I want to become a DO

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And what do you do if the pt has no relief of their symptoms with FPR?

Same thing I would do if the patient got no relief from Pepcid. Try something else. Protonix, Nexium, Axid, etc.

Would you just apologize, circle the billing code, and give them the boot?

:rolleyes:

The issue I have with OMM as a whole is that some things don't work for some people and I have a problem performing a 10 second technique that might not work and then sending them on their way and billing for it.

One thing you are going to eventually learn is that medicine is not perfect. We try to help our patients in every way possible (hence the reason we use OMT in the first place). We try to do our best but something even our best doesnt work. Would you charge a patient for a cholecystectomy if they had residual symptoms after the surgery? Would you charge a patient for seeing them and telling them their symptoms are from influenza, and thus you are unable to give them a prescription? Would you charge a patient who coems to you with migraines and you have already given them Rxs for every triptan on the market with no relief?

For example, you're placing the pt into completely opposite positions for ME vs. FPR. Theoretically speaking, how can they both have a theraputic effect? I understand the anatomical reasons for both treatments but it seems like almost a crapshoot when trying to choose which treatments to use in 2 minutes.

You have more to learn about OMT. Im not about to conduct an online lecture series.

Just out of curiosity, how many of your patients come to you specifically with musculoskeletal problems?

Top reasons people see their doctor:

Children: 1. Common cold 2. Otitis media 3. Nausea/Vomiting/Diarrhea
Adults: 1. Common cold 2. Undiagnosed pain (MSK or other) 3. Dermatologic complaints 4. Gastrointestinal complaints 5. Low back pain 6. Depression/Anxiety

If a patient comes to you with a sinus infection or pneumonia, would you perform a lymphatic technique and have no problem billing for it? Ethically speaking, would you perform a pedal pump and bill for it? Or would you tell the patient to walk on a treadmill for 10 minutes once a day?

Patient compliance. What is the likelihood that my patient will heed my advice? Recent studies show that patient compliance is as high as 60% and as low as 25%. 2 minutes of treatment in my office is GOING to get done. Relying on them to walk on a treadmill while they are feeling ill is ridiculous.

Again, this is assuming that there is a justification for performing these OMM techniques on the patients.

Why assume? Look at the literature. You can do the online searches for yourself.

History has shown that there is an osteopathic manipulative treatment for just about every type of disease or dysfunction out there. While I don't consider myself to have nearly as much experience as you do, I can tell you right now I don't buy into some of it.

Me neither

It's not due to closed mindedness, but rather a lack of evidence supporting it AND proposed mechanisms that seem unbelieveable to me.

Agree 100%

For example, to bring up the issue most commonly bashed here, I find it hard to believe anyone can feel CSF moving under skull bones.

You are in the overwhelming majority, and I agree with you.

Until there is a way to measure these pulsations from contact outside the skull with a computer and then compare it to the sensitivity of the human finger tip I will refuse to perform this in a practice.

Agreed. But to lump cranial in with the true musculoskeletal treatment techniques is obsurd.

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ok a few quick things here...

1. you're going to be prescribing drugs that work by many different and sometimes opposing mechanisms....and they can all be for the same goal.....some drugs don't work the same in all people for the various reasons that you have learned (or will learn)

2. Knowing exactly which treatment to use is something that comes with more experience and practice....something I don't claim to have yet either and none of us likely will unless you practice and continue using OMM after your pre-clinical years. For now, concentrate on acute vs. chronic and just learning how to do the various types well

3. you can't just lump all of OMM together and judge it by looking at one modality (cranial)


1. But there are explanations as to why many of the drugs won't work in some people. There is no explanation as to why ME will work in one person and counterstrain will not. This is not to say they shouldn't be used, but I have a problem with just choosing one and throwing it into a medical office visit and then billing for it regardless of if it works on that occasion.


2. Obviously there are benefits to some treatments over others in certain patients. For example, an elderly patient with little to no energy would probably do better with counterstrain than ME. A pt with severe osteoporosis you'd probably want to stay away from HVLA. But if your patient is completely healthy and having a muscle spasm, why choose ME over counterstrain or the other way around? I'm not arguing, rather asking an educated question if anyone knows

3. I would never lump all of OMM together. I don't doubt the efficacy of certain techniques.
 
You have more to learn about OMT. Im not about to conduct an online lecture series.

Nobody is asking for a lecture series. I asked you a simple question. I understand the concept behind muscle spindles and gto's. So which do you choose to utilize and how do you come to that decision in your 2 minute OMT treatment of an otherwise healthy person? If I was using OMM on a regular basis I would try one and then the other, and then other treatments. I'm not starting an argument, and if you feel like this is wasting important thread space for the original DO vs. MD argument feel free to PM me.

I guess it comes down to me feeling silly about billing for a 10 second manipulation that didn't even work.
 
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But if your patient is completely healthy and having a muscle spasm, why choose ME over counterstrain or the other way around? I'm not arguing, rather asking an educated question if anyone knows

This is where experience comes into the mix. Not every patient is going to present with exactly the same way. I.E.- Cause, length of time since incident, etc. So when one finds what works for different situations you apply them to the next case as they come along. Yes, it takes time and experience to become effective, but what doesn't?

If you feel that silly about billing for a 10 second treatment that might or might not work, don't bill for it until you have done it enough to be confident that it will help the patient. If it only takes you 10 seconds and it improves your patients perception of you then it is good for both of you.
 
So which do you choose to utilize and how do you come to that decision in your 2 minute OMT treatment of an otherwise healthy person? If I was using OMM on a regular basis I would try one and then the other, and then other treatments.

Experience. Experience not only with that particular complaint, but experience with treating similar palpatory diagnostic findings. All of that comes with treating hundreds of patients. Its not something you can adequately do right out of medical school. It takes practice, additional training and self learning. Thats why there are residency programs, CMEs and conventions.

I guess it comes down to me feeling silly about billing for a 10 second manipulation that didn't even work.

Then make sure you do something that works.
 
Speak for yourself.

3 areas in 3 minutes

If you cant adequately treat a body area in a minute then either you arent doing it correctly or you dont know what you are doing.

Dont be fooled by the second year medical student fumbling around trying to figure out which way to HVLA someones neck.

I can HVLA the entire C-spine, treat the first ribs bilaterally and then fix the upper thoracics in under 2 minutes.

You need to learn high yield OMT techniques. What is going to get you the best patient response in the shortest amount of time and in the safest manner. Like when someone comes into the ER. CT scan vs Ultrasound vs MRI. What will give me the most information and the correct information in the shortest amount of time, while still being cost effective based on patient presentation.

I would say $50.00 for 3-5 minutes of OMT is fair reimbursement.

I didn't realize that reimbursement was that high.

So how much of a salary boost is typical for a DO icorporating OMT into their Practice?

Also, how many DOs do this? Is it hard to set up a practice and make it cost efficient for OMT, or including omt in a normal practice
 
I didn't realize that reimbursement was that high.

Can be a lot more in some places.

So how much of a salary boost is typical for a DO icorporating OMT into their Practice?

Depends on how much OMT you do, whether your charge cash or bill insurance and how good you are (repeat business, time efficiency, word of mouth, etc).

I know of at least one case where a DO in a FP group (with 3 MDs) makes $45,000 more than his partners. He does OMT every Friday and charges cash...hourly rate.

Also, how many DOs do this?

Not many. Thats part of the reason is it lucrative. Patients search out DOs. Many of the older patients comment on how their "osteopaths" retired and its getting harder to find someone who does manipulation.

Is it hard to set up a practice and make it cost efficient for OMT, or including omt in a normal practice

Not at all. First and foremost you need to be well trained in OMT. You need to know the indications, contraindications and limitations of the techniques. Establishing a good relationship with a Physical Therapy or Rehab center helps as well. Word of mouth advertising is the best around. Many DOs who do OMT are not shy about sending their patients to another DO who may be able to help them better or who is closer geographically. There are more than enough patients to go around. Waiting lists for OMT practices, especially with certain docs, can exceed 6 months.
 
even here in Philly where there is a heavy concentration of DO's.....my friends and family who I have worked on and then put in contact w/ DO's around here who use OMT regularly....most have had to wait at least a month and usually much longer for an initial appointment....
 
Damn right.

My appointment book is full within 1 week of my return to campus for my OMT months.

Im just that good. ;)
 
Experience. Experience not only with that particular complaint, but experience with treating similar palpatory diagnostic findings. All of that comes with treating hundreds of patients. Its not something you can adequately do right out of medical school. It takes practice, additional training and self learning. Thats why there are residency programs, CMEs and conventions.



Then make sure you do something that works.

fair enough
 
I am dumbfounded that cranial found its way into the curriculum. Flabbergasted. Even if it were real; it just seems too stupid to take seriously. It does cast a sour light on the rest, just by its mere presence. And what about the hair? Say super-tight perm versus a bald spot?

And why don't physicians get paid what they charge? This makes no sense. That's a lot of income going bye-bye.
 
I am dumbfounded that cranial found its way into the curriculum. Flabbergasted. Even if it were real; it just seems too stupid to take seriously. It does cast a sour light on the rest, just by its mere presence. And what about the hair? Say super-tight perm versus a bald spot?

And why don't physicians get paid what they charge? This makes no sense. That's a lot of income going bye-bye.

Lets not forget that touch, itself, can be inherently soothing and therapeutic. I am not saying that it will cure an acute medical problem but that it helps a lot of people just to be cared for and physically touched. Cranial may have its place in the emotional and mental realm of patient care. I shadowed a Candian Osteopath and although most of you would not consider him a real "Medical Doctor" (because he is not), his cranial work and subtle touch and manipulation of visceral organs truly helped pain and discomfort in his patients. Were they liberal, spirtual people to start with? Mostly. But one thing I have learned while working with trouble youth and drug addicts is that there are a lot of lonely, abused people out there and a little touch, empathy, and postive energy work can go a long way. Touching one's head is an initimate experience for both patient and doctor and thus, cranial might just have its place in osteopathic medicine.

dave
 
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Lets not forget that touch, itself, can be inherently soothing and therapeutic. I am not saying that it will cure an acute medical problem but that it helps a lot of people just to be cared for and physically touched. Cranial may have its place in the emotional and mental realm of patient care. I shadowed a Candian Osteopath and although most of you would not consider him a real "Medical Doctor" (because he is not), his cranial work and subtle touch and manipulation of visceral organs truly helped pain and discomfort in his patients. Were they liberal, spirtual people to start with? Mostly. But one thing I have learned while working with trouble youth and drug addicts is that there are a lot of lonely, abused people out there and a little touch, empathy, and postive energy work can go a long way. Touching one's head is an initimate experience for both patient and doctor and thus, cranial might just have its place in osteopathic medicine.

dave

Well, I admit I cannot really make a decision without being fully informed, and as I am gonna have to learn this stuff: I will try to keep my incredularity under tight rein until I can make an informed decision. I certainly admit that I don't know everything! But unusual claims generally require unusual proof.
 
Well, I admit I cannot really make a decision without being fully informed, and as I am gonna have to learn this stuff: I will try to keep my incredularity under tight rein until I can make an informed decision. I certainly admit that I don't know everything! But unusual claims generally require unusual proof.

It's appropriate to have different "indexes" of proof for different treatments and conditions. If a treatment carries a high risk of adverse effects, I want strong proof of its efficacy before I subject a patient (or myself) to this risk.

If, however, a treatment is extremely safe and has some potential to help a patient, I would be more likely to use it, even if I can't produce a DBPC trial to back it up. Much of OMM might fit into this category, but there are other examples, too, ie. perhaps extra folic acid can help modulate homocysteine levels. The jury may be out on this question for many years to come, but in the meantime, recommending supplemental folic acid is extremely unlikely to cause any harm and might reduce risk.

Conditions which are severe and elude treatment may also justify a lesser index of proof. For example, an acquaintance of mine with treatment resistant depression will soon get a pacemaker implanted in his neck to provide vagal nerve stimulation. To the best of my knowledge, no one is really sure what exactly this does, or why it might work, and the procedure is not risk free, but he has tried everything else, so, proof or not, the treatment is provided.

RAMBLE OFF/
 
Where do you get most of your OMT education from? Med school? Post Grad?

I am asking because COM-Mesa uses video lectures for years 2-4 OMT, and I have to question how effective the education can be when it is just a few students watching a video and then attempting the OMT on each other w/o a faculty member correcting them.
 
It's appropriate to have different "indexes" of proof for different treatments and conditions. If a treatment carries a high risk of adverse effects, I want strong proof of its efficacy before I subject a patient (or myself) to this risk.

If, however, a treatment is extremely safe and has some potential to help a patient, I would be more likely to use it, even if I can't produce a DBPC trial to back it up. Much of OMM might fit into this category, but there are other examples, too, ie. perhaps extra folic acid can help modulate homocysteine levels. The jury may be out on this question for many years to come, but in the meantime, recommending supplemental folic acid is extremely unlikely to cause any harm and might reduce risk.

Conditions which are severe and elude treatment may also justify a lesser index of proof. For example, an acquaintance of mine with treatment resistant depression will soon get a pacemaker implanted in his neck to provide vagal nerve stimulation. To the best of my knowledge, no one is really sure what exactly this does, or why it might work, and the procedure is not risk free, but he has tried everything else, so, proof or not, the treatment is provided.

RAMBLE OFF/

Sure. I should have specified I meant proof for myself.

Where do you get most of your OMT education from? Med school? Post Grad?

I am asking because COM-Mesa uses video lectures for years 2-4 OMT, and I have to question how effective the education can be when it is just a few students watching a video and then attempting the OMT on each other w/o a faculty member correcting them.

No actual instructors? That seems odd.
 
No actual instructors? That seems odd.

At some of the CHCs possibly, but the are planning the majority to be done through video conferencing and video lectures. It would not be financially feasible to send 11 instructors out to 11 different CHCs to just teach 10 students each.

I am not even sure they will be sending a D.O. to function as the support liaison for each CHC.

I looked at the website for El Rio healthcare centers in Tucson (the CHC I was accepted to) and there is not even a D.O. currently on staff there, so It doesn't seem like they could even line up a preceptor-taught program.

This is one reason why I chose to decline the acceptance.
 
At some of the CHCs possibly, but the are planning the majority to be done through video conferencing and video lectures. It would be financially feasible to send 11 instructors out to 11 different CHCs to just teach 10 students each.

I am not even sure they will be sending a D.O. to function as the support liaison for each CHC.

I looked at the website for El Rio healthcare centers in Tucson (the CHC I was accepted to) and there is not even a D.O. currently on staff there, so It doesn't seem like they could even line up a preceptor-taught program.

This is one reason why I chose to decline the acceptance.

Sounds like they need to do some ironing!
 
At some of the CHCs possibly, but the are planning the majority to be done through video conferencing and video lectures. It would not be financially feasible to send 11 instructors out to 11 different CHCs to just teach 10 students each.

I am not even sure they will be sending a D.O. to function as the support liaison for each CHC.

I looked at the website for El Rio healthcare centers in Tucson (the CHC I was accepted to) and there is not even a D.O. currently on staff there, so It doesn't seem like they could even line up a preceptor-taught program.

This is one reason why I chose to decline the acceptance.
Wow.....the programs in Arizona just shot up on my list of backups because apparently they don't put a lot of emphasis on OMM. :thumbup:
 
dropkick one of these days you're going to start a real flame war and get the boot... i knwo you don't intend to, but you're really gonna piss someone off one of these days on here...
 
:thumbup: :thumbup: I wholeheartedly agree with both of you!:)

I think that there is way too much emphasis put on the MCAT anyway. A lot of great people with otherwise strong stats miss out on opportunities because of their MCAT score. There are plenty of people that graduate from schools (MD or DO) who had lower MCATs that go on to become wonderful doctors.

I am very agree on that one :)
 
Hi. I was considering of being an MD, but after reserching about DO, I reconsidered. How do I go about applying for DO school. Is it like AMCAS or is individual application for every DO school?
Here is my info: I just graduated from college in December of 2006. I graduated with a 3.53 GPA. I have volunteered at two hospitals, currently working as a CNA, volunteered as an assistant basketball coach, soon to volunteer at a shelter for women and children and as research lab assistant. I plan on entering medical school in 2008. Can someone point me to the right direction. I'm new to the DO application process.




Shuttap and just do it! You'll get into DO school, no problem with your stats, it not as competetive as allo
 
:thumbup: :thumbup: I wholeheartedly agree with both of you!:)

I think that there is way too much emphasis put on the MCAT anyway. A lot of great people with otherwise strong stats miss out on opportunities because of their MCAT score. There are plenty of people that graduate from schools (MD or DO) who had lower MCATs that go on to become wonderful doctors.

Bah, come on. I think the MCAT is the easiest way for any sort of med school to assess its applicants. The MCAT isnt the last test that people going into med school have to pass...comlex and usmle are some mean tests. The schools want to admit people who can get through their cirriculum (so GPA matters somewhat) but in the end they want to brag about a high 1st time pass rate and a great match list. THE ONLY way I see that happening is by selecting those who have empirically done well on standardized tests. For this reason i cant blame adcoms for putting as much weight as they do on the MCAT.
 
I Am A Doctor Of Chiropractic With A G.p.a. Of 3.43 In School . What Are My Chances Of D.o. School?
 
Bah, come on. I think the MCAT is the easiest way for any sort of med school to assess its applicants. The MCAT isnt the last test that people going into med school have to pass...comlex and usmle are some mean tests. The schools want to admit people who can get through their cirriculum (so GPA matters somewhat) but in the end they want to brag about a high 1st time pass rate and a great match list. THE ONLY way I see that happening is by selecting those who have empirically done well on standardized tests. For this reason i cant blame adcoms for putting as much weight as they do on the MCAT.

You know that the MCAT doesn't really have a strong correlation with USMLE Step I, right? It's mediocre at best.
 
stronger than any other factor though. And the correlation is not as weak as people think it is.

Okay. I can't argue with that. Between the two, it's a median R=.72 (Koenig, et al, 1996). I just reread rnp614's post and I don't disagree with it. I think schools are out to, as rnp614 put it, "brag about a high 1st time pass rate and a great match list." Sounds about right.
 
Wow this thread is confusing.

When posters say DO is less than MD, you guys get mad. I can understand that.

When posters say DO is the same as MD, you guys still get mad? I'm thinking there's only one thing that will make you happy and that is if DKM says DO >>> MD??

Poor DKM. No wonder he goes on pic sprees in Pre Allo, hes a village pariah here.
 
Let's use another martial arts analogy. I am a 2nd degree blackbelt in Taekwon-Do. I don't pretend that I have a blackbelt in Karate, okay? People with blackbelts in either are both skilled martial artists, however. Effective fighting is effective fighting; it knows no style. One can say that these martial arts are really just forms of the same thing, with different emphasis and packaging. They have common roots and both are based on how the body mechanically works. That is, there are no real significant differences between these two styles, just personal preferences and perhaps different emphasis. Neither of these styles represent the gospel truth. As a martial artist, I'm not going to limit myself to tradition or schools of "thought"; I'm going to do what works, okay? But I've got to choose one school as my foundation of knowledge. I might as well choose the one that I align with the most in as many aspects as possible.

No this analogy doesn't work. DKM and Invis are arguing that the package of DO doesn't change medicine and therefore is the same as MD. You also agreed that medicine is medicine, just packaged in different ways. But this martial arts analogy isn't correct because TKD is not Karate packaged differently.

TKD's package drastically changes the type of practitioner you are. If you are coming from ATA/WTF/or even some of the mainstream ITF, you are a martial athlete. The philosophy and general direction of TKD is taking it far from arts like Muay Thai or Kyokushin Karate. And yes you can argue that the individual can take it back to fighting roots, but then you wouldn't be doing this TKD package you are referring to.

If you were just talking about the system of TKD and Karate, bereft of any human influence whatsoever, and just looking at the base systems and the potential for each, I would agree, that on a foundational level, they are similar - obviously because TKD was developed out of Karate in the mid to late 1950s. But when you include "personal preferences" and philosophy into it, they become drastically different packages with different goals.

Here's a better martial arts analogy for the point you are trying to make. In MMA, you have generally two systems of approach - grapplers and strikers. Now like you said, you don't limit yourself to one mode, but you encompass what you need. So grapplers learn enough striking to defend standing and get the fight to the ground. Strikers learn enough grappling to defend on the ground and stand back up. Two different packages but with the same ultimate goal. You take whatever fits you best. If you have a wrestling background, you will like grappling better. If your dad taught you some boxing when you were a teenager, you might be inclined to like striking better.
 
Here's a better martial arts analogy for the point you are trying to make. In MMA, you have generally two systems of approach - grapplers and strikers. Now like you said, you don't limit yourself to one mode, but you encompass what you need. So grapplers learn enough striking to defend standing and get the fight to the ground. Strikers learn enough grappling to defend on the ground and stand back up. Two different packages but with the same ultimate goal. You take whatever fits you best. If you have a wrestling background, you will like grappling better. If your dad taught you some boxing when you were a teenager, you might be inclined to like striking better.

good analogy. :thumbup:
 
So which one are you with?

I'm guessing by your hypenation that you're prob with ITF.

I spent 2-3 yrs in WTF TKD getting a black belt before I realized I didn't want to do a sport and moved on to systems that suited me better.
 
So which one are you with?

I'm guessing by your hypenation that you're prob with ITF.

I spent 2-3 yrs in WTF TKD getting a black belt before I realized I didn't want to do a sport and moved on to systems that suited me better.

Yeah, very astute of you; it was ITF. I have my 2nd in ITF TKD, but I dabbled in WTF. I found that my old bones couldn't take the heavy athletic focus in WTF. I'd go home from a hard work out and wouldn't be able to walk for a while. :laugh: :oops:
 
You know that the MCAT doesn't really have a strong correlation with USMLE Step I, right? It's mediocre at best.

I just saw some unpublished data today which disagrees with this. Specifically, the biological sciences section had a strong (.8) correlation with performance on COMLEX. VR and PS sections did not. Undergrad science GPA and undergrad institution also had no correlation.
 
I just saw some unpublished data today which disagrees with this. Specifically, the biological sciences section had a strong (.8) correlation with performance on COMLEX. VR and PS sections did not. Undergrad science GPA and undergrad institution also had no correlation.

Thanks for the update, DragonWell. It's good to know. I was basing my thoughts perhaps on some dated studies and/or perceptions. It's good to know that BS correlated strongly with COMLEX scores, actually. It was my highest section (12). :laugh: :thumbup:
 
Yeah, very astute of you; it was ITF. I have my 2nd in ITF TKD, but I dabbled in WTF. I found that my old bones couldn't take the heavy athletic focus in WTF. I'd go home from a hard work out and wouldn't be able to walk for a while. :laugh: :oops:

Yea in my opinion, out of all the TKDers, ITF is still the most respectful because they haven't gone all tappity tap point sparring with giant maxipads strapped to their chests.

We got one ITF guy that shows up to our fight class (open mat, MMA rules) that is pretty decent standing. Just needs some submission grappling/clinchwork to get well rounded. Lot more variety in kicks and more emphasis on power and technique than WTFers, who are only concerned with speed so they can play foottag...
 
No, I won't be applying for another couple of years, and you're right- what I say here (unless I provide evidence to back it up) is simply my opinion. The same as what DGriss, Kuba, Inviz, or anyone else states here. Personally I'm not claiming any more insight, it's just that I don't temper my opinions out of fear of appearing less than "worthy" of being a physician in the eyes of a bunch of premeds and a few med students. My concern is simply for the ability to be able to deliver quality and timely care to my patients today and for years into the future....anything beyond that is secondary.

wow dude, you actually have the nerve to troll around on sdn all day every day when you aren't even applying to med school for a couple of years? If you aren't the saddest respiratory therapist or nurse or whatever you are, I don't know who is. Well, at least they finally put your account on hold.
 
No offense, but many of us did VERY WELL on the MCAT and chose to go DO. Osteopathy is no longer the bastard step-child of medicine./QUOTE]

If MANY of you did "very well".....the average would be higher. Or did you not take statistics? You're exhibiting the same bias towards my assumption that DO matriculants did not do as well on the MCAT or in regards to their GPA, but my assumption is based on the average GPA and MCAT scores. What is your bias based upon?


So DKM is now on account hold; what did he do this time worthy of it. I think he deserves it most of the time; so what finally qualified?

I mean this in of itself was pretty nasty, presumptuous and conceited. Not that that makes one worthy of account hold but when you sum up all his comments like this, they deserve it.
 
Please do not discuss other members in the public forums; the decisions made by moderators are not open for discussion to anyone other than that person and the moderator.

This thread has outlived its usefulness and has become a sparring ring so closing
 
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