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Trapeziectomy

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I had a trapeziectomy on my left thumb on the 1st Oct (6 weeks ago) As soon as the anesthetic wore off i experienced a burning pain on the site of the surgery. I am still experiencing the burning pain which comes on all of a sudden and can last for several hours. Am now in a removable splint and can only just manage the exercises. Cannot touch fore finger with thumb without some pain. Is this type of burning pain the norm? Cannot yet move my wrist to the upward position. The pain is making me very depressed. How long should this go on for?
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First Helper User Profile Gaelic
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replied November 7th, 2011
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oscardog,

Surgeries done for arthritis at the base of the thumb are significant procedures. Though a few patients rehab readily from this surgery, most patient take several months to get back to regular activities. We usually tell patients undergoing trapeziectomy or LRTI (ligament reconstruction, tendon interpositional) arthroplasty to expect prolonged rehabilitation and that it may take up to 18 months before the final result can actually be determined.

Again, a few patients get over this very quickly, but most take several months, and some can take as much as a year to 18 months.


Usually, patients are kept immobilized for about 4-6 weeks after surgery, to allow the soft tissues around the base of the thumb to heal. Then a removable splint is applied so that patients can begin therapy, but still have some support for comfort.

When joints are immobilized, they become stiff. In one way, some of the stiffness is desired, around the base of the thumb, so that the joint becomes stable. But, in other joints, it is not wanted. So, it is a balancing act, to get the scar tissue to form where you want it, but for it to stretch out in the places where you don't want it.

It will take some concerted effort in therapy to get your motion in the wrist back. You should have been moving the fingers the whole time you were in your post-op cast, so they should be okay. But, if you do have stiffness in them also, well, you have your work cut out for you in the next several weeks.


The burning pain can be from a couple of things. Some patients describe any intense pain as burning. In this case, the pain is probably coming from the joint capsule and ligaments in the area, from which the trapezium was taken. There are a lot a cut edges of soft tissues in there. These have to scar over. With time, the nerve endings in the cut edges will calm down.

The other problem, is that there is a fairly large sensory nerve that runs across the area where the incision is usually placed. It is common to irritate that nerve during the surgery. So, it is not uncommon for patients to complain of a burning pain, with/without tingling in the area supplied by the nerve.

Or, it could be a combination of the two.


Don't get too discouraged right off the bat. Keep working on the range of motion. It will gradually get better and better.

You should expect to have some discomfort in the thumb and wrist while it is healing and you are getting your motion/strength back. But, it should gradually get less and less.

If you continue to have the burning pain, contact your surgeon for advise. He/she will need to examine the wrist/thumb to determine exactly where it is coming from.

There is one condition, that is very rare, but does occur after surgery or trauma, and that is a condition called Chronic Regional Pain Syndrome Type I. This is a condition where the sympathetic nervous system gets turned on, to heal the injury, but does not get turned off. This results in a particular pattern of symptoms including pain out of porportion, burning pain, mottled red dry skin, decreased ROM, etc.

It would take an evaluation by your surgeon to determine what is causing your pain.


Good luck. Hang in there. It is going to take some time to get over this operation. But, you can do it.
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Users who thank Gaelic for this post: Suems56 

replied January 10th, 2014
Gaelic,
thank you so much for this post. I had surgery on 26th November and had the cast removed 2 days ago, after 6 weeks.
I was concerned about the stiffness, numbness and other discomfort, but the information you have given makes me feel assured that everything is going to plan.
You have explained things better than my surgeon did!
Today, while soaking my hand in a bowl of warm water, I was able to move my thumb. It was only a fraction, but it moved and I am very pleased. I found the combination of warm water and relaxing my hand/wrist really helpful.
Of course when my hand wasn't in the water it all went back to being stiff, but at least I now know that it can ease.
Thanks again
Sue
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replied February 7th, 2012
Hi All

just been reading all your posts i am having a Trapeziotomy on Thursday on my right thumb then having my left one done if all goes well .Consultant says 6weeks in plaster !! seems a long time.I have to admit
i'm a little nervous ..
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replied February 8th, 2012
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Nanamags,

Six weeks immobilization is about the usually time after surgery at the base of the thumb. Some surgeons MAY shorten the time a little, going to an OrthoPlast splint rather than a cast after about 3 weeks or so. But, that is up the the surgeon and how he/she feels about the tissues at the time of surgery.

If it very important the the ligaments and joint capsule at the basalar thumb joint (the CMCJ - carpometacarpal joint) to heal well and in the correct position. If these tissues are too loose the joint will end up sliding around and subluxing.

It takes about 6 weeks for soft tissues to physiologically heal. This is the reasoning behind the immobilization. Again, it is very important for those tissues not to stretch out and become too loose.


Any surgery at the base of the thumb is a significant hand surgery. But, it is also a very successful surgery, from which many patients have regained the use of their hand. However, it is not to be entered into lightly. Most patients who have this done have end stage arthritic changes and do not have the use of their hand anymore. So, for them, it is a great surgery.

No surgery can ever make a patient "normal" again. But, they are designed to make the patient better, so that they can functional use the body part again. This is what this surgery does. But, it will take some hard work in therapy to regain your range of motion and strength again. And, it can often take several months before the final outcome is known.


Be sure to tell you surgeon and anesthesiologist that you are apprehensive. If you are really unsure about having the surgery at all, that you need to discuss with your surgeon. Do not have a significant surgery, if you have doubts. Post-pone it till you feel that you absolutely need it. Going through with a surgery you are not sure about, can sometimes lead to disappointing results.

However, if you are just anxious about the unknown, then tell your surgeon and anesthesiologist. Steps can be taken to make you more comfortable during and after the procedure. Your surgeon can also tell you more about the procedure and the post-op therapy protocol, so you can prepare yourself for the work ahead.


Good luck on your upcoming surgery.
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replied February 9th, 2012
nanamags

i had my trapeziectomy on 29/12.the first plaster was removed after 1 week and stitches removed.a more lightweight plaster was then in place for 4 weeks.
at the time of the op i was given plenty painkillers so i got through that ok,but you should be prepared for being quite debilitated during the period the plaster is on.
i think it will be a long road ahead as i can't use my hand at all but physio starts next mon so i have high hopes for that.
i think if your life has been blighted by athritis then any chance of relief has to be tried.
try not to worry too much,you will get there.
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replied February 11th, 2012
Hi All
well had the op on thursday everything went fine have had quite a lot of pain and as i am right handed i am really getting annoyed with myself .I have to have this plaster on for 2 weeks then have it changed.I am really thinking twice though about having my left one done,Abig thank you for your support ,
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replied February 12th, 2012
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Nanamags,

In the big picture, a couple a weeks, then the several weeks of rehab, is actually a very short time. If this makes it so you can do things more easily, with less pain, it will be well worth it in the long run.

Hang in there, just a little while longer.

Good luck with your rehab.
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replied December 4th, 2012
hi i have had my op 6 weeks friday coming got a lot of burning in my hand i am thinking twice about having left hand done aswell
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replied December 4th, 2012
hi i have had my op 6 weeks friday coming got a lot of burning in my hand i am thinking twice about having left hand done aswell
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replied December 4th, 2012
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chipstick,

You are just barely out of the immediate post-op period. You have not really even started into the main part of the rehabilitation phase. This is a major orthopedic joint surgery and takes a long time to recover from.

The vast majority of patients are happy that they had the procedure done, once they have fully recovered. But, again, that can take a looonnng time. In some patients, it even takes up to 18 months for full recovery, until they know their final outcome.

So, try not to get too discouraged this soon after your surgery.

The burning type of discomfort can come from a few different things. The first is no make sure that any cast or splint is not causing a pressure point on the skin. Sometimes, the nerves in the skin get irritated during the surgery (or from swelling after) and develop a neuropraxia (which can cause a buring type of pain).

If the burning pain is really bothering you and does not seem to be subsiding, discuss it with your surgeon. There are some therapy techniques which can help and also some medicine which may help (gabapentin, pregabalin).

Good luck. Hang in there.
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replied March 2nd, 2012
Hi All
well i had dressing changed to full cast wound looked good but 3 weeks after op am getting tingling in whole thumb base and up to tip of thumb .Also wrist stiff as are my fingers but am moving them .|The base of my thumb feels very sore still not on top where scar is though its all on inside right the way round am i worrying for nothing or will the aching and all the pains get less Question
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replied March 3rd, 2012
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Nanamags,

Let me make sure I understand things correctly. You are now three weeks out from surgery. The surgeon took off the surgical dressing and put you in a short arm thumb spica plaster.

You noticed that your wrist was very still while it was out of the dressing, before it was placed back into plaster.

Your fingers are also stiff, but you are working on them while you are in the plaster cast.


Now that your thumb gets tingly and goes numb, after the new cast was applied.

You have soreness deep in the base of the thumb, not so bad up around the skin.



Okay. It is expected that your wrist will be very, very, stiff. When you come out of the plaster at six weeks, it is really going to be stiff, and SORE.

You really need to work on those fingers. Since they are not immobilized, you've got to jump on them and don’t let them get any stiffer. Use something you can easily squeeze, like a dry sponge or one of those computer sponges the stores give out for stress relief. You need to make sure the fingers go through a full range of motion, all the way extended and all the way flexed. If you have to use the other hand to help some, that's fine. But, you really need to have those fingers as supple as possible. Try to use the fingers as "normally" as possible. If you knit or do other fine work, try to do it. It may not be fast or the best, but it is good therapy.


It is a little concerning that your thumb is getting numb. That usually means that the cast is too tight. It could be from swelling, if you are not elevating the hand enough. When the tingling starts, elevate the hand above the head and wriggle the fingers. If this makes the tingling go away, you know it is from the swelling.

If the elevation does not take care of the tingling, then you should contact your surgeon, because the cast is too tight. It may need to be monovalved of bivalved, so that your hand and thumb have more room in there. There is pressure being placed on the nerves.



As to the soreness deep down in the base of the thumb, more so than at the skin, that too is to be expected. The skin just has an incision made through it. While the tissues deep inside had the majority of work done on them. The ligaments had to be cut, and are twisted some while being removed. The nerves and blood vessels had to be transected, along with the fascia and fat planes. Then, a soft tissue spacer was sewn in, and all of the raw tissue bled some. This formed a hematoma. As the body consolidated that hematoma, collagen fibers are deposited. Eventually, that all becomes a rubbery bumper between the metacarpal and the carpal bones. The capsule has to heal, so the metacarpal won't sublux.

All of this is going on, deep inside the base of the thumb. As it heals, which usually takes around 6 weeks or so, it is going to be a little sore. It will gradually get better and better.

They you will start therapy, and some of the soreness will come back for a short period of time. And, as therapy goes on and you get stronger and more flexible, the soreness will again get less and less.



So, hang in there. You are just right at the beginning of the process. You will have some ups and downs over the next several months.


Do, have that cast looked at if the elevation does not take care of the tingling.


Good luck. Wishing you the best.
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replied March 9th, 2012
Hi all

I am still having bit of pain and fingers and wrist stiff but need to ask if i can fly {on a plane}as my grandaughter in tenerife is in hospital and she is only 4 i need to see her .will i be able to go and do i have to do anything please advise .Iam still in plaster
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replied March 9th, 2012
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Nanamags,

Call the airline and ask.

Some airlines will allow a patient to fly with a cylindrical cast as long as it is not for a fresh fracture (as within in the past couple of weeks). If there is any possibility of the passenger developing swelling, then the airline usually wants the cast to be "bivalved".

This is mainly so that, if you do develop swelling while in flight, the cast can be opened up a little, or taken off, without the need of a cast saw. This is for your protection.

If they want to have the cast bivalved, just call your surgeon. It should be no problem for an orthopedic technician to cut the cast on two sides (but not remove the cast, just make the cuts). The cast is then wrapped with an elastic bandage.

The cast will still provide the support, but it can also be removed if needed when in the air.


So, again, just call the airline you are going to be flying on and ask about their policy. Some also may require a note from your surgeon, stating that it is okay for you to fly with the cast on, and will leave it up to the surgeon to make the decision as to whether or not to cut the cast.



As to the wrist stiffness, that is to be expected while you are in the cast.

Work on moving your fingers. The more flexible the fingers are, the less discomfort and swelling you will have. So, again, try to move the fingers as much as you can.


Hope your granddaughter is okay. Good luck.
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replied March 17th, 2012
Hi all,
Has anyone had a trapeziectomy,,carpal tunnel and a trigger finger done at the same time?
I am in the early recovery stages of this and am anxious to hear any anecdotal stories.
I know it's going to be a significant recovery but am wondering what type of splint I will be using and anything else which may be of help
Thank you ymous60
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replied September 4th, 2012
I find all the comments quite strange , I had my left thumb done 5 years ago and have not looked back, I used medication twice directly after surgery and that was it. I really can do anything with my thumb. Same as before operation. Having my right hand done in October . Can't wait. And my age is 66 so I must heal very quickly.
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replied September 4th, 2012
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joeymark,

Everyone reacts to surgery differently and everyone has his/her own pain tolerance.

You also have to remember that you see a skewed population on the forums. Usually, patients who do well do not post to forums. They are doing well, getting on with life, and do not need the support.

Glad that you have done well with your surgery. Most patients usually do well. But, there is a certain portion of the patient population that does have some problems in regaining function. Again, everyone is unique.

Good luck.
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replied October 23rd, 2012
Hi,
I had my second trapeziectomy with sling procedure on the 26th July this year. Six weeks the plaster came off. My fingers were very swollen and a hard lump running directly across my palm of my hand to my ring and little finger. I complained to my consultant that my fingers were very painful, as was my hand. Since then, I have had four physio sessions. My thumb is healing and is very much the same as when I had my left one done. However, my fingers and hand are not. There is a tightness, I still cannot straighten my fingers and the lump is still there. I spoke to my consultant again, and he told me the lump and stiffness has nothing to do with his surgery. It is a common problem and must run in my family.....!

I have a lump in the palm of my other hand, this came about twelve months after I had that thumb done. This right hand is totally different, with the lump being there straight after the operation.

In the morning I cannot move my fingers, they will not form a fist, and I have to passively move them backwards and forwards to get the, to move.

I am very concerned. I have been booked in for an ultra sound scan possibly followed by some steroid injections into my hand, which I don't want.

I want my hand back so that I can use it properly!! I want to know why this has happened...

Has anyone else suffered with this?
Jacquie
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replied October 24th, 2012
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Jacquie,

Sorry that you are having such problems after your thumb surgery.

As to your fingers, have they been this swollen since the surgery? Have you been doing range of motion on the fingers since the day of surgery? Unfortunately, if the fingers are not moved several times a day, they do tend to become very stiff and swollen, which is then very difficult to get back to "normal".

But, you have to deal with what you now have.


As to the thickening in the palm of the hand, it could be due to Dupuytren's Contractures. This disorder does run in families. It is a thickening of the fascial bands in the palm of the hand, which can cause the fingers to flex towards the palm. In other cases, it just causes thickening of the tissues in the palm.

But, there are other causes of lumps and thickening in the palm, such as EIC (epidermal inclusion cysts). These would not be associated with the surgery.


Hope your surgeon figures out what is going on with your palm. In the mean time, do work on the range of motion in your fingers. You can try to massage the fingers, starting at the tips, working up towards the hand and forearm. You might also try some compressive gloves, to help with the swelling which develops overnight.

Warming the tissues up with a paraffin bath or hot packs before doing range of motion therapy often helps to make the tissues more pliable.


Again, hope you figure out what is going on so that you can get back to your usual activities. Good luck.
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replied November 8th, 2012
Experienced User
Hello Jacquitc,

Have just read yours!
I have/am suffering with this, yes!
I am as disillusioned as yourself.
My surgery was around same time as yours, also!
If you are still reading this site, please do write.
We may be of support to each other,swapping ideas of possible avenues to investigate.

Take care
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replied November 30th, 2012
Trapeziectomy numbness
I had my trapeziectomy with sling op on 31st October
I m still in a cast and have some swelling still in both my thumb and fingers and regularly get sharp pain so still need to take some pain relief but ...
My biggest concern is that from the end joint of my thumb and down onwards my hand has no sensation at all, I have feeling underneath but none on top.
Has anyone else had this ?
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replied December 1st, 2012
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jdl59,

It is not uncommon to have an area of skin around an incision to be numb after surgery. Branches of the radial nerve supply the dorsal aspect (back) of the hand and digits on the thumb side of the hand. When the incision is made to approach the basal thumb joints, it is not uncommon to have to cut through some of the very tiny skin nerve branches. The larger branches are identified and move out of the way. But, nerves are delicate and finicky, and just handling them in the moving can cause them to go to sleep for awhile.

The most important sensation areas for the thumb are on the volar (palmar) side of the pad and on the side towards the index finger. The dorsal aspect is not really needed for everyday activities.

As to whether or not this area will wake up cannot really be determined. Most patients do get a return of sensation, but a few do not. The only way to know is to just wait and see what happens. Usually, nerve function will return by around six weeks (or at least begin to), if it is going to return.

The development of a neuroma is the most concerning problem that can occur with the sensory nerves. On rare occasion, the nerve will form a tangle or ball of nerve tissue, which can be irritating. So, if you develop a spot, which causes a shock like sensation when it is tapped or bumped, you should notify your hand surgeon.

Good luck. Hope your surgery does well.
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replied January 28th, 2013
Neuroma ?
Thanks, unfortunately I have had continued problems and in the last ten days have developed a small lump near the scar that causes really sharp pains if bange or touched even sometimes.
I am going back to the specialist the day after tomorrow so will keep you posted.

If this little lump is a neuroma what are the likely outcomes, it won't mean more surgery will it?
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replied January 29th, 2013
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jdk59,

It depends upon your course and symptoms.

Sometimes neuromas can be desensitized with occupational therapy. Occasionally, cortisone injection will quite them down. Some will just decrease in symptoms over time.

But, if it does turn out to be a neuroma, and nothing seems to relieve the symptoms, and the symptoms really, really bother you, then surgical excision of the neuroma is sometimes needed. That is something to discuss with your hand surgeon.

Good luck. Hope everything goes well with your appointment.
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replied July 28th, 2013
Trapeziectomy
Hi, I had my trapeziectomy done on my left hand just on three months ago. Straight away I was a star pupil, I did my exercises and could move my hand with ease. well that was until a few weeks ago.
Suddenly I have pains shooting down my thumb that are debilitating, my hand has gone back to where I started. I am seeing the surgeon on Thursday and the occupational therapist has put me back in a sling. Has anyone else experienced this? I know this is an old post, but was hoping someone would reply.
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replied July 28th, 2013
Hi, I had my trapeziectomy done on my left hand just on three months ago. Straight away I was a star pupil, I did my exercises and could move my hand with ease. well that was until a few weeks ago.
Suddenly I have pains shooting down my thumb that are debilitating, my hand has gone back to where I started. I am seeing the surgeon on Thursday and the occupational therapist has put me back in a sling. Has anyone else experienced this? I know this is an old post, but was hoping someone would reply.
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replied November 14th, 2013
Trapeziectomy with issues
I am in the process of waiting for a trapeziectomy and possibly release of trigger at the same time. I have a few extra problems in that I have had the radial artey removed at 35 for a bypass graft and have therefore staples etc around my wrist area. I also use my hand for venous access for apheresis and the same arm higher up so operating will deny me my treatment and increase my risk of a MI.I have had most operations including ones where I might not pull through and that take 18 months to recover but this scares me more than anything. I have previously lost my independence but through medical interventions my husbands help and my determination I have managed to return to full time work some 10 years after being retired. The surgeon says I will not be able to return to my job and I know the job makes my pain worse. But without a job and socialisation none of what I have been through will have been worth it. I lost most of my hobbies when I became ill and the ones I could do I can no longer because of my hands. So do I have the operation and loose my job or carry one until I can carry on no longer. Help please.
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replied November 14th, 2013
Hi Dawnydaybreak.,
this is ymous 60 as you can see in march 12 I had trigger finger release, trapeziectomy, carpal tunnel and a ganglion surgery.
For me, I am grateful, however, I was very handicapped for at least a year and even now I have not got full strength or movement back in my wrist and fingers. On my first visit after the surgery I was already experiencing another finger triggering and had to have an injection into it at that visit. I have since had one more injection in it. Also I need to have a cyst removed off the old trigger finger.
I found loosing my independence troubling and will continue to put off any further surgery until I cannot function. I look at the surgery as a success but it has created more problems .Think, tasks that need a little pressure e.g. wiping the bench or personal hygiene using lever doorhandles.
I took my rehab seriously, and did everything. AND extended it with another physio after being released from the original one. Home rehab is lengthy and tiring, I separated my left shoulder because of overuse with the rehab of my right hand and daily tasks.
I couldn't drive for 3 months as I had no strength. And it took me a further 3 months to be able to drive more than 15 mins without difficulty.
driving longer than an hour is still difficult because of the stiffness in my wrist and fingers.
I am sure this isn't what you wanted to hear but it is what it is,
good luck
Ymous60
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replied November 16th, 2013
thanks for this it makes me realise perhaps it is a step to soon.
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