Ask Your Pharmacist
Regel Pharmalab Blog

I needed a lifestyle change. Are you “Man” enough?

In my quest to help patients (and myself) find ways to prevent chronic disease, I have had plenty of crazy ideas.  As we all should know chronic disease is usually a product of poor choices related to diet and exercise.  Yes, I can help you improve your nutrient and hormone balance, but there is nothing more powerful in preventing chronic diseases than diet and exercise.  This is often referred to as a lifestyle change.

About a year ago I visited my brother-in-law in Knoxville, TN.  He asked me to get up on game day (Saturday) at 6:00am to go to a workout with him.  I thought to myself, 6:00am is 5:00am central time.  That is a bit early to be working out, and also I haven’t really been working out much lately.  I wasn’t about to let my brother-in-law in on this bit of information because that is what guys do, right?  “I thought I can hang with this guy”.  The next morning I roll out of bed and hop in his jeep and off we go.  We pull up to a dimly lit parking lot in a park.  I thought, “this is odd, where’s the gym?” A bunch of guys in black t-shirts are stretching out and hanging out chatting.  When we walk up to the group they start saying hello to someone named “Proton”.  I soon realize they are talking to my brother-in-law.  As I was being introduced to several of them they all had odd names.

One was “Crawdad”, another “P-nut” on and on it went.  I also noticed that there was not much common about each of them, some were in school, some had blue collar jobs and some white collar.  Their group didn’t seem to care what race, religion, or nationality you were.  There were only a couple things that were common among this group.  They were all men, they all had a weird name, most had a black t-shirt, and they were all crazy enough to wake up on Saturday morning at 6am to go to a workout.

About that time a 30ish year old guy named “Woodshack” starts gathering the group into a big circle around an american flag sticking out of the handle of a shovel.  He quickly gets everything started with some exercises.  I have watched a military movie or two to know we were doing each exercise in cadence.  He then instructs us to “Mosey” over to the baseball field now that the warm-up is over.  At this point we are in lines like I remember in football practice and starting to do shuttle runs, lunges, squats and an assortment of exercises.  At this point I am trying to remember if I had ever heard of a 40 year old acquiring asthma?

I am not giving up yet but through the sweat I realize that I am at the back of the pack with a guy that is 60ish.  I am not sure but I think they assigned him to make sure no man was left behind.  We are jumping on stuff, pulling up on stuff and running all over the place.  Meanwhile these jokers are chatting the whole time, making jokes and just having a grand old time.  Me, I am wheezing so loud the neighborhood dogs are barking back.  I realize that we have been going for 45 minutes straight without much of a break.  Woodshack leads the group on what seems to be the last exercise.  Run up the hill and touch a building called the Asylum.  When he said hill I thought that is not a hill, in Memphis we call that a mountain.  So, me and my new 60ish year old buddy work our way up the hill and we finally make it.  We “mosey” back to the parking lot and the rest of the group is already doing some kind of not stop abdominal torture.  This lasts for several minutes and I am now to the point of not caring anymore and giving up.  Crawdad then says recover and everyone is on their feet.

Next is the part that I thought was unique and different about these guys.  Crawdad then asked all the new guys to come to the center and they named each one of us.  I was assigned the name “Escobar”.  I believe that this is because I am a pharmacist (drug lord) from Memphis.  Crawdad then gives a little talk on something that had challenged him spiritually that week then we huddled up and prayed.

A few things were revealed to me during this hour of torture.

First, these men came together regularly and bonded while pushing each other to their limits.  They were friends and accepted any and all men.  The friendships that they formed were not the kind that changed as soon as their job changed.  They were not the friends of their wives husbands.  They joked with teach other but they pulled for each other and helped each other.  These men were learning how to lead each other which translated over to leading their families, leading their churches and leading at work.

If you know someone that needs accountability, discipline and better health send him to www.f3memphis.com.  We recently started this in Memphis and any man can get up to 6 workouts a week.  We have 4 locations throughout Memphis.  All workouts are free and are always outdoors.  All workouts are peer lead and are difficult.  All workouts will change you as a man.

Join us for a workout, if you are man enough.  

F3nation.com

Regel Rectal Rocket

Have you ever wondered what we are doing in the lab?  Here is a little sample of us preparing one of our favorite options for hemorrhoids.

If you need some relief from your hemorrhoids give me a call.

 

 

A Satisfied patient makes my job exciting!

My hope every day is to leave work with satisfied patients.  Patients that are seeing results and not just getting by.  I love to hear how our team is making a difference in your life.  I work with an amazing team of problem solvers that are dedicated to help find answers to medication related problems.  What a powerful combination when your physician and our team come together to find answers.

Here are a few examples of patients that have succeeded in finding answers.

“Regal Pharmalab has been a wonderful experience for me.  I was suffering from hormone imbalance and they were pro-active about getting me back on track.  The customer service is always wonderful and the staff responds to me with wisdom and compassion.  It has been a joy to have Regal Pharmalab on my side.  My doctors all know their name and agree with my choice to use them for my pharmaceutical needs.  Thank you for taking such great care of me.  Peace be with you. Kris C”

“I have felt like a brand new person since on the bio-identical cream. A lot more energy and greater sense of well-being. Thank you!”

“I just wanted to thank you for getting my prescription ready so quickly.  Everyone there is so professional and friendly.  Regel is the pharmacy I tell everyone about if they need anything compounded.”

“I think you are the best at serving your customers according to their individual needs. And you do it with concern, humor, patience and knowledge. Very pleased with your pharmacy!”

“From the very first time I picked up the phone and called your office last week and Josh answered the phone, I have been nothing been excited to learn more about Regel and your services. It’s like I finally felt that someone knows exactly how I feel and that there is hope to making me “ME” again. There’s nothing more frustrating than not feeling good and not knowing what to do especially after you’ve tried everything you can think of. And this has been going on for almost 2 solid years. So with that said, I know I’m on the right track. I just have to give this time and with your help I know we will find the old “ME” again.”

“I went to Regel Pharmalab to begin my hormone replacement therapy in the most natural way I could find.  I immediately noticed a reduction in my menopause symptoms. I had much more control over my emotional reaction to my daily stress.  I later tried hormone pelleting, but returned to Regel for the controlled, daily dose because the pelleting caused uneven levels at the beginning and towards the end of the pellet life. This fluctuation caused facial acne for the first time since puberty, and the initial dose of testosterone caused increased aggression for me.  I believe that topical, daily doses of bio-identical hormones are the best possible delivery of replacement hormones!  Thank you Regel Pharmalab for your product, but mainly for your great customer service in presenting, explaining, and regulating the doses of your hormones!  Marty H”

Thank you again for letting our team be a part of your success.

Josh Regel, Pharm.D.

It is time to start taking a pro-biotic

75 Billion CFU

Let’s be honest, if you took everything that someone told you that you need, you would be overwhelmed.  Supplements, vitamins, minerals, herbs, pro-biotics, essential oils and the random witches brew that is the new fountain of youth.  All of this adds up and can be expensive and sometimes harmful.  So, “What should I be taking?”  I have been answering this question the same way for over 12 years now and I don’t see a reason yet to change my answer.  I personally take 5 items.  The picture below shows 6 items.  The Zinc on the end is in the Active Life Nutrient Multi-Vitamin.

My essentials

I am writing this article because I have witnessed patients and family members respond to Pro-Biotics within a couple weeks.  If you have not decided to take a pro-biotic yet, let me help you make a decision.

Why pro-biotics?

The first time I decided to take a pro-biotic was when I asked a pharmacy student to compare the flu shot with a pro-biotic on preventing the flu.  The results were the same.  Both prevented the flu equally.  I thought to myself, great! no more flu shots for me.  By the way, to this day I have not had another flu shot (more on this in a future post).  The gastrointestinal tract is one of the most important systems for our immune system.  Most infections come by way of the gastrointestinal system.  Oh, I need to be clear, the GI system starts in the mouth.  So, seeing your dentist is very important.  A healthy GI tract is key in preventing sick days.

Reason 1 – Prevention of flu and other bacterial, fungal, and viral infections

What can a weakened immune system create?  A weakened immune system prevents, not only the clearing of infections, but also the elimination of irregular growing cells.  Irregular growing cells are what can become cancer cells.

Reason 2 – Promoting healthy immune system for cancer prevention

Stomach issues are one of the most common problems that I hear complaints about.  From reflux, GERD, Gas to constipation and diarrhea we all struggle at times with a normal GI tract.  Most of these issues involve inflammation in some part of the GI tract.  Patients that have a diagnosed inflammatory bowel disease have seen remarkable results when taking a pro-biotic.  Ulcerative Colitis, Crohn’s disease, diverticulitis and Irritable Bowel are all examples of inflammatory conditions in the GI tract.

Reason 3 – Resolving symptoms of Inflammation in the GI tract

“Leaky Gut” This new condition is now being recognized by physicians.  Let me explain a bit about leaky gut.  The inflammation that I discussed above allows for larger molecules to be absorbed and enter the blood stream.  These larger molecules cause the immune system to respond and attack.  This creates more work for an already weak immune system.  The condition known as food sensitivities is caused by leaky gut.  Many of us are lactose intolerant.  Cows milk is God’s designed milk for a cow.  Some of the proteins that are in cows milk are not designed for our body to tolerate.  Therefore you might get bloated, gassy, have a loose stool and other issues.  Did you know that acne, rosacea, psoriasis and eczema have been linked to sensitivity to lactose?  If you have been to our pharmacy and have picked up a medication for an inflammatory skin issue like these our advise is always to eliminate dairy products for a month and see if your skin condition improves.  Most of the time there is a notable improvement.  This is just one example of what leaky gut is responsible for.  I could go on but I will save it for another post.

Reason 4 – Reduce “Leaky Gut”

Which one should I choose?

This question is why you come to Regel Pharmalab.  At last count we have 8 different choices for a pro-biotic.  We can help you select the one that will fit you best.  If you want the basics here is what to look for:

  1. Refrigerated – Make sure you choose a pro-biotic that is sold in the refrigerated section and keep it in the refrigerator.
  2. CFUs – These are the amount of bacteria in the capsule that have been tested to perform the task of forming colonies.   Your pro-biotic needs at least 10 Billion CFUs.
  3. The Strains of Bacteria – I recommend taking a pro-biotic with at least 5 different strains of bacteria.
  4. Bifidobacteria – This specific strain has been shown to be very effective and sometimes is left out of the capsule.

For more information on this subject I have written a couple other posts you can find them by clicking on the links:

The Core of health – Probiotics for Gut Health

5 Reasons why I take probiotics.

Let me know how I can help you resolve your health problems.  I look forward to solving your medication problems.

Comment below if Pro-biotics are working for you.

Are you “Rocking it”? 5 tips for preventing kidney stones.

Have you had the pleasure of having a kidney stone?  If you have I would recommend you take a look at your nutrients.

Kidney stones can be extremely painful, and in some cases, patients may require medical treatments or even surgery to remove them.  Most people that I have talked with about kidney stones would do anything to avoid the pain of passing a kidney stone.  Chances are if you have had a kidney stone your are likely to have another one.  My hope in writing this is to help you avoid having to suffer through this again.

The Basics

The most common type of kidney stone is calcium oxalate. Patients with these stones exhibit hypercalciuria (elevated urine calcium) and hyperoxaluria (elevated urine oxalate).  Simply put, we want to reduce the calcium and oxalate from our urine.  To reduce the chances of a recurrence of these stones, patients should follow dietary adjustments to calcium, protein, sodium and oxalate. Calcium from food sources should be encouraged over calcium from supplements. Calcium from food sources will bind with oxalate in the intestine and prevent it from moving to the kidneys and urine. High protein and high sodium diets can increase calcium in the urine, so moderate protein and sodium consumption should also be recommended. Water intake should be high enough (minimum six liters per day) to increase urine output so that the patient needs to urinate every two to three hours through the day. Because vitamin C degrades into oxalate in the body, vitamin C intake should stay at or under the recommended daily allowance (RDA), which is 90 mg for men and 75 mg for women. Due to its low bioavailability, there is no current consensus on the effects of dietary oxalate in stone formation. However, most physicians will recommend lower intakes. One surprising nutritional fact is that cranberries are high in oxalates. Spinach is also high in oxalates, but kale is low. As a guideline, you can find a list of foods that are highest or lowest in oxalates online here.

5 Steps to prevent Kidney Stones

  1.  Get calcium from food sources.  Do not take as much calcium from supplements.
  2.  Limit your sodium intake and monitor your protein intake.  50 to 100 grams of protein is safe to consume.
  3.  Increase water intake to 6 liters per day.
  4. Limit Vitamin C intake
  5. Limit foods with high oxalates (Cranberries, Spinach, etc) See link for list.

If you have struggled with kidney stones what advice would you share?  Please comment below.

Your thyroid may not be working

“I have always thought that my thyroid was not working right, but my doctor says my thyroid is fine”.  This is something that I keep hearing.  I also hear “my doctor says my thyroid is fine but I feel terrible.”  If you are interested in having our staff review your thyroid give me a call.  Every week we are helping patients find balance with thyroid.

Did you know that thyroid medication is one of the most commonly prescribed medications in the US?  Our staff nurse Anita Hester, RN has written about thyroid imbalance.  You can review it here and here.

It is time to get answers to the reason you feel:

  • Fatigue
  • Increased sensitivity to cold
  • Constipation
  • Dry skin
  • Weight gain
  • Puffy face
  • Hoarseness
  • Muscle weakness
  • Elevated blood cholesterol level
  • Muscle aches, tenderness and stiffness
  • Pain, stiffness or swelling in your joints
  • Heavier than normal or irregular menstrual periods
  • Thinning hair
  • Slowed heart rate
  • Depression
  • Impaired memory

We have a nurse, two pharmacists and a physician trained in functional medicine to help you finally get it right.

Here is something you can do for ADD and ADHD

What are you doing this year to help your child with ADD/ADHD?

It is that time of year again.  Kids are starting back to school and the questions come about ADD and ADHD.  Most parents I talk with do not want their child to have to take ADD or ADHD medications.  A few years back I provided a guide to help your child with ADD and ADHD.  You can see it here.

I have a bit more information on this subject, but for the most part, this regimen works if you can stick to it.

Exercise – Let them play outside
Eat right – See below for more on this
Sleep – Get to bed on time and wake up on time.  If you exercise enough you should sleep great.
Limit screen time

Here is some additional information:

Children on long term ADD and ADHD medications are altering their neurotransmitters.  This often times requires the child/teenager to have to take an antidepressant.  The reason is because the overstimulation of the serotonin receptor.  These receptors experience “burn out” due to continual sympathetic receptor stimuli from the stimulant add/ADHD medications.

There separate studies dating all the way back to 1985 showed negative effects on ADD/ADHD from items in the diet.  Those items include:

Artificial Colorings
Artificial Flavorings
Sugar
Dairy
Wheat (gluten)
Chocolate
Soy
Citrus Fruits
Yeast
Eggs
Peanuts

How about a short 2 week elimination of these foods from your or your child’s diet and see the response?  What are you doing for your child with ADD/ADHD?  Is it working?

My perspective on the opioid epidemic

Is there a problem?

I am sure you are aware that there is an opioid epidemic out there and many are overdosing and some are dying.  Overdosing is not a new problem.  So why is this topic being talked about so much?  Is there something new going on or is this one of those things the media has overblown?

In my opinion, this problem is getting worse and this subject is not getting reported enough.  I am sure many of you have heard reports or you may know of a family that has been affected by a drug overdose.  My intention in writing this is to help make you aware of the problem and understand what you can do to help prevent this problem from directly affecting your family.

The reports that I have read are putting the blame on the easily accessible medications that are sitting in your medicine cabinet right now.  Many of us have had dental work or minor surgery and an opioid was prescribed for pain.  Even a medication that is years beyond it’s expiration date can still be effective.  Your teenager or young adult may not be the one to take the medications out of your medicine cabinet but did you think about friends and relatives that come to visit?  You probably would not even know the medication was gone.

A few years back the Drug Enforcement Agency (DEA) made one of the most common pain medications (Lortab, Vicodin, Hydrocodone) a schedule 2 medication.  This change made these medications a lot more difficult to get on the street.  So the supply of medication was not meeting the demand.  This forced the price “on the street” to go up for these illegal medications.  What the drug dealers saw was an opportunity.  This opportunity was by lowering the price of another opioid that was plentiful and easily smuggled in they could profit more.  That opioid is heroin.  When I first thought about it I asked myself “who would decide to take heroin?”  Many make this decision for several reasons, the price of the prescription opioids, the availability and the higher high from a stronger opioid.  Also, there are many names that heroin goes by and often times individuals don’t know that they are taking heroin.

For $5 to $10 you can get a dose of heroin.  Heroin is 3 times more powerful than morphine and will cause a pronounced high (euphoria).  So, for many, this is a perfect solution to their addiction.  Cheaper and more powerful.

The latest reports indicate that some of the heroin on the street is being mixed with another opioid that is 50 to 100 times more potent than morphine.  This opioid is called fentanyl.  Fentanyl is a synthetic opioid that is used in cancer pain and other chronic pain situations.  It is usually dosed in a slow release patch.  When snorted along with heroin the effect is immediate and can be deadly.  There is no way for someone to tell if their heroin has fentanyl in it.

So the reason I think that we are seeing more overdoses is the individual is addicted to prescription pain medications first.  Then there is a need for a cheaper version that gives a higher high.  Then the addicted person unknowingly takes a heroin/fentanyl combination and overdoses.

What can you do to avoid being apart of this epidemic?

Get rid of your old pain medications.  You can drop off medications at area locations for disposal.  Click here to find out were you these facilities are located.

Do your part and dispose of these medications.  These medications in the wrong hands can affect you or your loved one for a lifetime.

Did you know that the compounding pharmacists at Regel Pharmalab can help you control your chronic pain?  If you have uncontrolled chronic pain and would like me to review your story, give me a call or send me a message.  You can reach me (901) 757-9434 or jregel@regelpharmalab.com.  I look forward to helping you with your pain and possibly reduce the amount of pain medications that is required for your pain.

Comment below on other ways to help prevent opioid addiction.

A compounding pharmacist’s guide to Migraines

Have you tried everything for migraines?

Many of our patients that suffer from migraines tell me that they are glad that they asked “What can you formulate for my migraines?”  Many of these patients are desperate for something that really works.  If you or someone you know struggle with migraines I may have a couple new ideas to consider.

It has been estimated that migraines cost ~ $20 Billion a year in medical expenses and loss of productivity.  Affecting 36 million Americans.  Migraines can last from hours to days.  With several reasons that can cause a migraine, it is a difficult problem for patients as well as for physicians to deal with.

What are the current treatment options?

When you are diagnosed with migraines most likely your physician will prescribe a medication that is in the family we call triptans.  Examples of this family are:

  • Imitrex (Sumatriptan)
  • Zomig (Zolmitriptan)
  • Maxalt (Rizatriptan)
  • Relpax (Eletriptan)
  • Treximet (Sumatriptan and Naproxen Sodium Tablets)
  • Amerge (Naratriptan)
  • Frova (Frovatriptan)
  • Axert (Almotriptan)
  • Sumavel DosePro (sumatriptan)
  • Zecuity (sumatriptan iontophoretic transdermal system)

These medications do have side-effects and many cannot take them.  They are also very expensive and can be out of the price range for many patients.  These medications are not recommended for patients that have cardiovascular disease, history of a stroke, and uncontrolled blood pressure.

Another option for patients that have 15 migraines or more a month is Botox.  These injections can cost $6000.00 up to $10,000.00 a year.  And this option requires a monthly office visit for each shot.

Migranal is a nasal spray that can cost $1500.00 up to $2500.00.

With these options many report poor success relieving migraines.  A study has shown that 56% of patients report inadequate relief 2 hours after their treatment.  Since there is not a current cure for migraines and there are many causes, a product that has multiple benefits may be more effective than using just one medication.

What can a compounding pharmacist do for migraines?

  • A compounding pharmacist can provide medications in different dosage forms
    • Combining several medications into:
      • capsules
      • sublingual tabs
      • transdermal gels.
      • Nasal Sprays
  • Using TRNA therapy
  • Taking a medication like sumatriptan in a transdermal gel and administering it at the base of the head/neck area.
  • Ketamine can help with the prolonged aura that meany patients suffer with as well as increasing blood flow.
  • Gabapentin reduces the release of inflammatory neuropeptides that are consistent with headache pains, such as calcitonin gene-related peptide and substance-p.
  • Tizanidine inhibits the release of norepinephrine and acts as a muscle relaxant.
  • Magnesium reduces inflammation, relaxes muscles and blood vessels, and modulates calcium ion channels within our cells.  This can trigger the release of neurotransmitters.  Magnesium also decreases the release of substance P and may be more effective in migraines with auras.  For more information on Magnesium click here.
  • Lavender oil is known for its soothing and calming effect.  71% of patients inhaling the fragrance of lavender oil for 15 minutes fully or partially improved their headache.
  • Lidocaine is a local anesthetic that can help by its membrane-stabilizing effect, which inhibits the release of vasoactive substances from platelets.  This inhibits the inflammatory response.
  • Caffeine can inhibit neuronal activity.  Activating adenosine receptors leads to antinociception in neuropathic pain and inflammatory models.
  • Hormones can effect migraines when there is a sudden drastic drop in estrogen usually at the start of a menstrual cycle.  Progesterone can play a huge part at balancing the effects from the estrogen dropping.  Progesterone also calms the stimulatory effect of estrogen.  Read more about Hormones and Migraines click here.

As you can see, a compounding pharmacist can provide quite a few more options than the standard of care.  If you would like me to help you talk with your physician about your migraines give me a call.  What we will do is set up an appointment for you to meet with myself or Anita Hester, RN.  We will work out a plan and send a recommendation for your physician to consider.  Our best results for patients usually happen when we team up with you and your physician.

What is your trick to prevent migraines?  Post in comments below.

Know your medications – High blood pressure

Beta-Blockers

There are so many medications that are being used for blood pressure and many patients suffer the side effects from these medications.  Today I would like to talk to you about a class of medications called Beta-blockers.  Here is a quick list of the medications that are in this group or drug class.

Propranolol (Inderal)
Sotolol (Betapase)
Nadolol (Corgard)
Atenolol (Tenormin)
Acebutolol (Sectral)
Metoprolol (Lopressor and Toprol)
Timolol (Blocadren)
Pindolol (Visken)
Betaxolol (Kerlone)
Bisprolol (Zebeta, Ziac)
Cartelol (Cartrol)
Carvedilol (Coreg)
Labetolol (Normodyne)
Nebivolol (Bystolic)
Penbutolol (Levatol)

This list is not a complete list and many blood pressure medications are a combination of a beta-blocker and other blood pressure medications.  To determine if you currently take a Beta-Blocker give me a call (901) 757-9434 or send me a message jregel@regelpharmalab.com so you can know for sure.

These medications have been around for years and are very helpful in lowering blood pressure as well as controlling heart rate, migraines, chest pain, glaucoma, and anxiety.  Here are some quick facts/helpful tips about these medications:

  1. Be sure to check your pulse (heart rate) regularly.  There are many devices like digital blood pressure cuffs and smart watches that have this capability now.  A normal resting heart rate is between 60 and 100.  A highly trained athlete may have a lower resting heart rate.  For us normal people the closer you get to 60 the more efficient your heart is working.
  2. For most of the medications on this list I would recommend that you take the medication with a meal.  This enhances the absorption of the medication.
  3. Avoid foods and beverages that can alter your heart rate like caffeine and alcohol.
  4. Do not take medications for cold and allergies that contain pseudoephedrine (Sudafed).  This can increase your blood pressure and heart rate.

Nutrient Depletions with Beta-blockers

Did you know that these medications can cause a depletion of the key nutrients Coenzyme Q-10 and melatonin?

A depletion of Coenzyme Q-10 can lead to the following symptoms:

  1.  High Blood Pressure
  2. Chest Pain
  3. Stroke
  4. Irregular heart beat
  5. Congestive heart failure
  6. Poor insulin production
  7. Lack of energy
  8. Gingivitis
  9. Weak immune system
    With a list like this it makes me wonder if the Beta-Blocker is helping or hurting.

A depletion of Melatonin can lead to the following symptoms:

  1.  Insomnia and other sleep disturbances
  2. Some reports are showing a link between low levels of melatonin and increase in cancer risk

If you take a Beta-Blocker I would recommend a quality Co-enzyme Q-10 product as well as a small dose of Melatonin.  If you would like me to suggest a strength for these nutrients contact me so I can determine your specific needs.  jregel@regelpharmalab.com or (901) 757-9434.

 

Order Refills Online

Order Refills Online

Refill your prescriptions so they are ready when you are! Schedule a time when you’ll be ready to pickup your medication and we’ll have it ready and waiting!

Sign up to receive the blog post by e-mail and receive 10% off your order of nutrients, vitamins or minerals. Details to follow in your inbox.

Join our mailing list to receive the latest news and updates from our team.

You have Successfully Subscribed!