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20 PVCs in a row

after wearing the halter monitor the doctor was telling me at one point i had 20 pvcs in a row.. for about 12 seconds.  i guess this is what he is most concerned about.  reading online says over 3 is potentially dangerous.

i'm not really sure if this means i can drop at any minute??  i'm having some anxiety tonight thinking about it (he just told me today).  i don't have any history of heart problems, but was reading these can come out of nowhere
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267401 tn?1251852496
The good thing about almost every arrhythmia is that they usually progress slowly over time.  This site is littered with stories of people who had a single PVC ten years ago and now they have a few every day.  So you don't need to worry about falling over dead tomorrow.  If you did, I'm certain your doctor would not have let you leave his office.

If there was no normal contraction between any of those 20 PVCs, it sounds like it was NSVT, non-sustained ventricular tachycardia.  There are quite a few people here that have been living for decades with NSVT without any problems.  Smartly, your doctor is wanting to make sure that your variety is benign as well, before sending you outside to play.

Try not to stress about it until there's a good reason for it.

Does your doctor have you scheduled for any further tests?
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177337 tn?1310059899
Well, I am positive you won't drop over any minute because the doctor would have done more than just call you.  But what is it with some doctors.  Why is it we have to be so persistant with them to just get information to help reasure us that we will be okay.
I would call him back tomorrow and just ask him to explain the level of his concern regarding the 20 pvc's in a row.  I can tell you that 3 pvc's in a row is not dangerous in a structurally sound heart.  I have had up to 7 in a row (documented on my holtor) and my doctor wasn't the least bit concerned.  Try not to do too much reading.  Just call him tomorrow.
Frenchie
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363281 tn?1714899967
Don't worry, they won't kill you, they just feel like it, and the fear you get is very scary too. I get them too, and I get so scared, if anything were to kill me, it would be the fear. In a structurally healthy heart, they are nothing, just scary and a pain in the butt.

All of us on the forum have them, and that is why this forum is so great, it is such a help to learn you are not alone.
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Avatar universal
thanks all for your input.  my sleep was horrible i have to say.

Wisconsin2007, the doctor has ordered another stress test (had one three months ago) but wants to do a nuclear stress tomorrow.  wants to make sure that he didn't miss some blockage of any kind.  he said he believes that will be negative but then i'm not sure what next steps would be.  
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Avatar universal
the doctor has ordered another stress test (had one three months ago) but wants to do a nuclear stress tomorrow.  wants to make sure that he didn't miss some blockage of any kind.  he said he believes that will be negative but then i'm not sure what next steps would be.  when i did exercise i never felt the 'flutter' sensation.  it was only when i would walk or get up, etc.  never felt it sitting still.
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967168 tn?1477584489
I'm sure you'll hear different things from different people & different doctors.  You have to have a patient/dr relationship and trust your doctor, if you don't, find one you do.

I'm still scratching my head over some of the answers I've gotten.  I don't think there's alot of research being done, but with the high incidence of pvc's (#1 reason for ER visits - Ill have to find the link for that I think mayo clinic) they need to do more.

I have 54,000 extra heartbeats in a 24 hr period, sometimes more every 3rd beat pvc's, day in day out, night after night, sometimes couplets, triplets; SVT & NSVT been this way about for the past few months 24/7-  that I can remember with going back 6 mth - a year with persistant problems that I didn't know I had.

I have Mild Tricuspid insufficiency, trace MVP, mild LVH (left ventricular hypertrophy) but I'm told they consider that a "normally structural heart".  I have nothing wrong with me but a low sodium lvl (135) and mildly low EGFR.   All of us have some type of problems with our heart, there is no perfect heart - as we age, the "leaking" can worsen.

In some of us even with "normal" hearts such as mine, pvc's can be dangerous. There's alot of factors in that though, where they're coming from, what is causing them, how long are they sustained in a 24 hour period and a million other things.  That's what they do all of these tests for to see what's outside the "normal abnormal" which I'm told are 6,000 - 8,000 pvc's in a 24 hr period.

The thing I have been told by my cardiologist, 2 ep's & the ER drs is WHEN pvc's are sustained over a period of time, they weaken the heart and can cause major problems.  I pass out, have black outs, my blood pressure drops so low I had to have meds via iv for 7 hours to get it stable 70/40.

If it were serious your dr would have done like mine - tried to get me in surgery in a few days, which scared the living daylights out of me and I chickend out on surgery and opted for a 2nd opinion.  I went for my 2nd opinion & ended up in the ER from 1 dose of meds they prescribed,  the ER doctor said if I didn't have my surgery already set up they would do it then, my problems are getting worse :(

I would definitely get a copy of my test results and look them over - I had a doctor tell me 5 years ago and 2 years ago nothing was wrong, looking at the EKG's  from back then, the cardiologist & ep's don't agree.  If you haven't; be checked out by a cardiologist.

Oh yes, 3 in a row can be dangerous - I had 3 & 5 SVT's in a row on cool down from my stress test, it all depends on WHEN it happens.  I still haven't gotten over the wedgie from the dr grabbing me when I passed out from them lol

Good luck and I hope you find your answers.
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267401 tn?1251852496
I think we should probably spend a few minutes getting the acronyms correct for future readers of this thread.  Sometimes the difference between something completely benign and something potentially dangerous is a single letter in one of these alphabet soup acronyms.  

SVT is supraventricular tachycardia, and is not a single fast beat.  Tachycardia is measured in beats per minute, so a single early beat can't be defined as tachycardia.  That single, early beat would either be defined as a PAC (premature atrial contraction/complex) or PVC (premature ventricular contraction/complex), depending on where it originated.  So while you can have 3 or 5 periods of SVT on cool down, they would need to be periods where many fast beats were strung together consecutively.  You could also have 3 or 5 periods of sustained ventricular tachycardia on cooldown, but again they would have to be periods where many PVCs were strung together (and for at least 30 seconds).  But when ventricular tachycardia is sustained, it's not usually referred to as SVT, as that would confuse it with Supraventricular Tachycardia, a tachycardia that originates above ("supra") the ventricles.

Now if you string together 2 consecutive PVCs without a normal beat between them, that's a couplet.  3 is a triplet.  There is no quadruplet - once more than 3 consecutive PVCs are strung together, it's defined in terms of non-sustained ventricular tachycardia or NSVT.  

NSVT has a lot of the same letters as PSVT, but they are very different.  Paroxysomal Supraventricular Tachycardia is a tachycardia that originates in the atria, is sudden in onset and sudden in termination.  Sometimes it lasts a few seconds.  Other times it can last much longer.  It is almost always a non-life threatening situation.  

Bigeminy is where there is a single PVC between every single normal beat.  beat-skip...beat-skip...beat-skip.  Trigeminy is a PVC between every two normal beats: beat...beat-skip...beat...beat-skip.  You can probably guess what Quadrigeminy is - though you don't hear that term much.

So if someone had 50,000 PVCs a day and was in bigeminy that whole time, that would mean that person only had 50,000 normal beats as well.  The average human has about 100,000 normal beats a day.  So if you're having only 50,000 normal beats, being tired would certainly make sense.  That's 34 normal beats per minute - certainly low enough to cause syncope and chronic fatigue and tiredness.
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967168 tn?1477584489
Ok now my head is spinning even MORE than when doctors have explained it to me... Wisconsin what's your background that you know so much about this stuff?  You have to have some kind of degree lol

What in the world then were they referring to; not that they explain too much of anything; but the EP in there said SVT...  my results said  svt, pvcs - 2 couplets & 1 triplet during the 4:55 test warmup/cooldown included.  

SVT doesn't even sound like what they were talking about if I read that part correctly you wrote. I know they said something about dangerous being over 30 sec and thats what made me pass out.   2 couplets & 1 triplet, seems like a weird combo;  is that even possible on a test this short? [starts biting nails] lol is that the 3 & 5 of something - I was too busy losing it to ask questions.

I understood the Bigeminy, Trigeminy part - that's pretty basic but the PVC part is quite confusing - if I have 54,000 pvc's that means I'm only having 50,000 normal beats? I completely misunderstood them on that if so  - where does it show how many "normal" beats you have?

The way the cardiologist explained it to me...[scratches head]  was I have 54,000 extra beats? my holter showed my heart rate was never below 89 with mid range at 131 with a few episodes of 170, which makes me more confused that you put 34 normal beats per minute.
  
You don't even have to answer, this is all stressing me out more than I am lol

I'll just go back to the happy lazy state I was in before knowing I had this problem - Im way better off.  None of this confusion would happen if doctors did their jobs and actually took their time to explain things in plain patient english :P
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967168 tn?1477584489
I just had one of those Ah-ha moments - one of those switch the lightbulb on lol

I looked at my tests - it's NSVT not svt wooppps two totally different things; thank you for clearing that up.  I had to go post my rant in my journal about my doctors lack of explanation and reading it I realized what you were saying lol

ahhh thanks Wisconsin I see now - so the nsvt I had were actually the 2 couplets & 1 triplet - do you practice somewhere near Tampa FL? or take my health insurance :)
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267401 tn?1251852496
lol -

Nope.  Not unless your health insurance covers landscape contractors doing EP studies.  Though I do have family in the profession.  I just have a voracious appetite for reading, and when it's something I'm worried about, I simply cannot pull my *** out of my computer chair until I'm satisfied that what I have isn't going to kill me.  Or that it is, and I run away in a panic!

Couplets and triplets are in the same vein as NSVT, but doctors don't usually call a couplet or triplet NSVT - has to be at least 4 PVCs in a row without a normal beat between them to be considered NSVT.  NSVT can cause syncope, so that makes a bit more sense.

And I'm thinking that while you did have a good number of PVCs, if your average heart rate (I'm not sure if that's what you meant by "mid range") was 131 for a 24 hour holter, if you multiply that out (1440 minutes in a day X 131 beats per minute), you get 188,000 heartbeats.  My presumption in that report you received is that the 54,000 PVCs were in addition to the 131 avg heart rate/188,000 heartbeats.  

However, that may not be correct, and you may have had 134,000 normal beats and 54,000 PVCs for a total of 188,000.

When you said you were in bigeminy 24/7, and since that means every other beat is a PVC, if you had 54,000 PVCs, you'd also have to have 54,000 regular beats (which is really low).  Reading the data in this last post it sounds like you weren't in bigeminy that entire time, otherwise you would have had many more PVCs counted on your holter.  

So that's good news, right?  Many more normal beats than PVCs?

Relative to what's going on inside your chest it's just semantics, but I wanted to make sure all the acronyms were explained here so that future readers wouldn't get confused.
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967168 tn?1477584489
Hmmm wonder if my flexible spending plan would cover the cost :P

future readers get confused? what about current readers lol thanks for explaining though, Im going to pull out the tests again and look - just to make sure I copied word for word

188,000 heartbeats, average heart rate is 100,000 per 24/ it's no wonder I'm tired.... but I do think you brought up some great points and things I'm going to pinpoint my EP down about when he gets back in the country.

back to the orginal topic now - can 20 pvcs in a row be dangerous? sustained or nonsustained? I read 3 in a row was dangerous too, wonder why the differences?
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267401 tn?1251852496
I think the operative word here is "can."  It CAN be dangerous.  Sometimes it's not.  More than three (which technically makes it NSVT) warrants investigation to see if it is dangerous or not.  I've read posts from people here that have been living with benign NSVT for years.

So, yeah.  It CAN be dangerous.  Might be dangerous.  Possible to be dangerous (not irreparable, by the way - just dangerous.  possibly). Seeing a cardiologist is going to be the best way to determine if it is or it isn't.

BTW, 20 PVCs in a row, by definition, is going to considered non-sustained, because it's only 20 (presumably those 20 take place in less than 30 seconds, which is the threshold between non-sustained and sustained VT).  If it were, say, 100 PVCs in a row, that's probably sustained VT (just called VT), because it probably is lasting more than 30 seconds - and yeah, that's dangerous.  It can be treated, cured too - but it's not something you can just cross your fingers on and hope for the best.  You have to see a doctor and get things sorted out.
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Avatar universal
Thanks of being more clear than my doctor!

I'm going today for the nuclear stress test.  he's making sure the first stress test with ultrasound didn't miss anything

On the prescription form my cardiologist wrote some scribble but I can make out "Flutter (Vent Tach) at Rest"

I'm not clear if it's sustained or not.  The only thing I remember his saying was that one did last 12 seconds, so from definition not sustained possibly.
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967168 tn?1477584489
sorry to hijack your thread, but since part of this has been brought up in my rambling misconceptions, I wanted to make sure we cleared this up

Ok, I found what I was looking for with the heart rate - (holter monitor)

The predominant rhythm is sinus with ventricular bigeminy and trigeminy and an average rate of 89 beats per minute.  

Minimum heart rate of 67 and a maximum heart rate of 131 beats per minute.  

The longest run was 3 beats long and the fastest run was at 170 beats per minute at 15:51 and 5:44 respectively.

I have an average of 89 bpm x 1440 minutes in the day = 128,160 in a 24 hour period

Out of those 128,160 average beats, 54,181 are PVC's - 73,979 normal beats
So this would mean I have 51.4 normal beats; 37.6 abnormal beats per minute, so roughly 42% - I always knew I was "abnormal" :P

Does that sound right now? It would be good to let others know if that's how to do it.

Wonder how to start a sticky thread for faq's, what's "normal" what's not, what CAN be dangerous, what usually isn't,  what to do about symptoms, "normal" rates  etc?

I know those were and still are the majority of my questions when I was diagnosed.
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21064 tn?1309308733
Wisconsin, your explanations are right on!!  Thank you for clearing up the differences with the acronyms : )

I'm one of those people who lived for years with NSVT....I was in bigeminy, trigeminy, had couplets, triplets, nsvt, and I did just fine for many years.  Even with over 20,000 PVCs on 24-hour Holter, benign : )

I did eventually develop "PVC-induced cardiomyopathy," a rare occurrence in the setting of very frequent PVCs over a long period of time.  The good news is, it was curable and I am doing well and in NSR!!!  It has been about 6 years since the ablations, and lub-dub, lub-dub, lub-dub....Ahhh, life is good : )
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967168 tn?1477584489
Connie, question for you - what's a long period of time? I could never get my dr to pinpoint what a "very short period" of time was, I wish he had just said 1 mth, 3mths, 1 year - really anything.

and Yea! I know what NSR is lol nsvt, vt, svt I'm still confused over - but I'll get over that, I think I ask too many questions sometimes.

That's amazing btw 6 years with no recurrences and no problems.  I hope I do as well as you with it, I wonder what the difference is that made yours such a success, but some others recur.  What's your secret or what triggered yours that you got rid of?

I'm with JKFrench, what is it with some doctors...you have some that rush you through and into surgery like now, within a few days, then you have others like the one in 2007 that never told me a thing
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21064 tn?1309308733
I was first told of my "quirky" heart around the age of 19.  I didn't really have any triggers, though caffeine could make them worse.  My PVCs were there regardless of my stress, anxiety, what I ate, etc.  Those things could just exascerbate (sp?) them.  Around 24, I learned that I had MVP and mitral regurgitation.  I had periodic echocardiograms to watch for any changes, but no problems.  I took beta blockers on/off for around 12 years, but eventually was able to take them only as needed, which was great!  

Around 40, my "quirky" heartbeats were driving me batty, and I was referred to an EP.  More tests and continued serial echos.  Still doing well despite thousands of PVCs daily.  They were "normal" for me.  About 4 years later after an annual echocardiogram, my doctor phoned to tell me she thought it was probably time for valve surgery!!  I was scared!  I was referred to the Cleveland Clinic where I had more tests, and it was determined the valve leak was moderately severe, but I was not a surgical candidate at that time...WHEW!!

The following year, I went for the annual echo, and that's when I was diagnosed with cardiomyopathy!  I was shocked since I had been feeling pretty good.  Because of the mitral valve stuff, the doctor was very assertive with a treatment plan.  I took the meds for about 7 months, but when I realized I would be on them for the rest of my life (side effects), I agreed to try ablation.  I had 2 ablations, and my ejection fraction returned to normal and the cardiomyopathy eventually resolved.  I had 2 procedures because I was multifocal, there appeared to be 2 predominant sites, and the doctor wanted to proceed conservatively.  

I was never afraid of the "weird" beats, but that could be because they felt "normal" to me.  NOW, when I have a PVC or a short run of NSVT, I am more aware since it is such a difference to NSR  : )  
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967168 tn?1477584489
Oh wow that sounds alot like me not being afraid or sitting at the ER daily lol Won't do me any good worrying over them and will just drain me of money to pay the ER that I could use for other things.

That is terrifying though you went from watching your mvp to cardiomyopathy in a year. Maybe the meds helped in the 7 months  you were on them even with side effects...I shudder just thinking about the side effects lol I'm such a wimp sometimes. I'm surprised you didn't notice a difference in that year of anything happening, you are alot braver than I am - I would be anxious over every symptom.

btw I found this interesting thing from one of the universities I think Utah - salvos (4-6 PVCs in a row), also called brief ventricular tachycardias  - since it was brought up in the explanation earlier, I read that and chuckled thinking that's a strange name for them since the others are couplets, triplets. quadruplets, etc.  

I'm so glad you're sharing with us, hearing others who have success really makes me less fearful of surgery,  Thanks :)

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Avatar universal
I live in Wisconsin too, and am going to see a cardiologist in Madison (Dr. Kushner, Dean Clinic).  I can see him in about a month, and hope he'll give me some answers.  I'll have my local family doctor send him the results of my last treadmill test in  February (was okay except for the mild mitral valve prolapse thing I've had for years).

It was a real surprise to find, after noticing an irregular pulse when listening to the beeps on my home blood pressure monitor, that I had a problem with premature ventricular beats.  There were none of those on my stress test in February.  None. The 48  hour Holter monitor a few weeks ago showed that I had 195,000+ beats over the 48 hour period, and 17,000 premature ventricular ones. I sometimes have short runs of bigeminy, but my local doctor says there were regular beats in between.  So, I guess it could be worse. I'm trying to figure out what brought this on so suddenly.  Some nights, after dinner usually, I have a variety of types of irregular heartbeat that can go on for maybe an hour, or up to several hours.  If I exercise some, it goes away, but comes back when I rest.  Oddly, it never wakes me from sleep once I turn in for the night. I'm mystified by all this, and am hoping things won't get worse.

At age 66, I'm finally retired and enjoying getting out with my friends + babysitting with our first grandchild.  I certainly didn't need this. I don't like to go out with friends in the evenings because of the crazy heartbeat thing.

I've posted elsewhere about how my local doctor suggested metoprolol, 1/2 dose once a day (taken in the morning so it won't interfere with the clonazepam I take at bedtime). I took a beta blocker once before and it dropped my pulse and blood pressure so low that I just sat in a chair (feld dizzy and had no energy) and hoped I'd feel normal the next day. Beta blockers can also make heartburn worse (I take Nexium for that). So, if I take the metoprolol, I may have more painful heartburn and esophageal damage, and also weakness, dizziness and fatigue...and I already have all of those.  What to do...I don't know.
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1 Comments
I am age 64,have suffered with pvc&#3g9;s since I was a child and diagnosed with them at age 35. I have a MVP, single pvc's and multiple runs of pvc's.  I will cut to the chase and tell you I have spent a lifetime figuring out what my triggers are, it is worth the time & trouble to keep a diary. When I would have a bad day of them I started writing down what I ate from previous day to current day.  A lot of mine are caused from food example, MSG, a biggy, and it goes by about 35 other names just google it.  Decafe drinks, including teas - there is something in tea leaves tannins or something like that, that will set me off. Anything that is very sweet - a tiny bit is fine.  Marinades, garlic, my food list goes on and on.  Eat clean, stay away from all processed foods.  Also at night don't lay on your left side. Another interesting thing to read about is your Vagus nerve and how it can affect your heart beat.  People with MVP have a tendency to be sensitive to most medications.  Anyway, I hope my experiences might have helped you or somebody else, I gathered a lot of my info from others in order to help find my triggers.
Avatar universal
I forgot to add that I'll have the results of the 48-hour Holter monitor sent to my Madison cardiologist also.  And I think I have palpitations too, not sure.  All I know is that I feel mild thumps and twinges in my stomach, chest, and throat, especially in the evenings about an hour after dinner. This is all  new to me.

To make things worse, heart procedures like ablation and surgery are even more dangerous for me than the average person, because almost every antibiotic closes  my throat. I've nearly died twice from antibiotics, once before surgery and once when taking an antibiotic for strep throat. My doctor has called me a "surgeon's nightmare." So, there's also that. Any advice (or assurance about the palpitation thing)  that you might have would be greatly appreciated. Feeling kind of lost right now.
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967168 tn?1477584489
I'm not Wisconsin2007 but I'm sorry hear you're going through this.

I was interested in your post because of the drop in bp on metoprolol - the dr acted like I was crazy when I went in to the ER with such a low bp and they couldn't get it back above 70/40 he told me normally it doesn't happen on low doses or quickly.

I asked someone else here, and they said it they had some side effects too and were switched to another BB.  Maybe tell your dr and asked to be switched so it won't cause the bp side effects, I'll try and look back at my posts and see who it was...I think Momto3.

I've read quite a few here say they have problems eating also - I wish there was more research for triggers & pvc's for a more effective treatment.

Hope you feel better soon
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267401 tn?1251852496
Hi Madge -

Your number of PVCs over the 48 hour period really aren't that alarming.  I've had that many in a single day - and poor Lisa33167 has that many in about 8 hours.  However, if this is a new problem, it's certainly worthwhile to have it checked out.  But once a trained eye has had a look and can assure you they are benign, you should be good to go.

So you know, there was a study done that showed that 90% of people over the age of 65 had PVCs.  So you are most definitely not in the minority.  You can email me if you'd like to talk more.

@Lisa - those numbers make a lot more sense, and should also be a lot more reassuring.  A 3-beat run of PVC is still a triplet, and 170 bpm for it is really not that fast - so that's a good thing.  And the resting HR of 67 is in the right range, too.

And I agree, Momto3 has a great story that can provide inspiration to many.
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Avatar universal
The doctor who did test said all looked fine.  I had one skipped beat during the entire process.  

So now what??  The heart and arteries look good from this test but what is or was causing the NSVT (which i found out IS what was picked up on holter monitor)

He said just keep taking the beta blocker doctor had prescribed and didn't really say much else.  
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967168 tn?1477584489
That is wonderful news!

Did you get your results from him?

For me seeing my test results on paper helps me - like the one time I had the 170 hr, I know it was when I was driving and probably stressed out from coming from the drs office, traffic was bad and I let it get to me.

are your BB's helping or do you have severe side effects that could be causing problems?

I hope you feel better & keep a watchful eye on things
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