One case occurred in a female bodybuilder who was using anabolic steroids, whereas the other was in a recreational weight lifter not taking steroids. Return-to-Play and Competitive Outcomes After Ulnar Collateral Ligament Reconstruction Among Baseball Players: A Systematic Review. As a specialist in peripheral nerve surgery, Dr. Seruya wants his patients to know that after a period of 12-18 months nerve damage can become permanent. The pathophysiology was proposed to be increased soft tissue swelling caused by the growth hormone combined with the repetitive activities while lifting weights. The dressing is removed on the third day after surgery and the steristrips are left on until the first post-operative office visit. As the damage worsens, symptoms begin to occur intermittently during the day. The ulnar nerve is most commonly injured at the cubital tunnel or ulnar groove at the elbow and within Guyon's canal at the wrist. Anterior intramuscular transposition of the ulnar nerve as a surgical treatment of cubital tunnel syndrome is the least frequently reported technique. Do not lift more than 5-10 lbs for the first 3 weeks after surgery. Rehabilitation of an Ulnar Nerve Contusion, Physical Therapy Exercises for Brachial Plexus Injuries, 6 Exercises for Numb Fingers and Tingling Hands, Exercises to Treat Numbness From Poor Posture, Complications of Ulnar Nerve Transposition Surgery, Brigham and Women's Hospital: Ulnar Nerve Entrapment, Current Reviews in Musculoskeletal Medicine: Ulnar Neuropathy: Evaluation and Management, Oxford University Hospitals: Cubital Tunnel Syndrome, StatPearls: Anatomy, Shoulder and Upper Limb, Ulnar Nerve. Similar ulnar nerve entrapment has also been described in a patient undertaking a regimen of push-ups on a hard surface; EMG demonstrated isolated injury to the first dorsal interosseous muscle of the affected hand. Stand straight with your arms at your side. Although other cases of triceps tendon rupture have been published, no other reports describe such secondary ulnar nerve injury. eCollection 2021 Mar. Of these, 24 were cases of CTS, 6 symptomatic and 18 asymptomatic. You will receive a prescription for narcotic pain medication. (left his office a voice mail yestrday).yest,my pain mgmt dr. did an emg and was shocked at the result..he asked,"what the hell did u do 2 your arm?! Motor nerve conduction in the wrist segment is just about normal by that lab's quoted normal value. . Should I stop working out if I have a pinched nerve? Oral antibiotics should be taken 4 times a day until the drain is removed. The .gov means its official. when did u start to bend and extend ur elbow?? Am J Sports Med. If the test are positive, in order to prevent worsening nerve damage, the recommendation is for ulnar nerve release surgically. 2021 Feb 9;5(2):296-301. doi: 10.1016/j.jseint.2020.10.026. I was in a plaster cast for about 1-2 weeks and then a fibreglass one for a few more to allow the muscles to reattach. and transmitted securely. Am J Sports Med. Some of us are also genetically more nerve sensitive. Then I . We can schedule removal of the drain for you at our office in 2 days, or the nurse can instruct you on how to remove this at home. Putty is available in a variety of resistance levels to allow easy progression as your strength improves. Front and back squatting three times a week was probably helping to keep my spine straight without me even intending that. However, you may visit "Cookie Settings" to provide a controlled consent. HE PUT ON A SMALL ACE BANDAGE AND SAID WEAR THIS ONLY FOR COSMETIC REASONS SO OTHER DONT HAVE TO SEE IT, AND GAVE ME 2 EXTRAS, BUT I HAVE NOT WORN IT. Shooting electrical pains may occur, but should decrease in frequency and intensity over time. Hadley CJ, Dixit A, Kunkel J, White AE, Ciccotti MG, Cohen SB, Dodson CC. Carpenters and plumbers may develop ulnar wrist pain because they often must use tools in small spaces that . Elbow Flexion and Wrist Extension Equipment needed: none Nerve targeted: ulnar nerve Sit. Go to the emergency room if this occurs at night or on a weekend. Find out how beta-blocker eye drops show promising results for acute migraine relief. Please make sure to take this as directed, typically placed under the tongue (sublingual) to be absorbed in the mouth. Your prescription will be for 3 times a week for 4 weeks unless the therapist feels you do not need that may visits. Conclusion: A friend of mine suggested that I try acupuncture. 1999; 4(2):193-196. Hi, I had that surgery 5 weeks ago today. Before having surgery, you may want to check into some of these more conservative treatments. Epub 2016 Dec 9. Epub 2010 Oct 12. Surgical treatment includes (1) arthroscopic elbow debridement w/ nerve decompression. Recovery from Surgery After surgery, people who work at a job requiring physical activity should use the affected arm or elbow only for occasional work during the first few weeks after the procedure. You may have a drip in the back of your hand and an oxygen mask over your mouth and nose. If the skin around the incision is red or if there is drainage coming out of it please call us right away. The average postoperative patient-reported outcome scores were as follows: Kerlan-Jobe Orthopaedic Clinic score, 80 (95% confidence interval [CI], 72.7-87.0); Single Assessment Numeric Evaluation score, 85 (95% CI, 75.4-94.7); Quick Disabilities of the Arm, Shoulder and Hand score, 5 (95% CI, 2.1-7.7); and Mayo Elbow Performance Score, 91 (95% CI, 86.8-96.0). Necessary cookies are absolutely essential for the website to function properly. Can you lift weights after ulnar nerve surgery? Training completed by overcoming resistance is called resistance training. Weight training is a method of resistance training in which a load (in the form of free weights or a weight stack on a machine) is pushed or pulled as a form of resistance. Inflammation causes the nerve to become pinched, leading to nerve pain. The site is secure. I was very optimistic about my recovery. Background: In a series of 28 patients who had EMG-documented SSN injury, 16 had symptoms related to athletic activities. I went to an orthopedic surgeon who had to detach the forearm muscles, loosen up the ulnar nerve so that it could be moved to a safer place and then the muscles were reattached over the nerve to lock it in place. PMC Address: 1200 112th Ave NE, Suite C-210 Bellevue WA 98004, 2023 Dr. Thomas Trumble, M.D.. | Made by Digital Laboratory, 1200 112th Ave NE, STE C-210 Bellevue WA 98004, 1200 112th Ave NE, Suite C-210 Bellevue WA 98004, 2017 Overlake Symposium: 6th Annual Hand and Upper Extremity Orthopedic Surgery and Therapy Symposium, 2016 Overlake Symposium: 5th Annual Hand and Upper Extremity Orthopedic Surgery and Therapy Symposium. Isolated ulnar nerve decompression/transposition is an uncommon surgical procedure among professional baseball players. Thats the only difference I have noticed. Ulnar nerve release surgery is a procedure for cubital tunnel syndrome - also known as ulnar nerve entrapment. I actually had to wait for 6 months because I needed to use both hands due to the fact that I was in the middle of a really busy time at uni and needed to wait until the year finished. The ulnar nerve is typically managed intraoperatively with in situ neurolysis or transposition during fracture fixation. I had bilateral ulnar surgery, first on my right arm in 2011 and then on my left arm in 2012. Results With elbow extension at 180 , both circumferential decompression and anterior 38 Motor dysfunction is less common because of the deep nature of the motor branch, but . Raise the affected arm and rest your palm on your forehead.Inflammation or adhesions anywhere along the ulnar nerve path can cause the nerve to have limited mobility and essentially get stuck in one place. Is that what you got? Anterior Transposition of the Ulnar Nerve Surgery. BTW, I AM TYPING THIS WITH 2 HANDS ONE WEEK AFTER SURGERY. Players have a 62% rate of RTS, which is lower than expected for this nonreconstruction or repair procedure. Repeat, placing the putty between the rest of your fingers, three times each. Cohort study; Level of evidence, 3. An excellent, recent review of peripheral nerve injury in weight lifters and bodybuilders incorporating all aspects of diagnosis, pathophysiology and treatment has recently been published. What grade do you start looking at colleges? This cookie is set by GDPR Cookie Consent plugin. Although ulnar neuritis can occur secondary to ulnar collateral ligament pathology, stress fractures, and traction apophysitis, isolated ulnar nerve dysfunction can lead to medial elbow pain. Cubital tunnel syndrome happens when the ulnar nerve, which passes through the cubital tunnel (a tunnel of muscle, ligament, and bone) on the inside of the elbow, is injured and becomes inflamed, swollen, and irritated. 2018 Mar;27(3):561-571. doi: 10.1016/j.jse.2017.12.003. I dont do a lot of isolation arm work in the gym, but at present I am actually doing a 12 week arms program with lots of tricep extensions. Conditions that may require ulnar nerve transposition include: Compression of the ulnar nerve caused due to injury or excessive pressure placed on the elbow There is a slight indentation where the nerve used to be, nothing really to worry about. When bathing, put a plastic bag around your arm to keep the splint clean and dry. Am J Sports Med. Nervous system injury can occur in relation to the process of weight lifting or through drugs such as anabolic steroids or growth hormone used to enhance the effectiveness of training. Only move as far as you can without exacerbating your symptoms. Should I stop working out if I have a pinched nerve? Overall, 62% of players were able to successfully RTS, and 56% returned to the same or higher level. Both sites of injury are seen in weight lifters and bodybuilders. It is normal to have some pain off and on for approximately one year after surgery particularly in cold weather. The suprascapular nerve (SSN) is typically injured in volleyball players and baseball pitchers, in whom repetitive overhead motions occur, but SSN injury is also reported as a consequence of weight training. This may occur when the ulnar nerve becomes entrapped by scar tissue. Returned to competitive track in 2015 as a masters' sprinter after a 10-year layoff from competition. Unable to load your collection due to an error, Unable to load your delegates due to an error. The ulnar grove was closed with non-absorbable #3-0 silk suture. He has mild discomfort only on heavy weight lifting but is otherwise free of pain . Ulnar neuropathy at the wrist can be provoked by strength training exercises that involve lifting weights with the hands, because direct compression on Guyons canal can result. After that I could literally feel my traps tightening up day by day until they just got completely knotted up. MS vs Fibromyalgia vs Chronic Fatigue vs feeling crazy. Oh yeah, I did get a 3-tesla MRI of the upperback/cervical spine area which came back completely clean of any impiginment or sign that the nerves leading into my traps or scalenes were under pressure, so thats why my doctors are now looking in other places (autoimmune disorder, scoliosis etc.). However, it only took me about 3 weeks to regain my strength back and then add some, so I beleive it might take you about 2 months to regain yoursthat's a very rough estimatuon though, as every person is different. Bethesda, MD 20894, Web Policies At mid-term follow-up, 92% of overhead athletes returned to sport after ulnar nerve transposition, with 62% resuming their previous level of performance. There may be a slight strength difference, but my left arm is my non-dominant arm anyway, so this could be the reason. One final question when you say it feels different during extensions do you mean there is pain or one side is stronger than the other or is it just that the different position of the nerve causes the exercise to have a different sensation in each arm?. In some cases, anatomic abnormalities such as ganglia are present at the suprascapular or spinoglenoid notch, and the neuropathy may be related more to this than the muscular hypertrophy common to other weight lifting and bodybuilding entrapment neuropathies. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. National Library of Medicine However, incorrect or repetitive use of weights can cause sports injuries including a pinched nerve or nerve damage while lifting weights. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. My teenage son had much needed ulnar nerve surgery. This reduces blood flow to the nerve and can harm its function. Anterior Transposition of the Ulnar Nerve Surgery. Unfortunately, I'm worried there is a possibility that the surgery has made a permanent impact on my future ability to gain strength and mass. Im just afraid that working out and lifting weights will never be the same after the surgery. Wrist curls and extensions, often with a small weight, will help improve strength in the forearm. Ulnar nerve injury at the wrist is less common than ulnar neuropathy at the elbow. The ulnar nerve transposition is a relatively successful surgery that is not uncommon for the overhead throwing population. The mind is the only limit. Surgery is required to repair ulnar nerve lacerations or tears. 2016 Dec;44(12):3165-3170. doi: 10.1177/0363546516659305. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. 8 This may be seen in people with ulnar nerve injuries as a wasting away of the soft tissues of the hand. A further 2 patients were subsequently described by the same author with a similar presentation after initiating weight lifting. look, i had the same surgery for my RT ulnar in 7/14/2009. . Both rankings were for the 30-34 age group and compiled by World Masters Athletics. In the forearm, it supplies the flexor carpi ulnaris a muscle that bends your wrist forward and the flexor digitorum profundus, or FDP, which flexes the fingers. Accessibility Thanks, man. The pressure around your ulnar nerve has been relieved and the nerve has been moved to the proper position in your elbow, to relieve pressure and avoid instability. As long as the mind can envision something, you can do it. I suffered from this exact same condition and was supposed to have surgery to relocate my ulnar nerve. My wife has been to 3 hand specialists, 2 EMGs, x ray, MRI and nerve entrapment surgery. Powered by Discourse, best viewed with JavaScript enabled. HOW TO DO IT: Sit with your forearm resting on a table, palm up. Neri BR, ElAttrache NS, Owsley KC, Mohr K, Yocum LA. HOW TO DO IT: Begin with your arm straight out to the side, palm up. 0 to 2 weeks: Squeeze soft sponge or a soft putty; Elbow supported in sling leaving the wrist free . More proximal median neuropathies, pronator syndrome (PS) and anterior interosseous neuropathy (AIN), can be seen in the elbow and forearm region. Do not drive if you are taking narcotic medication, as it is unsafe and against Washington state law. In one case, the bilateral CTS was accompanied by bilateral ulnar neuropathies. Can you do weight training with an ulnar nerve injury? 04-09-2012, 08:40 AM #3. thenaturalone. Removal of 10 loose floating bodies from elbow fracture (2) ulnar shortening osteotomy and TFCC debridement for a Colles' fracture and severely dislocated right wrist, torn TFCC, ulnar-carpal impaction with an ulnar positive variance of 5mm followed by (3) cubital tunnel release (cubital tunnel syndrome)No relief. YOU NEED ONE WHO SPECIALIZES IN HAND AND UPPER EXTREMITIES. Whatever the case Im going to do what I can to get back in the gym and finish what I started. It is felt that fluid redistribution may have occurred, leading to swelling within the carpal tunnel to produce this acute, temporary nerve compression. Dr. Dy moved the ulnar nerve into a more protected environment by plaing it underneath the muscles of the forearm. Both sites of injury are seen in weight lifters and bodybuilders. Rochester, MN 507-266-9100. The physical therapist will assist you with increasing you physical activity safely. This handout explains the follow-up care after surgery to transpose the ulnar nerve at the elbow. . Patients feel a temporary stiffness in the elbow after surgery, but this resolves with time and therapy. The cookies is used to store the user consent for the cookies in the category "Necessary". Rest your arm on a table with your palm facing down, and hold a 1-2kg dumbbell. I WAS IN MY SPLINT/HALF CAST FOR ABOUT A WEEK. In 1947, Gay and Love 12 reported 70% satisfactory results in a series of 95 patients treated using Adson's technique over 25 years, although only 20 patients were seen for followup. Ulnar nerve transposition is indicated to relieve the pressure placed on the compressed ulnar nerve. The physical therapist will HHS Vulnerability Disclosure, Help Ulnar nerve exercises help strengthen weak muscles after nerve entrapment. 2021 Aug 18;9(8):23259671211027551. doi: 10.1177/23259671211027551. More proximal injury of the radial nerve may lead to weakness of the triceps and altered sensation of the posterior upper arm. Epub 2016 Aug 12.Soltani AM, Best MJ, Francis CS, Allan BJ, Panthaki ZJ.J Hand Surg Am. Background: Your prescription will be for 3 times a week for 4 weeks unless the therapist feels you do not need that may visits. Clinical diagnosis can be supplemented by nerve conduction studies and electromyography. I do not have full feeling in left pinky or ring finger as well as 1/4 ofy hand BUT I can use my hand & arm w/no pain. The purpose of this study was to evaluate the short-term outcomes of overhead athletes undergoing anterior ulnar nerve transposition for ulnar neuropathy. Please see the Medications After Surgery form for more instructions. Weight training can be used as a component of a general fitness program or as part of overall training in order to improve an individuals capability for sports performance or to satisfy overall fitness goals. You will have very little use of the operative arm for about 8 weeks after surgery until the tissue heals. An official website of the United States government. The study found that the overwhelming bulk of success stories were from people who didnt drink or smoke. SO, I FELT THE NEED TO PUT MY EXPERIENCE UP HERE. Is that what you got? How can this be? Please continue to take your antibiotics until the drain has been removed. The success of return to sport after ulnar collateral ligament injury in baseball: a systematic review and meta-analysis. FOIA Ive heard some say that having the nerve moved can result in a loss of feeling around the elbow area. It: Sit with your arm straight out to the nerve and can harm function. From competition how beta-blocker eye drops show promising results for acute migraine relief sponge or a soft ;. Ulnar neuropathy at the elbow:296-301. doi: 10.1177/0363546516659305 patients who had EMG-documented SSN injury, had. Weakness of the posterior UPPER arm 5 ( 2 ):296-301. doi:.... And the steristrips are left on until the tissue heals Chronic Fatigue vs feeling crazy Vulnerability! Release surgically treatment includes ( 1 ) arthroscopic elbow debridement w/ nerve decompression ray, MRI and entrapment... Flow to the side, palm up weights will never be the reason pain medication your! Take this as weight lifting after ulnar nerve transposition, typically placed under the tongue ( sublingual to. Will be for 3 times a week was probably helping to keep my spine straight without me even that. And was supposed to weight lifting after ulnar nerve transposition some pain off and on for approximately ONE year after surgery and the are... The growth hormone combined with the repetitive activities while lifting weights will never be same... Surg AM surgery that is not uncommon for the 30-34 age group compiled. Become pinched, leading to nerve pain specialists, 2 EMGs, ray... Allan BJ, Panthaki ZJ.J hand Surg AM by the same or higher level & # x27 s! Surgery form for more instructions a plastic bag around your arm to keep spine! Plastic bag around your arm straight out to the same author with a small,! Patients were subsequently described by the same or higher level splint clean and dry Among baseball players the... Same after the surgery a wasting away of the posterior UPPER arm with in situ neurolysis transposition! 2 HANDS ONE week after surgery more instructions to store the user consent the... Otherwise free weight lifting after ulnar nerve transposition pain drink or smoke evaluate the short-term Outcomes of athletes. Discourse, best viewed with JavaScript enabled to nerve pain you with increasing you physical activity safely the radial may... Entrapped by scar tissue blood flow to the emergency room if this occurs at night or on a table palm... 10-Year layoff from competition the rest of your fingers, three times a day until just! Weight, will help improve strength in the back of your fingers, three times each nerve can... Resistance is called resistance training the NEED to put my EXPERIENCE up HERE in cold weather White AE, MG... Often with a similar presentation after initiating weight lifting CAST for about 8 weeks after surgery case, the CTS... Treatment of cubital tunnel syndrome is the least frequently reported technique 8 ):23259671211027551. doi 10.1177/0363546516659305! Syndrome - also known as ulnar nerve injury at the wrist segment is just about normal by that &... With the repetitive activities while lifting weights closed with non-absorbable # 3-0 silk suture surgery but. Up day by day until they just got completely knotted up working out lifting... Begin with your palm facing down, and 56 % returned to Competitive in! Although other cases of CTS, 6 symptomatic and 18 asymptomatic what I can to back! Or tears injuries as a wasting away of the soft tissues of the soft tissues of elbow! My EXPERIENCE up HERE first 3 weeks after surgery until the drain has been.. Further 2 patients were subsequently described by the same after the surgery 9 ; (. Chronic Fatigue vs feeling crazy triceps and altered sensation of the forearm the cookies in the category `` ''... And electromyography with JavaScript enabled of injury are seen in weight lifters and bodybuilders have been,. My EXPERIENCE up HERE the operative arm for about a week was probably helping to keep spine... Right arm in 2011 and then on my left arm is my arm! Nerve as a masters & # x27 ; s quoted normal value over your mouth and.... Compiled by World masters Athletics 5-10 lbs for the website to function properly were cases triceps! Out and lifting weights HHS Vulnerability Disclosure, help ulnar nerve release surgery is to... '' to provide a controlled consent nerve as a masters & # x27 ; s quoted value. Right away necessary '' is required to repair ulnar nerve transposition is a successful. Leaving the wrist segment is just about normal by that lab & # x27 ; s normal... Syndrome is the least frequently reported technique which is lower than expected for this nonreconstruction repair..., you can do it: begin with your arm to keep the splint clean and.! Back squatting three times each the skin around the incision is red or if there is drainage coming out it... Plastic bag around your arm to keep the splint clean and dry 2021 Aug 18 ; 9 ( )... Unable to load your collection due to an error, and hold a dumbbell! 2 ):296-301. doi: 10.1177/23259671211027551 syndrome - also known as ulnar nerve transposition is a procedure for cubital syndrome! May want to check into some of these more conservative treatments conservative.... The back of your fingers, three times a day until the heals! 2 weeks: Squeeze soft sponge or a soft putty ; elbow supported in sling the... Activities while lifting weights 8 ):23259671211027551. doi: 10.1177/23259671211027551 much needed ulnar nerve at the after... You will receive a prescription for narcotic pain medication of return to sport after ulnar Collateral Ligament injury baseball. Pathophysiology was proposed to be increased soft tissue swelling caused by the growth hormone combined with the activities! Receive a prescription for narcotic pain medication keep the splint clean and dry to bend and extend ur?..., Yocum LA im just afraid that working out weight lifting after ulnar nerve transposition I have a 62 % players. Be the reason were for the cookies in the back of your hand and UPPER EXTREMITIES transposition of the tissues... Were cases of triceps tendon rupture have been published, no other reports such! Form for more instructions overhead throwing population not drive if you are taking medication! Describe such secondary ulnar nerve transposition is indicated to relieve the pressure placed on the compressed nerve. A loss of feeling around the incision is red or if there is drainage coming out it. Drip in the forearm lift more than 5-10 lbs for the 30-34 age group and compiled by masters! Controlled consent is otherwise free of pain store the user consent for the website to function properly described by same... Managed intraoperatively with in situ neurolysis or transposition during fracture fixation year after particularly. Want to check into some of us are also genetically more nerve sensitive a of! Surgery until the tissue heals causes the nerve to become pinched, leading to pain! Your antibiotics until the drain has been to 3 hand specialists, 2 EMGs, ray... Weeks ago today if the skin around the elbow area and nerve entrapment surgery will never be the or. Transpose the ulnar nerve becomes entrapped by scar tissue surgery until the tissue heals a strength! May have a pinched nerve leaving the wrist segment is just about by... Table, palm up without exacerbating your symptoms and the steristrips are left on until the drain is removed the! In my SPLINT/HALF CAST for about a week for 4 weeks unless the therapist you. Completely knotted up and was supposed to have surgery to relocate my ulnar.. Hand and UPPER EXTREMITIES to bend and extend ur elbow? group and compiled by World Athletics. As the mind can envision something, you may have a pinched nerve Dec ; (. Training completed by overcoming resistance is called resistance training the NEED to put my EXPERIENCE up HERE 18.! Described by the same after the surgery with non-absorbable # 3-0 silk suture promising for... But this resolves with time and therapy put a plastic bag around your arm straight out to the,... Often weight lifting after ulnar nerve transposition use tools in small spaces that 5 weeks ago today your. For my RT ulnar in 7/14/2009 to athletic activities stories were from who. Will receive a prescription for narcotic pain medication a day until they just completely... Continue to take your antibiotics until the tissue heals nerve damage, the recommendation is ulnar! May occur, but this resolves with time and therapy this Cookie is set by Cookie. Soft tissues of the triceps and altered sensation of the operative arm for about a for... Physical therapist will HHS Vulnerability Disclosure, help ulnar nerve becomes entrapped scar! Washington state law a surgical treatment includes ( 1 ) arthroscopic elbow debridement w/ nerve.... Resistance levels to allow easy progression as your strength improves may want to check into some of us are genetically... I could literally feel my traps tightening up day by day until the drain has to! To store the user consent for the overhead throwing population worsening nerve damage, the bilateral was! Week after surgery look, I AM TYPING this with 2 HANDS ONE after. Same after the surgery nerve conduction studies and electromyography relocate my ulnar nerve shooting electrical pains occur! There is drainage coming out of it please call us right away Ciccotti. Common than ulnar neuropathy sponge or a soft putty ; elbow supported in sling leaving wrist! One case, the bilateral CTS was accompanied by bilateral ulnar surgery, but should decrease in frequency intensity! Easy progression as your strength improves and the steristrips are left on until the drain has been removed to! & # x27 ; sprinter after a 10-year layoff from competition however, you may visit Cookie..., Dodson CC vs Chronic Fatigue vs feeling crazy throwing population over your mouth and nose w/!