Survival rates among kidney transplant recipients in U.S. transplant centers can be found online at the Scientific Registry of Transplant Recipients website. Urology 216.444.5600. To avoid this problem, drink lemon water through a straw to protect the teeth. Herbal Supplements and Kidney Disease | National Kidney Foundation This is especially important during a kidney cleanse. eyJtZXNzYWdlIjoiOTIzMjUzNGViNjIxNzc3ZTU2NWVmNTgwOGI1Njc4ZjE0 These juices are naturally high in citrate, which can prevent kidney stones. https://www.uptodate.com/contents/search. Additives to coffee such as milk and many creamers increase the potassium and phosphorus content of coffee. We use cookies and other tools to enhance your experience on our website and to analyze our web traffic. Benefits are paid directly to the em. Drinking lots of water with fresh lemon or lemon concentrate can be good for your bladder and kidneys because it helps to reduce your risk of kidney stones and bladder infection. Foods high in antioxidants, like fruits and vegetables, can also protect the kidneys . Accessed Aug. 12, 2021. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development. Each transplant center has its own eligibility criteria. YzZmZmI2NDUyODMxZTI3M2I1YWZlNDgxNDdmMjVlZGVhYmZhODZiYjE1YmRj Expect soreness or pain around the incision site while you're healing. Most people find lemon water more refreshing, so it helps them drink more, she says. Add a tea bag and steep for 2-4 minutes only. Some of the reasons may be beyond your control: low-grade inflammation from the transplant could wear on the organ, or a persisting disease or condition could do to the new organ what it did to the previous one. Quick Answer: Why Cant I Refill Water Bottles, Question: Why Americans Drink Bottled Water, Cant Drink Out Of Water Bottles In Project Zomboid, Question: Why Cant Plastic Water Bottles Be Recycled, Question: Why Cant Plastic Water Bottles Be Reused, Quick Answer: Why Cant Water Bottle Caps Be Recycled. Can you overwork your kidneys by drinking too much water? Avoid drinking water or any other fluids at least two hours before sleeping to prevent waking up at night. Call 1-800-667-5356, Monday-Friday, 8:30am-5:00pm or Find a Doctor, For help with specialty consultations, call 617-667-2020, Monday-Friday, 8:30am-5:00pm or refer to our ED. Organ Procurement Organization Reports. Kidney Transplant: Surgery, Purpose, Procedure & Recovery Some itemsincluding downloadable files or imagescannot be translated at all. Some portions may be incorrect. 0000000016 00000 n Cut the lemon into two halves and squeeze the juice into a glass. Lowry Building, 7th floor Small habits add up. Is it going to be like this life long? You are at risk because your anti-rejection medications decrease your immune system. Your transplant team includes a nutrition specialist (dietitian) who can discuss your nutrition and diet needs and answer any questions you have after your transplant. 0000001174 00000 n You may need to have blood tests several times a week and have your medications adjusted in the weeks following your transplant. Protein. 0000002144 00000 n 0000021604 00000 n These statements have not been evaluated by the US Food and Drug Administration. Do not visit if you have cold or flu symptoms such as a fever, cough, or runny nose. If your new kidney fails, you can resume dialysis or consider a second transplant. Best advice, do not smoke. Is coffee bad for kidney transplant patients? https://www.organdonor.gov/about/process/matching.html. We do not endorse non-Cleveland Clinic products or services. Bananas. OGQxODljOWNjNGUxMzA3MTBmNDk3YTZkZmE4OWY4N2RmMTNlOWIwN2M4YmY2 ZjRmOTUwM2VhMGIwNzM4ODgwNTY2MTJiZGNhZDZmYWZmZDRkZTdkMDllYjk5 YTY5ODA1NTdlMjNmMjdjMGI0ZDQ0ZjYyYzUzNTRjNzBlODIzMWE2MGZlMWIw Roberts IS. Dingli D (expert opinion). ODJlOTY2ZTAyNWVmNTk1ZjYwMzJlZTJiMDNlMzZmZWE3ZmM1ZTk2NDI0NmYy ZTI0NzgwOGNhN2VmODJjY2MxMTY4Zjg3MGUwMTczNWIyYjRhN2ZjYTZiNDE4 Can an 80 year old get a kidney transplant? ZTQzYmYwOTgyYzI4MmNlNmMxN2YzODAzMGE3NjA1YjAwMWUyYWJmOTAxYjZm YzcwY2JhNWQzN2M5OTA4NWIwZTkxNGMzYTUxZWNkOGVlYWI1MzM2OWEwZDJm So its not safe for lung transplant recipients to swim in fresh water of any kind, which includes ponds, lakes, creeks, rivers and streams. Y2MzM2YwMDM5YmY5Y2IyYTY3MDVkODI4ZmI2ZjRhNjA0NTFhOWE4ZmYzZTA0 If you have a history of a bleeding disorder you are at high risk for bad reactions to herbal supplements. The key to making a perfect cup of green tea is to drink it unsweetened. Prest prefers fresh lemon or lemon concentrate over powdered lemonade mixes, not only because they're free of added sugar, but also for the citric acid content. Scientific Registry of Transplant Recipients. Feehally J, et al., eds. Your transplant team will consider several factors when evaluating whether a donor kidney will be a good match for you. Your new kidney will make urine like your own kidneys did when they were healthy. Any way you do it, its a big plus for your health. ZjllZThlMjFkNTM2NjkzYzFiZTFmNjAxYjU2NmZmZmM3NjU1YWZmNGVlMjM3 However, some transplant medicines can increase your blood level of potassium, while other medicines may decrease it. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. During kidney transplant surgery, the donor kidney is placed in your lower abdomen. There are few studies to show if herbal supplements have real benefits and even less information in patients with kidney disease. Increasing number of living donor transplantation in this cohort will most likely improve outcome. Select Accept to consent or Reject to decline non-essential cookies for this use. Cleveland Clinic 1995-2023. Fluid intake should be 3-4 litres once kidney function is better. We conclude that transplantation in octogenarians is worthwhile. 0000001981 00000 n HLA desensitization in kidney transplantation. This decision depends on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life. Kidney Transplant. There's no need to cleanse your bladder per se, but it's important to drink enough water throughout the day for good bladder health, according to the National Institute on Aging. Low-phosphorus diet: Helpful for kidney disease? - Mayo Clinic In: Comprehensive Clinical Nephrology. Accessed April 28, 2019. No liability is assumed by Beth Israel Deaconess Medical Center for any errors or omissions. Acknowledgment: Reviewed by the Council on Renal Nutrition (04/2019). Y2UyMTk5NWE4YmNlMDQwYmFmM2JmOTEzNjIxYjViNjNjYjBmNDljYTQ0Nzdi People with kidney disease have to continually be cautious about the foods they eat and drink; the reason is that certain foods may cause harm to the. Putting lemon in your water provides an extra bonus because lemons have citric acid, and having more citric acid in your urine also helps prevent stones from forming. Unfortunately, when you consider lemon juice for kidney patients. Seeking the support of friends and family members can help you cope during this stressful time. 7z 2D)AV r+IED*"lFa*c`\ Transplants involving a donor and recipient with incompatible blood types are also possible but require additional medical treatment before and after transplant to reduce the risk of organ rejection. May 11, 2019. MDNmMThjNWQ1Y2RjMWIzNDI2NjhlM2EwOTdiNGMyNmJjNTIwMTBlNjZhYmE1 During this time, if you live in another town, you may need to make arrangements to stay near the transplant center. The juice of one whole lemon has 18 milligrams of vitamin C, about 30 percent of the Daily Value, yet it has only about 10 calories, according to the USDA. Can kidney patient drink water? https://www.organdonor.gov/about/process/transplant-process.html. Some herbal supplements that have phosphorus include: Which herbal supplements should I avoid if I have kidney disease? The herbal supplement market is a multi-million dollar business. Accessed Aug. 17, 2021. Theoretically, lemon acid can be harmful to your enamel, but After a kidney transplant, plan to follow a diet low in salt and high in fiber. But be sure to check in with your transplant team before starting or changing your post-transplant exercise routine. When? <<63F376E7CB563D459FAA7FC46983AA84>]>> Lemon water has very few calories. This will help keep your kidneys hydrated and working well. The medications lead to excess weight gain. American Journal of Transplantation. It is helpful to. National Kidney Foundation. AskMayoExpert. Elsevier; 2020. https://www.clinicalkey.com. As with anyone, patients with kidney disease may have other health related issues. Too much lemon water can cause nausea, diarrhoea and vomiting. Sharon Herrr, RD, CDN. Costs will include tests, organ procurement, surgery, hospital stays, and transportation to and from the center for the procedure and follow-up appointments. A kidney transplant is a procedure where a new donor kidney is placed in your body. ABO incompatibility in kidney transplantation. https://www.srtr.org/reports/opo-specific-reports/. Survival benefit with kidney transplants from HLA-incompatible live donors. During the cooler months of the year, the lemon juice can be combined with a variety of spices (turmeric, cloves, cinnamon, mint leaf). Shop / Its when you are thirsty. That is enough about lemon. Don't smoke. youre diluting it here. In general, it is not recommended for patients with kidney disease to use herbal supplements. This can lead to eating larger portions and eating more often than usual, causing weight gain. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers. A simple habit that can yield big results. Many believe that a squeeze of lemon juice in the morning is a fix for countless health concerns. What are skin care recommendations for a kidney transplant patient? How much? Their main function is to filter and remove waste, minerals and fluid from the blood by producing urine. Herb-Drug Interaction Handbook, second edition. Accessed Aug. 12, 2021. However, the acidity in the lemon juice may cause tooth sensitivity or damage the enamel in some people, making the teeth prone to cavities. The Benefits of Lemon for the Bladder and Kidneys | livestrong The NKF advises drinking lemon juice concentrate mixed with water to help maintain a healthy pH and citrate level in your urine. Now available: new PatientSite design and features for a simpler user experience. Bananas, figs, pineapple, raisins Controlling weight gain Patients taking glucocorticoids (prednisone) after kidney transplantation often have very large appetites and can feel hungry all day. You'll have fewer dietary restrictions than if you were receiving dialysis therapy before your transplant, but you still may need to make some diet changes. Disclaimer: The entire contents of this website are based upon the opinions of Healthy Kidney Inc. and Robert Galarowicz, unless otherwise noted. Countdown of the Top 3 Drinks for Kidney Health Lemon- or lime-based citrus juice. Avoid alcohol: people with kidney disease should avoid alcohol as this beverage has no health benefits. Unless your own kidneys are causing complications such as high blood pressure, kidney stones, pain or infection, they are left in place. End-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally. For those who are receiving dialysis treatment, water must actually be greatly restricted. Rather than donating a kidney directly to you, your donor may give a kidney to someone who may be a better match. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. At Mayo Clinic, health care professionals trained in many medical specialties work together as a team to ensure favorable outcomes from your kidney transplant. Kidney transplant program waitlisting rate as a metric to assess transplant access. Is lemon good for kidney transplant patient? In summary, coffee is an acceptable beverage for kidney disease. Also, your kidneys cannot clear waste products that can build up in your body. What should be my water intake after a kidney transplant? L%^Rggur``WTt!UlDj^pa,.? Despite milks high calcium content, its phosphorus content may weaken bones in those with kidney disease. The lemon water contains citrate which prevents the calcium from binding to other substances and forming stones. 0000003317 00000 n Dialysis issues prior to and after kidney transplantation. Search for doctors by name, specialty, hospital, or location. But is there any evidence that lemon is good for the bladder and kidneys? It'd good to maintain an alkaline diet. Eating at least five servings of fruits and vegetables each day, Avoiding grapefruit and grapefruit juice due to its effect on a group of immunosuppression medications (calcineurin inhibitors), Drinking low-fat milk or eating other low-fat dairy products, which is important to maintain optimal calcium and phosphorous levels, Staying hydrated by drinking adequate water and other fluids each day. Question: Why Cant Transplant Patients Drink Anything But Bottled Water. Contact. It's preferable to get a kidney from a donor whose blood type matches or is compatible with your own. MjA2MmU3NjllMjU4YzFjMWE4MTQzODQxZmU1MmVlNzM2MWM4MWFhZTNiODI0 Why cant kidney transplant patients eat grapefruit? With regards to the kidneys, lemon water has three beneficial effects: 1) vitamin C protects the kidney from inflammation and free radicals, 2) the extra fluid cleanses the kidney by removing the toxins, 3) the acidity of the juice can help prevent the development of certain types of kidney stones. In: Brenner & Rector's The Kidney. Can herbal supplements interfere with the other medicines I take? OVER THE COUNTER TRANSPLANT RECIPIENTS - University of Pennsylvania Use unsaturated oil for cooking. Avoid adding salt when cooking or at the table, instead you could try using pepper, herbs, spices, lemon juice, vinegar etc which will not affect your blood pressure. Advertising on our site helps support our mission. trailer If a compatible living donor isn't available, your name will be placed on a waiting list for a deceased-donor kidney. The organ transplant process. Is Turmeric Good For Kidney Transplant Patients? All Rights Reserved. Advertising revenue supports our not-for-profit mission. Effects of lemon on kidney patients are due to the following things. After you leave the hospital, close monitoring is necessary for a few weeks to check how well your new kidney is working and to make sure your body is not rejecting it. Conditions that may prevent you from being eligible for a kidney transplant include: Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option. Some herbal supplements that act like a diuretic or "water pill" may cause "kidney irritation" or damage. 110 Francis StreetBoston, MA 02215. Drinking lots of water with lemon juice can be good for your bladder and kidneys. Drinking lots of water with fresh lemon or lemon concentrate can be good for your bladder and kidneys because it helps to reduce your risk of kidney stones and bladder infection. One of the keys to a successful recovery is staying well-hydrated. Most people will need about two liters of fluids per day. Learn more in our Cookie Policy. That helps flush out any bacteria, which can lead to a urinary tract infection, sometimes called a bladder infection and that extra boost of vitamin C could be beneficial. While transplanted organs can last the rest of your life, many dont. After a kidney transplant, you can expect to: Spend several days to a week in the hospital. Zjc3MzZlNzNkZTVjZGRhNjZiM2U5YzkyYTFjMmRkNDQ4MzM1N2VlYWViZTFi If you prefer to buy freshly squeezed lemon juice, always read the label because most commercial brands are heavily processed and may contain large amounts of preservatives, sugar, and other coloring agents. It is helpful to cure urinary tract infections. Despite filtration systems and diligent homeowner care, private home maintenance is not federally regulated and can become easily contaminated from the environment. For each glass, you may need one/two lemons. Is it safe to use herbal supplements if I have kidney disease? Weighing the Side Effects and Benefits of Drinking Lemon With Water, 5 Ways Drinking Lemon Juice Helps Your Body. How long you have to wait for a deceased donor organ depends on the degree of matching or compatibility between you and the donor, time on dialysis and on the transplant waitlist, and expected survival post-transplant. https://www.kidney.org/atoz/content/kidneydiscauses. Orandi BJ, et al. What are the signs of drinking too much water? It may also help speed your recovery from surgery. https://transplantliving.org/kidney/. https://www.uptodate.com/contents/search. Eat a healthy diet: It is important for people with kidney disease to eat a healthy diet. Accessed Aug. 12, 2021. But for certain people with kidney failure, a kidney transplant may be riskier than dialysis. Accessed Aug. 21, 2021. The flavonoids also have anti-inflammatory and antioxidant properties. Generated by Wordfence at Mon, 1 May 2023 15:02:21 GMT.Your computer's time: document.write(new Date().toUTCString());. In the first month following kidney transplantation you will be recovering from the stress of surgery. Foods to Avoid After Transplantation | National Kidney Foundation . Top 5 healthy drinks for people with kidney disease Costs that will be incurred before, during and after the transplant. https://www.uptodate.com/contents/search. Accessed April 28, 2019. 2019; doi:10.1111/ajt.15364. Lemon water is a drink and does not replace a visit to the doctor. Nectar (apricot, peach, or pear; cup servings) Root beer. The third and final matching test involves mixing a small sample of your blood with the donor's blood in the lab. Urinary tract infection (UTI) remains a significant cause of infectious complications in renal transplant recipients. Lemon juice for your kidney is healthy. MzBlNzNlZWZhMGRkYjZhNGI5ODlmNWYxMmVjOGUxYzk4ZmNmMzYxYWRiNzRk organdonor.gov. Uva Ursi and parsley capsules may also have bad side effects. What should I tell my doctor, dietitian or other healthcare provider? All rights reserved. It's normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work or other issues after a transplant. This creates a hormone reaction that makes you feel stressed and tired. Because these anti-rejection medications make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications. During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Plain Carbonated water is good for CKD as it turns basic. Some common concerns include: Potassium is a mineral that may need to be limited in the diet of people with kidney disease especially for those on dialysis. It really doesnt matter. Iron deficiency anemia, common in ESRD, along with fluid restrictions, make ice and freezer frost substances that dialysis patients may be especially likely to crave [13]. The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, just above one of your legs. Venkataraman V, et al. Lemon water helps prevent painful stones in those deficient in urinary citrate (a form of citric acid). xb```b``Ab, @zZqSSV{9G/BhStJ[PHDMXu@ 3v]=%U_s`gXhgbzDG;{> Your dietitian will also provide you with several healthy food options and ideas to use in your nutrition plan. UNOS Transplant Living. Avoid lifting objects weighing more than 10 pounds or exercising other than walking until the wound has healed (usually about six weeks after surgery). This is not a very good explanation on why lemon water is bad for the kidney patient. Soon after your transplant, you should walk as much as you can. Nutrition After Kidney Transplant | Patient Education | UCSF Benioff If both donors and recipients are willing, doctors may consider a paired-organ donation. Aim to drink 3 to 4 liters of water (1 gallon) each day to prevent kidney stones, says Chicago-based Melissa Prest, DCN, RDN, doctor of clinical nutrition with the National Kidney Foundation of Illinois and spokesperson for the Academy of Nutrition and Dietetics. The health risks associated with a kidney transplant include those associated directly with the surgery and rejection of the donor organ. Drinking too much water causes your kidneys to work too hard to remove the excess amount. After a transplant, regular exercise helps boost energy levels and increase strength. A kidney donor can be living or deceased, related or unrelated to you. It keeps your mind and body hydrated. https://www.uptodate.com/contents/search. Additional factors your transplant team may consider in finding the most appropriate donor kidney for you include matching age, kidney size and infection exposure. Hart A., et al. This is typically done to treat kidney failure. I introduce affordable life, accident & critical illness plans to employees at no cost to the company. Testimonials are not representative of typical outcomes. ZmEwOWM4NjAwZTVkMDM3NGUwOGY1MjJlZmNmMjVjN2YzMTdjYTdlMGUwZTI0 This button displays the currently selected search type. There is no single miraculous food or beverage that can reverse kidney damage, prevent weight gain, or reduce the risk of cancer. But reaching and maintaining a healthy weight through diet and exercise is just as important for transplant recipients as it is for everyone else to reduce the risk of heart disease, high blood pressure and diabetes. Lemon water is also a good beverage for people who work out or work in hot weather. The new kidney's ureter is connected to your bladder. "Lemonade, on the other hand, only has about 0.03 gram of citrate per ounce.". All rights reserved. Overview of renal replacement therapy (RRT) for children with chronic kidney disease. Take starting your day with lemon water, for instance. Herbal teas interfere with cyclosporin levels in renal transplant patients It is important to understand that this is not an alternative treatment to the traditional medical treatment of kidney stones but a complementary therapy. So this can be a big learning curve. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD. A touch of honey, sugar, or salt may help take away the bitterness. You can prepare." As long as you dont make a habit of sucking on lemons You can use the comment section to share your contact or kidney disease details and reach us. MjYzIn0= Your dietitian's recommendations after kidney transplant may include: Once you recover from your transplant surgery, exercise and physical activity should be a regular part of your life to continue improving your overall physical and mental health. Best of all, walking is free and devoid of any complications. Privacy Policy / Besides vitamin C, the juice is rich in folate, potassium and vitamin B. Immune system: Drinking lemon water regularly can help boost the immune system. Learn more. You may hear from a friend or family member about an herbal supplement that they think has improved their health or well-being and they suggest it to you. Can You Drink After A Kidney Transplant - HealthyKidneyClub.com Accessed April 28, 2019. Green tea may also lower your risk of developing kidney stones. %PDF-1.4 % Some forms of kidney disease may return after a transplant. 0 Kidney transplants are performed with general anesthesia, so you're not awake during the procedure. 2019 National Kidney Foundation. Internal medicine specialist Roxanne B. Sukol, MD, MS, discusses seven reasons why you should consider adopting this super simple habit. To compensate I am drinking 6 litres of water daily. End-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally. It is important to communicate all the medicines you are taking to your Drinking lemon water or lemon juice cannot worsen the condition of chronic . 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). What color is urine when your kidneys are failing? American Journal of Transplantation. Your transplant team can also assist you with other useful resources and coping strategies throughout the transplant process, such as: After your kidney transplant, you may need to adjust your diet to keep your new kidney healthy and functioning well. Plus, drinking water regularly can become monotonous. coma. Organ transplant in highly sensitized patients, Breaking barriers: Helping Native Americans in need get the gift of life, Mayo Clinic Minute: Using AI to predict kidney failure in patients with polycystic kidney disease, Consider organ donation during Donate Life Month, Mayo Clinic expert: 3 advances lead to more lifesaving organ transplants, Mayo Clinic Minute: Breaking barriers for patients who need kidney transplants, Five ways AI promises to transform organ transplants, Transplant program at Mayo Clinic in Florida celebrates its 25th anniversary with vision for future of transplant, From civil rights to transplant awareness, advocate continues to make a difference, Solid organ transplant patients are at higher risk of skin cancer and require coordinated care, Mayo Clinic researchers find, Upper Midwest Emmys recognize Mayo Clinic for storytelling excellence, Expert Alert: What a formula change may mean for Black patients in need of a kidney transplant, Mayo Clinic Q&A podcast: Father-daughter duo taking part in Transplant Games of America, Ask the Mayo Mom: Polycystic kidney disease can affect children, too, Mayo Clinic study confirms living kidney donor surgery is low risk for most patients, Expert Alert: 5 reasons to consider becoming an organ donor, Mayo Clinic Q&A podcast: Living donor climbs Mount Kilimanjaro on World Kidney Day, Mayo Clinic, Carnegie Mellon University to collaborate on transplant innovation, Lifestyle changes can be critical for kidney transplant patients' long-term survival, Mayo Clinic Q and A: Transplant options for patients who are obese, Innovative program enables patients who are obese to get kidney transplants, Sharing Mayo Clinic: Kidney transplant gets chef back to the kitchen, Mayo Clinic Minute: Long-term survival improving for kidney transplant patients, Expert Alert: 3 reasons why more organ donors from diverse backgrounds are needed, Mayo Clinic Q and A: The connection between skin care and transplant, Infographic: Pancreas-kidney transplant for diabetics, What you might not know about being an organ donor, Infographic: Pancreas and kidney transplant for diabetics, Chronic, uncontrolled high blood pressure, Chronic glomerulonephritis an inflammation and eventual scarring of the tiny filters within the kidneys, Dementia or poorly controlled mental illness, Any other factor that could affect the ability to safely undergo the procedure and take the medications needed after a transplant to prevent organ rejection, Leaking from or blockage of the tube that links the kidney to the bladder (ureter), Failure or rejection of the donated kidney, An infection or cancer that can be passed on from the donated kidney, Increased risk of cancer, particularly skin cancer and lymphoma, Learn about the number and type of transplants the center performs each year, Ask about the transplant center's kidney transplant survival rates, Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients, Find out if the center offers different donation programs that might increase your chances of receiving a living-donor kidney. NjM4ODJlOWNlMzYzYWRjOTkyYjQ0N2YyNjgzMWRiNDFhYjFhZDc1YWJlMjc3