Episiotomy: A Cut Above (the anus)
Lyricist of my vaginal nightmares.
Now that I’m seven months pregnant, I have finally gotten around to taking a break from worrying about what kind of mother I’m going to be in order to get to the urgent business of stone cold panicking about how this kid is getting out of me, and what damage he might do as he leaves. At my last doctor visit, we had the episiotomy talk, and now I can’t stop thinking about the potential slicing of my privates, or the uncontrolled tearing, or the aforementioned fecal freaking incontinence, which happens to some women after childbirth.
According to Rod Stewart, “the first cut is the deepest,” but I think it’s safe to say any cut that might lead to bowel leakage is the deepest, at least emotionally and spiritually.
First and second trimester concerns seem almost quaint in their solvability. Nauseas? Enjoy some ginger chews and pop some B-12. Leg cramps? Stretch your calves before bed and eat a banana. Your baby’s head is too big to exit your vagina? Slice open the area between your anus and vulva, stitch it back up, and hope you don’t end up with the inability to control the seepage of gas and stools from your bowels due to a torn sphincter.
Perhaps I was intentionally fuzzy on the episiotomy thing. I wasn’t ready to know about my perineum. Call it squeamishness, or emotional immaturity, or just ignorance.
That is, until last week, when my doctor told me that he was a big fan or cutting, that most women will tear and if you do a preemptive cut, you can control the severity and direction, keeping the tear away from the bad place. Fecal incontinence and severe, lingering sexual pain averted.
Sounded reasonable to my husband and me, until we got home and consulted a few pregnancy books, most of which suggest that cutting is old school, and that perineum massage during labor can help the vaginal opening stretch, leading to just a small tear or no tear at all. Friends who have had babies are all over the place, some insisting, like my doctor, that cutting saves you from a jagged tear, others saying a rip is more natural and heals more easily.
I’m in labial limbo – okay, not precisely, but alliteration is so seductive.
At times, I feel guilty for making such a big deal out of this cut/tear thing when I’m bringing a person into the world. Why should I care so much about my little old vagina and anus? That’s when I come to my senses. This is a big deal. Fecal incontinence hangs in the balance. I have no idea which is best, and I assume it depends on you, your baby, your labor and I also assume that you probably want a doctor who hopes for a tear but makes a cut if need be.
I haven’t figure out what to do about this yet. I comfort myself with the notion that just as boots are made for walking and kidneys are made for filtering, vaginas are made for stretching. I should be fine. Sometimes, this is obvious, and other times, it ‘taint.
I really enjoyed that post.I will be reading a lot more of this blog.But
J’ai le m
Hi, Love your Mommy ramblings! After perineum stretching with oil, I tore (slightly) with both of my babies and highly recommend it. When my first was nearly out, my Dr said “she’ll be out in 5 seconds if I cut you.” I replied “Not unless she is in danger.” My daughter popped out 10 minutes later and healing was a dream. My birthing coach recommended the following for perineum care: take 6-8 overnight maxi pads with wings and cover them in witch hazel and aloe gel. Then, freeze them before you go to the hospital. When you get home, they will be there to soothe your bottom, not melt (like the hospital ice packs) and catch the rest of the fluids too. Good luck! P.S. Check out my blog to read about both of my birth stories..
I was cut with my son. Worst.pain.of.my.life recovering from that (and I’ve had natural childbirth so I do have something to compare it to). I didn’t have sex for 12 weeks it hurt so bad. I sat on an inflatable donut for 8 weeks. Worst pain ever. Then came my daughter, where I tore along the freaking scar my ex-sOB left and was jumping back in the saddle 4 weeks later, no pain at all following that delivery.
Get a c-section. Dont let the va j-j rip.
I’ve had a c=section and then v-bac (vaginal birth after c section) get a c section- I have more problems than you can imagine!!! C section!!!
T, I loved you on Adam Corolla’s morning show. I did not listen until you came on. I love the way you laugh with him and soften him up. I have changed my opinion about him because of you. I love it when you are on the podcast with him too. PLEASE come back to radio!
OK now to the episiotomy debate. I had a regular OBG doc the first time and a Mid-Wife the second. The first I had a small tear and no epi. I had back labor which hurt so much I didn’t really mind the sting of the tear. I had one stitch and had sex with my hubby 7 wks later. The second time around was much better. No tear and the Mid-Wife was awesome. The pain of crowning was intense and the massaging barely mitigated it. However-I did have my son naturally and was completely conscious for my son’s arrival. The care I received from my Mid-Wife felt like family. So worth it. My girlie parts healed fast and sprang back fast. Having a baby is like a truck ran over your girlie parts. No matter how you do it. You forget quickly cuz there is so much to do and so little sleep and that baby is your life. My kids are 18 and 21 now. I have never forgotten looking into their eyes right after they arrived. It was the most intense experience I have ever had. The love and gratitude that they are ok and relief and joy are all mixed up at the same time. Babies are little miracles. Every time. Do what your heart tells you. Revel in the experience and enjoy your baby. You and your husband are embarking on the most important thing you will ever be a part of in my opinion. Raising a child. It’s hard and scarey-but at the same time joyful. You are a wonderful, smart woman and you have a great guy. Follow your heart.
I did a lot of research on this too and I will ask for a C-section. I am sorry, there is no way I am pushing out a 7-9lb baby. Sorry, not doing it. I have talked to to many women that are petite that tear like hell and complain that sex is shot afterwards and some are still in pain. I do not want anyone to tell me to be brave and hang in there when I will walk out of the hospital with a wind tunnel for a vajajay after birth. I want the TRUTH. I will arrive to the hospital and ask for my gown and to point me to the OR. For all the women that pushed it out and tore, good for you, but don’t judge me because I want to actually take advantage of medical advances. This isn’t 1735 and I am not giving birth in a barn.
So rather than dealing with stitches (if you even tear), and some soreness (that will pass), and a “wind tunnel vajajay” (which can be strengthened through the magic of keegal exercises), you choose a major surgery. I would recommend a strong consideration of the risks of major surgery including risks of anesthesia before going that route. Realize that you will be tired and asleep for the first moments of your child’s life and will need a lot of help for the first couple weeks as your body recovers.
Delivering naturally in most cases you can leave the hospital after 24 hours.
I beg to differ!!! Who cares if you get out of the hospital in 24 hours? You try laughing in public and not peeing on yourself!? Or when you throw up you piss/shit your pants? You still bond with your baby at the hospital!
Teresa, I’m glad you didn’t end up at Summerlin Hospital, my sister had a c section there and she almost ended up back in surgery cuz she got a major infection on her c section incision: even her doc admitted she wasn’t happy with their surgical suites/tools. That says alot! she’s not the 1st person I know who dealt with a problem like this from there, so stay in CA until this little cherub makes his debut!
P.S. Ever wonder why all LV celebrities/stars come to CA for medical attention? Need I say more!?
I was inspired to come here after listening to the podcast this morning, just to give you one comforting story. Obviously not everyone’s the same, but like anyone else the terror of episiotomy overshadowed everything else childbirth-related for me too.
My doctor prefers the natural tear- but with my first (big-headed) baby, I wouldn’t tear. Didn’t happen. And after two hours pushing, it was either cut or c-section. I’m sort of glad she didn’t consult me.
The cut (third degree) and stitches healed within a week. I was sore through my back and legs from pushing longer than the cooch hurt. True story. And with my second (small-headed) baby, not even a tear (though with that one the epidural didn’t take, but that’s a separate problem and just one of those things- life went on).
Third is on its way and by this time, I’m not worried at all (though I would prefer another small-headed one). The husband also claims everything’s as it always has been.
At any rate, what I’ve discovered is that when it comes to pregnancy and childbirth (and breastfeeding, but that’s another story) real life stories is much better than internet moms stories.
God Damn you are funny!
Teresa, I had no episiotomy and I tore STEM TO STERN, inside AND out. It hurt so much, I thought I was dying–seriously–I saw my life flash before my eyes–everything went black, but I was awake, watching my life flash across the black screen. I pictured fire. Forget Rod Stewart, go with Johnny Cash’s “Ring of Fire”, cuz that’s what it feels like. Had to be stitched up for an hour after the baby came, with knitting needle size implements. The scar tissue from the tear granulated, and from then on out, whenever we had intercourse, it felt like I was being raped with a kitchen clever. When the baby was 6 months old, I finally had to get surgery to get that fixed. AND I’ve been incontinent ever since. (Not fecal! Ew.) I 100% agree with one of your other blog readers: go with a C section so that your nether region stays in tact. I tell all my friends: get a C, get a C!!!
It’s really not a big deal. A small cut and you’re fine. It sounds much scarier than it actually is. Like pooping on the table while pushing out the baby. They’ve seen it all before, and honestly it’s not something to get all worked up about. Your dr. has done this way more than you have. You’ll be fine. I had FAR less pain recovering from the episiotomy than just ‘stretching’.
I just had my second baby two weeks ago and I had a second degree tear. I am still sore! With my first child I also tore but I was only sore for about a week. At my hospital they don’t do epi’s unless medically necessary. With my daughter they pulled her out with that vacuum thing and they didn’t cut me! That hurt like hell!! My best friend had an epi and it took her over a month to recover. Also, she leaks urine all the time.
My advice: no c-section, get an epidural and if you tear I’m sure it will be minor. By the way, I love your video about the snoogle. That was hilarious. If you think you are uncomfortable now, just wait…that last month is the worst!
I don’t blame you for being scared to death about the episiotomy thing. Luckily, my doctor never even considered a pre-emptive one. I’m a very small person, though, and had a large baby (10 pounds!) and it just wasn’t coming out despite a day of hellish labor. So we went the c-section route. BEST DECISION EVER! Blissfully numb, they took the baby out and put me back together. Sure, there’s pain afterward but I’d take stomach pain (and it really is a TINY scar) over being messed up “down there” ANY time. And no way would I ever go through labor again. I would definitely do C-section again.
All the naturalists out there who happily made it through natural childbirth pain free, kudos to them. For most of us the whole childbirth process is hell. Pure hell. It’s not something “the body just does naturally”. I feel it’s actually evolution’s way of killing off the weak mothers who weren’t strong enough to bring up kids in the olden days. Thank God for modern medical interventions!
Matt commented:
Remember, birth is as safe as life gets! Birth is a natural thing that your body knows how to do. It is not a sterile medical procedure. If where you deliver offers water births, consider it!
Hiya Matt !
Whilst I’m totally on your wife’s team with the lowest tech possible for birth – I just feel compelled by duty to my bigger team of double X’ers to mention that childbirth is the most dangerous thing the average woman will do in her lifetime (‘cept for the solid sista’s who run into burning buildings, jump out of perfectly good airplanes, date Chris Brown (alledgedly) … while today, there are many safeguards and options that didn’t exist a century ago – we have to acknowledge that women (and / or their babies) still die in childbirth everyday of the year. I don’t think this stat supports the medical-industrial complex that has sprung up around birth … but ignoring truth is never a good place to start with alternatives.
I am jealous of your wife I ALWAYS wanted a water birth and couldn’t make it happen three times.
Hey Sheila,
I totally agree and perhaps misstated what I intended to say. You are absolutely correct that birth is one of the most dangerous things that a woman will do. Many times it is the first hospital stay for her since she was a baby herself. My intent was to say that for the child, birth is as safe as life gets. Once you leave the womb it’s all downhill from there! As for my wife, her deliveries are all in hospital. No home births. They just do less intervention unless something funny is happening.
The water births were incredible and highly recommended!
Hi T!
Just listening to the AC podcast and enjoying the talk of episiotomy and swallowing. Good times! Anyway, as far as breaking up with your doctor, what you need is a mid-wife.
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I am married to a wonderful mid-wife and as such, have become pretty familiar with the ins and outs, so to speak, of birth. What is all comes down to is patience and the baby. My wife has a very low tear rate because she takes her time and lets birth happen. When you rush things (or if the baby comes too fast, that’s when you tear. You need to feel the burn so to speak while you stretch to make room for the grapefruit that’s on its way out!
Remember, birth is as safe as life gets! Birth is a natural thing that your body knows how to do. It is not a sterile medical procedure. If where you deliver offers water births, consider it! Both of my kids were delivered under water and it was an amazing experience (not to mention much cleaner!).
As for being involved with the birth, it’s personal preference. When my son was born I watched in awe, video camera in hand and was amazed at what I saw. I cut the cord. When my daughter was born, I caught her as she came out through a process called hands on hands where the Mid-Wife would put her hands on mine and guide me in the delivery. Well, my daughter came so fast that it was more me catching and the Midwife talking me through it. What an incredible connection with both my daughter and my wife.
So, you should come to Maine, finish your pregnancy here and my wife will take you as a patient!
I agree… GET A MIDWIFE!!!!!!!
http://pregnancy.about.com/cs/episiotomy/a/perimassage.htm
Hi Teressa – knowing that you obsessively search the internet my guess is that you have already read about how to help prep the poor thing BEFORE going in to labor ( like starting tonight) but in case you haven’t, you can read about the massage here.
And – sorry – if you push, you poop. No # 2 ways about it.
wishing you an easy birth and enjoying your work!
Thanks for this.
Yes, I read about how you should massage your perineum with olive oil, which can’t hurt, other than the irony of the olive oil being Extra Virgin.
Ha!
T-
My wife had the episiotomy for the first kid and then ripped up for the second, not good, healing time sucked, she could barely pee without intense pain and was pissed, no pun intended, that they didn’t cut her the second time.
I love you on the Adam Carolla podcast and I love the idea of having you, Adam, and Drew do a talk show. That’s a chat show I would watch! So what I want to tell you is… Get the episiotomy! My sister in-law told her doctor, “If you cut me, I’ll cut you!”–true story. She tore and it turned into a big mess! She couldn’t have sex w/ her husband for a year. It was finally repaired when she had her second child. I’ve had two babies and two episiotomys and my taint, although not exactly the same after pushing two 7 pounders out of it, is just fine. You’ll be ok. Trust your doctor.
T–The scariest moment is the first bowel movement after childbirth. Ask for a good amount of stool softeners and pray those stitches hold. Thinking about it now makes my ass pucker.
I didn’t even have an opportunity to have episiotomies with my 2 boys…they arrived too quickly. They must have been claustrophobic because they were scrambling to get out – and I had to endure tears both times.
It hurt then, it will cause all of the aforementioned issues, and it just sucks in general.
Good Luck.
Hire a midwife or doula to assist. They can massage and help you make decisions about this stuff. Seriously.
Baby Doll,
You are sooooooo F’ing funny !!!!
I miss you and Adam in the mornings. I was a “BIG” Stern fan but switched over to Adam as soon as you joined the team. No “Sirius” for me…….Robin’s got nothing on you :0) Heck, you even made Bona”Douche” palatable.
I love the podcasts….hope you keep doing them post baby bump !!!
I have the answer – c-section. I’ve had one regular birth (extensive tearing – large baby) and one c-section (even larger baby – over 10 lbs.) It took me 4 months to heal from the first and 10 days for the second. Has the doctor told you that if you elect for drugs during labor they turn them off when you start to push? C-section offers drugs during the surgery, no tearing, no labor, much easier recovery. I’m not a doctor but this was my experience. Tell little Buster to turn sideways. My big 10.2 lb baby was sideways and backwards because he couldn’t fit in my tummy any other way. There are tons of other fun things no one has told you about yet…ask about the ice packs that you are given after a normal birth…Keep in mind that however horrific all of this sounds, in the lifetime of raising your child – this part of the process is mearly a tiny moment. And don’t forget that most of us go back and do it again. Yes, the hysteria over the birthing process started really early for me with #2 because of the memories from #1 (you DON’T forget this stuff), but somehow, we all get through it and then you get to join the club where we all sit and tell our stories and laugh…and then we get to hug our children.
You know what else is good times? Prenatal yoga. I’m quite certain that all the Kegel exercises and the deep breathing resulted in only a very small tear. It was sore for a couple days, but I was too thrilled with the new baby to care!
Ahahaha… “labial limbo” and “it ‘taint”. Maybe I’ve had way too much coffee this morning, but it made me literally Laugh Out Loud.
I love that you have the same concerns as I did when I was pregnant. I only wish that I had this blog when I was going through with it also.
I’m not going to offer you any advice because at this point, you already know the pros and cons. Whatever you decide on, don’t obsess over it (even though you have googled “fecal incontinence” dozens of times). It will all work out in the end… uncontrolled poop or not.
Just say no. In my opinion, the epi is in line w/ an elective c-section. why?! you don’t know what will happen so just go with it. you may not tear at all or just a little, which requires a few stitches and 10 days of uncomfortable sitting. you could be setting yourself up for something you wouldn’t need anyway. and I have NEVER heard of anyone I know having anal leakage. it has to be super rare and us moms have talked about everything….loves ya…
I watched 16 and pregnant for the first time this weekend and after seeing a kid do it, I figure I should be able to do this in a few years. Then I read this. Now I am terrified.
So you’re not even considering an elective cesarean like all the CA moms do now? It seems like in 2009 with all the medical technology available why should we risk ruining things if we don’t have to? Sure, things can go wrong but that’s true for any birth — surgical or not. Like I said it’s 2009 so it means that it’s your choice.
No matter if it’s a tiny chance, if one girl is the one peeing when she sneezes it’s a huge deal to her!
Hi T,
Off topic, but I was listening to Adam’s podcast with Jules Asner the other day, and growing more uncomfortable by the minute as he kept going on and on about how she made the wrong decision on whether to have children. It occurred to me that over the years, there have been at least three times that he has given a female guest a hard time about not having kids, either on the podcast or on ACS or on Loveline. I’ve never once heard him give a male guest a hard time about choosing not to have kids.
Anyway, since you see Adam far more often than I do, could you please slap him for me? Or at least pee on the floor of his garage? Thanks!
You never know what may happen. After all the worrying and preparation, it’s still possible you may have a C-section.
I kind of want to punch “Meow” in the face. I mean really? “I liked the way my vag looked and performed and it’s never the same after child birth.”
Thanks for ruining my fantasy that somehow my kooch will return to it’s almost normal size. JERK.
Anyway..as for the tearing business. It sounds horrible and I’m with you 100 percent on the fear of wearing diapers for weeks after delivery. (Even though I’ve been told we’ll be needing the Depends anyway due to massive and nasty bleeding.) (YAY!)
My tip that may or may not work: olive oil or any other natural oil that you can rub into the taint area to get it all stretchy.
I can’t say I’ve been doing that religiously because honestly I still feel a little odd about it. :O Household cooking items and my private parts working together seems far fetched and tad weird to me. Just sayin.
I think it’s more likely that you’ll leak urine after giving birth rather than fecal matter. My son was 91/2 lbs. and I had a 3rd degree tear afterwards. It didn’t feel great, but they gave my nice pain medication afterwards which I would not have received otherwise. It healed, my vagina has no lasting effects from the tear. Has anyone told you that your feet may get permanently bigger after pregnancy? I was so sad when I learned that.
Are you shitting me? Seriously – episiotomies = hell. There is no medical evidence whatsoever that even supports it. My Ob thought he would sew me up nice and tight and it led to 3 years of chronic pain. I am so thankful to have torn with my second baby so my midwife could fix the job. Those horrible 4th degree tears that cause the most problems are almost non-existent without epi’s. A cut happy doctor would have me run shrieking from the room. Regardless of your birth preferences (epidural in the parking lot or in a pool of water and floating candles in your bedroom)- any care provider worth beans is following current recommended evidence based practices.
Geez. Having babies is a lot of work. I too was really freaked out by the whole, as my friend calls it ‘pussy exploding’- but, in the long run it all works out. Our son was a c-section (breech) and daughter was a 9 1/2 pound vaginal birth (lucked out with no tearing/cutting).
You will get through it all, promise!
By the way, did you see ‘Away We Go’? Thought of you when I saw it. I really enjoyed it.
I love your blog and I’m so happy that your married and having a baby it couldn’t have happen to a better person. I miss you and Adam in the mornings you made my drive to work so intersting sometimes I would get to work and sit in my car until you guys would go to commercials so I wouldn’t miss anything. Take care and I wish you the best!
This is the most disgusting thing I have ever read in my life.
Mom likes to tell me the story about how she tore after having my brother, especially at dinner. This was the seventies and her old hippie doctor told her not to worry about tearing. Skin will tear naturally along its weakest points. Episiotomies just make it easier for doctors to stitch up but are harder to heal.
“Tearing isn’t that bad, honey,” Mom tells me.
Um, thanks Mom. I’m now totally at ease about giving birth some day.
I may be married, in my twenties, and not intending to have children any time soon, but my mom never fails to remind me that you can massage your taint every day with olive oil to prevent tearing. Mom doesn’t realize that this advice doesn’t help me raise my dog.
Loved you on the Adam Carolla Podcast this week!
Oh my god, T. Nothing like starting my day w/ talk of torn taint (there’s some alliteration for you). You’re hilarious.
Being only “a little pregnant” I don’t even want to ponder the episiotomy just yet. But also being a Cat Stevens fan, I can’t help but point out that he said “the first cut is the deepest” before Rod Stewart did…he wrote the song & recorded it around 10 years before ol’ Rod.
You’re right. I wondered if anyone was going to point that out. Thanks for giving Cat his due. Is it just me, or is Rod Stewart somehow funnier?
I will look forward to Cat Stevens lyrics following me through the rest of my pregnancy like a Moon Shadow. “Water Has Broken” anyone?
Sorry.
I would agree that Rod Stewart is funnier. Cat Stevens, or Yusef Islam as we’re supposed to call him now, definitely doesn’t come across as funny.
I also think that somebody should come up with lyrics to “Water Has Broken”!
You’re a small girl, so I bet a little cut would be safer than risking a tear. If I had to do it all over again … Cesarean.
I liked the way my vag looked and performed and it’s never the same after child birth. Plus the poor baby gets all squished and tortured coming out the “natural” way. I say that’s why we have medical professionals, to come up with better ways to do most everything. But if I ever need a little nip/tuck, I’ll find a great doctor to help circumvent nature
There’s nothing that will make you stop worrying about it, but trust me, when the time comes you won’t even know that it’s happening. I had the mother of all episiotomies, and had no clue until someone present at the birth mentioned it later. Also, the doctor stitched it all up nice and tight and I have experienced no leaking of any sort, anal or otherwise.
When it’s time to push out that baby, you won’t care about anything – not crapping in front of people, not the episiotomy, not the fact that a dozen people are studying the inside of your vagina – all you will care about is getting the baby out.
But nothing stops the worrying. And lamaze does nothing but scare the bejeezus out of you.
Good luck!
I was going to say the exact same thing!
After I gave birth (without an epidural because I was already at 10cm when I got to hospital… and by the way, 5 minutes after the whole thing was over, I was already thinking I could do it again. This coming from someone who fears pain like poison.), I was chatting with my doula while the doctor was sewing down there, and I was like: “What, this is it? This is NOTHING!”
Speaking of doulas, I would recommend to any pregnant woman to get one. It made the birth so much more relaxing. I’m sure it would have been much worse without her; her knowledge and reassuring presence was amazing and also lifted some of the pressure on my husband.
there are massages you/the mister can do to prevent or lessen tearing and get rid of need for episiotomy. There is a great section on it in Baby Mama. (But seriously, google it.)
Hey T,
Hilarious – and who but you could make this funny. For what it may be worth, I’ve had this lovely bit of arcane medical misadventure twice, the first time, my sweet babe decided to “present” (dontcha love their terminology) slightly occipital-transverse (meaning that the baby didn’t complete the final rotation) so they needed to go in with the salad tongs and fetch the infant terrible as the French might say. In order to fit giant salad tongs and an 8 pound kid they needed to make what the OB called a “generous” episiotomy – I won’t even get in to the specifics, but seasoned obstetrical RN’s that had to check my “area” during the 12 hours after birth actually winced. Though the two weeks after delivery were unpleasant as humpty-dumpty sealed back together again, I am happy to report that all bodily functions are contained in their G*d intended portals even though my third delivery required a tiny cut too. Weird – if you would have told me you were going to do that before I was 10 seconds from delivery I would have said you better have track shoes on, because I my time in the 100 yard dash is pretty good and when I catch you, heaven knows what I’ll cut … but at the moment of delivery it was like cut me, use cable ties, get a toilet plunger whatever, just get the d*mn baby out of my hooha.
Not pretty or lady like but sadly truthful
Ouch. That made my woohaa hurt.
Do you know how likely that it is that incontenience could happen after either tearing or an episiotomy? I’m not sure but I’m thinking it’s unlikely that either will be needed in your case, and if one or the other happens it’s still only a percent chance that you will have issues with the poopin’. All I’m saying it likelihood of actually happening; probably pretty low.
who cares, once you’re drugged up it wont matter. the important thing is to have the doctor throw in a few extra stitches for your husband. remember you are going to need that thing back in good working order after this is over.
T – You are cracking me up. (pun intended) I heart you.
I have 2 kids and one doctor gave me an episiotomy and the other let me tear all to hell and the episiotomy was about a million times better in the healing process. A million. And no lasting side effects. That’s my 2cents