At what point does someone need surgery by the time you see them what have they gone through to determine that this is the best option so when we’re just talking about sort of typical degenerative situations they’ve usually gone through quite a bit Andrew before we get to the point where we’re talking about surgery we always like to try to resolve these things without surgery if we can and in our least invasive manner and so typically they’ve been through probably with their primary care physician or maybe even with a pain specialist or a physiatrist we have several of those at our own Baptist group they’ve gone through physical therapy they’ve gone through multiple types of medications and nonsteroidals maybe even steroids and they’ve really kind of reached the end of their rope by the time they get to me any idea of what percentage of people that is because I’ve known several people who have basically done that exact path they go through physical therapy they’ve received some sort of shots they’ve received medical treatment and the end seems to be the same which is they go in for surgery Andrew that’s a good question and people are really interested in this sort of thing I think it does seem perhaps to the world like everybody’s getting back surgery there’s a lot of back surgery going on out there but if you look at the statistics the vast majority of people who have an episode of back pain or even who have an episode of radiculopathy that’s what most people call sciatica the pain running down the leg from the back most of them never need surgery most of them never even come to see me