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What is a Hiatal Hernia?

A hiatal hernia occurs when part of your upper stomach bulges out through an opening in your diaphragm. Here’s what you need to know about this condition. 

Causes and Risk Factors

Most often, a hiatal hernia is caused by an increase in pressure in the abdominal cavity. This cavity is in the middle of your body and holds many vital organs like your kidneys, liver, and small intestine. Pressure can come from a few things, including physical strain, coughing, vomiting, or strain during a bowel movement. In any case, the pressure causes the stomach to push through the diaphragm in your upper abdomen, causing a hiatal hernia.

People at risk for this include overweight people, smokers, and people over 50. Additionally, some pregnant women develop this condition. However, anyone at any age can develop a hiatal hernia.

Hiatal Hernia Symptoms

It’s fairly common for people with a hiatal hernia to experience no symptoms at all. In many cases, you may not know you have one until your doctor finds one during an exam or procedure for another purpose. This is often the case for smaller hernias that don’t cause issues in your body. However, larger hernias may impede certain functions and are more likely to lead to symptoms. For those who do experience symptoms, some of the most common are GERD-like symptoms including heartburn, regurgitation, acid reflux, and pain in the esophagus. This is because the hernia can allow food and acid to back up into your esophagus. Some other symptoms include chest pain, shortness of breath, feeling full soon after eating, vomiting blood, or passing black stools. 

Diagnosing a Hiatal Hernia

Doctors diagnose hiatal hernias in a few different ways. They may perform an upper endoscopy to visualize your upper digestive tract and identify any signs of the hernia. Another test they use is called a barium swallow test. Here, you drink a special liquid that coats your digestive tract, which doctors then visualize by taking an x-ray. They can also use esophageal manometry to measure the strength and coordination of your esophagus. 

Complications and Treatment

In the majority of cases, hiatal hernias don’t cause any issues and thus don’t require treatment. If you have GERD-like symptoms, doctors will likely use treatment methods used to manage GERD itself. They may recommend lifestyle changes like decreased portion sizes, losing weight, limiting acidic foods, quitting smoking, and eating well before you lie down to sleep at night. They may also recommend over the counter antacids to neutralize stomach acid, or medications that reduce acid production. 

In some cases, if these treatment methods do not improve your situation or if a hernia is severely constricting your esophagus, you may need surgery. In this procedure, doctors pull your stomach down into your abdomen and improve the valve at the bottom of your esophagus. This provides a long-term solution which prevents food and acid from backing up into your esophagus.  

Our experienced team at GHP has years of experience treating patients with conditions like hiatal hernias. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Wilson Disease

Wilson disease is a rare inherited condition that causes copper to build up in your body. It can cause a range of liver, neurological, and psychological issues over time. Here’s what you need to know about this disease.

Causes and Risk Factors

This is an inherited disease, meaning it is passed down in families genetically. It is passed down as an autosomal recessive trait. To develop the disease, you must have a copy of the mutated gene from both parents. If only one parent has the defective gene, a child will not have Wilson disease. You are at a higher risk of Wilson disease if you have a parent or sibling with the condition. If you know you are a carrier of the defective gene, you should be aware that you could pass it to your children as well.

Symptoms of Wilson Disease

People with Wilson disease often develop symptoms between the ages of 5 and 35. However, it is possible to experience symptoms within the age range of 2 to 72. Symptoms occur due to copper buildup in the body, which is what this disease causes. When copper builds up in the brain, liver, and eyes, it can lead to various symptoms. Liver disease is most often the first feature of Wilson disease in children and teenagers. Symptoms associated with this include jaundice, lack of appetite, and abdominal swelling. People diagnosed later in adulthood are more likely to have developed neurological and psychological symptoms. The symptoms associated here include problems with speech or physical coordination, uncontrolled movements, mood swings, depression, and anxiety. Many people with Wilson disease, at all ages, develop golden-brown pigmentation around the corneas as well.

Diagnosis

Diagnosing Wilson disease is often challenging since its symptoms are also caused by other liver diseases. Some of the behavioral changes that develop in people with the condition are hard to link to Wilson disease as well. One way doctors can diagnose the disease is during an eye exam using a microscope with a light source. They look for golden-brown pigmentation around your corneas (called Kayser-Fleischer rings) and a specific type of cataract associated with the disease. In fact, in some cases doctors find Wilson disease during routine eye exams.

Doctors can also use blood tests to measure copper levels in your blood, and can use urine samples to measure copper levels in your urine. They can also pursue a liver biopsy to get a sample of your liver to analyze in the lab. If you have parents or siblings with Wilson disease, doctors may suggest genetic testing to screen for the mutated gene that causes the disease.

Complications and Treatment

Over time, Wilson disease can be very serious or even fatal if left untreated. People with the condition can develop cirrhosis (liver scarring), liver failure, kidney problems, neurological problems, psychological issues, and blood problems. Ultimately, the copper buildup that results from the disease can cause severe or fatal damage to the brain, liver, and other organs.

Fortunately, Wilson disease is treatable. Doctors first prescribe medications that reduce copper levels in your body and prevent future buildup. It is likely that you will have to take a course of medications for the rest of your life to help manage copper levels in your body. Often, symptoms begin to improve once you start treatment. Your doctor will also instruct you to avoid certain copper-rich foods like shellfish, and may need to avoid alcohol if you have suffered liver damage from the condition. In more severe cases, you may need a liver transplant if you have suffered significant liver damage.

Our experienced team at GHP has years of experience treating patients with conditions including Wilson disease. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Welcome Dr. Luckett!

Gastroenterology Health Partners is pleased to announce that Robert Tyler Luckett, MD will be joining our practice. Dr. Luckett is currently finishing a gastrointestinal and hepatology fellowship at the University of Louisville and will join GHP in June.

GHP continues to lead the Kentuckiana region with its structure as a large, independent, GI-subspecialty private practice. Dr. Luckett’s addition to the team will contribute to the continued improvement of quality, cost, and access that sets GHP apart.

Read on to learn more about Dr. Luckett’s background.

A Look at Primary Sclerosing Cholangitis

Primary sclerosing cholangitis (PSC) is a chronic disease that damages your bile ducts. This is an uncommon disease, and is most likely to occur in people who have inflammatory bowel disease (IBD). Here’s what you need to know about PSC.

Causes and Risk Factors

There is no clear cause of PSC in general. It’s possible that it can occur in people who have a genetic predisposition to the disease when their immune system responds to a toxin or infection. We do know that PSC tends to occur mostly in people with IBD, which includes ulcerative colitis and Crohn’s disease. PSC tends to occur more often in men and people with Northern European heritage, and is most often diagnosed between 30 and 40 (though it can occur at any age).

Symptoms of Primary Sclerosing Cholangitis

In people with PSC, their bile ducts become blocked by inflammation and scarring over time. PSC is a very slowly progressing disease- many people do not have any symptoms until several years into having the disease. Symptoms of PSC early on include itching, fatigue, and abdominal pain. As it progresses, symptoms can include weight loss, fever, an enlarged liver or spleen, and night sweats. Depending on the person, these symptoms can appear more quickly or slowly.

Diagnosing Primary Sclerosing Cholangitis

In many cases, doctors diagnose PSC incidentally while doing blood testing or an X-ray for an unrelated condition. This is due to the often slow progression of PSC symptoms (as mentioned before)- many people do not have any PSC symptoms that would lead them to go to their doctor. However, there are a few diagnostic tests doctors use to identify this disease. They can perform a blood test to check your liver function, which can support a PSC diagnosis. Additionally, they may take an MRI of your bile ducts to visualize them and identify any signs of PSC. Finally, if other diagnostic testing is inconclusive, they may perform a liver biopsy by removing some liver tissue with a needle and testing it in a lab.

Complications and Treatment

People with PSC and IBD are at an increased risk of colorectal cancer. They also have an increased risk of bile duct cancer and cirrhosis. As such, they should consult closely with a medical provider to monitor their condition over time.

Treating PSC involves first managing the symptoms and mitigating complications from the disease. Doctors can treat itching with specific medications they can prescribe. Sometimes, backed up bile (due to narrowed ducts) can cause recurring bacterial infections; in this case, doctors may prescribe antibiotics. Bile ducts can also become blocked due to scarring and inflammation in people with PSC. Doctors can either place a stent in the bile duct or dilate the bile duct with an endoscopic procedure. However, blockage can sometimes be a sign of cancer or a precursor to liver failure. In serious cases of PSC, you may need to pursue a liver transplant. This is the only way to fully treat the disease.

There are some lifestyle changes you can make to help manage PSC as well. Avoid alcohol, maintain a healthy weight, get vaccinated against Hepatitis A and B, and follow your doctor’s prescriptions carefully. A combination of lifestyle changes and treatments targeting both symptoms and potential complications is often the best course of action for people with PSC. You should consult with your doctor to establish the best plan of care.

Our experienced team at GHP has years of experience treating patients with liver conditions. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Liver Transplant: An Overview

A liver transplant is a surgical procedure in which doctors remove a diseased liver and replace it with a healthy one. This may involve replacing the entire liver or just a section of it. Here’s what you need to know about this procedure.

When is a liver transplant pursued?

A liver transplant is often the best option for people with uncontrollable liver failure. In most cases, liver failure in adults is caused by a chronic condition. For instance, cirrhosis is one factor that leads to liver failure over time. Hepatitis B, hepatitis C, alcoholic liver disease, cancer, and some genetic diseases can also cause liver failure in adults. Children sometimes need a liver transplant as well, often due to genetic disorders or diseases affecting the bile ducts or liver.

Before the procedure

Leading up to a liver transplant, doctors assess your condition with rigorous testing to see the severity of your liver failure and whether you should get a liver transplant. This includes blood testing, diagnostic testing, a psychological evaluation, and more. All of these factors go into whether you may be placed onto the national liver transplant waiting list. Some reasons people are not able to get a transplant include having a chronic untreatable condition, having metastatic cancer, drinking too much, and having severe heart issues.

If you are able to get a transplant, you’ll be placed on the waiting list. People who need a transplant most urgently are at the top of the list, and people with a less urgent need are further down the list. Your place on this list is determined with a structured scoring system called the Model for End-Stage Liver Disease (for children under 12, the Pediatric End-Stage Liver Disease (PELD) is used instead).

If you are preparing for a transplant, your doctor will discuss the steps you need to follow before the procedure. These steps can include avoiding eating and drinking 8 hours before the surgery. If you are receiving a transplant from a living donor, your surgery will be scheduled out in advance. However, if you are receiving a transplant from a deceased donor, you may be called to the hospital for an immediate procedure.

During the procedure

During a liver transplant, doctors sedate you and make an abominable incision while monitoring your vital signs. They remove the diseased liver (or portion of liver) from your body and replace it with the healthy donated liver. They work to connect your blood vessels and bile ducts to the new liver. This is a long process and can take up to 12 hours depending on your situation.

After the procedure

Following a liver transplant, you will spend a few days in intensive care until your condition is stabilized. During this time, doctors will monitor your condition to ensure the transplant has gone well. You will likely be on a ventilator to help you breathe initially. You may also receive IV drips, antibiotics, and anti-rejection medications to help fight against your body’s immune response to your new liver. After you have stabilized, you may spend a week or two more in the hospital in a general non-intensive care room to recover.

Once you have returned home, you will need to follow your doctor’s instructions on keeping your surgical area clean. You should report any symptoms like jaundice, fever, bleeding, or redness around the incision site.

You will also need to take anti-rejection medication indefinitely following the transplant. This involves taking immunosuppressants that weaken your immune response so that your body doesn’t reject your new liver. This puts you at a higher risk of infections, and can also increase your blood pressure and put you at risk for diabetes. Fortunately, over time you will be able to take less medication as your body adjusts. You should consult with your doctor closely to follow the best plan.

Our experienced team at GHP has years of experience treating patients with liver conditions. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

What is the low FODMAP diet?

The low FODMAP diet is a temporary diet designed to help people with IBS (irritable bowel syndrome). In this diet, you tactically remove FODMAP foods to eliminate IBS symptoms, and then slowly add them back in to identify which cause you issues. You can think of it as a short diet that will help identify problem foods to avoid long-term. Today on the blog, we’ll go into detail on the FODMAP diet and how it can help you.

What is FODMAP?

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Basically, these are all short-chain carbohydrates (sugars) that you can find in foods. The small intestine may absorb these poorly, causing stress on the digestive system. Many people with IBS are sensitive to some of these sugars, and can experience symptoms like bloating, diarrhea, and cramping if they eat them. This diet is designed to remove foods that contain the sugars to help relieve symptoms first.

Phase 1 of a FODMAP Diet

In the first phase of this diet, you’ll avoid eating certain foods. The foods you remove in a FODMAP diet include milk, honey, fruits, beans, sweeteners, and more. Your medical provider will provide specific guidelines to follow. For this phase, you’ll need to avoid FODMAP foods for 4-6 weeks. This may help eliminate symptoms you’ve had from the foods. For people with a bacterial overgrowth issue in their small intestine, it gives time for the bacteria levels to decrease.

The diet does eliminate a lot of foods you may be used to eating. Some foods you can continue to eat in this phase of the diet include eggs, meat, certain cheeses (like brie), potatoes, grapes, and almond milk.

Phase 2

Phase 2 involves slowly reintroducing certain foods. While Phase 1 is all about eliminating everything and calming down symptoms, Phase 2 is an exploration of what specific foods you react to. The way this usually works is by adding one FODMAP food back into your diet every few days. This gives you time to see if the latest food you added causes any reaction. When you encounter a reaction from a specific food, you will be able to avoid that food long-term with this knowledge.

Effectiveness

The FODMAP diet approach is considered one of the most effective therapies for treating IBS. It reduces symptoms in around 86% of people. However, since it is so restrictive initially, you will need to work with a doctor or dietitian who can coach you on staying healthy while avoiding FODMAP foods. They can provide a full list of FODMAP foods, and provide key guidance while you undergo this therapy. When successful, the long-term dietary changes you make as a result of FODMAP dieting are a powerful tool to reduce IBS and bacterial overgrowth symptoms.

Our experienced team at GHP has years of experience treating for IBS. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Colon Cancer Stories

Colon cancer touches many lives each year. It can be powerful to learn how other people have experienced screenings, a diagnosis, and fighting the disease. To wrap up our blog posts on colon cancer for this awareness month, we’re going to showcase a few stories from several sources today.

Colon Cancer Foundation: Jamie’s Story

The Colon Cancer Foundation (CCF) has compiled a number of patient stories about colon cancer. One story features Jamie Crespo, who had both parents diagnosed with colon cancer in the same year (2017). Jamie details how the diagnoses came as a surprise due to a lack of immediate family history of the disease, and how it changed everyone’s lives. She also talks about her parents’ recovery, what she’s learned, and how she has made lifestyle changes following the experience. Read Jamie’s story and others on the CCF’s website.

Colon Cancer Coalition: Melissa’s Story

The Colon Cancer Coalition (CCC) also has a huge number of patient stories you can peruse. One is from Melissa Marshall, who was got colorectal cancer at the age of 51. She had been ignoring symptoms for a while before her diagnosis, including rectal bleeding, weight loss, and fatigue. Melissa eventually met with a colorectal surgeon who performed a colonoscopy and found a tumor in her sphincter. She was diagnosed with Stage III colorectal cancer, and went on to receive chemotherapy and an ostomy bag. Today, Melissa is cancer-free and is a strong advocate. She has also formed a non-profit dedicated to educate people about colorectal cancer. You can read Melissa’s story along with many others here.

Colon Cancer Prevention Project: Lindsay’s Story

The Colon Cancer Prevention Project has featured a striking story from Lindsay Norris, an Oncology nurse who survived Stage III colorectal cancer. She talks about how she never truly understood how her patients felt until she experienced colorectal cancer. In a lengthly blog post, Lindsay goes through all of the elements of her diagnosis and experience receiving treatment, comparing how she viewed these things as a nurse versus how she experienced them personally. It’s a highly insightful read- you can read the post here or visit her website.

Celebrity Colon Cancer Stories: Chadwick Boseman and Will Smith

Colon cancer has affected several well-known celebrities. Just in the past year, Chadwick Boseman passed away with colorectal cancer. The actor, known for films like Black Panther and Thurgood, was only 43. He had been fighting colon cancer for four years. We wrote a blog back in November of 2020 about Chadwick’s life and battle with colon cancer. You can read that post here.

Another story we recently featured is about actor Will Smith. Back in 2019, Will documented the process of his colonoscopy screening. In a vlog posted to his YouTube channel, he shows conversations with his doctor, the prep process, the day of the screening, and the follow-up. It’s a great video that showcases what the experience of getting a colonoscopy is like, and it also drives home the importance of screenings. Read our blog post on the video here.

Our experienced team at GHP has years of experience screening for colorectal cancer. We can help establish the best plan of care for your situation. Read more about how we perform screenings here. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

ValueOfColonoscopy.org: ASGE’s Useful Awareness and Screening Tool

There are a lot of great resources if you are interested in learning more about colon cancer and screenings. One of our favorites comes from the American Society of Gastrointestinal Endoscoy (ASGE). The ASGE has a plethora of resources including videos, a screening tool, and statistics at ValueOfColonoscopy.org. Today on the blog, we’ll take you through some of the useful resources on the website.

Screening Tool: Determining Which Test You Should Get

One question many people have about screenings is which test to get. There are numerous options available. It can be confusing when figuring out which is the best fit. Fortunately, the ASGE created a tool that helps you identify the screening method that’s right for you. In a simple yet informative document, they take you through your options based on your risk level (no personal or family history of colon polyps or cancer, family history, or personal history). This tool shows you how these factors impact when you should be screened, how often, and with which screening method. For example, if you have a family history of colon cancer or polyps, it shows that you should have a screening as early as age 40. It also shows that a colonoscopy is best screening given your family history. It recommends talking with your doctor to establish a plan.

Colonoscopies during the Pandemic

During the pandemic, many people have had valid concerns about the safety of activities like doctor’s visits. This has actually impacted how many colonoscopies doctors have performed, and as a result an increase in the number of missed colorectal cancer diagnoses (read our blog post here to learn more). In a video, the ASGE shows how many steps medical professionals are taking to ensure your safety during screenings. They talk about pre-arrival screenings, in-office distancing and barriers, masking, PPE, testing, staff vaccinations, and more. We highly recommend watching this video to get a clear picture of how safe your screening will be. Plus, read our blog post here about what we have been doing at GHP to keep you safe.

Tips as you Prepare for a Colonoscopy

Another important thing this website covers is common patient FAQs leading up to a colonoscopy. The ASGE has a number of helpful guides and tips for you as you prepare for a screening. For example, they have a webpage dedicated to understanding bowel prep, an aspect of screening that many patients dread. They discuss the importance of bowel prep, what type of prep you may need to pursue, and other helpful tips. They even discuss common side effects, specific steps in prepping, and what to do if you forget to take prep medication. This is a great resource to help you make sure your screening is as effective as possible. The ASGE also has content and FAQs that help you understand colon polyps and colonoscopies.

Our experienced team at GHP has years of experience screening for colorectal cancer. We can help establish the best plan of care for your situation. Read more about how we perform screenings here. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Colon Cancer Awareness: Our Favorite Online Resources

March is colon cancer awareness month. This disease is preventable with timely and regular screenings. Awareness-raising resources and campaigns are a key part in increasing screening rates, so today on the blog we’ll share some of our favorite online resources on the topic.

CDC Resource Library

The Centers for Disease Control and Prevention has an excellent website full of resources. Among these resources is all of their colon cancer content. They have everything from personal stories to an awareness quiz and posts to share on social media. Here’s a list of some of our favorite resources they offer:

  • Data visualizations tool
    • You can examine colon cancer statistics with tools including an interactive map, tables, and charts.
  • Basic information
    • The CDC provides a central hub for all of the basics about colorectal cancer, including symptoms of the disease, screening information, and questions you can ask your doctor.
  • Screening stories
    • Read stories from people who have gotten screenings and learn about their experiences.

ASGE Colon Cancer Awareness Resources

The American Society for Gastrointestinal Endoscopy has a number of great resources you can use as a patient and as an advocate. Here are a few highlights from their website:

  • Tool to start dialogue about screening for patients and doctors
    • This document breaks down the different types of screening available, divided by different risk categories.
  • Videos
    • ASGE has a number of videos that cover topics like colonoscopies, myths about colon cancer, and community outreach.
  • Banner and poster
    • The organization provides a banner you can use on your website or email signature, plus a poster you can print and hang up.

ASCRS’ Resources

The American Society of Colon & Rectal Surgeons has several resources on their website that you might find helpful. Here are a few favorites:

  • Media pitch letter
    • ASCRS has a letter that you can modify and send to local news organizations, asking for air time to talk about colon cancer.
  • Online store
    • The organization has an online store where you can purchase brochures in bulk for use in treatment settings.

Colon Cancer Coalition’s Targeted Campaign

The Colon Cancer Coalition has a targeted awareness campaign called #BlueForCRC that you can participate in. Their website has resources for this campaign including:

  • Sample social media posts
  • A training webinar for advocates
  • Informational resources that can be distributed
  • Tips and tricks for successful advocacy using their campaign

ACG’s Website

The American College of Gastroenterology’s website features resources that you can use for awareness-raising. Some of our favorites are:

  • A library of graphics that you can print for patients, hang as posters, and share on social media.
  • A podcast series that addresses colon cancer topics in a Q&A format. Episodes cover topics including risk factors, screenings, bowel prep, and early detection.

Our team at GHP has years of experience screening for colorectal cancer. We can help establish the best plan of care for you. Read more about how we perform screenings here. Contact any of our office locations to learn about the options we offer and book an appointment today.

How has the Pandemic Affected Colonoscopies?

The coronavirus pandemic has impacted our lives in countless ways. From finances to health and other aspects of life, it has changed how we live each day. In particular, many common medical check-ups, screenings, and elective procedures have been put on hold or delayed. One of these, the colonoscopy, has seen significantly decreased rates during the pandemic. This is a serious issue, as we know colonoscopies are a key screening strategy to prevent colorectal cancer. On today’s blog, we’ll take a look at how the pandemic has affected colonoscopies.

Colonoscopies During the Pandemic

Early on in the pandemic in 2020, medical practices put many elective and non-essential medical visits and procedures on hold. As a result, screenings for cancer like colonoscopies dropped significantly. One study examining screening rates in the San Francisco area found that colonoscopies decreased about 90% from February to May 2020. This coincided with an 85% decrease in fecal immunochemical testing (FIT), another screening method in the same time frame. There was also a 70% decrease in all in-person appointments, and a 60% increase in telehealth visits. Another report estimated that if that trend continued through early June 2020, there could be around 19,000 missed colorectal cancer diagnoses and over 4,000 additional colorectal cancer deaths across the United States.

These are significant impacts, and compound existing inequities in health outcomes. Many groups that have an increased risk of colorectal cancer have also experienced a higher risk of death from the coronavirus. These groups include Black, Native American, and Hispanic people.

Clearly, the pandemic has caused cascading public health problems. Fortunately, as we have learned more about the coronavirus, medical practices have been able to respond to transmission threats to practice safely. Masking, social distancing, sanitizing, and now vaccinations for medical staff have helped to create safe spaces for patients to receive medical care.

Importance of Screening for Colorectal Cancer

Screening for colorectal cancer is extremely important. When properly done, it has a high success rate at cancer prevention. With a colonoscopy, doctors can identify and remove precancerous polyps that could otherwise develop into cancer over time. The colonoscopy is the gold standard for screenings. When patients get colonoscopies on a proper schedule, the incidence of colorectal cancer falls by around 90%.

Gastro Health Partners, in line with various other organizations, is now endorsing regular screenings starting at age 45. Previously, 50 was the standard for beginning screenings. By changing this to 45, we can prevent more potential cases of cancer and save lives. If you are close to 45 or older, talk with your doctor about getting screened. They will take your situation into account and may recommend earlier or more frequent screenings depending on factors like family history and personal history of polyps.

Our experienced team at GHP has years of experience screening for colorectal cancer. We can help establish the best plan of care for your situation. Read more about how we perform screenings here. Contact any of our office locations to learn about the options we offer and schedule an appointment today.