11/10 Ivy Amps 105, +3 107, +6 136, +9 191, Pmps 188, +3 116 Libre Thyroid complications

Staci & Ivy

Very Active Member
11/9/24
Amps 105 Libre

Good morning, well another late night of sleeping on the sofa for me and Ivy. Gave had another reduction this morning of insulin. We are down to 3 units.

She definitely seems to be needing less insulin to get the same result as when I was giving more insulin.
Colleen, @SmallestSparrow kindly made me aware overnight of a complication that can arise from methimazole, been given for hyper thyroid treatment.

I have noticed since her latest increase of methimazole almost 3 weeks ago, Suddenly, the insulin seems to be too much for her, and I have given back to back reductions yet I’m still getting the same result as higher doses. I salon taking her lower than I prefer to keep her and it’s keeping her lower overnight and I’m spending pretty much every night up all night with her and giving carbs that aren’t really working to bring her up.

This complication seems to be noted in the attached article which Colleen provided.

I do have a feeling there is a correlation here. I have reached out to my vet this morning and hoping I will hear back from him early this week. Not sure he will have any clue what to do about it, however.

Again, unfortunately, she’s not a good candidate for the 131 treatment which would most likely solve the problem of the hyperthyroid issue, so I’m between a rock and a hard place with her and all that’s going on. (Several docs I’ve called have refused to treat her with I131).

Feeling very anxious and more stressed than ever today :arghh:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4973408/
 
11/9/24
Amps 105 Libre

Good morning, well another late night of sleeping on the sofa for me and Ivy. Gave had another reduction this morning of insulin. We are down to 3 units.

She definitely seems to be needing less insulin to get the same result as when I was giving more insulin.
Colleen, @SmallestSparrow kindly made me aware overnight of a complication that can arise from methimazole, been given for hyper thyroid treatment.

I have noticed since her latest increase of methimazole almost 3 weeks ago, Suddenly, the insulin seems to be too much for her, and I have given back to back reductions yet I’m still getting the same result as higher doses. I salon taking her lower than I prefer to keep her and it’s keeping her lower overnight and I’m spending pretty much every night up all night with her and giving carbs that aren’t really working to bring her up.

This complication seems to be noted in the attached article which Colleen provided.

I do have a feeling there is a correlation here. I have reached out to my vet this morning and hoping I will hear back from him early this week. Not sure he will have any clue what to do about it, however.

Again, unfortunately, she’s not a good candidate for the 131 treatment which would most likely solve the problem of the hyperthyroid issue, so I’m between a rock and a hard place with her and all that’s going on. (Several docs I’ve called have refused to treat her with I131).

Feeling very anxious and more stressed than ever today :arghh:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4973408/

Oh ((((Staci)))),

just read the article and tried to bit of research. I can imagine you are stressed to the max out about all this and I send you many, many hugs. :bighug::kiss::bighug:

As far as I understood, that Methimazole-induced insulin autoimmune syndrome is a very rare condition in humans, I didn't find any cases in cats. On the other hand I found very logical what Wendy wrote, that the better adjusted thyroid might lessen her need for insuline - which is a good thing. Please don't get me wrong, I am worried all the time and also think in every direction with Binie. I just want to encourage you, to look at the likely (and good) options first. Maybe reducing insulin further will help?

Lots of hugs and positive vibes for you and Ivy! :bighug::cat::bighug:
 
Hi Staci,
Oh boy. That's scary. The stress of uncertainty is also so stressful!
I wonder if drain depot and cut down insulin to much smaller dose? You can always increase.
Something like 50% down and see? I know that's not a conventional method but Ivy's case is not conventional.
I'm worried for your health as well, Staci.
Sending you hugs. :bighug::bighug::bighug::bighug::bighug:
 
This is from Veterinary Practice.

When managing feline hyperthyroidism, your protocol does not need to be changed and medications can be used at the standard dose of methimazole, thiamazole or carbimazole. As per the product SPC, doses should be titrated as necessary until the cat is euthyroid. However, following the control of hyperthyroidism in a diabetic cat, the insulin dose may simultaneously need to be decreased and care should be taken to monitor patients for hypoglycaemia during this initial stabilisation period. Furthermore, due to accelerated protein turnover, fructosamine levels will often be lower than expected in uncontrolled hyperthyroid cats with concurrent diabetes and this is therefore considered a less reliable indicator of diabetes control in these patients.
 
Back in my early days, I remember a kitty who came out of remission for the second time. What had happened is that his thyroid was no longer well controlled (T4 high) and meds needed adjusting. Same thing happened the first time time he fell out of remission. Once the hyperT was in better control, the kitty went OTJ again. Another case was an acro kitty on a decent sized insulin dose, diagnosed hyperT, and not long after meds started his dose came tumbling down but stabilized at a lower number.
 
Furthermore, due to accelerated protein turnover, fructosamine levels will often be lower than expected in uncontrolled hyperthyroid cats with concurrent diabetes and this is therefore considered a less reliable indicator of diabetes control in these patients.
Hi Elise, this is very interesting to read. I’m not sure how to interpret what I just highlighted and replied to. Are they saying That a diabetic cat and its fructosamine levels will not be accurate? I’m just not sure how to read and understand this particular passage. Are you able to explain?
 
Back in my early days, I remember a kitty who came out of remission for the second time. What had happened is that his thyroid was no longer well controlled (T4 high) and meds needed adjusting. Same thing happened the first time time he fell out of remission. Once the hyperT was in better control, the kitty went OTJ again. Another case was an acro kitty on a decent sized insulin dose, diagnosed hyperT, and not long after meds started his dose came tumbling down but stabilized at a lower number.
Hi Wendy, these are very interesting cases that you have cited. I’m not sure if I should be cautiously optimistic after over two years of diabetes that there is any possibility of remission, but that would certainly be lovely.
Thank you so much for sharing this with me. I could only hope and pray for such great news.
 
Oh ((((Staci)))),

just read the article and tried to bit of research. I can imagine you are stressed to the max out about all this and I send you many, many hugs. :bighug::kiss::bighug:

As far as I understood, that Methimazole-induced insulin autoimmune syndrome is a very rare condition in humans, I didn't find any cases in cats. On the other hand I found very logical what Wendy wrote, that the better adjusted thyroid might lessen her need for insuline - which is a good thing. Please don't get me wrong, I am worried all the time and also think in every direction with Binie. I just want to encourage you, to look at the likely (and good) options first. Maybe reducing insulin further will help?

Lots of hugs and positive vibes for you and Ivy! :bighug::cat::bighug:
Hi Heike, thank you so much for your incredible support always. You’re the biggest cheerleader ever. Ivy and I appreciate you so much. Let’s just hope that maybe something has clicked and things will become more balanced and lead us down a better path. We sure could use a little luck.

Sending big hugs back to you and Binie :bighug::bighug::bighug:
 
Hi Staci,
Oh boy. That's scary. The stress of uncertainty is also so stressful!
I wonder if drain depot and cut down insulin to much smaller dose? You can always increase.
Something like 50% down and see? I know that's not a conventional method but Ivy's case is not conventional.
I'm worried for your health as well, Staci.
Sending you hugs. :bighug::bighug::bighug::bighug::bighug:
Hi Kit, it is scary. I keep thinking about possibly draining her dose even more instead of just incrementally reducing it.

I’m just not sure what is the proper way to go about it. I know this is not a conventional situation and that’s why I have been giving her frequent reductions, which normally I would never do.
it feels so weird to give back to back reductions, but something just feels different about what’s going on right now and I have to trust that she seems to be needing less insulin, and I have to be mindful and pay attention to all the clues to keep her safe.

Like you said, I can always increase her if I see her numbers climbing.

Thank you so much for your thoughts and your caring. We appreciate you so much. ❤️
You’re here for me every single day and I really appreciate that. Sending you and Mikan lots of hugs :bighug::bighug::bighug:
 
Back in my early days, I remember a kitty who came out of remission for the second time. What had happened is that his thyroid was no longer well controlled (T4 high) and meds needed adjusting. Same thing happened the first time time he fell out of remission. Once the hyperT was in better control, the kitty went OTJ again. Another case was an acro kitty on a decent sized insulin dose, diagnosed hyperT, and not long after meds started his dose came tumbling down but stabilized at a lower number.
Hi again, Wendy, I wonder if you think there’s any merit to reducing her dose any further or draining the dose depot or should I just try to take it day by day?
Decrease if I need to if I still feel like she’s just not staying up.

This has just been such a crazy week this past week With me being up all night watching her, but I’m trying real hard not to reduce too much, but I’m sort of conflicted about how to handle dosing and her depot.

I keep hoping I’m gonna see the depot coming down and her not diving all night long. I know she hasn’t gone under 50 or 40 as far as I know on a handheld, but this is more of a quality of life situation.
With every dose reduction I have taken she’s not climbing any higher so it doesn’t seem to have hurt her any by taking the reductions I’ve taken in the past week. :eek:
 
Hi Staci. Ivy has a great cycle today, hopefully she will keep at those numbers tonight!
That's rather good news that she needs less insulin, and maybe that means that her T4 levels will be great next time you test her. It's exciting.
I hope you can have a good rest tonight :bighug:
 
I’m not sure how to interpret what I just highlighted and replied to. Are they saying That a diabetic cat and its fructosamine levels will not be accurate?
Fructosamine number may not be accurate if kitty is also hyperT. From this note on advantages and disadvantages of the fructosamine:
Reference Ranges for Fructosamine Test
Limitation: Hyperthyroid cats with diabetes mellitus may have decreased fructosamine concentrations, despite having normal serum protein concentrations due to an increase in the protein turnover rate (decreased protein half-life) due to increased thyroid hormone concentrations.

As far reducing the dose, the 3.F5 unit depot is still influencing the numbers, as is the 3.25 unit dose. If you need a break, you could do a half dose tonight to drain the depot, then resume with 3.0 units tomorrow. Note, this is for you, not for Ivy. It's not something I'd recommend in normal circumstances unless kitty was on a much higher dose. She did have a lovely cycle today.
 
Fructosamine number may not be accurate if kitty is also hyperT. From this note on advantages and disadvantages of the fructosamine:
Reference Ranges for Fructosamine Test


As far reducing the dose, the 3.F5 unit depot is still influencing the numbers, as is the 3.25 unit dose. If you need a break, you could do a half dose tonight to drain the depot, then resume with 3.0 units tomorrow. Note, this is for you, not for Ivy. It's not something I'd recommend in normal circumstances unless kitty was on a much higher dose. She did have a lovely cycle today.
Ugh. I literally just shot the full 3 units. :arghh::arghh:
 
That's OK - Ivy could also give you a quiet night. For tonight's cycle, most of the 3.5F unit dose should be pretty much gone. Paws crossed you get some sleep.
 
Staci! This is rough on you! Really hoping you get some rest tonight. All this is way over my head and I'm sure it is too soon to tell how these reductions go for Ivy, since she still has some depot buildup from the bigger doses, but her numbers are amazing. I wish her AM and PM cycles would reverse for your sake!
 
Hi Staci. Ivy has a great cycle today, hopefully she will keep at those numbers tonight!
That's rather good news that she needs less insulin, and maybe that means that her T4 levels will be great next time you test her. It's exciting.
I hope you can have a good rest tonight :bighug:
Thank you Cecile. She did have a good day. Just hope she stays flat so we can recover Tonight.
Wishing you and Bella a nice night :bighug::bighug:
 
Staci! This is rough on you! Really hoping you get some rest tonight. All this is way over my head and I'm sure it is too soon to tell how these reductions go for Ivy, since she still has some depot buildup from the bigger doses, but her numbers are amazing. I wish her AM and PM cycles would reverse for your sake!
Thanks Seth. We appreciate your kind wishes. I’d love if she reversed her cycles too. Maybe she will hear you :)
Hope you and Bell have a nice night and a calm cycle, too :bighug::bighug:
 
Are they saying That a diabetic cat and its fructosamine levels will not be accurate?
Nerd alert: (you’ve been warned)
Fructosamine is a protein that’s had a sugar molecule attached to it. The amount of fructosamine is proportional to the amount of sugar in the blood in the preceding 3 weeks or so. (we may all have already know this since it’s a test we talk about). most of the protein we’re talking about here is albumin.

In an uncontrolled hyperthyroid state the patient’s body is set on “high”—burns calories faster, blood cells turn over faster, bowels work faster etc. One of the things that turns over faster is blood proteins (including albumin). Because the body is yanking serum proteins out of circulation faster than normal less fuctosamine forms, not because the sugar is lower but because theres less albumin for it to hang onto.
 
Nerd alert: (you’ve been warned)
Fructosamine is a protein that’s had a sugar molecule attached to it. The amount of fructosamine is proportional to the amount of sugar in the blood in the preceding 3 weeks or so. (we may all have already know this since it’s a test we talk about). most of the protein we’re talking about here is albumin.

In an uncontrolled hyperthyroid state the patient’s body is set on “high”—burns calories faster, blood cells turn over faster, bowels work faster etc. One of the things that turns over faster is blood proteins (including albumin). Because the body is yanking serum proteins out of circulation faster than normal less fuctosamine forms, not because the sugar is lower but because theres less albumin for it to hang onto.
Hi Colleen, thanks for the note I appreciate your explanation. Being that I am not a science nerd, can you explain to me what all that means about the albumin and if in fact, her hyperthyroid is becoming somewhat more stabilized how will that change What’s going on with her?

Does it mean that if it “appears” her bg is lower that’s not really true?
Since I don’t plan to have a fructosamine test done since I have the Libre on her and have a 24/7 accounting for where her glucose levels are am I missing something by not having a fructosamine??
Thank you!
:bighug::bighug:
 
Hi Colleen, thanks for the note I appreciate your explanation. Being that I am not a science nerd, can you explain to me what all that means about the albumin and if in fact, her hyperthyroid is becoming somewhat more stabilized how will that change What’s going on with her?

Does it mean that if it “appears” her bg is lower that’s not really true?
Since I don’t plan to have a fructosamine test done since I have the Libre on her and have a 24/7 accounting for where her glucose levels are am I missing something by not having a fructosamine??
Thank you!
:bighug::bighug:
Your testing is better than a fructosamine level—that would be used if the owner wasn’t testing and the cat too stressed to do reliable in-clinic testing (cats BG goes up when stressed but fructosamine doesn’t )

In a well controlled cat the fructosamine level would be reliable. In a hyperthyroid cat it may not be reliable because kitty is turning over protein too quickly for the sugar in the blood to become attached. Let’s say you’re playing a carnival game where you put a hat on some plastic ducks floating on a stream. In ten minutes we will count the ducks with hats. You have 50 hats, there are 100 ducks and in 10 minutes 50 ducks have hats.

but if I keep reaching in and pulling ducks out of the pond so there are only 25 ducks, in 10 minutes there will only be 25 ducks with hats, not 50. Because I pulled out the ducks (turned over the albumin) there’s less ducks with hats (lower feuctosamine number) even though you still have A LOT of hats (glucose)

Being hyperthyroid won’t *artificially* alter the BG reading, just the fructosamine (because fructose mine relies on protein being available to be bound with glucose). Being hyperthyroid can *affect* BG because it make the person insulin resistant (so BG can rise). Correcting the thyroid problem reduces the insulin resistance (so insulin works better) and BG can drop.
 
If it’s still unclear let me know—I’m a visual thinker so words aren’t my strong suit, I was known at the pentagon for always sketching the disease process when explaining to my patients…they thought it was to help them but it was actually to help me translate my thoughts into words for them.
 
If it’s still unclear let me know—I’m a visual thinker so words aren’t my strong suit, I was known at the pentagon for always sketching the disease process when explaining to my patients…they thought it was to help them but it was actually to help me translate my thoughts into words for them.
I think I get it. Thank you. You’re very good with the visuals. That’s a true talent :)

I’d does * sound like * maybe because Ivy‘s thyroid is being corrected under medication she is finally seeing some movement and the need for insulin is being reduced.
After two years of being on insulin perhaps she’s been having thyroid issues and it wasn’t diagnosed so it wasn’t being addressed.
So possibly she had some insulin resistance going on and now that we have been tweaking her methimazole dose on a monthly basis we may have broken through and all of a sudden pushed through the insulin resistance.
The last test we had was almost 3 weeks ago and we increased her meth dose and since then I have noticed a change and have been reducing her dose.
I have a feeling when we retest her next Tuesday we will probably see that her T4 has come down if it matches what we are seeing going on with the insulin situation.
So it will be very interesting to see what that test shows next week.
Meanwhile, I need to very carefully monitor her, which of course I do, and keep reducing her insulin If it is needed.
This is all very new to me because she has not been on this low of a dose of insulin since January of this year and her BG was much, much higher and we have only been increasing her since that time.
I guess there’s nothing I can really do until next week when we have her lab work done and that will show what’s truly going on.

Thank you so much for explaining what you are saying and sharing your knowledge with me.
:bighug::bighug::bighug:
 
After two years of being on insulin perhaps she’s been having thyroid issues and it wasn’t diagnosed so it wasn’t being addressed.
Certainly a possibility since symptoms (increased appetite, weight loss, coat changes, bowel issues) overlap
So possibly she had some insulin resistance going on and now that we have been tweaking her methimazole dose on a monthly basis we may have broken through and all of a sudden pushed through the insulin resistance.
I agree and I think this is the most likely cause as others said above. How great would it be if her diabetes dramatically improved? Similar to her, methos recently had his vetoryl increased, causing me extra anxiety bc if it kicks in his insulin requirement could suddenly decrease (he’s insulin resistant—can’t efficiently utilize insulin—because of the excess cortisol and aldosterone from his tumor…usually the dog (bc it’s a dog disease :rolleyes:) is a controlled diabetic before Vetoryl is needed so insulin is proactively reduced. Unfortunately methos insists on being opposite so his DM isn’t yet controlled so insulin is increasing…although another day like yesterday and I think we will be granted a slight decrease
 
Certainly a possibility since symptoms (increased appetite, weight loss, coat changes, bowel issues) overlap
Ivy didn't have any of the above situations which you note here...so not sure what you meant.

I'm glad Methos earned a reduction!! That's good news, too. It is interesting how one things causes changes with diabetes..
Yes, it would be great if Ivy's diabetes FINALLY is better controlled. It's been a very LONG 2+ years around here...:bighug::bighug::bighug:
 
Ivy didn't have any of the above situations which you note here...so not sure what you meant.
Most diabetic cats and most hyperthyroid cats have an increased appetite with weight loss (diabetic bc they either lack insulin or are resistant so no matter how much they eat they can’t get the glucose in their blood to get into their cells for nourishment , hyperthyroid bc their metabolism is set on Extra High). The inadequate nutrition affects coat. Diabetic nerve damage can cause constipation and/or diarrhea while hyperthyroid causes frequent bm because gut also set to extra high. I’m glad ivy had neither—so if she had no symptoms of either disease then I guess that would also explain not noticing possible cause of insulin resistance sooner
:bighug::bighug::bighug:
fingers and paws crossed for Ivy
 
I'm glad Methos earned a reduction!!
Just so no one is confused, meet those didn’t “earn” a reduction. He’s not following the usual protocol here. I contact his vet if I see either the insulin not doing anything or doing too much. And then she and I discuss whether or not his dose can be increased or decreased as needed. she reluctantly agreed to an increase to 3 1/2 because three .25 was leaving him with a Nader in the 300s and ketones of 0.6. But she and I both knew when he was 3 1/2 before his response to the insulin was all over the map. the Internist thinks that’s because his sugar is being influenced mostly from the tumor so it’s not going to respond in the way most diabetics would respond to insulin. Which is why he got an increase. The Internist thinks that’s because his sugar is being influenced mostly from the tumor so it’s not going to respond in the way most diabetics would respond to insulin. Which is why he got a vetotyl increase in the hopes that I would not need to increase his insulin because at a higher dose of insulin depending on how his tumor feels it is either too much or not enough. Just a clarify so no mod jumps in to say that my cat is not the typical cat.
 
Most diabetic cats and most hyperthyroid cats have an increased appetite with weight loss (diabetic bc they either lack insulin or are resistant so no matter how much they eat they can’t get the glucose in their blood to get into their cells for nourishment , hyperthyroid bc their metabolism is set on Extra High). The inadequate nutrition affects coat. Diabetic nerve damage can cause constipation and/or diarrhea while hyperthyroid causes frequent bm because gut also set to extra high. I’m glad ivy had neither—so if she had no symptoms of either disease then I guess that would also explain not noticing possible cause of insulin resistance sooner
:bighug::bighug::bighug:
fingers and paws crossed for Ivy
Yes, agreed, Ivy had none of those symptoms. Only the neuropathy in her hind legs, which I noticed early on after she was diagnosed with FD. She still walks on her hocks :arghh:
But it doesn't stop her from getting around or jumping on the sofa or chair.
With FD, I noticed her drinking and peeing more, so that was my tip off that something was off.

With hyperT I didn't see any of the typical symptoms, just her T4 was elevated in March. So they began her on methimazole and we have been steadily increasing dose over these months. I think we just hit a breakthrough and she's all of a sudden needing less insulin.
Yes, everything crossed that we are making some type of headway. :bighug::bighug::bighug:
 
Just so no one is confused, meet those didn’t “earn” a reduction. He’s not following the usual protocol here. I contact his vet if I see either the insulin not doing anything or doing too much. And then she and I discuss whether or not his dose can be increased or decreased as needed. she reluctantly agreed to an increase to 3 1/2 because three .25 was leaving him with a Nader in the 300s and ketones of 0.6. But she and I both knew when he was 3 1/2 before his response to the insulin was all over the map. the Internist thinks that’s because his sugar is being influenced mostly from the tumor so it’s not going to respond in the way most diabetics would respond to insulin. Which is why he got an increase. The Internist thinks that’s because his sugar is being influenced mostly from the tumor so it’s not going to respond in the way most diabetics would respond to insulin. Which is why he got a vetotyl increase in the hopes that I would not need to increase his insulin because at a higher dose of insulin depending on how his tumor feels it is either too much or not enough. Just a clarify so no mod jumps in to say that my cat is not the typical cat.
It's so good you have a very good relationship with your vet, Colleen. And great that they are so involved with helping you to make tweaks to Methos' dose of all meds he is on.
(I don't have that kind of vet relationship or guidance)
Here's hoping that continued good guidance will help Methos improve with all conditions over time! :bighug::bighug::bighug::bighug:
 
It's so good you have a very good relationship with your vet, Colleen. And great that they are so involved with helping you to make tweaks to Methos' dose of all meds he is on.
It is. I am so very blessed. I hated moving away from friends to come to a state I can’t really afford but I love my little town, my little house, and I lucked into an amazing vet. I wish everyone here could be so lucky.

luckily for everyone here this is also an amazing place with wonderful help and guidance. I hope your night is quiet. At the risk of jinxing myself mine should be, so I may give methos some fluids and get some sleep. Maybe even five hours !!

:bighug::bighug::bighug:
 
It is. I am so very blessed. I hated moving away from friends to come to a state I can’t really afford but I love my little town, my little house, and I lucked into an amazing vet. I wish everyone here could be so lucky.

luckily for everyone here this is also an amazing place with wonderful help and guidance. I hope your night is quiet. At the risk of jinxing myself mine should be, so I may give methos some fluids and get some sleep. Maybe even five hours !!

:bighug::bighug::bighug:
Thank you for the good wishes Colleen. (Where are you located, in general I mean?)
I’m sorry you’re without your friends from the move. I’m sure that was very hard (for work?)

You are right that we are so lucky to have each other for support here. I am thankful for that every day, too!

I’m so glad for you and your kitties that you’ve found a wonderful and supportive vet where you are. I wish everyone could be so lucky in that department.

I hope you had a calm night with some rest! You surely need it, too. Hugs :bighug::bighug::bighug:
 
Hi Staci—I hope you got a little sleep last night. I moved to the central coast of CA (technically although I’m not in a beach city, but a more rural inland small town on the eastern side of the mountains—not beachy weather at all, more like desert)—the move was to be closer to family when I retired from military. Leaving friends behind is something you get used to in the military but at the time I’d planned to often visit them—not something I can do right now. But it is what it is—I got a wonderful vet in the deal and that’s priceless.
 
Hi Staci—I hope you got a little sleep last night. I moved to the central coast of CA (technically although I’m not in a beach city, but a more rural inland small town on the eastern side of the mountains—not beachy weather at all, more like desert)—the move was to be closer to family when I retired from military. Leaving friends behind is something you get used to in the military but at the time I’d planned to often visit them—not something I can do right now. But it is what it is—I got a wonderful vet in the deal and that’s priceless.
Hi Colleen, oh I see! I totally understand.
I hear you on that no travel. I can’t leave for more than a few hours. So travel is completely out of the question for me, too.

I’m so glad you did get a great vet though! :cat:
 
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