Shoulder Arthritis And Shoulder Replacement
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- Опубліковано 5 кві 2022
- In this video, guest surgeon Dr. John Haverstock discusses shoulder arthritis. He discusses various treatment options including total shoulder replacement.
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I'm 2 years post TSR. I am absolutely over the moon with the outcome. I can now do everything I want to do - swimming, strength work in the gym, overhead work...anything. My range is about 85-90% of normal, I hardly notice the deficit. I did lots of rehab post surgery with a slow build over about 18 months to get to where I am now. And NO MORE PAIN 😁
That is awesome Barbara. Thanks for watching and subscribing
Hi Barbara. I'm scheduled for TSR and am terrified! Like you, I'm an active person and an 18 month recovery sounds too formidable. When did you start to get comfortable doing light resistance work in the gym? How about lifting any kind of a weight overhead? Thanks in advance for any insights you may be able to give me.
@@Thetruthhurts708 it is a pretty daunting thought. I got to the point I couldn't sleep because of the pain so accepted it had to be done. I was terrified of the outcome as I hadn't been able to find anyone with my lifestyle that had been through a TSR. The surgeon wasn't prepared to say I would be able to get back swimming successfully and that just made me more determined 😃 (swimming is my main, lifelong sport and greatest love). I did very little strength work for the first 6 months, it was all low resistance working range (bands and in the water using water resistance). The following 6 months was back in the gym with my physio building strength with some limited, controlled overhead work and back swimming trying to get back good technique. 12-18 months my phsio pretty much told me to do anything I can as long as it wasn't causing pain. I started in the gym properly, building into bigger weights and worked hard on my technique in the pool while building my fitness. The last 6 months have been great, no restrictions. Big weights in the gym. Even swam a 20 kilometer open water race in a team of 2 (ie:10k each) in February this year (22 months post TSR). It's a long journey but I could feel improvement right through the first 18 months. I still think I have some improvements to come, although smaller and probably through the strength I'm gaining in the gym. Get yourself a good physio, someone who knows you and what your long term goals are and work with them; I pushed my physio as much as she pushed me. She held me back initially because I wanted to push too hard too early. My physio is also a world class athlete so definitely had the understanding and I respect her opinions. I will never be as good as I was before my TSR but I'm pretty rapt with what I am able to do. Thanks for reaching out to me. If you want to know anything more I'm happy to help. All the best with your journey 👍
I didn't know shoulder replacement was a thing. Never heard of it before. Many thanks for sharing.
Welcome BW. It’s definitely a thing! Thanks for watching and subscribing
Excellent. Every doctor on these videos can explain things so well. Too many doctors in Australia say too little. The silent treatment. 🤫 Australia needs more Canadian doctors. Keep talking guys.
Thank you so much Helen! Thanks for watching and subscribing
You guys are awesome. So sorry about Neil Peart. July '97 I took a jet up to CFB Bagotville. It was a blast. Best wishes.
My ortho doc advised that I put off TSR as long as possible. Right now, I can deal with it and my quality of life is not severely impacted. We shall see what the future holds.
Great video! And yet another thing I can look forward to!
Ha Martin. Thanks for watching and subscribing
Thanks docs for sharing this video.
Very welcome Marcia. Thanks for watching and subscribing
Thanks for the info - very helpful!
Glad you liked it Cindy. Thanks for watching and subscribing
Thank you!
Great job again, very informative thanks Docs
Glad you liked it Robert. Thanks for watching and subscribing
That was great information and very interesting video! Thanks again!
Glad you liked it Darlene. Thanks for watching and subscribing
@@TalkingWithDocs anytime Docs! Look forward to seeing them!
Interesting topic gentlemen! Always a pleasure to listen to you and your guests. Take care of yourself and looking forward to your next video.
Thanks so much Carl. Thanks for watching and subscribing
Great detailed and clearly presented info. Than you so much for another awesome video!
Hi vitoshaword. So glad you liked it! Thanks for watching and subscribing
Great video thank you so much🙏
You are very welcome NIMASHA. Thanks for watching and subscribing
Meeting with my doctor to go over shoulder replacement this week. Appreciate this video and giving me a heads up.
My shoulder hurts so much I can't sleep and have trouble finding any position that's comfortable...looking forward to the potential relief.
Thank you! It’s so appreciated to watch great doctors who are exceptional communicators!
Thank you so much yorktown. Thanks for watching and subscribing
Something I'll never need but showing support.
Thanks so much Michael!
Great info!❤👍
Thanks Mustang Sally. Thanks for watching and subscribing
great video
Glad you liked it Chad. Thanks for watching and subscribing
Thanks Docs again for the very informative talk it is for sure something in the future for me👍
Glad to help
Always great to see videos like this.
Often the patient doesn't understand the steps or details and just gets frustrated..
A lot of pain has to happen before referral.
Thanks for sharing
Very welcome PJ thanks for watching and subscribing
Thank you, thank you!! 😊
Very welcome Sooz. Thanks for watching and subscribing
As someone with shoulder issues, I really appreciate this video. Thanks for all of the videos, very informative.
You are very welcome Richard. Thanks for watching and subscribing
Another superb video guys. I had a decompression, some years ago, and it revolutionized my life. I could even reach up and put an IV on a pole again. Got to say, Ive seen very few replacements herein the UK.
Glad it helped ROBIN. Thanks for watching and subscribing
I’m getting a total shoulder replacement next week at the Houston VA. I’m 52 and have had two surgeries on each shoulder so this one will be the 5th. I’m in a lot of pain so I hope this will help!
Good luck!
I had very very little pain healing for my shoulder replacement just took Tylenol. I’m not looking forward to my knee replacements because I don’t think I’m gonna be so lucky.
Just had a reverse shoulder arthroplasty two weeks ago and am doing well. Always appreciate these videos!
Very nice Bruce. Thanks for watching and subscribing
I am having a reverse shoulder replacement surgery in August because I am also having a knee replacement surgery in June. I had never heard of it and now read your comment. Glad I am not too weird!
Hey guys, I'm ready to have this done because currently I can no longer function, sleep without great pain. I've had arthroscopic surgery in the past and a knee replacement. My question is how long will I stay at hospital after surgery and how bad is the pain the first few days/weeks afterwards? I accept the fact that rebab is painful, but my main concern is for the first few days post surgery. I ask because doctors are now hesitant to prescribe opioids for more than a day or two. I just don't want to be in pain because the doctor won't prescribe the medication that works well. Thanks in advance.
@@Cap-ku6ok The rehab is not bad but it is a much slower process to get full functionality. The pain is not really a problem but the six weeks of immobilization, particularly at night, is the worst part of the operation. Most doctors will give you a week of opioids and if they don’t, ask for them. One week will not addict you.
Thanks for making this video available. Well explained. 45 years in drywall trade and still not in need of your expertise. (yet), 👍
Nice ddt1. Thanks for watching and subscribing
I just had rt shoulder diagnosed with arthritis. Doc did the cortisone injection and so far so good!!!
Very nice M. Thanks for watching and subscribing
A wonderful video. It gives me hope. I am in a lot of pain and just had an MRI showing moderate to severe cartilage loss/none at all. Now I can wait for an appointment with peace of mind.
Perfect Patricia
This was very helpful. Shoulder surgery is a frightening procedure but I feel better knowing the outcome and their step by step explanation of the process. Thank you.
Very welcome
Thank you so much. I had rotator cuff repair in Oct 2022. I still have pain of 5,6,7
I tore the long head bicep totally away, two tendion, two bone had to be shaved, and not only that I had a whole in my rotator cuff. Authorities is not helping any. After 1 1/2 year I'm so done with all the pain.😢
It can nag on and sometimes the tissue is too poor to heal properly. Best of luck
Thanx for keeping us healthy n informed..now let's cook, eat and dance👏👏👏
Yes KITCHEN! Thanks for watching and subscribing
Wow, you Docs are covering a lot of my medical issues! But then at 68 yo and always having been a very active person, it kind of goes with the territory. I had a total reverse shoulder replacement in October of '20. I fell when I tripped over a concrete island while pumping gas into my car. Landed totally on my left shoulder and heard a snap. It tore the main tendon off completely. Also, I've had both knees replaced and the shoulder was WAY longer to recover from. I still haven't gotten the strength back like it should be, but overall I'm happy with it. I would like to suggest something that wasn't mentioned, no matter what replacement you get, always, always, always do the exercises that the doctor prescribes for you. I do them faithfully and have no regrets. I know some people who do not and have had some terrible outcomes. PS - I bought a mountain bike and I'm beginning to learn to ride the trails. Can't keep this old girl down lol. - Sharon in PA
Good advice sreihart. Thanks for watching and subscribing
Great video. Thank you for sharing. This answered several questions I had. If you do Lipogems Stem Cell procedures, would like to see you feedback.
We don’t do them L. At this point the stem cell evidence is weak for arthritis. Thanks for watching and subscribing
Thank you for the information. After proper recovery would be be possible to ease back to a strength training regiment?
Another great video! With lots of information and explanation about shoulders!
Several years ago I had a frozen shoulder, some of the worst pain I've ever had. A Medrol dose pack seemed to get it moving again .
A couple of years ago it started acting up again, thankfully not as bad, and I had an injection. Ten months later the injection didn't help.
Then more recently, the others shoulder started giving me problems. Mostly pain and range of motion declining. I've been having PT and OT on it and have reduced the pain and increased the range of motion. But now that it's feeling better, the other shoulder is back to hurting with little range of motion.
Of course I'm in the prime age group for the current symptoms. But after having back and neck surgery in the past couple of years, the thought of shoulder surgery isn't something I care to do any time soon.
As long as I can keep reducing the pain and increasing my ROM, can I possibly delay having surgery?
I've had x-rays of both shoulders and both are in bad shape. And with them trading places for giving me aggression, I'm not sure which one would be first for surgery. At this time my doctor hasn't referred me to a surgeon, although he's talked about it as the next step.
Am I really buying time or is surgery inevitable with my history?
Thanks for sharing another great video!
Hi Vickie. You certainly can delay things if you’re controlling the pain and improving the range. You may be able to delay surgery inevitably depending on your pathology. Best of luck to you. Thanks for watching and subscribing
Thank you for another great video! When tendons partially tear, does the tear usually completely heal on its own?
Hi Anke. Usually one of the four rotator cuff tendons. They can heal partially but often don’t. Thanks for watching and subscribing
Hello gentlemen, thank you for your content. I am both a patient and a practitioner, so these videos are quite entertaining, as well as educating. Quick question: if a patient is having thyroid/parathyroid issues, can that cause and/or exacerbate osteoarthritis? I understand the basics of calcium control but do not understand if the parathyroid can contribute to osteoarthritis. Thank you kindly
No. Osteoporosis yes. Not osteoarthritis. Great question
@@TalkingWithDocs grateful, thank you
hi docs is this good for your liver I didn't know where to post this love your you tube channel thanks 🙂
Hi KS. Is what good for your liver? Thanks for watching and subscribing
@@TalkingWithDocs the link I have on here the next comment I made thanks it's a small snibet video of this plant based gel caplets called ENA LIVER IVE SEEN THIS ON THE SHOPPING CHANNELS
I was diagnosed with arthritis in my right shoulder when I was in my mid thirties. After some useless physical therapy, the doctor went in and as I understood it, he just got in there and scraped away some the arthritic tissue and created some space where it was rubbing together before. I'm in my mid 60's now and haven't had any problems since the surgery.
Very nice Wayne. Thanks for watching and subscribing
Great video as always. Would it be possible to do an episode on reverse total shoulder replacement and the benefits/risks. My better half had a RTS and is being worked up for a possible stress fracture post surgery. Thanks in advance!
Birch, that’s basically what I was going to ask about. I’m having a reverse total shoulder replacement at the end of May, and I would like to hear about the recent updates on this type of surgery. Thank you.
Hi Bert109. We have already filmed that episode just have to edit it. Thanks for watching and subscribing
It is coming very soon Cleo. Thanks for watching and subscribing
Another great video. I had a reverse total shoulder replacement. Really good results and I’m very happy. I’m able to play 60+ rounds of golf a year, pain free. (I’m retired). Thanks for the easy to understand information.
@@TalkingWithDocs Thanks for all that you do! As a side note, I am a nurse and work in the field of patient safety and education, specifically OR safety. I would love to share some resources that may be helpful for a future topic. Let me know if there is any interest. Thanks again.
Great video again!! Could you revisit Tiger Woods as he sets out for the Masters this weekend. How difficult will it be for him a year after his injuries?
Hi Ryan. The walking will be the hard part. Especially at Augusta and especially now that it is soft with all of the rain. He will likely make the cut but likely will not win. Thanks for watching and subscribing
Do you recommend pre op and post op physical therapy? Always nice to see Dr. John. Very informative video.
Yes Denise always a good idea on both fronts. Thanks for watching and subscribing
@@TalkingWithDocs Motion is lotion! Recovery takes time and hard work. Physical therapy...the great human equalizer! Take care guys!
Can you explain why a patient would undergo a reverse TSA vs a TSA? Dx? Thanks!
Hi Denise. We have a video coming very soon abkur that. A reverse is used when you have an incompetent rotator cuff. Thanks for watching and subscribing
I had to have a reverse shoulder replacement. It eventually ended my working career after a few years. I worked in elecrical construction and could never regain the strength and stability in that shoulder.
Sorry to hear that Tom. Hope it is ok now. Thanks for watching and subscribing
What do you think of TSR for a shoulder damaged by multiple dislocations? I’ve had 6 dislocations and the docs say I’m not a good candidate for orthoscopic surgery again
Hi Mitch. If it is arthritic because of the dislocations that may be an option. If the rotator cuff is severely damaged you maybe a candidate for a reverse TSA. video coming soon. Thanks for watching and subscribing
Wow I thought y'all were talking about me . Both my shoulders have been repaired . Have meshed up my right one again . Can your rotator cuff be repaired twice . I will talk to my doc about that. Approaching 61 I need to remember who's body I'm in not a 20 year old hocker players body lol .This was very informative video thank you for doing it. Hope y'all are having a terrific week !!!!!
Hi Kubota. Sometimes they can but it gets harder and less successful. All the best! Thanks for watching and subscribing
I had shoulder replacement 5 weeks ago and it is really painful when I do physio exercises now. What should I do now
Amazing there are shoulder replacements…I wonder what will be next ….🙂
Hi Linda. Hard to know. Thanks for watching and subscribing
Good Stuff Doc's-Had a Scope Only about 10 Years Ago. Seems to Have Fixed me up!-Good as New so far. Wear and Tear Usage!-Keep 'em' coming-Always Looking for Good Information-You Guys Supply This!-Sgt. Tom from N.C. 27019
Thanks so much Sgt Tom!! Thanks for watching and subscribing
An MRI study of my left shoulder last Friday shows, diffuse degenerative tearing of the glenoid labrum. Severe glenohumeral osteoarthrosis with effusion, etc. Can that be repaired without TSR? I am 99% trying to avoid invasive surgery. I am 68 yo and have high risk for successful surgery. 70 yo husband is 5 weeks post op, TKR. Your videos are very helpful.
It is hard to say Kathy without a full assessment but it does not sound like it. Sorry
Hi Docs, followed you before with my 2x TKR over the past year and a half. Much good info and hope I gave out patient pre and post tips help afterward. Now what happened to me. Used a walker for about 2.5 yrs while waiting for the TKR, post the 2nd one, my arms started showing impingement pain and then the shoulders (both) involved a cpl months later. MRI, ct scan and xrays show some arthritis but both rotator cuffs are torn due to constant pressure from the walker on them. My knees were reaklly bad according to my surgeon so there was a lot of pressure dragging myself with the walker. Not sure if "The motion is the lotion" using a walker so long was good in my case. Good info for some patients with really bad knees to be aware of. Taking Melaxican then just got a cort injection in each shoulder last week. So far they helped tremendously with pain and it is systemic wherever I was hurting. See the doc in 6 weeks and we go from there. I sure do not want more replacements, feel like the bionic woman. 73 female here btw.
Awesome job!
Thanks, fascinating. You know what? My shoulder suddenly feels kinda sore! Just kidding.
Ha Mike. Thanks for watching and subscribing
Does the cobalt chrome metal ever cause an inflammatory reaction? I had a friend with a hip replacement with cobalt that had to have the first one replaced because of a reaction to cobalt.
Hi Leila. That was typically associated with a metal on metal bearing surface. Thanks for watching and subscribing
I have not had shoulder surgery but lately when I sleep on my side it seems the blood flow gets cut off to my hand I wake up throughout the night with severe pain in my fingers and sort of numb. Any thoughts? Nerves? blood vessels in shoulders? Thank you Love your channel
Hi FAB. Definitely sounds like nerves that could be from your shoulder or your neck. If it continues talk to your doctor. Thanks for watching and subscribing
I’ve had cortisone injection for my osteoarthritis of my knee. It didn’t work. Had hyaluronic acid instead which has really helped. I now have moderate osteoarthritis of the AC right shoulder. Could the better option for me the hyaluronic injection for the pain?
Hi Rosemary. Using HA in the AC joint is tricky because although it does have a capsule it is not a nice big sack like the knee has. Thanks for watching and subscribing
No mention of “reverse” shoulder replacement?
Hi Lane. That video is coming very soon. Thanks for watching and subscribing
What about a shoulder arthroscopic clean out for arthritis? Does it help temporarily?
Hi Michael. There is evidence to show that it does not. We used to do it for most of the joints. No longer. Thanks for watching and subscribing
Hi Doctors, so how do people get shoulder arthritis? Its not a weight bearing joint, is it?
Hi Linda. Not really weight bearing but primarily from wear and tear. Thanks for watching and subscribing
What about reverse shoulder replacement? That’s what my surgeon says I need ?
Hi Debbie. That video is coming very soon. Thanks for watching and subscribing
Years ago I had a minor tear in one of the ligaments between the clavicle and scapula. I could not raise my arm, and excruciating pain on left shoulder and arm. My physician prescribed oral steroids but it did not help. A coworker had gone to Canada on vacation and picked up Voltaren (3.2%), he gave me a tube and this cured the anti-inflammation causing the pain. Afterwards my arm movement went back to normal. I think I endured the pain for 2-3 months until I used Voltaren.
I told my doctor of Voltaren and unfortunately in the US the dosage is half from what Canada and other countries prescribe. 😳
If my pain was this bad for a slight tear of a ligament I can’t imagine how much more the pain when the ball joint is rubbing against the joint.
Thanks for sharing. Thanks for watching and subscribing
When I was 55, I was bone on bone with a rotator tear. The Doctor did a hemi replacement with a rotator repair . 2 1/2 years later; I’m facing a reversal 😩 I think I should have had the reversal in the first place! Lots of pain! Ugh!!!!!
Yes it sounds like it Penny. Best of luck. Thanks for watching and subscribing
I’m 33 and was just recommended a TSR by a surgeon based on severe arthritis and other treatments not working. I’m pretty active so can the parts that may wear out be easily replaced down the road?
Yes they can but it gets harder and harder each time you have surgery. That is why we always tell patients to wait as long as they can. Best of luck. Thanks for watching and subscribing
What is frozen shoulder? My mom was just diagnosed with this and we have never heard of this before. What kind of treatment can she do ? It is extremely painful and has limited mobility.
Hi 1979KitKatt. It is also called adhesive capsulitis. It causes the shoulder to be very stiff and swollen. Usually physio and pain control. It can be very slow to improve but usually will. Sometimes a cortisone injection is needed. Good luck. Thanks for watching and subscribing
Hey docs, is shoulder replacement surgery such a thing?
It sure is Alida. We talk about it in this video. Thanks for watching and subscribing
I have had a Hemi on my left shoulder, it was an easier recovery than the total knee
For sure Brenda. Thanks for watching and subscribing
I assume a GA is used for the surgery??
Yes Rosemary. And sometimes a block to help with post op pain control. Thanks for watching and subscribing
Docs, I have a question on reinjury to a rotator cuff repair. Last week or so I tried to open up a very stubborn bag. The moment I put all efforts in to it I felt pain to the top of the shoulder but also developed tennis elbow pain. Is this scenario really plausible?
I'm going to see my Ortho but I'm wondering what causes such weak muscles and tendons in autoimmune diseases? Can a steroid shot help the reinjured shoulder?
Hi Tory. Yes possible. It can be cause by autoimmune diseases. And yes a cortisone shot may help. Thanks for watching and subscribing
@@TalkingWithDocs does the autoimmune disease weaken the muscle fibers? I'm trying to understand how it plays a role, it's very frustrating to live with.
Your channel and input is not just helpful but it really lifts the spirits 😊😀🤗
I'm 34, Avn in multiple joints. Is there any long-lasting joints for young people?
So joints last a lot longer than they used to. Nowadays there is less distinction between young and old prostheses
I'm in my 30's and ordered to get shoulder replacement done. Is it possible to do multiple revision surgeries based on that I will live another 50 to 60 years?
It is possible but variable. Each surgery gets more complicated. Best of luck. Thanks for watching and subscribing
Had an shoulder infection today with ultrasound. He said it bone on bone. The doctor is sending me to therapy. I don’t think he thinks the infection will work very long. The doctor said replacement would be needed for quality of live. My question is these parts beings metal. Some being to anchor.the plastic side WOULD THAT mean no more MRI for me?
You can still have MRI but it is less useful due to scatter
Hi,Docs!! It's been a year since my last TKR and a visit with my surgeon. ( excuses: We are in seperate states, COVID, Russian invasion, PTSD from my wife's decision to move her mother in with us,etc.) I'm afraid I have this issue throughout my entire body, where there's a joint, there's extreme pain. Mornings are a nightmare as I have somehow turned into a statue during the night. 800 mg's of IBU daily does nothing. Am I slowly becoming crippled? Thanx.
Hi Darth. Let’s hope not. Keep moving. Maybe see a therapist to get some exercise advice. Good luck. Thanks for watching and subscribing
I have been having issues with my shoulder for months and months. They say I have a "frozen" shoulder. However, my sx. Are not getting better even with exercises specifically for this issue. Should I see another surgeon? I have had all the tests, and they won't inject it anymore. Your thoughts?
Your frozen shoulder will get better. It lasts for about six months and then will just return to normal on its own. I had a frozen shoulder, then THE OTHER one froze. Then it got better and I've had absolutely no issues since (it would be 15 years ago...) It's horrible ...
It has been 8 months
It's been over a year for me, but it has much improved. Just keep up with the exercises, doing them several times a day. I also use a hanging bar that has helped a lot.
@@cindytomlinson2326 I must say, I didn't do any exercises for it. I wonder if that could be aggravating it? It is SUCH a drag. I'm a side sleeper and I remember the total relief of being able to sleep on that side again. Hang in there.
It will likely improve but often takes a long time to burn out Cindy. Hang in there. Thanks for watching and subscribing
Very informative, but you didn’t address reverse shoulder replacement. My sweetheart ( husband) has two!
Now if he didn’t have severe osteoarthritis in every other joint, he’d be in great shape!😳
Hi Glynny. Coming in a future video very soon. Thanks for watching and subscribing
I am having a reverse shoulder replacement surgery. I guess it must be because of the tears in the rotator cuff and labrum. I have never heard of switching the ball and socket and even my chiropractor hadn't heard of it.
Hi Miss Helen. It is becoming very common for arthritis in the setting of advanced rotator cuff disease. Best of luck! Thanks for watching and subscribing
What percentage of people have allergies to the cobalt/ metals?
Hi Joe. Very low. Less than 1% but it is usually the nickel. Thanks for watching and subscribing
Time for a Tiger update. He’s limping but seems to be swinging okay.
Hi BZ1340. We predicted his return at Masters 2022. He is limping. We are going on a radio show tomorrow called the Roy Green show to talk about just that. Thanks for watching and subscribing
Mine is different, rotator is within, cup is attached to humorous.
Sounds like a reverse Edward
@@TalkingWithDocs anatomical reverse, rotator was eat up with arthritis, cup tore, tendon damage. Thanks to uncle Sam. Knee replacement also, a train wreck @ 64.
I need a new shoulder, due for a another postponing Cortisone injection, can't have it because I have just had surgery and I am on Eliquis, tell me when I have eventually have my shoulder replaced, is my hobby of shooting large caliber rifle and shot guns going to destroy the new bits.
Hi pijnto. It may be time to put down the rifle. Discuss with your surgeon for sure. Thanks for watching and subscribing
@@TalkingWithDocs I new you were going to say that, just been told I can no longer use a arc welder, the way things are going after all the surgery I may as well just sit in a chair and watch tele
2:30
If you don't tell them the problem up front don't expect them to get the problem fixed
Yes Ian. Thanks for watching and subscribing
Keep up the great work
Well, someday all my joints are going to be artificial! ;-)
Well let’s hope not Dino. Thanks for watching and subscribing
What about your thumbs?
We can add it to the list Darlene! Thanks for watching and subscribing
@@TalkingWithDocs please do! Thank you!
A male surgeon that is taller is better looking than physician 😄😄
Thanks for watching and subscribing
Thank you!
You are very welcome Winston. Thanks for watching and subscribing