Is the first trimester supposed to suck this much?
May 6, 2013 2:51 PM   Subscribe

I'm 7-and-something weeks pregnant with my first (very much wanted) pregnancy, and the morning sickness is just brutal. Are there any tricks you know for dealing with it when none of the usual ones seem to work? And how bad counts as 'bad' for the purposes of getting medical help?

Morning sickness kicked in at four weeks, and has been getting steadily worse since then. On the one hand it seems fairly mild compared to what I know a lot of people have experienced: I'm not throwing up often (once every few days), and I can keep food down. But on the other hand, the nausea - the constant, unrelenting, hellish nausea - is making me so, so miserable.

I feel sick every waking hour of every day. Sometimes, although increasingly rarely, it's mild enough that I can try to just power through it; other times it's so bad I have to close my eyes and stay totally still. It's always there, like living with constant seasickness. Eating makes it worse, not eating makes it worse, everything seems to make it worse. I have zero appetite and could happily get through the day without eating at all, but I try to at least get two meals plus snacks every day (if I eat one bite too much, I end up retching).

I've tried bread, bland food, all sorts of crackers. I've tried eating before getting out of bed. I've tried ginger in all forms, and peppermint as well. I've tried eating little and often, never getting hungry or full. I've tried those sea-sickness wristbands. My husband does all the cooking and washing up so I can avoid the smell and sight of food, too, but nothing really helps. It is relentless, and dealing with first-trimester fatigue on top of it is just beating me into the ground. Exercise in the fresh air helped for a while, whenever I felt like I could manage it - I'm still trying to do that, but it no longer takes the nausea away, just temporarily reduces it a bit until I get home and it comes back in full force before I've taken my shoes off.

It's also really isolating to deal with. My husband is great and very supportive, but I don't want to announce the pregnancy to friends and work yet, so I feel like I have to constantly put on an act of being totally when fine is the last thing I feel. (And it's not a very effective act, from all the people who've asked if I'm ok and told me I look pale.) Getting through a normal workday in my stuffy office is hell. I have a 4-hour bus ride to take in a couple of weeks, and I'm just dreading it.

I've already spoken to my GP about this once. She was sympathetic, but recommended trying to deal with it through diet and lifestyle alone. Most antenatal care here (I'm not in the US) is done by midwives, but I'm still waiting for the first appointment with mine and because our local services are so stretched it's unlikely to be until 11 or 12 weeks.

I don't know whether it's worth pressing the GP for drugs, or whether drugs would even help when I'm not really vomiting, just nauseous. I feel like I'm coping less and less well by the day, though. I was so happy and excited to be pregnant, and now it's all overshadowed by this awful hellish nausea. Everything I've read says it'll probably ease up at the end of the first trimester, but when I imagine another five weeks of this I just want to curl up and cry.

Mefites who've been through this too, how did you cope? What would you advise?
posted by anonymous to Health & Fitness (31 answers total) 7 users marked this as a favorite
 
Drugs can absolutely help. Ask your GP about Zofran or Reglan, both of which are commonly prescribed in the US for these purposes. If that's not a possibility for whatever reason, doxylamine succinate (Unisom in the US) is a sedating antihistamine that's also a pretty effective anti-nausea drug -- it will make you very, very, VERY sleepy for the first couple of days, but it may also help, and it's usually available over the counter. All of those medications are considered quite safe in pregnancy.

This is affecting your life, substantially. It is definitely worth pursuing with your doctor. I'm sorry this is happening to you; it happened to me too, and it was awful.
posted by KathrynT at 2:56 PM on May 6, 2013 [6 favorites]


Mrs. Tanizaki had rather severe morning sickness with both pregnancies. (with our first child, she was vomiting before she even showed up as pregnant on a doctor's pregnancy test). I just asked her and she confirmed my recollection that she was prescribed an antiemetic, but she could not recall what it was. She also remarked that while it helped, it did not make the nausea totally go away.

Please talk to your GP about getting an appropriate antiemetic.
posted by Tanizaki at 2:57 PM on May 6, 2013 [2 favorites]


I've heard half a Unisom sleep aid plus an extra vitamin B6 supplement can help. I used the B6 and I recall it helping a little bit.
posted by ThePinkSuperhero at 2:59 PM on May 6, 2013 [4 favorites]


yeah, I had that, it sucked. My experience was that unless you're dehydrated (or very very underweight), doctors around here won't do much about it anyway until the end of the first trimester, when most women get less nauseated. (Your doctor mileage may vary.) I threw up throughout both of my pregnancies, and had nausea throughout both of them, the entire time; with the second one I took zofran but they only gave it to me after 12 weeks. They were like, "Keeping fluids down?" "Some." "Okay, see you at 12 weeks."

Things that helped: I ate before I got out of bed (as you mentioned) and I ate a piece of toast toasted VERY DRY with a piece of swiss cheese melted on top, for breakfast. Having a little protein seemed to help with the nausea.

I got Lemonheads (which are sweet-sour lemon hard candy, if you don't have them in your country, I'm sure there's something similar) and I basically kept one stuffed in my cheek at all times. Peppermint didn't work very well for me, and ginger not at all, but the lemon flavor kept my stomach a bit settled and let me keep the nausea under control. They're small enough candies that I could suck one all the time, even while talking to people. I also put lemon juice in all my water, which helped. (I just got a bottle of lemon juice and put a squirt in every glass, I didn't muck around with actual lemons.) The lemon scent/flavor really helped. So if peppermint and ginger aren't doing it, try lemon, and then try any other flavor that is not currently making you want to vomit, if you can find any. Sometimes hard butterscotch candies helped settle my stomach, or those extra-chalky candy hearts.

It's so, so much harder with the first pregnancy than subsequent pregnancies, because it does seem like it will last FOREVER, but -- this is your new mantra, chant it to yourself -- "it's only nine months." Whatever you're suffering, it is not forever, it is, at worst, only nine months.

I suggest curling up and having a good cry about it. It might help. I was so excited to have both my kids, but I hated being pregnant both times. It's okay to be excited for the child but not enjoy the process of getting there.
posted by Eyebrows McGee at 3:02 PM on May 6, 2013 [2 favorites]


I say this as a pregnant lady who is fairly anti-meds. I had my first kid med free, and am receiving midwife care in the US.

Demand the meds.

In the meantime, here is what works for me. (For the record, I'm 15 weeks along and have hyperemesis. I got sick pretty much at conception and have gone on meds. They are a LIFESAVER.)

- Ginger tea
- Strong lemon flavors - I like lemon ice pops.
- Actually, any fruit based ice pop that has little to no sugar (other than the fruit itself).
- A constant diet of crackers. An empty stomach is as common a nausea trigger as a too full stomach. DON'T allow your belly to be empty AT ALL. A single cracker every 15 minutes does it for me.

A good rule of thin for when you need medical attention is when you think you do. Trust your gut. If your miserable, get the help you and your wee parasite need.
posted by waterisfinite at 3:02 PM on May 6, 2013 [4 favorites]


Ugh, I am so sorry. I had the exact same experience. I was hideously nauseous 24/7 for the entire first trimester, that specific upper-throat nausea you never get otherwise. For me, eating (certain foods) temporarily made it go away, but it came roaring back the second I was no longer chewing. It was important to find the EXACT RIGHT foods. Ginger did not do it for me either. Things I had always enjoyed previously (like salads) were disgusting to me, and things I would not think about eating before turned out to be helpful: boring white bread and turkey sandwiches, for example.

The only other thing that helped me was keeping a bar of very strong mint-scented soap in my pocket at all times. I would take it out and smell it constantly. I basically walked around with my face in a bar of soap. For the exact moment I was smelling mint, I felt a little better. I didn't get an anti-emetic because I wasn't actually vomiting that much, and I was maniacally natural with all things preg, so I don't have any medical advice to give -- just the mint scent and the Right Food. And remember it doesn't last the whole pregnancy...
posted by third rail at 3:04 PM on May 6, 2013


Zofran! Today!

I had this. The term "morning sickness" is so minimizing. It's awful. The Zofran might not eliminate it entirely, but it will take it down to a point where it's just an annoyance.
posted by fingersandtoes at 3:12 PM on May 6, 2013


I've found Psi Bands are way more effective than the regular sea sickness bands. Pay attention to where they should be placed, it's a couple of finger-widths above the wrist.

Sipping on strong gingerale (like Reed's) through a straw -or, if ginger doesn't work for you, lemon or lime juice in sparkling water. I found the straw helpful. The taste is strong, but chewing/sucking on cardamom seeds (just the dark seeds, not the outer pod) can help, also.

Seconding avoiding an empty stomach. Something in there all the time helps a bit.
posted by quince at 3:13 PM on May 6, 2013


(and by the way yes, yes the Zofran will greatly reduce the nausea. I had the same thing with my second, no vomiting, just constant debilitating nausea... the Zofran saved me.)
posted by fingersandtoes at 3:13 PM on May 6, 2013


you cant try Preggie Pops. my friend swore by them.
posted by pyro979 at 3:16 PM on May 6, 2013


Reading this sounded word-for-word like my wife's first trimester.

The turning point came when she hadn't eaten anything in, like, 36 hours and could barely get out of bed. I called the doctor in a panic, got a prescription, went to the Safeway and got her some Zofran. The results were almost instant.

Zofran. It doesn't fuck around.
posted by Tevin at 3:28 PM on May 6, 2013 [4 favorites]


I had terrible morning sickness until 20+ weeks. I tried Zofran and it only made me headachy, constipated, and still nauseated, but obviously it works for a lot of people! What did work was Unisom/doxylamine succinate, sometimes with B6 and sometimes not. I have friends who have had success with just B6. I took half a Unisom tablet before bed and could function the next day. Sometimes it would wear off in the evening so I would take another half if necessary. I found that only taking half a tablet and being up and about kept me from getting sleepy. Every time I tried not taking it I would be miserable the next day, so I know it worked. Finally around 26 weeks I didn't take it and felt fine the next day. It truly made the difference between being able to function more or less normally and being stuck at home vomiting. I'm usually pretty anti-medication, but it was a lifesaver.

I know Doxylamine succinate and B6 is available in a combined pill as Diclectin in Canada. It may be available where you live too.
posted by apricot at 3:58 PM on May 6, 2013


I'm sorry. I had terrible nausea throughout both of my pregnancies.

Things that helped: Unisom + B6, candied ginger, ginger tea

Things that didn't help me: Zofran, SeaBands (acupressure bands)
posted by belladonna at 3:59 PM on May 6, 2013


You might try switching your prenatal vitamins too. Some brands are far worse than others. Ask about changing to one with less iron, or take iron at a different time, or in another form. It probably won't change things completely, but it might help ease some of the horrid discomfort :-(
posted by barnone at 4:10 PM on May 6, 2013


You might try switching your prenatal vitamins too. Some brands are far worse than others.

I can confirm this. Even I, a non pregnant male, can get the spinny ulps from taking vitamins on an empty stomach. If you can't eat much in a sitting, perhaps you can cut the pills into smaller pieces and dose yourself throughout the day. Or perhaps there is a liquid preparation available that you can sip with whatever you can keep down?
posted by gjc at 4:26 PM on May 6, 2013


Yes, I had exactly what you have, constant terrible nausea but only throwing up every few days. It suuuuuucked.

Things that helped: sleeping as much as possible. Seriously, I would come home from work and go directly to bed, the less I was conscious, the faster the time went and the less I had to deal with the nausea. Eating major protein. I was vegetarian until I was 7 weeks pregnant, when in desperation I ate turkey because maybe it would help, and it did. Meat was apparently what I needed. It didn't make the nausea go away, but it made it slightly better.

Things that didn't really help: everything else. I consumed every form of ginger I could find. I sniffed mint and lemon. I ate, I didn't eat. None of it mattered. Life just simply sucked for about 2-3 months. I thought the drugs were just for when you were actually throwing up a lot, which I wasn't, so I didn't pursue drugs.

I seriously did not know how I would survive it, and I did. My biggest fear was that I would end up being one of those people that would have the nausea for my entire pregnancy, which thank heavens I did not.

IT WILL GET BETTER. I promise. Good luck.
posted by rabbitrabbit at 4:39 PM on May 6, 2013 [1 favorite]


You might try Activia (flavored yoghurt) to 'sweeten' your stomach. It helped two people I know.
posted by Cranberry at 4:41 PM on May 6, 2013


Oh, the memories of unrelenting nausea and loss of appetite (but not throwing up. That didn't come until the third trimester). I lost 10 pounds during the first trimester.

Because I could keep food down, the midwives would not prescribe an anti-nausea. So what worked for me was as much sleep as humanly possible, watching the entire series of Gilmore Girls, dumping the prenatal vitamins for a Flintstones chewable and (weirdly enough) peach flavored penguin gummy candies.

I also followed the midwives instructions for getting through the first trimester: eat what seemed appetizing and I could keep down. They literally didn't care if I lived solely on milkshakes for the first 12 weeks, as long as I was eating something.

I think I may have been nausea-free for 3 weeks the entire pregnancy. It never went away completely, but it did get somewhat better once the first trimester passed.
posted by theBigRedKittyPurrs at 5:05 PM on May 6, 2013


I drank flat ginger ale by the pallet (through a straw - the straw made a difference to me for some reason). And there is no shame in calling in sick from work.
posted by spec80 at 6:07 PM on May 6, 2013


One thing that helped me was drinking smoothies -- basically frozen fruit blended up with soymilk (I'm sure milk is fine if you can digest it), and drinking it from a cup with a lid (with a lid and thick straw is even better). If someone else makes it for you, even better. You never smell or see the food at all, and get it in tiny bits, still mostly tasteless.

This and oyster crackers are what I lived on for the first trimester. Also, try to find as many times a day where you don't have to fake it as possible -- just lie down whenever you can.

I hope you're feeling better soon!
posted by Margalo Epps at 6:21 PM on May 6, 2013


Ugh, I'm so sorry you're feeling so awful! I had some mild nausea and my doctor prescribed Diclectin, which a quick Google indicates might be a Canadian thing. Basically, it's B6 and an antihistamine -- it makes you a bit sleepy though so I tended to take it at night to get me through the next day. So the B6 recommended above might be something to look for. I'm at 25 weeks now and I've found that not eating enough makes me insanely nauseous to the point that I throw up what little I have eaten, but I feel tons better after that (though I'm like, "KID. If you're hungry, throwing up what I've given you seems counterintuitive, no?), but YMMV. I would go back to the doctor and explain all the things you've tried and see if she can't give you something to help. If you are in Canada, try the Diclectin, though by the sounds of it, you might be beyond it at this point, as I think it's for more mild nausea, and you can hopefully go to the stronger stuff so you can feel better quickly.
posted by pised at 6:34 PM on May 6, 2013


Oh, I have sooo much sympathy. I was right where you are just over a year ago -- in fact I had my own question about it. Like you, I mainly "just" had unrelenting nausea: puked only a few times a day, but the nausea never ended. It was one of the most miserable times of my life.

I don't know where you are, but here in Australia, I didn't find it too difficult to get medication for it (and I got it starting around 8-9 weeks) once I explained exactly how much it was killing my quality of life, and even making me regret getting pregnant (this was a much-longed-for pregnancy). Zofran really made a huge difference. It didn't eliminate the nausea entirely, and caused some pretty bad constipation, but I finally felt like a (occasionally sick) human being rather than some dying nausea-filled thing all of the time.

Really. Go look into it. All of the different foods and other techniques did nothing at all for me; only the medicine made even a speck of difference.

Also remind yourself that there is light at the end of the tunnel. I now have a six-month-old son who I love SO much, I would go through that again a hundred times to get him.

But, yes, it is SO difficult. Don't feel bad for feeling this way, some of us just get hit with it hard. You'll make it, and in the meantime, be kind to yourself.
posted by forza at 6:51 PM on May 6, 2013 [2 favorites]


Oh, I'll add that in my question I mentioned medication but that it was only somewhat effective... at the time that was not Zofran. The doctor changed it to Zofran a week or two after that because the previous one (I forgot what it was called) wasn't doing the trick. So if one medication doesn't work for you, don't be afraid to try other things.
posted by forza at 6:53 PM on May 6, 2013


I had the same problem in my first trimester - constant nausea with little to no actual vomiting. My problem turned out to be dairy. I was lactose-intolerant for the first 6 months and then sensitive to just milk (not yoghurt, cheese, ice cream, etc.) for 3 months. I was able to eat all the dairy I wanted once the kid was born and have not had a dairy problem since. Pregnancy is so weird. So, try eliminating/limiting dairy? Hang in there!
posted by bijou243 at 7:31 PM on May 6, 2013


I had some morning sickness with all of my pregnancies, but the last was by far the worst, so I totally sympathise; and I didn't ever really just throw up, but that unrelenting nausea can really drain you. I hope you're in Australia, because my favourite remedy is only available here: chocolate paddlepops. Something about the cold, sweet, not very chocolatey flavour really settled my stomach. If not, I can only agree with other suggestions for mint and lemony things. Good luck!
posted by Kaleidoscope at 8:38 PM on May 6, 2013


Hey, high five! I'm doing the morning sickness thing right now, at 34 weeks. I lost five kilos in my first trimester and everything. I was throwing up three, maybe four times a day, up to six or seven times a day on a rough one. Good times.

Firstly, get yourself some meds. I was taking Maxalon for a while there, but had to ditch it because it was making me gassy.

Try and eat very small meals at regular intervals. It's a pain but it'll cut back a little bit of the nausea, provided you find something that agrees with you. I can't handle toast at all and biscuits and crackers made things worse. Dry pretzelz, Twisties (sort of like Cheez Doodles, I think), Cheezles (also, oddly enough, a bit like Cheez Doodles) and cherry tomatoes were good. Try getting some protein in there if you can. Fruit juice is good too, especially thicker juices like banana and mango. Bit of fibre is your friend.

It's hard but keep looking for food your body can manage. I found garlic, onion, nuts of all sorts, and seedy bread all make my nausea worse, ginger gives me heartburn and chilli gives me violent stomach cramps. DON'T FEEL GUILTY IF YOUR SURVIVAL FOOD IS A CHEEZBURGER! Right now you can eat whatever the damn hell you want. Early fetal development, the baby can suck what it needs from your body. You have a very small window of junk food loving, and if it keeps your calories up, then go for it. It'll cut back on the fatigue. I got through most of first trimester on vanilla icecream, plain greek yoghurt and dry pretzels. It's eased up enough that I can eat like, fruit and veg again, most of the time anyway.

Eyebrows McGee's advice to get some sort of strong hard sweet to suck on is great too. I was addicted to small fruit flavoured drops, mainly lemon and grape, that I found at a Korean import place, and they were total lifesavers. Just enough flavour to take my mind off the need to hurl, a little bit of calories to keep me powered and less likely to fall asleep on my feet.
posted by Jilder at 3:37 AM on May 7, 2013


Also, those seasickness wrist bands (that put pressure on an acupuncture site on the wrist) helped me with my (grantedly much milder) nausea, so it's worth finding a pair of those while you're waiting for medical help to arrive.

My sympathies. I have a friend whose whole pregnancy sounded like that, but medicine did help. Still, biology can be a cruel mistress!!
posted by acm at 7:40 AM on May 7, 2013


1. I switched not my prenatal vitamins but when I took them: right after dinner, instead of in the morning. And I mean literally after the last bite of food. If I waited 10 minutes, the nausea would begin.

2. Vinegar-y foods settled my stomach. So did smelling a fresh lemon (carried lemon slices with me).

3. Instead of having full meals, eating a little, but often throughout the day, did the trick.

4. Empty stomach = nausea. So I made sure I always had a couple bites of SOMETHING in me.

5. It all went away after the 2nd month.

Hang in there - this too shall pass!
posted by out_of_order at 8:39 AM on May 7, 2013


I went through this for the first 15 weeks or so. Constant nausea, plus vomiting a couple times a day. I never took meds, but a couple things definitely helped: switching to gummy prenatals before bed, drinking tea, jolly ranchers and lemonheads candies. The big problem, I realized, was that I was having awful acic reflux in addition to the morning sickness. Once I started taking prilosec religiously before breakfast and dinner, I saw a huge improvement.
posted by galvanized unicorn at 9:12 AM on May 7, 2013


I have been lucky both times to have heartburn and nausea, starting almost on the dot at six weeks, and it's that never-ending rather than actual-barfing kind. Hooray! I also can't stand ginger or peppermint. Seabands helped some with my first pregnancy, as did lemon drops by the truckload. Now I do a lot of sleeping, and I drink a lot of Arnold Palmers (half lemonade/half iced tea). Treating the heartburn (Zantac, though I suspect I will switch back to Prilosec in a few weeks, like I did with my first) has helped quite a bit. I suspect that the heartburn was a large part of the issue with my first, too, but I didn't realize that's what was happening until later in the pregnancy.

I eat a lot of popsicles. Everything's worse on an empty stomach, so finding something I can eat helps---saltines, fast food chicken sandwiches, cheese, peanut butter toast, milkshakes, whatever---but I'm also really sensitive to eating too much at a time. Which is fun--I'm queasy, then STARVING, and then I eat and want to barf. This time around I'm also struggling with significant food and smell aversions. I'm also taking a regular multivitamin with a folic acid supplement instead of a prenatal, and I'm taking that at night.

I haven't tried the Unisom/B6 combo but have heard it's successful for many. My doc gave me a Zofran prescription because she was concerned I'm not staying hydrated enough (despite no vomiting, until recently I couldn't drink practically anything due to the nausea/reflux). It helps, but it also gives me a headache, knocks me out, and makes me terribly constipated, so I try not to take it unless I really have to. It is still better than feeling so awful. And the bad days are getting fewer now that I'm almost to the end of the first trimester.

I also felt that unrelenting nausea wasn't "bad enough" to do something about, but really, if it's interfering to that degree with your everyday life, it is. It sounds as if you've tried a lot of the common diet and lifestyle changes already. I'd emphasize that when you talk to your doc.
posted by percolatrix at 10:27 AM on May 7, 2013


Is it supposed to suck so much - hell no. Does it, for many people, apparently the answer is yes. I'm currently in like week twelve and since about week four I've been in "What the hell....you have got to be kidding me!" mode. Part of the insult to injury part is that I am pretty sure that many people seem to have glossed over the morning sickness part (yeah, it happens, but it will pass...unless it doesn't). I'm not saying that had I known that the first twelve weeks would be like this I wouldn't be having kids - but I am saying that if I'd truly understood that there is a reason that pregnancy is designated as a disability in the US, I sure as heck would have modified my expectations, food plan, and schedule a lot earlier.

What I find notable is that every couple of days I need to find a new strategy. For a few days mandarins worked, until one day they sent me into dry heaves. Last week it was pineapples. This morning, it occurred to me that plums may work. So try everything, because it isn't clear what might work for you, and be prepared to cycle. So yes, go back to the doctor, and ask for the meds, and if they don't agree, find a new doctor. Try B6. Also, I'm at the point where I have to eat something small about every hour while awake (and realize that that something will change from day to day, so I don't buy bulk). Right now, it's small pretzel sticks. It was crackers, but now they seem to make me gag. Also, if I eat too much, I gag, so I try to limit myself to something like '10-20 bites' of whatever I am eating, because really, I have no appetite. Also, I take gummy prenatals, usually before bed. I can't really drink any beverages - they just seem to help me want to throw up, so it's chewing ice for me. And every minute I am not at work, I am lying down, prone, just trying to focus on my present breathing, rather than the fear that this would last for another 30 weeks. Every break at work, I am lying down, and I have rearranged my schedule as if I only have 40% of my capacity - I'm in total maintenance mode.

Sleep all you can. Seriously, the work you body is going through to create a spine and internal organs for another human being would astound you. Do not try to 'power through' this, and have any expectations of keeping any semblance of your previous schedule. Don't worry about talking to friends, or how your husband is feeling - just lie there, and take it one breath at a time. At some point it will end, but you just have to focus on getting through each moment in front of you.
If you'd like you partner to help, then let them help you experiment through possible solutions - preggy pops, or flat gingerale, or whatever. Or set up something so you are listening to your favorite podcast or whatever while in bed, so you have something to do while lying there. Or have them buy you a little plastic step stool that you can sit on while you are busy wretching in the bathroom for 15 minutes, so you don't have to sit on the cold floor. Have them buy those antibiotic wipes to wipe the toilet afterwards, because there is something about being in a nasty bathroom that will just make you want to wretch more. Have music in the bathroom so you have something to listen to while you're waiting for the next wave. And gatorade, or whatever, for right afterwards.

I guess my advice is - Just keep trying to do small things, and new things to see what brings some comfort. I really thought I was alone in this until I joined one of those online pregnancy sites (in my case a bunch of women on forums grouped by expected birth month). I can just tell you that for the past 8 weeks the November 2013 forum has been filled with tales of nausea and woe. (I'm assuming the lucky non-nausea experiencing women giving birth in November aren't posting, but are out hopefully having a life). So you so, so aren't alone.
posted by anitanita at 3:00 PM on May 7, 2013


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