Tag Archives: Multiple Sclerosis

MS and My Four Legged Guardian Angel

A Guardian Angel Named Lucky

My Guardian Angel

I moved to the Washington State in 1996 to be closer with family who had already relocated to the ever-green-state. I quickly found a job at a private golf club and then became involved with an animal rescue organization on Whidbey Island in Western Washington. WAIF or, Whidbey Animal Improvement Foundation, as it is still called, took on the daunting task of financially supporting many unwanted and abandoned pets as people moved off of the island leaving their dogs and cats to fend for themselves.

About a year and half after my move I got a phone call one early evening from another volunteer from the WAIF shelter in a state of pure panic. Earlier in the day she had witnessed a car throw something out of a window as it sped past her house, concerned about just what that might have been she went out to look. And to her shock and dismay she found that the object that had been tossed was a kitten lying semiconscious in the middle of the road. She quickly scooped up this tiny ball of fur and was off to the vet where it was diagnosed as just being in shock and having a few bumps and bruises. This volunteer already had many dogs and cats in her own home and felt that one more was just too much for her small house and yard, which is where I came in, and why she was calling me. She couldn’t bare the thought of taking this kitten and turning her over to the shelter as she felt that this kitten had been through enough already and would I please consider adopting her? Answering no wasn’t an option, even though I already had two cats in my apartment. Which is how Lucky, as this volunteer friend had already named her, came to me.

Two years later one of those original two cats passed on just as I was struck down with my first MS attack and it wasn’t long after that the second cat followed in much the same way leaving just myself and Lucky to deal with my new life as a person with Multiple Sclerosis. I was literally rocked to my physical and emotional core but Lucky became the lifeline that I clung to as she always seemed to sense when I needed her most.

For most people dealing with insurance companies, hospitals, doctors, while trying to stay employed are just some of life’s little nuisances that have to be dealt with when time permits. However, when you find yourself facing an incurable disease they become something more on the line of monumental challenges where the rules are rarely, if ever, explained to you. And it’s at times like these where the tears often fall as the aggravation mounts to levels that most people either don’t, or can’t, comprehend. And it was always at times like these that Lucky would realize how badly she was needed on my lap, even when I’m sure, she would much rather have been outside climbing a tree or chasing a bird or a mouse.

As the years passed Lucky was my ever present rock against, for profit insurance companies, who could have cared less whether I got any better or not as they tried their best to keep the cost of my healthcare as low as possible. And she never complained once about my loud vocal outbursts when trying to map my way through government agencies that I thought were there to help you but more often then not end up creating even more stress as they pass you from one level of bureaucracy onto the next.

And now eighteen plus years later, as I watch her deal bravely with her own health issues of having both kidney and liver disease knowing that the end is not far into the future for her, I realize the most important gift of all that she has given me. And that is that we are all here to learn to live, love, and overcome all of these challenges that are thrown our way as best we can with what God has given us to help us endure these trials of life. And my Angel Lucky taught me this, without ever saying a word.

This article was recently published in MS Focus Magazine!

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MS and How Drug Companies Can Profit from Outdated Counts

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My kind of Tooth Fairy!

Visa recently commissioned a study to find out just how much parents where giving their young children for each baby tooth that they lost? It turns out, quite a bit. On average each child was receiving $3.19 per tooth. That in it self kind of blew me away because I think fifty some odd years ago I was getting a dime to maybe a quarter per tooth. Times certainly have changed.

Now you’re probably asking yourself, what does the Tooth Fairy have to do with multiple sclerosis? And truth be told, very darn little actually. However there is one big irony that I have discussed before in a couple of my posts here regarding, MS by the numbers, and how these numbers just do not add up.

It seems strange to me that Visa would spend money commissioning a survey, or study about baby teeth, but large corporate drug companies seem to have little if any interest in finding out just how many people in America and around the globe really have multiple sclerosis? Let’s face it, these corporate drug giants are raking in hundreds of millions, perhaps billons, of dollars on these horrifically expensive drugs so you would think it would be to their advantage to know just where the incidence and higher numbers of MS patients are around the world and where their future profits might lie?

Apparently though, they are satisfied in using numbers that were collected some twenty to thirty years ago, and they are still quoting those numbers today, as I have read recent drug company pamphlets where these very same numbers are still being used. If you don’t recall, those numbers were something like 450,000 people in the U.S with perhaps two to three million people worldwide having multiple sclerosis, which I believe to be a huge undercount of what the real numbers truly are. But since these numbers were taken so long ago, who knows what they actually are today?

It makes one wonder why drug companies would not want to update these numbers in light of the possible increased sales potential around the world? Unfortunately, there is a possible financial motive for drug companies to stay with these decades old smaller numbers. If they used larger numbers they fear that this would actually decrease their profits on these drugs because they would have to produce larger batches driving down the overall cost because of the larger patient base that might use them. And because most industrialized nations outside of the U.S. control drug costs at much lower prices then what these drug behemoths want to sell them for. But by keeping the smaller numbers, remember it’s a supply and demand kind of thing, and because of how ridiculously expensive these drugs are, especially in America, drug companies can actually justify making more of these drugs then are really needed and then letting them reach their expiration dates so they can destroy whole batches and claim large tax write offs against what they do sell, increasing their profits on the back end as well.

Greed in its truest form, they got you coming, and going. And the saddest part of all, the insurance industry probably knows that they do this and says nothing about it to protect their own bottom line, because drug companies are probably heavily invested in them as well!

MS and Melatonin for Sleep

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A couple of months ago I took part in a survey about melatonin and if I felt it had any positive benefits for people with multiple sclerosis. In the questionnaire I answered that I did take melatonin and it did help me to sleep. I also added that when I first started taking it many years ago I felt that it might be helping in reducing some of the stiffness in my legs but I wasn’t a hundred percent certain either then or now. Back then I was using 3mg nightly and then would sometimes add an extra 3mg dose on particularly bad nights.

Recently I also read that melatonin is now considered safe at larger doses of up to 10 mg a night and it may also have some anti-inflammatory properties as well. And I must admit, as the years have gone by I have upped my nightly dose to 5 mg at bedtime with an additional 5 mg if I wake up in the middle of the night and can’t go back to sleep. I also have an anti-spastic drug Cyclobenzaprine that I can take if I feel the need but I worry about becoming addicted to it over the long haul so I don’t like taking it very often. But I sure do sleep deeply when I do take it. And in the spring I often also add 25mg of Benadryle before bedtime when the trees start to pollinate because of a severe allergic reaction to certain trees. That also helps as well for sleeping, though the survey was only concerned about melatonin.

I don’t know when the results of this survey will be made public but I am more than curious to see what it has to say? As the survey did hint that there may be some added benefits for people who suffer from multiple sclerosis who also take melatonin on a regular basis, beyond its ability to help in falling asleep, but it didn’t elaborate. We’ll see?

MS COULD SCIENCE HAVE IT ALL WRONG

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Natures own Dream Catcher

When I was in high school, all of those many decades ago, we were taught that each cell in the human body would eventually die off and over a period of seven years every cell in your body would replace itself with a new cell. I assume that is still true even though many things have been changed since that prehistoric time of the early to mid 1970’s.

Recently I have read in quite a few new studies concerning multiple sclerosis that researchers are starting to believe that after the first major attack or exacerbation the body actually repairs most of the damage to the myelin sheath causing a period of near normal function without any further symptoms. In my case, I experienced a period of almost six years before my next attack, which was far worse then the first attack. And reading this just makes me wonder if perhaps doctors and researchers might not be looking at this from the right perspective?

What if the immune system is doing exactly what it’s supposed to be doing by cleaning out these myelin cells as they die off but it’s our body’s ability to replace these cells with new ones that is the problem? This would far better explain, in my opinion at least, why almost no two individuals with multiple sclerosis experience the disease in the same way with the same symptoms.

If this were true it could also explain why some people have a benign form of this disease because there body might retain a larger portion of its ability to regenerate then say people who have a more progressive form of the disease where they may have lost the ability to regenerate new cells at all with in the central nervous system.

And of course it’s very possible that my little theory here is completely wrong but it does bring me to believing that, “I really don’t care what causes MS”. I would really much rather see science and researchers spend their research dollars on ways to repair the myelin sheathing because I can live with having this disease. I just don’t want to have to live with the symptoms of having this disease!

Does that make sense?

MS AND MS LIKE DISEASES IN DOGS AND CATS

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A recent MS study suggested that people who grew up with cats during most of their lives appeared to have a less aggressive form of multiple sclerosis then those people who didn’t grow up with cats. However, on the flip side of that, back in the eighties there were researchers who also thought that one possible contributing factor in developing MS may have been a bacteria/virus found in cat feces that people were getting from cleaning their cats liter boxes. In the years, and from several studies done since, that connection has never been proven as being true even though that bacteria is very real and anyone with MS, or otherwise, should take precautions when cleaning cat liter boxes as it would more than likely make your MS symptoms even worse were you to contract that nasty bug as well as being difficult to get rid of.

And surprisingly enough dogs have their very own disease that is very similar to multiple sclerosis called, Degenerative Myelopathy or DM, as it is often referred to as. And just like MS this disease is considered to be an auto-immune disorder with many of the same symptoms in dogs, as their human MS sufferers experience, but no link has ever been found that even remotely connects these two diseases. And finally, dogs are also prone to a degenerative disc disorder that can mimic some of the symptoms of MS but this can usually be treated with surgery in the more extreme cases.

Degenerative Myelopathy, again like multiple sclerosis, has no cure and progressively gets worse just like MS. The only treatment for DM that seems to help hold this disorder at bay is taking your dog for long walks and even somewhat extreme workouts with their toys as physical activity appears to slow the progression of DM significantly in many cases. And what is a bit strange about that, is that Neurologists are starting to believe the exact same thing about people suffering from MS, that a sedentary lifestyle may be the worst thing for multiple sclerosis sufferers over the long turn.

Do cats and dogs offer any real health benefits to people with MS? It turns out that; “yes!” they offer a whole host of beneficial health enhancing benefits. If you have a dog I am pretty sure that many of you are aware of the need to walk your dog several times a day for potty trips and so dogs can use their social skills by smelling trees, sign posts, street lights and anything else that lies in their usual walking path which also helps lower high blood pressure in the person doing the walking. I recently had a friends dog and got several workouts everyday which I’m sure my Neurologist would have loved to know if I had told him as he is constantly telling me that I am physically able to do more than I currently do. And that dog also liked to play rough, so I was the one who had to adjust to the extra workout, not him.

And yes cats provide their own unique health benefits for their human companions.It has been shown in lab studies that just having a cat around can reduce the stress related chemicals that humans experience throughout any given day. And it’s also been proven that when a cat purrs it actually reduces the blood pressure in any human that is in ear shot of their kitty. And that drop can be as much as twenty points according to some studies and that’s very significant for someone like me who has high blood pressure. And yes, one of my best friend’s, is my eighteen year old cat, Lucky!

Lucky!

In conclusion, if you have MS or any disease that causes you to feel lost and alone I can not stress enough how much having a pet can help you through the hard times. If you can and don’t already have a pet, and if you don’t suffer from allergies, please consider going to your local shelter and see if you can’t hook yourself up with a forever four legged companion. I honestly think that it could be the best treatment you ever got for all of your ills!

*****

I’m requesting stories from any and all of you who have ever had a pet die and than return in any way to let you know that they survived death and came back to ease your fears about their crossing. I think I’m going to write a book about pets surviving death as I have had like at least three of my pets return after death to comfort me after their transition.

What I would like for you to do is to first write the experience you had out in long hand and put it down for a day, or a little while, and then type it out and send it to me at the email address below. If and when I write the book I will certainly let everyone know especially if their story made it into the book. This is kind of a nonscientific study that I am undertaking so I would love to hear from you all if you’ve got a story to tell. The reason for having you write it out twice is that usually after you write something once and wait a little bit your mind starts to recall the experience and you often remember more than you did in your first draft. And I want the stories to be as in-depth as they possibly can be.

Please send your stories to: wc.walker@yahoo.com

Thank you in advance. And please ask around family and friends to see if they have stories to contribute. Please put, Pets surviving Death, in the subject box!

MS IF YOU WEREN’T ASKED DON’T TELL

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Mount Baker Foothills

Many Americans are aware of the fact that because of the ADA, Americans with Disability Act, they are not required to answer any questions about whether or not they suffer from any disability. In fact about the only thing a prospective employer can ask goes something like this; Are you capable of performing all of the tasks that are required in the job description with reasonable accommodations? That’s it; you don’t have to answer anything else about being disabled or not unless you choose to.

The reason I bring this up is because of a comment a gentleman made on one of my articles that I posted. He said that recently his drivers license came up for renewal so off he went to get it renewed. And everything was breezing right along until he mentioned that he also had multiple sclerosis and then everything changed.

Normally the only thing that you need to do is fill out some paperwork, take the vision test, pay, and you’re done. However, in his case they not only made him do that they also made him take the entire driving part of the test as well. I’m not sure what state he lives in or whether or not this was even legal, but I thought I would write about it and make others aware of this.

And the moral of this story is, if they don’t ask, don’t tell!

MS MERCURY DENTAL FILLINGS AND THE FDA

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Lake at Mount Baker Washington

Is your body a mercury filled time bomb just waiting to explode? Recently senior health officials at the Department of Health and Human Services denied a Food and Drug Administration proposal to phase out the use of all mercury compounds used as fillings for tooth decay which is one of our planets most dangerous and toxic heavy metals.

This FDA proposal was kept secret from the public since it was approved back in 2011 by top FDA officials. This proposal stressed all of the dangers that mercury fillings present to pregnant women, nursing moms, children under six, people with mercury allergies, kidney disease or anyone who suffers from a neurological disorder which would include just about every single autoimmune disease known to man.

The Department of Health and Human Services rejected this proposal after a cost benefit analysis showed that it was cheaper then other alternative compounds for filling teeth regardless of the dangers of mercury or benefits a patient might expect from other materials used for filling teeth.

In 2009 54% of all surveyed Dentists still said that they were using mercury fillings because it was more affordable. And they are still used by many Dentists today who serve both Medicaid and Medicare patients as well as many other price sensitive groups including those that treat children, the military, and on Indian reservations.

Mercury is often described as insidious. After it builds up in the lungs it moves into the bloodstream where it accumulates in the kidneys, liver and brain tissue where it damages the central nervous system. And multiple sclerosis, in particular, is a disease of the central nervous system.

Mercury is linked to all of the following health problems, memory loss, nerve damage, autoimmune diseases, vision problems, kidney failure, depression, autism, and foggy thinking. And recent research is also showing a strong possible link to Alzheimer’s disease. And all of that can occur at very low doses that accumulate over time. And it can also be lethal!

Much of the information used in this article came from Greg Gordon from the McClatchy Washington Bureau

MS AMERICA AND THE COMING ATTACK ON YOUR DISABILITY BENEFITS

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The positive effects about disability laws.

If you haven’t heard yet, the government is saying that social security disability will run out of money by the end of 2016. There are a couple of things that have been discussed to deal with this problem. The first would be to blend social security disability straight into the social security trust fund which is sound financially, at least, for the near future. The second would be for Congress to make a one time cash infusion making it sound until another plan can be worked out. And the third, and the one that seems to be the most preferred by Congress right at the moment, is to just let it go bankrupt forcing a 19% cut in cash benefits across the board for every one on disability including veterans.

And if that wasn’t bad enough, there are also many members of Congress who would like to dissolve the Medicare health care plan that retirees as well as people with disabilities depend on for their health insurance needs. And replace it with a voucher system where you would be required to go out and purchase your own health insurance on the open market. And I can almost assure you right now that whatever voucher they plan on giving you it certainly will not be enough to cover your health care coverage.

I’m not sure how this would affect each of you personally? But for me a 19% cut in my cash benefits means that I will have to put my house up for sale next summer as I would no longer be able to afford both my health insurance premiums as well as the mortgage payment on my home.

In America one in six people are considered to have a disability. And that makes us a very large and powerful voting block with a National election coming up in 2016. I worked all of my life before multiple sclerosis invaded my body and I have no intention of going down without a fight on this. And just as I have written this article I will also be writing letters and making phone calls to Senators as well as members of the House of Representatives letting them know that this is not acceptable.

And that’s something; you should consider doing as well!

GUNS MEN AND VIOLENCE: A question that needs asking.

What do Charleston, S.C, Aurora, Tucson, Virginia Tech, Columbine, and the Navy Yard all have in common, along with all the other mass shootings over the last few years? A gun was used in each place to commit these heinous acts of terror. However, there is one more thing that each has in common, and it’s just as obvious, at least to me, these shootings were all committed by young to middle aged men, not a single woman among them. Which begs the question, why?

Don’t get me wrong, I do feel that America’s gun laws are far too liberal, but it’s obvious that there are more issues than just our gun laws at play here. And putting the blame on mental health problems also falls willfully short of an explanation. Women have just as many mental health challenges as men do and they seem far better at controlling the urge to grab a weapon and act out on their uncontrolled rage.

Is this the fault of society in general or is the American family dynamic so miscued that we are blind to what male children and young men are learning as they grow up, or would it be better to study how we raise are girls and young women to see if an answer to why they are less prone to violence when they reach adulthood?

Just where does the answer lie? And is it possible that if we find that answer might we also discover why rape and sexual violence are also so prevalent, not only in the United States, but also throughout the world?

It’s certainly something to consider, in my opinion!

MS CHOCOLATE AND MY RESPONSE TO A COMMENT

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Yum!

My last article discussing the benefits of eating small amounts of high quality dark chocolate was seen and read by literally thousands of people who also made hundreds of comments. A few of these comments told of getting headaches or stomach aches after eating chocolate. And a few discussed how they just didn’t like chocolate. However, one from a man in Europe, flat out stated that the entire piece was complete rubbish and I shouldn’t be writing such things. It goes on to say that there are several studies showing that chocolate is harmful for people with multiple sclerosis.

And that comment sent me off to the internet for a three hour plus search to see if I could find these studies that he was referring to. My search came up empty as to any study that found chocolate to be bad for people with MS. What I could find basically said that if chocolate, or anything for that matter, makes you feel worse after eating it, then don’t eat or drink it. The closest thing that I could find to a study that was not favorable to chocolate came from a Naturopath site and their belief that MS is primarily a disease that is being caused by food allergies of which chocolate could be one of these foods.

You would think out of the thousands of people who read the article, some of which most certainly work in the health care industry, that one of them would have disputed what I wrote about, but not one of them did.

What I did find of relevance, which wasn’t a whole lot, is copied below with links so you can read it for yourself. And I encourage anyone to do their own searches as I could have missed something along the way. And with that said, I stand behind what I wrote a couple of weeks ago!

Why Dark Chocolate for Peripheral Vascular Disease?

Previous studies suggested dark chocolate may have a role in helping people with peripheral vascular disease. Dark chocolate can help the diseased blood vessels dilate; allowing more blood flow, according to a study in the journal Heart in 2011. Dark chocolate also has properties that block chemicals in the body that constrict the blood vessel, researchers from Heinrich-Heine-University in Germany found. Finally, as mentioned in my prior column, dark chocolate improves body inflammation, is an antioxidant, and can help with certain parts of our cholesterol, all of which contribute to the growth and stability of the atherosclerotic plaques.

What’s New With Dark Chocolate?

A new study of dark chocolate included twenty patients with an average age of approximately 70 years and with moderately severe peripheral vascular disease. The authors, from Rome, Italy, wanted to understand what happened to the function of the arteries and exercise capacity 2 hours after people ate 40 grams of dark chocolate (40 grams of dark chocolate on average is about 200-220 calories, and 1.4 ounces).

The investigators studied blood flow into the patient’s limbs before and after consuming the dark chocolate. They also performed treadmill exercise testing. The patients were studied after having 40 grams of dark chocolate and then a second time after receiving a placebo chocolate (milk chocolate). Even with a single treatment the findings were quite interesting.

11 percent increase in the patients’ walk distances after eating dark chocolate

15 percent increase in their walking time

57 percent increase in the blood protein (nitric oxide) that helps with relaxation and dilation of the arteries
Two markers associated with constriction of the arteries went down by 23-37 percent

In summary, dark chocolate improved blood flow through mechanisms related to relaxation of the arteries (nitric oxide) and oxidative stress and as a result improved walking distances and times.

We currently don’t know how much dark chocolate is too much. So if you are a dark chocolate enthusiast, look to use 40 grams (1.4 ounces) a day as this is what has shown in this study to provide benefit. Hopefully these studies will continue to stimulate investigators to look at multiple doses to allow the consumer to receive the maximum benefit without risks.

Jared Bunch, MD

Dr. Bunch is a native of Logan, Utah and graduated from the University of Utah School of Medicine with alpha omega alpha honors. He completed internal medicine residency and fellowships in cardiovascular

I use chocolate- dark chocolate- to battle pain which presents in a certain part of my brain. It works quite well for me and the pain disappears quite quickly. Yesterday I had this pain twice in one day which is rare. Still, each time the pain hit, the dark chocolate was 100% effective- for me- in melting the pain.

I read of a recent study in Italy using chocolate to combat dementia and to slow down Alzheimer’s. Though the study is still inconclusive, the initial results have been quite promising. Knowledge is important and I always encourage others to read and learn because it is a lifelong pursuit. If we do not use our brain, we will in fact lose it. The saying ‘use it or lose it’ applies to muscles and brain both!
Now I do not have dementia nor Alzheimer’s, but I will keep using it for my MS pain!

This conversation continues at the link below:
Read more: http://www.healthboards.com/boards/multiple-sclerosis/914130-chocolate-mmmmmmmm.html#ixzz3ftvh2tFJ

Foods which are high in magnesium include raw spinach, squash and pumpkin seeds, soy beans, fish (mackerel), brown rice, avocados, plain non-fat yogurt, bananas, dried figs, and dark chocolate. Foods high in folate include raw spinach, black eyed peas, lentils, asparagus, romaine lettuce, avocado, broccoli, mango, oranges, and wheat bread.
Would you be willing to independently undertake the effort to study your own nutritional intakes and take note of any effect on specific MS symptoms you may have, including fatigue? The results would be interesting.

– See more at: http://www.healthcentral.com/multiple-sclerosis/c/19065/169283/folate-correlates/#sthash.7KToo5xt.dpuf

The following from a Naturopath site was about the only extremely negative comment about chocolate that I could find in two hours of searching. And again even here it assumes that a food allergy may be the cause of Multiple Sclerosis.

Chocolate Avoidance

Epidemiology studies have documented a correlation between high cocoa consumption and high MS incidence. When cocoa is introduced to an area, MS incidence rises sharply. Cases are reported in which chocolate ingestion by MS patients was followed by exacerbations [Maas AG, Hogenhuis LAH. Multiple sclerosis and possible relationship to cocoa: A hypothesis. Ann Allergy 59: pp.76- 9, 1987]

Here is the abstract of this article: “The hypothesis presented in this paper suggests that MS may be caused by an allergic or other adverse reaction to certain foods, mostly cocoa products, cola, and coffee. Many MS patients have one or more manifestations of other well known reactions to those foods, such as migraine, urticaria, or gastrointestinal disturbances.”

Multiple Sclerosis by the Numbers

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Worldwide the number of people that have been diagnosed with Multiple Sclerosis is somewhere between 2.3 million and 2.5 million. In the United States there are roughly 450,000 to 600,000 individuals that have been diagnosed with MS which mathematically works out to 1 in 4 or 25% of all patients world wide. And that number is quite simply staggering when you consider that there are 7.5 billion, give or take a few million, people now living in this world. Which if my math is correct means that about 3 out of every ten thousand people will be diagnosed with MS worldwide. In the US that number works out to roughly about 2 out of every thousand. I admit these are very rough numbers but there close enough to show that the incidence of MS in the United States is much more prevalent then anywhere else on the planet.

Let’s look at this in a different and even more startling way. If we take the number of US diagnosis’ and divide that into the total number of people afflicted with MS worldwide we find that 1 in 4 or 25% of all people with Multiple Sclerosis live in the United States which definitely begs the question, why? Especially when you consider that we have roughly 5%, or one 20^th, of the total world population, again I ask, why?

When I worked through these numbers I did only the Multiple Sclerosis numbers that are easily found on the internet and I didn’t look into all other autoimmune disorders as a whole but I wonder if I did would they show a similar distribution of autoimmune disease in the US as compared to the combined world population?

If my math is even close to being correct it strongly suggests that there is some kind of environmental trigger that is far more prevalent here in the United States then anywhere else in the world that’s the only thing that makes any sense. And in my opinion with this information it should not be all that difficult to determine what that environmental trigger really is which would answer a whole lot of questions about this, and perhaps other, disorders of these kinds and what kick starts these disease processes into over drive.

What do you think? Make some noise whenever and where ever you can. I strongly suspect that we, who have these autoimmune diseases, are the canaries in the mine and are just the first people to succumb to an ever, and increasingly more polluted, and sick planet!

Bill Walker

Multiple Sclerosis And Beyond

Bill Walker: msandbeyond@gmail.com