Dsthymia and PMDD

Tis the season for me. Holidays are always hard. What has helped is knowing that I am up against two constants...depression and severe pre-menstral mood swings. Since I was a teenager I have battled these two constants with therapy and anti-depressants yet they linger. I have tried every intervention known to man and now just accept them as part of my mortal life. Unfortunate for me and my family are years when the holidays and my cycle overlap. It's hard to keep a smile on my face when I am in a lot of physical pain.

Currently I take Cymbalta which helps most of the symptoms stay at bay so I can function in every day life. I also take prozac four days before my period and during my cycle as prescribed by a physician. I have thought about a hysterectomy or surgery to decrease the pain as I have endometriosis as well. There are side effects for me with taking any hormonal treatments like over the counter birth control pills which are worse than the symptoms. It is so good to know I am not alone in my conditions.

"Depression, in its various forms, affects nearly 19 million Americans each year according to the National Institute of Mental Health (NIMH). With prolonged major depression, shortages or imbalances of mood-influencing chemicals in the brain usually play a role.

Studies show that depressive illness can and often does run in families. The genetic connection is beyond controversy. Another proven fact is that women, as a group, are twice as likely to experience depression" source: http://www.selfgrowth.com/articles/Dysthymia_Chronic_Low-grade_Depression_What_Does_it_Feel_Like.html

Dysthymia defined by one author " The best I ever hoped to feel occurred when I was totally distracted, immersed in something that diverted my attention or completely consumed me. So, I worked hard at staying busy, achieving and excelling in whatever I did, in spite of the way I felt.

I now know that all those years I was suffering from chronic, low-grade depression. This condition, called dysthymic disorder, is a long-term, less severe form of depression that is rarely detected, recognized or talked about.

I spent the majority of my waking hours battling a constant smothering, confining hopelessness, until my depression manifested itself in a more outwardly visible debilitating condition." Here is a really good article on post-holiday blues. http://www.healthline.com/blogs/teen_health/2007/12/post-holiday-blues.html

The other known factor in my life is PPMD.

"Premenstrual dysphoric disorder or PMDD is a condition associated with severe emotional and physical problems that are linked closely to the menstrual cycle. Symptoms occur regularly in the second half of the cycle and end when menstruation begins or shortly thereafter. PMDD is not just a new name for premenstrual syndrome (PMS), a condition that affects as many as 75% of menstruating women. It is, however, considered to be a very severe form of PMS that affects about 5% of menstruating women. Both PMDD and PMS share symptoms in common that include depression, anxiety, tension, irritability and moodiness. What sets PMDD apart is its severity. Women with PMDD find that it has a very disruptive effect on their lives." http://pmdd.factsforhealth.org/what/

"Over the years, many treatments have been used for premenstrual symptoms, for premenstrual syndrome (PMS), and most recently for premenstrual dysphoric disorder (PMDD). Until recently, few of these treatments were evaluated in carefully designed research studies and even fewer were shown to be effective. There are now four prescription drugs that have been approved by the U.S. Food and Drug Administration (FDA) for treating the condition. These FDA-approved medications are fluoxetine (Sarafem), paroxetine controlled-release (Paxil CR), and sertraline (Zoloft), together with drospirenone/ethinyl estradiol oral contraceptive (YAZ). Nonetheless, many treatments of less well established value remain in widespread use and some women find them to be quite satisfactory. Unfortunately, promise of "cures," often costly, are sometimes made for treatments that have not been subjected to well-designed confirmatory research. When we discuss treatments for PMDD here, we'll base our comments on the best available research data, the opinions of experienced clinicians, and a generous sprinkling of common sense.

There are 3 broad approaches to treating PMDD. While most experts recommend a combination of all 3, there have been no scientific studies to determine if combination treatment is really the best approach. It is likely that the best approach or combination of approaches will vary from woman to woman based on things like symptom severity and which symptoms are most troublesome.

Here are the 3 approaches with some examples of each:

Medications - including antidepressants, antianxiety drugs, analgesics, hormones and diuretics.
Psychobehavioral - including exercise and psychotherapies (cognitive-behavioral, coping skills training, relaxation).
Nutritional - including diet modification, vitamins, minerals and herbal preparations.
source http://pmdd.factsforhealth.org/treatment/

Safeguarding Your Home

One of the biggest issues I see attacking people and families today is that of pornography. With internet access as open and liberal as it is, many children and parents can be exposed to pornographic material with the click of a button. I have been looking for resources on safeguarding our homes against it, the harms of pornography as well as the best places to look for treatment of the addiction.

I found this on lds.org in the provident living section on Protecting:

Pornography

Parents can do many things to safeguard their homes from the harmful influences found on the Internet. While there is no foolproof system, some simple steps can help reduce the risk of family members seeing pornographic materials on the Internet.

Place computers in high-traffic areas of the home. Kitchens, family rooms, and studies usually have the most traffic. Because these rooms usually don’t have doors, they are typically less secluded than bedrooms.

Position computer monitors so the screen faces out for public view.

Install a filtering program, and learn its features and how to use it. Good filtering programs allow you to view a history of which sites (including chat rooms) have been visited and when, as well as a record of incoming and outgoing e-mails. Information on filtering programs can be found on Internet sites such as http://www.internetfilterreview.com/.

Teach family members about the dangers of Internet pornography, including how to escape if an inappropriate site is accidentally accessed. This usually involves shutting down the entire system.

Teach family members to tell parents if they encounter any form of pornography while on the computer. This will help reduce the fear or shame of accidental exposure. It also serves to open discussion about the dangers of pornography.

Teach family members to use the Internet for a specific purpose only. Aimless surfing makes it easier to wander onto inappropriate sites.

Instant messaging is a cost-effective, easy way to communicate with family and close friends. However, teach family members to avoid public chat rooms, bulletin boards, or unfamiliar areas on the Internet. Such places present an unnecessary risk for children and adults.

Teach children not to share any personal information online without parental knowledge and permission. Many predators pose as children to gain access and information that may put children at risk.

Educate yourself about your computer and how the Internet works.

Be aware of what your children’s school and public library policies are regarding Internet use and accessibility.

Teach family members to never open e-mail from someone they don’t know.

The Internet is a wonderful tool and resource for families, but caution must be exercised in order to protect families and individuals from the potential dangers that are present online.

From Protect Kids comes a definition: Pornography can be thought of as all sexually explicit material intended primarily to arouse the reader, viewer, or listener. Each category of illegal pornography has a specific legal definition established by the courts. The Supreme Court has said that there are four categories of pornography that can be determined illegal. Illegal pornography includes indecency, material harmful to minors, obscenity, and child pornography. Click here for the legal definitions of types of pornography.

Here are some resources on The Dangers of Pornography


http://www.protectkids.com/effects/index.htm

http://www.aclj.org/Issues/Resources/Document.aspx?ID=330

www.leaderu.com/orgs/probe/docs/porno.html

Treatment

One of the best tools I have heard in treating pornography addiction is the twelve stop program here are some other links to check

http://en.wikipedia.org/wiki/Pornography_addiction

http://www.endpornaddiction.com/?hop=denkster3

LDS Resources

http://www.lds.org/ldsorg/v/index.jsp?vgnextoid=84010fd41d93b010VgnVCM1000004d82620aRCRD&locale=0&hideNav=1&bucket=AllChurchContent&query=pornography&submit=Search

"Satan has become a master at using the addictive power of pornography to limit individual capacity to be led by the Spirit. The onslaught of pornography in all of its vicious, corroding, destructive forms has caused great grief, suffering, heartache, and destroyed marriages. It is one of the most damning influences on earth. Whether it be through the printed page, movies, television, obscene lyrics, vulgarities on the telephone, or flickering personal computer screen, pornography is overpoweringly addictive and severely damaging." -Richard G. Scott

Lesson Learned

Jelly bellies

+

Caffeine

= Panic Attack and increased anxiety

Usually I stay away from sugar and caffeine because I got into the habit after running cross country for so many years. However, this weekend I took a few sips and ate some jelly bellies (well okay, half the bag) and WHAM! First panic attack in a long time.

I was curious if there was any scientific research to back this up so I googled it, sure enough there is!

Brewing trouble http://caffeineweb.com/?cat=2

http://www.medicinenet.com/script/main/art.asp?articlekey=50820

Caffeine induced mental anxiety

http://caffeineweb.com/?cat=2

School Thy Feelings

School Thy Feelings, O My Brother
President Thomas S. Monson

If we desire to have a proper spirit with us at all times, we must choose to refrain from becoming angry.

Brethren, we are assembled as a mighty body of the priesthood, both here in the Conference Center and in locations throughout the world. We have heard inspired messages this evening, and I express my appreciation to those Brethren who have addressed us. I am honored, yet humbled, by the privilege to speak to you, and I pray that the inspiration of the Lord may attend me.

Recently as I watched the news on television, I realized that many of the lead stories were similar in nature in that the tragedies reported all basically traced back to one emotion: anger. The father of an infant had been arrested for physical abuse of the baby. It was alleged that the baby’s crying had so infuriated him that he had broken one of the child’s limbs and several ribs. Alarming was the report of growing gang violence, with the number of gang-related killings having risen sharply. Another story that night involved the shooting of a woman by her estranged husband, who was reportedly in a jealous rage after finding her with another man. Then, of course, there was the usual coverage of wars and conflicts throughout the world.

I thought of the words of the Psalmist: “Cease from anger, and forsake wrath.”1

Many years ago, a young couple called my office and asked if they could come in for counseling. They indicated they had suffered a tragedy in their lives and that their marriage was in serious jeopardy. An appointment was arranged.

The tension between this husband and wife was apparent as they entered my office. Their story unfolded slowly at first as the husband spoke haltingly and the wife cried quietly and participated very little in the conversation.

The young man had returned from serving a mission and was accepted to a prestigious university in the eastern part of the United States. It was there, in a university ward, that he had met his future wife. She was also a student at the university. After a year of dating, they journeyed to Utah and were married in the Salt Lake Temple, returning east shortly afterward to finish their schooling.

By the time they graduated and returned to their home state, they were expecting their first child and the husband had employment in his chosen field. The wife gave birth to a baby boy. Life was good.

When their son was about 18 months old, they decided to take a short vacation to visit family members who lived a few hundred miles away. This was at a time when car seats for children and seat belts for adults were scarcely heard of, let alone used. The three members of the family all rode in the front seat with the toddler in the middle.

Sometime during the trip, the husband and wife had a disagreement. After all these years, I cannot recall what caused it. But I do remember that their argument escalated and became so heated that they were eventually yelling at one another. Understandably, this caused their young son to begin crying, which the husband said only added to his anger. Losing total control of his temper, he picked up a toy the child had dropped on the seat and flung it in the direction of his wife.

He missed hitting his wife. Instead, the toy struck their son, with the result that he was brain damaged and would be handicapped for the rest of his life.

This was one of the most tragic situations I had ever encountered. I counseled and encouraged them. We talked of commitment and responsibility, of acceptance and forgiveness. We spoke of the affection and respect which needed to return to their family. We read words of comfort from the scriptures. We prayed together. Though I have not heard from them since that day so long ago, they were smiling through their tears as they left my office. All these years I’ve hoped they made the decision to remain together, comforted and blessed by the gospel of Jesus Christ.

I think of them whenever I read the words: “Anger doesn’t solve anything. It builds nothing, but it can destroy everything.”2
We’ve all felt anger. It can come when things don’t turn out the way we want. It might be a reaction to something which is said of us or to us. We may experience it when people don’t behave the way we want them to behave. Perhaps it comes when we have to wait for something longer than we expected. We might feel angry when others can’t see things from our perspective. There seem to be countless possible reasons for anger.

There are times when we can become upset at imagined hurts or perceived injustices. President Heber J. Grant, seventh President of the Church, told of a time as a young adult when he did some work for a man who then sent him a check for $500 with a letter apologizing for not being able to pay him more. Then President Grant did some work for another man—work which he said was 10 times more difficult, involving 10 times more labor and a great deal more time. This second man sent him a check for $150. Young Heber felt he had been treated most unfairly. He was at first insulted and then incensed.

He recounted the experience to an older friend, who asked, “Did that man intend to insult you?”

President Grant replied, “No. He told my friends he had rewarded me handsomely.”

To this the older friend replied, “A man’s a fool who takes an insult that isn’t intended.”3

The Apostle Paul asks in Ephesians, chapter 4, verse 26 of the Joseph Smith Translation: “Can ye be angry, and not sin? let not the sun go down upon your wrath.” I ask, is it possible to feel the Spirit of our Heavenly Father when we are angry? I know of no instance where such would be the case.

From 3 Nephi in the Book of Mormon, we read:

“There shall be no disputations among you. . . .

“For verily, verily I say unto you, he that hath the spirit of contention is not of me, but is of the devil, who is the father of contention, and he stirreth up the hearts of men to contend with anger, one with another.

“Behold, this is not my doctrine, to stir up the hearts of men with anger, one against another; but this is my doctrine, that such things should be done away.”4

To be angry is to yield to the influence of Satan. No one can make us angry. It is our choice. If we desire to have a proper spirit with us at all times, we must choose to refrain from becoming angry. I testify that such is possible.

Anger, Satan’s tool, is destructive in so many ways.

I believe most of us are familiar with the sad account of Thomas B. Marsh and his wife, Elizabeth. Brother Marsh was one of the first modern-day Apostles called after the Church was restored to the earth. He eventually became President of the Quorum of the Twelve Apostles.

While the Saints were in Far West, Missouri, Elizabeth Marsh, Thomas’s wife, and her friend Sister Harris decided they would exchange milk in order to make more cheese than they otherwise could. To be certain all was done fairly, they agreed that they should not save what were called the strippings, but that the milk and strippings should all go together. Strippings came at the end of the milking and were richer in cream.

Sister Harris was faithful to the agreement, but Sister Marsh, desiring to make some especially delicious cheese, saved a pint of strippings from each cow and sent Sister Harris the milk without the strippings. This caused the two women to quarrel. When they could not settle their differences, the matter was referred to the home teachers to settle. They found Elizabeth Marsh guilty of failure to keep her agreement. She and her husband were upset with the decision, and the matter was then referred to the bishop for a Church trial. The bishop’s court decided that the strippings were wrongfully saved and that Sister Marsh had violated her covenant with Sister Harris.

Thomas Marsh appealed to the high council, and the men comprising this council confirmed the bishop’s decision. He then appealed to the First Presidency of the Church. Joseph Smith and his counselors considered the case and upheld the decision of the high council.

Elder Thomas B. Marsh, who sided with his wife through all of this, became angrier with each successive decision—so angry, in fact, that he went before a magistrate and swore that the Mormons were hostile toward the state of Missouri. His affidavit led to—or at least was a factor in—Governor Lilburn Boggs’s cruel extermination order, which resulted in over 15,000 Saints being driven from their homes, with all the terrible suffering and consequent death that followed. All of this occurred because of a disagreement over the exchange of milk and cream.5

After 19 years of rancor and loss, Thomas B. Marsh made his way to the Salt Lake Valley and asked President Brigham Young for forgiveness. Brother Marsh also wrote to Heber C. Kimball, First Counselor in the First Presidency, of the lesson he had learned. Said Brother Marsh: “The Lord could get along very well without me and He . . . lost nothing by my falling out of the ranks; But O what have I lost?! Riches, greater riches than all this world or many planets like this could afford.”6

Apropos are the words of the poet John Greenleaf Whittier: “Of all sad words of tongue or pen, the saddest are these: ‘It might have been!’ ”7

My brethren, we are all susceptible to those feelings which, if left unchecked, can lead to anger. We experience displeasure or irritation or antagonism, and if we so choose, we lose our temper and become angry with others. Ironically, those others are often members of our own families—the people we really love the most.Many years ago I read the following Associated Press dispatch which appeared in the newspaper: An elderly man disclosed at the funeral of his brother, with whom he had shared, from early manhood, a small, one-room cabin near Canisteo, New York, that following a quarrel, they had divided the room in half with a chalk line, and neither had crossed the line or spoken a word to the other since that day—62 years before. Just think of the consequence of that anger. What a tragedy!

May we make a conscious decision, each time such a decision must be made, to refrain from anger and to leave unsaid the harsh and hurtful things we may be tempted to say.

I love the words of the hymn written by Elder Charles W. Penrose, who served in the Quorum of the Twelve and in the First Presidency during the early years of the 20th century:

School thy feelings, O my brother;
Train thy warm, impulsive soul.
Do not its emotions smother,
But let wisdom’s voice control.
School thy feelings; there is power
In the cool, collected mind.
Passion shatters reason’s tower,
Makes the clearest vision blind.8

Each of us is a holder of the priesthood of God. The oath and covenant of the priesthood pertains to all of us. To those who hold the Melchizedek Priesthood, it is a declaration of our requirement to be faithful and obedient to the laws of God and to magnify the callings which come to us. To those who hold the Aaronic Priesthood, it is a pronouncement concerning future duty and responsibility, that you may prepare yourselves here and now.

This oath and covenant is set forth by the Lord in these words:

“For whoso is faithful unto the obtaining these two priesthoods of which I have spoken, and the magnifying their calling, are sanctified by the Spirit unto the renewing of their bodies.

“They become the sons of Moses and of Aaron and the seed of Abraham, and the church and kingdom, and the elect of God.

“And also all they who receive this priesthood receive me, saith the Lord;

“For he that receiveth my servants receiveth me;

“And he that receiveth me receiveth my Father;

“And he that receiveth my Father receiveth my Father’s kingdom; therefore all that my Father hath shall be given unto him.”9

Brethren, great promises await us if we are true and faithful to the oath and covenant of this precious priesthood which we hold. May we be worthy sons of our Heavenly Father. May we ever be exemplary in our homes and faithful in keeping all of the commandments, that we may harbor no animosity toward any man but rather be peacemakers, ever remembering the Savior’s admonition, “By this shall all men know that ye are my disciples, if ye have love one to another.”10 This is my plea tonight at the conclusion of this great priesthood meeting, and it’s also my humble and sincere prayer, for I love you, brethren, with all my heart and soul. And I pray our Heavenly Father’s blessing to attend each of you in your life, in your home, in your heart, in your soul, in the name of Jesus Christ, amen.


NOTES
1. Psalm 37:8.
2. Lawrence Douglas Wilder, quoted in “Early Hardships Shaped Candidates,” Deseret News, Dec. 7, 1991, A2.
3. See Heber J. Grant, Gospel Standards, comp. G. Homer Durham (1969), 288–89.
4. 3 Nephi 11:28–30.
5. See George A. Smith, “Discourse,” Deseret News, Apr. 16, 1856, 44.
6. Thomas B. Marsh to Heber C. Kimball, May 5, 1857, Brigham Young Collection, Church History Library.
7. “Maud Muller,” The Complete Poetical Works of John Greenleaf Whittier (1876), 206.
8. “School Thy Feelings,” Hymns, no. 336.
9. D&C 84:33–38.
10. John 13:35.

A More Beautiful You

Little girl fourteen flipping through a magazine
Says she wants to look that way
But her hair isn’t straight her body isn’t fake
And she’s always felt overweight

Well little girl fourteen I wish that you could see
That beauty is within your heart
And you were made with such care your skin your body and your hair
Are perfect just the way they are

There could never be a more beautiful you
dont buy the lies disguises and hoops they make you jump through
You were made to fill a purpose that only you could do
So there could never be a more beautiful you

Little girl twenty-one the things that you’ve already done
Anything to get ahead
And you say you’ve got a man but he’s got another plan
Only wants what you will do instead

Well little girl twenty-one you never thought that this would come
You starve yourself to play the part
But I can promise you there’s a man whose love is true
And he’ll treat you like the jewel you are

There could never be a more beautiful you
dont buy the lies disguises and hoops they make you jump through
You were made to fill a purpose that only you could do
So there could never be a more beautiful you

So turn around you’re not too far
To back away be who you are
To change your path go another way
It’s not too late you can be saved
If you feel depressed with past regrets
The shameful nights hope to forget
Can disappear they can all be washed away
By the one who’s strong can right your wrongs
Can rid your fears dry all your tears
And change the way you look at this big world
He will take your dark distorted view
And with His light He will show you truth
And again you’ll see through the eyes of a little girl


There could never be a more beautiful you
dont buy the lies disguises and hoops they make you jump through
You were made to fill a purpose that only you could do
So there could never be a more beautiful you
There could never be, a more beautiful you.


I have heard this song several times on my favorite radio stations KLOVE and Sirius 66 Spirit. It has a wonderful message for Young Women and Women about our real divine worth and what matters to our Heavenly Father. Our inner beauty.

The Cardall Family

photo from Paul's blog

My husband and I follow closely the story and music of Paul Cardall as he has inspired us so many times. This past week there have been some poignant and beautiful posts about adversity and forgiveness. Paul lost his brother Brian a young and brilliant scientist and father in a trajic accident. Here are his words on the news:

"I have struggled my whole life with a severe heart defect while Brian experienced some mental illness. Rarely did Brian have episodes which triggered this horrific tragedy. The public should know that Brian is a wonderful son, loyal brother, loving father, and faithful husband who loved being with people. He was extremely intelligent and full of personality. He wanted to make a difference in this world. He was working on his Ph.D. in molecular ecology at Northern Arizona University. He loved being in the outdoors with his daughter Ava and beautiful wife Anna. Brian was a great friend. He brought so much joy to our family and had the biggest heart in the world. He was a good man striving to learn how to be a better man. It was an honor to know him in this life and call him brother. Our family will miss Brian but we are comforted by our faith in a loving Heavenly Father whose grace is sufficient enough. Here is to our brother Brian. God speed my friend. You are free to exercise the spiritual depths of your heart. We love you!"

May the Cardall family find peace in the Savior and may Paul get a heart very soon. Pray for them!

There are some amazing video clips and tributes if you would like to follow this family's journey. at http://mytricuspidatresia.blogspot.com/

Finding Balance

I know most women in their mid-thirties don't even think about these things, but here I am! After years and years of multiple health issues a team of doctors and therapists finally started putting my pieces together. Most of my problems were interrelated and changed drastically during each of my pregnancies. Two of my physicians suggested looking into bio identical hormone replacement.

I had tried over the counter drugs for endometriosis, thyroid problems, depression, OBGYN issues and loss of appetite. Nothing really seemed to address the gambit of symptoms and pain I was experiencing. I really felt drained after the 15 year process of trying to find some peace and comfort. Surgeries, specialists, and side effects one on top of the other.

I am now two weeks into the process of hormone replacement after my tests came back that I had a major progesterone deficiency, issues with cortisol and androgen balance. Finally I saw on paper what we have suspected for so many years. It just makes sense to me to go to the root of the problem and start healing instead of trying to patch up symptoms. You may want to look into it for yourself. Here in Utah there is "All for Women Health Care" and Jolley Compounding Pharmacy.





I also found out about a prescription drug called Deplin from a friend of mine who suffers from severe post par tum depression. Yet another answer to prayers.

Taken from their website, here is an explanation of the supplement which helps process anti-depressants to make them available and effective.

Deplin® Facts

How Does Deplin® Work?Deplin® works through a natural process in the brain to regulate all three monoamine neurotransmitters associated with mood by providing the increased dietary requirements for folate. L-methylfolate is needed by depressed patients with suboptimal folate to regulate the synthesis of monoamines (serotonin, norepinephrine and dopamine) and known as a trimonoamine modulator (TMM). By managing trimonoamine neurotransmitter synthesis, L-methylfolate, when taken with antidepressants, improves benefits.
Click here to read more about how Deplin® works »

Deplin® vs. Folic AcidFolic acid is a man-made product that needs to broken down by the body through a lengthy 4-step process. Folate that comes from your diet (e.g green vegetables) must undergo a 3-step transformation.

Click here to see how Deplin® differs from folic acid »

Here's to finding answers!!! May you find some as well...

Women's Wellness

Yesterday I went to a women's health specialist and wanted to pass along the information she gave me because it all made sense. Her approach is one of looking for a long-term solution and getting to the core issues instead of just treating symptoms. Much of the advice she gave me I have heard repeatedly over the last few years as I have been seeking a cure for the long haul.



5 Things your family can do every day to stay well

1) Eat a diet rich in antioxidants. Eat 9 servings of fruits and veggies every day. Make sure oyu are getting enough protein in your diet. Breakfast is a good time to get it in with eggs or turkey bacon. Take whole food vitamins

2) Eat a low sugar and refined carbohydrate diet

Get 35 grams of soluble fiber a day for increased good cholesterol

Try probiotics like Activia yogurt or flora 2 supplement by Kenwood Therapeutics





3) Eat essential fatty acids. Omega 3's are anti-inflammatory and anti-oxidant Try Coromega brand Omegas or flax seed/ flax seed oil

4) Do 40 minutes of physical activity every day. Try to get outdoors on walks or to play

5) Decrease stress in your life any way you can. Avoid the trap of thinking you need to "do" more. You body is a diary of your stress, it stores it all. Keep a journal. Do yoga, breath or meditate. Say "no" to more than you can handle.