A recently published case study takes out the ‘WOW! Factor Medal’ for its extraordinary illustration of just how impacting simple silly old lil’ (I’m being tongue in cheek of course) threadworm (aka Enterobius vermicularis) can be on a child’s mental health.
“The patient was a 10-year old Syrian female, who presented with unusual and vague symptoms like insomnia and irritability, nightmares and weight loss. Given the violent background of the Syrian warzone that the patient had escaped, she was firstly diagnosed with post traumatic stress disorder (PTSD) before eventually getting correctly diagnosed with enterobiasis.”
They understandably thought she had a mental disorder
The medical officers understandably had it flagged as PSTD.
She had worms – threadworms
Two rounds of systemic (not OTC) worming drugs – with each dose two weeks apart, in order to avoid reinfection, the symptoms all resolved and after a 3 month follow-up period, the patient remained asymptomatic without any signs of recurrence.
 
Just makes you think are there others out there with the wrong diagnosis when it could be these creepy critters – doesn’t it
 
Want to learn more in the whole area of the potent overlap between GIT and neurobehavioural presentations in kids? Paediatric Digestive Issues & Neurocognitive Abnormalities was one of Rachel’s most popular presentations captured last year which talks you through the links and the practical work-up in each of paediatric patient. Rachel’s presentation reviews the key neurobehavioural manifestations of a variety of common paediatric digestive issues and introduce you to a few of her favourite paediatric patients that taught her all this (!), along the way. Available as Audiovisual streaming and PDF notes.

Not long ago, Kathryn Simpson and I were sharing a hotel room on yet another work trip to somewhere. The lights were out, it was way past our bedtime and we were just gasbagging incessantly like a couple of teens, when a thought pops into my head:

“Hey Kathryn, back when you were my student, did you ever imagine this scenario in the future – you know us being colleagues and friends and having slumber parties full of laughing?”, she replied, “Well no, but you know what I REALLY never could have imagined in my wildest dreams…the Australian Naturopathic Summit and you inviting me to be a co-founder of something that’s had such a big impact! That one I just didn’t see coming!”

Well to be honest, neither did I but sometimes I just have an idea that won’t leave me alone and is too important and too promising to ignore. Three years ago when I shared one of these, the vision of a national naturopathic conference by naturopaths for naturopaths, that would lift us all professionally, offer collaboration over competition and provide us the highest level of non-biased education, with Nirala Jacobi, turned out she’d been visited by the same thought bubble.  Then I approached Kathryn, who was working for me at the time and pretty fresh out of uni but full of passion and drive about building a better ‘new’ naturopathic career path, one that supported rather than splintered those emerging out of great courses into a harsh, challenging professional space.

Time-travel forward to now, we are just 10 weeks(ish) out from erecting the chai tent, marquees and lanterns, for the second inception of this extraordinary thing called the Australian Naturopathic Summit 24-26th August at Lennox Head.

This is the culmination of 3 years of work from us, one paid project manager and the exceptional generosity of over 25 of our naturopathic idols, thought leaders and torch bearers who are donating their time to present plenaries, workshops, case studies, panel discussions… because they believe so strongly in the cause and the need for such an event. 

If you think I am running out of breath between all these words..I am. This thing…has taken on a shape and life much greater than even we had envisioned.

If you follow the work I do – you’ll know that I am passionate about collaboration over competition.  I could never have come to this place in my career without the input of many (some who remain on speed dial even now!) and through my mentoring programs, the infamous RAN internship and hopefully times we’ve come across each other…I’ve encouraged you to do the same and by doing so, grow bigger together.  So just imagine the value of collaborating face-to-face…over 3 days…at a festival in Lennox Heads… ? And not just for 1 hour, but for 3 full days with 100’s of other practitioners from all areas, specialities and locations. Oh and if you’re thinking you’ll just have to wait ’til the next one’…SPOILER…there is no guarantee of a next one! Being a passion project that we 3 donate our time to, for you, it requires your support to keep it going.

So with saying all that…..(cajon roll…that’s a drum for you non-hippies)….It is with great excitement and enthusiasm that today I can announce a special deal for RAN subscribers. Yes….that’s you! Just like myself you all see a need to grow and build skills, knowledge, competence and confidence in the practice of naturopathic medicine. Come join the very best of your profession and take up this special offer to attend the second independent Australian Naturopathic Summit held in Lennox Head on 24-26 August.

To get 15% off a full 3 day pass enter Festival at the checkout

Book your tickets before they run out at  www.australiannaturopathicsummit.com.au.
For information or questions about this special email hello@australiannaturopathicsummit.com.au.

This summit is unprecedented in Australia for the following reasons:

  • It is free from commercial bias
  • It is about professional development, improving our practices and career paths, not products
  • The primary objective is to support the Australian Naturopathic community, celebrating our diversity and creating a platform for our own Naturopathic torch-bearers in various areas (Practice, Research, Herbal Manufacture, Corporate Health, Entrepreneurship etc.) to help light the way for the broader professional community

This year our theme for ANS 2018 is ‘Coming Together On Common Ground’
Naturopathy has many different practices and paths,
but we all work for the same purpose, guided by the same principles.

The ANS 2018 program has three distinct themes across the 3 days…

  • Friday 24 August: Custodians of the Vital Force
  • Saturday 25 August: Upskilling Your Clinical Practice
  • Sunday 26 August: The Business of Business Development

The morning of each day consists of plenary sessions followed by a lengthy lunch break that allows for networking, beach walking, guided outdoor meditation, perusing the vendor village, or simply enjoying the festival atmosphere in the beautiful outdoor location that our summit is surrounded by OR for those die-hards some amazing case studies presented by the likes of Jason Hawrelak, Dawn Whitten and Sandra Villella.  Afternoon sessions are workshop-style, designed to be more interactive. There are plenty of workshops to choose from to keep you riveted and inspired.

We have created a jam-packed program to do just that.
Download your copy of the full program here!

ANS 2018 – come join the very best of your profession.

Book your tickets before they run out at  www.australiannaturopathicsummit.com.au.
To get 15% off a full 3 day pass enter Festival at the checkout.
For information or questions about this special email hello@australiannaturopathicsummit.com.au


Enough said.

These little blighters are getting a lot of airplay this month and rightly so…..! Oh Em Geeeeeeeee….so much misinformation out there!! It’s time to set the record straight

Worm infestations never conjure up a pretty picture in our minds although a video of humans trying to bum slide across the floor like some dogs we know would get a fair few laughs (…will share that vid later) 

Despite much talk of the potential therapeutic activity of helminths for things like autoimmune diseases and allergies due to their immuosuppressive effects, there’s nothing nice, friendly or ‘good for us’ about a chronic Enterobius vermicularis (threadworm) infestation in a child or adult (YES! You heard me). Oh and don’t forget the possible link with your D.fragilis patients…you just might need to treat these guys instead.

It was great to get down and dirty on worms with Andrew at FX Medicine. This podcast has us uncovering and debunking myths on these creepy critters that have more to answer for than you probably realise…

The outcry from the public is enormous, in terms of their need for help and the gaps that are there at the moment in terms of getting it. There is an online resource called thewormwhisperer.com.au, which is primarily there for the public to meet this need and practitioners can learn a lot by going on there as well.

Help!!! I’m about to share the stage at the 3rd International Acid-Base Symposium on the 25th-27th Jun, with the best acid-base researchers in the world, all of whom I actively stalk (well read and recite everything they’ve ever published but close enough!) I’m terrified and excited in equal doses…but urgently need to change my presentation approach because until now I’ve had the privileged position of simply fulfilling the town-crier role, announcing far and wide the findings of their incredible research into acid base physiology and their findings about impact of chronic mild metabolic acidosis.  But I can’t quote Arnett to Arnett! I can’t tell Dawson-Hughes about the incredible insights of Dawson-Hughes’ large body of work in this area! Oh my Goodness (cue, shaking knees), I’m going to meet Thomas Remer…of Potential Renal Acid Load Formula Fame!!

Yes, my partner is a musician and through him I have brushed shoulders with all kinds of famous…but nothing that has made my heart beat quite this fast! 

Must buy an autograph book for them to all sign. 

Joking (kind of). (more…)

 

Good morning San Fran!!! 🙂 You know me…I’m notorious for challenging outdated ideas in our fabulous integrative health landscape and along the way, trying to introduce new ones that are backed by better scientific evidence. I regularly get asked to speak in spite of this (!) and now I get to be heard by over 20,000 people who subscribe to the Fertility Hour which is based in San Francisco. It’s great to be spreading the (real) word on Iodine!

Iodine deficiency can constitute a major barrier to fertility and in some individuals increases risk of miscarriage 4 fold. Not to mention decreasing IQ,possibly increasing rates of ADHD and contributing strongly to poor pregnancy and delivery outcomes, generally for mum and bub. We can agree that iodine is essential to health but what has become hotly debated is how does one assess if they are iodine deficient and what dosage is appropriate?

And given a long period of basic neglect, does our current increased attention and use of this essential mineral, constitute the pendulum swinging too far the other way?

Here are some points covered in this freely accessible podcast, for those of you who haven’t quite had your iodine fill yet 😉 (more…)

Ever feel like you’re chasing your own tail trying to treat & find the source  of GIT parasites in some patients?!  Well guess what, you just might be!

We’re seeing more & more patients test positive for Dientamoeba fragilis and increasingly patients struggling to eradicate it and prevent relapse. And then there’s Blastocystis hominis affected patients… and then those lucky enough to have both. 

Well, while we might have been grouping D.frag together with B.hominis, being the two most common GIT parasites in humans, looking for what they share in common,  they are worlds apart (we think!) in terms of how they are transmitted to humans. (more…)

 

How many times have you heard me suggest a vegan diet as the most effective and sensible dietary intervention for a condition….yup…not often but here I am saying it now.   I had a great one-on-one session with a long-term mentee yesterday to discuss a case of advanced Chronic Kidney Disease (CKD).  Her patient, a 60 something male, has had a GFR < 30 for over 5 years, (I know don’t get me started again, right…Goodness Friends Really!), but was only alerted to this being indicative of severe renal impairment (stage 4 of 5 stages, in fact) in the last 6 months. Pause. Everybody who cares about kidneys, take a deep breath. 

So…what’s been his dietary advice and management to date in response to the NEW (!) recognition that his kidneys are not functionally normally, can not clear wastes – whether that’s nitrogenous wastes from protein, or fluid, hence the diminished urinary output & susceptibility to oedema, or even excess potassium and other nutrients, as well as he should?

Cut down on red meat. 

That’s the advice from his renal specialist & there’s not even a referral to a specialist dietitian. (more…)

You know I’m not one to raise my voice and make scene.

Ok, I always raise my voice and make a scene, but only when I think something really warrants our attention and the issue of under-recognised, under-estimated and mismanaged chronic worms, demands our attention.  I’ve been talking about this ever since the first patient stepped into my clinic, a young girl with severe mood issues who just happened to also have treatment-resistant chronic threadworm, and since then, as the volume of patients I see affected by this has grown, so too has the volume of my message. And there’s actually so much to say.

Chronic worm problems don’t always come with an itchy bottom calling card. In fact, many individuals don’t have any of the telltale signs you might be used to screening for.  Recent research suggests adult men, in particular, are commonly asymptomatic when infected with them (Boga et al 2016)

So what alerts us as practitioners to the possibility of chronic worms – so many things…but here’s just some thought bubbles to get you started.

Are you treating patients with recurrent or treatment-resistant Dientamoeba fragilis?

Are you seeing women who have thrush-like symptoms, in spite of negative swabs and no benefit from antifungals?

Are you faced with families coming undone because of one child’s behaviour whether that’s aggression, defiance, emotional lability or just serious sleep problems? (more…)

Goodness Friends Really (GFR) – where do we start talking about the GFR (Glomerular Filtration Rate)!

This is the standard way to estimate the competency of your kidneys, in particular their ability to filter waste from the blood. There is SO much to say and not quite enough attention span for most of us because renal stuff is silent, it’s not typically what patients write down on their forms as requiring your utmost urgent attention &, let’s be real, it only happens to old people, right? So wrong.   Commonly reported as part of ELFTs or General Chemistry, of course it is only an estimation & it’s not infallible – the GFR can both under and over-estimate renal health depending on a number of confounders, however, putting that aside for another time, can we all just agree that renal risks are REAL, they are RIGHT NOW, (CKD won’t happen over night but for 1/3 it WILL happen) and they are REALLY REALLY not talked about enough, by most health practitioners?

Less than 10% of people with chronic kidney disease are aware they have the conditionwhich means more than 1.5 million are unaware they have indicators of the disease. One in three Australians is at an increased risk of developing chronic kidney disease (CKD).”

Hmmmmmmmmmm… knowing how effective our kidneys are at removing waste is a pretty important insight to have about our whole health story and if we are truly aiming to practice preventatively then, this system has to come somewhere close to the top of the to do list! Essentially we are all aiming for a GFR >90 and the lower the actual result, the greater the renal impairment. CKD arguably begins with any value <90, although this is only regarded as ‘mild impairment’, that may well still be highly significant, if for example, your patient is only in their 30s!  But conversations about this typically start when results drop under 60, at which point you are in CKD stage 3 = moderate impairment. Not yet time to put the patient’s name on the dialysis wait-list ….yet, however, the reduced ability to remove nitrogenous waste will not only hasten the progression to needing this but also potentially contribute to heavy metal accumulation and cognitive decline but increase cardiovascular mortality risk  by up to 57% ! So today I have a bewildered mintie pose a very sensible question – check it out: (more…)

I need to clear the air, to clarify.  If you’ve listened to my So you think you know how to treat Iron deficiency podcast and implemented a less frequent dosing regime and it’s worked like a treat for your patients, like Tina….HOORAY! And if you tried out this protocol and instead your patient’s ferritin plummeted…listen up.

Something I said during the podcast but likely needs re-emphasising is that this strategy of separating each dose by at least 48 hours is for those patients who are non-responders. This means their iron stores have failed to really budge in spite of big (>50mg elemental iron) daily iron supplements OR for those individuals, of which there are many, who simply can’t tolerate large iron doses but their ferritin is bottoming out as a result 🙁

So just to balance out the feedback…it’s true my days are not exclusively punctuated with good vibes & pats on the back ;)… I also heard from another practitioner whose vegan client’s ferritin had increased  by about 30mcg/L on 50mg iron daily and after hearing my podcast, she decided to try pulling the dosing back to alternate days.  So, unsurprisingly (to me), her next lot of bloods showed a drop in the iron stores.  Why?  Because she is a vegan, so there is little iron outside the daily supplement dose itself coming in, she is ‘hungry’ for the iron, and in response to this her body is appropriately increasing her iron transporters on enterocytes to improve uptake in the gut and increasing the number of taxis for iron in the blood (transferrin) and there are no other issues at play like inflammation, to mess up this lovely example of nutritional physiological compensation.  She is not the right target for this approach.

But Tina’s patient was… cue email subject header; ‘Iron dosing in pregnancy awesome!!!’  (more…)

Got fair skin and white spots on your nails and go a bit off-grid in stressful situations? Thinking it’s pyrroles? Well, you’re probably wrong!  Man. I’ve been waiting a long time, since being introduced to the pyrroluria biochemistry and diagnosis over a decade ago in fact, to get something that looks anything like validated scientific clarification about this condition: what exactly we’re measuring in the urine test, where the line is between healthy & unhealthy with these results and a clear set of physical and psychological traits that actually correlate with this disorder and therefore can help to screen your patients in order to determine in whom testing for urinary pyrroles is really warranted and most likely to bear fruit. And finally we’re getting somewhere! Cue Crowded House ditty 😉
With mental health patients, understanding their unique biological & psychological contributions and drivers is the key to individualised treatment and optimal outcomes but in terms of biological assessment, we can’t just order ‘one of everything’, using a dragnet approach & drain their bank account along way.
Previously, what I had learned, 1st and 2nd hand about patients with pyrroles left me with uncertainty about the specificity of the clinical picture. Then when I caught glimpses of the incredibly, (ridiculously) long list of symptom attributions being made with pyrroluria online via public and some practitioner forums, I felt even more uneasy.  It was becoming more likely a Dolly quiz – that’s a mag from the 80s young folk 😉 – than a credible way to pick up pyrroles in patients.  And like every health fad, it seems to have been reaching scapegoat and panacea heights. Consequently, it really lead me to question my own convictions about how this condition presents and the significance of that. I started ordering the test left often.

(more…)

Luckily I still had the file. After seeing patients for a couple of decades, I have to get periodically ruthless with the shredder for those I haven’t seen in a long time and 7 years qualifies as a long gap between appointments but when I saw her name in my calendar, I knew exactly who she was and had clear a sense of where we had left off…somewhere I regarded as the early stages of treatment, in the sometimes vast space of no man’s land, a long long way before done.  Where had she been?  Why was she coming back? Hadn’t my attempts to treat failed?

I’m sure we’ve all thought about the patients that don’t return and effectively disappear, after the first, the third or the sixteenth appointment. Chances are, there is often some sense of failure…’I failed in keeping them engaged in the process’ or ‘I failed to get them the results they were after’…and certainly sometimes, ‘they failed to undertake a perfectly good management approach because they weren’t ready.’  But this is really just left up to our imagination & we tend to fill in a lot of gaps with our particular bias.

We’re both full of smiles when she enters. It actually feels like reuniting with an old friend, because the rapport building it turns out has a long shelf-life (for both of us).  She’d moved interstate, then back again and today she has traveled over 2 hours to come and see me.  She likes me, she’s in fact fond of me and therefore she proceeds to share deeply what’s happening for her and I feel so honoured that I am trusted in this way with such personal information, but I am also a little surprised.  Didn’t my treatment approach fail? And then she drops the biggest surprise bomb of all… (more…)

Sometimes we wonder who put the invisible sign up out the front of our practice, right? The one that says…absolutely everyone with Condition ‘Z’ come and see me, now!  I’m sure you know what I’m describing.  Well this week I have hit the trifecta, performed a neat little hat-trick and diagnosed 3 patients with Gilbert’s Syndrome who all present in their own individual way but actually each one also with quite a textbook Gilbert’s picture, it almost beggars belief.  Have a little look

70yo Female says: Since childhood she has felt like she has had a rock in her stomach after she eats. This ‘rock’ is there for hours. Her stools are never the same in spite of a regular diet and she has always been uptight and anxious. All her bilirubin results are in the 20s & she reports she’s ‘always’ had high values

55yo Male with severe ‘constitutional anxiety’ and surprisingly high oestrogen and a worrisome profile of oestrogen metabolites. His bilirubin is in the 20s

30yo something Female presents with unexplained severe unwellness for 20yrs that mostly involves nausea, bloating, a functional gut disorder without a real diagnosis, anxiety, depression and poor stress tolerance. Her bilirubin fluctuates between 30 to high 40s. (more…)

When Dr. Christabelle Yeoh says, ‘Hey, we all need to up-skill in Mitochondrial & Metabolic Medicine, Gut and Immunity & Healthy Ageing,’ and then invites  a dozen or so absolute experts in each of these fields to speak at the 8th Science in Nutritional Medicine Conference…I listen.  Ok to be fair I listen to everything Christabelle says because she is one of the clueiest & most effective integrative GPs I know, however, I do think if you like being on the front-foot of medicine and research and you’re dealing in these complex areas, then this is really a stellar line-up.  Check this out

Dr. Rob Roundtree – of IFM fame

Dr Sebastian Brandhorst – heard of the Fasting Mimicking Diet? This is the man.

Associate Prof. Ross Grant – haven’t heard him talk on specific nutrients & the brain? It’s a must

Prof. David Cameron-Smith – connects ALL the dots in ageing..from individual nutrition to the global environmental impact and back

Check out the full list of speakers and program here

So I’m also excited to say, because I am on the playlist (minor B side role)… YOU GUYS GET A DISCOUNT!! (more…)

I’m packing the bag and getting my ‘roadies’ ready……well, not really but it would be great to have one or three! 
I’m super excited to be going on tour in May with Nutrition Care and introducing new clinical tools I’ve been developing to help you master the maze of mental health, and what a maze it is! With so many possible biological drivers: from methylation to inflammation and from gonads to gut, these tools can help you quickly identify those most relevant to each patient and also outline the strategies necessary for redressing these. 
This year’s theme for Nutrition Care is
Mastering Mental Health: New Assessments and Management Resources in Your Clinic. 
I’ll be visiting all the major cities again and I’m especially excited about coming to Newcastle and the Gold Coast! Can’t wait to see you all and pow-wow about what I’ve learned about mental health management.
Better than online.
When we’re all in the same room is when the magic happens with a true sharing of our experiences and knowledge.

(more…)

The words together with the horror on her face made me feel instantly nauseous.  I’d been internally debating for months now if I was simply imagining things and intellectualising about how this just might be the case… observing myself looking in the mirror more often, getting closer to the mirror, brushing my hair more often, cleaning the brush more frequently…in psychology it’s called something like confirmatory bias…ah yes just enough psych knowledge to be a danger to myself!

But louder than the chronic self-analysis and attempts at reassurance was the voice that said, ‘You’re losing your hair like an old woman. You’re not even menopausal.  You eat fabulous food and have too much energy for your own good but you’re starting to look like you’re ill’.  The horror. I felt instantly like a fraud. (more…)

Upgrade’s always give you so much more and here at RAN, we wanted to give our UU30 subscribers more….more podcasts…actually, access to the ENTIRE LIBRARY OF UU30 PODCASTS!

Get yourself plugged into Rachel’s knowledge from over the last four years with 55+ podcasts worth a total of $1300+ for only $299!  You can audio stream Rachel’s pearls of wisdom in one online location, anytime.


“It has become the most useful, productive and effective way for me to learn new information. I can listen to it when it suits me, and stop and start the recording as I am noting the key points into the format I need ready for easy access when I have clients in front of me! “
– Maria Harpas, Naturopath


Another reason to go premium… 

You can look through the back catalogue and with no need to purchase them individually. These include ones that provide you with actual clinic handouts and other downloadable tools such as: Ten Top Tips for Accurate Blood Tests (includes a Pathology Testing – Patient Support Questionnaire) , ‘Dear Doctor – tips on letter writing’ (includes a referral letter template), ‘Taking Care Down There’, and the famous ‘Gilbert’s Girls’,‘Histamine Excess’ and the very popular ‘Chronic Threadworm’. Listen to these incredible clinical updates anytime and make the most of the time-saving clinical tools that are shared with you.

PREMIUM SUBSCRIPTION 
Access the ENTIRE back catalogue of podcasts over the last 4 years, in addition to all podcasts released over the next 12 months.
Best value of just over $4.50 per UU30 edition.


Let’s get in you plugged in to the UU30 library by becoming a Premium Subscriber or upgrading your Standard Subscription by logging into your account, selecting your subscription and clicking on ‘upgrade’.

I was just reading the results of a spot Facebook poll of GPs asking what the most wonderful medications ever invented are.  Once everyone got the customary “caffeine” gag out of the way, the rest of the nominations and auspicious award winners unfolded like a who’s who of the modern medicine prescription pad.  Naturally, Penicillin took out first prize (no surprises there unless you’ve been living under a rock…a very clean sterilised one at that that!), one vaccine made the top 10 but I thought there were a few unexpecteds in here:

1. Penicillin “Because of it, entire nations can now afford to worry more about diseases of old age rather than infection. Penicillin’s success ushered in the era of modern pharmacology. To be fair, alongside antibiotics were profound improvements in housing and sanitation.”

2. Smallpox vaccine according to the author of this poll Dr. Justin Coleman,”was a triumph of research, pharmaceuticals, human cooperation and public health planning.”

3. Contraceptive pill for changing the lives of women all around the world. True but BOY does it change it for the worse in some!! (more…)

This is. 

 I think we’re all going to scream when the next patient says, ‘I’ve got an MTHFR’, right?!

Congratulations, I want to say, because you would be in much more serious trouble if you didn’t have a copy…

‘Oh, sorry, you mean you have a mutation on at least one allele encoding for the MTHFR enzyme…Oh, I hate to tell you but contrary to popular (online) belief, you’re not special.’

<Ouch> (more…)

“I always give some Glutamine to heal their leaky gut”

Cue pained expression on my face.  No, I’m not a fan.  I take that back, I have no problem with the amino acid itself and I’m still in awe of its incredible multifaceted role in the gut.  What I do have a giant issue with is the mismatch between everything we are being told Glutamine is going to help our patients with, and the dosages that apparently will do that, and the reality.   I know, I’m attacking the Holy Grail of Gut Health 101….right? But it’s time to set the record straight. Firstly, where’s the evidence at in terms of Glutamine interventions in GIT pathology, particularly in relation to reducing excessive intestinal permeability and improving lining integrity  Well if you’re a rat – Good news!  Rats’ GITs have a greater dependence on Glutamine than ours, a deficiency of this amino produces clear reproducible negative effects and supplementation fixes these brilliantly!

But if you’re treating humans not rats – well – the evidence & the case for Glutamine for the Gut is not so straight forward or impressive. (more…)