Tag: supplements

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Ankylosing Spondylitis

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Wellness as a Healthy Lifestyle
Wellness as a Healthy Lifestyle

Nowadays, health can mean very different things when we consider our status. Indeed, being healthy is not the same for a patient struggling with cancer…

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Safe Supplementation

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Neuromuscular reffered pain | El Paso
Neuromuscular Referred Pain, Is It Impacting You?

When it comes to Neuromusculoskeletal disorders, many techniques are available for one to learn. Some of these techniques include: 

Activator methods 
Applied Kinesiology
Atlas Specific 
Meric System 
Network Chiropractic 
Pro-Adjuster 
And Many More 

As a healthcare practitioner, upwards of 90% of your consultations involve a clinical investigation. The most often asked questions to patients include “How long have you had the pain?” and “What aggravates the pain?” However, it is imperative to determine the best course of treatment for patients. To properly do this, you do a functional history that includes all dimensions of wellness, not just physical and pain. These questions include: 

Past Medical History 
Occupational Status 
Social Status 
Medication History 
Surgical History 
Identifying non-neuro muscular disorders the patient may have like diabetes, fibromyalgia, rheumatoid arthritis, and cancer 

Understanding all areas of injury is vital due to neurological referred pain. Neurological referred pain occurs when signals get mixed in your neurological wiring. Sensory inputs from different areas of the body combine into single neurons (the nerve cells) in the spine. In the spine, they are integrated and modified before being sent to the brain. To properly assess and have successful treatment, one must identify the proper tissue that has been compromised. 

Along with this, there are perpetuating factors that can lead to downfalls as well. 

Mechanical Stresses

The stresses that directly impact pain and the skeletal system include short leg, hemipelvis, long second metatarsal, short upper arms, postural stresses, misfitting furniture, poor postures, abuse of muscles, and immobility. 

Short leg is seen frequently and puts a biomechanical strain on the supporting muscle. This creates a distortion of axial alignment. The main muscle impacted is the quadratus lumborum. This muscle being compromised is one of the most overlooked sources of low back pain. Once this is identified, the shoulder girdle should be evaluated next. If individuals are suffering from low back pain frequently, nutritional inadequacies should be considered. 

There are research studies done showing nutritional deficiencies to be associated with chronic neuromusculoskeletal system disorders. For optimal health, we focus on the body down to the orthomolecular components. These include: 

B1
B6
B12
Folic Acid
Vitamin C
Calcium 
Potassium 
Iron 
Magnesium 
InBody

Part of obtaining a full history is having patients undergo an InBody scan. This scan focuses on body composition and inflammation. It provides a full report of water, percent body fat, phase angle, visceral fat, basal metabolic rate, ECW/TBW and contains multiple segmental analysis sections. The InBody 770 high power technology to accurately assess patients.

[embedyt] https://www.youtube.com/watch?v=WwbIsPNUYqs[/embedyt]

 

THE HUMAN BODY IS VASTLY INTERTWINED AND HEALTH CARE PROVIDERS SHOULD BE LOOKING AT EVERY AREA IF YOU ARE EXPERIENCING PAIN OR DISCOMFORT. A DETAILED HISTORY CAN HELP DOCTORS GET TO THE ROOT SOURCE OF YOUR PAIN. -KENNA VAUGHN, ACSM-EP, SENIOR HEALTH COACH 

References: 

Dr Ron Grisanti,D.C “Insiders Guide.” Functional Medicine University (FMU). 

Williams FH. Neuromuscular complications of nutritional deficiencies. Phys Med Rehabil Clin N Am. 2008 Feb;19(1):125-48, vii. doi: 10.1016/j.pmr.2007.10.006. PMID: 18194754.  

Additional Online Links & Resources (Available 24/7)



 

Online Appointments or Consultations:  https://bit.ly/Book-Online-Appointment



 

Online Physical Injury / Accident Intake Form: https://bit.ly/Fill-Out-Your-Online-History



 

Online Functional Medicine Assessment: https://bit.ly/functionmed

 

 

Disclaimer

 

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.  Read More…

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*

email: coach@elpasofunctionalmedicine.com

phone: 915-850-0900

Licensed in Texas & New Mexico

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How Iodine Can Impact Overall Health | El Paso TX
How Iodine Can Impact Overall Health

Iodine is a substance that can be found in salt and food. Due to contrary belief, iodine deficiency is very much alive, and over 96% of people are deficient. Hypothyroidism is very common, and the highest concentration of iodine is in the thyroid. Simply put, you can not make thyroid hormone without iodine. However, by treating the thyroid with iodine, the cysts also improve. It is essential to acknowledge that thyroid cancer is one of the fastest growing cancers.

Iodine

Iodine has many functions, but one of the most prevalent is to maintain the typical architecture of glandular tissue. These tissues include the thyroid gland, ovaries, uterus, breasts, prostate, and pancreas. Cysts are the first thing to appear on these tissues when iodine deficiency is present. Iodine used to be very present in food; however the National Health and Nutrition Examination Survey that is done by the United States every ten years that measures the vitamin, mineral, and toxicity level has shown that iodine levels declined over 50%. Throughout this time, when iodine levels are low, we have seen an increase in thyroid illness, hypothyroidism, and Hashimotos.

Thyroid

The thyroid gland is located in the neck. It is part of the endocrine system and is a butterfly-shaped gland that is responsible for hormone release. These hormones are associated with metabolism and the way the human body uses energy. The hormone released is Thyroxine (T4) and consists of four atoms of iodine. The other hormone released is triiodothyronine (T3) which contains three atoms of iodine. These hormones become biologically active and influence the cells and tissues throughout the body.
Common problems associated with T3 and T4 include too much or too little production. Too much is referred to as hyperthyroidism. Hyperthyroidism symptoms include weight loss, heat intolerance, anxiety, and sore or gritty eyes. Too little is known as hypothyroidism. Those impacted by hypothyroidism suffer from tiredness, feeling cold, weight gain, poor concentration, and depression. Hypothyroidism is a more common disorder.

Phase Angle

Phase angle is an overall snapshot of cellular health. The higher the phase angle, the more robust an individual’s cellular membrane is, indicating they are able to fight off inflammation and infection better. Those with a poor phase angle tend to have overall poor health and are more susceptible to inflammation, metabolic syndrome, and infections.
Phase angle can be impacted by thyroid disorders if the hormones are not balanced. For example, hypothyroidism causes weight gain, depression, and tiredness. These three combined can lower phase angle. The more weight an individual carries, the more cortisol and fat cells they create. These cells breed inflammation, reducing phase angle. Depression and tiredness make it extremely hard for individuals to exercise and want to live a healthy lifestyle. The reduction of exercise and increase in unhealthy food causes more weight gain, inflammation and can lead to joint pain if left untreated.
We monitor phase angle and inflammation with the InBody 770. This machine uses bioelectric signals to create a report showing an individual’s body composition. The report shows crucial numbers such as intracellular water, extracellular water, percent body fat, lean muscle mass, and more.

[embedyt] https://www.youtube.com/watch?v=WwbIsPNUYqs[/embedyt]

THE HUMAN BODY IS AN EXTREMELY DELICATE SYSTEM THAT CAN BE THROWN OFF WITH THE SMALLEST CHANGE. IODINE DEFICIENCIES ARE PREVALENT, AS WELL AS THYROID PROBLEMS. DIETARY CHANGES, EXERCISE, AND POSSIBLE SUPPLEMENTATION (AFTER SPEAKING WITH YOUR HEALTHCARE PROVIDER) COULD HELP INDIVIDUALS WHO SUFFER FROM LOW PHASE ANGLE AND THYROID ISSUES. -KENNA VAUGHN, ACSM-CEP, SENIOR HEALTH COACH

References: 

Brownstein, David. “Iodine: The Most Misunderstood Nutrient.” Functional Medicine University. 18 May 2021. 

Triggiani V, Tafaro E, Giagulli VA, Sabbà C, Resta F, Licchelli B, Guastamacchia E. Role of iodine, selenium and other micronutrients in thyroid function and disorders. Endocr Metab Immune Disord Drug Targets. 2009 Sep;9(3):277-94. doi: 10.2174/187153009789044392. Epub 2009 Sep 1. PMID: 19594417

Additional Online Links & Resources (Available 24/7)



 

Online Appointments or Consultations:  https://bit.ly/Book-Online-Appointment



 

Online Physical Injury / Accident Intake Form: https://bit.ly/Fill-Out-Your-Online-History



 

Online Functional Medicine Assessment: https://bit.ly/functionmed

Disclaimer

 

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.  Read More…

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*

email: coach@elpasofunctionalmedicine.com

phone: 915-850-0900

Licensed in Texas & New Mexico

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adrenal fatigue| health caoch
The Impact Of Adrenal Fatigue on Phase Angle

What is Adrenal Stress/Fatigue? 

Adrenal fatigue has been applied to individuals who suffer from a group of symptoms. These symptoms include body aches, restless sleep, digestive problems, nervousness, lightheadedness, and overall fatigue. Individuals with these symptoms are recommended to do a diagnostic test to determine their level of adrenal hormones. A test we use is a Stress & Adrenal Hormone Panel from ZRT Laboratories. A sample report is shown below: 

 

Natural Ways to Combat Adrenal Stress

Over time, adrenal stress impacts the body by raising cortisol levels and causing fatigue. There are many areas to be considered when dealing with adrenal stress. The first step is to identify the sources of stress. Stress can be caused by exogenous and endogenous factors. An example of exogenous stress could be from grains if one has an intolerance. This causes an inflammatory response on the adrenal axis. Other examples include family, financial, or work. Endogenous stress is typically a side effect of a medication or oxidative stress. Once the main source of stress has been discovered, remove as much as possible. 

The second crucial factor for proper adrenal function is adequate sleep. Sleep hygiene is often overlooked when in reality, it should be a priority. Below is a page of suggestions on how to improve sleep quality. *include living matrix sleep hygiene sheet*. The human body utilizes the hours we sleep to physically repair. Without a restful full night’s sleep, the body is not able to regenerate itself. 

Thirdly, reduce the amount of coffee and tea as they interrupt the sleep pattern. Anything with caffeine should be limited and avoided before bed. 

Maintaining glycemic control is another important factor for adrenal health. By improving cortisol balance, the insulin level will not spike rapidly and drop drastically after meals. To maintain glycemic control, individuals need to eat complex carbohydrates like sweet potatoes. Excess carbohydrates have an adverse effect on blood sugar levels by excessively raising the levels of insulin. This puts a significant amount of stress on the adrenal glands. 

Exercise is a great component in relieving adrenal fatigue as it oxygenates the body. Regular exercise reduces depression, increases blood flow, normalizes levels of cortisol, insulin, growth hormone, and thyroid. Interval training and resistance training are highly recommended. 

Finally, eating a well-balanced diet, especially breakfast, will reduce blood sugar spikes. If the body is low on glucose and breakfast is skipped, the body will react by secreting cortisol. Cortisol activates gluconeogenesis to increase sugar levels. 

Phase Angle 

The phase angle is how health care professionals can monitor the integrity of cellular membranes. If the phase angle begins to decline, it has been linked directly to a decline in overall health. Similar to if phase angle increases, overall health is increasing. The integrity of cellular membranes is essential as cell survival depends on solid membranes. When the cellular wall is weak, it can collapse. From here, it is difficult for the body to take up the proper nutrients it needs. Additionally, with a weak cellular membrane, the cell is left with little to no protection from outside invaders. Stress impacts phase angle by causing individuals to release cortisol, be under adrenal stress, gain weight and decrease their overall health.

We monitor a patient’s phase angle with the use of the InBody 770. This advanced machine allows us to not only track the phase angle of our patients but many other areas of their health as well, including but not limited to intracellular and extracellular water. 

[embedyt] https://www.youtube.com/watch?v=WwbIsPNUYqs[/embedyt]

“IT IS IMPORTANT NOT ONLY FOR PHASE ANGLE BUT FOR THE OVERALL REDUCTION OF INFLAMMATION TO REDUCE STRESS. THOSE WHO ARE CONSTANTLY STRESSED AND UNDER ADRENAL FATIGUE ARE MORE SUSCEPTIBLE TO GETTING SICK, AMONGST OTHER DISEASES. IF YOU DO NOT KNOW WHERE TO START, IDENTIFYING STRESS AND STARTING TO EXERCISE IS A GREAT STEP IN THE RIGHT DIRECTION. -KENNA VAUGHN, ACSM-EP, SENIOR HEALTH COACH” 

References: 

 Yancey JR, Thomas SM. Chronic fatigue syndrome: diagnosis and treatment. Am Fam Physician. 2012 Oct 15;86(8):741-6. PMID: 23062157. 

https://inbodyusa.com/products/inbody770/ 

Additional Online Links & Resources (Available 24/7)



 

Online Appointments or Consultations:  https://bit.ly/Book-Online-Appointment



 

Online Physical Injury / Accident Intake Form: https://bit.ly/Fill-Out-Your-Online-History



 

Online Functional Medicine Assessment: https://bit.ly/functionmed

 

 

 

Disclaimer

 

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.  Read More…

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*

email: coach@elpasofunctionalmedicine.com

phone: 915-850-0900

Licensed in Texas & New Mexico

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NonInvasive Hormone Testing | El Paso Texas Chiropractor
A Functional Approach To Hormone Imbalance

When treating the body with a functional medicine approach, it is necessary to give the body at least three months. A 3-month protocol allows the body a chance to get in sync with itself again, re-build the foundation and get back to the basics without inflammation. To begin, a case history is needed. This detailed history allows the practitioner to determine what diagnostic lab work will be most beneficial for you. 

Hormone Balance 

Many patients have some degree of hormone imbalance, especially females. Females’ cycles and hormones are typically imbalanced due to contraceptives such as birth control pills, patches, or shots. For tracking hormone levels, we use a diagnostic lab test from DUTCH. The DUTCH plus test uses a 24-hour collection method consisting of urine and saliva samples. This allows us to track and follow hormones all day to give us the best picture of what is occurring. Below is a sample of a male and female DUTCH Plus test. 

Next Steps

The results of the DUTCH Plus test often come back with some degree of irregularity. This test, along with the detailed history form, allow us to create a custom protocol per patient. The treatment protocol involves natural supplements, dietary adjustments, and lifestyle changes. For hormone balance, one of the best supplements to use is chaste tree. This natural supplement helps with: 

 PMS symptoms
 Dopamine
 those who have heavy bleeding
 irregular, short, or long cycles
 pain during ovulation
 Acne
Is safe for lactation, so it can be used to help reduce baby blues 
Dietary Adjustments 

When it comes to balancing hormones, it is crucial to consume healthy fats. Omega 3s are the building blocks the body needs to reduce inflammation and combat symptoms of menopause. Additionally, foods that contain selenium are important. Selenium is an antioxidant that helps to remove free radicals that cause damage to the body. A list of foods to consume while balancing hormones include: 

Salmon 
Mackerel 
Sardines 
Tuna 
Chia Seeds
Brussel Sprouts 
Avocado 
Walnuts 
Hemp Seed
Flaxseeds
Eggs
Coconut Oil 
Lifestyle Changes

One of the biggest endocrine and hormone disturbances come from the daily products we wear and use. Perfume is a major trigger to the endocrine system and scented laundry detergent, aluminum deodorant, body wash, and air fresheners. By removing these disturbances you are getting rid of a slow poison and reducing your chances of thyroid disruption. Additionally, changing to an all-natural deodorant, body washes, and free clear laundry detergent will help your body heal. This article by Patel shows how harmful these scented products really are: 

 “…It has been observed that this fragrance-laden unhealthy lifestyle runs parallel with the unprecedented rates of diabetes, cancer, neural ailments, and teratogenicity…” 

To many people’s surprise, even cleaning products advertised as organic or antibacterial contain these toxic chemicals. As a general rule of thumb, stay away from scented products. 

Additionally, regular exercise and stress management will help the body maintain homeostasis, reduce inflammation, and produce good sleep hygiene for optimal healing. 

Phase Angle 

Phase angle is a snapshot of an individual’s cellular health. The lower the phase angle, the more permeable and fragile the cellular membrane is. This means that individuals are more susceptible to infection, inflammation and will not be able to attack a virus as well. Those who have high phase angles have strong cellular membranes that are hard to infiltrate. When a virus enters the body, those with a high phase angle can fight off the virus and inflammation easier. Phase angle is important because if the endocrine system is off-balance, your body is already at war with itself. Hormone imbalance combined with a low phase angle is a recipe for disaster. We can improve a phase angle by reducing visceral fat (the fat held around the internal organs)

[embedyt] https://www.youtube.com/watch?v=WwbIsPNUYqs[/embedyt]

In today’s society, everything smells “good”. These fragrant chemicals are being pumped into everything and constantly disrupting the endocrine system. Many people do not realize this but “clean” does not have a smell. Clean is not lemon fresh or fresh laundry. That is the chemicals. Clean is odorless. It has become so normal to cover up scents that trash bags are now infused with scents, when in reality, if the trash can smells, you just need to take it out. The first step is to get rid of all these added chemicals in the home. Ditch the plug-in air fresheners and get plants to naturally clean your air instead. -Kenna Vaughn, ACSM-EP Senior Health Coach

References: 

Patel S. Fragrance compounds: The wolves in sheep’s clothings. Med Hypotheses. 2017 May;102:106-111. doi: 10.1016/j.mehy.2017.03.025. Epub 2017 Mar 22. PMID: 28478814.  

Additional Online Links & Resources (Available 24/7)



 

Online Appointments or Consultations:  https://bit.ly/Book-Online-Appointment



 

Online Physical Injury / Accident Intake Form: https://bit.ly/Fill-Out-Your-Online-History



 

Online Functional Medicine Assessment: https://bit.ly/functionmed

 

 

 

Disclaimer

 

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.  Read More…

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*

email: coach@elpasofunctionalmedicine.com

phone: 915-850-0900

Licensed in Texas & New Mexico

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C. majus
Detox Therapy with Chelidonium majus L.

Once again, traditional Chinese medicine and herbal medicine are coming back to treat chronic conditions’ underlying cause potentially. Consequently, Chelidonium majus L., commonly known as…

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Mitochondrial Dysfunction: The Link Between Migraines & Fibromyalgia

Migraines and Fibromyalgia have one thing in common, they are both due to mitochondrial dysfunction. More often than not we see those with mitochondrial dysfunction suffering from more than one type of discomfort. The first thing we do is take a detailed history, to truly understand the patient’s history, environment, previous treatment plans, and symptoms. 

Mitochondrial function is a necessity for the body to perform properly. There have been studies that show that magnesium and malic acid is needed for mitochondrial function. In fact, giving magnesium malate 2 tabs, three times a day showed decreased pain in fibromyalgia patients. Magnesium also helps as a laxative and is often helpful in cleansing the gut and beginning to restore gut health. Another step we take to restore gut health is to perform a food sensitivity test to make sure they do not have any specific IgG reactions to foods consumed in their daily diet. We use the Food Sensitivity Test from Vibrant America. Genes

There is research supporting that individuals who have an MTHFR gene mutation are more susceptible to instability in the central neurovascular system. Those who have a MTHFR gene mutation can not convert folate to methylfolate. This is linked to migraines, mood problems, and increased susceptibility for fibromyalgia. For more information regarding MTHFR, please refer to GeneCards: MTHFR.

Nutrition / Supplements 

After analyzing lab work, and when implemented correctly, there are many foods and supplements that can help patients with symptoms associated with mitochondrial dysfunction. 

Some foods to eat include: 

almonds and other nuts and seeds
broccoli
beans
tofu
oatmeal
dark leafy greens
Avocado

The supplements we use are from Biotics Research and include:

Bio-Multi Plus
ProMulti Plus
Bio D Mulsion 
B12-2000
Optimal EFA caps
A.D.P

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muscle wasting treatment
Muscle Wasting: Treatments

Muscle wasting conditions have multiple etiologies. For example, sarcopenia is generally associated with aging, the decline of muscle function, and quantity. On the other hand,…

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diabetic neuropathy and methylcobalamin
Methylcobalamin Effects on Diabetic Neuropathy

Methylcobalamin is an active form of vitamin B12 and has been used as a therapeutic adjuvant to treat multiple chronic conditions. In fact, methylcobalamin modulates…

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R-alpha-lipoic-acid
R-alpha Lipoic Acid and Energetic Metabolism

The prevalence and effects that obesity can cause on the human body and health are a big concern in the health care system. It is…

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