Meperidine Withdrawal Help - New York

Never ever Stop Stopping
Our medical professionals are on a mission to serve, support, as well as elevate the lives of people we offer via Medication- Assisted Therapy (FLOOR COVERING). MAT is considered the most reliable therapy for opioid usage disorder by the CDC, SAMHSA, FDA and various other federal companies. We are happy to report 95% of our individuals state they have no withdrawal signs at 5 days.


OPIOID WITHDRAWAL New York
What is Opioid withdrawal?To understandopioid withdrawal, it is necessary to first recognize what taking opioids over a long period of time does to ones body. Taking an opioid daily for three weeks or longer causes an adjustment in mind chemistry which can be defined as medication tolerance. This means that over time, even more of the drug is needed to accomplish the same end result (bliss, pain control, or control or anxiety/depression). Reliance does not always imply dependency nevertheless, which is identified by frequently desire and also constantly busying oneself with the requirement to acquire more of the medicine. If someone who is dependent on opioids stops instantly, they will likely have both physical as well as emotional symptoms of withdrawal as the body is no longer receiving a drug that it depends on. One of the most usual withdrawal signs are flu- like in nature as well as include:
1. Runny nose

2. Muscle mass aches

3. Upset stomach, queasiness, throwing up, looseness of the bowels

4. Chills/sweats.

5. Fast heart beat.

6. Goosebumps on the skin.

7. Anxiety.

8. Lack of ability to rest.

9. Tiredness.


There are 2 primary ways of entering into withdrawal:.

1) Instantly stopping all opioid usage without tapering down first (spontaneous withdrawal).

2) Taking an opioid antagonist like naloxone (consisted of in suboxone) or naltrexone prematurely (precipitated withdrawal).





For How Long Does Opioid Withdrawal Last?
If you ask anyone who has experienced opioid withdrawal, the answer is that it is quite unpleasant and in some situations, life- threatening. Withdrawals can start as early as a few hours as well as generally last 3-5 days. Nevertheless, depending upon the extent of dependency and also the sort of drug used, symptoms may last as much as 3-6 weeks (methadone). A harsh guideline is a start of signs happen after a couple of times the half-life of the withdrawn opioid.
Exists Anything to Make Withdrawals Easier?
While the pillar oftreatment for opioid withdrawal, Buprenorphine/Naloxone (Suboxone), concentrates on pleasing your bodys physical dependence to opioids and also reducing yearnings, we additionally have added treatment to assist alleviate the other unpleasant symptoms of withdrawal. Below is a checklist of signs and symptoms with matching treatment medications:.
1) Muscle aches, headache- acetaminophen, ibuprofen, and naproxen.

2) Muscle mass spasm- cyclobenzaprine, baclofen, as well as methocarbamol.

3) Nausea, vomiting- tigan, and ondansetron.

4) Diarrhea- loperamide, bismuth subsalicylate.

5) Abdominal cramping- dicyclomine.

6) Failure to sleep (sleeping disorders) - diphenhydramine, hydroxyzine, melatonin, trazodone, as well as doxepin.

7) Anxiousness, impatience, restlessness- diphenhydramine, hydroxyzine, as well as clonidine.


The Family Members MD Concentrates On Opioid Dependency and Withdrawal Treatment.
We offerMedication- assisted treatmentwith Buprenorphine/Naloxone (Suboxone) to help patientsovercome opioid addictionand withdrawal. Get going today by setting up an online check out with one of our board- licensed medical professionals. Whether youre at home, at work, or on lunch break, weve obtained you covered and also are right here to make healing very easy. Click here to schedule now!

MEDICATION- ASSISTED TREATMENT New York

 
At the Family members MD, our team believe there are numerous roads that lead from dependency to recuperation
What is Drug Assisted Therapy (FLOOR COVERING)?

Prior to we begin discussing treatment for opioid dependency, it is important to recognize what is specified as opioid addiction. Opioid addiction is identified by a strong, compulsive desire to take in opioid medications, even when they are no longer clinically needed. Opioid dependency remains at epidemic degrees in the U.S as well as the numbers are just expected to rise. Right here are some fast facts:

-More than 263,000 individuals died from opioid overdose from 1999 to 2020 (21 years).
-More than 75,000 individuals passed away from opioid overdose in simply this past year ending in April 2021.
-10.1 million individuals misused prescription opioids this past year.
-Overdose fatalities involving opioid have enhanced a minimum of 6 times since 1999.

Its clear that opioids have a high potential for causing addiction in people, also when they are taken as recommended. Although there are numerous roadways torecovery, only one is referred to as one of the most effective by the CDC and also authorized by numerous federal agencies (FDA, SAMHSA, as well as other firms), which is Medication- assisted treatment.Medication- assisted therapy( MAT) entails making use of medicine, combined with cognitive or behavior modification, to give a holistic strategy to treatingopioid dependency.

Right here at The Household MD, we incorporate reducing side innovation with MAT therapy inOyster BayNew York.
Although floor covering has actually saved numerous people from opioid associated complications and death, less than 20% of those suffering from opioid addiction have accessibility to it.In enhancement to geographic restraints, there is a shortage of doctors that are learnt its application. According to SAMHSA, much less than 7 percent of physicians are efficiently waivered to treat opioid addiction. Tele- MAT services, like we provide atThe Household MD, is one method to enhance accessibility to care for those that may not or else have the ability to do so due to cost, lack of access to or lack of accessibility of recommending doctors.

The M inMATstands for specific FDA authorized drug that is made use of to lower desires and physiologic dependancy on opioids. While there are several formulations as well as makers, every one of them can be summed up in 3 medications:.
1) Buprenorphine.
2) Methadone.
3) Naltrexone.
The initial 2, buprenorphine as well as methadone, are both partial and also full opioid agonists respectively, whereas naltrexone is an opioid villain. While all 3 are accepted for therapy of opioid dependency, possibly the most effective one for many clients is buprenorphine/naloxone (Suboxone) as a result of its beneficial profile. Considering that it is just a partial agonist, it prevents the feelings of ecstasy when taken, reduces cravings at the very same time, and prevents IV injection. Because of this, buprenorphine/naloxone (Suboxone) is the only FDA authorized therapy that is recommended at The Household MD. With higher than 95% of clients withdrawal cost-free at 5 days, our outcomes are a testament to our experience when handling opioid addiction. Set up a consultation currently to review further exactly how we can best help you accomplish enduring sobriety.


TRANSITION FROM METHADONE New York.


What is Methadone?

Methadone is among three medicines that is FDA approved for the therapy of opioid use.
condition, as aMedication- assisted treatment( FLOOR COVERING). It is the initial of the floor covering medicines (approved in the 1960s) and also is the most heavily researched.Unlike the various other 2 medicines that are used in MAT, methadoneis a full opioid agonist, which suggests it brings all the risks that any type of various other opioid off the road would have.These include bliss, threat of breathing depression, opportunity of overdose, as well as hallucinations to name a few points. Because of this, other floor covering medicines such asSuboxonehave currently become much more chosen as a result of its very little side effect account. Oyster Bay New York.



How Long Does Methadone Withdrawal Last?

If changing fromMethadoneto another floor covering drug, such asSuboxone, it is initially crucial to.
lower the amount of methadone one is on to 30 mg daily for a minimum of one week. Once secure on this dose, methadone is ceased completely and also suboxone began once mild- moderate withdrawal signs and symptoms begin to embed in, which is typically after 36 hours but may differ depending on dependency seriousness. After 3 to 5 days, withdrawal is usually full and also person is now effectively on Suboxone.

The Family MD Focuses On Methadone Addiction as well as Withdrawal Therapy.

We provide Medication- assisted therapy with Buprenorphine/Naloxone (Suboxone) to aid patients.
gotten over methadone addictionand withdrawal.Get started today by setting up a digital visit with one of our board- accredited doctors.Whether youre in your home, at work, or on lunch break, weve obtained you covered and are here to make recuperation easy.Click here to schedule now.

 

  

How it functions
It is necessary to initial quit all methadone usage. You have to wait until you have light to modest withdrawal symptoms (typically 12- 72 hours) before taking your first dose of Suboxone. If it is taken prematurely, it can force you right into precipitated withdrawal, which is both very awkward and might threaten. Continue as directed by your medical professional and thats it. Normally 95% of our individuals do not have any kind of withdrawal symptoms after the first 5-7 days of beginning Suboxone. You might likewise ask for additional drug to aid ease withdrawal signs and symptoms so that you can continue with your day to day tasks (job, college, etc) without avoiding a beat.

 

TREATMENT FOR NORCO WITHDRAWAL Oyster Bay New York 

 What is Norco?

Norco is a combination pain drug, including both acetaminophen and hydrocodone. It is made use of to deal with moderate to severe discomfort. Hydrocodone, which is the addictiveopioidcontained withinNorco, is stemmed from either codeine or thebaine as well as it is the most frequently recommended opioid in the USA. It is usually for short term pain and is often used as an antitussive (coughing suppressant). When mistreated, it can also be crushed as well as snorted. It takes around 10 to half an hour for you to really feel the results ofNorcowhen taken as well as impacts can last as much as 4 to 6 hours. Other trade names that contain both hydrocodone and acetaminophen are Lortab, Vicodin, Lorcet- HD, Hycodan, and also Vicoprofen.


How Much Time Does Norco Withdrawal Last?

The beginning ofwithdrawal symptomsroughly begins regarding six to twelve hrs after last usage. Signs typically peak around day 3 and also are usually considerably lowered by seven to 10 days. Occasionally it is possible to last longer than 10 days relying on the intensity of the addiction as well as it differs on a situation by situation basis.


The Household MD Focuses On Norco Dependency and Withdrawal Treatment

We offerMedication- aided treatmentwith Buprenorphine/Naloxone (Suboxone) to help people overcomeNorcoaddiction andwithdrawal. Get going today by setting up a virtual browse through with among our board- accredited physicians. Whether youre in your home, at the office, or on lunch break, weve got you covered and also are below to make recuperation very easy. Go here to arrange currently.





Just how it functions
It is necessary to first quit all Norco use. You should wait until you have light to modest withdrawal signs (normally 12- 72 hours) prior to taking your very first dosage of Suboxone. If it is taken prematurely, it can require you into precipitated withdrawal, which is both extremely unpleasant and also may be dangerous. Continue as directed by your physician which it. Typically 95% of our patients do not have any type of withdrawal signs after the very first 3-5 days of startingSuboxone. You may also ask for additional drug to help ease withdrawal signs and symptoms to ensure that you can proceed with your everyday activities (work, institution, etc) without missing a beat.

THERAPY FOR OXYCODONE WITHDRAWAL Oyster Bay New York


What is Oxycodone?

Oxycodone is a prescription opioid medication that was initially made in 1916 from thebaine, a component of poppy plant. It is used for therapy of moderate to serious pain as well as is recognized for being highly addicting. It typically starts to control pain within fifteen minutes as well as can for approximately 6 hrs with the prompt release formula. It is also marketed under the brand names Roxicodone and also OxyContin (which is the prolonged launch type), among others. The extended launch kind is gradually launched right into the body and also provides around the clock pain control. As a result of the slower onset, it has much less possibility for misuse contrasted tooxycodonewhich has a quicker onset of activity.



How Much Time Does Oxycodone Withdrawal Last?

The beginning ofwithdrawal symptomsroughly starts regarding eight to twelve hrs after last usage. Symptoms commonly come to a head around day 3 and hardly ever last longer than 5 to 7 days. As always, there can be a long term withdrawal stage relying on the intensity of addiction and also relying on private aspects.

The Household MD Concentrates On Oxycodone Dependency as well as Withdrawal Treatment

We offerMedication- aided treatmentwith Buprenorphine/Naloxone (Suboxone) to help clients overcomeoxycodone addictionandwithdrawal. Get started today by scheduling a virtual browse through with one of our board- licensed physicians. Whether youre at home, at work, or on lunch break, weve got you covered as well as are below to make recuperation easy. Click on this link to schedule now.

 

 

Just how it works
It is very important to very first stop all oxycodone use. You need to wait till you have mild to moderatewithdrawal signs( normally 12- 72 hours) prior to taking your very first dose of Suboxone. If it is taken too early, it can compel you right into precipitated withdrawal, which is both very uneasy and may threaten. Proceed as guided by your physician which it. Typically 95% of our individuals do not have any type of withdrawal symptoms after the first 3-5 days of starting Suboxone. You may additionally request added drug to help reduce withdrawal signs and symptoms so that you can proceed with your daily tasks (work, institution, and so on) without missing a beat.

THERAPY FOR FENTANYL WITHDRAWAL Oyster Bay New York


What is Fentanyl?

Fentanyl is an artificial opioid, which suggests that it is developed by pharmaceutical companies in the laboratory. It is a very powerful opioid and also is about 50- 100 times a lot more stronger than morphine. Due to its effectiveness, it is mostly being utilized for discomfort monitoring treatment of cancer cells clients. Of note, several customers are not aware they are purchasingfentanyllaced products when they purchase opioids. Distributors do this due to the fact that it makes medications cheaper, raises strength, enhances addictive buildings, and consequently, makes thesefentanyllaced drugs exceptionally harmful also in small dosages. Beginning to action is three to 5 minutes if used intravenously. Other usual types that it is produced in is as a transdermal spot (Duragesic), as a lozenge called lollipops (Aqtic), as well as in an injectable kind (Sublimaze).



How Much Time Does Fentanyl Withdrawal Last?

The start ofwithdrawal symptomsroughly starts regarding six to twelve hours after last usage. Symptoms normally come to a head around day 3 and hardly ever last longer than 5 to seven days. However, it may happen relying on the severity of addiction or instance by instance basis.

The Household MD Focuses On Fentanyl Dependency as well as Withdrawal Therapy

We offerMedication- aided treatmentwith Buprenorphine/Naloxone (Suboxone) to help people overcomefentanyladdiction andwithdrawal. Get going today by arranging a virtual go to with one of our board- licensed physicians. Whether youre in your home, at work, or on lunch break, weve got you covered and also are below to make healing easy. Visit this site to arrange now.





Exactly how it functions
It is necessary to initial quit all Fentanyl usage. You must wait till you have light to modest withdrawal signs (usually 12- 72 hrs) prior to taking your initial dose ofSuboxone. If it is taken prematurely, it can compel you into precipitated withdrawal, which is both really awkward as well as may be dangerous. Proceed as routed by your physician which it. Typically 95% of our individuals do not have any kind of withdrawal signs after the very first 3-5 days of beginning Suboxone. You might additionally ask for extra drug to assist reduce withdrawal signs and symptoms to make sure that you can continue with your everyday activities (job, college, etc) without missing a beat.

TREATMENT FOR OXYMORPHONE/OPANA WITHDRAWAL Oyster Bay New York

 

What is Oxymorphone?

Oxymorphoneis an extremely potentopioidindicated for the therapy of severe pain. It is extra commonly recognized asOpanaor Numorphan. It is dramatically stronger than morphine and also is made use of to treat pain that is unresponsive to various other opioid medicines. In 2017, the FDA asked the producer of oxymorphone to eliminate its product from the US market as well as since has actually been unavailable in the US. However, prolonged launch oxymorphone formulations are still available in the United States because of its a little reduced misuse potential. The immediate launch regulates discomfort 5-10 minutes if taking IV, and after 30 minutes if taken by mouth, and after that last 3-4 hrs. If taking the prolonged launch, pain control lasts 12 hrs.

 

How Long Does Oxymorphone/Opana Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four to forty eight hours after last use. Symptoms typically intensify at two to five days and peak during the first week.
 

The Family MD Specializes in Oxymorphone Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome oxymorphone addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

 

How it works

It is essential to first stop all oxymorphone usage. You need to wait until you have mild to moderate withdrawal symptoms (typically 12- 72 hours) prior to taking your first dose of Suboxone. If it is taken prematurely, it can force you into precipitated withdrawal, which is both extremely unpleasant and may be dangerous. Continue as directed by your medical professional and thats it. Usually 95% of our individuals do not have anywithdrawalsymptoms after the initial 5-7 days of startingSuboxone. You might additionally request added medicine to help relieve withdrawal signs and symptoms so that you can continue with your everyday tasks (work, school, and so on) without skipping a beat.

TREATMENT FOR TRAMADOL WITHDRAWAL Oyster Bay New York

 

What is Tramadol?

When it was initially approved in 1995, tramadol was not considered an opiate although its mechanism of action was comparable. Nonetheless, due to all the instances of abuse and dependency, the FDA at some point designated tramadol as a dangerous drug in 2014. Compared with other illegal drugs nonetheless, tramadol has much less potential for abuse. As a result of this, tramadol is just one of the many common therapies for osteoarthritis and various other unpleasant conditions.


The Length Of Time Does Tramadol Withdrawal Last?

The onset of withdrawal signs approximately starts regarding thirty- six to seventy- two hrs after last use. Signs usually last 5 to eight days. As always, there can be a prolonged withdrawal stage depending on the intensity of dependency and depending upon specific aspects.


The Family MD Focuses On Tramadol Addiction and also Withdrawal Treatment

We provide Medication- assisted therapy with Buprenorphine/Naloxone (Suboxone) to assist patients overcome tramadol addiction as well as withdrawal. Start today by setting up a digital browse through with among our board- licensed doctors. Whether youre in your home, at work, or on lunch break, weve got you covered and also are below to make healing very easy. Click on this link to set up currently.

 

 

How it works

It is necessary to initial stop all tramadol use. You have to wait till you have mild to moderate withdrawal signs (normally 12- 72 hrs) prior to taking your initial dosage of Suboxone. If it is taken prematurely, it can force you into precipitated withdrawal, which is both really uneasy and may be dangerous. Continue as guided by your medical professional and thats it. Normally 95% of our individuals do not have any type of withdrawal signs and symptoms after the first 3-5 days of beginning Suboxone. You might also request added medicine to help ease withdrawal signs so that you can continue with your daily activities (job, school, etc) without skipping a beat.TRAMADOL

TREATMENT FOR CODEINE WITHDRAWAL Oyster Bay New York

 

 What is Codeine?

Codeine is an opiate that is commonly found is prescription- grade cough suppressants. Tylenol 3, a popular painkiller, is codeine combined with acetaminophen. Because codeine- based cough syrups are less regulated that some other opiates considered to be more dangerous (Such as morphine and oxycodone), it is relatively easy to start getting and abusing it. Once ingested, codeine is converted into morphine in the body, thus producing similar effects but to a lesser degree.  

 

 How Long Does Codeine Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four hours after last use. Symptoms typically intensify at one to three days and peak during the first week. The final phase of codeine withdrawal can last anywhere from one week after last dose and can linger for months.

The Family MD Specializes in Tramadol Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome tramadol addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

 

How it works

It is important to first stop all methadone use. You must wait until you have mild to moderate withdrawal symptoms (generally 12- 72 hours) before taking your first dose of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both very uncomfortable and may be dangerous.  Continue as directed by your doctor and that’s it. Generally 95% of our patient’s do not have any withdrawal symptoms after the first 5-7 days of starting Suboxone. You may also request additional medication to help ease withdrawal symptoms so that you can continue with your day to day activities (work, school, etc) without skipping a beat .

TREATMENT FOR MORPHINE WITHDRAWAL Oyster Bay New York

 

 What is Morphine?

Morphine is considered the classic opioid analgesic with which other painkillers are compared. It is a non- synthetic narcotic that is derived from opium and has a high potential for abuse. Traditionally morphine was almost exclusively used by injection, but the variety of pharmaceutical forms that it is marketed as today supports its use by oral and other routes of administration.  

 

How Long Does Morphine Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four hours after last use. Symptoms typically intensify at one to three days and peak during the first week.

The Family MD Specializes in Morphine Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome morphine addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

 

 

How it works

It is important to first stop all morphine use. You must wait until you have mild to moderate withdrawal symptoms (generally 12- 72 hours) before taking your first dose of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both very uncomfortable and may be dangerous. Continue as directed by your doctor and that’s it. Generally 95% of our patient’s do not have any withdrawal symptoms after the first 5-7 days of starting Suboxone. You may also request additional medication to help ease withdrawal symptoms so that you can continue with your day to day activities (work, school, etc) without skipping a beat .

TREATMENT FOR HYDROMORPHONE WITHDRAWAL Oyster Bay New York

 
What is Hydromorphone?

Hydromorphone, also commonly known as dilaudid, is an opioid medication used to treat severe pain. It is a semi- synthetic opioid that is derived from morphine, however it is 2-8x more potent than morphine. It has higher addictive potential because of its shorter duration to onset and causes greater sedation. It is used to treat pain that is not controlled by other opiate medications.  

 

 How Long Does Hydromorphone Withdrawal Last?

The onset of withdrawal symptoms roughly starts about four to eight hours after last use. Symptoms typically intensify and peak at one to two days. After three days the symptoms should start to subside and are generally resolved after the first week.

The Family MD Specializes in Hydromorphone Addiction and Withdrawal Treatment

We offer Medication- assisted treatment with Buprenorphine/Naloxone (Suboxone) to help patients overcome hydromorphone addiction and withdrawal. Get started today by scheduling a virtual visit with one of our board- certified doctors. Whether you’re at home, at work, or on lunch break, we’ve got you covered and are here to make recovery easy. Click here to schedule now.  

 

  

How it works

It is important to first stop all hydromorphone use. You must wait until you have mild to moderate withdrawal symptoms (generally 12- 72 hours) before taking your first dose of Suboxone. If it is taken too early, it can force you into precipitated withdrawal, which is both very uncomfortable and may be dangerous. Continue as directed by your doctor and that’s it. Generally 95% of our patient’s do not have any withdrawal symptoms after the first 5-7 days of starting Suboxone. You may also request additional medication to help ease withdrawal symptoms so that you can continue with your day to day activities (work, school, etc) without skipping a beat .
 

TREATMENT FOR MEPERIDINE WITHDRAWAL Oyster Bay New York

What is Meperidine?

The trademark name version of Meperidine is called Demerol. It has an abuse potential similar to that of morphine, but it must not be utilized for therapy of chronic discomfort. Meperidine must only be made use of in the therapy of acute episodes of serious pain as a result of the danger of seizures from the buildup of meperidine metabolites, specifically normeperidine, if it is utilized long term. In addition to seizures, it can also create serotonin disorder if made use of in mix with certain drugs. It is available in intramuscular, subcutaneous, intravenous, syrup, as well as tablet types.



The Length Of Time Does Meperidine Withdrawal Last?

The onset of withdrawal signs approximately starts about three- twenty four hrs after last usage. Symptoms usually peak around 3 days as well as start to decrease in strength after the initial week. Some symptoms may be presented for an extended time period depending upon the extent of the dependency.

The Household MD Specializes in Meperidine Addiction as well as Withdrawal Treatment

We offer Medication- assisted therapy with Buprenorphine/Naloxone (Suboxone) to aid individuals conquer Meperidine dependency and withdrawal. Get started today by scheduling a virtual browse through with one of our board- accredited medical professionals. Whether youre in your home, at the workplace, or on lunch break, weve obtained you covered and also are here to make recuperation easy. Visit this site to set up now.







How it works

It is necessary to initial stop all Meperidine usage. You should wait up until you have moderate to moderate withdrawal symptoms (usually 12- 72 hrs) before taking your first dose of Suboxone. If it is taken prematurely, it can force you into precipitated withdrawal, which is both extremely unpleasant and also might be dangerous. Proceed as routed by your doctor and thats it. Generally 95% of our patients do not have any type of withdrawal signs and symptoms after the first 5-7 days of beginning Suboxone. You may additionally ask for extra medication to assist relieve withdrawal signs to ensure that you can proceed with your daily tasks (job, college, and so on) without avoiding a beat.