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Hi everyone,

 

This is my first post but I have been reading daily for about a month. My son was diagnosed with PANDAS in August after a sudden, explosive onset of tics. ( he had previously had a chronic cough since age 3 - now we know it was a tic) In August this year a week before starting Grade 1 he pretty much woke up with complex vocal and motor tics that occured every second all day long. The doctor was familiar with PANDAS and he was put on antibiotics, on day 3 of antibiotics tics were 80% gone. By the end of the course of antibiotics they were 95% gone. To make a long story short every time he went off the antibiotics within a few days to a week the tics would return and he would deteriorate quickly and then again improved within 3 days on antibiotics although each round of antibiotics it seemed to take longer to improve. He is currently on day 25 of amoxycillin and is pretty much tic free other than in the evening watching tv ( which is a clear trigger - Claire your survey was excellent --when his tics were really bad we did try to eliminate the tv - the most he is currently watching is a 1/2 hour - we did see improvements with the reduction of tv) We have stayed at the 1/2 hour rule as best we can. He does not play game boy or use the computer. We had seen a naturopath who recommended EFA, oil of oregano and a Probiotic, none of which we could get into him because of the taste.

 

Currenly my son is tic free through the day, he has some vocal gasping sounds while watching tv in the evening - for his half hour before bed - a month ago it was literally every second and would include facial, vocal, eye, and body tics -- so there has been a tremendous improvement, I am also noticing as he is falling asleep he is making a vocal sound, almost a humming sound - this seems new. Again a month ago when falling asleep he was doing a loud jaw click and eye roll every second so again this is much better - maybe the hum was always there but I did not notice it as I was so focused on the more obvious tics.

 

 

I am pretty overwhelmed when I read all of the vitamin/supplement info, my current plan is to switch to a prophylactic antibiotic for a while, I have read the pros and cons of this but as I have seen such positive results I am not prepared to stop at this time. I am interested in adding some supplements in hopes of eventually going off the antibiotics and sticking with more natural stuff. Are there some basic vitamins I could easily add at this time? He currently takes a chewable multivitamin as he does not know how to swallow pills. He is also a very fussy eater.

He has no other medical issues, no OCD, no anxiety, no social issues. Academically he is doing very well, he had some trouble briefly when off the antibiotics with ADHD type behavior but once back on the antibiotics he was fine again. He also briefly seemed to have trouble at school with concentration - at the time that his eyes were ticcing pretty much constantly. Teacher currently has no concerns and has advised she has seen no tics in recent weeks.

 

Thank you in advance for any info. I have learned a lot from this site along with many other sites.

[Claire]

Hi Alison and welcome!

 

I completely understand your wanting to do what works (e.g. the antibiotics). I suspect that they DID kill the residual strep (and it may well have recurred--I have been there myself). Keep in mind that the studies I have seen show that prophylactic antibiotics didn't seem to work.

 

I am betting that the antibiotics killed the strep, but with recurring doses, yeast started becoming an issue.

 

It is a viscious cycle that I have been in myself with bladder and yeast infections, darned if you do, darned if you don't.

 

Recurring infections can be a sign of zinc deficiency. Many many of these kids are deficient there. Some doctors recommend taking nystatin with the antibiotics (as well as probiotics, which you know about). (they can compound a liquid for you). I think the probiotics are critical here. Klaire has a powdered one that I personally thought (and still think) tasted good, but my son wouldn't touch it. Even so, it could easily be blended into an icecream and I am sure it wouldn't be noticed, it is such a small amount.

 

Many came to this board with PANDAS and many found they also had other underlying issues such as elevated metals. The metals depress the immune system, as part of this cycle. I would suggest getting some of the other tests done and seeing what else is going on.

 

Re the TV, have you looked into a small LCD monitor/TV combo? It definitely made a difference for us. A friend told me COSTCO has them for dirt cheap right now. Remember to keep the room well lit. And I sure hope you avoid the video games as long as is possible.

 

Good luck.

Claire

[Chemar]

Hi Alison

 

Ronna is a PANDAs expert and found that only certain antibiotics were effective for the strep elimination.

 

You may want to PM her for details. I know there is a thread she kindly did with lots of PANDAs info on it, so you may want to search the forum for it.

 

 

Her son is much improved since she implemented supplements and dietary modifications etc

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Hi Claire and Chemar,

 

Thank you for your quick replies. I have connected with Ronna through the brain talks site - and have probably read most of her previous posts which have given me a lot of information. I feel at times through I am at information overload and just want a quick answer or better yet a quick solution!!!

I re-read an old post from Claire about a quick test for yeast - spitting in water in am - we are going to do that tomorrow. To our knowledge our son is not experiencing any yeast problems or leaky gut problems but I am not sure what we should be looking for. There have been no obvious signs of bladder or yeast infections. Claire you mentioned we should look into further testing regarding metals - what sort of testing do you mean and who would do that testing - our regular doctor? When you say that I should give him nystatin with the probiotic and they can compound this for me - is this at a pharmacy? naturopath store? You said Klaire has a powdered probiotic, is this a brand name? You said zinc may be a problem in terms of deficiency, should I just start giving him a zinc suplement? I am currently giving him antibiotics three times a day, my understanding is I should not give vitamins at the same time, what time should I allow between the two? I really am new at all of this - sorry if these are such obvious questions.

He currently gets a children's multivitamin, he is a terrible eater, eats pretty much no vegetables, and only apples, grapes and banana's for fruit. ( I do hide sweat potato, yams, and zucchini is small cupcakes). Meat wise he will only eat hamburgers and hot-dogs. He went about 6 months on ketchup sandwiches when he was 4 - I had blood work done then as I was concerned about iron deficiency but all blood work came back normal. He is growing normally and in fact probably the tallest in his class, he seems to be going through a growth spurt which my mother's believes is somehow responsible for some of the tics. He has lots of energy, plays sports and is never lethargic.

He seems keen on trying to learn how to swallow pills so I am going to go to the naturopath store tomorrow and see if I can get the EFA in pill form as well. With regards to the LCD monitor, has this made a big difference for many kids, is it noticeable right away? Tonight he has been watching more tv than usual after a busy day of Christmas concerts etc - his tics are actually minimal, much better than last night while watching TV. The Tv tics seem to be the slowest to improve but if I step back a re-read my daily notes he does continue to improve significantly, I almost feel I should just be happy where he is now as the tics are minimal, I just would prefer they be non existent. I also do find it a challenge to limit the TV for a 1/2 hour. I never realized just how much I rely on it when I am busy with the baby etc etc etc. I will have to check out Cosco here in Canada, you said they have one that is cheap - I guess that is all relative, a week before Christmas with 3 kids waiting for many present from Santa!! But...if it does seem to help most kids I will buy one regardless of price.

Claire, was your son diagnosed with PANDAS, I seem to recall you saying he would have some OCD or anxiety along with strep and it would clear up with antibiotics. Did you do a long round of antibiotics the way we currently are?

 

Thanks again for any information you are able to share. What a fabulous forum.

[Claire]

Alison,

 

Under the direction of our DAN/environmental doctor and later Pfeiffer clinic, my son has been through most of the same testing protocol that they do for autism spectrum disorder kids. He isn't on that spectrum, but it appears that many of our kids with tic disorders have similar underlying issues. For example, their desire for a limited diet is very common--my son had it too in a big way. When we removed gluten and casein, that changed somewhat. But we tested for issues before we did anything. Anyway, he isn't big on proteins either. Unfortunately, the foods they crave are often those they are allergic too.

 

The LCD monitor is night and day for our son. He has had zero tics in over one year, one set from accidental exposure to CRT screen, and none for 6 months before that. I looked at the costco site and my friend was wrong, the LCD monitor they had didn't work for TV. LCD TV's were $1000, but you can now get the SyncMaster TV/computer monitor that Samsung makes for $450.

 

I am not for restricting screens, or even buying a LCD unless you are pretty confident that it is a trigger. That is why I recommend the no screens week--the TV tics can take a full week to resolve! I know how hard it is, many here have had difficulty. Many of us have also experienced the electronic babysitter aspect. That is why I got booktapes and building toys for his much needed downtime.

 

My son has no diagnosis at all. He only had facial tics for a month (never vocal) 3 years ago when I figured out the cause and removed the computer for a long time and the tics completely disappeared--no exaggeration there. Later he developed the TV sensitivity also, so we removed it, and the tics went away completely also. It took us a while to figure out that the LCD monitor (small one, far away in a well lit room) was viable. But someone here (efgh) had a child who was sensitive to the LCD for a time too. I wasn't comfortable letting my son watch unlimited LCD until we treated his mercury, vitamin deficiencies and food sensitivities.

 

He did get fears with strep for sure, so I studied PANDAS a lot. I would still do antibiotics at any sign of strep/fears--the fears disappeared with the strep disappearing 100% correlation. But he is not PANDAS because we cleared it up immediately--mostly because by the time it happened, I had read about it and as you know if you treat right away, then at risk children tend to not get the tics/OCD as a chronic issue. I did one round of antibiotics, but the strep cycled through our house twice (we all got it and my husband's came back (he retested positive) so we all got it again. THe fears came back with the second round and went away with the antibiotics. I personally believe it worsened his yeast. He never had any signs of yeast (as I get), but the Great Plains test showed positive (as did the spit test).

 

Certain compounding pharmacies can make nystatin (liquid or capsules), with a doctor's prescription. I wouldn't treat yeast unless the Great Plains (or whatever test your doctor likes) shows positive.

 

Heather's child had PANDAS and she did the yeast treatment using Threelac with great success.

 

The probiotics are to be given 2 hours after the antibiotics, per our doctor. Vitamins can be given anytime, or at least we weren't told of a restriction.

 

Klaire Labs makes the probiotic and www.needs.com (I use the phone sales) sells that brand. We just buy our brands locally, but I know that I liked the taste of their powder. Some do yogurt, but my son can't have casein.

 

Great Smokey's Lab does an elemental analysis blood test for mercury and other metals.

 

You have clearly read a lot on here and elsewhere good for you. I would read the threads I bumped--others may bump other threads for you. It took a year of intense work for me to get here--with lots of ideas from the board and an excellent doctor. Too much info for one thread! Fortunately, the site editor is writing a book, I am looking forward to being able to refer people to it.

 

Claire

[Ronnas]

Hi Alison,

 

As I said on braintalk I don't know anymore what exactly has made the biggest difference for my son. We have done so much at this point. In hindsight I can see that his food sensitivities/leaky gut may have always been a problem and was made worse by the antibiotics he was on.

 

As a toddler my son had delayed speech. At about age 4 (maybe a bit earlier) my son was a HUGE milk drinker. He was ill one night and threw up a bunch of milk and after that night would not drink milk again. He has never been one to eat cheese etc. Well, it was shortly after discontinuing milk that he began to make real progress with his speech. There is alot to be learned from reading about autism and I have read that many parents report improved speech in their autistic childen with the removal of casein (milk).

 

My son NEVER ever responded to penicillin. He was started on Keflex for a post op infection and then we saw a dramatic improvement. We did try switching him to penicillin several times and he always immediately got worse. I think a turning point for us was actually doing a course of clindamycin...this is a more intense antibiotic and is used to erradicate strep in carriers. At this point we only use antibiotics if needed at any sign of increased tics, definite exposure. My son has a dx of rheumatic fever due to a mitral valve regurgitation. We recently saw our cardiologist and he said that the normal recommendation is prophylactic antibiotics but our cardiologist and infectious diseases doctors agree with me that there is no studies that support the use of prophylactic antibiotics in the prevention of strep. There was one study done in the 60's that did show prophylactic antibiotics are effective but I think the majority of doctors agree that the study is outdated and was very poorly designed. As well my sense from the information coming out of the NIMH is that pen Vk is not effective in preventing PANDAS out breaks.

 

In terms of my son I do think that the clindamycin may have really helped erradicate all of my son's strep. We are also from Canada. It is difficult to get many of the docs really on board with PANDAS. We have settled in nicely now with our docs but this took a huge amount of effort to find a team that we worked well with. The majority just did not want to believe the improvement we saw with the antibiotics. We went through a whole year of my son't symptoms returning with the discontinuation of the antibiotics.

 

I think giving my son suppplements has been really beneficial for him, especially the essential fatty acids. It took a LONG time for me to get to a place where I understood what I needed to do in terms of supplements. With the improvement on antibiotics the urgency to find a solution was not as necessary to me for a long time. Over time though I realized we needed to really look at "why" my son was vulnerable to strep and try and encourage his body to be as healthy as possible. Keep in mind though that my on was on much harsher antibiotics and that if penicillin is working for you...I think it is more tolerable prophylactically.

 

Prior to working on healing my son, changing his diet and adding supplements, TV was a trigger for him but over time this is no longer a problem. I wish I had more answers for you. We were in your exact postition 2 years ago and with time my son has healed and is doing very well. This fall he had one sudden onset of tics but the decreased after another round of clindamycin. Currently he is tic free and his behavior is stable. Let me know if there is anything I can do to help. We live in Sk.

 

Ronna

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Hi Claire and Ronna,

 

Thank you both again for the responses. We did the spit test this morning and it floated - so guess yeast is not a problem. Claire, I will hold off on the purchase of the LCD - I noticed this morning while he was watching TV his tics were not at all as bad as when he has been watching in the evening ( when in reality they are not that bad then either) so I imagine there is probably a contributing factor of being tired at the end of the day as his half hour of TV is usually before bed - it also happens to be Yu-Gi-Oh - these japanimation shows seem to set him off more than shows like Little Bear or Berenstein Bear, I imagine there is a difference in how it is stimulating the brain. As I said yesterday when I step back and review how he is doing he is doing so well - no eye tics, no jaw clicks, no grimacing, no gasping, coughing, throat clearing, no leg tics, no arm twitches, all of which we were seeing only a few weeks ago - only a month ago I could not sit with him while he was watching TV as I found it way too upsetting to watch and listen to.

So... it seems his body is healing and "detoxing the tics" slowly but surely. Previously we found the TV and driving in the car as both obvious triggers. The car is no longer a trigger and so I am hoping the TV will also continue to be tolerated better.

Ronna, I had a "light bulb" moment after reading your e-mail, you said as well at the beginning of your journey that you did not feel the immediate need to look at alternatives as the antibiotics were working, I felt the same, and I also did not want to have too many things being taken at the same time and not knowing what was and was not working. Your comment about wanting to find out "why" he was vulnerable really hit home for me. I had partly dismissed the "alternative" route as the antibiotics were working, but after reading this forum I was so amazed by how many people have had success with the alternative supplements. The other piece is that each time we stopped the antibiotics the tics would come back full force within days and would take longer to get rid of with each antibiotic treatment. I did find it interesting that a lot of these kids do not eat well, it really makes sense that their immune systems are stressed as they do not have the proper nutrition fueling them. I always wondered how my son functioned well with such a poor diet, I guess in reality while he functioned well from the outside, he was not doing well on the inside. He had that chronic cough from age 3 -which must have been a tic as it lasted for 3 years and then went away with the antibiotics. I wish I had found this forum years ago and started on these supplements to deal with the minor tics he experienced, it may have prevented this full blown PANDAS and all the stress and anxiety of the last few months. I do however believe things happen for a reason - not sure the reason on this one!! I did go and get some EFA pills today, as he would not take the liquid form - he was able to swallow them without a problem - it felt like such a victory. I am also giving him some flax seed oil as I have read a lot about that as well. I will also be more vigilant with the probiotic. I had tried to reconnect with the naturopath but she seems to be on holiday - so I will just start on the original plan we had set out with.

 

 

I was wondering how long it takes for the EFA and Flax Seed Oil to start working? Again, his tics are pretty minimal at this time and do continue to get better, but I imagine with any viral infection they will flare up again so I am hoping that by working on boosting his immune system we can help prevent this.

The naturopath had also recommended a homeopathic remedy called colocynthis homaccord - has anyone heard of this or tried it - it is supposed to "level our the tics"

 

Again, thank you for your support and for sharing your knowledge.

Today seems like the next chapter.

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Hi again,

 

Just wanted to update and get any advise/support. Things had been going very well for my son - basically tic free except when at the TV in the evening. On Friday he started with a neck tic, shrugging his shoulder's like he had a tag that was bugging him, but all the tags are out of his clothes. He is still on antibiotics, full dose, and I started EFA on Saturday. He is taking them well, we also decided to do a no-screens week and started that on Sunday morning as the neck tic seemed to be getting worse. He is open to the no screens as he is getting a reward at the end of the trial - since my husband is home this week it seemed a good time to do the trial. He also started on a homeopathic remedy on Sunday, today his tic seems to be getting worse, of note is I did wake up with a really sore throat and I do not feel well today at all, I was pretty happy to feel miserable as I feel it may explain the increase in tics in him as his immune system is probably fighting off what I have ( at least I hope that is what is happening) - I know I am doing several things at once here, but I figured none could do any harm, and that it would speed things up and I could figure out later what thing(s) worked. I have noted in other's e-mails that some have not tolerated EFA well, did that mean that it upset their stomach or increased tics. Just wondered if there could be any correlation of the new tic and the EFA, I am assuming not as the tic started slowly on the Friday and he started the EFA on Saturday. I am hoping I will see improvement tomorrow as that seems to be the most recent pattern when other's are sick, his tics increase a little but then peak then decrease. I am hoping this is the peak today. This is so stressful - I feel all consumed by it. No other tics are really present, he has not had eye or facial tics for several weeks now. He is not complaining of feeling sick, but never does.

 

Thanks in advance,

[Claire]

Hi Alison,

 

Please be careful about adding new supplements while you are doing the no screens test. If his tics increase due to a reaction to the supplements. (eg some kids react to EFA's and some of the homeopathic solutions and other supplements have a period of worsening before improvement--or so I have heard.

 

I used to recommend doing a lot at once (I have a thread on this) but now I think it is best for no screens to do it on a week with no other changes.

 

It is tough to do things one at a time--we did this with supplements and I got so impatient, but either you can make things worse and then think no screens doesn't matter, or, like marina, you can find something else that does work, and thing it may be the no screens.

 

There is no 'detox' from no screens, so you should just see improvement as the days go by.

 

Claire

 

I am glad you have a reward set up.

[Ronnas]

Alison,

 

I am not sure which homeopathic treatment you are using. I have never posted much about our experience with homeopathy. It is hard to think of the exact thing we used now but I think it was streptozyme drops. We used them for 2 days and Kurt had a horrible setback with them...it took about a month to get over it.

 

I understand completely wanting to do a bunch of stuff at once. I have been there and at one point went bonkers doing everything. In the end we had to start over so we could figure out what was helping and what wasn't. Kurt did react to fish oil with increased hyperactivity and a few tics. Having been there my best advice is that the "turtle" wins the race. Take time to do things one at a time...it will be worth it in the long run.

 

Ronna

[Claire]

Ronnas,

 

Ha, I think we all tried a bunch at once, just to try to accelerate things. But you and are are in sync in that in the end, being methodical has advantages. I definitely space things now, but I still get impatient.

 

 

Alison,

 

Yes, for a few people here, certain EFAs actually made their child's tics worse. This doesn't mean it is the case for your child (mine did fine with them), just that it really is best add them in when other things aren't going on. But I know this is easier said than done----A few times I have had to start over myself to figure out what caused a particular reaction when I did multiple things. I am mostly concerned because usually you only get one chance to do a no-screens week, and both the kids and the parents need to see the improvement--or not--to make the important decision on whether you make adjustments. (e.g. to justify the expense of an LCD TV).

 

Claire

[Guest Jeff]

Hi Alison, You mentioned your son is taking antibiotics. By any chance are they "colored" and/or "flavored" ? If so, that could be a reason for increased tics...

Just a thought.

Jeff

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Thank you Ronna, Claire and Jeff for your responses, Jeff- the antibiotic he is on is flavoured and coloured and he has been on it for about a month, he has been on that antibiotic in the past without a problem so I do not think that is the cause of the current tic. The neck tic seems a little better today so it seems to be running it's course, I felt terrible all day with fever and chills so I am guessing he is fighting the same thing. I hope so anyway as it would explain the increase in tics.

I did decide to stop the homeopathic remedy and the fish oil today - I just assumed trying everything all at once would make the process faster not slower. I will wait until the neck tic is gone and then re-introduce the fish oil at one pill a day instead of two and if there is another increase I will know the culprit although I am guessing it is coincidental as the neck tic did start slowly on Friday and he did not start the EFA or homeopathic remedy until Sunday - the tics really escalated on Sunday night and yesterday they escalated through the day but today are on the decrease.

We will stick with the no-screens as I feel that has absolutely no down side to it. He is also keen on earning his reward! He has not complained once about the tv.

 

Thank you again for your responses,

[Claire]

Hi Alison,

 

Merry Christmas!

 

I wasn't sure from your post if your child watched TV last Sunday morning, so the no screens started on Monday, or if he last saw screen last Saturday, in which case the no screes week is over.

 

Did he last the whole week and get his 'reward'? Did it make a notificeable difference? I think you had recently restricted him to 30 minutes a day (what did he use to watch on average before that?)

 

Anyway, I hope things are going well, but either way, it would be great if you could let us know. I add both the ones that showed results and the ones that didn't to the TV/computer 'survey' thread, so that newcomers can get some idea of what difference this made for others.

 

I am also very interested in knowing how you plan to proceed moving forward.

 

Claire

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Merry Christmas and Happy Holidays to everyone!

 

Thank you Claire for following up with me. We did stop watching tv last Sunday and the week is up, we plan on continuing. He did very well not watching, it is amazing how he adjusted, I am sure it helped tons that my husband was home. He did a lot of lego, kenex, listening to stories on the CD, playing, skating in the backyard, ( he has been earning 2$ a day - with a plan on buying more YuGiOh stuff, and want's to keep on going for three weeks! He shows all his friends the calendar that shows how much money he has earned) however, I think I am probably not getting a true reading of the no screens as I believe he has been fighting a viral infection that had me quite sick for about a week - remembering he is a PANDAS/PITANDS kid. I really wish we had done the no screens when he was ONLY ticing in the evening when watching tv. Last Friday, Dec 17 - he had started with a brand new neck tic, (previous to that we had a few weeks of only minor tics when watching 1/2 hour of tv in the evening) this got worse over the next few days, at it's worst on Monday and Tuesday then started to get better. We had started EFA on the Saturday 18th and Homeopathic Remedy on Sunday as I was feeling desperate. As the tics continued to get worse I was not sure if it was the supplements or the usual course of his tics with illness. I did follow yours and Ronna's advice and stopped everything, but kept up with the no tv. Looking back I do not believe the EFA increased the neck tic as it had started on the Friday. I have to say, that my guess would be if he had been watching tv through the week the tics would have only been worse. Once his tic had improved we decided to try the EFA again, we started that last night ( only one pill instead of two)- I must admit that although I know the turtle wins the race I did spend the week searching the internet for info on vitamins and did go to the drug store today and bought some B complex vitamins and the Magnesium/Calcuim and Zinc combo and gave him a small dose of both tonight. I have also e-mailed for info on bonnie's vitamins. I really did intend on going slow but it is so hard, after I rationalized the EFA did not cause the increase in tics I felt I would give one more go at the vitamins in combination of each other and if things increased again I would REALLY take the turtles pace. It is so hard to see him ticcing, heartbreaking really, he is such a vibrant, happy, charming boy, and to see his neck swinging with a jaw click when he was seeing Santa made it very difficult for me to enjoy the moment, instead I was holding back tears. I just wanted to enjoy the moment but it seemed impossible, I was not even able to watch my other kids I was just so focused on his every tic. So... to answer your question, I think it was a bad week to see a true result of no screens although I am absolutely positive that had he been watching tv this week things would have only been so much worse. There is no question in my mind that TV has been a trigger since we first started dealing with this in August. He would be fine then go to the tv and start ticcing by the second, then turn away from the tv and be fine again. There was ALWAYS an increase in tics while watching TV. The only other regular trigger was driving in the car and this has stopped probably over the last month. There seems to be no increase in tics in the car anymore.

I believe this week the viral infection had increased his tics. I did check out Cosco and it seems the cheapest LCD tv monitor is around 500 Canadian, it is a fairly small screen - I am definetly open to buying it ( personal motives, it would look great in my planned renovation of my kitchen a few years down the road!)

In answer to your question about how much tv he was watching prior to the 1/2 hour restiction prior to starting the no screens, he did watch a fair bit of tv - not so much in the summer months but in the cold winter months he could easily watch several hours in a day - with the 1/2 hour before school and maybe a movie after school or a few shows. It is amazing how easily the time adds up. We also had a new baby in the house so it was easy for me to suggest the kids go and watch a show while I feed the baby/make dinner etc.

 

So.. there it is. I am possibly making a mistake by going back to trying several things at once but it is hard not to. If things do increase in the next day or so I will stop and start one at a time and stick with it. I also figured since we are not at school this week it is a good time for this trial.

 

Does anyone have any info on any adverse affects of EFA, B complex, and Mag/calcium and Zinc combo's - or better yet anyone with good results seen, and if so how quickly???

 

Thank you in advance,

 

PS I cannot seem to spell check for some reason so I apologize for typos - when I re-read my posts I notice all the mistakes!