5 Early Signs of Multiple Sclerosis

Inflammatory bowel disorders refer to conditions that cause inflammation and trigger complications in the digestive tract. This tract comprises various organs, from the esophagus to the rectum, which helps break down foods for energy consumption. IBDs like ulcerative colitis and Crohn’s disease majorly affect organs in the digestive tract and remain undetected till those advanced stages when the symptoms flare up. Here is a brief overview of the diseases and the best foods for managing flare-ups.

Ulcerative Colitis and Crohn’s Disease – An overview
Ulcerative colitis is classified as an inflammatory bowel disorder that develops ulcers in the organs of the digestive tract. These sores can affect the intestine’s inner lining, predominantly affecting the colon and rectum at the end of the digestive tract. In most cases, the symptoms and discomforts do not show up until the progressive changes of the disorder. Ulcerative colitis causes rectal bleeding, abdominal pain, cramps, diarrhea, increased incontinence, constipation, fatigue, and fever. The symptoms can flare up unexpectedly without any prior warning.
Crohn’s disease is another inflammatory bowel disorder affecting older adults, triggering inflammation in the digestive tract. While the disease can spread and affect any part of the digestive tract, in most cases, the small and large intestines are severely affected. Common discomforts and symptoms develop similar to that what one experiences with Ulcerative colitis. Outside of the intestinal tract, inflammation of the skin, vital joints, liver, bile ducts, and even the eyes are some unusual signs of developing colitis. Flareups can also trigger complications like kidney stones, iron deficiency, and delayed growth among young children.

Diagnosis and treatment options
Blood tests and stool studies help determine the type of inflammatory bowel disease. Further, endoscopic procedures like colonoscopy or flexible sigmoidoscopy are done to determine the condition’s severity and progression. Doctors also recommend imaging tests like X-Ray, CT scans, and MR enterography to locate the size and extent of inflammation in the small and large intestines. For Crohn’s disease, further Magnetic Image Resource testing is done to confirm the progression of the digestive disorder. Post-diagnosis treatments generally include a combination of prescriptions and surgery depending on the stage and severity of the condition. Apart from this, gastroenterologists will suggest healthy daily nutrition and lifestyle changes. These changes help improve the outlook of living with symptoms in the long run.

Superfoods to manage ulcerative colitis and Crohn’s disease
The following foods can help prevent and manage flare-ups during ongoing treatment.

Nutritious fruits
Fiber is one of the best nutrients to be consumed regularly to manage flare-ups associated with digestive disorders, including ulcerative colitis and Crohn’s disease. Low-fiber fruits are easy to digest and don’t pressure the organs excessively. Peaches, bananas, watermelon melon, honeydew melon, and cantaloupe are good sources of fiber, energy, and carbohydrates. These fresh fruits replace starchy foods and heavy proteins to ensure the body digests proper energy supplements. Small servings of assorted berries, including strawberries and blueberries, can boost antioxidant intake to counter inflammation and prevent healthy cell damage. Oranges can also boost immunity as the fruit contains vitamin C necessary for overall health.

Dense vegetables
Skinless mashed potatoes can help supplement the body’s daily potassium requirements without being too heavy on the digestive system. The vegetable pulp is low in fiber and provides a healthy source of carbohydrates to be broken down to supplement energy needs. Avocados are an excellent source of healthy omega-3 fatty acids that actively counter inflammation. Flareups of known chronic digestive disorders like Crohn’s disease and ulcerative colitis are generally triggered due to inflammation. Avocados are also rich in healthy B vitamins, Vitamin E and are a nutrient-dense source of soluble fibers that are digested quickly. Additionally, cooked carrots and spinach can supplement the body with essential vitamins A and K, both excellent fat-soluble vitamins that help manage discomfort linked to flare-ups.

Healthy probiotics
Gut bacteria in the digestive tract are critical in maintaining overall health. Any imbalance can cause chronic diseases to trigger flare-ups and, as a result, disrupt vital body functions. Introducing healthy dairy and supplement-based probiotics helps prevent several discomforts linked to ulcerative colitis and Crohn’s disease from flaring up. Yogurt is an excellent naturally derived probiotic-rich with live bacteria and helps restore gut microbiome balance. Also, calcium deficiency is one of the complications linked to Crohn’s disease. Yogurt can also substitute calcium loss by naturally introducing the nutrient with each serving. Fortified milk and cheese are also excellent sources of calcium to be consumed in addition to yogurt. In addition, plant-based soy milk can supplement the daily requirements if one suffers from lactose intolerance.

Lean proteins
Protein is one of the most crucial nutrients the body should digest for bone and muscle health. It helps overall growth and prevents bone loss and muscle deterioration caused due to chronic disorders. However, it is important to include only lean sources of meats and poultry to ensure these foods are digested easily. Chicken meat, turkey meat, and whole eggs are the best sources of heavy fat-free proteins that are digested easily. These meats also don’t release any triggering compounds when cooked on high heat, for example, grilling, making them a healthy alternative over red cuts of beef, pork, and lamb. Whole eggs are also rich in healthy omega-3 fatty acids and vitamin D, which counters inflammation and helps effectively absorb proteins and calcium.

Fatty fish
Healthy fats help manage flare-ups associated with known digestive disorders like ulcerative colitis or Crohn’s disease. And fatty fish like salmon, tuna, mackerel, herring, sardines, and trout are excellent sources of natural omega-3s that actively counter the inflammatory responses. Grilling the fish makes it easier to digest than cooking on high heat with shallow or deep frying. Fish can also be baked to prevent the loss of nutrients and vitamins and retain its fatty goodness. It is, however, best to add sauces and condiments in moderation since these store-bought products contain preservatives and additives that upset digestion.

Asthma is a condition wherein a person’s airways become inflamed and swell, procuring extra mucus, making breathing difficult. Getting rid of asthma triggers from one’s house and workspace and protecting against external triggers outdoors are crucial factors in managing and treating asthma. In critical cases, doctors may suggest relocating to a new city with fewer asthma triggers. Since there is no cure for asthma, effective management becomes key in ensuring that the condition doesn’t worsen.

What is uncontrolled asthma?
When asthma symptoms become severe and start interfering with one’s everyday life, they might indicate uncontrolled asthma. These symptoms need urgent treatment. If left untreated, they could cause severe damage to one’s lungs. 

Causes of uncontrolled asthma
Stress
Chronic stress could lead to flare-ups of asthma symptoms. One must make an attempt to reduce stress and anxiety in life. Meditation and yoga could help a person deal with stress.

Underlying health conditions
Certain health conditions like environmental allergies and GERD could lead to asthma flare-ups. Other respiratory conditions like sleep apnea could block the upper airway while sleeping, leading to an asthma flare-up. 

Weather change
Moving from warmer to colder air or drier to humid air can trigger an asthma flare-up. It could also be brought on by simple weather changes or moving out from a controlled environment.

6 cities with the most asthmatic emergencies
Springfield, MA
Springfield has recorded the highest number of asthma-related emergency visits and has consistently been ranked as one of the worst cities in the country for asthma patients. In most other cities, while air quality could be the biggest trigger, pollen and household triggers are the leading causes in Springfield. Springfield also has a very high volume of old housing stock. The climate is also extreme, with extremely warm summers and below-zero-degree winters. These are major asthma triggers. Springfield’s asthma prevalence and emergency room visit rates are more than three times higher than the national average. It also ranks high on seasonal allergies and asthma. Springfield’s air quality, however, is good and falls within the quality limits and standards set by the Environmental Protection agency. 

Detroit, MI
Detroit is considered one of the most unfavorable cities in the country to live with asthma. The city has about 46% more asthma cases and four times more cases of hospitalization than the whole of Michigan state. The number of children requiring emergency care is twice the state average, and more than 58% of children with asthma filled prescriptions for inhalers. Detroit has dangerous levels of sulfur dioxide from factories, industries, and old diesel engines of automobiles. Over 57% of the houses are old, increasing the risk of asthma triggered by dust, mold, and mildew. The city also has more than recommended levels of ozone. There is a lack of medical care access as emergency care gets overcrowded during peak asthma season in the city. 

Cleveland, OH
Cleveland has higher than average rates in asthma prevalence, emergency room visits, and asthma-related deaths. Cleveland has high air particle pollution caused by the presence of oil, gas, and manufacturing industries and vehicle carbon emissions. The city also has higher poverty rates and unsafe ozone levels that cause a worsening of uncontrollable asthma symptoms that require urgent medical attention. Aging buildings and the high presence of mold, dust, and lead paint are common indoor triggers in Ohio, as the cost of rehabilitation or rebuilding is too high for families and governments. 

Allentown PA
Allentown metropolitan area is ranked high on the number of asthma-related emergency visits in the country. Allentown is a valley situated between two mountain ranges. When the winds are high, the pollen gets dispersed across the area triggering uncontrollable asthma. In the absence of wind, the mountain pollen stays in the air. Heavy truck traffic emissions, fumes from cement companies, and other incinerators hang in the air without getting driven away. Allentown also ranks low on the air quality rankings. 

Richmond, VA
Richmond ranks high on springtime pollen prevalence, one of the biggest environmental triggers of springtime, and seasonal allergies and asthma. Richmond also has a high growth of ragweed, creating a risk of higher asthma-related emergency room visits in the fall. The city is surrounded by power plants emitting chemicals like sulfuric, hydrochloric acid, and ammonia. Poor ventilation, old school buildings, and poor air conditioning are significant causes of high asthma prevalence in children. Richmond’s average for emergency room visits exceeds the national average. The high presence of particulate matter, unsafe ozone levels, and hot and humid summers add to the woes of asthma patients. 

Baltimore, MD
The average of asthma patients in Baltimore is more than double the state and national average. The rate of young children with asthma is 33.3%, which is also higher than the state average of 25.9%. It also has the highest hospitalization and emergency room visits in the state. Old housing stocks and air pollution is extremely high in the city, significantly adding to Baltimore’s asthma prevalence. 

Environmental and outdoor triggers of uncontrollable asthma
Doctors and patients agree that outdoor triggers are more likely to trigger uncontrollable asthma rather than food or household allergens. Avoiding exposure to triggers is an integral part of asthma management. Identifying and taking steps to avoid the triggers are as crucial as the treatment. Doctors advise patients to maintain a daily journal that can identify potential triggers in the long term. They may also prescribe provocation tests and irritant challenges that expose a person to triggers like smoke, perfumes, or household chemicals and analyze how one’s breathing and lung function change. Apart from food and household allergens, some of the most common asthma triggers include:

Ragweed pollen
Mold 
Risk of flu and cold due to weather conditions
Air quality
Vehicular and industrial pollution
Wildfire smoke

Our bodies change considerably when we age. Some of these changes can include the state of our teeth (damaged, missing, or hurting). However, most of these issues can be resolved by consulting a dentist and receiving professional treatment. Dental implants for seniors are one treatment that can provide many benefits, from improving one’s oral health to boosting self-confidence with a brighter smile. This article explores eight advantages of dental implants for seniors.

How does a dental implant work?
A dental implant involves replacing a missing tooth or teeth in the mouth. An implant (replacement tooth root) is surgically inserted using a titanium post into the jawbone. This implant acts as a strong foundation for the new artificial tooth. The titanium fuses with the existing bone while creating a secure base, and this process may take a few weeks before abutment fixing.

Then, the dentist will securely attach an abutment (a metal piece that connects the implant and the new tooth). Upon this abutment sits the custom-made crown (artificial tooth) to the implant, completing the procedure.

Thus, patients can enjoy a permanent and durable teeth replacement that looks and functions just like a natural tooth through a dental implant process. If seniors have lost their teeth due to decay, as a side effect of other conditions, or merely due to age, the procedure can help restore their confidence and make several things easier for them.

Benefits of dental implants for seniors
A dental implant surgery helps seniors regain their ability to consume food without uneasiness, as the top benefit. The following is a list of benefits associated with dental implants for seniors.

Enhance the bone structure and facial profile
A senior citizen may experience skin sagging or shrinking. One of the main reasons for a sagging face is teeth loss since it causes the jawbone to shrink.

A dental implant can restore your jawbone’s strength and improve your facial appearance. After the treatment, you’ll have healthier-looking bones and enhanced facial features due to a full set of teeth.

  Improved speech and confidence
Teeth loss or removable dentures may impact an individual’s speech or ability to communicate clearly. Implants can make seniors converse more confidently by helping prevent slurring or speech difficulties. They facilitate better speech by fixing an immovable artificial tooth in place.

Long-term investment
Dental implants are a lifetime investment for seniors because they have a 90-95% success rate. The implant surgery is an ideal alternative for seniors with missing teeth and the inability to chew or bite food properly. Dental implants are also cost-effective because they prevent future dental issues (which may cost you time, effort, and money).

They are an investment worth considering if you want longevity and a feel of natural teeth. Implants appear and feel the same as regular teeth and can last long, making them a valuable financial decision in the long term.

Easy maintenance
Dental implants (permanent fixtures) in your mouth require extra care, such as diligent brushing and flossing. However, the benefits of dental implants far outweigh any extra effort spent on them. Additionally, taking care of implants is less troublesome than caring for dentures.

You may find maintaining dentures difficult because they require regular cleaning. You must take out the dentures at night, soak them, clean the gums, and look for sore spots before wearing them again. However, dental implants do not require such complicated maintenance.

Maintain adjacent teeth in place
Losing a tooth can have far-reaching effects, including shifting adjacent teeth into the newly created gap. This can disrupt an individual’s ability to bite and chew properly and alter their facial structure. Furthermore, it may even create lasting stress on the temporomandibular joint (TMJ). The pressure worsens body pain and headaches in the elderly who already suffer from them due to age-related wear and tear.

A dental implant helps keep adjacent teeth in place with the help of the titanium root’s stronghold.

Adaptability and customization
A dental implant is not one-size-fits-all. Your dentist will create a customized crown (or teeth) of the most appropriate size for your jawbone. The implant is made to replicate your missing tooth, which makes this process highly effective. Additionally, unlike dentures, implants cannot be detected easily in an open or closed mouth.

Prevents jaw loss
When you are missing a tooth, your jaw has to exert excessive force for everyday actions like biting, chewing, and speaking. This leads to gum and jawbone deterioration and, ultimately, jaw loss. Undergoing a dental implant affixes a permanent tooth replacement in place of your missing tooth, bringing the normal teeth structure back and preventing jaw loss.

Improved nutrition and meals
Seniors with dentures may have to restrict their food intake, consume only soft food items, or cut foods into very small bites before eating to put less pressure on the weak jaw. However, with dental implants, you do not have to follow such restrictions.

Additionally, your body’s nutrition may improve after getting dental implants. Your dentist may prescribe a meal plan post-surgery to keep you healthy and help you heal quickly. If you consumed unhealthy foods before the surgery, this plan might help you keep a check on your health.

Are dental implants safe for seniors?
Is there a minimum age for receiving dental implants? No. Will implants be as effective for seniors as they would for somebody younger? Yes.

The implants work just as effectively in the elderly, including those with reduced bone density. 

However, older patients heal from the surgery at a slightly slower rate than younger people. Elderly patients recover from the implants in about four months. That said, you must remember that all patients, regardless of age, may feel discomfort for 3-5 days after the implants are installed. The best solution is to take modest pain relievers to eliminate the discomfort.

In conclusion
All in all, dental implants are a great option for the elderly to replace missing teeth. They look and feel just like real teeth, making them virtually indistinguishable. Additionally, they provide superior stability compared to other tooth replacements, such as dentures and bridges. Dental implants can help improve oral health, improve the ability to speak and chew properly, make the appearance of a smile more natural-looking, and enhance self-confidence!

For these reasons, it’s no wonder why so many elderly people choose dental implants to replace their missing teeth. However, you must always consult your dentist regarding any queries about the procedure before opting for it.

Remote work has allowed employers, employees, and freelancers to work from anywhere with the help of a laptop. However, to carry out work without hassles, one should invest in a compact device with decent specifications. You must buy a laptop that suits your budget, is durable, and runs an OS you are comfortable with. To help you with a purchasing decision, here are seven laptop models that are suitable for various types of working professionals.

Best for MacOS users – Macbook Air M2

If you have the budget, want a lightweight laptop with a compact form factor, and prefer MacOS, consider the Macbook Air M2. The laptop is available at a starting price of $1100, which includes 8GB of memory and 256GB of storage. The laptop also comes with the Apple M2 chip, which includes an 8-core CPU and 8-core GPU. If you need a variant with more storage, go for the 512GB option, which is available at $1400. Either of these setups will give you enough power to complete daily tasks efficiently. Speaking of design, the Macbook Air M2 is an absolute head-turner wherever you use it. The 13.6-inch IPS display could enable you to enjoy content wherever you go. Furthermore, the laptop can give you up to 18 hours of Apple TV app movie playback on a single charge and up to 15 hours of wireless web usage. You also get a 1080p FaceTime HD camera that is suitable for work-related video conferences. If you use the device outdoors in sunlight, the display can go up to 500 nits, which should help improve visibility by a decent margin. Shop for this lightweight yet powerful machine on Apple’s official website.

Top overall for Windows OS users – Lenovo ThinkPad X1 Carbon Gen 10 14-inch

Lenovo is famous for creating laptops for various industries, including for those who wish to carry out work-oriented tasks. The laptop features a 14-inch screen, making it ultraportable for users who are always on the move. Furthermore, the device is powered by the standard 12th Generation Intel® Core™ i5 processor. You could even pay an additional amount for a more powerful processor. The device includes a Windows 11 Home operating system, with 8 GB or 16GB of available RAM. As for the display, the base variant comes with a 14-inch IPS Anti-Glare display that makes it ideal for creating documents, spreadsheets, and reading PDF files. However, the electronic device packs enough juice to run slightly heavier applications or several tabs with minimal latency. The base model is available at a sale price of $1,320, instead of its original retail price of about $2,4000, and is available on Lenovo’s website.

Top pick for creators – 16-inch MacBook Pro

Another laptop from Apple that you should consider, especially if you create content, is the 16-inch MacBook Pro. The big screen will ensure you view videos and pictures with better colors and clarity. The base variant also comes with 16GB of RAM and is configurable up to 32GB, while the M2 MAX version can handle up to 96GB of RAM. You also get up to 512GB of SSD storage on the standard 16-inch Macbook Pro. The storage is also configurable, up to 8TB for those looking to store bigger files without rummaging for space, especially when they are on the move. Other bells and whistles included with the MacBook Pro are a six-speaker sound system with force-canceling woofers and HDMI digital video output support for one display with up to 8K resolution at 60Hz (4K resolution at 240Hz). There is also a 1080p FaceTime HD camera. You could pick the base model for about $2500, which comes with the Apple M2 Pro chip, or choose the Apple M2 Max chip starting at $3,100 for maximum performance. You can find the laptop on Apple’s official website.

Popular budget device – Acer Aspire 5 Notebook (A514-54-395V)

If you are interested in a budget-oriented laptop for work, the Aspire 5 Notebook is an ideal choice. The device has a Windows 11 Home OS installed, Intel® Core™ i3 11th-Gen processor, and 8GB of onboard RAM. The setup may allow you to take up and complete daily tasks such as typing documents, conducting research, and running a few tabs with ease. Apart from using the 14-inch screen for work purposes, you could also use it to enjoy streaming content. The device also features a battery that can last up to 10 hours (based on your usage) which is suitable for those who are on the move and do not always have access to a charging dock. The price of the Acer Aspire 5 Notebook is about $490 on the brand’s website. For the price, it also includes 256GB of SSD storage and a webcam.

Top 2-in-1 Chromebook – HP Elite Dragonfly 13.5 inch Chromebook (6K058UT#ABA)

ChromeOS enthusiasts who want a decent, 2-in-1 laptop for work should consider this option from HP. The Elite Dragonfly Chromebook is available for a sale price of $1,370 on the brand’s website, which is $150 lower than its retail price. The device also features good specifications, which include 8GB of memory, 128GB of SSD storage, and Intel®️ Core™️ i5 chipset. Furthermore, the device features a 13.5-inch display that is also touch-enabled, making navigating websites and opening pages much quicker. The touch display also means that you can fold the device and use it as a tablet when you are on the move. The screen can also render 2K content, which means you could use it to watch high-quality streaming content when you take some time off from work. You also get a 5MP camera to help take work-related video calls when you are at home or on the move.

People with anxiety disorders regularly and excessively experience fear and panic in everyday situations. If unchecked, anxiety can impair normal functioning and degrade the quality of life. One must consult a health expert if anxiety is affecting their social life. But first, ensure that any physical health issues are ruled out before consulting them. Most individuals with anxiety disorders need medication or therapy, but coping strategies and lifestyle decisions can also be helpful.

Stop and take a breath
When you experience an anxiety episode, take a moment to think about what is making you feel uneasy. Usual anxiety symptoms include concerns about a recent or distant event. For example, you can worry that something wrong will happen to you in the future. Or, you can still be upset about something that has already happened in the past. But, whatever your concerns, most anxiety issues stem from not focusing on the present. The next time you feel nervous and get distracted from the present moment, sit down and take some deep breaths to reclaim your composure. You can regain balance and return to the present moment by pausing and taking a few deep breaths. If you have the time, consider advancing this practice by experimenting with breathing techniques.

Noting down your triggers
One must identify what’s upsetting them to address the underlying cause of their anxiety. One can achieve it by setting aside time to assess your emotions and thoughts. Journaling is a fantastic method to connect with your anxiety triggers. Keep a diary or notepad beside your bed if your anxiety-related thoughts keep you awake at night. You can note down all the issues troubling you. Another technique to identify and understand your nervous feelings is speaking with a friend.

Consider the things you can change
Worrying about things or incidents that are yet to occur or might never occur can often lead to anxiety. For instance, even if everything is fine, you could still be concerned about unnecessary concerns such as losing your job, falling sick, or ensuring the security of your loved ones. Understanding the fact that life can be unexpected and you cannot constantly regulate what happens is vital. You can, though, choose how you will approach the unknowable. By letting go of anxiety and channeling your attention toward gratitude, you can transform your worries into a power source. Change your perspective on your fears to get rid of them.

Look for distractions
Sometimes, wilfully distracting yourself from your fears can be most beneficial. You can do so by helping others, performing housework, indulging in a fun activity or hobby like music, watching movies/shows, and more.

Learn to recognize and control your triggers
One can identify triggers either on your own or through a counselor. It may take time to pinpoint a long-term problem, such as financial difficulties or the workplace environment (deadlines, relations with colleagues, or any specific incident). Again, this can require some additional help through therapy or with colleagues. Limit your exposure once you’ve discovered your trigger. However, alternative coping strategies can be helpful if you cannot lessen it, for instance, if a challenging workplace triggers your trigger. Still, you are unable to move away immediately.

Implement cognitive behavioral therapy
Cognitive behavioral therapy (CBT) teaches people various ways to perceive and react to anxiety-triggering situations. With a therapist’s assistance, CBT teaches you to change negative thoughts through new habits and actions before they spiral into serious complications.

Socializing
Each person is unique, and not everyone experiences anxiety, but regularly spending time with loved ones can help one regulate anxiety levels if they experience such bouts. Social interactions mitigate loneliness, reduce stress, and encourage laughter and a sense of community. In addition, research shows social interaction can eventually increase your tolerance to stress.

Making changes to lifestyle habits
Lifestyle changes can also be beneficial in reducing anxiety and helping you cope with anxiety-related attacks. For example, your degree of physical exercise, the amount of rest you get, and what you eat affect your anxiety levels. Research indicates that food habits can impact mood or stress factors. For instance, those who eat foods high in vegetables and fruits usually have reduced stress levels. Your mental health and stress levels can both be significantly impacted by sleep. Research suggests that one potential cause for anxiety disorders, including generalized anxiety disorder, is sleep issues. An increase in tension and anxiety can result from even brief sleep disturbances.

Understand your condition
Consulting a healthcare professional will help a person discover what triggers their condition and the type of therapies that may be appropriate for managing it. Invite your loved ones and friends and solicit their assistance while seeking professional help.

Enquire about prescriptions with your doctor
If your anxiety becomes alarming and prompts a mental health practitioner to think you may benefit from prescription treatment, there are several ways to approach this method based on your symptoms. However, discuss your concerns with your doctor before opting for any prescription therapy.

Make changes to your nutritional regime
Nutritional changes and the use of supplements are long-term solutions to managing anxiety. Research indicates that regular intake of vitamins and nutrients can reduce anxiety levels in people. Lemon balm, green tea, and kava are a few items you can fit into your meal plan. It may take a few months to notice the benefits provided by these food choices. However, be careful while opting for herbal remedies, as they may involve side effects.

Most individuals occasionally experience episodes of anxiety. During such times, one can try breathing techniques, journaling, finding diversions, and taking overall care of yourself. Anxiety can also indicate an underlying mental health disorder when they interfere with social relationships, work productivity, and other aspects of life. Speak to your physician or a mental health expert if you regularly feel anxious or panicky. They’ll be able to answer your queries, explain the diagnosis, and walk you through possible treatment options.