The roller coaster begins...

thepuckhead

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Hello!

53-yr old healthy, active woman here - avid cook, volunteer wildlife rehabber prone to running in traffic to save turtles crossing the road, swimmer, recreational ice hockey player, weightlifter, desk jockey day job employee, reader of just about any book you put in front of me, married with 3 cats and currently a complete headcase with regards to THR for my left hip.

I am posting here because my poor wife is under so much stress already with her mom also badly needing a THR (left hip, too!) that she doesn't have enough emotional energy left to help me with my own ruminating and inability to be confident in any decision I make. So, I've been reading a lot here and decided to post to give some outlet to all this BS and maybe give my wife a break. ;)

Backstory - about a year ago or so, I thought I'd tweaked my quadricep muscle. Felt like a muscle pull when I walked. Sometimes it was so sharp I limped. I limped into the locker room for a hockey game and my teammate (a veterinarian) took one look at me and said, "you need an x-ray." I laughed and said it was just a muscle thing and it would always resolve during exercise. Nonetheless, I mentioned it to my primary care doc. She moved my leg around a bit, said she didn't think it was bone on bone or anything and said I could start PT or go see a sports med. I started PT.

PT tried a bunch of different stretches/exercises for 3 months and they helped a bit. Discovered that my left glute would barely move when isolated - was super tight and could hardly do the prone leg lift. Also, the step-ups tended to hurt. Could not get rid of the "tightness in my quad" no matter what we did, so she said she thought it was time for imaging. Said she suspected my back or my hip.

Into an ortho specialty clinic I went and was whisked back for a hip x-ray. The whole time I'm thinking "WHAT is this obsession with my hip? My hip doesn't hurt! My QUAD does!" Geez, people, I know you're medical professionals, but come ON. In walks the surgeon and says, "I think we have a reason for the ouch." Left hip is grade 4 OA with bone spurs. Bone on bone. He said I'd probably gotten all I could out of physical therapy and that the next conservative treatment would be cortisone shots. Said I would be a candidate for THR depending on how much the pain limited my life. I nodded. I smiled. I was in complete shock. HIP REPLACEMENT? Are you INSANE? Well, very nice to meet you, have a nice day goodbye!

Had cortisone shot. Was miracle. Such relief. My wife said I was walking upright again. Relief lasted two weeks until I climbed eight flights of stairs, did an elliptical workout and then played hockey. Nope. Back to the "quad pull" pain again. But at least there was no longer any doubt in my mind that my hip was indeed the source of the pain.

A few months later, I fell off the edge of my deck. The fall was just a few inches but it resulted in two sprained ankles. Yay.

My ankles got better after a few months. My hip pain did not. It was now more frequent and severe. I went on a business trip and had been looking forward to walking around the new city, sightseeing. Ha. I have never gotten so many offers of "ma'am? Can I help you? Are you OK?" Any given step might result in a sharp, catching pain that would stop me in my tracks. I was afraid I'd fall from one of those "catches." I was afraid to walk. I will never forget what it felt like to limp across the street like a frail old lady and see the pity/worried stares on some people's faces. I was done. I scheduled a second cortisone shot and another consult with the ortho.

Second cortisone shot did nothing. Ortho came in and I said "I am sick of this." He nodded and said I could schedule the surgery anytime. I figured, OK, I'll get through another hockey season and then schedule it after.

Hockey season starts. First practice - I can't even do the skating drills. Not only is the original pain back, but now other muscles are joining on the fun. Hamstring, IT band, calf: any of them might tweak, too. I skate through it. The season starts and each game I have no idea what may or may not tweak. Could skate a shift and be fine and then step off the ice only to feel my knee buckle in. OK, maybe I don't want to try to do this all season.

I start researching hip replacement surgery and scare myself to death. The limitations, the question of what's safe to do. Anterior or posterior. Leg length differentials. Permanent nerve damage. Limp forever! You can walk all day, but don't run an inch! Swim, but not breaststroke. Be careful on hills. Yarrrrrrrrrrggghhhh!!!!! My brain broke.

After hearing a testimonial from random YouTube guy about the only way to get back to hockey is to have the anterior approach, I booked an appointment with surgeon #2 who does the anterior approach. He tells me that yes, I can keep playing hockey and the only thing I can't do is run marathons. He said that after about 3 months, everyone is in the same place, regardless of approach, because by then biology has taken over. He assured me that the data isn't showing a significant difference in dislocation rates between posterior and anterior and says the first ortho I saw is absolutely excellent.

Back to surgeon number one last week with my wife because I wanted her to hear everything so she could maybe help my squirrely brain when it goes on its tear. Surgeon says yes, hockey is fine and he's worked on a number of hockey players, that he doesn't put restrictions on his patients after surgery, showed me the small amount of space he'd need for the surgery and the major muscles he wouldn't cut. Most importantly, when he came in, he sat down, looked at me and said, "Ready?" And I sheepishly said, "yes", without a moment hesitation. He said he thought I'd do really well. I left feeling so good and ready and confident. So, what happened?

Oh, wouldn't ya know? My hip feels better! I'm walking better, had two games without twinges. So now, I'm doubting whether I really need this surgery, whether I was imagining how bad the pain was, freaking out that I'll make things worse by having an unnecessary major surgery. It's insane. Every day I look for the pain and get angry/upset if I feel OK. My wife said I should enjoy the good days but understand they're just luck. I have a great surgeon (turns out he's an arthritis and hip/knee replacement specialist) who I trust completely. But when I walk and feel OK, I'm wondering what in the world I'm thinking. I just want to do the right thing by my body, but I don't know what that is and I'm making myself absolutely miserable.

I have a phone call tomorrow with the clinic for a preop screen or something and I think that may be when I schedule, but not sure. I just want to make a decision and live with it, but I am in tears trying to figure out what I can live with.

As an added bonus, my mother in law's surgeon wants to fit her in for THR before Christmas. Her hip has collapsed and she's confined to her lift chair, in agony 24-7. She's terrified, depressed, angry and doesn't want surgery. She knows it's the only thing that will give her any kind of mobility back, but she is so trapped in her misery that she can't see anything but awful outcomes. My wife is so tired from trying to help her that I want to keep up my game face so I don't add to her stress, but the game face is cracking.

Anyway, blah blah, I just wanted to get this all out somewhere. I'm pretty sure I'll go through with the surgery - I want this fixed. I don't really relish the idea of waiting until I'm in "enough" pain. My surgeon said the goal of the surgery is to give me a hip that has full range of motion and function. That sounds like, even if I'm not in pain, a good thing to do. I'm about 98% committed to getting it over with and bearing whatever awfulness the recovery brings and trusting what he says about getting back to hockey and all the other things I do but with good days being based on sound mechanics and not luck.
 

djklaugh

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@thepuckhead Welcome to BoneSmart! :welome: And thanks for the extensive history of your hip and your thinking about hip replacement. That does help us get a sense of where you are in the process. Yup, hips can be tricksy - it's like as soon as they hear a replacement may be coming they start to "behave" .... at least for a little while. But then they go back to the pain and dysfunction. And as you have seen with your M-I-L, hips can collapse when they get too worn out and that is horrendous pain!

The main thing to keep in mind while recuperating from a hip replacement is HEAL FIRST, THEN GET BACK IN SHAPE (for hockey and all other sports and strenuous activities). If you rush things you run the risk of doing more harm than good! We have seen a lot of people through here who return to very active lives once they are done with the hip replacement(s). I had both mine replaced 11 years ago and no longer even think of them ... until I log in here :wink:

As for your M-I-L have her check out this site ... we have a number of folks her age and several who have had collapsed hips who may be able to reassure her and help her get to the place of accepting this needed surgery.

Here are our suggestions and recommendations for pre-op folks:

Hip: pre-surgery considerations

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:


Score Chart: How bad is my arthritic hip?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:


Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?

And if you want to picture what your life might be like with a replaced hip, take a look at the posts and threads in stories of amazing hip recoveries
 

Layla

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Hello and Welcome to BoneSmart! Thanks for joining us.
Your story is a familiar one. The pain, the shock of diagnosis, wrestling with doubt, then submission. Almost forgot about the achy painful hip that suddenly begins behaving. It's like a dirty little trick because it won't last. Even if it does for awhile, your hip is bone on bone and unfortunately that's not changing.

You're missing out on a life without pain and your deteriorating hip will hinder your lifestyle more and more as time goes on. Maybe your MIL will schedule her THR if she realizes you are putting yours on the calendar and you can support one another. The sooner you schedule the surgery, the quicker you'll get back to all you know and love. You'll be surprised at how mobile you are within a short period of time and aside from the temporary discomfort of healing from major surgery, that annoying hip pain will be gone!
Wishing you comfort as you make decisions and move forward. Please know that we're here to answer questions and offer support whenever you're feeling the need.
@thepuckhead
 
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thepuckhead

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Thank you both so very much for your gracious and timely replies. They made me feel much better. You're very kind to respond to my long-winded spew, which I am a little embarrassed about now, so please excuse my lack of board manners ("oh, hi, I'm thepuckhead....LIFE STORY THERAPY RANT...."). :bolt:

I'm thinking this dark cloud of panic is mainly reacting to uncertainty. Even though there's a high likelihood that the surgery will go well, the mind still yearns for 100% money-back guarantee if it's not perfect. This is planet Earth, though, with humans, so...

I keep thinking back to how good it felt to decide to go ahead with the surgery. It's the only thing that will fix a degenerative joint and prevent the OA from progressing. I'm seeing this as a chance to start over with a hip that doesn't have limited range of motion and has complete functionality and, while I can't know now what my recovery will be like, I do know that I'm ready to just let my body be in charge for a while after the surgery and to take it slow.

My MIL is hopefully going to get her surgery scheduled this week. I really, really hope she does and experiences the relief of being rid of a collapsed joint. Maybe by this time next year we'll both be sitting comfortably around Christmas Eve dinner and hips and pain and fear and surgery will NOT be part of the discussion.
 

benne68

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Maybe by this time next year we'll both be sitting comfortably around Christmas Eve dinner and hips and pain and fear and surgery will NOT be part of the discussion.
Yes, you will!

Many of us have been on the same emotional roller coaster. I was so worried about the hip replacement that I put it off too long and ended up needing a cane to get around. As you can see from my signature, my THR was three years ago.

The night before, I was ready to cancel. My husband had to drag me to the hospital that day. But it didn't take long to see I'd made the right decision. And I can honestly say that, well before the year was up, I would "forget" that I'd had a THR as I went about my daily life.

Yes, the unknown is scary. As others have said, we are here for you. We've been down the same path and will support you on your journey. Lean on us!

Sending hugs :console2:
 

Woodstockhip

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Your story sounds much like mine (except for the level of activity you are used to!). Well do I remember that sudden “catch” that takes your breath away. I found that the first cortisone shot bought me about three months and the second did nothing. Deciding when to go for the THR is the hard part. If you are already bone on bone, sadly, it’s not going to get better on its own. Enjoy your good days when they happen and know that at some point down the road, you’ll be back on the ice. You and your MIL can heal together — your wife is gonna’ have her hands full for a few days!
 

Hip4life

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When the doubt creeps in, remember those bad days because eventually, they will come roaring back with a vengeance until you have your surgery. I look back and can't believe I endured that incredible pain for so long! Part of that was misdiagnosis (muscle/tendon strain: sound familiar?) I hobbled into pre-op with a cane and I could read the relief on my husband's face that I was finally going to be helped. There is the requisite pain from major surgery but I kid you not, you can tell the difference and that miserable joint pain is GONE! There is such relief and hope in life again. You won't be sorry in taking the chance to get back in the game again. It sounds like you've come to very healthy grips with it. We'll be here if you need a pep talk or willing ear. Keep us posted.
 
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thepuckhead

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Thank you all so very much! I went to a hockey practice last night when I was feeling absolutely miserable (mentally - the whole unknown anxiety/ohmygod I'm never going to do X Y and Z again...blah blah) and one strange thing happened and one not so strange thing happened.

The not so strange: Huh. My pain was back by the time I got out of the car at the rink! Whaddya know!

The strange: As I was changing after practice, I suddenly had a...well, not premonition, exactly, more of a flash forward/intuitive vision....that I had had the surgery, was changing in the locker room and telling all my teammates how great I felt with my new hip. My whole body *felt* the certainty of that vision. And it was like a light bulb went off in my head and I felt soooo much better and reassured. I know, not scientific and likely from a bunch of whackadoo stress neurons, but it seriously felt amazing.

I decided that I would do one positive thing each day in prep for the surgery and otherwise live my life until the day comes.

So today, my perspective is much more balanced. I scheduled the surgery for January 24th, which works out well because if my MIL gets hers done before Christmas, then we have a bit of breathing room between surgeries. I told my employer and my volunteer orgs the date and let them know I'd be out between 6-8 weeks, depending. I got my pre-op physical scheduled.

I think that counts as enough positives for several days. Or is that cheating, LOL? @Hip4life - my wife is like your husband in how relieved she is that I'm going forward with the surgery. It makes a big difference to her now that she can plan from an actual date and she's really happy to see me moving forward with my decision and coming to terms with it. It takes a lot off her plate emotionally.

I like this part of the roller coaster. :)
 

CricketHip

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Congratulations on making your decision. That was one of the hardest parts of the whole deal for me.
I like your vision of seeing yourself in the locker room with your happy new hip supporting you.
 

HollyNY

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Good morning @thepuckhead ,
A stage 4 OA hip can go from maybe manageable to limiting every aspect of life *very* fast.

There is no way to inject cartilage or lubricate the joint. Yet.

You are young and healthy. Lean into that to prepare for recovery.

You are in the right place for support. These folks have all been through it!

I never had so much as a broken bone and I thought 'Hip replacement? Hell no.' What an idiot I was.
 
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thepuckhead

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OK - having a down/freak out day.

What am I freaking out about? Whether I should reschedule with a surgeon who does the anterior approach and cancel the surgery I have with the surgeon who does posterior.

Why?

Because it looks like a lot of the successful recovery stories are all anterior approach. I think of the one youtube video where the hockey player said all posterior approach surgeries he knew of were really struggling because of muscle weakness.

And a random google search for anterior vs. posterior popped up a study that concludes no differences in gait improvement after sixteen weeks, but the posterior group didn't recover glute medius or adductor strength like the anterior group did after sixteen weeks.

So now, I am freaking the heck out. Nevermind that the anterior approach surgeon I met with said results were the same after 3 months. Nevermind that I really liked the surgeon I'm scheduled with and that he told me he'd had hockey players before. I mean, he did say he had one patient who has been playing for 4 years. But what if that means his other patients didn't play again? What if he's completely trying to sugarcoat everything?

He showed me the major attachment muscles and said he wouldn't need to cut those. I asked about getting my regular walk back and he said the surgery would absolutely address my gait issues.

I am panicked now. I am kicking myself for not asking for more specifics.

Anyone have successful posterior approach stories?

And it's reasonable to expect to re-learn to walk normally, right? I just caught a glimpse of myself walking and, even though it's a good day painwise, I look like a weeblewobble.

I don't like this part of the rollercoaster.
 

djklaugh

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@thepuckhead I've been a BoneSmart member for over 11 years and have seen threads about every possible approach and technique for hip replacement. There have been excellent results with each one ... and not so excellent results with each one. Dr. Google is often confusing and does NOT know your particular situation, symptoms, and life style. The best predictors of excellent out come (IMO --I'm not a doctor or a nurse) are 1) the skill of the surgeon and his/her experience doing hip replacements; 2) the over all health of the patient - not necessarily their athleticism just over all good health; and 3) Patient's willingness and ability to be patient and HEAL first before trying to resume any strenuous job or activity.

My own hip replacements (both done at the same time) were an anterior-lateral approach --- straight down the outside of each hip with no muscles cut (just retracted aside so surgeon could access hip capsules). I was not athletic at all but was generally healthy. I was patient and allowed myself to heal first before trying to strengthen muscles. So for me the process of recuperation and return to a lovely, pain free new normal was without complications.

Please don't second guess yourself! If you like and trust your surgeon just go ahead as planned. Changing surgeons now will delay your surgery and prolong your pain and dysfunction. Plus could make recuperation even longer and harder.

Having doubts in the lead up to joint replacement is normal as is having anxiety about surgery and the whole process. Just try to stay away from Dr. Google --- s/he really will make things worse for you.
 
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thepuckhead

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Thank you. The surgeon I'm seeing is a specialist in arthritis and knee/hip replacements. He's seen many, many surgeries. Thousands, I think he said. Dang but these panic demons can really sideswipe you. Returning to Earth now....
 

subie2021

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Yep, that's the idea... go with opinion of the guy who has done thousands of procedures and seen the outcomes over the opinion of some random internet guy who knows someone who knows someone who....:thumb:

Good luck to you. Best wishes for successful surgery and smooth recovery, from a happy posterior hippie. :snow::wreath::snow:
 

Woodstockhip

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I was one of those patients who bought the “anterior is better” line….that is, until I met my surgeon. First off, I love this man. He defies the old stereotype of the “no bedside manner orthopedist.” Before I saw him, I checked out his practice’s website and learned that he was one of the pioneers of anterior THR. Thus, I was a little surprised when he told me he was going to do posterior on me. When I asked him why, he was very straight with me. Of course, everybody and every surgeon is different but in his opinion, he had better visibility with posterior, preferred the instruments used in posterior, and was less likely to accidentally break a femur, knee, or ankle using the special table they need for anterior when dislocating the hip. So…he now does posterior only. And he’s done both of my hips. As others have said, ultimately, if you have an excellent surgeon, both methods will end up with the same results, hopefully good ones! The recovery might feel a little different at times, but if you trust your surgeon, that’s the most important factor. Good luck and smooth recovery wishes to you. And let me add — they do not cut muscles doing posterior…they tease the fibers apart. Yeah, there’s a lot of rooting around in there and it will take a while to restore your strength but I truly believe that would be the case either way.
 

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What part of the country are you in?

I am by no means an athlete but I did aerobics classes 3x a week for 15 yrs. I had an excellent baseline fitness level when I was active into my 40's. The only med I was on for 20 yrs was birth control.

I had anterior surgery at 52 and could not be happier w the result.

I looked at it this way. I did not want anything that restricted my movement for 6 weeks. I did not have 6 weeks to recover. I only had 3 weeks. My boyfriend only had 3 weeks to be there to help me.

The surgeries get to the same final point in success rates. But the difference in the 90 degree restrictions/hip precautions needs serious consideration.

I did not want any of that.

From Day 1 I had no restrictions. For me that was worth it.
 

Layla

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Anyone have successful posterior approach stories?
Yes, thankfully mine has been a success. My surgeon uses the posterior approach only and I had zero restrictions. I was cautioned to move thoughtfully / slowly and if anything hurt, stop. I also learned that if anything were to go wrong during your surgery re; approach used, they would revert to posterior approach since it affords easier access with better visibility. With that said, in the 5+ years I've been involved here, I've never read of the need for this. As others have mentioned, you should concentrate on finding a reputable surgeon that you have confidence in and trust that he will use the approach that's best for you. Best of luck to you!
 
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thepuckhead

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Hi, @HollyNY - I'm in the Midwest and being seen at a specialty ortho clinic (several of those around here, luckily). I used to do aerobics, too! Waaaay back in the hi-lo days and then step and kickboxing. Yes, the restrictions I'd read about terrified me. I thought I was going to basically be a mummified couch potato for three months and if I moved a millimeter, bang! Dislocation emergency!

But my surgeon didn't give me any restrictions/cautions, like @Layla's surgeon, including sleeping on my side if I wanted to (and if I could, haha). Was blown away. He said it would be great if I could take two weeks off and do nothing but really take it easy, mentally and physically, but I didn't *have* to. He said there was no need to push myself with a hip replacement, unlike a knee replacement that can necessitate some harder PT.

I told him that my primary care doc looked at me like I was insane when I told her about getting back to hockey and he kind of smiled and said, "well, maybe I'm a bit aggressive with activities but....I've seen a lot of hockey players. Now, marathon running is whole different animal..."

I'm so heartened to read all of these replies from everyone who's happy with their hip replacement. It really helps. Happy Friday!
 

Eman85

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I've had 2 posterior THR's, what do you want to hear? No one can tell I've had a THR. I do anything I want and some things I shouldn't. I have trouble seeing my scars they are just fine pink lines barely visible.
my OS gave me restrictions. He didn't have to tell me why as I learned about the procedure and understood why they tell you about restrictions. Basically it allows the body to heal and helps prevent putting strain on the joint until the body heals. If I didn't follow the restrictions there was no policeman going to come and put me in hip jail. I was the only one that would have to deal with the consequences. I just decided it was best for my recovery and I followed the restrictions for the 6 weeks. Seriously there wasn't much to it as doing things beyond the restriction advise wasn't comfortable. people ask their OS what they can do post op and get all different responses. Once your recovered you can do anything you want, you just have to be willing to accept the consequences of your actions. If you don't read the gloom and doom stories or worry about approach, you'll be better off. Come to understand what they do to our bodies to perform this procedure and what your body will need to recover from it and you'll have a good experience.
 
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subie2021

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Restrictions don't mean that you lay on the sofa for weeks on end, or that you need to hobble along like a wounded turtle for the rest of your life. They're in place to remind you to take care of yourself and allow your body to heal.
If any one surgical approach was the magical answer to every patient's problems, all surgeons would be on board with it. They'd be crazy not to be. If every posterior hippie was having weeks or months of trouble, and every anterior hippie was back to every activity within a couple of weeks, why would there be any option? And vice versa of course :loll:
No matter where the surgeon opens you up, your hip will be forcefully dislocated, the end of the femur will be sawed off, an artificial cup will be fitted to your pelvis, and the surgeon will use a nice heavy mallet to pound a big ol' spike into the sawed off stub of your leg bone. That will be followed by cranking the new artificial joint into place, then putting all the displaced soft tissues back where they belong.
This is a great place to educate yourself because so many experiences are detailed. Just remember that your recovery will be unique to you regardless of approach.
 

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