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Author Topic: Thoughts on going with Dr. Parihar?  (Read 3106 times)

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Gman23

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Re: Thoughts on going with Dr. Parihar?
« Reply #31 on: November 12, 2020, 11:48:08 PM »

Excited for your diary... You have given us hope that Dr Parihar is still an option... Do you know the new price list for surgery with Parihar, if so please could you send me the link on mention it here. If possible In $ or £. I believe it’ll be around 50k for one surgery ???

Also I am from India too but live in Uk so it’ll be a better option for me. Please reply, thank you !
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Height 156cm / Goal 168cm / femurs and tibia with Dr Parihar or Dr Giotikas

http://www.limblengtheningforum.com/index.php?topic=65614.0

deletedaccount

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Re: Thoughts on going with Dr. Parihar?
« Reply #32 on: November 13, 2020, 07:28:30 AM »

Nice scarface. looks like promising option.

I think for LON also India is better than south korea for me. not worth doing so much hassle just to experience some modern looking hospital and be around people who wont understand english ( in south korea ) and not find my favourite foods.

if Im going to do in India I can think of stryde also, since I Will save a lot of money being in India.

whats your plan buddy?
Indeed, my plan is to go for it after I graduate from high school, my parents financing it or maybe in some time off I get during college.
You can ask your queries at info@bonedocs.in. They REALLY need to switch up their website design though lol.
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deletedaccount

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Re: Thoughts on going with Dr. Parihar?
« Reply #33 on: November 13, 2020, 07:31:01 AM »

Excited for your diary... You have given us hope that Dr Parihar is still an option... Do you know the new price list for surgery with Parihar, if so please could you send me the link on mention it here. If possible In $ or £. I believe it’ll be around 50k for one surgery ???

Also I am from India too but live in Uk so it’ll be a better option for me. Please reply, thank you !
Thanks Gman!  :)

"How Much Lengthening is possible:
5 cms can be safely done in most situations
Usually not more than 5 or 6 cms in the tibia, depending on function (see other comments at bottom of page)
internal lengthening nails may allow 7.5 cm of length in the FEMUR (again depending on clinical progress)
We don't do external lengthening of the femur in cosmetic cases, only for unilateral LLD due to unequal growth in the femur.
There are three methods that can be used:
"lengthening over nail" (LON) method.

External fixator only - if patient does not want to undergo the LON or if the anatomy does not allow the use of the nail.

internal lengthening nail (precice 2).
Description of the technique:

1. LON:
at the initial surgery, a fixator is applied on both the legs and a rod is put inside the bone.
The bone is then cut and gradual lengthening begun after 7 days. This lengthening is done at 0.75 mm to 1 mm per day.
at the end of lengthening, (usually 50 to 60 days if distracting at 1 mm per day, more if 0.75 per day), the rod which was place inside earlier is locked, so that the fixator can be removed. the rod then holds the bone in its lengthened position till such time as the bone matures. this process normally takes a minimum of additional 120 days.
The overall period before a patient gets back to normal for a lengthening of 6 cms is a minimum of around 6 months.
However, oftentimes, depending on the patient it may take anything from 8 – 12 months.

2. External Fixator only:
Similar to the above, except that an internal rod is not implanted. Therefore the fixator has to remain on the legs till the bone is fully healed.

3. Internal Lengthening Nail:
No external fixator is used. A special, imported nail is implanted in the bone to be lengthened, and a magnetically actuated mechanism in the nail lengthens the nail (and thus the bone) by 1 mm per day. 
Once desired length is achieved, the distraction is stopped and bone heals.

Advantages / Disadvantages of each:

LON:
Advantage: The “external fixator time” is much less than the “healing time” and patient is free of the inconvenience of the fixator. (fixator is removed after the lengthening – about 2.5 to 3 months)

Disadvantage: small risk of infection in the bone due to the nail inside. Small risk of pain in the knee from the insertion site of the nail.

External fixator:
Advantage: least risk of intramedullary infection. No risk of knee pain
Disadvantage: The ‘external fixator time” is the same as the “healing time”. i.e. fixator has to be on the leg till the bone is healed.

Internal lengthening nail:
Advantage: no external device, therefore no problems with scars, least amount of pain of the three methods.

Disadvantage: cost. Small risk of complications related to the nail – embolism, infection etc.

Time periods involved:

hospitalisation is usually for 7 days, but the patient has to stay in mumbai till the distraction is complete as this is the time till which problems if any can occur. once the rod is locked, patients can go back home and just send xrays to monitor the healing.
overall return to normal activity would take a minimum of 6-8 months.
in the initial period while the distraction is going on, the patient is relatively 
incapacitated, and is only able to do bed to wheelchair transfers. after the locking is done, patients can begin putting weight on their legs and walking with the aid of a walker (zimmer frame) depending on pain and the xray apperance. usually i would expect most patients to be taking almost full weight about 4 months after surgery (with crutches)
The time taken to heal depends on multiple factors, which are primarily related to the patient – i.e. LON or external fixation or internal nails, will all heal at the same rate for a given patient .
Stay in Mumbai:
Since the patient needs to stay  in Mumbai for the duration of lengthening, a stay of 90 - 100 days is envisaged
Short term rentals are not easy to find, and patients most likely would need to stay in a hotel in the vicinity. Hotels would give you cheaper rates for a long stay. This is not included in the costs of treatment.
Other comments: 

normally we do not do lengthening more than 5 or 6 cms for cosmetic reasons, as the rate of complications rises exponentially after that length.
in any case, we are very clear that function is more important than length, and in case any problems with function (such as stiffness in the ankles) arises during the treatment, we stop at whatever length has been achieved, and concentrate on the physiotherapy to regain function.
the process is fairly taxing for the patient, and needs good emotional support from a partner or other member of family.
For Surgery, we need an accompanying Relative to be present in the hospital. Only in very rare situations we do we undertake surgery without a relative present.

Costs:

The overall costs for the procedure come to around Indian Rupees 9,00,000/- (Rupees nine lac only).
This includes, stay in hospital for the surgery, doctors fees, physiotherapy, OT charges materials used in hospital / surgery. 

in case of internal lengthening there is an additional cost for the nails which is ordered directly by the patient from the company –see below for costs.
This does not include stay in Mumbai after discharge from hospital, physio after discharge from hospital etc.
Future Function after lengthening:
Once the bones have healed, there should be no problem with exercise and full activity.
When the LON Cannot be done:
If the bone to be lengthened is too thin, or too narrow, or too short, to accept a nail, LON cannot be done.
In that case, only External fixator lengthening can be done. In that event, the fixator remains on the leg till the bone is completely healed, (a process which may take 10 – 12 months for a 6 cm lengthening).
The patient is able to move around and perform most activities, but the fixators on the leg may be a bit of an impediment, depending on the patients personal and job profile.

More about Internal Lengthening: (Precice 2 nails):

Precice 2 nails are available in India.
The cost for the nails (in addition to hospital charges) is 10.55 lakhs per nail (total 21.10 lakhs). This includes the costs to do the paperwork for the import of the nails (by the local distributor). (This is a new, reduced price)
This cost is ONLY the nails, and costs for hospital and professional fees are additional.
Patient needs to stay in India during the lengthening phase.
Using this nail, the femur, or the tibia can be lengthened. The femur is preferred.
Once a patient decides for the surgery, the entire payment for the nail is to be made to the local distributors, who in turn will start the paperwork to import the nail to India, specifically for that patient.
It takes 6 weeks, after payment for the nails to be available for implantation.
After the paperwork is completed, a clinical support person from Nuvasive USA will double check the sizes etc and discuss with us, prior to despatching the nails.
A clinical support person from Nuvasive USA, will be present during the surgery, for support.
in case of malfunction, a replacement would be provided without charge. there would be some OT charges etc involved, which would be charged by the hospital, but no surgeon charges
More Information (Skype Consultation):
we apologise that we do not do email consultation (replying to and fro to various questions on email)
If you have a lot of questions that need answering, we would be happy to do a 20 minute Consult on Skype, @ at cost of US$ 200, at a time that is mutually convenient to you and us.
Please write down a list of questions that you may have, so that you can make the most of the time available.
email us at info@bonedocs.in with 'skype consult' in the subject line, and your convenient times to speak (with your time zone) and we will get back to you with possible times and details of how the payment is to be made, before the consult.
Alternatively, if you live in India, we are happy to see you in Mumbai for a consultation in person.
"

Just quoted from the link sent here. Also in the original post for Stryde.
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deletedaccount

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Re: Thoughts on going with Dr. Parihar?
« Reply #34 on: November 13, 2020, 07:35:19 AM »

bro can you ask if dr Parihar only does surgery himself and on both legs?
okey
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Infinity

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Re: Thoughts on going with Dr. Parihar?
« Reply #35 on: November 13, 2020, 11:27:11 AM »

bro can you ask if dr Parihar only does surgery himself and on both legs?

That is a good point and should be clarified as a few of the doctors do only 'One' leg and his colleague is doing the second leg at the same time.
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AnotherShorty

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Re: Thoughts on going with Dr. Parihar?
« Reply #36 on: November 13, 2020, 04:32:47 PM »

I think Dr. Lee is a very good option specially for Asian patients, if price is not an issue as he provides one stop shop and everything is cutting edge. Parihar is a great option if you are considering India, which i believe is not everyone's cup of tea for various challenges it presents. It has nothing to do with Dr. Parihar's ethics or skills, which i believe to be quite good rather certain issue related to general hygiene conditions of the environment.

I agree with you, Dr Lee is a great option because there is no issue with his workmanship, but after reading marathonrunners diary I just don't feel like Dr Lee is the best option. Parihar’s technology is certainly not cutting edge but I am curious about his pain management... Penguin had almost a painless journey but was it specific to him ? or pain management at Parihars is just fantastic? I NEED to know... Also, Penguin never uploaded any x-ray and scars images which would have helped many folks to make decisions... I am badly looking for Parihar dairies.

About the general hygiene - once you will visit Mumbai I am sure you will realize its somewhat exaggerated...     

@Scarface: Under the given circumstance, you cant travel to Greece or Korea... India and US are the only options but acquiring US medical visa due to COVID is almost impossible .. here is the list you can see to know India's current travel bubble:

https://www.civilaviation.gov.in/en/about-air-transport-bubbles#:~:text=%E2%80%9CTransport%20Bubbles%E2%80%9D%20or%20%E2%80%9CAir,of%20the%20COVID%2D19%20pandemic.

Make your decision wisely and I wish you all the best mate...Thanks for sharing the info

Regards
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Infinity

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Re: Thoughts on going with Dr. Parihar?
« Reply #37 on: November 13, 2020, 06:41:33 PM »

I agree with you, Dr Lee is a great option because there is no issue with his workmanship, but after reading marathonrunners diary I just don't feel like Dr Lee is the best option. Parihar’s technology is certainly not cutting edge but I am curious about his pain management... Penguin had almost a painless journey but was it specific to him ? or pain management at Parihars is just fantastic? I NEED to know... Also, Penguin never uploaded any x-ray and scars images which would have helped many folks to make decisions... I am badly looking for Parihar dairies.

About the general hygiene - once you will visit Mumbai I am sure you will realize its somewhat exaggerated...     

@Scarface: Under the given circumstance, you cant travel to Greece or Korea... India and US are the only options but acquiring US medical visa due to COVID is almost impossible .. here is the list you can see to know India's current travel bubble:

https://www.civilaviation.gov.in/en/about-air-transport-bubbles#:~:text=%E2%80%9CTransport%20Bubbles%E2%80%9D%20or%20%E2%80%9CAir,of%20the%20COVID%2D19%20pandemic.

Make your decision wisely and I wish you all the best mate...Thanks for sharing the info

Regards

I have visited parihar's facility and stayed in Mumbai for few days. My comments about general cleanliness and hygiene were based on first hand experience. Without sounding offensive or stereo typing, i believe there is a big difference between Indian and western standards of hygiene and cleanliness.

If scars and other other cosmetic factors are an issue the scars on Dr. Lee patients are barely visilble. So far I have see scars only on Parihar's LON/external patients and they a very visible and significant as he uses metal staples for closing of the skin opening. I am not sure how they are with his internal nails.

As i said earlier i am not trying to dissuade anyone from going to India and specially to Dr. Parihar, who i think is a good honest doctor. But if money is not an issue and, one has to do do the surgery in Asia, i will be more inclined to go to Dr. Lee.
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AnotherShorty

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Re: Thoughts on going with Dr. Parihar?
« Reply #38 on: November 13, 2020, 07:13:28 PM »

Point taken Infinity... we have different eligibility criteria so I understand your views.
Well lets hope you have a great experience in korea so we all can have good faith in Lee.

Regards
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Infinity

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Re: Thoughts on going with Dr. Parihar?
« Reply #39 on: November 13, 2020, 07:43:56 PM »

Point taken Infinity... we have different eligibility criteria so I understand your views.
Well lets hope you have a great experience in korea so we all can have good faith in Lee.

Regards

I think most sensible people generally would agree both are good options depending upon budget and few other factors. I am not going to either of them, at least not in next few months :)
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Gman23

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Re: Thoughts on going with Dr. Parihar?
« Reply #40 on: November 13, 2020, 08:04:15 PM »

I believe Dr Parihar is probably the cheapest best surgeon out there... As he also trained with Dr paley ... I don’t know who this Dr lee is or Dr Halil budul but Dr giotikas seems like a decent surgeon...
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Height 156cm / Goal 168cm / femurs and tibia with Dr Parihar or Dr Giotikas

http://www.limblengtheningforum.com/index.php?topic=65614.0

Infinity

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Re: Thoughts on going with Dr. Parihar?
« Reply #41 on: November 13, 2020, 08:21:03 PM »

Dr. DongHoon lee is actually recommended by Dr. Paley and also trained with him.
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Medium Drink Of Water

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Re: Thoughts on going with Dr. Parihar?
« Reply #42 on: November 13, 2020, 09:04:33 PM »

If scars and other other cosmetic factors are an issue the scars on Dr. Lee patients are barely visilble. So far I have see scars only on Parihar's LON/external patients and they a very visible and significant as he uses metal staples for closing of the skin opening. I am not sure how they are with his internal nails.

Metal staples aren't much of an issue long term for scarring, if at all.  I had pretty bad scars and my doctor did not use staples.  Other factors such as how bad the wound was and genetics determine how bad they are.
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Infinity

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Re: Thoughts on going with Dr. Parihar?
« Reply #43 on: November 14, 2020, 08:36:28 AM »

Metal staples aren't much of an issue long term for scarring, if at all.  I had pretty bad scars and my doctor did not use staples.  Other factors such as how bad the wound was and genetics determine how bad they are.

From my limited knowledge base it seems stapling is not the best option for wound closure and from what I have seen parihar was using this method as he is primarily a tauma  and deformity correction surgeon, which can be both good and bad when it comes to choosing a surgeon for CLL.. I am not sure if he still does so but this point might be relevant for some people who do LL for cosmetic purposes. Below I share some text I came across, ..
" FACTORS TO CONSIDER WHEN USING STAPLES
1. APPLICATION AND REMOVAL
Stapling can usually be performed quicker than suturing, saving about 2-3 minutes of time, which is why stapling is the preferred method of choice for trauma care involving mass casualties, whether it’s a natural disaster, major vehicular accident, or even a shooting. In a physician’s office. And while both stapling and most suturing require return visits for removal, staple removal in particular requires usage of a special tool versus a simple set of scissors for sutures. There are times when staples can become embedded in the skin, making removal difficult; on rare occasions, staples can become completely lodged within the skin, requiring a new incision to remove the buried staple.

2. RISK OF INFECTION
Wound complications are one of the main sources of illness following surgery, extending a patient's stay in the hospital or even leading to readmission. To find out which were less likely to lead to infection—stitches or staples—researchers analyzed the results of six trials, comparing both methods following surgeries in over 680 adults. They compared the use of staples to sutures following orthopedic procedures in adults. Their conclusion? The risk of developing a superficial wound infection was over three times greater after staple closure than suture closure, and for hip surgery in particular, staples were four times more likely to lead to infection.

3. SCARRING
Just as with sutures, staples can cause scarring. Because staples do not allow for precise wound alignment, healthcare professionals should not use staples on the face or neck (and discomfort makes them a poor choice for usage in the hands or feet). In patients who easily scar, staples could make their scar more pronounced, especially if the staples are left in for any stretch of time (>5 to 15 days, depending upon the location). Between 2013 and 2016, 163 women were analyzed, including 84 who received staples and 79 receiving sutures. There was some variance in weight and aging, but women with staples reported worse median cosmetic scores, darker scar color, and more skin marks compared to women with suture closure. "
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Gman23

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Re: Thoughts on going with Dr. Parihar?
« Reply #44 on: November 14, 2020, 06:33:29 PM »

Dr. DongHoon lee is actually recommended by Dr. Paley and also trained with him.

Suggest me a good diary from Dr Donghoon lee please haven’t really read any of his diaries
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Height 156cm / Goal 168cm / femurs and tibia with Dr Parihar or Dr Giotikas

http://www.limblengtheningforum.com/index.php?topic=65614.0

urbuddy

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Re: Thoughts on going with Dr. Parihar?
« Reply #45 on: November 22, 2020, 11:46:28 PM »

I actually would really like to go with Parihar and stay in one of those fancy Mumbai hotels. I’m actually Indian myself living in the US as a US Citizen. I have a Indian Visa that allows me to stay there for 6 months at a time. Would Dr. Parihar allow me to come back to the states after 2 months lengthening is complete?
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2020hope

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Re: Thoughts on going with Dr. Parihar?
« Reply #46 on: November 25, 2020, 07:48:21 PM »

I actually would really like to go with Parihar and stay in one of those fancy Mumbai hotels. I’m actually Indian myself living in the US as a US Citizen. I have a Indian Visa that allows me to stay there for 6 months at a time. Would Dr. Parihar allow me to come back to the states after 2 months lengthening is complete?

Yes you can definitely go back after distraction. You can actually leave whenever you want and won't be stopped or anything but you would have to rely on a local surgeon for follow ups and also figure out how to return the ERC machine.
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KiloKAHN

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Re: Thoughts on going with Dr. Parihar?
« Reply #47 on: November 26, 2020, 02:13:17 AM »

From my limited knowledge base it seems stapling is not the best option for wound closure and from what I have seen parihar was using this method as he is primarily a tauma  and deformity correction surgeon, which can be both good and bad when it comes to choosing a surgeon for CLL.. I am not sure if he still does so but this point might be relevant for some people who do LL for cosmetic purposes. Below I share some text I came across, ..
" FACTORS TO CONSIDER WHEN USING STAPLES
1. APPLICATION AND REMOVAL
Stapling can usually be performed quicker than suturing, saving about 2-3 minutes of time, which is why stapling is the preferred method of choice for trauma care involving mass casualties, whether it’s a natural disaster, major vehicular accident, or even a shooting. In a physician’s office. And while both stapling and most suturing require return visits for removal, staple removal in particular requires usage of a special tool versus a simple set of scissors for sutures. There are times when staples can become embedded in the skin, making removal difficult; on rare occasions, staples can become completely lodged within the skin, requiring a new incision to remove the buried staple.

2. RISK OF INFECTION
Wound complications are one of the main sources of illness following surgery, extending a patient's stay in the hospital or even leading to readmission. To find out which were less likely to lead to infection—stitches or staples—researchers analyzed the results of six trials, comparing both methods following surgeries in over 680 adults. They compared the use of staples to sutures following orthopedic procedures in adults. Their conclusion? The risk of developing a superficial wound infection was over three times greater after staple closure than suture closure, and for hip surgery in particular, staples were four times more likely to lead to infection.

3. SCARRING
Just as with sutures, staples can cause scarring. Because staples do not allow for precise wound alignment, healthcare professionals should not use staples on the face or neck (and discomfort makes them a poor choice for usage in the hands or feet). In patients who easily scar, staples could make their scar more pronounced, especially if the staples are left in for any stretch of time (>5 to 15 days, depending upon the location). Between 2013 and 2016, 163 women were analyzed, including 84 who received staples and 79 receiving sutures. There was some variance in weight and aging, but women with staples reported worse median cosmetic scores, darker scar color, and more skin marks compared to women with suture closure. "

From my experience, the staples didn't leave any scars. I only have indentations where the pins and wires from the frame were located.

You can see the initial appearance of the staples here:

https://www.turboimagehost.com/p/19408943/fib_osteotomy_close.jpg.html

And what it looked like after the staples were removed while I was still in frames:

http://www.limblengtheningforum.com/index.php?topic=634.msg38454#msg38454

I couldn't even tell there were staples earlier.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Skyisthelimit

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Re: Thoughts on going with Dr. Parihar?
« Reply #48 on: November 26, 2020, 10:58:36 AM »

Hey KiloKhan,
I was checking the images of your legs after frame removal and then some of your mock-ups came up. Is it still in your plans to get 7cm on femurs and with who would you think of doing this?
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184dream

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Re: Thoughts on going with Dr. Parihar?
« Reply #49 on: December 02, 2020, 06:32:23 AM »

very informative
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