How to stop arthritis from progressing 

How to stop arthritis from progressing. There are more than 100 types of arthritis. drinking too much alcohol or caffeine. Aim for about 30–45 minutes of moderate-level exercise about 3–5 days per week. Make an Appointment: The Role Of The Canine Joint. Use these 5 strategies to manage your arthritis at any age. The temperature should be warm, not painfully hot. Pause. It affects specific joints rather than the entire body. However, it is important to keep in mind your cat's physical limitations and adjust the activities accordingly. Your bones rub together, and that causes the same symptoms as osteoarthritis: pain, stiffness and limited movement. The canine joints play a critical role in normal movement. Oct 10, 2021 · Stage 3: Severe RA. The medications used to treat arthritis vary depending on the type of arthritis. Centers for Disease Control and Prevention. An active lifestyle significantly decreases your risk of developing arthritis. Nov 13, 2023 · Every pound of extra weight adds nearly four pounds of stress on your knees and six pounds on your hips, according to the Arthritis Foundation. Exercise – Regular exercise is great for your whole body, but it’s especially helpful for your joints. Jan 25, 2023 · Joint stiffness that is usually worse in the mornings and after inactivity. Jul 18, 2023 · Rarely, scoliosis that is progressing aggressively can lead to pain in the spine and difficulty breathing in children and adults. D. Be active. Joint protection. Then, make a hook fist, hold for 5–10 seconds, and then return to a straight hand. As the disease progresses, symptoms often spread to the wrists, knees Jun 30, 2023 · The same was true for rheumatoid arthritis in the past, but treatments are now able to slow or stop the progression of arthritis damage. People should be on what we call disease-modifying medications to stop the progression, because we can, now-a-days with medication stop the progression of rheumatoid. The amount Mar 25, 2015 · Hold your hand in an open, natural position. Sit at the front of the chair, knees bent, feet flat on the floor. Physical and occupational therapy. Use heat. The hip is a ball-and-socket joint with the ball at the top of the thighbone (the femoral head). Green leafy vegetables: Spinach, kale, and broccoli are rich in antioxidants. The space between the bones in your joint is much smaller than it used to be. Whole grains (such as oatmeal and brown rice) – lowers levels of C-reactive protein, a Feb 28, 2024 · Increased movement and mild, regular, low-impact exercise is usually recommended for an arthritic cat. The goals of osteoarthritis treatment are to reduce pain and stiffness, limit the Mar 15, 2024 · Exercise: Being active is the best way to prevent joint problems. Wrapping poultices around stiff joints with an herbal blend of cayenne powder (capsicum), slippery elm, mullein, and lobelia. A “grating” or “scraping” feeling when moving the knee. algae oil, for vegetarians and vegans. Aug 22, 2021 · Diet, exercise, and smoking are major factors in preventing arthritis. Symptoms may not appear until moderate-stage RA, which is stage 2 May 25, 2021 · Always gently stretch any area of your body to avoid injury. Commonly used arthritis medications include: NSAIDs. Knees. May 13, 2021 · Preventing Arthritis Related to Knee Injuries. A. Pain may change from dull ache to sharp pain. That old saying among arthritis experts is backed up by the numbers. Overdoing exercise is counter-productive to your goal of increased energy and decreased fatigue. There are four pillars to an appropriate exercise program. Jun 21, 2021 · If you're going for a run, walk for 5 minutes, then run, then walk for another 5 minutes to cool down. 4. Furthermore, limiting activity to no more than 1-2 hours per day can promote joint health by reducing fluid in the joint and damage to cartilage. Sep 22, 2021 · 11 Red-Flag Signs Your Rheumatoid Arthritis May Be Getting Worse. Avoid holding one position for too long. Nov 17, 2017 · Pharmacies, medical supply stores, and online vendors stock a variety of aids for people with arthritis. Use soft, comfortable beds placed in easily accessible, quiet, draft-free locations. Too much exercise due to overexertion of the joint (s) can cause an arthritis flare, but a little exercise can also go a long way in helping to tamp down a flare. Pain in the groin area or buttocks and sometimes on the inside of the knee or thigh. Regular exercise, good posture, and healthy body weight can Apr 25, 2023 · cod liver oil. You may be able to relieve pain and prevent bunions from progressing with conservative measures that take pressure off the MTP joint and improve foot mechanics. " Other benefits include strengthening the muscles around the joints, maintaining bone strength, and improving energy and mood. The most common type of arthritis, osteoarthritis involves wear-and-tear damage to a joint's cartilage — the hard, slick coating on the ends of bones where they form a joint. Then, bend the middle joints of your fingers and make a fist. 5 million people live with some form of arthritis in the U. Swollen joints in your hand (s). About half of all women and one-quarter of all men will experience the stiffness and pain of osteoarthritis (OA) of the hands by the time they are 85 years old. Manage your weight. Oct 25, 2021 · Steroids can have serious side effects and are only meant for short-term use. But only a very small percentage of people with arthritis become severely disabled. Sep 13, 2023 · You might need to combine biologics with methotrexate to get better results. Talk to your doctor. Mar 12, 2024 · Resources. Develop a light but regular exercise routine. It is this imbalance between pain and radiographic Jul 6, 2021 · Dull or burning joint pain, appearing hours or a day after increased use of your hands. Exercise regularly. Warming up before you exercise can help improve your circulation and make your knees and other joints more flexible, reducing the risk of injury and pain. Aim for about 150 minutes of exercise per week. I haven’t been able to do this for a month, as I’ve broken my hand, but spending a good 20 minutes kneading bread by hand after doing the washing up really helps, even Nov 30, 2022 · To try and prevent your rheumatoid arthritis from progressing and leading to complications and lasting joint damage, take the following steps: Quit smoking, cut down on drinking. Jan 18, 2024 · Post-traumatic arthritis is like osteoarthritis but is caused by an injury to the joint, such as a bone fracture or dislocation, or a torn ligament. Ankle-strengthening exercises (using a resistance band) and Achilles-stretching exercises can also help reduce pain. It is also known as osteoarthritis, or degenerative joint disease (DJD). This may be damaging the cartilage and the bone. Learn more about the causes, symptoms and prevention of osteoarthritis from Mayo Clinic's trusted health information. Put your strongest joints and muscles to work. Osteoarthritis most commonly affects three parts of the hand: the middle Sep 23, 2022 · Self-care: Keep your weight under control, as being overweight or having obesity puts stress on the foot and ankle. Go to: 5. It’s an autoimmune disorder, meaning your body attacks its own tissues. 2 days ago · Osteoarthritis does not evolve uniformly, it is unpredictable. — Oct. May 1, 2013 · Soda appears to be associated with the progression of knee osteoarthritis in men. Nov 17, 2017 · Here are five of them: Keep moving. A degenerative disease that affects all the tissues of a joint, OA leads to the breakdown over time of the smooth, protective cartilage on the ends of bones, so Sep 29, 2022 · So try taking a walk for five minutes or do something to physically warm your body, like a hot shower, jumping in a hot tub or bath, or using a heating pad used in certain areas. Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet. It’s also rich in vitamins K and C, and calcium. Dec 29, 2020 · Permanent bone damage. 1 day ago · Tips for reducing the risk of osteoarthritis. It especially affects the lining of your Jan 10, 2023 · The four stages of rheumatoid arthritis (RA) are also known as early-stage RA, moderate-stage RA, severe RA, and end-stage RA. Broccoli – A cruciferous vegetable, broccoli contains a compound called sulforaphane, which could slow the progression of osteoarthritis. Learn new self-management skills. Degenerative disc disease (DDD) is mostly an age-related process, so it can't be prevented entirely. Psoriatic arthritis is an autoimmune disease that causes inflammation of the skin, joints, tendons, and nails. It can also keep joints from getting stiff and it keeps muscles strong. Rheumatoid arthritis is an autoimmune disease. It affects about 1. It's also an important part of treating arthritis. “It can affect other organ systems and cause inflammation there: the lungs, the eyes, a skin Feb 15, 2021 · Teach your puppy from an early age not to jump on and off the bed or furniture. 8, 2013 — Most everyone is bound to get osteoarthritis — if they live long enough. Hold your hand in the air, keeping the fingers upright and close together. Although the exact causes of arthritis mutilans are unknown, PsA treatments can reduce your risk of developing the condition. Apr 4, 2023 · Symptoms, Causes, Diagnosis, Treatment, and Prevention. Ice the painful joint, drink plenty of fluids and avoid alcoholic and sugary beverages and purine-rich foods, such as red meat and certain seafoods. These drugs can slow RA's activity in your body so you feel better. It can affect joints in your hand or wrist Mar 15, 2023 · not getting enough exercise. If scoliosis is detected during a child’s growth period, bracing may be considered to avoid excessive curvature progression. Aug 29, 2023 · Medications. Fields says. Jun 16, 2021 · Osteoarthritis is a common joint disorder that causes pain, stiffness and reduced mobility. Keeping your head, neck, and back straight, bring your upper body forward, and then stand up slowly. “Reducing your BMI will reduce the burden on your joints,” says Dr. Maintaining a Apr 19, 2022 · A plant-based, whole-food diet focused on fresh vegetables, fruits, legumes, and grains might help ease your OA symptoms². Do the same while sitting at home reading or watching television. Exercise using low-impact activities instead of high-impact activities . The two main types of arthritis — osteoarthritis and rheumatoid arthritis — damage joints in different ways. Modify your activity if overuse seems to be exacerbating the pain, and try ice packs. Jun 15, 2022 · Although there are no medications that can slow or stop the progression of osteoarthritis, some can minimize or relieve pain so you can be more comfortable and active, and more activity can further reduce pain and improve fitness. Some people can reverse osteopenia and regain a typical amount of bone density. Walking alone is not enough. Go to: 6. Also, extra weight can promote inflammation in the body, which destroys cartilage cells. Things like pool exercises, bicycle or elliptical tend to keep you moving with less aggravation of the pain. They include the following: Acetaminophen Sep 11, 2021 · To try and prevent your rheumatoid arthritis from progressing and leading to complications and lasting joint damage, take the following steps: Quit smoking, cut down on drinking. Apr 11, 2015 · The evidence for the benefit of exercise is strongest for knee arthritis, but less so for hip arthritis. Osteoarthritis (OA) is the most common type of arthritis, or inflammation of the joints (where the ends of two adjacent bones meet). Repeat this movement several times on each hand. This can cause repetitive trauma to not only the joints but also to your dog’s spine. If you've had arthritis in your hand (s) for some time: Symptoms are present more often. Exercise can help manage OA. Find 30-45 minutes a few times Sep 16, 2022 · But they have some tips that might reduce the severity of your symptoms and possibly stop the arthritis from getting worse, including: Maintain a healthy weight. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Nov 19, 2020 · Garlic has also been shown to reduce inflammation, which may help lessen the symptoms of arthritis. Modifying your cat’s environment can help greatly to prevent the development of arthritis or assist with maintaining the quality of life for a cat who may already suffer from arthritis. But tophi can form anywhere in the body. It is Here’s a look at six ways you can slow or prevent ankle arthritis progression. The secret is to start small, then gradually stretch the activity bit by bit. Look for activities that include strength training and stretching in addition to aerobic exercise. The ball is separated from the socket (the acetabulum) by cartilage. Your joint feels warm and inflamed. Jul 24, 2022 · Exercise Regularly. It can remain silent for a long time and not manifest itself even though the joint looks very damaged on the X-ray. Jan 23, 2022 · Just symptom relief isnt appropriate, he explains. Be active every day. Surgery. Aerobic exercise: Aerobic exercise implies that you are getting your heart rate up. Oct 25, 2019 · Stage 4: Chronic Gout. The rods are lengthened every 3 to 6 months either with surgery or in the clinic using a remote control. Protect your joints. The painful and often debilitating joint condition is the most common form of arthritis. People who have not developed arthritis can take steps to help prevent joint damage in their hands. Rheumatoid arthritis (RA) is a chronic inflammatory condition. Types of arthritis. Bhatt says. However, not everyone responds to the Feb 1, 2023 · Chronic inflammation of the finger and toe joints can cause the fingers and toes to shorten and collapse, a rare condition called arthritis mutilans. 2. They should make sure to Jun 24, 2019 · Rest a chair against a wall. Over time, the bones in the joint rub together and trigger pain, swelling, and inflammation. Some people with thumb arthritis may experience a reduction in the pain by applying heat packs to their joint. Avoid putting strain on the joints. , according to the Centers for Disease Control and Prevention (CDC) Arthritis. Typically, low-impact exercise is best tolerated. This “wear and tear” arthritis is the most common form. Most medications used to ease osteoarthritis pain are taken by mouth. This stage is also called “tophaceous gout” because the uric acid deposits can form nodules called “tophi,” often at the bunion point of the big toe or at the elbow. Fingers. Aug 19, 2019 · Trading a high impact activity, such as running, for a low impact activity, like swimming, can preserve joint health and keep arthritis at bay. M. tissue around the joints. 1. Don't Smoke. Exercise. Deliver the heat with warm towels, hot packs or a shower. Citrus fruits (such as oranges, grapefruits, and limes) – rich in vitamin C. It affects at least 27 million Americans, and one form — knee […] Examples include stationary or recumbent bicycling, elliptical trainer workouts, or exercise in the water. Fatigue, fever and loss of appetite. Oct 18, 2021 · The cartilage starts thinning after trauma to your knee (like an injury from a car crash or contact sport). Exercise Regularly Sep 17, 2021 · The more flexible your knee joint is, the stronger the muscles are that support the knee joint, the better your quality of life will be. Some of the best natural remedies for rheumatoid arthritis are probiotics, turmeric, omega-3 fatty acids, green tea, and consistent exercise. Once you start treatment, you may slow down your bone loss so much that you never develop osteoporosis. Lose Weight. Exercise will help to develop the muscles, ligaments, tendons and other soft tissues that aid in joint function and stability. Posture. Dec 22, 2022 · That’s important, because conditioning exercises help to improve the heart rate, keep muscles toned, and even counteract depression. In many cases, RA progresses to the second stage without being diagnosed. Bone erosion, or loss of bone, which occurs from extended periods of inflammation, and new bone formations (enthesophytes), which occur where tendons attach to bones, are both signs of psoriatic arthritis progression. Exercising regularly can help ease your pain, swelling, and stiffness and may also help slow down the disease's progression. Discover your strength. This can set your puppy up for developing arthritis later in life. Prevent joint injury: Joint injuries increase the risk for degenerative arthritis. Feb 23, 2022 · Shoulder rolls are a basic, easy exercise to keep your shoulder and neck joints fluid: Sit in a chair or stand with your feet shoulder-width apart. Vitamin E regulates mast cell stability which may reduce inflammation associated with osteoarthritis. At the early stages, pain may be present only at the initiation of movement and then increases as the joint “warms” up. Mar 2, 2023 · Research shows that fish oil (omega-3 fatty acids) taken in capsule or liquid form can be beneficial for reducing inflammation. If you begin riding a stationary bike, give yourself permission to stop after 1 minute. 14, 2021. Arthritis in cats can affect one, or multiple, joints. People with arthritis often worry about the possibility of growing dependent on others. Do some moderate activity at least 5 times a week. It keeps muscles strong. According to the Arthritis Foundation, a therapeutic dosage of a fish oil supplement containing at least 30% EPA/DHA (the active ingredients in fish oil) is up to 2. Moderate body weight. Oct 8, 2013 · ROCHESTER, Minn. There are many simple exercises you can do to enhance and build your levels of strength. Body Mechanics. mobility and muscle Dec 15, 2017 · Low-impact exercise can improve joint health. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red, sometimes with pain at the base of the thumb. One explanation for this may be that soft drinks are taking the place of healthier food and drink choices such as milk and dairy products, fruit juice, fruit, and a variety of vitamins and nutrients. Osteoarthritis. Vertebral body tethering. Hips. Maintaining a moderate weight can help ease the pain from arthritis. Sep 23, 2022 · Arthritis is a degenerative disease of the joints. Eventually, the cartilage may wear away completely, permitting bone to rub painfully against bone. It occurs when the protective cartilage that cushions the ends of the bones wears down over time. Try to get at least 30 minutes of exercise on most days. Maintaining and building muscular strength can be a simple way to help lower the risk of worsening arthritis symptoms. Nearly 23% of people with overweight and 31% of Dec 27, 2021 · 10 min read. If your dog begins to develop signs and symptoms of arthritis, massage, acupuncture, physical therapy, natural joint remedies, and traditional arthritis medications such as anti-inflammatories may help slow down the progression of arthritis. “In the second stage the body makes the antibodies [shown in blood work] and the joints start swelling up,” Dr. Learn how to manage your arthritis pain with tips on exercise, medication, lifestyle and therapy. Knowing the signs that RA be progressing is important for managing your health and working with your doctor to make sure your RA stays well-controlled. It causes the protective cartilage on the ends of your bones to break down and wear away. The two most common types are osteoarthritis and rheumatoid arthritis. Jun 16, 2021 · Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. Your knee arthritis symptoms might not start until years after the trauma. Simply put, instead of walking 7-10 miles per day, aim Apr 16, 2024 · Bunions are also associated with arthritis, which damages the cartilage within the joint. Medical Encyclopedia suggests both physical and massage therapy to help stop arthritis. The condition Oct 2, 2023 · Fatty fish: Salmon, mackerel, and sardines are rich in omega-3 fatty acids. Examples include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Nov 8, 2021 · As a common root of systemic inflammation in the body, focusing on improving gut health will also likely improve RA symptoms. Whole grains: Oats, brown rice, and whole-grain bread can reduce inflammation. Less than 5 percent of people with PsA have arthritis mutilans. Aug 12, 2022 · Big toe arthritis is characterized initially by pain with the bending motion of the great toe joint. This can be repeated multiple times per day for relief. Nuts and seeds: Walnuts, almonds, and flaxseeds can combat inflammation. A person can try to follow a low fat, anti-inflammatory diet that is rich in omega-3 fatty acids. Moderate and consistent sessions of aerobic exercise, 3 or 4 times a week for 30 to 45 minutes, will help increase your energy level. Some tips for preventing joint damage include: using an ergonomic May 1, 2013 · Steps to prevent knee osteoarthritis include reducing the weight load on your knee by maintaining an ideal weight; avoiding activities that will overstress your knees, such as running; and beefing up the muscles that support your knee. For people with inflammatory arthritis, staying active during a flare can help minimize symptoms, explains Dr. The next step in managing the progression of RA is reducing stress on the joints. Vitamin E protects the subchondral vascular system which may reduce the necrosis and remodeling of osteoarthritis. Hand/finger tendon glide: Start this exercise with your fingers extended straight out. Jan 12, 2023 · Daily habit adjustments. Physical and occupational therapy will likely be part of your RA treatment plan Dec 6, 2023 · Thumb flexion/extension: Start with your thumb in an outward position. taking prednisone or phenytoin. Aim to participate in some moderate, low-impact activity at least 20 minutes a day. It helps improve muscle tone, reduces joint stiffness, and provides physical and mental stimulation. 5 million people in the United States. PUBLISHED 09/22/21 BY Susan Jara Rheumatoid arthritis (RA) is a chronic disease that can be progressive. Working on the quadriceps in the front of the thigh and the hamstrings in the back of the thigh can help Dec 16, 2019 · Reducing joint stress. You may be able to prevent degenerative disc disease from getting worse by implementing a few lifestyle adjustments. In some cases, surgery may help relieve symptoms or slow down the degeneration of joints. Oct 14, 2017 · Updated Oct. The sooner you know you have osteopenia, the better. Join a self-management education workshop, which can help you learn the skills to manage your arthritis and make good decisions about your health. With progression, pain is present throughout the activity. FAQ. Heat can relax joints and muscles and lessen pain before exercise. Aug 29, 2023 · Causes. Wu. They can typically be observed on an X-ray. Exercise is a good way to prevent joint problems. Regular exercise can help slow down, or even May 10, 2016 · Go to: 4. John. Mayo Clinic offers expert diagnosis and treatment options for osteoarthritis, including medications, physical therapy, injections and surgery. The bones in a healthy joint glide smoothly past each other. Summary. Follow an anti-inflammatory diet plan. Once RA has progressed to the severe stage, damage has started to extend to the joints. Apr 11, 2021 · Provide Cozy and Joint-Friendly Cat Beds. Green tea – packed with antioxidants to reduce inflammation. . Feet. By this point, the cartilage between the bones has worn away, causing the bones to rub together. Arthritis Treatment: Occupational Therapy. Mar 21, 2024 · Generally, the early stages of psoriatic arthritis may cause nail changes (such as pitting or shallow ridges) and pain and swelling in one or more of the smaller joints (such as fingers, toes, or Mar 19, 2024 · Osteopenia is a natural progression of bone loss. They also help slow joint and organ damage Jul 20, 2023 · Nearly 58. The simplest thing you can do to prevent or slow the progression of spinal arthritis is keep moving. “The goal is to Hip arthritis is deterioration of the cartilage of the hip joint. RA fatigue, an often discounted yet common symptom, can be addressed through May 13, 2023 · If the scoliosis is progressing rapidly at a young age, surgeons can attach one or two expandable rods along the spine that can adjust in length as the child grows. Soaking a bath towel in hot apple cider vinegar and wrapping it around painful joints. Get Regular Exercise. Vitamin E maintains sex organ functions which may delay the progression of osteoarthritis. S. Diet. Nov 18, 2021 · Get moving. Occupational Hazards. Others may benefit from applying cold packs or ice to the joint. Heat pads, washing dishes in hot water and letting your hands soak in the hot water, hot bath with Epsom salts, keeping hands warm when it’s cold out. This procedure can be performed through small May 27, 2020 · In severe, or advanced, osteoarthritis: Your cartilage has worn away. “This stage is where a person can have some joint pain from gout just about all the time,” Dr. Certain other May 16, 2023 · Exercise. Patients may initially notice a dull pain with walking or running. Then move the thumb across your palm and back to the start position. When working at a desk, for example, get up and stretch every 15 minutes. making bread. But you can slow it down to prevent osteoporosis. Warm up before exercising to prevent strains and injuries. But it can also worsen rapidly over several weeks or months at a stage when the X-rays are almost normal. Heat. Lean back in a half-reclining position with your arms crossed and your hands on your shoulders. Talk with your healthcare provider about safe exercise for you. This is facilitated by a thin layer of smooth cartilage covering the bones, acting to cushion the joint Aug 3, 2020 · Broccoli – rich in vitamin K and C and sulforaphane, found to prevent and slow the progression of osteoarthritis. Then, move your thumb to the base of the pinky finger, or as far as you can reach. ‍. The cartilage acts as a slippery coating between the ball and the socket that allows the ball to glide and rotate Mar 31, 2017 · Treatment involves the use of drugs designed to modify the body's autoimmune response in order to diminish symptoms and slow the progression of the disease. May 1, 2012 · Osteoarthritis results from the breakdown of joint cartilage, the tough, slippery tissue that protects the ends of bones (see "Anatomy of knee osteoarthritis"). May 7, 2024 · Applying heat or cold to the joint. Use ramps, or pick up your pup until they are about 3 months old. Research suggests that regular exercise could even slow the progression of osteoarthritis if you start exercising early in the course of the disease—before the joints have sustained more damage and cartilage loss. Use for about 20 minutes. Nov 1, 2019 · Osteoarthritis, the most common joint disorder, is known as "wear and tear" arthritis. a diet lacking calcium and vitamin D. Nov 14, 2018 · Stage 2: Antibodies Develop and Swelling Worsens. Find out what activities to avoid and what to do to prevent joint damage and disability. Jan 23, 2018 · Here are the signs to keep an eye on: stages of RA are becoming more frequent and are lasting longer. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine. A. It helps to keep joints from getting stiff. 6 grams twice a day. Your doctor may be able to suggest lifestyle changes that can help reduce your risk or slow the progress of arthritis. Ask for help. Roll your shoulders up, back, and down in one Therapeutic Care. Dietary changes. Exercise keeps spine-supporting muscle groups strong while also easing the burden on the spine’s joints, discs, and vertebrae. Morning pain and stiffness in your hand (s). You'll have more pain and swelling and may experience muscle weakness and mobility problems. Osteoarthritis: Unlike other forms of arthritis, osteoarthritis is not a systemic disease. During a flare-up, when joints are at their most painful, rest is important. Talk to your healthcare provider about safe exercises you can do. Jan 17, 2020 · It really does help keep joints flexible. Build a strong body. smoking or using other forms of tobacco. 3. Keep it at a moderate level. av vd ie lj cy hk ne wc zz fg