# Vet Follow-Up Tomorrow: What Would You Do?



## enigma731 (Aug 12, 2011)

Tomorrow Roo is going back to the vet for a recheck. 

If you haven't been following the epic mess that is her other medical thread, here's the short version:

Roo was rescued in July from a hoarder. I adopted her at the beginning of August. She seemed healthy at the rescue, but after I got her home she began losing weight and showing respiratory symptoms. She was treated with 10 days of Baytril and mostly recovered. Then, about a month ago, she started slowly losing weight again with no additional symptoms. At that time the vet wanted to take blood, but couldn't get a sample because Roo bruised too easily. So we opted to treat with Baytril again. Now, after two weeks, she has regained the weight she lost and appears to be eating more and acting better.

Here's my question: Would you just be satisfied with this result, or would you still want to do other tests? 

The vet had suggested we should consider bloodwork for organ function even if she did recover, just because of her background. However, I'm torn on this decision. There is a part of me that wants to be sure. But there's another part of me that knows bloodwork is invasive and stressful, and she's already been through a lot recently. 

Would you do the bloodwork? Would you do it even if it required anesthesia? Is it worth the risk to be sure, or should I trust that she is healthy now, and revisit bloodwork if the need arises in the future?


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## MeanneyFids (Aug 24, 2010)

I would do the blood work to be sure theres nothing going on further  it would at least give you peace of mind if nothing is wrong


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## sunnysmom (Sep 23, 2011)

That's a tough decision to make, and I'll let the more experienced people answer rather than me, but just wanted to let you know Sunny and I will be sending Roo good thoughts tomorrow.


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## enigma731 (Aug 12, 2011)

Thank you.  I'm thinking that if he can get the blood from a toenail clip, I'll do it. But I'm not very keen on putting her under anesthesia again after last time, unless he has some really compelling reason that it needs to happen now.


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## sunnysmom (Sep 23, 2011)

That makes sense to me. If she is doing well, anesthesia does seem like an unnecessary risk.


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## enigma731 (Aug 12, 2011)

It's tough because I'd hate to cause her more problems with invasive tests, but I also don't want to miss the opportunity to catch it early if there is another problem. Sigh.


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## morla (Aug 15, 2011)

I would do the bloodwork! It's better to be safe then sorry!


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## enigma731 (Aug 12, 2011)

morla said:


> I would do the bloodwork! It's better to be safe then sorry!


But was is "safe" in this case? Last time we attempted the bloodwork, she ended up with a huge bruise on her neck and feeling sick for the rest of the day. For all I know, if we try again she might not wake up from anesthesia. :/ I'm inclined to want to do it for the peace of mind, but I'd also never forgive myself if she died trying to get the blood.


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## MeanneyFids (Aug 24, 2010)

can you request they clip a toenail for blood? explain to them your concerns?


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## enigma731 (Aug 12, 2011)

I can try. I just don't know if they can get enough that way. Last time he was pretty adamant that she needed to be put under to get enough without hurting her, but maybe if she's doing better, we could do a less extensive test.


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## MeanneyFids (Aug 24, 2010)

ive heard on some forums for lovebirds they suggest taking blood from the toenail from smaller birds as its safer... but lovebirds are how tiny...


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## enigma731 (Aug 12, 2011)

Yeah, I've read that too. I also think it depends on the vet and their personal feelings about what's safest/most humane. I do think my vet is great, but his comfort level with things is not always the same as mine.


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## tielfan (Aug 31, 2008)

If this was my bird, I'd go for bloodwork from a toenail if possible but I wouldn't go for anything that required anesthesia. It's risky and didn't work last time, and there's no assurance that it would work this time either.


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## jeme (Jan 19, 2010)

I would also argue for least invasive, but before any tests I would want to know exactly what the doc is looking for. Is it something treatable? If we're just going to to find out about possible impaired function with no good treatment options, I would say no to the tests.


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## enigma731 (Aug 12, 2011)

jeme said:


> I would also argue for least invasive, but before any tests I would want to know exactly what the doc is looking for. Is it something treatable? If we're just going to to find out about possible impaired function with no good treatment options, I would say no to the tests.


We don't really suspect anything. He just wants it as baseline data because she comes from a background of neglect, is inbred, and has now had several episodes of unexplained illness.


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## jeme (Jan 19, 2010)

enigma731 said:


> We don't really suspect anything. He just wants it as baseline data because she comes from a background of neglect, is inbred, and has now had several episodes of unexplained illness.


In that case, I would say yes to a toenail clip, no to anesthesia.

Let us know how it goes!


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## enigma731 (Aug 12, 2011)

jeme said:


> In that case, I would say yes to a toenail clip, no to anesthesia.
> 
> Let us know how it goes!


That's the direction I'm leaning.  Honestly she acts extremely healthy (plays with toys, preens, eats well, has a ton of energy all the time, droppings look normal). It's just the two episodes of unexplained weight loss that are odd. But they were close enough together that it's conceivable we just didn't continue antibiotics long enough the first time. She's responded very well to Baytril within 48 hours both times. So I find it hard to believe that she could have some sort of severe organ problem, but I also don't want to miss anything.


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## enigma731 (Aug 12, 2011)

tielfan said:


> If this was my bird, I'd go for bloodwork from a toenail if possible but I wouldn't go for anything that required anesthesia. It's risky and didn't work last time, and there's no assurance that it would work this time either.


That's my general feeling too. Plus, then she didn't eat all day after the anesthesia because it made her feel gross. I don't want to be making her feel sicker when she's just recovered.


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## chloe92us (Jul 12, 2011)

If it were me, I would pass on the invasive testing. But, it's YOUR decision!


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## DyArianna (Aug 7, 2011)

I have not had to face a decision like this yet.. but I think I would choose with those that vote for the testing ONLY if what they are looking for is going to be treatable. If the testing is just going to reveal something that is going to run its course anyway.. I think I would opt against it. It would still be hair pulling crazy not knowing but it's just not worth the trauma to little one for it. By the way.. GOOD LUCK LITTLE ONE!


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## enigma731 (Aug 12, 2011)

I don't think we're considering anything untreatable at this point. There are lots of things that can be done if liver or kidney problems were to be detected. It's just a question of whether those problems are likely, given that she seems so healthy apart from the weight loss. If there was no risk to the bloodwork, I wouldn't hesitate. But unfortunately, it is an invasive and risky test.


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## Elysianphoenix (Jun 15, 2011)

I agree with the others. If the bloodwork can be acquired non-invasively, go for it, but avoid the anesthesia. If the vet insists on anesthesia, try getting a second and even third opinion. Other vets may know other ways then. 

As for that vet saying "can't get enough otherwise", I'd ask him... What's wrong with getting a little blood repeatedly? Maybe he'd be able to get more blood that way without endangering the bird. I'm not sure if it all HAS to be in "one go". Then again, I'm no vet, but that just seems like a safer option than "all at once". 

Anywho, good luck! I'll be following this.


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## enigma731 (Aug 12, 2011)

I know enough to know that blood has to be taken all at once, and kept under very specific conditions or else it starts to clot in the tube and ruins the tests. It's the same reason they have to take blood all at once, and all from the same spot on us when we go in for bloodwork. I have worked in animal labs before and done bloodwork on rats. So I can appreciate the delicacy of this.

I don't doubt his opinion or his ability. He is considered an expert in the field and has practiced for several decades. Getting a second opinion would require driving several hours, so it would have to wait anyway, and I don't think it would be worth the stress on her.

To me, it's just a question of whether or not it's worth doing the tests at this point if they do require anesthesia. He put that choice up to me, mainly because I was so worried about what might be going on.

I do appreciate everyone's input, though.


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## enigma731 (Aug 12, 2011)

Roo is back to 81g on my scale this morning, so she's still gaining but slowing down a bit. I guess that makes sense, since my vet feels her ideal weight is about 83-85. She's not so severely under anymore, so her body isn't compensating as much as last week. I think we'll explore the possibility of a toenail clip, but I'm not willing to do anything more invasive when she appears to be doing so well. Thanks for your help! More after our appointment.


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## enigma731 (Aug 12, 2011)

So okay, there were good and less good things about that appointment. This is going to be long, I apologize in advance.

Less good: 

-Roo only showed a gain of 2g on his scale as opposed to 4g on mine. However, I think this is mostly due to the fact that I weighed her at 7am and he weighed her at 10, and she was too stressed to eat or drink in between. Either way, it's a gain and not a loss. 

-He still wants bloodwork at some point, and he will only do it with anesthesia. However, I prodded him some more, and it sounds like he encourages all his patients to do bloodwork as a precaution, so it's not really a specific thing about Roo that led him to want it. I don't intend to do it unless she gives me a specific reason. He says he encourages everyone, because the bird could have congenital liver or kidney failure, and we'd never know otherwise. But if that's the case, why would I want to know? I'm happy just enjoying my time with her, however long that is.

-He also wants to see her again 2 weeks after finishing Baytril. I get the logic, but this was our 5th vet trip in 2 months. I think I'll see how she does and then decide whether or not to make that appointment.

The good:

-He agrees with me that whatever caused the weight loss is bacterial, and also responsive to Baytril. So we did the right thing. He also does not think she is immunocompromised; as he put it, if that were the case she wouldn't have lived long enough to be rescued. So now it's a matter of good hygiene and probiotics to prevent reinfection.

-Roo looks and acts extremely healthy, despite everything, including the stress of the vet trip.

-He was not concerned with the occasional slightly yellow urine that I mentioned in the other thread. He says it would be very obvious if it were due to a liver or kidney problem, and that her urates would also be discolored if that were the case.

-Her feathers look great! In fact, he rexamined the area where he lanced a little feather cyst last month, and discovered that the follicle is now growing through the skin normally! So she should have a normal feather there, and very little risk of a cyst recurrence. He also feels that her continuing to grow healthy feathers is a very good sign of her overall health.


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## sunnysmom (Sep 23, 2011)

Good news for Roo! I'm glad she's doing better.


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## enigma731 (Aug 12, 2011)

Thanks.  Roo is such a little trooper. She took a quick nap after we got back from the vet, but she's already playing with her toys again.


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## sunnysmom (Sep 23, 2011)

Ahhh.  What a sweet little bird.


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## enigma731 (Aug 12, 2011)

She really is. She let the vet give her scritches too.


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## DyArianna (Aug 7, 2011)

This is awesome news! Yayy for Roo!! And you too. Maybe now you can get a little more REAL rest and not be so worried about your sweetie. Will continue to keep you two in our thoughts.


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## enigma731 (Aug 12, 2011)

Ugh, I hope so! I think it'll still be a bit touch-and-go as she comes off antibiotics this weekend, but hopefully we're on top of it this time!  BTW, I'm about to post some new pics of her.


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## tielfan (Aug 31, 2008)

There are a lot of avian vets, maybe even the majority, who routinely do bloodwork and other labs at least once a year. My own vet has a good reputation with the local pet-bird community, and he doesn't believe in doing this. He says that it's meaningless in the absence of symptoms and frequently leads to unnecessary treatment for things (like bacteria) that weren't actually a problem. So if you want to skip doing bloodwork when Roo is healthy, you have my vet's approval for it!


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## jeme (Jan 19, 2010)

Yay Roo! Sounds like basically a good report and Roo is doing very well!


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## enigma731 (Aug 12, 2011)

She is.  Although of course being me, I always want her to have gained, like, 20 grams. Unrealistic expectations. I has them.


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## enigma731 (Aug 12, 2011)

tielfan said:


> There are a lot of avian vets, maybe even the majority, who routinely do bloodwork and other labs at least once a year. My own vet has a good reputation with the local pet-bird community, and he doesn't believe in doing this. He says that it's meaningless in the absence of symptoms and frequently leads to unnecessary treatment for things (like bacteria) that weren't actually a problem. So if you want to skip doing bloodwork when Roo is healthy, you have my vet's approval for it!


My vet in Florida, and the rescue's vet in Atlanta share that philosophy. It's just sort of tough, because my vet is telling me it's risky not to do bloodwork, while the rescue director is telling me I should never risk anesthesia again unless it's a true emergency. I realize that this is all a matter of opinion and personal comfort level, just like when you consult with two different human doctors. But it still kind of puts me between a rock and a hard place. Hopefully Roo just won't present a need for that decision to be made anytime soon.


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## enigma731 (Aug 12, 2011)

Roo is now five days off antibiotics and remains stable at 80g. I wish she would keep gaining, but maybe this is a good weight for her for now. 

Last night I had an interesting thing happen. She has had intermittent clear nasal discharge ever since I adopted her. I mean, we're talking it happens maybe once every 3-5 days. She's had tests done and been through three rounds of antibiotics and still has the discharge, so my vet thinks either something is irritating her nose or she has an allergy. Well, last night I heard her sneezing after preening (which she often does, I assume to clear dander out of her airways) and went to check. Sure enough, one nostril was a little bit wet. I usually just leave her alone when this happens, but for some reason this time decided to get a wet paper towel and try to clean her nose. Sure enough, I got a bunch of what appeared to be feather/seed dust out of the inside of her nares. I was shocked, because I always thought it was just normal for her nares to be a bit dark inside. Now I'm thinking that maybe she's getting irritated by breathing in her own dander, and needs my help to clean out her nose. 

Has anyone ever heard of this? We're pretty sure it's not an infection, because its been three months and it still only happens once or twice a week, plus all her tests and cultures have been negative. Is it possible that this is a residual breathing issue from living in a smoker's home?


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## DyArianna (Aug 7, 2011)

I wonder about spritzing her now that she's feeling better. Might help with some of her dander issues.. ?


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## enigma731 (Aug 12, 2011)

I want to wait a few more days on that because she's still newly off meds and we are having record low temperatures right now. It definitely does help when I'm able to mist her regularly, though. I don't know. On some level it bothers me that she's had this discharge and hasn't really regained a substantial amount of weight. I mean, I guess 4g is substantial. I just wish she would get up to 85 or so. On the other hand, the timing of the discharge and the weight loss doesn't seem to coincide at all. It's definitely not bacterial, and as my vet pointed out, if it were fungal it would be much worse by now. He thinks it's behavioral, that she stimulates herself to sneeze until the fluid comes out to clear her airways. This would appear to be pretty accurate since it only happens when she is picking and sneezing repeatedly.


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## tielfan (Aug 31, 2008)

Next time you're at the vet's you could ask him to take a look inside her nares to see if there are any problems there. It's normal for birds to sneeze after preening, and common for them to stick a toenail inside the nare to stimulate sneezing when they want to clear the nostrils. Teela kinda knocked herself off balance doing it this morning. 

It's possible that Roo might have some residual irritation from living in a smokers home, and sticking a toenail up her nose to bring on a sneeze is harder on the tissues than it is in a normal bird, with a "runny nose" as the result.


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## enigma731 (Aug 12, 2011)

He's examined her specifically for that on four different occasions. There's no sign of irritation, no sign of respiratory distress, nothing grew out of her cultures from the choana or nares. We tried the first round of Baytril back in August to see if it would help. It improved her weight and activity level, but did nothing for the intermittent discharge. That's how we arrived at the behavioral/allergy hypothesis. He said I could try her on Benadryl, but that it would make her groggy. Since the discharg only happens once or twice a week, I decided it wasn't worth making her feel crappy all the time on meds. 

I suppose bloodwork would be the only way to conclusively rule out something like a fungal infection, but you know where I stand on that. The vet also feels pretty strongly that if it were fungal, we would have seen worsening by now. 

This little bird is such a mystery.


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## enigma731 (Aug 12, 2011)

tielfan said:


> It's possible that Roo might have some residual irritation from living in a smokers home, and sticking a toenail up her nose to bring on a sneeze is harder on the tissues than it is in a normal bird, with a "runny nose" as the result.


I should also note that it only happens maybe 1/100 times she sneezes, and only when she's been sneezing repeatedly as when she's breathed in a feather or something. It's not like it's a constant runny nose, or even the majority of times she sneezes. 

What do you think about the dust in her nares? They looked perfectly pink and healthy after I cleaned them out. In fact, that's the best her nose has ever looked - I hadn't even realized it was supposed to look pink inside. But it was definitely dirt/dust, not snot in her nose.


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## tielfan (Aug 31, 2008)

It's possible that she can't blow the dust out effectively. I don't know what would cause this, but it's possible that the ability will improve with time. It's even possible that the dust was sticking to something that has now been removed, and the problem will disappear. If not, then just clean out her nares every now and then.


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## enigma731 (Aug 12, 2011)

That was my thought. I'm actually hoping that now she might not have the discharge issues if I've managed to clean out something that's been there the whole time. I was just hoping you guys could confirm that this isn't an "omg take her back to the vet right now!" kind of thing. I'm pretty sure it's not, since she's been so closely monitored, but still. My latest paranoia is that she has something like aspergillosis, but the vet didn't even bring that up as a possibility. Plus I would think she'd have clearer clinical symptoms by now.


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## tielfan (Aug 31, 2008)

It certainly doesn't sound like an emergency to me, especially since she's already had her nares checked several times. Although it seems a little odd to me that the vet didn't comment on the dark color and check into it.


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## enigma731 (Aug 12, 2011)

It really looked normal to me, so I'm not surprised he didn't notice. It wasn't until I got the dust out that I realized it should have been a lighter color. It really just looked like the normal membrane tiels have in their nares. In fact, her nares have been checked by both avian vets in the practice, and neither of them noticed.


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## tielfan (Aug 31, 2008)

Maybe there's individual variation in color - I've never paid enough attention to know if there are differences in my flock.


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## enigma731 (Aug 12, 2011)

I think there is, because I certainly didn't think anything of it despite the fact that I've been repeatedly examining her nares for signs of inflammation. I realize I'm not vet, but I'm pretty sure I'd still notice something that looked grossly abnormal. I think it was mostly clear/light dander from her molting, so I didn't realize it wasn't supposed to be there.


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## jeme (Jan 19, 2010)

I wonder if she's still clearing gunk from her lungs from living with a smoker before? That would be my guess since everything else has been pretty well checked out.


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## enigma731 (Aug 12, 2011)

I was thinking something along those lines. Hopefully it's a good sign.


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## enigma731 (Aug 12, 2011)

The vet called to check in today. I think he probably wanted to know if he was going to have to work us in over the weekend, since they get a lot of emergencies on Saturdays. It's incredibly nice of him to stay this much in touch, but somehow it always manages to unnerve me.  He reiterated that we need 2 weeks of her holding her weight to feel confident that she is fully recovered. He's also still trying to push bloodwork and a follow-up appointment. I get the sense that that's his own anxiety, because in the past he's been blamed for missing things when owners didn't have comprehensive testing done. But it makes me feel irresponsible for NOT authorizing bloodwork, even though I think my rationale is pretty good.


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## tielfan (Aug 31, 2008)

You can tell him that if something is missed because the blood work wasn't done, it will be your responsibility not his because you decided not to do the tests.

You can change your mind about the tests if you want, but it seems unnecessary to me. Stress increases susceptibility to infections, and anesthesia puts quite a lot of physical stress on the body. If the bloodwork could be done by clipping a toenail that would be a different matter, it's not such a big deal.


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## enigma731 (Aug 12, 2011)

He said if we did it from a toenail we'd have to make that nail bleed for like 30min to get enough for organ function tests. And that that's both inhumane and ineffective because the metabolic products of that much stress would ruin the sample. 

Roo remains 80g now nearly a week off the antibiotic, and she seems happy and healthy. She had another episode of a little bit of wet sneezing last night, but it was right after I had given Benebac, so I'm guess she just still had some in her mouth and that's what was wet. Her nose has remained clean since I cleaned it out on Tuesday, so I'm pretty sure whatever was in it wasn't produced by her body.


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## sunnysmom (Sep 23, 2011)

I say follow your instincts. If Roo seems fine to you, hold off. The whole blood work thing does seem really invasive and stressful.


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## enigma731 (Aug 12, 2011)

Well, I've also had birds 18 years and never had bloodwork done on any of them. I mean, I know Roo is somewhat of a different case, but not doing it certainly hasn't hurt the others.


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