With Hereditary Cancer Syndrome, Every Month Is an Awareness Month

Thank goodness it's November.

It's taken me a long time to realize what a toll October, Breast Cancer Awareness Month, takes on me each year, but last week, it hit me. At an awareness event at my synagogue, one of the presenters scribbled the word "metastatic" in all capital letters on the flipchart at the front of the room - M-E-T-A-S-T-A-T-I-C - and I thought I might lose it.

As though a time machine had whisked me away, it was Friday, April 2, 2010, all over again; I was alone with my mom at the hospital. Just outside the room where she'd been since the previous Monday (the night we were to have hosted the first seder of 5770), amidst the constant bustle of the nurses' station, her oncologist offhandedly said to me: "It's everywhere."

It's impossible to believe that fateful day was nearly a decade (a decade?!?) ago, but in the intervening years, I've done everything possible to protect my own health since I learned I carry the same BRCA2 genetic mutation that we now know contributed to my mom's death. In addition to significantly increasing carriers' lifetime risk for breast and ovarian cancer, it also raises my risk of melanoma and pancreatic cancer - and in men, the risk of breast, prostate, melanoma, and pancreatic cancer.

Although I'm glad to have turned the corner from October into November, the latter is Pancreatic Awareness Month, and my vigilance is year-round, so, here are a few statistics about the disease from the Pancreatic Cancer Action Network (PANCAN):

• Pancreatic cancer is the third leading cause of cancer-related deaths in the United States;
• One of the deadliest cancers, it has an extremely low survival rate - just 9 percent;
• This year, an estimated 56,770 Americans will be diagnosed with pancreatic cancer and 45,750 will die from the disease; and
• It is estimated that in or around 2020 (just two months away), the disease will rise to be the second leading cause of cancer-related deaths.

Of course, I'm grateful that my family doesn't have a history of pancreatic cancer. At the same time, according to PANCAN, the cause of most pancreatic cancer is unknown, and there are no early detection tests and few effective treatments.

Having said that, with each passing year, I'm increasingly grateful to FORCE: Facing Our Risk of Cancer Empowered, the grassroots organization that has done so much for me during the last decade. In addition to introducing me to other BRCA+ women whom I could learn from and lean on throughout my journey, FORCE has given me a network of friends who are framily and a platform from which I can spread awareness about hereditary cancer mutations, as well as share my knowledge, gained through experience, to help women who are behind me - as thrivers, survivors, and previvors - on their own hereditary cancer journeys.

Most recently, FORCE helped me uncover this clinical trial for pancreatic surveillance, designed to collect enough data to allow the researcher to obtain funding to conduct a full study that may lead to early detection among individuals at highest risk. Because it's open to individuals with BRCA mutations, but without a family history of pancreatic cancer, it ensures that I can continue to do everything possible to protect my health. For this and so much more, I'm ever-grateful to my FORCE family.

With that in mind, please consider making a donation to FORCE - not only in gratitude for what the organization has done for me, but also to ensure that it can continue to provide much needed support, resources, and advocacy to others affected by hereditary cancer syndrome, and to help me fulfill my annual $250 fundraising goal as a volunteer outreach leader for FORCE in New York City.

With deep thanks and appreciation,
~ Jane.

Yes, It’s ThatTime of Year Again

Friends,

You know the least favorite part of my work on behalf of FORCE: Facing Our Risk of Cancer Empowered is asking for funds to support the critical work this organization so effectively accomplishes, but as Liza Minnelli rightly sang in “Cabaret,” “Money makes the world go round.”

You also know that your philanthropic donation (no matter the size) will help ensure that FORCE is able to continue to raise awareness about inherited genetic mutations (most people who carry them are unaware of their status), offer emotional support, provide practical, evidence-based resources and scientific updates, advance targeted research, advocate for protections on behalf of those in the hereditary cancer community, and more. Most vital of all, thanks to FORCE, no one has to travel this journey alone.

Lastly, you know that the FORCE community and the work to which we, a cadre of mostly volunteers, are deeply devoted mean so much to the countless individuals and families affected by hereditary cancer-causing mutations – including me.

For these reasons and so many others, I appreciate your support of this cause and am extremely grateful to have you in my life.

From the bottom of my heart, thank you,
~ Jane.

#BlogExodus: Grow

I know today has grown entirely too long because I am just now, at slightly after 10 p.m., lighting the yahrzeit candle for my grandfather, who died 32 years ago tomorrow... and having no luck with either the wick or the match.

I wasn’t home to light the candle earlier in the evening because I was facilitating the NYC meeting of FORCE: Facing Our Risk of Cancer Empowered , a grassroots organization that offers information, resources, and support to individuals and families affected by hereditary cancer.

Ironically (or perhaps not), my grandfather died from BRCA-related metastatic prostate cancer before “BRCA-related metastatic prostate cancer” was in the lexicon. For the last seven-plus years, though, it’s been part of my lexicon, as I’ve worked to raise awareness about the prevalence of BRCA mutations in Ashkenazi Jewish families – and most especially how they can lurk in the background, undetected for generations.

Making the tough decisions to undergo multiple surgeries and long recoveries to prevent cancer and ensure my genetics would not determine my destiny has helped me grow.

Learning the ins and outs of these mutations, advocating on behalf of the community affected by them, and offering advice and information to women (and men) following me on this path has helped me grow.

Perhaps most of all, the warm, wonderful embrace of others in the hereditary cancer community has helped me grow and enriched my life in untold ways – ways I could not have ever imagined back when BRCA wasn’t part of the lexicon.

Inspired by Ima on (and off) the Bima , this post is one in a series marking the days of the Jewish month of Nisan leading up to Passover, which begins at sundown on Friday, March 30, corresponding to the Hebrew date 15 Nisan 5778. If you want to play along, check out this year's #BlogExodus and #ExodusGram prompts .

Shechinah at #FORCE17

Last Friday afternoon, as I do each week, I texted a few friends a Shabbat shalom message: “Shabbat shalom from Orlando and #FORCE17 – annual hereditary cancer conference. 🌞”

One of them responded with this: “Shabbat shalom to you, too, in sunny Florida. Will there be a Shabbat service?”

Our conversation continued.

Me: “The place is crawling with M.O.T.s, but Friday night is reserved for “show and tell,” a different kind of ‘service’ for those facing tough decisions.”

My friend: “HaShem is found in many places and in many ways.”

Me: “She (Shechinah, the feminine divine presence of God) definitely is here. There’s something that feels very sacred about empowered women and pikuach nefesh (saving a life).”

My friend: “It will be a wonderful Shabbat, even if you are not in temple."

Me. “Indeed.”

#FORCE17 was this year’s annual hereditary cancer conference organized by FORCE: Facing Our Risk of Cancer Empowered , a grass-roots, non-profit organization devoted to providing support, research, resources, and advocacy to those affected by hereditary cancer. Approximately one in 400 people in the general population carries a BRCA mutation, significantly increasing their lifetime risk of breast and ovarian cancer (in women) and male breast cancer and prostate cancer (in men), as well as raising the likelihood for others, including pancreatic cancer and melanoma. Hereditary mutations can be transmitted from either parent to both sons and daughters. Among Ashkenazi Jews, the prevalence of BRCA mutations is 10 times greater than in the general population; approximately one in 40 individuals carries a mutation, and most are unaware of their status as carriers.

#BlogExodus: Join

Back in January, I started working with my fellow FORCE group leader to plan a spring fundraising event for the organization that means so much to us because it was there when we needed information and support in dealing with our hereditary cancer mutations.

Although we volunteer, giving generously and caringly of our own time and knowledge to those following in our footsteps – planning and facilitating group meetings and providing one-on-one support to members – it still takes money to run a non-profit organization. There are brochures and business cards to print, conference calls to connect volunteers, salaries to pay, an annual conference to organize, and so much more that goes into making sure no one travels the hereditary cancer journey alone.

With that in mind, I invite you (or your friends and family in New York City) to join us for a terrific evening to support FORCE and its work on behalf of the hereditary cancer community:

Monday, May 1, 2017 

6-8 p.m.

SideBAR

118 East 15th Street and Irving Place

New York City

Purchase tickets or donate today.

$65 per person includes appetizers, two drinks, and your chance to be chosen as the evening's model for a make-up or guy brow demo, done by celebrity make-up artist and brow expert Ramy Gafni. 

The best-selling author of How to Fake Real Beauty: Tricks of the Trade to Master Your Makeup, Ramy will inspire you with his personal story, professional experiences, “minimum make-up, maximum impact” application techniques, and the guy brow, his trademarked eyebrow sculpting for men.

There also will be chance drawings for fabulous prizes, including samples of Ramy's cosmetics, lots of great books, a professional massage, an acupuncture session, two tickets to Broadway's Phantom of the Opera, including a signed Playbill, and guided backstage tour....and more!

We look forward to seeing you (or your NYC friends and family) on May 1! 

How You Can Help Me Give Back to the BRCA Community

I’ve been telling and re-telling my family’s BRCA story for nearly six years now, and with each re-telling there are new pieces and evolving elements to incorporate into the narrative.

However, there are three parts of the account that never change:

1. Diagnosed as a BRCA mutation carrier at age 47, I am thankful each and every day that even at that age, I was able to become a “previvor.” By taking action to protect my health, I prevented my genetic predisposition to cancer from determining my destiny.
2. As a result of my experience, BRCA awareness, particularly in families like mine where the presence of a cancer-causing hereditary mutation may not be blatant, has become my “soapbox issue.” I will talk about it with anyone and everyone because you just never know when you might change the trajectory of someone’s life or that of their family.
3. None of this important and, yes, sacred work would be possible without the incredible support I received from FORCE: Facing Our Risk of Cancer Empowered, a national not-for-profit organization that provides support, evidence-based resources, and a community of people who have been affected by hereditary cancer.

I’m proud to be giving back to the organization that has given me so much. Currently, i volunteer as one of two Peer Support Group Leaders for the NYC FORCE group, and as a Research Advocate, which means I’ve been specially trained to engage in research advocacy on behalf of the hereditary breast and ovarian cancer community.

In addition to sharing my time, energy, and experience as a BRCA mutation carrier, I support FORCE financially. Although asking my family and friends for an annual donation is not among my favorite activities, I know you appreciate how important this organization and this work are – not just to me, but to all of us in the hereditary cancer community. With your help – at whatever level you choose – I can reach my goal of $500, which will help FORCE continue to provide vital support and myriad resources to individuals and families affected by hereditary cancer.

Thank you. I am grateful for your friendship and for your support of this important cause in my life.

Last Tuesday marked the fourth anniversary of my prophylactic bilateral mastectomy (PBM) and reconstruction.  It was surgery that I believe saved my life.  FORCE: Facing Our Risk of Cancer Empowered has been equally life-saving in my BRCA journey.  If you're the least bit inclined to support this incredible organization during its annual fundraising campaign, I'd be grateful. The letter below provides addition information about this year's campaign and my ongoing involvement with the organization.  

July 21, 2015

Dear Friends and Family,

Thank you for visiting my FORCE fundraising page!  

Four years ago today, I underwent life-saving, life-changing, and life-affirming surgery that kept me in the hospital for five nights, including one in intensive care, and then at home recovering for more than eight weeks.  As tough as it was, I'd do it all again in a heartbeat.

Funding for FORCE: Facing Our Risk of Cancer Empowered

Dear Friends,

Although asking friends and family to donate to a specific cause is not among my favorite things to do, I'm willing to do it once a year on behalf of FORCE: Facing Our Risk of Cancer Empowered, whose 2014 fundraising campaign is underway.  I wholeheartedly believe that I would not be where I am in my BRCA journey today were it not for this incredible organization that is devoted solely to providing up-to-date information, resources, and support to the individuals and families that are at risk of hereditary breast and ovarian cancer (HBOC) syndrome.

As readers of this blog know, I have been exceedingly open and forthcoming about my BRCA mutation and the steps I've taken in the last several years to reduce my personal risk.  I'm not going to retell my story here, but if you want to read about it, there are plenty of details elsewhere on this blog. (Just put one or more of these keywords in the search field in the upper left hand corner on this page and you should get lots of posts from the past:  HBOC, breast cancer, BRCA2 mutation, BRCA BRCA awareness, breast cancer awareness, FORCE, gene mutation, mastectomy, prophylactic mastectomy, and/or breast cancer awareness month.)

I will say, however, that I am proud and honored to give back to FORCE as one of two volunteer outreach coordinators in New York City. In this role, I work with my partner coordinator to schedule, organize and help facilitate peer-to-peer support meetings on topics of interest to the hereditary cancer commuity; provide one-on-one support to members dealing with emotional and physical impacts of their BRCA status; and manage regular communications to members of FORCE's NYC group.  I also speak and write frequently about BRCA gene mutations in an effort to raise awareness about their presence, particularly in the Ashkenazi Jewish community, where one in 40 individuals (both women and men) is a carrier, and most of these people are unaware of their status.

Indeed, until four years ago, when my sister (thankfully, she's negative) and I took the initiative to get tested after we lost our mom to exceedingly virulent breast cancer, we, too, were unaware of the presence of a BRCA mutation in our family.  Although we'll never know how different our family's story might have been had we known about the mutation sooner, if my work with FORCE can prevent even one other family from enduring what we did because we didn't know, I believe some good will come from our experience and that my endeavors will contribute to the Jewish concept of tikkun olam -- repair of our world.

Because FORCE has been been -- and continues to be -- a tremendous blessing to me and to so many others, I would be exceedingly grateful for your support during this year's fundraising campaign.  (Donating through my FirstGiving page is simple, fast, and fully secure.)

Thank you, as always, for your support of me and of FORCE, the organization that means so much to me.

xoxo,

~ Jane.

In Honor of My Mammoversary

Yesterday, I posted this update on Facebook:

Happy erev mammoversary to me! Three years and counting...on many more healthy ones. @facingourrisk #BRCA #grateful

Today, I posted this one:

Three years ago today, I slept through the entire day. Oh, right...I was saving my life. Thanks, Dr. G and Dr. M!

This evening, I wrote this post:  

I promise this will be the last mammoversary post until next year. 

In honor of the occasion, I just made a donation to FORCE: Facing Our Risk of Cancer Empowered, the amazing organization that empowered me to make the tough medical decisions that I believe saved my life...and has been with me every step of the way, providing information, resources and incredible support. FORCE's 2014 fundraising campaign is underway and I'm proud to pay it forward. I'd be grateful if you'd consider joining me.Thank you!

A link at the bottom of this last post takes you to my FirstGiving fundraising page, where you can read this message and donate:

Thank you for visiting my FORCE fundraising page!

Although asking friends and family to donate to a specific cause is not among my favorite things to do, I'm willing to do it to benefit FORCE:  Facing Our Risk of Cancer Empowered during the 2014 fundraising campaign.  I truly believe that I would not be where I am in my BRCA journey today without this incredible organization that is solely devoted to providing up-to-date information, resources, and support to the community of people who are at risk of hereditary breast and ovarian cancer (HBOC) syndrome.

Because I have been exceedingly open and forthcoming about my BRCA mutation and the steps I've taken in the last several years to reduce my personal risk, I'm not going to retell my story here.  If you want to read about it, there are plenty of details elsewhere on this blog. (Using the box in the upper left-hand corner of the page, search "BRCA" and then sort by date and you should be able to piece the story together fairly well.)

I will say, however, that I am proud and honored to give back to FORCE as one of two volunteer outreach coordinators in New York City. In this role, I work with my partner coordinator to schedule, organize and help facilitate peer-to-peer support meetings on topics of interest to the hereditary cancer commuity; provide one-on-one support to members dealing with emotional and physical impacts of their BRCA status; and manage regular communications to members of FORCE's NYC group.  I also speak and write frequently about BRCA gene mutations in an effort to raise awareness about their presence, particularly in the Ashkenazi Jewish community, where one in 40 individuals is a carrier, and most of these people are unaware of their status.

Indeed, until four years ago, when my sister (thankfully, she's negative) and I took the initiative to get tested after we lost our mom to exceedingly virulent  breast cancer, we, too, were unaware of the presence of a BRCA mutation in our family.  Although we'll never know how different our family's story might have been had we known about the mutation sooner, if my work with FORCE can prevent even one other family from enduring what we did because we didn't know, I believe some good will come from our experience and that my endeavors will contribute to the Jewish concept of tikkun olam -- repair of our world.

Because FORCE has been been -- and continues to be -- a tremendous blessing to me and to so many others, I would be exceedingly grateful for your support during this year's fundraising campaign.  (Donating through this FirstGiving page is simple, fast, and fully secure.)

Thank you...xoxo,

~ Jane.

I Got All My Sisters With Me

Kara DiGuardio, my BRCA sister

A generation ago at this season, I attended a number of sorority semi-formals at my alma mater.  At the time, the school was heavily Greek, with nearly 20 fraternities and five sororities. Invariably, each of these spring events--no matter the sorority--closed with the DJ "spinning" Sister Sledge's "We Are Family" as all the young women, in various states of intoxication, gathered on the dance floor, linking arms and singing along as a gaggle of young men watched from the sidelines.

I was reminded of this scene last Wednesday evening at FORCE's NYC Spring Celebration 2014: Live Life Empowered at Hudson Terrace.  The organization's inaugural benefit event, which was sponsored by Quest Diagnostics, featured two of my BRCA sisters, Stacey Sager and Kara DiGuardio, in a joyful celebration of the organization that is the unequivocal voice of the hereditary breast and ovarian cancer (HBOC) community.  In addition to providing resources, education, and support to individuals and families at risk for hereditary cancer, FORCE, comprising a staff of 11 and a tremendous corps of dedicated volunteers throughout the country, advocates on our behalf within the medical, pharmaceutical, and policy arenas, helping to ensure that we don't encounter discrimination, insurance snafus, or other obstacles as we--individually and collectively--deal with the inevitable roller coaster ride that comes along with our attempts to ensure, to the extent possible, that our genetics don't dictate our destiny.

Throughout the evening, we cheered Sue Friedman, FORCE's founder, celebrated Stacey's survival of both breast and ovarian cancer, and marveled at the serendipity that propelled Kara, who shared her songs and her story, to get tested.

As regular readers of this blog know, I am one of thousands of FORCE members who will be ever grateful to the organization for its strong, supportive, knowledgeable, powerful, and empowering voice.  Most of all, I appreciate my countless FORCE sisters (and one brother, who sports a New Jersey license plate that reads "BRCA1") who are ever ready and willing--as am I--to answer questions, share experiences, recommend doctors, dry tears, commiserate, or just listen.  Help from our BRCA sisters empowers so many of us to make tough decisions, undergo surveillance and surgeries, deal with both expected and unexpected consequences, and move on in our forever-changed lives, all in the hopes that cancer won't steal us the way it already has stolen far too many of our mothers, grandmothers, sisters, aunts, and cousins.

Indeed, Sister Sledge's "We Are Family" is the perfect soundtrack for my BRCA family.  Had a DJ and a dance floor been in the room on Wednesday night, I am quite sure that as our partners, spouses, friends, and supporters stood on the sidelines and watched, we all would have been out there, linking arms and singing along with Sister Sledge:

We are family
I got all my sisters with me
We are family
Get up ev'rybody and sing

Ev'ryone can see we're together
As we walk on by
(FLY!) and we fly just like birds of a feather
I won't tell no lie
(ALL!) all of the people around us they say
Can they be that close
Just let me state for the record
We're giving love in a family dose

We are family
I got all my sisters with me
We are family
Get up ev'rybody and sing

Living life is fun and we've just begun
To get our share of the world's delights
(HIGH!) high hopes we have for the future
And our goal isnt in sight
(WE!) no we don't get depressed
Here's what we call our golden rule
Have faith in you and the things you do
You won't go wrong
This is our family Jewel

We are family
I got all my sisters with me
We are family
Get up ev'rybody and sing

Where's JanetheWriter's #BlogElul Post?

Today my #BlogElul essay is over on the blog associated with ReformJudaism.org.  I hope you'll click over there to read what I've got to say...it's a topic that's near and dear to my heart and if you think about it, you probably can guess what it is.  But don't just guess, take a click over there and see for yourself!

Stay tuned here for more #BlogElul in the coming days.

Facing Our Risk of Cancer Empowered: A FORCE for Good

Earlier this evening, I posted this status update on Facebook:

Happy erev mammoversary to me! Tomorrow is two years since the 12-hour surgery that saved my life...and I wasn't even sick! 

I have no doubt that the surgery—a prophylactic bilateral mastectomy (PBM) with micro-surgical reconstruction using my own abdominal tissue and blood supply—saved me from a diagnosis of breast cancer.  Knowing that I had a pre-surgical lifetime risk of developing the disease that hovered somewhere in the 80^th percentile, I wasn’t willing to sit around and wait for the odds to play themselves out.

Although there were many factors that propelled me down the road to surgery (an option that isn’t necessarily the right one for every BRCA-positive woman), I’m not sure I could have taken those first tentative steps without FORCE and the women I’ve met through the New YorkCity chapter of the national organization devoted solely to individuals and families affected by hereditary cancer syndrome, most often because of the presence of a BRCA mutation.   I attended my first FORCE meeting just weeks before the hysterectomy that preceded my mastectomy by about six months.  As wonderful as it was to get some terrific ideas about preparing for surgery, the best part of the gathering was being together for the first time with so many BRCA “sisters,” many of whom were dealing with the same difficult choices and hurdles I’d just had thrown in my own path.

Needless to say, I was hooked, and I’ve hardly missed a local FORCE meeting since.  I’ve also attended the last two annual conferences in Orlando and, most recently, joined another member as a volunteer Outreach Coordinator in New York City.  I believe that if sharing my experiences and the knowledge I’ve gained as a result of being BRCA positive can ease others’ travels, I am fulfilling a part of my obligation to partner with God in repairing our fractured world.

As I’ve noted on this blog before, because FORCE is a grassroots, not-for-profit organization on a shoestring budget, it faces a constant need for funding.  The New York City chapter is in the midst of a fundraising campaign that ends on July 31.  I’m grateful to those of you who have made generous donations to this cause that has become so very important to me and hopeful that others might consider a contribution to this incredible organization that’s been there for me and given me the tools and training to be there for others.  Your support on behalf of FORCE will help ensure that none of us in the hereditary breast and ovarian cancer community ever has to walk this bumpy path alone.

Thanks to FORCE, None of Us Walks Alone

Tonight on the way home from work, I stopped at the grocery store to pick up a yahrzeit candle.  Although I’m generally not superstitious, I don’t like to keep them in the house and so I buy them one-at-a-time, only as needed.  I’ll light this one tomorrow night, marking the beginning of my mother’s third yahrzeit.

As regular readers of this blog know, my mourning has been complicated by the fact that just a few months after my mom’s death from exceedingly virulent triple negative metastatic breast cancer, we learned that I carry a BRCA gene mutation (inherited from her, we surmised) that significantly increased my lifetime risk of both breast and ovarian cancer.  This same mutation (unbeknownst to us at the time) was a substantial factor in the rapid course of my mother’s disease.

Looking back, sometimes the time feels like three seconds and other times like three millennia.  In addition to living without her for the last three years, I’ve spent nearly as much time living with and learning about the BRCA mutation I carry.  Thankfully, I haven’t had to walk this path alone. 

In addition to the outpouring of love and support I’ve received from all of you—my family, friends, and colleagues, both in real life and virtually—I am especially and deeply grateful to my sisters in the FORCE community. As the organization's full name, Facing Our Risk of Cancer Empowered, suggests, these women—each of whom comes from a family that struggles with hereditary cancer syndrome that all too often leaves gaping holes where mothers, grandmothers, aunts, cousins, and sisters used to be—willingly and lovingly stepped up, taught me what they knew, answered my questions, shared their experiences, and saw me through a complete hysterectomy in 2010, and, in 2011, a prophylactic bilateral mastectomy with autologous reconstruction that was complex, multi-phased, and not without complications—some of which continue to this day. 

Initially, as I grappled with an overload of medical information, an abundance of emotional stumbling blocks, and ongoing mourning, I was surrounded by generous and unyielding support from women who had been empowered to face their own BRCA challenges head-on and, despite lingering physical and emotional scars, were moving forward in their lives, even as they were passing along to me what others previously had given to them.

Now it’s my turn.  Last December, I was invited to join the ranks of FORCE’s volunteer Outreach Coordinators, a role that I, like my predecessors, have taken on willingly and lovingly in the hopes that I, too, can step up to help other BRCA-positive women as they come to terms with their genetic mutations and decide upon which positive, life-affirming steps are right for them.

Because FORCE is a grassroots, not-for-profit organization on a shoestring budget, it, of course, faces a constant need for funding.  As I mark my mother’s yahrzeit tomorrow night, I am hopeful that you might consider a contribution to this incredible group that’s been there for me and so that I can be there for others.  Your support will help ensure that none of us in the hereditary breast and ovarian cancer community ever will have to walk this bumpy road alone. 

Thank you for the innumerable ways you have supported me on this unanticipated journey.  I am grateful to each of you.  xoxo.