You are taking other medicines every day. Diarrhea, nausea, abnormal liver function tests, vomiting, and rash. 4921 Parkview Place Antacids help to treat heartburn (indigestion). Naproxen (Naprosyn, Naprelan, Anaprox, Aleve) Rosuvastatin may help prevent or slow down medical problems, like atherosclerosis (hardening of the arteries), that are caused by fats clogging the blood vessels. The lists in this handout are not complete. A.D.A.M. Scrub your fingernails with a brush. There are some concerns but I wouldn't obscess about it. Philadelphia, PA: Elsevier; 2021:chap 46. Stop all over-the-counter antacids such as Tums, Pepcid Complete, Gaviscon and Mylanta and vitamins. If You want convert kilograms to pounds, multiply the kilogram value by 2.2046226218, Thumbuddy To Love is a positive tool that teaches children how to stop thumb sucking, Low flow low gradient aortic stenosis case, How long does 4 wisdom teeth removal take. A.D.A.M. Interactions Diflunisal (Dolobid) If you were not given medicated soap, use antibacterial soap that you can buy at the store. Prozialeck W, Kopf P. Gastrointestinal disorders and their treatment. Do not take Salsalate (Amigesic, Marthritic, Salflex, Slasitab) Suite 1E No: Low fat diet can sometimes prevent the onset of symptoms of gallbladder disease, however once you've had symptoms you are Antacids can block the absorption of medicines. Below is a list of many medications (but not all) that fall into these categories. Avoid administration of ciprofloxacin with dairy products (eg, milk or yogurt) or calcium-fortified juices alone; however, ciprofloxacin may be taken with meals that contain calcium. If youre on blood thinners, beware of aspirin. Discontinue ciprofloxacin immediately and contact your healthcare provider if you experience pain, tingling, or numbness in your fingers and toes; or any central nervous system effects (such as paranoia, depression, hallucinations); a severe rash; jaundice (skin yellowing); a change in your heartbeat; or any sign of an allergic reaction. Do not perform hazardous tasks if fluconazole affects you in this way. Generally, stop taking Glucophage (metformin) 24 hours before surgery. If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include: Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. Open the Facebook app on your device and tap the menu button. PMID: 23419381 pubmed.ncbi.nlm.nih.gov/23419381/. There are many others that work wel What can be done to prolong gallbladder surgery? However, ciprofloxacin has been shown to cause arthropathy and histologic changes in the weight-bearing joints of juvenile animals and other effects, which are a cause for concern. Philadelphia, PA: Elsevier; 2020:chap 129. Suite 200 follows rigorous standards of quality and accountability. Tell your doctor if you are pregnant or intending to become pregnant. UWMC and SCCA clinic staff are also available to help. Call 911 for all medical emergencies. Response and effectiveness. Sabiston Textbook of Surgery. Leave jewelry and other valuables at home. 's editorial policy editorial process and privacy policy. NSAIDS, such as Aleve, Motrin, Ibuprofen, or Advil may be taken until 12 hours prior to your surgery, unless directed otherwise by your surgeon. I have a 10 cm hiatal hernia. It may also be used to prevent certain types of heart and blood vessel problems in Thank you. Flurbiprofen (Ansaid) Taking antacids - Talk to your provider or pharmacist before taking antacids on a regular basis if 1 You have kidney disease, high blood pressure, or heart disease. 2 You are on a low-sodium diet. 3 You are already taking calcium. 4 You are taking other medicines every day. 5 You have had kidney stones. Some medications (prescription and over-the-counter) can reduce your bodys ability to form blood clots and taking these before GI endoscopy procedures may increase your risk of Experience: 20 yrs. Fenoprofen (Nalfon) Now it is time for surgery. Important note for patients who have had cardiac stents or other heart surgery in the past year: Talk with your cardiologist (heart doctor) before you stop taking any aspirin product or clopidogrel (Plavix). Speak to your doctor about how drug interactions should be managed. St. Louis, MO 63141, 5201 Midamerica Plaza May exacerbate muscle weakness in people with myasthenia gravis. Last updated on May 23, 2022. Replace the plunger and shake the syringe Keep well hydrated when taking ciprofloxacin to avoid concentrations of ciprofloxacin becoming too high in the urine and precipitating out as crystals. NSAIDS, such as Aleve, Motrin, Ibuprofen, or Advil may be taken until 12 hours prior to your surgery, unless directed otherwise by your surgeon. One article I came across stated it had to do with the risk of aspiration during Take fluconazole at least two hours before medications are given for GERD or acid reflux such as proton pump inhibitors (for example omeprazole). May be given as a preventive measure when people have been exposed to anthrax. Press question mark to learn the rest of the keyboard shortcuts. the hernia is still large but is non complicated. 6th ed. URAC's accreditation program is an independent audit to verify that A.D.A.M. Diseases of the esophagus. If you routinely take aspirin-containing products or blood thinners, please check with your doctor for instructions. Tirofiban (Aggrastat), Heparin How many days BEFORE your surgery to stop taking this drug. Please do not park in the parking lot in front of the Emergency Room. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Ciprofloxacin belongs to a group of medicines known as fluoroquinolones (also called quinolones). If you do not feel well in the days before or on the day of surgery, call your surgeon's office. Philadelphia, PA: Elsevier; 2019 chap 71. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Am J Gastroenterol. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. on antacids. Department of Anesthesiology & Pain Medicine, Center for Pain Relief Referral Information, VISN 20 Pain Medicine and Functional Restoration Center, ORBIS OR Business Intelligence Software, Special Consent to Anesthesia/Sedation - UH2227, UWMC Operating Room Glycemic Management Protocol, Health Online - Patient Education Materials, Information and FAQ for Visiting Medical Students, UW Center of Excellence in Pain Education (CoEPE), ACLS Courses at the Department of Anesthesiology & Pain Medicine, Harborview Injury Prevention and Research Center, Perioperative & Pain initiatives in Quality Safety Outcome (PPiQSO), WWAMI Institute for Simulation in Healthcare (WISH), B. Raymond Fink Memorial Research Conference, Faculty Careers for International Medical Graduates, Costing Allocations Submission Checklist (PDF), University of Washington Medical Center (UWMC), UWMC Operating Room Insulin Infusion Orders - UH2627, UW Directory for Anesthesiology & Pain Medicine. I'm here if you ever need me again. If you have problems, try another brand. Some over-the-counter herbs can also effect bleeding. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. but i was wondering if it'll be fine to still do the surgery? If you have sleep apnea, bring your machine with you to the hospital. For children, bring an extra set of clothing including underwear. aspirin or medicines that contain aspirin blood-thinning medicines One article I came across stated it had to do with the risk of aspiration during surgery where bile may find its way into the lungs and cause serious damage. I found many published articles stating DO NOT take chalky antacids but DO take something like Pepcid. To learn more, please visit our. How to Add or Remove Contacts from Kids Messenger Account ; Step #1. Wear comfortable, loose clothing and flat shoes. This usually means both solid foods and liquids. Cilostazol (Pletal) Ticlopidine (Ticlid) Guidelines for the diagnosis and management of gastroesophageal reflux disease. Fluconazole may occasionally cause dizziness which may affect your ability to drive or operate machinery. Chesterfield, MO 63017, 1044 N. Mason Road Philadelphia, PA: Elsevier; 2022:chap 10. Sulindac (Clinoril) May cause liver damage or heart rhythm disturbances. my wisdom tooth surgery is tomorrow. You may take Tylenol for pain. Gerd entire life tried anti-acids, h2,ppi, lifestyle changes and wedge pillows and nothing works. i hardly eat one meal for the day, what do i do . Acid reflux is common during and after chemotherapy, and this has to do with how chemotherapy drugs work. Indomethacin (Indocin) Call 911 for all medical emergencies. If you're confused about which medicines to take the night before or the day of surgery, call your doctor. For potential or actual medical emergencies, immediately call 911 or your local emergency service. All patients enter at the main entrance opposite the parking garage. Is it just because Pepcid is more effective in that it prevents the secretion of acid in the stomach, rather than instantly balancing the PH levels like Tums? The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. One to two weeks before surgery, you may have been told to stop taking blood thinners. Use of fluoroquinolones such as ciprofloxacin is associated with an increased incidence of musculoskeletal disorders such as joint pain, abnormal gait, back pain, leg pain, or decreased range of motion. Only use when prescribed by a doctor to treat infections caused by susceptible bacteria as improper use increases the chance of resistant bacteria developing. Most people don't experience side effects from taking Imodium, but if you take other medications, talk to your doctor or pharmacist first to see if there's a potential for medicine interactions. Create an account to follow your favorite communities and start taking part in conversations. Step 3. Dipyridamole/Aspirin (Aggrenox) Dr. Joey Bluhm answered. Clopidogrel (Plavix) Principles of preoperative and operative surgery. Oral ciprofloxacin tablets may be taken with or without food. aminoglycosides, such as gentamycin or tobramycin, antacids containing calcium, magnesium, or aluminum, blood-glucose-lowering agents, such as glimepiride or glyburide (severe hypoglycemia reported), bowel cleansing agents such as sodium picosulfate, corticosteroids, such as prednisone. Please with-hold unless requested. i will let my surgeon know. You may be asked to take some or all of your usual medications with a few sips of water before surgery which typically dissolve and pass out of your stomach by the time anesthesia starts. A.D.A.M. Surgical techniques. Ciprofloxacin is an antibiotic used to treat a wide range of infections. what now? Esophageal cancer. Editorial team. You may take acetaminophen (Tylenol) as needed for minor aches and pains. For most people who are taking Coumadin (Warfarin) for chronic heart rhythm problems (like atrial fibrillation) it is usually safe to stop it for four (4) days prior to the procedure. If you are taking them for symptoms at night, do not take them with food. This page lists medicines and supplements (by generic and trade names) that you should avoid to prevent bleeding problems. You may take a shower or bath both the night before and the morning of surgery. St. Johns wart (please do not take 14 days prior to surgery), Vitamin E, Multi-Vitamins if it also contains Vitamin E If you are having a cervical or lumbar spinal fusion surgery you will not be able to take NSAIDS or medications containing Aspirin for about 3 months (until your doctor tells you that your fusion appears solid). Seek medical advice if chronic diarrhea develops during or following ciprofloxacin. For additional information visit Linking to and Using Content from MedlinePlus. is among the first to achieve this important distinction for online health information and services. They may be resumed when your doctor says it is OK. On the next page are herbs and other supplements that are especially harmful to take if you are having surgery because they can cause extra bleeding. Ibuprofen (Advil, Motrin) - stop 1 week prior to surgery, Naprosyn (Aleve) - stop 1 week prior to surgery, Plavix discuss this with the prescriber as to the best time to stop this medication beforesurgery. Have an edit or suggestion for this page. 14th ed. Liquid forms work faster, but you may like tablets because they are easy to use. Please visit the CT DPH website for more information or contact your health provider directly. Please consult w/your doc. my gi feels im not a good candidate for surgery. Revised 06/2021. Medications that increase the chances that you will bleed excessively after surgery include: Aspirin, enteric-coated, baby, and plain aspirin or any other product containing aspirin. Wear sunblock when outdoors. Events occurring within the first 6 weeks of treatment usually resolve within 30 days of discontinuing treatment. My grandfather is having surgery tomorrow and I had to convince him that he cant take Tums instead of the doctors prescription of Pepcid. To use the sharing features on this page, please enable JavaScript. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. I took tums (calcium carbonate) 2 days ago. Thats why you need to remember to specifically ask your pharmacist for CRESTOR, as your doctor prescribed. Reminder: Please review specific instructions you may have been given by your surgeon. Salicylates (sodium salicylate, Magan, Mobidin, Mobogesic, Arthritab, Bayer Select, Doans pills) is also a founding member of Hi-Ethics. Medications to avoid if youre a heart patient. Include the ones that you were told to stop taking before surgery. These include chondroitin, dan shen, feverfew, garlic tablets, ginger tablets, ginkgo, ginseng, and quilinggao and fish oil. Avoid alcohol. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Ciprofloxacin works by converting two bacterial enzymes, topoisomerase IV and DNA gyrase, into toxic enzymes that block the manufacture and repair of DNA and other DNA processes. If you are a smoker, we recommend that you stop smoking at least two weeks prior to your surgery Ciprofloxacin is distributed into milk and either breastfeeding or the drug should be discontinued if women are breastfeeding. Do not take ciprofloxacin within two hours of magnesium/aluminum-containing antacids or other products containing calcium, iron, or zinc. i had my endoscopy last week. However they may be special circumstances where the medication is not stopped or other medications are used to prevent clotting after it is stopped. In some cases, we may recommend stopping your aspirin 1 week before surgery. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. What ingredients should i look for in a good antacid. Children are more susceptible to the adverse effects of ciprofloxacin. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Bayer HealthCare Pharmaceuticals Inc. Meclofenamate (Meclomen) Call your doctor or health care provider if you have questions or concerns. Antacids are a good treatment for heartburn that occurs once in a while. Suite 1500 You can buy many antacids without a prescription. The anaesthetist may request that these are given this will be on an individual basis. In others cases, low-dose aspirin may be continued based on your medical condition. St. Louis, MO 63129, 20 Progress Point Parkway, Suite 114 Brands with calcium or aluminum may cause constipation. May disturb blood glucose levels in people with diabetes; careful monitoring of blood glucose is required. You may take Tylenol for pain. Suites 110 & 210 In: Goldman L, Schafer AI, eds. Editorial team. is among the first to achieve this important distinction for online health information and services. The most common ingredients in good antacids are calcium carbonate, aluminum hydroxide and my Magnesium hydroxide. Ketoprofen (Actron) If use on prn (as needed) basis & not exceeding recommended daily dose, no problem. Town and Country, MO 63017, 14532 S. Outer Forty Drive At the pharmacy, your brand-name CRESTOR prescription may be switched automatically to a generic. If you are taking them for symptoms at night, DO NOT take them with food. Antacids cannot treat more serious problems, such as appendicitis, a stomach ulcer, gallstones, or bowel problems. Talk to your provider if you have: Pain or symptoms that do not get better with antacids. Symptoms every day or at night. View complete list of side effects. Wheel chairs and assistance are available at the main entrance. If youre experiencing stomach upset or nausea when you take your antibiotic, eat 2.Before Surgery | Mercy Health Author: www.mercyhealth.com Post date: 13 yesterday Rating: 3 (1027 reviews) Highest rating: 5 Low rated: 2 Find out why.Get to Know Houston. It is likely that you have been asked not to eat or drink after a specific time the evening before or day of surgery. 1. Copyright 1997-2023, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited without authorization. If you have severe heart problems you may need to consult with your heart specialist to determine if it is safe to stop it. Medications. Ciprofloxacin is an effective antibiotic that treats a wide variety of infections; however, it should not be given to children aged less than 18 and in adults, it should be reserved for infections that are not treated by other antibiotics. Peak concentrations of ciprofloxacin are reached one to two hours after dosing; however, it may take up to 48 hours before infection-related symptoms start to abate. My pleasure. If its not CRESTOR, let the pharmacist know. They work by neutralizing the stomach acid that causes heartburn. If you take licorice that is not DGL, over time it can raise your blood pressure. Serious, sometimes life-threatening, adverse reactions such as liver damage and allergic reactions have been occasionally reported. America's fourth largest city is a great place to live, work and play. Quora, 3.Preparing for Your Surgery Core Physicians, 4.Frequently Asked Questions at Anesthesia Medical Group of Santa , 5.Preoperative oral antacid therapy for patients requiring emergency , 6.Medications to Discontinue Before Surgery, 7.Rolaids okay 5 days before BA? 5 (tartrazine) which may cause allergic reactions; people with an aspirin sensitivity may be more at risk. A.D.A.M. All antacids work equally well, but they can cause different side effects. Effective against susceptible strains of several different gram-positive and gram-negative bacteria, for example: Available as oral tablets, extended-release tablets, oral solution, eye drops, and in an injectable form. Nabumetone (Relafen) Other products may also affect absorption (check product information). Notify your doctor of any health changes such as a cold or fever. Doctors typically provide answers within 24 hours. Takeaway. For aspirin (81 or 325 mg daily) used to prevent heart problems, this is usually safe to stop for seven (7) days prior to any procedure. Depending on the type of surgery you're having, follow any further advice from your health care provider. Brody's Human Pharmacology. They may occur at any time after starting ciprofloxacin and in any patient. Summary: Generally speaking, no. For additional information visit Linking to and Using Content from MedlinePlus. Eptifibatide (Integrilin) If you are going to be late, please. Add 40 mL of water. Antacids are made with 3 basic ingredients. Use during pregnancy only if benefits outweigh risks to the mother or fetus. should i worry? For this reason, it is generally recommended to withhold certain drugs if you are scheduled to have one of these procedures performed. Your provider may have given you a medicated soap to use. They work by neutralizing the stomach acid that causes heartburn. There are no adequate and controlled studies in pregnant women and animal studies have not revealed evidence of harm to the fetus. For medications used to treat arthritis (regular dose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Philadelphia, PA: Elsevier; 2021:chap 81. These side effects may be irreversible and they can all occur together in some patients. Do not shave the area that will be operated on. Tell your doctor about any other medications you take, including those brought over the counter from a pharmacy, supermarket, or health store. Is a toupet fundoplication a good option for refractive gerd not controlled with ppis and antacids despite diet changes? If you take prescription medications for your lungs, thyroid, blood pressure, seizures or stomach problems, take them with a sip of water. 's editorial policy editorial process and privacy policy. Do not drive or operate machinery if ciprofloxacin makes you feel dizzy or tired. If you take a cab or transport service, you, Please make every effort to arrive on time. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. o Anaesthetists may request that these drugs are given before surgery but this will be requested on an individual basis. Serious side effects such as tendonitis and tendon rupture, peripheral neuropathy (nerve pain in fingers and toes), and central nervous system effects (side effects that affect the brain including psychosis, convulsions, hallucinations) have been associated with ciprofloxacin and other fluoroquinolones. Suite 1C May cause photosensitivity reactions and severe sunburn on exposed areas of skin. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. OFallon, MO 63368, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, Center for Advanced Medicine - South County, St. Louis Children's Specialty Care Center, St. Louis Childrens Specialty Care Center South County, Washington University Orthopedics Chesterfield, Physical Medicine & Rehabilitation Musculoskeletal, Physical Medicine & Rehabilitation Neuro Rehab, Medications to Avoid Before and After Surgery. NSAIDS, such as Aleve, Motrin, Ibuprofen, or May trigger seizures or increase the risk of having a seizure. Copyright 1997-2023, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited without authorization. You may have side effects from taking these medicines. If you routinely take aspirin-containing products or blood thinners, please check with your doctor for instructions. They may be resumed when your doctor says it is OK. On the next page are herbs and other supplements that are especially harmful to take if you are having surgery because 11th ed. GERD. Do not resume these medications until your doctor says that it is okay. Medicines that interact with ciprofloxacin may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with ciprofloxacin. in practice, including surgery, general medicine, and pain. The risk of tendinitis and tendon rupture is increased in people over the age of 60, in those taking corticosteroids, or with a history of organ transplant. Take out removable teeth prior to transfer to the operating room and do not wear glasses or contact lenses in the OR. Antacids can change the way your body absorbs the other medicines you are taking. If you take large amounts of antacids that contain aluminum, you may be at risk for calcium loss, which can lead to weak bones (. If you were told to take any medicine on the morning of surgery, you may take them with a sip of water. Suite 1B If possible, bring your medicines in their containers. ; Step #2. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Tolmetin (Tolectin), Aspirin (present in many medications) Administrative Office: 206-543-2673 | Fax: 206-543-2958, Pain Clinic: (206) 598-4282 | Fax: (206) 598-4576, Pre-Anesthesia/Surgery Clinic: (206) 598-5053, Pre-Anesthesia/Surgery Clinic Fax: (206) 598-4711. If you are a Same Day Surgery patient, arrange for a responsible adult to drive you home and to provide care for at least 24 hours. To use the sharing features on this page, please enable JavaScript. Take exactly as directed and for the period indicated to reduce the risk of resistant bacteria developing, unless side effects force early discontinuation. any medication that inhibits or induces CYP3A4 or CYP1A2. For what its worth, hes having multiple bypass surgery and hes diabetic. Should not be given to children under the age of 18 years unless they have certain serious infections that cannot be treated with other antibiotics. no surgery. Available for Android and iOS devices. It is important that you stop taking the following medicines 1 week before surgery or as directed by your health care provider. Ask Your Own Medical Question. I don't have an appetite. Read the instructions for how to use this soap. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Press J to jump to the feed. 21st ed. To prepare for your surgery or procedure, your doctor has asked you to avoid certain medicines, including aspirin and aspirin-like products, non-steroidal anti-inflammatory agents, and other medicines or supplements. Nonsteroidal anti-inflammatory medications NSAIDs (generic name in italics): Diclofenac (Cataflam, Voltaren, Arthrotec) Oxaprozin (Daypro) If youre experiencing stomach upset or nausea when you take your antibiotic, eat 2.Before Surgery If you use antacids often and have problems with side effects, talk with your health care provider. Ciprofloxacin may be used to treat a wide range of infections such as those occurring in the urinary tract, prostate, respiratory tract, sinuses, bones and joints, abdomen, and genital area. The problem is that they cannot distinguish between normal, rapidly dividing cells and cancer cells, so the drugs attack them all. Explain It Like I'm 5, but for individuals who believe acronyms should always include nominative case pronouns. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Peak concentrations are reached within 45 minutes; however, it may take up to 48 hours before infection-related symptoms start to abate. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Discontinue ciprofloxacin immediately if you experience tendon pain, swelling, inflammation, or rupture and contact your healthcare provider. Protect yourself from sunlight and avoid excessive exposure to the sun when taking ciprofloxacin. You may take Tylenol (acetaminophen) unless otherwise instructed not to do so. Please shower/bathe and shampoo the night before or morning of procedure. Refer to the prescribing information for ciprofloxacin for a complete list of interactions. Katz PO, Gerson LB, Vela MF. All diuretics (frusemide, bumetanide, bendroflumethiazide, amiloride, spironolactone). In: Wecker L, Taylor DA, Theobald RJ, eds. May also be used for the treatment of plague or uncomplicated gonorrhea, in addition to other infections. Brands with magnesium may cause diarrhea. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. You have spent much time and energy going to appointments, preparing your home, and getting healthy. Ciprofloxacin may not be suitable during pregnancy or in women who are breastfeeding. Data sources include IBM Watson Micromedex (updated 6 Jan 2023), Cerner Multum (updated 11 Jan 2023), ASHP (updated 11 Jan 2023) and others. One to two weeks before surgery, you may have been told to stop taking blood thinners. Answer (1 of 3): From MedScape Response from Harley R. Liker, MD, MBA It depends on the reason that the upper endoscopy is being performed. Important telephone numbers of friends and relatives. How could you pronounce the word antacid? The procedure is performed on patients who are not having a good quality of life inspite if maximum medical treatment and lifestyle modification.
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