Back in the Saddle

I’ve been holding off telling you about how I got on during my first post-hysterectomy fully-penetrative sexual experience because I’m trying to put my usual (funny I hope) spin on events.  The trouble is that getting back into the saddle proved to be rather serious business.  I mean, I would have felt awkward climbing back on the horse after all this time even without the added complication of ensuring that none of my internal tenderness gets pushed about.

The hospital said that I would be perfectly OK to “climb aboard” between 6 – 8 weeks and we tried a small amount of penetration during the 6^th week with no discomfort.   So just before the 8^th week, I decided I could wait no longer and threw myself at him.

I am delighted to report that all the things I really like about intimacy with Helios are still there.  Everything appears to work and I’ve not been turned inside out during the experience.  However, my stamina isn’t what it was and I asked to stop before I began to feel uncomfortable.  Also, the following day or two I did feel a bit sore – as if someone had been poking a bruise deep inside.  I didn’t bleed, but I was moseying like John Wayne the next day.  It’s a fetching look if high fashion takes a distinctly “redneck” turn.  (!)

To be honest, I probably should have looked at the hospital guidelines and added two weeks.  They’ve got me on some sort of naff “speedy recovery” plan but let’s face it, a body can only recover so quickly after a strenuous surgery!  I still think that, had I only had access to public transport, I would not have been able to manage after only four weeks recovery.  It’s only because my work have been keen to look after me that I’ve had access to a car parking space so close to my office which, in turn, has enabled me to return fully-functioning to work as quickly as I have.  With hindsight, I feel I should have known that waiting just a bit longer would have made the first journey in the saddle a bit more comfortable for me.

As it is, I feel as if I’ve taken a step back because I’m aware of where my cervix is.  That may sound bizarre but I know my body and if I am aware of something, I generally find that it’s not quite right.  This sensation, it’s not discomfort, it’s an awareness of that exact part.  If it were working properly and totally healed, I would have no notice of it.  I would take it for granted.  I think of it like my laptop or my refrigerator – I know it works well and only notice when it’s not.

The plus side is that so far I’ve only had a little spotting for a couple of days about four weeks after my hysterectomy.  I may be expecting more from time to time but I’ve not had more just yet.   I’m still recovering well and am still taking care to pace myself.

Foxy

Will power

Apparently everything is healing nicely.  We’ve not had actual post op penetration but, after a bit of fun, what little discomfort I had when fooling around is now gone.  I’m finally in the position to contemplate “the full Monty”.  You’d think that I would be more mentally wary about the idea of any sort of penetration but I’m married to someone very gentle.  The thought of me being in pain is a turn-off for him.  Although I am not having a problem with desire, and there are times when I simply want to do all the things that I love doing with Helios without waiting a second longer, I’m also in the mood to be cautious.  Given Helios’ gentle nature, I am concerned that he will feel terrible if I experience any pain or discomfort.  I worry that he may never want to be with me again if I rush us in the bedroom.   I know if I pace myself with him everything will go smoothly but I hate waiting.  I may be patient in other areas of my life but not when it concerns Helios.  It’s a good thing he has more will power than I do!

My first full week back to work post hysterectomy

I completed my first full week back but only did 32 hours out of the usual 37.5.  Although I am a secretary and not a manual  or skilled labourer, I was still incredibly tired by the end of each day.  Monday was tiring.  I went home at 4:30pm instead of my usual 5pm.  Tuesday was fantastic.  I felt great.  I was nearly bouncing around.  However, in an effort to pace myself I left the office at  4:30pm.   I was tired on Wednesday but went to a friend’s house for dinner.  Although I got home at 9:30  – which under normal circumstances is certainly early enough for me to feel fine the next day especially as I didn’t have a drop of wine!  I had a little sore throat and I started to wonder if I was picking up Helios’s cold.  I took a night nurse and slept like a log but I was tired again on Thursday.  I left the office before lunchtime and had a nap on the sofa.  I went to bed that night at 7:30.  After sleeping like a log, I managed to stay at my office at 3pm on Friday.  I may have done better had I paced myself last week.  I’ve had another good rest this weekend.  I slept overnight and had a nap on Saturday.  I slept well again last night.

Tomorrow I’m back to work again.  I am still fighting off a cold but am eating well and (clearly) sleeping a lot!  I have a car park space just outside the back door of my building and I’m sure my stamina will return quickly!

In other news, because I had a sub-total hysterectomy I can expect a little bleed every 4 weeks.  Well, I had my first period which consisted of a couple of days of a light  bleed requiring only panty-liners.  I had pain but nothing that a paracetamol couldn’t handle.  It may mean that I will finally feel like a normal woman – and all it took was a hysterectomy!

I spoke with my clinical nurse about my stitches which still haven’t fallen off.  She suggested that I go to my GP if I’m concerned about it and they can take them off but I’m enough of a wimp to leave it for a while longer to hope that they fall off of their own account.  Also, regarding scars, I cannot recommend Bio Oil highly enough.  My scars have shrunk  measurably since I started using it – just add a little dab on the scars twice daily is all it needs!

Foxy

Looking forward to Hysterectomy

I must admit that I found the whole idea of a hysterectomy to be very daunting at first but, after having spoken to a number of women, I’m more confident about the procedure.

I spoke with a girlfriend recently who had her hysterectomy done at my local hospital and she couldn’t have said nicer things about how she was treated.  She was done a few years ago and has a scar where one would have a caesarean scar.  She stayed in for four days.  She was therefore pleasantly surprised at how my procedure will be performed and how quickly I’m expected to recover.  I’m due to have another laparoscopy to remove my ovaries (which will be attached to the sides of my abdomen – not just floating around) and then they’ll pull everything remaining through my va.  They’re going to remove my cervix and everything else.  They’re going to close everything back and voila! I’m expecting to go back to work within 4 weeks but have been told by my work that if I need my first week to ease me in gently (i.e. just work mornings or just work 3 days…) they would be happy to give me that opportunity.

I was chatting with my mom a few weeks ago about the procedure and what I can expect.  I said I think it’s a good thing that I have to wait bearing in mind that I have 3 months or so to get myself into better shape than I am now.  I think I’ve needed the excuse to trim up.  Since 2008 I’ve grown two dress sizes.  I’ve called it my “happy weight” and not given it much thought but with a goal in mind, I’m consciously working on my posture and trying to take more exercise.  I’ve been doing a little standing Pilates exercises everyday which I hope helps.  I occasionally do “the hundred” as a Pilates mat exercise and I’m delighted that I can still do it!  I’ve also been taking the train to and from the office which means I’m walking between 20 and 30 minutes each way a day – both journeys have a significant hill involved.  The duration usually depends on how much I’m carrying and what shoes I’m wearing.  Generally speaking I get home at the end of the day and I’m glistening – which isn’t a bad thing healthwise!  Finally, I don’t have a terrible diet but I’ve been eating more and more salads lately.  The weather has been so unseasonably hot in England lately that I haven’t fancied anything else!  I’m sure it all counts for something at the end of the day.  Even if I don’t lose a dress size or two, I’ll be happy that I’ve at least made the effort to get myself into the best shape I can before my next operation.

Speaking of losing a dress size – do you think they’ll give me a little liposuction while they’re in there?  Just trim my stomach, bum and thighs?  I expect I’ll ask that next time I’m on the table and they’re about to wheel me in…

Foxy

Hysterectomy Prep

I went along for my follow-up to my follow-up.  Helios came with me.  I asked all my questions.  I got answers.  In particular, I said, in no uncertain terms, that I was afraid that I would lose the ability to have an orgasm if I had everything removed.  The consultant asked me if I have orgasms now.  I laughed and said yes.  She said, “well if you didn’t have them before the operation you won’t have them after – I’m not a miracle worker!  But I’ve never been told that a woman loses her ability to orgasm after a hysterectomy.”

I also mentioned all the other maladies I endure – the endometriosis, the polycystic ovaries, the insulin resistance.  She said I had “The full whammy!” and I said I was indeed a very lucky girl!  Because these other issues won’t go away with the hysterectomy, I mentioned wanting to stay on my birth control pills in order to maintain my current hormone levels.  She said I should try life without them first and concentrate on feeling better.  I reluctantly agreed.

As certain as she was that the hysterectomy would be a great thing for me, I’m still apprehensive but satisfied that a hysterectomy is my best of all my options.  I suppose I’m still apprehensive because I’m still not entirely sure that this change in my body won’t effect how I feel when I’m physical with my husband.  However, I feel I don’t have much choice – the pain I have with my Fiona the Fibroid is too much for me.

The consultant asked Helios how he felt about me having more surgery and he said that he was concerned about me and would support any decision I make.  Only I could decide how much pain I could endure.

I now know what they’ll do to me when I’m under:  they’re opening me up at the belly button again and moving my ovaries to the sides of my abdomen before pulling everything else out my vagina.  They will take the cervix, my uterus, and fallopian tubes.  Normally they don’t bother taking the cervix but I’ve had a number of instances over the past few years where precancerous cells were found on my cervix.  I was told that they could leave the cervix but if it needed to be removed at a later date, it would be a very difficult operation to undergo.  It is better to have it out now and I reluctantly agreed.

As this surgery is more involved than all the others I’ve had, I’ve been told that I need to start Pilates classes again: a strong pelvis is important for a quick recovery.  I’ve also been warned about other post-op issues like constipation and what to eat when in order to keep my strength up.  I was a little concerned that the consultant was a little surprised that the surgeon’s confidence that the hysterectomy could be performed vaginally (Fiona the fibroid is a big girl!) but, because it’s being done this way, my recovery time should be between 3 and 4 weeks.  If I had a more physically demanding job it would be more, and less if less.  Helios has enough holiday to stay with me during my first week.  The waiting list is about 3 months so I’m looking at August for the surgery and recovery.

I’ve told my work recovery will be four weeks, just to be on the safe side.  They have suggested, if I need to ease myself back into a 5 day week, I could build up to it over a period of weeks.  I do feel very lucky to be in such a supportive environment!

I’m still feeling down about it.  I’ve been telling myself that losing my uterus and other accoutrements wouldn’t make me feel less like a woman but I’ve associated physical love with being a woman for so long.  I’m afraid that if I lose my libido or my ability to have an orgasm that I won’t feel like a woman.

I need to focus on the positive: with Fiona gone, I’ll never have another period and, potentially, never have pain again.  It could be that my endometriosis comes back in a few years but I’ll have to cross that bridge when I come to it.

Is this the future for Endometriosis treatment?

Finally a new surgical approach: remove the endometriosis!  Dr Trehan believes that endometriosis “…is a generalized disease of the pelvic peritoneum and a radical approach like total pelvic peritoneal excision is the answer”.

If my experience is anything to go by, I wholly agree with his hypothesis – I have found medicines to help me cope with symptoms but really do nothing to actually help my condition.  I have had 3 surgeries so far and am in the process of contemplating a fourth.  Although I do not want to have children, I don’t want to lose my feminine organs if I don’t have to.

I’m reading this site and wondering how no one has thought of this before!  I’m reading this and thinking that I have nothing to lose by having another “plain” endometriosis treatment surgery so that the techniques used by Dr Trehan can be used on more women and, hopefully, by the time I need another further surgery (which will be number 5!) the techniques will have trickled down to the people I go to!

Feel better!

Foxy

Choices, choices

I’m going to take the time to thrash out what I feel are the pros and cons of the treatments I’ve been offered by the consultant I saw on Tuesday.  As I find thinking on the page just as helpful as talking to Helios and my mom, I hope you don’t mind my “thinking out loud”.

1. Drug Treatment (Lupron)

Pros

• Temporary effect
• Won’t have a period at all while on it

Cons

• Will take time to take effect (which is a bad thing if I am trying to cope at a full-time job)
• May not work
• May not have the same effect as a surgical hysterectomy
• Would need to take HRT (progesterone) which has been known to make me crazy.

2. Laparoscopy to treat endo

Pros

• I’ve had this before so know what to expect
• If done well, can significantly reduce pain for a period of 2-3 years for me (but not guaranteed!)

Cons

• It’s still surgery and has risks
• Will still need to take birth control tablets
• Will still get periods
• I know for certain that pain will return in due course

3. Hysterectomy (but retaining ovaries)

Pros

• Never have a period again!!!!
• No need for birth control

Cons

• Endo will certainly return and I will need to ascertain what new symptoms to anticipate
• Need to find out if I will need hormone treatment for endo and/or PCOS post surgery
• Irreversible
• Need to find out how to ascertain when endo has spread enough that I need to see a doctor again
• Will my hormone levels still rise and fall every month?
• Will it affect my physical relationship with my husband?
• Not sure if it will positively affect my pain levels
• Don’t forget all surgery has risks

4. Hysterectomy (with ovary removal

Pros

• Never have a period again!!!!!
• No need for birth control

Cons

• With the added element of ovary removal – hormone levels will be a complete unknown and therefore impossible to anticipate.
• Will need to take HRT post-surgery
• I will still have endometriosis – so need to ascertain what new symptoms to anticipate
• Irreversible
• Will it affect my physical relationship with my husband?
• Unsure if it will positively affect my pain levels
• Osteoporosis runs in my family so, at the very least, I would want a strategy to combat this.

My current thinking is to reject the chemically induced hysterectomy – but not outright.  If I have surgery and then try the lupron, I may find that an appealing option because, if the lupron is difficult for me, I would know that my pain would not be as bad when I came off it.  I don’t know if they’ll let me try it in that order but that’s what I’d like to do.

As appealing as the lap is, I am concerned that my doctor may be right in her thought (I won’t have a diagnosis until the womb is taken!) that I may have adenomyosis.  The symptom that tipped her off was post-intercourse back pain.  She examined me with a trans-vaginal ultrasound (or I call it sonogram on a stick!) and found that my uterus seemed “painful”, that she expected it to be pliable but it seemed very solid and had no movement.  She asked if I had a history of fibroids and I had the rare opportunity to say “no, not that one doc!”  If she’s right then the lap won’t go far enough in removing my pain-giving beasties…

Since my examination, when Helios and I were intimate, I experienced discomfort on climax.  It wasn’t horrible and, because I was enjoying myself, I called it “odd” at the time because I didn’t want Helios to stop.  I am so grateful that Helios hates me in pain.  Pain is not sexy.  However, the incident served to cement the thought in my mind that if I don’t do something to get my uterus out, that I may be having more discomfort during intimacy.   This could lead to less frequent intimacy which, over a significant time period, may lead to a change in our relationship.  I think I’ve said it before but it bears repeating – now that I’m in a healthy and happy relationship, I want to do everything in my power to ensure that it remains so.

My next choice therefore is the hysterectomy but retaining my ovaries.  The significant plusses to this are 1) I will never have a period again, 2) with ovary retention I can ask to try the chemically-induced hysterectomy post-surgery in order to suppress the return of my endometriosis and 3) if I do have adenomyosis, the discomfort I experience on intimacy will completely disappear.  However, if it’s not adenomyosis, then I may have another new pain-giving beastie and I’ll be a medical miracle worthy of study!!

As with all my choices, I assume I will need further surgery for endometriosis in due course – while that will be the case for all my choices, I am slightly in the dark as to what form of pain I will encounter next if I have my womb removed.  Will it be worse?  Will endometriosis spread throughout my pelvis?  Perhaps it will want to travel further afield, get a train ticket and go around the UK?

At the moment I’m completely discounting a full hysterectomy with ovary removal.  I feel this option is simply a bridge too far.  I feel that I need to retain my ovaries (as PCOS-ridden as they are) in order for me to feel a bit more womanly.

With all the usual frustration of my conditions, why oh why can’t I just have an easy choice?  Just for once wouldn’t it be nice to be given a tablet and told “You’re cured!  Now off you go, I have sick people to attend to!”  Nope.  We’re stuck in the queue of sick people, tapping our fingers against our new list of ever-growing symptoms.  I wish I had a crystal ball to see the different ramifications of each option so I could choose the option I can live with.

Isn’t it ridiculous!  I’m sitting here crying because my options are so crap that I have to choose one that is the least worst!  When else does anyone do this??  Oh yeah.  When we choose our politicians!  That’s the only time when healthy people can begin to contemplate how CRAP my life has become thanks to endometriosis!

Wishing you a brighter future

Foxy

National Health Service

As you know I’ve always been an advocate of the National Health Service.  I think it’s a fair way to allocate funding for illness and a sign of a civilised society.

Let’s talk about funding for a health service for a moment.  I’m originally from the US but now live in the UK.  I currently hold down a decent full-time job.  Last year I had 3 days off work sick.  I am a productive member of society.  Technically speaking I ought to be able to afford any sort of health care payments.  So why do I prefer NHS?

I dislike ambiguity in my life.  For example, Helios and I have a mortgage that we pay every month.  When we took out the loan, I insisted that we have a repayment mortgage at a fixed percentage rate: I wanted to be sure that we know what the outgoings are every month and that the flat would be ours at the end of the term.  A state-funded health care system provides me with the same concrete certainty: I know what I must pay every month and I know that my policy will cover me throughout my life at a rate that I can afford.

I am not at the mercy of an insurance company that can change my status from “healthy” to “unhealthy” on a diagnosis and therefore require me to pay more in premiums than I cannot afford.  Although I am a productive member of society, I have a number of chronic illnesses.  Since 2005 I have had three laparoscopic surgeries and a raft of prescriptions to treat PCOS, Insulin Resistance, Endometriosis, Depression and lichen planus: a stress-related skin condition.  Had I remained in the US, I cannot imagine being able to afford adequate healthcare despite the fact that I am healthy enough to be a productive member of society.

A state-funded health service ensures that everyone has the health care they need in a reasonable timeframe.  People who are less healthy are not penalised for their situation.  Everyone pays what they can reasonably afford.  Everyone is covered no matter what their condition.  It’s concrete coverage.

A state-funded health service ensures that my money isn’t going to greedy corporations.  I compare insurance companies to banks: they’re only out for themselves.  How can anyone afford adequate healthcare when insurance companies are essentially middle-men who get paid to ensure sky-rocketing prices?

In the National Health Service there are no hidden extras: I go to the doctor when I need to, as often as I need to and walk out the door after the appointment.  No need to stop at reception and get out my credit card.  I go to the pharmacy and pay a flat fee for each of my prescriptions.  When I compare this with the US system, many insurance policies require patients to call to authorise appointments and treatment and, to add insult to injury, only cover a percentage of treatment.  To my mind, what is good for insurance companies is bad for patients.

The last time I mentioned the NHS I had a number of volatile comments.  I was surprised at the venom I instigated: as if I didn’t pay for healthcare.  Please remember that I pay for my health care.  I pay my taxes.  My country has cut out the middle-man of the insurance industry and my taxes go directly to the NHS.  I do not begrudge paying taxes when I know that my tax money is funding projects that I am happy to fund: the NHS is at the top of that list.  Thanks to the National Health Service, I am not over-burdened financially and am a successful member of society.

I think the US system is fundamentally flawed.  How would I have coped with all my health problems if I had to pay a bill on top?  It’s an extra stress that those of us with chronic illnesses do not need.  Please remember that I have illnesses.  I didn’t ask for my health problems.  Thanks to my steadfast National Health Service, I will remain a positive member of society for many years to come.

Foxy

Endometriosis Treatment: Birth Control Pill

I don’t think any treatment for endometriosis is worth its weight in gold but this one works for me.  I take several pill packs back to back.  My last cycle was nearly 12 weeks between periods.  The theory is that the fewer periods I have, the less pain I am in.

Plusses

The theory is fairly accurate.  I have a fantastic time when I feel normal.  I don’t live in the constant dread of pain.  I have it on good authority that I can leave it as long as 6 months between periods.  On the same theory, the fewer periods I have the better love life I have.  Because I have so many weeks between periods, my hormone levels are regular and I don’t have too many weeks where I need to take Milk Thistle.

Because I take birth control, I can plan when I have a period and ensure that my periods occur at the most convenient time for me: I can organise my periods around my life instead of my life around my period.

Minuses

My body periodically demands a period – meaning I have PMT and then spotting for a week or so before I go back to feeling more human.  Also the bloating is hard to hide.  I do spend a lot of time feeling a bit like a beached whale.  The longer I take the birth control, the more days I need to take Milk Thistle for PMT.  I also experience bloating and a right ovary that burns regularly.

It’s not ideal by any stretch of the imagination.  Ideal would be take a tablet and all the pain goes away totally.  However, I would tolerate another surgery if it meant that all the endometriosis would be completely eradicated.

Endometriosis is a nuisance because different treatments work for different women so just because something works for me (or rather I can tolerate this treatment plan) doesn’t mean that this will be good for you.  However, you have to know about all the options before you can try things that work for you.

Have a pain-free tomorrow!

Foxy

Treatments for Endo: The Mirena Coil

The official line from my favourite informative website:  http://www.endo-resolved.com/treatment.html

“The Mirena Coil – The Mirena Coil is used by some doctors to treat the symptoms of Endometriosis by reducing the amount of blood flow in a woman’s periods.

The Mirena Coil is like many other types of Intrauterine Contraceptive Devices (IUD’s or coils) in that it is fitted by a doctor and remains in the womb for a fixed amount of time, after which it must be changed.

Most IUD’s make a woman’s periods heavier, but the Mirena actually makes periods lighter than usual. Because of this, it is frequently used as a treatment for heavy periods, and is now used as a treatment option for Endometriosis, for the same reason of reducing blood loss with the menstrual cycle.

It is made of a light, plastic, T-shaped frame with the stem of the ‘T’ a bit thicker than the rest. This stem contains a tiny storage system of a hormone called Levonorgestrel.

This hormone is also used in contraceptive pills. In the Mirena, however, a much lower dose is released than take the Pill (about 1/7th strength), and it goes directly to the lining of the womb, rather than through the blood stream where it may lead to the common progesterone-type side effects.

Although the IUD was originally developed as a contraceptive, the discovery that it leads to much lighter periods was seen as a bonus. Many gynaecologists now suggest the Mirena as a treatment for heavy periods if tablet treatment doesn’t work.

After 3 months use, the average blood loss is 85% less, and by 12 months the flow is reduced by 97% every cycle About one third of women using the IUS will not have any periods at all. There is no ‘build up’ of blood, because the hormone in the IUD prevents the lining of the womb from building up at all.

Negatives of the Mirena Coil

There are many who feel that the Mirena Coil is very unsuitable as a treatment for Endometriosis as this particular type of Coil increases the risk of developing ovarian cysts.

It is the use of synthetic Progestogen hormones used in the coil that increase the chance of benign ovarian cysts. This is more common with the higher hormone levels associated with the progestagen-only pill. Overall the risk is about 3 times higher. The device could also lead to other complications of infection in the womb.”

As informative as this is, there are no mention of the possible side effects.  Details of this can be found here: http://www.netdoctor.co.uk/medicines/100001706.html

“Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Very common (affect more than 1 in 10 people)

• Change in menstrual bleeding, such as spotting, lighter bleeding or stopping of bleeding.
• Development of fluid filled sacks (cysts) in the ovaries.

Common (affect between 1 in 10 and 1 in 100 people)

• Depression.
• Nervousness.
• Headache.
• Decreased sex drive.
• Abdominal pain.
• Nausea.
• Acne.
• Back or pelvic pain.
• Painful periods.
• Breast pain or tenderness.
• Vaginal inflammation or discharge.
• Weight gain.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

• Mood changes.
• Abdominal bloating.
• Migraine.
• Hair loss or hair growth.
• Skin reactions such as rash or itching.
• Pelvic inflammatory disease.
• Inflammation of the womb.
• Inflammation of the cervix.
• Excessive fluid retention in the body tissues, resulting in swelling (oedema).

Rare (affect between 1 in 1000 and 1 in 10,000 people)

• Perforation of the womb.

The side effects listed above may not include all of the side effects reported by the medicine’s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.”

OK so far?  Now it’s worth speaking to people who have had experience with the Mirena Coil – if only to know things that the doctors may have failed to mention.  For instance, I would recommend taking a paracetamol before your appointment for insertion.  While I didn’t find the experience as bad as my endo pain, the pain was significant enough for me to mention to friends who are considering the coil.

Ultimately, my experience with the Mirena Coil was less than satisfactory.  I had one inserted and it twisted my bowel in two places.  Within just a few months I was having another surgery, partly for my polycystic ovaries and partly to untwist my bowel and partly to remove that awful coil.

I know the coil feels a lifesaver for some.  Knowing what I know now, I probably would have tried the thing again in desperation for relief from my endo pain.  However, if you are aware of the risks involved, you are more likely to demand the correct treatment in your follow-up appointments.  Information is vital.  Don’t make decisions in haste.

Wishing you a healthier tomorrow

Foxy