The Bipolar Organisation is running its Annual conference on 27th October 2007 at King’s College London and this year’s theme is Families and Bipolar Disorder (Conference schedule and available workshops are detailed below together with speakers’ biographies).

To find out more about going to this conference (only £18) then call the Bipolar Organisation or visit their website at
“http://www.mdf.org.uk/”>http://www.mdf.org.ukContact the Bipolar Organisation for more details and membership

Jean Wit, Office Manager

Tel. 020 7793 2605, Fax: 020 7793 2639

Email: jean@mdf.org.uk, web site: http://www.mdf.org.uk/

CONFERENCE SCHEDULE

9.30 – 10.00          Registration

10.00 – 10.15        Chair’s Introduction – Helen Waygood, MDF The BiPolar Organisation

10.15 – 11.00        Keynote Presentation: ‘Mental Illness – Understanding the Genetic Dynamic’

                                Professor David Porteous, University of Edinburgh

11.00 – 11.15         Families and Bipolar Disorder: An Introduction

                               Michel Syrett, Editor, Pendulum (MDF)

11.15 – 11.45         Families and Bipolar Disorder: A Global Overview

                                William P. Ashdown, Mood Disorders Society of Canada

11.45 – 12.30      “Planning a Family: A Bipolar Perspective’

                               Dr Ian Jones, Mood Disorder Team, University of Cardiff

12.30 – 13.30            LUNCH

1.30 – 14.30               Workshops – please refer to the plan provided

14.30 – 15.00            Social Break (Tea and Coffee)

15.00 – 16.15           ‘Families and Bipolar Disorder: Personal Perspectives’

                                   –   Making a Marriage Work: Andrew and Heather Heald

                                    -  A Mother and Daughter Perspective: The Two Anns

                                    -  Discussion led by Michel Syrett

16.15 – 16.30         Closing Remarks

                                Helen Waygood, Chair, MDF The BiPolar Organisation

WORKSHOPS:  

Please note that selected workshops will be offered to attendees pre – booking preferences and that the workshops will located within the conference venue, to be advised immediately prior to lunch

1.       Families with Bipolar : “Needs and Support”

         Michel Syrett (MDF)

2.       Art as a Source of Recovery

         Lorraine Nicholson and Jackie Proctor (Perth Plus)

3.    Cognitive Behavioural Therapy: The benefits to Bipolar Disorder

       Dr Warren Mansell – Clinical Psychologist – University of Manchester

 4.    Nutrition and Good Mental Health

       Jane Asto (Eat Right)

Social Get-Together and Opportunity to Relax

Speaker Notes/ Biographies of Speakers

Helen Waygood : Chair of MDF The BiPolar Organisation since January 2007

 Helen is a an HR specialist who has steered the charity through a period of intense change, drawing on almost twenty year’s experience working for the organisation as a volunteer and more recently as a Trustee, as well as a passionate belief in its future. She continues to work as an interim HR consultant in the public and private sector

Professor David Porteous is a graduate of the University of Edinburgh and a former Head of Section at the MRC Human Genetic Unit, Edinburgh.

 In 1999, he was appointed Professor of Human Molecular Genetics & Medicine at the University of Edinburgh and also Head of the Medical Genetics Section. He is the current Director of the Molecular Medicine Centre, University of Edinburgh, Director of the Genetics Core at the Wellcome Trust Clinical Research Facility Western General Hospital Campus and on the Executive Board of the Institute of Genetics and Molecular Medicine in Edinburgh, a partnership between the University of Edinburgh, The UK Medical Research Council and Cancer Research UK

Michel Syrett is a founding trustee, former chair and guarantor of MDF The BiPolar Organisation.

He is currently Editor of Pendulum the charity’s quarterly journal. He has conducted research into families and bipolar disorder for The Scottish Recovery Network and is the author of The Secret Life of Manic Depression, the booklet that accompanied last year’s BBC2 Documentary Stephen Fry: The Secret Life of a Manic Depressive. Michel is also a business writer and commentator and the author of 15 books on topics as varied as leadership, innovation and strategy execution

William Ashdown is an active lobbyist and educator, currently Vice President of the Mood Disorders Society of Canada, Founder Member of the Canadian Alliance for Mental Illness and Mental Health and Chairman of the Depression and Bipolar Support Alliance.

Additionally, he serves on a number of boards for organizations in both Canada and the United States. He is a founding member of the Canadian Alliance for Mental Illness and Mental Health (CAMIMH), serving for eight years. Starting with five organizations, the alliance is now made up of 18 national organizations concerned with mental illness and mental health. CAMIMH is one of the strongest voices for mental healthcare in Canada

Dr Ian Jones is Senior Lecturer in Perinatal Studies in the Department of Psychological Medicine at the University of Cardiff. He is co-leader of the Mood Disorder Research Team which is undertaking extensive research into the triggers and provenance of bipolar disorder. Dr Jones is currently undertaking extensive research into the influence of hormones in women who suffer from bipolar disorder and was author of an article on the subject in the Summer 2007 edition of Pendulum, quarterly journal of MDF The BiPolar Organisation

Jane Aston – Jane Aston qualified as a nutritional therapist with the Institute for Optimal Nutrition which was founded by the leading nutritionist Patrick Holford. A member of the British Association for Nutritional Therapy, Jane has been working within organisations supporting people with a disability for over ten years. She wrote a summary of the issues she raises in the workshop on nutrition and mental health in the Autumn 2007 edition of quarterly journal of MDF The BiPolar Organisation.

Jackie Proctor is a Multimedia Artist, working in mediums of painting sculpture and photography. She ran her own gallery for eight years in Fife, Scotland and a ceramic and Sculpture business in Pitlochry for  seven years. She has had many solo exhibitions both at home and abroad. She has pursued her artistic career despite being diagnosed with bipolar disorder at 18. This year she took on the ambitious community project One Leaf – One Link exhibited in the foyer at the Art at the Heart of Wellbeing conference in Perth, Scotland earlier this month. She will talk briefly about this project at the workshop on Art as a Source of Recovery

Lorraine Nicolson has always been an artist at heart but missed her original vocation until severe depression revealed it to her. Up until then she had been trained as a linguist at university and lived life according to others’ expectations. Having now corrected this error she is keen to explore the possibilities of the healing nature of art with other people based on her own lived experience. She has had solo exhibitions of her artwork and photography which have been seen as the visual expression of her recovery

Dr Warren Mansell works as a practising Clinical Psychologist at Salford Early Intervention Service and as a Lecturer in Psychology at the University of Manchester. He completed his PhD at the University of Oxford, and his Clinical Psychology training at Kings College, London. He is a co-chair of the national conference of the British Association of Behavioural Cognitive Therapies and has authored over a dozen recent publications on CBT for bipolar disorder. His work has been covered regularly in Pendulum, the quarterly journal of MDF The BiPolar Organisation and he has been a regular contributor to the charity’s conferences and seminars.

The Two Anns, mother and daughter, are long standing members of MDF The BiPolar Organisation Cymru. They wrote a joint article on the dynamics of being a mother in a caring role and a daughter’s perspective of both family life and marriage as someone who has bipolar disorder in the Autumn edition of , the quarterly journal of MDF The BiPolar Organisation

Andrew and Heather Weald Andrew has been an active member for the Wales branch of the charity for over 14 years, more recently becoming Chair of MDF The BiPolar Organisation Cymru, and is a self management group facilitator. Married to Andrew for six years, Heather gained an MA in Literature at Cardiff University as a mature student. She is a regular contributor on the issues and challenges facing carers in mental health for Pendulum, the quarterly journal of MDF The BiPolar Organisation Cymru.

 This is what the Bipolar Organisation has said about the Bipolar Parenting programme which is currently running at the University of Manchester: http://www.mdf.org.uk/?o=67897Parents with bipolar disorder are taking part in a study that will give them the chance to follow a highly successful parenting skills programme.
Dr Steven Jones and Dr Rachel Calam at the University of Manchester’s School of Psychological Sciences assess the volunteers’ current mood and experiences of parenting with an online questionnaire before offering some of them help via an online version of the Triple P Positive Parenting Programme that featured on the ITV1 television series called ‘Driving Mum and Dad Mad’.
The Triple P system, developed by Australian clinical psychologist Professor Matt Sanders, is known to be effective in modifying and improving children’s behaviour by rebuilding positive relationships, tackling discipline and setting rules and limits.

The first series of ‘Driving Mum and Dad Mad’ in spring 2005 followed the experiences of five families attending a Triple P group. An average of 4.23 million viewers watched the show, with 500 families taking part in a parallel study by Dr Calam, The Great Parenting Experiment. All the parents who followed the TV series and used the strategies shown reported improved behaviour in their child and greater confidence in managing it. The group receiving additional web-based information and email support experienced an even greater improvement, and six months after the series most of the families reported long term benefits and continued improvements to their children’s behaviour.

Dr Jones said: “Parents with bipolar disorder face many challenges in bringing up their children with key facets of the disorder, such as instability of mood and behaviour, impulsivity and anger problems, likely to lead to parenting difficulties. These difficulties can serve as stressors likely to contribute to distress, destabilisation and possible relapse in the parent.  At the same time, recent research suggests that children of parents with bipolar disorder are at increased risk of behavioural and emotional disturbance, which are risk factors both for their own development and for parental mental health.

“This study is a great opportunity for these parents and their children. Triple P is a very good, sound programme that has helped many families. Professor Sanders has used this with depressed mothers and had good results.”

He added: “We hope that this system will prove to be a beneficial, efficient way of delivering help to parents with bipolar disorder and their families, and services can adopt it with little cost to them. There are 60 million people in this country and 1.5% of them are diagnosed with this disorder, which is a lot of people. At the same time there are a very small number of clinical psychologists so face-to-face therapy is expensive and difficult to get. But this study could lead to, say, a Manchester intervention from London.”

Dr Jones and Dr Calam, who are also working with MDF The Bipolar Organisation on this study, are now recruiting more parents who have been diagnosed with bipolar disorder, have children aged three to ten and online access.

The initial questionnaire will assess family background, parental and family chaos, strengths and difficulties in the face of child behaviour, mood in terms of mania or depression and patterns of stability such as leading an orderly life and getting enough sleep. This will involve a combination of a standardised measure of child adjustment, a self report measure of parental symptoms and questions designed specifically to establish the extent to which parents think that a parenting intervention would be helpful to them and how likely they would be to take part if one was offered, and a self report measure of parental symptoms. It will thus establish whether the parents would have an interest in a self-directed version of Triple P, as this would be a cost-effective way of evaluating delivery of parenting interventions to a geographically dispersed group with variable access to high quality parenting services, and how their current mood symptoms influence this level of interest.

The first questionnaire will be followed by ten weeks on a self directed Triple P programme for some of the sample and no intervention at all for the others (the control group). This will be followed by a second questionnaire to assess how each area has been affected by the intervention and if the families’ situations have changed. The control group will then be offered the chance to take part in the Triple P programme.

· To take part in the study, volunteers can contact reachingabalance@manchester.ac.uk, or register on www.reachingabalance.org.uk

For more information or to arrange an interview with Dr Steven Jones or CASE STUDY contact Media Relations Officer Mikaela Sitford on 0161 275 2111.

The University of Manchester (www.manchester.ac.uk) is the largest higher education institution in the country, with 24 academic schools and over 36 000 students.  Its Faculty of Medical & Human Sciences (www.mhs.manchester.ac.uk) is one of the largest faculties of clinical and health sciences in Europe, with a research income of around £51 million (almost a third of the University’s total research income).

The School of Psychological Sciences (www.psych-sci.manchester.ac.uk) was founded in 2004, and comprises the oldest Psychology department in the UK together with Human Communication and Deafness and Clinical Psychology divisions.  All were rated 5/5 in the last higher education Research Assessment Exercise.
MDF The BiPolar Organisation (http://www.mdf.org.uk/) works to enable people affected by bipolar disorder / manic depression to take control of their lives. It supports and develops self-help opportunities for people affected by manic depression, expands and develops the information services about manic depression, influences the improvement of treatments and services to promote recovery, decreases the discrimination against and promotes the social inclusion and rights of people affected by manic depression

I have been researching the DVLA rules regarding whether or not you can drive if you suffer from Bipolar to determine whether or not the DVLA can refuse me a licence as I suffer with Bipolar 2. Being a parent with young kids, driving is very important; if I am forced to give up my licence it will make seeing my kids even more difficult than it is already.

I’ve continued driving whilst the DVLA are undergoing their investigations as to my fitness to drive. I know that I’m absolutely fine to drive, so I should have my licence re-issued as I pass all the tests i.e.:

• I have been well for 3 years
• I am fully compliant with my medication regime
• I do not abuse substances such as alcohol or illicit recreational drugs
• I don’t fall asleep from my sedatives whilst driving
• My judgement isn’t impaired unless its a white van driver behind me driving 2mm from my rear bumper – then there’s a slight wish to slam on the brakes and shout at him/her that I’m a crazy woman who he/she shouldn’t mess with…………………..only kidding…….

I think the following aspects of my driving should also be taken into account………………

• I don’t think that going 150 mph in a 30mph zone is ok……….
• I do think that anyone who goes 20 mph in a 30mph should be shot……well, ok shooting them’s a bit extreme…………maybe I could just through eggs at their back windscreen so that they’re forced to pull over and I can then get on my merry way………
• I do think that blasting up my favourite Killers song (Mr Brightside, for those of you who are interested) is a fantastic accompliment to my driving happiness levels. (As is Fat Boy Slim, Faithless, Primal Scream, Prodigy and loads of others as I am a musicaholic…..)
• I limit my caffeine intake whilst driving to 3 cups per hour ………………………………………………….!!!!!!!!!!!!!!!!! Is this an “illicit substance” for the purposes of the DVLA’s investigation???? Causes anxiety and mania???Affects concentration as your hands are too busy shaking so you can’t clutch the wheel properly…….
• I don’t think that I’m Jeremy Clarkson or any other celebrity who thinks that they are beyond the speed limits……………………………………………………..(PS I really like Jeremy Clarkson and would dearly love to go the speeds that he goes as I am an adrenaline junkie, but I reckon it would give the Judge too much to go on.)
• I don’t think that putting on my mascara, doing my nails or otherwise tending to my personal appearance is worth being pulled over for by the police
• I don’t yell down the phone at my ex-husband whilst not on a hands free device (although it has to be said that this affects my concentration momentarily as I imagine all the ways I’d like to throttle him……………..JOKE! I am NOT dangerous…..)
• Eating chocolate, crisps and sweeties is OK whilst driving as it increases my endorphin levels so that I am a happy bunny which means I can tolerate other people’s bad driving more easily……
• I have stopped talking to my lawyer whilst driving as this substantially increases my ability to concentrate and my anxiety levels due to the thoughts that the conversation I’m having is costing my £100 every half an hour I spend on the phone to him…………Bloody lawyers………

So, I will stick to my normal driving habits and hope that I’ll be given my new licence……….Watch this space.

There are various websites giving information about the DVLA’s rules with regards to drivers with mental health problems, including:

•  Rethink is an organisation for people suffering with a mental health illness – www.rethink.org http://www.rethink.org/living_with_mental_illness/everyday_living/driving/index.html (gives the rules but also tells you how to appeal if the DVLA refuse you a licence or revoke it.
• Open Up:Mental Health Media’s anti-discrimination toolkit project. 
  http://www.openuptoolkit.net/know_your_rights/driving.php
• MIND: The mental health charity: http://www.mind.org.uk/Information/Legal/driving.htm
• DVLA: The guidelines, “Guide to the current Medical Standards of Fitness to Drive” can be found on the DVLA website at http://www.dvla.gov.uk/ . They have produced a Form M1 which you can view and download here http://www.houlston.freeserve.co.uk/mentalhealthdvla.pdf
• DirectGov: the Government’s website giving information about Government departments: http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDrivers/DG_4022415

The law can be found in the Road Traffic Act 1988 and Part VI of the Motor Vehicles (Driving Licences) Regulations 1999 together with other regulations and guidelines for medical practitioners.

 Here is what the Bipolar Organisation ~( www.mdf.org.uk) says:

Driving – DVLA

Below is the current information from the DVLA on Psychiatric Disorders and what action needs to be taken.
If you have any queries about these you should contact the DVLA directly.

If you have a medical condition which has become worse since your licence was issued or you develop a new medical condition, you must inform the Drivers Medical Group of your condition, as it may affect your fitness to drive. Failure to do so is a criminal offence and is punishable by a fine of up to £1000.

Psychiatric Disorders

GROUP 1 ENTITLEMENT
ODL CAR, M/CYCLE

GROUP 2 ENTITLEMENT
VOC LGV/PCV

ANXIETY OR DEPRESSION

(without significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts).
DVLA need not be notified and driving may continue. (See note about medication in appendix at end of this Chapter).
Very minor short-lived illnesses need not be notified to DVLA. . (See note about medication in appendix at end of this Chapter).

MORE SEVERE ANXIETY STATES OR DEPRESSIVE ILLNESSES

(with significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts)

NB: For cases which also involve persistent misuse of or dependency on alcohol/drugs, please refer to the appropriate section of Chapter 5. Where psychiatric illness has been associated with substance misuse, continuing misuse is not acceptable for licensing.

Driving should cease pending the outcome of medical enquiry. A period of stability depending upon the circumstances will be required before driving can be resumed. Particularly dangerous are those who may attempt suicide at the wheel.

Driving may be permitted when the person is well and stable for a period of 6 months. Medication must not cause side effects, which would interfere with alertness or concentration. Driving is usually permitted if the anxiety or depression is long-standing, but maintained symptom-free on doses of psychotropic medication, which do not impair. DVLA may require psychiatric reports.

NB. It is the illness rather than the medication, which is of prime importance, but see notes on medication.

ACUTE PSYCHOTIC DISORDERS OF ANY TYPE

NB: For cases which also involve persistent misuse of or dependency on alcohol/drugs, please refer to the appropriate section of Chapter 5. Where psychiatric illness has been associated with substance misuse, continuing misuse is not acceptable for licensing.

Driving must cease during the acute illness. Re-licensing can be considered when all of the following conditions can be satisfied:

• (a) Has remained well and stable for at least 3 months
• (b) Is compliant with treatment
• (c) Is free from adverse effects of medication which would impair driving
• (d) Subject to a favourable specialist report

Drivers who have a history of instability and/or poor compliance will require a longer period off driving.

Driving must cease pending the outcome of medical enquiry. It is normally a requirement that the person should be well and stable for 3 years (i.e. to have experienced a good level of functional recovery with insight into their illness and to be fully adherent to the agreed treatment plan, including engagement with the medical services) before driving can be resumed. In line with good practice, attempts should be made to achieve the minimum effective anti-psychotic dose; tolerability should be optimal and not associated with any deficits (e.g. in alertness, concentration and motor performance) that might impair driving ability. Where in patients with established illness the history suggests a likelihood of relapse, the risk should be appraised as low (either in the treated or untreated state). DVLA will normally require a consultant report that specifically addresses the relevant issues above before the licence can be considered.

HYPOMANIA/MANIA

NB: For cases which also involve persistent misuse of or dependency on alcohol/drugs, please refer to the appropriate section of Chapter 5. Where psychiatric illness has been associated with substance misuse, continuing misuse is not acceptable for licensing.
Driving must cease during the acute illness. Following an isolated episode, re-licensing can be reconsidered when all the following conditions can be satisfied:

• (a) Has remained well and stable for at least 3 months
• (b) Is compliant with treatment
• (c) Has regained insight
• (d) Is free from adverse effects of medication which would impair driving
• (e) Subject to a favourable specialist report

REPEATED CHANGES OF MOOD: Hypomania or mania are particularly dangerous to driving when there are repeated changes of mood. Therefore, when there have been 4 or more episodes of mood swing within the previous 12 months, at least 6 months stability will be required under condition (a), in addition to satisfying conditions (b) to (e).

Driving must cease pending the outcome of medical enquiry. It is normally a requirement that the person should be well and stable for 3 years (i.e. to have experienced a good level of functional recovery with insight into their illness and to be fully adherent to the agreed treatment plan, including engagement with the medical services) before driving can be resumed. In line with good practice, attempts should be made to achieve the minimum effective dose of psychotropic medication; tolerability should be optimal and not associated with any deficits (e.g. in alertness, concentration and motor performance) that might impair driving ability. Where in patients with established illness the history suggests a likelihood of relapse, the risk should be appraised as low (either in the treated or untreated state). DVLA will normally require a consultant report that specifically addresses the relevant issues above before the licence can be considered.

Appendix

PSYCHIATRIC NOTES

• The 2nd EC Directive requires member states to set minimum medical standards of fitness to drive and sets out the requirements for mental health in broad terms
• The Directive makes a clear distinction between the standards needed for Group 1 (cars and motorcycles) and Group 2 (lorries and buses) licences, the standards for the latter being more stringent due to the size of vehicle and the greater time spent at the wheel during the course of the occupation
• Severe mental disorder is a prescribed disability for the purposes of Section 92 of the Road Traffic Act 1988. Regulations define “severe mental disorder” as including mental illness, arrested or incomplete development of the mind, psychopathic disorder or severe impairment of intelligence or social functioning. The standards must reflect, not only the need for an improvement in the mental state, but also a period of stability, such that the risk of relapse can be assessed should the patient fail to recognise any deterioration
• Misuse of or dependency on alcohol or drugs will require the standards in this chapter to be considered in conjunction with those of Chapter 5 of this publication.

MEDICATION

• Section 4 of the Road Traffic Act 1988 does not differentiate between illicit or prescribed drugs. Therefore, any person who is driving or attempting to drive on the public highway, or other public place whilst unfit due to any drug, is liable to prosecution
• All drugs acting on the central nervous system can impair alertness, concentration and driving performance. This is particularly so at initiation of treatment, or soon after and when dosage is being increased. Driving must cease if adversely affected
• The older tricyclic antidepressants can have pronounced anticholinergic and antihistaminic effects, which may impair driving. The more modern antidepressants may have fewer adverse effects. These considerations need to be taken into account when planning the treatment of a patient who is a professional driver
• Anti-psychotic drugs, including the depot preparations, can cause motor or extrapyramidal effects as well as sedation or poor concentration, which may, either alone or in combination, be sufficient to impair driving. Careful clinical assessment is required
• The epileptogenic potential of psychotropic medication should be considered particularly when patients are professional drivers
• Benzodiazepines are the most likely psychotropic medication to impair driving performance, particularly the long acting compounds. Alcohol will potentiate the effects
• Doctors have a duty of care to advise their patients of the potential dangers of adverse effects from medication and interactions with other substances, especially alcohol
• Drivers with psychiatric illnesses are often safer when well and on regular psychotropic medication than when they are ill. Inadequate treatment or irregular compliance may render a driver impaired by both the illness and medication.

CONFIDENTIALITY

When a patient has a condition which makes driving unsafe and the patient is either unable to appreciate this, or refuses to cease driving, GMC guidelines advise breaking confidentiality and informing DVLA. [GMC Confidentiality Handbook] PATIENTS UNDER SECTION 17 OF THE MENTAL HEALTH ACT

Before resuming driving, drivers must be able to satisfy the standards of fitness for their respective conditions and be free from any effects of medication, which will affect driving adversely.

Here is some advice from the following link on the Flesh and bones website: http://www.fleshandbones.com/readingroom/viewchapter.cfm?ID=994
 Do I have to inform the DVLA that I am taking antidepressants?
Straightforward anxiety and depression does not need to be notified to the DVLA. If there are problems relating to memory, agitation or suicidal thinking, then this needs to be notified. If the condition may make the driver dangerous, this must be notified, and the DVLA may then make  enquiries to decide whether the licence should be withdrawn. There is no obligation to notify the DVLA if you are taking antidepressants, providing you are aware that all medication can impair alertness, concentration and driving performance especially within the first month of starting medication  or increasing the dose. If you experience any problems then you should not drive. Sedative antidepressants are more likely to cause drowsiness, and antidepressants can interact with other drugs and tranquillizers as well as alcohol. In general, drivers with depression are safer when well and on regular antidepressant medication than when ill. If in doubt about your fitness to drive you should not drive and should notify the DVLA. It is the illness and the general condition that you suffer from that is the most important thing rather than the medication that you are taking.

I also found an article that said that the DVLA was setting up an independent review to look into the way medical conditions are assessed and their effects on an individual’s ability to drive.

In 2000 the Department for Transport set up a research programme into “Medical Fitness to Drive” with a number of important studies, including the attitudes of healthcare professionals towards giving advice. Areas of concern include the effects or side effects of medication. This was due to be completed in November 2005. I will look further into the results of this and post them on a separate post…………..

Well, there you go. Are there any readers who have had any experiences regarding their ability to drive and their encounters with the DVLA? Please do comment so that we can all see what the issues are and then how we may be able to address them.

 Thanks.

P.S. Any other music recommendations for driving to? No “air guitar” suggestions please as I try hard to keep my hands on the wheel at all times, even when gesticulating madly to my lawyer who can’t see what I’m gesticulating…………………