Pretty bad medical issues but broke, advice on how to proceed?

KenDiaMoi on 27/05/2019 - 03:22
Last edited 27/05/2019 - 21:58

TL;DR down bottom

Hey guys, hope this post is allowed.
I am not looking for medical advice (unless you have some, a pm would be appreciated. If its against the rules, then no medical advice is required)
But I am getting pretty desperate, and am not really sure where to turn to for advice. Heads up if youre eating, I talk about my bowel movements in case I put you off your lunch :(

After getting food poisoning Thailand 8 months or so ago my stomach has been really bad.
Some days I go to the toilet about 7 or 8 times a day to do number 2. Its loose, like basically water.
Sometimes there is slight stomach pains (not as bad as really bad indigestion), most times I just feel tired and lethargic, sudden urges to go to toilet but no real pain in the stomach.

Some days are better than others. I can go a few days with relatively normal bowel movements (I still go 1-3 times), but it always comes back.
There have been periods of up to 2 weeks where I have loose bowels every single day, and I am on the toilet 6+ times.

I have lost my job because of this issue, too many sick days and nights staying up till 3am on the toilet.
While at work I took too many toilet breaks and left early too many times.

Every single day I am dehydrated and I feel weak constantly.

Things I have tried:
Edit: forgot to mention in original post the GP game me antibiotics already, I don't recall what they were
I have gone to my GP, he has ordered several blood tests.
(test for celiac)
Nothing has come back out of the ordinary, aside from high Iron levels.
He seems at a loss to what it could be.
I have been referred to a gastrologist however I cannot afford the colonoscopy and consultation fees as I am paying rent, bills, food with centrelink at the moment.
I have tried cutting out milk, in case I am lactose intolerant.
No luck.
Tried cutting out gluten, in case I am actually celiac.
No luck.

What are my options when I have no money right now?
Can I go to the hospital and ask for help?
Is there some kind of centrelink assistance?
I feel weaker by the week.

Thanks everyone for taking the time.
Sorry about the weird post, I am not sure who to ask.

TL;DR : Have loose stools 6+ times a day for 8+ months after getting sick in Thailand.
GP is not much help, lost job and unable to afford gastrologist consult.
What are my options?
Can I go to the hospital and ask for help?
Is there some kind of centrelink assistance?

Edit. Thank you for all the responses. I actually feel really heartwarmed everyone took some time out of their day to give me some assistance.

I will go to another GP tomorrow and explain my situation and get some stool samples to see if it is a parasite or bacteria.
I will also ask for a referral to a public health gastrologist.

Thanks again for all the replies.

Health & Beauty

Comments

    • [Deactivated] on 27/05/2019 - 13:32
      +3

      Had to bring up veganism, didn't you? How do you know it wasn't infected water, the more common reason in SE Asia for issues where meat is cooked.

      • [Deactivated] on 27/05/2019 - 13:38
        -5

        Fresh fruit is not related to the vegan movement as plants that produce the fruit are inanimate lol!

        • [Deactivated] on 27/05/2019 - 13:42
          +4

          Are you Pete Evans' moonunit wife?

          • [Deactivated] on 27/05/2019 - 13:45
            -3

            @[Deactivated]: Fresh fruit can be eaten by anybody doesn't mean you are paleo, vegan or vegetarian. Plants belong to nobody…

            • [Deactivated] on 27/05/2019 - 13:47
              +1

              @[Deactivated]: And you haven't worked out that human excrement is used extensively in SE Asia as fertiliser for fresh fruit and E Coli other pathogens are common?

              • [Deactivated] on 27/05/2019 - 13:54
                -2

                @[Deactivated]: It's not just excrement that plants consume from animals they also consume the toxic gases animals breath out. Plants negate the toxic animal air with fresh oxygen and negate the toxic blood/bone/excrement with fresh fruit.

                If you are ill from inhaling animal gases like carbon dioxide then you would negate that with plant produced fresh oxygen. In this case though it is toxic animal excrement which may have leeched into the water supply or been served up as a dinner dish thus negate it with fresh fruit…

                • [Deactivated] on 27/05/2019 - 14:14
                  +1

                  @[Deactivated]:

                  animal gases like carbon dioxide…

                  You do know that plants also expel carbon dioxide, right?

                  • [Deactivated] on 28/05/2019 - 09:44

                    @[Deactivated]: That carbon dioxide did not originate from the plant though…

                    • [Deactivated] on 28/05/2019 - 10:18

                      @[Deactivated]: I'm not sure if you're actually serious…

                • fantombloo on 27/05/2019 - 14:15
                  +3

                  @[Deactivated]:

                  OP, you chose to eat animal products which gave you a problem

                  That was never said.

                  Plants negate the toxic animal air with fresh oxygen and negate the toxic blood/bone/excrement with fresh fruit.

                  That should never have been said.

    • p3nf0ld on 27/05/2019 - 13:50
      +3

      That is the stupidest law ever - "if you have a problem seek out the solution". Super helpful.

      • [Deactivated] on 27/05/2019 - 14:16

        That's not it.

        Warier's Law of Problem Solving states that - first you have the solution. The problem that requires solving is how to make the solution fit.

      • [Deactivated] on 28/05/2019 - 09:47

        The solution equals the inverse of the problem.

        Solution = ~ Problem

        Why is it stupid? :)

    • smartazz104 on 27/05/2019 - 20:41

      OP is unwell so your suggestion is to just finish the job then…

    • greatlamp on 28/05/2019 - 13:15

      How do you explain that the herbivores flesh you ate had parasites? They don't eat meat

      Parasites aren't going to be harmed by eating fruit.

    • MagicMushroom on 28/05/2019 - 19:30

      Fruit has enough moisture content in it that you shouldn't need to drink any water either whilst on an all fruit diet

      For healthy individual seems pretty reasonable, but for a person with frequent diarrhoea, this can be life-threatening. Please don't spread this kind of nonsense.

  • poohduck on 27/05/2019 - 13:29
    +1

    It sounds like you still have a bug. It is amazing how many things are related to stomach flora. I was diagnosed with IBS, and I have athsma - both things are actually related. Generally I can manage it, without any medical intervention. I was also lethargic for 20 years or so - I thought I was diabetic or had chronic fatigue syndrome; I still don't know. I try to find the simple answers that are also healthy. I use a blender most mornings. Whatever vegetable looks good, two small apples, 12 prunes, add some water. It's usually around a litre and nice to eat. No ibs and lots of other advantages. The theory is try to help your body help itself. The long haul for me is to avoid nasty things like cancer. I eat bad stuff too, like chips once a week - life's a balance. Whatever you do, this certainly wouldn't hurt. Going down the medical path can be a tightening spiral. And you don't have to buy into it. I was also diagnosed with crps - chronic regional pain syndrome, from a badly smashed, mangled foot. My foot will never be the same, but I don't take any meds at all, and I'm mostly pain free and active. And try to maintain some exercise and stretching - even start off with a bushwalking group. I did; it's awesome. Make it all a lifetime committment and don't look back. Don't go hard and blow it - just ease into it and do things that you can maintain (half hour exercise each day, 10 or even 5 mins stretching). I can focus on symptoms or focus on health. I've been focusing on health, and one day I realised I'm actually pretty fit and strong, sleep well, no more huge farts and cramps :) I feel good.

    • Kill Joy on 28/05/2019 - 19:05

      Same boat with the Asthma and IBS - it was hard through university but has settled well now.

  • pformag on 27/05/2019 - 14:40
    +4

    Can I suggest after you have sorted this out medically, that you start taking Probiotics? Even when I travel to Asia, I always take probiotics as a precaution, and I have never had food poisoning.

    • rave75 on 27/05/2019 - 16:51
      +2

      me too. Always take yakult twice a day while I am overseas.

    • Dungeon Master on 27/05/2019 - 22:20

      Any suggested brands? I'm heading there soon and it always ends in tears (of diarrhea).

  • zer0ne on 27/05/2019 - 14:48
    +1

    Sounds like you have a parasite. A relative had similar issues to you after visiting Thailand. He was told to cut out all Yeast from his diet which includes bread, cake, beer, wine etc. Try it, could help!

    • Cluster on 27/05/2019 - 15:32
      +1

      As a wine maker I can tell you there is virtually no yeast in your average bottle of wine. If some gets through the fining and filtering process it will long be dead. It will also be dead in bread and cakes too.

    • funnysht on 27/05/2019 - 18:07

      As i can assure everyone- this is all complete shit. yeast.

    • Logical on 28/05/2019 - 17:09

      OP should be drinking straight Vodka. That will kill off the bad bacteria quite quickly.

  • Cluster on 27/05/2019 - 15:17
    +2

    As someone who visited Thailand and also got food poisoning with identical symptoms for 8 days, I strongly sympathize with your position. In my case the lab tests came back without any specific cause identified. The problem went away by itself.

    But I have to ask… 8 months of suffering with periods of 2 weeks!? That must be unbearable.

    I am at a loss however as to why Medicare can't help you. Surely if you get admitted to a public hospital then Medicare picks up the entire tab? Try another doctor if your current one is not delivering results. Please don't follow any advice you read on the Internet (including this page) that suggests it could be this illness or that, or to eat this or not eat that. No one here has met you, knows all the symptoms, nor do they have lab results or qualifications to make an informed guess.

  • pistachio on 27/05/2019 - 15:21
    -3

    sounds like 'Crohn's disease' to me

  • OzzyOzbourne on 27/05/2019 - 15:23

    We have the best health care system in the world, I doubt the system will leave you to get worse just because you can't pay for private care… If it does we might as well be third world…. Some sarcasm intended

    • Trying2SaveABuck on 27/05/2019 - 15:37

      We do but Thailand certainly dont if OP didnt have travel insurance then he will probably be subject to VERY long Waiting lists. Who knows what bugs/viruses/infection run rampant in a 3rd world countries….It being over 7 months is very concerning i can almost guarantee his GP he is seeing is useless if he hasnt WL him yet which it sounds like he hasnt…

  • Trying2SaveABuck on 27/05/2019 - 15:33

    Go via the public system your GP should be able to refer you. I would advise to not take medical advice off randoms off the internet talk to a specialist

    You will have to wait but it should be free

    Otherwise

    Your travel insurance sure cover medical expenses…and if you didnt have travel insurance in Thailand well then that is really on you…

    • [Deactivated] on 27/05/2019 - 15:55

      Agree but I wouldn't call it free.

      Purely semantics but the tests are expensive, they're just covered by Medicare/tax payers. When people have the idea of free medical care ingrained, it loses it's value.

    • KenDiaMoi on 28/05/2019 - 14:04

      I had travel insurance when I was in Thailand. I can claim medical expenses here now in australia for an illness that I got in thailand?

      • Trying2SaveABuck on 28/05/2019 - 14:33
        +1

        you would have to read the pds but i would say you could

        • Love a bargain on 29/05/2019 - 11:41

          There might be a time-limit on that coverage though

      • Meho2026 on 29/05/2019 - 15:50

        No you cant, travel insurance only covers you overseas and the policy ends when your journey is completed on return to Australia.

  • HansieSYD on 27/05/2019 - 15:39
    +12

    Get your GP to do a stool test, and ensure they include Blastocystis hominis in the test, which is best done as a sample in a fixative. These tests 100% covered by Medicare.

    69336 Faecal microscopy $28.45 $28.45 $0.00 Bulk Bill
    69345 Faecal culture $45.00 $45.00 $0.00 Bulk Bill

    • Cluster on 27/05/2019 - 15:58

      If the OP's statement is correct and they've only had blood tests, that puzzles me. When I turned up in a public hospital with very similar symptoms the doctor ordered two things: IV drip to replenish liquids, and a stool test (which came back negative).

    • dvd107 on 28/05/2019 - 11:28
      +1

      "Ensure they include Blastocystis hominis in the test"
      This is poor advice.
      https://www.health.nsw.gov.au/Infectious/factsheets/Pages/bl…

      • HansieSYD on 28/05/2019 - 16:27

        I've had this 3 times… so just speaking out of my own experience. matches the symptoms.. hard to kill off unfortunately.

        adding a test doesn't cost anything extra either.

  • Riddler2018 on 27/05/2019 - 16:01
    +14

    You need a Stool MCS + OCP + Viral PCR. This test will likely show a protozoal infection, for which, you may need Metronidazole 400mg three times a day for a week.

    Blastocystis hominis + other bugs - will all be covered by the above test.

    No need to see a gastroenterologist at this stage. I wish you quick recovery.

    • diazepam on 28/05/2019 - 00:12
      +1

      Finally someone who at least sounds like they know what they're talking about compared to all these "internet doctors"

      • Riddler2018 on 28/05/2019 - 08:32
        +5

        Thanks 🙂
        I am a GP. This is exactly what I would have done if a patient had presented to me with this history. Start from common sense, non-invasive and least expensive management. If all tests come back negative, then consider referring to an appropriate specialist.

        • Tsuska on 28/05/2019 - 12:58
          +1

          I agree.
          (I'm also a GP)

        • diazepam on 28/05/2019 - 23:25

          nice to meet you fellow doc :)
          surprised to find that there's so many doctors on ozbargain tbh… I still remember that post with the BPT2 asking how to get more money…

    • KenDiaMoi on 29/05/2019 - 04:40

      Amazing info. Thank you. Hopefully I can get this sorted without a camera in my butt.

  • Riddler2018 on 27/05/2019 - 16:07
    +2

    PS. Since you have had the symptoms for a few months, I'd ask the GP to add Giardia PCR to the stool test.

    • ColonialBoy on 08/07/2019 - 23:14

      I don't think these tests were around when I had similar symptoms 20 years ago.

  • PaperplaneXXX on 27/05/2019 - 16:10
    +1

    feels like some sort of a parasite.
    Get to see an infectioous desease doctor.
    There are liver flukes very common in Thailand.
    Certainly something is wrong with the intestine and the flora is abnormal!

    you need infectious desease doctor ASAP.

  • akyeeeahdude on 27/05/2019 - 16:38
    +1

    Too much iron is an interesting observation and is very unusual which leads me to ask:

    Have you talked to your doctor about Haemachromatosis? Possible side effects include digestive disturbances, abdominal pain and diarrhea. Fatigue/lethargy is a common symptom of the condition.

    Do you recall the iron count in your blood when you were told you had high iron?

    • May4th on 27/05/2019 - 21:43
      +1

      ferritin is an inflammatory marker and could be raised in case of infectious colitis. i would be at a loss if OP has not had a stool culture yet, it would be almost negligent not to do one given the history

  • gimme on 27/05/2019 - 17:04
    -3

    Not sure if anyone already said this. Some will neg away but I don't care. Goto Emergency outside peak hours. e.g. During the day midweek. 'Pretend' to have unbearable pain in your gut area. Also tell them about your stool etc etc when they ask. They'll run all the necessary tests and hopefully narrow it down as far as next steps are concerned.

    • diazepam on 28/05/2019 - 00:14

      You know it's pretty (profanity) hard to pretend to a doctor
      They might go hmmm atypical presentation but you're bound to slip up, they'll ask you things that results in impossible combinations and investigations will come back clear
      At best you'll get labelled with psychosomatic symptoms and they'll tell you to (profanity) off. :)

    • Jaystea on 28/05/2019 - 03:36
      +4

      Currently working in ED. We won't do a stool culture for you right here right now. No benefit as the results will take a couple of days. Unless you're sick enough to be an admission which is difficult to tell until one of us sees you, you're likely going to be sent home with a letter to the gp to do the stool mcs

      • Riddler2018 on 28/05/2019 - 08:34

        I agree. Since the above is not an acute presentation.

    • [Deactivated] on 28/05/2019 - 10:27

      Pain is a symptom.

      Pretending to obtain gain (ie. Priority in a taxpayer funded system) is fraud.

      OP will end up with a whole lot of unnecessary tests due to a falsified symptom and likely end up with a misdiagnosis.

      This brings us back to a full circle of the problem not being fixed, except someone who may have needed urgent care may not have received it in a timely manner and the system is several thousand dollars poorer.

  • Sawtell on 27/05/2019 - 17:23
    +1

    I posted this in the whirlpool cross thread before it was deleted but (in case you didn't see it) get your doctor to order stool sample testing.

    Make sure he ticks bulk bill too as it is relatively expensive.

  • Good-Dil on 27/05/2019 - 17:24
    +1

    http://www.bowelcancer.org.au/early-dection.php?gclid=Cj0KCQ…

    You need a specialist ASAP.

  • chumlee on 27/05/2019 - 17:28
    +2

    Commit a crime, get sent to jail and get free health care, free Foxtel, free gym, free internet, free meals etc.

    Just don't end up in a nursing home otherwise you will be physically abused by unqualified staff

    • [Deactivated] on 28/05/2019 - 10:29

      …you will be physically abused by unqualified staff…

      What qualification does the staff need to physically abuse the patients?

  • Dreamcast on 27/05/2019 - 17:58
    +5

    Damn, I know you'd doesn't mean much, but I hope you get better soon mate.

  • funnysht on 27/05/2019 - 17:59

    did you have ice in you drinks- it's usually where the germs are- otherwise other food is usually cooked

    see another GP- some GPs do subspecialise in gastro disorders like checking stools for ova/parasites

    Also gastro bosses are expensive- HOWEVER there are new bosses who do not charge above what medicare rebates- and they may do the scopes sooner because their wait list is shorter- maybe seek that avenue

  • [Deactivated] on 27/05/2019 - 18:20
    -3

    While we are oversharing, my most violent reaction was to a large oreo McFlurry from the US in 2000. Don't go large with foreign dairy right away.

  • blackorange on 27/05/2019 - 19:01

    As everyone has pointed out, you need a GP to care about your symptoms enough to escalate the investigations & treatment. Ask around for recs for a good GP (many good ones do not bulk bill but needs to be taken into consideration) cos you need someone to advocate for you to navigate through the system..

  • redslert on 27/05/2019 - 19:26
    +1

    See another GP, see more!
    Seek help at public hospital with specialists… you need to wait but the longer you delay the worst the wait….

    Health care is free in Australia. Thank god for medicare!

    • UNO on 27/05/2019 - 21:23
      -1

      Free =/= paid by taxpayer!

  • wallaceff on 27/05/2019 - 19:56
    +1

    WHAT EVER YOU DO, DO BOT JUST ROCK UP TO AN EMERGENCY DEPT SAYING I HAVE THIS PROBLEM FOR 8 MONTHS! (Yes, all caps). It is not an emergency. Find a gp to send you to your outpatients.

    • gimme on 27/05/2019 - 21:17
      -1

      No just do it. You're no worse than the long list of drunks and junkies tying up the system. At face value you sound a lot more deserving. Don't listen to self righteous misguided advice.

  • Spic3y on 27/05/2019 - 20:09
    +1

    Aside from the usual 'get a second opinion' suggestions, maybe look into a Low-FODMAP diet?

    You mention cutting out milk and gluten but there can be many other causes for your symptoms (if it isn't a stomach bug).

    All the best!

  • ashpete02 on 27/05/2019 - 20:11

    .+ to Gardia , took 4 tabs and a day later fixed almost…

  • MessyG on 27/05/2019 - 20:23
    +2

    Have you been tested for giardia? That's the most common cause in the situation you've listed.

    Here's the guideline for diarrhoea in a returned traveller (it talks about parasitic and non parasitic causes), check if your GP has specifically checked for the bugs listed in the article (the tests have to be requested specifically, they're not just part of a general poo microscopy and culture).

    https://www.racgp.org.au/afp/2012/october/parasitic-causes-o…

    Failing this the GP can ring up the local hospital gastroenterologist for advice on further testing (or their registrar), or the infectious diseases consultant (or both). But there's no reason you can be referred to the public outpatients clinic for a review. Failing that (I know wait times can be long), can you go and see the gastroenterologist you've been referred to and see if they have any ideas for further tests that don't involve a scope? Then you'd just have to pay their consult fee.

  • ozgeek on 27/05/2019 - 20:37

    Possible Parasitic worms inside your intestines? Ask your GP to do a scan of your intestines?

    • diazepam on 28/05/2019 - 00:18

      What's any parasite going to show on a scan… At most it's going to show nonspecific inflammation
      Lol.

      • ozgeek on 28/05/2019 - 08:22

        tube Camera??

  • Twocupteabag on 27/05/2019 - 20:57

    Hi. Ask for Azithromycin. It fixed me.

    • DogGunn on 28/05/2019 - 01:04

      How about diagnosing the problem first? haha

      • diazepam on 29/05/2019 - 00:11
        -1

        Funny because azithromycin probably will look against Giardia (most likely cause if you read through all the doctor's posts on this thread)

        • DogGunn on 29/05/2019 - 00:16
          -1

          Yes, that is the most likely diagnosis considering OP's events, however it is important to actually get a diagnosis of what it is.

          Over prescribing of antibiotics in Australia and other places is helping the creation of superbugs.

          • Twocupteabag on 02/06/2019 - 14:24

            @DogGunn: Two gps could only tell me I had infection markers from two blood tests. The emergency GP prescribed azithromycin and fixed me up. I don't care I didn't get a diagnosis. I was not well.

  • May4th on 27/05/2019 - 21:45
    +3

    In summary, see your GP again, or see a new GP.

    Ensure basic workup is done - ie. stool testing. It may very well not require specialist input if a simple diagnosis such as giardia is made.

    If you do require gastroenterology input, most public hospitals have outpatient clinics that bulk bill. Request a referral to one of those.

  • amazonaddict on 27/05/2019 - 22:58

    I watch these Street food videos in youtube with hosts making weird sounds after each bite; decide to go on trip to south east asia and figure out what so orgasmic about those street food; then see this post. :-/

    • KenDiaMoi on 27/05/2019 - 23:39

      Worth it lmao

    • Hahuh on 28/05/2019 - 14:52

      Drink scalding hot boiled water afterwards. See no problems.

  • dufflover on 27/05/2019 - 23:26

    Reading the description "worm(s)" randomly came to mind as well.
    /#notadoctor

  • diazepam on 28/05/2019 - 00:20

    @op where abouts in Vic are you located? I might be able to refer you to a good GP.

  • HamsterNZ on 28/05/2019 - 00:51
    +2

    I had similar symptoms a couple of months ago, thought it was food poisoning, started to slowly get better after a week, then got worse again. After couple of weeks I d finally went to Dr he ordered stool test and found out I had Giardia. Got the specific antibiotic for that kind of parasite and definitely improved.

    However note that even though the parasites are killed by antibiotic, there can be a longer term gastro problems as the parasite can cause some damage to the intestines. So even if things get a lot better your gastrointestinal health may still be off for a while while it trys to heal. Mine hasnt always been quite the same since, sometimes is fine other times more senstive.

    I had it checked a few days after antibiotics as was a strong two day dose and I felt some minor symptoms came back, but it was negative for Giardia, so just my body dealing with the aftermath.

    All the best finding the cause and getting treatment.

    • KenDiaMoi on 28/05/2019 - 14:41

      Cheers I will keep this in mind

  • me4president on 28/05/2019 - 01:28

    If you have anything in your super, you can request to withdraw I think its a maximum of 10k for financial difficulty, one of the criteria is being on centrelink - goodluck

  • neosin on 28/05/2019 - 02:02
    -5

    Plant based diet!

    This will solve your issues.

  • RefusdClassification on 28/05/2019 - 06:33

    I hope you get better. The lower part of my gastrointestinal tract is currently okay; it is the upper part (stomach/esophagus) that causes issues.

    Public hospital endoscopies and colonoscopies are free, but they might be significant waiting times. In the old days you would have no problems getting sickness allowance or Disability Support Pensions, but now you would need to have positive evaluations in your favour from several GPs and gastrentrologists to have a chance of qualifying for DSP (the pay rate is at least 30% more than the Dole + none constant bureaucratic harassment).

  • movieman on 28/05/2019 - 06:45
    +1

    OP.
    Sorry to hear about your situation.

    Have you tried charcoal tablets to see if that assists?

    https://www.chemistwarehouse.com.au/buy/53452/charcotabs-250…

    Take two tablets and see if you notice a difference.

    • snivy on 29/05/2019 - 16:04

      I was gonna suggest that too but it seems to be late now as he's got something more serious going on.

      Good to keep in mind for next time, not like we expect food poisoning but we'll never know.
      This one isn't available in Australia but can be found in Asia; https://www.lagaay.com/shop/product/10977

      I usually get one during my travel just in case.

  • anzacpaul on 28/05/2019 - 10:52
    +2

    Good luck OP. May I ask that you update this thread with your progress?

    Although it's none of our business, nothing worse than a thread starter that disappears.

    • KenDiaMoi on 28/05/2019 - 14:07
      +2

      yeah i will update :)

  • Homr on 28/05/2019 - 11:02
    +1

    Loose stools 6+ a day in the last 8 months??? That could also be a sign of colon cancer, have you had it checked out??

    • [Deactivated] on 28/05/2019 - 11:06

      It happened immediately after the trip. It would be highly coincidental for a chronic disease to present symptoms only after a holiday to a country well known to cause other gastro issues.

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