7, 7, 2022

Spider Veins: Before & After Transformation

2022-06-25T16:03:26-07:00

What are spider veins?

Spider veins are the fine, thread-like reddish veins at the surface of the skin. These veins are not healthy. Veins are often considered a cosmetic issue, but they can be associated with underlying feeder veins, not visible to the naked eye.  Feeder veins are the ‘blue veins’ also known as ‘reticular veins,’ that give rise to spider veins. Spider veins may also be a sign of underlying venous insufficiency. For example, spider veins located in the inner ankles and inner thighs can indicate an underlying problem with the saphenous vein. As a result, an ultrasound examination may be recommended to identify and effectively treat the underlying source of these veins.

What are the symptoms?

Vein conditions affect people differently. For some, these veins can be a painless cosmetic concern, and for others they may cause symptoms. The most common symptoms of spider veins are burning, throbbing, and localized pain. They can also feel hot and itchy and bleed.

What causes them?

Spider veins in the legs are caused by the same condition that causes varicose veins. Leaky vein valves allow blood to pool within the veins causing them to stretch and become enlarged. These veins on other areas of the body, such as the face, and chest can be caused by sun damage, hormone changes or liver disease. Hormones, such as with pregnancy, birth control or hormone replacement therapy can weaken the vein wall.

Below you can see the transformation of 3 of our patients who received vein treatment.

spider veinsspider veinsspider veins

If you experience any vein disease symptoms, please call our office at (858)-434-5998 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular.

For more information on vein health please check out our Youtube Channel or visit our helpful guide of resources. 

Spider Veins: Before & After Transformation2022-06-25T16:03:26-07:00

Vein Health: Helpful Anatomy Phrases to Better Understand

2022-12-13T14:15:11-08:00

If you're not a vascular specialist, it may be difficult to understand the words used to describe your vein condition and understand vein health. Vein terms are not used in everyday life.  Especially, when it comes to the anatomy of the veins. Below is a glossary of the terms, we as vein specialists, use on a daily basis but may be foreign to the patient.  This is provided from the American Vein and Lymphatic Society (AVLS) healthyveins.org.

Anatomical Vein Terms for Vein Health:

Anterior: The front of a body part.

Posterior: Back of a body part.

​Deep Leg Vein: The veins that are deep in the thigh and leg that carry blood back to the heart.

​Connective Tissue: This strong tissue is the white tissue that covers muscle.

Great Saphenous Vein: (sometimes called GSV or long saphenous vein) A long vein that can be seen just in front of the ankle bone. This vein travels along the inside of the leg and thigh (about one-half inch beneath the skin in the thigh) until it empties into the deep vein called the common femoral vein in the groin.

Perforating Vein: A vein that passes directly from a superficial vein to a deep vein.

Popliteal Vein: The deep vein located behind the knee. The small saphenous vein originates from the popliteal vein.

Small Saphenous Vein: (sometimes called SSV, Lesser Saphenous Vein, or LSV) A superficial vein that starts at the outside of the foot and travels up the back of the calf where it empties into the deep vein (popliteal vein) in the crease of the knee.

​Spider Vein: A tiny varicose vein that may be blue or red color that does not protrude above the skin surface and frequently looks like a spider. Common medical terms you may hear for spider veins are telangiectasias and telangiectatic veins. Slightly larger varicose veins that do not protrude above the skin are called reticular veins.

​Superficial Vein: Any vein in the lower extremity above the deep fascia that covers the muscles of the thigh and leg.

​Varicose Vein: A bulging vein that protrudes past the skin surface and usually measures greater than one-fourth of an inch (6.4 mm) in diameter.

Vein Function Terms

Competent Vein: Blood flow occurs in the proper direction back to the heart. Also referred to as Having No Reflux Or Normal Flow Direction.

Incompetent Vein: Blood flows in the wrong direction. Also referred to as a vein that has reflux.

Reflux: Blood that flows backward in the veins.

 

Anatomical Images and Explanations

Normal Blood Flow: After the blood has been replenished with oxygen in the lungs, it is pumped to the body by the heart. Blood that is pumped to the lower extremities is pumped back to the heart partially by the action of the calf muscle pump. The blood returning from the lower extremities in the deep and superficial veins goes past a series of one-way valves. These valves stop the blood from flowing backwards in the vein.

​

Reflux: The valves in the veins close just as blood begins to flow backwards. If the valves do not close properly, the blood falls backwards through the poorly closing or leaking valves. The veins downstream that are now unprotected by valves further upstream are exposed to the weight of an increasingly high column of blood. These downstream veins cannot endure the pressure of the column of blood and expand becoming snake-like in appearance. This causes the vein to bulge through the skin surface and become varicose veins.

If you experience any vein disease symptoms, please call our office at (858)-550-0330 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular.

For more information on vein health please check out our Youtube Channel or visit our helpful guide of resources. 

Vein Health: Helpful Anatomy Phrases to Better Understand2022-12-13T14:15:11-08:00

Fourth of July BBQ & Venous Reflux Disease

2022-12-13T14:06:06-08:00

After a holiday, patients frequently complain about leg pain, which can be reflux venous disease. Especially holidays where hours of cooking are involved like Fourth of July, Thanksgiving, Easter, Christmas, Passover, etc. Some people who may have mild venous reflux disease, may not notice any symptoms until they are standing for hours- like during cooking. Over the years, we always hear from patients that their legs were aching and fatigued after cooking. 

The reason for this is venous reflux disease causes backflow of blood. 

The blood pools in the legs and the pooling of blood causes sensations of heaviness, fatigue, aching, and even night cramps and restlessness. Ankle swelling may also be more prominent.

Helpful tips to combat leg fatigue during the holidays: 

1.Elevating the legs allows the blood to flow in the correct direction and reduces the pooling of blood and symptoms.

2.Wearing compression stockings during cooking can be helpful to reduce symptoms. 

3.Also when standing upright for hours, it is helpful to do calf pump raises.

4.Minimize your time standing. Bring a chair to sit for the bbq or in the kitchen while you cook.

5. Delegating food preparation to other family members, to reduce standing for long periods of time, which can cause more pain.

The true culprit of leg fatigue and soreness after standing and cooking for numerous hours is leaky vein valves allowing the blood to pool, causing leg pain, heaviness, and fatigue. Try these few tips this July 4th holiday and see how you feel after. 

If you experience leg fatigue or pain after standing for long periods of time, this may be venous reflux disease, please call our office at (858)-550-0330 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular. 

 

For more information on vein health please check out our Youtube Channel.

 

Fourth of July BBQ & Venous Reflux Disease2022-12-13T14:06:06-08:00

What could be causing your varicose veins?

2022-12-13T14:16:03-08:00

What are varicose veins? 

Varicose veins are the twisted, bulging veins just beneath the surface of the skin. Varicose veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs, but they also can form in other parts of the body. Varicose veins are a common condition.

Who gets them and why.

Both women and men can develop vein disorders at any age.  It can affect the healthiest of individuals, but there are some conditions that increase your risk of developing varicose veins.  They are mostly inherited; if both of your parents had varicose veins, you have a 90% chance of also having them.  Other factors that increase your chance of developing vein disorders include being female, hormonal changes, pregnancy, getting older, having a job that requires many hours standing or sitting, being overweight, and history of leg injuries. Some of the causes of varicose veins are listed below: 

  • Increasing age. As you get older, the valves in your veins may weaken and not work as well.
  • Heredity. Being born with weak vein valves increases your risk. Having family members with vein problems also increases your risk. About half of all people who have these this type of venous reflux disease have a family member who has them too.
  • Hormonal changes. These occur during puberty, pregnancy, and menopause. Taking birth control pills and other medicines containing estrogen and progesterone also may contribute to the forming of varicose or spider veins.
  • Pregnancy. The hormones during pregnancy greatly influence the leg veins. These veins can even be a symptom of pregnancy and can show up during the first trimester. As pregnancy progresses, there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The growing uterus also puts pressure on the veins. Varicose veins usually improve within 3 months after delivery. More varicose veins and spider veins usually appear with each additional pregnancy.
  • Obesity. Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.
  • Lack of movement. Sitting or standing for a long time may force your veins to work harder to pump blood to your heart. This may be a bigger problem if you sit with your legs bent or crossed.
  • Leg Injuries

If you experience any vein disease symptoms, please call our office at (858)-550-0330 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular.

For more information on vein health please check out our Youtube Channel. 

What could be causing your varicose veins?2022-12-13T14:16:03-08:00

14, 6, 2022

How is Osteoarthritis of the knee diagnosed and treated?

2022-05-30T13:30:35-07:00

How is Osteoarthritis of the Knee Diagnosed?

osteoarthritis

At La Jolla Vein & Vascular we diagnose and treat patients with Osteoarthritis.

Besides collecting the information and performing a physical examination, your doctor may also request additional testing such as x-rays and MRI scans. The X-ray imaging shows the extent of the cartilage damage and any presence of bone spurs. Magnetic resonance imaging (MRI) scans are more precise and detailed and help the doctor see the bones, cartilage, and other joint tissue damage. The doctor may also request blood tests that will help him to rule out other conditions that may be causing the knee pain.

Treatments for Osteoarthritis (OA)

Like most other diseases, addressing the symptoms of knee OA from early stages helps prevent the condition from worsening. Various treatments are available for knee arthritis. As mentioned, this treatment’s primary aim is to stop the condition’s progression since damaged joints are not reversible. The main types of knee osteoarthritis include medications, non-surgical treatments, surgeries, and injections.

Your doctor will choose the right approach depending on your general wellbeing and the condition progression level. Like other arthritic conditions, lifestyle modifications can help protect your knee health and slow the progression of knee arthritis. Your physician may recommend following the following lifestyle changes.

  1. Minimizing the activities that aggravate the condition. Avoiding activities such as heavy lifting or climbing stairs can help in slowing OA progression.
  2. Losing weight. Maintaining the proper weight will reduce the stress on your knee joint.
  3. Switch from intense activities such as tennis or jogging to low-impact activities like cycling or swimming. Low impact activities will help you stay in shape while protecting your knees

Options for Osteoarthritis include: 

-Medications and Injections

-Physical Therapy

-Surgery

So, if this is you and you’ve been experiencing pain, please give our office a call at 858-550-0330.

For more information please check out our Youtube Channel at this link.

 

How is Osteoarthritis of the knee diagnosed and treated?2022-05-30T13:30:35-07:00

20, 5, 2022

Signs and Symptoms of Varicoceles

2022-04-29T16:45:32-07:00

 

 

What are Varicoceles? 

A varicocele is a term used to describe abnormal enlargement of the veins within the scrotum. The veins carry blood from the various body organs back to the heart. Typically, veins have valves that prevent blood backflow. When the valves in the veins within the scrotum don’t work as they should, blood tends to collect in the scrotum.

Signs and Symptoms of Varicoceles

Most often, Varicoceles have no symptoms or signs. As mentioned earlier, you will barely notice it. However, although rarely, the condition might cause pain. When it does cause pain, it might;

  • Switch from a sharp to a dull discomfort
  • Become worse over the day
  • Increase when due to physical exertion or standing for extended periods
  • Pain that goes away when you lie on your back
  • Impaired infertility

Over time, varicoceles may become more enlarged and become noticeable. Varicoceles are often described as looking like a “bag of worms” sometimes, the condition may also cause a swollen testicle, most often on the left side.

 

When Should You Seek a Doctor?

 

Since symptoms do not accompany varicocele, it often does not require treatment. In some cases, varicoceles are discovered during a fertility evaluation. However, you should see a doctor if you notice any of the following.

  • Pain or swelling in the scrotum
  • Discover a mass on the scrotum
  • You are having a problem with your fertility
  • When you notice that one of your testicles is larger than the other

 

For more information on vein and vascular treatment please visit our YouTube Channel.

Signs and Symptoms of Varicoceles2022-04-29T16:45:32-07:00

Process of being diagnosed with Peripheral Arterial Disease

2022-04-28T19:14:18-07:00

Peripheral Arterial Disease – Diagnosis

At La Jolla Vein & Vascular, we have highly trained physicians who offer a comprehensive diagnosis to develop customized treatments of Peripheral artery disease (PAD). We understand that no two patients’ conditions are similar. Our full-service vascular lab provides state-of-the-art testing to ensure that our physicians address each patient case quickly and accurately. Our doctors and nurses also have broad experience in this field and use advanced tools to achieve limb-saving results even for challenging, impaired patients. Our PAD diagnosis procedure involves the following:

peripheral arterial disease

Detailed Physical Exam

To help diagnose Peripheral Arterial Disease, our skilled doctor will start by doing a thorough physical examination. The doctor will also want to learn about your signs, symptoms, personal health history, risk factors, and family health history. The doctor will ask you several questions regarding your medical conditions, such as diabetes, heart disease, and kidney disease. They will also ask you whether you experience pain or cramps in your leg while walking or exercising.

The doctor will also ask about your family history of PAD and other heart diseases. You will also discuss your smoking habit, either current or in the past. After gathering the information, the doctor will proceed to perform a detailed physical examination. The process involves checking for weak pulses in your leg, listening for poor blood flow in the legs using a stethoscope. The physician will also check for any problems on your legs, such as sores, swelling, and pale skin.

Detailed Physical Exam

Ankle-brachial index (ABI)

Ankle-brachial index (ABI test) helps diagnose PAD. This test usually compares the blood pressure in your arm with the blood pressure in your ankle. The doctor usually uses a pressure cuff together with an ultrasound device. Sometimes, the physician may request you to walk on a treadmill and have the doctor take the readings before and immediately after the exercise. The procedure will help the doctor to capture the severity of the narrowed arteries.

 

Arterial Ultrasound

La Jolla Vein & Vascular doctors also use ultrasound-guided procedures to determine whether a specific vein or artery is blocked or open. The procedure is non-invasive, meaning that you will not experience any pain. The technique visualizes the artery with sound waves that measure the blood volume that flows in the veins and arteries. After the procedure, the patients receive a thorough consultation. The doctor will recommend the most effective treatment option to help promote blood flow to the feet and leg.

The treatment will help reduce leg pain, promote healing of sores and increase the mobility of the affected limb. Doctors utilize two main ultrasound methods. The first method is the Doppler ultrasound utilized to locate areas with blockages or reduced blood flow. The procedure involves using a handheld device that sends sound waves through the arteries to measure how fast blood flows. The second method is the segmental Doppler pressure testing that checks various parts of the legs for blocked or narrowed arteries. The procedure is similar to the ABI test, but the ultrasound device will amplify the sound of blood flow, making it easy to measure blood pressure and diagnose peripheral arterial disease. 

 

Angiography (venography)

Angiography is minimal invasive testing that helps to visualize and diagnose blockages inside veins and arteries. In this procedure, the physician will insert a thin tube that injects a special dye that enables blood vessels to appear on an X-ray. As the dye is introduced to the arteries and veins, fluoroscopy imaging captures the detailed images to see the extent of blockages in the arteries.

 

Blood Tests

Doctors also take a sample of your blood to measure the levels of cholesterol and triglycerides. Blood samples are also used to check for diabetes.

 

Magnetic Resonance Angiography (MRA)

MRA tests are conducted to examine the structure of the arteries in your leg. However, the doctor will speak to you before using the procedure. Magnetic resonance angiography is not recommended for people with metal implants in their bodies.

For more information on Vein and Vascular conditions, please check out our Youtube Channel.

Process of being diagnosed with Peripheral Arterial Disease2022-04-28T19:14:18-07:00

What is Peripheral Arterial Disease (PAD)

2022-04-28T18:54:59-07:00

Peripheral artery disease is a subset of vascular disease,also referred to as peripheral arterial disease (PAD), which develops when excessive plaque buildup on the artery walls causing the narrowing of the arteries.

peripheral artery

The arteries deliver oxygen-rich blood from the heart to other parts of the body. When plaque builds up, it usually restricts the flow of blood, oxygen, and glucose. The obstruction causes pain in the leg as the muscles and tissues are starved for oxygen and other nutrients from the blood. While the pain usually occurs in your legs primarily, it can also be felt in other parts of the body, including your arms, stomach, hip, head, and kidneys.

Are You at Risk for Peripheral Arterial Disease (PAD)?

In most cases, the PAD symptoms are on the lower extremities. You may experience some pain, craping, or tiredness in your hip or leg muscles when climbing stairs or walking. However, the pain usually goes away with rest, only to resurface when you start walking again. Individuals suffering from peripheral arterial disease are at a high risk of coronary artery disease, stroke, or heart attack. Even worse, if left untreated, the condition can lead to gangrene and amputation.

 

Peripheral Arterial Disease – Symptoms

 

The most common symptom of Peripheral arterial disease is claudication. The fat and cholesterol build up on the artery walls cause a lack of blood flow, causing a condition referred to as ischemia. Ischemia is a condition that results when there is a greater demand for oxygen than the supply.

Claudication is a condition that causes cramping in the legs and buttocks. As mentioned, the pain and clamping flares up when you start to walk and subsides when you rest. Intermittent claudication affects about 50 percent of individuals suffering from peripheral artery disease. Some of the other common symptoms include loss of hair around the ankles, numbness or coldness in your feet.

Pain and cramping while walking may lead to a more sedentary lifestyle, meaning that the individual will burn few calories and add weight. An increase in weight also increases cholesterol, blood pressure, and other heart disease risk factors. The claudication severity often varies from mild discomfort to debilitating pain, making it hard for you to walk or perform other types of physical activities. 

PAD

Other common symptoms of the peripheral arterial disease include;

  • In extreme cases, an open wound or ulcer occurs on your toes or feet. These extreme cases lead to non-healing ulcers. The ulcer can progress to gangrene, making it hard for you to walk. In such a scenario, immediate medical attention is necessary.
  • Weakness or numbness in your legs
  • Coldness in your lower feet, especially when you find one foot is colder than the other one.
  • Experiencing pain in your feet or toes while you are resting
  • Sores on the legs, feet, and toes that do not heal
  • Slower toenails growth
  • Change in the color of your feet
  • Erectile dysfunction in men can be treated by prostate arterial embolization (PAE), which also treats benign prostatic hyperplasia (BPH)
  • Weak pulse in your feet or legs
  • Developing shiny skin on your legs
  • Having pain in your arms, especially when writing, knitting, or performing manual tasks

As the peripheral disease progresses, you may start to experience pain even when you are lying down. In extreme cases, the pain becomes intense enough to distract your sleep. Resting your legs by hanging them at your bed edge or walking around the room helps stimulate blood flow, relieving the pain temporarily.

 

What is Peripheral Arterial Disease (PAD)2022-04-28T18:54:59-07:00

Symptoms and signs of non healing ulcers and wounds

2022-04-28T17:32:09-07:00

Symptoms of Non-Healing Ulcers

 

As we’ve seen, there is a very wide range of causes of non healing ulcers and wounds that may contribute to the formation and persistence of non-healing ulcers. It follows that the methods or treatment options at the disposal of healthcare professionals will also be varied.

You shouldn’t allow a wound to fester for weeks on end before seeking professional assistance, especially if you fall under one or more of the risk categories we’ve outlined above. The following are some warning signs to look out for:

  • -Darkening or bluish discoloration around the wound edges
  • -Significant pain around the wound that persists without improvement or progressively grows worse
  • -Foul odor or smell emanating from the wound
  • -Swelling and redness emanating from the wound and spreading to surrounding skin and tissue
  • -Continuous leaking, draining, or weeping from the wound

Notice that these symptoms of non healing ulcers and wounds are mostly indicative of infection. This is a good measure as it often indicates a failure of the body’s natural mechanisms to deal with the wound through its normal processes. The rapid and timely intervention will be called for to forestall further tissue damage and complications.

 

ulcer4

Treatment of Non-Healing Wounds

 

Doctors will discuss the available options for non healing ulcers and wounds with their patients in order to arrive at the best possible options, but the type and severity of the wound will be the decisive point of consideration. These measures include:

Compression Wrapping

Specialized Dressings and Topical Medication

Patient Self-Care and Education

Negative Pressure Therapy (NPWT)

Surgery

Growth Factor Therapy

Debridement (removal of dead tissue)

Symptoms and signs of non healing ulcers and wounds2022-04-28T17:32:09-07:00

Causes of Non-Healing Ulcers & Wounds

2022-04-28T17:24:16-07:00

Non-healing ulcers & wounds do not follow the usual healing process and are referred to as chronic wounds should they persist beyond 3 weeks. Such wounds can be a heavy burden to live with for anyone. Still, the board-certified vascular surgeons and specialists at La Jolla Vein & Vascular are dedicated to administering effective treatment and management solutions to all patients so they may resume a healthy, productive, and pain-free life.

Types of Non-Healing Ulcers

In general, patients will present with one of three categories of non healing ulcers & wounds, with these categories being broadly defined by the major causative factors allowing for their development. These are:

Arterial or Venous Ulcers

 

These are found to account for between 70% up to 90% of non-healing wounds or non-healing ulcers. Mostly occurring in elderly patients, they are believed to come about as a result of a failure of the valves in a person’s blood vessels of both arteries and veins. These valves are responsible for preventing the backflow of blood as it passes within them. The consequent outcome is a lack of nutrient and oxygen-rich blood from reaching the affected tissues and sets up the conditions favoring non-healing wounds.

 

Pressure Ulcers

 

These are ulcers that are brought about by the restriction of blood flow to certain regions of the body due to the persistent and prolonged application of pressure upon them. It is mostly encountered among patients with full or partial paralysis and those who are bedridden for extended periods.

 

Diabetic Ulcers

 

These are also highly prevalent chronic wounds, and are on the increase among patients owing to the ever-increasing cases of diabetes among the population. In fact, the prevalence of chronic wounds among diabetics makes this demographic 15% more likely to have to undergo limb amputation as a complication of the condition.

The causes of non healing ulcers & wounds: 

footulcer3

The underlying factors contributing to the risk of developing a non-healing ulcer or wound are widely varied. What they have in common is their ability to interfere with the way the body normally functions with regard to wounds.

 

–Nerve Damage (Neuropathy)

–Circulatory System Issues

–Underlying Health Conditions

–Nerve Damage (Neuropathy)

 

Non healing ulcers & wounds are prevalent in people living with certain circulatory ailments such as atherosclerosis, diabetes, alcoholism, etc. In a healthy person, the nerves will send signals to the brain whenever pain or discomfort is experienced in any body tissues. Neuropathy makes this system non-functional; tissue can be damaged without warning signals being sent to the brain. This will prompt the person to change position or remove the object, causing injury. Over time, the affected area might see the development of an ulcer.

Circulatory System Issues

 

A person’s circulatory system is responsible for delivering blood rich in oxygen and nutrients to all the tissues in the body that need it. Without it, tissues will begin to die. Due to their extremity (distance from the heart) and the effect of gravity, a person’s feet will often be the first problem area for a person with an impaired circulatory system. Peripheral artery disease (PAD) is a particularly culpable condition in this instance as it may lead to numbness, skin discoloration, severe pain, ulcers, or even the patient’s demise if left unchecked.

Underlying Health Conditions

 

The formation of non-healing ulcers will indicate that an advanced stage of certain conditions has been reached in a patient. These conditions include high blood pressure, diabetes, kidney failure, high cholesterol, or peripheral artery disease (PAD). These conditions contribute to the formation of ulcers by causing ischemia, or the interruption of oxygenated blood to all parts of the body, or by damaging the nerves in the wound areas.

Contributing Lifestyle Habits

 

Some various habits and lifestyles will place patients at a heightened risk of developing non-healing ulcers. Smoking, for instance, has the effect of narrowing the vessels carrying blood to body tissues, thus increasing one’s chances of developing ulcers. A sedentary lifestyle involving little to no active movement will also carry the risk of encouraging ulcer development due to the constant pressure applied to certain tissues. Old age is also a factor here, as our skins will gradually lose their ability to repair themselves as quickly and efficiently as they once did.

 

Causes of Non-Healing Ulcers & Wounds2022-04-28T17:24:16-07:00
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CONTACT INFORMATION

La Jolla/UTC

Vista

Patient Privacy Practices

Privacy Policy

Hippa Privacy Practices
HIPAAOneTM Certified Seal 2

Use the search features below to find articles and insights for the diagnosis and treatment of vascular disease

TWO CONVENIENT LOCATIONS THROUGHOUT SAN DIEGO

La Jolla/ UTC

North County San Diego/ Vista — Endovascular Center
Now Open! Call/Text for Appointments

© Copyright 2010-2024, La Jolla Vein & Vascular | All Rights Reserved

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