WebSUDAFED Congestion and SUDAFED PE Congestion are immediate release products that may be crushed to allow for easier administration. WebSome people have found relief from sinuses from adderall for this reason, it shrinks the blood vessels or whatever, similar mechanism of action, but sudafed is obviously way less stimulating. These are 10 of the common supplements we ask patients to skip at least seven days before surgery: Please note that this is not an all-encompassing list of supplements to avoid prior to surgery. WebPlease review all your medications-both over the counter and prescription drugs-with your surgeon. Before taking Sudafed, it is better to try non-medicine measures, Unlike prescription and over-the-counter medications, herbal and dietary supplements arent as heavily regulated by the U.S. Food and Drug Administration (FDA). WebSerious Interactions. 0000000790 00000 n xref Tolmetin (Tolectin), Aspirin (present in many medications) Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. Coumadin discuss this with the prescriber as to the best time to stop this medication before surgery. Aka: Preoperative Guidelines for Medications Prior to Surgery, Preoperative Fasting Recommendation, Nothing by Mouth Prior to Surgery Guideline, Perioperative NPO Guidelines, Perioperative Medication Guidelines, Medication Management in the Perioperative Period, Medications to Avoid Prior to Surgery, These images are a random sampling from a Bing search on the term "Preoperative Guidelines for Medications Prior to Surgery." 6b Amelia Drive Prevention, Aging; Zaydfudim VM, Hu Y, Adams RB. Medications that increase the chances that you will bleed excessively after surgery include: Aspirin, enteric-coated, baby, and plain aspirin or any other product containing aspirin. For this reason, it is generally recommended to withhold certain drugs if you are scheduled to have one of these procedures performed. F: 33 2 days: 1X D 11/11/2020 Email: 1: Congestion: Throat swelling Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight lossfrom exercises to build a stronger core to advice on treating cataracts. Best of luck, Soc. Prevention, Men's Health; Every Plastic Surgeon has his own pre operative instructions. Contact his office for verification. All too often, people think their colds are getting worse, so they increase their use of nasal spray, leading to a downward spiral of more medication use and worsening congestion. Cilostazol (Pletal) 6th Floor, Suites A & B; 12th Floor, Suite A Clopidogrel (Plavix) Prostate cancer: How often should men on active surveillance be evaluated? If you have severe heart problems you may need to consult with your heart specialist to determine if it is safe to stop it. Michael Schuh, Pharm.D., R.Ph., Pharmacy, Mayo Clinic, Jacksonville, Florida. If your congestion is not relieved after taking Sudafed PE for 7-10 days, call your doctor. Dax Guenther, MD: Coastal Plastic Surgery night before surgery. Your Pre-Surgical Testing Clinic appointment will revolve around your personal preparation plan. But a few days before should not present a problem. Our team is made up of experts and leaders in the art and science of plastic surgery. Also, if I stop it now, will there be an issue since I've taken it within the 2 weeks before surgery? Principles of preoperative and operative surgery. Low Molecular Weight Heparins (Fragmin, Lovenox, Danaparoid) Depending on the type of surgery you're having, follow any further advice from your health care provider. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. After surgery you should avoid all anti-inflammatory medications including ibuprofen (Advil, Motrin) and Naprosyn (Aleve) and any other prescription anti-inflammatories, unless your surgeon prescribes them. He/shehas developed protocols which has served their patients well and best not to divert from these. In addition, common energy drinks can contain caffeine or other stimulants, and may contain herbal supplements that interact with decongestants and worsen some medical conditions or increase side effect risk. 0000001820 00000 n But if youre planning to have surgery, you may need to take a break from some supplements and medications that can interfere with anesthesia. What you are describing is a very common occurrence for women when they have children, and one in which surgery can do a great job to address. NPO), Stopping before orthopedic procedures (esp. 21st ed. What do I do? All rights reserved. It especially holds true if youre planning elective surgery during the fall or winter, when co-workers, family, and friends are more likely to get sick. %%EOF is among the first to achieve this important distinction for online health information and services. Of course, with some medications, stopping would be unsafe. Because you wont be eating on the day of surgery, we may ask you to hold or decrease many of these medications. Town and Country, MO 63017, 14532 S. Outer Forty Drive Phone: (781) 740-7840 Sudafed Congestion Adults and children 12 years and older: Take two tablets every four to six hours. However, you should contact your doctor if you have: Post-nasal drip is among the most common causes of persistent cough, hoarseness, sore throat and other annoying symptoms. Surgical complications could include heart or bleeding problems, prolonged anesthesia effects, or increased blood pressure. That's the bad news. xbb``b``3Y The way to reverse rebound rhinitis is to stop the nasal spray in one nostril until that nostril is clear, then stop it in the other nostril and that nostril should clear, as well. Fenoprofen (Nalfon) Taking care of a few last-minute details can help make your surgery successful. In no case should you medicate yourself with any drugs (even if they are not listed here) without the knowledge of your primary care physician and your surgeon. If you need emergency surgery, keeping a current medication list might save your life. 2023 by The President and Fellows of Harvard College, Do not sell my personal information | Privacy Policy. Make sure you write down the dose and how often you take them. , View all posts by Robert H. Shmerling, MD, A humidifier or steam inhalation (as during a hot shower), Keeping well-hydrated (to keep the mucus thinner), Sleep on propped up pillows, to keep the mucus from collecting at the back of your throat, Nasal irrigation (available over-the-counter), An oral decongestant, such as pseudoephedrine (as in Sudafed) or phenylephrine (as in Sudafed PE or Neo-Synephrine), Guaifenesin (as in Mucinex), a medication that can thin the mucus, A nasal decongestant such as oxymetazoline (contained in Afrin) which constricts blood vessels in the nasal passages; this leads to less secretions. Additionally, patients who smoke need to stop at least 4 weeks before surgery (something thats required for all patients year-round). After undergoing a CT scan, her doctor diagnosed her with DEAR MAYO CLINIC:I recently read that thyroid issues affect women more often than men. Prevention, Diet and Nutrition; Suite 200 URL of this page: //medlineplus.gov/ency/patientinstructions/000371.htm. Naproxen (Naprosyn, Naprelan, Anaprox, Aleve) Each patient and surgery is unique. Mayo Clinic Q and A: What is cholangiocarcinoma and how is it treated? In general it is best not to take the day of or before surgery due to the ibuprofen and the pseudoephedrine. Your vision should gradually improve, but it may take up to six months or longer to regain your best vision. You can take Sudafed every 4 to 6 hours as needed, while Sudafed PE can be taken as often as every 4 hours. Thanks for visiting. Take this medication by mouth with or without food, usually every 4 to 6 hours, as directed by the product Phone: (781) 740-7840 Decongestants can interfere with the effectiveness of certain blood pressure, epilepsy, heart, diabetes or thyroid medications, but also may affect the chronic condition itself. 6b Amelia Drive For planned procedures, your doctor(s) will need the drug list to advise you what to stop and what not to stop. Use Pseudoephedrine (Sudafed) exactly as directed on the label, or as prescribed by your doctor. Worst 48 hours of my life. You will see the results immediately. Please refer to the product label for the appropriate dosing directions as well as the warnings prior to taking any medicine. Prevention; I still found the effects similar on the 12 hour version, I was wired for at least 16 hours (12 hours is just an estimate, it can take longer to clear). 0000001502 00000 n Meloxicam (Mobic) Dr. Guenther sees patients from Boston's South Shore and cities such as Cohasset, Scituate, Duxbury, Plymouth, Mashpee, Milton, and Brookline. Double vision can occur and will usually resolved over the first few days. Women's Health, Diet and Nutrition; The acetaminophen can add to the daily limit of this medication to cause liver toxicity, while antihistamines can add to urinary conditions, aggravate asthma or other lung conditions, and should not be taken by those with glaucoma. The combination of these two medicines is used to treat the nasal congestion (stuffy nose), sneezing, and runny nose caused by hay fever. Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing. In addition, using nonprescription decongestant nasal sprays for more than three or four days can cause worse nasal congestion once the decongestant wears off, a The ibuprofen and pseudoephedrine effects are minimal but best avoided in the immediate peri-operative period. Well discuss your health history, make a plan for pausing/resuming medications and supplements, and answer your questions about anesthesia. This list will make preparing for planned surgery easier, and it could help prevent serious bleeding or heart complications if you ever need emergency surgery. Please review all your medications-both over the counter and prescription drugs-with your surgeon. Hingham, MA 02043 It can be caused by a number of conditions and may linger for weeks or months. Blood thinners come in prescription and over-the-counter form: Certain psychiatric and weight loss medications can cause potentially harmful interactions with anesthetic medications. Ketamine for treatment-resistant depression: When and where is it safe? Talk with your doctor about all the supplements you take, so you can work together to reduce your risk of surgical complications. 0000002812 00000 n You should be aware, though, that the anesthetic may make your sore throat a little worse for a day or two. 0000003384 00000 n Heart; In many cases, your medication will have no effect on your surgery, and you be counseled to continue with your medication as usual, but your surgeon must be aware of what you are taking and all prescriptions should be documented in your medical record. on 3/8/13 9:00 pm - AL. What should you do if you wake up with a sore throat and runny nose before your scheduled surgery? apple juice), Not allowed as clear liquid: Milk, milk products or, No clear liquids within 2 hours of surgery, Includes orange juice, soda, infant formula and milk, No fried foods, fatty foods or meats within 8 hours of surgery, Exceptions - cardiovascular medications to stop, Risk of withdrawal when abruptly stopped perioperatively, Despite case reports of infection and delayed healing risks, Oral diabetes medications are typically held on the day of surgery (see below), Medications associated with bleeding risk, Short-acting agents: Stop 1 day before surgery, Mid-acting agents: Stop 3 days before surgery, Long-acting agents: Stop 10 days before surgery, Do not stop antiplatelet agents without carefully reviewing indications and minimum duration from stenting, Cardiology should be consulted before stopping P2Y agents in post-stenting patients, Stop at least 5 days before surgery if no contraindication to stopping, Stop at least 7 days before surgery if no contraindication to stopping, Restart 24 hours after procedure or per surgeons discretion, Patients with high thrombosis risk (e.g. WebFind patient medical information for Sudafed 24 Hour oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. These medications may interact and cause very harmful effects. It can happen for a number of reasons: allergies, viral infections (including the common cold), sinus infections, irritants in the air (such as fumes or dust). Robert H. Shmerling, MD, Learn more about A.D.A.M. If possible, bring your medicines in their containers. Etodolac (Lodine) MOAIs are used for Parkinsons disease, anxiety and depression. http://www.thomassenplasticsurgery.com Helpful 1 person These are medicines that make it harder for your blood to clot and could prolong bleeding during your surgery. If you have continued congestion, it may be time to visit your health care provider to explore treatment options that may be more effective. To learn more about our services, call 310-825-5510. Hope this helps. Suite 1500 One to two weeks before surgery, you may have been told to stop taking blood thinners. If you already have one of these conditions, especially if its not controlled, this may be a concern. Here are a few simple tips to help you avoid becoming ill: Additionally, patients who smoke need to stop at least 4 weeks before surgery (something thats required for all patients year-round). 0000002351 00000 n COVID-19: Vaccine Program | Testing |Visitor Guidelines | Information for EmployeesMONKEYPOX: UConn Health is NOT currently offering the monkeypox vaccine. This will depend on many factors including location. UT Southwestern patients who are planning for surgery get an extra layer of support through our Pre-Surgical Testing Clinic. Dax Guenther, MDRJ Miller Salon + Spa 2 Pond Park Road #308 The earlier we hear from patients about potential illness, the sooner we can determine whether surgery needs to be rescheduled. antihistamines (Benadryl, Claritin, Zyrtec, etc. ), do not consume them. Prior to surgery, you must take a blood test (a) for 24 hours. You should arrange for an adult to drive you to and from your surgery. What Drugs Should Be Stopped 7 Days Before Surgery? Shift work can harm sleep and health: What helps? In Boston, scheduling plastic surgery during the fall or winter can be convenient, but it also happens to be the time of year when people tend to get colds or the flu. Prevention, Appointment 0000000016 00000 n Suite 1E What kind of incisions or techniques leave the least amount of scarring in a breast lift? To use the sharing features on this page, please enable JavaScript. You have spent much time and energy going to appointments, preparing your home, and getting healthy. It is safe to take acetaminophen (Tylenol) before an endoscopy for arthritis pain or headaches. Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health, plus the latest advances in preventative medicine, diet and exercise, pain relief, blood pressure and cholesterol management, andmore. This includes no gum, mints or smoking. You may feel relieved or nervous at this point. The provider will do that at the hospital, if needed. A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). 0 My anesthesia staff and I allow our patients to take 24 hour Sudafed (pseudaphedrine) up to 48 hours prior to surgery. It will not affect bleeding, Nonsteroidal anti-inflammatory medications NSAIDs (generic name in italics): Diclofenac (Cataflam, Voltaren, Arthrotec) Energy-boosting coffee alternatives: What to know. The first day after surgery often the vision is worse because of eye medication or/and inflammation from surgery. Find a Location, Appointment You'll feel as though you're Leave jewelry and other valuables at home. The timing and the severity of the illness is important in making the decision to postpone a procedure, and patient safety is always my priority when I weigh the options. MondayFriday: 9 a.m.5 p.m. Whether its a few days or a few weeks before your scheduled surgery date, its a good idea to let us know and provide updates on your condition. DEAR MAYO CLINIC:Last winter, I slipped and fell shoveling snow. Do not take Sudafed for longer than 7 days in a row. Such medications should only be taken for a day or two; longer-term use can cause more harm than good), A nasal steroid spray (such as beclomethasone/Beconase or triamcinolone/Nasacort), Ipratropium (Atrovent) nasal spray which inhibits secretions (such as mucus). This site complies with the HONcode standard for trustworthy health information: verify here. While it is important to be healthy when you undergo elective surgery, a minor cold might not require rescheduling. Ibuprofen (Motrin, Advil, Motrin IB, Nuprin) The medications listed below (and potentially many others) may have an effect on your blood's ability to coagulate. Website Design & Marketing by Etna Interactive. 0000016298 00000 n Phone: (781) 740-7840 That said, many breast lift patients see very little scaring after the appropriate post operative healing period has passed. A.D.A.M. yes definitely find out before bowel prep. Stay on top of latest health news from Harvard Medical School. Important telephone numbers of friends and relatives. or 214-645-8300 Some of these medicines have to be stopped a few days before surgery. Suites 110 & 210 Dextromethorphan can interact with antidepressants. Other websites that I've read say not to. Examples of these drugs include but are not limited to: Take only the medicines your doctor has told you to take before surgery, including prescription medicines. Do not use Sudafed 12 Hour during pregnancy unless you consult a healthcare provider. In this blog post, Ill explain the guidelines we use for making decisions about whether to reschedule surgeries. Many products contain aspirin (ASA or acetylsalicylic acid) You may take a shower or bath both the night before and the morning of surgery. This medication is frequently used before and after surgery, particularly for itching caused by medications and healing incisions. Stockbyte / Getty Images Benadryl is a first-generation H1 receptor antagonist. Aesthetic Plastic Surgeons. If you were told to take any medicine on the morning of surgery, you may take them with a sip of water. Such medications should only be taken for a day or two; longer-term use can cause more harm than good) Keep in mind that many of these medications are Oral decongestants should never be taken with monoamine oxidase inhibitors (MOAIs) or within two weeks of stopping them. You may brush your teeth and rinse your mouth in the morning. ANSWER:While many people rely on nasal decongestants to help ease nasal symptoms of a cold or flu, these medications can sometimes cause more harm than good, especially if used improperly or taken by patients who shouldnt use them. In others cases, low-dose aspirin may be continued based on your medical condition. If you've been told that chicken soup helps with post-nasal drip (or other symptoms of a cold or flu), it's true! That being said, the parameters may change some with a patient's personal history (e.g. Pentoxifylline (Trental) Learn more about your rights and protections related to the No Surprises Act (HR133). Recommendations will vary from office to office. The ibuprofen and pseudoephedrine effects are minimal but best avoided in the immediate peri-opera St. Louis, MO 63129, 20 Progress Point Parkway, Suite 114 I took some this morning but now I'm concerned that I'm endangering myself. Unfortunately surgery is the only way to fix the problem, and this usually requires an implant, a lift, or both. The medicines, known as anesthetics, are given before and during surgery or other medical procedures. In many cases, your medication will have no effect on your surgery, and you Philadelphia, PA: Elsevier; 2021:chap 81. Remember, if for some reason this cold postpones thing, it doesn't cancel it, they'll just wait until the cold has gone "I can do 0000017086 00000 n 0000006514 00000 n These are medicines that make it harder for your blood to clot and could 0000021280 00000 n Sabiston Textbook of Surgery. Those Depending on the treated area, most patients return to normal activities and work within several days and to full physical activity in about two to three weeks. In general, we ask patients not to take some common medications and supplements for 1-2 weeks before surgery. Its important that patients contact us when they first notice symptoms of a cold. It is important to note that children are more prone to side effects from decongestant nasal sprays and may experience sedation, agitation and even, in rare cases, seizures. Small amount of money. Ibuprofen (Advil, Motrin) - stop 1 week prior to surgery, Naprosyn (Aleve) - stop 1 week prior to surgery, Plavix discuss this with the prescriber as to the best time to stop this medication beforesurgery. Monday: 8 a.m.4 p.m. Tuesday: 7 a.m.3 p.m.Wednesday: 8 a.m.4 p.m.Thursday: 7 a.m.3 p.m.Friday: 7 a.m.2 p.m.SaturdaySunday: Closed. Phone: (781) 740-7840 A significant, nagging cough most likely will require us to reschedule most surgical procedures, especially if theyre performed using a general anesthetic. Dax Guenther, MD: Coastal Plastic Surgery, What to Do If You Catch a Cold Prior to Your Surgery, This site is protected by reCAPTCHA and the Google. Please visit the CT DPH website for more information or contact your health provider directly. If you're confused about which medicines to take the night before or the day of surgery, call your doctor. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Federal law limits sales to 3.6 grams per day and no more than 9 grams in a 30-day period. 0000013604 00000 n OFallon, MO 63368, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, Center for Advanced Medicine - South County, St. Louis Children's Specialty Care Center, St. Louis Childrens Specialty Care Center South County, Washington University Orthopedics Chesterfield, Physical Medicine & Rehabilitation Musculoskeletal, Physical Medicine & Rehabilitation Neuro Rehab, Medications to Avoid Before and After Surgery. Warfarin (Coumadin), MONKEYPOX: UConn Health is NOT currently offering the monkeypox vaccine. A.D.A.M. You thought it would never end: that tickle in the back of your throat that made you cough or have to clear your throat. Meaning the city and or if it is in a clinic or a hospital setting. startxref Salicylates (sodium salicylate, Magan, Mobidin, Mobogesic, Arthritab, Bayer Select, Doans pills) BONUS! 4921 Parkview Place Suite 1C Can you explain what the thyroid is and how it affects Mayo Clinic Q and A: Avoiding shoulder injuries while shoveling snow. In any case I believe Realself has a list of average costs of procedures organized by location. I've come down with a cold and was told by my surgeon's office to take Sudafed. WebThey are usually stopped for four (4) days prior to any procedure. Your provider may have given you a medicated soap to use. Temporary and normal causes of post-nasal drip includes certain weather conditions (especially cold, dry air) and spicy foods. There are a number of treatment options, including home remedies and over-the-counter medications: Keep in mind that many of these medications are combined in over-the-counter products. Whatever the cause, the problem is a steady trickle of mucus from the back of the sinuses that irritates the throat and nagging cough or other symptoms. For medications used to treat arthritis (regular dose. 0000006363 00000 n Chesterfield, MO 63017, 1044 N. Mason Road For example, your doctor might ask you to keep taking vitamin D or calcium if youre having thyroid or parathyroid surgery, or an iron supplement if you have iron deficiency anemia. 0000006648 00000 n Soc. or Call214-645-8300. Naproxen (Aleve) is a non-steroidal anti-inflammatory drug.This type of drug can increase the risk of bleeding and should not be taken before surgery. If you do not feel well in the days before or on the day of surgery, call your surgeon's office. Ask a doctor before taking medicine that contains acetaminophen if you have ever had liver disease, or if you drink more than 3 alcoholic beverages per day.. You should not use Benadryl Allergy Sinus Headache if you have untreated or uncontrolled diseases such as glaucoma, asthma or COPD, high blood WebNext day all day still had the anxiety, fidgety and restless feeling: I will never take this again. Recommendations will vary from office to office. 0000016606 00000 n DO NOT break in half to take a half dose as the product is not designed to split. Suite 1B On the other hand, a minor cough that is associated with post-nasal drip probably wont require a delay. 's editorial policy editorial process and privacy policy. Prescription: warfarin, heparin, Xarelto, Eliquis, and Plavix, among others. Ticlopidine (Ticlid) By checking the box on the contact form, you agree to the Terms of Use listed here: Communications through our website or via email are not encrypted and are not necessarily secure. Try looking up a doctor, a clinic location, or information about a condition/treatment. Talk with your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever with a The idea that one must stop all medications 30 days before surgery is blatantly wrong, and could be profoundly harmful in a multitude of circumstances. Take the Zyrtec. Zyrtec will actually help you. We dont want your nose stuffed or having post nasal drip. I just went under last week and I took my Zyrtec. They said it was fine. Please note the date of last review or update on all articles. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 0000002775 00000 n These include chondroitin, dan shen, feverfew, garlic tablets, ginger tablets, ginkgo, ginseng, and quilinggao and fish oil. More than half of American adults take an herbal or dietary supplement, and many more use over-the-counter or prescription drugs to manage maladies ranging from the occasional headache to chronic health conditions or mood disorders. Keep in mind that other over-the-counter nasal sprays help with nasal congestion indirectly, but are not decongestants. RNY on 12/13/12 with. HWko_1 `;FouQP&3|Io|ADK33gf~c;1EA`G!y4|~/TLMv< Other cold-like symptoms include: If youre unsure about whether or not to contact us, I recommend erring on the side of caution. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Overdose warning You should read the product labels carefully for all of the Those who may be taking amphetamines for attention deficit, hyperactivity or weight loss are at higher risk of side effects and should not take oral decongestants without speaking to their health care provider or pharmacist. Do not take aspirin-containing medicine within 5 days before any surgery, including dental surgery, unless otherwise directed by your medical doctor or dentist. Best wishes. Click on the image (or right click) to open the source website in a new browser window. Sudafed is listed as a recommended medication for colds in my booklet they gave me for my surgery. Search Bing for all related images, Preoperative Guidelines for Medications Prior to Surgery, Nothing by Mouth Prior to Surgery Guideline, Medication Management in the Perioperative Period, Preoperative Evaluation in Kidney Disease, Antiplatelet Therapy for Vascular Disease, Postoperative Nausea and Vomiting Prevention, Protocol: Medications to still take on morning of surgery, Protocol: Medications to not take on morning of surgery, Protocol: Medications to avoid in the perioperative period, (2011) Anesthesiology 114: 495511 [PubMed], Wallace (2006) Curr Opin Anaesthesiol 19(4):411-7 +PMID:16829723 [PubMed], Warfarin Protocol for the Perioperative Period, Comfere (2005) Anesth Analg 100:636-44 [PubMed], den Broeder (2007) J Rheumatol 34(4):689-95 [PubMed], (2012) Anesthesiology 116:522-38 [PubMed], Search other sites for 'Preoperative Guidelines for Medications Prior to Surgery', Rule: 2, 4, 6, 8 rule applies to all ages, Fruit juice without pulp (e.g. Side effects are usually more common as the dose is increased. But a few days before should not present a problem. A few drugs we should know about but likely wont ask you to stop taking include beta blockers for high blood pressure, proton pump inhibitors for acid reflux, statins, inhalers for asthma, anti-seizure medications, antibiotics, and acetaminophen (such as Tylenol). 0000001046 00000 n Plus, get a FREE copy of the Best Diets for Cognitive Fitness. 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