Is Prozac allowed for cadets with anxiety or depression?

Discussion in 'ROTC' started by anxious, Aug 16, 2013.

  1. anxious

    anxious New Member

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    Hello.

    Our cadet is about to enter into MSIII year. She is highly ranked in the Battalion, with top half PFT and top 10% in GPA. She has a lot of friends at school and seems to be popular in her social group.

    We were having lunch today and she explained how she wasn't excited about going back to school. We asked why, and she explained that she is always anxious about change, and that she is actually always anxious about everything! And she says she is mildly depressed a lot of the time, whether at school, at home, or anywhere really. We knew she worried more than most people, but hadn't really understood she is always, at all times, anxious.

    OK, so I know enough based on family history of mild anxiety and mild depression that Prozac/Zoloft/Wellbutrin/ a couple of others are good for both mild anxiety and mild depression. The problem is, I tsuspect that it is not allowed for a cadet to continue in ROTC if they are prescribed a psychiatric medication like Prozac. Am I wrong about that? I am assuming the diagnosis would be "mild anxiety", or "mild depression", or both.

    She can

    1) "soldier on" (this is her current plan) and just live with being mildly anxious and depressed (and therefore mildly unhappy) a lot of the time. She says she will soldier on, but would love to be able to stay in ROTC and take Prozac, etc., or

    2) go see a Psychiastrist and get a diagnosis of mild anxiety and mild depression, and get medication fo this. If she does this, does she get kicked out of ROTC?, or

    3) procure some Prozac without a prescription (which is really easy from off-shore pharmacies), and self medicate.

    The problem with 1) is that I don't think a person should have to just soldier on through a brain chemistry deficit when there is medication taken by literally tens of millions of Americans that mostly corrects for this brain chemistry ideficit (excessive Seratonin re-uptake).

    There may be no problem with 2), but I cannot advise her to do this, when she would need to report this medical change to her cadre, and when she is willing to "soldier on" if there is a good chance it would lead to separation from ROTC and a huge payback in scholarship money

    The problem with 3) is that at some point she will take a DOD physical again, and she will need to truthfully answer that she has "taken a drug not prescribed by a physician", or whatever the exact wording is to see if you've taken illegal drugs... and a legal medical drug is illegal when not prescribed by a physician. I don't know if that would DQ her as an MSIV getting ready to commission.

    So, that's why it is very important for me, as one of her advisors in life, to find out if option #2 above would allow her to continue on in ROTC, then into her chosen Military Intelligence, which requires certain Top Secret Security Clearances. I'd also need to know , since she is interested in CIA or State Dept. as a possible career if and when she leaves active duty, whether an employee in the CIA or State Dept is even allowed to be taking a psychiatric drug like Prozac?

    Well, that's a handful, and I appreciate any information about ROTC in particular, and then CIA or State Dept. as a possible post-Army career, while taking Prozac.

    Thanks for your responses.
     
  2. Jcleppe

    Jcleppe Member

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    Let me start out by saying, Do Not let her self medicate, purchasing Prozac off shore will be seen the same as purchasing illegal drugs, her time in ROTC and the Military will be over with no chance of ever getting back in.

    Beyond the above reasons, nobody should ever self medicate with Prozac, there are serious possible side effects and she could be putting herself and others at risk.

    Only she can decide whether to "Soldier On" Realize, as I'm sure your aware, that Depression and Anxiety is something that can be serious and get worse without treatment.

    If your daughter seeks a medical diagnosis and is prescribed medication, she will need to alert Dodmerb of the change in her medical status right away. I can't say definitively whether she would be disenrolled, my guess is that she would be. She has the option of talking with her Cadre, but realize once she does the cat will be out of the bag.

    I can see how this will be a difficult decision but above all, please do not allow her to self medicate, that would be the worse decision she could make.

    In the end the most important thing is your daughter's health.

    Best of luck to your daughter,
     
  3. nick4060

    nick4060 Member

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    Well I don't think option 3 needs to be addressed. That one's pretty cut and dry.

    Bottom line: your daughter is obligated to report any changes in her health to her cadre. This includes mental health. If she goes on prescription anti-depressants, there will most likely be an investigation and it will be determined whether or not she'll be allowed to stay in the program. I honestly couldn't tell you with certainty what the outcome would be.

    But I can tell you that during my time in ROTC, the few cadets I knew who went on anti-depressants were subsequently dis-enrolled from the program.

    I can also tell you with certainty that working in the intelligence community with a documented history of mental health problems will be difficult, if its even possible. I've been working in this field for less than a year and I couldn't tell you how many times I've filled out paperwork asking me whether or not I've been prescribed those kinds of drugs. It will be a giant red flag that follows her throughout her career, and it'll be something she'll have to explain over and over again, every time she moves to a new assignment and gets read in and out of programs.

    That said, I don't think its wise to ignore any health issues she might be having. There's no harm in seeing a specialist. Maybe they will have some ideas for helping her with her anxiety that don't involve prescription drugs. I am obviously not familiar with the particulars of your daughter's case, but I wouldn't advise anyone to go into a doctor's office with the goal of simply getting prescribed drugs. Shouldn't the goal be to get better, with or without them?

    I hope it all works out, good luck.
     
  4. Roxymom

    Roxymom Member

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    Has your daughter talked to a counselor or advisor at school? Perhaps there's a Prof or even someone in the cadre she could talk to about worrying or stress reduction techniques. Sounds like she could be like a lot of high achievers.
    Counseling-a regular outside person to talk to- relaxation techniques-yoga are other first steps.
     
  5. MabryPsyD

    MabryPsyD Dr. G.

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    Eh...

    If this is a temporary (one time situational) anxiety, then self-care COULD be effective. However, if patterns start to emerge, this could indicate an anxiety disorder requiring psychotherapy and/or psychopharmacological intervention. If the anxiety is to the point it's causing social, occupational, and/or academic impairment she may not be ready to commission.

    The military is starting to shy away from giving compensation for preexisting conditions. In the event the anxiety is unresolved before she hits her first duty station, a "failure to adapt" vs a MEDBOARD might be in order.

    Basically, if SHE feels (not mom and dad) something is wrong. She needs to actively seek treatment. Unresolved anxiety disorders are ugly...
     
  6. JMS

    JMS Member

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    I wonder if an individual were to visit with the college clinic to discuss a concern in detail and get options from a professional, is a medical 'issue' triggered?. I am supposing such a visit is confidential, and exploratory. Thus no meds are prescribed, no diagnosis made, nothing to report to the cadre. Does this 'thread the needle?' Sort of a partial #2 ... see the Dr but without a diagnosis or meds ... they could come later if needed.
     
  7. mbitr

    mbitr Member

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    Your daughter is going to fill out paperwork for a security clearance that will ask in no uncertain terms if she has ever been counseled. They will then want to know what it was for. I don't see how a provider could offer her options for treatment without a diagnosis, which I think is what you're asking.
     
  8. Roxymom

    Roxymom Member

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    +1 - all we heard about at recent college orientation were the opportunities for counseling, crisis counseling , hotlines available to students throughout the university . Getting the student to talk to someone as a first step.
     
  9. anxious

    anxious New Member

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    Thank you for your responses.

    - this isn't acute, nor is it sudden. As I'm understanding it now, all through High School, and now the first two years of college, she has felt pretty consistently this way -- much more anxious than the average person, and a little more depressed than the average person. At what point on the bell curve continuum does "much more" become diagnosable? It isn't like there is an exact laboratory result that passes a physical threshold... To my understanding, a lot of these psych diagnoses that pertain to high functioning people are of the type "does the person meet at least six of these ten characteristics", and so forth. In other words, it is a judgement call by the healthcare provider (MSW, Psychologist, Psychiatrist, general MD).

    At what point does "more anxious than her peers" become an "anxiety disorder"? These chemical deficits that lead to mood disorders are not, at present, measurable in a lab. There is no laboratory test, to my knowledge, that measures the amount of serotonin re-uptaken by the brain, so there can't be a lab test defining how much is diagnosable, and how much isn't. She will not take alcohol or drugs as a coping mechanism as do most of her peers, so she is a little bit out in virgin territory dealing with this anxiety and mild depression with no, zero, chemical coping medication (alcohol, pot, etc.)

    - At what point does a person self medicate for a mild, but persistent condition (in other words, genetic) that is not severe enough to merit an actual DSM-V diagnosis? Let's say for the sake of our discussion, more anxious than 90% of the population, but less anxious than 10%? More depressed than 80% of the population but less than 20%? These things are not 1,0 in a binary world. Everything is about degrees, about position on a continuum of human experience.

    - Medication: again, this is an observation. Since the chemical deficits in the brain that lead to a person feeling more anxious, or more depressed, or more whatever than the average person are not measurable in a lab, the prescriptions for drugs that would likely improve the situation are, well, experimental. A drug is prescribed that past experience shows will likely be a benefit to the person, the person takes it and then reports to the physician how it affected their mood, and the physician makes a judgement call about dosage, or whether a different drug might work.

    Well, those are the questions we are tossing around.
     
    Last edited: Aug 17, 2013
  10. cajuncarrier

    cajuncarrier Member

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    I agree with the posters so far. Visit the on campus clinic to begin. Get some tips and suggestions to help with some of the issues she is having. It's a start. Look at all of the options available. (counseling, natural remedies, stress reduction therapy, behavioral therapy, etc.) There are so many options available these days to try before prescription medication is needed. Maybe one or several will work.

    Bottom line... her mental health is most important. I can only imagine the more stress that is added when thinking about how this situation will affect her ROTC/military career. My heart goes out to you guys. Prayers sent your way.
     
  11. goaliedad

    goaliedad Parent

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    Maybe MabryPsyD can give some more insight here (not asking for a diagnosis here), but the questions that the OP's daughter needs to ask herself are:

    1) Does this anxiety/depression significantly interfere with one or more daily living activities (sleep, eating, socialization, etc.)?
    2) Has she explored non-medical alternatives (yoga, exercise, etc.) to manage these feelings?

    I think much of the reason we medicate today is that we've lost touch with how to manage our own moods through various activities in our daily life. A lot of the time, all a person with these types of issues needs is a regular activity that releases the various neurochemicals necessary to maintain proper balance.

    This post is in not considered medical advice as I am not in any way an expert in these issues. I've just known quite a few people who find therapy to such feelings in various exercise related activities - anything from distance running to climbing to yoga.
     
  12. puzzler

    puzzler Member

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    Maybe she could talk to a member of the clergy. They often are trained in counseling, but since they aren't counselors per se, there might be fewer worries about the impact on her military career.
     
  13. kinnem

    kinnem Moderator

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    +1 to goaliedad. I've been thru this myself. At one point recently in my career, I was extremely (and I mean extremely) stressed at work. I had difficulty sleeping, massive anxiety attacks, and random thoughts that "If I just drive my truck at high speed into that tree over there...". Went on anti-anxiety meds and that made a massive difference. I've been off them for a couple years now. I still sometimes have trouble sleeping at night and my solution for that is exercise during the day so I'm more tired at night. I'm certainly not suggesting your daughter shouldn't have a conversation with someone about this but IMO, if she is able to deal with day to day life successfully (and she appears to be doing so), then I would stay off the meds. Hope everything works out for your DD.
     
  14. MabryPsyD

    MabryPsyD Dr. G.

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    I think the student counseling center is a good start. They see all types of anxiety issues ranging from test anxiety to full-blown anxiety disorder. I also support the use of clergy if one cant see a licensed mental health provider. I would have your daughter revisit her current coping strategies for stress. What does she do to relax? Therapists can be used to teach her additional coping strategies and maybe keep her off of medication. Not all anxiety issues lead to medication.

    It's good you have a open line of communication with your daughter. Most people don't discover people have anxiety issues until it's too late. You stated you had a family history of anxiety and depression. Genetics can play a factor on how long it takes for your daughter to bounce back and the effectiveness of her coping strategies.

    Most the previous posters got it right. As long as she sees somebody for her issues I think she'll be in good hands.
     
  15. JMS

    JMS Member

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    So, in your view, would following your good advice be a medical event that one would need to report to one's cadre or otherwise register on the military 'Richter' scale? Or is it just a college kid trying to get their self sorted out?
     
  16. markbrown6

    markbrown6 Member

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    Speaking just on anxiety: There's self-education and self-calming too. We had a family member achieve good enough results with this. There's an enormous amount of helpful info on the web, books and videos to help learn about, understand your body's reactivity and methods to self-calming: yoga, reading about body awareness, exercise.

    http://www.npr.org/2012/07/03/156200170/monkey-mind-when-debilitating-anxiety-takes-over

    http://www.youtube.com/watch?v=wTn9Y7D82Co

    http://opinionator.blogs.nytimes.com/category/anxiety/

    My son keeps this by bed and says it has helped:
    A Life Less Anxious
     
    Last edited: Aug 17, 2013
  17. MabryPsyD

    MabryPsyD Dr. G.

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    Two things:

    Yes, the student counseling center would warrant notification to the cadre, but this is how I would approach the issue...

    1. I would FIRST approach the student counseling center and ask if the sessions could be classified as a "V-Code". If the behavioral issues are too severe (needs meds or more comprehensive therapy), then the official diagnosis will move the Richter scale.

    2. She has to tell her cadre that she is in treatment, BUT she isn't require to state WHY she is in treatment (medical privacy).

    If records were requested for a medical review, the V-Code COULD show her issue isn't debilitating.

    Mental Health V-Codes:

    http://www.psyweb.com/DSM_IV/jsp/DSM_VCodes.jsp
     
    Last edited: Aug 17, 2013
  18. anxious

    anxious New Member

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    Unfortunately recent events have caused me to come back here to revisit this issue.

    Things have started to reach a crisis point. I’m not sure how much of it is mental health related, and how much is lifestyle choice realization and crisis. I suspect it is about 80% mental health related. She wants to drop ROTC asap. She also would like to transfer schools at this late date, even as a Dean's List student.

    I am torn between

    1 - suggesting she drop ROTC, and either stay there or transfer back home, and be financially strapped for 10-20 years, and
    2- suggesting she try to “soldier on”, try to treat her anxiety without medication, and possibly hate the next 18 months, then deal with resenting the Reserves obligation for the next 8 years (with the possibility of being called to Active)

    Updates:
    We learned she is having newly emerged issues in the classroom because she worries about virtually everything. Here is what has transpired since I last posted:

    Late August
    - she worried about passing the APFT (she passed with a 265 the next day)
    - she constantly worries about performing well as an MSIII Master Seargent, and being in charge, as I understand it, of STX lanes

    Early September
    - She reports she is having trouble studying, she worries about ROTC all the time, and
    - She thinks she is going to fail Physics (for BS Life Science majors). A week later, she called to say she just missed a D grade in her first test by 4 points, so, she was right, she got an F. She is a Deans List every semester student with a 3.8 CGPA and a 3.6 GPA in her BS degree prep courses of Calculus, Biology and Chemistry.
    - She reports that her first formal Evaluation as a Master Sergeant was an E. She dreaded that evaluation, and continues to dread future evaluations even though she got an E.

    Third week of September:
    - She is stressing a lot about Physics b/c she realizes she knows the math, but doesn't understand the underlying concepts. I offered to get her a Physics tutor, which is in process. She also learned that she still has until mid October drop Physics without any grade repurcussions. She can do this and still graduate on time.
    - She is currently enrolled in the most difficult class in her major, a 4 level class, because , well, another story. But she has no choice. She got a C on the first test, in which 40% of the class got D or F. She just called to say her next Physics test is the day after this class's next test, and how is she going to be able to prepare for both demanding classes?
    - She reports she has definitely made up her mind to go Reserve Component when /lifestyle/culture enjoyable at all. She thought she could learn to appreciate it the Army lifestyle, and wants to serve, but the structure is so different from what she wants in life that she doesn't think she can possibly go Active.
    - She asked me to help research for her what it would take to transfer back to her home city to finish college there. Though she loved this college when she visited as a HS senior, she has never taken to it. It seems like a foreign country to her. She's never felt socially alive there.

    Late September:
    - She reports that the thought of being continually evaluated for performance in ROTC and later in the Army just seems like death to her.
    -She reports she wants to drop ROTC for two reasons: 1) it causes her a tremendous amount of stress, and 2) she just plain hates it. She says she no longer has any desire to work in Military Intelligence, in Foreign Service, or in the CIA, etc. and in fact doesn't have the slightest idea what she DOES want to do in life.. I guess you could call it a midlife crisis, but in college. I don't know if she would even know if she still had those desires until she were able to get control of her anxiety and depression, by some method.
    - I suggested she see a Psychologist to speak to an impartial person about all these things -- failing Physics, anxiety about being evaluated, depression about her general place in life. I found three names who are providers on my company's insurance, and found one who had an opening this past Monday. She visited him.
    - She called to report the Psychologist said she should seriously consider dropping ROTC for her own mental health. The Psychologist sad she has either moderate or major depression, not sure which. She did tell him about the very large financial obligation she would incur if she dropped ROTC, so he is aware of that. Mind you he didn't "recommend" she drop, but in her mind, he told her to seriously consider it, and she did. She wants to drop.
    - She is worried about failing the APFT, the officially recorded one that is part of the OMS, given next week.


    So the real question is – does she have too much anxiety to properly function in life, in ROTC, and then in Reserves (her recent thinking)? Is she medically disqualified as I type?

    If she is able to work through her anxiety and depression either with non-medical techniques (therapy, yoga, etc.), would she want to stay in ROTC b/c rid of extra-normal amounts of anxiety, she might get satisfaction from it? I don’t know the answer to that, because she is in the midst of her anxiety and depression.

    Financial impact if she drops ROTC now:

    OK, so by my reckoning, if her Cadre or CC decide she owes the financial obligation referenced in her ROTC Scholarship Cadet Contract, she would owe the Army $68,000 in repayment obligation through this 5th semester, and it would cost her an additional approx. $45,000 ($20,000 from Direct Loans plus $25,000 from PLUS loans) to continue at this college and graduate. This is compared to $0.00 (her school scholarship pays for Room/Board) if she doesn't drop.. That's an obligation of $117,000 -- that she doesn't have.

    So, if she stays in ROTC, she graduates debt free, goes Reserves, and will need to find a job. But not a lot of pressure because she will be debt free.

    She has absolutely no clue how that amount of unforgiveable debt -- $117,000 (you cannot declare for bankruptcy relief) would limit her choices of career and recreation for the next 20 years. She wouldn't even be able to consider a job paying less than 60,000 per year, so that rules out school teaching, relief work, church work, administrative assistant work, or any other job paying less than.... get this... $70,000 per year. No vacations. No expensive trips to visit friends. Share a 1 bedroom apartment. Keep repairing her 9 year old car, etc. No possibility of masters level work, which is expensive and typically not funded like PhD work is. She would basically be in a straight jacket that allowed for no more than very hard work, and little play, with no other options, for at least 10 years. Nose to the grindstone. She would almost be like an indentured servant from midieval days for the next ten years.

    I found a loan calculator online, and the monthly payment for a 10 year loan at 7.9% interest on the PLUS, 5.9% on the Direct and 0.2% on the Army payback would be $1,108 per month. For 20 years on the Student Loans, but still 10 yrs. on the Army payback, it would be $1,029 per month for the first ten years, then $536 per month for years 10-20.
    First, I think the odds of her finding a job that pays more than $50,000 per month as a Life Sciences major is about... 10%? The odds of a job paying $70,000 are about.. maybe 2% as a Life Sciences major.

    At $50,000 per year income, minus benefit deductions, minus Fed Benefit taxes, minus State and Federal Income taxes, and a modest lifestyle in any larger city (where sharing a one bedroom apt. would cost her $800 rent), she would be $950 per month short each month in being able to pay that $1,108 montly loan payment.

    She is in a world of hurt either way if she cannot correct the anxiety and depression: if she drops ROTC, she is financially strapped for the next 10, or maybe 20 years. If she continues in ROTC still being anxious and depressed, it would be, in her current state of (unhealthy) mind, like working on the chain gang pounding in railroad spikes for the next 18 months in ROTC, and then being trapped by the monthly and 15 day summer training obligation for Reserves. Then there is obviously the very real chance she would be transferred to Active in the event of a fast buildup in Korea, or somewhere else.

    If she is not able to figure out how to work out of her anxiety and depression, nobody wins, especially her. By dropping ROTC because of her aversion to stress, the Army loses a high performing cadet with a valuable major. She loses financial freedom for 20 years. Most importantly, she loses the ability to enjoy life the way most people do, and make the most of her opportunities. We as parents would suffer with her, and lose some financial security in our retirement if we attempt to help her relieve the debt she will have incurred by dropping.

    I don’t think this is mostly about ROTC at all… or failing Physics. Or being in the hardest class in her major too early. Those are all just symptoms of the root cause -- being anxious and depressed, and not at this time being able to handle stressful situations.

    Though her unhappiness is not, in my view, mostly about ROTC, it is possible that dropping is the best way for her to work her way back to some sort of mental health. And yet that creates 10-20 years of financial stress in itself. At this point it may be beyond choice... she must report to Cadre that she visited a Psychologist and he diagnosed her as depressed.
     
    Last edited: Oct 1, 2013
  19. sancontoa

    sancontoa Member

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    If you get a medical discharge from ROTC you don't have to pay the scholarship back. I personally know two cdts who got discharges their MS3 year and didn't pay anything back. I'm not a 100% sure you can get discharges for a mental illness but you do need a wavier to be on antidepressants and can't enlist if you're on them. I would seriously advise your daughter to get help and if she gets kicked out for it she can try to get a medical discharge. She should go talk to her cadre about her options.
     
  20. kinnem

    kinnem Moderator

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    Some random thoughts which I definitely hesitate to call advice...
    1. Since dropping Physics would eliminate a stress-er in her life, and since she can still graduate on time, perhaps that is an immediate first step. It might help somewhat.
    2. I wonder if it would help her deal with ROTC if she was lead to realize that she will always be evaluated in life. I don't know of any job where you are not continually being evaluated. It may only come up for a formal review on an annual basis, but its there.
    3. It certainly sounds like it's not just ROTC that's the issue.
    4. I agree its financially undesirable to drop ROTC, but her health is the primary thing here. Nevertheless if she decides to do it, I don't think she should just drop ROTC. There are medical issues here that may alleviate the financial obligation. If she were to try to go that route I would suggest trying to tackle it that way. This would necessitate a full discussion with the cadre, which may be in order anyway. There may also be a way to get some temporary relief via this route? Just hoping that's the case. No knowledge one way or the other.
    5. I wonder if there is some way to rejigger her schedule to also drop the intense major course that is causing some anxiety. Perhaps it could be taken over the summer or at some other time when the course load was a little easier.
    6. How is her sleep schedule and does she have difficulty sleeping? It can be a factor in severe stress either as a cause or an effect.
    7. Some anxiety and stress can be beneficial as a motivator, but it sounds like there is too much here at present.

    This is certainly not an easy thing to deal with. I think you're fortunate that she seems so open about discussing all this with you rather than just dealing with it on her own. The money is nothing compared to her health. I hope you all are able to work this through to some satisfactory resolution. Your daughter will certainly be in my prayers.
     

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