update 6 May 2014 see new insights at DMSO – The Persecuted Drug by Dr. Stanley Jacob 27 Feb 2011
UPDATE 18 JUNE 2013 Ji Sayer reviews Evidence-Based Medicinal Properties of Coconut Oil
16 March 2013 THE THREE OILS SYMPHONY – FISH OIL, COCONUT OIL, DMSO,- and EXPOSURE OF THE DEADLY OMEGA6 HOAX OF THE 20TH CENTURY:
this “Three Oils Symphony ” lacks references on virgin coconut oil. A comprehensive on-line synthesis referenced to 1995 is by Dr Ray Peat.
COMPARATIVE BENEFITS OF FISH OIL AND COCONUT OIL
Perhaps our expert ornithologists and sea researchers can find good support for their argument in birds and marine life- why do warmwater fish have so little marine oil?
there is still zero support against good fishoil supplement for cooler climate populations on literature search.
a 2012 Univ Virginia analysis concluded that “With the possible exceptions of Vitamin D and omega-3 fatty acids there is no data to support the widespread use of dietary supplements in Westernized populations; indeed, many of these supplements may be harmful.”
But see the exhaustive favourable fish oil evaluation up to Jan 2012 at the Linus Pauling Univ oregon website .
and recent new papers promote fish oil supplement- but mostly for people in the colder northern hemisphere or airconditioned cities, offices, factories, homes. .
Just two recent 2007/2009 papers express some doubt about the potential risk of fish oil triggering atrial fibrillation. But I have had worsening familial atrial fib for 23 years , and a tsp a day of cod liver oil helps control it.
I cant find any reference supporting their argument that pure modest-dose fish oil supplement- as all authorities recommend. – is dangerous except Peskin’ and Rowens’.
BUT their argument may be valid for people who live in warm climates. South African cities are certainly not warm for much of the year; and the more industrious work in airconditioning when it is warm. Their argument against fish oil supplement might certainly be valid for those who live in the tropics outside cities ie latin America, North and Central Africa, the middle east, northern India-Pakistan, accross subtropical asia and the near-equatorial pacific.islands., who thrive on coconuts.
Peskin’s theory that low-freezing point fish oil is essential only for denizens of the cold deep may well apply also to human and animal inhabitants of the semi-arctic/antarctic land masses or living at cool high altitude like Mexico city.
It rings a bell with the opposite: coconut oil (melting point 24-26C) being staple food and so heathgiving for those living in hot (coconut palm) climates – it thins in more than temperate climates (20 to 40C) , hence may have a different protective lubricant/rheological effect to the vital antifreeze benefit of fish oil in human and animal/marine dwellers living at -20 to <20C. .
Thus it seems rational that I, we now balance my 1tsp codliver oil a day with 1 desertsp coconut oil twice a day, and advise accordingly – the best of both oils. . .
for seriously ill pts I recommend up to 2gm fish oil concentrate 2x/day, with up to 60gm coconut oil twice a day, if tolerated. .
Rowen and Peskin’s published references (other than vegetarian tribes that eat virtually no seafood) for their contrary viewpoint are in their 2011 book,
Does their theory apply to more affluent people who live and work mostly in controlled temperatures (the mid twenties) in 1stworld countries? ..
So if you live in a hot city with warmed houses and offices, combining the two oils makes sense for you too. Arctic and antarctic circle outdoor dwellers certainly need their marine oil.
while Rowen supports Peskin’s antifishoil argument, analysis may justify both oils depending on the climate the population lives in eg fish oil in the icy latitudes, coconut oil in the triopics- and both in balance in the temperate zones.
In fact the Peskin-Rowen theory supports our policy to recommend both fish oil and coconut oil combined:
go back to the Peskin-Rowen book – even just their joint summation at the end: They stress that those who eat no seafood and live long are 5 tribes of humans: vegetarian Adventists- SDAs – who destress, and walk/exercise a lot and also do not smoke, altho they may live in all climates in USA- where presumably they are mostly caucasians ; but SDAs have total racial/tribal diversity . The other longevity claims in closed tribal communities are heavily doubted. More recent researchers have concluded that the older people get, the more they tend to exaggerate, confabulate their age because it brings them eg more attention- eg the tribes Rowen/Peskin list – the Hunzas of Pakistan, Okinawans of Japan, Vilcambans of Equador, Abhascans of the caucasus, not to mention our own oldest old whether in tribal villages or in our cities. . That would explain why they live at such diverse altitudes and latitudes. And isolated tribal people are mostly poor, dont have mechanized transport, and have to work outdoors till they drop,; and as % of their communities, the young leave to find work or get massacred/ conscripted, kidnapped, banished/ sold as slaves in wars against invaders, so their aging seniors are all that are left in those areas.
Peskin/Rowen ignore that by proven Darwinian evolution, land-ambulant mammals evolved : from micro-organisms to eg mammalian coelocanths only about 400 000 years ago, in deep ocean waters, and hence are very oily. But mammalian evolution dates back about 160million yrs; and our endothermy– ability to thermoregulate arguably dates from the dinosaurs and thus birds about 300million years ago.
Perhaps human endothermic adaptation evolved when the first homo sapiens evolved at the tips of Africa and migrated from Africa around the globe some 10 000 to 100 000 years ago ( ie before and after the last Ice Age that started 40 000yrs ago and ended about 20 000yrs ago); thus spreading from temperate sunny climates to cold semi-arctic lands of Europe, Asia, Iceland, Greenland and Canada, and extremely hot equatorial/desert regions.
Hence we adapted from obligatory hot climate survival at up to 50C – the coconut eaters- to icy conditions down to -40C – who survived on antifreeze fish oils as a staple. Fish oils freeze apparently between 18C and -50C (DHA
UPDATE 2 Feb 2013. Dr Cynthia Koelker MD is a modern family practitioner in Ohio who muses on DMSO as effective non-prescription pain relief. A recent NaturalNews.com review notes “Miracle cure’ controversy and why people should use DMSO for cancer, inflammation and more; There is evidence that DMSO can cause cancerous cells to become benign. DMSO can pass through human skin like water and enter cells. It can also stop or slow the development of cancers, such as breast, skin, bladder, colon, and ovarian cancer. Some people use it for cancer prevention. DMSO is used to help patients in withdraw from conventional cancer treatment and is promoted as an immune system booster.
Cancer centers use DMSO to protect healthy cells from chemotherapy and to decrease side effects from the deadly drugs. The DMSO Potentiation Therapy uses DMSO to allow chemotherapy to target cancer cells. This allows doctors to use extremely small doses of chemo, which lowers profits for the drug companies. No doubt the use of DMSO with conventional treatment, or better yet with other natural cures, is blocked because of the effect on drug profits.
A California research group in 2010 noted that Intractable and untreatable pain from cancer remains a challenge, major impact on patients’ quality of life and survival. A significant number of patients receiving analgesic therapy with opioids report persisting pain of a higher intensity than the pain in those who were not on this class of drugs. DMSO is a naturally derived, inexpensive, non-toxic solvent and pharmaceutical agent that has been demonstrated to have numerous health enhancing and therapeutic benefits. In the present article, we provide the scientific evidence and substantiate possible application of DMSO as a well-tolerated excitatory modulator in the management of cancer pain.
UPDATE: 27 January 2013 Stefanie Seneff ea at MIT point out that perverse modern industry has subverted agriculture and nutrition in 1. creating sulfur deficiency in crops (and thus in humans) through oversupplementing phosphate at the expense of sulfur; 2. driving down optimal cholesterol levels (ie cholesterol sulfate) through combined obsssive futile cholesterol restriction and cholesterol-busters eg statins; and 3. the overload of fructose in processed food. So increasingly both fast -processed -food eaters and the poor are sulfur deficient since they dont eat much food sulfur –“eggs, onions, garlic, and leafy dark green vegetables like kale and broccoli, Meats, nuts, and seafood; Methionine, an essential amino acid, that we are unable to synthesize, is found mainly in egg whites and fish. A diet high in grains like bread and cereal is likely to be deficient in sulfur. This deficiency is worsened by acid rain and soft water- and worsens the epidemic metabolic syndrome, diabetes , vascular disease, Alzheimers, and cancer.” She reviews why these diseases are much lower in those living in volcanic mountainous areas eg Iceland, South America where sulphur abounds in food, and along with enough ascorbic acid (also seriously deficient in processed foods) is the backbone of vital cholesterol sulfate and its daughter sterols (vit D3 sulfate, the corticosteroid and sex- and heart – ouabain- hormones).
She points out the crucial role of iron sulfate in energizing cell metabolism by insulin and glucose, depositing needed cholesterol in cell membanes and promoting myoglobin and brain strength instead of adverse tissue, hemoglobin and especially brain glycation AGES – advanced glycation endproducts.
Is it surprising that (not just the rare patients with serious hypercholesterolemia eg familial, nephrotic, cirrhotic who needs statins) but the progressive deliberate successful poisonng of the entire UK-USA population with statins by Big Pharma aided by the FDA and most Govt Regulators, to drive down healthy average cholesterol levels to hypocholesterolemia, is notorious for causing brain fog, depression, fatigue, dermatitis, muscle pain/dissolution (rhabdomyolysis) and liver-kidney- heart dysfunction , while doing nothing to combat insulin resistance, obesity and diabetes?
When – instead of statins and other designer drugs – to combat wasting diseases like infections eg AIDS and TB, cancer, diabetes (muscle wasting as fat accumulates), osteoporosis, atheroma, heart/liver/kidney failure and neuro/muscular disease eg neuropathy, stroke, Alzheimers and muscular dystrophy- what the population needs is especially detox of heavy metal and eg estrogenic plastic overload; more vitamin B, C , D3, K, coQ10, arginine, carnitine, zinc, chromium and magnesium, melatonin and GABA, marine omega3, sulphur in diet or as methionine/cysteine/DMSO/ MSM/glutathione; and for serious lipidemia and resistant obesity at any age, metformin -dimethyl guanidine.
It is speculative as to when nutrigenomics – ie costly genetic testing – is going to prove widely useful in real live clinical practice to provide useful diet guidance for our common lifestyle and aging diseases.
Already in 1995 Shen and Murphy at Wisconsin University showed that while amyloid proten fibril deposits are a neurotoxic cornerstone of Alzheimers’ disease in mice and man, pure DMSO totally prevents the formation of amyloid betasheets at least in testtubes.
In 1999 Cherry ea in Australia and 2004 House ea in Staffordshire confirmed the adverse effects of aluminium and ferric deposits in Alzheimers; and the potential benefits of heavy metal chelators like EDTA with enough magnesium and calcium.. .
and by 2009 Gupta ea in India showed also on the workbench that garlic extract – ie sulfur- both prevents amyloid sheet fibrillation and dissolves it.
So there are different safe nutritional ways of slowing if not dissolving amyloid plaques as well as atheroma plaques in Alzheimeirs with combinations of minerals, vitamins and other antioxidants/ chelators including sulfur foods like DMSO, MSM and garlic.
Pine Tree Source v Fossil Fuel Source of MSM and DMSO: Mike Pritchard-Jones in 2008 detailed the great but academic debate .
But already by 1957, MacDonald ea at UCLA affiirmed the primary role of calcium and sulfur in bone healing after fracture in rats. Yet the first Pubmed entry on sulfur deficiency disease in human nutrition – from a casava diet- is from Nigeria in 1968. and the latest from India in 2012 from their staple cereal-legume diet
A 2012 study Julien ea from Quebec and Greece shows important benefit of DMSO against excessive tau phosphoprotein deposits in Alzheimers Disease.
Methionine, cysteine, homocysteine, and taurine are the 4 common sulfur-containing amino acids, but only the first 2 are incorporated into proteins.
Like GABA, Melatonin is a prime ubiquitous brain hormone that (like the sex steroids ) also declines from age 30years, that profoundly maintains memory by preventing both hyperphosphorylation of tau protein and amyloid beta protein, in melatonin doses reported from 3 to 9mg/night.. theories about its therapeutic role go back 25 years on Pubmed.. so melatonin is conveniently combined with the supplement GABA before bedtime, while GABA is the ideal daytime anxiolytic for these distressed patients.
23 January 2013
For some time many of us have been taking and recommending the multisystem benefits of evidence-based natural micronutrients – fish oil, coconut oil, vitamins, minerals, and biologicals like HRT and metformin –dimethyl guandine HCl – all natural supplements.
Now we have added medicinal natural DMSO liquid, the universal miscible solvent, never mind its crystallized sister form DMSO2-MSM.
DMSO gives early and permanent preventative benefits without risks in many musculoskeletal, cardiac and neurological conditions. It is the only remedy registered in USA for chronic interstitial cystitis, and solely for that rare condition. But it is reported major benefit against trauma, thermal and radiation burns and scars, all infections, sinusitis-otitis, goitre, and pain including headache, gingivitis, dry socket; infertility from tubal blockage; dermatitis; burns, asthma; arteritis, arthritis, lumpy mastitis, diabetic and viral (eg shingles and herpes simplex) and other neuritis, and ischemic/varicose and diabetic ulcers and swollen varicose legs.
DMSO thus understandably has good synergy with the similarly anti-inflammatory antioxidants like tumeric, fish and coconut oils; and metformin which also like DMSO and MSM crosses membranes well including into the brain.
We are seeing good pain and swelling relief with massage with combined DMSO + coconut oil+ zinc + Lugol’s iodine 15% including on scars and painful/lumpy breasts, head, neck, back, abdomen, joints, sprains, skin (pre)cancer etc. As usual one has to beware of too hastily overdoing movement after effective pain relief.
Ongoing experience suggests that sore or lumpy breasts including new painful lumps months after excision and radiotherapy be massaged daily orinitially twice daily: first with coconut oil, then Lugol’s (15%) iodine, then medicinal grade(98%) DMSO to improve deep penetration of the iodine to promote healthy tissue regrowth from deep. It is encouraging how tender lumps disappear within days , including on repeat breast mapping with mechanical tactile Sure Touch scanning.
Adverse effects: apart from possible smell and taste (which some of us don’t experience), pure DMSO may cause redness and burning, as may strong iodine; this is avoided either by diluting the DMSO in a bit of water; or better by applying coconut oil first, then the iodine then last the DMSO.
One must be careful starting with DMSO. Extracted from woodpulp, it is volatile, warms on mixing with eg the oils, or undiluted on the tongue. But there is no evidence of toxicity apart from the smell – which my metabolism apparently does not produce even on a tsp of 99% medicinal DMSO twice a day.. Megadoses of up to a gram per kg have reportedly been used in severe conditions. Fair-skinned people are more sensitive to it so doses should be lower, starting with massage of sore/superficial lesions and/or just ¼ tsp by mouth. Any taste of it is obviously easily masked by mixing it with the essential oils (fish oil, coconut oil) and supplement powders listed, and whatever else is desired eg yoghurt, fruit squash or just water.
There are promising studies on Pubmed between 1989 and 2011 of the benefits of DMSO in management of prostate problems in rats, and humans for transrectal procedures , and intravenously as cancer adjuvant palliation. DMSO-MSM is cheaply and safely available
CHEMISTRY and further references::
DMSO2 MSoM METHYLSULPHONYLMETHANE C2H6O2S or (CH3)2 SO2 dimethylsulfone crystals melt @ 109C and boils @ > 238C. its Molar mass is 94,. Density 1.45
DMSO MSiM METHYLSULPHINYLMETHANE C2H6SO Dimethylsulfoxide Me2SO crystals melt @ 19C , and boils @ 189C Its Molar mass is 78. Density. 1.1
So the two dimethylsulfa sisters cost the same and have the same benefits against pain, chronic cystitis, arthritis, brain trauma, radiation and cancer http://www.dmso.org/ . But only the melted ie liquid form at household temperature is the strong penetrating solvent. It’s not clear whether oral DMSO gives better blood levels than DMSO2 –MSM, since only the DMSO is melted at body temperature whereas DMSO2 is not..
The purist argument against DMSO/DMSO2 as sulphur supplement is that sulphur is not an essential element. But this is obviously fallacious since our chief components are the elements CHOPNS carbon hydrogen oxygen phosphate nitrogen sulphur- we cannot survive without ingesting these. Only plants and microbes can apparently photosynthesize living tissue from CHOPNS by breathing air and absorbing water.
MSO2 ie MSM has also been shown in humans to readily cross the blood-brain barrier. In the rat DMSO carries diazoxide into the ischemic brain to mitigate hypoperfusion, and protects the brain against scute traumatic brain injury.
Comprehensive updated review of DMSO to January 2013 from the USA Natural Medicine Database supplied by the Drug Information Centre of Groote Schuur Hospital UCT echoes Steinberg’s review (Albert Einstein Med Centre in Philadelphi) aAnn N Y Acad Sci. 1967;141:532-50 The employment of dimethyl sulfoxide as an antiinflammatory agent and steroid-transporter in diversified clinical diseases. that 90% DMSO massage in some 500 cases, gave overall good outcome in 80% with no serious or sustained adverse effects reported.
In particular, no evidence can be found overall in the accessible literature supporting one old report that a DMSO product was withdrawn in Japan because of cataract concerns.. A 2011 review of transdermal joint DMSO use from Arizona University found no evidence of human eye toxicity in their series or in the reported literature.
Studies on DMSO have been ongoing at University Oregon for >45years:
Ann N Y Acad Sci. 1967;141:214-20.The effect of DMSO e on the induction of breast cancer in the rat. Fletcher WS, Dennis DL at Univ Oregon showed that in the rat, breast cancer induced by nitrobenzene was progressively reduced by 18months by DMSO 50ppm (ie 0.5%) in their water from after and even better from before the cancer was provoked. In humans this equates roughly to taking 10gm DMSO in 2L fluid a day..
JC de la Torre in 1975 wrote “DMSO has been tested in various experimental injuries of the central nervous system CNS in relation to other therapies. It appears a useful drug in acute extradural mass-forming lesions, middle cerebral artery occlusion, respiratory anoxia, and spinal cord injuries, in rhesus and squirrel monkeys, dogs, and rats. The data from these studies suggest that in the experimental models, DMSO is clearly superior to no treatment, and appears to be more generally effective than other comparable treatments. No satisfactory answer has yet been found to explain the beneficial effects of DMSO…..”
and 2009 JC de la Torre and SW Jacobs Oregon University , ea described Pharmacology of DMSO in cardiac and CNS damage: “The pharmacological effects of DMSO administration include some desirable properties that may be useful in the treatment of medical disorders resulting in tissue injury and compromised organ systems. These properties include the reported effects of DMSO on impaired blood flow, suppression of cytotoxicity from excess glutamate release that may result in lethal NMDA-AMPA activation, restriction of cytotoxic Na(+) and Ca(2+) entry into damaged cells, blocking tissue factor (TF) from contributing to thrombosis, reduction of intracranial pressure, tissue edema, and inflammatory reactions, and inhibition of vascular smooth muscle cell migration and proliferation that can lead to atherosclerosis of the coronary, peripheral, and cerebral circulation. Review of the basic and clinical literature on the biological actions of DMSO in cardiac and CNS damage or dysfunction indicates that this agent, alone or in combination with other synergistic molecules, has been reported to neutralize or attenuate pathological complications that harmed or can further harm these two organ systems. The effects of DMSO make it potentially useful in the treatment of medical disorders involving head and spinal cord injury, stroke, memory dysfunction, and ischemic heart disease. “
Rheology is obviously crucial for health. . The lower the melting point and the higher the viscosity the healthier. Coconut oil (melts at 24C) and DMSO(19C) a universal solvent miscible in both water and oil have similar melting point well below the temperature of the healthy human (+-37C), while fish oil http://www.high-fortune.com/En-index-SW04.asp. melts at similar temperature (20C, freezes at 10C.) Since the brain is about 20% omega3 ie fish oil, it perhaps explains why both coconut oil and DMSO with similar melting point and rheology –good flow- to omega3 have such profound benefit crossing the bloodbrain barrier and fighting vascular and inflammatory degenerative disease eg Alzheimers, as well as against cancer, which while supported by vascular growth factor VGF depend on hypoxia and thus acidosis..
PLoS One. 2012;7:e33361. doi: 10.1371/journal.pone.0033361. .Methylsulfonylmethane suppresses breast cancer growth by down-regulating STAT3 and STAT5b pathways.Lim EJ, Hong DY, Yang YM. Ea Konkuk University, Seoul, South Korea. Breast cancer is the most aggressive form of all cancers, with high incidence and mortality rates. The purpose of the present study was to investigate the molecular mechanism by which MSM inhibits breast cancer growth in mice xenografts. MSM is an organic sulfur-containing natural compound without any toxicity. In this study, we demonstrated that MSM substantially decreased the viability of human breast cancer cells in a dose-dependent manner. MSM also suppressed the phosphorylation of STAT3, STAT5b, expression of IGF-1R, HIF-1α, VEGF, BrK, and p-IGF-1R and inhibited triple-negative receptor expression in receptor-positive cell lines. Moreover, MSM decreased the DNA-binding activities of STAT5b and STAT3, to the target gene promoters in MDA-MB 231 or co-transfected COS-7 cells. Through in vitro and in vivo analysis, we confirmed that MSM can effectively regulate multiple targets including STAT3/VEGF and STAT5b/IGF-1R. These are the major molecules involved in tumor development, progression, and metastasis. Thus, we strongly recommend the use of MSM as a trial drug for treating all types of breast cancers including triple-negative cancers.
Invest Radiol. 2008:43::298-305..Magnetic resonance imaging assays for dimethyl sulfoxide effect on cancer vasculature.Cyran CC, Brasch RC ea. University of California San Francisco: To evaluate the potential of quantitative assays of vascular characteristics based on dynamic contrast-enhanced magnetic resonance imaging (MRI) using a macromolecular contrast medium (MMCM) to search for and measure effects of dimethyl sulfoxide (DMSO) on cancer vasculature. treated control (n = 8) and DMSO-treated (n = 7) human breast cancer xenografts (MDA-MB-435) in rats were imaged dynamically by MMCM-enhanced MRI before and after a 1-week, 3-dose treatment course. CONCLUSION: Reductions in cancer microvascular leakiness induced by a 7-day course of DMSO could be detected and measured by dynamic MMCM-enhanced MRI and were confirmed by microscopic measurements of the leaked macromolecular agents in the same cancers. Results support the robustness of an MMCM-enhanced MRI approach to the characterization of cancers and providing first evidence for an in vivo effect of DMSO on cancer blood vessels.
Neoplasma 2004;51:460-4.Acetaminophen (paracetamol) and DMSO modulate growth and gemcitabine cytotoxicity in FM3A breast cancer cells in vitro.Bilir A, Guneri AD, Altinoz MA. McGill University, Quebec, Canada. Addition of antioxidants to chemotherapy is an unresolved problem in oncology. It is still an issue of debate, whether antioxidants may reduce rough cellular toxicity and thereby the systemic side effects of the chemotherapy, without sacrificing the anti-tumor efficacy. Tumor-sensitivity towards gemcitabine a new anti-cancer agent can be increased with anti-inflammatory agents. Acetaminophen and DMSO are two unique anti-inflammatory and anti- oxidant agents with unrelated structures, both able to block RR and COX, simultaneously. we monitored efficacy of acetaminophen and DMSO to modulate growth and gemcitabine sensitivity in breast tumor cells, Peculiarly, acetaminophen alone stimulated S-phase, which was not accompanied with enhanced plating, rather resulting in 40.3% growth inhibition at the 96 hour. DMSO alone significantly diminished both the plating and S-phase, which resulted in 71.7% growth inhibition at the 96 hour. Gemcitabine drastically reduced S-phase and plating until 72 hours, yet at 96 hours it lost its efficacy to suppress the S-phase with concomitant 2-fold rise in cell numbers in comparison to 72 hour time point. Both DMSO and acetaminophen brought S-phase to around zero percent in combination with gemcitabine until 48 hours, yet they both reduced early cytotoxicity of gemcitabine at the same time interval. However, at the 96 hour, they both strongly augmented gemcitabine efficacy to block S-phase and prevented the rise in plating.
Oncol Nurs Forum. 1991;18:683-5.Case report: topical DMSO for mitomycin-C-induced skin ulceration.Alberts DS, Dorr RT Arizona Cancer Center. Mitomycin-C is a commonly used anticancer drug for patients with advanced anal, breast, colorectal, gastric, lung, or pancreatic cancers. Mitomycin-C can cause severe necrosis and ulceration when extravasated inadvertently into skin and soft tissues following IV drug administration. Local applications of heat, ice, and common antidotes such as glucocorticosteroids and hyaluronidase or sodium thiosulfate have failed to reduce the experimental toxicity of these vesicant reactions in mice. Plastic surgery with split-thickness skin grafting may be required to palliate local pain symptoms and loss of function, although some extravasations heal without any local treatment. This brief communication summarizes two case reports of the treatment of severe mitomycin-C venous extravasations using topical applications of dimethylsulfoxide (DMSO). Although the authors’ experience represents the results of DMSO interventions in only two patients, the response to treatment in both patients was so pronounced that others may find this useful in their practice.