A Tempting TV Broadcast - Too tempting by far!

On ABC1 TV 23/08/12 at 8pm, a program called “Catalyst” was screened, of which the first 14 minutes suggested a possible cure (or at least, significant improvement) for Multiple Sclerosis. As Pam is now totally physically disabled because of Primary Progressive MS (PPMS), diagnosed in 1986, we both took great interest in what the program had to say.

The doctors named in the program were Dr David Wheldon and Dr Paul Thibault. They claim that MS is caused by an infection by Chlamydia Pneumoniae and it could be successfully treated by an extended term of three concurrently delivered antibiotics– a term well in excess of twelve months.

I soon after asked our GP, Dr Meyer if he could prescribe these for Pam – as Pam is now so weakened by MS that I fear she will not survive her next inevitable attack of the common cold. (The last time she caught a cold was in 2009 when it developed into pneumonia and a brain haemorrhage resulting in a stroke. As you may have read, Pam, who was much stronger than she is now, very nearly died back then; but was saved by an emergency treatment of the antibiotic Vancomycin.)

Reasoning that even if the treatment prescribed by Dr Wheldon and Co merely improved Pam’s strength against her next attack of a cold, at least then she’d have a better chance of surviving it.
 

Dr Meyer explained that he was unable to prescribe anything but ‘normal periods of treatments’ of antibiotics, which certainly didn’t extend to the time-period suggested on the video, but at least he encouraged me to see what I could find on the internet in relation to Dr Wheldon. Dr Meyer also gave me a referral to a local physician, Dr Terry Cook.

Upon searching the internet I quickly found two documents written by Dr Wheldon: The first was a highly detailed “Empirical antibacterial treatment of infection with Chlamydophila pneumoniae in Multiple Sclerosis” and the second was a detailed rebuttal of another doctor’s argument which claimed that “Chlamydophila (Chlamydia) pneumoniae was unlikely to have any input into Multiple Sclerosis”.

I printed off both of the above documents and copied the 14 minute segment of the Catalyst segment onto a DVD, all of which I submitted to the physician's receptionist for his eventual perusal should he so decide to familiarise himself (when he returns from a seminar in Melbourne). I explained in a covering letter that the video program goes to some trouble to explain that the described treatment has not yet had any clinical trials, nor is it ever likely to ever get any because the antibiotics involved are all ‘old’ and out of patent, and therefore there is no money to be made to justify/fund any such trial. Dr Wheldon (on the video) said himself that he’d be a widower by now if he’d waited for a clinical trial prior to his (successful) treatment of his own MS-afflicted wife.

In that letter I left for Dr Cook I also noted that because the treatment hasn’t (yet) been clinically trialled, it is alleged that most medicos either avoid or actively reject it. I wrote "Pam and I are admittedly ‘grabbing at straws’ – we urgently seek anything that will possibly strengthen her to give her a better chance to cope with the inevitable. Anything better towards, say, a cure, would be an unexpected bonus".

Pam's and my appointment with Dr Cook is not until mid-October (and I'm writing this on 10th September) but since making that appointment I'm having serious second thoughts about Dr Wheldon's treatment. Just today we received a copy of 'Intouch Magazine' and in it was a feature about the different forms of MS. Pam has PPMS and according to this article, dated Spring 2012, there are no medications at all which are affective with that. Dr Wheldon is a poet and a novelist as well as a doctor - that bothers me somewhat... Is his supposed treatment of MS also a fiction - at least, for Pam?

Once again I contacted Dr Cook's receptionist and explained my revelations, but she encouraged me to nevertheless continue with the appointment, regardless - and so I shall; but with a VERY different point-of-view to what I originally had in mind.

Good news happens - sometimes

It’s been a long time since my last addition to this story of my darling wifey.  I suppose that’s because peace reigns at the moment as Pam is going really well.

As Pam reached the weight agreed between her dietician and me and began to exceed it, I experimented with PEG-feed delivered quantities and also timed the delivery so as to suit my morning getting-up habits.

Pam was struggling to consume 3 brix of PEG-feed and that amount was also raising her weight without apparent bound, so I reduced it.  I discovered that the feed pump was much more reliable than I first thought at delivering a constant rate, although the indicated rate is quite wrong.  Each brik contains 237ml of food and Pam’s quantity was reduced from 3 brix to about 2.6 brix. 

Now a quick calculation gives 2.6 x 237ml = 616.2ml, however this amount reads on the pump display as just 460 (ml).  But what’s in a number name?  That amount turns out to be the magic feed quantity to keep Pam’s weight to around 60.8kg – 61.4kg (clothing dependent) and very satisfying to my understanding of the agreement with the dietician.

Further experimentation showed that if I slowed the delivery rate to 44ml/hr (44 pump mls) and commenced the nightly PEG feed at 9:30pm, the 460ml (indicated) amount  would be reached 2 – 3 minutes before 8am, which is when I normally arise to start my day.  The pump is so consistent and reliable that that turn-off time is easy to replicate on a daily basis.  Pam gets 460 indicated ml, (616ml in reality) each day and the world can keep turning. 

(Check the maths: 10.5hrs at 44ml/hr = 462ml but it doesn’t get to go for quite that long)

Above is a "Happy Snap" just now taken to prove Pam's a happy girl - in spite of her 'desparately' needing a haircut.

Here we are next morning, it's Saturday and Pam has just had her shower and her hair washed and she's in the lounge ready to face the day.

She is my reason for living!

A Curious Development in PEG-feeding / Use it or Lose it

Pam's Mildura Base Hospital dietitian had been very keen, as were we all, for Pam to put on weight. It wasn't too very long ago when Pam was very underweight - 30-something kilograms was measured at the hospital as I recall, but since I started daily weighing her, the lowest figure I have on record is 44.5kg - and that was in August 2010.

The dietitian was keen to get Pam up to 65kg, but over time I noticed that most of the weight increase was focused on her abdomen and not her legs or arms, so I got a mutual agreement with her (the hospital dietitian) that a more appropriate target weight for Pam would be just 60kg.

Pam was consuming three brix of Novasource 2.0 liquid food in a continuous overnight PEG-feed, commencing at 9pm and usually finishing around 7:30am and her weight steadily improved and eventually reached 60kg in early January - and continued to increase until Pam evidently decided to do something about it.

In the past few weeks, Pam started to politely announce that she'd ‘had enough’ when there was still half a brik or so remaining in the pump's supply-bag. Prior to this, Pam was daily struggling to accept the full three brix of feed and was keen to comply with the rules in order to gain weight, but in hindsight that may well have been the cause of the regurgitations mentioned below. Anyway, Pam had apparently personally and privately decided that she had no further need to put up with the discomfort anymore and had begun to regularly report the first moment of this feeding displeasure.

Sadly, I’m not Superman and me getting woken up at 5:30am or earlier, being requested to turn off the feed-pump (and disconnect it, post-flush the PEG, discard the bag kit and remaining food etc and then go back to bed to 'sleep'), quickly became onerous. So I just as quickly rescheduled the PEG-feed start time to 10:30pm (or later) instead of 9pm, and the Nexium stomach-settling med just 10 minutes prior (exactly, more or less), not 10 to 20 minutes as was previously done. At least now I can sleep until 7am or so before Pam feels the need to make her pump-switching-off request.

Curiously, for the past fortnight, Pam’s weight has settled to a steady 61kg and just this morning I rang the dietitian and explained all this to her – and she is more than happy with what’s happened, by the sound of it.

Peace at last, I hear you ask?    Nah, sorry…

A couple of days ago, Pam yawned and subsequently reported that she had hurt her jaw in the process and last night, she twice asked for Panadine Forte to help her cope with the pain. For the first such dose at midnight, I remembered to put the feed-pump on ‘hold’ while I administered the tranquiliser, but not so, unfortunately, for the 4:30am request. Although I only took a moment to deliver the pain-soother, a couple of millilitres of PEG food had pumped into the cap which I’d temporarily placed over the tube nozzle. That was more than enough to make the nozzle slippery and it came away from the PEG tube as a consequence within minutes of it being ‘tightly’ reconnected thereafter.

The mess that followed has been much worse in the past. Pam, of course, had not had any feed since 4:30ish because of the disconnection and so she slept peacefully until my alarm radio sounded at 7:30am. She then arose from her deep sleep, recognised the digital display of 541ml of food that had been pump-delivered (in total) throughout the night and had the grace to announce, perplexedly I presume, ‘Darling, I’ve had enough!’ Of course she had – so had I. But today is sheet-changing day anyway; besides, the tea-towel I had folded and placed under her PEG connection point had caught most of the mess, so there was minimal impact on my day, as far as I could tell.

I’m left wondering if Pam’s jaw problem needs a medical opinion.  I’ll let you know.

(5 hours later)

Well it didn't take long to find out...

Pam's jaw pain continued to worsen and eventually (at 5pm this afternoon) she finally consented to me taking her to hospital to find out the cause of her pain.

I won’t go into what’s involved in getting Pam from her bed to the Outpatients/Emergency Dept. at Mildura Base Hospital, but within 40 minutes we were there and it was 9:45pm by the time we were settled back home; but we were thankfully wiser by the knowledge that the ‘jaw’ problem (was it broken or dislocated) was in fact Parotiditis – inflammation of the Parotid gland which is one of the salivary glands. The inflammation is apparently caused or exacerbated by blockage of the gland through lack of use.

Here's my beautiful Pammy back home from hossy, butterly uggered and enjoying the Nexium-aided part of her overnight PEG feed.  The time is 11:45pm.

Parotiditis is a direct consequence of Pam no longer being able to take anything, food or liquid, orally. It just has to be the classic "If you don't use it, you'll lose it" – and that opens a BIG bag of worms. The problem can be temporarily relieved, evidently, with antibiotics but if Pam is to overcome it permanently, oral intake of some sort is going to be necessary. But these days, anything untoward getting involved with Pam’s swallowing process runs a good chance of getting into her lungs and finishing up as aspiration pneumonia. Pam and I both definitely don’t want that!

This sounds like real fun coming up.  I’ll wait and see - and let you know, no doubt.

Continuing frustration for my very brave Pammy

It's now mid January 2012 and I felt it was time to report on my poor wife's frequent torments.  (I don't think I'd wish MS on my worst enemy - if I had one.  MS is simply horrible!)

As was reported earlier under the heading 'Applied Love v/s Applied Cruelty', Pam continues to be bothered by random feelings of nausea, all too frequently developing as a regurgitation into her mouth and subsequent aspiration - potentially all the way into her lungs. There, it would quickly result in aspiration pneumonia which, as you may have already read below, is now well known to Pam

Since the last posting, Pam has aspirated her stomach contents on two more occasions - including one just yesterday.  I looked through my diary to see if I'd written the dates when Pam got crook enough to be hospitalised, but that wasn't a happening thing - I'd been a bit slack; so I went over to the hospital to ask.

I should add at this point how impressed Pam & I are with the attitudes, help and care regularly demonstrated by the doctors, nursing staff, administration and general staff, given the trying conditions they have to work under in the hopelessly under-designed facility; it is without exception that their attitudes are simply amazing.

Well, none of the staff took pleasure in telling me that these days, information about other people's hospitalisation is forbidden due to privacy laws - even to loving husbands. (It's funny, but I anticipated that very response as I spoke.) It was OK though I thought - I have Pam's medical and financial powers of attorney and I remember giving copies of those to MBH months ago, so that'll give me the right to be told.  Ah, but they couldn't find them as it turned out; so I was almost back to square one.

However, Chris from Hospital Information Services said I could email a copy of Pam's medical P of A if that was easier and he would then be able to tell me the dates. I did that deed just before I took the picture below.

Just to prove a point, here's a picture of my brave lady taken only a few moments ago.  Who'd have thought just yesterday, she was troubled enough to be ambulanced to Mildura Base Hospital's Emergency Dept?

Here it is now Thursday 19th and I've just received Chris's reply. He says…

Inpatient

8/11/11 – 9/11/11

ED Presentation

12/12/11 – 12/12/11
17/01/12 – 17/01/12

… which is exactly what I wanted to know.

The November overnight admission prompted the previous posting and that was for Pam's PEG tube replacement but the next two entries (ED Presentations) were identical to each other insofar as that was when Pam regurgitated stomach contents and consequently had breathing difficulties.  She was coughing feebly (and ineffectually) and had a gurgly chest.  In each case I monitored her temperature, but that was all I could do.  On each occasion, Pam didn’t seem to be getting any better with time and if she had aspirated into her lungs, all that my thermometer could eventually tell me was that she had (once again) developed aspiration pneumonia. 

Each time, I was between a rock and a hard place.  Pam reckoned she was OK and didn’t want to go to hospital.  I on the other hand, didn’t want to risk Pam getting pneumonia.  That eventuality would take weeks to get over – but that’s the time I reckon (by experience) when her MS will attack most viciously and mercilessly. In fact it was a safe bet that Pam wouldn’t quite ‘get over it’.  She never does – her MS sees to that.

No, I was over the moon each time the X-rays confirmed Pam's aspirations had got no further than her trachea (wind pipe). The staff even congratulated me for dialling 000 for an ambulance, because they agreed it was far better to be safe than sorry.

...but when I look at those dates - September, October, (November), December, January.  This is very bothersome - what has February got in store I wonder?

New PEG - New Hope?

Today's date is 13th November 2011, our youngest daughter's birthday. It occurred to me that our country leaders are 20 years my junior but still my ‘in their mid-30s’ daughters’ seniors - and that's good!

Just 5 days ago, Pam was hospitalised (Day Surgery) for her overdue PEG-tube replacement. For many months, the old tube had been blocking up and otherwise temperamental and our Surgeon, Mr Chambers agreed that it was well overdue for a change. The poor old tube was knobbly and gnarled with bits of dried, caked food internally clinging in the bumps and frequently dislodging, subsequently causing difficulty.

Neither Mr Chambers, nor me as it turned out, had any idea of what the type of PEG the old one was. I thought it’d be in some hospital records, but not so apparently. I assumed it was a “non-balloon” PEG which has a different removal technique to the balloon type. Anyway, that wasn’t my problem and I got Pam to the Base Hospital at 9:30am as required.

I took Pam to the Day Surgery as required and she was soon transferred to a hospital trolley, but not a lot was happening thereafter so I eventually went home at about 11:30am to return closer to Pam’s recovery, post procedure. The old PEG indeed turned out to be a ‘non-balloon PEG’. For the curious, the non-balloon peg removal is demonstrated at http://www.youtube.com/watch?v=4CCnlUtBcdU

When I finally got to see Pam at around 2pm, I was VERY impressed with the new PEG. It was of clear quality soft plastic tube, balloon secured, slightly shorter and with NO tube clamp. The lack of a tube clamp had me bothered for a while until ‘the penny dropped’ and I realised that this meant that a potential force-feed pump issue no longer existed! Furthermore, I quickly discovered to my enormous pleasure, how easily PEG feeds and hydrations now flowed. In addition, being a balloon type tube, it suddenly comes into the class of Pam’s catheter situation – and I do these changes myself when necessary. I’ve already asked about my future changing of Pam’s PEGs and so far have had positive feedback from the hospital dietician. (Training will be required, but not until the next changeover.)

Pam got over the procedure quickly although I was lucky in that bed-space was found for her to stay over until Wednesday 9th, when I brought her home and had her there by 10am. The overnight stay was precautionary but fortunately unnecessary (in hindsight), as it turned out. It’s a pity hindsight is about as dodgy as foresight, isn’t it?

Life’s going along well enough at the moment although over the past two nights, Pam hasn’t been able to quite finish her 3-brix overnight feed. (Each of the ‘brix’ contains 237ml of food, totalling 711ml per night; 9:45pm – 7:45am.) Pam’s been feeling full with just 50ml still remaining and yet her dietician has specified she consume FOUR brix (948ml) of liquid food per night. The dietician wants Pam’s weight to reach 60kg, but at the moment she is 56.8kg and possibly now losing some. For many nights, Pam was managing 3 brix completely.

A reminder of the reality

The Dawsons left on Thursday 13th October. On Friday 14th, I visited Pam at the Base Hospital, fully expecting it to be quite a few days before she’d be ready to come home – but found the Registrar with her and soon after he left, Pam announced the he said she could come home ‘now’.

She didn’t have to say it twice, but it took a further 3 hours before I got her into the car. Apart from me having to go back home to get the electric wheelchair, there were pharmaceuticals to collect, Dietician instructions in regard of Pam’s new overnight feeding regime and awaiting a lifter to get Pam from her hospital bed into the wheelchair.

I got Pam home at about 12:30pm and put her to bed straight away. The new 2-hourly hydration flushes until 7pm proved to be ‘surprising’ - I thought I was going to get it easy given the daily PEG feeds had been moved to an overnight feed, but soon realised something still happened every 2 hours, regardless.

At 9pm I gave Pam her 4-pack, 948ml, 12-hour PEG feed – the pump being set to deliver 80ml/hr. When I eventually got to bed myself, I thought “I can sleep in! Nothing to do until 9am.”

However, at 4:20am, Pam woke me to tell me she was ‘full’. OK, I took a little time to soak this in, but soon realised that it didn’t make sense. The slow delivery rate was prescribed to allow the stomach to continually shift the trickle to the duodenum, never letting it ‘fill’ and then becoming a regurgitation issue. How could Pam be ‘full’?

I switched the pump off and got back into bed – but I couldn’t sleep. My mind was being torn between Pam’s desires for a feeding break and the instructions of the Dietician, ie that Pam should get the full 12 hours worth.

And so after giving Pam a 30 minute break, I then switched the pump back on. Pam seemed to be game enough and didn’t complain (but she never complains). About an hour later, Pam woke me to say that she felt ‘a bit sick’. I got up and stopped the pump straight away, but as I watched Pam I could see her regurgitating again.

Soon the pathetic ineffectual coughing started up and I thought “Oh no! Here we go again.” I monitored her temperature and in spite of it not rising, I was still very worried that pneumonia would not be very far away. Pam’s cough was disarming and I eventually rang TRIO Support to cancel today’s respite cover and then rang ‘000’ for an ambulance. While they were coming I decided to change Pam’s colostomy which was in need of attention. As I unclipped the bag from its base-plate, watery diarrhoea spilled a bit further than I anticipated. “This is turning into a bloody good day”, I sarcastically said to myself. When the ambulance arrived and heard my story, they seemed happy for my pre-emptive concern and took Pam to the ED for an x-ray et al.

Cutting a long story short, Pam’s lungs proved to be relatively clear and subsequent blood tests showed no problems. Another long wait for a lifter and Pam was happily home again at 12 midday. I rang TRIO and got cover from 1pm to 3pm, then I showered Pam and washed her hair (which hadn’t happened since 1st October) and set her up in the lounge in readiness for the TRIO respite carer. The delay caused by the hospital visit resulted in her hydration flush regime being put back two hours, and so I prepared her 11 o’clock medicated flush and attempted to deliver it to Pam before the carer arrived. But alas, with all the rush of the early morning, I’d forgotten to post-flush the PEG tube after disconnecting the pump, and I found it to be thoroughly blocked!

It eventually took a long skewer carefully pushed down the tube to open a flow path; but in the mean time, I had squirted half her medication all over her cover towel by pushing too hard on the syringe against the blockage – prior to when I thought of the skewer.

I was really glad to get down to the Working Man’s Club for a beer with some mates and then a blow of my euphonium at the bandroom prior to my return home at 3pm. If anyone tries to tell you that respite leave doesn’t do you any good, have ‘em talk to me!

BTW Since writing that second last paragraph, it's been pointed out to me that Coca Cola is more effective (and safer) than any skewer - and so I shall keep a can thereof in the fridge, just in case the 'good' advice really is.

Welcome reminiscence

Pam was coming along nicely, gradually gaining weight and not getting too many nausea bouts – as far as I could tell, although she did manage to get some regurgitation into her trachea (wind-pipe) on one occasion shortly after she came home, so I hired a nebuliser from our local Flanagan & Poole Pharmacy and gave Pam a single treatment which almost immediately solved her problem.

Time went by; the days were ones of contentment for Pam and baby Ellie visits were an added joy for my Pamela Joy. The world could keep turning, I thought.

On Wednesday 5th of October, TRIO Support carer Andria turned up as usual at 10am and I took off into town, as per usual. I had been gone but a couple of minutes when Andria rang my mobile to tell me that Pam had aspirated yet again, but on speaking to Pam, she seemed confident it was simply another tracheal deposit and so I said I’ll hire the nebuliser again and bring it back later – will that be OK? Pam said she wasn’t coughing much and there was no hurry.

And so it was – I got home at 1:30pm, thanked Andria, put Pam back to bed and applied the nebuliser as before. Once again, just one dose sufficed and Pam reckoned she felt much better. I contemplated purchasing a nebuliser and Case Manager Peta suggested one might possibly be funded for me if I could get her a letter to that effect from Dr Bob, our GP. So I made an appointment for Friday 7th at 2:30pm, completely unaware of what was about to happen.

As the afternoon wore on and although it was rather cool, Pam eventually called for me to turn on her ceiling fan – as she was feeling hot. Later she called me to help her lift and bend her right arm (that’s her good arm) so she could scratch her itchy nose. Well, when I got her hand near her nose, I had to even straighten her finger so that she could scratch herself. I was alarmed! Apart from it being easier for me to scratch Pam’s nose myself, I was astonished as to where had her strength gone?

I didn’t waste any more time. I rang the hospital much to Pam’s chagrin and described her apparent discomfort with the ‘heat’ of the cool bedroom and her sudden utter weakness. I was advised to ring 000 straight away and call for an ambulance. Bugger – here we go again!

Pam was found to have an elevated temperature and was taken to the Emergency Dept. Cutting a long story short, she finished up in Ward 2, Room 5 with aspiration pneumonia in both lungs. As it turned out, it didn’t seem to be too severe, but it would take some time to repair. I am writing this bit on Thursday, 13th October and Pam’s just entered her second week, but there’s hope she’ll be discharged soon. By the way, I forgot to go to see the doctor (!)

In the mean time, a strange thing has happened…

Several weeks ago, a friend forwarded me an email from one Ross Dawson – a man I’d not seen for 40 years and with whom I had graduated as a Mechanical Engineer. Evidently, Ross decided to attempt to contact me as a direct consequence of him finding this blog, using links to interest groups on my profile. I was ‘over the moon’ at the prospect of renewing that old friendship. Ross, like me turned out to be a Geelong FC supporter and many happy emails, phone-calls and SMSs subsequently ensued, consequenting with Ross and his lovely wife Stella deciding to come from their Melbourne home to visit us here in Mildura. Indeed, that decision was made prior to the 5th and so it was anticipated that they would be visiting Pam & I together here at home. Sadly, that wasn’t to be the case.

Ross knew Pam from the early days, when I first met and married her and he was very keen to see us both – as I was to see him once again. That he was bringing his wife, who was also very keen to meet us, was a huge plus and the impost of hospital visits paled into insignificance.

The two welcome guests arrived Monday evening, 10th October, and stayed in the nearby Aquarius Apartments. Ross and Stella both were delightful in how they showed a genuine interest and empathy in Pam's and my situation.

I remembered a video I made just a year after we moved into this unit – around about 1996. In it Pam is seen walking around with the aid of her walking stick and describing where we live after first saying “Welcome to our little house” using a voice quality I’d not heard for several years. (Pam’s stroke affected Pam’s voice subtly.) I hadn’t seen this DVD for several years and it brought a tear or two to my eyes.

During a visit to see Pam, we were fortunate to have Jeni and baby Ellie also visit while we were there, so Ross and Stella met them both. Our other daughter Sharon rang my mobile while we were there and so Ross got to speak to her as well. Ross took this picture during that visit...

Just yesterday I remembered the two books Pam and I wrote about each of our early lives. They are each one ‘generation’ of us, meaning they contain our life stories from our earliest memories to when we reckon our own girls can start to remember their childhoods. We had the books properly bound and we had had 4 copied of each produced (at around $100 each). One set is for Sharon, another for Jeni, one for ourselves and one to lend out to interested persons. We’ve met no-one more interested than the Dawsons.

While they were here, Stella took a shine to my rather unshiny motorbike. In spite of it being somewhat in need of a 'lick and a promise' (as the old saying goes), she got me to wheel it into the sunshine so I could take this picture of the lovely Stella...

Stella could have been pillion with me if Ross and her had another day or so to stay. In the Mildura district, Curatin and Coclin Avenues to Red Cliffs can be a bit of an eye-opener for a pillion. Ah, perhaps next time - and I'll get the dust off the bike especially for that trip.

Ross in particular knew just what to say so sooth us all – even daughter Jeni who is going through the ‘delights’ of early motherhood with baby Ellie who seems to have developed several fairly typical 9-week old baby issues. Sadly, they (Ross and Stella) left for home just this morning and I miss them already.

It was a visit from the way, way past. At least they can read our stories – mine mentions Ross in several spots throughout and time will tell if that pleases him – but I think it will. The sting of their departure is tempered by their promised return in around three months. I can hardly wait.

Here's a pictures of us two old mates