My Nissen Fundoplication-Pre and Post Op Journey

Do you feel you were prepared sufficiently for your recovery by your physician?
1
Yes-Absolutly - 7.7%
3
Yes-Somewhat - 23.1%
0
Didn't effect me - 0.0%
4
No-There were gaps - 30.8%
5
No-Not at all - 38.5%
0
If it hadn't been for friends and family I would have been unprepared. - 0.0%

 
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Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/15/2013 1:21 PM (GMT -6)   
July 15th-

I am having the Nissen Fundoplication on July 18th (Thursday) and I wanted to document my recovery. I am 45 yo, male, and have been living with excruciating GERD for years. I requested this surgery years ago and was told that I should just use medication. I've been on medication for years and have now developed Barrett's Esophagus. So, NOW my Gastroenterologist has referred me to a surgeon.

I have read so many great stories and tips on these forums that I feel very prepared for the surgery and the recovery.

I know everyone recovers differently, but during this Pre-Op period of a few days, I wanted to mention my impressions of how my surgeon has prepared me for the RECOVERY.

I have had a number of surgeries in the past and the main take away that I have is that neither the surgeon nor the hospital staff (nursing, dietitian, PT, social work)prepare you for recover the way I think they should.

I should also mention that I am single, live alone and because I live in a large city, do not keep a car.


After reading the forums on HW about recovery, I make a 2 page list of questions mainly about food choices, medications and possible symptoms.

My surgeon dismissed all of them, saying that I can eat anything that I can chew small enough to swallow. This is not the case with most people on this forums and I certainly don't want to use trial and ERROR to decide what agrees with me. I will stick to the approved Nissen Diet.

I also asked about needing a pill crusher (as I take some daily medication) because many people spoke of not being able to swallow anything but liquids for some days after the surgery. He told me that wasn't an issue. I bought one anyway just in case (I can always use it for the dog's pills when he has them!)

The biggest issue that I have about not being fully prepared is prescriptions and groceries.

I asked for my prescriptions to be sent to the pharmacy in advance of my discharge so I would not have to wait at the CVS after just leaving the hospital (this happened after my spinal fusion and was intolerable). I also requested a scrip for anti nausea medication and was told NO. I was told that If I needed it after I was discharged I should call for a script. This is exactly what I wanted to avoid and anti nausea meds are not a controlled substance that is in demand on the street so why not err on the side of caution and send me home with it?

The groceries part is what flabbergasts me. I was told that I would get a consultation with a dietitian at the hospital AFTER my surgery to discuss my diet, Post-Op! I am speechless. Why would you not provide that information PRIOR to the surgery o you can be stocked up on the items you need? It's not as if most people are normal prepared for a liquid diet at all times, and who wants to grocery shop after being discharged from the hospital?!

Thankfully, because of these forums and other sites I am prepared food-wise and in over the counter items such as Gas-X.

I know this was a bit of a rant but this is what my experiences with surgery have told me. There is an assumption that everyone has; Transportation, Caregivers, and Capacity to tackle all of these necessary things Post-Op and on pain meds. It doesn't make sense to leave these things until after surgery, when you could be VERY prepared at home for the recovery, which is the hard part for the patient, not the surgery.

So that's my Pre-Op statement/rant. I will post next after my surgery (Unless something interesting happened between now and then!). smhair
Until next time,

Ben

scg619
New Member


Date Joined May 2013
Total Posts : 9
   Posted 7/15/2013 5:43 PM (GMT -6)   
Hi Ben,

Good luck with your surgery! I am having the NF surgery on Thursday as well, so I look forward to comparing notes with you.

I didn't receive too much information from my dr, but through my own research, particularly through this forum, I feel well prepared.

Sheila

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/15/2013 6:25 PM (GMT -6)   
Best of luck Sheila!
Until next time,

Ben

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 7/15/2013 7:07 PM (GMT -6)   
Ben & Sheila-
Welcome to Healing well.

Not getting the correct recovery info from the surgeons has been a bad problem for many.

Anything you eat chew to a liquid, stay away from solid meat and soft bread for at least a couple months, ground is usually okay. Remember things will get worse about week 2 or 3 and gradually get better. If you have issues when you advance your diet, back off for a few days and things will settle down.

As for anti nausea meds....DEMAND them before you leave the hospital. The odds are very good you will be nauseous at sometime and that's not a good feeling and trying to vomit id even worse. My surgeon that did my last redo I had for a different surgery years before and he even prescribed it for me a couple years before he did my redo. I have found that some surgeons are just way better caring for their patients after the surgery than others.

Be aware that sugary foods can cause dumping, but dumping will most likely happen early on no matter what you do.

Take care,
Bill
opnwhl4
Moderator: GERD/Heartburn, Kidney disease

Nissen 6/06 and 5/09
#3 8/24/11

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/15/2013 8:17 PM (GMT -6)   
Bill,

Thanks for the recommendations. It's interesting that you mention things getting worse after 2-3 weeks (wrap swelling), my surgeon dismissed that as well
I will DEMAND the nausea medication. I think it doesn't hurt to have it anyway and there's a better than average chance I WILL need it.

Out of curiosity, what anti-nausea medication did you get, and was it helpful? Also, aside from Gas-X, is there any other over the counter OR prescription I should consider having available?
Until next time,

Ben

Tarachriso
Regular Member


Date Joined Mar 2013
Total Posts : 88
   Posted 7/16/2013 8:14 AM (GMT -6)   
Ben another Gas type medication is Phazyme it over the counter liquid gel for after it does help with the gas pain a little.
Tara

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/16/2013 12:14 PM (GMT -6)   
Thanks for the tip Tara!
Until next time,

Ben

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/16/2013 12:33 PM (GMT -6)   
July 16th-

I just received a call from the hospital to take a medical history Pre-Op.

I don't want this to be nothing but negatives (although the Negatives are really what we NEED to know as much as the Positives!) but I am surprised by some of the misinformation I was given.

The hospital wanted to confirm my surgery time, I had not been given it yet by the surgeon's office. The covered my allergys and medications - I updated all of that at my Pro-Op physical last week and much of what they had on file was entered incorrectly (reaction, dosages & times of day).

I asked about two meds I MUST take each night, whether they would be provided or, did I need to bring them? I was told they would be provided, BUT TO BE SURE, I should bring them too! I had to ask (even though I know) if they had to be in their original bottles and, of course, they do!

I was also told I could take the following medication that I take AS NEEDED, for my back, the morning of the surgery; Valium, Percocet and also my Omeprozole. I know very well I can't take Valium or Percocet the day of the surgery and actually need to not take for several days prior according to the anesthesiologist. As for the Omeprozole I will check with the surgeon's office.

The person taking this history and giving you check-in and day-of information is NOT a DR in most cases and this sort of thing happens all the time. I know it depends on your hospital, but I have found this across the board so MAKE SURE you check with your DR about meds.

Nothing else about what to bring, what not to bring, security for any valuables (phone, etc). Having been through several surgeries I'm pretty aware of these things, but I post it because unless you know some of these answers prior, you could be surprised, inconvenienced or just unprepared.

Forums like this are SO helpful for finding the answers AND the questions you need. The hospital and your DR are not infallible and you HAVE to be your own advocate!

So I am preregistered for the surgery. :)

Next I am calling my surgeon's office to go over it all with them.
Until next time,

Ben

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7185
   Posted 7/16/2013 3:04 PM (GMT -6)   
Hi Ben,
Good luck with your surgery!  You're right about this forum...it's a lifesaver for providing answers and important things to know.  Yes, DEMAND anti-nausea drugs.  You don't just need them for possible post-op nausea, but should always have them on hand.  Once wrapped, you won't want to vomit or retch severely with a stomach bug, as it can damage the wrap.  I can't believe how obtuse surgeons can be about that. 
 
My surgeon happily provided me with a script for Zofran (great for run-of-the-mill nausea) and my PCP gave me Compazine suppositories for those all out stomach bugs.  I didn't know if I'd be able to vomit post-op, but since my surgery 4+years ago I had 3 stomach bugs and each time I vomited once before taking the Compazine to stop the nausea.
 
Interesting that your surgeon doesn't buy the "wrap swelling" fact.  My surgeon actually told me that my swallowing would get worse before it got better because of swelling, and that peak swelling would be on or about the two week mark.
 
I took my own medications to the hospital, so I wouldn't have to pay the big bucks for the hospital's version.  They took the meds to the hospital pharmacy to get them approved and then I could take them no problem.
 
As Bill said, when you eat solids you need to chew them until they become a liquid/creamy consistency.  My surgeon was unique in that I was on liquids in the hospital (don't use straws--they will most likely give them to you) and went home with a soft diet.  Then when I saw him at Day 6 I was set free to eat "whatever can be chewed to a liquid".  My teeth/mouth became my blender.  It was trial and error, and I kept a handy paper napkin available in which to deposit anything that didn't chew completely.  It worked great for me.  Toasted bread chews fine, but stay away from untoasted bread and steak. Don't swallow anything that doesn't chew to nothing.
 
Good luck with your surgery!
We'll soon be welcoming you to the Wrapped Club!
Take care,
Denise
GERD/Heartburn Moderator
Nissen Fundoplication 2/09
Allergy/Asthma

"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Eckhart Tolle

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/16/2013 4:11 PM (GMT -6)   
Denise,

Thanks SO much for your post! Great info, especially about being prepared for a "Bug" sometime in the future! I would think any surgeon who wanted the wrap to stay intact as long as possible would agree. I'll speak to mine Thu. Thanks again!
Until next time,

Ben

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 7/16/2013 6:38 PM (GMT -6)   
Ben-

I use Phenergan for nausea and it works well for me, but others use Zophran, etc.

I have found OTC Pepsid to work well for any lingering heartburn while healing. I never really had any issues with gas, so I can't comment on that.

Now for the uninformed doctors. Since most have never had to go through this recovery they have no idea!

When I was at the University of Iowa for an esophagus tear I met lots of GIs and GI surgeons. They were all very interested in what my recoveries were like with my past 2 nissens. One of the GIs training there moved to my area and became my new GI. He remembered me because I was such a difficult case. Anyway, he told me I should write a book or a blog about my experiences because the doctors don't really understand what we go through. I told him I was a mod for this site and explained to him about this site and he thought what we do here is very valuable.
Mt PCP has been thinking of this surgery and even he wasn't properly informed. He asked me what to expect if he went through with the surgery. Now that was a strange appointment.

In my experience there are 2 types of doctors, 1) willing to listen and learn from what there patients go through and 2) those that have a severe complex and won't believe anything that doesn't come from another doctor or research. I am lucky to have had mostly the 1st type.

I have had a nissen since 6/06 and I carry anti nausea meds with me everyday.

Take care,
Bill
opnwhl4
Moderator: GERD/Heartburn, Kidney disease

Nissen 6/06 and 5/09
#3 8/24/11

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/16/2013 8:16 PM (GMT -6)   
Thanks Bill!

Great information and also great insight. I felt the same way about my spinal fusion and my neurologist. I think there are two kinds of Dr's but I just had a conversation about this topic with a family member and they pointed out something I never considered. Some people don't WANT to know about their surgery. I guess Dr's have to play to some middle ground. I want ALL the info there is and it is to bad that Dr's don't direct you to forums such as this for some REAL insights instead of allowing us to go hunting for them.

The up side is that I found this site, and I appreciate everyone's interest, information and well wishes.

Last day to eat tomorrow....I'm thinking BREAD! LOL
Until next time,

Ben

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/19/2013 7:52 PM (GMT -6)   
July 19th-

Well I'm home 29 hours after my surgery.

My surgeon sent me home with out pain and anti nausea meds. He knows that I have Percocet for occasional use for my spinal fusion, I asked for Oxycodone (w/o the Tylenol) because that little pill would be tiny and easier to swallow. He told me to just crush my Percocet, which I did and I throw it up every time.

He told me that Zofran has terrible side effects and he wouldn't prescribe it or anything else, despite the fact that I had been on it intravenously every six hours since the surgery.

So that is my Dr experience.

I can not seem to even get water down. Water and anything else just accumulates in my throat until it comes up.

It's going to be interesting without the IV saline. Hopefully it will be better tomorrow.

I am burping like crazy and that worries me, on the other hand I'm so glad I can, even though it hurts. So that's it for today!
Until next time,

Ben

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7185
   Posted 7/20/2013 8:31 AM (GMT -6)   
Hi Ben,
Welcome to the yeah yeah yeah Wrapped Club! yeah yeah yeah Glad to hear you came through your surgery with flying colors!  Now the work of recovery begins, but it's all worth it!  You'll be so glad you had this surgery, once things settle down and you've had a chance to heal.
 
Be sure to take small sips, and only room temperature water.  No iced drinks or straws, as they can cause spasms.  If you drink a milkshake, give it a chance to warm in your mouth before swallowing.
 
As far as the Zofran goes, it's not like you're taking it forever.  It's just a stopgap medication for those times when you're at risk for vomiting.  I recommend that you pursue this issue with your PCP, specifically focusing on the risk to your wrap.  The Compazine suppositories are great for all out vomiting bugs, as they don't have to go through the stomach.  I wouldn't be able to keep anything down long enough for it to work. 
 
Yes, they all have horrible listed side effects.  But when they're necessary, they're necessary. The amount of time you'll take them isn't enough to be concerning.  I've never noticed a single side effect, although I'm sure that chronic users might have a bigger risk.  Zofran is used during chemotherapy for cancer patients.  It has its role.  Others around the forum use Phenegran and it works well for them. I believe it's over the counter, but I may be wrong.
 
If your wrap is swollen enough to keep even sips from going down, be sure to contact your surgeon and let him/her know.  You don't want to get dehydrated.
 
Happy healing!!
Denise
GERD/Heartburn Moderator
Nissen Fundoplication 2/09
Allergy/Asthma

"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Eckhart Tolle

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/20/2013 10:36 AM (GMT -6)   
Thanks Denise.

I am seeing how this goes today. I seem to be able to get down some juice, but not enough to keep hydrated. I'll contact him if it doesn't get better by this afternoon.

I did find that I can get a pain pill down with a small sip of liquid antacid, so that has helped.
Until next time,

Ben

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/20/2013 11:38 PM (GMT -6)   
July 20-

Well today sucked. I was not able to get ANY water down, nor pain meds. Two of my incisions started looking bad, so I went to the emergency room.

The Head of Emergency Medicine happened to be my DR and he was pissed that my Surgeon sent me home with no meds and discharge care documents for a gall bladder removal. I was put on saline, antibiotics, morphine and anti nausea meds intravenously.

I stayed for a few hours and felt much better. The DR sent me home with LIQUID main meds, disolvable anti-nausea meds and Cipro for my infections (all things I asked for from my surgeon). I guess the DR's had words and my surgeon wants to see me on Mon.

All I can say is that the Emergency dept was great to me and I'm feeling much better.

I can also report that I am able to drink water and juice when I am on anti-nausea and pain meds. :)
Until next time,

Ben

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7185
   Posted Yesterday 9:28 AM (GMT -6)   
Hi Ben,
Sorry to hear you required an ER visit, but happy that your doc was there to take care of you.  It is amazing how dense some surgeons are regarding these things.  Did your surgeon have lots of Nissen experience?  It's unbelievable that you were sent home with gallbladder surgery instructions.  That was a big "oops"!
 
Occasionally someone's wrap swells more than the average amount, which causes lots of problems with getting nutrition and liquids down.  In that case, medical intervention is required.  I'm glad you're seeing your surgeon on Monday.  He really dropped the ball.  Maybe it will be a learning experience for him and someone else will benefit from your problems.  Too bad you had to deal with it, though.
 
The problem is, the wrap generally gets more swollen before it goes down and things straighten around.  I will say this.  Even now, if I chug water, it backs up and drains down.  It's not a problem, but I can feel it.  I chug water all the time...it's just an interesting experience!
 
Hang in there.  You're in the roughest part of your recovery.  It'll gradually get better and better.  Let us know what the surgeon says!
Happy healing,
Denise
GERD/Heartburn Moderator
Nissen Fundoplication 2/09
Allergy/Asthma

"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Eckhart Tolle

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted Yesterday 11:28 AM (GMT -6)   
Thanks again Denise for the support!
Until next time,

Ben

Gail&Dan
New Member


Date Joined Jul 2013
Total Posts : 1
   Posted Yesterday 2:50 PM (GMT -6)   
My husband had Nissen surgery May 1st along with fixing a massive hiatal hernia and opening the lower part of his stomach for quicker discharge. There was no options other than this surgery for him because he had a double lung transplant 8 months ago and was starting to have chronic rejection because of Gerd. It's been very slow recovery for him and at 2 1/2 months post he still struggled with bloating and difficulty eating certain foods. Because of his anti rejection meds for his transplant he has slower healing results. But the good news is that all rejection of his new lungs have stopped. For some reason he finds it easier to get food down if he lays down right after eating.

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted Yesterday 8:52 PM (GMT -6)   
Ben-

I was concerned you would need to go to the ER. Very glad you did.

Very happy to hear your doctor took charge and got you the meds you sholud have had from the start.

Very sorry your surgeon treated you this way. It seems you do have one of the surgeons I detest. No excuses for not sending you home with the correct information nor meds.

Take care and welcome to the wrapped club!

Bill
opnwhl4
Moderator: GERD/Heartburn, Kidney disease

Nissen 6/06 and 5/09
#3 8/24/11

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted Yesterday 9:42 PM (GMT -6)   
Thanks for the support Bill!

I am meeting with my surgeon tomorrow. He wan'ts to see me.

I am interested to see if he is conciliatory or berates me for not calling him first. :) I detest these sorts too.

The saving grace is that this should be our last appointment. I will go to my GI for the rest of my recuperation.
Until next time,

Ben

Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted Today 9:19 PM (GMT -6)   
July 22-Day 4

Well today I turned a bit of a corner and the swelling subsided a little bit. It allowed me to drink more fluids and actually feel it reaching my stomach (that's a BIG milestone for me at this point!).

I met with my surgeon today and it was interesting. After my emergency room visit 24 hours after being discharged, he wanted to see me ASAP. He met with me for 4 minutes (yes I timed it and recorded it) and told me that my infected incisions "were just showing bruising", implying that they were not infected. This is after 3 days on Cipro and one bag of IV antibiotics at the ER. He also didn't comment on the meds that have helped SO MUCH, that the ER Dr. prescribed, but let me know that he would not be prescribing any thing more for me (the ER Dr. prescribed for 4 days, as they usually do).

He also told me he was releasing me (4 days after my surgery) to my Gastroenterologist and a pain Dr. I see for cortisone shots occasionally for my spinal fusion as well as to my primary care Dr. for any follow up I may need. He told me to start eating soft foods, which I can't begin to consider for a while yet. And that was that.

I am so very thankful for all the threads in this forum that I read prior to my surgery and to the information I reviewed from the Mayo Clinic, Johns Hopkins and the Cleveland Clinic. Due to MY homework I was prepared for the REALITY of this surgery and am giving myself excellent care! :)

Thanks to all of YOU for the support. I will need it in the coming weeks and I appreciate knowing it's available from the "Wrap Club".

The good news is that my pain Dr., (who is associated with the same hospital as my surgeon and has access to ALL my records from my surgery) reviewed my case and was very annoyed and sympathetic and is taking the responsibility of prescribing additional liquid pain meds for another week and dissolving Zofran now and for the future. He has really stepped up when I need a Dr. who would LISTEN to me!

I am making an appointment with the hospital administration to make a complaint, now that I have been released, and hope they address the issues will this surgeon so that another patient will be spared this. The ER nurse told me that the hospital take this sort of issue VERY seriously and encouraged me to do this. The ER doesn't want to waste their resources on patients that shouldn't be there in the first place and I completely understand that!

So, Day 4 ends positively both recovery-wise and mentally, just knowing that I am in better hands.
Until next time,

Ben

Post Edited (Ben_Nissen) : 7/22/2013 8:44:51 PM (GMT-6)


Ben_Nissen
Regular Member


Date Joined Jul 2013
Total Posts : 29
   Posted 7/23/2013 8:36 AM (GMT -6)   
July 23-Day 5

I have been wondering about burping. I am burping after drinking and eating anything. I am sure that this is better than NOT burping, but I guess it worries me that I am able to do this SO much. Could the wrap be to loose? As of this morning I feel like I cold eat or drink anything (not that I will) because everything is going down easily and with the burping (releasing gas) I am not uncomfortable.

Any thoughts?
Until next time,

Ben

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7185
   Posted 7/23/2013 9:24 AM (GMT -6)   
Hi Ben,
Lucky you!  Burping is a huge benefit.  It'll keep the bloating at bay, and you'll be a lot more comfortable during your recovery.  My surgeon told me I wouldn't be able to burp or vomit after my surgery, and I'm able to do both.  I think he needed to give that warning so I wouldn't be surprised if that was the case.
 
I started small burps in the hospital, right after surgery.  Like you, I was worried.  Another surgeon in his practice took my burping question and said it was a lucky thing to be able to burp, and it was not a problem at all. 
 
Don't force burps, though.  That could be hard on the wrap at this early stage in your recovery.  Let your stomach burp itself, instead.  Are you staying away from straws and carbonated beverages?  Also, don't talk when eating...all these things can cause more air to enter the stomach.
 
These days, most experienced Nissen surgeons are making loose wraps, which are more likely to allow burps and reduce the number of recovery side effects.
 
Remember that once you start solid foods, take small bites and chew, chew, chew until whatever you're eating is a liquid/creamy consistency.  Don't swallow anything that can't be chewed completely.
 
Glad to hear you're doing well!
Happy healing,
Denise
GERD/Heartburn Moderator
Nissen Fundoplication 2/09
Allergy/Asthma

"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Eckhart Tolle

Andy1986
Veteran Member


Date Joined Dec 2012
Total Posts : 1177
   Posted 7/24/2013 7:01 AM (GMT -6)   
Ben, thanks for doing the diary, I like to read successful outcome stories.

Your surgeon sounds rubbish, hopefully he did well on the actual procedure though. Its always a bit of a roll of the dice with doctors some are good others aren't, I've found that out the hard way after seeing many doctors.
GERD, Anxiety, Depression, Rolling Hiatus Hernia, Esophageal Hypersensitivity
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