Patient Testimonial: Alyson Mitchell

patient testimonial

 

If you feel as though your life is on hold because of your weight, you’ll want to read Alyson Mitchell’s weight loss journey. It may just inspire you to make the commitment to stop waiting for a better life and start living the life you deserve now.

Alyson’s Story

Prior to her gastric sleeve surgery with Dr. Dirk in July 2016, Alyson had been battling her weight since she was in high school. Later, as a wife and mother, she found that being overweight was negatively affecting her mood and keeping her from being outgoing with her husband and kids. “The best way to describe my life before surgery was it was on hold,” she says. “Looking back, I wasn’t myself — at least not to my full potential.”

Alyson also found that much of day-to-day life was a challenge. She was hindered by her constantly worries about what she should wear, how she looked and how she felt. Even the activities she loved — like going to the beach, swimming and shopping — became sources of stress rather than enjoyment.

Although Alyson had been able to lose weight on her own, it always managed to creep its way back, and then some. One of the last times she had lost the weight was after her dad passed away. Within about six months, she had gained at least 50 pounds or more. “I didn’t even recognize myself anymore. I knew that I could try to lose it again, and that I would be able to, but I was just tired! Tired of gaining it all back.”

 

That was the turning point for Alyson. She talked to her husband and met with Dr. Dirk to schedule gastric sleeve surgery. She says the first week or so after surgery was extremely hard, but that she eventually began to feel better. Her biggest challenges following surgery have been learning her new limits regarding how much to eat, what to eat and how often to eat.

Now, she feels truly amazing and is thankful to Dr. Dirk for helping her to finally change her life and feel truly happy and confident. Prior to surgery, Alyson weighed 207 pounds. She currently weighs around 130 pounds.

“I am so happy that I chose to have this procedure done. I have energy, I feel happier and healthier. Going to the beach is way more fun, and my two girls and husband get the happy version of me back — the one that is not self-conscious about every little thing.”

Her advice to anyone considering weight loss surgery? “Do it for yourself, nobody else. Take the time to decide if it is right for you without telling everyone. If you do decide to do it, do it 100 percent. Follow the rules and guidelines, and you will have truly successful results!”

Read more inspirational success stories from Dr. Dirk’s patients here.


How to Avoid the New Year’s Slump to Reach Your Goals

reach goals

 

At this point in January, you may find that you’ve lost motivation and have gotten off track in sticking with the health resolutions you set for this year. Whatever you do, don’t beat yourself up over it. You are far from alone! According to U.S. News, 80 percent of goal-setters drop their New Year’s resolutions by February.

So how do you pick yourself back up and stop yourself from throwing in the towel completely? Below are five tips to get you back on track so you can feel good about accomplishing your goals come December.

1. Revisit your “why”

There will be plenty of days when you don’t feel like doing what it takes to get healthy. The couch may be calling you to stay cozy instead of lacing up your sneakers and getting outside for a walk in the cold. When this happens, you need to know your “why” — the true, deep reason you want to achieve your goal.

For example, are you looking to lose weight? While looking better and being able to wear certain clothes are certainly good benefits of losing weight, they may not be strong enough reasons for you to commit to healthy eating and exercise over the long term. Getting healthy so you can be around to enjoy your grandchildren or to have the energy to give back to a cause you truly care about are some deeper reasons that may pull you off the couch time and again.

In a nutshell, when you have a strong connection to the reason for your goal, you are much more likely to be successful in reaching it.

2. Be realistic

Make sure your goals are attainable and avoid an “all or nothing” mentality. For example, don’t resolve to NEVER eat ice cream or French fries again. Instead, avoid these foods most of the time but allow yourself to mindfully indulge (and enjoy doing so without guilt) from time to time.

3. Break down big goals into small steps

Set small, attainable goals to work on each week that will help you work toward your larger goals. For each goal, write down every possible action you can think of that you will need to take to reach that goal. Then put the first few actions, or steps, on your calendar. Once those are done, add the next few steps and so on.

4. Track your progress

Keep track of and celebrate each small success to help you stay motivated. If your end goal is to lose 25 pounds, focus on 5 pounds at a time. Each time you lose 5 pounds, acknowledge and celebrate this smaller step toward your larger goal. Some ideas to celebrate might be going to the movies with a friend or buying yourself some new fitness gear.

One great way to track your progress is by keeping a food and/or exercise journal. You’ll be able to look back in your journal to remind yourself of all your hard work and see how far you’ve come. This is a great tool to keep you moving forward whenever you feel you’re losing steam or getting frustrated.

5. Enlist help

Decide how you will deal with the temptation to skip your workout or grab a few cookies before dinner. Think about what works best for helping you to stay on track.

It may be as simple as reminding yourself of your “why” and thinking about how giving into temptation will derail you from the better future you want to create for yourself. If you need outside support and accountability, have a trusted friend or family member who you know you can call to help you when you’re facing temptation. Have a friend who is also working toward health resolutions? Propose that you’ll be each other’s accountability partners!

The key is to not let yourself get down when you occasionally get off track — life happens! Take it one day at a time and do the best you can each day. Remember, you still have 11 months to work toward your goals. Apply these tips and you’ll find yourself making great progress in no time.


Smart Healthy Eating Strategies to Get You Through the Holidays

healthy eating

 

The holidays are quickly approaching, which means it’s time to plan your healthy eating strategy for the season. Because most holidays are food-focused, they can cause a large intake of calories and throw your otherwise-healthy lifestyle off track.

Prevent the holidays from sabotaging your healthy lifestyle by putting a plan in place for handling all the extra food and drinks that will come your way during the season. Follow the tips below to celebrate guilt-free!

Plan activities that don’t center on food

Whether you’re hosting a holiday gathering or going to someone else’s house, keep some activities in your back pocket to take you away from the snack table. For example, bring a few favorite board games or set up some simple physical activities that children and adults can enjoy, like a bean bag toss or a relay race.

If you enjoy running or walking, sign your family up for a local 5K event. There are always a ton of turkey trots, jingle bell 5Ks and other holiday-themed races at this time of year. If you’ve never done one, you’ll be hooked after your first race!

Not only will these ideas get your mind off food, but they’ll give everyone something fun to do together. And isn’t that really what the holidays are about?

Avoid skipping meals

Many people make the mistake of skipping meals on the day of a holiday party to “save” their calories for the event. Skipping meals is unhealthy, however, as it leads to poor food choices and often results in overeating.

Instead, eat small meals and snacks throughout the day to keep your blood sugar levels stable and your appetite controlled. When you get to the party, you won’t risk derailing your diet because you’re starving.

Practice mindful eating

The most important thing to practice is being mindful about your food choices and portion control. When you’re mindful about selecting your food, you’ll choose a satisfying portion instead of piling your plate high. You’ll take a small amount of an “indulgent” food to enjoy and balance it out with healthier foods, rather than filling your entire plate with unhealthy choices.

The best part of mindful eating? When you pay attention to what you eat, you’ll actually taste and appreciate your food! Eating mindlessly, on the other hand, always results in the realization that you didn’t enjoy the ton of calories you just consumed.

Make food swaps

As you make your holiday cooking plan, choose your ingredients carefully to keep your dishes on the healthier side. For example, prepare traditional stuffing with whole wheat or whole grain bread rather than white bread. Make a cauliflower mash in place of the traditional mashed potatoes. Substitute whole-wheat flour in place of all-purpose flour in your favorite baking recipes.

Limit your cocktail consumption

The empty calories in alcoholic beverages add up. If you want to enjoy your favorite cocktail occasionally throughout the season without overdoing it, add some mineral water or seltzer to it to keep it light.

 

While food and drinks are certainly a great part of the festivities, holiday celebrations are not just about eating. Focus on the joyous, giving spirit of the season and enjoy spending time with your family, friends and colleagues.


Obesity: A Major Contributor to Rising Death Rates

rising death rates

After years of decline, mortality rates among middle-aged Americans throughout the United States have begun to increase. Additionally, in some parts of the country, life expectancy is falling.

What are the factors contributing to this rise in death rates? A recent article in the Denver Post highlighted the findings of a new study that sheds some light on this important issue.

Obesity a major contributor to rising death rates

Ryan Masters, an assistant professor of sociology at the University of Colorado’s Institute of Behavioral Science and the lead author of this study, concluded that there are two main drivers of this trend in rising death rates: drug overdoses and obesity.

Masters and his research team identified the opioid epidemic as the bigger problem of these two drivers. According to the study, drug-related deaths of middle-aged white men have increased dramatically since 1980.

Obesity was also identified as a main factor in mortality. “We are just starting to see the real health consequences of the obesity epidemic,” Masters wrote. The study found that decades-long progress in fighting heart disease, diabetes and other metabolic diseases has slowed, contributing to the rising death rates.

Dr. Dirk’s opinion

Dr. Dirk agrees with the study’s conclusion that obesity is killing a lot of people. He also believes that, while the drug epidemic is dramatic, obesity affects far more people. There are many more obese people in the US than drug users, and more people die as a result of obesity because of the wide array of health issues it leads to, such as diabetes, high cholesterol, high blood pressure and sleep apnea.

Dr. Dirk believes the drug epidemic is important and must be addressed. However, he feels that obesity is a more pressing issue with a simpler solution. It is high time to make being healthy financially and physically possible for everyone.


The importance of exercising after surgery

exercising after surgery

Whether you’ve undergone weight loss surgery or another kind of surgery, exercising after surgery is important for a quicker recovery and a more successful outcome. Exercise is a critical part of the healing process, and it has many benefits for people

Why it’s important to exercise after surgery

After surgery, it’s common for muscles to weaken and joints to become stiff from lack of use. For each week you don’t exercise after having surgery, it can take twice as long to regain strength in that area.

Additionally, the recovery time stated by your surgeon depends on whether you follow your post-surgery exercise program. Not exercising often results in a recovery period that’s longer than anticipated.

The benefits of exercise after surgery

Exercising after surgery provides numerous benefits for patients, depending on the specific surgery and the person’s unique situation.

While the following benefits are often seen in patients who exercise after having bariatric surgery, many of them are also seen in patients who exercise after having other types of surgeries.

  • Increased life expectancy
  • Reduced abdominal fat
  • Stronger muscles, bones and lungs
  • Reduced risk of disease
  • Lower blood pressure
  • Reduced triglycerides
  • Higher good cholesterol and lower bad cholesterol
  • Improved blood sugar control
  • Improved insulin control
  • Reduced risk of cancer
  • Increased energy
  • Improved balance
  • Improved appearance
  • Improved motivation and mental alertness

How to ease into exercise following surgery

Before beginning any type of exercise after surgery, you’ll want to check with your doctor and ask when it’s safe for you to start, what types of exercises are safe and how much exercise you should begin with.

While the appropriate time to begin exercise following surgery will vary, a walking regimen is the best place to start once you get the OK from your doctor.

When you first begin, your walks don’t need to be long or intense. Start with a short, casual stroll around the block. Do this every day and gradually increase the amount of time you spend walking each day, whether by increasing the distance you walk or the amount of time spent walking. In addition to increasing the duration of your walks, you’ll also want to slowly increase your speed as your fitness level improves.

The main point is to start walking as soon as your surgeon says it’s safe to do so and then start slowly, working your way up gradually.

Types of exercise to do after surgery

All exercise programs should include components that focus on endurance, flexibility and strength. This is also true for post-surgery exercise.

1. Endurance

As mentioned above, walking is a safe bet following most surgeries. As the walking gets easier, increase the length and intensity of your daily walks. Eventually, you can check with your surgeon about incorporating riding a stationary bike and/or swimming into your exercise regimen.

2. Flexibility

Stretching is an important part of an overall exercise program and offers many benefits. Stretching helps to improve flexibility and coordination, as well as increase blood flow to your muscles, which results in less soreness and more energy.

Begin with basic stretching exercises provided by your surgeon. You could also try a beginner’s yoga class, which is great for increasing flexibility, in addition to building strength.

3. Strength

Strength exercises are the third part of a well-rounded exercise routine. However, these exercises should not be started until you have been doing your endurance and flexibility exercises for a while and your surgeon approves adding them to your routine. Speak with your doctor about using exercise balls or weights.

Keep the post-surgery benefits above fresh in your mind so they’ll motivate you to stick with your exercise routine on the days you’re tempted to skip it. Making physical activity part of your daily routine will become easier and easier over time and will eventually become a habit that you won’t have to think twice about.


5 Essential questions to ask during your weight loss surgery consultation

essential questions

 

The decision to have weight loss surgery is a big one, and it can’t be taken lightly. You’ll need to change your habits and commit to a new, healthy lifestyle for the rest of your life. Otherwise, you won’t see results after the surgery or be able to keep the weight off for good.

Because weight loss surgery is not a quick fix, you need to take control and learn as much as you can about the surgery as early as possible. It’s important to go into the first consultation with your weight loss surgeon with a prepared list of questions.

Here are five questions you’ll want to ask during your initial weight loss surgery appointment. It’s a good idea to write these questions down in a notebook and bring it with you so can refer to your questions and write down answers.

1. What is your experience?

Experience plays a big role in how skilled a person is at their job, and it’s no different for surgeons. This is a good question to start with, since it will help you better understand the surgeon’s background and skill set.

Of course, experience isn’t the only factor you need to consider. A surgeon who has performed a lot of surgeries isn’t always the most skilled. But a surgeon with more cases under their belt will often be a doctor you can be confident in.

2. Which weight loss procedures do you perform?

Many surgeons don’t perform every bariatric procedure that’s available, and there’s usually a reason why they don’t offer certain ones. Once you’ve found out which surgeries your surgeon offers, ask if there are any procedures they don’t perform and why. A lot of times you’ll find that, after offering a certain type of procedure, the surgeon found that too many patients weren’t seeing results, so they stopped offering it.

Usually, you’ll want to go with a surgeon who has enough options. If only one type of procedure is offered, do your research to see if that procedure is the best choice for you before moving forward. If not, it’s best to find someone who offers one that’s a better fit for your needs.

3. Which procedure would you recommend for me?

Any good, honest bariatric surgeon will tell you that there isn’t one procedure that will work for everyone. To answer this question, the surgeon will need ask you about your lifestyle, risk tolerances, exercise and dietary habits and medical history.

Your surgeon won’t choose a procedure for you — they will give their professional opinion about which procedure(s) will be most suitable for you and explain the benefits and risks of each procedure.

4. What kind of resources do you offer before and after surgery?

Weight loss surgery is a long process that you’ll need to be mentally and physically prepared for both before and after the surgery. The most successful weight loss surgery patients change their habits, take time to learn how to keep their weight off and have a good support system in place.

Your weight loss surgeon should be able to provide you with resources that will help you be successful over the long term. For example, does the surgeon provide a follow-up program after surgery to keep you accountable with sticking to the diet and other lifestyle changes that are critical to your success? Do they run support groups or recommend a good support group? Can the surgeon provide resources to help educate close friends and family members about how they can support you throughout this process?

5. What are your complication rates?

There’s no beating around the bush here. While complications vary depending on the specific procedure, they can and do happen. However, according to a study published in the July 2010 issue of JAMA, serious complication rates during bariatric surgery are relatively low. Serious complication rates were listed at 3.6 percent for gastric bypass and 2.2 percent for gastric sleeve surgery (sleeve gastrectomy).

If your weight loss surgeon’s rates are around or lower these national averages, you’re in good hands.

Stay informed

The questions above will give you the information you need to make the best decision for you. Remember to continue to write down all your questions and the surgeon’s answers before and after surgery. You’ll find this helpful for keeping track of questions and concerns you have throughout the entire process.


Feeling nervous before surgery? Try these 6 tips

surgery anxiety

It’s totally normal to feel stressed or nervous before having weight loss surgery. If you’re feeling a little surgery anxiety — or if you want to prepare for potential anxiety about your upcoming weight loss surgery — the following tips may be helpful in the days and weeks before your surgery.

Here are six simple and effective ways to help ease some of the fear and anxiety you may feel as your weight loss surgery gets closer.

1. Do your research

Get lots of information about your surgery as early as possible. The more you know about what to expect, the better you’ll feel about it. Pay close attention to information about success rates and the steps you can take to make your experience more positive before, during and after surgery.

2. Talk to your doctor about your fears

Talking to your doctor about your fears is a great way to learn more about the surgery and get further details on anything you’ve come across in your research. This open communication will also increase your level of trust in your doctor and help ease your worries.

3. Take care of pre-surgery tasks

Focusing on what you need to do to prepare for your surgery will keep you productive and give you a more positive outlook about your surgery. Tasks can include packing your bag, arranging for rides to and from the surgery and making sure you have friends and family around to help with daily chores and activities as you recover.

4. Keep a written list of questions and fears

Sometimes just the simple act of putting your thoughts and fears on paper can help you feel better. Your mind will be free to focus on more positive thoughts and actions. Keeping a list also allows you to keep track of things you want to discuss with your doctor.

5. Get support

Remember, you’re not alone! You can find support from family, friends and co-workers. If you’re feeling especially anxious — or want to talk to someone who can relate more — it might be a good idea to talk to other people who have already gone through the surgery. Hearing about their experiences and getting tips from them can lessen your worries. If you don’t know anyone personally, see if your doctor knows of a local support group or a former patient who would be open to talking to you.

6. Find a calming activity

Spend time each day doing something that helps you to relax. This could be reading, walking, meditating, listening to music or something else. If you aren’t sure what works for you, try different activities until you find the one that suits you best. If possible, take some time doing this activity on the day of your surgery to help you feel as relaxed as possible.

Try these suggestions to combat surgery anxiety and feel more at peace on the day of your procedure. Before you know it, you’ll be on the other side and others will be asking you for support!


Strategies for keeping your healthy lifestyle on track

It’s been proven over and over again that eating a good, nutritious diet and sticking to a daily exercise regimen is the most reliable way to lose weight and keep it off.

But committing to a healthy lifestyle is no easy feat. It’s a long journey, filled with speed bumps and occasional wrong turns.

So how do you keep up the hard work of living healthy? Here are some strategies to help you stay on track.

Lean on friends and family

Involving a few family members or friends can be crucial to finding the support you need on your journey. Find people who you trust, who you know love you and who will be non-judgmental about your new lifestyle.

Instead of eating a high-protein, low-carb dinner by yourself, invite your people over and share a dinner with them. Talk to your people about how you feel about your progress. Be willing to accept their support, and listen to what they have to say.

Bounce back from bad days

Discipline is key to a healthy lifestyle. But you will have moments of weakness, when you eat too much of something you shouldn’t or miss a few days of exercise. That’s OK.

The most important thing is to not beat yourself up about it. Just wake up the next morning and commit to eating your healthy meals and getting your exercise in. You’ll be surprised how much easier this journey is when you don’t blow your small mistakes out of proportion.

Keep a long-term perspective

On this blog, we’ve talked a lot about steering clear of “lose-weight-quick!” schemes and fad diets that promise fast results.

Here’s the truth: Losing weight and achieving your health goals will take time. Putting in the work over a period of time is the only healthy and effective way to lose weight and keep it off.

By looking at the long term, it’s easier to look past minor setbacks or seemingly slow progress. Keeping your expectations realistic means you won’t psych yourself out of a process that takes time.

Plan, plan, plan 

The sad fact is it’s easy to be unhealthy. When you’re busy with work, errands and family and friends, it can be simpler just to pick up fast food and veg out on the couch. Using your time wisely and getting ahead of daily stresses and tasks can help you keep your health commitments.

One example of this is meal planning. Instead of preparing entire meals every day, use the weekends to prep meals for the week. That can mean cooking enough chicken breast, salmon and/or tofu on the weekends to last you the week, and/or chopping all your veggies and packing all your salads for the week.

And the planning shouldn’t stop there. Always think ahead to make sure that, no matter what’s going on in your life, you can eat healthy and work out. Going on a vacation? Call ahead to find out if there’s a gym you can work out in. Having a dinner out with friends? Have a look at the menu beforehand to pick the healthiest item.

Be positive

Finally, stay positive and don’t dwell on negative thoughts. There will be lots of difficult moments on your health journey, but you’ll be surprised how much easier it becomes when you choose to be positive about it. You’re doing the hard work to improve your life — you have good reason to be happy with yourself.


New AspireAssist obesity device pumps food out of your stomach: Is it a gimmick?

AspireAssist

As we’ve discussed on this blog before, there are plenty of lose-weight-fast fads and gimmicks out there that make big promises, but rarely deliver results.

Add to that list an unusual new device that pumps undigested food from your stomach and dumps it into a toilet. The AspireAssist weight loss system is offered in North Texas, but Dr. Dirk cautions against it.

Here’s why.

What is the AspireAssist device?

AspireAssist is an external pump that connects to a surgically placed tube, which allows a person to drain a portion of the food in his or her stomach after every meal. The process takes around 10 minutes and removes nearly 30 percent of undigested food from the stomach.

The device is advertised as a less invasive treatment option for people who are obese. It’s designed for obese patients who are 22 and older, and have a body mass index of 35 to 55.

What are the drawbacks of the AspireAssist system?

Because the AspireAssist is a new device — the FDA approved it about a year ago — there isn’t a lot of hard data on its effectiveness. However, it has already gotten a lot of criticism from doctors.

There are doubts about the safety of AspireAssist. Draining 30 percent of your stomach can lead to problems including dehydration, irritation of the stomach lining and a lack of electrolytes.

Others say that, in time, we may see problems with infections, leakage, lack of nutrient absorption and other real problems.

And to top it off, there have already been instances of food clogging the tube, because the pump is unable to break up large foods.

What is Dr. Dirk’s opinion on the AspireAssist?

Besides all the risks associated with the AspireAssist device, Dr. Dirk believes that it is bound to fail because of one key reason: It doesn’t ask the obese person to make changes to his or her lifestyle.

According to Dr. Dirk, lifestyle changes — such as eating a calorie-controlled, high-protein, low-carb diet and getting daily physical exercise — are crucial to losing weight and living a healthy lifestyle.

The major issue with this device is that “it does not emphasize the need to change nutrition,” Dr. Dirk says. “Instead, what it says is, ‘I can eat whatever I want and just suck the stuff out!’”

Secondly, although the device claims to be less invasive, it is still “a surgical procedure that changes the stomach anatomy,” says Dr. Dirk. “This makes future surgery more difficult, and people will eventually need it when this device fails.”

And then there’s the “gross” factor.

“How cool is this?” says Dr. Dirk. “You get to walk around with a bag and tube sticking out of your stomach, so you can suck out food from your stomach after eating. What an exciting first date!”

Learn about weight loss procedures offered by Dr. Dirk here. 

 


Why does the lap band often involve multiple operations?

lap band revision
For more than a decade, lap band surgeries have been popular with people looking to slim down.

But a new study from the University of Michigan in Ann Arbor has found that people who undergo surgery to have lap bands placed around their stomachs often need one or more new operations to move or remove the device.

Here’s what you need to know about lap bands and Dr. Dirk’s expert opinion of them.

What are lap bands?

Laparoscopic gastric banding (also known as lap bands) work by placing a band around the upper part of the stomach, which a little pouch that holds about 1 ounce of food. The food from the small pouch then empties into the closed-off portion of the stomach and continues the normal digestive process.

The band limits the amount of food you can eat by making you feel full after eating a small amount of food. After the surgery, the band can be adjusted to make food pass more quickly or slowly through your stomach.

What are the findings of the new study?

The University of Michigan study found that one in five people who had a lap band procedure needed more surgery within five years of the procedure.

Lap bands can cause a variety of complications. They can erode into the stomach or slip down and cause a blockage. Problems can also happen if the stomach pouch gets bigger.

The study followed more than 25,000 people with lap bands and found that 18.5 percent of patients (4,636 patients) needed at least one more surgery to fix problems.

Those 4,636 patients required more than 17,500 surgeries for their lap bands. That’s an average of nearly four additional surgeries per patient!

Doctors have known about these risks for a few years, which is why lap bands have grown less and less popular in recent years.

What is Dr. Dirk’s professional opinion of lap bands?

“This study shows what we have known for almost 10 years,” Dr. Dirk says. “The adjustable gastric band is not the fantastic solution everyone thought it was going to be.”

According to Dr. Dirk, the fact that lap bands can have as high as an 80 percent failure rate, plus the new data about multiple follow-up operations, means that lap bands are a not a good idea.

“Lap bands involve placing an artificial device right next to the stomach,” says Dr. Dirk. “The stomach moves hundreds of times a day, so the device moves with it. Add to that coughing, sneezing, lifting and getting in and out of the car, and the band is constantly moving about.”

That’s where the problem happens. Bands end up slipping, and this is the most common cause of re-operation.

While less invasive procedures like this may seem like a good idea, Dr. Dirk says the lap band has had a long track record of failure.

“Don’t be swayed by gimmicks or fancy advertising promising a ‘less invasive’ option,” says Dr. Dirk. “In the long run, they don’t work.”

Instead, he recommends making real lifestyle changes, like eating a healthy diet and exercising every day. If these solutions don’t help, weight loss surgery — not the lap band — can be an effective solution.