Angelika gets off NSAID’s with the Paddison Program For RA
We discuss how:
– Angelika got diagnosed with RA in 2001 and started taking medications
– She got a synovial cyst aspirated three times and injected with cortisone
– Her CRP was 89 and she had stiffness all over her body so she started taking ibuprofen and Advil
– She refused to go on Methotrexate and Plaquenil as later suggested
– She had continuous flare-ups and things were getting worse until November 2017
– Angelika found Clint’s TED Talk while searching on the internet
– She started the Paddison Program for Rheumatoid Arthritis and eliminated much of her pain within days
– After a couple of weeks she’s been able to come off Advil
– Angelika has also improved her thyroid function
Clint: Today I’m really excited to have Angelika on this podcast with me. We’re going to talk about non-steroidal anti-inflammatory drugs. Angelika has been on them for what seems like a lifetime. But with the Paddison Program she’s now gotten off them and feels tremendous. So this is going to be a feel good story. She’s all the way originally from Germany but now has lived most of her life in Canada. Welcome Angelika.
Angelika: Welcome. Thank you. Thanks for having me. I just wanted to say before I start this talk, that I’m eternally grateful to you for sharing your story because if it hadn’t been for you I would not be in the position that I am that is to be off my anti inflammatories, and to feel absolutely fantastic. So thank you so much.
Clint: Oh, you’re very welcome. And it’s for wonderful feel good moments like that, and being able to help people that Melissa, my wife originally said to me Look if we can only just help one person by sharing our story then it will be worth it. And we had all these notes that we’d put together, like all these sort of scattering of little workbooks, and journals, and Excel spread sheets, of body pain levels scoring and all sorts of stuff. And we’d had a collection of all of the articles that we’d used to justify the direction that we’d gone. And so it was just a matter of putting it together and then seeing if other people benefited. And sure enough, that began you know what’s been an incredible ride of hearing wonderful news frequently which is certainly it’s a wonderful situation to be in where you can help other people, and let’s take nothing away from all the work that you’ve had to do which is to actually implement the information. Because so many people skim across a website and see that they can do these things and choose not to. So you can take a huge amount of responsibility and credit for what you’ve been able to achieve which will now hear about. So tell us, when you got diagnosed with rheumatoid arthritis, when?
Angelika: So I got diagnosed with rheumatoid arthritis in 2001, and I was put on (inaudible) first and that was taken off the market, and then put on Celebrex. And it didn’t really do anything much for me. The doctor said I should be on it for a few months because it may not work right away, which is what I did. But nevertheless, it really didn’t help. And I also had a synovial cyst at the back of my knee, that was aspirated about three times and injected with cortisone. And that did help, and whenever I had the cortisone injected all the pains in my body went, and that was good for about a month. And after the third time he said I can’t do it anymore. The next time it blows up you’re going to have to have surgery, and that wasn’t in my books. I wasn’t going to have anybody touch me, give me medication or touch me with a knife. So then that rheumatologist retired, and my GP started taking care of me. Initially when I was diagnosed my CRP was 89.
Clint: Wow, that’s a huge CRP. Mine only ever got as high as 55, which is still very very high given that it’s meant to be below five. But you know 89, that’s probably in the top 10% bracket for cases that I see.
Angelika: I was really, I was very stiff. I had total stiffness all over my body, and I had pain in my feet, and in my hands mostly. And initially I had it in every joint in my body except my elbows, and my hips. I had pains right from my neck, my jaw, my neck, all the way down to my toes, my ankles my toes. But I never had any pain in my hips or in my elbows, the whole all those years that I’ve had it. But nevertheless, my GP started to take care of me and she said Well try Advil, Ibuprofen I should say, which is what I did and it did help me. And initially I would take probably about 1200 milligrams sometimes more. But over the years, it worked for a while and I felt reasonably comfortable with it. Then I added Tylenol to the mix, and I needed more medication, and so it did help. However, she eventually sent me to another Rheumatologist, and he suggested that I go on Methotrexate, and or Plaquenil. And I had research those meds and I didn’t want to go on them. And he said well you know if you don’t take them you’re going to get joint deformation, and the Advil will only help the pain, it won’t help the progression of the disease. And so I said well I will take that chance, and I will monitor myself which is what I did.
Angelika: So anyway, until November 2017 I had flare ups on and off. I managed reasonably well but I can say that I was really in the best shape. I think somebody with Rheumatoid Arthritis would feel a lot better than I did. But somehow you just sort of accept your lot in life, over the years and I kept on going and doing but I had to do. And I did everything from gardening to whatever, sometimes this pain my joints would flare up, and I kept on going. So in the meantime the rheumatologist would say, well I really think you should go on these medications and I said I really don’t want people on them. And as the flare ups got worse, I started to feel that I was being boxed into a corner that soon I won’t have a choice and I may have to go on them.
Angelika: So one day I’m sitting very nicely in my chair, and I’m watching TV and I had this enormous nosebleed. And prior to that I had indigestion, for about the past year I had indigestion, heartburn, and I was taking antacids. And the nosebleed really kind of, I started to get really scared and worried because I knew bleeding was one of the problems, I was taking anti-inflammatory. So I have the nosebleed, I managed to stop it, I didn’t have a repeat.
Angelika: I got on my internet and I started to research. And before long I came across your TED talk, and that’s what started my whole recovery. Your TED talk was so exciting I thought, I can’t believe this is happening, I’m going to try this. So I listened to you, and then I came across all the people that you had mentioned, Dr. Klaper, all the research, and the nutritionist. And I started to research, and research, and research, and they were all saying the same thing. And I said I’m going to try this. So I immediately stopped coffee, and alcohol. And that was before Christmas, and then a just after Christmas I stopped cold turkey, all meat products, eggs, cheese, I stopped it immediately. And with i n couple of days I noticed that my neck pain was gone, completely gone. And prior to that I had tried so many different pillows, and I wasn’t getting any relief, the medication wasn’t giving me any relief. So that was the first thing I noticed, and then I started juicing. And when I started the juicing, I noticed for the next day I had no pain, no pain in my hands. I felt like, I woke up in the morning I couldn’t move my fingers, it was unbelievable.
Angelika: Anyway, and from then on, I did the diet, and so I thought well I’m going to have to come off this medication, how am I going to do this.? So I tried a few times but I was still having pain, and then I decided that even if I have pain I’m going to decrease it, and I’m going to keep on eating what I’m eating what’s good for me. And so over a two week period I noticed a big difference. Gradually I was able to take less and less ibuprofen, and my pain decreased. And up to this point it is still getting better all the time. And this was my situation, I tried many times to come off the medication, but I would take it in the morning, I would take it at night. But sometimes I would forget to take it at night, and I would get up in the middle of night to go to the bathroom and I could barely move. I felt ill, I felt unwell, the veins in the back of my head which would all be engorged, and it was just an awful feeling. I take the Advil, and I go back to bed, and I get up in the morning I feel okay.
Angelika: So I did have that feeling a little bit, but it got less and less. And over a two-week period, I was able to come off the Advil. And I was so happy, and my pain level had decreased to the point where now I’m completely off. I haven’t touched an Advil for weeks and weeks, and I’m eating the healthy diet, and I feel absolutely fantastic. That’s my story.
Clint: That is unbelievably awesome. You know it’s very very unusual to have the condition for 17 years, and never go on a disease modifying drug. it’s probably, you’re probably 1 in a hundred, maybe 1 in two or 300 people who like statistics of that kind of approach. And what’s fascinating is that you also never took any Prednisone, right? You never went on that either. And that was a great blessing, because what I seem to see is that people who take the Prednisone for long periods, have a much greater difficulty with being able to come off it and to get well almost compared to any other drug. And so it’s fortunate that you didn’t go down that path.
Clint: I never went down that path, even though one time I walked in and requested this of my rheumatologist I said, what about one of those steroid shots? Just to give me some pain relief for a couple of months, so that I can get my knee working better, my everything, I’ll be able to exercise more. And I had quite a case for having just a one-off prednisone shot. And he said we don’t do them in our office, he said I just don’t think it’s a good strategy based on the science and based on his own personal opinion on it. And thank God, because you know we know that even a general steroid shot to the backside like that causes more leaky gut. I have my own personal views that are unscientifically substantiated. That it actually prednisone deletes the mucosal lining of the intestinal wall and the colon. In the same way it reduces mucus in asthma patients. I believe reduces the mucus that’s present that is the place where the bacteria need to live and to thrive, and therefore there by making it so difficult to recover, there’s nowhere for bacteria to regrow. And so, your situation is unique from that viewpoint.
Clint: Now I also think that’s fascinating, in that I’ve had other clients who have taken painkillers as long as you have. They’ve done other drugs as well though, but they’ve taken painkillers daily for as long as you have. And I’ve also seen them when they’ve changed to this program be able to get off their painkillers even after a few decades of taking them. And so I find that really interesting. So there’s something about the painkillers that although they cause more leaky gut and we know that, the studies are really clear on that. I want to go through some in a second, if we want to. I might just post the studies inside the show notes which is probably better. So on our website when you come to Angelika’s podcast, you can just search by her name ANGELIKA and you will find the show notes all about non-steroidal and inflammatory drugs and there are problems that have been medically published. But somehow, they don’t seem to be as I guess are catastrophic long term. And so this is more education for me as I continue to learn, and it supports what I’ve seen with other people. We don’t want to be taking them on a daily basis because of their negative impacts on our healing. But you’re a great example and I have others to cite, where even if you do once you get things right with diet lifestyle you can come off them without the enormous consequence that we can see with other drugs.
Angelika: Yes I was worried that perhaps I was addicted to them but they say you can’t be addicted to this anti-inflammatory ibuprofen. But then the other problem was there was so much new evidence out there that you would get problems with heart disease, and heart attacks, and strokes, so that all weighed heavily on my mind as well. But my rheumatologist did I think that I had a milder case of rheumatoid arthritis. He didn’t think I had a really very serious case. My CRP eventually went down to about 11.7, but even 11.7 I’ve felt that my body did not feel right. But just the end of March I had my CRP checked and it had come down to 4.7 and that’s the lowest it’s ever been, and I really felt the difference. I didn’t feel my body was inflamed, I felt totally loose and relaxed and pain free. I could go down the stairs one step after another instead of one step at a time, and I could get up at night and walk without being stiff. And so this diet really really helped me and it just did wonders and now, my husband also started to go on that he share it. He said if you’re going to eat like this, I’m going to eat like this. So that made a big difference because now I could just cook one meal for the two of us. And his cholesterol went way down, my cholesterol went down as well and he feel so much better. And so I’ve passed on the information to friends, and family, and I’ve told them about the Paddison Program. And so yeah it’s been great and all my friends and family everybody’s been so supportive.
Angelika: People are always asking, how are you feeling? You look great. And I’ve also lost 28 pounds, and that makes me feel wonderful. I’ve got a little bit overweight so now I’m just back to the weight I was in high school and I feel great. So psychologically it’s just boosted my morale like you wouldn’t believe. Plus, I don’t have the depression of feelings of depression, and there was always this thing in the back of my mind I need to come off these drugs. That you know I couldn’t end up with a stroke or a heart attack or something one of these days or a bleed in my gut.
Clint: Yes, exactly.
Angelika: And now I’m off it, and I don’t have that pressure anymore, and I feel great, it’s just wonderful, I’m just so happy.
Clint: Yes isn’t it, we could bask in the joy that we get from pain relief all day every day, because the pain is so heavy and such a burden and so monotonous. That when it lifts its horrible pressure from our lives than the feeling is elation at the highest level, it’s euphoric isn’t it?
Angelika: It is absolutely!
Clint: Yeah. I mean It’s something that. I’m rewriting my book at the moment and I’m coming up with these nice little sentences at least I think they’re nice and phrases about wanting to be evangelical about some things in life. And I think that if there is anything to absolutely shout from the rooftops, it’s that if we eat as many plants as possible, and if we take it to the extreme. We just eat all plants to give ourselves the best possible opportunity of gut health, and low inflammation levels, and in that instance a cruelty free life to animals and a very low carbon footprint for Earth. I mean what else would you not want to be excited about, and scream about, and tell everyone about, and quite frankly be annoying about, and self-righteous about. Because this is the ultimate way to live a life for you and other animals and the planet, to provide everyone with the kind of best outcome. And so you feel good about yourself when you do this right?
Angelika: Yes absolutely, absolutely. It’s mind boggling, I’m still sometimes in disbelief. I’ve turned my whole life around because of this man, this wonderful person that I came across. And I’ve gone to, I’ve read, I’ve listened to all your podcasts and I just couldn’t get enough of them. Every time there’s a new one I’m right there, every time you send a message about some new thing, I’m right there, and I’m reading it. And then I’m reading up on Dr. McDougald’s site. I went to his site and I listened to all his podcasts, and all his information, and all the research. And everything makes sense and I wonder why haven’t I done this before? But I don’t dwell on that too much, It’s just the here and now, it’s done, I’ve started it, and yesterday was yesterday, today is today, and the future, well hopefully it’ll be bright.
Clint: Yeah, it will remain bright as long as you continue to do what you do. You’ve already sort of demonstrated that after just a few weeks the small amount of drug although it’s a significant dose that you were taking. Just a single anti-inflammatory drug that you’re on, that you don’t need anymore, and that your body feels amazing. It would be inconsistent with everything else I’ve ever seen. Should you suddenly develop symptoms again tomorrow or the next day, right?
Clint: As long as you keep doing what you’re doing, and every time that you start to feel some kind a little bit of symptoms not quite as good as they were the day before. Quickly get back onto the basic foods, makes to resume your juicing, add a little bit more salad, and exercise more, and then it will subside again. And so you’ve got this game to play now, now and forever just like I do. I’m the same, if something’s not quite perfect I’m straight. For me I don’t normally go back to baseline foods, but I’ll go to the gym. I’ll just exercise a little more, I’ll Move my body a little more, and I just squash that thing till it’s non-existent. You know what I mean? And so, we’re always going to have some little bit of a one percent thing that we need to watch out for here and there, and we’ve got to get rid of it and make it 0%.
Angelika: Absolutely. And it’s not a problem. I’m getting used to cooking this way, I’m looking at new exciting new ways of cooking, and I’m always finding new ways of doing it. Today I found out that you can slice sweet potatoes lengthwise and thick slices put them in the toaster, several goes and then you could spread bean spread or something on them and that’s a great snack that you can make quickly. And then I keep a little book and every new recipe that I like, that I’ve enjoyed making. I write into the book, because I don’t have a huge appetite in the back of my mind because I’ve cooked a certain way all those years. So now I put it in a little book, and so if I what are we going to eat today? What I’m gonna shop for? I have my little book for reference, and then I’ve got all the recipes in there. Whether they’re in a cookbook, or on line, or written down, and it’s that’s a great help.
Clint: That’s is a great help.
Angelika: That’s fun. I’ve even baked a chocolate cake, a vegan chocolate cake with no oil and it was totally delicious, and everybody loves it. So I’m happy, and my husband loves everything I cook. Whether it’s good or not I’m not sure, but he’s just happy and he’s so totally supportive, he’s happy to see me slim, and healthy, and happy, and he says it couldn’t be. He says this stage of our lives to have this kind of thing happening to us is wonderful. So it’s great. I’m smiling.
Clint: It is an amazing, so am. Now is he also originally German or is he Canadian?
Angelika: Yeah, he’s German also.
Clint: Okay great, okay nice. Because the Germans tend to love traditionally. I used to live with a big German guy is about 6 foot 4. You know when I was in a share house in Australia before Melissa moved to Australia to live with me. You know I was in a share house, and in the big German guy and his diet was atrocious. I mean everything was fried in oils, and he was doing sausages all the time, and it was very very fatty. So this must be you know to turn a German vegan. I mean you must have German friends that are looking at you sideways.
Angelika: Well you know what, I think it was pretty modern in what we eat. We pretty much international food. But I mean there’s certainly a lot of my mother’s cooking that I kind of kept and and still made, although over the years we’ve cut back on meat, and oils. Always I was eating a reasonably good diet, until I started this and then I realized how much oil. It was always olive oil is good for you, so olive oil went into everything.
Angelika: The other thing I wanted to say, many many years ago I was diagnosed with a latex allergy, and I went to an allergist. And he told me that I was allergic to lots and lots of vegetables. And I kind of laughed at the time because I thought, I’m eating all those things all the time. How could I be allergic to them? I didn’t have any, I mean I had the rheumatoid arthritis, but I didn’t connect it to. And now I’m finding that I can tolerate potatoes, the nightshade families don’t agree with me, nuts don’t agree with me. And so there are a few foods that are the same in the same category as latex food. So that’s melons, bananas, avocados, I can’t eat any of those. So it does limit me in some way when I cook. And so I’m just sort of wondering what I should do once I don’t want to lose weight anymore. How I keep up my weight? If I can’t eat those like avocados, then you know just nuts.
Clint: Yeah. So avocados and nuts are overkill when it comes to maintaining weight and even adding weight. Okay, so they are high in fat, and if we eat a lot of those each day then you know if you ask your friends or extended family who don’t eat the sort of diet that you’re on. They’ll find that they’re gaining weight by eating to much of those foods because of their fat content. So I found once I did an experiment where all I did was eat as much basmati rice as I possibly could with a tall glass of orange juice at every meal. So I was having what I call the mega miso meal. So that’s basmati rice with miso paste seaweed, and I was having salad, and then a huge amount or like a big glass 600 mil of orange juice.
Clint: I gained something like three kilograms in two weeks just by having most of my meals just rice, orange juice, heaps of greens, and a little bit of other stuff. A little bit different you know diversity with some different fruits and probably a little bit of my two-grain mix and stuff. But mostly it was just a simple repetitive diet like that, and I was very surprised myself that I can put on three kilograms and I’ve never carried much body fat so it’s just muscle. But you have to go to the gym, your muscles won’t spontaneously build. They need to be challenged to have micro tears, when they get these micro tears they then rebuild themselves and overcompensate for future exercise of the same nature. And so yeah, look if you can eat rice, if you can have orange juice or another form of easy calories that don’t cause you to have any kind of pain imbalance, then you’ll find that your weight is fine.
Angelika: It’s not a problem yet, but this thought had occurred to me you know what to do.
Clint: Yeah start getting into a routine with some exercise, add a little bit of resistance training. You might just want to get some light weight from a store like Wal-Mart or say a couple of weights for a few bucks just do some arm exercises, do some simple squats at home.
Angelika: Yes I have those.
Clint: Yeah, this is good practice anyway. Even if you’re not trying to add weight, it’ just good practice just to add a little bit of resistance training. It’s good for the bones, for strengthening them, and for avoiding osteoporosis which is mostly according to Dr. Klaper mostly a weight bearing or a lack of weight bearing disease. You know we’re just sitting around too much, and not loading our bones enough and forcing that microscopic compression through the bones with some weight. That causes them to then demand the nutrients that are needed to maintain good strength. He’s got information, if people want more on that they can just go to DoctorKlaper.com, and Doctor is the whole word not D.R. And he’s got training on that online that’s very cheap.
Clint: So that’ll keep your weight just fine, and everything else sounds like it’s well under control. So I just want to just highlight some of the, we talked about putting on the show notes some of the dangers of nonsteroidal and inflammatory drugs. The main categories are, that they create gastro intestinal complications. So you get things like gastric ulcers especially when they’re used in parallel with prednisone. So prednisone plus nonsteroidal and inflammatory drugs is the worst possible combination or pairing of rheumatoid drugs, and then also with the leaky gut. And the studies are very clear around that, in fact in my guide for rheumatologist I think I have something like five different studies that confirm that. And my own personal story with taking nonsteroidal antiinflammatories, is that after a few months of being in a lot of pain I went and took some of those and found them very effective at fast pain relief. But found that the effectiveness wore off after three weeks I was taking increasingly high doses to get the same amount of pain relief.
Clint: And then after three weeks of taking them I decided to stop taking them altogether, because I thought something’s not right here. And I wanted to find out where my pain levels were after stopping those drugs. Well let’s say I went into that three-week period with my pain levels around f5 out of 10. I came out of that three-week period my pain levels were an 8 out of 10 and that’s where they stayed. I could not shake it down, it was like in three weeks I’d gone up that massive jump in pain and I was locked in and that’s where I stayed. And of course I didn’t know any of the tools or ways of eating that I describe now. I was completely blind guessing game, and eating the way that most people eat and looking for changes through supplements and things the way that most people do. You know things like your glucosamine sulfate, conjoint, and then fish oils and stuff. I mean that’s the kind of 101 level that I had when I was starting out, so I didn’t know what to do to offset that pain.
Clint: So I hope this has been really great for people listening, who are on these painkillers, who are going to be inspired by this. And it’s really great that you’re able to have done this and and just before we started this recording. You also mentioned your age which shocked me because you look very very healthy and young. But would you be kind to show your age with people who are watching this.
Angelika: I’m 73.
Clint: 73, right. So you know you could you could easily pass for at least a decade younger than that.
Angelika: Thank you.
Clint: So you know I think that this is also a really encouraging for our viewers or listeners who are around your age bracket and think you know if Angelika can do this maybe maybe I can as well. And we’ll also note that you haven’t done anything radical because nonsteroidal are discretionary drugs. They’re the sort of things that you take based on your own feelings day today that aren’t prescribed to certain dose and require rheumatologist approval. So look you haven’t done anything radical. You’ve done something amazing with your eating and then what you’ve been able to do was then not radical whatsoever, just coming off these medications. But in terms of the profound impact on your life and your future health, that’s where it’s radical.
Angelika: So one more thing I wanted to mention, my TSH was actually went up to over 5 and I started to get very weepy, and depressed. So my doctor increased my thyroid medication to increase it slightly, and it gradually came down it went down to 4.8 or something, and then two just over 3.7. And then when I just had it checked after I’d been on this diet for several weeks, it had gone down to 1.75. And that made me feel absolutely fantastic. I felt a lot calmer, my anxiety is gone, I’m just more relaxed, I sleep better, and I think it’s all due to the fact that I’m now eating this healthy diet and it’s the weight loss also has affected this.
Clint: Yeah that’s sensational.
Angelika: So and I see my doctor again in end of June, I’m going to see if perhaps she can drop the thyroxin or perhaps I can come off it so we’ll have to see. But I’m very happy about that, and that’s the only medication I take other than that I’m very lucky not to be taking anything else.
Angelika: So I’m very happy to be in relatively good health in spite of having the rheumatoid arthritis all those years, so I consider myself very fortunate.
Clint: Yeah absolutely. And you mentioned, I want to comment on the thyroid medication and the thyroid markers in just a moment. But first of all you mentioned, that your rheumatologist earlier about halfway through our call said that he didn’t think you had a very particular bad case of rheumatoid arthritis. And yet, you said you had an 89 C-Reactive Protein. So there’s an inconsistency there. Your marker at the start was enormously high, you had pains throughout your body. So let’s not dismiss what you’ve achieved as something that can only be done by people who have a small amount of like you know one finger problem. You were throughout your body except for just a couple of major joints, so let’s not allow that to be just dismissed. And then second of all we do see thyroid markers improve with people who have hypothyroidism. Not in all cases but in enough cases for it to be exciting. And if anyone has that condition should certainly be having their markers checked and see if they can improve by following this program.
Clint: So that’s super exciting especially how much your numbers came down. So is that the lowest that your thyroid markers have ever been?
Angelika: Yes that’s the lowest they’ve ever been.
Clint: Right so you’ve got the lowest C-Reactive Protein, and you’ve got the lowest thyroid markers, and you’ve got the lowest pain that you’ve had.
Angelika: Yes absolutely.
Clint: But the most happiness.
Angelika: Oh absolutely you can’t compare. I’m just thrilled over the moon.
Angelika: I’ve got all the reasons to keep this going because, I don’t want to, I don’t want to ever feel sick again like that with my joints and feeling unwell. And so I’ve got you know I’ve got the motivation to keep me going on this. And really if people say I couldn’t do that, but you know what. If you don’t want to have pain, you will do it.
Clint: It always goes back to that, the pain, the pain is a great motivator.
Angelika: Absolutely yes. I’m very very happy about it, very happy. And thanks again so much. I can’t thank you enough. I wish I could go and hug you.
Clint: Well maybe we’ll get to one day, what part of Kennedy are you in?
Angelika: I’m just about an hour and a half east of Toronto. I used to live in Toronto, but we’ve retired to the country where we had a cottage which we tore down a couple of years ago and we built our dream house. So that’s where we live now, and I paint, and I have a little artist studio here, and yeah I’m quite happy living out here now.
Clint: Oh that’s lovely, that’s lovely. Well great, well if I get to Toronto which I would love to come up and maybe give a seminar then given that you told me that you open my emails with a frantic pace. Then I think you’ll find out about when it’s happening and be able to meet.
Angelika: For sure, for sure.
Clint: Okay well lovely to chat with you. Really really great to hear your progress, and please keep me updated as you continue to do well down the track.
Angelika: I will, thank you so much Clint bye.
Clint: Thank you. Bye bye.