My name is Igal Nevo, and I live in Rehovot, Israel. I'm not going to go into details here on the theory and background of the PRK procedure; there are many web sites out there that do that a lot better than I could ever possibly hope to do (click here for links to some of those sites). Suffice it to say that this is a fascinating, relatively recent and risk-free procedure which anyone (with a few thousand dollars to spare) who would like to get rid of their glasses or contacts should think seriously about looking into. I made this page to give a detailed description of my personal experience with this procedure, for anyone else out there who might be considering having it done and would like to know more about exactly what goes on before, during, and after the laser surgery. I'll start with my first pre-treatment eye check-up appointment at the laser center (Sept. 18, 1996), and update this file with any new developments.
Before I start, though, here's just a brief description of the laser center which I chose. The place where I'll be having the procedure done is the laser institute in the Assaf Harofeh Medical Center, Z'rifin, Israel. There are several reasons I chose this particular center over the many others which exist in the country. Firstly, of the places I contacted, the price seems to be about the same everywhere: US$1100 per eye, everything included (note: from reports I've read on the net, this is quite a bit cheaper that what's being charged in the U.S., Europe, or Canada, which is usually in the US$2000 per eye range; hey, I'm not complaining!). Plus, payment conditions in all the centers I contacted are pretty well identical, i.e. you can pay in up to 10 interest-free, monthly installments. So, cost was not really an issue in choosing the place. What decided me was (1) a recommendation from my ophthalmologist, who said that this place was the one with the most experience with this procedure (>2500 patients treated to date) of all the centers in Israel; (2) knowing that this was the first center to begin doing the PRK procedure in Israel (about six years ago); and (3) knowing that the doctor who would perform the procedure, Prof. P. Nemet (head of the Ophthalmology department), is the one who introduced the procedure in this country. Also, the fact that it is geographically close to where I live was a definite plus.
My first appointment at the laser center was today, at 5:30 p.m. My first impression of the place (very clean and modern) and the staff (friendly and professional) was a good one. Nothing like starting off on the right foot. Basically, the check-up consisted of them putting several different kinds of drops in my eyes and doing a bunch of tests: my vision (corrected and uncorrected), topographical corneal map, corneal thickness, length of the eyeball, retinal exam, plus a few other tests, the purpose of which I'm not quite sure. Then, I had a talk with the doctor, who told me he would explain all the details of the procedure to me; he asked if I had any particular questions which would help direct the conversation. I knew just about everything there is to know about generalities of the procedure (thanks to all the info I found on the WWW), so I asked a few specific questions relating to the equipment they use and the way they do the procedure. The laser they're using is the Meditech Aesculap. I'm pleased about that for one main reason: there's a mechanism to physically hold the eye in place and prevent it from moving during the procedure. I know that other lasers that don't have this mechanism supposedly have safeguards to automatically stop or to follow the eye if it moves during the time that the laser is active, and I'm sure they're perfectly safe, but that somehow just doesn't quite reassure me.... One other thing I was a little worried about (from what I had read on various internet reports about PRK) was the method they used for removing the corneal epithelium before starting on the actual laser procedure. I read a few reports where the doctor actually uses a scalpel to scrape off the epithelium, which sounds kind of scary... I was reassured, though, when the doctor explained to me that they use another technique, which consists of putting alcohol on the cornea (within a ring which is placed on the corneal surface) for a short time, then absorbing the alcohol off and "brushing" away the epithelial cells with a Q-tip. So, after I was reassured that I was comfortable with the way everything would be done, I made the appointment to have the procedure performed on my first eye: Sept. 30, 1996, at 8:15 a.m. They're going to do my right eye on that day, as they always do the weaker eye first. The doctor told me that with my prescription (-2.00 diopters for the left eye, -2.25 for the right for glasses, or for contacts, -2.25 for the left eye and -2.50 for the right), the chances of being corrected to 6/6 (20/20) are very good (albeit not guaranteed, of course). I'll just have to keep my fingers crossed.... What they do guarantee, however, is that the corrected vision will be at least 6/12 (20/40), which is the minimum vision required for driving without glasses; otherwise, they re-do the procedure for free within the first year.
I'm to have someone accompany me on the day of the procedure (to drive me back home afterwards), and I'll miss three days of work. My eye will be patched for those first three days (apparently the epithelium grows back faster that way), although I'll have to apply drops a few times a day. I'll have to come back the morning following the procedure for a check-up, and on the third day after the procedure, at which point they remove the patch. After that, I'll have another appointment a couple of weeks after the procedure, then every month for at least half a year. I'll also have to apply steroid drops every day for six months after the procedure; apparently, this has the effect of slowing the healing process, which supposedly contributes to the prevention of scar formation on the cornea.
Bad luck: I seem to have developed a viral conjunctivitis (an apparently relatively common eye infection, where the eyes are basically red and sore for a few days). It should be completely gone within a few days, but they won't be able to do the procedure for at least a week or two after the infection disappears, because the eyes may remain swollen for a while. So, my appointment for the first eye has been moved to Oct. 9, 1996; I'll do the second one about a month after the first.
I arrived at the laser center a few minutes before my 11:00 a.m. appointment. I was given a consent form to read over while I waited my turn to go in to see the doctor. I ended up waiting 30-40 minutes, during which time about 5-6 people were treated; there were another 3-4 waiting to be treated after me. All in all, given that they start working at 8-8:30 a.m., I would say that they treat a good 20-30 people every day that they do the procedure (which is not every day of the week). Well, I finally got to go in to see the doctor. I signed the consent form, and the nurse put four different kinds of drops in my eyes (I assume among them were antibiotic, anti-inflammatory and anesthetic drops). About ten minutes later, I was called back in for the procedure itself. More drops were put in my eyes, and I was told to lie down for the procedure. The doctor put an eyelid speculum in my eye to hold the lids open. Then, he put alcohol on the eye and wiped it off with a Q-tip (to soften the epithelial cells to make them easier to remove). A black "ring" was then placed on my cornea (to keep my eye from moving, I assume), and the laser began working--this phase, which is intended to remove the epithelium, lasted close to a minute. Then, more drops and the cornea was wiped clean with what appeared to be a smooth spatula. The next step, which was the actual "shaving" of the cornea itself by the laser, took about 20-30 seconds. This was accompanied by a clicking sound, as the red light seemed to make left-right passes over my eye. More drops were put in my eye, followed by an anesthetic ointment, and my eye was bandaged closed with an eye pad and tape: no bandage contact lens was applied, as is done in some laser centers. I was out of the laser center by noon.
After the procedure was done and before I left, I was given a post-operative kit, which contained further instructions as well as all of my medicines plus a few spare eye pads. There were some pain killers (Optalgin), as well as a Valium pill (5 mg) to take before I went to bed in the evening. There were also 3 other boxes, two of which I was told not to touch until my appointment the next morning. The third contained a vial of Tarocidin, which consists of an antibiotic (Chloramphenicol, 2 mg/ml) and a local anesthetic (Polymyxin B Sulphate, 2500 u/ml). I was told to apply two drops every 3 hours, but only if I was in pain. In case of pain, I could also take the Optalgin, leaving four hours between each pill.
I took my first pain killer around 1:30 p.m., along with a drop of the anesthetic/antibiotic; not so much because I was in pain, but because I was starting to feel a little discomfort and I wanted to try to avoid the pain part... By the way, since they had bandaged my eye immediately after the operation, this was the first opportunity I had to take a look through my right eye: everything looked blurry, as if I were looking through a fog.
The rest of the day and night all just seemed to blend together, probably because I was taking pills and trying to sleep as much as possible (apparently, that's the time when the eye heals the best). The pills didn't seem to do much for the pain (and there definitely was pain!), I was taking them mostly to try to sleep. However, those anesthetic drops are amazing: they provide instant relief. Unfortunately, I was only supposed to take them every three hours, and the relief didn't last that long. I ended up applying a drop (one was enough) every 1-2 hours, except when I managed to sleep a little longer than that. Needless to say, I didn't get much sleep that night.
I got a drive down to the laser center again, where I arrived around 8:30 a.m. The nurse took off the bandage and applied some anesthetic drops to my eye, and I was told to wait to go in to see the doctor. I told the nurse that I had used the anesthetic/antibiotic drops more that I was supposed to. She was not surprised, but told me that today I should make an effort to use them as little as possible, as they slow the initial healing process. When I went in to see the doctor, he examined my eye and said it was coming along exactly as it should. He applied some ointment, Tevacycline (Tetracycline HCl 1%), to my eye and bandaged it again. I am to apply this ointment twice a day, morning and evening, until my next appointment Sunday morning (Oct. 13). He asked me how much pain I had experienced yesterday, on a scale of 1 to 5. Without hesitating, I answered 5; not constantly, but at the "peak" moments of pain. I asked him how much longer I should expect the pain to last. He said today I should already feel a lot less pain than yesterday, and by tomorrow it should mostly be gone. But he told me that this varies a lot from person to person.
I know he was right just from what I heard in the waiting room before going into see him. As I was sitting there, I recognized most of the people who had also been treated yesterday. From talking with some people and just listening to conversations, I understood that my experience yesterday had been pretty typical. Apparently, however, as the doctor told me, the pain level varies greatly from one individual to another. I heard one person, for example, tell of a friend who had had the procedure done, went home, removed his patch, watched TV all day, and then slept peacefully all night, without taking any pain killers at all! This was by no means the general concensus, though. One person, who had had the procedure done last year, was accompanying his girlfriend, who had had it done yesterday. He recalled, after he had had the procedure done and was complaining about the pain, how his girlfriend started nagging him about how men could not stand pain, and how they should try giving birth some time and see how they would complain then! The boyfriend then described, however, with evident satisfaction, how three hours after the surgery, his girlfriend was almost in tears from the pain... The moral of the story, though, is that even if the pain is strong, it eventually goes away, and, I'm hoping(!), you're left with good eyesight (which, in my case, still remains to be seen, so to speak...).
My next appointment was set for Sunday morning, Oct. 13, at 8:30 a.m.
Despite what the doctor said, yesterday (day two) was still quite painful. I kept taking pills and, although less frequently than yesterday, the anesthetic drops. Last night, however, I slept a little better overall, usually getting 4-5 hours of sleep at a time. I did wake up once around 5 a.m. with quite a bit of pain; I applied an anesthetic drop and put in some ointment and changed my bandage, and went back to sleep. When I woke up the next morning (day three), I felt like a new person. My eye was still a little irritated, but nothing compared to what it had been. It felt now more as if I had an eyelash stuck in my eye--something which, while irritating at times, I can live with...
My eye feels much better today. I even watched a little TV and typed all this up on the computer. Mind you, the vision in my corrected eye is still very blurry--not good enough to read or see clearly with. The only reason I could watch TV etc. is that my other (uncorrected) eye was doing all of the seeing. I'm hoping that when the patch comes off and my eye will remain open for long periods of time, the blurriness will clear up.
Slept great last night, and woke up with no pain and hardly any discomfort. Some of the "fog" even seems to have cleared, although my vision is still blurry. I had an appointment at the laser center this morning at 8:30. The doctor checked my eye and said everything was going as it should. My patch came off today, although I could theoretically have removed it a couple of days ago, i.e. two or three days after the operation (that just happened to be Friday/Saturday, which are the two days of the weekend here in Israel). I am now to stop using the ointment and to start applying the corticosteroid drops, Dexamycin (Dexamethasone Sodium Phosphate, 1 mg/ml, and Neomycin Sulfate, 5 mg/ml), four times a day. My next appointment is set for October 23, 1996 (two weeks after the procedure), and I've scheduled the operation for the left eye on October 28, 1996.
It's been a week and four days since the procedure. I must say that I'm amazed at how fast my eye has been improving, especially these past few days--I never thought I would be seeing so well so soon. Actually, with the "fog" and the blurriness I was experiencing immediately after the operation, I was originally a little disappointed (I had read several PRK reports where people claimed to see clearly the instant the laser stopped working, so I guess that was what I had been expecting). But by the end of the first week, the "haze" had completely cleared up, and I was starting to see more clearly. In fact, I'm noticing a marked improvement in my vision with every day that goes by. When I go for my two-week check-up in three days, I suppose they're going to check my vision and tell me how I'm doing on the 6/6 (20/20 for those of you who aren't into the metric system) scale. But if I had to estimate now, I would say that I'm probably already pretty close to 6/6 in my corrected eye. It's hard to say exactly, though, for a few reasons. For example, although my vision seems to be getting more and more stable, it still varies during the day. That is to say, I see by far the best when I wake up in the morning, with a slight deterioration during the course of the day. I also noticed, though, that this is accentuated when I'm tired, i.e. if I'm working a lot during the day (especially on the computer, but not necessarily), by the evening my vision will be getting a little blurry. However, when I'm taking it easy, during the weekend for example, my vision hardly seems to change from morning to evening. Another reason it's hard to say exactly how good my vision has gotten is that my focus seems to be different in my corrected eye than it was previously when I wore contacts or glasses. So, if I close my right (corrected) eye, I can see perfectly with my left (when I'm wearing a contact lens, of course). And if I close my left eye, I can see just about the same with my right eye (sometimes, it even seems to me that I'm seeing better with this eye than with the contact-corrected unoperated eye), except that I have to change my focus to do so. So the problem is when both of my eyes are open, in that the focus in both my eyes is different. That means that if I make myself focus with my left eye, the vision in the right is slightly blurry, and conversely, if I focus with my corrected eye, the vision in my left eye is blurry.... I expect that as soon as I have the operation done on the other eye (a week from today), this will no longer be a problem. One final reason is that my vision is now slightly hyperopic, i.e. "plus"-corrected by the laser surgery, as opposed to the "minus" situation of myopia. This means essentially that although I can now see very well from far, I'm having a little trouble focusing close up (for reading, using the computer, etc.). This, however, the doctor explained to me, was planned: they always "overcorrect" a little (slightly into hyperopia), knowing that with time there will be a slight regression in the direction of the original state (myopia). This is actually also getting better every day; I can now work on the computer and read without straining too much.
Aside from that, the rest of my observations are pretty standard. As most people mention, there's a little glare and a halo around bright lights at night. This, however, hasn't bothered me yet. As for the supposed sensitivity to sunlight and bright light I was told to expect, I haven't really experienced that at all. Nevertheless, I do wear sunglasses with UV protection when I go out during the day, as they don't yet know what effect the UV rays can have on the eye while it's healing.
I just got back from the laser center, where I had my two-week check-up for my right eye. They confirmed what I already suspected: the vision in my right eye is now 6/6 (20/20)! I didn't try reading the line below (i.e. smaller letters than) 6/6 (which is 6/4, I believe). However, seeing as how my vision is still better in the morning, and I had my appointment around 4 p.m., I'm sure that had they checked my vision earlier in the day, I would have been able to read that line too. The doctor then checked my eye and said that it looked very good. Also as expected (and also explaining why I have to strain slightly to read close up), my right eye is now at +2.0 (i.e. hyperopic), right where it should be according to the doctor. He explained once again that this is due to a voluntary overcorrection by the laser procedure, since there is a natural regression of the eye back toward "minus" with time. They usually overcorrect such that when the eye stabilizes, it is left at zero, or minus one-quarter diopter. I asked how long this would take, essentially because I wanted to know how soon I would be able to read without straining. Once again, this varies from person to person: for some it only takes a couple of weeks, for others it might take anywhere from a month to three months. The doctor told me to continue applying the corticosteroid drops four times a day, and gave me another vial of the drops. I told him I still had a lot left in the first one, but he told me I could take it anyways, just in case. My next check-up for the right eye is scheduled close to three weeks from now, for Nov. 17, 1996. The laser procedure on my left eye is scheduled for next Monday, Oct. 28, 1996, at 8:30 a.m.
Last week, on Monday Oct. 28, I had the laser surgery on my left eye. Basically, I don't have much to report on the actual procedure itself, as it went pretty well the same as for the previous eye. I did notice though that they only put three types of drops in my eyes before the procedure, and not four as I thought the first time.
Post-procedure: this time was a little more painful than the last. Again, I applied the anesthetic drops often (more than for the first eye) and took a lot of Tylenols. I think it was a mistake to apply the drops so often, though. They told me again this time at the laser center to use them as sparingly as possible, since they slowed the initial healing process. I, however, in my infinite wisdom, thought that I knew better: for my first eye, I had applied them more often than I was supposed to, and it turned out great, so logically, I could do the same again this time, and even use more. However, when I went for my second post-procedure check-up (on Thursday), when they normally remove the bandage, the doctor told me that my epithelium hadn't completely healed yet, and that I would have to keep the patch on and the eye closed for another 24 hours. I guess maybe they do know better after all.... Anyhow, it all worked out in the end. Today (day 7 for the left eye), my eye feels fine. It's still a little red, but other than that OK. The fog/haze has already cleared up. My vision is still a little blurry, but it's getting clearer each day. As for my first eye (right eye, 3.5 weeks post-procedure), my vision is still 6/6, and I believe the hyperopia is decreasing, as it's becoming easier and easier for me to read from close up.
There was also a question I had been meaning to ask the doctor for a while, which I finally remembered to do during this check-up: I wanted to know the diameter of the zone on the cornea that the laser works on. As far as I know, in many places they still use a 4.5- or 5-mm ablation zone diameter (when they started doing this procedure in Europe, they were using a 3.5-mm zone). The doctor explained to me, however, that here they're using a 6-mm diameter zone (as they usually now also do in Canada and many places in the U.S.). This is apparently a major advantage, in that it significantly reduces the glare and halo effects at night, compared to a smaller diameter zone. As it was explained to me, these effects are due to the fact that the cornea doesn't become quite as smooth at the edges of the circle on which the laser operates. So at night, when it's dark and the pupil is maximally dilated, some of the light coming through the pupil and reaching the retina goes through this not-completely-smooth part of the cornea, at the edges, causing halo/glare effects. By increasing the zone to 6 mm, therefore, the pupil can dilate much wider and the light coming through will still be passing through the smooth part of the cornea. I can now compare my two eyes, the first of which was operated about three weeks before the second. I do experience a pronounced halo/glare effect at night now with my left eye (the one which was operated last week), as I did for a couple of weeks with the right eye. This effect is almost completely gone now in the right eye. There is still a little glare and a halo around very bright lights in dark places at night, but nothing that causes any annoyance whatsoever, and I think even that will probably go away with time.
That's about all there is to report for now: I just have to continue applying the corticosteroid drops 4 times a day to each eye. My next appointment is scheduled for Nov. 11, 1996 (two-week check-up for the left eye).
I just got back from the laser center. I originally had an appointment next week to check my right eye, but as it was so close to this appointment, I asked them to do both eyes at the same time (from now on, I'll be having both my eyes checked on the same day). The doctor looked at both my eyes through a special scope, and said they were coming along perfectly. They did an extra test on my right (first) eye. I'm not exactly sure what it was, but they first put some drops which I believe to be anesthetic drops in my eye. I think that he was checking the pressure in my eye (which sometimes has a tendency to increase with prolonged use of corticosteroid drops). He said that too was perfect, exactly as it should be.
Then came the vision test. It would appear that I now have 6/6 vision in both eyes. I feel, however, that I must qualify this with a brief description of how I actually see. First of all, my right eye (the first one to be operated, a little over a month ago), is doing great. I would say that my vision is about as close to perfect as it can be. From far, I see things perfectly clearly (no blurriness, no double vision, essentially no glare or halos at night), and I can read from close up almost as comfortably as before I had the procedure done (the hyperopia in my right eye decreased from +2 two weeks ago, to about +1.25, and should continue decreasing toward 0.0, or emmetropia). In my left eye, however, although I was able to read the 6/6 line on the chart, my vision is still slightly blurry, and still not stable throughout the day. In addition, when I grow tired and find it a little more difficult to focus, I experience a slight doubling of my vision in this eye. For big objects, this makes them look slightly blurry, and for small letters, for example, it looks like the word or object I'm seeing has a shadow (the doctor told me that this is normal and should disappear eventually). Aside from this "double vision" effect, all of this is basically what I had experienced with my first eye, except that it seems to be taking a little longer this time (with the first eye, by two weeks I was already seeing essentially completely clearly). I still think that this is likely due to my taking too many anesthetic drops after the procedure. However, as everything seems to be progressing basically the same way as it did with the right eye, albeit a little more slowly, I expect that within probably no more than a couple more weeks, I should be seeing as well with my left eye as with my right.
At the end of my appointment, I received two more vials of Dexamycin, the corticosteroid drops, although I'm still just on my first vial. That means I now have four spare vials.... The doctor also told me that I can now apply the drops only three times a day, for both eyes. My next appointment (for both eyes) was set for Dec. 9, 1996, at 1:30 p.m.
Nothing much new to report this time. My vision is still the same, i.e. around 6/6 (that is, I can read the 6/6 line, although it's not 100% clear). The hyperopia in my right eye is down to about +0.75 diopters, and down to +1 in my left eye. I no longer have the "double vision" effect in my left eye. They checked the pressure in both eyes, and said that it was OK. I'm to apply the eye drops only twice a day now in each eye. I'm to call to set my next appointment, a month to six weeks from now.
Basically the same as the previous times: my vision is still the same, i.e. around 6/6 (= essentially perfect vision). The hyperopia in my right eye is down to about +0.5 diopters, and down to between 0 and +0.25 in my left eye.They checked the pressure in both eyes, and said that it was OK. I'm to apply the eye drops only once a day now in each eye for another two weeks, and then I can stop altogether. I'm to call to set my next appointment, about a month and a half from now.
Sorry for the delay in adding this update--nothing much special to report, though. I can still read the bottom line (6/6) on the eye chart. I'm now at emmetropia in the left eye (i.e. no more hyperopia), and the right eye is also near zero. I'm not using the drops anymore, so there was no need to check the pressure in my eyes this time. My next appointment is set for May 26, 1997.
I just returned from the laser center, where they confirmed what I'd been thinking lately: my vision has actually continued improving little by little. With my right eye I could still read the 6/6 line on the chart, although the numbers in this line appeared a little clearer than they did last time. With my left eye, I read the 6/6 line so clearly, that I asked to try to read the next line down. The doctor said this line was the one Air Force pilots had to be able to read (6/4.5), and put it up for me--it was perfectly clear, and I read it without any problem! My left eye is still at emmetropia, but I've still got just a little hyperopia in my right eye. Maybe with time, as the hyperopia disappears in my right eye, I'll be able to get down to the 6/4.5 line with that eye also. My next appointment is in three months, at the end of August.
I had what will probably be my next-to-last check-up today. Not much more to report, except that my vision is still at least 6/6 in each eye. I asked the doctor what my situation was, and he said that it is the best that it can be: perfect. I have another appointment (my last, I assume) three months from now.
Today I had my last check-up at the laser center. Essentially, the doctor told me that my vision was "officially" perfect, which I of course already knew. They then had me sign a "guest book", in which all patients traditionally write a short note to the staff upon their "release". Glancing through the many pages of thank-you notes from former patients, I was reassured to see that my good experience with the laser center and with PRK was definitely not an exception.
In addition, I already have a couple of friends who, based on my experience, also had the procedure done at the same laser center (one a few months ago, and one just about three weeks ago). Both of them are as satisfied with the results as I was at those stages. So, I just want to say again that as far as I'm concerned, the whole thing was definitely worth it.
I'll continue to update this file in the future if there are any new developments.
I'm just including this update to let anyone who's interested know that at two years plus, I'm still seeing perfectly. My vision has been perfectly stable, and I haven't noticed any significant changes either way (i.e. for the better or for the worse) since my last report over a year ago. I've become so accustomed to having perfect vision, that sometimes I try to remember what it was like to need correction (glasses, contacts), and I find it hard to imagine that that was ever the case...
I've gotten quite a few e-mails asking me to give an update on my condition, since it's now been almost four years since I've had the procedure done. Well, I'm pleased to report that there has been no change in my condition and that I'm still seeing perfectly from both eyes.
Once again, I have nothing special to report, except that there has been no change in my vision (for better or for worse) since my last report. I'm still extremely pleased with the results of the procedure, which I had done over four years ago...
I'm happy to report once again that nothing has changed significantly since my last report. As they say, no news is good news... :-)
I've received a few e-mail queries requesting updates on my condition. I'm again happy to report that there have been no significant changes since my last report. Nearly 10 years have past since I had the procedure done, and I still have excellent vision and no problems/side effects.
I've recently answered a few e-mail queries as to the state of my eyes, so I thought I'd update my webpage. It's hard to believe it, but it's been almost 12 years since my surgery, and I'm very pleased to report that I'm still extremely happy with the results and have never had the least regret for going through with it. As I was asked about the halo/starburst effect: I have almost no discernible halo/starburst effect - no more, in any case, than I had before my surgery (although that may also be because I wore contact lenses at the time, which also tend to produce a small halo/starburst effect); in any case, it's nothing that bothered me with the contacts, and it doesn't bother me now either. I also have no problem whatsoever driving at night. All in all, everything is still as good as I could possibly have expected and hoped for it to be at this point.
I just want to thank those of you who have been sending me e-mail messages. It's nice to know there really are people out there actually reading and possibly benefitting from what I'm writing!