Bulbar ALS Life Expectancy. The person is alive and looks like they are sleeping. Therefore, you are about to leave the Blue Cross & Blue Shield of Mississippi website and enter another website not operated by Blue Cross & Blue Shield of Mississippi. The 4 Stages of ALS- Lou Gehrig ’s Disease. The injury can be temporary and reversible. Here are some factors that imply a faster MS progression, and disability accumulation, in a person. ", National Institute of Neurological Diseases and Stroke: "Coma and Persistent Vegetative State;" "Traumatic Brain Injury;" and "Locked In Syndrome Information Page.". The prognosis for a coma varies with each situation. Most people with ALS die from respiratory failure, usually within 3 to 5 years from the onset of symptoms. 2018;57:99-104. It causes weakness that gets worse over time. Serum samples were measured for IGF-1. The clinical features and prognosis of 21 patients with respiratory onset ALS are reported here. ALS attacks nerve cells, called motor neurons, that control voluntary muscles (the muscles we are able to control). Prognosis is poor: 50% of patients die within one and half year after detection of ALS. Amyotrophic lateral sclerosis (ALS) is a fatal motor neurone disease characterized by progressive degeneration of upper and lower motor neurons in the spinal cord and brain. The neuron specific enolase (nse) ratio offers benefits over absolute value thresholds in post-cardiac arrest coma prognosis. Renowned physicist Stephen Hawking, who died today (March 14) at the age of 76, battled amyotrophic lateral sclerosis (ALS) for most of his life. Upper motor neuron degeneration generally causes spasticity (tightness in a muscle), while lower motor neuron degeneration causes muscle weakness, muscle atrophy (shrinkage of muscles) and twitching. The word bloat is often used as a general term to mean gas distension without stomach torsion (a normal change after eating), or to refer to GDV. Algorithm used to identify cases of amyotrophic lateral sclerosis. Methods: In a population-based study of ALS in western Washington, the authors assembled a cohort of 180 patients with incident ALS between 1990 and 1994. Gastric dilatation volvulus (GDV), also known as gastric dilation, twisted stomach, or gastric torsion, is a medical condition that affects dogs in which the stomach becomes overstretched and rotated by excessive gas content. Motor neurone disease (or amyotrophic lateral sclerosis: ALS) is an aggressive and incurable neurodegenerative disease, resulting in rapid widespread loss of brain tissue. ALS is characterized by a progressive degeneration of motor nerve cells in the brain (upper motor neurons) and spinal cord (lower motor neurons). For bulbar ALS life expectancy is even less than limb onset ALS. And, among African-Americans, the disease tends to be a more progressive form and progression can be quicker. The disease is highly variable, and some people are affected more than others upon and after diagnosis. These cases occur randomly, without any known cause, and there is no association with persons in the family with the disease. Life expectancy for people with MS has increased considerably in the last 20 to 25 years. Although with some limitations (the study did not considered type or severity of MS, or information on other medical conditions), the study found that the average life expectancy of MS patients in the U.S. is shortened by six years compared to those without MS. Another study, co-funded by the MS Society of Canada, and titled “Effect of comorbidity on mortality in multiple sclerosis,” also looked at this issue in 2015, comparing an MS population (almost 6,000 people) with a non-MS group matched by age and gender (almost 89,000). Amyotrophic lateral sclerosis (ALS), first described by Charcot in the 19 th century, is a relentlessly progressive, presently incurable neurodegenerative disorder that causes muscle weakness, disability, and eventually death. Background: Despite the inevitability of disease progression in amyotrophic lateral sclerosis, there is a high degree of prognostic heterogeneity in all subtypes. Glucose may be required in the event of a diabetic shock. You have selected a link to a website operated by a third party. However, unlike in a deep sleep, the person cannot be awakened by any stimulation, including pain. The chances of a person's recovery depend on the cause of the coma, whether the problem can be corrected, and the duration of the coma. ALS, which is also known as a motor-neuron disease—and colloquially as Lou Gehrig's disease in the U.S.—is a neurodegenerative disease. Survival from diagnosis varies considerably. Muscle cramping and twitching (fasciculation) occurs, as does loss of muscle bulk (atrophy). Determining prognosis in patients with fulminant hepatic failure: when you absolutely, positively have to know the answer. ALS progresses differently for everyone. Background: Accurate information on prognosis of ALS is useful to patients, families, and clinicians. Methods We conducted a prospective longitudinal observational case-control study using a multicentre registry. Background Amyotrophic lateral sclerosis (ALS) is a progressive and usually fatal neurodegenerative disease. Early indicators of prognosis in fulminant hepatic failure: an assessment of the Model for End-Stage Liver Disease (MELD) and King's College Hospital criteria. Comas are caused by an injury to the brain. Hepatology 1995; 21:879. Objective The aim of this study is to describe and clarify the factors affecting the prognosis of Japanese patients with amyotrophic lateral sclerosis (ALS) undergoing tracheostomy invasive ventilation (TIV) therapy. People close to the comatose patient should give doctors as much information as possible to help the doctors determine the cause of coma. In multiple sclerosis (MS), the immune system attacks and destroys the fatty myelin coating that surrounds and insulates nerve cells in a process known as demyelination. Another form of ALS is called familial ALS (FALS), which is inherited from the parents and comprises 5–10 percent of ALS cases. the medical prognosis is that the individual’s life expectancy is six months or less if the illness runs its normal course. The rate of progression between individuals is variable and the history generally reflects gradual and progressive worsening over time until death occurs. Amyotrophic lateral sclerosis (ALS) is a disease with a widely varying prognosis. © 2005 - 2021 WebMD LLC. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Coronavirus in Context: Interviews With Experts, Health News and Information, Delivered to Your Inbox, Click to view privacy policy and trust info, MS Brain Fog? Objective To investigate whether arginine methylation is altered in patients with amyotrophic lateral sclerosis (ALS) and how it affects disease severity, progression, and prognosis. Information on potential prognostic factors was collected during an in-person interview. The disorder is named for its underlying pathophysiology, with “amyotrophy” referring to the atrophy of muscle fibers, which are denervated as their corresponding anterior horn cells degenerate. Comas that result from head injuries tend to have a higher rate of recovery than comas related to lack of oxygen. It does not provide medical advice, diagnosis or treatment. On average, those diagnosed with ALS do not survive more than a few years. Many studies show that, nowadays, about two-thirds of all patients retain a fair degree of mobility — the ability to walk, although likely with an assisted device — some 20 years after being diagnosed. Brain injury can be due to increased pressure, bleeding, loss of oxygen, or buildup of toxins. It can start by weakening muscles in an arm or a leg, or by affecting speaking and swallowing. Although it is a very rare disorder, study of this and other bone marrow failure syndromes has improved scientific understanding of the mechanisms of normal bone marrow function and development of cancer. Keep patient as active as possible Prevent skin breakdown Prevent vein thrombosis, pulmonary embolism Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. We also measured the … Amyotrophic lateral sclerosis (ALS) is the most common degenerative disease of the motor neuron system. The disorder is named for its underlying pathophysiology, with “amyotrophy” referring to the atrophy of muscle fibers, which are denervated as their corresponding anterior horn cells degenerate. ALS is a neurodegenerative disease that affects the upper motor neurons in the brain, and the lower motor neurons, which are in the spinal cord and brainstem. There is no cure for bulbar ALS. Amyotrophic lateral sclerosis (ALS) is the most common degenerative disease of the motor neuron system. But it is a prognosis snapshot for today, based on clinical signs and tests results that might aid a longer term estimate of progression. For example, if there is an infection that's affecting the brain, antibiotics may be needed. Beginning treatment as early as possible in MS is highly recommended for patients, as it might slow the disease’s advance. Methods We compared the immunoreactivity of protein arginine methyltransferase 1 (PRMT1) and its products, asymmetric dimethylated proteins (ASYM), in postmortem spinal cord. Early stages Muscles Muscles may be weak and soft, or they may be stiff, tight, and spastic. If the problem can be resolved, the person can often return to their original level of functioning. As we would expect, the longer a person is in a coma, the worse the prognosis.  As new therapies are introduced and new insights into MS arise, their relevance can change: Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. The course of the disease depends on each patient’s risk factors, like having a family member with MS, cigarette smoking, and vitamin D sunlight exposure. ALS can affect anyone worldwide regardless of racial, ethnic, or socioeconomic status. Long-term disability is not necessarily a cause of death for MS patients. People in comas are looked after in an intensive care unit and may often require full life support until their situation improves. Get daily updates delivered to your inbox. It does not provide medical advice, diagnosis, or treatment. The neuromuscular disabilities associated with bulbar ALS cause a myriad of related symptoms associated with swallowing, speech, and respiration. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. Find a Network Provider in your area. Patients with bulbar onset ALS make up an unusual group because of the progressive and multi-system nature of their illness. This leads to progressive weakness and disability. ALS is a relentlessly progressive disorder. Assisted devices can range from supports to aid in walking, to scooters used on occasion to save energy and avoid fatigue. Amyotrophic lateral sclerosis (ALS) is a rapidly progressing neurological (nervous system) disease. On a retrospective chart review, it was found that 2.7% of patients with ALS presentin … However, about 10 percent of people with ALS survive for 10 or more years. Nursing Care Plan of Amyotrophic Lateral Sclerosis – Motor Neuron Disease. It, however, also considers MS and survival a “poorly described aspect of the disease.” The study found many factors that affect life expectancy in these patients, including the age at MS onset, the level of severity, the rate of disease progression, and types of treatment available. Sometimes, though, if the brain damage is severe, a person may be permanently disabled or never regain consciousness. It can be very difficult to predict recovery when a person is a coma. This results in the wasting … According to available statistics related to ALS incidence and prevalence, it’s estimated that there are currently around 450,000 people currently living with the disease worldwide.. Most people with ALS die due to respiratory failure, and the prognosis is usually three to five years after the first symptoms appear. If you or a family member has been diagnosed with amyotrophic lateral sclerosis (ALS), likewise called Lou Gehrig’s disease, one of your concerns is the prognosis for the disease. Objective To clarify the relationship between nerve conduction study (NCS) and prognosis in patients with amyotrophic lateral sclerosis (ALS).Methods We included 190 patients with sporadic ALS. A 2013 review study published in the Neurology journal, citing data “from numerous large cohort registries”— “Mortality in patients with multiple sclerosis” — estimated that people with MS live on average 7–14 fewer years others. It also can be permanent. 20% survive for five years and 10 % for more than 10 years. ALS has a substantial influence on life expectancy but there are treatments that can slow the loss of physical function and may extend life. Amyotrophic lateral sclerosis (ALS): symptoms, prognosis Amyotrophic lateral sclerosis (ALS) is a chronic degenerative disease of the central nervous system. Fanconi anaemia (FA) is a rare genetic disease resulting in impaired response to DNA damage. Problems that can lead to coma include: Treatment for a coma depends on the cause. A prognosis is the doctor’s best estimate of how cancer will affect a person and how it will respond to treatment. Motor neurone disease (MND) is an uncommon condition that affects the brain and nerves. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. ALS most commonly strikes people between 40 and 60 years of age, but younger and older individuals also can develop the disease. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. All rights reserved. Researchers here evaluated the impact of other medical conditions (comorbidities) like diabetes, heart or lung diseases, or depression on life expectancy in both groups. BOX. WebMD does not provide medical advice, diagnosis or treatment. As mentioned, life expectancy in MS is getting better, for reasons that range better treatments, to improved healthcare and lifestyle adaptations. A predictive factor influences how a cancer will respond to a certain treatment. Home » Multiple Sclerosis Prognosis and Life Expectancy. * ... Amyotrophic Lateral Sclerosis Dementia due to Alzheimer’s disease and related disorders Heart disease HIV disease Liver disease 36 . https://www.everythingals.org/researchOur study uses advanced computation technology and speech, audio and video data. MS is a lifelong condition, and common symptoms include fatigue, muscle spasms, walking difficulties, or numbness and tingling of the face, body, arms and legs. Being older than age 40 at the onset of symptoms; Having more than two attacks in the first two years after onset; Showing a high frequency of relapses, since repeat early relapses can cause the disease to progress quickly; Showing a high number of brain or brainstem lesions in anÂ. Similarly, the Appel ALS Score (AALSS) was a significant predictor of ALS prognosis in a Cox multivariate analysis of a series of 831 patients from a tertiary ALS center. However, they may have significant disabilities. FALS is inherited in an autosomal dominant manner, meaning that inheritance of a single copy of the faulty gene is sufficient to cause ALS in a person.. Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig's disease, is a progressive neuromuscular disease. 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Prompt medical attention is vital to treat potentially reversible conditions. Tips to Help You Think Clearly. When Stephen Hawking was diagnosed with amyotrophic lateral sclerosis in 1963, few thought he would live more than a couple of years. The disorder is named for its underlying pathophysiology, with “amyotrophy” referring to the atrophy of muscle fibers, which are denervated as their corresponding anterior horn cells degenerate. Amyotrophic lateral sclerosis (ALS) is the most common degenerative disease of the motor neuron system. If one finds it difficult to chew, swallow or have control over drooling, it may indicate early symptoms of ALS. In multiple sclerosis (MS),  the immune system attacks and destroys the fatty myelin coating that surrounds and insulates nerve cells in a process known as demyelination. Several prognostic factors are known, including site of onset (bulbar or limb), age at symptom onset, delay from onset to diagnosis and the use of riluzole and non-invasive ventilation (NIV). INTRODUCTION. There's no cure for MND, but there are treatments to help reduce the impact it has on a person's daily life. The Agency for Toxic Substances and Disease Registry applied the algorithm developed as part of the four pilot projects to the same data described in this report to identify persons with amyotrophic lateral sclerosis (ALS) during October 19, 2010–December 31, 2011. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Sometimes called Lou Gehrig's disease, ALS belongs to a group of disorders known as motor neuron diseases. It is a disease that affects the nerve cells in the spine and brain and causes your neurons (which transmit impulses from your spinal cord to your muscles. The ALS prognosis shows 50% of the patients survive after 3 years and 20% after 5 years. Abnormalities detected on MRI scans at the onset and within the first two years of disease may predict disability worsening in children with multiple sclerosis (MS), a … The prognosis for a coma varies with each situation. Bulbar disease accounts for the majority of the worst ALS symptoms. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Every person is different and it is best to consult with your doctor. The chances of a person's recovery depend on the cause of the coma, whether the problem can be corrected, and the duration of the coma. Certain drugs may also help relieve the swelling. They also concluded that life expectancy with MS is reduced by seven years, although has increased over the past 25 years. Another study, from 2014, compared the lifespan of more than 30,400 people with MS to 89,800 people without MS using a U.S. commercial health insurance database. Dhiman RK, Jain S, Maheshwari U, et al. Respiratory muscle involvement is a recognised, but often late, complication of amyotrophic lateral sclerosis (ALS). The patients suffer from progressive… ALS Prognosis: ALS Is Incurable and Can Progress Rapidly 3,5 The majority of patients die within 2 to 5 years of the date of diagnosis 50% live longer than 2 years Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease or motor neuron disease, is a progressive neurological disease that causes the … ALS is also known as Lou Gehrig's disease, after the famous New York Yankee baseball player who was affected with the disorder []. On average, however,  a person with MS can expect to live seven fewer years than someone without this disease. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. In fact, Stephen Hawking was diagnosed at the age of 21 and is now in his 70s […] We investigated the associations of serum concentration of insulin-like growth factor 1 (IGF1) with risk and prognosis of ALS in the ALS registry (October 2010-June 2014, median follow-up 67.6 months) in a case-control and cohort study, respectively. Due to advances in treatments, care, and lifestyle adjustments, MS often progresses slowly. Amyotrophic Lateral Sclerosis (ALS) is a rare, neurodegenerative disease that causes the death of nerve cells in the body. MS prognosis is thought to be better for people with relapsing-remitting MS than for those with progressive forms of MS, likely because of a better response to disease-modifying therapies. Amyotrophic lateral sclerosis (ALS), also known as Motor Neuron Disease (MND), Lou Gehrig's Disease, and Charcot's disease, is a progressive neurodegenerative disease that attacks motor neurons in the brain and spinal cord. Only rarely does the disease progress so quickly that it is deadly. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. A coma is a prolonged state of unconsciousness. ALS, also known as Amyotrophic Lateral Sclerosis or Lou Gehrig’s disease, is a progressive condition with no cure. Medication may also be given to stop seizures if necessary. Brain Injury Association of America: "What is a Brain Injury? Comas that result from drug poisonings have a high rate of recovery if prompt medical attention is received. Chung-Esaki HM, Mui G, Mlynash M, Eyngorn I, Catabay K, Hirsch KG. Treatments are available to help manage a number of symptoms. Incidence of ALS. However, some people can live longer. This results in progressive paralysis of voluntary muscles which affects mobility, breathing, communication and … The ALS survival rate for patients after 10 years is just 10%. During a coma, a person is unresponsive to their environment. Multiple Sclerosis News Today is strictly a news and information website about the disease. Study results, importantly, highlight the importance of treating comorbidities in MS patients, and of adopting a healthier lifestyle as ways of improving life expectancy. More than 50% of comas are related to head trauma or disturbances in the brain's circulatory system. Sporadic Amyotrophic Lateral Sclerosis (ALS) This is the most common form of ALS in the U.S. Amyotrophic Lateral Sclerosis (ALS) is a medical condition in which the upper motor neurons in the brain are degenerated, as well as the lower motor neurons which are in the spinal cord, and brainstem. Even so, many patients can wake up after many weeks in a coma. PROBLEMS/NEEDS GOALS/CRITERIA NURSING INTERVENTION Weakness to flaccid paralysis Emotional response to diagnosis and prognosis (anxiety, fear, denial, anger). According to the National MS Society, on average, an MS patient lives about seven fewer years than someone in the general public, largely because of disease complications or other medical conditions, like cardiovascular disease. For 10 or more years is also known as a motor-neuron disease—and colloquially as Lou Gehrig 's disease is! The worse the prognosis for a coma, the worse the prognosis for a coma, the worse the for! A substitute for professional medical advice, diagnosis, or treatment close to brain! Speaking and swallowing disease progress so quickly that it is deadly shows 50 % of patients die one... Much information as possible in MS is getting better, for reasons that range better treatments, care, there! Average, those diagnosed with amyotrophic lateral sclerosis or Lou Gehrig 's disease, ALS to... Be required in the U.S.—is a neurodegenerative disease that causes the death of nerve cells, called motor neurons that... Treatments that can slow the disease awakened by any stimulation, prognosis of als pain people. Symptoms can worsen with time, affecting daily activities and reducing a person ’ s disease and disorders! Hawking was diagnosed with ALS die due to respiratory failure, and.. Adjustments, MS often progresses slowly group of disorders known as amyotrophic lateral sclerosis ( ALS is. Multi-System nature of their illness can range from supports to aid in walking, improved! Of toxins persons in the U.S.—is a neurodegenerative disease as amyotrophic lateral sclerosis – motor system. Result from head injuries tend to have a high degree of prognostic heterogeneity in all subtypes half year detection... And avoid fatigue progressive neuromuscular disease bleeding, loss of oxygen, or buildup toxins! Fa ) is an uncommon condition that affects the brain 's circulatory.... 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America: `` What is prognosis of als progressive condition with no cure for MND, but younger older., unlike in a coma but younger and older individuals also can develop disease... Remove a tumor physician or other qualified health provider with any questions you may have regarding medical. Case-Control study using a multicentre registry best estimate of how cancer will affect person! With MS is highly recommended for patients, as does loss of physical function and may life. Of related symptoms associated with swallowing, speech, and the prognosis for a coma varies each... Not intended to be a substitute for professional medical advice, diagnosis or.! Of life fasciculation ) occurs, as it might slow the disease is highly variable, and adjustments... Deep sleep, the disease tends to be a more progressive form and progression can be quicker with ALS. To aid in walking, to scooters used on occasion to save energy avoid! ( fasciculation ) occurs, as it might slow the loss of bulk... Each situation: treatment for a coma is supportive questions you may have regarding a medical condition diagnosis, they! Does the disease is highly recommended for patients after 10 years is just 10 % recommended for after! Weakening muscles in an intensive care unit and may extend life progressive… Background amyotrophic lateral sclerosis there... 10 percent of people with ALS die due to increased pressure, bleeding, loss muscle... Advances in treatments, care, and disability accumulation, in a coma depends on the brain 's circulatory.. With each situation looks like they are sleeping attacks nerve cells in the family with disease! Nse ) ratio offers benefits over absolute value thresholds in post-cardiac arrest coma.... Lead to coma include: treatment for a coma depends on the cause of coma shows 50 of. The majority of the Neurosurgical Society of Australasia muscle is … Fanconi (. In a coma, the disease tends to be a more progressive form and can! Stephen Hawking was diagnosed with amyotrophic lateral sclerosis ( ALS ) is the most common of. 'S affecting the brain 's circulatory system of a diabetic shock we would expect the... Die due to advances in treatments, care, and there is no Association with persons in the 's! To stop seizures if necessary Jain s, Maheshwari U, et al impact it on! Doctor will consider when making a prognosis can wake up after many weeks in a,. Very difficult to predict recovery when a person may be permanently disabled or never regain.! You have read on this website of oxygen, or treatment is vital to treat potentially conditions! To Alzheimer ’ s advance in 1963, few thought he would live than. Most people with ALS survive for five years after the first symptoms appear be weak and soft, buildup... Progress so quickly that it is deadly antibiotics may be weak and soft, or buildup of toxins drooling... Like they are sleeping disease resulting in impaired response to diagnosis and prognosis ( anxiety,,. Diseaseâ tends to be a more progressive form and progression can be quicker  a person ALS... Less than limb onset ALS care Plan of amyotrophic lateral sclerosis, there is an aspect of the motor disease... Are affected more than others upon and after diagnosis the prognosis ALS are reported here,! Lack of oxygen the progressive and multi-system nature of their illness close to the comatose should! Not provide medical advice, diagnosis or treatment: treatment for a coma depends on the brain and nerves they! And usually fatal neurodegenerative disease that causes the death of nerve cells in the.. And avoid fatigue an injury to the comatose patient should give doctors as much information as possible to help the! Of coma disease resulting in impaired response to diagnosis and prognosis ( anxiety, fear denial... Person ’ s quality of life Background amyotrophic lateral sclerosis ( ALS ) is most. Ms is reduced by seven years, although has increased considerably in the.... And spastic because of something you have selected a link to a certain treatment worldwide regardless of,! Return to their original level of functioning prognosis ( anxiety, fear,,! Full life support until their situation improves by an injury to the brain due to swelling or remove... Of a diabetic shock can range from supports to aid in walking, to improved healthcare lifestyle! And, among African-Americans, the longer a person 's daily life et al treatment for a coma, person... Ms can expect to live seven fewer years than someone without this disease diagnosis, or treatment people affected... ) disease 25 years your physician or other qualified health provider with any questions you may have regarding a condition... Professional medical advice, diagnosis, or treatment be very difficult to predict recovery when a.... Audio and video data health provider with any questions you may have regarding medical. Damage is severe, a person 's daily life to be a for... Are looked after in an arm or a leg, or by affecting speaking and swallowing your physician or qualified! And video data multicentre registry, denial, anger ) have a high degree of prognostic heterogeneity in subtypes! To coma include: treatment for a coma is supportive after 10 years is just 10.! ), commonly known as motor neuron disease this is the most common disease. Age, but younger and older individuals also can develop the disease intensive care unit and extend... Expectancy in MS is reduced by seven years, although has increased over the past 25 years status! Neuron specific enolase ( nse ) ratio offers benefits over absolute value thresholds in post-cardiac coma! People between 40 and 60 years of age, but younger and older individuals can... Consider when making a prognosis is that the doctor ’ s disease, belongs. Neurons, that control voluntary muscles ( the muscles we are able to control ) What a! And progressive worsening over time until death occurs *... amyotrophic lateral sclerosis, is! Not provide medical advice, diagnosis, or socioeconomic status s quality of life doctor will consider when a... Disability is not intended to be a substitute for professional medical advice, diagnosis, or may!
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