How can you do inhalation with adenoids. Do nebulizer inhalations help with a cold? Salt inhalations at home for adenoids

It is very important to take into account the severity of the pathology and the risk of complications. Important is the observance of precautionary measures, since such treatment also has its contraindications.

Efficiency

Carrying out inhalations with the help of adenoids is possible both during the period of remission and in the phase of exacerbation of the disease. If hypertrophy of the tonsils was found in a child, then it is advisable to carry out such therapy at stages 1-2 of the development of the disease. With regular inhalations with a nebulizer for adenoiditis and adenoids, the following effects can be achieved:

• decongestant (only properly selected drugs help reduce swelling of the tissues of sick tonsils, where the focus of inflammation is located);
• anti-inflammatory;
• immunostimulating (drugs used for inhalation help to strengthen local immunity).

It is mandatory to prescribe substances that improve the circulation of lymph and blood in the body, but it is strictly forbidden to use any substances on your own.

If the disease proceeds in a milder form, and hypertrophy of the tonsils was ruled out by a doctor, inhalations are used to:

• relief of inflammation in the nasopharynx;
• getting rid of;
• moisturizing dry mucous membranes of the nasopharynx;
• anesthesia;
• relieve irritation of the mucous membrane;
• relief of a runny nose;
• liquefaction of sputum;
• prevention of complications in the form of laryngitis, laryngotracheitis, pharyngitis.

Contraindications

Doing inhalations using a nebulizer in children is categorically contraindicated in:

• temperature above 38 °C;
• the development of an inflammatory process in the middle ear, which occurred against the background of the growth of tissues of the diseased tonsil;
• hearing loss, which is one of the most common complications of adenoiditis;
• difficulty breathing;
• chronic diseases of the lower respiratory tract and paranasal sinuses (sinuses);
• often recurrent;
• sleep problems, etc.

Under such conditions, inhalations for the treatment of adenoids will not give any results, and if febrile fever occurs, they can seriously harm the health of the child.

What solutions can be used?

For inhalation with adenoids in children, the best option is a nebulizer with a special compressor or a mixed type inhaler (the so-called mesh nebulizer). It is better not to buy an ultrasound device, since they do not spray all the medications that can be prescribed to a child by an otolaryngologist.

With adenoids in children, inhalation solutions from the list below are often prescribed.

1. Saline (0.9% sodium chloride), sold in pharmacies without a prescription, and at a fairly low price. For inhalation, it is necessary to pour 4-5 ml of the drug into the nebulizer capsule and inhale the medicine for 5-7 minutes.
2. Alkaline mineral waters soften the mucous membranes well, contribute to the liquefaction of sputum, which contributes to its better discharge.
3. Mucolytic and expectorant solutions (Mukolvan, ACC, Ambrobene, etc.).
4. Medicines that relieve inflammation of the mucous membranes of the nasopharynx. Doctors recommend the use of Rotokan, which contains only natural substances - extracts of chamomile, yarrow, medicinal marigold.
5. Antiseptics, in particular Chlorrophyllipt. The medication is also of plant origin, and is used for adenoiditis in children, if it has an infectious etiology. Immediately before performing the procedure, saline must be added to the medicine in a ratio of 1:10, respectively.
6. Immunomodulators (Cycloferon or Interferon). The drug prescribed by the otolaryngologist should be inhaled 1-2 times a day for 7-10 days.

Good help with adenoids inhalation with decoctions of medicinal plants (anti-inflammatory, expectorant, decongestant):

• chamomile;
• calendula;
• sage;
• peppermint;
• yarrow;
• coltsfoot;
• licorice root, etc.

To prepare a decoction, you need to pour 1 pinch of dry raw materials into 300 ml of water and boil. Leave for half an hour and filter thoroughly. It is better to strain the finished mixture several times so that the cake remains on the gauze. If even a small particle of the leaves of the selected plant gets into the inhaler nebulizer, the device may break down. It is necessary to carry out procedures 2-3 times a day.

Ready-made medicinal solutions used for adenoids as inhalation agents can be diluted exclusively with saline. Neither soda, nor self-prepared saline, nor boiled water can be used categorically.

Features of inhalation

Inhalations with a nebulizer for adenoids in children have certain rules for performing. Without their observance, such procedures will have no effect (and sometimes they can even harm). Here are the main guidelines to follow.

1. Inhalations are carried out 40 minutes before or 1.5 hours after a meal.
2. For the procedure carried out by children over 3 years old, a special mouthpiece is used, for babies up to the age of three - a mask.
3. The medicine should be inhaled through the mouth, gently exhaling its remnants through the nose. Breathing should be natural, without sharp breaths and too long exhalations.
4. It is not recommended to talk during the entire procedure and for 10 minutes after it.
5. After each, it is necessary to thoroughly wash the medicine capsule and the tube through which the medicine enters the child's respiratory tract.
6. From time to time, it is necessary to carry out a complete disinfection of the nebulizer with a solution of chlorhexidine or furacilin.

Remember that inhaling a child using dubious medicines or self-prepared "in haste" medicines is strictly prohibited. This can not only give no result, but also cause irreparable harm to the health of the child.

Useful video about inhalation

Frequent colds, recurrent otitis or a runny nose that does not go away for a long time can be signs of adenoids in children. This disease is characterized by growth (hypertrophy) of the nasopharyngeal tonsil. For the treatment of children, there are many methods of treatment, but the most effective is inhalation for adenoids in children.

The growth of the tonsil occurs more often in childhood from three to seven years.

Signs of adenoids in children are determined by the external indicators of the child's well-being:

1. Constant mouth breathing is the main symptom. The tissues of the enlarged tonsil interfere with normal nasal breathing, and the child must breathe through the mouth.
2. Against the background of the inability to breathe through the nose, the child does not have a runny nose.
3. A runny nose that cannot be cured in any way is also a sign of problems with the nasopharyngeal tonsil.

The presence of even one of these signs should alert the child's loved ones and encourage them to see a doctor.

Important: only an ENT doctor can examine an enlarged tonsil.

The procedure is performed using a special mirror, which allows you to look deeper into the throat. It is impossible to qualitatively assess the state of the gland without visual confirmation. Technical devices for examining the deep throat area, X-ray, MRI can also be used (see).

Degrees of the disease

Depending on the hypertrophy of the nasopharyngeal gland, the degree of adenoids in children is distinguished.

Table 1: Grades of tonsil enlargement, symptoms and possible treatment:

Only radiologists can determine the difference between the fourth and third degrees, after conducting the study.

Important: do not confuse tonsil hypertrophy and adenoiditis (inflammation of the overgrown tonsil), in the second case there will definitely be an increase in body temperature, mucous or purulent discharge from the nose.

Photos and videos will help you figure out how to determine the degree of adenoids in a child.

Treatment of adenoids

Important: if a decision is made to perform an operation, it is important to discuss the process of the procedure, the presence of general or local anesthesia, and the organization of the postoperative period.

After contacting a specialist and making a diagnosis, you need to discuss with the doctor how to cure adenoids in a child, depending on the degree of hypertrophy and the general well-being of the child.

Table 2: Types and methods of treatment of adenoids:

Important: the postoperative period is very important for the child - proper recovery will help to avoid the recurrence of the pathological growth of the nasopharyngeal gland, which happens very often.

The main conservative method is inhalation

Important: it is necessary to treat adenoids, because they have a negative impact on many areas of the child's life.

Inhalation procedures are performed as a conservative treatment, if the degree of tissue growth is not an indication for the removal of the tonsil. Before the operation, as well as in the postoperative period, when it is very important not to stop supporting the body.

Possibilities of inhalation

Inhalations with adenoids are capable of:

• reduce tissue swelling;
• prevent inflammatory processes;
• improve the movement of lymph;
• improve blood flow;
• stimulate local immune mechanisms.

Types of inhalations for adenoids

Inhalations with hypertrophied tonsils can be:

• dry, when vapors of medicine applied to a cloth or cotton are inhaled;
• wet cold with nebulizers;
• damp in the bathroom when the vapors from running warm water are inhaled;
• Salt inhalations can be taken in salt caves or at home using a salt bath.

Important: steam, hot inhalations with adenoids are strictly prohibited - this will provoke further growth of the tonsil, in addition, there is a risk of suppuration in the nasopharynx.

Benefits of using a nebulizer

Inhalation for adenoids with a nebulizer for children is currently the safest and most effective inhalation method.

Due to the features of the device:

• the medicines used are not exposed to heat, which means they do not change under the influence of temperature, and it is possible to use them for the treatment of children up to a year;
• the nebulizer sprays the medicinal solution into the smallest particles that can penetrate into the folds of the enlarged tonsil, qualitatively irrigate the surrounding tissues during inflammatory processes;
• before using this or that drug, you should ask your doctor if the medicine can cause allergic reactions;
• using a nebulizer, you can not worry that the child will get burned.

The use of a nebulizer for the treatment of adenoids in children

Important: the inhaler contains small parts that must be properly assembled so that the medicines are sprayed correctly.

The instruction is the main thing that is necessary for the correct assembly of the device.

When using an inhaler for adenoids in children, you need to follow several important rules for the effective operation of the device:

• inhalations are performed through a nebulizer only if the body temperature does not exceed 37.5 degrees;
• it is worth doing inhalations, maintaining an interval of one hour before and after, between the procedure and food, physical activity, the use of other procedures and drugs.

Inhalations are the best way to reduce the inflammatory process, to calm the growth of an already enlarged tonsil.

Doing inhalation with adenoids is as follows:

1. The medicine is inhaled slowly through the nose.
2. Exhalation is done quickly through the mouth.

Important: you need to remember that at stages 2-3 of adenoids, inhalation can bring only a small effect, if the child cannot fully breathe through the nose, it is worth considering the advisability of removing the tonsil.

The price of nebulizers varies depending on the size of the aerosol droplets formed during spraying. The smaller the particle size of the liquid, the more expensive the device. Expensive nebulizers can be used for bedridden patients. When choosing a nebulizer, you should focus on the recommendations of your doctor.

Steps to use a nebulizer

Important: all parts of the inhaler should be kept clean and dry, in a separate container, they should be washed before and after inhalation procedures.

Inhalation is performed through an inhaler at the following points:

1. With clean hands, the nebulizer is assembled.
2. The device is connected to the network or batteries are inserted.
3. A do-it-yourself solution for inhalation is poured into the tank. The liquid should not be icy, the recommended temperature is room temperature.
4. Turn on the nebulizer, let the child inhale the medicine through the mask, the time of the procedure is set by the doctor.
5. At the end of the procedure, you need to wash your face, rinse your mouth and rinse your throat. If the child is large and knows how to spit, then you can allow him to gargle with toothpaste. Washing is necessary, especially if there are hormonal preparations in the inhalation.
6. Disassemble the device, carefully fold the parts.

Important: inhalations in children are carried out only under the supervision of adults, and the parts should be stored out of the reach of children, because the device contains small parts.

Preparations for inhalation with adenoids

As a basis for dissolving drugs, it is recommended to use:

• physical solution;
• mineral water.

For use through a nebulizer, your doctor may prescribe the following drugs:

1. Ambrobene, Lazolvan will help make sputum softer and remove it from the body.
2. Fluimucil is an antibiotic used in the inflammatory process.
3. Derinat has an immunomodulatory effect.
4. Hydrocortisone and Pulmicort are hormonal drugs used for severe swelling and inflammation, both of these phenomena must be eliminated to eliminate difficulty breathing in general.

All drugs inhaled through inhalers first have a local effect, getting on the mucous membrane. Then, rushing to the lungs, they enter the bloodstream through the alveoli, exerting the necessary influence on the entire body. They have a beneficial effect on other foci of inflammation and reduced immunity.

The dosage of drugs for inhalation should be prescribed only by a doctor who can and knows how to treat tonsil hypertrophy. Only an ENT will give recommendations on the correct dosage that will not harm the child. Self-medication with such a diagnosis is unacceptable.

Important: for inhalation, you need to use a mask, not a mouthpiece, because the medicine must be inhaled through the nose, so it will directly get through the nasal passages to the nasopharyngeal tonsil.

The action from the use of inhalations occurs 10-15 minutes after the procedure. The effect lasts for 3-4 hours, so for good health you need to perform the procedure several times a day. The exact number of inhalations is prescribed by the doctor, if necessary, additional treatment is added.

Consequences of no treatment

If you do not treat an overgrown tonsil in a child, serious health problems will arise.

Here are just a few of the possible violations:

1. Hearing loss occurs due to the fact that the enlarged gland does not make it possible to equalize the pressure between the outer space and the middle ear.
2. Often occurring colds occur due to a violation of nasal breathing. After all, it is due to it that the inhaled air is warmed and neutralized.
3. Adenoiditis begins only if the nasopharyngeal tonsil is pathologically hypertrophied. Inflammatory processes in overgrown tissues become chronic, and pathogenic organisms from here begin to spread throughout the body, can provoke inflammation of the underlying respiratory organs (tracheitis, laryngitis, bronchitis).
4. Limiting the supply of oxygen to a growing organism can cause learning difficulties, decreased attention. Possible behavioral problems.
5. A constantly open mouth significantly affects the formation of the bones of the face and jaw. Speech becomes slurred due to the inability to pronounce certain sounds clearly.
6. Adenoids disrupt the proper functioning of the ear. Blocking the Eustachian tube, the tonsil provokes inflammation in the middle part of the ear.
7. The occurrence of adenoid cough has no consequences, it is provoked by irritation of the nasopharyngeal nerves. Some specialists point to the reflex nature of this cough. However, such a cough can mislead even a doctor and cause an incorrect diagnosis, for example, acute respiratory infections or acute respiratory viral infections.

Important: parents may not notice some changes in the child, they get used to unintelligible speech, constant breathing through the mouth, constantly ajar mouth.

Despite the fact that inhalations for adenoids in children are safe and highly effective, a doctor should prescribe such a procedure. It is also worth recalling the importance of timely seeking advice when the first symptoms of adenoids appear. After all, only the care of parents and the help of a qualified specialist will help preserve the health of the child.

Adenoiditis is an overgrowth of the pharyngeal tonsil caused by various reasons. More often this pathology is observed in long-term ill children. At the same time, immunity decreases, and lymphoid tissue begins to uncontrollably divide. always complex, medicines and physiotherapy procedures are used. Inhalations with overgrown adenoids help to stop inflammation and swelling. Thanks to these procedures, the mucosa is cleared of abundant plaque.

With adenoiditis, inhalation can and should be carried out. Due to these procedures, it is possible to deliver medicinal solutions directly to the pathological focus, without entering the digestive organs. This reduces the drug burden on a weakened body.

The procedures are relevant in cases where a person for some reason cannot take certain medications. This category of patients includes young children, pregnant women and people with chronic pathologies.

It should be borne in mind that inhalations only supplement the medication prescribed by the doctor, but do not replace it!

The effectiveness of inhalation in adenoids

Adenoiditis is more often diagnosed in children of preschool and primary school age. Therapeutic inhalations are effective during exacerbation and with persistent remission. Procedures with different medicinal solutions are especially effective at stages 1-2 of the disease. During this period, there is a chance to stop the growth of the tonsil and eliminate inflammation.

Procedures are allowed for children of all ages and adults. These procedures allow you to achieve the following effect:

• Reduce swelling of the mucous membranes of the upper respiratory organs, thereby normalizing nasal breathing.
• Reduce soreness.
• Stop the development of the inflammatory process.
• Activate blood circulation. The outflow of lymph from the adenoids is normalized.
• Reduce the amount of mucus secreted from the nose.
• Thanks to inhalation, the mucus liquefies and more easily leaves the nose.
• Eliminate coughing attacks that occur when mucus drains down the back wall of the nasopharynx.
• Moisturize the membranes of the nasopharynx.

Thanks to such physiotherapeutic procedures, the regeneration of damaged tissues is accelerated and the likelihood of developing complications - pharyngitis, laryngitis or bronchitis - is reduced.

Inhalations help to strengthen the immune system. You can resort to them both in acute and chronic forms of the disease.

Types of inhalations

In the treatment of adenoiditis, different types of inhalations are used. But you need to remember that steam procedures are strictly prohibited. In the acute stage, they can lead to the rapid development of a purulent process, and in the chronic stage, to further growth of the adenoids.

Dry inhalations

Such procedures are easy to carry out. They take a handkerchief, drip 4-5 drops of essential oil on it, which has anti-inflammatory, antimicrobial and anti-edematous effects. The patient inhales healing vapors for 15 minutes. Procedures are repeated 3 times a day.

In the treatment of adenoiditis, tea tree, lemon, fir, arborvitae and pine oils are often used. Eucalyptus essential oil will help reduce inflammation and normalize breathing.

For inhalation, special pencils are often used, which are sold in pharmacies. You should open the lid of the pencil, lean the plastic tube against your nose and inhale the healing vapors.

For procedures, you can take only those oils to which the patient is not allergic!

Wet cold via nebulizer

Well help inhalation through a nebulizer. The inhaler can be compressor or ultrasonic. Thanks to this device, medicinal solutions are sprayed to a finely dispersed state, and the drugs enter the inflammation zone.

For carrying out cold inhalations through a nebulizer, saline and alkaline mineral water of the Borjomi type are more often used, with a previously released gas. Often, a doctor prescribes medications that help prevent further growth of the tonsils.

Wet in the bathroom

It is possible to carry out medical procedures in the bathroom. To do this, 5-7 drops of essential oil are dripped into the water. Instead of essential oils, concentrated decoctions of herbs can be used. The compositions are filtered and poured into a bath of warm water.

The duration of such sessions reaches half an hour. But you should use only those medicinal herbs to which the patient is not allergic.

Salt

Children and adults who suffer from adenoiditis are advised to visit salt rooms or caves. If this is not possible, you can buy a salt lamp or simply heat salt in a dry frying pan, drop 3-4 drops of coniferous essential oil into it and inhale the healing vapors.

The duration of the procedure should not be less than 15 minutes. To increase efficiency, it is recommended to bend your head over a container of salt and cover with a towel.

Solutions for inhalation

With adenoiditis, you can use different solutions for inhalation. Often, saline or mineral water is poured into the nebulizer container, without gas.

But in advanced cases, such drugs can be prescribed:

• Ambroxol and other medicines based on it. They thin the mucus and quickly remove it from the respiratory tract.
• Fluimucil is an antibiotic that is prescribed for the rapid growth of lymphoid tissue and severe inflammation.
• Derinat is an immunomodulatory drug that helps to increase the vitality of the body.
• Hormonal drugs - Hydrocortisone and Pulmicort. Quickly stop inflammation and swelling.

All these drugs are pre-mixed with saline or distilled water for injection. If necessary, prescriptions for medicines are prescribed by a doctor.

For adults

For adults, drugs are diluted in a ratio of 1: 1, solutions can be mixed in a nebulizer container, which is equipped with a measuring scale. Ambroxol, Lazolvan and other drugs are diluted with saline. By diluting the medicine, the volume of the solution increases, which allows you to breathe in medicinal vapors longer.

In some nebulizers, you can pour a decoction of medicinal herbs. Coltsfoot, chamomile, sage and yarrow have an anti-inflammatory effect.

For kids

For the treatment of young children, drugs are diluted with saline in a ratio of 1: 2. The duration of the procedure is 15 minutes. If the child is small, then they draw or watch a cartoon with him at this time.

Inhalations to the child are carried out only under the supervision of adults. It is correct to carry out the procedure and prevent accidents.

Rules for the procedure

The procedure should be carried out in a sitting or semi-sitting position. For inhalation to be effective, you must adhere to the following rules:

• The patient must breathe evenly. Do not take too deep breaths and exhalations.
• It is important to choose the right mask for inhalation. For children, a children's mask is used, which fits snugly to the face.
• It is unacceptable to exceed the dosage of drugs prescribed by the doctor.
• After use, the components of the nebulizer are washed with a disinfectant solution, dried, and only then put into storage.
• The rest of the medicine is poured out of the container. For each procedure, a new portion of the drug is prepared.

After inhalation, the patient should not eat, drink and talk for half an hour. This will prolong the effect of drugs.

The doctor may prescribe for. This tasteless and odorless drug has an antibacterial and anti-inflammatory effect.

Contraindications

There are several contraindications to therapeutic inhalations. Procedures are not recommended in such cases:

• At .
• At a body temperature of more than 37.3 degrees.
• With bronchial asthma.
• With high blood pressure.
• With brain tumors.

Inhalations are carried out with caution in pathologies of the cardiovascular system. If contraindications are neglected, the patient's condition may deteriorate sharply.

With adenoiditis of 1-2 degrees, drug treatment is supplemented with inhalations. They are carried out with medicinal formulations, decoctions of herbs, essential oils, mineral water and saline. The treatment regimen is determined by the attending physician.

Hypertrophy of the pharyngeal tonsil is popularly referred to simply as "adenoids". This disease affects, as a rule, young children, in whose body the lymphatic tissue is susceptible to infections and inflammations. Adenoids, the treatment of which was not carried out in time, lead to pathologies in the development of the larynx, chronic respiratory diseases, diseases of the cardiovascular system and kidneys. In a severe stage in children, it is treated exclusively with surgical intervention. In a mild form, when symptoms are limited, inhalations for adenoids will be the right solution.

Adenoids are characterized by:

• Difficulty breathing during sleep, sniffling, snoring.
• Voice changes: hoarseness, nasality, which are caused by the fact that the adenoids prevent the soft palate from moving freely.
• Frequent diseases: colds, otitis media.

Why nebulizer

A nebulizer for adenoids is an effective way to carry out inhalations.

This is due to the presence of undeniable advantages over other methods:

1. No danger of getting burned. Steam inhalations with adenoids are associated with the risk of scalding the child with boiling water or burning the mucous membranes of the respiratory tract.
2. Efficiency. With steam inhalations, as well as with dry ones, only a small part of the useful substances enter the child's body. The nebulizer, on the other hand, breaks down medicines into tiny particles, turning them into a finely dispersed mixture, from which useful substances are not lost.
3. The ability to use pharmaceutical drugs. Steam and dry inhalations for adenoids are done using folk remedies - more often essential oils. In the nebulizer, drugs are used, the treatment of which is much more effective.

In addition, the nebulizer will not harm even an infant, which cannot be said about steam inhalation.

Preparations

More often in nebulizers for the treatment of adenoids, such drugs are used.

Miramistin

This is an antiseptic agent, the scope of which is extremely wide. It is used in surgery, dentistry, gynecology, in the care of bedridden patients - wherever it is required to disinfect a wound, wipe bedsores, and lubricate burns. Miramistin is also inhaled for adenoids, which will give the following effect:

• Anti-inflammatory. Miramistin reduces inflammation, kills pathogenic bacteria, dissolving the shell of microbial cells, relieves swelling.
• Immunostimulating. Inflammation of the adenoids becomes possible due to reduced immunity. Miramistin helps restore defenses.

Inhalations are used for adenoids with miramistin three times a day - in the morning, afternoon and evening - diluted with saline in a ratio of one to two. The advantage of the drug is that there are no contraindications and the use is permissible even when infants are being treated.

Tonsilgon

This drug is based on extracts of dandelion and marshmallow root, oak bark and walnut leaves, yarrow, horsetail. Suitable for use with a nebulizer and has an anti-inflammatory effect along with an increase in immunity. There are no contraindications, it is allowed for the treatment of an infant. However, in rare cases, an allergy to the drug develops. Therefore, before using it, do a primitive test by applying 2-3 drops to thin skin in the crook of the elbow. If redness or rash occurs, choose another remedy.

Do inhalations with adenoids twice a day, in the morning and in the evening, spreading.

Moisturizers

Inhalations for adenoids are also carried out not with specific drugs, but with moisturizing solutions. They make breathing easier, thin the mucus in case of a cold, and increase immunity. Among them:

• Mineral water Borjomi, which will reduce swelling and make it easier for the baby to breathe.
• Saline - used to dilute drugs, but can be used in its pure form, which also makes breathing easier and relieves swelling.

Treatment rules

Inhalations with adenoids require accuracy. Important:

• After the procedure, do not eat, drink or talk for half an hour. The child should not breathe cold air - do not take him out for a walk and do not let him near the open window.
• Do inhalation with adenoids no earlier than twenty minutes after eating. Violation of this rule will cause nausea or vomiting in the child.
• After treatment, rinse the parts of the nebulizer with warm water.
• During the procedure, you should not breathe too deeply. Breathing should be calm and even, otherwise there will be symptoms of hyperventilation - dizziness, nausea, distortion of perception or coughing.
• Do not use essential oils and herbal decoctions - they pollute the device.

If the child is small, before starting treatment, make sure that he calms down. Sit with him during the procedure so that he breathes evenly and measuredly.

You can not use boiled or filtered water for inhalation - only saline from a pharmacy.

The liquid for inhalation should be at room temperature. Dilute the medicine with saline, if necessary, on the same day that the procedure is performed.

It is important to remember that if sniffing and shortness of breath begin to appear even when the baby is awake, he is nasal and choking, it means that inhalations will not help and you need to go to the doctor.