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Medical student syndrome
July 14, 2014 6:08 AM   Subscribe

I was once CONVINCED I had Boerhaave syndrome, an extremely rare condition where your esophagus is ruptured and acid and air spill into your chest, because my chest tickled after a small bout of coughing. I spent two hours in the dark, unable to sleep, listening to my chest with a stethoscope, and UpToDate-ing (our version of WebMD) the various ways in which I'd be dead before morning. I ran to the Emergency Room and told them I needed a stat Gastrografin Esophogram, stat as in: yesterday. The attending took one look at me and said, “Congratulations, you're a cliché! Go Home.”
posted by ellieBOA (48 comments total) 25 users marked this as a favorite

 
GREG:
(v.o.)
...and lately I've had the chronic fluctuating mood disturbances which would indicate psychothymic disorder. I mean, the hypomanic symptoms are there and yet I'm experiencing moments of aphasia and aproxia and I just want to pull my teeth out, Dr. Crane. What do you think?
FRASIER:
Well, Greg, two possible diagnoses come to mind. Either you are seriously mentally ill and you should be institutionalized immediately, or you are a first-year psychology student!
(source)
posted by The Confessor at 6:21 AM on July 14 [20 favorites]


I only know a few doctors socially, but in my small and unrepresentative sample they fall into two clear groups, either hypochondriac worriers or incredibly blasé about serious risks. I assume it's partly the personality types that do well in medical school, plus needing to find a response to exactly what the article describes.
posted by Dip Flash at 6:25 AM on July 14 [1 favorite]


There's a subtype of this. The med students I used to live with, who were doing anatomy at the time, used to constantly tell me which bit of human viscera my meal reminded them of.

Fortunately I have a strong stomach, or I'd have gone hungry a lot that year.
posted by Happy Dave at 6:26 AM on July 14 [3 favorites]


I remember going to the British Museum one day to read up the treatment for some slight ailment of which I had a touch—hay fever, I fancy it was. I got down the book, and read all I came to read; and then, in an unthinking moment, I idly turned the leaves, and began to indolently study diseases, generally. I forget which was the first distemper I plunged into—some fearful, devastating scourge, I know—and, before I had glanced half down the list of “premonitory symptoms,” it was borne in upon me that I had fairly got it.

I sat for awhile, frozen with horror; and then, in the listlessness of despair, I again turned over the pages. I came to typhoid fever—read the symptoms—discovered that I had typhoid fever, must have had it for months without knowing it—wondered what else I had got; turned up St. Vitus’s Dance—found, as I expected, that I had that too,—began to get interested in my case, and determined to sift it to the bottom, and so started alphabetically—read up ague, and learnt that I was sickening for it, and that the acute stage would commence in about another fortnight. Bright’s disease, I was relieved to find, I had only in a modified form, and, so far as that was concerned, I might live for years. Cholera I had, with severe complications; and diphtheria I seemed to have been born with. I plodded conscientiously through the twenty-six letters, and the only malady I could conclude I had not got was housemaid’s knee.
source
posted by zadcat at 6:44 AM on July 14 [22 favorites]


Never, ever look any symptom up on the internet because in half an hour you will have every disease known to man.
posted by GallonOfAlan at 6:45 AM on July 14 [10 favorites]


One of the reasons that doctors seem so blasé about risks is that people are generally incompetent at self-diagnosis. People will latch on to the one or two reasons they do have something, and lack the insight or experience to see all the reasons they don't.

(This is, of course, the worst thing about hypochondriacs: that they make doctors suspicious of everyone else.)
posted by mhoye at 6:50 AM on July 14 [4 favorites]


Just recently, I read that A) rabies symptoms can manifest up to 2 years after exposure and B) You can't necessarily tell if you've been bitten by a bat, and should assume you've been bitten if you've been in contact with one and C) the symptoms of rabies are difficulty swallowing and flu-like symptoms, and that once the symptoms started, you're as good as dead.

Having slept in a bungalow on the beach where there were lots of bats a couple of years ago, I had a low-grade, persistent anxiety that I was developing rabies, since I'd had headaches, a sore throat and difficulty swallowing. Turns out, it was just a sore throat and it went away. I'm pretty sure I don't have rabies now.

I feel like 'never read about diseases' is pretty good life advice.
posted by empath at 6:53 AM on July 14 [9 favorites]


I've had rabies for years and I'm doing fine.
posted by philip-random at 6:58 AM on July 14 [15 favorites]


Me too empath and phillip-random. Sure I got Australian Bat Lyssavirus after I lived under that mango tree in Darwin. But I think the longest span for rabies might be something like 18 years..

Sorry..

From the article -

It doesn’t help that, as placebo studies keep demonstrating, our bodies are highly suggestible to inferences from our minds.

There's this bloke in a little town in Western Australia. Kept getting bitten by redback spiders. They've got a pretty distinctive bite. Purple ring around it. And he got lots of them all at once.

He was new in town. It really was a small town. So when it happened the first time, and he rolled up to the nursing post, covered in purple rings/nauseous/sweaty/agitated, they give him shot of anti-venom and stuff got better.

Round about the third or fourth time it happened within six months, they were out of anti-venom. Toddler needed it the day before. They're also starting to think, hey.. something's wrong here. He's gotta be self harming or something.. So they rush him the 150kms or so to the nearest hospital. Back of someone's truck.

Hospital sends him straight back with a note. Patient X. Schizophrenic. Profound anxiety about spider bites. Nurses look at each other and say "WTF?" Then they ring the hospital.

"Okay sure, but.. we saw the bites." "Yeah, we know. It's somatic" "But.. we saw the bites." "Trust us, it's somatic." "But what do we do? We can't just do nothing?"

"Shot of saline.."

And that worked.

It still works. He's a happier man these days.
posted by Ahab at 7:00 AM on July 14 [6 favorites]


Speaking of Rabies, this phenomenon is not confined to human medicine. Veterinary students come up with the craziest diseases for their pets to have as well.
posted by Rock Steady at 7:01 AM on July 14 [4 favorites]


I was having pains in my chest once so I went on the NHS Direct symptoms checker (which is the worst thing ever for those of us suffering from hypochondria). I followed the flow chart, getting more and mroe worried, until it led me to the final answer which was pretty much in all red caps GO TO HOSPITAL YOU ARE HAVING A HEART ATTACK!! At which point I realised that I probably wasn't and decided to step away from the computer and go and lie down.

Oh and also, I once got a sudden stabbing pain in my head and thought I had clearly just had some kind of hemorrhage. I got my then-boyfriend to drive me to casualty while passing on my goodbyes to all my loved ones: "And make sure you tell Mum and Dad that I loved them very much *sob* and Brother and Sister - tell Sister I will always, always watch over her kids *wail*" etc. The doctor told me there was nothing wrong with me and sent me home. I was sort of dissapointed.

Meanwhile I have a few cousins and friends who are doctors and their approach to their own health is basically "Pfft. It'll be fine. You gotta die someday!"
posted by billiebee at 7:04 AM on July 14 [3 favorites]


Dad always thought laughter was the best medicine, which I guess is why several of us died of tuberculosis
posted by obscure simpsons reference at 7:15 AM on July 14 [10 favorites]


This phenomenon is also common to psychology students.

SOURCE: Lived with several weeping psychology students
posted by shakespeherian at 7:27 AM on July 14 [12 favorites]


I'm a first-year medical student. So far this year I've had diabetes, asthma, gallstones, unstable angina, hyperthyroidism, hypothyroidism, Reiter's syndrome, MS, and most kinds of cancer, including a pheochromocytoma, an exceedingly rare adrenal tumour that can cause high blood pressure (clearly a more likely cause of high blood pressure than, say, being in med school).

And I'm not alone. A bunch of my classmates and I all went to get our thyroid levels checked at a walk-in clinic because we were too ashamed to go to our family doctors. We are all fine. (BUT WHAT IF IT WAS A LAB ERROR)
posted by saturday_morning at 7:40 AM on July 14 [24 favorites]


I remember going to the British Museum one day to read up the treatment for some slight ailment of which I had a touch

HA! My neighbour just finished a Fringe run stage managing an adaptation of Three Men in a Boat. (And is now doing the post-run Best of Fringe!)

/derail
posted by feckless fecal fear mongering at 7:55 AM on July 14 [1 favorite]


I've had all of those too saturday_morning, plus heart failure, osteoporosis and scurvy. But I have a cash job on the side role-playing as a patient for international doctors and nurses seeking local skills recognition.

Flipping out while insisting someone gives me pills isn't such a creative leap.
posted by Trivia Newton John at 7:58 AM on July 14 [2 favorites]


I was a psychology student and for a couple of years I seriously thought I was human.
posted by srboisvert at 7:59 AM on July 14 [9 favorites]


I took ab-psych in university, and on the first day, our instructor suggested we make a list of any pre-existing psychiatric diagnoses that we or any of our loved ones had, and then during the course, if we ever found ourselves diagnosing ourselves or any of our loved ones with anything we were reading about, we should re-examine that initial list. If it wasn't on the list, it wasn't real.
posted by jacquilynne at 8:00 AM on July 14 [2 favorites]


I know that Slate has to be contrary about absolutely frigging everything. But I have damned awful hypochondria, and I don't think my doctors need to learn anything from me at all.
posted by Coatlicue at 8:06 AM on July 14


Never, ever look any symptom up on the internet because in half an hour you will have every disease known to man.

Am I the only person who uses it exactly the opposite way? I will look up a symptom, find the most benign possible explanation, and assume it's that.

I woke up in the middle of the night once with chest pains and trouble breathing, but I felt better pretty quickly, so I just went back to sleep. I figured it was probably something stupid, but if I'd had a heart attack, it was over anyway so I'd just get it checked out in the morning if I felt weird.

I did feel pretty weird in the morning, so I went to the doctor told him about the episode, and he said YOU WHAT?

(It was pleurisy. I probably should have just walked it off and saved myself the copay.)
posted by ernielundquist at 8:13 AM on July 14 [5 favorites]


I think one of the reasons that hypochondria prevails within my profession is that there are precious few diagnoses that can be 100% made based exclusively on signs and symptoms. Absent labs, imaging, ekg, microbiology, and pathology, it's tough to be certain of anything (and even then, diagnostic accuracy is not guaranteed). I've sent myself to the emergency department exactly one time in the last four years after I started having undeniable peritoneal signs and RLQ pain and took them for appendicitis. Even then, it turns out that I was wrong about having appendicitis (it was invasive campylobacter, likely from a pot-luck, thus fulfilling an ancient practice question prophesy).

Which goes to show that, despite all our book-learning and knowledge of physical diagnosis, physicians are relatively worthless without a functional medical system behind them. When I first decided to become a doctor, some small part of me thought that in some dystopian post-apocalyptic/EMP/zomibe future, I'd still be able to function as a healer in society. I'm a little more pessimistic nowadays; without electricity and a lab and imaging technicians and radiologists I'm little more than a first responder.

Now, I recently acquired a microscope and gram staining kit. I'm getting pretty good at sputum smears, so we'll see how many pneumonias I get this coming winter.
posted by The White Hat at 8:21 AM on July 14 [12 favorites]


The hardest part about medical anxiety / hypochondria is that a little voice in your head tells you that while Disorders #1 - 94 turned out to be nothing, you only have to be right ONCE for Disorder #95 to turn your liver to chocolate pudding and make blood shoot from your nipples.
posted by delfin at 8:41 AM on July 14 [8 favorites]


Yeah. I was a psych grad student (developmental, not clinical) with a side interest in developmental disorders. Took psychopath for a year. I think I had or a family member had every disorder in the book. After driving myself crazy for a year, I sold my DSM back to the bookstore and decided to stick to the babies. Turns out I was crazy (severe PTSD and depression, but I already knew that) and I left school after getting my MA.
posted by kathrynm at 8:52 AM on July 14


I was sure I had small pox once when the first season of Deadwood was on. I even requested my boyfriend to drag me out in the woods so I wouldn't contaminate the subdivision with my plague of death.
posted by teleri025 at 8:58 AM on July 14 [4 favorites]


It's rarer than the cliché, but this mindset cuts in a negative way, too. I has a transient ischemic attack when I was in graduate school (epidemiology, housed in the school's main hospital). I went to the ER when numbness in my nose and lips spread symmetrically to my forearms, hands and fingers. I was holding a spoon stirring soup on the stove and noticed that I could touch the soup without feeling pain. I kept telling myself I was being a typical naive medical student, so I took Metro to the ER instead of calling an ambulance. On the way there, I started having trouble holding my Smartrip card and started having visual aberrations. The physician who saw me gave a chuckle when he saw my backpack, which identified me as a student at the hospital. I protested, but he just sort of shrugged me off and told me to get more sleep. Two days later and back in my home state my family doctor immediately sent me to an imaging office. He was so pissed at the ER doctor that he called the institution to make a complaint. I got better over the course of a year and a half or so, and it's never left me that sometimes casualness about ha-ha-you-cliché is not the best frontline response in the diagnostic toolbox. I wonder how often it clouds judgment to the degree it did in this example, which was enough to convince the physician that a serious exam wasn't called for?
posted by late afternoon dreaming hotel at 9:05 AM on July 14 [22 favorites]


Glad to know I'm not alone, TNJ. Scurvy is only off of my differential because of a healthy diet of lemon custard tarts.
posted by saturday_morning at 9:47 AM on July 14 [1 favorite]


Is this also common to nursing students? I ask because my son is about to go away to school to study nursing and need to be prepared if he calls to report he has scurvy.
posted by maurice at 9:57 AM on July 14 [1 favorite]


My wife and I experienced a sort of hypochondria by proxy a couple months ago. A couple years ago, we had lost one of our cats to cancer. Recently, when another one started losing weight, we imagined all of the worst-case scenarios, then went to the vet.

The diagnosis? Fleas.
posted by metaquarry at 10:27 AM on July 14 [6 favorites]


aw glad the Little Fleabag didn't have something more serious metaquarry.
posted by sweetkid at 10:28 AM on July 14 [2 favorites]


I wonder if anyone has ever diagnosed themselves with hypochondria after reading about it on the internet?
posted by Foosnark at 10:44 AM on July 14 [4 favorites]


that made my brain hurt
posted by feckless fecal fear mongering at 10:48 AM on July 14


I feel this is a good time to yell "YOLO!" and blithely ignore all of the diseases I have self-diagnosed because I am a fucking reckless hypochondriac living on the edge (is that a sympton of something?).
posted by srboisvert at 10:56 AM on July 14 [1 favorite]


This whole discussion is either confirming my tendencies as a fatalist or going to make me a Christian Scientist.
posted by emjaybee at 10:58 AM on July 14


I agree with Dip Flash, and think people in the medical profession tend to fall into one of two groups. I think people studying medicine like to think themselves as good diagnosticians, which is good, but practice and experience makes (near?) perfect. We often hear "when you hear hoofbeats, think horses, not zebras" in training, to reinforce the idea that common things are common. But it's important to learn about and remember the zebras.

Really, though, I think experience plays a huge role in how people turn out. Over the years, a handful of incidents has made me feel pretty apathetic when it comes to self-diagnosing. Partly because it's difficult to be objective about my own health, partly because I can seek the help of people who are better at it than I am, and mostly because a handful of personal experiences that strongly reinforced the first point.

Once I suddenly up with chest pain. Severe. Crushing. Seemed substernal. It was bad. I went to work. People said I looked bad. I got an EKG, it looked fine. I ignored it, kept working. It reoccurred the next day, and a cardiology saw me, said: "hey man, you don't look so good, what's going on?" And I explain my chest pain to him. I had terrible eating habits, was generally out of shape, and thought: huh. Maybe I am having heart problems?

So I went to his office, and we did a stress echo. Ran on the damn treadmill. Faster! Faster! You can do it! Jumped off, had goo slathered on my chest and an ultrasound probe slapped on to my chest. Heart is fine. Everything is fine. Chest pain went away in a few days.

Around the same period of time, I started sleeping on the right side of the bed to try to even the mattress out. I don't think it worked. But one morning I woke up, and saw a pair of cat ears peeking over the loft wall, and it clicked: my damn cat would always jump down from the wall to the bed, and must've landed on me. Mystery solved.


Another time I pooped and the poop was maroon. I mean, I don't shit and sit and stare at my poop, and I don't wanna go into my pooping habits, but that shit was maroon. Immediately I started to feel lightheaded, thinking about all sorts of things, like GI bleeds and anemia, and hey, yeah, I had taken some Alka-Seltzer for a trip and that has aspirin in it, and maybe I'm really bleeding out oh god I don't feel so well things are spinning and ohhhh! I looked at the garbage can in the bathroom. It had a large, empty bag of Flamin' Hot Cheetos in it. Mystery solved.


There was another time where I drank a bunch of Yoo-Hoo and everyone thought I had acute appendicitis and I had a finger up my bum in some dood's office, and we were quickly going through a pre-op checklist, which included a question about allergies. Anyway, I didn't have appendicitis. I'm just lactose intolerant.


Anyway, I've stopped trying to diagnose myself. If I'm really sick, I'll see or call someone. If anything, time and experience has proven me to be an idiot when it comes to figuring out my own health issues.
posted by herrdoktor at 11:25 AM on July 14 [9 favorites]


After flipping through one of my Mom's medical textbooks, I was convinced for quite a long time that I was going to develop black hairy tongue disease. Thankfully that proved to be unfounded and as a bonus, my oral hygiene improved.
posted by jamincan at 12:32 PM on July 14


my damn cat would always jump down from the wall to the bed, and must've landed on me. Mystery solved.

Heh. I have endometriosis: many years ago now, a burst torsioned ovarian cyst nearly bled me out, which led to the surgeons & docs discovering that. I'll never forget the pain; I immediately knew something was wronger than my adolescence and young adulthood spent passing out from unbearable pain (after taking ibuprofen!) once or twice a month – because of course it contributed to irregularity too, sigh.

Fast-forward to a healthier, more stable adulthood. Occasionally I wake up in the middle of the night with a sharp stabbing pain in my abdomen, only to move my hand to check and discover there's a 6-kilo ball of fluff standing on my chest, jabbing one paw into my belleh. Diagnosis: felis catosis. Endometriosis is when the endometrium goes "GONNA GO ANYWHERE I WANT OH YEAH" which is basically what cats do, after all.
posted by fraula at 12:34 PM on July 14 [4 favorites]


Good news maurice, today's nursing students don't know the symptoms or causes of scurvy. It is the one ailment that consistently stumps them.

(We even give them the diagnosis for that one. They look at each other in 'wtf-ness'. I can only imagine what they think of this fine land they are seeking to practice in.'
posted by Trivia Newton John at 2:35 PM on July 14 [2 favorites]


Oh, maurice, my entire nursing school class came down with acute renal failure one afternoon in pathophysiology. The instructor grinned evilly throughout.
posted by gingerest at 3:45 PM on July 14 [1 favorite]


I don't wanna go into my pooping habits, but that shit was maroon.

Also known as "AAAA I HAVE COLON CANCER or wait no sorry I had beet salad last night."
posted by KathrynT at 4:37 PM on July 14 [3 favorites]


One time when I got a scratch on my eyeball and went to the ER and they cavalierly gave me a shot for tetanus "just in case" and then I went home and googled tetanus from eyeball scratches and freaked myself out when I found out that tetanus on your eyeball can get to your nervous system before the immune response from the shot does, I finally had to call my general practitioner. I said, "If I promise to never, ever use google again, will you reassure me that I don't have tetanus of the eyeball?"

She laughed and laughed and laughed and said, "Well, technically, it'd be tetanus of the central nervous system, but let's hear it."

I did not have tetanus.

empath : "Just recently, I read that A) rabies symptoms can manifest up to 2 years after exposure and B) You can't necessarily tell if you've been bitten by a bat, and should assume you've been bitten if you've been in contact with one and C) the symptoms of rabies are difficulty swallowing and flu-like symptoms, and that once the symptoms started, you're as good as dead."

This, but with bat exposure of your 6-week-old baby and health authorities reluctant to administer prophylactic rabies shots to a 6-week-old. (After six months on nightly sleepless Bat Patrol to inspect the house every hour or so for bat preying on my sleeping, pre-verbal children, they gave me ambien and PTSD counseling. Now he is three and is still not foaming at the mouth so it's probably fine, but I still check for bats now and then.) PS, if you are sufficiently hysterical and post-partum, you can convince a doctor to come to your house on Labor Day weekend to inspect your baby for nearly-invisible bat bites.
posted by Eyebrows McGee at 5:45 PM on July 14 [2 favorites]


I went to the ER when numbness in my nose and lips spread symmetrically to my forearms, hands and fingers.

If by "symmetrically" you mean "bilaterally", I agree with the ER doc, that history isn't typical of a TIA. Almost all strokes are unilateral. The only way a stroke would produce bilateral sensory loss is with bilateral pontine or thalamic lesions, and if you have one of those, you're not walking into ER.

Slowly spreading paresthesiae without motor involvement are a common migrainous symptom in otherwise healthy people. They tend to develop when the person is sick or tired or stressed, can happen without following headache, and can happen without a preceding or subsequent history of more typical migraines. They get attributed to anxiety and most docs will check for metabolic disturbances but in my experience, a particular cause is rarely found.

TIAs in otherwise healthy young people are very rare. Purely sensory strokes (say, a thalamic infarct) almost always cause ataxia acutely, in which case the objective motor impairment is fairly obvious even to non-specialists. So a default approach of reassurance for paresthesiae (especially when bilateral) is entirely defensible IMO.

(I'm a neurologist.)
posted by Plasmon at 5:47 PM on July 14 [5 favorites]


My brother went through this for about the first half of medical school and nearly drove us all crazy.

Then he turned his attention on me and managed to diagnose my immune condition, which had been stumping my PCP for over a year.
posted by bile and syntax at 6:08 PM on July 14 [5 favorites]


I went through the rabies paranoia as well and for me it was the main symptom of a crushingly bad SAD season (thanks, New England!).

I'm not a med student but - alas! - my father was a doctor: I had mumps as a kid and he was sure I had cancer. I had a cough once and he sent me for x-rays because it was definitely TB. I know enough about diseases to work myself up into a panic and I am locked and loaded with my hypochondria.
posted by lydhre at 6:54 PM on July 14


I mostly got over this after I had been out of nursing school for a year. But damn ovarian cancer, with symptoms like "bloating, constipation, fatigue, increased abdominal girth"... I get a case of it like once every 6-7 months. Thankfully not really, because I care for those patients on a pretty regular basis, and it rarely goes well. Fuck ovarian cancer.
posted by vytae at 7:03 PM on July 14


It is handy to have relatives who are medical. One of my sisters is a nurse and when I arrived at her house a while back, she took one look at me and was all "stick out your tongue, cough and now take a deep breath" and then made me take medicine and eat stuff until we could get a doctor's appointment because hey! it turns out you can get malnutrition by accident. The downside is that she is cheerfully gloomy about any illness, predicting a speedy and gruesome demise - the pharm rep sibling is more upbeat (You probably won't die! There are pills!)

I have whatever is the opposite of hypochondria ("I don't feel so well. Uh. Well I guess the chest pains and the falling over and um, oh yes did I mention I've been coughing up blood?") and my husband has WebMD open on his phone constantly. I'm sending him the NHS symptom checker because it will make his hypochondriac heart flutter with joy (not angina).
posted by viggorlijah at 8:29 PM on July 14 [1 favorite]


A month ago I noticed blood in the toilet, googled what it could mean, freaked the fuck out and started mentally writing letters to my daughter so she would know how much I loved her when I was dead. Now that I've been diagnosed with inflammatory bowel disease I refuse to even look at the wikipedia page for it or to ask my gastroenterologist any questions. So long as I know I'm not going to die of it tomorrow, my curiosity is exhausted: I'll just take the pills and avoid thinking about all the terrible things that might happen (LALALACOLOSTOMYBAGSICAN'THEARYOU).
posted by Wantok at 9:16 PM on July 14 [4 favorites]


Plasmon, excellent points all around, and yet, the "tend to" and "almost always" bits are what's contentious about the medical student hypochondria trope. My medical history wasn't simple or healthy (Crohn's, prednisone/infliximab hx, inflammatory drug clinical trial subject) and that should have merited closer attention. There was no indefensible wrong on the physician's part, but other physicians reacted with displeasure at his diagnosis in light of my condition and history. Medicine can and should set its standards higher than, there's a practical defense for why we missed an uncommon diagnosis.
posted by late afternoon dreaming hotel at 2:19 PM on July 15


After a strange bout of food poisoning, and learning that some bacteria, viruses, and parasites can hide in your organs, periodically shedding infectious particles, I fear that eventually it will be discovered that I am the new Typhoid Mary.

Also - fun fact - humans are coated with various strains of HPV on every surface.

Microbiology is clearly the most terrifying.
posted by bobobox at 9:54 PM on July 15 [1 favorite]


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