Woman with two different cancers

 Cancer Crossing was recently approached to help a woman in her mid-70s. She lives in western Manitoba and she has both lymphoma and lung cancer. She lives in a small town and must travel to all her appointments. She had been going to Brandon but must now travel to Winnipeg for treatment for the newly diagnosed lung cancer. What a double blow! She has a lot to deal with by herself, as she lives alone. It's a lot for anyone to cope with and we were happy that we could help lift some of the financial burden she has been experiencing. Your donations help Cancer Crossing to help Manitobans living with cancer. Please give generously at https://cancercrossing.com/. A tax deductible receipt will be given.

Colon cancer screening, part two

 Colon cancer screening - the colonoscopy.

Here is what happens if you are referred for a colonoscopy. You will be asked to not consume corn or seeds like poppy seeds for a week before your procedure. You will be fasting the entire day before your colonoscopy. That means you may have clear broth (no veggies, no rice or noodles, only broth), jell-o except red or purple, popsicles except red or purple, coffee or tea - sweetener or sugar is allowed but milk or cream is not. You may not eat any other foods for this entire day. You will be asked to drink one glass of water every hour.

You will need to buy a "lyte" prep at the pharmacy. Pro tip, if you are over 50 you probably qualify for a discount at the pharmacy, usually one day a week. The prep costs about $50 so if you get your discount you can save about $10. Plan ahead by buying your prep on whatever day your pharmacy gives discounts in order to save a little money. Mix the prep on the morning you will start taking it and refrigerate it. Drinking the prep is the hardest part of this all and if it is cold it will go down easier.

You will start your bowel prep the day before your appointment, at either 4 pm if you have a morning appointment or 6 pm if you have an afternoon appointment for your colonoscopy. Instructions may vary a little but overall you drink one cup of the bowel prep solution every 15 minutes for two hours. This will be a total of 2 liters. Then you take a two hour break. After two hours you will start drinking one cup of prep every 15 minutes for 2 hours, until you finish the entire container of prep solution. It helps to set a timer to keep on track as you must finish 2 liters of prep within 2 hours. Note, if you have an afternoon appointment for your procedure you will wait until the following morning to drink the second course of prep solution. This solution will empty your bowels so plan on staying home and close to the bathroom. It's not uncomfortable but you will have sudden urges to "go".

The day of your procedure you may consume liquids only, up to 4 hours before your appointment. You may not drink anything after that, and of course no solid food this day until after your colonoscopy.

You will arrive at the clinic or hospital one hour before your scheduled appointment. You will be asked to undress and wear a hospital gown. You will have an EKG depending on your age, your blood pressure and heart rate will be taken. Then they will start an IV line so it is ready to be hooked up when you go into the procedure room. Once you are ready you will be taken in for your colonoscopy. The doctor will review your medical history and reason for colonoscopy. The nurses will hook up your IV and give you sedation. Then the procedure starts but you will be unaware of what is happening. This is not a general anaesthetic, it is conscious sedation. You will be able to respond to staff but you will not remember a thing. Next you will wake up back in the recovery room. It takes 20 minutes or so to fully be aware of your surroundings. You will be hooked up to a monitor and nurses will make sure you are ok. They will call your contact person to come pick you up. You may not drive yourself since you had been sedated. The staff will inform your of your colonoscopy results and will give you a printed copy and send a copy to your doctor. Once you are fully awake you may get dressed and go home.

If you are uneasy with the whole idea, remember that colonoscopies save lives! Polyps can be removed during the procedure so they never turn into cancer. If there are any lesions viewed they can be removed in further surgery or can be treated with medications. The worst part of the whole thing is drinking the prep. You will not have any pain from the colonoscopy nor any memory of it.

Colon Cancer Screening

 Your risk of developing cancer in your lifetime is about 45%. A cancer diagnosis is not a death sentence. Some types of cancer are highly survivable and an early diagnosis can help make surviving a reality. Getting screened for cancer can make a huge difference in the outcome, so let's talk about screening tests.

About 69 persons in Canada are diagnosed with colon cancer every single day. Most colon cancer happens to older adults, aged 50 and over but this is trending to more young people being diagnosed now.

In Manitoba, screening for colon cancer for most people starts at age 50. If you have a Manitoba Health number, the Colon Check program will mail you a FIT test for you to do at home. This is a Fecal Immunochemical Test and is sent to you once every two years until age 74. Instructions are in the package, and you collect a small amount of stool on a swab and mail it in. You will receive your results by mail in a week or two, and your doctor will also get results. This is an easy, non invasive screening program. If your result is normal nothing further is needed until the next FIT test is due.

If your FIT result is abnormal you will be referred for a colonoscopy. The wait time is short, about a month. You will have an appointment for a review and then a colonoscopy will be scheduled within a week or two. If you have symptoms that include persistent abdominal pain, change of bowel habits lasting at least 2 weeks, or have visible blood in your stool you should contact your doctor for referral for testing even if you are not due for a FIT test.

If you are under 50 and have a personal history of Inflammatory Bowel Disease (Crohn's Disease or Ulcerative Colitis), Familial Adenomatous Polyposis (FAP) or Lynch Syndrome, have a sibling, parent or child diagnosed with colon cancer under age 60, or have two or more relatives diagnosed at any age you are at increased risk of developing colon cancer. In this case you should be screened with a colonoscopy every 5 to 10 years. Note that Irritable Bowel Syndrome does not increase your risk of colon cancer.

You can reduce your risk of colon cancer by being screened with a FIT test and if necessary by colonoscopy. Also eating healthy by limiting highly processed foods, alcohol and not smoking. The next post will discuss the process of getting a colonoscopy - its not as bad as you think!

Tears of joy

 Do you ever wonder if your donation to Cancer Crossing actually helps anyone? Wonder no more! A recipient of your generosity recently wrote to us to tell us how moved she was when she opened our letter and found our support payment included. She said she sat down and cried - that's how much of a difference your support means to cancer patients in Manitoba. She went on to tell us that her cheque could not have come at a better time. She was feeling very alone, with few friends or family walking her journey alongside her. And the boost she got from knowing that she was not forgotten gave her the strength to continue.

You can continue to help others in need by donating at https://cancercrossing.com/. We are a registered charity, tax receipts will be given.

Interlake man

 An Interlake man with prostate cancer has asked for help to pay for transportation costs to travel to Winnipeg for radiation therapy. His estimated total travel over the course of his treatment is about 10,000 km. As he is on a limited pension he needs help to pay for travel. Cancer Crossing has stepped in to give him a hand up. We rely on your assistance to help others , please donate generously at https://cancercrossing.com/. We are a registered charity and provide tax receipts.

Woman with leukemia

 When you are on CPP, OAS and GIC, have no savings and nothing left over at the end of the month it doesn't take much to put you in a precarious position. This was the case for a women from north-western Manitoba. She is in her early 70s and was diagnosed with leukemia. She had limited assistance from family but couldn't find the money to travel to Winnipeg for testing. Cancer Crossing helped out with a donation to pay for travel costs. We appreciate all your donations to help Manitobans with cancer. Please donate at https://cancercrossing.com/, tax deductible receipts are provided.

Northern man

 Cancer Crossing was approached to assist a man from the far north of Manitoba. He is in his 70s and has prostate cancer. He is without resources and has no family or friends to lean on for help. He gets some CPP and EI benefits but the amount is meager. He is at the end of his options, yet still must pay for accommodations while he is in Winnipeg for treatments. Help us to help Manitobans like him. Please donate at https://cancercrossing.com/, tax deductible receipts are provided.

Riding Mountain area man

 Cancer Crossing was asked to assist a man with prostate cancer. He lives in the Riding Mountain area of Manitoba. As he is self employed he does not have EI benefits, although he is expected to be off work for 8 weeks. The financial crunch was severe and we were pleased to offer some help toward travel for tests, surgery and treatments. We extend our best wishes for a full recovery to this gentleman.

Thanks

 A recent client emailed us to thank Cancer Crossing for the financial support while they had cancer. It eased the shortfall in finances. Their advice to others is to advocate for yourself and delegate that task when you don't have the energy. Donate to Cancer Crossing today and help us help others, tax deductible receipts are provided. http://www.cancercrossing.org/

Thank you

 Everyone wants to know that they make a positive difference in the world. At Cancer Crossing we appreciate the thank you notes we receive. Recently a recipient wrote to thank us, saying that our cheque helped them make the long trip from her treatment in Winnipeg to her home so that she could see her daughter. Both parent and child got a boost from this! Help us to help Manitobans with cancer by donating at https://cancercrossing.com/ Tax receipts will be given.

 When one child in a large family gets cancer it upends everyone's life. A 3-year old child from north-eastern Manitoba is in Winnipeg for treatment of leukemia. His parents and siblings are all with him. Between taking him to treatments and caring for all the children, helping them adjust to a new school and new place, the parents are not able to work. Luckily they are a close, happy family and they can navigate this upheaval together. Money is very tight and due to an accident in their building many of their personal items must be replaced. Cancer Crossing is happy to help this family in such a difficult time and send our best wishes for better days ahead. Donate at https://cancercrossing.com/

Two year old with neuroblastoma

 Cancer Crossing recently learned of a two year old child with neuroblastoma. She lives in northern Manitoba and she, her younger sister and her mother are currently in Winnipeg for the child's chemotherapy treatments. Their housing is provided to them and their only income is $500 a month from social assistance. Buying diapers and wipes and food has become unaffordable and so we were pleased to be able to provide financial assistance to make ends meet. Help us help Manitobans living with cancer. Donations are gratefully received at https://cancercrossing.com/ Tax deductible receipts will be given.

Trouble sleeping?

 There is an exciting new study involving cancer survivors that is being conducted in Dr. Sheila Garland’s Sleep, Health, and Wellness Lab at Memorial University of Newfoundland (MUN). The purpose of the study is to examine the efficacy of smartphone-delivered Cognitive Behaviour Therapy for Insomnia (CBT-I) in improving sleep among cancer survivors.

We are recruiting cancer survivors across Canada who have problems with sleep and who have either 1. completed active cancer treatment at least three months ago, or 2. who have been considered clinically stable for at least three months.

Sleep is foundational to physical and mental health and quality of life. Despite sleep difficulties being one of the most common challenges experienced by cancer survivors, it remains one of the most undertreated. This research is an important step toward making effective insomnia treatment accessible to cancer survivors.

If you are interested please click on the following links to learn more. You may also email icansleepapp@gmail.com for more information or to determine if you are eligible.

https://www.mun.ca/medicine/faculty-and-staff-resources/faculty-a-z/garland-sheila-n.php

https://drsheilagarland.com/icansleep-app

Donate through payroll deduction

 Did you know that Cancer Crossing is a registered charity in Canada? We are now able to provide you with a tax deductible receipt for your donations.

Employees of the City of Winnipeg are now able to donate through payroll deduction and they made that happen simply by asking the HR department to set it up. You can ask your employer to do the same.

We are an entirely volunteer run charity which means we have low expenses and most of your donation goes directly to cancer patients in Manitoba.

Woman with pancreatic cancer

 A Winnipeg women reached out for help. She has pancreatic cancer, which is a tough cancer with a tough treatment program. She had chemotherapy here before traveling to Toronto for surgery. She is self employed and her earnings were almost non existent, the expenses around travel to Toronto were more than she could absorb. Cancer Crossing gladly gave her a hand up so she could pay this bill. Sometimes just knowing someone is in your corner can help as much as financial help does. We receive your donations gratefully at https://cancercrossing.com/, a tax deductible receipt will be provided.

Man with lung cancer

 Cancer Crossing was contacted regarding a man with lung cancer. He is 64 years old and his income consisted solely of CPP. This meant that he had a shortfall every month and could not pay his bills. He was turning 65 soon and was optimistic that his financial situation would be easier then since he would then qualify to receive OAS. He just needed a little help to bridge that gap so that he could buy the medication and supplements that he needs. We were glad to be there when he needed us! Help us help others by donating at https://cancercrossing.com/, tax receipts will be given.

Woman from south eastern Manitoba

 A woman from south-eastern Manitoba contacted Cancer Crossing for financial assistance. She has had a hysterectomy as part of her cancer treatment. Additionally she has had chemotherapy and will be going for 28 days of radiation treatment. She is unable to work and is receiving EI payments. Their budget is tight. We were pleased to be able to help her with a cheque to pay for gas so she can get to her treatments. Help us to help Manitobans with cancer. Your donations are gratefully received at https://cancercrossing.com/. Tax receipts will be provided.

Thank you from patient's family

 The family of a cancer patient recently sent us thanks for the help they received from Cancer Crossing. They remarked that everyone that is involved in cancer treatment and assistance has gone above and beyond in the level of compassion, understanding and care. They were given help in ways that were unexpected. We are glad that we were part of thegroup that has shown this level of kindness and we couldn't do it without your financial support. Cancer Crossing is entirely volunteer run and we depend on your donations. Please give at https://cancercrossing.com/

Young mom from the Interlake needs support

 Cancer Crossing was approached by a woman from the Interlake. She is in her late 30s and has cervical cancer. There is no volunteer driving program in her community and she must travel to Winnipeg for many of her treatments, including daily radiation therapy. She is awaiting disability benefits and meanwhile her only source of income is child tax benefits. We were glad to be of help to her with a cheque to help pay for transportation. Cancer Crossing gladly accepts your donations so we can help those in need. https://cancercrossing.com/

Young dad receives help

 Cancer Crossing was approached to help a young dad with cancer. He and his wife have two small children. His wife was on maternity leave when he was diagnosed and so she is now caring for him as well as the children. She now has no income and he is on EI benefits. Their expenses exceed their income and so they need help. They must travel to Brandon and to Winnipeg for his treatments which is a financial hardship. Cancer Crossing is pleased to help them and send him best wishes for a return to full health. Help us help others, donate at https://cancercrossing.com/

Cancer patient is grateful for help

 When a parent has cancer it affects the entire family. Such was the case for a young mom and her son, who struggled with family issues and with her diagnosis. This mom asked for nothing for herself, but she did ask us to help her son with costs to play in a sports league. Due to her cancer she was not able to afford his fees. She wrote that she was amazed and her son was so grateful for the generosity that was given them through Cancer Crossing. Your help makes a difference in many lives, please donate at https://cancercrossing.com/. Charitable tax receipts will be given.

Thanks for help buying medications

 A recent client sent us a letter of thanks. She wrote that Cancer Crossing provided financial help so that she was able to pay for two months of medication. Her employer had canceled her extended health insurance after she went on disability and this left her with substantial bills to pay. Her suggestion to other cancer patients was to speak to the social worker that helps you through your cancer and have them assist you to find help. Once again we were pleased to step into the gap and help someone navigate their cancer and to provide some monetary assistance. Help us to help others by donating at https://cancercrossing.com/, charitable tax receipts are available for donations.

Woman with oral cancer

 A woman from western Manitoba has asked Cancer Crossing for financial help. She has an oral cancer and must stay in Winnipeg for many weeks while she undergoes radiation therapy. She would like to travel home on weekends in order to see her teenage child. This is out of reach for her and so we were pleased to offer a cheque to help pay for fuel. There are so many burdens and worries when a person has cancer and we are happy to have helped to lift one of them. Our sincere best wishes for a return to health.

Child from northern Manitoba

Cancer Crossing was approached to assist a family from northern Manitoba. Their young daughter has cancer which meant her leg would have to be amputated. Besides cancer, she now needs a prosthetic leg and to learn to walk again. This means staying in Winnipeg for an extended time and she is feeling isolated and missing her sibling. Her mother is with her and they needed help for the many extra expenses. Children should not have to deal with illness and grown up worries. While we can't solve that, we were pleased to be able to give monetary assistance to help where we could. Please help cancer patients in Manitoba by donating at https://cancercrossing.com/ charity tax receipts will be given.

Vault Cycle Fundraiser fun

Do it if you can! There are people with cancer, in hospital or in treatment, unwell and unable to get up and get going. But you know who DID get going? Over 25 people came out to @Vault Cycle Club for a high energy, fun spin class and to raise money for Cancer Crossing! That's right, on March 7th we had a full room of men and women giving it their all so they could support cancer patients in Manitoba.

Huge thanks go out to @Vault Cycle Club for offering us a discounted rate. Also huge thanks to Allyson Kendall who graciously donated her time to instruct the class. Allyson reminded us all to keep going for cancer patients. Thank you to our participants for their donations to Cancer Crossing. A fun and sweaty time was had by all!

Small town woman in financial need

 Cancer patients have multiple needs often over a very long time. We were recently asked to help a woman in her 50s with her ongoing expenses. She lives in a small town south of Winnipeg. She's unable to work at present and is on disability and is awaiting further surgery. She also has limited financial support and struggles to afford items she needs for her care. We were able to give her a one time payment to assist with her needs. You can help us provide financial relief to cancer patients in need by donating at https://cancercrossing.com/

Winnipeg child with brain cancer

 Children should get a pass on cancer, and too often they do not. This is the case for a teenage boy with brain cancer. He was diagnosed 5 years ago and continues to receive treatment. His father is a single parent to him and two other children. His income consists of EI Caregiver support. This family is dealing with a lot, from a sick child, to raising other younger children, and doing it all on a substantially reduced income. They recently received an unexpected repair bill and were extremely grateful for the assistance that Cancer Crossing was able to provide to them, covering their bill and providing for some extra's for the child's care and comfort. We wish this family well and good health in the days ahead. Donations are gratefully received at https://cancercrossing.com/

Interlake woman needs help

 Cancer Crossing was asked to assist a woman in her mid-70s with transportation costs. She is travelling to Winnipeg for radiation therapy, which is 30 total round trips. Since she has pets at home she must return daily to take care of them. She will drive herself as long as she can as there is no volunteer driver program in her community. Her retirement income consists of CPP and OAS, which doesn't leave much for extra travel costs. We were pleased to be able to help her and wish her all the best for renewed health. You too can help Manitobans with cancer by donating at https://cancercrossing.com/, charitable tax receipts will be given.

Child must travel to Toronto for surgery

 We were sad to hear of a pre-school age boy with liver cancer. He is undergoing treatment in Winnipeg had an assessment at Sick Kids in Toronto and will be going again for further testing and surgical planning for a liver transplant there. There is also a baby in the family and so one parent is on maternity leave and the other parent is on EI Caregiver benefits. This leaves the required travel out of reach financially. While we cannot cover the entire cost, we were able to provide the family with some financial help which hopefully make their travel easier. We wish them all the best for their son's full recovery. Please donate at https://cancercrossing.com/

Winnipeg woman receives help

 Cancer Crossing was recently able to help a woman in her early 60s who has lung cancer with metastasis. She is unable to work, her employer will not give any accommodations so that she can work with some help, and so she is receiving CPP Disability as her only income. This is leaving her stretched tight and she asked for help so that she could buy groceries. It's hard to imagine being in such circumstances and so we were glad to lighten her load by providing some monetary assistance. Please help us help others by donating at https://cancercrossing.com/. Tax deductible receipts will be given as we are a registered charity.

Thank you!

 We at Cancer Crossing were delighted to receive thanks from some clients recently. One woman wrote that the support from Cancer Crossing was huge as they were dealing with financial stresses due to her diagnosis. Her advice to others to is to give yourself a lot of grace, rest when you can and take care of yourself. A surprise to her in her illness was that it took a lot of strength and compassion for herself. It took a lot of self love to deal with not having hair, eyelashes or eyebrows. We are so glad to have been of help. You can help too by donating at https://cancercrossing.com/

Man asks for help

 Cancer Crossing has been asked to provide help to a 65 year old gentleman living east of Winnipeg. He has a recent diagnosis of gastroesphageal cancer and has daily trips to Winnipeg for treatment. Total distance to be traveled is in excess of 2000 km. He needs help for gas and parking expenses and we are are pleased to be able to step in.

Mom and Dad both have cancer and need help

 Some families go through unrelenting hardship. Such was the case for a young family living south of Winnipeg. First, the young mom received a shocking diagnosis of inoperable brain cancer. She soon started on the difficult treatment plan that included daily trips for radiation, chemo and appointments. Her husband ended up taking EI caregiver leave as she was no longer able to drive and was on permanent disability. Family stepped in to help their young children's routines, getting to school etc. Very unexpectedly the husband also received a cancer diagnosis and is embarking on his own treatment plan of chemo and surgery. To say this is devastating is an understatement. They desperately needed help as they had to place a hold on mortgage payments due to the drop in income. Fortunately Cancer Crossing was able to give them a little help to ease their financial burden. Please help us help others, donate at https://cancercrossing.com/

Fundraiser coming soon

 Watch this space! We have an upcoming spin class fundraiser in March. Full details to follow.

Payroll donation deductions

 Good news! The City of Winnipeg has set up payroll deduction for employees to donate to Cancer Crossing automatically. We are now a registered charity and all donations are provided with a tax receipt. Automatic payroll donations are a one-time set up, making this an easy way to help Manitobans with cancer. https://www.winnipeg.ca/

Thank you

 Cancer Crossing has received thanks from a grateful recipient. We assisted a gentleman who wrote to us later to tell us that it was a huge help in being able to get to appointments. He expressed surprise as well as he had no idea that help was available until his social worker told him. He tells other cancer patients to not give up hope! Your donations help other Manitobans with cancer, please give at https://cancercrossing.com/ a tax receipt is given.

Cancer Warning Signs

 Seven cancer warning signs include changes in bowel/bladder habits, a sore that won't heal, unusual bleeding/discharge, a thickening/lump, indigestion/trouble swallowing, a change in a wart/mole, and a nagging cough/hoarseness, though many other persistent symptoms like unexplained weight loss, fatigue, fever, or pain should also prompt a doctor's visit. These signs aren't definitive cancer indicators but warrant medical investigation, especially if they last more than a few weeks or worsen. Early detection significantly improves cancer outcomes.

Series of misfortunes for Winnipeg family

 Imagine not only being diagnosed with breast cancer, but having a a quadruple whammy of misfortune. That's what happened to this young Winnipeg family. This young mom was let go from her career of over 10 years when her company was acquired by another. Seven days after the expiry of her employer health benefits she was diagnosed with breast cancer. Then she was in a car accident and her vehicle was totaled. Further troubles happened when her husband had surgery for a lump and had to take time off work. This woman cannot work due to her health but she also has no critical illness insurance and she doesn't qualify for EI coverage. There is no money to buy another car so they have been taking the bus to appointments and to get her child where they need to go. Not only is this difficult enough, but being so ill while trying to juggle the logistics of getting everyone where they need to go is a huge burden. Money is so tight that they are now going to the local food bank so they can eat. This is a horrible series of misfortunes for this hardworking couple. Cancer Crossing is so glad that they reached out for help and are pleased to have been able to help in a small way.

Gimli man with prostate cancer

 Cancer Crossing was approached to assist a gentleman from the Gimli area. He has prostate cancer and must travel to Winnipeg for radiation treatments. He does not drive and the cost to him to hire a driver is over $100 each trip. This is adding up and putting a dent in his budget as he is on CPP and OAS and there is no room for this cost. Fortunately we are able to provide some financial help and we wish him the best for renewed health. We gratefully accept tax deductible donations at https://cancercrossing.com/ so that we may help more people in need. Photo: Travel Manitoba

Western Manitoba man receives help

 Recently Cancer Crossing was approached to help a man in his late 60s. He lives west of Brandon and has metastatic melanoma. He does not drive and is relying on friends to drive him to Brandon and to Winnipeg for scans and treatments. He cannot afford ongoing costs of travel and medication as he is reliant on a small pension. He hopes to apply for Pharmacare which could help with some costs of medication. Luckily we are able to provide him with a small cheque to assist towards costs. Please help us help others by donating at https://cancercrossing.com/, tax receipts are available.

An ounce of prevention...

 We have all heard the expression "an ounce of prevention is worth a pound of cure". These days we are all aware of the risks of smoking. Of course with the rise in vaping there is a new risk that we need to be aware of. Vaping may be a lower cancer risk but it's still a risk, and there is growing evidence that it can cause damage to DNA. This is especially important for young people to know as they are more likely to vape than to smoke.

We are beginning to understand the risk of alcohol consumption in causing cancer. Lesser known cancer risks are being overweight especially in conjunction with alcohol and tobacco use. A risk that is more recently known is the risk from salt-preserved foods like salted dried fish, meat jerky, and pickled vegetables.

All these risks play a role in some more aggressive and difficult to diagnose cancers. We can do our part to help ourselves and our loved ones by not smoking, reducing alcohol consumption, maintaining a healthy weight, and eating a healthy diet by decreasing salted and pickled foods, and with daily physical activity. Of course, despite best efforts, some of us will be diagnosed with cancer. This is when medical treatment takes over, giving us our best chance at overcoming the illness. The good news is that the cancer rate in Canada has been dropping for 10-15 years. Read more at https://www.statcan.gc.ca/o1/en/plus/4547-lifetime-probability-developing-and-dying-cancer-canada

Help Cancer Crossing help Manitobans by donating at https://cancercrossing.com/ Charitable tax receipts are available.