Myth-Busting Facts: The Truth About Esophageal Cancer

Welcome to our “Myth-Busting” page!

The purpose of this page is to address common misconceptions regarding esophageal cancer risk factors, symptoms, demographics and more in order to increase public education and awareness.  All of these facts are supported by research and studies which are working to reduce the incidence and mortality of esophageal cancer.  Click on each link below to reveal the truth behind the myth.

Myth-Busting Fact #1: “Heartburn is just an inconvenience.”

Myth-Busting Fact #2: “Esophageal cancer is rare.

Myth-Busting Fact #3: “Esophageal cancer shows symptoms early on.”

Myth-Busting Fact #4: “Esophageal cancer receives adequate research funding.”

Myth-Busting Fact #5: “Esophageal cancer usually only affects Caucasian men over 55 years of age.”

Myth-Busting Fact #6: “There are standard screenings for esophageal cancer.”

Myth-Busting Fact #7: “PPIs always prevent or decrease the risk of esophageal cancer.”

Myth-Busting Fact #8: “An esophageal cancer diagnosis is always fatal.”

 


 

Myth-Busting Fact #1: “Heartburn is just an inconvenience.”

Wrong! Don’t ignore frequent heartburn!

Chronic heartburn (occurring twice a week or more) should never be ignored. Overtime, acid reflux can damage the lining of the esophagus and increases the risk of esophageal cancer.

Esophageal cancer, specifically esophageal adenocarcinoma, is a type of cancer of the esophagus and is directly related to Gastroesophageal Reflux Disease (GERD). Chronic heartburn is a symptom of GERD and is also a major risk factor for esophageal cancer. Unfortunately, many are unaware of these facts and often disregard heartburn or believe that taking medications or acid reducers will help.

Esophageal cancer has skyrocketed over the past decades and is now the fastest growing cancer in the United States. With an increase of over 600% since 1975, esophageal cancer is also one of the most lethal types of cancer. The overall five-year survival rate is only 17.5%. There are no routine or standard screenings to detect esophageal cancer in its earlier stages when there are better treatment options. Esophageal cancer is often detected in later stages, as symptoms often arise too late, once the cancer spreads. This partially attributes to the fact that Stage IV has a survival rate of only 3.8%.

{Back to top}

 


 Myth-Busting Fact #2: “Esophageal cancer is rare.

“Esophageal cancer is rare.” Yes, when compared to other cancers such as lung, breast and prostate. However, esophageal cancer (adenocarcinoma) is among the fastest growing cancers in the Western World and is considered the fastest growing cancer in the United States according to the National Cancer Institute.

It has increased over 600% in the past decades. While esophageal cancer is currently “rare”, more and more people are becoming affected by this deadly cancer. We predict that if appropriate actions are not taken, esophageal cancer will run rampant and become widespread.

Some researchers say that this tremendous increase in esophageal cancer diagnoses “may be due to an increase in the number of people who develop Gastroesophageal Reflux Disease (GERD), a condition in which contents from the stomach, such as acid, move up into the esophagus repeatedly, causing chronic inflammation.” Other risk factors of esophageal cancer include poor diet, obesity, smoking and consuming large amounts of alcohol regularly.

“This rise has been associated with the increase of the obese population, as abdominal fat puts extra pressure on the stomach and causes gastroesophageal reflux disease (GERD). Long standing GERD can induce esophagitis and metaplasia and ultimately, lead to adenocarcinoma. Until now, acid suppression has been the main strategy to treat GERD; however, it has not been proven to control esophageal malignancy effectively. In fact, its side effects have triggered multiple warnings from regulatory agencies. The high mortality and fast growth of esophageal cancer demand more vigorous efforts to look into its deeper mechanisms and come up with better therapeutic options.”  (Esophageal malignancy: A growing concernJianyuan Chai and M Mazen Jamal, World J Gastroenterol. Dec 7, 2012; 18(45): 6521–6526.)

Raising awareness of these risk factors associated with esophageal cancer may help to reduce the number of people diagnosed. Also, it is important that people become proactive about their health by eating a nutritious and well-balanced diet which is high in whole foods and low in processed foods, exercising according to their doctor’s recommendation, avoiding all tobacco products, limiting alcohol consumption and for those with acid reflux disease, properly treating GERD.  Awareness of symptoms associated with esophageal cancer is equally as important as knowing the risk factors.

To read more, click here!

 

{Back to top}

 


Myth-Busting Fact #3: “Esophageal cancer shows symptoms early on.”

Esophageal cancer is often detected in later stages, as symptoms often arise too late, once the cancer spreads. There are no standard or routine screenings to detect esophageal cancer in its earliest stages, when the cancer is more treatable. Paired with late onset symptoms, cancer of the esophagus is highly aggressive and unfortunately, for many, a lethal diagnosis.

Unlike other cancers which can sometimes show early warning signs, esophageal cancer typically does not have any obvious symptoms in the early stages, when the cancer is in the esophagus and has not spread to other organs or lymph nodes.

Symptoms of esophageal cancer include:

Dysphagia (difficulty swallowing)
Chronic heartburn or indigestion
Frequent choking while eating
Chest pain, pressure or burning
Unexplained weight loss
Cough or hoarseness
Vomiting
Coughing up blood
Family history of esophageal cancer.

The most common of the symptoms listed above is difficulty swallowing. Dysphagia is the medical term for the symptom of difficulty swallowing, “This is usually a progressive problem, which means that it initially begins when large pieces of food are not chewed thoroughly before swallowing, but then the problem can become much worse to the point where liquids can’t be swallowed easily.”

Any of the symptoms listed above should be taken seriously and you should consult with a physician. Symptoms should never be ignored or overlooked. Do not solely rely on information retrieved from the internet or other sources.

Early detection of esophageal cancer saves lives!

There are more treatment options available for early stage diagnoses of esophageal cancer. There is also a better chance of survival and recovery when the cancer is detected in the early stages, as the cancer is still relatively small and is less likely to have metastasized (spread to other organs or areas in the body).  Tests are necessary to detect if there is a growth in the esophagus and to see what is causing symptoms.  Learn more about How esophageal cancer is diagnosed. 

{Back to top}

 


Myth-Busting Fact #4: “Esophageal cancer receives adequate research funding.”

This couldn’t be further from the truth. Esophageal cancer research is critically underfunded. Despite the fact that esophageal cancer is the fastest growing cancer in the United States with an increase of over 600% in the past decades, esophageal cancer is also among the cancers that receive the least in research funding.

The overall death rate from cancer in the United States has fallen 20% from its peak in 1991. Breast cancer death rates have dropped 27% from 1990 to 2005 and colon cancer death rates, which have been declining for 20 years, fell about 30% from 2000 to 2010. These great developments are thanks, in part, to nationwide public awareness campaigns, improvements in early detection methods and billions of dollars in research funding.

There are major disparities in esophageal cancer research funding, both from the government and private funders.

The National Cancer Institute decreased its investment in research of esophageal cancer by 15% in 2012; esophageal cancer research receives a mere $28.0 million out of NCI’s total $5.07 billion budget; that’s approximately half of one percent.

While The American Cancer Society reports that they currently fund 1,165 cancer research projects, only 8 of those research projects are related to esophageal cancer.

In the past three years, The Salgi Esophageal Cancer Research Foundation has been approached by 13 medical research facilities from across the United States, requesting funding for their research projects dedicated to esophageal cancer.

Read more about how Esophageal cancer research is critically underfunded; despite incidence and mortality rates and learn what you can do to help! Click here.

 

{Back to top}

 


Myth-Busting Fact #5: “Esophageal cancer usually only affects Caucasian men over 55 years of age.”

Esophageal cancer does not discriminate against anyone.  Men and women of all ages and ethnicities can be affected.

Known risk factors of esophageal cancer include:

Chronic heartburn (acid reflux disease, Gastroesophagael Reflux Disease, GERD)
Obesity
Poor Nutrition
Smoking/tobacco use
Excessive drinking
Environmental Factors

Age, gender and ethnicity are also considered risk factors. The American Cancer Society states om their website that “men are more than 3 times as likely as women to get esophageal cancer” and that “the chance of getting esophageal cancer is low at younger ages and increases with age. Less than 15% of cases are found in people younger than age 55.”

While it is true that older men have a higher risk of developing esophageal cancer, esophageal cancer is increasing rapidly and has increased over 600% in the past decades.  Therefore, esophageal cancer diagnoses are increasingly affecting all ages, genders and races.

Esophageal cancer diagnoses are increasing at such a rate that Gastroenterologists have projected that “within 10 years, esophageal cancer is going to exceed colon cancer as the second most common cancer in this country,” Dr. Jonathan Aviv noted in his video presentation “The Changing Face of Esophageal Cancer.” 

Take for instance Yosra El-Essawy, International photographer and documenter who in more recent years worked with Beyoncé. Yosra El-Essawy —passed away earlier this week at age 33 after her battle with esophageal cancer.

To read more, click here.

“Screening tests are used to look for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat.  By the time symptoms appear, cancer may have begun to spread.” (National Cancer Institute)

 

{Back to top}

 


Myth-Busting Fact #6: “There are standard screenings for esophageal cancer.”

False! There is no routine or standard screening test for esophageal cancer.

 “Screening tests are used to look for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat.  By the time symptoms appear, cancer may have begun to spread.” (National Cancer Institute)

Some examples of standard, routine screening tests for other cancers:

Colonoscopy for colorectal cancer

Mammogram for breast cancer

Pap test (also known as pap smear) for cervical cancer.

While the overall cancer death rate in the United States has declined in recent years, esophageal cancer incidence and mortality rates have increased dramatically.  In fact, esophageal cancer has increased over 600% in the past decades.

Esophageal cancer (adenocarcinoma) is now the fastest growing cancer in the United States.  It is also one of the deadliest cancers.   

esophageal cancer, esophageal cancer ri, esophagus cancer, cancer of the esophagus, cancer ri, ri cancer, ri esophageal cancer, cancer treatment, cancer ri treatment, esophageal cancer treatment, esophageal cancer treatment ri, rhode island cancer, cancer rhode island, nonprofit, non profit ri, ri nonprofit, ri non-profit, esophageal non profit, esophagus, barret esophagus, barret esophagus ri, esophagus ri, ri esophagus, esophageal cancer rhode island, gerd, GERD ri, ri gerd, GERD treatment, GERD, GERD help, heartburn, heartburn ri, heartburn treatment, treatment heartburn, acid reflux, acid reflux ri, acid reflux treatment, acid reflux help, ri acid reflux, esophageal cancer, esophageal cancer ri, ri cancer, cancer ri, cancer rhode island, esophageal cancer rhode island, rhode island esophageal cancer, heartburn, acid reflux, gerd, reflux, gerd reflux, acid, pain in chest, doctor ri, gi doctor ri, gastroenterologist ri, ri gastroenterologist, ri health, health ri, esophageal cancer awareness, esophageal cancer treatment, esophageal cancer diagnosis, esophageal cancer research, esophageal cancer donate, esophageal cancer funding, esophageal cancer fund, esophageal cancer funds, esophageal cancer , esophageal cancer awareness, esophageal cancer nonprofit, esophageal cancer events, esophageal cancer rhode island, esophageal cancer new england, esophageal cancer Massachusetts, esophageal cancer screening, esophageal cancer detection, esophageal cancer signs, esophageal cancer symptoms, esophageal cancer diagnosis, esophageal cancer doctors, esophageal cancer doctors in ri, esophageal cancer doctor ri, esophageal cancer symptom, esophageal cancer heartburn, heartburn can cause cancer, cancer heartburn, heartburn cancer, esophageal cancer salgi, esophageal cancer rates, esophageal cancer death, esophageal cancer death rate, esophageal cancer survivors, esophageal cancer survivor, esophageal cancer survivorship, esophageal cancer surviving, esophageal cancer groups, esophageal cancer organizations, esophageal cancer teams, esophageal cancer board, esophageal cancer charity, esophageal cancer nonprofit, esophageal cancer money for research, Networking RI, cancer ri, esophageal cancer, cancer in ri, networking event ri, cancer charity, cancer research, cancer charity ri, cancer research ri, esophageal cancer awareness, esophageal cancer awareness ri, esophageal cancer research ri, esophageal cancer research, esophageal cancer prevention, esophageal cancer prevention ri, esophageal cancer cure, esophageal cancer, in hopes of a cure, networking cancer, cocktails in hopes of a cure, cocktails, Esophageal Cancer Walk/Run, Cancer Walk, Cancer Walk RI, Walk RI, Run RI, Rhode Island Walk, Rhode Island Cancer, Cancer Walks in RI, Cancer Run in RI, Run for charity, Run in RI, cancer run, cancer walk, cancer walk ri, cancer run ri, esophageal cancer, cancer of the esophagus, cancer, esophageal cancer ri, cancer of esophagus, ri cancer, cancer awareness, cancer research, cancer prevention, ri cancer research, ri cancer prevention, ri cancer treatment, ri cancer charity, charity ri, charity, cancer, treat esophageal cancer, treat cancer, treatment of esophageal cancer, treatment of esophageal cancer ri, acid reflux, heartburn can cause cancer, heartburn ri, acid reflux ri, heartburn, heartburn remedy, heartburn remedies, acid reflux remedies, charity run ri, charity walk ri, run for cancer esophageal cancer, esophageal cancer ri, ri cancer, cancer ri, cancer rhode island, esophageal cancer rhode island, rhode island esophageal cancer, heartburn, acid reflux, gerd, reflux, gerd reflux, acid, pain in chest, doctor ri, gi doctor ri, gastroenterologist ri, ri gastroenterologist, ri health, health ri, esophageal cancer awareness, esophageal cancer treatment, esophageal cancer diagnosis, esophageal cancer research, esophageal cancer donate, esophageal cancer funding, esophageal cancer fund, esophageal cancer funds, esophageal cancer , esophageal cancer awareness, esophageal cancer nonprofit, esophageal cancer events, esophageal cancer rhode island, esophageal cancer new england, esophageal cancer Massachusetts, esophageal cancer screening, esophageal cancer detection, esophageal cancer signs, esophageal cancer symptoms, esophageal cancer diagnosis, esophageal cancer doctors, esophageal cancer doctors in ri, esophageal cancer doctor ri, esophageal cancer symptom, esophageal cancer heartburn, heartburn can cause cancer, cancer heartburn, heartburn cancer, esophageal cancer salgi, esophageal cancer rates, esophageal cancer death, esophageal cancer death rate, esophageal cancer survivors, esophageal cancer survivor, esophageal cancer survivorship, esophageal cancer surviving, esophageal cancer groups, esophageal cancer organizations, esophageal cancer teams, esophageal cancer board, esophageal cancer charity, esophageal cancer nonprofit, esophageal cancer money for research, the salgi foundation, the salgi esophageal cancer research foundation, salgi, salgi foundation, salgi esophageal, salgi esophageal cancer, salgi esophageal cancer research, salgi esophageal cancer research foundation, salgi esophageal foundation, foundation salgi, esophageal cancer awareness salgi, esophageal cancer awareness salgi ri, ri esophageal cancer awareness salgi, ri salgi esophageal cancer, salgi esophageal cancer awareness ri salgi, salgi treatment esophageal cancer, salgi treatment esophageal cancer awareness, salgi treatment esophageal cancer awareness ri, Esophageal Cancer Walk/Run, Cancer Walk, Cancer Walk RI, Walk RI, Run RI, Rhode Island Walk, Rhode Island Cancer, Cancer Walks in RI, Cancer Run in RI, Run for charity, Run in RI, cancer run, cancer walk, cancer walk ri, cancer run ri, esophageal cancer, cancer of the esophagus, cancer, esophageal cancer ri, cancer of esophagus, ri cancer, cancer awareness, cancer research, cancer prevention, ri cancer research, ri cancer prevention, ri cancer treatment, ri cancer charity, charity ri, charity, cancer, treat esophageal cancer, treat cancer, treatment of esophageal cancer, treatment of esophageal cancer ri, acid reflux, heartburn can cause cancer, heartburn ri, acid reflux ri, heartburn, heartburn remedy, heartburn remedies, acid reflux remedies, charity run ri, charity walk ri, run for cancer

Esophageal cancer does not usually show any signs or symptoms in the early stages. Symptoms, such as difficulty swallowing, often appear once the cancer has spread and becomes advanced.

When esophageal cancer is diagnosed in late stages, it is very difficult to treat the cancer and there is rarely a cure.  Patients who are diagnosed with Stage IV esophageal cancer face a five-year survival rate of only 3.8%.

Early diagnosis of esophageal cancer is critical to saving lives.

Tests that may detect esophageal cancer in earlier stages are being studied.  Unfortunately, esophageal cancer research is extremely underfunded, both from the government and other nonprofits.

You can make a difference by making a tax-deductible donation to help fund these research projects.  Click here to donate.

If you think that you may be at risk of esophageal cancer (or any other disease), speak to a doctor immediately.  The earlier that esophageal cancer is caught, the better the chances of survival.

 

{Back to top}

 


Myth-Busting Fact #7: “PPIs always prevent or decrease the risk of esophageal cancer.”

Over the past decades, esophageal cancer has increased over 600% and is now the fastest growing cancer in the United States*. Esophageal cancer is also one of the deadliest cancers, as less than 20% of those diagnosed with esophageal cancer will only survive five years.

While there are no established reasons for this alarming rise in esophageal cancer, researchers agree that risk factors such as the increase in obesity and Gastroesophageal Reflux Disease (GERD) may be to blame.*

Here we include various research with conflicting outcomes on how PPIs are related to esophageal cancer.  It is important to remember to never stop taking any medications without first speaking to your doctor.

But first, what are Proton Pump Inhibitors (PPIs)?

Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach. PPIs are used to treat the symptoms of Gastroesophageal Reflux Disease.*

Gastroesophageal Reflux Disease (GERD) is a primary risk factor for esophageal cancer.

Gastroesophageal Reflux Disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.

gerd_les_ esophageal cancer

What causes GERD?

GERD occurs when the lower esophageal sphincter (LES) is weakened or damaged. The LES is then unable to close and keep food, acid and other secretions from flowing backwards or refluxing into the esophagus. Overtime, the reflux of stomach contents and acids can cause serious damage to the esophagus, including bleeding and scarring of the esophagus, ulcers, Barrett’s esophagus and esophageal cancer.

Lifestyle changes can help to manage GERD symptoms.

Some of these changes are to avoid eating at least three hours before bed, stay upright after meals, lose weight, moderate exercise and avoiding certain foods that trigger symptoms. Surgery may be an option for some patients.

755992_14112585

PPIs work to treat the symptoms of acid reflux disease.

Many chronic heartburn sufferers turn to antacids or other over-the-counter medications for relief. Others seek help from medications known as Proton Pump Inhibitors (PPIs), which reduce the amount of acid in the stomach; treating the symptoms of GERD. Some PPIs do not require a prescription and can be also purchased over-the-counter.

RefluxMD states:  “since their introduction in 1989 the cost of [PPIs] has grown to over $11 billion dollars annually while adenocarcinoma, esophageal cancer that results from GERD, has become the fastest growing cancer in the US, Europe, Japan and Australia (Reflux-Induced Esophageal Cancer Trends)

“PPIs work to control the symptoms of GERD but they do not reduce acid reflux or prevent the progression of the disease and the damage to the esophagus”, RefluxMD states.

Dr. Jaime Koufman, a physician in New York who specializes in voice disorders and acid reflux, wrote an article in the New York Times which details the dangerous link between acid reflux, PPI use and esophageal cancer.

“A Danish study…concluded that there were no cancer-protective effects from using the common anti-reflux medications, called proton pump inhibitors and that regular long-term use was actually associated with an increased risk of developing esophageal cancer.”

The Danish study also showed that “PPI use may facilitate the formation of carcinogenic bile acids.”  Stomach juices also contain the compound gastrin, which has been shown to “stimulate cell growth that may contribute to cancer.” The Danish study showed that levels of gastrin can increase with the use of PPIs and other similar medications and that PPIs “may increase the risk of gastrointestinal tumours.” (People’s Pharmacy)

Another research study, however, indicates that proton pump inhibitor usage may indeed reduce the risk of high-grade dysplasia and/or esophageal adenocarcinoma in patients with Barrett’s esophagus:

Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett’s oesophagus: a systematic review and meta-analysis.

Takeaways:

Continued research is needed to study the association of PPIs, acid reflux, Barrett’s esophagus and esophageal cancer.

Do not stop taking any medications and do not make any changes regarding your health without first consulting your doctor.

If you would like to stop taking PPIs, speak to your doctor first and discuss ways you can reduce and/or treat your acid reflux disease and reduce your risk of esophageal cancer.

Methods of preventing esophageal cancer need to be researched and that can only happen with your help! Consider a financial contribution to help support research, which will explore prevention of esophageal cancer research. Click here to donate.

 

{Back to top}

 


Myth-Busting Fact #8: “An esophageal cancer diagnosis is always fatal.”

Fact:  “Chances of survival are higher for people diagnosed with early esophageal cancer.”

Like any other cancer diagnosis, a diagnosis of esophageal cancer is daunting, especially when diagnosed in later stages.

While it has been long known that esophageal cancer is one of the deadliest cancers, we wish to provide hope to everyone who is diagnosed.  The statistics that you will read below are not intended to predict individual outcomes and are only estimates.  A number of factors play a big role in survival of all esophageal cancer diagnoses, from Stage I to Stage IV.   These factors include but are not limited to treatment and the overall health of the patient.

Right now, due to lack of awareness, no standard or routine screenings and underfunded research, the outlook for esophageal cancer is grim.   However, we can and we will change these statistics.

The Salgi Esophageal Cancer Research Foundation’s duty is to provide people with information they need to be proactive about their potential risk and to seek the help of a doctor to make the best decision for their individual health.   We must work together in order to change the course of this deadly cancer.

 “When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated but rarely can be cured.” (National Cancer Institute)

In order to explain the importance of early detection we will break down the above paragraph.

“When esophageal cancer is found very early, there is a better chance of recovery.”

When patients are diagnosed with early stage esophageal cancer, the 5-year survival rate is 39.6%.

Unfortunately, only 21.3% of patients are diagnosed with esophageal cancer at the local stage.  The term “local stage” means that the cancer is only growing in the esophagus.

If and when standard and routine guidelines are established for screenings of esophageal cancer, it will help to increase the number of people who are diagnosed early and therefore improve the chances of survival.

“Esophageal cancer is often in an advanced stage when it is diagnosed.”

More than 67% of patients are diagnosed with regional or distant esophageal cancer.  The 5-year survival rate of regional esophageal cancer is 21.1%.   However, distant esophageal cancer which is also referred to as Stage IV esophageal cancer has a 5-year survival rate of less than 4%.

“At later stages, esophageal cancer can be treated but rarely can be cured.”

When esophageal cancer is diagnosed in late stages, it is difficult to completely rid the patient of cancer. Treatment options rarely include surgery.   The main focus of treatment for advanced esophageal cancer is to control the cancer and to relieve any symptoms caused by the cancer.  The latter is called palliative therapy.  (American Cancer Society)

The Salgi Esophageal Cancer Research Foundation strives to provide people with information they need to be proactive about their potential risk and to seek the help of a doctor.  We must work together to change the course of this deadly cancer.

Please remember to connect with us on Facebook help support this mission:  Facebook.com/SalgiFoundation

 

For more information, please visit the sources below that were used in this post. 

  • Esophageal Cancer Treatment (PDQ®), National Cancer Institute, cancer.gov
  • Survival rates for cancer of the esophagus by stage; Treating cancer of the esophagus by stage; Palliative therapy for cancer of the esophagus, American Cancer Society, cancer.org
  • SEER Stat Fact Sheets: Esophageal Cancer, Surveillance, Epidemiology and End Results Program, seer.cancer.gov

 

{Back to top}

 

Stay tuned for more myth-busting facts!

 



 

Sources:

cancer.net , cancer.gov , cancer.org ,refluxMD.com
ncbi.nlm.nih.gov , aats.org , medicalnewstoday.commskcc.org
teamslugslayer.com , WebMD , National Center for Biotechnology Information
MedlinePlus , National Library of Medicine , New York Times
MedScape , People’s Pharmacy , seer.cancer.gov
Advertisements

Comments are closed.

%d bloggers like this: