The diagnosis for CML is definitive; i.e. if the Philadelphia
chromosome is detected, then you have it. Since your WBC is not
elevated, the chances are that you do not have CML. In any event, a
simple test for the Philadelphia chromosome will settle the matter.
The symptoms you describe can be
For the uninitiated, osteonecrosis is a condition in which the blood
supply to bone has ceased. There is no known way to bring it back. It
usually spreads. Eventually the bone dries and breaks up. Most common
in knee and hip joints. The condition is easily seen in an MRI. I was
diagnosed wi
I'm also 68. My blood pressure varies between 120/60 and 160/80. None
of my Drs. thinks I ought to be on medication for blood pressure,
possibly because there is no history of cardiovascular problems in my
family. Nevertheless, I bought a blood pressure wrist cuff from
Costco, and I take my bl
Chances are that it is not a calcium deficiency, but that is easy to
check. See an endocrinologist, who will run some specialized blood
tests and a bone density test.
Chances are that it is muscle spasm resulting from injury or posture.
I have suffered from mid and lower back pains for 40 years.
Give it a couple of weeks to see if it settles down. If not, then
maybe he can get on a Nilotinib trial. During last night's LLS
teleconference, boths Drs. Druker and Shah enmphasized the need for
patients willing to participate in these trials.
My words of comfort are that it is very likely th
I've been on Gleevec for 2 years. I had nausea for the first couple of
weeks, but it then went away. Lately, I've been nauseous in the
morning. I've no idea if the problem is the Gleevec or something else.
Have any of you had nausea after taking Gleevec for a long time?
Mike Burwen
--~--~--
Of all the cancers, there are more support groups for breast cancer
than any other. If you want something local, see if there is a Gilda's
Club in your area. If not, call the Social Services Department of your
local hospital.
Online, simply Google "Breast Cancer Support." You will find dozens
Hey Greenie, this is your aging buddy talking. Just had an eye
checkup. The opthamologist says "This is amazing. 69 years old and
you have 20-20 in one eye and 20-25 in the other. Never seen anything
like it." "Oh yeah," says I, "How come stuff is blurry, I can't see a
golf ball in flight and
I recently went through a bout of acute viral gastroenteritis. The ER
Dr. that treated me for the condition told me that, because I had CML,
and even if it was in remission, my immune system was compromised, and
that I was more susceptible to viral and bacterial attacks than the
average person.
Please see my responses in-line.
> My dr told me the other day if I had a 0% reading on my PCR then I
> would have 100% chance of living 5 years and I was cured. The
> definition of cured being I would continue on Glivec. Well like many
> others I am grateful for Glivec but not sure what qualit
I take flax seed oil. It has had a salutory effect on my hair, skin
and nails. It is high in Omega-3 so presumably good for cardio, but
that is not why I take it. I take 2000 mg/day. Flax seed oil is
supposed to (according to some) provide the same Omega-3 benefit as
fish oil, but it is purpor
The problem with books is that the technology is moving so fast, that
by the time they are published, the technical info is out of date.
There is a book entitled "Adult Leukemia" by Barbara Lackritz (ISBN
0-596-50001-7) you may find useful for emotional support, but the tech
info is 5 years old.
artist934 wrote:
> Mike,
>
> I must have missed Dan's post. When was it?
>
> Adrienne
I was within the last week. Perhaps the day before my post.
--~--~-~--~~~---~--~~
[CMLHope]
A support group of http://cmlhope.com
Dan's post in which he said that he was on 800/day and is now
maintaining remission on 400/day piqued my interest. How many of you
have lowered your dose after achieving remission? Of those of you who
did that, did you manage to stay in remission or did the bad stuff come
back?
I'm currently on
Her test results are excellent. Tyically, doctors look for a major
cytogenetic response by 6 months. After only 4 months, the molecular
test will typically show that the disease is there, although the system
has not yet stabilized, and the PCR results are not yet likely to be
accurate. Although
Dave, I commiserate. I haven't had your specific syndrome, but at our
age it's tough to sort out the results of aging from Gleevec side
effects or from something new neing wrong. All I can suggest is to get
every test covered by Medicare, and, if they don't find anything
specific, blame it on ag
Richard was the first to post about flax seed oil and I was the second,
acting on Richard's advice. I've found it helps hair, nails and skin.
I've been taking it now (1000 mg 2X/day) for about 4 months. Not only
is my hair softer than it ever was, I've lost a lot of gray! My nails
are much less
I posted this before, but seems like it may be worth repeating. I have
those painful foot arch cramps as well. I ony get them at night.
Walking for a few seconds alleviates the pain, but it can come back
quickly. I found that quinine works pretty well. I now take 2 pills
called "Leg Cramps wit
This is the third and final installment of this story. To recap, three
successive quarterly blood tests showed a below normal phosphorous
count. Since recent studies have tied this parameter to bone loss, my
hemo/onc sent me to an endocrinologist, Dr. Chiu, who has a lot of
experience treating p
!) Dental surgery shouldn't be any different than any other surgery.
If your blood numbers are OK, partuicularly platelets and white cells,
you shouldn't have any more risk for surgery than a person without CML.
2) Once upon a time their was danger from overexposure to radiation.
Remember the flu
> does anyone else out there notice that taking carbohydrates in some form
> helps avoid nausea? I usually get sick if I don't have at least some type
> of carbo.
I found I need to take Gleevec with protein. Carbs don't do it for me.
--~--~-~--~~~---~--~~
[
Thanks Anjana, I knew you would be as on top of this issue as anyone.
In one of the study abstracts you cited it says, "Preliminary data
suggest that D is more effective and better tolerated than high dose
IM." I think that was written quite a while ago during an early phase
of testing Sprycel.
This thread highlights the fact that Drs. aren't in any hurry to move
their patients from Gleevec to Sprycel. That includes my Doctor. Yet
Sprycel has an anecdotal reputation for far fewer and less intense side
effects than Gleevec (with a few relatively rare exceptions), and there
isn't any sta
Steve, please do not post in all capitals. It is hard to read and is
known as "shouting" - considered bad Internet etiquette.
There should be no problem getting a torn meniscus repaired or even a
knee replacement. A lot of orthopedists want to do scraping. In fact,
a lot of them make their ent
[EMAIL PROTECTED] wrote:
> This is an interesting subject.
It sure is. I'll bet that there are hundreds of herbal remedies out
there that work. Unfortunately, there are hundreds that don't work and
many that can cause harm. If you want to be fascinated, visit a
Chinese herbologist. I don't
> Mike , is there a certain amount of mg of ginger one should take to help
> with the nausea , have read 250-500mg is good
If you buy tablets they are usually 500 mg, but I'll bet that there is
nowhere near that amount in ginger ale, and a lot more than that in a
piece of candied ginger. I do
There is inconclusive evidence that ginger makes the platelets "less
sticky" in the same way that a low dose of aspirin does, and the
homeopathic people would have you believe that ginger is the way to go
to reduce cardiovascular disease. There is no evidence that ginger
reduces the platelet coun
I agree that Zofran is magic. Unfortunately, it is prescription, and
it is expensive if you do not have drug insurance. I recommend that
you try ginger first, as it has no known drug interactions or side
effects that I know of. You can take it in any form: ginger tablets
(health food store), dr
Terry, you should resume drinking immediately! Cures a lot of ills.
Seriously, booze is OK as long as it doesn't impair liver function, and
you don't drink too much. The liver info will appear in your blood
tests and the local gendarmerie will take care of any other issues.
:-))
Mike
--~--~--
I've been getting foot cramps at night and they have been getting
increasingly worse. Since a number of people on CMLHope have posted
the same, I assume it is a Gleevec side effect. My Dr. advised
drinking tonic, but drinking at night makes me get up a lot (I'm sure
you men over 50 or 60 will re
Fortunately, the timing is good. There are alternatives to Gleevec
both on the market and in trials. You should certainly be consulting
with with one of the experts who is aware of all the alternatives. On
Oct. 18th or 19th, the Leukemia Society is holding one of its
informational teleconference
I'm no Dr., but from my reading, it seems that Trisomy 8 is potentially
serious in patients with AML, but not CML. It seems to be particularly
serious in the first trimester of pregnancy. In any event, if you
Google "Trisomy 8" you will find dozens of articles and other
references. You might al
Mayo ought to be pretty good, although I have not heard anything
specific to CML from there. You might look into having the test
analyses done at Mayo since it is likely to have superior equipment and
staff training. As I said before, it is easy to ship blood, and, even
if the blood is 2-3 days
Guys, find out how many BMAs/BMBs the Dr. does each week. If the
number is less than 10 or so, find somebody else. I can personally
attest to the fact that there is a huge difference in skill level
between Drs. You might be able to tell something by the length of the
appointment. Drs. who know
Sandy, is your Dr. Doing regular PCR tests? If not, he should be.
After 6 months on Gleevec, the FISH test is not terribly useful. Be
that as it may, 6% is not a bad result, and, depending on the
capabilities of the lab that did the test, may even be within the
margin of error of the test proces
Chrissy, I will try to respond in simple terms - not easy for me!
First, after you have been on Gleevec 6 months or so, the FISH test is
not very useful. The PCR test is the one you want. The FISH test
looks at 100-200 cells, but the PCR test looks at 1,000,000+. A 5%
response on FISH is not m
I am pleased to present the following quote which I received from City
of Hope this morning via email:
"City of Hope has a Charity Care Policy by which patients are screened
for financial need. Once a patient is accepted for care under this
policy, then any treatment including transplants, chemo,
> Unfortunately, this is no longer accurate. City of Hope discontinued
> several years ago its former policy of accepting all comers for BMT
> regardless of ability to pay.
H. I will check. A friend of mine is on the City of Hope Board of
Directors, and he thinks the policy is still in ef
Sandy, something I think is wrong with the data, either as you have
presented it or as told to you by your doctors. At this stage (after 6
months on Gleevec), the FISH test is virtually useless. The PCR is the
only one that counts. In the PCR test, 1-2 million cells are examined.
19 out of 100
A few weeks ago, I submitted a post about the effect of Gleevec on
phosphorous, and received several requests to keep people informed of
my experience. This is Chapter 2.
My phosphorous count measured below the normal range for 3 consecutive
blood tests taken over a period of 6 months. My
hemat
The person who submitted the post quoted the number .9 which is
essentially 1.0, meaning (I thought) nearly 100% positive for BCR-ABL.
This made little sense to me. (BTW, I used to be a mathematician and I
do know what a logarithm is.) The system you describe requires that
one know the baseline
Those numbers you quoted don't sound like PCR test results, which are
generally expressed as a logarithm. They sound like FISH results. If
so, they are all in the "noise level." If they are PCR numbers, then
they are all high. .06, for example is 6 log 2. Good results are log
3 or better. Th
gbengston wrote:
> Anjana, OHSU is where I really want to go. My mother on the other hand
> thinks that if a bone marrow transplant is inevitable, then we should
> go to Hutch. She thinks that since I have a local oncologist and a doc
> at Emory(Atlanta), we would be involving too many people if
Are there any studies that show the effects of reducing the Gleevec
dose after achieving PCRU? I've seen a fair amount of anecdotal
information, but nothing scientific.
I achieved 3 log on 400/day. Went to 600 and almost immediately became
PCRU where I've remained going on 9 months. I'd like t
> It is pretty sad when being almost 40 I am really starting to
> become so distrustful of our goverment, and jaded about society in general.
If you are sad now, in 30 years you will be devastated.
--~--~-~--~~~---~--~~
[CMLHope]
A support group of http://cmlhop
As the others have mentioned, doesn't seem like your test results are
that bad. I suspect that you don't need a BMT, but if it turned out
that you do, make sure that you go to one of the few BMT centers that
specializes in seniors (you said you were on Medicare). I'm treated at
City of Hope whic
> I did a quick Google search on this and the R&D annual budget for the
> NIH (US government health research) is 28 billion and Novartis spent 4.8
> billion in 2005 on R&D.
One has to be pretty careful about throwing around these numbers. The
US spends considerably more than $28B. There are su
I've had trouble breathing lately. I'm seeing an ENT specialist. He
says the problem has several contributing factors; deviated septum,
which he says I've probably had for a very long time; enlarged
turbinates, which he says come with age; sagging muscles in the nasal
passage, another result of
> There is an article on low phosphorus and bone loss on Gleevec by
> MSKCC doctors, published this year. The article is a very comprehensive
> article.
That is probably the article my Dr. referred to since he specifically
referred to Vitamin D. I think he said it was published in the NEJM.
> Finally her hair is thinning a little, again as a response to the
> Gleevec. Does anyone have any advice?
Try flax seed oil, 1000mg 2X/day. Takes a couple of months to start to
work, but couldn't hurt. It's cheap - about $6 for 200 capsules at
Costco - and there are cardiovascular benefits f
I had my quarterly checkup today. Everything good except for low
phosphorus count. My phosphorus count has been low since a few months
after I started on Gleevec. Up to now, my Dr. has ignored this, but
today he said that a new study was released showing 1) Gleevec can
reduce the phosphorus cou
Richard Troxel wrote:
> I eat one to two bananas every day and take a calcium supplement. Further I
> do daily stretching exercises and have managed to keep my cramping down to
> mild levels.
See http://www.ext.colostate.edu/PUBS/foodnut/09355.html for a list of
foods high in potassium. Bananas
I didn't know I had CML when I was diagnosed. High WBC picked up in my
annual physical. After starting Gleevec, I had several side effects,
some of which have gone away (nausea), some of which have remained
(edema, especially around the eyes) and some new ones that have since
developed (weight g
lbailes wrote:
> I was told to avoid acetaminophen (Tylenol and Excedrine). This is also
> listed on the Gleevec site.
The issue with Tylenol has to do with its effect on liver function. The
body's system for processing Gleevec taxes the liver in some people.
Adding Tylenol can exacerbate the pr
Thanks, Cynthia, but I can't take much credit because I merely parrot
what is said by people who do the real research. BTW, I think what is
written or presented here by Anjana, Trey, Richard and Rob are also to
be believed.
Mike Burwen
--~--~-~--~~~---~--~~
[CM
Several weeks ago, someone posted a message stating that he found that
flax seed oil had a salutory effect on his skin which suffered the
common Gleevec side effects. He said it took a couple of months.
When I read that, I decided to try it. It's been about two months.
Not only has it improved
Please read the following: http://experts.about.com/e/i/im/Imatinib.htm
You'll see that the half-life of Gleevec is 18 hours and its metabolite
40 hours. That means that most of it will be out of your system on a
matter of days. It may take one's system a long time to adjust to
being off of Gle
Recently, I attended a presentation by a Chinese Dr. (A Harvard med
school graduate) in which he described some of the stem cell research
programs at one of China's leading medical schools in Shanghai. I was
blown away by the extent of the research, almost none of which gets
published for western
Right on John. This sort of post has no place on CMLHope. I like to
think we deal with real-world science and experience.
Mike Burwen
--~--~-~--~~~---~--~~
[CMLHope]
A support group of http://cmlhope.com
-
You re
> I ask my onc and he acted like he didn't know about it.
Jeanie, please find another oncologist - one who specializes in CML.
CML treatment is all about the latest chemistry. A Doctor who does not
keep current with all the latest developments/treatment options is not
appropriate for CML.
I ha
An oft-mentioned remedy is to drink tonic or take quinine tablets. If
it is going to work, it will work very fast. Acetomeniphen (Tylenol)
can help, but takes a 1/2 hour or so to kick in. Tylenol can adversely
affect liver function, so don't take it too often. If you are going to
take Tylenol
I've been on Gleevec 19 months. I have thin skin and bleed easily if I
bump into something. Unlike the guy who is freezing, I'm the opposite.
I'm warm all the time, and sweat profusely if the temperature is over
about 80. I've not noticed any difference in skin pigmentation, but
hair and nails
I am treated at City of Hope, the only NCI site in Southern California.
I try to keep up with its layman literature, and just received some
info that might be of interest to CMLHope readers. I'll paraphrase:
"The underlying cause of all leukemias is the presence of leulemia stem
cells. Althoug
SuzieQ, you already heard that your reasults are excellent from Anjana
and Trey, but I wanted to comment on what you said about getting the
information from your Dr.
I get my blood drawn quarterly by a local blood lab 2 weeks before my
quarterly Dr's visit. The blood is then shipped to my Dr. at
Jeanine Crabtree wrote:
> I agree, my husband hasn't had one for 3 years, his onc said it wasn't
> necessary for him as long as his blood work was good. But I worry just the
> same and can't seem to change the onc's mind.
>
If I were you, I would find a new oncologist, one that specializes in
b
> If I were you I would tell my doc that for my own piece of mind I WANTED to
> have at least one, but I worn you they are no picnic and are quite painful
> even with sedation.
Naturally, there are huge differences in pain tolerance from one person
to another, but from personal experience I kn
My cholesterol dropped from 220 to 160 due to Gleevec. I discussed
this with my hematologist, and he said that this is a relatively common
side effect of Gleevec - one that was discovered more or less by
accident. Assuming that there is a correlation between cholesterol and
cardiovascular diseas
It is true that a PCR test can be run on peripheral blood, but I
believe that bone marrow analysis is generally considered to be more
accurate, and there is additional information that can be gleaned from
BM. From my reading, after you have been on Gleevec for a year or so
and have good numbers,
Following is the transcript from the recent LLS presentation by Dr.
Nimer who is the head of hematological oncology at Sloan-Kettering. In
the last two sentences, he states that the nested test can sometimes
show things that are not there. I discussed this with my Dr., and he
says that is precis
>My husband can have the coldest feet on earth
If he does, that is your fault. And no, I do not let my wife see these
posts. :-)
--~--~-~--~~~---~--~~
[CMLHope]
A support group of http://cmlhope.com
-
You received
> Also I am always very, very cold.
> chris in Minn
1. My wife does not have CML, and she is always cold. Not trying to
be sexist, but I think it is a common female syndrome that gets worse
with age.
2. You are in Minn? What the heck do you expect? If you want to be
warm, move to Palm Spri
Someone mentioned the existance of a "nested" PCR test, purported to be
more accurate than the conventional PCR test. I emailed my Dr. to ask
about it, and this is his answer:
"I used to do the nested PCR in my lab. It is a qualitative assay that
is 10 to 100 times more sensitive than the quanti
I just wanted to add a bit to the previous posts in this thread.
After several months on Gleevec, the PCR test is the only truly useful
chromosonal test. I get a FISH every three months and have yet to get
a satisfactory explanation as to why it is done. My Dr. is a
researcher, and I suspect he
It is common for some blood counts (especially WBC and Platelets) to
oscillate a bit during the first few months on Gleevec. I assume your
wife is being tested every month at this stage, so you will be able to
track the blood counts. The initial dose of Gleevec, whether 400,
600, or 800, is Dr.
Glucosamine helps cartilage matrix regenerate. There is a lot of
evidence that it is very effective for arthritic knee and hip joints,
but it would not have any effect on bone pain since cartilage is not
involved. Chondroitin is supposed to be a hydroscopic material that
attracts fluid to large
I'll take issue with part of Robert's message. Leg pain (or foot pain)
is a relatively common side effect of Gleevec. For most people, the
symptom diminishes after a while. I've been on Gleevec for 18 months
and still have foot pain occasionally at night. The easiest way to
alleviate the pain
I posted a mention of generic Gleevec being made and sold in India and
received several private emails asking me for more information re how
to get the drug. To head off more of these emails, I'll post what I
know - which isn't much.
A Gleevec copy is being made by Ranbaxy Labs, Ltd. and sold un
suzieq wrote:
> Avis: I was informed that there is no generic form of Gleevec & I
> think the discussion we had with the doctor about this is because the
> drug company that develops Gleevec holds the drug patton (spelling?)
> and it takes several years (it was either 7 or 14, can't remember)
>
You indicate that she is on Medicare. If so, and she has Part D and
one of the new drug supplement plans, her financial exposure should be
considerably less than that. I suggest that you contact one of the
non-profit Medicare advisory organizations in your area for advice
about how to maximize h
Just Google her name. You'll find references to all the papers she
participated in writing, maybe a bio or two and the trials that she
managed. You could contact some of the big name Drs. in the CML
treatment business and see if they have anything to say, but I suspect
you'll get positive respon
Rob, he mentioned maybe three serious side effects. The only one I
remember is fluid accumulation in the lungs. My Dr. is David Snyder at
City of Hope, and CML is his specialty. The primary dasatinib trial
site in Southern California is at UCLA run by Dr. Charles Sawyers.
Snyder and Sawyers col
I was just tested PCRU, and I wanted to post my history for those of
you keeping tabs.
As a result of a routine annual physical, I was diagnosed 10/04 with
CML showing a WBC of 36,000. No other symptoms. Started on Gleevec
400/day 12/04. I volunteered to participate in a year-long dosage
trial
I don't think it matters which meal you take it with, but I do think
that the content and size of the meal can affect the intensity of
nausea and other digestive side effects. I found that these side
effects are minimized if I have a complete protein in the meal
accompanying the Gleevec.
Weight
Many Gleevec patients have pains in legs or feet. I get foot pain,
also at night. Taking quinine will generally alleviate the problem (a
few ounces of Schweppes will do the trick). Since my 68-year old
bladder isn't real happy about my consuming liquids in the evening, I
don't do that often. I
Jeanie, I turned 68 in March. Also diagnosed when I was 66. My best
friend was just diagnosed with Stage 4 lung cancer. It is unlikely
that he will live more than a year. He was a widower who married a new
lady just two years ago. I am the lucky one.
Mike Burwen
--~--~-~--~~---
Jim, I also have the same problem with scabs persisting for a very long
time. I'm hoping to try dasatinib (Sprycel) when it becomes
available. The anecdotal information suggests that side effects for
most patients are significantly less than Gleevec's.
Mike Burwen
--~--~-~--~~---
I don't bruise easily, but my skin tears with barely any effort. My
hands look like I shuck oysters for a living. I'm going to try the
flaxseed oil - couldn't hurt?!
Mike
--~--~-~--~~~---~--~~
[CMLHope]
A support group of http://cmlhope.com
I too have fragile skin, although it does not seem to be susceptible to
bruising than normal. I believe this is a fairly common side effect of
Gleevec since it is mentioned extensively in the literature.
I also have dry, brittle nails. Although I do not think fungus is the
issue, I'll give the
The FISH test examines a limited sample (usually not more than a few
hundred) cells for the presence of BCR-ABL, the protein that causes
CML. When the % of leukemic cells is less than the precision of the
measuring equipment (which can vary from lab to lab), the patient is
considered to be in cyt
This is quite a thread. A real primer on the side effects of Gleevec.
I'll add my 2 cents and I hope others will do the same.
I'm 68, diagnosed with CML 18 months ago. I'm in cyteogenic remission,
but still some residual disease showing up in the PCR test. I went
from 400 to 600 mg three month
Your experience is probably more typical than atypical. My experience
is similar to yours. I am hoping to change from Gleevec to dasatinib
as soon as it becomes available, probably this coming June. The
anecdotal evidence strongly suggests that dasatinib is just as
effective as Gleevec (even mo
Join the crowd. Gas is a very common problem and GAS-X won't help much
because the gas is probably forming in the intestines, not the stomach.
Tinkering with your diet may help. Tony suggests drinking less, but a
lot of Docs suggest drinking a lot on Gleevec. Try both. Almost
everyone on Glee
I'd like to echo the comments of Terry and Rob. That said, in the
first several months of taking Gleevec, it is normal for blood counts
to oscillate, sometimes quite a bit as in your case. I think most of
the experts would advise shots or oral medications to compensate if you
are too far outside
With me it is not shortness of breath issue and has nothing to do with
lungs or the bronchial system. My problem is restricted airflow
through the nasal passages, a condition that hits a lot of people,
especially men, in their 60s and 70s. The reason I suspect Gleevec
might have something to do
I've been on Gleevec for 14 months. Over the last year I have had
worsening problems breathing, especially at night. I know that some of
the problem is age-related (I'm 68), but my ENT Dr., who knows
virtually nothing about Gleevec, says that fluid retension can swell
the nasal and sinus tissues
Palm Springs Unified in California.
I may be the most fortunate Gleevec recipient of all. My wife's
insurance (she is a teacher) has a drug plan through Caremark. When I
was on 400mg/day, a 90-day supply cost $30. Now I am on 800 mg/day and
the $30 copay is waived!
Mike Burwen
I strongly recommend that your son go to a Dr. who is a recognized CML
expert. Either your description of the circumstances is misleading, or
your Dr. is unfamiliar with current progress in CML treatment. If you
follow the threads here at CMLHope or review the considerable
information available
There are many posts about this subject. I'll just reply to this one.
India has a history of supporting inexpensive home-made drugs at the
expense of those companies who sell costly patented ones. If you are
clever about it, you can find examples of some drugs available on the
web that you can
I am 68. I've been on Gleevec for 14 months. Now at 800mg/day. My
testosterone level remains normal. I've had fatigue problems off and
on since I started Gleevec, but there is no evidence to link that to
low testosterone.
Mike Burwen
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