Guest guest Posted October 27, 2006 Report Share Posted October 27, 2006 Hi Nikki, I can't remember if you are going to Shriners or somewhere else (there are so many new people on the board this week that I am getting confused, lol!), but I am sure they will want to take another x-ray to see if there is any progression. Just to give you an idea of how quickly it can progress - Ian went from 27 degrees to 36 in 8 weks. Four weeks later he was 43 degrees. I should mention that he stayed at 27 for quite a while and then out of the blue it just started getting worse really fast. We waited on the treatment since he seemed stable. If I had it to do over again, I would have started treatment ASAP. Usually the earlier you start treatment, the better results you get and less time spent in the cast. Noelle (12-2-01) Ian (8-15-04) Re: Lilia Hi , Thank you for the reply. We very much appreciate the information on Jake (glad to hear he is doing so well!) and on Shriners. At this point we don't know much, but we want to make sure we take every precaution. A few questions I have that perhaps you can answer form your own experience... Lilia's X-rays were taken at the end of August, so they will be two months old by the time we actually see the ortho. Is this unusual? Will the doctor be able to tell whether it has gotten better/worse without taking another X-ray? Would you ask for another x- ray so soon? Was Jake's curve very bad when you found it? How long after diagnosis did he begin treatment? Thanks for responding - it is so nice to meet people who have first- hand knowledge about infantile scoliosis. Best, Nikki Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2006 Report Share Posted October 28, 2006 Nikki, Ditto what Jenn C. said. Scoli can progress quickly enough in 2 months that they will probably order another x-ray. You cannot believe how many x-rays Jake had before his 1st birthday. His pedi took an x-ray to rule out pneumonia at 3 1/2 months old, and that's when we found the scoli. His curves were 20 and 19 then. We took the " wait and see " approach as we didn't know any better at the time. His curves would go up and down, and it was a year later when we began treatment. If I knew then what I knew now, we would NOT have waited that long!!! At that point his curves reached 25 and 35 degrees. Still not as high as where most of these kiddos were when they started treatment but enough to cause mild concern. Our Boston doc put us in a brace (after our insistence) which corrected one curve and brought the 2nd down to 28. That's where we were when we started casting. Thank goodness for ETTP (Early Treatment Trial Project). Our Erie doc would not have casted at 28 degrees had it not been for that conference. We are all glad he did! As Jenn C. said (I think it was she) the earlier they catch it, the sooner they treat it, the better the outcome -- the less amount of time in cast. Good luck at your next appointment. Let us know how your little girl makes out. Our best, & Jake ncivettini <ncivettini@...> wrote: Hi , Thank you for the reply. We very much appreciate the information on Jake (glad to hear he is doing so well!) and on Shriners. At this point we don't know much, but we want to make sure we take every precaution. A few questions I have that perhaps you can answer form your own experience... Lilia's X-rays were taken at the end of August, so they will be two months old by the time we actually see the ortho. Is this unusual? Will the doctor be able to tell whether it has gotten better/worse without taking another X-ray? Would you ask for another x- ray so soon? Was Jake's curve very bad when you found it? How long after diagnosis did he begin treatment? Thanks for responding - it is so nice to meet people who have first- hand knowledge about infantile scoliosis. Best, Nikki --------------------------------- Want to start your own business? Learn how on Small Business. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2006 Report Share Posted October 29, 2006 Just jumping in here to say that sometimes there are structural issues that cannot be detected on an x-ray that an MRI will pick up. It's usually standard procedure to use an MRI to determine definitively whether it is congenital or idiopathic. If it were me, I would insist that they do one. Noelle (12-2-01) Ian (8-15-04) Lilia > > > Hi All, > > Just wanted to introduce myself and get a little feedback from the > wisdom of the group! My name is Nikki, and my daughter Lilia was > diagnosed with infantile scoliosis at her four-month well child visit. > We have our first appointment with an orthopedic surgeon - Dr. > Weinstein - in Iowa City (Children's Hospital of Iowa at the > University of Iowa) on Monday. Though we have not had an " official " > interpretation of her X-rays yet, but the assistant said over the > phone that it looked like about 20 degrees. We are a little nervous, > but trying not to get overanxious because we do not yet know whether > her case seems progressive. > > Does anyone know anything about Dr. Weinstein or orthopedics at > Children's Hospital of Iowa? > > Pleased to meet you all (and your beautiful little ones)! > > Many thanks, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2006 Report Share Posted October 29, 2006 Hi Nikki, Yes, Ian goes to Shriners. It's a 9 hour drive for us, but well worth it! Ian is doing fantastic thanks to the casting and our wonderful doctor. He was down to 11 degrees out of his cast last month and he is only 3 degrees in his current cast. We're probably only looking at one more cast and then he will move on to a brace. You know, I went to one of the top doctors in Virginia for scoliosis and he didn't have a clue about the Mehta casting technique and really had no experience with infantile scoliosis. So, while you may be going to someone who is fantastic at treating adolescent scoliosis, you really want to see someone who has treated many infantile scoliosis kids and is familiar with Mehta's casting technique and the importance of early treatment. If you end up seeing him, I would go in with a list of questions which include asking about the number of infants he's treated and if he is familiar with Mehta's work. As for Shriners, honestly, they are just AMAZING. All you have to do is call them and they can schedule and appointment right over the phone. Not sure which one you would call (Erie, PA, Philly, PA, or Salt Lake City), but I know Erie was willing to do all of the paperwork over the telephone...not sure if they are all like that or not though. Also, they will require you to send copies of x-rays and they will also want copies of an MRI, so you would need to get that done. I think it took 6 weeks for me to get our initial appointment. I think it depends on how busy they are. Also, there is an article in the Shriners Magazine coming out in November about there infantile scoliosis program. My son is featured in it, so I can make a copy of the article for you when it comes out if you are interested in reading more about the program. Good luck with everything. I know this can be very overwhelming in the beginning. Feel free to email me any time. Noelle (12-2-01) Ian (8-15-04) Re: Lilia > > > Hi , > > Thank you for the reply. We very much appreciate the information on > Jake (glad to hear he is doing so well!) and on Shriners. At this > point we don't know much, but we want to make sure we take every > precaution. A few questions I have that perhaps you can answer form > your own experience... Lilia's X-rays were taken at the end of August, > so they will be two months old by the time we actually see the ortho. > Is this unusual? Will the doctor be able to tell whether it has gotten > better/worse without taking another X-ray? Would you ask for another x- > ray so soon? > > Was Jake's curve very bad when you found it? How long after diagnosis > did he begin treatment? > > Thanks for responding - it is so nice to meet people who have first- > hand knowledge about infantile scoliosis. > > Best, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2006 Report Share Posted October 29, 2006 Hi Nikki, It is always so humorous for me to hear " he is one of the best in the world " . I say that because that's exactly what I heard about our doc here in Cleveland. And I hear that often from new members of this board. I don't doubt that these doctors are good. I'm sure they are very good, but when it comes to infant scoli. you need more than that. I HIGHLY recommend Shriner's Hosp. in Erie, PA, Philly, PA, and SLC, Utah. As far as I know, they are the only three hosp. is the U.S. that have both the correct training and the correct AMIL frame that is key in the casting process. They are free if your insurance doesn't cover it, and it can take 1-3 months to get in. Philly just started this past month, and they may not be as full as the other two, but check out the one closest to you first. They will require you to have an MRI, and as said, YES it is absolutely neccessary to get this done to fully rule out congenital scoli. I belive you are the one that's daughter is at 20 degrees? That is a low number and this is a great time to take advantage of treatment since she is so young. You potentially could be done with most treatment within a year if things go perfect. Some things to ask your doc tomorrow. Make him answer all of them. 1. What is Lilia's RVAD? (Very important and indicates weather or not she could have progressive scoli. >20 degrees indicates high probablility the curve will progress) 2. Is she flexable or rigid. (she is so young, and would probably be very flexable still) 3. Ask him what he knows and thinks about Dr. Mehta's POP casts. 4. How bad is her rotation? 5. Ask what type of casting he does/ bracing. If he casts does he have the AMIL frame? 6. How many infants has he treated....not children, but infants. Most docs numbers are very low, because infantile scoli. is very rare. 7.What are his success rates without surgery? Make him take another x-ray of Lilia and order an MRI. MRIs can take long to schedule. They wanted me to wait three months. VERY unacceptable, and with a few phone calls and a griping crying mother, Cole had his MRI three days later. Lilia is so young and timing is key with infantaile scoli. Good luck tomorrow. These questions will make him think and let him know you have done your homework. We will all be anxious as to what he has to say. It will be really interesting if he says " let's watch her for three months, and come back then and we'll see whats going on. " Good luck. Our thoughts are with you. /Cole Hi , I'm sorry to hear that your experience with Ian's scoli was not ideal at first. Is he well now? Best wishes to you all. We are being seen at the Children's Hospital of Iowa (at U. of Iowa), here in our hometown of Iowa City. We are seeing Dr. Weinstein, whom we were told by the referring doctor is one of the best in the world for treating scoliosis... strangly, though, most people on the net haven't heard of him. We'll find out soon enough... we see him on Monday for the first appointment. About Shriners... Is that where Ian is treated? How would I go about getting an appointment there for Lilia? Do you know how long it usually takes to get in? We are very interested in casting, should treatment be necessary, and from what I can tell Shriners is the best place for it. Best, Nikki > > Hi Nikki, > > I can't remember if you are going to Shriners or somewhere else (there are so many new people on the board this week that I am getting confused, lol!), but I am sure they will want to take another x-ray to see if there is any progression. Just to give you an idea of how quickly it can progress - Ian went from 27 degrees to 36 in 8 weks. Four weeks later he was 43 degrees. I should mention that he stayed at 27 for quite a while and then out of the blue it just started getting worse really fast. We waited on the treatment since he seemed stable. If I had it to do over again, I would have started treatment ASAP. Usually the earlier you start treatment, the better results you get and less time spent in the cast. > > > Noelle (12-2-01) > Ian (8-15-04) > Re: Lilia > > > Hi , > > Thank you for the reply. We very much appreciate the information on > Jake (glad to hear he is doing so well!) and on Shriners. At this > point we don't know much, but we want to make sure we take every > precaution. A few questions I have that perhaps you can answer form > your own experience... Lilia's X-rays were taken at the end of August, > so they will be two months old by the time we actually see the ortho. > Is this unusual? Will the doctor be able to tell whether it has gotten > better/worse without taking another X-ray? Would you ask for another x- > ray so soon? > > Was Jake's curve very bad when you found it? How long after diagnosis > did he begin treatment? > > Thanks for responding - it is so nice to meet people who have first- > hand knowledge about infantile scoliosis. > > Best, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2006 Report Share Posted October 29, 2006 An MRI can also find other anomalies like tethered spinal cord, and syrinx (fluid filled pockets) in the spinal column which can disrupt growth. Shellie Grant (Moriah's Mom) ncivettini <ncivettini@...> wrote: Thanks, , for the kind words and helpful info. I would love to see the DVD - I'll shoot an email your way about it. On another line... is an MRI necessary to determine whether it is congenital or idiopathic? The pedi who looked at the x-rays said (over the phone) that there were no vertebral anomalies, so it was not congenital. Can they really tell that from the x-ray? They also said that when they don't believe it is congenital, they don't do an MRI. I am relieved that there doesn't appear to be anything structurally wrong with the vertebra, but if there's still a chance that an MRI would uncover a deeper problem, I'd like keep it as an option. What is your take on this? Thanks again - we are so grateful to have people like you to chat with! Nikki (husband Andy) Lilia (6/3/06) > > Hi Nikki. > > Welcome to CAST! This group is amazing when it comes to providing information on the early treatment process. My advice to you, would be the same as Jenn V.s. The ortho should first determine if its infantile or congenital, with an MRI. Then a plan of care can be established. If the MRI reveals that the scoli is infantile, and of the progressive nature, then early treatment is essential in reducing/correcting the curve. > > Can ISOP provide you with a an early treatment dvd? This dvd is crucial in understanding the basics of early treatment with serial corrective plaster. If so, please e-mail me privately at heather@..., and I will send one asap. > > I dont know anything about the Univ. of Iowa, except that they should understand the importance of early treatment with serial corrective plaster, because of Prof. Ponsetti and his proven/accepted work for club feet. > > Again, welcome to the group. > > Sincerely, > > HRH > () > > **Definately go to the FILES section of this group and read Dr. Mehtas recently published article. > > > Lilia > > > Hi All, > > Just wanted to introduce myself and get a little feedback from the > wisdom of the group! My name is Nikki, and my daughter Lilia was > diagnosed with infantile scoliosis at her four-month well child visit. > We have our first appointment with an orthopedic surgeon - Dr. > Weinstein - in Iowa City (Children's Hospital of Iowa at the > University of Iowa) on Monday. Though we have not had an " official " > interpretation of her X-rays yet, but the assistant said over the > phone that it looked like about 20 degrees. We are a little nervous, > but trying not to get overanxious because we do not yet know whether > her case seems progressive. > > Does anyone know anything about Dr. Weinstein or orthopedics at > Children's Hospital of Iowa? > > Pleased to meet you all (and your beautiful little ones)! > > Many thanks, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2006 Report Share Posted October 29, 2006 Nikki, When you see him tomorrow, keep in mind that he is a surgeon. I pulled up his bio through Google. He's an older man who has written text books on the spine and spine surgery. Surgery is probably what he knows best. If he has heard of casting, it will probably be the Risser casting with the Risser frames. Go in there with your questions and get them answered. I truly hope he is open to learning about EDF casting with the AMIL frame. Many of us have had to go face to face with these older surgeons who have been in the " business " for a long time. Some have even belittled us and our attempt to know about our child's scoliosis. One Mom was even escorted out of a hospital by security!! She's a little fiesty! (You know who you are! :0) )Your child's curve is low. You have some time to explore all options. I pray he will take you and your husband seriously and show you respect as parents with brains in their heads trying to do the best for their child instead of taking everything he says as law. Let us know how it goes, Shellie Grant ncivettini <ncivettini@...> wrote: Thanks, , for the kind words and helpful info. I would love to see the DVD - I'll shoot an email your way about it. On another line... is an MRI necessary to determine whether it is congenital or idiopathic? The pedi who looked at the x-rays said (over the phone) that there were no vertebral anomalies, so it was not congenital. Can they really tell that from the x-ray? They also said that when they don't believe it is congenital, they don't do an MRI. I am relieved that there doesn't appear to be anything structurally wrong with the vertebra, but if there's still a chance that an MRI would uncover a deeper problem, I'd like keep it as an option. What is your take on this? Thanks again - we are so grateful to have people like you to chat with! Nikki (husband Andy) Lilia (6/3/06) > > Hi Nikki. > > Welcome to CAST! This group is amazing when it comes to providing information on the early treatment process. My advice to you, would be the same as Jenn V.s. The ortho should first determine if its infantile or congenital, with an MRI. Then a plan of care can be established. If the MRI reveals that the scoli is infantile, and of the progressive nature, then early treatment is essential in reducing/correcting the curve. > > Can ISOP provide you with a an early treatment dvd? This dvd is crucial in understanding the basics of early treatment with serial corrective plaster. If so, please e-mail me privately at heather@..., and I will send one asap. > > I dont know anything about the Univ. of Iowa, except that they should understand the importance of early treatment with serial corrective plaster, because of Prof. Ponsetti and his proven/accepted work for club feet. > > Again, welcome to the group. > > Sincerely, > > HRH > () > > **Definately go to the FILES section of this group and read Dr. Mehtas recently published article. > > > Lilia > > > Hi All, > > Just wanted to introduce myself and get a little feedback from the > wisdom of the group! My name is Nikki, and my daughter Lilia was > diagnosed with infantile scoliosis at her four-month well child visit. > We have our first appointment with an orthopedic surgeon - Dr. > Weinstein - in Iowa City (Children's Hospital of Iowa at the > University of Iowa) on Monday. Though we have not had an " official " > interpretation of her X-rays yet, but the assistant said over the > phone that it looked like about 20 degrees. We are a little nervous, > but trying not to get overanxious because we do not yet know whether > her case seems progressive. > > Does anyone know anything about Dr. Weinstein or orthopedics at > Children's Hospital of Iowa? > > Pleased to meet you all (and your beautiful little ones)! > > Many thanks, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2006 Report Share Posted October 29, 2006 I wanted to ditto what said about the MRI. I was told I would have to wait two months for Ian's MRI. I called my pediatrician and had her call and get us in at another hospital. Needless to say we had the MRI done 2 weeks later. Sometimes you have to get aggressive with this stuff. Noelle (12-2-01) Ian (8-15-04) Re: Lilia > > > Hi , > > Thank you for the reply. We very much appreciate the information on > Jake (glad to hear he is doing so well!) and on Shriners. At this > point we don't know much, but we want to make sure we take every > precaution. A few questions I have that perhaps you can answer form > your own experience... Lilia's X-rays were taken at the end of August, > so they will be two months old by the time we actually see the ortho. > Is this unusual? Will the doctor be able to tell whether it has gotten > better/worse without taking another X-ray? Would you ask for another x- > ray so soon? > > Was Jake's curve very bad when you found it? How long after diagnosis > did he begin treatment? > > Thanks for responding - it is so nice to meet people who have first- > hand knowledge about infantile scoliosis. > > Best, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2006 Report Share Posted October 29, 2006 Hello , I hope you don't mind ,, but i was reading your post and Infantile Scoliosis is all new to me, could you please send me a copy of your article I would love to learn more about the casting... THANK-YOU, Rhonda Claflin <noellesmommy@...> wrote: Hi Nikki, Yes, Ian goes to Shriners. It's a 9 hour drive for us, but well worth it! Ian is doing fantastic thanks to the casting and our wonderful doctor. He was down to 11 degrees out of his cast last month and he is only 3 degrees in his current cast. We're probably only looking at one more cast and then he will move on to a brace. You know, I went to one of the top doctors in Virginia for scoliosis and he didn't have a clue about the Mehta casting technique and really had no experience with infantile scoliosis. So, while you may be going to someone who is fantastic at treating adolescent scoliosis, you really want to see someone who has treated many infantile scoliosis kids and is familiar with Mehta's casting technique and the importance of early treatment. If you end up seeing him, I would go in with a list of questions which include asking about the number of infants he's treated and if he is familiar with Mehta's work. As for Shriners, honestly, they are just AMAZING. All you have to do is call them and they can schedule and appointment right over the phone. Not sure which one you would call (Erie, PA, Philly, PA, or Salt Lake City), but I know Erie was willing to do all of the paperwork over the telephone...not sure if they are all like that or not though. Also, they will require you to send copies of x-rays and they will also want copies of an MRI, so you would need to get that done. I think it took 6 weeks for me to get our initial appointment. I think it depends on how busy they are. Also, there is an article in the Shriners Magazine coming out in November about there infantile scoliosis program. My son is featured in it, so I can make a copy of the article for you when it comes out if you are interested in reading more about the program. Good luck with everything. I know this can be very overwhelming in the beginning. Feel free to email me any time. Noelle (12-2-01) Ian (8-15-04) Re: Lilia > > > Hi , > > Thank you for the reply. We very much appreciate the information on > Jake (glad to hear he is doing so well!) and on Shriners. At this > point we don't know much, but we want to make sure we take every > precaution. A few questions I have that perhaps you can answer form > your own experience... Lilia's X-rays were taken at the end of August, > so they will be two months old by the time we actually see the ortho. > Is this unusual? Will the doctor be able to tell whether it has gotten > better/worse without taking another X-ray? Would you ask for another x- > ray so soon? > > Was Jake's curve very bad when you found it? How long after diagnosis > did he begin treatment? > > Thanks for responding - it is so nice to meet people who have first- > hand knowledge about infantile scoliosis. > > Best, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 30, 2006 Report Share Posted October 30, 2006 Ditto what said about docs who are " the best in the world " . They may be best at something, but for infants with scoliosis, there are a select handful of ped. orthos. I would trust my child's life to. Being the BEST is such a subjective title, and something that doesn't carry much weight with me. FWIW Carmell mom to Kara, idiopathic scoliosis, Blake 16, GERD and Braydon 11, VACTERL, GERD, DGE, Titanium Rib Project patient #137 (dbl implant 8/01), thoracic insufficiency, rib anomalies, congenital scoliosis (fusion surgery 5/96), missing coccyx, fatty filum/TC (released 4/99), anal stenosis, chronic constipation, horseshoe (cross-fused) kidney, dbl ureter in left kidney, ureterocele (excized 6/95), kidney reflux (reimplant surgery 1/97), neurogenic bladder, bilateral hip dysplasia, right leg/foot dyplasia, tibial torsion, clubfoot with 8 toes (reconstructed 2/96, 3/96, 1/97, 3/04), pes cavus, single umblilical artery, tonsil-adnoidectomy and ear tubes (3/98), etc. http://carmellb-ivil.tripod.com/myfamily/ __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 30, 2006 Report Share Posted October 30, 2006 Sure Rhonda! I'll let you know when I get the article. I am also wondering if the article will be available online in PDF format. I found an earlier issue of the magazine on the net by doing a Google search. Noelle (12-2-01) Ian (8-15-04) Re: Lilia > > > Hi , > > Thank you for the reply. We very much appreciate the information on > Jake (glad to hear he is doing so well!) and on Shriners. At this > point we don't know much, but we want to make sure we take every > precaution. A few questions I have that perhaps you can answer form > your own experience... Lilia's X-rays were taken at the end of August, > so they will be two months old by the time we actually see the ortho. > Is this unusual? Will the doctor be able to tell whether it has gotten > better/worse without taking another X-ray? Would you ask for another x- > ray so soon? > > Was Jake's curve very bad when you found it? How long after diagnosis > did he begin treatment? > > Thanks for responding - it is so nice to meet people who have first- > hand knowledge about infantile scoliosis. > > Best, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 30, 2006 Report Share Posted October 30, 2006 I would LOVE it too-- and Evan Claflin <noellesmommy@...> wrote: Sure Rhonda! I'll let you know when I get the article. I am also wondering if the article will be available online in PDF format. I found an earlier issue of the magazine on the net by doing a Google search. Noelle (12-2-01) Ian (8-15-04) Re: Lilia > > > Hi , > > Thank you for the reply. We very much appreciate the information on > Jake (glad to hear he is doing so well!) and on Shriners. At this > point we don't know much, but we want to make sure we take every > precaution. A few questions I have that perhaps you can answer form > your own experience... Lilia's X-rays were taken at the end of August, > so they will be two months old by the time we actually see the ortho. > Is this unusual? Will the doctor be able to tell whether it has gotten > better/worse without taking another X-ray? Would you ask for another x- > ray so soon? > > Was Jake's curve very bad when you found it? How long after diagnosis > did he begin treatment? > > Thanks for responding - it is so nice to meet people who have first- > hand knowledge about infantile scoliosis. > > Best, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 30, 2006 Report Share Posted October 30, 2006 I'll send a copy to anyone who wants one. I'll let everyone know when I get it and then I can get addresses from everyone who'd like to read the article and I will mail it out. Noelle (12-2-01) Ian (8-15-04) Re: Lilia > > > Hi , > > Thank you for the reply. We very much appreciate the information on > Jake (glad to hear he is doing so well!) and on Shriners. At this > point we don't know much, but we want to make sure we take every > precaution. A few questions I have that perhaps you can answer form > your own experience... Lilia's X-rays were taken at the end of August, > so they will be two months old by the time we actually see the ortho. > Is this unusual? Will the doctor be able to tell whether it has gotten > better/worse without taking another X-ray? Would you ask for another x- > ray so soon? > > Was Jake's curve very bad when you found it? How long after diagnosis > did he begin treatment? > > Thanks for responding - it is so nice to meet people who have first- > hand knowledge about infantile scoliosis. > > Best, > Nikki > > > > > > Quote Link to comment Share on other sites More sharing options...
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