ADHD in Children - old answers, new facts
The diagnosis of Attention Deficit and Hyperactivity Disorder (ADHD) has been around for some time. In understanding ADHD, it may help to sort out the tried and true from more recent information and research about the condition.

Allergic Rhinitis - Understanding and controlling a common condition
Allergic rhinitis involves a natural body response that is out of control. You may already be familiar with the symptoms – a drippy blocked nose, mouth breathing, aches in forehead and cheeks, perhaps a spouse who complains about your snoring. Over a quarter of people experience these problems – fortunately not most of the time, but often for several weeks every year. You may not have known you or your child had allergic rhinitis. However, once you recognize the signs, there are many ways to reduce the effects.

Allergies - Managing an annoying and sometimes life-threatening condition
Spring and summer are well-known as the seasons when 'hayfever' strikes. The common symptoms are itchy, red, watery eyes, a runny nose and sneezing. Coughing and wheezing may occur in more serious cases. The discomfort usually lasts for several weeks through the period when the trees pollinate in April and May, and the grasses flourish from May to July. In eastern Canada, the ragweed season in late summer can be the most troublesome for sufferers.

Antibiotic Use - Not all bugs need drugs
Antibiotics are clearly one of the most important discoveries of modern medicine. In the 60 years since they have been discovered, antibiotics have saved millions of lives. Unfortunately, some bacteria can no longer be killed by antibiotics.

Arthritis and You - understanding a common condition
Arthritis refers to a group of more than 100 diseases that cause pain, swelling and limited movement in or around the joints. The condition affects one in six Canadians and has no known cause or cure. It is not simply a disease of the elderly. Juvenile arthritis affects many kids, and most people with rheumatoid arthritis are between the ages of 30 and 50. Still, we often think of arthritis as a natural part of aging, and that nothing can be done about it.

Asthma - understanding this common chronic disease
Asthma is the most common chronic disease of childhood. Unfortunately, over 500 asthma-related deaths occur each year in Canada. The good news is that they are all preventable. More and more people are being diagnosed with asthma, for many reasons. Indoor and outdoor air pollution may contribute. Health care professionals are also increasingly aware that a persistent wheeze or cough may actually be asthma.

Back Pain - conquering the myths
It is the end of a long, tiring day at work. As you pull into the driveway and undo your seatbelt after battling rush-hour traffic, your mind turns to what you will make for dinner. Your next move chases routine thoughts from your mind. You twist to get out of the car. It’s a perfectly ordinary move, one that you have done countless times before. This time, however, a sudden, severe stab of pain in your lower back takes your breath away.

Birth Control - understand your options
There are many different ways to prevent pregnancy. Both partners should be involved since birth control is a shared responsibility. If pregnancy is not wanted, a reliable method of birth control must be used every time intercourse occurs. It is also important to protect against sexually transmitted diseases (STDs).

Blood Transfusions - Questions and answers about blood products
A transfusion is the injection of a blood product through a needle inserted into a patien's vein. Many blood products are made by Canadian Blood Services (CBS) from human blood donated by volunteers across Canada. Commonly transfused blood products are red cells, platelets and plasma.

Breast and Prostate Cancer Screening Recommendations
Many people are confused by recent recommendations to screen less often for breast and not to screen for prostate cancer. Those who have had cancer found and treated through these tests defend their value. The idea of finding such a disease early is appealing, and makes recommendations to delay or omit screening hard to understand.

Carpal Tunnel Syndrome - can it be helped?
A commonly diagnosed condition associated with the modern workplace is carpal tunnel syndrome (CTS). CTS is a collection of symptoms caused when the median nerve at the wrist becomes compressed.

Chronic Obstructive Pulmonary Disease (COPD) - when breathing becomes a chore
Most people never think about breathing. For those who suffer from Chronic Obstructive Pulmonary Disease (COPD), breathing can be all they think about. COPD affects the airways, or the tubes that take air to the lungs, and the air sacs in the lungs. COPD is different from asthma. While asthma symptoms can be reversed, COPD is permanent, and we cannot make it go away. However, there are things people with COPD can do to improve their breathing and reduce the effects of COPD on their daily lives. Since COPD is almost always the direct result of a person smoking, it is very important that someone with COPD quit smoking as soon as possible. Not everyone who smokes will develop COPD. A very small number of people who have never smoked will get this disease.
Colon Cancer Screening - health from the inside out
When you think of having your health checked, what comes to mind? Being weighed and measured, having vision tested, checking the heart and lungs, and measuring blood pressure are all routine. Women think of Pap tests, and women over 50, mammograms. However, many of us forget to think about the health of the digestive system – specifically, the colon (large intestine) and rectum. It is time that we did.

Contact Lenses - many choices, many options
Improved contact lenses with new materials and designs enter the market all the time. Today, contacts fit better, pass more oxygen, bridge over uneven eye shapes, stay cleaner and give striking colours to the eyes. Even astigmatism can now be corrected with them.

Contraception - answers to common questions
Family planning is an important aspect of life and a basic human right. In 2003, the Society of Obstetricians and Gynaecologists of Canada brought together a group of health care professionals to update the Canadian ...

Diabetes Management - learn your ABCs and stay healthy
Diabetes is a very complex disease that can lead to the development of serious complications. Managing diabetes involves controlling blood glucose levels, eating well and maintaining an active lifestyle. Knowing the ABCs of diabetes also helps with staying healthy.

Diarrhea - always a bother, sometimes serious
In Canada, the United States and Europe, diarrhea is an important cause of death in young children. In less developed countries, diarrhea accounts for more infant deaths than any other ailment.

Dizziness - When Your World Begins to Spin
As people get older, they are more likely to experience dizziness. For an older person, this can be very disabling. While dizziness is often a vague symptom, it is very disruptive to everyday activities. It can be difficult to do household chores, shop, walk or even enjoy leisure activities such as golf.

Do I Need a Bone Density Test? Your questions answered
The current Canadian guidelines suggest that all men and women should have a bone density test if they are over the age 65. Younger people may have a bone density test if they have certain conditions known to weaken bones or lower the body’s ability to absorb calcium. Those with a low risk of fracture may repeat a bone density test in five to 10 years. People at higher risk may be advised to test more often. Protecting bone health begins long before you reach the age where bones are at higher risk of breaking. As you grow older, you may need to actively prevent fractures. While bone density testing and supplements play a role, advice on when to use them is changing.

Does Your Heart Measure Up? - Take charge of your heart health
Keeping your heart fit and healthy is basic to enjoying a long, active life. A large part of having a healthy heart is up to you. It is a matter of choice and you can do it!

Driving Vision - Can you see well enough to drive?
Several eye diseases become more common after the age of 40. By the time we become senior citizens, these conditions may affect our ability to drive a car. For this reason, regular eye exams become increasingly important as we age. What are some of the eye diseases that can cause problems?

Dealing with Dry Eyes - More than one cause, more than one solution
Do your eyes often burn, feel gritty or sandy? Are they dry and scratchy? If so, you may have a dry eye syndrome. Dryness can come from different sources, and ranges in severity. As more than one cause may be involved, a combination of approaches may be needed to provide relief.

How Digital Technology is Improving Your Care - Not the health care system you once knew
Computers are used in your doctor’s office, and by just about every other member of the health care team. Computers record and track your health information. They help your health care team to provide you with better care.

Eczema - the itch that rashes
Eczema, or atopic dermatitis, appears as dry, red, painfully itchy patches of skin. It often emerges in infancy and childhood, though it can happen at any age. Since scratching further inflames the skin, eczema is called ‘the itch that rashes.

Electronic Medical Records - computers have advantages for both doctors and patients
Everywhere today, we use computer devices to assist us with our tasks. Whether it be having an oil change, withdrawing money, buying dinner or shoes, or forecasting weather, computers are key in supporting work and recording information. It is no surprise that many doctors and other health care providers are using computers to help with patient care.

Epilepsy - Facts about a common disorder
Epilepsy is a common disorder. In Canada, about one to two percent of all people have epilepsy. According to Epilepsy Canada’s 2000 survey, 75 to 80 percent of people who have epilepsy develop it before the age of 18. While epilepsy is often thought of as a childhood condition, it can develop at any time in life.

Is an Annual Eye Exam Necessary? - It all depends on your age
Whether or not you need an annual check-up largely depends on your age. Doctors perform examinations that can detect early signs of disease. It is generally easier to treat diseases discovered early than those found in advanced stages. Various illnesses are more common at different times of life. Treatable eye disease is fairly common in children and quite common in the elderly. Youngsters and seniors have the most to gain from regular check-ups.

Fibromyalgia - It’s a real pain
Fibromyalgia is persistent, widespread pain and tenderness affecting the muscles. It is a chronic condition. Three to six per cent of the population may be affected, women more often than men. Although the term is quite new, fibromyalgia was described in the Bible. Other terms include fibrositis, myofibrositis, and tender point syndrome. Fibromyalgia is a major, costly cause of long-term disability. One large insurance company in Canada made payments of $11 million a year to clients with fibromyalgia.

Floaters and Flashes - Should you be concerned about them?
Seeing floaters or flashes in your vision is common and usually not serious. Still, sometimes they indicate the beginning of a serious problem. What are these symptoms and what do they mean?

Food Poisoning - was it something I ate?
Foodborne illness (food poisoning) strikes about two million Canadians and costs society over $1 billion each year. Accurate numbers are difficult to determine because only about one in 25 cases is reported. Many people pass the symptoms off as "stomach flu."

Your Gallbladder - do you really need it?
You may have a friend or relative who has had abdominal pain from problems with the gallbladder. Perhaps you have experienced it yourself. In either case, you probably know that gallbladder disease can be both painful and serious. Fortunately, it is usually very treatable.

Get Active! It's the key to good health
Name a serious disease associated with aging – heart disease, stroke, adult onset diabetes, osteoporosis, colon cancer, premature disability – and you will find physical inactivity to be a major risk factor. Medical experts believe aging is not the only reason why we decline in mobility between the ages of 30 and 70. An inactive lifestyle may account for up to half of this decline. Contentment and independence in our later years directly depend on how physically active we are now. Exercise is an investment – the cheapest anti-aging pill going.

Get the Most from Visiting your Doctor - Good preparation is essential
In these rushed days, time is precious. This is especially true in the stressed area of health care. How often have you left your doctor feeling that your concerns have not been addressed or that you did not get the answers that you need?

Glare - simple methods to avoid it
Many people in this world are sensitive to light. Being photosensitive can cause problems such as headaches and eye fatigue. Many common-sense ways exist to tone down brightness and glare in your work and home environment.

Heading off Headaches - their causes and how to control them
Do headaches affect your quality of life? If the answer is yes, you are not alone. Almost half of Canadians say they suffer from headaches. Although seldom life threatening, headaches can severely affect day-to-day life. Your relationship with family members and friends, social life, and effectiveness on the job can all suffer.

How to Talk To Your Doctor - tips on getting the help you need
Communicating with a doctor can sometimes be difficult. You may feel embarrassed about your symptoms, or fear the cause of your illness. Perhaps time is limited or you lack a relationship with the doctor. Any of these could mean that important information is missed or not addressed. Expressing your symptoms, ideas, and fears clearly is key to ensuring that you are satisfied with your visit.

Working with a Health-care Team - Anne's Story
Health-care teams work. They can help patients with or without chronic diseases. While not all teams are alike, they share the same basic principle: a group of professionals, each with an area of expertise, that works with patients to help them take control of their health and their lives.

Hemorrhoids - the bottom line
People complaining of itching, burning, pain or bleeding around the anus often go to their doctor complaining of hemorrhoids. Interestingly they are often wrong. It may be hemorrhoids causing the problem, but is also quite likely another unrelated problem ranging from an easily treatable skin condition to a much more serious condition such as cancer of the anus or rectum. The biggest error patient’s and physicians alike make when dealing with these common complaints, is to assume the diagnosis of hemorrhoids is correct and embark on a treatment program that doesn’t help and often hurts.

Hepatitis C - questions and answers
When HIV was discovered, people had many questions about this virus as they tried to understand the infection and learn how to protect themselves from it. More recently another disease caused by a virus, hepatitis C, has been prominent in the news. People became ill after receiving blood contaminated by the virus. Once again, people want to understand the disease and learn how it can be prevented..

High Blood Pressure - The facts about hypertension
Your heart pumps blood around your body. Blood pressure is the force of blood pushing against the walls of your arteries. This force is necessary to make blood flow, delivering oxygen and nutrients throughout your body. However, high blood pressure or hypertension means there is too much pressure in your arteries. This can damage them and cause health problems.

How to Talk To Your Doctor - tips on getting the help you need
Communicating with a doctor can sometimes be difficult. You may feel embarrassed about your symptoms, or fear the cause of your illness. Perhaps time is limited or you lack a relationship with the doctor. Any of these could mean that important information is missed or not addressed. Expressing your symptoms, ideas, and fears clearly is key to ensuring that you are satisfied with your visit.

Human Papilloma Virus – Vaccine - a new era in cancer prevention
You probably know about the human papilloma virus (HPV) that causes warts on your hands and feet. Many of us have had at least one wart that resulted in a visit to the pharmacy or the doctor’s office for treatment. What you may not know is that many different types of HPV exist. Some are harmless, some cause warts, and others are linked to certain types of cancer.

Insomnia - What to do when you can't sleep
Insomnia is a sleep disorder that affects as much as 30 to 35 per cent of the Canadian population. Insomnia can take many forms. Some people have trouble falling asleep, while other people have trouble staying asleep. Other people wake up too early, or have a restless sleep, leaving them feeling drained during the day.

Irritable Bowel Syndrome - easing a condition that can tie you in knots
Donna is 29 and has had trouble with her stomach since adolescence. Minor bouts of constipation, diarrhea and abdominal pains have come and gone for most of her adult life. These problems never became severe enough or lasted long enough for Donna to see her doctor – until recently. To her surprise, her symptoms suddenly became much worse. Her bowel movements began to alternate between diarrhea and constipation. She seldom had a normal bowel movement. As the weeks went by, her stomach cramps became more painful. Frequent trips to the bathroom and recurring abdominal pain made life miserable. Donna talked to her family doctor, who explained that her symptoms were typical of a common and often debilitating condition called irritable bowel syndrome (IBS).

Joint Replacement Surgery - Giving joints a new lease on life
Orthopedic surgeons have been replacing hips and knees for about 40 years now. In that time, surgical techniques and designs for artificial joints have greatly improved. Today, hip and knee replacement surgery is one of the best ways to relieve severe joint pain and restore mobility.

Kidney Disease - a surprise that could change your life forever
Some surprises can be fun and empowering – a gift, a promotion, a new grandchild. Another kind of surprise is no fun at all. That surprise is kidney disease. Left undetected, it can be devastating to your health. Could you have it?

Learning to Live with Diabetes
You've just been told that you have diabetes. People respond to this diagnosis in many ways. You may have been on the journey towards diabetes for a long time. Perhaps your blood glucose has been elevated for years and you were told to just be careful. You may feel shock, disbelief, anger, frustration, and maybe even denial - all very common responses. One of the most effective ways to deal with these emotions is by learning more about how to live with your condition.

Low Back Pain - help managing a common problem
If you've ever experienced low back pain, you already know how disabling it can be. Understanding how your spine and muscles work together and how they can be injured can help you manage the condition.

Low Thyroid? - The symptoms and treatment of hypothyroidism
If you wonder why you feel tired or are gaining weight, low thyroid function may be the reason. This is especially true if you are a teen or a pre-menopausal woman. However, fatigue and weight gain are only two of several symptoms, and men and older people are increasingly at risk of this condition. In recent years, diagnosis and treatment of hypothyroidism have been closely examined.

Managing Migraines - how to cope with this disabling condition
If you suffer from migraines, you know firsthand just how disabling the pain can be. This common headache disorder affects 18 per cent of women and six per cent of men. The impact of migraine on patients and their families is extreme. The severity of migraine pain can be disabling and result in lower quality of life. Society also pays a price for migraines, in direct medical expenses and indirect costs linked to low productivity and lost work time.

Meningitis - Spot the signs and treat it fast
When meningitis hits, it makes headline news. As this disease often strikes the young and early diagnosis is critical, parents want to know what signs to watch for in a sick child. Although meningitis can happen at any age, it is more common in children, especially those under five.

Multiple Sclerosis - Increasing awareness about a mysterious condition
You have probably read and wondered about multiple sclerosis. Someone in your family may have the disease. It is a difficult illness to pronounce and even harder to spell. Often it is shortened to MS. Sometimes the symptoms of MS are very visible, sometimes invisible. The symptoms are different for each person. That is why we talk about the mystery of multiple sclerosis.

Multiple Myeloma - treatment and hope
Multiple myeloma is a cancer of the bone marrow, the jellylike substance within large bones that makes new blood cells. Plasma cells are one type of cell in marrow. As part of the immune system, their job is to produce special proteins to prevent infection. In myeloma, these cells begin to grow and no longer follow their normal pattern. As with most other cancers, the problem is not rapid growth of cells. Rather, it is the high number of abnormal cells that appear when normal cells do not go through the full cycle of maturing and death.

The New, Improved Check-Up - It’s not the same old physical exam
We have all been taught that an annual check-up with our family doctor is one of the best ways to stay healthy. However, both times and health care have changed. The old check-up examined the body, and may have included a few tests. Now, reviews are designed specifically for you and your health risks. Check-ups were once a yearly intervention applied in the same way to everyone. Now, they are based on what each individual needs. With these changes, you may be assessed more or less often. It all depends on your personal health and risk factors.

Obesity - dealing with the diagnosis
If your doctor has recently told you that you are obese, know that you are not alone. In Canada, 59 per cent of adults and 26 per cent of children are overweight and in many of these so overweight that in medical terms they are considered obese.

Opioid Myths - The facts about these powerful pain medications
Through the ages, the use of morphine and opium-based narcotics has had a long and colorful history. Wars have been fought over their supply, and attempts made to control abuse. In developed countries, these attempts have led to a wide variety of control measures.

Primary Care Reform - what it is and how it will help Canada's healthcare system
Primary care reform has been in the news a lot lately. The Kirby and Romanow Commissions, as well as consulting documents and provincial commissions, have examined health care and found it wanting. All have recommended primary care reform as a way to improve the health care system. Primary care is the first, non-emergency level of health care most people receive. Reforms will help us use the expertise, knowledge and resources of our health care system efficiently while providing more effective health care to Canadians.

Prostate Problems - What it does and why it can cause trouble
It seems like the prostate gland gets more media attention these days than any other part of the male anatomy. Sitting like a cuff around the urethra (the urine passage just beneath the male bladder), the prostate gland is about the size and shape of a chestnut.

Quit Smoking - Research suggests effective ways to quit
It’s no secret that smoking is a health hazard, both directly to the smoker and indirectly to those around them through second-hand smoke. Many smokers do want to quit. Often they think about it or try unsuccessfully more than once. Is there a right way to stop? Do the various quitting methods really help?

Red Eyes - why you may be seeing red
At one time or another in life, most of us have experienced red eyes. Some red eyes can be treated easily and simply. At other times, you will need the help of an eye doctor and prescription medication. Several common causes of red eyes exist.

Respiratory Tract Infections - identifying and treating them
Respiratory tract infections (RTI’s) including common colds and ear, sinus or lung infections are usually caused by a virus. Over 200 different viruses can cause a cold, and some people are more prone to colds than others. A child attending pre-school may catch as many as eight colds in a year.

Screening Tests - helping your doctor protect your health
It's time for your annual physical. Your doctor listens to your history, asks you questions about your health, pokes and taps. She goes over your health with a magnifying glass and a fine-tooth comb, and can't find anything wrong. You feel great – but she still orders a whole battery of medical tests! Are all of these tests really necessary?

Shingles - questions and answers
Shingles is an infection that is said to be localized – that is confined to a certain area of the body. The varicella-zoster virus (VZV) is responsible, the same virus that causes chicken pox.

Sinusitis - more than a simple cold or allergies
Do colds seem to hit you harder than they should? Do you get pain around your eyes or upper teeth along with a thick yellow-green discharge from your nose? With these episodes do you sometimes have a bad cough? Do these symptoms often last longer than 10 days?

Sports Eye Injuries - Protect Your Vision
Do you play a sport that involves a ball, puck, racquet, stick, or bat? If you’re not wearing protective eyewear while you play, you risk a serious eye injury.

Stopping Stroke - Recognize and treat a ‘brain attack’ quickly
Your brain is the most complex organ in your body. It consists of over 100 billion specialized nerve cells called neurons. These brain cells control everything we do, from speaking to walking to breathing.

Superbugs - the war against antibiotic-resistant bacteria
If you watch the news or read the paper, chances are you’ve heard of ‘superbugs.’ The headlines read like an alphabet soup of these complicated bacterial names.

Thyroid Disease - questions and answers
Thyroid disease is quite common, and can happen in anyone whether newborn or elderly. You may have relatives or friends who have or have had a thyroid problem. The thyroid is a complex and important gland. The hormones it produces play a significant role in many of the body's day-to-day functions. Different thyroid conditions may lead to very different problems requiring a variety of treatments.

Top Five Health Tips - simple ways to stay healthy this summer
With hot, sunny days and leisurely vacations, summer offers a great chance to relax and develop healthy habits. These five simple tips can help keep you feeling your best - for life.

Understanding Diabetes
Diabetes mellitus is probably as old as mankind. We certainly know that the ancient Egyptians gave an accurate description of the condition. The name came from the way the Greeks described diabetes 2,500 years ago. Diabetes means a siphon or "running through."

Urinary Incontinence - Treatment for an embarrassing problem
Does the thought of sneezing in public or being far from a bathroom make you nervous? Urinary incontinence is the unwanted release of urine at the wrong time. More simply put, it is wetting your pants. It may be a relief to learn that you are not alone. In fact, urinary incontinence is surprisingly common. Although embarrassing, it can be treated effectively.

Urine Tests - Much can be learned from this low-tech investigation
Doctors often request a urine test because this simple but effective investigation offers a wealth of information about your body. Different tests may be ordered on the urine. For example, the urine may be tested to detect the fertile part of a woman’s cycle, an early pregnancy or to screen for the presence of drugs.

Stomach Ulcers - the causes and treatment
When you hear about an 'ulcer,' it is often the kind occurring in the stomach and the duodenum. The duodenum, the first part of the small bowel, connects to the far end of the stomach. An ulcer is a small area of a surface that has been eroded away. It is similar to a deep scrape or a cigarette burn on the skin. When this happens in the stomach or duodenum, it can cause pain, discomfort, bleeding, scarring and even a hole (called a perforation) that passes right through the wall. Most ulcer patients will tell you this is not a nice thing to have going on in your insides. On the other hand, others have ulcers without any sign of trouble.

Special Diagnostic Tests - Bone Density Testing, CT Scans, and MRI
Many tests are available to help doctors care for you. Knowing more about the different kinds of tests can help you understand why they are needed. Bone density testing, CT scans and MRI tests are three important testing tools. Here, you can find out what to expect and why they are used.

Win by Losing - Shedding pounds can lead to a longer, healthier life
Despite spending billions each year on weight loss, we are getting heavier. Obesity rates are continuing to rise in Canada and around the world. Today, over half of adult Canadians are overweight and close to a quarter are obese. Compare this to 1979, when only 14 per cent were obese. Carrying extra weight greatly raises our risk of type 2 diabetes, cardiovascular disease, cancer and other diseases.

Urinary Tract Infections - troublesome but usually easily treated
If you sometimes feel you can't get to the bathroom quickly enough and when you do, have pain or a burning sensation and pass only a small amount of urine, you might have a urinary tract infection (UTI). Infections of the urinary tract, especially the bladder, are a common occurrence.

Urinary Incontinence - Treatment for an embarrassing problem
Does the thought of sneezing in public or being far from a bathroom make you nervous? Urinary incontinence is the unwanted release of urine at the wrong time. More simply put, it is wetting your pants. It may be a relief to learn that you are not alone. In fact, urinary incontinence is surprisingly common. Although embarrassing, it can be treated effectively.

Does Your Preschooler Have Vision Problems? - Undetected lazy eye blindness can result in serious vision loss
Years ago when cartoonist Charles. M. Schulz put an eye patch on Peanuts character Lucy, he did an enormous service to parents. Millions of faithful readers checked in every day to see how Lucy was handling the eye patch treatment for ‘amblyopia ex anopsia’ – lazy eye blindness. Millions of parents wondered if their child might have the same problem.

You and your Family Doctor - a relationship worth building
Traditionally, everyone has had a family doctor. For many good reasons this is how health care has been handled. However, changes to society and our health system are making it more difficult to build a relationship with a family doctor. With higher education, Internet access, and other ways to get care, we may wonder whether a family doctor is still necessary. Is such a relationship worth the time and effort it takes to build it?

Your Sore Shoulder
Your shoulder is made up of bones, muscles, tendons, ligaments and joints. When these structures mesh properly you use your arms without a thought. However, if something goes wrong with one of the structures, the pain in your shoulder is a constant reminder that you cannot ignore.