.  I wouldn't know what to adjust.  I'm not willing to go low fat and high carb.  The diabetic diet they put my mother on probably made her diabetes worse (hopefully they aren't recommending the same dumb stuff these days).

 

Not to mention doctors know very little about stuff like nutrition.  If I have elevated cholesterol they are going to write me a prescription before telling me what to eat.

You don't have to fill a prescription just because they give it to you.  I take the information that comes from good scientific lab work and then I do my own research.  I monitor my own blood sugar levels and tweak my diet accordingly.  But it is helpful to have the big picture provided by the lab.  I need to do some research on cholesterol levels since mine were  high for the first time in my life.  Doctors and lab tests are resources.  Right now one of my doctors is a dud resource so I'm going to look for a better one, but the good ones are worth their weight in gold.  

[TrixieB]

I go for a general physical & cholesterol testing every year (required by our insurance to get a discount on the premiums).  My PCP does a pelvic exam every year due to family history of ovarian cancer.

[Word Nerd]

I don't go every year, but my doctor likes to do them yearly for the breast check and general checkup even though she doesn't do a pelvic exam every year unless there are problems.

[Lolly]

Because it allows you to adjust your diet in order to help manage both your cholesterol and your blood pressure.  It allows you to do these things before you have a heart attack, which is not painless and is not always fatal and can severely impact your life.  

 

Blood pressure is easy to monitor on your own. Cholesterol levels can be obtained for free by donating blood. It isn't the in depth test, but it is enough to let you know to alter your diet.

[Jean in Newcastle]

Blood pressure is easy to monitor on your own. Cholesterol levels can be obtained for free by donating blood. It isn't the in depth test, but it is enough to let you know to alter your diet.

I agree.  I was more responding to the idea that it wasn't worth even finding out about those things.  I take responsibility for my own health and am very DIY about it - when I can.  Unfortunately my body is a bit too complicated to do it all on my own.  

[Crimson Wife]

I was going every year but this last interval was either 1.5 or 2.5 years (I remember the month but am not sure of the year). My new gyn says that she wants to do an exam every year but the pap will be only every 3rd year. It's considered preventative care so no deductible or co-pay under Obamacare rules. The biggest issue for me will be scheduling logistics (that's why I had put the last one off for so long).

[SKL]

No.  I don't have a "lady doctor."  I went for a PAP one time and ended up with a false positive, so I had to go again for no good reason.  It was so unpleasant and I'm not sure those exams don't actually increase the likelihood of cancer.  I don't know when/if I'll ever go back.

 

By the way, check before giving/following advice regarding annual mammograms.  My insurance company stopped recommending routine mammograms as they now suspect mammograms might increase the incidence of cancer.

[SKL]

My mother went to her exams faithfully.  In fact, she was constantly at the doctors.  They didn't find it until it was too late.  If they find it as a result of a regular exam that would be some serious luck.

 

My mom practically lived at the doctor's because of her many symptoms, but they never thought to schedule a colonoscopy.  My sister told my mom she needed one and only then did it happen.  My mom had advanced colon cancer.  Thankfully she is cancer-free now.  If it had been left up to the doctors, I'd be talking about her in past tense.  :/

 

[Audrey]

It is covered for many people in the US too.  I don't have to pay for mine.  It is 100% covered under my insurance.  (Pre ACA and I think post ACA too.)

 

I realise that, Jean, but when *I* say it's covered, it's because it is covered for everyone and no one is buying extra insurance and paying deductibles and premiums to get their annual exam here.

[Catwoman]

My mom practically lived at the doctor's because of her many symptoms, but they never thought to schedule a colonoscopy. My sister told my mom she needed one and only then did it happen. My mom had advanced colon cancer. Thankfully she is cancer-free now. If it had been left up to the doctors, I'd be talking about her in past tense. :/

 

I'm so glad your mom is OK. Cancer is so scary.

[Catwoman]

I do go for checkups. I just don't go every year. It's been awhile though. Growing up my mother took us to the doctor every other week. It got to the point where I am a nervous wreck when I go to a doctor because I've had so many pointless and painful things done to me.

If I'd had to go to the doctor that frequently when I was growing up, I think I'd have an incredible doctor-phobia as a result. I would probably never go unless I was in really bad shape!

[umsami]

I go every year because about 12-13 years ago I had an abnormal pap that led to a colposcopy and LEEP.   That's also why my DD will get the HPV vaccine. 

[creekland]

I realise that, Jean, but when *I* say it's covered, it's because it is covered for everyone and no one is buying extra insurance and paying deductibles and premiums to get their annual exam here.

 

You are paying extra taxes though - everyone pays somehow - the method is just different.  If we were in Canada, the difference in taxes we'd be paying (personal, business, and sales) would have a higher cost than our cost of our health share - and in neither case would I be "inspired" to go.  

 

I'm not complaining about the Canadian system BTW.  I'm in favor of "free" health care for all - worldwide, and I REALLY dislike our main "insurance" system here.  I'm just pointing out that it isn't really "free."  Some still pay more than others too.

 

If I'd had to go to the doctor that frequently when I was growing up, I think I'd have an incredible doctor-phobia as a result. I would probably never go unless I was in really bad shape!

 

I'm not sure if the number of times one visits a doctor really matters.  I think it's more of a personality thing.  The only times I remember going in my youth were for true needs (rare) or to update vaccs.  Most things were "fixed" at home.  Our neighbor was also our doctor, so visits were rather easy, but we still didn't go often.  I can only remember a couple of times.

[Laura Corin]

I get called in every two years - it used to be every year because I had an issue once, but as that was decades ago I'm now on the less frequent schedule.  I go in when called.

 

L

[Mrs Mungo]

You are paying extra taxes though - everyone pays somehow - the method is just different.  If we were in Canada, the difference in taxes we'd be paying (personal, business, and sales) would have a higher cost than our cost of our health share - and in neither case would I be "inspired" to go.

You might be interested in this article:

http://slumbuddy.wordpress.com/2012/03/01/comparison-of-canadian-and-us-federal-tax-rates-for-2011/

[happypamama]

I see my regular doctor every year or so, because I need to keep my asthma meds up to date. I also have gotten a breast exam and Pap smear about every three years for the last decade; I get them at my 6-week postpartum checkups. I am very low-risk for cervical cancer, so the recommendation is every few years, rather than every year. I'm also young enough that mammograms haven't been recommended, although again, I am very low-risk for breast cancer, although, of course, low doesn't mean no risk. I haven't decided what I will do when I am 40.

 

My midwives have done my Pap smears and breast exams, but I got the last couple done through my regular doctor, because I was seeing her anyway. If we don't have any more babies in two or three years, I'll probably get a Pap smear then. Now, I do have a heavy family history of diabetes, so my doctor suggested that we start diabetes testing for me next year (37).

[Soror]

I just went for my first in 6 yrs (multiple reasons why here), before that I was fairly close to yearly. I was so glad to get it done as I had felt worried that something could be wrong and I didn't know it. I plan to stick to the every 3 yrs that are recommended going forward.

[twoxcell]

Yes I have gone in for my yearly exam pretty much every year except for a couple when I was uninsured.

[creekland]

You might be interested in this article:

http://slumbuddy.wordpress.com/2012/03/01/comparison-of-canadian-and-us-federal-tax-rates-for-2011/

 

Interesting... and the sales tax comparison is where (esp since that is a major funding source of health care if I remember correctly)?  ;)

 

I know when we visit each year the difference is quite noticeable.

 

But yes, it does appear that it is the provincial tax rate that is considerably higher than our state tax rate - not the "federal" taxes.  I don't know how much provincial taxes go to fund health care.

 

[indigomama]

After my last kiddo, I was told that since I have no reasons for concerns I only need a pap every 3-5 years, which is fine by me. I get a physical and basic blood work done every year. Never had any problems. 

[mamaraby]

I'm in my 30s and go every year for a physical and bloodwork. It's one of the many hoops we jump through. Every year we are required to have bloodwork done and schedule an appointment with a nurse who works for the TPA/health insurance. Failure to do so means we have to pay a certain percentage of our premium. The physical is more or less required because we get points for doing so. We have to earn 275 points a year (I think) or there would be another additional percentage of the premium that we would be required to pay. Pre-ACA, the only thing our health insurance covered was an annual pap-smear and then only because the law required they did. They also didn't cover birth control or prevenative care for anyome over the age of 4yo.

 

The pap is only done every 3yrs, but that's because my HPV test is negative. I see a family practice doc whose an integrative medicine type and she still insists on the HPV test/pap guideline even though I am as low risk as they come.

 

My dad went from normal PSA to sky high, aggresive cancer between his yearly physicals and had no idea that anything was awry. My aunt died of ovarian cancer with less than one year between dx and her death. My mom had early stage bladder cancer caught and had none of the risk factors associated with bladder cancer.

 

So, yes, I go because we can't afford to pay the penalties for not going and because I think it's an important part of being healthy, but I also eat a low fat, high carb, low animal product diet and watch my salt intake. I like where my numbers are and want to keep them there. As is true for most people, while I think my diet is very healthy, I also know that it's human nature to under estimate what we eat and have a few blind spots. Getting my bloodwork done gives me feedback on how I'm doing and it lets me know if I should make adjustments. In reality the physical takes far less time than the administrative paperwork and phone calls the insurance requires, but I just add that to my list of things to do.

[LucyStoner]

You know, my mother's cancers weren't cured with early detection. But had she fallen into the no preventative/treatment group, she never would have lived long enough to meet her 7 grandchildren. I think 10 or more years of extra life are worth fighting for.

[LucyStoner]

You are paying extra taxes though - everyone pays somehow - the method is just different. If we were in Canada, the difference in taxes we'd be paying (personal, business, and sales) would have a higher cost than our cost of our health share - and in neither case would I be "inspired" to go.

 

I'm not complaining about the Canadian system BTW. I'm in favor of "free" health care for all - worldwide, and I REALLY dislike our main "insurance" system here. I'm just pointing out that it isn't really "free." Some still pay more.

In the United States we spend more tax dollars for healthcare per capita than many nations with universal coverage pay. We just get healthcare for way fewer people for those dollars. Efficient, isn't it? ;)

[Crimson Wife]

In the United States we spend more tax dollars for healthcare per capita than many nations with universal coverage pay. We just get healthcare for way fewer people for those dollars. Efficient, isn't it? ;)

We also have a higher-than-average obesity rate, lower-than-average produce consumption, high crime rate, low population density leading to a high number of total annual miles driven, etc. If we could get those numbers to similar to the ones of Scandinavia or Japan, how much money would that save in healthcare costs?

[LucyStoner]

Ack, trying to embed video from phone.

[Halcyon]

i go yearly but only in the last 4 years. We have health insurance and dh feels strongly we might as well "use" our free annuals than not. So I get a mammogram (although I think once a year is too often, given I have no history) and pap. Also, my nurse practitioner put me on continious birth control to deal with some extremely painful monthly symptoms. As long as I take them faithfully, my week of agony, vomiting, writhing on the floor is no more. Ain't going back to that.

 

 

[LucyStoner]

We also have a higher-than-average obesity rate, lower-than-average produce consumption, high crime rate, low population density leading to a high number of total annual miles driven, etc. If we could get those numbers to similar to the ones of Scandinavia or Japan, how much money would that save in healthcare costs?

 

 

http://m.youtube.com/watch?v=qSjGouBmo0M&desktop_uri=%2Fwatch%3Fv%3DqSjGouBmo0M

[Audrey]

You are paying extra taxes though - everyone pays somehow - the method is just different.  If we were in Canada, the difference in taxes we'd be paying (personal, business, and sales) would have a higher cost than our cost of our health share - and in neither case would I be "inspired" to go.  

 

I'm not complaining about the Canadian system BTW.  I'm in favor of "free" health care for all - worldwide, and I REALLY dislike our main "insurance" system here.  I'm just pointing out that it isn't really "free."  Some still pay more than others too.

 

 

I'm not sure if the number of times one visits a doctor really matters.  I think it's more of a personality thing.  The only times I remember going in my youth were for true needs (rare) or to update vaccs.  Most things were "fixed" at home.  Our neighbor was also our doctor, so visits were rather easy, but we still didn't go often.  I can only remember a couple of times.

 

 

I didn't say "free."  I said "covered."  I do pay taxes, of which only a small part goes to pay for my and others' healthcare.  Your argument, though, fails for me at the first point bolded above.  I used to be a US citizen and when I lived there, insuring ONLY myself through a group plan, what I paid in one year to that plan -- not including any deductibles or co-payments, is much LESS than what my dh and I COMBINED pay in taxes to both our province and our federal government for our full net tax bill.

 

ETA: And, I am not arguing one system over the other for quality or efficiency.  I am, however, defending against the erroneous claim that the average Canadian pays more for healthcare than an American because of taxes.  Only a small part of my provincial taxes go to healthcare.  The rest goes to run the province.  Healthcare is not a federal tax issue.  Even still, I include our full net tax bill as proof we still pay less, not more. 

[SKL]

I didn't say "free."  I said "covered."  I do pay taxes, of which only a small part goes to pay for my and others' healthcare.  Your argument, though, fails for me at the first point bolded above.  I used to be a US citizen and when I lived there, insuring ONLY myself through a group plan, what I paid in one year to that plan -- not including any deductibles or co-payments, is much LESS than what my dh and I COMBINED pay in taxes to both our province and our federal government for our full net tax bill.

 

The fact that you personally pay less does not mean the average Canadian, or Canadians at all income levels, pay less.  I also seem to recall that Canada had higher sales taxes and value-added taxes, which should be considered even though they are not directly included in individual income tax.  Ultimately they are passed along to the individual one way or another.

 

Health care is overpriced for sure, which is one reason many of us are skeptical about recommendations to go get checked.  However, pap tests are "included," free, or very affordable for most people who want one.  Many/most of us who do not go for pap tests are not deciding based on cost.

[creekland]

I didn't say "free."  I said "covered."  I do pay taxes, of which only a small part goes to pay for my and others' healthcare.  Your argument, though, fails for me at the first point bolded above.  I used to be a US citizen and when I lived there, insuring ONLY myself through a group plan, what I paid in one year to that plan -- not including any deductibles or co-payments, is much LESS than what my dh and I COMBINED pay in taxes to both our province and our federal government for our full net tax bill.

 

ETA: And, I am not arguing one system over the other for quality or efficiency.  I am, however, defending against the erroneous claim that the average Canadian pays more for healthcare than an American because of taxes.  Only a small part of my provincial taxes go to healthcare.  The rest goes to run the province.  Healthcare is not a federal tax issue.  Even still, I include our full net tax bill as proof we still pay less, not more. 

 

We are both talking about individual families here, so hardly something that can be generalized.  We pay $370/month to belong to our health share and it covers our whole family with 100% coverage for incidents over $300.

 

We never came close to that with insurance (and I detest for-profit insurance).  Calculating out the difference between tax rates (provincial & sales) and knowing our income for this year (sorry, won't put that on here) + how much we buy in a given year (roughly), I still say that the health share works out best financially for us.  Insurance would not.

[creekland]

You know, my mother's cancers weren't cured with early detection. But had she fallen into the no preventative/treatment group, she never would have lived long enough to meet her 7 grandchildren. I think 10 or more years of extra life are worth fighting for.

 

Everyone has many things to consider when they make their choices - but it should be just that - their choice.

 

In the United States we spend more tax dollars for healthcare per capita than many nations with universal coverage pay. We just get healthcare for way fewer people for those dollars. Efficient, isn't it? ;)

 

There are pros and cons... the biggest con being how much the CEOs of the insurance companies "earn" (and I add that last word loosely as I don't really feel they earn their excessive amounts).

 

Here's just one example, from one state and one company:

 

http://www.chicagobusiness.com/article/20130411/NEWS03/130419970/blue-cross-parent-ceos-compensation-rockets-past-16-million

 

And it's just the CEO - one can go on to add stockholder dividends and other such things.

 

Ditch insurance and "wisely" go non-profit and we'd have far more affordable options while maintaining excellent care.

[Doodlebug]

Every year! I can't get my hormone replacement if I don't do the exam. And I'm not very nice without estrogen. It's best for everyone. ;)
 

[Mrs Mungo]

We are both talking about individual families here, so hardly something that can be generalized.  We pay $370/month to belong to our health share and it covers our whole family with 100% coverage for incidents over $300.

 

We never came close to that with insurance (and I detest for-profit insurance).  Calculating out the difference between tax rates (provincial & sales) and knowing our income for this year (sorry, won't put that on here) + how much we buy in a given year (roughly), I still say that the health share works out best financially for us.  Insurance would not.

 

Except there are a lot of things not covered by health share plans. 

 

Everyone has many things to consider when they make their choices - but it should be just that - their choice.

 

<snip>

 

Ditch insurance and "wisely" go non-profit and we'd have far more affordable options while maintaining excellent care.

 

My son's medical issues would make us ineligible. Thankfully, we don't need to rely on such a service. But, that is why it is able to operate like it does. It doesn't accept people with congenital or pre-existing conditions. Otherwise, they would need a much larger pool of healthy people paying in. Permanent conditions are ineligible for "sharing." So, you're golden as long as one of your children isn't diagnosed with a serious life-long medical problem. There are a lot of adult medical issues that are also ineligible for "sharing." You may feel you're making a wise decision. But, I believe you're taking a gamble.

[imagine.more]

Nope, DH and I were abstinent individually and now monogamous so there is zero chance of me developing the STD that causes the cancerous cells that the Pap smear is looking for. I went for 4 years faithfully because I was told it was necessary for all adult women and was furious when I found out I was doing it for no good reason since it's an STD. Ugh, so frustrating! But anyway, even though my doctors never believe me the fact is that with me and DH having no history I don't need pap smears. When I get to that age I will of course get mammograms as recommended.

[Audrey]

We are both talking about individual families here, so hardly something that can be generalized.  We pay $370/month to belong to our health share and it covers our whole family with 100% coverage for incidents over $300.

 

We never came close to that with insurance (and I detest for-profit insurance).  Calculating out the difference between tax rates (provincial & sales) and knowing our income for this year (sorry, won't put that on here) + how much we buy in a given year (roughly), I still say that the health share works out best financially for us.  Insurance would not.

 

I missed the bit about "health share" as opposed to insurance. I have been gone long enough that I admit I don't even know what that is.