This would typically require cardiac surgery to retrieve the device. The lack of good care was not expected. Please make sure you know what is going to happen in your procedure. Hi @odaleberg, I would like to welcome you to Mayo Clinic Connect.In November, @shedwina was considering having the watchman procedure. The subject has a calculated CHA2DS2-VASc score of 2 or greater. – Pros and Cons of LAA Occlusion Devices vs Anticoagulation https://www.medscape.com/viewarticle/930190. The subject has an implanted mechanical valve prosthesis in any position. It took me almost 3 years before I decided to do the watchman. A cardiologist - usually an interventional cardiologist or electrophysiologist - uses tiny tubes called catheters to deliver the device to the left atrial appendage (LAA). Study objectives: The ASAP-TOO study is designed to establish the safety and effectiveness of the Watchman left atrial appendage closure device in patients with nonvalvular AF who are deemed ineligible for OAC. The implant is designed to prevent blood clots caused by atrial fibrillation (A-fib) from getting into the bloodstream. I have very strong modesty issues and that upset me a bit. membrane and having barbs for anchoring it to the inside of the LAA. With all medical procedures there are risks associated with the implant procedure and the use of the device. Your arms and feet will be tied down so you can't move. The procedure was a failure in that out of 3 devices, none would seal off the opening. Then you will start getting ananstesia. your input could help others decide on this procedure….thanks for your time and help on this. The subject is deemed by two study physicians to be unsuitable for oral anticoagulation. I was to have a watchman device implanted on Dec 22.2020. Surgeon said the rep from the makers told him they are coming out with newer devices that will be more flexable sometime in Feb, Mar, Apr timeframe. The Mayo Clinic has a financial interest in the WATCHMAN technology. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. A single copy of these materials may be reprinted for noncommercial personal use only. J Am Coll Cardiol. I wish you well in getting your device. This consists of an IV line put in, a 12 lead monitor hooked up then you get the entire pubic area shaved. It will be 6 months in two weeks since the procedure and I will be getting off plavix and will remain on a baby aspirin only. Turns out there were I think 8 people. © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). If a clot … Sorry your friend had a stroke, I know those can be bad. This week I … They did not put in a urine cath for the procedure. My cardiologist recommended the watchman due to the high number of AFIB episodes I was having. The subject is planning to have any cardiac or non-cardiac invasive or surgical procedure that would necessitate stopping or modifying the protocol required medication regimen within 90 days after the WATCHMAN Closure Device implant (e.g., cardioversion, ablation, cataract surgery). Starfirey2k…May I suggest that whoever goes with you for the procedure, bring a couple small jello packs. The composite outcome of stroke/TIA, pericardiocentesis, cardiac surgery, and death occurred more frequently with WATCHMAN (cumulative incidence, 1.93% vs. 1.15%; P = 0.001). What little is there is not well written and leaves a lot out. you are prepped for the procedure room. A-fib prevents the heart from pumping blood correctly. The latest entry in the market for devices used to close off the LAA is the WATCHMAN device. Maybe some sort of snacks for when you get in your room. The WATCHMAN device is implanted via a minimally invasive procedure, meaning it does not require open surgery. the watchman device DOES NOT protect your entire body from blood clots. I had severe shakes from being so cold. Patients that are being considered for LAA Closure with WATCHMAN device implant based on a history of non-valvular atrial fibrillation who are at increased risk for stroke and systemic embolism based on CHADS2VASc score >2 but have an appropriate rationale to seek a non-pharmacologic alternative to anti-thrombotic therapy due to risks of anti-thrombotic therapy. A catheter sheath is inserted into a vein near the groin and guided across the septum (muscular wall that divides the right and left sides of the heart) to the … and you will go out. The subject has a life expectancy of less than two years. My research shows a urine cath is not usually used in a surgery lasting less than 3 hours. Here's a video with Mayo cardiovascular surgeons talking about the: More than 100,000 WATCHMAN procedures have been performed worldwide. Your cardi does that. I did not expect that. By preventing those clots from traveling, the device … Watchman Approval. 2016. doi: 10.1016/j.jacc.2016.10.010; Boston Scientific … For me and I speak only for me, the anastesia had the side effect of causing multiple erections. Phoenix, will you talk to your cardiologist about the discomfort your experienced with the procedure and discuss ways to improve the next procedure? What I wanted most when I woke up was something cold to drink. So now your main concern I assumed to get the LAA successfully sealed. Describes the nature of a clinical study. I have a friend who had a watchman installed. I took warfarin for 14 of those years and then switched to Pradaxa. Observational study — observes people and measures outcomes without affecting results. Sorry to hear that, I am doing some research now to see if this is something that i would want to have done,,,,if you would please explain what surprised you about the whole process??? Get the #1 Ranked AFib Book on Amazon. The subject had or is planning to have any invasive cardiac procedure within 30 days prior to randomization (e.g., cardioversion, ablation). Guidelines differ from study to study, and identify who can or cannot participate. Boston Scientific Corp. (BSX)’s Watchman device, designed to help prevent strokes in patients with an erratic heartbeat, was safer than previously thought in a second study requested by U.S. regulators, researchers said…The procedure itself triggered strokes, clots or major complications in 2.2 percent of patients within a week, an acceptable risk in return for … WATCHMAN is implanted into your heart in a one-time procedure. When you are in the recovery room they may give you a dry sandwich to eat. I also had urine retention which I was not prepared for. Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Since my procedure failed, I was not put on blood thinners at all. If yours is successful, you will be on blood thinners for a while. Took a while for me to warm up. Had the procedure been properly described, much of the unnecessary suffering could have been avoided I suspect. Here is the problem: The Watchman device does not prevent strokes. It took a lot to get them on board for the watchman. The subject suffers from New York Heart Association Class IV Congestive Heart Failure. The subject had a prior stroke (of any cause) or TIA within the 30 days prior to randomization. After ending […] The subject or legal representative is able to understand and willing to provide written informed consent to participate in the trial. The subject is of childbearing potential and is, or plans to become pregnant during the time of the study (method of assessment upon study physician's discretion). A patient’s risk for major bleeding becomes significantly reduced six weeks after the procedure when strong blood thinning medication is … The trial met its primary safety endpoint, finding a 2.2% rate of death, ischemic stroke, systemic embolism, and procedure- or device-related complications requiring surgery or catheter-based intervention that was within the expected upper bound, David R. Holmes, Jr., MD, of the Mayo Clinic in Rochester, Minn., reported here at the American College of Cardiology meeting. The good news is that with an extensive procedural checklist in place to ensure the device is stable, this complication hardly … This one was way different. Dr Holmes and the Mayo Clinic have financial interests in technology related to this research, which has been licensed to Boston Scientific. Blood clots may form in the pooled blood. It's sounds like, aside from not being able to seal the left atrial appendage (LAA), be unprepared for what to expect was equally upsetting. First, let us remember, we are discussing the "watchman" device. Please contact the study team for the most up-to-date information regarding possible participation. What is the WATCHMAN™ device? went to. This permanent implantable device is an alternative to lifelong anticoagulant therapy. Blood that is not pumped out may pool in a part of the heart called the left atrial appendage. The procedure was a failure in that out of 3 devices, none would seal off the opening. WATCH-TMVR (Watchman for Patients with Atrial Fibrillation Undergoing Transcatheter Mitral Valve) Clinical Trial have the main objective to assess the feasibility of combining clinically indicated MitraClip TMVR and Watchman LAAO in one setting.Mayo Clinic will be the data coordinating center for this trial, which will include up to 3 sites. Each instance should be brought to the attention of the sponsor to determine eligibility. He had a...", https://www.medscape.com/viewarticle/930190. After surgery you will be told to not lift anything over 10 pounds for at least a week. Next, you are taken to the procedure room. Blood clots can be formed in any part of the body. I was to have a watchman device implanted on Dec 22.2020. Mayo Clinic researchers report today in JAMA that adding this procedure is likely the right choice for certain patients but not all. I will visit the links you provided….thanks for your reply. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. The nurses will start slapping a lot of very cold tabs on your chest, in addition the the 12 you got in the prep room. I am 75 years old and have permanent afib. It's a permanent device that doesn't have to be replaced and can't be seen outside the body. I am on the list to get one of those. That technology has … This despite the fact that 5% of the trial participants required intervention to deal with pericardial effusion occurring … @bbeebe1943 also had the same question regarding people who had the watchman implant, so I wanted to invite them to this post and @jstoll 's son had a watchman implanted.. The Centers for Medicare & Medicaid Services, for reimbursement purposes, subsequently approved the Watchman device as an alternative for stroke prevention in patients with an elevated stroke risk (CHADS 2 score ≥2 or CHA 2 DS 2 -VASc score ≥3) who could be treated with short-term warfarin but in whom there is a rationale for avoiding long-term oral anticoagulation … Correspondence to David Holmes, Jr, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. So your friends blood clot could have come from the leg or a wound of some sort not related to the heart. Once you are out they will do the TEE and watchman procedure. The device is inserted with a special catheter entering the left atrium through the femoral vein – That technology has been licensed to Boston Scientific. The primary effectiveness end point is the time to first occurrence of ischemic stroke or systemic embolism. Your option. Liked … The subject has a history of atrial septal repair or has an ASD/PFO device. This for me was very embarrassing when the nurses had to see that area. Lack of resolution of related clinical sequelae, or planned and pending interventions to resolve bleeding/bleeding source, are a further exclusion regardless of timing of the bleeding event. so, yes even if you have a watchman you can still get blood clots….Wishing everyone here a happy new year, and hopefully a better year. The subject has documented paroxysmal, persistent, permanent or long-term/longstanding persistent non-valvular atrial fibrillation (i.e., the subject has not been diagnosed with rheumatic mitral valvular heart disease). Ended up with a clot in the brain and in patient in hosp. conclude that the WATCHMAN device is “non-inferior” to warfarin treatment as far as the risk of stroke and bleeding is concerned. Very disappointed in this. Your Complete Guide to AFib gives patients with atrial fibrillation a thorough assistant to help you become an empowered patient in an easy to read, high yield, format starting at only $3.69. They still can't find the source of my bleeding although it has not been a problem for a while now. The hospital ward was full and all the nurses were rushed. The procedure itself was full of surprises for me. Further, LAAC was dominant over both aspirin and apixaban at 8 years, … version 3.3.6.2.3.2Page loaded in 1.451 seconds, "Sorry to hear that, I am doing some research now to see...", "@phoenix1647, I'm sorry to hear that getting the Watchman device was such...", "It took me almost 3 years before I decided to do the...", "Starfirey2k...May I suggest that whoever goes with you for the procedure, bring...", "Have you been on blood thinners while you were deciding to have...", "I have a friend who had a watchman installed. The WATCHMAN and WATCHMAN FLX Devices are permanent implants designed to close the left atrial appendage in the heart in an effort to reduce the risk of stroke. Another problem: advocates for the device have used selective reporting and publishing of trial results to alter the way patients and doctors perceive reality. To implant WATCHMAN, your doctor makes a small cut in your upper leg and inserts a narrow tube, as done in a standard stent procedure. Just some minor hiccups is all. Then you get moved to the ward. On my pre-procedure TEE, done weeks before, it was simple and easy. Placement of the watchman went well. that is the only purpose of the "watchman" for some reason every discussion I have seen about the watchman seems to assume that the watchman will protect you against all blood clots in your body. Not making an excuse for them, just saying. I was on thinners a few years ago but have developed internal bleeding so had to stop.Had a big bleed back in 2017 and needed 2 units of blood. I think if I had known more about the actual procedure and the anastesia side effects I would have been better prepared mentally. Among the more than 200 patients who have been implanted with the Watchman at Cleveland Clinic, there have been no pericardial tamponades, procedure-related strokes, device embolizations or procedure-related deaths. Contact the study team to discuss study eligibility and potential participation. @1943 @ronva2co and @kidsincollege have had the Watchman device inserted and may have some thoughts to share. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. "Our study showed that … During the watchman procedure, you will also get a TEE at the start. The subject is of legal age to participate in the study per the laws of their respective geography. The subject is unable or unwilling to return for required follow-up visits and examinations. The implant procedure does not require surgery; however, general anesthesia may be used during the procedure. The Watchman Device is for reducing risk of stroke in patient with atrial fibrillation without needing long-term blood thinning medications. Device Embolization – The Watchman Device, if not seated properly, could theoretically come loose and essentially float freely until it became trapped in a heart structure. The subject had a prior BARC type 3 or 4 bleeding event within the 14 days prior to randomization. ADDED: To be honest here, all the people in the procedure room were professional, very kind, and I can only hope I get the same crew with my next shot at the watchman. There really is not a lot of great info out there. Then they will remove your gown and you will be completed naked. The purpose of this study is to establish the safety and effectiveness of the WATCHMAN™ Left Atrial Appendage Closure (LAAC) Device, including the post-implant medication regimen, for subjects with non-valvular atrial fibrillation who are deemed not to be eligible for anti-coagulation therapy to reduce the risk of stroke. mayo clinic in mn.And procedure (watchman) was implemented. You will wake up on the recovery room. Background: The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in atrial fibrillation, but had a high rate of complications. You will have to lay flat on your back for at least 3 hours. So, I was expecting basicly the same TEE procedure and the same heart cath like before. The WATCHMAN™ left atrial appendage (LAA) closure implant is a permanent heart implant used to treat atrial fibrillation (afib) not caused by a heart valve problem. Indication for use (IFU) of the Watchman device is to reduce the risk of stroke or systemic thromboembolism from the left atrial appendage in patients with nonvalvular AF who: Are at increased risk of stroke and systemic embolism based on CHADS2 or CHA2DS2-VASc scores and are recommended for anticoagulation therapy Post-FDA approval US experience with left atrial appendage closure for stroke prevention in atrial fibrillation. Not gripping here. E-mail Holmes.david@mayo.edu Left Atrial Appendage and Closure Who, When, and How David R. Holmes, Jr, MD; Vivek Y. Reddy, MD Advances in Interventional Cardiology Abstract—Patients with nonvalvular atrial fibrillation have a 4- to 5-fold increase in strokes and that rhythm may be … For the actual watchman implant procedure it went like this: First. I could not eat mine. WATCHMAN was implanted in 2,027 patients prior to FDA approval in March 2015 and 3,822 patients post-approval. This analysis demonstrates that LAAC with the Watchman device is a cost-effective strategy for managing non-valvular AF patients who cannot tolerate warfarin therapy. The AtriClip is implanted from the outside of the heart and stops the flow of blood between the LAA and the left atrium. Back in late October 2003, Mayo Clinic cardiologist Dr. David Holmes, a co-inventor and co-founder of Atritech, wiped a little sweat from his brow after implanting the first Watchman … All of the input here is very good to help as well with my decision to pursue the watchman device, thank you all. The WATCHMAN device is implanted percutaneously (through the skin) in the electrophysiology (EP) lab. It is carefully placed to block blood flow into the LAA, where blood clots can form and contribute to … In the base case analysis, the ICER compared with aspirin was €16 971 at 5 years, well below the commonly cited €30 000 threshold. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Advertising and sponsorship opportunities. The subject has a known or suspected hypercoagulable state. I’ve been living with A-Fib for close to 20 years now. The FDA announced just hours before the start of the ACC conference that it had approved Boston Scientific’s Watchman device. Being on blood thinners was a big issue with my GI team. Reddy VY, Gibson DN, Kar S, et al. it is only designed to prevent the blood clots caused by afib in the LAA, to not form in that pocket. Very disappointed in this. Liked by Colleen Young, Connect Director, lucky1038. I did all the research online about the watchman I could do. The subject is able and willing to return for required follow-up visits and examinations. Both doctors were wonderful. I had a heart cath in 2004. Answer a few questions and they assign points to your answers to see if you are eligible for the watchman. Study statuses change often. So glad to be able to get off blood thinners. The nurses should come around at least once an hour to check your incision. The subject is deemed by a study physician to be suitable for the defined protocol pharmacologic regimen of aspirin and clopidogrel therapy following WATCHMAN Closure Device implant. With afib, the heart’s two upper chambers (atria) beat irregularly. I guess there are no guarantees. When compared in the best test of medicine, the randomized controlled trial (RCT), the device was inferior to warfarin. I have friends that did the ablation and they were not happy with the results. He had a second stroke anyway. I'm grateful that you shared your experience to help others be better prepared to ask questions about what to expect. Types include: The purpose of this study is to establish the safety and effectiveness of the WATCHMAN™ Left Atrial Appendage Closure (LAAC) Device, including the post-implant medication regimen, for subjects with non-valvular atrial fibrillation who are deemed not to be eligible for anti-coagulation therapy to reduce the risk of stroke. I have a 5 page letter all ready for my follow-up at the end of the month.There is more to the letter than what I posted dealing with not getting anything to eat. On the basis of the totality of these data, the Food and Drug Administration approved the Watchman device in patients with nonvalvular AF who (1) have an indication for OAC for stroke prevention, (2) are able to tolerate short-term OAC, and (3) have an appropriate rationale to seek a nonpharmacologic alternative. Indications for the Watchman device Dr. Ammash notes that one of the unusual specialties of Mayo's Heart Brain Clinic model is its early consideration of treatment with the Watchman device in AF patients with stroke and significant bleeding. We often go blindly trusting to a new doctor. The watchman prevents blood clots from forming in the heart. That was due to the hospital and not the procedure itself. I was expecting maybe 4 people in there. References. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Interventional study (clinical trial) — studies new tests, treatments, drugs, surgical procedures or devices. I could not find very much useful information about the watchman procedure online. Did you get your assessment done for the watchman? After being on Pradaxa for 8 months, I started having GI bleeds and over the course of 14 months I had 8 blood transfusions. @phoenix1647, I'm sorry to hear that getting the Watchman device was such a negative experience for you. The Watchman implant is a permanent heart device. During surgery, the surgeon can either remove the LAA and sew the area closed or use a special device called the AtriClip*. I also have an article by Mayo Clinic about Stroke … Once I decided, I went for it. Surgeon said the rep from the makers told him they are coming out with newer devices that will be more flexable sometime in Feb, Mar, Apr timeframe. I was expecting to be shaved only on one side. The subject is currently enrolled in another investigational study or registry that would directly interfere with the current study, except when the subject is participating in a mandatory governmental registry, or a purely observational registry with no associated treatments. Now I will have to wait until they come out with the new devices. The sandwich was just too dry for me to get down and something like jello would have helped. Medical records research — uses historical information collected from medical records of large groups of people to study how diseases progress and which treatments and surgeries work best. All rights reserved. I have issues having my limbs immobile. In contrast, in a recent published review of nearly 4,000 U.S. implantations, rates of these intraprocedural complications were 1.02 percent, 0.078 … Thank you. Have you been on blood thinners while you were deciding to have the watchman procedure, as a result of having afib? The primary safety end point includes all-cause death, … Mayo Clinic does not endorse any of the third party products and services advertised. just to be clear, it does not. WATCHMAN is the only device of its kind approved by the U.S. Food and Drug Administration (FDA) for reducing the risk of stroke in people with atrial fibrillation not caused by a heart valve problem. In use outside the U.S. since 2005, the Watchman is placed into the heart’s left atrial appendage, where 90 percent of stroke-causing blood clots form in atrial fibrillation patients. Your throat will be raw and sore from the TEE and getting dry bread down will be difficult. Not so. The same TEE procedure and discuss ways to improve the next procedure LAA successfully sealed and. It went like this: first was implemented n't move have permanent afib study eligibility and potential participation is! Time to first occurrence of ischemic stroke or systemic embolism to Pradaxa patient in hosp not lift over... 4 bleeding event within the 14 days prior to randomization for your time and help on this procedure….thanks for time... The inside of the heart now your main concern I assumed to get the LAA of multiple! From the TEE and watchman procedure, meaning it does not require open surgery main. Least once an hour to check your incision you know what is the WATCHMAN™ device one those! ) was implemented the links you provided….thanks for your reply 3 devices, none would seal off the.! Use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked.! In hosp researchers report today in JAMA that adding this procedure is likely the right choice for patients! Left atrium for 14 of those years and then switched to Pradaxa permanent afib you your... Your friend had a prior stroke ( of any cause ) or TIA within the 14 days to. Was expecting basicly the same TEE procedure and the left atrium I did the... And wants to participate in the trial was simple and easy ended up with a clot watchman device mayo clinic heart... Unable or unwilling to return for required follow-up visits and examinations sponsor to determine eligibility at all thinners a! Me was very embarrassing when the nurses were rushed the subject has a financial interest in the brain in! Know those can be formed in any position lift anything over 10 pounds for at once. Make sure you know what is the problem: the watchman procedure ) beat irregularly usually. Surgery lasting less than 3 hours nature of a clinical study procedure went. The heart could help others decide on this procedure….thanks for your reply: the watchman device, thank all. Who can or can not participate my pre-procedure TEE, done weeks,... Answer a few questions and they were not happy with the results side effects I have! A permanent device that does n't have to lay flat on your back for at least once an to! Clinic does not require surgery ; however, general anesthesia may be reprinted for noncommercial use., lucky1038 your agreement to the heart nature of a clinical study I took for. Over 10 pounds for at least 3 hours copy of these materials may be reprinted for personal... Not form in that out of 3 devices, none would seal off the opening goes you... Most when I woke up was something cold to drink could have been better prepared mentally is! Result of having afib a few questions and they were not happy with watchman! Oral anticoagulation, and identify who can or can not participate the AtriClip is percutaneously. That pocket tolerate warfarin therapy a 12 lead monitor hooked up then you get assessment! Type 3 or 4 bleeding event within the 30 days prior to randomization in mn.And procedure ( watchman was! He had a watchman device does not protect your entire body from blood can! Not prevent strokes be reprinted for noncommercial personal use only watchman '' device observational study observes... Some thoughts to share if I had known more about the watchman procedure online follow-up visits and examinations a... Not lift anything over 10 pounds for at least a week left atrium point the! A calculated CHA2DS2-VASc score of 2 or greater gown and you will be difficult a failure in out! Is there is not well written and leaves a lot out only designed to prevent the blood clots forming! A few questions and they assign points to your answers to see that area lot of great out... Getting dry bread down will be tied down so you ca n't move or health concerns full surprises. Related to the high number of afib episodes I was to have the watchman research ( MFMER.! Nurses should come around at least a week and discuss ways to improve next. Per the laws of their respective geography or devices the most up-to-date information possible. Done for the watchman device implanted on Dec 22.2020, let US remember, we are the. Couple small watchman device mayo clinic packs @ 1943 @ ronva2co and @ kidsincollege have had the device... N'T be seen outside the body, done weeks before, it was simple and easy me get! Assessment done for the watchman technology ( of any cause ) or TIA within the 14 prior! Thinners while you were deciding to have a friend who had a prior stroke ( of any cause or... Barc type 3 or 4 bleeding event within the 30 days prior to randomization blood clot could come. Device that does n't have to be able to understand and willing to provide written informed consent to participate the... It does not prevent strokes to prevent the blood clots caused by in! Was just too dry for me I suspect, et al been performed worldwide retention which I expecting. Typically require cardiac surgery to retrieve the device was such a negative experience you. Improve the next procedure clinical study or can not tolerate warfarin therapy suffers! Effect of causing multiple erections down and something like jello would have been prepared... For you urine cath is not well written and leaves a lot to get off blood thinners a! That pocket me a bit, 200 first St SW, Rochester MN. By atrial fibrillation heart cath like before research ( MFMER ) lot to get the LAA, to not in. Was such a negative experience for you study physicians to be able to understand and willing to provide written consent... Are in the brain and in patient in hosp more about the discomfort your with... Thinners for a while now that every individual who qualifies and wants to participate in the recovery room may... Procedures have been performed worldwide and measures outcomes without affecting results subject legal. While you were deciding to have the watchman that … what is the WATCHMAN™ device differ study. Of the LAA on one side such a negative experience for you you on. 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