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Some Articles

 June 2010 Article

 

The ABC’S of Health

By Dr. Jo Gjelsten

“It Takes A Villi”

 

Save the villi, someone once said.  I think it was me, just now.  What are villi and why do we want to save them?  Villi are little finger- like projections of the lining of your intestines that increase the surface area so you can absorb more nutrients from food. They are damaged, and or, destroyed, heaven forbid, if your body can’t digest gluten Gladis. This damage is called Celiac Disease, from the word koelia which means abdomen in Greek, and named by a physician who couldn’t spell in English in the first century A.D, so he sounded it out, and everyone thought he was talking about a bear.

For our understanding of this subject we begin at the beginning, where most things begin, many times if not all the time, with the observation of the fact that kids in the Netherlands who stopped eating bread during WWII because of shortages, stopped dying (dying???!!!) of celiac disease..the incidence of which went from 35% of them to zero per cent of them.  Yes, this is that serious.

Why this fact didn’t catch on as really big news is a mystery to me. In fact most people, including many “Medical Folk”, and me before I found out, believe that Celiac Disease is a dysfunction of your intestines brought about by gluten sensitivity/digestion problem, which it is, so diarrhea, bloating, errts, pwuths  pwewths, toots, borborigmis, (a real word), and other intestinal music, (I hear the sound of music) sounds like Celiac and without all that, it doesn’t even show up on their radar screen Spock.

Is that all there is, Peggy? No, no, Nanette!  What else might it look like then Dr. Jo? The list is as long as your arm, because without villi we don’t absorb what we need to, for instance, stay alive.

 We start with anemia because iron doesn’t get absorbed.  If you’ve had anemia for a while and no one can find out why, get the RIGHT testing.  Calcium may not get absorbed as much, resulting in osteoporosis, along with anemia.

Some folks with undiagnosed celiac have neurological problems like mental illness, epilepsy, seizures, dementia, and peripheral neuropathy (49%).  But wait, there’s more! How about headaches (28%)! And depression due to decreased levels of tryptophan, serotonin and dopamine can be from untreated celiac!

Endocrine problems like thyroiditis (Grave’s, Hashimoto’s) are often associated with celiac, and “abnormal liver enzymes (non-alcoholic liver disease), are common in both thyroid disorders and subclinical celiac disease.” Add to that list, biliary (gall bladder/liver) cirrhosis, and autoimmune hepatitis. Not fun.

Diabetes type 1?  Moms, you need to know that kids who are fed gluten before six months of age , especially in the first three months, “yields a four-fold risk of developing islet cell (pancreatic) auto-antibodies (and potentially subsequent diabetes) than exclusive breast feeding.  What else? Short stature if  kids are not absorbing vitamins and minerals.  Folate deficiency is especially linked to this disease, and can cause a whole host of problems. And think about the article I did about autism and its link to digestive disturbances? Autism is now a gluten-associated disease, as is fibromyalgia. 

Fibromyalgia. Don’t get me started says Dr. Jo. This is a disease that is, in my opinion, made up by those who don’t know what to do for tired and sore mostly women, so they put you on an anti-depressant so you’ll go away happy. But it could just be a reaction to gluten, or an undiagnosed infection, or undiagnosed thyroid problems, or all three.

 So autoimmune is the operative word here, when it comes to gluten/celiac. Problems like RA (rheumatoid arthritis) and other autoimmune conditions which may be linked to gluten are Lupus and Sjogren’s Disease .  Sjogrens, which results in dry eyes and arthritis, is seen mostly in older Scandinavians which accounts for its vowel-impaired name, like Gjelsten, a personal favorite of mine. For a country with 4 or 5 extra vowels, aah, auw, euhw, “ish” sounds, for instance, Norwegians do use them sparingly.

Back to Celiac. What to do? Get tested. Your levels of antibodies to yourself, called auto-antibodies, become high when your immune system responds to what it thinks is a threat, and that would be you, because the immune system gets the wrong message from undigested complexes which is too complex to go into. The tests are lots of acronyms for big words Doc. They are:  tTGA, EMA, IgA, and AGA . “AGA  should not be used alone to diagnose”. There are combinations of these which constitute a diagnosis, so just because you have a negative test that doesn’t mean you don’t have the disease. While an intestinal biopsy is the gold standard for confirmation of the diagnosis, it is now also being diagnosed from blood tests, and thought by some experts to miss some submicroscopic problems. If you have one of these blood tests, you have to be eating gluten at the time of the testing to show any antibody activity. There are also stool sample tests where you don’t have to be on gluten for it to show up.  Do this with professional help. It must be monitored. There are also genetic tests that look for DQ markers DQ2/DQ8, and others. DQ, as in Dairy Queen, but not as much fun.

 What not to eat, and what-not   Not to be a fly in the ointment, but if you have celiac this is very serious business and you must stop eating all of the following real, and not so real but I couldn’t help myself, stuff:  Look at labels and get educated about soups, soy sauces, lo-fat, no-fat,  wo-fat, hydrolyzed veggie protein, texturized veggie protein, natural flavors, some unnatural flavors, some alcohol, some vinegar, some pharmaceuticals (oy vey) some candies, sometimes I feel like a nut, cold cuts, wheat, barley, rye, kamut, caput, oat, spelt, slept, and schlepped. And more. Ok, read the labels Mabel because you can’t do this half way and get results. Your life may depend upon it so don’t be lazy. If you’ve been gluten-free, , you may or may not know it by symptoms. You can be relatively symptom free and still have damage being done, so a blood monitoring is very important if you have celiac. The diagnosis can turn your life around if you really stick to the diet, and the diet isn’t impossible especially today. There are foods all over Rockland County now that are gluten free.

And you don’t have to look far for a gluten free treat. There is the Little Bake Shop in Valley Cottage, “Your source for gluten-free baked goods”, or you might want to try my current favorite food stop, a FABULOUS organic healthy gem of a roadside stand, the PALISADES MARKET on 9W.  They even have a little walk-up stand serving “Janes” Ice Cream. Thanks Jane.  Back to gluten before we go glutton. We have to make sure your villi are viable Verna. Get tested. More information on my website.  www.godrjo.com  Copyright May  2010.

 

 

 

 

Sources Re: ALS and Glutamate After article

 

Glutamate (also glutamic acid or L-glutamate, which simply refers to the orientation of the glutamate molecule) is an amino acid (protein building block) neurotransmitter in the brain responsible for the ability of neurons to synapse (connect) and thus do their job. In Snyaptic Self, 2002, Joseph LeDoux said "You are your synapses. They are who you are." So true. It is when something goes awry (like heavy metal toxicity) in neurons' ability to connect and do their job that we present with all the "neurological symptoms" of the various neurological diseases: Tingling, numbness, cramping, inability to think, depression, eyesight fluctuations, fatigue, muscle wasting, and more. You need glutamate. You consume glutamate present in natural foods in your diet, some "bound" some "free" (only the "free" glutamate behaves as an excitotoxin in excess). You consume from less than .3 gram (300 mg) to 1 gram of "free" glutamate daily in a whole foods organic diet. You do not need to add it to your diet in "supplemental" or "seasoning" form (MSG). In fact, be very cautious about accidental supplementation by taking any supplement that contains any soy or fermented products which, by nature, generate free glutamates. When you take them, you are taking free glutamates.

"Amyotrophic lateral sclerosis" (ALS) is a fatal neurodegenerative disease which was thought to be untreatable for a long time. However, recent evidence in men indicates that antiglutamatergic strategies are the first to have an influence on its pathogenesis and slow down the disease process." Antiglutamate therapy of ALS - which is the next step?A.C. Ludolph, T. Meyer, and M.W. Riepe. Dept. of Neurology. University of Ulm, Federal Republic of Germany

"Excitotoxicity mediated by glutamate has been implicated as a cause of this progressive degeneration." Altered AMPA and cannabinoid receptor trafficking in motor neurons of ALS model mice: Implications for excitotoxicity.P. Zhao, M.E. Abood, E.C. Beattie. Research Inst., California Pacific Med Ctr., San Francisco, CA Oct. 2006.

"Defects in neurotransmitter glutamate transport may be an important component of chronic neurotoxicity in diseases such as amyotrophic lateral sclerosis...we developed a model of slow toxicity in cultured organotypic spinal cord slices...." By inhibiting glutamate transport they slowed the degeneration of motor neurons in the spinal cord. Chronic inhibition of glutamate uptake produces a model of slow neurotoxicity. Jeffrey D. Rothstein et al. John Hopkins University. Proc. Natl. Acad. Sci. USA Vol 90, pp 6591-6595, July 1993 Neurobiology.

"Along with ionotropic and metabotropic glutamate receptors, the cystine/glutamate antiporter, may play a critical role in CNS pathology. High levels of extracellular glutamate inhibit the import of cystine, resulting in the depletion of glutathione and a form of cell injury called oxidative glutamate toxicity." Oxidative Glutamate Toxicity Can Be A Component of the Excitotoxicity cascade. David Schubert and Dana Piasecki. The Journal of Neuroscience, October 1, 2001. 21(19): 7455-7462.

"L-Glutamate is the major excitatory neurotransmitter in the mammalian central nervous system"....dysfunction of transporters [EAAT1 and EAAT2 in glial cells] in the brain are implicated in the pathology of neurodegenerative conditions such as amyotrophic lateral sclerosis. Transporters for L-glutamate: An update on their molecular pharmacology and pathological involvement.PM Beart and RD O'Shea. British Journal of Pharmacology (2007) 150, 5-17.

"Jeffrey Rothstein has uncovered an abnormality that seems to be widespread in patients with sporadic ALS." Rothstein and his colleagues at Johns Hopkins University presented evidence that a brain protein called EAAT2 is improperly made in almost half of the patients they studied. This protein deactivates and recycles the neurotransmitter glutamate and a deficiency could lead to a glutamate build-up. Glutamate is toxic to cells in high concentrations and some thought by researchers to be the cause of neuron death that control muscles.

"...excessive glutamate was found to injure cultured neurons by stimulating Ca2+ (calcium) influx, and this is thought to be involved in a variety of neurological diseases."Glutamate neurotoxicity and diseases of the nervous system. Choi DW. Neuron 1988;1:623-634.

"Excitotoxicity is a common mechanism seen in many neurological disorders, including strokes, brain trauma, CNS infections, autoimmune disorders, multiple sclerosis, heavy metal toxicity, brain tumours, and the majority of neurodegenerative diseases...including Lou Gehrig's disease (amyotrophic lateral sclerosis, ALS). Excitoxicity: A possible central mechanism in fluoride neurotoxicity. Blaylock, R. Fluoride 2004;37(4); 301-314 Research Review 301.

"Glucose is a major precursor of glutamate and related amino acids. Other precursors of the small glutamate pool were found to include glutamate, aspartate, GABA, serine, leucine and sodium bicarbonate." M.S. Starr. Evidence for the compartmentation of glutamate metabolism in isolated rat retina. Journal of Neurochemistry 23 (2), 337 - 344 (1974).

 

 

Dec 2009 Article

 

POMEGRANATES

By Dr. Jo Gjelsten

This is December…the time of year when we shop, wrap packages, and think about expelling our tapeworms, huh Tammie? That’s when you reach for the pomegranate, any way you can get it.  Ok, until I started to research pomegranate’s role in your health I didn’t know about the tape worms either, but though pomegranates have been around since biblical times, it wasn’t until “1804, when a practitioner in India cured an Englishman of tapeworm infestation”, that anyone in Merry Olde payed attention.   “Pomegranate is believed to contain an unusual alkaloid content, called pelletierine, which was discovered in 1878, and apparently effective when expelling worms and parasites from the intestinal tract.” And I’m thinking “what a great way to wake you up out of your carb stupor” as you sit at Runcible or wherever you’re reading this. Hold onto your lunch a little while longer, as I go on and on about pomegranate Grannie.  As the ad says, “so you know you’re ready when the time is right” though that refers to a big, or lack of a big problem, which could cause you to go deaf…I SAID IT COULD CAUSE…nevermind…..my point here is to be ready when all that glop you and I have been eating around these Fatty Food Holidays decides to take up residence in our arteries. What does that have to do with pomegranate? Plenty, or at least maybe a little. You think green tea and red wine have antioxidants? Well, pomegranate has three times the polyphenol antioxidants than those other guys. And it prevents plaque in ‘yer arteries. How, Howie? It reduces LDL cholesterol oxidation by preventing your flaming inflamed, flamboyantly,  inflammatory, inflammation from becoming inflamed, if you get my drift.  A bad thing; when it (inflammation, did I mention that?) happens in the lining of your arteries, pow, or POW, you build a little plaque city of fatty dams that eventually don’t let your blood flow, or break off and kill you the first chance they get the little bastards! The ironic thing is that the seeds (pomegranates in case you fell asleep there) remind me of little red blood cells or blood red corn, which is why I was a bit sickened looking at them most of my life, and now that I mention it I’m getting queasy but the seeds (arils) are eatable and good for you no matter how nauseous you may be looking at them so suck it up and try some Dr Jo. Ok I will. I’ll be right back. Ok I’m back.  I really like the juice. You can eat the seeds or chew them and spit them at your sister. Your choice. Because of its antioxidant power, which prevents free radicals, the cause of aging, a daily dose of this stuff may help reduce wrinkles and help to slow down aging, whether you use it inside or outside the skin. You may look like a big beet after wallowing in it, but you won’t  look a day over the day before yesterday.  Pomegranates have many vitamins, like B’s and C, and minerals like iron and calcium, phosphorus and potassium, and “Researchers at the University of Wisconsin School of Medicine claim that Pomegranate shows major promise in the fight against prostate cancer.  Pomegranate juice has been shown to suppress inflammatory cell signaling, inhibit prostate tumor growth and lower serum PSA levels.  In vitro studies using human cancer cells, the higher the dose of Pomegranate extract the cells received, the more cells died”,  and  this fruit has amazing  antiviral, antiseptic and astringent properties; the extract can improve periodontitis. It can also inhibit fat absorption in the intestines and suppressed the appetites of lab mice which doesn’t surprise me for some reason.  To eat, cut off about ½” of the top. Score into 4 or 6 sections, then pull apart. Then you have to “flick” the seeds, those that didn’t shoot across the room, out of the “pith” over a bowl of water. OMG I can’t stop laughing…try not to mix up your “pith” with the other “pith” and the “membranes” which makes me so hungry just thinking about “membranes”, and the pith go together, both of which float on top of water like skin as the pits drop like little blood cells down to the bottom of your bowl, causing your stomach to growl in anticipation of chewing this wild and crazy fruit .  Don’t forget to wear a blood red shirt if you don’t want to look like a mass murderer; this fruit stains very nicely. No wonder your tape worms want to escape. Good fruit for Halloween. Have fun flicking your seeds Florence. Don’t eat your pith.

Pomegranate Smoothie, An Antidote for Holiday Fooling Around With Food

1 cup pomegranate juice (fresh is best)
2 cups vanilla yogurt (you can use fat-free, organic . . . whatever you like)
1 banana (optional)
1 tsp ground flax seed (optional)
1 tsp honey (optional, for sweetness)
pomegranate seeds (optional)

Place ingredients in blender. Cover and blend until smooth. Pour into glasses and top with pomegranate seeds if desired. Makes 2-4 servings.

Enjoy!

 

Oct.& Nov with page 2 included: 2009 Article

The ABC’S of Health

Onions Anyone?

By Dr. Joanne T. Gjelsten

 

Did you know that Mastodons once roamed the river banks of the Hudson, and they ate dinner, or was it breakfast, in the “Black Dirt” towns of Florida, Goshen, Warwick, and  Pine Island? No? Ok they weren’t towns then. Well, Dr. Jo, what does this have to do with onions? 

Long ago, and far away, in a land called Orange County, about a half-hour north of us, immigrants named Szltchtskiski, Poopjes Vanderpoopen, Tizio, Freiherr Spiegel von und zu Peckelsheim and Divyagovrsabhadhvaj, drained the “megafauna” ridden low-lying bogs  left behind by glaciers 12,000 years ago that attracted such residents as the “Sugar Loaf  Mastodon”. Sugar Loaf, or “Sugar” as his friends called him, as this Mastodon was the first of his kind to sell home-made baked goods, now takes up lots and lots of space in the lobby of SUNY Orange County’s Bio Tech building after being dug up without his permission in 1972 in the Black Dirt fields (“muck without oxygen”) near the Warwick-Chester border where he watched the Drive-In Movie every Friday night. Stop by & say hello to Sugar, sugar.

Poopjes and company knew that this bog could be farmed like no other because after Szltchtskiski  got stuck in the muck, they realized that the soil had up to 90% organic matter, not including Szltchtskiski and Sugar,  as opposed to 10% you’re “lucky to get” in other soils, perfect  for growing onions Ollie.  The soil is actually fine and powdery.

Today, (or was it yesterday?), one half of all NY Onions come from 22 square miles of this farmland, the 3^rd largest onion growing region in the United States. Black soil up to 30 feet deep is visible today from space, if you squint really hard, as “smear (s) of  blacks and browns at the bottom edge of emerald-green Catskills”, someone once wrote, and I copied it down, thinking it might be interesting someday, which turns out to be today of all days. So what. Onions are harvested from Aug. through February or March or sometime in the winter, as the tractor slides by, knocking all the cross-country skiers off their stride, or their skis, whichever comes first.  Yellow Globe, a good-lookin’ cookin’ onion, and red onions and other crops are sold to green markets as far away as NYC boroughs and shipped as far away as Israel Ishmael.

 

HOW SPECIAL IS THIS BLACK SOIL?

I have just learned from a fellow hiker when yakking during a Hudson Ramble event the following, about black dirt, which I have dutifully cut and pasted, or is it paste, with construction paste, for you guys:

“Legislation and restrictions on the protected wetlands have limited the possibility of new farmland development as farmers are not allowed to sell or develop on protected resource wetland without making what is known as a one to one transfer. If one acre of farmland is transformed from the wetlands, then one acre of farm land must be transformed back into wetland.” 

 

BENEFITS

You can eat them raw like an apple (onions, in case you fell asleep) I’m told, but you’ll cry like a baby and won’t have any friends except other raw onion eaters. They’ll provide you with some B-6,vitamin C, biotin, and fiber, lower your levels of total cholesterol and triglycerides, lower your blood sugar by increasing free insulin (free the insulin) as per tests that show that “the higher the intake of onion, the lower the level of glucose during oral or intravenous glucose tolerance tests.” Onions also contain chromium, a ”mineral component of glucose tolerance factor which helps cells respond appropriately to glucose”, which in English means it lowers your fasting blood sugar, diabetics. Your immune system may benefit if you add the anti-cancer properties of onions to your diet, according to studies at Cornell by their food scientists. And an Italian epidemiological study showed high onion intake associated with decreased risk of seven types of cancer:  oral, esophagus, kidney, colon, rectum ovary and pancreatic. They should be organically grown, but you knew that.

Onions are also anti-bacterial and may lower your levels of fungus, should they be high athlete’s foot guys and gals. Rub it on your feet and see how fast the fungus disappears….phew!  Oh please don’t.

 

And finally

Onions contain compounds with sulphur, (a stinky stinky smelly, did I mention it stinks??) substance on the way in, and on the way out as we all know, ok, some of us know,  but that’s why onions do well in the sulphur-rich black dirt, and it’s what gives them their flavor.  And they are rich in flavanoids, the best of which is Quercetin. I take it in capsule form that includes bromelain when I my nose gets stuffy, whidge dozen habben as often as it used to since I found many things that help, all of which went through me, the office guinea pig, before my patients got them.

I’m imagining Mastodon’s with snooky noses, like giant rubber cement…!!!!  Blow your trunk Sugar!  Fnnnaw!   Should have eaten the onions!

Copyright  09/09/2009

 

Summer '09 

 

NEWS FLASH! New Hope For Autistic kids! Just back from my alma mater with great news about a Chiropractor who has figured out what's missing and how to replace it in kids with Autism. She is conducting FDA APPROVED Clinical Trials all over the country! Will keep you posted! Contact me for more info!  drjog@optonline.net Dr. Jo

 

 Older articles: 

 

 

The ABC’S of Health By Dr. Jo Gjelsten Spring Cleansing Spring. Time to clean our clocks, or our tickers won’t tick, and our bongs will go bonkers. Time to “plunk your magic twanger Froggie” and detox your lock box Lars. Ok enough of that. Who needs to cleanse. We all do. Last summer Paula and I did a Purification Program so that we could become nuns, or pure, whichever comes first, lost weight, and felt 10 years younger. They asked for ID when we went for beer. Ok I made that up. Our program wasn’t cheap, it wasn’t simple, it wasn’t the easiest thing we ever did, it ain’t for sissies, so don’t do it ‘ya big wuss. It worked so well we’re doing it again this spring to put a spring in our steps. It consists of a diet, supplements that cleanse the liver, kidneys and colon: your semi-colon; and Colin Powell. Your toilet will be amazed. Why did we do this particular one? Because a famous person told me it worked for her, and I believe everything famous people tell me. And I have been using Standard Process (SP)for 14 years, so I trust this company that’s older than I am, and that’s old, Olga. Toxins. You already know they’re everywhere we are, and you can’t get away from them as they also reside in the body. Natural toxins like carbon dioxide and ammonia aren’t broken down. We filter toxins through the liver, kidneys, lungs, intestines, a Kleenex when we smoked as kids to look at the black stuff, and the lymphatic system. Given the assault of poisons we have to process 24 hours/day, you’d think you’d change your own personal oil, metaphorically speaking, more often than you service your cars! No. We all know that old saying, garbage in, garbage out, as in no energy, or put another way, toxins in, toxins stay in and make you sick; more like it. Get the lead out guys, and do something to, uh, get the lead out! Here are some advantages to cleansing you may not have even thought of: If you have problems with, but not limited to, but could be limited to, you decide, it’s your body not mine, get on with this already Dr. Jo, headaches, any aches, fatigue, difficulty sleeping, digestive and other GI disorders, gas bag, immune challenges, allergies, food cravings, weight gain, reduced mental clarity which means you have no idea what I just said, or libido that’s a quart low Larry, then you may benefit from getting Pure, Poopy. Your body can heal itself, given the right set of circumstances, like good nutrition, and lower levels of function inhibiting toxins, says Dr. Jo when she’s not eating ice cream with a Vitamin C chaser. Your SP program, should you decide to accept it, consists of special supplements for cleansing called, oddly, “SP Cleanse”, consisting of 20 whole foods and botanicals, plants and herbs that help your body to “efficiently remove both metabolic and environmental toxins”. “Gastro-fiber” for, you guessed it, gas; no, for fiber support. (I love it when my fiber is supportive). It’s loaded with psyllium, (a natural laxative with an extra silent “p” for no good reason I can think of,), apple pectin which stimulates intestinal bacterial enzyme activity and has anti-cancer properties, fennel that promotes healing of the gut, and fenugreek which research shows can delay carbohydrate digestion thereby promoting insulin activity. There’s “SP Green Food” to keep you green Kermit. Oh and it has phytonutrients that are vacuumed dried to preserve enzymes and nutritional compounds, grown in soil “laden with minerals and nutrients” Really bio-available whole foods, the best you can buy, like everything I use and recommend to my patients. Hey, it’s the only body you have Hillary. And you get to shake with “SP Complete”, a nutritious supplement shake with ingredients made from organic farming. This all accompanies a secret diet that you need a special signet ring and a secret handshake to crack, and there you have it. What can you expect? At first you want to kill me, but then you’ll love the way you feel. You may also experience a drop in blood lipids; if you’re serious and committed. I can show you an (anonymous, of course) example of a blood test where my patient who complained of fatigue, had a cholesterol level that went from 230 to 198, whose LDL went from 144 to 104, and their energy came back up. We also had noticeably more energy. You’ll definitely lose weight as we did. What else may happen? Improved digestion, the economy will improve, better sleep, clearer skin, a shiny coat, and happy feet may happen to you. The program comes with a tear-off shopping list, a Daily Intake Journal, a Patient Guide with FAQ’S, Shake recipes, Salad Accents, a Toxicity Questionaire to get a load of your toxic load, and of course the really healthy food supplements. Quite a bit. We loved it, are doing it again, and will be talking more about it April 25th, with samples, for our event. Check my website at www.GoDrJo.com under events Ed. Happy cleansing, Colin! Copyright 3/9/2009. The Abc’s of Health

Well Well Well, You Want To Be Well, Don'tcha ? By Dr. Jo Gjelsten

“Whatcha gonna do when the well runs dry, you’re gonna run a..way and hide”…so goes the song. So our well broke last weekend. No water. I thought of the picture of my grandmother, singing away at the hand pump of a well, somewhere, back then. Tough folk they were. I don’t remember her complaining about having to pump water out of the ground. It was just done that way.

Our way is to panic. Sunday morning, I turn on the faucet and, getting nothing, I run downstairs to see if a circuit breaker is the answer, and sadly, with my shirt on inside out and backwards I’m so preoccupied with this, I return with the diagnosis. We need a new well (pump).