The Politics of Perimenopause with Gabrielle Blair

TOPICS DISCUSSED

  • The Politics of Perimenopause with Gabrielle Blair

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EPISODE RESOURCES

UPCOMING EVENTS:

Gabrielle Blair

This book is not mentioned in today’s episode, but The Vagina Bible: The Vulva and the Vagina: Separating the Myth from the Medicine by Dr. Jen Gunter is one of the “18” resources available about what we do know about Women’s reproductive health and we felt it would be valuable to link to it here.

TRANSCRIPT

230118_PP_Perimenopause_mixdown.mp3

Sarah [00:00:07] This is Sarah Stewart Holland.  

Beth [00:00:08] And this is Beth Silvers.  

Sarah [00:00:10] Thank you for joining us for Pantsuit Politics. Hello and welcome to another episode of Pantsuit Politics. Life has intervened in our well-laid plans this week. Beth has experienced a death in the family. And so today we are sharing a conversation we recorded with Gabrielle Blair, founder of Design Mom, and All Summit, and overall amazing human. Now, before we get to that, a friendly reminder that we will be at Maryville College on February 7th, competing with Joe Biden State of the Union as we learn this week. That's okay. If you live in Knoxville area, the event is open to the public and the link for tickets is in the show notes. And we would absolutely love to see you there. Now, on to Gabrielle Blair. Gabrielle Blair is the mother of six and the author of Ejaculate Responsibly: A Whole New Way to Think About Abortion. You heard her on our show several months ago talking about her new book, and we'll put the link to that show in the notes if you missed that conversation. But we originally invited her here to discuss an email she sent to her subscribers talking about perimenopause and how little we all know about this important phase in a woman's life. And we are delighted to share that conversation with you today.  

Beth [00:01:37] Gabrielle Blair, we're so happy to have you back at Pantsuit Politics. Thank you for joining us.  

Gabrielle Blair [00:01:42] I love being here.  

Beth [00:01:44] Let's start at the beginning. We are all in our forties as we're having this conversation and we have all been having spells-- I don't know, hot episodes, some strange things happening in our lives.  

Sarah [00:01:58] We don't even have language.  

Beth [00:02:00] And so we wanted to begin maybe with each of us just describing what's been going on to sort of level set for the discussion we're about to have. So you want to start since you're our guest?  

Gabrielle Blair [00:02:11] Well, as we'll say many times, it's all mysterious. Never quite sure what it is. But I was experiencing something that I thought might be like a panic attack. I deal with depression, but I haven't dealt with anxiety. So I'm not familiar with panic attacks. But my heart was racing for no good reason. I couldn't figure out like was there some trigger that's stressing me out? And then it would come down. I figured out how to manage it. And then this happened a few times over a couple of months, and this is just barely. And I remember reading something, a response to a tweet that said heart racing and things that like panic episodes may be a version of hot flushes. And I've never experienced a hot flash that I'm aware of. I mean, the way they're described am, like, no, I haven't had that.  

Sarah [00:03:04] I think you know when you've experienced one, that's for sure.  

Gabrielle Blair [00:03:08] I assume so. Like an orgasm, right? You know.  

Sarah [00:03:12]  That's right.  

Gabrielle Blair [00:03:13] So I was like that it clicked for me. I'm like, oh, maybe my version of hot flashes is this panic mode, is this heart palpitations-- I don't know. So that's where I'm at.  

Sarah [00:03:25] Same. It's a podcast, y'all can't see us. Beth and I are just nodding, nodding, nodding. This summer, when I was about to head to Europe, I had this sort of sharp chest pain. I was like, oh my, am I having a heart attack? But it was in the center of my chest. And the only way to describe it is it's like I'm like weirdly aware of my chest and heart beat in a way that I am not usually. Usually, it's doing its thing; I don't really think about it. And when these happen, it's like I can feel it. I can feel my heart beating. It happens a lot sometimes when I wake up in the middle of night and it feels like my chest is almost vibrating. It's so weird. And I would have it and I would have it, and then I noticed in Europe I started my period and it went away. And I was like hold on a minute, wait a second, I think I know what's going on here. I do think it's a combination of, for me, it's definitely stress. I think it has to be a part of it. Which makes sense, hormones and stress are one and the same. And it was just so weird because I was in my head about this freaking out. I get back, Beth is like, "I didn't want to stress you out, but I've been having these heart episodes." And I was like, wait, wait, wait. Then I had a friend go to the emergency room because she had a heart episode. I've had another friend just emailed me two days ago and said, "I was in the emergency room for a heart thing." Then I also went and got an EKG, and then I was like playing around and my chart thought, oh my God, I had one of these in May too because I was freaked out, especially after I had COVID. I think we're all so hyped up about heart stuff after COVID that I went and got an EKG in May too. And I'm like, so when you sent that newsletter and talked about it, I was like, oh my Lord, what is happening to all of us?  

Beth [00:05:04] So I was with my mom a few weeks ago, she was recovering from surgery and I was there to help out. So in many ways it was very stressful because I was concerned about her, but in many other ways it was not stressful at all because it was just the two of us in a quiet house with no children. I mostly wasn't working. It was a very mellow time. And I'm there and I'm standing up and I just remember all of a sudden thinking I am going to pass out now. I saw kind of black coming over my eyes like a curtain closing. I sat down on the chair, I sort of recovered. And then I suddenly had horrible diarrhea for about 48 hours. And I started noticing that I could feel my heart like Sarah was saying, just this awareness of it. And it started to feel like like flutter, flutter, jolt. And that jolt was this really intense beat. It wasn't painful, but it was intense. It felt like an earthquake in my body, especially in the back of my body. And that just continued for several days. And I went to bed one night and I thought, am I going to die? Like, am I going to wake up? Something is very wrong. So I got in with my doctor very quickly. They did an EKG. It happened during the EKG, thank goodness. Because there's always that risk that the thing you go for is gone by the time you get there. But it happened. And the nurse said, "Oh, I want to make sure I capture that." And I said, "Well, that is it. That's what brought me here, that feeling that I just had, that you commented on, is why I'm here." And she told me that they were PVCs, premature ventricular contractions, that there are a million reasons that can happen. And so we did a full battery of bloodwork to rule out thyroid, kidney diabetes, all kinds of things. And then I wore halter monitor for 24 hours. I had a thousand of those PVCs during the 24 hours I had the monitor.  

Gabrielle Blair [00:06:59] A thousand. 

Beth [00:07:02] And then I had a five second pause. My heart just didn't beat for 5 seconds, which is kind of a long time. I've been through a lot of discussion about this, and the conclusion is basically it's probably hormones. It's happening at that time in your cycle when your progesterone is really ramping up and you're probably just getting more sensitive to that progesterone. And if it doesn't come with shortness of breath or pain, if it continues to stop once your period starts, then maybe we just tolerate it. And that's where it landed.  

Gabrielle Blair [00:07:37] So the response is literally shrug.  

Beth [00:07:40] Yeah. So when I saw your tweet about every Google search result and I had this experience preparing for this episode, I saw the word tolerate more than I've ever seen the word tolerate in my life. That's the conclusion of everything. It's really weird. We don't know. It's about 10 years, but maybe more, maybe less, and hopefully you can tolerate it. It's bizarre.  

Sarah [00:08:06] Well, here's the crazy thing, I'm not even under the medical definition. So I think all of us have sort of circled around this idea that this is a hormonal situation happening. I pulled from the depths of my memory very, very, complete and cataloged memory of all Oprah shows that Oprah had these PVCs and talked about it on her show. I remember this. I remember her talking about her heart racing and her bringing in all these menopausal experts. I have a memory of this and it's like I'm not even under the definition. The definition is when you start having irregular periods, which I don't have. So it's like I'm not even technically under the definition of perimenopause, but I'm absolutely experiencing some sort of hormonal sensitivity without a doubt. Without a doubt.  

Gabrielle Blair [00:08:53] Well, we just don't know. So my older sister who is in graduate school, Rachel, and she is studying online support groups through menopause an how they've forced the medical community to start learning about women's health. She's studying that phenomenon. And she sent me this little thing.  I'm going to just read this online that says, "A literature review was conducted using multiple databases with the keywords online, Internet, web, intervention, and menopause. And using these keywords, a total of 18 eligible articles were analyzed. That's it.  

Sarah [00:09:30] Eighteen?!  

Gabrielle Blair [00:09:30] So in the whole of the Internet talking about it, there's only 18 articles. And how many billion people live on the earth right now? Eight. Are we at eight-- nine? I don't even know where we're at now. A full half of those at least are dealing with this at some point in their life, whether they had a hysterectomy earlier and it's like they suddenly are in menopause or whether they come by their body just does it naturally. We have 18 articles, and who knows that even those are useful to give us any guidance on this? And I know there's books that are being written. I mean, there's stuff people have started.  

Sarah [00:10:03] It's getting better. It's getting better for sure.  

Gabrielle Blair [00:10:06] Well, we're on an upward trajectory, that's good news. But there should be so much research on this already.  I mean, we cannot comprehend how many people it's affecting, really. And we just know nothing. We just know nothing. And if you do know something, you haven't talked about it because you're not even sure if it has to do with menopause. Maybe it's COVID, maybe it's just aging, who knows?  

Sarah [00:10:35] Stress. Yeah.  

Gabrielle Blair [00:10:35] So we just have nothing. And essentially, like, it might as well be zero. That's just nothing compared to what it should be. And obviously we need more and more and more. So even anything that's coming out, it's so exciting, it's so wonderful, but you're also like this is going to be based on a couple of years of research, where we should have hundreds and hundreds of years obviously.  

Sarah [00:11:04] I have some sympathy for the lack of research because, I mean, let's just be honest, for most of human history, women just had babies till they died. They just had babies till they died. The lifespan wasn't long. It was pretty short. And the women who pass through this phase of life it was, objectively as particularly compared to where we are now, a smaller subset of the population. And I get that. I also think it is difficult because it is so individualized. But then in my head I'm like, is it? I mean, we tell ourselves that, but I got a lot of people right now having these episodes. It doesn't   feel that individualized to me. So that's what I think I struggle with. I think there's a sense in the medical community of like, well, every person is different, so how are we going to get to the bottom of this? I don't know. Well, let's just start trying because there's this sense of like, well, you catalog it and you keep up with your symptoms and you do all the data collection and then maybe we can help you. And that seems really backwards from how it should be to me.  

Gabrielle Blair [00:12:05] Right. Because I need to see patterns among the billions of women that are experiencing this. Yeah, we're all individuals, but there are products for periods and there's a variety to choose from, but we all know we need period products. So there's period products even though we each personally have our own individual experience, it's a generalized enough experience that we can also say, "Oh, here's some stuff we can put on a store shelf that will be useful to people. It's just that just feels like such a cop-out to say, well, it's all individual. Like, come on.  

Sarah [00:12:39] Well, think about how much that one tweet helped you. Just that one person saying, "Hey, I heard that some people, it shows up this way." And you're like, "Oh, that's helpful."  

Gabrielle Blair [00:12:48] Yeah. And then I share that and who knows who that helps. And we just need that times a billion or whatever it might be, and I'd love to see it happen.  I tried to find information, I have since found it just by talking to human beings, but on the Internet trying to figure out like have I had a hot flash? And I tried to get a description of it. Could not find a description of a hot flash. And I think I'm pretty good at using the Internet. I specifically talk to someone who had had it and say can you please describe it for me? I'm not sure I had it. And then I realized that doesn't actually even help. I need to talk to like 20 different people that have had that, because who knows what someone else thinks are hot flashes. It's that thing you figure out when you're a kid when you're like, well, I'm seeing the color blue; is the person next to me saying the same thing. Do we all think blue is the same thing? It's like that. Do we all think hot flashes are the same thing? And apparently, no, they're not all the same thing. The more we talk about it, the more we discover that. But that seems like the most basic thing, right? Everyone's associates hot flashes with menopause, and there's still not even information on that.  

Beth [00:14:02] Beyond the caricature in pop culture of menopouse. And this is the thing to me, that it's one thing to have the research and have us cataloging and tracking everything, which I get mad about, I get angry about this types of requests. What else do you want me to manage that men don't have to manage? What else would you like to stuck on my plate? But the other piece is that I just feel like nowhere along the process-- and this is reflected in all that tolerate, tolerate, tolerate talk-- is the experience of living in this body, doing these mysterious things taken into account. I love the Honeypot period products. They put aloe in maxi pads and I so appreciate that someone thought, I wonder what it feels like to have this happening and how we could make this a little bit more comfortable for you, just slightly, just the tiniest thing better in this horrific process. And I just think that kind of thinking is absent every step along the way. The experience of a gynecological exam is as brutal as it could possibly be. Where are the folks who've been saying, could we make this a little better?  

Sarah [00:15:18] Yeah. Well, because I feel like the answer is either catalog it to manage it yourself, which even if you are a data analysis person, like that's your job, it really reminds me of my youngest son was diagnosed with diabetes and in theory it sounds like carbs and insulin, that's what you're dealing with, right? This is a simple equation, but it's not because everything can affect your blood sugar-- stress, adrenalin, how much sleep you've had, a growth hormone. And it's the same thing when we say hormones, well, what exactly am I tracking? What would you like me to track? My stress level day to day, how much sleep I had, what I ate? Did I have a reaction to what I ate? What was in that food at the restaurant that maybe I didn't actually understand? Come on, what exactly would you like me to track? When I'm tracking my symptoms, a million things could be affecting my hormones and how they play out in my body. I don't even know what you want me to track. And then I feel like the other advice is just well then just have a hysterectomy. Just yank it out, move on, as if that's just this really simple solution. And I feel like those are both really shitty options you're presenting to me.  

Gabrielle Blair [00:16:29] Yeah. And just to casually present a hysterectomy as an option, it's a very serious surgery. Even a tubal ligation, which is not nearly as serious as a hysterectomy, it can have all sorts of risks, it can be a super serious thing. And that we could just casually ask women to do stuff with their bodies is just so bizarre to me. It's so bizarre. I've found the most help in not cataloging but just talking to people. I'm not going to be cataloging every day. I don't have time. And it feels too much like a food diary or something that I just [Inaudible]. That's too gross, please tell us we've moved beyond this stuff. This is just all so harmful. And of course I should be aware of my body. It's not like that, but it's like put down every little thing. And did I have a softer stool than normal today? I can't. I think it's just putting too much on women and it's this excuse to say, well, we just don't know. And everyone's different, so it's on you now. You've got to figure this out for yourself. And that's just not going to be true. Of course, there's going to be universality. Of course there will. We're talking about billions of people, of course, that some of this experience will be universal. We're just not talking about it. And we're sort of shamed if we do talk about it. Like you're supposed to be really embarrassed to talk about menopause because, of course, we're not allowed to age. We're all supposed to still, I guess, look like we're 25. I don't know. I certainly don't. You're supposed to be embarrassed to talk about it. There's supposed to be shame around it. I want research being done, it's not me doing the research.  

Sarah [00:18:10] Word.  

Beth [00:18:10] Yes.  

Gabrielle Blair [00:18:10] I don't think it's being helpful when we have all of us individually doing the research. We need researchers to be doing this on a massive scale where they can ask us the questions and we can check in once in a while-- those who have volunteered, it doesn't need to be everybody. And you can get this wide variety. But each of us doing our own research, it feels like each of us are trying to come up with our own vaccine or something. It's like the dumbest waste of resources, the dumbest waste of time.  

Sarah [00:18:36]  I think the only positive of that is-- but again it's a positive in the most backwards way, which is because I was forced to basically, because when you go (in my experienced) an OBGYN and express some frustration with hormones, the advice is to get on birth control, which I'm not going to do. It's not good for me. It makes me feel like crap. So I had to sort of learn myself. And I do think why was I learning this at 30? Why wasn't there a space where somebody was like, okay, here's what happens in your body?  I even think about the way we organize birth control pills, which is the opposite of how your actual cycle is counted; why do we do it like that?  I remember learning that in my twenties when I went off birth control and started trying to get pregnant. I was like, hold on, my period starts my cycle? Now I'm just confused. Like it's just all these ways in which we sort of obfuscate and keep hidden what hormones are doing and how they work inside your body sucks, and it shouldn't be up to the individual to educate themselves. There should be places and ways that we talk about, well, this is what estrogen does to your body and this is what progesterone does to your body. And these broad strokes might play out differently on you individually. But like broad strokes, I think some of the period apps have been amazing for me, just so I can watch because they'll show you, okay, here's where this is happening. So helpful. Where was that? Why is that not normalized? Why is that not information we're giving to girls and women at really early ages?  

Gabrielle Blair [00:20:07] I feel like some of this has-- it is too big of an umbrella, but patriarchy. For centuries part of the rule of patriarchy is making sure women aren't handing down our knowledge, not giving them a voice, and making sure they don't have a voice, making sure they don't have a platform, have a way to share. So there's also this feeling the more you dive into feminist literature or anything like that, you're like, oh, stuff that I'm just figuring out people figured out a long, long time ago. And then that  knowledge was taken away.  

Sarah [00:20:42] That's probably true for menopause.   

Gabrielle Blair [00:20:45] I feel like that knowledge about our bodies that surely people must have shared this information in the same way we're sharing it now, like we want to get information. Surely this has been known. I would hope that whatever the medical knowledge was at whatever time frame in history, that there was some knowledge about this being passed down from woman to women and then it disappears, or maybe this burns up in the library in Alexandria or I don't know where, but it's taken away from us. [Crosstalk]  

Sarah [00:21:18] It's so true.  

Beth [00:21:22] Well, and it gets shamed out of us, right? Like the core four symptoms of perimenopause, the most common things that I could find in the 18 or so articles out there are: hot flashes, sleep disruption, depression, and vaginal dryness. Okay, well, we've made hot flashes a joke. Sleep disruption and depression we talk about as though they are symptoms or manifestations of individual toughness or health that you're totally in control of. And vaginal dryness, no one wants to chat about. And if they do, it's going to be in a very objectified way. So it's no wonder I remember the first time Sarah and I mentioned perimenopause on our show several years ago, we got a couple of responses from women that were like, "You all are way too young to be talking about this. You can't possibly know." I hope we wouldn't get those responses today. I hope there's at least more coming out saying, no, this can start in your thirties. This can be a decade long situation. But I don't know. I just think there is so much shame baked in, and it reminds me of how women can shame each other so much about birth experiences. We know so little. So what we think we know, we get really stuck in and it becomes really kind of precious to us and we're really hard on each other in the conversations.  

Sarah [00:22:40] Yep. We get really, really defensive about it too.  

Beth [00:22:43] Yeah.  

Sarah [00:22:44] It's so frustrating. And, again, it's not like women in our conversations about our bodies exist outside the patriarchy, right? That's just one more manifestation of what you're describing, which is control to information, very specific perspectives that limit that interaction, limit the knowledge. It is a very specific type of of cordoning off; just cordoning it off and saying that's not what the rest of us are concerned about.  

Beth [00:23:30] As your talking with multiple women, you said that's the most effective thing that you've done, how do you perceive their openness to sharing these stories and receiving stories that differ from theirs?  

Gabrielle Blair [00:23:40] That's a great question. I usually begin by being really open. These conversations will come because I just wrote out a newsletter or a post on Instagram where I'm like, "Hey, this is what I'm experiencing. It reminded me of this. Anyone else?" And so if I start myself by being really open, anyone else who might be comfortable being open, I'll hear from. Now, if they're not comfortable being public, then I'll get an email instead. But I find just by being open myself that people are quite willing to be open and hungry for this knowledge, Just hungry. And, again, not everyone is going to be comfortable talking about it in person in public, but if they can read a public discussion, they are desperate for it. So not everyone's open enough to public, but enough are that it's useful to everyone else. And you'll still get a lot behind the scenes as well. As far as it being different from their experiences, I haven't had any pushback on that. I mean, maybe just by the time you get to menopause, curious age that you're at a place where you're like, oh, there are lots of different experiences in life. Maybe we're more mature now. I don't know. But I haven't had people push back and go, "No, no, no, that's not a hot flash. You're having a panic attack." No one has. And maybe that also I think related to that is nobody knows. There is no expert. No ,one reading is like actually, I do have all the facts and all the knowledge and you're wrong. No one knows. It's hard to push back and say, no, that's from something else-- because we don't know.  

Sarah [00:25:13] I think the only place I hear that is around hysterectomy. Like what's the big deal? Just get a hysterectomy and move on. I do hear that. I've heard that from female relatives. I've heard that from women in my life that were like, let's just do this. Like this is the solution and then just move on. And I think that's hard. I just don't think that's going to be the solution. I think it absolutely is the solution for some people, and it won't be the solution for everybody. And to your point about the patriarchy, it feels like we're very much in this like consciousness raising part of the process where there's a lot of more books coming out, there's podcast about perimenopause. And I do think it is political. Absolutely. And the way that everything affecting women's bodies is political, just as the reality that we find ourselves in, and I think that we're in this spot where we're just trying to give voice to things. That's why when you said that, I was like, oh, we should have her on and have a conversation because that's just the best we can do right now, is just share our stories and raise consciousness and hope that  those of us not involved in medical research, that there is more information shared and more storytelling and more knowledge and more strategies being passed around. I mean, I think that that's just where we're at right now.  

Gabrielle Blair [00:26:26] I would really like to see our anger and frustration inspire people to do more research. And not even just that, so much of this comes down to money, right? There's a story in in a book about Viagra, do you guys know the story? And they were developing this pill that it was going to be like a heart medicine, and they realized it works for erectile dysfunction. It just was like a total surprise. At the same time, they also realized it was highly effective for menstrual cramps, for pain relief. So guess which one they decided to study and put money behind?  Okay. So we know they put money behind Viagra, obviously. And Viagra affects a lot of people. It really does. I think it's been subscribed over 6 million times since it's come out. So that's great. Well, guess how many people experienced menstrual cramps? About 80 percent of people who menstruate. So billions of people compared to the 6 million. And if they had developed that, how much money could they have earned from that? They didn't consider it a public health issue. Women have some money to spend.  

Sarah [00:27:34] We do.  

Gabrielle Blair [00:27:34] Women control about 80 percent of household spending. Even if they're not the primary earners, they're still making the grocery list and choosing which car and making these household purchases. We will spend money on this. If you can give us a product that will help us, if you can give us guidance that will help us to just experience this phase as gracefully as we can, as healthily as we can, we want that product We're desperate for it. We're hungry for it. We're asking for it. We don't even know what those products are. Put the research and put the money and invest in us. We will spend money on this more even than the Viagra people. I promise you, there's more of us dealing with this than the Viagra men. I promise.  

Sarah [00:28:19] In my more graceful moments, I'm willing to entertain arguments about patriarchy. But when you see something like that, when you see there was money to be made and they didn't do it, why do you think that is? Because that's supposed to be that what motivates us more than anything else. So maybe there is something else going on here than just the bottom line of how do we sell this and how does it work? I mean, in the same way that you saw in  the sixties, there was money to be made in the black community, but they chose not to make it. Why do you think that is? Why do you think that is? Like in particular these moments where the choice was made and it wasn't one that was financially beneficial, that means something else is going on here, guys. Something else is going on here.  

Beth [00:29:03] Well, thank you so much for starting this conversation with us. I'm sure we'll return to the subject many times. We'd love to have you back sometime. Thank you again, Gabrielle Blair, for all of your vulnerability in putting this good stuff out into the world.  

Gabrielle Blair [00:29:16] Beth, Sarah, you're a delight. This was so much fun. Thank you. Thank you.  

Sarah [00:29:20] Thank you to Gabrielle for having this amazing conversation with us. Thank you to all of you for listening. We look forward to your comments and questions. We will be back in your ears on Friday and until then, have the best week available to you.  

Beth [00:29:44] Pantsuit Politics is produced by Studio D Podcast Production. Alise Napp is our managing director.  

Sarah [00:29:49] Maggie Penton is our community engagement manager. Dante Lima is the composer and performer of our theme music.  

Beth [00:29:55] Our show is listener-supported. Special thanks to our executive producers.  

Executive Producers (Read their own names) [00:29:59] Martha Bronitski. Allie Edwards. Janice Elliott. Sarah Greenup. Julie Haller. Helen Handley. Tiffany Hasler. Emily Holiday. Katie Johnson. Katina Zugenalis Kasling. Barry Kaufman. Molly Kohrs. Katherine Vollmer. Laurie LaDow. Lily McClure. Linda Daniel. Emily Neesley. The Pentons. Tawni Peterson. Tracy Puthoff. Sarah Ralph. Jeremy Sequoia. Katie Stigers. Karen True. Onica Ulveling. Nick and Alysa Vilelli. Amy Whited. Emily Helen Olson. Lee Chaix McDonough.  

Beth [00:30:36] Jeff Davis. Melinda Johnston. Michelle Wood. Joshua Allen. Morgan McCue. Nicole Berklas. Paula Bremer and Tim Miller. 

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