A little bit about me

Many people including patients ask me what got me into this field? Why I chose physical therapy over something else in the healthcare field? And the most frequently asked question…do you like what you do? I can’t even count how many times someone has asked me one or all of these questions, but my answers never change, especially the last one.

Ever since I can remember I knew I wanted to do something in the healthcare field. I didn’t always know that physical therapy would be my calling. When I was younger I always said I wanted to deliver babies. If anyone asked me that is what I was going to do. It wasn’t until later when I found out exactly what had to be done when I decided that just wasn’t for me! That didn’t switch my focus because I wanted to be a helper. I wanted to be someone that could make a difference in someone’s life. Now, there are many ways to do that outside of healthcare, but the body just always fascinated me.

I can still remember in high school I wanted to take an anatomy and physiology class. I was a B/C student. I even had gotten a D in a few classes. I wasn’t a bad student, I just never really applied myself unless it was in something I enjoyed to learn about. You could tell in my grades, math and science were always my strong suit. History and language arts not so much. I will never forget when I signed up for the anatomy class and the teacher who was going to be in the class called me to her class room during a study hall. She asked me why I signed up for the class. I explained to her that I wanted to learn more about the body and I planned on being in the healthcare field at some point and this would help me get started. She looked at me with a very serious look and said, you know this is an advanced class to take right? Looking at your grades I’m not sure this would fit you. She said I take my position here serious and try to make sure that I have the right students. So you know what I did? I said yes I know that this is an advanced class and my grades don’t reflect the type of student that I can be. My grade will show you how serious I am when I’m done with this class. She agreed to allow me to take the class even though she was hesitant. Well, needless to say I got an “A” in the class and proved her wrong! I knew I would do well because I enjoyed what I was learning. This started my obsession of the human body and after this one class I realized that health care was going to be my route.

I played baseball and basketball in high school and eventually played baseball in college. Before applying to schools for college I decided that I wanted to go into Athletic Training. I loved sports and this seemed like the right fit for me. I knew I didn’t want to go far, but I didn’t want to commute either. I had applied to 5 colleges and got accepted to 4 of them. Waynesburg University was at the top of my list. They had a great AT program, it was only about an hour and 15 minutes away and I was going to play baseball there. So I decided to accept my acceptance and move to Green County PA. This is also where I met my wife who is really responsible for my grades in college. If it wasn’t for her studying with me, I would have never made it through some of those classes I had to take!

I started baseball about 2 weeks after school started and it was great! It took up a lot of my free time, but I didn’t mind because I loved to play. The other part of my time was spent in class as well as trying to get hours in the clinic for AT. It turned out that in order to start doing anything with athletes you needed a minimum of 2,000 hours in the clinic observing! I thought wow! How am I going to find time for this? Well, after a long time thinking about what I wanted to do I made the decision to change my major. I know what you are thinking. You changed your major because you didn’t want to do the observation hours? I thought you wanted to do something in the health care field? Well, you have to realize that I was 18 at the time. My number 1 priority besides baseball was socializing and of course partying. Baseball took up most of my time, class took up the other and I wanted to have fun. Something had to give. So I switched to Biology (pre-physical therapy). This was kind of like a pre-med degree and gave me avenues to go to.

My freshman year anatomy teacher was Dr. Giles! He was an awesome teacher! He made things fun and easy to learn. And since I loved anatomy he made the class that much better. But Dr. Giles was not only an anatomy teacher…he was also a Chiropractor. I thought, this might be my calling. It just seemed like a good idea. He had great stories of how he made patients well and how he helped so many people. It got me thinking. Over the next few years I thought about what I wanted to do after college. I knew I was going to go on to grad school it was just a matter of where. In my second to last semester I had to do 200 observation hours in a health care facility. It could have been anywhere. They gave me a list to choose from. The list included chiropractic, medical doctor, surgical center, dentist and then physical therapy. At this point I had been tossing up chiropractic and physical therapy. I just was not sure about the differences. So I decided to go to a PT clinic. I had had PT in the past on 2 different occasions for my knee and my elbow. From what I remember about it I really enjoyed it and it helped get me back to playing baseball of course!

During my time at the clinic I met so many different people who had so many different injuries and pains. Some worse than others. I loved the fact that patients would come in with problems and leave able to do the things that they couldn’t before. Physical therapy was able to get patients back to doing what they loved. I wanted to do that! I wanted to be a helper, a healer and a person that people came to to get them well. Needless to say, after my 200 hours, which took me about 4 months to get, I was dead set on physical therapy school. I started applying right away. I had 3 choices for where I wanted to go. Chatham University was my first choice, Pitt was my second and Slippery Rock was my last. I remember where I was when I found out I got accepted. I was in Cocoa Beach Flordia on spring training for baseball. I called home daily to talk to my parents and my mom had said I got a letter from Chatham. I told her open it. She opened it and read that I had been accepted to Chatham University’s Physical Therapy program! And you can say the rest is history!

Here I am today 12 plus years in the field and I love being a helper, a healer and most importantly a person someone can come to to get them well! There is nothing like seeing someone come into the clinic miserable, visibly in pain, unable to do the things they love and on crutches. And months later seeing them smile because they are running, walking, playing with their kids and doing everything they love to do because of something that you were able to do for them! So to answer the question of do I like what I do? The answer will always be yes!

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Do I need a prescription for physical therapy?


For the longest time, to come to physical therapy you had to get a prescription. First you had to make an appointment with your PCP and take time out of your day. They would take a look at you and say I think you should go see a physical therapist. They would write you a prescription and send you on your way. Nowadays, there is something called direct access for physical therapy. Patients can come right off the street without seeing a physician and get physical therapy treatment. So does this mean that you no longer have to see a physician to be able to come to physical therapy? Well it kind of depends.  

The short answer to if you need a prescription is no. Direct access is meant for just that, to not have to worry about seeing a physician to get permission to come to physical therapy. Now, what will decide that is your insurance. Some insurance companies still require you to get a prescription, Medicare being one of them. My best advice to people that are wondering if their insurance accepts direct access is to call the number on the back of their card and ask. If patients do call in we can check for them, but it is much easier for them to call on their own.

How does direct access help the patient? For one, it takes an extra visit to the PCP away. This means they can just come straight to the PT and not worry about seeing an extra health care provider. Another way direct access helps is that it cuts costs for the insurance companies. Unnecessary visits are avoided and this in turn makes them happy. Direct access also saves patients time. Again taking away another visit can be the difference in an entire afternoon or evening for some patients. Busy schedules require efficiency and direct access does just that. And finally, it eliminates barriers to entry. If a patient wants PT, there should not be anything that stands in their way of getting it. This, in turn, opens of and enables people to seek this service without having restriction.

So the next time you get injured call your physical therapist so that they can properly evaluate you and get you on the right path to better health!

When can I get rid of my knee brace after surgery?


There are a number of different braces given out after surgery for your knee. Most of the time it’s for support of the joint due to weakness. Braces can be cumbersome and bulky and very hard to deal with. The first question I usually get from patients with a brace is when can I get rid of this thing? I understand, your already in pain due to surgery and now you have to lug this thing around with you everywhere you go.

Each surgery to your knee is different and depending what was done will determine when you get out of the brace. A few different surgeries that I see commonly are ACL repair and patellar fracture. Other injuries that require a brace are quadriceps tendon rupture and femoral fractures. All of these surgeries end up with a common problem…atrophy. Atrophy is the wasting away of a muscle and in turn it becomes weaker and does not work as efficient as it once did. Your quadriceps muscles are what help support your knee from collapsing when walking, and when they are not working properly is when the brace is needed. The brace is usually locked at first to take up the slack of any weakness.

So what causes atrophy to happen? When you have surgery on your knee it becomes inflamed. That inflammation works it’s way into the quad and causes it to shut down. When the muscle stops working it starts to atrophy. Have you ever heard the saying “ if you don’t use it you lose it”? Well this statement holds true, especially after surgery. Another reason atrophy occurs is after surgery the last thing you want to do is move your knee or even put weight into it. When you are not working the muscle like it is used to, you start to atrophy. It’s the same move it or lose it atmosphere.

What do we do in the clinic to determine when you can stop wearing the brace? We want to make sure that you have proper strength in your quad muscle to support your knee when you walk. One way we determine this is to have you perform a quad set. You are instructed to keep your leg straight and push the back of your knee down into the table or the bed. We look at if your quad muscle is firing properly and moving your knee cap as it’s activated. We then ask you to perform a SLR. This is done by laying on your back and doing a quad set. Then while keeping your leg straight, lift it up off of the table. If you can keep the leg straight without the knee bending in the air you are ready to be out of the brace.

So the next time you are wondering when that pesky brace can be thrown out ask your physical therapist. The more you do your home exercises the faster you will be able to get rid of it.

Why is form so important with exercise?

I have people ask me this question a lot especially if I am correcting them as they do a specific exercise. Why do I have to do it this way? This way is harder for me to do it. It’s easier if I do it this way. These are just some of the things my patients say during their time with me. Now I’m all for doing something a certain way if it is easier and more efficient. But when it comes to exercise there is some form that we all must follow. So why is it so important that we follow proper form while doing exercise? And what can happen if we don’t?

Injury prevention: this is the number one reason why form during exercise is important. If you continue to do an exercise incorrectly, you run the risk of injury. In my world of physical therapy most people that come to see me are already injured or have some form of pain. The last thing we want to do is cause another problem.

Efficiency: with proper form comes efficiency. We all want to be efficient with things because this makes things work more smoothly, it saves time and helps to not overwork yourself. Being efficient with exercise allows our body to adjust quicker and avoid fatigue. This, in turn, will prevent injury as we talked about above.

Accessory muscle use: if proper form is not used this can cause you to use accessory muscles. These muscles are the ones that start to kick in if the other is either too weak or your form is not correct. The best example I can give is when someone is doing a bicep curl with a barbell. If the weight is too heavy or their biceps are just weaker they start to rock their back and extend back and forth. This causes them to start using muscles in their back and increases risk of injury. My advice is always quality reps increased weight. It’s better to do 20 quality reps with a lighter weight than 10 reps of heavy weight with poor form.

Increased joint mobility: form plays a role in mobility of our joints. Deep squats for instance, are a great example. Deep squats are an excellent exercise to get more mobility in your hips, knees and ankles. If the goal is to increase the mobility in those joints then this exercise is for you. But if we decide to just do squats to 90 degrees of knee flexion this could cause a decrease in the mobility of the hips because they are not going through that entire range of motion. Now mini squats and squats to 90 are great for strengthening but if you want increased mobility this will cause those structures to tighten and not allow for full mobility. In turn, causing you limitation and sometimes pain.

As I tell all of my patients. I am not interested in how much weight that you can do or how many reps. I just want you to have proper form while doing your program.

Is there a fountain of youth?


If you look all over the news especially on ESPN there is no way you are missing all the hype behind Tom Brady the quarterback of the New England Patriots. Now, let me preface that I am a huge Pittsburgh Steelers fan and it pains me to even talk about him. But it is really amazing what he has done for the length of time that he has done it. How has he been this good for so long? How is he getting ready for his 17th season in the NFL and 16th as a starter? Brady is 40 today August 3rd and in football years that is an eternity! The average NFL career is between 3-6 years depending on position and ability of play. Brady has broken records, won 5 Super Bowls, is a two-time NFL MVP and has the most wins as an NFL quarterback EVER! So how does he do it? How has he been able to keep up with all of these other younger more versatile quarterbacks? And how does it seem that he just has a knack to win the big game?

To be an NFL player you have to be special! You don’t just luckily get drafted and you don’t just get a starting job because you made the team. You have to work and work hard if you want to be successful in the league. There are many players that have gone past their years as a football player trying to get that one last season before leaving the game that they have loved to play for so long. Payton Manning comes to my mind right away. Even though he won a Super Bowl to end his career he was a shell of himself that year. His defense carried him most of the way and he did what he needed to do to win, even if it wasn’t pretty. Tom Brady has evolved as the exact opposite only getting better and more focused with age.

Let’s start with his diet and how he decides to fuel his body. It is no secret that he eats vegan most of the year. Now I’m not saying this is the option for ultimate health because there is no way that I could go without meat. But this is his secret to success. Diet plays a huge rule in your health and weight control. I have posted in older blog about the 80/20 rule that most should follow. 80% diet and 20% exercise. There is no need to kill yourself at the gym 6 days a week if you are not eating the right things to fuel your body. Next, his workout regimen is very strict requiring him to wake up very early each day because of his busy schedule as an NFL player. His workouts along with him being very conscious of his health play a huge rule in how he is able to keep going. He is a very focused individual and it shows through all that he does.

If you want to get serious about your health and the way that you feel I suggest you take a look at what this man has been able to accomplish. Tom Brady is an extreme case, but he is a perfect example of what hard work and dedication to your body and health can get you. Is 40 really the new 25? If so, Patriots fans would seem to think he might have at least 10 years left in the league! We all wonder how much longer he will be in the league for. The short answer, as long as his body will let him be. Truth is there is no telling how much longer he will play. He’s like the damn energizer bunny! All that I know is as a Steelers fan his retirement can’t come soon enough!

Who doesn’t like a walk off?!?!

As long as I can remember I have always loved the Pittsburgh Pirates. I grew up in the 80’s and 90’s with the Killer B’s, Bonds, Bonilla, Bream and Bell! That was a great era of baseball to be a part of! The pirates were so competitive and seemed like they made the playoffs just about every year! Once free agency really took it’s tool on the Pirates they seemed to have nothing left but a farm system for the rest of the major leagues. Every year it seemed obvious, if a player started to do well it was certain they were getting traded by mid season. And every year that was the case. 20 years of losing was upon us! Do you even understand how long that is to suffer from losing? It hurts to even think about it. Even though it was rough I continued to watch my team get pummeled every year. I may have lost hope for about a year until they brought up Cutch! That was a great time because you knew he was something special! Even after they brought him up the losing continued up until 2012.

The Pirates actually had a great shot that year! They started out slow as usual, but at one point in the season they were 16 games over .500 with 7 walk off wins! They hadn’t had a winning season in 19 years and we were that far over! We were all going to win that year! And then the wheels fell off. They had a total collapse the last month and a half of the season and ended up in forth place in the N.L. Central with a record of 79-83 4 games under .500. Another losing season in the books!

2013 was a different story. They added some pieces that were going to prove to be key! Francisco Liriano and Russell Martin were added to help and boy did they ever. Again the pirates had 9 walk off wins that year! Liriano went 16-8 revitalizing his career and Martin ended up with 15 home runs! The key home run being in the wild card game when he belted a 2 run HR over the left field wall off of Johnny Cueto! It was still by far the best game I have ever seen. I was in my living room jumping up and down screaming! 20 years of losing can do that to a fan let alone a town! It was awesome! They lost in the divisional series against the Cardinals but it was still a great season. Their record was 94-68.

2014 started off just as strong in and out of first place of the division all year with the Cardinals. They ended up with with a record of 88-74 and made the wild card game for a second consecutive year. They had 10 walk off wins that year! They ended up losing to the Giants that day, but it was still a great season. Winning baseball was back in Pittsburgh!

2015 was even better then the year before. This time the national league central was stacked and between the Pirates, Cardinals and Cubs it was a battle all year. The pirates had 11 walk off wins that year and ended up with a record of 98-64! And they didn’t win the division! They made the wild card game for the 3rd consecutive year and lost to the Cubs. It was a very promising year!

2016 was very disappointing. They had just came off of a 98 win season and just didn’t look good. A lot of blown opportunities and they finished the season with only 4 walk off wins and a record of 78-83, another losing season! I personally was very upset and frustrated about it. How can you have a 98 win season and lose that many games the following year? Do walk off wins play a part in momentum?

As most of you know I help coach my sons travel baseball team. This past year has been a blast and I have enjoyed being a part of every moment. This year alone they have had 4 walk off wins that I can think of. One of them was just the other night in the sectional little league tournament. My son came up and hit a single into right center to win the game. It was great to be a part of! The next day those kids carried that momentum into another win and a birth into the championship! Last night we came in and totally dominated! A 12-5 win and a birth into the PA state little league championship! I am a big believer in momentum and feel that the experience these kids have will give them a huge advantage.

When I talk to my patients in my office about their success and failure I try and relate it to the walk off hit to win the game. If you have a great day or week or month of physical therapy you need to celebrate it! You need to use that as fire to build upon. Mindset alone can change what you believe and how you think. If your down it will show in your effort. If you use it to your advantage nothing can stop you!

So far this year the pirates are 48-48, 3 games out of first. They have had 7 walk off wins so far this year. One of them coming two nights ago. The momentum is starting to show because they have won 11 out of their last 13 games. Hopefully the walk off will hold true as to what type of season they will end up having.

Could bi-yearly follow ups with your physical therapist be the key to musculoskeletal health?

 

I had to go to the dentist the other day to get my teeth cleaned. Yes it was that time of year again, my 6 month check up and cleaning. As I was leaving the office I went to the front desk and scheduled my appointment for the next 6 months not even thinking about it. I said good bye to the office staff and went on to work. As I was driving to my office I started thinking about how natural it was for me to schedule a follow up visit with my dentist. It’s drilled into our brains that maintenance on our mouth and teeth will prevent us from having problems in the future. Catching things early can prevent pain, decrease cost of care and keep our mouths healthy overall. If we have an issue in the mean time we just give the dentist a call. Can this work with physical therapy?

 

As the day went on I thought about it more and more. What if I started to set up a follow up check up after discharge for all of my patients? Six week, Six month and one year is what went through my mind. This is what is done at your PCP, dentist, surgeon, dermatologist and many more health care professionals. I know first hand what happens when patients are discharged from PT. 95% of patients stop there home program the day after they are done. 6 months to a year goes by and all of a sudden they have a problem again. Who do you think they call? Not me! They call their PCP or their surgeon. That is what people think of when dealing with pain, strains, weakness, functional deficits. Finally patients will come back to me after going through the chain to be treated. Look at the time and money it takes for someone to get to me.

 

Now, what if I discharge someone and set up a 6 week follow up to see how they are doing? Add certain things as well as make sure they are continuing to improve. Just doing this would prevent them from having to spend insurance money to go to their PCP only to tell them to come to me. This would also help patients be held accountable to what they should be doing knowing that they will have to come to see me in 6 weeks. This can train patients to think about follow up appointments. This can help patients understand the importance of their health and know who they can come to for their musculoskeletal needs. We as physical therapists have to do a much better job of keeping in contact with their patients, making trusting relationships and making sure people are getting everything that they can out of us. We are such a valuable asset that most people don’t know how to use. Take advantage of it!

Can your discs actually slip?


You were doing yard work all day, went to lift that last bag of topsoil and felt a pop in your back and pain down your leg. You hobble into the house, sit down, pop a few Tylenol and put some ice on it. The next day you can barely get out of bed so you go to your physician. You come out of the appointment with all kinds of information. Everyone asks what happened and you say I have a slipped disc in my back. This term has been used for a long time. Is it really possible for one of your discs to slip in your back? Is that even a medical term? Is it something that we should be concerned about?

A disc can’t physically slip. The term is not accurate. Discs are attached to adjacent vertebrae with tough, ligamentous fibers, so discs can’t “slip”. These discs are very flexible in nature and allow for spinal movement and shock absorption. However, over time discs break down with wear and tear. A disc can move, bugle and completely rupture, ultimately expanding past it’s normal position of comfort.

The term slipped disc is often used interchangeably, and most of the time incorrectly, with bulging and herniated discs, but there is a difference in the terms. The anatomy of a disc helps to understand how the they are defined.

Disc Anatomy:

Annulus fibrosus – is the outer layer of the disc and is composed of a fibrous layer helping protect the inner portion of the disc.

Nucleus pulposus – is the inner layer of the disc and is composed of a gel like substance.

There are many layers in your back that help protect the disc. You have muscles and multiple ligaments along your spine that are the front line defenders. If any or all of those layers are weakened the annulus is all that is left before the nucleus. When a disc bulges the nucleus pushes into the annulus and causes the disc to lose shape and push into the spinal canal. This can cause a nerve to be pinched and cause symptoms down the leg. When a disc herniates the nucleus is now not contained in the annulus and leaks out into the canal causing pain and sometimes numbness or weakness.

Looking at these two terms and knowing how they are defined tells us there is no way that a disc can physically slip out of place. The term is widely used around the health care field. We just need to understand what it is being used for.

Is physical therapy going to be painful?

Before I leave the room after all of my evaluations I always ask my patients if they have any questions. I also ask, if what I just explained to them makes sense? At least 50% of the time, if not more, I get “ is this going to hurt? It is a very good question considering the majority of people have no idea what to expect from physical therapy. When people are already in pain to start the last thing they want is to have more pain. Also, at this point, people can be fearful of movement. Therefore, it can become challenging trying to explain what to expect. Let’s talk about this question of pain and if it’s really something to expect when you go to PT.

I absolutely hate when people say that I love putting them in pain! I also get very upset when patients and PT’s alike will state PT stands for pain and torture. Or a PT is a physical terrorist. Really? Is that what most people think we are and do to people? Let’s get one thing straight. My job is to promote movement, function and mobility using your own body to heal itself. I am not here to try and put you in the most pain possible. I have no desire to try and increase your pain nor do I get excited when I do. This is a misconception that a lot of people have and it needs to stop.

Yes, there are times that you may have some discomfort from certain movements, activities and treatments. Take the shoulder for example. A patient that has RTC surgery is going to have pain during PT because you have to move the joint in order for you to gain motion. The shoulder is healing from surgery and that is another reason that it is going to be painful. Any time you have limited motion you are going to experience some sort of pain/discomfort because the joint is not moving properly. It’s not a sign for me to see how much pain I can put you in. It’s just a guarantee that you will be in some sort of discomfort because of the limited motion the joint has.

Will you experience some sort of pain during PT? Depending on what you are coming for the answer is yes. Other times PT can and should be very relaxing and calming. General soreness from activity and exercise is not what I consider pain. It’s just your bodies way of telling you to move your ass more often and you wont feel this way. If you are seeing someone that calls themselves a pain and torture expert or refers to themselves as s physical terrorist I suggest you find a different place to go.

When things get tough will you quit?


As most of you know that read my posts my son plays travel baseball and I’m a coach on the team. Lately it has taken over my life, and I’m okay with that because I enjoy it so much! But I keep finding different reasons to talk about it because these kids show me something different each week. As with all 9 year olds there is an up and down attitude about them each day, week and month. One day they look like super stars out there and nothing can stop them. The next day they look like they are back in T-ball again. This past weekend was one of those weekends where you wondered how they would respond after the events that took place.

We played in a tournament called the Battle of the Boarder in Youngstown Ohio. Leading up to the weekend we knew that competition was going to be very good. 2 teams in particular were going to be there. Beaver Valley Red and West Hills. The last time we played West hills they beat up on us pretty badly. By about 13 runs to be exact! It wasn’t pretty, but our kids had bounced back in the next tournament they played in to take 2nd place. We were in a different bracket then either team and were set to face 2 teams we had never played. The day before the tournament started one dropped out and our schedule changed. Now we were scheduled to play Beaver Valley. I was excited to see how our kids matched up against them since we had never played them before. Once the kids heard that was who they were playing that’s all they talked about. They obsessed about it actually! And it was not in a good way. The game started and we walked the first batter, not a good start! Nerves were probably going crazy for most, but we managed to get 2 outs and the score was only 1-0. Then all hell broke loose! We committed 6 errors giving up 12 runs in the first inning! After the first inning it was 12-0! How does this happen? Little things like catching the ball before trying to throw it. Balls going through their legs, and coming in on fly balls instead of stepping back first. All things our kids do very well most of the time. Their nerves got the best of them. Needless to say the game ended in 4 innings after losing 18-1. We lost the second game 12-6 against another team we had never played mostly due to mistakes and kids just not being in the game. It was tough to watch and hard to talk to the boys afterwards. Sunday would tell us what type of team we have and how they respond.

The next morning the kids warmed up and you could tell they were more lively and upbeat. They started out strong and lead most of the game until the bottom of the 5th giving up 2 runs to be down 5-4. The kids battled that last inning but couldn’t find a way to get another run. We lost that game, but showed great resilience and determination to come back after getting the crap beat out of us the day before. It was great to see how our boys responded.

I wanted to share this with you all because there are always going to be times in life and in physical therapy that you are going to want to quit. Things are just going to get too hard for you and giving up seems to be the easiest thing to do. I know because I have felt like quitting before. My first 2 weeks of PT school I almost quit! I felt that it was going to be too hard and too much for me to handle. I was sick of school at that point and now I was going to have to go for an additional 3 years! I went home that weekend and thought about it a lot. I kept telling myself I could go and get a job for a little while and figure it out. Then I realized that I committed to doing this and this was what I felt passionate about. I’m so glad that I decided to continue my journey. Just know that it’s normal to want to just give up when things are tough and not going your way. It’s the way you respond and show resilience that makes all the difference.