Jun 2, 2022 · Lung problems are another common cause of pulmonary hypertension. Parikh says that these types of symptoms can be signs of a more serious blood clot in the legs, “which can travel to your lungs and cause dangerous problems Sep 8, 2022 · Bronchitis. Pneumonia is an infection that inflames the air sacs in one or both lungs. Mar 22, 2023 · Tuberculosis (TB) is a serious illness that mainly affects the lungs. Shortness of breath is associated with a myriad of symptoms, depending on what brings it about. Sarcoidosis is a condition that causes lumps or nodules (granulomas) to form in your lungs, lymph nodes, skin, eyes and other parts of your body. Oct 27, 2022 · The symptoms of long-term pulmonary edema include: shortness of breath when physically active. Pneumonia can cause pulmonary oedema because the infection of the lung tissue can cause fluid to build up. anemia. The symptoms of pneumonia can develop suddenly over 24 to 48 hours, or they may come on more slowly over several days. It’s usually caused by a bacterial infection. Sep 10, 2023 · However they have different causes. Elevate your head. May 11, 2023 · Anemia is a problem of not having enough healthy red blood cells or hemoglobin to carry oxygen to the body's tissues. High altitudes. Feb 6, 2024 · Swelling or pain, tenderness in legs. Capillary leak syndrome attacks, or episodes, can occur several times a year or only once. Changes in your vocal volume (how loud or soft your voice sounds). Or it could be a chronic symptom that persists over longer periods, according People often mistake their symptoms as signs of aging or lack of fitness. The germs that cause tuberculosis are a type of bacteria. Decreased tolerance of cold temperatures. ”. Pneumonia. There are clusters of tiny air sacs in your lungs. This condition is also known as pneumonia in medical terms, and must not be treated at home. If you’re Oct 4, 2023 · Bluish color of the skin due to lack of oxygen (cyanosis) Infants are most severely affected by RSV. When the lungs are weak, the voice is also weak and Nov 7, 2022 · Symptoms include chest pain, shortness of breath, and a dry cough. If left untreated, complications can be serious, even fatal. The quality and clarity of one’s voice hinge on the health of the lungs. Feeling easily fatigued and exhausted. Sudden loss of consciousness following a severe headache. Dec 1, 2021 · Other times, lung congestion can be indicative of bronchitis or pneumonia. Sarcoidosis may cause skin problems, which may include: A rash of red or reddish-purple bumps, usually located on the shins or ankles, which may be warm and tender to the touch. Dec 3, 2023 · Common symptoms of aspiration in babies and children are similar to those of silent aspiration and can include: Weak sucking. Myasthenia gravis (MG) is a chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle, resulting in weakness of the skeletal muscles. Carbon monoxide poisoning. The airways create mucus, often called sputum or phlegm. But there are many other possible causes. Orthopnea (the inability to breathe easily unless you’re sitting up straight or standing up straight). rapid heart and breathing rate. Inhaling toxins or breathing in some stomach contents when vomiting (aspiration) causes intense irritation of the small airways and air sacs, resulting in fluid buildup. When breathing, a normal trachea widens and lengthens with each breath. Other prominent causes of left-sided heart failure include infections involving the heart muscle (such as viruses and Lyme disease Aug 8, 2023 · Dyspnea Causes. Bronchitis is when the airways leading to your lungs (trachea and bronchi) get inflamed and fill with mucus. On the third intake, lift your arms over your head. Often, people experience chest congestion as a symptom of an acute illness. Myasthenia gravis affects the voluntary muscles of the body, especially those that control the eyes, mouth, throat and limbs. In patients that are extremely ill, those muscles are weakened from lack of use. Apr 16, 2022 · Sudden, severe pain in your head, chest, abdomen or back. shortness of breath. Slight fever and chills. Acute respiratory failure occurs when the lungs can’t release enough oxygen into your blood. Your healthcare provider can diagnose emphysema through imaging and breathing tests. Most lung infections are treatable with antibiotics or antivirals, and mild infections often resolve on their own. Chest discomfort. Lung infections can be caused by pneumonia, influenza, COVID-19, the common cold, and other upper respiratory illnesses. Joint pain. Weight loss. They can cause symptoms such as nasal congestion, a runny nose, itchy or watery eyes, chest Weakness; Sometimes there are no symptoms, and radiation pneumonitis is found on a chest x-ray. This leads to many people adjusting their daily activities to accommodate or reduce their symptoms, rather than getting help. Sleep-related breathing disorders, such as sleep apnea. It's also a possible complication of other respiratory problems, including cystic fibrosis, lung Tuberculosis is an infectious disease that can cause infection in your lungs or other tissues. Blue or gray skin color due to low oxygen levels. Jun 13, 2020 · Shortness of breath that comes on suddenly (called acute) has a limited number of causes, including: Anaphylaxis. Qi deficiency also affects the voice. Apr 7, 2022 · Capillary leak syndrome happens when plasma (the liquid part of your blood) leaks out of tiny blood vessels (capillaries). You might notice signs of shock, such as a drop in blood pressure, feeling clammy and “out of it,” and having a pounding heart. org Jun 22, 2023 · Digestive symptoms, including diarrhea and stomach pain; Blood clots and blood vessel (vascular) issues, including a blood clot that travels to the lungs from deep veins in the legs and blocks blood flow to the lungs (pulmonary embolism) Other symptoms, such as a rash and changes in the menstrual cycle Sarcoidosis is a rare condition that causes small patches of swollen tissue, called granulomas, to develop in the organs of the body. If you feel short of breath — lean forward, stay calm, take slow deep breaths and use your inhaler if you have one. Newsletters Search. Signs and symptoms of Afib usually result from the effects of the heart not pumping as well as it should. Your symptoms worsen. Aug 25, 2023 · The second most common form of lymphoma is called alimentary lymphoma, which accounts for less than 10% of canine lymphomas. Cigarette smokers and ex-smokers are most at risk of COPD. persistent fatigue. A red face, watery eyes, or grimacing while feeding. Fatigue. Another person can then breathe in the droplets, and the germs enter the lungs. Feb 4, 2024 · Symptoms and signs of wet lung can vary, depending on the underlying cause. Pneumonia Aug 30, 2018 · Chronic cough: Coughing for more than a month, may be a signal that something is wrong with your respiratory system. Pulmonary edema can also develop over Jul 28, 2023 · Symptoms get worse as the disease progresses. Rapid or irregular heartbeat with shortness of breath, chest pain or fainting. May 27, 2022 · A blood clot moving from the blood vessels in the legs to the lungs can cause pulmonary edema. Symptoms include shortness of breath and difficulty breathing. wheezing. Having anemia can cause tiredness, weakness and shortness of breath. Nov 28, 2022 · 3 min read. This infection can impact anyone at any age, and it can be caused by viruses, bacteria, or fungi. Congestive heart failure is life-limiting for many. May 31, 2020 · Muscle weakness: CO2 buildup as a result of severe muscle weakness; There are two basic treatment options for removing the excess carbon dioxide from your lungs: A non-invasive treatment called Bipap; An invasive treatment with intubation and mechanical ventilation; Bipap should be the first treatment choice when it can be done. Descend. Dec 8, 2022 · Pneumonia is a common lung infection. Fever. General symptoms include chest pain, fever, cough, and trouble breathing. Swelling of your legs, feet and ankles in severe cases. Inflammation can cause scarring and narrowing of Nov 16, 2023 · This leads to fluid retention and the buildup of fluids in the limbs, thorax (chest cavity), and lungs. Sudden (acute) pulmonary edema requires immediate treatment. It may last for 1 or 2 minutes after strenuous activity. Jun 5, 2024 · Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. Chronic mucus production: Mucus can defend against infections or irritants. recurrent lung infections, such as pneumonia or bronchitis. Swelling in your feet, legs and ankles or shortness of breath every time you exert yourself may be a symptom of constrictive pericarditis. Cardiac tamponade (excess fluid around the heart) COPD (chronic obstructive pulmonary disease) — the blanket term for a group of diseases that block airflow from the lungs — including emphysema. Jan 11, 2023 · Sarcoidosis. Common signs of heat exhaustion include: weak, rapid pulse. Three of the most common COPD conditions are emphysema, chronic bronchitis and chronic asthma that isn’t fully reversible. For adults older than 65, symptoms may also include Mar 23, 2022 · Common signs and symptoms of post-polio syndrome include: Muscle and joint weakness and pain that gets worse over time. Apr 11, 2024 · Take three short inhalations through the nose. Many cases go away on their own or with treatment, but sometimes it becomes a chronic condition. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. Menu. One example is sterile talcum powder. Some people with left-sided heart disease also have lung disease or a lack of oxygen (hypoxia). Emphysema is a lung disease. Lungs. Biopsy A biopsy of the lungs, Muscle weakness or aching joints; Emphysema. Jun 3, 2022 · The most common causes of left-sided heart failure include: High blood pressure (hypertension) Coronary artery disease and heart attacks. Wheezing. It often affects the lungs and lymph nodes, and can also affect your skin. With treatment, most people recover without any lasting effects. The flu is caused by a virus. Weakness. fatigue. Poor blood supply to the heart or the rest of the body can cause a variety of symptoms that may seem unrelated. When you breathe, your lungs take in oxygen. If capillary leak syndrome isn’t Mar 2, 2023 · hoarseness. Bronchitis can affect people of all ages. difficulty breathing when lying down. Fatigue or a general feeling of being sick. Atypical pneumonia treatment. The trachea, known as the airway or windpipe, is a tube that starts under the larynx (voice box) and runs behind the breastbone. Aug 29, 2018 · coughing that may produce phlegm. Signs and symptoms of severe RSV infection in infants include: Short, shallow and rapid breathing. nausea and vomiting. Apr 28, 2024 · Along with these symptoms, older adults and people with weak immune systems might be confused or have problems with thinking. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. Pulmonary edema is a buildup of fluid in your lungs. This is a group of diseases that includes chronic bronchitis and emphysema Diaphragmatic weakness or paralysis is caused by damage or pressure on the phrenic nerve. waking up at night with a breathless feeling that May 2, 2023 · Many breathing problems are long-term (chronic). Rarely, pulmonary sarcoidosis can cause permanent, irreversible scarring and damage to lung tissue. They include: Breathing problems: These can include severe shortness of breath, rapid, shallow breathing, or pain while breathing. Most cases of bronchitis can be treated at home. It happens when tiny air sacs within the lung, called alveoli, lose air. Dyspnea (shortness of breath, or difficult, labored breathing). Tuberculosis can spread when a person with the illness coughs, sneezes or sings. Acute respiratory distress syndrome is a serious condition that occurs when the body does not receive enough oxygen from the lungs. Jan 22, 2024 · Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Your cough can last two or more weeks. Infections. It can occur due to nonheart-related conditions, too. Symptoms include shortness of breath, coughing and fatigue. Chest pressure or pain. Stopping and resting is a good idea at the first signs of altitude sickness. Saliva and nasal mucus may increase when, being tired, you eat, especially if you over-eat, or eat cold foods or drink cold liquids. If symptoms are more severe (such as additional dizziness, fatigue or nausea) or get worse, descending is a top priority. You get a nagging cough as your body tries to get rid of the mucus. This is a severe type of pericarditis where the pericardium gets hard and/or thick. General aches and pains. If left untreated, bronchitis can spread from the bronchial tubes into the lungs, progressing into pneumonia. Chronic bronchitis never really goes away but Jan 8, 2024 · Chest congestion, difficulty breathing, coughing, wheezing, and fever are the result. Influenza is commonly called the flu, but it's different from the stomach "flu" viruses that cause diarrhea and vomiting. diarrhea. Bacteria then grows in the mucus, causing more inflammation and damage to your lungs. Symptoms of left-sided heart failure can include chest pain, fatigue, shortness of breath, and leg swelling. Chronic mucus production. Difficulty breathing or the sensation that it is difficult to breathe in or out is another crucial warning sign. Knowing the early warning signs of lung disease can help you receive treatment before the disease becomes serious or life threatening. It’s most common in children under the age of 5. Learn about different treatments for lung diseases and conditions, including oxygen therapy, pulmonary rehabilitation, thoracentesis, tracheostomy, and lung transplants. On the second intake of air, move your arms to the side, keeping your arms at shoulder level. Changes in your vocal pitch (how high or low your voice sounds). These conditions can occur separately or together. You might feel anxious or depressed, get frequent headaches, be short of breath or have heart palpitations. Jan 11, 2023 · Pulmonary sarcoidosis causes inflammation and lumps called granulomas in the lungs. when blood potassium levels are low Tracheal Disorders. These symptoms may be due to heart failure. General signs and symptoms of most types of vasculitis include: Fever. Rapid heart rate: Trouble breathing can make your heart work harder. 4 days ago · Lung Yang deficiency leads to more mucus. Pulmonary hypertension symptoms include: Shortness of breath, at first while exercising and eventually while at rest. This makes you cough a lot as your body tries to remove the Shortness of breath can have many different causes, such as a lung problem, heart problem, infection, panic attack or allergic reaction. Medications and other treatments help manage symptoms like swelling. The word “tuberculosis” comes from a Latin word for "nodule" or something that sticks out. Other signs and symptoms are related to the parts of the body affected, including: Digestive system. Sep 16, 2022 · Pulmonary Edema. Coughing up blood: The blood may be coming from your lungs or upper respiratory tract, signaling a health problem. Afib Symptoms. Production of mucus (sputum), which can be clear, white, yellowish-gray or green in color — rarely, it may be streaked with blood. Treatment depends on your specific symptoms. Depending on your skin color, these changes may be harder or easier to see. Apr 1, 2024 · Tracheobronchomalacia (TRAY-key-oh-bronco-mă-LAY-cia) is a condition where your trachea (windpipe) and your bronchi (the tubes that lead from your trachea to your lungs) are so weak that they collapse and close down when you take a breath or cough. They can be similar to other medical conditions and, early on, even go unnoticed. This can put tiny droplets with the germs into the air. Laughing. excessive sweating . Many conditions can cause chronic shortness of breath including: Chronic lung diseases, including COPD, asthma, pulmonary fibrosis and pulmonary hypertension 3 days ago · Bronchitis. If vasculitis affects your lungs, you could have shortness of breath or Jun 24, 2024 · Pneumonia is an infection of the lungs caused by fungi, bacteria, or viruses. Your nose is often cold. D. The infection leads to weak lungs due to the presence of excessive bacteria in them. Exposure to certain toxins. . Dec 22, 2023 · Symptoms. Your lungs This aims to stop fluid from building up and helps to relieve your symptoms. Symptoms include flu-like illness, unexplained fatigue, weight loss, wheezing, and Oct 20, 2022 · Learn more about symptoms, diagnosis, treatment, and complications. Peripheral edema (swelling of the legs, ankles, and feet) Apr 11, 2017 · For either acute bronchitis or chronic bronchitis, signs and symptoms may include: Cough. Disfiguring sores (lesions) on the nose, cheeks and ears. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. Tuberculosis is also known as TB. Symptoms may include: A voice that sounds hoarse, weak, scratchy or breathy. If you have symptoms of a collapsed lung, go to the nearest emergency room. Shortness of breath (dyspnea). Sudden, severe shortness of breath and coughing up white or pink, foamy mucus. The main symptom of dyspnea is labored breathing. Difficulty inhaling or exhaling. Jul 1, 2022 · Anxiety or fatigue. Acute bronchitis is usually caused by a virus and goes away on its own. Headache. Build-up of nasal mucus, also throat mucus, worse in the cold. See full list on my. Outlook. Bacterial pneumonia is an infection of your lungs caused by certain bacteria. Blood and fluids collect in your lungs and legs over time. Throat problems include increased mucus and/or a feeling of a lump or ‘frog’ in 6. May 21, 2021 · This happens because this side of the heart is too weak to pump blood forward to the lungs. Raising the head of your bed on 6-inch blocks or sleeping on a specially designed wedge lets gravity lessen the reflux of Mar 24, 2022 · Practicing good hygiene, getting annual vaccines, and adopting healthy lifestyle choices such as heart-healthy eating and not smoking are very important. The symptoms of sarcoidosis depend on which organs are affected, but typically include: tender bumps on the skin. It commonly affects your lungs, but it can also affect other organs like your spine, brain or kidneys. Pneumonia is an infection of the lungs, which could be caused by a bacteria, virus or fungus. fatigue and weakness. If you have pneumonia, these tiny sacs become inflamed and fill up with fluid. Quitting smoking and losing weight can help prevent shortness of breath. The main cause of emphysema is smoking, but other causes include air pollution and chemical fumes. Fainting or severe weakness. It’s more common in winter, and often develops after a cold, sore Signs and symptoms of a pneumothorax include: Chest pain on one side, especially when taking breaths. If your stomach or intestines are affected, you may experience pain after eating. There is an old saying in Chinese Medicine that, “ The Lungs govern the voice . The fluid leaks into muscles, tissues, organs and body cavities (spaces that hold organs). “It also clears out your lungs by forcing enough stale air out that allows fresh air to enter into more areas of the lung. fever, sweating, and chills. Staying active. The most common causes of shortness of breath are: Anxiety disorders; Asthma; A blood clot in your lungs, known as pulmonary embolism Jul 5, 2022 · Symptoms of Shortness of Breath. Weakness and fatigue are common signs of potassium deficiency for a few reasons:. Coughing. Hemoglobin is a protein found in red cells that carries oxygen from the lungs to all other organs in the body. It can be treated with appropriate medications. While the cause can be identified in some cases, as many as 40 to 50% of paralyzed diaphragms are idiopathic, meaning the cause is Aug 21, 2023 · Stop and acclimate. When the heart has to work harder to pump blood because of a condition like heart disease, the heart weakens. Atelectasis is one of the most common breathing complications after surgery. Smoking Mar 10, 2023 · Congestive heart failure is a long-term condition that happens when your heart can’t pump blood well enough to give your body a normal supply. Feeling of suffocation. Cough. It then divides into two smaller tubes, (bronchi) which lead to the lungs. It is a complication of an Apr 21, 2023 · Usually lung cancer is the problem, but other cancers that have spread to the lung or pleura can cause it, too. If you have Afib, you might experience one or more of the following symptoms. Oct 17, 2023 · Vasculitis can cause numbness or weakness in your hands or feet, along with swollen or hardened palms and soles. These include chronic sinusitis, allergies, and asthma. You may wheeze or cough a lot. Nov 16, 2022 · Symptoms depend on the extent of the paralysis and the position of your vocal cords in relation to each other. When an aneurysm causes symptoms, the signs depend on its location. Jun 27, 2024 · Here are 7 signs and symptoms of potassium deficiency. Abdominal (stomach) pain. Nov 3, 2021 · Popcorn lung is caused by exposure to toxic chemicals found in microwaveable popcorn factories and e-cigarettes. These substances inflame the area around the lungs, so they stick together. Your organs, such as your heart and brain, need this oxygen-rich blood to work well. Aug 17, 2023 · What are vasculitis symptoms? Some of the most common vasculitis symptoms include: Trouble breathing. Numbness or tingling, especially in your hands and feet. Jun 24, 2024 · Stopping smoking is important to reduce GERD symptoms. A main cause of pulmonary edema is congestive heart failure. Coughing or deep breathing makes it worse. The condition can go away on its own, but some people need treatment with prednisone or other medications. Most people with the flu get better on their own. Sometimes you can have both problems. 7. Damaged airways can’t clear mucus like they're supposed to. Apr 20, 2023 · Chest pain. Bluish skin, lips or nails (cyanosis). clevelandclinic. loss of appetite and weight loss. Aug 6, 2022 · Bronchiectasis (“bronk-ee-EK-tuh-sis”) is a lung condition where your airways (tubes going into your lungs) get damaged and widen. Losing muscle tissue (atrophy) Breathing or swallowing problems. It affects the air sacs of your lungs. Pulmonary oedema is an excess of watery fluid building up in the lungs, usually caused by a heart problem. Jan 18, 2023 · Pleural effusion symptoms include: Chest pain. Fainting sensation. Asthma. Areas of skin that are darker or lighter in color. Jun 13, 2020 · Pneumonia and your lungs Enlarge image. There are many forms of anemia. Steroids, like prednisone, are usually used. It can steal your energy, your ability to think clearly, and your sense of smell or taste. Oct 7, 2021 · Aspiration pneumonia is an infection of the lungs caused by inhaling saliva, food, liquid, vomit and even small foreign objects. This treatment seals the space between the tissues covering the lung (pleura). “Early [viral pneumonia] symptoms are similar to influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness,” according to the American Lung Aug 22, 2017 · Diagnosis and treatment. Common causes of May 20, 2024 · Pneumonia is inflammation of the lung tissue. Feb 28, 2023 · Causes of chest congestion can include flu, asthma, and COPD. This can lead to an array of symptoms associated with a weak heart, including: Shortness of breath with activity or even at rest. Lung issues that can cause pulmonary hypertension include: Chronic obstructive pulmonary disease (COPD). Treatment includes quitting smoking and taking medications. Symptoms include cough, shortness of breath, tender sores on your shins, eye pain and redness. If you have TBM, you may have issues breathing. The main symptoms of COPD are breathlessness, chronic cough and sputum (mucus or phlegm) production. Struggling to breathe — chest muscles and skin pull inward with each breath. Muscle weakness, in turn, can directly affect lung capacity. The most common one is Streptococcus (pneumococcus), but other bacteria can cause it too. On your first inhale of breath, lift your arms, reaching in front of you and keeping the arms at shoulder level. Rashes, bumps or areas of discoloration on your skin. Jan 10, 2024 · Flu, also called influenza, is an infection of the nose, throat and lungs, which are part of the respiratory system. Chest pain or pressure (angina) Nov 8, 2023 · Atelectasis (at-uh-LEK-tuh-sis) is the collapse of a lung or part of a lung, also known as a lobe. There are several known causes that can lead to diaphragm paralysis: Cancer that has spread and compresses the phrenic nerve. Jan 16, 2018 · The symptoms of heat exhaustion can be easy to overlook and are similar to those of many other medical conditions. The result may be a buildup of fluid in various parts of the body, including the legs, abdomen, and liver. Weakness and fatigue. Dec 15, 2022 · Coping. It can be caused by problems like heart failure, blood clots, pneumonia, kidney disease, and tuberculosis. The oxygen passes into your blood, which carries it to your organs. “Laughing is a great exercise to work the abdominal muscles and increase lung capacity,” Singh says. This is a slow, gradual process that Pulmonary embolism (blood clot in the lungs) Emotional distress, anxiety or a panic attack; If your symptoms last for four weeks or longer this may be a sign of a chronic health condition. Many conditions can cause shortness of breath. Heart valve disease, especially aortic stenosis and mitral regurgitation. Bronchitis is an infection of the main airways of the lungs (bronchi). Apr 26, 2023 · Acute Respiratory Failure: Types, Symptoms, Treatment Medically reviewed by Adithya Cattamanchi, M. The disease can strike anyone at any age Jun 19, 2023 · Long COVID is a collection of symptoms that last three months or longer after your first COVID symptoms. There are a few different substances your doctor can use. Symptoms often go away on their own, but if treatment is needed, it is based on trying to decrease the inflammation. Alimentary lymphoma targets the intestines, which is where the majority Sep 24, 2022 · Other signs and symptoms may include: Tiredness and weakness; Chest pain; This is most common in treatments to the chest area for lung cancer, breast cancer, Hodgkin’s disease, Jan 30, 2019 · Skin symptoms. Fast heart rate. Jun 13, 2020 · A hallmark aspect of qi deficiency symptoms is that they are generally worse with exertion. Shortness of breath. Acute infections may also cause other symptoms, such as Jul 28, 2023 · Symptoms get worse as the disease progresses. Health Conditions A-Z. These symptoms include: Tightening of the chest. Fast breathing. Breathing that Feb 4, 2010 · In some cases, an infection can be brought on by changes in the weather and environment, by chronic obstructive lung diseases, or due to hereditary factors. Most experts recommend descending until the symptoms get better. It causes them to become irritated and inflamed. Some illnesses that lead to pleural effusion are pneumonia or Jul 21, 2021 · In addition to the diaphragm, secondary muscles connected to the rib cage, as well as those in the shoulders and back, help the chest cavity expand to allow air into the lungs. It can cause shortness of breath, cough and fatigue. Contents Overview Symptoms and Causes Diagnosis and Tests Management and Treatment Prevention Outlook Shortness of breath that persists after exercise or occurs with little or no effort is not natural. mq ec gr so oa xu wa zy nd ww