Eagle Acupuncture Blog

Chinese medicine and the treatment of swine flu (H1N1) Boise, Idaho

2010-07-20T10:30:00.000-07:00

Acupressure panties

2009-11-10T11:46:00.001-08:00

Acupressure panties are here! Do they come in brief, bikinis or smaller? http://htxt.it/sqY5

Swine Flu Stew: http

2009-11-06T11:41:00.001-08:00

Swine Flu Stew: http://htxt.it/40hu

Swine Flu Stew: http

2009-11-06T11:00:00.001-08:00

Swine Flu Stew: http://htxt.it/40hu

American Acupuncture

2009-11-06T10:58:00.001-08:00

American Acupuncture Center's Open House is this Fri. Nov 6, 6-9 pm. 128 S. Eagle Rd. Demonstrations, food and drink! Some nice people too!

Study: Tai Chi Helps

2009-11-03T09:42:00.001-08:00

Study: Tai Chi Helps Lower Blood Glucose levels: http://htxt.it/9zMW

American Acupuncture

2009-11-02T16:08:00.001-08:00

American Acupuncture Center's Open House is this Fri. Nov 6, 6-9 pm. 128 S. Eagle Rd. Demonstrations, food and drink! Some nice people too!

Do you know how hard

2009-06-30T14:55:00.001-07:00

Do you know how hard this is, people? Operating without the benefit of institutionalized medicine? Aah, so what. What's up!!

Alternative medicine

2009-06-15T10:57:00.001-07:00

Alternative medicine may actually be less utilized under national health coverage. Let's see how this pans out...

I'm featured in the

2009-06-09T13:47:00.001-07:00

I'm featured in the Valley Times newspaper this week. Fortunately, they got my good side, my front. http://tr.im/nWZJ

Wed. clinic: 57 y/o

2009-06-03T11:24:00.001-07:00

Wed. clinic: 57 y/o F with tenosynovitis of the R wrist. After 4 tx. she's able to lift some poundage in R arm and pain is reduced.

Never use aconite ro

2009-05-29T11:10:00.001-07:00

Never use aconite root (fu zi) w/o seeing me first. A versatile and irreplaceable herb, but can deliver bad side effects if used improperly.

Steelers linebacker

2009-05-28T09:12:00.001-07:00

Steelers linebacker James Harrison uses acupuncture to stay in one piece. Read it here! http://tr.im/mGtM

Steeler's linebacker

2009-05-28T09:08:00.001-07:00

Steeler's linebacker James Harrison uses acupuncture to stay in one piece. Check it out! mGtM

A great single herb

2009-05-21T15:35:00.001-07:00

A great single herb for Cushing's Syndrome: Astragalus (Huang Qi in Chinese). It works as an adrenal regulator on the kidneys.

What's the longest a

2009-05-19T13:21:00.001-07:00

What's the longest acupuncture needle I use? 6 inches. People never complain about it....really.

A website in Malaysi

2009-05-19T10:30:00.001-07:00

A website in Malaysia is using my "Testimonial" page from my website and passing it off as their own. Change the names & addresses, guys!

President Obama favo

2009-05-15T11:26:00.001-07:00

President Obama favorable towards acupunture. The fact that he even talked about it is a major miracle, let's be honest. http://tr.im/lsAB

Pretty sweet (or sou

2009-05-12T14:29:00.001-07:00

Pretty sweet (or sour). I am mentioned in the Chicago Tribune talking about creative ways to use lemons! http://tr.im/lb1e

Friday clinic: 60y/o

2009-05-08T16:13:00.001-07:00

Friday clinic: 60y/o WM, vomiting episodes, anxiety, stress, insomnia. Reports no nightmares for 2 wks after decades of nightly occurence.

Tai chi class clashe

2009-05-07T11:07:00.001-07:00

Tai chi class clashes with Bible, say Baptists in Australia http://tr.im/kKXD

I never prescribed M

2009-05-05T15:07:00.001-07:00

I never prescribed Ma Huang much, but it sure is a big loss to legitimate herbal practitioners since the FDA banned it in 2006...

We're teaching the 8

2009-05-05T11:59:00.001-07:00

We're teaching the 8 Brocades qi gong on Wednesdays. Come on down and have some fun!!

We're teaching the 8

2009-05-05T11:58:00.001-07:00

We're teaching the 8 Brocades qi gong on Wednesdays. Come on down and have some fun!!ollow hellotxt team on http://htxt.it/MVDH

Little Boise Zoo: Se

2009-05-04T10:28:00.001-07:00

Little Boise Zoo: See tigers every time! World-famous San Diego zoo? Listen to piped-in tiger roars...

Acupuncture Effective for Hypertension

2008-09-30T13:45:00.000-07:00

Practitioners and other devotees of Oriental medicine are well-aware of acupuncture's many health benefits – the profession has literally thousands of years of clinical success stories. The challenge in today's evidence-based health care culture is the lack of solid, well-designed research to scientifically support these success stories, particularly for certain conditions.

A randomized, double-blind study, published online for the June 4, 2007 issue of Circulation, suggests regular acupuncture treatments can help with an all-too-common condition: high blood pressure. Researchers found that patients with hypertension achieved significant short-term reductions in systolic and diastolic blood pressure following the administration of acupuncture.

Researchers from the University of Erlangen in Germany and Nanjing University of Traditional Chinese Medicine in China randomized 160 hypertensive patients to six weeks of either active acupuncture or sham acupuncture (22 sessions for 30 minutes each), to determine if active acupuncture could reduce systolic and diastolic blood pressure. Blood pressure measurements were taken before treatment and after each session.

Needling points were chosen according to the Chinese type of hypertension and conformed to typical prescriptions for the disorder. Sham needling was done on locations not relevant for lowering blood pressure. In looking at the blood pressure readings for the subjects, the researchers found:

"There was a significant (P<0.001)>

For example, before treatment, the mean 24-hour systolic/diastolic reading was 131/81 for the active group and 129/80 for the sham group. By the end of the six weeks of treatment, the active group mean systolic/diastolic was 125/78 and the sham group was 130/80. The active group daytime systolic/diastolic scores before and during treatment were 136/84 and 128/80, respectively. The daytime sham group scores were 133/82 and 134/82, respectively. The nighttime scores for the active group, before and during treatment were 120/73 and 117/72. The sham group's nighttime scores were 120/73 before treatment and 120/74 during treatment. Blood pressure changes during peak bicycle stress-testing were also measured, but the changes were not significant.

It's important to note that these results were short-term. When the researchers measured blood pressure again at both three- and six-month follow up, they found: "Mean systolic and diastolic blood pressures [had] returned to pretreatment levels in the active treatment group." This outcome suggests that reductions in blood pressure are based on receiving regular acupuncture treatment.

In conclusion, the researchers recommended: "As shown in the present study, acupuncture may offer an alternative antihypertensive therapeutic option. Acupuncture effectively lowered systolic and diastolic blood pressures during the treatment period with no or minimal side effects. Patients with mild or moderate hypertension who want to avoid drug therapy or are attracted to the spiritual foundations of acupuncture may therefore be candidates for such a therapy. This modality might also serve as an additional option together with drug therapy."

Qi Sensation: East and West

2007-02-14T15:12:00.001-08:00

In China, the intent with acupuncture is to elicit a "qi sensation". The qi sensation is the heavy, achy, dull feeling patients may experience from the insertion of the acupuncture needle. The Chinese believe that this is a vital indicator as to the effectiveness of the treatment(s). Therefore Chinese practitioners often use large gauge needles and may do a lot of manipulation with those needles to get that sensation.Japanese acupuncture tends to favor the use of much smaller, finer needles and the qi sensations are much less obvious.

In the West, patients are often fearful of needles. Most patients do not want to "feel" anything. Any sensation at all is considered "pain". This is a cultural difference. Chinese patients usually do not consider the strong qi sensations from acupuncture to be "painful". They understand that as qi, because it is a part of their cultural tradition and they are familiar with it.

At American Acupuncture Center we have a wide range of needling styles. It really depends on the patient. Some people benefit from strong qi sensation and some do not. Some patients ONLY want strong and obvious qi sensation and don't feel the treatment is effective without it. Others simply can not relax with too much stimulation. After a few treatments, you will be able to recognize the sensation of "qi" as opposed to "pain".

To be honest, patients benefit from all styles; it's really a case-by-case basis.Also, the acupuncturist will know when the needle is at the correct depth and location by the "feel" of the needle in the fingers. This ability simply comes from treating a lot of people. You can not learn it from a book...

Does Acupuncture Hurt?

2007-02-14T15:10:00.000-08:00

It shouldn't.

If the practioner inserts an acupuncture needle correctly, the patient will often feel a heavy, dull ache at the spot of insertion. This feeling may travel up or down one's leg/arm back or torso. Some patients describe it as a "weight" or a "mini toothache". It is not referred to as "pain", though.This heaviness is positive, and desirable. It is often referred to as a "qi sensation". This means that the needle has encountered a substantial amount of qi at that point. This is a very good therapeutic indication.

Not all points are the same and patients will not feel the exact same sensation on each point. Some points are characterized by potentially strong qi reactions and some are considered quite benign. The key, especially for new patients, is communication between patient and practitioner.

At American Acupuncture Center, I try to stay in contact with what the patient is experiencing during treatment. This makes the patient feel "safe", helps guide my technique and renders a better result and experience.

Mayo Clinic Study Confirms Acupuncture helps Fibromyalgia

2006-11-27T13:55:00.000-08:00

A new study from the world-renowned mayo Clinic confirms what we at American Acupuncture Center have known for a while-- that acupuncture helps those suffering from fibromyalgia. Read the article from their website here.

Kristen Featured on San Diego Television Show

2006-11-14T21:58:00.000-08:00

Kristen Burris was featured on "Inside San Diego", a San Diego news magazine show on Oct. 11. Kristen was interviewed by the host Sandra Moss regarding a recent study supporting the efficacy of acupuncture for the relief of menopausal hot flashes. One of our patients from American Acupuncture Center served as a model so acupuncture needling could be demonstrated to the television audience. Congratulations, Kristen! You are a wonderful ambassador for the medicine and our center. "Inside San Diego" airs weekdays at 10 a.m. on KUSI-TV Channel 51. Visit their website here.

Acupuncture Relieves Low Back Pain Over Long-Term, Study Says

2006-09-14T15:18:00.000-07:00

Low back pain is probably the most common reason patients seek treatment at American Acupuncture Center. If it's not the primary reason it is often a nagging, secondary problem. The unfortunate truth is that most of us will suffer some degree of low back pain in our lives. The lumbar spine is very flexible and allows us a lot of movement. It sacrifices strength and stability in order to achieve flexibility which makes it prone to injury. Our intervertebral disks, the "cushions" between our spinal vertebrae, tend to deteriorate beginning in the 30's. This combination is a recipe for low back pain. Acupuncture can be very effective in treating this condition and, in fact, is often the only thing that works for many people. Read the latest scietific study regarding acupuncture and low back pain:

By Patricia Reaney
REUTERS
11:33 a.m. September 14, 2006

LONDON – Acupuncture can be effective in treating patients with low back pain and the benefits seem to improve with time, according to research published on Friday.
The ancient Chinese treatment, which involves inserting fine needles at specific meridians of the body, is a popular complementary therapy for a variety of ailments.

Hugh MacPherson and scientists at the University of York in England said the benefits of a short course of acupuncture were evident in their study of 241 back pain sufferers.

'If you offer acupuncture to someone with back pain on average it is expected you are likely to benefit, not just in the short term but particularly in the longer-term of 12 and especially 24 months,' he said in an interview.

'That's a remarkable finding in that normally you would expect the benefit of the treatment to wear off,' MacPherson added.

Low back pain is one of the most common medical complaints. It affects ten of millions of people and is a leading cause of sick days.

The researchers compared the impact of adding 10 acupuncture sessions over three months to the normal treatment for back pain, which includes medication, physiotherapy and exercises.
Patient satisfaction and pain levels were measured and recorded during the two-year study. After three months there was not too much difference between the acupuncture group and patients who had the standard therapy.

Weak evidence of improvement in the acupuncture group was found at 12 months, according to the study published in the British Medical Journal.
By 24 months the difference between the two groups increased.

'This is the first study to show this growing gap up to the two-year point. It is quite unique in that sense,' MacPherson added.

In a separate study in which they looked at the cost of acupuncture, the researchers found that the additional money spent on the acupuncture treatment appeared cost effective. The cost of treating each patient in the acupuncture group was 460 pounds ($863) during the study, compared to 345 pounds ($647) for patients who received just the standard care.

Kristen Featured on Pregnancy Podcast

2006-09-13T15:14:00.000-07:00

Kristen is featured on a 50 minute pregnancy podcast on the website Pregtastic.com. Pregtastic.com is a website that features weekly podcasts addressing issues women face during pregnancy. A regular panel of 4 women bring in an expert in the field of women's health to discuss pregnancy issues. Well, this week it was Kristen who discussed how acupuncture and Chinese medicine can help with things like morning sickness and back pain.

For those of you not familiar with podcasts, it is an audio file you can listen to on your computer. It's like listening to the radio.

To hear Kristen's podcast, click here and click "Listen now". Enjoy!

Are There Different Styles of Acupuncture?

2006-07-31T23:06:00.000-07:00

Yes, there are many different types and styles of acupuncture. There are different techniques of needling and different ways of viewing the body and how to heal it. Let's look at some of them.

Acupuncture originated in China a milennia or more ago. The "bible" of Chinese acupuncture is known as the Yellow Emperor's Classic of Internal Medicine, or Nei Jing. Named after the legendary Yellow Emperor Huang Ti, this book outlines the major principles of practice. Of course, China was a massive country in geographical size and population, so, like the martial arts, the practice of acupuncture varied slightly from province to province, village to village and family to family. It's well-known that many families developed their own style or version of kung-fu and tai chi and this was true for acupuncture as well. While the general, underlying intention was common, the methods often differed according to the preference of the family style. Taoism also had a profound effect on acupuncture and several esoteric methods such as the "8 Magic Turtle" style were influenced heavily by the Taoist belief system.

In the 1950s, Mao Tse-Tung helped to change the face of modern acupuncture. He realized he had a large, impoverished nation that severely lacked enough medical personnel, especially in rural areas. He decided to use one of China's great cultural treasures, acupuncture and herbology, as a means to spread healthcare to the people. In order to do this most efficiently, much of the theory from these family styles was codified into one system, so that a practitioner in Beijing would be on the same page as a rural doctor in Chengdu. In keeping with Communist ideology, much of the theory that was considered too spiritual, religious, archaic or superstitious was deleted. Mao wanted it based on a more Western model. This system is known as Traditional Chinese Medicine (TCM). This is by far the most common style practiced in the world today. What's ironic is that prior to Mao's dilemma in the 1950s, he was a staunch opponent of traditional medicine, even though he had been cured of Bell's Palsy with acupuncture during his campaign against Chang Kai-Shek.

Japan and Korea had been exposed to acupuncture by the 5th century. Japanese acupuncture is really just basic Chinese meridien acupuncture with much less emphasis on use of herbs. Japanese acupuncture is often characterized by very light needle technique, which many patients find appealing.

Five element acupuncture is based on the traditional Chinese philosophy that natural phenomena, including our own being, can be classified into Five Elements (Chinese: 五行; pinyin: wu xíng): wood, fire, earth, metal, and water (木, 火, 土, 金, 水). Five phases is actually the more appropriate way of translating wu xíng — literally, "five goings". Health concerns arise when these elements are not in balance, and needling points based on their elemental catagory can re-establish this balance. Herbal use in this school is also limited.

Ear acupuncture, or auricular acupuncture has roots in China but was actually developed in France in the 1950s by a man named Nogier. The concept is that the ear is a micro-system of the entire body, and that every part of the body, internally and externally, is represented by points on the ear.

Chinese acupuncture is often characterized by strong needling. This is because Chinese practitioners place such a heavy emphasis on achieving a qi sensation with each needle. Qi sensation is that heavy, dull, achy feeling that arises from a needle insertion. Japanese acupuncture relies less on qi sensation and more on choosing the appropriate points. This is a generalization, of course.

More modern techniques include target tissue needling, a technique popular in sports acupuncture. This involves stimulating the motor points of muscles in order to achieve a fasciculation that will re-set the muscle length. This is a very effective technique for soft-tissue pain relief, but requires good technique and anatomical training as some of thepoints require very deep insertion. Very similar is trigger point (TrP) needling, developed by Dr. Janet Travell, a pioneer in pain medicine. She uncovered how muscles developed trigger points, or painful nodules within the tissue. These nodules could be relieved by needling. Dr. Travell used a hypodermic needle, but the concept is the same.

Of course, most practitioners use an amalgam of these styles and techniques. At American Acupuncture Center, I practice mainly TCM/target tissue/TrP style, but use ear and Five Element as compliments. I can needle very heavy or very lightly, depending upon the patient. It's important to have a several tools in the toolbox. Remember; if all you have is a hammer, all your problems look like nails...

10 Reasons To See an Acupuncturist

2006-07-22T15:26:00.000-07:00

1.) It's part of your healthy lifestyle
2.) You are taking a lot of supplements but aren't sure if they're right for you
3.) You want advice from a specialist that is well-trained in natural and Asian medical therapies
4.) You have hit a plateau with conventional therapies
5.) You want a natural health program designed for you
6.) You are confused by contradictory health claims
7.) You have a vague complaint but aren't "sick" enough to see a medical doctor or use drugs
8.) You are concerned about the long-term side effects of drugs
9.) You have an uncommon health problem which baffles your doctors
10.) The drugs you are taking cause side effects worse than the original problem

"Do I have to believe in acupuncture for it to work?"

2006-07-12T17:03:00.000-07:00

I get asked this question now and again. Almost all are patients on their first visit. They're not quite sure about what acupuncture is or how it works. They may not even really believe in acupuncture's efficacy. The other group are patients who have had several treatments and may not "feel" anything regarding their condition or state of being. Let me address this question.

First of all, acupuncture is a system of medical treatment. It is not a placebo. It has been developed over many centuries with empirical protocals and treatments for various ailments. Modern clinical research is revealing that acupuncture treatments elicit chemical and biologic changes in the body. How it does all of that exactly is still not clearly understood. We know how acupuncture stimulation releases the body's natural painkillers like endorphins. We also understand how acupuncture can block pain signals from reaching the brain and spinal cord. These have been proven scientifically.

Other aspects are less well understood. Research at UC-Irvine conducted a study using PET scans. Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three dimensional image or map of functional processes in the body. There is an acupuncture point in the hand that classically is indicated for ear problems. From a modern medical perspective, there is no logical relationship between the ear and this point. When the point was needled, the PET revealed increased activity in the auditory cortex of the brain, which suggests there is a connection. The subject was not told what the point related to, so there was no suggestion to influence them.

So, acupuncture is not "hocus pocus". It's also not "magic". It's a legitimate system of healing that, like any system, has it's strengths and weaknesses. I've treated many patients that were skeptics or declared that they did not believe in it at all. Many of those people are now regular patients.

That being said, the mind is a very powerful force for healing. Any doctor of any type of medicine will tell you that a patient that maintains a positive mental outlook on their treatment and recovery will, generally speaking, do better than those that do not. A well-known cardiologist wrote a best-seller suggesting that prayer is a very powerful aid in healing and recovery. One of the pre-eminent acupuncturist in the country once told me, "If you think about it, we're really just one big brain." His reasoning is that almost everything in our body is influenced, governed, managed or monitored by some aspect of the brain. Think about it; we know that prolonged stress affects the sympathetic nervous system and will produce changes such as high blood pressure, tight muscles, headaches, etc. We don't call that "hocus pocus". Why would setting positive affirmations and intention about our healing be any less valid?

Does believing in the relationship with your significant other not enhance the quality of that relationship? Does believing in the significance and validity of your work not give you more satisfaction? These are general statements, but, of course they do. So, I tell these patients, no, you don't have to believe in acupuncture, but since you're here, why wouldn't you? You wouldn't take a prescription medicine home from your doctor and say, "I don't believe in these pills or that doctor, but I'll take them begrudgingly." No. You take the meds for a while and make a judgement about your progress on a date determined by you and your doctor.
Thats what I do. I tell my patients on their first visit whether I think i can help them and what they can expect in a number of visits.

So, be a "believer" while you're getting treated. Don't analyze yourself on the treatment table. Just relax and let it have it's effect on you.

What should I expect from acupuncture?

2006-04-24T17:17:00.000-07:00

This is a very common question from patients. Most people know only one thing about acupuncture--it involves needles. And, that's usually not a positive association for most people.

Patients must understand that acupuncture is a therapy. That is, you gain benefits by an accumulation of treatment. It is not a procedure, like an operation, where it's performed once. Remember, acupuncture's intent is to send a signal to your body in order for your body to regulate itself. The acupuncture needle stimulates your peripheral nervous system which then travels to the central nervous system, the brain and spinal cord. After translation in the CNS, a signal is sent back out to the body. So the idea is to do this a few times in order to initiate a healing response. The number of visits required to address an ailment depends on several factors including what the patient wants to achieve and how their body "takes" to acupuncture. We have patients that have gotten great results with one or two treatments and others that took several months of regular visits. One problem I encounter is that some patients simply give up way too early. If their problem of 20 years is not "fixed" after 2 treatments, then "acupuncture doesn't work". I try to encourage patience and be reasonable about expectations. It takes people a long time to gather a ball of yarn; it's going to take us some time to unravel it. The Chinese classics liken medicine to the idea of clouds parting in the sky. It's subtle and sometimes barely noticeable until you look back in a minute or two.

People often say, "What will I feel like afterwards?" The general feeling after acupuncture is relaxation and general well-being. This is because acupuncture stimulation triggers the release of endorphins in the body.

Some patients may be helped with supplementation with herbs and/or vitamin supplements. The combination of acupuncture and supplementation is often more effective and results tend to be faster, which patients like.

Acupuncture and the rest of Chinese medicine

2006-03-07T11:50:00.000-08:00

Although acupuncture is the most well-known Chinese healing modality to us in the West, it is only one of many. Classical Chinese medicine is likened to a tree; a tree with eight branches. Each branch represents a a particular modality. Acupuncture is one. Herbology is another. Qi gong/self-cultivation, massage/bodywork/bonesetting, philosophy, feng shui, nutrition are some of the others. Together they constitute one tree, or one body of medicine. This is the idea of holistic medicine; practiced together they constitute a complete regimen for health maintenance.

Not all of these "branches" are considered equal, though. In fact, acupuncture is considered the least refined of these branches. Why? Because somebody else has to do it for you. Anything that you can do for yourself is considered more effective and thus a higher level of medicine. Which branch is considered the most powerful? Qi gong/ self-cultivation is considered the highest level of medicine. Why? Because you can do it for yourself.

This is empowering medicine because it stipulates that you are responsible for your own health. A classical Chinese saying says " Seeking a doctor when you are sick is like digging a well when you are thirsty." Now, of course, SEEK a doctor when you are sick. But, listen to the intent of the message. We have a good saying here in America. too: An ounce of prevention is worth a pound of cure.

what is acupuncture?

2006-03-02T15:31:00.000-08:00

Acupuncture is an ancient medical practice that originated in China several thousand years ago. A practitioner inserts a thin needle into a patient in order to attain a therapeutic effect. What kind of effect is attained depends upon what technique the practitioner is applying. More on that later.

Before one can understand how acupuncture works, we must come to understand how ancient Chinese medicine viewed the body. The body is criss-crossed by fourteen major pathways, or meridians. Each of these meridians corresponds to a major organ or bowel system. For example, there is a heart meridian, large intestine meridian, etc. These meridians are located all over the body, from the top of our head, to our fingers, toes and internally to our muscles, organs, glands and cells. There is no part of our system that is not influenced by one of these meridians.

The meridians are pathways for a vital, bio-electric energy that animates and provides our organs, muscles, tissues glands and cells the ability to function. Think of it this way. A television set is composed of a screen, dials, buttons, tubes and wires. However, it does not function unless it is plugged into a wall socket that provides electricity, or energy. Our bodies are viewed the same way. Without this energy, our bodies do not have this ability to function. This elusive concept of bio-electric energy is called qi (pronounced chee). We get our Qi or energy from air, water, food, emotions, spirit, exercise, herbs and acupuncture.

Sufficient and unimpeded flow of qi in these pathways is the classical Chinese idea of health. When this energy is blocked or damaged in some way, as in an injury, there is pain and reduced function. This is where acupuncture comes in.

By inserting a thin needle into various locations, or points, along the affected meridians, the acupuncturist is able to influence the qi energy that is damaged or blocked. Acupuncture treatments will help restore the meridian flow and thus help heal the injured area. The severity and chronic nature of the injury determine how many treatments may be required to achieve a satisfactory result. Typically a patient will have treatment once a week for six weeks. At that time we assess the personal needs of that patient. American Acupuncture Center recommend a check-up every three to six months depending on the severity of their illness.