My latest hemorrhoid FLARE and SCARE. | Lessons learned.
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- Опубликовано: 8 сен 2024
- 🌟 Pranicura cream - hemorrhoids, anal fissure, anal itching treatment:
www.pranicura.com
😷 Dr. Chung is offering 💻 video consultations to everyone! This is Your time to tell your story and give additional information to help Dr. Chung give some recommendations to help you with your bottom end issues.
If interested, please email: YourFriendlyProctologist@gmail.com
❤️ I wanted to provide a place where you can easily gather supplies that will help you to better deal and heal your problem. I really appreciate you clicking on the links. Your support will help to grow this channel!
Stool softening:
Colace stool softener (100ct): cutt.ly/PTgUQJy
Colace stool softener (400ct): cutt.ly/4TgxpkF
Miralax laxative powder: cutt.ly/HTgURTC
Skin care:
Desitin barrier cream: cutt.ly/aTgUPQM
Calmoseptine barrier cream: cutt.ly/TTgUHlb
Dove hypoallergenic liquid soap: cutt.ly/2TgU1G3
Moist wipes:
Honest baby wipes: cutt.ly/tTgUNsl
Hemorrhoid care:
PreparationH cream max strength: cutt.ly/NTgUZit
Tucks pads: cutt.ly/NTgUXH1
PreparationH with lidocaine: cutt.ly/bTgUVbX
Recticare 5% cream: cutt.ly/yTgIeh1
Wound care supplies:
4x4 gauze pads: cutt.ly/tTgU7sx
Paper tape for skin: cutt.ly/fTgIqp6
Blue disposable underpad: cutt.ly/2TgIVzE
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DISCLAIMER: This video is purely educational and does not constitute medical advice. The content of this video is my personal opinion and not that of my employer(s). Use of this information is at your own risk. Albert Chung, M.D. will not assume any liability for any direct or indirect losses or damages that may result from the use of the information contained in this video including but not limited to economic loss, injury, illness, or death.
Thanks for keeping it real and relatable. Suffering alone is not fun!
Seeing all the pain we go through in our modern lives. I wonder how our ancestors lived their lives. Probably better than us since they did manual labor everyday.
I wonder as well
I'll tell you...way worse! Hemorrhoid problems have been documented since Ancient Greece! The treatments were barbaric and essentially torture.
@@yourfriendlyproctologist please tell me how to not get it every again these but problems.
@Your_Friendly_Proctologist your calm and moderated voice eases the panic I start to feel when thinking of my hemorrhoids . I believe I'd like a video consultation. How do I go about doing that ?
@@yourfriendlyproctologist Omg! You have to share the stories with us! I am so curious! I'm taking a Greek Myth class rt now, and I'm kind of sad they don't talk about this in their mythology 😁
I feel like this is the main reason why hemorrhoids develop in the first place: our muscles being unable to fully relax, more so than the popular belief of constipation and lack of fiber. When we are stressed, our muscles contract much like eye strain, some are voluntary while others are semi-voluntary.
Love your analysis! thanks for sharing.
I think its the pushing and straining
@@alistairfreedom2456 but why do you have to push and strain? Exactly.
Wow I only know to well about rectal trauma, seems to be getting worse everyday for me😞 I’m sorry for everyone that suffers and it’s nice that this channel gives it a voice!!!!
Bless this human being's heart..
Please get better
Ugh me too.. I've had hemeroids since I was 18 and have got worse. I'm 40 now. I also had IBS... ughh.. what is life
@@tyrantla7120😢
As awful as this experience was, it was nice to hear someone that is a professional and in the public eye on RUclips go through something that can be related to some viewers showing we are all human going through similar health trials.
Have you tried colestipol?
Aww doc I feel like giving you a hug 🤗 for having hard time there, we all relate completely and I’m just so happy you talk about it so openly, makes us feel we aren’t alone ❤ I’m glad we are here to help each other I’m glad I’m in this community
Yes! We need to stick together!
We are sufferer
Thank you Dr Chung for being so honest and willing to share your experience especially because you're a Proctologist yourself. That does not diminished your ability as a doctor but that doctors like also human like everyone else. Keep up the good work! You will be blessed!
Thanks for sharing and thank god this has gone away. Please continue to do what you are doing and spread the knowledge, you can't imagine how useful this channel is. These bottom end issues are so painful and it does really impact how we live and what we can and cannot do anymore........Appreciate the content and keep up the good work Dr. Chung!!
Thank you for your support!
As I listen to your experience I am struck with immediate gratitude…….your willingness to share and relate to those of us looking for information and support are so thankful. 😊 I’m sorry for all the discomfort……it seems that we’ll have that ‘food’ that messes with us. Personally, I don’t like “moderation “ when it comes to anything fun or tasty!, but it seems very necessary for many of us!! Like you say, lessons learned… so glad you feel some better today 🎉 Thank you so much for all you do 🤩🎉
Thanks for your support. Yes, moderation sucks for sure.
Had chronic constipation the last few years, about a month and a half ago the bleeding really started up. Napkins and the bowl itself had a lot of blood, and mostly painless bleeding as well. (Sometimes) It stung a bit like something spicy in there although - didn't go to the doctor but changed my diet to include more fiber. Seems to be doing better and sometimes I get a few drops of blood but NOTHING like it used to be. At first i was absolutely terrified that it was something else other than hemorrhoids or a fissure, (looking on google definitely didn't help) thought i was dying with a disease lol. But after some reassurance and changing my diet, I'm doing much better. Now sometimes i still have sharp sudden pains deep up there, but nothing too bad. Just waiting to fully recover now. So just hemorrhoids and a fissure, or one or the other. But By the grace of God i am healed! Stools are wayyy looser now, thank the Lord for prune juice!!!
A warm shower and massage the area. Dry gently and then Hemorrhoid wipes or cream. Then sit somewhere comfortably. I've been dealing with it twice a month for three years.
you are, without a doubt, the most human doctor I've ever seen. you really get down to earth with what happens to people. Thanks Doc!
I just wanted to thank you for sharing your story. It really does put it in perspective and helps show how everyone including even Dr's go through these situations. I have been dealing with mainly external hemorrhoids for about 8 years. I've also had a opene hemorrhoidectomy 2 years ago. Thank you for your story, hearing someone else going though this and with being a Dr really does help. I hope you continue to keep getting better though.
Thanks for your support! I always try to remember that I am a patient as well.
So how do you feel after the hemorrhoidectomy my brother?
I want to do same but I'm really afraid.
You had surgery and still suffers from hemorrhoids? Please reply.
how come you had surgery still suffering?
Sending you lots of love, Dr. Chung! Can’t imagine how scared you must have felt. People who don’t suffer from fissures/haemorrhoids never really need to worry about getting enough fibre/water - but this worries me (as someone who suffers from fissures) every single day! Your videos provide me a lot of comfort, knowing that a lot of people suffer (and even doctors!) from this. Take care and hope that everything settles back to normal real soon!
Thanks so much for your support! TRUTH!
Hello Sara I wanted to ask you does your fissures every go away.
@@johnphelps2513 hi john! The fissures will heal, but if I’m not careful (ie I don’t get enough fibre and/or water), then the fissures will come back and I have to repeat the entire process of healing it. I try to make sure I have about 5-6 portions in total of fruit and vege everyday. If I know I’m not able to meet that, I will still aim to get at least 5, but with a stool softener.
@@saraliwen5 so if you eat right for the most part you can keep it ar bay
@@johnphelps2513 yep that’s right. Think the last fissure I had was about a month ago. It’s been okay so far
I find 3 prunes a day helps, also Bran buds cereal with a few blueberries are beneficial. That's become my almost daily breakfast. Again, thank you so much for needed information and sharing your experiences, it's nice to know we are not alone with this.
Keeping it real with a down-to-earth delivery. Makes me feel better already.
Thanks for sharing your story. You save me from thinking I was going through this only. Your story saved me, Dr. Chung 😢😢😢😢😢
Thank You for being real,many will get better because of you! God Bless
You're amazing! And so cheerful. Yes I quit eating 10 days ago because my bottom end just couldn't take the pain anymore. Just a cup of broth and about 3 cups of Gatorade a day until yesterday. I added one bottle of ensure so I could lift my head off the pillow.
Four more days until my colonoscopy. (Which I'm nervous about) Whodathunk a bottom could hurt so much! 😭
Thanks doctor Chung for being so straightforward! Your videos save me daily!
You should have used something called Perineal Massage if constipated. Also, persimmons contains 80% water so it's hard to believe that they caused constipation. I find that if I eat slowly with smaller amounts of food at a time, the stools are smaller compared to gulping food down without much chewing.
Brah, I had almost the exact same experience except a baby came out...and THEN another baby came out! Wild. I'll never forget it either!
This guy is best doctor ever wow. I love the honesty. I feel so ashamed right now of my situation. It’s hard to talk about
This scary experience will make you an even better doctor. My proctologist doesn't understand my pain & anxiety from anal spasms. Thank you for sharing
Hello Dr Chung I am glad you are feeling better now
Hi! Thanks for the support!
Man I know what you mean to stand up and give a push. Such a relief. I have IBD and the feeling of constantly having to go is terrible, the push is fantastic. I have Bile Acid malabsorption too so I never have had constipation problems but severe watery diarrhea that I don't know is coming. Happy pooping!
Found this video while suffering from painful thrombosed hemorrhoids. Can't get in to see the doc until next week! It was so helpful to hear your struggles, to have someone just talk about these things without shame or embarrassment. I was able to laugh at myself. My nemesis? Broccoli! Honestly, you'd think broccoli was the best thing for hemorrhoids if you look online. But it destroyed me! Subscribed. Thank you so so much and I wish you always the best of health.
Omg just found this video, thank you for being so real with us! That turning inside out feeling is EXACTLY what I've had the last few days off and on while suffering with the hemorrhoids! You described it perfectly, I've been wearing Depends because of that and the leakage.
Thanks for sharing, doc. I've been having psyllium husk these last few months and it's helped so much with my constipation issues.
Thank you for discussing this issue. Just this morning I had a bad episode of constipation. First ever since my hemorrhoidectomy (10 weeks out) I've had too much fiber. I know what I did. Worst discomfort I've had is a painless throbbing afterward. Think I'll be alright. I do not want hemorrhoidal problems anymore. Although my post op recovery wasn't bad still, don't want to have to go through that again.
Btw, hope you're not experiencing any rectal prolapse.
Sounds like protalgia fugax to me. Episodes usually last 10 to 30 minutes. It is a spasm and can be associated with hemorrhoids. Lying down helps a lot and deep breathing. Hope you feel better. Oh persimmons are better when they soften. I never heard of anyone eating them crunchy.
Thanks for the warning for the aftermath that Persimmon does doctor Chung. I also love this fruit very much and eat 2-3 in one go but not again now. 😒
Get well soon doc and thanks for sharing your experience with us. Despite of this episode you sound so relaxed and positive that is something really inspiring. I start crying and get into stress for days after such incident.
Thanks for your support! They are definitely tough to deal with.
This is awful me my husband son daughter and my stepdaughter all suffering from what you describing it's agony and am embarrassing subject but we should talk about these things more it is very distressing when flare ups acure 😔
What a gem you are! Super helpful information and your transparency is a helpful reminder not to be embarrassed about these things. Thank you sir :)
I know exactly what you’re talking about. I’m going through it right now. I just hv been doing exactly what you did, all of it. Thank you for sharing, makes me feel a lot better knowing I’m not alone.
I went through a similar experience. Warm Sitz bath and deep breathing along with changing my pelvic angle fixed it for me.
What do mean by changing your pelvic anngle.
Do you mean posture?
I love you. You are evert patients want to be doctor. 😘
Dr. Chung, I absolutely LOVE you!!! I just came across your channel and I’m about to get everyone I know to subscribe to your channel. Dude, you are THE REALEST!!!
Know exactly what your talking about, really feel for you!!!!
Thanks for your support!
You are the REALEST! You've gained a new sub, doc! I am suffering with the hemorrhoids at the moment and frankly speaking I want to die lol
I just keep reminding myself it won't last forever. It's hard to believe myself at the minute though lol
Watching this as I'm lying down.. I wanted to go do errands but oh well 😭
You are very friendly doctor
Can you please make a video on infared coagulation of internal hemrhoids and what your thoughts are on the procedure?
Now you can feel the feelings of patients doctor.
Your talking style is amazing you have to take medical classes as a best teacher 👍🏻
I think u should have tried a TENs unit to knock out the spasms. One trode on an ischial, the other trode on the same side placed above and to the side of the butt crack. The TENs in a variable mode, not constant, can override and cancel spasms.
I am greatful with gratitude for your video. I am hurting so bad. I really want to die to get the pain to go away as I dont know what else to do. My doctors are not helping 😢 .
Thanks for sharing 👍. There is no better anecdotal experience online than an experienced Dr explaining the symptoms with all the knowledge to back up the explanation.
May I suggest that maybe unripe persimmons might be culprit? Did you have some allergic reaction (inflammatory)to them?
Hey Doc, and everyone else. If you feel that coming along again then do the cat/cow yoga pose before and then again afterwards. It really helps stretch that area out before you go and can make the result much easier. I usually start a bath just in case as well. Something else you can try is a vibrating wand to stretch out your pelvic area a bit. Also take just a little Vaseline and put inside before you go to kind of coat the area and help it slide out. Good luck! Im on week 17 of an external hem removed and seem to have picked up several tricks along the way.
Hi Dr. Chung thanks for recommending not to touch the anus as much as possible when having hemorrhoids!!! I got myself a bidet and the next day all my symptoms were completely gone!!! I’m so happy the burning and itching is gone! I was using lidocaine cream, medicated wipes and was getting very little relief. I love your channel! Thanks for all the information you share. Hope you’re having a fantastic day! ❤
Thanks for your support! Best to you.
a bidet just washes your anus, how is it possible that a bidet cured your hems?
Thanks for sharing. I had one last weekend. Spent 6hr until i was able to push out the poops. Had serious anal spasm. It was crazy and very painful especially because I am still recovering from the hemorrhoidectomy procedure i did a month ago.
It's the worst!
If I take 250-500 MG of magnesium at night, not only does it help me sleep, but it keeps the constipation away. Maybe this will help you. If not, try a high dose of vitamin c. You can safely take up to 8000 MG of C a day.
Been dealing with the internal hemorrhoids for a couple years, (literally ate Taco Bell everyday at work for years before, I I am linking the two 😂)
It’s got to the point where it prolapses during the day when I walk ( about 12 miles a day for work).
New scary symptom was a lot of bleeding at work, but now bleeding comes and goes, pretty much just when I poo. Blood drips till I replace my angry buddy.
Desperately trying to manage and shrink at home.
Any tips or advice is welcome!
Similar status here. More water, dulcolax, psyllium husk, more water, less or no diary, more water, smaller meals, repeat. This helped me a lot.
I have had a number of painful personal experience you are describing dear Dr. Chung, it was like having a light standard stuck in there. Sometimes I wished I could simply say, "Scotty, beam it out of there."
So TRUE!
I so appreciate your complete openess! I can relate to what you are saying. Using Pranicura
You're so awesome. Intelligence. Perfect pace. Great information.
Thank you for sharing YOUR experience! Hearing a wonderful Dr like you having an issue makes all of us feel that much more normal and we’re not fighting this battle alone! Glad things got better after laying down!
Thanks for explaining it so well, that’s exactly what I’m going through. It’s painful but applying pressure and lying down really helps
I don't know where you are from....But I am starting loving you....your an awesome an honest doctor love from India ❤️
Get well soon dok.
Wow, I so feel for you! That must have been super scary. Thank you for sharing and thank you for all the content that you do. It has helped me immensly. 🙏
Thanks for your support! It was the craziest thing ever!
How the heck are you still so pleasant in such pain?
LOLOLOL!!!! I'm definitely more scared.
@@yourfriendlyproctologist how are you doing now?
Good day dr Chung. I hope you have an awesome day. Appreciate you soooooo much. You're my hero.
Thanks so much for your support! you have a great day as well!
A certified practitioner being so vulnerable regarding his own speciality area at the expense of sounding stupid 6:59 ...you heal us dr. By being empathetic and relatable only.
Hang in there Dr. Chung! You’re an inspiration! ❤
I just found your channel as I have been trying to figure out what is going on with me.
First I am so sorry that you went through this a few months ago, very scary and not a fun experience.
I would guess you are a very good doctor as you can relate to this very embarrassing issue. After watching a number of your videos I am already feeling better about my hemorrhoid that popped out 2 days ago.
I appreciate your efforts to give clear and accurate information on how to deal with this problem, thank you.
Part of the battle--maybe the most difficult part--seems to be developing a willingness to get up off the toilet early...it's like you need to know the difference between swelling and not being finished.
Totally agree with you. The temptation to push out what you think is poop will result in pushing out your hemorrhoids, or possibly even prolapse your rectum. It’s a bad habit that I’m trying to break, so I feel the pain.
YES!!!!! x100000000000.
Has anyone resorted to "standing up" at the toilet to poop? I have never had luck with the squatty potty - but sometimes a standing /knee bent slight positon with a bit of movement - can facillitate the evacuation (if indeed there is more to go). These are issues most are blessed to never know about ... Currently have 2 chronic fissures (anterior and posterion)... For me everything went crazy in this dpt. after the COVID19 Booster vaccine :( - I was under control prior to that. :(
@@rls1231 I never went that far, but I have done the following: Stand up immediately after the BM, sit down again only if needed to pass more. It can make a certain swelling/pain cycle reset faster. There are vids on this channel that describe what happens as you sit on the toilet, and it heads off that "damage". So, kinda ya on your question.
You are a comfort to so many. Thank you for sharing and being so genuine i appreciate you.
I was experiencing this frequently,,,! 3 scopes over last 5 years,, but thank you, as I came across one of your videos about too much fiber,,, i have been great the last few weeks because I reduced the fiber,, psyllium husk and lots of water really gentle fiber and helping. I put the last leaflet regarding fiber post scope in the bin! I just focus on gentle soluable fiber now in small amounts. So thank you🙏🙏
Thanks for the laugh! I needed it. You are an excellent story teller.
A train through a mouse hole, lol too funny
Yes yes, same feeling im feeling from many days😭😭, pains moves around many parts of whole pelvic muscles
I love this channel!!! 😂😂😂 Doctor, you're the definition of REAL. ❤ #ImABigFan #Subscribed!
Loads of water, soluble fibre, Miralax, and a little vaseline before BM. That is my perfect recipe to survive...
Omg I've been going through this more months! My colorectal surgeon hasn't been able to do anything until I can get regular bowel movements. So for two weeks I've had one tbsp metamucil one prune bran cereal in plain yogurt and amatiza sp? Twice a day to get regulated. Finally regulated and seeing the surgeon Monday. He's done numerous bands in the past yr. Ughh!
Wish you the best!
Try homeopathy
You're so lovable, doc!
So are you!
I noticed a connection between a brow/hair growth serum & prolonged proctalgia fugax.
Supposedly there is an ingredient the the serums that create an over abundance of prostaglandins. My first very bad bout was with a thrombosed hemorrhoid, the second was just the spasming, for like 3 days. I asked for a muscle relaxer as my entire pelvic bowl & abs up to my ribs have been contracted & really tender.
Liquid GABA has helped too.
I hope maybe this but of info helps someone here.
Oh my God, I’m dealing with it right now. I have a haemorrhoid and Fisher and the pain is horrible. It rocks me to my knees and it lasts for hours.
Great video Dr. Chung. What was the reason the inside out feeling occurred? The sensation of the rectum falling out, is this related to a cancer of some sort? Thank you for your honesty.
Omg that's terrifying! It was like prolapsing almost! That's scary a.f. omg im still listening to the video as im typing and your description is terrifying. It's like your body was trying to get something out of there that was attached in there and the nerves thought it was a second poo or something. Dear god thats terrifying. The blood flow was going crazy. Jesus thats a terrifying story. I hope that never happens again.
I know I shouldn't laugh but this video was really funny, I know probably not intentional but it was even funnier coming from a proctologist I couldn't stop laughing...
You helped me by telling us to take the softeners with your meal combine with the meal - my wife said also pears soluble fiber or dulcolax with meal ! Thank you so much prune juice also nice and soft.
Don't use dulcolax long term. It can damage your colon.
Nice to know you’re going through something we are going through 🙏
Poor choice of words
I'm human....I eat and poop just like you!
I believe that sensation happens when your body is pushing the poop but the doors are shut. When we lie down the pressure releases but the urge to poop again will come after sometime when we stand and walk again.
Thank you. I totally share your experience
I've watched a lot of your videos and admire your honesty and telling it like it is Is graphically especially about your experience with hemorrhoids. I just have one question. Since you're the expert in this, how did you end up getting hemorrhoids?
I totally relate about not wanting to poop because it hurts for hours afterward. I’ve been using the pranicura but I feel like the hemorrhoids and fissure are getting worse. Off to my doctor tomorrow to see what my next steps are.😢
Take homeopathy Constitution medicine
So I’ve been having that exact thing for 18 months since a fissure which has now healed.
Sometimes the spasm feel like burning they are the worse. Sometimes I can’t feel the burning even with the spasm. But it is super frustrating to feel like you have to keep going. Drives me insane.
Either way lying down definitely helps. I’m trying Botox for this exactly reason. It’s gone in my puborectalis and IAS yet to see any results.
But I hve noticed many things effect the spasms behind the BM itself. It can be mental state or as you say the panic after. I find the worse thing is to be too active after a BM. Lying down for 20 mins done an amazing job especially after a bath!
Thank you for sharing this though!
Try homeopathy
Thanks for your tips and support! Yes, lying down also helps me the most as well.
I understand the fear. I fear every morning, because I know it's going to be bad or really bad. It often makes me depressed and I just wish my butt was normal.
This is The Iliad of Pooping.
Thank you for being real, Doc!
I have IBS c and piles for year's I know ur pain❤
Sorry but I had to laugh because you are so real and many of us have been there!
Hi Doctor thanks for your help sharing this video. I have problems with hemorrhoids I will like have something that cured me.
Apply the cream before going to poop...it helps
Dr you needed to used a warm water enema before the dump to soften the dump... once you knew it was hard you needed to use warm water enema to hydrate the rock
No need to do what u did. Use water
Thanks for the video, brilliant as usual.
I need your opinion regarding the laser as a technique for the hemorroids surgery.. Urgently please
gads - scary stuff - you take care Doctor Chung - I take it as a warning to be more conscious about what I eat ...
Life happens! I have to let go of things I can't control.
Thanks Doc. New subscriber here!
Welcome!
Hey Dr Chung. I'm so sorry you had to go through this. I'm hoping you feel better now.
Just curious to know. If you know you have some hemorrhoids down there? Why don't you remove them through a procedure? Your wife is a doctor, right? I remember you made a video of how you got a Rubber band ligation done.
Good question!
Currently just used my pranicura
For anal itching and burning from a hemorrhoid
I've actually got Colo rectal cancer and under treatment. However idk if my hemorrhoid is due to this tumor or if it's the tumor itself.
What I do know us that I've anal itching burning so badly that it literally has my body shivering in pain that I walk like I'm an elderly man.
So far the menthol feels soothing and cool. I pray that this product brings me relief and Salvation from the pain. So that I can sleep and allow this all down there to heal...
💞🙏👍
How are u now hope u feeling better
@Mahnam well idk if it's working to its full potential. But its somewhat given some relief.
Doctor dude! This is such good stuff. So I had something flare up in the last 2 days and I am in excruciating pain. Like I'm laying on my side and hip so there's no pressure on my ass. My rectum is just throbbing. Anyway I've had some troubles in the past and had the preparation h on hand so I've tried that but it's not really giving me much relief. I know I sit too much but it's hard to avoid. So I'm hitting the internet today inquiring about rings or cushions to sit on and I came across your name and a link to this channel.
So like basic stuff Idk. Never had any hemorrhoid issues till my '30s but I knew of them because my mother and grandmother were sufferers.
So I do remember getting checked out around age 30 and the doctor going yep hemorrhoids. Since then in the past 20 some years I get occasional blood with my stool. It's the bright red so I always just figure it's hemorrhoid.
Listening to you though, I'm wondering now if it isn't one of them fissure things. It's an internal not external hemorrhoid if it is a hemorrhoid. So it's really been hard to get that cream where I think it's needed, though if it's a fissure does preparation h even help?
How do you know which one you got?
So I don't think the preparation h I got has the lidocaine either...
I'm just wondering how to get some relief from this literal excruciating pain in the ass.
Its easy to fix.
It's hard to say without seeing you. I suggest seeing a specialist near you
At the age of 40, I can't believe I have this butt talking🤣..but yeah thnk you so much. I really need this so I understand I'm not the only one
Talking about fiber, as I understand there are 2 types of fiber. Soluble and insoluble fiber. We need both for better poop.
Soluble fiber attracts water. So if you eat persimmon (high in soluble fiber) then you may want to increase the amount of water you drink.
Does that make sense?
Absolutely correct and agree! I definitely lacked water.