Category Archives: Sexual Health

April 2017 Newsletter: Four Hot Topics of Natural Health

Thanks for all the enthusiasm for last month’s Open House! It was awesome! Somehow we got all 30 people comfortable in the office. Also special thanks to my wife, Susana, for suggesting the idea and then preparing all the yummy and healthy food for the event!

We had great discussion and learning related to four topics:

First, we talked about the importance of the lymphatic system for proper drainage of waste and toxins from the body. While I was tongue-in-cheek with my yoga pants remarks, it is a valid point. Tight yoga pants (as well as other tight clothes) restrict the flow of lymph. Over time this can cause a wide variety of health issues from increased toxicity. We demonstrated some simple muscle testing techniques to see if additional lymph drainage support was required. If you want more information on this check out the March 2017 newsletter.

Second, we learned about auto-immune disease. We learned what causes it and what can be done from a natural perspective to prevent and reverse these diseases. Look for a feature article on this topic in next month’s newsletter. If this is relevant to you now and you would like to learn more now about a natural solution please call the office and schedule an appointment.

Third, we talked about the importance of the brain and the nervous system to overall health. Without proper balance in these systems it is difficult for complete healing to occur. We demonstrated some simple muscle testing techniques to see if the brain and nervous system are balanced. And, we saw which supplements can help bring the body back to balance.

Fourth, we learned about the nutritional deficiencies caused by hormone based birth control methods and how these specific deficiencies are strongly associated with depression, low energy, and thyroid issues which seem to affect significant numbers of women. Please see the article below for more detail on this topic.

I am pleased to announce the next Open House which will be Thursday, May 4 at 7:00 PM at my office. I’m planning to discuss two topics which emerged from feedback from the Open House. They will be Graceful Aging for Women and Men and The Anti-Inflammatory Diet.

Nutritional Deficiencies Caused by Hormone Based Birth Control
What you will read below is how the nutrients depleted by hormone based birth control pills play a major role in overall health and may be directly responsible for some of the issues experienced by the women using them including: depression, low energy, and thyroid issues.

Birth control is big business! It is marketed for a variety of purposes to women aged 10-60! They are claimed to make periods “regular”, “lighter”, or “less painful”; to relieve menstrual headaches; to control endometriosis; to clear acne; to help with Polycystic Ovarian Syndrome; to help with peri-menopausal changes; and “may lower” ovarian and endometrial cancer risk. Whether or not they live up to these claims is highly debatable.

These oral contraceptives are marketed as “hormones”, but they are not natural – they are synthetic estrogens and progesterone. As such, they do not act the same of natural hormones. In fact they are suppressing the normal cycle, not “regulating” it. They create a false period. One of the ways the female body clears toxins is through the monthly shedding of the uterine lining. This “false period” creates the condition where there is less cleansing of toxins.

For the rest of the article click here: http://brwellness.com/nutrition-news/?p=737

Improving Health One Client at a Time

I’m thankful for the opportunity to learn from the best and do my part to pass it along to my clients. It is a joy to see my clients improve their health.

“Thank you so much!! Your care is tremendous and I’m so fortunate to have the opportunity to work with you!! Thanks again!!”

Nutrient Deficiencies Caused by Hormone-based Birth Control

Note: This article is not intended as a debate about birth control. It is intended to offer education regarding nutritional deficiencies that are known to be caused by the use of hormone based birth control. Most medications have known associated nutrient depletions. There are multiple books available on this subject. While the books are helpful in listing the depletions, they do not discuss the ramifications of these deficiencies. The purpose of this article is to take that next step and help individuals make better informed decisions. If you use or intend to use this form of birth control, you may want to consider nutritional supplementation.

What you will read below is how the nutrients depleted by hormone based birth control pills play a major role in overall health and may be directly responsible for some of the issues experienced by the women using them including: depression, low energy, and thyroid issues.

Birth control is big business! It is marketed for a variety of purposes to women aged 10-60! They are claimed to make periods “regular”, “lighter”, or “less painful”; to relieve menstrual headaches; to control endometriosis; to clear acne; to help with Polycystic Ovarian Syndrome; to help with peri-menopausal changes; and “may lower” ovarian and endometrial cancer risk. Whether or not they live up to these claims is highly debatable.

These oral contraceptives are marketed as “hormones”, but they are not natural – they are synthetic estrogens and progesterone. As such, they do not act the same of natural hormones. In fact they are suppressing the normal cycle, not “regulating” it. They create a false period. One of the ways the female body clears toxins is through the monthly shedding of the uterine lining. This “false period” creates the condition where there is less cleansing of toxins.

There are numerous known side effects including headaches, vomiting, unclear speech, dizziness, weakness or numbness in arms or legs, chest pain, coughing blood, shortness of breath, rash, heavy bleeding, blood clots, stroke, leg pain, altered vision, stomach pain, loss of appetite, tired, weak, fever, swelling, and depression. In fact, many women quickly discontinue usage due to these side effects.

It is likely that many of these side effects are associated with the nutrient depletions. Following is a very brief description of the key impacts of some of these nutrients:

Vitamin B2 (Riboflavin) and Vitamin B6 (Pyridoxine): These have many functions, but a major one is the tryptophan pathway. Tryptophan is an essential amino acid and a precursor to melatonin and serotonin. Melatonin is a key anti-oxidant and important for sleep; serotonin is important for mood. Depression is associated with lack of serotonin.

Vitamin B2 is also an integral part of enzymes involved in oxidation reduction reactions that drive cell respiration. What does that mean? It is critical in our cell making energy for our body. It also supports the function of antioxidant enzymes and interacts with the other B vitamins. It promotes a healthy immune system and regulates the activity of 50 of our enzymes.

Vitamin B6 plays an important role in our metabolic reactions, specifically amino acid metabolism (making proteins for your body to use in building itself) and glycogen utilization (blood sugar control). B6 also acts as a co-enzyme for 100 other enzymes that play key roles in many biological processes. It is also involved in supporting the production of hormones and neurotransmitters – the chemicals that are directing all your body’s activities.

Vitamin B9 (Folate): Folate is key to the process of methylation which covers just about everything our body does – from clearing of toxins to energy production to neurotransmitter regulation to DNA replication. Folate is critical to the metabolism of nucleic acids and amino acids. Because of this, it supports overall growth and development and blood cell formation and supports normal growth of the fetus.

Vitamin B12: Shortages of B12 can cause anemia. B12 is a cofactor for two, yet very important enzymes. One is used for methionine metabolism. Methionine is an essential amino acid. The other enzyme aids in producing energy from proteins and fats. Overall B12 supports the nervous system, promotes the maturation of red blood cells (hence the tie to anemia when deficient in B12) and other cells, and supports bone and joint health.

Vitamin C: Many functions, chief among them immune system support. Vitamin C is also involved in forming collagen which is in our connective tissue. It also facilitates iron absorption and assists in cholesterol metabolism. So it is helping the blood, cardiovascular, endocrine, immune, musculoskeletal, and nervous systems.

Zinc: Many functions, main co-factor in many biological processes plus immune system support. Zinc supports the formation of many enzymes and insulin. The same insulin we need for blood sugar control. It also assists with wound healing, reproductive organ growth and development, and metabolism of phosphorus, carbohydrates, and proteins. Putting it simply – zinc helps many body processes work.

Magnesium: Many functions and most people are deficient even without being on hormonal birth control. Magnesium aids in enzyme activation; helps metabolize blood sugar; supports healthy nerve and muscle function; assists in forming bones and teeth; and plays a role in nucleic acid, protein, carbohydrate, and fat synthesis.

Tyrosine: A building block of thyroid hormone. Shortage of tyrosine can then lead to low thyroid symptoms.

Selenium: Many functions, among them converting thyroid hormones from storage form (T4) to available form (T3) and for breast health. Selenium supports a healthy immune system response, prostaglandin production (hormone precursors), and healthy reproductive, pancreatic, and thyroid functions.

CoQ10: A key nutrient for energy production in the mitochondria.

It is evident that the nutrients depleted by hormone based birth control pills play a major role in overall health. When we look at three main health concerns of women today (depression, low energy, and thyroid issues) there is a very strong association between these symptoms and the nutrient being depleted by birth control pills.

Bernard Rosen, PhD is a Nutrition Consultant and Educator. He works with individuals, groups, and at corporations to create individualized nutrition and wellness programs. His office is in Mequon, WI. To learn more or to schedule an appointment, e-mail at bernie@brwellness.com, call (262) 389-9907 or go to www.brwellness.com.

July 2014 Newsletter – “I Want to Say Thank You”

These are my favorite words to hear. Here’s the rest of the text I received last week:

“I want to say thank you! I woke up this morning feeling like I’m “back in my body”. I woke up energized and full of joy! I’m much more at ease. I can tell I’m shedding toxins and old Gunk that doesn’t belong in my body.

I just finished the first bottles of the parasite tinctures and the consistency of taking them 3x a day is paying off!! I’m healing. Still more to go. Thanks to your help I’m headed in the right direction.”

Later this month is my annual trip to Rhindelander for the University of Wisconsin School of the Arts. I will be doing workshops on Saturday July 19 and Sunday July 20. Click here for more information: http://continuingstudies.wisc.edu/conferences/school-of-the-arts-rhinelander/index.html?source=soawisconsin.org

What Can You Learn From Your Urine? A Lot!

Introducing two new easy at home tests to measure internal function related to cell membrane health and detoxification capabilities. If you want these tests can also be done at my office.

The Meta-Oxy Test is a quick and easy test that measures malondialdehyde in the urine. To read more about malondialdehydes and this test click here: http://brwellness.blogspot.com/2014/06/what-can-your-urine-tell-you.html

The Sulfite and Sulfate Test is a quick and easy test that measures sulfites and sulfates in the urine. Both excess sulfites and sulfates are toxins, particularly to the nervous system. To learn more about this test click here: http://brwellness.blogspot.com/2014/06/what-can-your-urine-tell-you.html


Nutrition and Erectile Dysfunction: Progress on My Book

I continue to make progress on my book that is about male health with particular emphasis on the connection between nutrition and erectile dysfunction. I have been working with the title “The Dick Diet.” Some people love it and others don’t. I’m trying to figure out exactly what to do about that. I want the title to be catchy and memorable and yet at the same time not offensive. And, it needs to appeal to the target audience. I have a few ideas on ways to get more input. But the important part remains writing the actual book and getting that complete.

At the same time it is important to remember how a man’s sexual performance is affected by his diet. For a reminder on that here’s my most recent article on nutrition and erectile dysfunction: http://brwellness.blogspot.com/2014/06/the-strong-link-between-nutrition-and.html

And if you have any input on what to call the book you are more than welcome to offer some suggestions!

The Strong Link Between Nutrition and Erectile Dysfunction (ED)

Have you ever wondered why there seem to be so many advertisements for erectile dysfunction (ED) medication – Viagra, Cialis, and Levitra – on television and in the magazines you are reading? I did, and began an investigation that would ultimately become my Doctoral dissertation. The reason is quite simple – there is a lot of erectile dysfunction (ED). Over 30 million men in the United States suffer from it. ED affects over 50% of men between the ages of 40 and 70 and the incidence of complete ED triples between those ages. Even more disconcerting, experts expect cases of ED to more than double over the next 25 years.

Erectile dysfunction imposes significant social costs. It impacts a man’s satisfaction with his life and his relationship with others. Studies show that sexual intimacy is desired by older adults. A study in 29 countries consisting of 27,000 men and women aged 40 to 80 found less than 20% of the respondents agreed with the statement “older people no longer want sex”. Due to the rising incidence of erectile dysfunction many couples will not be able to enjoy healthy sexual relations in their later years.

Why is erectile dysfunction on the rise? Many researchers, including me, believe it is a direct result of poor dietary habits and lifestyle choices. For many years it was thought that ED was mostly psychological, but recent studies have shown that over 80% of ED is due to physical causes. For the erectile process to function correctly several systems of the body need to be healthy – blood needs to be flowing smoothly and unobstructed throughout the body, nerves need to be firing and sending messages between the brain and the relevant body parts, and libido needs to be present to encourage sexual interest. All of these systems require proper nutrition to correctly function.

To better understand the causes of ED we can look at the scientifically documented risk factors. Risk factors related to lifestyle choices include alcohol consumption, diet, hormone levels, inflammation, obesity, sedentary (lack of exercise) lifestyle, cholesterol levels, use of prescription drugs, tobacco smoking, stress, and (yes) motorcycling. There is also a strong association between ED and the medical diagnoses of depression, atherosclerosis, cardiovascular disease, high blood pressure, metabolic syndrome, diabetes, and lower urinary tract symptoms (LUTS). Studies show that most men with ED suffer from these conditions which are often a direct result of the same lifestyle choice risk factors previously listed. In fact, the connection has been made that ED is often a warning sign for cardiovascular disease.

So, how is this all related to diet and nutrition? For the body to operate optimally it needs the right nutrients. Many studies have shown the connection between a poor diet and all the risk factors and conditions listed above. Diets that are high in sugars, refined grains, processed meat and dairy; while low in fruits, vegetables, protein and healthy fats produce these conditions. Once men are placed on healthier diets, their symptoms of ED are reduced and often completely eliminated. Through proper nutrition, regular exercise, and sometimes with the help of specific supplements proper erectile functioning can be restored.

Many people will ask, “What’s wrong with using medications”? My answer is while the medications will work in most cases, there are side effects, some of which can be quite dangerous. But even more important, the medication is not repairing the underlying condition. Erectile dysfunction is your body telling you that something is not quite right and needs your attention. It is your warning sign to take action before a more serious or life threatening event occurs.

Bernard Rosen, PhD is a Nutrition Consultant and Educator. He works with individuals, groups, and at corporations to create individualized nutrition and wellness programs. He is an expert in the field of Nutrition and Erectile Dysfunction. His office is in Mequon, WI. To learn more or to schedule an appointment, e-mail at bernie@brwellness.com, call (262) 389-9907 or go to www.brwellness.com.

Announcing Viggor.com – a new health information website

Never underestimate the power of networking! Several months ago I was introduced to David Guinther by a mutual friend in Madison. David is an awesome guy. In a nutshell he is a prostate cancer survivor who now devotes significant energy to helping other men live healthier. He offers education and information to both help prevent prostate cancer and to support those who are currently battling it. While we don’t hear much about it, prostate cancer will impact 1 in 6 men at some point in their life.

David has several health ventures going. One of them is Viggor – which David calls, “… a guiding light on your journey to improve your health and quality of life. Our Expert panel is driven by a common desire to freely share their training, experience, research, insights, and knowhow with you…” We are just up and running, but check it out; there is something there for everybody! http://viggor.com/

In addition to David and myself there are two more contributing experts. Meet Dr. Geo Espinosa, a naturopathic doctor recognized as an authority in integrative management of urological and prostate conditions. Dr. Geo is the founder and director of the Integrative Urology Center at NYU Langone Medical Center in New York City.

Together, David and Dr. Geo created XYWellness a company focused on integrative approaches to improving the health of men diagnosed with serious urological conditions. David and Dr. Geo have been inspirational and supportive in getting me back on track in writing my book on men’s health. You’ll be hearing more on that in coming months.

The fourth contributor/expert at Viggor is David’s wife Amy Guinther. She is an acupuncturist and owns Madison Acupuncture and Complimentary Medicine.

Check us out http://viggor.com/

Steroid Hormones Part 3: Introduction to Testosterone, Estrogen, and Progesterone

Steroid Hormones Part 3: Introduction to Testosterone, Estrogen, and Progesterone

Testosterone

Testosterone is the main male and androgen hormone. It is produced in the testes (males) and in the ovaries and adrenal glands (females). It is also produced by the conversion of androstenedione and at times DHEA. It is a steroid, anabolic, body building hormone.

In both sexes testosterone on a physical level is known to: enhance libido and improve sexual response; protect against heart disease and stroke; increase and enhance energy and stamina; build strong bones; build strong muscles and maintain muscle tone; assist in balance and coordination; normalize weight; improve insulin sensitivity; and help maintain a healthy cholesterol balance. On a mental level it protects against depression, age-related mental decline, and helps to improve memory.

In men testosterone is also needed to achieve and sustain erections and may protect against prostate problems and cancer.

In women testosterone helps to reduce breast tenderness; reverses estrogen-induced breast proliferation; and decreases hot flashes and night sweats.

Estrogen

Did you know that there is more than one “estrogen?” While we use the generic term “estrogen” in fact there are several types of estrogen. It is made by the ovaries in women, and to a lesser degree, the testes in men. Estrogen is also made in fat cells (which is the primary site of production for both menopausal women and men.) Estrogens are steroids.

The three major estrogens are estrone (E1), estradiol (E2), and estriol (E3). Estrone is typically 5-10% of total estrogen. It is considered a “strong” estrogen because of its ability to cause cell proliferation. Estradiol is also typically 5-10% of total estrogen. It is considered the “strongest” estrogen because of its ability to cause cell proliferation.

Estriol is typically 80-90% of total estrogen. It is considered the “weak” estrogen because it does not cause cell proliferation. It appears to balance the cell proliferating effects of estrone and estradiol, thus protecting against their cancer-causing ability.

Following are some of the main functions of estrogen. This is by no means a complete list and there are many still unknown functions of estrogen as well.

Estrogen is known for promoting the female secondary sex characteristics. (Thus, you can now understand how overweight men will develop breasts. Their fat cells are producing excess estrogen!) Estrogen plays a key role in reproduction. It promotes cell proliferation, especially of the uterine lining and breast tissue and is part of the hormone signaling sequence that induces ovulation. It also maintains vaginal lubrication.

It also plays a key role in how we feel as it interacts with the nervous system. It stimulates brain function thereby impacting cognition, memory, emotions, mood, stamina, ambition, pain perception, and sleep.

Estrogen’s emergence at puberty stops the growth of long bones in both females and males and slows bone loss. It can increase body fat, especially in the breasts, hips, abdomen and thighs.

Estrogen helps keep our skin healthy and smooth. It increases production of type III collagen which helps skin heal faster and remain soft and pliable. It promotes the hydration of body tissues.

From a heart health perspective estrogen increases HDLs, lowers LDLs and total cholesterol. It also helps maintain the endothelial lining of the blood vessels.

Progesterone

Progesterone is a steroid hormone produced in the ovaries and adrenal glands during the follicular phase of the cycle and in the corpus luteum during the luteal phase of the cycle in women and in the adrenal glands in men. One of its primary roles is to work with and balance estrogen. It is also produced by the brain and peripheral nerves, and possibly other locations.

Many of progesterone’s functions are highlighted below. However, similar to estrogen, there are still many unknown functions.

Progesterone functions as a precursor for other steroid hormones, most importantly cortisol. It is important to understand that stress and blood sugar handling take priority in the body. Therefore, it is common to see progesterone deficiencies created as it is converted to cortisol to handle the stress response.

It is also critical to understand that progesterone is still needed in healthy amounts in menopausal women. Although ovarian progesterone is no longer produced, the adrenals of menopausal women must continue to make sufficient progesterone to balance the effects of menopausal estrogen levels. This is where the medical world got in trouble with estrogen only hormone replacement therapy by supplying unopposed estrogen and not its balancing partner progesterone.

Progesterone plays an important role in reproduction. While estrogen causes cells in the endometrium to multiply, progesterone balances this effect by stopping cell division and signaling the process of cell maturation, differentiation, and apoptosis (cell death). Thus, it prevents excessive production of the uterine lining. The production of progesterone in the second half of the cycle after ovulation helps signal other developing follicles to stop developing (and thus stop producing estrogen). By maintaining the secretory endometrium it “ripens” the uterine lining for possible pregnancy. If there is pregnancy progesterone maintains and protects the developing fetus; prepares the breasts; and promotes the development of the brain and nervous system.

Progesterone interacts with the nervous system and regulates how we feel. It helps calm the mind, focus the brain, increases libido, and is a natural antidepressant (when in balance with estrogen).

It not only interacts with estrogen, but other hormones as well. It facilitates thyroid hormone function and helps normalize androgen levels (keeps testosterone from getting too high). It has been found to be preventative against breast, uterine, prostate, and other forms of estrogen related cancers.

Some of the other functions of progesterone include: stimulates new bone growth; helps burn fat for energy; a diuretic; and a muscle relaxant.


ONE FINAL IMPORTANT POINT:
It is critical to understand that progesterone only functions correctly when it is in the right proportion with estrogen. These two hormones are designed to work together. In a cycling woman these proportions change throughout the cycle. In menopausal women the proportion of progesterone to estrogen will remain relatively constant. When these are out of balance a condition known as “estrogen dominance” is present. More on that later.

Bernard Rosen, PhD is a Nutrition Consultant and Educator. He works with individuals, groups, and at corporations to create individualized nutrition and wellness programs. His office is in Mequon, WI. To learn more or to schedule an appointment, e-mail at bernie@brwellness.com, call (262) 389-9907 or go to www.brwellness.com.

Meet Your Hormones: The Endocrine System – Part 1

Many experts would argue that among your body’s functional systems the most important is the endocrine system. It is composed of glands (the endocrine glands) that produce hormones that control everything that is happening in our body. So, it’s time to meet your hormones. Or, as one of my favorite clients called them: her “horror-mones!”

Hormones are very powerful biological chemicals that are produced in very small amounts by our endocrine glands. They are released into the blood stream and carried to specific cells where they initiate specific activities. They regulate, control, and coordinate all body functions. Many hormones are made at additional tissue sites as well as their “parent” gland. You can think of this as your body’s own inherent back-up system. They are powerful in very tiny amounts so their levels are precisely and carefully monitored and controlled by the body.

Hormones from the different endocrine glands interact with each other in complex ways to coordinate the body’s systems. One of the best illustrations of this I have seen is from endocrinologist Dr. Henry Harrower. You can see this below or follow this link:

http://naturalhealthtechniques.com/wp-content/uploads/2011/03/Harrowers_chart_Endocrine_Imbalance.gif

Proper nutrition is critical for the endocrine glands. Each of the major glands relies on a specific trace mineral to support its normal physiology and biochemistry. We consume these trace minerals when we eat real foods from both plant and animal sources. If we do not consume sufficient amounts of these minerals the glands will not function properly which will ultimately lead to a variety of symptoms in the body. More on this later when we look at each gland.

The endocrine gland and its associated trace mineral are as follows: pituitary (manganese); thyroid (iodine); adrenal (copper); pancreas (chromium); prostate/uterus (zinc); and testes/ovaries (selenium). The other major endocrine glands are the hypothalamus, pineal, parathyroid, thymus, and believe it or not – your fat cells.

A few more basics about hormones to provide you with additional background. On each human cell are receptor sites. You can think of these as ‘gates” located on the cell membrane that control the entry of hormones and other bio-chemicals into the cells. These receptors determine if and how effectively a hormone message is received.

There are a variety of scenarios in which these sites are not functioning optimally. They can become “resistant” to the hormone meaning more of the hormone is required to deliver the message. You may have heard of the term “insulin resistance” a condition that often precedes diabetes. In other cases an excess of one hormone may block the gate of another, or another substance may mimic a hormone and block a receptor site (this is called a xenohormone).

Hormones exist in two formats in the blood stream. Protein-bound hormones are considered inactive (as they are bound to a protein). “Free” hormones are the active form that is able to bind to cell receptors and initiate the cellular response.

The main control of the endocrine system rests in the hypothalamus-pituitary axis (or H-P axis). The hypothalamus is part of the limbic system so it is in the brain and receives information which it relays to the pituitary. The pituitary is also known as “the master gland” because it sends information to all the endocrine glands based on what it has learned from the hypothalamus.

In Part 2 of this article we will take a brief look at each gland, the hormone(s) it produces, and the basic function of those hormones.

Bernard Rosen, PhD is a Nutrition Consultant and Educator. He works with individuals, groups, and at corporations to create individualized nutrition and wellness programs. His office is in Mequon, WI. To learn more or to schedule an appointment, e-mail at bernie@brwellness.com, call (262) 389-9907 or go to www.brwellness.com.

The Fourfold Path to Healing

Looking for natural cures for chronic diseases (cancer, heart disease, hypertension, diabetes, digestive issues, emotional issues, etc) then take a look at Dr. Thomas Cowan’s The Fourfold Path to Healing.  Billed as the “companion to Nourishing Traditions” (Sally Fallon’s excellent book), this book utilizes nutrition, nontoxic therapeutics, movement, and meditation to facilitate healing.  Truly a book that will transform your thinking and guide you along the way to vibrant health.

Eat Fat – It’s Good For You – 2 for 1 Today

Happy July 4th!  Celebrate your Independence, break away from the conventional thinking about fat.  Eat fat – it is good for you.  Of course it needs to be the right kinds of fat.  Today I offer two books that provide both scientific evidence, real life experience, and rational thinking as to what fats we need and why.  Eat Fat, Lose Weight by Ann Louise Gittleman and Eat Fat, Lose Fat by Dr. Mary Enig and Sally Fallon both explain how we don’t get fat from eating fat, and in fact eating fat will help us lose weight!