Andrew Fink, MD, 385 Prospect Avenue Suite 200, Hackensack, NJ (2025)

10/12/2022

PERSPECTIVE ON THE LATEST COVID BOOSTER

The FDA recently approved the Omicron BA4/5 vaccine for COVID. Every time a new COVID vaccine is approved, I hear questions from my patients. “Should I get it?” “Should get it now or wait?” “Do I really need to get it? I’ve already had COVID.”

These are all valid questions that others may have as well, so here are my thoughts.

The Brief History of COVID Vaccines

The first MRNA vaccines for COVID were approved in December 2020 under an Emergency Use Authorization. Given the number of hospitalizations and deaths at that time due to COVID, issuing an Emergency Use Authorization was not surprising, even though studies were limited and data somewhat inconclusive at the time.

Fast forward almost two years later to this latest version of the COVID vaccine. Unlike two years ago, the COVID virus today is far less deadly and dangerous than the 2020 version. Almost no one these days goes on a ventilator due to COVID without underlying and/or secondary causes.

The Current Conditions Around COVID and Vaccines

While data is incomplete due to low self-reporting of COVID cases, it is currently estimated that at least two-thirds of U.S. residents have contracted COVID, with more of those people having had an Omicron or Omicron variant version of the disease. Contracting COVID provides at least some level of antibodies for at least several months.

Also, vaccines are, inevitably, always “chasing” the currently prevalent variants of the diseases for which they are developed. This is true “in spades” as it applies to COVID. By the time a COVID vaccine has been developed and released, the dominant variant has mutated several versions from the variant(s) for which the latest vaccine has been created.

Where are the Safety and Efficacy Studies?

With all of this medical science being well understood by medical professionals and government health officials, there have been no (as in zero) studies of this latest COVID vaccine in humans. The FDA approval is reported to be based on a study with a few mice mounting an immune response.

What this means is that the early recipients of this COVID vaccine booster will effectively be the participants in a real-time, nationwide experiment.

The Normal Process for Approval of New Drugs by the FDA

Honestly, I expected that the Omicron version of the vaccine would be vetted more thoroughly before being approved, particularly given the protections afforded by the previous COVID vaccines and boosters, the naturally produced antibodies from all of those who have had COVID and the development of antiviral medications like Paxlovid.

The normal way of showing that a new drug works involves 3 phases of trials:
a safety and dosing trial where different doses of the new drug are given to people, and the recipients are monitored for reactions, side effects, and some promise of it working. These trials are usually small, but an important step.
a real dosing trial to see if there is an optimal dose to achieve the desired effect.
a large, placebo-controlled and randomized trial designed to determine if there is a clear benefit to the new drug.

None of the above trials have been performed on humans for the Omicron BA4/5 vaccine. The first COVID vaccine had at least some human data before it was approved. The reality is that we have no clue if this vaccine is safe, if it saves lives, how many people need to be treated to save one life, etc.

I often wait a few years after any new drug has been released before prescribing it, even with all of the studies that have not been applied to this latest COVID vaccine, because post-marketing, real-world, time-tested experience really reveals all the side effects and issues with a new drug/therapy.

Dr. Fink’s Bottom Line

To be clear, this does not mean that the new booster is not safe or effective. It just means that no one really knows yet.

I realize there are people who will still want the updated version of the vaccine, and in all likelihood, it will be roughly as safe as the original version, but it would be nice to know before using the American public as participants in a massive trial to which they don’t even understand they are volunteering.

09/22/2022

PRIMARY FAMILY CAREGIVERS NEED SUPPORT FROM THE REST OF THE FAMILY

A friend of mine shared a story with me recently that is all too familiar. I would imagine that at least some of you can relate because it’s an increasingly common challenge for many families with aging parents and grandparents.

One Family's Story

My friend’s wife has a 97-year-old mother who recently fell and broke her hip in her assisted living facility in the Midwest. There are 5 adult siblings in her family, but none live near their mom because her facility is located near the sixth sibling who passed away about a year ago. Their mom was too frail to relocate even before her injury, so that leaves the widow of the deceased sibling as the primary caregiver and communications coordinator for the rest of the family.

Even with the mom in assisted living, the burden of responsibility on the local daughter-in-law is disproportionately higher, including interactions with facility staff and regular visits to see mom even before the accident. Now add to that having to be the onsite family representative for interactions with physicians, surgeons, professional caregivers at the rehab facility and then skilled nursing facility and communicator of issues and updates to all of the long-distance siblings. What’s more, the daughter-in-law is not the family member with the healthcare power of attorney.

Sound Familiar?

How many of you face a similar situation with one or more aging relatives, usually parents or maybe grandparents? If you are the primary caregiver, bless you, because you have a heavy responsibility. But my message is really intended for other family members who rely on one family member to be the primary caregiver for the kind of support and time commitment that may not be able to be equally shared.

It's hard enough to be the primary family support for aging parents or grandparents when they live in an assisted living facility or skilled nursing facility (nursing home). But in many cases, the aging parents or grandparents may actually live with their primary family caregiver. Or they may be aging in place in their own home or apartment but require more help than they or other family members may have anticipated.

Not everyone has the financial resources to hire professional caregivers or pay for the costs of assisted living or skilled nursing care. In fact, probably more don’t than do.

How Families Can Share the Responsibility for Aging Loved Ones

1. Plan or Rethink the Family Support System

Who can play which role(s) in supporting an aging parent or grandparent or other loved one? In some families, it’s possible to share the responsibility and have more than one primary family caregiver. In other situations where only one primary caregiver is possible, there may be other ways that family members or extended family can support the primary caregiver and the aging loved one. (See suggestion #2 below.)

Also, have backup plans in case the current primary family caregiver becomes unavailable to continue in that role. It’s much better to be prepared for such contingencies than find yourself scrambling to adjust to changing circumstances that could have been anticipated and planned in advance.

2. Support the Primary Caregiver\

A primary family caregiver often experiences more stress as well as physical and emotional exhaustion related to the responsibilities associated with caring for an aging loved one on a regular or even daily basis. Feelings of loneliness and being unappreciated are also common. Some will complain and make their feelings known while others will just shoulder the burden quietly and stoically until they can’t any longer.

In both situations, you can anticipate, empathize and come up with ways to support the disproportionate burden on a primary family caregiver. If you hear complaining from this family member, take it seriously and respond with a solution before the situation deteriorates. Even better, have a support plan in place so that the burden doesn’t become so heavy or overwhelming. That support plan is particularly important for the non-complainer caregiver because they won’t complain until they break.

Caregivers need time for themselves, even when they may not think so. Look for ways to help them have that time and encourage them to take care of themselves even if they are inclined to deprioritize self-care.

Family member caregivers who live with their aging relatives need alone time – outside the home – so they don’t start to feel trapped. A primary caregiver needs roughly 3 hours per day to run errands and interact with other people to stay sane. Maybe it’s lunch with friends, shopping for themselves, or just some interactions with friends, other family members or other people who can engage them in conversations and activities that help them stay balanced.

Also, primary care givers often worry about the safety of the person they are caring for, especially if the family member has dementia and is reasonably physically strong and functioning. Going outside the home can become quite frightening for a person with dementia, and they will often resist. They are also at risk of leaving a stove on, falling, wandering the neighborhood, etc. This requires the primary family caregiver to be ever vigilant and that can also contribute to feeling "trapped."

Focus on empathy and communication with the primary family caregiver. If you are in a distant location, call them to talk on a regular basis. That’s a phone call, not a text. Remember phone calls? Family caregivers experiencing stress and heavy responsibilities for aging loved ones need verbal interaction and they need to be and feel heard – even if they don’t think so. (FaceTime is good, too.)

If you live close enough to the aging parent or other relative to spell the primary caregiver occasionally, please find time to commit to that. Most of us are busy living our busy lives and it can feel like you genuinely don’t have time. But you may be surprised at the time you can find if you commit to it and plan for it. I can promise you it’s less of a time commitment than you may have if your primary family caregiver gets sick or overwhelmed and just can’t continue with the primary family caregiver responsibility.

3. Have a Communications Plan for Emergencies

The primary family caregiver may not always be the best communicator to the rest of the family – particularly in case of a health emergency for an aging parent or grandparent. Make a plan now for who will be the primarily communicator to the rest of the family in case of an emergency. Have a backup for the primary communicator and maybe even a backup for the backup if that’s possible. If a family member with the healthcare power of attorney is not also the primary caregiver, make sure that there is a plan in place for communications between them in case of a health emergency for the aging relative.

Dr. Fink’s Bottom Line

The burden of responsibility for an aging parent or other family member often falls to a single individual as primary family caregiver, but caregiving for aging parents and grandparents should really be a team activity, even if one individual family member is the “quarterback.”

P.S. My friend’s wife’s mother is actually recovering well from her accident which is little short of a medical miracle. And they have a stronger family support system for the primary family caregiver than they did before.

09/21/2022

LIMITED OFFICE HOURS IN LATE SEPTEMBER AND OCTOBER

With the upcoming Jewish holidays, I will have more limited office hours during the end of this month and part of October. Below is a list of the days that our office will be closed during the next 30 days.

Monday, Sept. 26

Tuesday, Sept, 27

Tuesday, Oct. 4

Wednesday, Oct. 5

Monday, Oct. 10

Tuesday, Oct. 11

Monday, Oct. 17

Tuesday, Oct, 18

Because our office will be open fewer days during this upcoming period, we expect to have more demand for appointments during the days we will be open. If you anticipate the need to schedule an appointment during the next month, please call soon to schedule.

09/08/2022

YOUR HEALTH FOCUS AS AUTUMN APPROACHES

Another Labor Day holiday is in our rear view mirrors and Autumn will be upon us before we know it. Many of us look forward each year to the time when the leaves begin to change color and the Fall season brings the enjoyment of holidays, cool weather and good times with family and friends.

Autumn is a time of change and that means adjusting our health focus and priorities to match the season. Here are some health tips to prepare for the Fall season.

Autumn Allergies

For some, the beginning of the Fall season is a worrying reminder and harbinger of dreaded seasonal allergies that can make Autumn a miserable time for those who are susceptible to certain allergens.

Allergens that are More Prevalent in the Fall

While allergies affect some people at all times of year, the Fall season, in many areas around our state, brings with it certain allergens that are more common and challenging. Particularly in Autumn, mold spores found in wet leaves and damp basements can trigger allergic reactions, as can dust mites, which are more of a problem as the weather changes and people spend more time indoors.

How to Limit the Impact of Allergies

Being proactive is a good way to start. If you know that your allergies are worse in the Fall, getting antihistamines on board before you get an allergic reaction is easier than catching up later. Antihistamines block histamine, which is a chemical released by your immune system that causes symptoms – including runny nose, itchy or watery eyes, hives, swelling and other symptoms – during an allergic reaction.

Oral and Nasal Allergy Medications

Oral antihistamines are available over-the-counter as well as by prescription. Because some of these drugs can make you feel drowsy and tired, take them with caution when you need to drive or do other activities that require alertness. If you have had good results in the past from over-the-counter allergy medications (Claritin, Zyrtec, Allegra, etc.), start taking a daily dose now. Be sure to follow instructions on the package for appropriate dosing.

Oral decongestants or antihistamines containing pseudoephedrine or ephedrine should not be used by people with high blood pressure (hypertension) or other cardiac conditions. These medications can raise blood pressure and can cause arrhythmia or even heart attack. (Check the label for active ingredients.)

Afrin, Dristan or Sinex are over-the-counter decongestant nasal sprays that shrink swollen blood vessels and tissues in your nose that cause congestion, but they only provide temporary symptom relief and do not address the cause of allergy-related nasal congestion. Decongestant nasal sprays should not be used for more than three days. Using them for a longer period of time can actually make your nose more congested through what is known as a "rebound" effect. When the medication wears off, and normal blood flow returns to the nose, you get enhanced nasal congestion. You should also avoid these nasal sprays if you have high blood pressure or glaucoma.

Confusing Symptoms

Some similar symptoms are present in allergies, flu and COVID, particularly related to congestion. All runny noses and head congestion aren’t necessarily a sign of COVID or flu and could be allergies. Fever is not a symptom associated with allergies, so if you are running a fever and have other congestion symptoms, call our office before scheduling an in-office appointment so we can discuss your symptoms and determine the most accurate and safest way to get you the appropriate diagnosis and treatment.

Get Your Flu Shot Sooner than Later

It's difficult to predict the exact timing for the onset of flu season, so it's a good idea to get your flu shot before the flu starts spreading. September is not too early so I encourage you to get your flu shot soon.

Injury Risk in Autumn

It's not unusual for me to see people who have injured their backs and other areas of their bodies from activities such as raking leaves, falling from ladders while cleaning gutters or hanging holiday lights and other injuries more common to the Fall season.

How to Prevent Common Autumn Injuries

Be honest with yourself about your abilities, and be real about the risk. Orthopedists stay very busy in the Fall season because of wet leaves and people with imperfect balance climbing ladders. I know I think twice before climbing up a ladder outside.

if you do not exercise year round, you have a much higher risk of injuring your back raking.

Find a rake that fits – you shouldn’t have to bend down to rake.
Listen to your body!

Autumn can be a wonderful time of year. Being proactive about your health focus and priorities can put the odds in your favor to really enjoy the upcoming Fall season.

08/24/2022

WHY EVERY FAMILY SHOULD HAVE A PLAN FOR AGING LOVED ONES

As a primary care physician and internal medicine specialist, I see and treat adult patients of all ages. Sometimes, my patients even include multiple generations from the same family. I know the health challenges that come with advancing age, even for those who are in generally good health.

I believed my experience, training, and expertise in working with many older patients put me in a good position to be more helpful than most in the event of a health crisis affecting older members of my own family.

I was wrong.

The issues I and other members of my family experienced recently with my father-in-law’s illness and subsequent passing gave me a jolt of clarity about the importance of family planning and communication involving aging family members, regardless of their current health status.

How Assumptions, Poor Communication and Lack of a Family Plan Let Us Down

My father-in-law had not been feeling well. He was a man of few words, so it was not surprising that he wouldn’t let everyone know what was going on. What did turn out to be surprising is that my mother-in-law, who usually spoke for both of them, was not communicating the seriousness of his illness to the rest of the family.

My father-in-law had been in the hospital a few times before his last, but for the most part, those hospital stays were planned. He needed a procedure, scheduled treatment, etc. The family set up a rotation for people to always be around, not only to help with my father-in-law, but also to give support to my mother-in-law and keep her calm.

The last hospital stay was for an acute illness, and that is when the support system collapsed into chaos. The extra set of eyes and ears were not in the room.

My in-laws live in Israel, so my wife and I were not visiting him in the hospital, but even family members in Israel who did visit him had no real appreciation for how serious his situation was. We relied on my mother-in-law for updates on his condition, but she was not processing all of the information she was receiving from the medical team taking care of her husband and she also later admitted that she didn’t want to believe what his physicians were telling her. As a result, we were relying on the person closest to him to keep us accurately updated and, in reality, that wasn’t happening.

I could tell that something was wrong, but it was not clear from the updates what was wrong, or how serious the situation was. I was able to convince my family there to get me on the phone when a physician came into the room, which happened to be around 3 am our time. When I was finally able to speak to a physician, my father-in-law had only a few hours left.

The physician was surprised we did not know, because the medical team had told my mother-in-law 4 days prior to tell any family members that needed to say goodbye to come to the hospital. At that point I was able to organize the family members in Israel to go to the hospital, but my wife and brother-in-law were stuck here in the States, as was I. Unfortunately, an opportunity for those of us in the States to say goodbye in person was lost.

I think the lasting insight for me was that the doctors were unaware that his family were unaware. They communicated very clearly with my mother-in-law. We were also unaware because we only got snippets of information from my mother-in-law, which were often unclear and cryptic.

I want to share some of the most important lessons I have taken away from my persona family experience because I know this is not unique to me or my family.

How to Develop Your Plan for Aging Family Members

1. Determine what levels of care your elder loved ones want in the event of serious, acute illness or end-of-life situations.

It's important for a family to have discussions about what levels of care people want, particularly in case of unanticipated acute illness that could be life-threatening and when the patient may become incapacitated and unable to communicate their wishes. Having this conversation compassionately as well as honestly helps alleviate potential for stress and confusion during a health crisis. Once determined, make sure the entire family is on board and has a communications and support plan in place to be prepared for this type of circumstance.

2. Establish a family communications network.

The family member in closest physical proximity to the patient is the ideal person to lead family communications but that may not always be the best choice. In the case of my father-in-law's final illness, his wife was physically closest to him, but was not able to convey information accurately. I was far away, but able to understand everything going on. Further complicating matters, due to my location in a different part of the world from my in-laws, it was between 2-4 am Eastern time when my father-in-law's doctors would visit his bedside.

As important as proximity, the ideal point person is someone who remains calm and level headed in a stressful situation and is also available for this role. Based on demeanor and personality, my sister-in-law or her husband may actually have been great people to take on this role in our family situation. Even though they are not medically trained, they remain calm in crisis situations and would be able to convey information accurately.

Our family problem was that my sister-in-law and her husband both work and did not go to visit until late in the day when doctors were gone. In our situation, it would have been better for my mother-in-law to call my sister-in-law when doctors came into the room.

3. Expect the Unexpected.

Preparation helps reduce stress, confusion, and avoidable mistakes but illness and end-of-life situations are not always predictable. It’s useful to discuss and, when possible, plan for alternate scenarios that might occur outside the more predictable patterns, but there are limits to how many “what ifs” can be planned in advance.

In our family, we had a system that seemed to work, but we did not take into consideration the “what if” there is an acute illness. We did not understand that our entire way of communicating accurate information in an unexpected crisis situation would be missing, and we would all be in the dark.

My main point is to be prepared for unexpected, unpredictable developments and have a health crisis communications plan between family members and between the family and the medical team taking care of your loved one.

Dr. Fink's Bottom Line

I’ve written frequently about strategies to focus on maintaining health habits and lifestyles as we age so that our quality of life remains as high as possible for as long as possible. However, this recent event in my own family really drove home the additional need to be prepared for an unanticipated health crisis affecting your family members when circumstances often change rapidly and sometimes unpredictably.

I encourage you all to be prepared with your own plans for your family if you don't already have one. It's often a neglected priority until an unexpected crisis forces the issue. Don't be caught unprepared.

08/04/2022

WHEN IT COMES TO YOUR HEALTH, PROCRASTINATION IS NOT YOUR ALLY

Putting things off doesn’t always come back to bite you, but procrastinating rarely works to your benefit when your health is at stake. I am all too familiar with the consequences of postponing decisions and actions related to health because, unfortunately, I see those repercussions almost every day in my practice.

As most people navigate their way through the world with the expectation that COVID will be around but that our lives have to return to some level of normalcy, I've noticed that for many people, even getting back to basic good health habits that were routine before COVID -- like exercising or getting back on a good diet after returning from a vacation -- are harder than they seemed to be prior to COVID.

Procrastination is the Normal Reaction to Things We Don’t Want to Do

We all procrastinate and that's not always a bad thing. Sometimes we have valid reasons, including being too busy at the time or having more important priorities. When it comes to life issues that we really don’t want to deal with, it’s easy to rationalize dealing with it “some other time.” In some cases, delaying a decision can even work to our advantage when the delay allows time for the issue to resolve itself or become moot for other reasons.

More often than not, though, choosing to put off dealing with our health issues and decisions doesn’t result in the issue resolving itself. It just allows the problem to get worse and the consequences of delay to become more serious and harder to fix later.

Some Health Decisions are Easier to Postpone Than Others

It’s easy to put off seeing a doctor or a dentist if we’re not in any pain. Maybe we just feel that we don’t have time (or want to make time) to deal with it right now.

Sometimes we choose to postpone an appointment because we just don’t want to be told that we aren’t doing things we know we should do – whether it’s not eating right, gaining weight, not exercising, not brushing and flossing often enough, not taking prescribed medications the way we should, and on and on. You know the drill.

Some may anticipate and want to avoid hearing bad news about their health status or don’t want to deal with what they will need to do to get healthier, or at least not continue to let their health get worse. Even when it involves physical and/or emotional pain, some will choose to “tough it out” and continue to postpone until the pain becomes too severe to ignore or tolerate. That doesn’t mean they are being reckless or irresponsible. Different personalities and life experiences shape our decisions regarding what’s more important at any given moment and what we feel we can postpone or try to ignore.

COVID Made Procrastination a Requirement

COVID only made things worse because it closed off most non-emergent healthcare for a long time and it also gave everyone a very valid reason to postpone any non-critical treatment, much less routine, preventive care. Important medical procedures have been postponed for the past sixteen months, much less regular doctor’s appointments. The problem is that our bodies didn’t put our health challenges on “pause” during the pandemic, even if we were fortunate enough to avoid the virus.

Another COVID-related impact on many people's health during the worst of the pandemic is that changes in daily routine due to COVID exacerbated underlying, symptomless but gradually worsening health conditions, like high blood pressure, high LDL cholesterol and diabetes due to people becoming more sedentary and gaining extra weight.

You Know What’s Coming Next

I strongly urge you to make an appointment to see me if any of the following apply:

- You have not been in for an appointment in more than a year.

- You have not had updated lab work in more than a year.

- You have one or more chronic, recurring conditions that need to be continually treated and monitored and you haven’t had an appointment or updated lab work within the last 4-6 months.

- You are experiencing bothersome or painful symptoms and you’re continuing to postpone or tough it out.

- You look in the mirror (literally or figuratively) and know you are less healthy than you were a year ago.

When it comes to your health, procrastination is not your ally. Help me help you.

P.S. You probably know some procrastinators you care about who you may know have health problems they are putting off. Some may not even have a physician they see regularly. We are happy to see any health procrastinators you may want to point in our direction and we accept most health insurance plans.

07/13/2022

WHAT'S NEXT WITH COVID?

By now, most everyone realizes that COVID will be around for the foreseeable future. That means that each of us must decide how to navigate our way through life in a world where COVID is omnipresent.

How a Disease Moves from Pandemic to Endemic

When a disease becomes endemic, it means that it will be present at a certain level in our population either at certain times of the year or year-round. When a disease becomes endemic in a population, it’s considered to be present at a manageable level that is not causing significant disruption in our daily lives.

Of course, disruption can be subject to different interpretations by different people, and that’s true of our reactions to COVID as endemic in our society. Some people will either temporarily or permanently adjust their lifestyle and patterns of interacting with friends, family, coworkers or society at large. Others will go about their daily lives with some minor adjustments and perhaps a heightened awareness. Still others won’t give COVID a second thought except when they or someone they know is infected.

Just as we live with the flu, we now have to learn to live with COVID.

Continued variants and mutations

The current variant (BA.5) is also referred to by some as the “Ninja” variant because of its ability to slip past the COVID antibodies that were created by COVID vaccines or through previous COVID infections.

The nature of viruses is to mutate, and with mRNA viruses, the rate of those mutations is extremely quick. Our immune system is always adjusting to the new threat. This is why prior immunity via infection or vaccine helps, however, it is not perfect.

As the target molecule of the vaccine keeps changing, our immune systems have greater adjustments to make, meaning that it is easy to get infected, but at least our bodies have a head start fighting the infection. Natural immunity fares somewhat better than vaccination in this regard because our body has a template to work from and adjusts quickly. In reaction to a COVID infection, our bodies will make a response to multiple targets, and not only to the m-spike protein. This means that if one immune target has changed, we have multiple others to attack, giving us a quick response to infection.

A vaccine lags further behind because it is based on studying the current structure of the virus, and creating a vaccine for that. By the time scientists are able to effectively develop a vaccine to combat one version of the virus, the virus has already moved on and mutated to a different variant.

We Continue to Make Progress Against COVID

The encouraging news is that even those antibodies from COVID vaccines as well as natural infection in response to previous versions of COVID appear to provide some protection against severe cases requiring hospitalization from the current variant. We know this because even as the BA.5 variant sweeps through the northeast (and other parts of the U.S.), the rate of related hospitalizations and deaths remains low. In fact, the risk of hospitalization and death from bacterial pneumonia is greater than from COVID.

Additionally, we now have medications (Paxlovid and molnupiravir) that helps protect against a more severe case of COVID, which was not the case at this time last year. So far, these drugs do seem to be highly effective, but need to be used early in the disease process. In my professional opinion, these medications should be reserved for people who start off with more severe symptoms because people with mild symptoms are at very low risk for serious complications from COVID such as shortness of breath leading to respiratory failure.

In truth, we are still learning about all the aspects of these new medications. That's why I am judicious in deciding which patients I prescribe for these medications.

Deciding What Level of Disruption You are Willing to Accept

Certainly, some people will be more cautious in their interactions than others. We can expect an increase in voluntary mask-wearing and social distancing by some, while that will not be the case with others. Individual decisions will be based on each person’s level of concern and risk tolerance.

Andrew Fink, MD

10/12/2022

09/22/2022

09/21/2022

09/08/2022

08/24/2022

08/04/2022

07/13/2022

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One-to-One Medical Care the Way It Was Meant to Be.