Archive for the ‘Diet’ category

The Integrative Journey

March 28th, 2022

 

After having returned from the Ornish Coronary Artery Disease Reversal program in Sausalito, California, my life, my mental health, and my view of healthcare had been changed forever. Having previously been selected as the CEO of a traditional hospital that, like all hospitals, was all about sickness, I now realized I had new tools in my toolbox, new arrows in my quiver, and new eggs in my basket. . . you get the idea.

That workshop had taught me that there is no one right way to go through life, to achieve a better quality of life, to deal with health issues, and to survive this journey. I came home armed and informed that sickness could be stopped or reversed, and this concept did not just apply to heart disease. There was significant evidence that Type 2 diabetes, some autoimmune diseases, erectile dysfunction, some prostate cancers and other diseases could be positively impacted by diet, exercise, stress management and group support.

As Americans in one of only two developed countries that permits advertising of pharmaceutical products on our air waves, we had been carefully trained, pruned, mentally shaped and, if you will, brainwashed to believe in the “heal to the pill” method of care. We get sick, go to the doctor or hospital, are prescribed pills, and move on. Or we get a shot, or get the offending body part cut out, and life goes on, or not. Those were the options previously permitted on the proverbial healthcare menu.

It was only a few years later when the chief scientific officer of a major drug company explained his world to me like this, “You don’t understand the pharmaceutical industry. We’re like the movie business. We only want the blockbusters. We want to give you a pill that you’ll have to take from the time you’re five until you die at 75 or 80 that will never make you better. It will just help control the symptoms.”

In 1987, I was working toward another Masters Degree at Carnegie Mellon University, and our epidemiology professor challenged us to find something that would significantly alter the health, lives, or future of at risk people in our hospital’s catchment area. I decided to have our physicians give pneumococcal (pneumonia) vaccines to our at-risk senior population.

When I told my CEO of that plan, he suggested I present it to the primary care physicians at their monthly meeting. I boldly stood in front of a room full of internal medicine and family practice physicians and made my pitch. You would have thought I asked them to bring in their first born child to be assassinated. I was very nearly strung up. I heard cries like, “How are we supposed to pay or bills? How can we pay off our loans? What am I supposed to do, pull my kids out of college? Treating those patients is how we make our livings.”

Ironically, in 2017, I found myself in front of the leadership of a major health system with 125 cardiologists, and I informed them we were going to enter into the coronary artery disease reversal program. The spokesperson for the group put up his hand and said, “Let’s talk about the elephant in the room, do we really want these people to get better?”

Bottom line, we have created a medical industrial complex that is dependent upon sickness, and what I had learned in California was, “Yes, we’re all going to eventually die, but why not give your body a chance and live as healthy as you can for as long as you can?”

Interestingly, the Ornish program was not yet being offered in many places in the country, and when I asked if we could bring it to Western Pennsylvania, there was a long pause on the other end of the line, and Dr. Ornish asked,”What do you want?” He explained that he was working on a licensing project with our local Blue Cross, and I was not going to be able to bring it into my hospital, but that didn’t stop me.

We worked out a deal with some local churches to bring elements of the program that were available to the public just to test the water. Within weeks, we had heart disease participants in their 60’s, 70’s, and 80’s doing stretching exercises, meditation in whatever form they selected, nonjudgmental group support, and vegetarian covered dishes to church halls and basements.

The amazing thing about this program was that people who were suffering from angina pectoris (chest discomfort) found relief in sometimes less than a few weeks. They were no longer living in fear of dropping dead, and more importantly, they were taking control of their life without having to be afraid of the outcome. It was giving their bodies a chance to do what those bodies are so great a doing, healing.

Of course no good deed goes unpunished, and those non-believers, or those individuals who were potentially most negatively impacted by a health and wellness program began to identify me as a zealot, a fanatic, a vegetarian warrior. I was openly mocked at board and physician meetings when I ate my specially prepared vegetarian meals, and when I started holding meetings on the indoor track we had created with our new wellness center, those who would not benefit from my new found center for wellbeing went on a mission to discredit these ideas.

At one point the powerful head of a local Baptist Church began to take steps to have various conservative sects actually picket our hospital for teaching yoga and trying to take away the souls of our participants. (Their interpretation of yoga.) One of our powerful physicians sent emails on a regular basis to our staff with the intention of discrediting me and my programs for wellness and prevention. It was not unlike Salem, Massachusetts for a few years. Then something incredibly powerful occurred.

I was, for only the second time in my 30+ year career in hospital administration, invited to have dinner at a physician’s home. At that dinner, I was seated beside our local congressman, John P. (Jack) Murtha. The host’s wife did not know what to prepare for my meal so she gave me a large white plate with two egg whites on it. When the Congressman saw it, he asked, “What the heck is wrong with you?” I carefully explained my experiences in California with heart disease reversal, meeting patients who had successfully stopped and or reversed their disease, and how well they were living. He leaned back and said, “We’re spending a billion dollars a year on heart disease in the military. Maybe if you got to Bethesda or Walter Reed and find someone who would work with you, I might be able to help>”

We knew that his 25 plus years in Congress had given him some seniority, but what I didn’t realize was that he was in charge of the subcommittee on appropriations for the department of defense. His committee was responsible for well over $300B dollars of government spending. Well, my board chair was a former Navy airman and he flew me to Bethesda where we met with and were politely turned down by the Navy. A few months later when I was in D.C. for a meeting, I got in a cab and, without any knowledge of military life, command, or structure, I showed up at the front door of Walter Reed Army Military Hospital which became Walter Reed National Military Medical Center Bethesda several years later.

When I walked inside, I saw hundreds of soldiers, family members, and medical personnel, but I didn’t have an appointment. Consequently, I walked up to the first white coat I saw, explained who I was, where I was from, and who had suggested I come there. Serendipitously, he was the only physician who had ever received a federal earmark and it was about $75M from Senator Ted Stevens of Alaska to create a center for the study of prostate cancer. He looked at me, smiled, and said, “Follow me.”

After meeting with a Walter Reed cardiologist, I went home, wrote a white paper, and several months later we established two Ornish Centers, one at Walter Reed and one at Windber with a grant that was made possible through Congressman Murtha. The reason you need to understand this back story is that without these grants, there would have been no way a hospital our size could have supported a program featuring integrative medicine.

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Pittsburgh Post Gazette. Op-Ed

December 11th, 2017

Nick Jacobs, among his other affiliations, is an officer of the Integrative Health Policy Consortium, which represents more than 600,000 IHM practitioners; president of the Clinical and Translational Genome Research Institute, which he founded; and a consultant to the Department of Defense in breast cancer research.

Pennsylvanians received good news recently when the Pennsylvania Health Care Cost Containment Council reported that hospital readmissions and mortality rates continue falling locally and statewide.

The report shows these rates declining for a number of common types of treatments. It gives much of the credit to a “commitment of PA hospitals to provide quality care” and to the Affordable Care Act, which ties reimbursements to that quality care. This, in turn, encourages health care facilities to strive for improved mortality rates because doing so helps keep government funds flowing through their doors.

Regardless of the motivation, this is good news. But it’s not good enough.The mortality rate could be improved even more dramatically if more healthcare administrators and physicians would introduce integrative health and medicine practices into their services.

Integrative health and medicine (IHM), as defined by the American Board of Integrative Medicine and the Academic Consortium for Integrative Medicine & Health, recognizes the importance of the relationship between practitioner and patient. IHM focuses on the whole person, is evidenced-based and employs a wide range of appropriate therapies, healthcare professionals and disciplines to achieve optimal health and healing.

Integrative health practice includes treatments and therapies such as acupuncture; natural products; deep breathing; Tai chi and Qi Gong; meditation; massage; special anti-inflammatory diets; progressive relaxation; journaling; biofeedback; pet, music and dance therapies; hypnosis and guided imagery. When provided by a licensed or certified health care professional, IHM provides numerous benefits. It can decrease chronic pain, post-operative pain and the need for medications. It can improve patient satisfaction and shorten hospital stays. It can lower mortality rates. IHM methods also are relatively inexpensive.

Many places, including the Cleveland Clinic, have reported cost savings per patient, while also seeing reductions in patient anxiety, pain, and medications. During my tenure as CEO at Windber (Pa.) Medical Center, I worked with physicians, staff, and volunteers to create a healing environment by embracing all methods and therapies used in integrative medicine and combining them with the ambiance of a fine hotel and the amenities of a health spa. We carefully scrutinized and credentialed practitioners specializing in services such as aroma and massage therapy, integrative nutritional counseling, acupuncture, chiropractic manipulation, pet and music therapy, reiki and spirituality, to name a few.

In short, a healing environment permeated our facility.

Yes, we had our share of naysayers and opposition among physicians, allied health care professionals and others, but over time our infection rate dropped below 1 percent and stayed there for a decade. (The national average is 9 percent.) Of our peer hospitals, we had the lowest readmission rates, restraint rates and lengths of stay. Even with a palliative care unit to care for dying patients and their families, we had the lowest death rate among our peer hospitals.

For those who would say it was all coincidence because Windber is a small hospital, I would direct them to the 19,000 papers written supporting the efficacy of acupuncture alone, and then to the thousands of papers written about the healing power of music, massage and so many other treatments dismissed all too readily by traditional practitioners.

IHM practices are not at odds with traditional medical practices; rather, they enhance them. Yet in many hospitals and physicians’ offices, they are ignored, discouraged, even ridiculed. Such negative reactions result from ignorance, misinformation, prejudice and even greed — pharmaceutical companies, for instance, see no profit in promoting most IHM treatments, and some medical practices might earn less if, instead of scheduling patients for costly treatments or surgeries, they instead treated patients with acupuncture, spinal manipulation, massage therapy or even mindfulness.

Resistance to IHM is breaking down, but this shift in attitude needs to be accelerated. If you travel to Europe or Asia, you will see integrative medicine practices thriving because their value is acknowledged and embraced. In America, IHM beachheads are being established in health care systems and universities, thanks to such groups as the Family Medicine Education Consortium, Integrative Health Policy Consortium and the Academy of Integrative Health and Medicine, of which I am a co-founder. The academy includes among its member’s hundreds of licensed physicians who have successfully merged IHM with traditional medical practices.

Much remains to be done to more broadly spread the healing benefits of IHM, which will happen only when more patients take more responsibility for their health and demand IHM treatments, more physicians research and adopt them, and more insurance companies pay for them. When that day comes, there will be a lot more good news about mortality rates and other measures of medical care for Pennsylvanians and people all over the country to celebrate.

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Don’t Eat Sparkling Sandwiches

May 23rd, 2012

When I was 18 years old, I got a summer job for college in the local glass factory. As a pre-college student, I had assumed that my work would be in the corporate offices, but I was so wrong. That first night I was to report to a place called the forming department (I thought they filed forms there) but no, it was where the molten glass was molded into beer bottles, baby food containers, and fancy cut glass vases. This place glowed like the fires of hell. As I entered the building that very hot summer night, the unbelievable temperature from the furnaces hit me like the exhaust of a moon rocket, and my relationship with salt tablets, the treatment recommended for perspiring in those days, was also about to begin.

It was during my lunch break where I got my first real taste of the glass business, literally. My mom had packed a chicken breast sandwich with lettuce and mayo on white bread, an apple and a couple of chocolate chip cookies. All of the employees were permitted to use factory-made glasses for drinking their Mountain Dew, and there was even chipped ice to put in the glass to cool the hot sodas down.

I carefully positioned myself on a filthy bench without noticing the tracks where the batch cars passed overhead. As I carefully opened the waxed paper protecting my chicken sandwich and then opened my mouth to take that very first, long awaited bite, the wind blew. With that a magical cloud of fairy dust came blowing off the car above me. At first I was dazzled by the sparkles as they rained down on my body, but then I realized that the batch cars were carrying pulverized glass. They were filled with infinitely tiny recycled glass particles.

As I looked longingly at my sandwich, it struck me that the glistening topping twinkling across it was, in fact, glass, but my hunger prevailed. I took what turned out to be a little bit of a crunchy bite of the sandwich and began to chew that glass dust-coated chicken. It was after the first few bites that I seriously started to question my own sanity, but my hunger prevailed, and I ate the whole thing. To this day, my mind still wonders if any of my physical imperfections are directly related to glass consumption; GERD, nervous leg syndrome, painful itching…well, you get the idea.

Todd Robbins - Hyalophagia - glass eating - picaSo, the question remains. Did I eat that sandwich because I was starving, exhausted and overworked? Or did I eat it because the frontal lobes of my brain had not yet fully developed and, not unlike many other stupid things that eighteen year olds tend to do, it was the Gump saying, “Stupid is as stupid does.” Either way, it was probably an irresponsible, careless, foolish decision that minimally could have permanently damaged my – oh so exquisite – taste buds or at least caused irreparable tongue scars. The good news is that, to my knowledge, I have not eaten any more glass since then.

The moral of this story? Be aware of the fact that, if you are hired to work in a factory, you will probably end up actually working in a factory. If your black trousers turn white and your white shirt turns black from dirt and perspiration, don’t eat 15 salt tablets. Always, and I do mean always, duck when you see molten glass stringing wildly out of the ceiling like Toffee gone wild. Don’t ever steal uncured cut glass, because it will explode on your mom’s mantel a week or two later. Don’t sit under a batch car (whatever the heck a “batch car” is), and when your white bread makes a glass-like crunchy sound, for goodness sake, don’t swallow it!

As my grandmother would always say, “Keepa you chickie covered.”

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Coffee and Cancer

May 19th, 2011

Several years ago, at the Clinical Breast Care Project’s (CBCP) offsite retreat with the physicians from Walter Reed Army Medical Center, our biomedical informatics group had prepared a demonstration for the CBCP’s Scientific Advisory Board, a group of distinguished scientists, breast cancer consultants and physicians.

Colonel Craig D. Shriver, MC Director, Clinical Breast Care Project Program Director and Chief, General Surgery Walter Reed Army Medical Center

COL Craig D. Shriver, MC Director, Clinical Breast Care Project (CBCP), Program Director & Chief of General Surgery, Walter Reed Army Medical Center

As the 7:00 PM meeting time approached, it was obvious that there was not going to be a quorum present to start the formal meeting.  The two additional members had called in and we sat waiting patiently for the remainder of this august body to join us; fifteen minutes passed, then twenty and finally at about 7:25 PM, the group burst apologetically into the conference room to begin the call.

In case you’re wondering what would have caused such a delayed response from an otherwise very prompt group of individuals, it was the introduction provided by the biomedical informatics group of how this data repository’s capabilities could be explored.  The advisory group was so captivated by the power of this tool that they literally became lost in the excitement of the demonstration.

This form of science was fascinating to me, because having trillions of pieces of data available from thousands of women allowed the queries to be guided by the data itself.  When this power was coupled with the normal questioning generated by the intellectual curiosity of the individual scientists, the outcomes were beyond fascinating.

For example, you could ask the question, “How many of you drink coffee?” The thousands of participants whose biopsies – both malignant and benign – were being stored in the tissue repository at our research institute had agreed to answer over 500 demographic questions relating to their very personal and now anonymous lives. A graph appeared showing the proportion of women who were coffee drinkers. When I then asked, “How many cups a day do you drink?”a new graph appeared with that information as well. My final question was, “How many of you were diagnosed with breast cancer?” This resulted in an interesting fusion of information. The women who consumed the most coffee had the least amount of breast cancer. Of course, that general assumption needed to be researched, confirmed and proven in numerous ways, but there it was, way back in about 2005.

A report that touched on this topic was released during the second week of May, and it was fascinating. It was a Harvard study that followed almost 50,000 male health professionals for more than two decades.  Over 5,000 of the participants got prostate cancer – 642 of them the most lethal form. “For the men who drank the most coffee, their risk of getting this bad form of prostate cancer was about 60 percent lower compared to the men who drank almost no coffee at all,” says Lorelei Mucci, an epidemiologist at the Harvard School of Public Health and an author of the study. The same group reported about a 50 percent reduced risk of dying from prostate cancer among men who took two or three brisk walks a week. As a part of our funding, similar studies performed by the Preventative Medicine Research Institute under the direction of Dr. Dean Ornish also confirmed this exercise theory of risk reduction for prostate cancer.

The new study shows that a 60 percent reduction in risk of aggressive prostate cancer requires at least six cups a day. However, men who drank only three cups a day still had a 30 percent lower chance of getting a lethal prostate cancer, and that’s not bad. Earlier research also suggests coffee reduces the risk of diabetes, liver disease and Parkinson’s.

But here is best part of this story. Just last week, Swedish researchers reported that women who drink at least five cups of coffee a day have nearly a 60 percent lower risk of a particularly aggressive breast cancer that doesn’t respond to estrogen.

Epidemiologist Mucci says more research is needed before officially urging people to drink coffee for its health benefits. Meanwhile, she says, “there’s no reason not to start drinking coffee.

So, all of these years later, the National Cancer Institute is using about 200 of these CBCP biopsies from that same tissue repository to map the Human Breast Cancer Genome, and everyday new reports are emerging that confirm the value of this research. All of this from a little coal mining town in Western Pennsylvania – the location of the research institute and hospital where I served as President and CEO – just three seconds in air miles from where Flight 93 went down.

Now that’s a story.

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What’s Still Missing?

April 3rd, 2010
We are on a not-so-merry-go-round which, even after health care reform, continues to promote a system of illness incentives  that are improperly reimbursed, improperly addressed, and inappropriately segmented. We continue to consider body parts as if they are not connected to or a component of the whole.
Wellness Wheel - Image credit: Marquette University

Tort reform still has virtually no teeth.  This causes physicians to practice sometimes over-the-top medicine in self-defense. When will it be time to begin to throw the switch and teach patients what we already know so well; that wellness, wholeness, and health can change the quality of our lives completely? Our medical schools need to embrace wellness and prevention as a path to health. Not unlike indigenous man, it is time that we begin to realize that our brains do have something to do with our bodies.  We live in a commodity driven society which does not always promote the best, most healthful food, even miminal exercise, stress management, or self-nurturing. Instead, because of those quarterly reports to the stockholders, these companies promote what is the most lucrative and often the easiest to sell.

Oprah.com - Health and Wellness - Nick Jacobs -  HealingHospitals.comWe know that drinking a soft drink with 10 teaspoons of sugar is not healthful. We clearly understand that quadruple cheese anything might eventually catch up with us, or that Uncle Buck’s 72 oz. steak can’t really be good for our arteries. Fried and buttered everything, a total lack of exercise, and more stress than anyone can ever dream of will not extend our lives

One night a few weeks ago I couldn’t sleep, and at 3:00 AM, I looked up and saw an apparition… Oprah. There she was, talking about food. The person she was interviewing said, “Oprah, in the 1960’s, our food cost us 18% of our annual income. ” Maybe that’s why there weren’t more restaurants at that time. Families were stretched just eating at home. He went on to say that, “In the 60’s, healthcare costs us 9% of our income.”  Finally he said, “Now healthcare costs us 18% of our income, and food costs us 9%.”

So, that’s the trade off. We can buy good, farmer’s market-type healthy, organic food and have low healthcare costs, or we can buy manufactured, additive filled food, and pay more for our healthcare.  How much further down this cul de sac must we go as a country before we begin to realize the path to health and wellness or longevity?

Health and Wellness - Nick Jacobs - HealingHospitals.com

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Don’t Drink the Water?

July 8th, 2009

Ever wonder about this whole water, nutrition, thrown-away-or-passed-through-pill thing?  I was talking to a friend who was explaining her box filled with powered, bio accessible supplements to me.   You know, the kind you drink in a milk shake in the morning.  She explained that her house had a septic system and that the annual visit by the septic maintenance truck was usually an occasion to discuss topics that the rest of us don’t get into on any given day.  Interestingly, she asked the septic  guy if things have changed “down there” over the years. (I know, I know. Too much information.)

His answer was terse.  He said, “Yep, all we see now when we start our work is pills, undigested pills.”  I’ve written blog posts about the lack of filtration capability built (or not built) into our water purification systems, and suggested that you move to Chicago if you have high cholesterol because there are so many lipids in the water.

Nicholas D. Kristof, Pulitzer Prize winning columnist for the New York Times has always been one of my literary heroes.  His coverage of Darfur, his reports on the Iraq war, Afghanistan, China, and gender rights issues have all captured my attention and admiration.  His column last Sunday in The New York Times, It’s Time to Learn from Frogs, was deeply disturbing and raised issues that should capture not only our imaginations but also should tickle our most profound concerns.

three legged frog
Photo credit: Discovery Channel/TreeHugger.com

For those of you who did not read it, the basic thesis was one of caution as we see our amphibian friends sprouting extra legs and some developing stunted genitals, while some of their fish companions are devolving into intersex fish that display female characteristics and produce eggs.  The reason for these changes is being attributed to a class of chemicals that scientists refer to as endocrine disruptors.  Some are passed into the environment through the urine of human females on estrogen treatments.  Although these theories for the disruptive changes in nature are still only theories, we have also begun to see a serious percentage of male babies  (7%) being born with undescended testicles and 1 percent being born with the urethra exiting the penis improperly.  Obesity may also be impacted by chemicals that contributors.

As the founder and former CEO of a research institute, our scientists constantly reminded me that 75% of our cancers were produced from the environment.  As we saw completely substantiated reasons in our economy to add man-made chemicals to retard spoilage, discourage bug infestations, and produce larger chicken breasts, or more attractive fruits and vegetables, the cascade of potential consequences caused by these decisions were never really known to us.

Mr. Kristof ends his op-ed by stating that “Those deformed frogs and intersex fish – not to mention the growing number of deformities in newborn boys-should jolt us once again.”

Could someone pass the “Fresh Mountain Spring Water?”  Oh, yeah, the one that’s full of heavy metals from the acid rains.  You know, that Grey Goose is looking better every day.

For further reading:

What Are Endocrine Disruptors?

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Dr. Atkins and Me…

December 23rd, 2008

Some of you know my history . . . for a decade I was a totally dedicated follower of the Dr. Dean Ornish coronary artery disease reversal program.

For example, for the past ten years, the only thing that would typically pass between my lips at a holiday party would be party garnishes. No kidding; decorations, twigs, sticks… and the occasional veggie. No dips, no chocolates, no meats or shell fish, no cookies, no pie, no fat.

One interesting factor that evolved from embracing that philosophy is that, in spite of all of my efforts to enlongate my life, my personal challenges never really decreased. It hit me one day when I was looking in the mirror that I was actually peering at the enemy, and it was me. It has been pointed out to me that, for all intents and purposes, I am a crisis magnet.

During those years of complete passion for the Ornish program, there were many days where my adrenaline flowed freely. It usually happened when Dr. Ornish and Dr. Atkins had debates on television about their very different diets. Truthfully, the diet was such a small part of the Ornish program that it angered me when so much emphasis was placed on the complete disparity between these two very different programs.

Well, tonight I felt closer to Dr. Atkins than I had ever felt. In 1976, my buddy Jim and I went on the Atkins diet and lost about 30 pounds. That diet ended because the pork rinds, hard boiled eggs, and thousands of chicken wings, rashers of bacon, sides of beef, and pounds of cheese just became too much for me, and they probably resulted in my needing the Ornish diet.

What made me feel close to Dr. Atkins this time? Ice. He had slipped and fallen on the ice, hit his head, and eventually died from the injury. Well, tonight provided me with a bonding opportunity with Dr. A. It was the beginning of the holiday season. The kids had gathered for dinner with the four and a half grandkids, the soon to be deployed son-in-law, Moosie the dog, and Kiki the cat. It was a nice gathering and, as I walked off the porch and onto the walk, my feet went out from under me, my body went air borne, and I fell directly on my back with the force of a meteor hitting a dry lake. The wind left my body. Stars were flying around my head like a Road Runner cartoon, and pain began sweeping through my limbs in waves.

The difference between Dr. Atkins and me was that my head did not hit the ground. Was it a conscious decision to hold it up, or was it just pure luck? Don’t know, but, at least for now, it seems like I might live. The last time this happened to me was on a cold winter afternoon in 1978. After teaching for eight hours, I was leaving school with a baritone saxophone case in one hand and a euphonium case in the other, both destined to go to the repair shop. It was then that my feet left the ground. Once again, the air completely evacuated my lungs. It was that very day that I vowed to always wear rubber-soled shoes in the winter. Didn’t help tonight. Oh, well, at least my fall didn’t include a head injury. Dr. Atkins and I both needed more salt in our diets.

No fear. I’m still here.

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