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MRI results

I was sent for an MRI because of really bad neck pain and paraesthesias in my hands, a previous MRI showed degenerative disease within the cervical spine. Please could you explain the MRI report to me and what the treatment options are?
There is mild canal narrowing and  there are multilevel degenerative changes with disc narrowing and prominant posterolateral osteophytes particularly at level C4/5 C5/6 C6/7.There is no evidence of cord compression.There is no abnormal signal intensity within the cord. There is marked foraminal encroachment by osteophytes by osteophytes bilaterally at levels C4/5, C5/6 C6/7  and on the left side at C7/T1. The left invertable foramen at T1/T2 is also narrowed dy a combination of disc and osteophytes.
Comment; Multi level foraminal stenosis at several levels on both sides.There is no evidence of chord compression.These changes have progressed over the last year.

I don't see the Neurologst until October.
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Avatar_m_tn
How bad is your pain, can you work? Most of your MRI is about the arthritis you have in your neck. At each level in your cervical spine such as C4-5, C5-6, etc, you have a neural foramen, there’s one on each side, this foramen is where the roots are for the nerves that go to various parts of your upper extremity, like the shoulder, arm and hand, etc. You have osteophytes or bone spurs that are compressing these nerve roots, bilaterally which means on both sides. This is what is causing your pain. You have this at 3 levels and on 1 side at C7-T1. You have the same thing at T1-2, except here you have a disc bulge pressing on the nerve too. I know all this is probably overwhelming you, but let me assure you, it could be much worse.

The good news is that the signal is normal and you have no spinal cord compression at any level. There was no mention of disc space narrowing in the Impressions or comment section of your report, so that might not be a significant factor either. And with the exception of T1-2, you have no disc bulges or herniations.

None of these means anything until its correlated to your pain and symptoms. How long have you been dealing with this? Do you have pain in your shoulders, arms, hands and upper back? Stabbing electric pain? I know what you’re going through, I’ve been through it. I hope you have a Doctor to help manage your pain. Why do you have to wait so long to see your Neurologist?

Probably, the first thing they’ll do is send you to Physical Therapy.  Types of treatments may be therapies that massage, stretch and strengthen the area(s)

If that doesn't help, your doctor may try spinal steroid injections. This could help with the pain anywhere from a week to a year. But spinal injections only provide pain relief temporarily, so if your condition doesn’t improve on its own before the effects of the injection wear off; your doctor may recommend surgery. Get back to me with answers to those questions, like I said I’ve been through this, I’ll help you in any way I can.

Take Care
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Avatar_f_tn
Hi there, thanks for your response.
The pain has varied for several years but it got really bad last January after I started a fitness regime at the gym. I had previously had complete numbness in my right thumb and first two fingers for about a year. The numbness increased and went into my arm also which began to ache and still does to this day. Every time I tried to lift weights in the gym it would set off shooting pains in my neck and arms.I went to the GP who thought it could be carpal tunnel syndrome and was referred to an orthapaedic doctor, who asked me to do a nerve conduction study. The test showed mild carpal tunnel in both arms and I was offered surgery. I refused the surgery because I was sure there was something going on with my neck and was given an MRI last April.
The MRI showed moderate to severe degenerative changes throughout the cervical spine more so in the lower cervical discs. So I guess there is damage to the discs. The MRI said that there was some severely stenosed foramen.

I was referred to a neurologist last August who told me that I was not able to take the normal prescribed medication because I have kidney problems so he recommended physio, pain management and acupuncture.
It didn't really work out well with the physio, I was having too much pain in my neck and my arm was continuosly aching so she would only treat me with a few gentle exercises and then she said there was nothing more could be done because my nerves were too irritated. The pain management was a complete waste of time. The Consultant was not in the least bit interested in anything I told him did not examine my neck. He told me that there was nothing wrong with my neck and I just had mild carpal tunnel and so I was sent away with no treatment.
After this I was mowing the lawn and that night when I was laid in bed, I turned over and my neck cracked really loudly 3 times at the same time a tremendous amount of pain shot through my neck and down my left arm. I couldn't move and spent two days in bed. I was given Morphine patches and Tramadol for the pain and Amitriptiline and Diazepam for the nerve pain and muscle spasms. I haven't recovered from this episode,which was last August and that is why I was sent for another MRI this year.
The Neurologist told me that if there was any changes for the worst then he would refer me for neurosurgical opinion and my GP told me that the cervical spondylosis has progressed and it was a 50/50 chance I would need an operation.
This scares the hell out of me because i'm stuck with this excruciating pain whatever treatment I choose. I can't work anymore because it is too painful. I do get pain in my shoulders, arms. hands and upper back every single day.

You say you've beenthrough this; how do you cope?
What treatment have you had?
Does it continue to get worse because mine has progressed alot in the last year.
Thanks  You take care.
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Avatar_m_tn
My neck pain developed rather quickly, Over the years I’ve had minor neck problems and I knew my left side was getting pretty weak, but for the most part I chose to ignore it as long as I could. I think a lot of my pain was being masked by heavy caffeine and nicotine use. I use to drink a lot of coffee, and I’ve found that it always helped with my spinal pain.

Anyway, one day I began getting severe burning in my neck, stabbing pains in my upper back, shoulder, arm and hand. It affected my upper chest too, tightness and constant pressure. It was so bad I couldn’t sleep, but I continued to go to work because we were really busy at the time. I was in a lot of pain, but work provided a distraction, the worse part was when I wasn’t doing anything or when I was driving.  Then I began getting intense tingling in my left hand. The next day, my thumb and first two fingers were numb. I was getting horrible shocking pain in my shoulder, arm and hand. My hand felt like someone was literally taking a sledge hammer and pounding on it, that’s how bad it felt. I’ve had low back pain and surgery, and I’ve had very similar nerve pain in my leg, but it never occurred to me that this was coming from my neck.

I ended up going to the emergency room a night or 2 later because I couldn’t stand the pain any longer. The Doc said my pain was more than likely coming from my neck, and prescribed me some pain pills and steroids. Next day, saw my family Doctor who ordered a MRI and then I saw a Surgeon. Like I said, I’ve had back surgery, but for some reason neck surgery scared me more. My MRI showed broad based disc protrusions and foraminal stenosis at 3 levels. The Surgeon sent me to PT and said he’d evaluate me in 30 days. At PT I ended up getting hurt worse, my muscles were so tight and guarded from the pain that the mechanical traction he ordered ended up tearing one of my ribs away from  my vertebra in the thoracic spine, you want to talk about painful, Oh my God! It’s been 5 years and that thing still hasn’t healed. To top it off one of my disc protrusions moved and I began getting horrible migraines.

Needless to say, 30 days or so later I ended up having surgery, I made a big mistake and didn’t get a 2nd opinion, I asked my Primary about it and she said not to worry about it. I knew I had 3 levels messed up and this guy only wanted to do one, I asked him about it and he said the other levels weren’t that bad. I took his word for it and because of this; I still have a lot of pain. Searching for answers and because my recovery was so painful, I saw a couple other surgeons and was shocked to find out that I should have had at least one more level fused and possibly two. At that point in my life, I couldn’t deal with another surgery and pretty much decided to live with it for awhile thinking I might get better, this is where I’m at now. It hasn’t got better. I’ve wasted a lot of time and money seeing specialists and I still deal with the pain daily. I know I need surgery, but I’ve been stalling because the recovery is lengthy and it totally disrupts your life.

What happened to me is my fault. My previous back surgery went great and I was a little naive about these medical people. When I didn’t start getting better, I came to see what jack***es these Doctors can really be.

Except for at that one level, I didn’t see anywhere on your MRI where it said anything about your discs being damaged, it did say disc spaced narrowed, but a lot of that can just be aging. There’s a procedure that they do for foraminal stenosis, called a Foramintomy that is very successful. If they don’t have to go in there and fuse several levels the surgery probably wouldn’t be that bad. What I didn’t tell you about my surgery is that when he got rid of the foraminal stenosis at C6-7 and took the pressure off the C7 nerve root my arm and hand pain was gone instantly. I still have pain in my shoulder and other places, but their innervated by different nerves.

There’s a lot Doctors don’t know about the spine, but foraminal stenosis is one thing they do understand, and the procedure has really has good results. I think you should look in to it, there’s a good chance it could help you. The alternative is pain management I guess, if you don’t mind being doped up all the time and you can find a Doctor that isn’t scared to prescribe. I don't know about you but, Tramadol doesn’t do much for me, right now I’m stuck taking too. I guess it’s better than nothing.

Take Care
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Avatar_f_tn
Kalvin, u are such an incredible trooper and inspiration!!!! *hugs* u've been thru a lot and still remain strong push forward. Having any kind of foraminal stenosis anywhere hurts cuz its usually accopanied (sp) by nerve root compression. U both are in my thoughts, greatest blessings to u both.
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Avatar_f_tn
Thankyou for letting me know how it started with you. I found myself nodding in agreement when you described your symptoms except my problems started on the right. I remember once going to my GP, about 13 years, ago and I told him I was in a load of pain in my neck and I could hardly turn my head and he just looked at me like i was a simpleton and said not in so many words 'what do you want me to do about it'. I persuaded him that i needed something doing because it hurt so bad so he sent me for physio. When I went to the appointment the physiotherapist asked me to lay on the treatment bed and proceeded to manipulate my cervical spine, I suppose it must have been slightly out of whack because I could feel the bones moving and cracking. when I got up off the bed I thought 'Great, that must have done the trick'. Little did I know that was just the start of it and spent that night rolling in complete agony. I had to go back to the physiotherapist the next day and she put this magnetic type machine over my neck and it kind of sucked out all the pain. She said it was moving all the bad blood out from the manipulation or something, I forget, but that was enough to put me off anyone messing about with my neck again and I just put up and shut up after that.

Your pain must have been incredible especiially when you damaged your rib, that sounds so painful , does it still give you alot of pain?

You said that you could'nt see anywhere on my report about my discs being damaged but I have been told i have degenerative disc disease. Is that not the same?
I was just wondering how the nerves have become trapped. Would that be from the bone spurs. It's all so confusing and I have been told so many different things by the doctors, I don't know what's up with it.

Have you ever been bothered by really muscle cramps and spasms in your hands and feet?  I got them so bad that even holding a cup would distort my fingers into a stiffened mass.


You mention about a foraminectomy. I looked it up and it was described to me by one of the consultants. Another procedure mentioned was a Laminectomy which sounds pretty nasty. My GP was pretty guarded when I spoke to him about it and said the neurosurgeons are very blunt and it will be either 'you need surgery' or 'no, you can't have any surgery'. He told me to ask lots of questions, but i've no idea what I need to ask. Maybe i'm jumping the gun, but I'm trying to be prepared for every eventuality 'cos i've been told i'm not good with surgery whatever that means.

Sorry for rambling, you take care.
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Avatar_f_tn
Discs can began to dry out as we age causing deteriation. Its a normal part of the aging process. Yes ur bone spurs have made the places on either side of ur vertabrae that the nerve root exits narrow. That in and of itself can cause root nerve compression and much pain and neurological dificiencies.
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Avatar_f_tn
Discs can began to dry out as we age causing deteriation. Its a normal part of the aging process. Yes ur bone spurs and dried out discs have made the places on either side of ur vertabrae that the nerve root exits to narrow. That in and of itself can cause root nerve compression and much pain and neurological dificiencies. U have multilevel foraminal stenosis. Ur report doesn't mention root nerve compression, but I bet ur close to gettin sum of that if u don't already.
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Avatar_m_tn
Yeah the rib thing has been pretty bad. Its just one more thing to worry about. It’s funny, when it happened I had no clue what had happened, I definitely knew it was a new pain, it was much lower, in my mid-back, and it was a sharp stabbing nerve pain kind of similar to what I had going on everywhere else so I just assumed it had something to do with my neck. I was real stressed and in a lot of pain at the time, so I wasn’t exactly thinking clearly. After surgery, I had about 3 months of PT for my neck pain, and I was constantly was complaining about this pain that I had in my mid- back, they tried ultra-sound, some kind of electric therapy, massage, nothing helped. Can you believe that the Physical Therapist actually suggested motorized traction again? I’m no Doctor, but it seems pretty logical to me that if you just had a disectomy and fusion, the last thing you want to do is stretch your spine, she said it was safe to do, I told her about the protrusion moving and the horrible headaches and said there was no way I was doing it. Since then, through research I’ve learned that you don’t give post-op fusion patients motorized traction. This is scary stuff; some of these people are dangerous. Anyway the therapist didn’t know what to do about mid-back pain, and said it might be a disc herniation in the Thoracic spine, she said I should see a Doctor. I got a referral from my Surgeon to see a D.O. She was a nice lady and helped some with my neck pain, but didn’t have much luck with my mid-back either, but when I explain the time line and when it began, she knew right away that it was caused by the traction, she said its not that common, but that it does happen. It was later confirmed by MRI but I didn’t have a previous MRI of the Thoracic spine to compare it to so there was no way I could substantiate my claim. I wasn’t interested in going after them anyway; I just wanted to get better. It wasn’t the PT peoples fault, even though they are obviously incompetent. It was the Surgeons fault; he’s the one that ordered it. There’s a lot more to this story, but this is getting kind of lengthy. I’ve seen Doctors and Chiropractors; and they push the rib in, but won’t stay. I’m going to have injections to try and numb it, if that doesn’t work, then a procedure were they try to burn the nerve out. I’ve just been tying a shirt real tight around my middle, which helps a little and dealing with it.  

When I was told I had Degenerative Disc Disease, I thought I was going to have a heart attack. Until I found out what it actually means. I found this paragraph on a site that explains it much better than I can. Degenerative disc disease is a misnomer: A large part of many patients’ confusion is that the term “degenerative disc disease” sounds like a progressive, very threatening condition. However, this condition is not strictly degenerative and is not really a disease. Yes you have a lot of degeneration in your neck and discs, but a lot of that is just aging, believe me, they don’t have to go in there and replace all your discs. I thought the same thing too.


Yeah, the bone spurs are what’s compressing the nerves. With a lot people, me included, you can also have disc herniations or extrusions that press on the nerves. That’s harder to fix because they have to go in there and remove the damaged disc and replace it usually with a piece of bone, then they screw a plate over it to keep it in place while it heals.

I use to have a lot of muscle cramps, before surgery, I’d get real bad ones in my legs and hands. I don’t have much problem with that anymore although I do get a lot of spasms and twitches all over. My fingers are still numb, I don’t really care, because they don’t hurt and I do have a problem with the left side of my face often being  numb.

Your GP’s right Surgeons think their gods, and I wasn’t implying that you should be the one suggesting the type of surgery. You just need to be a little familiar with what  their proposing. Believe me; they won’t do any more than they need too. You mentioned that you were going to be seeing a Neurologist, are you going to be seeing him before the Surgeon, I assume? If you can, it would probably be a good idea, if you can’t its not the end of the world, but those guys are the diagnosticians, their real brainy and most of them don’t mind explaining to you, what’s wrong and what they need to do to fix it. The majority of Surgeons diagnosis too, but after what I've been through, I don't trust them. I can give you some questions to ask them. It’s best to keep it simple; a lot of them get threatened if they think you know too much. I hope you’ll be able to get a 2nd opinion, take it from someone who knows, it’s a good idea. Most people generally do and the majority of Surgeons don’t have a problem with it. Some people even see different Doctors within the same practice for 2nd opinions.  This is serious business; the more input you have the better. As far as your rambling, ramble all you want. We all ramble.

Take care,
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Avatar_f_tn
I had foraminectomy, laminectomy, tlif, and a few more procedures done that I can't remember. Since I've never had anything like this done before, I have nothing to compare it to. But yes, get 2nd and 3rd opinions from different docters, hell even different specialists. Do ur research so u can be prepared to defend ur symptoms as dr's tend to think its in ur head. Take care and have a blessed nite:)
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Avatar_f_tn
Forgot to ask, why in heavens name do u have to wait until oct to see a nuerologist? Is there only one in ur area? Insurance will only pay for certain ppl? If u can, schedule with another neurologist. Take care
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Avatar_f_tn
Thankyou very very much, for your much needed advice and information. You've helped me more than any doctor.
I  have either a neuroma or dermoid cyst [they're not sure which] about the size of a raspberry, in the front of my midbrain which was found after they scanned my head. I need another scan in September to see if it has grown. If it has then I will be referred to neurosurgery for treatment. The neurologist wants to see me in October to tell me the result of that scan. He told me if the current neck scan is worse than the one I had last year then he would refer me straight to neurosurgery. I was just really worried about what a neurosurgeon would decide was the treatment for my problem if I do get referred. I was wondering how bad it has to be before you need surgery. I'll try to keep positive and sometimes I think i can cope with this pain as it is but I haven't really got any treatment options. Anti inflamitories are out of the question because I have renal impairment so i feel as if i'm stuck between a rock and a hard place as they say.
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Avatar_f_tn
Aww hun so sorry ur going thru everything like that. U don't have to wait for a neurologist for ur neck issues, just so u know!!! *hugs*
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Avatar_m_tn
Hopefully your neuroma is just an incidental finding and won't increase in size and you won't have to worry about it. You seem extremely apprehensive about neck surgery,  I can understand that, its scary business. As far as how bad it has be before you need surgery, if there aren’t any neurological concerns, and its strictly a quality of life issue, you are the one that is going to have to make that decision. With most of us, it’s when the pain gets to an intolerable level.  All the Surgeon can do is make a recommendation; it’s up to you whether you want to have it done.

Maybe you can use this time to explore pain management, you’re obviously in no shape to go to PT or anything like that, but there’s no reason why you can’t see a pain specialist. Maybe they can come up with the right combination of meds so that you can feel half way decent again for a change. A lot of people go this route. You have all your reports, so it’s not like you have to prove to them that something’s wrong with you.

Just try not to stress too much, take care of yourself and keep us posted as to how you are and what’s going on.

Kalvin      
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Avatar_f_tn
Thanks Kalvin, I feel better for getting all this off my chest. It was stressing me out really, because I have known there was a real problem but nobody took me seriously. I was telling the doctors that I had shooting pains and numbness in my arms and hands but the Pain management Doctor told me that all he could do was inject my neck which was a waste of time because there was nothing wrong with it, it was carpal tunnel and I should stay away from hospitals and not bother anymore neck doctors, This statement upset me enough to raise it with hospital but they told that they agreed with his decision and if i want more treatment then I should go and see another pain doctor in another hospital and I couldn't prove otherwise so they had me thinking it was a bit of wear and tear that everybody has as they get older (although they said i was young to get it as I am only 40)

But this MRI proved that all the pain and funny sensations that I had been feeling were serious and now i have to figure out what my options are and how I am going to proceed with this health condition.

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Avatar_m_tn
That has to be one of the worse feelings in the world, to go to a Doctor for help and have him to tell you that there’s nothing wrong with you. It’s almost absurd, when you think about it. Some of these so-called medical professionals are beyond contempt. I don’t blame you for getting upset, not only have your tests shown that there’s a problem, but a serious one at that. I guess they think we don’t have anything better to do than to go to doctor appointments.

I’ve had similar experiences, we all have and it one of the reasons why my pain remains under medicated and I haven’t had the surgery I need yet. After my experience a few years ago, I developed a serious disliking and lack of trust in the medical establishment. I’ve seen a lot of Doctors over the years, and there’s been 1 maybe 2 that I like and respect. My family doctor managed my pain for quite awhile, and when that practice closed, I tried Pain management briefly, but the doctor was lousy and it was a total waste of time. I refuse to beg some suspicious doctor for medication to treat my pain, I’d rather suffer.

In your case since you want to avoid surgery, you really ought to take a look around for another Pain Management place. Good ones do exist that can and will help you. You are kind of young to have that much arthritis in your neck, but I was a couple years younger than you when I was first diagnosed and my MRI is much worse than yours. My work pretty much caused my neck problems.

Take Care

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Avatar_f_tn
I understand where both of u are comming from and have lived thru very similar experiences this last year. It all began for me March 21st, 2009 @ 11 am. I developed this heavy, sluggish feeling in both legs. Within an hour, I could no longer control my legs, I walked like someone with a bad case of cerebral palsy. I knew I had spondylolisthesis and ddd at l5/s1, and that I had had yrs of neck and lower back pain. I never had any symptoms in my legs so I did not know to correlate the two together. Well I still walked like this after work and was debating on whether or not I was going to go to instacare. I had a 12 a day weekend shift sit down job.  I figured I had maybe just sat too long, that there wouldn't be anything organically wrong with me. I almost didn't pull into instacare parking lot, sure that it would be a waste of time and money. At the last min, I did. I had had a great painfree day and was flabbergasted at my new leg symptoms. I saw the dr, found I couldn't bend either toes up or down, had decreased sensations in my feet, I explained to the dr bout having spondylolisthesis and ddd at l5/s1 and he right away wanted me to go to the hospital for a brain and lumbar mri. Never had a mri b4, was very scared. Things were moving fast. Went to hospital, had my mri's (come to find out dr wanted to rule out MS). Waited for dr to call me back in this waiting room. He did and says my brain mri is great, but my back is bad. I'm going to need surgery. I friggin flipped out. He said my spondylolisthesis had gotten severe enough that it caused severe bilateral foraminal stenosis with significant bilater root nerve compression atb l5/s1. Went to spine dr the first time, he thought I was exagerating my abnormal gait and suggested I could use with a "psycological evaluation". Went to a neurosurgeon who thought I was faking too. I began to feel as though the medical community should began researching me as I must be so unique in my symptoms that ppl were doubting they were real. The nerve pain began the second day in both legs march 22nd 2009. I went thru a hellish year fighting to prove my symptoms were real. I had an emg study done 6 months later of which showed choronic and acute radiculopathy of l5/s1 and motor root nerve damage in my anterior ribialis
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Avatar_f_tn
...in my anterior tibilas and gastro muscles. But this was all in my head???? I still don't understand how I was treated like this. No matter how bad my nerve pain in my legs got, I never ONCE asked for any pain med's. From anyone!!!! All I wanted was a valid reason for what I was going thru and a treatment plan. One spine dr I saw actually told me his back looked like mine "and he ran marathons". This is the one who said I could benefit from an evaluation. So I began independantly researching what I may have. I researched ALS, lu gerig's disease (sp) parkinson's disease etc. I began to scare the **** out of myself, had to stop googling. I knew there was an organic reason my legs became impaired...and it WASN'T in my damn head!!!! If dr's only knew what they put us thru...anyway, god bless:)
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Avatar_f_tn
Hi Kalvin, Hope you are well.
You gave me some good advice and I'd like to thank you for it. I just wanted to tell you that I have taken your advice and I am seeking a second opinion from another neurologist. I still have pain in my neck and the numbness in my hands gets really bad. My GP thinks the hospital have treated me very badly so he has agreed I should see a neurologist at another hospital.  I'll keep in touch. Take care
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Avatar_m_tn
Its good to hear from you, and Good Luck with your new Doctor, I hope he/she can help. Squirtatious hasn't been on here in awhile, last time she posted it sounded like she was almost fully recovered, so I imagine she's gotten on with her life.


Take Care
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