Tag Archives: Rocky Mountain Spotted Fever

Straight, No Chaser: Rashes on Your Palms and Soles; It's Not Always Hand, Foot and Mouth Disease

Pediatrics/Kids Health, Skin/Dermatology, , , , , , , , , ,

In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles.  However, there are a few of note, so here’s some Quick Tips to point you in the right direction. This doesn’t take long for you to learn, so commit this to memory, and you could save yourself a lot of drama down the road. Don’t forget to wear gloves and wash your hands!
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus.  It’s rather benign.
Hand-Foot-and-Mouth-Disease-3hand-foot-mouth-disease1hand-foot-mouth
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii).  If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.

RMSFRMSFfeet

If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease.  This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.

kawasaki

Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.

Kawasaki2

And yes, secondary syphilis presents with rashes on the palms and soles.  The real take home message is this.  Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed.  Trust me, you want to get treated before tertiary syphilis develops.  Here’s what that rash looks like.

2ndsyphilis2ndarysyphilis

The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.
Feel free to ask your SMA expert consultant any questions you may have on this topic.Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Sealed with a (Wrong Type of) Kiss – Zoonotic Diseases

General Health and Wellness, Infectious Disease, Public Health, Health Prevention, , , , , , , , , , , , , , , , , ,

zoonosisdoglick

It’s interesting how we take animals for granted. Many of us touch and handle them, play with them. Some people keep their pets in their faces, allowing them to kiss and lick them. Do you ever think about where they’ve been and whether they are ill and contagious? Would you be surprised if I told you that approximately 60% of the bacteria, viruses and other microorganisms that cause human disease originates from animals?

 zoonosis

That’s right. There are many diseases that animals have that can be transmitted to humans. These groups of diseases are called Zoonoses. It’s at least worth giving it some thought; many of these diseases don’t even require direct contact with the affected animal. Even more concerning is the fact that about 75% of newly emergent infectious diseases affecting humans are of animal origin.
We spend a lot of time in places where infected animals and insects may exist. Besides exposures in relatively exotic areas such as farms, woods, nature parks and petting zoos, simpler environments such as pet stores, fairs, schools and childcare facilities may also prove to be risky.

 zoonosisdeer

Many different types of animals pose these risks, including rodents, amphibians, live poultry, reptiles, insects and an assortment of domestic and wild animals. Here are a few examples (but not an exhaustive list) of how disease may spread that have been particularly common in the news of late.

  • Many animals carry rabies, including bats, raccoons, foxes, skunks, wolves, coyotes, cattle, monkeys, mongooses and dogs.
  • Reptiles such as turtles, iguanas and snakes can transmit Salmonella, a prominent cause of food poisoning.
  • Handling your cat’s kitty litter (or otherwise handling stool) can transmit toxoplasmosis, an infection that can be deadly to those with weakened immune systems or to unborn children.
  • West Nile has been in the news every year this millennium, causing over 1.5 million infections in humans since 1999.
  • Deer and deer mice carry ticks that can lead to Lyme disease, a bacterial infection involving a rash, fever, chills, body aches and possible arthritis, neurological and cardiac disorders.
  • Other common infections caused by these exposures include anthrax, dengue, Ebola hemorrhagic fever, E. coli infection, malaria, Plague and Rocky Mountain spotted fever.

If you’re a good pet owner (and otherwise healthy), you shouldn’t have to worry about this much. Simple steps such as keeping your pets’ shots up to date, keeping their play areas clean, avoiding direct contact with wildlife and maintaining basic hygiene measures such as hand washing after contact sufficiently lowers your risk. Here are a few additional tips:

  • Keep tabs on your kids to ensure they wash their hands properly and avoid thumb-sucking, eating and pacifier use after animal contact and before cleaning up.
  • Use insect repellents that contain 20% or more DEET on the exposed skin and be generous with it when in risky areas.
  • Use products that contain repellents (such as permethrin) on your clothing and gear, such as boots, pants, socks and tents.
  • Look for and remove ticks from your and your children’s bodies.
  • Limit mosquito breeding grounds around your home by getting rid of items that hold still water.
  • Feel free to ask your SMA expert consultant any questions you may have on this topic.Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
    Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
    Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
    Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Rashes on Your Palms and Soles; It's Not Always Hand, Foot and Mouth Disease

Pediatrics/Kids Health, Skin/Dermatology, , , , , , , , , ,

 
In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles.  However, there are a few of note, so here’s some Quick Tips to point you in the right direction. This doesn’t take long for you to learn, so commit this to memory, and you could save yourself a lot of drama down the road. Don’t forget to wear gloves and wash your hands!
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus.  It’s rather benign.
Hand-Foot-and-Mouth-Disease-3hand-foot-mouth-disease1hand-foot-mouth
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii).  If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.

RMSFRMSFfeet

If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease.  This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.

kawasaki

Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.

Kawasaki2

And yes, secondary syphilis presents with rashes on the palms and soles.  The real take home message is this.  Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed.  Trust me, you want to get treated before tertiary syphilis develops.  Here’s what that rash looks like.

2ndsyphilis2ndarysyphilis

The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress
 

Straight, No Chaser: Sealed with a (Wrong Type of) Kiss – Zoonotic Diseases

General Health and Wellness, Infectious Disease, Public Health, Health Prevention, , , , , , , , , , , , , , , , , , ,

zoonosisdoglick

It’s interesting how we take animals for granted. Many of us touch and handle them, play with them. Some people keep their pets in their faces, allowing them to kiss and lick them. Do you ever think about where they’ve been and whether they are ill and contagious? Would you be surprised if I told you that approximately 60% of the bacteria, viruses and other microorganisms that cause human disease originates from animals?

 zoonosis

That’s right. There are many diseases that animals have that can be transmitted to humans. These groups of diseases are called zoonoses. It’s at least worth giving it some thought; many of these diseases don’t even require direct contact with the affected animal. Even more concerning is the fact that about 75% of newly emergent infectious diseases affecting humans are of animal origin.
We spend a lot of time in places where infected animals and insects may exist. Besides exposures in relatively exotic areas such as farms, woods, nature parks and petting zoos, simpler environments such as pet stores, fairs, schools and childcare facilities may also prove to be risky.

 zoonosisdeer

Many different types of animals pose these risks, including rodents, amphibians, live poultry, reptiles, insects and an assortment of domestic and wild animals. Here are a few examples (but not an exhaustive list) of how disease may spread that have been particularly common in the news of late.

  • Many animals carry rabies, including bats, raccoons, foxes, skunks, wolves, coyotes, cattle, monkeys, mongooses and dogs.
  • Reptiles such as turtles, iguanas and snakes can transmit Salmonella, a prominent cause of food poisoning.
  • Handling your cat’s kitty litter (or otherwise handling stool) can transmit toxoplasmosis, an infection that can be deadly to those with weakened immune systems or to unborn children.
  • West Nile has been in the news every year this millennium, causing over 1.5 million infections in humans since 1999.
  • Deer and deer mice carry ticks that can lead to Lyme disease, a bacterial infection involving a rash, fever, chills, body aches and possible arthritis, neurological and cardiac disorders.
  • Other common infections caused by these exposures include anthrax, dengue, Ebola hemorrhagic fever, E. coli infection, malaria, Plague and Rocky Mountain spotted fever.

If you’re a good pet owner (and otherwise healthy), you shouldn’t have to worry about this much. Simple steps such as keeping your pets’ shots up to date, keeping their play areas clean, avoiding direct contact with wildlife and maintaining basic hygiene measures such as hand washing after contact sufficiently lowers your risk. Here are a few additional tips:

  • Keep tabs on your kids to ensure they wash their hands properly and avoid thumb-sucking, eating and pacifier use after animal contact and before cleaning up.
  • Use insect repellents that contain 20% or more DEET on the exposed skin and be generous with it when in risky areas.
  • Use products that contain repellents (such as permethrin) on your clothing and gear, such as boots, pants, socks and tents.
  • Look for and remove ticks from your and your children’s bodies.
  • Limit mosquito breeding grounds around your home by getting rid of items that hold still water.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Rashes on Your Palms and Soles; It's Not Always Hand, Foot and Mouth Disease

Pediatrics/Kids Health, Skin/Dermatology, , , , , , , , ,

In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles.  However, there are a few of note, so here’s some Quick Tips to point you in the right direction. This doesn’t take long for you to learn, so commit this to memory, and you could save yourself a lot of drama down the road. Don’t forget to wear gloves and wash your hands!
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus.  It’s rather benign.
Hand-Foot-and-Mouth-Disease-3hand-foot-mouth-disease1hand-foot-mouth
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii).  If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.

RMSFRMSFfeet

If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease.  This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.

kawasaki

Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.

Kawasaki2

And yes, secondary syphilis presents with rashes on the palms and soles.  The real take home message is this.  Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed.  Trust me, you want to get treated before tertiary syphilis develops.  Here’s what that rash looks like.

2ndsyphilis2ndarysyphilis

The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Sealed with a (Wrong Type of) Kiss – Zoonotic Diseases

General Health and Wellness, Infectious Disease, Public Health, Health Prevention, , , , , , , , , , , , , , , , , ,

zoonosisdoglick

It’s interesting how we take animals for granted. Many of us touch and handle them, play with them. Some people keep their pets in their faces, allowing them to kiss and lick them. Do you ever think about where they’ve been and whether they are ill and contagious? Would you be surprised if I told you that approximately 60% of the bacteria, viruses and other microorganisms that cause human disease originates from animals?

 zoonosis

That’s right. There are many diseases that animals have that can be transmitted to humans. These groups of diseases are called zoonoses. It’s at least worth giving it some thought; many of these diseases don’t even require direct contact with the affected animal. Even more concerning is the fact that about 75% of newly emergent infectious diseases affecting humans are of animal origin.
We spend a lot of time in places where infected animals and insects may exist. Besides exposures in relatively exotic areas such as farms, woods, nature parks and petting zoos, simpler environments such as pet stores, fairs, schools and childcare facilities may also prove to be risky.

 zoonosisdeer

Many different types of animals pose these risks, including rodents, amphibians, live poultry, reptiles, insects and an assortment of domestic and wild animals. Here are a few examples (but not an exhaustive list) of how disease may spread that have been particularly common in the news of late.

  • Many animals carry rabies, including bats, raccoons, foxes, skunks, wolves, coyotes, cattle, monkeys, mongooses and dogs.
  • Reptiles such as turtles, iguanas and snakes can transmit Salmonella, a prominent cause of food poisoning.
  • Handling your cat’s kitty litter (or otherwise handling stool) can transmit toxoplasmosis, an infection that can be deadly to those with weakened immune systems or to unborn children.
  • West Nile has been in the news every year this millennium, causing over 1.5 million infections in humans since 1999.
  • Deer and deer mice carry ticks that can lead to Lyme disease, a bacterial infection involving a rash, fever, chills, body aches and possible arthritis, neurological and cardiac disorders.
  • Other common infections caused by these exposures include anthrax, dengue, Ebola hemorrhagic fever, E. coli infection, malaria, Plague and Rocky Mountain spotted fever.

If you’re a good pet owner (and otherwise healthy), you shouldn’t have to worry about this much. Simple steps such as keeping your pets’ shots up to date, keeping their play areas clean, avoiding direct contact with wildlife and maintaining basic hygiene measures such as hand washing after contact sufficiently lowers your risk. Here are a few additional tips:

  • Keep tabs on your kids to ensure they wash their hands properly and avoid thumb-sucking, eating and pacifier use after animal contact and before cleaning up.
  • Use insect repellents that contain 20% or more DEET on the exposed skin and be generous with it when in risky areas.
  • Use products that contain repellents (such as permethrin) on your clothing and gear, such as boots, pants, socks and tents.
  • Look for and remove ticks from your and your children’s bodies.
  • Limit mosquito breeding grounds around your home by getting rid of items that hold still water.

Feel free to ask any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Sealed with a (Wrong Type of) Kiss – Zoonotic Diseases

General Health and Wellness, Infectious Disease, Public Health, Health Prevention, , , , , , , , , , , , , , , , ,

zoonosisdoglick

It’s interesting how we take animals for granted. Many of us touch and handle them, play with them. Some people keep their pets in their faces, allowing them to kiss and lick them. Do you ever think about where they’ve been and whether they are ill and contagious? Would you be surprised if I told you that approximately 60% of the bacteria, viruses and other microorganisms that cause human disease originates from animals?

 zoonosis

That’s right. There are many diseases that animals have that can be transmitted to humans. These groups of diseases are called zoonoses. It’s at least worth giving it some thought; many of these diseases don’t even require direct contact with the affected animal. Even more concerning is the fact that about 75% of newly emergent infectious diseases affecting humans are of animal origin.
We spend a lot of time in places where infected animals and insects may exist. Besides exposures in relatively exotic areas such as farms, woods, nature parks and petting zoos, simpler environments such as pet stores, fairs, schools and childcare facilities may also prove to be risky.

 zoonosisdeer

Many different types of animals pose these risks, including rodents, amphibians, live poultry, reptiles, insects and an assortment of domestic and wild animals. Here are a few examples (but not an exhaustive list) of how disease may spread that have been particularly common in the news of late.

  • Many animals carry rabies, including bats, raccoons, foxes, skunks, wolves, coyotes, cattle, monkeys, mongooses and dogs.
  • Reptiles such as turtles, iguanas and snakes can transmit Salmonella, a prominent cause of food poisoning.
  • Handling your cat’s kitty litter (or otherwise handling stool) can transmit toxoplasmosis, an infection that can be deadly to those with weakened immune systems or to unborn children.
  • West Nile has been in the news every year this millennium, causing over 1.5 million infections in humans since 1999.
  • Deer and deer mice carry ticks that can lead to Lyme disease, a bacterial infection involving a rash, fever, chills, body aches and possible arthritis, neurological and cardiac disorders.
  • Other common infections caused by these exposures include anthrax, dengue, Ebola hemorrhagic fever, E. coli infection, malaria, Plague and Rocky Mountain spotted fever.

If you’re a good pet owner (and otherwise healthy), you shouldn’t have to worry about this much. Simple steps such as keeping your pets’ shots up to date, keeping their play areas clean, avoiding direct contact with wildlife and maintaining basic hygiene measures such as hand washing after contact sufficiently lowers your risk. Here are a few additional tips:

  • Keep tabs on your kids to ensure they wash their hands properly and avoid thumb-sucking, eating and pacifier use after animal contact and before cleaning up.
  • Use insect repellents that contain 20% or more DEET on the exposed skin and be generous with it when in risky areas.
  • Use products that contain repellents (such as permethrin) on your clothing and gear, such as boots, pants, socks and tents.
  • Look for and remove ticks from your and your children’s bodies.
  • Limit mosquito breeding grounds around your home by getting rid of items that hold still water.

Feel free to ask any questions you may have on this topic.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK (844-762-8255) and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Quick Tips – Rashes on Your Palms and Soles – Pay Attention!

Skin/Dermatology, , , , , , , , ,

In the world of rashes, there aren’t an abundance of rashes that appear on the palms and soles.  However, there are a few of note, so here’s some Quick Tips to point you in the right direction.
There’s actually an entity called hand, foot and mouth disease, commonly seen in children and caused by the Coxsackie A virus.  It’s rather benign.
Hand-Foot-and-Mouth-Disease-3hand-foot-mouth-disease1hand-foot-mouth
If you’ve spent any time in the woods of the Southeastern U.S. (usually between April and September), you may recall being bitten by a tick (which will transmit an infection from a bacteria named Rickettsia Rickettsii).  If you contract Rocky Mountain Spotted Fever (yes, it’s misnamed – the Rocky Mountains aren’t in the Southeastern U.S.), your rash may look like this.
RMSFRMSFfeet
If you’re a child with five or more days of fever, pink eye, dryness in the mouth, big lymph nodes in the neck and this rash, your physician should consider Kawasaki’s disease.  This is caused by an inflammation of blood vessels, and demographically, it is seen more often in those of Asian descent.
kawasaki
Sometimes in Kawasaki’s disease, the tongue may look like a strawberry.
Kawasaki2
And yes, secondary syphilis presents with rashes on the palms and soles.  The real take home message is this.  Primary syphilis is so overlooked (because the initial genital lesion is painless and may come and go without much announcement), the development of rashes on the hands and feet may be the first time you get diagnosed.  Trust me, you want to get treated before tertiary syphilis develops.  Here’s what that rash looks like.
2ndsyphilis2ndarysyphilis
The long and short of it, is if you or a loved one develop a rash on the palms and/or soles, get it evaluated.