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PostPosted: Sun Oct 04, 2015 4:54 pm 
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Hi everyone, nice to see some familiar people still here.

The short version: I have been off Suboxone maintenance (16mg/day) for 2 years 8 months. I suffered from major depressive disorder prior to becoming an opiate addict (and yes, opiate agonists worked like a charm, until they didn't anymore). After coming off of Suboxone maintenance I had some very serious depressive episodes. My depression is treatment resistant, and I have been on 10+ medications/combinations over the years. Against my protests, my psychiatrist (who was previously my Sub doc) put me on 0.5mg buprenorphine/day for depression. It has been about 6 weeks now and I have been very stable.

The longer version: I relapsed a few times for short periods since I have been off the Sub. I take that very seriously. Each relapse occurred during a depressive episode. I was hospitalized for depression 15 months after stopping Sub, while clean. I had a genetic test done that showed that I don't metabolize a number of psychiatric medications properly. Between that, and the ones I am allergic to, and the ones that simply don't work for me, or worked for a while then didn't, I was ultimately offered ECT.
I am not opposed to ECT per se, but I am concerned about possible memory loss, especially now that I am doing post graduate work in college. I am also 49 *shudder* and having hormonal issues that just turned managing the depression into a shit storm. So now I am taking birth control pills to regulate my cycle, and buprenorphine really imo as more of a mood stabilizer than an antidepressant. It seems to keep me very level.

So, for those of you who know me, the prospect of this terrifies me. I had difficulties on Suboxone and difficulties coming off. The only reason I even agreed to it, ironically, is that my support people in NA strongly suggested I try doing what the doctor tells me rather than thinking I always know what's best for myself.

Just a couple of days ago I switched from the generic bupe tablet to the 2mg film, because I was having trouble cutting the tablets without them crumbling. I didn't even want to fill the script because I was afraid I would get the "junkie treatment" at the pharmacy as I had at times in the past. But actually, they were very kind to me. Also, just seeing those foil packs brought up some difficult memories for me. But I have to remember that I am different today, and my circumstances are different. And if and when the time comes to stop again, coming off 0.5mg won't be the same as coming off the high dose.

I believe Dr. Junig said that at very low doses bupe acts more like a short acting agonist, and doesn't have the 36 hour half life. So I won't have the "stacking" effect I did at higher doses.

Anyway, I know that was long winded, but I wanted to get it all off my chest. And I feel I owe it to you guys to give you all the information and experience that I have. Everyone here helped me a lot when I was going through tough times.
So thank you all,
Lilly


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PostPosted: Sun Oct 04, 2015 8:41 pm 
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Hi Lilly,

I've gained an appreciation for the horrible damage that major depressive disorder inflicts on the life of some people. The pain can be excrutiating-- and people should not be judged for whatever they find to relieve some of that suffering.

I think that over time, we will learn that some cases of major depression are caused by dysfunction in opioid pathways. Biodelivery Sciences is investigating treatments using buprenorphine, combined with other molecules. I have patients who do not respond at all to SSRI's, but DO respond to opioids. But the problems with opioids make them hard to use as a long-term treatment.

If buprenorphine makes you more stable, then more power to you. The effects of buprenorphine do not change over time-- unlike the effects of opioid agonists. One correction though--- it is about the same degree of difficulty stopping 1 mg of buprenorphine per day as it is to stop 16 mg per day. That is a function of the ceiling effect-- which causes the same tolerance for any dose above about 1-2 mg per day. But the 'good news' is that we know of no long-term problems with buprenorpine. The medication has been around for almost 40 years, and we know of no toxicity from buprenorphine.

So take it-- and try to enjoy life, without the heavy weight of major depressive disorder. If you need to stop buprenorphine at some point, you will manage it. But for now-- try not to even think about it. Taking an effective medication once or twice per day is a good exchange for living with depression.


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PostPosted: Mon Oct 05, 2015 3:15 pm 
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Hi Lilly,

It's so good to see you posting again here. And I'm very pleased that Dr. Junig was able to see your post and respond.

You've been a member for quite a long time and I do remember how hard you struggled to get off Suboxone the last time. But if your overall health is improved by small doses of Buprenorphine, then so be it.

Good luck with the peri-menopause. My wife found solid relief by seeking out a specialist in that field. Now she is on some hormone cream that is made by a compounding pharmacy and she is doing great. It's just a matter of regulating the right hormones in the correct dosages. Keep looking until you find the right provider. They are out there.

Welcome back and please continue to pop in whenever you can.

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PostPosted: Mon Oct 05, 2015 7:47 pm 
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Thank you Dr. Junig for taking the time to reply personally. It's helpful having someone who is an expert in the field confirm that the approach I am taking with my doctor is legitimate, and there is some science, and/or clinical experience to back it up.

I do have to admit that the prospect of having the withdrawals from 1mg possibly be as difficult as 16mg terrifies me. While my script is written for 1mg/day, I have been successfully only taking the first 0.5mg dose most of the time. The problem is that I can "feel" my dose because I am under the ceiling level. Its a dilemma for me because I want to take the lowest dose possible, but I don't want to feel an opiate effect (funny how things change when you've been in recovery a while).

Thank you rule62. Its great that you are still here as a moderator helping people. I know you are one of the people who remembers my last detox well. Thanks for the suggestion of the hormone cream. I am aware of what you are talking about. Unfortunately, my symptoms are so severe that I have to hijack my entire cycle with birth control hormones.

It's all a trade off. I really dont want to be on either med (as well as one other that I am on). But I have to weigh the overall quality of my life against the side effects of the meds. I've been looking for that "magic bullet" that is going to fix me, but it doesn't exist. I'm most torn about the Suboxone, but even my husband, (who is very anti-Sub after what I went through), feels that I am doing well on the low dose. It can be hard to judge our own mental health, so it helps to have a family member give feedback.

Thanks again,
Lilly


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PostPosted: Tue Oct 06, 2015 12:36 pm 
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Hi Lilly! I'm so glad you checked in and let us know how you are doing and what is going on. I just commented on a thread a few minutes ago where the subject is treatment-resistant depression and the use of bupe to combat it.

My opinion of psychiatry is that it is based in science, but is also somewhat artistic. The leap that has been taken by psychiatrists to treat some depressive disorder with bupe, now being studied, was probably a instinctual leap since there wasn't any evidence backing it up.

I'm happy for you that you have found a combination that is working for you. I would hate for you to be in pain.

Amy

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PostPosted: Wed Oct 07, 2015 9:40 am 
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Hi Amy,
Thanks for your kind words. Also thanks for posting the link about bupe for depression. I'm posting it again below for anyone who is reading this thread & hasn't seen the other one.
I had read that article before (as well as the Harvard study), but I appreciate you pointing me to the comments section, which was actually the most informative part. It's like you were saying about psychiatry being an art - it all lies in the experiences of real people.

For me, the jury is still out. I have actually tried low dose bupe twice prior to this. The first time I don't even count, because it only lasted a week. I wasn't ready to have a strong opiate in my hand again and started increasing my dose by day 2 - total addict behavior and I knew I was in trouble. The second time I stuck to my dose but I felt dysphoric, which is what I'm struggling with now. Is mild dysphoria for a few hours a day better than almost monthly bouts of severe depression? My husband thinks so, and I understand why, but he has never personally experienced the side effects of psych meds.

The gratitude thread reminded me you are working toward your addiction counseling degree. I am doing the same now. What is it with us addicts, huh? Everyone in my class is in recovery. I guess we all want to turn the most difficult experience of our lives into something positive - and we want to help alleviate the suffering of other addicts. We should compare notes on our programs.

:) Lilly

Bupe for depression article: http://mentalhealthdaily.com/2014/03/19 ... d-agonist/


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PostPosted: Fri Oct 23, 2015 9:14 am 
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Just thought I should update. And also, should this thread be moved to Buprenorphine and Mood, Mods?

Anyway, this is roughly week 9 for me. Like I said above, the .5 mg made me feel kinda crappy. Because the dose was so low, I could feel it kick in every day, and I felt foggy, tired & irritable.
I tried splitting my dose, which seemed to help, but if I took the second dose too late I had insomnia (Only opioid addicts know how that sleepy during the day, wakeful at night thing works, lol). I also started sleeping in a lot more, like going back to bed after kids go to school - like I used to do on the high dose - which troubles me (I'm between job assignments right now).

So, I ended up on the full 1mg that I was originally prescribed. I'm much more level, and don't really feel the daily up & down. I'm not depressed, but I feel a lot of the undesireable effects I had on the high dose, just to a lesser extent (unemotional, detached, less motivated, oversleeping, less sexual).

So I'm seriously considering putting an end to this experiment. The thought of going off 1mg being as bad as going off 16mg really, really bothers me. People keep telling me not to think about it, but I painfully went off Sub twice and I can't NOT think about it.

I've been looking for more info on Vortioxetine, the AD TeeJay had mentioned. Anyone know anything about it? I've read that it is fairly effective for people who don't do well on standard SSRIs and SNRIs, and has fewer side effects. When I see my doc next I'm going to ask her about it.

Hope something in all of this helps someone.
Lilly


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PostPosted: Mon Nov 02, 2015 3:56 pm 
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Another update:

Went to the psychiatrist today. Was feeling pretty discouraged about how I've been feeling on the Suboxone. I asked her about the Vortioxetine (Brintellix). She hadn't prescribed it to anyone yet, but said she heard it had a favorable side effect profile at a recent psychopharmacology conference. She gave me the samples she had (10mg) and I'm going to be cutting them in half because Wellburin, which I'm also on, potentiates it.

My original thought was to go on the Brintellix and go off of the bupe, but she talked me into trying it WITH the bupe because it is said to improve mental clarity and cognitive function.

Also, another member here said the Brintellix helped with the fogginess he experienced on Sub.

So, I'll let you guys know how it works if you're interested. Still considering going off the Sub - but the beginning of the holiday season usually isn't a good time for me to go off something.

Lilly


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PostPosted: Mon Nov 02, 2015 7:12 pm 
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Thank you for continuing to update us, Lily!

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PostPosted: Tue Nov 03, 2015 1:23 pm 
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Hi Lilly, Your story resonates with me so well! Some of what you are going through is the same for me. And, some of what you are going through I have supported my clients through. First me, I became addicted to tramadol that I was prescribed for osteoarthritis. I was also experiencing depression for the first time in my life as a result of menopause. My doc also prescribed sarafem which is an anti depressant designed for menopause. It did not work. In the meantime tramadol was, in increasing dosages, working on the joint pain and the depression. The problem was that I was taking more and more to get the same effect. I never wanted to be high just feeling my normal self without pain and without depression. So, long story short, August of 2014 the class of tramadol changed and I could not get it online in the USA any more. That is when I started suboxone. I started at 24 mgs and have weaned myself down to 6mgs. I will continue to drop as long as it continues to be painless. My feeling about treating depression is when you get relief, keep doing whatever you are doing to stay in a place of relief! Who cares how much of whatever you are taking to be free from the darkness! As long as you are working with a doctor...it is between you and him/her. Please, continue to post about your journey! I find you to be such an inspiration!


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PostPosted: Fri Nov 06, 2015 12:20 am 
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Thanks you guys for all your support. I went through the Ultram thing, too, using it as an antidepressant - and honestly it was the best one I ever used - until I was taking up to 700mg a day and I knew I'd probably have a seizure if I didn't stop. And the withdrawals were hell!

Right now I'm going through a tough time. My mother in law is currently in the process of dying. She has been in my life for 30 years and it's a huge loss, not to mention what my husband and kids are going through.

The good news is the Brintellix already seems to be working. It's very subtle, but I feel calm while positive and alert at the same time. And it does seem to be helping with the fogginess I get from the Sub. So it's a good combination.

The bad part is, when the whole family found out she was going to die yesterday, every single person, men and women, were crying, and I was the only one not crying. I think it's unnatural to not be able to cry. And me not on Sub or AD's cries at the drop of a hat. I was like this before on Sub maintenance, but I can't totally blame the Sub because I know the AD is a big factor, too. It really bothers me. I feel like there has to be a happy medium where I'm not depressed and crying constantly, but I can at least cry at appropriate times like when a close loved one DIES.

I feel like I've spent decades of my life trying to achieve something close to "normal".

Another thing I should mention is that there are tons of opiates in play right now with my MIL, oxy, morphine and dilauded. And I have no desire whatsoever to use. Yes, I am working a program, going to meetings and have a sponsor. But I believe even 1mg of Sub blunts the desire to use. I don't believe in all the magical thinking that goes around in the rooms. But I can't help but think my higher power had something to do with me being safe on 1mg of Sub right now while the family is in crisis.


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PostPosted: Fri Nov 06, 2015 2:38 am 
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Lilly, I'm so sorry that your family is losing your mother-in-law. What a blow. We lost my mother-in-law on September 8th, but she wasn't that involved in anyone's life but her own, so the loss wasn't felt too badly except by her kids and her husband. Still, even though their mom died, the family is just not super emotional about things. However, what they don't show on the outside they make up for in the way they've supported my father-in-law.

In any case, I hear what you are saying. You are upset that you can't show the emotion that you feel on the outside because of the treatment for your depression. Are you feeling like your other family members will notice and think badly of you? That wouldn't be fair anyway because everyone grieves differently.

I'm sorry what you think is normal is difficult to attain. I can only imagine that feeling like that might compound any depression you might already be feeling.

Please remember, though, that you are not frivolously on this medication. You have a disorder that can result in deadly consequences, so please don't feel badly that you're not able to cry right now. Maybe write your mother-in-law a beautiful letter about how you feel about her. I'm sure she would cherish this and show others in the family how thoughtful you are.

I also hope you know how death can bring out the crazy in families, so try not to take any unkindness personally. My sister told me that I always sounded too OK in our phonecalls in the months after Mom died and that I didn't cry enough. She thought I was just getting over her death too quickly. Of course, how could she know that my grief coupled with other things would lead me down the path toward opiate addiction? I forgave her for saying that to me within a few months. I'm a terrible grudge holder anyway. Just know that people say stupid things during times of grief and sorrow.

I tend to think that God doesn't hang around all day making everything in our life happen a certain way, but I do feel that God nudges. In the month before I admitted my addiction and asked for help I had asked God to give me a sign that it was time to stop the madness. There's no doubt in my mind that he can speak to us or answer us in subtle ways that work out to our benefit. (I know people who think that God makes you trip over your shoelaces because he's that involved, and that's fine. I just don't happen to believe that he doesn't have better things to be doing.)

If you want to talk about your sadness and grief here, please do. Maybe you're back on sub again to make you want to check in to the forum so that we can be your support in the upcoming weeks. We want to be there for you.

Amy

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PostPosted: Sat Nov 07, 2015 2:06 pm 
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Amy,
Thank you so much for your kind words. I really, really appreciate it.

I'm actually not concerned about what the family thinks of me. I've done a lot of work on myself over the years through recovery and counseling, and as long as I'm kind to people and do my best to do the right thing, I'm pretty ok with myself. Oddly, it seems to be becoming a contest of who can be at the hospital the most. But I don't see the value of sitting in a hospital room with 6-8 other people.

Before we knew she was dying, I was there one day for hours when no one else could be there. I don't think those who came rushing in when they found out she was dying have given any thought about those who where there for the three surgeries. For instance, my husband was there alone for one of them and saw her almost bleed out before they rushed her back into surgery. Thank God he's an EMT and didn't freak out. Being the only one there, he had to sign all the releases and whatnot for the next surgery. Sorry I'm digressing, but the point is I love my MIL, and if someone wants to judge my performance at her deathbed that's their problem.

Our stories are very similar. I didn't cry when my father died, but I careened into opiate addiction in the year after.

About the Suboxone: I know people are reading this to find out about treating depression with Sub and I've gone way off topic. But I stopped taking it yesterday. The Brintillex seems to be making a huge difference, and it seemed like the Sub was actually making my mood lower.

Before I went on the Sub my psychiatrist/addiction doc gave me the ok to take Ultram one week a month for the PMDD. I went through extreme measures before going this route, including trying to shut down my cycle with hormones, and then having a D&C. It wasn't a decision made lightly. I had a genetic test done that showed I couldn't metabolize most SSRIs, which are usually prescribed for PMS. The Ultram helps both the physical and emotional symptoms.

I stopped taking the Ultram for the 3 cycles I was on Sub. I didn't need it, so the Sub was definitely keeping me level. But it's that week now and I stopped the Sub and started the Ultram, and I don't feel much difference yet. But I thought it was a good idea to time it that way to step down from Sub, even though I was only on a low dose for a short time. (I think I only started the 1mg 3 weeks ago).

For people who don't know me, I've written RANTS in this forum against Tramadol. I've advised many people to not use it to get off of Sub. It's highly addictive (even though people consider it "weak"), and has a real shitty WD, because you are going thru an SNRI WD and an opiate WD at the same time. The only reason I'm doing it this way is because I proved to myself and my doc that I can take it for that one week and not seek more. I only get the week's worth from the pharmacy at a time. The first two cycles my husband held on to it and doled it out to me. The next two I handled it myself.

I know I wrote a book again. But if I have any issues from stopping the Sub after this week, I'll let you all know.


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PostPosted: Sat Nov 07, 2015 3:19 pm 
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I hope that you can stay successfully off the sub since you've found a new drug that is working. The great thing is that you now know that that 1 mg of sub daily can help your depression if the other drug stops working. I love how flexible your doctor is with trying new things for you!

I think I still have a big bottle of tramadol around here somewhere. The only time I ever used it was when I had run out of my percocet until I got my next prescription to stave off withdrawals. It never got me high. But it did give me heart palpitations, so I had to stop using it. Which put me in the desperate situation of really withdrawing for the first time, which made me reach out for help. I'm glad it's helpful to you though and glad that you are able to take it for one week at a time.

I would still love you to hang around despite changing meds. Your posts are so helpful and right on! Try to at least pop in occasionally, OK?

Amy

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PostPosted: Sat Nov 07, 2015 8:48 pm 
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Yes, I meant to say that I will still contribute to the forum.

Also, I have a script for bupe, so if this ends up being a mistake I can still go back to it.

Also, my MIL did pass away late this afternoon. I know the next week or two are going to be difficult. Leave it to me to go through a transition right at the wrong time, but that's how I roll. Just taking it a day at a time.

Also, I have tons of people offering me/us support. That's one thing great about being in recovery - not having to ba alone anymore.


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PostPosted: Mon Nov 09, 2015 2:07 am 
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Wow, that was so fast. :( I'm sending prayers of comfort and healing to you and yours and virtual hugs too. Let us know if we can help in any way. I am so sorry for your loss.

Amy

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PostPosted: Wed Nov 18, 2015 10:39 am 
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Just an update. I started the bupe again yesterday. My mood was taking a nosedive - I don't know if it was the emotional hangover from the funeral & everything that went with it, being off the bupe, or any of a number of other factors. But bottom line, I took the advice of those closest to me, and went back to what was working (and what my Dr. wanted me to do).

I think the unspoken reason I went off was because of my deep fear of another bupe WD. For what it's worth I didn't experience any real WD symptoms in the 12 days I went off. The exception being the most prominent and long lasting feature of my previous 2 WD's, which was my internal thermostat being all screwed up. As in shivering under heavy blankets with a sweatshirt or more on, and then being bathed in sweat a few hours later with just a sheet or very light blanket on. But if that's as bad as it gets I'll take that any day. It's just an inconvenience compared to the painful and debilitating WD's I've had in the past.

I was never sick, nor did I lose any sleep. I have some 0.5mg klonopin that I take prn. A couple of nights I felt a little sketchy and took one, but I'm sure I could have gone without it.

So I'm back on .5mg (was afraid 1mg would get me "high"). Also on Brintillex, 150mg Wellbutrin (down from 300 and working my way off).

Does anybody remember a while back there was a thread on what meds people were taking with Sub? Has that been done recently? If not, I think I might start that again.

Thank you all for your kind words and support


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PostPosted: Wed Nov 18, 2015 10:30 pm 
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I don't remember it, Lilly, but feel free to start another one. I'm sure that going back on a little bit of sub was the best option for you. :)

Amy

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PostPosted: Fri Nov 20, 2015 4:42 am 
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Lilly, I'm so sorry you lost someone beautiful to you. On top of that it sounds like it's been a difficult road trying to find your normal. I hope your decision to give bupe another whirl works well for you.
Take care Lilly


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PostPosted: Wed Nov 25, 2015 7:37 pm 
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Hi Lily, old friend,

It seems we suffer from some of the same conditions. I, too, have treatment resistant MDD as well as PMDD and am also now in full-on menopause. (Good times!) My psychiatrist did a couple of things for me.

He gave me a very low dose of T3 (Cytomel). It's a thyroid medication and it's used to help treatment resistant depression. I had great luck with it pretty quickly. I take 25 mcg.

Second, he did a DNA test that told him what kind of meds are best for me. It included antidepressants, anti-psychotics, ADD meds, pain meds, etc. Anyway, that led him to a fairly new antidepressant for me - Viibryd.

Lastly, it also showed I was lacking some kind of folate/folic acid metabolizer and I now have to supplement with L-Methyfolate daily and that specifically is helping to make my antidepressant work better. I even tried not taking it daily and I really noticed the difference in my mood.

I just wanted you to know you are not alone. I support you in all your challenges and wish you the very best.

HAT

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