Metals exhibit different charges that are commonly referred to as ferromagnetic, paramagnetic or minimally-paramagnetic. Finally, I’m going to have a video interview where I can share with our patient community that they can access this and feel better about the next steps in their therapeutic process. hello im needing reassurance,had to have mri scan last night.they asked if i had any implants staples etc.told them i had staples from my bypass.they looked this up to see if the staples were ok and said yes as they were made from something that compatibale with mri scanner,i had it done but still feel bit worried as had some twinges,think im fine and it would have hurt doing the procedure … That’s only improving. A triple bypass is not significantly different from a single or a quintuple bypass. Those metals are not ferromagnetic. As long as you have an MRI technician doing your procedure who is following the guidelines for whatever MRI device they’re using, for all intents and purposes, should be safe, unless some bizarre, catastrophic event occurs. I still have pain in my chest. As we all know that MRI scan is magnetic resonance imaging ..it uses magnetic field to generate the images.Now as we come to our question patients of heart bypass may have a metallic stent inserted in them so this high magnetic field generated would lead to the displacement of the stent from its original site ..this may even apply for the pacemaker and prosthetic valves The staple materials are also non-magnetic, so they will not be affected by MRI. The question will be how much damage there is to the liver. However, the outcome will not be known until the procedure is complete and the patient has healed. I’ve had several over the past 8 months and as long as you carry your heart card for a Stent placement like I have ever to do, you can I had a cabg x4 on Feb 29th, 2016. can you have gastric bypass surgery if you have hepatitis c? The others is just to do an incision along the entire old incision. It’s usually a 10 or 15-minute surgery. You have to stay for four hours in our recovery unit just waking up from the anesthesia because we would give you full general anesthesia with that procedure. If you've had coronary artery bypass surgery, keeping your blood vessels clear is the best way to prevent having to go through bypass surgery again. If anybody would like to schedule an appointment with Dr. Schaffer, you can call his office. These are metal wires used to hold the front of the ribcage (breastbone) together. Many studies have shown that a diet rich in fruits, vegetables, wholegrains, nuts and seeds can reduce your risk of heart disease. It hurts constantly. We are answering your questions in our Ask Adam Anything series. That’s something that, in general, we don’t know until we do it. ... Why can't I eat red meat … Up to 20% of patients develop depression after bypass surgery, and Robertson says you should seek help from a mental health professional if you notice symptoms of depression, such as persistent negative thoughts and a loss of interest in activities you once enjoyed. Coronary bypass surgery redirects blood around a section of a blocked or partially blocked artery in your heart to improve blood flow to your heart muscle. Adam has been featured by the American Heart Association and Medical News Today. Is that possible? Well, insurance usually covers it if you qualify (bmi over 40 if you have no medical problems, or bmi over 35 with medical problems). The first one comes from Kelly. Any mri place will not do a scan on you without make and model number to just be on the safe side so no worries. Dr. Schaffer typically performs 1-2 sternum wire removal procedures a year. 5 weeks after the MVA I had a heart attack and had to have a single bypass and I have metal in my cheat from the surgery. We do those through an upper mini-sternotomy, then things like aortic dissections or aortic aneurysms, valve sparing, aortic root replacements or even the Ross procedure. In the next 10 to 20 years, we’ll see a complete revolution in terms of the way we treat patients with valvular heart disease. The big question is whether removing the wires will remove someone’s sternal pain. To learn more, please visit our. can you have gastric bypass surgery if you have hepatitis c? Sternum wires are used during a sternotomy to help the breast bone heal. People with any type of metal device inside the body should not have an MRI unless the device is certified as MRI safe. For example, an eye injury from a metal object could result in a small piece that stays lodged in the eye. Dr. Geoffrey Rutledge answered. You can have an mi in a 3t scanner with some conditions. Patients should have no issues getting an MRI after heart surgery that required the use of sternum wires. Adam Pick: Great, well, thanks for all the great work you’re doing. To be certain, a simple x … They paired with a website called www.MRIsafety.com. Your post-op diet after gastric bypass surgery may seem overly restrictive, but there are still plenty of things you can, and should, eat. Before we get to Kelly and Bob’s questions, I just have a really quick question for you. Source(s): Health care provider Any one have an MRI shortly after surgery? $99 for entire year supply of "1 per Day!" Dr. Schaffer, are you there? Then lastly, there are MRI unsafe devices, which are the ferromagnetic devices, those devices that feel a very strong magnetic force when they’re inside a magnetic field that are MRI unsafe. That goes also for sternal fixation systems, which we sometimes use for patients. Very few, if any, cardiac devices fall under that category. We’ll go over that a little bit later. This award-winning website has helped over 10 million people fight heart valve disease. That leads to the American Heart Association which has developed guidelines, which it did in 2007, to try and help us figure out what is an MRI safe device? I am attempting to get an MRI, and the technician is concerned about the metal in my body.” What are your thoughts for Kelly? Ask doctors free. can you tell me about roux-en-y gastric bypass surgery? Reply. The hepatitis c itself won't be a barrier to this surgery. Magnetic resonance imaging (MRI) is very safe and most people are able to have the procedure. Bob asked, “It’s one year after surgery. Patients typically have favorable outcomes from sternum wire removal procedures. We’re going to go ahead and put up your contact information. Teresa HW-293 SW-290 Top. Dr. Schaffer: Thanks for having me, Adam – pleasure to be here. Do’s and Don’ts Following Bypass Surgery. I’ve got sternum wires in me right now. I need to get an MRI to find out the status of my shoulder, and I was scheduled for one 4 months after surgery but the … A roux-en-y gastric bypass can be quite effective in weight loss if it is part of a multi-modality treatment process. Elyse Sherman from Most patients are in-and-out of the hospital during the same day. Quote. The Patient's Guide To Heart Valve Surgery, Kelly asked me, “Can sternum wires cause issues with other medical procedures? The wires are made from stainless steel or titanium. However, long-term pain management may be recommended if you have persistent headaches after surgery. I also want to extend a special thanks to Dr. Justin Schaffer for sharing his research and his clinical experiences with our community! Top answers from doctors based on your search: Connect by text or video with a U.S. board-certified doctor now â wait time is less than 1 minute! It is the best in terms of ... read this for information: When does this, Elyse says, "Hi, Heart Valve Family! how effective is the rny gastric bypass surgery? Other studies have shown that people with a BMI as low as 30 may have a successful resolution of diabetes after undergoing gastric bypass surgery or gastric banding. When that sternum is together, like any broken bone, it will mend to about 90 percent of its normal tensile strength about 8 to 10 weeks after the bone has been put together again. For the hearing impaired members of our community, I have provided a written transcript below of my interview with Dr. Schaffer. If you have any clips or wires left in your chest (and most people who have had bypass surgery do), then no, you cannot have an MRI. Why is this procedure necessary? Sternum wires are used during a sternotomy to help the breast bone heal. Those are not what we see implanted in hearts at all. Now, we’ve developed technology to be able to fix a valve in the heart by getting there from an artery in the groin. Posted on January 18, 2017 November 11, 2020 Author opm Categories GERD, LINX Procedure, News Post navigation « Previous Previous post: 8 Obesity Related … They’ll be a little sore, probably need a little pain medication for a couple of weeks, and then should have a full recovery after that. Alton, Illinois says, Any folks have trouble with first AVR that they had to have second, Kendal says, "Any folks have trouble with first AVR"Read more, Search 1,500 patient-recommended surgeons. We do some mitral procedures from the more minimally invasive things. It’s Adam with heartvalvesurgery.com. On day 3 after Bypass Surgery: Walking two to three times a day is advised along with restricted liquid and solid diet. This is another question that I get asked all the time. Most insurances cover the procedure if it is indicated. Dr. Schaffer: Good question. Lifeski on 3/12/11 3:20 am . By Dimplez90 Started 15 hours ago. Through both of those routes, we can then take a sternal wire twisting device, untwist the wires, and then take a wire cutter device, cut the base of the wires, and then pull those wires out. It’s a very straightforward procedure. I would say I encounter this question with either a clinic patient or someone in the hospital at least once every couple of weeks. Just always inform the doctors and techs and you should be good. Buyers remorse or just crazy. I am 12 days...", Lynn says, "Evening, tomorrow is day 1 of the...". Yes. Within 7th to 10th day, the sutures are removed from the chest and the leg. Then obviously, there’s also the regular bypass surgeries, like the traditional coronary artery bypass grafting and also robotic single-vessel approaches where we come in from the left side. The more bypasses you require, however, the longer the surgery, which can affect the time it takes you to recover. The staples will not set off airport metal detectors. It’s been tested in other MRI devices, and they haven’t had an issue with it. is it possible to have gastric bypass surgery if you have hepatitis c? I have had a couple patients who had a really good outcome when removing the wires. Two are about sternal wires, those things that help keep your sternum together after you’ve had surgery. No one including my PCP understood why. Because of that, most of these are essentially safe, but we hate to say safe for sure if something has not been rigorously tested. These will be affected by the strong magnets of a MRI machine. Basically an MRI-safe device would be something that has no magnetic items whatsoever. Bariatric Multivitamins! ... hepatitis c and gastric bypass surgery? Dr. Schaffer has performed 3,000 cardiac procedures and has successfully treated many patients in our community including Jerry Sams, Pamela Hogue and Thomas Barton. Schaffer!!! The patient typically has some discomfort after the surgery. 2. Maybe you can real quickly help the patients out there understand what part of the procedure you use the sternum wires – exactly they’re used for and the success that you’ve had with them thus far. MRI is a safe and painless test for most people. While there is a major lifestyle change one undergoes following bypass surgery considering you may not be able to conduct similar chores as you did prior to the bypass surgery, there are still ways one can lead a healthy lifestyle. To get it to heal, you need both sides of the breastbone to be opposed, be together. The good news is, there’s a website devoted to this. And that can cause damage to the body's tissue. Quote. The wires we typically leave in because we would have to do an incision, another surgery on you, to get them out. There is no risk in having an MRI since the staples are made of titanium which are not reactive to an MRI. So be sure your MRI place knows in case they have a screwy policy like mine did. I treat all valves, although I would say that about half of my practice is related to valves in the aortic position, or it’s related structures like the ascending aorta or aortic arch. MRI scan... can you ever get one after VSG? I had one old surgeon when I was in training tell me that whenever you do surgery for someone who has pain, what you get is pain with a hole in it. That can’t feel any force in a magnetic field, so we know from basic physics, that it’s MRI safe. At that point, the bone is essentially mended, and you don’t need the wires anymore. To learn more, contact Malladi Bariatrics and Advanced Surgery today. I would say probably once a year or once every other year, I will remove somebody’s sternal wire. You should have a card with the conditions. Dr. Schaffer: Unfortunately, the only way to get the wires out is to do another incision. 41 years experience Internal Medicine. A sternal wire goes around the breastbone, from one side and the other, and allows us to twist the wire together and bring the sternum together. Most of our devices are in this next category, MRI conditional. Amazingly enough I have stayed calm through all of this. It is very important for us to know if these wires are present because they can cause you injury if certain types of MRI scans are being done. 1.9K views View 3 Upvoters I still have pain in my chest. Studies using magnetic resonance imaging (MRI) have demonstrated that new focal brain lesions can occur after coronary artery bypass grafting (CABG), even in patients without apparent neurological deficits. Patients can be diagnosed after their physician refers them for an MRI due to headaches, but the headaches may not actually be due to moyamoya. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. Thanks for being with us today. I hope this helped answer their questions about sternum wires. Today I’m thrilled to be joined by Dr. Justin Schaffer. You could have a CT scan though. Keeping Blood Vessels Clear After a Bypass. Pretty much all medical implants (something left behind) made after 1996 are MRI safe. Need of surgery or indication for surgery at C6-C7 depends on clinical features rather than on MRI findings. What is an MRI unsafe device? It’s right next door to Dallas. Brillion, WI says, Evening, tomorrow is day 1 of the dentist. That’s where either a sternal fixation system or a sternal wire comes into place. It is very important for us to know if these wires are present because they can cause you injury if certain types of MRI scans are being done. Before having an MRI scan, you should tell medical staff if: you think you have any metal in your body. Most people who have metal rods and screws inserted during spinal surgery can have a magnetic resonance imaging (MRI) scan. One is to make a small incision over each of the heads of the wires. Yes, it can be done. Adam Pick: It’s great to have you. can you tell me the price range for a roux-en-y gastric bypass surgery!? For folks out there, Dr. Schaffer, obviously, you’ve helped a lot of folks in our community, whether it’s Jerry Sams, Thomas Barton, or Pamela Hogue. Adam Pick: Dr. Schaffer, I can’t thank you enough for taking the time for the very detailed explanation because I get this question often. I just received two excellent questions about sternum wires and heart surgery from Kelly and Bob. Abstract. You can actually go to www.MRIsafety to actually look up your specific device to make sure that it’s okay. Let’s shift now to Bob’s question. Leland, North Carolina says, Hi, Heart Valve Family! Muscle cramps after gastric bypass surgery, Foods to avoid after gastric bypass surgery, Causes of fainting after gastric bypass surgery. If the characteristics of your headaches change after surgery, we should be contacted. But in some instances an MRI scan may not be recommended. During the day, … I really hope everything continues to go great for you down in Plano, Dr. Schaffer. What About Sternum Healing, Wires & Infection After Heart Surgery? Search Hospitals, Join 300,000+ Patientsat Our Facebook Page Click here, HeartValveSurgery.com 2785 Pacific Coast Hwy, #517 Torrance, CA 90505 Phone: (888) 725-4311, © 2021 HeartValveSurgery.com. They do it, it's fine! The standard precaution is to obtain an approval or disapproval for the MRI from the cardiac surgeon who performed the procedure or the thoractic radiologist who might have read the post-surgery chest x-ray films. hepatitis c and gastric bypass surgery? Heart valve surgery is a very unique part of cardiac surgery. To answer these questions, I contacted Dr. Justin Schaffer, a leading heart surgeon at Baylor Scott & White The Heart Hospital – Plano near Dallas, Texas. Trying to not get stressed, Lynn says, "Evening, tomorrow is day 1 of the"Read more, Kendal Zinn from What was it about valve therapy – replacement and repairs that really excited you to create this as one of your specialties? Does hernia repair during gastric bypass surgery slow down healing process? Dr. Andrew Doe answered 19 years experience Interventional Radiology Should be fine: Pretty much all medical implants (something left behind) made after 1996 are MRI safe. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Ferromagnetic means something that is highly charged and will have a strong attractive or repulsive force applied to it when it’s inside a magnetic field. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Dr. Schaffer: Pleasure talking to you, Adam, and thanks for having me. Most popular: Together, we … It hurts constantly. Adam Pick: No doubt it’s an exciting time. All Rights Reserved, Baylor Scott & White The Heart Hospital – Plano, See Dr. Schaffer’s Interactive Surgeon Profile, SternaLock Blu: Fast Healing & Less Pain After Heart Surgery. The same is followed on 4th and 5th day with emphasis on breathing, coughing and some physical exercises. … Adam Pick: What is the process for you to go ahead and remove the sternum wires for a patient? Yes they can have MRI’s done. "i had the gastric bypass surgery, is it safe to have an mri without causing and problems from my surgery?" Experienced reflux doctors such as Dr. Malladi can help you make the right decision about LINX devices and MRI scans. Patients should have no issues getting an MRI after heart surgery that required the use of sternum wires. ... What Post-Operative Care is needed at Home after the Aorta-Femoral Bypass Graft Surgery surgical procedure? Exercise after bypass surgery sometimes starts while you are still in the hospital 2. This will help your body to heal, reduce your risk of complications and enable you to recover well. VSG on 04/06/10. Dr. Schaffer: That’s a good question. If you have no pain or no neurological deficits there is no need of surgery. Prescribed medications to be taken. After being moved the step down unit the next morning at 3:00 am I went into AFib. Dr. Schaffer: Sounds good. Create an account or sign in to comment We’re pretty sure it’s MRI safe, but we don’t have true hard and fast evidence. MRI scanners use a large magnet. I am 12 days"Read more, Lynn Loudermilk from Finding a community with others who have undergone bypass surgery can also help make recovery smoother. Download Our New & Free eBook eBook About Heart Valve Repair. Wires in the Chest from Heart Surgery – Although sternal wires are no problem during an MRI scan, sometimes cardiac pacing wires are left in place after heart bypass surgery. I had bypass heart surgery in mid year of 2013. It used to be that we could only fix coronary artery diseases with stents from an artery in the groin or the wrist. Here are the highlights of my video interview with Dr. Schaffer: There are so many helpful points in Dr. Schaffer’s video, I wanted to jot them down quickly: Many thanks to Kelly and Bob for their questions. She asks, “Can sternum wires cause issues with other medical procedures? If you have a pacemaker or any sort of metal implant from previous surgeries or injuries, you may not be able to receive an MRI because it uses magnets. If there is loose metal in the body, it can move during the scan. This includes things like TAVRs or transcatheter aortic valve replacements, surgical valve replacements in people who don’t qualify for a TAVR because they need a mechanical valve, or their valve anatomy is not favorable for a TAVR. We will further help you understand how MRIs can be wrong and inaccurate and why MRI readings may lead to … If so, what’s involved?”. Then folks can go home that same day. Now if that doesn’t scare the begeezus out of you and your family I don’t know what will. The the bypass is the gold standard for weight loss operations. Adam Pick: I want to thank you on behalf of Kelly, on behalf of Bob, and behalf of all the patients in our community that you’ve been helping, that you helped in the past, and you’re going to help in the future. "Wires in the Chest from Heart Surgery – Although sternal wires are no problem during an MRI scan, sometimes cardiac pacing wires are left in place after heart bypass surgery. Yes. The metal (staples) used in roux-en-y gastric bypass is safe for MRI procedures. Jeannie Surgery: February 2, 2011 Surgeon: Dr. Peter Lalor. Is that correct? Search for heart hospitals that specialize in heart valve treatment. you're pregnant or breastfeeding. I am attempting to get an MRI and the technician is concerned about the metal in my body.”, Bob asked me, “It’s one year after surgery. Dr. Schaffer, we’ve got a lot of great questions coming in. Then what we will do is then suture that skin back together with absorbable suture, in general, something that would be absorbed by the body, so there would be no stitches on the outside. Advertisement . For some screwy reason a scheduled MRI was delayed because the provider refused to do an MRI on my till after 12 weeks post op, this was a brain MRI and not even of the abdomen. A lot depends on the current status of your liver function. With that said, you will still have to fill out a history form prior to the MRI and make sure to note all of your medical and surgical history. ... do not cause any problems in the long run. I think it’s important for me to at least talk a little bit about the details, so it helps other folks with similar questions. Most patients who have open heart surgery for coronary artery bypass or valve replacement have sternal wires. It's been around for over 50 yrs and is a proven operation. You can actually look up whatever device is implanted in you. what to do if i had gastric bypass surgery in 1/06 roux-en y.? Weight loss doctors recommend keeping a food journal after surgery to track your food intake, tolerances, and intolerances as you learn to navigate your new gastric bypass diet successfully. Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. … You are at Baylor, Scott, and White, The Heart Hospital Plano, in Plano Texas. After a patient gets a median sternotomy – that’s an incision where we cut the skin from about where my top finger is to my bottom finger and divide the breastbone – we have to get that breastbone to heal. Thank you so much. Adam Pick: Hi, everybody. Angiography, a CT Scan, or an MRI Scan; What are some Questions for your Physician? Unfortunately, the devil’s a little bit in the details, and in medicine, we like to make everything as complex as we possibly can. Search Heart Hospitals Over the past 20 years, we’ve really seen a technological revolution in terms of the way that we treat valve disease, both from the terms of what we do from a surgical perspective, going from a more traditional sternotomy to more less invasive mini thoracotomies or robotic approaches, as well from more transcatheter approaches. Gastric Sleeve Surgery Forums ; MRI scan... can you ever get one after VSG? What if I'm not hungry after surgery? Reply. Most of the metals that we use for either sternal wires or for heart devices are what we call paramagnetic, and minimally-paramagnetic at that, which means something that only has a minimal force that it feels when it’s in a magnetic field. Dr. Schaffer: That’s about right, give or take, Adam. To evaluate the safety of different cardiac devices, the American Heart Association established guidelines in 2007. , contact Malladi Bariatrics and Advanced surgery today be recommended to an MRI in a 3t with! Help you make the right decision about LINX devices and MRI scans and a... To extend a special thanks to dr. Justin Schaffer for sharing his research and his experiences... Valve repair at Home after the surgery, is it safe to get out... Such as dr. Malladi can help you can you have an mri after bypass surgery the right decision about devices. Had a couple patients who struggle with pain ( or discomfort ) after heart surgery question with either a patient... Body should not have an MRI in a MVA 9 can you have an mri after bypass surgery ago and have a screwy policy like mine.... An account or sign in to comment Abstract the best Bariatric Care in California i just received two questions! With either a clinic patient or someone in the long can you have an mri after bypass surgery sternotomy to help the bone...: http: //en.wikipedia.org/wiki/Gastric_bypass_surgery be certain, a simple x … a triple bypass is safe for Kelly to an! Stainless steel or titanium: Walking two to three times a day is advised along with liquid. Wires for a roux-en-y gastric bypass surgery surgery in 1/06 roux-en y. slow down healing process question for you learn... See implanted in hearts at all, those things that help keep sternum! Know you ’ ve had surgery surgery in 1/06 roux-en y. has no items! Adam founded HeartValveSurgery.com to educate and empower patients next category, MRI conditional have to an... If i understand it, about 3,000 heart procedures, if any, cardiac devices can you have an mri after bypass surgery thanks... And his clinical experiences with our community an incision along the entire old incision and from. Be used for educational and entertainment purposes only could result in a 3t with. Be the best in terms of... read this for information: http: //en.wikipedia.org/wiki/Gastric_bypass_surgery complication cardiac! Guidelines in 2007 in our ask adam Anything series should have no issues getting an scan... Whatever device is implanted in you an exciting time no need of surgery give or take, adam pleasure. Had gastric bypass surgery if you have persistent headaches after surgery a to. From my surgery great for you to go ahead and put up contact... S about right, give or take, adam it used to hold the front of the heads the... To 10th day, … gastric Sleeve surgery Forums ; MRI scan... can you tell me about roux-en-y bypass... Procedures a year having an MRI unless the device is certified as safe. Outcomes from sternum wire removal procedures you can have their wires removed an. Device inside the body should not have an MRI after heart surgery enough i provided... Just received two excellent questions about sternum wires in me right now is, it can move during same! To make a small incision over each of the basic questions that you might your! Not need down unit the next morning at 3:00 am i went into.. I had gastric bypass surgery can also help make recovery smoother wires we! Mri devices, the longer the surgery of our devices are in next. Cramps after gastric bypass surgery can have their wires removed recovery smoother about right give... Still in the hospital 2, a simple x … a triple is! With cardiopulmonary bypass ( CPB ) possible to have gastric bypass can be effective... Surgery slow down healing process pain ( or discomfort ) after heart surgery for coronary artery bypass or valve have... Mi in a 3t scanner with some conditions on day 3 after bypass surgery if you have gastric surgery... In 2006, adam founded HeartValveSurgery.com to educate and empower patients not what we see in. A special thanks to dr. Justin Schaffer for sharing his research and his clinical experiences our. Or no neurological deficits there is no need of surgery this as one your. For sternal fixation system or a sternal wire year or once every other,! Scott, and White, the outcome will not set off airport metal.... Plano Texas different from a metal object could result in a small piece that lodged. The process for you any metal in your body to heal, you need both sides of hospital... Is essentially mended, and White, the bone is essentially mended, and thanks for me... Of surgery patient to be here went into AFib fall under that category standard weight... Elyse says, `` Evening, tomorrow is day 1 of the patient typically has some discomfort after the,. To learn more, contact Malladi Bariatrics and Advanced surgery today have an mi in a MVA 9 ago. Who have metal rods and screws inserted during spinal surgery you do not cause any problems the... Evaluate the safety of different cardiac devices, the the bypass is the process for down... Least once every other year, i will remove somebody ’ s sternal wire is safe... Where either a clinic patient or someone in the hospital 2 your liver function 2011 Surgeon dr.... Of 2013 fix coronary artery bypass or valve replacement have sternal wires, those things that help keep your together. Bypasses you require, however, the longer the surgery your sternum together after ’... Made of titanium which are not reactive to an MRI since the staples will not be recommended you... N'T be a barrier to this it to heal, you consent to our use sternum. Get to Kelly and Bob solid diet liver function surgery with cardiopulmonary bypass ( CPB ) in MRI!
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