Altostrata

Tips for tapering off stomach acid blockers or PPIs (esomeprazole, lansoprazole, omeprazole)

67 posts in this topic

Stomach acid blockers or proton-pump inhibitors (PPIs) block the absorption of important vitamins, particularly B vitamins, and particularly vitamin B12.
 
Over time, you gradually use up all your stored B12. Low B12 causes a lot of neurological symptoms.
 
"Among the most widely sold drugs in the world," according to http://en.wikipedia.org/wiki/Proton-pump_inhibitor , PPIs are terrible for general health. See That acid reflux pill may be causing your health problems
 
Stomach acid blockers, usually PPIs such as omeprazole, lansoprazole, ranitidine, and cimetidine, or antacids are intended for only short-term use, unless you have an extremely serious case of gastroesophageal reflux disease (GERD).

Most people can resolve their digestion issues without PPIs. Read Chris Kresser on how to resolve acid reflux without drugs http://chriskresser.com/heartburn
 
If you don't have very severe GERD -- and very few people do -- and you've been on a stomach acid blocker for any length of time, you are putting your health at risk.  To quit a PPI, tapering is a good idea, or you might suffer rebound reflux that will make you very sick.

Stomach acid blockers on their own can have adverse neurological effects:
http://www.rxlist.com/prilosec-drug/side-effects-interactions.htm

Nervous System/Psychiatric: Psychiatric and sleep disturbances including depression, agitation, aggression, hallucinations, confusion, insomnia, nervousness, apathy, somnolence, anxiety, and dream abnormalities; tremors, paresthesia; vertigo

 
Stomach acid blockers might cause vitamin B12 deficiency
In addition, these drugs block the absorption of vitamin B12, which is essential to good neurological functioning. Low B12 may cause symptoms that can be mistaken for a psychiatric disorder and make your nervous system susceptible to damage from withdrawal.

Taperinq required to prevent rebound reflux
To prevent rebound reflux, taper off an acid blocker as soon as possible. As a medical non-professional, my guess of a good rate is 25% per week. If you get rebound reflux, lower the decrease and take longer to taper off.

For example, to taper Prilosec OTC, I would open the Prilosec OTC capsule, carefully pour 1/4 out, put the capsule back together, and take the other 3/4. Do this for a week. Then pour more out a half, take 1/2 capsule for a week. Then take 1/4 capsule for a week. After that, stop taking the drug.

If you're taking this kind of prescription Prilosec:
http://www.drugs.com/prilosec.html
 

You may open the Prilosec delayed-release capsule and sprinkle the medicine into a spoonful of applesauce to make swallowing easier. Swallow this mixture right away without chewing. Do not save the mixture for later use. Discard the empty capsule.


If you've been on an acid blocker for any length of time, you may wish to get a vitamin B12 shot before starting a taper of a psychiatric drug, or start supplementing with sublingual B12, See http://survivingantidepressants.org/index.php?/topic/1392-vitamin-b12-essential-for-mood-nervous-system/

Read also:

Chris Kresser on how to resolve acid reflux without drugs http://chriskresser.com/heartburn


But in recent years, the Food and Drug Administration has issued numerous warnings about P.P.I.’s, saying long-term use and high doses have been associated with an increased risk of bone fractures and infection with a bacterium called Clostridium difficile that can be especially dangerous to elderly patients. In a recent paper, experts recommended that older adults use the drugs only “for the shortest duration possible.”

Studies have shown long-term P.P.I. use may reduce the absorption of important nutrients, vitamins and minerals, including magnesium, calcium and vitamin B12, and might reduce the effectiveness of other medications, with the F.D.A. warning that taking Prilosec together with the anticlotting agent clopidogrel (Plavix) can weaken the protective effect (of clopidogrel) for heart patients.

Other research has found that people taking P.P.I.’s are at increased risk of developing pneumonia; one study even linked use of the drug to weight gain.


People's Pharmacy calls for tapering information on all drugs



Although the official medication guide warns patients not to stop Prozac without checking with their doctors, it doesn't tell doctors how to help people discontinue the drug without symptoms such as anxiety, irritability, changes in sleep habits, headache, sweating, nausea, dizziness or electric shocklike sensations.

Doctors may encounter similar challenges when they try to help patients discontinue other medicines. Acid-suppressing drugs such as esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) may trigger rebound hyperacidity and reflux if they are stopped abruptly.

Vitamin B12 deficiency can be mistaken for dementia

Edited by Altostrata
updated

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I have been on PPIs for over 13 years. They did not cause a deficiency in Vitamin B12.  What they did do, was exacerbate my iron deficiency anemia and cause gall stones.   A lowered acid environment reduces iron absorption and a deficiency in iron contributes to gall stones.   Acid blockers over long term can also lead to osteoporosis and inflammation.  A complete study of the long term use of these drugs was done by the University of Texas.

http://www.utexas.edu/pharmacy/divisions/pharmaco/rounds/01-13-12.pdf

 

When I switched from taking 40 mg of Nexium to 15 mg of Prevacid, it took about 3 months for my body to adjust and stop producing rebound acid.

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Thanks, Lilu. Perhaps you might reduce Prevacid as well.

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Thanks, Lilu. Perhaps you might reduce Prevacid as well.

Wish I could, but at 15 mg it's barely controlling my symptoms of reflux/regurgitation.  Don't know if I'll EVER be able to stop taking PPIs altogether.

 

There's no way to taper this med, btw.  For those wanting to get off of it, as it is an extended release tablet that can't be cut. you pretty much need to stop and get by with the help of antacids and avoiding trigger foods if you have heartburn.  My dad did that, but unfortunately continued to suffer with heartburn and after more than 6 months decided to go back on meds.  But he manages on the lowest possible dose, 10mg of Prilosec (which many docs don't even know is available), and it controls his symptoms just fine.

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Hi Lili,

 

One more time, I realigned how similar our med history on both PPI and AD, including timing!

 

Ironically, after taking 16 yrs proacid 15 mg, my doctor suggest me to switch to antacid. I did about 3 weeks ago and that was when I started seeing lights with my WD symptoms. It made me wondering if PPI is somehow part of the reason of the Wd.

 

I just read this topic today. Hope sudden stop of the PPI won't cause me any future problem. I'm good so far with the prescribed antacid.

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Oh, by WD I meant WD from lexapro.

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I used tums and baking soda and water... to help get off the ppi... I got the lowest dose and took them only when I really had to....eventually I was done with them... thank heavens.  Changing my diet helped too.  Lots of bran veggies and  water. 

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I should also say I started waiting in between pills .. that is how I started getting off taking it only once the symptoms came... not treating before there was an issue... depending how bad the symptom... I would try all else to treat it before resorting to the pill.... the only ppi I could tolerate was pariet... all the others cause reactions. Some caused psych reactions. ... search the drug you take for psych reaction you have such as famitodin and depression you may be  surprised. 

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I've recently quit taking PPI's   (Omeprazole ) After 20 years. I took a few months to taper but at the

end had to take a full dose now and again. I have just realised after seeing this thread bumped that I haven't

taken one for a few weeks now which is great but I do still have antacid medicine occasionaly when the reflux

gets right up my nose, literally! I've had to reassess my diet and make some changes because I was falling

back into bad habits but things are settling again. I started PPI's for a hiatus hernia that was made worse by the

pain and psych meds.   Meds cause heartburn......PPI's cause depression...... more meds.... and on it goes,

the drugs merry go round is in full swing. 

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Occasional use of PPIs shouldn't be harmful.

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I've recently quit taking PPI's   (Omeprazole ) After 20 years. I took a few months to taper but at the

end had to take a full dose now and again. I have just realised after seeing this thread bumped that I haven't

taken one for a few weeks now which is great but I do still have antacid medicine occasionaly when the reflux

gets right up my nose, literally! I've had to reassess my diet and make some changes because I was falling

back into bad habits but things are settling again. I started PPI's for a hiatus hernia that was made worse by the

pain and psych meds.   Meds cause heartburn......PPI's cause depression...... more meds.... and on it goes,

the drugs merry go round is in full swing. 

I did not know ppis cause depression ... guess it would makes sense as it stops the use of B12 and low B12 causes depression... 

Is this what you mean?  I hope I got it straight. 

I used them when I needed them when I was first off but I could feel a difference like I was not getting the most out of the food I ate and my digestion was not near as good as before I went back on them.  I had been off them for 5 years before he car accident but for some reason maybe breaking the rib ... acid became a problem again .. tho I did not think it was acid as the symptoms were extreme pain.. in abdomen and neck. It seemed to help it did not stop the pain completely but helped. peace

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The nice thing about the Omeprazole capsules I have is that they are filled with little beads instead of powder. That makes it so much easier to taper than having to measure a fine powder or having to cut and shave tablets.

I opened the capsules and found 18 granules inside each one. The method I'm using to taper is to simply reduce my dosage by one granule every two weeks.

I bought empty capsules from Amazon.com and every two weeks I put together a new batch.

As of today I'm down to taking one capsule per day of six granules of Omeprazole. On Monday, I start my new dosage of five granules per day.

So far, I have no rebound acid at all.

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I'd also like to say that when I first told my doctor that I was concerned about the problems associated with long-term use of PPIs, he was happy to try to help me get off them. But when he switched me right from Omeprazole to a milder antacid, I had terrible heartburn symptoms. His response? He told me that since I got heartburn, that meant that I would need to stay on PPIs "indefinitely."

Yeah, he gave up that quickly. When I told him that I'd like to try tapering more gradually, he told me that would be fine. But if I hadn't spoken up for myself (because of what I read on this site), I would be on this medication "indefinitely."

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Right, you got rebound stomach acid!

 

Thanks for sharing the details of your tapering off omeprazole; I'm glad it's going well for you.

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VERY informative thread, thank you!

 

For the past few years withdrawing from benzo's has ruined my life. Just when i didnt think things could get any worse, they did. 

 

In comes Prilosec, just a few months on this poison and im suffering every problem known to man. Currently im having a symptom that had me see every doctor on the east coast, and get every test known to man done: 3 months of nonstop chills/bodyaches. For awhile i thought i was getting better, but recently they've gotten way worse. Luckily ive finally discover (i think) the nature of this condition after months of research. I believe i have destroyed all the good flora in my stomach with antiobiotics, and then shut down my acids with prilosec, leading a massive uncontrolled growth of bacteria and fungus in my intestinal tract. These bacteria produce toxins that spill out an produce a plethora of symptoms which mimic over 50 different diseases. 

 

Take it from me, i havent worked/gone to school/gone to the gym in 3 months, i lost 50lb (of muscle), and my face is paler than a ghost - prilosec is poison. The doctor that put me on it said im going to haveto take it for the rest of my life.

 

at the moment ive tapered down to 2mg (i open the capsules and count the little pebbles inside, than close them back up), and im going to buy some probiotics from vitamin shoppe today, any recommendations?

Most likely im going to haveto take a megadose of bactrim and other antibiotics to treat my condition, but lets hope not, i will try natural healing first. 

 

Thank you everybody

 

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Welcome, Bodybuilder.
 
Please start a topic for yourself in the Intro forum.
 
My understanding is that Saccharomyces boulardii, a beneficial yeast probiotic, helps drive out destructive yeasts in the gut and provides a substrate for the growth of beneficial bacteria.
 
See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296087/
 
Other good probiotics are Lactobacillus plantarum and Bifidobacterium infantis.

 

I like a juice-type probiotic called Goodbelly, it contains Lactobacillus plantarum.

Some people like soil-based bacteria probiotics to heal the gut.

 

Nothing is more complicated than gut flora, though -- it's impossible to predict what will help. Try a small amount of something -- open the capsule and take a fraction of a dose -- before you start taking it.

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https://labdoor.com/rankings/probiotics

 

renew life utlimate flora critical care - is this any good?

 

ive also been told florastor (number 14) is really good. Someone told me the good probiotics good in the frigde - is this true?

 

thank you

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People like both of those products. You'll have to look at the ingredients for each product yourself.

 

You'll have to evaluate Labdoor's criteria, I think they're quite limited.

 

Some probiotics are shelf-stable and do not need refrigeration. They should be labeled as such.

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ok i bought ultimate flora critical care, its refrigerated. It says 50 billion on it, there was one that also said 200 billion...whats the difference should i take 4x 50 billions or just 1?

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I would start low. The bacteria multiply inside you.

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I have a bit to add to this I found this today antibiotics are made from the earth.. I mean soil. 

http://www.ctvnews.ca/health/antibiotics-breakthrough-could-offset-problem-of-drug-resistant-bacteria-1.2178643

 

I just thought perhaps this is why some people find the earth probiotics better.  The more I thought about it the more sense it made to me and I am thinking of trying one... 

If anyone has a type they have used with good results for diarrhea please send the names.  I have used the fridge lacto bacil... kind and the self steady kinds both worked well for me in the past... this round.. I find there use seems to increase the pain I have in my foot the one I keep breaking... seems this way to me.  Hence I am not using to the extend I could or maybe should and can't beat this hit of runs.  

 

I can get it to settle using what the doc said that worked before... 3 caps in apples sauce 3 times a day... I find now one dose of this causes a l of pain.. I know it does not seem to make sense but I do listen to my body now and this is what it is tell me. 

 

I have had countless stool test for bacteria and have always been ok... I am thinking science is not as smart as it thinks it is .. so just maybe this soil one will work better. 

 

I did use pariet a ppi unlike the others when I reacted to all others..it is a bit different I am not sure how you would have to ask the pharmcist who adviced my stomach specialist years ago... I don't live in that city anymore but I reacted to all other ppi drugs. still I taper of this one asap it is still a ppi but if I need one badly it is the one I take.  I know it may not be good for everyone I had severe side effects immediately from the others... 

 

. famitodine cause a psych reaction of suicide on increase dose tho it has a different route than ppi it dose the same thing... by lowering histamine ..... so careful with that one..... and floristore gave me the bonus yeast infection... ya says it can't do that.  but it did... 

 

I keep looking hope it helps somebody.. 

I am thinking of buying the earth type probiotic soon so if there are any suggestions soon would be the time to post them other wise I will report how it goes which ever sort I get

peace all

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I would like to add a trick that helped my mom when acid reflux is in the chest causing pain.

This is usually due to gas build up forcing acidic gases up the esophagus.

Low stomach acid causes the spincter to stay open.

 

Ice cold contracts gas and has helped my mom's chest pain from acid reflux (rebound) while getting off Nexium and tapering Valium.

Putting an ice pack on the abdomen and taking fennel extract was a life saver.

Fennel extract with this helps to get rid of the gas.

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I am glad that I found this thread. I have been on Omeprazole for just 2 years, and I'm already having bad side effects. I was just diagnosed with iron deficiency anemia a few weeks ago. Currently, it feels like the Omeprazole, vitamin c, and iron are fighting with each other, because I've been losing my appetite frequently. I will be following up with my doctor in about two hours, and I'm going to ask her if I can taper off of the Omeprazole. I think it will solve all of my medical problems. I tried to quit cold turkey about 6 months ago, and I felt like I had morning sickness all day long for a week. I didn't want to move. I couldn't eat. I just curled up in bed and didn't want to move. I'm guessing this is the rebound reflux that I saw someone else talk about. I found a website that said that DGL Licorice or Mastic Gum will help with the withdrawal from Omeprazole. Hopefully, this will work for me. 

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I find DGL (deglycyrrhizinated licorice) to be very helpful for digestive issues.

 

Be sure to get the deglycyrrhizinated kind, regular licorice can have strong hormonal effects.

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Hi,

  I was searching about rebound effects of PPIs when i came across this site. I was diagnosed with GERD when I was 17 and put on prilosec which worked grest for 5-7 years, then I got switched to prevacid and finally was upped to 30mg 9 yeasr ago. Well The first of May my acid spiked and I had an EGD scope (everything looked normal) they said continue and didn't change it. Due to the sever acid I wasn't eating alot and ended up with severe weight loss I noticed first of June. Since I couldn't get in to see the gastro dr. that did the scope right away my dr. finally upped my previd to 60mg a day and gave me a nusea pill, after a couple days I could eat again and started to get some energy back. Then the gastro dr. switched me to Zantac 300mg 2xs a day, and siad it was fine just to stop and switch. I had no idea till recenly about the rebound, so took it for 5 days or so and thought it didn't work, only partially. In the mean time they are doing all sorts of tests that were all negative, and no explination for my sudden increase in acid. So called them back and the assistant told me they would try me on a different PPI but they never pre-approved it or called me back, so i was forced to go back to the prevacid which started giving me headaches, but I could eat. Finally Mom took me to a different dr/place and she has been wonderful so far, but again, not finding anything wrong and I started getting a tight feeling my throat for about an hour after taking my prevacid, so she switched me to nexium and pepcid if I needed it for break through the second evening after my second dose of the day I got a swollen tonugue with large red bumps (no pain to them, felt solid), almost went to the ER, I called the on call gastro who had me take a clariton and promise to go if it got any worse, thankfully it didn't. So I had to stop PPIs cold turkey and can't taper off of them. :(
        Now they are talking about a 24 hour probe to check my acid and PH levels and if meds can't control it then surgery!! :( Is there other alternative therapies for acid reflux? or the rebound which I am sure I am having, been on the 20ish years?  I saw the info on the liquorice and saved it, and been trying the applecider to no avail, it might be slightly working? Currently on a pepcid a day I started today and tums.  I am just frustrated and upset and of course they label you depressed immediately.
        The only other things I could tink of that happend is my allergy dr. started me avoiding 3 foods aroudn that time, cause I had reacted to something 2 days in a row (tomatoes - I eat alot of ketchup, garlic - eat alot of that, and hard/moldy cheese - eat some but not as often), so I stopped eating all of those first of May. In late April I had to stop hard and fast due to someone stopped in the middle of the road in a 40 and ended up with whiplash in my neck (realized this a month later beginning of June).

Thank you all for listening and any suggestions for the rebound or where to look would be great? Alternative medicine, accupunture?, grapsing at straws?

Deb

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Hi, Gypsy. We mostly talk about going off psychiatric drugs on this Web site.

 

Please read this topic from the beginning and read the links, too -- there are many alternatives to taking PPIs.

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I've been on 40mg Protonix since 8/6/15 due to stomach issues caused by an E coli infection that I'm thinking I obtained while in the hospital. I've been having terrible insomnia, anxiety, anxiety attacks, and dizzy/double vision sort of spells. I don't know if it's from the Protonix but I am guessing that could be a piece in this puzzle, due to the gut-brain interaction.

 

How do I taper off of this without it causing rebound acid? I've never had a problem with acid before this.

 

Unfortunately, I can't talk with doctor about the possible mood side effects of Protonix listed here, since he just thinks I am "anxious" and told me that "Protonix has very few possible side effects". Before taking this medication, and before being in the hospital where they stopped my Zoloft, my anxiety was under control with 25mg Zoloft.

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Please read this topic from the beginning.

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I have to take a Zantac every night because my meds cause bad heartburn when I take them. 

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Please read this topic from the beginning.

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Have you tried acupuncture to offset withdrawal symptoms from Omeprazole? I came off Omeprazole and had acupuncture 5 days ago. I have only had minimal reflux and very slight stomach discomfort, all hardly worth mentioning. I hope this helps.

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What worked for me:

At my worst I was taking 40 mg Omeprazole plus 75-150 mg of ranitidine and antacids. Thankfully I am down to just 20 mg of Omeprazole. I tried to follow the Specific Carbohydrate Diet the best that I could. That diet's aim is to let your gut heal so you don't need acid reducers, antacids, etc. This website gives more info on the diet plus recipes.

 

http://www.breakingtheviciouscycle.info

 

The diet is very similar to the Paleo diet which is popular now. It is/was hard for me since I live in Midwest US and fresh produce can be expensive in off seasons. It was also hard because you basically have to cook everything from scratch, and I don't particularly like cooking. I plan on getting back on that diet or a modified version next month. I want off the Omeprazole all together.

 

The biggest things for me were cutting out all coffee and soda pop. I was drinking 20 oz of coffee in am and 12-24 oz of pop with lunch. I got to where I didn't need the caffeine and just drank water or milk during the day. Plain water upset my stomach sometimes, especially if it was nearly the only thing in my stomach. I would add a little lemon juice or a flavor packet and that seemed to help.

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Thanks, JustMe. Good to hear you're off the acid blockers.

 

It sounds like you might have low stomach acid. You might find a little apple cider vinegar, lemon juice, or betaine HCl with meals will help.

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Ugh so I just came back from GI doctor. I saw a nurse practitioner this time and she told me that what I have isn't heartburn or acid reflux so I should go off the Prilosec the other GI doctor Rx'd me last year. My symptoms were always FULLNESS in the upper abdomen. So, I haven't been on it for a full year yet, I started last May or June 2015. 

 

Are the withdrawal symptoms bad for coming off these? I am so scared that it will make me nauseas or vomit. Please help!!

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The nice thing about the Omeprazole capsules I have is that they are filled with little beads instead of powder. That makes it so much easier to taper than having to measure a fine powder or having to cut and shave tablets.

I opened the capsules and found 18 granules inside each one. The method I'm using to taper is to simply reduce my dosage by one granule every two weeks.

I bought empty capsules from Amazon.com and every two weeks I put together a new batch.

As of today I'm down to taking one capsule per day of six granules of Omeprazole. On Monday, I start my new dosage of five granules per day.

So far, I have no rebound acid at all.

I'm currently on 40mg of Omeprazole. What were you on? And 1 granule every 2 weeks? That must take forever! This is all so discouraging and I am cursing another doctor for prescribing me yet another medication that I never needed!!!

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blackrabbit, please read this topic from the beginning.

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