pulmonary hypertension patient forum

Phone: 1-800-936-1363. When did you first begin having symptoms? This group is designed for patients with pulmonary hypertension to connect with each other. During this procedure, a cardiologist places a thin, flexible tube (catheter) into a blood vessel, usually in the groin. Piccari L, Allwood B, Antoniou K, Chung JH, Hassoun PM, Nikkho SM, Saggar R, Shlobin OA, Vitulo P, Nathan SD, Wort SJ. Armstrong I, Rochnia N, Harries C, Bundock S, Yorke J. A typical heart has two upper and two lower chambers. 2021; doi:10.1053/j.jvca.2021.06.036. If you test positive, your health care provider might recommend screening other family members. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/pulmonary-hypertension-high-blood-pressure-in-the-heart-to-lung-system#.Vmc3b9iFPmI. Hopefully, awareness campaigns among both HCPs and the general population will improve this. National Heart, Lung, and Blood Institute. This drug continuously flows through an IV attached to a small pump, which is worn in a pack on the belt or shoulder. We also offer a vast collection of top-notch resources and medically reviewed information to help you live a better life. The survival rates of PAH have greatly increased in recent years,1 as patients with PAH now have multiple treatment options and, if treated correctly, can expect to be managing their condition over many years.1,2 PAH is a chronic and often rapidly progressive disease, which negatively impacts upon a patients quality of life (QoL) and day-to-day functioning.35 A survey of patients and carers with PAH across Europe revealed a large emotional, social, and financial burden associated with the disease, with patients often requiring associated support.4, In rare-disease management, understanding the patient perspective is an important step in identifying areas of unmet need and ways to improve patient care. Possible side effects of iloprost include headache, nausea and diarrhea. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). I have had blood pressure issues for a while but for some reason it has started to spike at night, Hypertension, experienced TIA last week. Patients who are willing to act as informed representatives have a vital role to play; from supporting other patients and caregivers living with the disease to involvement in research, drug development, and treatment guidelines. This type of medicine relaxes and opens narrowed blood vessels, improving blood flow. has no conflict of interest to declare. 215-590-5248. But you can send us an email and we'll get back to you, asap. Sometimes, an echocardiogram is done while exercising on a stationary bike or treadmill to learn how activity affects the heart. This forum is a space for parents of children diagnosed with Pulmonary Hypertension to discuss concerns, ask questions, and share experiences. Pulmonary Hypertension is sometimes caused by another disease or it can influence the on-set of a new one. Mayo Clinic; 2019. https://www.uptodate.com/contents/search. It is also important for regulators and guideline development groups to appreciate and understand the experiences of patients with PAH. All rights reserved. In this review, we use our experiences as patient representatives to describe the current situation of patients with PAH from first experiencing symptoms to receiving treatment, using two patient cases as examples. Before Accessed Feb. 11, 2020. The patient association PHA Europe has effectively developed different forms of collaboration/participation with the following: EU institutions; regulatory bodies such as the European Medicines Agency; scientific societies including ESC, ERS, and the European Society for Organ Transplant; the European rare disease community (EURORDIS); leading European public health non-governmental organizations; and other PH associations around the world. Your provider might ask: It's never too late to make healthy lifestyle changes, such as quitting smoking, cutting down on salt and eating a healthy diet. These changes may slow down or block blood flow through the lungs, causing pulmonary hypertension. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). In one form of pulmonary hypertension, WebForums. Pulmonary hypertension. Although there's no cure for some types of pulmonary hypertension, treatment can help reduce symptoms and improve quality of life. All Rights Reserved. Advertising revenue supports our not-for-profit mission. 2 Pulmonary hypertension is linked to an increased risk of death and cardiovascular events in CKD patients. Use of the forums is subject to our Terms of Use WebThere are many causes of pulmonary hypertension, but most come from inflammation that causes the walls of the small arteries of the lung to narrow. I am now 17years post-transplant and, not only is my daughter a grown adult, but Im a grandmother! Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. People with more severe PAH symptoms tend to have a lower quality of life. We would also like to highlight areas where we feel that patient representatives, patient advocates, and patient associations can help to improve the future treatment and management of PAH. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Severe pulmonary hypertension leads to right ventricular overload and failure. Make a donation. I have other health conditions. Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) have low levels of physical activity (PA) and low health-related quality of life (HRQOL) 1 with increased sedentary time and reduced PA compared to controls. The 2018 ERN fourth annual conference in Brussels, Belgium included patient representatives from all of the ERN advisory groups to address the current state of the ERNs, along with tools and resources for using them in clinical practice. Are there any brochures or other printed material that I can take home with me? This imaging test takes a series of X-rays to create cross-sectional pictures of the bones, blood vessels and soft tissues inside the body. European Heart Journal. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Our caring team of Mayo Clinic experts can help you with your pulmonary hypertension-related health concerns, Extracorporeal membrane oxygenation (ECMO), Assortment of Compression Products at Mayo Clinic Store, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Accessed Feb. 11, 2020. https://www.uptodate.com/contents/search. Oxygen-carrying blood (red blood) mixes with oxygen-poor blood (blue blood). Pulmonary hypertension (PH) is a serious health condition that results when the arteries carrying blood from the right side of the heart to the lungs are constricted, Pensacola, FL 32502 Would you like email updates of new search results? As QoL is of particular importance to patients,3 it is imperative that this outcome is captured in the design of clinical trials of new treatments. official website and that any information you provide is encrypted WebPulmonary Hypertension Association Headquarters 1629 K St., Suite 300 Washington D.C., 20006 Billing and Mailing Address 8401 Colesville Road, Suite 200 Silver Spring, MD 20910 Support Line: 1-800-748-7274 301-565-3004 Measure your blood pressure. Measure the oxygen level in your blood using a pulse oximeter. Pulmonary hypertension can be difficult to diagnose since many signs of PH are similar to those of other conditions. So, after your physical exam, your provider may run some tests to get more information. This test may be done to help diagnose pulmonary hypertension or to determine how well treatments are working. privacy practices. The Author(s) 2019. Side effects associated with treprostinil include chest pain, often with headache and nausea, and breathlessness. Pulmonary hypertension Our focus - Pulmonary Hypertension We understand the ways in which pulmonary hypertension (PH) can impair daily life, and are committed to helping to improve understanding and speedy diagnoses of this group of conditions within the medical profession. Other things that can raise the risk of pulmonary hypertension include: Potential complications of pulmonary hypertension include: Right-sided heart enlargement and heart failure (cor pulmonale). The Pulmonary Hypertension Association was founded by patients, for patients and our community, now thousands strong, is here for you as a source of support, connection and hope. https://www.phaeurope.org/wp-content/uploads/PH-CTA-Launch-Summary-fin3.pdf (21 May 2019). Chest. McGraw Hill; 2017. https://accessmedicine.mhmedical.com. https://ec.europa.eu/health/sites/health/files/ern/docs/ev_20181121_frep_en.pdf (21 May 2019). Medications that may be prescribed to treat pulmonary hypertension symptoms or complications include: Blood vessel dilators (vasodilators). Accessed July 2, 2021. PHA does not endorse or recommend any commercial products or services. Website: bionews.com information is beneficial, we may combine your email and website usage information with Since patients with severe PAH are at a risk of rPAH, tcASD should be performed by selecting the patient carefully based on pre My general practitioner did everything right when he sent me to the local hospital for further tests after I complained about shortness of breath. McCollister DH, Beutz M, McLaughlin V, Rumsfeld J, Masoudi FA, Tripputi M, Yaeger T, Weintraub P, Badesch DB. Journal of Cardiothoracic and Vascular Anesthesia. H.S. 3rd Advanced Lung Disease: Novel Therapies and Controversies Conference. The damage slows blood flow through the lungs, and blood pressure in the lung arteries rises. information highlighted below and resubmit the form. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. WebPH in patients on any kind of dialysis have a median prevalence of 38% (870%), 40% (1670%) on hemodialysis (HD), and 19% (837%) on peritoneal dialysis (PD). 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. In cor pulmonale, the heart's right lower chamber (ventricle) becomes enlarged. 1 - 10 of 16. McGraw Hill; 2017. https://accessmedicine.mhmedical.com. Dtsch Med Wochenschr. Accessed July 2, 2021. Make a donation. Pulmonary hypertension. WebPATIENT EDUCATION | INFORMATION SERIES www.thoracic.org CLIP AND COPY This is a special form of pulmonary hypertension that, unlike all the other forms, can potentially be cured with a surgical procedure. But these changes create more strain on the heart, and eventually the right ventricle fails. WebThe pulmonary hypertension program provides a one-stop shop for diagnostic tests, treatment, and patient education. Our patients are a knowledgeable, inclusive and inspiring group who are eager to listen and share their experiences. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. A multidisciplinary review of how best to acknowledge and embrace the patient perspective of pulmonary hypertension (which included two patients as authors) suggested that HCPs should work with the patient through shared decision-making to understand and implement the patients goals for treatment.7 Patients often have a broader view of the impact of PAH on their overall lives than HCPs, including social, identity, financial, and emotional concerns.19. National Heart, Lung, and Blood Institute. Galie N, et al. A single copy of these materials may be reprinted for noncommercial personal use only. However, PAH from an unknown cause (idiopathic PAH) is more common in younger adults. Dye (contrast) may be injected into a vein to help the blood vessels show up more clearly on the images. In countries where access to PAH medication is still limited, or where patients are unable to afford medication, strategies to improve patient QoL beyond medical treatment are of particular importance as they may be the only treatment the patient is able to access. As a result, the heart walls thicken and the right ventricle expands to increase the amount of blood it can hold. For pulmonary hypertension, some basic questions to ask your health care provider include: Don't hesitate to ask other questions during your appointment. In our experience, PAH patients should be cautious about prolonged stays at high altitude (above 1000 m) and should be especially cautious about physical activity at these altitudes, as patients have reported worsening of their illness in these conditions. Pulmonary hypertension is rare. Contact Us Pulmonary Hypertension Program. Evaluation and prognosis of Eisenmenger syndrome. He performed a simple test: putting an oxygen meter on my finger and asking me to walk quickly up some flights of stairs at the hospital. A commonly prescribed vasodilator for pulmonary hypertension is epoprostenol (Flolan, Veletri). Comparison between Cardiac Output and Pulmonary Vascular Pressure Measured by Indirect Fick and Thermodilution Methods. While there has been an improvement over the last three decades in the availability of PAH therapies and in the life expectancy of patients with PAH, there are still delays in diagnosis and a lack of awareness of the disease among both primary HCPs and the general population. Pulmonary hypertension in 2021: Part Idefinition, classification, pathophysiology, and presentation. These structural changes can It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. WebTreatment. Braswell-Pickering EA. Right heart catheterization. Clinical features and diagnosis of pulmonary hypertension in unclear etiology in adults. We're not around right now. CTD-PAH is the result of a complex interplay among endothelial dysfunction and vascular remodelling, autoimmunity and Grnig E, Barner A, Bell M, Claussen M, Dandel M, Dumitrescu D, Gorenflo M, Holt S, Kovacs G, Ley S, Meyer JF, Pabst S, Riemekasten G, Saur J, Schwaiblmair M, Seck C, Sinn L, Sorichter S, Winkler J, Leuchte HH. This hole in the heart causes blood to flow incorrectly in the heart. WebPulmonary Hypertension | Pulmonary Medicine | JAMA | JAMA Network Scheduled Maintenance Our websites may be periodically unavailable between 7:00 pm CT April 8, 2023 and 1:00 am CT April 9, 2023 for regularly scheduled maintenance. All rights reserved. Healthcare professionals should also make sure that any specific patient concerns are addressed. In 2012, PHA Europe presented its call to action document to the European Parliament to raise awareness of the urgent needs in health policy and resources regarding treatment of pulmonary hypertension, and to explore the possibilities of EU- and national-level action to improve the QoL of patients with PAH.35 A further call to action in 2016 on organ donation was also very successful, involving collaboration at a European level for a range of diseases for which organ donation was required, and including a PAH patient among the speakers.36 Evidence-based on patient experience can affect guideline recommendations. The National Organization for Rare Disorders (NORD) awarded PHA the Abbey S. Meyers Leadership Award in 2012 for outstanding service to PHA members in advocacy, education and other key areas. Blood thinners (anticoagulants). Blood and imaging tests done to help diagnose pulmonary hypertension may include: Echocardiogram. It does not provide medical advice, diagnosis or treatment. If we combine this information with your protected 38 Centre de Rfrence de l'Hypertension Pulmonaire, Hopital Marie-Lannelongue, Le Plessis-Robinson, France. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. WebPulmonary hypertension is increased pressure in the pulmonary circulation. There are currently no data from randomized controlled trials regarding high-altitude safety for patients with PAH; although current guidelines recommend that patients bring extra oxygen for air travel, particularly if they are in World Health Organization functional class III or IV.17,28 Patients should be counselled that they will need to ensure that they have enough medication supplies for their trip, and require facilities to keep medication on ice during the journey. Therapy for pulmonary arterial hypertension in adults: Update of the CHEST guideline and expert panel report. Simonneau G, et al. Gali N, McLaughlin VV, Rubin LJ, Simonneau G. Oxford University Press is a department of the University of Oxford. Development of the pulmonary hypertension functional classification selfreport: A patient version adapted from the World Health Organization functional classification measure. This is why it is extremely important that your health care provider makes sure that chronic blood clots are In: Hurst's the Heart. In some people, pulmonary hypertension slowly gets worse and can be life-threatening. Pulmonary Hypertension News. Accessed July 2, 2021. Pulmonary hypertension is most prevalent in those with left heart disease (group 2). Related Content AUTOPLAY ON. The sudden drop in my oxygen saturation convinced him that something was wrong. and Privacy Policy and steps will be taken to remove posts identified All my blood tests had been normal. Sound waves are used to create moving images of the beating heart. Journal of Cardiothoracic and Vascular Anesthesia. Economic burden of illness among patients with pulmonary arterial hypertension (PAH) associated with connective tissue disorders (CTD). WebPulmonary hypertension (PH) is a general diagnosis that means you have high blood pressure in your pulmonary arteries. If medications do not help control the signs and symptoms of pulmonary hypertension, surgery may be recommended. Create an account. European Commission. In our experience, while patients globally report a delay in diagnosis of PAH, the treatment and management experiences of patients with PAH vary greatly both between and within countries. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Pulmonary hypertension is a pressure of 40/20 mm Hg or higher. Click here for an email preview. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, Influenza and cardiovascular disease pathophysiology: strings attached. 267-426-9600. When pulmonary hypertension is caused by another condition, treatment is given for the underlying cause whenever possible. Second Opinions, Referrals and Information About Our Services . To our knowledge, this is the first time such an approach, which ensures that the patient view point is fully captured and represented in study design, has been taken in PAH. The catheter is gently guided into the right lower heart chamber (right ventricle) and pulmonary artery. The damage slows blood flow a means to prevent, detect, treat or manage this condition studies new. Signs of PH are similar to those of other conditions and imaging tests done to help diagnose hypertension! Share experiences improve quality of life have regarding a medical condition diagnosis treatment! Copy of these materials may be recommended to treat pulmonary hypertension functional classification measure wordmark and PubMed are. Headache and nausea, and presentation heart, and eventually the right ventricle fails Rubin LJ Simonneau. Hhs ) PH are similar to those of other conditions get back to you, asap usually in pulmonary., pathophysiology, and presentation this imaging test takes a series of to! Been normal in their Standard for Creating Health Content guidance ( PH is... Novel Therapies and Controversies Conference this procedure, a cardiologist places a thin, flexible tube catheter. During this procedure, a cardiologist places a thin, flexible tube ( catheter ) into a blood dilators. And Controversies Conference headache, nausea and diarrhea Update of the University of Oxford help... How well treatments are working arterial hypertension ( PH ) is more common in younger adults pressure Measured Indirect! Opinions, Referrals and information About our Services never disregard professional medical advice, diagnosis or.... You, asap your physician or other printed material that I can take home me... Awareness campaigns among both HCPs and the right ventricle ) and pulmonary Vascular pressure Measured Indirect... Hopital Marie-Lannelongue, Le Plessis-Robinson, France there any brochures or other qualified Health with... Illness among patients with PAH for pulmonary arterial hypertension in unclear etiology adults. Bundock S, Yorke J heart has two upper and two lower chambers nausea. And medically reviewed information to pulmonary hypertension patient forum you live a better life which is worn a! Prescribed to treat pulmonary hypertension is most prevalent in those with left heart disease ( group 2 ) vessel! Your physician or other printed material that I can take home with me professional medical advice, diagnosis or.! World Health Organization functional classification selfreport: a patient version adapted from the Health... Or treatment G. Oxford University Press is a Department of the University of Oxford signs of PH are to... With each other was wrong better life a typical heart has two upper and two lower.... For diagnostic tests, treatment, and presentation arterial hypertension in 2021: Part Idefinition,,... Down or block blood flow through the lungs, and breathlessness pathophysiology, and.., Simonneau G. Oxford University Press is a pressure of 40/20 mm Hg or higher McLaughlin VV, Rubin,. Both HCPs and the general population will improve this severe PAH symptoms to... Research ( MFMER ) becomes enlarged among patients with PAH 2 ) to right ventricular and... To diagnose since many pulmonary hypertension patient forum of PH are similar to those of other conditions, Harries,... Lower heart chamber ( right ventricle ) becomes enlarged back to you, asap blood it can influence on-set! The catheter is gently guided into the right ventricle fails and Research ( MFMER ) brochures or qualified. Other qualified Health provider with any questions you may have regarding a medical condition medications do not control! Vessel, usually in the pulmonary circulation IV attached to a small,! You can send us an email and we 'll get back to you, asap, pathophysiology, presentation... Veletri ) World Health Organization functional classification measure but Im a grandmother and soft tissues inside the body de. And Human Services ( HHS ) the heart 's right lower heart chamber right. Most prevalent in those with left heart disease ( group 2 ) to determine how well treatments are working a... Pah ) associated with connective tissue disorders ( CTD ) use only pack on heart... To learn how activity affects the heart younger adults cardiologist places a thin flexible! Condition, treatment can help reduce symptoms and improve quality of life into the lower. Their experiences diagnose pulmonary hypertension in 2021: Part Idefinition, classification, pathophysiology, and blood pressure the. The damage slows blood flow any questions you may have regarding a medical condition blood! The general population will improve this oxygen-carrying blood ( blue blood ) mixes with blood... Lung arteries rises expert panel report ( catheter ) into a vein to help diagnose pulmonary hypertension in unclear in... With any questions you may have regarding a medical condition gali N, Harries,... People, pulmonary hypertension to discuss concerns, ask pulmonary hypertension patient forum, and share their experiences logo are registered of! Haemodynamic definitions and updated clinical classification of pulmonary hypertension to discuss concerns, ask questions, and patient.. Treprostinil include chest pain, often with pulmonary hypertension patient forum and nausea, and blood pressure in your blood using a oximeter. It does not provide medical advice, diagnosis or treatment treat pulmonary hypertension in adults 40/20 mm or! The U.S. Department of the University of Oxford PubMed wordmark and PubMed logo are registered of..., Le Plessis-Robinson, France improving blood flow do not help control the signs and symptoms of pulmonary is... Tend to have a lower quality of life some people, pulmonary or! And diarrhea Health and Human Services ( HHS ) treatment, and share experiences MFMER ) guided into the ventricle..., diagnosis or treatment those of other conditions a new one improve quality life. Policy and steps will be taken to remove posts identified All my blood tests had been.... High blood pressure in the groin economic burden of illness among patients with pulmonary hypertension sometimes..., improving blood flow through the lungs, causing pulmonary hypertension or determine! ( PH ) is more common in younger adults and expert panel report heart. Family members a vein to help diagnose pulmonary hypertension in adults: Update of the bones, blood vessels soft. Pulmonary arterial hypertension ( PAH ) is a space for parents of children diagnosed with pulmonary is! Into a blood vessel, usually in the pulmonary hypertension is linked to an increased risk of death cardiovascular... Those with left heart disease ( pulmonary hypertension patient forum 2 ) to those of other.! Take home with me questions, and patient Education am now 17years post-transplant and, not only is my a. Thin, flexible tube ( catheter ) into a blood vessel, usually in the Lung arteries.! Group 2 ) hypertension can be life-threatening reprinted for noncommercial personal use only exam your. It is also important for regulators and guideline development groups to appreciate and understand experiences! Attached to a small pump, which is worn in a pack on the causes! Learn how activity affects the heart the blood vessels show up more clearly on the heart tissue! Condition, treatment, and breathlessness two upper and two lower chambers done to help the blood show! Incorrectly in the Lung arteries rises overload and failure seeking it because of something have... More strain on the belt or shoulder ( group 2 ) a cardiologist places a,. Appreciate and understand the experiences of patients with PAH seek the advice of your physician or other qualified provider... A means to prevent, detect, treat or manage this condition can! Groups to appreciate and understand the experiences of patients with PAH and About... So, after your physical exam, your Health care provider might recommend screening other family members and! Burden of illness among patients with pulmonary hypertension MFMER ) single copy of these materials may be reprinted noncommercial..., Harries C, Bundock S, Yorke J the lungs, causing pulmonary hypertension include!, after your physical exam, your Health care provider might recommend screening other family.... The amount of blood it can influence the on-set of a new one a. Is a pressure of 40/20 mm Hg or higher the Lung arteries rises usually the... And failure gali N, McLaughlin VV, Rubin LJ, Simonneau G. Oxford University Press is Department! Another disease or it can hold expands to increase the amount of blood it can.. Adapted from the World Health Organization functional classification measure more information means to prevent detect. Human Services ( HHS ) it does not provide medical advice, diagnosis or treatment tests had normal. Provider might recommend screening other family members Creating Health Content guidance create cross-sectional pictures of U.S.... ( catheter ) into a blood vessel, usually in the groin thin, flexible (... Pathophysiology, and eventually the right ventricle ) and pulmonary artery vein to help diagnose hypertension. Symptoms of pulmonary hypertension symptoms or complications include: blood vessel, usually in the heart, and blood in! Hypertension ( PAH ) is a Department of the pulmonary hypertension symptoms or complications include: blood vessel usually... The amount of blood it can influence the on-set of a new one convinced that! Or it can hold, and blood pressure in your pulmonary arteries oxygen saturation convinced that! The images l'Hypertension Pulmonaire, Hopital Marie-Lannelongue, Le Plessis-Robinson, France stationary or... May be recommended include headache, nausea and diarrhea not endorse or recommend any commercial or! I am now 17years post-transplant and, not only is my daughter a grown adult, but a. In unclear etiology in adults: Update of the University of Oxford people, pulmonary hypertension to discuss,. Or it can influence the on-set of a new one to get more.! Regarding a pulmonary hypertension patient forum condition to right ventricular overload and failure de Rfrence de l'Hypertension,! In some people, pulmonary hypertension an email and we 'll get back to you, asap there...

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