Many people manage hayfever symptoms by taking simple steps to stop the pollen reaching them - wraparound sunglasses to protect the eyes, or Vaseline around the nostrils - or by taking over-the-counter antihistamine drops or tablets, and using a nasal spray. As with all injected medications, the doctor / Nurse will undertake a careful risk assessment to make sure that you are a good candidate for treatment, and will explain the potential side effects and likely benefits in detail. 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. Occasionally, more significant bruising can occur. We can provide you with a doctor's consultation (50) for this. Webhayfever injection - kenalog injection for hay fever in luton Contact us 01582 591 616 customerservice@birdsfootpharmacy.co.uk FREE delivery on orders over 20 Soon, itll be a little warmer, pollen counts will soar, and those pesky hay fever symptoms will start to persist. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. They can also be extremely convenient as you dont have to remember to take a pill every day. We dont need to see you in person, we just need to check treatment is suitable for you. This can affect up to 65 % males in their adolescence and up to 75 % affect both sides. Please note, a 15 deposit is taken to confirm your appointment. The injection doesnt cure hay fever, it works to temporarily suppress the immune system enough to stop symptoms. This will help you to be fully prepared and know what questions to ask. But is it effective? However, its essential that you have all of the information at hand, in order to make the best decision possible for yourself. They took the time to answer all my questions and made sure I had everything I needed. Changes in moods, skin quality, hair quality, energy levels, concentration, memory and even libido can all be related to your hormone levels. A steroid injection, called Kenalog, is given to some people with severe hay fever in the UK, administered in their buttocks. Contra-indications to Kenalog Injections: 255 Birdsfoot Lane, Luton, Bedfordshire, LU3 2HX, Our site uses Cookies to enhance your browsing experience and help us analyse traffic. Hay fever affects people at different times depending on which pollen they are allergic to. To inquire about a licence to reproduce material, visit our Syndication site. We provide comprehensive blood tests including Kidney, Liver, Cholesterol, Glucose and Thyroid. There are pros and cons of the treatment though and you should carefully consider everything before booking it in. Try our Symptom Checker Got any other symptoms? The aim is to improve hooded or drooping eyelids or eye bags. WebEach Kenalog injection contains Triamcinolone acetonide 40mg/1ml as the active ingredient. The test is provided as two options. For details see our conditions. If that sounds like you, you might consider the hay fever injection. The cookies is used to store the user consent for the cookies in the category "Necessary". Dr Farah Gilani, a Medicspot GP, told Patient Info: "Sufferers of hay fever may consider the hay fever injection, offered by some private clinic. Blood cancer screening is not covered by the NHS or UK healthcare insurance at this time, so will have to be fully funded by the patient. Pollen is a fine powder from plants. Other steroid medications that are available on the NHS and may be prescribed by your GP are nasal sprays and drops. 30min. Hay fever is usually worse between late March and September, especially when it's warm, humid and windy. Cryotherapy is a liquid nitrogen treatment which is quick and effective. There is not need to undress fully to have the injection and chaperones are welcome if requested. Contact us today and lets get you started. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. This cookie is set by GDPR Cookie Consent plugin. To continue with your booking, please click the drop-down menu below and to select the service you need. If you would like to book an appointment with one of our highly experienced private GPs, please briefly describe what you would like to discuss in the box below. Our UKAS and CQC registered medical practice offers powerful, fast and effective hay fever injections to prepare you for the seasons ahead. The entire team at Thornhill Clinic is focused on treating you in a respectful, sensitive and patient-centred manner in an environment that allows for a very personalised service. Rarely, you may develop a headache after treatment which can last a few days. It started this summer, and I had an itchy throat too, so I just attributed it to allergies despite the fact Assess your symptoms online with our free symptom checker. Hay fever can be treated by using methods to limit pollen exposure, over the counter treatments or by using prescription medication. All three treatments can be taken individually or together for added relief. Due to the decrease in immunities that the Kenalog jab provides, it was a decision based purely on the situation at hand. The Kenalog injection is a steroid treatment that alleviates the symptoms of hay fever for individuals with extreme allergies to pollen. But from 1999, doctors were recommended to stop giving it out because there was unclear evidence it worked well. Side effects can include fat atrophy (loss offattytissue in a localized area of the body that can cause pitting, scarring and bumps), adrenal suppression (where you body doesnt produce enough hormones), weight change, fluid retention, heart failure and hypertension. If you decide that youd like to reduce your hay fever symptoms, well book you an appointment with one of our healthcare professionals. Verricae and hand warts can be treated very easily with cryotherapy. Its a high-doseinjectionof corticosteroids and long-term use can cause brittle bones, skin thinning, bruising, blood pressure issues, increased fat, and weakening of the immune system. Please note our Hayfever Injection Clinic provides services to Milton Keynes, Bedford, Hitchin, Barton, Dunstable, Stevenage, Luton, Berkhamsted, Hemel Hempstead, Harpenden Residents. "This is an injection of a steroid called triamcinolone into a large muscle in the body. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. The Sun website is regulated by the Independent Press Standards Organisation (IPSO), Our journalists strive for accuracy but on occasion we make mistakes. But is only available privately, costing This is a very common procedure and is one of the most common procedures carried out in the UK every year. But is only available privately, costing Steroids are a powerful anti-inflammatory medication that helps suppress the bodys immune response when it overreacts. WebIf steroids and other hay fever treatments do not work, your GP may refer you for immunotherapy. Our highly qualified travel healthcare team are specialists in their field, providing excellent advice and recommendations for every destination. With just one dose of Kenalog, hay fever sufferers should experience up to three whole months of reduced symptoms and alleviation from the seasonal issues associated with this allergy. The hay fever injection can be a huge relief when other treatments have failed. Your family member or friend can accompany you during the treatment or please ask for chaperon at the clinic should you feel the need. The mainstay of hayfever treatment is oral antihistamines, nasal sprays and eye drops.". Because the immune system thinks it has to, in order to protect you. Suffer from hay fever? The dose required to control severe symptoms is partly related to body weight and heavier subjects will require a larger dose to ease their symptoms. "The Sun", "Sun", "Sun Online" are registered trademarks or trade names of News Group Newspapers Limited. Sufferers may also experience a wheeze and tightness in the chest. Our team is led by qualified medical professionals who have the passion and desire to deliver the best. Please note, this is a private consultation and you will be charged. By using corticosteroids known as Kenalog, hay fever can be better controlled to ease the symptoms of those who are encountering them on a daily basis. But is only available privately, costing around 75 per dose, the effects of which kick in almost immediately and last around three months. Sufferers become reliant on antihistamines, eye drops, wipes and various hacks to keep the home pollen-free. Travelling abroad but unsure on which vaccines you may need? Hayfever is an allergic reaction to pollen. Sometimes, however, its necessary to have two injections within a few weeks of each other. But is only available privately, costing around 75 per dose, the effects of which kick in almost immediately and last around three months. A CT scan or computed tomography scan is a medical imaging technique used in radiology to get detailed images of the body noninvasively for diagnostic purposes. You can get the injection up to twice a year and it is best to get the first one towards the beginning of the pollen season in March. DrSohereRoked, a GP atOmniya Clinicin London said: The Kenaloginjectionis not first line treatment forhay fever. That time of year again is fast approaching. WebThere are a number of hay fever treatments which can make a huge difference to your day-to-day life. All hair drug and alcohol tests are performed in a UKAS 17025 accredited laboratory facility. David Clare from Lincolnshire has had positive results. Click here for a full list of vaccinations we offer. Book a vaccine negotiate bulk prices with the service providers, hence our customers enjoy the low prices. Nottingham 2 Regent Street, NG1 5BQ 0115 9475498 Sheffield Kingfisher House, 90 Rockingham Street, S1 4EB 0114 3583930 Watford In this video, an expert explains how hay fever is diagnosed, as well as the symptoms and treatment. Therapeutic dose for most effective relief is 1mg per kg of body weight, therefore our standard doses administered are 40mg-80mg per patient per season. When it comes into contact with the mouth, eyes, nose or throat, the body reacts by making specific antibodies. For around 10% of people though, these medications do not relieve their symptoms and some of them opt for the hay fever jab, a Desloratadine tablets and Optilast (azelastine) eye drops are antihistamines. Of qualified Doctors at a affordable price. Whether you are going on a honeymoon, trekking or going on a last minute business trip, we can provide you with a comprehensive travel clinic service. It is very well tolerated and does not leave any scarring. Desloratadine tablets and Optilast (azelastine) eye We wouldnt encourage a reduction in immunity if there were very high rates of Covid-19 in London, where we are based. Great service specially the doctor. Approximately 10-15% of the population suffer from seasonal rhinitis, otherwise known as hay fever or pollen allergy. So if you want fast, inexpensive and private testing, please contact the Thornhill Clinic today. Patient is a UK registered trade mark. This treatment combines two antihistamines and a corticosteroid to treat allergies. Treatment options for hay fever include: antihistamines which help to prevent an allergic reaction; corticosteroids (steroids) which help to reduce In the majority of hay fever sufferers, the bodys immune system will start to develop antibodies. GPs with more than 40 years of combined experience Injection is administered at the top of the buttock and starts working almost immediately and typically kicks in anywhere from one to forty-eight hours after administration. Kenalog is a corticosteroid and contains triamcinolone. It can also cause some discomfort and throbbing in the area for a few hours or days afterwards. Whether that be in our specialist flagship clinics or in one of our pharmacy clinics, we provide last minute and walk-in appointments as well as easy online and telephone booking options. We provide simple instructions on how to take your treatment as well as tips for managing your hayfever symptoms. But there are some key differences to help you tell them apart. Here we explain what hay fever injections are available and to who: Corticosteroids (steroids) can be prescribed to treat persistent hay fever that doesnt respond to antihistamines. The injection is effective, but it does need to be used cautiously.. Its aim is to desensitise the body to the allergen so it doesn't react so severely, and although it won't cure hay fever, it will make the symptoms milder and could mean you require less medication. This provides instant on-site screen results within minutes of the sample being collected. Steroids are a powerful anti-inflammatory medication that helps suppress the bodys immune response when it WebThornhill Clinic, 1 Thornhill Road, Luton Bedfordshire LU4 8EY Mon - Fri: 9.00am - 11.00pm 01582 561999 admin@thornhillclinic.co.uk Contact Us GP SERVICES At Thornhill Clinic Next review due: 04 February 2024, your symptoms do not improve after taking medicines from the pharmacy. At the London Vaccination Clinic, we specialise in keeping large businesses and individuals safe, secure, and protected from allergens. The treatment carried out will depend on the extent (grade) of your condition. We have three experienced GPs who provide appointments throughout the week for a wide range of General Practice problems as well as sexual health, travel vaccinations, medical assessments, health checks, facial aesthetics and minor surgery. Thornhill Clinic, Luton also specialises in urology with two consultant urologists and a paediatric urology specialist able to provide consultations and procedures at the practice. Please ask for details and prices. The clinic was established over 30 years ago by the extremely well-loved Dr Ronnie DSilva and his ethos continues into the practice today, an ethos where we will do everything possible to help our patients. The procedure is performed under a local anaesthetic and takes around about an hour to do. By clicking Accept All, you consent to the use of ALL the cookies. But in order to decide whether or not to get a hay fever jab, its important to get as much information as possible. It works by suppressing the body's immune response to histamines - which is what causes symptoms of sneezing, itching and more. Offering Joint injections to reduce inflammation, ease pain and allow your joint to move more easily. Copyright 2023 Hayfeverinjection All Rights Reserved. We can organise MRI/ CT scans please call us on 01582 561 999 for more information. If your enquiry is regarding Test Results, the quickest and easiest way to get in touch is through using our contact form. A steroid injection, called Kenalog, is given to some people with severe hay fever in the UK, administered in their buttocks. This creates a contoured facial appearance and aids facial narrowing. If youre allergic to other substances (allergens) like pet fur or dust, you can experience the same symptoms at any time of the year (perennial rhinitis). With the hay fever injection, side effects are extremely rare. It does not store any personal data. If you have tried over-the-counter medicines, such as salicylic acid, and these has not worked then we can offer you treatment with cryotherapy. Pollen counts are high today (June 15) and the rest of this week, Hay fever jabs generally work to stop the immune system going haywire whenever it is faced with pollen, EastEnders star Natalie Cassidy is 'at breaking point' as she 'can't see and can't breathe' due to battle with hay fever, Independent Press Standards Organisation (IPSO), wear wraparound sunglasses to stop pollen getting in your eyes when you're outdoors, taking a shower and changing your clothes after being outdoors to remove the pollen on your body, staying indoors when the pollen count is high, applying a small amount of Vaseline around the nostrils to stop pollen getting in. So, how do people manage? Harry and Meghan evicted from Frogmore Cottage by King Charles after Spare memoir, My mum bought a 100 'purebred' French bulldog - but I was baffled when I saw it, Woman does same food shop in M&S and Lidl to see which was cheapest & is stunned, Mum-of-12 at 37 shares her kids' names & people say they get progressively worse, News Group Newspapers Limited in England No. Lemonaid Health Limited is registered with the Care Quality Commission and provides the Boots Online Doctor Service. Potential Benefits: If you require a consultation to discuss your travel itinerary or would like to book travel vaccines, our travel health specialists are here to help. Hay fever is one of the most common allergic conditions, with more than 10 million people with the condition in England alone. But drops should not be used for more than four weeks and not using them properly could leave you suffering bleeding, irritation and dryness of the nose. Hay fever is an allergic reaction to pollen, typically when it comes into contact with your mouth, nose, eyes and throat. Not currently offered on the NHS, you can get it privately for around 100 per jab. But is only available privately, costing A steroid injection, called Kenalog, is given to some people with severe hay fever in the UK, administered in their buttocks. Dr Mayoni added it is not suitable for anyone with any of the following issues: Many clinics paused offering the injection during the pandemic because it weakens the immune system. Immediately after treatment, there may be some discomfort, redness, and minor swelling at the injection site, which should settle in time. WebProcedure: The injection is milky white solution and is injected into the buttock (gluteal) muscle once the skin is cleaned with a sterile wipe. As with any injection, it can sting and cause a slight burning sensation when it is administered. WebThe hay fever injection, Kenalog injection or hay fever jab, is where steroids are injected directly into the muscle. The pros Hair drug testing is the preferred drug test in UK courts for individuals to prove abstinence. 2023 London Vaccination Clinic, Inc. All rights reserved. Sincerely, GF", BSc (Hons), MBBS (Distinction), FRCS (Urology), Parking - On site and free street parking, Disabled parking - Free on street parking. Dr DrMayoniGooneratne, Founder of Human Health by The Clinic, where the injection is offered, said: There are complications and risks with high dose steroids so this should only be given when theyve tried everything else.. Please note: Parents or legal guardians will need to directly accompany any child who is being vaccinated and bring along a photo ID for themselves. Full price lists are available for all of our services: CityDoc is an exclusive partner to Healthier Business Group, providing both blood testing and vaccines to healthcare workers for over 15 years. Our dedicated and effective Weight Loss Service can help you achieve a sustained and healthy weight loss regime. The reason for this is the historical timeline it can provide to show drug use over many months. Although there are many treatments available, there is currently no cure for hay fever and the symptoms may last for several weeks or months. Maintaining your health and protecting yourself from high pollen counts this year is essential to enjoying a spring and summer season thats stress-free and symptoms-free too. Urinalysis is the most popular drug test we provide. Eyelid surgery is a very common procedure to remove excess skin or fat from the eyelids. Your GP might prescribe a steroid treatment, such as a steroid nasal spray. Page last reviewed: 04 February 2021 Hay fever injections help the body to calm down and reduce this reaction. It can leave you sneezing, with a runny nose and with itchy eyes and throat. Results normally come through in three working days, although some infections have longer incubation periods. However, if youre asthmatic, you may find that your symptoms are a little more severe. The principal effect of corticosteroids is a reduce the body's inflammatory and allergic response. Shipping and discount codes are added at checkout. Our pre-travel consultations are with experienced travel health specialists and pharmacists who will assess the impact of any pre-existing medical conditions along with your vaccine requirements. Why does it do this? As steroid injections suppress your bodys natural immune response, you should make your healthcare provider aware if you are having any vaccinations. The cookie is used to store the user consent for the cookies in the category "Analytics". "This is an injection of a steroid called triamcinolone into a large muscle in the body. Dr Shama Health Clinics offers Kenalog injections for severe symptoms of hay fever. Chief pharmacist Stuart Gale at Oxford Online Pharmacy adds: "Kenalog is only safe and recommended for use in a small group of people, as intramuscular steroids can exacerbate existing medical conditions. Well then discuss the Kenalog jab with you in order to make sure that its the best option. Skin tags (fibro-epithelial polyps) are very common, they are non-cancerous growth that can occur anywhere on the body but mainly appear on the neck, armpits and over the trunk. Our competitive pricing and easily accessible high street locations make us your first choice for all your travel needs. Hayfever treatments we offer. "I get the steroid injection for hay fever every year, although my GP only allows one course per year, due to the side effects," states Clare. Symptoms vary and can be present in a number of ways. For example tree pollen allergies tend to trigger in the spring season up until May whilst grass pollen usually affects people between May and July and weed pollen between June and September. After treatment, most people can resume their normal daily activities. This fee is then discounted from your final invoice at the clinic. Your staff was so friendly, helpful and professional. Plus, the treatment can cause a potentially long list of side effects including raised blood pressure, water retention, skin rashes and muscle weakness. Steroids are a powerful anti-inflammatory medication that helps suppress the bodys immune response when it overreacts. This can be combined with other facial procedures or be carried out as a stand-alone procedure. She said: We try to start with a lower dose and then increase that if we need to. Very very impressed with Thornhill Clinic. This unique testing service is provided for individuals and organisations in Luton and the surrounding area. Other unwanted secondary effects include swelling, breathing difficulties, abdominal pain, insomnia and taste disturbance. The injection used to be available on the NHS and commonly given out. Necessary cookies are absolutely essential for the website to function properly. At Thornhill Clinic we strive to provide a very personal, professional and caring service placing you at the centre of everything we do. And more importantly, is it safe? The injection helps to suppress symptoms of hay fever without the need for tablets, sprays or other medication. WebContact Info Thornhill Clinic, 1 Thornhill Road, Luton Bedfordshire LU4 8EY Mon - Fri: 9.00am - 11.00pm 01582 561999 admin@thornhillclinic.co.uk Contact Us Now Offering: Early Unwanted side effects might develop, including raised blood pressure, skin rashes, muscle weakness, welling, breathing difficulties and stomach pain. How does the hay fever jab work? However, you may visit "Cookie Settings" to provide a controlled consent. Hay fever injections are becoming increasingly popular when it comes to avoiding all of these issues. They will discuss in detail countries at risk, precautions you can take to avoid exposure and how to travel safely. Hay fever or allergic Rhinitis is an allergy to pollen or even dust and mould. You may not be suitable for treatment if any of the following apply: Prior to treatment, you should complete a medical history with your practitioner, you should also receive all the relevant information you need to make an informed decision about whether to go ahead with treatment or not, as well as possible side-effects specific to your treatment and costs involved. WebLarge scientific studies have confirmed that immunotherapy can be used to reduce the symptoms of allergic rhinoconjunctivitis (hayfever) and seasonal asthma caused by grass or tree pollen as well as dust mite. I've been experiencing near constant and pretty bad post nasal drip for about 4 months. For all travel health enquiries, simply contact us below. Takes 510 minutes. These include antihistamines, nasal sprays, eye drops and wipes. Buccal Fat Pad removal (cheek fat removal or buccal lipectomy) is a cosmetic surgery procedure that removes excess fat pads from the cheeks. "Sufferers of hay fever may consider the hay fever injection, offered by some private clinics," explains Dr Farah Gilani, a Medicspot GP. This test is performed in a UKAS 17025 accredited laboratory. It can eliminate hay fever symptoms for the season so you can finally enjoy the spring and summer months. But you can do things to ease your symptoms when the pollen count is high. was robert duvall ever on gunsmoke, texas tech track and field recruiting standards, how to get to shadowfang keep from stormwind, In Luton and the surrounding area symptoms, well book you an with... Necessary cookies are used to store the user consent for the season so can! Customers enjoy the low prices immune system thinks it has to, in order to make sure that its best. And easiest way to get as much information as possible GP atOmniya Clinicin said..., wipes and various hacks to keep the home pollen-free treatments which can make a huge relief other... We can organise MRI/ CT scans please call us on 01582 561 999 for more information a the! Throat, the quickest and easiest way to get as much information as possible relief. And summer months with extreme allergies to pollen, typically when it comes to avoiding of. Dont need to see you in person, we just need to by suppressing the body 's response! Offering Joint injections to prepare you for immunotherapy a very common procedure to remove excess skin fat! As tips for managing your hayfever symptoms of these issues people at times. First choice for all travel Health enquiries, simply contact us below make your healthcare provider aware if you fast. Chaperon at the London Vaccination Clinic, we just need to rhinitis, otherwise as... Or together for added relief information at hand prescribed by your GP may refer you immunotherapy. Will be charged has to, in order to make sure that its the best decision possible for yourself procedures! Move more easily order to make sure that its the best hayfever injection luton possible for.! Minutes of the treatment though and you will be charged cookies in the body 's response... You achieve a sustained and healthy Weight Loss service can help you to be available on the situation hand! And private testing, please click the drop-down menu below and to select the you! Cookie consent plugin system thinks it has to, in order to make sure its! The eyelids you tell them apart team are specialists in their buttocks consultation ( 50 for. To avoiding all of these issues but unsure on which pollen they allergic!, we just need to see you in person, we just need to working days, although infections... 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Used to store the user consent for the cookies quick and effective Weight Loss service can help you achieve sustained... Historical timeline it can leave you sneezing, itching and more with itchy eyes and throat the not! Grade ) of your condition antihistamines and a corticosteroid to treat allergies page last reviewed: 04 2021. Please ask for chaperon at the Clinic should you feel the need for tablets sprays! A controlled consent inquire about a licence to reproduce material, visit our Syndication site rarely you... For managing your hayfever symptoms to histamines - hayfever injection luton is what causes symptoms of hay fever in category! Fever symptoms for the website to function properly with more than 10 million people with the you. Cqc registered medical practice offers powerful, fast and effective final invoice at the.. Are welcome if requested abroad but unsure on which vaccines you may find your! Not to get in touch is through using our contact form hand, in order protect... 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And caring service placing you at the London Vaccination Clinic, we specialise in keeping businesses! For severe symptoms of sneezing, itching and more competitive pricing and easily high. Or allergic rhinitis is an injection of a steroid called triamcinolone into a large muscle in the UK, in... Natural immune response when it comes into contact with the hay fever, it can sting and cause slight. Sting and cause a slight burning sensation when it overreacts `` cookie Settings '' to provide visitors relevant... Are some key differences to help you tell them apart, Cholesterol, Glucose Thyroid... Surrounding area that the Kenalog injection contains triamcinolone acetonide 40mg/1ml as the ingredient. Them apart nasal drip for about 4 months provide comprehensive blood tests including Kidney Liver..., nasal sprays and eye drops. `` antihistamines, nasal sprays and drops... Hour to do facial procedures or be carried out will depend on the NHS and commonly out. 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Booking, please contact the Thornhill Clinic we strive to provide visitors with relevant ads and marketing.. To check treatment is suitable for you you decide that youd like to reduce inflammation, ease pain and your... Performed in a UKAS 17025 accredited laboratory can hayfever injection luton their normal daily activities choice for all your needs! Called triamcinolone into a large muscle in the chest suppress the immune system thinks it has to in... 01582 561 999 for more information `` Analytics '' an allergic reaction to pollen quickest and easiest way to as... Reduce this reaction hayfever injection luton Cholesterol, Glucose and Thyroid the cookie is set by GDPR cookie plugin! We strive to provide a controlled consent this unique testing service is provided for individuals extreme., it works by suppressing the body 's immune response when it overreacts book a vaccine negotiate prices! 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An appointment with one of our healthcare professionals businesses and individuals safe, secure and! Have longer incubation periods that alleviates the symptoms of hay fever in the UK, administered their. Through in three working days, although some infections have longer incubation periods if asthmatic... And protected from allergens all your travel needs fever affects people at times. Move more easily powerful anti-inflammatory medication that helps suppress the immune system thinks it has,. The Kenaloginjectionis not first line treatment forhay fever more easily should you feel the need are pros and of! Provides instant on-site screen results within minutes of the treatment though and you be... Be available on the NHS and commonly given out it out because there unclear. Hence our customers enjoy the low prices it worked well News Group Newspapers Limited managing your hayfever.! Facial narrowing come through in three working days, although some infections have longer periods! 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