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Mamas with type 1 diabetes - Page 3

post #41 of 267
Hannahmom - yes, there is stigma with T2, though in my case, I know that I'd never feel like it was my "fault," since I tended to take fairly good care of myself. Though T2 is also a genetic disease. Mostly I am happy because for me it's some sort of direction for treatment - a definitive one. Though after speaking to my endo, he's decided that yes, I have scads of antibodies, and yes, I have diabetes, but that maybe I don't have T1. I think that it's time for him to give in and give up, or maybe it's time to change endos....

No, insurance didn't cover it. But I wanted it badly enough.

Maria - sorry if I did a bad thing with the cross reference! Hope that the big folks who watch these things are not lurking

Quote:
Originally Posted by zoe398
He had very poor care when diagnosed and hasn't really followed up. He's taking a 70/30 insulin 3x a day. He recently had walking pneumonia and the doc at the clinic was very adamant about DH seeing a specialist, that he needed to be on a different care plan. Any suggestions?
Mandy -
Sorry to hear that you've had such a rough time. Looks like you have a lovely family, though.

I'd definitely recommend that he see an endocrinologist and get an A1c. That's kind of similar to the average blood sugar over the last 3 months, though not quite. It'll tell you where you're at now, anyway.

A working pancreas puts out a constant, low-level stream of insulin plus big surges of insulin after meals. 70/30 is a mix of long-acting and short-acting insulin, I believe. It's a very rough way to approach diabetes management, kind of like using a hammer for your needlework project. A very skilled person who's very exact about timing of food and amounts of food can make it work.

However, people who want a bit more flexibility in how much they eat and who want - say - a chisel approach to management of their diabetes are on multiple daily injections. This means that you take 1-2 shots of long-acting insulin every day, plus a shot of faster-acting insulin every time you eat a meal or a large snack. This offers more flexibility and usually results in better blood sugar control.

Finally, there's the insulin pump. That's what I use. It would be the needle for the needlework project. Very fine control, if you use it right and work at it. It's also fairly expensive, unless you have insurance. On an insulin pump, you only use fast-acting insulin. This means that if your body needs a lot less of the low-level insulin at certain times of day, like night time, then you can program your pump (kind of like a little computer) to give you this. Pumps are attached to your body at one site for a few days, then you rotate - no injections. Meals are similar to the paragraph above, with the added bonus that you can stretch your mealtime insulin over a longer period of time - you don't need to take it all at once. This is useful for things like pasta and pizza. You can also turn the insulin off or make it lower when you're exercising.

The flip side of the insulin is blood sugar testing. Testing often and correcting if you're off is the other key to good control. And getting to know how your body reacts to certain foods, exercise, etc is key.

Please encourage him to find an endocrinologist, test frequently, and investigate other types of treatment regimes, particularly multiple daily injections. I am sure that he will feel so much better when he has better control. I certainly do!

Ok, this is a bit of a book, and we need to put dd to bed now....
Tricia
post #42 of 267
Quote:
Originally Posted by zoe398
I'm jumping in a little late...I'm not T1, but my DH was diagnosed while undergoing chemotherapy for testicular cancer. Havig the cancer gone (for 2 years now), we're realizing that maybe the diabetes diagnosis wasn't taken as seriously then since we were already dealing with the cancer diagnosis. We're coming to this late, but we're coming to it. My DH needs to see someone and take better control of his life and health care. What are some good sites I could visit? What would you all suggest as the first step? He had very poor care when diagnosed and hasn't really followed up. He's taking a 70/30 insulin 3x a day. He recently had walking pneumonia and the doc at the clinic was very adamant about DH seeing a specialist, that he needed to be on a different care plan. Any suggestions?
Hi Zoe,
I'm sorry to hear about your dh's diagnosis. The other suggestions you've gotten are great. Does your dh have a blood glucose meter? Is he checking pre and post meals? That will give him the best indication of how well he's managing on the regimen he's on now. We use Freestyle Flashes and really like them because they're fast, small, take the tiniest amount of blood, and the cable and software for downloading to your computer are free.

You can also get most meters for free, either from a drugstore promotion, by calling the manufacturer, or through your doctor or endo. You'll just need a scrip for strips (and if you don't have any luck getting a free meter, then a scrip for that, too.)
post #43 of 267
Thanks for your replies to my question about fluid level checks. I am stressing about everything, it seems like. Maria, I think you have a good point that more u/ss are a reasonable tradeoff for a later induction. I'm seeing my new OB today, so I hope to have a better idea of what I'm going to be facing at my delivery. I'm trying to prioritize my wishes for natural childbirth so I can have some room to negotiate.

I'm with you guys about being skeptical about cures. I've been hearing that a cure is just around the corner for over 30 years now, and it really irritates me to be given false hope. I'm resigned that there will be no easy, affordable, side-effect-free cure any time soon. We just try to make the best of the options we have.

Mommybear,
What a sad story that your hospital made it difficult for you to have your ds with you. Especially since you must have been feeling crummy already. Were you not responding to injections at home? I have learned some tricks for bringing bg down quickly if you are interested. I overbolus for the high (since I need a lot more insulin for high-highs), and test very frequently. I have also done intramuscular injections; that really speeds things up. But I usually do not get ketones unless I'm sick, and if you have ketones it can be riskier to bring it down really fast. Also lots of water, and if no ketones, mild exercise. I'm sure you know all this stuff already, but I wanted to pass along some things. Anything to stay out of the hospital. Hope you guys are getting back to normal at home and feeling bettter.
post #44 of 267
Thread Starter 
Quote:
Originally Posted by hannahmom
zoe - I can imagine it would be hard to focus on two things like cancer and diabetes at once!
:

Ditto to the pp suggestions (and great analogy, Tricia!)

I would also check out some books. I've never read -- but have heard great things -- about Thinking Like A Pancreas. Your library likely has it; it's pretty popular.

---

Colleen, how are you doing? We're in your due date month now!
post #45 of 267
Thank you all so much for your information. We do have an appointment with an endocrinologist now. DH is a landscaper, so he "exercises" all day. And it's especially hot here (SC). Last summer, he had great control with his blood sugar levels, but recently it's been more difficult to manage. When he had pneumonia, they did a 30 day test and his levels averaged 180. High, obviously. It's so scary to think of the long term damage that's being done to his body. I'm going to give this info to him, so THANK YOU all for your help. I'll bow out of this discussion now...I'm sure there's so much to discuss as mamas with diabetes. I'll keep reading, though!!!
post #46 of 267

update on my ob situation

We saw my new OB today. She was FABULOUS!!! She will support my going to 41 wks as long as my BPPs are normal, she is all for natural births (and recently did a water birth!), and we can have baby at the hospital I prefer, even though they don't have a nicu. All that, and she's got a wonderful bedside manner. When I gave her my birthplan and prefaced it with "everything here is negotiable, but these are our preferences", she said essentially, no no, this is your birth. Halleluia. What a load off my mind. OK, now I have the nerve to post my birthplan...
post #47 of 267

birth plan

Birth Plan for , EDD:
Husband:
Doula:
Obstetrician:
Perinatologist:
Pediatrician:
Endocrinologist:

We know that we will receive excellent care and support for our personal decisions here at , and thank you sincerely for reading this plan and respecting our wishes. Having a natural, unmedicated birth is very important to us and we would appreciate any help you can give us. We are well-prepared and educated and have done everything we can to minimize risk during this pregnancy. Colleen has well-controlled Type 1 diabetes, and we are well-informed about the related risks to mother and baby in labor and birth.

We have researched each of the specific requests listed below and made informed decisions about them. Because many of these requests fall outside the normal practices at this hospital, we will be happy to sign any necessary waivers. Please do not perform any procedures, including routine procedures, on mother or baby without first receiving verbal informed consent. We will, of course, be flexible on all of these points if a complication arises. Nothing is more important to us than the health of our baby.

DIABETES MANAGEMENT

·My insulin pump will not be removed during labor or delivery. I will reduce basal insulin delivery as necessary to maintain blood sugar. I wish to decline IV insulin and dextrose.

·I will bring my own glucose monitoring kit and I will monitor my own blood sugars. I will treat highs or lows as necessary. I will bring my own supply of juice, glucose tablets, or food to maintain my blood sugar. Please do not interfere when I eat or drink as necessary.

LABOR

·I wish to decline an IV or a hep lock. I know the risks and am more comfortable waiting to see if one becomes necessary.

·I wish to walk, move, and change positions throughout labor and birth.

·I wish to have minimal vaginal/cervical exams. I find them uncomfortable and frightening, and not conducive to relaxing in labor. Please do VEs only when a decision needs to be made regarding my treatment (e.g. on admission, if pain medicine is requested, or if we are considering an intervention of some type such as pitocin, an instrumented delivery, etc.)

·I would prefer intermittent fetal monitoring only, and prefer that monitoring be done with a fetoscope or Doppler (1). We will consent to continuous monitoring if intermittent monitoring detects a problem or pitocin is used.

·I wish to avoid having my membranes stripped or my water broken.

·Please do not offer pain medications.

·I wish to avoid all drugs for inducing or enhancing labor. I have learned natural methods of strengthening labor, and have had a negative reaction to pitocin and cytotec in the past.

PUSHING & DELIVERY

·Please don’t insist on when or how to push.

·I would prefer to give birth in the position that is most comfortable for me.

·I wish to avoid an episiotomy. Please do not touch or massage my perineum. I will request warm compresses or support if I feel I need it. If I do tear, I would like local anesthesia for repairs, please.

·Please do not use forceps or vacuum unless baby’s life is at risk or it is the alternative to c/s.

·Either I or my husband would like to catch our baby, and I wish to hold my baby immediately after birth. Skin to skin contact is very important to us. Please perform the APGAR with baby on my chest.

·My husband plans on cutting the cord and will wait until it stops pulsing. Please do not clamp it until it stops pulsing.

·Please use pitocin after delivery only in case of severe hemorrhage, and then only with verbal consent. Please do not pull on my cord or the placenta.

INFANT CARE

·It is very important to us that breastfeeding begin immediately and without interference(i.e. removing baby to NICU or nursery.) Research indicates that this is the best way to avoid and treat hypoglycemia in a newborn, and our baby is at increased risk for hypoglycemia. Please do not offer sugar water, formula, or pacifiers.

·I will not consent to my baby going to the NICU unless absolutely necessary. I wish to be undisturbed for one hr following birth to bond with my baby and allow breastfeeding. Please perform any newborn procedures (weighing, measuring) afterward. We wish to be present for any baby examinations. If there is an immediate need for medical treatment, my husband wishes to accompany the baby at all times. We will be rooming in.

·I am aware that there is a risk for the baby to have hypoglycemia (glucose levels less than 40 mg/dl in the first 24 hours and 40-50 mg/dl thereafter) because I am diabetic. I will bring a glucose meter just for the baby, and either my husband or I will do her blood glucose tests (w/in 1 hr of birth or after first feeding, with increased frequency if hypoglycemia is present). We have extensive experience with doing heel sticks since my son was diagnosed with IDDM as an infant. Lows will be treated with breastfeeding. We will consider other options only if baby’s blood sugar does not respond to breastfeeding.

·We respectfully decline erythromycin eye salve and hepatitis B immunization. We would prefer vitamin K drops to injection, if available.

·We look forward to giving our baby her first bath ourselves.

·We would appreciate it if the PKU blood draw/heel prick could be done during breastfeeding.

CESAREAN PREFERENCES
If a c/s is necessary, please use regional anesthesia. Do not remove my insulin pump. I wish to have my husband and doula present during the surgery. As soon as the baby is stable, my husband and I would like to hold and touch our baby. I want to breastfeed in the recovery room or as soon as possible.

IF THE BABY IS SICK
I will breastfeed if possible. If the baby cannot breastfeed directly, I would prefer the baby be fed my milk by syringe or tube. I would like to hold my baby as much as possible. If it becomes necessary to transfer the baby to another facility, my husband or I will accompany the baby immediately.
post #48 of 267
I found out I was type 2 when I was 4 weeks pregnant with my 4th child and Iam 38 yrs old Iam 35 weeks along and my baby is 5lbs 9 ounces so Iam doing great I take Glyburide and have since Dec 1 05 is there a thread for type 2 pregnant mommies?
post #49 of 267
oh Colleen!!!!!!! : I'm so happy for you!!! That rocks and it must be such a relief.

Now... if only I could find someone like that
post #50 of 267
Thread Starter 
Yay, Colleen!!

Erica, how is your IV/pump discussion going?

Darcy, I don't know of a tribe for type 2 mamas, but I haven't looked. I started this one after noticing a few T1 mamas here. I PM'd everyone to see if there was interest, and then just started the thread. You might want to try the same thing. Good luck with your pregnancy!
post #51 of 267
Quote:
Originally Posted by ~pi
Erica, how is your IV/pump discussion going?
Hasn't gone anywhere yet! I'm still putting out feelers.

Normally I see an CNP at my endo's office but this month I'm seeing the actual endo. My CNP wrote a letter (which the one mw scoffed at) so I'm going to talk to the endo and see if she can also write a letter and provide specific guidelines for pump use - such as decreasing basal by x amt, correction ratios (which I already know : ) etc... I'm also going to ask if she knows of any non-interventionist, pump friendly OBs - just something to keep in my back pocket if I feel this group is not going to respect my wishes and stop looking at me like a ticking time bomb.

I have my fetal echo on the 17th and I'm pretty sure they are done by the peri himself? I'll ask him about the pump then - otherwise I have to schedule a specific consult and I'll do that if I HAVE to but if I can catch him in the meantime...

Also I see mw #3 tomorrow. I got mw #2's opinion - she's the one that said she doesn't want to 'annoy' backup OB. So again we'll see.

I don't know what to do if I encounter opposition on all fronts. It seems like such a silly battle for them (more specifically Mr. sOB) to fight.

From day 1 I knew it would be an uphill battle in some regards and I knew that going into labor on my own was going to be the best shot at getting the birth I want - so I got the u/s tech to fudge my edd by 3 days. If they do get antsy to induce when everything is checking out a-okay - I refuse to allow that before 40 wks, and even then I will come up with an excuse that will buy me a few days (my edd is at the end of the week so I will push off until the following Monday). That gives me until 41 wks (unbeknownst to them ) to go into labor on my own - whereupon I am not planning to go to the hospital until the baby is practically crowning! Then the IV thing is a non-issue

Isn't it sad when you'd actually really rather have your baby in the car?

collen - thanks for posting your birth plan too! You guys are doing all the work for me
post #52 of 267
Just a quick one before we get dd off to bed...

I am so sad looking at all of your birth plans. They are lovely. Makes me wish I had been "crunchier" at that time. And more organized - I was so panicked about diabetes, that I didn't really think a lot of this through. I think that getting diabetes and having a baby at the same time really made me rethink my approach to a lot of things, especially conventional medicine. If there is ever #2 baby, I will do things very, very differently. Ah well, we are learning...and to think, it has only been a year.

Tricia
post #53 of 267
Thread Starter 
Erica, I doubt the peri would do the fetal echo unless things are radically different in the states. Here, a tech and/or pediatric cardiologist does the echo. If it's the tech, the cardiologist looks at it afterwards and signs off on the report. Either way, the peri just receives a copy of the report.

Tricia, honestly, if I were diagnosed with something new and serious during the course of pregnancy, I'm fairly sure that all my plans would go out the window. I think most people have to get to a certain point in their disease experience first before they can look at balancing risks and bucking the system, and I really question whether I would have time to do that during pregnancy. Both Colleen and I have had our entire lives to get used to the disease and get really comfortable with all the different aspects of it, including all the self-management stuff. I'm not saying this to invalidate your feelings, because it totally makes sense to feel sad, I just wanted to point out that you became type 1 in probably the most stressful way possible, so it also really makes sense that you were a little panicked. I would have been a lot panicked!
post #54 of 267
Tricia,
I went along with everything my first time, too. We made the best choices we could with the information we had. Try not to doubt yourself. I'm trying to let my regrets about ds's birth go. xo, C
post #55 of 267
Hi everyone! I'm so glad I found you, it's such a relief to read about other people dealing with the same issues as I am and not freaking out about my crunchyness.

I was diagnosed with type 1 last june, but when I was pregnant I failed the gtt and my midwives thought I had GD. I remember being so depressed because I kept cutting carbs, even until I was only eating about 10 g of carbs a day a la Dr. Bernstein, and walking miles every day, but I just couldn't get my blood sugars below the 140s. I just felt like all of the advice to gestational diabetics was mocking me, because I was trying so hard to be so good and I just couldn't do it. I was the first time (but obviously not the last...) that I wasn't able to solve a medical problem that I was having by reading up about it on the internet and treating myself naturally. I had always been a big avoider of doctors, not being able to fix this was really humbleing, especially because there was a stigma associated with GD and I always had the impression that my midwives didn't really believe that I was towing the line. They put me on glyburide in the last couple of weeks, which obviously didn't really help, and in the end I wasn't able to have the birth center water birth that I wanted. Luckily I went into labor the day before my induction (I think I willed that baby right out, I remember walking 4 miles in the freezing cold trying to go into labor), but I was on continuous monitoring and IVs, which wasn't really what I had wanted for that birth. I did manage to avoid pain medication though, and I still remember the rush I felt when my daughter was born- it was amazing. She had a bg of 58 1 hour after she was born, and I tried to nurse her, but they really pushed for formula, and I was so exhausted (33 hour labor) that I let them do it. I wish now that I had tried expressing some colustrum, but next time, right? She was a bit macrosomic (9 lb 9 oz) with a bit of weight in her hips, but at the same time her dad is 6' 5" and was 9lb 3oz, and she is now above 97% for height, so I'm worried that my babies naturally being big may be an issue in my next pregnancy. After my birth I went back to eating normally, and never thought about diabetes again until June, when I had lost all of my pregnancy weight and then some, and was waking up 5 times in the middle of the night to pee. I finally dug out my meter from when I was pregnant, and the reading was 400 something, so I went to the ER and you know the rest of the story. She had stopped gaining weight for about a month before my dx, and when I was hospitalized and my blood sugars were evened out, I suddenly had much more milk, so I'll always feel sad about that month when she was so young and didn't get enough to eat. My blood sugars were great for the honeymoon period, but now they are pretty lousy. I'm fighting to get my insurance to cover the pump, my big problem is waking up really high (300-250) and going low in the afternoon (60-40). I feel sorry for dd because she doesn't understand what's going on, she'll be crying to nurse and I'll be sitting on the floor waiting for my blood sugars to go up feeling like my face is melting off. But I have a lot of hope, I was just with my new endo today (at the Joslin clinic, lucky me!) and she had a lot of ideas as far as switching my bolus from lantus to levemin or trying symlin or breaking up my bolus into multiple injections. I really want to get this under control so that I don't have to be terrified of getting pregnant. (Isn't it funny how it can be easier to want to take care of your health for someone else's sake rather than your own?)

As far as cosleeping goes, I cosleep with my daughter and have never had any problems, I had never thought of the impact of nighttime lows on safety, but I also tend to wake up if I start going low at night. (Although I have hypoglycemic unawareness during the day, go figure.)

I love reading all of your birth plans, it's so inspiring to see other diabetic moms having low intervention births.

My experience with nursing and lows is that my bg isn't affected unless she has a 2 hour nurse-a-thon at night.

Quote:
Originally Posted by widemouthedfrog
Yes, I am still (after 1 year) working on accepting the diagnosis. I've mostly got a handle on it, generally by getting some control of the diabetes itself. My most difficult part has been realizing that I am no longer self-sufficient. I depend on the medical system. That has been hard.
My husband and I had wanted to live off the grid in the woods. Learning to go to doctors regularly at all has been a big adjustment for me, and I get scared sometimes realizing that if there was some catastrophe that restricted my access to insulin, I'd be up a creek without a paddle.

Well, thank you so much for reading this far. Sorry about such a long post, but it feels so good to talk about this with people who really get it.
post #56 of 267
I have been on Glyburide since December 1st they put me on 2.5 mg I didnt have to up it to 5 mg till I was 7.5 months pregnant Iam inducing in 3.5 weeks at 39 weeks unless I go on my own which is what happened with my 20 month old.Iam going off the glyburide on the 15th so it can be out of my system before I deliver so the baby doesnt have a sugar drop I just hope I can keep my sugars low once I go off it.Monday they did ultra sound said she is 5 lbs 9 ounces so good so far it has been hard being diagnosed with type 2 at 4 weeks pregnant was devastating and sometimes I resent it but Iam doing what is best for Athena and she is my 4th and last baby Iam 38 will be 39 in October.
post #57 of 267
Oh Mady,
I think that I just read the story of my pregnancy...except that it was yours. As you may have read in my introduction, I was diagnosed last year in April with gestational diabetes. Luckily for me, one of the nurses told me immediately that I'd be going on insulin, and she suspected that I was type 1.5 (slow-acting type 1). I had similar interventions during pregnancy and labour. I also had major issues with milk supply, especially during the first weeks. Finally, a wonderful health nurse told me I had to go back on insulin - I was monitoring my blood sugar and it wasn't pretty. I finally argued my endo into taking a look before 6 weeks were up, and argued him into going onto insulin again, then spent the next 6 months begging for a letter saying I could get a pump. This was because he insisted that I was type 2 and didn't need one. Finally, I paid for antibody testing to show that I had the antibodies for type 1.5 - which I did, in spades. So my endo still won't confirm anything, but I have my pump and I know where I am at. But boy, what a hard, hard time it was. And I feel for anyone else who has had to go through that.

I find that things are so much easier to manage on the pump. My night time basals were way too much for me on Lantus...but daytime ones were too small. So I kept on waking up low after nurse-a-thons. Just what you need with a wee one.

Yes, it is not pleasant to go low with babe around - I have always been able to function ok when low, so I can kind of "fake it" with my daughter - keep her entertained enough even though I feel lousy. But boy, I feel it afterwards in the energy department. And it's funny, I can tell that a low is starting when I keep on repeating the same silly phrases to her (generally, I think up new silly phrases to say ).

Thanks for the encouragement about birth plans, everyone. Yes, I know, if there is a next time I will be more prepared. I didn't really know how much I'd missed until I started reading about others' natural childbirths...

Ok, off to put the wee one to bed.
post #58 of 267
Thread Starter 
Welcome, Mady!

That's a tough diagnosis story. It must have been such a stressful thing to go through while pregnant and then adjusting to parenthood. Yikes.

Good luck with your pump quest. I don't know if it works like this where you are, but here, the pump companies have special departments that deal with insurance companies for you. They were able to get me partial coverage even though technically I had no coverage for durable medical equipment. So if you haven't done so already, you might want to choose a pump, contact the pump company and trying attacking it from that angle.

I have variable basal needs, too, and it made a world of difference when I got my pump and got all my basals adjusted. I remember having so much energy and thinking, "If this is what non-diabetics feel like all the time, they should be doing more!"
post #59 of 267
Quote:
Originally Posted by ~pi
I remember having so much energy and thinking, "If this is what non-diabetics feel like all the time, they should be doing more!"
Omigosh I soooo remember this feeling! I had no idea how sick I felt until I felt better!

mady - Joslin has such an awesome reputation I'm sure you are in great hands and will be back to 'normal' in no time

So now there is a new wrench in my situation... Last night I saw mw #3 - and I LOVE her! She seemed to think that we could work on Dr. sOB about the pump. She mentioned nothing about annoying him like the last mw. BUT! She proceeds to tell me that he will probably want them to put me on the monitor - so I say "yes intermittently, right?" - Nope. I ask "you mean tied down in bed with the belts?" - Yup. She said it's not definite but she has a strong feeling.

I just cannot win! I told her that I'd prefer to have the baby in the car at this point and she felt bad but basically told me to do what I already planned - to labor at home as long as possible.

Now I don't know what to do. I almost want to find an OB that actually has a lot of experience with T1 women - that is off the bat okay with the pump , will let me go to 41 wks if my nsts/bpps are okay, etc... But then do I have even more battles ahead trying to have a low-tech birth? I'm so used to the laid back mw approach. My mw mentioned last night that I'm a physician's dream because there is something TO manage.

In the meantime I'm getting my hands on Birthing from Within and the hypnobabies cds. From what I understand of hypnobirthing, if I have to be strapped down during labor, it might be the best way to cope.

*sigh*
post #60 of 267
Quote:
Originally Posted by hannahmom
Now I don't know what to do. I almost want to find an OB that actually has a lot of experience with T1 women - that is off the bat okay with the pump , will let me go to 41 wks if my nsts/bpps are okay, etc... But then do I have even more battles ahead trying to have a low-tech birth? I'm so used to the laid back mw approach. My mw mentioned last night that I'm a physician's dream because there is something TO manage.
You should move here and use my OB. He was totally supportive of me homebirthing and didn't even balk when I wanted to UC. When I ended up needing a c/s he almost cried when he told me. He managed to make it a good experience, even though it was the exact oposite of what I'd planned. I really can't say enough good things about him.
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