Mitochondrial Myopathy Disorder Health And Social Care Essay

A “ vitamin D ” bottle of O is now in the house for good due to the frequence of the chest & A ; back musculus cramp. triggers can be “ obvious ” eg allergic reaction ( pollens, grasses, cats and Canis familiariss ) ; weather ; dramatic alterations in temperature ( eg: can non travel shopping in the country that some shops maintain at “ icebox temperatures ” . Occasionally I can acquire off with it if I merely need milk – I can keep my breath long plenty to acquire that, but I have to travel every bit rapidly as I can or the musculuss can spasm. However, the latter is still far better to “ run the gantlet ” for than what I have to “ travel through ” if I inhale the cold air ) . If I do hold to travel out into the cold during the winter months ( normally merely to travel to Doctors ) I must guarantee that I am adequately clothed, do certain that I am have oning my ski-goggles ( to maintain the cold air off from the oculus country, so that the oculus musculuss do n’t spasm ) , and that I can take a breath “ through ” something ( like a warm scarf – I have a manner that where I can put the scarf merely a small higher at the forepart, and no-one realises what is truly “ taking topographic point ” ) ; A SUDDEN MOVEMENT OF ANY NATURE “ AT THE WRONG MOMENT ” , OR SIMPLY BEING UNABLE TO MOVE, BE IT EVER SO SLIGHTLY AT LEAST EVERY 15 MINUTES, REGARDLESS OF THE TIME OF DAY. The conditions or the trouble in being able to “ writhe ” or “ shuffle ” or travel the weaponries and custodies are the major factors doing the really painful “ bad cramp ” .
BOTH VOLUNTARY AND INVOLUNTARY MUSCLES ARE AFFECTED BY THE MITOCHONDRIAL DISORDER
THE VOCAL CHORD MUSCLES HAVE DEGENERATED TO THE POINT WHERE THEY NO LONGER Work ALL THE TIME. ANY ATTEMPT AT SPEACH IMMEDIATELY BRINGS ON ACUTE PAIN AND CHRONIC SPASMS IN THE THROAT AND NECK WHEN THE VOCAL CHORDS BECOME PAINFUL AND THROBBING WHEN STRAINING TO SPEAK.

Changeless INFLAMATION IS IN THE VOCAL CHORD / THROAT AREA.
I HAVE BEEN ADVISED BY DR. WOOD NOT TO SPEAK BECAUSE OF THE NOW CONSTANT Menace OF MAJOR INFECTION, BUT THIS HAS PROVEN TO BE IMPRACTICAL, AND I HAVE LEARNED TO MANAGE THIS TO BE ABLE TO SPEAK THE MAJORITY OF THE TIME.
WHEN NECESSARY, I USE A LAPTOP FOR ALL SPEECH/VOCAL COMMUNICATION NOW. I ALSO MAKE WHAT NOISE I CAN BY CLAPPING MY HANDS OR THIGHS [ I try non to stomp my pess as that gives the incorrect feeling ] , DEPENDING ON CIRCUMSTANCES AND SITUATION TO GAIN THE ATTENTION OF THE 2ND/3RD PARTY REQUIRED IF THE MATTER IS IMPORTANT.
I AM NOT STUPID OR DEAF, AND MY “ MENTAL FACULTIES ” ARE FULLY COMPREHENSIVE. PLEASE SPEAK NORMALLY.
Muscle “ Problem ” – Diagnosis by Dr Katekar:
There are at least ( 2 ) neurological upsets, 2 muscular upsets and mitochondrial upset [ non genetic/hereditary ] .
The Mitochondrial Disorder has caused Muscle Atrophy and Weakness resulted in an instability in the musculus fluids ( but NOT Dystrophin, although non good this fluid is produced sufficiently to Govern OUT Muscular Dystrophy ) , with Acute/Chronic Pain. There are 3 types of hurting, necessitating 3 types of medicines for “ alleviation of kinds ” ; and Chronic Muscle Spasm in BOTH the Voluntary and Involuntary Muscular Systems eg: Voluntary Muscles: legs, weaponries, bole of organic structure, stop and upper trunk [ this can do major jobs take a breathing and there is oxygen kept in the place for this intent, guaranting O impregnation is at an acceptable degree despite dramatic deceleration of heart/pulse. Requests for the Blood Trials to Confirm this for entry to DVA have been refused on the evidences that my life would be at great hazard, as my heart/pulse beads to around 50bpm and blood force per unit area drops at best, to approx 60 over 70 [ mean [ normal ] blood force per unit area for me is 70 over 90 ; eyes ( doing blurred and/or dual vision to impermanent sightlessness of unpredictable clip frame. If unable to talk at these times, I use deaf/blind sign language ) . It is non unusual for an oculus musculus to spasm, doing said oculus to be “ immobilised ” for the continuance of the cramp, and the other to travel usually. It has been known for both eyes to spasm at the same clip. This is farther complicated at present by fast turning Cataracts, which are scheduled for remotion whilst I am “ In Remission ” ; pharynx ( trouble swallowing, and “ little stairss ” often halt medicine go throughing into the tummy, particularly if merely 1 tablet is being taken ) . The pharynx is besides “ unfastened ” from vocal preparation in my teens and early 20s and it is non uncommon for the vocal chords to acquire inflamed or infected. This is minimised by regular “ intervention ” of a one-fourth a lemon followed by sipped Dry Ginger Ale ; vocal chords have degenerated doing them to be strained, annoyed and inflamed. I sip Dry Ginger Ale to ease this, but the menace of major infection is now a invariable, and I have been advised by Dr Wood non to talk or whisper at all. I use a laptop computing machine for all speech/vocal communicating now ; jaw musculuss cramps make eating hard, although non impossible, and I tend to maintain to soups, soft nutrients and fluids at these times. Involuntary Muscles: tummy, vesica merely. The vesica is now dystrophic and I “ maintain a mental oculus on my unstable consumption and what is “ passed ” . If I feel that there is an instability, and fluid is being retained, I so use catheters to guarantee that the vesica is being wholly emptied to cut down infection and take the Lasix until it is one time once more “ under control ” ( if infection is indicated so I start a class of anti-biotics instantly – this has proven to be greatly good, maintaining the infection mild and minimal ) . Another Fluid Chart has been kept from Mid January, 2009 to supervise that all is one time once more as it should be, and whether catheters are being used. Please make non waver to bespeak a transcript of the Chart if required ; diaphragm merely ; big intestine ( when the musculuss spasm, it is hard to make more than a “ little ” gesture. As there has been an escalated frequence in this, and it takes an norm of 7 yearss before the intestine starts to empty anything like “ to the full ” , suppositories are traveling to be trialled to see if they can give equal alleviation and cut down the hazard of any “ nasties ” developing ; little intestine ; pes musculuss ; facial musculuss ; neck musculuss ( jobs can be caused in the cervical spinal column as a consequence of this, every bit good as terrible concerns. Migraines are non uncommon and hurting or blaze related ) ; etc.
The lone “ musculus ” that appears to be working at its best, without “ bugs ” is the bosom, despite all the musculuss around it traveling into chronic cramps, although this happening does decelerate it down. To day of the month, all trials are clear despite the low blood force per unit area ( and I am making my best to guarantee that it stays that manner ) .
MY PHARMACY IS TORONTO AMCAL PHARMACY
For any questions the REFERRING PHARMACIST is SAM ZOGHBI
FOR RELIEF and / or aid DURING PERIODS OF MUSCLE SPASMS ( these can be of short ( if treated rapidly ) or prolonged continuance. There is no “ put ” clip frame here – it can travel on for hebdomads, necessitating the pickings of medicines for an drawn-out period of clip, including the IM Injections, although these are merely used when perfectly necessary. Oral medicine merely is preferred ) :
TRAMAL 50mg ARE GEL CAPSULES and are SLOWER TO RELEASE into the system. This medicine is the lone analgesic able to be used because of my Opiate Allergy, and so merely for every bit short a period of clip as possible.
If the stop muscles spasm, unwritten medicine takes excessively long – I am unable to inhale, as the musculuss maintain fastening around the lungs/diaphragm. For the cramp ‘ it ‘s unwritten BUSCOPAN and VALIUM ( 10 to 40 milligram ) . I self inject into the thigh musculuss DIAZAPAM ( 2mls to 12mls ie 1- 4 phials ) when it “ hurts large clip ” . Quick Relief. The 6 phials are merely used if bulk of all musculuss are in cramp, and particularly the stop to throat musculuss and similar up the back. This “ event ” is Rare. It feels like I ‘ve got a large broad set of steel around my organic structure and that it is being continually tightened. The hurting does n’t assist. Oxygen is besides indispensable when the musculuss are at this pont.
FOR MEDICAL PROCEDURES [ USUALLY IN THEATRE ] and MRIs REQUIRING MUSCLE SPASM FREE IMMOBILITY FOR MORE THAN 10 MINUTES:
No “ pre-medication ” prior any GENERAL OR LOCAL ANAESTHETIC
WITH THE EXCEPTION OF:
30mls MEDAZOLAN to be injected IV prior.
MRIs require a General Anaesthetic.
CT Scans, ULTRASOUNDS and NUCLEAR SCANS require VALIUM [ DIAZAPAM ] IM Injections [ ego administered ] and Buscopan, the latter depending on the process and clip frame required 30 proceedingss prior Scans so to guarantee musculuss are spasm free and to help by leting me to put level for a minimum clip. 30mls IV Valiumor Medazolan is required for drawn-out processs and this needs to be “ topped up ” with 10mls every 30 proceedingss [ please refer to Medical Records at John Hunter Hospital when I had to hold a Nuclear Scan ] .
POST TRAUMATIC STRESS DISORDER ( PTSD ) – Primary and secondary, has been diagnosed. This is being treated by Dr Kim John Street, Swansea.
Allergies:
ALL OPIATES, including: Morphine ; CODEINE ; PETHADINE ; and ALL RELATED MEDICATIONS AND INJECTIONS ;
ALL PLASTERS except HYPAFIX by BSN medical As it is non often used or stocked, I guarantee that I carry some all the clip – you will happen I ever have some with me, and kept in a bluish vinyl, 2 zippered “ billfold ” with my medicines and injection rubs. Any lesion will necessitate some kind of dressing before the aerated plaster is put on ( for obvious grounds ) I do do up some into “ set AIDSs ” , used chiefly when I need any injections or blood trials. DO NOT USE MICROPORE OR ANY OTHER PLASTER UNDER ANY CIRCUMSTANCES. GAUZE BANDAGES ARE OK IF THE HYPAFIX IS UNSUITABLE.
Plastic SKIN, OR OTHER SIMILAR PRODUCTS, INCLUDING “ LIQUID BANDAIDS ”
MAXILON, TOTAL INTOLERANCE = must be given STEMETIL
BARIUM, INFLAMATION OF ALL “ DIGESTIVE TRACT ”
WHEAT ; RYE ; KIBBLE & A ; OTHER “ DRY ” GRASSES/GRAINS AND GLUTEN including family “ Lawn Grass ” ;
DUST & A ; MOULDS
CATS, DOGS HORSES & A ; COWS ;
WATTLE & A ; POLLENS
KNOWN REACTIONS TO ALLERGIES:
“ MEDICATIONS ” & amp ; “ WATTLE ” & amp ; “ POLLENS ” = ACUTE SWELLING INTERNALLY, WITH ITCHING ; POSSIBLE FULL MUSCLE COLLAPSE, INCLUDING = CHRONIC NAUSEA ; VOMITING ; DIFFICULTY BREATHING ; THROAT CONGENSTION
“ Plasters ” = RED RASH DEVELOPING INTO A FORM OF WELT, EXTREMELY ITCHY and OFTEN LOOKING LIKE A BAD SCALD, WHICH EVENTUALLY BLISTERS – Time FRAME CAN VARY DUE TO CIRCUMSTANCES.
Grasss, Cats, Dogs, Horses and Cows: “ Swelling AND EXCESSIVE WATERING OF EYES ” “ WELTS ” and “ CHRONIC Itch ” , AT ALL PHYSICAL CONTACT POINTS
List of Previous Operationss and Anaesthetics & A ; /or Hospitalisation, including twelvemonth and Hospital
Year Operation & A ; /or Hospitalisation and Details
2009 Cataract Right Eye Removed by Dr David Manning at Hunter Valley Private
Hospita
cubic decimeter
2009 Larynx Infection – Kurri Kurri District Hospital
2009 Larynx Infection – Maitland District Hospital
2009 Lumbar Spine Traction and Larynx Infection – Lingard Private Hospital
2009 Larynx Infection – Belmont Hospital
2009 Larynx Infection – Belmont Hospital
2009 Cataract Left Eye Removed by Dr R Griffits at Toronto Private Hospital
Chronic Chest Pain, Muscle Pain and referral to and monitoring by Pain Clinic [ John Hunter Hospital so transferred to Rehab at Toronto Private
Hospital ]
Possible Spinal Fracture – Lumbar ( subsequently diagnosed Lumbar Spine
status aggravated and T8 wedged and stress break by T7 and T9 )
[ Lingard Private Hospital ]
Multiple Cyst Removals ( assorted topographic points on Scalp ) [ Newcastle Mater
Hospital medazolan used ]
Multiple Cyst Removals ( both Breasts ) and Nipple Reconstruction ( Right
Breast ) [ Belmont Hospital medazolan used ]
Left Shoulder Rotator Cuff Surgery for break [ Hunter Valley Private
Hospital ]
1991/1992 Probes of Muscle Disorder and admittance for possible spinal
harm as a consequence of backwards autumn in the wheelchair [ Prince
Henry Hospital – Records should now be held at Prince of Wales
Hospital, Randwick ]
26 Cysts removed from Head and Full Body [ Prince of Wales Hospital,
Randwick ]
Multiple Haemorrhoids removed [ Prince of Wales Hospital, Randwick ]
Muscle Biopsy – Deltoid Muscle Left Arm [ Orange Private Hospital ]
Colonoscopy – non completed due to Chronic Muscle Spasm of the Bowel
[ Dubbo Clinic ]
Spinal Manipulation [ Dubbo Base Hospital ]
Hysterectomy – Womb Merely [ Crown Street Womens Hospital – Records
are now at Royal Womens Hospital, Sydney ]
1981 – 1973 D & A ; C ‘s every 3 – 5 months ( about 11 surgeries that are
remembered ) [ Gosford District Hospital and Crown Street Womens Hospital ]
1977 Reconstruction of Bridge of Nose due to poisoning of Sinuses [ Royal North
Shore Hospital ]
Very Large Tumour Removal from cervix ( approx 18cm x 9cm ) [ Royal North
Shore Hospital ]
Appendectomy [ Gosford District Hospital ]
Removal 4 Molars [ Wyong Hospital ]
Hernia in Groin – fix to exceed of leg by Plastic Surgeon [ Brisbane Hospital ]
Full Reversal Blood Transfusion – “ Rhesus Baby ” [ Unscreened Blood had Hepatitus B Strain, but Liver Functions [ closely monitored ] show no indicants, and are normal ] . Please bespeak a transcript of the Last Blood Test for Your Records & A ; General Information [ Crown Street Womens Hospital – Records now at Royal
Womens Hospital, Sydney ]
Pregnancies:
4 ten Miscarriages so Daughter Born 09/01/1952 [ Crown Street Womens Hospital
– Records now held at Royal Womens Hospital, Sydney ] ;
1 ten Miscarriage so Son Born 03/02/77 ; [ Crown Street Womens Hospital
– Records now held at Royal Womens Hospital, Sydney ]
GENERAL INFORMATION
I usually have really low blood force per unit area: it is non unusual for it to be 60/70, and after general anesthetics, it has been known to be in the high 40s-low 50s over 60-70.
My pulsation is besides “ slow ” : seldom greater than 60 per minute, and it is non unusual for it to be in the low 50s. It has been known to be in the high 40s for considerable periods of clip.
The above rates are non a consequence of musculus cramps, although they can lend to said degrees.
Both my low blood force per unit area and decelerate pulsation have been apparent for every bit long as I can remember [ my female parent besides has changeless low blood force per unit area ] .
If I feel that there is an at hand job with blood O soaking up, I have some O and albuterol instantly, and remain on it until my coloring material has returned “ to normal ” and my pulsation has increased to above 60. Although non a frequent happening, it has occurred frequently plenty for me to hold this “ a criterion operating process ” when I feel that my pulsation has dropped a small excessively low and my skin coloring material changed – albeit merely little. There has been considerable concern during the last 12 months about these degrees and I have learned a manner of intensifying them, but it is a difficult subject to keep, and when stressed or dying, I merely ca n’t look to pull off to “ draw it up ”
I DO Not hold asthma and a bosom status has non been diagnosed, although regular ECGs are ever done anterior any “ medical processs ” , and when it is felt to be necessary to guarantee that the musculuss have caused no harm or other “ bugs ” , particularly as chest musculus cramp is “ common ” . I ‘ve had several ECGs of late – all indicate a really slow bosom rate, but no-one has expressed concern at this [ pulsation is averaging 54 at present ]
I am besides intolerant of onion and Allium sativum as a consequence of the degenerated sphincter musculuss at the tummy [ this does non include “ spring onions ” or “ peppers ” – there has been no reaction to them to day of the month.
Dry Ginger Ale sooths and helps the vocal chords, although it is accepted that the “ harm ” [ devolution ] will non be able to be “ improved ” .
Thank you for your clip and apprehension of these recent alterations, and your forbearance.
Update: 5th July, 2010
I am Dr Mannings patient for my eyes. Both have had cataract surgery and the 3.8mm+ ocular nervousnesss are damaged from the mitochondrial upset over 10 old ages ago.
The Guide Dog Association has come back on board with retraining and reassurance with some Cane Work, which has helped my morale vastly. For low vision and blind periods.
Professor Ghabrial had me in grip for two hebdomads in Lingard Hospital which was successful. It eased the hurting well from all the shrinkage and wedged vertebra that took topographic point while being out of remittal for some 10 uneven old ages. I had a autumn that once more made the spinal column Mobile and I have had a physical therapist gently rub my dorsum for some hebdomads, and this seems to hold helped. I have been advised to acquire an elastic surgical girdle when present chest “ issues ” have been resolved.
I am now, gratefully, in full remittal, so hold legs do travel once more i?S – good carefully planned travels er walks. I am really careful non to exaggerate it and do them “ want to give up and set down me on my proverbial butt ” ! I was thrilled to happen that I was able to March in Sydney on Anzac Day in 2009 [ my late hubby, Bear, was one of the last smattering of Combat Field Engineers/Tunnel Rats to go forth Vietnam ] and so walked from Hyde Park to the “ bottom terminal ” of Wentworth Street without any jobs, and after holding “ a drink ” [ dry ginger ale ] with some of “ the Mates ” and a friend, went on to walk the short distance to Central ] . I had no jobs with my legs making any of this and neither were there jobs the undermentioned twenty-four hours, bespeaking the strengthening of the Remission “ Stage ” . It has got even better since so.
I have no jobs walking to and from my place [ three blocks up the ridge above Toronto High School ] to Toronto shopping Centre, although I do non transport my purchases, but use a “ shopping streetcar ”
General wellness is first-class. The Voluntary musculuss appear to hold stabilised peculiarly good [ the best since the late 1980s ] , the involuntary are prolonging and changeless in their present status = non great, but could be worse. The sphincter muscles work the least, the saddle sore vesica has shrivelled to virtually nil, the liver map is great as at the last blood trial, The vesica can non do up its head so I keep the catheters handy, and the intestine does its ain thing although it has been decided that if I am non happy with “ my motions ” for three yearss and there is no alteration on the 4th, I have been advised by Dr Sharon to utilize clyster to guarantee “ the build-up ” from the musculuss non desiring to let go of and remain spasmed, does non do jobs further down the path.
No processs can be done internally, as, for illustration, with the small cameras attached to whatever, as the musculuss will spasm around them, and any tools being used every bit good, and has been deemed unsafe and perchance life threatening, depending on where.
The Blood Gases blood trial still has to be done for DVA to pay for the O that I need and use and have been paying for for old ages, but non been done to day of the month because my blood force per unit area and bosom rate are excessively low and at least 14 physicians to day of the month hold denied me the pickings of the blood for the trial because they deem it to be life endangering. Without it – I continue to pay for all that is required to hold the O in the place and the “ gas bottle in usage ” . No worries the monthly $ 110 has become a portion of my general budget now – one gets used to holding to pay for these things. Dr Katekar has wanted me on specific minerals and vitamins to feed the musculuss and maintain the fluid degrees every bit high as possible – prescribed medicine – those originally put frontward are now covered by DVA and “ the needed DVA test period of 3 months ” will get down early January. They can so be approved for lasting prescription and with the status now being accepted, farther addendums can now be put frontward. I have found the Blackmores Magnesium to be an “ indispensable ” [ although I have found that the Thompsons Organic is better, it is besides harder to acquire ] .
I am prone to fluid keeping as a consequence of the medicines that I am on, but this is now virtually under control and I am able to maintain such keeping to a minimal thanks to the Lasix fluid tablets as required. I merely take them when I feel the demand Internet Explorer I bloat with the fluid or experience the fluid is non being passed as it should and observe whether or non the vesica “ issues ” require the usage of catheters
.
I am unable to put level – period! My spinal and musculus conditions combined [ including wedged vertebrae ] , have made this impossible [ and yes, now being in remittal, I do seek, but to day of the month, pay a immense monetary value for it within a twosome proceedingss = chronic hurting and musculus cramps, worsening the already “ shrunk spinal column ” symptoms ] . To put level I need to be good medicated with anti-spasmodics including IM Injections, which I ever carry with me should the musculuss go into an unexpected cramp. I have an electric bed at place with allows me to kip in a “ zigzag ” manner, taking every bit much emphasis off the back musculuss as possible. Yes, it is a important consideration with respects the grip, although non unsurmountable.
With my voluntary musculuss bit by bit beef uping, it is a great feeling for me and has decidedly given me greater quality of life, being able to travel around independent of Jade – my wheelchair.
The lone cloud on my skyline, as such, is my ability to talk and recent ache, uncomfortableness and rubing 24/7 and intermittent crisp hurting [ day-to-day ] in both my chests – really different from that which is caused by any of my musculuss in the yesteryear.
The “ little musculuss that create a p ” between the vocal chords and the pharynx have atrophied and broken, making trouble to talk, although frustrating, does non trouble oneself me, being the 2nd clip unit of ammunition that I have “ been here ” and I have Sheeba [ my laptop ] to help me now, where in the past, I had My Bear [ late hubby ] who came with me to construe the sign language that I had to make, or guarantee that he was at that place to compose for me should my manus musculuss “ give out ” . Dr Sharon has advised me non to talk at all because of the chronic hurting induced by the annoyance, exasperation and redness that is created in the pharynx in that part, so that the infections are kept minimum. I need the same antibiotics if the vesica gets infected, and can non, because of my medicine allergic reactions, “ have my organic structure acquire excessively used to taking them ” in instance of “ unsusceptibility ” . That said, I have managed the hurting and uncomfortableness to be able to talk most of the clip, and there are distinguishable indexs when I need to halt and fall back to the laptop, and it now happens merely on occasion. WHEN THE LARYNX IS SWOLLEN, AS IT IS AT PRESENT I CAN SPEAK. IT ‘S A BIT ROUGH FIRST Thing IN THE MORNING BUT EXERCISES GET IT “ UP AND RUNNING ” Oklahoma AND I HAVE LEARNED TO LIVE WITH THE PAIN.
IF THE SWELLING BECOMES TOO GREAT, THE LARYNX BLOCKS THE THROAT, CHOKING ME AND REQUIRING HOT DRINKS AND OXYGEN. THE BLOOD GASES DROP DURING THE BLOCKAGE – Acerate leaf SENSATIONS DOWN TO THE BREASTS AND AT THE SAME LEVEL IN THE ARMS.
The custodies and pess are still a changeless job with spasms/cramps, hurting, pins and acerate leafs and all activities tire them, including keyboards, although I can work on them the longest. Thank goodness I have been an Executive Secretary in the yesteryear and that has stood beside me now. When the hands/fingers get weary, I have to take a interruption, although these are now going less frequent.
I can non utilize my present brailler – the keys are excessively difficult for my fingers to press, but Vision Australia are traveling to interchange it for me for one with an easier keyboard, which will be great. Yes, I am larning Braille. My status includes periods of entire sightlessness and I have no purpose of halting my life because of it in the yesteryear, nowadays or hereafter.
A TTY phone has besides been set up in the sofa room for me to do my phone calls.
I call a Relay Officer to whom I type who I want to name, they dial the figure and on the “ travel in front ” I start typing what I want to state and they relay it to the individual I am naming. When she has finished what I have typed, she says “ travel in front ” and the individual I have called speaks straight to me, on their “ travel in front ” I so respond and so the conversation axial rotations on. It is non linking every bit easy as it should at nowadays, so it ‘s usage is minimum at present. Electronic mails have come to my deliverance until we can acquire the TTY “ sorted out ” . At this point in clip, I have put it awayaˆ¦aˆ¦Nice!
Having a high hurting tolerance does non do the appraisal of my conditions an easy thing for me.

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