Which doctor to see?

[etabetac]

Sorry for posting this in a forum. I'm at a loss for what to do.

I recently switched from a regular work insurance to graduate student/research assistant insurance. As a result I have to be seen through the campus health service clinic. I've had a dragging sinus or allergy thing going on for 28 days, at least. I am beginning to feel like it's starting to hit my lungs (but it's not there yet). I tried to get an appointment at campus health but because of classes andfew open appointments, I cannot get an appointment this week. To make things worse, I have been to campus health on a handful of occasions and they know about my medical background which means they are reluctant to treat without contacting the pulmonologist. But due to red tape and weird phone rules it can take days to get them in contact with the pulmonologist. I know it is nothing serious yet.

I would not normally go to the pulmonologist for this and I doubt I can get an appointment much quicker because it's not an emergency, or even urgent, I need to go through the hospital scheduler which would also mean next week. I also prefer to have insurance cover things and I think if I circumvent campus health I may have to pay completely out of pocket.

Should I self treat and just hang on longer? Do I have other options.

 

[etabetac]

Sorry for posting this in a forum. I'm at a loss for what to do.

I recently switched from a regular work insurance to graduate student/research assistant insurance. As a result I have to be seen through the campus health service clinic. I've had a dragging sinus or allergy thing going on for 28 days, at least. I am beginning to feel like it's starting to hit my lungs (but it's not there yet). I tried to get an appointment at campus health but because of classes andfew open appointments, I cannot get an appointment this week. To make things worse, I have been to campus health on a handful of occasions and they know about my medical background which means they are reluctant to treat without contacting the pulmonologist. But due to red tape and weird phone rules it can take days to get them in contact with the pulmonologist. I know it is nothing serious yet.

I would not normally go to the pulmonologist for this and I doubt I can get an appointment much quicker because it's not an emergency, or even urgent, I need to go through the hospital scheduler which would also mean next week. I also prefer to have insurance cover things and I think if I circumvent campus health I may have to pay completely out of pocket.

Should I self treat and just hang on longer? Do I have other options.

 

[etabetac]

Sorry for posting this in a forum. I'm at a loss for what to do.

I recently switched from a regular work insurance to graduate student/research assistant insurance. As a result I have to be seen through the campus health service clinic. I've had a dragging sinus or allergy thing going on for 28 days, at least. I am beginning to feel like it's starting to hit my lungs (but it's not there yet). I tried to get an appointment at campus health but because of classes andfew open appointments, I cannot get an appointment this week. To make things worse, I have been to campus health on a handful of occasions and they know about my medical background which means they are reluctant to treat without contacting the pulmonologist. But due to red tape and weird phone rules it can take days to get them in contact with the pulmonologist. I know it is nothing serious yet.

I would not normally go to the pulmonologist for this and I doubt I can get an appointment much quicker because it's not an emergency, or even urgent, I need to go through the hospital scheduler which would also mean next week. I also prefer to have insurance cover things and I think if I circumvent campus health I may have to pay completely out of pocket.

Should I self treat and just hang on longer? Do I have other options.

 

[etabetac]

Sorry for posting this in a forum. I'm at a loss for what to do.

I recently switched from a regular work insurance to graduate student/research assistant insurance. As a result I have to be seen through the campus health service clinic. I've had a dragging sinus or allergy thing going on for 28 days, at least. I am beginning to feel like it's starting to hit my lungs (but it's not there yet). I tried to get an appointment at campus health but because of classes andfew open appointments, I cannot get an appointment this week. To make things worse, I have been to campus health on a handful of occasions and they know about my medical background which means they are reluctant to treat without contacting the pulmonologist. But due to red tape and weird phone rules it can take days to get them in contact with the pulmonologist. I know it is nothing serious yet.

I would not normally go to the pulmonologist for this and I doubt I can get an appointment much quicker because it's not an emergency, or even urgent, I need to go through the hospital scheduler which would also mean next week. I also prefer to have insurance cover things and I think if I circumvent campus health I may have to pay completely out of pocket.

Should I self treat and just hang on longer? Do I have other options.

 

[etabetac]

Sorry for posting this in a forum. I'm at a loss for what to do.

I recently switched from a regular work insurance to graduate student/research assistant insurance. As a result I have to be seen through the campus health service clinic. I've had a dragging sinus or allergy thing going on for 28 days, at least. I am beginning to feel like it's starting to hit my lungs (but it's not there yet). I tried to get an appointment at campus health but because of classes andfew open appointments, I cannot get an appointment this week. To make things worse, I have been to campus health on a handful of occasions and they know about my medical background which means they are reluctant to treat without contacting the pulmonologist. But due to red tape and weird phone rules it can take days to get them in contact with the pulmonologist. I know it is nothing serious yet.

I would not normally go to the pulmonologist for this and I doubt I can get an appointment much quicker because it's not an emergency, or even urgent, I need to go through the hospital scheduler which would also mean next week. I also prefer to have insurance cover things and I think if I circumvent campus health I may have to pay completely out of pocket.

Should I self treat and just hang on longer? Do I have other options.

 

[welshwitch]

man, this is a tough one. when i was in grad school i had the same predicament. i completely blew off my cf doctors because i wasn't on the correct insurance and went to the student health clinic.

right off of the bat i would tell you to try to do whatever you can to go see a CF doctor if it's a sinus or allergy thing because these things are directly related to CF.....why not, you know? then follow up with an allergy doctor.

i only say this because when i went to a "regular" doctor it was clear she had absolutely no idea what CF was and how to treat it. i only saw her in the first place because i had to get a perscription for digestive meds filled at the campus pharmacy and you had to get a dr.'s note to get it filled. nice, huh? anyways, i caught her checking up CF on her computer right before the appointment. (hopefully it wasn't the wikipedia article on it!<img src="i/expressions/face-icon-small-happy.gif" border="0">) and our appointment was a complete BS session...how are you feeling, etc. etc. when i was only there to get the frickin' med persciption refilled.

long story short, i have no idea how a grad. student is supposed to get CF care. but there ARE graduate students on this website who have successfully pulled it off. (i don't know if this means taking out more loans or what!??) why the hell not see a dr. who specializes in your condition...if it's a sinus issue they should be able to take care of it right away and also keep a lookout for anything else that might be coming up.

 

[welshwitch]

man, this is a tough one. when i was in grad school i had the same predicament. i completely blew off my cf doctors because i wasn't on the correct insurance and went to the student health clinic.

right off of the bat i would tell you to try to do whatever you can to go see a CF doctor if it's a sinus or allergy thing because these things are directly related to CF.....why not, you know? then follow up with an allergy doctor.

i only say this because when i went to a "regular" doctor it was clear she had absolutely no idea what CF was and how to treat it. i only saw her in the first place because i had to get a perscription for digestive meds filled at the campus pharmacy and you had to get a dr.'s note to get it filled. nice, huh? anyways, i caught her checking up CF on her computer right before the appointment. (hopefully it wasn't the wikipedia article on it!<img src="i/expressions/face-icon-small-happy.gif" border="0">) and our appointment was a complete BS session...how are you feeling, etc. etc. when i was only there to get the frickin' med persciption refilled.

long story short, i have no idea how a grad. student is supposed to get CF care. but there ARE graduate students on this website who have successfully pulled it off. (i don't know if this means taking out more loans or what!??) why the hell not see a dr. who specializes in your condition...if it's a sinus issue they should be able to take care of it right away and also keep a lookout for anything else that might be coming up.

 

[welshwitch]

man, this is a tough one. when i was in grad school i had the same predicament. i completely blew off my cf doctors because i wasn't on the correct insurance and went to the student health clinic.

right off of the bat i would tell you to try to do whatever you can to go see a CF doctor if it's a sinus or allergy thing because these things are directly related to CF.....why not, you know? then follow up with an allergy doctor.

i only say this because when i went to a "regular" doctor it was clear she had absolutely no idea what CF was and how to treat it. i only saw her in the first place because i had to get a perscription for digestive meds filled at the campus pharmacy and you had to get a dr.'s note to get it filled. nice, huh? anyways, i caught her checking up CF on her computer right before the appointment. (hopefully it wasn't the wikipedia article on it!<img src="i/expressions/face-icon-small-happy.gif" border="0">) and our appointment was a complete BS session...how are you feeling, etc. etc. when i was only there to get the frickin' med persciption refilled.

long story short, i have no idea how a grad. student is supposed to get CF care. but there ARE graduate students on this website who have successfully pulled it off. (i don't know if this means taking out more loans or what!??) why the hell not see a dr. who specializes in your condition...if it's a sinus issue they should be able to take care of it right away and also keep a lookout for anything else that might be coming up.

 

[welshwitch]

man, this is a tough one. when i was in grad school i had the same predicament. i completely blew off my cf doctors because i wasn't on the correct insurance and went to the student health clinic.

right off of the bat i would tell you to try to do whatever you can to go see a CF doctor if it's a sinus or allergy thing because these things are directly related to CF.....why not, you know? then follow up with an allergy doctor.

i only say this because when i went to a "regular" doctor it was clear she had absolutely no idea what CF was and how to treat it. i only saw her in the first place because i had to get a perscription for digestive meds filled at the campus pharmacy and you had to get a dr.'s note to get it filled. nice, huh? anyways, i caught her checking up CF on her computer right before the appointment. (hopefully it wasn't the wikipedia article on it!<img src="i/expressions/face-icon-small-happy.gif" border="0">) and our appointment was a complete BS session...how are you feeling, etc. etc. when i was only there to get the frickin' med persciption refilled.

long story short, i have no idea how a grad. student is supposed to get CF care. but there ARE graduate students on this website who have successfully pulled it off. (i don't know if this means taking out more loans or what!??) why the hell not see a dr. who specializes in your condition...if it's a sinus issue they should be able to take care of it right away and also keep a lookout for anything else that might be coming up.

 

[welshwitch]

man, this is a tough one. when i was in grad school i had the same predicament. i completely blew off my cf doctors because i wasn't on the correct insurance and went to the student health clinic.

right off of the bat i would tell you to try to do whatever you can to go see a CF doctor if it's a sinus or allergy thing because these things are directly related to CF.....why not, you know? then follow up with an allergy doctor.

i only say this because when i went to a "regular" doctor it was clear she had absolutely no idea what CF was and how to treat it. i only saw her in the first place because i had to get a perscription for digestive meds filled at the campus pharmacy and you had to get a dr.'s note to get it filled. nice, huh? anyways, i caught her checking up CF on her computer right before the appointment. (hopefully it wasn't the wikipedia article on it!<img src="i/expressions/face-icon-small-happy.gif" border="0">) and our appointment was a complete BS session...how are you feeling, etc. etc. when i was only there to get the frickin' med persciption refilled.

long story short, i have no idea how a grad. student is supposed to get CF care. but there ARE graduate students on this website who have successfully pulled it off. (i don't know if this means taking out more loans or what!??) why the hell not see a dr. who specializes in your condition...if it's a sinus issue they should be able to take care of it right away and also keep a lookout for anything else that might be coming up.

 

[NoExcuses]

I have CF and I'm a grad student.

I realized that staying on top of my health would be essential for my success at grad school. So I did all I could to make sure I was seen by a CF doc covered by my school insurance (I had to get a referral which can be a lot of paperwork).

For me, the trade offs were clear - what would be the point of having a graduate degree if I didn't have my health? So health is at the top of my life.

Being proactive about your health is essential. Many CFers on this site will tell you - you can go from being super healthy with CF to a bad situation QUICKLY if you don't take the time to take care of yourself (100% compliance with meds, getting a hold of problems right when they come up, getting proper sleep & nutrition).

Allergies make my PFT's drop about 25-30% points and I'm sure many CFers are similar. So I would get your allergy issues under control which will surely get your sinus issues under control. And once your sinuses are healthy, you lungs will be healthier.

The key to living longer is not defense - it's offense.

 

[NoExcuses]

I have CF and I'm a grad student.

I realized that staying on top of my health would be essential for my success at grad school. So I did all I could to make sure I was seen by a CF doc covered by my school insurance (I had to get a referral which can be a lot of paperwork).

For me, the trade offs were clear - what would be the point of having a graduate degree if I didn't have my health? So health is at the top of my life.

Being proactive about your health is essential. Many CFers on this site will tell you - you can go from being super healthy with CF to a bad situation QUICKLY if you don't take the time to take care of yourself (100% compliance with meds, getting a hold of problems right when they come up, getting proper sleep & nutrition).

Allergies make my PFT's drop about 25-30% points and I'm sure many CFers are similar. So I would get your allergy issues under control which will surely get your sinus issues under control. And once your sinuses are healthy, you lungs will be healthier.

The key to living longer is not defense - it's offense.

 

[NoExcuses]

I have CF and I'm a grad student.

I realized that staying on top of my health would be essential for my success at grad school. So I did all I could to make sure I was seen by a CF doc covered by my school insurance (I had to get a referral which can be a lot of paperwork).

For me, the trade offs were clear - what would be the point of having a graduate degree if I didn't have my health? So health is at the top of my life.

Being proactive about your health is essential. Many CFers on this site will tell you - you can go from being super healthy with CF to a bad situation QUICKLY if you don't take the time to take care of yourself (100% compliance with meds, getting a hold of problems right when they come up, getting proper sleep & nutrition).

Allergies make my PFT's drop about 25-30% points and I'm sure many CFers are similar. So I would get your allergy issues under control which will surely get your sinus issues under control. And once your sinuses are healthy, you lungs will be healthier.

The key to living longer is not defense - it's offense.

 

[NoExcuses]

I have CF and I'm a grad student.

I realized that staying on top of my health would be essential for my success at grad school. So I did all I could to make sure I was seen by a CF doc covered by my school insurance (I had to get a referral which can be a lot of paperwork).

For me, the trade offs were clear - what would be the point of having a graduate degree if I didn't have my health? So health is at the top of my life.

Being proactive about your health is essential. Many CFers on this site will tell you - you can go from being super healthy with CF to a bad situation QUICKLY if you don't take the time to take care of yourself (100% compliance with meds, getting a hold of problems right when they come up, getting proper sleep & nutrition).

Allergies make my PFT's drop about 25-30% points and I'm sure many CFers are similar. So I would get your allergy issues under control which will surely get your sinus issues under control. And once your sinuses are healthy, you lungs will be healthier.

The key to living longer is not defense - it's offense.

 

[NoExcuses]

I have CF and I'm a grad student.

I realized that staying on top of my health would be essential for my success at grad school. So I did all I could to make sure I was seen by a CF doc covered by my school insurance (I had to get a referral which can be a lot of paperwork).

For me, the trade offs were clear - what would be the point of having a graduate degree if I didn't have my health? So health is at the top of my life.

Being proactive about your health is essential. Many CFers on this site will tell you - you can go from being super healthy with CF to a bad situation QUICKLY if you don't take the time to take care of yourself (100% compliance with meds, getting a hold of problems right when they come up, getting proper sleep & nutrition).

Allergies make my PFT's drop about 25-30% points and I'm sure many CFers are similar. So I would get your allergy issues under control which will surely get your sinus issues under control. And once your sinuses are healthy, you lungs will be healthier.

The key to living longer is not defense - it's offense.

 

[etabetac]

Thanks guys for the help. I do like being a grad student and I would actually like the chance to use my doctorate when I actually earn it. I am trying very hard to be proactive about health but I frequently do a bad job of it.

I couldn't miss another night of sleep so I went to the student after hours clinic (had to pay but I would have to at the cf clinic too). The doctor I saw was very nice and fairly well informed. As soon as I told them why I was there, they pulled my chart and then read brief history and handed me a face mask (which is good because the curtain on one side of me had someone with mono and the other person had the flu). Not suprisingly I had wheezing in all areas of my lungs. Surprisingly my sats were great, fantastic even. I tried to protest but the doctor made me do two nebs before I left. She also made me promise to stop taking the benadryl because it is drying up my respiratory system. We added more inhaled steroids (already maxed out on advair, adding flovent 3x/day in hopes of avoiding pred taper), mucinex, a round of antibiotics (just in case it is not just an allergic reaction), and some steroid cream for eczema, which flared up simultaneously. It could have been worse. I'm following up next week with them. I have a regularly scheduled clinic appt at the end of February. Since my clinic (a very good one too) is at my university my assistantship insurance covers it with a copay. I did have two insurances for awhile but I could not continue to work and do school and research and teach. So I left in October but the insurance was still covering me. Also, the allergy/immunology people are out of the same clinic so I have been seen regularly by both. This just felt small and not necessarily something I need to take time away from other patients for.

I am trying to be compliant but I have had bad habits the last couple of years. And before that my clinic was 4 hours away so I just told the local doctors what I needed. My parents nearly killed me for moving there and not going to clinic but I am an adult and they realized it was up to me to make decisions. And they were bad decisions that my clinic confirmed when I moved here for grad school. I've paid for it since. I am lucky because I rarely get infections (the one thing that my team thinks protects me is a hyper-immune system) and so my needs are less obvious. I do have some pretty decent scarring from childhood infections so I know I need to be careful because I have damage. I also tend to tank really fast once things get to my lungs.

Thanks again for your help. I am glad I could come here for advice.

 

[etabetac]

Thanks guys for the help. I do like being a grad student and I would actually like the chance to use my doctorate when I actually earn it. I am trying very hard to be proactive about health but I frequently do a bad job of it.

I couldn't miss another night of sleep so I went to the student after hours clinic (had to pay but I would have to at the cf clinic too). The doctor I saw was very nice and fairly well informed. As soon as I told them why I was there, they pulled my chart and then read brief history and handed me a face mask (which is good because the curtain on one side of me had someone with mono and the other person had the flu). Not suprisingly I had wheezing in all areas of my lungs. Surprisingly my sats were great, fantastic even. I tried to protest but the doctor made me do two nebs before I left. She also made me promise to stop taking the benadryl because it is drying up my respiratory system. We added more inhaled steroids (already maxed out on advair, adding flovent 3x/day in hopes of avoiding pred taper), mucinex, a round of antibiotics (just in case it is not just an allergic reaction), and some steroid cream for eczema, which flared up simultaneously. It could have been worse. I'm following up next week with them. I have a regularly scheduled clinic appt at the end of February. Since my clinic (a very good one too) is at my university my assistantship insurance covers it with a copay. I did have two insurances for awhile but I could not continue to work and do school and research and teach. So I left in October but the insurance was still covering me. Also, the allergy/immunology people are out of the same clinic so I have been seen regularly by both. This just felt small and not necessarily something I need to take time away from other patients for.

I am trying to be compliant but I have had bad habits the last couple of years. And before that my clinic was 4 hours away so I just told the local doctors what I needed. My parents nearly killed me for moving there and not going to clinic but I am an adult and they realized it was up to me to make decisions. And they were bad decisions that my clinic confirmed when I moved here for grad school. I've paid for it since. I am lucky because I rarely get infections (the one thing that my team thinks protects me is a hyper-immune system) and so my needs are less obvious. I do have some pretty decent scarring from childhood infections so I know I need to be careful because I have damage. I also tend to tank really fast once things get to my lungs.

Thanks again for your help. I am glad I could come here for advice.

 

[etabetac]

Thanks guys for the help. I do like being a grad student and I would actually like the chance to use my doctorate when I actually earn it. I am trying very hard to be proactive about health but I frequently do a bad job of it.

I couldn't miss another night of sleep so I went to the student after hours clinic (had to pay but I would have to at the cf clinic too). The doctor I saw was very nice and fairly well informed. As soon as I told them why I was there, they pulled my chart and then read brief history and handed me a face mask (which is good because the curtain on one side of me had someone with mono and the other person had the flu). Not suprisingly I had wheezing in all areas of my lungs. Surprisingly my sats were great, fantastic even. I tried to protest but the doctor made me do two nebs before I left. She also made me promise to stop taking the benadryl because it is drying up my respiratory system. We added more inhaled steroids (already maxed out on advair, adding flovent 3x/day in hopes of avoiding pred taper), mucinex, a round of antibiotics (just in case it is not just an allergic reaction), and some steroid cream for eczema, which flared up simultaneously. It could have been worse. I'm following up next week with them. I have a regularly scheduled clinic appt at the end of February. Since my clinic (a very good one too) is at my university my assistantship insurance covers it with a copay. I did have two insurances for awhile but I could not continue to work and do school and research and teach. So I left in October but the insurance was still covering me. Also, the allergy/immunology people are out of the same clinic so I have been seen regularly by both. This just felt small and not necessarily something I need to take time away from other patients for.

I am trying to be compliant but I have had bad habits the last couple of years. And before that my clinic was 4 hours away so I just told the local doctors what I needed. My parents nearly killed me for moving there and not going to clinic but I am an adult and they realized it was up to me to make decisions. And they were bad decisions that my clinic confirmed when I moved here for grad school. I've paid for it since. I am lucky because I rarely get infections (the one thing that my team thinks protects me is a hyper-immune system) and so my needs are less obvious. I do have some pretty decent scarring from childhood infections so I know I need to be careful because I have damage. I also tend to tank really fast once things get to my lungs.

Thanks again for your help. I am glad I could come here for advice.

 

[etabetac]

Thanks guys for the help. I do like being a grad student and I would actually like the chance to use my doctorate when I actually earn it. I am trying very hard to be proactive about health but I frequently do a bad job of it.

I couldn't miss another night of sleep so I went to the student after hours clinic (had to pay but I would have to at the cf clinic too). The doctor I saw was very nice and fairly well informed. As soon as I told them why I was there, they pulled my chart and then read brief history and handed me a face mask (which is good because the curtain on one side of me had someone with mono and the other person had the flu). Not suprisingly I had wheezing in all areas of my lungs. Surprisingly my sats were great, fantastic even. I tried to protest but the doctor made me do two nebs before I left. She also made me promise to stop taking the benadryl because it is drying up my respiratory system. We added more inhaled steroids (already maxed out on advair, adding flovent 3x/day in hopes of avoiding pred taper), mucinex, a round of antibiotics (just in case it is not just an allergic reaction), and some steroid cream for eczema, which flared up simultaneously. It could have been worse. I'm following up next week with them. I have a regularly scheduled clinic appt at the end of February. Since my clinic (a very good one too) is at my university my assistantship insurance covers it with a copay. I did have two insurances for awhile but I could not continue to work and do school and research and teach. So I left in October but the insurance was still covering me. Also, the allergy/immunology people are out of the same clinic so I have been seen regularly by both. This just felt small and not necessarily something I need to take time away from other patients for.

I am trying to be compliant but I have had bad habits the last couple of years. And before that my clinic was 4 hours away so I just told the local doctors what I needed. My parents nearly killed me for moving there and not going to clinic but I am an adult and they realized it was up to me to make decisions. And they were bad decisions that my clinic confirmed when I moved here for grad school. I've paid for it since. I am lucky because I rarely get infections (the one thing that my team thinks protects me is a hyper-immune system) and so my needs are less obvious. I do have some pretty decent scarring from childhood infections so I know I need to be careful because I have damage. I also tend to tank really fast once things get to my lungs.

Thanks again for your help. I am glad I could come here for advice.

 

[etabetac]

Thanks guys for the help. I do like being a grad student and I would actually like the chance to use my doctorate when I actually earn it. I am trying very hard to be proactive about health but I frequently do a bad job of it.

I couldn't miss another night of sleep so I went to the student after hours clinic (had to pay but I would have to at the cf clinic too). The doctor I saw was very nice and fairly well informed. As soon as I told them why I was there, they pulled my chart and then read brief history and handed me a face mask (which is good because the curtain on one side of me had someone with mono and the other person had the flu). Not suprisingly I had wheezing in all areas of my lungs. Surprisingly my sats were great, fantastic even. I tried to protest but the doctor made me do two nebs before I left. She also made me promise to stop taking the benadryl because it is drying up my respiratory system. We added more inhaled steroids (already maxed out on advair, adding flovent 3x/day in hopes of avoiding pred taper), mucinex, a round of antibiotics (just in case it is not just an allergic reaction), and some steroid cream for eczema, which flared up simultaneously. It could have been worse. I'm following up next week with them. I have a regularly scheduled clinic appt at the end of February. Since my clinic (a very good one too) is at my university my assistantship insurance covers it with a copay. I did have two insurances for awhile but I could not continue to work and do school and research and teach. So I left in October but the insurance was still covering me. Also, the allergy/immunology people are out of the same clinic so I have been seen regularly by both. This just felt small and not necessarily something I need to take time away from other patients for.

I am trying to be compliant but I have had bad habits the last couple of years. And before that my clinic was 4 hours away so I just told the local doctors what I needed. My parents nearly killed me for moving there and not going to clinic but I am an adult and they realized it was up to me to make decisions. And they were bad decisions that my clinic confirmed when I moved here for grad school. I've paid for it since. I am lucky because I rarely get infections (the one thing that my team thinks protects me is a hyper-immune system) and so my needs are less obvious. I do have some pretty decent scarring from childhood infections so I know I need to be careful because I have damage. I also tend to tank really fast once things get to my lungs.

Thanks again for your help. I am glad I could come here for advice.