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Offline Janet

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Re: Pain scale system
« Reply #15 on: May 31, 2006, 01:01:33 AM »
I never know how to rate that, either. Actually, I haven't had a doctor ask me to rate it on a 1-10 scale in a long time. Maybe they are finally learning that pain is very subjective and it makes more sense to ask about activities! Anyway, I came up with my own scale. If asked to rate my pain, I tell that them I figure a 5 means I want to take something for the pain, and rate it from there. It might not be very scientific, but that way I am always evaluating my pain against a specific number that means something to me.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline KatieO

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Re: Pain scale system
« Reply #16 on: May 31, 2006, 01:10:03 AM »
How is your pain today, Janet? I hope you had a good day! It is too hot here and there is rumblings of thunder in the distance. Hoping for RAIN!
Katie
P.S. My knee hurts!
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin

Offline sharon74

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Re: Pain scale system
« Reply #17 on: May 31, 2006, 03:50:06 AM »
Janet, my OS hardly ever asks me to rate my pain - it is at the hospital they pounded it on me for surgery.  I think they may have asked once or twice at my OS, but that is about it.

Hope everyone is doing well, and mostly pain free!
1990 - left knee exploratory - removed scar tissue
1991 - left knee LR
1993 - right knee LR
2002 - left knee LR
2006 - left knee TTT/LR

Offline blackbeltgirl

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Re: Pain scale system
« Reply #18 on: May 31, 2006, 01:39:06 PM »
When I went for PT after my last surgery they had a gazillion page form, and I had to rate my pain during all sorts of activities.  Going up stairs (about 10).  Going down stairs.  Getting up from a sitting position.  Walking for 1 block, for 5+ blocks.  Standing still (like when you're in line).  And on and on and on.  I remember consciously putting myself in a position to do some of those things, because I'd bene avoiding them, and couldn't tell anyone how they made the knee feel.

But I'm more like Janet. 
     Either I don't notice it (0-1)
     it takes me a while of some mild nagging irritation to realize it's my knee (2-3)
     I decide to take ibuprofen and keep going (4-6)
     I decide to take ibuprofen and stop (7-9),
     or I look at the world like everyone's crazy for thinking I'm doing anything more than laying on the couch wishing I could be out doing more. (10)

Fortunately, I rarely get past a 6, 7 max.  And most of my days range somewhere between a 2 and a 4.

Whoever had the rain, please send some our way.  So far this year, we're way behind on rainfall, and they're starting to talk about drought conditions.  Again.

Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline laxplayer5

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Re: Pain scale system
« Reply #19 on: May 31, 2006, 02:20:31 PM »
Mine usually like this:
0-Which knee is it again? (the one with the big thing going from your hip to ankle LOL)
1-2-some little nagging
3-4- Ooh that hurts I better sit down for a minute
5-6- Ice Tylenol and ICe here I come
7-8- Breathjing hard and trying to lift knee into comfortable positon
9-- I'll be on the couch for the next hour or two or three... OUCH!
10- When is the ambulance coming!!!!!!!!!!!!!!!!!

I am generall at a 6, 7 or 8  :P, but I ususally hit a nine once a day  : :'(. Cross your fingers for meniscus repair.

Keith
December 01-Chromadic Pattela tracking problem
January 06- Tear in Patellar Tendon (no surgery
Febuary 06-Paralysis Sprees gone now
March 06- knee tendinitis in L and R
August 06- suspected meniscus tear

Offline Leentje

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Re: Pain scale system
« Reply #20 on: May 31, 2006, 06:39:02 PM »
We participated a post operative pain management research project and used painscales after TKR/THR/laminectomies/major vascular surgeries. We noticed people can rate pain better once we showed them the scales and explaining how pain can feel. We showed people a blanc line, on the other side (the side we saw as nurses) we saw a pain-rating scale. It helped us tremendously in what painmeds we could/should give post-op. However I need to say we never gave pain medications like some people got them here.

Like we never gave morphine! Never ever! The best pain med we gave was DipidolorR IM which is almost always effective. People with post-operative epidural paincontrol weren't allowed to receive any further strong painmeds.

Our drs changed their post-operative pain management protocol, people are now better treated and pain is something that is controlled, with minor painmeds.

It was a great help, minor work (the scale is easy to use), great outcome!

In the ER we do use morphine however only in major trauma cases and with people who suffer an MI (protocol). While it has to be thinned with water we only give it when people are monitored (heart monitor) as morphine IV can cause apnea!! (believe me it can!!!!!)

Helena
Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation

Offline stgiles16

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Re: Pain scale system
« Reply #21 on: May 31, 2006, 07:57:28 PM »
Helena, morphine is part of my pain management plan. I honestly dont think that it helps me much so I am weaning myself off of it. I am now up to 3 days between pills. I do have other meds that I can use when I need them but my pain management is for more than just knee pain. I also have fibro which can be a very uncomfortable  thing. Morphine is not given out as easily as you seem to think. It is very closely followed by the gov't and the doctors (at least my doctor is very careful). If there was something that worked that was not narcotic, believe me, I would be the first in line. I hate drugs. I use a TENS machine quite often instead of taking anything.

missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline Heather M.

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Re: Pain scale system
« Reply #22 on: June 01, 2006, 06:04:59 AM »
I have had many doctors use the 1-10 scale, but they always specified that a 10 was "going to the ER" or "writhing on the floor, crying uncontrollably."  Unfortunately, I have had an experience with that kind of pain--had a laparoscopic appendectomy go bad, was cut open from guggle to zatch, and very nearly bled to death on the operating table.  When I was finally in recovery, they decided that my blood pressure was TOO LOW for pain medications!  So they gave me nothing...when I came to from my surgery, I really was rolling and crying and pretty much out of control.  So that is always the "10" in my book, and I make sure to say that when talking to a doctor or PT--that 10 is the worst pain imaginable, almost-ready-to-pass-out kind of pain.

And I agree that morphine is not given out like candy, here.  Day surgery cases usually get dilaudid or demerol after surgery.  I have only ever been given morphine when I was kept at least overnight in the hospital and the other stuff wasn't working--and I was on pulse monitors and oxygen.  Frankly, though, I much preferred my femoral nerve block over morphine!  The narcotics tend to give me awful hiccups--can you imagine having a violent attack of hiccups with 18 staples in your belly after abdominal surgery in which all of your internal organs were removed to clamp off a bleeding artery that had retracted deep into the stomach cavity...gah!!  That was one of the worst nights of my life.

Unfortunately, most arthroscopy and even TKR patients are given hydrocodone/Vicodin (aka Lortab, Lorcet and a couple other names).  This is because it's a much milder narcotic, only slightly stronger than codeine, which is rated for mild to moderate pain. Because of this, hydrocodone isn't monitored as rigorously by the DEA and state governments...and that means doctors choose to prescribe it because it's just less trouble for them.  It may be fine for some patients but others report ongoing pain issues and even debilitating, agonizing pain that threatens their recovery.  Frankly, I think it's a crime to undertreat pain.  A lot of newer doctors are being taught that pain is the fifth vital sign, as important an indicator of the patient's wellbeing as pulse, blood pressure, temperature, etc.  By all means, use the least potent medicine that is effective...but if that doesn't work, for the patient's sake, the doctors had better have a backup plan!!  Otherwise, other folks may get a chance to experience at 10 out of 10 on the pain scale....

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Nettan

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Re: Pain scale system
« Reply #23 on: June 01, 2006, 06:16:41 AM »
Hey !!

I have been using morphine for several years..simply because of 3 things..my severe pain and allergy to a lot of meds and because I developed seizures some years ago..they are now gone.
But I quit it a year ago by myself cause I didn't feel well of it.
But that was the toughest thing I have ever done..first the pain went up, then my whole body shaked,I was freezing, feeling warm, had spasms in my legs and after a week or 2 when that was gone..then there was the psychological part, as I have been sleeping for years and just woke up learning to smell and hear and react on things. Some sounds where very hard to hear..made me feel sick. But though I took it easy I will not be without the time i had my morphine casue when it worked for my pain it was like a miracle...I could live.
So now pain is worse, but my head is clear !! ;D
Pain is one of the worst things you can have...and it doesn't matter how you treat it, just that someone takes it seriously and try getting the pain down.
I do normally not get lower then around 6-7 on the scale...but with a bit of planning I can live with it.Okay, I have my days but in general life is pretty good. people around me say when you have more pain you talk more and maybe that is true, but it's great to find a way to ease pain ;D
HUGS NETTAN  8)
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline KatieO

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Re: Pain scale system
« Reply #24 on: June 01, 2006, 03:40:07 PM »
Heather and Nettan,
While I am very hopeful that Dr. Fulkerson will be able to fix me (!!!!) if he doesn't, I really feel like I need to get my pain more under control. I do also live in the 5 to 8 range. I think my ten was when I was dilating super fast during birthing my girls. Like a train running out of control. But such a better pain than when from an injury! If there can be such a thing as positive pain (at least in looking back at it), that is child birth.
I had a horrible time weaning off methadone though it wasn't a bad drug to be on. I won't go back there. I take hydrocodone all day long and it only really does a little. i did have an interesting discussion with my pain management therapist yesterday. While i told him that my goal is to be pain free, we talked about if I would be content with having low pain and lower limitations. You bet ya! I could live with a 3 on that pain scale and getting 3/4 of my life back. But I am heading first for the big goal of no pain and being able to DANCE. (and walk and sit and stand and bend....)
I hate trying different drugs, though. They can really mess you up.
Katie
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin

Offline KatieO

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Re: Pain scale system
« Reply #25 on: June 01, 2006, 05:00:47 PM »
It's me again.
With talking about pain scales, I have been thinking about it more. Today, I had to take a bunch of stuff up and down stairs, a bunch of times. It zooms up the pain level. I don't know what number corresponds to this, but I get to the point where I tighten my jaw. That is a signal that the pain is rising and while I might be carrying on as normal, I am hiding what is going on. Took my hydrocodone at 3 hours instead of 4, and will try to settle down long enough to ice.
Here's something else I noticed. When I was thinking about my personal pain scale in my head, I noticed there was an abnoxious self blame thrown in. I was saying, well, if I do too many stairs, I CAUSE more pain, or if i walk too far, I BRING ON more pain. While this is true, I do have to live my life, and it isn't my fault that I have pain. I know this sounds obvious but maybe for other people who like to be in control (and aren't) this would sadly ring true. Or maybe I am the only insane one! Can I blame this on my Jewish upbringing? I dont' think so.
KatieO
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin

Offline Teresa_S

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Re: Pain scale system
« Reply #26 on: June 01, 2006, 05:26:11 PM »
One of the most important things taught in nursing school in the US is that pain is personal. IF THE PATIENT SAYS HE HAS PAIN< HE?SHE HAS PAIN> Believe them, and treat it. It is also taught to ask them to rate it, and what helps that pain. There is a scale of 0-10  with pics of a face happy to grimacing and crying with pain that is shown to kids, and patients who have trouble rating or communicating. I have always hoped that I have never felt a 10 as it is supposed to be the worse pain you ever feel. I pray that I don't get any that is much worse than that I have already experienced. I believe it is universal to ask if a scale below 4 is tolerable witout meds and to treat anything 6 and above.

As for the meds, the universal comparison is most likely to how much equivalent morphine is required, or just to each other. THe government has put out a new salce of comparing eveything for the post Iraq soliders. I found out that the 100mcg Duragesic is supposedly equivalent to 360-480mg of Morphine. Perhaps, that is why 1mg IV every 6 minutes post op does NOTHING FOR ME. Here they do not use Demerol as it actually builds up in the body to where you reach a point the pain is much better controlled but it is at a higher level and harder on the liver, etc.  I never got much relief from the 20 or 40 or oxycontin BID or MS contin 40 mg bid with breakthrough beds or MS IR or Lorcet or Perocet. Here they only give the 5mg Percocet, but prescribe Lorcet at 10/500 which gives me better relief to take 20 mg of hydrocodone as opposed to 10mg or oxycodone. I was also given a months worth of Ultram 240 pills, and after 6 descided no noticable relief. I am sure that the duragesic I am on is not helping all that much after 10 years, that I have pretty much just become physically tolerant of it,  but do know that going without it would cause severe withdrawal, as converting would be such a large amount of morphine, I would be afraid as I am allergic to it if given very long IV, NOT allergic actually but start itching and swelling. Mostly an intolerance. It is recommended to convert to morphine and decrease by 10% every 3-7 days, depending on how long you have been on it, until you have gotten off the meds. BUT Then the pain really kicks in .  ost physicians are not even familiar with the pain meds for chronic pain and think you can just take a liitle of this and that and quit something else.

When in severe pain, it is hard to actually evaluate it calmly and on a scale. I know an old Os who does not practice anymore who used to write his order to give Demeral 75mg IM every 3-6 hours. NOT PRN or as needed but they could have it at 3 hours or any time up to 6 hours but if they didnot ask by 6 hours we were to give it every 6 hours to keep the pain from escalating out of control. IN addition, for his obese patients, or heaveier patients whom the med was just siiting around in the tissue and not being absorbed through the muscle as the fat tissue was too thick. HE ordered the meds be given with a spinal 5-7 inch needle in the tissue that is on the top of the shoulders below the neck so it could reach muscle. WE would cringe about giving it there. The problem with so much tissue is though, that the med sits around in the sub q tissue and just absorbs through it instead of systemically. and it takes longer, and may eventually reach a level of too much meds. I once had an OB with a c section on the next morning, and we were switching her to oral meds, She said she had had no relief from the  pca the night before. I checked her IV and it was infiltrated, and all the med was actually going into the sub cutaneous tissue, not the vein and was being absorbed so much slower she actually did not feel any relief. Another example is an older woman there ti basically have pain relief till death. She was writhing and rolling around in bed, and again, her morphine had been increased and increased but no relief, but the site when I checked it was infiltrated. We Spent 3 hours getting a central line in as she was so dehydrated, etc. and then they hooked up the morphine drip, NOT adjusting it for the hours it was being increased but she was not actually getting it due to the IV being infiltrated. AND she died in an hour or so, basically she got too much morphine over too short a time, without increasing gradually to her tolerance. Another example is never never NEVER cruch or cut an extended release pain med. A nursing home patient on hospice care could no longer swallow and an undereducated LPN cruched her extended morphine and gave it to her in applesauce, resulting in slower and slower respirations, until she died. THE dilemna was how far did they go to revive her as she was on hospice care to die. THE NURSE NEVER got in trouble, never lost her licence, as she should have, and never had to even go to a med class as the nursing home needed her and she was a "good employee"  SCARY.

Upon entering a patients room in pain, I begin by acessing what causes the pain to increase, and offer non medicine ways to relieve it like position change, heat , ice, distraction with conversation, change of subject, asking about family, etc. BUT I also give the med and return to reaccess the pain level in thirty minute. IN FACT< the nursing notes that chart pain meds have a place where you write the time you return to reaccess and how the patient rated befoe the med and 30 minutes later. In fact sometimes I will give toradol or motrin, and then go on to narcotic in 30-45 minutes if there is no relief. not of course on a post op. SO nurses who do not come back and reaccess , how do they fill out the chart? THEY FAKE IT> I once saw my nurse with the chart with the assessment on my roommate in her hands and the roommmate was in x ray and then she picked up mine, When she left I read mine and all about the color of my urine, pain, heart, lungs, etc, and she had not TOUCHED ME> SO I called her to my room and asked her about it, and she said "OH I must have mixed up you two and the two next door. " SO I looked at her and said "SO YOU made up all of them?" They sent me a patient advocate who said "You want an apology and you are not going to get it." I SCREAMED AT HER "YOU Bet I do , she falsified four peoples medical records, and basically committed fraud. SHE should be fired" INSTEAD I was dismissed. Later, that evening I got a call from the head nurse apologizing as she said she had never seen a patient treated that badly and altough she was head nurse at the other hospital when they merged she could now see why people complained so much about this hospital. Even my physican called and apologized saying that nurse called him and explained what had happened. IN fact,The RN had told the AIDE to come in and measure the left side to the right, and seveal other things pertinent to returning to surgery, and it was not even done. I was just dismissed.

I would advise everyone to lookup the IRAQ new pain med comparison. To see where you are on it. IT does not MATTER which med gives you the best relief, just that there is one that does. OF course, there is the big thing about oxycodone. A cardiologist once told me that ii is the most addictive med around. AND he would rather see somebody take four times the amount of any other med. There is a quality of percocet that makes the patient feel better whether it relieves pain or not.

AS a nurse, I believe a patient who tells me they have pain.I have been put in many bad situations asking physicians for meds for some of them,as drs. think many times they do not have pain. BUT I will continue to believe them as somebody has to help. Pain alters the perception of other problems, like nutrition, PT, etc. and their participation. RELIEVE the pain, and then work on getting them to move, and eat.
Hope everybody finds somebody to deal with their pain postively. Teresa   Please excuse errors my dane puppy is trying to bite as I type.
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline Nettan

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Re: Pain scale system
« Reply #27 on: June 01, 2006, 06:32:35 PM »
Teresa thank you for being such a great nurse...would love to have more nurses like you  ;D
HUGS NETTAN  8)
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline Doc79316

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Re: Pain scale system
« Reply #28 on: June 01, 2006, 07:51:05 PM »
Hi,

Teresa - We could do with more nurses like you here in Birmingham. Those we have here right now could learn a lot from you and those who've I've been unfortunate enough to come across should be hung! I'm sure your baby dane was just trying to help you type.

KatieO - Childbirth has nothing on my knee pain. It was easy by comparison and at least there was an end to it.

Heather - I have reached (quite often over the past 2 weeks) a 10 on the pain scale. I believe I truly know what agony is. Morphine for some reason doesn't do a lot for me and the combination of pain meds I currently take seem to have a lesser effect every day.

Nettan - I've done as you suggested on Messenger and I've started a pain diary since yesterday. I Hope to see a pattern occurring so I can boost the pain control when necessary.

Fortunately for me my pain management appointment has come through - it's not until 17th. July though. Frustrating to say the least but for now I have to continue on pan meds that although have an effect and seem to change my perception of pain they don't take it away. I've already reached maximum doses and they're not working well. To try to go to work and do a "normal" day is incredibly difficult when I'm so spaced out I'm practically unconcious at my desk or in a meeting. People at work are very understanding but it will only last so long before my work suffers.

Hope everyone has better knee days than I d.

Take care,

Laura x
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline KatieO

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Re: Pain scale system
« Reply #29 on: June 01, 2006, 08:30:33 PM »
Laura,
Please, accept my sympathy even if I can't offer anything useful! I am horrified at your pain levels. i don't think I have ever had a 10 for my knee. Child birth was an experience and had a mighty fine outcome. As you say, it doesn't relate to ongoing pain. I hope there are at least times at home when you can collapse into even a drugged state of relief. You have to have relief. I hope the pain diary gives you some insight. That is a long time to wait for the pain management appointment! Lindsay (I forget her geek name; can look half way through the thread of "can't tolerate anything tight on my knee") is 18 and has horrible RSD, among other problems. She is going to Phila in July to their pain management center for a very new treatment for RSD, supposedly actually a cure. Her original appt was Dec 2007!!! There is only one doc in the country doing this procedure. But he has trained someone and they moved up her appt to this summer! She is graduating from high school tomorrow by the way, and doesn't know how she will tolerate her gown on her legs.
Thinking of you...
Katie
5/98 twisting injury
10/98 ACL partial tear repair/ and RSD
10/01 ACL reconstruction w/allograft
7/03 LR
1/06 diagnosed with patella baja
7/5 open knee surgery for IPCS
Life shrinks or expands in proportion to one's courage...Anais Nin















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