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PostPosted: Tue Nov 22, 2016 10:36 pm 
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Sorry if this is in the wrong forum section. Admin, Please, move it if need be and let me know where these types of questions should go.

I currently take suboxone, lamotrigine, mirtazapine, ambien, and prazosin for nightmares. I am trying to get a side job in addition to my current job and have had to take a drug test. The drug test that I had to take was a standard "pee in cup" 12 panel test. I've taken three tests. All three have came back positive for PCP and methadone.

I have not done either of these two substances. I have taken methadone in the past, but not for several years. I did some research and found that lamotrigine will come as being a false-positive for PCP a very alarming ammount of time on these cup tests. I have my explanation there, but I have not found anything about these medications giving a false-positive for methadone.

Do any of you have any shared experiences with this sort of thing, or information that might be helpful to me?

Thanks for the help

-Z


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PostPosted: Wed Nov 23, 2016 11:11 am 
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Unfortunately ur not the first to experience false positives on drug screens. I don't know anything about the medication ur talking about but hopefully someone else will or Dr.Junig or docm2 will respond.

What happened, did u explain to the ppl that a medication ur taking is pretty notorious for giving a false positive? Or did they just not care to listen?

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PostPosted: Wed Nov 23, 2016 3:45 pm 
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I suggest that you print out any information you find. I'm a grad student with access to a great online library, so I will take a look to see if this particular false positive has any information via scientific evidence.

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PostPosted: Wed Nov 23, 2016 7:14 pm 
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Amy-Work In Progress wrote:
I suggest that you print out any information you find. I'm a grad student with access to a great online library, so I will take a look to see if this particular false positive has any information via scientific evidence.

Amy


Amy, your help would be greatly appreciated! I hope that you may be able to find something for me. I looked, and looked, and looked, but couldn't find anything on the web about any of the meds that I'm taking throwing a false-positive for methadone. One of the meds that I saw that could give a false-positive was a blood pressure medicine that was similar to prazosin, but I can't remember the name of it. I'm going to look to see if I can find it again and let you know what it was. Thank you for getting back in touch!

jennjenn wrote:
Unfortunately ur not the first to experience false positives on drug screens. I don't know anything about the medication ur talking about but hopefully someone else will or Dr.Junig or docm2 will respond.

What happened, did u explain to the ppl that a medication ur taking is pretty notorious for giving a false positive? Or did they just not care to listen?


Hello, Jennifer. I'm going to take them the information that I can find, and I'm sure my psych doc (who also prescribes my subs) will help me out too. I've got to talk to her when she gets back after thanksgiving, though. I still can't figure the thing out about the methadone. I took a UA that was sent to the lab for testing for my sub doc the other day, and it came back fine. Those cup tests are just crap. But, still, it came back positive on three different tests! What the heck is going on with that?! Thanks for replying to me.


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PostPosted: Wed Nov 23, 2016 8:33 pm 
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By the way, you should be able to submit a new test right away if you are contesting the results. Still looking. Or have a blood test done instead.

Amy

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PostPosted: Wed Nov 23, 2016 9:42 pm 
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Hi ramblinz, wow, no experience with the false positive, Idk WHAT is going on with that!? But I just wanted to welcome you to the forum.


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PostPosted: Wed Nov 23, 2016 10:47 pm 
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Bamagurl22 wrote:
Hi ramblinz, wow, no experience with the false positive, Idk WHAT is going on with that!? But I just wanted to welcome you to the forum.


Thanks for the welcome! I take it that you're from Bama? ha. I'm from MS. About 30 minutes from Mobile. I guess I should probabaly post an introduction. I've lurked on here for quite a while, but just joined yesterday when this situation arose. I figure someone might be able to help me out, and also get some support and maybe be able to help someone else out myself!

Amy-Work In Progress wrote:
By the way, you should be able to submit a new test right away if you are contesting the results. Still looking. Or have a blood test done instead.

Amy


Hey, Amy. The way that these people are talking, they won't send it off to a lab because it costs too much. I'm hoping that my docs from the VA will provide me with some type of explanation. I'm sure everything will come out for the best, by the will of God.


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PostPosted: Thu Nov 24, 2016 7:10 pm 
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I bought a couple home drug tests, and they are all showing positive for pcp and methadone still. I've been taking my normal medicine regimen as usual, so I've got to assume that it's one of my meds making this happen. I have no other explanation. If any of you have had any problems with the same type of issues, please, let me know.

In the pictures I posted, you can clearly see the positive results for methadone, bupe, and PCP.

You can't see the line very well, but there is a line on the MDMA line for a negative result. Just wanted to make that clear!


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PostPosted: Fri Nov 25, 2016 7:56 am 
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Wow that's scary that something like that can actually happen. We work so hard to gain trust. I hope u can prove it's one of ur other medications making this happen. Don't give up on it!

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PostPosted: Sat Nov 26, 2016 3:27 am 
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So far I have not been able to find a link between your medications and false positives for PCP. I did find this article:

How often do false-positive phencyclidine urine screens occur
with use of common medications? *
ARVIND RENGARAJAN and MICHAEL E. MULLINS
Division of Emergency Medicine, Washington University, St. Louis, MO, USA
Background. Previous reports describe false-positive urine immunoassay screens for phencyclidine (PCP) associated with use of tramadol,
dextromethorphan, or diphenhydramine. The likelihood of these false positives is unknown. Objective. We sought to fi nd the relative
frequency of false-positive PCP screens associated with these medications and to look for any other medications with similar associations.
Methods. In an IRB-approved study, we retrospectively reviewed charts of all ED encounters with positive urine screens for PCP in our
hospital from 2007 through 2011, inclusive. Urine samples were tested for drugs of abuse using the Siemens Syva EMIT II Immunoassay.
Our laboratory routinely confi rmed all positive screens using GC-MS with results classifi ed as either “ confi rmed ” (true positive) or “ failed
to confi rm ” (false positive). We recorded all medications mentioned in the chart as current medications or medications given before the
urine sample. We used Fisher ’ s exact test to compare frequencies of tramadol, dextromethorphan, diphenhydramine, and other medications
between the two groups. Results. Tramadol, dextromethorphan, alprazolam, clonazepam, and carvedilol were signifi cantly more frequent
among the false-positive group, but the latter three were also associated with polysubstance abuse. Diphenhydramine was more frequently
recorded among the false-positive group, but this was not statistically signifi cant. Conclusion. False-positive urine screens for PCP
are associated with tramadol and dextromethorphan and may also occur with diphenhydramine. Positive PCP screens associated with
alprazolam, clonazepam, and carvedilol were also associated with polysubstance abuse.
Keywords Phencyclidine ; Tramadol; Dextromethorphan; Diphenhydramine; False positive test
Introduction
In 2010, the Drug Abuse Warning Network (DAWN)
recorded over 4.9 million Emergency Department (ED) visits
in the 10 US metropolitan areas covered in the network. 1
Of these, 53,716 ED visits were classifi ed as involving phencyclidine
(PCP) with positive toxicology testing in 28,938 of
these visits.
Urine drug screening in the ED usually involves immunoassay
testing for major classes of drugs of abuse. Most
hospitals do not routinely perform secondary testing to
confi rm positive screen results. Therefore, the true rate of
false-positive urine drug screens is unknown. False-positive
drug screens for illicit drugs can lead to an incorrect treatment,
prejudice from nursing and physician staff, increased
healthcare expenditures, and adverse legal or employment
action.
Published reports describe false-positive urine screen for
PCP associated with certain commonly used medications
such as tramadol (Ultram ® ), 2 – 4 dextromethorphan (cough
suppressants with ‘ DM ’ in the name), 5 – 7 and diphenhydramine
(Benadryl ® ). 8,9 This is likely due to structural
similarities including 2 six-member rings separated by one
atom of carbon or nitrogen (Fig. 1). However, the frequency
of such false-positive results is unknown. The objective of
this study was to determine the frequency of false-positive
urine screens for PCP in association with reported use of
medications.
Methods
The approach for this IRB-approved, retrospective study
was very similar to a previous study of false-positive urine
drug screens for amphetamines associated with the use of
bupropion by Casey et al. 10 We reviewed ED and hospital
charts for patients presenting to the Barnes-Jewish Hospital
ED from 2007 to 2011 with a positive urine screen for PCP.
All urine specimens were tested using the Siemens Syva
EMIT II Immunoassay ™ on a Siemens Dimension ™ analyzer
(Siemens Healthcare Diagnostics; Deerfi eld, IL). Our
hospital laboratory confi rms all positive screen results and
used the Hewlett-Packard 5890 Chromatograph with an SPB
35 column for GC-MS confi rmation of PCP throughout the
Clinical Toxicology (2013), 51, 493–496
Copyright © 2013 Informa Healthcare USA, Inc.
ISSN: 1556-3650 print / 1556-9519 online
DOI: 10.3109/15563650.2013.801982
BRIEF COMMUNICATION
Received 19 February 2013 ; revised 27 April 2013 ; accepted 30
April 2013.
* This work has previously been presented at the SAEM Great Plains
Regional Research Forum on September 29, 2012 and the Graduate Research
Symposium at Washington University in St. Louis on February 16, 2013.
Address Correspondence to Michael E. Mullins, MD, Division of
Emergency Medicine, Washington University, 660 S. Euclid Avenue,
Campus Box 8072, St. Louis, MO 63110, USA. E-mail: mullinsm@wusm.
wustl.edu
Clinical Toxicology vol. 51 no. 6 2013
494 A. Rengarajan & M. E. Mullins
period of this study. We then divided these patients into two
groups: those that were “ confi rmed ” by GC-MS, and those
that were “ non-confi rmed ” , either because of an interfering
substance or because the concentration of PCP was below
the reportable threshold of 25 ng/mL.
We recorded documented use of tramadol, diphenhydramine,
and dextromethorphan, as well as any other medications
that frequently appeared. We defi ned “ documented
use ” of a particular medication if one of the following was
applicable: 1) a medication the patient was already taking at
the time of the visit on which the UDS was performed, 2) a
medication that was administered in the ED on the visit the
UDS was performed but before the results of the UDS were
given, and 3) a medication that was prescribed on the preceding
ED visit. We then compared the proportions of each
medication within the “ confi rmed ” and “ non-confi rmed ”
groups. The null hypothesis of each comparison was that the
frequency of a given medication would be the same in both
groups.
We defi ned polysubstance abuse as recorded use or detection
of any combination of three controlled or illicit drugs or
any combination of two controlled or illicit drug plus ethanol
within the index ED visit or the preceding or following ED
visit.
Before starting the data extraction phase of the project,
researchers met to clearly defi ne variables and standardize
data collection. Weekly meetings were scheduled to discuss
progress and to ensure uniform handling of data that were
confl icting, missing, or ambiguous. The rater was not blinded
to the purpose of the study.
All protected health information (PHI) was de-identifi ed
and recorded into a password-protected Microsoft Excel ®
(Microsoft; Redmond, WA) fi le for tabulation and statistical
comparisons. We used Fisher ’ s exact test (GraphPad
Software, www.graphpad.com) to compare the observed frequencies
of reported use of tramadol, dextromethorphan, and
diphenhydramine as well as other medications mentioned in
the ED charts of patients with confi rmed or non-confi rmed
positive urine PCP screens. We adjusted the p value to 0.001
for multiple comparisons.
Results
Between 1 January 2007 and 31 December 2011, 33,972
urine drug screens were performed by the laboratory at
Barnes-Jewish Hospital on patients presenting to the ED.
Out of 33,972 urine screens, 491 (1.4%) screens were positive
for PCP. Of those 491, 391 (79.6%) were confi rmed
positive for PCP by GC-MS, 88 (17.9%) failed to confi rm,
and 12 (2.4%) were excluded because of inadequate urine
volume.
Among the 391 confi rmed positives, patient charts
refl ected documented use of tramadol in 32 patients (8.2%,
95% CI: 5.5 – 10.9%), diphenhydramine in 37 patients (9.5%,
95% CI: 6.6 – 12.4%), and dextromethorphan in eight patients
(2.0%, 95% CI: 0.6 – 3.4%). Among the 88 who failed to
confi rm, records refl ected documented use of tramadol in 19
patients (21.6%, 95% CI: 13.0 – 30.2%), diphenhydramine in
13 patients (14.8%, 95% CI: 7.4 – 22.2%), and dextromethorphan
in 21 patients (23.9%, 95% CI: 15.0 – 32.8%). The
p values for tramadol, diphenhydramine, and dextromethorphan
were 0.008, 0.175, and 0.0001, respectively.
Alprazolam, clonazepam, and carvedilol unexpectedly
were also signifi cantly overrepresented (p 0.001, 0.001,
and 0.003, respectively) among patients with PCP screens
which failed confi rmation. Of the 391 confi rmed positives,
four patients had documented use of alprazolam (1.0%, 95%
CI: 0.0 – 2.0%), two patients with clonazepam use (0.5%,
95% CI: 0.2 – 1.2%), and four patients on carvedilol (1.0%,
95% CI: 0.0 – 2.0%). The 88 patients with PCP screens that
failed to confi rm included nine patients with recorded use of
alprazolam (10.2%, 95% CI: 3.9 – 16.6%), eight patients with
clonazepam (9.1%, 95% CI: 3.1 – 15.1%), and eight patients
with carvedilol (9.1%, 95% CI: 3.1 – 15.1%).
Figure 2 illustrates the proportions of these six medications
among patients with confi rmed or non-confi rmed positive
PCP urine screens.
Discussion
All three of the medications suggested by previous case
reports had higher proportions in the non-confi rmed group
than among the confi rmed positive group. However, these
differences were signifi cantly different for tramadol and dextromethorphan
but not for diphenhydramine, which showed
a nonsignifi cant trend for positive PCP screens which failed
confi rmation by GC-MS.
The manufacturer ’ s information acknowledges a crossreaction
with dextromethorphan (at 121 mcg/mL or 121,000
ng/mL). 11 Tramadol, diphenhydramine, alprazolam, and
clonazepam are listed as not cross reacting at concentrations
up to 1000 mcg/mL, but the list does not mention
carvedilol.
Unexpected drugs with signifi cant disproportion of false
positive PCP screens included alprazolam, clonazepam, and
carvedilol. This fi nding might be due to the fact that these
medications appear to share some structural similarity with
PCP, each with 2 six-member rings that are one atom apart
(Fig. 3). However, somewhat similar two-dimensional structures
may have quite different three-dimensional structures.
Fig. 1. Structures of PCP, tramadol, diphenhydramine, and
dextromethorphan.
Copyright © Informa Healthcare USA, Inc. 2013
False positive PCP screens 495
An alternative explanation for the unexpectedly high
frequencies of alprazolam, clonazepam, and carvedilol may
be associated with polysubstance use. Out of nine patients
with alprazolam, all met criteria for polysubstance use, and
one presented with a combined overdose which reportedly
included acetaminophen, alprazolam, clonazepam, diphenhydramine,
ibuprofen, paroxetine, tramadol, and zolpidem.
The results for clonazepam were less clear. Out of eight
patients with recorded use of clonazepam, four met criteria
for polysubstance abuse (including the previously mentioned
patient with the multiple-drug overdose).
Carvedilol is commonly used in patients with cardiomyopathy
and heart failure. Its appearance in this data set may
refl ect the nonischemic cardiomyopathy from substance
abuse. Out of eight patients with reported use of carvedilol,
fi ve met criteria for polysubstance abuse.
Another limitation is that we could not obtain the original
chromatographs to confi rm the presence of any of the
medications associated with non-confi rmed positive PCP
screens or to identify which GC-MS analyses detected PCP
below the reporting limit of 25 ng/mL. For example, one
patient with a recorded prescription for carvedilol had a
non-confi rmed PCP screen on one visit and a confi rmed
PCP screen on the next ED visit. In this case, we can neither
confi rm his compliance with carvedilol nor disprove a
measurable PCP concentration below 25 ng/mL on the fi rst
visit. We propose a future study of patients taking carvedilol
to determine whether carvedilol (or a metabolite) actually
causes false-positive PCP screens.
Only one patient in our data set received an ED diagnosis
of PCP use solely on the basis of the positive screen which
was subsequently non-confi rmed. This patient presented
with an overdose of diphenhydramine. Her urine drug screen
was positive for PCP (non-confi rmed) and opiate (confi rmed
codeine and norcodeine), and she had detectable ethanol in
her serum. Most hospitals do not routinely confi rm every
positive screen result, so similar patients in other settings
would simply be assumed to be using PCP.
Fig. 3. Structures of PCP, alprazolam, clonazepam, and carvedilol.
Fig. 2. Observed proportions of tramadol, diphenhydramine, dextromethorphan, alprazolam, clonazepam, and carvedilol among patients with
confi rmed and non-confi rmed PCP screens. Whiskers represent the 95% confi dence intervals around these proportions (colour version of this
fi gure can be found in the online version at www.informahealthcare.com/ctx).
Clinical Toxicology vol. 51 no. 6 2013
496 A. Rengarajan & M. E. Mullins
As with most retrospective studies, a limitation of our
study is the assumption that the information recorded in
patient ’ s chart was correct, complete, and accurate. Also,
this was a single-center study, of which the results might not
be generalizable to other patient populations.
The investigator who abstracted data from the charts was
not blinded to the purpose of the study. However, the data
elements were recorded by ED nurses, physicians, and/or
hospital laboratory technicians at the time of the ED encounters,
when the study was not yet conceived. Identifying the
presence or absence of the data elements in a given chart was
objective, so we believe that unblinded data abstraction did
not appreciably bias the results.
Another potential limitation is that we did not stratify
our sample based upon renal or hepatic function. We did
not record serum concentrations of creatinine or hepatic
enzymes because most patients were missing one or both.
We believe that any hepatic or renal abnormalities would be
equally distributed among both of our study groups.
Conclusion
Tramadol, dextromethorphan, alprazolam, clonazepam, and
carvedilol were signifi cantly associated with false-positive
urine screens for phencyclidine. Diphenhydramine was
among the most frequently identifi ed medications among
patients with false-positive screens for phencyclidine but
did not reach statistical signifi cance. The associations with
alprazolam, clonazepam, and carvedilol may more likely
refl ect ongoing illicit drug use than cross-reaction with the
immunoassay.
Declaration of interest
The authors report no declarations of interest. The authors
alone are responsible for the content and writing of the
paper.
This work was supported by NIH Clinical and Translational
Science Award program through the National Center
for Advancing Translational Sciences under award numbers
UL1 TR000448 and TL1 TR000449.

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PostPosted: Sat Nov 26, 2016 3:40 am 
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The information I found on prazosin looks encouraging as it relates to your nightmares. It's being more widely used now for PTSD symptoms. It's also being looked at as a drug that can decrease the desire for alcohol. I found one source that claims that the medication is particularly effective on PTSD if the person had high blood pressure before developing PTSD. Prazosin is being studied extensively in many clinical trials.

I found this:

"Drugs of Abuse Testing
Screening tests generally are performed to identify presumptively positive specimens. Positive
screening results are followed by confirmation with a different, a more specific analytical test,
usually gas chromatography/mass spectrometry (GC/MS). Confirmation utilizing a more
specific method is necessary since immunoassays, which are widely used as screening tests, have
a relatively high rate of false positive (FP) and false negative (FN) results. FP results are
generally due to the fact that the antibodies used in immunoassay technologies may recognize
substances which may have similar structural features as the drug of interest. Confirmation
testing is generally much more accurate, and can distinguish between drugs, their metabolites,
and other interfering substances in the sample. Confirmation testing of screen positive results is
performed by laboratories that use more specific alternative chemical methods such as GC/MS or
LC-MS/MS. In addition, clinical consideration and professional judgment should be applied to
any drug-of-abuse test result.
In the United States, medical testing and most drug screening programs require confirmation of
all positive screening test results and all invalid tests or runs. This enables good statistics of the
false positive rates for PCP and other drug tests. The Substance Abuse and Mental Health
Services Administration (SAMHSA) reports that 50% of PCP screening tests are false positive
tests (i.e., tests that do not confirm as positive tests with follow-up confirmation testing). High
quality testing programs will generally also perform confirmation testing on a portion of negative
tests. However, because in most populations, the number of negative screening results far
8
exceeds the number of positive results, even if 10% of the negative results are confirmed, it is
difficult to get a good estimate of the false negative rate for any particular program. There is
little information on the rate at which OTC test results, even positive results, are confirmed.
Various body fluids and tissues can be tested for the presence of drugs, such as blood, saliva,
hair, sweat and urine. Each sample matrix has advantages and disadvantages. For example, urine
testing, which is frequently used, is noninvasive and contains relatively high concentrations of
drugs and their metabolites for a reasonable duration after ingestion.7 However, the
concentration of drugs and drug metabolites in urine are influenced by urine flow, pH, hydration
status, and metabolism. Urine commonly indicates the presence or absence of drugs, but it
cannot easily be used to quantify levels or to determine the time or duration of use. Thus it is not
generally possible to prove whether an individual abuses a drug habitually, or sporadically and
casually. Also, it is not possible to correlate the presence of an abused substance in the urine
with any specific degree of central nervous impairment in the user. Saliva samples are easily
obtainable for testing and avoid the privacy and collection issues inherent to urine testing, but
drugs can only be detected in saliva for hours to days rather than days to weeks for urine
samples. Therefore, it is important that test matrices are chosen carefully for each particular
testing purpose.

The link is here:
http://www.fda.gov/downloads/AdvisoryCo ... 348937.pdf

Amy

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PostPosted: Sat Nov 26, 2016 3:42 am 
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Also, an idea. Offer to pay for the additional testing.

Amy

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PostPosted: Sun Nov 27, 2016 10:49 pm 
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Jenn and Amy,

I received the results from my drug test that was sent off to the lab from my sub doc from the VA. The test was done by gas Chromatography/mass spectrometry (GC/MS). It all came back negative for everything except for my suboxone, so that was good news. I still can't figure out why the cup tests were coming up positive for methadone, though. I'm puzzled. These results from this test is going to clear everything up, though. Thanks for the time and effort that y'all put forth to help me

-Z


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PostPosted: Mon Nov 28, 2016 1:07 pm 
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That's great news ramblinz!

U set the record straight, good for u :) thank u for coming bk and letting us know. I hope u stick around the forum.

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PostPosted: Tue Nov 29, 2016 4:01 pm 
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So glad to hear it!!

Amy

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