I’m Back Again, with My Personal Blueprint for Health!

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claudia-mdHi there. It’s Dr. Louella… Yes! I’m still alive!!! It’s been over a year since I’ve posted. I’ve been through many transitions since then. For example, I now see ‘dead people.’ I do medico-legal duty which involves pronouncing people dead from homicides and accidental deaths and referring bodies for autopsy if needed. I am not a CSI (crime scene investigator) but I work with them.

On the lighter side, I have been trying to practice what I preach, a healthy lifestyle. Over my 20 something years in medicine, I’ve heard all kinds of formulas. But for my life, I just want to keep it SIMPLE. My formula for health is to lead a balanced life.

I now emphasize the basics as a lifelong approach to health. It contains nothing new, but as a natural mathematician, I need my own formula. The first four are for your physical health. The last 2 are for your emotional well being. Do not underestimate the power of either. We need them both:health-living.jpg

1.  EAT….we agree it must be done to live.

Eat regularly. Starvation is wrong for many reasons.

But eat small portions (this is key).

Eat balanced: your fruits/veggies, starches/fibre, beans/meat.

Eat a variety of foods. Who cares about ‘superfoods’? Each fruit and vegetable has different benefits which man has not yet discovered. Why go off on the latest trend? Eat them all.

Reduce sugar. Reduce fats.

Use specific vitamin/mineral supplements we are still likely to be lacking.

2.   DRINK WATER…. water is in a class by itself. Most people don’t drink enough. Drink it and drink it often. It actually is needed more than food.

3.   SLEEP….. many of us do not understand the importance of sleep. When we sleep insufficiently our brains do not function at their maximum, leaving us with slower thought processes and fatigue. Find out how much sleep you need at nights, according to what makes you function best, and schedule it!

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4.   EXERCISE….. you may or may not lose weight but exercise has a dozen other benefits. You will also live longer with less pain in later life. Exercise (power-walk, run, skip, cycle, dance, swim, kick box, weight train, do aerobics, karate, etc.) for about half hour a day, plus other routine physical activity (house chores, regular walking, gardening). If you lie around all day and then do half hour exercise, it will benefit you little.

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5.  GIVE LOVE AND RECEIVE LOVE…. to your creator, co-workers, friends, family, significant other, pets. Both giving and receiving love release the feel-good hormone, oxytocin, and improves your well being and functioning.

6.  RELAX/DO WHAT YOU ENJOY…. obviously this would make for a healthier you. Life for most of us on planet earth is stressful. When we are stressed our blood pressure and sugar can rise. Relaxation/de-stressing/fun are aspects of the human nature we cannot properly live without. Schedule breaks. Do something different. Switch your mind off work. Do something you really enjoy. This will give your body and mind time to better assimilate the work you have done and prepare you for what lies ahead. Recreate to re-create your being.

Now that there is MY blue print for me to live healthy. I haven’t got it mastered as yet. For example, I started having more fast food as I was ‘transitioning’. Now I have to practice good old home cooking to get what I need. And I am starting back to exercise…again!!!

This is Dr. Louella, over and out! From the beautiful isle of Trinidad.

Talking To The Trini Patient; The Language Barrier

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Hi there! This is Dr. Louella. I’m literally stealing time here (hope I don’t get caught). But I was just thinking how I am not sure I can be a doctor anywhere in the world besides Trinidad because of the language. Yes! The language.

Of course, we speak English here, as a first (and practically only) language, although Spanish is our second. But these patients!!! It’s pure ‘Tringlish’ (Trinidadian English; ok fine, that isn’t a word; pure ‘creole’ then).

That was the strangest part of newly becoming a doctor, for me… the communication barrier! These people used different terms and different sentence construction from me.

I was raised in central Trinidad but honestly, my family didn’t mix much.  My mum sent me to a private primary school, then I passed for a convent for my secondary education, then off to university. So I was not well exposed.

I’m frequently asked by patients, “You’re not from here?” I still want to knock  someone’s head off every time I hear that. I bet them that I am more from here than they are, because I work three minutes from where I grew up.

Some say it’s because I have some sort of an accent. What accent??? I’ve never lived anywhere else!!! One or two have tried to explain it’s just that I speak well. Ok, I can accept that.

But it’s been sixteen years and by now I can understand the patients. I also ensure that they understand me.

I understand when a granny has ‘junjuni’ (parasthesiae; i.e. pins and needles) and when her head ‘hutting’ her (i.e. is hurting her). Maybe she has an ‘inside fever’ (is feeling feverish) or perhaps the poor old dear was ‘waking’ all night (probably went to a ‘prayers’ or wake or something and got to bed fairly late.

I can even interpret when an old man says he is ‘whizzing,’ ‘Ah only whizzing doctor!’ because the elderly gentleman is wheezing constantly. I start calling it ‘whizzing’ too so he’ll have no confusion.

A real classic in Trinidad is ‘gas,’ a nuisance that reaches up as far as the shoulders and head in some patients. I explain to some that ‘gas’ resides in the stomach and intestine only, but not to everyone, because they would not believe me if I tried.

One thing that still gets me is the ‘bad feeling’. When a patient is getting a ‘bad feeling’ I don’t know if they mean nausea,  dizziness or some other symptom, so I enquire.

I sometimes come across the unpleasant cases where they are differences in terminology, such as a grandmother being distressed that her  grandson was ‘interfering’ with her little granddaughter’s ‘bajina’ (i.e vagina, i.e. a case of incest).

When you ask a Trini patient how long he or she has had an ailment, say a pain, the answer is usually, ‘A while now,’ or better yet, ‘A long while now.’ They then need to be  asked for clarification because their ‘while’ and your ‘while’ may be very different (like weeks and years!)

When someone says their ‘stomach’ is hurting I insist they point to the area. In Trinidad the stomach seems  to be anywhere from the neck to the pelvis and I don’t pretend like I know where they mean.

Recently a clerk was laughing at a patient who was saying ‘CDAT’ for ‘CDAP’ (Chronic Disease Assistance Programme, where our patients get free medicines). I couldn’t join her because that was old news for me. As far as I see, more than half of them call it CDAT and I am cool with that.

What about the (mis)-pronunciation of drugs?  Does not bother me. Sometimes I correct them but if they are elderly, I am just glad they were able to come up with something identifiable.

So! The one who has changed in all this is me. I’m quite used to their language so there is usually a smooth flow of  Trini talk between the patient and me, except when they want to know if, ‘I’m not from here!!!’

Dr. Louella, over and out. Enjoy the season y’alls!!!!

 

 

Doctor, Does This Drug Have Any Side Effects?

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Hello again. It’s Dr. Louella, just winding up my weekend here. I’m a bit tired but still very much excited that I got some time to do this post.

You see, yesterday I was musing on a young patient I had seen earlier this week. He had asked me one of the most frequent questions I get from patients.

But let me give you the context of this case first. It was another busy chronic disease clinic. The ‘patient care attendant’ told me about a walk-in patient to be seen who had chest pain.

I asked for his age. He was 22 years old. Cool. I ordered an ECG ( EKG, electrocardiograph; or ‘heart tracing’) and said that I would see him later.

A few patients later they brought a perfect ECG for me in ‘normal sinus rhythm’ with no abnormalities. Good. No serious heart problem. I saw him a few patients after that.

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He was a healthy looking young male. It was easy to make the diagnosis. He told me he had central chest pain. I asked him why (because most of the times patient already know the cause). He confessed to having lifted some heavy boxes of meat the day before.

I did a brief examination of the heart, lungs and chest wall. He had a muscular strain. Case closed.

But not quite. When I attempted to prescribe an analgaesic (pain killer) for him I was confronted with the oh too familiar question…

“Does this drug have any side effects, doc?”

I think this is where public education should step in because I am asked this question repeatedly nowadays. People need to understand these simple concepts so they can make informed choices.

I start by replying, ‘Of course. All tablets have side effects.  If you look in my book right here (the British National Formulary on my desk), each drug has a long list of side effects.

And there is no way for anyone to remember all of them. That’s why I walk with my book. Doctors usually know the most common and/or most serious effects.

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I like to refer to them as potential or possible side effects because it does not mean that you are going to get them.

Research is done so they know how many people suffer with each side effect of a drug and it is usually a very small number, like 5% or 0.5%. If many people are affected they wouldn’t allow the drug to be sold.

Now for the most, you may get one side effect of a drug. Or if you are really ‘bad lucky’ (Trinidadian for ‘unfortunate’) you may get two.

No one can predict whether you will get a side effect. It is only if  you use the drug you will know the effect. If something happens we  will deal with it. But we would not want to lose the benefit of this drug for no reason.’

Now there are some conditions where I can tell patients that using a medication is optional, such as for pain, itch or stomach discomfort but for diseases such as diabetes and hypertension which can ravage their lives, I urge them to take their pills everyday.

Many of our patients have heard from friends and family that these medication damage their kidneys and liver. They often do not take them as a result, or take them intermittently to mitigate these supposed effects.

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I stress to them that chronic diseases (especially diabetes and hypertension)  are the ones that have been proven to damage their organs. The pills are given to them to protect them.

Yes, sometimes the pills themselves can damage organs but this is rare compared to diabetes and hypertension which ALWAYS impair kidneys, whether to a minor or great extent.

People get complications and die of chronic diseases all the time. I don’t really hear of people dying from their medication. But I know it probably happens.

Our patients are also exposed to television advertisements where side effects of drugs are rattled off. But without the explanation I gave above we can see this turning people further away from conventional medicine if they believe that all these negative effects would happen to them.

The young man I saw that day accepted my prescription in the end. He understood that the likelihood of him getting a side effect of the drug was slim and we would deal with that if and when it occurs.

I also explained to him that although he was young and fit there was no reason to strain his body beyond its capacity as he had done recently because he would suffer for it. Damaged muscles often take several months to heal.

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Unlike the young man, some patients turn to alternative medicines. They are free to do so but I let them know my position on it.

I let them know that the medicines we use originally came from plants but they have been purified and from them synthetic ones were made.

All our drugs are extensively researched and the effects documented. Yet allopathic medicine is still far from perfect.

Many herbal products are not purified and contain several chemical compounds with varying effects. There is very little in the way of formal study of these chemicals.

Claims are based on anecdotal accounts (of people’s personal experiences) rather than on large controlled studies. Anyone can sell anything and claim anything about them because there is no regulation of these products. But not everything ‘natural’ is safe.

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But the thing is, it’s not that herbal products don’t have side effects. It’s just that the people distributing them don’t know, so everyone pretends like they don’t. And when people experience them, does anyone sue the herbalist? No! But sue your doctor, because he is rich!

Never mind that, if you see Dr. Louella dying, bring me the tablet, bring me the ‘erb, the weed, bring anything!!!

But while I’m living and can make a rationale choice, bring me the evidence to support your medicine!

Dr. Louella saying, do enjoy your day! Laugh! Sing! Dance! … I do!!!

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Once I Had a Naked Patient

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Hi. It’s Dr. Louella on a Saturday afternoon. I just remembered this doctor-patient story. It is a classic and I love to tell it.

I was at work in a rural health centre in deep south Trinidad. I had only worked in the community about two years then.

I was attending to patients, when the nurse called me, for some emergency I presumed. I started to grab my stethoscope. She said I wouldn’t be needing that but refused to say what the problem was.

Of course, I became suspicious, but not for long. As soon as I stepped out my door and unto the corridor I saw a naked female  in the waiting area.

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I looked again. Yes! There was a young woman in her forties of African descent butt naked, as they say, standing among the seated patients in the health centre!

So naturally I was shocked and disturbed and thinking, oh my God, what am I supposed to do? The doctor is always in charge, right?

The history was that of a mentally in female walking in off the streets without any clothes. The only real experience I had had with psychiatric patients was in medical school. Mentally ill patients were seen in a separate clinic at another centre.

Ok, so we had to do something. All the other patients were staring and it was causing quite a commotion.

All the clothes we had were on our back but nurse got a yellow surgical gown. It was a task to convince the patient to put it on but eventually she complied. What a relief! Remember, everyone was watching and listening and commenting.

We decided that she needed to be taken to hospital. We would call the ambulance but she had to be sedated first. Another task!

We got her to go with us into the treatment room. I had researched how much CPZ (chlorpromazine) to give. We used 100 mg and thankfully she fell off to sleep.

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She reached her destination but unfortunately it was said that she jumped out the ambulance and ran off into the town as soon as she did. I didn’t give enough CPZ! Hopefully she kept the gown on.

All that drama took a while but of course I had to resume seeing patients. I will never forget one of them, this elderly gentleman, smiling from ear to ear saying that he enjoyed the show. Dirty old man!

One has such amazing experiences as a doctor! Trouble is you are usually the one expected to fix the situation. I do it. With all the terror inside, I still do it.

Enjoy the rest of the day folks. This has been Dr. Louella down memory lane and back. Laterrrr!

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Ew! Sometimes It’s Yucky Being a Doctor!!!

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IMG-20140910-WA014Hi! It’s Dr Louella again on a cool Thursday evening (at least with the a/c on) here in our beautiful island of Trinidad. I want to recount this story from work because it definitely impacted me. It entailed basic medicine, yet it was quite unique and reminded of how unglamorous a doctor’s job often is.

This was about a week ago, in a clinic dedicated to children at the health centre. My morning had been busy, because there was an asthmatic emergency, along with routine cases and those without appointments.

The asthmatic was not settling down and needed transferral to the emergency centre. Securing an ambulance is not easy nowadays and we were relieved to get one and send her off.

There was a lull as clinic was almost over. I thought I’d grab a quick lunch in the kitchen.

Some nurse or other had tried to tell me about an adult patient they wanted seen, an amputee. Honestly, I did not pay much attention at the time because I was tired. But as I picked up my lunch bag I knew I would have to assess the situation before settling down so I went in search of the patient.

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She was easy to find. The female patient was seated on a wheelchair just outside the screening room. She was in fact a double amputee and had only two stumps without knees. She was flapping here arms up and down. One female relative beside her was panicking.

I identified myself and tried to bring some order to the situation. I enquired as to why they had brought her. There was a bit of rambling but from what I could decipher the elderly wheelchair-bound patient was well the day before but started shaking violently today.

Then I heard the word ‘fever.’ I was very glad that I did. I asked the nurse to include a temperature with the screening and explained to the relative that if she indeed had a fever then this would most likely be chills she was having.

Of course, she wanted to know why she would have a fever. I explained that a simple viral illness (or ‘the virus’ as we say it in Trinidad) could be the cause but when I attend to her I would be looking for a source of infection to make sure that is not the cause.

Whilst having lunch they gave me her temperature as 39 degrees Celsius. That was pretty high so she did have a fever. I ordered two Paracetamol (acetaminophen) for her and said I would see her shortly. I could not order a cold shower.

fever-thermometer-11947388While still eating I found out that this patient’s relatives had been trying to accost the ambulance attendants for our asthmatic patient to take their mother down to the emergency facility even before she had been seen by a doctor.

It seemed quite strange to me that they would behave so desperately. I was glad I had taken a little time to explain to them that it was most likely something minor.

I didn’t spend any extra time in the lunch room that day. But now I wish I had. I went to the office, called the patient and they wheeled her into my office.

The door was still open as they were positioning her wheelchair when she lurched forward in what I thought was a sneeze. Then I felt wet stuff on both my forearms. I flew out of my seat and sprinted to the wash basin about 5 feet away.

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I could not help it. I got into protect-me mode. I continued scrubbing my forearms intently until I felt clean again. I did not pay any attention to the patient and the relatives at this point. I had heard them mentioning something about vomit.

When I returned to my seat there it was. The old lady had vomited all over her clothes, the wheelchair handle, the wheel and the floor. They had a vomit bag for her. They had gotten it from the nurses when I was busy cleaning myself.

I quickly realized that I could not continue this consultation with things in this state. The wheelchair was rolling in vomit. I excused myself to find one of the cleaners.

Well I found them, but both cleaners were having their lunch in the kitchen. One asked me to relocate because they would not be coming right away. I had no choice. I could not talk to these people while staring at and smelling vomit.

(It is only when everything was over and I was recounting the events to some nurses later that they pointed out to me a few spots of vomitus on my pants. Of course I was disgusted and did a make-shift cleaning. I couldn’t wait to fling those filthy trousers to be washed.)

At the time I felt all clean, though. But I had to ask someone to leave a room for me to use it. A clerk was using one of the doctors’ offices as we are short of doctors this month so I borrowed that room and the relatives wheeled the patient over.

I understood from one daughter that it was whilst the patient was being bathed that morning that she began complaining of feeling cold and started to shake. The shaking grew worse as the day progressed. With the vomiting she was now convinced that it could be “the virus”.

The patient had had one leg amputated earlier this year and one three years prior. They were all properly healed and there were no signs of infection on the stumps. She was diabetic of course.

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Examination was otherwise normal, including the chest. I confirmed my presumptive diagnosis of a viral illness and gave her medication for vomiting (“Gravol” – dimenhydrinate), rehydration salts (Gesol) and more Paracetamol. I advised on increased fluid intake.

I was pleased with my management of the patient but I still felt a little shaken. It reminded me of other exposures I have had from one of the fattest needles ever going straight through my finger; to a needle stick injury with a confirmed HIV infected needle and my developing a fungal rash on the forehead from being kicked by a baby’s booty.

But what can I say? Every day is not the same. This one could not have been prevented but we take precautions whenever we can. Importantly, I was able to bring some assurance to this family.

I will bring you more interesting cases as I explain the some of the medicine behind it as well as the social aspects.

Life is still more than good. It is great and terrific and we must ever have gratitude that we live! Catch you later… Dr. Louella!!!

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Doctor advise us! This man’s blood pressure is very low!!!

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Hi. It’s Dr Louella. I had an awesome time dancing in church today. I promised to tell you about a sweet elderly gentleman in “Caring for others more than they care for themselves part II.” Well this is it, but with a different title.

The new title reflects how they bombarded me that day, as soon as I dropped my bags in my office. When I walked into the screening room last Wednesday, I was accosted by nurses.

They were sorry to disturb me so early but they wanted advice on an elderly man with a very low pressure. Now we hardly ever get patients with low blood pressure as a problem; unless they are in heart failure or it is from blood or fluid loss or a severe allergy.

This old timer was a regular, they said. He had been seen for low blood pressure before and had already been  referred to hospital. I looked at the BP. It was for real, 59/35. That’s quite low. I looked at the man. He looked terrible, really sunken in temples and cheeks. He looked like a homeless person.

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He was not out cold so he could speak. He complained of dizziness and some weakness. Said he was 72 years old. First thing that came to mind is if he had had breakfast. Yes he did, was the reply, after I had identified myself. He had had a coconut water. (Ok, so now I knew he did not have breakfast).The nurses had started giving him water to drink. I said, “Let’s get this man something to eat”. All we had were his crackers and my slice of chocolate cake (my lovely cake that I had baked from scratch and brought to have as a snack).

We moved him to the treatment room and gave him these things to eat. I proceeded to find out what his normal diet was like. Turns out he was married, his wife died and he lived with three subsequent women after that, all of whom had died. He has eleven children, who visit him from time to time but he lives alone. He drives his own vehicle.

He often neglected his meals now that there was no one to care for him and did not go through the trouble of preparing anything. He drank about quarter of a 1.5 litre water bottle a day. He sometimes felt weak when going to his garden.

So I was wrong about one thing. Here was no homeless person but a gentleman with the means to take care of himself but not the will to do so. I stressed the importance of regular meals and lots of water and asked if he wouldn’t mind a visit with our dietitian to advise him on meal planning.

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Water is needed for blood. It makes up about 50% of it. When we are dehydrated the blood volume decreases and there is less blood for the heart to pump so blood pressure drops. Eating helps the water to remain in the circulation by providing salt.

I explained that he found difficulty going to the garden because his muscles were weakened by old age and without eating and drinking he would feel much weaker. He was interested in avoiding that.

As soon as he had eaten the snacks he wanted to leave. I had to say “Slow down pappy. That food is not digested so it cannot benefit you as yet”. He himself admitted to still feeling somewhat ill.

I realised that with all this talk I did not do a physical exam on this man. When I did, I found him to have a bradycardia, an unusually slow heart rate. His was 48 while the normal heart beats between 60 and 100 beats per min.

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Here was another cause of a low blood pressure. I ordered an electrocardiogram (ECG or EKG), or heart tracing. It was normal except for a heart rate of 54. He was not on any medication.

I was now able to explain to him that his slow heart rate was most likely responsible for his low blood pressure. But this becomes exacerbated when he is dehydrated. Also when he does not eat, there is less salt to keep liquid in the circulation.

I explained that if his heart rate decreased further to the point where he could not support a decent blood pressure he would need a pacemaker inserted in his heart. He reacted strongly to that because in no way did he wish to go to hospital.

After a couple hours I felt pleased to see our elderly gentleman walking out of the centre, looking and feeling much improved, and with a blood pressure of 105/65. I’m sure that he would now be more empowered to manage such episodes. I’m also sure we’ll be seeing him again, if even for an update.

My next case will be what the doctor does when threatened by someone else’s body fluids. Does she save herself or play the brave doctor? My next post will tell. Bye for now! Dr Louella.

 

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Caring for Others More Than They Care for Themselves Part 1

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Hi folks. Dr Louella is back after a long break!!! I was busy getting married and settling into this new phase of my life (at this age).

I’ve always been looking for a new approach to this blog and I finally hit upon it. I plan to use my numerous unique patient experiences to teach about medicine, and by extension, life.

I have two interesting, touching cases to bring to you to demonstrate the title of this post and the medicine that goes along with it. The second case will be in the following post.

Now the part of medicine that I really enjoy is relating with the patients. I am different in this regard from many doctors I know. I take the time to find out about my patients and work with their situation. That’s one of the reasons why I am such a good family doctor.

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Just yesterday (Oct 6, 2015) we had a chronic disease clinic on work. Clinic was practically over when a nurse came to ask me to re-write an insulin prescription for a diabetic patient. She was an amputee. He husband had broken her insulin vial. He had also put her out of the house and she was staying with a cousin.

I was about to re-write it when she also revealed that the patient had missed her appointment and had come to get a new one. She was in the car.

Well, I thought that the only humane thing to me was for me to attend to her one time. But it was not that easy because this patient believed herself to be inappropriately dressed and refused to get out of the car.

To speed things up I said I would go outside and have a look at what she was wearing. I thought it was fine, a dress with a tube top, and reassured her.

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