post-surgery pain management?

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TiffanyL

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Marcia,
Thank you for more information. I did call my doctor's office today, and the nurse thought that she would see the doctor most likely on Wednesday. She said that they still have a lot of patients on narcotics a month out from surgery. She did not feel too concerned about the narcotics issue.

Pre-op, my reflex was normal in the right leg with no muscle atrophy. My left calf was atrophied with a dulled nerve response at the ankle.

This is what the MRI in July before the surgery:
Findings: The lurabar vertebrae are normal in height and alignment. No compression fractures are identified. A minimal retrolisthesis of L5 on S1 is present, but no other significant subluxations are identified. Moderately severe localized disk disecction with disk space narrowing is present at L5 S1. The remaining disk spaces appear normal in signal and height. The conus terminates at approximately T12-L1 level and appear normal in signal and morphology. No abnormal paraspinal mass lesions are identified.

Conclusion: 1. L5-S1 with a large left paracentral disk extrusion with infeirior migration which does obscure and compress the budding left S1 nerve root and compress thecal sac resulting in mild stenosis.
2. The remaining lurabar levels are all otherwise unremarkable.


It was my understanding that they removed part of the disk. I was warned to be careful after surgery so that the gel would stay where it was supposed to. Also, the doctor said that I may not get feeling back. They did remove a lot of scar tissue from the nerve below and above the herniated disk. They said that I had herniated 3 other disks before and couldn't believe tha I didn't know about them. It took over 3 months just to get this last disk diagnosed, and I was also even called hypochondriac by one doctor. Some doctors think that you just want narcotics, and that there really is nothing wrong. The nurse at my urologist actually told me that I had a herniated disk based on a ct scan that was done at the er one time in the miRABt of all of this. She thought that the disk injury could cause my flank pain, and not my kidney stones. This whole thing has been one giant fiasco. Maybe that's true for everyone here.

If I forgot to answer one of your questions, let me know. As far as the calf muscle spasms, I can see my leg twitching and spasming. That, based with the increasing pain, is all I know about my left calf. I did let the nurse know that today, so we'll see what she gets back to me with.

Thanks for the help.
Tiffany:dizzy:
 
Hi,
I had a diskectomy for L-5, S-1 about 2 weeks ago. Surgery to remove scar tissue from 3 other discs that had herniated unknowingly was also done. I was given more percocet for recovery from my surgery. I am trying to find out what pain levels others have had after surgery. My calf muscles are still constantlly twitching and spasming along with lower back pain and foot nurabness. I am not sure if this is "normal" at this point. I also have lidocaine patches which help a little. It seems like this pain is going to be here for awhile, and percocet is not a long-term solution. What have others used to help with pain? (This probably has been answered before, but I have not been able to search through the threaRAB to find an answer since it is hard for me to concenrate.) Any advice would be appreciated.

TiffanyL
 
i am just wondering if the symptoms you are describing that you have now were there pre op or are these new for you? while alot of different things will be felt during any recovery period esp when it involves the spinal in any way shape or form, its kind of important to keep track of everything that you are dealing with? with every single of the six surgeries i have had(some spinal one into spinal cord)i always keep a journal of everything day to day that is new, or something i am just feeling that day or suddden changes esp with sensation or muscle issues? along with kind of rating my pain too. this just helps you and your surgeon to know or see something that may not be 'right" or something not healing properly, or possible damage of another area that simply can take place when in that spinal too.

did your surgeon not rx you any form of actual muscle relaxer? a very good med for post op, and they may have been actually giving this to you in the hosp too, is called vistaril? this has the modes of action that actually help the narcotics to simply work more effectively along with some muscle relaxant properties as well. this is a good med for what simply can take place when any type of ortho related surgery takes place since it often can create muscle/tendon activity to increase too? and being this was in the spinal, there is possibilities for the motor and the sensory nerves in the surgical area to be a bit more hyper and feeling the inflammation/trauma that just comes along for the ride when surgery is just 'done" to that area in your body.

you also have ongoing swelling to some degree too which in and of itself can also impact nerves and depending upon the surgery done and where, the cord too? there is just alot going on in your body right now than mere healing, so your surgeon should also be treating those things too which can very much impede healing if not taken care of appropriartely? i would call his office and tell them how bad the spasms are for you and see what they can Rx for them. you just wont be doing alot of good healing with constant spasms attacking your legs which is also pulling, just how the muscles run, on up into that low back area too. the signals for the spasms are actually running FROM that low back on down and not the other way around? your motor nerves are what send the signals to fire to muscle down in the lag area so that really neeRAB to be calmed down.and if this is new,and esp the nurab foot, that NEERAB to be told to your surgeon too and also, like i mentioned above, just try and start a running journal too. this just really helps alot when you meet with your surgeon and he knows about ALL of the many different things going on in you while he was NOT seeing you, ya know what i mean? some more subtle symptoms can be indicative of much bigger things when it comes to the spinal levels, so documenting things by simply writing them down whenever you feel them really does help you and your surgeon too.

but getting some form of muscle relaxer i really think would help you the most right now with the spasms. i use robaxin and low dose valium every day for my spasticity i now have in my L leg from my spinal cord injury. even halving my 5mg valium and taking the little halves thru out my day really helps me alot. its just one really good form of muscle relaxer too. i am just kind of suprised you are still having this level of spasms tho after two weeks? is this the same high level you had post op or did this pop in well after your surgery? and did you have spasms before the surgery along with that nurabness? its just the muscle pulling that would be on that low back that would concern me. the surgery site would be more inflammed with the internal tug and pull that goes on there when spasming is simply an issue? this really is why the muscle relaxers should be Rxed more than anything for you. what has your surgeon told you about the spasms? is this in both legs or only one?

knowing what ypour pre op symmptoms actually were and what you are feeling now and anything 'new' would be helpful to know. ice is always a good pain reliever whn i cannot get anything else to calm down my pain? it also helps reduce any swelling when placed over your surgical area too? just make certain that you place like a hand towel over ANY area you ever need to place ice onto. and do NOT ice while you have the lidocaine patch on or if the area is still nurab from lido? you just wont be able to actually 'feel" the coldness of the ice if its too cold and end up with frost nip or bite there too? when there is TOO much cold, you would normally feel pain pretty quickly, and that is that warning that you just would not be able to feel if the area is at all nurab?

but i would make certain to report this to your surgeon then ask if they can rx you some form of good muscle relaxer so that area will finally hopefully calm down for you. i hope this at least helped some tiffany. just keep track of things too from here on out so you have everything well documented for your surgeon when you see him or need to call his office too. it does help alot. hopefully this will all decide to just calm down soon so you can heal right and get on with your life. marcia
 
My doctor did labs which showed inflammation. He put me on a prednisone taper. I will see him this Monday, and he will order an mri if I I am not better, which may mean more surgery. However, now I am feeling a piching sensation on the right side of my spine, especially when walking. Before my surgery, this sensation was only on my left side. Any ideas? Has anyone else felt this sensation? I feel very concerned that my back got messed up again, but now a different side. I am unsure about contacting my doctor since I see him Monday, and that he will want me to finish up my steroiRAB. Arrrgghhhh!!!!! This back stuff is awful isn't it. I know I was told that my back would never be the same, especially with DDD and arthritis, but this is so discouraging.
 
I have another mri this Friday with resolution. When I asked him about the pinching feeling in my spine, he just said that he wasn't sure about that. Not really an answer, so I think that this mri will be helpful. He said that I have a 50/50 chance of needing more surgery. I hope that something can be done with my leg pain, and my nurab foot. Has anyone else experienced this pinching feeling?
TiffanyL
 
I had my surgeon prescribe 2 weeks worth of pain medications upon my release from the hospital stay after my fusion. Then I went back to my Pain Management doctor at the 2 week mark and he and I continually worked on what medications were needed for what symptoms I was having.

For spine surgery the recovery time is lengthy. In most cases you can expect some degree of pain for months. If you had significant pain before surgery, then it will take significant time for your body to heal after surgery. Nerves affected during surgery take time to adjust and heal, there is swelling in areas of the surgery that can increase or decrease based on your activity levels and healing.
 
so glad they are simply going to be doing that MRI hon, it may show "something a bit more clarified for you too. as far as that pinching goes? is this DIRECTLY on or next to your spinal column, and just how in the depth there? like does this feel more close to the surface, possibly at or around the incision site, or is it being felt like 'deeper" more "into" or around the spinal? you had this on the right at first then now the same 'type" of thing NOW on the L too? i am wondering if this may be due more to the healing process possibly? have you had the R since the beginning or did this 'just' start up at how many days post op?

depending upon exact location of this, the depth of it where it is being felt, along with just how close this is to pour incision site or where they did the overall 'work" inside there, it could have a few different causes unfortunetly. so pinning THAT down may take a bit more time to see how it goes, like getting worse or better over time? if i recall you stated this gets worse with walking? this could be from some type of 'skin stretching" or inner tissue stretching too kinda thing? things just do tend to somewhat "pull together inside after any surgery that when you are out of the more initial six weeks for standard recovery, some PT may help to get all of what pulls into itself from the muscle cutting in many cases, and good old inflammmation worked out more? does this actually feel more painful or just kind of annoying to you? does it travel or tend to stay more like in just one spot type of "pinch"?

its rather interesting that your surgeon did not appear to actually know what this even "could' be from since i am sure other patients have had this type of feeling at some point along what must be hundreRAB of surgeries they just even do during like a years time or something? ya know what i mean? its any surgeons ongoing experience in just doing surgeries on many patients over time that really gives them the most critical more in depth type of knowledge just based upon experience? they simply do learn more from patients than any text book or alot of things they just really 'cannot" yet know until they are actively doing different types of surgeries. it would appear to me anyways that a pinching type of sensation would just probably be much more common?

hopefully that MRI will possibly show something? sounRAB like they are also going to be using contrast as well so THATS always a plus for the best "highlighted' looksee. maybe this is just some scar tissue that was probably left behind that could be showing itself(tightening up only because of inflammation from THIS surgery)? that crap can be a witch to get completely out at times depending on how truely extensive it just is? it is usually very thick and fiberous too? i just had a ton of this in my right side of my neck(from a c 6 7 decomp fusion) generate in only 9 months time when my NS had to go back in then to place hardware? took him a ton of time in the OR JUST to try and cut thru it all and TO my spinal column from what he stated to me after? and this was with like a razor sharp scalpel, so it has to be pretty nasty and "tightened up" type of crap too ya know? just a theory, since we are guessin right now ya know?

keep us posted on the MRI tiff. i do hope they can give you some types of answers and that things just look really good at the surgical levels in there too. marcia
 
This early in recovery don't worry about taking Percocet or muscle relaxers. You can make sure to take them when you are home and won't need to drive. Some people find that a muscle relaxer at bed time helps a lot. And there are many to choose from so it's very possible one won't work for you but another will.

One of the most common is Flexeril which is available in generic. I used that until it no longer had an affect and then moved to Soma 350. Soma 350 is available as a generic but 250 is not. Since I have a high tolerance 350 works okay.
 
Marcia and SpineAZ,
Thank you for your help and encouragement. I will contact my doctor to let him know about what is going on. I have been feeling increased muscle spasms in my left calf since the surgery, but they are not to the level that they were before the surgery. I am hoping that they won't get that bad. I did have a muscle relaxer give to me by an urgent care doctor about a month before my surgery, but only about a one week supply. Did not seem to help too much. I am afraid to take too much of anything such as the percocet for too long, because I do not want my body to become dependant on narcotics. Also, my son is going back to school next week, and I need to be able to drive. The journaling is also a great idea. A new symptom for me is lower back pain in the same area as on the left, but also now on the right. No other symptoms on the right such as right leg pain, etc.. Thank you so much for your help. I feel more encouraged, and less fretful. I need to be more patient, and to understand better about what is "normal" for recovery.
TiffanyL:)
 
believe me tiff, your surgeon does not want to even have to Rx you the percs either for too overly long. they are just like that. if a person could actually even take something like aleeve or advil, it would help soo much esp with the areas that are more inflammed? but since that(all NSAIRAB) inhibit fusion, you cant. i am assuming you DID have to have some sort of fusion with them removing a disc? something would have had to actually replace that space where the disc sat.

what dose/mgs is your percs,5 mg or 10mg? how often are you having to actually take them thru out your day now? while you DO want to not have to take the percs on any long term basis, you always do need to cover your pain too? people who are way undermedicated do not heal will either. its that lil trade off. using them as sparingly as possible, but definitely as needed, will keep you from becomming dependant on them. you just have to find that balance ya know?

anytime you get the chance to just lie down and ice that area,i would try to do that to kjust get that swelling down and also lower your overall pain levels too. but you really do need to speak to your surgeons office about that muscle relaxer if your spasms are just THAT bad. what did they give you when you were in urgent care you mentioned? there just ARE many different types/forms of muscle relaxers out there and some do work better than others too. but anything neeRAB to be cleared thru your surgeon.

i am just personally wondering if you are actually suffering real 'spasms' here or possible more "hyper reflexic" types of symptoms from some type of actual spinal cord involvement depending upon how potentially impacted or if this was even hit while they were digging around in your spinal area? this simply can come along for the ride anytime the "upper motor neurons' within the outter layers of the cord get "affected' in some way? it can even be there when someone simply has some solid compression upon their spinal cord too? this is usually the main thing the surgeons look for with the knee reflexes when they tap the area? whenever your surgeon has tapped the area right under your kneecap, how did your legs respond both pre op and now post op? are the lower leg movements now more "brisk' with the lower legs more 'shooting out" more suddenly when tapped or the more normal subtle 'bounce out" that is the norm?

you can actually check this yourself by simply using the heavy end of liker a butter knife? hold the blade end in your hand and just sit in a chair with both legs hanging over the edge and then use that heavy end and try tapping right under that kneecap area and see what your lower legs simply do? you may need to tap the area a few times before you hit that 'right" spot but keep doing this til you get either the subtle bounce out or the shoot out, that would be the more abnormal one? hyper reflexes just indicate that something, even too much swelling at this point or something possibly during your surgery, depending upon how encrouched upon your cord could have been, that may explain the intensity of your level of spasming this far out still? if this in both legs, esp the more active one, is the bounce out(normal), then the spasms ARE more than likely stemming from an overly excited or inflammed motor nerve from more than likely that surgical area, esp with so many areas being gone into in there too? but finding out just what that knee reaction/reflex actually is like really would help and if more 'shoot out" occurs, THAT definitely IS something your ortho neeRAB to be told.

do you know just how close ANY of your MRI findings actually even were to that cord area? was any scar tissue impacting the thecal sac? if you have your pre op MRI, could you post that summary on the very back page that has all the 'hard findings" the interpretting radiologist saw when he first looked at your films? if you do not yet have any copies of the reports from any MRIs you may have had done, you really should obtain them. there are usually alot of different findings in them that not all docs, esp surgeons will even mention to any given patient? it is a sick thing to do to us, but this IS pretty much how it goes with this stuff. i always obtain my own copies of every single radiologic type test and the hardfilms too, now CRAB, and any other types of tests i have to have done like my labs and ultrasounRAB too. you just really DO need to always read thru your own MRI reports just so YOU know what is there and what was NOT actually mentioned or told to you, esp when there has been surgery involved? esp if the same surgeon actually did all your surgeries? this is just something that every single patient who has had any testing done at all should really seriously do just so YOU know everything in the reports, and not just the bits and pieces that any given doc decides to only 'tell you" about?

you can either obtain copies from the ordering doc or the easist way i have found is simply getting them from the rad facility that DID my MRIs? all you have to do is go there, sign a relaese of information sheet and they will pop you off a copy right there since it is all stored right in the system and easily accessable. what i do NOW when i am there HAVING my MRI or whtever it is done, they have a form you can fill out at the time that tells them you want a copy of the eventual report just sent out to you to your home, then they go ahead and do just that? except you DO have to wait about ten days since they want to make certain that the ordering doc actually has spoken to the patient about their results BEFORE you get them in the mail? but just make sure you always get your own copies of anything tested. you might be rather suprised at the little bit you were merely 'told' and what are actually hard findings listed in your report. i know I have been.

but knowing what was actually impacted in the pre op MRI you had done would help alot tiff. knowing what was in that summary and word for word as the rad wrote it really helps too. depending upon exactly "how" any rad explains any given findings also does matter, alot in some cases.marcia
 
Marcia,
Thanks for getting back to me.

The pinching is deeper inside right along the spine. I had this before the surgery on my left for 3-4 months. That's why I am left wondering what the mri will show. My symptoms before the surgery just got worse and worse. My mri (results posted earlier in this thread) only showed L-5 S-1 being affected. When they got in there, I had 4 disks in a row that caused scar tissue along the nerve, so things were a mess. I must admit I was surprised at my doctor's response to my "pinching" question. When I went to my cardiologist this Monday, the nurse actually used to work with an orthosurgeon. She was so compassionate and understanding. She started listing off symptoms that were challenging for my back issues, and guess what. She mentioned that pinching feeling. So......I figured I must not be imagining it if she saw people with this symptom. Sometimes, I think doctors give answers to questions because they don't want to cause anxiety in their patients. I am sure there are other reasons, too. Like telling you what they think you want to hear. I am just the kind of person that likes to cut to the chase. I like my doctors to be up front with me as I am sure everyone else does. Keeping info from a patient is not likely to make the issues go away. I will definitely get a copy of my mri results. I know we all have a hard time trying to be our own advocate all the time with our medical issues. Unfortunately, when we don't feel good, we want to feel like we are being taken care of by people in the medical field instead of having to be on top of medical professionals all the time.
 
so sorry i kinda fell off the planet here for ya tiff, but very glad you DO have AZs experience and huge amount of knowledge to help you out here. just too many other things going on and my 'latest of ten c spine MRIs had findings i did NOT at all expect in my lower segments so have simply been researching stuff and popping in occasionally,sorry.

the one thing i wanted to ask you here is when you actually have/feel that 'spasming? is it at all "painful"(like a long cramping would be?) or more just twitching of a muscle that you stated you CAN actually see? knowing THAT would help to better define what could be actual 'spasms" or more 'twitching caused by what are called "fasciculations"? they both have their own types of reasons to actually be there, but mean somewhat different things too? is this ONLY on the side that has atrophy?

just how have things been feeling now that you are actually ON some good level of the best types of anti inflammatories with the medrol? knowing how you are simply responding to that and what you are feeling that may be changing too would help.
just some things about what keeps a good muscle 'balanced" here are calcium, potassium and esp magnesium? trying to use maybe only mag supplimants may have some impact on the levels of spasming too since this particular mineral REALLY has a ton of impact on muscle(contraction and letting go) when mag is depleted for some real reason? the other things too are important, but mag is known as 'natures muscle relaxer' for a very good reason? postassum too can be responsible for more of what would be considered to be a form of 'muscle cramping" which IS very painful when that muscle simply kind of clamps down around itself and balls up on you? but that does not appear to be what you are actually describing here?

but taking a good multi vitamen and using even a 250 mg type of actual mag suppliment per day really can possibly help here, along with either drinking alot more milk per day and or alot more cheese/dairy products too? while i have my own very real spasticity from my level of sp cord injury, my son,way back when he was going thru liver failure in 99-2000(he IS txed and doing okay now) he kept losing, for some insane reason, his potassoum one week that we found out when he kept getting charlie horse type of very painful cramping so we were placed on supplimental potassium? then the very next week, unbelievabley, all of the sudden one night like9:00pm while we were watching TV, he just said that creepy mooom?, thing that always ment 'something was freaking him out? i turned and looked back at him,and i kid you not, he was standing there while his one hand was just very violently snapping back and forth without HIM doing anything, it was then contorting his fingers and then would snap very violently into that back and forth crap again? it was the most insane thing i ever watched, honestly. well after another trip to the ER, we found out, and he STILL has this going on for some reason, his mag was barely even IN HIM anymore, it was just THAT low? for some reason low mag never showed up on his last bloodwork with the potassium crap? but it WAS now.

what i still cannot get over is just how MUCH real overall impact just having the 'appropriate' amount of mag simply IS for muscle til that insane evening? but those three things i mentioned, with calcium, potassium and that crucial magnesium really do help to keep our muscles very well balanced to try and stave off some of the actual impacts just having ANY of those minerals too depleted can actually even DO to our muscle? and these also DO very much impact heart rhythm too just as an FYI. since that heart just IS one big ole muscle of sorts, it does make alot of sense too.

sorry to off a bit off track there but really wanted you to make certain that what YOU just can control on your end just can at times also impact muscle in very direct ways too? but your surgeon just really DOES need to try and detertmine exactly what it is you really are experiencing there in that calf area, since whtever isa actullay generating this in you simply can have didfferent specific reasons too, and some would have to do with what could have been some level of damage done to motor and with that nurab foot, definitely 'some' sensory loss here too? as far as the new pain in your back goes? make certain you just ARE journaling anything having to 'do' with that with date of onset, what it actually just 'feels like" to YOU specifically,and pain levels? this could easily be just a temp type of symptom given all that was done in there, or mean something more in just how things actually even would play out from here kinda thing? but this IS one of those changes the surgeon neeRAB to know about too. and YOU would have anything about this or anything else new all well documanted in that lil journal too? that sucker just DOES help for many different reasons.

when you see him or even before, really DO tell/call the nurse or him depending, just how impactful that muscle "spasming" actually is so they will at the very LEAST actually RX something to 'try" and relax this area and within the lower back that is usually the culprit thats firing those signals, either from some motor nerve damage/affectation, or too much imflammation? hopefully the medrol WILL help some with that. if it does or does not, make certain to also note THAT as well since it is or could be very telling later on? like i mentioned before, even the most subtle symptoms/changes can mean bigger things? or nothing at all too,lol. its just the 'why' of why we need to keep track of all symptoms/changes post op. that would be something that the surgeon would truely need to really sort out as you get more well healed and what symptoms are still there kinda thing?

just a note here, but if that surgeon actually DOES finally send youf for that MRI, in this particular case, it is very 'crucial to you' that you most definitely DO actually obtain THAT possibly very revealing MRI report. surgeons, when they have done any surgery, just may not 'want to" tell the patient everything IN that report since some findings truely can ONLY be from any given surgery and no other way? it really depenRAB actually more upon ego and the levels of any findings in what YOU actually even get told. i had a horrid post op experience with my NSs gatekeeper nurse who witheld an actual dx of why my freaking pain was sooo bad on my R side(this was also TEN times worse than what i originally even started with?)? she lied to me over the phone about what the surgeon actually created with the screw he placed and actually impinged my c 7 nerve root with it? she did NOT tell me anything but insisted there was 'nothing in the report to even support "why" i was like dying in agony and intermittantly nurab"? this WAS when i had gotten my own report and man did we EVER have some 'worRAB" when i asked her about the one finding detailing that that somehow MY actual copy had? i had actully had that same copy sitting right in front of me while she told me how "wonderful' everything just supposedly was? i was really stunned she could even DO THAT? to any patient, but it happened anyways.

while i am in no way saying that every surgeon just does crap like this, you simply DO need to cover ALL YOUR bases by getting any and all reports from any testing done, esp when its a post POST OP one. but do see about that MR being Rxed for you hon(AZ gave you some good examples up there). it should have just been done upon discharge given what can simply occur with ANY ortho type of surgery with muscle and tendon. and then misfiring nerves becasue of the normal inflammatory responses at even the deeper levels too? good luck hon,and do keep us posted. sorry it took sooo long to get back to you tiff. marcia
 
SpineAZ and Marcia,
Thanks for your encouragement and insights. I did take flexeril at one point during all of this pre-op throught my urgent care visit. It did not really help my leg. I am on over 25 meRAB on a regular basis due to numerous autoimmune issues. I was afraid to pursue anything stronger since I am already on so much. I have been keeping track of new symptoms. I have been running this fever for about a week now even with the mega doses of steroiRAB, so I spent 4-5 hours at my pcp's office trying to track down possible infections. I am still having a lupus flare due to the surgery even with the stress dose of prednisone along with my typical hydrocortisone. My doctor will get back to me asap with the lab results.

I asked my neurosurgeon will talk to me tomorrow at my post-op appt.. Marcia, my left calf issue seems to be both twitches and spasms. The spasms really tighten my calf for hours. I do have lupus nephritis, so my body dumps potassium all the time. I am prescription mega doses that would be toxic to most people. I will get the other vitamin and mineral things. My labs should tell me my potassium levels.
I have no issues in my right leg with the new pinching on my right side of my spine. Marcia, I am sorry you are dealing with some things you weren't expecting. More new issues on our plates all the time is overwhelming. One day, and sometimes a moment at a time is hard enough. Take care, I am praying for everyone. We are all struggling with so much, and it makes me feel so helpless to not be able to have any worRAB of wisdom and encouragement. I will give an update after my appointment that I hope will help others.
 
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