Mind & Body

Several times I have mentioned I am back to teaching the emotional regulation module for DBT. We have a great class and I love teaching. This is one of the directions I hope to go in when I am no longer able to do psychological testing. Teaching is easier on the eyes. Hope for the best.

Plan for the worst and planning for the worst includes finding rewarding things to do ‘after’. Do not leave yourself without viable options.

Anyway, getting off the soapbox and getting behind the lectern…I started on the topic of sensing today. Many of you may remember back when people talked about the mind/body dichotomy. Back in 16-something or other the philosopher Rene Descartes proposed a theory that said mind and body are so very different there was no way they could truly interact.

Old Rene had a very good run but back in the 1990s scientists were discovering mind and body are not distinct at all! In fact, there is an elegant feedback system between mind and body. Enter the concept of sensing.

Marsha Linehan refers to sensing as being aware of your body and brain changes. Sensing body and brain changes is experiencing emotions. Why is that? Because Linehan believes emotions are actually changes in your brain and your body.

Linehan includes sensing as a way of identifying emotion. As a way of identifying emotion it works well. At least one study has shown emotional reactions are hard-wired and people all over the world say they experience the same emotions in their bodies in the same way. Have a certain set of bodily sensations and you can usually name the emotion that goes with them.

Linehan also suggests being an observer of yourself. Notice how your postures and mannerisms express your emotions, often without you even being aware.

Ever have an obstinate three-year-old in your presence? Did he cross his arms and hunch his shoulders? He was defending and no one was changing his mind!

But you know what is wonderful about postures? They can be changed and by changing postures emotions can be changed.

DBT – as well as many other sources, see Amy Cuddy’s TED talk about how your body language shapes who you are – believes one of the ways we can influence our emotions is by altering our body language. It is sort of a postural opposite to emotion. Find yourself slumping? Sit up! Find yourself in a closed posture? Open up! An act as simple as sitting up in your chair can improve your feelings of personal power. Uncrossing your arms can make you more willing to listen to a different point of view. It is magic in a little postural adjustment. Cool.

People ask what they can do to improve their moods when they are depressed over their diagnosis. I recommend education, support groups, therapy, exercise, etc. But if all that seems too much? Sit up! Like I said, there is magic in a little bit of postural adjustment. Be your own magician. It works. Continue reading “Mind & Body”

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Counting Pennies

Greetings from the lunatic fringe…Or not. Which is sort of the theme of this page. To quote a corruption of an old poem: if you can keep your head when all around you are losing theirs….maybe you don’t understand the situation!

What I am trying to say is, life can be crazy! When you are dependent upon others, other people’s late meetings and dead batteries can all make life, well, very interesting. Crazier, in fact.

Yesterday my usual ride from work was staying late. Unless I found another ride, I was staying late. Staying late meant no weekly walk with a friend and no yoga. Went to backup ride. First problem solved.

Then I get a text from my ride home from yoga. Dead battery. The weather has been brutally cold. After some finagling, I actually ended up with three potential rides home (I love my fitness community!) and I was still able to go to yoga. But that is not the story for the page. The story for the page is this: I did not stress out!

How the devil did THAT happen? Gulf Bend Center published a webpage entitled The Four Stages of a Stress Reaction. It is sort of like the diagram we use in DBT to discuss identifying emotions. The first step is what DBT calls the prompting event (also called trigger) and the article calls the demand. You folks know all about demands. In this case my prompting event (demand) was being faced with no evening activities.

DBT calls the next step interpretation and the article calls it ‘appraisal of the demand’. Appraisal has two parts. First you determine if the demand is a threat and then you decide if you have the resources to meet it. These questions are the crux of the matter.

Was it a threat? Yes, but I would only miss one evening of activities. I might be able to do half. That is walk, but no yoga. This variation in my schedule was uncomfortable but not a crisis. I used a comparison skill (could be worse!), reframed and did not catastrophize. That is half the battle.

The other half was my estimation of my resources. Would I be able to meet the demands? Hey, the girl has people! People for whom I am grateful everyday. I could most likely meet the demand. A few months ago I would not have been able to say that, but I have been actively working on developing plans and backup plans for months now.

I had confidence things could be worked out.

Otherwise? I would have bitten the bullet and looked at all of the positives I have collected. This is another DBT skill. Collect positive experiences like pennies in a piggy bank. If things turn to crap, counting your ‘pennies’ can help you realize there is a lot of good in your life. I don’t know about you, but in the positive ‘pennies’ department, I am a millionaire. (Did I mention I know fantastic people?)

The article goes on to discuss the physiological reactions we experience to threats, responses to the demands and a ‘bonus’ item (the title really said 4), returning to baseline. DBT emotional regulations talks about bodily reactions and action urges, so, like I said, they have their parallels.

My opinion remains the second section, interpretation of the level of threat and the strength of your resources to deal with that threat, is still the most important part of the whole thing. Use your skills to compare and reframe. Count your positive ‘pennies’ and amass your resources. It may allow you to understand the situation totally and still keep your head. Make all those other people wonder what your secret is!

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Permission to Feel

Life is crazy and destined to get crazier. We have had a therapist leave the practice unexpectedly. Everyone is being asked to take up some of the slack. It seems as if every kid who is in the school is on my list to be seen. Today I got lunch at 3:30. I was ‘flying’ by the end of the day. I guess it is a good thing I start teaching emotional regulation soon!

Emotional regulation involves keeping your balance when everyone else is losing his. I have read emotional regulation is the ability to respond to the ongoing demands of experience within a range of emotions in a manner that is socially tolerable and sufficiently flexible to permit spontaneous reactions as well as the ability to delay spontaneous reactions as needed.

Whoa. That was a mouthful.

First of all, I stole that but I have no idea where I got it. If it belongs to you, let me know and I will give you credit.

Second of all, what the hey does it mean? We shall begin at the beginning…

  • …Ability to respond to the ongoing demands of experience… When something happens in life, can you do something about it? What is your reaction? We are ‘allowed’ to respond to what happens to us, good and bad.
  • …With the range of emotion. Emotional regulation does not mean we don’t feel. It does not mean there are emotions that are ‘bad’ and we are not supposed to feel. The full range of emotions is acceptable. We are also allowed to express all emotions as well as feel them.
  • …In a manner that is socially tolerable. In a nutshell there are ways to express emotion and ways not to do it. We are not going to do ourselves any good if we become so expressive we alienate people.
  • …Sufficiently flexible to permit spontaneous reactions. We are not so controlled we cannot react with spontaneity. Emotional regulation does not mean we are robots and have to follow a script.
  • …The ability to delay spontaneous reactions as needed. Let’s face it: there are appropriate and inappropriate times to express ourselves. It is not all about us and how we are feeling. Sometimes our moment comes later.

So what does this have to do with AMD? Many of you – like me – have had a pretty significant emotional reaction to your AMD diagnosis. We are ‘allowed’ to express the full range of emotions about that.

Don’t listen to those who say you should not feel what you are feeling. Don’t tell yourself it is wrong to have an emotion. All emotions are acceptable.

The amendment to that is your expression of emotion should not be so intense you act in socially unacceptable ways. Other people have their rights and this includes the right not to have to deal with someone who is crazy out of control. Like I said before, alienating people is counterproductive especially when you are looking for social support.

Lastly, we want to be able to respond to our emotions both positive and negative. However we do not want to be seen as drama queens always hogging the limelight. Other people have their needs. Some of them may be more urgent than ours.

So that is the thinking behind emotional regulation. To summarize: all emotions are acceptable. There are no wrong emotions. We are ‘allowed’ to experience emotions but should try to regulate their expression. Overburdening or abusing others with emotional expression – read freaking out, if you will – is not appropriate. It is also not helpful.

And that is my intro to emotional regulation. I start again in the classroom next week so I may add more…or not. ::grin::

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Grandma’s Reindeer

This time next week I am supposed to be on a plane to Reykjavik. First thing I want you to notice is in the last week I have learned how to spell Reykjavik correctly. The second thing I want you to note is in real-time it is the end of August and Iceland just had two reasonably substantial earthquakes ….and they expect a volcanic eruption in the near future.

My husband thinks this is utterly cool. He would like a front seat to an apocalypse. I would like to see an eruption as long as nothing gets hurt. You know, like in a movie: no animals were killed or injured in the making of this extravaganza.

With my luck, I will be in the way when the caribou decide to make a mad dash for it. You know the song about Grandma getting run over by a reindeer? Yep. That would be me.

Besides thinking about living a bad Christmas song, I have been thinking about everything that has to be done before I leave. I have work to finish at two places of employment. I need to go to the pharmacy and the bank. The list of things I want to see in Iceland is only half done. Packing has hardly been given a thought, etc, etc.

It is enough to make a girl crawl into a fetal position in the corner and hyperventilate….which reminded me. I told you I had had panic attacks when this mess first started but we never really talked about the ‘delightful’ things. According to the Mayo Clinic a panic attack is a sudden episode of intense fear that triggers severe physical reactions. They happen in the absence of any obvious danger and often come “out of the blue”. There is no good theory for why some people have panic attacks and others don’t. There are theories about genetics and temperament. Major life changes, stress or trauma can put you at risk for panic attacks.

I never had one until I started to lose my vision. Then I had a time I was having four or five a day. Symptoms included a lot of autonomic nervous system stuff like rapid heart rate and hyperventilating not to mention the feeling of impending doom and fear. Like I said, ‘delightful’.

I treated mine with good drugs. If you are having panic attacks, run, don’t walk to your doctor for anxiety medication. Many of you won’t need to be on the medication for the rest of your lives and, if you do, so what? It is better than waking up screaming three and four times a night like I was.

Other treatments? Psychotherapy is helpful. The emotional regulation component of DBT, including all aspects of physical regulation, is useful. Remember to stay active and try to get enough sleep. The ubiquitous mindfulness meditation is also beneficial.

And speaking of sleep, it is time for me to toddle off to bed. I got a lot done today and have a lot to do. Still, all things in moderation. If I pace myself, I can get it done.

Oh, and the volcanic eruption and the reindeer and all that? No sense worrying about the future. It distracts you from the now. The volcano will erupt if it chooses, but if it doesn’t? My husband will be really disappointed.

written 8/31/2016

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Pecked to Death by Ducks

As I posted a few pages ago, I am back to work a few days a week. I had naively hoped that everything would be good and everyone would be in my corner. Note the word ‘naively’.

I am not the me who was doing this job several weeks ago. Remember the woman who was able to see what she was doing? I have made some dumb mistakes I never would have made if I were still totally sighted. It’s damnably frustrating, not to mention embarrassing. While I have a steep learning curve and have vowed not to make those particular mistakes again, I anticipate I will be making other mistakes and facing other challenges.

I have made some dumb mistakes that are frustrating and embarrassing.

Locally, people are great. My coworkers are supportive.  My bosses are good. Just a little scared they may have taken back someone who will not be able to do her job. News flash: there are times I am afraid of exactly the same thing. My Blindness and Visual Services (BVS) and low vision people rock. I have all sorts of cool toys to help me. For a government agency, BVS is moving at the speed of light to get me set up with what I need. No complaints locally.

Local people and services are great!

I have contacted two large publishing houses about my need for some things in digital format. You can enlarge things when they are on your tablet, don’t you know. What I thought was going to be a simple “Hey, help me out here” seems like it is turning into a corporate run-around. They keep suggesting I purchase digital versions of materials that are, in some cases, not even on the market yet. And what, pray tell, am I supposed to do about serving my clients in the meantime? Good customer here! Cut me a break.

I’m a good customer of 2 large publishing houses and yet they want me to purchase digital materials that they should be happy to supply me with for free.

But screaming about – and at – people who don’t get a good deed is not only good for the soul but also good for business and that is probably the topic for another post. Right now I want to go back to DBT and talk about how I can get through the frustration without blowing a fuse.

DBT has some skills for improving the moment. These skills are good for getting through the rough patches when you are down or frustrated and there is not a great deal you can do about fixing things at that time. Conveniently, they are called – acronym alert here – IMPROVE skills.

DBT has skills that will help me deal with frustration without blowing a fuse.

I is for imagery. Imagine yourself someplace calm and peaceful. Take your mind on vacation somewhere you felt wonderful. Go back to that safe place where nothing ever hurt you. These places do not have to be real anywhere but in your head. My favorite place got washed away in a flood in 2004. Just the same it still exists in my head. I can go back to the ol’ swimmin’ hole any time I want as long as it is in my mind.

Imagine yourself someplace calm and peaceful even if it is not anywhere real.

M is for meaning. Viktor Frankl was a German Jew. During his time in several of the Nazi death camps, Frankl, a neurologist and a psychiatrist, spent his time ministering to his fellow prisoners. He had a purpose and a meaning to his life. Frankl also discovered the prisoners who did the best and were able to survive the camps were those who had a purpose and saw their lives as having meaning. Frankl said that people who have a ‘why’ can survive any ‘how’.

Perhaps there is meaning to your life, meaning to what is happening to you. A meaning I put to my life, my disease, is believing I will get into the clinical trials and help to find a cure for AMD. What is your purpose? Find your ‘why’ and you will more easily endure the ‘how’.

I have found a purpose to my life with the disease…what is yours?

P is for prayer. Some of you have a strong faith and some do not. It has been said there are no atheists in a fox hole. Therefore I will assume that, no matter what your religious beliefs, many of you pray.

The Serenity Prayer is nice. So is the 21st Psalm if you are of a Judeo-Christian faith or even if you are not. The Prayer of St. Francis is also good (“Lord, make me an instrument of thy peace…”). You can make one up. It is up to you.

Prayers are basically of three forms: “HELP!”, “thanks” and “nice job”. When I am in troubled times, such as now, I use the “HELP!” type of prayer a lot. However, “thanks” and “nice job” prayers are good because they remind you of what all is going right. Thanks and praise allow us to realize we have accumulated many positives. They have just been forgotten in the face of a crisis. Remember Accumulating Positives is an Emotional Regulation Skill.

There are wonderful prayers out there.  You can even make one up.

R is for relaxation. Relaxation can be anything from a massage to a hot bath to meditation or any one of hundreds of other things. What relaxes you? Indulge. Just make sure it is not a habit that will eventually be hurtful to you.

What relaxes you?

O is for one thing at a time. I adopted an expression many years ago, not even sure where I first heard it, but the expression is ‘being pecked to death by ducks’. What it means is you are being assaulted by a dozen little things at one time and you feel as if you are succumbing to the cumulative effect of the onslaught.

Some days we are just being ‘pecked to death by ducks’. We spin from peck to peck and never actually deal with any one of them. DBT says to deal with one of those unfriendly fowl at a time. You cannot fight a war on too many fronts. Decide where to put your resources and win that battle first. Then go on to the next battle.

What do you do when you are being ‘pecked to death by ducks’?

V is for vacation. Vacation, unfortunately, does not always involve flying to some sun-drenched beach in the tropics. In DBT terms a vacation can be as simple as drawing a hot bath and locking the bathroom door. Hang a sign: “I am not available to deal with any crises for the next 20 minutes. Please check back later.” Remember, as much as we wish it would be, DBT vacations are not running away to Bora Bora and making a living beach combing. They are short and assume we will get back to dealing with things within a minimum of 24 hours or so.

Finally, the E is for encouragement. Get out those pom poms and cheer your favorite player – yourself. Be the Little Engine That Could. Celebrate your progress.  Remember it is important to acknowledge how far you have come. Praise yourself for still being in the fight. Be in your own corner.

Be the Little Engine That Could.

Those, quickly, are the IMPROVE skills from DBT. They are used when there is nothing else you are able to do that moment to solve the problem. You use them when either circumstances are not right or you don’t have the energy to deal for another minute or when you are overwhelmed with the chaos. I hope you find them helpful Continue reading “Pecked to Death by Ducks”

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A Tutu and A Tiara

I would like to go back a day or so in time but continue on the topic of DBT Emotional Regulation Skills. Needless to say, finding out my AMD had progressed that quickly and I would have to redefine myself as a visually impaired person was not fun. It was downright depressing and we have already addressed the lovely panic attacks that have been – and actually continue to be – enveloping me at odd moments. Saying that I was in a state would be an understatement. My husband said that I cried more than I had cried in all the previous 25 years of our marriage. So, in that state, why in the name of heaven am I wearing a blue tulle tutu and a paper tiara? The answer is: it was Marcy’s birthday. We had been planning a party in Zumba class.

I had cried more than I had cried in all the previous 25 years of our marriage.

Could I have stayed home and cried? Of course.  Part of me wanted to and no one would have faulted me. I had drawn the bad card and it was understandable if I had crawled into my shell for a while, even a long while.  The problem was that it was Marcy’s birthday and I had a tutu and tiara waiting for me. I was supposed to be in my usual place dancing.  The problem also was that I had to do something to challenge my mood or I would have been a long time crawling out of my hole.

It was Marcy’s birthday and I had a tutu and tiara waiting for me.

DBT has a technique called Opposite to Emotion. It is just what it sounds like. If you have an unhealthy emotion, act in the way you would act if you were having the opposite emotion. Behavior follows emotion but emotion also follows behavior. Not a new concept, Ignatius Loyola said something about performing the acts of faith and faith will follow. In other words: fake it until you make it.

Opposite to Emotion boils down to fake it until you make it.

So, for one hour, I acted as if all was right in my world. I dressed up. I danced. I laughed. And for that hour I felt better.

Please note I said for that one hour. It is all right that it did not last forever. It is all right if I went back to being distressed. For that one hour I was improving my mood and fighting the downward spiral that could have led to more problems, such as a serious depression. Maybe I could do it another hour another time.  Behavior follows emotions but emotions also follow behavior. Fake it until you make it. Put on your tutu and your tiara and dance.

Put on your tutu and your tiara and dance.

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Teacher, Teach Thyself

Do I need to even say that I was distraught? I had been struggling at work for days.   I had been lately having panic attacks. Now I knew why but knowing why had not really helped.

One thing I knew was that I had to take a leave of absence from my employment. Tearfully, I sat in the hallway at the ophthalmologist’s office and called my employers. It was not fair to my clients to do a poor job. It was not me to do a poor job. The only option was to hang it up for a while.

It was not me to do a poor job. I had to hang it up for a while.

That weekend I continued with the panic attacks in earnest. I was waking up hyperventilating with my pulse racing. I felt as if I had a rock in the pit of my stomach. This is what dread feels like.

For the past two years, I have had the opportunity to teach the educational components of Dialectical Behavioral Therapy (DBT). Just by chance, the unit I was teaching was Emotional Regulation. If anyone needed emotional regulation at that time it was me. Teacher, teach thyself.

I will go into some of the tenets and strategies more in-depth later on in my postings. Suffice it to say now, I needed to use the first of the PLEASE strategies (PLEASE is an acronym that I’ll explain below) for dealing with Emotional Regulation—the strategy is taking care of physical illness (that’s the P).

The P in PLEASE stands for taking care of physical illness.

I was in my general practitioner’s office that Monday morning. I was totally worked up. I have been up with panic attacks at least three times the night before and I was using over-the-counter sleep medication to get any rest at all. Even worse, my blood pressure was up to 182/ 81. I think this was my personal best!

After listening to my tale of woe – about going blind, taking a leave from work, not being able to drive, and, on top of everything, having my mother-in-law in intensive care – my general practitioner prescribed psychotropic medication to help me deal with my anxiety.

DBT stresses that you have to take care of physical illness in order to deal with emotional distress. I am not a big believer in medication but having a stroke was not going to help the situation.

I accepted that I needed the prescribed medication to help control my panic.

The S in PLEASE is sleep. I wasn’t doing a lot of that but I needed to. I had never given it a lot of thought but, take it from me, losing your vision is exhausting. The emotional stress of losing your vision is exhausting.  That is one thing but just trying to SEE is another. It has been taking me three and four times as long to do basic tasks like reading my mail. I have a reputation for being a high-energy-and-always-on the-go woman. It amazes me that in the last few weeks I have started taking naps.

The S in PLEASE stands for sleep.

The first E in PLEASE is proper eating. One does not eat well when she is in crisis. In fight or flight mode, the digestive process is shutdown so the blood can go to the limbs. Before I started on my medication, I had no appetite and when I did eat, it sat undigested.

The problems with being in fight or flight mode were two: first this was not some short-term problem. This crisis was going to last for a while. And two, what was I going to fight? Where was I going to flee? Better to interrupt the process so I could get proper nutrition. After all, every army marches on its stomach and this was going to be a protracted campaign.

The E in PLEASE stands for proper eating.

For you curious sorts who wonder what the A and the second E are (the L is part of the word Physical; I did not forget it), I will inform you. The A is to avoid mood- and mind-altering drugs. That has never been one of my problems, but it might be a problem for some of you. Remember that drugs and alcohol work in the short run but in the long run, your problems are still there and often worse. Escaping with drugs and alcohol is not going to allow you to learn skills to deal with you problems and they certainly will do nothing for your Macular Degeneration. End of lecture.

The A in PLEASE is for avoiding mood- and mind-altering drugs. Not one of my problems but I’m informing you of it.

The E is one of my favorite things in the whole, wide world…exercise! A little autobiographical note here. I have, in at least one aspect, lived my life backwards. I was an intellectual in high school and college. Never did any physical exercise that I was not absolutely obliged to do. That changed when I was in my mid 20s and discovered STRESS. The one thing that helped to relax me and let me sleep was exercise and I was born again. It is true there is no greater zealot than a convert. I will witness to you any time you like. I may also witness to you when you don’t like.

The E in PLEASE is for exercise which is one of my favorite things in the whole, wide world.

So, be that as it may, this time of the year, I generally take Zumba, hip hop, yoga and walk. Exercise is an amazing stress reliever and great for calming crazy emotions when you are in crisis. Even though my vision had gone to serious crap, I continued my classes. I have had to. Friends and my exercise have been my life lines.

When some people hear that I am legally blind in one eye and nearly legally blind in the other, they assume I cannot dance any more. Not the case at all. Macular Degeneration affects your central vision. If I concentrate on looking at something off-center of the instructor, I can see the moves with my peripheral vision just fine.

Even though my vision had gone to crap, I continued my exercise classes.

People also think I am not able to navigate on a walk. That’s not true either. Keeping my head up and focusing on a spot a bit beyond where I am walking, I can see what is at my feet. The peripheral vision is still there.

When I walk, I can use peripheral vision.

Then there is yoga. Sorry all of you exercise haters, but totally blind people do yoga. ‘My’ yogini is hands on and will physically correct your alignment, etc. I have worked with another yogini who is about 100 pounds and will literally climb on you! Yoga is great for flexibility, balance, strength and even endurance and can be done by people of all ages. Yeah for yoga!

Totally blind people do yoga. Yeah for yoga!

So, trying to keep myself from being a screaming, crying basket case, I practiced what I was preaching and used the PLEASE skills from Marsha Linehan’s Dialectic Behavioral Therapy.

I also used ABC and Master from DBT. A is accumulate positives; I got out there and had fun. I walked to the park with my yoga instructor and her two daughters. I contacted a friend and went to a blues concert. These may have been just pleasant interludes that don’t do anything to help my eyes but they helped my soul.

The A in ABC means accumulate positives. I got out there and had fun.

B is for building mastery. My job is very visually demanding. I never realized how often I needed to use my eyes. My vision was there and taken for granted. Yesterday I tried to do something I have done thousands of times over the last 38 years. It was a debacle. I cried whatever is left of my eyes out. Tried again today and it was better.

Also today, I started to use Siri on my iPad for my searches. She found something I was wondering about. Minor triumphs matter and I am trying to celebrate them.

The B in ABC means build mastery.  I started to use Siri for my searches.

The C is for cope ahead. Basically this is a positive imagery technique. What do I imagine? I see me lecturing on Macular Degeneration to Lion’s Clubs and other civic organizations. This is, of course, after I have become the most successful lab rat in the history of Wills Eye Hospital and have written a website that is turned into a best seller for people who are suffering from AMD. There IS life after your macula does a mass extinction worthy of the Jurassic period or whenever the dinosaurs ceased to be.

The C in ABC is for cope ahead which is a positive imagery technique. I imagine myself the most successful lab rat in the history of Wills Eye Hospital.

Do these strategies always work? Hell no. I want to be back at work. I want to drive. I want to read a paperback mystery cover-to-cover in a weekend like I used to. Screaming and crying, frustration and disgust have been part of my life recently and I suspect they will continue to visit. The skills may not be 100% effective but I will take all of the help I can get at this point.

Do these always work? Hell no, but I will take all the help I can get at this point.

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