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Old 08-22-2012, 11:34 AM   #1
Schfifty Five
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Default Can a herniated disc heal on its own over time?

I Recently had an MRI which revealed I had a herniated disc (L5-S1). I can either get injections or go for surgery.

Both will most likely cost me a lot of out of pocket $ since my insurance sucks badly (really high deductible). Before I go and spend the $ though, is there any possibility that this herniation will heal on it's own?

The pain (sciatica in right leg) has lessened over the past few months, but I feel like I've hit a wall in terms of improvement. I'm at a point where I can do most functions normally, but there's always that pain if I stretch to far, sit too long, stand up for too long, etc.

Any advice would be greatly appreciated.

Edit: fixed "it's" typo in the title haha

Edit 2: How much do steroid injections cost typically? What about surgery to fix a herniated disc?

Last edited by Schfifty Five; 08-22-2012 at 01:57 PM.
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Old 08-22-2012, 12:40 PM   #2
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Symptomatic disc herniations rarely heal on their own to the extent that you won't be in pain. Injection and surgery aren't your only options. Physical therapy is valid and works wonders - it's probably the closest to letting it heal on its own. PT will not only treat the pain (via massage, electric stimulation, etc), it will also treat things that contributed to the disc herniation (range of motion limitations, sub-optimal motor programs, strength issues, core control, etc). I've treated a ton of people with sciatica caused by lumbar spine issues and I've had a lot of luck. I'd say every one of my patients experienced some form of relief - most had full alleviation within 4-6 weeks. It's cheaper for both you and insurance to try that first. It should definitely help you 1) understand your condition better, 2) empower you to know what you can do to help it, 3) know when not to push it. Any healing that would've happened spontaneously likely would've happened by now. PT isn't voodoo like some people think - the way your spine is positioned and moves literally changes the mechanical positions and therefore pressures on your spinal nerve roots (the thing that's likely impinged causing your pain). If we can get you out of a bad position and keep you out (with postural re-training, strength improvements, exercises, etc), the symptoms can go away and the disc can heal optimally. Hope this post was informative.
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Old 08-22-2012, 01:20 PM   #3
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Symptomatic disc herniations rarely heal on their own to the extent that you won't be in pain. Injection and surgery aren't your only options. Physical therapy is valid and works wonders - it's probably the closest to letting it heal on its own. PT will not only treat the pain (via massage, electric stimulation, etc), it will also treat things that contributed to the disc herniation (range of motion limitations, sub-optimal motor programs, strength issues, core control, etc). I've treated a ton of people with sciatica caused by lumbar spine issues and I've had a lot of luck. I'd say every one of my patients experienced some form of relief - most had full alleviation within 4-6 weeks. It's cheaper for both you and insurance to try that first. It should definitely help you 1) understand your condition better, 2) empower you to know what you can do to help it, 3) know when not to push it. Any healing that would've happened spontaneously likely would've happened by now. PT isn't voodoo like some people think - the way your spine is positioned and moves literally changes the mechanical positions and therefore pressures on your spinal nerve roots (the thing that's likely impinged causing your pain). If we can get you out of a bad position and keep you out (with postural re-training, strength improvements, exercises, etc), the symptoms can go away and the disc can heal optimally. Hope this post was informative.
Thanks for the response.

I should add that in early June, I had started some PT sessions. Went to about 5 session over the course of 3 weeks and I didn't see any real improvements.

The things that I did during the PT session were mostly just stretches and on occasion, electrical stimulation. I stopped going for a couple reasons 1) was taking too much time away from work 2) I didn't see any improvement after those sessions, and 3) found out it was out of my network and had insurance problems to deal with.

In your opinion, is stretching the main thing that you'd recommend during PT?

The PT guy who I saw pretty much just had me do stretching exercises on my own and he would just periodically check up on me. I felt like I was paying $ just to do the PT on my own. On occasion he'd put me on the electrical stimulation machine thingy but that never felt like it did anything either.
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Old 08-22-2012, 01:58 PM   #4
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Thanks for the response.

I should add that in early June, I had started some PT sessions. Went to about 5 session over the course of 3 weeks and I didn't see any real improvements.

The things that I did during the PT session were mostly just stretches and on occasion, electrical stimulation. I stopped going for a couple reasons 1) was taking too much time away from work 2) I didn't see any improvement after those sessions, and 3) found out it was out of my network and had insurance problems to deal with.

In your opinion, is stretching the main thing that you'd recommend during PT?

The PT guy who I saw pretty much just had me do stretching exercises on my own and he would just periodically check up on me. I felt like I was paying $ just to do the PT on my own. On occasion he'd put me on the electrical stimulation machine thingy but that never felt like it did anything either.
Sigh. No, this is not the main thing that I would prescribe. It would be a small part of a much larger program. I'm much more of a manual therapist so I would personally try to restore motion at given segments, reduce pain, and do a lot of patient education and postural/movement re-training. Many PTs get lazy since most of the time they can get away with doing fairly little and the patient gets better. I'm much more hands on and I do a lot more patient education. If you could find a good PT (somebody with an OCS behind their name which stands for orthopedic clinical specialist), I'd say try that. You don't have to have an OCS to be a good PT, but it assure you that they will spend some hands on time with you. If that's not available, then go with the injections first. Should be a cortisone injection. I definitely wouldn't go with the epidural yet. I'm disappointed by some of these reports I hear. I have a very high standard of care and the fact that there are some that don't in my profession is frustrating. I mean, there are good and bad doctors too, but that doesn't make me feel any better.
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Old 08-22-2012, 02:43 PM   #5
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OP, I had this same thing. Over the course of five years I did PT, injections and nothing worked. My disc only got worse in time until two years ago when I had a fusion. I dont regret it because life has been great since then. I know what you are gong through so if you ever need to talk about it just PM me.
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Old 08-22-2012, 02:53 PM   #6
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OP, I had this same thing. Over the course of five years I did PT, injections and nothing worked. My disc only got worse in time until two years ago when I had a fusion. I dont regret it because life has been great since then. I know what you are gong through so if you ever need to talk about it just PM me.
This is definitely something to think about. But the reason they try all those things prior to surgery is that they frequently work. A fusion is a pretty significant surgery and ideally would be avoided. Sixguns has a vital viewpoint, but I also want to present why they do those things. It's not just to poke you and make you angry
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Old 08-22-2012, 03:12 PM   #7
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Sigh. No, this is not the main thing that I would prescribe. It would be a small part of a much larger program. I'm much more of a manual therapist so I would personally try to restore motion at given segments, reduce pain, and do a lot of patient education and postural/movement re-training. Many PTs get lazy since most of the time they can get away with doing fairly little and the patient gets better. I'm much more hands on and I do a lot more patient education. If you could find a good PT (somebody with an OCS behind their name which stands for orthopedic clinical specialist), I'd say try that. You don't have to have an OCS to be a good PT, but it assure you that they will spend some hands on time with you. If that's not available, then go with the injections first. Should be a cortisone injection. I definitely wouldn't go with the epidural yet. I'm disappointed by some of these reports I hear. I have a very high standard of care and the fact that there are some that don't in my profession is frustrating. I mean, there are good and bad doctors too, but that doesn't make me feel any better.
Thanks. If I do end up going the PT route again, I'll make sure to look for the OCS background.
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Old 08-22-2012, 03:14 PM   #8
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OP, I had this same thing. Over the course of five years I did PT, injections and nothing worked. My disc only got worse in time until two years ago when I had a fusion. I dont regret it because life has been great since then. I know what you are gong through so if you ever need to talk about it just PM me.
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This is definitely something to think about. But the reason they try all those things prior to surgery is that they frequently work. A fusion is a pretty significant surgery and ideally would be avoided. Sixguns has a vital viewpoint, but I also want to present why they do those things. It's not just to poke you and make you angry
Is the fusion surgery the same as getting the bulging part of the disk clipped and then caged?

My orthopedic mentioned that the surgery I can get would be a minimally invasive surgery where they make a small incision and basically cut off the part of the disk that's bulging out and then put a cage around the disk so it won't pop out again and it keeps the structural part of your back in tact.
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Old 08-22-2012, 03:16 PM   #9
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This is definitely something to think about. But the reason they try all those things prior to surgery is that they frequently work. A fusion is a pretty significant surgery and ideally would be avoided. Sixguns has a vital viewpoint, but I also want to present why they do those things. It's not just to poke you and make you angry
I really wish that PT would have helped me. The three months of PT after my surgery were hell. The biggest thing is dont give up on your PT. It sucks that you seem to have a guy who doesnt really do much with you. Mine was tough. A lot of hours per week and I never really did just stretching. A lot of it was trying to strengthen my lower back. But none of that helped and surgery was my final option. I know I am lucky and that my fusion came out great. My age had a lot to do with it, was 23 at the time.
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Old 08-22-2012, 03:18 PM   #10
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Is the fusion surgery the same as getting the bulging part of the disk clipped and then caged?

My orthopedic mentioned that the surgery I can get would be a minimally invasive surgery where they make a small incision and basically cut off the part of the disk that's bulging out and then put a cage around the disk so it won't pop out again and it keeps the structural part of your back in tact.

Mine wasnt. My disc was beyond repair by the time surgery came around. My disc was removed and I now have 2 metal boxes where it was. I also have 2 screws in my L5 an S1 with a brace between the two. My range of motion seems to be better since but I have also lost a lot of weight since then.
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Old 08-22-2012, 03:21 PM   #11
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Aren't you a young guy OP? I think you're jumping the surgery gun big time. I'd give myself at least a good solid year of pt and see if you see any improvement. Surgery should be the very last option and even then you might end up worse than you are now.
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Old 08-22-2012, 03:41 PM   #12
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Is the fusion surgery the same as getting the bulging part of the disk clipped and then caged?

My orthopedic mentioned that the surgery I can get would be a minimally invasive surgery where they make a small incision and basically cut off the part of the disk that's bulging out and then put a cage around the disk so it won't pop out again and it keeps the structural part of your back in tact.
No, that's called a microdiscectomy, which is less invasive than a fusion. The fusion is the next stage up, essentially. The microdiscectomy is typically arthroscopic and has minimal damage. Recovery is typically pretty quick and they will almost always prescribe PT in conjunction with it.
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Old 08-22-2012, 03:46 PM   #13
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Aren't you a young guy OP? I think you're jumping the surgery gun big time. I'd give myself at least a good solid year of pt and see if you see any improvement. Surgery should be the very last option and even then you might end up worse than you are now.
If conservative care doesn't help in a couple of months, surgery is actually a better option. With long term nerve impingement, there can be permanent nerve damage or changes. For example, nerves are what's called plastic and change according to their surroundings. A lot of the times, you get compensatory growth of blood vessels, permanent changes in the membrane permeability (changing how the neurons fire), etc. These can result in permanent weakness, allodynia (abnormal pain sensation to non-painful stimuli), hyperalgesia (increased sensation to slightly painful stimuli), and more. The microdiscectomy actually has pretty good outcomes, especially if paired with PT. Typically, docs will go the 6mo route - if it's not improving with PT, injections, and education, then surgery is the best option. However, if the pain or dysfunction is really bad, you should do it sooner.
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Old 08-22-2012, 04:38 PM   #14
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Aren't you a young guy OP? I think you're jumping the surgery gun big time. I'd give myself at least a good solid year of pt and see if you see any improvement. Surgery should be the very last option and even then you might end up worse than you are now.
I'm 31. Not old, but definitely no young spring chicken. I honestly don't know if I could handle a full year of PT. 1) I probably couldn't spend that much time away from work, and 2) my insurance would only cover up to 20 visits per year.

I'm not rushing to get surgery or anything....it's kind of last thing on my mind. I'm definitely going to look into all my options before deciding what to do, but if surgery is a long-term fix, then I might prefer than over other short term fixes.
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Old 08-22-2012, 04:41 PM   #15
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If conservative care doesn't help in a couple of months, surgery is actually a better option. With long term nerve impingement, there can be permanent nerve damage or changes. For example, nerves are what's called plastic and change according to their surroundings. A lot of the times, you get compensatory growth of blood vessels, permanent changes in the membrane permeability (changing how the neurons fire), etc. These can result in permanent weakness, allodynia (abnormal pain sensation to non-painful stimuli), hyperalgesia (increased sensation to slightly painful stimuli), and more. The microdiscectomy actually has pretty good outcomes, especially if paired with PT. Typically, docs will go the 6mo route - if it's not improving with PT, injections, and education, then surgery is the best option. However, if the pain or dysfunction is really bad, you should do it sooner.
The PA at the orthopedic facility said pretty much the same thing, that the nerves could be permanently damaged if it's impinged for too long.

I can get through the day with minimal pain. I can sit in a regular position w/o much pain. I can sleep without any pain. It's just when I sit for too long or stand for too long do I feel a sharp pain as well as pins/needles in my foot. Also when I wake up in the morning, my leg feels a lot tighter and it hurts more then.

So overall, the pain isn't unbearable unless I try to straighten out my leg or stretch/bend in a certain position. However, it's definitely annoying and frustrating to have to be careful of how I move/bend/flex/etc.
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Old 08-22-2012, 04:45 PM   #16
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Also, how much would losing some weight help in the recovery process?

I've gained some weight recently (10lbs or so) and it's noticable in my mid section.
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Old 08-22-2012, 04:55 PM   #17
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The PA at the orthopedic facility said pretty much the same thing, that the nerves could be permanently damaged if it's impinged for too long.

I can get through the day with minimal pain. I can sit in a regular position w/o much pain. I can sleep without any pain. It's just when I sit for too long or stand for too long do I feel a sharp pain as well as pins/needles in my foot. Also when I wake up in the morning, my leg feels a lot tighter and it hurts more then.

So overall, the pain isn't unbearable unless I try to straighten out my leg or stretch/bend in a certain position. However, it's definitely annoying and frustrating to have to be careful of how I move/bend/flex/etc.
Hm, well, that's good. I'd call that mild dysfunction and would definitely suggest you find a good PT. It sounds like you could be a great candidate for good, manual physical therapy. To be perfectly honest, it could also have something to do with your piriformis (or hamstrings or calf musculature), as the sciatic nerve made up from the spinal nerve roots (think of it like a converging highway) can be affected further downstream as well. That sort of phenomenon is called a double crush syndrome, where the nerve is both impinged at the spine and further downstream by muscle, abnormal adhesions, joint immobility, etc.
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Old 08-22-2012, 04:57 PM   #18
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Also, how much would losing some weight help in the recovery process?

I've gained some weight recently (10lbs or so) and it's noticable in my mid section.
Well, think of the disc like a jelly donut. You've got the tougher, thicker outside (the donut) and the viscous jelly substance inside. Essentially, when you get a disc herniation, the jelly substance protrudes out of the dough surrounding into the neural foramina. If you add more weight to the structure, the jelly inside will squeeze out more due to increased pressure. I'd definitely say that weight gain likely isn't helping your situation. In addition, increased abdominal mass increases muscular demand on the back extensors, which could be aggravating any dysfunction or pain.
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Old 08-23-2012, 01:16 PM   #19
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Well, think of the disc like a jelly donut. You've got the tougher, thicker outside (the donut) and the viscous jelly substance inside. Essentially, when you get a disc herniation, the jelly substance protrudes out of the dough surrounding into the neural foramina. If you add more weight to the structure, the jelly inside will squeeze out more due to increased pressure. I'd definitely say that weight gain likely isn't helping your situation. In addition, increased abdominal mass increases muscular demand on the back extensors, which could be aggravating any dysfunction or pain.
Well, I'm going to try to work on losing some poundage. I've been spending so much time studying for the CPA exam that I've pretty put exercising/working out to a minimum and eating is just whatever is most convenient.

Also, just in general, do you know the range of prices for injections and/or microdisectomy surgery?
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Old 08-23-2012, 03:35 PM   #20
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Well, I'm going to try to work on losing some poundage. I've been spending so much time studying for the CPA exam that I've pretty put exercising/working out to a minimum and eating is just whatever is most convenient.

Also, just in general, do you know the range of prices for injections and/or microdisectomy surgery?

For me the injections ran around 2k. Not sure how much I had to pay after insurance though. Its been a long time. My surgery was different so I am not sure about that either. But the fusion I had cost 94k
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Old 08-23-2012, 03:46 PM   #21
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Well, I'm going to try to work on losing some poundage. I've been spending so much time studying for the CPA exam that I've pretty put exercising/working out to a minimum and eating is just whatever is most convenient.

Also, just in general, do you know the range of prices for injections and/or microdisectomy surgery?
That's a fair thing to do. Definitely couldn't hurt. Yeah, it's hard to eat well when you hit crunch time. Even if you're not eating well, just eating less is important.

I don't know the price ranges. Typically, I refer a patient out for a procedure and then see them afterward. I don't actually see the billing for anything and talking money with patients is a bit taboo.
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Old 08-23-2012, 06:50 PM   #22
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Apologizing if I am thread jacking but this thread got my attention.

The wife has Degenerative Disc Disease and basically most of her disk between L4-L5 is gone. We have started physical therapy and we are seeing how that goes. However the pain for her is fairly bad and can lay her up a lot. She is 34 and is seeing a pain management DR. We have discussed surgery and we are keeping it as a final option if PT therapy doesn't seem to make a difference. One of the things I have been reading is lumbar disk replacement instead of fusing. Has anyone had any experience with that procedure?
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Old 08-23-2012, 06:52 PM   #23
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Apologizing if I am thread jacking but this thread got my attention.

The wife has Degenerative Disc Disease and basically most of her disk between L4-L5 is gone. We have started physical therapy and we are seeing how that goes. However the pain for her is fairly bad and can lay her up a lot. She is 34 and is seeing a pain management DR. We have discussed surgery and we are keeping it as a final option if PT therapy doesn't seem to make a difference. One of the things I have been reading is lumbar disk replacement instead of fusing. Has anyone had any experience with that procedure?
I've read some articles about the disc replacement and been to a couple of presentations on it. What questions did you have?
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Old 08-23-2012, 07:02 PM   #24
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I've read some articles about the disc replacement and been to a couple of presentations on it. What questions did you have?
I was wondering if it is a better option than fusing? Fusing to me seems kind of drastic and I am worried about her loosing some mobility in her back.
Isn't with fusing you have to wait for the bones to grow over where the fusion took?
The disc replacement seems to have a very quick recovery speed for the patient.
Have you worked with any patients that have done a disk replacement?
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Old 08-23-2012, 07:52 PM   #25
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Originally Posted by Brovane View Post
I was wondering if it is a better option than fusing? Fusing to me seems kind of drastic and I am worried about her loosing some mobility in her back.
Isn't with fusing you have to wait for the bones to grow over where the fusion took?
The disc replacement seems to have a very quick recovery speed for the patient.
Have you worked with any patients that have done a disk replacement?
Well, there are different viewpoints. Fusing a heavily degenerated segment is tried-and-true. It's the only thing that ensures not having further problems with the segment. The disc replacement is meant to maintain SOME mobility, but the issue with any replacement is that damage that occurs to the surgical hardware is permanent. If she overuses it, she can break off debris and cause all new problems. IMO, if the bone is healthy enough to take a disc replacement, that's probably what I would do. However, almost no joint replacement of any kind lasts longer than 10-20 years. If she gets the disc replacement surgery, she can expect to have surgery again later in life to revise or fuse it because it will degenerate.

With a fusion, they essentially roughen up both ends of the vertebral bodies, put some screws in, and make the bones bleed. This hold the vertebra in position under circumstances similar to a fracture. It takes a fair amount of time for a fusion to set and there are a set list of precautions.

I can assure you that the disc replacement does not have a "quick" recovery. It's still fairly significant surgery and I believe it is open surgery (as opposed to arthroscopic). There will be several months of recovery, strengthening, mobilization, etc involved and she will have to make sure not to bend through her lumbar spine too much early on.

I haven't seen any patients after having a disc replacement yet. However, I have dealt with other joint replacements (knees, shoulders, patellae, hips, etc). They're a big deal. You essentially remove the previous bony surface and put an artificial one in. Plus you have to cut through a bunch of stuff to get there. It's fairly significant surgery. I'd much rather be in the position of getting a microdiscectomy than getting a disc replacement or fusion. There's a LOT of cutting with the latter two procedures.
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