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Dr. Ramani

Radiologist, Bangalore

Dr. Ramani Radiologist, Bangalore
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Our team includes experienced and caring professionals who share the belief that our care should be comprehensive and courteous - responding fully to your individual needs and preferences....more
Our team includes experienced and caring professionals who share the belief that our care should be comprehensive and courteous - responding fully to your individual needs and preferences.
More about Dr. Ramani
Dr. Ramani is a renowned Radiologist in HAL, Bangalore. She is currently associated with Cloud 7 Healthcare Multi Speciality and Diagonstics in HAL, Bangalore. Save your time and book an appointment online with Dr. Ramani on Lybrate.com.

Lybrate.com has a number of highly qualified Radiologists in India. You will find Radiologists with more than 27 years of experience on Lybrate.com. You can find Radiologists online in Bangalore and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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#3155, Srinivasan Towers, HAL 2nd stage, Indiranagar. Landmark: Opposite ESI HospitalBangalore Get Directions
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I have been suffering from disk problem since 7 months. I have consulted a doctor. I took x-Ray as per his advice. He said disk has been narrowed. He prescribed some painkillers and vitamin tablets. Could anyone please prescribe some medicine for me. I am really unable to sit without any support.

Diploma in Orthopaedics
Orthopedist, Morena
Dear, do the following things. 1. Hot fomentation for 1/2 hrs with lukewarm water. 2. Back extension excercises. 3. Pavan muktasan yoga 4. Bujangasan 5. Muscle relaxant tablets for 5-7 days. 6. Local application of analgesic ointment. 7 vitamin d in form of capsules/sachets under guidance of doctor. Check your vit. B12 level.
1 person found this helpful
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I want to know about exercises being done in case of diffuse disc bulge at l1-l2 level indenting anterior the cal sac mildly with bilateral mild neural foraminal narrowing.

Diploma in Radio-Diagnosis
Radiologist, Shimla
If pain is there no exercise indicated, after relief mild passive exercises, lumber exercise, lumbo-sacral exercise, mild lumber extension exercise; click on private quastion in my name for any clarification.
1 person found this helpful
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Know All About Gynae Laparoscopy Surgery

Panchkula & Delhi
Mother and Child Care, Panchkula
Know All About Gynae Laparoscopy Surgery

Q1. What exactly is Laparoscopy?

Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.

Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?

Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.

Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?

Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.

Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?

Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.

Q5. Will there be much pain or discomfort after Laparoscopic Surgery?

There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.

Q6. When can I be discharged from hospital?

Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.

Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?

Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.

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I am an advocate and have got sitting job for long hours and walking job too. I am suffer from slip disc. Any treatment?

Fellowship In Arthroplasty and Arthroscopy, MS Orthopaedics, MBBS
Orthopedist, Gurgaon
Regular exercises and maintaining good posture whie sitting is the key to avoid most of the back pain problems. Please do take frequent breaks every hr and strech your muscles and do not sit for long.
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Good day to you. For a few months i've been having numbness and weakness in my left leg and scrotum. Got my mri results back and they say. Mild scoliosis at L4 L5 region with minor disc bulge with no nerve compression. No sign of cauda equina. Small annular tear at L4 region with muscular spasm. What's causing my numbness? How do I fix the disc bulge?

MBBS, MD - General Medicine, DM - Neurology
Neurologist, Hyderabad
Good day to you.
For a few months i've been having numbness and weakness in my left leg and scrotum. Got my mri resul...
Most likely, the cause of your symptoms are disc bulge. The best treatment at this stage is physiotherapy. Medications such as pregabalin and gabapentin are also helpful.
1 person found this helpful
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Why Is Cancer the Biggest Threat to India

PGD IN ULTRAASONOGRAPHY, Non invasive cardiology course, MD - Medicine, MBBS
General Physician, Narnaul
Why Is Cancer the Biggest Threat to India

Cancer is the one of the biggest threat to the young Indian population because of the factors that cause cancer, but also due to late detection. However, certain bad habbits and the factors increase the risk of cancer in India.

Causes of cancer in India:

  1. Overpopulation and the problem of nutrition: As per records, India is the world's third most populous country. However, it lacks in resources to feed the multiplying number of mouths. Nutrition plays a key role in deciding the quality of a person's life. Nutrition has therefore emerged as an essential branch of research and medical care in the last few decades. Lack of nutrition directly results in weakened immunity. Your body becomes prone to diseases, some of which can be fatal. To fight off cancer cells, one must have a strong immune system that comes from the right kind of nutrition.
  2. Smoking is a recurrent habit among children and adults: Smoking can cause cancer. Every cigarette packet reads the same warning messages but it doesn't actually deter smokers in any way. Smoking is prevalent among people of all age groups in India. From poor children to conscious educated adults, all are seen smoking.
  3. A Tropical country and its woes: Tropical countries are known to face the wrath of the sun. While most places in central, western, partly eastern and southern India experience extremes of temperature in summer, other places with moderately hot summers are not exempted from the harmful UV rays. Ultraviolet rays can be very harmful for one's skin, as it can cause skin cancer. Indians have a high amount of melanin, which protects them against sun rays, but the threat exists nonetheless.
  4. The concept of fast food: A global economy has opened avenues awaiting your attention in the realm of food. To suit the tones and moods of a fast life, fast food has been made available to you. We take pride in consuming things that can be prepared in an instant: instant noodles, soups and even curries. Packaged food and junk food are sources of cancer cells.
  5. Lack of awareness regarding the most common types of cancer: Breast and cervical cancer are the two most common types of cancer eating away the health of Indians. The problem lies in being unaware about the root causes, symptoms and treatment procedures related to these kinds of cancer. Social repression turns health concerns into matters of insignificance. Women fear social alienation after coming in the open with their problems.
5587 people found this helpful

I have a back disc doctor has advised to take complete bed rest for 3 months but I am preparing for competitive exam which is not possible. is there any way so that I will be ok?

DNB (Orthopaedics), Diploma In Orthopaedics (D. Ortho), MBBS
Orthopedist, Gurgaon
The current philosophy of treating disc problems is to enforce strict bed rest for a week to 10 days,
1 person found this helpful
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Dear sir I have problem of slip disc or disc herniation in cervical. Kindly solve my problem?

MBBS, cc USG
General Physician, Gurgaon
Hello kindly review with X ray cervical AP and Lateral report consult neurosurgeon/orthopedic surgeon
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Types and Diagnosis of Uterine Fibroids

Fellowship In Minimal Access Surgery, MS - Obstetrics and Gynaecology, MBBS
Gynaecologist, Hyderabad
Types and Diagnosis of Uterine Fibroids

Noncancerous growths of the muscle tissue surrounding the uterus are known as uterine fibroids. This is a common disease which about 70 to 80% of women contract by the time they are 50 years of age. The uterine fibroids can sometimes be very big and cause heavy periods as well as severe abdominal pain while at other times, uterine fibroids give no signs or symptoms whatsoever and go away on their own. This is why it is crucial to know what type of uterine fibroids you have and how to diagnose them. Here are the types of uterine fibroids and how to diagnose them;

Types
There are three main types of uterine fibroids. They are;

1. Intramural fibroids
The most common type of uterine fibroids are intramural fibroids. They typically appear in the endometrium and may grow larger which results in your womb getting stretched.

2. Subserosal fibroids
Subserosal fibroids are called so because they form on the serosa. The serosa is the outside of your uterus. Sometimes, Subserosal fibroids may grow so large that your uterus appears bigger on one side.

3. Pedunculated fibroids
Pedunculated fibroids tumors are basically Subserosal fibroids with a stem. A base which supports the tumor is called the stem.

Diagnosis
There are a number of tests done to diagnose uterine fibroids. They are;

1. Pelvic exam
A pelvic exam is a thorough inspection of a woman’s pelvic area. The organs which are in the pelvic area include the cervix, ovaries, uterus and vagina. Normally, this and the next test in this article are enough to diagnose uterine fibroids.

2. Medical history
The history of your periods as well as the other symptoms you have will often be enough to diagnose the uterine fibroids. If your medical history is not enough, then you might need to undergo a pelvic exam.

3. Pelvic ultrasound
An ultrasound is when high-intensity sound waves are used to produce images of the pelvic area. This is only done when a pelvic exam and your medical history are not enough to diagnose uterine fibroids.

2 people found this helpful

Health Benefits Of Barley

Diploma in Diet n Nutrition, BHMS
Homeopath,
Health Benefits Of Barley

Did you know barley water is good for kidney stones?
Barley (jau), a member of grass family, is a cereal that has been cultivated for over 13, 000 years. Packed with carbohydrates (78%), fat (1%), protein (10%) and water (10%), barley is a rich source of essential nutrients, dietary fiber, vitamins such as niacin, manganese, phosphorus and vitamin B6.

With several health benefits to its name, barley water is termed as the elixir to good health. It has been found to be beneficial in reducing chances of heart disease, soothing bowels, reducing blood cholesterol levels, improving blood sugar regulation in the body and acts as nutritive broth for fever, cold and cough. Additionally, studies support that barley water has also been found to play an integral role in maintaining renal health.

What is a renal stone?
A renal stone is a solid stony piece consisting of crystal forming substances in the urinary tract. They are usually formed when the urine is abundant in substances such as calcium, oxalate and uric acid and lack substances that inhibit their accumulation. While small kidney stones can pass through the urinary system without any symptoms, a stone larger than 5 mm can result in blockages in the urinary tract causing severe pain in the back and lower abdomen.

What causes renal stones?
- A family history for stones, lack of adequate water in the body, high BMI, excessive intake of diets rich in protein, sodium and sugar have been found to be some of the common causes for stone formation.

Try protein foods & supplements
- Medical conditions such as hyperthyroidism, inflammatory bowel syndrome and renal tubular acidosis have also been found to alter the digestion of calcium.

How does barley water aid the dissolution of renal stones?
Studies show that regular use of barley water can dissolve and eliminate existing kidney stones and prevent the occurrence of stones and other kidney problems. Use of diuretics either natural or synthetic can help speed up the expulsion of the stone.

Diuretic in nature, barley water helps to flush toxins from the kidneys by creating bladder pressure and increasing the frequency of urination.

- It helps maintain the PH levels in the body, making it alkaline, preventing various urinary tract issues, including kidney stones.

- The vitamin B6 and magnesium in barley helps break down the masses of toxic calcium oxalate (primary cause for stones) in the kidney.

Dietary fiber in barley reduces the amount of calcium that is excreted by the body through urine, restoring renal health and cleansing the kidneys.

Ways to prepare barley water:
- Boil 1 litre of water with a tablespoon of barley pearls and boil on a low flame for about 30 minutes or until the water has reduced to half.
- Strain and cool this mix and drink it through the day.
- Add lemon juice or honey to make the mix tasty

Regular use of barley water ensures that the renal system is hydrated, healthy and free of depositions such as renal stones. So, go ahead and add this elixir to your diet to ensure a healthy renal system and a healthier you. Eat healthy, stay healthy!

5 people found this helpful

Sir I have slip disk problem in l4 l5 Vert disk and pain in lower spine and pain goes to leg randomly both legs. This is from last 6 months What is easiest way to solve this problem.

BPTh/BPT, MPTh/MPT
Physiotherapist, Noida
Sir I have slip disk problem in l4 l5 Vert disk and pain in lower spine and pain goes to leg randomly both legs. This...
Postural correction- sit tall, walk tall. Extension exercises x 15 times x twice daily. Apply hot fomentation twice daily. Avoid bending in front.
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Hello Dr. Sir, I am Harvinder singh from yamunanagar, Haryana. I have lower back pain since last 2 years. Its slip disc and sciatica pain in left leg. I am very unhappy with this problem. Please advice me best of best treatment for the same and where I can get the same.

BAMS
Ayurveda,
Hello Dr. Sir, I am Harvinder singh from yamunanagar, Haryana. I have lower back pain since last 2 years. Its slip di...
You may use yogi joint pain churna for few days, if its helpful for you, then continue to get relief from sciatica.
1 person found this helpful
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5 Easy Ways to Decrease Your Breast Cancer Risk

MBBS, MS - Obstetrics and Gynaecology
Gynaecologist, Noida
5 Easy Ways to Decrease Your Breast Cancer Risk

Breast cancer is the form of cancer that occurs from breast tissues in women. Signs of breast cancer may include a lump in the breast, changes in the shape of the breast, dimpling of the breast skin, a fluid coming out of the nipples or development of red scaly patches on the skin. There might be pain in the bones, swollen lymph nodes, shortness of breath, or the skin turning yellow and pale.

Breast cancer is a fatal mode of cancer in women, and one must try to abstain from this cancer in all possible ways. Here are 5 ways you can decrease the risk of breast cancer.

  1. Keeping a check on your weight: Although the process is tough to maintain, keeping up a sound and healthy weight is a critical objective for everybody. Being overweight can expand the danger of a wide range of cancers, including breast cancer, particularly after menopause in women. Exercise is very important for maintaining a healthy body and lifestyle. Women who exert physically regularly are fitter than others and are at a much lower risk of acquiring diseases of any kind. Regular exercise decreases the chance of getting breast cancer and also keeps the body weight in check.
  2. Maintaining a healthy diet: Maintaining a healthy and balanced diet is a key for keeping away from any kind of cancer or major health problem. Include a sufficient amount of fresh fruits and green vegetables in your daily diet to ensure the supply of all vital nutrients to your body. This would increase your immunity.
  3. Avoid smoking and consume less alcohol: Smoking is a very unhealthy and harmful habit. Smoking lowers the quality of your life, and causes numerous diseases. Heart diseases, stroke and many kinds of cancer, including breast cancer can be caused from smoking. If you drink alcohol, you should moderate your drinking habits and drink less, as drinking in excess may lead to breast cancer.
  4. Practice breast feeding: Breast feeding your children for a span of one year or more is likely to reduce the risk of breast cancer.
  5. Avoid taking birth control pills: Birth control pills, in spite of having several benefits are associated with risk factors as well. Birth control pills have got worse effects in younger women than older aged women. Using birth control pills may cause breast cancer and these pills should be avoided.

There are many ways, adapting which you can lower the chances of getting breast cancer.

3 people found this helpful

My mother is suffering from disc extrusion in L5, is surgery necessary? Or something other will be helpful.

MPT - Orthopedic Physiotherapy, BPTh/BPT
Physiotherapist, Noida
My mother is suffering from disc extrusion in L5, is surgery necessary? Or something other will be helpful.
avoid surgery do physiotherapy treatment for few days and spine stretching and strength exercise. avoid long sitting toward bending lifting weight. posture correction must
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How Is Breast Cancer Diagnosed?

MBBS, MD - Obstetrtics & Gynaecology
Gynaecologist, Delhi
How Is Breast Cancer Diagnosed?

Breast cancer is a form of cancer which develops from the breast tissue. Breast cancer is indicated by signs such as a lump in the breast, changes in breast shape, fluid flowing from the nipple, dimpling of skin, or the development of red scaly patches. Breast cancer is a fatal form of cancer in women and immediate diagnosis is required on observing the symptoms.

Diagnosis of breast cancer
Other than the regular breast screening, the diagnosis of breast cancer involves the following steps and methods:

  1. Seeing your general practitioner (GP): It is very important to visit your GP soon after noticing the symptoms of breast cancer. Your GP will examine you properly and in case your symptoms need more assessment, he/she will refer you to a breast cancer clinic.
  2. Mammogram and breast ultrasound: You will be required to have a mammogram, as recommended by a specialist breast unit. This is an X-ray of the breasts. An ultrasound scan may also be required. Breast ultrasound should be undertaken only if you are less than 35 years of age. This is because, young women have denser breasts and a mammogram is not as effective as ultrasound in the diagnosis of breast cancer. In ultrasound, high frequency sound waves are used for obtaining an image of your breasts. It is observed to notice any abnormality or lumps. A breast ultrasound is also important for determining whether a lump is solid or contains liquid.
  3. Biopsy: In this diagnosis process, a sample of the tissue cells is taken from the breasts and tested under a microscope to find out if it is cancerous. A scan and needle test for the lymph nodes present in your armpit is also done to check whether they have also been affected. A biopsy is undertaken in several ways, depending upon the condition and severity. A needle aspiration biopsy is used for testing a sample of your breast cells without the removal of the tissues. This is the most common form of biopsy and it is also used for draining a small fluid-filled lump or benign cyst. During the process, you will be given a local anesthetic. Usually, a needle biopsy is carried out guided by an X-ray, ultrasound and an MRI scan as well. This helps in distinguishing it from non-invasive changes such as ductal carcinoma in situ.

Another form of biopsy used for the diagnosis of breast cancer is called vacuum assisted biopsy or mammotome biopsy. In this process, a needle gets attached to a suction tube, which helps in obtaining the sample and for clearing the bleeding. If you wish to discuss about any specific problem, you can consult a general-surgeon.

3010 people found this helpful

Treatment Of Uterine Cysts With Homeopathy

MD - Homeopathy, BHMS
Homeopath, Gurgaon
Treatment Of Uterine Cysts With Homeopathy

Uterine cysts are a type of cysts or tumours, which grow in the uterus. This is prevalent in women when they are near their childbearing years. Uterine cysts have some typical symptoms, which would let you know when to consult a medical practitioner for further help. It would cause excessive bleeding for a long duration of time. There is bleeding from the uterus in between your menstrual cycles. At times, it becomes very difficult to empty your bladder and irritation and discomfort are caused. It also leads to constipation. These are frequent symptoms, which accompany uterine cysts. These types of cysts are almost always non-cancerous, but it is beneficial to take an expert advice on that matter. Homeopathy is a great option to treat such cysts.

Homeopathy is becoming increasingly popular throughout the entire world. Now it is time to prove to the world what homeopathy can offer in surgical diseases. Homeopathic medicines cannot take the place of surgery but can be of great help to the patients who do not want to go for surgery or cannot be operated upon due to various medical reasons. There are specific medications to treat cysts through homeopathy.

Some of them are:

  1. Calcarea Carbonica: This medicine is suitable for those who bleed profusely during their menstrual cycle. Such excessive bleeding causes shivers and shrills in them, making them more prone to anaemia. In fact, excessive bleeding also influences their fertility cycles. This medicine is administered on overweight women who suffer from uterine cysts.

  2. Thlaspi Bursa Pastoris: This is prescribed to women who experience frequent menstrual cycles within short intervals. In fact, one does not even recover from the shock of the previous cycle and the new one starts. It is usually accompanied by excessive pain in the uterus. This medicine not only treats the cysts, but also the frequent period cycles and pain in the uterus.

  3. Trillium Pendulum: At times, due to excessive bleeding from the uterus, the patient suffers from fainting spells. Such cysts are also characterised by bright red blood flow during the menstrual cycle. These are the two main symptoms to administer this medicine on the individual.

  4. Fraxinus Americana: Apart from irregular periods with pain in the uterus, it is also followed by breaking down spells. One experiences cramps in the feet during this type of cyst. In such conditions, the best natural homeopathic therapy that can be administered is Fraxinus Americana.

  5. Calcarea Fluorica: This is a common medicine which is given to those patients who have extremely large tumours. These tumours are also characterised by their unique hardness.

Uterine cysts are a common problem in women and can be treated effectively. One needs to be alert about the symptoms and must immediately report to a specialized homeopathic practitioner for an effective administration of medicines, which may lead to a successful cure.   

3294 people found this helpful

I am 20yr old male. I had an accident 2 years ago & I had suffered severe back pain. My spinal cord's disc had moved a bit so that I have pain in my back till now. What should I do for this?

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Kindly show me a photograph of the affected part. Rule out diabetes & vit. D deficiency or any other metabolic disorder. Sleep on a hard bed with soft bedding on it. Spring beds, folding beds or thick matress are harmful Do hot fomantation. Paracetamol 250mg od & sos x 5days. Caldikind plus 1tab od x10. Do neck, back & general exercises. It may have to be further investigated. You will need other supportive medicines also. Make sure you are not allergic to any of the medicines you are going to take. If it does not give relief in 4-5days, contact me again. Do not ignore. It could be beginning of a serious problem.
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Lumbar Degenerative Disc Disease

MBBS, Diploma In Orthopaedics (D. Ortho), DNB - Orthopedics, mch
Orthopedist, Delhi
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Different methods to treat Disc problems

3713 people found this helpful

Does Knuckle breaking at neck at regular intervals when I'm feel stressed, will that leads to an disk injury or any problems in future. Usually I keep doing that when I work out in gym.

MBA (Healthcare), MRCPsych UK, MBBS
Psychiatrist, Bangalore
Does Knuckle breaking at neck at regular intervals when I'm feel stressed, will that leads to an disk injury or any p...
Try to sleep without pillows-it helps your neck and shoulder muscles to relax properly and maintain a good spine posture.
2 people found this helpful
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