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Thursday, May 7, 2015

An Update on the Medical Frustrations

After making my complaint to the "Customer Service Department" at Rady Children's Hospital I got a call from a supervisor in the Orthopedic Department. Dustin was wonderful. We arrived back at the San Diego clinic shortly after lunch and they were ready for us.

We were escorted straight back to the cast room, where a very nice technician removed the wonky cast and swiftly but carefully applied a new one. He advised her to try walking around the lobby for a bit before leaving, to make sure it was OK. It did poke her a bit under the toes, so he trimmed it and then she could finally walk in her walking cast! As we were leaving, Dustin met us in the hallway and we had a brief chat. He assured me that the issue of student supervision had been addressed.

The next day, the Orthopedic Department Lead called me. We had a long chat about all the issues that I was concerned about. At least 45 minutes was given to the situation over the phone. I was assured that all of the Medical Assistants would be advised against trying to influence any child's responses or  assessing any child's pain levels, and that they should be recording information only and leaving the assessment to the licensed medical professionals.

I was told about the medication list on the paperwork. I was told that only the prescribing physician can remove a medication from a child's chart. It should have had a note next to each medication stating "Not Taking" but my child's paperwork only said "By Oral Route" next to each drug name.  This ridiculous rule has come up before, and she said it would be brought up again. She said all staff take the med lists with a grain of salt, and no one prescribes based on it for that reason. WUT?! This is insane. This makes me not trust their records.

I was also told that my concerns about the Emergency Room would be forwarded and that the Lead for that department would call me. It's never happened.

When we first saw the NP in the Ortho Clinic we were told to return in 3 weeks. There was but ONE appointment available, with a PA. Isn't it amazing that when I talked to the Lead I suddenly had a choice of THREE different appointments--all with MDs? Also, we don't have to go back to San Diego because the appointment we got, with the Sports Medicine specialist that we have actually seen before, is in North County, much closer to home.

We will see the doctor on Tuesday, and hopefully, she will be done with being casted. I will request some Physical Therapy for her before sending her back to Taekwando and summer Horse Camp.

I will also avoid Children's ER if at all possible in the future!

Thursday, April 23, 2015

A Comedy of Errors, But No One is Laughing

The ankle saga continues!

Because I was told there was no fracture (see previous blog post), I let Treklet perform last weekend in The Little Mermaid while wearing an orthopedic ankle boot. She did not perform in the shows that she cast as ensemble, only the 3 shows that she was Flotsam. We integrated the boot into her costume, and despite some pain, she was eager to be onstage. After each show we went straight home to splint and ice the sore limb, and when not onstage she used crutches. She was, as my friend Andrea said, more than a Brave Little Toaster, and she shined on stage as the slipper pet of the villainess Ursula.

Monday morning, with the show now a memory, we went back to Rady Children's to the Orthopedic Clinic for her follow up. I was expecting them to say it was a sprain, keep off of it for a week or so, and that would be it. What really happened was more aggravation and more degradation of my faith in the organization to properly care for my child.

The MA that took us into the exam room was nice first. Then she asked Treklet to rate her pain on a scale from 0-10. When Treklet replied with 6 she answered back, "So you need medication?" No. "Then it's not a 6." My confused daughter looked to me for help. I told the MA that a child doesn't understand that a 6 means medication. She merely feels that it's somewhere in the middle of no pain and severe pain. So the MA asked again. And again. Every answer my child gave her seemed unsatisfactory. She seemed upset with my daughter and my daughter felt frustrated and confused. Finally she said, "I'll just put a 3."

Then she asked about allergies and prescriptions. I told her that my child takes no medications. She read the list of meds on the chart and again I said that she takes nothing. I thanked her for updating the records, because the ER discharge papers had several medications listed that my daughter does not take. Guess what? The discharge papers from the Ortho Clinic still say she takes those medications!

Soon the Nurse Practitioner entered the room. She was very nice. We confessed to doing the show in the ortho boot because we were told there was no fracture. She examined the afflicted ankle and said there IS a fracture at the growth plate. I'm sure my jaw dropped to the floor. Then I was given an explanation about these things not being visible on x-rays, but when she touches the ankle at that spot my child nearly jumped off the table with pain, so she knows it's broken. Then she showed me x-ray and pointed out the telltale sign that it's broken... wait..what? So you can't see it on x-ray, but look at the x-ray and see it?

We were ushered to the cast room. What should have taken 15 minutes took well over an hour. Three other patients came and went while we were there. Why? Because we had an unsupervised student applying a cast!

At first he seemed professional enough. He positioned Treklet's foot on the stand, and proceeded to wrap the cotton padding. Then he applied the cast material. When he was nearly finished he declared that the bottom had a lump and she wouldn't be able to walk on it so he would need to remove it and start over. OK, I'm all for diligence. He waited a few minutes for the cast to harden up and then cut it off with the saw. He started completely over. Did I mention that it took as long for him to put the cotton on as I remember putting a whole cast on takes?

The second cast was eventually completed but then someone with more experience looked at it and decided her foot wasn't flexed enough. Out came the saw again. The cast technician told me he would be doing the next one. He had Treklet lie on her stomach with her knee bent so the foot was in the air. He instructed the student intern step by step as he wrapped the limb and mentioned several times that this was an advanced technique but he had years of experience. When her cast was finally finished he put a cast shoe on her and informed her that she could walk on it, but if it was painful she could support her weight with the crutches.

Treklet, pointing out the sign that says No Photos. Oops!

I painted her toenails and cast when we got home. It's a Rideout Family Cast Tradition. ;-)

We were told to return in 3 weeks. Scheduling that appointment was just one more aggravation. Evidently, there is just one appointment available in 3 weeks, at just one of the clinics, and it happens to be a time that I can't make. There were no other days or hours available unless we waited an additional week, so I took the appointment, hoping that my husband could take her.

She won't walk on the cast. She needs her crutches or at least a cane, even 3 days later. We think we figured out why. The cast seems wonky to us! If her foot is facing forward, in a walking position, her knee is twisted inward and bearing weight on it hurts her ankle and her knee. If her knee is facing forward in a walking position, her foot is angled outward like the Penguin, and it hurts her ankle. I am calling this morning. I am also calling the hospital administration, as soon as I can figure out who to file a complaint with. I also just noticed that the wrong pediatrician is listed on her discharge papers! I suppose this means another blog post will be forthcoming.
Look at her knee! No wonder she can't walk.

Friday, April 17, 2015

Adding Insult to Injury

Wednesday night, Treklet had an accident on stage at final dress rehearsal for The Little Mermaid. Evidently her heel got caught on a step and she twisted her ankle and fell from one platform to another.  I got the call at 8:10 p.m. to come to the theater. "It looks bad," are the words I remember.

My husband and I arrived to see our crying child in a wheelchair with an icepack on her ankle. The theater security staff provided them for her and some of the stage moms helped her change out of her costume and gathered her things. One of the moms is a physician, and when I gave permission, she examined the injured limb. Her opinion that there was a possible fracture and an x-ray was indicated.

Because we've been similar situations with both daughters before, I knew that if I took her to the local hospital and there was any indication of a break or a torn ligament, etc., we would be sent to Children's Hospital for Orthopedic care. Because of the growth plates in the bones, most regular Orthopedic doctors send kids and teens to Childrens to the Pediatric Orthopedic specialists. We decided to go straight to Rady Children's Hospital to cut out the "middle man," since the first performance was the following morning and we needed answers ASAP.

We arrived at the Emergency Room entrance at 9:05 p.m. to find no valet, and no wheelchairs. It's a good thing I had my husband come along to drive! I went inside to see a completely full waiting room and a makeshift secondary triage area behind some screens. Oy vey! It was going to be a long night. I asked the security guard at the desk where I could find a wheelchair and he wandered off to find one.

Once I got her inside, we queued up at the registration window. We gave her name, and the briefest description of her injury, and were told to have a seat. Ninety minutes later we were finally called by a triage nurse! She weighed Treklet and took her vitals and asked her how she became injured. The nurse put in an order for an x-ray and sent us back to the waiting room.

The x-ray technician called us in after about 10 minutes. The Alien went in with her for the pictures and when they emerged from the lead-lined room Treklet was in tears. The positioning for the films caused her a lot of pain.  We were taken to an exam room and told to wait.

The exam room was the size of a closet, with a child-sized gurney, a sink, a wall-mounted computer screen, a flat screen TV and two chairs in it. Once the wheelchair entered the room, there was barely room for someone to stand alongside it. The heavy door with a viewing window in the center of it closed behind us and there we sat. And sat. And sat some more. By midnight, I the Alien was dozing and Treklet's head was bobbing. I went into the hallway and flagged down a rushing nurse and asked for a blanket for my child. I covered her in the thin fabric and turned off the TV and the lights and she slipped into a light sleep.

At 1:00 a.m. I felt like all the useable air in the room had  been exhausted and I opened the door and leant against it and closed my eyes. Sleeping standing up is for horses, not moms. This room was like a prison cell, except at least prisoners get toilets. Finally, my husband wandered the halls in search of a staff member and asked if our daughter would be seen soon. She was a clerical employee and looked quite confused but offered to find a nurse for us.

Four and half hours after our arrival a doctor finally showed up. We woke our sleeping patient and she offered her painful extremity to him. By this time it was swollen to elephantine proportions. I pointed out to the physician that when we arrived it was not that big, but no one had provided an ice pack, or even so much as a tylenol for her pain. He apologized, and said that was unacceptable. We had an ice pack within minutes.

The doctor examined the ankle. He thought there was something on the x-ray that could be a small fracture, and at the corresponding place on the exam there was pain. He was not confident in his diagnosis, though, and there was no radiologist available to read the films. A splint was ordered, and we were instructed to make a follow-up appointment for 5-7 days at the Orthopedic Department at Childrens. We were told that a radiologist would read the films and call us in the morning with a definitive diagnosis.

The ice pack nurse returned to apply the splint. After molding and wrapping the quick-set plaster splint, she informed us that a set of crutches had been ordered from central supply. About 20 minutes later she returned with them and told us to wait for discharge papers.

Once Treklet stood up on the crutches I noticed that the splint was all wrong. I told my husband that there was no way we were leaving with that mess on her leg and he needed to go get the nurse.  He returned with the doctor, who took one look at the poorly formed immobilization device and apologized.  The foot was at a 45 degree angle (not 90 as intended) and the plaster and elastic wrap stuck out at least 4 inches in front of the foot. She couldn't even keep it off the floor when using the crutches! So we spent an additional 30 minutes waiting for two other nurses to come in and make a proper splint.

It was shortly after 3:00 a.m. when we finally left for home. We were in bed at 4:00 and I woke up at 7:00. My first thought was checking in with the director, and then I couldn't get back to sleep. Next I called for the Orthopedic appointment, as instructed. I was told there was nothing available until April 29th. I said that the ER doctor wanted her seen Monday or Tuesday and the receptionist's reply was, "I am aware of the script they give you at the ER but can't do that." I reluctantly took the appointment, which wasn't even with a doctor, but a Nurse Practitioner.  A little while later, she called me back and said there was a cancellation for Monday, with another Nurse Practitioner, but we would have to drive to San Diego as the local office was booked. Better than nothing, I supposed. Also, upon reviewing the discharge papers I noticed that they never updated her medication list and several drugs were listed on there. She takes no medication whatsoever. So much for accuracy.

Treklet slept until 10:00 and after feeding her we headed to the theater. The cast was all so warm and welcoming to her. She was happy to be reunited with them, and there was one empty seat in the balcony for her to watch the second show. The alternate casting worked well and audience seemed to enjoy the show. Afterward, she got in costume from the waist up and was included in the official cast photo.

I still hadn't heard from Radiology by 2:00 p.m. when we left the theater so I called. The ensuing aggravation was compounded by my lack of sleep and the uncertainty of whether she would be able to try bearing weight on the foot for the Friday performances. I was told, "We don't give results to parents." WHAT?! I am her mom, her legal guardian, and the one paying for that x-ray! The woman on the phone told me they would fax the report to our pediatrician and we could get the results from her. I asked, "since we are seeing an ortho on Monday, so shouldn't they send the report there?" Nope,  call your pediatrician. ugh.

When I called the pediatrician's office I got voicemail. I left a message. After 20 minutes I called again and got a human who told me that our doctor wasn't in and that there was no report faxed to them. Why was I not surprised? I was also told that the ER gave us the wrong protocol. They should have had us follow up with the pediatrician, and if orthopedic consult was required they would  make the appointment. Yeah, everyone wants their piece of the action.

I told the receptionist that I didn't care who looked at the report, but I need to know if my child had a broken bone or not. I exaggerated just a little when I said a cast of 70 plus the crew and director all were waiting to find out if my daughter would be able to go onstage tomorrow in her lead role!

I told her it was ridiculous that the radiology department couldn't tell me fracture or no fracture when they were supposed to call me to begin with. I was given some legal babble about privacy laws and how they couldn't know it was actually me on the phone. My reply to that was that they could simply hang up and call the number listed on the patient chart!

I implored her to help me out by calling the hospital for the x-ray report, but she said she had to wait for a doctor to come out of an exam room to ask permission. ::head desk::

Finally, 19 hours after arriving at the ER, I got a call from the pediatrician's office. There is no fracture. They could not recommend any weight bearing until the ortho follow up. I said OK thanks, bye!

This morning we removed the splint. There is very minimal swelling--you have to look hard and compare ankles to see it. There is no discoloration. I put her in my Borg boot and cinched it up and she was able to walk on it, and even practiced her blocking. We're gonna do this.  She will continue to use the crutches, but for the show, she will wear the boot and be Flotsam! She will sit out the three shows that she is the ensemble, since she can't dance, but she will be able to be an eel. Yay!

We will follow up at ortho on Monday, and hopefully there is no serious ligament issues. My non-professional, mom-with-multiple-ankle-issues opinion is that it is a moderate sprain.

The whole experience was made so much worse by the ridiculous medical-legal system. Inaccurate medication list, no ice pack, ridiculous wait, a botched splint, no radiologist, no follow up, & hassle getting the report. These are all insults to her injury...and to my intelligence and parental rights.  I can't wait to get that patient satisfaction survey!

Friday, February 27, 2015

The Conscience of Star Trek

Leonard Nimoy passed away this morning.

I'll just let that sink in....

I'll admit, when I was first told, in the parking lot of the school by my friend, Cameron, who ran out of his office to tell me he just saw it on Facebook, I didn't have much to reply. I knew he was ill. I knew he had been rushed to the hospital earlier this week. The last time I saw him at a convention he looked frail. It wasn't unexpected.

When I got home, and had a few minutes to look at the internet, and read the numerous texts, tweets, and Facebook messages sent to me it really sunk in. I read the NY Times piece. I read Star Trek Continues tribute. My friend, Genevieve, was very shaken, and her posts and texts pricked my heart. Then I watched this YouTube clip and that's when I lost it.

Leonard Nimoy could not shake off the iconic role of Mr. Spock. The fame he garnered through Star Trek afforded him (and his cast mates) opportunities to write books, direct movies, record albums, publish his photography and even write poetry, yet he would forever be tethered to that character. He eventually accepted that, and wrote in one of his books, “In Spock, I finally found the best of both worlds: to be widely accepted in public approval and yet be able to continue to play the insulated alien through the Vulcan character.”

I read that Gene Roddenberry once called him the "Conscience of Star Trek." I'm not sure about the context of that statement, but I can imagine that it reflected positively on Mr. Nimoy's personal character.

Mr. Nimoy had an opportunity that his other cast mates did not. He was given a role in the revived Star Trek film franchise, and was able to personally pass the character torch on to his successor in the role, Zachary Quinto. What an honor for the younger actor to not only learn about the roots of the beloved character from the man who shaped it, but to act alongside him as well. 

I met Mr. Nimoy at the Star Trek Las Vegas Convention and he was a gentle soul. His signature graces my movie teaser poster, alongside many others.

While the internet explodes this weekend with the tributes, homages, and memorials, I will be watching Star Trek---The Original Series and The Voyage Home film. I might even bite the bullet and watch Star Trek 2006 and try to ignore the lens flares. 

RIP Leonard Nimoy. You will be missed.

Wednesday, February 18, 2015

First Con of the Year is Now a Memory

Treklet and I went to our second Gallifrey One last weekend. 
While I consider this to be one of the better run conventions that we have attended, and at a reasonable ticket price for all we get, the accommodations and food were outrageous. 

We were unable to book a room at the convention hotel (LAX Marriott) again, so we stayed a short walk away at the LAX Hilton. It was a nice place, but I MUST remember to bring my own pillow next year! Parking fees and taxes bumped our bill up by about 50% of the base room rate for two nights.. from $210 to $318! We brought our own food, and only bought one meal, which was greatly overinflated in price.  We had a veggie burger, a Greek salad, and one cocktail at the Marriott's cafe and the bill was $44 plus tip! Crazy, right?

OK, enough ranting about the cost of conventioning near the second busiest airport in the country...

We arrived Friday in time to drop our car off at the hotel and store our luggage before the Eve Myles interview. Wow, she was hilarious. To no one's surprise, she dished on John Barrowman exposing himself on set and other antics. She was animated and fun and cute and, well, nothing like her character on Torchwood!

After that, we browsed the exhibits, tables and vendors and Treklet started her badge ribbon collection. We were pleasantly surprised to run into our friend Nathan Adams, who had just purchased a Jayne hat. Isn't he adorable in it? 

We also found Huston and had a nice visit with him. Treklet liked the prop replica table, and had a great chat with comics illustrator Christopher Jones, who gave her a signed Flash pic and some drawing tips. I got Eve Myle's autograph on my Torchwood cast photo. She was beautiful in person, and very nice to us. 

We separated for a while so I could go to the Naoko Mori and Burn Gorman interviews. Of course, Naoko independently confirmed everything Eve said about Barrowman! LOL 

Unfortunately, Alex Kingston canceled her appearance. Since I didn't think Treklet would know anyone else at the reception I had purchased tickets for that evening, we decided to get a refund. That refund paid for our dinner out and all of our autographs, so I think it was a good choice. 
Sometime on Friday we snapped this selfie with Huston Huddleston, sporting his seemingly only outfit. I'm a proud backer of the Hollywood Sci-Fi Museum Kickstarter, and I have that same shirt and hat! I MUST wear it to my next con! Learn more here:

Back at our hotel we munched on snacks and watched some Torchwood on my iPad and were asleep pretty early. This is definitely not a party con for me! I know there are a lot of shenanigans in the evening and well into the wee hours at Gally, but I really enjoy this con with Treklet.

Saturday morning we had breakfast in the room from our stash then hit the fitness center before heading back to the Marriott. We had a full day scheduled. I enjoyed listening to a panel called Getting the Science Right. The panel members were David Gerrold, Gillian Horvath (writers),  Robert Smith (writer and biomathematics professor, and Craig Miller (writer). The next panel I went to was Sustaining Television with writers and web developers Hayden Black, Arnold Blumberg, Richard Dinnick, Len Wein and Deric Hughes.  I found it very interesting!

Something that Gally offers is the opportunity to participate in kaffeeklatsches. What's a kaffeeklatsch? It's a small group of 12 people sitting around a conference table with a writer or celebrity drinking coffee (or tea) and having a discussion. The kaffeeklatsches are FREE. How cool is that? (Creation would charge you $100 for that, am I right?) 

We were able to do two--the first with David Gerrold, in which he did most of the talking. I learned quite a bit about the man who wrote The Trouble With Tribbles (which never came up), his body of work, and his strong opinions on certain topics, which may or may not have included Star Trek TNG and Gene Roddenberry. 

The second kaffeeklatsch was with writers Deric Hughes (Warehouse 13 and Beauty and the Beast) and Gillian Horvath (Highlander). This was a true discussion, in which everyone got to participate and ask questions and make comments. We talked quite a bit about advertising in the DVR/Web age and internet and social media tie-ins. 

Larry Nemecek
I missed every other interview and panel after that. We spent some more time in the vendor room chatting with Larry Nemecek (and taking yet another SFMom-Larry con pic--what is this, like our millionth?) and Gene Turnbow from Krypton Radio (which I am listening to now as I type this). 

We hung out some more with Nathan, Treklet got her Hollow Earth book signed by John Barrowman, and I got my torchwood cast photo completed with Burn Gorman's autograph. We also placed some bids on some beautiful stoneware pieces at the art show. 

Michele Specht and I look nothing alike at a Who Con! 

I greeted Michele Specht at the registration table when she ::finally:: arrived and we snapped some selfies. ----->>>>

We were able to watch about half of the Star Trek Continues screening of Fairest of the Them All before our Reception. You can watch it here: Star Trek Continues Episodes

We headed up to room 1701 (how cool is that?) where our name was checked off the list and we were each handed a Torchwood cast photo and two autographed photos--one of Nina Toussaint-White (Mel in Let's Kill Hitler) and one of Siobhan Hewlett (Harriet Derbyshire of the Torchwood Institute). We were then assigned to a group and told to help ourselves to as much wine and soft drinks as we liked. 

Soon, celebrities started arriving and visiting the groups in rotation. We got to visit with Dan Starky (Strax the Sontaran), Ellis George (Courtney Woods in Series 8), Ross Mullan (many roles incl Teller in Time Heist, the Silent, Ice Warrior), Burn Gorman (Owen Harper, Torchwood) and John Barrowman (Captain Jack Harkness). Ellis was energetic and fun! Dan was interesting and sincere. Ross was comfortable and relatable. Burn was friendly and brought his own beer. John was wonderful and gave Treklet a lot of attention. It was a great 90 minutes, although I think they could improve the experience by holding it in a ballroom downstairs with tables and chairs!

After our reception we hung out for a little while with Michele and Chris Gore, too. Treklet was starting to feel poorly, so we headed back to the Hilton early, where she wanted nothing more than to sleep. Uh-oh...

Sunday morning she woke up feeling better, but it wasn't to last. We packed up, checked out and went to the Marriott. There were some scheduling changes, so we spent the first hour or so watching the most recent Christmas Special on the big screen. It was wonderful that way! At 11:00 we had to go to the voice auction to see if we could secure the items we previously bid on.   I was able to help her a bit financially with one item that she won, but everything else we had our eyes on got too pricey for us. 
Treklet's souvenir from the art auction
Stoneware piece from Peri Charlifu
check out his work here:

As the 2-hour auction event wore on, Treklet deteriorated. She felt hot to the touch and had a panicked look on her face. She just wanted OUT. I paid for her piece and we headed straight to the car. I found an Advil in the luggage and took her straight home. She's been sick with the flu ever since. I just hope she didn't infect any of our friends that we hung out with---or me, who slept next to her! 

I didn't even know I knew these guys when I took their picture! It's Darnell Davis and Anna Yeutter!

Old School -- and he didn't delete me!

Star Trek Continues screening!

There were quite a few Missy cosplayers this year!

cutest Dalek ever
Captain Jack Hart
well done!

Officer on the Bridge!
Ha! Nathan crossed the streams....

lovely...I'd wear this anywhere

Crocheted Dalek

Saturday, January 17, 2015

Get a Piece of the Action!

Have you checked out Star Trek Continues yet?

So far, there are three episodes and three short vignettes available to view for free. I suggest you watch them ASAP because your life is not complete until you do.

This isn't just any fan made Star Trek project. This IS Star Trek. It's all done by professionals--from the writing, to the acting and everything in-between. The sets are perfect replicas of the Original Series. There has been meticulous attention to detail on the lighting, the makeup, and the costumes. Our beloved characters have stayed true to their original inception and new crew members have strong, positive attributes.  

What really makes this series stand out is the writing. The essence of Star Trek shines through in all three episodes thus far. One of the main reasons that most Trekkies love Star Trek is it's ability to shine light on the human condition and socio-political issues, while providing hope for our future. There is no post-apocalyptic despair in Star Trek, only a positive vision of a future where equality, exploration, and peace are the ideals that drive the Human Race.

I have had the honor and pleasure of spending time with some of the actors, directors and writers of Star Trek Continues. Each is passionate about the project, and determined to produce the best Star Trek possible. They have given of their time and their talents for no profit, as they must, because they are not officially licensed by CBS, who owns the television rights to the franchise. On the plus side of this situation, they are not beholden to any corporate overseers or advertisers and are free to adhere to their own convictions about what Star Trek is.

I am happy to announce that filming of Episode 4 has begun. Classic Doctor Who fans will be thrilled with the casting of Colin Baker (the 6th Doctor) in this episode. I can't wait to see it! Here is a pic that Colin posted to Twitter a few days ago:

It is quite expensive to produce a show of this high quality. At first, STC was almost completely and lovingly funded by Producer/Writer/Director/Actor Vic Mignogna (who is brilliant as Captain Kirk, btw) and his production company. A successful Kickstarter campaign (Kirkstarter 1.0) helped fund more.

Kirkstarter 2.0 has just launched, with the purpose of keeping the mission going.  True Trekkies are hungry for more! There is a great video on the Kirkstarter page with several film professionals singing STC's praises. Please check it out and donate if you can! Kickstarter 2.0