It happens to millions of women and men. It's so frequent, in fact, that there's a billion dollar industry of "solutions" to the problem. We're talking hair loss, and it ain't no laughing matter.
Normally, our hair grows in a cycle. When hairs are in their growth phase, they are called anagen hairs. When they are resting (not growing), they are called telogen hairs. Catagen hairs are transitioning from growth to rest. Anagen hairs grow for about 3 years on average (the range can be between 2-6 years). The transition phase lasts about 1-2 weeks, and then hairs rest for 3-5 months. They shed, and the cycle starts all over again. At any given time, if you pluck a number of hairs from the scalp, about 85% will be in the growth phase and 10-15% will be resting. Less than 1% will be in the transition phase. We can tell this by the shape of the hair and follicle when it's examined under the microscope.
It's normal to shed 100-150 hairs daily. Think about it- that's a lot of hair. And even more so on days that you shampoo. But sometimes, that number increases, and the hair starts thinning or revealing bald patches. So let's look at some reasons why people lose their hair.
Pregnancy. During pregnancy, the anagen (growth) phase is often prolonged and many women enjoy thicker, fuller hair. On delivery of the baby, however, many follicles change into the telogen phase, and then are shed simultaneously, resulting in thinning/loss of hair 3-5 months after baby comes. This process is known as telogen effluvium. And it's one more reason to give your mom a hug-- she brought you into this world and then endured hair loss!
Iron Deficiency. Low iron levels (seen in a blood test), sometimes caused by mensturation or gastrointestinal blood loss, can also cause a telogen effluvium. Nutritional deficiencies are often treated with vitamin supplements and a varied, healthy diet.
Thyroid Deficiency. Variations in thyroid levels can often cause telogen effluvium as well. Levels can be checked with a simple blood test. Thyroid medications, usually monitored by an endocrinologist (doctor who specializes in hormones) can help.
Medications. Lots of medications can cause hair loss. Drug-induced telogen effluvium has been reported with amphetamines, blood pressure medications (captopril, metoprolol), antipsychotics (lithium), retinoids (etretinate), and more. Changing/discontinuing medications can help.
Androgenetic alopecia is another term for male-pattern and female-pattern baldness. In this condition, a hormone called dihydrotestosterone affects the androgen receptor gene to cause hair loss. There is likely a genetic component. Men tend to show a receeding hairline with loss of hair on the top of the scalp. Women tend to get thinning along the middle part of the hair in a "Christmas tree pattern." Several treatments are available, such as rogaine, and for men, finasteride (propecia) is FDA-approved.
Other conditions that can lead to hair loss include fungal infections, autoimmune diseases (such as lupus or alopecia areata), psoriasis, bacterial infections, and syphilis. Trauma to the hair from tight ponytails, frequent relaxer and hair color use, and overstyling can also lead to hair loss.
Often blood tests and scalp biopsies are useful to find the cause of the hair loss. Dermatologists are expert in skin, nails, and hair, and can help!
Wednesday, July 27, 2011
Tuesday, July 26, 2011
Keeping Up with Kim and Psoriasis
Kim Kardashian has revealed she has psoriasis. (Not ringworm, like Khloe originally thought). She now joins the millions of other people affected with this condition. So what is psoriasis?
Psoriasis is a common, chronic, inflammatory disease that can affect the skin and nails. Although it's not completely clear what causes it, it is an autoimmune disease where the body's own white blood cells (T-cells) attack the skin. There is also a genetic component. It happens equally in males and females, and usually appears when a person is in their late 20's, but it can be seen at any age, from babies to the elderly. Severe stress tends to make it worse (i.e. the dermatologist told Kim to work less).
Typically, psoriasis looks like red patches with white silvery thick scale on top. The patches can vary in size. Common locations include the elbows, knees, scalp, abdomen, and loewr back. Sometimes the patches can itch or burn. The nails can show changes, too - pitting (which look like little indentations), oil spots (yellow areas), or can be thickened. Patients can get arthritis which can affect the fingers and/or spine. Sometimes psoriasis can occur after a strep throat infection, and will look like little patches the size of water droplets.
The course of psoriasis is unpredictable. And unfortunately, currently there is no cure. But there are a lot of great treatment options to help manage this skin disease and relieve the pain from arthritis. A laser called the eximer laser is helpful for smaller areas or limited disease. Light treatments in the dermatologist's office can help for more widespread disease. Topical steroid, vitamin D, and retinoid creams and foams are often prescribed. More more extensive disease, oral treatments are available. The most recent class of medications are called the biologics. These are injected by the patient every month and are extremely beneficial to relieve both the skin lesions and the arthritis. Some names of medications you may have seen comercials for are enbrel, humira, and stellara. They can make a huge difference in daily quality of life.
The bottom line: there's hope.
Psoriasis is a common, chronic, inflammatory disease that can affect the skin and nails. Although it's not completely clear what causes it, it is an autoimmune disease where the body's own white blood cells (T-cells) attack the skin. There is also a genetic component. It happens equally in males and females, and usually appears when a person is in their late 20's, but it can be seen at any age, from babies to the elderly. Severe stress tends to make it worse (i.e. the dermatologist told Kim to work less).
Typically, psoriasis looks like red patches with white silvery thick scale on top. The patches can vary in size. Common locations include the elbows, knees, scalp, abdomen, and loewr back. Sometimes the patches can itch or burn. The nails can show changes, too - pitting (which look like little indentations), oil spots (yellow areas), or can be thickened. Patients can get arthritis which can affect the fingers and/or spine. Sometimes psoriasis can occur after a strep throat infection, and will look like little patches the size of water droplets.
The course of psoriasis is unpredictable. And unfortunately, currently there is no cure. But there are a lot of great treatment options to help manage this skin disease and relieve the pain from arthritis. A laser called the eximer laser is helpful for smaller areas or limited disease. Light treatments in the dermatologist's office can help for more widespread disease. Topical steroid, vitamin D, and retinoid creams and foams are often prescribed. More more extensive disease, oral treatments are available. The most recent class of medications are called the biologics. These are injected by the patient every month and are extremely beneficial to relieve both the skin lesions and the arthritis. Some names of medications you may have seen comercials for are enbrel, humira, and stellara. They can make a huge difference in daily quality of life.
The bottom line: there's hope.
Monday, July 25, 2011
An Unwelcome Guest
We've all seen someone with it. Or maybe you've got it yourself. The dreaded cold sore on the corner of the lip. It warns you it's coming with a tingling and burning feeling, then the painful blisters arrive and often outstay their welcome. So what's the deal with these cold sores? Where do they come from?
A virus called herpes simplex virus (HSV) is responsible for causing cold sores, also referred to as fever blisters. It most commonly occurs in young adults, but can be seen at any age, including infancy. Many people are infected with the virus and never develop cold sores. Others may have sores but they aren't painful or symptomatic. And yet others will have fever, headache, or pain associated with the blisters.
80-90% of herpes infections seen on the lips are caused by HSV type 1, and 10-20% are caused by HSV type 2. Genital herpes is usually reversed, with 70-90% caused by HSV-2, and 10-30% caused by HSV-1. But this is not a hard and fast rule; either type can be seen with lips or genitals.
So how is this virus spread? Usually skin-skin contact is required. The virus is shed in skin or secretions. When herpes is seen in wrestlers due to skin-to-skin contact, it's called herpes gladiatorum, and is more common on the head, neck, or shoulder.
Unfortunately, once you've contracted HSV, it's there for life. (So what happens in Vegas doesn't always stay in Vegas...). It stays dormant in the nerves and gets reactivated later on. About 1/3 of people with cold sores on the lips will have a recurrence. And of these, 1/2 will have at least two recurrences annually. Usually there is a precipitating factor to bring it out: sunburns/sun exposure, fevers/colds, stress, and altered hormones.
Before we discuss treatment, let's talk prevention. Avoid skin-to-skin contact with an area during an outbreak. The outbreaks are usually treated with oral antiviral medications such as acyclovir, valcyclovir (valtrex), or famciclovir. If the outbreaks are very frequent, daily suppressive therapy may be used. There are topical presciption creams, as well, but they are typically not as effective as the pills. The medications work best if they're used as soon as the tingling/burning feeling comes on. Although there's no cure, with today's treatments, the discomfort can be minimized and sometimes prevented.
A virus called herpes simplex virus (HSV) is responsible for causing cold sores, also referred to as fever blisters. It most commonly occurs in young adults, but can be seen at any age, including infancy. Many people are infected with the virus and never develop cold sores. Others may have sores but they aren't painful or symptomatic. And yet others will have fever, headache, or pain associated with the blisters.
80-90% of herpes infections seen on the lips are caused by HSV type 1, and 10-20% are caused by HSV type 2. Genital herpes is usually reversed, with 70-90% caused by HSV-2, and 10-30% caused by HSV-1. But this is not a hard and fast rule; either type can be seen with lips or genitals.
So how is this virus spread? Usually skin-skin contact is required. The virus is shed in skin or secretions. When herpes is seen in wrestlers due to skin-to-skin contact, it's called herpes gladiatorum, and is more common on the head, neck, or shoulder.
Unfortunately, once you've contracted HSV, it's there for life. (So what happens in Vegas doesn't always stay in Vegas...). It stays dormant in the nerves and gets reactivated later on. About 1/3 of people with cold sores on the lips will have a recurrence. And of these, 1/2 will have at least two recurrences annually. Usually there is a precipitating factor to bring it out: sunburns/sun exposure, fevers/colds, stress, and altered hormones.
Before we discuss treatment, let's talk prevention. Avoid skin-to-skin contact with an area during an outbreak. The outbreaks are usually treated with oral antiviral medications such as acyclovir, valcyclovir (valtrex), or famciclovir. If the outbreaks are very frequent, daily suppressive therapy may be used. There are topical presciption creams, as well, but they are typically not as effective as the pills. The medications work best if they're used as soon as the tingling/burning feeling comes on. Although there's no cure, with today's treatments, the discomfort can be minimized and sometimes prevented.
Wednesday, July 20, 2011
3-2-1 Contact!
Almost daily, I see someone with an itchy rash from something they came into contact with that has irritated the skin. This condition is called, fittingly, contact dermatitis. Figuring out what caused the rash requires a little bit of detective work. Luckily, the location of the rash can often give some clues:
Eyelid rashes: the most common causes are nail polish (especially containing formaldehyde) and acrylic nails (the glue contains ethyl methacrylate or methyl methacrylate). Also makeup/cosmetics (preservatives like methylchloroisothiazinolone and imidazolidinyl urea) can irritate the eyelids. Contact solution containing thimerosal is a common culprit.
Earlobes and belly buttons/abdomen rashes are often caused by items containing nickel, the most common allergen. This includes costume jewelery, belt buckles, and metal snaps/fasteners that rub against the skin. Kids with eczema/atopic dermatitis (see my previous post- Itchin' An A Scratchin'- to learn about this condition) often have nickel allergy. Parents can sew patches on the inside of pants to keep the metal parts from coming into contact with skin. Test before you wear: a chemical called dimethylglyoxime can be painted on a metal object and will turn pink if it contains nickel.
Hand contact dermatitis often varies based on profession and hobbies. People who wear gloves often have allergies to latex and rubber. A fun fact: people allergic to latex may also be allergic to avocado, bananas, chestnuts, and kiwi. Dentists and surgeons can get rashes from ethyl methacralate. Cleaning agents can contain preservatives that release formaldehyde. (Aside from the fact that frequently wetting hands will cause irritation in general). Hobbies, like building model planes and cars, can expose you to glues.
Foot contact dermatitis may be caused by the rubber in shoes (mercaptobenzothiazole) or the leather portion (chromates). The rubber part along the top of socks may cause a contact dermatitis on the shins.
Scalp contact dermatitis may be due to hair dyes containing para-phenylenediamine. This chemical is found in henna tattoos (this is what makes the tattoo have that black color instead of the traditional reddish-brown), and people can get rashes from those, too.
One of the most common allergies is to neomycin. This is found in topical antibiotic creams or first-aid creams, ear drops, and nose drops. Often people are also allergic to bacitracin as well.
And the list doesn't stop there. People can be allergic to fragrances, lanolin, tape adhesive, plants, and medications. If the cause of the contact dermatitis isn't obvious, patch testing can be performed by the dermatologist, where the most common allergens are taped on the back and then removed a few days later to look for a reaction. Learning what allergens to avoid can make all the difference!
Eyelid rashes: the most common causes are nail polish (especially containing formaldehyde) and acrylic nails (the glue contains ethyl methacrylate or methyl methacrylate). Also makeup/cosmetics (preservatives like methylchloroisothiazinolone and imidazolidinyl urea) can irritate the eyelids. Contact solution containing thimerosal is a common culprit.
Earlobes and belly buttons/abdomen rashes are often caused by items containing nickel, the most common allergen. This includes costume jewelery, belt buckles, and metal snaps/fasteners that rub against the skin. Kids with eczema/atopic dermatitis (see my previous post- Itchin' An A Scratchin'- to learn about this condition) often have nickel allergy. Parents can sew patches on the inside of pants to keep the metal parts from coming into contact with skin. Test before you wear: a chemical called dimethylglyoxime can be painted on a metal object and will turn pink if it contains nickel.
Hand contact dermatitis often varies based on profession and hobbies. People who wear gloves often have allergies to latex and rubber. A fun fact: people allergic to latex may also be allergic to avocado, bananas, chestnuts, and kiwi. Dentists and surgeons can get rashes from ethyl methacralate. Cleaning agents can contain preservatives that release formaldehyde. (Aside from the fact that frequently wetting hands will cause irritation in general). Hobbies, like building model planes and cars, can expose you to glues.
Foot contact dermatitis may be caused by the rubber in shoes (mercaptobenzothiazole) or the leather portion (chromates). The rubber part along the top of socks may cause a contact dermatitis on the shins.
Scalp contact dermatitis may be due to hair dyes containing para-phenylenediamine. This chemical is found in henna tattoos (this is what makes the tattoo have that black color instead of the traditional reddish-brown), and people can get rashes from those, too.
One of the most common allergies is to neomycin. This is found in topical antibiotic creams or first-aid creams, ear drops, and nose drops. Often people are also allergic to bacitracin as well.
And the list doesn't stop there. People can be allergic to fragrances, lanolin, tape adhesive, plants, and medications. If the cause of the contact dermatitis isn't obvious, patch testing can be performed by the dermatologist, where the most common allergens are taped on the back and then removed a few days later to look for a reaction. Learning what allergens to avoid can make all the difference!
Monday, July 11, 2011
Melanoma
This past weekend, The Miami Herald published a special section called skin health. In it, they talked about two new drugs for the treatment of advanced (stage 3 and 4) melanoma. These are the FDA approved Ipilimumab, or Yervoy, and the not-yet approved Vemufafenib. These drugs are very promising and exciting because patients diagnosed with advanced melanoma have previously had few options for treatment, and are often facing a sentence of less than 6 months to live. The studies, (part of which were performed at Mount Sinai in South Florida) are promising and show a lot of hope for those with advanced disease.
It's really important to realize though, that IF melanoma is caught and treated early, it can be nearly 100% curable. Thankfully, the majority of melanomas that I see are called melanoma in situ (stage 0). This means that the melanoma is in the very very top layer of the skin and has not penetrated deeply. It's removed surgically, done in the office under local anesthesia. Even melanomas that go a little bit deeper in the skin (stage 1, 2) often have a good prognosis and are treated with surgical excision. Melanomas that measure deeper need more testing (in addition to the surgical removal), such as lymph node testing and imaging. If a melanoma is deeper than that, then it is considered advanced and chemotherapy is added to the treatment regimen.
Early detection is the KEY. Any new, changing, itchy, bleeding, crusting mole needs to be evaluated asap by a dermatologist. Don't wait to see your doctor. With melanoma, the depth is the greatest predictor of survival. The earlier we catch it, the better. But once you've been diagnosed with melanoma, you're at increased risk for developing another one. You'll need close monitoring by your dermatologist for the rest of your life.
While genetics definitely plays a role in the development of melanoma, what you do on a daily basis makes a difference. Of course, sunburns are a big no no, which I think pretty much everyone knows. But any tan is a sign of sun damage, which puts you at risk for melanoma. DON'T TAN - either in the salon or outdoors. "Oh, don't worry, Doc, my skin is naturally tanned." Really? Take a look at your buttocks. That is your real skin color. Still think you're naturally tanned? Slather on a physical blocker, at least an SPF 30, and reapply. Avoid the sun between 10 am - 4 pm, when the rays are strongest. Wear a hat, sunglasses, and sun protective clothing. Stay in the shade. And teach your kids to do the same.
While we are all excited over the new developments for advanced melanoma, my hope is that with prevention and early detection, we won't have to use them.
It's really important to realize though, that IF melanoma is caught and treated early, it can be nearly 100% curable. Thankfully, the majority of melanomas that I see are called melanoma in situ (stage 0). This means that the melanoma is in the very very top layer of the skin and has not penetrated deeply. It's removed surgically, done in the office under local anesthesia. Even melanomas that go a little bit deeper in the skin (stage 1, 2) often have a good prognosis and are treated with surgical excision. Melanomas that measure deeper need more testing (in addition to the surgical removal), such as lymph node testing and imaging. If a melanoma is deeper than that, then it is considered advanced and chemotherapy is added to the treatment regimen.
Early detection is the KEY. Any new, changing, itchy, bleeding, crusting mole needs to be evaluated asap by a dermatologist. Don't wait to see your doctor. With melanoma, the depth is the greatest predictor of survival. The earlier we catch it, the better. But once you've been diagnosed with melanoma, you're at increased risk for developing another one. You'll need close monitoring by your dermatologist for the rest of your life.
While genetics definitely plays a role in the development of melanoma, what you do on a daily basis makes a difference. Of course, sunburns are a big no no, which I think pretty much everyone knows. But any tan is a sign of sun damage, which puts you at risk for melanoma. DON'T TAN - either in the salon or outdoors. "Oh, don't worry, Doc, my skin is naturally tanned." Really? Take a look at your buttocks. That is your real skin color. Still think you're naturally tanned? Slather on a physical blocker, at least an SPF 30, and reapply. Avoid the sun between 10 am - 4 pm, when the rays are strongest. Wear a hat, sunglasses, and sun protective clothing. Stay in the shade. And teach your kids to do the same.
While we are all excited over the new developments for advanced melanoma, my hope is that with prevention and early detection, we won't have to use them.
Thursday, July 7, 2011
Itchin' an a scratchin'
I see it in babies, kids, teens, and adults. It gets itchy, sometimes infected, and often annoying to patients. In Greek eczema means "to boil over," which refers to the blistering or weepy phase of the disease. Eczema can start in infancy as crusted patches on the scalp, cheeks, tushies, arms, and legs. Later, as kids get older, it often shows up on the inside of arms and backs of knees. Adults usually develop hand and finger dryness and cracking, which is often painful.
Although we don't know exactly what causes it, it seems to run in families and has a genetic link. The immune system may be more sensitive to certain triggers. Often, asthma and seasonal allergies run together with eczema. People that have two of three of this conditions are called "atopics." They have sensitive skin that is easily irritated.
Here are my tips for anyone with eczema or sensitive skin. Make sure all soaps, detergents, and moisturizers are mild and fragrance free. I like dove, cetaphil, cerave, eucerin, and vanicream. Since I just mentioned moisturizers, let me say it again: MOISTURIZE! You can't do it enough. The love of my life (after my hubby and daughter) is aquaphor. I love it for any skin area, as a lip moisturizer, for laser and peel after-care, for wound healing, on areas after biopsies and surgeries, etc. Slather it on. If it seems too greasy to use during the day, put it on at night and sleep with it. For dry, cracked hands, slap on aquaphor and then cotton gloves on top. It's amazing stuff. Did I mention that I love it? Make sure baths and showers use lukewarm water, not hot water. Moisturize right after coming out of the bath, when skin is still damp. Avoid soaking your hands in water; use gloves when doing the dishes or housework. And certain fabrics, like wool, can be very irritating to atopic skin.
When moisturizing is just not enough, there are prescription steroid and non-steroid creams for the skin, as well as antihistamines that can be recommended by your doctor. Also: raw, scratched areas can easily become superinfected with bacteria and viruses, so it's important to see a dermatologist regularly. Although many kids will outgrow eczema, there are plenty of adults with it to tell you that this doesn't always happen. Luckily, summer months are usually better for atopic skin than cold, dry winters. And here in south Florida, we have plenty of summer!
Although we don't know exactly what causes it, it seems to run in families and has a genetic link. The immune system may be more sensitive to certain triggers. Often, asthma and seasonal allergies run together with eczema. People that have two of three of this conditions are called "atopics." They have sensitive skin that is easily irritated.
Here are my tips for anyone with eczema or sensitive skin. Make sure all soaps, detergents, and moisturizers are mild and fragrance free. I like dove, cetaphil, cerave, eucerin, and vanicream. Since I just mentioned moisturizers, let me say it again: MOISTURIZE! You can't do it enough. The love of my life (after my hubby and daughter) is aquaphor. I love it for any skin area, as a lip moisturizer, for laser and peel after-care, for wound healing, on areas after biopsies and surgeries, etc. Slather it on. If it seems too greasy to use during the day, put it on at night and sleep with it. For dry, cracked hands, slap on aquaphor and then cotton gloves on top. It's amazing stuff. Did I mention that I love it? Make sure baths and showers use lukewarm water, not hot water. Moisturize right after coming out of the bath, when skin is still damp. Avoid soaking your hands in water; use gloves when doing the dishes or housework. And certain fabrics, like wool, can be very irritating to atopic skin.
When moisturizing is just not enough, there are prescription steroid and non-steroid creams for the skin, as well as antihistamines that can be recommended by your doctor. Also: raw, scratched areas can easily become superinfected with bacteria and viruses, so it's important to see a dermatologist regularly. Although many kids will outgrow eczema, there are plenty of adults with it to tell you that this doesn't always happen. Luckily, summer months are usually better for atopic skin than cold, dry winters. And here in south Florida, we have plenty of summer!
Tuesday, July 5, 2011
The Appeal of Peels
What can brighten dark spots, improve acne, even out skin tone, and treat mild photoaging, but with minimal downtime? Glycolic acid peels! Of all the tools in the dermatologist's toolbox, a glycolic acid peel is a tried and true procedure for great cosmetic results and an overall improved texture of the skin.
What is glycolic acid? It's an AHA, alpha-hydroxy acid, which is a naturally occurring compound made from sugar. The depth or strength of the peel depends on which concentration is used. 20-50% glycolic acid is a very superficial peel, while 50-70% is a little stronger (deeper), but still considered a superficial peel. Superficial peels affect the very top layers of the skin, so there is little risk of scarring or hyperpigmentation (darkening after the peel).
What happens when I come for a peel? Before the peel, the skin is cleansed with soap and water, cleansed with alcohol or acetone, and the rinsed with water. The reason for this is to remove oil and debris from the skin. The glycolic acid is then applied to the skin. Usually it is left on for 2-4 minutes. It may sting a little or feel like mild burning during this. Often, handheld fan helps. Then the skin is neutralized with a solution and/or washed with water.
What happens after? Most people will have mild redness/pinkness a day or two after the peel. If it was a deeper peel, mild crusting can be seen. Often, vaseline is applied to help with healing. After any peel, it's very important to avoid the sun and wear sunscreen. Daily moisturizer should be applied. Smoking is should be avoided (although, shouldn't it always be avoided?) because it slows healing.
And then? Radiant, healthier looking skin! Peels can be done every few weeks. Who shouldn't do peels? Anyone who has been on accutane in the last 6 months, anyone with an active herpes infection, and anyone with a tan. Not that you would ever be tan, though...right?!
What is glycolic acid? It's an AHA, alpha-hydroxy acid, which is a naturally occurring compound made from sugar. The depth or strength of the peel depends on which concentration is used. 20-50% glycolic acid is a very superficial peel, while 50-70% is a little stronger (deeper), but still considered a superficial peel. Superficial peels affect the very top layers of the skin, so there is little risk of scarring or hyperpigmentation (darkening after the peel).
What happens when I come for a peel? Before the peel, the skin is cleansed with soap and water, cleansed with alcohol or acetone, and the rinsed with water. The reason for this is to remove oil and debris from the skin. The glycolic acid is then applied to the skin. Usually it is left on for 2-4 minutes. It may sting a little or feel like mild burning during this. Often, handheld fan helps. Then the skin is neutralized with a solution and/or washed with water.
What happens after? Most people will have mild redness/pinkness a day or two after the peel. If it was a deeper peel, mild crusting can be seen. Often, vaseline is applied to help with healing. After any peel, it's very important to avoid the sun and wear sunscreen. Daily moisturizer should be applied. Smoking is should be avoided (although, shouldn't it always be avoided?) because it slows healing.
And then? Radiant, healthier looking skin! Peels can be done every few weeks. Who shouldn't do peels? Anyone who has been on accutane in the last 6 months, anyone with an active herpes infection, and anyone with a tan. Not that you would ever be tan, though...right?!
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