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our health, how not to get sick. and if you get sick, what to do in general, it will be interesting and informative, too, stay, we are starting. today in the program about the most important asthma, what is important to know about this disease, why do adults get sick more and more often? what popular drugs can provoke this disease and how effective pets are in preventing asthma. people would not be alone, there are worlds of some nasty things very much depends on mom installed allergic to her husband's hair. they spazmiruyutsya air does not pass. and you see now. how effective are vitamins in protecting against colds and which dairy products contain the most calcium

? it would seem that in hopeless situations and for which oncological diseases this type of therapy, severe pain was especially effective, nausea, constant appetite. a seriously ill person was lowered, lay down. he won't. well we're really getting ready for the very immune cells start to see start to find cancer cells and then they start to destroy them. about bronchial facts, see who is visiting me. and

so on, he clearly knows when, for example, i drive a dog, you see, dogs jump into the car. he immediately turns around. so the tail is leaving, i 'm not going anywhere. i'll tell you that despite the fact that in general. maybe the numbers are not impressive, but it doesn't kill almost half a million people a year. that's asthma. yes, this is only less than one percent of deaths on the planet, but nevertheless , we lose half a million lives a year. and how many people's quality of life is declining here, of course, well, baby. do you want me? come on, come on my fish. i think that these are generally the most amazing animals in the world, which give you a good mood and, by the way, are a cure for asthma. including, although it would seem that there is a

paradox so bronchial. i want to show okay i will go. but i will return that bronchospasm occurs under the influence of various causes. bronchus, these are tubules. you see, they are spasmodic, the air does not pass, and thousands of septa whistle these retinues. you hear that he exhales through the distance through the whistle, because he has a spasm then, well, if you don’t come, i curse with status, when a person can die, a person takes certain treatments and that’s it. it is slowly being restored. and by the way, sometimes it is difficult to separate even from chronic structural lung disease, because there blockage also occurs, bronchial inflammatory contents, and so on. but unlike dangerous , it is precisely in the fact that it eventually recovers from this one with a groove that is caused for various

reasons by different mechanisms, of course, heredity plays a lot of role. so to speak, we live longer and longer and understand that even the most innocent things. it would seem that heredity is traced very strongly. you are in the case of bronchial asthma - this is also very important aspirosis we see asthma from childhood. we see mass teenagers. we see asma in adults in older people everywhere. it has its own characteristics. even by gender, if in childhood it is mostly boys, then at the age of 20 to 40, it is both women and men. i think the fish is yes, and if you already take over 40 years there, mostly women. we all know that asthma suffers more in people who are predisposed to allergies and to various things to pollen to animals. well, then i will

remind you why they are a cure for asma and everyone knows bronchial triggers quite well. asthma. that is, what can provoke it. here is a human predisposition. you may have had it as a child . maybe she didn't even show up because he was choking, but he was coughing all the time. well, they say bronchitis, but finds nothing. well, put on some antibiotics. well, in fact, this is a cough form of oil, which is very typical for children, just then the triggers appear, that this is either home at home that we meet, but this is home dust, these mites that are in bed, they are actually like in horror movie and i once did they made a film about the dangers at home and showed them curative pillows there. mattresses we don't sleep alone, there are myriads of some nasty things, and therefore, when you read the manual that asthmatics need to cover pillows with special impenetrable

film. i think, how to sleep on it? we just saw that i really want to cover myself with a film to get rid of, but besides this, we are cockroaches. that's all that from cockroaches there are wings legs. we do not see it crawled, somewhere it seems, but in fact it is quite high source, but and so on and so on. all that and , accordingly, as i say, is pollen, this is also domestic animals of their epidermis. eh, skin skin and so on, cause very big problems. clearly, smoking is much more common than smokers. well , pereper, by the way, this is not only smokers, but also what we are talking about, uh, secondary smoking, that is, relatives or people, uh, who live with carnivores. i inhale these microparticles of combustion , by the way, they provoke oncology. and uh, heightened sensitivity. uh bronchi, well

classically we know aspirin. yes, the aspirin series, when allergic to aspirin and asthma, is called the triad and the three components are not only aspirin and other non-steroidal anti-inflammatory drugs. such as ipoprofen and diclofenac and so on can provoke. well, it is clear that all kinds of chemicals and aerosols, gasoline smells and so on and so forth, and perfumes, as far as hair is concerned. i remember very well, we were brought together at his institute, and i remember a woman patient who, through all these fronts, had visions established an allergy to the hair of her own husband, and then i still asked the teacher. right there, what should she do now? sometimes, she decides herself. i 'm going now, what could i just shave him yes , bald and shave all the time, even if the jews do not enter the room. why do i say animals reduce risk when we say asfa and so on. uh wool actually. yes, if you have never

dealt with animals higher than rice, but when you have a cat at home, like mine, which jumped into the lullaby of a newborn son? here i had one, well not the first cat, i have been a cat lover since childhood. but this is what i have lived for 18 years, with whom my son grew up, and now today's ramis, he also goes after me , he always calls when there is some kind of disorder or when he wants to go to the bath, he comes meow. i already know that the army is in the bath. he raised his tail in front and goes to the bathhouse and simps. still, yesterday with him soared. here, uh, he loves doing it. so they are still sociable , so when you generally communicate with them since childhood. it’s like you know an allergy vaccination, because these microdoses of wool are troubles from everything child, as it were. to this and that, he received, as it were, an allergy vaccination, because such an allergy vaccination is given to you only in microscopic doses of an allergen gradually and in the end it is worth it. you just lose sensitivity to him. or , let's say there is a separate factor of communication with

pets, there are goats, pigs, and so on. this can prevent asusa so realistically that in schools abroad it is mandatory in many places to go to the farm, that is, the class takes you to the farm. they carry goats with donkeys there, combining once a week. it's good. well, we have a lot of things to do. by the way, in fact, i read the article here and was surprised. how much we think about this food depends a lot on mom. and here 's how she leads all the time of pregnancy, well , it's clear, a smoking mother, a non-smoker would turn out to be. this is understandable. yes. mom must be a certain weight. mom regret, they have children more often himself, by the way obesity risk factors for shaving. but let's say if the mother takes antibiotics, the children are more at risk, if the mother takes pills for heartburn it would seem that the child has a greater risk of bronchial

asthma, and if the mother regularly takes the recommended pregnant vitamin, d in the fetus, well , the risks of the unborn child are reduced and there is a list. if you look at these medicines, here it is. well, i don’t remember what, because the general rule is clearly pregnant, you do n’t need to take any extra drugs, but it just once again confirms this postulate. here we measure from the perimeter. this can reveal chronic obstructive pulmonary disease. well, asthma. there may be nothing there. and even if something there is, there is only one indicator important for us for treatment, this is the so-called forced exhalation in 1 second. how much can you forcefully exhale quickly? me 1 second here is this mistletoe and there is also the ratio of this forced exhalation to per second to the total. this is important for healing. this is important for various things

asthma treatment. it's not just doctors. we can prescribe for you there three or four drugs that we use. and how to use is up to you? why well, if there is, uh, screens asthmatics, they cannot but be in fact, and the indication for treatment is, if you resort to your pshikalka, which is short-acting, which helps to inhale more than twice a week, well, what is twice a week? well, once i puffed up on friday, and another time the next time on thursday, it’s normal, it’s not normal. you should already be adding other drugs, either hormonal inhalers, or long-acting dagonists already there, although it seemed only twice. or if within a month twice woke up at night from the fact that you do not have enough air. i think unless weeks, i wake up at night. nothing wrong. now that's scary. that is, you must understand the criteria when we treat below, what we go to reach and the same if

you do not have any problems. with treatment, you can slowly move away, remove the same hormonal inhalers, and so on. a number of people have severe asthma. here, especially those who are rather allergic to spirins and so on. by the way, who has shooting aspirin. do not use paracetamol paracetamol causes these reactions treatment. akin. here 's the stairs. one two three four. here there is no longer an increase in control below below, and there you must understand how intervals go along these steps. here is this increase in treatment intensity of treatment or decrease in 2-3 weeks. it is important to know that you should be taught by doctors. so let's ask what's going on behind our backs. the doctor turns around so as not to worry, warmed up here here, you know, what are you laughing at? prophet muhammad like this cat he fell asleep on the sleeve on the hands of the dressing gown cut her off, and not disturb. so, that's what, what's happening with us

there, that you found something like twelve people and found that most of our subjects, a, have a decrease in forced expiratory volume and, uh, vital capacity of the lungs. you see what i'm talking about, that, most likely, this is not that, already. here is something that is very widespread. this is chronic obstructive pulmonary disease people who are smokers people who live in childbirth with poor ecology or obesity, who have reduced diaphragm mobility. this, unfortunately, is what the doctor said. this is not the first time we have done pyrometry. it's really. you see, against this background, it can develop, among other things. yes, but you have everything initially reduced and pluses you get brocco spasm, which is another factor close to aggravation. these are viral diseases. this is what we breathe in winter. if anyone here is a

doctor at the screens or medical nurses, they say that the emergency room is littered with wheezing patients, starting with acute respiratory infections provokes growling exacerbation in asthmatics. so from pneumococcus, here is the flu, and excuse me, from the corona virus, asthma. better to take root there will not help. you know the lord will figure it out, but you have to do it. well , baby? do you think we talked about everything? yes? well, yes, my good. let's love our smaller brothers. it seems to me that they are much smarter than we are, but still we should be shooting so healthy, it will still be good. further, how effective are vitamins in protecting against colds and what dairy products contain the most calcium questions from dr. alexander myasnikov

asks you answer when they look at me with such eyes at two, it is chicory ecology, well, because it is about health several times a day, an absolutely natural product chicory ecology is also very tasty ecology of chicory. it's about health. he separated us from the fiasco by one phrase. and what song are you singing at 21:30 does he

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come here. what is your name? good morning. my name is olga what are you doing housewife? well done twist. can you cook? yes, what is your favorite dish, well, except for scrambled eggs

, i think so. but thinking is forbidden. but in fact , why do we say so, here's a study of vitamin c turned out to be, if following that they say that here it does not prevent diseases of viral

infections, but it can reduce, uh, the number of days of illness. i already somehow even wrote in a book that my grandmother was engaged in vitamin c with my grandmother. this was when it was the fifties, that's when she also spoke. eh, here's both. uh, there, what does not prevent can, reduce it later, there 60 for years, the americans have confirmed that this is generally vitamins for immunity, of course, to put it mildly, this is a wiring. still no. everything, but on the other hand, on the other hand. i'm now so categorical, especially after a period, well, make it difficult to speak. i know one thing that you can’t buy in a pharmacy. eat right, boris, he is tempered, and so on and so on and so on and so forth. by the way, the task was answered. what will you do if you haven't already answered 10 times well, but chances are you answered

correctly once, and the second time, i'm like, only did not play along. as soon as not two by two or one by two. when they look at me with such eyes for two. once well done.

we continue the series of enlightened oncology columns, or rather, the treatment of oncology is not a secret for anyone, that this diagnosis is often a tragedy for the patient and for his entire family. yes, once upon a time they lived bach and that's all, this is our traditional attitude to ecology. still, we still live in the ideas of thirty years ago today, oncology of the disease, firstly, which can prevent, but also the treatment, which is so treatment methods have become successful and now a lot of patients simply. well, it's like chronic diseases, like hypertension is growth, and so

on and so on, many types of oncology, for example, such as cancer, the thyroid just got tired and stopped dying. it became practically curable, but here the word chronic diseases was said, because a person lives in a family if he has a poor quality of life, well, you understand, yes , even if chemotherapy, what kind of quality of life we ​​have this short period, a naturally and the family has to change theirs; someone quits their job to take care; someone hires someone if they can afford it. that is, this is such a difficult test for the whole family, the right treatment here, of course, is extremely important not only in the prognosis of life, but also in the prognosis of these activities of this unit of society. here. let's see the plot of boris petrovich kruglikov, 84 years old, for an appointment with an oncologist, he came on the twenty-seventh of september this year, more precisely, his wife brought him. and we barely made it

by taxi and it was in a very bad condition. uh, the strongest weakness loss of coordination. and when he walked around the apartment, i followed him like a shadow in order to support him. he held on to the walls and made a slightly awkward movement. he fell, his legs did not hold. troubles with the gastrointestinal tract began, nausea complained that he had pain, his arms hurt, his legs hurt, his ribs hurt in 2013. boris petrovich was diagnosed with kidney cancer in 2014, the tumor was removed, it seemed that the disease was defeated, but in august of this year, recurrence left the diagnosis secondary metastasis of the image of the space and chest and chemotherapy not indicated due to

his age and general condition at that time, i accidentally saw a program on tv about the most important thing, and i thought that i should take this chance and try to treat him with cytokine therapy . i wanted to do everything in order for him to live. whether the method of cytokinogenetic therapy would help boris petrovich then no one knew ben omar mohammed amir, oncologist, mammologist, surgeon, in our away, the attending physician of boris petrovich and the world, come here. is this not the first time you've met here? what he was like when he first came to the reception, the quality of life was around 30 points out

of 100, there was a pronounced pain syndrome throughout the body, there were severe pains, nausea. constant appetite is reduced, that is, the person practically did not move. he lay down and didn't eat. there would have been progressive disease in august 22 in the form of many metastases in both lungs, plus a conglomerate of metastasized lymph nodes in area, the gate of the liver, that is, well, and then the distance of metastases, yes, and you are a patient turned to me. we have appointed the first course and so gene therapy, let me remind you that this part of e-cytokinotherapy has been the standard for partycological diseases for many years. here a more specific narrow frequency movie is genetic therapy. yes, the background is the tumor necrosis factor. it is produced in the blood by white cells of the immune system, that is, macrophages, lymphocytes or

leukocytes. uh, yes protein, when it is not in the blood does not work against tumor immunity, or it works very weakly, so we raise the fans in the blood by adding fnl and madina alpha 1 immune cells. they begin to see, they begin to find cancer cells. and then they start to eat and destroy and there is a fight against oncology without fnl against your immunity, either it doesn’t work, or it works very weakly. this is typical for oncocentes, so genetic therapy raises the level of fanal and this increases the body's resistance. oncology cancer process stabilizes quality of life improves and the patient and his relatives after two courses. fnl rose below one before treatment and rose to 70 pictograms per milliliter. a

control ct scan with contrasted chest and abdominal organs was done. we note stabilization on all fronts. that is, those foci of metastases that were, they do not grow, new foci do not appear, and this is assessed as a positive trend in terms of the quality of life. i remember when i came to the internship in america and i got into the department of ecology. and the manager at the entrance says well, what does the doctor say? you are from russia. tell me what determines the prognosis of an oncological patient. i'm talking about the presence of metastases. it's good that i also returned the size of the tumor. he says, ok. and what 's most important. i guessed something else. the most important thing is the quality of life. this is the quality of life scale. can he go to the store himself, washing shit himself? does he clean up his bed? that's all there are many, many questions that you raise? well, general meaning. what any experienced doctor knows, if a seriously

ill person lies down, he will not get up. and if he will move, and this indicator is 60-70, it doesn’t matter what kind of stasa he has well, roughly speaking, a person whose quality of life is 70 with noros metastases will live longer, well, so to speak, a person whose quality of life is 30 there, but metaphors. not at all, but after two courses, with such genetic therapy, boris petrovich almost lost his appetite, his pain syndrome decreased by about 60-70%, the patient began to walk, he serves himself, 36.0 before me, this color is very impressive. well let's ask the patient's wife, she's here. good afternoon, irina alekseevna irina, yes, what happened to her husband, did the trouble happen to her husband? no, we already got it. yes, i

mean, that's how it is clear at this stage that you know, i have him as a living person. he walks around the apartment. he serves himself. he eats by himself. well, now i'm leaving for you. he stayed on the farm, he reads. he reads newspapers. he watches tv, listens to the radio, he jokes with me. well, he became a normal living person. compared to what it was in september august before treatment it's well we really prepared for the worst. i know you brought the video with you, right? the house itself could not come. please show us more, please tell us how your condition was before treatment. here is the end of august, the beginning of september, because i was passed out. so here is in

pain disease. if i put it that way, everything that happened around me was far away for me. now , after two courses of treatment, two courses of injections, how do you feel better? how are you? here you evaluate yourself. we plan to continue treatment for up to five to six courses and hope for better results, i just have to thank the doctors, er, but it's a miracle, what happened to my husband? i think it's a

miracle. well, god bless him. god bless him. i just to all the people who find themselves in this situation, never give up never talk. thank you, good luck and we will all be attentive to all health, okay? onco-keynik 38 is a cancer treatment and prevention service that can keep cancer at bay . chronic disease and affect life expectancy oncoker clinic, clinics, 38 works with oncology at the gene level. call 8.8008. in what cases it is necessary to remove tonsils from a sore throat and what chest pain signals, at night you ask the doctor questions alexander

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good morning. good alexander leonidovich cheat sheet wrote, clearly. my son is sick. uh, he gets angina 3-4 times a year and uh. he has chronic tonsillitis, deformed tonsils and indicators of 720. and analyzes and remove the approach. by the way, i myself am very tough against such a removal, but it is recurring exactly streptococcal tonsillitis. uh, you're just telling me to take a transsipitalizin. so we are down to our throats. in general, now it is not the most important thing. the main thing for us is to prevent complications in the heart and kidneys only by sanitizing. in this case, this is the law, uh, seven, tonsillitis a year - this is

an operation, if there are seven tonsillitis, here, there are certain standards, he fits these standards, there are no classical age restrictions. no, well, i mean, he's 25, and he's 25, right? well, again, the law is the same seven times or there was or was an abscess, or seven times, then we still make this operation from an adult to an adult. we are always apprehensive. i now understand, i thought about a little boy, and as an adult, i understand the fears of your doctors, because this problem begins. we are not exhausted, we remove the two largest other parts of the tissue tissue begin to develop, which can also present certain problems. but remember, the streptococcus still remains. you are precisely streptococcal angina. it is dangerous to develop problems with the heart and kidneys, if

seven times a year, then this is a direct indication for removal. good morning doctor. and i have such a problem. and now, for two weeks now, i have been waking up at 3 o'clock from the fact that i have a pain behind my sternum that gives between my shoulder blades. the same situation. i had 2 years ago cardiology. i dismissed. that is, there, everything seems to be fine. they did their ecg for me. i gave myself tests. hmm and somehow, while i was being examined. this problem is gone for me. and now here she is again. that’s how my sugar was, it was normal, cholesterol was normal, everything was fine. maybe now it's all over again here , after all, think for yourself you lie and talk at 3:00 with me here regularly, yes, which is given back, what are you doing, continue to lie. i stand, i try to

walk. i take on steroids very much like that. toothache, you know, dull, tedious pain i mean, it's impossible to sleep. well, no, i would not say that it is easier that it passes two hours after taking it, pills are not anti-inflammatory steroids. why did i ask about sugar, because immediately different thoughts, but you dismissed cardiology . well, first of all, how shallow. well, in general, really little. similar, although it may well be, but i would, among other things, probably put out the holter monitor for the night, well, so that you sleep with him and try to catch this state, and at 3:00 am i was watching cardiogram and i see what is there, if there is a decrease, well, i just tried to just put it there, but try to catch it. and i, of course, would have

made you try with physical activity, nevertheless , on a bicycle, then it happens for 3 hours, especially other disorders of glucose and glucose are not necessarily diabetes in physiologically there is such an effect, glucose drops sharply and a person usually sleeps and this is not feels. but sometimes it can be accompanied by a burning sensation, shaking, maybe that's why i asked, what is the level of glucose and and so on, but now, when i talked with you a little more, anyway, it’s good for me, skeletal muscle and more, you need to change the pillow mattress . i don't have a mattress, good fitness. i 'm busy. and i do not correlate this with fitness. i may work out, i may not work out together. uh, anyway, this is how it sounds like a dull pain that does not go away lying down, which aches, yes, which i get up do not change according to i take, there they are raw anti-inflammatory after 2 hours

, or i have more chest heart if he lasts longer than thirty minutes means the service is a heart attack. yes, that's just you can write on that's it . but a particular society, right? doctors, and everything else and good luck good morning. hello the new year is coming soon and many people think that the new year is the holiday when the chair should burst from different salads from delicious dishes from all sorts of snacks. and this is such a direct celebration of the stomach for the whole country, and that is why the number of patients with problems of the gastrointestinal tract who

go to a medical institution on new year's holidays increases many times and in the first place, probably, pancreatic diseases are worth the number of patients who are admitted to hospitals with an exacerbation of chronic pancreatitis , a rather severe exacerbation. this period of the new year holidays is also increasing and the first advice here that can be given on the eve of the celebration of the new year. this is to check the condition of your pancreas. while our audience in the hall can go through ultrasound. oh, i propose to find out the history of our today's guest svetlana svetlana zhukovskaya, 57 years old, nizhny novgorod svetlana began to feel pain in the left hypochondrium after eating fatty and spicy food. sometimes. it's just heaviness. and sometimes it can even be a sharp pain that can radiate to the shoulder blade in the back and at the same time, heartburn and belching can occur as the heart rate increases. well , sometimes there are even problems with the table. svetlana

is afraid that these symptoms may be a sign of a serious illness. it worries me a lot, because at one time my mother had one. e, i was diagnosed with chronic pancreatitis and this disease later developed into oncology. at she was diagnosed with stomach cancer. it's already quite late. i don't want the same disastrous consequences. svetlana doesn't know how to celebrate the new year with a discovered problem. would you like to know what is happening to me? soon new year's holidays all of us will go to visit all of us will sit down at the festive table. i would like to avoid the consequences svetlana in our studio come to us. please. hello svetlana do you have any problems with your pancreas? some discomfort after eating some spicy or fatty food in the left hypochondrium, my god, what will you do on new year's eve? that's about it, i also wanted to

talk to you, because, well, of course, we all love to eat and we will visit each other there will be a lot of delicious things on the tables and i want to avoid the consequences that you generally like to eat usually in the new year olivier mimosa herring under a fur coat like this all mayonnaise fried. yes oh, how tasty you tell, of course, uh, that is, everything which is absolutely not useful for older men is true, svetlana please tell me, have you ever visited a doctor. here are the symptoms of pancreatitis. no, i notice these problems literally, like six months ago, then they began to increase to the point of a doctor. unfortunately, it has not yet reached, and someone in the family has a problem with pancreatic jelly. yes, and my mother was once diagnosed with pancreatitis, which unfortunately, uh, turned into a malignant disease, really any disease. easier to prevent than to cure therefore, the diagnosis of the pancreas really comes to the fore, especially on

new year's days, in order to figure out what is happening to you. i want to invite an expert doctor alena alexandrovna to the studio, a gastroenterologist, a nutritionist, a candidate of medical sciences alexandrovna good morning alexandrovna please tell me, is it really possible to somehow prepare the pancreas for the new year holidays? is it necessary to do this point the first news is bad , it is impossible to prepare the pancreas for the holidays, if a person has c chronic pancreatitis he has exit pain, nausea, vomiting. trust me this man. olivier himself will not want to eat fatty foods, which he cannot stand, because the consequences arise immediately new year - this combination is not only fatty foods, but first of all alcohol for our pancreas. the enemy is much bigger than fatty foods. well, svetlana has already complained about and the severity of pain,

heartburn, heartburn can be belching. should svetlana now also undergo an examination and see if whether there really are already some problems with the pancreas when symptoms occur, the need to undergo an examination. there is always a need to understand what is the reason, because the approaches to treatment and prevention of exacerbations will be different clinic onco-kir clinics 3008, these are services and treatments. and the prevention of oncology, which can keep cancer at the level of a chronic disease and affect life expectancy. it is like me at 308 clinics. call 8.800-22-38 next in the pancreas program. can it be prepared for new year's holidays and what not to do before a feast? and how many times i said don’t get in the face

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i just couldn't believe it was a little girl. maybe some kind of minimalism is all so simple some kind of work. pasha pure sincere performance appears real. i wish you a lot of serious advice on what not to do before the new year, so that in the midst of the new year holidays you don’t end up in the hospital can cause exacerbation of duodenitis inflammation of the mucous membrane of the duodenum 12, where the ducts, both bile and structural. she hasn't been changed. e in the gastric bladder. yes, you have put my mind at ease. thanks to the doctor there were unrest. still need to undergo additional testing. if we say the same delivered, yes fatty foods, especially mayonnaise. it's against. no, this is good news. we started quietly the news the good news

is after the meal. you just overate and that means your task. i'm not a fan of mayonnaise at all. i would still replace the manse in salads with olive oil, now there are so many good dressings that can and should be absorbed directly in the intestines, bypassing this whole system, uh, with the gallbladder . i would like it to be more than just mayonnaise the time of the new year holidays and in particular the new year's feast. we also add sweets to mayonnaise to cause pain and discomfort. wasabi for example. in general, it’s not so scary, you see, we again share patients all the time, in whom, like spices, they also increase appetite , probably about physical rewards. of course you can dress warmly to go for a walk. here we sin like this on new year's eve. is it possible to use some special means in advance in order to pancreas?