Hoffman Quintuplets 1+5= The 6-Pack

Hoffman Quintuplets 1+5= The 6-Pack
Babies getting big!

Thursday, June 26, 2014

June 13th...Happy Birthday Quintuplets!

            I woke up early the morning of the c-section to get makeup on and look the best I could (even though I was miserable) for the grand event I worked so hard to achieve!  I was in shock to find out that morning that Dr. Elliott had flown across the country Thursday night to help perform the procedure and was flying back out after the procedure was done!  When we first arrived, he promised he would be there, and he was!  I was a lot more relaxed since he had done this eighteen times before with quintuplets and many more times with quadruplets etc.  The hospital was amazing and video taped the entire birth and gave photographs to us since the day was such a whirlwind!  Michael had to stay on the outside of the OR and change as they prepped me inside the OR.
           Upon entering, I met with the anesthesiologist, anesthesiologist tech, scrub nurses, OR nurses, camera people, residents, and saw the teams for the babies ready in the glassed area conjoined to my OR.  It was about 50 people in there at that point.  I was given a spinal epidural and was laid down on the table.  The sterile field was created and then my three doctors and Michael entered the room and more people too!  I'm glad they were there since I was so nervous of both the c-section and the condition of the babies. I entered the OR at 8 am.  The first incision was made at 8:13am.  The first two babies were delivered at 8:15, second two babies at 8:16, and last baby was born at 8:17.  During the procedure, Dr. Elliott was calling out when to start certain drugs to help my overly stretched out uterus to clamp down at the right time. HOM have to be delivered quickly to prevent shock to set in with my body and my uterus from clamping down on the remaining babies.  The longer each one remains in my body the worse the outcome after the first incision.  As they were delivered, Dr. Elliott held them for the camera and us to see!  They all cried at birth and I did too!
            The babies were then immediately handed off to their NICU team in the other room.  As I was being sewn up on my vertical and horizontal incision, they started bringing them over for us to quickly see in their isolates!  Elias was stable enough they could take him out of the isolate so I could see him and kiss him before they whisked him off!  Michael followed the last baby out.  Dr. Elliott and most staff left as the remaining staff finished closing me up and removed my cerclage.  I was then taken to recovery exactly one hour from the first cut at 9:13.
             I stayed in recovery for another hour.  I was able to start eating ice chips there.  Michael and Susan (cousin) kept running between NICU and me to give updates, show pictures etc.  Afterwards, I was returned to my antepartum room for frequent monitoring, and was allowed a clear liquid diet for the rest of the day.  I wasn't hungry though at all buy forced myself to eat the clear liquids and walk when I was able to slowly.  After I walked, Michael was allowed to take me down to the NICU by wheelchair and wheel me to each baby so I could see them!  It was so special!  They weighed between 3lbs1oz and 3lbs11oz!  Both are great rates for a single baby at 31w1d let alone multiples! They were all on ventilators but at minimal settings! Otherwise, they looked amazing!

June 9th-June 12th (the day before the c-section)

June 9th-June 10th always hold a sad place in my heart.  These were the dates I lost a daughter at 24 weeks to Turner's Syndrome and associated heart defects.  It totally devastated me.  She would have been three this year.  I know she is in a better place though and is free from the lifelong hurt this syndrome and the heart defects would have caused.  I spent these two days in solitude and just kept myself busy with other tasks.  I listened to a lot of music during this time.  Also, I did a lot of thinking, took minimal phone calls, stayed off social media, away from tv, etc.  I mainly wanted to be left alone. I don't think the pain will ever be gone from this loss.  I just have learned how I personally need to heal and handle these days in a positive manner.  Her name is Allyannah Alexsys and I love her forever and always.

In addition to these days already being a little more sad and stressful, all of our household items from NJ were delivered to a house I leased in AZ from the hospital bed (sight unseen).  Also, a house I had previously purchased at eighteen in another state was fixed up and put on the market to sell since the renter's moved out.  Furthermore, the effects of the magnesium sulfate were starting to get worse.  Suddenly, I was gaining at least 10 lbs of water weight a day!  This was terrible timing since 2 out of my 3 doctors were out of town!  I had met their "replacements" before they left just in case but it was still scary.

After four days, I could barely move or breath!  I had gained forty pounds of water weight (in four days) and it was starting to leak into my lungs causing pulmonary edema. They could not just take me off the magnesium since the babies would have pushed through the cerclage causing major damage to myself and them!  The contractions were also coming more frequently and we were out off options... the doctors decided it was time to deliver.

They decided on June 12th the c-section would be the next day at 8 am.  This gave ample time for the prep work to be done on me and the room appropriately staffed!  I was relieved for the extreme swelling pain to be gone, to be able to breath, and to meet the babies.  However, I felt like I failed! My eyes were on the prize to make it another 3 weeks for them...  I had beat the average of 27 weeks for quintuplets by a month, did everything they told me, had daily injections, fought to get to AZ, etc. but it did not feel like enough!

My favorite past time was my once a day hydrotherapy bath!  It relieved so much pressure and made me feel weightless even though I weighed so much.  After my hydrotherapy bath on the 12th, the prep work fun began!  I stood in the tub as the CNA helped bathe me in a solution that killed any bacteria etc on my body. Afterwards, I put on a gown, had bloodwork done, a second IV inserted, prophylactic IV antibiotics given, and was shaved by the CNA! Luckily, the CNA and I had 70 days to become acquainted before this!  We were joking throughout and I'm sure it's something neither of us will forget.  Honestly, by this point with so much fluid and breathing issues anybody could have done anything with me I was so miserable it did not even matter.  I then rested the best I could until 5 am on the 13th...I was hoping my fight was a enough for healthy babies.

Last growth ultrasound before the birth and events starting to lead to an earlier delivery...

Since the last update, a lot has happened!  At the last time of the last post, I was doing well,  I was only getting daily injections of Terbutaline and other oral tocolytics to maintain my contractions at less than 3 an hour.  However, starting the next day, I was put on a high level of magnesium sulfate as a bolus and then on a continuous dosage.  The nurses said they had never seen such a high maintenance dose given and most moms who they have had on a lot lower dose could not function at all.  I was lucky since I was still able to move to use the rest room by myself slowly, and could still function.  At that point, my main complaint from the magnesium was feeling very warm constantly (I had a fan on high and air turned all the way down and was still on fire feeling).  I also had a burning sensation in my eyes that came and went.  Magnesium Sulfate is the "super drug" that is the last resort tocolytic since it is the most powerful.  I was put on it since the combination of the other drugs would not keep my contractions low.  I was averaging 8-12 regular contractions an hour.  These contractions were painful and I had them getting stronger for 13 weeks now! Talk about a long labor!  

At 30w4d (June 9,2014), I had another growth ultrasound, my twice a week biophysical profile ultrasound, and a cervical length measurement.
The babies weighed:
Baby A: 3lbs 13oz
Baby B: 3lbs 11oz
Baby C: 3lbs 5oz
Baby D: 3lbs 9oz
Baby E: 3lbs 11oz

They all scored well ranging 8/8 on the biophysical profile.  Occasionally, we would get a 6/8 from one not wanting to show off their practice breathing.  However, it is not alarming since we know they can do it since we've seen it done at other times.  Plus, there is "always one in every crowd" that does their own thing!  

My cervical length had shortened to 0.9, I was fully dilated above the cerclage, and my cervix was "paper thin".  At this point, I was placed on even more strict hospital bed rest.  

I was still looking forward to doing whatever was needed to get to the 34w1d scheduled c-section date of July 4th since I knew how amazing the outcome would be for all the babies!

Tuesday, June 3, 2014

A day in the life of the hospital and status update!

Life in the hospital is interesting when you are not sick...you just are super pregnant and things can get crazy fast!

A typical day in the hospital for a higher order multiples mom includes:
-3 meals (ordered like room service), 2 snacks (brought around 2x a day on a cart), 4+ protein shakes.
-Total daily calorie consumed at least 7000 calories a day. I was dropping weight at 5000 cal a day.
-Daily Ultrasound to see/hear heartbeats and movement (impossible to pickup all babies on NST in room).
-At least 3-hour naps a day ordered by doctors.
-Daily Shower, makeup/hair done, changing clothes, and changing bed linen to remain feeling "normal".
-Twice a day toco monitoring of contractions (if I have more than 4 an hour I get a Terbutaline injection).
-Every 3 day blood draws of Type and Screen encase you suddenly need an emergency c-section (luckily       my Dr. stopped these from weeks 26-30 so I can have a little break).
-I am on Motrin 4x a day, and Nifedipine 6x a day to help maintain contractions at 4 or less an hour.
-Vital signs taken frequently.
-Meeting lots of awesome CNA's, nurses, ultrasound techs, housekeepers, transporters, etc.  Everybody    
eventually knows you around the hospital lol.
-Random visitors of hospital personal such as pet therapy, prenatal yoga, Chaplain, nutritionist, and many others.

Other things to look forward too:
-Cerclage (thankfully mine is holding firm!)
-Biophysical profile ultrasound (2x a week to watch the babies practice breath, check heart beat, check amniotic fluid levels, and look for movement.  The top score is an 8/8 and test is started at 28 weeks).  All the quints have been getting 8/8 on the twice weekly tests!  Little Rockstars!
-Cervical length check (checks for  funneling-dilation of cervix and shortening of cervix)
-Every three weeks, growth scans to find out how much the babies' weigh and check their anatomy.  (All of the babies, have been bigger than singletons which is very unusual for multiple babies).  Grow Sumo Babies, Grow!
-Steroid injections to help mature lungs of babies at 24 weeks and 28 weeks!  Doesn't feel great since they inject in your hip/buttock area but it wasn't too bad!  Totally worth it so they can breath a lot better if born early.

Latest Update from yesterdays Biophysical Profile Ultrasound  (BPP) and cervical length check:
Gestation 29w4d: Days in hospital: 60 days!

BPP- all babies received an 8/8!
Cervical length was shortening and more importantly internal os of cervix started dilating all the way down to the cerclage :(.

New plan of attack from the doctors:
Same meds as before, toco monitoring of more than 3 contractions now equals a Terbutaline injection), and strict bedrest (only bathroom or laying flat in bed on my sides)  At least there is only 31 days until scheduled c-section!  Not bad considering how far we've come!

Sunday, June 1, 2014

Positive Outlook and Goals for the Quintuplets first year!

Love that this past week's focus was wrapping up old things and creating new beginnings!  NJ is officially history as all stuff is moved from there and on it's way here!  The IL house is officially on the market for sale with a Realtor and looks amazing! Thanks to everybody's hard work for chipping in and making it look immaculate after the tenants left!  I've learned how much you can coordinate from a hospital bed hundreds of miles away from everything.  I also have learned to get rid of any negative people from my life and any "friends" who turned out not to be so... I learned to let go of control and fully trust others (who I know have my back always) for help when needed.  This is hard for me since I like taking over the job! My car is on the selling market too! Thanks Mom for getting it ready to sell.  Overall, it has been a stressful but awesome week! This week I've done a lot of thinking and made a bunch of goals to accomplish by the time the quintuplets turn one!  I can't wait to meet the babies and  start tackling the goals! I have also finished most of my "Type A to do project list" this week.  I even had time to be crafty (something I am not) and make the babies adorable name tags for their individual isolates!  Sorry can't show the names until big brother, Conner, gets to help decide which baby gets which name!  The house is rented in AZ and waiting to be set up for the 6-pack! The doctors have said nesting instinct is definitely kicking in for me...so game on let's do this (from my personal office, the hospital bed, of course haha)!

Some goals for the first year with the 6-pack:
-Have all quintuplets healthy, solely breastfeed, on a "normal" developmental scale, and sleeping through the night!
-Be a hands on mommy to Conner, work with him daily on extra school stuff, sports, and fun stuff!
-Finish getting out of debt.  I'm getting there!
-Jump start my Pure Romance Business in AZ!
-Finish nursing school and one other degree (I've finished two degrees since bed rest)!
-Take exam/Get a great Nursing job!
-Hit goal weight (125 lbs), tone up after quints, and get the family clean eating!
-Run a 10k with the 6-pack!

This is in addition to the daily tasks of having a 6-Pack at home.  Hopefully, these can happen.  I want to show myself, the 6-pack, and others the sky is the limit :)

Womb Mates! Meet the Babies in the Womb!

Current Pictures taken at 27w4d!

Baby A cuddled up and keeping it classy with a pinky in the air!

Baby B (head), Baby C (foot), Baby E (Face)!

                                                   Baby D relaxing and playing with her fist!

Baby E kissing Baby B's Forehead!

Baby A resting her hand on her face!

What to expect in a day of a quintuplet parent!

Since coming down to AZ for initial medical care, it is ideal for them to stay with the same doctors for two years. They will be premature (even at 34 weeks) and they will require many follow-up visits. They are expected to be caught up with singleton children of the same age no later than two years old!    So as I'm stuck in the hospital in AZ, a move has happened from NJ to AZ.  This includes all of the baby gear!  The key to being a higher order multiple parent is organization!  This is just some of the items waiting for the babies.  Luckily, everything was organized before I went on  bed rest.  This merchandise was all donated, gifted, or bought by us on clearance, sale, or with coupons!  Thanks to everybody who helped support the quintuplets!  Mainly, diapers and wipes are the only things being stocked up on still...

What to expect in the day of the life of a quintuplet parent for the first six months:

4 baby girls
1 baby boy
40-50 bottles
120-150 ounces of breast milk
22 hours of dedicated pumping by Mommy
40-50 dirty diapers
1 box of wipes gone a day
1-2 loads of baby laundry (plus 2-3 loads of other household laundry)
5 baths
10 ears to wash behind
5 swings
5 bouncers
2 changing tables
2 rocking chairs/gliders
5 bassinets
40 burp cloths
10 blankets
10-15 outfits for babies
15 pacifiers
3 tummy time mats
50 fingers
50 toes painted with nail polish that match their  individual clipboards
5 clipboards, to record diaper changes, feedings, naps, activities, developmental milestones
5 beautiful smiles
25 minutes to feed/change/burp/comfort each baby, every 3 hours.
1 big brother to keep entertained, in sports, in school, and feeling special still.  He is for sure the best big brother ever already!

Pictures of some of the organization:

Welcome to Arizona

I started having Braxton Hicks contractions at sixteen weeks pregnant with the quintuplets.  I was not informed to go on any type of bed rest, adjust activities, or “take it easy” even though I reported the contractions to the doctor.   At 2130 on 30 Mar 14 (20w3d pregnant), I started having stronger more frequent contractions.   I went to the hospital where I was supposed to deliver an hour away but they said they would not intervene to stop contractions until twenty-four weeks (viability point).   This was just a start of a horrific experience with this MFM doctor and the hospital that night. After this incident, I realized this hospital would not intervene and would not be prepared to handle my cesarean section.  A quintuplet cesarean consists of a minimum of a neonatologist, respiratory therapist, NICU nurse, and NICU technician per baby.  This is in addition to the anesthesiologist, two physicians, scrub nurses, and scrub technicians assisting with my part of the cesarean section.  There was absolutely no way they could have gotten this team together when needed quickly!  It is imperative the babies get out quickly from the time the first to the last is born and have appropriate teams ready.  The delivery of all babies should be done in under two minutes to prevent complications to the babies since my body starts going into shock.  The team must also be effective. We decided on our way home, we had to do something, otherwise, we would have a very poor outcome for my health and the babies’ health.  Thus, affecting our entire family.  This incident happened on Sunday night.
We contacted Dr. John Elliott Monday morning, and asked if he would still accept me as a patient.  He said yes as long as we arrived in AZ quickly. I immediately requested my records.  With this pregnancy especially, stress causes contractions.  I started preparing for this rapid change of events.  Stress made the contractions significantly worse.  My husband, tried to take care of as many logistic things and find out our options on Monday.

On 4 April 14, I arrived at Banner Good Samaritan Hospital in Phoenix, AZ and became Dr. Elliott’s patient.  Upon arrival, I was having strong contractions.  They intervened and stopped contractions.  I was also found to have two infection, was severely underweight for a quintuplet pregnancy (I only gained 29lbs in 21 weeks.  I should have gained 60lbs total by 24 weeks and 80-100 total over the entire pregnancy), and my cervical length was getting shorter.  All of these aspects were missed in my prior prenatal appointments and OB triage visit.  Since being here, I get monitored often, interventions given for contractions, and am gaining weight.  I had a cerclage done and my cervix is getting longer each week.  As of 26 May 14, it was averaging to be 2.7 (normal is 3-5 for any pregnancy).  I still do have runs of contractions.  At 22w1d, I had contractions that showed on the monitor coming every 5 minutes.  I received a Turbutelene injection and contractions were better.  Had I not had this simple intervention, the contractions would have become more frequent and I would have delivered the babies too soon.  My previous doctor/hospital would not have given this one shot since I was not 24 weeks yet.  At 23 w5d, I had a cerclage placed to help my shortening cervix.  I was on Magnesium Sulfate for six dys at this point.  I also have recived two rounds of steroid injections to help the babies' lungs mature.  Due to constant care and interventions as needed, the babies are more than thriving.  They have me seeing a nutritionist and on a 7000 calorie day diet to make up some deficiencies from my previous MFM doctor on my weight gain.  At 27w4d, the babies’ weights ranged from 2lbs 3oz-2lbs 9oz.  A single baby weighs about 2lbs at this time and statistically multiples weigh less than single babies at the same gestation.  They also all have been getting 8/8 on their biophysical profiles.  I am currently 29w3d and have a Cesarean section date in early July set up (34 weeks roughly)  The difference between my previous  MFM doctor’s goal of 27 weeks to Dr. Elliott’s goal of 34 weeks is night and day in a premature infant.  This is for both viability statistics, and long-term disability statistics and is especially true with higher order multiples.

So far I have been in the hospital 58 days on bed rest.  It's totally worth it for five babies lives! The hardest part about being on hospital bed rest alone in a state you have never been to is feeling like I am neglecting my Mommy roles to my older son.  I know it is temporary and for the betterment of everybody the healthy the babies are; however, it is still difficult.  Luckily, it is almost over and modern technology is great for us remaining close during a time of physical distance.

Gender reveal picture at seventeen weeks!  Four girls and one boy are baking! Purple top 25 weeks.  Blue tank top 26 weeks!

Selective Reduction Appointment

In January 2014, we went to our first appointment with the MFM specialist we were referred too.  Upon entrance to his office for this stressful appointment, he seemed very rushed with us.  Even with the abruptness of the MFM, we tried to keep an open mind though we were both scared and faced with a lot of hard decisions in a pregnancy again.  The MFM doctor very strongly pressed the issue of selective reduction for two to three of the fetuses.  Selective reduction has a high risk of terminating them all though accidentally.  He also explained how he does not do “old-school” methods such as cerclage and only performs proven methods that work.  He said if we choose to keep all of the quintuplets, he could handle the high risk case, our goal would be to make it to 27-28 (the national average), a large team could be quickly called in if an emergency c-section needed to occur, interventions would be done prior to twenty-four weeks (since this pregnancy is shorter than a singleton’s pregnancy), and I would be closely monitored by him.  We left the appointment talking about all options and decided we would progress with the pregnancy.  Due to not feeling completely confident in his attitude or abilities, we spent days analyzing HOM maternal fetal medicine doctors on the East Coast.  We really liked Dr. Elliott but wanted to stay together as a family during this physically and emotionally difficult pregnancy.  After much research, we decided the referral MFM credentials seemed to be the best choice for the East Coast.
            We went to every three to four week appointment with the practice.  However, we only saw the referred  MFM doctor at one of those appointments.  We saw his partner at the other appointments.  They did vital checks, ultrasounds, and a brief doctor visit at each appointment.  Things seemed to be progressing in the pregnancy.  However, I was having issues gaining weight (I suffered from occasional nausea but rarely threw up). I asked to speak with a nutritionist or get counseled on how many calories, special diet, etc I needed to support this pregnancy.  I was never given this information.  I was skeptical of the care but kept going since we felt “trapped”.  Most doctors will not take on a quintuplet pregnancy.  

First act of business after the big news!

The situation was amazing and a blessing just extremely unexpected! The fertility doctors kept apologizing to us, said they did not know how this happened, and they urged us to strongly consider selective reduction with this very high-risk pregnancy.  They gave us a referral to a maternal fetal medicine (MFM doctor).  Immediately upon leaving this appointment, we started doing research of doctors (both close and far), contacting other quintuplet and higher order multiple (HOM) parents, and determining if selective reduction was an option for us.  Through research and referrals from the HOM parents we contacted, the name Dr. John Elliott from Phoenix, AZ kept arising.  We immediately contacted him and did a phone consultation with him for almost two hours.  Dr. Elliott did not charge for this consult.  He explained his personal HOM statistics, statistics of quintuplets born at different times, what to expect of a quintuplet pregnancy, life-long disabilities/death that could occur with the quintuplets, and answered many of our questions.  He stated if I would become his patient he would ideally like me in AZ by 18-20 weeks due to the fact my uterus would be the same size as a 40-week pregnant woman with a singleton pregnancy and contractions and other issues normally began at this time.  Hearing the statistics and possible grave outcome during the phone call was extremely scary.  Even though I knew from my medical background these risk, hearing them out loud made me cry from stress and the unknown.  We were still deciding what to do about the pregnancy when we had our referral appointment to the MFM doctor the fertility specialist recommended..

First picture (by flag) is me before I was pregnant, Second picture (maroon shirt) is 9 weeks, and third picture (black and white top) is 13 weeks.

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Merry Christmas! You're pregnant with twins...I mean quints!

In the beginning and middle of December 2013, blood work and two ultrasounds confirmed a twin pregnancy had occurred.  On December 27, 2013, at the third ultrasound to “hear heartbeats” it was determined that this was a healthy (5 heartbeats, 5 yolk sacs/placentas) quintuplet pregnancy instead of a twin pregnancy!  I was relieved my husband and son were there so I was focused on their reactions and could start processing the situation.  I normally have a very Type A personality, including being extremely organized, a list maker, handle a million tasks at once, and like being in "control" of situations.  When unexpected things come up (good or bad), I automatically start problem solving.  My son immediately said, "I'm not prepared for this...wow Five Babies!"  My husband was pale white, mouth open, and was in complete shock.  When we walked out of the ultrasound room and sat in the waiting area to talk with the doctor, other patients kept looking at him and asking if he was okay.  His only response was, "There's five"!  I just kept explaining to the other patient's who were waiting what he meant.  Needless to say, I think he gave the entire waiting room a scare!

Our Christmas announcement of twins before we found out two days later that it was quintuplets!

The start of babies...

I am often asked to describe the sequence of events of the experiences my husband and I have had with the quintuplets.  A little background information is required first. I had a son born in 2006.  His name is Conner and he is the highlight of our lives!  He loves sports and has a heart made of gold!  Prior to my husband and I conceiving this time, we had conceived in the past but lost that daughter to Turner’s Syndrome and severe heart defects at 23w6d in June 2011. We had a D/C at that time.  This loss more than devastated me!

Since then, we had been trying to conceive with no luck. After following the proper protocol, we were referred to a fertility specialist in NJ.  In May 2013, we had our first appointment!  After running many tests on both of us between May 2013-Sept 2013, they diagnosed us with unexplained infertility.  I was excited but nervous to run these tests.  Some of these tests were uncomfortable to say the least.  At ths time, only a few people knew we were seeking assistance.  In September 2013, we did one round of Clomid and timed intercourse.  Two follicles were produced but conception did not occur.  In October 2013, we did another round of Clomid and timed intercourse.  This time one follicle was produced; however, conception did not occur.  In November 2013, daily injectable medications were given and an Intrauterine Insemination (IUI) was performed.  Prior to the actual IUI procedure, I was monitored every other day-daily to see how my body was responding.  The day before the IUI procedure, the ultrasound and blood work showed one possibly two follicles would be mature enough to possibly become fertilized.


Hi! My name is Roxanna Hoffman.  My Mother always said that I have been in a rush through life.  I graduated high school when I was sixteen, had my oldest son and started college at seventeen, bought a house at eighteen, joined the military and became an EMT at nineteen, and was married at twenty-one. Personally. I have always worked really hard for all I have and am always striving for the next goal.  I met my husband in the military.  He is active duty military and just completed his Bachelor's degree! We had a beautiful, princess-like wedding on 1/1/11 at 1:11pm (suppose to be 1pm; however, we were delayed with my hair and it worked out perfectly)!  It incorporated a lot of family into it in many ways.  I loved this since I am very family orientated.  Currently, I am a nursing student that will have my nurse practitioner license within the next couple of years.  I also sell Pure Romance supplies since it is a great Girl's Night Out and helps provide for my family.  I have my plate pretty full right now but things are about to go on an even crazier adventure!  This is because I'm unexpectedly pregnant with quintuplets!  That's right fifty toes and fifty fingers are currently in my abdomen! I would love to share this journey with others to provide hope, strength, and support for whatever journey you find yourself aiming to achieve!