Tag: medication

Monday, July 19th, 2010

Misdiagnosed with Rheumatoid Arthritis (RA): My Lyme Disease Story

As some of you may have heard, I just recently found that I was misdiagnosed with rheumatoid arthritis (RA). I have Lyme Disease.

Anyone who has followed this blog probably knows that I thought that I had Rheumatoid Arthritis (RA) for over 9 years. I have always had some doubt about what was going on with my body and the effectiveness of the treatments the doctors were prescribing. But I trusted my doctors more than I trusted my instincts. My story is a cautionary tale for anyone who has been diagnosed with an autoimmune disease.

Let me start by saying that we live in rural Rhode Island. We have a small 3/4 acre wooded lot. All sorts of wild life can be found in our yard at any given time and there is no shortage of deer that visit our property. We moved out here to raise our family in a quiet, serene place with good schools and friendly neighbors. Unfortunately, with the good comes the bad, and the deer carry ticks that carry Lyme Disease.

Each member of my family at one time or another has had Lyme Disease. It is not uncommon to be outside for only a few moments and pick up one of the poppy seed-sized ticks. For the most part we have all either tested positive with Lyme Disease or the tick if we were able to keep it tested positive with the disease.

9 years ago I had been bitten by a tick. At the time, I was tending to my newborn son, and had two older boys to watch over as well. In prior exposures to the disease, I had felt “flu like symptoms” and that was my cue to get tested. I don’t know if it was adjusting to three boys and 2 jobs or if I was just too busy to notice, but I really don’t remember any “flu like symptoms”.

It started with my ankle. It hurt and was swollen so I went to the urgent care center where they X-rayed it and told me they could find nothing wrong with me. The doctor prescribed an anti-inflammatory and gave me and air-cast. We were going with the assumption that I must have sprained my ankle even though I couldn’t remember doing anything out of the ordinary.

The swelling did eventually go down on my ankle but shortly after my knee on the opposite side started swelling. Ice, rest, and ibuprofen seemed to help with the swelling in my knee. Then, my wrist on my left hand began to swell. My husband and I were discussing the weird joint issues I had had over the previous few months when he suggested that I go get a Lyme test. I thought that it couldn’t hurt, so off I went back to urgent care for a Lyme test. The Lyme test came back positive and the doctor gave me zythromax.

Unfortunately I did not get better after taking the antibiotics, so I went back to the same doctor who gave me another course of the same antibiotic. When after finishing the second course of medication and I was not improving, the doctor said to me that this was beyond his level of expertise and I needed to see either an infectious disease specialist or a rheumatologist. He felt that I should start with a rheumatologist because if it was Lyme or something joint related a rheumatologist would be the best choice. He gave me the name of a rheumatologist and sent me on my way.

The rheumatologist seemed nice; he listened to my story and took a medical history. It may be my perception of what happened next, but it seemed to me that the minute he heard that my mother had rheumatoid arthritis (RA) his mind was made up. He told me that more than likely it was RA. He examined me and put me on prednisone immediately. When I asked about the Lyme he said that it was very unlikely that I had Lyme and that he was fairly certain it was RA. He told me the steroids should get the inflammation under control and ordered some blood work.

The blood work came back and showed that I was positive for RA. What I did not know then that I know now is that an active infection like Lyme Disease can affect the test results for RA.  He gave me a prescription for methotrexate, talked to me about Enbrel, and sent me home with a handful of pamphlets.

To be completely honest, I never felt comfortable with the diagnosis, but I somehow talked myself out of trusting my instincts by comparing his knowledge on the subject with mine. His practice was a teaching practice with Brown Medical School and I felt like he should know more than me on the subject. I really trusted that he knew what he was talking about. I have beat myself up for not going with my gut many times over the years on this topic.

Over the next several years I just seemed to get worse. Every time I brought up the fact that I was not really improving he would tell  me that the first several years with the disease are the worse, when the most damage occurs and that we needed to increase the medication. For a while he really had me scared. He would say things like “We don’t want to see you in a wheelchair, do we?”. After way too long I decided to find a new rheumatologist.

I took my time looking for a new doctor. One I went to yelled at me when I told him why I was looking for a new rheumy. Turns out he was friends with the one I left. I finally decided on a rheumatologist who I was told was well versed in Lyme disease.  She had plenty of posters on the walls of the office with picture of both damaged joints and Lyme disease bulls-eyes. I discussed my story with her and she felt I had rheumatoid arthritis as well. She decided to add Plaquenil to the cocktail and that did seem to improve how I felt. The disease seemed to ebb and flow with the increased mtx and plaquenil combination. There was never a time when I didn’t feel sick.

Over the years I have had some symptoms that no doctor has been able to  explain. I have had extreme sensitivity to light and sound. It’s like having a migraine without the headache. I have ear pressure so it feels like I am in an airplane all the time. I have also had other more traditional RA symptoms (i.e.  joint swelling, pain, fatigue)

Last summer everything came to head when Kevin had a bout of the swine flu and I had to go off the methotrexate. I had to take antiviral medication for 3 weeks, and immediately following that I got bronchitis and was on antibiotics for two weeks, followed by 3 more weeks of antiviral medication because Nathan got H1N1, and finally 6 weeks of antibiotics because I got bit by another tick. I tested positive for an active Lyme infection and stayed off the mtx for another 6 weeks. After 14 weeks off methotrexate I felt surprisingly good.

The doctor told me to start back on the methotrexate, and being the dutiful patient I did what I was told. After 2 doses of the methotrexate I felt like I was back in Lyme hell. I went to the doctor and I told her I was not going to take any more mtx. She order more tests, including a new Lyme test. A few days later my primary care doctor’s office called to tell me that I tested positive for Lyme and I needed to start antibiotics. I was surprised that I had not heard from the doctor that ordered the test, so I called my rheumatologist office to find out what was going on.

She told me I did not have Lyme disease. She said that it was a cross reactive protein and ordered more tests. I again brought up the long ago Lyme test that started this RA nightmare and the look on her face scared me.  She looked frightened. She claimed that there was nothing from the previous doctor that mentioned Lyme disease. ( I know now that this was untrue because when I requested copies of my medical records from her office the previous rheumatologist did sent his notes on the Lyme and that he felt it was a false positive.) Over the next several weeks as I felt worse she ordered more and more tests, she managed to rule out quite a few different ailments and still could not explain the Lyme results. Finally, I got tired of being poked and went to see my primary care physician and asked her to put me on antibiotics. She agreed that there was no harm in trying antibiotics and if I felt better than it must be Lyme.

After 2 weeks on the antibiotics I started to feel normal again. After 3 weeks I felt better than I had in years.  The inflammation was almost gone. I walked with a spring in my step. I felt really really good. One day I was going about my daily routine and I stopped myself in mid-stride because it was as if I had been in the situation before. It was the most beautiful deja vu that I have ever experienced. As it occurred to me what I was reliving I began to cry. I felt the way that I did BEFORE. Before the rheumatoid arthritis diagnosis. It was as if time had melted away and that I was the old me, the healthy me. That moment will stay with me forever.

In that moment everything changed for me. I decided that I was going to investigate Lyme disease. I wanted to find out if this had happened to anyone else. What I found was that everyday people are diagnosed with chronic autoimmune diseases that really have Lyme disease because of the ignorance of some of the medical community about what Lyme Disease is and what it can do.

I took my time and thoroughly investigated several doctors. I knew after doing my research that I needed to find a Lyme Literate MD (LLMD). I got references and asked questions about each one. I decided that I wanted the opinion of someone who was respected in dealing with Lyme not only by his colleagues, but also by his patients. After quite a lot of research I found the doctor I felt comfortable with. It took me 2 1/2 hours to get to his office but I didn’t  mind the drive if it meant that I would get some answers. I figured if he told me that I did not have Lyme disease, I would believe him, and I would move on from there. I needed to know once and for all if I had Lyme disease or something else.

I spent 90 minutes with this doctor discussing the past nine years of my life. Every tick bite, every treatment, everything. When all was said and done, he said to me that it was no surprise that I did not feel better after the original doctor put me on a Z pack for 5 days and then repeated the process; it would not have done anything to fight Lyme Disease.  He felt very strongly that after I described all of my symptoms and heard all my treatments that I have Lyme Disease and never had Rheumatoid Arthritis.

I left the LLMD’s office overwhelmed. I could not hold back the tears. 9 years. 9 years that could have been so different. 2 of my children don’t even know what I was like before all this happened. I am angry and sad. I want as many people as possible to know my story because it could be there’s as well. I am not the first person to be diagnosed with Rheumatoid Arthritis that has Lyme disease and I am certain not to be the last.

My new doctor offered no guarantees. He told me that this is going to be a long, hard battle. The very last thing you want to do to treat Lyme disease is to weaken the immune system. We have a lot of work to do. I was prepared for that.

Today I have something now that I did not have 10 days ago.

Hope.

My final thought to anyone that ever had any doubt about whether or not they had been “cured” from Lyme disease,  or had concerns about their current autoimmune disease diagnosis is to trust yourself, trust your instincts, and if it feels wrong it probably is.

As a side note, as of this writing I have been on antibiotic therapy for ten days. The results are that at least half the inflammation if gone from my joints. I don’t need any more proof than that.

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Thursday, May 20th, 2010

Rheumatoid Arthritis: How My Journey Began

When I started this blog the idea was to talk about what works for someone with rheumatoid arthritis.  I wrote a fair amount of posts about what foods and herbs help to fight inflammation and a few about the products that made my life with RA a little easier.  All in all I have been pleased with what I have shared and learned along the way about RA.  I hadn’t planned on all the amazing women and men that I have met through this blog that have given me strength and support. That was an unexpected blessing.  To all of you I am truly grateful.

It occurred to me that I really have not shared my story.  How I got to where in am now and the questions that I have been wrestling with lately.  I haven’t written much because I was hoping to have some answers to report instead of more questions.

So I want to take a step backward and start at the beginning, because  how I got here is important.   I didn’t know until recently how important.

About 6 months after Kevin, my youngest, was born my right ankle started to swell.  I hadn’t twisted it. I hadn’t fallen.  There seemed to be no explaination as to why it was swelling and why it hurt. So I went to an urgent care center where they took and X Ray and really could find nothing wrong with my ankle.  The doctor told me I must have sprained the ankle and gave me an air cast to wear for several weeks with some anti inflammatory drugs to take and sent me on my way.  I followed his instructions; I stayed off the ankle as much as possible, I iced it and I took the medication.  Eventually the ankle improved.

Almost as soon as my ankle improved, my left knee started to swell and hurt.  I thought maybe that I had been over compensating for the ankle and had somehow thrown my knee out of whack.  I iced the knee and took anti inflammatory medication and rested it as much as possible and it seemed to improve after about a month or so.

Shortly after my knee stopped bothering me my left wrist began to give me problems.  It really hurt and was swelling a lot.  I thought maybe that I had carpal tunnel because I spend a good amount of time everyday typing.  I went back to urgent care and they seemed to agree that this could be carpal tunnel and they gave me some wrist guards to wear.

I wore the wrist guards as instructed, took more anti inflammatory medication  and hoped for the best.

While my body was giving me all this trouble I was trying to raise a 10 year old, a 6 year old and a new baby boy.  I was exhausted all the time, but at 35 I figured that I was not as young as I used to be and now I had 3 boys needing my attention, a full time job and a business to run with my husband.  I certainly had a full plate and there were plenty of reasons for me to be tired all the time.

My husband works outside all the time and Lyme disease is something that I thought we were pretty familiar with.  It was Eric who thought that maybe it was Lyme disease that was causing this joint swelling.  It is typical for Lyme disease to kind of skip from one spot on the body to the next wreaking havoc. So a few days later I was back at the urgent care center asking for a Lyme test.  The doctor asked me if I remembered a tick bite and I really didn’t.  We live in a wooded area and there were many times that I have been bitten by ticks. We are really careful with deer tick and I am fairly sure that if I had seen a deer tick in me I would have been tested immediately.  The thing is some of these ticks are the size of a poppy seed.  It is within reason that I could have been bitten by a tick the size of a poppy seed in a location that I could not readily see and not know it.  It doesn’t hurt when they bite.  So it is completely possible that I could have been bit and not known it. That was really not what the doctor wanted to hear but I was able to convince him to give me a Lyme test.

Anyway to make a long story longer… after about a week the test came back positive for Lyme disease.  The doctor put me on zythromax for 5 days.

After two weeks I was still not feeling better.  My wrist was really bothering me and the swelling was so bad that I actually lost the ability to give a thumbs up.  There was so much swelling in my wrist that the ligament that moves the thumb was lifted from its initial location (because of the swelling) so that I could no longer give a thumbs up.

I went back to the doctor and he put me on another course of zythromax with some new anti inflammatory medication and sent me on my way.  He told me to give it another two weeks and I should be feeling better by then.

By the time two weeks had passed not only was my wrist swollen and painful but now my feet were swelling and my knee was back to giving me trouble again.

When the doctor took one look at me and knew that the current course of treatment was not working.  He said to me that this was beyond his level of expertise.  He said that he could send me to a infectious disease specialist or he could send me to a rheumatologist.  He felt that the rheumatologist was probably the best way to go because a rheumatologist could handle Lyme disease as well as any arthritis issues that I might have. He said that there was a new rheumatologist in Providence that he had heard good things about and he set up an initial appointment for me and wished me luck.

This is how my journey began.

Stay tuned to hear how we progressed to where I am today.

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Friday, July 17th, 2009

Methotrexate for Rheumatoid Arthritis: Long Term Use Considered Safe

The results of a recent study published in the Annals of the Rheumatic Diseases indicate that the drug methotrexate (MTX) appears to be safe for long term treatment of rheumatoid arthritis.  This conclusion was based on data collected from 88 studies that involved patients treated with methotrexate for at least 2 years.mtx 001

Methotrexate is classified as a disease-modifying anti-rheumatic drug also known as a DMARD.  Methotrexate had been used to treat psoriasis and cancer prior to its approval by the U.S. Food & Drug Administration in 1988 to treat rheumatoid arthritis. It is also used to treat other autoimmune diseases including ankylosing spondylitis, psoriatic arthriis, lupus and vasculitis. It can take from 6 to 12 weeks to feel the full effect of this medication.  Taken once weekly via either 2.5 mg tablets or self injection,  methotrexate blocks certain enzymes that affects the production of folic acid which is necessary for growing cells. Therefore it is necessary to take folic acid suppliments while on methotrexate.

It is important to avoid drinking alcohol while using this medication because of the increased risk of liver damage.  Methotrexate can cause abnormal liver function so it is necessary to have blood work monitoring done every 8 weeks. The 88 studies concluded that 13% of people taking methotrexate experienced elevated liver enzymes however only 3.7% had to stop using the drug due to liver toxicity. Other side effects include nausea, vomiting ( may be based on the dosage), mouth sores, rash, diarrhea, blood count abnormalities,  persistent dry cough, unexplained shortness of breath, cirrhosis of the liver ( rarely), gradual hair loss, and sensitivity to sunlight.  Some over the counter and prescription medications may increase the toxicity of methotrexate so it is important to check with your doctor or pharmacist before taking any additional medication. Methotrexate can cause birth defects and can cause complications during pregnancy.  It should not be taken if you plan on starting a family.

Patients in the study experienced side effects but usually mild. Methotrexate rates of discontinuation were less than gold, sulfasalazine and penicillamine but more than plaquenil in this study.

Of the 88 studies only 2 assessed the relationship between methotrexate and cardiovascular disease. One study concluded that there was no increased risk of cardiovascular disease, the other suggested that there may be a reduced risk.  There was no increased risk of infections linked to methotrexate.

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Thursday, July 9th, 2009

The Swine Flu (H1N1) At My House

I had planned on doing an update on any news regarding the swine flu for a while now.  I planned on keeping up to date on the spread of the virus and certainly a reminder update when it got closer to flu season for those of us in the Northern Hemisphere.  What I hadn’t planned on was the swine flu hitting my home so soon.  As of the writing of this post we have been dealing with the swine flu for 10 days now.  This morning”s paper announced that another Rhode Islander has fallen victim to this virus.  We are told that she had an “underlying medical condition”.

Late Sunday afternoon a week ago my 9 year old son Kevin started to get quiet.  He was just not is usual bubbly self.  He is normally a very active chatty boy.  My little firecracker.  He started slow down quite a bit and I even found him sound asleep in the middle of the day.  Not at all like my Kevin.  My motherly instinct new that something wasn’t right.  As the day wore on he seemed to lose his appetite and was way too quiet.  His color was off, he looked pale to me.

Later Sunday evening I went in to check on him and he felt really worm.  I took his temperature and it read 104.  Not a number I am comfortable with, but Kevin is my third child and I have seen dozens of times when one of the kids would spike a temperature only to have it go back down 24 hours later with no explaination.  I knew what I needed to do.  I gave him some ibuprofen and put a cold compress on him and gave him plenty of fluids.   The ibuprofen seemed to bring the temperature down but only down to 100.2.  I knew then it would be a long night.  Every hour I checked his temperature, made sure that I kept a cool compress on him and watched and naturally worried.  He seemed to be out of it the next morning, but then again Mom had been into bother him many times the night before.

First thing the next morning I started asking questions, Does anything hurt? Do you feel achy?  Do you have a head ache?   He said no he just felt cold.   I suspected  that was his fever that was making him feel cold.  I continued to monitor him and by the end of the day his fever seemed to have broken and I thought it was just one of those 24 hour things that kids get.

Boy o boy was I wrong .

The next few days he had no fever or aches or pains just coughing and coughing and more coughing, post nasal drip and stuffy head. Night after night coughing all night long.  He had no appetite but I was grateful that he was drinking plenty of fluids.   Although I was not happy about his cough I was not overly concerned by it either.  I gave him some cough medicine.  I thought that he had caught a summer cold.

Then late Thursday evening he started with another fever.  This time the fever was only 102.  I knew at this point it was neither just a cold nor a 24 hour thing.  He needed to see a doctor.  This thing was not getting better on its own and now he’s got fever number 2.  The first thing Friday morning I called the pediatrician’s office.  We were lucky and got a 10:00am appointment.  On the way there Kevin starts telling me how much better he is feeling. I still wanted the doctor to take a look at him.

We got into to see the doctor and after a thorough check up he announces that Kevin has all the symptoms of the swine flu.  He tells me that he is  seeing a dozen cases every day and they all seem to follow the same pattern. Initially a really high temperature that seems to pass after about 24 hours followed by cold like symptoms and then a secondary fever with contiunuing cold like symptoms. He even had one patient in the hospital with this virus. He also tells me that the state is not testing anymore because it is too expensive for so many mild cases of this virus.  He said that the only time that the state would test is if the patient ended  up with complications that cause them to end up in the hospital.  He  then tells me that Kevin has seen the worst of it and there is really nothing to do but keep an eye on him and if he gets worse come back in, but he didn’t anticipate that happening.

I actually asked the doctor if he was sure that it was the swine flu.  I just couldn’t believe what I was hearing.  After the shock wore off I asked the doctor if I should be concerned because of the medication I take for my RA.  He suggested that I call my rheumatologist immediately which is exactly what I did.  She put me on tamiflu for ten days and wanted immediate blood work done to check on my white blood count..

While we have spent the better part of 2 weeks now coughing and sneezing with tissues galore in my house,  this was according to the doctor a really mild case of this H1N1 flu virus.  The doctor’s say that we are actually lucky to have caught this virus now when the symptoms are mild so that our bodies have the chance to build up a resistance to this virus come flu season.  I want everyone reading this to know I am very concerned how bad this will be during flu season.   If what we have experienced is mild I for one cannot imagine what severe of even a normal case of this virus is like.  When the flu vaccine is available I would suggest that everyone get it.  You do not want to get this virus.

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Friday, March 27th, 2009

What Rheumatoid Arthritis Has Taught Me: Lesson #2 Patience

RA has forced me to learn to be patient.  I have had to be patient with my medication and with my body. Patience in doctor’s offices, waiting for test results, and for prescriptions to be filled has been a difficult lesson. I wish I could say that I readily accepted the fact that my life was changing and that I would need to become a patient person to deal with all that lay ahead.  That was not the case.  I spent a lot of time just being aggravated that things took me so long to finish, or that the meds I am on were taking forever to start to work.

Some lessons come easy and some don’t.  Becoming a patient person has not been easy for me.  RA has given me no choice. It took almost 2 months before the methotrexate started giving me some relief from the pain and stiffness. The very last thing I wanted to hear from my rheumatologist was to be patient and that many RA medications can take from several weeks to several months to take the full effect.  I wanted to take a pill and be better.  Wasn’t that why I was going to the doctor in the first place?  I wanted him to make me better NOW not 2 months from now.  I don’t know why I was so dense about the whole process.  I have watched my mother for years deal with these issues.  I guess I thought I would be different.

I spent a lot of time feeling frustrated because I could not control the basics in my life.  I could no longer just finish a project in what I felt was a timely fashion.  Each project needed to be done gradually so that I would not over do things and be out of commission for several days recovering. At some point I had to accept that my body has limitations now.  I have to do things differently and that means I have to be patient. Things take longer now.  Because repetitive motions can be painful, I can do some and then I need to rest a bit.  Because staying in one postition too long can be painful, I need to sit for a while and then get up and move around.

I have chosen to be patient now and accept that my life is going on a slower path than I had planned.  I do not want to waste any more energy on something that is completely futile.  I think that somewhere along the way I had to give up trying to control things and just trust that there is a reason for all things and with patience I will understand what that is.

I think that Brian Adams put it beautifully…

“Learn the art of patience. Apply discipline to your thoughts when they become anxious over the outcome of a goal. Impatience breeds anxiety, fear, discouragement and failure. Patience creates confidence, decisiveness, and a rational outlook, which eventually leads to success.” -Brian Adams

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Saturday, March 7th, 2009

Sleep and Rheumatoid Arthritis

sleeping-oneLack of adequate sleep is a common problem for many people with rheumatoid arthritis.  Most healthy adults need 7-8 hours of uninterrupted sleep. People with RA can need up to 10 hours of rest.   There are several factors that can contribute to sleep issues for people with RA. Medications such as steroids can interfere with sleep.  Chronic pain is another common reason for insomnia. Too little sleep can weaken your immune system, increase fatigue and lower the pain threshold which increases your perception of pain. 

To improve the outlook for sleep:

  •  Set a routine; go to bed and get up at the same time each day. 
  •  Prepare your room for sleep; make sure the temperature is comfortable for sleep 
  •  Keep your room free from stimulating activities such as television, video games, or computer 
  •  Limit caffeine, alcohol, tobacco, chocolate to 6 hours prior to bedtime
  •  Try meditation to calm and center the body/mind before sleep
  •  Try milk with honey: Milk has a natural sleep inducer (tryptophan)
  •  I found myself having difficulty moving and turning  at night. What worked for me is silk pajamas.  I can move  and turn easily because the covers don’t stick to my pajamas

 

If you have tried all these things and you are still experiencing a restless night’s sleep, talk to your doctor.  It is important to communicate with you physician any difficulties that you are experiencing.

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Monday, February 23rd, 2009

RA Treatments Require Patience

purple-clockRheumatoid Arthritis has forced me, whether I like it or not, to become more patient; with myself and my medication. When you are hurting and want relief the last thing you want to hear is to be patient.  Unfortunately that is exactly what you need to do with many RA treatments.  Methotrexate (Rheumatrex, Trexall) starts to work faster than the other DMARD’s (Disease Modifying Anti-Rheumatic Drugs) in about 3 to 6 weeks.  Hydroxychloroquine (Plaquenil) originally used for the prevention of malaria can take up to 6 months to reach the full effect.  With Sulfasalazine (Azulfidine) symptom relief can take up to 3 months.  Gold (Myochrysine and Solgana) injections take 3 to 6 months before they have an effect on symptoms.  The class of drugs known as biologic DMARD (Disease Modifying Anti-Rheumatic Drugs) include Enbrel, Remicade, Humira, Kineret, and Orencia. These medications can take from several weeks to several months to achieve the full effect.  Some of these medications are taken in conjunction with one another, so that may influence the time it takes to start feeling improvement.  If you are not seeing or feeling results from your current course of treatment, discuss it with your rheumatologist. 

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  • Jo-Ann Colburn: Kelly, I will email you the name and address of my...
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