Big Heart - Patrick Holland's Transplant Journey (2025)

02/04/2025

I had told myself to post an update yesterday, Patrick's 2 year anniversary with the new heart, and found my motivation to do so lacking. I have been busy preparing the shop for the summer season when tourists from around the world will wander in and hopefully purchase one of Patrick's knives, or a piece of my art. My mind has been elsewhere.

In truth, I feel like the 2 year anniversary is March 30th rather than the 31st. It was that day that I spoke to Patrick for the last time, not knowing if he was going to survive the operation. They began the procedure at about 9 or 10pm Seattle time. This, to me, means the anniversary is the 31st.

But the team in Seattle says it is when the surgery is finished successfully, so that's the official date. That span of time surrounding the weeks prior and the months following are all just a blur to me.

What truly matters is the last two years and what a blessing the new heart has been to us.

Patrick has lived up to his promise. He helps everyone, every chance he gets. He jumps in when his family needs him. He volunteers every Sunday at church for anything they might need - ushering, passing out Communion plates, putting away chairs, and whatever else they might need. Patrick is the guy most called upon in the Co-Op Plaza when there is an altercation, an individual stuck in their addiction and semi-conscious, or a shoplifter who needs to be escorted out of the building. In this way he helps our own shop and that of our fellow shop owners.

Patrick also helps the community when he can. He has taken donations for seniors and utilized funds, time, and effort to help the elderly in our community when they have perhaps been forgotten. He has selflessly helped to clear out a hoarded house after simply being asked to do it. He has towed strangers out of the ditch, cleared driveways for those who can't do it themselves, given rides to stranded tourists, and bought coffees and crepes for countless friends and random wanderers who happen by the shop on any given day.

He has big plans, too. We both do. We would love to hold a marriage group in our living room, helping other couples weather storms that we have already survived. We would like to pursue avenues of charitable giving of our time and resources, and possibly one day have the means to pursue more philanthropic causes. Patrick also has a gift for helping individuals who find themselves trapped in addictions, for encouraging incarcerated people, and for helping recovering addicts get back on their feet.

In short, we have an abundant plan for how to give back to the universe what the universe has gifted to us.

If you're local, we would love it if you would stop by the shop this Friday during the Co-Op Plaza's First Friday event, and say hello to Patrick and our family. We will be there from 4pm until 7pm, honoring sweet Andrew's gift and celebrating fourteen years as the local knife shop in the Co-Op Plaza. (That anniversary is in fact today - April 1st).

And if you can't make it Friday, well, we'll run into you locals at some point. This is Interior Alaska, and we all know someone who knows someone. And Patrick talks to EVERYONE. Lord, can he talk.

At the risk of sounding like a broken record, our gratefulness for your support, your generosity, your love, and your kindness knows no bounds. Locals, and those of you who follow us from afar - we thank you from the bottom of our hearts.

Strangers have become friends, and friends have become family. Heck, a handful of you strangers have become family! And we wouldn't have it any other way. To say you have shaped our lives, and our family, is an understatement. We can no more tell the story of our family without the indelible imprint all of you have made on it, than we could deny the enormity of Andrew's sacrifice.

So, on this two year anniversary of said sacrifice, thank you. Thank you, Andrew. And thank you, wonderful followers, friends, and family. We love you.

09/12/2024

I have good news and disappointing news.

The good news is that Patrick feels better most of the time. At one point a few days ago he said he felt 75% better, but tends to sit around the 40% level. This is good. He is slowly recovering. He can walk up stairs without being completely winded, although he can certainly tell that physical activity is harder than it used to be (and he knows when to save his energy for *ahem* important tasks).

He had a checkup in Seattle on Thursday and that's where the disappointing news comes in. They did a repeat chest x-ray and found that his pleural effusion has doubled in size. I don't have a copy of his October x-ray, although I wish I did for comparison's sake. But the first photo is what his December x-ray looked like.

For comparison's sake, the second photo is what he looks like with no pleural effusion. That x-ray is from February of this year, and you can see the difference below his right lung.

See that stunning wire work around his sternum? I will never fail to be impressed by how tightly the transplant surgeon managed to get them. He never felt his sternum crunch and slide together this time - not even once. After his 2007 bypass it was a nightmare. I still don't know what the difference was, besides the two different surgeons.

So Patrick will have the thoracentesis procedure done with a CT scan at the Fairbanks Memorial Hospital Imaging Center. Am I nervous about that? Absolutely. But complications are rare and Patrick is strong.

Now, for giggles, the third x-ray is from March 30, 2023, ten days before the start of his transplant surgery. It shows his pacemaker in amazing detail!

I think it's fascinating how it shows where is pacemaker leads are placed, and where they hooked up to his old heart. This pacemaker/defibrillator was Patrick's implanted paramedic team for 18 years. We relied on it to keep his heart beating evenly, and to bring him back from the brink of death when his heart was ready to quit. I lost count of how many "widow-maker" events he had. I lost count of 911 calls. I lost count of how many shocks he received from the defibrillator, and of how many times I held him while he waited for the shocks to finally work and pass.

I am not sad to see the pacemaker missing from the newer x-rays.

Back to those x-rays - what's interesting is he has 10 wires looped around his sternum from his bypass, and only 7 from the transplant. Maybe the quality of wire has improved?

We have access to the portal where we can view all CT scans with and without contrast, arterial scans, angiograms, and ultrasounds he has had through UW. They are FASCINATING. I browsed for nearly an hour when we found it in his chart, imagining how neat it would be to know exactly what I'm looking at, the signifance of the colors on the scans, what the shadows mean, exactly how healthy the arteries and veins in his brain are, or why his new heart looks similar in size to the old one. These are thoughts that will never be fleshed out, and questions that will never be answered.

But on the flip side, I have him. I felt encouragingly grateful the other day to have a husband next to me, making what Samuel dubbed last summer as "pig noises." It could be worse. He could be dead. I could be making plans for what to do with his things, how to donate his clothes, how to raise kids without him.

I did tell him a couple days ago that if he had died I would have traded in our king sized bed for a full sized mattress so I could create a reading nook in the bedroom. He cracked a joke about how crass it is to make plans like that when he's still here, but he knows. He really does understand.

I would encourage you to have those thoughts. Imagine those plans. And have those thoughts and plans for your family, as well. Our days are numbered, and when we find ourselves on the other side of kids, grandkids, careers, relationships - whenever our final day decides to show up - both we and our loved ones will be grateful. Because it could be tomorrow, or it could be sometime around 2075. We just don't know.

These are tough conversations to be had, for sure. But have them. We do, with each other and with our kids. It might not soften the blow of losing a loved one, but it will smooth the struggle after their passing, at least a little bit.

Or at least, for the love of God, write a will. Sign it. Tell people. File it with the court. Do your family a favor and help prepare them.

In the meantime, live your life. We welcomed a lovely little addition to our family last month named Olive, and she has brightened our days immeasurably. I have reminded Patrick to wash his hands at least a thousand times since we got her.

I will update again after the thoracentesis, which is later this week.

20/11/2024

Just a little update for you guys.

Patrick is doing better. Yesterday he said he felt 20% better, but then last night he attempted to use his c-pap and it set him back. Now we know he can't use it until his lung issues are completely healed.

It was a rough night, and I'm exhausted.

The good news is we finally got his antibody testing back, and his level of DSA is 1,500, which is going in the right direction! He won't need another infusion, thank God.

As of right now we are to stay the course, and to focus on getting him rest and healing. He has his ups and downs, but if his recovery were a line graph it would have a definite upward trend.

Those dips, though... Damn.

Keep us in your thoughts and prayers, and keep sending those positive vibes!

13/11/2024

So, funny story...

The transplant coordinator called me this morning.

I had told all of you that I have been avoiding calling her. Why ask questions to which I really didn't want to know the answer?

I had written her an email this morning (my preferred communication method) asking if we should be monitoring his oxygen levels with our oxymeter. I knew the answer, but I suppose I wanted reassurance that the things I'm doing in my role as caregiver are the correct responses to what has been happening.

In the phone call she said yes, and took it even further to say we should be monitoring it at rest and after activity.

I also asked in the email at what point he should be going to the ER and she said if his oxygen drops below 94 or 95.

His oxygen levels are important because they are a vital marker of heart function. If his oxygen is high his heart is likely functioning very well and helping to oxygenate his body adequately. But if his oxygen levels are down there could be a problem with his heart function and he would need to fly to Washington to be further evaluated for diagnosis and treatment.

I even told her, "I have been avoiding calling you because all of this stuff is very heavy." I didn't have to say more. She knows, as her job includes being the middle-woman between very capable doctors and at times very worried patients and their families.

We spoke a bit about Patrick's current illness since that is what my email was in regards to, but before she got off the phone I said the words I really didn't want to ask - "Do you have a minute? I have some questions I would like to ask you."

Here are the answers in a format that, while retelling them, I won't end up worrying myself anymore than I already have been over the last few weeks.

Yes, Patrick's blood tests showed an increase level of Donor Specific Antibodies, or DSAs. These are present when Patrick's body creates antibodies to fight off the foreign body - the donor heart.

His levels were 4,800 at one point, and then 4,300. I do not know the dates of these tests. The last two antibody monitoring tests listed in his chart are for March 2024 and August 2024, but I thought he had one done in early October.

Regardless, what is important is that the coordinator said these results came out of nowhere - from a negative, or 0, result, to 4,800 and the 4,300. Because they happened suddenly, his provider wrote the order for the IVIG infusion.

Patrick did labs yesterday but we won't know the results of the antibody monitoring for a couple days.

And actually, about the test results - his WBC was 6.5, which sounds high. It's within the normal range for a non-transplant, healthy individual. I only checked that after I spoke with the coordinator, so I haven't asked her about it. The previous infusion paired with his current cold makes me confused about that WBC level and how it is outside of what seems to be Patrick's normal range.

A transplant recipient can live with low antibody counts, as long as they are stable. For heart transplant recipients it is also important that they don't have any effects on their heart function. This stability may be due to medication, or a natural balance created by the recipient's body. So again, Patrick's suddenly high DSA counts were alarming. However, she also told me she has patients who are upwards of 20,000 on their DSA counts. What makes Patrick's concerning is that he is still in the 6-months-to-2-years window where they want to set up recipients for success and monitor these things diligently.

Patrick has DSA. Does this mean he is in Antibody Mediated Rejection? This is another question I didn't want to know the answer to, thanks to Google and the widespread availability of medical knowledge I know nothing about but have little reservations to trying to understand.

"De-novo DSA have threefold increased risk of mortality."

And also, this little gem - "AMR is a major factor in reduced long-term survival after heart transplant."

I don't like you, Google.

I know, I know. Don't Google medical stuff. And yes, I know. Each recipient's journey is different, and just because Patrick has DSA and AMR right now doesn't mean we won't make it to our 45th wedding anniversary, or that he won't see 30 years with Andrew's heart.

And yes, we are still eternally grateful for Andrew, for his family, for the UW team and the providers that have led us to where we are today. Patrick always says, "If I died today, the heart transplant will still have been worth the time I've had since receiving it."

But it's hard. I spilled my guts to all of you in the last post. I dread bad news, but have grown extremely adept at handling it over the last nearly two decades. Every day it's a new challenge, but also every day it's a new blessing.

Well, doing the dishes isn't a blessing in my eyes, but being able to listen to a podcast while zoning out washing pots and pans... It's the small things, right?

We have no idea what the future will bring. We don't know if I'll be dress shopping in 2050 for a vow renewal in 2051 for our 45th anniversary. We don't know if Patrick will live to see our kids graduate high school, or marry, or have kids, or have amazing careers. We just don't know, but neither do any of you. And in that we can have solidarity - that today is a day to be thankful for.

Find reasons to smile today. And if you see me, I could use a hug.

I will update soon.

05/11/2024

Two updates in one. I wrote the first update yesterday, and have an update from today following. Thank you for being here!

Monday, 11/4/24 - I would like to start off this blog post with a request.

Please pray for Patrick. He has his first cold since getting the transplant, and it's hitting him hard for reasons I will explain in a moment. He and I sat up last night after he came to bed because he was coughing so hard he was throwing up and having a hard time breathing. After the fits pass his breathing calms, but it was enough for him to ask sheepishly, "Brings back memories?" as I rubbed his back and held the small trash can on his lap.

After his body had calmed and he was able to lay back down and not sound like he was on death's door, I had a hard time sleeping for so many reasons.

But first, I'll explain why this cold is hitting him so hard.

I am not clear on the exact details, and I have questions I have been planning on asking his transplant coordinator. Not all of them are questions I'm sure I want answers to. His labwork showed Donor Specific Antibodies, which either mean he may go into, or is in, a form of rejection called Antibody Mediated Rejection. I'm not sure my mind could handle the latter, so I have avoided calling for weeks. There is a medical journal article online that states, "De-novo DSA have threefold increased risk of mortality."

That's not the bedtime lullaby I was hoping for.

Also, "AMR is a major factor in reduced long-term survival after heart transplant."

Yay.

After getting the results of that labwork he was instructed to receive an IVIG (intravenous immunoglobulin) infusion at FMH on October 9th that would bring down his immune system in an attempt to mediate the risk of rejection. He was told it could make a person feel sick and weak, but he wasn't prepared for the horrible side effects.

The infusion lasted from 9am until 1pm, when he returned to the shop. During the infusion he felt fine, but after an hour he was feeling exhausted, at two hours he was shaking, at three hours he had nausea, and at four hours he was in so much pain he came home. His body, his bones, and his joints felt like the worst Covid symptoms one could imagine. It hurt to move - "Like I had just rolled down a mountain." And every inch of skin felt like he was three inches from a fire, but underneath, he was frozen - cold and uncomfortable.

When I tell you that was the worst day for us since before the transplant... It was awful. Full on PTSD flashbacks and fear.

The day after, he was feeling better, but any movement caused him to be out of breath. He still is not fully recovered from the infusion, which makes sense knowing how greatly it affects the bone marrow. When the foundation of the human body doesn't feel good, nothing feels good.

And in reference to the cold, for the purposes of explaining how well we isolate Patrick when colds are going through the house, this is cold Number 6 that he finally caught. Yes, six colds have gone through the house since the start of the school year, and this is the first one Patrick has caught. It just so happens to coincide with the infusion, which has made a regular common cold hit him like a bus. Of course, the worry is that it will affect his heart.

Last night was awful. His coughing was horrendous. Without him knowing, I saw on the end of the bed for about ten minutes because there was no way I was going to be able to get back to sleep. I also wanted to be ready to spring into action should he need me, which he did. After ten minutes of coughing, he asked me for the little bedroom trash can, and I then sat with him and comforted him while he threw up and heaved.

When he finally did calm, I wasn't able to fall back to sleep for a long time because of the thoughts running through my mind. With that fear of his heart being affected, of course, I thought of what would happen if he died. What a terrible thought to have, but it is one we both have had all too often.

How could I function without him? With four kids? A kindergartner and a young adult with special needs? The 17-year-old would have to get her license, or she would be forced to drop out of the one public school course she takes. She would have to be home when the others got off the school bus because I would either have to run the shop full time or get a full time job, and I wouldn't be able to afford childcare. What would I do if the lift station pump went out? Our lower oven heating element just started sparking and caught on fire, luckily under Patrick's watch. What if I had been cooking and had left the room? I managed to switch out the elements by myself, but still, what if the house burned down? What if Blue, our golden retriever, was in the house and died? Or the kids? Without Patrick, who's left to save me from myself when I make silly mistakes or dumb decisions? Where would I be left without my other half? How could I live? How could we ever be happy without his presence?

The mind can run wild when given a little bit of fuel, and I had a lot of fuel last night. My next thought was, "Oh, God. He doesn't have a defibrillator." Through his c-pap mask, I couldn't quite hear regular breaths because the machine is so loud. I stopped, all thoughts ceasing as I listened for the telltale inhale and exhale, or any rhythmic pattern I could make out beneath the sound of the c-pap machine that would signify Patrick was breathing.

Because if he wasn't, he no longer has a defibrillator in his chest - his portable paramedic team. If his heart stopped...

I know CPR. I'm trained.

That doesn't mean I relish the idea of breaking his sternum while performing chest compressions, knowing the love of my life is dying.

All normal thoughts, I assure you, when you have been through what we have been through.

The last three weeks have been tough. As I said before, we are on the sixth cold to come through our house since the start of the school year mid-August. I have had at least three of them, our 5-year-old has had all of them (since I am pretty sure his kindergarten class is the source), and the other kids have had them in varying degrees and instances. But until now, we have been able to keep Patrick safe. I don't know what the implications are for a person with a heart transplant to have a cold.

We are asking for prayer and positive thoughts, for healing for Patrick, and a reprieve from these illnesses for our household.

Our pantry is well stocked with cough medicine, Nyquil, cough drops and throat lozenges, and Cloroseptic spray - none of which Patrick is willing or able to take.

This is going to be a long winter.

Tuesday, 11/5/24 - An update to the update.

Patrick went to a clinic yesterday to be seen by a doctor. His hope was that his illness was... bacterial? Viral? I can't remember which one gets antibiotics.

It wasn't the case, and instead, he was referred to the emergency department at the local hospital, FMH. His chest x-ray at the clinic had revealed a spot on his lung that was concerning, and a visit to the emergency room left him with a diagnosis of pleural effusion. This means he has a build-up of fluid in the pleural space outside the surface of his lungs inside his chest wall. The recommended procedure to alleviate symptoms is Thoracentesis, which is where a provider inserts a tube between the ribs on the side of the abdomen to drain the fluid.

Patrick chose not to have the procedure done in the emergency room and has a referral to radiology, where they may be a bit more specialized in the procedure. While he is at such high risk of infection, he doesn't want to take any chances.

With that being said, last night was terrible. The majority of the night was much like the previous ones where he coughed a lot, couldn't really wear his c-pap mask, and pretty much kept me awake most of the night.

Last night, he woke up gasping for air.

I can't even begin to describe how awful that sounds, waking up to it. It gives me chills as I write about it.

He only gasped twice and quickly settled afterward, breathing in a way that I could tell his body had calmed, and he was able to drift back to sleep. As soon as he gasped, I had reached over our son and grabbed Patrick's arm, probably a little too hard, as though knowing I was there would help him. I think it did. I hope it did.

I don't know what today will bring, but I am praying he recovers from this cold and that it doesn't affect his heart. I'm praying the rejection goes away, and we can go back to the 30-years-hopeful state we were in.

I will update when I know more. But in the meantime, please keep Patrick in your thoughts and prayers.

23/08/2024

I spoke too soon.

Patrick received a call a couple days ago about a test result from the Seattle trip. It was his transplant coordinator saying a certain number was too high so they wanted to bring his Mycophenolate dose back up to where it was, 1,000mg per day. He is experiencing a rejection. They aren’t too worried about it, but since he is still within the “new” category of heart transplants less than two years out, its better to manage it with medication than to wait and see how it plays out.

I wish I knew more about it. Patrick fielded that call and relayed his usual 5% retained information back to me. I may ask him to call the coordinator to have her explain it again so I can understand more. Apparently the Tacrolimus and Mycophenolate work to protect against rejection but in different ways, so they are keeping with the plan to lower the Tacrolimus, while increasing the Mycophenolate.

I may just refer to them as Tac and Myc from now on. Tack and Mike. That saves me some headache trying to type words I am not familiar with.

In my previous post I mentioned living every day like it is your last. We had a situation yesterday that put the fear of God into everyone in our van.

We were driving home from town and were on the 40 MPH road by our house. Patrick had begun to slow down and had his blinker on to turn left into our road, had turned the wheel, and the van had just begun to move in that direction when a large crew cab Dodge pickup BLEW past us on the left, quite obviously going faster than the speed limit.

They say your life will flash before your eyes in moments when you come close to death. Patrick was driving, behind him sat our 18-year-old with special needs, and behind her sat our 16-year-old. In that moment I knew he could have killed them instantly, and injured or killed myself, our 5-year-old, and our 13-year-old.

Everyone I care most about on this earth were in that van last night, and it could have ended horribly. I remember the air pressure shaking the van as the driver sped past, and as Patrick realized what was happening the exact split-second he needed to.

Patrick gave chase, as I knew he would, and we pulled into the dump behind the guy as he had his doors open while parked next to a dumpster. Patrick rolled down his window, and the young man immediately approached. He looked to be late 20’s, maybe early 30’s. He was shaking, and I was mad.

If you knew you nearly killed a family, why would you not stop? There is something going on in that man’s heart that I don’t like, based on that act alone.

He did apologize profusely after Patrick rather calmly stated he almost killed our entire family. He explained something about being cut off and getting mad at the other driver, and then speeding out of anger, which is when he passed us.

Hot headed. I think that’s probably a good term for him. His road rage attitude nearly ended everything for us.

Luckily, he and Patrick spoke and the man apologized again and again, even once directly to me, rather genuinely.

But… Damn. That was scary.

And I had the opportunity to kindly remind Patrick he needs to be aware of traffic both in front of him and behind him (which is something he has always bragged about doing…)

So, you never know. Hug your loved ones today.

I’ll update the blog again when we know more. If we do call the transplant coordinator and I find out more about Patrick’s rejection situation I will definitely post an update. Until then I will keep reminding Patrick to TAKE NOTES.

22/08/2024

LIVING THE GOOD LIFE

Patrick went to Seattle last week for a follow-up, for tests the team didn't do in March when he was admitted for signs of infection. He had a Dexa scan and his 13th heart cath/biopsy.

He has NO rejection! And they are decreasing his Tacrolimus, which is his major anti-rejection medicine. He takes four milligrams in the morning and four at night, so now they are decreasing his nighttime dose to 3.5mg. It isn't a huge development, but it's better than 1) needing to increase it, or 2) keeping the original dose. His numbers looked to be a smidge high which means his immune system could be repressed unsafely, so without personally talking to the team myself, this is what I can infer by their decision to decrease his dose.

And this is while he is still on 25% of his original dose of Micophenolate, his other anti-rejection medication. The team is happy with what they see.

His white blood cell count is 5.5, which is wonderful for him.

His kidney function looks good.

His bone density looks good.

Why can't they fix his sense of humor?! While at Six Flags in Georgia, on the way out I was trailing behind the family taking photos. He stopped a security guard at the exit and said, “Excuse me, security guard? This lady groped me.”

The security guard was a wise man. He replied, “How'd you get so lucky?”

It's not as sweet as it sounds. The guard's parting words were, "I can't get any of them to grope me."

Lord, help me.

Due to his unexpected infection in March and his continued low dose of Micophenolate, Patrick is on the schedule for another biopsy in four months. While this had not been in the original plan, I can see the wisdom behind it. I wouldn't be against it if they wanted him to live in a bubble. I don't want anything to happen to him.

While we know things can turn on a dime for transplant recipients we are enjoying each day together. This summer we have gone on nature walks, gone swimming several times at the lake, enjoyed a vacation out of state, worked on our yard and improving our home, and lived as normal a life as we can while Patrick continues what feels like recovering from the heart transplant.

Not much of an update, but we are happy with his progress.

I can't tell you how many stories I've heard from Facebook groups I'm in, that make me feel so blessed that his journey has developed the way it has. There are people suffering from joint replacements, amputations, recurrent infections and rejection, and piss-poor quality of life. We were always told a heart transplant was trading one illness for another, but Patrick's is turning out to be an illness for which we are both profoundly grateful.

We went on our first family vacation that wasn't an Alaskan road trip fishing excursion.

Patrick has been blessed with countless visits to our shop from people who are thankful to see that he is still alive.

He was able to retrieve our 5-year-old after Samuel's second day of school, when the bus arrived at our driveway.

I asked him if he wanted to watch a movie tonight, just the two of us.

He got into water fights at the lake with our kids, without fearing his heart would act up.

We ate at the local Chinese restaurant and he felt no effects from the massive amounts of sodium they pack into their food.

I have no complaints about what happens in our bedroom…

It's the big things, and it's the little things. It's all things, really, that we are thankful for.

It's watching him tell tourists who come into the shop asking for the code to the bathroom, “You have to hold the keypad between your fingers, lean down, and say into it, ‘Rubber chicken.’”

Patrick has an amazing poker face.

That's not to say I don't occasionally imagine my hands around his neck, but for anyone who has known Patrick for any length of time, I'm sure you wouldn't begrudge me a moment or two of weakness.

Live every day like it's your last. Don't go to bed angry. Hug those who are dear to you. Tell them you love them. These aren't just empty platitudes. I've said it before - tomorrow isn't guaranteed.

Just think of the alternatives - your family dying in an accident on the highway; cancer taking away a loved one in weeks; even something like losing your sight, or your mobility, or, God forbid, your dignity.

Life is so precious.

Thanks again to everyone for your support, well wishes, and prayers. I don't mean to get sappy, but when faced with the threat of losing the most important person in my life and then being blessed with getting him back in such good health, I can't help but wish everyone - including myself - could see the blessings in our lives every moment of every day.

Until next time…

Big Heart - Patrick Holland's Transplant Journey

02/04/2025

09/12/2024

20/11/2024

13/11/2024

05/11/2024

23/08/2024

22/08/2024

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