Acalabrutinib

 It is my second week on this cancer-killing drug, brand name Calquence, generic acalabrutinib, 100 milligrams taken every 12 hours. Doctors and patients often refer to it as "acala". 

The first week was complicated due to a flu vaccine received the day prior to starting this medication. I have never had an adverse reaction to any vaccine, but can only speculate that the combination of the high dose given to people over the age of 65 and starting to take a BTK inhibitor might have triggered the symptoms that started on the third day. I got the flu shot on a Monday afternoon, started taking these pills on Tuesday evening, and on Thursday started to feel a little off. Something did not feel right, but it was vague...mild discomfort all over and by Friday morning it was a level of sluggishness I have never experienced as far back as I can remember. It felt overwhelming to even consider the idea of getting up! But I had to get up, and quickly, because the feeling of nausea quickly turned into an uncontainable urge to regurgitate and I barely made it to the toilet. For the rest of the day, I struggled to keep water down and even after a few sips, swallowed several minutes apart, my digestive system said, "Nope." 

I called and left a message for the oncology pharmacist, reporting the symptom as instructed, and she soon returned my call and told me to pause taking acala and prescribed Zofran, an anti-nausea pill. Unfortunately, I was too weak to drive and could think of no one able to go to the pharmacy for me, and same-day delivery was not an option. I had to wait until my husband could pick up the prescription on his way home from work. 

I share this as a recommendation to others who may be planning to start CLL treatment with this drug or another BTKi often prescribed as first-line treatment, Brukinsa (zanubrutinib)... if you are in need of a vaccine, get it done a week or two before starting this drug. We cannot be certain that it was the combination that triggered my flu-like symptoms, but it's awfully coincidental and probable. 

Pausing a few days, taking the anti-nausea med, rehydrating and getting my body nourished restored me to my new normal and I began taking acala again the following Monday. It is Saturday as I write this and I have had no problems at all. I have been able to enjoy my morning swims and healthy foods and even some homemade treats. No nausea whatsoever. 

As others who have walked this path before me have informed me, a mild headache is common, but it disappears with a cup of coffee (a little caffeine). Today the headache was barely noticeable. Seems my body is adjusting to this cancer-killing process. 

Starting in November, I will be prescribed the second drug in this two-year regimen: Venclaxta (venetoclax). This will be started on a low dose and gradually increased, with weekly blood tests to monitor my body's tolerance. This drug scares me a little due to the higher risks[1] involved. I feel a bit anxious about it and do my best to stay focused on the present, to nurture a state of calmness and minimize stressors. 

Speaking of calmness, I discovered this fantastic video on HBO MAX. It is categorized as a documentary, but it is unlike any documentary I have ever seen. It is magical, mesmerizing, and yes, very calming! The trailer really does not do it justice. I find myself wanting to tell everyone to watch it! Each episode is a different topic and features a different narrator. Check it out! ❤

A World of Calm

___________

[1] URL: https://www.drugs.com/venetoclax.html#warnings

Follow me on Instagram @herzenity

TP53 mutations

 I started reading up on the topic of "TP53 mutation" as it relates to cancer treatment planning. Interesting read. It hits me like String Theory did a couple decades back when I first dipped my toe in that wild water. I kinda get the gist. Ha! 

Check out the Abstract:

TP53 mutations in cancer: Molecular features and therapeutic opportunities [1]  

TP53 is the most commonly mutated gene in human cancers. These mutations are blah blah characterized by blah blah blah dominant negative effect oh no i'm lost lost lost.

omg. what?

Okay. Here's the thing. Finding out your TP53 mutation status is critical knowledge to any cancer patient. So what's the nutshell? Three simple things: 

1. Do I have a TP53 mutation? (If unknown, ask for the test.)
2. How does my TP53 status affect my treatment plan/prognosis? 
3. What do I need to understand about this situation? (In other words, can my choices improve the odds?) 

I don't need to understand the jargon and specificities in the highly technical abstract. It is enough to make one recognize the importance of asking one's doctor if I have a TP53 mutation. The rest is beyond my, and dare I say the most cancer patients' ability to comprehend...the complexities of oncology and the human gnome...probably very well written and sourced in that medical publication. 

What do we average cancer patients need to know about TP53 mutations? That there is such a thing. That I need to know if I have one. That having that piece of info affects my quality of life as a cancer patient. 

Simply ask your doctor: "I was told to ask about TP53 and IGHV...have I been tested for that? What do my TP53 and IGHV results mean?" [2]

Happy hunting for the answers to questions you didn't know you should have, until someone told you. I thank the people who told me (CLL Society Support Program), and now I am passing it forward. You're welcome. 

___________

Source URL:

[1] NIH National Library of Medicine / National Center for Biotechnology Information
https://pmc.ncbi.nlm.nih.gov/articles/PMC11554381/

[2] PatientPower.info
https://www.patientpower.info/chronic-lymphocytic-leukemia/your-questions-answered-tp53-and-ighv-results

Faith or the lack thereof

 Speaking of mine. When people get diagnosed with terminal illnesses, other people tend to ask them if they believe in God, etc. So I will spell it out, for any curious onlookers wondering what I believe, and more importantly, why I don't believe what they believe. 

We will have to back up a spell because first off, the verb "believe" is a literary conundrum for me. Simply put, I believe nothing. I do not believe anything. I wonder. I prefer. I hope. I imagine. I thoroughly enjoying doing all of those actions with my brain, but believing is not a thing I do anymore. I stopped doing it in 2004. It was a conscious, pragmatic decision. 

Religious belief has never served me well and as far as I have seen, on the whole, it is the root of many evils. Fanaticism. Fundamentalism. Evangelism. Pushing your ideas onto others, pushing your values onto others. It's always done in the name of God or some prophet or messiah. Yet time and time again, those systematic, zealous beliefs do more harm than good and breed a great deal of cherry-picking and hypocrisy. No, thank you. I've never had any use for it. Religion, that is. 

Now that that's been said, there was a time that I spent nearly three years of my life living monastically. It began a month after my fifteenth birthday and ended a month before my eighteenth birthday. It was within the sanctuary of the Shiloh Youth Revival Centers. I became curious about the Jesus People Movement when I happened upon an article in a small town newspaper when I was fourteen. The headline grabbed me. The concept had me spellbound for months, but I was not one to run away and join the circus! It merely filled me with questions and wonder, so that when I eventually met two young men who identified themselves in a way that made me realize they were part of that movement, I sat with them under a tree in a public park and listened for five hours. I shared very little about myself. They were eager to tell me all sorts of stories about their lives, how they came to know Jesus as their lord, and the differences between churches, religions, and having a personal relationship with God through faith in Jesus as their savior. It was riveting. Especially to someone who had been traumatically traumatized the night before and violated in the most humiliating way possible for one human being to betray another's trust. No details needed. Everyone has been through some kind of trauma, you know how it shakes you to the core. 

What attracted me most was their peacefulness. Peace sounded mighty nice. So I started going to their bible studies. And it was in the Shiloh houses that I learned so many things that have served me well, but most of all, I learned to really love being at peace. Feeling calm, relatively safe, steadied. The structure, the routines, the loving one another like brothers and sisters--it was very cool indeed. I have such fond memories. The watermelon fight after a long hot day unloading a truck of watermelons at the Farmer's Market. The camping trips in the Uintah mountains. Learning to play the banjo and guitar. Learning how to make curry and how to bake biscuits and make yogurt from milk. It was there I learned to love the simple pleasure of polishing wood furniture and keeping the bath houses pristine. The bath houses at the Land in Oregon, where every small act felt sacred, were like new. Outside they looked like small log cabins. Inside they were gloriously modern, sparkling clean as if brand new because everyone who had lived at the Land had had a week or two of bathroom duty and kept it spotless. Not a trace of mold or mildew or rust or grime. It was a pleasure to be alone in the bathhouse, cleaning it, in the impeccable silence of a dense forest where moss and ferns muffle every sound. It was a pleasure to walk on the paths of damp pine needles. I'll never forget that sound or the feel of it. 

We studied the King James Version from Genesis 1:1 to Revelations 22:21, each year. We took turns reading the verses. Our pastors or their delegate led group discussions about it. And we studied parts of the bible on our own in our spare time. We read nothing else. We did not go to movies or watch television. We had no TV, and we could not care less about it. We listened to no radio, no records. The only music in our lives were the songs we sang to and with each other, while we worked, before and after we studied, or sitting around a campfire. Yeah. A real life, honest, sweet and good kumbaya experience. A monastic lifestyle. I miss aspects of it. 

In high school, me and my friends from Shiloh were taunted as "Jesus freaks" by the LDS teens who thought it was really godlike, if actions speak louder than words, to throw their food scraps at us in the cafeteria. Hmm. That was puzzling. Are we not worshipping the same teacher? You know...the one that stood up for a woman who was about to be stoned to death for committing adultery? The one that overthrew the moneychangers' tables at the temple? The one that sat with pagans and outcasts, lepers and criminals? C'est la vie.

Well, that was all grand, a truly magnificent time in my life, overall, in spite of the poo-throwing neanderthals. 

Then all kinds of bad things happened no matter how much or often or fervently I prayed. Some would say God has a reason. Some would tell me his ways are mysterious. All sorts of platitudes were offered. But there was no security to be had. Nothing could be counted on for protection, for guidance, for light. Some would say I was in the wrong religion, that I should convert to this or that. Some would silently question my faith or morality. Perhaps I deserved to be beaten, eh? Perhaps I deserved to be cheated on, lied to, used and abused? Perhaps it was my karma!!! 

Eventually, I walked away from it all...faith, the bible, the hymns, the tight little circle of believers, the praying and especially the trusting God. I would not live my life that way anymore. Wisdom. That is what preserves and guards you. And so I sought wisdom. I studied other teachers. I learned the way of Zen, the Tao. And I found that peace again. It is a different kind of peace. Less like a result of believing in fairy godmothers, more like the natural state of understanding human nature and the suffering caused by ego and emotional attachment to things staying as they are--in a universe that is constantly changing. The peace of going with the flow, detaching from a particular outcome, not resisting the boulders in my path...being as a drop of rain on the river of life. 

Do I have any ideas about what happens after these molecules expire? What happens to the "me"--the ego--the personality that goes with this stuff in this space and time? Does it merge with a collective consciousness? Do "I" become one with the universe? 

Zen is recognizing "I" am already one with the source of all life and creativity. Separateness is an illusion. "I" is a construct. 

Does this "I" that is me, Carma, aka Herzenity, believe in reincarnation? There's that verb again. Believe. See the problem? There is no way to know whether or not reincarnation is a real thing that happens in this universe, or any other plane of being. No way to know. All we can do is wonder, hope, imagine--and if there is something else after Earth, after being human, what could it be? Again, we all get to wonder, hope and imagine. 

Do you see the problem with believing that you know the absolute truth about life, the universe and everything? Perhaps we are meant to imagine possibilities. Perhaps by evangelizing, you are not doing the will of the creator, but rather thwarting another's opportunity to wonder, hope and imagine. 

As I face my mortality, at age 68, with bone marrow 50% malignant and lymph nodes all over the body swollen with cancer cells, aware that the treatment for this could extend life many years--that something else could terminate this body before this cancer does. See? 

When I was in my early twenties, I read Jim Morrison's biography. Perhaps attracted by the fact that he was a poet and I was a poet. But mostly the attraction was a damn good, irresistible title: No One Here Gets Out Alive. Compelling, is it not?

I never forgot that lesson. 

Credit: By http://pictures.abebooks.com/FLORENCEFROGER/735642554.jpg,
Fair use, https://en.wikipedia.org/w/index.php?curid=31321363

Peace be with you. Hug a tree.

The Big Adventures of My Sad Little Guts

 The good news today is that the results of the capsule camera (endoscopy) showed that there is no internal bleeding. The so-so news is that it showed inflammation in the small intestines. The medical term for this is enteritis. 

There are numerous causes for enteritis which anyone can easily research at various medical websites. In my case, we can rule out infection, celiac disease, Crohn's and Lupus. My gut is simply irritated. It has been through a lot! First, the rupture caused by the airbag hitting me so hard in that little deathtrap of a car (explained in this blog). Then infection caused by food leaking into my abdomen, causing weeks of painful peritonitis. Then an adverse reaction to oral antibiotics that caused severe abdominal pain, vomiting and diarrhea. Then weeks later, another surgery to remove a tumor they found in the colon, where my abdomen lay open for hours while they poked around to remove 44 swollen lymph nodes along with the colon cancer. And as if all that wasn't enough trauma for my sad little guts, they then had to suffer three more GI cleanses for follow-up colonoscopies and the capsule endoscopy. 

All they want now is to be left alone. To rest. To heal. 

I have no doubt the inflammation will disappear with a sensitive diet, good hydration, probiotics and some peace and quiet. 

Enteritis can cause nutrient deficiencies due to malabsorption. It's safe to say this is the main cause of the low nutrient and anemic test results I have had to varying degrees since surgery. 

The BRAT diet is recommended to treat an inflamed gut. That's bananas, rice, applesauce and toast--white dry toast. 

My case is not that extreme at this time. I can have other easily digestible foods, like steamed sweet potatoes and carrots (peeled), yogurt, eggs, lowfat milk, oatmeal, braised chicken--the main thing for me is to eat very small portions throughout the day. I can do that. 

The point is to avoid making too many demands on the gut. Give it a rest. 

Low fiber. Low fat. Bland. 

Avoid caffeine. I can have a little decaf. 

Avoid greasy, fatty foods (I always have). Lay off the peanut butter, nuts, curry lentils and black bean chili for a while (it's giving up spicy foods that is hardest for me!) 

Avoid rich meats and high-fat foods--that means no tiramisu for me until this is completely resolved! I can do that. 

No chocolate. OMG!!! :(

This is temporary. 

In the near future, I'm confident I can have small amounts of my favorite foods occasionally without blowing up my sad little guts. I simply have to respect what they've been through! 

too excited to eat

 After a gut cleanse for a medical procedure, I am excited to eat. Too excited to eat. 

Carma eating the most delicious dessert:
brandy-flambéd caramelized bananas in Cancun:)  

When I have to prepare for a GI procedure, such as swallowing a capsule camera, colonoscopy or endoscopy, the prep starts a week before the appointment. Normally I enjoy a high-fiber diet rich with whole grains, nuts, seeds, salads, and a variety of raw or lightly cooked vegetables. I did not get a good cleanse the first time. 

Immediately following the first colonoscopy, I made the huge mistake of going to Polly's Pies (not that there's anything wrong with that!) and ordered Cinnamon Roll French Toast. I had been on clear liquids only for a day and half and had suffered through the obnoxious formula they prescribe for cleaning out the colon. It's brutal! (I'm a big baby.) It not only tastes awful, you have to drink gobs of it all at once and chase it down with a liter of water within the hour! My body put it more bluntly--it rejected the first pint of awful medicine altogether--cast it out like a demon within 5 minutes. 

I sipped water for an hour and let my tummy settle down, and tried again. The second pint I managed to keep down for an hour. This did not get a good result, but given the urgent need for a known tumor biopsy, the colonoscopist went above and beyond his oath as an M.D. and worked it out. He only got as far as the sigmoid colon, where the tumor was seen in a CT scan, a mere 7 inches from the anus, and the tumor was too big to push past it. The first colonoscopy took all of 10 minutes, if that long, and when the anesthia wore off Dr. Chen immediately and soberly informed me that I had colon cancer. 

"I'm not surprised." No emotional reaction. I wasn't suppressing anything, I truly felt no emotional reaction to the diagnosis. "I knew it was cancer." 

What led to this moment and followed it is described in a series of posts starting with zen and the art of living with cancer. I started journaling online so that friends and family could easily find the latest update and see how I'm doing, without my having to repeatedly tell old people bodily function stories. Spare me.

Actual photos of my cancer tumor. 
Don't do what I did. Get your colonoscopy
when your doctor advises.

Further, my cancer journey is visible to all for the educational value it may have to public health. Perhaps more people will get colonoscopies sooner rather than later. Perhaps reading my journal will enlighten them as to how easily removed polyps are compared to a big, nasty tumor blocking the colon. Dr. Chen noted in his report that the inner opening (of the colon/tumor) was <10 mm. He described it as "about as wide as a dime." 

Some people have said the car accident that required a CT scan that revealed the tumor was a blessing in disguise. I said colonoscopies are a blessing. Period. Get it while it's a polyp and you won't have to be splayed on a surgery table for seven hours and hope you don't wake up with a colostomy bag. 

I can also help others who have been diagnosed with sarcoidosis, chronic kidney disease, osteoporosis, colon cancer, and/or a totally separate type of cancer at the same time. In my case, it is Non Hodgin's Lymphoma subtype SLL/CLL. Finding people who understand what it's like to live with this type of cancer is important. (See https://healthunlocked.com/cllsupport and cllsociety.org)

Back to gut cleansing and a word to the wise... do not rush to a favorite restaurant and fill your hungry belly with heavy foods. Do not. You will regret it. Painfully. The bloating and constipation that will haunt you for days is utterly avoidable! Start light. Be gentle with your gut, it has been through a lot. It has gotten irritated. It is resting, recovering. Don't make unreasonable demands of it immediately following a GI cleanse. 

Start with liquids. Clear within the first three hours. Full liquids the next three hours. (Full liquids include milk, soupy cream of wheat, creamy soups, tomato soup, pudding, and maybe a smoothie if it is not loaded with raw skins and seeds--a thin banana peach yogurt smoothie made with canned peaches, not raw with skin. Avoid skins, raw veggies, whole grains and heavy meat for the first couple of days. Seriously, these things are very hard to digest and you are more likely to get constipated because your digestive tract is not yet ready for prime time. 

Be sure to restore your gut biome with a good probiotic-prebiotic capsule that survives stomach acid. Helping your gut to regain its healthy bacterial balance will make a huge difference in a comfortable belly! 

With my most recent procedure, the cleanse went very well, I swallowed a capsule camera, and followed the nurse's instructions as to when it was safe to eat and what to avoid. Unfortunately, those instructions do not appy to a gut that has been traumatized as much as mine in recent weeks and months. I had a colonoscopy in October and had to have another in May to look for possible internal bleeding (anemia diagnostic tool), and at the same time they did an upper GI endoscopy, and then had me cleanse again 3 weeks later and swallow a capsule camera on June 4th. The procedures themselves do not bother me. What is enormously difficult on my body is the prep--it takes days afterward for my digestive tract to come back online. I learned the hard way. 

I just had to go to Urgent Care, didn't I? And they had to send me to the E.R. Of course. Because I needed another CT scan. Sit in the waiting area for hours awaiting blood test and scan results: partial obstruction in the small bowel. They admitted me to the hospital for observation and urgent care. They urgently put me back on a clear liquid diet. After the capsule passed along with a small amount of stool, they advanced me to full liquids for two meals and if that went well--if I didn't blow up and throw up again--they would advance me to soft foods and see how that goes. 

Lesson learned. Do not go back to your normal diet six hours after a GI cleanse, even when the nurse thinks the typical guidelines apply--she doesn't know the history your body had with recovering from cleanses. Listen to your body. If your gut blows up again at home and you feel like you're going to throw up again, keep calm and do not add anything at all to your stomach. Walk, casually, around the house. Take slow deep breaths. Walk it off. And when your tummy settles down a bit, lie down in a quiet, dark room so that your nervous system does not get overstimulated. Let it focus on digestion. 

Get up and walk around some more until bed time, and do not eat anything else until your belly feels soft and and things are moving along. Repeat a cycle of clear liquids, full liquids, soft foods. Don't go back to your normal diet until things are really back to your normal, and you're feelin' good! 

who swallowed a camera

There was an old lady who swallowed a fly. I dunno why she swallowed that fly. I think she'll die. 
There was an old lady who swallowed a camera. I dunno why she swallowed a camera. I think she'll die.

Wearing Gastroenterology equipment as I swallowed a capsule camera.

When I was a child, we sang that song about the old lady. She swallowed spiders and shoes and I don't recall what all else, but dang if she didn't manage to entertain us for what seemed endless hours of summer nothingness. Holly G, I miss that. 

So, yeah, I swallowed a capsule with a tiny digital camera in it. It was as easy to swallow as a fish oil capsule. Which is to say, I dreaded it for nothing. 

Oh, there's that nothing. Again. 

I have an afficinicity for nothingness. The broad concept of it enthralls me. Nothingness. I crave it. I eat hours of it and still cannot get enough of it. 

A blank mind. 

A blank page. 

The lack of ambition. Lack of worry. Lack of pride. Lack of concern. Lack of effort. 

It is effortless. To experience nothingness. 

I digress. I swallowed a stupid little camera to take stupid little pictures of the insides of my guts as a diagnostic tool. Process of elimination, dontcha know. Holly G, the world's gotten complicated. Do you know that? (I hope you saw the movie Fargo.) 

So that's over with. In a couple weeks I will hear whether or not they think anemia, in my case, is due to a little leakage where I had surgery perhaps? Or internal bleeding has been ruled out and it's caused by a combination of the fact that 50% of the cells in my bone marrow (sample) were CLL type cancer. Consistent with my SLL/CLL diagnosis in June 2025. 

Oh me guts. 

Not to worry. Nothingness is coming round again. 

You can tell when I et a bit too much of the THC gummy. 

I should be walking across the street. Shopping for a decent pick of organic tomatoes, zucchini and carrots. Instead, I'm here, blahgging about what it's like to swallow a camera. 

It's no big deal, okay? No big deal. Unless, of course, you have an overactive gag reflex. In which case, I wish you all good luck on avoiding the necessity of this diagnostic procedure. 

Hopefully, they do not see any internal bleeding. 

Now stay present. Live while you are alive. Don't worry about a thing. Cuz like the man said, every little thing is gonna be alright. ❤

The capsule was not as big as an iPhone

Yep. Just checkin. Did I have swollen lymph nodes
in my neck in 2022? Didn't notice. Or care.

Once upon a time in Santa Rosa
2013, February -- yeah, the red chairs
before the cats clawed em.

Now rub your belly and pat your head at the same time. And sing the song at the top. 

Happy Saturday ❤

watch and wait

 It is only logical that people would wonder why in the world specialists -- experts in their field of research -- would advise cancer patients like me to wait to start treatment. Isn't it better to "nip it in the bud"? Stop it in its tracks? Kill it NOW!!! One would think. But SLL/CLL is a lazy cancer. SLL/CLL is a type of lymphoma/leukemia they have seen do so little to their patients for so many years, that taking prescription drugs that come with some serious risks, such as bleeding internally and infections that could lead to sepsis, the CLL experts tell us to wait. 

The progression of this cancer is easily monitored with blood tests and a CT scan to measure changes in the size of swollen lymph nodes. That's the way we watch it. We watch it do almost nothing to our quality of life. Sure, some lymph nodes wax and wane like the moon -- they increase a little, then decrease, painlessly, imperceptibly -- we wouldn't even know we have cancer if they weren't monitoring it. 

Many people live with CLL for >10 years without symptoms or treatment. This is why the experts generally advise us to watch and wait. Until it does something that affects quality of life or presents life-threatening symptoms, such as a swollen lymph node that constricts breathing or swallowing, or blood cell counts that are dangerously outside of normal range, or impacts vital organs, it simply does not warrant taking on the immediate risks of prescriptions that carry high risks, including possibly fatal risks. 

It is better for us to go on with our lives, ignore the disease unless it presents a significant symptom, such as night sweats, fever, chronic anemia or fatigue -- and they make it a point to tell us that what they mean by night sweats is soaking through clothes and bedding, not merely waking up a little sweaty. By fatigue, they mean severe lethargy, not merely feeling tired or low energy. 

I am at a stage where my hematology/oncology (hem/onc) specialist says it is optional -- if I want to start treatment, I may, she would prescribe it, it's my choice. My bone marrow sample had 50% cancer cells. That sounds like an awful lot. My doctor says I could start treatment at this time, if I choose, it is optional at this stage. 

Before I make a decision either way, I will get a second opinion from an expert. The CLL Society offers this service. (cllsociety.org)

Several people in a CLL forum (healthunlocked.com) have told me they do not understand why my doctor even suggested starting treatment, given my current numbers and factors. Some have told me their numbers were worse than mine years ago and they continued to watch and wait, based on expert advice, and they've been fine, enjoying their life without the nuisance of the potential side effects and the frequent monitoring that goes with cancer treatment. They strongly urged me to speak with a CLL expert. Of course I will do that, because my recommendations are specific to my case, and those forum members do not have all of the relevant details and they are not experts. 

I am confident in my doctor, she has ordered the recommended first-line tests, she has told me the same things I am reading in the CLL Society articles. There is no harm in getting a second opinion. I have time for it. This situation is not urgent. Nothing is imminent, as far as this cancer goes. It is not bothering me in the least. 

For now, I plan to watch and wait in favor of other priorities this year...spending quality time with family who live far away, making memories, taking a special trip with my son while I am able, focusing on bone strengthening measures, and creative writing. I am working on a novel right now that I am very excited to complete. 

Family time

Family time

Family time

Family time

Family time