Patients and their Pastimes

knee doctor

Mr Hardy is interested in returning his patients to the activities, sports and careers they love. He adopts a conservative approach for the majority of the patients he sees, directing each to the appropriate and evidenced based treatments that work. His "Surgery only when it Saves" policy is consistent with the Hippocratic oath.

Below are some of the activities his patients have returned to and testimonials from the adventerous patients. Many of the patients featured in the tabbed index below came for a second opinion or after failed surgery in other parts of the world.

Whether it be a desire to return to sport after injury or to recover from the debilitating symptoms of osteoarthritis patients should plan their goals thinking "SMART".

  • Specific
  • Measurable
  • Attainable
  • Realistic
  • Timely

Mr Hardy can help you to manage your medical condition, describe your prognosis based on his experience and help you to set goals that are realistic. In this way you can manage your own expectations..

  • TE
  • BM
  • ACL
  • CK
  • JM
  • AP
  • AC
  • NG
  • DC
  • MN
  • SF
  • DC
  • LP
  • AP
  • UR
  • GB
  • MRI
  • RM
  • LB
  • YB
  • JP
  • JM
  • MS
  • AC
  • MF
  • KM
  • SW
  • MT
  • AM
  • MN
  • RH
  • MB
  • ZB
  • CA
  • MC
  • IG
  • HM
  • MB
  • NR
  • MB
  • MD
  • BT
  • RB
  • SK
  • DC
  • EC
  • SG
  • EB
  • GD

Walking after knee surgery up Ben Nevis Hello Dr Hardy,

Voila the proof! Only 3 months after surgery walking up Ben Nevis for 12 hours! Thank you for making it possible.

A short break in the Dolomites from Dr Bruce Marks on Vimeo. "Happy New Year John. Yes, getting back into flying has been great, and believe me, though I may have started earlier than advised, it was needed for my well being. I hope you have had a chance for a little relaxation? Here is a link to a video in my Vimeo channel shot at Christmas flying south of Perth "Christmas at Shelly's Beach" only two months after being evacuated from the dolomites with a broken ankle and thumb. Thanks again for your great care, it's very much appreciated still". Bruce Marks, Consultant Anaesthetist.

ACl Rupture Skiing - Brilliant Knee Surgeon - I am not sure who this was but thank you for the anonymous vote of confidence - John Hardy

Spurs "A after visiting our daughter in Australia in 2006, I started having pains in my knees and all down my left leg. My knees and legs ached, as though I’d walked miles. We couldn’t figure out what was causing it. Over the next five years, I tried everything. I saw a rheumatologist, other orthopaedic surgeons and a neurologist who ran tests but couldn’t find a cause for the pain. My GP told me I’d just have to manage with painkillers. But I wanted a second opinion, so we scoured the internet and found an orthopaedic surgeon called John Hardy — I saw him privately at Spire Hospital Bristol in July this year. I had X-rays and other scans. Mr Hardy diagnosed a bone spur — an abnormal growth of bone caused by the gout. He explained that when the soft tissue around a joint becomes inflamed, it can prompt the lining of the bone to start growing. Now that all my medical ailments seem to have been successfully overcome, I must thank Mr Hardy and his team for the help and advice you have given in going through the surgical process to get my knees and legs back in normal working order".

Janet MenziesJanet Menzies is an author and journalist writing regularly in the Field magazine. She said: "3 years after my ACL surgery I am now up and running again - literally.  The knee has been holding up to such good effect that I was able to complete the French Riviera Marathon last autumn (proud pic enclosed) and the Torbay Half Marathon this June".

Alex Poole, who is a fitness training instructor in the UK blogged "I went to see the knee surgeon Mr John Hardy yesterday for the two week post op consultation. He removed the stitches and we were both extremely happy with the results considering only two weeks had passed. I have excellent range of motion and great quad tone. I have a little swelling in the knee still but that’s to be expected since I have been trying to stay active and doing as much rehab as possible. I warmed up with a cross train for five minutes in my Fat Burn In 30 workout".

knee injury from enduroORE enduro, Wellington on 1st April 2007. "I had my doubts if I would ever return to this weekend pursuit, due to the knee injury I experienced last year playing Badminton. I consulted John Hardy and I now have the knee I thought I left behind 10 years ago, I'm pain free competing in the enduro events which is something I thought I would never experience, oh and I'm playing Badminton again with no problems. Thanks for the 2nd
chance". Andy Chubb.

Equestrian elbow injuryNick Gauntlett is currently ranked 19th in the world and is on course for selection to the Senior British Eventing Team. Representing Britain in 2012 is the ultimate prize for his drive, determination and talent.

knee injury"I went into the Sport and Orthopaedic Clinic at The Glen Hospital in Bristol with severe damage to my knee ligaments and cartilage. From the moment I first contacted the hospital the service was nothing short of magnificent. I got a consultation within 24 hours of my first phone call. I had a scan that day, a follow up consultation the next and was on the chopping table a day later. All the staff were very professional throughout. I can honestly say that I enjoyed the stay in hospital for my first operation and had no worries about returning for the second, as the quality of care was so high. My surgeon John Hardy was excellent and reassured me when times seemed hard. The follow up physio was also very good. I have now made a good recovery and have been back as an operational Aviation Fire Fighter, returning to normal duties which include hose running, vigorous realistic Fire training and ladder drills. I would like to thank all staff at the Glen and I will not hesitate to recommend the facility to other I know with injuries. Thanks." Darren Colman.

knee osteoarthritis"This is me exercising at the Perito Moreno glacier in Argentina. Thanks John for the advice and help during the knee operations and hope to see you soon. FYI...have included a picture from 10 days ago. Biking 2 months after the op". Mark Naylor

"I went to John following a failed operation on my knee. He diagnosed the problem that had been missed by the first surgeon. Now after simple day case surgery by John Hardy I am back to my sport". Steven Fromm.

"A couple of shots of me skiing on day 12 after the op. I actually skied (carefully) on day 11. My daughter is much faster than me now but with your help I should now be able to stay in touch! Best regards". Don Coates

Leonardo Poggiali  - "I am an Italian (London based) patient of Doctor Hardy. He treated my knee in 2008/2009 after a ski accident and surgery in Bologna. Thanks to his second opinion, skill with keyhole surgery, supervision and the talented physiotherapists of the BUPA Cromwell Hospital not only I recovered all the key knee function: last winter I have also been able to ski 11 days with no problem what so ever".

"Of course I am treating my knee with the right care, but it has been holding extremely well under all circumstances and without any bracer".Leonardo Poggiali; - "I am an Italian (London based) patient of Doctor Hardy. He treated my knee in 2008/2009 after a ski accident and surgery in Bologna. Thanks to his second opinion, skill with keyhole surgery, supervision and the talented physiotherapists of the BUPA Cromwell Hospital not only I recovered all the key knee function: last winter I have also been able to ski 11 days with no problem what so ever".

Upender Rawat

Before surgery at the Private Hospital in London that looks after the Indian High Commission I had problem in running, climbing stairs or any other task putting pressure on my knees, which would cause significant pain. However, after surgery my problem has been solved. My knees are recovering well now and I hope to reach to full sporting activity soon. Though I have not yet starting running, I am confident it will be fine when I am ready to resume running. The surgery with Mr Hardy has also solved my problem of broken ACL in right knee with which I was living with over the last 12 years after a motor bike accident in 1999.

Mr Hardy and Ian Winson operating as part of the management of "turf toe" in an international rugby player.

Long_Term_Knee_Pain"Long Term Knee Pain knee pain is often caused by a build-up of gritty tissue after a fall. Treatment traditionally involved painkillers and physiotherapy, but Glenn Bailey, 46, an insurance company project manager from Bristol, had a new 30-minute operation that reduces the risk of further problems such as arthritis. He talks to Carol Davis" in this article on John Hardy and his patient Glen Bailey in the Daily Mail.

John says click on the link above as this patient has explained very well his experience of the symptoms and signs of plica syndrome and how 30% of patients need it managed by this minor day case technique.

 

The MRI is no longer an unpleasant experience.

"I developed severe knee pain over 12 months before my first key hole surgery. The first arthroscopy in my local private hospital left me in terrible pain and discomfort. I knew that things were not right in my nee from the minute I left hospital. I was then in pain until I saw John Hardy and he advised and performed the second arthroscopy on my knee within 8 weeks. After the first arthroscopy I was advised to try the usual tablets, ice packs, exercise and physiotherapy when possible but things were definitely not improving. I saw Dr Jo Longstaff who is a Private GP in Swansea. She referred me very quickly for an appointment with John Hardy in his Bristol Clinic.

Before seeing Mr Hardy I was really concerned that I been left with no option but to have a knee replacement. I really can’t compare the levels of care and service I got at Spire Hospital Bristol to the first hospital. There was a different feeling about the surgery and Mr Hardy seemed much more concerned with my individual care even though he was obviously looking after other patients as well. The anaesthetist Mr Hardy works with at Spire seemed more attentive. My treatment at the Spire Hospital Bristol was excellent, including the after care following arthroscopy.

At the previous hospital there was no plan in place regarding after care. I was allowed home the same day and the following day I could tell straight away that the knee surgery was healing and this time getting better by the day. This was compared to the first arthroscopy which was getting worse by the day.

My conclusion is that there is a spectrum of orthopaedic surgeons that do knee arthroscopy but few who really understand how to get good results!" - Robert Morgan

Les after knee surgery in 2005 Extreme Ballooning at the world famous Bristol Balloon Fiesta.

"After I had surgery with John at the Spire Hospital Bristol I was made player of the year at North Bristol RFC.

"I am so grateful that I was recommended by my GP for a second opinion with Mr John Hardy who finally sorted my knees out, after two arthroscopic attempts by another surgeon which did not work.  I had never heard of Hoffa’s posterior fat pad impingement syndrome and an Orthopaedic Consultant I met at a Christmas party had also never heard of it but clearly in my case I had been suffering from this condition for several years as Mr Hardy and his team fixed both knees for me.  At long last my knees are fabulous with great movement and pain free.  I am happy to report that I am now firmly back in the saddle which for me is a very important part of my life. With thanks to Mr Hardy".
Jane ParkerJane Parker

“With short notice, Mr John Hardy and his team fitted us into his busy schedule and it was a very efficient service, which was really appreciated. The Donjoy Comfortform Wrist Splint was extremely comfortable and allowed me to carry on with my training schedule. As a left handed Nationally sponsored player (one of the AEGON Future Stars Programme) having an undisplaced Salter-Harris II fracture on my left dominant fifth metacarpal could have meant no tennis for 6 weeks, but my Biomechanics Coach, Team Bath Tennis and John Hardy have allowed me to cross train with my right hand which will strengthen it and obviously improve my backhand!” “Thank you all"!! – James Mitchell.

"A picture from my cricket at the weekend. Exactly 10 days after John fiddling with my knee, here I am playing cricket at my son’s school. I never would have believed it. Managed to bowl and bat – innings restricted by a yorker, not a knife on the knee! Some things don’t change. Pleased to say that my knee feels in great shape". Michael Saunders - Managing Director and Chief Operating Officer of the UK's premier  Wine Merchant and Fine Wine Shop

A picture from Swamp Creek caves. "Following a successful 'lateral release' operation for Chondromalacia Patellae on each knee I am now venturing underground again in the world of Caving Taking it steady but now able to crawl and climb in places I would not have been able to go prior to surgery.  Walking, cycling & horse riding are all now pain free and enjoyable once more.

Thank you John for my new knees!!!! Angela, Bristol".

"A couple of photos of Marion back on the bowls green within 4 weeks of arthroscopy for osteoarthritis of the knee.  Marion wants to avoid knee replacement surgery for as long as she is able to compete in this sport. She is due in for the same on the other knee soon! Stuart Fisher". Update December 2010: "Marion asked me to send a quick email to say that last weekend she bowled over 150 woods in a bowls competition and won – and all without pain".

“last time I saw John I promised to send him some pictures of Alan taking part in the 100 mile bike ride from Bristol to London (it was in fact 117 miles) on 29.8.10. John operated on Alan's knee a few years ago - and without the surgery Alan would never have been able to do this. Alan completed the 100 miles in just 9 hours with 7 hours pedalling and 2 hours of rest stops throughout the trip”. Kirstie Mann.

When I saw John on 21st September as you know he "discharged" me...hurrah!! When assessing my progress, he said he had photos of "repaired" rugby players, skiers, ballet dancers, etc etc...but no gardeners. So...herewith a recent photo of me doing what he suggested I should ...digging the vegetable patch after my arthroscopy for osteoarthritis of my knee on March 9th 2010! Many Thanks. Steve Williams

"My recovery and rehabilitation was planned by John without surgery and instead we utilised the Donjoy leg brace with initial restricted movement. This was key to giving my knee support and the ligaments a chance to heel. Being an active guy I was consistently pushing the boundaries on various recovery exercises, this  had an element of trial an error as sometimes I had overexerted the knee. The  TROM Advance Cool ROM knee brace was fantastic at giving my knee that extra support and rest allowing it to recuperate faster when these few instances happened. The DJO service was impressive and replaced the whole brace within 2 days when one of the adjustment widgets was dislodged in training.

After 2 months as my recovery without surgery was progressing well,  I felt it was not unrealistic to consider the possibility of trying to participate in a bike event at just past the three month stage post accident. My knee surgeon and Physio. suggested a strategy to optimise muscle recovery by using the Compex Wireless system which definitely accelerated quad muscle recovery. Thankfully I had no issues with my knee or lactic acid build up on my two day ride."

So far in 2012 we have raised £150,000 from this ride. And it looks like we hope to do an enlarged version of this next year for GOSH again.

Kind regards,
Mungo Tennant

Mr Hardy. Good luck with your sports clinic - Alex Morris BMX #01

"When I saw John with a ruptured ACL I thought my career as a professional sufer and skateboarder was over. He reconstructed my ACL and I have never looked back" - Ross Mace-Nicholas.

Mr Hardy congratulates Ross for his heroic rescue mission in 2005 some 4 years after his ACL reconstruction. 05 April 2005: - "Two British surfers escaped Nias island yesterday after saving a local family and surviving on the beach for seven days and nights. Ben Clift, 24, and Ross Mace-Nicholas, 26, rescued a heavily pregnant woman, a ten-year-old girl, a grandmother and a man in a wheelchair from the waves that hit the Indonesian island of Nias on Easter Monday".

A picture of me back at work on our farm. John got me back on my feet following a fall from a horse in West Wales. I was looking for an Orthopaedic Surgeon to get me back to work and following an ACl reconstruction which was "Brilliant" I am lambing at one end of the year and shearing at the other. I have recommended him to many friends and family - Ruth Hughes.

I was nervous about knee replacement surgery before I met Mr Hardy. I saw him with my husband and he examined me and with the x-rays he took explained the options available to me. I was keen to return to dancing and so I decided to have a knee replacement. This is me 9 weeks after knee replacement in Dec 2004. We are delighted with the way things have turned out. Thanks again Mr Hardy.

This is me eight months after a knee operation with John Hardy riding a "Bucking Bronco" outside our restaurant. " I lasted 2 minutes! Zena Burland...

John says please do not try this at home everyone! 

Zena's is an Award Winning North Devon Restaurant

Meniscal Tear

“I went to see a Consultant in April 2011 after a 2 or 3 year period in some pain with my left knee. I suffered a lot of knee pain while walking up and down hills. I was diagnosed with an arthritic knee so I decided to go ahead with an arthroscopy on 30th August 2011. The staff at the hospital in Cheam were pleasant and I was seen by my first Consultant, the anaesthetist and a physiotherapist before the operation. After the operation I felt quite unwell having to stay in overnight. My Consultant did not visit me in my room after the operation at all. The following morning I was unable to walk. It was from then that my nightmare began! My knee felt as if a "cheese wire" was cutting through my knee. I couldn't sleep at night and the final straw came when my husband found me sobbing downstairs in the middle of the night! I was told there was nothing further surgically that could be offered for the glue feeling in my knee.

My husband found an article in The Daily Mail newspaper dated 3rd January 2012. I emailed Mr Hardy's secretary and on the first appointment, after assessing me, he seemed to know what was wrong. After completing the peroperative rehabilitation I was admitted under Mr Hardy's care in London for a revision arthroscopy. I was visited by a physiotherapist to go through the exercises I would need to do in the early days after the operation and by Dr Coates (the Anaesthetist) and of course Mr Hardy himself. By late morning I was back in my room chatting and laughing with my husband and attentive nursing staff. I felt perfectly fine with no sickness and quite hungry! When Mr Hardy came to see me in my room for the first time after the operation I walked to find that the glue feeling had gone. It's been about 12 weeks since the revision operation and apart from 2 operations in less than a year my life has now got back on track. An attentive and experienced Consultant, Mr Hardy, and a proper rehabilitation plan with ongoing care and advice is what I needed". - Christine Armour

“I was referred to Mr. Hardy following my GP attending a lecture, given by him, on Dupuytren’s Contracture which for me was a worsening condition in both my hands. How lucky I have been that this happened at the right time. I took the first date offered to have my dominant right hand, repaired and now, two weeks later, I am using both hands on the computer and for many household tasks. I experienced no pain following the operation due to his expertise and sound advice. Mr Hardy asked in my history if I had always been active - the sailing picture left shows the answer was “yes”. Pulling on ropes in our 505, No.16, (the oldest in the fleet at Lyme) a long time ago probably has helped to give me the strength to start upholstery classes so it was really important to me to be able restore the function in my hand. Anyone hesitating to have this procedure done should go ahead sooner rather than later. My left hand will be “mended” early in 2012.” - Maggie Coker

Regarding Coccydynia - “There is obviously some good information out there also - to me the most crucial would be to see a surgeon who has done this procedure many times, has depth of experience, and knows what they're doing. I cannot recommend Mr Hardy highly enough, for anyone in the UK seeking treatment.” - IM on Coccyx.org

Regarding Coccyx pain and pregnancy - “This was the best operation I have had. Now in 2016, I live my life to the full. I have a beautiful daughter aged 5, and because of the operation, giving birth was easy as well, as I know speaking to other mothers, that they experienced real pain with their coccyx, at least I was spared this pain. I have to say that if there is anyone out there in the UK suffering severe pain, I cannot recommend Mr Hardy at The Spire Hospital in Bristol highly enough. He had no hesitation in carrying out the procedure and is the best consultant for this type of operation.” - Helen M on Coccyx.org

MRI Scanner StaffClick on the yellow letters for a testimonial from a Spire Hospital patient who had a poor response to surgery in another hospital but cam to Mr Hardy for an accurate MRI and successful keyhole knee surgery.

“I was referred to Mr. Hardy because of rapidly developing osteoarthritis of both knees in 2010. I was keen to continue to be involved in sport and avoid knee replacement surgery. My case was complex as I had a rupture of a previous ACL reconstruction in one knee and a meniscal tear in the other. With rapidly progressing osteoarthritis in both knees I needed a plan of action to deal with the pain, lack of range of movement and instability. From the first meeting we formed a plan of surgery and rehabilitation that over two years has worked.

In a bid to raise money for The Teenage Cancer Trust South West I and my partner Gill will be cycling from John O’ Groats to Land’s End to raise money for the Teenage Cancer Trust. The total distance covered will be 1,050 miles and aim to average 100 miles a day covering the total distance in 10.5 days. Adding to our challenge we will be completing the journey on a tandem and without any support crew. Our journey will commence on the 22nd July 2012 and we would very much appreciate your support in making the Bristol Build a reality for teenagers across the South West, by logging onto our Just Giving page and sponsoring our ride to help improve the lives of others. I would never have been able to contemplate undertaking this prior to my series of knee operations ” - Neil Richardson

“I recently had an injection of Xiapex into my left hand to straighten my little finger which was bent over and unusable for several years with Dupuytrens. My hand was then dressed and I returned home. During the night I had the urge to stretch my little finger and something snapped in my hand.

The next morning I thought a miracle had happened as my little finger had started to straighten. The following day my hand was manipulated by Mr Hardy, which I may add was painful, my skin did tear but after two weeks my little finger is almost straight and my hand almost healed. This procedure has got to be a cost effective alternative to an operation, plus a safe way to give back a quality of life to a lot of suffering people and to be really honest with you I now have my hand back. I am now looking forward to Mr Hardy doing the right hand. Thank you.” - Michael Badman

Meniscal Tear

“The London Moon Walk 2015 full marathon, by pure serendipity, had me walking right past the Cromwell Hospital, where Dr. John Hardy did an ACL reconstruction on my knee. I stopped to take this photo, remembering his words post operation: "You will be doing marathons"....:) Three years ago, before the operation, I was using a cane to walk, so doing marathons sounded like a bygone dream. This Sunday morning, 17.05.2015, I was crossing the finishing line of the Moon Walk Marathon, with a smile on my face and huge gratitude in my heart! I have to say that Dr. Hardy gave me a lot of confidence from the moment I met him, for the first consultation. Thanks to his expertise, and his wonderful team, I was recovering pain free after the operation and I fully recovered a day after power walking for 26,2 miles. Thank you for making dreams come true.

Meniscal Tear

Click on the yellow letters for a testimonial from a Spire Hospital patient who set and achieved all of his goals for total knee arthroplasty with Mr Hardy and his team.

Meniscal Tear

Click on the yellow letters for a testimonial from a Spire Hospital patient who appreciated her total knee arthroplasty with Mr Hardy and his team at Spire Hospital.

Meniscal Tear

“Hi John,

This is the Everest photo I mentioned. Taken on the trek in 2001 only a few months after you sorted out my knee. The trek gave it a real test, as you can imagine, reaching 18,500 feet over really rough ground."

Professor Selby Knox

Meniscal Tear

“Mr Hardy,

The first arthroscopy on my knee (done elswhere) was a waste of time and the surgeon suggested I would need radiotherapy as treatment.

Then I found out about you. Thanks to you 7 weeks after my second knee arthroscopy I'm pleased to say goodye to synovial chondromatosis."

Danielle Calthorpe

Click on the image for a You Tube video of Danielle at a Gala after surgery!

Anterior knee painI am a competitive Aerobic Gymnast and I was successfully treated by Mr Hardy for a recurrent Hoffa's Fat Pad injury. He was very friendly and he was able to arrange an MRI scan and follow up appointment for me all on the same day which meant I could get my diagnosis immediately and start the appropriate physiotherapy treatment straightaway. This enabled me to get back to training within eight weeks rather than have to take significant time out. I have just found out that I have been selected for the GB squad this year!

EC

Anterior knee painMr Hardy, Here's a few of the photos that you asked for. You carried out arthroscopy on my knee 28 June 2016. You corrected a problem that caused me a sharp pain, when cycling, on my left knee. Less than 10 weeks later, and with suitable training, I cycled up both Alp d'Huez and Mont Ventoux - pain free! The knee felt great. Thanks again for your skilful intervention.

Kind regards,

Steve Green

Anterior knee pain Mr Hardy carried out an ACL reconstruction (using hamstring) and atheroscopy on my left knee on 31st March 2015.

I was very excited to get back in to running after my operation. I built up the training and completed the Relish Running Cheddar cross country series during the Summer of 2016. Firstly the 10km, then the half marathon and lastly the marathon in August. It was very challenging terrain with lots of steep, rocky ups and downs. I ran and trained with a Velcro wrap around knee support but probably more for reassurance! I was really pleased with how well my knee coped with all the slipping and twisting and over the moon to have completed my first ever marathon. I came fourth out of the ladies and completed it in 5 hours 3 minutes. Not the fastest but a massive achievement for me and I was pleased to be in one piece and have no issues with my knee.

Emma Betterridge

Meniscal Tear

"I have to say since you did it it probably took me three or four days to not feel any more pain up and down stairs."

Click Medial Meniscal Tear to hear the whole televised interview between George Davies and John Hardy.

Or click to see the Spire Hospital News review on this video.

What can I expect during an assessment With Mr Hardy either as a new patient or for a second opinion?


Clinical Management

The traditional approach to the management of any pathology is to make a diagnosis and only then offer treatment.

The diagnosis is made by a doctor taking a full history to elicit clinical symptoms, examining the patient to elicit clinical signs and only then confirming the diagnosis using the appropriate investigations.

Mr Hardy says: "each patient may have more than one diagnosis and getting the correct outcome for the patient with minimal risk of complications means getting this part of the process correct. It takes time"

Investigations

Many patients ask if they should get a particular test before seeing Mr Hardy.

Mr Hardy appreciates it if the pateint brings along historical investigations. However, there are many types of MRI for example and the choice of the correct one is important.

Mr Hardy said: "the choice of x-ray or scan that is appropriate to the diagnosis only comes with many years of experience. It is always a pity when an expensive investigation is performed but it is not appropriate to the patient's condition and another more appropriate one has to be prescribed in addition".

Mr Hardy is happy to advise on the correct investigation following a clinical assessment.

Treatments

Treatments on offer should consider Evidenced Based Medicine and the first approach should be conservative unless surgery is indicated.

Mr Hardy will always discuss the relative benefits and risks of the available treatments with you.