Signs and symptoms of UTI

The most common symptoms are

1. burning sensation or pain during urination
2. need to urinate more often than usual
3. urgency of urination and pain during intercourse.

If the infection is severe and the kidneys are also involved, there can be fever, nausea, vomiting, malaise and pain in the abdomen or flanks.

These symptoms may also be accompanied by cramps in the lower abdomen and blood or pus in urine.

Women Are More Prone to UTI

UTI is more commonly seen in women than men because anatomically a woman’s body is more prone to infections of the urinary system. They are so common that more than 50 per cent of women will have at least one episode of urinary tract infection during their lifetime. More so, about 40 per cent of these recur within six months of the first episode of infection. UTIs are more likely to occur in women who are newly married or have a new sexual partner. The term ‘Honeymoon Cystitis’ has been applied to the phenomenon of frequent UTIs during early marriage. The other risk factors are pregnancy, after menopause or in women who have a history of kidney stones, diabetes, stroke, and bladder surgery.

Pregnancy and UTI

During pregnancy, especially in its early stages, women have an increased risk of urinary infection due to the rise of the hormone progesterone. This causes a decrease in the tone of the bladder and ureter, which leads to a greater likelihood of urine flowing back up the ureters and towards the kidneys. During pregnancy, even if there are no symptoms but the urine test shows presence of bacteria, treatment is still recommended as there is a  25 per cent risk of infection spreading to the kidneys. Recurrent urine infections during pregnancy can lead to anemia, pre-term labour, pre-eclampsia [high blood pressure], and may also affect growth of the baby.

Menopause and UTI

After menopause, the risk of urinary tract infections is higher due to a deficiency of the hormone estrogen. Any sign of vaginal infections like discharge or any foul-smelling odor should be treated by the gynecologist.

Urinary tract infection is diagnosed by doing a routine test of the urine to check for pus cells, red blood cells and bacteria. Urine culture and sensitivity testing is also done to identify the bacteria-causing UTI and treat it with an appropriate antibiotic. If there are recurrent UTIs, one may go for an advanced ultrasonography of the kidneys and urinary bladder. The urologist may suggest intravenous pyelogram [IVP], CT scan or cystoscopy. UTI is treated with antibiotics for 7 – 10 days. If there is severe or recurrent UTI along with fever, a prolonged course of antibiotics is advised. Symptomatic relief is offered with the help of urine alkalizers and bladder relaxants.

7 Tips to Prevent Urinary Tract Infections in Women

Here are a few ways you can protect yourself against contracting a UTI.

• Drink at least 2 – 3 litres of water daily. Avoid excess of caffeine and alcohol, as that can cause the body to lose fluids. Cranberry juice is recommended for those who have recurrent UTIs since it has properties which make the bacteria adhere less to the urinary tract.
• Keep your genital area clean and use only cotton underwear and pantyhose. Maintain good toilet hygiene. For example, pat genital area dry, wipe from front to back and not in the opposite direction as this prevents bacteria from anus spreading to the urethra and vagina.
• Avoid using irritating cosmetics or chemicals in the genital area like strong soaps, scented napkins or liners. Do not douche.
• You may use medicated lotions with lactobacillus for hygiene of genital area. Lactobacillus is the good bacteria normally present in the intestinal and vaginal flora, which maintains the protective acidic pH balance.
• Urinate and wash before and after sexual intercourse.
• Avoid sexual intercourse during urinary and vaginal infections. This can aggravate the infection and also spread to your partner.
• Maintain good immunity level with adequate dose of vitamin C, vitamin D and Vitamin A. Eat citrus fruits like oranges, sweet lime and amlas [Indian gooseberries].

The post Treating and Preventing UTI in Women appeared first on Complete Wellbeing.

If night sweats are plaguing you [and your partner], here are some simple solutions to prevent or lessen them.

Deep breathing

Simply breathing slowly and deeply can lessen a severe hot flash and stave off night sweats. Before retiring each night, spend some time deep breathing as a preventive measure. At the first sign of excess heat during the night, gently relax your muscles and breathe in quietude.

Bedclothes and bedding

Changing the fabrics that you sleep in [and on] is a great first step to beating the heat. A number of companies now sell wicking sleepwear for people suffering from night sweats and flashes. These pyjamas literally wick away heat and moisture as you sleep, preventing a night sweat from becoming a bed drencher. Always be sure to wear loose fitting and light bedclothes as constrictive clothing is known to precipitate night sweats.

Cooling bed linens also aid in preventing night sweats. Bamboo sheets and/or mattress pads are naturally cooling. Linen sheets cool as well, but some find them too coarse for comfort. Ditch the high thread count bedding for low thread count cotton which has a looser weave, allowing air to circulate more freely.

Down comforters are very popular, but can trap heat and increase the incidence of night sweats. Try a light cotton comforter or blanket, instead. Similarly, down pillows can cause overheating, so replace them with a comfortable synthetic or one made with buckwheat hulls.

Stress is a frequent trigger of hot flashes and night sweats

Cool the bedroom

Open the windows for breeze or turn on the air conditioning. If this proves too cold for a bed partner, a fan may be a better option.

A simple bedside fan can provide instant relief.

Exercise

Regular exercise has been shown to reduce the severity and number of hot flashes and night sweats. Think of it as sweating during your workouts, so you don’t have to sweat at night. It has the added benefit of reducing stress which too is implicated in nocturnal flashes and sweats.

Stress reduction

Stress is a frequent trigger of hot flashes and night sweats. Unfortunately, each nocturnal episode of overheating causes more stress and a vicious cycle can ensue. It’s important to relieve stress on a daily basis to reduce these occurrences.

Meditation has been shown to decrease the incidence of night sweats. You don’t have to take classes or do anything special—simply set aside time to relax without interruptions and clear your mind.

You may also wish to try a walking meditation—simply walk noticing every step, the trees, breeze, and birds. In this way, you can get your exercise and reduce stress at the same time.

Avoid sugar, which has been linked to an increase in night sweats

Natural modalities

Be cool. At the first sign of a hot flash, apply something cold to the back of the neck or to your wrists—you can use an ice pack or a bag of frozen peas. Using an ice pack covered with a soft cloth can aid in sleeping and help prevent those night-time hot flashes.

Hypnosis and acupuncture have been shown to be successful for some women in reducing these and other symptoms of the Pause. If your night sweats are not diminished or relieved by the above suggestions, you may wish to try one of these complementary treatments.

Yoga has been shown to provide both, relaxation and the added benefit of increased flexibility. Be sure to check with your yoga instructor about poses that are beneficial for midlife women. Bikram [hot yoga] is not recommended for women who are suffering from hot flashes or night sweats.

Diet

Increase your intake of soya, chickpeas, flaxseed and lentils which contain plant oestrogens that may act as weak oestrogen for your body. Other foods that are beneficial include grains, beans, fruits and vegetables. It is recommended to use these dietary sources rather than supplements which may cause sensitivity or allergies in some women. Avoid sugar, which has been linked to an increase in night sweats.

Avoid hot flash triggers

Ideally, avoid caffeine, alcohol, chocolate and hot beverages as they can cause hot flashes. If that feels like all the joy has gone out of your life [as some women have told me after hearing this suggestion], then try limiting your intake. If you do have an evening cocktail, limit yourself to one several hours before bedtime. Similarly, with caffeine, chocolate or hot beverages, try not to indulge after 6pm.

Spicy food is another culprit that can raise your core temperature and lead to night sweats. If you are suffering from night sweats, you may wish to avoid your favourite Mexican, Thai, or Cajun dinners until your hormonal state stabilises.

Keep a track

Every woman’s menopause is unique. Discover your own hot flash triggers by keeping a hot flash diary to see what produces or exacerbates your flashes. Note what you were doing, how you were feeling, what you ate or drank prior to the onset of flashes or night sweats. A pen that lights up when you click it on is ideal for night time notes without waking your partner.

Time

Tincture of time helps in all things, including menopausal night sweats. As your body reaches a new level of hormonal balance, these and other symptoms will likely diminish or disappear. Menopause can be a wonderful beginning of a woman’s Second Act, once the worst of the changes are in her rear-view mirror.

Note: Night sweats are a common symptom of menopause but may also result from other more serious conditions. If you suspect you are perimenopausal or menopausal, it is helpful to have your hormones tested by your trusted health care practitioner to confirm this as well as to rule out other causes. Certain medications such as antidepressants and certain high blood pressure meds may cause or worsen night sweats.

The post Are night sweats keeping you up? appeared first on Complete Wellbeing.

Anxiety

There are many emotional factors particular to perimenopause that can contribute to anxiety. When perimenopause hits, a woman is likely to suffer from anxiety as well as depression. Anxiety is a mental state where you worry too much—sometimes persistently—are nervous and tense. You can’t seem to shake off your concerns and worries about everyday events even though you know that your anxiety is unjustified. You can have difficulty concentrating and feel restless and irritable, which can sometimes lead to panic attacks. Changes in oestrogen levels have a direct effect on the neurochemicals that regulate mood. Hence, fluctuations in them can lead to anxiety. Other social factors, like worrying about your child’s exam results, may worsen this condition. Managing this condition requires a lot of family support and understanding, lifestyle changes and sometimes also medication.

Even for those women who are essentially happy and upbeat, things may change quickly and drastically when perimenopause appears. It’s a time of emotional distress. Because of this, they have more conflicts than usual with the people around them and that creates tension. At this stage, some women even go through a difficult time with their husbands sexually, which further aggravates anxiety. The problem may also be aggravated by caffeine, stress, thyroid problems, or heart disease.

Anxiety leads to palpitations or rapid heartbeats. It is a good idea to visit a physician and have a thorough check-up done if the heartbeat is faster than 100 beats per minute. If all your tests are normal, try yoga and relaxation techniques and avoid caffeine, colas, smoking and alcohol—these steps will help reduce episodes of palpitations.

Depression

Women over the age of 40 go through a lot of changes that can give rise to depression in them. This doesn’t mean that every woman over 40 will get depressed. But if your life was already stressful, the physical and emotional changes that typically accompany menopause may send you into a full-blown state of depression.

Depressive illness can make you feel exhausted, worthless, helpless and hopeless, and sometimes you may just want to give up. Women often suppress their need of autonomy, neglect their health, and fail to equip with skills, competence and self-confidence.

They may experience sadness, crying spells, sleeplessness or excessive fatigue, lack of interest in surroundings, neglect of self and display other signs of depression which may be as serious as suicide attempts. Treatment consists of lifestyle changes, exercise, yoga, support from family and friends and often anti-depressant drugs.

Mood fluctuations

Frequent mood change is the most common symptom of perimenopause. As a teenager, some of you may have cried at the drop of a hat. As a woman in your 30s PMS made you bite your best friend’s head off when she asked you how your day went. Or remember-that feeling of wanting to punch someone because they just wouldn’t shut up when you told them to? Well, that feeling is going to come back to you when you least expect it, in circumstances that may at times be classified as volatile. We’d all like to keep these episodes to a minimum, but perimenopause can sometimes make that seem like an impossible challenge. Perimenopause shares many of these symptoms with PMS. The difference is that PMS lasts only for one week, once a month, but perimenopause can last anywhere from 1 to 10 years. It’s no wonder that the overriding emotion women in their 40s feel is that of being overwhelmed.

And because you have to train yourself to cope with these feelings, perimenopause also results in a pretty drastic change in a woman’s personality. There are days when you don’t really know what is happening with you. You’ll find yourself annoyed by things that you never even noticed. I have had patients who are very disturbed by the changes that are taking place because they’re shocked by the fierceness of their irritability and the sharpness of their mood swings. Wild mood swings and increased irritability are linked to the sudden shifts in hormonal balance. These fluctuations in the levels of oestrogen, testosterone, and progesterone can occur when your body doesn’t get the right kind of support to maintain a natural balance. Sometimes, mood swings can take you high and you feel intense joy in everything around you. At other times, however, they can take you on a downhill ride with emotions such as sadness, anger, despair, anxiety, or fear.

A mental shift

40s are a time when many women find themselves at the peak of their career. While the 20s were spent trying to climb the ladder of success, the 30s were about consolidating your presence in the workplace. But it’s in your 40s, that it all comes together for you. This also means added pressure and stress.

For homemakers too, this is the time when they begin to assert their independence. By this age, a woman realises that time has passed her by and that she now has to make some changes in her life. Many women show a lot more independence now than they ever did. When they were younger, they were dependant on their husband or parents. There’s the feeling that they couldn’t do much to change their situation because the kids were too young. So if they are not happy in their relationships, this is the time that they assert themselves.

But that assertiveness can have a dark side too. I’ve noticed that for certain women, this phase brings out a side of their personality that was dormant for several years.

Let me give you an example. My husband and I have been friends with a couple for many years now. Theirs was a love marriage and they have two children who are in their teens. Ever since we’ve known them, this couple has been very happy. But about three to four years ago, I noticed a change in the attitude of the wife. A woman who for so long was happy to just be known as someone’s wife, suddenly was coming into her own. She seemed more confident and was very focused on her appearance. Whenever the two of us would meet for lunch, she’d only talk about how it was important to be your own person and that now she was keen to do things her own way. She had always been slightly plump, but now she was an active member at her gym and exercised regularly. She had become a completely different person from the one I had known for so many years. I was glad that she was happy with the changes she had made in her life, but was also taken aback by the aggression behind those changes. Soon after, her husband told me that she had been having an affair with a man she met at the gym, and that they were on the verge of separation.

After years and years of making adjustments to live according to how their husbands and in-laws want them to, during their 40s women realise that there’s more to life. The realisation that the person they have moulded themselves to be is not what they started out as can be very crushing. And then they feel a need to rebel.

One of the reasons for this is that women in their 40s often have a lot of free time at hand and don’t know what to do with it. If you aren’t a working woman, you may have a  ‘vacuum’ in your life at this stage. That’s why I always encourage women to work. At 25, if you aren’t a working woman, you may feel empty when you are older. Starting work at 40, when you have no skills or experience, is not easy! 40s is also the time when women try to reclaim old friends. Indian women tend to lose touch with their school friends after they get married. But suddenly, in their mid-40s, they reconnect with old friends because they have time on their hands. So now, a woman has a social circle of her own that’s not dependant on her husband.

That’s probably why, as I have observed, a lot of couples experience trouble in their marriage in their 40s. Whether they divorce or not depends on their individual mindsets as well as what their social environment allows them to do.

Anthropologist Margaret Mead said, “There is no greater power in the world than the zest of a menopausal woman.” The symptoms you feel through perimenopause ultimately influence your actions and reactions. Don’t let these symptoms define you during this stage of your life. The power to help yourself during this time lies with the best person—you.

This was first published in the April 2015 issue of Complete Wellbeing

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Carotenoids are good

“Carotenoids reduce oxidative stress, oestrogen levels, and help in inflammation,” says Dr Cynthia Thomson, PhD, RD, associate professor, Department of Nutritional Sciences, University of Arizona. This makes them useful bioactive compounds in cancer prevention.

Carotenoids are primarily found in the colourful portion of the plants. So, having a colourful diet will ensure that you get all the carotenoids you need. Natural sources of carotenoids include orange coloured fruits and vegetables like carrots, apricots, mangoes, and sweet potatoes.

Types

The most popular carotenoids are lycopene, lutein, and beta-carotene. German researchers say that carotenoids like lutein, lycopene and beta-carotene improve skin health and reduce effects of skin ageing.

Further, natural carotenoids, including beta carotene, lutein and zeaxanthin, may help decrease the risk and even reverse the development of age-related macular degeneration [AMD], the leading cause of blindness, according to a study published in the Journal of the American Medical Association [JAMA].

Let us now discuss the two most important carotenoids that benefit women.

Lycopene

The antioxidant property of lycopene protects our DNA [our genetic material] inside the white blood cells, playing an important role in preventing heart disease.

According to a study published in the American Journal of Clinical Nutrition, women with the highest plasma levels of the antioxidant lycopene had a 34 per cent reduced risk of cardiovascular disease [CVD], compared to women with lower plasma levels of the nutrient.

Red fruits and vegetables like tomatoes, watermelons, figs, pink-grapefruits, apricots and pink-guavas are common sources of lycopene.

Beta-carotene

Beta-carotene is helpful in treating unpleasant menopausal symptoms of vaginal dryness and frigidity. Research shows that a combination of beta-carotene and evening primrose oil is effective in reducing the itchy, crawling sensation in the skin that often occurs during menopause. It also reduces the risk of ovarian cancer in women after menopause.

Some natural sources include sweet potatoes, carrots, spinach, broccoli, fresh thyme, and lettuce.

Bioflavanoids work best

Bioflavonoids act as antioxidants and are found in citrus fruits, berries, green tea, soy products, herbs, and spices. Bioflavonoids affect blood vessel strength and permeability and have an anti-inflammatory effect—important to women with allergies, menstrual cramps, or arthritis. They are useful in lifting mood and increasing energy levels in women with PMS or menopause.

“Giving women vitamin C with bioflavonoids has shown to help reduce hot flashes,” says Dr Marilyn Glenville, author of The New Natural Alternatives to HRT.

The post The benefits of eating colourful veggies appeared first on Complete Wellbeing.

The best ones are plump, fragrant and have a very slight dent when touched. Avoid those that are hard, mushy, or show signs of mould.

However, dried figs are more popular and commonly used than the fresh ones.

The many health benefits of figs

Figs are healthy. Here’s why eating them is good.

Relieves constipation and helps heal piles

They have a mild laxative effect because of their high fibre content [the fibre content in figs is higher than in any other fruit or vegetable]. Eat two dried figs soaked in water overnight every morning and before going to bed with a glass of warm water to stay away from problems like haemorrhoids (piles) and constipation.

Helps control blood pressure

The potassium in fig helps control blood pressure. Also being high in magnesium, the potassium-magnesium combination combats acidity and gas formation to a great extent. Soaking a fig overnight in water and having it early in the morning with 4 – 5 basil leaves is of great help here.

Improves heart health

Dried fig is rich in phenol, omega-3 and omega-6 fatty acids. These fatty acids reduce the risk of coronary heart disease. The high soluble-fibre content helps reduce cholesterol levels in the blood by over 20 per cent, thus preventing plaque buildup in the arteries.

Promote weight loss

They have zero cholesterol or saturated fats, which, along with their fibre content promotes weight loss.

Elevates mood

They are abundant in vitamin B6, which enhances production of serotonin [mood-boosting hormone] and prevents water retention.

Eases symptoms of menopause

Menopausal women with major mood swings can benefit from eating figs. Women on birth control pills too can have figs to replenish their vitamin B6 levels, which gets depleted by the pill.

Increases bone density

Being rich in calcium, figs help in increasing bone density.

Helps sleep better

Get rid of insomnia by eating them regularly—figs are rich in tryptophan, a vitamin that induces good sleep.

Soothes respiratory ailments

Soothe your respiratory ailments with this simple remedy. Boil 4 – 5 fresh figs in about half litre water. Bring the water to a boil and then strain the mixture. Once cooled, drink the mixture and get instant relief from a sore throat.

Boosts skin health

Get soft, glowing and blemish-free skin by including them in your daily diet. A natural way to treat boils is by applying the inner red part of a fresh fig over it and sealing it. Keep it on for 10 – 15 minutes and then wash it away with warm water.

Figs in your food

Here are some ways to incorporate figs into your diet and reap its benefits:

• Dried figs added to milkshakes or smoothies lend extra flavour, while making the drinks high in energy—an ideal way to start your day.
• They can be added to baked goodies like muffins, cakes, cookies, muesli and energy bars.
• They double up as natural sweeteners in oatmeal, ragi or any other wholegrain breakfast porridges.
• Dried figs can also be added to fruit salads or custard. You can finely chop the figs and add them to your favourite salad with cinnamon before serving.

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She wondered if she was entering her menopause. She had noticed that her menstrual cycle had become irregular. After consulting the doctor, it was confirmed that she was experiencing symptoms of menopause. These are typical symptoms faced by women during menopause.

What is menopause?

Menopause is a part of every woman’s life. It is the stage when your menstrual period permanently stops and is associated with hormonal, physical and psychological changes.

This natural phase occurs generally between 40-45 years, although it can be as early as 35 or as late as 65. The average age is around 50 years.

Some women go through menopause without much discomfort, but for many it is a distressing and painful experience. Hot flushes, night sweats and sleeplessness are common symptoms of menopause. A hot flush is a sudden feeling of heat in the chest, which spreads to the neck and face. It is followed by a cold, shivery feeling. Hot flushes may occur several times in a day. At night, a hot flush may be accompanied by sweating and can be particularly troublesome. Other problems include palpitations, headaches, irritability, anxiety, depression, loss of confidence and concentration, poor memory, difficulty in making decisions and loss of sex drive.

The long-term problems of menopause include: Osteoporosis [thinning and weakening of bones] that makes your bones more susceptible to fractures, cardiovascular disease which increases your risk of heart attack, and Alzheimer’s disease wherein there is progressive loss of memory.

Yoga for menopause

Let’s take a look at some meditative and conditioning yoga postures which will help one to focus, quieten the mind and create a sense of discrimination and discipline [Dharma].

All the asanas have to be done with the correct feelings [Bhavas] because Yoga aims at inculcating good attitudes and stilling the mind. Meditation is a process where a meditative state has to be fostered throughout the day.

Sukhasana

• Sit on the floor with legs crossed.
• This posture can be done on the chair or bed also.
• Keep the palms of the hands on your knees.
• Keep the spine and neck erect.
• Close the eyes.
• With eyes closed watch your breathing.
• Retain the pose for at least five minutes, if comfortable.

Tip: This meditative asana helps to calm and focus the mind.

Parvatasana

• Sit cross legged.
• While inhaling 2 seconds, lift the arms from the sides, palms facing upwards.
• Keep the elbows straight and join the palms.
• Retain the breath for 4 seconds.
• While exhaling 2 seconds, bring the arms down, palms facing downwards.
• This asana tends to strengthen chest muscles and gives upward stretch to the spine, thus improving the posture.

Tip: Stretching asanas like Parvatasana create body awareness and concentration.

Hastapadangushtasana II

• Lie down supine.
• Stretch out arms horizontally.
• Exhaling, slide the right leg towards the right hand and grasp the toes if possible without bending the knee.
• Inhaling, slide the leg back to starting position.
• Repeat on the other side.

Tip: Improves circulation in the legs.

Pavanmuktasana Variation

• Lie supine with knees flexed.
• Cross left leg over the right leg.
• Grasp the left knee with the right hand and draw the leg towards the right shoulder while exhaling.
• Unlock the legs and return to starting position while inhaling.
• Repeat with the other leg.

Tip: Provides abdominal compression and stretches hip muscles.

Yastikasana

• Lie supine, with arms alongside the body.
• While inhaling, stretch the arms upwards and the toes outwards.
• Retain position for six seconds.
• While exhaling, return to starting position.
• Repeat three times.

Tip: Offers extreme stretch and relaxation to the arms and spine.

Ardha Matsyasana

• Lie down supine.
• Keep the right leg straight and the left leg flexed with the left foot flat on the ground.
• With the help of the hand, place the right foot on the left thigh.
• Gradually, straighten the left leg till it touches the ground.
• Stay for a little while.
• Keep the interlocked hands on the abdomen.
• Repeat the same with the other leg.

Tip: Strengthens pelvic muscles and thighs. Helps prevent oedema and varicose veins

Shavasana

• Lie down supine.
• Slowly start relaxing different parts of the body — starting from the toes, to the ankles, the knees, the thighs, the arms, the anus, the generative organs, navel, abdomen, heart region, neck, lips, tip of the nose, eyes, space between the eyebrows, and top of the head.

Tip: Helps create feelings of relaxation, let go [Vairagya] and rest.

Pranayama IV

• Lie supine.
• Keep the knees flexed with the feet flat on the floor.
• Place one hand on the abdomen.
• Inhale, moving the abdomen upward slowly.
• Exhale, moving the abdomen downward slowly.
• Avoid jerky movements.
• Do 10 rounds.

Tip: Aids in concentration and provides gentle massage to the abdomen organs.

Anulom Vilom

• Slowly sit up.
• Sit comfortably cross legged on the floor or on a chair.
• Keep the spine and neck erect.
• Close the left nostril with the little finger and ring finger.
• Inhale through the right nostril for three seconds.
• Now closing the right nostril with the thumb, exhale through the left nostril for three seconds.
• Then inhale through the left nostril for three seconds and exhale through the right nostril for three seconds.
• Continue inhaling and exhaling through the alternate nostrils for five rounds.

Tip: Calms the mind and aids in concentration.

Konasana 2

• Stand with back touching a wall.
• Keep the feet parallel and approximately thirty inches apart.
• Keep the arms alongside the body.
• Raise the right arm upwards, keeping it close to the wall.
• Inhaling bend to the left, keeping the body close to the wall.
• Slide the left hand down along the body.
• Stay in this position as is comfortable for a few seconds.
• Exhaling return to starting position.
• Repeat the same on other side.

Tip: Little used muscles on the side of the body are exercised.

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