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Cryotherapy for Early Stage Breast Cancer


CW Hall and Dr. April Speed

Cryotherapy for Early Stage Breast Cancer

On this week’s episode I sat down with award-winning Atlanta-area breast surgeon, Dr. April Speed regarding treatment options for breast cancers, including cryotherapy.  She shared what motivated her to enter the medical field as her chosen profession and how she is pleased to have brought her expertise in treating cancers of the breast to a community that has limited access to cancer care.

Dr. Speed discussed the process through which she determines best course of action for treating a worrisome lump of the breast, be that a lumpectomy (removing the lump but leaving the healthy breast tissue), mastectomy (removing the affected breast), or a minimally-invasive approach.

Given the short recovery time of the minimally-invasive option, it is desirable when the tumor type and size fall within established guidelines.  In many cases, patients are able to return to work the same day and typically results in less pain for them. One such procedure is the Visica 2 Procedure, made by Sanarus. (Visica 2 is the Treatment system, the Visica Procedure is the procedure.)

This technology allows the breast surgeon to use a small, super-cooled probe that is guided to the abnormal tissue within the breast by imagery.  The probe is below freezing, and is used to freeze the cancerous tissue, destroying it.  Over time, once the procedure is complete, the destroyed tissue is slowly reabsorbed.

I was pleased to talk about this with Dr. Speed, as she is one of fewer than 10 breast surgeons in the state of Georgia who are able to perform this minimally-invasive, early stage breast cancer treatment.

About Sanarus/the Visica Procedure – In 2001, the Visica® Treatment System was the first system available for cryoablation of fibroadenomas. Since then, our systems have been used to successfully treat thousands of patients. Since 2007, the Visica 2 Treatment System has been used to treat cancer in hundreds of cryoablation-assisted surgeries and dozens of cryoablation-only procedures in clinical trials.

Disclaimer:  The Visica 2 Treatment system is FDA-cleared for the ablation of cancerous or malignant tissue and benign tumors. It’s been used in over 5,000 cryo-assisted surgeries and cryo-only procedures.

Special Guest: 

Dr. April Speed, MD, Global Breast Health & Wellness Center; Just Breast, LLC

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  • Doctor of Medicine, Morehouse School of Medicine
  • Residency, MD Anderson Cancer Center
  • Board of Directors, Susan G. Komen for the Cure
  • Board of Directors, Southeastern Primary Care Consortium

Dr. Priyah Rudolph

Dr. Priyah Rudolph

On this episode of Top Docs Radio I hosted Dr. Priyah Rudolph, medical oncologist with Georgia Cancer Specialists.  Dr. Rudolph practices in the Athens, GA office for the group and has expertise with several forms of cancer.  She shared her poignant story about how she came to choose oncology as her specialty of practice.

Dr. Rudolph described how several members of her family experienced cancer in their lives, including her mother.  In speaking with her it’s clear she has a very personal connection with patients she sees in her practice and clearly understands the stress and concern they feel.

For this conversation, we focused on breast cancer.  According to, in the US, roughly 1 in 8 women will develop breast cancer in their lifetime.  Nearly 300,000 new cases will be diagnosed this year.

Priya shared the importance self-breast exams, conducted at least monthly, paired with annual mammograms annually after the age of 40 or sooner if direct descendants of breast cancer patients.  Early detection helps give the patient more options for treatment, as well as the likelihood of successful treatment.

She talked about various treatments available and what to expect should the troubling news come that a finding is indeed cancer.  On a positive note, we talked about the fact that breast cancer is very survivable with today’s technology and medical advancements.

Special Guest:

Dr. Priyah Rudolph, MD, of Georgia Cancer Specialists  Pinterest-logo  facebook_logo_small3  instagram-logo-transparent-png-i11 (16x16)  linkedin_small1  youtube logo

Georgia Cancer Specialists

  • Doctor of Medicine, Coimbatore Medical College
  • Residency, Yale University School of Medicine
  • Fellowship, Yale University School of Medicine
  • American Society of Clinical Oncology
  • American Society of Hematology
  • PhD in Physiology at The Ohio State University


Radiation Oncology

Radiation Oncology

On this week’s show I sat down with Radiation Oncologist, Dr. Chad Levitt. We talked about how he decided he wanted to go into radiation oncology as his chosen field of practice. He shared how he enjoyed the fact that the specialty allowed him to call on his liberal arts schooling, helping him to be able to be perceptive to his patients’ needs and concerns, and allowing him to communicate effectively with them in a period of significant stress.

Chad explained how important it is for oncology physicians to make time to insure their patients’ questions are answered and that their concerns have been addressed. He believes the patient needs to be well-informed so they can hopefully experience less anxiety and allow them to make educated choices about their care. He stated the patient should be the “Captain of the Ship” and the health team the crew that helps them get to where they want to go.

We talked about the importance of getting 2nd and even 3rd opinions when facing life-changing illnesses such as cancer. Chad shared that it is vital to do so before engaging in treatments that cannot be undone. Given the political and personal alliances that can be present in a given hospital ecosystem, it is wise to seek 2nd opinions in hospitals or systems that are outside that of the primary physician to allow for likelihood of a more objective opinion.

Special Guest:

Dr. Chad Levitt, MD, of Radiotherapy Associates of Forsyth

Radiotherapy Associates of Forsyth

Loving Arms Cancer Outreach

Loving Arms Cancer Outreach

Loving Arms Cancer Outreach

Over the past year we’ve talked about cancer on several occasions.  We have hosted physician panels, sharing how to prevent cancers and how they’re diagnosed, and treatment options patients have to choose from.

We’ve also spoken with cancer survivors who have come on the share their stories about being diagnosed, and their experiences during treatment and beyond, as survivors.

This week I hosted cancer survivor, Angel DeJesus, office manager for Loving Arms Cancer Outreach.  This non-profit cancer support organization was started by two practicing oncology nurses.  They had seen how many patients deplete their financial resources paying for their cancer care.

This leaves them with with limited ability to pay for obligations of daily life such as rent/mortgage, utilities, gas to get them to treatment, and more.  They started Loving Arms Cancer Outreach to provide some measure of assistance with these needs along with support group services, education, opportunities to volunteer, and others.

Angel shared his poignant story about experiencing a cancer that ultimately cost him is right eye and how he, too, lost his home, job, and savings paying for his cancer care.  He explained how Loving Arms Cancer Outreach provided him with their support services and even were able to provide rides to his treatment when he was a patient.

The financial expense and logistics of providing rides to cancer patients was too great for the organization to continue that service.  But they continue to offer financial assistance and support group services and others.  We are hopeful listeners will help with donations, time, or share this message with folks who may be able to do so.

Special Guest

Angel DeJesus, Office Manager, Loving Arms Cancer Outreach

Loving Arms Cancer Outreach


Atlanta Plastic & Reconstructive Specialists


Atlanta Plastic & Reconstructive Specialists

This week I featured 3 of the physicians from Atlanta Plastic & Reconstructive Specialists.  They are known for providing expert care for patients in need of reconstructive surgery after cancer treatment or trauma as well as for those who are seeking aesthetic procedures.

Dr. Donald Nunn is a triple-boarded surgeon and unique in the fact that he completed residencies and board certification in 3 specialties, Oral & Maxillofacial Surgery, Ear, Nose, & Throat, and Plastic surgery.  He is able to bring this range of training and experience to bear for his patients who need facial surgery as well as the full scope of plastic surgery procedures.

Dr. Bahair Ghazi shared how he benefited from spending several months training in Belgiam, learning some subtle differences in approach that he’s able to apply in his work when it can enhance the final outcome of his surgeries.  It’s clear talking with Dr. Ghazi he is passionate about plastic surgery and how it can have such a positive impact on quality of life for the patients he sees.  He shared some great information on the tummy tuck and pandectomy procedures for patients who have lost significant amounts of weight or that are wanting to become more active but excess body fat inhibits doing so.

Dr. Susann Bedford talked about how she feels a special relationship with the women she’s treating with breast surgery, whether reconstructive after cancer treatment, or aesthetic for women wanting to change their look for improved body image.  She shared how she was able to spend time during her training with some of the world’s highly-regarded specialists in breast and plastic surgery, helping her provide some of the best techniques available to achieve the best aesthetic result possible for a given case.

Special Guests:

Dr. Donald Nunn, MD, of Atlanta Plastic & Reconstructive Specialists  facebook_logo_small3  twitter_logo_small-e1403698475314  linkedin_small1  youtube logo  Pinterest-logo  google-plus-logo-red-265px


  • Doctor of Dental Surgery, Medical College of Virginia
  • Residency, Oral & Maxillofacial Surgery, University of North Carolina
  • American Board of Oral & Maxillofacial Surgery
  • Doctor of Medicine, Medical College of Virginia
  • Residency, Neck and Head Surgery, Medical College of Virginia
  • Residency, Plastic Surgery, University of California
  • American Board of Plastic Surgery
  • American Board of Otolaryngology/Head and Neck Surgery

Dr. Bahair Ghazi, MD, of Atlanta Plastic & Reconstructive Specialists  twitter_logo_small-e1403698475314  facebook_logo_small3  linkedin_small1


  • Surgical Training

    Emory University Plastic & Reconstructive Surgery
    Emory University General Surgery
    West Virginia University, M.D.

  • Externships

    Cosmetic Surgery Sint Martens Latem, Belgium
    Cosmetic & Breast Reconstruction Brussels, Belgium
    Microsurgical Breast Reconstruction Ghent, Belgium

  • Board Certifications

    American Board of Plastic Surgery
    American Board of Surgery

Dr. Susann Beford, MD, of Atlanta Plastic & Reconstructive Specialists  facebook_logo_small3  linkedin_small1


  • Doctor of Medicine, University of Pittsburgh, School of Medicine
  • Residency, Plastic Surgery, Barnes-Jewish Hospital of Washington University Hospital
  • Fellowship, Breast & Aesthetic Surgery, Georgetown University
  • American Board of Surgery
  • American Board of Plastic Surgery



Cancer Support Community Atlanta at Northside Cancer Institute


Cancer Support Community at Northside Cancer Institute


Cancer Support Community Atlanta


at Northside Cancer Institute  linkedin_small1  facebook_logo_small3

This week I sat down with three ladies from the Cancer Support Community at Northside Cancer Institute.  The Cancer Support Community, Atlanta, is a nonprofit organization that is dedicated to providing a variety of supportive services for cancer patients and their families in a home-like environment in the heart of Atlanta. Their staff provides a wide range of support, informative education programs, a variety of gentle stress reduction and exercise classes.  The Cancer Support Community also provides access to a number of social activities that enable cancer patients, survivors, and care givers to get to know others who are in or who have experienced similar challenging circumstances.  All classes are offered free of charge and are led by seasoned professionals committed to supporting individuals and families in our community facing cancer.  Through participating in these educational, supportive, and social offerings, patients, survivors, and loved ones can reduce anxiety in their lives, gain hope and a sense of greater control in their lives, and achieve higher levels of health and fitness (physical and emotional).

My guests on the show have all experienced cancer either as a patient or as a loved one/care giver for a person dealing with cancer.  As you listen to their stories it is quickly apparent that when you engage in the services offered by the Cancer Support Community at Northside Cancer Institute you will be cared for by people who truly understand and can relate to your situation.  Many of the folks you’ll meet when you go to the Cancer Support Community are long-time survivors who have been utilizing their services for a number of years—and they plan to continue.  Check out today’s show and you’ll understand why!

Special Guests:

Rachel Newby, LMSW

Rachel is an Atlanta native who attended Oglethorpe University, where she received a BA in psychology.  She continued her education at UGA where she received her Masters Degree in Social Work. Rachel currently lives in the city of Decatur, is married, has 2 kids and way too many pets!  As for her connection to cancer, Rachel’s mother was diagnosed with advanced breast cancer in 1998, her freshman year of college. Unfortunately, at the time, supportive services for cancer patients were limited and she was extremely isolated. She died during Rachel’s senior year of college. She has been with the Cancer Support Community since 2005, making this her 9th year with the organization. Rachel’s day to day goal is to make sure that people that come to CSC Atlanta feel supported by the staff and one another.

Bonnie Bennett

Volunteer coordinator, CSC-Atlanta, 12-year breast cancer survivor and client of CSC-Atlanta

Bonnie is from Winston-Salem, NC and graduated from UNC-Chapel Hill in 1966 with a BA in Elementary Education. After teaching in NC, she moved to Atlanta in 1969 and went to work for what was then the Trust Company of Georgia, now SunTrust. In 1973, Bonnie married an Atlanta native and started a family. Twelve years ago at age 58, she was diagnosed with breast cancer. Due to a strong family history of the disease, she elected to have a bi-lateral mastectomy with no reconstruction. Two years after this experience, she was introduced to the Cancer Support Community. She found she was having difficulty in returning to life as she had known it before the experience. At CSC, Bonnie found the support she was looking for. The positive and welcoming environment, along with the many activities and events offering further support, helped her move forward. Since that time, Bonnie has continued to participate as an active member in addition to serving as the volunteer coordinator. She coordinates a wonderful group of volunteers who staff the front desk during the week. They are there to greet CSC members, as well as to assist the staff. Bonnie also conducts the Monday morning orientation meeting, which introduces new members to the facility.  Cancer Support Community Atlanta has an annual fundraiser in April, the Chastain Chase 5K, which is staffed by CSC volunteers. Bonnie is a wife, mother and grandmother who is grateful for and passionate about the Cancer Support Community!

Donna Meyer, BSN, MS

Donna Meyer is the Survivorship Coordinator at the Northside Hospital Cancer Institute. In her role she works with patients and caregivers from the time of their diagnosis throughout the balance of their lives—that’s the definition of a “Survivor”! Her focus and passion is on improving the quality of life for families impacted by cancer through treatment summaries, survivorship care plans, supportive care, education and special events.

Donna is a RN with many years of experience in a wide variety of care settings. In addition she has a Master’s Degree in Counseling. She is a cancer survivor herself so she has personal experience with many of the same concerns that patients and families are experiencing. Donna has been active in the community working in schools, churches and community organizations and promotes health and wellness as part of cancer prevention and healthy living after a diagnosis

She is a liaison with the Cancer Support Community and works with them to support their programing and advocate for needs of patients and families within the Northside care system.




Breast Cancer Awareness

Breast Cancer Awareness Month


Breast Cancer Awareness

This week I sat down with three women who each contribute great energy to promote breast cancer awareness in our community.  We kicked off Breast Cancer Awareness Month (October) on this episode with Janet Beebe, CEO, of Breast Cancer Survivors Network, Kim Goff, Executive Director, of It’s The Journey/Atlanta 2 Day Walk for Breast Cancer, and breast cancer survivor/6x Atlanta 2 Day Walk for Breast Cancer participant, Yvonne Lloyd.  Breast Cancer Survivors Network is a non-profit organization that supports breast cancer patients who have insufficient means to purchase breast prostheses after mastectomy as well as covering cost for mammography for women under 40 who are at higher risk for developing breast cancer.  To date the organization has helped over 30,000 women in Georgia through their various services.  The are currently being supported through an impressive charitable donation by McD0nough Toyota.  The dealership is covering the cost of a month-long TV ad campaign on Atlanta’s 11 Alive TV with a “Drive Cancer Away” series of ads to help raise awareness of the organization and breast cancer in general.

The Atlanta 2-Day Walk for Breast Cancer is an annual fundraising endurance walk that takes place this year on October 11-12th and takes participants through 30 miles of Atlanta over the course of 2 days. This year, 950 walkers have committed to fundraising and training for this event. Participants commit to raising $500-1000 each, depending on whether they intend to walk 1 or both days.  Since 2002, the Atlanta 2-Day Walk for Breast Cancer has funded 214 grants totaling $10 million to support breast health programs throughout Georgia. These programs provide mammograms, clinical breast exams, genetic counseling and testing, biopsies, support services, education, and much more. Many of our grants have a specific focus on under-served individuals in our community- uninsured and under-insured women for whom these types of breast health measures are often not available.

Kim Goff, Executive Director, of It’s The Journey/Atlanta 2 Day Walk for Breast Cancer brought along 6 year survivor of breast cancer (and with this year’s event, 6x participant in Atlanta 2 Day Walk for Breast Cancer), Yvonne Lloyd.  Yvonne was kind enough to share her story of diagnosis and treatment and talked about participating in the 2 Day Walk.  She gave some practical advice for folks looking to participate in the event as well as how to remain strong in the face of dealing with breast cancer through faith and support from friends and loved ones.

Breast Cancer Awareness on TopDocsRADIO

Special Guests:

Janet Beebe, CEO of Breast Cancer Survivors Network  twitter_logo_small  google-plus-logo-red-265px  facebook_logo_small3  

Breast Cancer Survivors Network

  • 31 Yr, 2 time Breast Cancer Survivor…4 time cancer survivor
  • President, Founder and Director of The Breast Cancer Survivors’ Network, Inc.
  • Recipient of multiple awards including “Volunteer of the Year” from Am. Cancer Society and United Way and “Business Woman of the Year” by Nat’l. Assoc. of Business Women
  • Frequently spotlighted by numerous publications and media outlets including Atlanta Magazine, ATL Journal & Constitution, Fayette Woman’s Magazine and others

Kim Goff, Executive Director of It’s The Journey, Inc/Atlanta 2 Day Walk for Breast Cancer  twitter_logo_small  facebook_logo_small3  linkedin_small1  youtube logo

It's the Journey Atlanta 2 Day Walk for Breast Cancer

  • Consultant, The Chason Group
  • Former Senior Vice President, Georgia Chamber of Commerce
  • MBA, Georgia State University
  • Georgia State University Robinson College of Business Alumni Award

Yvonne Lloyd, Breast Cancer Survivor

Atlanta 2 Day Walk for Breast Cancer

  • Lobular carcinoma Stage 2 lesion without lymph node involvement
  • Chose mastectomy/reconstruction
  • 5 year course of aromatase inhibitor, Femara
  • This year makes 6x participant in Atlanta 2 Day Walk event

Talking Skin Cancer

Northside Cancer Institute


Skin Cancer

According to, more than 2 million persons per year are diagnosed with skin cancer.  There are more cases than breast, lung, prostate, and colon cancers combined.  Left undiscovered or untreated for too long, these cancers can spread to other parts of the body, leading to serious illness and death.  1 in 5 Americans will develop skin cancer in their lifetime.  It’s a problem we can reduce in frequency with which it occurs.  When skin cancer does occur it is ideally treated by a team of physicians from a variety of specialties to most effectively eliminate the cancer and reduce the risk for it returning.  On this week’s show I sat down with 5 of Atlanta’s top physicians who make up the multi-specialty team who treat skin cancer at the Northside Cancer Institute.  We discussed expert-recommended ways to limit the likelihood of developing skin cancer as well as how to get thoroughly checked for the presence of worrisome lesions that could potentially be or that could become cancers.  In this way, patients who do develop cancerous skin lesions can catch them at an early stage, making it possible to successfully eliminate the cancer with less aggressive treatments.  In addition to a dermatologist who frequently works with skin cancer patients we had a chance to learn what the treatment options are for the various stages of skin cancer.  And we discussed what a patient can expect as they progress through the course of care from a surgical oncologist, medical oncologist, reconstructive plastic surgeon, and radiation oncologist.

Northside Cancer Institute

Special Guests :

Dr. Alexander Gross, MD of Georgia Dermatology Center  google-plus-logo-red-265px  twitter_logo_small  youtube logo  facebook_logo_small3 

Georgia Dermatology Center

  • Doctorate of Medicine, University of South Florida College of Medicine
  • Residency, Dermatology, Vanderbilt University
  • Fellow, American Academy of Dermatology, American Society for Laser Medicine and Surgery, American Society for Dermatologic Surgery and American Academy of Cosmetic Surgery

Dr. Jenny Chang, MD of Artisan Plastic Surgery  facebook_logo_small3  linkedin_small1

Jenny Chang

  • MD, Universidad de Buenos Aires with Honors
  • w Residency, General Surgery, Providence Hospital and Medical Center
  • w Faculty, Department of Surgery, Providence Hospital and Medical Center
  • w Fellowship, Plastic Surgery, Detroit Medical Center/Wayne State University
  • w Board Certified, Plastic Surgery and General Surgery

Dr. Sahar Rosenbaum, MD of Northside Hospital Radiation Oncology Care  

Northside Radiation Oncology Care

  • Doctorate of Medicine, Medical College of Pennsylvania
  • Residency, Radiation Oncology, Cooper Hospital/UMC
  • Board Certified, Radiation Oncology
  • Also holds degrees in Speech Pathology/Audiology and Masters in Psychology

Dr. Scott Davidson, MD of Melanoma Specialists of Georgia    

Melanoma & Sarcoma Specialists of Georgia

  • Doctorate of Medicine, University of Florida School of Medicine
  • Residency, General Surgery Orlando Regional Medical Center
  • Residency, Surgical Oncology, MD Anderson Cancer Center
  • Board Certified, American Board of Surgery
  • Fellowship, Surgical Oncology, MD Anderson Medical Center

Aaron Alizadeh, MD of Georgia Cancer Specialists    Pinterest-logo  instagram-logo-transparent-png-i11 (16x16)  youtube logo  facebook_logo_small3

Georgia Cancer Specialists

  • Doctorate of Medicine, Wayne State University
  • Residency, Oncology, Emory University
  • Fellowship, Hematology/Oncology, Emory University
  • Board Certified, Medical Oncology/Hematology, and Internal Medicine

Important Cancer Resources for Georgians

GeorgiaCORE and TurningPoint Breast Cancer Rehabilitation


Cancer Resources for Georgians

Special Guests: Alice Kerber, Angie Patterson, and Erin Long

This week we’ll hear about important cancer resources available to patients in Georgia from Alice Kerber and Angie Patterson of GeorgiaCORE. The organization is a public private partnership dedicated to facilitating cancer prevention, care, research, and education.  They are focused on helping patients get better access to available cancer resources from early diagnosis to best treatments available, and support once they are survivors.  Through initiatives such as, Georgia Breast Cancer Genomic Consortium, and the Cancer Patient Navigator program, GeorgiaCORE facilitates greater community awareness and helps improve cancer outcomes for Georgians.  TurningPoint Breast Cancer Rehabilitation provides a range of specialized rehabilitation services tailored specifically for the breast cancer survivor.  As a charitable organization they are able to provide care to under- or uninsured patients who require care as well.  Director of Development, Erin Walker Long discusses the therapies they provide along with some of their upcoming fund-raising initiatives.

Alice Kerber, MN, APRN, ACNS-BC, AOCN, APNG, GeorgiaCORE   facebook_logo_small3  twitter_logo_small  linkedin_small1  youtube logo

  • Oncology Nurse Specialist working to improve quality of cancer care in Georgia
  • 34 years of oncology experience, both inpatient & outpatient
  • Heavily involved in a CDC program, “Georgia Breast Cancer Genomic Consortium”
  • 2011 Recipient, Oncology Nurse of the Year by Georgia March of Dimes

Angie Patterson, Vice President of Research & Education, GeorgiaCORE

  • Co-founder, Cancer Patient Navigators of Georgia
  • Focused heavily on improving cancer care through implementation of patient navigation and survivorship programs
  • Breast Cancer Survivor
  • Volunteer with Northside Hospital’s Network of Hope

Erin Long, Development Director for TurningPoint Breast Cancer Rehabilitation  facebook_logo_small3  twitter_logo_small  feed logo

  • 15 years of fundraising experience in healthcare and education
  • Enjoy tennis, exercise and reading
  • Mother of two children under 4

Cancer Survivors Discuss Late Effects of Radiation


cancer survivors and late effects of radiation


Cancer Survivors

This week I am joined by two cancer survivors who successfully beat their cancers but ended up as part of the group of patients who have problems where they received radiation therapy, called “late effects of radiation”. For most patients who experience these issues the symptoms they experience get better with a few weeks of time and conservative measures. But for some, they persist and can have significant impact on quality of life.  The symptoms these patients experience depend upon where the radiation was administered on to the body.  They can include non-healing wounds on the gums, sometimes exposing the jaw bone (mandible), necrosis (cell death) of the jaw bone, breast pain, chronic diarrhea, bleeding with urination or bowel movements, bladder pain, painful bowel movements, and sensations of urinary and/or bowel frequency and urgency.  Hear how they were able to successfully treat their late effects of radiation with hyperbaric oxygen therapy.

cancer survivors and late effects of radiation

Dick Cailouet and Dan Dodson, cancer survivors who are among the group who experienced late effects of radiation.

Special Guests

Dick Caillouet   facebook_logo_small3 twitter_logo_small Pinterest-logo google-plus-logo-red-265px

Dan Dodson  

  • 3 year survivor of tonsilar cancer  twitter_logo_small linkedin_small1 facebook_logo_small3 google-plus-logo-red-265px
  • CEO, Co-founder, Mastermind Marketing
  • Previously, CPA, HLB Gross Collins, PC
  • Expert in Involvement Marketing, having been published in numerous publications and speaking at trade shows on the subject.