Episodes

  • Episode 130: What Kind of Doctor Treats Scoliosis? [ANSWERED]

    Episode 130: What Kind of Doctor Treats Scoliosis? [ANSWERED]
    Dec 3 2024
    Choosing the Right Doctor for Scoliosis Treatment In this episode of our scoliosis-focused podcast, we delve into a crucial aspect of scoliosis management: selecting the appropriate healthcare provider. Dr. Tony Nalda discusses the differences between various types of doctors who treat scoliosis and the importance of finding a specialist who aligns with your treatment goals. Understanding the Types of Scoliosis Care Providers Generalists vs. Specialists: Many patients are initially diagnosed by generalists who do not specialize in scoliosis. These patients are often referred to specialists who focus primarily on scoliosis and its comprehensive management. Treatment Focus: It is vital to determine whether a doctor treats scoliosis as a primary focus or just as part of a broader practice. Specialists who concentrate solely on scoliosis are likely to provide more targeted and effective treatments. Approaches to Scoliosis Treatment Traditional Treatment: This approach often involves a "watch and wait" strategy to see if the curvature worsens, typically using pain management, bracing, or surgery. Surgical treatments might include spinal fusion, which uses hardware to correct the curve. Conservative Treatment: Focused on avoiding surgery, this method uses therapies, exercises, and corrective bracing to manage and potentially reduce scoliosis. It aims to improve the function of the spine and alleviate the effects of scoliosis without invasive procedures. Factors Influencing Treatment Decisions Desired Outcomes: Your treatment goals significantly influence the type of doctor you should see. If avoiding surgery is a priority, a conservative approach managed by a chiropractor or a non-surgical scoliosis specialist might be preferable. Expertise and Certification: Seek out providers who have extensive training and certification in scoliosis-specific treatment protocols. Providers might be certified in methodologies like CLEAR, SIAS, or use specific tools like the SCOLI Brace. The Role of Comprehensive Care in Scoliosis Treatment Multi-disciplinary Approaches: The best outcomes often result from a combination of treatments tailored to the patient’s specific needs. This can include a mix of manual therapy, specialized exercises, and bracing. Certifications and Skills: A well-rounded scoliosis doctor will have multiple certifications and a deep understanding of various conservative treatment methods. This multi-modal approach allows them to customize treatment plans effectively. Finding the Right Doctor Research and Referrals: Look for a doctor whose practice is dedicated to scoliosis care. Check their credentials, read patient reviews, and consider their treatment philosophy. Consultations and Outcomes: Don’t hesitate to ask for examples of the doctor’s results with cases similar to yours. Successful treatment centers should be able to provide evidence of their efficacy, such as before-and-after X-rays and patient testimonials. Conclusion Selecting the right doctor for scoliosis treatment is a decision that can significantly affect your health outcomes. Whether you opt for traditional or conservative treatment, ensure that your provider is not only skilled in general spinal care but is also specifically trained in managing scoliosis. By choosing a specialist who aligns with your health goals and offers a comprehensive treatment approach, you can achieve the best possible management of your condition. For more insights on navigating scoliosis treatment options and choosing the best care path, subscribe to our podcast and stay informed about the latest in scoliosis care and management. Artlist.io 847544
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  • Episode 129: Scoliosis Exercises: Which Exercises are Bad for Scoliosis?

    Episode 129: Scoliosis Exercises: Which Exercises are Bad for Scoliosis?
    Nov 26 2024
    Scoliosis and Exercise: What Works and What Doesn’t In today’s episode of our scoliosis-focused podcast, Dr. Tony Nalda addresses a common concern among patients with scoliosis: identifying which exercises are beneficial and which may potentially exacerbate their condition. Dr. Nalda brings his expertise to clarify misconceptions and provide guidance on physical activities for individuals diagnosed with scoliosis. Understanding Scoliosis and Exercise Scoliosis involves an abnormal curvature of the spine, viewed from the front, often accompanied by a rotational component. This deformity can affect the natural curves of the spine seen from the side, known as lordosis and kyphosis, which are essential for strength and flexibility. The disruption of these curves can impact how effectively the spine handles daily stresses and gravitational forces. The Role of Exercise in Managing Scoliosis General Fitness: Regular exercise contributes to overall health, which can enhance responsiveness to scoliosis treatments. A strong, fit body is more capable of supporting the spine and managing symptoms. Scoliosis-Specific Exercises (SSEs): These are tailored exercises designed by professionals who understand the unique dynamics of scoliosis. SSEs aim to improve flexibility, especially in directions that counteract the spinal curvature, and strengthen the core and spinal muscles to support and potentially correct spinal alignment. Effective Exercises for Scoliosis Non-Compressive Exercises: Activities that do not exert excessive pressure on the spine, such as walking and cycling, are generally beneficial. Swimming and Water Therapy: These can be particularly good for scoliosis due to the buoyancy of water, which reduces stress on the spine. Yoga and Pilates: While not curative, these practices can enhance flexibility and strengthen the core, aiding in overall posture and comfort. Exercises to Avoid with Scoliosis Certain activities can increase the curvature of the spine or exacerbate the rotational component, particularly those that are asymmetrical or involve repetitive motion on one side of the body. High-Impact Sports: Activities like gymnastics, horseback riding, and contact sports can cause jarring impacts to the spine, potentially worsening scoliosis. Asymmetrical Sports: Sports such as tennis, golf, and bowling can increase the asymmetrical loading of the spine, promoting an increase in curvature. Hyperextension Activities: Activities that require excessive arching of the back, such as certain dance forms and gymnastics, can flatten the thoracic spine and exacerbate scoliosis. The Reality of Scoliosis Management Dr. Nalda emphasizes that while scoliosis cannot be cured or completely corrected (even if the curvature is reduced to zero), it is a manageable condition. The management approach focuses on maintaining the smallest possible curvature to minimize complications. Early Intervention: The sooner treatment begins, the easier it is to manage the curvature. Combination of Therapies: The most effective treatment plans combine general physical fitness, scoliosis-specific exercises, and other medical or therapeutic interventions tailored to the individual’s needs. Conclusion For individuals with scoliosis, understanding which exercises are safe and effective is crucial for managing the condition and enhancing quality of life. Dr. Nalda’s insights provide valuable guidelines for navigating the complexities of exercise with scoliosis, highlighting the importance of a personalized approach to treatment and the potential benefits of targeted physical activity. To explore more about scoliosis management and other related topics, subscribe to our podcast and stay updated with expert advice tailored to those dealing with this spinal condition. Artlist.io 847544
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  • Episode 128: Does Scoliosis Make You Tired? Find Out Here!

    Episode 128: Does Scoliosis Make You Tired? Find Out Here!
    Nov 19 2024
    Exploring the Link Between Scoliosis and Fatigue In this insightful episode of "Scoliosis Treatment with Dr. Tony Nalda," we delve into an often-overlooked aspect of scoliosis—its impact on energy levels and fatigue. Drawing on 26 years of clinical experience, Dr. Nalda discusses how the structural changes associated with scoliosis can lead to increased fatigue, offering an understanding of why this happens and what can be done about it. Understanding Scoliosis and Its Effects on the Body Scoliosis is characterized by an abnormal lateral curvature of the spine that often comes with a rotational component, creating a three-dimensional deformity. This condition is not just about the curvature from the front view, but also involves a loss of normal spinal curves from the side view, which can lead to a range of physical consequences. Spinal Curvature Impact: The spine is naturally curved in the neck, upper back, and lower back to provide strength, flexibility, and shock absorption. In scoliosis, these natural curvatures can become distorted, diminishing the spine's ability to handle gravitational forces efficiently. Mechanical Inefficiency: As the curvature deviates from normal alignment, it places additional stress on the body. The spine becomes less effective at distributing forces, leading to muscle fatigue as the body works harder to maintain balance and upright posture. Fatigue Related to Scoliosis Patients with scoliosis often report higher levels of fatigue compared to those without the condition. Dr. Nalda explains that this fatigue can be attributed to several factors: Increased Energy Expenditure: The body compensates for the asymmetry of the spine by overworking the muscles to maintain balance and alignment. This continuous exertion can lead to general fatigue. Pain and Discomfort: Many adults with scoliosis experience chronic pain, particularly in the lower back, which worsens by the end of the day. Pain can significantly impact energy levels, further contributing to fatigue. Sleep Disturbances: The physical discomfort and pain associated with scoliosis often disrupt sleep patterns. Difficulty finding a comfortable sleeping position due to asymmetrical rib formation and uneven shoulders can lead to poor sleep quality, exacerbating daytime fatigue. Factors Influencing Fatigue in Scoliosis Patients The degree of fatigue experienced by individuals with scoliosis can vary depending on several key factors: Curve Severity: Larger curves place more strain on the body, leading to greater fatigue. The severity of the curve correlates directly with the amount of extra work the body must do to function normally. Associated Conditions: In cases where scoliosis is part of a broader neuromuscular condition, fatigue can be more pronounced due to the overall impact on the body's musculoskeletal and neurological systems. Age: While children and teenagers may adapt more quickly to the demands of scoliosis, adults often find that fatigue increases with age, particularly after the age of 40, as the body becomes less resilient. Managing Scoliosis-Related Fatigue Addressing the fatigue associated with scoliosis involves more than just treating the symptoms; it requires a comprehensive approach to manage the underlying spinal curvature: Early and Proactive Treatment: Initiating treatment soon after diagnosis can help manage curve progression and reduce the biomechanical inefficiencies that contribute to fatigue. Customized Care Plans: Treatment should be tailored to individual needs, taking into account the severity of the curve, associated symptoms, and the patient's overall health. This may include physical therapy, bracing, and possibly surgery. Lifestyle Adjustments: Incorporating regular exercise, proper nutrition, and strategies for effective pain management can help improve overall energy levels and reduce fatigue. Conclusion Dr.
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  • Episode 127: Scoliosis Pain Eliminated + 18 Degree Curve Reduction!

    Episode 127: Scoliosis Pain Eliminated + 18 Degree Curve Reduction!
    Nov 12 2024
    Overcoming Scoliosis: Vanda’s Journey and the Power of Intensive Treatment In this episode of "Scoliosis Treatment with Dr. Tony Nalda," we hear the powerful story of Vanda, a scoliosis patient who traveled from Europe to the Scoliosis Reduction Center for a specialized, coordinated approach to her condition. Her experience illustrates the challenges of scoliosis management, the long-term impacts of untreated scoliosis, and the benefits of a comprehensive, intensive treatment plan. The Early "Wait and See" Approach Vanda's scoliosis journey began at age 10, when a routine checkup revealed a mild curve. Initially, her doctor advised a “wait and see” approach, which led to years of minimal follow-up. Unfortunately, this approach is common but often means scoliosis progresses undetected until symptoms worsen. In Vanda's case, her mother eventually noticed asymmetry in her shoulders, prompting a further evaluation. By then, her curve had progressed significantly, and she was given a brace with the potential for surgery if there were no improvements. The "Snowball Effect" of Scoliosis Progression As Vanda entered adulthood, she had no awareness of scoliosis's potential to worsen over time. It wasn’t until her 40s that she began experiencing discomfort, a result of what Dr. Nalda refers to as the “snowball effect.” Even small degrees of progression in adulthood add to existing curves, leading to significant pain and limited mobility as the spine degenerates under daily stresses. This progression can cause a cycle of increased discomfort and reduced quality of life in later years. Intensive Care at Scoliosis Reduction Center Seeking effective treatment options, Vanda discovered Dr. Tony Nalda’s clinic in Celebration, Florida. Impressed by the personalized, coordinated approach, she made the decision to pursue intensive care there, knowing that similar comprehensive treatment wasn’t available in Europe. The intensive treatment is designed to work at each patient's pace, allowing those with high motivation, like Vanda, to achieve substantial progress. In just three weeks, she saw her thoracic curve reduce from 58 to 40 degrees and her lumbar curve from 42 to 33 degrees—a life-changing improvement. The Value of a Coordinated, Comprehensive Approach Dr. Nalda emphasizes the importance of a unified treatment approach, combining various therapies, rehabilitation, exercises, and bracing in one location under one doctor’s supervision. Unlike fragmented healthcare systems where patients often receive conflicting advice from different specialists, the Scoliosis Reduction Center’s model ensures that each component of the treatment plan works in harmony for maximum effectiveness. Motivation and Results For Vanda, the commitment to travel, endure intensive care, and invest financially was worth it. Her motivation came from wanting the most effective treatment to avoid surgery and significantly improve her quality of life. The results were immediate and transformative, highlighting the value of a structured, multi-modal approach that prioritizes reducing scoliosis curvature early and effectively. Final Thoughts Vanda’s journey is a testament to the power of an intensive, well-coordinated approach to scoliosis treatment. Her story serves as a reminder of the importance of proactive care and the impact of choosing the right treatment center. This episode is an inspiring look at the possibilities available for scoliosis patients worldwide who are seeking lasting solutions. To learn more about effective scoliosis treatments and patient success stories, subscribe to our podcast and join us in exploring how comprehensive care can change lives. Artlist.io 847544
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  • Episode 126: What is Hyperlordosis? What Does It Mean?

    Episode 126: What is Hyperlordosis? What Does It Mean?
    Nov 5 2024
    Understanding Hyperlordosis and Its Relationship with Scoliosis Welcome to "Scoliosis Treatment with Dr. Tony Nalda," where we explore complex spinal conditions and their treatments. Today, we delve into a common condition often found alongside scoliosis—hyperlordosis. What is Hyperlordosis? Hyperlordosis refers to an excessive inward curve of the spine, typically seen in the lumbar region. This condition is distinct from scoliosis, which involves a lateral curvature of the spine with a rotational component. Hyperlordosis results in what is often described as a "swayback" appearance, where the abdomen protrudes forward while the buttocks stick out backward. Normal Spinal Curvatures vs. Hyperlordosis The human spine naturally forms several curves, which help to absorb shock, support the weight of the head, and align the body properly. These include: Lordosis: Curves inward at the neck (cervical) and lower back (lumbar). Kyphosis: Curves outward in the upper back (thoracic). Hyperlordosis is essentially an exaggeration of the normal lordotic curve in the lumbar region, leading to an increased arching of the lower back. Causes and Implications of Hyperlordosis Hyperlordosis can develop due to various factors, including: Lifestyle and Habits: Sedentary activities can weaken the abdominal muscles, placing more strain on the lower back. Obesity: Carrying extra weight, particularly around the abdomen, can pull the spine forward, creating a deeper lumbar curve. Neuromuscular Conditions: Certain conditions like muscular dystrophy and cerebral palsy can disrupt muscle balance around the spine. This condition is not only a postural issue but can also lead to discomfort and lower back pain due to the abnormal stress placed on the spine. Hyperlordosis and Scoliosis Patients with scoliosis frequently present with hyperlordosis, possibly due to the compensatory mechanisms of the body trying to maintain balance and alignment. The exact relationship between scoliosis and hyperlordosis isn't fully understood, and it remains unclear whether one condition predisposes someone to the other or if they develop independently based on similar risk factors. Management and Treatment Treating hyperlordosis involves several strategies aimed at reducing the excessive curvature and strengthening the core to support proper spinal alignment: Physical Therapy: Exercises that strengthen the abdominal and back muscles can help in reducing the lordotic curve. Lifestyle Changes: Weight management and incorporating activities that encourage movement and flexibility can be beneficial. Avoidance of Aggravating Activities: Sports or activities that exacerbate the lordotic posture, such as gymnastics and certain forms of dance, should be approached with caution or modified to prevent worsening of the curve. Special Considerations for Adolescents In young individuals, especially girls who are more prone to both scoliosis and hyperlordosis, proactive measures are essential. Monitoring spinal development during growth spurts and intervening early with physical therapy or lifestyle adjustments can prevent the progression of these conditions. Conclusion While hyperlordosis and scoliosis can co-occur, addressing them early and effectively can lead to better spinal health and prevent further complications. Understanding the dynamics of spinal curvatures and the impact of lifestyle factors plays a crucial role in managing these conditions. For more insights into spinal health and to keep up with the latest discussions on scoliosis and related conditions, subscribe to our podcast and stay informed about how to manage and treat these spinal deviations. Artlist.io 847545
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  • Episode 125: 4 Facts About Scoliosis Treatment for Teens

    Episode 125: 4 Facts About Scoliosis Treatment for Teens
    Oct 29 2024
    Unveiling Scoliosis: A Lifelong Journey Through Progressive Stages In this episode of the "Scoliosis Treatment with Dr. Tony Nalda," we explore the progression of scoliosis through different life stages, focusing on how growth, hormonal changes, and aging influence the condition, with a particular emphasis on the impact of menopause on women. Scoliosis Overview and Types Scoliosis is a spinal condition characterized by an abnormal lateral curvature and is primarily classified into several types depending on the age of onset and underlying causes: Idiopathic Scoliosis: Predominantly found in adolescents, this type lacks a definitive cause and accounts for approximately 80% of all cases. It is most noticeable and diagnosed during puberty when children undergo rapid growth spurts. Neuromuscular Scoliosis: Linked to conditions like cerebral palsy or Ehlers-Danlos syndrome, this type stems from muscle or nerve abnormalities that affect spinal alignment. Congenital Scoliosis: This form arises from spinal malformations present at birth, typically involving abnormally shaped vertebrae like a hemivertebra. Degenerative Scoliosis: Often developing in adults over 50, particularly post-menopausal women, this type results from spinal degeneration and asymmetrical wear, commonly affecting the lumbar spine. Traumatic Scoliosis: Caused by spinal injuries, this type can occur at any age following significant trauma to the spine. The Impact of Menopause on Scoliosis Menopause significantly affects women with or at risk of scoliosis due to hormonal changes that influence bone density and spinal health. As estrogen levels decline, bones become more susceptible to compression and wear, which can exacerbate or trigger the onset of scoliosis in later life, particularly: Degenerative 'De Novo' Scoliosis: This form occurs in individuals without a prior history of scoliosis. It arises as the spine begins to deteriorate asymmetrically due to aging, compounded by menopausal changes. Progression of Existing Scoliosis: For women who had adolescent idiopathic scoliosis, menopause can lead to a rapid progression of their condition due to decreased bone density and increased vulnerability to spinal compression. Gender Differences in Scoliosis Adolescence: Girls are significantly more likely to develop scoliosis than boys during adolescence, attributed to earlier and more rapid growth spurts, which can quickly exacerbate spinal curvatures. Adulthood: Women are also more prone to developing scoliosis as they age, especially post-menopause, due to hormonal changes that affect bone strength and spinal integrity. Proactive Management and Treatment Early detection and proactive management are crucial across all stages of life but become particularly important during key phases such as adolescence and menopause: Adolescence: Early intervention can prevent the progression of scoliosis during growth spurts. Smaller curvatures respond better to treatment, making early action essential. Menopause: For post-menopausal women, managing bone density and closely monitoring any changes in spinal alignment can help control the progression of scoliosis. Conclusion Understanding scoliosis as a condition that can evolve with a person's hormonal and biological changes underscores the importance of lifelong monitoring and tailored treatment strategies. Whether it's during the rapid growth of adolescence or the hormonal shifts of menopause, proactive and informed care can lead to better management of scoliosis, reducing the need for invasive treatments and maintaining a higher quality of life. For more insights into managing scoliosis across different life stages, continue following our podcast series and subscribe for updates on the latest in scoliosis treatment and care. Artlist.io 847544
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  • Episode 124: Does Scoliosis Worsen in Menopause?

    Episode 124: Does Scoliosis Worsen in Menopause?
    Oct 22 2024
    Understanding Scoliosis Across Life Stages: From Adolescence to Menopause In this episode of "Scoliosis Treatment with Dr. Tony Nalda," we delve into how scoliosis affects individuals differently at various stages of life, emphasizing the impact of growth and hormonal changes, especially during menopause. Types and Causes of Scoliosis Scoliosis, a multifactorial condition, manifests primarily as idiopathic scoliosis in adolescents, accounting for 80% of cases. This form lacks a singular cause, often developing due to multiple factors during juvenile years and exacerbating during growth spurts in puberty. Other less common types include: Neuromuscular Scoliosis: Linked to conditions affecting connective tissues or the nervous system, such as cerebral palsy or Ehlers-Danlos syndrome, leading to abnormal spinal curvatures due to tissue rigidity or laxity. Congenital Scoliosis: Caused by malformations like hemivertebrae during fetal development, resulting in inherent genetic scoliosis present from birth. Degenerative Scoliosis: Typically found in adults over 50, often post-menopausal women, resulting from spinal shifts that go uncorrected and lead to asymmetric spinal deterioration. Traumatic Scoliosis: Arises from spinal injuries that cause curvatures. Gender Differences in Scoliosis Idiopathic scoliosis predominantly affects females during adolescence, with girls ten times more likely to develop and see progression in scoliosis than boys. This is attributed to earlier and quicker growth spurts in girls, which exacerbate spinal curvatures during critical developmental phases. Scoliosis in Menopause Menopause marks another critical phase for scoliosis progression, particularly in women who may not have had scoliosis during adolescence. Known as de novo scoliosis, this form develops due to hormonal changes and bone density decreases associated with menopause, leading to vulnerabilities in the spine, particularly in the lumbar region. These changes can accelerate scoliosis progression due to reduced osteoblastic activity and increased susceptibility to compression. Importance of Early and Proactive Treatment Regardless of when scoliosis develops—whether during rapid growth phases in adolescence or as a result of physiological changes during menopause—the key to managing the condition effectively is early detection and proactive treatment. Addressing scoliosis when curvatures are smaller and before significant progression occurs can greatly improve treatment outcomes. This applies to both conservative and surgical interventions. Closing Thoughts Understanding the nuances of how scoliosis can develop and progress at different life stages, particularly in response to hormonal changes in women, underscores the need for regular monitoring and early intervention. Proactivity is crucial, not only in managing the condition but also in potentially mitigating its impact on quality of life. This episode offers insights into the dynamics of scoliosis across life stages and the importance of tailored approaches to treatment. For more information on scoliosis management and treatment options, stay tuned to our podcast and subscribe for updates on new content. Artlist.io 847544
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  • Episode 123: Scoliosis Testing & Screening

    Episode 123: Scoliosis Testing & Screening
    Oct 16 2024
    Navigating Scoliosis: Early Detection and Proactive Treatment Welcome to another enlightening episode of "Scoliosis Treatment with Dr. Tony Nalda," where we tackle the crucial aspects of scoliosis screening, detection, and proactive treatment strategies. Understanding scoliosis and its progression is vital for effective management, especially in children and adolescents where growth can dramatically influence the condition's severity. The Critical Role of Early Detection Scoliosis is inherently progressive, meaning it tends to worsen over time. Early detection is pivotal as it significantly enhances the potential for positive treatment outcomes, particularly with conservative approaches. The earlier scoliosis is identified—preferably when the curvature is minimal—the more effective treatment can be, helping to avoid severe progression. Idiopathic Scoliosis in Adolescents The most common form of scoliosis, idiopathic scoliosis, often remains undiagnosed until a child hits a rapid growth phase during puberty. This period, typically between ages 10 and 18, is when mild curvatures can quickly become severe. Surprisingly, the initial cause of scoliosis may not be present anymore as the rapid growth itself drives the progression of the curvature. The Importance of Regular Posture Checks Subtle postural deviations might be the first sign of scoliosis. Uneven shoulders, hips, or an abnormal rib arch in children as young as five to seven can be early indicators. Unfortunately, these signs are often overlooked or dismissed by health professionals and parents alike, only to become pronounced during the growth spurts of puberty. Challenges in Scoliosis Screening Standard screening methods, like the Adams Forward Bending Test, are designed to detect more obvious thoracic scolioses but can miss less pronounced curves or atypical forms like S-shaped scoliosis. This method, often employed in school screenings, might not capture a developing scoliosis if the child has not yet entered their peak growth phase. Proactive Treatment Strategies Proactive treatment for idiopathic scoliosis, particularly when curves are still below 25 degrees, can lead to much better outcomes. Treatments focus on utilizing growth phases to correct spinal alignment, rather than just containing progression. For smaller, more flexible curves, treatment can effectively prevent the need for invasive procedures like spinal fusion surgery later in life. The Role of Comprehensive Evaluation For families with a history of scoliosis, or when any postural deviation is observed, taking immediate action is recommended. This involves thorough physical examinations and possibly X-rays to confirm the diagnosis and determine the extent of scoliosis. Early, conservative treatment can substantially alter the disease's trajectory, improving the quality of life and physical function. Conclusion Detecting and treating scoliosis early, especially before major growth spurts, can significantly impact the severity of the condition. Regular posture assessments during critical growth phases and understanding the signs can help catch scoliosis at a manageable stage. If you suspect scoliosis, consult a specialist experienced in pediatric and adolescent scoliosis for a comprehensive evaluation and tailored treatment plan. Stay informed and proactive in scoliosis management by subscribing to our podcast and visiting our website for more resources and guidance on conservative treatment options. Join us next time as we continue to provide insights and support for those navigating the complexities of scoliosis. Artlist.io 847544
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