Help in Interpreting Test Results?

Discussion in 'Fibromyalgia Main Forum' started by redhummingbird, Dec 19, 2008.

  1. redhummingbird

    redhummingbird New Member


    I just got the test results of HHV 6, EBV, and chlamydia pneumonia and was hoping someone could help me out.

    The doctor who ordered these tests died in a tragic accident over Thanksgiving so I don't have his help. I will be seeing a new doctor on the 29th but wanted to prepare before my appointment.

    My original doctor was recommending Valcyte but it doesn't look like my HHV 6 titers are high enough.

    HHV 6 = 1:160 (Focus Labs-Reference range high < 1.10)

    EBV - VCA IGM Equivocal at <0.91 (Quest Diagnostics)

    EBV VCA IgG Positive at 3.71 (Quest-Reference Range >1.10= positive)

    EBV VCA Nuclear AG IgG Positive at 2.82 (Quest-same range as above)

    Labcorp EBV IgG 1640 (in October, 2008)

    Focus EBV IgG 1:320 (Feb, 2008)

    Chlamydia Pneumonia IgM <1.10 (Focus Labs Reference Range <1.10)


    Here are my questions:

    1. Am I positive for chlamydia pneumonia? I can't tell. This is a brand new test developed by Focus. The labwork says it can cross react to other similar organisms but also says titers of 1.10 or greater usually indicate recent infection.

    2. Is my primary infection EBV? And HHV 6 is along for the ride?

    3. I've had two other test through Focus for HHV 6. One result was 1:320 and the second was 1:160. I'm wondering if Valcyte is not indicated based on these titers.

    I'd appreciate anyone's input on this. I was all set to start Valcyte right after Christmas but now I'm not so sure.

    I also moved a week ago due to mold but it hasn't made any difference in my symptoms. Now I also have an achey chest pain (but no other cardiac symptoms).

    Thanks for your support and advice!
  2. Slayadragon

    Slayadragon New Member

    Hi Redhummingbird,

    A few things about the mold.

    1. Nobody feels better just because they've moved away from mold.

    That's not how this works. Nobody feels better the day after they start taking antivirals, and nobody feels better the day after they move to a lower-mold environment. Getting well from CFS should be that easy.

    It took Erik six months before he started feeling even a tiny bit better. I had a few symptoms improve within a short period of time, but it was about six months for me before I made much progress either. Ditto Forebearance. Khaly's progress came at about the same speed. So did Erik's ex-girlfriend, who was deathly sick after moving from the house (they spent a whole summer living in a tent) and now is well enough to live an almost wholly normal life (only avoiding extremely bad buildings.) Josh made a slight improvement right away, but he was not nearly as sick as any of us to begin with. StormySkye's improvements (she now self-identifies as a Moldie) came gradually as well.....meaning quite a long time after she moved away from what she thinks was a moldy environment.

    2. In many cases, CFS patients recovering from mold toxicity will feel worse before they feel better.

    This is called an "intensification reaction." Once the body starts to feel safe, it starts to spit out the poisons that have been stored inside of it. It waits until it feels safe (e.g. away from a lot of mold) because detoxifying internal poisons while being exposed to external poisons is too stressful.

    A typical pattern for a CFS patient who moves to a lower-mold environment is to feel slightly better for a few days to a few weeks, then to feel a lot worse.

    3. An "achey chest pain" is perhaps the most common symptom suggesting mold exposure.

    It's possible that you're getting that from detox. It also may be occurring when you get new exposures to higher levels of toxic mold than usual (e.g. when you're out of the apartment).

    If the latter, this would be a symptom that you would want to pay attention to in order to know what to avoid.

    4. Insofar as a mold responder has any contaminated belongings in his or her living environment, no progress will be made.

    CFS sufferers are not sick just because they're poisoned (though that's true too).

    They're sick because their systems over react to MINISCULE amounts of toxins.

    Erik says that the thing that was hardest for him about the mold is to accept just how small an amount of mycotoxin could totally destroy his health, even after six months had passed and he was feeling better.

    We have to keep in mind the peanut allergy analogy. For an extreme peanut responder, the amount of substance on the breath of someone who ate a peanut butter sandwich is enough to cause an attack severe enough to bring the person to the emergency room.

    If a CFS sufferer does not get WHOLLY away from mold, including all belongings contaminated with mold, it will not calm down enough to start making progress.

    There have been dozens of people on SickBuildings and elsewhere who have tried a modified version of Erik's approach. They've moved out of their moldy residences and put aside some but not all of their stuff. None of those who were really sick to begin with made any significant progress at all, though many did stop a downward slide.

    Of those of us who did discard all of our belongings (Erik, Khaly, Forebearance, Josh, Erik's former girlfriend, me), eventual wellness (from disability to 80-100% functioning) has been obtained.

    5. The way to tell if mold avoidance is working is to go back to a moldy place and see if it has become more intolerable.

    Once the body gets away from mycotoxins (as a result of moving to a lower-mold environment and being away from contaminated objects), it starts spitting out internal poisons through detoxification.

    When it is re-introduced to mold poison, it goes bonkers. That's when you get the "peanut allergy" type anaphylactic response symptoms.

    This is called "unmasking." The negative effect of the toxins was previously "masked" as a result of chronic exposure. Removing the chronic exposure makes their negative effect known.

    In my case, the big "ah hah" moment came when I decided to put on my winter coat to go to the store to buy some new clothes. I'd decided to trust Erik completely for a while, and thus had put aside everything that had been in my house. After several days of putting EVERYTHING aside (and being away from almost everything for a couple of weeks), I put on my coat to go shopping. I wouldn't have worn the coat, but it was 10 degrees outside.

    After driving for a mile, I had to pull the car over to the side of the road in order to repeatedly vomit. Finally I gave up and turned around. I had to stop several times more on the way back to vomit more. After I got back and took a shower, I was fine.

    I also reacted to washed clothing (heart beat fast and felt nauseated) and to putting my hand inside my purse (red burn that didn't go away for about 10 days).

    NONE of this happened until I got out of the house and away from the stuff though. And I'd been away from the house for a period of a couple of weeks dozens of times prior to this, including a couple of times in preceding months. It was the EXTREME avoidance that made the difference.

    I felt no better during this time. But the fact that I was reacting so violently to all my possessions made me realize there was something dreadfully wrong and that I needed to do something drastic.

    This all sounds nuts. Those of us who have gotten well as a result of mold avoidance sound out of their minds and extremely controlling when we say that people aren't going to get better if they don't follow the "rules." So far though, that's the pattern. As Erik has said, "I didn't make the rules, I just learned to play the stupid game."

    Any time I've explained this all patiently to a person with a scientific mind though, it's been absolutely believed. It's perfectly consistent with everything that's known about medicine. It's just that it's complicated. Sometimes the truth is.

    I can't say for sure that your illness is in part or whole due to mold poison. All I can say is that thus far, you have no evidence whatsoever that it isn't.

    Best regards,


    P.S. Of course, every time I say "mold" here, I mean "toxic mold." There's no way we could get away from ALL mold (that would be silly), and we wouldn't want to.[This Message was Edited on 12/20/2008]
  3. redhummingbird

    redhummingbird New Member

    Thanks for your thorough response. I did have a day and a half upon leaving my old place where I felt better but then have felt worse.

    It didn't occur to me it could be intensification reaction.

    The chest pain is a new symptom. My fatigue is quite bad leaving me basically bedbound.

    Things that have improved are that I haven't had a dizzy spell, I don't get those deep indentations on my skin, and I haven't had the feeling that something is in my throat.

    Other than that I feel awful. And the lymph nodes on the side of my neck are swollen and painful so I'm assuming I do have some sort of viral infection as well.

    I got rid of most of my belongins. The rest I followed my doctor's instructions (who follows Shoemaker's protocol) and the guy at Mouldworks in terms of washing things.

    My doctor told me that getting out of the moldy environment was vital but that it wouldn't be "the" answer as he believes that viruses are at the root of my illness.

  4. girlcat24

    girlcat24 New Member


    I've been watching your progress for quite awhile. It sounds like you are taking all the steps you can, considering your situation, to get as well as possible. I'm really glad you listened to your doctor and the other people you trust, and got out of a bad situation with your old place.

    I've read along as you've been diagnosed with CFS, Lyme, Babesia, possible myocarditis, and now, possible mold toxins. I'm not convinced that it is any ONE of these things to the exclusion of everything else; in other words -- why should it be ONLY mold, rather than ONLY Lyme, ONLY CFS, etc. From what you've said it sounds like it was a situation of 'a perfect storm' -- a buildup of a lot of things, perhaps set off by the introduction of mycotoxins.

    I know you are doing everything you can. It isn't possible for some people to leave behind every bit of their belongings and you just have to do the best you can. Maybe you won't have as much improvement as those who were able to leave everything behind -- but maybe you will. Slayadragon says it will take at least six months to see. You are doing everything else possible to build your immune system, and you have a doctor who is on your side, battling every possible enemy to your health.

    YOU ARE DOING EVERYTHING YOU CAN. Your strength is amazing, in the face of such a foe. An unseen, unidentified, invisible and shifting foe.

    I don't know what your test results mean, but you will find out soon and I know you will take active steps, as you have done with every other test result you've gotten. I've never seen someone take such control of their illness as you. You are relentless.

    Hang in there. You're doing everything right. You may decide at some point that you feel well enough to try living in a tent in the desert for a week or two, but right now you're doing the very best you can and exhibiting superhuman strength of will. I applaud you.

  5. Slayadragon

    Slayadragon New Member

    I thought about my response to you all weekend and hoped that it didn't come across as too bossy.

    That's the kind of thing that got Erik ignored for 20 years. He's mellowed out a bit recently, but I seem to have taken up his old approach. Sorry!

    Stormy, Khaly and I all are feeling bad winds from the stuff that's rotting in Texas (leftover from the flooding). Swollen lymph nodes are part of what we're getting. Erik's said that mold exposures give him swollen lymph nodes too.

    Erik apparently corresponds with Dr. Shoemaker on an almost daily basis, but I'm not sure that Dr. S knows just how extreme Erik has to be in terms of cross-contamination to stay well. It will be interesting for me to talk to him one day, when I have all the specifics in writing.

    I'd suggest that for the stuff you kept, put it all in one place (away from your sleeping area). That way you'll only be near it at certain times rather than all of the time. Giving the body lower exposures sometimes and higher ones others seems to work better than medium exposures all the time.

    You're actually following what turned out to be my approach at this point. I didn't go from my house to anything near "extreme avoidance" overnight. It took me nine months to get to that point, stair-stepping down with lower exposures to mold as time went on. It worked out well for me, that's for sure. What's important is not to take that first move as "this is as good as it's going to get." As time goes on, you'll be more in a position (both in terms of your energy and your ability to sense mold) to get away from it more.

    What you're getting sounds like intensification reaction, for sure. This is a really tough part! If you wanted to tell for sure, you could try going back to your old apartment. Or actually, your sister's house, since you seemed to be bothered there too. If those places feel WORSE than they did before, that means you're on the right track.

    The lessening of the skin dents is HUGE. That means that the hypoperfusion is lessening. Measurement of hypoperfusion is one of the key measures that Dr. Montoya used in his study to show that Valcyte was working. Eventually that should lead to more energy. If indeed you're detoxifying at a manic clip right now, that would cancel out the hypoperfusion improvements. Eventually that should help you though.

    I would never tell anyone not to consider antivirals or antibiotics. I'm taking doxy myself (I think it's helping with the Lyme), and eventually may give an antiviral another trial. I'm doing so fantastically well tolerating the doxy that I'll be curious to see if I could do the same with Valcyte. My immune system seems to be in great shape right now, but that doesn't mean that it can kill of these entrenched heavy-duty bugs all by itself. It would be interesting to see what would happen to me if I did take it, so I'm inclined to try it at least as an experiment.

    If I were to give advice though, I wouldn't take any antivirals or antibiotics while you're feeling especially sick. My experience was that before I moved out of my house and then a month or so later (when I was getting that big intensification), even the tiniest bit was intolerable. A weak system can't handle that stuff! If you have even an inkling that this is intensification, I think it would be better to postpone at least until the symptoms aren't as severe.

    The thing about doctors is that they've never seen patients pursue extreme avoidance. They tell them to move and nothing happens, so they conclude mold isn't the problem. Even my wonderful Dr. Guyer was shocked at how well I was doing (after 10 years with him) and at my experience. After a couple of appointments in which I filled him in on the theory and specifics, he told me that going off to live away from civilization for a while to detox was the best thing he could think of for me, after all. (Of course, you can't just live in the wilderness. You need to be sure to decontaminate if you run into mold when going to get foodstuffs etc. God , how complicated this is!)

    Anyway, that's where all doctors are now. They've seen patients move, not get better, so they say, "That's not it." The idea of just how few molecules it takes to set off a huge reaction never sinks in. Erik keeps saying he can't believe it himself, even after a dozen years of experimenting. (On the other hand, my very rational and scientific mother said it made perfect sense to her. Thanks, Mom!)

    Informing doctors and patients of the details of this and persuading them to do it _right_ is the hardest marketing challenge I've ever seen. But if Erik could figure out the mold (how the hell did he do that?), maybe I can figure out this.

    Anyway, it sounds like you're on the right track. Please keep me/us posted, okay?

    I promise not to metaphorically bite. Please give me a hard metaphorical slap if I forget though!

    Best, Lisa
  6. redhummingbird

    redhummingbird New Member

    Thanks Lisa, I really appreciate this. I was feeling a bit like I had failed myself by bringing some of my belongings. I have been reluctant to post on cfsunited because of that especially given how badly I've been feeling since the move.

    I had no idea one could feel this bad detoxing from mold. The other thing I've noticed are the bruises on my legs are gone. I just noticed this today. I've had a couple bruises that were caused by doing the Cell Therapy injections. I was surprised to see they had vanished. They'd been there so long I'd come to consider them as old friends.

    I probably got rid of 85% of my belongings (including the bed and all living room furniture).

    I got a latex bed which is moldproof. There is nothing in the bedroom from my old apartment and I have a great Hepa air filter to hopefully catch any mold toxins.

    It's a great idea to store the things from my old apartment away from everything. I just couldn't afford a storage unit given the cost of the move.

    I sure hope this is intensification reaction. This feeling matches the worst lyme herx (minus the pain). I have just pure profound fatigue. I can't even leave the building at this point. I was a little alarmed because even fixing myself lunch today left me exhausted-that's never happened before.

    I have an appointment with a podiatrist tomorrow near my old place. Maybe I'll try an experiment and visit my old apartment.

    I agree about not trying an antiviral right now. My body is way too weak.

    I've been taking csm though not as regularly as I was at the old place. Maybe I need to step it up again.

    Anyway, I can use all the help and advice that I can. It's kind of a frightening experience to go through this and not have a clue as to why I have felt so bad.

    I really appreciate your last post. I do believe that mold is an issue that everyone on this board needs to look into. I can't wait until your mold manual is finished-it's very much needed to help people out, especially people like me whom this stuff just doesn't come naturally.
  7. Slayadragon

    Slayadragon New Member

    Dr. Montoya selected only people with IgG=640 or above to be in his study. (That was my own level at that point.) I seem to recall that in his preliminary study, at least some people with lower values didn't get much if any improvement.

    These viruses come and go though. My impression after hearing the stories of many people on this board (I was as obsessed about viruses all during 2007 as I have been about mold during 2008) and my own half-dozen tests is that if you get one high reading of HHV6a and/or CMV, you can feel pretty confident that you have "real CFS" (whatever that is). After that, it's a crapshoot even from day to day. Some people on Valcyte have their titers go up by huge amounts (say 100% or more). Mostly they hide, I think. At one point when one patient's titers went up, Dr. Montoya told her he thought that was good because the body was now able to "see" the virus (since it had been driven out of hiding, he said). On the other hand, he thinks that decreases are good too. I don't like to be critical of someone I don't know, but having it both ways seems a little suspect to me. Again, it just seems random.

    The thing to look for with EBV is a) whether it's reactivated and b) whether the titers are really high. I don't have my notes down here in Las Cruces, but I believe that for it to count as "reactivated" you'd want to see a high IgM (yours is equivocal). The titers you're reporting are not high at all. Of course, as with HHV6, I don't think these numbers mean much in themselves, since they could just be a low fluctuation.

    I don't think any of the top doctors would put you on Valcyte with those scores though.

    I don't know about the lesser antivirals (Famvir or Valtrex), but people seem not to improve on them a lot unless they use them as a stair-step to Valcyte. (The idea there is that the lesser antivirals kill off some bugs and leave Valcyte to kill the more stubborn ones, thus keeping the system from having to cope with a huge amount of die-off all at once.)

    Note that I had a horrible die-off to Famvir (equivalent to that of people on Valcyte), and that I felt much sicker after I discontinued the drug until well after I moved out of my house. I have an unsubstantiated theory that the antivirals have a negative effect on MSH, thus giving the system fewer resources to handle the biotoxins. (Dr. Guyer suggests, and my own experience confirms, that they have a big effect on human growth hormone. The idea that they might affect MSH thus seems reasonable and possibly explains why I stayed sick after I discontinued. Certain other people remain sick after they discontinue too, of course.)

    Dr. Peterson used to talk about HHV6a vs. EBV. Erik still discusses it that way, and acts like people without HHV6a don't really have CFS. I try not to argue with him about that, since it gets us nowhere. Anyway, I don't know that Dr. Peterson looks at it that way any more either. And I've not heard of the other doctors who use antivirals (Dr. Montoya, Dr. Lerner, Dr. Guyer, the other major ones mentioned on this board) discuss them in this way either.

    If you have babesia, I'm not surprised that you're as sick as you are. That seems to me the killer. I really wonder if a lot of the folks in Incline Village (the really sick ones) had that bug too. Did you get any treatment for that one? If so, did you get a die-off?

    Babesia seems REALLY hard to kill, and a lot of the Lyme doctors seem to wait to address it even when they believe it's the core problem. I certainly wouldn't start on that if you think you might be in the midst of an intensification reaction. And based on everything I know, I feel confident that Dr. Shoemaker would agree with that.

    I agree that mold isn't your only problem. What seems to happen for a lot of people is that mold weakens the system, presenting the opportunity for the infiltration of a lot of pathogens. When those pathogens are Lyme or (especially) babesia, the system is devastated.

    After seeing hundreds of patients suffer hideously for years treating Lyme and babesia though, I have to think that if there's a way to lessen the pain, it's well worth doing. The only way that I've seen anybody do this is by addressing mold on the front end though. The thing about mold is that, apart from the initial detox reaction, you CAN get away from it if you try hard enough. Pathogens, of course, you cannot. So if your goal is to strengthen the system (which it should be for anyone treating pathogens), that seems the logical place to start.

    Oh, for Cpn: well, you're borderline for IgM. That suggests maybe. A lot of doctors look at IgG for that too, since this one "hides" pretty well too. Right before I moved out of my house, I had a negative IgM and a horrific IgG.

    However, since the same drugs kill lyme and cpn, and since the tests for both are so inaccurate, it's hard to know exactly what's being killed. (I can't remember what drugs you took for Lyme, but they would have addressed cpn too.)

    To my recollection, Cpn causes two problems: lung pleurisy (it's the acute disease "walking pneumoia" in normal people) and heart issues. Heart issues are something to pay attention to for the long run, of course. In the short run though, treating them isn't likely to make you feel better. And if you get the mold under control, the heart symptoms should go with it (except when you get acute exposures, at which time "heart palpitations" usually are the first sign).

    Do you have a copy of "Desperation Medicine" (by Dr. Shoemaker)? There's a case study of a woman with babesia and Lyme in it, with a case history of how other doctors addressed her issue (unsuccessfully) and then how Dr. S finally got it under control. The combination of mold, Lyme and babesia in a multisusceptible patient is tricky, to say the least. Do you have a good LLMD?

    The good ones have horrid wait times, but that's not necessarily bad in your case. Perhaps if you address the mold in the meantime, you'll be in better shape to tolerate their treatments if you get them. I wish I could remember what Lyme drugs you took and how bad your die-off was; that would provide a good clue with regard to what your core situation is.

    I'm just a fountain of knowledge about all this stuff, aren't I? Pretty pathetic, that I've studied it so hard over two years of my life. However, I am well. That counts for something! And maybe I can help others get well too.

  8. Slayadragon

    Slayadragon New Member

    PLEASE do come over and ask Erik about this stuff. His experience is much greater than mine! He also was more ill than I was (more at your level, also with your genotype), and so he can tell you more if what you've got right now matches what he went through. He also seems to be in a really mellow and helpful mood recently, and so we all should take advantage of that!

    I actually felt a bit better in some respects after moving out, along with periodic clear detox symptoms (such as repeated vomiting even when not in contact with possessions). But I know Erik went through hell that was far worse than any he'd previously experienced (and of course, he was really sick to begin with). I'm sorry we didn't get across to you that it could happen though. There just is so much information to process. I've been spending most of my time thinking about this for a year, and I feel like I'm not anywhere near the end of it.

    I NEVER could have survived the past year without direct contact with Erik, from beginning to end. He knows so much. It's truly astounding. That's why I want to do this book. I have no belief that he's not going to live a whole lot more years, but it would be horrible if his knowledge were to go away when he does. Like when all that knowledge went away in the Dark Ages.

    So please do come. We miss you and want to help.
    [This Message was Edited on 12/22/2008]
  9. Slayadragon

    Slayadragon New Member

    Oh! I see you're taking CSM!

    Now I certainly can see why you're feeling so bad. If you've got Lyme, CSM will knock you hard on your butt, especially when you're detoxing mold.

    Dr. Shoemaker talks about this in "Desperation Medicine" in the chapter called "Surviving the Herx." The intensification reaction from csm for lyme patients (but not just mold or other biotoxins) is MUCH worse than antibiotics, he says.

    I'd stop the CSM for the time being, therefore. You'll be detoxing enough without it. Or if you get bored because your life is too easy, maybe take a little bit. Like 1/4 teaspoon, Dr. Guyer suggested. That was enough to knock me on my butt, so I only did it sporadically. I think it helped, but I'd have been in agony if I'd done it all the time.

    (Erik insists that Dr. S insists that the 4 packet a day dosage must be adhered to. I don't agree that much is needed in order to make progress. I do think I made progress with my tiny doses. And you should SEE the tiny dose Forebearnce is taking! A Forebearance-sized dose, I call it.)

    Dr. S recommends a drug called Actos for patients with Lyme, which he says reduces the intensification response. I have a prescription but haven't tried it seems like a pain, and I'd like to knock out the active Lyme with antibiotics first. I've yet to find anyone on any of the boards who's tried it, so it will be interesting to see what happens.

    I'm still not wholly convinced that the biotoxins don't go at all through the methylation/glutathione channel, or that supporting detox through that channel won't be helpful. Did you get a reaction from taking the folate/B12 combo?
  10. Tina P.

    Tina P. New Member

    I am new to this website & am having problems for the past few weeks with mycotoxins in my home & car now. Ive been speaking with a Dr Croft from Wisconsin & he is saying he can help me remove all mycotoxins from my home & cars.

    Please read my profile for my history.

    I am devastated by all this happening & my husband & I are so depressed bc we just are shocked at all this crazy game people have to deal with.

    Please tell me if you have heard of Dr Croft & is this a possibility for us to still live in our home- with detoxifying all our belongings... We have had progress with washing our clothes with 2 cups of Ammonia tho. Thats the positive side of this.

  11. jole

    jole Member

    I too became ill after mold in my home.....and have reactions to riding in our car, but blamed it on the air conditioner. Could you explain what your symptoms to your cars are? After riding, I always have a sore throat, earache, headache, raspy voice and swollen glands the next day. No fever, and it goes away within 24 hours. Is this anything like you experience? Not at all like the fatigue/flu symptoms I normally have though.......thanks.....Jole
  12. Tina P.

    Tina P. New Member

    I do not have mold in my car or in my home. I did have something bothering me in my car, but replaced the carpet & seat & was fine. What I have now is mycotoxins that have been cross contaminated with my car. From my understanding this is caused from bringing in the mycotoxins from a mold contaminated bldg into my vehicle. I too had lost my voice & felt dizzy.
    I found out that you can spray your vehicle down with 50/50 ammonia & water to correct this. I have sprayed my vehicle down 3 X's so far & it is getting somewhat better, but I will continue to spray it down to neutralize the mycotoxins. Remember to spray in the vents & the supply air vents under your window wipers (outside your car) while your car is still on to circulate the air.
    Do you still live in your home? You may be bringing in the mycotoxins from your home into your car.
    I hope this helps you.
  13. Tina P.

    Tina P. New Member

    I wanted to let you know that I have been using an infuser with an essential oil called Thieves.. It is allowing me into my vehicles without losing my voice or feeling too bad. The only problem is that I dont think its getting deep enough in the fabrics bc once I get out of the car I can still have symptoms of the mycotoxins on my clothes once I am out. This may be another option for you. The Thieves essential oil has a cinnamon smell to it- so its not too bad.....