Tag Archive | Tan Tock Seng Hospital

Coward & snob

… that’s what I am.

This is the conclusion I came to after I reflected sadly in recent days over how I let a high society dame swipe $50 from me in the name of charity when all I wanted was buy a book for $20.

Why didn’t I say “no” when I handed her a $50 note, fully expecting to receive my change, but she said, “Lucia” ever so sweetly and insincerely, “you want to donate the balance to the scholarship fund?”

I actually had no such intention or inclination but I was so taken aback at her audacity that I was at a loss for words momentarily. Then I said “OK” somewhat weakly and unenthusiastically. She, the brazen fund raiser, said a brief “thanks” and was already “charming” the next sucker before I could even gather my wits together to demand a carrier bag for the $20 book for which I had paid a reluctant extra $30.

Now contrast this with the firm folded palms “salem” and “no, thank you” I always dish out to volunteers at the Tan Tock Seng Hospital who invariably gather at the start or end of the hospital’s main escalators trying to sell stuff to raise money for needy patients.

Why can I say no to needy patients when I could allow myself to be intimidated to part with $30 ($50-$20 for the book)?

I can only put that down to cowardice. I was instinctively afraid to offend the high society dame. I was afraid to say “no” and make her lose face since there were many people around. And possibly I was also afraid that the people milling around would consider me mean or couldn’t spare the extra money.

Yup, like it or not, I want acceptance even from people I don’t particularly care about or strangers that I don’t even know.

Then why was I so brave to turn down fund solicitors at TTSH?

Guess I go to the hospital on such a regular basis that I have already grown callouses on my heart. I am less afraid of the volunteers thinking me mean since droves on either side of me also say no or just ignore them. At least I acknowledge their request — even if I don’t give in.

And worst of all, I probably value the opinions of the volunteers less than I do the fellow guests at the book launch, even though the majority were as unknown to me as I to them. But socially I most likely placed them subliminally above the hospital fund raisers.

Which makes me a snob of the worst kind. And a coward to boot!

Since I have for some time decided not to donate to organised charity — a decision taken long before the NKF and Renci sagas among others but strengthened in the wake of the scandals — I should have been as firm with the society dame as I am with knick knack fund raisers.

But I wasn’t.

So I resolve to do better the next time a well heeled tai-tai tries to intimidate me into parting with my money, or at least more than I want to!

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Alzheimer’s isn’t just about memory loss

I am delighted to read the letter in today’s Straits Times by two doctors putting a lid on the enthusiasm — misplaced I think — with which the newspaper had published the findings of Prof Kua Ee Heok  on the topic. (see letter and earlier report reproduced below)

Besides these two good doctors, my old classmate from Convent days, MA-MD was visiting Singapore from the United States and read the same article. MA-MD, who is an established geriatrician newly retired from her practice in Virginia, was kinder. She thought the ST had either misinterpreted or over-summarised Prof Kua’s findings!

As a lay person who has been looking after her mother diagnosed with mild cognitive impairment at Changi General Hospital some 8 or 9 years ago– based on a simplistic test at best — and who has been working closely with a Tan Tock Seng Hospital geriatrician for perhaps longer than that to understand mum’s problems, I will say the illness is as irreversible as autism.

It’s not just about memory loss; it’s not about engaging or not engaging with the patient. It’s like having a brain that’s like a computer constantly in “hang” mode 😥

For autistic kids, it’s about working really hard to make sure they learn to do some of the basic things that separate a human being from an animal, such as having showers and brushing their teeth. And with effort, they could be taught more, much more.

For cognitively impaired adults due to the onset of old age or a combo of old age and other brain-related illnesses, it’s about ensuring that they retain whatever basic life skills they have, such as every little thing from eating with utensils to sitting at table or lying down on a bed, even as the ability to do these things independently is inexorably lost like water through a sieve.

As I write this, I watch my mother being told repeatedly to put on her indoor slippers after taking off her outdoor shoes on returning home from an outing. It’s simple, routine, something which she has done all her life and yet she has now to be reminded, and reminded repeatedly.

Ditto, brushing her teeth on waking up and before going to bed. We have progressed — or should I say regressed?– to where we have to put tooth-paste on the toothbrush and leave it as a “cue” or a “clue” to prompt her to clean her teeth, in the morning and at night.

Most times, she doesn’t know whether she’s thirsty or hungry and eat and drink only when meals are put in front of her. Hence the importance of asking regularly whether she would like a sip of water or other liquid in between meal times.

At other times, her brain signals to her she’s super hungry and she would hobble with walker to forage for edibles in the cupboards, sometimes making do even with 3-in-1 coffee sachets, when she couldn’t find biscuits or nuts. And, no she doesn’t make coffee. She just eats the contents, as is 😥

Well, mum has had super early intervention. She’s taken medication to slow down her cognitive impairment, starting with Aricept. Then we tried Exelon patches to make it easier on her stomach but because it affected her dry and sensitive skin, we reverted to Aricept. As we learnt of another cognitive medication called mementine or Ebixa we asked and got her doctor to prescribe.

However, the doc drew the line when we asked for mum be prescribed with a combo of Aricept and Ebixa — as I know that has been done in the US and of at least one case directly from a friend whose elderly dad in Shanghai takes such a combo.

Prof Kua is right. Alzheimer’s isn’t a death sentence. But it’s definitely an incurable disease that remains with the patient, for better or worse, till death do they part. 😦

www.straitstimes.com

Published on Jul 19, 2013

No evidence of delay in dementia progression

TUESDAY’S article (“Don’s study sheds light on dementia here”) raised the controversial statement that “early treatment – including proper nutrition, stimulatory activities such as exercise or listening to music, and medication – has been shown to effectively delay the progression of dementia”.

Dementia is a syndrome of cognitive impairment with diverse causes.

Three diseases make up the bulk of dementia cases in Singapore: Alzheimer’s disease, vascular dementia (when one or more strokes damage critical brain functions) and mixed dementia (a combination of stroke and Alzheimer’s disease). The rate of disease progression varies greatly even within each category.

Everybody hopes that treatment can delay disease progression in dementia. Unfortunately, apart from blood pressure control and anti-stroke medications for vascular dementia, there is no evidence that we can delay dementia progression.

Many researchers have admitted failure in modifying disease progression in Alzheimer’s. Drugs may improve short-term memory, alleviate symptoms, make patients more manageable and even help to delay institutionalisation, but they do not change the natural history of the disease.

Researchers planning well-funded prospective studies of drug and non-drug interventions in dementia are confounded by two major problems.

First, dementia, including Alzheimer’s disease, is a clinical diagnosis. The milder the dementia, that is, the earlier one makes the diagnosis, the less certain one is of the aetiological diagnosis.

Second, any assessment of social intervention or drug efficacy is confounded by variables like age, educational background, social class, medical co-morbidities and so on.

Professor Kua Ee Heok’s retrospective study, based on a clinical diagnosis of dementia made over the last 15 to 20 years – in some cases, before high-quality neuroimaging was available – will face insurmountable challenges.

Misdiagnosis or misclassification (which is a common problem even in the best of hands) could easily corrupt data.

The condition of a patient with vascular dementia arising from a few small strokes could remain static for many years before a second stroke in a critical location, or even new-onset Alzheimer’s disease, pushes him overboard. It would be easy to misinterpret this delay in progression and give credit to social intervention or medications.

Thus, we cannot see the scientific basis behind the claim that “with proper treatment, a patient with a mild form of the condition (dementia)… can delay the onset of the next stage to six or eight years later”.

Tang Kok Foo (Dr)

Tan Chue Tin (Dr)

Copyright © 2013 Singapore Press Holdings. All rights reserved.

Published on Jul 16, 2013

Don’s study sheds light on dementia here Tracking disease progression can help sufferers get treatment early

By Janice Tai And Joan Chew

DEMENTIA patients in Singapore can expect to live 10 to 12 years after being diagnosed, longer than the eight years for those in the West.

But Professor Kua Ee Heok also warned that as many as 80 per cent of sufferers here do not benefit from early treatment, as only a fifth of all cases here are detected.

Prof Kua, a senior consultant psychiatrist at the National University Hospital (NUH), will present his findings on dementia life expectancy at next month’s World Congress of Asian Psychiatry in Bangkok.

Using previous studies and data collected from patients at NUH’s memory clinic over the last 20 years, the veteran geriatrician has mapped out the course of dementia in Asians for the first time.

By breaking down the debilitating condition into mild, moderate and severe stages, he has also managed to figure out the health cost of dementia, and how much stress care- givers face.

“This helps families know what to expect and do at each stage, and also helps policymakers to develop support services,” the 64-year-old said.

Around 28,000 Singaporeans aged 60 and above have dementia, and the number is projected to hit 80,000 by 2030.

The condition robs a person of his memory and ability to think, which affects his daily life. It also increases the risk of death as it lowers the person’s immunity to other diseases.

Given the smaller family units in the West, patients there are often sent to nursing homes, where their condition deteriorates faster if there is inadequate care.

Those diagnosed with dementia here live longer because the condition is detected and treated earlier. And that is key.

This is why Prof Kua has spent the last 20 years mapping out how the disease progresses, so that family members and doctors can recognise the symptoms.

He found that someone with mild dementia is usually forgetful – for instance, failing to remember where he left his car keys. During this stage, the patient usually spends a monthly average of $280 on medical bills.

Those with moderate dementia go on to see and feel things that are not real. These may include feelings of paranoia, such as a belief that people are planning to steal from the patient.

At this point, the cost of health care can soar by more than four times to $1,250, as patients have to see the doctor more frequently, and may even need to hire a maid to provide home care.

It is also at this stage that caregivers face the highest levels of stress, as patients are more likely to display distressing behaviour – such as rushing to the door when footsteps are heard – because of the hallucinations and delusions they experience.

When the condition becomes severe, the patient may no longer recognise his family or even his own reflection. Medical costs drop to around $850 a month, given that the patient would likely have to be kept in bed most of the time.

Prof Kua said that early treatment – including proper nutrition, stimulatory activities such as exercise or listening to music, and medication – has been shown to effectively delay the progression of dementia.

With proper treatment, a patient with a mild form of the condition, for instance, can delay the onset of the next stage to six or eight years later, instead of the usual four.

“With what we know now, family members and doctors can better help patients seize the day so that they can have more than a few good years,” said Prof Kua.

“Dementia is not a death sentence.”

jantai@sph.com.sg

joanchew@sph.com.sg

Copyright © 2013 Singapore Press Holdings. All rights reserved.

My cup overflowth with Each A Cup

There were two things that got my goat yesterday and I really wanted to rant and rave about them.

The first concerns Magnus Bocker, the CEO of SGX, who has been given a 25% pay rise, not counting his other perks. After what he’s done in 2010 re the abortive attempt to swallow ASX, it makes me wonder what his pay rise would be had the attempt succeed? Quadruple or more?

But I’ll let that pass.

I also wanted to rave and rant about a bank teller who made me feel I wasn’t speaking English by the way she answered my questions concerning putting funds into what her bank employer calls a “bonus + savings” account which pays 1% pa every quarter if one doesn’t withdraw the $ 🙄

It was only after 5 minutes of to-n-froing that I got the answer I wanted. I had to open a new account, if I wanted to benefit from this savings account, never mind that I’ve been a customer for aeons and also have several accounts with this bank.

As I wanted to open the account in joint names, the other person had to be present to open the account too. It didn’t matter that we already had a joint with the bank.

However, instead of saying all this from the word go, she kept parrying my questions by saying that I needed to open a new account because my papers were with headquarters. Ditto my joint account holder.

So I suggested i go down to the HQ in Chulia Street and they could then activate the bonus + savings account for us.

“It would still be the same,” the teller said.

“Why? You said my papers are there; so are my joint holder’s. They should be able to give us the joint bonus + savings account there and take our money?”

No, no, it finally came out: it doesn’t matter what, where or how. The two of you just have to be present, geddit? Nothing to do with papers. The two of you just have to be present to open the account.

The teller didn’t say all that. It just finally dawned on me that was what she meant but just didn’t know how to tell me. Or mayb my kind of English and hers didn’t connect.

Normally i would have complained to someone at her HQ but I also let that passed!

Because yesterday had been an extraordinarily good day for me, in the sense everything went my way – other than the bank teller, but mayb there’s something better waiting for moi? Like better interest rates.

But I digress.

Yesterday had been good first of all because I got my mum with the help of her Picky just in the nick of time to see her geriatrician at Tan Tock Seng Hospital, even tho the appointment was at the early 9.40am slot.

We didn’t have to wait nor did we keep the doctor waiting.

As we were on time, mum’s next appointment with the geriatric physiotherapist at 11am (chosen earlier on the assumption that we would have to wait be4 seeing the doctor) meant we might have to sit around twiddling our thumbs for almost an hour.

It was all right  for me as I could walk around but mum being in wheel-chair would get pretty impatient, might throw a tantrum and we would probably have to cancel the physio appointment.

A brain-wave struck me as we were in the doctor’s room and I sent Picky to check if the physio could squeeze us in. He could provided his 10.30am appointment didn’t show — which happened and mum went almost straight from Dr Angel Lee (her ever accommodating geriatrician) to her exercise, because we the good doctor gave us almost 45 minutes!

And an earlier stroke of luck in the carpark — after I had dropped mum n Siti off — made me sing again the praise of the efficacy of the parking lot prayer!  As anyone who visits TTSH would tell you, the carpark is often a nightmare.

But when I got in and did a counter-intuitive thing — turn into the area leading out of the carpark — which I saw was packed as I drove in, I uttered the prayer wit fervour. Once again, I wasn’t disappointed. A car moved out just as I was resigned to having to go hunt in the rest of the carpark.

That immediately put me in an excellent mood for the rest of the day, which included an early lunch at Bumbu Desa in Square 2, with mum and Picky after mum’s exercise.

To cap the meal, I wanted to have Each a Cup’s millet tea with agar agar — to which I’ve recently grown addicted. As I only had it at City Square, I was debating whether to drive over there to indulge when heading for the carpark of Square 2, I saw a Each a Cup kiosk materialise be4 my eyes! Natch I induldged in my new fav brew 😆

With so many good things happening to me within a few short hours, why should I angst about what pay is going to Mr Magnus Bocker –whom I don’t know other than from media reports. And I can most certainly be magnanimous with a rather dense bank teller!

I ran into Prof Lim Chong Yah…

… today….

I was about to get into a lift to go to the Novena Square carpark and he was coming out.

He was carrying a Fairprice plastic bag which suggested he must have gone to shop at Square 2 (where there’s a Fairprice outlet) but parked somewhere else… perhaps like me, he is a frequent visitor to this Golden Triangle of Tan Tock Seng Hospital, Novena Square and Square 2.

No matter.

I greeted him. He looked very pleased and we shook hands. He asked for my name.

I told him gladly but it didn’t register so I said I last met him many, many years ago in Kuala Lumpur when he was with University of Malaya.

He remarked on my good memory. I said no, it’s just that I follow the news and could recognise him from the newspapers and TV appearances over the years.

I didn’t dare refer to his Shock Therapy to raise the wages of the lower paid in Singapore as our short encounter is no place for me to knock what he has suggested nor would there be time for him to defend his “solution”, assuming he was so inclined.

We said good bye; he went on his way and me into the lift.

We managed that two-minute exchange because there was no one inside the lift and none were behind me waiting to get in!

After I left him, I couldn’t help thinking how tiny and bent he had become. I somehow felt I towered over him, which probably wasn’t true, as I was wearing flatties today, due to the rain, not my normal stilts. 🙄

After I left him I couldn’t stop those terrible lines from Yeats from coming unbidden to mind! (I’ve bold the crucial words!)

THAT is no country for old men. The young
In one another’s arms, birds in the trees
– Those dying generations – at their song,
The salmon-falls, the mackerel-crowded seas,
Fish, flesh, or fowl, commend all summer long
Whatever is begotten, born, and dies.
Caught in that sensual music all neglect
Monuments of unageing intellect.

An aged man is but a paltry thing,
A tattered coat upon a stick, unless
Soul clap its hands and sing, and louder sing
For every tatter in its mortal dress,
Nor is there singing school but studying
Monuments of its own magnificence;
And therefore I have sailed the seas and come
To the holy city of Byzantium.

O sages standing in God’s holy fire
As in the gold mosaic of a wall,
Come from the holy fire, perne in a gyre,
And be the singing-masters of my soul.
Consume my heart away; sick with desire
And fastened to a dying animal
It knows not what it is; and gather me
Into the artifice of eternity.

Once out of nature I shall never take
My bodily form from any natural thing,
But such a form as Grecian goldsmiths make
Of hammered gold and gold enamelling
To keep a drowsy Emperor awake;
Or set upon a golden bough to sing
To lords and ladies of Byzantium
Of what is past, or passing, or to come.

She turns 87 & she turns 84

Mum turned 87 on Monday. No fanfare. No celebrations. We just had simple lunch at Lenas in Bugis Junction. She and I shared a set. Her Picky had a set all to herself.

On Sunday, there was the usual family lunch with hongbaos to her from the usual suspects. H and C bought tarts from Baker & Cook at Hillcrest Road as I suggested. They also gave mum hongbaos despite my saying “no need”. Guess it’s the usual Asian reaction to suggestions of “no need” 😆

What a diiference a year has made. Last year, a week be4 mum’s birthday I was able to give her a pre-birthday treat at ION’s Paradise — just the two of us. She was able to hobble on her own two legs with the help of a folded golf-stool.

This year, no such luck. When we go out, she needs a wheelchair, for her sake as well as for mine, since many a stranger had gone so far as to suggest to me that I shouldn’t make my mother suffer. “Get her a wheelchair,” they said!

I might still be dithering if not for the fact that events took the decision out of my hands. Mum took a bad tumble at home on Oct 2 last year that led to her hospitalisation at Tan Tock Seng Hospital for one night for observation.  Apres that, although she suffered no more than bad bruises, I didn’t want to take any more chances.

We got her a wheelchair for outdoor use and another for indoor use, although most times the latter isn’t used at all, as mum still manages to move around at home with the help of a frame-walker.

Now contrast my mum’s latest birthday with what another octogenarian whom I know. Auntie GY celebrated her 84 on March 3 at her lovely home off Swiss Club Road.

I got to know Auntie GY thru a mutual friend and this is the second time I have been included in her birthday bash, the first being two years ago when we went in a group to Sarawak.

The difference lies in the fact that one birthday girl is still full of joy of life whereas my mum while still enjoying her food has lost much of her ability to engage with others. And that ability is what makes living vibrant — unless one has always been a hermit or a recluse 🙄

  Although there were about 40 of us, we couldn’t even manage half of what was available, supplied by Glory of East Coast Road… because there was still the dessert of birthday cake, cakes I mean, as there were two!

Two of the best for the 84-year-young birthday girl

Life is still blooming at 84!

 

More blooms still!

 

Guests making themselves at home

 

Back @ Tan Tock Seng A& E again

It’s now late August 2011. So I should count myself really lucky that it’s only now that I’m back again at Tan Tock Seng Hospital’s Accident & Emergency Department — after some 16 months and not any sooner.

I was there in April 2010 and the reason for that visit is detailed here.

I was back again on Tuesday, Aug 23, and mum’s Picky Siti was again the reason.

But rewind back to last Saturday night.

I was out at a Strauss opera called Salome performed at the Esplanade, Theatres on the Bay, courtesy of an invite from JL, my regular provider of cultural fixes.

When I returned home a little after 10pm, i was surprised to find everyone sound asleep as Picky usually waits till 10.30pm.

I went by her room and saw she was flat on her back with a face cloth on her face which i thought was a bit creepy and made a mental note to tell her so in the morning.

That I did when I found she was still sleeping at 8.30am when both mum and I were up and mum waiting for her breakfast.

That was when Picky told me she developed a high fever just as i was going out the nite be4 and decided “not to worry you” by mentioning it. To keep the fever at bay, she kept a wet face towel on her face! The panadol she took didn’t help. She had also been purging, she said.

Rest of family arrived and after a hurried meal, I rushed her to see the Sunday doctor at Holland Village. Thanks to the kindness of Kinara, the Indian restaurant, we were able to park right behind the Silver Cross chain clinic, got three types of medication and was home in no time.

With Picky out of action, I had a taste of what it meant to have to look after mum, including giving her her shower, her be4 sleep leg massage, cook and clean. Add all the little chores of putting out the vases of flowers to catch the dew at nightfall, put out food for the invisible family of lizards we maintain etc that may be no hard work individually but collectively are very time consuming. 🙄

But Picky remained flat out on Monday and in addition to her stomach cramps, a light fever and diarrhea, she also began vomiting, and so wasn’t able to keep down any of the medication she was precsribed by Silver Cross! Not the best way to get better 😦

So it was another flat out day for me, besides worrying whether Picky was seriously ill or play acting, always opting to believe that her sour face and moans meant she was really, really sick. She couldn’t even keep down a tea-spoon of water by evening, though she kept stirring my doubts by pausing in between throwing up loudly to watch TV!

I wavered between rushing her to A&E in the middle of the night or waiting till day break; the first option wasn’t easy as I’ve a cognitive impaired octogenarian to take care of. Calling family members to mother-sit or sending her to them weren’t real options as it meant spreading the problem far and wide, without lightening it a jot for me.

By early on Tuesday morning, I decided to call a private ambulance — and hang the $50! —  to send Siti to TTSH’s A&E to begin the tedious queueing process for those without obvious life-threatening injuries, while I clean house and send mum to my sister’s, and then go to A&E to check on her.

As things turned out, the ambulance won’t arrive for another 45 minutes and while waiting for the minutes to pass, a light bulb lit up in my head. I didn;t really want an ambulance to arrive at my condo and set curious neighbours’ speculation. I should call a taxi for Picky, not any taxi but that driven by one taxi auntie I’ve known for years.

That’s what i did. Cancelled the ambulance n located the auntie taxi at Changi airport and made her a $40 offer to do the necessary.

To cut a long story short, with mum safely ensconced at my sister’s home, I rushed to TTSH to find Picky treated like a queen by the A&E staff. She had been given two packs of saline and something else drip and could be discharged, together with 7 kinds of medication. In addition, she had tests for “creatinine, potassium, sodium, urea and full blood count”!

The doctor in attendance was kindly, a Dr Tong whom Picky claimed was a Muslim and, like her, was doing puasa.

Be that as it may but one of the better things to happen that day besides Picky not being diagnosed with dengue or worse was the bill. It cost $90. Not a small bill to be sure but I had paid $59 at Siver Cross for a 5-minute consultation on Sunday. Also, the A&E bill’s actual cost was $240, be4 government subsidy and another $6.30 GST also absorbed by the government.

The not-so-g0od thing was Picky returned home and was averse to taking her medication, much to my chagrin. I coaxed and threatened but eventually she gave in not because of what I said but because her illness got better of stubborness.

The diarrhea, vomiting and fever have gone but the pain in her stomach area persists, she says. Let’s hope what my cousin Peter’s pronouncement on a flying visit to Sg from London doesn’t come true.

“You know, Siti could be having stones in her gall bladder!”

I blanched.

I can do without a further visit to the A&E at TTSH for at least another 16 months. Even when the government subsidises my bill so handsomely!

Politicians: look after this old man?

I’m a bit cynical whenever politicians — on whichever side of the divide — declare themselves to want to serve the old and disadvantage, especially in these days of high faluting talk when trying to elicit the Singaporean vote.

I wonder why, instead of making promises, they don’t do something concrete? Better to actually help one person than vaguely promise to help thousands!

Especially for the not so invisible poor who tramp our roads or congregate in particular at the Kwan Im Hood Cho Temple in Waterloo Street flogging packs of tissue paper to hurrying passers by!

Which brings me to my favourite charity cause — till hunger, neglect, disease finally frees him from his world of terrible sufferings.

I refer to the old tramp who I used to see trudging down Dunearn Road and then up Bukit Timah Road, in sunshine, in rain, in tattered clothes and looking quite spaced out.

Then I began to give him small amounts of cash, enough to buy him a basic meal or two, whenever I see him, which isn’t that often. And every time I don’t see him for several weeks, I’m both fearful he might be dead or worse, not dead but lying in some gutter wishing for death.

TTSH shop spree

So what a blessed day I thought April 29 was when after a quick shopping spree at the Tan Tock Seng Hospital’s pharma (which was giving a 20% discount on most products to celebrate a national service award), I turned into Moulmein Road and guess what?

I saw the old tramp trudging in the direction of Newton Circus.

As traffic was light, I pulled up and handed him a little something that should stave him from hunger for that day.

I was so glad to see him, as it’s been almost six or seven weeks since I last saw him and that last time, it wasn’t convenient to help him because of the heavy traffic along my neck of the woods, what with construction of the Downtown line going hammer and tongs, as well as new condos in various stages of completion every few steps.

Now why can’t, why don’t, our politicians target this segment of Singaporeans who have no voice and more importantly, no or little food, no home, no family; in short no support?

Just as well I don’t have to vote this year 😛