03-14-2011, 02:13 PM
Join Date: Mar 2011
Location: Columbus, OH
My Lisfranc Injury - Surgery Required, Several Dislocations and Fractures
Day of Injury - 08/07/2010
Well...I literally got up on the wrong side of the bed. My right foot found a space between the mattress and the side rails of my roommate's bed instead of the floor. There wasn't enough room to fall outwards due to the wall being so close and I had to topple sideways. Snap, crackle, pop, loss of consciousness. When I came to a moment later my toes were strangely contorted..and my whole foot was quite painful. I immediately knew something was very, very wrong. Friends helped get me to a couch, wrapped and elevated my foot, and placed a bag of frozen corn on it for the night. I might want to mention that this was my birthday party. I (along with everyone else) was intoxicated at the time so there was no hope of getting to the hospital at that time of night, and an ambulance would have been too expensive (even with insurance). Hunkered down on the couch for a while until I finally crawled to my bedroom when the party died down.
As much as falling off of a bed sounds like an alcohol-induced incident, in review, the circumstances (open side rails, confined space between the bed and the wall) provided an excellent opportunity for the accident to happen drunk OR sober. Just a strange, freak accident. In retrospect, being drunk was actually a bonus, as the pain throughout the drunkenness was certainly reduced...that was, until the morning.
Day 1 - 08/08/2010
Holy Lord, waking up stone sober and the brick on the bottom of my right leg, previously known as a foot, was just bursting to get out of that ace bandage it was wrapped in. Excruciating pain prompted an SOS text to everyone in my apartment for a trip to the ER as I quickly realized there was no chance in hell of sleeping that pain off. My god, it literally hurt so bad that breathing was difficult. Next challenge, I live in an apartment building on the top floor and had 4 flights of cement stairs to contend with. I'm surprised I didn't rip a hole on the bottom of my pants from scooting down every single one of them on my ***.
My trip to the ER went as such: Got some crappy medical advice, unreadable x-rays due to me convulsing and shaking in pain on the x-ray table every time I was touched, an almost useless prescription to extra-strength Aleve, a flimsy ice pack that burst and leaked the same day, a gel-lined air splint for my ankle that wasn't even the real reason I came in, 2 pieces of aluminum that I can lean on, an almost certain mis-diagnosis, and a referral to someone that can help me in a week or less, maybe.
I was discharged with the diagnosis of torn ligaments aka sprained ankle. Sprained ankle my a$$. In their defense, the ankle was the part that looked the worst off, as it was swollen to the size of a softball. As they said, and as I, the expert at spraining ankles knows, that appearances are often worse than the actual injury. Regardless, I told them that my ankle didn't hurt, despite what it looked like. Ok, it was a little sore, but nothing in comparison to the top and bottom of my foot, which were also quite swollen. In addition, I've walked, albeit painfully and with quite a limp, on an ankle that size before in swelling, also when the bone was cracked. This is clearly not the reason I came in. I know how to deal with a sprained ankle. In response to the question "does your foot usually bend that way?" I said "no". Does this not throw out the possibility of a sprained ankle either? I guess not. They wrapped the ankle and then sent me on my way with a pair of crutches and a useless prescription.
Day 2 - 08/09/2010
Realizing that I was confined to a couch was not easy. With every other foot/ankle injury I've had, I've only had to rest easy on it for a day or two. This was not the case this time unfortunately. Little to no improvement was noticeable except that I could wiggle some of my toes. Every single basic task I can think of was now 100 times harder and significantly time-consuming and exhausting. Re-situating myself in a seated/lying down position was even difficult since my over-compensating left side was exhausted with its own existence. Staying in a slightly horizontal position with one foot elevated 24/7 is murder on the rest of your body. Be ready for that. Have tons of pillows.
I also chanced bathing and taking care of some personal hygiene on Day 2. I'm single. I do live with a roommate, but since he was opposite gender it would have been incredibly awkward to ask him for the help that I didn't know I needed at the time. I decided to give it a go when I knew he would be home for a while so that I could have emergency back-up in the case I needed it. I managed to make some sort of cleanliness improvement after a few hours. I had to literally launch myself into the bathtub, so I sustained some bruises there. I think I brushed my teeth for the first time since the injury. Is it disgusting that I waited 2 days to do this? Absolutely. I was completely mortified and disgusted with myself, but unfortunately all of my crap was at regular standing height, and I was now in need of midget housing as everything required being on my knees to do. There was absolutely no pressure I could put on my injured right foot without excruciating pain, and I hadn't quite learned how to get up from a floor position using just upper body strength and the good leg. I was incredibly weak and nearly helpless. I hadn't expected this.
Eventually, my roommate had to leave to go to work. At that point, depression started to set in as I realized how utterly helpless I was. I have a dog as well, and there was no way I could take care of him, not with 4 flights of stairs to battle in order to potty him anyway. I tried to teach him how to use potty pads. But that was highly unsuccessful, he just sat on them and looked at me, lost. Fortunately he was able to hold it until the roomie came back from work.
Day 3 - 08/10/2010
I gained a teensy bit more mobility today. I took the braces, bandage and sock off to play with my "brick". It was actually foot-shaped instead of one huge swollen blob. It was very purple all over, with a lot of dark blue pooling on the side and bottom of my foot, and slightly mis-shaped compared to my other foot. My ankle moved rather freely with little to no discomfort, further disproving the sprained ankle diagnosis. The bottom of my foot appeared to be swollen and bruised the most. After trying to put pressure on it, I wasn't sure if I just couldn't or if it just felt too different with all the swelling to do so. It was still quite sore. The top of the foot was incredibly swollen, down to the toes and very painful to the touch. After looking up diagnoses of foot problems, I discovered that a mid-foot fracture was in the location and description of where my foot hurt. It was also stated on the orthopedic website that I visited that these types of breaks are difficult to determine through simple x-rays due to the amount of other activity (bones, ligaments, body junk in general) in the area.
I received some words of encouragement from a colleague who, coincidentally, had recently been able to come back to the office after 5 months of agonizing healing with an almost identical foot problem. She fell down the stairs, sober, cat tripped her. And she's fairly athletic, which helped me accept that my accident was just that, an accident. And that yes, everything would be incredibly difficult but that you just have to rely on friends and family to help you since you really can't live like you're used to by yourself anymore. As comforting as it sounded, it really got to me. I don't like being a burden, and it pains me to ask for help. I broke down and called a friend to come get my dog while I was layed up.
Bathing today was quite a bit easier though. Was able to steady myself into the tub instead of painfully launching into it like last time.
Day 4 - 08/11/2010
Getting around on the crutches was becoming a lot easier. My left leg had also gained enough strength to compensate for the loss of the other and had for the most part stopped seizing up/cramping/convulsing slightly when I used it to support my full weight. 10 steps with the crutches no longer felt like I just ran a mile, and I was starting to get better at judging the floor thickness so that I didn't have to "peck and place" each crutch before deciding to take a step as often as before. This was my first time on crutches, and I was incredibly fearful of injuring my other foot as I've sustained several foot/ankle injuries and knew it wasn't in the best interest to use it to the full extent that I would need to.
Day 5 - 08/12/2010
My foot no longer felt like it was boiling hot, and it didn't immediately start to swell when I removed it from an elevated position. Seems like the circulation has returned to a little bit of normalcy. This was also the first day I haven't felt like crying from pain, hopelessness, worry, etc as my roommate was home all day that day and able to help me out. Never in a million years would I have guessed that I would succumb to that amount of depression. My mood was probably more debilitating than the actual injury itself.
Day 6 - 08/13/2010 (Ortho Specialist)
Well I WAS excited for this day, mainly to get some closure on this ridiculous injury. Bad closure, bad. New X-rays were taken and the doc confirmed it was a midfoot fracture (Yes! I was right, take THAT stupid hospital staff). But, he told me these types of injuries almost always required surgery to correct so that there weren't further complications, like arthritis etc. further down the line. So he sent me back to the hospital for MRIs to be sure that surgery was required, and we would review those on Monday. They put me in a partial cast/splint to support the foot instead of the ankle air cast, which felt a lot better.
Amusing dialog between my doc and I (enjoy the little things):
Me: "They told me at the hospital that it was a sprained ankle"
Doc: "Well, there's nothing wrong with your ankle at all."
Me: "I KNOW!!!! I tried to tell them that my ankle didn't hurt, it was the top of my foot"
Doc: "That's because you probably broke your foot"
Day 9 - 08/16/2010
The bad news. Surgery was requried to prevent the injured area from setting incorrectly. The good news, I could have it scheduled as early as the following day. After having nothing to do the previous weekend, aside from surf the net, I did a lot of reasearch on the injury and read stories from others. These health boards as a matter of fact, helped a lot!!! I learned that with this type of injury, recovery is most successful if surgery is done right away. I agreed to getting the surgery the next day and hoped I was right in the rushed decision. I moved in with some friends that night for the recovery process from surgery as I knew there was NO way I was getting back up those 4 flights of staris after surgery.
Day 10 - 08/17/2010 (Surgery)
I waited a nerve-wracking 4 hours in the recovery room prior to surgery. Was under the knife for 2 hours. Sat around and "woke up" for about 2 1/2 hours. Actually, they didn't really allow me to wake up. They just rushed me out the door. Worst day of my life. The pain after surgery was 10 times more excruciating than the day I broke my foot. And this was including the fact my leg was numb from the knee down due to the block. Made a note to myself to write a nasty gram to the hospital when I recovered. My roommate came to pick me up from the hospital and was utterly amazed they didn't keep me in for observation over night. I could barely move a finger without extreme nauseau setting in, couldn't make any sensible communication whatsoever no matter how I tried, and I refused food and water. The only thing I can remember actively doing post surgery (the moments when I was awake, anyway), was to cry and cry and cry. I'm not a crier.
I don't want to scare anyone with this, but it would probably be best to talk your anesthesiologist's ear off if/when they visit you prior to putting you under, about any past medical history you have, and if you're unsure of something, speak up. I had had surgery once before and came out of it rather well. However, I wasn't nearly this nervous the previous time, and I believe a lot of the questions posed to me I couldn't answer or wasn't able to fully devote my attention to answering them correctly. I'll certainly make a note of it to discuss this particular event if I ever need to undergo a surgical procedure again so that they don't over do it on the drugs.
I was in and out of it for about 2 days, and still couldn't make sensible speech most of the time. My friends observed me and kept me medicated. At one point the day after surgery, I believe when I was left alone for a brief period, I called the hospital in a panic cuz I couldn't feel my injured leg at all but that my foot was "on fire" and felt like it was "crushed in a vice." I know because I received voice mails from concerned nurses and my doctor's office asking if I was okay.
Note: make sure you are kept under constant observation either by friends or doctors so you don't act like an idiot.
Day 12 - Thursday 08/19/2010
The anesthetic started to wear off somewhat by the end of the day. I was still rather nauseous and my entire leg was still partially numb. I was prescribed percocet and aspirin and was heavily dependant on the pain meds. I wasn't able to stay awake for long periods of time, and unfortunately, I wasn't able to sleep for much longer than 3 hours at a time either. The cast/splint they put me in was incredibly heavy. No joke, it had to have weighed a good 20 pounds so getting up on my crutches was nearly impossible. Still crawling.
A friend after seeing my ginormous cast: "*** is there a dead body in that?"
3 Weeks (Post Op Follow-Up) - 09/01/2010
Follow up appointment to get the cast off and the super itchy stitches out. My dependence on the pain meds had decreased a little by this point. Was only taking about half a dose as I had to be "with it" enough to be able to work from home. Had I not been forced to work from home during the injury, I would have taken the full dose and had more comfort throughout the duration of the injury. However, as it was, the pain was manageable with only half a dose.
After getting stitches taken out and x-rays taken, the doctor didn't find it necessary to put me in another cast. Walking boot it is! Non weight-bearing (NWB for those who aren't familiar with the acronyms) for about 10 more weeks. As far as wiggling the pigglies, they unfortunately didn't move...yet. But the doc said it was most likely due to the swelling. That, and being cooped up in a splint/cast for 3 weeks had taken a toll on motor function capability. My calf looked like a chicken leg compared to the other one, as if there was no muscle in it at all. All in all though, the doc seemed quite confident that this may be the only surgery I require on this foot (for this injury anyway). Physical therapy is even a play-it-by-ear as healing seemed to be right on track.
The diagnosis of the exact injury itself (as I had failed to inquire specifically about it previously) was that there was a dislocation of the midfoot, causing 4 or 5 fractures of the bones in front of it (I don't know the names of the specific bones, don't ask), and a separation of the lisfranc ligament from the bone. 4 screws and a pin were inserted in the midfoot area to assist the ligament's reattachment process. The hardware was put in with the intent to be left in permanently. I'm fine with that, as I really didn't want to have to undergo that ridiculously painful procedure ever again. The doc mentioned potential arthritis issues in the future and a need to have a procedure to fuse the bones if arthritis became an issue. Will cross that bridge if/when I get to it.
I asked for some things to do to speed up healing/recovery and improve mobility. He suggested I start taking calcium supplements (1 or 2 ultra strength Tums a day was fine) and double up my vitamin D3 intake to 4 or 5000 IUs. I was already previously on a daily multi-vitamin, 2000 IUs vitamin D3, and 2 grams vitamin C (recommended by another doctor about a year ago for some insomnia issues and general good health maintenance). With the foot now able to be exposed, he recommended light daily massages of the area to improve blood flow and promote healing of the skin at the incision sites. Also to start stretching my toes, rotating my ankle, and stretching the leg. Keep icing the area to reduce swelling and pain and keep it wrapped/in the boot whenever I was up and about.
These were a lot easier said than done. I began my own rehabilitation efforts in the bath since the hot water improved the mobility slightly. It was incredibly difficult to will the toes to move. Pretty much every muscle in the foot had atrophied over the 2 week period. This got easier after a while, but felt nearly impossible at first. I simply just rotated my ankle in full circles (clockwise about 20 times and then switched to counter-clockwise for about 20 more rotations). After I got out of the tub, I would massage the area with a skin-healing lotion (Burt's Bees Thoroughly Therapeutic Honey & Shea Butter Body Butter was recommended to me from a friend who had used it while she was pregnant to improve the appearance of her stretch marks and could help lessen the severity of the developing scar tissue on my foot). And then finally, stretching. With my leg straight in front of me, I practiced pointing my toes back and upward as much as possible and holding the position for about 20 seconds. (the best I could do at first was to get my foot a little less than perpendicular to the leg). Then I would point my toes away from me as much as possible, hold for 20 seconds, and the same thing with right and left stretches. When I was able to stand pressure on the bottom of my foot (several weeks later), I began to do these stretching exercises with therabands.
1 Month - 09/09/2010
Almost all of the swelling had gone down. Doc said it would take about 6 weeks. Either I had Wolverine healing powers or I'd been seriously OD'ing on vitamins. I'm going to assume the latter. I could move my toes much more freely at that point. I'm not sure if this was due to the significantly reduced swelling or the rehab I had been doing. The scarring was starting to become more pronounced unfortunately. After having the cast/splint off, pain was almost non-existant as long as I didn't accidentally put pressure on the area. I stopped taking the percocets and switched to over-the-counter Aleve when necessary to reduce pain and swelling.
Week 9 - 10/13/2010
I began standing for short periods of time (a minute or two) with slight discomfort. I also got bored and tested myself by taking 3 "steps" that day.
Note: I don't recommend going against doctor's orders with weight bearing. Understandably, after being confined to a couch for 2 months, you start to get really bored and restless, not to mention with the improvements you start to notice in the affected area, your confidence increases. I tried it, I lived, I didn't re-injure anything, and I felt generally good about it. But I also had the sense to sit my bum back down and chalk this up to a satisfied test and to commit to being NWB at least 99% of the time. Know your limits.
03-14-2011, 02:15 PM
Join Date: Mar 2011
Location: Columbus, OH
Re: My Lisfranc Injury - Surgery Required, Several Dislocations and Fractures
I had to break this down for a few postings. Rest of the story:
Week 9 - 10/18/2010 (Follow-Up Appt)
Doc said x-rays and everything looked great. Fractures were healed and aligned nicely. NWB period to end on 11/2 (11 weeks total from surgery date, 1 week less than the predicted 12) in order to give the tendons a little extra time to heal. My rehab efforts were showing great improvements. I mentioned at this appointment that the boot was actually irritating the area (causing it to swell) and that when I was up and about on my crutches I kept my injured foot in a tennis shoe that had arch supports. He supported the decision.
Week 10 - 10/23/2010
I started walking...out of boredom of course. My research online showed that most people with this type of injury started walking somewhere between 10 and 12 weeks. Despite the tightness and extreme discomfort, the foot felt able to bear the weight. I took it easy at first, still using the crutches for support.
Again, I don't recommend going against your doctor's orders. I made the decision to start walking early, and I would live with the consequences if I re-injured myself. Being no stranger to previous foot/ankle sprains, my biggest hurdle in this injury was the misalignment and fractures of the bones. Once those were good, I felt that slowly introducing the injury to new challenges would be a wise move.
When I say that I "started walking" I didn't just put the crutches down and start going about things as normal. I started slowly by one day, taking 1 roundtrip down the hall to the bathroom walking on my injured foot for example. And that would be it for the weight-bearing on that day. The next day I would increase to maybe taking 2 trips. And so on and so on.
Week 11 - 11/06/2010
I started driving. I had to drive with 2 feet, as the injured was my right and braking was difficult. I was also able to get around for longer periods of time with just 1 crutch for support or none at all. Got my dog back and was able to take him down the stairs for potty breaks about twice a day. Had to get the roomie to help out on others.
3 Months - 11/15/2010
I put the crutches away officially on Sunday night after not needing to use them for support the whole previous week. Stairs, squatting, anything faster than a slow walk was difficult or not possible. Shoes with the arch support in them were the only thing I could wear to walk in. Barefoot walking was still painful. The entire foot was incredibly stiff constantly and still swollen and a little purple. Still kept up on rehab exercises.
I went to a chiropractor a few days prior to start getting my back and shoulders adjusted after being hunched over on crutches for about 3 months. He recommended additional rehab exercises to do: write the alphabet with my foot, scrunch a towel on the floor with my toes, and concentrate on not limping, as it could injure/produce future difficulties in my hip and back if done for too long.
4 Months - 12/06/2010 (Follow-Up Appt)
Follow-up doctor's appointment confirmed everything looked good. Recommended for physical therapy on my suggestion. Walking was slightly uncomfortable and quite painful for long periods of time (1 hour +) and I still had a significant limp. My entire foot was still very stiff and difficult to get going in the morning as well as being quite painful by the end of the day. I could only fit into my tennis shoes and needed to use the arch support inserts for support and comfort. Mobility was slowly improving. Doc said stiffness could take 6-9 months to fully dissipate. At this point, I had still been taking 1 or 2 Aleve every 12 hours since the stitches came out for pain and swelling.
5 Months - 12/28/2010
3 weeks of physical therapy under my belt. Going down stairs has certainly gotten easier. I can now balance on my right foot for longer periods of time and with little discomfort. End of day pain is, on average, down to a 3 or 4 and not requiring pain meds. Still discomfort in the morning (about a 2) but a lot faster to get up and going. I might be able to jog or at the very least, hobble incredibly quickly. The limp while walking is almost gone.
The physical therapists gave me upon my first visit, several seated exercises to do to increase mobility. As every situation is different, and these exercises were tailored to my specific situation, I wouldn't feel comfortable sharing them all here. I can say that we usually started off the session with a warm-up (about 10 minutes on an excercise bike for the first week or two of PT and then graduated to about 6 minutes on an elliptical, increasing time on the machine as I got better/stronger). Then I stretched, did a few balancing excercises, strength exercises (seated and NWB for the first few weeks, then later graduated to strength exercises while standing). I had about an hour of exercises that I was to do at home on my own several times a day. If you do end up deciding to do physical therapy, just know you will be given homework and the more committed and consistent you are in doing this will speed up your recovery process. Even while still practicing my own rehab schedule consistently, there were times when I'd have a few set backs or a day would just be incredibly difficult for no apparent reason. You will have ups and downs in your recovery. This is normal.
6 Months - 02/23/2011
3 months-ish of physical therapy done. I can run! And also do most other things that I should be able to do. If a zombie apocalypse happens, I'm all set...after I've been trained up a bit more of course. My regular gait is back, no limping. Unless of course, I've just ran for several minutes on a treadmill. I have 3 more PT sessions left, to make sure I'm staying on track with my at-home rehabilitation. And the vitamin supplements are doing some awesome stuff for my hair, nails, and skin.
03/09/2011 (6 Mo. Follow-Up Appt)
X-rays are still good. The doctor sees no need to follow-up with any talk of future surgical procedures. We talked about how my physical therapy is progressing. At this point, I have 2 sessions left. I asked him about the skin healing, as my foot still had a significant bruise on it and was still slightly darker in skin color than my other foot. He says this is normal and that it will take a while for the hemoglobins in the skin to react to the trauma of the surgery. I asked about further supplements and he suggested to squeeze the oil from a vitamin E capsule over the scars to help minimize the external scar tissue. The area as it is now is no longer tender, and the skin moves freely over the foot. A lot of the scar tissue inside has broken up due to the daily massages. My foot will still get a little purple if I do a lot of activity on it in a day, such as running or extensive walking, but for the most part is fully functional. My next appointment will be in 5 months, approximately 1 year from the date of the injury.
More updates to follow.
Now, my story was just one of many. Every story and injury is different, and not all advice is created equal. Some things to consider along your own lisfranc journey:
- Be informed - Ask your doctors, surgeons, nurses, hospital staff, etc every question conceivable about your injury and progress, medical history, lifestyle etc., even if it seems stupid. Trust your own judgement as well as your doctor's. You will probably know your body and its limits and signs of distress better than anyone else. If something feels wrong, it probably is. Get additional opinions if necessary and if time allows. Although it's wise to shop around for medical care, don't waste time finding something that's perfect. The body's natural ability and willingness to fix distressing situations sets in quickly, and this can work against you if you require surgery.
- Build up a strong support network - If you've never been immobile or crippled, depression will set in. Hard. And especially if you don't have a good network of friends, family, co-workers, or neighbors able to help you out. Call on these people as soon as you can for help. Don't be afraid to trust people and allow them to help you. Offer money or IOUs for assistance if necessary. In my situation, my network of co-workers was completely unreliable and I got a lot of flack from my job for not being able to pull my own weight. If this is the case for you, take advantage of your company's Family and Medical Leave Act (FMLA) or short or long-term disability if you have it. If I had to do over again, I would have taken FMLA and took the financial hit, rather than have to deal with all the stresses involved with trying to work a full-time job during this incredibly trying time.
- Your ducks will NOT be in a row. Accept that this is okay - Speaking of disability programs, if you have any current major projects going on for work, school, etc., consider taking a leave or handing them over to someone else. You will be weak. You will be tired. Depending on what sort of pain management you and your doctor agree on, you may be considered too intoxicated to be held liable for important decision-making. Hire someone else to assist you with these projects if necessary or put them off until you are better able to get around. Things such as bathing, eating, going to the bathroom, will take much longer to do, especially if you have to do them on your own. These are HOURS in the day you will need to set aside to do non-negotiable, necessary activities. If you barely had time for yourself to begin with, you certainly won't have time now. There's no shame in watching TV and playing video games all day during the first month or two of the injury. You'll probably spend a considerable amount of time sleeping during the first few weeks anyway. Get a comfy piece of furniture to claim your own and park it.
- This is not an excuse to get fat - I would consider trying to eat as healthy as possible during this time due to the lack of exercise/movement you'll be able to do, however not being mobile enough to prepare your own meals could put a bit of a damper on that. Have friends/family who are rather healthy cook and do your grocery shopping. Resist the urge to have someone pick up fast food for you or ordering pizzas. Consider taking dietary supplements/vitamins to balance out your diet. At some point, you will regain your mobility, and having atrophied muscles on top of a significant weight gain can severely hinder your recovery process.
- Do your homework - When you regain your ability to use your injured foot, start rehabbing it as soon as possible and keep consistent with the exercises. Whether you decide to undergo professional physical therapy, or do it on your own, the key is to be committed and consistent. You will have ups and downs in your recovery and it will come slowly. Don't be discouraged. Know your limits also. If an exercise is too difficult to do, modify it or scale back. Risk of re-injury is fairly high. If your research or physical therapist has led you to an unscaleable obstacle that you can't seem to cross, don't be afraid to ask if something else is impeding your progress.
- Write everything down. Keep tons of records - As well as keeping your medical records for future reference, it also helps to talk about this, at least to yourself. Write down your thoughts and experiences as they happen, in a blog, on this site, etc. It will help you notice progress on your situation and may keep your spirits up in darker times.
- Talk to people who have experienced what you are going through - I was lucky enough to have a colleague that just went through a lisfranc injury right before I sustained mine. But I also turned to health boards and forums such as these to gain insight and read what others have gone through. I, along with many others here will be happy to help provide advice or just a listening ear if you have any questions or problems during your journey.
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