Read about it in, Insomnia is more commonin fact worsefor people with chronic conditions. In other words, trying out a new seat certainly wont hurt you, but dont expect that spending more money on a fancier saddle to guarantee a pain-free ride. Alan has completed the new Pain Recovery Program. Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. How did you deal with the clothing irritation? Use to have trouble ejaculating. Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use in pregnant women clearly outweigh potential benefits. I am back on the trainer 3 days a week for 60 minute zone 2 rides. Lets build this page together! Nerve compression and swelling often causepain described as burning, stinging or feeling like pins and needles.. You can have multiple cup of coffee with the help of these machines.We offer high-quality products at the rate which you can afford. Hyperbaric Oxygen Treatment what, when, how? When you share what its like to have pudendal nerve entrapment through your profile, those stories and data appear here too. We need to keep moving as the hunter gatherers we are designed as, but modern living. There, the nerve branches out to three areas: I pulled this off the internet " Nortriptyline works The anaeasthetic part didn't work at all but the steroid kicked in exactly 2 weeks after and I really thought I'd been cured. A whole lot, as co-founder Jamie Heywood explains in this video. Pudendal Neuralgia (PN) is a condition that involves pain of the pudendal nerve, which runs between the anus to the genitals of both men and women. Complete your request online or contact us by phone. I'm going back to Doctor to get back on them. One symptom that Is not subject to the Controlled Substances Act. When sitting aggravates or causes the pelvic pain (perineum, genitals, coccyx, rectum, and pubic hair) we suspect pudendal neuralgia, often called pudendal nerve entrapment. This medication may not be approved by the FDA for the treatment of this condition. I crushed the left branch of the Pudendal N. in 1995. Abuse may lead to severe psychological or physical dependence. Most importantly, they help you churn out several cups of tea, or coffee, just with a few clicks of the button. As I indicated previously these issues have likely been building over a couple decades, so getting quick resolution is not realistic. I dont have ED or genital pain but I do have genital numbness and less size, indicating a lack of blood flow. In this diagram, we have overlayed the most likely sites of a nerve Hi everyone, I hope everyone is doing well in their journey. Thanks you again for responding. Ive found it helpful/hopeful to scroll through this forum and find others with my diagnosis heal themselves with TMS. last year, and won't refer me again, as traditional checks were carried out and nothing detected, and now I really I don't know what to do. WebThe two meds apparently work well together. 2008. pp 39-56. Please feel free to contact me here or by private message to discuss the complexities of this terrible problem. I dont know if the block caused it, or the 1-2 weeks before of messing with my saddles, perhaps setting the stage for injury, who knows. Pelvic floor dysfunction refers to a wide range of issues that occur when muscles of the pelvic floor are weak, tight, or there is an impairment of the muscle, nerves or joints. Now that you have the Water Cooler of your choice, you will not have to worry about providing the invitees with healthy, clean and cool water. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Moreover the pain doesn t move its always at the same place. Currently any clothing touching the head of my penis irritates it, has a raw feeling. My first encounter with Pudendal Neuralgia started when I was eighteen years old. If you have chronic pelvic pain caused by pudendal neuropathy, your healthcare provider may use any combination of these treatments. Morning ladies. Welcome to Connect. This interconnectedness is essential to the way our pelvic pain specialists approach treatment. If the cause is excessive sitting or cycling, pudendal neuralgia can be treated with rest. Would you mind saying what bladder meds and muscle relaxer? So pn goes on and off Wat symptoms do u have or had? However, there is no scientific research that states certain seats decrease the incidence of pudendal neuralgia in distance cyclists. If you are looking for a reputed brand such as the Atlantis Coffee Vending Machine Noida, you are unlikely to be disappointed. This condition may be caused by pudendal nerve entrapment, when the nerve becomes compressed, or by damage to the pudendal nerve itself and is also known as pudendal neuropathy. Most cases are in women who have had pelvic surgery. Finally in the forums about tms nobody mention erectil dysfunction. This is a subreddit to raise awareness and offer support for people with PFD. Create an account to follow your favorite communities and start taking part in conversations. He is going to a pain management clinic as well. Genitourinary Pain And Inflammation. Living with Usher syndrome: Share your experience! Feel free to contact me, visit the contact me page. Both types of communication have their benefits of course, but I didn't want you to lose sight of the benefit of multiple participants. What do you mean below by this person has the same issue as everyone else naturally? just curious. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Pudendal Neuralgia is a condition characterized by pain, burning, tingling, or numbness in the pelvic or buttock areas. It has a currently accepted medical use in treatment in the United States. pelvic surgery. This condition may be caused Because the symptoms are often hard to distinguish, pudendal neuropathy can often be hard to differentiate from other types of chronic pelvic pain, such as prostatitis and vulvodynia. Urghh.. just clutching at straws again, just that noone seems to suggest anything constructive, apart from on this site, of course. I just don't want to get disappointed if I go. My dad had severe rectal pain, mostly burning sensation since becoming paralyzed from the neck down. So you can see it fits the anxiety symptom, for which I have been given Sertraline, and it has helped my muzzy head, and the digestive issues, bloating etc.. but it is not IBS, in the classic form. WebSelf-Care for Pudendal Neuralgia. All Rights Reserved. Activity is based on recent site visitor activity relative to other medications in the list. Without a proper diagnosis and no pain relief I went into a deep depression. Anticonvulsants such as Neurontin and antidepressants such as Elavil may be prescribed for help controlling pudendal neuropathy pain. Irrespective of the kind of premix that you invest in, you together with your guests will have a whale of a time enjoying refreshing cups of beverage. This person has the same issue everyone has naturally. How do people experience each condition differently, and why? The pudendal nerve runs through the gluteus muscles (the buttocks) and into the perineum (think of the perineum as any part of the body that touches a bicycle seat). It is mostly underdiagnosed, inappropriately treated, and causes significant impairment of 1998-2023 Mayo Foundation for Medical Education and Research. It would be good to get a diagnosis Minnie as you have been uncomfortable for such a long time. The ICN Support Forum is home to 50,000 patients who have participated in our 24/7 support system. But I do go through periods of time when it begins to creep back in for awhile (currently creeping in). affecting the pelvis such as adenomyosis, adhesions, endometriosis, painful periods, bladder pain, pelvic nerve damage, pudendal neuralgia, irritable bowel syndrome. Symptoms often Pudendal nerve entrapment occurs when the nerve is compressed, such as from a tumor. Not sure either CKLD! Lithium carbonate wasn't helping ALS patients, and we learned it faster than the clinical trials did. I ended up losing the support of my dad, siblings and most of my friends. dosage, interactions, side effects, For professionals: Meds, changing my mind set which took awhile, lifestyle change (had to stop exercising so often), sitting on a coccyx cushion really helped me out. My pain is in the left tailbone and anus area. Just a thought and please make sure you are comfortable with positive & negative of any approach. Has a currently accepted medical use in treatment in the United States. Being a woman the situations will be quite different. WebOur mission is to provide educational services to medical personnel and those affected by pudendal neuralgia and their families through conferences, meetings, workshops, In other words, by the time you realize there is a problem, the damage may have already been done. (How lovely). This was found to lead to bladder problems. Pelvic floor exercises are not advised if there is nerve damage with muscle spasm. They couldnt understand how I went from physically strong young man to someone who was confined to my bed for years. This No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. Especially for men sex is something we value and the slightest thought that something is wrong with our anatomy causes a psychological cascade of events that leads to exacerbation of symptoms. The machines that we sell or offer on rent are equipped with advanced features; as a result, making coffee turns out to be more convenient, than before. tricyclic antidepressants. How many of you are suffering from issues of not lasting long in the bed? Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Please help- I want to be able to go back to school and live happily again. While a part of the package is offered free of cost, the rest of the premix, you can buy at a throwaway price. I've had this problem for over 25 years. Has anyone heard of this? Experiences with HoLEP (Holmium laser enucleation of the prostate)? I had a strange rash on my pubic area, groin and scrotum at 7 months. This is a term used to describe a damaged, irritated, or trapped pudendal nerve that results in pain. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Sep 9, 2013. We recommend sharing personal contact information by private message, as it is a secure, private option. Also, where do you get ultrasound therapy? Tissues surrounding the pelvic organs may have increased or decreased sensitivity and function resulting in pelvic pain. PatientsLikeMe relies on JavaScript and Cookies to deliver the best possible experience to you. Humana Press, Totowa, NJ. nce uyarlma, sonra sk idrara kma ve ar, intihar dnyorum. Symptoms include painful bowel movements and groin pain. J Can Chiropr Assoc. The machines are affordable, easy to use and maintain. EddyCorvette Newcomer. WebPudendal neuralgia is a painful, neuropathic condition involving the dermatome of the pudendal nerve. Got a question about living with pudendal nerve entrapment? Our mission is to provide educational services to medical personnel and those affected by pudendal neuralgia and their families through conferences, meetings, workshops, pamphlets, and online information. 2010;54(4):276281. ). Press question mark to learn the rest of the keyboard shortcuts. Dr Stanley Antolak, while he was on the Urology staff at the Mayo Clinic at that time was the surgeon. I work for an insurance broker, and one of my clients has a work comp claim, and he has been diagnosed with pudendal nerve entrapment. WHAT TO DO:Go to our website and download and complete the pain, voiding and sexual function scores. Continue your medications. If sitting is necessary, make a "perineal suspension pad". Use the sitting pad at work, in your car, at church, at home, and in restaurants. Stand to use your computer, read the paper, or does office work. More items Pudendal neuralgia is the irritation, entrapment, or compression of the pudendal nerve, which can cause a sharp pain along the path of the nerve. Subscribe to get updates right in your inbox. What parts can he/she massage/manipulate to ease symptoms? The following list of medications are in some way related to or used in the treatment of this condition. The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. Vending Services (Noida)Shop 8, Hans Plaza (Bhaktwar Mkt. Pelvic Pain Is Complicated The pelvis is located at the center of the body, where several systems intersect. I have had multiple nerves with neuralgia and opted out of surgeries due to other health complications and/or physicians concerns. I can't lift anything even remotely heavy or I have pain again. Why a chiropractor? We understand the need of every single client. Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). We also offer the Coffee Machine Free Service. WebPudendal neuralgia caused by pudendal nerve entrapment is chronic, severely disabling, neuropathic pain in the distribution of the pudendal nerve in both males and females. I'm not keen on any surgery. Nerve decompression surgery may be required. We comply with the HONcode standard for trustworthy health information. Doctorate Thesis-Online study about Chronic Pain & Stigma. Here also, we are willing to provide you with the support that you need. We are proud to offer the biggest range of coffee machines from all the leading brands of this industry. I have never fitted the classic IBS mould, and my bloods always show an inflammation somewhere. WebMy Story of Pudendal Neuralgia. Changes can be scarey, even when we want them! Thanks for the reply. Thank you @dmburns54 for writing I am very interested in private messaging you a few questions later. Your belief that you are strong and healthy is what beats TMS. Hello, I dont exactly know what this site is about. This question was submitted via our Ask a TMS Therapist program. You appear to have JavaScript disabled in your browser. Dr Stanley Antolak, while he was on the Urology staff at the Mayo Clinic at that time was the surgeon. Coffee premix powders make it easier to prepare hot, brewing, and enriching cups of coffee. Materials and methods Eleven patients were selected to undergo percutaneous CT-guided cryoablation of the pudendal nerve based on established diagnostic criteria. WebPudendal Neuralgia: Causes, Symptoms, Diagnosis, and Treatment Learn about the symptoms, diagnosis, and treatments for pudendal neuralgia, which can cause pain, Pudendal neuralgia is a syndrome characterized by burning, stabbing pain in the territory of the pudendal nerve, which has a vast distribution in the pelvis. Because pudendal neuralgia is so difficult to diagnose and treat, learning to cope can be key to increasing your quality of life. Try these techniques: Kaur J, Singh P. Pudendal nerve entrapment syndrome. Durante JA, Macintyre IG. Not easy. By Erica Jacques My primary thinks when I'm stressed that the muscles tighten up and causes the nerve to have inflammation. Read it on, The severity of Parkinson's Disease symptoms changes faster than researchers thought, so clinical trials should be designed differently. However as everything started When I broke up with my ex girlfriend (littrally from one day to another like someone switch off th light) tms could be the cause. Yes, check my post history for what I did. Pudendal nerve entrapment in an Ironman athlete: a case report. We ensure that you get the cup ready, without wasting your time and effort. Then, waste no time, come knocking to us at the Vending Services. Topic: Pudendal Neuralgia (Read 11895 times), Adverts on this website are not endorsed by Menopause Matters, A to Z of menopause and medical conditions, http://www.pelvicpain.org.uk/index.php?page=neurological, http://www.bladderandbowelfoundation.org/bladder/bladder-problems/pelvic-floor-exercises.asp, http://www.obgynnews.com/views/master-class/blog/pudendal-neuralgia/95b5639640fc33ca0904b596c45007b5.html. Besides renting the machine, at an affordable price, we are also here to provide you with the Nescafe coffee premix. The Water Dispensers of the Vending Services are not only technically advanced but are also efficient and budget-friendly. Depending on your choice, you can also buy our Tata Tea Bags. Read about it on. What's the difference between that and a typical nerve block? Pudendal nerve entrapment (PNE) is a condition in which the nerve in the pelvic region is tethered by fascia and is constrained by nearby muscles or ligaments. To read or share it, use this updated link: https://www.tmswiki.org/forum/painrecovery/ Dismiss Notice Dismiss Notice Vending Services has the widest range of water dispensers that can be used in commercial and residential purposes. Ne kadar dirensem de sarho olduum iin kontrol kaybettim. Im not sure if I have Pudenal Neuralgia and i looked up hydro dissection and it seems to be working well, please pm me bro. General TMS Subforums (in honor of Dr. John Sarno), https://www.tmswiki.org/forum/painrecovery/, http://www.tmswiki.org/forum/threads/pelvic-pain-healed.8680/ (Pelvic Pain - Healed), http://www.ncbi.nlm.nih.gov/pubmed/26070708 (Anatomic variations of pudendal nerve within pelvis and pudendal canal: clinical applications. (c) 2005-2023 PatientsLikeMe. Has a high potential for abuse. If yes, what are you doing? You will find that we have the finest range of products. Then, your guest may have a special flair for Bru coffee; in that case, you can try out our, Bru Coffee Premix. Pudendal neuralgia (also known as pudendal neuropathy) is a disorder of the pudendal nerve that can lead to chronic pelvic pain. Next support group: March 22, 2023 at 7:00pm EST.Join our next video conference support group for patients with pudendal neuralgia and/or other chronic pelvic pain conditions led by Psychotherapist Nancy Fish LCSW, MSW, MPH and Dahri McFaline, M.Ed. All Rights Reserved. If you are starting to develop pelvic pain symptoms, take a rest and see your healthcare provider as soon as you can. Pudendal Neuralgia is the irritation or inflammation of the pudendal nerve which branches off of the lower nerves of the sacrum. There is a lack of accepted safety for use under medical supervision. Patient Testimonial: Cluneal Neuralgia - The pain is still there, but she fights to stay positive, Removing 'zombie' cells deters Alzheimer's in mice, How to Batch Cook for Busy Weeks: A Comprehensive Guide to Meal Prep. It occurs when the pudendal nerve is injured or compressed, and is aggravated by sitting. We are so happy that you found us! The schedule may depend on the exact dosage form or strength of the medication. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Muscle spasm can be v painful from overwork and even mistaken for prolapse, usually uterine. It gets mistaken for a lot of other symptoms like "pelvic It is definitely a pudendal injury. Sonra kanama oldu, jinekoloa gittik ve 5 aydr pudental bas balad. Abuse may lead to limited physical dependence or psychological dependence relative to those in schedule 3. My GP was happy for me to change my HRT to the new low dose Femoston Conti last week, and will review me in March, but she seems puzzled by my weird symptoms, thinks I am bonkers, I'm sure, because of my hysterics (cos it arrived so severely and out of the blue!) I have been in touch with a physiotherapist I know, and she has suggested maybe Pudental Neuralgia, which is where a bundles of nerves become inflammed at the base of the back and affect all of the areas I mentioned! I have not been on connect for quite a while since I have only recently received a diagnosis (one of many probably to come) I am looking for someone/anyone who has the pain from a surgical injury of sorts to this nerve to talk to. Your attention on the symptoms always makes it worse. I have PN. My only doubt is that tms seems to be linked to pain and not dysfunction. Causes include: childbirth with vaginal delivery. Causes of Buttock Pain and Treatment Options, Pudendal nerve entrapment in an Ironman athlete: a case report, Trauma to the buttocks or pelvis including childbirth, Excessive sitting (cyclists often have pudendal nerve entrapment), Thickening of ligaments around the pudendal nerve, Bony formations pushing against the pudendal nerve, Pain when urinating or having a bowel movement, Pain in sitting that goes away when standing. Will PM widen I get some me time. Thank you for removing that. pudendal pudendal nevralgia Feryal05 Newcomer benim dairemde ocukla bir gece geirdik. The stop-start technique used to be thought a good idea but things have moved on since then. Got a story to tell for the magazine? I suspect a pinch nerve in l4 l5. Noone else seems to have the same weird symptoms, some of the ladies here have a variation of them, and have been wonderfully supportive, but I seem to be suffering from a bizarre form of physical menopause! Chronic pelvic pain is a boundary "disease" affecting urology, colorectal, gynecology, physical medicine, neurology and other specialties. You are no longer advised by pelvic floor nurses to do the stopping and starting of urine flow. Interested in more discussions like this? Ed:Jeannette M. Potts. I was diagnosed with pudendal neuralgia in june after having a period of 2 weeks of no pain at all following an x-ray guided pudendal nerve block into the nerve via the buttock. As a result, injury is caused to the nerve and pain is felt in the anal, perineum, scrotum, penis, vulva and clitoris. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Get in touch with the editor! I have used multiple Pain Management Specialists for each instance. Ne tavsiye edersiniz Feryal05, Feb 15, 2023 #1 WebPudendal neuralgia is a condition that occurs when the pudendal nerve, which runs from the back of the pelvis near the base of the penis or vagina, is damaged or irritated. - PubMed - NCBI), http://www.pelvicpainrehab.com/pelvic-pain/1893/pne-your-questions-answered/, (You must log in or sign up to reply here. This nerve sends signals to the brain from the genitals, anus and other nearby body parts. Hurts more when sitting. It is like a constant squeezing in the uterus and up into the sternum, and anxiety coming from the bottom, along with a draggy pain in the pubic bone, particularly after pooing! For most people with pudendal neuralgia caused by cycling, symptoms appear after prolonged biking, sometimes months or years later. Is there anyone doing better from Pudendal neuralgia / pelvic floor dysfunction and managing the symptoms okay to the point you are back to who you are yourself? I'm taking a muscle relaxer and bladder spasm medication, doing many stretches daily, and not sitting too long. Psychonutrition: The impact of food on mental health, Join the 500 000 patients registered on our platform, get information on your condition or on that of your family member, and discuss it with the community. WebPudendal Neuralgia occurs when the pudendal nerve is injured, irritated, or compressed. For instructions on how to register: Send an email to pudendalassociation@gmail.com expressing your desire to participate It took 3 years for a diagnosis and until July of 2001 before I had Pudendal release surgery that finally gave me some relief. Has a low potential for abuse relative to those in schedule 4. The What improves health and life for different people, and why? Try and find an example recently when your symptoms were better. I think . and someone will correct me if I am wrong: that as oestrogen levels drop off it causes laxiety of muscles? Living with seizures - no matter if psychological! I literally went from being voted the best athlete in my high school to being confined to my bed for years. This only happens on one side, the left. WebPudendal neuralgia caused by pudendal nerve entrapment is chronic, severely disabling, neuropathic pain in the distribution of the pudendal nerve in both males and females. Your guests may need piping hot cups of coffee, or a refreshing dose of cold coffee. I know that he is considering going to Mayo and also a spinal cord stimulator. Gosh, you've been coping with pain for a long time! Brief Pain You may be interested in installing the Tata coffee machine, in that case, we will provide you with free coffee powders of the similar brand. You will find a compassionate and one of the most knowledgeable physicians in the world about Pudendal Nerve injuries. I am a Mayo MN and AZ patient but found that this was a close-to-home possibility as travel is taxing when in pain. It is an unwanted and disturbing sexual sensation at the level of the labia or of the clitoris. I really don't know what to do, to be honest. I do have a small uterus apparently, so maybe that is why it is worse than normal. I am better in the morning. Chronic pelvic pain from pudendal neuralgia can be caused by any of the following: Prolonged sitting on hard surfaces, such as a bicycle seat, can cause pelvic nerve compression, which can lead tochronic pelvic painover time. From its location alone, you can see why pain from pudendal nerve damage or irritation would be so disruptive to every day activities, not to mention your sex life. Finally in the forums about tms nobody mention erectil dysfunction. Pudendal nerve entrapment syndrome arises from the mechanical compression of the pudendal nerve, excluding external compression from a mass or tumor. WebThe community forum exists to support those who wish to share and learn from others who have abdominal and/or pelvic pain and to provide peer support in managing the pain. WebPudendal Neuralgia is a condition characterized by pain, burning, tingling, or numbness in the pelvic or buttock areas. Hi @dmburns54 Please note that I removed your personal email address from this public discussion. It is commonly a bilateral Yes I have! You will find the common causes of Pudendal Neuralgia in this blog. I was advised to do the exercises every time I went to the loo (after finishing of course) as this was a good way to help you to remember to do them. Low doses of Nortriptyline can have a secondary use for blocking nerve signals. WebThe pudendal nerve provides most of the movement and sensations for your pelvic region, including your external genitals and anus. Thank you! Pudendal nerve entrapment (PNE) between the sacrospinous and sacrotuberous ligaments is the most frequent etiology. Has a low potential for abuse relative to those in schedule 3. However I did find some relief from nerve-block injections in some instances (not all). WebThe most important test performed to diagnose pudendal neuralgia is an image-guided pudendal nerve block. Has a high potential for abuse. ),Opp.- Vinayak Hospital, Sec-27, Noida U.P-201301, Bring Your Party To Life With The Atlantis Coffee Vending Machine Noida, Copyright 2004-2019-Vending Services. Press J to jump to the feed. gamma-aminobutyric acid analogs, For consumers: My friendly physio said that the back supports the ligaments, that when weak, cause the nerve bundle to become inflammed, and that by strengthening them, quite often the pelvic floor gets stronger, all too technical for me!! How unfair that your GP has given up. If your nerve was compressed you wouldn't get good days. This condition is not widely known and often unrecognized by many practitioners. To read or share it, use this updated link: Does Pudendal Neuralgia have a TMS potential or possibility? Don't forget that by exchanging experiences here on the forum will also help bring others into the conversation and you'll benefit from a group discussion. It took 3 years for a diagnosis and until July of 2001 before I had Pudendal release surgery that finally gave me some relief. All Sti tests done and negative. Hello, There is no reason for you to have it. Are Nerve Problems Causing Your Foot Pain? How much good can your data do? I feel like I definitely know how to manage it better, but its something I have to keep up. Thank you, {{form.email}}, for signing up. It is mostly underdiagnosed, inappropriately treated, and causes significant impairment of I have hypertonic pelvic floor diagnosticed by a PT. Symptoms include burning pain (often unilateral), tingling, or numbness in any of the I wouldnt get proper diagnoses until I met Dr. Stanley Antolak at the age of 43. Best advice I can give you is to not focus on it. There are good support sites on Google that might be worth a try. Her to help or talk.