I'm so tired, so very tired. Please help.
March 12, 2012 3:40 PM   Subscribe

I am tired. I am always tired. I have always been tired. And it seems like nothing can change this fact. I'm asking y'all at this point because I'm out of ideas on what to do from here.

Every single day, I wake up and I'm tired. I've tried getting eight hours of sleep a night for a few months (no change), seven hours (no change), five to six hours (no change).

This tiredness has been present when I was on a healthy diet (high in protein and low in carbs with various supplements like B12 and fish oil) and on an unhealthy diet (Pancheros, Buffalo Wild Wings, the good stuff.). This tiredness has been present when I was exercising every day and when I wasn't.

Every day, when I get home from work, whether it's a five hour shift or a nine hour shift, I am absolutely wiped out. No matter how hard I try, if I'm sitting down at all after work, I'm going to fall asleep. If I'm using the computer, watching TV, reading, I'm going to fall asleep.

Obvious solution here is to do something active, but my entire body is sore and stiff, my eyes are dry and throbbing with pain, and the only thing I can maybe bring myself to do is to take the dog out to pee.

I have been on a number of different antidepressants, each inducing drowsiness at various levels. However, now I'm solely on Wellbutrin, which I was told doesn't cause much drowsiness, particularly since it can be used as a stimulant. And yet, the fatigue is still present.

I had a sleep study done several months ago. They found no evidence of sleep apnea or of narcolepsy, so I was diagnosed with ideopathic hypersomnia. They tried a few things that were incredibly ineffective – amitiza, melatonin – and were gonna try methyphenidate (ritalin) before I expressed hesitation due to my history of substance abuse. I'm going to have to give it a try, I guess, and I'm not too happy about that but if it helps then thank goodness.

Let's see, other health facts: I drink energy drinks regularly. Once a day, sometimes. This is to combat the constant fatigue. It doesn't help, 95% of the time. I started this a couple years ago, after the fatigue started, although by that point I was very much a nerd used to playing D&D once a week with a twelve pack of Mountain Dew. Despite the fact that I work at Starbucks, I rarely drink coffee. I also smoke a third of a pack a day, on average.

Other history: I've fallen asleep in a lot of places/while doing a lot of things. I've fallen asleep while driving, while biking, while walking. I have the ability to sit down practically anywhere and fall asleep in a matter of minutes – the bus, a bench, even just lying down on the sidewalk.

I started drinking, in fact, because I kept falling asleep while driving and it was the only thing that could help me stay awake on the road. I somehow got it in my head that a few beers over the two hour drive was less dangerous than my constantly fighting sleep while driving. I also drank a lot to fall asleep and particularly to fall asleep without having to dream. I did this almost every night for three years. I've been sober for eleven months.

This has been going on for a long time now. Six, seven years. Basically, since I began college/since I turned sixteen. It's driving me insane. I can't read because I'll fall asleep almost immediately. I can't write for the same reason. I can't watch TV. Video games I can usually stay awake for, but not always. Why does my body hate me?
posted by Modica to Health & Fitness (47 answers total) 39 users marked this as a favorite
Have you had your thyroid levels checked? If you have hypothyroidism, it would at least be easy to fix.
posted by vacapinta at 3:45 PM on March 12, 2012 [14 favorites]

Obvious solution here is to do something active, but my entire body is sore and stiff, my eyes are dry and throbbing with pain, and the only thing I can maybe bring myself to do is to take the dog out to pee.

That stands out to me. If your entire body is sore and stiff and your eyes are dry and painful, that is a problem. If you're in crazy pain, your sleep could be disturbed even if you're not aware of it, or you could have an underlying condition that is causing both the pain and the fatigue.

Is the pain in your joints? Rheumatoid arthritis can cause joint pain, fatigue, and cripplingly dry eyes. Have you been seen by a rheumatologist?
posted by KathrynT at 3:51 PM on March 12, 2012 [1 favorite]

If your eyes are dry and throbbing with pain, your entire body is sore and stiff, and you're tired all the time, then it seems reasonable to ask a doctor to check for autoimmune disease, specifically Sjogren's Syndrome. You'll want to go to a rheumatologist for this.
posted by HotToddy at 3:51 PM on March 12, 2012 [10 favorites]

Have you seen a doctor for things other than depression and sleep study? It could be a lot of things -- thyroid (as vacapinta says), Vitamin D deficiency, pernicious anemia. You mention dry eyes and achiness, which both (along with fatigue) can be symptoms of Sjögren’s syndrome.

Which is to say, it could be a lot of things. Go to the doctor and work through them, one by one. It sucks, especially when you're fighting fatigue, but there is an answer. I found I was more successful at getting doctors to take me seriously when I was extremely precise about how the symptoms were affecting my daily life, and when I kept following up.

Good luck.
posted by pie ninja at 3:51 PM on March 12, 2012

It sounds like it may be hormonal, I would go get blood work, electrolyte, and a thyroid panel done at the doc. It might be an easy fix!
posted by katypickle at 3:54 PM on March 12, 2012

How about allergies? Did you move to a new part of the country when you started college? Do you still live in that part of the country? Allergens where I live now make a lot of people drowsy and definitely cause itchy eyes. Do you have any pets?
posted by mareli at 3:55 PM on March 12, 2012

Response by poster: The dryness and soreness in my eyes happens right when I get off work, which I find odd, and becomes more pronounced on the drive home until I reach my house and it's just full on soreness, dryness. I have the same problems when I wake up in the morning – eyes are very dry and sore, my mouth is particularly dry.

And the pain is mostly in my muscles. Everything feels like I've been sitting in an small enclosed space for hours. Everything's real weak and stiff.

RE: Allergies – I've lived in the same state and I've never had allergies. Half my family does, I'm on the half that doesn't. My eyes aren't ever itchy, though. Just dry and sore.
posted by Modica at 3:58 PM on March 12, 2012

Dry mouth points to Sjogren's, also.
posted by HotToddy at 4:00 PM on March 12, 2012 [2 favorites]

You definitely need to have some medical diagnosis work done, especially blood work. Your symptom are amazingly similar to my daughter's -- in her case, it was anemia, very serious anemia indeed. She still has to take massive doses of iron supplements, but at least she's feeling better. What you are feeling is not normal, and although I know how hard it is to try to find an answer when you just want to sleep, please do try to find a doctor to help you out with this.

And also, there are lots of people who need 9-10 hours of sleep a night; you might be one of them on top of whatever else is wrong.

Good luck ... no one deserves to feel tired all the time.
posted by kestralwing at 4:05 PM on March 12, 2012

This raises red flags for possible thyroid and/or autoimmune issues (particularly Sjogrens, as others have said) for me as well. Have you seen an endocrinologist and/or a rheumatologist?
posted by scody at 4:06 PM on March 12, 2012

I am assuming you haven't had comprehensive blood work done, nor an allergy test, since you didn't mention either of these things. First thing I would get the blood work. This tests for things like your thyroid functioning and testosterone.

You say that 'you've never had allergies', but fatigue, muscle aches, and dry/sore eyes can be symptoms of allergies! So if the blood work doesn't show anything, that would be my next step.

After that the path is a bit more murkey. I know it is hard to seek medical health for fatigue - if you had the energy to fight for medical care, you wouldn't need medical care! But choosing between driving drunk or driving tired is not healthy or safe, and you know this.
posted by muddgirl at 4:06 PM on March 12, 2012

Response by poster: Well, I had a lot of blood work done a year or so ago for this very reason. I went in to see my doctor shortly after I got sober/started treatment the second time. I wanted him to check a lot of things, like checking for anemia, checking my blood sugar, that sort of thing. IIRC, he said there was nothing unusual.

But I have not had an allergy test, no. I didn't see the reason for it, since this fatigue has been present year round for several years and because it carried with it no other signs of allergies.

I have Wednesday off work, though. I have to see my therapist and my psychiatrist, might as well go see my doctor too. What do I tell him? Check for everything?
posted by Modica at 4:12 PM on March 12, 2012

I had a friend who had fibromyalgia. Some of the symptoms are similar, including dry mouth in some people.
posted by SpacemanStix at 4:22 PM on March 12, 2012

Best answer: What do I tell him? Check for everything?

Yeah, pretty much. Print out your question. Show it to your doctor. Use words like "debilitating," "chronic," "unable to function," and "interfering with daily function." Do not downplay your symptoms at all. Good grief, you're falling asleep on the sidewalk!

So, the sleep study didn't turn anything up. Same with your basic blood work. Now ask your doctor what next. What next to figure out what the heck is wrong with you? If another panel of blood work comes back normal, ask your doctor "what next?" Keep doing that until you and your doctor get this figured out. This is no way to live.
posted by Sassyfras at 4:23 PM on March 12, 2012 [15 favorites]

Following the above advice and checking for the above mentioned medical conditions is the 1st thing to do.
If they come back negative then it's probably the activity thing.
In the past that I've felt extremely tired (not as bad as falling asleep everywhere) ... but gradually I'm able to start getting active. You have to go very light to start and then learn to create a routine.

It's an aweful Catch-22 that you need to be active to have energy but have to have energy to be active. But somehow you need to start and continue with it consistently if you do then you'll start feeling like you have some life in you (also provided you go back to a healthy diet)

Otherwise, maybe your just too bummed out about stuff in your life, which also can make you tired ... i can see that happening too .... the solution to that is also various.
posted by pytar gucchy at 4:32 PM on March 12, 2012

In addition to the above suggestions, which are all good ones, you might want to get tested for Lyme Disease.
posted by gudrun at 4:46 PM on March 12, 2012

I know you said you supplemented with B-12, but which kind were you taking? Was it a high dose of methyl-B-12 in lozenge form, 2,000- 5,000 mcg? Cause if you were taking other forms you may not have been getting the benefit, which is night an day in terms of difference. You may also want to check your exact B-12 levels. The "acceptable" range here in the US is significantly lower than elsewhere in the world, and you could be deficient enough to have a problem. If you are borderline or slightly low (especially if you're vegetarian, even sometimes) this is especially important.

Also, do you have SAD or live in a not-so-sunny place? Do you feel any different when you visit sunny places? Some of us can't handle dreary weather and moving is a excellent solution.
posted by devymetal at 4:47 PM on March 12, 2012

Adding to the list of things to get checked for: Celiac. Fatigue and muscle soreness are common with Celiac.
posted by leslies at 4:51 PM on March 12, 2012 [1 favorite]

Check for everything?

Well, your doctor can certainly do a thyroid panel. For autoimmune issues, the testing gets more complex.

Autoimmune disorders can be very challenging to diagnose. There is almost never a single lab test that can confirm a diagnosis, so it's really more of a process of looking at a range of tests in conjunction with the entire suite of symptoms. That said, tests like ANA (antinuclear antibody), RF (rheumatoid factor), and ESR (erythrocyte sedimentation rate) seem to be pretty common starting points in looking for evidence of autoimmunity. Your doc can certainly get that ball rolling, but if there's reason to pursue it further, you will really need to see a rheumatologist.

IANAD (though I do have both thyroid AND autoimmune issues!)
posted by scody at 4:52 PM on March 12, 2012 [2 favorites]

This sounds a lot like Chronic Fatigue Syndrome, but it also sounds like what I had for a while which was a combo of horrifically low vitamin D, too few calories, and depression. It was a disaster. I never had energy to deal with anything. Another vote for a major blood, hormone, thyroid panel.

Good luck. I have been there, I am sometimes still there, but usually it has to do with being depressed and/or Vit. D deficient.
posted by These Birds of a Feather at 4:57 PM on March 12, 2012

Oh, and also: autoimmune diseases and allergies are related (an allergy is an immune reaction to an outside substance; autoimmunity is an immune reaction to a tissue within the body), and they tend to run in families, even if different family members don't get the same specific autoimmune disease or allergy. So the fact that you have a strong family history of allergies could suggest a predisposition to autoimmunity on your part.
posted by scody at 5:00 PM on March 12, 2012

Response by poster: They did check for celiac's, I know that for sure. I had a colonoscopy and all that. It was terrible.

I have a lot of digestive problems, too. Severe (and random) bloating, abdominal pain and distension, and excessive belching and gas production that goes on for hours. It started, actually, around the same time the fatigue did, now that I think about it.
posted by Modica at 5:04 PM on March 12, 2012

Definitely see a Dr, but do you still drink energy drinks regularly?
Cutting caffeine out of my diet entirely helped a lot.

2nding trying more than 8 hrs of sleep. Sleep needs are individual, there is no magic number, maybe you just need 10?

Are you getting enough vitamin C in your diet? 2nding checking for Lyme disease, it's rare, but does happen.
posted by fragmede at 5:07 PM on March 12, 2012 [1 favorite]

I had near identical symptoms last year and it turned out I had cancer. B-cell lymphoma, to be precise. The fatigue was absolutely overwhelming, pre- diagnosis. It seems the tumor was not only taking up a lot of space where my lungs used to be but was also causing fluid to accumulate around my heart, making it work so much harder for basic function. Hence, extreme fatigue. I was so worn out all the time that I actually felt MORE energetic after I started chemo and the tumor began to reduce in size.

Your case is probably not cancer but it sounds serious as heck. Get to a doctor!
posted by DSime at 5:08 PM on March 12, 2012 [4 favorites]

Well, I had a lot of blood work done a year or so ago for this very reason. I went in to see my doctor shortly after I got sober/started treatment the second time. I wanted him to check a lot of things, like checking for anemia, checking my blood sugar, that sort of thing. IIRC, he said there was nothing unusual....

What do I tell him? Check for everything?

The thing is, there's no such thing as "checking for everything." There are many, many different blood tests that can be done, and any actual bit of bloodwork is going to involve a small fraction of them. When your doc found "nothing unusual," that just means none of the specific tests that he decided to run came back with unusual results. Let's say your thyroid is way out of whack — if he didn't make a point of testing your thyroid hormone levels, then he wouldn't have noticed anything one way or another.

Anyway, the upshot is that you can't just say "check for everything." Better to come up with a list of specific conditions to rule out. If your doc is taking your symptoms seriously and seems reasonably knowledgeable, you can come up with that list in consultation with him. If he isn't — and unfortunately, many doctors have trouble taking symptoms like yours seriously — then you should be willing to advocate for yourself, either by finding a new doctor or by doing your own research or both.
posted by nebulawindphone at 5:10 PM on March 12, 2012 [1 favorite]

Response by poster: fragmede, I've cut them in and out of my diet. Went a few months without caffeine, didn't notice a difference. Also had a period where I tried to get ten hours of sleep a night for a couple months. My body actually refuses to let me sleep that much, though. It wakes me up at about 8.5 hours if I try.
posted by Modica at 5:11 PM on March 12, 2012

Wow, that's a real host of symptoms you are dealing with -- I'm so sorry you're going through this. Does your doctor really seem to be fairly unconcered about all this, in a young adult of your age? Are you seeing an internist, or a GP/family practitioner? (This is not at all to diss GP/family practitioners; just to note than internists can often be more dialed-in to more complex health disorders, in my experience.)

On preview: I agree with nebulawindphone. You can't really ask a doctor to test for "everything," and if you don't feel your current doctor is taking you seriously even after all the symptoms you're presenting, you'll need to advocate for yourself by getting another doctor (either a new primary physician, or by getting referrals to specialists).
posted by scody at 5:14 PM on March 12, 2012

My exhaustion subsided once I went off SSRI's.

Oh and dry mouth is a common side effect as well.
posted by radioamy at 5:14 PM on March 12, 2012

Check for Lyme's disease while you are there.
posted by JohnnyGunn at 5:25 PM on March 12, 2012 [1 favorite]

I was dealing with extreme exhaustion a few years ago. My regular doctor didn't have much to say about it, so I asked around and got a recommendation from someone with similar symptoms. My new doctor gave me a full panel of tests. I didn't have Lyme disease or celiac, but I was mildly hypothyroid and anemic, and very vitamin D deficient. I went from being almost unable to get up from my couch in the evening, certain I had fibromyalgia or Lyme, or Chronic Fatigue Syndrome...to now feeling pretty darn normal. I was just thinking last week how much better life is, and how grateful I was to have a really good doctor.

So I'd say, ask around for a recommendation for a doctor who specializes in dealing with fatigue issues. Mine is just a family doctor (not an endocrinologist), but she is amazing.
posted by instamatic at 5:27 PM on March 12, 2012 [3 favorites]

I know you say they checked for celiac, but apparently diagnosis is not clear cut. For instance, I have a friend who is wildly, wildly celiac and has never once had a "positive" biopsy. Her symptoms -- soreness, extreme fatigue, and especially the sore eyes -- sound just like yours. Maybe give cutting gluten out a chance?
posted by Mrs. Rattery at 5:30 PM on March 12, 2012 [1 favorite]

Response by poster: I want to say thanks to everyone for your suggestions and advice. I'm probably just going to end up printing out a lot of what was suggested here, because I know I won't remember it. I really appreciate all the insight.
posted by Modica at 6:00 PM on March 12, 2012

My boss was a high-pressure, full-partner lawyer in a huge firm, and he had symptoms like these for four years before they diagnosed Epstein-Barr (infectious mononucleosis) in him. Fatigue, chronic muscle aches, headaches, eyes, intestinal discomfort... I guess it's so old fashioned they don't routinely check for it on the front line anymore? Anyway, once they figured it out, he was back in fighting shape in four to six weeks.
posted by halfbuckaroo at 6:02 PM on March 12, 2012 [4 favorites]

I don't know how much you can know how you really feel when you're zinging between what sort of sounds like multiple dependencies (caffeine, nicotine, alcohol). I know how hard these habits are to change from personal experience, but no question, when I quit smoking I felt about 10 years younger within three months. The body likes oxygen. IT just sounds like you have a problem under there, but the amount of self-medicating is going to just complicate the symptoms to a point where it might be hard to tell what's going on.

Definitely look for the cause in all ways you can. but these things - smoking, heavy caffeine use, other energy drink additives, and drinking - all cause the body some energy loss, and together they really divorce you from a natural understanding of what the body needs.

Also, some people need more than eight hours' sleep as a regular thing. Maybe you're one. Also seconding the sleep apnea thing - if you have it, you can sleep twelve hours and still get no helpful rest. A good friend got diagnosed with apnea at age 58 - he was heartbroken he hadn't found out twenty years ago. He used to be irritable, cranky, slack and hangdog all the time. He couldn't keep a relationship. With treatment, he's now sunny and energeti and happil y married. It's kind of amazing.
posted by Miko at 6:23 PM on March 12, 2012

Talk to your doctor. It doesn't sound like your lifestyle is the culprit. Maybe get a referral to a rheumatologist.
posted by elizeh at 8:01 PM on March 12, 2012

My friend in college discovered she needed a pacemaker only after several months of being very, very, very tired all the time.
posted by troublesome at 8:22 PM on March 12, 2012

I need 9 hours of sleep, not 8. Try that. And maybe try out one of those apps (or borrow a device like a FitBit) that charts your sleep and can wake you up when you're in a lighter sleep.
posted by IndigoRain at 8:49 PM on March 12, 2012

Seconding Lyme disease!!!
posted by lulu68 at 8:59 PM on March 12, 2012

Maybe someone above mentioned this, but what about a food allergy, instead of celiac's? You say you have lots of gastro symptoms. An allergy could lead to poor absorption, leading to fatigue.

A relative of mine had bad leg cramps and weakness, and sever diarrhea. He started taking magnesium citrate an my recommendation.* It almost immediately helped with those symptoms, and when he told his doctor, he still tested low in magnesium levels.

* It helps me with muscle knots and cramps. YMMV
posted by annsunny at 9:05 PM on March 12, 2012

I agree with These Birds of a Feather -- the aches and pains and fatigue point to Vitamin D for me, but you probably have a lot of other things too. If you have stomach pains, your body may not be processing vitamins the way it should. (Happens with older people usually but not unusual in younger people.)

I really hope that you can find help.
posted by Ms. Moonlight at 1:08 AM on March 13, 2012

I've tried getting eight hours of sleep a night for a few months (no change), seven hours (no change), five to six hours (no change).

I'm a bit confused, you're so tired you're falling asleep all the time, and you tried getting less sleep as a cure? If your body is telling you you need to sleep, maybe you just need to sleep. Try getting more than 8 hours a night. Go to sleep on weekend nights without setting an alarm, let yourself sleep in. See how you feel after a couple of weeks of that.
posted by EndsOfInvention at 3:18 AM on March 13, 2012

Man, I could have written this. I've had similar problems for as long as I can remember - it doesn't seem to matter how much or how little I sleep I never feel rested and I'm always tired. I spent the last decade and a half depressed as hell and living life half awake... and I still have no idea what is going on.

I ended up seeking out therapy for help with the depression piece and, with the help of a wonderful psych, have found the combination of drugs that help me function. If this condition runs your life like it does mine, I think you might want to reconsider the stimulant. I can't tell you how much it changed my life. I can get actually hold down a job now. I can think clearly. I can do laundry, walk the dog, and all sorts of basic life things that I couldn't believe that people had the energy to do.

Find a doctor that will work through the drugs with you and that you can check in with constantly. Tell them your concerns about potential abuse. They should be able to work with you on it. FWIW both Ritalin and Adderall come in extended release tabs which are a bit easier to handle and feel less like a ride.

The other piece is sleep. Look up all you can about sleep hygiene and start practicing. There are a ton of threads on here about it. I know it's hard to care when you won't feel rested anyway, but just having a 'regular' period or cycle for sleep goes a long way towards staying healthy and sane. Cut out all the drinking. Depressing your system constantly will only make things worse. Also you sleep even more like shit when you are drunk. Find something else to help you get to sleep. I sometimes take Mirtazapine. It's an antidepressant that at low doses has a side effect of making you drowsy. It's a pretty natural feeling and doesn't have the punch of a sleeping pill.

My heart goes out to you man, no one should feel like shit all the time. I hope you can find treatment that works for you. Just keep at it.
posted by grizzly at 7:00 AM on March 13, 2012

I can't offer any suggestions as to what this might be, but crying in the doctor's office helped him see how awful my (unrelated) condition was. Be sure that the doctor understands how debilitating this is and keep pressing for referrals. Do you have a partner, or a close friend or relative that you can enlist as an advocate for you? If you're in a relationship, this is no doubt greatly affecting it and I'm sure your partner wants to see you well. Don't be afraid to ask for help. You'd be surprised who will come through for you.
posted by desjardins at 8:38 AM on March 13, 2012

I really sympathize with your situation, and hope that you find some solutions. Everyone seems to have pretty much covered what I would suggest. I agree with grizzly that -- especially if tests don't turn anything up -- you could inquire about the abuse potential of extended release forms, and other stimulants such as Provigil/modanifil, and see if it helps.
posted by NikitaNikita at 2:21 PM on March 13, 2012

You said:
"The dryness and soreness in my eyes happens right when I get off work, which I find odd, and becomes more pronounced on the drive home until I reach my house and it's just full on soreness, dryness. I have the same problems when I wake up in the morning – eyes are very dry and sore, my mouth is particularly dry."

(forgive my lack of mad formatting skillz)

I've got this stuff, too, along with rheumatoid arthritis. It really does sound like you need a rheumatology referral. Sjogren's goes with other autoimmune conditions quite a lot, but can make you feel crappy all by itself, too.

Your eyes might be drier and more sore when you're driving home because of air blowing in your face during your drive, which makes dry eye symptoms worse. Bright sunlight can make things more uncomfortable, too. Wearing sunglasses while driving during the day, pointing vents away from your face and using a lubricating eyedrop before driving (not the Visine/red eyes type) might help.

Eye dryness in the morning is more common than you'd think, too. There are eye gels and thicker types of eye drops that you can use right before going to sleep, many of which are ok even for people who use contacts.

Speaking of contact lenses - you don't mention using them, but if you do, you want to make sure they're the newer silicon hydrogel type. You might find that your eyes feel better with the lenses in than without.

BTW, eye dryness can make you feel even more fatigued when you're already tired. Helping out the dry eye stuff won't solve everything, but it's something you can address while you're waiting for a rheumatologist. It would be wise to see an ophthamologist as well.

Good luck! If it does turn out to be autoimmune, there's no cure but there are options that can help.
posted by terrierhead at 4:10 PM on March 13, 2012

Nthing that you should get checked for Lyme disease. A good friend of mine was dealing with symptoms like this for years before she got diagnosed with Lyme disease. It got so bad for a while that she was on disability and could only get around in a wheelchair. Then she got diagnosed and is much better these days. Before she got diagnosed, they were treating her for everything from mono to Chronic Fatigue Syndrome.

I also had some similar symptoms a few years ago (especially the aches, fatigue and dryness) and it turned out to be a combination of extreme iron-deficiency anemia and Vitamin D deficiency. I know you were tested for anemia but it couldn't hurt to try again. And a Vitamin D deficiency this bad is not out of the question.
posted by lunasol at 4:13 PM on March 13, 2012

Sounds like chronic fatigue syndrome, esp. the sore muscles.
posted by windykites at 8:23 AM on December 17, 2012

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