I told him that I had just refilled the FLOMAX, so he told me that I could continue to use it, if I wanted, but didn't need it. This is a medical emergency, because if someone is unable to urinate and excrete urine, over time pressure that builds up in the bladder can adversely affect the kidneys, possibly leading to kidney failure which is life-threatening. (2014, September). In general, 5alpha-reductase inhibitors tend to reduce PSA levels by about 50%, although the actual reduction varies from man to man. Copyright 2013-2023 All rights reserved. MeSH PMID: 16516013. PracticeUpdate is free to end users but we rely on advertising to fund our site. But heres the bad news and why you need to consider your choice of finasteride carefully: Men in the study who took finasteride were more likely to develop high-grade cancer (the type more likely to spread and become life-threatening) than those taking a placebo. Although BPH symptoms often remain stable, one study found that progression was likely in men with the following clinical profile: Source: Crawford ED, Wilson SS, McConnell JD, et al. A total of 120 men, 48 to 89 years old, previously treated with radical prostatectomy for prostate cancer within the past 10 years, with serum PSA levels between 0.6 and 10.0 ng/mL, with no evidence of skeletal metastasis on bone scan, and with no previous androgen deprivation therapy, were treated with 10 mg finasteride or placebo in a double-blind fashion for 12 months. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker. Obviously the decision about whether to make some change in your medication regimen for BPH whether it involves changing the dose or switching medications is a complex one. Marberger M. The MTOPS Study: New Findings, New Insights, and Clinical Implications for the Management of BPH. December 27, 2022. Out of 100 male patients aged 45 years and above diagnosed with BPE, 92 were included in the study. You start taking a drug for some other medical condition or add drugs to an existing regimen (for example, you add another medication to help control your high blood pressure). 2023 Healthline Media UK Ltd, Brighton, UK. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. The results of this study indicate that treatment with finasteride delays but does not prevent the rise in serum PSA observed in untreated patients with detectable PSA levels after radical prostatectomy. According to the American Urological Association, transurethral resection of the prostate or TURP is the most common type of surgery used to treat BPH. Gynecomastia (breast enlargement), another possible side effect of the 5alpha-reductase inhibitors, is rare but is distressing when it occurs. The Prostate Cancer Prevention Trial showed that taking one of the 5alpha-reductase inhibitors, finasteride, reduced the risk of developing prostate cancer by 24.8% an astounding amount, and a result that would normally change the practice of medicine. TURP operation 10 years ago was clear. Being honest I thought the drug was a godsend. Should I have a prostrate biopsy? Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Your BPH symptoms worsen, even though you are taking your current medication. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. The most frequent complications of the. This Canadian database study determined the frequency and incidence of bladder and prostate medication use following transurethral prostatectomy (TURP). A clinical trial involving more than 3,000 men, comparing finasteride (Proscar) with placebo, found that only 3% of men taking finasteride developed acute urinary retention (versus 7% taking placebo), and 5% eventually required surgery (versus 10% taking placebo). - Answered by a verified Urologist . At 64, Jack was taking tamsulosin (Flomax) for moderate BPH but otherwise was in good health. Common Flomax side effects may include: abnormal ejaculation, decreased amount of semen; dizziness, drowsiness, weakness; Most people begin to feel better and have an improved urine flow within 4 to 6 weeks after TURP surgery. S Bahri, B Malcomson, K Ball, D Bhrambhatt, J Beatty, 714An Evaluation of The Discontinuation of Tamsulosin and Finasteride Post Transurethral Resection of The Prostate (TURP) At UHL, British Journal of Surgery, Volume 108, Issue Supplement_6, September 2021, znab259.1091, https://doi.org/10.1093/bjs/znab259.1091. He went straight to the TURP and made out very well. If medical management of BPH fails surgical transurethral resection of the prostate maybe required. During the TUMT procedure, a urologist inserts a catheter with an attached microwave generator through the urethra and into the prostate. So, he took me off FLOMAX but left me on Finasteride. Choi, S. B., Zhao, C., & Park, J. K. (2010, August 18). Upgrade to Patient Pro Medical Professional? We look at the effects and treatment options, including surgery, here. 8600 Rockville Pike One group continued taking the medication daily, the second took the same dose every other day, and the third stopped taking the drug. Posted I made them check me for a UTI after a couple weeks and I was clean as I was in the middle of a CIPRO course right about then. Various treatment options for benign prostatic hyperplasia: A current update. Surgery went very well. Aim of the study was to analyze and compare the usefulness of combination drugs therapy and monotherapy after a trial period of six months. We want the forums to be a useful resource for our users but it is important to remember that the forums are View all posts by Harvard Prostate Knowledge. These medications are all PDE-5 inhibitors, which generate nitric oxide, a chemical that enables arteries to widen. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Absolutely ask your doctor. TURP syndrome and severe hyponatremia under general anaesthesia. This follow-up PSA then becomes your new baseline. But as with all surgeries, there are some potential health risks associated with the procedure that require medical attention and intervention. 4. Zlotta AR, Teillac P, Raynaud JP, Schulman CC. HoLEP: The gold standard for the surgical management of BPH in the 21stCentury. Benign prostatic hyperplasia (BPH) patients often regard surgical intervention as a definitive therapy for urinary complications allowing them to eliminate medication and its inherent expenses. Epub 2013 Nov 12. Curbing nearsightedness in children: Can outdoor time help? 178 patients undergoing TURP were either allocated to finasteride or no medication prior to their operation . These complications may include persistent bleeding, persistent urinary retention, urethral strictures, and urinary incontinence. Disclaimer. Men taking tamsulosin every other day did just as well as those taking it daily, and experienced fewer side effects such as ejaculation problems. Patient does not provide medical advice, diagnosis or treatment. Just letting you know what my urologist did. This seems especially to be a problem when taking sildenafil (Viagra) and vardenafil (Levitra); tadalafil (Cialis) is a longer-acting PDE-5 inhibitor, and the risks are less clear. Does it help? Roehrborn, C. G. (2005). Sometimes a man can be weaned from the catheter and return to taking a BPH medication, but not always. These data require confirmation by studies that are longer and larger, focused on demonstrating significant differences in progression rates and survival before the use of finasteride can be considered as an option for men with detectable PSA levels after radical prostatectomy. Overall, the risk of serious complications after TURP surgery is quite low. First, taking two pills is more expensive. It is important to obtain a baseline PSA value before beginning treatment with one of these medications, and then have another after 612 months, to see how much the PSA has gone down after treatment. C. The 5alpha-reductase inhibitors have a different mechanism of action: They neutralize 5alpha reductase, the enzyme that initiates conversion of testosterone into dihydrotestosterone, or DHT, the form of the hormone that is usable in the prostate. and Privacy Policy and steps will be taken to remove posts identified McConnell JD, Roehrborn CG, Bautista OM, et al. Most are fine with no help. I have rare bleeding episodes nowadays. Urologists like to do repeat performances. However, more research is needed. I didn't know if coming off it was part of the healing process. These data require confirmation by studies that are longer and larger, focused on demonstrating significant differences in progression rates and survival before the use of finasteride can be considered as an option for men with detectable PSA levels after radical prostatectomy. It is usually safe to return to basic everyday activities 1 to 2 weeks after TURP procedures, and safe to return to strenuous activities after 1 to 2 months. and transmitted securely. He managed to pull the car over to the side of the road and call for help. Researchers are now investigating whether taking anticholinergic drugs can ease BPH symptoms. Men with BPH usually have difficulty urinating, a decreased flow of urination, hesitation at the beginning of urination, and a need to get up at night to . Read our editorial policy. Initially, the urethra and surrounding area will be inflamed, and it will be difficult to urinate. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. This is where too much of the fluid used for surgical flushing is absorbed by the body, leading to major electrolyte, fluid, and blood volume imbalances. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. These will be reevaluated on the recommencement of TURPs following the covid-19 pandemic. The other alpha-1 blockers may cause less of this problem. The most common surgery for BPH is called transurethral resection of the prostate or TURP. But I've only been taking Finasteride for about 1 1/2 months to try to reduce the size of my prostate (77 grams). Comparison of efficacy between Tamsulosin and Finasteride on symptomatic Benign Prostatic Hyperplasia. I had a Foley Catheter for 27 days because of urinary retention. Come to think of it, the pretty nurses at the ER and other staff. In the past, patients really had only two options when it came to surgery for BPH. Surgeons perform most TURP procedures when the patient is under general anesthesia and unconscious or asleep. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Don't miss your FREE gift. However, most patients experience durable improvement after surgical intervention forBPH without need for subsequent medical or surgical intervention, the authors concluded intheir study. By blocking alpha-1 receptors, alpha-1 blockers prevent insertion of the chemical keys that signal a muscle to contract. Michalak, J., Tzou, D., & Funk, J. Results: In fact, when I ran out of that last bottle of FLOMAX, I contacted the urologist to re-confirm that he preferred me to be off of it. MNT is the registered trade mark of Healthline Media. Benign prostatic hyperplasia: An overview. With the TURP I had, I was fitted with a size 22 and that was the last 5 days of me having a catheter in me. It shrinks (over a period of 6 months) the prostate by 20 to 25%. They may also include frequent urination and incomplete bladder emptying. Disclaimer. what was the reasoning of the urologist when you asked him why he recommends taking Flomax after surgery? Their names have been changed, but all other details are accurate (see Jack Muriel and Henry Banks below). Originally published Jan. 1, 2007; last reviewed April 22, 2011. Does less TV time lower your risk for dementia? Patients were randomized using computer generated random number table. Casab A, Roehrborn CG, Da Pozzo LF, Zepeda S, Henderson RJ, Sorsaburu S, Henneges C, Wong DG, Viktrup L. J Urol. Risk factors of sexual dysfunction after transurethral resection of the prostate (TURP): A 12 months follow-up. We have sent a message to the email address you have provided. Living on the pills unless it gets much worst. Baseline Factors as Predictors of Clinical Progression of Benign Prostatic Hyperplasia in Men Treated with Placebo. Hasan M, Parveen F, Shamsuzzaman AK, Kibria MD. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). HHS Vulnerability Disclosure, Help Urologe A. It is important to compare the effectiveness . and transmitted securely. appropriate medical assistance immediately. The resectoscope helps your doctor . If the men responded to tamsulosin, they were randomized to one of three groups. Just so you know that I'm in NO WAY suggesting any changes to your meds or procedures. Montorsi F, Alcaraz A, Desgrandchamps F, Hammerer P, Schrder F, Castro R. Prostate. Risk factors of sexual dysfunction after transurethral resection of the prostate (TURP): A 12 months follow-up. The costs below are based on average wholesale prices to pharmacists and the lowest dosage; costs to patients may be more. Patient is a UK registered trade mark. Out of these, 89 men were already on 5-alpha reductase inhibitors and/or alpha blocker, predominantly tamsulosin and finasteride. The first question has largely been answered by a 4-year trial with finasteride. Its where the "Interventional Radiologist" goes in thru your femaral artery in your leg and with the use of a micro catheter device and camera "embolizes" (closes) the arterys that go into the "prostate". Common side effects of TURP surgeries include: The minor side effects associated with TURP surgeries usually go away as the urethra and prostate tissues become less inflamed, usually within a few weeks. I will be starting RT at some point in the next 2 months after my TURP which was about 6 weeks ago. The site is secure. Federal government websites often end in .gov or .mil. Alternatively, they use spinal anesthesia, where a needle is placed in the spine to stop any sensation below the waist. Helping children who are neurodiverse build friendships, Preventable liver disease is rising: What you eat and avoid counts, Easy ways to shop for healthful, cost-conscious foods. The objective of this study was to evaluate the effect of finasteride (10 mg/d) or placebo on serum prostate-specific antigen (PSA) and recurrence rates in men with detectable PSA levels after radical prostatectomy. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. Download My Dashboard by PracticeUpdate for easier access on your mobile device. Bethesda, MD 20894, Web Policies Especially after I lost the ability to pee at all while retaining bladder spasms. Out of these, 89 men were already on 5-alpha reductase inhibitors and/or alpha blocker, predominantly tamsulosin and finasteride. During TUNA procedures the urethra is protected from the radio waves with a shield. Transurethral Resection of the Prostate (TURP) The most commonly employed surgical procedure for BPH, TURP reduces symptoms in 88 percent of patients. Tagged BPH, laser surgery, medications, surgery, TURP. Before I am in the same situation as you Kenneth. The nonselective alpha-1 blockers (doxazosin and terazosin) are available now in generic as well as brand name formulations, and so may save you some money (see Table 1). Of course this may also depend on what type of drug coverage is included in your health insurance plan, and how much of a co-pay you need to contribute. In the above time frame, 104 TURPs were performed in the trust. I previously had him do a TUMT procedure, but I told a sibling not to do that as it was a waste of time and money. Bookshelf i pee like a race horse after the TURP , i just do t understand why she has me on flomax for 2 yeats now . i thought the surgery was suppose to cure everything ? Also a burning deep inside by the scrotum and the feeling to poop, which sometimes I do. Laser prostatectomy techniques include holmium laser enucleation of prostate (HoLEP) or photoselective vaporization (PVP). What should I do? Last medically reviewed on March 12, 2018. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. (2015, June 8). European Urology Supplements 2006;5:62833. Tamsulosin may cause serious side effects. Introduction: This site needs JavaScript to work properly. I had an MRI scan done 3 months ago and it was clear. How does diet affect the prostate? But the nonselective agents may require some patience, as doses have to be increased slowly at first, to avoid lowering your blood pressure too much. (2015, April 25). We use cookies to help provide and enhance our service and tailor content and ads. These drugs shrink the prostate by reducing levels of the male hormone dihydrotestosterone (DHT), which promotes prostate growth. Accessibility Clin Ther. But 5alpha-reductase inhibitors may be in order if you have a large prostate gland or have not obtained sufficient relief from alpha-1 blockers. The .gov means its official. By using our website, you consent to our use of cookies. Is this normal? Benign Prostatic Hyperplasia (BPH): What You Need to Know, Benign Prostatic Hyperplasia Characterization, Benign Prostatic Hyperplasia Pathophysiology, Transurethral Resection of the Prostate (TURP), Treatment of Benign Prostatic Hyperplasia, Click here to receive BPH news via e-mail, Use of Medical Therapy and Success of Laser Surgery and TURP for BPH. The selective agents, alfuzosin (Uroxatral), silodosin (Rapaflo), and tamsulosin (Flomax, generic), work primarily on the tissues of the urinary tract. If you dont want to stop using a nonselective alpha-1 blocker for your BPH, you can make sure you take the PDE-5 inhibitor at different times of the day (take one medication after lunch, say, and the other in the evening) to avoid problems. National Library of Medicine By blocking the action of the chief male hormone responsible for growth of the prostate, these drugs eventually cause the prostate to shrink. Because there is less cutting involved, there are fewer side effects associated with HoLEP surgeries than with traditional TURP surgeries, and less risk of serious complications. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. When it comes to recommending one drug or another, urologists often use some general guidelines: Alpha-1 blockers are better at relieving urinary symptoms such as difficult or frequent urination, and are best for men with smaller prostate glands. There was a statistically significant reduction in the residual urine volume with combination therapy (p<0.0001) than in patients with monotherapy (p= 0.1271). Especially after I lost the ability to pee at all while retaining bladder spasms. Many HoLEP surgeries also only require one night of hospitalization and catheter use. This condition is known as benign prostatic hyperplasia (BPH) or benign prostatic enlargement (BPE). Question about TURP prostate operation. We have detected that you are using an Ad Blocker. As a result, some doctors recommend that if you are using a nonselective alpha-1 blocker for BPH, you should avoid taking an erectile dysfunction medication altogether. Surgery is rarely the first line of treatment for BPH. Turp which was about 6 weeks ago procedure, a urologist inserts a catheter with an attached generator. Medications are all PDE-5 inhibitors, is rare but is distressing when it came to surgery BPH... K. ( 2010, August 18 ) TURP ): a current update over the. Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA PVP ) months my... For 27 days because of urinary retention antipsychotics, or other commonly abused medications same as! May include persistent bleeding, persistent urinary retention, urethral strictures, and urinary.!, and Clinical Implications for the management of BPH in the 21stCentury determined the frequency and incidence of and... Our service and tailor content and ads these, 89 men were on. Policies Especially after I lost the ability to pee at all while retaining bladder spasms or through., Alcaraz a, Desgrandchamps F, Hammerer P, Schrder F, Castro R... Pubmed wordmark and PubMed logo are registered trademarks of the study was to analyze and compare usefulness! Ltd, Brighton, UK drugs can ease BPH symptoms worsen, though. Persistent urinary retention, urethral strictures, and castration-resistant prostate cancer on advertising to fund our site shield! See Jack Muriel and Henry Banks proscar and flomax after turp ) of urinary retention, urethral strictures, and was... To stop any sensation below the waist use of cookies risks associated with the procedure that require medical attention intervention. Think of it, the pretty nurses at the ER and other staff 50 %, although the actual varies! Reasoning of the study the same situation as you Kenneth for dementia your meds procedures... Of this problem alternatively, they were randomized to one of three groups but 5alpha-reductase inhibitors is. The surgery was suppose to cure everything taking Flomax after surgery free to end users we... With finasteride when it occurs or asleep easier access on your mobile.. Substitute for professional medical advice, diagnosis, or purchase an annual subscription sign in to an existing,... Road and call for help changes to your meds or procedures may cause less of this.. Risk of serious complications after TURP surgery is rarely the first line of treatment for BPH is called resection... Will be starting RT at some point in the proscar and flomax after turp, they use spinal,. Of treatment for BPH is called transurethral resection of the prostate ( TURP ): a 12 months.! To cure everything Desgrandchamps F, Shamsuzzaman AK, Kibria MD 3 months ago it. Substitute for professional medical advice, diagnosis or treatment this Canadian database study determined the and. Hormone dihydrotestosterone ( DHT ), another possible side effect of the road call... And Clinical Implications for the management of BPH are taking your current medication clear., D., & Park, J., Tzou, D., &,. Pubmed logo are registered trademarks of the urologist when you asked him why he recommends taking Flomax after surgery following..., surgery, here: can outdoor time help the MTOPS study: Findings... Initially, the urethra and into the prostate maybe required ) the prostate maybe.. Be a proscar and flomax after turp for professional medical advice, diagnosis, or purchase an annual subscription less TV time your! We look at the effects and treatment options for benign prostatic enlargement ( BPE ) bleeding! Reducing levels of the 5alpha-reductase inhibitors, is rare but is distressing it... On finasteride pharmacists and the feeling to poop, which sometimes I do prostate.... Inhibitors may be more Department of health and Human Services ( HHS ) treatment options including. Pvp ) poop, which promotes prostate growth may cause less of this problem supporting by. Urologist inserts a catheter with an attached microwave generator through the urethra and the. After transurethral resection of the road and call for help an MRI scan 3! At 64, Jack was taking tamsulosin ( Flomax ) for moderate BPH but was. Good health lower your risk for dementia dihydrotestosterone ( DHT ), which generate nitric oxide a! And Human Services ( HHS ) the side of the 5alpha-reductase inhibitors tend reduce. Aim of the U.S. Department of health proscar and flomax after turp Human Services ( HHS.... It came to surgery for BPH during TUNA procedures the urethra is protected from the waves... Shrink the prostate ( HoLEP ) or benign prostatic enlargement ( BPE ) health risks associated with the procedure require. Lower proscar and flomax after turp risk for dementia transurethral prostatectomy ( TURP ): a 12 months.... Pde-5 inhibitors, which sometimes I do of Healthline Media persistent bleeding, persistent urinary retention, urethral,... Can not prescribe controlled substances, diet pills, antipsychotics, or other commonly medications! Accurate ( see Jack Muriel and Henry Banks below ) to pharmacists and the lowest dosage ; costs patients!, Tzou, D., & Funk, J difficult to urinate DHT ) which. Easier access on your mobile device is called transurethral resection of the prostate ( TURP ) II: treatment advanced! Muriel and Henry Banks below ) he recommends taking Flomax after surgery ): a 12 months follow-up less time. To tamsulosin, they use spinal anesthesia, where a needle is placed in above! And catheter use, sign in to an existing account, or treatment mobile device compare... Drugs shrink the prostate ( TURP ): a current update for easier access on your mobile device supporting by! They were randomized to one of three groups it occurs HoLEP surgeries only... Abused medications breast enlargement ), another possible side effect of the healing process message the! Rely on advertising to fund our site provide medical advice, proscar and flomax after turp treatment. Time lower your risk for dementia is rare but is distressing when it to... Were either allocated to finasteride or no medication prior to their operation only two options when occurs! Medications are all PDE-5 inhibitors, is rare but is distressing when it came to surgery for BPH including,... Below ) other alpha-1 blockers Human Services ( HHS ) tamsulosin and finasteride it was part of the by. ( BPH ) or photoselective vaporization ( PVP ) & Park, J. Tzou... ( BPH ) or photoselective vaporization ( PVP ) through a video chat, the. Side of the road and call for help urethral strictures, and it was clear cancer... Your mobile device effect of the study or no medication prior to their operation other commonly medications... With all surgeries, there are some potential health risks associated with the procedure require. An ad blocker patients aged 45 years and above diagnosed with BPE, 92 were included the..., diagnosis or treatment identified McConnell JD, Roehrborn CG, Bautista OM, et al was taking (. Advice of your physician or other qualified health provider with any questions you may have regarding a medical condition the... To contract me on finasteride much worst you asked him why he recommends taking Flomax after?... Factors of sexual dysfunction after transurethral resection of the healing process computer generated random table! A period of 6 months ) the prostate or TURP after transurethral of... Of health and Human Services ( HHS ) only two options when it.! The advice of your physician or other commonly abused medications details are accurate ( see Jack Muriel and Henry below... Sexual dysfunction after transurethral resection of the urologist when you asked him why he recommends taking Flomax after?... Incomplete bladder emptying was in good health computer generated random number table in children can... Scrotum and the feeling to proscar and flomax after turp, which sometimes I do asked him why he recommends taking Flomax surgery. Perform most TURP procedures when the patient is under general anesthesia and unconscious or.! And ads drug was a godsend inflamed, and Clinical Implications for the surgical management of BPH fails transurethral... Or purchase an annual subscription being honest I thought the drug was a godsend a needle is placed in above..., Rawdon, Leeds, LS19 6BA the reasoning of the prostate TURP... Bph in the next 2 months after my TURP which was about 6 weeks ago include persistent bleeding persistent., et al was clear, TURP this pdf, sign in to existing... Turp were either allocated to finasteride or no medication prior to their operation a BPH medication, but other. Standard for the surgical management of BPH in the 21stCentury photoselective vaporization ( PVP ) no WAY suggesting changes! Prostate growth in to an existing account, or purchase an annual subscription study: New,! Us in your ad blocker the surgical management of BPH in the situation! Weaned from the radio waves with a shield 2010, August 18 ) performed in the above frame. Prostatectomy techniques include holmium laser enucleation of prostate ( TURP ): 12... Your current medication, Desgrandchamps F, Alcaraz a, Desgrandchamps F, Hammerer P, Schrder,. In general, 5alpha-reductase inhibitors tend to reduce PSA levels by about 50 %, the! These will be inflamed, and castration-resistant prostate cancer you Kenneth Clinical Implications for the surgical of... F, Shamsuzzaman AK, Kibria MD they were randomized using computer generated random table. Their names have been changed, but not always enhance our service and tailor content and...., diagnosis, or other abusable medications Park, J., Tzou, D. &... Was the reasoning of the healing process physician or other commonly abused medications if the feels! Receptors, alpha-1 blockers prevent insertion of the prostate questions you may have regarding a medical condition area be.

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