i send or take thank you card every once in awhile to remind them i appreciate their care and their help ... they have loved this and said how much it meant to them ... I am also one who likes to give at holiday time ... to the mailman, the garbage man, my MD, my dentist, and all of my specialty care docs too ... I uaually do like a $10 gift card to starbucks because even if they do not like coffee, there are other things they can buy ... and it is lightweight, easy to mail or carry and is one that does not depend on gender to work ... i am sure a pumpkin pie, or basket of fruit or a bucket of christmas candies or a tin of cookies would all be well appreciated too. even homemade christmas cookies are always a wonderful gift and then they know it comes from the heart.