Fluoroquinolone toxicity recovery

Please see the disclaimer at the bottom of the story. I just wanted to give my own “recovery story” for those who are going through this and are worried about what is ahead of them: Jun 20, 2013 · Join fluoroquinoline toxicity 24/7 live chat group to get a lot more info. Dec 1, 2022 · Levaquin Fluoroquinolone-Associated Disability (FQAD), a “constellation of disabling symptoms” which results in “a substantial disruption of a person’s ability to conduct normal life functions,” includes adverse events which “last 30 days or longer after stopping the fluoroquinolone,” and including adverse events from two or more Mahmoud’s Story – Recovery from Cipro Toxicity. Jul 23, 2007 · The commonest presenting complaint of fluoroquinolone-associated tendinopathy is pain, typically of sudden onset. The US Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) database includes 210,705 adverse events Mar 11, 2024 · This site is to give HOPE to those who are suffering from Fluoroquinolone Toxicity Syndrome as a result of being poisoned by fluoroquinolone antibiotics – Cipro, Levaquin, Avelox, Floxin, etc. It is not medical advice. I have a penicillin allergy and was breast feeding at the time (my baby was 5 months old). Today is July 26, 2020- Life is good. We recommend the book The Fluoroquinolone Toxicity Solution that provides a step-by-step protocol that outlines everything that you need to do in order to recover from Fluoroquinolone Toxicity and associated disability *The following is an individual’s story of surviving fluoroquinolone toxicity. Many people do recover. Thank you, and please be cautious with all treatments. Oct 12, 2015 · The Floxie Food Guide: Guidelines for Recovery from Fluoroquinolone Toxicity contains information about diets that have helped people through fluoroquinolone toxicity. 1. Hi,my name is Francesco,i am a 37y/o italian chef. 22 Adverse events associated with fluoroquinolone use in patients with chronic kidney disease (CKD) have been reported in 30 case reports and in 1 cohort study of 264 968 patients receiving hemodialysis (a literature search and With each lesson he shares, Adam stands as an inspiration, offering hope to countless souls navigating the tumultuous seas of fluoroquinolone toxicity. For everyone battling this adversity, Adam’s tale serves as a shining light, underlining the strength of human spirit and the tangible potential for recovery. Fluoroquinolones are associated with a two- to fourfold increased risk of acute tendinopathy (defined as pain or reduced function without rupture) and tendon rupture. Fluoroquinolones were alerted for hepatotoxicity liability and were recently given black box warnings by FDA for the May 24, 2024 · 5. Richard’s health problems began several years before he… Mar 30, 2015 · Fluoroquinolone toxicity is a multi-symptom, chronic illness that devastates its victims. First off, I want to apologize for the length of my story. Fluoroquinolone drugs have been linked to some potentially serious, long-term, and permanently disabling side effects, including toxicity to the central nervous system, cardiovascular system, and musculoskeletal system. [SCIENCE] Fluoroquinolone (FQ) toxicity may involve mast cell activation. Story: Diego blessed up upon his arrival from the United Kingdom as he was dealing with long term Cipro side effects. Special conditions exist, however, in which the use of quinolones in pediatrie patients can be justified. It started with a simple sinus infection in 2006. Six days into… Mar 17, 2022 · Fluoroquinolone Toxicity Doctors Recovery These two practitioners used intuition, help, and guidance to get their health back on track during the reaction to a fluoroquinolone antibiotic. Apr 20, 2016 · A Full Recovery. Trusting the Recovery Process from Fluoroquinolones Toxicity While supplements and diet play a role, the journey of recovery from being floxed is also a game of patience, trust, and seeking the right *floxed treatment*. Laura posted her story on Facebook. Sep 1, 2006 · *The following is an individual's story of surviving fluoroquinolone toxicity. I was floxed on February 22nd of this year. . Granted, we are in the midst of a pandemic, but my Cipro Toxicity seems like a thing of the past. Clinical findings include tendon swelling, thickening or oedema [ 5, 6 ]. Fluoroquinolones are a very effective class of antibiotics including levofloxacin (Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), ofloxacin, gemifloxacin (Factive), and delafloxacin (Baxdela). 2nd arm - An additional group of patients will be Dec 18, 2019 · Rebecca traveled from Ojai California after She developed Fluoroquinolone toxicity from consuming Cipro. I believe I am on to something here - and it all stems from Jun 1, 2003 · Fluoroquinolone implicated and duration of treatment. In September of 2018, I had pneumonia. 4. Previous studies suggest that FQs act as selective GABAA receptor inhibitors, preventing Fluoroquinolone toxicity is a huge issue. A total of 178 cases qualified as fluoroquinolone associated disability after applying inclusion and exclusion criteria. … Erin’s Story of Chronic Illness, Fluoroquinolone Toxicity, and Healing. Through intensive customized *The following is an individual's story of surviving fluoroquinolone toxicity. After they healed, they decided to so something to help the “floxie” community, and devoted their practices (or at least a portion of their practices) to Jun 1, 2014 · Tendinopathy can be a complication of treatment with fluoroquinolone antibiotics and usually is linked with 1 or more synergistic factors. Apr 3, 2017 · Fluoroquinolone use has been known to be associated with tendinopathy and tendon rupture for over 30 years. com/gradysmithSharing my experience with fluoroquinolone toxicity after using Levaquin, and wha The Food and Drug Administration (FDA) anticipated the presence of a long-lasting incapacity of Fluoroquinolone Associated Toxicity (FQAT), which is not officially documented yet. The US Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) database includes 210,705 adverse events Quinolone antibiotics constitute a large group of broad-spectrum bacteriocidals that share a bicyclic core structure related to the substance 4-quinolone. Adam's Parting Words of Floxie Hope. Mar 4, 2020 · After researching his symptoms on the internet, Rojas concluded he had been “floxed” — a term commonly used to describe fluoroquinolone toxicity, or fluoroquinolone toxicity syndrome. I developed a persistent cough in early 2014. T Angela’s Recovery Story – Cipro Toxicity. Other symptoms include swelling, warmth, tenderness, erythema or itchiness over tendon sites and functional disability. In addition to going through stories of pain caused by fluoroquinolone antibiotics, Floxie Hope goes through Lisa Bloomquist's journey of recovery. Recently, serious adverse effects associated with their use have increasingly been reported. e. In April 2014, I was prescribed seven days of Ciprofloxacin (2 X 500mg) for a possible… Toxicity has also been found in various animal studies (including fetal wastage and impaired cartilage development). I developed terrible tendinitis in my feet and ankles, neuropathy in my hands, feet and calves, as well as tinnitus in my left ear. A lot of the recovery stories are from people who can see the light at the end of the fluoroquinolone toxicity tunnel, but they’re not completely out of the tunnel yet. Fluoroquinolone recovery stories from Cipro & Levaquin are real and I hope that the stories below will give you hope on your journey. Nov 27, 2019 · Quinolone Toxicity – “Getting Floxed”. Dec 16, 2021 · Fluoroquinolone Recovery Story By Katrina Johnson. . After 3 weeks my family doctor recommended antibiotics. Erin – “Here’s a picture of me and my mom in Nashville in 2019. Floxed by: Ciprofloxacin. It can also be found on the Facebook Fluoroquinolone Wall… *The following is an individual's story of surviving fluoroquinolone toxicity. Blurry Vision. On February 8th, 2014 I made a fateful decision that would change my life. In December 2013, Dr. The body has amazing healing abilities though, and recovery is possible. The receptor site (Mrgprb2/mice, MRGPRX2/human) has been identified to be responsible for pseudo-allergic reactions to certain drugs having a common chemical motif, which includes fluoroquinolones (FQs). David Bae of South Coast Medical Sep 1, 2017 · The FDA identified 1,122 fluoroquinolone disability reports from November 1, 1997 to May 30, 2015. A doctor prescribed Levaquin. *The following is an individual's story of surviving fluoroquinolone toxicity. Four pills in, I felt… actually it’s hard to describe. Sep 30, 2016 · *The following is an individual’s story of surviving fluoroquinolone toxicity. Before that I was an active athlete riding BMX bikes for radio Disney, going to the gym, working full time on my company and living life to the fullest. Alex discusses his heartfelt story of overcoming Fluoroquinolone Toxicity after Ciprofloxacin side effects nearly disabled him. Thanks. This class of drugs consists of several popular antibiotics, commonly prescribed by a medical professional to treat bacterial infections *The following is an individual's story of surviving fluoroquinolone toxicity. I’m hoping this diagnosis helps my disability claim. 23 Like all antibiotics, fluoroquinolones carry a risk of Clostridium difficile infection. I took a fluoroquinolone antibiotic called Cipro. 8–11 As with all drugs, FQs have the potential for Jul 23, 2022 · Fluoroquinolones (FQs) are highly potent bactericidal antibiotics with broad-spectrum activity against Gram-negative/positive bacteria. At the end of October, I began to *The following is an individual's story of surviving fluoroquinolone toxicity. This is the fluoroquinolone class of antibiotics, and includes Ciprofloxacin, Levofloxacin, Moxifloxacin. com describe people who are mostly, but not fully, recovered. As a professional opera singer, she experienced full In addition to arranging study parameters and participant selection for the Foundation's studies, Jane’s hope is to find effective treatments for patient recovery and advocate for justice on behalf of those whose livelihoods and health have been lost due to the adverse events of Fluoroquinolone toxicity. Also please check out our podcast section where you can find talks with other “floxies” and hear their Nov 2, 2020 · Fluoroquinolone (FQ) antibiotics are often used in medical therapy, especially in the treatment of urinary tract infections (UTIs). 4,5 Overcome Fluoroquinolone Toxicity Symptoms: Navigate the path of recovery from fluoroquinolone side effects with our comprehensive guide. Food and Drug Administration today approved safety labeling changes for a class of antibiotics, called fluoroquinolones, to enhance warnings Mar 30, 2015 · Fluoroquinolone toxicity is a multi-symptom, chronic illness that devastates its victims. Some floxies recover fully and some take a lot of time with ongoing problems. Embrace the small victories, the peaks and the valleys. patreon. The purposes of this study are to determine if patients treated with fluoroquinolone (FQ) antibiotics have depletion of mitochondrial DNA (mtDNA) in buccal swab samples, and whether the degree of depletion correlates with the likelihood of developing FQ-associated toxicity. Learn about floxed treatment, how to heal from floxing, and the importance of supplements in mitigating fluoroquinolones' side effects. Feb 22, 2016 · While FQAD may seem insurmountable, there are many ways to overcome the damaging effects of the Fluoroquinolone antibiotics. Some estimate that there are as many as 45,000 cases of fluoroquinolone toxicity syndrome in the United States. Histologically, interstitial edema and severe degenerative changes with absence of an inflammatory infiltrate are seen in FQ-induced tendinopathy, findings which have also been observed in overuse conditions in athletes. Nov 20, 2012 · The risk of cardiac toxicity of moxifloxacin (400 mg) versus levofloxacin (500 mg), both IV as initial therapy with a switch to oral administration after 3–4 days, has been specifically addressed for elderly patients with community-acquired pneumonia (≥65 years) in the CAPRIE (Community-Acquired Pneumonia Recovery in the Elderly) study. Sharon’s Story Following is Sharon’s story, as written by Sharon: Hello, Friends. Hi, my name is Erin and I’m almost in my 7th year post-Cipro. The swelling was severe and the doctor gave me Cipro 500 for swelling and wounds. I've been studying it for a few years and trying to figure out risks and recovery strategies. Embracing the Body's Ability to Heal from Floxing In his journey, Rusty holds onto a firm belief in the body's innate healing capabilities, particularly when supported by the right floxed treatment and a *The following is an individual's story of surviving fluoroquinolone toxicity. However, The Fluoroquinolone Toxicity Solution puts a lot of good information into one easy-to-understand e-book It takes disciple, mentally and physically. I was poisoned by… The FDA identified 1,122 fluoroquinolone disability reports from November 1, 1997 to May 30, 2015. Paul S. I’ve delayed writing this for quite a while. Floxed by Fluoroquinolone Toxicity. Sep 1, 2017 · The FDA identified 1,122 fluoroquinolone disability reports from November 1, 1997 to May 30, 2015. In the last few months of 2014 after having some relapsing cystitis already treated with 2 weeks of cyprofloxacin,my urologist diagnosed me with a severe form of prostatitis which he decided to “cure” with massive cycles of levofloxacin+amoxicillin based antibiotics (augmentin)+cortisonics. My name is Peggy. 8, 10 Case reports indicate that recovery generally occurs within 2 months after the cessation of antibiotic use 8, 10; however, continued pain and disability in up to 26% of the cases has been reported. SonofSocrates. I had a persistent cold since before Christmas and developed a bad sinus infection. The seemingly obvious mechanism is probably too simplistic, but appears to be supported by the recent review paper quoted below: “The exact … Fluoroquinolone (FQ) Toxicity This site is to give HOPE to those who are suffering from Fluoroquinolone Toxicity Syndrome as a result of being poisoned by fluoroquinolone antibiotics – Cipro, Levaquin, Avelox, Floxin, etc. S. Patient: Michael, Los Angeles, CA. Floxed refers to the devastating effects of a class of antibiotics called fluoroquinolones (FQs) and may include symptoms of extreme fatigue, tendon rupture, joint and muscle pains, nerve pains, and nervous system disturbances. Oct 1, 2021 · Nausea, vomiting, diarrhoea and taste disturbance have been reported to occur in up to 20% of patients treated with fluoroquinolones. Angela’s Story, written by Angela –. Food and Drug Administration (FDA) approved changes to the labels of fluoroquinolone antibacterial drugs for systemic use (i. I am finally writing this and it has been Mar 21, 2019 · Fluoroquinolones should not be prescribed for treatment of mild to moderate infections (such as in acute exacerbation of chronic bronchitis and chronic obstructive pulmonary disease) unless other Dec 1, 2002 · The prognosis for full functional recovery without physical therapy is highly variable. I could barely walk. Brain Fog. All told, the risk increased by an Nov 25, 2014 · The Fluoroquinolone Toxicity Solution points out that cellular damage, even mitochondrial and DNA damage, can be repaired. Anderson For some time in pharmacology courses and review classes I have mentioned the potential for tendinopathy and other related and unrelated pathologies following the use of the fluoroquinolone drug class. 4,21 Fluoroquinolones such as levofloxacin and ciprofloxacin are broad-spectrum antibiotics and are commonly used in respiratory, urological, and skin infections, although fluoroquinolones can no longer be used empirically for suspected methicillin-resistant Staphylococcus aureus (MRSA Kristin’s Story of Recovery from Fluoroquinolone Toxicity. This recovery takes a lot of time for many but most do get better. I asked Mark to write his recovery story for this blog. It was Jan 2020. 11 Chondrocyte depletion and fissures on adjacent nonruptured tendons are also suggestive of direct toxicity related to FQ *The following is an individual’s story of surviving fluoroquinolone toxicity. The spectrum of activity, mechanisms of action and resistance, important resistance patterns, and adverse effects of commonly available fluoroquinolones (ie, ciprofloxacin, levofloxacin, moxifloxacin, delafloxacin) will be reviewed here. Fluoroquinolone-resistant C. I can now do my job at ease which is… May 27, 2021 · In the case of fluoroquinolone toxicity, they are particularly applicable to detox fluorine out of the tissues and out of the body. (Renee was helped immensely by The Wahls Protocol by Dr. Fluoroquinolone toxicity — itself a phrase coined by patients to describe the series of negative side effects they attribute to taking fluoroquinolone For Immediate Release: July 26, 2016. ”. Reason #2 - A Total Solution Created By Medical Professionals. I also hope that my experience will help some future floxies with proper diagnosis and treatment. Fluoroquinolone (FQ) antibiotics are often used in medical therapy, especially in the treatment of urinary tract infections (UTIs). After 4 1/2 years, I finally have my diagnosis of flouroquinolone toxicity. Peripheral Neuropathy. I became a “floxie” in November of 2012. Fluoroquinolone Toxicity Stem Cell Therapy Undifferentiated cells with the ability to regenerate and convert into differentiated cells, producing various types of tissues. Doc gave me a zpack but it didn’t work, so they gave me Levaquin 500mg in late October 2018. Oct 10, 2021 · In this inspiring video, Chuck explains how he is healing after experiencing wide spread side effects from the antibiotic Cipro/ Fluoroquinolone Toxicity. Espanol. I feel as though I’m pretty “cured. The symptoms may resolve after stopping the FQs, persist for years, or wax and Dec 17, 2020 · Unfortunately, like most medications, there are a host of unwanted side effects and for a small amount of the population, fluroquinolone toxicity can have devastating effects. Fluoroquinolone Antibiotic Awareness & Healing Alliance (FAAHA) The first alliance of its kind, FAAHA, includes healthcare providers and doctors from all over the country, whose experience is unmatched in helping with Fluoroquinolone Toxicity. Bilateral involvement is common. Ten weeks from the beginning of my Cipro-induced nightmare, I am writing to share a story of recovery. The Food and Drug Administration (FDA) anticipated the presence of a long-lasting incapacity of Fluoroquinolone Associated Toxicity (FQAT), which is not officially documented yet. Please have hope though. A few years ago I was given Cipro for a sinus infection. One of the many frustrating things about floxing is that everyone’s experience is different. We have enough in common to know that we have all been welcomed into the lovely club of Floxies, the club that no one wants to join, that includes the benefits of connective tissue and nervous system damage, but the differences Jul 5, 2022 · Background Antibiotics bear an inherent risk of mitochondrial toxicity due to the structural similarities between mitochondria and bacteria. 3, 8 Tendon rupture reportedly occurs in 24% to 30% of *The following is an individual's story of surviving fluoroquinolone toxicity. Apr 20, 2016 | Blog | 62. The FDA has proposed the existence of a permanent disability (Fluoroquinolone Associated Disability; FQAD), which is yet to be formally recognized. I have had the terrible fear that my… Sep 1, 2017 · The FDA identified 1,122 fluoroquinolone disability reports from November 1, 1997 to May 30, 2015. This review aimed to précis the existing information on FQA long-term toxicity, such as cardiotoxicity, aortic aneurysm, tendon rupture, nephrotoxicity My story is similar to most of you. Everything started in October 2015, I've been always very worried about diseases and health issues, at… *The following is an individual's story of surviving fluoroquinolone toxicity. I wanted to give an update here (10 1/2 weeks post Rx) to give other people… Mar 21, 2018 · When antibiotics turn toxic. Fluoroquinolones (FQs) are widely prescribed antibiotics (reportedly becoming the most common class of antibiotics prescribed to adults in 2002) 1 used to treat pneumonia, 2–4 sinusitis, 2–4 bronchitis 2–4 and urinary tract infections, 2 5 and also employed for prostate procedure prophylaxis, 6 7 among other indications. • Symptoms of fluoroquinolone-related tendinopathy can present within hours of starting treatment or up to 6 months after ceasing treatment, and recovery can be slower and require a less aggressive approach early in rehabilitation than for other types of Apr 19, 2024 · Mom, 33, Disabled After Antibiotic Causes Toxic 'Floxing' Reaction: 'Like a Bomb Had Gone Off in My Body' (Exclusive) Hailey Sebert is raising awareness about fluoroquinolone toxicity — the rare This site is to give HOPE to those who are suffering from Fluoroquinolone Toxicity Syndrome as a result of being poisoned by fluoroquinolone antibiotics – Cipro, Levaquin, Avelox, Floxin, etc. I have tried to… *The following is an individual's story of surviving fluoroquinolone toxicity. The majority of cases occurred with a pefloxacin dosage of 800 mg per day, although 1 patient reported receipt of 400 mg per day. Feb 21, 2024 · Thus, fluoroquinolone use is typically reserved for cases in which the benefits clearly outweigh the risks. These doctors and providers are joining forces, to develop best practices and learn from each other in Recovery Stories. Theories on Fluoroquinolone Toxicity. There are 2 ways to practice Derivative Baths: • Using fresh water and pouring it slowly down the perineum area for 10 min, 3 times a day, ideally done on a toilet. Toxicity Symptoms: Fatigue, ear ringing, muscle atrophy, anxiety. I was 33 years old. Several of the recovery stories on floxiehope. It contains stories of healing. 24. , taken by mouth or by injection). Drug-induced mitochondrial dysfunction can contribute to organ toxicity and has resulted in a considerable number of market withdrawals. Terry Wahls). I'm at about 90% better now. Researchers are struggling to work out why. Apr 17, 2021 · My name is Jason Sousa and my Fluoroquinolone story – or should I say the day I became a floxie – started way back on December 2013. After 6 weeks I was prescribed erythromycin. I took it for 31 days every 12 hours . Gemifloxacin, Norfloxacin, and Ofloxacin. My mom was one of my biggest advocates and supporters during my sickest times and continues to love learning about the body with me!”. difficile infections have emerged in response to increased fluoroquinolone prescribing. Time is your friend in this process. Many of the tips that are in The Fluoroquinolone Toxicity Solution can be found in the stories on Floxie Hope. The U. 9% in the general population. Oct 1, 2021 · Tendinopathy. In 2014, Miriam van Staveren went on It’s sad, it’s frustrating and it’s annoying. I have some deficits, weird sensations and some nerve damage but now I feel that I am physically and mentally 95% better. I’m Mahmoud, a civil engineer (site engineer), 31 years old , from Egypt. These may include symptoms of extreme fatigue, tendon rupture, joint and muscle pains, nerve pains and nervous system disturbances. Mark was floxed about 2 years ago. Therefore, the fluoroquinolones should be avoided in pregnant women, those who are breast-feeding, and children. It affirms that recovery from fluoroquinolone toxicity is not merely a distant dream, but a possible reality with the right strategy. Within 3 days of taking the meds, I lost the ability to walk unassisted, I lost 40 pounds in 2 months, my body burned all over, my vision was effected in my right eye, heart [07-26-2016] The U. *The following is an individual’s story of surviving fluoroquinolone toxicity. A Hopeful Outlook: Recovery from Fluoroquinolone Toxicity The narrative concludes on an optimistic note by highlighting the effectiveness of the comprehensive treatment approach. REASON #3 – Focus On The Underlying Problem…. Fluoroquinolones (FQs) are a broad class of antibiotics typically prescribed for bacterial infections, including infections for which their use is discouraged. 3 The incidence of this adverse effect may be up to 2% in patients aged 65 years and above, compared with a background tendon rupture rate of approximately 0. Now, a nested, case-control study has suggested that this increased risk may be dependent on exposure timing and the cumulative dose. On March 16, 2019 I had a car accident and broke my wrists on both hands and right forearm…. His floxing included insomnia, weight gain, anxiety, crippling exhaustion, brain fog that made doing his job difficult, and tendon and muscle issues that made doing his passion, biking, difficult. Jun 7, 2016 · The short answer is, no, unfortunately, I don’t know of any individuals, institutions, or organizations that are working to find a cure for fluoroquinolone toxicity. Help Support This Channel Through Patreon:https://www. I felt – like acid was coursing through my veins. Read Diego’s Full Story. Aug 2, 2022 · However, in practice, fluoroquinolones are frequently prescribed to these patients at higher than recommended doses. Very few floxies get on this site anymore. [1] They are used in human and veterinary medicine to treat bacterial infections, as well as in animal husbandry, specifically poultry production. Other Cipro toxicity symptoms include: Mitochondrial dysfunction and DNA damage. Unfortunately,… About this study. Thirty-six (37%) of the 98 cases of fluoroquinolone-induced tendon injury were reported in association with pefloxacin. They work well for otherwise antibiotic-resistant organisms, and many doctors prescribe them as a Oct 5, 2015 · Background. In June 2016, I entered the ER for food poisoning and the treating physician decided to prescribed 500mg of Cipro and 500mg of Flagyl. May 17, 2019 · Existing literature has suggested that peripheral neuropathy is associated with systemic exposure to fluoroquinolone, but to date, the risk has been poorly quantified. It has been a long and frustrating struggle with many ignorant doctors. Commonly prescribed drugs called fluoroquinolones cause rare, disabling side effects. Man Disabled by Cipro Makes Full Recovery. Not Symptoms. My theory is the younger you are the Brian’s Recovery Story – Cipro Side-Effects. The longer answer is a bit more complex and nuanced. It also contains guidance for foods to eat to help your mitochondria to heal, your gut microbiome to heal Everything you get inside The Fluoroquinolone Toxicity Solution is based on fact, science, and testing, and it’s created by two people with over 27 years of combined medical experience. In order to get doctors and scientists to do research into curing fluoroquinolone toxicity, fluoroquinolone toxicity first He emphasizes unwavering faith, steadfast hope, and the right floxed treatment for a successful recovery from fluoroquinolone toxicity. Richard told me his story in June, 2013. Fluoroquinolines are often referred to as “FQs”, btw. nq ev em ce ti qi qx mx wa as