12/09/2011

After the “After”

Five months and well over 48 inches ago, I had a full head of hair – hair that, in fact, I had not cut in almost three years. Its tenure came to an abrupt end at the 2011 St. Baldrick’s Shave-a-Thon, an annual event which benefits the St. Baldrick’s Foundation for pediatric cancer research.

Before
After

I was joined by a number of other brave women, including one who traveled from the far reaches of Minnesota to participate in this event. One young girl surrendered nearly two feet of beautiful blonde locks, while another female participant – facing her own battle with cancer, having only recently re-grown her hair lost to the rigors of treatment – shaved her head in honor of kids fighting the same fight.

Once I took my seat in the barber’s chair, it hit me smack in the face.

For a woman, taking it all off is insanely intense.

This is not to discredit the generosity and selflessness of the men who shaved their heads for the cause. Each fine fellow who “took the bald” helped raise awareness, raise money and raise the spirits of the pediatric cancer patients in the audience that day.

Two months following the event, however, you’d be hard pressed to spot the male shavees in a crowd.

Five months after the event, we women shavees tow a strikingly different line. Five months and a meager two inches later, I still resemble a spiky Chia® pet and feel a hint of surprise each time I catch a glimpse of my reflection.

My involvement with St. Baldrick’s opened my heart to the hardships and hope of pediatric cancer patients. It’s after the “after” that has opened my eyes to the issues of identity and confidence faced by women who lose their hair to cancer treatment. This foray into female baldness has taught me a lot about how people view women and how a woman can view herself.

I’ve heard the questions left unasked and felt those curious sideways glances. Whispers or giggles, conversation that falls to a hush, gazes met and gazes averted as you walk by. Standing out when sometimes you just want to blend in.

In a blog for Psychology Today, Deborah King, a health and wellness expert and media commentator, explored the significant relationship between a woman and her hair with the following: "You know the saying, a woman’s crowning glory is her hair. Without it, she seems ill or disfigured in the eyes of the world, and therefore in her own eyes."

With every emotion I’ve experienced since surrendering my hair – the insecurity, the uneasy sense of standing out, the fears of being judged, or pitied, or dismissed for my appearance – I am at least bolstered by the fact that I had a choice. I chose to take on this new appearance. I went willingly into bald. Beyond that, I had my health.

Women who lose their hair to the rigors of cancer treatment do not have that choice. These women, confronted with cancer and moving forward into the unknown, are faced with even losing the comfort of their old familiar reflection in the mirror. Their illness and struggle, things so intensely personal, are magnified by this hair loss and highlighted by the striking transition to baldness.

Ann Yager, director of the Village Pointe Cancer Center and a cancer survivor, recalls the surprise of learning that she would lose her hair as early as one week into chemotherapy treatments.

The experience of hair loss for a cancer patient can be startling. "Your hair begins to fall out in big clumps," Ann said. The initial loss led her to shave her head, using "a sticky lint roller every morning and night" to corral the remaining loose hairs.

"I think many times, hair loss is such an emotional time for many patients," Ann continues. "It was always the obvious thing that made me a cancer patient to everyone else. I wanted to be treated the same, and always felt like my lack of hair … defined me as a ‘patient.’"

Opened in the spring of 2011, The Life Renewal Center at the Village Pointe Cancer Center seeks to tackle many of the appearance-related issues that cancer patients face. Now, in addition to the clinical expertise available at the hospital, a space exists to address the emotional side of cancer treatment. Among the services offered at the center are wig fitting, prosthetic assistance, educational sessions, massage therapy, yoga and support group meetings. The Life Renewal Center currently has a grant from the Susan G. Komen foundation which allows the center to provide wigs, free of charge, for people who might not otherwise be able to afford one.

Life Renewal Center The Life Renewal Center at the Village Pointe Cancer Center

"When you feel unattractive, you just don’t have any spark," Ann said. "It’s amazing how much your hair plays a role."

Send a spark this holiday season by donating to the Life Renewal Center. Contact Judy Booth, major gifts officer in the Office of Development, at 402-552-6707 or jubooth@nebraskamed.com to support patients seeking wigs or other confidence-building assistance to help them face the challenges of their illness.

Your support can help ignite the spirit of a survivor this season.

Learn more about the Life Renewal Center in the current issue of 1001.

Jordan Maddex
Graphic Designer
The Nebraska Medical Center

To find a physician at The Nebraska Medical Center please call 800-922-0000.

10/25/2011

The Evolution of Leukemia Treatment

Evolution of Leukemia Treatment - Infographic

More than 250,000 people are living with, or in remission from, leukemia in the United States today. That means that approximately every four minutes, someone else is diagnosed with the disease. Those struggling to overcome leukemia come from all walks of life—in fact, non-Hodgkin’s lymphoma is the fifth most common cancer in the United States, affecting people of both genders and of all ages. Despite this fact, adults are diagnosed with leukemia 10 times more often than children, and the median age at diagnosis is 66 years old.

Treatments for leukemia have come a long way since the early 1900s when the primary therapy for the disease was arsenic. This evolution can be seen as a function of the way physicians and researchers have come to understand the disease, and early in the 20th century, four types of leukemia were classified: chronic lymphocytic leukemia, chronic myelogenous leukemia, acute lymphocytic leukemia, and erythroleukemia. It was in the 1920s that doctors understood that radiation, which was then used as a standard treatment for leukemia, could be a cause of the disease as well as a cure.

Today many people both young and old are able to successfully fight the disease with modern treatments like chemotherapy and bone marrow transplants, and research is being done all the time for effective and safe new ways of helping people win the battle with leukemia.

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10/13/2011

LRF Meet the Doctor Series
Julie Vose, MD

Julie Vose, MDI am looking forward to being the guest physician speaking at the Lymphoma Research Foundation’s Meet the Doctor series where I will be giving an update on lymphoma treatment options. The meet the doctor series allows patients to have close interactions with physicians who are specialists in their area of care and research. It gives them opportunities to interact with others in a similar situation and ask questions.

The program includes a general Lymphoma overview, an update on lymphoma treatment and current research. I think it is important that people know there are about 100 different types of lymphomas and the diagnosis and treatment need to be personalized for each patient and is very specialized based on many factors.

This spring new research illustrated that some patients with transformed lymphoma showed remarkable response to lenalidomide, an oral drug with few side effects. I believe strongly in the importance of lymphoma research and clinical trials conducted to discover new lymphoma treatments. At any given time, The University of Nebraska Medical Center has about 20 to 25 clinical trials open for various types of lymphomas and we gather information on all patients to help future patients.

I encourage my patients to join clinical trials during all phases. Clinical trials examine the side effects, effectiveness and outcomes of new treatments compared to standard of care agents.

Event Details
Tuesday, Oct. 18
6 p.m.
Michael F. Sorrell Center for Health Science Education
4201 Emile Street
Room: MSC 4053 (Seminar)
Registration
Phone: 800-500-9976
E-mail: mspellman@lymphoma.org
Web: lymphoma.org/askthedoctor

Julie Vose, MD
Hematology Oncology
The Nebraska Medical Center

Neumann M. and Mildred E. Harris Professor, Chief, Division of Hematology Oncology and Professor of Medicine, University of Nebraska Medical Center

Call 800-922-0000 to make an appointment with Dr. Julie Vose. For clinic location and hours use the Find a Physician link.

09/26/2011

Update on Acute Myeloid Leukemia (AML) - Mojtaba Akhtari, MD

Akhtari

Recently I was invited to give an Update on Acute Myeloid Leukemia (AML) at a seminar put on by the Leukemia Lymphoma Society. It was important for me to take the opportunity to share with patients, caregivers and health-care professionals that we are we are doing more and more allogeneic stem cell transplant for AML and outcomes are improving. Our center is the only one, which can offer this type of therapy in the state of Nebraska.

At the seminar, I received a couple of questions regarding a new leukemia treatment which seems to have exceeded researchers wildest expectations. This new strategy is quite attractive since it has the potentials to overcome problems such as short-lived T-cell expansion and transient antitumor effect, which are the major limiting factors for using adoptive T cell immunotherapy. Interestingly, the patient developed delayed tumor lysis syndrome 22 days after receiving autologous T cells; and chimeric antigen receptor-positive T cells were detectable 6 months after treatment; those observations are indicative of prolonged and sustained effector function of the transfused chimeric-receptor T cells. This case report highlights the promising potentials of adoptive T cell immunotherapy by redirecting them, through chimeric antigen receptors, as a novel and effective therapeutic modality for cancer.

Cancer physicians, nurses and scientists are in a good fight against cancer and trying to help patients.

Cancer is a unique diagnosis, which changes patients' lives forever. There are a lot of myths, controversies and unknowns that can make patients feel helpless and defeated. Cancer physicians, nurses and scientists are in a good fight against cancer and trying to help patients. I am involved in research on therapy-related myelodyspalstic syndrome and acute myeloid leukemia, and bone marrow transplantation. I regularly participate in clinical trials. I encourage my patients to join clinical trials as it can provide a more structured care for each of them, and at the same time we could answer important questions in cancer.

Mojtaba Akhtari, MD
Hematology Oncology
The Nebraska Medical Center

Assistant Professor, Internal Medicine, Hematology Oncology, University of Nebraska Medical Center

Call 800-922-0000 to make an appointment with Dr. Mojtaba Akhtari. For clinic location and hours use the Find a Physician link.

07/29/2011

Superstar in the OR

Foster Cue up the Michael Buble. Crank up the Sheryl Crow, Queen and Colbie Caillat. Turn up the lights, ratchet up the pressure, and prepare to witness a performance of epic proportions. This isn’t center stage at the Orpheum or center court at the Qwest Center. The audience is limited to a very fortunate few. This is the operating room at The Nebraska Medical Center. And the super-rock-star-athlete – the Michael Jordan/Justin Bieber amalgam in the middle of it all- is Dr. Jason Foster.

As a member of the hospital’s marketing and media relations team, I have the opportunity to be in the operating room from time-to-time to capture a wide range of life-saving and revolutionary procedures. We use these photos and videos for student, patient and public education - all with patient permission, of course. I always look forward to these days – I know I’m going to see something very few people will ever have the opportunity to see. But while I knew the procedure I was about to witness was unique, I had no idea what kind of awe-inspiring performance I was going to see from the surgeon.

Foster is one of a handful of surgical oncologists in the country who performs a procedure called Hyperthermic Intraperitoneal Chemotherapy, also known as hot chemo. It begins with the traditional removal of tumors from a patient’s abdominal cavity, and concludes with bathing the patient’s internal organs in a heated solution of chemotherapy to kill the microscopic cancer cells, which are likely still present.

The events that follow astonish many of the other medical professionals in the room. But Foster is unfazed. Foster is unflappable.

It’s a procedure that rolls several treatments into one – the surgery and chemotherapy happens all at once, instead of multiple surgeries and multiple rounds of chemo each time the cancer recurs. But not only is it unique, it is also time consuming. Scrubbed in, and with the modern day equivalent of a mix tape playing over the operating room’s speaker system, Foster makes the first incision at 8:30 a.m.

The events that follow astonish many of the other medical professionals in the room. But Foster is unfazed. Foster is unflappable. The hours tick by. Foster’s focus on the task at hand is as sharp as when he started. By the middle of the afternoon, Foster is still on his feet. There have been no breaks. There have been no signs of stretching tired back or leg muscles. By early evening, the surgical mix tape plays on, and Foster still hasn’t missed a beat. He calls out for surgical instruments in the same calm but assertive voice. He spends hours on one side of the patient removing cancerous organs and tissue, then slowly strides to the other side for a few hours more. Where most others would crumble, Foster is comfortable. Where some would panic, Foster perseveres.

It is now 10 p.m. and the meticulous removal of the cancer continues. Still no breaks – still no stretches. Other members of the surgical team have rotated in as others have gone home. But Foster remains. At 1:30 a.m. the following morning – 17 hours after he started - Dr. Jason Foster calls it a night.

He begins again roughly ten hours later. With the visible cancer removed, Foster pumps the heated chemotherapy into the patient’s abdominal cavity. For two more hours, the doctors assisting Foster shake the patient’s stomach back and forth – seeking out any rogue cells that could cause the cancer to recur. The entire procedure lasts nearly 24 hours. But Foster estimates it will give the patient another four or five years of life before a possible recurrence. In many cases, it will give them a quality of life they never could’ve had with traditional treatment. Let’s see Michael Jordan or Justin Bieber pull that off.

Taylor-Wilson Taylor Wilson
Senior Media Relations Specialist
The Nebraska Medical Center

For media relations please contact Taylor Wilson Monday through Friday from 8:30 a.m. to 4:30 p.m. by calling (402) 559-7037 or contact us online.

To make an appointment with a physician at The Nebraska Medical Center please call 800-922-0000.

07/13/2011

Why I’m Doing This – Part 2

I expected that having my head shaved would be an "experience." That was honestly one of the secondary reasons I decided to do it. As I explained in a previous post, my primary reasons were the same as everyone who donates their time and/or money to a cause like this: to move the ball forward on researching treatments and cures.

I guess didn’t expect it to be the moving experience it turned out to be. Maybe that’s a lack of foresight on my part, given the fact that this was a fundraiser for pediatric cancer research. I’d been to three St. Baldrick’s Foundation shave-a-thons before, but I suppose it’s a little different when you’re in the chair and have spent weeks hitting up your friends and family for donations.

It’s easy to get choked up when you hear about why people raised money for this cause and why they chose to get their heads shaved. With the exception of Dr. Bruce Gordon (who will be the first to tell you that nature has done some of the head shaving for him already), us full-grown men had the least to lose in terms of appearance. What impressed me were the women like 21 MORGAN-smaller year old Anna Meneely who drove to The Nebraska Medical Center from Minnesota to have her very long hair cut off; and the children like eight-year-old Christina and nine-year-old Morgan.

Morgan’s mom Jenise decided to have her head shaved at last year’s event. She was there to cut hair not to have hers cut. Morgan liked what her mom did, so this year she joined in. Jenise and Morgan were the first ones here for the shave-a-thon. They were there waiting as everyone was still setting up; Jenise, Morgan, and a large jar full of cash Morgan collected for the cause.

Christina came because she had a friend at school who lost her hair because of cancer treatment. She saw some kids teasing her. That was all the motivation she needed. Hair gone, money raised, and hopefully less reason to tease a child who’s lost her hair through no fault of her own. Better still, Christina convinced her aunt who came to watch the shave-a-thon to go bald as well. Pretty amazing isn’t it?

 

It was stories like those which caused some of us to get a little choked up, including event MC Adrian Whitsett, a news anchor and reporter for KETV Channel 7. Adrian is one of the nicest guys you’ll ever meet. He’s also an ex-Marine and Iraq War veteran, someone who’s definitely earned his tough-guy stripes. Hearing Christina’s story moved all of us. The event started with 12 "shavees" and finished with 22. Adrian’s charm and personality helped convince an additional ten people who just came to watch take a seat in the "hair chair" and go bald for the cause.

Baltes
Supporting their father in the fight against pediatric cancer, Baltes’s sons Paul and James decided to shave their heads.
And that’s why we did it - because fundraisers like this or for other worthy causes work on a number of levels. They help raise necessary money. They help educate and they help us to think of a world that’s bigger than our own. They help “regular” people like Morgan, or any of the other people who decided that words without action weren’t enough to be part of a solution. That feeling rubbed off on my own kids. They were just there to watch but after seeing two of Dr. Gordon’s patients taking turns shaving his head, and hearing some of the other stories of why people were involved, they both decided to go under the clippers. All three of us are temporarily bald, richer in experience, and a little more well-rounded. Especially on top.

Paul Baltes
Senior Media Relations Specialist
The Nebraska Medical Center

For media relations please contact Paul Baltes Monday through Friday from 8:30 a.m. to 4:30 p.m. by calling (402) 552-2282 or contact us online.

To find a physician at The Nebraska Medical Center please call 800-922-0000.

07/08/2011

A Little Less Hair – a Little More Research

JordanMaddex

Working for a hospital, even in a non-clinical setting, I’ve seen a lot of things. And when I became a mom three years ago, I began to notice one such thing in particular - much more often, and with much greater intensity.

Sick children.

I read stories in our employee newsletter of our exceptional nurses going above and beyond for a child struggling in the PICU. When I am on my way to a meeting, I see a parent pushing his or her child in a wheelchair through the halls of the hospital for a change of scenery--probably hoping for distraction from the daily pokes and prods and pains of inpatient life.

And then, I came across patient blogs.

Some of these brave families share their experiences - good, bad, terrifying and beyond - in daily journaling and family photos. They celebrate the remissions and openly grieve the setbacks. They are personal, raw, engaging and impossible to ignore.

It’s easy to fall in love with these children - their will to survive, their warm smiles in spite of needles and tests, their love for life that is evident in even the sickest of eyes. Even their families take up residence in a special place in my heart. I imagine the mom is just trying to juggle hospital life and home, the dad searching for answers to the latest medical surprise.

My hair will grow back, ya’ll. A child who loses the battle with cancer will not.

A happy ending for each child and their family is what I wish for on a daily basis.

A few weeks ago, I was sitting in the waiting room at a doctor's office for my own minor medical inconvenience, agitated at the wait I turned to the distraction of scrolling through my Facebook news feed. I read that a little girl I have followed for years lost her fight to cancer. And I was stunned - numb.

How could she be gone? Just like that? How does a family go on?

I think the family blog said it best - "Words fail."

When I tucked my son in bed that night, I let myself read just one more book, or three, or five. I let him stall my exit with close to a million "What's that?!" inquiries. I looked at my healthy boy and thought of the family that would, without question, give anything for that one more book, that one more question - the family that lost those things when they said goodbye to their little girl.

Cancer is mean. Relentless. It is a word that strikes fear into even the most seasoned adult. Kids deserve days of wonder and exploration, not doctors upon doctors - candy (in moderation, of course), not chemo - a CHILDHOOD, not cancer.

My hair will grow back, ya’ll. A child who loses the battle with cancer will not.

If the money raised by the St. Baldricks foundation can give one more child a chance at a cancer-free childhood - or spare one more family the pain of losing their pride and joy - I'd say a little less hair and a little more research seems a most wonderful trade.

If you care to join me on the journey to baldness, please check out my page at http://www.stbaldricks.org/participants/mypage/participantid/469975. A donation to the Patient Assistance Fund at The Nebraska Medical Center can also support the families dealing with extended hospitalizations.

Every donation is one that can help build hope.

Jordan Maddex
Graphic Designer
The Nebraska Medical Center

To find a physician at The Nebraska Medical Center please call 800-922-0000.

07/07/2011

Why I’m Doing This - Part 1

Paul-Baltes

It’s a question I’m bound to be asked in the next several weeks.

"What happened to your hair?"

"Did you do that on purpose?"

"Why did you do it?"

"Are you OK?"

I’m fine. Which is why I’m doing this - shaving my head in the name of helping others who aren’t OK. Specifically, kids who are in the fight of their lives against cancer.

I’m not one of the many people here at the medical center who work directly to help these kids in their fight. There are lots of them. The doctors, the nurses, the techs and therapists and the child life specialists who give so much of themselves so that these children who are up to their necks in an intensely adult world don’t forget what it means to be a kid.

I’m one of the people who help to tell their stories. My job title is “senior media relations specialist.” I help reporters with stories involving our patient. I’m one of The Nebraska Medical Center’s spokesmen. I’m also one of the guys behind our Facebook, Twitter, and YouTube pages.

Less than a year ago I put together a video for our YouTube channel about a kid named BJ. A regular, happy kid who found out he had cancer when he was ten. The day I met BJ and his mom, he was finishing his last cancer treatment. His family was cautiously optimistic. He wasn’t in the mood to talk that day; eleven year olds can be like that sometimes. But he had a heck of a smile.

 

And now the hard part. A few weeks after I met BJ and his mom, he was back in the hospital. It wasn’t the cancer that was back, he’d just gotten an infection. Something most of us could fight off. But BJ couldn’t. He died at just eleven years old.

This will be the fourth year I’ll be at the St. Baldrick’s fundraiser. We usually have the news media there to cover the event, so I’m there to make sure they get all the information they need. At last year’s event, I thought, “I should do that.” After I met BJ and his family, I decided I would.

So that’s why I’m doing this. Because maybe the $1500 or so dollars I raise for the St. Baldrick’s Foundation will be part of what pushes forward a new or improved treatment. A cynical person might not believe new treatments will ever come. But those of us who work at the med center, or people who’ve been patients here know those advances do happen. There are people all around us working on them every day. Because of past advances in treatment (some very big ones developed right here at the med center), there are many thousands of people alive today who certainly would have died of cancer in the past.

On the surface, it’s just a haircut. It’ll grow back (though my wife has asked a few times, “What if it grows back grey?” I’m not sure what to make of that...). It’s also a chance for someone like me who isn’t “med school material” to be part of this effort. It’s not too late to join us. You can help the St. Baldrick’s Foundation through my donor page: www.stbaldricks.org/participants/PaulBaltes. If you’d like to support our patients going through this fight right now, The Nebraska Medical Center patient assistance fund is a great way to do that.

One last note about my soon-to-be-bald head; I just ask everyone who may be tempted pat me on the head, offer to shine it for me, or put sunscreen on it - please refrain. Or better yet, make a donation to the cause and I just might let you.

Paul Baltes
Senior Media Relations Specialist
The Nebraska Medical Center

For media relations please contact Paul Baltes Monday through Friday from 8:30 a.m. to 4:30 p.m. by calling (402) 552-2282 or contact us online.

To find a physician at The Nebraska Medical Center please call 800-922-0000.

06/29/2011

Quick Tip

In a recent brain tumor support group meeting, Carol Gaebler, MS, CCC-SLP, presented strategies for adapting to changes in thinking and memory due to cancer treatments.

Impairments in cognitive function occur in memory, attention, concentration, organization skills, judgment and problem solving.

Suggested adaptations included making lists, using prewritten notes, ask people to repeat messages, bring tape recorder to important meetings, limit distractions, keep a routine and plan breaks in activities, rephrase and summarize at end of discussions and meetings, write out important information in advance if would need to complete forms, plan for next day (your lunch, clothes to wear), make "pro" and "con" list before making decisions.

Call 800-922-0000 to make an appointment with a brain cancer specialist.

06/02/2011

Answering the Call on the Cell Phone and Brain Cancer Debate

UNMCNicoleShonkaLG

Recently media outlet CNN has aired a report citing results from the largest international study on cell phones claiming those who used a cell phone for 10 years or more had doubled the rate of brain glioma, a type of brain tumor.

As a physician who has read and reviewed the results of the study, I find this information to be inaccurate. This study, known as the INTERPHONE study, did not conclude that there is any increased risk for brain tumor development from cell phones. The highest decile (10 percent) of users had a slight increased risk but when they evaluated that data, they found that those participants’ recall of the number of hours spent on cell phones was impossible. The study overall did not show an increased risk.

I also noticed that MSNBC reported that this same study only evaluated with people who already had brain cancer. Again, having read the actual study, published in the International Journal of Epidemiology in 2010, I find this statement is also inaccurate. The study looked at 2,400 meningioma and 2,700 glioma patients along with 7,600 controls, or people without brain tumors.

The odds ratio for cell phone use and developing a meningioma was 0.79 and for developing a glioma was 0.81. If an odds ratio is below 1.0, then the factor studied cannot be determined to increase the risk to develop a disease. Only if the odds ratio is greater than 1.0 do we consider the factor studied as increasing the risk for a disease.

Maybe someday down the road a conclusive link will be made between the two, but the studies they are citing do not prove this link.

To recap, as of today, no new studies have been done and there is still no scientific evidence proving a link between cell phone usage and brain tumors. Maybe someday down the road a conclusive link will be made between the two, but the studies they are citing do not prove this link. I encourage anyone interested in the topic to read the studies thoroughly and speak with a professional with any questions regarding the research. Below are some links to related studies.

Patients of The Nebraska Medical Center and residents of the state of Nebraska may utilize the University of Nebraska Medical Center McGoogan Library of Medicine’s Consumer Health Information Service (CHIRS) free of charge for researching conditions and medical information and understanding personal health issues.

To use the University of Nebraska Medical Center McGoogan Library of Medicine’s Consumer Health Information Service (CHIRS) call 866-800-5209.

Recent studies regarding cell phone use and cancer risk

Volkow et al. Effects of cell phone radiofrequency signal exposure on brain glucose metabolism. Journal of the American Medical Association 2011; 305(8):808-814

Myung et al. Mobile phone use and risk of tumors: a meta-analysis. Journal of Clinical Oncology 2009; 27:5565

Brain tumour risk in relation to mobile telephone use: results of the INTERPHONE international case-control study. International Journal of Epidemiology 2010;39:675

Nicole Shonka, MD
Neuro-oncologist
The Nebraska Medical Center

Assistant Professor, University of Nebraska Medical Center

Call 800-922-0000 to make an appointment with Dr. Nicole Shonka.

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