2024 Treatments for cushing

Burdock Root. Burdock root is one of the very popular and effective herbal treatments for Cushing’s syndrome due to its impact on hormonal levels. Burdock root tea can be prepared very easily and can help to modulate adrenal function, thus eliminating many of the symptoms of this syndrome. [5]. The earth

Begin long term mitotane treatment. Mitotane treatment is lifelong. Long term mitotane treatment is usually once or twice weekly. Unfortunately, for some dogs, Cushing’s disease symptoms come back during long term mitotane treatment. If this happens to your dog, it will need to go back to daily mitotane.Treatments & Medication for Cushing’s Disease in Dogs. There are two main drugs used in the treatment of Cushing’s disease in dogs. A form of the insecticide DDT (drug names include Lysodren® and mitotane) can destroy the cells that produce cortisone in the adrenal glands. Other medications such as trilostane help decrease the amount of ...Radiation treatment of pituitary tumors … or removal of the pituitary gland (hypophysectomy) has a better prognosis of 2-5 years. Adrenal tumors can sometimes be removed with surgery, giving prognosis of 18 months. Options For Conventional Cushing’s Treatment. The goal of conventional drugs for Cushing’s is two-fold:Sugar cubes, apples, sweet feed and other things high in carbohydrates and sugars should be eliminated. Instead, feed your horse a diet that is high in protein and fiber; seek out types of feeds that meet your requirements or find feeds specially formulated for horses with Cushing’s disease. Your horse should also be given vitamins and ... Treatments. Treatment for Cushing's syndrome depends on the specific reason for cortisol excess and may include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs. Surgery Surgery typically involves transsphenoidal removal of the adenoma. It is one of the primary treatment method used to achieve a long-term cure of Cushing ...Treatment options include: Reduce the use of corticosteroids. If the cause of Cushing’s syndrome is the long-term use of corticosteroid medications, the doctor may be able to control the signs and symptoms of Cushing’s syndrome by gradually lowering the dosage of the corticosteroid-containing medicine over a period of time, while still managing the condition for which you take it.The best natural treatment for Canine Cushing's disease is a combination of Melatonin and Lignans combined with a healthy lifestyle and dietary changes. Another great option is our A-Support For Dogs which combines a specific blend of herbs to relieve the symptoms related to Cushing's Disease in dogs.Oct 10, 2021 · Best Cushing’s Disease Treatment For Horses. The most common and effective treatment for Cushing’s disease is a drug called pergolide mesylate. Your veterinarian may also refer to this drug as Prascend®. Pergolide comes in tablet form and is given once per day. It works by reducing the high levels of ACTH. Jul 13, 2023 · The optimal treatment for Cushing’s disease depends on a patient’s particular clinical situation, the severity of the symptoms, and the characteristics of the underlying pituitary tumor that causes the condition. Usually the first line treatment for Cushing’s disease is the surgical removal of the pituitary tumor — a procedure called ... Treatment should be directed, whenever possible, at the primary cause of the syndrome. This topic provides an overview of the various therapeutic options available in the treatment of Cushing's syndrome. A detailed review of therapy for Cushing's disease and some of the primary adrenal causes of hypercortisolism is presented separately.Go for Acupuncture. This treatment is surprisingly very helpful for dogs that have Cushing’s disease. Acupuncture has a lot of success in normalizing the endocrine system and reducing any inflammation. A session every two months will be enough as part of a maintenance program for pets that have been stabilized already. Jul 13, 2023 · The optimal treatment for Cushing’s disease depends on a patient’s particular clinical situation, the severity of the symptoms, and the characteristics of the underlying pituitary tumor that causes the condition. Usually the first line treatment for Cushing’s disease is the surgical removal of the pituitary tumor — a procedure called ... Mar 8, 2019 · Beyond herbal treatment for Cushings disease, supplements may also be beneficial to your dog. Fish oil can help improve the condition of your dog’s skin and coat. HMR or flaxseed lignans are other excellent options for treatment, as they inhibit certain enzymes that aid cortisol production. These two lignans alone can make an enormous ... Endocrine System What is Cushing's syndrome? Cushing's syndrome is a hormonal disorder. It’s caused when you have high levels of the hormone cortisol over a long time. Cushing's syndrome is fairly rare. It most often affects adults who are 20 to 50 years old. It is sometimes called hypercortisolism.Treatment of Cushing’s Disease. The location of the tumor dictates which treatment to use. More than 90 percent of dogs with CD have a pituitary-gland tumor. This type of tumor is only ...Jun 26, 2023 · Treatment for Cushing’s depends on which type your dog has and the severity of it. If your dog has adrenal-dependent Cushing’s and the tumor is benign, it could potentially be removed and ... Radiation treatment of pituitary tumors … or removal of the pituitary gland (hypophysectomy) has a better prognosis of 2-5 years. Adrenal tumors can sometimes be removed with surgery, giving prognosis of 18 months. Options For Conventional Cushing’s Treatment. The goal of conventional drugs for Cushing’s is two-fold:Melatonin and Lignans together provide an excellent natural treatment for both Cushing’s and Atypical Cushing’s disease. In fact, Melatonin and lignans help your dog’s system return to normal. What’s even better is that both of these supplements are readily available at my online store, TCVM Pet Supply.Dec 16, 2021 · Cushing’s disease is a hormonal disorder that affects dogs. It is caused by an overproduction of the hormone cortisol, which can be due to a tumor on the pituitary gland or the adrenal glands. Cushing’s disease can cause a variety of symptoms, including hair loss, obesity, muscle wasting, diarrhea, and vomiting. Mar 3, 2017 · If a tumor is the cause of Cushing, treatments may include medication, surgery, radiation, chemotherapy, or a combination of these treatments. The treatment depends on the tumor’s location and type. Pituitary tumors. The most common treatments for pituitary tumors are: Surgery. Treatments. Treatment for Cushing's syndrome depends on the specific reason for cortisol excess and may include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs. Surgery Surgery typically involves transsphenoidal removal of the adenoma. It is one of the primary treatment method used to achieve a long-term cure of Cushing ...Treatment of PPID. PPID = Pituitary Pars Intermedia Dysfunction = Equine Cushing's Disease. It is caused by loss of neurons in the brain, originating in the hypothalamus, that send nerve endings down to the pituitary where they release dopamine. Dopamine inhibits/controls the release of the hormones that are elevated in PPID.Nov 3, 2017 · That said, 50% of the horses were alive 4.6 years after diagnosis (most that didn’t live got euthanized, and most of those got euthanzied because of problems related to Cushing’s). So, the bottom line is that you shouldn’t expect a treated horse to live longer with treatment, nor even to necessarily avoid problems. 10. Mayo Clinic researchers have helped improve how Cushing syndrome is diagnosed and treated. These improvements include new MRI techniques to pinpoint small pituitary tumors, petrosal sinus sampling, endoscopic transnasal pituitary surgery, laparoscopic adrenalectomy and stereotactic radiosurgery .Dec 16, 2021 · Cushing’s disease is a hormonal disorder that affects dogs. It is caused by an overproduction of the hormone cortisol, which can be due to a tumor on the pituitary gland or the adrenal glands. Cushing’s disease can cause a variety of symptoms, including hair loss, obesity, muscle wasting, diarrhea, and vomiting. Health. In order to help combat or prevent an existing condition or simply improve general health, our articles cover the latest research, new treatments (both conventional and natural) as well as wellness trends. Written by qualified journalists, expert guest authors or Dr. Axe himself, each piece is based on studies and always fact-checked. Sugar cubes, apples, sweet feed and other things high in carbohydrates and sugars should be eliminated. Instead, feed your horse a diet that is high in protein and fiber; seek out types of feeds that meet your requirements or find feeds specially formulated for horses with Cushing’s disease. Your horse should also be given vitamins and ...Mar 29, 2023 · Equine Cushing’s Disease is more commonly known as Pituitary Pars Intermedia Dysfunction (PPID). It involves the overproduction of certain pituitary hormones and is the most common endocrine disease of older horses and ponies. PPID occurs in all breeds and both genders, with increasing age as the only proven risk factor. Symptoms of Cushing’s Disease in Dogs. A dog with Cushing’s disease can show a variety of symptoms. Some of the most common symptoms of Cushing’s disease in dogs: Blackheads. Drinking more water. Firm, irregular plaques on the skin (called calcinosis cutis) Hair loss or poor regrowth. Increased appetite.The cost of diagnosis will depend on the underlying type of Cushing’s disease and any concurrent diseases that may mask certain signs. Typically, a complete diagnosis costs between $500 and $1,500. The treatment can cost from $50 to $200 a month, depending on the pup’s response to the selected medication. Other causes include tumors that make the body produce excess cortisol. Cushing syndrome includes a range of treatable symptoms. In most cases, the syndrome is curable. NICHD is one of the many federal agencies that support and conduct research on the causes of Cushing syndrome, ways to diagnose it earlier, and better treatments.Treatments. If Cushing’s syndrome comes from a tumor on your pet’s adrenal glands, the vet might be able to remove it with surgery, which will cure him of the problem. But if the tumor has ... Natural Treatments for Canine Cushing’s. In addition to a good diet, your dog may benefit from a few herbs and supplements that are proving to help with this condition. Cushing’s is a complicated disease, and you may have to experiment a bit in order to get the best treatment for your dog.Treatment for Cushing’s depends on which type your dog has and the severity of it. If your dog has adrenal-dependent Cushing’s and the tumor is benign, it could potentially be removed and ...Treatment is typically pursued when the clinical signs start affecting a dog’s quality of life, and also when it’s necessary to reduce the complications associated with Cushing’s syndrome. It’s important to talk with your veterinarian about how to weigh the risks of surgery or the possible side effects of available medications. Acupuncture as a natural treatment for Cushing syndrome can be particularly effective in reducing physical symptoms of Cushing disease like lowering pain, enhancing heart functions, and promoting quality sleep. It can also help in restoring your hormonal imbalance. However, it’ll take multiple sessions before you can see results.Treatment is typically pursued when the clinical signs start affecting a dog’s quality of life, and also when it’s necessary to reduce the complications associated with Cushing’s syndrome. It’s important to talk with your veterinarian about how to weigh the risks of surgery or the possible side effects of available medications.Cushing’s disease is a hormonal disorder that affects dogs. It is caused by an overproduction of the hormone cortisol, which can be due to a tumor on the pituitary gland or the adrenal glands. Cushing’s disease can cause a variety of symptoms, including hair loss, obesity, muscle wasting, diarrhea, and vomiting.May 20, 2022 · Treatment of Cushing's Disease in Horses The first-line treatment for Cushing’s disease is an FDA-approved tablet called Prascend (pergolide). Some horses may need to be started on Prascend gradually as it can cause a decrease appetite. Cushing syndrome is a rare disorder caused by having high levels of cortisol over a long time. It’s caused by a tumor on the pituitary gland or adrenal gland, or taking some kinds of medicine. Cushing syndrome may cause excess weight, slow growth, and problems with sexual development. Treatment may include medicines or surgery.Other causes include tumors that make the body produce excess cortisol. Cushing syndrome includes a range of treatable symptoms. In most cases, the syndrome is curable. NICHD is one of the many federal agencies that support and conduct research on the causes of Cushing syndrome, ways to diagnose it earlier, and better treatments.Dogs with a urine specific gravity greater than 1.025 are less likely to have Cushing’s. This is by far the most accurate, safe and effective method of diagnosing Cushing’s disease. If this test shows an elevated Cortisol-Creatinine ratio, you’ll also want to follow up with an ultrasound. I’ll talk about this next.The cost of diagnosis will depend on the underlying type of Cushing’s disease and any concurrent diseases that may mask certain signs. Typically, a complete diagnosis costs between $500 and $1,500. The treatment can cost from $50 to $200 a month, depending on the pup’s response to the selected medication.Burdock Root. Burdock root is one of the very popular and effective herbal treatments for Cushing’s syndrome due to its impact on hormonal levels. Burdock root tea can be prepared very easily and can help to modulate adrenal function, thus eliminating many of the symptoms of this syndrome. [5]Treatments & Medication for Cushing’s Disease in Dogs. There are two main drugs used in the treatment of Cushing’s disease in dogs. A form of the insecticide DDT (drug names include Lysodren® and mitotane) can destroy the cells that produce cortisone in the adrenal glands. Other medications such as trilostane help decrease the amount of ...The U.S. Food and Drug Administration today approved Isturisa (osilodrostat) oral tablets for adults with Cushing’s disease who either cannot undergo pituitary gland surgery or have undergone the...Sugar cubes, apples, sweet feed and other things high in carbohydrates and sugars should be eliminated. Instead, feed your horse a diet that is high in protein and fiber; seek out types of feeds that meet your requirements or find feeds specially formulated for horses with Cushing’s disease. Your horse should also be given vitamins and ...Lifestyle and home remedies Increase activities slowly. Work up to a comfortable level of exercise or activity without overdoing it. Don't do... Eat sensibly. Nutritious foods are a good source of fuel for your body during recovery. They also can help you lose any... Keep an eye on your mental ...Mar 15, 2023 · 1. Reduce Corticosteroid Use. One of the best natural treatments for Cushing’s syndrome is reducing the use of corticosteroid. Reducing the usage of corticosteroid is known as an important way of the treatments for Cushing’s syndrome. It is because the long- term usage of corticosteroid medication can be the cause of this disorder. 1. Treatment goals for Cushing's syndrome. 1.1 In patients with overt Cushing's syndrome (CS), we recommend normalizing cortisol levels or action at its receptors to eliminate the signs and symptoms of CS and treating comorbidities associated with hypercortisolism.III. The First-line Treatment of Cushing's Disease. The main objectives for the treatment of CD include: 1) normalization of cortisol secretion; 2) reversal of the clinical picture; 3) prevention or recovery of the concomitant comorbidities and clinical complications; and 4) long-term disease control without disease recurrence (1, 2, 7, 84 ...Treatment is typically pursued when the clinical signs start affecting a dog’s quality of life, and also when it’s necessary to reduce the complications associated with Cushing’s syndrome. It’s important to talk with your veterinarian about how to weigh the risks of surgery or the possible side effects of available medications. 1. Reduce Corticosteroid Use. One of the best natural treatments for Cushing’s syndrome is reducing the use of corticosteroid. Reducing the usage of corticosteroid is known as an important way of the treatments for Cushing’s syndrome. It is because the long- term usage of corticosteroid medication can be the cause of this disorder.Health. In order to help combat or prevent an existing condition or simply improve general health, our articles cover the latest research, new treatments (both conventional and natural) as well as wellness trends. Written by qualified journalists, expert guest authors or Dr. Axe himself, each piece is based on studies and always fact-checked.Treatment is typically pursued when the clinical signs start affecting a dog’s quality of life, and also when it’s necessary to reduce the complications associated with Cushing’s syndrome. It’s important to talk with your veterinarian about how to weigh the risks of surgery or the possible side effects of available medications.Jun 26, 2023 · Treatment for Cushing’s depends on which type your dog has and the severity of it. If your dog has adrenal-dependent Cushing’s and the tumor is benign, it could potentially be removed and ... Sep 22, 2020 · Cushing’s syndrome is a very “stressful” disease to contract, but there are many natural remedies for this condition, including sleeping more, reducing stress, exercising regularly, altering your diet, and using herbal treatments, among others. Cushing's syndrome is a disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as Cushing's syndrome. Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid ... What's the Treatment for Cushing's Disease in Dogs? Treatment of Cushing’s disease in dogs is largely dependent on the underlying cause. Treatment options include: Surgery. Medication. Radiation. If Cushing’s disease is caused by the excessive use of steroids, the steroid dosage should be carefully tapered down and discontinued.In cases with an ACT, either trilostane or the adrenocorticolytic drug mitotane can be used. Although mostly effective, both treatments have disadvantages. This review discusses the current treatment options for canine hypercortisolism, and considers their mechanism of action, efficacy, adverse effects, and effect on survival. Mar 1, 2018 · The Leptin Connection. Cushing’s disease, which causes a constant fight-or-flight state of elevated cortisol, forces the body to store loads of fat to protect the organs. “People often gain 100 pounds. I was lucky to gain a little over 30, but as a trainer that can end your career,” says Lombard. May 9, 2019 · Other causes include tumors that make the body produce excess cortisol. Cushing syndrome includes a range of treatable symptoms. In most cases, the syndrome is curable. NICHD is one of the many federal agencies that support and conduct research on the causes of Cushing syndrome, ways to diagnose it earlier, and better treatments. Cushing’s Medication These treatments are meant to either reduce the levels of cortisol in the blood to normal levels or to shrink the size of pituitary or adrenal tumors. The most commonly prescribed drugs for Cushing’s disease are Mitotane and Trilostane (5) Mitotane is a human chemotherapy drug that is meant to shrink adrenal or ...Nov 15, 2022 · Cushing syndrome impacts around 10-15 million people each year and has far-reaching implications for overall health. It can be difficult to get a proper diagnosis as it mimics so many other conditions. While Cushing disease shares the same symptoms, it has a different cause. Let’s take a closer look at both and the natural remedies that can help. Treatment is typically pursued when the clinical signs start affecting a dog’s quality of life, and also when it’s necessary to reduce the complications associated with Cushing’s syndrome. It’s important to talk with your veterinarian about how to weigh the risks of surgery or the possible side effects of available medications. Treatments. Treatment for Cushing's syndrome depends on the specific reason for cortisol excess and may include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs. Surgery Surgery typically involves transsphenoidal removal of the adenoma. It is one of the primary treatment method used to achieve a long-term cure of Cushing ...May 9, 2019 · Other causes include tumors that make the body produce excess cortisol. Cushing syndrome includes a range of treatable symptoms. In most cases, the syndrome is curable. NICHD is one of the many federal agencies that support and conduct research on the causes of Cushing syndrome, ways to diagnose it earlier, and better treatments. Treatment options include: Reduce the use of corticosteroids. If the cause of Cushing’s syndrome is the long-term use of corticosteroid medications, the doctor may be able to control the signs and symptoms of Cushing’s syndrome by gradually lowering the dosage of the corticosteroid-containing medicine over a period of time, while still managing the condition for which you take it. Oct 26, 2022 · Cushing’s disease is a debilitating disease, usually affecting geriatric dogs. Cushing’s happens due to a malfunction in your dog’s Endocrine System. Specifically, Cushing’s disease in dogs occurs when the dog’s adrenal glands overproduce Cortisol, also known as the “stress hormone”. The adrenal glands produce and store Cortisol. III. The First-line Treatment of Cushing's Disease. The main objectives for the treatment of CD include: 1) normalization of cortisol secretion; 2) reversal of the clinical picture; 3) prevention or recovery of the concomitant comorbidities and clinical complications; and 4) long-term disease control without disease recurrence (1, 2, 7, 84 ...Best Cushing’s Disease Treatment For Horses. The most common and effective treatment for Cushing’s disease is a drug called pergolide mesylate. Your veterinarian may also refer to this drug as Prascend®. Pergolide comes in tablet form and is given once per day. It works by reducing the high levels of ACTH.Sugar cubes, apples, sweet feed and other things high in carbohydrates and sugars should be eliminated. Instead, feed your horse a diet that is high in protein and fiber; seek out types of feeds that meet your requirements or find feeds specially formulated for horses with Cushing’s disease. Your horse should also be given vitamins and ... Equine Cushing’s Disease is more commonly known as Pituitary Pars Intermedia Dysfunction (PPID). It involves the overproduction of certain pituitary hormones and is the most common endocrine disease of older horses and ponies. PPID occurs in all breeds and both genders, with increasing age as the only proven risk factor.Cushing’s syndrome, also called hypercortisolism, refers to the presence of excessive amounts of cortisol in the bloodstream over a lengthy period of time. The most common cause is steroid use. Other causes include ectopic tumors and adrenal cortex tumors. Cushing’s disease refers only to hypercortisolism caused by the presence of a tumor ...May 18, 2023 · Top 7 Best Treatment for Cushings in Horses. Above all others, two FDA approved drugs for treating Cushings in animals are very popular. They are Trilostane (Vetoryl) and Mitotane (Lysodren). Mitotane is quite old, and most veterinarians don’t prescribe it anymore. Cushing syndrome treatment Pituitary tumors. The most common type of treatment for pituitary tumors is surgery. The surgeon will go in through a... Ectopic ACTH-producing tumors. Like pituitary tumors, surgery is typically the first option for ectopic tumors. If... Adrenal tumors. Surgery to remove ...That said, 50% of the horses were alive 4.6 years after diagnosis (most that didn’t live got euthanized, and most of those got euthanzied because of problems related to Cushing’s). So, the bottom line is that you shouldn’t expect a treated horse to live longer with treatment, nor even to necessarily avoid problems. 10.Feb 26, 2016 · These treatments might be the only option for people with Cushing’s disease that has progressed, but for others with Cushing’s syndrome or just symptoms of high cortisol, lifestyle changes can ... Treatment is typically pursued when the clinical signs start affecting a dog’s quality of life, and also when it’s necessary to reduce the complications associated with Cushing’s syndrome. It’s important to talk with your veterinarian about how to weigh the risks of surgery or the possible side effects of available medications.

Cushing’s disease is a progressive disorder in which there is an excess of cortisol in the body. While the disease can be treated surgically, this option is not possible for all patients. Following are currently approved medication treatments that assist in controling cortisol levels in individuals with Cushing’s disease. . Rss feed

Go for Acupuncture. This treatment is surprisingly very helpful for dogs that have Cushing’s disease. Acupuncture has a lot of success in normalizing the endocrine system and reducing any inflammation. A session every two months will be enough as part of a maintenance program for pets that have been stabilized already.Treatment for Cushing's Disease in dogs. As noted above, Cushing's Syndrome is due to a tumor growing in the pituitary or adrenal gland. Now it could be a benign or malignant tumor.The main indications for medical therapy of Cushing's syndrome include (see "Overview of the treatment of Cushing syndrome" ): Control of hypercortisolism in preparation for surgery – Although the hypercortisolism of Cushing's disease is optimally treated surgically, medical therapy is often required when surgery is delayed.Treatments. Treatment for Cushing's syndrome depends on the specific reason for cortisol excess and may include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs. Surgery Surgery typically involves transsphenoidal removal of the adenoma. It is one of the primary treatment method used to achieve a long-term cure of Cushing ...The Leptin Connection. Cushing’s disease, which causes a constant fight-or-flight state of elevated cortisol, forces the body to store loads of fat to protect the organs. “People often gain 100 pounds. I was lucky to gain a little over 30, but as a trainer that can end your career,” says Lombard.Endocrine System What is Cushing's syndrome? Cushing's syndrome is a hormonal disorder. It’s caused when you have high levels of the hormone cortisol over a long time. Cushing's syndrome is fairly rare. It most often affects adults who are 20 to 50 years old. It is sometimes called hypercortisolism. Cushing's disease is responsible for roughly two thirds of the cases of endogenous Cushing's syndrome. 1, 3, 4 The remainder of the endogenous cases are caused by ectopic ACTH-secreting tumors and ...Health. In order to help combat or prevent an existing condition or simply improve general health, our articles cover the latest research, new treatments (both conventional and natural) as well as wellness trends. Written by qualified journalists, expert guest authors or Dr. Axe himself, each piece is based on studies and always fact-checked.Cushing's disease is responsible for roughly two thirds of the cases of endogenous Cushing's syndrome. 1, 3, 4 The remainder of the endogenous cases are caused by ectopic ACTH-secreting tumors and ...Mar 15, 2023 · 1. Reduce Corticosteroid Use. One of the best natural treatments for Cushing’s syndrome is reducing the use of corticosteroid. Reducing the usage of corticosteroid is known as an important way of the treatments for Cushing’s syndrome. It is because the long- term usage of corticosteroid medication can be the cause of this disorder. Treatment for Cushing's Disease in dogs. As noted above, Cushing's Syndrome is due to a tumor growing in the pituitary or adrenal gland. Now it could be a benign or malignant tumor.Cushing's syndrome is the result of excessive corticosteroids in the body. The main cause is overproduction of adrenocorticotropin hormone (ACTH) in the pituitary gland. ACTH causes the adrenal glands to produce corticosteroids, so too much of ACTH means too much of corticosteroids. Another main cause is taking long-term external steroids like ...Sugar cubes, apples, sweet feed and other things high in carbohydrates and sugars should be eliminated. Instead, feed your horse a diet that is high in protein and fiber; seek out types of feeds that meet your requirements or find feeds specially formulated for horses with Cushing’s disease. Your horse should also be given vitamins and ....

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