[Daniel]

Hey ,

The ideal scenario we are striving for is personal. It is balancing the reasons for taking them versus are you happy with the costs. Reasons, why women take birth control, can be because of several reasons: preventing pregnancy, heavy & irregular cycles, cramps, acne, excessive body hair growth, PCOS, PMS, Anemia, etc
 
Unfortunately, people don’t get educated enough about the possible costs. Besides preventing pregnancy, all the other ‘reasons’ do have to a certain degree natural solutions, which in general aren’t taught to people.

But let me give you an example from my practice in which it wasn’t so clear cut: one of my female clients was struggling with PMS so bad she became physically violent once a year. If you asked her why she couldn’t explain why. When she uses birth control pills, her PMS symptoms are gone. To her the benefits of the pills outway the costs even after we talked about different solutions extensively. Do I believe natural remedies could have helped her and would be better for her body? Yes, definitely. But it probably would take some time to find the right balance. To her, it isn’t worth the risk if she hurts the people she loves. 
 
I guess I believe that the first achievable ideal scenario is that women are educated about natural solutions for other symptoms and educated about the risks of long-term contraceptives use.
Copper IUDsLet’s talk about IUDs now. Although copper IUDs don’t use hormones, I wouldn’t categorise them as naturally.

I personally look at it this way: Any form of birth control is designed to interfere with a natural process in the body.

How do copper IUDs work?
The copper IUD isn’t using hormones for this, but it works differently. The copper IUD is a plastic T-shaped device wrapped in coiled copper. The copper layer will start an inflammatory process that will kill the sperm. It will also inflame the endometrium so that the implementation of the ovum(egg) becomes hard. This is why some women experience heavier periods when they start with a copper IUD.

Heavy bleeding & how to asses risks.
I attached a document from Washington University in St Louise that reflects general advice about copper IUDs. Usually, these heavy periods become less after a while. The document says 3-6 months but may last longer.

I do have some doubts about this general type of advice. This research is a little older (2009) but followed almost 2000 first time copper IUD users a year long. From them
• 177 (9.1%) experienced more pain than before copper IUD use in the first 9 weeks. This number decreased to 68 (4.7%) after a year
• 106 women (5.4%) experienced an increase in menstrual bleeding after 9 weeks. This number dropped to 44 women (3.1 %) after a year.

This risk assessment is helpful before you place an IUD. Once you have a copper IUD and you have complaints, we have to make a new calculation to asses risks. We have to look at the change in the group of women who experience pain/menstrual at the beginning of the IUD placement and after a year. This means calculated from these numbers (and please realize that this is an ‘on the back at an envelope calculation’):
• If you experience an increase in pain after placing a copper IUD there is a 38% chance you still have increased feelings of pain after a year.
• If you experience an increase in menstrual bleeding after placing a copper IUD there is a 41.5% chance you still have increased feelings of pain after a year.

Now I do believe these numbers calculated from this study need more research behind them. Still, I just wanted to give you a rough idea of what it means when general advice says: after 3-6 months heavy periods usually disappear.

Does reducing inflammation help?
The first mode of action of IUDs is by creating inflammation. There is some limited evidence that stopping the formation of prostaglandins (with ibuprofen – see this study) helps with reducing the blood loss. Therefore anti-inflammatory supplements might help. 
• Try for example high dose omega 3’s (dosages between 2000-4000 mg of EPA+DHA) which actually helps to resolve the inflammation faster
• Curcumin (the Meriva form – for example, this supplement from Thorne) can reduce inflammation as well.

Estrogen dominanceHowever, copper & estrogen are related (see this video here from the mineral balance course). Elevations in copper could lead to elevated levels of estrogen for example. The natural hormonal cycle with the use of copper IUDs is still present unlike with the use of hormonal contraceptives which actually disrupt the communication between the brain & the ovaries.

Testing & Things you can do right now
If you are in your reproductive years a DUTCH complete test can give you insight into what type of estrogen imbalance you are dealing with and how you are detoxifying your hormones. With this type of information, you can do much more targeted interventions. That doesn’t mean you couldn’t do anything right now. These are things you can do:
• Make sure you aren’t constipated. By that I mean you need 1 bowel movement per day. If you are experiencing problems with that, focus on movement, eat the right types of fats (Olive oil & Avocados help in particular). Make sure you eat enough fiber, drink water, get enough Magnesium. In the presence of constipation magnesium citrate is the best choice for a magnesium supplement.
• With bloating, diarhea, cramping or other gut issues: the gut health masterclass is full of helpful tips. Estrogen leaves via the stool your body, but gets reabsorbed after staying 24 hours in the gut.
• Magnesium glycinate (my favourite brand of magnesium glycinate comes from Designs for health). This is magnesium bound to glycine, which is an amino acid necessary for bile & glutathione production. These are both important for estrogen detoxification as well. Magnesium helps with something we call phase 2 detoxification of estrogen.
• Zinc will help with female hormone balance (see this study) and could bring balance to a possible copper dominance that might be present. More targeted recommendations could be done by testing copper and zinc status as well. This is something I would recommend you do.
• B vitamins help with all kinds of liver detoxification.
• Broccoli sprouts contain Sulforaphane which helps to reduce the metabolites causing DNA damage. You will need 2 to 5 grams of Sulforaphane powder daily for that.
• Reducing estrogen-like substances from plastics, makeup and pesticides, herbicides and insecticides in your life.
• Reduce alcohol intake since alcohol and estrogen compete for the same enzymes that will break them down.
• Make sure you can produce enough progesterone by reducing stress, reduce inflammation in the ovaries, insulin resistance, PCOS, Hypothyroidism, low cholesterol, too much or aggressive exercising, and age… Ok, the last one can’t be helped, but in the 10 years before menopause, we often see progesterone slowly decreasing.

As I said: with testing there are many more targeted interventions you could do. If you like to explore that option, we can help you with the interpretation of for example the DUTCH test, which in my opinion gives you a lot of insight.

I hope this gives you some answers you can work with!

[Daniel]

Hey ,

Welcome around here! My name is Daniel and I help Bernadette on the platform. I hope we can guide you to some relief!

Understanding how estrogen & progesterone dance with each other will help you make it easier on deciding how to approach your perimenopausal symptoms.

Keep an eye on the general tips section. I am near completing an article (2-3 minutes read – I hope) that will describe how estrogen & progesterone behave during a cycle.

Yes, heavy periods are a risk factor for low iron. Another thing to keep in mind is that there is a genetic condition called Thalassemia that causes low iron levels. Have doctors ever ruled this out? I’m just asking in case you like to use iron supplements. With Thalassemia iron supplements might not work for you –  or make things worse, so be aware!

If you have been tested, we have a course around minerals in the monthly courses folder. You can find the video’s over iron here (just click the bold words, they are hyperlinked). The video about correcting iron deficiency will be answering those questions.

 

[Daniel]

 I will let Bernadette advise on your question about Spatone. I just want to present you an liquid alternative which contains Ferrous Bisglycinate which is also very well absorbed. I am talking about this iron tonic from Vitanica.

Be aware that with a possible H. Pylori infection stomach acid might be low and iron could be harder to absorb. The enzymes that free the iron are in the stomach acid and need vitamin C to do their job.

GI Maps could be used to test for H. Pylori. Breath tests can be used as well, although  might have some additional recommendations here.

Probiotic strains that can help with reducing H. Pylori overgrowth according to studies are Lactobacillus Reuteri and Lactobacillus johnsonii la1. 

Saccharomyces boulardii helps as well, but if you are suspecting yeast sensitivity this might not be the best option since this is a yeast.

I personally recommend starting with bitter foods based instead of digestive bitters. They can help digestion as well. I know kids might not always like some of them, but here are some options:
• bitter melon
• dandelion greens
• Jerusalem Artichokes
• Cranberries
• Chicory
• broccoli
• arugula
• kale
• radicchio
• endive
• Brussels sprouts
• dark chocolate

I hope this helps!

[Daniel]

Hey ,

Personally, I have no experience with the brand or the ingredient humic extract. They mention ‘terrahydrite’ on the bottle which is a lignite that contains humic acid within turn contains fulvic acid.

I’m afraid that because of the acids it might not be the right choice for you right now.

[Daniel]

Hi ,

I love that you have shared this bottle of ketchup. Let’s turn this into a discussion! A lot depends on how often you use these products and what you try to avoid in foods.

What is for you important besides that the ingredients are of organic origin? Do you like to avoid salt for example? Are you avoiding grains? Sugars? Additives?

I do see on the ketchup bottle the word ‘spices’ which could mean so many things. The FDA has a complete list of what can be called spices. Just click here – and search “182.10” in the Title21 Part.Section field:

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm

They define ‘spices’ as:

Any aromatic vegetable substance in the whole, broken or ground form.
The significant function of food is seasoning rather than nutritional.
Material is true to its name and no portion of any volatile oil or other flavoring principle has been removed.

Exceptions to this rule include, salt and any ingredients traditionally thought of as food.

I hope that this can help you make your choice.

Personally from the labels you posted, I would have bought them both 😉

[Daniel]

I agree with  🙂 The reason is that an overgrowth of H. Pylori can lead to damage of the stomach lining and this could lead to ulcers when you are supplementing with betaine HCl.

[Daniel]

Hey ,

Fasting Insulin
I usually consider fasting insulin between the 2-6 uIU/ml optimal. (The typical reference range is: 2-25)

OGTT (Oral Glucose Tolerance Test)
The glucose tolerance test (usually done with 75 gram of glucose – not with food) gives back a curve. 
• The curve is optimal when blood sugars spike in the first 30-60 minutes and return to normal after 2-2.5 hours. The highest value should not exceed the renal threshold (160-180 mg/dl). This means basically there should be no glucose in the urine afterwards.
• With early insulin resistance, we can see blood glucose drop after 2-2.5 hours below fasting levels. In this stage blood sugar levels can still appear normal, but there is already a more robust insulin response. In this stage, insulin is winning and blood glucose is dropping below fasting levels
• In a more advanced stage, blood sugars rise less quickly (the blood sugar peaks between 1-1.5 hours). The highest blood sugar level exceeds the renal threshold.  The blood glucose level does not return to normal after 2.5 hours.

Just remember that a blood glucose meter can make errors. With mild unclear values, you wouldn’t want to evaluate only one curve(Because glucose is a reflection of insulin). For that reason, I usually recommend doing an oral insulin tolerance test at the same time.

for both these tests, make sure if patients are on a ketogenic diet they raise their carb intake for a minimum of 3 days.

Fasting glucose
I consider optimal likely between 80-88 mg/dl. Above is evidence of insulin resistance.

C-peptide
I consider optimal likely between 1-2 ng/ml (with a typical reference range of 1.0-4.2). 

I hope this helps!

[Daniel]

 Wow! This is how powerful ‘small’ lifestyle changes can be! Congratulations!

[Daniel]

Hey ,

Welcome to B Better! My name is Daniel and I help Bernadette on the platform.

I have learned in this field: there is always another layer. The feeling of ‘still missing a few key pieces is actually quite healthy to have! That being said, if there are specific areas you would like to know more about feel free to ask.

If you post them in the ‘Ask Your Questions’ space like Bernadette mentioned, we can turn them into a learning opportunity for everyone.

Happy studying here!

[Daniel]

Hey ,

Did you have her tested, for example with an OAT, a MycoTOX profile or some other test? Do you know if there is an environmental exposure? Is the mold infection in the sinus, longs, GI tract? Or at another place? Right now I will give you some tips if you believe there is mold in the gut.

With any treatment of mold I would recommend finding out where and how she was exposed.
 
• Was there water damage somewhere in the home/school or other places she visits regularly?• Think for example of basements, wall cavities, showers, leaks in roofs, windows or pipes but also behind floor & ceilings
• Mold can also grow in areas around heating and cooling appliances. 
• Mold grows well on paper products, cardboard, ceiling tiles, and wood products. Mold can also grow in dust, paints, wallpaper, insulation, drywall, carpet, fabric, and upholstery.
• Do you suspect she was contaminated by moldy foods?

If you think environmental mold exposure isn’t a problem anymore, you could help her by getting rid of mycotoxins and mold. Here are some strategies:

Mold
If you would like to use botanical antifungals I usually recommend my clients. In the general tip section, I have written about Candida here & here. Goldenseal (active ingredient is berberine), black walnut, garlic, echinacea, grapefruit seed extract are all ingredients that have antifungal properties. A Broad spectrum antifungal product I like is for example Biocidin from biotic research (always use in combination with GI Detox – click here and here to find them in Fullscript)

Mycotoxins
Molds produce toxins called mycotoxins. Even when you address mold, mycotoxins could still stay in the body. You can remove them by supporting the body with detoxification.
• NAC is a precursor for glutathione, an antioxidant which also helps detoxification
• Glutathione as supplement is also possible. Make sure its a liposomal form though
• GI Detox has a lot of binders that bind to toxins in the gut. If you are using antifungal (yes, also botanicals) the fungi die and their toxins are freed up in the GI tract. Binders can prevent some of those toxins to make someone feel worse.
• Probiotics in foods an beverages can also help. With kids I like to work as much with foods as possible. The B Better library (click here and scroll down) has some powerful recipes for probiotic foods & beverages.
• Bitter plant foods can increase bile flow which can help to get rid of mold as well. Here are some bitter foods that I sometimes recommend to my clients: broccoli sprouts, chicory, radishes, dandelion greens, and arugula contain phytochemicals that activate bitter taste receptors, causing a chain reaction of physiological events that lead to enhanced bile flow. You could also brew Organic Danelion tea as an option.

[Daniel]

 Giving your immune system support with some zinc can help if you are zinc deficient. But you need to know if you are first. 50mg of elemental zinc is quite a lot though and could cause nausea within 1 hour of supplementation.  I also would recommend supplementing with high levels of zinc for a short time only since high levels of zinc make it hard for copper to be absorbed. Personally I don’t recommend my female clients to take more than 40 mg if they are zinc deficient and on a low zinc diet.

Click here if you would like to learn more about the signs & symptoms of a zinc deficiency.

An autoimmune disease is not necessarily caused by a weak immune system. More by a busy immune system. Let me try to explain – and I know I oversimplify this here.
How can autoimmune issues start?Some types of white blood cells called macrophages can ‘eat’ and kill pathogens or components that are foreign to our own body. They can engulf viruses, bacteria or other things foreign to our body like parts of bacteria called Lipopolysaccharides (LPS for short). LPS can come from gram-negative bacteria living in our gut. When the gut lining is damaged those parts could get into the circulation of our body.

Now the macrophages are part of our innate immune system and ‘live’ mostly inside tissues. Sometimes they say ‘Hey, I can only do so much’ and ask the help of the adaptive immune system. They present some proteins unique to the foreign invader to help produce antibodies for example.

Neutrophils are another type of white blood cell that can eat and trap pathogens and just like macrophages they are part of the innate immune system. They are the most abundant type of white blood cells. But unlike macrophages they don’t help with antibody production.

What can happen is that a neutrophil engulfs a pathogen. Now it just sits and waits until other parts of the immune system, for example, macrophages come along and deal with them.

But Neutrophils, once eaten a pathogen will fall apart after a certain amount of hours and if they are not dealt with in time, they release their toxic content.

If this happens in tissue layers like for example the thyroid, this then can cause inflammation in these tissues and cell death of the body’s own tissues (in this example the thyroid). That inflammation communicates to the rest of the body: we need more neutrophils.

And now a vicious cycle can be formed. Neutrophils come in, engulf the toxic material, sit around & wait, die off and fall out of each other, spilling their toxic content, which leads to more inflammation and thyroid tissue death…

Where things get tricky is that the macrophages that engulf (just like neutrophils) bacteria, viruses and other toxic debris like dead tissue now start to learn the adaptive immune system to deal with the dead cells of the thyroid tissue and picks it up as a problem. Suddenly your own thyroid tissue becomes a target.
Where to focus on with autoimmune disease?With autoimmune disease, I like to reduce the load on the immune system with my clients and provide nutrients for optimal function of the immune system.
 
We like to have optimal vitamin D levels. Why? Because vitamin D is necessary to keep the tight junctions between the cells in the lining of the gut closed. This is to minimize unwanted exposure to foreign material coming from the gut. I usually advise avoiding gluten, because gluten can open the tight junctions as well. Of course, vitamin D is also necessary for optimal immune function and it helps reduce inflammation. Things that further help resolve information are for example the omega-3 fatty acids EPA & DHA.

Other nutrients that our immune system needs are vitamin A and the B vitamins. Some people aren’t real good converters of the plant-based precursors of vitamin A (betacarotene) and do well to have the fully formed vitamin A in their diet (in supplements I personally look for ‘retinal-palmitate’ on the label since I like my carrots and sweet potato, so I get enough betacaroteen from foods)

I usually focus on stress reduction, reducing inflammation, focus on organic foods, gut healing, addressing SIBO if this is at play, and having optimal hydrochloric acid in the stomach.

All the things we described in ‘The Gut Health Masterclass’ will help – which if you didn’t watch it, I really recommend you do! You can find the masterclass here.

But supporting your immune system with zinc is definitely part of it! If you do want to be on the safe side because you don’t have Signs and symptoms of a zinc deficiency you can add 10-15 mg of zinc in supplement form without testing. There are even nice products containing zinc & a little copper that makes sure you keep your minerals in balance! 

[Daniel]

Hi ,

First of all, I hope your daughter is doing weel considering the circumstances. These labtest (although some labvalues still show status ‘pending’) can provide us some insights already.

You mentioned you were doing lab tests since September. Does that mean you have other tests done as well? Posting them as well can provide us even more insight into what might be playing.

I will be sharing some key insights I see on the labresults. These insights give us directions on what to do.

Low Iron
You might have seen the low iron on the labresults yourself as well. Iron is needed for the production of hemoglobin – which carries oxygen and gives the red blood cells a certain size. On this labresult you can see other markers related to Hemoglobin as well:
• MCH (Mean Corposcular Hemoglobin) – A value that refers to the average quantity of hemoglobin present in a single red blood cell. 
• MCHC (Mean Corposcular Hemoglobin Concentratioon) – A value that refers to the average concentration of hemoglobin inside a single red blood cell.
• Transferrin saturation – Transferrin is a carrier protein for iron. The saturation refers to the percentage of transferring carrying the iron
• Ferritin – A storage form of iron.

What you can see here is that all these markers are either just bearly in the reference range – or low. The symptoms (pale, hair loss – if you want to learn more about signs & symptoms of an iron deficiency just click here) you are describing are fitting with anemia which can be caused by an iron deficiency.

Low iron can be caused by a low iron diet which can happen on plant based diets, but also due to absorption problems. Here is a video on how to correct an iron deficiency. Just be aware that (simmering) infections can make it hard for the body to absorb the iron. Its the an attempt of the body to protect itself because microbes/viruses can use iron to make things worse. If you are going to use iron supplements when an infection is going on, raising iron can be hard or cause problems. 

Before you consider iron supplements you might want to answer these questions first:
• Was your daughter feeling ill around the time when this test was done?
• Does your daughter have any digestive complaints (Bloating/gass/diarrea/constipation/cramps/etc)

Hormone balance
Another thing to keep in the back of your mind when it comes to iron is that your daughters body is starting to change. Her female hormones are becoming more active. This process more often than we would like is going to cause a temporary disbalance. 

This is normal. 

But getting periods is new to her body. When women are starting their menstual cycle the blood loss can increase the risc of an iron deficiency as well and the needs for iron go up.

Vitamin D & Immune system
I have mentioned that infections can impair iron absorption. On the labresults you can see that the amount of white blood cells is enough. However, the ratio between the neutrophils and lymphocytes tells us that either something was going on – or still is going on to a certain degree. Neutrophils are the primary mediators of the rapid innate host defense against most bacterial and fungal pathogens. With an immune system in rest we usually see the percentage of neutrophils higher and the percentage of lymphocytes lower.

We also see a low vitamin D on the lab results. Correcting vitamin D levels will give the immune system more support to what might be at play. Zinc & B12 play also an important role in the creation of white blood cells. I usually with my clients aim for B12 levels of 600 or higher since I consider that as optimal.

Low thyroid hormones
You also might have noticed the low T4 and free T4 (fT4). fT3 is the metabolic most active thyroid hormone and is in the lower half of the reference range. Insufficient iodine is the most known nutrient deficiency that can cause a low thyroid, but iron is crucial as well for balanced thyroid hormones. Stress, for example caused by an infection, can lower thyroid hormones as well. Lastly, thyroid hormones can also be influenced as a result from the sudden change in her female hormones.

Therefore my advice would be: focus on correcting the vitamin D & the iron deficiency first. Usually it can take a few months before anemia disappears, but since her hemoglobin looks like it is borderline you might see improvements faster. You might need to wait at least 6 weeks when you start correcting her iron levels before you notice any improvements. Most people recover from an iron deficiency anemia in 2 to 3 months.

I hope this helps!

[Daniel]

 I would love that!

Cheers

[Daniel]

Hey ,

Welcome here! My name is Daniel and I help Bernadette on the platform here! Feel free to ask any question you like! I hope you will enjoy the content.

I see you are from India. I totally love Indian food! If you feel like sharing good recipes, you will have at least one big fan! 

[Daniel]

Hi ,

There can be many reasons for joint pain. Sometimes the root cause can be viral, sometimes there are immune complexes building up in the joints, sometimes inflammation can cause swelling in the joints. All cases need a different approach.

Maybe you can help us help you by giving us a few more details about your lifestyle. For example:
• How often did you work out in the last few years?
• What type of workouts do you do? And how long are you exercising for?
• Are you using supplements and if so, what supplements are you using? (Think about protein powder, vitamin D, magnesium, omega 3’s, etc)
• What does your diet look like? Are you consuming a lot of protein since you are working out? 
• How old are you?
• Are you experiencing a lot of stress in your life?
• How is your sleep? Are you waking up refreshed?
• Are there any medications you are currently using? (This includes PPIs, any kind of pain medications, etc)
• Are you having gut related problems? (Blpoating, gas, diarhea, constipation, cramps, etc)
• Do you have allergies or food intolerances that you know of?
• Did you use antibiotics in the past?

Vitamin D/K2
Often inflammation plays a role in joint pain. We can help the body manage inflammation by having optimal vitamin D levels. If you are currently not supplementing, I recommend checking your blood levels and bringing them up if necessary. Where I come from without medical supervision you can supplement up to 4000 IU safely. But if your levels are low, you might need higher dosages. I personally try to keep my vitamin D levels around 75 nmol/l.

Raising vitamin D levels will increase calcium absorption. Vitamin K2 mk7 or mk4 will help calcium directed towards bones. If you like to use higher dosages of vitamin D I recommend you use a nice combination formula like for example this product from Thorne. By the way, this link will bring you to an online supplement store called fullscript. B Better members get discounts, but you need to sign up first. High calcium can build up in joints causing joint pains as well. If you are already supplementing with vitamin D but without K2 I would recommend you add K2 as a supplement.

Magnesium
Magnesium is anti-inflammatory, can reduce pain by influencing receptors in the brain and is needed to relax muscles. Stiff muscles can cause joint pains as well. Magnesium malate & glycinate are well absorbed. Magnesium oils containing magnesium chloride can be applied topically and could provide some relief as well. Although the RDA for men for magnesium is 400mg, a lot of people benefit from dosages between 400 – 1000 mg. Magnesium is also needed to convert vitamin D to its final form, so make sure you are not magnesium depleted. If you would like to know what the signs & symptoms are of a magnesium deficiency, click here. Workouts, sweat, stress, coffee and a refined diet can deplete your magnesium levels.

Specific recommendations for joint pain.
With joint pain, high dosages of DHA+EPA can help. I often recommend my clients dosages of 2000-4000 mg of EPA+DHA (note that I am not writing fish oil or Omega 3). EPA & DHA help resolve inflammation.

Omega 3s in combination with curcumin help often well with pain. Make sure you use a phytosome form of curcumin (Thorne has a nice product called Curcumin phytosome, just click here). I recommend my clients for quick relief 2x daily 500 mg and increase slowly to 2x 1000 mg if needed.

A more specific anti-inflammatory product used for joint pain is Boswellia. An effective dosage I sometimes recommend people could try is 300 mg. Pure encapsulations has a high-quality Boswellia product – just click here.

Immune complexes
Sometimes pain in joints is caused by immune complexes that have built up in joints. Proteolytic enzymes taken on an empty stomach could help to break down immune complexes (Otherwise the enzymes will just help with digesting food – so taking them on an empty stomach is essential).

I had some good experience with IntenZyme from Biotics Research (just click here). Taking these 2x daily for 2 weeks could lead to some relief if immune complexes are causing the pain.

Again – these recommendations might help with pain, but might not help you address the root cause. If inflammation is the root cause, we still need to learn why the inflammation is there. If immune complexes have build-up, it’s still important to need to know why and address this.

We might be able to help you better when you have answered these questions above!

I hope this helps!