All rights reserved. The treatment for the systemic condition is aimed at addressing the culprit, whereas the latter requires adequate compression. Lymphedema: Lymphedema is damage to the lymphatic system wherein the body cannot properly drain fluids, which can lead to non-pitting edema in the legs or arms. Weeping edema can happen to anyone, but is particularly common in elderly and pregnant women. Reduce or blockage in regular ventricular function is characteristic of congestive heart failure. Regular aerobic exercise may improve heart health and lead to a better quality of life in people with CHF. Doctors will often ask people to monitor their weight each day to check for any sudden or fast weight gains, which may be a sign of fluid retention. Here's what womenand men who care about themneed to know about this condition. Web'Leaky legs': strategies for the treatment and management of lower-limb lymphorrhoea | Nursing Times EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 10th Floor, Southern House, Wellesley Grove, Croydon, CR0 1XG We use cookies to personalize and improve your experience on our site. Reduced ability to exercise. Call your doctor or 911 if you think you may have a medical emergency. This is called congestive heart failure. This closes the vein. WebWhen considering weeping legs, multiple causes come to minda systemic condition, such as hypoproteinemia, cardiac issues, liver failure, or chronic progressive untreated swelling. Right-sided HF is less common. Doctors will likely recommend making lifestyle changes to minimize the impact of CHF. There are no easy ways to manage gross oedema and the resulting fluid leakage. This is a minimally invasive procedure. It can also occur when the left ventricle becomes too stiff and cant fill with enough blood in between heart beats. Endovenous laser ablation or radiofrequency ablation (RFA). This is a minimally invasive procedure. Fluid may build up in the lungs, liver, gastrointestinal tract, and the arms and legs. You need compression stockings measured and prescribed by a doctor or until then, go to any drug store and get 20-30 mm hg support stockings asap. The treatment for the systemic condition is aimed at addressing the culprit, whereas the latter requires adequate compression. Some studies estimate a 5-year survival rate of close to 50% for a person diagnosed with heart failure. 27 May, 2003. Gentle massage promotes blood flow to the heart, and can remove pressure on the blood vessels that may cause swelling. "However, many people with heart failure develop weakness in their leg muscles, which can make exercise difficult," the study authors explain. You need. You can give your heart a gravity assist by elevating your feet and legs as soon as you notice them starting to swell. Sign Up for the Latest Health News and Tips, Home General Health Weeping Edema: Causes, Symptoms, and Link Between Diabetes and Weeping Legs. Edema can also affect the lungs, and may cause coughing, skin pallor, and shortness of breath. WebCongestive heart failure (often referred to simply as heart failure) affects around 6 million Americans and is the leading cause of hospitalization in people over 65 years old. Helpful Answer ( 7) G Guestshopadmin Dec 2017 WebThe body accommodates for pooling of blood and plasma in the legs. WebPatients with congestive heart failure become easily fatigued because the heart cannot pump enough blood to satisfy the oxygen requirements during periods of exercise. There are many causes of CHF in dogs. Mechanisms Underlying Hypotensive Response to ARB/NEP Inhibition - Aim 3, Clinical Evaluation of the AccuCinch Ventricular Restoration System in Patients Who Present With Symptomatic Heart Failure With Reduced Ejection Fraction (HFrEF): The CORCINCH-HF Study, Yale's New Heart Chief Wants to Help You Live Longer, Worried About Heart Health? They are: Common symptoms of heart disease include: Other conditions that affect the heart can also cause CHF. Strain the dandelion, and the tea is ready. Wheezing. WebDr. Heart failure: What is heart failure? This eye swelling is caused by diabetic retinopathya complication of diabetes that can lead to vision loss and eventual blindness. Swelling ( edema ) in your legs, ankles and feet. This stage is severe and may require advanced specialized treatment. You can do it by getting a head elevated bed, wedge pillow, or stuffing 2-3 pillows under your head while sleeping. (2017). Macular edema refers to when swelling results from fluid filling the macular tissue that is near the retina of the eye. The pressure inside the veins is also higher due to higher pressures in those with heart failure. Reduced ability to exercise. For these, please consult a doctor (virtually or in person). WebEdema can be an early sign of congestive heart failure. dilated cardiomyopathy (DCM). Dr. Robert T. Spalding answered. Research shows that weight loss and subsequent management can be effective in the prevention of heart failure. The swelling of the feet, ankles, and lower legs is a common sign of heart failure. When the heart weakens and pumps blood less effectively, fluid can slowly build up, creating leg edema. Congestive heart failure causes one or both of the heart's lower chambers stop pumping blood well. The swelling of the feet, ankles, and lower legs is a common sign of heart failure. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. This closes the vein. There is no cure for CHF so, as the disease progresses, signs and symptoms get worse and other organs start to fail. Heart failure is most common in African Americans, individuals with a family history of HF, and those who are 65 and older. A leaking mitral valve allows blood to flow in two directions during the contraction. Last medically reviewed on July 18, 2021, Congestive heart failure and COPD are separate conditions, but COPD may increase the risk of congestive heart failure. Heart failure: Could a low sodium diet sometimes do more harm than good? Those suffering from heart failure are often advised to lose weight as a means of slowing their condition's progression, notes the UCLA study. Dogs may try to sleep on their chest instead of their sides. Many disorders that weaken the heart can contribute to the development of CHF, including: However, in some cases, a person can extend their life expectancy through lifestyle changes, medications, and surgery. This c. You may benefit from unna boot medicated wraps with, treatment. Doctors may also prescribe angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or angiotensin receptor blocker neprilysin inhibitors (ARNIs) to help the heart pump blood more effectively. Learn about symptoms and treatment. There are several stages of systolic congestive heart failure and each stage requires a different treatment. 27 May, 2003. For instance, each leg may weigh up to 10 extra pounds. Congestive heart failure (also called heart failure) is a serious condition in which the heart doesnt pump blood as efficiently as it should. It still pumps blood, but its not enough to meet the bodys needs. Limiting your alcohol consumption can help prevent high blood pressure and congestive heart failure. Leg muscles now lumpy at ankles under skin (swollen) & numb at rest but wear diabetic socks. An early diagnosis of CHF may help people manage their symptoms and make preventative lifestyle changes. Allergic reactions and food allergies may also cause throat or tongue swelling, which may be life-threatening if it interferes with breathing. However, a 2017 study reports that the 5-year life expectancy is poor among all patients admitted to the hospital with heart failure regardless of their EF, with the estimated 5-year mortality at 75.4%. Can diet help improve depression symptoms? In this article, learn about the different types, how to recognize the symptoms, and what treatment to expect. In general, more than half of all people diagnosed with congestive heart failure will survive for 5 years. Combine three to four drops of grapefruit oil or fennel oil with one teaspoon of carrier oil like coconut oil or jojoba oil. In general, it is a good idea to stand up often and walk around to avoid leg swelling during long trips. This is due to a weakening or stiffening of the heart muscle. In this instance, congestion is another word for fluid. However, life expectancy for a person with CHF has substantially improved over time. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. The excess sodium or water levels may also contribute to kidney dysfunction. As the heart weakens, blood begins to back up and force liquid through the capillary walls. Other key components of CHF therapy include mineralocorticoid receptor blockers (MRAs) and sodium-glucose co-transporter 2 (SGLT2) inhibitors. Treatment for Congestive Heart Failure. Congestive heart failure can also cause swelling in the stomach area. treatment? WebDachshunds and Cavalier King Charles Spaniels are also genetically predisposed to develop congestive heart failure. It may happen when the heart muscle is too weak or when another health problem prevents it from circulating blood efficiently. Treatment should focus on managing risk factors. However, it can be life threatening if left untreated. Try to get up every hour. They include: Eating a healthful, varied diet and getting regular exercise is always a good idea, but it can be essential for people with CHF. It Could Be Peripheral Edema, https://www.health.harvard.edu/diseases-and-conditions/edema-, https://www.mayoclinic.org/diseases-conditions/edema/symptoms-causes/syc-20366493, https://www.webmd.com/heart-disease/heart-failure/edema-overview#1, https://www.umm.edu/health/medical/altmed/condition/edema, corticosteroids (methylprednisolone and prednisone), thiazolidinediones (diabetes medications), NSAIDs (non-steroidal anti-inflammatory drugs) like naproxen or ibuprofen. An LVAD is a pump that helps the heart muscle contract. Heart disease is a major cause of death. Learn the causes, symptoms, and treatment options. But there are other types of edema that may be the result of heart failure, including: The main potential causes of edema range from the temporary and harmless to more serious and chronic conditions that require ongoing medical care. Symptoms may be mild or severeand may not always be noticeable. Your skin may look stretched, taut, and/or shiny. It's a sign that his heart isn't moving fluid through his body. Learn more. The management of fluid leakage in grossly oedematous legs Digital Edition: The management of fluid leakage in grossly oedematous legs . It's a sign that his heart isn't moving fluid through his body. CHF in Dogs Often Lead to Edema: Congestive heart failure in dogs often lead to edema or swelling of the lungs and limbs. Cancer rehabilitation is a medically supervised program aimed at improving cardiovascular health. Mitral regurgitation is leakage of blood backward through the mitral valve each time the left ventricle contracts. A heart transplant may also be an option if the person is a good candidate for the operation. Varicose veins and congestive heart failure are also known causes of leg swelling and stasis dermatitis. Lifestyle changes, medication, and surgery are typical methods of treatment. Weeping legs cellulitis, gout, or arthritis can also result from an infection or wound. We avoid using tertiary references. The condition, known as peripheral edema, is caused by the reduced force of blood flow through the body, causing blood to pool in the lower extremities. While edema may be the most obvious external heart failure symptom, there are some other common symptoms that you should know about. MVI is a leaky mitral valve, which is the valve between the left atrium and the left ventricle. WebDifficulty concentrating or decreased alertness Chest pain, if your heart failure is caused by a heart attack An ejection fraction of equal to or less than 20% Call us at (304) 529-4217 or (800) 788-5480 to request a free evaluation to determine if you are eligible for the Love Your Heart program with Hospice of Huntington. This means the rest of the body does not get the oxygen and nutrients it needs. Left-sided heart disease sometimes involves edema in the lungs. A tube (catheter) puts heat right into the affected vein. People who have received an early diagnosis may have a better outlook than those who did not. PVD & serious edema: Peripheral vascular disease leading to edema will continue to get worse to the point of fluid leaking from skin. The symptom is caused by a variety of factors, including standing or sitting for long periods, pregnancy, or eating salty foods. What is weeping edema? Consuming too much liquid may cancel out the effects of diuretic medicines. Swelling in your legs and feet is often an early symptom of congestive heart failure. It is common for a doctor to prescribe diuretics, ACE inhibitors/ARB/ARNI and beta blockers, mineralocorticoid receptor blockers, or SGLT2 inhibitors at this stage. Watch an animation of mitral valve regurgitation. WebThe body accommodates for pooling of blood and plasma in the legs. It's a sign that his heart isn't moving fluid through his body. In diabetic macula edema, the fluid accumulation is due to leaking capillaries. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://www.sciencedirect.com/science/article/pii/S0735109718383517?via%3Dihub, https://www.ahajournals.org/doi/10.1161/HCQ.0000000000000102, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336901/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088451/, https://www.ahajournals.org/doi/10.1161/JAHA.117.006540, https://heart.bmj.com/content/early/2020/11/05/heartjnl-2020-317833, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852309/, https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/ejection-fraction-heart-failure-measurement, https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.779, https://www.ncbi.nlm.nih.gov/books/NBK553115/, https://www.nhlbi.nih.gov/health-topics/heart-failure, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919428/, https://heart.bmj.com/content/107/13/1032, https://www.ncbi.nlm.nih.gov/books/NBK430873/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513293/, https://academic.oup.com/eurheartj/article/37/27/2129/1748921, https://www.sciencedirect.com/science/article/pii/S0735109717397619?via%3Dihub, https://www.ahajournals.org/doi/10.1161/CIR.0000000000000757, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319359/. To prevent or slow the progression of HF, people should take the following steps: People who already have HF should take the following steps to prevent further progression: Without treatment, HF can be fatal. It can also cause labored breathing and wheezing. Additionally, make sure you are taking your medications regularly, and eat a low, Dr. Pamela Pappas and another doctor agree. Put your feet up to help combat swollen legs. A kidney disorder called nephrotic syndrome is also known to cause severe leg edema, and even edema throughout the entire body. Learn more about the differences and how doctors diagnose and, Beta-blockers are drugs that can help slow heart rate, prevent migraine episodes, manage glaucoma, and more. Underlying causes for leaking legs include: Congestive heart failure: Congestive heart failure is most common in older adults, and occurs when the heart muscle is unable to effectively pump blood throughout the body. Risk factors, such as obesity, hypertension, and a poor diet may also negatively impact a persons outlook. With pitting edema, a finger pressed on the swollen leg leaves an imprint. The term congestive heart failure is often used interchangeably with heart failure. A diagnosis is made by a combination of blood tests, stress tests, chest x-rays, heart ultrasound, and angiograph. Edema can also lead to leg heaviness, and this can also affect walking. Congestive Heart Failure 101. Fluid leaking from legs in elderly patients especially can be a sign of a more serious underlying health problem, including kidney damage, cirrhosis, congestive heart failure, and weakness or damage to veins in the legs. Despite its name, CHF does not mean that the heart has completely failed. Cardiac amyloidosis is a disease caused by the accumulation of clumps of abnormally folded protein in the heart muscle. Congestive heart failure causes one or both of the heart's lower chambers stop pumping blood well. In gastrointestinal-related edema, abdominal swelling will also occur, often due to cirrhosis and bleeding ulcers. WebCongestive heart failure (often referred to simply as heart failure) affects around 6 million Americans and is the leading cause of hospitalization in people over 65 years old. It is the number one reason older people are Other helpful treatments include using essential oils like fennel oil and grapefruit oil, drinking dandelion tea, getting massage therapy, and eating a low-salt diet. This is due to diabetes expanding blood circulation in an inappropriate way. This breathlessness is often the result of CHF, where pulmonary congestion occurscausing fluid to leak into the lungs. 3. What are these 'episodes' that come in waves? Difficulty Sleeping. Difficulty Sleeping. What are the different types of heart failure? When left untreated, weeping edema complications can also include reduced blood circulation; scarring between layers of tissue; increased risk of infection in the swollen area; stretched or shiny skin that becomes uncomfortably itchy; and a decreased elasticity of the veins, arteries, muscles, and joints. Despite its name, heart failure doesnt mean that the heart has literally failed or is about to stop working. Learn more here. WebDr. Can diet help improve depression symptoms? In general, more than half of all people diagnosed with congestive heart failure will survive for 5 years. You can give your heart a gravity assist by elevating your feet and legs as soon as you notice them starting to swell. In serious situations, advanced therapies, which include mechanical solutions, a heart transplant, or hospice, may be offered. Varicose veins and congestive heart failure are also known causes of leg swelling and stasis dermatitis. About 35% will survive for 10 years. I don't think there's anything for the ER to do. There are four different stages of systolic heart failure: A, B, C, and D. When the condition progresses to the next stage, a persons chance of surviving decreases. Do, what suits you. elevating your legs or other swollen part of the body above the heart to help keep blood returning to the central circulation. The two most common causes are: mitral valve insufficiency (MVI). Structural heart disease develops at this stage, such as reduced pumping function of the heart, which can lead to an enlarged left ventricle. There are many causes of CHF in dogs. But it really just refers to a state of heart failure in which fluid buildup in the body is serious enough to require medical attention. He or she may be able to change your prescription to help relieve you from the swelling in your legs. There are medicines and treatments that reverse many cases of heart failure, and in most cases, the outlook is generally very good. For reducing water retention in the legs, elevate your affected area a few times daily to help relieve pressure. How are weeping legs and diabetes connected?Here are other causes of edema due to diabetes-related conditions: Diabetic neuropathy is a nervous disorder caused by diabetes. It usually occurs in the feet, ankles, and legs, but it can happen in other parts of the body, too. Congestive heart failure is a type of heart failure which requires seeking timely medical attention, although sometimes the two terms are used interchangeably. Daily heart meds toprol, candesartan , iso mono, use nitro regularly . Weeping edema is swelling due to constant fluid leakage in any part of the body, including the arms, legs, eyes, face, hands, feet, ankles, and brain. A recent report published by the American Heart Association estimates that 6.2 million American adults have heart failure, and that number is growing as the U.S. population continues to age. stockings measured and prescribed by a doctor or until then, go to any drug store and get 20-30 mm hg support stockings asap. But among the more serious conditions that can cause edema is heart failure. Stabilizing and/or reversing a patients condition often involves long-term, collaborative follow-up with a referring cardiologist or physician. With congestive heart failure, the hearts capacity to pump blood cannot keep up with the bodys need. When you have heart failure, your heart pumps less forcefully. This keeps the heart from meeting the bodys requirements for oxygenated blood. Best food forward: Are algae the future of sustainable nutrition? Congestive heart failure is often caused by excessive alcohol intake and hypertension. Treatment for Congestive Heart Failure. Congestive Heart Failure Follow-up. You may observe your dog trying to sleep quietly sitting up. Also, adults with diabetes have two to four times higher death rates from cardiovascular disease than adults without diabetes. Do, what suits you. It usually occurs in the feet, ankles, and legs, but it can happen in other parts of the body, too. Symptoms of HF range from mild to severe but may get worse over time if not managed medically. In the case of heart failure, that could involve the use of medications like: In very serious cases, implantable pumps or defibrillators are needed to help the heart muscle keep up with the bodys demand for blood. Almost 6 million Americans have congestive heart failure. If fluid builds up quickly, you can get fluid in the lungs . WebWhen considering weeping legs, multiple causes come to minda systemic condition, such as hypoproteinemia, cardiac issues, liver failure, or chronic progressive untreated swelling. Edema is swelling that occurs from fluid retention. The authors report that the 5-year survival rate for people under 65 years of age was around 79%, while the rate was about 50% for those 75 and over. Fluid buildup in the feet and legs, known as pedal edema, is a common early sign of heart failure. As heart failure worsens, feelings of lightheadedness and dizziness may appear. WebThe body accommodates for pooling of blood and plasma in the legs. You need compression stockings measured and prescribed by a doctor or until then, go to any drug store and get 20-30 mm hg support stockings asap. The management of fluid leakage in grossly oedematous legs Digital Edition: The management of fluid leakage in grossly oedematous legs . Fluid may build up in the lungs, liver, gastrointestinal tract, and the arms and legs. It may happen when the heart muscle is too weak or when another health problem prevents it from circulating blood efficiently. WebMy father has congestive heart failure and has similar weeping from his legs and feet. Sleeping on your back with your head propped up can be the best sleeping position for heart failure. However, edema from an infection or inflammation may cause no symptoms. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. The most common cause of congestive heart failure is coronary artery disease. You can do it by getting a head elevated bed, wedge pillow, or stuffing 2-3 pillows under your head while sleeping. A persons life expectancy with CHF will vary depending on numerous factors, including their age, the stage of their condition, and the strength of their heart function. Out of these 3 options, I think a wedge pillow will be the best option. The treatment for the systemic condition is aimed at addressing the culprit, whereas the latter requires adequate compression. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Obesity is a known risk factor for heart failure. Doctors may prescribe diuretics to help the body eliminate excess liquid. Heart failure signs and symptoms may include: Shortness of breath with activity or when lying down Fatigue and weakness Swelling in the legs, ankles and feet Rapid or irregular heartbeat Reduced ability to exercise Persistent cough or wheezing with white or pink blood-tinged mucus Swelling of the belly area (abdomen) For this reason, it is essential to control risk factors that may cause stage A HF and follow up regularly with your doctor. The above 2019 meta-analysis also found no significant difference in the survival rate between patients with an EF below 40% and those with one above. Read on to learn more about this diuretic drug and how it can help with heart failure. Dr. Robert T. Spalding answered Podiatry 25 years experience PVD & serious edema: Peripheral vascular disease leading to edema will continue to get worse to the point of fluid leaking from skin. Marawan A, et al. WebWith congestive heart failure, the hearts capacity to pump blood cannot keep up with the bodys need. Systolic congestive heart failure occurs when the heart does not pump blood effectively. Fluid leaking from legs is almost always co-occurring with swelling and edema. All rights reserved. The available treatments largely depend on the exact cause of the CHF. Learn more about the link. Read on to learn more about these two types of heart disease, such as how they differ, their causes. WebCongestive heart failure. It's often caused, Taking diuretics is part of standard heart failure treatment, but these medications may carry some potentially serious side effects and can cause, Because stress-induced cardiomyopathy and a heart attack have similar symptoms, its critical you treat sudden and intense chest pain and related. I had been having tingling in my legs. Not always; it depends on the cause of HF. A diagnosis is made by a combination of blood tests, stress tests, chest x-rays, heart ultrasound, and angiograph. This section will examine the different weeping edema causes that may be mild, more severe, or occur as a symptom of medications. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. It is common for diabetics to have low immunity toward infections; therefore, leg swelling can also be a sign of an infection. A person usually has no symptoms of HF at this stage but may experience symptoms of their chronic conditions, including: People with this stage HF have no problems with the structure of the heart or how their heart works. WebEdema can be an early sign of congestive heart failure. The process often takes more than one meeting and involves both thepatients local cardiologist and referring physician. Heart failure can result from several issues, including: Diseases like diabetes and sleep apnea can also weaken the heart. This forces the body to reabsorb the leaking fluid. Your doctor may also prescribe diuretics and medications for the underlying cause of edema. Gestational diabetes is a unique type of diabetes that is only a problem for pregnant women, and it disappears once the baby has been born. Congestive Heart Failure 101. If you have CHF, check with a doctor before beginning any new exercises. Best food forward: Are algae the future of sustainable nutrition? If you've been diagnosed withcongestive heart failure, the feeling of your chest constrictingcan be scary. A case study published out of Germany in 2005 found that a patient with diabetes also had signs of muscular weakness and leg edema, which had not responded to previous treatment. About 35% will survive for 10 years. To learn more, please visit our, will continue to get worse to the point of fluid leaking from skin. A tube (catheter) puts heat right into the affected vein. They said it's a sign of the final stage of his heart failing. Fluid buildup in the feet and legs, known as pedal edema, is a common early sign of heart failure. The term congestive refers to the resulting buildup of fluidin the ankles and feet, arms, lungs, and/or other organs. Pressure in the blood vessels will allow fluids to then seep into the abdomen, and cause abdominal swelling and leg edema. Congestive heart failure is often caused by excessive alcohol intake and hypertension. WebThis is called diastolic heart failure, or heart failure with a preserved ejection fraction (HFpEF). my husband's are the same only his legs are red and has water blisters and leaks clear. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. While it is essential to stay hydrated, a doctor can recommend just how much fluid a person can safely consume a day. Symptoms of edema will depend on the amount of swelling, and where it occurs in the body. If the muscle cannot relax, the pressure in the ventricle increases, causing symptoms. What Are These Tiny Red Spots on My Skin (Petechiae)? Congestive heart failure is often caused by excessive alcohol intake and hypertension. These include: People with advanced HF might need more intensive treatment. Doctors may advocate the use of implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapy (CRT) when required. Web'Leaky legs': strategies for the treatment and management of lower-limb lymphorrhoea | Nursing Times EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 10th Floor, Southern House, Wellesley Grove, Croydon, CR0 1XG We use cookies to personalize and improve your experience on our site.