KNEE INJURIES

THE anterior crucaite ligament (ACL) is one of four ligaments that stabilise the knee. It runs within the joint cavity of the knee (intra-articular) from the top of the leg bone (tibia) to the thighbone (femur) in an outward direction. It prevents the leg bone from sliding off the thighbone during activities like running or climbing down stairs.

Bundle of collagen

The ACL is a bundle of collagen (connective tissue) about four cm long and one cm thick. It, perhaps, deserves to be termed as the most valuable piece of collagen in the human body as many a high-profile sportsperson's career can be jeopardised by injury to the ACL.

In the last 10 years, there has been tremendous growth of scientific literature on the management of this injury. It is common to sportspersons and in the West, women have a greater incidence than man. This has been attributed to the peculiar anatomy at the end of the thighbone. In India, there is an additional high incidence in men after accidents.

Although there are very few randomised trials concerning surgical management, there have been reasonable studies in the initial assessment, surgical techniques and rehabilitation. Public awareness of the impact of the injury has led many people to seek early surgical treatment.

This is called ACL reconstruction, as attempts to suture the torn ligament have been largely unsuccessful. In an ACL reconstruction, a piece of tissue from the neighbouring tendons and bone (graft) of the patient's own knee (auto graft) is borrowed and fixed with implants. The source of the graft is commonly the patellar (knee cap) or hamstring tendons.

Bone tunnels are drilled in the tibia and femur to site the graft; the graft is threaded through them and is fixed at both ends by some implant (metal or bio absorbable).

Surgical reconstruction is advised in young people who wish to remain active in sports and even in those in whom it is symptomatic even if they are not engaged in sports.

There is no strict age limit or any reason to withhold an ACL reconstruction in a symptomatic individual.

Accurate history

Even consultants miss many ACL injuries. An accurate history should be obtained from the patient. There will be a "popping" sound at the time of the injury.

Immediate swelling ensues after this injury (haemarthrosis or blood collection in the joint). A routine MRI study to support diagnosis in cases of suspected ACL injury is not justified.

MRI has been shown to be less sensitive and specific than an experienced examiner. A MRI is useful in chronic injuries to pick up associated resultant damage to the menisci (semi-lunar cartilages). Concomitant treatment of articular cartilage lesions can logically improve the long-term results after an ACL reconstruction.

Surgical techniques have been refined over the last 10 years. Most knee surgeons now use Arthroscopic or minimally invasive technique. There is some debate about the best source of the graft — patellar tendon or hamstring tendon.

Advances

There is no one answer to this and surgeons should decide on the basis of the patient's needs. Patients whose occupations involve kneeling are not suitable for patellar tendon graft, as there is an increased incidence of anterior knee pain.

New forms of fixing grafts have been developed. These include bio absorbable fixation devices and screws. Early ACL reconstruction is advisable to avoid likelihood of damage to the cartilages of knee and osteo-arthritis.

Ten years ago, it was common practice to splint the knee after an ACL reconstruction. It is now considered unwise to protect the knee and an early return to normal activities is advocated.

Regaining the straight position of the knee is the first goal and regain flexion is the next goal to be achieved progressively. The exercise regime is in an "accelerated" nature and not "aggressive" to avoid strain on the graft.

The physiotherapist needs to supervise the rehabilitation process only on an intermittent basis.

IF SHE DISCOVERS A BREAST LUMP?

The discovery of a breast lump usually causes anxiety bordering on panic among many women. Most rush to the nearest doctor and plunge into a morass of illogical investigations and treatment, including surgery. Needless to say, many a woman regrets th is headlong rush at a later point of time.

Incomplete assessment and treatment, a false perception of cancer risk, a lifelong commitment to intensive and needless breast cancer screening, emotional and economic exhaustion are but a few fall outs that result from all this.
Lack of awareness

There are other women who in contrast are blissfully oblivious to the presence of a breast lump. A lack of breast awareness is often engendered by cultural inhibition and a conviction that once breast feeding is complete, the breasts are of no importance. Yet others do note the presence of a lump but assume rightly or wrongly that it will "go away". Often it requires a friend or family member to coax these women into seeing a doctor.

It is important to note that breast lumps are a common problem and the majority are benign. Lumps are usually discovered by the woman herself and only occasionally by doctors. A woman who is breast-aware tends to discover them early and obviously a painful lump is noted early in contrast to a painless lump.

What should a woman do if she discovers a breast lump? It is important not to panic. Approach a healthcare provider without loss of time. It is prudent at this stage to ask for a referral to a breast specialist (invariably a surgeon). This trend has become established in the developed countries after research showed significant benefits in outcome when a woman with breast disease is treated by a breast specialist.
Thorough examination

Next the patient will be subjected to a thorough examination by the surgeon to determine whether the woman truly has a lump. Often prominent breast tissue is mistaken to be a "lump". Breast imaging follows: mammogram in women over 35 years and an ultrasound scan in younger women. This is followed in the same sitting, if warranted, by an image guided needle biopsy of various levels of sophistication. On no account should a woman agree to bypass these steps and go straight for an open surgical biopsy. This can lead to serious repercussions in breast cancer management.

After comprehensive evaluation, (which may take four to five days) the treatment options can be discussed. With the dramatic and ongoing advances in the field of breast diseases, the emphasis is on individualised treatment. This may be in the form of clinical surveillance, medication or surgery according to the need. By and large there is no need for "emergency" surgery and even for cancers, a delay of a few days or even one or two weeks is of no medical consequence.
Don’t be short changed ?

The late 20th century saw a paradigm shift in the management of breast diseases, both benign disease and cancer. This came about due to two powerful influences: the women’s movement and mounting research evidence on the best methods to treat breast disease.

The First European Breast Cancer Conference held in 1998 issued the famous Florence statement: that all women (at least in western Europe) should have access to multidisciplinary breast clinics and that all breast related health services should have mandatory quality assurance. An important ground level consequence is that national guidelines were created in countries like the U.S., Canada, New Zealand, Australia to improve breast cancer outcomes. The impact was a fall in breast cancer death rates in these countries.

A powerful message of these guidelines is that only surgeons with a special interest in breast disease should treat patients with breast cancer and breast disease. The benefits are greater accuracy of diagnosis, better quality of treatment and a reduction in morbidity and mortality.
Indian situation

By contrast India is seeing rising incidence of breast cancer, high incidence of advanced breast cancer and shameful death rates. Indeed there are no national guidelines on how services should be organised, delivered and monitored within our socio economic constraints.

It is up to Indian women’s groups to push the medical profession and the Government to look at breast disease as a national issue.

Our women must assert their rights to get the best possible treatment and refuse to be short-changed as their western counterparts did nearly 50 years ago.

Spiralling costs

The advances in breast cancer medicine and surgery have been progressing at a prodigious rate. The crunch is that the best methods of diagnosis and treatment come at a cost.

In a highly specialised and evolving field such as breast cancer treatment, even diagnosis is an expensive business. A few thousand rupees need to be set aside just for assessment of the cancer. If in addition, genetic tests are required, the bill for this alone is about Rs. 50,000. But this elaborate evaluation helps individualise breast cancer treatment and enhances efficacy of treatment. Surviving a few years more without cancer is the direct result of this individualisation. It is indeed a balance between money and life.
Financial implications

Treatment in the form of surgery, chemotherapy and radiotherapy follows and is financially crippling. Families need a few lakhs of rupees to get the best in terms of the latest chemotherapy drugs of added efficacy or the latest machines for better and safer delivery of radiation.

Today we have special drugs such as anti-breast cancer antibodies, which can be given to selected patients to control the cancer remarkably well. The cost of these injections is approximately Rs.1,00,000 per dose. These drugs need to be given every three weeks for close to a year. To meet the bills, families have been known to reduce themselves to penury. The tragedy is that many do not survive.

Whom does one blame for this financial juggernaut: The government, the private sector or the multinational companies? Or the patient for asking to live in peace for a few more years?
Why see a specialist

• It gives better local control of cancer.

• It improves the survival of the patient significantly.

• The patient has greater satisfaction with the treatment.

• The patients receive greater psychosocial support.

• The patients have improved quality of life after treatment.

• It is cost effective to be treated by breast specialists in the long run.
If you discover a lump

• Ask to be referred to a breast specialist.

• Undertake investigations as per specialist advice.

• Wait for the full evaluation.

• Heed the specialist’s advice.

• Do not seek multiple medical opinions, particularly from "non specialists".

• Be reassured that the majority of breast lumps are benign.

• Even if you have a cancer, do not lose heart. It can be controlled effectively.
Tips to contain costs

• Ask to be referred to a breast specialist early.

• Do not undertake investigations without professional guidance.

• Adhering to international treatment guidelines contains costs in the long run.

• Be part of a breast cancer support group, on going information helps contain costs.

BALANCED DIET MEANS ?

Surviving the seduction of miracle-promising weight-loss programmes, fad-diets and food-fads is tough. After all, these are times when we have deep concerns about fitness for cosmetic and health reasons. Tougher still is making sense of their conflicting claims on the best ways to get fit.

However, doctors and nutritionists say the secret to lasting good health is not a quick weight-loss plan, fad-diet, or gorging on ‘super-foods’ but building Good Eating Habits. This means consistently watching what you eat –– planning each meal and its timing, following simple, golden rules.
Balance check

A balanced meal sounds simple but most times we slip up eating more of one food over the other because it’s our favourite or easier to source and/or cook. Result: nutritional imbalances.

Suja Mathai, nutritionist, Soukya, Bangalore, says: "Ensure your meal incorporates the five food groups: cereals and grains; pulses and legumes; fruits and vegetables; milk and meat products; nuts and oilseeds/oil."

Dr. Kalpagam Polasa, Deputy Director, National Institute of Nutrition, Hyderabad, advises: "The largest servings must be cereal-based; followed by vegetables and fruits; milk and milk products; pulses/non-veg protein; and lastly fat, oils and sugars."

Drink two litres of water daily to maintain body’s water-balance, flush out toxins, prevent dehydration and build-up of kidney stones, etc.

Go Organic. Avoid foods bred on artificial pesticides and fertilizer. Organic products are difficult to source, but make that effort. Or grow a kitchen garden.

Trim portion size. It’s directly proportional to waist-size. Moderation is the key to healthy eating.

Though, says Suja, moderation is a subjective term; one man’s moderation may be another’s excess. Therefore, each person should determine for himself or in consultation with a nutritionist, how much they need to add or cut down and of what, given their current constitution.

General rule: cut down first on fat intake (butter, cheese, oil, nuts, fried food), and then carbohydrates (rice/wheat, potatoes, mango, sapota, banana).
When good becomes bad

Limit portions even of healthy foods. Olive oil is healthy but an olive-oil drenched vegetable/pesto-sauce isn’t.

Vitamin tablets are beneficial but overdosing on certain varieties is counterproductive, causing health problems. Salad is great but not one smothered with mayonnaise.

Eat plenty of greens. They provide iron, fibre, calcium, and prevent indigestion, constipation.

Minimalism is in. Cook using minimum oil/ghee/butter. Unfortunately, some ruin that effect by smearing that dry roti or roasted papad with oil/butter/ghee or adding dollops of ghee to steamed, starch-drained rice.

You can’t do away with oil, ghee and butter; some of it’s actually healthy. Only, minimise their use. Steaming, broiling, roasting and poaching are healthy alternatives to deep-frying, shallow-frying, sautéing in lots of oil/ghee.
Don’t recycle oil

Avoid recycled oil or ghee. It’s rich in cancer-causing carcinogens. Sadly, many Indian homes, restaurants and street-food vendors repeatedly recycle cooking-oil/ghee. Seen that deadly brackish oil in simmering woks at street-food peddlers?

Homemakers and singles who celebrate today’s easy availability of sweets/snacks at condiment shops or supermarket shelves could be trading in convenience for ill-health. Ideally, home-cook these if you must have them.

Dr. Polasa explains: "Oils heated repeatedly at high temperatures for long time result in formation of peroxides and other chemicals, which are mutagenic (can cause changes in RNA, DNA); and of heart-damaging transfatty acids."

Go Natural. Fresh fruits and vegetables (including garlic, onion) are weapons against cancer, digestive ailments, heart disease. And wherever possible, with their fibre-rich peels on. Fruits and veggies prevent clotting tendency and protect arterial walls, says Prof. K. Srinath Reddy, eminent Delhi-based cardiologist and WHO consultant.

Conversely, limit foods high in cholesterol, saturated fat, transfat, salt and added sugar; like creamy pastries, cakes, chocolates, doughnuts, cheeseburgers, French fries, soft drinks, namkeens, sweets; Reddy adds.

Vitamin tablets are health-aids but your natural diet is the better source, says Mumbai-based physician Dr. Gireesh Mansukhani.
Travel discipline

The high-flying professional travelling 20 days a month often complains of lack of control over diet. Actually, she/he’s not that helpless. For example, from bread-baskets in planes choose multigrain or brown bread over transfat-rich croissants. At restaurants, order salad and fruits with each meal. Check menus for low-calorie options/health foods.

Or, design your own meal. For a snack, ask for a sandwich of multigrain/brown bread with filling of spinach and low-fat cheese; eaten with fresh-fruit juice/yoghurt.

A meal could be soup; dry rotis; steamed veggies/grilled fish; salad; skimmed-milk yoghurt; and fresh-fruit dessert.

Most hotels will give you customised meals if informed in advance. Carry bottled water when leaving the hotel and ensure you have downed two one-litre bottles by the end of the day. Best of all, ask your family doctor who knows your body-type and medical history, for a list of healthy-meal combos to order when travelling.
Regular timings

Adhere to regular meal-timings. Else, your body is thrown off-balance attempting to compensate. Also, eat a good breakfast, followed by a moderate lunch and light dinner, advises Dr. Polasa. "High-fatty meals are particularly to be avoided at dinner as there is little physical activity after consumption, so unused excessive calories are converted into fat stored in the body."

Go slow. "Chewing slowly," says Dr. Polasa, "prevents excess intake as satiety is reached 10 to 15 minutes after commencing food intake."

Finally, when it comes to the overall good-health menu, eating right is a major but not the only item. For best results, include: Regular exercise; regular check-ups. no -smoking; a package of positive thinking; yoga; and meditation.

HOW CAN ONE PREVENT STYES?

Boils on the eyelids (styes) are due to bacterial infection of glands present at the root of the eyelashes.

Treatment comprises hot water fomentation — hold a towel soaked in hot water over the area for five minutes — and using antibiotic drops or ointment for a week. Pain relievers are also prescribed. Oral antibiotics are held in reserve for those with severe infection that may lead to an abscess.

Tarsal cysts or chalazions are formed when vertically placed oil glands (meibomian glands) in the tarsal plates of the lids get blocked at their openings in the lid margins. This results in a pooling of the secretions, which usually increases with time. Occasionally this may get infected, resulting in a boil. A large chalazion requires a minor surgical procedure with a niche only on the inner side of the lid rendering aesthetic satisfaction of the patient.

Persistent boils tend to occur conventionally in diabetics, those with refractive errors, itchy eyes (those who frequently rub eyes) or are associated with lid margin infection called blepharitis.

Further questioning revealed that his working hours were 8.00 a.m. to midnight and that he could snatch only a four-hour nap. He was advised to sleep at least seven hours to build up immunity to combat the staphylococcal germs normally present around the lids.

The most common cause for repeated eruptions of boils on the eyelids is lack of adequate or quality sleep. Any prescription for infection of lids also includes control of blood sugar or correction of power.

STAY ON YOUR FEET

Inseam, hip and waist measures are critical in buying a pair of jeans, once the decisions on brand, style and price have been sorted. A trial room and mirror helps. Similarly, fit, size, cushioning and arch support are key in the choice of a running shoe and often override brand, price and style.

All new shoes feel great, but an inappropriate shoe leads to problems, sometimes over the years. It’s important to know whether you are flat-footed or have a high or a normal arch, and also understand if you over-pronate or under pronate

"Ouch, these guys just stopped writing in English!" Let me try and explain:

When you run

When you run, the outer part of your heel strikes the ground first. The middle part of your foot then begins to make contact with the ground, while it rolls inwards by around 4-5 degrees at the arch (or pronates).

This is the body’s means of natural shock absorption. The entire foot is in contact with the ground for a fraction of a second before the ball of the foot (the part just next to the five toes), kicks off, with the help of the toes. And we have lift off.


Here are some simple ways to understand your feet better.

The wet test: Wet both your feet, step onto a sheet of paper, and view the wet pattern.

If the imprint shows your whole foot, then you are flat footed and, perhaps, over-pronate i.e. when your foot hits the ground your arch collapses a bit more than needed (over-pronates).

You need a shoe that has a much firmer middle, a stability shoe or if you are severely over pronating or are a heavier runner (over 75kgs) then a motion control shoe.

If you see some of your foot and a curved arch, a normal arch, the best shoes are those that provide stability (as above).

A thin line connecting your heel to the ball of your feet and your toes means you have a high arch (the foot most probably supinates or turns outwards.

You need a shoe with a soft middle to absorb the shock of every foot strike.

The old shoe test: Flip your old running shoes over (or if you don’t have one, examine the soles of your old shoes).

If the inside of the sole is more worn out, then you are most likely flat-footed and over-pronate. If the outer sides of your soles are worn out, you are likely high-arched and under-pronate (or supinate)

The walk test: Walk towards a full length mirror and then away from it, and observe your feet motion. Also, just watch other people jogging or walking in the park or on a treadmill and see if the inners of their shoes are getting most of the wear.

Then you can tell if they are over-pronating or under-pronating. About 80 per cent of the population have structural problems in their feet that cause abnormal walking pattern
Basic shopping tips

Feet swell during the day. Shop in the afternoon or evening.

If you run longer distances (10km or more) buy a size larger than normal to allow for foot expansion. You should be able to stick in a finger between your heel and the shoe. Don’t ever fall for the sales talk (it will loosen out). While that could happen with a leather shoe, it’s the wrong answer for a running shoe purchaser to hear.

Most of us, strange as it may sound, have one foot longer that the other. So measure the shoe size of each foot and try out the shoe size for the bigger foot.

Wear socks during the try out.

Visit multiple stores, try multiple brands and models, ask questions and learn more, before you buy. This will be your most important investment, as problems with arches often travel up the skeletal system to the ankles, shins, knees, hips and finally the lower back.

Do not assume that the most expensive shoe is the best for you. Many in the Rs. 2,500 to Rs. 4,000 range could be just right for you.

So just like you would never buy a 40inch waist DKNY jeans just because they are the latest, don’t end up buying the latest and most expensive shoes and assume that they are the best for you.

If you are serious about running, keep two shoes and alternate them so that they get a day or more to breathe, and spring back to provide your feet the support they need.

Enjoy the run, and enjoy your running shoes even more than your jeans! Now you, like Fauja Singh, can run marathons in your nineties.

RUN LONG RUN STRONG

RUN LONG RUN STRONG

The incredible benefits of running go beyond the realm of health. The second in a series on running and living. Every run is a gift. Run long. Run strong.


Running tends to release endorphins (indigenous morphine produced by the body). Sounds great, right? Takes you on a trip and it’s free! Running in the outdoors in particular has been known to cause this runner’s high, which can last for long periods of time — even days. I have felt unbelievably ‘high’ for a few days after a marathon, on several occasions.
Effects on the brain

Running has also been used by many, over the years, to treat clinical depression. After a study in 2007, scientist said, "Exercise clearly has effects on the brain" and they are both direct and indirect. It’s possible, he explained, that the current findings reflect a direct effect of exercise on nerve cells in the hippocampus, or more general changes in the brain, like better blood flow or increased hormonal activity.

A natural compound (epicatechin) and exercise boost memory in mice and may help protect against cognitive decline in aging, says newly published research. "This effect increased further when mice also exercised regularly. The compound, epicatechin, is one of a group of chemicals known as flavonols and has previously been shown to improve cardiovascular function in people and increase blood flow in the brain. Flavonols are found in some chocolate."

Okay, so eat chocolate and exercise. I am sure this is now finally beginning to sound more palatable to you.
To manage jet lag

Now that may sound far fetched, but it isn’t. Believe me, in my last assignment at Motorola I had to travel a lot — 200,000 miles a year — so managing jet lag was important. I found that maintaining a regular regimen of running even a short distance, starting the day or morning after landing in a new time zone, helped me remain energised and perky, even without generous doses of coffee.

Most importantly, running is a great way to make yourself incredibly positive and optimistic, as you measure your progress, and see yourself achieve some things that you never thought possible of yourself. At 40, I could barely run one km without being exhausted and out of breath. Over a six-month spell of winter in Chicago, I found I could run five km without stopping, and then I felt I could achieve anything. It gave me that supreme sense of confidence. I then went on to run my first marathon that year and have done 22 more since! And I am no athlete.
Team up

While you run you make new acquaintances in the park, in a gym, on the road. As you greet them, they tend to reciprocate and, then all of a sudden, you have a few more friends. Or if you are running with people you know, you find soon enough that you are starting to bond on a different plane too.

It’s a great way to build teams in companies, being the most egalitarian sport, as CEOs rub shoulders with new recruits and so on. Try it!

Talking about running getting you to bond with others on a different plane brings me to Warren Kay, chair of the Department of Religious Studies in Andover, Massachusetts U.S., where he teaches a class on the Spirituality of running. He has written a book on sweating yourself to enlightenment: Running: The Sacred Art.

So whether you want to get younger by nine years, or attain Nirvana, all you have to do, is run, run! I hope that’s a succinct sales pitch, and you are running, and I can curl up in bed and have my chai and paratha, and I will chat with you next week. Go ahead and start.

Moving quote

In case, I haven’t convinced you yet, I would like to end with a moving quote from the blog of a cancer-fighting runner. "Oh how I do love running. I love the feel of wind in my air, the dull thud of running shoes against the packed dirt. The crunch of the gravel. The running endorphins enhancing my senses, and how alive I feel at the end of a run. Running is freedom. I hope I can run forever. Every run is a gift. Run long. Run strong."

PSYCHOLOGY OF EXERCISE

It is important to keep changing your routine and set new goals. This prevents monotony and gives one something to work towards.

Exercising regularly is not the easiest thing in the world. Not all of us have the good fortune of actually "liking" exercise. Having said that, it is possible however to train your self to enjoy it (well, at least for the most part). It is all in the mind!

There has been so much media hype about it (and rightly so), that it is hard to find an educated person today who is unaware of the benefits of regular exercise. Whether they act on it is another story altogether.

Why this complacency when the writing is on the wall? Maybe a sense of invincibility smothers us. Like the smoker who believes he will never fall victim to lung cancer, most of us think we can bypass that responsibility for the day without repercussions.
One step at a time

There is a psychology behind learning to exercise regularly. To begin with, focus on goals, both short term and long term. Visualise the positive changes in your body (both internal and external) while you go through the motions. Envision a healthier, slimmer, stronger you.

Don’t get discouraged by the gym rat or by slow progress. One step at a time, as you begin to feel better every day, and you really will, when the endorphins start kicking in.

I encourage people to see this as time alone for themselves. Most people multi-task trying to make ends meet. Rarely do they even have the opportunity to connect with themselves during the course of the day. Use this as a time to contemplate, unwind and de-stress.

How does one de-stress while breathless on the treadmill? The mere act of the repetitive, structured movement of the extremities diverts the mental stress to the physical action and actually creates alpha waves in the brain that generate a calm state of mind.

As you continue to work the cardiovascular system, the endorphins released give you the elevated mood and improved moral.

When this is repeated frequently enough, you start to look forward to that very activity that causes the "high". It feels great when it’s completed and the results are indisputable. This is reason enough to keep at it.
Making it a habit

According to the transthoretical model of change, an individual goes through a series of stages before the act of exercise becomes a habit. This could take as long as five years of regular exercising for you to fall into the category where "Fitness" is part of your lifestyle.

During the course of this process there may be many an occasion that can challenge your resolve and you may find yourself sliding backwards. But there is always the option of getting back on the wagon.

Initial rapid weight loss can be exhilarating. Inspiration in itself. Then comes the plateau. During the plateau phase it is important to find something other than your weight to keep you motivated. The compliments slow to a crawl and the scale doesn’t move. Keeping the weight off is just as hard work and you need to compliment yourself on that.

Take up other projects in the meantime and stop obsessing about the scale. This is a time when exercise can wane and inspiration runs low but persistence invariably pays off and the plateau gives way to a new horizon.
Maintenance phase

Then comes the maintenance phase where you have achieved your goals, but have to sustain it. Or improve your already excellent condition. Although not as hard as the earlier phases, there can be a sense of complacency that may result in return to earlier habits and weight gain.

I believe it is important to keep changing your routine and set new goals. This prevents monotony and gives one something to work towards. There’s always place for improvement.
Feel good

Emotional eating, stress, fatigue, travel, lack of sleep can all interfere with good intentions. Feel good about yourself, including the body you are in now.

Sometimes it may be required to lay off a little with the exercise or indulge in your favourite treat.

Keeping things in perspective and priorities right will get you the results you want and try and have fun while doing it.