Question:
Hi, I have posted here earlier regarding a chronic headache clinic. My new question has to do with panic attacks, which I believe are a function of extreme pain. My head hurts so bad, and my symptoms are so disturbing, that I often times feel like I’m going to have a stroke/convulsion and die. Generally what happens is that my neck and face start hurting all over, and my vision gets messed up, then I go into a migraine. At this point I’m very afraid, afraid that there is something really wrong with me, and I’m going to die. This problem has intensified in the last few months. Anybody else here have pain so intense or symptoms so disturbing they have serious panic?
Response:
A5d, You should see a couple hundred hands in the air. Just as pain will raise your BP, some of the pain is so intense, it’s hard to believe there is not something mortally wrong. Valium helps me, but I do get afraid . I have had panic attacks so long. I can usually wait them out. That doesn’t make them better. Also , yours sound a heck of a lot more intense in the beginning. I bet the " I’m gonna die " panic attack is pretty well distributed throughout ASC-P. Peace, Richard
– Hide quoted text — Show quoted text -> Hi, I have posted here earlier regarding a chronic headache clinic. My new > question has to do with panic attacks, which I believe are a function of > extreme pain. My head hurts so bad, and my symptoms are so disturbing, that I > often times feel like I’m going to have a stroke/convulsion and die. > Generally what happens is that my neck and face start hurting all over, and > my vision gets messed up, then I go into a migraine. At this point I’m very > afraid, afraid that there is something really wrong with me, and I’m going to > die. This problem has intensified in the last few months. > Anybody else here have pain so intense or symptoms so disturbing they have > serious panic?
Response:
I’m sorry you’re going through this. Have you had an MRI and ruled out anything else? If so, then I can tell you first hand that panic does set in for me when nothing is working well to treat the pain, or I have nothing for it. Then, it’s a vicious circle as the meds don’t work while you’re in an advanced state of anxiety. I’ve worked with relaxation etc.- but find a valium or ativan along with the pain meds makes them much more effective . But please get checked out, if you haven’t. ,Best of luck, and let us know how it goes, codeeee – Hide quoted text — Show quoted text -> Hi, I have posted here earlier regarding a chronic headache clinic. My new > question has to do with panic attacks, which I believe are a function of > extreme pain. My head hurts so bad, and my symptoms are so disturbing, that I > often times feel like I’m going to have a stroke/convulsion and die. > Generally what happens is that my neck and face start hurting all over, and > my vision gets messed up, then I go into a migraine. At this point I’m very > afraid, afraid that there is something really wrong with me, and I’m going to > die. This problem has intensified in the last few months. > Anybody else here have pain so intense or symptoms so disturbing they have > serious panic?
Before you buy.
Response:
Do you mean the panic that comes out of no-where and have no clue as to what’s causing the feeling that you’re going to jump out of your skin,hyperventilate, maybe die? Opposed to a feeling of panic from a known source like pain? I don;t know why you can’t have both . some attacks are triggered by previously normal events like driving,leaving the house fear of heights etc. I’m probably way off base about this, so if you can clear it up and maybe offer some solutions, it would be great Jack, All I know, Is when you have a genuine one – there’s no mistaking it. Thank you, codeee , – Hide quoted text — Show quoted text -> You may feel panic, but you really haven’t described a "panic attack". > In no way am I trying to minimize what you’re going through. > Jack > Hi, I have posted here earlier regarding a chronic headache clinic. My new > question has to do with panic attacks, which I believe are a function of > extreme pain. My head hurts so bad, and my symptoms are so disturbing, that I > often times feel like I’m going to have a stroke/convulsion and die. > Generally what happens is that my neck and face start hurting all over, and > my vision gets messed up, then I go into a migraine. At this point I’m very > afraid, afraid that there is something really wrong with me, and I’m going to > die. This problem has intensified in the last few months. > Anybody else here have pain so intense or symptoms so
disturbing they have > serious panic?
Before you buy.
Response:
I have had panic attacks in the absense of pain before. Was at the ER or ICU five times within one week in June. They did the EEGs and chest x-rays and so forth, and reassured me there was nothing wrong with my heart – thought maybe I was stressed out because my father had died a week before. The ER doctor wrote down ‘panic disorder’ on the charts, and my psychiatrist, neurologist and regular doctor agreed. Anyway, I know what it’s like to have panic attacks. The hyperventilation,losing your breath, chest pain, misinterpretation of what your body’s doing, fear of going crazy, sweating, and so forth. What I’m saying is that my head pain becomes so severe that it induces a panic attack. Anything that elevates anxiety will probably be prone – in my case – to cause panic. Severe head pain elevates my anxiety, and hence I become panic prone. I have anti-anxiety medication I can take when I get these panic attacks. I have a long history of panic/anxiety. However, it wasn’t the case until recently that headaches induced panic attacks. This is a recent development; probably because the intensity of the pain has increased. I think I’m going to request an MRI because the headaches have worsened. Thanks <<<<<<<<Do you mean the panic that comes out of no-where and have no clue as to what’s causing the feeling that you’re going to jump out of your skin,hyperventilate, maybe die? Opposed to a feeling of panic from a known source like pain? I don;t know why you can’t have both . some attacks are triggered by previously normal events like driving,leaving the house fear of heights etc. I’m probably way off base about this, so if you can clear it up and maybe offer some solutions, it would be great Jack, All I know, Is when you have a genuine one – there’s no mistaking it. Thank you, codeee
Response:
You may feel panic, but you really haven’t described a "panic attack". In no way am I trying to minimize what you’re going through. Jack – Hide quoted text — Show quoted text – > Hi, I have posted here earlier regarding a chronic headache clinic. My new > question has to do with panic attacks, which I believe are a function of > extreme pain. My head hurts so bad, and my symptoms are so disturbing, that I > often times feel like I’m going to have a stroke/convulsion and die. > Generally what happens is that my neck and face start hurting all over, and > my vision gets messed up, then I go into a migraine. At this point I’m very > afraid, afraid that there is something really wrong with me, and I’m going to > die. This problem has intensified in the last few months. > Anybody else here have pain so intense or symptoms so disturbing they have > serious panic?
Response:
"USUALLY", a "panic attack" wakes up a person from sleep, and consists of hyperventilation, rapid pulse, sweating, and a feeling of impending doom, WITHOUT being able to attribute the panic feeling to a specific cause. The person feels like they can’t "get enough air", when, in fact they are getting too much, which is why re-breathing air into a paper bag can help. These are "usually" self-limiting within a short time. I can’t overemphasize the "fear" aspect, and panic attacks account for a reasonable number of calls to 911 in the middle of the night. They do not end with a headache. There are variations on this theme (such as daytime attacks), but this is what they "usually" consists of. Yes, you can "panic" for a number of specific reasons, without a "panic attack", and you can have both at different times. If a panic attack was triggered by "driving", as in your example, you wouldn’t be able to drive. Panic, yes; panic attack, no. If they end up as a migraine (which I know something about), then the feelings you have may be a migraine prodrome, as may be the "vision" problems. However, the "feeling that you’re going to die" is NOT part of a migraine prodrome or a migraine. Wanting to die, perhaps; feeling that you will die, no. There’s just not a box to check for everything. Jack – Hide quoted text — Show quoted text – > Do you mean the panic that comes out of no-where and have no clue as > to what’s causing the feeling that you’re going to jump out of your > skin,hyperventilate, maybe die? Opposed to a feeling of panic from a > known source like pain? I don;t know why you can’t have both . some > attacks are triggered by previously normal events like driving,leaving > the house fear of heights etc. I’m probably way off base about this, so > if you can clear it up and maybe offer some solutions, it would be great > Jack, All I know, Is when you have a genuine one – there’s no mistaking > it. > Thank you, > codeee > , > You may feel panic, but you really haven’t described a "panic attack". > In no way am I trying to minimize what you’re going through. > Jack > > Hi, I have posted here earlier regarding a chronic headache > clinic. My new > > question has to do with panic attacks, which I believe are a > function of > > extreme pain. My head hurts so bad, and my symptoms are so > disturbing, that I > > often times feel like I’m going to have a stroke/convulsion and die. > > Generally what happens is that my neck and face start hurting > all over, and > > my vision gets messed up, then I go into a migraine. At this point > I’m very > > afraid, afraid that there is something really wrong with me, and I’m > going to > > die. This problem has intensified in the last few months. > > Anybody else here have pain so intense or symptoms so > disturbing they have > > serious panic? > Before you buy.
Response:
I am sure that someone has tried you on Celexa or another SSRI, right? Those are tailor-made for panic disorder. — Bill Work
– Hide quoted text — Show quoted text -> I have had panic attacks in the absense of pain before. Was at the ER or ICU > five times within one week in June. They did the EEGs and chest x-rays and so > forth, and reassured me there was nothing wrong with my heart – thought maybe I > was stressed out because my father had died a week before. The ER doctor wrote > down ‘panic disorder’ on the charts, and my psychiatrist, neurologist and > regular doctor agreed. > Anyway, I know what it’s like to have panic attacks. The > hyperventilation,losing your breath, chest pain, misinterpretation of what your > body’s doing, fear of going crazy, sweating, and so forth. > What I’m saying is that my head pain becomes so severe that it induces a > panic attack. Anything that elevates anxiety will probably be prone – in my > case – to cause panic. Severe head pain elevates my anxiety, and hence I become > panic prone. > I have anti-anxiety medication I can take when I get these panic attacks. > I have a long history of panic/anxiety. However, it wasn’t the case until > recently that headaches induced panic attacks. This is a recent development; > probably because the intensity of the pain has increased. I think I’m going to > request an MRI because the headaches have worsened. > Thanks > <<<<<<<<Do you mean the panic that comes out of no-where and have no clue as > to what’s causing the feeling that you’re going to jump out of your > skin,hyperventilate, maybe die? Opposed to a feeling of panic from a > known source like pain? I don;t know why you can’t have both . some > attacks are triggered by previously normal events like driving,leaving > the house fear of heights etc. I’m probably way off base about this, so > if you can clear it up and maybe offer some solutions, it would be great > Jack, All I know, Is when you have a genuine one – there’s no mistaking > it. > Thank you, > codeee
Response:
Hi Dr. Work, I cannot take SSRI antidepressant medication because for me it induces panic attacks, racing thoughts, sleeplessness, migraine and other unpleasant symptoms. Last time I tried an SSRI I ended up in the psychiatric facility. I have a medication sensitivity problem and become ‘manicky’ when taking drugs Paxil, Prozac, Celexa, Luvox, Zoloft and the other ones. More than one psychiatrist said it would be malpractice to give me these again, as they believed I had bipolar disorder. That’s why I was curious about trying the Nardil; maybe this drug won’t cause the above problems?
Response:
Nardil is used as a drug of last resort. Since you have tried others, perhaps this is the last one for you…good luck finding someone to put you on it…out of my league. — Bill Work
– Hide quoted text — Show quoted text -> Hi Dr. Work, I cannot take SSRI antidepressant medication because for me it > induces panic attacks, racing thoughts, sleeplessness, migraine and other > unpleasant symptoms. > Last time I tried an SSRI I ended up in the psychiatric facility. I have a > medication sensitivity problem and become ‘manicky’ when taking drugs Paxil, > Prozac, Celexa, Luvox, Zoloft and the other ones. More than one psychiatrist > said it would be malpractice to give me these again, as they believed I had > bipolar disorder. > That’s why I was curious about trying the Nardil; maybe this drug won’t > cause the above problems?
Response:
Have you not tried lithium carbonate for bi-polar? – Hide quoted text — Show quoted text -> Nardil is used as a drug of last resort. Since you have tried others, > perhaps this is the last one for you…good luck finding someone to put you > on it…out of my league. > — > Bill Work > Hi Dr. Work, I cannot take SSRI antidepressant medication because for me > it > induces panic attacks, racing thoughts, sleeplessness, migraine and other > unpleasant symptoms. > Last time I tried an SSRI I ended up in the psychiatric facility. I > have a > medication sensitivity problem and become ‘manicky’ when taking drugs > Paxil, > Prozac, Celexa, Luvox, Zoloft and the other ones. More than one > psychiatrist > said it would be malpractice to give me these again, as they believed I > had > bipolar disorder. > That’s why I was curious about trying the Nardil; maybe this drug > won’t > cause the above problems?
Response:
Have you not tried lithium carbonate for bi-polar? Yes, I took Lithobid for about 5 months at doses ranging from 600 to 2100mgs. The side-effects of the medication were intolerable, even with the addition of prilosec and inderal. Kept on getting flu-like symptoms, hand tremor, nausea, etc. I don’t think the diagnosis of bipolar was necessarily valid anyway. I think most of my mental symptoms are a product of having chronic headaches, tmj, and neck pain. Psychiatry: 90 percent speculation and the 10 percent guess work.
Response:
I have had several panic attacks due to heartburn (I think). My head felt cold but sweat profusely, could not catch my breath and pain in my chest that felt like my heart wanted out. Their was pain in my arms, jaw and hands and could not swallow. I didn’t know if I wanted to stand, sit down or run. Many images raced threw my mind then complete confusion. I literally thought I was having a heart attach and this was it. I eventually calmed down and drank a glass of milk and ate a few Tums. The "attack" left as abruptly as it came. The cause was narrowed down to the consumption of four large coffees on an empty stomach. Scariest thing that ever happened to me in my life. I have also noticed that since my injuries that I have an exaggerated fear of heights. I don’t like elevators that go farther than 3 floors and will climb stairs rather than go for the ride. Climbing stairs is tuff work but my fear prevents me from riding elevators. I also live close to the US/Canadian Border that has about a two year old bridge. If I can’t drive over the bridge without stopping, I will not go. This Friday my wife and I are invited to go out for dinner on the American side, I am very concerned about the trip over this bridge and am seriously considering canceling out due to this. I feel very embarrassed about this fear and cannot get threw to my wife how disturbing this is to me. It is very difficult communicating this fear to people, especially my wife. She wants to jump out of a perfectly good airplane! The odd thing is that before my injuries I used to work 60% of the time over 100 feet in the air. This does not make sense intellectually but the fear still exists. Rob Hartley
– Hide quoted text — Show quoted text -> Do you mean the panic that comes out of no-where and have no clue as > to what’s causing the feeling that you’re going to jump out of your > skin,hyperventilate, maybe die? Opposed to a feeling of panic from a > known source like pain? I don;t know why you can’t have both . some > attacks are triggered by previously normal events like driving,leaving > the house fear of heights etc. I’m probably way off base about this, so > if you can clear it up and maybe offer some solutions, it would be great > Jack, All I know, Is when you have a genuine one – there’s no mistaking > it. > Thank you, > codeee > , > You may feel panic, but you really haven’t described a "panic attack". > In no way am I trying to minimize what you’re going through. > Jack > Before you buy.
Response:
Hi Jack 
Hmmmm. I agree with your statement. Maybe we confuse ‘panicdisorder’ with ‘panic attacks’. My aunt has had them badly, and she refers to them as ’scream dreams’. I have had one panicattack, ( I have an anxiety/panic disorder ) because it was around 3 am.( EXTREME clausterphobia and inability to breathe/move ) All the other times, I get anxiety attacks, which are ‘milder’ ( but bladdy debilitating ). All the symptoms the above poster posted. So what makes the difference between panic disorder and anxiety disorders? My doctor sais I have ‘both’ which she misleadingly refers to both as ‘the same thing’. Though, the panic type, seems more severe. I am happy to report, that with therapy ( and no drugs!!!! ) that my aunt was able to ‘cure’ or at least put her ’scream dreams’ into remission. So there are happy endings. I prefer not to use meds, because they dont decrease my anxiety, so I am using Cognitive Behaviour Therapy to help me. That is *my* preferred method, as I simply do not want to take Benzos. It’s helping – I can now recognise how temporary they ( anxiety attacks )are, and breathe myself through them. In fact, every time I go to refill my meds, I get one. I call going to the doc, an exercise in breathing control – and an excellent ’staged’ anxiety attack, which ‘experts’ recommend you ‘deal with’ and face and conquer. It worked the last time! Thanks and have a great day, Shauna
– Hide quoted text — Show quoted text -> "USUALLY", a "panic attack" wakes up a person from sleep, and consists > of hyperventilation, rapid pulse, sweating, and a feeling of impending > doom, WITHOUT being able to attribute the panic feeling to a specific > cause. The person feels like they can’t "get enough air", when, in fact > they are getting too much, which is why re-breathing air into a paper > bag can help. > These are "usually" self-limiting within a short time. I can’t > overemphasize the "fear" aspect, and panic attacks account for a > reasonable number of calls to 911 in the middle of the night. They do > not end with a headache. > There are variations on this theme (such as daytime attacks), but this > is what they "usually" consists of. > Yes, you can "panic" for a number of specific reasons, without a "panic > attack", and you can have both at different times. > If a panic attack was triggered by "driving", as in your example, you > wouldn’t be able to drive. Panic, yes; panic attack, no. > If they end up as a migraine (which I know something about), then the > feelings you have may be a migraine prodrome, as may be the "vision" > problems. However, the "feeling that you’re going to die" is NOT part of > a migraine prodrome or a migraine. Wanting to die, perhaps; feeling that > you will die, no. > There’s just not a box to check for everything. > Jack
Response:
My friend was on Nardil for many years for Anxiety. Worked like a charm. She discontinued after 15 years. I know it is not agood drug – my neuro would rather die than put anyone on them – but for some people – on a last resort basis, it needn’t be too bad. It worked for my friend. We live in Canada ) Shauna
– Hide quoted text — Show quoted text -> Hi Dr. Work, I cannot take SSRI antidepressant medication because for me it > induces panic attacks, racing thoughts, sleeplessness, migraine and other > unpleasant symptoms. > Last time I tried an SSRI I ended up in the psychiatric facility. I have a > medication sensitivity problem and become ‘manicky’ when taking drugs Paxil, > Prozac, Celexa, Luvox, Zoloft and the other ones. More than one psychiatrist > said it would be malpractice to give me these again, as they believed I had > bipolar disorder. > That’s why I was curious about trying the Nardil; maybe this drug won’t > cause the above problems?
Response:
Lithium has such a narrow therapeutic range…glad I don’t play with it. — Bill Work
– Hide quoted text — Show quoted text -> 2100 mg. is, IMO, a very toxic dose. 900 comes close for many. Nausea is > usually the first sign of toxicity. > Have you not tried lithium carbonate for bi-polar? > Yes, I took Lithobid for about 5 months at doses ranging from 600 to 2100mgs. > The side-effects of the medication were intolerable, even with the addition of > prilosec and inderal. Kept on getting flu-like symptoms, hand tremor, nausea, > etc. > I don’t think the diagnosis of bipolar was necessarily valid anyway. I > think most of my mental symptoms are a product of having chronic headaches, > tmj, and neck pain. > Psychiatry: 90 percent speculation and the 10 percent guess work.
Response:
You need to have your heart checked out. I had quadruple by-pass a year and a half ago.My biggest symptoms were anxiety and panic attacks.If you haven’t done so allready,don’t wait,check it out. Good Luck Lem
Response:
2100 mg. is, IMO, a very toxic dose. 900 comes close for many. Nausea is usually the first sign of toxicity. – Hide quoted text — Show quoted text – > Have you not tried lithium carbonate for bi-polar? > Yes, I took Lithobid for about 5 months at doses ranging from 600 to 2100mgs. > The side-effects of the medication were intolerable, even with the addition of > prilosec and inderal. Kept on getting flu-like symptoms, hand tremor, nausea, > etc. > I don’t think the diagnosis of bipolar was necessarily valid anyway. I > think most of my mental symptoms are a product of having chronic headaches, > tmj, and neck pain. > Psychiatry: 90 percent speculation and the 10 percent guess work.
Response:
This post is too confusing to offer an intelligent response. It also belongs in the appropriate ng. – Hide quoted text — Show quoted text – > Hi Jack > Hmmmm. > I agree with your statement. Maybe we confuse ‘panicdisorder’ with ‘panic > attacks’. > My aunt has had them badly, and she refers to them as ’scream dreams’. I > have had one panicattack, ( I have an anxiety/panic disorder ) because it > was around 3 am.( EXTREME clausterphobia and inability to breathe/move ) All > the other times, I get anxiety attacks, which are ‘milder’ ( but bladdy > debilitating ). All the symptoms the above poster posted. > So what makes the difference between panic disorder and anxiety disorders? > My doctor sais I have ‘both’ which she misleadingly refers to both as ‘the > same thing’. Though, the panic type, seems more severe. > I am happy to report, that with therapy ( and no drugs!!!! ) that my aunt > was able to ‘cure’ or at least put > her ’scream dreams’ into remission. So there are happy endings. I prefer not > to use meds, because they > dont decrease my anxiety, so I am using Cognitive Behaviour Therapy to help > me. That is *my* preferred method, > as I simply do not want to take Benzos. It’s helping – I can now recognise > how temporary they ( anxiety attacks )are, and breathe myself through them. > In fact, every time I go to refill my meds, I get one. I call going to the > doc, an exercise in breathing control – and an excellent > ’staged’ anxiety attack, which ‘experts’ recommend you ‘deal with’ and face > and conquer. It worked the last time! > Thanks and have a great day, > Shauna > "USUALLY", a "panic attack" wakes up a person from sleep, and consists > of hyperventilation, rapid pulse, sweating, and a feeling of impending > doom, WITHOUT being able to attribute the panic feeling to a specific > cause. The person feels like they can’t "get enough air", when, in fact > they are getting too much, which is why re-breathing air into a paper > bag can help. > These are "usually" self-limiting within a short time. I can’t > overemphasize the "fear" aspect, and panic attacks account for a > reasonable number of calls to 911 in the middle of the night. They do > not end with a headache. > There are variations on this theme (such as daytime attacks), but this > is what they "usually" consists of. > Yes, you can "panic" for a number of specific reasons, without a "panic > attack", and you can have both at different times. > If a panic attack was triggered by "driving", as in your example, you > wouldn’t be able to drive. Panic, yes; panic attack, no. > If they end up as a migraine (which I know something about), then the > feelings you have may be a migraine prodrome, as may be the "vision" > problems. However, the "feeling that you’re going to die" is NOT part of > a migraine prodrome or a migraine. Wanting to die, perhaps; feeling that > you will die, no. > There’s just not a box to check for everything. > Jack
Response:
so I am using Cognitive Behaviour Therapy to help > me.
That is a great way to deal with anxiety, not panic attacks.
Response:
Yes, but the doses have come WAY down (from the standard 900 mg), and the signs of reversable toxicity are easily recognized by the patient. It has made many outpatients out of inpatients. It is also found in "almost therapeutic" levels in some drinking water, and is a very safe drug, IMHO. Worst problems are the interactions with everything from HCTZ to ibuprofen, but they’re not serious interactions—-just affect clearance time, and raise levels. Again, patients recognize the light nausea, sometimes tinnitus, and just skip a dose. A lot safer than buying 3 Cadillacs one weekend as has happened. And, a lot cheaper. A former internist of mine thought (only half jokingly) that it should be added to LA’s water supply—–to sorta mellow out the city. That was in the 60’s——remember those? – Hide quoted text — Show quoted text -> Lithium has such a narrow therapeutic range…glad I don’t play with it. > — > Bill Work > 2100 mg. is, IMO, a very toxic dose. 900 comes close for many. Nausea is > usually the first sign of toxicity. > > Have you not tried lithium carbonate for bi-polar? > > Yes, I took Lithobid for about 5 months at doses ranging from 600 to > 2100mgs. > > The side-effects of the medication were intolerable, even with the > addition of > > prilosec and inderal. Kept on getting flu-like symptoms, hand tremor, > nausea, > > etc. > > I don’t think the diagnosis of bipolar was necessarily valid anyway. > I > > think most of my mental symptoms are a product of having chronic > headaches, > > tmj, and neck pain. > > Psychiatry: 90 percent speculation and the 10 percent guess work.
Response:
Only neuro in town (where we used to live) put my husband on lithium, of all things, for cluster and tension H.A’s.(not frequent) After a week of dragging him around and waking him in a sitting position, we figured we’d given it a shot. It seemed like a drastic measure for that kind of H.A. New doc…all he needs now is some t-4 once in a great while, geeez. codeee – Hide quoted text — Show quoted text -> Lithium has such a narrow therapeutic range…glad I don’t play with it. > — > Bill Work > 2100 mg. is, IMO, a very toxic dose. 900 comes close for many. Nausea is > usually the first sign of toxicity. > > Have you not tried lithium carbonate for bi-polar? > > Yes, I took Lithobid for about 5 months at doses ranging from 600 to > 2100mgs. > > The side-effects of the medication were intolerable, even with the > addition of > > prilosec and inderal. Kept on getting flu-like symptoms, hand tremor, > nausea, > > etc. > > I don’t think the diagnosis of bipolar was necessarily valid anyway. > I > > think most of my mental symptoms are a product of having chronic > headaches, > > tmj, and neck pain. > > Psychiatry: 90 percent speculation and the 10 percent guess work.
Before you buy.
Response:
