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Wernicke-Korsakoff Syndrome: What You Need to Know?

Studies indicate that there is a huge rise in the number of people suffering with Wernicke-Korsakoff syndrome. It is a type of neurodegenerative disorder that is caused due to Vitamin B1 deficiency. What causes Vitamin B1 deficiency? The intake of large amounts of alcohol frequently is one of the main causes for this problem. However, this deficiency can also occur due to cancer, intestinal problems, stomach surgery and malnutrition.

Some people believe Wernicke’s is the acute phase, while Korsakoff syndrome as the chronic stage. Even after taking the therapy, Wernicke’s encephalopathy frequently develops this condition called Korsakoff syndrome in most cases. WKS is characterized by a variety of issues in mental processing. WKS can cause severe damage to your brain, if it is not treated at the early stages.

Looking for a solution for alcohol addiction? Whether it is you or someone in your family, the first thing that you must do is find a good rehab center. Detox to Rehab has got a name and fame in the US for its effective treatments for addiction. Their staff treats every patient with utmost care, which means you can always expect positive results at the end of the treatment. 

What are the wernicke disease symptoms? Continue reading to know about them. 

When it comes to Wernicke’s encephalopathy (WE), some of the symptoms which you may commonly experience are difficulty in walking, confusion and vision problems. WE are caused by thiamine insufficiency. Because thiamine is required by every cell in your body, and it cannot be produced by your body naturally, you must get it from food. Thiamine is extremely important for kidneys, liver, heart and brain.

Most people with WE generally look underweight and malnourished. However, the symptoms of WE can vary from person to person. Hence, it is important to contact a doctor or a therapist as soon as possible for the treatment. 

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DentalHealth

Benefits of Family Dentistry

Family dentistry deals with the prevention, diagnosis, and treatment of dental conditions of people of all ages. Family dentistry is the best option of dentistry for individuals that have families. You can take your partner and kids to the dentist and get all services in one place. Family dentistry provides all dentistry services to your kids at different ages.

 You can get Springfield, VA, family dentistry at Advantage Dental Care. The family dentistry experts are professionals that provide you with the dentistry services that you require. The following are the benefits of family dentistry.

Family dentistry specialists deal with people of all ages.

The family dentistry specialist can handle children, teenagers, and adults. They are the best specialists to offer dental services for your children because they have good experience. Many parents take their children to family dentistry to get different dental services. You can trust the family dental specialists to handle your children’s dental health.

The specialist is also good at providing their services to teenagers. You can also get the services even as an adult. The age of their patients does not limit the expertise of the family dentistry specialists.

Family dentistry services ensure the good dental health of your family.

Family dentistry needs to be started at a very young age. It would be best to take your family to visit the dentist within the recommended time, at least once every year. The family dentistry specialist will diagnose dental problems that may have occurred and treat them early. Your children will have good oral hygiene because their oral care will be impeccable.

Dental conditions such as misalignments and teeth discoloration can be treated early. Continuous visits to the family dentistry specialist’s office assure your families’ dental health.

All services are in one place.

Family dentistry provides you and your family members with one place to get all dental services. Family dentistry specialists are professionals that handle all dentistry services related to diagnosing, prevention and treatment.

Your family can book an appointment and get any of the services from the specialists. Dentists offer outstanding dental services to their patients. The provision of dental services will help you save a lot of time.

Family Dentistry creates a long-lasting relationship.

People take their children to the family dentistry specialists from a young age. The same family dentistry specialists provide dental services even though they grow into teenagers. The dentists may provide treatment for the entire treatment for many years, which creates a long-lasting good relationship between the dentists.

It becomes faster for the dentist to evaluate the person and provide treatment since the dentist has been providing treatment to the person for years.

Get Family Dentistry Services Today.

Family dentistry is the best option for dentistry services to choose. Call to book an appointment with family dentistry specialists at Advantage Dental facility. Ensure your family gets the best dentistry services.

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Health

A Good Sleep Creates a Productive Day

While some people may enjoy deep sleep to the extent of even getting to wake up late, were it not for the persistent alarms, others remain awake throughout the night. Most adults will experience these symptoms at some point in life. The prolonged lack of sleep causes people to struggle with their daily activities since the body is in distress. Getting a good Lakeway insomnia specialist can be daunting. However, at the Sleep Cycle Center, you are guaranteed quality treatment from specialists who will help you enjoy a good night’s rest. Learn more about insomnia before booking your appointment.

Insomnia Comes with Several Characteristics

You may struggle with insomnia, but you might not understand it. Insomnia assumes different characteristics, including difficulty falling asleep, waking up several times during the night, feeling unrefreshed, and waking up too early without falling back asleep. The specialist will also examine you for symptoms such as difficulty focusing or thinking during the day, fatigue, depression, and poor memory to ascertain whether it is insomnia or other sleeping disorder.

Insomnia Comes in Two Forms

There are two different types of Insomnia: Acute and Chronic Insomnia. Acute insomnia is mainly associated with life situations and lasts less than three months and then automatically goes away. Conversely, chronic insomnia is a prolonged lack of sleep and daytime consequences lasting for more than three months. It usually occurs due to clinical disorders or environmental changes.

Risk Factors for Insomnia

Some risk factors that lead to insomnia include bright lighting, disorders, and aging. Other factors may include job stress, relationship issues, psychiatric problems, irregular working hours, medications, drug abuse, and irregular sleeping and wake times.

Insomnia Is a Disorder and a Symptom

Specialists consider insomnia a disorder and a symptom of other issues, making it the most challenging condition to treat. It is difficult to pinpoint an underlying problem that leads to insomnia. People with medical conditions or stress will experience insomnia, and therefore narrowing it down to a single cause may be difficult. However, insomnia is treatable, and consequently, you do not have to worry about the condition.

How To Prevent Insomnia

Sleep is an essential part of your life if you want to be productive in your daily activities. It is crucial to ensure that you prioritize sleep by setting aside specific times for when you will sleep and wake-up every day. Maintain a consistent cycle of your sleeping time, including the number of hours you sleep. Also, prepare your brain to get ready for sleep by avoiding activities that will keep you awake, such as drinking coffee or eating heavy meals.

Many people have struggled with insomnia without knowing if they can get help. Insomnia is a treatable condition and if you are a victim, then worry not, as the Sleep Cycle Center is here to restore your sweet sleep and help you enjoy a peaceful night. You do not have to struggle every night; counting hours until morning finds you awake still. You can start by scheduling an online consultation or calling their office today.

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Health

The Importance of the Different Cancer Screening Tests

Most people are hesitant to schedule cancer screening due to fear of positive results. However, living in ignorance is not any better. Knowing your tests results is usually the first step in eradicating the disease. It is normal to get depressed or overwhelmed when the results are not in your favor. But on the flip side, early cancer detection helps prevent cancer from spreading. Treating the disease during its onset stages is easier, less costly, and enhances your chances of survival. You should talk with your doctor at Life Imaging Fla to understand what cancer screening involves.

Cancer screening tests

Mammography

A mammogram is a test that can screen for cancer in women with no breast complaints or can be used for diagnostic purposes. It involves the use of x-rays which produce internal images of your breast’s structure. The test can show abnormalities in the breasts, such as a lump but cannot establish the presence of cancer. Additional tests such as biopsies can be done to determine whether the tumors are cancerous. The testing process is not painful, but you may experience slight discomfort as the plates press against your breast. Although the process is generally safe, discuss it with your doctor, especially pregnant, as the x-rays could cause congenital disabilities.

Colonoscopy

A colonoscopy is a test used to check for abnormalities or changes in your large intestines and rectum. The test is minimally invasive, where the doctor uses a colonoscope to view the inside of the colon. If there is a presence of abnormal growths, a biopsy may be required for close examination. Individuals aged 50 and above and those at risk for colorectal cancer should get screened regularly. As part of the preparations before testing, your specialist may advise you to avoid eating solid foods and stick to liquids. You may also need to take a laxative that helps empty your bowel the night before or the morning of the procedure. Although complications hardly occur, there is a possibility of a perforation in the colon, bleeding, and reaction to the sedative used.

Pap smear

It is used to test for cervical cancer, but it can also detect abnormal cells that are not necessarily cancerous. Getting a Pap smear test is the first step to preventing or stopping the development of cervical cancer. One of the significant downsides of a Pap test is that abnormal cells could go undetected. This does not imply the test was wrongly conducted, but it could be due to a small number of abnormal cells and inadequate cells collection. However, since cancer cells take time to develop, the next test may detect any abnormal cells.

Low-dose helical CT

It is a lung screening test used to detect cancer in the lungs of healthy people who are at risk for the disease. Examples include older adults and chronic smokers. During the test, you will need to lie flat and remain still on a table as it passes through a machine. You are required to hold your breath during scanning for clarity in test results.

If you want to get screened for cancer, book a session with your doctor today at Life Imaging Fla.

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DentalHealth

5 Oral Sleep Appliances Benefits You Should Consider

Sleep apnea can be effectively managed through oral appliance therapy. If this is your case, you definitely need an expert to address your issue. Dr. Barry Chase offers this safe, non-invasive, and highly effective therapy to manage sleep apnea symptoms such as snoring at any severity of your condition. In most cases, oral appliances are used as an alternative to CPAP machines or surgery, especially for back or stomach sleepers. The devices mainly prevent airway obstruction while you sleep, with several incredible benefits. Here are several ways you can gain from using sleep apnea oral appliances. Have a look.

Get Quality Sleep

This is one of the most obvious and main benefits of using oral appliances for sleep apnea. The devices allow you to have less interrupted sleep with no snoring, some of the sleep apnea that affects the quality of your sleep. You will realize that you get a better night’s sleep when you wear the devices than when without. However, the devices need to be appropriately fit for effectiveness. Therefore, please consult your doctor adequately and follow their instructions carefully when fitting the appliances.

Use with Ease

Comparing oral appliances to CPAP machines makes using the devices more accessible. There are few pieces to track down or remember connecting since the devices are designed. This increases your likelihood to use the devices more consistently, improving their effectiveness. They are also more convenient for you if you are an active sleeper since they will not be easily knocked off when tossing and turning during sleep.

At Your Comfort

Many patients who have used oral appliances for sleep apnea have found the devices comfortable to wear. When you find the devices comfortable for you, they motivate you to improve their consistency. In return, the potential adverse short-term or long-term effects of sleep apnea are reduced, improving your life’s overall quality. Note that using the appliances consistently minimizes your irritability and daytime drowsiness while improving concentration.

Discreet

Having a friend overnight or living with a family member cannot be very comfortable when using the CPAP machines. But with an oral appliance, you can ease your sleep apnea symptoms more discreetly. The devices fit correctly in your mouth, while others are even made with translucent material to make you feel less embarrassed about using the devices. You get to treat your sleep apnea and remain confident and feel better about yourself.

Manage Underlying Issues

Some sleep apnea appliances may not only manage your active symptoms but also address the underlying problem causing your breathing issues. This means that when you achieve your desired results, you might not need to wear the appliances again. For example, the ALF appliance can straighten and bring your arches and teeth into proper alignment to clear the airway and manage TMJ disorders to some extent. Some people diagnosed with sleep apnea are diagnosed with TMJ disorder, bruxism, or clenching. The good news is that you can manage these issues at once with oral appliances.

You can benefit from oral appliances in many ways if you are diagnosed with sleep apnea and have symptoms like snoring. Most importantly, you get to get quality sleep and improve your overall well-being and quality of your life. Learn if the treatment is right for you by talking to Dr. Chase at Chase Dental Sleepcare. You can book an online appointment today.

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DentalHealth

Top 5 Reasons to Consider Invisalign

Invisalign has made it easier than before to straighten your teeth without the need for wires in your mouth. Whether your teeth are crooked, unevenly spaced, or overcrowded, no more worries as getting Invisalign in Midtown West Manhattan could be the best orthodontic treatment to end your problem. Many patients who have tried the treatment have reported positive feedback and are satisfied with the results, and you can be one of them. The modern orthodontic treatment ensures you attain a beautiful straight smile you can feel confident sharing with others. Here we look at five benefits of using Invisalign. Follow through.

No One Will Notice

You do not want everyone looking at you to notice the device in your mouth. This works for Invisalign since the aligners are clear and are made from a thin but durable material making them less noticeable on your mouth. The devices fit perfectly on different teeth textures, and combining this with their thin frame; they become more discreet compared to other orthodontic treatments. This means you can try the devices no matter your profession since it boosts your confidence and self-esteem knowing that no one notices them.

Get a Versatile Treatment

Consider discussing Invisalign with your doctor when dealing with several bite and alignment issues. You do not need several treatments since the treatment can address several issues all at once. Invisalign can work well for you when dealing with gapped, overcrowded, overlapping, or crooked teeth. It can also help you manage bite issues like overbite, crossbite, underbite, and open bites, all at once. This makes your overall treatment even cheaper than seeking treatment for every issue.

Convenient Treatment

Invisalign aligners offer a flexible treatment option, unlike some orthodontic treatments. The devices are removable, making them easy to clean and eat. In most cases, your diet and oral health care routines will not be affected when using the devices. Additionally, it is easier to maintain the devices with fewer complications. You will not have many visits to the dentist since you can fit the devices yourself without the doctor being present. But you have to ensure you consult your dentist adequately to ensure you do the right thing.  Even if you need to see your dentist, the visits will be fewer since only a few adjustments are needed.

An Effective Treatment

Invisalign aligners have been used for decades and proven as effective as metal braces, only with added advantages. The mechanism is similar to using metal braces despite employing a different orthodontic appliance to shift the teeth. Both treatments will apply gradual pressure to your teeth, shifting them over time, and have been found to produce similar results. But braces involve brackets and an archwire which may not be pleasant.

Affordable Treatment

There is a widespread belief that Invisalign aligners are expensive, but that is not entirely true. You will pay about the same price as you would have paid for traditional metal braces. Although the cost depends on several factors like your unique needs, there are several ways to offset the total cost, like insurance or monthly payment plans depending on your provider.

Invisalign aligners are effective, affordable, convenient, versatile, and discreet. Do not look further when looking forward to straightening your teeth in Midtown West Manhattan; reach out to Carnegie Dental Wellness today or book an online appointment for consultations.

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Health

Causes of Neck Pain

Neck pain is not just a slight pain that you always have. When it comes to neck pain, there are several reasons for it and several ways to get rid of them. No one wants to be in the middle of work and suddenly feel their head go numb because they’ve done something wrong with their neck. Neck pain means that you need to determine its cause and take action immediately. An experienced pain management physician specializing in treating neck pain in Northern Virginia can help you get relief from your condition. This article looks at some of the common causes of neck pain. Read on to learn more.

  • Poor Posture

If you have a habit of slouching, then it is time that you quit that. The constant slouching causes your neck muscles to strain. This means that these muscles will shorten and tighten up, making the surrounding area stiff. Over some time, this may cause pain in the back of your neck and also down into your shoulders.

Slouching also pinches the nerves in your neck. This pressure on these nerves can be excruciating and even lead to numbness or tingling down the arms.

  • Osteoarthritis

This is the number one reason for neck pain in people over 50. Arthritis is inflammation of joints, which can cause stiffness and swelling in the muscles around it. If you have arthritis, you will likely experience painful inflammation in the hips, shoulders, or even knees. This pain may also radiate into the neck area that can become very uncomfortable. If you are diagnosed with osteoarthritis, your doctor will recommend appropriate medications to ease the pain.

  • Degenerative Disc Disease

Another prevalent cause of neck pain is degenerative disc disease. This condition is similar to osteoarthritis, but it happens when discs get damaged due to their stress over time. Instead of inflammation, you will feel a great deal of stiffness or pain that radiates into your shoulder area with this condition. If there is irritation, you may experience tingling, numbness, or ulcers forming on the skin.

  • Spinal Stenosis

Spinal stenosis is an age-related condition that can affect your neck region. If you suffer from this disease, you may start feeling tingling or even weakness in your shoulders and arms. If left untreated, this may lead to loss of function in the extremities, like carpal tunnel syndrome.

  • Herniated Disc

If there is a herniated disc in the spine, then it can put pressure on the nerves in your neck and cause pain. This usually leads to a stabbing sensation near your shoulder or upper arm. The pain gets worse with any movement. If you are suffering from this condition, your doctor will recommend immediate treatment by way of surgery.

  • Cancer

Most people don’t associate neck pain with cancer. However, it is one of the significant causes of neck pain that can even lead to death if left untreated. The most common type of tumor that affects your neck region is lymph nodes. This may be caused due to throat cancer or prostate cancer. Whenever you experience this condition, seek immediate medical attention so that your doctor can determine the cause of it.

In summary, neck pain is extremely uncomfortable and can interfere with your daily activities. Some of the most common causes of neck pain include arthritis, spinal stenosis, herniated discs, and cancer. If you are suffering from this condition, you should seek immediate medical attention.

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Health

What Are Food Supplements That You Should Know

 

Food supplements such as SNAC nutritions for example, also known as dietary supplements, complement your general nutrition, a concentration of nutrients, or other substances that have a physiological or nutritional effect. Supplements are available in pill, capsule, powder, or other forms.

What Kind Of Supplements Are There?

There are many different types of dietary supplements on the market, and they can be divided into the following categories:

Vitamins and provitamins: 

folic acid, vitamin C, vitamin E, B vitamins

Macro elements and trace elements:  calcium, magnesium, iron, chromium

  • Carbohydrates: Compounds of fructose and glucose
  • Flavonoids
  • polyphenols, carotene, lycopene
  • Vegetable extracts: pomegranate extract, cranberry extract

Enzymes: enzymatic hydrolysis of proteins and sugars, such as lactase

  • Vitaminoids: substances with an action similar to vitamins such as flavonoids, coenzyme Q10
  • Amino acids and derivatives: L-arginine, L-carnitine, taurine
  • Mineral supplements: silica, dolomite
  • Other food supplements: probiotic cultures, yeast extract

Do I Need Food Supplements?

If you follow a balanced diet, you probably do not need dietary supplements. Still, there are times in life (such as growth, pregnancy, lactation, or old age) when many people need more vitamins, minerals, trace elements, and the like. These are some of the times when supplements should be taken. Some diseases, restrictive diets (such as vegan), food sensitivities (such as lactose intolerance), or heavy alcohol or tobacco use can lead to nutritional deficiencies. Supplements can have a positive effect on the symptoms of many diseases.

That is good to know

Before taking dietary supplements, you should take a blood test and discuss the results with your doctor. If you already get enough nutrients through your diet, you don’t need to take supplements. Do you have nutritional deficiencies? Depending on the degree of deficiency, your doctor may recommend that you include certain foods in your diet or may prescribe supplements.

How Much Should I Take?

Supplements contain substances with a transformative function in the body: they influence metabolism, cell division, and cell growth. Because of this, an overdose can be dangerous.

Multivitamin overdose can damage your organs. Too much vitamin A can cause skin and liver problems; too much vitamin C can negatively affect your digestion or cause kidney stones; too much vitamin K can decrease the effect of anticoagulants.

Where Can/Should I Buy The Supplements?

Today, in supermarkets, Para pharmacies, or pharmacies, you can buy food supplements everywhere. But here’s the danger: many of these substances are poor quality or contain the wrong dosage. We should be cautious with plant extracts because they can have a negative effect on essential processes in the body. You should only buy supplements recommended by professionals, such as at the pharmacy.

What Does The Science Say About Taking Supplements?

The results of several studies have shown that taking dietary supplements preventively does not provide any health benefits, nor does it guarantee that you will live longer. It’s the other way around: as discussed above, taking too many supplements or when you don’t need them can cause health problems.

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Health

The Place Of Herbal Medicine In Modern Medicine

It is necessary to define where Phytotherapy can help in maintaining health. As a complementary therapy, it cannot be seen as an adversary, substitute, or even alternative to traditional medicine, but rather as an ally that complements enhances, or helps its conventional therapies. There are many examples in medicine where traditional therapies can benefit either through prevention or the effectiveness of treatments, or improving the patient’s well-being. In this way, complementary therapies tend to be an option, and with them, the area of ​​Phytotherapy.

As already noted, modern herbal medicine combines traditional herbal medicine with the most advanced research in medicinal plants and is open to innovation.

The increase in the consumption of herbal products can also be associated with the dangers of the abusive and irrational use of synthetic pharmaceutical products that can have very serious side effects are increasingly being questioned, and they seek to replace them with medicinal plants. The evidence of therapeutic action also favors this dynamic.

Quality Assurance

Today, Phytotherapy is no longer based on its traditional use, contrary to what happened before. Studies increasingly support it as rigorous as conventional medicine with the same quality, efficacy, and security criteria. There is a set of requirements that a product must fulfill to be approved for sale on the market, with the primary objective of guaranteeing the well-being and safety of the consumer.

The prerequisites for ensuring quality in herbal medicine go through the standardization process, which begins during the cultivation of the fresh plant, continuing through validated production processes to result in a product that contains the constituents of the fresh plant in a stable composition. Nowadays, legislation regulates the production of different herbal health products.

What Is Natural? Is It Bad?

The use of plants for therapeutic purposes without proper guidance is a concern that must be considered by health professionals, as well as by all those involved in health education, given the incidence of species with a record of toxicity and contraindications in its use. Thus, the risk of intoxication caused by its misuse must always be considered. Care in the prescribed dosages and care in the precise identification of the material used can avoid accidents.

The false idea that everything that is “natural is good” or, as it is so often said, that “plants are not harmful to health” must be clarified by health professionals in the community. From the crossing of information obtained with bibliographic data, it can be concluded that a large part of the plants mentioned as being of therapeutic use in different populations presents some type of toxicity or contraindication for use in specific population groups.

The absence of information about some plants does not necessarily mean the absence of toxicity or contraindication, but it may be associated with the lack of studies in this regard.

Herbal preparations, despite being “natural,” are not harmless. Its possible negative effects are generally due to its active constituents’ pharmacological characteristics and dosages. Herbal medicines or preparations can be potentially toxic if misused and as a substitute for conventional medicines. In this way, both users and doctors or other health professionals must be able to make the best risk-benefit assessment before using or advising any drug or herbal product.

The use of health products such as PaylessKratom kratom capsules for instance derived from plants is complex because it results from an interaction between numerous components creating the global effect of a single extract. In this way, the rational and thoughtful choice and use is a huge advantage in maintaining health and preventing a series of health problems, leading to a lower incidence of minor pathologies that greatly impact global health and the economy.

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Health

Peripheral Arterial Disease: Here’s All You Need To Know

Arterial disease is a condition in which fatty deposits – known as plaque – build-up on the inner walls of arteries. This condition leaves narrowed, hardened arterial walls that can be difficult for blood to flow through. Peripheral arterial disease (PAD) refers to peripheral artery diseases affecting smaller vessels outside the heart or brain, such as those leading to the arms, legs, and pelvis. PAD is a serious concern because peripheral arteries carry oxygen-rich blood from the heart through the body’s network of arteries and veins to organs and tissues like muscle, skin, and bone. As such, you need to treat it seriously and visit a Davenport peripheral arterial disease specialist as soon as you develop any symptoms.

Causes

PAD is caused by the accumulation of plaque that narrows arteries over time. The causes are usually multifactorial, involving a complex interplay between heredity, lifestyle, and environmental factors such as smoking and high blood pressure. Some people develop PAD in their 30’s and 40’s without having any recognized risk factors for atherosclerosis, such as diabetes or high blood pressure.

Symptoms and Detection

While PAD can be symptom-free, patients may experience pain or cramping in the leg muscles during walking (claudication). Claudication is brought on by physical activity and is usually relieved by rest. But if left untreated, artery disease will progress, and symptoms may become more noticeable. If you are suffering from peripheral arterial disease, you may develop symptoms such as :

  • leg cramping or pain when walking
  • restlessness and tiredness in the calf muscles during exercise because of restricted blood flow
  • skin that itches feels numb or looks pale or blue due to a lack of circulation
  • ulcers that develop on the feet and legs if not treated properly

The best way to detect PAD is through a simple medical examination. Your doctor will perform a physical exam to look for PAD signs, check your pulse and blood pressure, and order more specialized tests such as an ankle-brachial index (ABI), which compares the blood pressure in your arms to that in your legs. A low ABI value indicates arterial disease.

Treatment

The treatment of PAD is dependent on how severe your symptoms are, your overall health, and your risk factors for atherosclerosis. For example, if you have diabetes or high cholesterol, it’s essential to keep these conditions under control to prevent further narrowing of the arteries. If you smoke, talk to your doctor about ways to quit.

In some cases, PAD can be treated with angioplasty and stenting in which narrowed or blocked arteries in the legs are widened by a balloon-tipped catheter inserted into an artery under local anesthesia. This procedure usually takes about two hours, and patients can go home after one to three days.

In summary, PAD is the narrowing of arteries, making it difficult to flow. If not treated properly, the symptoms can be leg pain while walking (claudication) and ulcers on the feet and legs. If you have PAD, you may treat the condition through angioplasty and stenting, a procedure used to widen narrowed or blocked arteries in the legs. Lifestyle changes can also help.

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