Partial Success

Partial Success

When I woke up from the procedure Monday night, I was told that the stent was successfully placed and I felt a great sense of relief. Soon, it became apparent that it didn’t work as it was supposed to, though, and I started getting all the terrible symptoms that brought me to the hospital initially. The fluids were continuing to build up in my stomach and soon I had reflux, nausea and vomiting. Monday night was an extremely rough night without the NG tube in place to provide relief. I saw the surgeon at 6:30am Tuesday, and he ordered the NG tube to be placed again. It seemed to take forever, but by 11:00, the tube was back in place and I started to get relief from the symptoms again. 

Clearly, we are on to step two in finding a solution to this current obstacle. The plan is being discussed and I have decisions to make along with the guidance of my surgeons. The GI surgeon would like to place a second stent. He used the longest one the first time, and was happy with the result, but did say there is another area at the edge of the stent with a partial restriction. He hopes to open that spot up a bit. In addition to the stent, he will place a venting G-tube directly from my stomach. The G-tube takes place of the NG tube that is currently down my nose and tethering me to the suction pump next to the hospital bed. With the G-tube, I will have full mobility with the goal of returning home. 

While we finalize the plan, I am being kept comfortable and resting. Happily, occupational therapy is working with me now to get me out of the room for hallway walks. It feels good to get up and around a little bit. I should have a plan in place today. The procedure may be today or possibly tomorrow. I will try to keep updated. Keep the good energy coming my way!

Hope

havalen push

It has been a very full week. It has given me hope that things can turn back around. Last week, we had decided to give my body a break from chemo until after the trip. Late Monday, the cancer clinic called and said my 5th line of treatment, Havalen, had been approved and we were scheduled to start Tuesday. This news hit me with a lot of mixed feelings. I was worried about side effects ruining my trip, but the nurse assured me that this chemo is not known to have too many difficult side effects. The other fear, as always for cancer patients, is that too much time off treatment allows the cancer to run wild, so delays are scary. They agreed that if I did an infusion this week to see how it goes, I would be allowed to  skip next week if I was worried about side effects during the trip. That sounded fair enough, so I agreed to get started. 

Tuesday, I went in prepared to start. My medport had other ideas, though, and was not working properly. There was a lot of waiting. When all else fails, they inject a clot-buster and try to draw blood again every half hour. Three hours later, as we were about to give up, the port finally cooperated enough to draw blood for labs. At this point in the day, it was too late to do the chemo push, so I was rescheduled to come back and get some IV vitamins in addition to the chemo. While I was there, I also asked for an abdominal ultrasound, because my PleurX catheter suddenly stopped draining, though it was obvious that the fluid was still building up. Sure enough, the ultrasound showed a moderate amount of fluid, so an order was put in for a line-study on the medport to find out why it was so temperamental and a paracentesis and possible replacement of the PleurX catheter.

Wednesday, I was back at the clinic bright and early, since I had to be at the consultation at Froedert at noon. Everything flowed beautifully this time. What a difference a day makes! The port worked without any hassle, and the infusion was started promptly. Right as I was asking the nurse about the orders for the port and PleurX, Interventional Radiology called and scheduled the procedures for Friday at 6:00am. We finished everything without incident and I had time to get to Froedert early enough to have a nice tea date with my SIL! 

Then, at noon, Andy met me and it was time for the consultation about the HIPEC surgery (see my previous blog for more on HIPEC) I’ve been so hopeful about. It went really well. I liked the Doctor. He explained everything very clearly and answered all of our questions. His concern now is that I’ve lost too much weight and may be too weak for surgery. He arranged for his nutritionist to come in after we were done talking so she could help me gain weight and get ready to handle the surgery. 

With peritoneal mets, the cancer causes inflammation and fluid builds up in the peritoneum (the lining around the digestive tract). I’ve been dealing with that for many months. My tumors are located in the omentum, which is another protective lining that drapes over the stomach, colon and intestines. The way the mets progress is the tumors grow out of the omentum and into the organs. So, the Doctor explained that we wouldn’t know if the surgery was a go until the day of surgery. He would start with an exploratory laparoscopy to see the extent of the tumors and the condition of the omentum. If the omentum is still free-floating and separate from the organs, he can proceed to remove the tumors or even remove the entire omentum. That may involve opening me up, if the omentum has become concrete-like with tumors. If the tumors have grown into the organs and everything is “stuck” together, then he will be unable to do the procedure, and that will be the end of that. 

I am scheduled to see him again in two weeks to do another CT scan and at that point we can schedule the surgery. I’m encouraged that I’ve cleared the first hurdle and am being considered a candidate for surgery. In the meantime, Andy gave them our insurance liaison’s contact information and the requirements she set out so they could approve the surgery for payment. Hopefully, that will be very helpful in getting everything approved. 

The meeting with the nutritionist was one of the most productive meetings I’ve had! I learned so much. She gave me exceptionally helpful advice, including lists of snacks and meals that my digestive system can handle, and what to avoid. She advised me to eat something small every two hours, and she gave me a whole bag full of different high calorie shakes and nutrition bars and powders. I’m on a mission now to gain the weight back so I can have the surgery.  

It’s a lot to take in. A lot to think about. Overall, it was a good week and I’m very hopeful that HIPEC can give me some relief from the effects of the cancer in my abdomen. Now, tomorrow I need to be prepared for a 6am surgery to fix the medport and the pleurX catheter. One step at a time. Being able to drain the fluid will go a long way to help me stay comfortable and it will increase my appetite, too. And then my homework is to go to Disney and get fit and try to fatten up a bit! And have fun with my family. All this will be waiting for me when I get home. 

5th Line of Treatment, but first…

Disney

WE’RE GOING TO DISNEY!!

At the beginning of the school year, when we saw that the kids had a long winter break, we decided to take a trip to Mexico. As fall went on, though, my cancer was not under control and I was uncertain about a trip out of the country. By December, my oncologist came right out and said no. She didn’t want me out of her reach in a foreign country. She did say I could travel within the US, where she would be able to help me, if needed. So, we decided on Disney. My kids are teens now, and it’s something I’ve always wanted to do with them. But not over winter break! So we are going in January!

It was a good choice to postpone, too. Winter break for me was mostly bed-ridden. I was very sick. My 4th line chemo was brutal. It was like having the worst flu imaginable for 5 out of every 7 days for two weeks, and then a week off to “recover”. My week off didn’t give me any relief, though, and I was beginning to realize that it was symptoms of the cancer that were effecting me, rather than side effects from the chemo. At this point, I had already booked the trip for my next week off chemo. I came close to canceling a number of times, but decided to wait for my next oncology appointment before I made any drastic decisions. 

My appointment was the 2nd day of 2020. The doctor told me the current chemo wasn’t working ( which I had already suspected) and I’d be taking a break while the next line treatment goes through the insurance approval process. At that point, I asked if I could take a break until after the trip. I need to let my body recover a bit and I need to gain weight. I’ve barely been able to eat, and when I do eat, I end up super sick. I’ve lost way too much weight. She agreed. I’m still uncertain about the trip. The chemo is out of my system, but I’m still suffering a lot of symptoms from the cancer. I can’t eat, my digestive system is a mess, and I’m very weak. The trip is fast approaching, and I want to make it happen. 

My doctor also referred me to a doctor at Froedert, who does a procedure that sounds very promising for me.  It is called HIPEC.  http://www.hipec.com  HIPEC is the surgical removal of all visible tumor in the abdomen followed by a “bath” of heated chemotherapy directly to the abdomen. In medical terms this is referred to as cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC). So far, this surgery has been used mostly for patients with mesothelioma, pseudomyxoma peritonei and patients with peritoneal cancer from a colorectal tumor. Some hospitals also offer HIPEC treatment for other indications, such as peritoneal metastasis from gastric or ovarian cancer. My oncologist does not know if it’s been used with Metastatic Breast Cancer yet, but my mets are to my peritoneum (lining around the stomach and intestines), so I’m hopeful that I will be considered as a candidate. I am worried that there may be a fight with insurance if I’m the first MBC patient to have HIPEC done. 

HIPEC

I have my consultation for the surgery this Wednesday. I’m very hopeful that the surgery could give me the relief that I need from the symptoms of the peritoneal mets. I will fight to have the procedure done, no matter what it takes! It sounds so promising. 

But first, 

WE’RE GOING TO DISNEY!!

This Phoenix Will Rise Again

This Phoenix Will Rise Again

The fire and ashes are building all around me. I’ve been through this cycle of burning down and rising up from the ashes before, and I will do it again. Metastatic Breast Cancer. My current set-back.  As a breast cancer survivor, it’s not an unexpected hurdle. Sadly, I’ve witnessed my peers going through similar difficulties. All I can do is take it day by day, trust my treatment plan, and do my best to redefine myself once more.

I haven’t been feeling well for some time. I wrote it off to my slow recovery from the knee injury, and the fact that I have not been able to get back into a regular exercise routine. This spring, I generally felt weak and out of shape. About a month ago, my symptoms were getting noticeably worse. I had shortness of breath, and I developed wheezing and a cough. I have to say, this is the worst cough I’ve ever had. And I’ve had all forms of bronchitis, pneumonia, etc. This is definitely worse.

On July 23rd, I went to the ER with sharp pain in my ribs along with the severe cough and shortness of breath. I knew something was not right with my lungs. After a number of tests, I ended up being hospitalized overnight. They found that I have pleural effusion (fluid in the lining around both my lungs). They did a thoracentesis (stuck a catheter into the pleural cavity via my back- yes, I was awake…) on the right side to drain the fluid and sent it for analysis. The left side was more complicated. The fluid was loculated, hardened into multiple, fibrotic pockets, therefore, not free flowing nor able to drain. I was told at this time that surgery would be the only way to clear the gunk from my left side.

Over the next week or so, I did several other tests, X-rays, CT scan and blood work. And coughed and coughed. 

On August 1st, I saw my oncologist to try to make sense of the results and develop a treatment plan. The fluid in my pleural cavity (space around my lungs) contains cancer cells that had spread from my original breast tumor. All of the other scans are clear, though, and the cells have not formed any tumors that could be detected. Of course, ILC, Invasive Lobular Carcinoma is known for being extremely difficult to detect via scan, so there’s that grain of salt. 

The cells have changed slightly from the original tumor (ER/PR+HER2- to ER+PR/HER2-), but not enough for me to need to go through chemo again. My doctor will put me on hormone therapies (Ibrance and Faslodex) which attack the cells directly. In her experience with other patients, the cells are quite responsive to this therapy. 

Originally, my oncologist felt that the surgery would be too invasive, and that the treatment would clear up the fluid. However, at my next appointment, on August 9th, when I told her that the cough was becoming unbearable, she called the lung specialist. He advised that since the left side is loculated, it will be difficult for the hormones to get into the fluid to do their thing, and he recommended the surgery. With that, he and my oncologist called a lung surgeon immediately and I got in for an appointment the next day. Yay, the perks of having a dream team of connected super-doctors.

Yesterday, August 10th, I met with the lung surgeon to discuss a robotic surgery, called thorascopy (no, I will NOT be awake this time). He will make a small incision and insert a camera, and several other incisions for the surgical instruments that will be used to “break up” the pockets and scrape out the goo. After that, there are two possible outcomes. Either my lung will re-inflate and he will put talc in the cavity to make the lung stick to the pleural lining so that fluid can’t re-fill the cavity. Or, my lung won’t re-inflate, due to damage or tumors or other bad stuff, and he will need to leave a catheter (chest tube) in so that the fluid can continue to drain. This could be for a matter of weeks or months. I’m pulling for option one! But, at this point, I’ll do whatever it takes to relieve the cough and get the cancer cells out. If that means a chest tube, then that means a chest tube. Depending on the outcome, I could be in the hospital for one night or for several nights.

Wasting no time, surgery is scheduled for this Monday, August 13th. This is the least amount of time I’ve ever had to prepare for surgery. My pre-surgery nesting mode is kicking in to high gear, but I don’t really have the energy to do the things on my “to-do” list, so I’m just going to have to accept that stuff isn’t going to get done before surgery. Surgery and healing are my number one priority right now.

This is not a hurdle I wanted to face, but it is the hurdle in front of me, so I have no choice but to charge at it and jump it. Overall, I am very positive about fully recovering from this. Right now, I am laying low and resting as much as I can (and did I mention, coughing…). I look forward to getting some relief soon with the surgery. I will keep everyone updated as new info comes in. 

Perfect 10

Perfect 10

perfect 10

Okay, the image of Bo Derek from the movie “10” has nothing to do with this blog post, but it came to mind when I wrote the title, and I thought it was humorous, so there she is…. On a more serious note, this post is about re-defining what my own “perfect 10” means after the last few years and, of course, after turning 50 (loud and proud!!!) I’m also rounding out my surgery count at a perfect 10.

I didn’t learn from my last blog post, because the first big thing I’m tackling on my “50 after 50 List”, exactly one week after my 50th birthday, is surgery number TENcheck. I’m aiming for a perfect 10. I’m quietly hoping that the nice, round number 10 will symbolize my last time under the knife, but I’m not holding my breath. If I’ve learned anything in my 50 years on planet earth, it’s that life does not fit into the neat little, predictable boxes we may envision for ourselves. I won’t waste my energy worrying about how many more surgeries I might have in my future. I’m going to focus all my energy on the present surgery.

January 26th will be  surgery number ten. Guess what? It’s not the knee surgery you might have anticipated due to my recent accident, rather I’m back at it with the plastic surgeon in Chicago. A lot of people have asked me what this surgery involves. They say, “I thought you did that surgery last year.” It’s complicated, so let me try my best to clarify why I am traveling to Chicago once again for surgery – Andy and I are calling it a “destination surgery”. I know, it is exotic. We did the same thing last January, and Andy still doesn’t let me count it as a honeymoon.

I’ve had a year to recover from Phase One. I’m not gonna lie to you- I’m still not fully recovered. It was one of the tougher ones, and I’m a bit of a connoisseur. My recovery goal was to build my strength back up and get as close to “normal” as possible before Phase Two. My method for recovery was volunteering with Team Phoenix, and completing the Tri-Ing for Children’s Triathlon, and (almost) the J-Hawk Late Bird. As you know, I never made it to the Late Bird, thanks to my rendezvous with a Jeep.

By September, I was feeling strong and setting my sights on a late fall surgery, leaving time to come back in 2018 for the Madison IronMan. My surgeon in Chicago knew that I wanted to have surgery after the September 24th triathlon. Ironically, they called me just after my accident with an opening – October 13th…. With the Honor Flight on October 14th, there was no way I was going to take that date. Anyway, I needed more time to let my knee and bruising heal before going through more trauma (I’m guessing the fat grafting won’t be coming from my thigh with this bruising). It would have to wait. Next available date would be January 26th. I’m so good at hitting “new year, new deductible….

Photo Sep 20, 7 36 40 AM

ouch!

Now, I am more than ready to get on with it. So, back to what this surgery is all about. This is Phase Two DIEP Flap breast reconstruction. If you look back at my post called “Ninth One’s a Doozy”, you will get a little more background on Phase One of this process, which I completed a year ago. In a nutshell, Phase One is the major “relocating” of tissue from my abdomen to my chest to reconstruct a breast post-mastectomy. That surgery included a Lymph Node Transfer in an effort to control my Lymphedema. This is the reason I am traveling to Chicago for surgery. Very few surgeons do this surgery.

diep-flap

Phase Two involves sculpting and tweaking to try to make my DIEP flap match my other implant side. I’m not going for a perfect 10. I am hoping to be done with the awkward 4.5 I’ve been since the double mastectomy, though. People “in the know” will recognize terms such as “Ken Doll”, “Dog Ears”, and “Fat Necrosis”. These are some of the unsightly, and painful issues that can be fixed in phase two. For more on that, go ask Dr Google (actually, don’t! I just did a google images search, and it ain’t pretty). The fat necrosis is the worst. It causes me pain every day. The other stuff is just embarrassing in a locker room.

Phase 2 will also involve a lymphovenous bypass in my arm as a further attempt to alleviate the swelling caused by my lymphedema. It involves micro surgery in my arm to re-route the lymph vessels into the veins, so that the veins can carry the excess lymph fluid out of my arm. Sounds pretty cool, in theory. I’ll let you know how it feels next week.

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I’ve said it before and I’ll say it again, “wish me luck….no….wish my surgeon luck-I’ll be sleeping.”

New Car Smell

Imagine you really need a new car. You save your money. You do all the research ahead of time, and find the best dealer. You pick out just the car you need and ask the dealer how much it costs. The dealer tells you that he can’t tell you a cost on the car until after you sign the deal. All the research you do turns up a huge range of prices that the car might cost you, rendering that information useless. Imagine, too, that your “savings” for the car was being held by a company. The company tells you that after you buy the car, they will let you know if they are going to let you have the money for the car. Would you still buy the car?

I’ve been a consumer for quite some time. I always do my research and get my costs upfront in the decision making process. Then I can negotiate and decide whether the cost is worth it. The above scenario sounds absurd, doesn’t it? Most of you would probably walk away from that deal, right? But that is how the scenario plays out in the medical field. There is no transparency in the pricing of medical services. First, patients get the services they need and then deal with the bills (and the insurance companies) after the fact.

Months before my surgery, I was back and forth on the phone between the hospital and my insurance company trying to ensure that this surgery would be covered. Surgery was even delayed while waiting for pre-authorization from the insurance company. I also wanted an estimated cost so I knew what I would be facing if I had to pay a portion of the costs out of my own pocket. I was mostly concerned about the lymph node transfer, which is still seen as “experimental” in the US.

The surgeon himself was confident that the breast reconstruction would be covered. He also told me that the lymph node transfer was most likely to be covered in conjunction with the reconstruction surgery, as opposed to if we did just Lymph Node Transfer. The Women’s Health and Cancer Rights Act of 1998 requires all group health plans that pay for mastectomy to also cover prostheses and reconstructive procedures. I never had any trouble getting coverage for my mastectomy or other reconstructive surgeries, so I was confident my insurance would cover this procedure. I had to trust that all would work out (which is why I pay that huge monthly health insurance premium) and I scheduled the surgery.

However, neither the hospital nor the insurance company would give me an estimated cost of the surgery and hospital stay. Neither would confirm whether the surgery was going to be covered by my insurance or not. I had the hospital tell me the billing codes, but the insurance company still wouldn’t tell me anything until after a claim is submitted. The insurance company pointed me to their online “cost calculator” so I could get an idea of the cost. The range was so large, it was not helpful. The hospital simply said that they would “go to bat for me” if the insurance company denied coverage (after the surgery). This was all the information anyone would give me on cost and coverage before I made the decision to proceed with the surgery.

Hundred Bill CornersBefore the hospital gown hit the bottom of the soiled linens hamper, the ink was dry on the letter from the insurance company. The ink was dry on lines stating “we have determined that the service is not medically necessary,” and “We did not receive any other medical information to make a decision about your admission. We do not have your test results. We do not have reports about your care. You were admitted 01/06/2017. Your admission is not covered.”

The letter was dated 01/09/2017. It was stamped before I was discharged from the hospital, and waiting at my house when I returned home from the hospital. I’ve never seen an insurance company work that fast. It certainly takes longer to process claims and PAY bills. Why would they subject someone to the anxiety and stress of facing medical bankruptcy before they even have all the information from the hospital? I bawled when I read this letter. Truthfully, though, I am not worried (yet.) Once they receive the information from the hospital (and my appeal to their decision to deny me coverage), I feel that they will have to cover this surgery. What frustrates me is the fact that I have to appeal and fight the insurance company. I’m upset that they didn’t wait until all the information was gather from the hospital before sending me a denial. “We do not have results,” “we do not have reports.” Well, GET the results and the reports and THEN tell me what is covered or not covered. I am trying to heal from major surgery. I do not need the added stress.

Thank goodness I’m starting a new career. I may need every penny to pay for this. Who’s buying and selling Real Estate? Call me.

I don’t even like that new car smell.

Waking Up is Hard to Do

Waking Up is Hard to Do

Everything went black as they wheeled me through the operating room double doors. The next thing I remember was faint sounds and confusion. A male nurse was introducing himself and telling me that it was time to move out of recovery and into my room. I gathered that he was in a rush, and everything seemed a bit disjointed. I faded in and out of sleep and don’t remember much.

What I do remember from the first night was extreme thirst. I’ve never been so thirsty in my life. I was not allowed to drink anything in case they needed to rush me back into surgery. Those first hours are critical for the blood vessels to connect to the flap (as boob #2 is now called.) I was too out of it to help myself, and am so grateful for Andy, who stayed awake by my side all night. He was able to use a little sponge on a stick to put water on my lips and inside my mouth. I think I begged for water all night. At some points, my mouth was so dry that my lips stuck to my teeth. The nurse finally slathered vaseline on my lips and that helped quite a bit.

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I also remember feeling my right arm puffing up like a balloon. Lymphedema does not like the trauma of surgery. I remember the nurses coming in every hour to check my vitals. I’d wake up enough to ask for water and push my pain med button. They used a doppler radar to listen to the blood flow to the flap. It sounded like a baby’s heartbeat. I couldn’t tell you much else about the night. I don’t know if I ever actually opened my eyes. I do remember once, when the nurse asked me if I needed anything else, I said, “a giant glass of water, please.” I did not get a giant glass of water. By morning, I was so parched I couldn’t talk. All I wanted was water, sleep and serenity.

Then, all of a sudden, there was a grating, raucous conversation that seemed all about sunshine and happiness but with a nasty undertone. It was the nurse’s shift change, and the raucous one would be my caregiver for the next twelve, long hours of my life. She was syrupy-sweet on the surface with an underlying toxic passive aggressive core. Let’s call her Nurse Saccharine. She managed to hold on to her tight smile as she insulted and criticized everyone around her, loudly. She crashed into the room, jolting me out of sleep every hour to check my vitals. She would be in charge of getting me to stand for the first time, which is never pleasant, even under the best of circumstances. She kept popping in telling me excuses and delays. In the meantime, the physical therapist came in to get me up for a walk, but I still had a catheter and was connected to drain suction on the wall. I told her the nurse was coming after lunch to get me up, so she arranged to come back around 1:00. Well, Nurse Saccharine did not like this at all. She thought it was ridiculous that the PT didn’t just do it herself and get me up.

I further inconvenienced her when I asked for additional pain pills before trying to get out of bed. This turned out to be a mistake, as she gave me something that made me very sick. Up until that point, I had a “magic button” that delivered dilaudid to me as frequently as every 10 minutes. It worked great on the pain, and didn’t cause nausea! A tough combination in my opinion. So now, nauseous and weak, it was time to let Nurse Saccharine pull my catheter and get me on my feet. Yippy!

The hospital bed did much of the work, but the final twist pulled hard on the fresh incision which spans from hip to hip. After the searing pain subsided, I put my feet on the floor and stood up. Next, three or four steps to the chair. I made it! I settled in and was finally able to sip on water. She told me that she would be back to get me walking to the bathroom in a couple hours. At this point, the water was too much for my stomach and just when the PT came to work with me, I started throwing up. I think this was Saccharine’s way of punishing the PT for not doing more earlier. We did not go for a walk. Instead, the PT wrapped my arm and I continued to sit in the chair feeling awful.

I asked for more anti-nausea meds, but the nurse said the doctor wouldn’t approve another one. I couldn’t keep the water down, and going on 30 hours without water, the nurse wanted me to pee. Not surprisingly, I could not. Saccharine threatened to put a catheter back in if I didn’t pee, so I started drinking my water a little more ambitiously. No way was I going to let this woman put a catheter in while I was alert.

I finally ordered some broth and jello to try to calm my stomach down. It was Saturday afternoon and time for the NFL play-off games. Andy came back from catching up on his sleep to watch the games with me. I slept through most of both games, though. The shift change came again and thankfully I got a much nicer nurse. She told us that the previous nurse informed her that I refused the additional anti-nausea meds. Imagine that. We told her that, despite begging for additional anti-nausea meds, Nurse Saccharine told us the doctor said no- an outright lie. Why would anyone make someone suffer like that? Once I got the nausea under control, I felt so much better. I had a pretty good night. I needed to rest up because the next day was the Packer game, and I didn’t want to sleep through that!

As 7am approached, and time for the shift change, I started feeling worse and worse, imagining another 12 hours with Saccharine. My whole day turned around when, at 7:15, a very nice nurse quietly came in my room and introduced herself as my nurse for the day!! No more Nurse Saccharine!! I later learned that Andy told them at the nurses’ station that we had trust issues with the nurse and did not want to have a repeat of the previous day! That made my day. Sunday was a turning point. I felt good. I could get up on my own, eat, manage the pain and nausea, and the Packer game was awesome!!!

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