Should I have an MRI first?

When most people have an injury, especially if it involves the neck or low back, they feel they need an MRI right away. Also, if a person is ordered to come to physical therapy after their injury without getting an MRI or some sort of advanced diagnostic testing they question why. These patients are usually fearful and hesitant to start physical therapy for fear that something is being missed about their condition and they might get worse or injure themselves more.

Many studies have have been done to show if there is any value of ordering an MRI or advanced diagnostic test following an injury. Unless it is a very serious injury there is very little correlation between positive findings and the relationship to level of pain.

Physical therapy is always the best conservative approach to any type of musculoskeletal injury. Early intervention is key to the overall healing process. Starting treatment early reduces the risk of the injury turning chronic. This can also help save you and your insurance company time and money. Unnecessary testing can get very expensive and this is what we are trying to avoid.

As physical therapists we are trained in detailed evaluations. I can guarantee that my evaluation will be more detailed than just about any health care professional that you will see. Education is a big part of what we do during our evaluation. We are able to find “red flags” and if something doesn’t add up we refer you out to another health care professional. There are clinical tests that we perform to determine what tissues are effected and if those are positive then we take the next step into treating them.

Advanced diagnostic testing is not necessary to have before starting physical therapy treatment. Sometimes, waiting to get a test before starting can delay the healing process of your injury. Physical therapists evaluate and treat a wide variety of injuries and can help with pain reduction and prevention of future injuries.

Can your discs actually slip?


You were doing yard work all day, went to lift that last bag of topsoil and felt a pop in your back and pain down your leg. You hobble into the house, sit down, pop a few Tylenol and put some ice on it. The next day you can barely get out of bed so you go to your physician. You come out of the appointment with all kinds of information. Everyone asks what happened and you say I have a slipped disc in my back. This term has been used for a long time. Is it really possible for one of your discs to slip in your back? Is that even a medical term? Is it something that we should be concerned about?

A disc can’t physically slip. The term is not accurate. Discs are attached to adjacent vertebrae with tough, ligamentous fibers, so discs can’t “slip”. These discs are very flexible in nature and allow for spinal movement and shock absorption. However, over time discs break down with wear and tear. A disc can move, bugle and completely rupture, ultimately expanding past it’s normal position of comfort.

The term slipped disc is often used interchangeably, and most of the time incorrectly, with bulging and herniated discs, but there is a difference in the terms. The anatomy of a disc helps to understand how the they are defined.

Disc Anatomy:

Annulus fibrosus – is the outer layer of the disc and is composed of a fibrous layer helping protect the inner portion of the disc.

Nucleus pulposus – is the inner layer of the disc and is composed of a gel like substance.

There are many layers in your back that help protect the disc. You have muscles and multiple ligaments along your spine that are the front line defenders. If any or all of those layers are weakened the annulus is all that is left before the nucleus. When a disc bulges the nucleus pushes into the annulus and causes the disc to lose shape and push into the spinal canal. This can cause a nerve to be pinched and cause symptoms down the leg. When a disc herniates the nucleus is now not contained in the annulus and leaks out into the canal causing pain and sometimes numbness or weakness.

Looking at these two terms and knowing how they are defined tells us there is no way that a disc can physically slip out of place. The term is widely used around the health care field. We just need to understand what it is being used for.

What can a good night sleep do for me?

A good night sleep makes you feel so good. The importance of a good nights sleep goes beyond feeling good the next morning or relieving exhaustion. Getting the right amount of sleep is a huge part of having a healthy lifestyle, and can benefit your mind, heart weight and more. So really what could an extra hour or two of sleep really do for you? If you are not getting the recommended 7-8 hours of sleep per night here are some reasons why you should consider going to bed an hour earlier tonight.

Improved health:

Getting a good nights rest is not going to cure you from disease or even make you immune. But many studies show there is a link between not getting enough sleep and health problems such as heart disease, diabetes, heart attacks and diabetes. These are usually after a longer period of time of not getting enough sleep. Shift work alone can cause interrupted sleep patterns causing you to lose sleep and in turn can cause health risks.

Less pain:

Getting the right amount of sleep helps you heal better and faster. Injuries take long enough to heal, why would you make it harder for your body to recover? I always tell my patients to try and find the most comfortable position to sleep in. If it’s in a recliner chair that’s fine. The more sleep you get the better you will heal and the less pain you will be in.

Better weight control:

Getting the right amount of sleep can help control your weight better than you think. If you wake up exhausted you are less likely to be physically active and go for that workout you planned on. You also might skip that healthy meal you wanted to make and grab a quick less healthy meal instead.

Lepton, the hormone that helps us feel full, is decreased in those that do not get enough sleep. So in turn those that do not get enough sleep tend to be more hungry than those that do.

Thinking more clear:

It’s a proven fact that if you get a good nights sleep you wake up refreshed and free of mind bogging information. Being rested clears the mind and helps with what you need to accomplish for the day. If you have that big test the next day, try to go to bed a bit earlier so that you can stay focused and rock it!

Reduces stress:

Sleep helps lower your blood pressure and stress hormones. Sleep helps encourage our bodies to relax. You know how it feels after a good nights sleep right? You wake up refreshed, in a good mood and ready to start your day. This is all due to decreased stress levels.

These are just a few reasons that an adequate amount of sleep can help your body and your mind. I encourage you to try and at least go to bed an hour earlier than normal each night this week. It will be difficult at first, but once you see the results you will see the benefits that it can have. Sleep should become a priority and can make a huge difference in the quality of life that you have.

When things get tough will you quit?


As most of you know that read my posts my son plays travel baseball and I’m a coach on the team. Lately it has taken over my life, and I’m okay with that because I enjoy it so much! But I keep finding different reasons to talk about it because these kids show me something different each week. As with all 9 year olds there is an up and down attitude about them each day, week and month. One day they look like super stars out there and nothing can stop them. The next day they look like they are back in T-ball again. This past weekend was one of those weekends where you wondered how they would respond after the events that took place.

We played in a tournament called the Battle of the Boarder in Youngstown Ohio. Leading up to the weekend we knew that competition was going to be very good. 2 teams in particular were going to be there. Beaver Valley Red and West Hills. The last time we played West hills they beat up on us pretty badly. By about 13 runs to be exact! It wasn’t pretty, but our kids had bounced back in the next tournament they played in to take 2nd place. We were in a different bracket then either team and were set to face 2 teams we had never played. The day before the tournament started one dropped out and our schedule changed. Now we were scheduled to play Beaver Valley. I was excited to see how our kids matched up against them since we had never played them before. Once the kids heard that was who they were playing that’s all they talked about. They obsessed about it actually! And it was not in a good way. The game started and we walked the first batter, not a good start! Nerves were probably going crazy for most, but we managed to get 2 outs and the score was only 1-0. Then all hell broke loose! We committed 6 errors giving up 12 runs in the first inning! After the first inning it was 12-0! How does this happen? Little things like catching the ball before trying to throw it. Balls going through their legs, and coming in on fly balls instead of stepping back first. All things our kids do very well most of the time. Their nerves got the best of them. Needless to say the game ended in 4 innings after losing 18-1. We lost the second game 12-6 against another team we had never played mostly due to mistakes and kids just not being in the game. It was tough to watch and hard to talk to the boys afterwards. Sunday would tell us what type of team we have and how they respond.

The next morning the kids warmed up and you could tell they were more lively and upbeat. They started out strong and lead most of the game until the bottom of the 5th giving up 2 runs to be down 5-4. The kids battled that last inning but couldn’t find a way to get another run. We lost that game, but showed great resilience and determination to come back after getting the crap beat out of us the day before. It was great to see how our boys responded.

I wanted to share this with you all because there are always going to be times in life and in physical therapy that you are going to want to quit. Things are just going to get too hard for you and giving up seems to be the easiest thing to do. I know because I have felt like quitting before. My first 2 weeks of PT school I almost quit! I felt that it was going to be too hard and too much for me to handle. I was sick of school at that point and now I was going to have to go for an additional 3 years! I went home that weekend and thought about it a lot. I kept telling myself I could go and get a job for a little while and figure it out. Then I realized that I committed to doing this and this was what I felt passionate about. I’m so glad that I decided to continue my journey. Just know that it’s normal to want to just give up when things are tough and not going your way. It’s the way you respond and show resilience that makes all the difference.

Putting in the work and staying consistent always pays off!

I am one of the coaches of my son’s travel baseball team. My son is almost 9 and it’s his first full year of kid pitch travel baseball. He has played with most of the kids on his team since he was 4. They all started out on a rec team together. Year to year you can see the improvement. Constant practice and playing for most of the year is our life right now. It’s so much different than when I was a kid. I played a lot of baseball, but only from April till August. These kids started in November and will play until the end of summer. Constant practice and games keep these kids consistent. They stay focused by doing things on a regular basis and it shows. Most of the things that we succeed at in life are done on a regular basis. We make a habit of them and they become a constant.

This past weekend we had another tournament for baseball. We played very well in pool play to earn the second seed to start the playoff/championship round. Sunday afternoon we were set to play the same team we beat the day before 5-4. It was a close game, but we played flat that game. The kids seemed pretty upbeat at the beginning of this game, but it didn’t start out the way we wanted it to. My son started the game pitching and was a little off with his location. He ended up giving up a 2 run home run in the 1st inning. Luckily we got out of it without going down by any more runs. He was down, but his teammates encouraged him as well as all of the coaches after getting out of the inning. The kids were off and losing most of the game. We entered the second to last inning down 7-3. The kids battled this inning getting timely hits and staying disciplined at the plate scoring 4 runs to tie it up! We would have scored 1 more if it wasn’t for me running my son into an out at third after a nice 2 run double. The last inning comes and the other team scored 2 runs to make it 9-7. Things just were not going our way. The rain came off and on and it was just a miserable feeling. The kids did not seem defeated though. They have been in this situation before! This is what they practice for each and every week. We ended up with bases loaded and 2 outs, a situation every athlete wants to be in! As a kid we always played and yelled out 2 outs bottom of the 9th bases loaded down by 1!. So who steps up to the plate? My son steps into the box ready and focused. First pitch is thrown and he swings out of his shoes! He was pumped up for this! I yell down from 3rd where I was coaching and tell him to relax, because a hit scores two! Next pitch comes and boom! He smokes this ball high in the air towards left center field. I knew it was gonna at least score two right? Then it keeps going and going and I yell “GET OUT OF HERE!” And the ball sailed over the fence! You would have thought I hit the ball because I was jumping up and down like a little kid screaming! As my son rounded 3rd he had the biggest smile on his face and it’s a moment I will never forget and cherish forever! I’m getting chills right now just typing this! The kids went crazy and it was just a great moment to be a part of! They won the game!


These kids never cease to amaze me! They showed me something that day that will always stick with me. Putting in the work and staying consistent will always pay off in the end. They never gave up on each other and they never quit. Even when my son gave up a home run in the first inning he kept his composure and stayed focused. Every single one of them contributed to that great victory!

I always like to bring things back to a situation related to physical therapy or situations in life in general. If we stay consistent with anything in life we are going to make our situation better. If we practice at something or make a habit of doing something on the regular it’s proven that you have a better chance of success. If you are trying to be more healthy then make a commitment to stick with a new way of eating and doing some sort of physical activity weekly. Do these things at the same time and same day to make a habit and stay consistent. When you make an appointment to come to physical therapy stick to it and commit to the full length of treatment sessions. Do your program at home and stay consistent. It’s proven to work because I saw it first hand this past weekend.

Ask questions and educate yourself before you get cut


Educating yourself as well as being educated about your body and some of the injuries that we have is very important. Google is a very powerful tool that we use for different things throughout the day. You hear people all the time saying, “Just google it!” It’s so easy isn’t it? It’s also very easy to ask questions about what is going on. When patients are seen by a physical therapist, a PCP, a surgeon or dentist questions should be asked by both the patient and practitioner. Communication is key to the success of the treatment set forth. As a practitioner you need to know details about what the patient is going through. You need to know what type of symptoms they are experiencing so your course of action will follow that. As a patient you need to know what is going on and what is going to be done about it. Do you think this is important?

I was just evaluating a patient after he had had shoulder surgery the other day. The script said eval and treat, status post right shoulder surgery. I had started talking to him about when his surgery was and asked him a few questions about what was done. I knew he did not have a rotator cuff repair, but I was unsure as to what was actually done because the script was so vague. I said what exactly did you have done to your shoulder? The patient looked at me with a straight face and said “ I have no idea what the doctor did he just told me I needed surgery.” WHAT????? Are you kidding me? I didn’t say that to the patient, but I was for sure thinking it. What kind of person would just take the doctors word for it and let them cut into their body part without even knowing what they were doing? It makes absolutely no sense to me. Now, I want to give the benefit of the doubt to the surgeon because I’m sure he explained something to him. Or did they?

This isn’t the first patient I’ve had like this and it wont be the last. Are they putting too much trust in their surgeon? I would say yes they are. I would never recommend to do a treatment on a patient without first explaining to them exactly what was going on and what we are trying to do to help it. Educating yourself about your condition through self searches and questions is highly recommended and a big key to help yourself get well. I’m not suggesting to self diagnose yourself. I am simply suggesting that you research your problem so you can have some sort of knowledge about your condition, then ask questions. Knowing exactly what is going on helps understand why things are being done. Don’t just let a medical professional treat you without knowing exactly what they are treating you for. We all have to be proactive in our care and take action to be more informed about what is being treated and why. This, in my opinion, will help clinician and patient relationships as well as trust. Educate yourself and stay informed, only good can come of it.

Practice, consistency and effort: All keys to have success

My son plays on 2 different baseball teams. He is on a travel team and an in-house athletic association team. For his travel team, we have been practicing in an indoor facility since late November. He is fortunate enough to play with most of the same kids for the past 3-4 years. They work well together and it shows. Since they started practicing until now there is a noticeable difference in their attitude, their work ethic, their desire and of course their overall ability! I’m one of the coaches, and it’s really amazing to see the transformation before your eyes with these kids! It’s truly something special. I can see that every single one of them has benefited from being on this team. You can see it from the pop of the mitt, the crisp and quick hands of a fielder and the sound of more and more solid contact of the bat! It wasn’t always like this though.

Rewind to November…and so it begins. Most of these kids play multiple sports, my son included. Flag and tackle football had just just ended and basketball was just about to get under way. Baseball seemed to be on the back burner for most. It usually is at that time of year. Practice started 2 days a week and only half the kids were ever there at one time for the first month and a half. It was frustrating at first because you could never really get the kids to gel. Even though these kids have all played with each other, there was just no consistency. And it showed in practice during drills and hitting exercises. You could tell which kids had been there more and which had not. It’s only natural that with consistency you improve. Over the next several months once basketball started to wind down is when it really started to show. You could just see it from practice to practice. Their attitudes changed, their ability to do things asked of them and the desire was there. Once we had a consistent bunch of kids who were committed and practiced together, is when they all started to gel together.

Just this past Saturday my sons in house team had their first practice. For most of the kids this was their first practice of the year. I am not a coach on this team, but I offered to help if needed. The coach talked to the kids at first and had them warm up. As they were warming up he stopped everyone and asked them to watch my sons mechanics on how he throws the ball. He said “everyone watch Caden and how he throws.” He wanted them to watch the entire motion through his follow through. He said that’s exactly how I want you guys to throw the ball. Great mechanics there! I’m always hard on my son with everything, and since baseball has been my passion since I was 5 I am extra hard on him with this! I thought, wow he is using my son as an example to all the players on what to do! Later on in the practice I was helping hit ground balls to the kids. I didn’t say much a I was just observing the team and what kids needed help with. The coach from time to time would jump in and tell a kid to do something different. When I coach for our travel team I am constantly correcting form, the way kids take a ground ball, throwing mechanics and everything in between. Like I said, I am extra hard on my son! What Dad isn’t hard on their kid? So I decided since I didn’t know very many people on this team I would just help and sit back. I was shocked, amazed and PROUD all at the same time! Not once did I have to correct my son! I mean I was really shocked that I didn’t have to even yell his name. Those that coach with me will tell you they hear me yell CADEN all the time during practice. I saw everything that we practiced so hard during the winter and more. He did everything that I normally have to correct him on! And to top it off he was instructing kids on how to do things better turning double plays! It was a very proud moment for me as a Dad!

I always try and take things back to how it pertains to Physical Therapy. This example is no different. My title for this blog post is practice, consistency and effort. Practice makes “BETTER” in my opinion. It never makes you perfect. There is always something that you can work on and something to improve on. Consistency with practice and technique will always help to focus on things that you are having difficulty with. The amount of Effort you put into something shows in your results. The more effort you put in, the better the results. If you truly want to get better, which I feel that every patient that comes to me does, then you have to take into account these 3 things. My son has shown me that with these 3 things he can do amazing things, and he is only almost 9! When I think about it though I wouldn’t expect anything less from him or my patients!

How much does weight really impact my joint health?


If you have the occasional twinge of pain in your knees, hips or even your back, it is your body’s way of warning you of a potential problem. Pain is your body’s way to tell you that something is wrong and you need to do something about it. Similar to an engine light coming on in your car, pain is indicating a possible problem. Now, what is the cause? There are multiple reasons why your body sends off pain signals. First, if you injure tissue your brain tells you that you are in pain. If you have bad posture, eventually you will feel pain. Our joints are designed to take a lot of pressure during different activities. But when that pressure is increased just the slightest it can cause an enormous chain reaction and your function can be lost. So how does increased body weight really impact our joints health?

Studies have shown that for every pound of excess weight exerts 4 pounds of pressure on your joints, your knees in particular. Let’s just think about that for a minute…if you are 10 pounds overweight you have 40 pounds of extra pressure on your knees. If you are 100 pounds overweight now you have 400 pounds of pressure on your knees!!! That’s a crazy statistic! Now, walking on a level surface puts a force equivalent to 1 ½ times your body weight normally with everyone. So if you weigh 200 pounds you are putting 300 pounds of pressure on your knees. If you add an incline, the pressure goes up. Going up and down a step increases this pressure 2 to 3 times. And squatting, a very functional activity that we all do on a day to day basis, can add up to 5 times your body weight of pressure. This is why it is so important to know what we are doing to our bodies and the affect a few extra pounds can have.  

What does this mean? Well, with increased pressure on joints this can lead to joint break down, in turn causing osteoarthritis. Obesity and being overweight is one of the leading risk factors of osteoarthritis. Osteoarthritis is caused from wear and tear of joints. Once the cartilage is worn away this causes a bone on bone atmosphere which causes inflammation in the joint. Increased weight causes this breakdown to occur quicker than normal. And, pain levels can be even worse with those that already have osteoarthritis. Now you have an inflamed joint that is bearing 3-5 times the amount of pressure that it should.  

What can be done to avoid this? The simple answer is to lose some weight. Most people can afford to lose a few extra pounds. It’s easier said than done, I know. It all comes down to 2 questions. Is it important to you? And what are my goals? You really have to decide what is important to you. If not having pain is important to you, then this should be a priority. If being able to do any activity you want without pain, then this should be a priority. What are your goals? I would suggest setting small goals at first so that they can be easily reached. Seek out another partner to hold you accountable during your journey. In the long run it’s a life style change and it needs to be done in steps. Nobody ever said that getting to a healthy lifestyle is easy, but once you get there it is very easy to maintain that environment.  
So to sum it up, weight has a huge impact on your joint health. Your joints already have a great deal of pressure put on them when doing a specific activity. Adding any additional weight, just increases that pressure even more. This, in turn, can cause other issues such as osteoarthritis. Having a healthier lifestyle can and will prevent such things from happening and should be a priority.  

Do I have Peripheral Neuropathy?

My feet burn throughout the day. My hands gets tingling into the fingers when I’m sleeping. I have less feeling in my feet and sometimes they are cold. These are all things patients tell me in my office and wonder what it is that is causing these symptoms. Is it peripheral neuropathy? What is peripheral neuropathy? The name peripheral neuropathy states what it is in its name. Peripheral: meaning away from or beyond the brain and spinal cord, neuro meaning relating to the nerves, and pathy meaning disease. So a nerve related disease occurring away from the brain and spinal cord in short. Patients ask me all the time if I think they have this condition. Here is a little information about it and what type of symptoms patients have.

The peripheral nerves are a network that connects our spinal cord and brain to our skin, muscles and internal organs. These nerves arrange themselves along lines in the body called dermatomes. These dermatome patterns supply the feeling to certain parts of our body. If one or more are affected you can track the nerve root by the pattern of pain or numbness that you feel. Clinically this is how we can come up with a conclusion as to what nerve is being affected. Damage to these nerves takes away the communication pathway from the brain and other parts of your body. This in turn can cause impairments to our muscles and show signs of weakness. It can also cause sensation problems to our upper and lower extremities causing pain.

Types of Peripheral Neuropathy:

Mononeuropathy- Damage to a single peripheral nerve is called mononeuropathy. An injury or trauma to a certain area can cause this. Repetitive movements can also cause this type. Carpal Tunnel syndrome is a common example of a mononeuropathy. Other types are Radial and Ulnar nerve palsy. Numbness and weakness can be caused by these types of mononeuropathies.

Polyneuropathy- This accounts for the greatest number of peripheral neuropathy cases. This happens when multiple nerves in the body are affected at the same time. Causes are usually poor nutrition, alcohol abuse and diabetes. Diabetic neuropathy is one of the most common forms. Symptoms include numbness, tingling, loss of feeling and burning in the hands or feet. This can cause people to get burned very easily as well as develop wounds and not know about them. This is why diabetics are extra careful with protecting their feet.

Causes of Peripheral Neuropathy: 

Acquired- meaning that is is caused by an environmental factor. Toxins, illness or an infection. Some examples are alcoholism, certain kinds of cancer and poor nutrition.

Hereditary- these types are genetically passed on from your parents.

Idiopathic- these are types that are from an unknown cause.

Knowing the symptoms can help a patients ability in taking care of themselves. Knowing what to do and how to treat is helpful too. If you or someone you know has symptoms similar to what is described above you should seek medical help. A neurologist would be the first medical professional to see. Neuropathy can be a very debilitating disorder, but if it is treated it can be managed.  

Can smoking affect the way my body heals itself?

Are you a smoker? Have you recently had surgery or an injury that just wasn’t healing in a normal time frame? Smoking might be the culprit. Just about everyone on earth knows the affects of cigarette smoke and how it can cause certain ailments and diseases. An estimated 15.1 % of U.S. adults aged 18 years or older smoke cigarettes. More than 16 million Americans live with a smoking related disease (2). But do people know the affect cigarette smoke can have on the healing process in the body? What ways does it delay healing time and why it can take so much longer than most.

Deprives the body of Oxygen:

The air is filled with Oxygen and we breath it in all day long. Oxygen is needed for our body to function as well as heal tissue that is wounded. On a more scientific level, cigarette smoke causes many changes to the way our bodies handle oxygen. Hemoglobin is a molecule that transports oxygen throughout the body. Cigarette smoke affects it’s ability to carry the amount it normally needs to carry at one time. The blood vessels in the body also become more narrow not allowing the oxygen and hemoglobin to get to your healing tissue.(1)

Cigarette smoke thickens your blood as well. This makes it more difficult for the blood to run smoother throughout our bodies. Just think of it this way, you have car carrier ( Hemoglobin) carrying 8 cars (oxygen) a piece on a 4 lane highway (artery/veins) at an average speed of 65 MPH. Now it starts to snow (chemicals in cigarettes) and those car carriers can’t go through the storm so you have to get a tow truck that carries 2 cars a piece now. Your speed has now decreased to 45 MPH. Less cars will get to the dealership (healing tissue) and it will take twice as long to get there. With a decreased amount of oxygen, the tissues have a difficult time healing in the allotted time.

Weakens the Immune system:

In addition, cigarette smoke has been shown to make it more difficult for the body to fight off infection after surgery. The chemicals in cigarettes prevent neutrophils, infection fighting cells, from working properly. Neutrophils are our guards that create a safe environment by getting rid of things that don’t belong in our body, such as bacteria. This in turn causes a greater risk to develop infection.(2)

There is some good news from all of this though. Research has shown that quitting smoking before surgery reduces your risk of complications. It is very difficult to stop smoking, but even a 4-6 week period shows a dramatic decrease in risk factors. Now you might say what if I had a fracture and needed surgery immediately? I don’t have time to quit. Quitting for 4-8 weeks while your fracture is healing has also shown great benefits in the healing process.

Quitting smoking or any nicotine product is a very difficult process. I know from experience. I chewed snuff for 14 years. I tried to quit on multiple occasions and nothing seemed to work, but then my son was born! I made a promise to myself that I would quit for him and for my family. 9 years later I don’t even miss it! In fact it kind of makes me sick to even smell it. Sometimes the big picture just makes sense.

References: 

1. http://www.aofas.org/footcaremd/how-to/foot-health/Pages/How-Smoking-Affects-Healing.aspx

2. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/
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