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Chronic Eosinophilic Pneumonia, Empyema & Pleural Effusion: Natural Solutions

Sun, 24 Jul 2011 20:57:17 +0000

You’ve heard the term ‘exploratory surgery.’

Sounds cool and macho.

However, when you are on the receiving end, or someone you love is on the receiving end, the term ‘exploratory surgery’ is far from cool or macho.

Actual Patient Case History leading to Chronic Eosinophilic Pneumonia:

82 year old male with a severe bout of bilateral pneumonia treated successfully with antibiotics.

Then the pneumonia came back.

Treated again with antibiotics.

Pnemonia came back ... again.

Pleural Empyema followed causing liters of fluid build-up in the lining of his lungs. While the paramedic was running the patient down the hall, he asked, “Do you want to be resuscitated if we lose you?”

The patient ended up staying in the hospital for 3 weeks. Every few days the doctor performed a thoracentesis removing fluid from between the lung’s linings. When I say removed fluid, they removed over a liter of fluid. Not an ounce.

There was no sign of the fluid production stopping.

The patient, who is my grandfather, called me and explained that he was going in for exploratory surgery. The doctors could not find a cause for the fluid and needed to open his chest and ‘dry the lungs out’ with powder.

Now, bear in mind that I was fresh out of naturopathic medical school but even so, it didn’t sound like the right way to go.

My first thought was lung cancer so I asked what the pathology report found in the fluid they removed. He told me the fluid was clear and no cancer cells found. Sounded promising but still something was missing.

I asked him to fax me the pathology report. The report explained that the 1.5 liters of pleural effusion was clear without signs of cancer. Eosinophils were found in high numbers.

Diagnosis: Chronic Eosinophilic Pneumonia.

Bingo. No need for exploratory surgery.

Albeit nervous, I called his surgeon and explained my viewpoint. I asked for three weeks to reverse the fluid using my own treatments. The surgeon agreed to this but said at the end of three weeks, he was ‘going in.’ Fair enough.

The team of physicians were doing the right thing. They even nailed the diagnosis Chronic Eosinophilic Pneumonia
. However, they did not complete it as they do not have the means to treat Chronic Eosinophilic Pneumonia successfully. Steroids are not an option as they cause immune suppression, brittle bones and irregular sleep patterns; all of which you do not want an 82 yr old male to have.

The Cause of Chronic Eosinophilic Pneumonia:

My grandfather got exposed to cats and to mold. He is highly allergic to the feline kind and mold is downright deadly. He moved out of the apartment with suspected mold and no longer got exposed to cats.

He told the physicians about the cats but they did not consider his comments significantly.

Medical school pounded many things in my head.

One is: “Patient history makes up 80% of the path to diagnosis. Laboratory testing and physical exam make up the remaining 20%.”

Patients often know the cause of their illness.

If the physician is skilled at history taking, then an effective diagnosis AND treatment plan are put into action.

Treatment plan for my grandfather’s chronic eosinophilic pneumonia:

1. No cats.

2. Move from moldy apartment.

3. N-Acetyl L Cysteine (NAC). 5 grams four times a day. NAC breaks up mucous and allows the patient to effectively expel and get it up and out. Given that my grandfather had liters of fluid in his lungs, he needed high doses of NAC.

4. Molybdenum . 3 drops a day. Molybdenum assists in breaking up sulfur bonds found in NAC (in the cysteine) via the sulfation pathway.

5. Sterol 117: 3 capsules in the AM on rising from bed and 3 capsules at PM on retiring to bed. Sterol 117 is a potent plant sterol product researched to help calm down hyperactive immune functions. Given that he had high numbers of eosinophils, I needed to calm his system down. High numbers of eosinophils cause inflammation. Inflammation causes fluid. My grandfather had liters of fluid…

6. Optimal Fish Oil: Fish Oil high EPA and DHA . 2 capsules twice a day. In order to calm eosinophils and inflammation, DHA and EPA found in pure fish oil are highly beneficial as they stabilize cell membranes.

7. Shower Filter . Chlorine is a lung irritant. Remove the irritant and keep your lungs heathy - especially if prone to lung infections or asthma.

8. ProBiota 12 Powder: Given that 70% of the immune system resides in the intestinal tract and antiobiotics kill all of the foundational requirements for a healthy intestinal immune system, probiotics are essential. I suggested 1/2 teaspoon of ProBiota 12 Powder taken daily after dinner. ProBiota 12 Powder provides 200 billion beneficial bacteria in 12 strains in 1/2 teaspoon.

9. Liquid Vitamin D3: Low vitamin D3 levels are a contributor to the underlying cause of recurrent infections in many people. Get your vitamin D3 blood levels checked and supplement with at least 2,000 IU of Vitamin D3. Vitamin D360 by Seeking Health, provides 2,000 IU per DROP which is very potent. In this situation, I recommend my grandfather to take 20,000 IU daily while he was in the hospital.

My grandfather did not need ‘exploratory surgery.’

His surgeon was pleased but at the same time unsure. “Pleural Effusion and chronic eosinophilic pneumonia never go away on their own.”

In this case, the chronic eosinophilic pneumonia and pleural effusion did go away on their own and has not returned.

If you provide the body with the necessary nutrients it needs and remove the obstacles to cure, the body can heal itself beautifully.

Big points here:

1. If the treatment sounds wrong to you, question it. Trust your gut. Get a second opinion. 3rd, 4th, 5th, 6th. Not one doctor has all the answers.

2. Create your own team. I highly recommend that you find a MD and ND who will work together for you. Find a naturopathic physician at the American Association of Naturopathic Physicians .

3. Doctors are busy and many don’t want to hear your long story. Come prepared with key points in mind and emphasize them. If they don’t listen to you, find a different doctor.

4. You know your body more than you think. You provide doctors often with the diagnosis through talking with them. Trust your instincts and be heard.

5. Nutritional support is paramount in every medical condition. Find a physician who understand nutrition and biochemistry sideways and backwards. ND’s excel here.

6. Your body has the ability to heal, if and only if, you remove the obstacles to cure. If you step on a thumbtack, don’t take a pain killer. Remove the thumbtack.

7. Terms like ‘exploratory surgery’ or ‘Idiopathic’ exist because the physician does not know the entire picture. Again, get a team. Two heads are better than one.

Let’s end with a great Exploratory Surgery Cartoon . Sums it up perfectly

Careful out there.

Schedule a consult with me should you have any questions.

In health,

Dr Ben

Chronic Pain and Fibromyalgia with Candida, Adrenal Fatigue and Food Allergies

Wed, 15 Sep 2010 07:55:33 +0000

This article is Dr Ben's follow-up notes from a Free 15 Minute Consult with Dr Ben. Helping direct you to which products, dietary changes & lifestyle products may help you. This phone consult was in regarding: "How can I treat chronic pain with cell salts?"

The Phone Consult Podcast:
"Chronic Pain and Fibromyalgia"

My follow up email to Claudia after the Phone Consult:

Claudia -

We had a very successful phone consult. You are extremely knowledgeable about your body and provided great information. The history you provided allows me to make some solid recommendations which should ease your chronic pain and Fibromyalgia.

As discussed, here are the things to consider to reduce symptoms of chronic pain in Fibromyalgia:

1. Restore the Health of Your Digestive Tract and Reduce Food Allergies
Given that you were on antibiotics for years as a youngster and got worse and worse from that point tells me your digestive system needs support. Combine this with the fact you are worse when eating sugar or refined carbohydrates tells me you have a candida overgrowth. We all have candida is our digestive system; however, when it grows out of control, symptoms such as chronic pain, fatigue and numerous food intolerances occur.

To control the candida, try to limit the intake of refined carbohydrates and sugars.
Continue eating garlic as that is an excellent natural antifungal.

For optimum effect, crush a raw clove of garlic, smash it together and let it sit for 15 minutes. Then add it to your salad or whatever meal you are to enjoy.

When garlic is crushed, mixed and allowed to sit, Allicin is made. Allicin is the key component to garlic that is strongly anti-fungal and anti-bacterial.

Enhance the elimination of the chronic candida with a potent concentrated capsule of Garlic. Consider taking 1 capsule of garlic with meals three times a day.
To restore the proper digestive bacteria in your digestive system, you need a potent probiotic mixed with a prebiotic that is not grown in a base of dairy.

ProBiota 12 Powder contains 200 billion beneficial bacteria across 12 different researched strains. This is the most potent probiotic that I have seen.

It is important to avoid the toxic feeling of killing the candida too quickly. Thus, I recommend starting with 1/4 teaspoon of ProBiota 12 Powder taken at dinner time.

Do this dose for 1 week. After the first week, up the dose to 1/2 teaspoon at dinner time. Take until the bottle is gone.
Once the bottle is gone, you should switch to ProBiota 12 capsules and take 1 capsule at dinner time. 1 capsule of ProBiota 12 contains 25 billion beneficial bacteria across 12 strains and is also grown in a non-dairy medium with a prebiotic.

Many foods do not agree with you at the moment. If you ingest the Garlic and ProBiota 12, this will help; however, there is a lot of intestinal inflammation that needs to be addressed. If intestinal inflammation is not addressed, food allergies and intolerances will continue.

Intestines use L-Glutamine as fuel
Specific enzymes breakdown inflammatory cytokines which trigger food allergens
Quercetin calms down mast cells which slows food reactions

All these nutrients are found in BioInflammatory Plus capsules.

Consider taking 4 capsules of BioInflammatory Plus two times a day away from meals. I would like to see you initially take BioInflammatory Plus capsules three times a day at four capsules each time. I realize this is a lot; however, you would need to do it only for 1 week, then you could reduce down to 2 capsules three times a day or 3 capsules twice a day.

Within a few weeks, you should experience much reduced pain and more tolerance to foods.
I do recommend maintaining a Rotation Diet while keeping the ingestion of wheat and dairy at a minimum - if at all.
Take a quality concentrated form of EPA and DHA. EPA and DHA are commonly low in those experiencing chronic pain.

Consider taking 5 grams of combined EPA and DHA daily with meals.

The most concentrated EPA and DHA is found in liquid fish oils.

Finest Fish Oil has a great taste and contains 5 grams of EPA / DHA in 2 teaspoons.

If you prefer capsules, which I do not for fish oil purely because you have to take so many to get 5 grams, consider EPA DHA Essentials capsules.

2. Reduce the Chronic Pain of Fibromyalgia Immediately through a Moor Mud Bath and Epsom Salts

Given that you are in a fair amount of pain, there is no time to waste in relieving your symptoms.

Moor Mud therapy, called Balneotherapy, has been used for centuries to relieve pain.

I recommend adding 500 mL of Moor Mud to a hot bath.
The bath water should be hot yet tolerable.
Add 1 pound of Epsom salt to the bath. This may seem like a lot, and it is, but it is very therapeutic.

Locate an Animal supply store, typically one that provides items for horses, chickens, cows, and obtain a 25 lb bag of Epsom salt.

Do the Moor Mud bath three to five times a week for 3 weeks. Japanese researcher, Yuko Agishi, PhD found that pain is reduced long term if the moor mud therapy is performed in a series rather than a few sporadic treatments.

Consider purchasing 15 tubes of 500 mL Moor Mud and this will get you through the 3 week period.

Here is a research study showing the benefit of Moor Mud treatment for Fibromyalgia symptoms.
Full instructions for the Mood Mud Bath Treatment is here

3. Reduce Chronic Pain of Fibromyalgia by Reducing the Acetylaldehyde from Candida with Molybdenum

Candida release acetylaldehyde.
Acetylaldehyde is a known toxin that interferes with numerous systems in the body including the brain and kidneys.
If one is deficient in molybdenum, acetylaldehyde builds up causing pain and symptoms mimicking a hangover.

Consider taking 6 drops of liquid Molybdenum a day for one month to reduce acetylaldehyde and relieve chronic pain. After one month, cease the use of molybdenum if symptoms of pain are gone. If not, maintain a dose of 2 to 3 drops a day until pain subsides.
Research shows that if one takes 200 mcg of Molybdenum daily, pain will reduce in those experiencing it.

4. Reducing Chronic Pain of Fibromyalgia using Cell Salts

The cell salt, Ferr Phos 6x, is the indicated cell salt for inflammation and pain.
Consider placing 25 tablets of Ferr Phos 6x in a liter of water. Sip throughout the day.
Do daily for one month or as you experience symptoms of inflammation and pain.

5. Improving Energy

Your energy should begin to come back once your pain decreases, inflammation decreases and your digestive system heals.
On the phone, I recommended adrenal support and it is still a very valid recommendation given the importance of how it relates to improper sleep, low blood pressure and fibromyalgia pain.

Adrenal Support Plus will improve your blood pressure, reduce your dizziness upon standing, improve your energy, memory, reduce stress and reduce reactions to foods.
Those suffering from chronic pain also have weakened adrenals.
Individuals with fibromyalgia demonstrate low cortisol levels. Low cortisol levels are directly related to poorly functioning adrenal glands.
Improper sleep is also associated with weak adrenals. Usually what happens is those with weak adrenals are more awake at night and fatigued in the morning. They cannot get out of bed.
As we age, our adrenals become fatigued as well.
Consider taking 2 capsules of Adrenal Support Plus in the morning and at lunch. I find it works best to take away from food and then eat 15 minutes afterwards. This allows better absorption of the tyrosine found in Adrenal Support Plus.

If you are not taking an effective multivitamin for women over 40 years of age, I recommend Women's Nutrients.

Women's Nutrients is designed to support healthy estrogen balance, vision, memory, cardiovascular, and urinary systems.

Consider taking 2 to 3 capsules at breakfast and 2 to 3 capsules at lunch.
Do not take adrenal support or a multivitamin within 5 hours of going to sleep as they will keep you awake.
Do not start taking Women's Nutrients until you have stopped or nearly stopped the BioInflammatory Plus capsules.

I don't want you taking so many capsules in a day. There is no need for that. Your body can handle only so much and the key supplements in the beginning provide a number of nutrients.
If you want to start on Women's Nutrients while on the other products, simply take 1 capsule at breakfast and 1 at lunch.

In summary, the main supplements you should consider to improve symptoms of candida, chronic pain, fibromyalgia and food allergies are:

1/4 to 1/2 teaspoon of ProBiota 12 Powder for one month and then move to 1 capsule of ProBiota 12 taken at dinner time as a long term maintenance dose.
Garlic capsules during meals. This is a short term recommendation - for 2 months or so.
BioInflammatory capsules: best to take 4 capsules 4 times a day initially and then down to 2 capsules 3 times a day or 3 capsules twice a day. You may find you are able to diminish all the way down to 1 capsule twice a day and then cease taking it altogether after a few months time.
EPA and DHA: Take a combined amount of 5 grams with meals. You may take it all at once or spread out twice a day. This is a long term required nutrient and at this amount as well.
Molybdenum: take 6 drops any time of day for one month and then down to 2 to 3 drops a day until symptoms of pain diminish. I foresee you taking this for a couple months and then stopping.
Adrenal Support Plus: take 2 capsules 15 minutes before breakfast and 2 15 minutes before lunch. I foresee you taking this supplement long term.
Women's Nutrients: as a general health supplement. Begin taking it in low amounts while on the other supplements. Once you stop or nearly stop BioInflammatory Plus, Molybdenum and Garlic, then you may consider taking 3 capsules of Women's Nutrients at breakfast and 3 at lunch.

Lifestyle Things to Reduce Chronic Pain and Fibromyalgia symptoms

Take the Moor Mud Baths with Epsom salt 3 to 5 days a week for three weeks. Once this is done, you likely only need to do one Moor Mud bath a week or once per month for maintenance.
Apply Castor Oil to your abdominal area each evening. This is fantastic at reducing inflammation and systemic pain. Do nightly approximately 30 minutes before sleep. This way, by the time bedtime rolls around, most of the castor oil will be absorbed through your skin.
Maintain avoidance of wheat and dairy products.
Limit intake of sugar and refined carbohydrates.
Go for walks. Start out for 5 minutes a day and then move up 5 minute increments as you feel comfortable. Don't push it. Start easy and work up easy. Motion is great for chronic pain but not over exertion.
Drink filtered water - around 8 glasses a day or so.

With the above changes in supplementation and lifestyle/dietary changes, you will notice significant improvement likely in one to two weeks.

Do follow up with me in 2 weeks to one month. I like to hear you are doing with the implemented suggestions. This way we can also modify the suggestions if needed.

The HealthE Membership is free with the purchase of any Seeking Health supplement. ProBiota 12 Powder by Seeking Health will qualify you for a free HealthE Membership. The HealthE Membership provides you 10% off regularly marked items for one year. The discount is applied immediately during checkout.

A recording of the entire phone consult may be found here.

In health,

Dr Ben
Keep HealthE. Stay in touch!
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Disclaimer: All information relating to medical and health conditions, products and treatments, is for informational purposes only. The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician.

Neti Pot or Saline Rinse for Allergies?

Thu, 02 Sep 2010 21:14:55 +0000

Hello,

Can someone please share with me the main difference between using a Neti-Pot (w/ Saline) and just rinsing the nasal mucosa with Saline? This is for a family member with Allergies. My thought is that the Neti-Pot is more thorough with the force of the irrigation (plus you can additional things), yet I’m not sure if that’s the most significant difference. Your thoughts as well?

Thank you!

With a neti pot, you get the water deep into the sinuses where the pollen sits.

Without a neti pot, one cannot really get into the sinuses well if you just rinse the nose with saline. They’ll still have allergies as the allergen is likely residing in the sinuses, not just the entrance to the nose.

You may have them break some anti-histamine things in there also like Vitamin C, urtica tincture, quercetin, etc into the neti pot along with baking soda and salt.

Hope this helps!

Dr Ben, ND

How Do Food Allergies Occur? A personal inquiry

Wed, 07 Jul 2010 12:42:35 +0000

QUESTION:

Hello Ben:

In your studies have you come across any information as to why a person may start to become allergic to the food they eat? Or even hypersensitive to a particular food they have stopped eating?

Thanks for your help,

Allergic

ANSWER:

Allergic -

Huge question. No way I can answer this completely - it is an entire book.

A few main reasons with the leading reason being anything that causes inflammation in the gut will likely cause food allergies down the road.

Some things which cause inflammation in the gut:

Pathogenic bacterial overgrowth due to antibiotic use in last 5-10 years. Locate a quality probiotic to restore healthy bacteria
Weak digestion due to stress causing little release of HCl from the stomach or enzymes from pancreas or bile from liver. [Weak digestion typically means constipation - or diarrhea. both of which cause inflammation if chronic.]
Weak digestion due to antibodies against your parietal cells - those which secrete HCl
Genetics - a gene turned on due to environmental stimulus - celiac disease is a big one - avoid wheat and see how you do - all wheat products. Not easy to do but try it for a week. If you're allergic to wheat, you'll feel incredibly better quickly.
Constipation, pathogenic bacteria, candida, celiac, crohns, IBD, IBS - causes increased absorption of toxins back into the bloodstream and irritation to the intestinal lining. Irritation to the gut lining causes inflammation. Inflammation causes the gut lining to open. Open gut lining combined with weak digestion causes protein complexes to enter the body's tissue space. Larger protein complexes are not supposed to be in the tissue space. macrophages come and eat them and then send out signals which tell the body's immune system to make antibodies against this potential invader - the leaked out specific protein complex which came from a specific food. That protein complex is then is a target and when seen by the immune system, gets acted upon - causing further inflammation and further intestinal inflammation. Protein complexes are not supposed to enter the body's tissue space. All proteins, fats and carbs are supposed to be absorbed into the blood via the intestinal absorptive layer. If they escape into the tissue space instead - bam. potential for allergies. Remember food is proteins, sugars and fats. The allergic foods are proteins as the body can make antibodies against them.
Example - say you ate some cheese. The inflammation in your gut and weak digestive enzymes and acids did not properly break down all the long chain amino acids - peptides - into single amino acids. So some longer protein escaped through the intestinal lining into your tissue space. The macrophage saw this as an invader and ate it. It then sent out a signal to the other immune cells and they created an antibody against...cheese. So next time you eat cheese and your gut lining is not healed, the protein complex that the macrophage saw before is recognized by the immune system. The immune system reacts - allergy.

Hypersensitive even after not eating that food much is caused by the immune system having memory. The IgG part of the immune system will recognize 'bad protein complexes' for months and months. The only way to get the immune system to stop recognizing it is to stop eating the culprit food, heal the gut, and decrease inflammation. With those 3 combined, say after 6 months to a year, one will be able to slowly begin to reintroduce that food.

One may not be able to introduce an allergic food back into their diet if they are genetically prone to a specific family of foods such as gluten or the poison oak family - which includes mango and cashews.

However, if one is overburdened with solvents, heavy metals and others and they are properly removed, one may be able to balance their system back and regain the ability to eat anything. A naturopathic physician trained in environmental medicine can help here.

Bottom line:

Eat fiber such as oatmeal for breakfast.
Limit dairy as its constipating.
Don't drink with meals as it dilutes stomach acids, bile and pancreatic enzymes.
Exercise - which helps absorption, mind/body so one is relaxed. that's important as relaxation allows the sphincters to open and when they are open, the enzymes, bile acids and stomach acids are released. When stressed, they are closed. Also exercise helps one have a bowel movement. It's important to have a bowel movement every day.
Drink plenty of water throughout the day - before and after meals - not during. There is way more to the story but this is something.

If you have inflammation and allergies, it is important to quench that inflammation and restore health to the gut.

Poor gut health led to the allergies - or environmental chemicals and toxins did - that's another whole ball of wax.

An outstanding supplement combination which quenches inflammation is Bioinflammatory Medical Food Powder by Biogenesis. It is best taken with intestinal repair complex as this product heals the gut while bioinflammatory powder quenches inflammation. taken together, healing is faster. If one has a weak digestion for some reason - and that reason should be determined by a good doc - then perhaps digestive enzymes and stomach acids will help. Panzyme by Biogenesis contains both of them in one bottle.

If any more questions - I'm here to help - not all answers will be this long - i had some time this evening - you caught me in the right moment!

In health,

Dr Ben
Keep HealthE. Stay in touch!
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Disclaimer: All information relating to medical and health conditions, products and treatments, is for informational purposes only. The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician.

How Do Food Allergies Occur? A personal inquiry

Tue, 10 Jan 2006 00:00:00 +0000

Pathogenic bacterial overgrowth due to antibiotic use in last 5-10 years. Locate a quality probiotic to restore healthy bacteria
Weak digestion due to stress causing little release of HCl from the stomach or enzymes from pancreas or bile from liver. [Weak digestion typically means constipation - or diarrhea. both of which cause inflammation if chronic.]
Weak digestion due to antibodies against your parietal cells - those which secrete HCl
Genetics - a gene turned on due to environmental stimulus - celiac disease is a big one - avoid wheat and see how you do - all wheat products. Not easy to do but try it for a week. If you're allergic to wheat, you'll feel incredibly better quickly.
Constipation, pathogenic bacteria, candida, celiac, crohns, IBD, IBS - causes increased absorption of toxins back into the bloodstream and irritation to the intestinal lining. Irritation to the gut lining causes inflammation. Inflammation causes the gut lining to open. Open gut lining combined with weak digestion causes protein complexes to enter the body's tissue space. Larger protein complexes are not supposed to be in the tissue space. macrophages come and eat them and then send out signals which tell the body's immune system to make antibodies against this potential invader - the leaked out specific protein complex which came from a specific food. That protein complex is then is a target and when seen by the immune system, gets acted upon - causing further inflammation and further intestinal inflammation. Protein complexes are not supposed to enter the body's tissue space. All proteins, fats and carbs are supposed to be absorbed into the blood via the intestinal absorptive layer. If they escape into the tissue space instead - bam. potential for allergies. Remember food is proteins, sugars and fats. The allergic foods are proteins as the body can make antibodies against them.
Example - say you ate some cheese. The inflammation in your gut and weak digestive enzymes and acids did not properly break down all the long chain amino acids - peptides - into single amino acids. So some longer protein escaped through the intestinal lining into your tissue space. The macrophage saw this as an invader and ate it. It then sent out a signal to the other immune cells and they created an antibody against...cheese. So next time you eat cheese and your gut lining is not healed, the protein complex that the macrophage saw before is recognized by the immune system. The immune system reacts - allergy.

Eat fiber such as oatmeal for breakfast.
Limit dairy as its constipating.
Don't drink with meals as it dilutes stomach acids, bile and pancreatic enzymes.
Exercise - which helps absorption, mind/body so one is relaxed. that's important as relaxation allows the sphincters to open and when they are open, the enzymes, bile acids and stomach acids are released. When stressed, they are closed. Also exercise helps one have a bowel movement. It's important to have a bowel movement every day.
Drink plenty of water throughout the day - before and after meals - not during. There is way more to the story but this is something.

In health,

Dr Ben
Keep HealthE. Stay in touch!
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