Learning the Facts About Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is a mental condition where an individual consistently displays no regard for right from wrong and is indifferent to the feelings of others.

In some cases, those with ASPD can appear witty, charming, and generally fun to be around, but they may also lie, antagonize, manipulate, or exploit others and not feel guilty about the consequences of their actions. They may also act destructively without regard for the law, or for their safety of the safety of others.

Modern diagnostic systems consider ASPD to include two related but not identical conditions:

A “psychopath” is someone whose hurtful actions toward others tend to reflect calculation, manipulation and cunning; they also tend not to feel emotion and mimic (rather than experience) empathy for others. They can be deceptively charismatic and charming.

By contrast, a “sociopath” has more of an ability to form attachments to others but still disregards social rules; they tend to be more impulsive, haphazard, and easily agitated than people with psychopathy.

People with ASPD may often do the following:

  • Lie, con, and exploit others
  • Act rashly
  • Be angry, vain, and aggressive
  • Fight or assault other people
  • Break the law
  • Not care about the safety of others or themselves
  • Not show signs of remorse after hurting someone else
  • Fail to meet money, work, or social duties
  • Abuse drugs or alcohol

ASPD is uncommon, affecting less than 1% of the population. It affects men more than women. While there is no direct cause of ASPD, genetics is considered a possible factor, as is exposure to a traumatic or abusive atmosphere as a child. Brain defects and injuries during developmental years may also be linked to ASPD.

 A diagnosis of ASPD cannot be made until age 18, though to be identified as having the disorder a person would have to have shown symptoms before age 15.  Symptoms of ASPD are usually at their worst during a person’s late teenage years and in their 20s, but may improve on their own over time.

Unfortunately, many people with ASPD don’t seek help for the condition because they don’t believe they need assistance, but for those seeking treatment for ASPD, participation in either individual or group therapy has proven to be beneficial. A mental health professional may also prescribe certain psychiatric medications like mood stabilizers or some atypical antipsychotics to treat symptoms like impulsive aggression.

If someone close to you has ASPD, consider seeking help for the disorder from a mental health professional. To make an appointment at the mental health clinic at xx Hospital, please call 718-670-5562.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Learn the Facts About Cellulitis

Cellulitis is a common, but potentially serious infection of the skin and the soft tissues underneath that occurs when bacteria enters the body through a crack or break in the skin. Cellulitis can also develop as a result of an infection typically after surgery or having untreated injuries such as a puncture would, cut, scrape or burn can also lead to the development of cellulitis.

Cellulitis most frequently occurs on the legs, but it can present on other parts of the body, including the arms or face. Cellulitis usually develops on one side of the body.

The skin of those with cellulitis is often skin swollen and red and is typically painful and warm to the touch. Other symptoms of cellulitis can include:

  • Red spots
  • Red streaking
  • Blisters
  • Skin dimpling
  • Fever
  • Infected area tends to expand
  • Leaking of yellow, clear fluid or pus

There are several factors that place someone at an increased risk of developing cellulitis, such as diabetes, obesity, liver disease, circulatory issues, or having a weakened immune system. Certain skin conditions including eczema, psoriasis, athlete’s foot or shingles can provide an entry point for bacteria to enter the body.

If left untreated, an infection can spread to a person’s lymph nodes and bloodstream and rapidly become life-threatening.  It is important to see your doctor immediately or seek emergency care if you experience any signs of cellulitis to prevent the condition spreading throughout your body.

Your doctor can recommend a care plan that may include pain relievers to treat the symptoms and possibly either oral or intramuscular antibiotics, depending on the severity of the condition, to treat the infection. In rare cases, surgery may be required.  Other tips to treat cellulitis include resting and elevating the infected area.

The best advice to prevent cellulitis includes taking proper safety precautions, including:

  • Washing your wound daily with soap and water
  • Applying a protective cream or ointment to surface wounds
  • Covering your wound with a bandage.
  • Moisturizing your skin regularly
  • Watching for signs of infection

If you believe you have cellulitis, make an appointment with your doctor immediately. If you do not have a doctor, you can make an appointment with a qualified physician at Flushing Hospital Medical Center by calling 718-670-5486.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Dealing With Holiday Stress

During the holiday season, many of us struggle to complete an extensive list of tasks in what often feels like very little time.   We run rampant decorating our homes, attending social gatherings, shopping for loved ones, volunteering, traveling or cooking.  These activities are often added to our already busy schedules, which can make us feel overwhelmed.

Contrary to what we may think, these activities which should make us feel happy can actually increase our stress levels.

Although there are various factors such as unrealistic expectations or financial strain that contribute to holiday stress, finding ways to avoid stressors or minimize their effects is very important. If stress is not managed well, it can have a significantly negative impact on our health.

Mental health professionals at Flushing Hospital Medical Center offers  five tips to help you cope with holiday stress and maintain good mental health:

  1. Set realistic goals– Unrealistic goals often equal added pressure and expectations that cannot be met. If these goals are not met, they can lead to negative feelings such as inadequacy or hopelessness.
  2. Know when to take a moment for yourself (Take a break) – We are often pulled in multiple directions during this time of the year. Know when to take a breather to decompress and clear your mind.
  3. Communicate- The added pressures of the holidays are clearly overwhelming and one of the ways that people sometimes deal with this is to isolate themselves. This is not recommended; instead, reach out to loved ones or a trained mental health professional to communicate how you feel.
  4. Do not neglect healthy habits– Taking good care of your health can help combat holiday stress. Moderating your food intake, fitting in a few minutes of exercise and getting adequate amounts of sleep can be profoundly beneficial for your health.   Additionally, maintaining a healthy daily routine can help take your mind off holiday demands.
  5. Ask for help- We live in a time where multitasking has become the norm but if you begin to feel overwhelmed, ask for help. Soliciting the help of friends or family can alleviate some of the holiday pressure. The holidays can also trigger depression; if you are experiencing symptoms of depression ask for help from loved ones or seek the assistance of a mental health professional.

The holiday season can be overwhelming; however, by applying these helpful tips you can take the steps needed to minimize stress and make this time of year more enjoyable.  If you find that you continue to experience elevated levels of stress or symptoms of depression, it is recommended that you seek the help of mental health professional immediately.

To schedule an appointment with the Mental Health Clinic at Flushing Hospital Medical Center, please call 718-670-5562.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Are Pediatric Vitamins Necessary for My Child

One of the most important jobs for every parent is to make sure they give their children a healthy start in life. A big part of that includes making sure they receive their daily recommended vitamin intake. Many automatically assume this includes providing them with a chewable or gummy vitamin each day, but is this really necessary?

The answer is not necessarily. Most experts agree that children should get their vitamins from a healthy diet that includes dairy products like milk, cheese and yogurt; fresh fruits and green leafy vegetables; proteins, such as meat, chicken, fish, and eggs; and a variety of whole grains.

However, given the busy lifestyles of most families, providing well-balanced meals isn’t always a realistic option. In these instances, because children may not be getting their vitamins through their daily diet, supplements should be considered . Other potential reasons to supplement your child’s diet with vitamins include:

  • If your child is a fussy eater
  • If your child has a delay in his or her physical development
  • If your child is living with a chronic medical condition such as asthma
  • If your child has digestive problems or food allergies
  • If you are raising your child as a vegetarian or vegan
  • If your child eats a lot of fast food or processed food or drinks a lot of soda

If you believe that vitamins are necessary for your child’s development, it is important to make sure they are receiving the right ones. The following vitamins are considered most critical for growing children.

  • Vitamin A– Promotes normal growth and development; tissue and bone repair; and healthy skin, eyes, and immune responses.
  • Vitamin B – The family of B Vitamins, including B2, B3, B6 and B12 aid metabolism and energy production. They also promote bone and tooth formation and development of healthy muscles and connective tissue.
  • Calcium – Essential for helping build strong bones as a child grows.
  • Iron – Builds muscle and is essential to healthy red blood cells. Iron deficiency is a risk in adolescence, especially for girls once they begin to menstruate.

If you do give vitamins to your children, follow these safety tips:

  • Put vitamins away, well out of reach of children, so they don’t treat them like candy.
  • Be sure not to exceed the daily recommended dosage as too many vitamins can be dangerous
  • If your child is taking any medication, be sure to ask your child’s doctor about any drug interactions with certain vitamins or minerals.
  • Try a chewable vitamin if your child won’t take a pill or liquid supplement.
  • Consider waiting until a child reaches age 4 to start giving a multivitamin supplement, unless your child’s doctor suggests otherwise.

There are many over-the-counter pediatric vitamins on the market today. Before you make a decision on which to buy for your child, consult with your pediatrician. They can advise you on what makes the most sense for your child.

To make an appointment at xx Hospital’s Pediatric Ambulatory Care Center, please call 718-670-5486.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Fascinating Facts About Our Liver

The human liver is a very vital organ. It is so important that we cannot survive if it stops functioning for one single day. Unfortunately, it is also one of the least thought about organs. Given its importance, let’s take some time to learn more about the liver and give it the attention it deserves. Here are some fascinating facts about the liver:

  1. Largest glandular organ – Our liver is the largest glandular organ of the human body and the second largest organ besides our skin.
  2. Multifunctional – Our liver simultaneously performs over 200 important functions for the body. Some of these important functions include supplying glucose to the brain, combating infections, and storing nutrients.
  3. It contains fat – 10% of our liver is made up of fat. If the fat content in the liver goes above 10% it is considered a “fatty liver” and makes you more likely to develop type 2 diabetes.
  4. It stocks iron – Our liver stores important vitamins and nutrients from the food we eat and stocks them up for when we need them later.
  5. Detoxifier – Our liver detoxifies the harmful things we take in like alcohol and drugs. Without the liver the body cannot process these items.
  6. Creator of blood – The liver creates the blood that circulates in our bodies. In fact, the liver starts producing blood before we are born. Without the liver there would be no blood and no life.
  7. It regenerates – Our liver has the amazing ability to regenerate itself, making liver transplant possible. When people donate half their liver, the remaining part of the liver regenerates the section that was removed.

As you can see, our livers are extremely important organs and serve many vital functions. In other words, our livers are no chop- liver.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Is Bariatric Surgery Right For You?

Obesity is a growing public health issue in our region.  According to NYC.gov, more than half of New Yorkers are overweight, and nearly a quarter qualify as obese.  The New York City Department of Health and Mental Hygiene, reports that an estimated 23% of the population living in Queens is obese.

These rates are concerning  because people who are obese are at an increased risk for developing chronic diseases such as diabetes, stroke, hypertension, heart disease and some cancers.  However, the good news is the risks associated with many of these conditions can be significantly reduced by losing weight.

Diet and exercise are highly recommended methods of weight loss but they may not be enough to yield significant results for those who are obese.   Bariatric surgery offers an extremely effective weight loss solution for people who have tried and failed to lose weight by way of diet and exercise. Additionally, it has been shown to help improve several obesity-related health conditions.

The two most popular bariatric surgeries are the sleeve gastrectomy and gastric bypass procedures. In the sleeve gastrectomy operation a large portion of the stomach is removed and a smaller, new stomach in the shape of a tube or “sleeve” is created.  During bypass surgery, a new small stomach pouch is created, and a section of the small bowel is bypassed. These surgeries are usually done through small incisions either laparoscopically or using the da Vinci surgical robot, ensuring a minimally invasive approach. Both surgeries offer excellent long term results and positive outcomes in most patients.

With this is in mind, it is important to understand that bariatric surgery is a major operation, no matter which procedure is chosen.  Bariatric surgery is not an easy way out. It is an important decision to be made under strict physician supervision and with the support of loved ones.  The process is immersive and takes approximately 4-5 months of supervised dieting and being seen by multiple specialties for approval.

Although bariatric surgery is considered safe, it is very important that patients understand the risks of surgery. As with most major surgical procedures, the risks can include bleeding or other complications.

For those who would like to explore non-surgical weight loss procedures, there are options such as the FDA-approved Obalon Balloon System. This involves three air filled balloons inserted via a swallowed capsule. The patient is given no anesthesia and most people return to work the same day. The balloons stay in for six months after which they are removed via endoscopy. The procedure is generally very well tolerated with some side effects such as nausea and cramping. Studies have shown weight loss to continue beyond removal and many patients lose significant amount of weight.

When deciding which procedure is best for you, it is recommended that you receive an expert consultation with a surgeon. Your physician can assess your health which can lead to the decision on which surgery is suitable for your needs.

To ensure the highest quality care and maximize your chances of a successful weight loss procedure, it is recommended that you receive treatment at a “Bariatric Center of Excellence”, such as Flushing Hospital Medical Center.

Flushing Hospital is the only Center of Excellence in Queens. The process to reach this designation is arduous and ensures that the center and the surgeons are of the highest quality and preparedness. Surgical outcomes are measured very strictly and the capability of both the surgeons and the center must be of the highest caliber when compared nationally.

To make an appointment, please call 718-408-6977.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Today is the Great American Smokeout – Quit Smoking Today!

Today is the Great American Smokeout, an annual event when the American Cancer Society encourages everyone to quit smoking. This event helps to make people aware of the dangers of using tobacco products as well as the tools that are available to help them quit smoking.

The Great American Smokeout started in 1970 in a small town in Massachusetts. People were asked to give up smoking for one day and to take the money that they would have spent on cigarettes and donate it to a local high school scholarship fund. The event spread to other cities both large and small and eventually led to legislation that bans smoking in workplaces, restaurants, and other public spaces both indoors and outdoors.

Smoking  is responsible for one in five deaths in the United States today. Lung cancer is the leading cause of death in both men and women. Smoking is also the cause of cancer of the larynx, mouth, sinuses, throat, esophagus, and the bladder. The number of people who smoke has dramatically decreased in the United States since the anti-smoking campaigns began. In 1965 it was estimated that over 40 percent of the population were smokers and today that number is around 18 percent.

Smokers have the best chances of quitting if they use at least two of the following methods:

• Smoking Cessation Groups
• Nicotine substitute products
• Support from family and friends
• Telephone quit lines
• Counseling
• Prescription medications that help to reduce the urge to smoke

If you would like more information about quitting smoking please call the American Cancer Society at 1-800-227-2345. If you would like to schedule an appointment with a doctor at Flushing Hospital to discuss smoking cessation, please call 718-206-8494.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Are You REALLY Allergic to Antibiotics?

If taken correctly and not used to inappropriately combat viruses, antibiotics can  be extremely effective in preventing the spread of infection.  While there is a great deal of information circulating about the misuse or overuse of antibiotics, there is relatively very little shared about the underuse of antibiotics due to suspected allergies.

Many Americans are under the impression that they are allergic to antibiotics, but according to a recent New York Times article, it is estimated that up to 90 percent of antibiotic allergy claims are not legitimate. So why do so many people believe they are allergic when they are not? Most often it is not the individual’s fault; they were either falsely told by their parents that they were allergic to antibiotics when they were a child or they do not understand what constitutes an allergic reaction.

In reality, many individuals experience some type of reaction after taking antibiotics, such as an upset stomach, headache or diarrhea. These bodily responses are considered side effects, and should not be classified as an allergic reaction. A true allergic reaction is when your body treats the medication entering your system as an invader and releases chemicals called histamines to attack it.

Symptoms of a mild allergic reaction can include the development of a rash, swelling of the face, or some difficulty breathing. For most mild reactions, medications such as antihistamines or corticosteroids can be taken to treat symptoms.

In rare case however, some experience a more severe allergic reaction, known as anaphylaxis. Symptoms of an anaphylactic allergic reaction include:

  • Difficult or noisy breathing
  • Swelling of the tongue
  • Swelling or tightness in the throat
  • Wheezing or coughing
  • Dizziness or fainting
  • Pale complexion

Signs of an anaphylactic allergic reaction usually present within an hour of taking an antibiotic. If this type of reaction occurs, medical attention is necessary and 911 should be called immediately.  Treatment for a severe allergic reaction often requires an epinephrine injection to alleviate the symptoms.

While many antibiotic allergy claims are false, there are some people who are truly allergic. For those who truly are allergic, the antibiotic that they are most frequently allergic to is penicillin, or other antibiotics that are closely associated with it. Those who suspect that they are allergic to penicillin can confirm it with a simple skin test.

With the rise of so many “super-bugs,” proper treatment of infections using the correct course of antibiotics has never been more important.  Limiting the number of medications you can receive because you think you are allergic can prove to be very dangerous or even fatal.

If you believe you are allergic to antibiotics, but are not certain, speak to your doctor. Together you can discuss the pros and cons and arrive at an appropriate course of treatment.

Flushing Hospital’s Ambulatory Care Center has many qualified doctors who can advise you on the correct use of antibiotics. To make an appointment, please call 718-670-5486.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Itchy Ears – What is the Cause and How do You Treat Them?

If you ever experienced a sudden itch inside your ear and asked an elder member of your family why, they may have told you it means that someone is talking about you.

With all due respect to those spreaders of old wives tales, there is probably a more credible medical reason why our ears itch on occasion. The hard part is figuring out which of the many possible conditions or habits is causing this reaction.

Identifying the culprit can lead to appropriate treatment. Here are some potential causes:

  • Psoriasis Pain or itching on the skin on or around your ear might be an indication of psoriasis, a relatively common skin condition. If this is the case, you might notice a buildup of rough, dry, red patches or scales in the external area of your ear that can itch or hurt. There are a variety of treatment options including topical medications or steroids.
  • Skin allergiesThe skin inside your ears can itch because of an allergic reaction to something that is applied in or near your ear. A new hair product may be the culprit and earrings that contain nickel have also been known to cause an allergic reaction. Be mindful whenever introducing anything new to your skin and stop using it if you believe it is the cause.
  • Food allergies – Similar to reactions from skin contact, some might have an allergic reaction to something they ate, causing their ears to itch. Certain fruits, vegetables, or tree nuts are the most common sources of food allergies. A doctor can test for the source of a food allergy, determine the severity and prescribe the appropriate medication.
  • Infections– Itchy ears can sometimes be a sign of an ear infection. Bacteria and viruses cause them, usually when you have a cold or the flu. One kind of infection, swimmer’s ear, can happen when water stays in your ear after you swim. To stop the itch, you’ll need to treat the infection, possibly with ear drops or antibiotics.
  • Improper cleaningPlacing cotton swabs into your ears can inflame your ear canal and leave you itching. Pins, paper clips, matchsticks, and your fingers can also scratch the skin inside your ears, making it easy for bacteria to enter and cause an infection. Excessive ear wax build-up can also cause your ears to itch. Your doctor can remove excessive wax using special instruments.

Regardless of the reason you are experiencing an itching sensation in your ear, it is important to be mindful of any changes in your diet or environment and share that information with your doctor so he or she can prescribe the correct course of treatment.

To make an appointment at Flushing Hospital’s Ambulatory Care Center, please call 718-670-5486.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Learn the Facts About Addison’s Disease

Just above each of our kidneys lie our adrenal glands. These glands are part of our endocrine system and are responsible for producing the hormones Cortisol and Aldosterone which help us to convert food into energy, maintain our immune system, and regulate our potassium and blood pressure levels.

When the adrenal glands become damaged they can affect our ability to generate a sufficient amount of these hormones, which could lead to a rare auto-immune disorder called Addison’s disease. This condition affects one in 100,000 people and can occur in all age groups and  both sexes.

While damage to your adrenal glands is the cause of over 70% of the diagnosed cases of Addison’s disease, long lasting infections, such as tuberculosis, HIV, or fungal infections can also lead to its onset. Addison’s disease may also develop after cancer cells spread from other parts of the body to the adrenal glands.

Addison’s disease symptoms usually develop slowly, often over several months, and may include:

  • Extreme fatigue
  • Weight loss and decreased appetite
  • Darkening of your skin (hyperpigmentation)
  • Low blood pressure, even fainting
  • Salt craving
  • Low blood sugar (hypoglycemia)
  • Nausea, diarrhea or vomiting
  • Abdominal pain
  • Muscle or joint pains
  • Irritability
  • Depression
  • Body hair loss or sexual dysfunction in women

Because symptoms of Addison’s disease progress slowly, they may go unrecognized until a physically stressful event, such as another illness, surgery, or an accident, worsens symptoms quickly. When this happens, it’s called an Addisonian crisis. For one in four people with Addison’s disease, this is the first time they realize they are ill. An Addisonian crisis is considered a medical emergency because it can be fatal.

While damage to your adrenal glands is the cause of over 70% of the diagnosed cases of Addison’s disease, long lasting infections, such as tuberculosis, HIV, or fungal infections can also lead to its onset. Addison’s disease may also develop after cancer cells spread from other parts of the body to the adrenal glands.

While Addison’s disease can be life threatening if not treated, those with it can live normal lives if they comply with a treatment plan that includes strict medication management.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.