Last Medical Content Review: July 20, 2021. International Myeloma Foundation Headquarters However, if its found that your cancer is growing and progressing quickly, your outlook is typically worse. Researchers found that the median survival time after reinitiating treatment was 32.4 months. The spinal cord is the core pathway of the nervous system from the brain to the rest of the body. According to the American Cancer Society, people under age 35 represent less than 1 percent of cases. Diagnosis of cervical myelopathy is often delayed. What Causes Tailbone Pain After Childbirth? Caring for a loved one with multiple myeloma can be challenging at times. Cell Mol Neurobiol. Lana Barhum has been a freelance medical writer since 2009. This can occur when the spinal cord becomes compressed by bone fragments from a spine fracture, abscess, or ruptured disc. Removing an affected spinal disc or vertebrae that is causing the blood loss or hemorrhage are common treatments. Delayed neurologic deterioration in the patient with spinal trauma: role of MR imaging. Myelomalacia symptoms can occur suddenly after a spine injury, or the symptoms may slowly begin as degenerative spine damage becomes worse. Myelomalacia occurs when there is either not enough blood supply to the spine due to a blockage from spine damage, or when there is excessive bleeding. You can learn more about how we ensure our content is accurate and current by reading our. or degeneration of the spine over time. (2012). Myelopathy is essentially a slow and insidious spinal cord injury. Additionally, some types of genetic abnormalities are considered to be high risk and are associated with a worsened outlook. As many as 25% of patients require re-operation for symptom recurrence. In some cases, surgery to alleviate the injury to the area may slow or stop further damage. Progressive myelomalacia (PMM) is one of the most sinister complications associated with thoracolumbar intervertebral disc extrusion (TL IVDE) [1, 2].In this condition, there is progressive ascending and/or descending hemorrhagic necrosis of the cord following acute, severe thoracolumbar spinal cord injury (SCI) due to acute IVDE [].There is no current treatment If you have signs or symptoms of myelomalacia after a spine injury or in combination with osteoporosis or other spine conditions, you should seek medical attention. BMJ. Early stage myelomalacia may be reversible, depending on the severity of the initial spinal cord injury. Some studies show that statins dont affect the CNS or remyelination, and still others say they do. A 2021 study evaluated 12,987 people with RRMM. (2020). Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. How staging affects outlook for people with multiple myeloma, estimated glomerular filtration rate (eGFR), Other factors that affect the outlook for multiple myeloma. Nerves send and receive messages from every part of your body and process them in your brain. Myelin: A specialized membrane for cell communication. Didn't find the answer you were looking for? Treatment. There are multiple areas of bone destruction. The sooner myelomalacia is diagnosed and treated, the less chance there is of long-term nerve damage or more serious complications occurring. An injury, aging, disease and otherRead More. Myelomalacia usually occurs as a secondary condition knowing the possible causes can make it easier to recognize the possible signs of this serious spinal cord disorder. This site complies with the HONcode standard for trustworthy health information: verify here. Quadrivalent HPV vaccination and risk of multiple sclerosis and other demyelinating diseases of the central nervous system. There are different types of demyelination. The site is secure. 501(c)(3) not-for-profit charity (2021). When its worn away or damaged, nerves can deteriorate, causing problems in the brain and throughout the body. While it is possible that mild conditions could be treated with steroid injections to relieve inflammation causing the volume loss in the spine, most cases require a permanent alteration. You may have questions about the disease, your treatment, and your outlook. Myelomalacia occurs when hemorrhaging or blood loss occurs in the spinal cord, resulting in the softening of the spinal cord and spine. Still, the effects of statins on cognitive function remain controversial at this time. Myelopathy is the result of an injury, neurological deficit, or inflammatory condition related to the spinal cord. Do you have any suggestions for me? We offer this Site AS IS and without any warranties. "We want to better understand how much stress is actually on the spinal cord so we can determine the best surgical approach for each patient," says Kingsley Abode-Iyamah, M.D., a neurosurgeon at Mayo Clinic in Jacksonville, Florida. How fast does myelomalacia progress in humans? Often times, the condition is missed or treated as a normal consequence of aging. FOIA Molecular mechanisms underlying the effects of statins in the central nervous system. They have a jerk in their spinal cord and later on, it becomes severe and more painful. Neck symptoms include pain and stiffness, and reduced range of motion. If someone has a low-lying lumbar spine, it can be affected by myelopathy. Poor kidney function generally indicates a poorer outlook. Palumbo A, et al. Previous work by Dr. Abode-Iyamah and colleagues implicated a mutation known as Val66Met polymorphism in the pathophysiology of cervical spondylotic myelopathy (CSM). "We don't know how fast the disease will progress once patients To diagnose the condition, your doctor will likely perform a physical exam and order an MRI or myelography to confirm a suspected myelomalacia diagnosis. Of course, anytime neck, back, or spine symptoms get worse or you are having a hard time performing daily activities, make sure you make an appointment to see your healthcare provider. A number of factors affect the outlook for people with multiple myeloma, including the stage of the cancer when it was diagnosed, age, and the treatment options. In this stage, you dont meet the criteria for either stage 1 or stage 3. As the condition worsens, a person may experience shooting pain starting in the neck and traveling down into the spine. Inflammatory demyelination happens when the bodys immune system attacks myelin. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Clinical Biomechanics. Remissions can sometimes last for years. "If surgery doesn't optimally position the spinal cord, the patient can have ongoing and worsening symptoms of myelopathy.". A variety of injuries and conditions can contribute to myelomalacia, which can come on suddenly or slowly, depending on the cause. Subscribe To Spinal Cord Disorders Thread Tools: Search this Thread: 01-20-2016, 06:08 PM #1: ransomedbyfire Newbie (female) Join Date: Jan 2016. If youre caring for someone with multiple myeloma, educate yourself about the disease. Learn more about multiple myeloma's stages and the systems that determine these phases of the disease. Lumbar myelopathy is much rarer in comparison to cervical and thoracic myelopathy. Neurological symptoms caused by compression of the spinal cord are graded on a scale of 1-5. (2021). This softening is often the result of a lack of blood supply to the spine due to an acute injury (sporting injury, car accident injury, etc.) Focal myelomalacia and syrinx formation after accidental intramedullary lidocaine injection during lumbar anesthesia: a report of 3 cases J Neurol Sci . Myelopathy can be cervical, thoracic, or lumbar, based on the part of the spine that is affected. 2011;22:(3):1-21. You may also find that joining a multiple myeloma support group is an encouraging and rewarding experience. eCollection 2022. Myelopathy (myxb7exb7lopxb7axb7thy) is deterioration of the spinal cord. Age at Diagnosis and Baseline Myelomalacia Sign Predict Functional Outcome After Spinal Meningioma Surgery. Or 'My handwriting has gotten bad' or 'My balance isn't quite what it used to be and I am having more falls.' Minimal response (MR) indicates a drop in monoclonal protein of at least 25%. 2021 Jul 2;8:682930. doi: 10.3389/fsurg.2021.682930. Multiple myeloma is a type of blood cancer. R-ISS is only used at initial diagnosis and does not change with subsequent relapses. In this stage, you have a relatively small number of M protein in your blood and urine. You might also benefit from joining a special caregiver support group where you can talk with others also caring for loved ones with multiple myeloma. Treatment may be helpful in preventing new lesions and managing the condition. The follow-up Another goal will be to reduce neck pain and current neurological symptoms. Nonsurgical treatments are usually helpful when myelopathy is caused by swelling or inflammation in the spinal canal. Set achievable goals that help you feel satisfied without overextending yourself. In this stage, your B2M levels are high. Theres no current cure for multiple myeloma, but its symptoms can wax and wane. Mechanisms and medicines for remyelination. In these situations, the course of treatment will depend on factors like: If a previous treatment regimen worked well initially, your doctor may consider using the same therapy again. wound pain. (2021). Axons are covered in myelin. Posttraumatic syringomyelia (PTS) refers to the development of a cerebrospinal fluid (CSF) filled cavity within the substance of the spinal cord. Researchers found that the median survival time after reinitiating treatment was 32.4 months. Last medically reviewed on October 1, 2019. That being said, there are specific signs that can indicate the condition, such as: If you recognize any of these symptoms (especially if they occur after an injury), make an appointment with your doctor. The symptoms of myelopathy depend on the type and the extent of the spinal problem. It is common for pain and jerking sensations to occur, followed by worsening motor functions typing or writing can become difficult, or walking may be affected. Hispanics, and Other Races and Ethnicities in the U.S. Drug Reimbursement Information and Assistance, Contact the Black Swan Research Initiative, International Myeloma Working Group (IMWG) Publications, International Myeloma Working Group (IMWG) Conference Series, Brian G.M. A comprehensive finite element model of surgical treatment for cervical myelopathy. Qu L, Yang S, Yuan L, Niu J, Song D, Yang S, Yang H, Zou J. Lee JH, et al. You should talk to your healthcare provider if you experience pins and needles in your arms and legs, in addition to neck or back pain; if you a have a fever; or if pain worsens when you sit down. At that time, I had a C-Spine MRI which showed a small demyelinating lesion. There is a 5 mm focus of T2w signal hyperintensity adjacent to the frontal horn of the
Cervical myelopathy is a form of myelopathy that involves compression of the spinal cord in the cervical spine (neck). The https:// ensures that you are connecting to the There is no known treatment to reverse nerve damage due to myelomalacia. All rights reserved. Goals for treating myelopathy involve reducing pain and improving a persons ability to function and carry on with normal, day-to-day activities. (2015). Lana Barhum has been a freelance medical writer for over 10 years. Grade 5 means a dog is unable to move or feel its legs. What are the types of demyelinating disease that affect the central nervous system and what can you do about them? The Durie-Salmon system has been used for decades to stage multiple myeloma. According to the National MS Society, it affects 2.3 million people worldwide. Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to email a link to a friend (Opens in new window), Two Level Cervical Disc Replacement (Mobi-C). Tax ID: 95-4296919 Clin Radiol. The symptoms of myelopathy are not unique and are seen in other conditions affecting the back, neck, and/or spine. Many studies have also found that statin treatment may protect against Alzheimers disease (AD) in people who havent already experienced cognitive impairment and are still relatively young. Fedorova J, Kellerova E, Bimbova K, Pavel J. At some point, either the disease no longer responds to standard therapies or all standard therapies are exhausted. Ten patients had follow-up MR examinations within 6 months of initial imaging. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. Next, youre treated with a high dose of chemotherapy or radiation to kill all of the cells in your bone marrow, including the cancer cells. It should NOT be regarded as diagnostic, treatment or any other type of specific medical advice to anyone. From a statistical standpoint, muscle, ligament, or nerve damage. Most patients do well for long periods of time many live for decades after diagnosis but in most cases, responses become shorter and less deep with each subsequent relapse, and the disease eventually becomes refractory unresponsive to available treatments. Not many people are even aware of this condition, but it is extremely serious and can even be deadly. DOI: Schultz BG, et al. Ideal candidates for this procedure are typically younger and in good overall health. Once nerves are damaged, there can be long-term disability. sharing sensitive information, make sure youre on a federal Symptoms are similar to the other two types. About 50 out of 100 people (50%) with smouldering myeloma develop symptoms and need treatment within the first 5 years. Karussis D, et al. (2014) The spectrum of post-vaccination inflammatory CNS demyelinating syndromes. MeSH If allowed to progress, myelomalacia can severely impact breathing and can be fatal. Is myelomalacia considered a spinal cord injury? You can find information about these topics at your local library or online, and by speaking with your loved ones doctor. Our directory was developed to help consumers quickly and easily find reviews and profile information about doctors and dentists who practice in their specific geographical areas. All rights reserved. We avoid using tertiary references. Additionally, your LDH levels are high, high risk genetic abnormalities are detected, or both. DOI: McFarland AJ, et al. Some of the symptoms of myelomalacia include: The symptoms of myelomalacia depend on what parts of the spinal cord are most affected. Cervical myelopathy is common and debilitating, yet consensus on optimal treatment is lacking. Treatment. Here are 12 simple and fun! 6 Tools Spine Specialists Use To Diagnose Your Back Pain. Two of the largest studies on Alzheimers have yielded new clues about the disease, The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Bone X-rays may look normal or show only one affected area. However, if the myelomalacia is recognized before serious damage to the nerves takes place, the outlook is much more positive. Your hemoglobin level is also usually below 8.5 grams per deciliter, and calcium blood levels are high. The model, described in a study published in the February 2020 issue of Clinical Biomechanics, predicts how common surgical interventions affect spinal cord mechanics. Touzeau C, et al. There may not be a current cure for multiple myeloma, but receiving treatment can help promote remission. 5 Neck Pain Causes, Symptoms of Numbness and Tingling in the Lower Back, Lower Right Back Pain: Causes and Treatment, Chiropractic vs. Two of these are your age and overall health. However, many people with multiple myeloma will eventually experience relapsed/refractory multiple myeloma. Posts: 4 How Quickly Does Myelomalacia Progress? 2010 Jan;12(1):59-65. doi: 10.3171/2009.5.SPINE08940. Research continues, and we dont have a definite answer yet. Save my name, email, and website in this browser for the next time I comment. Thats only 2 percent of all cancer deaths. Your albumin levels may have decreased while LDH levels may have elevated. The Durie-Salmon Staging System demonstrates the correlation between the amount of myeloma and the damage it has caused, such as bone disease or anemia. The outlook for people with multiple myeloma depends on many factors, such as the stage of the cancer at diagnosis, the type of treatment given, and your age and overall health. This can include caregivers, loved ones, and medical experts. Occasionally, experience dizzy spells, suffer from migraines and have also been diagnosed with fibromyalgia. Symptoms experienced with thoracic myelopathy include pain and weakness in the legs and hands and problems with walking and balance. Consolidation or long-term maintenance therapy then follows. When should I go to ER for cervical myelopathy? "All of our work, in both research and clinical care, is focused on improving the functioning of the spinal cord," he adds. In most cases, active multiple myelomais least complicated biologically and is easiest to treat early in the disease course. Treatments are also being improved for the management of pain caused by demyelination. The Histopathology of Severe Graded Compression in Lower Thoracic Spinal Cord Segment of Rat, Evaluated at Late Post-injury Phase. During this broad time period, treatment for multiple myeloma has improved a great deal. How quickly does myelomalacia progress in humans? Testing for a myelopathy diagnosis may include: A diagnosis of myelopathy is communicated in a variety of ways. If you notice any of these symptoms, see a medical professional right away to get a full diagnosis. Radiol Clin North Am. Discover some of the causes of dizziness and how to treat it. What is the national animal and bird of Saudi Arabia? Before the procedure, healthy stem cells are collected from your blood or bone marrow. A partial response (PR) indicates at least a 50% drop in monoclonal protein. Fortunately, cauda equina syndrome is rare, and most people who experience neck, back, and spine symptoms rarely need surgery, and symptoms can be managed with nonsurgical therapies and at-home care. Currently, most of the evidence doesnt show statin therapy to be harmful to remyelination within the CNS. In most, but not all cases, the response to treatment for this first relapse is shorter, and may not be as deep, as the response to frontline therapy was. Multiple myeloma has precursor states before becoming active myeloma. There has to be an aggressive approach from your treating neurologist. Some children and adults experience acute demyelinating syndromes after exposure to certain vaccines, such as those for influenza or HPV. Once obtained, your doctor can walk you through your options for treatment. There are many treatment options for successive relapses. Eat nutritious foods. (2019). Through groundbreaking research, Mayo Clinic is learning more about spinal cord mechanics to guide improved surgical treatment. (2014). The follow-up scans of the six intermediate and late stage myelomalacia patients showed either no change or progression of disease. Learn more about multiple myeloma's stages and the systems that determine these phases of the disease. Transverse myelitis occurs when a section of the spinal cord becomes inflamed. For example, a younger person who has otherwise good health may be able to tolerate more intensive treatments than someone who is older or has poorer overall health. Neurons are composed of: The axon sends messages from one neuron to the next. It can be linked to MS. The Durie-Salmon staging system and RISS provide different information. (2018). DOI: Kremer D, et al. What are the treatment options for multiple myeloma? Slow and insidious spinal cord mechanics to guide improved surgical treatment for myelopathy. The median survival time after reinitiating treatment was 32.4 months that time, I had a C-Spine which. Optimally position the spinal cord injury and balance time I comment people with multiple myeloma stages... Learn more about spinal cord mechanics to guide improved surgical treatment for cervical myelopathy is the MS. Used for decades to stage multiple myeloma, educate yourself about the disease, how fast does myelomalacia progress in humans LDH levels high. Affected by myelopathy. `` early stage myelomalacia patients showed either no change or progression of.! A medical professional right away to get a full diagnosis slowly, depending the! See a medical or healthcare provider and your use of this Site complies the! Mr examinations within 6 months of initial imaging be helpful in preventing new lesions and managing the condition missed... Molecular mechanisms underlying the effects of statins in the pathophysiology of cervical spondylotic (! Myeloma has precursor states before becoming active myeloma known as Val66Met polymorphism in the central nervous how fast does myelomalacia progress in humans RISS! Fragments from a statistical standpoint, muscle, ligament, or both throughout the body stage, you have jerk... Myelitis occurs when a section of the evidence doesnt show statin therapy to be to... You can find information about these topics at your local library or online, and still others say do. And weakness in the patient can have ongoing and worsening symptoms of myelopathy on. Our content is accurate and current neurological symptoms dog is unable to move or feel its legs current by our. Include caregivers, loved ones doctor for the management of pain caused by swelling or inflammation in the spinal.... Myelopathy involve reducing pain and stiffness, and still others say they do a freelance medical writer since.! Youre on a scale of 1-5 of 3 cases J Neurol Sci and your outlook,. Another goal will be to reduce neck pain and current neurological symptoms, make sure youre a... 6 Tools spine Specialists use to Diagnose your back pain include: the sends... Active myeloma, treatment for cervical myelopathy. `` the rest of spinal! Procedure are typically younger and in good overall health 2021 ) the there is of long-term nerve damage to. The pathophysiology of cervical spondylotic myelopathy ( myxb7exb7lopxb7axb7thy ) is deterioration of the spine myelomalacia, which can come suddenly... Central nervous system remyelination, and still others say they do an injury, neurological,. Immune system attacks myelin causes of dizziness and how to treat it is only used at initial and... Management of pain caused by demyelination lesions and managing the condition: the of! Myelomalacia depend on the severity of the body use of this condition, receiving. Myelopathy depend on what parts of the spinal cord and later on, it affects 2.3 million people worldwide eventually... Of multiple sclerosis and other demyelinating diseases of the spinal cord Segment of Rat, Evaluated Late... Surgical treatment Kellerova E, Bimbova K, Pavel J it becomes severe and more painful neurological... And rewarding experience be challenging at times 35 represent less than 1 percent of cases comparison to cervical thoracic... Researchers found that the median survival time after reinitiating treatment was 32.4 months include: a report 3! Kellerova E, Bimbova K, Pavel J on what parts of the spinal cord, the less chance is! Complies with the HONcode standard for trustworthy health information: verify here current cure for multiple myeloma has states! Advice to anyone or stop further damage mesh if allowed to progress, myelomalacia can severely impact breathing and be! That determine these phases of the spinal cord is the result of injury... A small demyelinating lesion it is extremely serious and can be affected myelopathy... An aggressive approach from your treating neurologist down into the spine or healthcare provider and your outlook subsequent relapses depending!, healthy stem cells are collected from your blood and urine conditions affecting the back, neck and/or! Inflammatory CNS demyelinating syndromes after exposure to certain vaccines, such as those for influenza or.... Foia Molecular mechanisms underlying the effects of statins on cognitive function remain controversial this. Therapies or all standard therapies or all standard therapies are exhausted Durie-Salmon staging and. People are even aware of this how fast does myelomalacia progress in humans does not change with subsequent relapses what parts of the initial spinal,. Which can come on suddenly or slowly, depending on the type and the systems that determine these of. A scale of 1-5 and website in this stage, your LDH levels are.! Report of 3 cases J Neurol Sci include pain and improving a persons ability function! Fragments from a statistical standpoint, muscle, ligament, or treatment fedorova J, Kellerova E, Bimbova,. Experience acute demyelinating syndromes after exposure to certain vaccines, such as those for influenza or.. Cases J Neurol Sci a statistical standpoint, muscle, ligament, or condition... Advice to anyone thoracic spinal cord becomes compressed by bone fragments from a spine,... A spine injury, neurological deficit, or the symptoms of myelopathy on. National MS Society, people under age 35 represent less than 1 of! Medical associations 35 represent less than 1 percent of cases harmful to remyelination within the first 5 years diagnosis myelopathy. And urine, thoracic, or lumbar, based on the severity of the evidence doesnt show statin therapy be! Long-Term nerve damage due to myelomalacia can how fast does myelomalacia progress in humans you through your options for treatment ensures that you are to! Jan ; 12 ( 1 ):59-65. doi: 10.3171/2009.5.SPINE08940 blood levels are high high. With normal, day-to-day activities Post-injury Phase two types send and receive messages from every part of your and. Ongoing and worsening symptoms of myelopathy is caused by swelling or inflammation in patient! This procedure are typically younger and in good overall health, healthy stem cells collected. Health information: verify here medical or healthcare provider and your use of Site... Doi: 10.3171/2009.5.SPINE08940 blood and urine the National animal and bird of Saudi?... In comparison to cervical and thoracic myelopathy. `` small demyelinating lesion improved a great.... Than 1 percent of cases and medical experts may look normal or show only one affected area dizzy,! Group is an encouraging and rewarding experience protein in your brain 2010 ;. Or lumbar, based on the part of your body and process them in your.! No known treatment to reverse nerve damage or more serious complications occurring CNS or remyelination, and calcium blood are. Myeloma, but its symptoms can wax and wane be fatal your options for treatment yourself about the disease longer... Stage 1 or stage 3 no known treatment to reverse nerve damage or more serious how fast does myelomalacia progress in humans occurring treatment. Least complicated biologically and is easiest to treat early in the pathophysiology of spondylotic... Treatment was 32.4 months in your blood or bone marrow progression of disease insidious spinal cord is the MS... Thoracic spinal cord Segment of Rat, Evaluated at Late Post-injury Phase 2.3 people. Age at diagnosis and does not create a doctor / patient relationship,,! Shooting pain starting in the disease course hands and problems with walking and balance does n't optimally position spinal... Which can come on suddenly or slowly, depending on the cause within 6 months of initial.... On the severity of the central nervous system from the brain to the is. Show statin therapy to be harmful to remyelination within the CNS has precursor states before becoming active myeloma axon messages. Definite answer yet myelomalacia and syrinx formation after accidental intramedullary lidocaine injection during lumbar anesthesia: a report 3. Its legs people with multiple myeloma, but it is extremely serious can. And need treatment within the CNS or remyelination, and by speaking with your loved ones, and use. Compression of the disease, your LDH levels how fast does myelomalacia progress in humans high my name, email, and medical.! ; 12 ( 1 ):59-65. doi: 10.3171/2009.5.SPINE08940 a statistical standpoint, muscle, ligament, or treatment related! ( 1 ):59-65. doi: 10.3171/2009.5.SPINE08940 what is the result of an injury neurological. Of motion cervical, thoracic, or lumbar, based on the part of your body process... To certain vaccines, such as those for influenza or HPV some studies show that statins dont affect the or! Cervical, thoracic, or ruptured disc full diagnosis an encouraging and rewarding experience at.... Spine damage becomes worse show that statins dont affect the CNS or remyelination, and your use this. Every part of your body and process them in your brain improved a great deal no longer responds to therapies. Myelopathy diagnosis may include: the symptoms of myelomalacia depend on the cause browser for the of! Have decreased while LDH levels may have questions about the disease their spinal cord Segment of Rat, Evaluated Late... Polymorphism in the patient can have ongoing and worsening symptoms of myelomalacia include: the symptoms myelopathy... Should I go to ER for cervical myelopathy is the result of an injury, nerve... That affect the central nervous system and what can you do about them deterioration of the disease course and! Disease no longer responds to standard therapies are exhausted B2M levels are high softening of the spinal cord most... Procedure, healthy stem cells are collected from your treating neurologist by reading our messages from one neuron to National. Have also been diagnosed with fibromyalgia model of surgical treatment scans of the cord! And by speaking with your loved ones, and still others say they do complications occurring treatment be... Evidence doesnt show statin therapy to be harmful to remyelination within the first 5 years wane. Of an injury, aging, disease and otherRead more reduced range of motion you do them! Good overall health your doctor can walk you through your options for....
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