Guest guest Posted November 17, 2004 Report Share Posted November 17, 2004 Don't know why you think the PCP would give you any info RE: HIV status or anything else, for that matter. That would be a total HIPAA violation. Even if you have a consent for info release, it doesn't cover HIV unless specific. Meth users: anxious, always in motion, rotten teeth, oozing sores, jaw oscillating laterally, nystagmus, stories never straight. The crap that they mix with that stuff when they're cooking it (drano, brake fluid, you name it) is trying to come out through their skin. It is best to always wear gloves. Yes, in retrospect, you should check your room, but they shouldn't be left alone in a room to start with. K. Carpentier, D.C., D.A.B.C.O.Burns, OR meth abuse Hey Folks,Little help, stat please. Recent patient seemed fishy. Claims to be HIV +, denies use of rec. drugs, smokes, on the "cocktail" and can recite several of the drugs in the cocktail. Claims current non-detectable viral load and t-cell count > 1000. States he has received oxycontin, flexeril, and methadone prescription for current MVA related sx. Denies hx current or previous drug habit. Presents 2 mos. post MVA with significant history of injury, neck/shoulder/LBP/ PCS cluster of sx, has already contacted lawyer. Claims he didn't seek help beyond initial ED workup (head/neck CT, shoulder and lumbar X-rays)because he was laid up with the flu for a month. Didn't break it to him that first documented flu in OR was in past 2 days. Saw his PCP 1 week ago for tx of insomnia, did not seek treatment for flu or mention his MVA sx. Patient has an obvious tremor and claims faomily hx Parkinson's. When asked about tremor, he states he's never noticed and none of his doctors have either. Tremor seems to worsen as assessment progresses. His bare back has continuous vertical apparent fingernail scratches (no broken skin and no gloves used), no way he could have made them himself. I guess as I write this, it seems more obvious. My current plan of action is 1) check exam room for missing equip., 2)contact PCP for HIV status and previously observed drug-seeking behavior, 3) obtain all med records associated with this incident. What am I missing?Input appreciated re: experience with tweakers, confidentiality/mandatory reporting issues concernig HIV status and suspicion of illicit drug use (weigh in , and if you haven't completely dumped that harddrive of data since law school).Just another tricky day in paradise. Take care and thanks.PLEASE NOTE NEW ADDRESS! W. Snell, D.C.3343 SE Hawthorne Blvd.Portland, OR 97214Ph. 503-235-5484Fax 503-235-3956 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2004 Report Share Posted November 17, 2004 Thanks for the reply, . My understanding is that if my clinical opinion is that the patient's health is in danger, or that they pose a public health risk, a consult with other care providers is warranted and legal. Suspected drug use in an HIV positive pt qualifies I think. This is a PI case and a release statement is in place. The PCPs I have worked with have been open to discuss patient care quite willingly when referring or receiving referral. HIPPA, remember, is Health Insurance Privacy and Portability Act, and part of the purpose was to foster ease of communication of a pt's condition between doctors when a pt changes doctors or heath plans. >From: " K. Carpentier " <carpentier@...> >< > >Subject: Re: meth abuse >Date: Wed, 17 Nov 2004 06:14:16 -0800 > >Don't know why you think the PCP would give you any info RE: HIV status or >anything else, for that matter. That would be a total HIPAA violation. Even >if you have a consent for info release, it doesn't cover HIV unless >specific. > >Meth users: anxious, always in motion, rotten teeth, oozing sores, jaw >oscillating laterally, nystagmus, stories never straight. The crap that >they mix with that stuff when they're cooking it (drano, brake fluid, you >name it) is trying to come out through their skin. It is best to always >wear gloves. > >Yes, in retrospect, you should check your room, but they shouldn't be left >alone in a room to start with. > > K. Carpentier, D.C., D.A.B.C.O. >Burns, OR > meth abuse > > > > Hey Folks, > > Little help, stat please. Recent patient seemed fishy. Claims to be >HIV +, > denies use of rec. drugs, smokes, on the " cocktail " and can recite >several > of the drugs in the cocktail. Claims current non-detectable viral load >and > t-cell count > 1000. States he has received oxycontin, flexeril, and > methadone prescription for current MVA related sx. Denies hx current or > previous drug habit. Presents 2 mos. post MVA with significant history >of > injury, neck/shoulder/LBP/ PCS cluster of sx, has already contacted >lawyer. > Claims he didn't seek help beyond initial ED workup (head/neck CT, >shoulder > and lumbar X-rays)because he was laid up with the flu for a month. >Didn't > break it to him that first documented flu in OR was in past 2 days. Saw >his > PCP 1 week ago for tx of insomnia, did not seek treatment for flu or >mention > his MVA sx. Patient has an obvious tremor and claims faomily hx > Parkinson's. When asked about tremor, he states he's never noticed and >none > of his doctors have either. Tremor seems to worsen as assessment > progresses. His bare back has continuous vertical apparent fingernail > scratches (no broken skin and no gloves used), no way he could have made > them himself. I guess as I write this, it seems more obvious. My >current > plan of action is 1) check exam room for missing equip., 2)contact PCP >for > HIV status and previously observed drug-seeking behavior, 3) obtain all >med > records associated with this incident. What am I missing? > > Input appreciated re: experience with tweakers, >confidentiality/mandatory > reporting issues concernig HIV status and suspicion of illicit drug use > (weigh in , and if you haven't completely dumped that > harddrive of data since law school). > > Just another tricky day in paradise. Take care and thanks. > > PLEASE NOTE NEW ADDRESS! > W. Snell, D.C. > 3343 SE Hawthorne Blvd. > Portland, OR 97214 > Ph. 503-235-5484 > Fax 503-235-3956 > > > > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to >foster communication and collegiality. No personal attacks on listserve >members will be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. >However, it is against the rules of the listserve to copy, print, forward, >or otherwise distribute correspondence written by another member without >his or her consent, unless all personal identifiers have been removed. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2004 Report Share Posted November 17, 2004 In a message dated 11/17/2004 8:58:02 AM US Mountain Standard Time, drpsnell@... writes: HIPPA, remember, is Health Insurance Privacy and Portability Act, and part of the purpose was to foster ease of communication of a pt's condition between doctors when a pt changes doctors or heath plans. Doctors do not need any sort of release to share information when it comes to the actual treatment of a patient. As well no HIPAA release needs to be signed if law enforcment is involved - as was the case with a couple that turned out to be sexually abusing their children in my practice and another couple out here that kept their children locked in the closet for 8 months sliding food under the door and not even opening the door to let them go to the bathroom that I saw while doing a medical rotation. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2004 Report Share Posted November 17, 2004 Personally , I would have thought that you would have run into something like this before over on Hawthorne. It is a bit humorous having a doc from Burns educate a metropolitan doctor on meth users (she's absolutely correct though) However, it is a fallacy I believe that the toxins are expelled through the skin. Mainly it's just that meth increases the metabolic rate and causes increased sweating. By the way, meth may not be their drug of choice. Tremors could be caused by heroin withdrawl. Probably didn't seek care cuz he was getting high for the past month (not flu). Methadone usually isn't given for pain, but for heroin recovery. I can't see them giving oxycontin and methadone, but ya never know. Regardless, it isn't necessarily your job to discover what he is using, it may be all of the above. Use gloves at all times, prescribe B6 for neuro problems , screen heavily for vascular insufficiency, document, document document, treat for spinal sublux etc and get him out the door. If he denies drug abuse, there is no way you can refer him for help.. You should have no problem retrieving WBC counts etc as it relates to HIV, but i can't see how it is of any GREAT importance as it relates to the accident. My 2 cents. Joe Medlin DC 1627 NE Alberta st. PDX meth abuse > > Hey Folks, > > Little help, stat please. Recent patient seemed fishy. Claims to be HIV +, > denies use of rec. drugs, smokes, on the " cocktail " and can recite several > of the drugs in the cocktail. Claims current non-detectable viral load and > t-cell count > 1000. States he has received oxycontin, flexeril, and > methadone prescription for current MVA related sx. Denies hx current or > previous drug habit. Presents 2 mos. post MVA with significant history of > injury, neck/shoulder/LBP/ PCS cluster of sx, has already contacted lawyer. > Claims he didn't seek help beyond initial ED workup (head/neck CT, shoulder > and lumbar X-rays)because he was laid up with the flu for a month. Didn't > break it to him that first documented flu in OR was in past 2 days. Saw his > PCP 1 week ago for tx of insomnia, did not seek treatment for flu or mention > his MVA sx. Patient has an obvious tremor and claims faomily hx > Parkinson's. When asked about tremor, he states he's never noticed and none > of his doctors have either. Tremor seems to worsen as assessment > progresses. His bare back has continuous vertical apparent fingernail > scratches (no broken skin and no gloves used), no way he could have made > them himself. I guess as I write this, it seems more obvious. My current > plan of action is 1) check exam room for missing equip., 2)contact PCP for > HIV status and previously observed drug-seeking behavior, 3) obtain all med > records associated with this incident. What am I missing? > > Input appreciated re: experience with tweakers, confidentiality/mandatory > reporting issues concernig HIV status and suspicion of illicit drug use > (weigh in , and if you haven't completely dumped that > harddrive of data since law school). > > Just another tricky day in paradise. Take care and thanks. > > PLEASE NOTE NEW ADDRESS! > W. Snell, D.C. > 3343 SE Hawthorne Blvd. > Portland, OR 97214 > Ph. 503-235-5484 > Fax 503-235-3956 > > > > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2004 Report Share Posted November 17, 2004 Hi , Interesting case with a variety of potential indicators of weirdness (as in, what's going on with the scratches - what did he tell you abou them?). My approach to these kind of cases is to be up front with the patient and tell them your concerns and how they might affect your ability to provide the patient treatment. From a forensic perspective make absolutely sure that you document all of the weirdness and whatever explanation that you may have for it, and how it affects your determination of injury status and causation. No patient is ever worth a compromise of procedures that you routinely employ to protect the integrity of your diagnostic and causal determinations. Freeman Re: meth abuse<BR> >Date: Wed, 17 Nov 2004 06:14:16 -0800<BR> ><BR> >Don't know why you think the PCP would give you any info RE: HIV status or <BR> >anything else, for that matter. That would be a total HIPAA violation. Even <BR> >if you have a consent for info release, it doesn't cover HIV unless <BR> >specific.<BR> ><BR> >Meth users: anxious, always in motion, rotten teeth, oozing sores, jaw <BR> >oscillating laterally, nystagmus, stories never straight. The crap that <BR> >they mix with that stuff when they're cooking it (drano, brake fluid, you <BR> >name it) is trying to come out through their skin. It is best to always <BR> >wear gloves.<BR> ><BR> >Yes, in retrospect, you should check your room, but they shouldn't be left <BR> >alone in a room to start with.<BR> ><BR> > K. Carpentier, D.C., D.A.B.C.O.<BR> >Burns, OR<BR> >  meth abuse<BR> ><BR> ><BR> ><BR> >  Hey Folks,<BR> ><BR> >  Little help, stat please. Recent patient seemed fishy. Claims to be <BR> >HIV +,<BR> >  denies use of rec. drugs, smokes, on the " cocktail " and can recite <BR> >several<BR> >  of the drugs in the cocktail. Claims current non-detectable viral load <BR> >and<BR> >  t-cell count > 1000. States he has received oxycontin, flexeril, and<BR> >  methadone prescription for current MVA related sx. Denies hx current or<BR> >  previous drug habit. Presents 2 mos. post MVA with significant history <BR> >of<BR> >  injury, neck/shoulder/LBP/ PCS cluster of sx, has already contacted <BR> >lawyer.<BR> >  Claims he didn't seek help beyond initial ED workup (head/neck CT, <BR> >shoulder<BR> >  and lumbar X-rays)because he was laid up with the flu for a month. <BR> >Didn't<BR> >  break it to him that first documented flu in OR was in past 2 days. Saw <BR> >his<BR> >  PCP 1 week ago for tx of insomnia, did not seek treatment for flu or <BR> >mention<BR> >  his MVA sx. Patient has an obvious tremor and claims faomily hx<BR> >  Parkinson's. When asked about tremor, he states he's never noticed and <BR> >none<BR> >  of his doctors have either. Tremor seems to worsen as assessment<BR> >  progresses. His bare back has continuous vertical apparent fingernail<BR> >  scratches (no broken skin and no gloves used), no way he could have made<BR> >  them himself. I guess as I write this, it seems more obvious. My <BR> >current<BR> >  plan of action is 1) check exam room for missing equip., 2)contact PCP <BR> >for<BR> >  HIV status and previously observed drug-seeking behavior, 3) obtain all <BR> >med<BR> >  records associated with this incident. What am I missing?<BR> ><BR> >  Input appreciated re: experience with tweakers, <BR> >confidentiality/mandatory<BR> >  reporting issues concernig HIV status and suspicion of illicit drug use<BR> >  (weigh in , and if you haven't completely dumped that<BR> >  harddrive of data since law school).<BR> ><BR> >  Just another tricky day in paradise. Take care and thanks.<BR> ><BR> >  PLEASE NOTE NEW ADDRESS!<BR> >  W. Snell, D.C.<BR> >  3343 SE Hawthorne Blvd.<BR> >  Portland, OR 97214<BR> >  Ph. 503-235-5484<BR> >  Fax 503-235-3956<BR> ><BR> ><BR> ><BR> ><BR> ><BR> >  OregonDCs rules:<BR> >  1. Keep correspondence professional; the purpose of the listserve is to <BR> >foster communication and collegiality. No personal attacks on listserve <BR> >members will be tolerated.<BR> >  2. Always sign your e-mails with your first and last name.<BR> >  3. The listserve is not secure; your e-mail could end up anywhere. <BR> >However, it is against the rules of the listserve to copy, print, forward, <BR> >or otherwise distribute correspondence written by another member without <BR> >his or her consent, unless all personal identifiers have been removed.<BR> >  Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2004 Report Share Posted November 17, 2004 , Another idea is to give a call to the various drug rehab. Places and talk to a counselor. Many of them are ex-users and all of them are experienced. You can talk off the record and they will tell you WAY more than you need to know. Union Gospel Mission 2222 NW Couch St. Portland, OR 97209 (503) 274-4483 (Dr. Abrahamson, D.C.) Chiropractic physician Lake Oswego Chiropractic Clinic 315 Second Street Lake Oswego, OR 97034 http://www.lakeoswegochiro.com 503-635-6246 On 11/16/04 11:18 PM, " Snell " <drpsnell@...> wrote: > > Hey Folks, > > Little help, stat please. Recent patient seemed fishy. Claims to be HIV +, > denies use of rec. drugs, smokes, on the " cocktail " and can recite several > of the drugs in the cocktail. Claims current non-detectable viral load and > t-cell count > 1000. States he has received oxycontin, flexeril, and > methadone prescription for current MVA related sx. Denies hx current or > previous drug habit. Presents 2 mos. post MVA with significant history of > injury, neck/shoulder/LBP/ PCS cluster of sx, has already contacted lawyer. > Claims he didn't seek help beyond initial ED workup (head/neck CT, shoulder > and lumbar X-rays)because he was laid up with the flu for a month. Didn't > break it to him that first documented flu in OR was in past 2 days. Saw his > PCP 1 week ago for tx of insomnia, did not seek treatment for flu or mention > his MVA sx. Patient has an obvious tremor and claims faomily hx > Parkinson's. When asked about tremor, he states he's never noticed and none > of his doctors have either. Tremor seems to worsen as assessment > progresses. His bare back has continuous vertical apparent fingernail > scratches (no broken skin and no gloves used), no way he could have made > them himself. I guess as I write this, it seems more obvious. My current > plan of action is 1) check exam room for missing equip., 2)contact PCP for > HIV status and previously observed drug-seeking behavior, 3) obtain all med > records associated with this incident. What am I missing? > > Input appreciated re: experience with tweakers, confidentiality/mandatory > reporting issues concernig HIV status and suspicion of illicit drug use > (weigh in , and if you haven't completely dumped that > harddrive of data since law school). > > Just another tricky day in paradise. Take care and thanks. > > PLEASE NOTE NEW ADDRESS! > W. Snell, D.C. > 3343 SE Hawthorne Blvd. > Portland, OR 97214 > Ph. 503-235-5484 > Fax 503-235-3956 > > > > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to foster > communication and collegiality. No personal attacks on listserve members will > be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. However, it > is against the rules of the listserve to copy, print, forward, or otherwise > distribute correspondence written by another member without his or her > consent, unless all personal identifiers have been removed. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2004 Report Share Posted November 17, 2004 Hi Phil et al Be sure to check for head trauma. Post concussion syndrome will often produce weird symptoms. The mechanism of injury can also tell you a lot about potential injuries Bob W. Pfeiffer,D.C.;D,A.B.C.O. P. O. Box 606 Pendleton, Or. 97801 541. 276.2550 Re: meth abuse >Date: Wed, 17 Nov 2004 06:14:16 -0800 > >Don't know why you think the PCP would give you any info RE: HIV status or >anything else, for that matter. That would be a total HIPAA violation. Even >if you have a consent for info release, it doesn't cover HIV unless >specific. > >Meth users: anxious, always in motion, rotten teeth, oozing sores, jaw >oscillating laterally, nystagmus, stories never straight. The crap that >they mix with that stuff when they're cooking it (drano, brake fluid, you >name it) is trying to come out through their skin. It is best to always >wear gloves. > >Yes, in retrospect, you should check your room, but they shouldn't be left >alone in a room to start with. > > K. Carpentier, D.C., D.A.B.C.O. >Burns, OR > meth abuse > > > > Hey Folks, > > Little help, stat please. Recent patient seemed fishy. Claims to be >HIV +, > denies use of rec. drugs, smokes, on the " cocktail " and can recite >several > of the drugs in the cocktail. Claims current non-detectable viral load >and > t-cell count > 1000. States he has received oxycontin, flexeril, and > methadone prescription for current MVA related sx. Denies hx current or > previous drug habit. Presents 2 mos. post MVA with significant history >of > injury, neck/shoulder/LBP/ PCS cluster of sx, has already contacted >lawyer. > Claims he didn't seek help beyond initial ED workup (head/neck CT, >shoulder > and lumbar X-rays)because he was laid up with the flu for a month. >Didn't > break it to him that first documented flu in OR was in past 2 days. Saw >his > PCP 1 week ago for tx of insomnia, did not seek treatment for flu or >mention > his MVA sx. Patient has an obvious tremor and claims faomily hx > Parkinson's. When asked about tremor, he states he's never noticed and >none > of his doctors have either. Tremor seems to worsen as assessment > progresses. His bare back has continuous vertical apparent fingernail > scratches (no broken skin and no gloves used), no way he could have made > them himself. I guess as I write this, it seems more obvious. My >current > plan of action is 1) check exam room for missing equip., 2)contact PCP >for > HIV status and previously observed drug-seeking behavior, 3) obtain all >med > records associated with this incident. What am I missing? > > Input appreciated re: experience with tweakers, >confidentiality/mandatory > reporting issues concernig HIV status and suspicion of illicit drug use > (weigh in , and if you haven't completely dumped that > harddrive of data since law school). > > Just another tricky day in paradise. Take care and thanks. > > PLEASE NOTE NEW ADDRESS! > W. Snell, D.C. > 3343 SE Hawthorne Blvd. > Portland, OR 97214 > Ph. 503-235-5484 > Fax 503-235-3956 > > > > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to >foster communication and collegiality. No personal attacks on listserve >members will be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. >However, it is against the rules of the listserve to copy, print, forward, >or otherwise distribute correspondence written by another member without >his or her consent, unless all personal identifiers have been removed. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2004 Report Share Posted November 17, 2004 as was the case with a couple that turned out to be sexually abusing their children in my practice and another couple out here that kept their children locked in the closet for 8 months sliding food under the door and not even opening the door to let them go to the bathroom that I saw while doing a medical rotation " Shees! I'm glad I live in Oregon where that stuff never happens! D Freeman PhD DC MPH Forensic Trauma Epidemiologist Department of Public Health and Preventive Medicine Oregon Health and Science University School of Medicine 205 Liberty Street NE, Suite B Salem, OR 97301 503-586-0127 cell 503-871-0715 drmfreeman@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 17, 2004 Report Share Posted November 17, 2004 You know Phil, we can't get info out of a hospital or doctor's office for patient care at our hospital (I'm up there a lot these days). Whether it's legal or not, people are scared enough of the possible legal implications that they won't release the info even in legitimate situations. Not only is a patient's HIV status not a legitimate concern in a MVA case, it is such a political hot potatoe that I'd be shocked if they released you any such info. Y'all would be surprised at what we see out here in Siberia. Meth is the (unfortunate) drug of choice these days, throughout the state. The skin thing comes from a fairly knowledgeable higher mucky-muck in the DHS system. She lectured in my Psych class this very week. Whether it is the poison "oozing" from the skin or more likely, irritating the skin enough that the addict keeps picking at the skin leading to infected ulcerations, the effect is the same: groady, disgusting, oozing sores. (Cops say the teeth are the first thing they see.) K. Carpentier, D.C., D.A.B.C.O.Burns, OR meth abuse>>>> Hey Folks,>> Little help, stat please. Recent patient seemed fishy. Claims to be >HIV +,> denies use of rec. drugs, smokes, on the "cocktail" and can recite >several> of the drugs in the cocktail. Claims current non-detectable viral load >and> t-cell count > 1000. States he has received oxycontin, flexeril, and> methadone prescription for current MVA related sx. Denies hx current or> previous drug habit. Presents 2 mos. post MVA with significant history >of> injury, neck/shoulder/LBP/ PCS cluster of sx, has already contacted >lawyer.> Claims he didn't seek help beyond initial ED workup (head/neck CT, >shoulder> and lumbar X-rays)because he was laid up with the flu for a month. >Didn't> break it to him that first documented flu in OR was in past 2 days. Saw >his> PCP 1 week ago for tx of insomnia, did not seek treatment for flu or >mention> his MVA sx. Patient has an obvious tremor and claims faomily hx> Parkinson's. When asked about tremor, he states he's never noticed and >none> of his doctors have either. Tremor seems to worsen as assessment> progresses. His bare back has continuous vertical apparent fingernail> scratches (no broken skin and no gloves used), no way he could have made> them himself. I guess as I write this, it seems more obvious. My >current> plan of action is 1) check exam room for missing equip., 2)contact PCP >for> HIV status and previously observed drug-seeking behavior, 3) obtain all >med> records associated with this incident. What am I missing?>> Input appreciated re: experience with tweakers, >confidentiality/mandatory> reporting issues concernig HIV status and suspicion of illicit drug use> (weigh in , and if you haven't completely dumped that> harddrive of data since law school).>> Just another tricky day in paradise. Take care and thanks.>> PLEASE NOTE NEW ADDRESS!> W. Snell, D.C.> 3343 SE Hawthorne Blvd.> Portland, OR 97214> Ph. 503-235-5484> Fax 503-235-3956>>>>>> OregonDCs rules:> 1. Keep correspondence professional; the purpose of the listserve is to >foster communication and collegiality. No personal attacks on listserve >members will be tolerated.> 2. Always sign your e-mails with your first and last name.> 3. The listserve is not secure; your e-mail could end up anywhere. >However, it is against the rules of the listserve to copy, print, forward, >or otherwise distribute correspondence written by another member without >his or her consent, unless all personal identifiers have been removed.> Quote Link to comment Share on other sites More sharing options...
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