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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
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Experience:  14 years as clinician in the field of Family Practice
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Could it be a cyst causing the pain

Customer Question

Could it be a cyst causing the pain
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD : Hello again,
Anthony Bray MD : Yes, that could be a possible cause certainly. A right side ruptured follicular cyst may cause right lower quadrant pain. Toward the same idea a left side ovarian cyst rupture would cause LLQ/pelvic pain. So if you have pain to either lower quadrant then such a cyst is certainly a possible cause. You can have discomfort due to a cyst before rupture but the rupture of one causes a small amount of bleeding into the pelvis and this is an irritant.
Anthony Bray MD : a stone in the lower aspect of the ureter on the affected side would be another possible cause....
Anthony Bray MD : As you finish your antibiotic I would recommend a quick follow up of the urinalysis...
Anthony Bray MD : Are you still having a great deal of lower abdominal pain? Which side is this on??
Anthony Bray MD : Let me know and I will be happy to get back with you!!
Anthony Bray MD : thank you for starting a new thread ...
Anthony Bray MD : Take care,
Anthony Bray MD : Anthony Bray MD
Customer: replied 1 year ago.
Hi.
Customer: replied 1 year ago.
What can i do for it
Customer: replied 1 year ago.
I am still having a moderate amount of pain on the roght aide
Customer: replied 1 year ago.
Right side
Customer: replied 1 year ago.
Are you getting my responses
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Sorry it appears that you had to take the question out of chat...

If you had a simple follicular cyst and this was on the large side then it is most often just a matter of time and it ruptured and resolves. Sometimes you may have multiple cysts --- polycystic ovarian syndrome and this condition may be treated medically...

If this should be suspected as a possible cause then you would first need a pelvic ultrasound to diagnose the problem.

Treatment would depend on what the cause if your pain turned out to be if course. A very large cystic mass may need surgery but this would be on the more extreme end if the spectrum.

Other causes for right lower quadrant pain are possible..

I hope this information helps! Let me know if you have further questions or concerns.

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
My last cyst was small. But it caused this kinda symptoms
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I see... That is possible. This would be a relatively good outcome if this were the cause of the pain. It would at least be a harmless cause if this were the case . Although the pain is an aggravation if this were due to a basically normal range size follicular cyst then this would not be serious or threatening to you.

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
How long do cysts usually last
Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Follicular cysts typically come and go with each menstrual cycle as you know. So a given cyst usually may last only a week or so. Large thickened wall cysts may not rupture as they should however and can last weeks to months... This is the type of variation which they may have.

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
What the heck. It seems like i cant catch a break
Expert:  Anthony Bray, MD replied 1 year ago.
Hi again

I know what you mean. It does seem that you have had note than your fair share if illness or health problems lately. Hopefully this will balance out as we go forward. Hopefully you will recover and enjoy a long period of good health!

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Anything i cam do to make my viens easier to access with an IV. Usually it take 3-5 tries to get it
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

The main thing you can do in this regard is to really push fluids before a blood draw. If you push fluids it will temporarily expand your blood volume and make phlebotomy easier.

I hope this helps. Take care!

Anthony Bray MD
Customer: replied 1 year ago.
Will that help when they start the iv monday
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes it will help to the extent that you may take in fluids on Sunday. Your doctor probably has you NPO for a period just before your procedure though, right? You may be limited as to how much you can help this... It helps if you know which arm is easier to access or even a specific vein... A tight tourniquet helps...

Good luck with this--- take care,

Anthony Bray MD
Customer: replied 1 year ago.
My procedures at 1pm. Npo after midnight. Last time it took the anesthesiologist 5 times
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well push fluids as best that you can until the pint that you are directed to be NPO. Examine your arms and try to identify the two most accessible veins. Hopefully these preparations will help you some. You may be a "difficult stick". This would be more true with you being dehydrated unfortunately...

Good luck with your procedure on Monday . Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Since im already on carafate protonix and ranitidine is there anything else to do to make my stomach feel better?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

You are maxed out on treatment to protect your stomach and promote healing. The only addition really would be the viscous lidocaine to mix as a GI cocktail as I described before. This would reduce pain from the stomach.

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Do i really need to be scoped. Im down 15.8# XXXXX monday
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Yes I think that you do need to be scoped. It is sounding more and more than you may need IV fluids to catch up your dehydration too however !! I would recommend that you be sure that your doctor is aware of the degree of trouble and weight loss that you have had.

I hope this helps! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
My stomach feels like its being tied up in knots
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Ask your doctor about this as well. You would likely benefit to take a GI cocktail as I described before ...

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I am sorry if i am frustratingyou
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

No, not at all. I hope that you feel better soon. I hope to be of help to you!

Take care! Anthony Bray MD
Customer: replied 1 year ago.
Findings: adherent white spots in the proximal and mid esophagus. Diffuse mild erythema ib lower third of thecesophagus. Scattered moderate mucosal abnormality characteriEd by erythema abd erosion was found in gastric body and in gastric antrum. Three nonbleeding cratered duodebal ulcers with pigmented material founf in duodenal bulb, in the first part of the duodenum and in the swcod part of the duodenum. The largest was 10 mm in domension.
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

It sounds that these results are largely as expected. Espohagitis gastritis AND ulcers..(I'm sorry that these results are as bad as they are. It could be worse but certainly wish it was better...)

You will need ongoing aggressive treatment to heal this!!

Let me know if you have further questions or concerns. Good luck to you. I hope that this will heal well for you!

Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Nexium, carafate, protonix, cholestyramine
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Cholestyramine? Have you been diagnosed with high cholesterol , fatty liver or IBS?? This med would be of potential help with these conditions...

The Nexium and the Protonix are redundant >> these are of the same class... I would not think that you would need both... I could more see high dose Nexium...

Let me know if you have further information, questions or concerns. Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
Cholysteramyne for bile. What do what spots on my esophagus mean
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

The description of adherent white spots sounds to me that they may have found some plaques of Candidal infection.. I'm not sure about this but suggest that you ask your gastroenterologist about this finding. Your being on the antibiotics would lead to Candida infection being more likely. If this is the case then a course of oral Diflucan would be a treatment option for this...

I hope this is helpful for you. Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
My gi dr also ordered me off the prednisone. Also during sedation they had a hard time keeping my bp up
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I agree with the stopping of the Prednisone in light of these findings!!I would avoid NSAIDS as well. Tylenol is still OK but that is all!!

I presume that your BP is stable again now , right?? It may have been a factor of you being dehydrated. I would first suspect this as the likely cause of you hypotension.

I hope this helps. Let me know if you have further questions. Take Care,

Anthony Bray MD
Customer: replied 1 year ago.
What exaclty do the findings mean? My gi dr gave me the week off
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

The results mean that you have severe diffuse irritation of the mucosa from your esophagus to the duodenum. The ulcers mean at these spots that the most superficial layer of the internal mucosa has been eroded away. It would be similar to an abrasion of the skin except this is the internal tissue surface. These eroded areas may ooze blood as well. This is probably why you have had the iron deficiency anemia...

You need rest, good nutrition and to say on your meds religiously in order to heal these injuries.

I hope this is helpful for you! Let me know if you have further questions or concerns! Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.
Do yo think i need a week off? Im trying to get nutrition. But it hurts to eat and it makes me feel like im going to throw up
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes I agree that you would do better with a week off. The increased rest should aid in your body healing!! BTW if you smoke then STOP!! I have seen cases where this was an aggravating factor... You might have a lot of stress and anxiety as a possible factor.. If you think that this is the case then I would recommend that you look to gain help in this regard as well!!

I hope this is helpful for you! Let me know if you have further question, concerns or discussion! Take Care!

Anthony Bray MD
Customer: replied 1 year ago.
How long will i hurt for
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well that does depend on the severity of the ulcers and how well you heal. It depends on how well that you take case of yourself. I would expect that the severe nature of the GI issues in your case will show gradual improvement but will likely hurt for several weeks I am afraid... It will take time. You do need to be very diligent and take the best care of yourself possible!!

 

Take all your meds that you are supposed to!! Rest this next week!! Get nutrition into your system! (Even if it is something that is not pleasant to you such as Ensure pudding or liquid > do get good nutritional support into your system!! ))

 

I think that the SEVERITY of the pain would probably be less in 1 to 2 weeks but that you will probably have some related pain for about 4 to 5 weeks likely...

 

Again I would recommend that you may ask your GI specialist about a GI cocktail with viscous lidocaine if you continue to have much pain....

 

I hope this is helpful for you! Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
You think it is severe?
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

It sounds bad enough! It could be much worse and I am glad that it isn't but you need to take this seriously and take care of yourself!! That is the main point here!! (Not to worry you except to the point of motivating you to take better care of yourself!!)

 

I hope this helps! let me know if you have further questions or comments and I will be happy to get back with you! Take Care !!

 

 

Anthony Bray MD

 

Customer: replied 1 year ago.
I do take good care of myself
Expert:  Anthony Bray, MD replied 1 year ago.

Hi again,

 

Well that is good! Try to rest this next week and take your meds as directed and you should heal well then. You are young and should bounce back quickly...

 

Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Im vomitting :(. Ive tried eating popsicles 3 times tonight and they came back up. What are some other soothing things i could try? I know you say milk shakes, but i generally stay away from milk products as they make me ill
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I'm sorry that you are still having so much trouble. You may try some Gatorade, iced tea, soups as possible,. OTC Emetrol may help with the nausea. Benedryl or Dramamine OTC may help... your doctor could prescribe you with Phenergan or Zofran to help even more with the nausea...

 

 

I hope this helps. I hope that you feel better soon. Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
My legs muscles feel cramp and tingly. I cant get out of bed without getting light headed
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

The leg cramps and tingling sensation are probably related to electrolyte problems that have probably developed due to your prolonged nausea, vomiting and dehydration.

 

The light headed sensation when you get out of bed is probably an indicator that your blood pressure is too low when you stand. This is a sign of serious volume depletion.

 

It sounds to me that you probably need to get IV fluids in order to help you recover.

 

I hope that you feel better soon. I'm sorry to hear that you continue to have these problems. I know that you must feel very frustrated and worn out with the series of illnesses that you have been dealing with.

 

Let me know if you have further questions or concerns. Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Is this something that can wait until tomorrow
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I suppose that it can wait until tomorrow>> that is really your decision. I would advise that you try to get help today as the better option. I understand that you are tired of illness and medical case as well at this point.

 

Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Is urgent care ok
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Urgent care is fine as far as getting further evaluated. I feel that they may well need to send you on to ER if you are as dehydrated as I suspect. I doubt that they would be set up to give IV fluids at urgent care if you needed them. It would be faster and cheaper to get evaluated however...

 

I hope this helps. Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
I feel miserable
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I understand... I hope that you feel better soon....

 

Best Regards>>

 

Anthony Bray MD

Customer: replied 1 year ago.
They wont want to admit me will they
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

They might > > that would depend on the severity of your situation.. I think it likely that you may need at least 1 to 2 liters of IV fluids. This could be done via the ER and discharge home...

 

I hope this helps. Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Do you think theres any way i wont need ivs
Customer: replied 1 year ago.
My gi dr just called said i have candidal infection of esophagus
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

That makes sense that you had the esophageal Candidiasis since you had the white plaques found on endoscopy....

 

I suspect based on your history that you will need IV fluids BUT I can't tell you that for sure that this is the case. You need to be evaluated. Orthostatic BP and pulse and labs done to judge your degree of dehydration and possible electrolyte disturbance...

 

I hope that this helps. Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Saw thr dr. He said what is he suppose to do about it. He didnt do any labs but gave me a liter if fluid
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Wow >> you seem to run into some real winners in the medical profession... Well I do hope that you benefit from the IV fluids.

 

Feel better soon !

 

Anthony Bray MD

Customer: replied 1 year ago.
Im already feeling a little better. Im reading up on candidal infection of esophagus it says immunocompromised people get it
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

In your case you being on the antibiotics recently would be a factor to increase your risk of getting Candida and the prednisone would have been a second risk factor for you... I think that these two in combination explains why you got Candida and that you are not immunocompromised...

 

I hope that this helps. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Are younsure
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

You have those two significant risk factors for the Candida and so I do not see reason at this point to suspect that you have yet a third factor (some other factor that may make you immunocompromised...)

 

I hope this helps. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
I have petechia where they took my bp today
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

This in itself is not that unusual >> it happens on occasion>> too much pressure on the cuff may do this..

 

Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.
Did a repeat ua today, still had WBCs in it. Also my potassium was low and my crp was elevated
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

It makes sense that the low potassium would be there... you had symptoms of that. The vomiting would have contributed to that.

 

Sorry that you still had the WBC's in urine.. that sounds that the UTI has not been cleared..

 

The elevated CRP would be expected with all the problems that you have had lately. It reflects inflammation for any reason...

 

I hope this helps. Let me know if you have further questions or concerns. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
My dr didnt but me on a new antibiotic
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Do you know how high the WBC's were? If they were very low such as 2 WBC's per high power field then it may not be necessary. If only Leukocyte Esterace positive on U/A then this should be followed by microscopic exam.

 

If you think it may have been an oversight then call their office back.

 

I hope this helps. Let me know if you have further concerns. Further ACCEPT and positive feedback would be appreciated! Thank you and Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
It was 15-19 per field.
Expert:  Anthony Bray, MD replied 1 year ago.

Hi again,

 

That level would be consistent with an ongoing UTI and should be treated. I would call your doctor's office on this. I suspect that it was an oversight that they did not give you an antibiotic for this.

 

I hope this helps. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Hes kinda thinking i could have pid
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well that would be more determined on a pelvic exam >> discharge and cervical motion tenderness would be evidence of PID for example.. this would not be determined by a U/A... did they perform a pelvic exam?? Does he think that the WBC's are contaminant from vaginal secretions? (High numbers of epithethial cells are clues that there may be vaginal contaminant in sample..)

 

I hope this helps. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
He did a pelvic exam and all that other fun stuff. Idk what he things the wbcs are from but he doesnt think uti.
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well UTI >>should be treated

 

PID >> even more dangerous and must be treated!!

 

Vaginitis > less critical by far but easy to treat...

 

Lack of any treatment makes no sense...

 

I hope this helps. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
He said if the crp would have been higher he woukda given me a shot of rocephin
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I doubt that you have PID. I think that you probably have UTI ...

 

Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
He said the lower belly pain, the pain on exam, wbcs on the trich& yeast make him think pid but he said watchful waiting. He did find a cyst on my cervix though. He also ordered a transvag u/s that causef an enormous amt of pain. As for the urine hes culturing it out again even though the otherone didnt pinpoint a specific bacteria
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I see... so that makes more sense... If you had abnormal degree of pain on pelvic exam and the ultrasound then that could be indicative of PID... I would think that if you had PID that a purulent discharge from the cervix would be expected finding however...the watchful waiting and follow up and the tests such as urine culture makes much more sense.. it had sounded that the ball was dropped from your earlier description...

 

I hope this helps.Let me know if you have further concerns. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
What if the urine culture doesnt pinpoint a bacteria? How come im having wbcs in my urine
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I suspect (but don't know this for certain of course) that you have a UTI > hence the white cells in the urine. This would be the most logical explanation of the WBC's of that degree in your urine sample. MOST of the time a urine culture will define the source >>ID the exact causing bacteria of infection and antibiotic sensitivities... This test is not 100% but is usually reliable... polymicrobial result would generally be interpreted as contamination such as vaginal...

 

Do you have UTI symptoms? Burning with urination, frequent urination, increased urgency?? Flank pain?? I know that you have had the nausea and this is probably more due to your ulcers and gastritis.. it can be a UTI symptom as well...

 

Let me know>> Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
I dont really have UTI symptoms. The only reason he did a ua on friday to begin with is because i was having lower abdomen/pelvic pain. That came up with10-14 wbcs. He said he wasnt totally convinced it was a uti but put me on cipro. When the culture came back monday it showed bacteria but not a specific one. So he wanted to check me for vaginal infection since my symptoms werent any better. He did the ua today which showed more WBCs than on friday. So i dont really know whats going on with me
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I see. I agree that the sequence of results and symptoms do seem puzzling in your case... Still to me it strikes me as being more likely that you have a UTI and I would have probably treated now with a course of Septra... I agree with your doctor sending the urine for culture and I understand the strategy of watchful waiting and reviewing results as they come in... it often is the case that everyone does not have typical UTI symptoms

 

Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
So whats the next step if the culture doesnt pinpoint something
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Well this would call for continued evaluation of the urine and your symptoms. Say if you feel back to normal >> 100% ( we hope so, right?) then there is no treatment that would improve you clinically.. this would be a good scenario....

 

Say that you do have more symptoms of UTI and positive U/A with questionable indeterminant culture results.. then you would need treatment... we treat the PATIENT not just lab results...

 

I hope this helps. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
The only symptom im having is the lower abdominal pain. I never would have guessed that i had a uti. So do i wait until rhe culture is back monday and see what it says? Do i need a repeat ua to make sure the wbcs are gone? Could a vaginal infection be the cause of the wbcs?
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Yes I think that in your situation that you are in a mode of waiting for the urine culture results to return... do be on watch for increased in symptoms and notify your doctor if this should occur..

 

Yes, vaginal contaminant is a possible source of the white cells. This can be eliminated as a possibility by obtaining a cath urine sample. (Unpleasant but it may be important enough if this issue is ongoing question...) A cath urine sample would eliminate the possibility of vaginal contamination...

 

 

I hope this helps. Let me know if you have further questions. Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Is wbcs something to worry about? how can it be from vaginal contaminants? Is that common?
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Yes it is fairly common to have vaginal contaminants causing white cells in the urine. That is a possible source.You could have some vaginitis as a possible source. This would mean that you could have a yeast infection or bacterial vaginosis as possible causes. (Gardnerella species of bacteria most common but others are possible for this) IF you had vaginitis due to bacterial cause then Rx for Metrogel would be what I would most commonly prescribe ... 5 day course... Vaginitis would be determined by swab and wet mount of vaginal secretions..

 

Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
Had a wet mount that was normal no yeast, no trich, no clue cells. Just WBCs
Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

I see... white cells on the wet mount as well?? Or just the urine?? Not normal finding to have many white cells on the wet mount of vaginal secretions... keep in mind that this is not a concentrated sample that is placed under the microscope as opposed to the urine which is spun down in centrifuge first...

 

I hope that this helps. Please ACCEPT and give positive feedback soon

 

Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
I had wbcs on the wet prep as well as in the urine.
Expert:  Camille-Mod replied 1 year ago.

Hi,

My name is XXXXXXX XXX I’m the moderator for this topic. I am sorry, but It seems that the professional has left this conversation. This happens occasionally, and it's usually because the professional thinks that someone else might be a better match for your question. ..or because they have to go off line for any number of reasons. But don’t worry….. If you are still waiting for an answer, I will try to find a new professional to assist you! Please keep in mind that sometimes finding the right professional can take a little longer than expected. All of our professionals come on at varying times, so sometimes it’s a bit difficult to predict. Either way....If you would prefer not to wait, please feel free to let me know, and I will cancel this question for you. Thank you.

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