Transplant Times - Papworth Hospital

Issue 52 | August 2012TransplantThe newsletter for transplant patients and staffRaising funds for TCCU and raising awareness of transplantation

Transplant Times | Newsletter for transplant patients and staffEditorialTransplantThe newsletter for transplant patients and staffContacting UsHospital General EnquiriesSwitchboard 01480 830541Fax 01480 831315Emailcorporate.affairs@papworth.nhs.ukWebsitewww.papworthhospital.nhs.ukPALS 01480 364896Dear readersWelcome to the Summer2012 issue of Transplant Times.In light of the London Olympics2012 we are having a bit ofa sporting theme runningthrough this issue to share oursporting achievements, hobbiesand fitness tips.As you can see from myphoto, horses are my passion.I have two horses of my own;Bridey, a 17yr old Welsh Dcross; and Maddy, a 3yr oldGypsy Vanner Cob who I amjust breaking in to ride. I alsoexercise polo ponies in the littlespare time I have!This all helps keep me fitand toned, and I find there isnothing more rewarding thanbeing able to put all my hardwork to the test and take themout to competitions.If you have any achievementsof your own you would like totell us about, something youwould like to share, then pleaseget in touch. We are delightedto receive and print your newsand photos, so keep themcoming in.I can be contacted via email:kirsty.dance@papworth.nhs.ukor on my direct dial telephonenumber: 01480 364444.Kirsty DanceEditor, Transplant TimesTransplant Continuing Care UnitTel 01480 364455Emailtransplant.continuingcare@papworth.nhs.ukWardsCritical Care 01480 364400Cardiac Day 01480 364150Hemingford 01480 364910Mallard 01480 364375Thoracic Day 01480 364193Cystic Fibrosis 01480 364292Baron 01480 364227Duchess 01480 364512Princess 01480 364232Higginson 01480 364420Varrier-Jones 01480 831431Hugh Fleming 01480 364370RSSC 01480 364259Transplant TimesKirsty Dance 01480 364444 kirsty.dance@papworth.nhs.ukDiane Goodwin 01480 364256 diane.goodwin@papworth.nhs.ukCheryl Riotto 01480 364483 cheryl.riotto@papworth.nhs.ukJas Parmar 01480 364457 jasvir.parmar@papworth.nhs.ukCarol Holder 01480 364672 carol.holder@papworth.nhs.ukCarolyn May 01480 364672 carolyn.may@papworth.nhs.ukGive the gift of lifeFor information about organ donation and transplantation,visit www.uktransplant.org.ukChanged your address, phone number or any other details?Let the TCCU nurses know if your contact details change, especially telephonenumbers - we want to stay in touch!Transplant Times is provided free. No part of this publication should bereproduced without the written permission of Papworth Hospital. The publishersand printers cannot accept liability for any errors or omissions.Front cover: Dr Jas Parmar, Consultant Transplant Physician and RichardQuigley, Transplant Co-ordinator prepare to cycle from Lands End to JohnO’Groats later this year - see page 8.1

August 2012From the TopHospital NewsWith all the sport around thissummer, I thought I would take part ina little sporting activity of my own.With other members of PapworthStaff, I took part in the NHS SailingRegatta which took place in April in theSolent.Despite the terrible weather, the boatI was in won the Papworth trophy outof the three Papworth boats. This wasquite an achievement, given not onlythe weather but also the fact that thecleat broke off our boat!I can see from the other articles inthis issue of Transplant Times thatothers have been inspired to takepart in events too, and there is a realsporting theme in this issue: from KarenHodgson taking part in the LondonMarathon; our successful TransplantA message from our DirectorViewing our services through the eyesof our patients was the idea behinda very successful afternoon here atPapworth in July. The Transplant PatientInvolvement Event, was held as partof 2012 Transplant Week and we werepleased to welcome 60 patients andtheir carers.The discussion focussed on thefour areas of our service, namelyassessment; being on the waiting list;Games participants to our Lands End toJohn O’Groats cycling endeavour. Goodluck to all.Diane GoodwinTransplant Directorate Managerthe operation and time as an inpatientand finally post transplant care. Theaim was to identify strengths as well asaspects of the service which could beimproved. Also discussed at the eventwas the idea of setting up a patientsupport group, which was warmlywelcomed. This and the other feedbackfrom the event will be displayed inthe TCCU waiting area, with updatespublished in future editions of theTransplant Times. Thank you to thepeople who kindly gave up theirafternoon to help us in this way.As you know nothing stands stillfor long at Papworth and a key partof keeping us at the forefront of thetransplant world is our commitmentto research and innovation. Despite itssuccess as a treatment, the shortage ofdonor organs still limits transplantation.There are a number of exciting researchprojects which are in development tobegin to address this limitation andover the coming issues of TransplantTimes I hope to outline these projectsto you.Steven TsuiClinical Director, Transplant ServicesProfessor John Wallwork CBE; RobertBurgin; Pam Blomiley; StephenBridge; Robin Cushing (Chairman ofthe NZC) and Sir Terence English30 years ofsupportMore than fifty members of theNorfolk Zipper Club travelled toPapworth Hospital on Tuesday 10July to mark 30 years of support forpatients from Norfolk undergoingheart surgery at Papworth Hospital.Robin Cushing, chairman of theNorfolk Zipper Club, said: “Ourmembers were delighted to attenda lunch to celebrate 30 years ofthe Norfolk Zipper Club with ourfriends at Papworth Hospital. Asan organisation we work closelywith Papworth Hospital, wherepatients from Norfolk have theirheart surgery, and in addition tothe support that our members giveto patients they also undertakefundraising activities for the hospitaland have provided the hospital withmany pieces of medical equipmentover the years.”Mr Cushing continued, “All of ourmembers are indebted to PapworthHospital in some way. We enjoysupporting those who may beapprehensive about undergoingcardiac surgery and also haveenormous fun raising funds for thehospital.”Stephen Bridge, Chief Executiveof Papworth Hospital, said: “Weare delighted to be able to markthe magnificent support by themembers of the Norfolk Zipper Clubboth to Papworth Hospital and heartsurgery patients from Norfolk.”2

Transplant Times | Newsletter for transplant patients and staffDoctor’s NotesMany of you will have seen therecent publicity around the WelshAssembly’s approval of the new donorlegislation for Wales. The publicationof this legislation, and the subsequentexpected changes in the law heraldsa new era for the UK, which has neverpreviously had presumed consent (ieopt out) in operation before.What does this change actually meanin clinical practice? Whilst as written,this law represents a significant changein the previous approach of seekingpermission from families at the timeof donation, in reality all doctors willcontinue to discuss at length withdonor families the possibility of organdonation. It would be a very unusualsituation that doctors would go againstthe wishes of the relatives.So does this help patients waiting fortransplantation? The projections fromWales would suggest that this changemay yield an increase in donationrate of approximately 25%. Withcurrent waiting list mortalities sadlystill running at an unacceptably high25%, it would seem a very attractiveprospect. If this increase in donationis achievable then we may have abetter chance to help more patients inneed of transplantation. Whilst I am alittle circumspect about the projectednumbers, I do think that this approachhas merits in that it raises the level ofawareness of organ donation for all thecitizens of Wales and as such it is a verygood thing.In England at the moment there isno presumed consent although therehas been extensive discussion. Anumber of other donation initiativesare being examined to address thecritical shortfall. In both heart and lungtransplantation the pursuit of perfusionsystems to help to re-condition orsupport organs are being studied andwe have a number of studies startingsoon.We hope that these developmentswill produce more donor organs fortransplantation and help to addressthe mismatch between the numbers ofrecipients and usable organs.As always it is key that we eachindividually continue to ‘bang the drum’to maintain a high profile for organdonation.As you will see I was greatly helpedby Dr Owain Davies (expert in all thingsWelsh) in the preparation of this article.Jas ParmarConsultant Transplant PhysicianTransplant Continuing Care News3With the Olympics in full swing itcreates a chance to look at our ownlifestyles to ensure we are all doingas much as is physically possible tomaintain as healthy a lifestyle. All of ushave our motivation tested and eventssuch as these are wonderful ways to bere-invigorated or be ‘kick started’ intoaction. Even small improvements in ourexercise or diet can make significantlong-term improvements in our healthand you will see lots of ways peoplefrom all walks of life and with all sortsof health conditions are doing this inthis edition. Our televisions over thenext few months will be constantlyhighlighting these things to us.Things I try to do in my life as abusy working Mum are to always cooka healthy meal for the whole familyevery day, ensuring all of the family areeating five portions of fresh fruit andvegetables - being a farmer’s daughtermakes this bit easy!I also try to incorporate as muchexercise as I can into everyday lifewhich can be a struggle but my familylove cycling so at weekends we alwaystry to do something which entails along bike ride and walking with ourmad dog Lucy every morning makesme fit in a bit of exercise daily.I realise not everyone is as physicallyable as I am but there is alwayssomething everyone can do to improvea little, so if in doubt give us a calland we can give you some ideasand direction on what to do which isappropriate for your health condition.The nursing team is dedicated toensuring all our patients receive thehighest quality care possible, so pleasecall, email or chat in person when youare here for your clinic appointments,about any concerns or issue you mayhave. Enjoy the warmer months andwatch all of the wonderful eventswe have occurring in Great Britainand I look forward to seeing you allinvigorated, fitter and maybe slimmer!Cheryl RiottoTCCU SisterCan all patients please be awarethat we will be sending youcopies of all your clinic lettersfrom now on. This is to ensurethat you are aware of theresults of all tests that you havehad performed during yourappointment.

August 2012Dietic NewsNutrition in sportWith the Olympics underway, we are sure you are keen to get into sport and exercise routines.Whilst not many of us are training like elite athletes there are some dietary things to consider.Fuel upCarbohydrates - bread, cereal, pasta,potatoesExercising muscles rely oncarbohydrate as their main sourceof fuel. The amount you needwill depend on your trainingprogramme. In general, the moreintense the training programme,the more carbohydrate you needto include in your diet. A diet low incarbohydrate can lead to a lack ofenergy, loss of concentration anddelayed recovery.What about protein?Meat, fish, dairy, beans, pulsesProtein is required for buildingand repairing muscle and plays animportant role in how the bodyresponds to exerciseProviding energy requirementsare met, a healthy diet will certainlyprovide enough protein to meetrequirements for your exerciseprogramme.FatTotal amount of fat will dependon your total energy requirements,body composition goals and sport.Healthy eating guidelines should befollowed which focus on consumingmoderate amounts of monounsaturated(olive and rapeseedoils) and omega 3 fats (oily fish -salmon, mackerel) and a reductionin intake of saturated fats.Think fluidDehydration affects bothphysical and mental performance.The choice of drink depends onintensity, duration of exercise andyour training goals. Water is fine ifyour exercise is of low to moderateintensity that lasts less than anhour and sweat loss is low. Isotonicsports drinks are for sessions thatare moderate to hard, that lastlonger than one hour, and whensweat losses are greater.Carol Holder & Carolyn MayDieticiansFive goals of sports nutrition1. Eat a varied and well-balanced diet.2. Eat plenty of carbohydrate-rich foods.3. Eat at least 5 portions of fruit and vegetables a day - fresh, frozen dried, canned all count.4. Start refuelling with carbohydrate foods and fluids as soon as possible after exercise.5. Ensure you are well hydrated by drinking throughout the day as well as before, during and after exercise.Facts and figures January 2012 to June 2012Number of patientassessmentsHeart 47Lung 109Total 156Number of outpatient clinicattendancesHeart* 1307Lung 984Total 2291Total number oftransplants and VADsHeart 13Heart-lung 1Single lung 6Bilateral lung 9Total 29VADs 7*This includes all heart, heart failure, andVAD clinic attendances4

Transplant Times | Newsletter for transplant patients and staffMail BoxPhysiotherapy News5From mobilityscooter tomarathonrunnerWhen I wastold that havinga heart transplantwould give mea better qualityof life I couldn’tbegin to imaginewhat a difference it would make.Now, with my third anniversaryfast approaching, I often find ithard to imagine how my life wasback then; how climbing one flightof stairs was so difficult, whenrecently I managed to climb all 528steps of St Paul’s Cathedral.Walking short distances wasa monumental effort, so it wasincredible to me that at the end ofa 100 mile walk last year, I wantedto walk even more, not less. Thefastest I used to move was in mymobility scooter, now I run. Backthen I could never have imaginedthat I would have completed a halfmarathonas part of my training forthe 2012 London Marathon.I pinch myself to think that I’ma long distance runner when notso long ago the only thing I couldrun was a bath. It’s not just the bigachievements that amaze me: it’sthe small things too, such as beingable to carry the heavy shoppingbags back from the shops insteadof giving those ones to my wife.Of course, this hasn’t allhappened overnight: I have hadto work hard at becoming fit, andapart from a few hiccups alongthe way, I have remained relativelyhealthy since my transplant. Asfor my next challenge, a 10,000ftskydive beckons, and that wassomething I never thought I wouldever be able to do.Kieran SandwellOlympic Games 2012: be inspired,be activeThis summer the London 2012Olympics will create a hive of activity.The media will be flooded withinspirational stories of people whoare taking part. This is the perfectopportunity to get active and boostyour fitness and there are so manyschemes in local areas to encouragepeople to find a physical activity thatsuits them.IdeasThe internet is already crammed withideas and downloadable apps to helpyou look at your lifestyle and to thinkabout your levels of activity.The NHS website: www.nhs.uk/livewell/olympics is an excellentwebsite with links to daily fitness tips,programmes to determine how fit youare, videos of new activities and thebenefits of sports.ExerciseRegular exercise is really importantfor your health. To maintain goodhealth, adults need to do a minimumof 150 minutes of moderate-intensityaerobic activity every week (usually fivesessions of 30 minutes per week).It can be hard to fit exercise in arounda hectic lifestyle but with so manyoptions available there is somethingout there for everyone - you just haveto realise the benefits exercise can giveyou and make it a priority to fit it in!How about:• Get inspired with the Olympic flame- walk that mile - several torchbearers have had heart or lungtransplants• Take up a new hobby or physicalactivity• Join the Transplant Games TeamYou can discuss any ideas with aphysio at your next clinic appointment(ask at reception for the physio onBleep 287). Have a happy and activesummer.Melanie LincolnPhysiotherapist Team Leader

August 2012Pharmacy NotesHospital NewsGeneric mycophenolateWhy are patients being changed to generic mycophenolate?The NHS has one pot of money whichit has to share between all patientsthat require treatment: therefore whena medication becomes available at amuch lower cost we have to considerwhether it is safe and appropriate foruse. Generic mycophenolate has beenavailable and used in other transplantpatients since 2009 with no reportedproblems. Hence the Papworth Hospitaltransplant team has now decided touse generic mycophenolate for ourtransplant patients.What is the risk?On switching from Cellcept ® togeneric mycophenolate, there maybe a small change in the level ofmycophenolate in your blood. Thegeneric versions contain the sameactive ingredient as Cellcept ® , but themethod of making the tablet or thenon-active ingredients (the ingredientsthat are there to make it tablet shapedor coloured etc) may be different. Thesedifferences may affect the way that yourbody deals with the medication (eg byincreasing or reducing the absorptionfrom the stomach), thus 1g Cellcept ®may not give the same blood levels as1g of generic mycophenolate. Howeverexperience indicates that the change islevel is small and has not been reportedto increase the risk of rejection.What should you look out for?Changing from Cellcept ® is notexpected to cause you any problems:however if you notice any changes inyour routine monitoring, such as weightand temperature, (and blows if lungtransplant) please alert the transplantteam. Note: if the swap causes aslight increase in the level getting intoyour body this may cause nausea ordiarrhoea which should settle in a fewdays.Once you have changed to thegeneric mycophenolate, we ask thatyou remain with the same ‘brand’.Multiple changes between genericpreparations will mean your levelsImportant informationOn switching, alert the transplantteam if there is any change inyour routine monitoring or youexperience nausea or diarrhoea.Please ensure that your GPcontinues to prescribe by the brandname, rather than just writing‘mycophenolate mofetil’.Do not change between genericpreparations. Once you havechanged from Cellcept ® to ageneric, stick with the same one.may alter each time you change. Thetransplant team at Papworth are nowprescribing the Teva brand (Myfenax ® ),due to its easy availability in primarycare.The consultants will only changeyou from Cellcept ® to the genericpreparation at a time that isappropriate to do so. Some patientsmay need to continue on Cellcept ® : ifthis is the case for you, your consultantwill let you know.Heather ChapmanTransplant PharmacistTransplantpatientinvolvementeventMore than 60 transplant patientsand their carers/relatives, came toPapworth Hospital on 13 July totake part in the Transplant PatientInvolvement Event. The eventhosted by the transplant teamaimed to hear from patients aboutwhat they thought was good aboutthe service they received and alsoareas for improvement.The event focussed on all areasof the transplant journey, fromassessment through to posttransplant care. Patients attendingincluded those waiting for atransplant, those who had receiveda transplant and those who havereceived a ventricular assist device.Mr Stephen Bridge, ChiefExecutive, welcomed patients andstaff to the event and Mr StevenTsui, Clinical Director, TransplantServices and Consultant Surgeon,set the scene both in terms of thenational and local transplantationservice.Feedback from the event will beused by the transplant team toimprove the service they provideto patients.6

August 2012Staff NewsWelcome toJonny BriggsTrainee DonorCare PhysiologistWelcome toBeth CrookStaff NurseWelcometo KarenShackletonSecretary to DrLewisGoodbye to TomWyattStaff NurseGoodbye toCarol BartlettClinic CoordinatorLands End to John O’GroatsAs some of you are alreadyaware Jas Parmar and I, along witha number of post transplantationpatients, family members and pastand present transplant staff, will becycling from Lands End to John O’Groats later this year.We shall be cycling almost 1000miles between 9 and 22 September,averaging in the region of 70 milesper day.We decided earlier in the year thatthis was a project that we wished toundertake and Jas has succeeded inrecruiting/bullying a team of fifteenpeople for this challenge.The Papworth Lands End to JohnO’Groats team (PapworthLEJOG)have two main objectives: firstlyto attempt to raise some muchneededfunds that can be used bythe Transplant Continuing Care Unitto undertake important transplantbasedresearch. Secondly, and just asimportant from our point of view, isto raise the profile of transplantationas a treatment option.As you all know transplantationcan transform lives, and this cycleride will be used to emphasise thefact that organ donation can helpindividuals realise superhumanachievements. It is also beingundertaken in order to showour appreciation to the manyindividuals and families who havegenerously offered their organs fortransplantation after death.If any of you would like to view theitinerary of our cycle ride, please visitwww.peak-tours.com/Lands-End-to-John-O-Groats-Itinerary.php whereyou can see our daily schedule.Alternatively, if you email me I willbe more than willing to email theschedule to you. If anyone would likewave at us or join us for a couple ofmiles on a particular day we wouldbe delighted, but I would advise thatyou contact me prior to Septemberin order that we can inform thesupport team.If anyone had any corporatecontacts that might be willing tosponsor our endeavour we would bemore than happy to speak to them.Richard QuigleyTransplant Co-ordinatorIf you would like to donate tothe fundraising aspect of thischallenge, the website to use iswww.justgiving.com/papworthlejogwhere any amount donated willbe both greatly appreciatedand carefully used in the area oftransplantation.8

Transplant Times | Newsletter for transplant patients and staffPapworth Transplant Games Team NewsLocal transplantrecipientswin Gold atEuropeanTransplantGamesTwo of Papworth Hospital’slocal transplant recipients havereturned triumphantly fromthe 14th European Heart andLung Transplant Games held inApeldoorn in the Netherlands from27 June to 1 July 2012.Maggie Gambrill from Kimboltonand Will Cramer from Combertonwere two of seven Papworthtransplant recipients selected torepresent Great Britain.Maggie, who had a hearttransplant at Papworth Hospitalin 2002, added to her alreadyimpressive tally of transplant gamesmedals by winning another fivegolds, in badminton singles anddoubles, table tennis singles anddoubles and also the 400m trackevent.Attending his first European Heartand Lung Transplant Games thisyear was 37-year-old Will Cramer,who had a double lung transplantat Papworth Hospital in 2009.Will won a gold medal in 20kcycling and 1500m track eventsand a silver medal in the 4k run and400m.Celia Hyde, Modern Matron forthe Transplant Unit at PapworthHospital, said: ”I would urge peopleto read Maggie and Will’s storiesand see how receiving a new organhas not only saved their lives butalso transformed their quality oflife. People need to talk to theirloved ones about their wishesand sign up to the organ donorregister.”British Transplant GamesMedway 2012 - meet the team23 - 26 August 2012The British Transplant Games are organised on behalf of the Transplant SportUK (TSUK). The Games were inaugurated in 1978 in Portsmouth by MauriceSlapak, who at the time was a Consultant Transplant Surgeon. Approximately100 participants took part in the first Games in a one-day event. Over the past 30years, the British Transplant Games has grown to a four-day annual event for over600 competitors and nearly 1000 supporters.Since these early beginnings with competitors, affectionately known as ‘99blooming miracles’, the Games have grown and are held every year in differentcities throughout the UK. The British Transplant Games have been staged annuallysince 1978 in 17 host cities across the UK including Portsmouth (1994), Newcastle(2000), Edinburgh (2007) and Belfast (1998) with the 2012 Games being hosted inthe City of Medway. Meet the Papworth Hospital Team for this year...Simon MorganClive AndrewsJoe MatthewsJohn SheehanPatrick de SoissonsLorraine Seager9

August 2012Keith AthertonJan RiceErnesto AntonioNick CondonMedway2012Allan TaylorJames GriffenWill CramerPeter de SoissonsHow to get involvedMaurice GreensladeMaggie GambrillKaren HodgsonIf you have been inspired by theOlympics or the stories in this issueof the Transplant Times and wouldlike to be a part of this very friendlyand enthusiastic team pleasecontact: Barry Matthews, PapworthTeam Manager.Email barryandval@sky.comTel: 01322 662660European and BritishGames results to befeatured in next issue.Kevin MayPauline MoronayKelly Mayes10

Papworth Transplant Team 50 Club - Lottery News UpdateThe 50 Club LotteryThe 50 Club Lottery, which is open to all, started in October2002. Monies raised from the lottery support the PapworthTransplant Games Team with items of equipment andsponsorship for events. The draw takes place every fourweeks with 50% of monies collected being paid out to 50Club winners.The Games provide a specific focus for fitness and awonderful opportunity to meet people, share experiencesand have fun as well as generating worthwhile publicity forthe Organ Donation cause. It is a proven fact that organdonor registrations increase markedly where transplantsports events take place.This summer our team members are participating inthe 2012 European Heart & Lung Transplant Games inApeldoorn, Netherlands and the British Games in Medway.The Team spirit is magnificent and as Papworth is thecurrent holder of the coveted Tesco Trophy which ispresented to the best heart hospital at the British Games,a stout defence is certain. Lottery funds can help with thecosts of attending these transplant sporting events as well asproviding equipment, uniform, kit etc.Applications to this fund can be made in confidence to theTeam Manager, Barry Matthews at 34 Selah Drive, Swanley,Kent BR8 7WD, tel 01322 662660.Our numbers continue to fluctuate and we still need moreof you and your friends and family to sign up for this worthycause. An application form is attached.Please note that the subscription is only £1.00 per week andthe draw is held every four weeks.Standing orders are the easiest format to administerand the bank details are on the attached form. Please letme know how you have arranged your payments. Pleasecontinue with your support.John BarnesPromoter and secretaryMonthNo inDraw First Second ThirdDecember 43 Gerry Churchill £43.00 Paula Taylor £21.50 Sue Barnes £21.50January ‘12 43 Jim Sheehan £43.00 Lorraine Seager £21.50 Paula Taylor £21.50February 44 Eric Muir £44.00 Ann Thompson £22.00 John McFarland £22.00March 45 Alan Wylie £45.00 Brian Geere £22.50 Nick Condon £22.50PapworthHospital CharityMarch 45 Sue Barnes £45.00 Trixie Taylor £22.50 Sharon Burns £22.50April 45 Mick Hanstock £45.00 Chris Matthews £22.50 Jo Hanstock £22.50May 46 Nick Condon £46.00 Barry Matthews £23.00 Joyce Pengelly £23.00Living & breathing PapworthLottery Application FormApplication for a ticket in the Papworth Transplant Team 50 Club LotteryName: ......................................................................................................................................................................................................................................Address: .....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Tel No: ............................................................................................ Email: ............................................................................................................................Fax: ................................................................................................... Amount enclosed: £……………….............… Date: ……..............…...................…50 Club bank details if wishing to pay by standing orderHSBC, 104 Front St, Arnold, Nottingham NG5 7EG Account No: 51549731 Sort Code: 40-08-46Please return form to the promoter:John Barnes, 7 Keeley Farm Court, Wootton, Beds MK43 9LFTel: 01234 840810Email: johnbarnes13@yahoo.co.ukThis newsletter is printed on paper stock that is 80% recycled and 20% FSC approved from well-managed forests and othercontrolled sources. When you have finished with this newsletter, please recycle it.