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Ever feel like you can tell the weather forecast based on how your joints feel?? Remember when quirky Aunt Sally used to say, “My knees are hurting, must be a storm coming”?? In our adult lives, we now might relate to her wives’ tale. There may actually be truth to her statement. When barometric pressure changes in our body, weather forecasting becomes our new super power. Feeling increased pain before the weather changes is actually quite common in people with arthritis and chronic pain. Knees, ankles, elbows, and wrists are the popular trouble zones. When mother nature cries, so too can our joints.  

There are a couple theories that might explain this. Barometric pressure (air pressure) seems to be the common denominator. This is the weight of the atmosphere around us. Think of what happens to the body when you go up on an airplane.  You feel different sensations due to the change of air pressure. Our joints are like a balloon. High pressure makes the joint push against the body and the tissues aren’t able to expand. When this pressure drops, which is what happens before rain, hail, or snow, there is less air and pressure on the body. This causes the tissues to start to expand. We feel this pressure sensation as the tissues put pressure on the joints. The cold weather causes our muscles, ligaments, and tendons to stiffen up. Synovium is the lining of our joints which have nerves at their ends. The nerves become especially sensitive post-surgery, if you have arthritis or fibromyalgia, or if you have had an injury. Think back to the plane. Just like in the airplane, where the pressure in cabin is less, this can result in swollen feet.

Another theory is that the change in humidity and temperature might affect the pressure in our brain. From this, our pain receptors are affected and not doing their blocking job. This aligns with the theory that people with migraines experience weather related headaches.

This does not mean that people with this pressure meter of pain can be alleviated by living in an ideal climate. Even the most minute changes can affect someone. Your body adapts wherever it goes. Warmth can help joint pain, so when it is cold dressing in layers and using a heating pad can be helpful. Loosen up those joints through exercise, because the combination of stiff and cold joints, only worsens the problem. The winter month is not a time to stay cooped up. Those joints need blood flow to ward off pain.

Fortunately, weather related pain is temporary. It comes and goes. We aren’t mother nature, so the weather is not in our control. How we manage our pain is in our control. Taking an Epson salt bath can help or wearing compression socks are two easy options. Dressing in layers and keeping warm can also help and using a heating pad or electric blanket can assist with this. Most people find joint pain relief in warmer climates, so we want to replicate that warmth to the joints. Sitting in a sauna or hot tub can also be a good way to help relieve joint pain if in a cold environment. The key is not to allow your body to be shocked with temperature or pressure changes, which means packing or being prepared. Set yourself up for a better flight or better experience, and the quality of your adventure will be much improved.

We all know the hazards of smoking. The person actually smoking is at risk for many health problems. Secondhand smoke can lead to emphysema and lung cancer. But have you heard of 3^rd hand smoke (THS)?? This is the less visible type which consists of all the particles and chemicals that land on basically every surface in the smoking area. It can be on the person’s clothes, in their hair, on the floor, and on the furniture.

There are 11 types of chemicals that when left on surfaces, are considered carcinogens. They’re all bad because these are cancer causing. “Off-gasing” is the terms for when the chemicals have landed on the surface but then release back into the air as gas. It seems toxins are released everywhere from cigarettes. These toxins can then interact with other chemicals in the environment. Toxins then are either inhaled, ingested (they land on food), or absorbed through the skin. Overtime, the toxins continue to accumulate and become more and more harmful. Let’s say a person smokes in their car, obviously these chemicals just keep piling up.

Children are the biggest victims of THS. Children sit and play on the floor. They put their fingers in their mouths and touch surfaces.

It is important to be adamant about not smoking in your home or vehicle to avoid THS. Studies have shown in a house left unoccupied for 2 months, these chemicals were still present. Acidic cleaners, especially vinegar, can help with some of the cleaning.

So what is the best solution to avoid third hand smoke?? Well, quitting smoking. Nicotine is highly addictive, and studies have shown it is nearly as addictive as heroin.

Smokers enjoy the “kick” from inhaling nicotine. The head change from nicotine entering the bloodstream, releases adrenaline and creates a euphoric feeling with dopamine.

Smoking doesn’t just affect the smoker. The cigarette residue remains on clothing, drapes, furniture, just to name a few surfaces. Opening the windows or turning on a fan don’t eliminate the problem. You don’t want to serve a nice dinner on a thirdhand smoke residue kitchen table. The best solution is to maintain a smoke free lifestyle. Even stepping outside to smoke is not the right answer. It is polite to share, but not when it comes to smoking and its plethora of harmful side effects.

Most people at some point of their life have been prescribed antibiotics by their doctor. This medicine helps fight against bacterial infections. They function to either kill or keep bacteria from reproducing. For best results, one should continue the use of antibiotics until the cycle is complete, even if they are feeling better. This medication will not help and should not be used to treat the flu, common cold, sore throat, or for a cough because these are not bacterial infections. The actual word “antibiotic” means “against life”. It is a drug that kills germs. This medication was discovered in the 1920s and prior to that time, people actually died from illnesses like strep throat. By the 1940s, antibiotics became more widely available and used, making surgeries safer and helping people live longer. Now, antibiotics are used to treat skin infections, dental infections, ear and sinus infections, strep throat, bladder and kidney infections, and whooping cough.

Our bodies are full of bacteria, both good and bad. Therefore, sometimes the use of antibiotics can cause digestive problems. The gut contains both the good and bad bacteria and taking antibiotics can cause nausea, abdominal pain, diarrhea, vomiting, and loss of appetite. This could mean that you are allergic to a particular antibiotic. It is also important to note that antibiotics can disrupt the efficiency of those who take birth control. Another downfall of this medication is that they are often readily over-prescribed and overused. Bacteria can adapt and resist this medication over time. It is always important to not skip doses, only take them when your doctor has prescribed them, take them for the full number of days prescribed, and don’t save them for later or lend them to someone else.

There are 7 main types of antibiotics. These include penicillin’s, cephalosporins, macrolides, fluoroquinolones, sulfonamides, tetracyclines, and aminoglycosides. Most of the time they have a trade name and brand name. A doctor will determine which to prescribe based on cost, dosing schedule, side effects, type of infection, and might even perform laboratory tests to decide which is best. Upon picking up the prescription it is important to read the directions and correctly store the medication.

Although antibiotics can do wonders, they are readily overused. The rate of prescribing can be somewhat disturbing. For example, the highest rate of prescriptions is 1.237 per person in West Virginia. In doing so, bacteria are learning how to ward of antibiotics. The CDC has now tracked nearly 20 strains of bacteria that have become resistant. Sometimes we have to let our own body fight the good fight and when symptoms become unmanageable, then the use of antibiotics can step in. The body is resilient and does not need to rely on extra help all the time. We have to pick and choose our battles.

Attention deficit hyperactive disorder, also called ADHD, is a condition that commonly involves hyperactivity, impulsive behavior, and the inability to pay attention. This condition used to just be called ADD or attention deficit disorder. This condition always begins in childhood and can be carried into adulthood. About 4 to 5% of adults have ADHD and not everyone seeks treatment. Some people even go undiagnosed but start to take notice later in life. As an adult it can be difficult to manage a job, be timely, or even trying to set goals.

This behavioral condition is more common in boys than it is in girls. Typically during the school age years a child begins to have trouble paying attention or sitting still at school. The symptoms can be categorized into three forms: hyperactivity, inattentiveness, and impulsivity. A child with hyperactivity has trouble staying seated and tends to bounce or fidget. They’re restless and climbing on things. They also talk excessively. Inattention is characterized by being distracted, having a hard time following directions, trouble getting organized, daydreaming, and losing things. Impulsivity is marked by interrupting others, blurting out, and impatience. These characteristics spill over into adulthood and can cause problems at work, result in anger problems anxiety, mood swings, feeling bored a lot, relationship problems, and depression.

ADHD might be caused by a number of reasons, and the exact or direct cause is unknown. Most of the time, this condition runs in families, it can also be caused by chemical imbalances in the brain, toxins that could affect the brain, a brain injury, or any substance abuse during pregnancy. Contrary to assumption, sugar does not cause ADHD. It is also not caused by watching too much T.V. or going to a bad school.

Although there is no cure for ADHD, medication and therapy is available. Medications called stimulants can help. There are also non-stimulant medications which can be prescribed after age 6. Omega 3s have also been found to be effective. Therapy might involve behavior modification, transitioning into a special education classroom to learn structure and have a more conducive environment to addressing the issue, counseling that can help with emotional control, and there are support groups.

Many people with ADHD live happy lives and are successful despite diagnosis. Catching the signs and symptoms early can really help modify behaviors and learn coping skills. Sometimes the body adapts to medications and may need to be adjusted. Some people even grow out these behaviors. Every individual is different and certain management therapies are effective for some and not others. When daily life gets hard to manage, seeking help is always important.

Breast implants can be performed for a number of reasons including to enhance size and fullness, cosmetic reasons, or reconstructive reasons after cancer or a mastectomy. There are two types of implants: saline or silicone gel. Saline are silicone shells that are filed with a salt-water called saline. Silicone are silicone shells filled with a gel called silicone. There are pros and cons to both types. The most commonly discussed difference is that women popularly agree that silicone breast have a more real feel, however, they run the risk of leaking. The bottom line is that is a matter of preference when making this decision. Depending on the size, texture, insurance, or cosmetic nature, this surgery ranges between $5,000 and $10,000.

A person must be over the age of 18 to have their procedure performed. This is because a woman is still developing her breasts prior to this age and the FDA has enforced these requirements. A person must be at least 22 years old to have silicone implants. A person considering this surgery will meet with a surgeon and consult on what is the best approach or recommendation. Typically, the procedure will take one to two hours and can be impatient or outpatient. General anesthesia is normally administered. Depending on the procedure, a doctor will make incisions under the arm or breast and near the nipple, in order to insert the implant. Once the implant is in the place, the surgeon will close the incisions. Post- surgery, one is told to take it easy and to not lift anything heavy for at least 6 weeks. Drainage tubes may need to be worn for a couple days. Often times, pain medication is prescribed. Swelling will diminish and any scars will fade over time.

This surgery does have risks. Breast pain can become consistent. There may be visible scars. There can be changes in feelings to the nipple or breast area. Infection can occur. The implants may not be symmetrical. The implants can rupture and then leak. When a silicone implant ruptures, the body will absorb the fluid. When a silicone implant ruptures, the implant actually deflates.

Breast implants are not designed to last for the rest of a person’s life. They may have to be replaced over time. Silicone implants require a three-year checkup and an MRI at these visits to check for ruptures. Implants can also require special mammograms to be performed so that the x-ray can be done. They can also make breastfeeding more difficult. Receiving this surgery is a personal decision and the reasons vary. As with any surgery there are risks to consider, but plastic surgery can be life changing in many positive ways.

Migraines 

Debilitating headaches can really ruin a person’s day and lead to time spent in bed or yes, even throwing up. Persons suffering from migraines have a difficult time performing daily tasks, which means missed time at work, missed workouts, and missed time spent with loved ones. Some have found this head throbbing pain to be so unbearable they have opted to undergo scientific studies to get to the bottom of the cause. This terrible condition can feel isolating, hopeless, and there’s a looming fear when the next headache will hit.  

Migraine 101 

By definition, “A migraine can cause severe throbbing pain or a pulsing sensation, usually on just one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and can be so severe that the pain is disabling. Warning symptoms known as aura may occur before or with the headache. These can include flashes of light, blind spots, or tingling on one side of the face or in your arm or leg” (http://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/dxc-20202434) . Imagine being bed ridden for a couple days by such intense pain.  

4 Stages 

There are actually 4 stages of a migraine and different people either experience some or all of them. (http://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/dxc-20202434)  

1. Prodome: you feel changes to your body that serve as a warming system a migraine may be approaching. These might include stiff neck, mood changes, thirst, constipation, and/or food cravings 

2. Aura: your senses seem “off” including vision, touch, and hearing 

3. Attack: the actual pain, throbbing, nausea, that can last up to 72 hours during the migraine 

4. Post-drome: total exhaustion after the attack 

Causes 

Causes vary among individuals and can be the result of genetics. Here are the most common causes (http://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/dxc-20202434):  

• Hormonal changes in women. Fluctuations in estrogen can trigger headaches, especially in women. Headaches typically occur immediately before or during a woman’s menstrual cycle, when the body is experiencing a major drop in estrogen. 

• Foods. Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks. 
• Food additives. The sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods, may trigger migraines. 
• Drinks. Alcohol, especially wine, and highly caffeinated beverages may trigger migraines. 
• Stress. Stress at work or home can cause migraines. 
• Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — can trigger migraines in some people. 

• Changes in wake-sleep pattern. Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag. 
• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines. 
• Changes in the environment. A change of weather or barometric pressure can prompt a migraine. 
• Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines. 

Migraines are not on our team. But we learn to overcome and know that the show must go on, which means we need to take care of ourselves, seek treatment and help when needed, and try to avoid situations that can trigger migraines. The community of sufferers is quite large, so one must keep hope there’s a medical solution to this phenomenon very soon.  

One of the most common questions I am asked is, “How much cardio should I be doing??” We are told we need to exercise and cardiovascular activities are the first item we refer to doing. There are a multitude of benefits when doing cardiovascular activity, but sometimes you might be doing more harm than good if you are doing too much. Just because you run ten miles per day doesn’t mean the weight will melt right off (even though one would assume this). So let’s take a look at the cardio overload affect and see what happens to the body when this occurs. 

There are a number of indications your body will show as signs that you are doing too much cardio. Every BODY is different. Here is what we are supposed to be doing: “The U.S. Department of Health and Human Services and the American College of Sports Medicine recommends that adults ages 18 to 64 engage in a minimum of 150 minutes of moderate-intensity aerobic exercise spread over three to five days a week. Or do 75 minutes of vigorously intense aerobic exercise spread over three days a week. These minimum recommendations outlined in the 2008 Physical Activity Guidelines for Americans decrease your risk of chronic diseases such as diabetes, high blood pressure, heart disease and osteoporosis” (http://www.livestrong.com/article/145445-recommended-amount-of-cardio-exercise/). It’s easy to think that the longer I run on the treadmill, the more calories I’m burning, so the more weight I will lose. Wrong!!!!!

Cardio doesn’t have the same after math effects that strength training has for us. Meaning, “Unfortunately, the positive fat-burning effects of cardio exercise are short-lived. Once you stop exercising, your body’s metabolism quickly returns to its normal state. If cardio is your go-to exercise then you are forced to do more and more in order to see ongoing weight-loss results. This becomes problematic because increased cardio training can lead to decreased muscle mass. If your body loses even the slightest bit of muscle, your resting metabolic rate (i.e. how many calories you burn when you’re NOT exercising) dips even further. Your body will begin to shed fat even more slowly…unless you do even more cardio” (http://www.huffingtonpost.com/dave-smith2/4-indicators-that-youre-doing-too-much-cardio_b_9321966.html). And cardio is hard on our joints so having to pound the treadmill longer and longer to see results becomes strenuous on both the body and mind. Plus, one can burn through muscle so although we might be getting smaller and seeing the scale drop, we are not re shaping the body appropriately. It’s similar to the effect of not working out after a surgery or injury. The scale might actually go down, due in part to muscle atrophy.  

Training smarter, not harder is the appropriate expression here. The cardio myth goes like this, “There is this horrible misperception in our society about fat loss. A lot of people think that if you starve yourself and do two or three hours of cardio each day, the fat is just going to melt off. Actually, performing too much cardio will put your body in a catabolic state and burn hard-earned muscle. The loss of muscle will not only reduce strength, but it will also slow down your metabolism. If your metabolism slows down too much, you’ll have a tough time burning fat” (http://www.bodybuilding.com/fun/ask-the-ripped-dude-how-much-cardio-is-too-much.html). 

Personally, I can run for hours (literally). But I have learned, especially while training for my competitions, that at some point I’m actually not doing myself any favors. Mentally, I love the clarity of just running and going until I just have to stop. Physically, I don’t want to burn through muscle. There is no science that says how much is too much, but realistically anything over 60 minutes is probably more counterproductive than good. Females love their cardio, but ladies, we have to use strength training to re-shape our bodies and ward off osteoporosis.

When I meet a client and they ask me why they haven’t seen results when they do the Elliptical or jog every day, well, we know that the cardio myth has come into play. It might be breath of fresh air to hear that you don’t have to run for hours on end to see results. Rather, use cardio in combination with strength training to achieve optimal results. Every BODY is different, and we learn on our fitness journeys what methods work best for us. Don’t be fooled I won’t write you a pass for P.E. that says you don’t have to run the mile haha, but I will tell you that don’t have to run 5 miles every day to achieve your fitness goals. 

What lights a fire under you?? What grinds your gears, makes you angry, sad, worried, or STRESSED?? We each deal with the components of life differently, and our reactions to circumstances dictate our emotional well-being. Time, relationships, work, school, kids, family…. all these responsibilities can require a balancing act that seems impossible. But that’s life. And unfortunately, stress can have adverse effects on our health… especially weight.

Your body and mind are one and the same. When put under pressure, your brain kicks into a flight or fight mode. And guess what?? Your body wants to use calories in its defense. As such, “Most of us become overeaters when we’re feeling a lot of pressure. This happens thanks to your fight-or-flight response, a.k.a. survival mode — once your body reaches a certain stress level, it does what it feels it needs to. In most cases, that means overeat” (

https://www.webmd.com/diet/features/stress-weight-gain#1).
Initially, adrenaline spikes in the body, making one feel less hungry. However, soon after cortisol takes over. Cortisol is the stress hormone. When activated, inhibition can go out the window. Here’s run down: “Because increased levels of the hormone also help cause higher 

insulin levels, your blood sugar drops and you crave sugary, fatty foods” (

https://www.webmd.com/diet/features/stress-weight-gain#1) . Cheap, convenient, processed foods, are right there to answer the calling.
Here’s the catch: “Today’s human, who sits on the couch worrying about how to pay the bill or works long hours at the computer to make the deadline, does not work off much energy at all dealing with the stressor! Unfortunately, we are stuck with a neuroendocrine system that didn’t get the update, so your brain is still going to tell you to reach for that plate of cookies anyway” (

https://www.psychologytoday.com/us/blog/the-mindful-self-express/201308/why-we-gain-weight-when-we-re-stressed-and-how-not).
We have to learn to relax, sleep, and breathe. Many clients ask me what foods to turn to. Here’s what I found:·         

Dark chocolate: Two studies of 95 adults showed that consuming dark chocolate reduced their cortisol response to a stress challenge.·         

Many fruits: A study of 20 cycling athletes showed eating bananas or pears during a 75-km ride reduced levels compared to drinking water only.·         

Black and green tea: A study of 75 men found 6 weeks of drinking black tea decreased cortisol in response to a stressful task, compared to a different caffeinated drink.·         

Probiotics and prebiotics: Probiotics are friendly, symbiotic bacteria in foods such as yogurt, sauerkraut and kimchi. Prebiotics, such as soluble fiber, provide food for these bacteria. Both probiotics and prebiotics help reduce cortisol.·         

Water: Dehydration increases cortisol. Water is great for hydrating while avoiding empty calories. A study in nine male runners showed that maintaining hydration during athletic training reduced cortisol levels. (

https://www.healthline.com/nutrition/ways-to-lower-cortisol#section11).
Life’s demands throw us for a loop from time to time. Reassure yourself that patience is the key and that this too shall pass. Don’t let your negative thoughts take the wheel. Healthy choices outlast split second mistakes. Be kind to your BODY, even in it’s weak moments.

Temptation is the desire to participate in short term enjoyment. It is an urge that threatens long term goals. Curiosity or fear of loss can cause temptation. Temptation actually has 4 stages:  

1. Desire: This word originated from the Greek word epithumeeah, which can be translated to mean lust or craving. This desire doesn’t have to be for something bad, it can even be for good things. Soon this amount of desire goes into over-drive.  

2. Enticement: This is the feeling of being lured by something. This can be onset by a trigger that gets the motor or process going. The second part is having tempting thoughts. The over-desire and the trigger meet.  

3. Conception: The desire becomes action. A person tells themselves that what they are doing is no big deal and starts to justify and rationalize the action that is to come. Then the action, the birth, takes place.  

4. Death: This describes the process of decay and misery that result from sin.  

Everyone faces temptation because it is the result of our own natural desires. We have to recognize this human tendency. Most of us face temptation daily. Think about food. We are tempted to eat what we desire, although if we always gave into these urges the obesity epidemic would be even worse. We have to be able to stand up to the temptation. We have to identify our triggers, know our struggles, and work to resist.  

Often times it is temptation that causes a person to fall off the workout or eating clean wagon. Desserts and fried food are luring everywhere. Food is celebration and socially part of meetings, occasions, and lurk at every corner. Act with your intuition and know that these choices have consequences. Find a source of accountability and seek help when needed. Making important lifestyle changes doesn’t have to be an isolated experience. You can. You will. And it is going to happen for you.  

We all know that too much sugar is bad for us. Sugar consumption affects our waistlines, brains, and hearts. We are told that everything in moderation can be acceptable, but truth be told, we are having far more than the daily recommended amount of sugar in our diets. Of course with October and Halloween approaching, I thought covering this topic was relevant. We are surrounded by sweets during the oncoming months, so let’s take a look at what happens to our bodies when we ingest sugar.

Sugar is a hidden ingredient in many of our foods. Obviously a candy bar has sugar, but so do many salad dressings, drinks, yogurts, and hey those packets added to our coffee count too. To summarize, “While sugar is nothing to be too concerned about in small quantities, most of us are simply eating too much of it. The sweet stuff — which also goes by names like glucose, fructose, honey and corn syrup — is found in 74 percent of packaged foods in our supermarkets. And while the Word Health Organization recommends that only 5 percent of daily caloric intake come from sugar, the typical American diet is comprised of 13 percent calories from sugar ” (http://www.huffingtonpost.com/2015/04/06/sugar-brain-mental-health_n_6904778.html).

There are many ways that sugar impacts our bodies. Initially after biting into that candy bar, we do feel a little “rush”. Basically, our blood glucose has spiked only to result in a crash a few hours later. Our blood sugar then becomes unstable. Furthermore, “Sugar takes the place of important nutrients. According to USDA data, people who consume the most sugar have the lowest intakes of essential nutrients––especially vitamin A, vitamin C, folate, vitamin B-12, calcium, phosphorous, magnesium and iron. Ironically, those who consume the most sugar are children and teenagers, the individuals who need these nutrients most” (http://www.atkins.com/how-it-works/library/articles/10-ways-sugar-harms-your-health)..

Chances of obesity, heart disease, and diabetes are also increased by an ongoing high sugar intake. Excess insulin continues to build up in the bloodstream which affects the arteries. Sugar can become an addiction: “Much like street drugs, sugar triggers the release of chemicals that set off the brain’s pleasure center, in this case opioids and dopamine. And as they do with street drugs, people develop a tolerance for sugar, meaning they need more sugar for a feel-good ‘fix’” (http://www.prevention.com/food/healthy-eating-tips/weird-effects-sugars-having-your-body/7-sugar-turns-you-junkie). Just like the highs and lows of using a drug, “You grab a chocolate candy bar, and with it, get the brief jolt energy. Soon to be replaced by unrelenting fatigue. Science shows it takes just 30 minutes or less to go from a sugar rush to a full-on sugar crash” (http://www.prevention.com/food/healthy-eating-tips/weird-effects-sugars-having-your-body/9-sugar-makes-you-energy-starved-zombie). Sugar sparks cravings and gives a false sense of never feeling full. And we can’t forget that sugar causes gum disease and tooth decay.

We turn to sugar to make us feel happy, but really we are doing more harm than good. Often times, we tell ourselves that we have earned the right to have a treat, or it’s special occasion, that we will only have it just this once, and so on. We make promises to ourselves and go all day on a mission not to have junk food. Then the 3 o’clock cravings call and suddenly we cave in. This substance is definitely and “in the moment” destructor. And consumer America…. well they know how to play to our weaknesses. Commercials and advertisements are enticing and call upon our taste buds. We have to use our strengths and fight the cravings. Total deprivation isn’t the answer. However, one sweet tooth denial victory at a time, just like we take it one rep at a time, we can stay on course as best as possible.