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Issue No. 11 • MICA (P) 149/10/2009

an nccs bi-monthly publication July / August 2010

...helping r e a ders to achiev e good he a lth Salubris is a Latin word which means healthy, in good condition (body) and wholesome.

Testicular Biopsy – Should I or Should I Not?

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In Other Words


July / August 2010

Make no mistake, at 66 he’s still very much on the job

While his peers are mostly retired, Mr Wong Toh Jui is still very much playing an important role as a consultant physicist at the National Cancer Centre Singapore.


ittle is known about what the 66-year-old does at the NCCS’ radiation oncology department. With little direct interaction with the patients, it is hardly any surprise. “We work behind the scene and underground,” he said jokingly. Toh Jui has held this job since the early 1970s. He likens his job to that of a pharmacist. “We dispense ‘medicine’ in the form of radiation dose and ensure that the right dose of the right quality gets delivered to the right location of the right patient.”

Patiently, he explained that before a cancer patient is put on the treatment couch of a linear accelerator used commonly in radiotherapy, the radiation oncologist will decide how the patient is to be treated and the radiation dose to prescribe. A dosimetrist then develops a treatment plan that can best destroy the tumour while sparing the normal tissues. The plan will be verified by a radiation physicist and approved by the radiation oncologist before treatment is eventually given to the patient by the radiation therapist. However, treatment planning for complicated and special treatment such as brachytherapy, radiosurgery, total body irradiation for bone marrow transplant, etc will still be carried out by the radiation physicist.

Toh Jui added that each morning before patients are treated, the radiation therapists will perform a quality control check of the machines to ensure that they are in working condition. He and his other colleagues who are also physicists will counter check and also conduct detailed quality assurance checks of the linear accelerators and imaging equipment on a monthly basis. “The nature of the job requires us to be perfectionists as an error on the machine affects not just one but many patients. If a patient is given a radiation dose lower than what has been prescribed, the patient may get a recurrence. On the other hand, a dose too high will lead to complications,” stressed Toh Jui. In this year’s National Day awards, Toh Jui was one of the recipients of the Long Service Medal. In fact, he is no stranger to such awards having been conferred the Commendation Award for his devotion to duty 10 years ago.

With a profound love for the law of nature at a tender age, Toh Jui pursued a Bachelor of Science degree in physics from then University of Singapore and graduated in 1969 with honours. After national service, he took up a job offer at the Singapore General Hospital but shortly after, he was given a government scholarship to pursue a Master’s degree in Radiological Health and Safety from University of Salford in 1972.

“In 1971, there were only four working radiation physicists in Singapore and back in those days, treatment planning was done with the help of a lead wire over, for instance, the face where the tumour was, hand drawn and manually planned and calculated,” recalled Toh Jui.

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In Other Words


July / August 2010

“The nature of the job requires us to be perfectionists as an error on the machine affects not just one but many patients. If a patient is given a radiation dose lower than what has been prescribed, the patient may get a recurrence. On the other hand, a dose too high will lead to complications.” Mr Wong Toh Jui

“I’ve witnessed how treatment planning has evolved over the years - from two-dimensional to four-dimensional planning done today. Technology enhances accuracy, precision and at the same time minimises accidents and medical errors.” Toh Jui has also been instrumental in the growth of the radiation oncology department in the NCCS and one of the reasons that he remains in employment of the Centre was because of the supportive management that allows him to turn ideas into reality. His desire to help patients also kept him going in the job for decades. “NCCS is a good brand name and is well-equipped to provide the latest radiation oncology care in Singapore. In fact, many institutions in the region request to be trained at our centre. NCCS is the World Health Organisation/International Atomic Energy Agency Secondary Standard Dosimetry Laboratory for Radiotherapy in Singapore. All other radiotherapy centres in Singapore send their dosimetry equipment to be crosscompared with our secondary standard system,” said Toh Jui with a smile.

However, it remains a fact that the job of a physicist is not glamorous and hardly any fresh graduate wants to join the trade. But if they do show up for interviews, rather than trying to convince them to accept the job offer, Toh Jui will make sure the candidates know what they are in for.

To be a radiation physicist, one needs to have at least a Bachelor of Science degree with good honours in physics. To groom the next generation of physicists, NCCS provides on-the-job training, opportunities for attachment and specialised training overseas to gain exposure. Married to a teacher, they have two grown up daughters, aged 32 and 34 who works in the telecommunications and real estate industry. When Toh Jui is not at work, he will spend time playing with his two grandsons, six-month-old Bing Cheng and four-year-old Bing Lin and occasionally bring them on an outing to the beach.

Perhaps not many of his colleagues know that he can cook too! When it comes to whipping up a dish or two, Toh Jui is definitely not the perfectionist he is at work. “I don’t follow recipes to the tee like some people do. In fact, I like to create my own dishes and cook according to what is available (in the fridge). That way I can vary the taste of the dishes.” But Toh Jui was quick to add that he has not cooked for a very long time. Retirement is certainly not far from his mind as he hopes to spend more time with his family especially his wife, Hwa San but when he asked Bing Lin if he can retire, the fouryear-old replied matter-of-factly that “Gong Gong (grandfather in Mandarin) has to work, otherwise cannot buy toys for me!” Looks like Toh Jui’s retirement plans may have to wait!

By Carol Ang

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In Focus


July / August 2010

Testicular Biopsy – Should I or Should I Not?

The doctor walks into the consultation room with your results from the scrotal ultrasound and tells you that they have found microscopic calcium stones in the testicles, otherwise known as testicular microlithiasis or TM. What is TM? TM is a common finding on testicular ultrasound with a “starry sky” appearance in the testicles. It is usually discovered when the person is referred to have a scrotal ultrasound done for other conditions. The condition affects four per cent of otherwise normal males and has been associated with the development of a type of testicular cancer known as the testicular germ cell tumour (TGCT) and intratubular germ cell neoplasia of unclassified type (ITGCNU), a non-invasive precursor of TGCT.


owever, as the actual risk, management and follow-up of TM have been controversial, your doctor may recommend self-examination, repeated ultrasound imaging over the long term or a testicular biopsy. Following a review of literature with an accompanying analysis, Dr Tan Min-Han and Dr Iain Tan, both medical oncologists at the National Cancer Centre Singapore (NCCS), may have found the answer by clarifying the link between TM and the risk of testicular cancer. This may lead to a possible change in clinical guidelines in managing patients with TM.

“Men between the ages of 20 and 39 should be mindful as testicular cancer usually hits them in this age group. However, TM does not necessarily mean cancer. Not for the majority of otherwise healthy people at least,” said Dr Iain Tan.

He warned that patients with TM and risk factors such as personal or family history of testicular cancer or sub-fertility are at an increased risk of pre-malignant ITGCNU. Fifty per cent of ITGCNU will turn cancerous within five years. Hence, testicular biopsy can be considered for patients in this category. Dr Tan Min-Han added that “Asymptomatic young men with TM will not benefit from aggressive investigations such as testicular biopsy as it carries a three per cent risk of complications, such as pain, swelling, bruising or infection.” Similarly, testicular cancer patients who are also diagnosed with TM, and who will be receiving chemotherapy for prevention of relapse are also unlikely to benefit from aggressive investigation, and a testicular selfexamination and follow-up, in this case, will be sufficient. “With the increasing use of testicular ultrasound, more cases of TM will be found. It is therefore important to address this issue which has no clear consensus on diagnosis and followup,” said Dr Tan Min-Han.

Both oncologists have taken the clinical context of the patient into account, including risk factors and recommend that aggressive management be primarily reserved for patients at high risk and hope that the proposed guidelines can provide immediate practical guidance for medical professionals and their patients. Even though the incidence of testicular cancer is relatively lower in Singapore as compared to the West, its diagnosis is important as it is one of the highly curable cancers that generally affects younger men. So if the doctor tells you that you have TM, panic not!

By Carol Ang

Cancer and Depression

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Looking Forward


July / August 2010

Sadness and grief are normal reactions for people who are faced with cancer. As such it is important to distinguish between sadness and depression. Some may experience greater difficulty adjusting to the diagnosis of cancer than others but almost everyone will go through sadness and grief periodically throughout diagnosis, treatment and survival of cancer.


hen people are told that they have cancer, they often have feelings of disbelief, denial and despair. They may even experience sleeping difficulties, loss of appetite, anxiety and extreme worries about the future. These symptoms and fears usually lessen as a person comes to terms with the diagnosis. Studies have shown that a person’s mental attitude can impact his/her physical health. Depression is a disabling illness that affects about 15 per cent to 25 per cent of cancer patients. It affects men and women equally. Cancer patients react and experience different levels of stress and emotional upset. Some issues that are significant to a cancer patient may include the following:

The findings of some researchers who analysed 26 studies with 9,417 patients on how depression affects patients’ cancer progression and survival was recently published in the November 15, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society. The study showed that depression has an effect on a cancer patient’s likelihood of survival and increased risk of death in patients who report more depressive symptoms and depressive disorders compared to patients who have not.

Just as patients need to be watched for depression throughout their treatment, family members and/or their caregivers too need to be observed for signs of depression. Caregivers have been found to experience greater anxiety and depression than people who do not provide care to cancer patients. Children are also affected when a parent with cancer develops depression. This was supported by a study of women with breast cancer which showed that children of depressed patients were likely to have emotional and behavioural problems.

• Fear of death; • Interruption of life plans; • Changes in body image and self-esteem; • Changes in social role and lifestyle; and • Money and legal concerns. When caring for a cancer patient, it is important to recognise symptoms of depression that require treatment. Major depression is not merely feeling sad or feeling blue. Major depression is prolonged sadness with or without reason; it affects about 25 per cent of patients with common symptoms that can be diagnosed and treated. Patients with pre-existing or a history of depression should be monitored closely as depression may reoccur or be aggravated following a cancer diagnosis.

If the family of a cancer patient is able to express their feelings openly and overcome problems together, the likelihood of the patient and family members being depressed are lowered. Good communication within the family, more often than not, reduces anxiety.

In the combined studies, death rates were 25 per cent higher in patients experiencing depressive symptoms and 39 per cent more in patients diagnosed with major or minor depression. However, researchers did not find a clear association between depression and cancer progression. According to the authors, more research must be conducted before any conclusions can be drawn. They added that their analysis combined results across different tumour types so future studies should look at the effects of depression on specific kinds of cancer. A person who cannot accept the diagnosis after a long period of time and who loses interest in usual activities may be depressed. Mild symptoms of depression can be distressing and should not be ignored. In mild depression, counselling may help. Even patients who do not display any symptoms may benefit from seeing a counsellor; however, when symptoms are intense and long-lasting, or when they keep recurring, intensive treatment is important. “Always laugh when you can. It is cheap medicine,” said Lord Byron, a British poet and philosopher. Indeed, finding humour in life can be helpful when dealing with cancer.

By Flora Yong

Senior Nurse Manager Cancer Education & Information Service NCCS

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Looking Forward

Healing With Humour


July / August 2010

Psychologists have for a long time recognised the benefits of humour. Humour enhances the creative process and is one of the coping devices used to combat stress. It can be used with great results in the classroom, at work, in therapy and counselling sessions and in medicine to assist in the healing process. Laughter improves selfesteem, enhances social interaction and generally makes life more enjoyable.


aughter is more than a visual and vocal response. It is accompanied by a wide range of physiological changes. During vigorous laughter, the body takes in extra oxygen, causes internal organs to shudder and muscles to contract as well as activates the hypothalamus, pituitary and adrenal glands. This results in an increase in secretion of endorphins, an internally produced morphinelike molecule. This internal jogging produces an increase in oxygen absorption and heart rate, relaxation of the muscles and increases in number of disease fighting immune cells. Illness and disease can be caused by an inability to cope effectively with daily adversity. Daily stressors, if left unchecked over time, are the biggest culprits and perpetrators of illness.

A sense of humour is one of our most powerful stress coping tools. Laughter is very freeing. If we can laugh at something, we can survive it. Laughter helps us gain power in powerless situations and gives us a sense of control when things around us seem out of control. Humour, is thus, physically, psychologically and spiritually beneficial. A good laugh can help us see life from a different perspective and face our problems with renewed concentration and hope.

Find it, create it and spread it.

When you are first informed you have cancer, there is no such thing as “humour.” Getting cancer is not funny! However, as soon as you have learned to live with your diagnosis and treatment, you can certainly benefit from humour.

Researchers are beginning to demonstrate that a good laugh relieves stress for everyone. The relief of laughter can be especially beneficial for cancer patients who have to deal with a higher level of stress than others. Humour for health improvement is not a new prescription and hopefully, you may discover that laughter helps the medicine go down.

By Flora Yong

Senior Nurse Manager Cancer Education & Information Service NCCS References: Cousins, N. (1989). Head first: The biology of hope. New York: E.P. Dutton. Fenwick, C. (1995). Healing With Humour. Muenster SK; St. Peter’s Press. Hanson, P.G. (1985). The joy of stress. New York: Andrews & McMeel. Hunt, A. (1993). Humor as a nursing intervention. Cancer Nursing, 16, 34-39. Powell, J. P. (1985). Humor and teaching in higher education. Studies in Higher Education, 10, 79 – 90. Zelinski, E.J. (1990). The art of seeing double or better. Edmonton: VIP Books.

Chemotherapy and Hair Loss

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Tender Care


July / August 2010

Chemotherapy is the use of powerful drugs to kill rapidly growing cancer cells. Unfortunately, these drugs also attack other rapidly growing cells in your body including those in your hair roots.


hus, chemotherapy may cause hair loss all over your body and not just on your scalp. Sometimes, hair from the eyelashes, eyebrows, armpits, pubic regions and other body hair also fall out. Some chemotherapy drugs are more likely than others to cause hair loss and different dosages can cause anything from a mere thinning of the hair to complete baldness. Your doctor or nurse can tell you what to expect.

It may take a few weeks after treatment for your hair to recover and begin growing again. When your hair starts to grow back, it will probably be slightly different from the hair you lost.

Fortunately, hair loss from chemotherapy is mostly temporary. What should you expect? Hair usually begins falling one to three weeks after you begin treatment. It could fall out very quickly in clumps or gradually. You will likely notice accumulations of loose hair on your pillow, in your hairbrush or comb, or in your sink or shower drain. Your scalp may feel tender too. This will continue throughout your treatment and up to a few weeks following that. Whether your hair thins or you become completely bald depends on your treatment. Generally, you can lose about 50 per cent of your hair before it becomes noticeable to others. It may take a few weeks after treatment for your hair to recover and begin growing again. When your hair starts to grow back, it will probably be slightly different from the hair you lost. But the difference is usually temporary. Your new hair might have a different texture or colour. It might be curlier than it was before or it could be gray until the cells that control the pigment in your hair begin functioning again.

How to make the best of it

Hair loss generally cannot be prevented or controlled, but it can be managed. Take the following steps throughout your treatment to minimise the frustration and anxiety associated with hair loss. Continued on page B4.

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July / August 2010

Upcoming Public Education activities / Programmes

Event Name

Date, Time, Venue

Registration Details

CancerWise Workshop –

2 October 2010, Saturday

Admission fee: $5


Session will be conducted in English.

To register, please call: 6225 5655 or register online:


1pm – Registration 1.30pm to 4pm – Workshop starts

a. Common Gynaecological Problems b. Contraceptive Pills & Hormone Replacements Therapy – Are there Health Risks?

Function Room, Level 4 National Cancer Centre Singapore 11 Hospital Drive, Singapore 169610

c. Cancers of the Female Reproductive System: Cervix, Ovary and Uterus d. What Are the Risk, Signs & Symptoms? e. Early Detection & Prevention f. What is PAP Smear? g. Screening & Treatment Procedures h. Questions & Answers

FOR MORE INFORMATION ABOUT CANCER Cancer Helpline Tel: 6225 5655 Email: Monday to Friday: 8.30am to 5.30pm Saturday, Sunday & Public Holiday: Closed


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July / August 2010

Cancer patients, staff from the National Cancer Centre Singapore and professional artists put their brush to the canvas for a charitable cause. Their artworks which were mostly done from art therapy sessions were put up for sale at this year’s Cancer Survivors’ Day charity exhibition. Veronica Lee reports.


ow after row the art pieces lined the exhibition hall. Beneath most of these art pieces there is a deeper meaning than just creativity. Each piece represents the feeling of hope and joy in being able to overcome the challenges of journeying with cancer.

These 100 pieces of artwork which were displayed at the Black Earth Art Museum in Joo Chiat Road were the outcomes of the patients and staff who came together to paint in a series of art therapy workshops. Themed Healing In Another Dimension, the exhibition is the culmination of the workshops that allowed patients an avenue to learn and explore their inner selves and feelings about their cancer journey and caring and journeying with patients for caregivers. With the help of art therapists, those who painted learn to interpret their own paintings. They provided cues to their cancer experience or their caring experience. About 65 patients, caregivers and staff painted 72 pieces of art with the rest being contributed by artists.

The exhibition which was held in conjunction with the Cancer Survivors’ Day is a first major collaboration between patients and staff to give encouragement to other fellow patients. The five-day exhibition was launched on 3 July by the Guest of Honour, Dr Choong Siew Foong, a philanthropist who donated four paintings for the charity sale. Dr Choong in her speech said she was touched by the gestures of patients, NCCS staff and the professional artists who did their bit for cancer patients, particularly for patients who despite their illness, have transcended their limits and share their experience with fellow patients.

Dr Yap Yoon Sim, Consultant, NCCS Department of Medical Oncology, and organising chairman of the art exhibition, said she was impressed by the patients’ and their family’s enthusiasm to take part in the exhibition. “Some patients have through painting and attending the art therapy sessions embarked onto the road of selfdiscovery and enlightenment. Art can be for everyone, regardless of your background,” said Dr Yap. Tokens of appreciation were also presented to all donors and the sale proceeds went in aid of NCCS Patient Support Programme. The exhibition is part of the series of “I Can Express Art Exhibition” that encourages patients to explore their inner selves and attitudes towards cancer and leverage on their emotional and psychological strengths to face the disease and overcome it.

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July / August 2010

World Cancer Survivors’ Day: A sight of positive characters at the Singapore Zoo

Cancer is the number one killer not only in Singapore, but also in the world. It is devastating to be diagnosed with this deadly disease.


any often treat their diagnosis as a death sentence. It is important to note that all hope is not lost. There are many patients out there who have survived their battle against cancer. These survivors who were treated at the National Cancer Centre Singapore serve as life-long inspiration to others who are fighting their battle against the disease. To honour and celebrate the lives of the victorious in their fight against cancer, NCCS brought the cancer survivors and family members together for a fun-filled day on 26 June.

A carnival atmosphere greeted slightly over a hundred participants who were ready for a day’s worth of fun and adventure at the Singapore Zoo. Mr Ezzy Wang, a cancer survivor and a committed fighter against cancer, was also on hand to share his own experiences. Titled “Zoomanji”, the highlight of the event was the treasure hunt, which closely followed the concept of “The Amazing Race”, a reality television game show where participants moved from pit-stop to pit-stop in search for clues to lead them to their destination. Professor Tan Ser Kiat, Group CEO of Singhealth, was on hand to flag off the race. Teaming up with their family members and volunteers from NCCS, these cancer survivors embarked on their journey to reach five different game stations around the zoo. It seemed like a gruelling and physically demanding journey for these participants when they were given their routes, but it never deterred them as their sheer determination and perseverance saw them through, as they were cheered on by their family members and volunteers from NCCS.

It was a meaningful Saturday, and an opportunity for a wholesome family outing. Dr Yap Swee Peng, acting Director for Public Education and Patient Support Unit at NCCS, who also co-chaired this event, said, “The road to recovery for every cancer patient is never an easy one and the effect can be profound. While we applaud cancer survivors for their bravery, we should not forget the critical role that their families and friends played.”

“I Can Survive” – Zoomanji Adventure is a major outreach programme held in conjunction with World Cancer Survivors Day celebrated annually in June. This special day is meant to demonstrate that life after a cancer diagnosis can be reality.

By Joshua Tan

Arts For Heath

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– MGS String Ensemble performance in NCCS



Nurturing a philanthropic mindset is important. This act to promote goodwill or improve the quality of life of others must not be neglected. And fostering it from a young age can build a benevolent character within individuals that can benefit society in years to come.


t is in this spirit that a partnership was forged between the Methodist Girls’ School (MGS) and the National Cancer Centre Singapore, to provide a platform for the students to extend a helping hand to bring hope to cancer patients and their families.

This exposure hopefully will help students develop compassion, altruism and good citizenship. Everyone has a responsibility to help inculcate values within individuals to care for others, regardless of economic status or background.

A group of 50 students in total from the MGS string ensemble team put up a one-hour performance at the Centre on 22 and 23 May. It was a sight to behold as cancer patients were intrigued by the pieces played while they were waiting to see the doctor at the clinics. In turn, the students received a warm round of applause from both appreciative patients and NCCS staffs, serving as great encouragement for them.

Moreover, this volunteer experience will enable the students to widen their circle of identification, helping them see the disadvantaged as less fortunate than they otherwise would, and inspiring a desire to contribute to purposes beyond self.



July / August 2010

Last year, MGS also collaborated with and supported NCCS by organising a charity concert titled “Sounds of Hope”. Donations raised were used to fund programmes for needy patients and their families. Mrs Shirleen Ong, Principal of MGS, explained that the concert was a good way for the students to learn about humility and look beyond their selves. It was also an opportunity to put these charitable efforts into action and create a significant difference in the lives of many needy patients’. It also served to highlight the approach that MGS is taking in education – to strive for academic excellence in the classrooms and also be active outside the classroom which can benefit the community. This benevolent tradition must be cultivated and passed from one generation to the next. This will undoubtedly lead to many more similar opportunities that give these students a platform to showcase their talents while also playing a part for the cancer patients in NCCS. Specially organised for patients, the Arts for Health programme aims to promote wellness in NCCS through the arts. Patients, visitors, staff and the community can participate in creative arts programmes such as concerts, workshops and exhibitions that enhance their physical, social and emotional well-being.

By Joshua Tan



Dr Lalit Kumar Radha Krishna

Senior Consultant, Palliative Medicine

Dr Yap Yoon Sim

Senior Consultant, Medical Oncology

Dr Ang Mei-Kim

Consultant, Medical Oncology

Dr Narayanan Gopalakrishna Iyer

Consultant, Surgical Oncology

Dr Ngo Su-Mien Lynette

Consultant, Medical Oncology

Dr Ng Quan Sing

Associate Consultant, Medical Oncology

Dr Tan Shao Weng Daniel

Associate Consultant, Medical Oncology

Dr Neo Patricia Dr Tuan Kit Loong Jeffrey Dr Chua Wei Ling Clarinda Dr Tewani Komal Girish

Associate Consultant, Palliative Medicine Associate Consultant, Radiation Oncology Registrar, Medical Oncology Registrar, Palliative Medicine

The Inspiration Circle

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NCC Foundation


July / August 2010

The NCC Foundation organised an inaugural benefactors’ networking evening and art exhibition at The Goodwood Park Hotel on 20th May 2010. The exhibition featured the inspirational works of a 13 yearold artist Dawn Kwan on the theme of ‘joie de vivre’ - the joy of living.


rs Mavis Khoo-Oei, Chairman of Goodwood Group of hotels, bought two of Dawn’s paintings in support of the NCC Research Fund and generously sponsored the banquet and hotel venue. Over 70 benefactors, from the board of trustees to major donors, corporate partners and sponsors had the opportunity to interact with the clinical and research stakeholders of NCCS in a convivial atmosphere. Professor Soo Khee Chee, Director of NCCS, delivered the welcome address and shared a few uplifting medical stories, highlighting the importance of research in paving way for a hopeful future for cancer patients.

A selection of 10 research projects from the Divisions of Medical Sciences, Cellular and Molecular Research, Clinical Trials and Epidemiological Sciences, and Department of Palliative Care were featured alongside the colourful artworks. The unique curatorial arrangement provided interesting counterpoints for dialogue and creative interaction.

Editorial Advisors Dr Kon Oi Lian Prof Soo Khee Chee Executive Editors Ms Carol Ang Ms Veronica Lee Mr Sunny Wee

Contributing Editor Dr Wong Nan Soon

Medical Editor Dr Richard Yeo

Members, Editorial Board Ms Audrey-Anne Oei Ms Sharon Leow Ms Flora Yong

Members, Medical Editorial Board Ms Lita Chew Dr Mohd Farid Dr Melissa Teo Dr Teo Tze Hern Dr Deborah Watkinson


is produced with you in mind. If there are other topics related to cancer that you would like to read about or if you would like to provide some feedback on the articles covered, please email to

National Cancer Centre Singapore Reg No 199801562Z

11 Hospital Drive Singapore 169610 Tel: (65) 6436 8000 Fax: (65) 6225 6283

Salubris - July / August 2010  

Salubris is a bi-monthly publication by the National Cancer Centre Singapore (NCCS). It aims to provide information relating to cancer, our...