New Treatment for Irritable Bowel Syndrome (IBS)

 

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“A critical weekly review of important new research findings for health-conscious readers”


NEW TREATMENT FOR IRRITABLE BOWEL SYNDROME (IBS)

An estimated 10 to 20 percent of the population suffers from a complex of gastrointestinal symptoms that are collectively referred to as Irritable Bowel Syndrome (IBS).  Irritable Bowel Syndrome affects women three times more commonly than men, and has historically been considered a “wastebasket” diagnosis for patients with functional gastrointestinal (GI) complaints when no other specific diagnosis can be found. 

While the precise causes of IBS are not well understood at this time, various theories have been proposed.  These include abnormal responses to infections of the GI tract, abnormal hormonal and neurological function of the GI tract, hypersensitivity to certain types of foods, abnormal motility of the colon, a “hyper-awareness” of bodily functions, and certain psychiatric conditions, in addition to other hypotheses.  (It is almost certain, however, that there is more than one cause for IBS.)

There are a variety of symptoms that have been associated with IBS, and the incidence, severity and frequency of each of these symptoms varies considerably from one IBS patient to another.  Typically, however, IBS-associated symptoms include bloating, crampy abdominal pain, diarrhea alternating with periods of constipation, and the passage of clear or white mucus from the rectum.  In many cases, IBS symptoms are more pronounced after eating, and patients with IBS often experience a powerful urge to move their bowels after meals.  IBS symptoms are also more frequent and more severe during times of stress.  In women with IBS, these distressing GI symptoms may become more intense around the time of their menstrual periods.  Other symptoms that have been commonly observed in patients with IBS include heartburn, nausea, and vomiting.

Because the precise causes of IBS are poorly understood, there have been a wide range of treatments recommended for this syndrome.  For example, exercise and other stress-reducing activities may be helpful for some IBS sufferers.  Giving up tobacco, and reducing or eliminating alcohol consumption may also help to reduce IBS symptoms, while promoting improved overall health at the same time.  Keeping a food diary can also help to identify foods that tend to provoke or worsen IBS symptoms in many patients.  Finally, dietary fiber supplementation has been almost universally advocated by most IBS experts.  Unfortunately, for many IBS sufferers, these and other recommended treatments for IBS are often ineffective. 

A new prospective, randomized, placebo-controlled clinical research study, just published in the journal Gut, has evaluated a new medical treatment for IBS that may hold promise for some of the millions of people who suffer from the unpleasant symptoms of this condition.  This small clinical research study included 60 patients with IBS.  Half of these IBS patients were randomized to receive an antihistamine medication (ketotifen) that prevents inflammatory “mast cells” from releasing inflammatory substances.  (Mast cells are present throughout the body, including the respiratory tract and the GI tract; and when stimulated, they release histamine and other substances that cause swelling and inflammation of adjacent tissues.)  The remaining half of this group of study volunteers was secretly randomized to receive an identical placebo (sugar) pill.  This study lasted for 8 weeks, altogether. 

At the start of this prospective clinical study, the 60 patient volunteers with IBS underwent an initial “barostat” study of the rectum.  This test involves the insertion of a balloon-like device into the rectum.  The balloon is then slowly inflated, which distends the rectal wall.  Prior studies have shown that many IBS patients perceive rectal discomfort with significantly less rectal distension than patients without IBS, a response that has been termed “visceral hypersensitivity.”  One theory as to why IBS patients experience visceral hypersensitivity relates to the abnormal activation of mast cells in the GI tract which, in turn, release multiple substances, including histamine, that generate an inflammatory response.

The 60 IBS patient volunteers also underwent biopsies of the rectum, and the results of these biopsies were compared with rectal biopsies taken from 22 age- and gender-matched “control” patients without IBS.  These biopsy specimens were then assessed for the number of inflammatory mast cells present, as well as the extent to which these mast cells spontaneously released inflammatory substances such as histamine and tryptase.

At the end of the 8-week study, the 60 IBS patient volunteers underwent a repeat barostat study of the rectum.  Among the IBS patient volunteers who experienced visceral hypersensitivity at the time of their initial barostat study, ketotifen significantly reduced the severity of visceral hypersensitivity when compared to similar patients who had been secretly randomized to receive placebo pills.  (There was no apparent change in visceral sensitivity associated with ketotifen among the IBS patients who had a normal response to initial barostat testing, however.)  More importantly, the IBS patients who had secretly been randomized to receive ketotifen reported significant improvement in abdominal pain and the other classic symptoms of IBS, when compared to the patient who had been randomized to receive placebo pills.  At the same time, the results of the rectal biopsies actually revealed fewer mast cells in the rectal biopsy specimens of IBS patients when compared to the control patients.  Moreover, there was only a very slight increase in histamine release by these rectal mast cells observed in IBS patients, when compared to the control patients.  (These latter two observations call into question the theory that increased numbers of mast cells, or/and an increased release of inflammatory substances from these mast cells, are responsible for visceral hypersensitivity in IBS patients, or for other symptoms commonly associate with IBS.  They also suggest that the favorable effects of ketotifen on the symptoms of IBS among these patient volunteers are likely occurring by a mechanism other than inhibition of mast cells within the GI tract.)

As I have noted in previous columns on this topic, there are likely multiple causes of IBS, and, therefore, individual treatments for this condition are not likely be equally effective in every patient with IBS.  However, the results of this small, early-phase study offer the hope that ketotifen (and, perhaps, other so-called “H1 antihistamines”), may be able to relieve the distressing symptoms of IBS in at in least some patients with this chronic GI syndrome.

 

To review previous columns on IBS, please select the following links:

Irritable Bowel Syndrome (IBS), Diet & Fiber

Irritable Bowel Syndrome: Cause Discovered?

 

Watch for the publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in September of this year.



 

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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Blueberries, Obesity, Diabetes and Metabolic Syndrome

 

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”


BLUBERRIES, OBESITY, DIABETES AND METABOLIC SYNDROME

Metabolic syndrome includes a constellation of health disorders that are associated with a high risk of developing diabetes and cardiovascular disease.  Specific disorders that are associated with metabolic syndrome include high blood pressure, abnormal cholesterol and triglyceride levels in the blood, obesity, and diabetes (or “pre-diabetes”).  In the United States, where obesity has become an epidemic, public health experts estimate that as much as 25 percent of the population currently meets the criteria for metabolic syndrome.

Excessive calorie intake, a sedentary lifestyle, obesity in the abdominal and waist areas (central, or visceral, obesity), genetic factors, and other adverse health risks are known to contribute to the development of metabolic syndrome.  Therefore, both the prevention and treatment of metabolic syndrome are based upon exercise, a healthy low-fat and low-sugar/low-carb diet, and weight loss.  A new prospective, randomized clinical research study suggests that consuming blueberries may also help to reduce some of the adverse health risks associated with metabolic syndrome.

In this study, which appears in the current issue of The Journal of Nutrition, 48 adults (44 females and 4 males) with metabolic syndrome were divided into two groups.  One group, the “experimental group,” consumed 50 grams of freeze-dried blueberries per day (equivalent to 350 grams of fresh blueberries per day), in the form of a beverage, for a period of 8 weeks.  The other group, the “control group,” consumed a “placebo” beverage that did not contain any blueberries (also for 8 weeks).  Blood pressure checks and multiple blood tests were performed at both 4 weeks and 8 weeks into the study.

When comparing the two groups of patient volunteers, the patients in the “blueberry group” were found to have significantly greater decreases in their high blood pressure when compared to the control group.  The level of oxidized LDL cholesterol in the blood, which is a form of the “bad” LDL cholesterol that can directly damage the lining of arteries throughout the body (atherosclerosis), was also significantly decreased in the “blueberry group” of patient volunteers.  At the same time, there were no significant differences between the two groups of patient volunteers with respect to blood glucose (sugar) levels, triglyceride levels, or the levels of HDL (the “good” cholesterol) or LDL (the “bad” cholesterol) in the blood .

Therefore, while a brief period of a diet supplemented with blueberries did not reverse all of the abnormalities associated with metabolic syndrome, the consumption of the equivalent of about 350 grams of blueberries each day did appear to significantly improve at least two of the adverse health factors associated with this syndrome (i.e., high blood pressure and blood levels of oxidized LDL cholesterol).  Based upon the intriguing findings of this small and short-duration study, patients with one or more health factors associated with metabolic syndrome might consider adding some blueberries to their daily diet, in addition to the standard treatment for this life-threatening disorder!

 

For more information on blueberries, and other sources of dietary polyphenols, as part of a cancer prevention lifestyle, watch for the publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in September of this year.



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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High LDL Cholesterol in Young Adults and Heart Disease Risk in Middle Age

 

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”


HIGH LDL CHOLESTEROL IN YOUNG ADULTS AND HEART DISEASE IN MIDDLE AGE

Most young adults look upon heart disease as an “old person’s” disease, and many young people therefore assume that they do not need to be concerned with their diet, or with their cholesterol profile, during this early stage of their adult lives.  However, a newly published prospective public health study, which appears in the current issue of the Annals of Internal Medicine, should certainly cause young adults to reconsider the relevance of these two very important health-related factors to them.

In this study, 3,258 men and women between the ages of 18 and 30 enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study between 1985 and 1986.  All of these research volunteers underwent blood tests for LDL cholesterol (the “bad cholesterol”), HDL cholesterol (the “good cholesterol”), and triglycerides (fat in the blood, which is also linked to cardiovascular disease risk).  Subsequently, these blood lipid tests were repeated throughout the 20-year course of this prospective public health research study.  Twenty years later, these now middle-aged adults underwent special scans of their hearts in order to detect and quantify calcium deposits in their coronary arteries (the “coronary calcium score” is used to predict a patient’s risk of experiencing future cardiac events like angina or heart attack).

The findings of this study are cause for considerable concern.  First of all, fully 87 percent of these volunteers were found to already have one or more abnormalities in their HDL, LDL or/and triglyceride levels, which are associated with an increased risk of cardiovascular disease.  Thus, nearly 90 percent of these young adults, who were recruited into this research study from nearby communities at 4 different locations in the United States, already had abnormal blood lipid test results at the time they entered into this clinical study!

After 20 years of observation, coronary calcium scores were obtained on each of these more than 3,000 study participants.  Once again, the results were striking (and concerning).  When the average LDL levels of these study volunteers were compared with their calcium scores, it quickly became apparent that elevation of LDL levels in the blood during young adulthood is associated with a rising and significant risk of coronary artery disease during middle age (based upon coronary calcium score results).  Among the volunteers who maintained normal LDL levels (<70 mg/dL, or <1.81 mmol/L) during their young adult years, there was an 8 percent incidence of coronary artery calcification (coronary artery atherosclerosis) 20 years later.   However, among the patients with elevated average LDL levels (160 mg/dL or higher, or 4.14 mmol/L or higher), the incidence of coronary artery disease was 44 percent. 

Even relatively mild increases in LDL levels during young adulthood were found, in this study, to be associated with an increased risk of coronary artery disease in mid-life.  When compared to patients with LDL levels <70 mg/dL (<1.81 mmol/L), patients with LDL levels of 70 to 99 mg/dL (1.81 to 2.56 mmol/L) were 50 percent more likely to have detectable coronary artery disease.  Patients with LDL levels between 100 and 129 mg/dL (2.59 to 3.34 mmol/L) were found have a 140 percent increased risk of coronary artery calcifications.  Patients with LDL levels between 130 and 159 mg/dL (3.37 to 4.12 mmol/L) experienced a 230 percent increased risk of developing coronary artery disease in middle age.  Finally, those patients with LDL levels of 160 mg/dl or higher (4.14 mmol/L or higher) had a whopping 460 percent increase in the risk of developing coronary artery disease by the time they reached middle age!

While the finding of coronary artery calcifications in these volunteers does not mean that every one of them will go on to experience heart attacks, or other serious complications of coronary artery disease, coronary artery calcium deposits (due to atherosclerosis) have been proven to significantly increase the risk of angina and heart attack, as well as other complications of cardiovascular disease.

This is a powerful public health study, because of its long-term follow-up of a relatively large group of patient volunteers.   Its findings tell us at least two very important things that we all should know regarding the risk of developing cardiovascular disease during middle age.  The first is that a strikingly large majority of young adults in the United States are already overweight, and already have abnormal blood lipid levels (and which are known to be associated with an increased lifetime risk of cardiovascular disease).  Secondly, even relatively mild increases in the level of LDL cholesterol in the blood during early adulthood are associated with a significant increase in the likelihood of having heart disease by middle age.  Moreover, significantly elevated LDL levels, over time, are associated with a huge increase in the risk of developing coronary artery disease by mid-life.

Based upon the findings of this important study, it is may be necessary to revisit the recommended age at which the routine annual testing of LDL cholesterol levels is initiated, particularly for young adults who are obese, or who have a family history of cardiovascular disease.  I also cannot stress enough the direct linkages that exist between diet and weight, on the one hand, and LDL cholesterol levels on the other had.  We are facing a true epidemic of obesity in this country, with two-thirds of the population already categorized as overweight or obese (and the proportion of the American population that is overweight or obese continues to rise every year).  The results of this study add to other prior research data regarding the lifetime health effects of poor lifestyle and diet choices, even when these poor choices are made during the very early years of our adult lives.

 

For a disturbing look at the links between obesity and cancer risk, watch for the publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in late August of this year.



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link:  http://www.youtube.com/watch?v=7-Tdv7XW0qg



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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Lactoferrin Reduces Abdominal (Visceral) Obesity

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“A critical weekly review of important new research findings for health-conscious readers”


 

LACTOFERRIN REDUCES ABDOMINAL (VISCERAL) OBESITY

Disturbingly, two-thirds of the American population already meets the criteria for being overweight or obese, one-third meets the criteria for obesity, and at least 2 percent of Americans are now considered to be morbidly obese. The cost of this rising epidemic of obesity is enormous (no pun intended), both to obese patients themselves, and to a nation that is struggling to pay for the skyrocketing cost of providing healthcare to its citizens.

Obesity has been unquestionably linked to cardiovascular disease, diabetes, liver disease, gallstones, gastroesophageal reflux, arthritis, cancer, and multiple other serious illnesses. Despite these sobering realities, however, the incidence of obesity continues to rise in the United States, and increasingly, throughout the world.

In our high-calorie, low-effort modern world, it is very easy to pack on excess weight over the course of our lives. People, being people, are always looking for quick, easy solutions to their problems, including excess weight. Unfortunately, other than decreasing our intake of food and increasing the amount of exercise that we regularly perform, no other cures for obesity have yet been found.

However, a newly published study in the British Journal of Nutrition has identified an unlikely new dietary supplement that may be helpful in the battle of the bulge. Lactoferrin, which is abundant in the colostrum and milk of most mammals (including humans), is thought to primarily function as an antibacterial and antifungal agent, and may help to protect breast-fed babies from infection (in some countries, lactoferrin is routinely added to infant formula for this purpose). Recent research has also suggested that lactoferrin may have a beneficial effect on the metabolism of fat within the body, and in particular, the so-called “visceral fat” that accumulates within the abdominal area, and which has been specifically linked to an increased risk of generalized inflammation in the body, as well as cardiovascular disease and cancer.

In this small prospective, randomized, doubled-blinded study, 26 overweight men and women with abdominal obesity were randomized to receive either daily lactoferrin supplements (300 milligrams per day) or an identical placebo (sugar) pill (none of the participating patient volunteers knew which group they were in until the study was completed). These patient volunteers were then followed for 8 weeks. All of these research volunteers underwent CT scans to measure the extent of their total body fat, superficial (subcutaneous) fat, and visceral (abdominal) fat.

At the end of this 8-week study, the group that had been randomized to receive daily oral lactoferrin supplements experienced very significant decreases in visceral fat content, as well as decreased body weight, decreased BMI (a standardized measure of obesity that considers both body weight and height), and hip circumference, when compared to the group of volunteers who were assigned to take the placebo pills. Additionally, blood tests to evaluate the impact of daily lactoferrin supplements on metabolism did not reveal any apparent adverse side effects associated with lactoferrin supplementation.

While this is a very small study (only 26 patient volunteers were included), and the length of follow-up was very short (only 8 weeks), the prospective, randomized, double-blinded, placebo-controlled design of this study, when combined with the rather striking results that were observed, are rather compelling. Certainly, a larger study, with long-term follow-up, needs to be performed before daily lactoferrin supplements can be recommended as both a safe and effective aid to weight loss. Moreover, such a study would need to show that the reduction in visceral fat that was observed in this small Japanese clinical study is not only reproducible over the long-term, but is also associated with a clinically significant improvement in the illnesses that have previously been linked to abdominal obesity. Meanwhile, and until such a study is performed, I find the results from this small prospective clinical study to be very interesting, indeed.

For a detailed review of the impact of obesity, exercise, nutrition, and other important lifestyle factors on the risk of developing cancer, watch for the publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in September of this year.



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

 


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam




I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit our premier global health information website every month. As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.





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Physician Error

 

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”


PHYSICIAN ERROR

Ah ne’er so dire a Thirst of Glory boast,
Nor in the Critick let the Man be lost!
Good-Nature and Good-Sense must ever join;
To err is human, to forgive divine.

Alexander Pope (1688-1744)

 

According to the prestigious Institute of Medicine, between 50,000 and 100,000 patient deaths are caused each year in the United States by negligence on the part of doctors, nurses, and other health care providers.  Nearly 1,000,000 patient injuries per year are also attributed to human error in the delivery of health care.

The presumptive causes underlying negligence in patient care are multiple and varied, and continue to be the subject of much debate among patient safety experts.  However, virtually all such experts agree that largely preventable human errors account for the vast majority of patient injuries and deaths associated with negligent patient care.

In the operating room, where I spend much of my time, as a cancer surgeon, we have adopted patient safety “check lists” inspired by the airline industry, and which are designed to reduce the possibility of errors during surgery.  At our institution, the patient’s identity (and the surgical procedure to be performed) is confirmed, twice, by everyone in the operating room before an incision is made.  Towards the end of the surgical procedure, an additional “debriefing” is performed, and the surgeon reviews the procedures that he or she has just performed.  The operating room nurse also confirms that all sponges, needles, and instruments have been accounted for, in an effort to reduce the possibility that any of these foreign bodies will be left within the patient.

 

One important aspect of physician error is that of errors in diagnosis.  In a newly published clinical study, which appears in the current issue of the journal Pediatrics, 1,362 pediatricians at three major academic medical centers, and 109 affiliated clinics, were invited to anonymously complete an Internet-based survey regarding their self-perceived frequency of diagnostic errors.  These doctors included experienced academic pediatricians, experienced community-based pediatricians, and resident doctors who were training to become pediatricians.  Altogether, 53 percent of the queried pediatricians agreed to complete the anonymous survey. 

More than half (54 percent) of these responding doctors indicated that they made significant diagnostic errors at least one or two times per month.  Not surprisingly, the resident doctors in training acknowledged the highest number of diagnostic errors, with 77 percent of these trainees admitting to at least one or two significant diagnostic errors per month.

Based upon their anonymous responses, nearly half (45 percent) of these 726 pediatricians believed that one or more of their diagnostic errors had harmed patients at least once or twice per year. 

When asked to analyze the underlying causes for their errors, these doctors cited the following explanations:  failure to gather adequate patient history information, inadequate physical examination, inadequate review of the patient’s chart, and inadequate coordination of care and communication among the providers involved (“inadequate teamwork”). 

Specific examples of diagnostic errors cited by these pediatricians included viral illnesses being misdiagnosed as bacterial infections, misdiagnosis of medication side effects, misdiagnosis of psychiatric disorders, and misdiagnosis of appendicitis. 

When asked to offer solutions to common diagnostic errors, these pediatricians most commonly recommended the implementation of electronic health records, as well as closer patient follow-up.

(It is important to note that, in view of the human tendency to “under-report” personal failures, it is very likely that the true incidence of significant diagnostic errors is actually considerably higher than what these pediatricians have self-reported in this study.)

 

In a perfect world, we physicians would never make the wrong diagnosis, or miss a diagnosis altogether, or miss an adverse reaction to medications or other treatments.  We would never prescribe the wrong medication or perform the wrong operation; and we would never, through acts of either commission or omission, perform anything less than a perfect surgical operation.  Unfortunately, the practice of Medicine, as with all human endeavors, will never become a “zero error” profession.  However, all of us, both patients and physicians (and physicians are patients, as well), certainly would agree that every effort must be made to drive preventable patient care errors down as close to “zero” as is humanly possible. 

While it is unlikely that human error can ever be completely eliminated, in Medicine or in any other profession, the findings of this important study are significant, and point to areas where substantial improvements in the delivery of health care can be achieved by physicians and other health care providers (and, I might add, by patients as well). 

 

Look for the imminent publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in August of this year. 



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg



I and the staff of Weekly Health Update would like to take this opportunity to thank the more than 100,000 new and returning readers who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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