![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Llurpsie_Noodle on February 13, 2007, at 17:26:52
I was so anxious when I went to bed last night that I woke up only 3 hours after falling asleep on my first night of rozerem.
In short, I'm going through a difficult withdrawal right now, and since quitting seroquel 2 weeks ago, I've been having extreme daytime (hypomanic?)anxiety, along with very early pre-dawn awakenings.
Well, the Rozerem was supposed to help me get a good night's sleep. after waking up on it, it was kinda freaky. lots of swirly feelings in my vision and I was still incredible anxious. I took a nibble of a klonopin tablet. Let's say .2mg. that might have helped. but I woke up hourly until giving up "sleeping" at 6 am.
Anyone had luck on rozerem? Thanks in advance,
Llurpsie
Posted by Quintal on February 13, 2007, at 17:58:32
In reply to waaaahh :( Rozerem made me loopy!, posted by Llurpsie_Noodle on February 13, 2007, at 17:26:52
I've never tried it and have no wish to. I find that melatonin 6-9mg taken with a high-dose calcium and magnesium supplement an hour before bed helps me sleep quite well. It does actually make me drowsy sometimes, which I never noticed before when I was taking meds.
I've noticed some slightly trippy psychedelic effects on occasion, maybe similar to what you're describing with the swirly things in your vision? I often get flashes of color and the sensation of unseen 'beings' close to me when I'm trying to sleep. I've read melatonin is linked with DMT in the pineal gland in some way I don't recall right now which might go some way to explaining this.
Q
Posted by Declan on February 13, 2007, at 18:42:02
In reply to Re: waaaahh :( Rozerem made me loopy! » Llurpsie_Noodle, posted by Quintal on February 13, 2007, at 17:58:32
In Alexander Shulgin's Pikhal or Tikhal, he gets to melatonin and says with what feels like justified sniffiness 'I have never felt any effect from this tryptamine'.
But I have. That swirly business.
Posted by Llurpsie_Noodle on February 13, 2007, at 18:42:11
In reply to Re: waaaahh :( Rozerem made me loopy! » Llurpsie_Noodle, posted by Quintal on February 13, 2007, at 17:58:32
Thanks Quintal
Just for my education, what is DMT in the pineal gland. I guess I know what the pineal gland is, but DMT?Sounds like
Deep Mental Tissue
Darting Mind Tricksetc.
I could speculate all night long, but I've got homework. Trippy statistics.
ciao,
Ll
Posted by Declan on February 13, 2007, at 18:45:21
In reply to Re: waaaahh :( Rozerem made me loopy! » Quintal, posted by Llurpsie_Noodle on February 13, 2007, at 18:42:11
DMT is dimethyltrytamine, an endogenous (and exogenous) hallucinogen. The one that can be smoked and only lasts about 20 minutes.
Posted by notfred on February 13, 2007, at 18:52:51
In reply to Re: waaaahh :( Rozerem made me loopy! » Quintal, posted by Llurpsie_Noodle on February 13, 2007, at 18:42:11
" I guess I know what the pineal gland is, but DMT?"
Dimethyltryptamine. Its a Schedule I drug, no legal use, except:
http://en.wikipedia.org/wiki/Uni%C3%A3o_do_VegetalA powerful psychedelic which is also thought to be a neurotransmitter. We are not totally sure what roal it plays:
"Several speculative and as yet untested hypotheses suggest that endogenous DMT, produced in the human brain, is involved in certain psychological and neurological states. As DMT is naturally produced in small amounts in the brains and other tissues of humans, and other mammals[1], some believe it plays a role in promoting the visual effects of natural dreaming, near-death experiences and other mystical states. A biochemical mechanism for this was proposed by the medical researcher JC Callaway, who suggested in 1988 that DMT might be connected with visual dream phenomena, where brain DMT levels are periodically elevated to induce visual dreaming and possibly other natural states of mind"
Posted by Declan on February 13, 2007, at 18:53:05
In reply to Allow me to interupt » Llurpsie_Noodle, posted by Declan on February 13, 2007, at 18:45:21
My post, the third in the thread, seems to have vanished.
What I said was that Alexander Shulgin in either Pikhal ot Tikhal said that 'I have never felt any effect from this tryptamine'.
But I notice a swirliness from it.
Posted by Llurpsie_Noodle on February 13, 2007, at 19:26:04
In reply to Re: waaaahh :( Rozerem made me loopy!, posted by Declan on February 13, 2007, at 18:42:02
Declan,
happily your third post did not disappear.sniffiness... hope that's not a side effect of messing with the DMT?
lol
my pdoc is such a lucky person. I present pdoc with a "virgin brain" unexposed to anything harsher than second hand smoke and the occasional ethanol binge. He gets to see Llurpsie's Noodle go crazy at intervals. What a treat. What a lovely and communicative lab rat I am.
Dear Dr. Pdoc, what is this thing that makes me feel dizzy and makes my vision all swirly?
Dear Dr. Pdoc, what is this thing called "withdrawal" that gives me bad dreams, nausea, forgetfulness, and dark thoughts?
Dear Dr. Pdoc, why cannot I fall asleep? (after he asks me to stop taking 2 medications that predictably knock me out (seroquel and cymbalta) and substituting with the somewhat anxiety-causing geodon
Dear Dr. Pdoc, why am I so blubbery? (after craving nothing but chocolate, ice cream and pastries for several months.
Sniffily, I maintain hope,
-Llurps
Posted by Declan on February 13, 2007, at 19:37:12
In reply to Re: waaaahh :( Rozerem made me loopy! » Declan, posted by Llurpsie_Noodle on February 13, 2007, at 19:26:04
It was gone.
And now it's back.
Posted by Llurpsie_Noodle on February 13, 2007, at 19:50:06
In reply to Re: waaaahh :( Rozerem made me loopy! » Llurpsie_Noodle, posted by Declan on February 13, 2007, at 19:37:12
I'm listening to an internet radio station with trippy ambient music.
No wonder all the kids get high and listen to this stuff. It is kinda loopy and trippy. Better than most Tuesday nights? maybe?
-Ll
Posted by Phillipa on February 13, 2007, at 20:51:06
In reply to Re: waaaahh :( Rozerem made me loopy! » Declan, posted by Llurpsie_Noodle on February 13, 2007, at 19:50:06
Lurpsie have you googled rozeram? I'm going to. Sounds too strange to me. Love Phillipa ps thought it was the weakest of the non addictive sleepers
Posted by Llurpsie_Noodle on February 13, 2007, at 20:54:05
In reply to Re: waaaahh :( Rozerem made me loopy! » Llurpsie_Noodle, posted by Phillipa on February 13, 2007, at 20:51:06
They make a big deal about it not being a controlled substance. non-scheduled...
right.
I think it's probably pretty powerful stuff. gonna take some more right now.
g'night (I hope)
-Ll
Posted by munificentexegete on February 13, 2007, at 21:32:29
In reply to Re: waaaahh :( Rozerem made me loopy! » Declan, posted by Llurpsie_Noodle on February 13, 2007, at 19:26:04
> my pdoc is such a lucky person. I present pdoc with a "virgin brain" unexposed to anything harsher than second hand smoke and the occasional ethanol binge. He gets to see Llurpsie's Noodle go crazy at intervals. What a treat. What a lovely and communicative lab rat I am.
> Dear Dr. Pdoc, what is this thing that makes me feel dizzy and makes my vision all swirly?
> Dear Dr. Pdoc, what is this thing called "withdrawal" that gives me bad dreams, nausea, forgetfulness, and dark thoughts?
> Dear Dr. Pdoc, why cannot I fall asleep? (after he asks me to stop taking 2 medications that predictably knock me out (seroquel and cymbalta) and substituting with the somewhat anxiety-causing geodon
> Dear Dr. Pdoc, why am I so blubbery? (after craving nothing but chocolate, ice cream and pastries for several months.
>
> Sniffily, I maintain hope,
> -LlurpsDear Mr Pdoc, what exactly is wrong with me, can you show me the test or the scan?
Dear Mr Pdoc, would you take any of the "medications" you put me on?
Dear Mr Pdoc, are seroquel and geodon safe medications to take?
Dear Mr Pdoc, are you making me sick?
Posted by gardenergirl on February 14, 2007, at 12:48:49
In reply to waaaahh :( Rozerem made me loopy!, posted by Llurpsie_Noodle on February 13, 2007, at 17:26:52
I get that if I wake up after taking Ambien. I always described it as the walls "shimmering." I also stagger around a bit if I actually get up. Imagine trying to do yoga (I have no idea why, but it seemed like a good idea at the time) while staggering, "shimmering", in the dark, and without your glasses. Yeah, um, it's better to sleep. I hate that ambien drunk feeling when I happen to wake up.
namaste
gg
Posted by Llurpsie_Noodle on February 14, 2007, at 13:03:02
In reply to Re: waaaahh :( Rozerem made me loopy!, posted by munificentexegete on February 13, 2007, at 21:32:29
> > my pdoc is such a lucky person. I present pdoc with a "virgin brain" unexposed to anything harsher than second hand smoke and the occasional ethanol binge. He gets to see Llurpsie's Noodle go crazy at intervals. What a treat. What a lovely and communicative lab rat I am.
>
> > Dear Dr. Pdoc, what is this thing that makes me feel dizzy and makes my vision all swirly?
>
> > Dear Dr. Pdoc, what is this thing called "withdrawal" that gives me bad dreams, nausea, forgetfulness, and dark thoughts?
>
> > Dear Dr. Pdoc, why cannot I fall asleep? (after he asks me to stop taking 2 medications that predictably knock me out (seroquel and cymbalta) and substituting with the somewhat anxiety-causing geodon
>
> > Dear Dr. Pdoc, why am I so blubbery? (after craving nothing but chocolate, ice cream and pastries for several months.
> >
> > Sniffily, I maintain hope,
> > -Llurps
>
> Dear Mr Pdoc, what exactly is wrong with me, can you show me the test or the scan?asked and answered.
>
> Dear Mr Pdoc, would you take any of the "medications" you put me on?oooooh. I do not dare. likely that question would be deflected like this: "If I had symptoms like yours, I would seek professional treatment and if my doctor recommended X and Y, I would seriously consider it."
> Dear Mr Pdoc, are seroquel and geodon safe medications to take?asked and answered
> Dear Mr Pdoc, are you making me sick?
>
asked and answeredI feel pretty good today. yay!
Posted by Quintal on February 14, 2007, at 13:18:04
In reply to Re: waaaahh :( Rozerem made me loopy! » Llurpsie_Noodle, posted by gardenergirl on February 14, 2007, at 12:48:49
>I get that if I wake up after taking Ambien. I always described it as the walls "shimmering."
Mine used to 'sweat' as if by some sort of condensation. I also saw the 'third eye' in the centre of my dad's forehead if I happened to see him while under the influence. I also had letters of the alphabet coming out of my fingertips and met the legendary Ambien elves when they set up a maypole my duvet cover. It's a pleasant little hallucinogen when it chooses to be.
Q
Posted by munificentexegete on February 15, 2007, at 21:00:56
In reply to Re: waaaahh :( Rozerem made me loopy! » munificentexegete, posted by Llurpsie_Noodle on February 14, 2007, at 13:03:02
> > > my pdoc is such a lucky person. I present pdoc with a "virgin brain" unexposed to anything harsher than second hand smoke and the occasional ethanol binge. He gets to see Llurpsie's Noodle go crazy at intervals. What a treat. What a lovely and communicative lab rat I am.
> >
> > > Dear Dr. Pdoc, what is this thing that makes me feel dizzy and makes my vision all swirly?
> >
> > > Dear Dr. Pdoc, what is this thing called "withdrawal" that gives me bad dreams, nausea, forgetfulness, and dark thoughts?
> >
> > > Dear Dr. Pdoc, why cannot I fall asleep? (after he asks me to stop taking 2 medications that predictably knock me out (seroquel and cymbalta) and substituting with the somewhat anxiety-causing geodon
> >
> > > Dear Dr. Pdoc, why am I so blubbery? (after craving nothing but chocolate, ice cream and pastries for several months.
> > >
> > > Sniffily, I maintain hope,
> > > -Llurps
> >
> > Dear Mr Pdoc, what exactly is wrong with me, can you show me the test or the scan?
>
> asked and answered.can i ask what the scan or the test showed? what was the abnormality he found?
> >
> > Dear Mr Pdoc, would you take any of the "medications" you put me on?
>
> oooooh. I do not dare. likely that question would be deflected like this: "If I had symptoms like yours, I would seek professional treatment and if my doctor recommended X and Y, I would seriously consider it.">
>
> > Dear Mr Pdoc, are seroquel and geodon safe medications to take?
>
> asked and answeredwhat did he say?
>
> > Dear Mr Pdoc, are you making me sick?
> >
> asked and answeredwhat did he say?
> I feel pretty good today. yay!
>glad to hear it!
Posted by Llurpsie_Noodle on February 16, 2007, at 9:37:27
In reply to Re: waaaahh :( Rozerem made me loopy!, posted by munificentexegete on February 15, 2007, at 21:00:56
> > > > my pdoc is such a lucky person. I present pdoc with a "virgin brain" unexposed to anything harsher than second hand smoke and the occasional ethanol binge. He gets to see Llurpsie's Noodle go crazy at intervals. What a treat. What a lovely and communicative lab rat I am.
> > >
> > > > Dear Dr. Pdoc, what is this thing that makes me feel dizzy and makes my vision all swirly?
> > >
> > > > Dear Dr. Pdoc, what is this thing called "withdrawal" that gives me bad dreams, nausea, forgetfulness, and dark thoughts?
> > >
> > > > Dear Dr. Pdoc, why cannot I fall asleep? (after he asks me to stop taking 2 medications that predictably knock me out (seroquel and cymbalta) and substituting with the somewhat anxiety-causing geodon
> > >
> > > > Dear Dr. Pdoc, why am I so blubbery? (after craving nothing but chocolate, ice cream and pastries for several months.
> > > >
> > > > Sniffily, I maintain hope,
> > > > -Llurps
> > >
> > > Dear Mr Pdoc, what exactly is wrong with me, can you show me the test or the scan?
> >
> > asked and answered.
>
> can i ask what the scan or the test showed? what was the abnormality he found?
>My brain scans look like any other brain scan. I didn't need to order one. I have one already. I don't have structural abnormalities.
Tests like Beck Depression Inventory and such are important for screening and for getting folks like me (who have a hard time being interviewed) to answer difficult questions about their bad thoughts and feeelings.
Mainly I think he relies on his experience asking me questions. When I ask him what is the matter with me he says that I have symptoms like (insomnia, panic, flashbacks, depression...) that are consistent with what my therapists have diagnosed.
If you know this literature very well, you know that there are very low-level theories that explain individual symptoms as an imbalance or dysregulation of a specific receptor located in a specific region... all the way up to theories that there is something wrong with an entire system. I think of my brain as a globe with a lot of political strife. Sometimes we can stop the war (the bad thoughts, feelings, etc) by cutting all communications. These are very crude crude tools.
My pdoc would agree that the current theories are insufficient to explain my overall psychiatric condition in terms that would satisfy a physicist, a chemist or even a biologist.
Often when I present him with a particular symptom like increased munchies and binging and weight gain he is confident to tell me that the seroquel is likely to blame. Other side effects he will tell me "I have no idea" and we just hope they will pass or else that they will not be so troublesome that they will require a med change.
> > >
> > > Dear Mr Pdoc, would you take any of the "medications" you put me on?
> >
> > oooooh. I do not dare. likely that question would be deflected like this: "If I had symptoms like yours, I would seek professional treatment and if my doctor recommended X and Y, I would seriously consider it."
>
> >
> >
> > > Dear Mr Pdoc, are seroquel and geodon safe medications to take?
> >
> > asked and answered
>
> what did he say?The FDA has approved these medications and that they are safe to take at the doses that I take and also at higher doses. However, he also reminds me that every individual responds differently, and that I need to tell him if I notice any unusual thoughts, behaviors or somatic symptoms.
He also reminds me that it's safer to take these drugs than to self-medicate with alcohol and/or continue having thoughts and feelings which interfere with my judgment and place me in potentially life-threatening situations.
> >
> > > Dear Mr Pdoc, are you making me sick?
> > >
> > asked and answered
>
> what did he say?He said that when starting and stopping and changing meds that I might feel sicker sometimes. Asked me to keep him up to date on whether the sick feelings get better or worse, and the extent that they interfere with my life and my psychotherapy.
I already felt plenty sick (mentally & physically) when I started seeing him. Since then, I've been feeling like myself for many many days in a row. He reminds me to hang in there when we are changing meds and that these feelings and symptoms are probably going to pass. I also try to remind myself of why I'm taking the drugs in the first place (so that I won't want to die) and why I continue to take them (so that I can have the mental stability to do the difficult task of dissertating and living a "normal" life). Sometimes it's hard to think of those things though when I'm in the midst of the 10th hour of panic and the 2nd week of horrible insomnia...
> > I feel pretty good today. yay!
> >
>
> glad to hear it!
>and today again. so I better get back to dissertating.
best to you munificent
-Llurps
Posted by munificentexegete on February 16, 2007, at 17:26:24
In reply to Re: waaaahh :( Rozerem made me loopy! » munificentexegete, posted by Llurpsie_Noodle on February 16, 2007, at 9:37:27
> I think of my brain as a globe with a lot of political strife. Sometimes we can stop the war (the bad thoughts, feelings, etc) by cutting all communications. These are very crude crude tools.
I like that metaphor, i think it probably sums up your problems precisely. So your problem is bad thoughts. Have you always had them, did they start at a point in your life?I imagine that depression and bad thoughts go hand in hand. I think a doctor needs to give lurpsie noodle's feel good system a proper check.
Have you had you had your levels of serotonin and dopamine measured (ask for a catcholamines urine test, should be almost free)? Also the operation of your receptors can be analysed with MRI or PET scans? I think you would need to see a neurologist for those sorts of tests and they could be expensive, but good health is priceless.
> My pdoc would agree that the current theories are insufficient to explain my overall psychiatric condition in terms that would satisfy a physicist, a chemist or even a biologist.
I think they have a much greater array of medical investigative scans and tests than most people are lead to believe. Most doctors prescribe psychotropics without even doing a single test after a five mintute consultation based on "feel" rather than science.
If they can find out exactly what is wrong with you I think they can target the medication if you need any, or therapy. Even finding out that nothing is wrong with you and that the feelings are normal and could be a result of environment and personal contact with certain types of people. Whenever I feel those sorts of feelings it usually means I am around some bad people, and so it is a warning to me, like pressure on your hand if someone squeezes it too tightly, its uncomfortable. So those thoughts and feelings could well be like an early warning radar system. If you shut your brain down then it can be like shutting your pain system down, and then you don't get alerted to a dangerous situation or people. without pain, you would hold your hand on a boiling kettle until your flesh melts.
> I already felt plenty sick (mentally & physically) when I started seeing him. Since then, I've been feeling like myself for many many days in a row. He reminds me to hang in there when we are changing meds and that these feelings and symptoms are probably going to pass. I also try to remind myself of why I'm taking the drugs in the first place (so that I won't want to die) and why I continue to take them (so that I can have the mental stability to do the difficult task of dissertating and living a "normal" life). Sometimes it's hard to think of those things though when I'm in the midst of the 10th hour of panic and the 2nd week of horrible insomnia...
I am sure that you won't die from naturally occuring bad thoughts, however, if lurpsie's feel good system is physically damaged or operating in an abnormal manner, then you might need some sort of targetted medical intervention for a short or a long time depending on the persistence of the problem.
the other thing is that if you don't have a problem with your dopamine or serotonin systems, taking medications that effect them introduces more instability to your system.
many people find they get suicidal and homicidal thoughts from medications such as ADs and APs, so medicating could actually make your situation a whole lot worse.
enjoy yourself lurpsie!
Posted by Llurpsie_Noodle on February 19, 2007, at 23:52:49
In reply to Re: waaaahh :( Rozerem made me loopy!, posted by munificentexegete on February 16, 2007, at 17:26:24
> > I think of my brain as a globe with a lot of political strife. Sometimes we can stop the war (the bad thoughts, feelings, etc) by cutting all communications. These are very crude crude tools.
>
> I like that metaphor, i think it probably sums up your problems precisely. So your problem is bad thoughts. Have you always had them, did they start at a point in your life?Well... um. probably. I've had flashbacks about episodes that happened when I was a preschooler. Let's say that there was trauma and violence in my household and directed at my person starting at 18 mos of age. (or so says my pediatric records)
> I imagine that depression and bad thoughts go hand in hand. I think a doctor needs to give lurpsie noodle's feel good system a proper check.
Okay. sounds good
>
> Have you had you had your levels of serotonin and dopamine measured (ask for a catcholamines urine test, should be almost free)? Also the operation of your receptors can be analysed with MRI or PET scans? I think you would need to see a neurologist for those sorts of tests and they could be expensive, but good health is priceless.
>true good health is priceless. I just wonder how my system is right now, since I'm in withdrawal from SSNRI and one AP, and am just getting up to plasma steady state on a new AP. I'm not sure what a test would tell me other than "f*cked up".
Also, this brings me back to the good old days of dex suppression tests- very good at showing that cortisol response if f*cked up, but very bad at predicting which drug/drugs/therapies a person will respond to.
> > My pdoc would agree that the current theories are insufficient to explain my overall psychiatric condition in terms that would satisfy a physicist, a chemist or even a biologist.
>
> I think they have a much greater array of medical investigative scans and tests than most people are lead to believe. Most doctors prescribe psychotropics without even doing a single test after a five mintute consultation based on "feel" rather than science.
>
I guess I should consider myself lucky that I merit more than a five minute consultation. I get lots more attention than that.> If they can find out exactly what is wrong with you I think they can target the medication if you need any, or therapy. Even finding out that nothing is wrong with you and that the feelings are normal and could be a result of environment and personal contact with certain types of people. Whenever I feel those sorts of feelings it usually means I am around some bad people, and so it is a warning to me, like pressure on your hand if someone squeezes it too tightly, its uncomfortable. So those thoughts and feelings could well be like an early warning radar system. If you shut your brain down then it can be like shutting your pain system down, and then you don't get alerted to a dangerous situation or people. without pain, you would hold your hand on a boiling kettle until your flesh melts.
>Interesting thing- I've been reading some about PTSD, (my Dx, by the way) and apparently we lucky PTSD people are so used to our bodies signalling "fire! alert! help! pain! ack!" that we completely ignore our bodies altogether, try to numb any somatic sensations or cut them out. use your imagination. hence dissociation, self-mutilation, etc.
problem is that when our mind doesn't get good information from our bodies we are also very bad at perceiving intensely POSTIVE emotions, like joy, love, horniness, etc...
however, at othertimes there is intense hypervigilance where any small thing is perceived as a grave threat. In my hypervigilant states I rarely leave the house, and send my poor pdoc many e-mails on the minutiae of my somatic and psychological distress.
this can lead to major depression and anhedonia. bummer. I've had a few times now. let's say starting in high school, most recently a year ago.
> > I already felt plenty sick (mentally & physically) when I started seeing him. Since then, I've been feeling like myself for many many days in a row. He reminds me to hang in there when we are changing meds and that these feelings and symptoms are probably going to pass. I also try to remind myself of why I'm taking the drugs in the first place (so that I won't want to die) and why I continue to take them (so that I can have the mental stability to do the difficult task of dissertating and living a "normal" life). Sometimes it's hard to think of those things though when I'm in the midst of the 10th hour of panic and the 2nd week of horrible insomnia...
>
> I am sure that you won't die from naturally occuring bad thoughts, however, if lurpsie's feel good system is physically damaged or operating in an abnormal manner, then you might need some sort of targetted medical intervention for a short or a long time depending on the persistence of the problem.
>I think it's pretty targeted. The target keeps moving though, given the complex nature of my life experiences and my current stressors.
> the other thing is that if you don't have a problem with your dopamine or serotonin systems, taking medications that effect them introduces more instability to your system.
>
yes. I'd definitely agree with you.> many people find they get suicidal and homicidal thoughts from medications such as ADs and APs, so medicating could actually make your situation a whole lot worse.
when I first started taking AD (cymbalta) my self-destructive instinct was very very strong. I had too many suicidal crises. I was not very forthcoming about them to my T or pdoc either, until long after the fact. I'm impressed that during my most recent crisis I was able to call T and leave a Vmail and send pdoc and email and tell them what was going on. ((((me)))) but I don't want that to happen again. it was really really scary.
Rozerem makes me sleep for about 10 hours in a row. This is very nice sometimes and too much at other times. right now is a good time for me to be heading off for beddy beddy.
gnite and thank you for magnificent discussion. I dunno Latin- can you translate your name for me? just curious,
my name is Lurpsish for llrrrpp pasta.
al dente, of course
-Ll
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