Rosie the super-hero and the amazing shrinking skeleton.

So had a temporary hiccup and consequential lapse of reason / loss of sense of humour at the beginning of this week upon receiving the results of my bone scan, which I had already decided in my head would be fine. I genuinely did not expect the degree of bonelessness that it revealed which has been a huge wake up call. This illness has now become potentially life changing and not in a good way. I honestly believed I was invincible so the confirmation of inner fragility was quite a shock. Plans for going skiing this winter and my goal of finally buying another horse when I recover have clearly been scuppered for now so I am now devising alternative methods of conquering the world. Hopefully the osteoporosis may be reversible to some extent though I am walking around at the moment fearing I may trip and part of me fall off.

Since forever, when stressed my go-to comfort has always been to skip meals (who needs food when they are a super-hero?) so I have fallen off the tightrope a bit this week, though am now feeling tentatively better. On that theme I thought I’d reinstate the stiff upper lip and visit some positive thoughts:

Reasons to eat:

1. Social interaction. Self isolation and anorexia go hand in hand and at my worst (and this persists on a bad day) , it takes far too much effort even to reply to a text message, crazy though it may sound. Last week, the farrier came to trim the ponies’ feet when I was at home, and rather than calling someone else when I saw him lurking by the back door, I went out to see him, caught the ponies and we had a 45 minute conversation about politics. Sounds like such a small thing but significant (for me) nonetheless. Later in the week, I spoke to someone at the practice nets in the village rather than diverting around 2 fields and through the graveyard to avoid them. I am usually quite sociable, and at work, client contact is the part of my job that I enjoy the most, so this compelling desire to avoid people is both contrary to my personality and torturing.

2. Restoration of health meaning life can be resumed as normal as much as possible including pushing the boundaries simply for the fun of it. (Climbing mountains in flip flops, galloping horses on a beach, sledging round trees, running out of control down a hill….)

3. Being able to watch a film or TV programme all the way through without lapse of concentration and ending up not knowing who killed who and why.

4. Being able to sit down comfortably. Boney bum + hard chair = ouch.

5. Not having to cover all parts of body in hot weather because they look truly awful.

6. Being able to go back to work so I can feel useful and not simply be a parasite.

7. Being able to buy clothes without worrying I may get fat and grow out of them.

8. Not spending half my life in a hospital. Six weeks is already six weeks too long.

9. Being able to plan ahead more than a few days, and not having to ask permission to wee, have a drink of water, have one measly paracetamol, go on holiday……

10. Being able to eat without considering the calories. (Though the last time I did this was probably in the 1980s)

11. Realising I can still have fun without running round at full pelt (see below)

12.  Throwing away the bathroom scales because I JUST DON’T CARE..

Vegetable patch (or slug party venue)

Family fake tattoo night

Makeshift croquet lawn (sorry ponies, you’ve been marginalised)

Apart from this, I have had my first 6 weekly review this week which helped me feel more positive as it confirmed that I am making some progress (woof, pat on the head). I know from the numbers on the scale that this is the case but it somehow helps when it is verbalised. Bit frustrated that holiday plans for August were not given the go ahead, partly because 2 weeks away was not recommended by the team for recovery (looking ahead does not seem within their capabilities) and partly because having a huge waiting list, they couldn’t keep my place open that long which is more understandable but still annoying. It may be that I am recovered enough to be discharged by then anyway but we can’t take the chance and book flights right now which only adds to the guilt of the effect this thing is having on the family.

I am now being increasingly affected by the attitude of other patients in the clinic and what at first was a novelty is becoming a never ending repeat of the same old issues. I’m seeing this as a sign that I’m getting better, but listening to fully grown people complain about the outrageous selfishness of others when it comes to yoghurt flavour choices has become more than a little tiresome. I fear institutionalisation because without the support I was failing to recover but the clinic environment creates a false sense of security by cushioning me from the reality of the world and this is something which is not sustainable. Nothing happens overnight so I just have to chalk up every meal as a win and get on with eating my way out!


Back on the Road!!

Week 5, another weekly review meeting and still making upwards progress. Baby steps but definitely going in the right direction. It’s a difficult line to tread as any less weight gain and I’d feel like I was failing myself and everyone else but too much too soon and there’s the danger of scaring myself back to square one! At the moment I feel comfortable with what I have achieved so far and the clinical team appear to be happy that I have made good progress. The big news is that I have also finally been given the go ahead to drive my poor unloved car again!!! I drove home (accompanied) from Oxford today; my first drive since January and I remembered where the brakes are and everything!

The science behind weight restoration is interesting and it seems not fully understood. Eating loads after being in a prolonged state of starvation doesn’t necessarily cause rapid weight gain, and it’s actually harder to put the weight back on than to lose it. The body often goes into a state of hypermetabolism which causes lovely symptoms such as night sweats where it tries to get rid of all the excess energy through heat (stupid body) and crashing headaches for which I am only allowed one paracetamol ‘for weight reasons’. One paracetamol really doesn’t hit the spot, believe me.

There are still rocky moments to navigate – we went out for a coffee and snack at the weekend and I had a bit of a meltdown with choosing a snack from a kiosk. The woman behind the counter was clearly getting shirty with me picking up each snack bar in turn, scrutinising the label and then discarding it, wailing ‘I just can’t choose’ – she must have thought I was insane, which in fact wouldn’t be far from the truth.

Continuing on the theme of madness, my allotted 10 minutes escape time from the ward today coincided with a sharp downpour so I popped into another part of the hospital to take shelter. This happened to be the reception to one of the secure psychiatric wards. I could, (but won’t) hide the fact that the unit I am attending is part of what used to be the Oxford Lunatic Asylum opened in 1826. People with eating disorders are thankfully generally not mad in the traditional sense but the area I strayed into gave me the creeps in a One Flew over the Cuckoos Nest way…I could still hear the screams and detect the smell of burning flesh from centuries past. Oddly, as a child I had recurring nightmares of being locked up in such a place and unable to prove my sanity. Funny that.

I must be feeling a little more like myself as I also added my first anonymous suggestions to the box ahead of the weekly ‘community meeting’ tomorrow. One was to request the addition of a goldfish to the ward for therapeutic reasons; though someone mentioned it would need to be PAT tested first. Who would have thought that a goldfish is actually defined as a portable appliance…

CBT – does it work or is therapy simply a sticking plaster ?

I did not have a good session with my therapist this week, I don’t think she likes me very much. It may be that there is a personality clash or it might be her method of delivery or perhaps a mixture of both that is making the experience less than helpful. My first response was to rattle off a cutting indictment of my experience but having given myself time for reflection, I have begun instead to think a little about the process itself. I do not claim to be a psychologist and my views arise simply from my limited personal experience so I can only apologise in advance to anyone who is likely to have a more academic and balanced viewpoint.

Firstly, by way of explanation, the therapy I am receiving is CBT or cognitive behavioural therapy which aims to challenge inaccurate and irrational views about oneself which can lead to disordered thoughts or behaviour. These are commonly those such as ‘I haven’t done it perfectly, so I must be useless’. Or ‘she didn’t find time to speak to me, so she must hate me’.

I have never experienced CBT or indeed any kind of therapy before and I appreciate that my therapist has seen many clients and so for her, repeating the same arguments and processes with each one must become a bit tedious. This approach however, has risks. Surely the process becomes formulaic? I am able to lend a little credence to this suggestion because I have talked at length with another patient at the clinic who has used the same therapist and who can amusingly repeat word for word the same responses I have received. In theory, CBT has been shown to have huge benefits (even if this is a placebo effect) but surely a ‘one size fits all’ approach isn’t entirely appropriate?

I am twelve weekly sessions into a course that is meant to last a year. The first three or four weeks I found extremely difficult not the least because for some reason it took that long for my actual name to register and I found the constant need to correct quite stressful. Probably more than it should have been in hindsight but it sort of matters. That apart, I found it hard not to resent the constant digging through my past and the unwelcome thoughts that accompanied this. These difficulties haven’t changed but I have become accustomed to something which was initially uncomfortably unfamiliar.  That said, I still feel that though I have now been ‘trained’ to give the responses, these are very much open to being judged, as if my reactions to a difficult episode in my life is somehow not good enough, and so by unravelling these thoughts and feelings paradoxically I actually feel worse about myself.

Generally, I have found the absence of social niceties very strange as my particular therapist doesn’t indulge in any small talk to ease the way into the session. I have no idea if therapists are taught not to talk about the weather or their holidays but it makes it difficult to engage when instead I am met with a silent but questioning stare. How do you even start a conversation about yourself when your levels of discomfort are already sky high because the encounter does not reflect in any way any social or business meeting you have ever been to? Even a job interview is easier because at least then you have someone asking you questions to allow you to sell yourself in a positive way. Here, it is all about searching for the negatives that I do not ordinarily choose to engage with, and I have to come up with these myself and without prompting.

Anyway, I have stuck with it, not being one to give up on anything lightly, although of the 12 sessions I have endured so far I have only felt better about myself after one. The others have left me feeling somewhere on the scale from suicidal to slightly despondent. I am not proud of my response to the latest session, in that, unable to process the intensity of my feelings afterwards, I turned to physical harm instead. Enough said. The fact is, I trusted to the therapist my feelings of somehow letting myself down by being my usual over active and over dynamic self in Cornwall and was not expecting her to suggest that I was creating a poor role model for my children in that I am not giving them any idea of how they can deal with their own stresses and difficulties in a healthy way. I did try to defend this assertion by saying that my children are all independent thinkers and are all very aware and not easily influenced, but by putting the idea into my head that I was causing them so much damage by my behaviour and openness she did not then allow me to accentuate the positive. If there is any positive.

She also asked me what I wanted from my upcoming review session in mid June which is a 4-6 weekly gathering of the people involved in my care. This will be my first such meeting so I found it difficult to answer but I suggested that I should stick with being in the clinic as I feel that I am making progress both with the weight gain and mentally. Now I thought this was me trotting out a positive and rational response which should surely invite some sort of agreement by the way of reinforcement. Instead all I got was a raised eyebrow. In my vulnerable state I could only take this to mean that no, I shouldn’t be allowed to be receiving help, I don’t deserve it, and all I am doing is wasting people’s time. Desperately seeking reassurance I asked if she thought I had made any progress. On the basis that this is very very important to me right now, and I really can’t stress this enough, I was hoping for a small crumb of comfort, but all I received was a curt, ‘well I can see there’s movement’. When I replied, ever desperate, that I hoped this ‘movement’ was in the right direction, she simply honked. I was left feeling bereft and confused.

Surely CBT should include some element of empathy and compassion? Some shared human understanding rather than a robotic response? I can clearly see the traps that I fall into of faulty thinking or inaccurate views leading to disordered emotion or behaviour patterns (though this is an over simplification as there are so many other things at play), but the gap caused by exploring these negative feelings needs to be filled by something that facilitates helpful and supportive thoughts. It appears to me, from my limited experience, that CBT is a somewhat inflexible approach, in that it aims to prevent the mental filtering that goes on by noticing failures more than success, but takes little account of the fact that the actual negativity is rather more a symptom than a cause. There is also a paradox in applying a rigid formula of therapy to an eating disorder, which is, after all, all about inflexibility of thought and behaviour.

I have a feeling that CBT as a method perhaps over simplifies the problems it is attempting to solve. By its very nature, it sets out to dispel negative thoughts that arise from cognition. However, there are other things at play, such as genetics (for example, my sister shares my perfectionist tendencies), and social context. Also, surely some negative feelings are actually rational and realistic? By reframing reality I am simply being told to exclude some legitimate feelings. This does not help someone like me who deals with the process of reward and punishment as a prop for everyday life (which to some extent I suspect is part of the human condition). As humans we are motivated to achieve goals, and by training the brain to thwart the process the mind is using to deal with basic emotional and motivational needs CBT is going to have limitations, and leave a gap that needs to be filled.

I mentioned earlier the social context, which is not to be taken at all lightly. CBT seems not to take account of the here and now responses which do not rely on cognition but on inherent response. Being part of a community, you can’t help but to have reciprocal reactions to those about you by mirroring their behaviours and thoughts. The community of a hospital ward where the patient’s interaction with the outside world is severely limited is a unique social situation where these responses can be seen only too clearly. Incredibly distressing and disturbing events are witnessed by this community and this causes a direct activation of emotion which bypasses any cognition. This can be seen in society generally by public overreactions to events such as Princess Diana’s death and the Manchester bombing which have no real personal effect but serve to show how another’s pain can be directly felt. The point is that CBT focusses primarily on the self and does not fully account for basic social needs and relationships which impact on mental health; being the sense of mutual support, kindness, care and sense of family that we all crave.

I fear that I am going to be unable to engage with the therapy either because of a tendency to over intellectualise and see the broad view rather than how it affects me personally or possibly it’s down to my stupidity in that I have an inability to process simple cause and effect. Either way, we are all different and have a multitude of experiences, needs and unique biological set up, and there can be no totally successful uniform approach.

Cornish Adventures 

Holidays always bring out the worst (or maybe it’s the best) in me. As soon as we leave home I’m overwhelmed by a compulsion to squeeze the last bit of juice from every waking minute, acting as if it’s my last day on earth and I might miss something. Just can’t stop. Even on the journey I’m constantly consuming google maps wondering if we might pass somewhere unmissable. It must be fairly exhausting for the family though I suppose they have grown up not to expect to be chilling out with a book on a sunbed.

So sadly, I found it impossible to follow orders not to walk anything over half a mile at a stroll, and have spent the last four days almost at full pelt. Part of me has enjoyed every minute but it has been accompanied with an awful feeling of guilt as if by enjoying myself I have been doing something illegal.

In between activities the food situation has proved challenging though I am pleased that I have managed on the whole to keep up with the food party. Pub meals are by far the hardest to tackle. There is never any indication of how large or calorific any particular meal is going to be and they don’t come in discrete packages unlike sandwiches. My dietician told me before I left that pub meal sizes are no larger than any normal portion size but I have to disagree. Having ordered something described simply as a cheese sandwich from the menu at a pub in Polruan, I was slightly panicked and overwhelmed when this appeared in front of me as half a loaf of bread shaped like a fully grown alligator, stuffed with at least a kilo of cheese and served with a bucketful of chips. There was definitely no mention of chips on the menu. I had to sit in the loos and take some deep breaths before going back to wrestle with its snapping jaws. Again, the sense of guilt and of letting myself down when I scraped off most of the cheese and donated all the chips. Ate the salad though.

On Friday evening we stopped on our way down to Cornwall for a drink (which for me amounts to a Diet Coke) at a pub in a small village on the edge of Dartmoor which claimed to be the ‘most unusual pub in Britain’. It was definitely that. I would have to be paid a lot of money to stay overnight given the proliferation of skeletons and mummified objects and I suspect the reason that the village was deserted was because most of the population had been part of the menu. Special pie anyone?

I know I’ve lost some weight, but this is ridiculous….
Later, on the tourist trail, we visited Lanhydrock House on Bodmin Moor. Partly because of the advertised mountain bike trails. I felt like I was missing out while the boys hired bikes and we sat sedately in the café with a pot of tea and a book with all the old people. I will either need to die before I get old or just be one of the crazy people who doesn’t know what day of the week it is. The house itself was a mile from the car park anyway so I’d failed to follow instructions before we even started. As expected, the house was full of the usual ancestral paintings and polished furniture, but this one also had a proliferation of dead animals at every turn, including stuffed parts of animals adorning the walls. Why would anyone think it’s in any way attractive to have eight goat hooves mounted on wooden shields adorning their library walls? What’s the thing with tiger skin rugs with the heads still attached? The sense of imperialist entitlement is hard to bear (excuse the pun) and it always gives me a sense of satisfaction to read that the owners had to eventually give up living in cuckoo land and give their estate to the National Trust to pay their taxes. I’m sure though they were lovely people despite being brainwashed into thinking they were in some way superior to the rest of us.

So onto the Eden Project and I couldn’t avoid the challenge of climbing to the top of the rainforest biome up the wobble-some steps which are suspended from the top, and despite the four page warning-you-may-die booklet handed out beforehand. It’s all about risk mitigation, nothing will happen to me. Yawn. Ok so technically probably not the best plan at 46 degrees centigrade and actually I gained nothing from this except self punishment. It’s a bloody long way up when your legs are feeling like they may give way and you may throw up at any moment over the edge and onto the crowds below. Might have been entertaining though. How much warning do you need to get out of the way when you see vomit approaching from 100 meters above you?
We were up there!!!

The Crazy Crew….

My beautiful girl…

Who’d have thought the thermoregulation of a pigeon head could be so beautiful when they are the most annoying creatures on earth….IMG_3462.JPG

Two long walks later, one a 4 mile trek from Fowey, across to Bodinnick, round the estuary and back to Polruan, again expressly against medical advice as I’d discussed how this very walk is a Bad Idea (yeah I know but I’d be letting everyone else down otherwise) and another 3 mile trot around Lydford Gorge to see the waterfall and Devils Cauldron, and I felt like I had finally earned the cheese sandwich. I appreciate this sounds disordered and it very probably is but that is just the way it is for now. No walk, no sandwich.

Now on our way back to reality after a lovely break made so much better by the presence of my amazing, irrepressible, noisy, beautifully opinionated and relentlessly energetic family. (I am so proud). I have a sneaking feeling though I feel I may pay the price in terms of recovery and feel somewhat a failure because of it as I owe it to so many people to get better. There’s a balance to be struck there somehow if only I could find it.

Me and my complementary counterpart…


Questions to which I am still awaiting answers

Quite by chance as I don’t ordinarily read it, three articles in the Times this morning caught my eye, all on page 16, and sharing column space with a seemingly randomly placed photograph of St Paul’s Cathedral. The juxtaposition of these articles alone raises questions; the first was suggesting that a smaller waist size reduces the risk of cancer and advised that by reducing the amount we eat and keeping physically active we can be healthier. No news there then. Articles such as this appear in our press with mundane regularity and seem to be almost directive in tone rather than simply informative, so it was interesting that printed within 8mm of this instruction to lose weight was an article reporting that eating disorders are on the increase and GPs should immediately refer anorexia cases to a specialist clinic. I am sure that the relative positions of these articles was no accident, but it serves to underline the contradictory public information sermons that we are subject to as a nation. I remain confused as to whether red wine is good for me or will give me cancer, whether I should eat 5 portions of fruit and vegetables a day or 10, coffee is bad for me, or is it? I can’t remember. I do know though that sugar is the evil that causes all wrong in society, otherwise why would it be taxed?

Not surprising then, that I am struggling with the concept of eating 2 desserts a day, 2 sugary snacks, crisps and other perceived unhealthy foods which have been prescribed as part of my therapy, all courtesy of the NHS. At the clinic on Friday we are even served the demon food: fish and chips. We are told constantly by the government and the medical community to avoid these foods, yet in order to recover from my eating disorder I have to face eating them as a challenge – eating chocolate is now a Good Thing, when all my life I have been taught it is not. I struggle to make contact and be at one with my inner chocolate bar. I have never bought chocolate or sweets or fizzy drinks and somehow by not doing so this has been assessed as being linked to my eating disorder rather than being a healthy decision. It’s a conundrum.

Returning to the Times, the third article the editor chose to share space with St Paul’s was a short report concerning the rise in mental health problems amongst students. Reportedly, the number of students with these problems has more than trebled in the last five years. Apparently this is particularly evident at many of the most prestigious universities. A possible explanation suggested is a combination of an increasing pressure to succeed together with the potential damaging effect of social media. Maybe there is a cruelty in a system that so early on in life, brands people on their academic achievements, which they will have to carry with them for life.

I can’t offer any sort of explanation as to why this is, but it did link in nicely to a conversation I had with my therapist this morning. I told her that I had noted that the vast majority of the patients in the clinic are either professional (a teacher, a doctor and a lawyer for starters), some academics doing doctorates and others studying or having studied at Oxbridge. We did discuss the link between high achieving perfectionists with eating disorders but this didn’t satisfactorily answer my question, why should someone high functioning be more likely to suffer from these self-destructive illnesses?

Which leads me onto another conundrum. The therapy is proving useful to me in that I am slowly untangling the root causes of my illness. Think along the lines of painstakingly separating and teasing apart a large number of entwined fine silver necklaces which have become knotted together over time and you may gain an idea of how difficult it is to do this. I have begun to realise, slowly, that I have separated myself into two; the successful, competitive and confident person who needs to over-achieve from the vulnerable person who I hate, and so shut behind a brick wall, with no sun and no sustenance. I have set myself impossible standards and not listened to the part of me that I see as being pathetic, small and needy. I am so not that person, and I beat it up regularly. However, as I have unfortunately proved, this approach is not sustainable. I suspect that these protective mechanisms have been put in place as a result of a less than ideal childhood but that’s not to say that I can’t find ways to deal with it now, as an adult.

The question that remains unanswered is how to do this, and this part of the jigsaw is still missing. If my method of shutting off my vulnerable self is unsustainable and has lead to me becoming ill, and I somehow allow the vulnerable side of me to surface then surely I will be less successful and lose the feisty, witty, sharp and successful self that I like so much? I remain confused but hopeful that someone will hand me the key (to the box in which a clue to where the missing piece of jigsaw is maybe hidden!).

To start with, at least I have accepted that there is no stigma in asking for help. Just as if I had broken a leg, I would need to ask someone to mend it for me. I remain confident that I will be mended and a better person for it.

Must keep swimming….

The good news is that we had a lovely weekend mooching around the shops on Saturday and then visiting Canons Ashby with a picnic on Sunday. Wish I’d managed the actual tea shop for food but then again the cakes in there were huge! (As were one or two of the customers) Later, I spent some time with the ponies. I had more energy than I have had for months and was able to put this to good although not necessarily physically beneficial use. It made me realise that there is light at the end of the tunnel and not only is recovery possible but the quality of my life will be so much better and is absolutely worth aiming for. It’s difficult to keep a grasp of this at all times but there are some occasional glimpses of what it is like to be fit and healthy and not allowing the punishing perfectionism to always gain precedence over living in the moment and enjoying being alive.

Pony time…..

I am attempting to keep on an even keel and think I am managing quite well for the most part though at the end of last week I had another unexpected and unannounced cliff-fall moment in an art therapy session! It would be helpful if I could have had some warning next time please brain, but it never seems to happen that way. The remit was to draw a pie chart with a pictorial representation of the most important things in your life. I drew a literal pie on an NHS plate (no food obsession or anything!) and divided my pie into three. One part was work; I drew a desk and a huge pile of files about to squash me. Second was family and friends; I was standing to one side while everyone else was together. The third was my need to exercise and be out in the open air. When I realised how important but how stressful these things are to me and what I had actually lost I was in pieces. I protect myself very successfully almost all of the time by putting everything into a box and firmly sticking down the lid. Not sure I really like it to be opened.

Jeremy Corbyn spotted at Canons Ashby…

Today I attended the weekly clinical team meeting. It was not as positive as I hoped. I have made a little less progress than I could have which is partly down to the challenge I have with eating the high calorie desserts at home but mainly because I have been doing a little too much exercise. That’s not to say that I have been running half marathons, far from it, but there is clearly a balance to be struck, and when spending time with other normal people, it’s very difficult not to join in with the activity. Especially if you’re me. I think Cornwall is going to be challenging next weekend unless I tie myself to a chair! I was disappointed too that I still wasn’t given the go ahead to drive thanks to some results not being quite as they should be. Ah well. Onwards and upwards. Next week maybe.


Beano, you have life so right. This should be me.

I’m about to eat my Big Brother….Get me out of here! 


(For the uninitiated this blog is loosely based on the tv reality show Big Brother, and does not represent any personal thoughts!)

In this show, contestants, called ‘patients’ live together in a specially designed building that is isolated from the outside world. The contestants are voted out without warning and at times non-standard evictions may take place when two may go at the same time or one may disappear without a trace. The contestants are always replaced so there is never a winner.

During their stay in this building, the contestants are continuously monitored and are severely limited in what they are permitted to do or say. They are given a rigid set of rules but occasionally these are not enforced or may be enforced more rigorously than normal so the contestants always need to be on their guard.

The contestants are required to engage in social behaviours comprising of group activities and are assigned daily eating tasks by the omnipresent Authority Figures who on most occasions remain unseen. The tasks are designed to test their abilities to eat the correct amount at the correct speed while being socially engaged with a ever changing set of strangers around a table on a weekly rotation. Their every movement is tested and observed, and if thought necessary, recorded. This allows the Authority to analyse how people react when placed in close confinement with people that are outside their comfort zone but who are considered to be similarly disordered.

There is a ‘confession room’ upstairs in this building where contestants convey their innermost thoughts and reveal these to their fellow contestants and sometimes, to the Authority. There are no secrets and little to occupy time and this survivalist element to the show increases the potential for social tension or disengagement. The results range from angry confrontations to tearful withdrawal.

Those who pursue a dissident agenda may be subject to punishment by the Authority in the form of mind control. This may be by brain washing or chemically induced. Either way, compliance is the quickest way to escape the dystopia.