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HOW TO WRAP (DOCUMENT)

DAY- 3/4 RE-WRAP PROTOCOL SUMMARY: FOLLOW THE STEPS BELOW

  • RE-WRAP WILL BE PERFORMED EITHER ON THE EVENING OF DAY-3 OR THE MORNING OF DAY-4. THIS RE-WRAP WILL BE THE VERY SAME WRAP RECEIVED ON THE TREATMENT DAY (UNLESS INSTRUCTED OTHERWISE).
  • WHEN IT IS TIME FOR YOUR RE-WRAP, PLEASE PREPARE FIRST: YOU WILL LAY OUT ALL OF YOUR WRAP MATERIALS FIRST, THEN TAKE A SHOWER, AND DURING THE SHOWER YOU CAN REMOVE THE CURRENT WRAP, THEN PAT ALL DRY, THEN TAKE PHOTOS WHILE THE WRAP IS OFF, THEN PLACE COMPLETE WRAP BACK ON, THEN TAKE PHOTOS AGAIN. 
  • PLEASE NOTE: THAT YOUR LOOPED RUBBER BAND AND TIGHT HALF FOLD AT THE PENILE BASE IS YOUR PRIMARY PENILE SHAFT BARRIER UNTIL DAY-8.
  • STEP 1 – REMOVE YOUR WRAP (EXCEPT GLUED DOWN SPOT BAND-AID) DURING YOUR 10-15 MINUTE HOT SHOWER, THEN PAT DRY, THEN TAKE PHOTOS.
  • STEP 2 – INSPECT THE SPOT BAND-AID AREA TO MAKE SURE ALL IS SECURE. IF LEAKING IS VISIBLE, REPLACE SPOT BAND-AID AND RE-GLUE.
  • STEP 3 – PLACE 2 TOE PADS OVERLAPPING EACH OTHER ON THE UNDERSIDE OF THE SHAFT, JUST UNDER THE GLANS.
  • STEP 4 – THEN PLACE YOUR WINGED BAND-AIDS ON AT THE VERY BASE OF THE PENILE SHAFT, ONE ON THE UPPER SIDE (PENILE SHAFT AND PUBIC AREA) AND ANOTHER ONE ON THE BOTTOM (PENILE SHAFT AND SCROTUM) (USE TAPE TO SECURE IF NEEDED).
  • STEP 5 – PLACE A THIN COAT OF TRIAMCINOLONE 0.5% OINTMENT SPREADING OUT EVENLY THROUGHOUT ON THE ENTIRE PENILE SHAFT, GLANS, PUBIC, AND SCROTAL AREAS (ESPECIALLY WHERE THE LOOPED RUBBER BAND AND THE PLASTIC RING PLACES PRESSURE ON THE PUBIC AND SCROTAL AREAS).
  • STEP 6 – PLACE BROWN STRETCH GAUZE WRAP ON ENTIRE SHAFT WITH MILD TENSION, STARTING FROM THE BASE, AS LOW AS POSSIBLE, AND OVERLAPPING 80-90%, UNTIL YOU REACH THE GLANS (HEAD OF PENIS), COVERING THE TOE PAD BUT NOT ABOVE. PLACE PAPER TAPE TO SECURE.
  • STEP 7 – PLACE 8-10 TURNS OF BLUE PRE-WRAP WITH VERY MILD TENSION AS LOW AS POSSIBLE ON THE PENILE SHAFT (ON TOP OF WINGED BAND-AID), JUST BELOW THE EDGE OF THE BROWN STRETCH GAUZE. PLACE PAPER TAPE TO SECURE. THIS PROVIDES SKIN CUSHION FOR WHEN THE TIGHT HALF-FOLD AND LOOPED RUBBER BAND ARE PLACED AFTERWARDS.
  • STEP 8 – PLACE BROWN STRETCH GAUZE WRAP DIRECTLY ON THE BLUE PRE-WRAP, AND WORK UP THE SHAFT TO ⅓-½ THE WAY, NO MORE, AND WITH MILD TENSION ONLY. LEAVE A SMALL VISIBLE EDGE OF THE BLUE PRE-WRAP.
  • STEP 9 – PLACE THE TIGHT HALF-FOLD ON AS LOW AS POSSIBLE ON THE PENILE SHAFT BASE AREA AND WITH TWO FULL TURNS AROUND THE PENILE SHAFT (DIRECTLY ON TOP OF THE BLUE PRE-WRAP & LARGE BAND-AID), AND WITH MODERATE (NOT HIGH) TENSION, LEAVE A VISIBLE BLUE PRE-WRAP EDGE THEN PLACE PAPER TAPE TO SECURE.
  • STEP 10 – PLACE LOOPED RUBBER BAND DIRECTLY ON THE TIGHT HALF-FOLD LOCATED AT THE PENILE BASE AREA. THIS IS YOUR PRIMARY PENILE SHAFT BARRIER. NOTE: ALTERNATE LOOPED RUBBER BAND PLACEMENT EACH TIME YOU TAKE A BARRIER BREAK.
  • STEP 11 – PLACE HALF-FOLD ON THE UPPER SHAFT AREA JUST UNDER THE GLANS. THERE ARE TWO WAYS TO DO THIS:
  • THE ‘SWOOP’ HALF-FOLD IS THE METHOD OF CHOICE IMMEDIATELY AFTER YOUR TREATMENT. IS DONE BY PLACING THE HALF-FOLD DIRECTLY ON THE FRONT OR TOP SIDE OF THE GLANS, AND THEN SWOOP DOWN ON THE UNDERSIDE OF THE GLANS. CONTINUE THIS, BUT ON EACH TURN THE HALF-FOLD SHOULD REMAIN ON THE FRONT OR TOP SIDE OF THE GLANS, AND ON THE UNDERSIDE THE HALF-FOLD SHOULD BE PLACED IN A MORE BROAD WIDE FASHION. PLACE ON WITH MILD TENSION.
  • THE SECOND METHOD: PLACE THE HALF-FOLD DIRECTLY UNDER THE GLANS, LEAVING NO VISIBLE SHAFT SKIN. GO AROUND TWO TIMES AND WITH MILD TENSION.  IF YOU ARE UNCIRCUMCISED, OR YOU ARE DEVELOPING A SHAFT SKIN BULGE THAT IS HANGING OVER THE GLANS, THEN YOU NEED TO PLACE THE HALF-FOLD ON IN THIS FASHION, BUT WITH MODERATE (NOT MILD) TENSION.
  • STEP 12 – PLACE YOUR STRETCHY RING ON – (THIS IS ONLY PLACED ON IF YOU HAD A SCROTAL TREATMENT).
  • FIGURE 8 SCROTAL RING.
  • THE BIG LOOP GOES AROUND THE SHAFT AND SCROTUM AT THE SAME TIME.
  • THE SMALL LOOP FLIPS UPWARDS TO ISOLATE THE SCROTUM ALONE.
  • TWO SCROTAL RINGS TECHNIQUE.
  • THE SILICONE SCROTAL RING (OR THE SMALLEST SCROTAL RING IN DIAMETER POSSIBLE), WILL BE PLACED AROUND THE SCROTAL SACK, ISOLATING THE SCROTUM.
  • THE NEXT SCROTAL RING (BIG RUBBER BANDS) IN SIZE WILL BE PLACED AROUND THE SHAFT AND SCROTUM.
  • STEP 13 – INSPECT EVERYTHING TO MAKE SURE ALL IS IN ON PROPERLY, THEN SEND PHOTOS FOR EVALUATION.

 

DAY- 7/8 RE-WRAP PROTOCOL SUMMARY: FOLLOW THE STEPS BELOW

  • WHEN THE EVENING OF DAY-7 APPROACHES, YOUR NEXT RE-WRAP SHOULD BE DONE. EITHER IN THE EVENING OF DAY-7 OR MORNING OF DAY-8.
  • PREPARATION FOR RE-WRAP: YOU WILL PREPARE ALL OF YOUR WRAP MATERIALS FIRST.
  • STEP 1 – REMOVE YOUR WRAP (EXCEPT GLUED DOWN SPOT BAND-AID) DURING YOUR 10-15 MINUTE HOT SHOWER (EASIER TO REMOVE WHEN WET), THEN PAT DRY, THEN TAKE PHOTOS.
  • STEP 2 – INSPECT THE SPOT BAND-AID AREA: THERE IS NO NEED TO RE-SEAL THIS HOLE AREA. IF THIS IS STILL LEAKING TAKE PHOTOS OF IT AND SENT TO THE GROUP MESSAGING FOR EVALUATION. 
  • STEP 3 – PLACE 2 TOE PADS ON THE UNDERSIDE OF THE SHAFT, JUST UNDER THE GLANS.
  • STEP 4 – PLACE YOUR WINGED BAND-AIDS ON AT THE VERY BASE OF THE PENILE SHAFT OR WHERE IT’S NEEDED (SHAFT/PUBIC AREA, SHAFT/SCROTAL AREA, BEHIND THE SCROTAL SACK).
  • STEP 5 – PLACE A THIN COAT OF TRIAMCINOLONE 0.5% OINTMENT SPREADING OUT EVENLY THROUGHOUT ON THE SHAFT, GLANS, PUBIC, AND SCROTAL AREAS (ESPECIALLY WHERE THE STRETCHY RINGS AND THE PLASTIC RING PLACE PRESSURE ON THE PUBIC AND SCROTAL AREAS).
  • STEP 6 – PLACE BROWN STRETCH GAUZE WRAP ON ENTIRE SHAFT WITH MILD TENSION, STARTING FROM THE BASE, AS LOW AS POSSIBLE, AND OVERLAPPING 80-90% UNTIL YOU REACH THE GLANS (HEAD OF PENIS), COVERING THE TOE PAD BUT NOT ABOVE. PLACE PAPER TAPE TO SECURE
  • STEP 7 – PLACE HALF-FOLD ON THE UPPER SHAFT AREA JUST UNDER THE GLANS. THERE ARE TWO WAYS TO DO THIS:
  • THE ‘SWOOP’ HALF-FOLD AS EXPLAINED BEFORE.
  • THE SECOND METHOD: PLACE THE HALF-FOLD DIRECTLY UNDER THE GLANS, LEAVING NO VISIBLE SHAFT SKIN. GO AROUND TWO TIMES AND WITH MILD TENSION. IF YOU ARE UNCIRCUMCISED, OR YOU ARE DEVELOPING A SHAFT SKIN BULGE THAT IS HANGING OVER THE GLANS, THEN YOU NEED TO PLACE THE HALF-FOLD ON IN THIS FASHION, BUT WITH MODERATE (NOT MILD) TENSION.
  • STEP 8 – PLACE THE “COMFORT PAD” OVER THE PUBIC AREA AROUND THE BASE OF THE SHAFT.
  • STEP 9 – PLACE STRETCHY RINGS DURING THE DAY AND PLASTIC RING & STRAPS DURING THE NIGHT (WITH HIGH TENSION). THIS ARE NOW THE PRIMARY PENILE SHAFT BARRIERS.
  • STEP 10 – PLACE YOUR STRETCHY RINGS ON- ALTERNATING WITH THE PLASTIC RING AND STRAPS.
  • FIGURE 8 SCROTAL RING (DURING THE DAY).
    • THE BIG LOOP WILL GO AROUND THE SHAFT AND SCROTUM AT THE SAME TIME.
    • THE SMALL LOOP WIL BE UNDER THE SCROTAL SACK, THEN IT FLIPS UPWARDS TO ISOLATE THE SCROTUM ALONE.
  • TWO SCROTAL RINGS TECHNIQUE (TWO SCROTAL RINGS WILL BE PLACED IN TOTAL).
    • THE SILICONE SCROTAL RING (OR THE SMALLEST SCROTAL RING IN DIAMETER POSSIBLE), WILL BE PLACED AROUND THE SCROTAL SACK, ISOLATING THE SCROTUM ALONE. THE NEXT SCROTAL RING (BIG RUBBER BANDS) IN SIZE.
  • STEP 11 – INSPECT EVERYTHING TO MAKE SURE ALL IS ON PROPERLY, THEN SEND PHOTOS FOR EVALUATION.
  • PLEASE NOTE: THAT YOU WILL NO LONGER WEAR THE LOOPED RUBBER BAND AND TIGHT HALF-FOLD AT THE PENILE BASE FROM DAY-8 FORWARD.

 

DAY-8 TO 21 RE-WRAP PROTOCOL SUMMARY: FOLLOW THE STEPS BELOW

  • RE-WRAP WILL BE PERFORMED EITHER ON THE EVENING OF DAY-7 OR THE MORNING OF DAY-8.
  • AFTER YOU HAVE COMPLETED THE DAY-7/8 WRAP, RE-WRAPS WILL BE PERFORMED EVERY 2-3 DAYS UNLESS DIRECTED OTHERWISE UNTIL DAY-21.
  • IF THERE IS A SKIN SORE OR ULCER, YOU WILL NEED TO CHANGE THE WRAP EVERY 1-2 DAYS. THIS EXTRA CLEANING OF THE SKIN WILL HELP THE SKIN ULCER TO HEAL. 
  • PLEASE NOTE: THAT YOUR LOOPED RUBBER BAND AND TIGHT HALF-FOLD ARE NO LONGER USED AT THE PENILE BASE. NOW THE PLASTIC RING & STRAPS DURING THE NIGHT, WITH THE STRETCHY RINGS DURING THE DAY WILL BE YOUR PRIMARY PENILE SHAFT BARRIER UNTIL DAY-21.

 

DAY-22 TO 90 WRAP PROTOCOL: RETAINER WRAP

  • THIS IS A SIMPLE LOW TENSION BROWN STRETCH GAUZE WRAP OF THE PENILE SHAFT TO BE WORN 12-18 HOURS A DAY.
  • IF THE BROWN STRETCH GAUZE IRRITATES THE SKIN, PLACE EITHER BACITRACIN OINTMENT ON OR WHITE GAUZE OR BLUE PRE-WRAP ON FIRST FOR COMFORT.
  • THE PURPOSE OF THIS WRAP IS TO HELP MAINTAIN SHAPE, AND PREVENT ANY UNCONVERTED FILLER FROM SHIFTING AND CAUSING ANY ASYMMETRIC AREAS (BUMPS AND LUMPS) UNTIL DAY 90.

 

RE-WRAP PROTOCOL: DETAILED DESCRIPTION

  • NOTE: THE RE-WRAP WILL TAKE PLACE ON THE EVENING OF DAY-3 OR THE EARLY MORNING OF DAY-4. THIS RE-WRAP WILL BE THE VERY SAME WRAP RECEIVED ON YOUR TREATMENT DAY.

  • REMOVING YOUR WRAP, OR RE-WRAPPING:

  • THE PRIMARY PURPOSE OF RE-WRAPPING IS TO ALLOW THE SKIN TO BE CLEANED, USING SOAP & WATER, PREVENTING BACTERIA BUILD UP WHICH WOULD INCREASE THE RISK OF SKIN INFECTIONS.

  • YOUR FIRST RE-WRAP WILL OCCUR ON THE EVENING OF DAY-3 OR THE MORNING OF DAY-4, THE SECOND RE-WRAP ON THE EVENING OF DAY-7 OR MORNING OF DAY-8, AND THEN ALL OTHER RE-WRAPS EVERY 2-3 DAYS UNTIL DAY-21.

  • SOMETIMES IT IS EASIER TO TAKE OFF YOUR WRAP IN A HOT SHOWER. REMEMBER YOU HAVE ABOUT 15-MINUTES TO TAKE THE SHOWER, REMOVE THE WRAP, AND PLACE THE NEW ONE BACK ON. IT WILL PROBABLY TAKE LONGER THE FIRST TIME, BUT DO THIS AS QUICKLY AS POSSIBLE.

  • PLEASE TAKE PHOTOS OF THE PENILE AREA WITHOUT THE WRAP ON. DR LORIA WANTS TO SEE WHAT YOU SEE. THEN MOVE FORWARD.

  • IF IT IS YOUR DAY-3 RE-WRAP, WHEN REMOVING YOUR WRAP, DO NOT TAKE OFF THE GLUED DOWN BAN-DAID. LEAVE THIS ON AND ALLOW THIS TO FALL OFF ON ITS OWN. IF IT FALLS OFF THEN YOU WILL REPLACE IT WITH A NEW ONE…YOU WILL GLUE DOWN ONE OF THIS SMALL SPOT BAND-AID. BY DAY-7/8 REWRAP, IF THIS GLUED DOWN BAND-AID FALLS OFF, LEAVE IT OFF.

  • ALSO, IF THE TOE PADS ARE ‘STUCK ON’ YOU CAN LEAVE THEM ON AS WELL UNTIL THE DAY-7 REWRAP.

  • AFTER YOU HAVE PLACED THE NEW WRAP ON, PLEASE TAKE PHOTOS FOR EVALUATION.

 

  • WHEN INSPECTING THE SPOT BAND-AID AREA

  • THE PRIMARY PURPOSE OF HAVING A GLUED DOWN BAND-AID ON THE NEEDLE HOLE OR PORT WHERE THE FILLER WAS PLACED FOR 7 DAYS (THIS PORT BEING LOCATED ON THE RIGHT LATERAL SIDE OF THE PENIS AND AT THE MID-SHAFT LEVEL) IS TO PREVENT LOSS OF FILLER MATERIAL FROM LEAKING OUT OF THAT HOLE.

  • AS MENTIONED ABOVE, THERE IS NO NEED TO PLACE ANOTHER GLUED DOWN BAND-AID IF IT IS STILL ON BY DAY-3 DURING YOUR REWRAP TIME.

  • HOWEVER, IF IT IS OFF, GLUE DOWN ANOTHER ONE. IF YOU ARE FINDING IT DIFFICULT TO SEAL THE HOLE, TEMPORARILY REMOVE THE LOOPED RUBBER BAND BARRIER, THEN PLACE THE GLUED BAND-AID ON, THEN PLACE THE LOOPED RUBBER BAND BACK ON.

  • IF THERE IS DRAINAGE FROM THE DAY-3 TIME FRAME, PLACE ANOTHER GLUED DOWN BAND-AID, BUT IF THERE IS DRAINAGE FROM THE DAY-7 WRAP TIME FRAME OR AFTERWARDS, DO NOT RESEAL THIS HOLE, AND SEND PHOTOS OF THIS DRAINAGE TO DR LORIA FOR EVALUATION.

 

  • TOE PADS PLACEMENT ON THE UNDERSIDE OF THE SHAFT, JUST UNDER THE GLANS.

  • THE PRIMARY PURPOSE OF PLACING TOE PADS IN THIS LOCATION IS TO HELP PREVENT SKIN BULGING AND IMBALANCE IN THIS HIGH RISK AREA.

  • THESE TOE PADS HELP PLACE ADDITIONAL PRESSURE ON THE UNDERSIDE AREA OF THE PENILE SHAFT THAT IS JUST UNDER THE GLANS. WHY IS THIS SO IMPORTANT? BECAUSE THIS IS AN AREA THAT IS AT HIGH RISK TO ‘BALLOON OUT’ AND FORM AN IMBALANCE IN THIS AREA. THE SKIN IN THIS AREA IS MUCH THINNER THAN THE REST OF THE PENILE SHAFT, AND IT HAS A GREATER ‘STRETCH’ FACTOR….SO IT CAN ACCUMULATE MORE OF THE FILLER AND RESULT IN A BULGE IF ‘COUNTER PRESSURE’ IS NOT PLACED ON IT.

  • IT IS THE COUNTER PRESSURE FROM THE TOE PADS, AND THE HALF-FOLD, AND, MOST IMPORTANTLY, YOUR DIRECT FINGER PRESSURE SHAPING EXERCISE THAT WILL HELP AS WELL.

  • WHEN PLACING ON THE TOE PADS, THE ‘FINGER’ PORTION OF THE TOE PADS ARE ALWAYS PLACED DOWNWARD (POINTING TOWARDS THE PUBIC/SCROTAL AREA).

  • THE ‘NON-FINGER’ PORTION OF THE TOE PAD WILL BE PLACED DIRECTLY ON THE UNDERSIDE OF THE SHAFT, WITH A SMALL PORTION OF THE TOE PAD ON THE LOWER EDGE OF THE GLANS ITSELF. IF A SECOND TOE PAD IS NEEDED, PLACE THIS ONE ON TOP OF THE FIRST.

  • ALL OF THESE FACTORS WILL HELP PREVENT THE BULGE IN THIS AREA.

 

  • WINGED BAND-AID PLACEMENT ON AT THE VERY BASE OF THE PENILE SHAFT

  • THE PRIMARY PURPOSE OF PLACING TWO WINGED BAND-AIDS, ONE ON THE TOP SIDE AND THE OTHER ON THE UNDERSIDE OF THE BASE OF THE PENILE SHAFT, IS TO PREVENT SKIN SORES AND ULCERS IN THIS AREA.

  • THE MOST SENSITIVE SKIN AREA THAT IS MOST PRONE TO SKIN ULCERATION IS THE UNDERSIDE OF THE BASE OF THE PENILE SHAFT WHERE THE SHAFT MEETS THE SCROTUM.

  • THE BAND-AIDS ALSO HELP PREVENT THE BROWN STRETCH GAUZE FROM RUBBING IN THE SKIN CAUSING IRRITATION AND ULTIMATELY A SKIN SORE OR ULCER.

 

  • TRIAMCINOLONE 0.5% OINTMENT PLACEMENT:

  • THE PRIMARY PURPOSE OF TRIAMCINOLONE OINTMENT IS TO PREVENT SKIN SORES, SKIN ULCERS, AND SKIN ITCHING.

  • TRIAMCINOLONE OINTMENT (OR “TRI” OINTMENT) IS PLACED ON THE GLANS EVERY EVENING. THIS TRI OINTMENT AND BACITRACIN ARE PLACED ON THE GLANS JUST PRIOR TO THE NITROBID OINTMENT. THE REASON YOU FIRST PLACE THE TRI AND BACITRACIN OINTMENTS FIRST IS BECAUSE THERE IS SUCH A SMALL AMOUNT OF NITROBID THAT IS PLACED ON THAT IT SI DIFFICULT TO SPREAD AROUND…SO HAVE THE OTHER OINTMENTS THERE WILL HELP WITH THIS.

  • TRI OINTMENT IS ALSO USED ON ALL OF THE PENILE SHAFT, PUBIC AND SCROTAL AREAS. WHENEVER THERE IS AN OPPORTUNITY TO PLACE TRI OINTMENT ON, ESPECIALLY DURING THE RE-WRAP TIMES, PLACE A THIN COAT OF TRI OINTMENT ON ALL VISIBLE SKIN (PLEASE NOTE THAT YOU ARE TO PLACE TRI OINTMENT AFTER THE TOE PADS AND PENILE BASE LARGE BAND-AIDS ARE PLACED ON OTHERWISE THEY WILL SLIP OFF). SPREAD OUT THE TRI OINTMENT EVENLY THROUGHOUT ON THE ENTIRE PENILE SHAFT, GLANS, PUBIC, AND SCROTAL AREAS (ESPECIALLY WHERE THE LOOPED RUBBER BAND AND THE PLASTIC RING PLACES PRESSURE ON THE PUBIC AND SCROTAL AREAS).

  • IF YOU HAD A SCROTAL TREATMENT, YOU CAN NOT ONLY PLACE THE TRI OINTMENT ON THE AREA WHERE THE BARRIERS AREA PLACING PRESSURE (SUCH AS THE PLASTIC RING AND STRETCHY RING), BUT ON THE ENTIRE SCROTAL SKIN.

  • THIS MEDICATION IS VERY HELPFUL IN PREVENTING SKIN IRRITATION, SKIN ITCHINESS, AND SKIN SORES & ULCERS.

  • IF YOU RUN OUT OF THIS MEDICATION AND DO NOT HAVE TIME TO GET A REFILL, USE THE SUBSTITUTE CORTISONE-10 OINTMENT YOU PURCHASE FROM THE PHARMACY ON YOUR TREATMENT DAY.

 

  • BROWN STRETCH GAUZE PLACEMENT:

  • THE PRIMARY PURPOSE OF THE BROWN STRETCH GAUZE IS TO HELP SHAPE THE PENILE SHAFT.

  • BROWN STRETCH GAUZE IS ALWAYS PLACED ON THE PENILE SHAFT WITH MILD TENSION, UNLESS INSTRUCTED OTHERWISE BY DR LORIA. IF YOU PLACE THE GAUZE ON WITH HIGH TENSION YOU WILL LOSE FILLER MATERIAL BECAUSE THE HIGH TENSION OVER TIME, 24 HOURS 7 DAYS A WEEK, WILL ‘PUSH’ THE FILLER OUT AND INTO THE PUBIC AND SCROTAL AREAS.

  • THE PRIMARY PURPOSE OF THIS BROWN STRETCH GAUZE IS FOR SHAPING THE PENILE SHAFT INTO A NORMAL CYLINDRICAL SHAPE, WHICH THE PENILE SHAFT IS NATURALLY.

  • THE BROWN STRETCH GAUZE ALSO HELP PREVENT EXCESSIVE SWELLING.

  • THIS GAUZE WILL ‘STRETCH’ WHICH WILL HELP WHEN YOU GET AN ERECTION (MAINLY AT NIGHTTIME DURING SLEEP). SO, DURING THE ERECTION BLOOD WILL FLOW IN AND ENLARGE THE PENILE SHAFT, BUT THE GAUZE WILL STRETCH WITH THIS ENLARGEMENT, AND EVENTUALLY CONTRACT BACK INTO FORM AFTER THE ERECTION IS OVER.

  • IF YOU ARE GETTING AN ABNORMAL AMOUNT OF ERECTIONS, THIS COULD BE DUE TO THE NITRO-BID. NITRO-BID HAS A SMALL CAPACITY TO INCREASE BLOOD FLOW INTO THE PENIS AND CAUSE AN ERECTION. IF THIS IS THE CASE, PLACE LESS OF THIS MEDICATION ON THE GLANS AT BEDTIME.

  • WHEN WRAPPING WITH THE BROWN STRETCH GAUZE, YOU ALWAYS START FROM THE LOWEST PORTION OF THE PENILE BASE AREA. YOU MUST OVERLAP MUCH MORE….LIKE 80-90%. THIS IS VERY IMPORTANT. KEEP IN MIND THAT THE GAUZE IS STILL PLACED ON WITH MILD TENSION, BUT GREATER AMOUNT OF OVERLAPPING WILL PREVENT THE PENILE SHAFT FROM BENDING OR CURVING DURING THE FIRST WEEK AFTER TREATMENT DUE TO THE NORMAL SWELLING PROCESS. IF THE PENILE SHAFT BENDS, KINKS, OR A CONCAVITY FORMS THIS IS A TEMPORARY NORMAL ISSUE DURING THE FIRST 7 DAYS. HOWEVER, WHEN THE SWELLING DECREASES, TYPICALLY BY DAY 7, THE SHAFT SHOULD ALL STRAIGHTEN OUT. IF IT DOES NOT STRAIGHTEN OUT THAN MORE VIGOROUS SHAPING EFFORTS WILL BE NEEDED BECAUSE IF THIS IS NOT ADDRESSED IT MAY RESULT IN THE PENILE SHAFT SHAPING THIS WAY AS WELL.

  • NOTE THAT THE SEQUENCE OF BROWN STRETCH GAUZE PLACEMENT IS: FIRST BROWN STRETCH GAUZE, THEN BLUE PRE-WRAP, THEN A SECOND ROUND OF BROWN STRETCH GAUZE AGAIN. THIS SECOND ROUND PLACEMENT OF GAUZE IS IMPORTANT. THIS SECOND ROUND OF BROWN STRETCH GAUZE IS TO ‘UNITE’ THE TWO PARTS TOGETHER…THE BLUE PRE-WRAP WITH THE FIRST ROUND OF BROWN STRETCH GAUZE. IF THIS IS NOT DONE THERE IS A HIGH RISK THAT THE NORMAL SWELLING OF THE PENILE SHAFT, WHICH WILL OCCUR OVER THE FIRST 7 DAYS, WILL FIND THIS JOINT AREA ‘OPENING’ BETWEEN THE BLUE PRE-WRAP AND THE FIRST ROUND OF BROWN STRETCH GAUZE…AND EXCESSIVE SWELLING MIGHT OCCUR THERE CAUSING A TREMENDOUS BULGING. IF THIS SEVERE BULGING WERE TO OCCUR, THE SECOND ROUND OF BROWN STRETCH GAUZE WILL NEED TO BE PLACED ON WITH HIGH TENSION FOR 5-MINUTES AT FIRST, THEN REMOVED AND PLACED ON WITH HIGH TENSION AGAIN FOR 5-MINUTES…AND THIS IS REPEATED UNTIL THE BULGE HAS FLATTENED OUT…THEN YOU WILL PLACE THE SECOND ROUND OF BROWN STRETCH GAUZE WITH MILD TENSION ONLY.

  • NOTE THAT THE SECOND ROUND OF BROWN STRETCH GAUZE PLACEMENT STARTS AT THE BASE OF THE PENILE SHAFT (DIRECTLY ON THE BLUE PRE-WRAP) AND ONLY CONTINUES UP TO THE MID-SHAFT LEVEL.

  • YOU ALWAYS WRAP FROM THE BASE OF THE PENILE SHAFT TO JUST UNDER THE GLANS, COVERING THE TOE PADS.

 

  • BLUE PRE-WRAP PLACEMENT:

  • THE PRIMARY PURPOSE OF THE PLACEMENT OF THE BLUE PRE-WRAP ON THE PENILE SHAFT BASE AREA IS TO CUSHION THE SKIN FROM THE LOOPED RUBBER BAND PRESSURE. THIS DOES NOT NEED TO BE USED AFTER THE LOOPED RUBBER BAND AND TIGHT HALF-FOLD ARE NO LONGER USED AFTER DAY 7.

  • IN ADDITION THIS BLUE PRE-WRAP WILL HELP PREVENT THE BROWN GAUZE FROM IRRITATING THE SKIN AT THE PENILE BASE AREA.

 

  • TIGHT HALF FOLD PLACEMENT

  • THE PRIMARY PURPOSE OF THE TIGHT HALF-FOLD IS TO NOT ONLY BE PART OF THE PRIMARY BARRIER OF THE PENILE SHAFT AND PREVENTING FILLER LOSS FOR THE FIRST 7 DAYS, BUT ALSO TO HELP DISTRIBUTE THE TENSION FORCES OF THE LOOPED RUBBER BAND SO THE SKIN UNDERNEATH DOES NOT FORM A SKIN SORE OR ULCERATION. IF THE TIGHT HALF-FOLD WAS NOT PRESENT, THE LOOPED RUBBER BAND FORCE WOULD PLACE TOO MUCH HIGH AND DIRECT PRESSURE ON THE SKIN BELOW RESULTING IN A SKIN ULCER.

  • THE TIGHT HALF-FOLD IS PLACED AS LOW AS POSSIBLE ON THE PENILE SHAFT BASE AREA. IT NEEDS TO BE PLACED ON WITH TWO FULL TURNS AROUND THE PENILE SHAFT (DIRECTLY ON TOP OF THE BLUE PRE-WRAP & WINGED BAND-AID), AND WITH MODERATE (NOT HIGH) TENSION.

  • REMEMBER TO LEAVE A VISIBLE BLUE PRE-WRAP EDGE.

  • THEN PLACE PAPER TAPE TO SECURE.

 

  • LOOPED RUBBER BAND PLACEMENT:

  • THE PRIMARY PURPOSE OF THE LOOPED RUBBER BAND IS TO BE THE PRIMARY BARRIER OF THE PENILE SHAFT AND PREVENTING FILLER LOSS FOR THE FIRST 7 DAYS.

  • THE LOOPED RUBBER BAND IS PLACED DIRECTLY ON THE TIGHT HALF-FOLD LOCATED AT THE PENILE BASE AREA.

  • DURING EACH BARRIER BRAKE, IN THIS CASE WITH THE LOOPED RUBBER BAND, REMOVE THE RUBBER BAND, BUT WHEN YOU PLACE THIS BACK ON, PLACE IT IN A SLIGHTLY DIFFERENT AREA ON THE TIGHT HALF-FOLD. BY DOING THIS, THE DIRECT PRESSURE PLACED ON THE SKIN UNDERNEATH WILL NOT ALWAYS BE IN THE EXACT SAME PLACE AND THIS WILL HELP PREVENT SKIN IRRITATION AND SORES.

  • WHY IS THE RUBBER BAND LOOPED? THE RUBBER BAND IS LOOPED FOR TWO MAIN REASONS:

    • FIRST: IF, DURING URINATION, THE STREAM IS VERY SLOW, YOU CAN PULL ON THE LOOP AND RELEASE SOME TENSION ON THE UNDERSIDE OF THE PENILE SHAFT (WHERE THE URETHRA OR THE TUBE WHERE THE URINE FLOWS), AND THIS WILL HELP WITH URINE FLOW.

    • SECONDLY: TO HELP LIFT OFF DURING THE BARRIER BREAK TIMES…EASIER TO GRIP AND LIFT FROM THE LOOP.

  • KEEP IN MIND THAT THE URINE WILL STILL SPRAY OUT DUE TO THE PRESSURE PLACED ON THE URETHRA FROM THE LOOPED RUBBER BAND AND TIGHT HALF FOLD CAUSING A TURBULENT FLOW AND THUS THE SPRAYING. THAT IS WHY YOU NEED TO URINATE INTO A CUP, PLASTIC BAGGIE, OR SIT DOWN ON THE TOILET DURING URINATION

 

  • HALF-FOLD PLACEMENT ON THE UPPER SHAFT AREA JUST UNDER THE GLANS:

  • THE PRIMARY PURPOSE OF PLACING A HALF-FOLD JUST UNDER THE GLANS IS TO HELP SHAPE A HIGH RISK AREA THAT TYPICALLY WILL BULGE IF IT IS NOT SUPPORTED BY ADDITIONAL PRESSURE.

  • THERE ARE TWO WAYS TO DO THIS:

    • THE PREFERRED WAY IS THE ‘SWOOP’ METHOD WHICH IS THE METHOD OF CHOICE.

      • THIS IS DONE BY PLACING THE HALF FOLD DIRECTLY ON THE FRONT OR TOP SIDE OF THE GLANS (NOT THE PENILE SHAFT), AND THEN SWOOP DOWN VERY LOW AND AROUND THE UPPER PENILE SHAFT ALWAYS UNDER THE GLANS, THEN CONTINUE AROUND AGAIN PLACING THE HALF FOLD DIRECTLY ON THE FRONT OR TOP SIDE OF THE GLANS, THEN SWOOP AROUND AGAIN BUT NOT AS LOW THIS TIME, AND WORK YOUR WAY AGAIN TO THE FRONT OR TOP SIDE ON THE GLANS. THIS SWOOPING WILL ALLOW MORE BROAD PRESSURE ‘COVERAGE’ IN THAT AREA WHICH IS NEEDED. NOTE THAT THE FRONT OR TOP SIDE, WHERE THE HALF FOLD IS DIRECTLY ON THE GLANS, THERE IS NO HALF FOLD PRESSURE EXERTED DIRECTLY ON THE FRONT PENILE SHAFT AREA (JUST UNDER THE GLANS) AND THIS IS IMPORTANT BECAUSE IF THE HALF FOLD IS PLACED ON THIS AREA IT WILL ‘PUSH’ FILLER INTO THE BACKSIDE OF THE PENILE SHAFT AND ‘ASSIST’ IN INCREASING THE BULGE IN THAT AREA…THE VERY AREA WE ARE TRYING TO PREVENT FILLER FROM ENTERING.

    • THE SECOND METHOD

      • PLACE THE HALF FOLD DIRECTLY UNDER THE GLANS, LEAVING NO VISIBLE SHAFT SKIN. GO AROUND TWO TIMES AND WITH MILD TENSION. IF YOU ARE UNCIRCUMCISED, OR YOU ARE DEVELOPING A SHAFT SKIN BULGE IS HANGING OVER THE GLANS, WHICH WOULD BE OBSERVED DURING WRAP CHANGES, THEN YOU NEED TO PLACE THE HALF FOLD ON IN THIS FASHION, BUT WITH MODERATE (NOT MILD) TENSION.

  • NOTE: THE MODERATE TENSION OF THE HALF-FOLD MAY ALSO OBSTRUCT URINE FLOW. IF IT DOES OBSTRUCT URINE FLOW THE HALF-FOLD WILL NEED TO BE TEMPORARILY REMOVED TO ALLOW URINATION, THEN PLACED BACK ON AFTER URINATION.

 

MISCELLANEOUS

FURTHER CARE & INSTRUCTIONS

  • TAKE ALL OF YOUR MEDICATIONS AS PRESCRIBED AND DO NOT REFILL YOUR MEDICATIONS UNLESS INSTRUCTED BY DR. LORIA

  • APPLY MEDICATIONS TO THE GLANS

  • NITRO-BID CREAM AND TRIAMCINOLONE OINTMENT ARE TO BE PLACED ON THE GLANS EVERY EVENING.

  • USE A Q-TIP TO PLACE THE MEDICATIONS…FIRST PLACING THE TRIAMCINOLONE AND BACITRACIN OINTMENTS, THEN THE NITRO-BID.

  • PLACE ON A VERY, VERY TINY PEA-SIZED AMOUNT OF NITROBID (LIKE A GRAIN OF RICE)

  • PLEASE NOTE THAT NITRO-BID CAN LOWER YOU BLOOD PRESSURE AND MAY GIVE YOU HEADACHES, SWEATS, HEART PALPITATIONS, AND DIZZINESS. IF THIS OCCURS, STOP USE FOR 2-DAYS, THEN RESUME PLACING ON BUT EVERY OTHER DAY. IF YOU STILL HAVE SYMPTOMS, USE EVERY 3RD DAY….AND IF SYMPTOMS PERSIST THEN STOP USING.

  • NITRO-BID CANNOT BE TAKEN WITH PROSTATE OR ERECTILE DYSFUNCTION MEDICATIONS SUCH AS VIAGRA, CIALIS, LEVITRA, ETC. THIS WILL CAUSE YOUR BLOOD PRESSURE TO DROP TO VERY UNSAFE LEVELS.

 

  • TISSUE OR PAPER TOWEL PLACEMENT OVER GLANS– IF YOU HAD THE GLANS ENLARGEMENT TREATMENT

  • AFTER A GLANS TREATMENT THERE WILL BE SOME DRAINAGE OVER A 24-48 HOUR PERIOD.

  • TO HELP PROVIDE MORE COMFORT AND COLLECT THIS DRAINAGE PLACE A LIBERAL AMOUNT OF WHITE GAUZE OR TISSUE OVER THE GLANS, AND APPLY SOME PAPER TAPE TO SECURE. YOU CAN ALSO SECURE THE WHITE GAUZE BY PLACING A SHORT STRIP OF THE BROWN STRETCH GAUZE AND GENTLY WRAPPING IT AROUND THE WHITE GAUZE.

 

  • TAKING PHOTOS: TO BE DONE DAILY- THIS IS MANDATORY.

  • TAKE TOP AND UNDERSIDE VIEWS SO WE CAN SEE THE ENTIRE AREA. USE GOOD LIGHTING AND KEEP PHOTOS NON BLURRY.

  • TAKE PHOTOS OF THE PENILE SKIN WHEN WRAP IS OFF (DURING A RE-WRAP), AND TAKE ADDITIONAL PHOTOS AFTER THE NEW WRAP IS COMPLETELY PLACED ON. THIS IS VERY IMPORTANT FOR EVALUATION.

  • TAKE DAILY PHOTOS AND COMMENT HOW YOU ARE FEELING AS WELL. THIS IS MANDATORY

 

  • SHOWERING:

  • ON DAYS YOU ARE NOT RE-WRAPPING, USE A CONDOM, PLASTIC BAGGIE, OR SARAN WRAP, TO COVER AND PROTECT FROM THE WATER. PLACE AN ADDITIONAL LOOPED RUBBER BAND ON THE BASE OF THE CONDOM TO MAKE SURE WATER CANNOT ENTER AT THE BASE OF THE CONDOM AREA.

  • IF THE WRAP GET WET YOU CAN SIMPLY USE A BLOW DRYER TO DRY.

 

SKIN SORES, ULCERS, AND BROKEN BLISTER CARE:

  •  IF A SKIN SORE/ULCER DEVELOPS, THERE WILL BE ADDITIONAL STEPS IN THE PROTOCOL. FOR EXAMPLE, IF A SKIN SORE WERE TO DEVELOP (TYPICALLY ON THE UNDERSIDE OF THE PENILE SHAFT BY THE SCROTUM), YOU WILL FIRST WASH WITH SOAP AND WATER, PAT DRY, THEN TAKE PHOTOS, THEN PLACE BACITRACIN OINTMENT ON, THEN PLACE A BAND-AID.

  • IF A SKIN SORE/ULCER DEVELOPS, YOU WILL NOW NEED TO CHANGE THE WRAP EVERY 1-2 DAYS (NOT EVERY 2-3 DAYS), PERFORMING MORE FREQUENT SOAP & WATER WASHINGS AND BACITRACIN OINTMENT PLACEMENT. AFTER CLEANING, AND BACITRACIN PLACEMENT, PLACE A NEW WRAP (FOLLOW WRAP PROTOCOL). IT IS CRITICAL FOR THE SKIN ULCER TO BE FIRST CLEANED, PAT DRY WITH A CLEAN TOWEL, AND THEN KEPT MOIST WITH BACITRACIN OINTMENT AT ALL TIMES FOR OPTIMAL HEALING. AGAIN, THIS NEEDS TO BE DONE EVERY 1-2 DAYS. IF YOU DO NOT DEVELOP SKIN SORES, YOU WILL NOT NEED TO CHANGE YOUR WRAP MORE FREQUENTLY.

 

SWELLING OF THE PUBIC AND SCROTAL AREAS

  • IF YOU EXPERIENCE EVEN VERY MINOR PUBIC OR SCROTAL SWELLING YOU WILL NEED TO INCREASE THE TENSION OF THE HALF FOLD. THIS IS DONE BY FIRST REMOVING THE LOOPED RUBBER BAND AND THEN REMOVING THE HALF FOLD GAUZE AT THE BASE AREA, THEN PLACING THE HALF FOLD ON WITH HIGHER TENSION, THEN PLACE THE LOOPED RUBBER BAND BACK ON.

 

NEEDLE HOLE CLOSURE:

  • ESPECIALLY DURING THE FIRST 3-4 DAYS, EXAMINE FOR LEAKS, OR IF YOUR WRAP IS GETTING EXCESSIVELY WET. WHEN THE WRAP IS OFF, DURING YOUR FIRST WRAP CHANGE ON DAY-3 FOR EXAMPLE, EXAMINE THE INTEGRITY OF THE SPOT BAND-AID AND REPLACE ONLY IF NEEDED. IF LEAKING IS OBSERVED OR IF YOU ARE UNCERTAIN, SEND PHOTOS FOR EVALUATION. YOU MAY NEED TO GLUE DOWN A NEW SPOT BAND-AID TO RESEAL THE HOLE. IF A NEW BAND-AID NEEDS TO BE PLACED, FIRST REMOVE THE LOOPED RUBBER BAND AND PLASTIC RING TO RELIEVE PRESSURE, THIS WILL MAKE IT EASIER FOR SPOT BAND-AID PLACEMENT. THEN PLACE LOOPED RUBBER BAND AND PLASTIC RING BACK ON AFTER A NEW SPOT BAND-AID IS GLUED DOWN.

 

REVIEW ALL INSTRUCTIONAL VIDEOS ON DR LORIA’S WEBSITE www.loriamedical.com (SOME VIDEOS MAY NOT HAVE BEEN FULLY UPDATED), BUT PLEASE REVIEW THEM AND ALSO PLEASE REFER TO YOUR CURRENT PAPERWORK AND PHOTOS TAKEN, WITH YOUR PHONE, DURING YOUR WRAP ON THE PROCEDURE DAY FOR REFERENCE AND TO REMIND YOU HOW TO PERFORM YOUR WRAP.

 

DAILY PHOTOS: TAKING PHOTOS IS TO BE DONE DAILY- THIS IS MANDATORY.

  • PLEASE TAKE PHOTOS IN THE MORNING, THIS WILL ALLOW THE APPROPRIATE TIME FOR EVALUATION AND RESPONSE BY THE LORIA MEDICAL STAFF DURING NORMAL AND REASONABLE HOURS OF THE DAY. AFTER HOURS OR NIGHTTIME COMMUNICATION SHOULD BE LIMITED TO EMERGENCY CONTACT ONLY.

  • TAKE DAILY PHOTOS WITH YOUR PHONE AND SEND TO THE GROUP TEXT MESSAGING (THAT WAS SET UP ON YOUR PHONE ON YOUR PROCEDURE DAY), AND ADD COMMENTS ON HOW YOU FEEL AS WELL. THIS IS MANDATORY. EVEN IF YOU FEEL FINE, LET US KNOW AND SAY, “I FEEL FINE”.

  • TAKE TOP AND UNDERSIDE VIEWS AS WELL SO WE CAN SEE THE ENTIRE AREA. USE GOOD LIGHTING AND KEEP PHOTOS CLEAR AND NON BLURRY.

  • DURING WRAP CHANGE TIMES, TAKE PHOTOS OF THE PENILE SKIN WHEN WRAP IS OFF, AND ALSO TAKE PHOTOS JUST AFTER THE NEW WRAP IS PLACED ON AS WELL. THIS IS VERY IMPORTANT TO EVALUATE YOUR SKIN, AND THEN EVALUATE HOW YOU PLACED YOUR NEW WRAP ON.

  • AFTER DAY-21 YOU ARE TO TAKE PHOTOS WEEKLY UNTIL DAY 90.

 

THE WRAP IS NOT TO BE REMOVED UNTIL THE SPECIFIED RE-WRAP TIMES.

  • THE ONLY EXCEPTION TO REMOVING SOME OF THE WRAP BEFOREHAND, PRIOR TO DAY-3, IS IF YOU HAVE A ‘LEAK’ OR IF YOU NOTICE THE WRAP GETTING WET.

  • IF THIS OCCURS, NOTIFY US AND SEND PHOTOS FOR EVALUATION. IF IT HAS BEEN CONFIRMED THAT A POTENTIAL LEAK MAY HAVE OCCURRED, THEN YOU WILL NEED TO UNWRAP A PORTION OF THE WRAP, NOT THE WHOLE WRAP, TO EXPOSE THE SPOT BAND-AID AREA.

  • YOU START WITH REMOVING THE HALF FOLD AT THE VERY TOP OF THE WRAP JUST UNDER THE GLANS, AND THEN UNWIND THE BROWN GAUZE ONLY, AND UNWIND JUST ENOUGH TO VISUALIZE THE SPOT BAND-AID/GLUED AREA (WHERE THE ENTRY POINT FOR THE FILLER INSERTION IS LOCATED, WHICH SHOULD BE ON THE RIGHT SIDE AND ABOUT THE MID-SHAFT AREA OF THE PENIS). IF THE SPOT BAND-AID FELL OFF, IS LOOSE, OR THERE IS FLUID LEAKING OUT, YOU WILL FIRST NEED TO REMOVE THE LOOPED RUBBER BAND AND PLASTIC RING…THIS WILL DECREASE THE PRESSURE IN THE AREA AND SLOW DOWN THE LEAK. THEN YOU WILL NEED TO CAREFULLY REMOVE THE SPOT BAND-AID (IF NOT OFF ALREADY) THEN PAT DRY, THEN PRESS GENTLY ON THE HOLE WITH CLEAN GAUZE FOR 2-3 MINUTES (TO HELP STOP THE FLOW OF FLUID COMING OUT), THEN PLACE 10-DROPS OF KRAZY GLUE DIRECTLY ON THE SPOT BAND-AID PROVIDED, THEN PLACE THE SPOT BAND-AID DIRECTLY ON THE NEEDLE HOLE AREA (WHERE THE FLUID IS COMING OUT), THEN TAP ON THE SPOT BAND-AID MANY TIMES FOR ABOUT 30-60 SECONDS.

  • THE REASON FOR THE TAPPING ON THE SPOT BAND-AID POST PLACEMENT, IS TO MAKE SURE THE SPOT BAND-AID STICKS ON EVENLY AND SO THAT YOUR FINGER DOES NOT GET STUCK ON THE SPOT BAND-AID DUE TO THE KRAZY GLUE WHICH DRIES SO QUICKLY (DO NOT HOLD SPOT BAND-AID DOWN BECAUSE YOUR FINGER WILL STICK TO THE KRAZY GLUE, NEED TO TAP FOR YOUR FINGER NOT TO GET ‘GLUED DOWN’). CONTINUE TAPPING THE SPOT BAND-AID DOWN FOR AT LEAST 1-MINUTE.

  • AFTER TAPPING AND SECURING THE SPOT BAND-AID, EXAMINE IF THERE IS ANY LEAKING, AND IF NOT, THEN PLACE SEVERAL PIECES OF PAPER TAPE ON TOP OF THE SPOT BAND-AID TO SECURE IT IN PLACE. THEN PLACE THE BROWN STRETCH GAUZE BACK ON, THEN PLACE THE LOOPED RUBBER BAND AND PLASTIC RING BACK ON AS WELL. IF IT IS STILL LEAKING AFTER YOUR FIRST ATTEMPT OF PLACING THE SPOT BAND-AID AND GLUE ON, THEN REPEAT THESE STEPS AND ADD AN ADDITIONAL SPOT BAND-AID ON TOP OF THE FIRST ONE. LET’S ASSUME THE HOLE HAS BEEN SEALED, BROWN STRETCH GAUZE IS BACK ON…NOW LET’S MOVE ON TO DAY-3 WHEN YOU WILL CHANGE THE WRAP.

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