When I first started working in the Cancer Clinic in Penticton I was surprised when a patient said to me that getting cancer had been a real blessing to her. What? How could that be? The patient (lets call her Ariel) went on to describe how getting her diagnosis had really focused her on the important things and people in her life.
Going through chemotherapy is an intense and challenging time for anyone. Amongst other challenges, it had left Ariel with very little time or energy to spend even with her family and closest friends. After reviewing her friendships she decided that she simply wouldn’t waste any of her precious energy on people that had never really been great friends anyway. We all know those friends. They are the ones who, when they leave, we breathe a sigh of relief because the visit has been draining, or tainted with negativity, or they have spent the entire time talking about themselves without once asking us about how we are. Ariel also realized that some friendships had run their course but she had kept seeing the person out of feelings of obligation or shared history. Once she resolved to focus on only those people with whom she truly enjoyed spending time, her life became so much more joyful. With regard to household chores and life’s general business, going through chemo gave Ariel pause for thought too. She realized that protecting her health and conserving her limited energy stores was far more important than exhausting herself trying to keep every surface spotless and dust free. As one famous home maker said, “I am happy to leave the dusting for another day, because it will always be there!” Sitting curled up with a book, or relaxing on her back deck in the spring sunshine became far more important to Ariel than having a Homes and Gardens-worthy house! Since I first heard Ariel express that getting cancer was a blessing, I have heard it many times again from other patients, and it no longer surprises me. I now have a better understanding of why people say this. They are living a far happier and improved version of their previous lives. Gone are the obligations and pressures of trying to live up to unrealistic TV versions of a best life. Instead these have been replaced with thoughtful reflection of what actually matters to the patient, and those closest to them. This can look very different for different people. For some, it may be selling up most of their worldly possessions once chemo is completed, and departing on that adventure holiday they have constantly been putting off “for one day”. For others, it might be deciding to retire early rather than holding on for a few more dollars in their pension cheques. Some people decide to move out of the Okanagan and back to the far colder place they came from, in order to spend more time with their children and grandchildren. This reflection and review of life’s priorities is something we can and should all do on a regular basis. Freshen up your back yard and sit and enjoy your dinner outside on a balmy summer evening with good friends. Lower your standards a little bit on what your perfect house should look like and use some of that time to go for a dip in the lake instead. Spend more time doing things you love with people you love and less time on obligations. Have a walk on the KVR instead of watching mindless TV. Book that trip you have always longed for. Life really is made up of the little moments - make sure you enjoy them before they slip away!
1 Comment
With spring finally arriving in the Okanagan, chirping birds will not be the only sound heard in the next few months. Hundreds of people will be sniffing and coughing and sneezing as the dreaded seasonal allergies hit in full force.
Hayfever, or seasonal allergy symptoms are sometimes confused with having a cold or other illness. Common symptoms include : Itchy and watery eyes, runny or stuffy nose, constant sneezing, itchy throat or itch inside the ears. In children sometimes they just have a slight sniff but puffy eyes or dark circles under their eyes. Occasionally, a dry irritating persistent cough can be the only symptom. Pollen is the major contributor in spring. As it is released into the air from trees, grass or weeds it can get into your nasal passages. When you are allergic, your immune system is overactive and kicks into overdrive, seeing the pollen as a dangerous invader. It causes your body to release histamines which cause the watery eyes and runny nose and sneezes in an attempt to rid your body of the foreign substances. Tree allergies are the first to appear, sometimes as early as March. A hot and early spring can be a bad sign for allergy sufferers. Although rain will wash pollen away, initially the pollen count can surge after a rainfall. Did you know you can get a pollen forecast on line? There are several resources around, but for locals of the Okanagan I like the pollen forecast which is reported on The Weather Network. You can find the one reported from Kelowna Airport which also has an option for Penticton although it is not a lot different between the two places. It lets you know for each day the overall pollen counts in terms of low (1-20 grains/m3), moderate (21-80), high(81-200) or very high (over 200). It is also broken down for each day with the main culprits listed. For example, today Tuesday 1 May there will be moderate exposure to Birch pollen, and low exposure to cedar, juniper, aspen and poplar. Seeing an allergist can help determine what you are actually allergic to, and thus is can be easier to work out when you need to be most vigilant about avoiding triggers wherever possible. Over the counter anti-histamines can help symptoms a lot, but be careful to ask your pharmacist for non-sedating types if you are working and driving. Many people don’t know that these are most effective if you start taking them about two weeks before your symptoms appear. So get started early if you suffer every spring. If your allergies are severe, and they can be really debilitating when they are, working with a physician specialising in immunotherapy can help. They can prescribe allergy shots in a desensitization schedule which has helped many people take their lives back. A 2001 study showed that asthma, allergic rhinoconjunctivitis (nose and eye symptoms), rhinitis (nose symptoms) and eczema improved with more healthy starches, grains and vegetables in the diet. Other studies show that diets rich in fruits and vegetables have a protective effect . This is likely because allergic diseases are characterized by inflammation and a diet rich in natural antioxidants helps reduce this. Another reason to eat more veggies! The days are suddenly so much longer and it is so much easier to get up in the mornings now that it is light out before the alarm goes off. When we are thinking about meals, our focus is moving away from the warming soups and stews that were so comforting during the long and grey winter.
A popular appetiser when having friends over for balmy summer evenings, is tortilla chips and salsa. Salsa is a delicious way to get some lovely plant based antioxidants into your diet. Cilantro is a popular salsa ingredient but one that can cause some minor domestic squabbles as people seem to either love it or hate it! If you hate it because you think it tastes like bugs or soap or dirt, you just won’t understand how your partner can love it and describe it as fresh or citrusy! And your partner may just ask you when you last ate a bug and how the heck would you know what one tasted like. Well luckily there is always a team of scientists somewhere looking into these little mysteries of life! Genetic studies of more than twenty-five thousand people identified an area on chromosome 11 that matched cilantro preferences. It is a gene called OR6A2 that allows you to smell a certain chemical that, guess what, is both a big component of cilantro and of a secretion from stink bugs! So for those of you that hate cilantro and think your partner is weird for loving it, you are right. He or she is actually a genetic mutant who has no ability to smell the unpleasant compound. This is actually an advantage to cilantro lovers as it is useful in treating inflammation. You have to eat a lot of it - about twenty sprigs a day for a couple of months reduced inflammation in arthritis sufferers and also cut uric acid levels in half. Uric acid is implicated in gout, so if you suffer from this painful condition try eating cilantro on a daily basis. Migraine sufferers may be interested to hear that ginger can be as effective as sumatriptan (Imitrex) which is one of the top selling drugs in the world, grossing billions of dollars a year! In a randomized, double blind controlled study (that is when the patients and the clinical team do not know which substance the patients are getting) just one eighth of a teaspoon of powdered ginger was as effective and worked just as quickly as the drug, for a cost of about one cent. Both groups reported equal satisfaction with the remedy they had received, but the group that had received the ginger were astounded to hear what it was that had cured their migraines. The anti-inflammatory effects of ginger are also as effective as taking 400mg of ibuprofen for menstrual cramps. Most people have heard that ginger is good for nausea although can be reluctant to try it, preferring to use a drug. I would suggest you give it a go, and get the natural benefits without the downside of drug side effects. In a test in 1982 it beat out Dramamine in volunteers who agreed to be spun around in a tilted rotating chair - ugh! It is now considered to be useful as an anti-emetic (anti-vomiting agent) during motion sickness, pregnancy, chemotherapy, radiation and after surgery. Variety is the spice of life and spices are essential for a healthy life! We have talked a lot about choosing from a wide variety of foods and “eating the rainbow” to ensure we get as many healthy antioxidants as possible into our diets.
We know that red onions have more antioxidants than white ones, and the darkest green broccoli will have more of the good stuff than its faded sad-looking neighbour. Intense colours are associated with higher benefits, healthwise. Everyone is talking about turmeric these days! I have many patients telling me that they are now using turmeric supplements daily for the health benefits. (More about this later..). More than five thousand articles haven been published in medical literature about curcumin, which is the pigment in turmeric that gives it the bright yellow colour. Curcumin plays a role in preventing or treating lung disease, brain disease and many cancers including pancreatic, colon and multiple myeloma. It has been shown to speed up recovery after surgery and effectively treat the pains of rheumatoid arthritis. In a study on ulcerative colitis it helped put fifty percent of the subjects into a remission. Because turmeric is a powerful spice with medical qualities - be careful with its use. More is certainly not always better! While many traditional diets in India use up to a teaspoon a day, the average is actually closer to about a quarter of a teaspoon daily. Dr Michael Greger therefore recommends using this small amount each day. Black pepper helps increase the levels of curcumin in your blood stream. Just a small pinch is enough. Most curry powders have black pepper as well as turmeric as one of their common ingredients. A fat source in the curry also helps absorption - and to keep to a plant based diet, using something like a cashew cream would be a great way to incorporate this. If you use fresh turmeric (which looks similar to fresh ginger) - about a quarter of an inch would be the equivalent of a quarter teaspoon of dried turmeric. Cooked and raw forms of turmeric seem to have somewhat different properties. Eating it raw seems to improve the anti-inflammatory benefits, while cooked turmeric seems to offer better DNA protection. Fresh turmeric also has a more subtle flavour which may help those of you that are not partial to the taste of powdered turmeric. So why not supplements? There are three reason why supplements should be avoided. Manufacturers state that curcumin is the active ingredient in turmeric, which is true, but it is just one of the many different components of the whole food spice which is turmeric. The second concern relates to dosing. Many supplements have amounts of curcumin so high that they could potentially cause DNA damage, the very thing the manufacturers are claiming to prevent. When black pepper is added to the supplement this can worsen the problem of overdosing. Finally, there is concern about contamination with toxic metals that has been found in many curcumin supplements. This has not been the case with whole ground turmeric powder. Did you know that you can increase your life expectancy by about 2 years just by eating nuts regularly? It’s true! Eating a small handful five days a week or more will give you this wonderful health benefit.
The Global Burden of Disease study that has been referenced throughout this series on the Daily Dozen, calculated that not eating enough seeds and nuts is the third risk factor for death and disability in the world. It kills more people even than processed meat consumption and is thought to contribute to the deaths of millions of people every year. A serving size is one quarter of a cup of nuts or seeds or two tablespoons of nut or seed butter. Be careful with the latter especially! A tablespoon is not that giant glob overhanging the spoon after digging into the peanut butter jar! Only one serving a day is the recommendation too. While nuts do make great, tasty snacks on their own, I personally love to use them as good sources of fats to make great creamy plant based sauces. Soaking half a cup of cashews overnight softens them so they can be blended either with water or a plant based milk. This gives a wonderful thickness and flavour to things like vegetable curries or stews. Salads can be elevated by adding a ginger-peanut sauce or tahini-based goddess dressing. These healthy fats also markedly increase the absorption of all the phytonutrients found in the salad ingredients. Some good choices include almonds, brazil nuts, cashews, hazelnuts/filberts, macadamias, pecans, pistachios, sesame seeds, chia seeds, sunflower seeds and walnuts. If you really want to compare, it does seem that walnuts have the edge in the “best nut” category. They have very high antioxidant and omega-3 levels and are excellent at suppressing cancer growth in laboratory tests. This was also confirmed in a large study of over seven thousand men and women. Did you know that peanuts are not actually nuts? Technically they are legumes and they have protective effects against heart disease and fibrocystic breast disease. I know many of you will be worrying about eating nuts and the effect on your weight. I definitely grew up with the idea that since nuts are so calorie-dense they should be avoided at all costs. There have now been many studies that have debunked this idea. The studies have mostly shown no weight gain or even sometimes some weight loss in regular nut eaters. There seem to be a few reasons for this - despite logic dictating that if you add extra calories weight gain should be inevitable. There seem to be several mechanisms at work. Firstly, it seems that eating nuts helps people feel more satisfied and thus less likely to overeat generally. Secondly, eating nuts boosts ones’ metabolism resulting in more fat burn. Finally, there are also some poorly understood mechanisms at work, whereby some of the fats are excreted through the stool so not all the calories are absorbed. Nuts may certainly be one of the easiest and most delicious of the Daily Dozen to check off your list each day. If you have diverticulosis and have been told to avoid nuts and seeds, be assured, studies have shown that this is incorrect advice and adding this healthy food group is actually protective for your bowel. A study published in the journal “Hypertension” in 2013 showed that ground flaxseeds have one of the most powerful effects on lowering high blood pressure compared to other dietary changes. Having just two to three tablespoons of ground flaxseed a day was far more powerful even than starting an aerobic exercise endurance program. This is not to say that you shouldn’t do both however!
The study was unique in that it was a dietary study that was able to hide from the participants what they were eating, which is obviously quite hard, if not impossible to do with most dietary changes. The researchers were able to do this by “hiding” the flaxseeds in food such as muffins and pasta. After six months, the people who had no added flaxseeds had the same blood pressures despite being on blood pressure medications. The group that had had flaxseeds added to their food had a significant drop in their blood pressures - at a level that would translate to almost halving the amount of strokes and reducing heart disease by about a third. Flaxseeds have also been shown in clinical studies to help control cholesterol, triglyceride and blood sugar levels. They help reduce inflammation and are a good remedy for constipation. Daily consumption is associated with a lower risk of breast cancer, and lower tumour aggressiveness in people with existing breast cancer. For the same reason that flaxseeds help prevent breast cancer, so too, do they help reduce rates of prostate cancer. As we have discussed previously, flaxseeds are rich in phytoestrogens called lignans. Higher levels of lignans are found in the prostate fluids of populations of men who have relatively low rates of prostate cancer. In the laboratory setting, lignans have been shown to slow the growth of prostate cancer cells. So now you realize you really do need to add flaxseeds to your daily diet. Dr Greger recommends one tablespoon a day as part of your daily dozen. So how do you go about this? Luckily, flaxseeds are now widely available and it is possible to buy them fairly cheaply at bulk food stores. Mother Nature packs them perfectly in a hard natural hull which also makes them pass right through you undigested unless you grind them first! If you buy the whole seeds it is easy to grind them in a coffee grinder, or I use the individual setting on my Ninja food processor. It is possible to buy them already ground or “milled” and they do last well in this form - up to about four months at room temperature. Ground flax can be added to oatmeal, soups and salads - pretty much anything really. Adding a tablespoon to your oatmeal each morning gets your day off to a good start. Flax can be added to baked goods such as muffins without damaging the lignans so that is another easy way to get your daily dose. Flax crackers are pretty easy to make - just mix two cups of ground flaxseeds with a cup of water, add your favourite herbs and spices, then spread the dough thinly on a baking sheet. Bake at 400F for about twenty minutes. Then enjoy the crackers with your favourite hummus or bean dip for more of your daily dozen. Finally, one tablespoon of ground flaxseed with three tablespoons of water replaces an egg in baking recipes, thus helping your cholesterol levels while enjoying healthier treats. The Global Burden of Disease Study, which we have discussed previously in relation to fruit consumption, also identified inadequate vegetable consumption as a leading risk factor for death and disability, being nearly as bad as eating processed meat. The Union of Concerned Scientists estimates that in the USA alone, if everyone increased their consumption of fruit and veggies to meet the dietary guidelines, over one hundred thousand lives a year would be saved. There are many other experts in plant based nutrition who feel that this estimate should be even higher.
So go mad on your veggies. Anyone who says they don’t like veggies really hasn’t tried hard enough! There are so many different kinds, from artichokes, to asparagus, carrots, mushrooms, different coloured potatoes and yams, squash, peas, beans and more. The recommended servings (excluding greens) is at least two a day. Half a cup of raw or cooked non-leafy vegetables is a serve, half a cup of vegetable juice is a serve as is one quarter of a cup of mushrooms. Eating a wide variety is a great way to maximize intake of different nutrients and fills you up without excess calories. The reason it is important to eat a wide variety is that different veggies have different effects on health outcomes and even different parts of the vegetable can have different activity in the body. For example, tomatoes are protective against heart attacks because the yellow fluid around the tomato seed concentrates a substance that suppresses platelet activation. This prevents blood clots that cause heart attacks and most strokes. Aspirin works in a similar way but not in everyone and it can increase your risk of bleeding. If you only have tomato in the form of tomato sauce, juice or ketchup you will not get this benefit as the seeds are removed during the processing. There have not been many studies on the importance of variety of fruit and vegetable intake. However, one study that looked at inflammation in middle aged adults did show that the increase in variety of fruits and veggies eaten was even more important than the absolute amount eaten in predicting lower inflammation levels in the body. If looking good motivates you, and if we are honest, this would be most of us - then eating more veggies should be high on your to-do list. One study showed that eating nine serves a day resulted in people looking a lot healthier and more attractive than the group who only ate three serves a day. In a study in Japan on the “crow’s feet wrinkles” around the eyes of over seven hundred women, researchers found that a higher intake of yellow and green vegetables was associated with less facial wrinkling. Mushrooms are an excellent dietary source of an amino acid called ergothioneine. This acts as a cell protector and is especially important inside the mitochondria which are the power factories inside your cells. The DNA inside your mitochondria is especially vulnerable to free radical damage since many other anti-oxidants cannot enter the mitochondria. Mushrooms have about nine times as much ergothioneine as their next rival which is black beans. A serving of black beans has about eight times as much as the next on the list which is chicken liver. So I would strongly recommend adding mushrooms frequently to your diet to get their antioxidant effect, and potential immune function and anti-cancer benefits. Garlic, onions and leeks also have special anti-cancer fighting properties, which is why everything I eat pretty much has at least garlic and onions in it (except for my morning oatmeal)! Number four in your Daily Dozen of must eat foods, is cruciferous veggies, but since I wrote about these in a column in November, I will go straight to number five, which is greens. Popeye certainly had it right when he said he got his strength from eating spinach. Dark-green leafy vegetables are the healthiest foods we can eat, providing the most nutrition per calorie of any whole food.
Dr Greger recommends eating two serves from this group every day, with a serving size being one cup of raw greens or half a cup of cooked greens. Only about one in twenty-five people are getting a dozen serves a month, when we should all be getting over a dozen a week! One important warning though! If you are taking warfarin, you should gradually increase your intake of greens under your doctor’s supervision. This is because you will get a whole lot of fresh vitamin K from eating more greens which will make your blood more likely to clot if you don’t also increase your warfarin dose. Of all the food groups analyzed by Harvard researchers, greens are associated with the strongest protection against major chronic diseases. Just eating one extra serve a day reduces the risk for both heart attack and stroke by about twenty percent. Eating more greens also helps regenerate the antioxidant CoQ10. This may be particularly important for people taking cholesterol lowering statin drugs, since these interfere with CoQ10 production. Some of the greens that are good to eat daily are arugula, beet greens, collard greens, all colours of kale, young salad greens, spinach and swiss chard. Many people have difficulties making greens taste good. Kale is fibrous and tastes like grass, right? Overcooked greens are slimy and give people flashbacks to their school cafeteria days. By adding some sweetness to your salads in the form of a balsamic glaze or figs or apples can help fool your tastebuds. Another easy way to get your greens is to put them into smoothies with fruit. Starting with a two to one ratio, such as one banana, one cup of berries and one cup of packed baby spinach will usually suit most peoples’ tastebuds. Mint is easy to grow, especially in the Okanagan in summer and adding it to fruit salads, or even oatmeal counts towards your daily ration of greens. Pairing your green salads with healthy sources of fat that you like, such as avocados, nuts and seeds will make them taste better and enhance the nutrient absorption. It can be as simple as adding a creamy tahini dressing to your salad, adding walnuts to your pesto or sprinkling sesame seeds onto sautéed kale. Researchers have shown by adding a source of fat to a healthy salad of spinach, romaine, carrots and tomatoes, the carotenoid phytonutrients in the blood rise over the next eight hours. With a fat free dressing, this absorption was minimal, almost as if the salad had not been eaten at all. Adding a tasty condiment containing vinegar to your salad, not only makes you more likely to eat more salads but also reduces the blood sugar spike after a meal and also can help with modest weight loss when taken daily. The 2010 Global Burden of Disease Study which was funded by the Bill and Melinda Gates foundation is the largest analysis of risk factors for death and disease in history. Almost 500 researchers from more than 300 institutions in 50 countries worked on this study.
In the USA, the study determined that the leading cause of death and disability was the American diet, followed by smoking! This is mirrored in Canadian statistics. Not eating enough fruit was one of the worst aspects of the north American diet. There are many ways to quickly increase your fruit intake. Although fresh fruit is a convenient and easy snack you can also enjoy it cooked in desserts such as baked apples, poached pears and grilled pineapple. If you like to drink fruit juices, be aware that juicing removes fibre and polyphenol phytonutrients at the same time, since these are bound to the fibre. The phytonutrients are only available for absorption once the friendly flora in your gut release them from the fibre they are bound to. Blending your fruit will retain more of the nutrition of the whole fruit than juicing does. Remember also, that while eating more whole fruit is linked to a lower chance of developing type 2 diabetes, the reverse is true with higher consumption of fruit juices. This is associated with a higher risk of diabetes! There is a good reason for the old saying “An apple a day keeps the doctor away”. A serving size is one medium fruit, or one cup of cut up fruit, or one quarter cup of dried fruit, with three servings a day being recommended. Dates make another delicious fruit snack. When frozen they become chewy and taste like caramel - yum! It is quite easy to find good quality Medjool dates in most grocery stores and health food stores around Penticton. There is a lot of literature about the clinical benefits of kiwi fruit. Probably not because they are necessarily a lot better than other fruits, but more likely because New Zealand has a major share of the global market so the research there is better funded. Eating kiwi fruit seems to help people with insomnia. Eating two an hour before bed seems to shorten the time it takes to fall asleep as well as improve the length and quality of sleep. Two a day also helps with constipation related irritable bowel syndrome and lowers your risk of getting upper respiratory infections. Be careful with children though as there is a fairly high incidence of children who are allergic to kiwi fruit. On average, humans are experiencing about 800 hits to their DNA per hour. If these are not repaired, eventually mutations will develop which can then give rise to cancer. By comparing twins, researchers have shown that only part of the DNA repair function capacity is determined genetically. The rest is under our control, especially through dietary measures. Eating citrus fruits is the dietary weapon best known to boost our natural DNA repair functions. Within two hours of consuming citrus, your DNA becomes significantly more resistant to change. This may help to explain why there is a lower risk of breast cancer in people who eat more citrus. Some of the compounds responsible for this effect are found in the peel, so be sure to use lemon and orange zest on salads and other meals to add a bit of extra flavour and health promotion. Supplements do not help with DNA repair - so eat the real thing! Berries are so good for you and taste wonderful too! They offer some protection against cancer, they boost the immune system naturally and help nurture your liver and brain. A study of nearly one hundred thousand men and women found that those who ate the most berries were way less likely to die of cardiovascular disease compared to those who ate the least.
Colourful foods are often healthier as they contain antioxidant pigments such as beta-carotene that makes carrots orange, lycopene that makes tomatoes red and anthocyanin pigments that give blueberries their characteristic hue. Knowing that the colours in produce represent their antioxidant levels will help you next time you are at the grocery store or farmers market. Red onions, for example, have 76% more antioxidants than white onions. Red cabbage can contain up to eight times more antioxidants than green cabbage. Are you seeing the theme? So when you are shopping, look for the darkest green broccoli, the reddest strawberries and the deepest coloured tomato to maximize your dose of antioxidants. Berries are second only to herbs and spices as the best food source of antioxidants. They average about ten times more of these lifesaving substances than other fruits and veggies, and more than 50 times more than animal based foods! I know you want to know what the best berries are - and the short answer is, the ones you like and will be happy to eat regularly. Compared to bananas that have antioxidant power of about 40 units, strawberries come in at about 310 units per cup, cranberries at 330, raspberries at 350 and blueberries at 380, although wild blueberries can have twice that. Blackberries have an amazing 650 units. I personally don’t love blackberries so I will get my daily serve (or two) by eating strawberries or using blueberries and other berries in a smoothie. Now I can hear all of you diabetics out there, shaking your heads, saying you can’t eat fruit because of the fructose. Luckily for everyone, it is only fructose from added sugars that is associated with declining liver function, high blood pressure and weight gain. Eating whole fruit has been shown to blunt the insulin spike from high-glycemic (processed foods) such as white bread. Eating a piece of fruit with each meal is actually recommended as it will usually lower the blood sugar response, not raise it as was once thought. Tart cherries are known to be good for inflammation and they are available canned with just cherries and water. These can be great in oatmeal with cocoa powder and palm sugar for a touch of sweetness. Goji berries are another great source of antioxidants. They contain 50 times more zeaxanthin than egg yolks and may help people suffering from macular degeneration, without any of the saturated fat of eggs! While fresh berries are wonderful to enjoy in summer, the benefits are almost the same from frozen berries which are readily available at any supermarket. Berries are also easy to freeze at home, so there is no reason why you cant have a plentiful supply to enjoy in smoothies, on your oatmeal or just as lovely little frozen snacks all winter long. This is an easy way to tick off one of your daily dozen! |