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THR Developed Heterotopic Ossification in Left Hip

Mr.HoNoMo

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Hey y'all. My name is Brandon and I was in a major motor vehicle accident last year on 01/17/19, and I'm currently suffering from a high grade of Heterotopic Ossification (HO) in my left hip. I don't have a THR, but this is the only forum with helpful information about HO, and I do have a THR related question, so I hope you'll allow me to stay. This is gonna be a pretty long post so thanks for taking the time to read it!

So first I'll give some background info before telling my full situation.

Background:

Age: 24
Gender: Male
Ethnicity: African american

Car Accident Ortho Injuries:
1. Open displaced fracture of proximal epiphysis of left femur.
2. Open nondisplaced fracture of anterior column of left acetabulum.
3. Left thigh morel-lavallee lesion.

Dates of Ortho Surgical Procedures:
01/18: Intramedullary nail (IMN) forced into left femur.
01/22: Open reduction and internal fixation (ORIF) of left both column acetabulum.
01/24: ORIF of left both column acetabular fracture with fixation of left posterior wall.

Alright so here's the breakdown. After going through the multiple surgeries and being discharged from the hospital I noticed my left hip looking deformed and noticeably bigger than my right hip. I discussed this with my orthopedic surgeon (OS) and he said it was Heterotopic Ossification.

Apparently HO is not a rare condition, but it usually isn't severe enough to affect range of motion (ROM) so he told me not to worry about it too much. Well turns out my HO is a rare case because it has affected my left hip ROM terribly. I can't lift my left leg up high, reach my toes, put on socks, tie my shoes, etc, etc, etc. Basically my left hip seems completely stiff and frozen due to the excess HO bone.

I have an appointment with my OS on the first week of February and we're going to discuss the possibility of surgically removing the HO. We actually briefly discussed removing the HO last year, but he said we needed to wait a year before removing it in order for the HO to fully mature. During my recovery process I've had a lot of time to research HO and I came across this forum and a member's (CalciumHip) incredibly helpful thread: https://bonesmart.org/forum/threads/heterotopic-ossification-after-total-hip-replacement.39660/

Like CalciumHip I also live in Georgia and have the opportunity to make an appointment with the OS at Emory University Hospital (Dr. Shervin Oskouei) that successfully removed his wife's HO. But before I make that appointment I wanted to ask the very helpful members of this forum a few questions first:

1. Should I make an appointment with Dr. Oskouei even though he wasn't the OS that operated on me after the accident? Or does it make more sense for the original OS to remove the HO? My original OS is great, but he doesn't have as much experience with HO.

2. Is it necessary to tell my current OS that I want a second opinion from Dr. Oskouei? Would they exchange info with each other to make it easier for Dr. Oskouei to perform the surgery? They are from different hospitals, but the two hospitals are affiliated if that makes a difference.

3. I read in CalciumHip's thread that his wife got a Full Body Bone Scan prior to her having HO surgery. My OS only said I would need a MRI prior to surgery. Has anyone had experience with a Bone Scan or a MRI? Or knows which is the better or safer method?

4. My OS said that I was supposed to recieve radiation treatment prior to him performing the three surgeries, in an effort to prevent HO, but apparently the radiation team refused to do it because they wrongly assumed I wouldn't be at high risk of developing HO. Now that I know radiation treatment is necessary to prevent HO from forming, are there any negatives or side effects to the radiation?

5. This is a scary thought but...Would a car accident like this make it more likely I'll need a THR in the future? And would HO surgery on the same hip also make it more likely?

I've included my x-rays for y'all to get a better understanding of my sitiation! Thanks!

20190417_113526.jpg


-- Brandon.
 
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Jaycey

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@Mr.HoNoMo Welcome to BoneSmart! Wow - you have been through some tough times with that hip.

Did you read the fairly lengthy thread our Nurse Director Emeritus wrote Heterotopic ossification?

Her first recommendation is to find someone with experience in treating HO. So I would say Dr. Oskouei is your best bet.

You don't need to tell your original OS that you are seeking a second opinion. I guess it depends on the kind of relationship you have with this surgeon. If he has little experience with HO I would think he would encourage you to see an expert. Perhaps ask for a copy of your medical records so that the new surgeon can see your history.

All your other questions will be the basis of that second opinion appointment. Anyone with expertise will recommend any diagnostic tests/scans and a course of treatment.

And no, the actual accident would not define whether a THR is needed. It's all about the condition of your hip and the level of damage to the joint. Again, a good surgeon will take a look and quickly access.

Although he has not visited BoneSmart in awhile I'm tagging @CalciumHip for you. Hopefully he has his alerts switched on so he will be notified.

Please keep us updated!
 

Pumpkln

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@Mr.HoNoMo
Welcome to BoneSmart, glad you joined us! :welome:
Wow, that is some hardware in your hip.
You will notice I edited your post to add the link to CalciumHip thread.
I also added your surgery dates to your signature, please take a look and advise if there are any omissions.
Should I make an appointment with Dr. Oskouei even though he wasn't the OS that operated on me after the accident?
Yes, with HO you will want a second opinion from a specialist. Once you have interviewed the specialist you will be able to decide who you want to perform the surgery.
Is it necessary to tell my current OS that I want a second opinion from Dr. Oskouei?
While it is not necessary or required, your current OS should be supportive of you receiving a second opinion. He wants the best outcome for you, and may be relieved to have input from another OS.

All the best in your search for answers.
 

VSlowLife

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@Mr.HoNoMo Welcome. You have great questions, and your image says so much. I am so sorry you had such an accident. Wow.

Sometimes there is a form you fill out to get your medical records released to another doctor for free. Either doctor may have this form. Maybe they can e-mail it to you?
 

Eman85

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WOW!! that is some x-ray. You're totally off the charts as far as someone like me giving you any real medical advice. Now as far as opinion goes I would go see Dr. Shervin Oskouei and get his opinion. I think any good surgeon would work to help a patient and not have a problem with getting a 2nd or 3rd opinion. It's your hip and your life.
 
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Mr.HoNoMo

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Thank y'all for the warm welcome! :happydance:

Glad to see I'm not the only one freaked out about the x-ray lol! My OS said despite how crazy it looks the hardware shouldn't negatively affect my hip's movement at all, but I still kinda find that hard to believe so I would love a second opinion. I honestly think he went a lil overboard with the hardware but I'm not the expert so I'll deal with it lol.

He also said it's ok for the hardware to remain there forever. Is it true that hardware like that can last a lifetime and doesn't need to eventually be removed?

@Jaycey @Pumpkln and @Eman85 Y'all are right I should trust my OS to want the best for me. But I was reading on this forum that some people recommend not getting a second opinion from a doctor that might be affiliated with your current surgeon, in order to avoid potential bias or shady practices. And like I said the two hospitals are affiliated with each other (although I don't know if the doctors themselves know each other), so I wasn't sure if I should be cautious about that.

Sometimes there is a form you fill out to get your medical records released to another doctor for free. Either doctor may have this form. Maybe they can e-mail it to you?
Ohhh okay that's a good idea about the medical records. I actually have a copy of my medical records downloaded on my computer. Is it possible for me to email it to Dr. Oskouei myself or bring it to him on a USB?

And thanks for tagging CalciumHip! He gave a great update about his wife's surgery being successful and the HO not reappearing. But he didn't really say if she regained ROM back in her hip or if she can walk again without a walker, put on her shoes, socks, etc. I would love another update!
 

Pumpkln

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In your circumstance seeing Dr Oskouei is your best source for a second opinion about HO.
The recommendation to seek out a surgeon with no affiliation is just that a recommendation. Usually our members have been told there is nothing wrong with their joint, and an independent opinion may be a better option.
 
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VSlowLife

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You are way ahead of me! You are really on top of things and I am impressed. :cheers2:You are a voracious reader.

Ohhh okay that's a good idea about the medical records. I actually have a copy of my medical records downloaded on my computer. Is it possible for me to email it to Dr. Oskouei myself or bring it to him on a USB?
Good question. Ask his staff. Just thinking they may not trust any USB, for security reasons, but you never know. Maybe e-mail could work? Tomorrow is a national holiday, but some doctors offices are open.

I usually ( me being a Boomer) bring a second copy of my records because sometimes you do not get all your originals back. Offices are busy places. I keep mine in a binder, not the Millennial way, I know. Now some hospitals have an online shared information system, you log into, to converse with your doctor and you can view your medical records.

Sometimes, if you are in a metropolitan area, they ask you if you want to link your other medical records from area hospitals, to their computer if your second opinion cooperates with a hospital network. This makes life so much easier.

On the topic of HO, my surgeon wants me to take 15 mg of meloxicam, an NSAID, the day before my surgery, to try to reduce the risk of HO from my hip surgery, as part of their protocol. You may want to ask your second opinion about his pre-surgery protocol vs, post-surgery protocol, for HO surgery. One way to compare doctors.

I am really hoping you do well.
 

Eman85

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I had a little bit of hardware before my THR, nothing compared to yours. I'd say it can stay as long as it doesn't bother you after all look at the THR x-rays quite a bit of hardware.
I don't get the bit about the bias or shady practices, if a DR. or surgeon works like that I don't want them. I want people that see me and aren't worried so much about their ego or wallet.
 

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I think your concern about how to handle a 2nd opinion with your existing surgeon is really common. Most of us are pleasers, and don't want to imply that our doctor isn't competent or that we don't appreciate them. With that said, a 2nd opinion is often the wisest thing to do to ensure that the treatment plan is the right one, and in your case it seems to me that the 2nd opinion with a specialist who has such a high level of expertise makes perfect sense.

Good luck to you on your next steps....I think it's great that you are being proactive and getting as much info, and support as possible.
 
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Mr.HoNoMo

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Thank y'all so much for the advice and support! Really happy that I stumbled across this amazing forum cause y'all have no idea how alone and helpless I felt having this rare condition! Thank God for the internet lol! :0)

On the topic of HO, my surgeon wants me to take 15 mg of meloxicam, an NSAID, the day before my surgery, to try to reduce the risk of HO from my hip surgery, as part of their protocol. You may want to ask your second opinion about his pre-surgery protocol vs, post-surgery protocol, for HO surgery. One way to compare doctors.
Interesting! I'll definitely ask both doctors a bunch of the same questions and compare answers. Regarding your surgery, did your surgeon mention anything about radiation treatment? Since my hospital refused to give me radiation, my OS told me to take indomethacin 25mg x3 daily for two weeks in order to prevent or lessen HO formation. And unfortunately that didn't work out for me (although I suspect it didn't work out because the HO had already started forming after the accident/surgeries, but I'm not sure). So I'm wondering if your surgeon is against using radiation treatment, or if they believe NSAIDs should be just as effective.


Another question for y'all. Do you think I should schedule an appointment with Dr. Oskouei right now, or should I wait until after I have my appointment with my OS in two weeks?

I've read that scheduling an appointment with a surgeon could take months to actually happen depending on how busy they are. But after reading y'all's advice I think I've decided to tell my OS about Dr. Oskouei, and maybe it makes sense to wait and see what my OS will do/say about that in terms of support, exchanging information with Dr. Oskouei, setting up an appointment for me, etc. Since the two hospitals are affiliated and the doctors might actually know each other, it could end up being a helpful/good thing if I tell them about each other.
 

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Good morning @Mr.HoNoMo

This can be very true:

I've read that scheduling an appointment with a surgeon could take months to actually happen depending on how busy they are.
The same can happen with a surgery date. I saw my surgeon in September, my surgery is next week.

An appointment can be made, and cancelled, if necessary. Your choice.

I am not having any radiation, pre-surgery to prevent HO. I did have a CT scan to coordinate with a Mako robot. I would imagine in young people, doctors try to avoid as much radiation exposure as possible. It sounds like your doctors did what they could to avoid HO. I do not know too much about it, but it sounds like something the body does to help protect itself, when tissues sustain damage. You may be correct, that it may have started after your accident.

I do know a few other forum members have dealt with it in varying degrees.
 
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Mr.HoNoMo

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Good morning @VSlowLife! Well....evening now! Sorry I took so long to reply lol!

The same can happen with a surgery date. I saw my surgeon in September, my surgery is next week.

An appointment can be made, and cancelled, if necessary. Your choice.
Wow yeah that's a crazy long time to wait! So it might even be possible to have to wait a whole year before surgery! I should definitely go ahead and make the appointment now.

I am not having any radiation, pre-surgery to prevent HO. I did have a CT scan to coordinate with a Mako robot. I would imagine in young people, doctors try to avoid as much radiation exposure as possible. It sounds like your doctors did what they could to avoid HO. I do not know too much about it, but it sounds like something the body does to help protect itself, when tissues sustain damage. You may be correct, that it may have started after your accident.

I do know a few other forum members have dealt with it in varying degrees.
See that's what I'm a little concerned about. Do you not want radiation treatment because of the potential risks or do you believe NSAIDs are just as effective at preventing HO?
 
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Celle

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I understand that neither one-dose radiation therapy nor NSAIDs are proven ways of preventing HO. Many surgeons do neither. This is something you should discuss with your surgeon, @Mr.HoNoMo .

In addition, NSAIDs can increase your chance of bleeding, especially from the stomach, and they also increase the risk of developing heart problems:
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study
 
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You reply when you can. No apology is needed.:SUNsmile:

Wow yeah that's a crazy long time to wait!
Yes, it is, and for some doctors in some places, such as Boston, it can be a year. It all depends on the density of the population, etc. Some folks may have an appointment and surgery in a few weeks.

See that's what I'm a little concerned about. Do you not want radiation treatment because of the potential risks or do you believe NSAIDs are just as effective at preventing HO?
I am not afraid of radiation, I respect it, and use it when necessary. It is what my doctor believes, which is important, because, as much as I can find online, I know it took a while to get that information approved for publication, before it went online.

Your question to me, is another good question to ask you surgeon.

I agree with
I understand that neither one-dose radiation therapy nor NSAIDs are proven ways of preventing HO.
 
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Mr.HoNoMo

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@Celle and @VSlowLife Thank y'all so much for the information! I now have plenty of great questions to ask my OS and Dr. Oskouei during upcoming appointments! Hopefully they take their time answering them and don't try to rush me through the appointment. My OS always seems so busy and bothered at these follow-up appointments, it stresses me the hell out lol!

I'll give y'all an update on how my appointment goes the first week of February. I'm a lil scared about what my OS has to say about radiation treatment vs NSAIDs and the possible risks involved with both of them...But all I can do is believe I'll have a successful and positive outcome!

Thanks again everyone! I feel sooo much better about all this mess after chatting with y'all and getting really helpful info/advice! :SUNsmile::yes::SUNsmile:
 

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@Mr.HoNoMo Welcome! I actually logged in instead of just lurking for once. You are the first person I have seen that also had acetabular fractures.

I was in a car accident in 2015 resulting in fractures. Mine were isolated to the acetabulum and my femur was left mostly intact. I did end up with a THR because my native femur would not stay in place and was considered permanently dislocated.

How was your recovery from the fractures? Were you non weight bearing for a period of time? How is your walking now? Are you pain free as far as the joint itself? I've only had opportunity to speak with one other person who had injuries similar to my own, so I am definitely curious here.

I don't know alot about HO. It was mentioned on one of my early ct scans, but then was never mentioned again. When I asked about it I was told that it was a concern with trauma patients who had multiple surgeries.

As far as if the hardware will remain for life: I was told that unless it was causing issues that it would most likely remain forever. There was a brief discussion before my THR about possibly removing hardware if it interfered with placing the cup. Apparently my surgeon did not have any issues since it is still there. I would think that if you ever had a THR though that they would definitely do something different with the hardware in your femur.

I wish you luck and hope you will continue posting here.
 
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Mr.HoNoMo

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Thank you @YoungHippy! Lol I know all about stalking and lurking on forums, so I'm glad my post was compelling enough to convince you to log in! :SUNsmile:

I was in a car accident in 2015 resulting in fractures. Mine were isolated to the acetabulum and my femur was left mostly intact. I did end up with a THR because my native femur would not stay in place and was considered permanently dislocated.
Wow sorry to hear about the car accident! That's wild you needed a THR from that! How are you dealing with the new hip, do you feel similar to how you felt before the accident?

How was your recovery from the fractures? Were you non weight bearing for a period of time? How is your walking now? Are you pain free as far as the joint itself? I've only had opportunity to speak with one other person who had injuries similar to my own, so I am definitely curious here.
My recovery was...Hell lol. I was in the hospital for almost two weeks and my hip and leg were in a lot of pain the entire time. When I was back home my recovery became somewhat easier as long as I took my medicine.

I was non-weight bearing for three months until my follow-up appointment with my OS.

My walking now is hindered by the HO. I still have to limp around because the extra bone prevents the joint from moving at all. So I can lift my leg up off the floor a little bit, but no swinging action is happening at all. Without the HO I'm almost positive I would be walking with no limp.

Well it took a long time, but after a full year of recovery I can confidently say that I'm 90% pain free in the hip! The remaining 10% of pain is from the HO stressing my hip out and not allowing it to relax at all. So any time I'm walking (limping) around and I accidentally put my stiff left leg in a weird or awkward position that the HO doesn't agree with, I'm gonna feel a lil pain.

As far as if the hardware will remain for life: I was told that unless it was causing issues that it would most likely remain forever. There was a brief discussion before my THR about possibly removing hardware if it interfered with placing the cup. Apparently my surgeon did not have any issues since it is still there. I would think that if you ever had a THR though that they would definitely do something different with the hardware in your femur.
Ohhh ok thanks for telling me this! My OS said the hardware shouldn't cause me any issues, so I'm trusting his judgment on that! I will get a second opinion from Dr. Oskouei though just to make sure.

I'm honestly not even sure how they would take the hardware out if they needed to cause it all looks crazy complicated! Apparently all of the hardware is outside of my bone, not inside, and they were only put there to hold my bones in place while the fractures healed...but some of them look inside the bone to me! Actually I think the rod is inside my femur so how the hell would they even get that out??? Orthopaedic procedures are crazy to think about lol.

Does the amount of hardware you have (minus the THR) look similar to mine? A bunch of nails and plates?

I wish you luck and hope you will continue posting here.
Same to you! This forum is a great source of support and information so I will definitely be here a while! :yes:
 

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Wow sorry to hear about the car accident! That's wild you needed a THR from that! How are you dealing with the new hip, do you feel similar to how you felt before the accident?
No, my life is totally different now. For the most part I don't have pain anymore, but I was left unable to do alot of things that I did well before the accident. I was a CNA before in a nursing home. I wasn't able to return to that line of work, or further pursue my nursing career. Now I work as a secretary. I do love my job, but really miss helping people. I have a limp that on some days horrifies people, and on other days just resembles a drunken monkey. But for the most part I am pain free, unless I do something that is a no-no. Internal rotation past a certain point is a pain, but I have found work arounds for that in most cases. If I lift and carry stuff my hip not so gently reminds me that I shouldn't be doing that. I don't do stairs unless there is a very sturdy handrail. I can only lift my leg to a certain height, past that point I can use my hand to lift it up if needed. And from a sitting position, like getting into the passenger side of a car, I always have to assist my leg in. (my injury was my right hip)

My hip dislocated during the accident. It was put back in place during the first ORIF surgery when the repaired my acetabulum. At my first follow up visit they discovered my hip had dislocated again, thus a second surgery to re-repair the acetabulum and put the hip back in place. At the next follow up it was already dislocated again. Which is when the first surgeon decided he was done with me, and passed me along to another surgeon at the same practice. After 2 surgeries within a month they decided it was too much of an infection risk to attempt to put the hip back in place. It wasn't until the actual hip replacement 3 months later that the surgeon discovered that a portion of the head of my femur was missing, which was probably the reason my native hip would not stay in place.


My recovery was...Hell lol. I was in the hospital for almost two weeks and my hip and leg were in a lot of pain the entire time. When I was back home my recovery became somewhat easier as long as I took my medicine.
Same! A little over 2 weeks, the last week of that in rehab teaching me about my restrictions and how to do things in my non weight bearing state. Once I was home and able to settle into my routine in my familiar environment things were better. Was a little stir crazy from not working though.

I was non-weight bearing for three months until my follow-up appointment with my OS.

My walking now is hindered by the HO. I still have to limp around because the extra bone prevents the joint from moving at all. So I can lift my leg up off the floor a little bit, but no swinging action is happening at all. Without the HO I'm almost positive I would be walking with no limp.

Well it took a long time, but after a full year of recovery I can confidently say that I'm 90% pain free in the hip! The remaining 10% of pain is from the HO stressing my hip out and not allowing it to relax at all. So any time I'm walking (limping) around and I accidentally put my stiff left leg in a weird or awkward position that the HO doesn't agree with, I'm gonna feel a lil pain.
In all I was non weight bearing for about 4 months. Weren't those first few steps the most awesome feeling in the world?

Glad to hear that the joint itself is doing well. And hopefully they will get a game plan together to handle your HO. Maybe once that's handled you can get back to life without any hold backs.

Ohhh ok thanks for telling me this! My OS said the hardware shouldn't cause me any issues, so I'm trusting his judgment on that! I will get a second opinion from Dr. Oskouei though just to make sure.

I'm honestly not even sure how they would take the hardware out if they needed to cause it all looks crazy complicated! Apparently all of the hardware is outside of my bone, not inside, and they were only put there to hold my bones in place while the fractures healed...but some of them look inside the bone to me! Actually I think the rod is inside my femur so how the hell would they even get that out??? Orthopaedic procedures are crazy to think about lol.

Does the amount of hardware you have (minus the THR) look similar to mine? A bunch of nails and plates?
I think when they installed our hardware it was placed outside the bone. But I think during the healing process the bone may also envelop some portion of the hardware, hence the reason some of it looks to be inside the bone, especially around the area where the fractures were. That's as far as the acetabuli fractures anyway. I don't have much experience with the femur fractures. In your case though I would think if you ever had to convert to a THR atleast part of the femur hardware would be removed. Here's hoping that is a long way into the future for you though.


Yes, I have alot of the same hardware as you. The first time I saw my x-rays I thought it looked like braided wire. I was on a good amount of pain meds at that time...lol. I later learned that it was actually plates and nails and screws. I'm uploading a pic of my x-ray that I keep on my phone for those times that someone tells me that I am way to young to be walking the way that I do.
 

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