Menopause Matters Forum
General Discussion => New Members => Topic started by: Nas on March 31, 2019, 06:41:02 PM
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Hello everyone,
I am new to the forum. 47 and experiening a selection of delighful menopausal symptoms. Had a BC diagnosis ten years ago and have subsequently been refused HRT on the NHS. I am seeing a private meno specialist in a couple of weeks, as want some relief; as of yet I am not even permitted to have an oestrogen cream for sore bits!
Hope to chat soon.
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Hi Nas..... :welcomemm:
Post away, have a moan, (we all do that at some point, ) ask questions, someone's
always on to try and help....
Good luck with your appointment......🤞
Jd xx
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Hi! well you can go back to the GP and tell her/him that localised treatment for vaginal atrophy is the only way of easing symptoms and that it is unlikely to affect your diagnosis of 10 years ago ::) which of course, he/she should already be aware of. I had treatment in the 1990s and my GP never hesitated - it was like razor blades up there :o and I could not have lived with those symptoms.
Browse round. Make notes ;)
Some ladies find that sylc and yes products help soothe the vaginal area.
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Hello Nas, please read Kirsty Lang in the Daily Mail today. I think you may be able to use all her info and research regarding BC and HRT xxx
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Hia Nas, a warm welcome to the madhouse ;D
Bit shocked at the hard-line your GP is towing. It's your menopause and it should be your way that they follow.
My mum died of BC age 50, so I wondered if I'd be a candidate for hrt. After seeing an NHS gyn. He said we will absolutely treat you if you present with issues needing help and relief, he then said..."Even if you yourself had BC we would still offer you hrt"
Hope you get the help you require.
Keep us posted.
TD
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Nas. Just wanted to say hi and welcome to the forum.
Please feel free to post about anything you want to I have only been on here 6 months but I'm so glad I came here.
Xxxxxx
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Hi all
Thank you so much for the warm welcome, it is very much appreciated.
To be honest, I feel quite hard done by at the moment. I first GP I saw, thought I was joking when I mentioned HRT. The second, was slightly more sympathetic, but when I asked the questions outright, he merely strugged his shoulders and said "oncologist says no"! I have since written to her (as he has done) and asked for an appoitment to discuss face to face, my risks of even using a cream! I have read the article in the Mail Agatha, which has made me feel more angry and resentful as I can see that there may be some benefits of taking HRT, it isn't JUST about potential risk.
Another question. The NICE guidelines. Who writes them? Who says that women with a history of BC must not be given HRT? Does that mean that GP's who do presribe. are going againat the grain? Why are some GP's (like the entire practice I am registered with, so against prescribing? What evidence of facts do they have?
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Hia Nas!
Your experience with GP's and the subject of hrt went almost exactly the same as mine did.
I saw a couple of different ones and there was a lot of shrugging of shoulders and go away and tough it out. After the 3rd time, I got a referral to a gyn bcz I needed more answers than they could give me, and as they saw me as being at a "perceived higher risk" I got referred.
I think there defo is a lot of passing the buck and no one GP wants to be left holding the baby on the decision to ok hrt to someone with a "perceived higher risk" such as us. The way I circumvented this was by researching my head off and being sure of what I wanted.
Armed with this all written on paper with questions too, I went to gyn apmnt and asked for bhrt, which he as I mentioned before had no problem with prescribing.
Interesting to note though when I received the copy of gyn's letter to my GP the gyn wrote...The patient has asked for such and such and I prescribed it. So in some way he was covering his back, and he was correct, I did ask for it. I'm cool with all of that, after all, it is my decision. It's me who is obv struggling suffering so much that I'm willing to educate myself and weigh up the risk/benefits and take control of my own health situation. Your health is everything, and quality of life is a big part of that, it's to easy to lose a grasp of this when you become fixated on risks, trust me I've been doing that for years :-\ Only you can decide whether the risks outweigh the benefits or visa versa in your given situ, and which of them deserves your full focus.
This day and age we can't remain ignorant regarding our own health and wellbeing, we have the internet now. it's not like the old days where the GP's were the only one's party to any in-depth info. Nowadays you can actually hold your own on a subject and go tow to tow with some GP's who have general knowledge on a lot of health concerns, but I found knew very little on the subject of hrt for ppl with any connection to BC.
TD
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Hi Nas, Welcome. I really hope with the advice you get on here that you get the required help. I am a higher risk of getting bc but do use Vagifem which has been such a relief to the ladybits. Good luck
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Hi nas welcome to the funny farm,ask away,nothing off limits here xx
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Thanks TD, you are so bang on the money with much, if not all of what you say.
Okay, they say I am 'more at risk; than a woman who have never had a BC diagnosis. Am I really, a decade down the line??
Risk,versus quality of life..Mmmm.. well I am 47 and my bits are sore as hell and I bought sylk last week, which to date has done notghing. I am dried out inside and out. A few weeks ago, I was barely able to drive, due to palpatations and anxiety. 20 minutes in the car was proving too much. Mood swings and trying to apply for jobs.
I relayed all this to the first GP, shrug of shoulders. Do I need to tell them I have suicidal thoughts? Or will they say "you should of taken your fluoxetine then"?
You are so right TD, we are in the 21st century, where we now take control of our bodies and well being. All you hear is 'well being and mental health' . I will continue to fight my corner and am hoping that the private meno lady is money well spent on!
Thank you again, you have made me feel less alone at least :) :)
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Please keep posting Nas.xx
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Hi again !
The estrogen creams; ovestin and estriol, which are listed on the the treatments section. What does the price relate to? How much they cost to be manufactured, or how much they are on prescription? I think I need one of these urgently, but cannot find a way of getting it. I see the private meno lady on the 16th and am hoping that she will prescribe it for me. Will I be able to get the prescription on the NHS, does anyone know?
Such a long haul to obtain the simplist of treament :(
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Nas, there's no reason why you shouldn't get Ovestin or Vagifem on the NHS. Your specialist can write to your GP with his/her recommendations as to what should be prescribed, and hopefully they will follow the advice.
JP x
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Joanie I an still waiting for the oncologist to get back to the GP. In their initial letter they didn't even mention localized cream etc, it's so so annoying. So the GP has written again and I have written. But it's taking ages. In the interim, I am suffering.
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Nas. Could you possibly contact the oncologist secretary and get them to send the letter electronically ?
When i was waiting for oncologist letter to gp I phoned the secretary and found that she was still typing letters from 3 months previous.it seemed to hurry up the process as it was sent very quickly after that by fax or email not sure which.
X
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That was my thought, contact the Secretary and ask for the Consultant to write to your GP. We have a Member here who has written a book, the Consultant is a candidate for a copy : Me and my Menopausal Vagina : ;)
Let us know how you get on! In the mean time, take some pain relief which can ease symptoms.
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Hi
Yes I've emailed her secretary and asked if the oncologist could please email my GP with ger thoughts on cream or pessary. It feels as though I have no control over my own body and it's making me so mad! Had she said yes to the cream in her initial letter, I could have obtained the prescription last eeek and might be feeling a bit better by now! >:(
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Hi Nas, so sorry to hear you are having problems getting the treatment you need. GPs are sadly often not up to date on HRT & will err on the side of caution. My understanding is that women who have had breast cancer, even if invasive, can usually use topical (i.e. vaginal) HRT with the blessing of their breast care team - including surgeon & oncologist.
After the initial few weeks there is virtually nil systemic absorption of the already low dose oestrogen these topical medications contain. They may be more willing for you to have Estriol cream than Vagifem though, as this is a weaker form of oestrogen, but I believe either is usually considered OK.
As you were treated so long ago I guess it's possible some of your breast care team will have moved on by now, but someone with access to your history should be able to advise, assuming you are not still having occasional follow-up appointments.
Some breast care specialists are also willing for their patients to take an informed decision to use systemic HRT for improved quality of life, but this may depend upon the type & stage of your past cancer.
I would chase for written approval from your oncologist as suggested by the other ladies & keep a copy of any letter of authority you get to show any future medics who may question your use. You may also find it helpful to read what Dr Avrum Bluming has to say in the recently published book Oestrogen Matters (co-authored by Carol Tavris). He is an American Oncologist who has spent 20 years treating breast cancer patients and is open minded about their later using HRT.
I do feel for you - it's a difficult & important decision, so I would find out as much as you can so you feel comfortable with whatever treatment you decide to push for. Good luck with it & I hope you start to feel much better soon.
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Quality of Life. As well as if the medical profession are so worried why not prescribe, watch and make notes? It's OK going back in time but we need modern-day information about how exactly HRT may impact on ladies who have had breast treatment.
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I agree CLKD - we need more studies. Women in need of systemic HRT after breast cancer sadly still face a very difficult decision.
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Thank you both.
I totally agree with what you say. I have regular mammograms, but no contact with breast nurses or surgeons now. I had no idea that they would have to consult with an oncologist who I haven't seen in years, to obtain a bit of cream. To me, it's my body, my decision, end of. The private lady who I am seeing on the 16th said she prescribes the cream and/or pessary, as the amount of oestrogen absorbed is minimal. You are right Wrensong, we do need more studies, otherwise how are they going to know what the exact risks are? I may get a recurrence without HRT, I may not. Life is a risk? I am currently waiting for the oncologist to email the GP and get an appointment to see her, but it's taking ages. I just don't get what the controversy is because none of them can tell me what my risks are now, therefore I can't even make an informed choice.
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I never had to see my Team after discharge back to the GP :-\ who prescribed VA treatment without hesitation.
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Hi again Nas, it sounds as though your GP is being ultra cautious - I think it's entirely possible that another surgery or maybe even a different GP at your current surgery would have prescribed the topical HRT without feeling the need to consult your oncologist, as CLKD tells us was her experience. It can come down to an individual GP's confidence & their past experience with other patients. My former GP, a middle aged woman who has now retired, was anti HRT altogether. She was a lovely person who I got on very well with but we did not see eye to eye on HRT. I felt it was unfair to push her to prescribe something she felt uncomfortable with so went to 2 private consultants for advice before I eventually began HRT after more than a decade of life-wrecking symptoms (with a family history of breast cancer). Another medic, a bloke & much more confident, clearly felt I was not enough of a risk taker & was fond of pointing out that every time we get into a car etc we take a risk. Neither approach was particularly helpful - becoming as informed as I could (& desperation) was what helped me decide what to do.
People have such strong opinions about HRT & sometimes these are unfortunately based on out of date information or worse still, ignorance. "Do no harm" also resonates louder with some medics than others - though of course denying you the topical HRT you need is a decision that has harmful consequences for you not only physically but in the amount of stress the runaround to get it is causing. But I imagine your GP would consider the harm at the other end of the scale to that he/she is afraid of. I think unless it is a female GP who has personally experienced VA it can be impossible to appreciate the misery the condition can cause. Some tend to think it's just a bit of dryness that can be sorted with a vaginal moisturiser or lube. But for many of us it is far more than that.
It can put us in a very difficult position & really ramp up the stress when we know a medic has our best interests at heart & opposes what we feel we need, though we are willing to take a risk for the sake of quality of life. It can feel as though there is an unfair balance of power & that's hugely frustrating.
There is simply not enough information for women who have had BC to make a thoroughly informed decision about HRT use - it can only be made on the incomplete info that is currently out there. It sounds as though you accept that & are wiling to take responsibility for the decision, but if it is just topical HRT you need it is generally considered OK after BC treatment has been completed & I think you have just been unlucky in coming up against such a song & dance to get it.
I hope the oncologist approval comes through quickly, but if not, you have the private menopause clinic appt coming up. Can't help feeling it should not have been necessary for you to go to these lengths or pay for private treatment, but many of us unfortunately have to resort to this where HRT is concerned. Good luck with it - I hope you find some sympathetic help & can get on with your life with good relief from symptoms.
Wx
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Hello Nas
:welcomemm:
You've been given a lot of excellent advice already.
To answer your earlier question about who writes the NICE Guidelines - they were drawn up after about 2 years of work by an expert panel - the Menopause Guidelines Development Group - who met regularly to go through all the literautre after first doing a public consultation to decide the scope of the guidelines. These were published in November 2015 as two main documents - the summary guidelinesa nd recommendations for clinicians, and full guidelines which gave detailed analysis of the sceintific papers and evidence used which enabled them to come to their conclusions and on which to base their recommendations.
Obviously the research is out of date as soon as the Guidelines are published as new research is happening all the time - but they are the best we've got. The British Menopause Society and other worldwide menopause societies also regularly publush their own recommendations every few years - on HRT generally and including risks of conditions developing after use and also from using HRT after certain conditions.
Just recently the BMS has prpduced papers on breast cancer and HRT and they have also produced a simplified consensus statement here:
https://thebms.org.uk/publications/consensus-statements/the-diagnosis-of-the-menopause-and-management-of-oestrogen-de%EF%AC%81ciency-symptoms-and-arthralgia-in-women-treated-for-breast-cancer/
The point you will be interested in is:
"Lifestyle measures and non-hormonal interventions should be first-line management for estrogen deficiency symptoms but if these are ineffective systemic hormone replacement therapy or low-dose topical estrogen may be considered but only after taking specialist advice."
There was also a very detailed somewhat technical paper produced in March which I downloaded but can;t find a link to the full paper but I have extracted the relevant part here - apols for formatting as it;s a pdf:
"The British Menopause Society
consensus statement on the
management of estrogen deficiency
symptoms, arthralgia and menopause
diagnosis in women treated for early
breast cancer
Jo Marsden1 , Mike Marsh1 and Anne Rigg2;
on behalf of The British Menopause Society
Vulvo-vaginal atrophy
(i) Commercially available vaginal moisturisers and
vaginal lubricants are recommended as first-line
treatment.38,54 It has been suggested due to the
weak estrogenic activity of parabens, that lubricants
containing these are avoided (e.g. K-Y
jelly, Replens, Astroglide); however, clinical
data to support or refute an adverse effect on
women treated for breast cancer are completely
lacking.55
(ii) If symptoms persist, low-dose vaginal estrogen
can be considered in women who have estrogen
negative tumours or who are taking tamoxifen,
but due to absence of clinical trial evidence confirming
lack of an adverse effect, advice about
prescribing should follow that as for systemic
HRT, above, and should be discussed with the
relevant oncology team.
(iii) Low-dose vaginal estrogens should not be used
in women taking aromatase inhibitors. The oral
SERM, ospemifene, is not recommended for the
treatment of refractory vaginal symptoms as
there is a lack of any evidence about safety in
women with breast cancer, although preclinical
studies suggest a neutral effect on breast
tissue.5,38 Available studies only have shortterm
follow-up using unreliable surrogates for
predicting future risk (i.e. clinical breast examination,
change in mammographic breast density,
breast tenderness).56 The Food and Drug
Administration and Endocrine Society support
this recommendation against its use although
The European Medicines Agency state it may
be used after completion of breast cancer
treatment.48,57,58
All guidelines and consensus statements concur with
the recommendations of the NG23 for use of vaginal
moisturizers and lubricants as initial treatment and
consideration of low-dose topical estrogen if symptoms
are refractory.5,43,48,51,53
Alternative interventions, which may be possible
options for future management of symptoms in
breast cancer patients include vaginal laser treatment
(i.e. the fractional CO2 and erbium lasers) and intravaginal
dehydroepiandrosterone (DHEA) but both
require further evaluation. Preliminary study of both
laser treatments and DHEA for their short-term efficacy
in breast59–62 cancer patients is encouraging. For
laser treatments, evidence of long-term efficacy and
direct head-to-head comparison with topical estrogen
is necessary before informed recommendations can be
made. DHEA has the theoretical advantage of local
delivery of active estrogen and androgen metabolites
via the activity of aromatase in vaginal epithelial
cells, with minimal, probably clinically insignificant
increases in serum estradiol, estriol or free testosterone
and appears efficacious in women treated with tamoxifen
and aromatase inhibitors, the latter suggesting
these may not impair intracellular, vaginal aromatase
action. However, its safety in this group of women
requires confirmation in clinical trials.54
Practice points
(I) If symptoms of vulvo-vaginal atrophy are not
relieved by vaginal moisturizers and lubricants:
a. Topical estrogen should not be used if a
woman is using an aromatase inhibitor due
to concern systemic absorption (albeit very
low) may negate the latter's efficacy.5
b. If a woman is using an aromatase inhibitor,
switching to tamoxifen may ameliorate symptoms.
This beneficial effect can take up to
three months to become evident.
c. If switching to tamoxifen fails to improve
symptoms, additional prescription of lowdose
topical estrogen can be considered.
d. No changes to breast cancer medication
should be initiated in primary care.
Discussion with the breast specialist team is
obligatory, as changes to therapy could
potentially affect disease-free survival, particularly
in higher risk women.
(II) Ospemifene should not be prescribed to women
with a history of breast cancer.
(III) In addition to the management of vulvo-vaginal
atrophy, women with symptoms of sexual dysfunction
may require referral for psycho-sexual
counselling, education about use of vaginal dilators,
pelvic floor relaxation techniques and support
for the management of body image
concerns arising from previous breast surgery,
treatment-induced hair loss or thinning or
other reasons.29
(IV) In a symptomatic woman who has completed
breast cancer therapy and been discharged
from specialist follow-up, health care professionals
in primary care should contact the patient's
breast care nurse for advice as they are best
placed to triage concerns and advise where to
direct the patient."
I haven't had time to read it recently but hope it might be of some interest!
Hope this helps :)
Hurdity x
PS Hello Wrensong - good to see you on here again - how are you?!
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Hi Hurdity, thank you for posting the new BMS guidelines etc. Para 4, which you have quoted, is especially interesting as it seems to indicate a shift in thinking towards a more open-minded, pragmatic approach towards systemic HRT after BC. I think the emphasis on advice from breast care specialists on a case by case basis is the important thing to take away - type & stage of disease, subsequent treatment etc will all be relevant.
I am OK - thank you for asking!
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I recently came across the following article on an American website called Breast Cancer Choices, containing the headline paragraph:-
"HRT After Breast Cancer - Published Evidence Contradicts Medical Advice
Most health care practitioners remain unaware that most published
medical literature shows breast cancer patients taking HRT actually
experienced equal or better survival than patients not taking hormones.
See studies below from the most prestigious medical journals.
The 26 studies below are listed in no particular order."
http://www.breastcancerchoices.org/hrt.html
I have not reread it before posting here, but from what I remember, some of the studies are short & followed only small numbers of women & some relate to oestrogen-only HRT, but they followed women who took HRT after a breast cancer diagnosis & don't seem to be referring to the statement we sometimes see quoted that women taking HRT at time of diagnosis seem to fare better than those not on HRT. I would not rely on it as a tool for making a decision about use of HRT after breast cancer - my feeling is that's a personal decision best made after in-depth discussion with the clinicians involved in an individual's treatment. Nevertheless, it makes for interesting reading.
If you see this Hurdity, I would be interested in your thoughts - I haven't looked at each of the studies quoted in depth so don't know how rigorous or reliable they are. :)
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Hello again and thankyou all (again!) for your excellent advice, thoughts and reading material.
Just to update you. I went to see a private GP with an interest in the menopause and well being yesterday. We spoke for an hour and a half and in that time, she gathered much information.
She was happy to write a 'Dear GP letter re: the vagifem (but the oncologist has now given the green light for this, finally!) Can I just ask what cream is recomended for the outer bits; is it ovestin?
Re: the prescription of any form of HRT. She wants to know from the oncologist, what my risks are of a recurrance, ten years down the line. How is the oncologist going to know that? Will studies have been done? Private GP said she is happy to prescribe either way (once I have these statistics!) but be it on my shoulders.
At one point yesterday, I did wonder if I was doing the right thing in requesting the drug??
She has given me Femarelle.. any experiences of that working? :thankyou:
Nas :)
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p.s is YES VM avaiable on prescription does anyone know? I have to pay for my prescriptions, so it may be cheaper to buy online? :)
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p.s is YES VM avaiable on prescription does anyone know? I have to pay for my prescriptions, so it may be cheaper to buy online? :)
Yes VM is available on prescription. To buy your own from the Yes website, 100 ml tube is £10, 6 x 5 ml applicators £12, 30 x 5ml applicators £40. I don't know which format they would prescribe on the NHS. The cheapest way to use it internally is to buy the 100 ml tube and use it with the syringe-style applicators from Stressnomore.
JP x
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Thank you Joanie.
I have bought some online and ordered a prescription too.
I hope it works! :)
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Hi Nas, thank you for updating us & I'm really glad you had a comprehensive consultation with a sympathetic & knowledgeable menopause-oriented GP :) Great to know your Oncologist is happy for you to use Vagifem - do keep a copy of any correspondence documenting that, to produce should any new medics question your use.
The lowest dose cream for external use is Estriol 0.01%. This is a weak form of oestrogen in very low dose & is applied thinly, but can make a make a huge difference to comfort levels. There is a stronger formulation - Ovestin & I was prescribed this for external use initially, but I would ask for the weaker Estriol to start with, as this may well be quite enough if you are using Vagifem internally. Either Estriol or Ovestin can be used internally with the appropriate applicator as an alternative to Vagifem, should you find after a reasonable trial period that Vagifem doesn't do all you hoped.
As for your question about risk of BC recurrence, your Oncologist should have access to stats relevant to your type of & treatment for BC. It may be difficult for them to give a definitive answer & you may want to request a consultation with him/her to ask questions in detail.
If you are considering systemic HRT, no-one can make the decision for you, but if you research as best you can & seek advice from relevant medics, this should help you arrive at a decision you feel comfortable with. Some forms of HRT are considered more breast-friendly than others.
Assuming you still have a uterus so cannot take oestrogen alone, it's generally recommended to keep progesterone exposure to a minimum - so sequential rather than conti regimes. The latter are anyway not usually used until postmenopause - sorry can't remember where you are on that. Micronised progesterone in the form of Utrogestan is currently thought less harmful to breast tissue than synthetic forms of progesterone, known as progestogens. However the Oestrogen Matters book I think I mentioned earlier also suggests that women who cannot tolerate the "gold standard" regimes using Utrogestan with a transdermal form of oestradiol (gel or patch), need not worry unduly.
Unfortunately there are not enough good quality, long-term studies of HRT use after breast cancer. Please do read up as much as you can though & maybe ask to discuss it with your Oncologist who will be best placed to advise according to the type of BC & subsequent treatment you had. It is a difficult situation to be in, so I do feel for you & wish you all the best.
I have no experience of Femarelle, but hopefully someone who does will be along soon to help with that.
Wx
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Hi Wrensong,
I would like to thank you for taking the time to write such an informative and comprehensive reply :thankyou:
I am awaiting an appointment with my oncologist, so I will most certainly have many questions at the ready. I too am pleased that she has agreed to allow me the vagifem; is the estriol cream or ovestin available over the counter do you know, or are they strictly prescription creams only? I am hearing that once the 14 day load of vagifem has been administered, the then twice a week dose may may not be enough? IF this is the case for me, does that mean a continous prescription of vagifem forever?? I am hoping the vagifem and either YES or Replens will do the trick, but I guess it's a case of watching and waiting.
I think my sage and red clover tablets may be doing something, as the flushes don't seem so severe or frequent. Or maybe, I have been too preoccupied with my bladder (another thread) to notice!
It is indeed a dilemma all of this and more more complex and controversial than I ever imagined. To me it was so black and white. To the medics, it opens up a whole can of worms!
:)
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Hi Nas, you are most welcome :)
Yaaay to the Oncologist appt! Well done you for getting that sorted. Should be the right person to help. Some are anti-HRT some are more open-minded where quality of life is seriously affected & their advice may also depend on your particular history.
I think Ovestin & Estriol are prescription only. Yes, it is possible that after the initial 2 week loading, twice a week Vagifem will not be enough, but equally possible that it will. No way of knowing until you try it! Some women are fine on 2 nights a week on a maintenance basis, some need more. Yes - topical HRT for the lady bits is usually a long term medication. Once we stop using it, the atrophy symptoms tend to return. But not everyone needs topical HRT in the first place. Some seem to get by with non-hormonal moisturisers & lubes. Even with Vagifem, Estriol & systemic HRT for those ladies who need the lot, an additional lube may be necessary for sex. There's a distinction between vaginal lubricants & moisturisers; lubes for sex, moisturisers for comfort from day to day, but some can be used for both - I think Yes market their water based product for both uses. I've tried everything on the market & had both Replens & Yes VM on prescription at different times but nowhere near adequate without HRT. You should be able to find an effective combination once the Vagifem gets to work though. A little blue magic wand!
You may want to discuss the Sage & Red Clover tablets with the Oncologist - they may be perfectly harmless but I would be wary of anything that may work on hormone receptors.
You are absolutely right - it is hellishly complex & very controversial. Never was there a bigger can of worms! It is a lot to get your head around - the studies are conflicting & understandably most medics err on the side of caution. No medic wants to cause any patient harm, so some shy away from getting involved altogether. But some with a special interest in the area are brave enough to become highly informed in an effort to help patients who find themselves in the horrible situation of needing HRT after breast cancer.
Do PM me if there might be any way I can help & I don't seem to be around on the forum - not sure how often I'll be logging on.
Wx