Bella, the Miracle Curcumin Cat?

By E. Vince Cowdry
protec4u@aol.com





On April 14th, 2009, Bella died of cardiac arrest.  More than two years ago, I was told Bella would die this way from anemia.  This was directly related to the lack of red blood cells in her blood.  This will be the last update for Bella's web site.  
 
I learned too late that erythropoietin antibodies had formed from the weekly Procrit injections I was giving her.  She was into her second week of being free from the injections.  The hope was that she would be able to endure about 3 weeks of high doses of prednisone to combat the destruction of her remaining red blood cells.  She successfully did this two summers ago.  That event is depicted further down in this document (summer 2007). The antibodies won out this time.  They were too strong this time and there weren't enough red blood cells in quantity to hold out until the antibodies dissipated.
 
It is fortunate Bella is no longer in discomfort or pain.  Unfortunately, I'm left with a lot of guilt and emotional pain.  In the past two weeks, I came to the reality that it was ok if Bella died.  This was the only time I felt this way throughout her entire time with me.  She always showed signs of strength before.  She was a true fighter.  This time it was different.
 
The recriminations will always be with me.   It was very selfish of me to want Bella to stay in this life with me.  She was a very special cat.  My commitment to her was sealed when I first insisted on saying goodbye to her at the Missouri University Hospital more than 2 years ago.  She was bound by all sorts of lines and IVs and in oxygen.  She was in an incubator.  I was told she was out of it and probably wouldn't recognize me.  I said, "Bella, give me a kiss."  She crawled over and through the opening she kissed my mouth.  It caused the staff to cry.  It was from that moment I decided I would do anything for Bella.  From that point, she was my (animal) soul mate.  Bella made me a fan of cats.  You would do anything for your family and Bella was family.
 
Stem cell therapy does work.  Kudos to http://www.vet-stem.com/ for the wonderful service they have been providing to pets!  With Bella's autoimmune disorder, the keys to success would have been routinely receiving a dose of stem cells about 2-3 times a year.  Along with the stem cells, she would have needed prednisone to help support her.   I feel that she has contributed to the argument that stem cell therapy does work.  This was evidenced by her more than 6 months of great health.  Unfortunately, more stem cells were not available in time to help.  The process of growing more stem cells are costly and time consuming.
 
I recently had been saying that Bella had been very emotionally taxing as well as being very taxing on my wallet.  You know that people always look for rationalization about life and death.  I will rationalize that we did all that we could for Bella and that in her short life, she taught us so much about living.  She has made us much better.  When I was in basic training an old sergeant asked us, what the hardest thing to give up.  We replied, our lives.  He said the hardest thing to give up was kindness, because it keeps on coming back. She was a labor of love for me and I am a much better person for it.  My family is as well!  She received more hugs and kisses than our other cats together.  She received a lifetime of love in such a short time!  Given the circumstances this time, it was time for Bella to go.  I did enjoy robbing the Reaper and giving Bella a fairly good life as long as I could.  

She was on course to get supplemental stem cells 2-3 times a year.  With the stem cells and varying amounts of prednisone, I feel she could of had a relatively long life.  In the first stem cell treatment, she was being weaned off the prednisone.  She had about 6 months of great health without prednisone.  Hindsight being 20-20, I would have probably of put her back on a minimal amount of prednisone after about 3 months.  We also had to deal wih a mysterious upper respiratory infection (URI) every 6-7 weeks that sometimes was confused with anemic symptoms.  The second stem cell treatment in January was done without prednisone being present at all.   That was a mistake and it became apparent after about a month.  I questioned the potency of the treatment, but in hindsight, it was apparent I should have had Bella on a minimal amount of prednisone. 

Starting Feb 24th and then on the 27th, I was concerned about Bella's PCV, but tests revealed things were ok.  Then on March 5th, I took her to the 24 Hour Emergency Vet.  The numbers were much lower and she had a fast heart rate and breath rate.  Within about a week, she showed much improvement with prednisone 5mg/12 hours.   She had been off prednisone for over 6 months!  I think I started her on Procrit on March 5th, which means she built up antibodies incredibly quick.  Her last Procrit shot was on 3/26/09.   I don't believe she had built up the antibodies in 21 days.  I thought it was procrit, but now I believe that Bella was exposed to Sago Palm (poison).  Now, I am currently reading that Sago Palm produces cyanide and the poison supposedly cuts off oxygen to the red blood cells and that they eventually die off.  So, was it erythropoietin antibodies or Sago Palm?  The night before Bella started throwing up, I had commented that her heart and breath rate was the best I had seen.  About 48 hours after suspecting the Sago that had been brought into the kitchen, I took her to an 24 hour vet.  I told them what I suspected.  She got oxygen and fluids.  It was too late to give her charcoal to treat the alleged ingestion.  Bella had never thrown up before when she suffered from erythropoietin antibodies.  It is making me wonder.

The approximate timeline was 03/25/09, when we brought in the Sago Palms.  I remember commenting on how Bella's breath and heart rate was great that night.  It was a nice bounce back to normalcy with her being on 5mg prednisone every 12 hours.  Remember, she was off prednisone for 6 months.  Our cats were rubbing up against the plants.  The next morning, Bella was violently throwing up.  It was something she never does!  It was 03/27/09, at approximately 9:00pm, when I got Bella to the 24 Hour Emergency Vet.  She received fluids and oxygen.  I was told it was too late to give her activated charcoal.  On 04/03/09, Bella spent the day on fluids and oxygen at my Vet.  From there until April 14th, Bella went gradually downhill until I took her back on April 14th.  Experiencing what she went through with erythropoietin antibodies the last time, I'm now believing Bella may have died from Sago Palm poisoning.  There is documention on line of hundreds of poisonings like this.  If it was poisoning that killed Bella, I am thankful it was just her.  Our other cats had also congregated by these same plants.  I've read that many of the pets that receive medical treatment still die.  In my experience with All-Things-Bella, she just went down too quick.  This despite the large doses of prednisone and force feeding her.  I had attended to this girl over 2 years on a daily basis and I had become a semi expert on her.  I did need routine CBCs to guide me, otherwise she would spin out of control.  It was a balancing act.  Prednisone, antibiotics, stem cells and procrit.

The site that really cinched by beliefs is:  http://www.vet.cornell.edu/consultant/Consult.asp?Fun=Cause_3161&spc=All&dxkw=poison&sxkw=&signs=   . This is the Cornell University College of Veterinary Medicine site.  Bella had the following signs: Anorexia, bloody stools, hematochezia, dehydration, diarrhea, dullness, generalized weakness, inability to stand, increased respiratory rate, pale, polydipsia, tachycardia, trembling and vomiting or regurgitation.  I found this site 2 days after Bella died.
 
By April 14th, I took Bella to my vet in the early morning.  She was very, very weak.  I wanted to make her as comfortable as possible getting her on fluids and oxygen.  My vet (Marcy) was concerned I would be upset with her and her staff if Bella died at their office.  I told her that I couldn't think of a better place for her to be.  At the time of her death, she was on fluids and oxygen.  Marcy and her staff had done so much for Bella and us.  Viewing, petting and saying goodbye to a lifeless Bella was very hard.  I also had to console the technicians, which probably explains why I took Bella there.  Kudos to: http://thepetdoctorinc.com/.   The quality of care Bella received was 5 star!

The ASPCA lists the 17 most dangerous plants to our pets.  I believe through the countless stories I have read, it is time to call for laws to warn the unwitting public what they are buying and bringing home to their pets.  Bella's new web page is: http://www.mo-driver.com/sago-palm-plants-kill.htm .  I know that this page has encouraged pet owners that there are options for their sick pets.  I believe and hope that Bella's story will do more for countless other pets from the potentials of being poisoned by plants that have been killing our loved ones for years.  That will be her legacy!
 
I also believe through my search for the magic bullets to save Bella on the Internet, she may have inadvertently saved me through the knowledge and use of Curcumin, Polyphenols and Resveratrol.  She taught me the lesson that you should not wait for illness to occur.  You should do all that you can to prevent illness.  Don't give the possibility of illness or disease an even break! 
 
In the context of The Little Prince (book), I have lost my Little Princess.
 
I will leave this page up as long as the page continues getting hits in tribute to my cat, Bella.  I want to emphasize how important having a pet can be.  You have the power right now to save an animal that is essentially is on death row and to turn it to a rewarding lifetime sentence for both you and the pet you save.  Go to your animal shelter and save some innocent pet today.  Remember Bella's story and how she transformed me into a much better person. Remember my anecdote about kindness?  Save a friend today!

I have put the updates for Bella first.  Her story is below the updates.

Update:  August 18th, 2008
Bella received stem cell treatment about a month ago and the CBC just came in showing she is in remission.  At the time of her surgery, her Hematocrit  was 23% and her red blood cell count was at about 4 million.  Fat cells were removed and were processed into stem cells.  They were then injected through an IV back into Bella.   The current CBC shows 34% Hematocrit  and red blood cell count of over 7 million.   In the 7 months preparing for this procedure, we had to get her up to a stabile health.  Curcumin did not play a part in this.  Increased prednisone and starting her back on procrit were the main factors.  Please note that procrit was discontinued 1 week after the treatment.

Update: September 17th, 2008
Bella's Hematocrit is at 39% (up 5%) and her red blood cell count is at 8.4 million!  All other levels of her CBC are in the normal range.  Our next move will be to wean her off the 5 mg prednisone she is still on. 

Update:  October 9th, 2008
Bella's Hematocrit is at 31% and her red blood cell count is at 6.8 million.  All other levels of her CBC are in the normal range.  She has been off of the prednisone for about 2 weeks.  Hopefully, her immune system will adjust quickly.   If she is failing, she does have 2 stem cell packages frozen that can be given to her through an IV.

Update:  January 27th, 2009
Bella received her stem cell IV today.  Unfortunately, I do not have a PCV to report.  She wasn't in any immediate danger, but I just knew it was time to give her some more stem cells.  She was becoming lethargic and not as pink as before in her nose.  I will report further as things develop.

I know that Bella is just cat and for outsiders, they probably can't understand the emotions that come into play.   For the majority of time, we have walked in darkness with little hope of seeing anything else.  This stem cell procedure has given us the most hope and about the best time period that Bella has ever had.  The big question: can it be sustained? The fact that she has taken on the normal behavior (very playful) of a young cat again is just amazing.  Was investing the large sum of money for her stem cell treatment worth it?  Stay tuned!

I want to give credit to The Pet Doctor located in St. Charles County and Kirkwood Animal Hospital located in St. Louis County.  I recommend both offices.  They have gone the extra mile to provide the Stem Cell Therapy that has already saved many pets.

The Pet Doctor
The Lakeside Shoppes at Winghaven
3046 Winghaven Blvd.
O'Fallon, Mo. 63366
636-561-9122
Website:  http://www.thepetdoctorinc.com/

Kirkwood Animal Hospital
11114 Manchester Rd.
Kirkwood, Mo. 63122               
314-965-2660
Website : http://www.kirkwoodvets.com/

I have been getting a lot of questions about stem cell therapy.  I am attaching a link to KSDK News that highlights my Vet, Dr. James Schuessler, who explains how this stem cell therapy works.  I cannot express in words how much I have appreciated Dr. Schuessler's assistance with Bella.  http://www.ksdk.com/news/local/story.aspx?storyid=146211

Below are the trials and tribulations we went through.  Much of what I did was wrong.  Her big bounces were probably due in part to big increases in the prednisone when I thought I was losing her.  Curcumin is a very valuable cancer fighter, but probably didn't have any significance.  I will probably start giving Bella Resveratrol, which is a powerful antioxidant.  It was just highlighted on 60 Minutes: http://www.cbsnews.com/stories/2009/01/25/60minutes/main4752082.shtml . My worry now is Bella getting cancer.  I can battle the Myelofibrosis now with her stem cells, but I could lose against cancer. 


Bella's Story

So, why write about Curcumin, Myelofibrosis and a cat? Regardless of whether it is a pet or someone in your family, blood cancer is a very insidious adversary. My cat, Bella, has a myeloproliferative disorder (often called smoldering leukemia) that apparently begins with a single stem cell going rogue and often graduates to leukemia and/or other blood cancers, if the anemia doesn’t kill first. If Bella had continued with the usual conventional treatments, she would probably be dead now. And I must say that when these treatments stopped working for Bella, I wish that someone had thought out of the box and told me, “look, your cat is going to die, but you might want to try this or that…” But nobody gave me any ideas or suggestions as to what I could do next. I was left to my own devices, but I didn’t give up. Instead, I tried to find a magic bullet on the Internet, and in the end I was successful. The following is a brief account of how Bella recovered from a very close brush with death. I hope that her story will inspire others not to give up.

We acquired Bella from Sarah, our daughter. She had found Bella in late July 2006. Bella was a 3-4 week stray kitten apparently born behind a local gas station. In August, Sarah had to go back to college, and Judy, my wife, and I took Bella into our home in Lake St. Louis. Bella slept by my side every night, and many nights I would wake up just in time to see her trying to touch Callie, our other cat. All Hell would break loose. Callie hated Bella. Bella was a very mischievous kitten.

A cat or any other pet becomes more than just a pet when hearts are exchanged. That is what happened between us.

Starting in December and going into January 2007, Bella was taken to our vet 2-3 times for what was diagnosed as “anemia.” Her pink nose had gone white, and her breathing was very bad. She was also very lethargic. She was prescribed prednisone and an antibiotic. In January, her breathing became very labored. We took her to an emergency hospital. Her red blood cell count or Packed Cell Volume was at 3%! The doctor told me that Bella’s only hope was a blood transfusion. She said the only place to do this was at the University of Missouri-Columbia College of Veterinary Medicine, about 90 miles away. The doctor confided that Bella probably wouldn’t make the trip. But Bella did make it.

The University of Missouri-Columbia College of Veterinary Medicine is a teaching hospital. Their staff was very knowledgeable and compassionate. They took a bone marrow sample, and at first it looked as if Bella was in the clear when they said she didn’t have leukemia. They went on to say she had Idiopathic Myelofibrosis (remember that Bella was born at a gas station, which means possible benzene exposure was the cause). It was also the cause of the non-regenerative anemia. Her bone marrow, where red blood cells are made, was being replaced by fibrous scar tissue. She was possibly one step away from having leukemia. Bella received a transfusion from one of about six donor cats that live in luxury at the hospital. Her donor was Jesse James, a Persian cat. Because Bella is an American Short Hair, most vets would have automatically given her type A blood. Fortunately, she was typed and her blood type was B. How she got that blood type, we will never know.

The next day, Bella was allowed to go home. She was obviously much better. Prednisone (liquid form) was prescribed. It was much easier to administer as she refused to swallow any pills. We were very optimistic that Bella would get better. She once again became the same kitten we knew and loved. If my family had one word to describe me, it was “obsessed.” I became obsessed in my quest to find anything that could save Bella. But I loved her too much to give up.

In mid February, Bella was at a 9% PCV, according to our vet. Her heart and breathing rates were very fast. Arrangements were made to take her to University of Missouri-Columbia College of Veterinary Medicine again. Bella had to be typed again, and this time they had a close match, but not an exact match. Once again, Bella spent the night there. Upon my arrival the next morning, the doctor described how Bella’s blood was rejecting the transfused blood. The doctor and his assistant told me there was nothing else that could be done for Bella. I had been torturing myself for weeks imagining how I was going to have to put her down. I cannot describe how desperate I felt. I asked, “so you are sending her home to die?” They said there was nothing else to do. Then the doctor said I could try giving Bella erythropoietin, (Procrit), a hormone produced by the kidney that promotes the formation of red blood cells in the bone marrow. The hope was that this would help kick start Bella into eventually making her own red blood cells. It would take at least a week for it to start working. When used for more than 3-5 months, human erythropoietin can cause felines to build up antibodies. I should mention that there is no feline erythropoietin available on the market at this time. The procrit shots did start working.

Ever since Bella had been diagnosed with Myelofibrosis, I had done extensive research on the Internet. I discovered two different compounds that many researchers said were promising against different forms of cancer and were affordable. Both ellagic acid (from pomegranates and berries) and curcumin (extracted from the Indian spice turmeric) were showing promise in causing cell death in some human cancers. Human clinical studies testing curcumin against different types of cancer were underway, and the non toxicity of curcumin had been established in Phase I human clinical trials. Furthermore, myelofibrosis is sometimes associated with vitamin B12 and/or folic acid deficiencies. So, along with the Procrit and prednisone, I began giving Bella vitamin B12, folic acid and curcumin. Because vitamin B12 and folic acid are water-soluble, I gave her generous amounts of both. Too much folic acid can cause damage, so please consult your vet.  Like most cats, Bella wouldn’t take any pills, so I had to grind up the curcumin and mix it with her food. I chose not to give her the pomegranate extract because she wouldn’t eat her food or take it any other way. I also tried to administer curcumin mixed in fish oil orally. What a mess! She hated those “shots” and she had bright yellow stains on her white fur to prove it. Curcumin will stain anything it comes into contact with (fur, skin, etc.) bright yellow. However, it was all well worth it in the end. In mid June, my vet was pleasantly shocked when her PCV turned out to be about 25%. I told him it was because of the curcumin, but as I would later learn, it was probably the doses of prednisone I was giving her in conjuction with the Procrit.

By the beginning of July, though, Bella had nosedived to 13%. Then one day, just hours after giving her a Procrit shot, her nose went white and she became very still. Based on her 13% PCV result, the vet concluded that she was rejecting the Procrit. Any normal erythropoietin she would be producing would also be neutralized by her antibodies. If we had continued to give her Procrit, she would have died. According to what I had read about antibodies, it would have taken as many as three weeks for the antibodies to dissipate. Either way, it probably meant death for Bella, but we were slightly hopeful that she could get rid of the antibodies and make a rebound. How she survived this difficult period, I will never know. Her heart rate and breathing rates were extremely high. I made her as comfortable as I could. She slept on a heating pad, but wanted nothing to do with us. She went off to be alone. Molly, my other daughter, left for college certain that she would never see Bella again. They are very attached to each other. Then, at the end of the second week in July, I began dividing one gram curcumin caplets into quarters. Pet Smart has a product called Pill Pockets. They are pliable doughy treats designed to contain pills. I molded the doughy treats into ball shapes containing the curcumin pieces. Bella learned to take curcumin this way. She was getting between 1 and 1 1/2 grams a day of curcumin. Her small body was being flooded with curcumin. By the end of her third week without Procrit, she actually became more sociable and her nose began turning pink. Her heart and breath rate were going down, too.  It was probably the large doses of prednisone I was giving her in an act of desperation and not the Curcumin. 

Going to the vet was (and is) a stressful time for Bella, but we just had to know. We were concerned about the curcumin doses. On September 10th, five weeks after stopping the Procrit treatment, we went to the vet. He knew, or thought he knew!, that Bella had been brought in to be possibly euthanized. He later confided to us that he had prepared his staff for this euthanasia. He was shocked when he saw the results of the first test, so then he did another. Bella was at 33% PCV and weighed 7.8 lbs! He acknowledged that it was a miracle for her to be still alive. He very much wanted more information about curcumin. However, he was concerned that Bella had liver damage because her blood had a yellow tint to it. I told him of curcumin’s yellow staining properties, and how I had given her mega doses of it, and that was probably why her blood was yellow.

Since then, Bella’s doses have been reduced to two 250mg BCM-95™ Bio-Curcumin™ capsules (http://www.epic4health.com/cuenbicu.html) a day. We hoped that the reduced dose would eliminate that yellow tint to her blood. The key is more bioavailability and less quantity, especially for small animals. These new capsules are supposed to get more curcumin into the bloodstream (increased bioavailability). Probably very little curcumin got into Bella’s blood even when she was receiving 1 ˝ grams a day. Humans can take up to eight grams a day without sustaining any toxic effects. Of course, 1 ˝ grams a day administered to a small cat was a huge amount, but we were desperate, and time was running out. Curcumin is a natural chemotherapeutic compound according to researchers. The advantage is that it only targets the bad abnormal cells, leaving the healthy ones alone. There hasn’t been much heralding of curcumin by pharmaceutical companies, because it cannot be monopolized and patented. Work is being done to synthesize curcumin to make it much stronger and more bioavailable.

On October 1st, we took Bella back to the vet. She weighed 9 lbs! Her PCV test came in at 36%. The vet said she was well within a normal range for a cat. We will now begin to cut the prednisone doses down, and eventually stop them altogether. Bella will continue to take vitamin B12 and folic acid, just to play it safe. As for the yellow tint in Bella’s blood, it was gone. There was no sign of liver damage, so it had indeed been the curcumin that had been tinting her blood. Our vet was still astonished. He told us that there hasn’t been enough research with animals. He is absolutely right. In spite of all my painstaking Internet searches, I didn’t find even one positive curcumin story for felines. I intend to publish this story so that other pet owners can read it, and perhaps be inspired by it.  In retrospect, Bella bounced back because of the large doses of Prednisone.

I hope to have Bella around for a long time. It is most comforting to just see her sleeping peacefully, and to see that she has a normal heartbeat and breathing rate. I think I have learned to take care of myself, too, through this ordeal. I religiously take pomegranate and curcumin every day. Between the two, I hope that they will offset heart problems, lower my cholesterol, offset possible Alzheimer's, and, of course, reduce my risk of cancer. I hope that my grandfather, Dr. E. V. Cowdry Sr., who was a famous pioneer in cancer research, is looking down at me and Bella with a grin on his face. What would be a fitting legacy for Bella? Saving dogs, cats, and of course us humans from similar illnesses would be a wonderful one. This article is being submitted by someone with no medical experience, just an anecdotal one, so please consult with your physician before relying on what you have read here.

12/15/07 Since my last entry, Bella went downhill and has come back up. About a week before leaving to Italy on 10/22, I noticed the decline. I had gradually removed her from doses of prednisolone and curcumin. By the time we returned in early November, Bella was in the danger zone. Since then, I was able to get her back up. Finding the balance between curcumin, prednisone, b12 and folic acid is the key. At this point, she takes 0.5mL prednisolone (15mg/ml) a day, probably 2.0 cc of B Sublingual Total brand, and 250 mg Curcu-Gel 3 times a day (about 6 hours apart). In doing this combination, Bella is back up. Her heart rate has slowed as well as her breathing. I know the dose of B Sublingual Total is way high. She has a disease that depletes B-12 and/or Folic Acid. Hopefully, I will be able to reduce her intake of that. Her intake of Curcumin is high according to most standards I have read about on the Internet. I must also consider how long just once dose would help her. According to most studies, curcumin serum level retention in the blood doesn't last long. So, Bella gets a Curcu-Gel about once every 6 hours to keep the curcumin serum level in her blood long enough to abate processes that progress her disease. I would love to hear from any professionals that could help guide me. My email is protec4u@aol.com. I will continue my updates time-to-time.

01/08/08  Well, Bella has gone downhill again.  Her PCV was 6%.  Her only hope is using Procrit again.  I do have some hope if I can get Bella's red blood cells up again.  I have talked to a Vet that is connected with a company offering stem cell tranplantations.  In Bella's case, fat cells will be removed and sent to a laboratory.  The laboratory will transform the fat cells to basic stem cells.  The stems cells are sent back in syringes ready for administration.  The stem cells will be injected into Bella's bones.  The stem cells will then take on the charactistics of bone marrow stem cells to re-build Bella's bone marrow and transform into stem cells relative to other deficient areas in need of them.

1/21/08 Bella's PCV made a big swing up to 35%!  I was really worried Bella would develop anibodies right away, but she is responding well so far. Now, we are in a wait mode for the stem cell therapy.  Bella has gained the most weight ever.  She weighed in at 9 1/2 lbs.  I should point out that Curcumin played no part in this dramatic rise in Bella's PCV.  Bella has developed a significant limp that I believe is attributed to the Myelofibrosis.  I believe the increased prednisone along with the standard doses of procrit really helped her get to the point she is now at.  Hopefully, I will be reporting on stem cells from this point on.  In retrospect, only use the Procrit for a couple of weeks with the Prednisone.  Then wait about a month before using the Procrit again.  This way you will probably avoid erythropoietin antibodies and if you detect them, they will dissipate quicker.  This has been added as the result of Bella's death from erythropoietin antibodies.  Procrit is a great short term aid, but not a long term solution for some cats.




Some informative websites:


http://www.margaret.healthblogs.org/
   (An informative blog created by someone who has an incurabile type of cancer and is keeping stable with curcumin)



http://www.maxshouse.com/Oncology/feline_lymphoma_and_leukemias.htm/  (Feline info)

http://www.felinecrf.org/  (Great info on medications for felines)

http://www.winnfelinehealth.org/  (Site dedicated to felines)

http://www.mayoclinic.com/health/myelofibrosis/DS00886  (Facts & info on Myelofibrosis in humans)

http://www.sciencedaily.com/search/?keyword=curcumin  (Big collection of curcumin articles from Science Daily. A very good read.)

  

    © 2007 Vince Cowdry protec4u@aol.com .  All rights reserved.  Article may be used with permission from its owner.