Announcement: Welcome to DrBloem.com!

Dear Visitor,

Thank you for visiting my website. I am Dr. Fred Bloem from Olney, Maryland, and I have a holistic and integrative medical practice.

Fred Bloem, MD

Fred Bloem, MD

Because my medical practice is unique, I attract patients from many states in the northeastern and midatlantic regions of the United States and some have come from more remote locations.

Many people found me because they have been referred by existing patients. Others have found me by searching the Internet. Many of these have suffered health problems for a long time, consulted with a lot of other physicians, and were not able to find or receive the care that they needed.

Other people are simply looking for a good personal physician for themselves or for their family. These are they who need more than a rushed 15-minutes-or-less face time with a physician in a crowded medical office. They recognize that over the years the mechanic spent more time with their cars than their doctors did with them..

Because of my background in internal medicine and family medicine,  I am comfortable treating both children and adult men and women with a wide variety of health concerns.

After practicing as a traditional allopathic physician for several years, it became clear to me that Western medicine as it is being taught and practiced by most physicians today has its limitations. One of the main concerns that I had was that many of the allopathic treatments do not address the underlying causes of a patient’s illness. I recognized that many common diseases, such as hypertension, diabetes, arthritis, and others were linked to obesity. However, like most physicians, I felt unprepared to help my patients lose weight.

Postgraduate training in bariatric medicine, bio-identical hormone therapies, orthomolecular medicine, and energy medicine (NeuroModulation Technique (NMT) and Emotional Freedom Technique), has made it possible for me to help my patients more effectively, more quickly, and with safer treatment methods.

Besides that, I am now able to help my patients with a much wider variety of health concerns. They include:

  • All allergies
  • All autoimmune diseases
  • Addictions
  • Acute and chronic musculoskeletal conditions.
  • Autism
  • Crohn’s disease, irritable syndrome
  • Diabetes mellitus
  • Emotional, psychological, and sensory/motor neurological disturbances
  • Hypertension
  • Hypothyroidism
  • Infectious diseases
  • Obesity

It is the combination of my genuine concern for my patients’ well-being and attention to detail, my traditional medical training, my experience in helping patients with their weight problems, safe nutritional, natural, and energetic treatments that makes my practice unique.

Please contact me if you have any questions.

Fred Bloem, M.D.

Proton Pump Inhibitors – What Does the Research Say?

Here is a collection of information about proton pump inhibitors.

Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095572/ (World Journal of Gastrointestinal Pharmacology and Therapeutics)
“Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections, bacterial overgrowth, adverse bone health, food allergy and drug interactions.”
Infants are physiologically predisposed to GOR [gastro-oesophageal reflux] because of their shorter intra-abdominal oesophagus, frequent liquid feeds that distend the stomach, and supine position[2]. Infants with GOR have been found to have frequent transient lower oesophageal sphincter relaxations, which are thought to be the pathophysiological basis of the condition. Fifty-percent of infants reportedly experience daily regurgitation in the first 3 mo of life, which resolve by 12-14 mo in most healthy infants[3]. The pathogenic mechanism leading infant GOR to develop into GORD is unclear, although decreased neural protective reflexes and delayed gastric emptying are thought to play a role[1].”
“There is also mounting evidence that children are being exposed to unnecessarily high doses of PPI with doses of 1 mg/kg per day up to as high as 4 mg/kg per day used in clinical practice. Recent randomised trials have shown that although there is a dose-dependant reduction in acid production, for the treatment of erosive esophagitis there is no significant difference in healing between 5 mg/d and 10 mg/d for children < 20 kg[20,21].”
“However, PPIs have consistently failed to show efficacy in reducing infant GORD symptoms compared with placebo. Chen et al[23] reviewed four randomised control trials (RCTs) of PPIs in treating symptomatic GORD infants < 12 mo, conducted by pharmaceutical companies under formal requests by the Food and Drug Administration. The results of independent studies such as Moore et al[24] have corroborated with their results, which are summarised in Table ​Table11[2328]. Notably, Moore et al[24] enrolled infants with endoscopically confirmed GORD and found omeprazole significantly reduced the reflux index (percentage of total duration pH < 4) in these infants compared with placebo, but irritability improved regardless of treatment. In the most recent randomised controlled trial of PPI (Esomeprazole) for the treatment of symptomatic GORD, without endoscopy, all children were initially treated with PPI and then randomised to continuation of PPI or placebo[25]. It found no statistically significant difference in apparent treatment failure between the PPI or placebo group.
Headache, diarrhoea, constipation and nausea are idiosyncratic effects of PPIs that occur in 14% of children[1]. Acute interstitial nephritis, a rare, idiosyncratic hypersensitivity reaction to medications including PPIs, has also been reported in observational adult studies[29]. Increased risk of infection, for example, Clostridium Difficile, is increasingly being recognised[30]. Side effects related to the direct inhibition of gastric acid and reflex hypergastrinaemia, immunosuppression and drug metabolism have also been suggested (Table ​(Table22).”
“The human stomach has a median pH of 1.4, and a pH < 4 has a powerful bactericidal effect on ingested acid-sensitive bacteria[18]. PPIs often cause a gastric environment with pH > 4, inducing a state of hypochlorhydria which allows the overgrowth of bacteria in the stomach[18].”
“These microbial changes are thought to be due to the lack of the gastric acid barrier allowing bacteria to enter the intestine and also the effect of impaired protein digestion providing nutrients to facilitate bacterial growth[31]. Links have previously been made between these and similar changes to intestinal microbiome and the pathogenesis of inflammatory and malignant conditions of the bowel[33].”
“The pathogenic mechanism that allows enteric bacteria to cause gastrointestinal infections is multi-factorial. Gastric acid inhibition reduces the gastric microbiocidal barrier, delays gastric emptying, reduces gastric mucus viscosity thereby increasing the risk of bacterial translocation in addition to increasing the risk of colonisation by bacterial agents. Gastric acid inhibition also has an adverse effect on leukocyte function by decreasing adhesion to endothelial cells, reducing chemotactic response to bacterial proteins and inhibiting neutrophil phagocytosis by phagosome acidification[16]. This is potentially important in neonates and infants, who have immature humoral immunity[16]. A study on the numbers and type of bacteria in nasogastric tubes of patients receiving GAI demonstrated increased numbers of bacteria including Streptococcus, a known cause of community acquired pneumonia[34]. It is possible that the risk of pneumonia is increased as result of reflux aspiration of gastrointestinal contents into the lungs. PPIs may also directly inhibit the H+-K+-ATPase present in the respiratory tract, altering the pH of its seromucinous secretions[35].”
“The few paediatric studies available have made similar conclusions. Notably, a prospective study of 93 paediatric patients (4-36 mo) with endoscopically diagnosed GORD, showed that children treated with either ranitidine or omeprazole for 8 wk were 3.58 and 6.39 times more likely to develop acute gastroenteritis and community-acquired pneumonia respectively, compared with healthy children during the 4 mo follow-up[17]. Comparing 4 mo before and after enrolment, a significant increase in the incidence of acute gastroenteritis and pneumonia was found only in the treatment group, demonstrating that infection susceptibility could continue even after therapy cessation[17].”
“The results of safety studies on the use of gastric acid inhibiting drugs in infants, particularly in intensive care, where hospital-acquired pathogens are responsible for significant morbidity and mortality are concerning[38].”
Elevation of gastric pH also interferes with protein digestion, and it is hypothesised that normally digestible dietary peptides are preserved and recognised by the immune system as allergens[19].”
“Increasing gastric pH leads to hypergastrinemia, which has growth-promoting effects on several epithelial types[46]. Consequently, long-term PPI therapy is associated with parietal and enterochromaffin-like cell hyperplasia, as demonstrated by a RCT between esomeprazole treatment for 5 years compared with laparoscopic antireflux procedures for GORD[47].”
“By reducing gastric acidity, PPIs may interfere with the absorption of dietary protein-bound vitamin B12 and ionised calcium from dietary salts[22].”
“PPIs have also been associated with an increased risk of fracture, as impaired calcium absorption is thought to cause a compensatory state of hyperparathyroidism to stimulate osteoclasts and bone resorption[51]”
“During 2006-2012, there were 26 reported cases of hypomagnesaemia associated with PPIs in literature, with symptoms including electrocardiogram abnormalities and neuroexcitability, including tetanus and seizures, which resolved following withdrawal of PPI[52].”
“The safety of PPIs in infants also requires more prospective RCTs to remove the effect of confounders and bias. Irritable infants with uncomplicated GORD are hence recommended to continue lifestyle modifications, such as changing feeding techniques or formula composition, and avoid acid suppression. If PPIs are to be prescribed, only the minimal effective dose should be used, and should be weaned as soon as possible. There is no direct evidence to suggest increased safety of H2RA medication compared with PPI and in situations where acid suppression is indicated (e.g., esophagitis) they have decreased potency. Attention should be paid to the substantial epidemiological evidence of increased infection risk with PPIs, especially in the vulnerable population group of preterm infants.”

PPI Side Effects News, What PPI Companies Hide From Doctors
https://youtu.be/fjtB2YIR5AM
New studies show that intake of these drugs for prolonged period are linked to chronic kidney disease, myocardial infarction, bone loss, dementia, and many more complications.
“Researchers found that patients who took PPI’s had a 96% increase risk of developing kidney failure and a 28% increased risk of chronic kidney disease.
“These acid reducing drugs may increase the risk for chronic kidney disease by 20 to 50%.”

Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease
https://www.ncbi.nlm.nih.gov/pubmed/26752337 (JAMA Intern Med)
” Twice-daily PPI dosing (adjusted HR, 1.46; 95% CI, 1.28-1.67) was associated with a higher risk [of chronic kidney disease] than once-daily dosing (adjusted HR, 1.15; 95% CI, 1.09-1.21).”
“Proton pump inhibitor use is associated with a higher risk of incident CKD. Future research should evaluate whether limiting PPI use reduces the incidence of CKD.”

Proton pump inhibitors are associated with increased risk of development of chronic kidney disease.
https://www.ncbi.nlm.nih.gov/pubmed/27487959 (BMC Nephrology)
“Use of proton pump inhibitors is associated with increased risk of development of CKD [chronic kidney disease] and death. With the large number of patients being treated with proton pump inhibitors, healthcare providers need to be better educated about the potential side effects of these medications.”

Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD.
https://www.ncbi.nlm.nih.gov/pubmed/27080976 (J Am Soc Nephrol)
“Our results suggest that PPI exposure associates with increased risk of incident CKD [chronic kidney disease], CKD progression, and ESRD [end-stage renal disease).”

Association of Proton Pump Inhibitors With Risk of Dementia
https://www.ncbi.nlm.nih.gov/pubmed/26882076 (JAMA Neurology)
“The avoidance of PPI medication may prevent the development of dementia.”

Proton Pump Inhibitors (PPIs) accelerate endothelial senescence (endothelial aging)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902745/
“Our data may provide a unifying mechanism for the association of PPI use with increased risk of cardiovascular, renal and neurological morbidity and mortality.”

Proton Pump Inhibitors Accelerate Endothelial Senescence (Circulation Research)
” To conclude, we found that chronic exposure of human ECs to the PPIs, esomeprazole or SCH-28080, accelerates endothelial aging. This adverse effect seems to be because of an inhibition of lysosomal acidification and subsequent impairment of proteostasis. The accumulation of protein aggregates is associated with an increase in oxidative stress, endothelial dysfunction, and senescence. Vascular senescence would provide a mechanistic explanation1113 for the accumulating evidence that PPIs increase the risk of cardiovascular morbidity and mortality, renal failure, and dementia.25 In the presence of consistent epidemiological evidence of harm and a unifying mechanism for the disparate disorders linked to PPI use and with the knowledge that PPIs are being used by millions of people for indications and durations that were never tested or approved, it is time for the pharmaceutical industry and regulatory agencies to revisit the specificity and the safety of these agents.”

HCG Diet

MY WEIGHT LOSS STORY

How the Dr. Simeons HCG Protocol has helped me and my patients lose large amounts of abnormal fat.

My quest to help my patients lose weight dates back to 2001. Although I knew that there was a clear association between obesity and the many chronic illnesses that family physicians see in their practices, I did not know how to address the underlying causes. I had come to recognize that eating less and exercising more was not the complete solution to the problem of obesity. Finding the answers was not easy. It has been a long road with many disappointments, but in 2007 I was fortunate to discover a time-tested, safe, and effective protocol which had been developed by Dr. A.T.W. Simeons, a British physician who practiced in Rome, Italy, from the 1950s through the early 1970s.

Dr. Simeons detailed his protocol, which combines the use of human chorionic gonadotrophin (HCG) and a specific low-calorie diet in his book entitled “Pounds and Inches”. Dr. Simeons found that HCG maximizes the functional capacity of all the centers in the hypothalamus, including what he termed the fat center, making it possible for fat to be released from abnormal fat deposits and to become available as a source of fuel to the body.

This is the first time in my career that I have seen large numbers of patients succeed in losing significant amounts of abnormal fat quickly without hunger and without adverse side effects.

I was so impressed and intrigued with my patients’ results and the safety of this protocol that I decided to start it too. Although I have never been grossly obese, I knew that I had excessive amounts of abnormal fat. In addition, I wanted to know for myself that this protocol was practical, safe, and effective. Finally, I recognized that the best way to learn and teach this protocol is for a physician to have a personal experience.

I started in April 2008 weighing 163 lbs and was impressed that I was able to drastically reduce my caloric intake without any hunger and without any side effects. I noticed that I quickly lost any desire and cravings for junk food such as potato chips. I experienced rapid weight loss manifesting as a significant reduction in the measurements of my waist and thighs. Within 2 months, by the end of May 2008, I had lost almost 20 lbs of abnormal fat. I was able to lose all this weight without engaging in any strenuous exercise activities.

As of the time of this writing, late July 2008, I am in the long-term maintenance phase of this protocol. I weigh 143 lbs and have been able to maintain my weight without any hardship and without restricting the amounts of food that I eat.

I invite you to learn more about the HCG Protocol by reading Pounds and Inches first. You can download it by clicking here. After reading this book you will be able to appreciate and understand the significance and importance of Dr. Simeons’s groundbreaking research that went into developing this highly effective protocol.

I offer to my patients both oral HCG and injectable HCG protocols as well as HCG Cream and Nasal HCG. Physicians around the world have successfully treated both men and women as young as 8 to 12 years of age.

Prolozone Therapy for Sciatica

I am a 68 year old man who is still very active, but have had increasing sciatic pain in my right hip when I sat for too long at a time, either driving or at my computer. I’ve also had pain in my left knee from a slow-healing injury. Over a month ago as I write this, Dr. Bloem gave me one Prolozone injection in each of those two sites. The pain in my knee was reduced significantly within a day and is now gone, and I could immediately sit for MUCH longer periods of time without my hip hurting at all–a great relief since I am about to leave on a three month driving trip. Prolozone has proven to be every bit as helpful to me as it has to so many others I had read about.

D.W.M.

Distilled Water Benefits

Over the years I purchased a lot of different water purification products. Most of them were water filters and one was a reverse osmosis product. None of these were perfect as some impurities and toxins just can’t be filtered out. Probably like most people I didn’t change the filters frequently enough because they were expensive or difficult to replace. After I purchased my ozone steam sauna which requires the use of distilled water I decided to purchase a water distiller. They are surprisingly affordable (under $200) for a unit that can distill up to a gallon at a time. The maintenance is pretty simple and inexpensive too.

I have been very happy with my distiller. It is quite amazing to see the brown/white residue that remains in the stainless steel water container after the distillation process is complete; especially when you consider that I distill water that has been prefiltered by my under the counter kitchen filter. Who knows what is in that residue? It could be anything, including waterborne contaminants such as viruses, bacteria, organic and inorganic chemicals, fluoride, fecal matter, pharmaceuticals, heavy metals such as lead, arsenic, and cadmium, cysts, and other contaminants that are dumped in our water supply. Chlorine and other gases are expelled from the waste vent as the water is distilled.

Contrary to what some people say I don’t believe that drinking distilled water is harmful. It is the purest water that you can drink. It was interesting to read a customer review which stated that heart arrhythmias disappeared when the person started drinking distilled water. I have started recommending distilled water to my patients and it will be interesting to see what they will report as they avoid the contaminants in their drinking water.

TA-65 – A Telomerase Activator

I was recently introduced to TA-65® which is a telomerase activator. It turns on the hTERT gene which activates the enzyme telomerase which can lengthen your telomeres. Telomeres are protective pieces of DNA material at the ends of each chromosome in every cell. The genetic material of chromosomes degrades if not properly protected by telomeres of a certain length. Telomerase activation in aged or chronically stressed normal cells has been shown to slow or reverse telomere shortening, increase replicative capacity, and restore or improve cellular function. In other words, the cells live longer and the patient benefits.

When telomerase is activated the shortest ones get “relongated” (made longer). Some illness associated with short telomere length are Werner’s Syndrome, congestive heart failure, ischemic cardiomyopathy, and Alzheimer’s disease.

In people who have taken TA-65® for one year or more they have seen the following statistically significant benefits:

  • A decline in the number of senescent (aging) CD-8 lymphocytes
  • A reversal of the normally seen, age dependent increase in natural killer cells
  • Improvements in total and LDL cholesterol
  • Significant decreases in fasting glucose and fasting insulin levels
  • Functional improvements in cognitive behavior-verbal memory and shifting attention
  • Statistically significant improvements in bone mineral density in males and a trend towards the same in females

Some anecdotal benefits that people taking TA-65® have reported include:

  • Need for less sleep but without fatigue – getting more done in a day
  • Improved joint flexibility
  • Improved skin health and appearance
  • Improved visual acuity
  • Improved sex drive

Those who should take TA-65® include anyone who has had a telomere length test and has short telomeres, anyone who believes their immune system is compromised and can benefit from its restoration, and everyone who is concerned about aging healthy and living longer.

I have just become a licensed distributor of TA-65® and am able to offer it to my patients at a good price. Please contact my office for pricing and ordering.

Please click here to read responses to frequently asked questions about TA-65®: http://bit.ly/Np1FLw

*These statements have not been evaluated by the Food and Drug Administration. TA-65® is not intended to diagnose, treat, cure, or prevent any disease.

Prolozone Therapy for Chronic Knee Pain

“I am a 64 year old man with a long history of arthritis in my knees.  It was very painful to walk and especially painful when I tried to get up out of a chair.  Dr. Bloem did one prolozone treatment to each knee and I have had complete relief of the pain.  I have now been pain free for over a week with no signs of the pain returning.  I can’t believe how easy it is to stand now.  Thank you Dr. Bloem!!”

This patient wrote this testimonial in July 2012, over two months ago as of the time of this writing, and he has remained pain free to this day. Prolozone therapy has been a very valuable addition to my practice. Since May 2012 I have successfully treated patients and have done Prolozone injections in knees, hips, shoulders, and in the neck. However, Prolozone can also be effective for back pain, sciatica, TMJ syndrome, rotator cuff injuries, elbow pain, plantar fasciitis, heel spurs, neuromas, carpal tunnel syndrome, and many different sports injuries.

Prolozone treatments may result in cartilage regeneration which explains why it is usually remarkably effective when patients have osteoarthritis of the hip or knee. In many cases it is not just a treatment for pain, but it is actually results in long-term relief.

The word Prolozone was coined by Dr. Frank Shallenberger. The first part means to regenerate or rebuild (“proli”). Ozone is the most active form of oxygen which causes damaged tissues, joints, ligaments, and tendons to regenerate.

Oxygen, vitamins, and minerals are necessary to tissues to regenerate and heal. Pain is often caused by low levels of oxygen which cause an accumulation of lactic acid, which causes pain. Prolozone injections include homeopathic anti-inflammatory medications that reduce inflammation and swelling. Vitamins and minerals are injected because they are required for healing. Oxygen in the form of ozone is injected last. Only one injection is  given in each joint treated and all the medication, nutritionals, and ozone is delivered in two syringes through the same needle. The treatment response varies with some patients experiencing complete pain relief in one treatment, but most patients only need 3 to 5 treatments spaced two weeks apart.

Please click here to view a video of Dr. Frank Shallenberger explaining Prolozone: http://bit.ly/QMl4b6
Click here to find an ozone doctor near you: http://bit.ly/TLNpPg

*These statements have not been evaluated by the Food and Drug Administration. Ozone therapy, including major autohemotherapy, Prolozone, and ozone steam saunas are not intended to diagnose, treat, cure, or prevent any disease.

Ozone Steam Sauna Benefits

After having become certified in ozone therapy and Prolozone therapy in May 2012 and seeing the wonderful results of major autohemotherapy and Prolozone I decided to also offer ozone steam sauna therapy to my patients.

Ozone therapy is not new and over the years there have been amazing reports from both doctors and patients. For example, there have been patients who reported cures from Lyme disease after receiving major autohemotherapy. According to Dr. Frank Shallenberger, a world renowned authority in this field whose course I attended in May 2012, major autohemotherapy is a slam dunk for patients with Lyme disease. He has also had much success treating patients with other chronic infectious diseases such as HIV and hepatitis. With regard to ozone steam sauna therapy there have been reports of people being cured of cancer using this method.

Ozone steam saunas have also been beneficial for patients with skin disorders such as shingles. One patient reported a dramatic improvement after just one session and complete resolution after several more sessions. Patients with eczema and psoriasis see rapid improvements too and symptoms are typically much improved within about three sessions.

Ozone steam saunas have also been effective for patients with a diagnosis of chronic fatigue syndrome and myalgic encephalomyelitis. Many patients have reported an improvement in their energy and overal sense of well-being within 4 to 8 weeks of starting weekly treatment sessions. Some reported cures whereas others did experience significant improvement.

As patients sit in the sauna they sweat profusely and are able to eliminate toxins. So any health concerns caused by toxicity is likely to respond. This includes silicon poisoning from breast implants and poisoning from other chemical exposures. The temperature of the sauna can be regulated precisely so it is comfortable for the patient. Usually we start with a temperature of 105 degrees Fahrenheit or less for a 15 minute session and then increase the temperature in subsequent sessions as tolerated and the duration up to 30 minutes.
Other health conditions that have improved in patients using ozone sauna also include arthritis, multiple sclerosis, and depression. With regard to depression it is believed that detoxification causes the brain to function better and that improved oxygenation causes the mood and overal mental functioning to improve.The advantage of the hyperthermia that is achieved by using an ozone sauna is that toxins are broken down and released, that the immune system works better, and that the growth of microorganisms is slowed down. In addition, the thermal effect causes blood vessels and capillaries within the deep layers of the tissues to dilate, which promotes better circulation.

 

Here is a link to the state of the art ozone steam sauna that I employ in my practice: http://bit.ly/PcGc6N
Click here to find an ozone doctor near you: http://bit.ly/TLNpPg

Please contact my office to schedule an ozone steam sauna therapy session. Sessions are $50 each.

*These statements have not been evaluated by the Food and Drug Administration. Ozone therapy, including major autohemotherapy, Prolozone, and ozone steam saunas are not intended to diagnose, treat, cure, or prevent any disease.

Cyanocobalamin vs. Methylcobalamin vs. Hydroxocobalamin

In my practice I use different forms of Vitamin B12. In this article I explain some of the differences between cyanocobalamin, methylcobalamin, and hydroxocobalamin.

Cyanocobalamin can be given as an intramuscular injection. It should not be given intravenously. However, after injection it will need to convert to methylcobalamin, and then to hydroxocobalamin to be used by the body. Of all the forms of Vitamin B12 it is the least painful for the patient to inject. After introduction into the body it provides a small amount of cyanide. For individuals who are overall very healthy this is a good choice and this is also the least expensive form of injectable Vitamin B12. It is known that some people, such as smokers, are less able to transform cyanocobalamin into methylcobalamin due to toxins and heavy metals in the liver. These individuals need to use other forms of Vitamin B12.

Methylcobalamin is more bioactive and can be given intramuscularly, intravenously, and intraarticularly. It is slightly painful to inject into the muscle. In my practice I also use methylcobalamin when I do Prolozone injections into joints and into subcutaneously (under the skin). This is also a better choice for smokers who are unable to convert cyanocobalamin into methylcobalamin.

Hydroxocobalamin is the most bioactive form of Vitamin B12 and mostly given intravenously as intramuscular injections are very painful. If given intramuscularly it is mixed the local anesthetic procaine. Hydroxocobalamin is retained longer in the body and can be dosed less frequently. An additional application of hydroxocobalamin is that it can be used for patients with cyanide poisoning as it binds cyanide and allows for elimination through the kidneys.

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