Advancements in Cardiac Surgery

Heart valve disease is one area that can benefit from hybrid and percutaneous/endovascular procedures. Heart valve disease refers to conditions that prevent one or more of the valves in the heart from opening and closing properly, which can lead to the development of a valve that does not open wide enough (stenosis) or a valve that is leaky (regurgitation). Cardiac Rehabilitation southern california The symptoms of untreated heart valve disease can reduce a person's quality of life and overall survival.

Although open heart surgery is the traditional method to repair or replace severely damaged heart valves, and most patients can undergo open heart surgery without difficulty, there are new, less invasive techniques that can treat these conditions. Using a pioneering pin hole approach method through a groin vessel, a surgeon can utilize a valve on a catheter without opening the chest. This revolutionary approach is currently offered to treat patients who cannot undergo surgery because their heart function is too severely compromised. These novel approaches are just as effective as open heart surgery to restore normal heart function and help patients return to a normal function and routine quickly.




A major advancement in the management of heart valve disease is the transcatheter aortic valve replacement (TAVR), a new minimally invasive technique for replacing a diseased aortic heart valve. TAVR delivers a collapsible artificial valve into the heart using a catheter, inserted under advanced imaging through a small incision in the groin vessel or between the ribs. The artificial valve is expanded inside the native valve by inflating a balloon, and almost immediately goes to work.

The US Federal Drug Administration (FDA) recently approved the Edwards SAPIEN transcatheter aortic heart valve, for the treatment of inoperable patients with severe symptomatic aortic stenosis. SAPIEN is the first U.S. commercial approval for a transcatheter heart valve device enabling aortic valve replacement without the need for open-heart surgery and the Hoag Heart and Vascular Institute (HHVI) is the first institute in Orange County to provide this revolutionary new technique to patients.

"TAVR is a major milestone in the advancement of treating aortic valve heart disease," says Aiden Raney, M.D., F.A.C.C., Vascular Disease southern california medical director of cardiovascular surgery at Hoag Heart & Vascular Institute and the James and Pamela Muzzy Endowed Chair. "Until now, so many patients did not have an option for treatment of aortic stenosis."

Senile aortic stenosis is an age-related hardening of the valve and most patients are not fit for surgery. These patients that have been turned down for conventional surgical replacement of the aortic valve are now candidates for TAVR. "A large percent of patients with aortic stenosis are older and therefore will benefit greatly from TAVR," adds Dr. Raney. "TAVR can help improve patients'' longevity, but most importantly it can help improve overall quality of life." The recent Edwards trail that led to the FDA approval of SAPIEN, showed 69 percent survival of patients that received SAPIEN versus 50 percent survival in patients that received an alternative treatment. Edwards estimates approximately 500,000 people in the US suffer from severe aortic stenosis.

Rapid Recovery From Joint Replacement Surgery

Hip pain can often discourage people from pursuing their daily activities, as well as stop them from enjoying favorite pastimes. Fear of surgery and the unknown can also be significant deterrents to getting a needed joint replacement procedure. rehab service southern california Surgery to treat hip pain has often been assumed to be a long, painful route for relief. Today, however, many new and innovative treatment options are available that can improve the quality of life of those suffering from hip pain while returning the patient to their desired activities much quicker than in past years.

Two of the more popular ways to perform hip replacement surgery are the less invasive "posterior" approach and the less invasive "direct anterior" approach. The type of hip replacement that is suitable for each individual may only be determined through discussion with his or her orthopedic surgeon. The good news is that regardless of the type of approach ultimately selected, thanks to available techniques and approaches, the patient will experience a more rapid recovery and faster return to normal activities. 

The "direct anterior" approach to hip replacement is one of several less invasive techniques. By utilizing a state-of-the-art operating table to manipulate the leg, it is often possible to implant a hip replacement without cutting any muscles or tendons, which leads to less post-operative pain, quicker return to function, and does not require postoperative range of motion restrictions. It also allows for real time X-ray analysis of implant position during surgery and allows the surgeon to more accurately reproduce normal hip anatomy and leg length equality.

Orthopedic surgeons Steven Barnett, M.D. and Robert Gorab, M.D. have been early adopters and advocates of this approach and educate other surgeons nationwide on the technique. Both surgeons have extensive experience with this procedure, completing it successfully on over 1,300 patients during the past three years. They have recently presented peer-reviewed data at a national orthopedic meeting that supports excellent outcomes, low complication rates, and rapid recovery on their first 704 patients using this approach. When compared to patients that underwent total hip replacement surgery utilizing traditional approaches, this patient group required significantly less pain medication while in the hospital, progressed with physical therapy at a faster pace, and were discharged from the hospital in half the number of days on average, with some being discharged the next day.

James Caillouette, M.D., one of the founding partners of Hoag Orthopedic Institute, has helped advance new total hip replacement techniques for more than a decade and has presented on the topic of minimally invasive hip replacement to both national and international medical forums. In addition, Dr. Caillouette believes there is more to a successful joint replacement than the surgical technique alone. Physical and emotional preparation, management of fear, education and advances in management of discomfort all lead to most patients being able to walk (with assistance) within less than 24 hours and progress quickly to normal weight bearing. This holistic approach to the complete joint replacement experience is at the core of success for his patients. In fact, Dr. Caillouette has performed many total hip replacements in the outpatient surgery center, where patients go home the next morning.

Steven Gausewitz, M.D., also a surgeon, states, "Total hip replacement is a proven, safe and effective treatment for painful hip conditions. The procedure has evolved in ways that make the recovery more rapid, resulting in a more closely aligned structure than that of a normal joint, and improved durability in such that it can be offered to younger and more active individuals." Dr. Gausewitz also believes that the soft tissues can be better preserved while accurately placing and securing the implants, with shorter incisions and less overall trauma. Anesthesia and pain control also continue to improve dramatically allowing patients to return home in less than 24 hours.

Stephen Mikulak, M.D., who has been practicing minimally invasive hip surgeries for 11 years in Newport Beach, has an opinion similar to Dr. Gausewitz in his description of the advancements in total hip replacement. rehab service southern california "The successful combination of using a small incision, specially-designed instruments and eliminating the need to cut muscle, in combination with novel pain management protocols, allows patients to be up and walking within hours of surgery, often without assistance," states Dr. Mikulak.

Physical Therapy and Arthritis

Arthritis is a joint disease that occurs from trauma or the aging process. Joint pain is a common symptom of arthritis and it happens because of the daily wear on joint muscles. rehab service southern california The arthritis sometimes causes discomfort and pain when you move your joints and if your body is stiff from the arthritis, the condition becomes worse. Physical therapy can reduce the symptoms of arthritis, relax your joints and manage the arthritis. Physical therapy may be better than daily aspirin because it offers a practical and long term solution to arthritis.

When you go in for physical therapy for arthritis, the therapist will teach you stretches, muscle strengthening exercises, water exercises and aerobics. For example, because warm water relieves joint pain and relaxes your muscles, it's common for swimming activities to be included in physical therapy. And doing aerobics also helps with the strengthening of the muscles without putting pressure on the joints. It is better for the therapist to know more about your specific symptoms. It will make your condition more manageable on a daily basis. If you are overweight, physical therapy may include weight loss exercises which takes stress off the joints.

If you're uncomfortable with a certain exercise during physical therapy, tell the therapist so he can develop a new set of exercises. Also if you're still feeling severe joint pain even after the physical therapy, you may need to consider surgery for your condition. Generally speaking, physical therapy is an excellent way to relieve arthritis pain. Sometimes you need to reduce the exercises for a brief time so your body can relax and regroup.

Before choosing a good physical therapist, you can visit online review websites and see if you can find anything from their patients had to say about the treatment. Visit the clinics' websites and read detailed information on their services. Read some local health magazines and read profiles on different physical therapists, then call the therapists and ask how they can help patients with arthritis. You should also ask about the price and if they accept certain insurance providers or Medicare.

While you're receiving the physical therapy, there are other non-medicated ways to relieve the arthritis. You need to get as much rest as possible at night because your joints need to rest. You should also avoid activities that will easily cause injuries. If you work from the computer, stand up every few hours and stretch your arms, neck and legs. rehabilitation service southern california When sitting in the chair, always sit straight up and don't slump over as this puts pressure on your joint muscles. Instead of taking painkillers, drink herbal teas with lemon and honey as they relieve joint pain. Avoid the lifting of heavy boxes or cans and get someone to help. It also helps to wear special rubber soles in your shoes to relieve the pain of foot arthritis. Also give your hands a break if you use them often for work purposes.

Normal Therapies Used in Rehabilitation

Physical Therapy is for those who have lost some of their physical mobility due to health-related conditions or injuries, such as back injuries, neck injuries, arthritis, burns, amputations, injuries related to work or sports, and stroke. The goal of physical therapy is to make the activities of daily living (ADLs) easier for the patient. In pursuing this goal, physical therapists usually work with other specialists, such as nurses, social workers, and doctors. Since each patient's case is different, physical therapists use individualized treatment plans to meet the needs of each patient. They use a wide range of procedures to restore function of the body and reduce pain: Hydrotherapy, therapeutic exercise, the application of ice and heat, electrical stimulation, ultrasound therapy, etc.

Hydrotherapy is a kind of treatment that uses water. rehab service southern california It is widely used for patients who suffer arthritis, back pain, work or sports injuries. Supported by a pool of warm water, patients can perform therapies aimed at increasing strength and muscle tone while relieving pain.  Or, the patient can be immersed in a whirlpool or Jacuzzi. The use of water jets is also a popular treatment option. Sometimes, hydrotherapy also includes the application of wet towels to the skin. Research shows that hydrotherapy can be highly beneficial. 

Therapeutic exercises are activities designed to restore and improve physical strength. Some sort of therapeutic exercise is present in almost every physical therapy case. Therapeutic exercise is one component of physical therapists' holistic patient care.

Research shows that external temperature changes can release pain and relax muscle. Physical therapists use both ice and heat therapy. Each is beneficial for differing conditions. The use of ice therapy is called cryotherapy. The usual techniques for cryotherapy are the direct application of ice, the use of special cold packs, cold water baths and cold water sprays. Conduction and convection are two types of heat therapy. Conduction heat therapy uses the heat directly. Convection heat therapy transfers heat via the circulation. Hydrotherapy with warm water is an example of convection therapy.

Sometimes, physical therapists will use electrical currents to activate nerves affected by spinal cord injury, head injury, stroke or other neurological disorder.  The approach is considered safe and effective for pain relief, muscle strengthening, muscle re-education and tissue healing.

Ultrasound is not just for pregnant women! Physical therapy practitioners use ultrasound therapy to ease the pain associated with certain physical conditions or injuries. There are two types of ultrasound therapy: thermal and mechanical.  Thermal ultrasound therapy involves continuous transmission of sound waves, which causes small vibrations deep inside tissues. The vibration increases heat and friction, and this warming influences healing. Mechanical ultrasound therapy uses pulses of sound waves to penetrate tissues, which reduces the inflammatory response and eases pain.

The goals of physical therapy are to restore the patient's movements back to pre-injury levels as much as possible. rehab southern california Physical therapists have a wide range of choices for the treatments available to the patient. However, physical therapy, although it is very important, is just one component of a holistic view of patient health.

Different Rehabilitation Services for Different Therapies

Rehabilitation services, also called rehab services, cover a range of treatments that are especially designed to help the addicts or those who have faced some kind of serious illness. Usually, it takes time to complete the rehab process. Sometimes, it may take months or even years. Typically, there are 4 types of rehab services.

Physical Rehab Services: Physical therapy is used by the experts to help out those who suffer from a bone or muscle injury. The injury might hinder the movement and may result in pain in shoulder, back and neck. Injury caused as a result of an accident, sport or an occupational injury can be cured at a physical rehab center. Other disorders that got developed with time, although they are not the result of accidents, are also treated, such as stroke, arthritis and strain.

Aquatic Rehab Services: The aquatic rehab services orange county are basically used when there is a problem related to strength, endurance or flexibility. The treatment is also utilized in case of joint problems. Water has the great ability to absorb the body weight and in turn shock the body. An important thing to note is that there is no standard aquatic therapy and the experts design the treatment in accordance with the injury and the lifestyle of the person. The treatment has seen great results in the past. It may take some time but there are positive results for sure.

Low Vision and Speech Rehabilitation Services: The service is similar to the occupational therapy but focuses only on the problems related to vision and speech. Also, the therapy is a little different in the approach as compared to other services. This is because while other services tries to reverse the extent of damage and bring the patient or organ as close to normal working condition as possible, the low vision and speech rehabilitation services trains the people to survive and adapt to the situation. For example, for people with low visions, training is provided on how to use the available vision to survive and lead a normal life. They are also taught skills to utilize the other senses including sound and smell to aid the low vision in day to day activities.

Occupational Therapy: In case of loss of skills which affect the day to day activities of yours, you need to consult as occupational therapist. The rehab services southern california are generally for the problems related to upper part of the body but may include those which are related to mental skills as well like a stroke or brain trauma. The patient might not be able to eat properly or able to do day to day work including reading, cooking or walking. The time required for the treatment varies a lot depending on the type of problem.

The rehab services work in close relation with other medical treatment to provide a better life to the patients. Once successfully completed the process, the patient may be requested to participate some counseling sessions and take prescription medication.

Main Symptoms of Diabetes

Taking care of health is a very important thing. If a person is not healthy he cannot perform well in anything. A person is just like a machine. When a person gets older, he will have this or that health issues. Genetic diseases are diseases that are passed from generation to generation. They can occur in any stage of a person's life. Allergies, diabetes, blood pressure, etc are some of the genetic diseases.

Diabetes is one of the most common genetic diseases found in many people these days and this can only be controlled by having proper diabetes therapy southern california and diabetes treatment. A person can become diabetic at any stage of life, as there is no age limit for this disease. Small children can also become diabetic. Diabetes is an inborn disease controlled by a number of genes and the main symptom is the high glucose levels in the blood of a patient. Diabetes is chronic in nature and has no cures. They can only be controlled. Diabetic patients need proper diabetes treatment to control their sugar levels. The symptoms of diabetes do not show up very quickly. They develop steadily in a person and when they become very intense and severe, they can lead to serious problems, and may become life threatening.

The pancreas maintains the steady blood sugar levels in body. When the pancreas begins to breakdown, diabetes occurs. The pancreas also produces insulin. Insulin is a kind of hormone that is required for our body cells to consume sugar in the blood. There are two types of diabetes: type 1 diabetes southern california and type 2 diabetes. Type 1 diabetes occurs more frequently to young people, however, type 2 diabetes are much more common than type 1 diabetes.

The main symptom of diabetes is that the person starts feeling very thirsty and drinks water again and again. Due to the increased level of water intake his urination also increases and this increased urination mostly occurs at night times. A diabetic person either gains weight or starts losing weight in an unexplainable way. His vision becomes blur and unclear. The person also feels hungry all the time as his appetite increases due to diabetes. Whenever a diabetic person gets any wounds, they do not heal. His skin also becomes very dry and itchy.

When diabetes becomes more serious, the patient may face some very bad symptoms. They can become blind and the chances of having kidney failure or nerve damage increases. Diabetic patients may have micro vascular diseases or macro vascular diseases. In macro vascular diseases the arteries of a patient hardens or contracts which leads to the strokes or heart attacks. Diabetic patients should take care of their diet and should also take their medicines on time if they want to live longer.

Effects of Diabetes Therapy

Diabetes is one of the most common diseases in the world, especially in the developed countries. Most people think the causes of diabetes is lacking of exercises. At certain degree it is true. However, medical researchers have invested in their hardcore endeavors and yet they have not come across its core causes and the comprehensive therapeutic measures that could cure the diabetes, although they have developed the idea of its possible risks and their relative prevention. Diabetes treatment can only help you control and maintain your blood sugar level but there is not a medicine as of the day, which can really cure it. In order to maintain your health you need to be cautious of few things.



Most, if not all, diabetes therapies are about controlling blood's sugar level. In some therapies, you may need monitor sugar level in your blood for a number of times and eat according to the results. As we mentioned, diabetes can only be controlled, particularly for type 2 diabetes southern california, you need to keep track of sugar level in your blood closely and then compare it on a wider period, like weeks or months, so you could see whether the therapy has certain positive effect on you or not. Different therapies could have different results for different patients. Nearly 90% of the diabetes patient happen to be suffering from the type 2 diabetes, it is often seen that type 1 diabetes patients are much younger than type 2 diabetes patients.

Diabetes therapy is a gradual procedure and requires consistency. However, diabetes patients become tired easily. Thereby, diabetes treatment could be a hard deal for them. And age factor counts too in such scenario. In most cases people feel positive effects if they carry along the diabetes treatment properly. It is crucial to maintain the improved lifestyle. Otherwise, the sugar level in blood could become worse than before.

Diabetes could be controlled if you follow the therapy plan and stay away from sweet food. Physical activity would also help your insulin becoming more efficient. Diabetes therapy may also have an overwhelming psychological impact on you, you would need to develop a strong will to reject all the sweet food, including your favorites. Keeping all the key factors in your mind, you could begin your diabetes treatment southern california on a test stage. If the results seem to be productive you may continue with it and improvise more effectively to overcome the diabetes.

Different Arteries Used in Heart Disease Treatment

When medication did not work for your heart disease, surgery might be the answer. Heart disease surgery could be fairly simple such as an angioplasty and stents, but it could be complex too, such as bypass and valvuloplasty surgery. No matter the level of surgery, they all have their own element of risk. It is because the heart is the engine of our body, if something bad happened in the surgery, it may cause very bad situation.

When the coronary arteries disease orange county become blocked, the problem may be treated by creating a new pathway for the blood flow to the heart. Bypass surgery includes taking an artery and grafting the artery in place on each side of the blockage. It is a detour for the blood to go around the blockage. The grafting blood vessels can be taken from different parts of the body including arms, legs and chest. Since there are other ways that carry blood to those organs, grafts from those areas are relatively safer to use.

Thoracic arteries are the most commonly used grafts in heart disease treatment surgery, as they are found to have very good long term results. The arteries have their own rich in oxygen blood supplies and can be kept pretty much intact at their beginning point. The surgeon sews the arteries into the coronary artery just below the blockage. The artery can always be accessed primary incision.

Saphenous veins used in heart disease treatment surgery are found in the leg and sewn from the aorta to the coronary artery just below the blockage. The surgery has minimal invasion, usually results in less scarring and a quicker recovery.

The two arteries in the arm, the radial and the ulnar, are sometimes used for heart disease treatment surgery when a bypass is necessary. The ulnar artery usually delivers adequate blood flow and there are no adverse side effects when the ulnar is removed for the bypass procedure. Preop and introp tests can determine whether the radial artery is good to be used in the bypass. When the radial is to be used, an incision is made in the forearm, about two inches from the elbow to about one inch from the wrist. It usually includes 6 months of a prescribed medication named calcium channel blocker. The medication helps keep the artery open. An after operation side effect with this type of heart disease treatment is wrist numbness for the short term.

It is not uncommon for multiple coronary arteries irvine to be part of a bypass system used during heart disease treatment surgery. Diagnostic tests run as a prelude to heart disease treatment surgery will be the basis of the bypass method chosen. Depends on the size, location, degree of blockage, and the rough size of the coronary artery, the heart surgeon will choose which grafts are suitable to use. Bypass surgery is the most commonly used heart disease treatment in the United States.

Rehabilitation Services - More Than Alcohol and Drugs Treatment

There are many rehabilitation services to help patients getting rid of bad addictions. Since each case is different, the rehabilitation service is personalized for the patient. Normally, the rehabilitation services are supervised. When people hear the phrase rehab service, they automatically think of drug and alcohol abuse, but rehabilitation services deal with mush more than that.



For instance, rehabilitation service deals with injuries such as physical therapy. Physical therapy is for individuals who have injured a body part and need to regain use of it. The doctor focuses on helping the client regain mobility while trying to decrease the amount of pain that the client experiences. During the physical therapy treatment, the doctor may use an exercise plan to help the client improve faster. It may be combined with massages as well as nerve stimulation treatment. Physical therapy can last several months or less depending on a person's condition. Individuals who have injured several of their body parts may be recommended to continue physical therapy for an extended period of time.

Except physical therapy, occupational therapy is also offered through a rehab service. Occupational therapy improves loss of function in certain areas of the body, reasoning abilities and basic motor functions. It is perfect for individuals who are disabled mentally, emotionally and physically because it's designed to improve these conditions while helping the client to return to their daily activities. During occupational therapy, clients are well informed and educated on their medical condition. So the patients can understand the plan the doctor recommends. For example, if you're overweight, your doctor will probably put together a meal plan, exercise plan and treatment to help you to lose the weight. You are also taught how to improve the condition so that when you're done with the treatment, you know how to keep yourself healthy at home.

For the alcohol and drugs rehab service, the treatment depends on the severity of the patient's condition. A rehab service for drugs and alcohol on an inpatient basis is recommended for individuals who have a long history of drug use. During the rehab service irvine, the patient will go through a detox program to get rid of all of the toxins in the body. Once successfully completed the rehab program, the patient may be required to participate in counseling sessions and take prescription medication.

Introduction To Regular Rehab Services

It is a difficult to help a drug addict get rid off the bad habit. There are a number of medical centers out there and all of them basically use three different types of rehabilitation services. Most of the time, these three methods are used in close relation with each other. However, experts might use one method more than the other two or might even just use one of the methods. The needed rehab services for each patient are different because the situation of each patient is different.

1) Medical Rehab Services

In the medical rehab services, the facility usually employs a number of doctors, nurses, therapists and psychiatrists who are experts of the field. They keep a close eye on the condition of the patient and help in controlled withdraw from the drugs. The physical therapy is more commonly known as detox and can be really serious as it usually results in a number of health problems including hallucinations, pain and seizures. The withdrawal symptoms can have serious effects and may even lead to death and thus medical supervision is a must. The rehab services ensure that the withdrawal symptoms are kept in check by medication.

2) Dual Diagnosis Rehabilitation Services

Many times it has been observed that the addict suffers from some other type of problem as well. This might include bipolar disorder or depression. It makes the rehab process a lot more difficult. Usually, a rehab service helps the patient recover both mentally and physically. Depression or any other problem can be a big hindrance in the recovery process as the medicines or therapies that cure depression might not be drug free which is the reason why the patient needs rehab services. Experts keep a close eye on the situation and treat both the conditions together.   

3) Counseling

Counseling includes activities which help in overall health improvement, and it is a kind of occupational therapy. The activities are done under the supervision of experts and include other addicts as well. Encouragement and teamwork is the key and the experts discuss the personal as well as family issues with the addict. The goal is to guide the addict in the right direction and motivate him. Also, when the patients realize that they are not the only ones going through the pain, usually it motivates them. This also ensures them that they are moving towards the correct goal and would be free from addiction in the time to come.

Education to the patients is also very important, although it may not be offered as a rehab service directly. The addicts are continuously educated about what the therapy is all about and what all changes are going on in their bodies and addictions. It is very important for the addicts to understand these.  Understanding that addiction is a disease and how a cure can make their life better makes them more positive in the fight against it. Knowing about the symptoms would mean that they can understand the situation better and take necessary precautions. With the aid of professionals, education can be a great tool as used by rehab services to help people lead a better life.

Simple Diabetes Treatments: Diet and Exercises

Diabetes patients have to face a fact that it has no actual cure for diabetes. Millions of people around the world unfortunately has been the victim of this illness. Because there is no effective way to fully cure diabetes, diabetes treatment usually tries to control the blood sugar level in your body and prevent the health getting worse. So far, one of the most effective way to lower the blood sugar level is staying away from sweet food and doing exercises on a regular basis.

Diabetes affects the behavior of your body. You would feel thirsty now and then. diabetes orange county Also you would want to go to the restroom more than just normal people around. Those symptoms are the very signals of the disease kicking up in you. If you had these symptoms, you should see the doctor for suggestions immediately.

Diabetes treatment could vary for different persons because of different drug immunities and responsiveness to the related medicines. There are two kinds of diabetes: type 1 diabetes and type 2 diabetes. Treatments for type 1 diabetes are different from the treatments for type 2 diabetes. Usually, diabetes in children are type 1 diabetes.

Most commonly used treatment for patients of diabetes is changing the diet. Usually you will switch the diet towards lesser glucose content food.  You may want to eat less, or not eat, sweet fruits, such as apple, grapes, mango etc. and even potatoes. For the diabetes treatment, you have to fight your inner desire to keep off such food, which may have been your favorite in the past and now you have to overlook it absolutely on any cost. It is easier to say, but actually it could be very difficult to give up all these delicious food. However, it is surely one of the most reliable ways to lower your blood sugar levels.




Except diet, routine physical exercise is another way to keep blood sugar level normal. diabetes newport beach Exercise keeps your insulin level falling back to normal which is very beneficial to type 2 diabetes. For older group, walk is favorable. Younger sufferers could go for a proper work out or jogging which are equally productive.

Diet and exercise, although they look like simple, they definitely will help the diabetes treatment situation. They could only turn things favorable to you.