Saturday, August 29, 2009

A return to normalcy...sort of

It's been over a week since I posted last, and I seem to be doing pretty good. I spent the weekend visiting with family and friends in Waco. It was such a shot of joy to see them, tell stories, laugh, and even do a bit of exercise! I took my mom's cocker spaniel out for a run, or should I say she took me for a run. It was a nice break form the lounge chair or couch a TV. I forgot how hot it gets in Texas. Not the best idea to go running in the middle of the day. If something had happened, I am glad to share the dog would have eventually pulled my body to the house! The visit with my friends was a real joy. One of my dearest friends was celebrating his eldest daughter and son's birthday party, so I stopped by for a visit and was able to catch up with some other dear friends from college that even sent me a cookie bouquet, well actually two bouquets, as the delivery person delivered it to the wrong house, and when the home owner found it, the bouquet had (and I mean this literally) melted and the cookies, which were still edible, had fallen off of the sticks and broken into pieces to some degree. The company redelivered the next day a new one with a balloon! What great friends! My weekends in Waco are never complete until my great friends and brothers get together for a 3-4 hour session of Rock Band. It is non-stop fun, and was a great healing dose of love before returning to the real world. I was glad to leave Waco when I graduated college, but now it is sometimes hard to leave with the family and friends who live their lives there now.

I have a hilarious story, well at least to me hilarious about getting back to work. I started back to work on Monday, and it was kind of a slow day as I was getting back to returning phone calls, and trying to catch up on emails from my absence. There was a short meeting at a facility not far from my office to inform some of the employees about supplemental insurance options for us. After the meeting, I returned to my building and office, when I was asked about my FMLA papers (FMLA is the Federal Medical Leave Act). My time off was under this, so I have to have paperwork filled out by my doctor to get my leave approved. It had not been completed, so I left a message with my doctors nurse about the paperwork, and did not get a call back. The rest of the day went fine. Ok, here comes the funny part. I returned on Tuesday to the office and as I walked in, I noticed that we were having a staff meeting, so I ran to my office to grab a pen and paper for the meeting. As I walked in, I was intercepted by our office Administrator Pat. Pat is like the worlds best grandmother! She is so sweet and full of wonderful stories. Well, Pat quickly pulled me from the meeting and asked if I had a note from my doctor to return to work. I immediately assumed she meant the paperwork to be filled out. I said I had not heard back from the nurse. She said, she was sorry, but I could not be at work. I gave her a confused look and ran to my office to call the nurse. When I phoned, I asked for my nurse, and the receptionist informed me that my nurse was out of town for the week, and left me another nurses name and transferred me to he voice mail. I left an urgent message for the nurse to call me back. As soon as I finished, Pat came in with a sad but serious look on her face. She said, "I am sorry Jeremy, but you will have to leave the premises immediately. You cannot be at the office until we have a note from your doctor saying you can return to work." At first I was shocked, and then I got mad. I was like what the heck is going on. Again, Pat said someone from the Corporate office had just called and said I had to leave the building right now. I was mad at this point. I was thinking, I don't want to go back home and sit on the couch or recliner anymore. I want to work, but they won't let me work. As I walked out, Timeka, our office assistant at the front door was confused at me leaving as I had just come in. I was thinking, "I am getting escorted out of the building!" I left the office and was pretty upset. I drove home fuming, then a thought popped in my head...You just got escorted out of the building by the grandmother of the office. At the point, I started chuckling, then it broke into a giggle, and then into full on laughter by the time I reached the house. I finally got home, and quickly realized I could call the surgeon. I reached his nurse, and she said she would be happy to write me a note. Well, within an hour, Pat called me and said I could come back to work. Now it is a pretty funny topic for the office as I 'claim' to have been escorted from the office by Pat the sweetest, kindest grandmother ever. After that, everything was fine at the office.

I also started back to school this week. I have two classes, one is Old Testament history, 1 Samuel to Ecclesiastes. The second is Angelology, Harmiotology, and Anthropology. It has been a year or more since I have sat in a class. I have been taking online classes, and I am so excited to be back in a classroom with people around me to talk to. I can't tell you the number of times I dreaded being online watching video and reading someones paper. Unfortunately, the Old Testament class will be a hard class to NOT sleep through as the professor is very monotone. Good, applicable information, but presentation is missing quite alot. The second class will be the highlight of the year! This professor is amazing and exciting, and he loves what he is teaching, so it may be hard to finish all he wants to talk about. It should be good.

Overall, I am feeling pretty good. I was able to be pretty active this past week. I rode the bike a couple of times, ran some, and even played tennis with some good friends. I am seeing a bit more of tiredness during the middle of the day, but for the most part, I feel full of energy and excited about what is ahead. The only strange thing for me is that I still cannot sing, and I feel like I have something stuck in my throat. Thankfully, many people remind me that it has only been two weeks since the surgery, so I cannot expect to be back exactly where I was before all of this.

Once again, I want to thank all of you for your prayers, cards, thoughts, messages, texts, and support throughout this time. I can literally feel the prayers affecting me everyday! I will do my best to write more frequently as time allows. Blessings!

J

Friday, August 21, 2009

So what's next, doc?

It's been a few days since I have posted. I did intend to write earlier this week, but wanted to wait until today as I had my follow up appointment with the surgeon. Not long after updating the photos of pre- and post- operation photos on Tuesday, I was updated by the surgeon on the pathology report. I'll get to that in a minute. After surgery as I was waking up in my room, and slipping in and out of consciousness waiting on my wonderful cup of jello, I overheard conversations from family and friends about the surgery and the surgeon's impression of the cancer. I caught bits and pieces of statements like, 'Thyroid looked good', 'it didn't look cancerous', and others very similar. Even as the doctor checked on me right before I left the hospital, I think he said the thyroid looked healthy. For some reason, I took that to mean that the nodule on the thyroid was cancerous and there was a strong possibility that the thyroid was not cancerous. I was feeling pretty good that surgery took care of everything! Well, that got squashed on Tuesday evening. The surgeon called and gave me the findings of the pathology report. The thyroid was cancerous, and I will need to take a radioactive iodine cocktail to kill off any remaining thyroid cells in my body. That was not the news I was looking for. I was pretty bummed! Fortunately, my good friends Andi and Adam were available for a nice dinner to encourage me after that news. I was hoping to not have to have radiation of any kind. The doc also commented that I would need to start my care under an endocrinologist, so he and my personal doctor set me up with a new doc. For some reason as I started to think about this, I started to feel like a football. I felt like I was being passed from doctor to doctor, or quarterback to running back with a lateral to the receiver, etc. Anybody else felt that way about your medical care???

Anyway, today I met with the surgeon, and he checked the incision site to see how it was healing, and he said it looked good. I promise, it's not very pretty, so it doesn't look good to me, but at least it doesn't hurt to swallow now! After checking the site, I started to bombard him with questions. What stage is it in? Has it spread? What about the body scan? What about this radioactive stuff? He was very gracious to answer all my questions! Spreading is a possibility, but they cannot tell at this point as it would be on the microscopic level. Body scan would be something my new doctor would do. The radiation bit would be a cocktail of radioactive iodine that, in his words, 'is like a smart-bomb.' Thyroid cells are the only cells that process iodine, so this cocktail would only kill thyroid cells and does not affect other cells or systems of the body. Boy was that a relief to hear!

Overall, I feel pretty good. My energy level feels similar to pre-op levels. I even want to start exercising again. I will start back to the office next week. That's all for this post. Thank you again for all of your prayers during this time! I definitely still need them, so please keep 'em coming! Love you all!

J

Tuesday, August 18, 2009

In my haste to post yesterday, I forgot to post the photo of my surgeon. So many of folks have called or emailed that experience is key in the surgery I was to face, so here is a photo of the surgeon, and please feel free to give me your input on what you would think after you saw him! By the way, he was an EXCELLENT surgeon, and one of my nurses said he is her favorite surgeon and she felt he does the best job of any surgeon she has worked with. That was very encouraging to hear. I have also included a few photos pre and post surgery. Thanks again for your prayers. I am scheduled to meet the surgeon at the end of the week, so I think that is when I will get the results of the pathology report. Love you all!

J














This is Fatama. She is from Guinea. She helped with the pre-surgery stuff. She was a blessing to know!














This is Terri. She was one of the main nurses to check me in and prep me for surgery. Very nice and sweet.














This is Chae. She was the final nurse to care over me and oversaw my checkout. She was one of the kindest nurses, and gave high marks to my surgeon.

Alright...ready for the surgeon???


















Hands as soft as butter and not a tremor to be felt in his handshake! Thank you Lord for a good surgeon!


Monday, August 17, 2009

Can't sing, but I can talk!

Good morning and welcome to the Roost. I had hoped to write some yesterday, but it didn't happen. Today I just want to catch you up on how recovery is going and how thankful I am for each one of your prayers! It has been an incredible journey, and it's not over. I never would have thought a simple doctors examine would have such life changing results, but I am thankful that he was so proactive in figuring this out!

The past few days have been lazy but good. Several coworkers and friends have stopped by to visit, offer food, or just hang out with me. Thanks! All of your prayers, phone calls, messages, etc. have been so uplifting. I have seen Christ in the words, actions, and hugs from everyone during this journey!

I have been very surprised by the low pain I have experienced! From past surgeries, pain has been terrible. I believe I have only had to have pain medication once or twice during the entire time, and that has mostly been tylenol. Right now the most painful part of this has been swallowing, thanks to the breathing tube, and the soreness of the muscles around my neck. I may try to venture out today for a walk or even a movie.

Several friends have asked
about the experience at the hospital. I must say first that your prayers, they were answered for the most part! Many cute nurses attended my surgery needs, but they were all married. I was also surprised by how many nurses, technicians, and others from another country were part of this experience. I met some from Guinea, Kenya, the Phillipines, and even Ethiopia. It was a joy to be served by so many in a time of need. I have to say my time at Presbyterian Hospital was very nice, and the care was exceptional!

I will do my best to connect with each of you to thank you for your words of encouragement, prayers, cards, flowers, and the many containers of ice cream that fill my fridge! I have such great friends and family! You are all such a blessing to my life! I know I will never be able to thank you enough for everything that each of you did during this journey. I continue to ask for your prayers as I continue with this journey over the next few weeks until we know the final outcome and until we get the medications adjusted to the correct levels.


It looks like the poem I
posted on Wednesday didn't show up, so here it is again. It really is pretty funny.

I have a followup with the surgeon on Friday, and either that day or earlier, I should get results on the pathology report on the thyroid. Let's pray it was not cancerous!

I can't thank you enough for your thoughts and prayers! I love you all dearly!

J





Saturday, August 15, 2009

Jambo sana!

Good morning buzzard fans. This will be a short update. I am home, got home yesterday around noon. Don't feel too good, but don't feel too bad. Rough night sleep, but that's to be expected probably for the next few days. Started the synthetic thyroid meds, throat hurts quite a bit mostly from the breathing tube. I kinda forget that surgery, anesthesia, pain meds, swollen tissue, and stitches mess you up, and take a while to get over. They will test the thyroid for cancer and I should know next week about radiation. It's good to be home!

Thank you to everyone that has been praying! I could feel your prayers! Our God is an awesome God, and he put all of the right people in the right place to take care of me during this experience. I was blessed to meet several nurses and technicians from Africa and Asia that were so kind, in fact I got to speak a little swahili with them. The nurses and doctors were exceptional at the hospital! I commend them for their quality of care!

That's all for now. Thanks for your messages, texts, calls, etc.! I love you all!

J

Wednesday, August 12, 2009

Party for a thyroid...it ain't your grandma's party!

I am a bit overwhelmed as I write this tonight, or is it morning. My last to friends left about 30 minutes ago after praying for me. Thanks Susan and Jennifer. Tonight was a great going away party! The food, fellowship, laughter, the thyroid cakes (thanks Andi), the t-shirt(can't stop laughing Alex and Jess), were great, but the best part for me was each friend that emailed, called, or came tonight to walk with me, to say they are praying for me. I am so humbled by each one of you. I can't thank everyone enough for their
words of encouragement, prayers, and even poems (I'll post that later in this). I love each one of you, and thank my God for you being a part of my life!

Sometimes in these moments of trials in our lives, we feel all alone. We wish that people would respond in a certain way to our situation and when it doesn't happen we feel like we are not loved or cared for. I admit at times during this journey, I have felt alone. And as soon as I felt that way, God sent an angel, one of you precious friends, to write an email, dial me up on the phone, or even stop by. Tonight was a house full of angels, as well as my email box and facebook wall was full of messages from angels. I would love to tell you about each of them, but for time sake, as I probably should be in bed trying to sleep, I want to tell you about one in particular that was an unexpected blessing. About a month ago, a week before visiting the doctor, I met a young man on one of my trips to Guatemala. His name is Santiago. This young man was one of the most eager youth on the trip. He jumped in and loved everything we did with the kids, and they loved him. After returning to the states, I received and email from his mom that he had a great time and wanted to go back to Guatemala. The same church had another trip planned two weeks after his first trip, and we arranged it so he could go. While he was on the trip, the team was informed of my diagnosis, and they began to pray for me. The team returned home and within a day or two, I received an email from Santiago's mom. She wrote that Santiago told her about my diagnosis and Santiago wanted to pass on a message. He said, 'Tell him I love him, I miss him, and I will be praying that God makes him completely OK." I was floored! Here was a youth I met three weeks ago on a trip, and he has faith that God will make me ok. WOW! Then to top that off, he has been following the blog. He saw that I was having the party and his mom emailed me to say they would like to stop by. They both came and brought some wonderful food from their family restaurant, and they stayed for most of the time and visited with my friends and coworkers. I was humbled beyond my own belief! He walked in, gave me a hug and said 'I am praying for you,' and was like a part of my family. Santiago, you are an angel, and you have lifted me up! Thanks brother!

It is getting REALLY late now, so I want to say so much about the party, but that will have to wait. I have a poem to share with you that a life-long friend sent me today. I have been sharing it with whomever I can (sorry party folks, I was enjoying my time tonight, and I forgot to share it with you). Thanks Kristen! I will be enjoying this for some time indeed!

Ode to My Missing Thyroid

Finally, I've got to share the cake and the t-shirt!

Thanks Andi for making 2 thyroid cakes and cupcakes! They were awesome! Who knows, I may freeze it and wait a year and have an anniversary party... You are a wonderful friend! I love you!
















Thanks to Alex and Jessica for the t-shirt! This took me by surprise, no idea it was coming, and yes, I am wearing it to the hospital! And it was made even better that you put it in a Christmas bag!!! I love you guys!















Thank you to all of you who were not able to make it out. Thank you for your emails, texts, messages, and phone calls. You are all such great encourager's and angels to me! I love you all.

Now to bed. I'll try to write more before the hospital, if not, I will write when I am next able!

Blessings,
JC

Tuesday, August 11, 2009

Thyroid going away party...

Good news for you readers...this one will be short. It's late and I am tired!

First, some folks emailed me some questions, so I will try to fill in some details about the surgery.

The surgery will take about 2 hours and they will remove the entire thyroid and if any lymph nodes look bad, they will take those too. I will be in the hospital for one overnight, and then I am out of there. I do have my mother staying with me for a few nights. I will definitely contact some of you if I need help, or if I am really bored and need to get away! They will send the thyroid off to see if cancer was in more than just the nodule. If so, then I will have a radioactive iodine cocktail i will drink that will kill only any thyroid cells still left in my body. Then I get to figure out the amount of synthetic thyroid medicine i will need to take to get back to normal.

Ok, yesterday I wrote about a going away party, and was just kinda joking about that...well, some folks thought it was for real, so...THE PARTY IS ON!!! There will be the Thyroid Going Away Party at my house Wednesday night from 7-9. It's a stop and go party, so just stop in, grab some food visit and go when you want. I just ask for you to bring a drink, like soda, or something you like. We will have a thyroid shaped cake!!! I was even thinking of making a t-shirt with an iron on thyroid that says 'get me outta here!'

That's all for this posting. Please continue to pray for the listed requests. You all have been a great blessing to me in this journey!

Jer

Monday, August 10, 2009

How old is this surgeon?

Have you ever been to an amusement park and stood in line for four hours for the biggest, fastest, longest, coolest roller coaster ever? When you finally reach the cars to load, you get in the back car. You lock the shoulder restraints and raise your hands excited for the journey about to begin. When suddenly you look to your left and you see the coaster operator in his booth and you think, "Is that guy old enough to operate this thing? He must be 16 years old, and he is going to work the brakes of this coaster?" Your arms slowly start to lower, the excitement you felt turns to worry or even fear as you think, "Does this kid have the skills to do this? Can he reach the buttons for the ride?" Well, that is sort of how I felt when I went to meet the surgeon today, except the 'operator' was much older than my example. After filling out pages and pages of paperwork, the nurse ushered my mother, father, and myself into a treatment room. We passed the doctor in his office as the nurse led us in. I took a quick glance at him in the office and a small knot developed in my stomach. As the nurse closed the door, I quickly looked at my parents and whispered, "How old is this guy?" He looked like my grandfather. I am usually not one to make judgements on how someone looks, but in this situation, my anxiety overruled, and I started to get worried.

With thoughts of my grandfather fresh in my mind, all I could think of was the Parkinson's he suffered from near the end of his life, and the constant shaking of his hands. I immediately associated visions of the surgeon with shaky hands. Within a few minutes, the surgeon came in and was quick to introduce himself and shake my hand. Surprisingly, he had soft, strong hands with no hint of Parkinson's. One point for the surgeon, no points for Jeremy's anxiety. As most surgeons are, he was not the most personable doctor. He did a quick examination of the area around my thyroid and jumped straight to the details of the procedure. All was fine and dandy until he started to explain the risks of the surgery. First he spoke of low blood calcium, no big deal. Second he spoke of risks of hoarseness. This one bothered me. He said there were three possibilities of hoarseness: 1. general hoarseness from the removal of the breathing tubes 2. short term hoarseness from bruising of the vocal chords 3. long term hoarseness from severing the nerve for the vocal chords. As he described the long term hoarseness, he used a raspy whisper and said, "you will sound like this for the rest of your life." Ok...one point for Jeremy's anxiety, no points for the surgeon. He even spoke about the possibility of death, and that didn't bother me, as I was still imagining this raspy whisper. For those that know me well, you know that singing is a big part of my life, whether that's singing hymns or the short neck buzzard song. Now I wasn't feeling so good about this guy. Even score, so I was pretty apprehensive at this point.

We finished up our time with him with questions, in fact, mom had a list of questions, and he had answered them all. He thanked us and left the room. His nurse then asked about scheduling. I told her I would need to check my schedule and would call her with a few days to work with. We then left the office.

I will divert here for a moment away from the day to touch on the spiritual side of things. I told you in the last posting there would be more, so here is more. I have a devotional book of sorts from theologian John Stott. Some folks love Stott and others don't share the 'love' for him. This morning before the surgeon hoopla, I was reading one of the devotionals. Stott was writing about 'living in the real world of constant pain and pleasure.' He was using a passage from Ezra 3. He writes about the Israelites return from captivity from Babylon, and as they return, they begin to rebuild the temple. "when the builders had laid the foundation of the temple of the Lord...all the people shouted with a great shout when they praised the Lord because the foundation of the house of the Lord was laid." Ezra 3:10-11 In the following verses, Ezra 3:12-13, the author writes of the priests, Levites, and heads of households were crying for they had seen the previous temple and knew the new one would not compare. Some were shouting for joy while others were crying. Both emotions are valid and real, and both were happening at the same time. While one group was joyful to see the new temple was better than captivity, the other group wept as they compared the new temple to 'the glory of what once was.' So this is with everyone today. As people face situations with their jobs, marriages, families, and in my case this medical situation, they will have to choose how to respond. For me, I am 'captive' to this cancer. Soon I will be free from captivity and my body will not be the same as it once was. I can shout for joy that I am free from the cancer, or I can weep that my body is not the same as it once was, not as it was in the 'glory days of old.' I know which one I choose for my hope is in the Lord. Romans 8:28 (The Message) That's why we can be so sure that every detail in our lives of love for God is worked into something good.

So, back to the surgeon. Left the surgeons office, had a bite to eat with mom, and then went to the office. As I walked in, I saw a coworker outside at a porch table, so I went out. She asked me how the visit went. I told her about my apprehension. She immediately lifted me in prayer. That's what I needed. Thanks Jess! Well, about two hours later, I made the decision to schedule the surgery. Two awesome things happened after the decision. First, called the office and scheduled the surgery. The nurse called me back and....drum roll please....I get to sleep in before the surgery!!! Second, the office took an afternoon ice cream break and I got a cup of Mediterranean Sea Salt Caramel Gelato!!! The second greatest frozen dessert after Blue Bell Homemade Vanilla ice cream!

Sorry, I digress sometimes...surgery. Well, I got two good references for this surgeon and obviously he has experience, so at this point, I feel good about the surgeon.

Thursday, August 13th at 12:00pm at Presbyterian Hospital Dallas.

Prayer requests: Same ones as yesterday, plus pray for continued peace about this surgeon.

I'm thinking of having a going away party for my thyroid on Wednesday night. Any suggestions for themes?

JC

Sunday, August 9, 2009

The past two weeks...

I'm sure most blogs start out this way...'Well I never done this blog thing before, so I thought I would try...' I guess that is how this one should start, but instead I will start with a Sunday school lesson.

In class to day, one of our class members was filling in for our regular teacher. The class had decided to collect subjects and ideas of topics discuss throughout the year. This particular Sunday was about forgiveness. The discussion was great and very engaging for the class. One particular story caught my attention as we discussed so many. Someone brought up the story of David and God's judgement on him for his adultery with Bathsheba. The judgement was for David, and Bathsheba, to lose the newborn child. As I thought about that story, I turned over and over in my mind the fasting and praying David went through for the time period that his child was alive. When God's judgement on David came to be, David got up, ate, cleaned himself, and went on with his duties as a father, husband, son, brother, king, etc. Someone in the class said David set an example of how we are to handle situations in our lives as Christians in such a manner as David. I see that I need to be ready to move on with what comes next with this experience I am facing, and with God's strength, I know I can.

With that being said, I too, realize that if God chooses to remove this cancer from my body before surgery or any other treatment needed, that He can do that and He will be glorified in doing so. I also realize that He may be choosing another way for this to be removed or manifested so that He is glorified in it. I pray that I am open to Him in this situation however he leads.

Ok...enough of the spiritual ramblings, there is plenty of time for that down the road...or so I hope. After trying to respond to so many people by email, I realized last night at 2:04 am that I may not be able to notify every friend individually like I want to. One of my coworkers said I should I should blog on a site so I would only have to update once and folks could check for themselves. I think that is a good idea, so here is my attempt at that. (Thanks to Mrs. Pat for that suggestion...I couldn't remember the name of the site, so I used this one.) So...here is my attempt to catch everyone up:

A little over two weeks ago, I was enjoying an upper respiratory infection, and Robitussin wasn't working. I called to see my doctor, and said I had this infection and might as well get a physical while I was there. I am not much for visiting doctors, so it had been about two years since I had a checkup. While getting the physical, the doctor felt a hard bump on my thyroid (who knew your thyroid was soft, much less hard). He said at my age it should be that way, so he ordered a couple of blood tests and an iodine scan at the hospital. You know how tests are at the hospital...you wait longer than the actual test is, so I got a pill, swallowed it, and went on with my day. The pill was an iodine pill with radiation. I returned the next day to lay in a machine while they took pictures of my thyroid followed by a machine with a small tube pointed at my throat and my thigh to measure the amount of iodine my thyroid was producing. The tests came back a day or two later, and the doctor called me in and said the test didn't tell him much, so he wanted me to get a needle biopsy. Well of course biopsy sends up the flags...something is wrong, so that began the frenzy of calls to and from friends and family to ask for prayers. I went in for the biopsy...which by the way took less time than it did to wait for the pill on the first test. Obama, where's my insurance card?!? Anyway, the biopsy went fast and relatively painless, and I overheard the technician say it would take about two days to get the results to my doctor. That was a Monday, so Wednesday no word. My boss at work was, and is, a pastor from time to time. He said in his experience, when the news takes longer, it is better news. So by the end of the day on that Wednesday, no word...then the phone rang as I was leaving the office. The nurse said the doctor wanted me in the next day...I knew it wasn't good. Thursday, August 6, I went to the doctor, and he says I have papillary carcinoma of the thyroid. He begins to explain that to have cancer, this is the best one to have...hmmm, not so reassuring as the word CANCER is in there, and no...it is not my astrological sign either! His recommendation was for me to have the thyroid removed, so that is where I am today. I will meet with a surgeon Monday morning to discuss the details and find a date to remove my thyroid.

Well, I thought that would be a quick synopsis, but it looks more like one of my papers from seminary. Anyway, that is the latest. The only thing I ask for right now are your prayers. Prayers for wisdom for the doctors, peace for me and my family, and that I would see God in this and what I can learn and share in this (and if you have room in your prayer for a cute nurse, that would be good too!).

J