Wednesday, September 27, 2006

Artificial Knees: After Two Years, the Doctor Deems Knee Replacements as "Perfect"

Well, who can can complain when the doctor says "Perfect?"

That's what my orthopedic surgeon at Mass. General in Boston said about my two-year-old knee replacements after studying the x-rays. He and the x-rays are shown below. I came into his office saying that I was concerned because I had been really pushing it with the knee replacements, playing singles tennis and doing a lot of heavy lifting building stone walls.

When he said, the knees were perfect, I was surprised. "You don't see any wear and tear?" I asked.

"Not at all," he said. "The knees look just the way they should."

"Isn't this excellent outcome kind of unusual, considering all the stress I'm putting on these knees?"

"No," he said flatly. "It's typical, actually."

And here I was thinking that I was some kind of a hero. All I am is a run-of-the-mill success story. For months, I have been telling people about how wonderfully successful my knee replacements are, strongly implying that I deserve the credit."

"I really worked on the rehab," I told people.

I was somebody. Now I'm back to being a nobody again. Oh, well ....

It's a measure of how far medicine has advanced. Ten years ago, a guy like me running around playing tennis and walking miles with artificial knees would have been a celebrity. I would have been been on Oprah. While a clip ran of me playing tennis, I would have been talking about what it's like being a medical miracle.

Woulda, coulda, shoulda. Instead, my surgeon tells me I'm "typical." Oprah does not call. Even the local rag can't find any news in the fact that I'm playing tennis on titanium knees. I'm the only one who thinks I'm a hero.

Wounded ego aside, everybody else is probably right of course. My surgeon does hundreds of total knee replacements a year. He and many other joint-replacement doctors have assembly lines going, no doubt with lots of good outcomes like mine.

Ed, 64 and a member of our tennis group just had arthoscopic knee surgury. He was told that he would probably need both knees replaced within 10 years.

"I'd have them done sooner rather than later," I told him when I called to see how he was doing.

"Now that I see what you're doing with those knees," Ed said, "I would consider having them done sooner. I know that I can still play tennis."

Thank you, Ed, for giving my faded star a farewell whirl.

Tall, a strong and highly competitive player, Ed is a former star basketball player at Assumption College and today is a successful tennis coach at St. John's in Shrewsbury, Mass. He's going to call me when he is ready to hit.

Another member of the tennis group, Connie, pictured below on crutches, just had his left knee replaced two weeks ago. A former tennis star at Yale and one of the best tennis players to come out of Worcester, Connie, 72, is home recovering his strength. He is walking with the help of the crutches and trying to decide where to go for rehab.

I stopped by to see him and we had a nice long chat. He was upbeat and in good spirits but said he was in a lot of pain. And for Connie to say so, told me that his pain must be excruciating.
His left leg, with the replaced knee, is straight compared to the bowlegged right knee. Before my replacements I was as bowlegged as a saddle-worn cowboy. With my new knees, I grew about two inches and Connie says he is taller already.

He is taking a painkiller, Vicodin, but it doesn't seem to help much. He says the pain is 24/7 and he is wondering if he should stop taking the painkiller since it doesn't seem to be doing anything for him.
My free advice was to stop. "What's the point if it's not helping?"

I told him that, generally speaking, I think we are all better off relying on our bodies rather than drugs. He agreed but would rather hear it from someone more qualified than I. I did tell him that I got off the painkiller, Percocet, as fast as I could, within a few days. The pain began to decrease a few days later and then quickly went away.

We talked about rehab. Continuing to dispense free unqualified advice, I told Connie I thought that rehab was key to a good outcome."Most of the people I saw in rehab didn't work," I said. "They expected the therapist to do the work for them. It works just the opposite."

Most of the people I met in rehab had very low expectations. The typical goal is to get walking again. I was the only one in my groups with a goal of getting back playing a physically demanding sport like tennis. "Work like a dog, Connie," I said.

He wasn't even thinking tennis. He just wanted to get back to playing golf. But, knowing what a terrific tennis player he is, I pushed for tennis. By the time I left, I had the feeling that tennis was back on the table for Connie. In fact, one of these days I think I'll be seeing Connie on the other side of the net.

I hope so.

With all due respect to my surgeon, I have not met anyone whose outcome from total knee replacement has been as outstanding as mine. Maybe he hasn't, either. He looked at the x-rays and examined the knees on the table. "Excellent range of motion," he said.

"You don't know the half of it," I said to myself. He didn't see me run around on the tennis court for two hours, pain-free and chasing down balls the way I used to twenty years ago. I'd like to see him watch me do that and then tell me that I am "typical."

You know what? I'm annoyed. Typical, my ass.

Now that I am into a rant, I have met quite a few total-knee-replacement people whose outcome is so-so and a few whose outcomes were terrible. I have read of too many bad outcomes for excellent outcomes like mine to be reasonably described as typical.

I say this with great respect for my surgeon whose excellent outcomes are indeed legendary in the Worcester area. I see them running around on the tennis court. There's not a bad outcome among them. For my surgeon, maybe excellent outcomes are indeed "typical."

I'm still annoyed because I do not think that this is generally true in the knee-replacement universe. Some doctors get better outcomes than others, though this information is almost impossible to get in writing. And there are just too many bad outcomes for mine to be typical.

Let me tell you about my friend, Jane Brody, pictured below. Well, she's not really my friend. She is the personal health columnist with The New York Times. She has held the job for thirty years. I have read so many of her articles that I feel that I know her, especially since she sometimes lets us in on her own personal health issues -- such as the replacement of her seriously arthritic knees with titanium ones.

On December 15, 2004, at age 63, she had double knee replacement surgery "at a leading orthopedic hospital" which she does not name. But you can be sure, given her wealth of medical information, that her surgeon and hospital are top-flight. (My surgeon declined to do both knees at once, saying that there is increased risk and that he "never does anything that increases risk.")

By February, Ms. Brody was writing about postoperative problems, primarily intense and prolonged pain. She wrote that many letters from other patients described similar experiences with terrible pain that was not adequately recognized and treated after they left the hospital. Far fewer letters described a much quicker -- in a matter of weeks -- and less debilitating recovery.

Several orthopedic surgeons wrote Ms. Brody to point out that her extreme pain and prolonged recovery were not typical and that she was unduly scaring people who could benefit from the surgery. She says that was not her intent and that she only wanted patients to know that terrible pain can follow knee-replacement surgery.

Initially, Ms. Brody regained reasonable mobility quickly. But about seven days after the surgery, her pain worsened. The analgesic drugs she had been prescribed no longer controlled the pain. She was in constant agony and could not sleep.

Her internist finally prescribed a cocktail of drugs, including the long-acting narcotic OxyContin, which gave her some relief. While stepping up her walking, swimming, and riding an exercise bike, she continued taking the cocktail through April -- four months after surgery. By May, she had weaned herself off the coctail to avoid withdrawal symptoms.

But she was not yet done with pain. By late summer, she suffered debilitating pain in the right calf and right buttocks. It was diagnosed as sciatica and treated successfully with a shot of steriods. Then her left leg began to hurt. It was diagnosed as iliotibial band syndrome (ITB). She cut back on her walking and did stretching exercises and the pain gradually decreased.

Since her knee replacement surgery, Ms. Brody has been outspoken about the need for doctors to become more sensitive to and better informed about the great pain that can follow the surgery. She says that too many physicians are "clueless" about how to treat this postoperative pain.
In a follow-up column, a year after her surgery, Ms. Brody wrote:

"A word of caution: As with any surgery, knee replacement is not always perfect even in the best hands. I have met several people with lingering problems, including one who experienced permanent nerve damage and another who must use a cane despite a year of physical therapy and reassurance that her new knee is 'perfect.'"

"Perfect" I'm okay with. But how can my surgeon call a hero like me "typical"?


So long and keep moving.

Update Aug 3, 2015

Wouldn't you know, but on June 8, 2015, I had my left hip replaced by Dr. Burke.  With two trips to the emergency room after the surgery, it's been tough. But I'm well on my way back now and should be back on the tennis court in late September or early October. Of course, I wrote the story.  But it is less about me than my amazing surgeon Dr. Dennis Burke of Mass General in Boston. Click here:

UPDATE February 28, 2014

Ten years since my  knees were replaced in 2004? That can't be -- but it is!  On Tuesday, February 25 I went back to Dr. Burke at Mass General in Boston for my regular 5-year check-up (10 years after the initial replacements).  After X-rays and a two-hour wait -- Dr. Burke's rep is such that he is routinely swamped -- he welcomed me with that natural, warm smile of his. 

"How have you been doing?," he asked.

"Great, playing tennis, walking everywhere. I played this morning."

"Let's have a look," he said, clicking on the computer and pulling  up the X-ray of my knees.

"Beautiful," Dr. Burke said, "They look just as good as when I put them in ten years ago. Have you had any problems?"

"None. I don't even think about them. Thank you, thank you."

"Great, we'll see you in five years," he said, shaking my hand. And then he was out the door. I was in his office about ten minutes.  For Dr. Burke, it was just another big success. For me, it is not only a life-changer but a life-saver.

In an early 2014 blog, I start off with the above X-ray and then crow about how my "beautiful legs"  just took me all over Nantucket. Check out the story here.
NOTE: Something Tells Her, my new 2014 e-book, is now available on Amazon.   (Miabella T. Riley is a combination of the names of my four granddaughters.)


Jane is abandoned as a baby and raised in multiple horrific foster homes. After her latest abuse, a sexual advance from her latest foster parent, she screams "NO!" and runs out the door Twelve years old, on the street, alone, no family, nobody, no money, how can she possibly survive? She can't -- except that Jane  is no ordinary foster kid. She doesn't understand "can't." Read excerpts.

NOTE: My novel, State Kid: Hero of Literacy is  available on Amazon and Barnes & Noble.

Billy Stone was a foster child.

He ran away from abuse.

He went to juvenile prison.

He went up from there.

And he did it his way.

With the power of the written word. 

Amazon E-Books by George Pollock

 "State Kid: Hero of Literacy" is fiction based on his  real-life experiences  growing up in foster homes; "Last Laughs," is the true story of how five foster kids (he and four younger siblings) found their way in life and each other. "Killers: Surprises in a Maximum Security Prison," is the story of his being locked up for 23 hours with killers in a maximum security prison;  "I, Cadaver" is about his postmortem adventures and mischief in the anatomy lab at UMass Medical School. “A Beautiful Story” demonstrates the art and process of creative writing as a 16-year-old boy goes all out to write a story that literally saves his life;  "A Long, Happy, Healthy Life,"  is about how to live the title every day; and "Unlove Story," Writing anonymously as "Elvis," a husband, dumped after 38 years of marriage, lets it all out on love, marriage, life, everything. A guy doing this? It's unheard of.
   For the Nook:

A Beautiful Story
A Long, Happy, Healthy Life
I, Cadaver
State Kid
Unlove Story



At October 12, 2006 7:29 PM, Anonymous Anonymous said...

"Typical!" You shittin me! I will be honored to attest to the fact that you are no ordinary guy- for sure.
Thanks for the advice, the inspiration and being so "atypical."
Jim Kane

At December 30, 2007 8:51 AM, Anonymous Anonymous said...

I am going in on Thursday 1/3/08 for a right total knee replacement. I am only 46 but both legs are bone on bone. I too played tennis in high school, college, and throughout my adult life on a 4.0 USTA team. I have not played singles in years due to my knees and doubles was getting impossible too. How long after your surgery did you play doubles? Your story is an inspiration to me and gives me the confidence that with hard work in therapy I will be back to the courts soon too!

Donna Arnold

At December 30, 2007 4:41 PM, Blogger georgepollock said...

Dear Ms. Arnold,

Thank you for your note letting me know that you are going in on January 3 for total replacement of your right knee. Since the other knee is also bone on bone, I assume that it is also scheduled to be replaced. After my second knee was replaced in March, I started hitting easily in June and by late August I was playing regular doubles. In March it will be five years and the results have been amazing to me. I now play regular singles as well as doubles and I run flatout. My tennis friends call me the bionic man. I would hasten to add that this great outcome didn't just happen. Before the surgeries I worked hard to get my leg, back and ab muscles as strong as possible. In rehab agfterwards, I took what the therapists suggested and doubled and tripled it. In both rehab groups, I was the only one who worked that hard and most got predictably poor to mediocre outcomes. Admittedly, most were just happen to be able to walk again without pain. Their goals were very modest. Mine were sky-high: to return to competitive tennis. You have the same lofty goal (good for you!), but to reach it you really have to push yourself in rehab. Tell the therapists that you are an athlete who MUST return to tennis and that you want EXTREME REHAB and nothing less. I hope this helps and I will be thinking of you on January 3 and pulling for you in rehab.


George Pollock

At August 21, 2008 11:57 PM, Blogger barb said...

I am so excited to read your story. I had bilateral knee replacement 16 months ago and my recovery has been phenomenal. Like you I worked my butt off to get these excellent results. Up til about 15 years ago I was a 3.5-4.0 tennis player. The pain forced me to give up tennis but I was too chicken to have the surgery. It finally became too much and I bit the bullet and had them both done at the same time.

Yesterday I went out and hit the ball with my husband. It was the first time I have had a racquet in my hand in 15 years and it felt awesome. I began to worry that I shouldn't be playing so I came to the computer to do some research and found your blog entry. I'm not looking to play singles again but will be thrilled if I can play a decent set of doubles. I am a little afraid of the lateral movements, on the court, but I am guessing that I will get over that feeling in time.
Thanks for making me believe I can play again too!
Barb (age 62)

At August 22, 2008 1:03 PM, Anonymous Anonymous said...

Thank you for your comment on my blog and congratulations on picking up a tennis racket again. But don't stop there. I have seen too many people sell themselves short by expecting too little from their knee replacements. Nearly five years after my replacements I am not only playing singles two or three times a week -- and tough, hard-running singles -- but also regular doubles. I just turned 70 and am running around on the court like a kid and never felt better or played better. Guys in my group are going around saying that they want knee replacements, too. Make the most of your new mobility. Play singles.

At February 10, 2009 7:09 PM, Blogger michael said...

I am 45 years old. I have had severely bad knees for 24 years. I have always been too young for knee replacement. I have also always been very active. Just climbed mt washington on crutches. I use crutches often. How old is old enough for knew knees and EXACTLY what can I expect to do with them.I am a big guy. 6 2 250lbs....IN PAIN AND HAD ENOUGH....MICHAEL

At February 24, 2009 9:54 PM, Anonymous Anonymous said...

I am 60 and had have had 11 knee surgeries. Last August I have a total knee replacement. the doctor took out enough bone spurs to make a necklace. I am 270 lb and love sports. I wan to play basketball. Maybe just half court, but the recovery was excruciating. I am fine now, however neither knee has an ACL. Does anyone have experience playing basketball?

At February 24, 2009 9:57 PM, Anonymous Anonymous said...

I am 60 and had have had 11 knee surgeries. Last August I had a total knee replacement. the doctor took out enough bone spurs to make a necklace. I am 270 lb. 6'2" and love sports. I still want to play basketball. Maybe just half court, but the recovery was excruciating. I am fine now, however neither knee has an ACL. My right knee is shot and probably needs replacing, however, I am not planing to replace it soon. Does anyone have experience playing basketball?

At April 28, 2009 9:05 PM, Anonymous Steve said...

I am 61 and have had both knees replaced about a year apart. I had significant pain with the first replacement which lasted only for a week. I had a physical therapist whom I called Attila the Nun as she was ferocious in her treatment protocol. I worked as hard as I could to maintain physical condition and to regain it after the surgery.
The second knee was a spectactular success by use of a femoral block I had almost no pain and again I worked very hard to get back in shape.
I now do all of the ordinary things but in addition I am still breaking, training and riding young horses and operating a full time horse ranch. I just completed my first 100 mile ride since surgery and feel great.

At October 05, 2009 12:28 PM, Anonymous Anonymous said...

I'm sixty four and schedualed to have my first knee replaced this Nov.
I've put it off for several years now, even though both knees are bone on bone and there is a lot of deviation (bow legs)
Riding, showing horses, trimming their feet and working with young horses is my life.
I don't walk without pain, haven't for years, but I still show all round horses and ride a few young ones
Posting when riding English requires a double dose of Tylenol 3
I can live with the pain, but I can't live without my horse life-thus the uncertanity of my riding life after knee replacement has me in a depression
Steve's story of riding after knee replacement has given me hope
Anyone know where John Lyons article on riding after total knee replacement can be found?
Love to hear from other riders!!

At January 21, 2011 9:08 AM, Anonymous mike said...

I'm encouraged by reading the postings on this blog. I'm 47, had ACL surgery on my left knee 15 years ago, and, through rigorous (and constant) tennis play, have worn away the cartilage to my knee so I'm now basically, bone on bone. I'm currently contemplating TKR for my left knee since my tennis has now ground to a stop due to pain / discomfort. I'm still getting orthopedic surgery consults now, but, I miss tennis greatly, and, would love to get back in the game.

My real concern is having having the surgery now (at 47), and, needing a 2nd (replacement) surgery down the line, which I understand can be highly problematic.

Can anyone lend insight on TKR surgery they've had 5+ years ago, how the knee is holding up, and, level of activity (i.e., tennis type activities) they've been able to maintain.

Would appreciate insight, patient experiences.

At January 21, 2011 4:58 PM, Blogger georgepollock said...

Hi Michael,

Nice to hear from you. In a word, I'm doing fantastic. The outcome is better than I or my doctors could have imagined. Over six years later I'm still playing singles tennis, never even think of my knees, and the way I move on the tennis court has made me something of a local legend. ( Forget false modesty at this stage in life). Still playing singles and have recently started playing ice hockey again, believe it or not, which I describe in my latest blog.

In recent years TKR has become commonplace with many tens of thousands done every year. Most bad outcomes are because people are unfit or don't do the rehab or both. Bottom line: the outcome is up to you. Let me know what you decide.



At April 18, 2011 3:20 PM, Blogger Vipper said...

I have had tkr on one knee, partial on the other. Generally, with biking and walking, I have either no discomfort or minimal discomfort - aching. I want to return to tennis but I went out a couple weeks ago and afterward the kids felt tender and a little miffed. I am wondering if you had the same experience initially? Also, would you advise wearing braces just to minimize impact wear?

At April 18, 2011 8:38 PM, Anonymous George said...

Hi Vipper,

I certainly would use a brace on the knee that hurts. No point in enduring pain if there is no benefit, which there isn't. If pain persists, if mobility declines(critical for a tennis player)I would get the second knee totally replaced, sooner rather than later. After my second knee was replaced, I was tentative at tennis for a few months. But as I realized that I had no pain, I began pushing harder. In about a year, I was playing almost normally. Today, I play singles, run flat out, and never even think that I have titaneum knees. I have KNEES just like everybody else.

Let me know what you decide.


At June 24, 2011 3:25 PM, Anonymous Anonymous said...

George - great blog! I had my left knee replaced 18 months ago, and I have just started playing basketball again. I was worried until I read your blog, and I agree with you, the doctor does make a difference! I see others struggling with their replacements. I also did work hard on the rehab like yourself. I'm only 58, so that might have helped too. I'm just glad to hear it's ok to be active. I was afraid I was overdoing it. Dan

At July 27, 2011 7:47 PM, Anonymous Anonymous said...

My range of motion was so wonderful, outpatient rehab
wasn't needed, post op. However, almost two years
post op I have intermittent pain on the exterior of my knee.
ROM is still above average, x-rays excellent. However, I never had the slightest desire to play tennis, but brisk walking would be great. I also have pseudogout, so getting
effusions in the other knee that needs to be replaced from
walking distance and aquatic aerobics hasn't helped
my mobility. Plus,two bombed bunionectomies,of which I
Had a big toe fusion with five screws and a plate. I need
a second toe fusion. Lots of chronic pain likely from pushing the envelope gardening. And, NSAIDs and Cox 2's cause kick my Ulcerative Colitis out of commission.
Seeing, outside of the first two weeks, I rehabilitated
the knee without ever needing outpatient I worked my
butt off. You almost get the knee in the best shape
possible, pre-op with exercise for best post op ROM.
Now, let's hope after the second TKR I WILL walk briskly.
I was 52 at the first surgery. I disagree with George
regarding pain management, as studies show better
Results with TKR when pain is managed, properly.
George, being from Ct. May I ask your doc's name.
I won't mention yours. Lol

Great job, George
Good luck to all,


At July 27, 2011 7:50 PM, Anonymous Anonymous said...

Oh, I'm not schlepping to Boston but would adore walking about cities, again.

At October 03, 2011 8:27 PM, Anonymous Anonymous said...

I am 65 years old, very active in Soccer and Tennis all my life and suffering from knee pain as long as I remember. 15 years ago I had a scope on the right knee followed by 5 other scopes on the same knee and one scope on the left within 8 years. I have heard the expression bone on bone over and over from many doctors who treated me but could never master the courage to do TKR. I started walking regularly averaging 3 miles/day, 4 times/week and dropped my weight from 210 to 190. I also play Tennis 3 to 4 times/week on clay. I don't play singles nor doubles and just hit with practice partners to keep moving. I noticed a great reduction in pain on both knees and managed to stay away from the doctor for few years.
I don't know if this is a good formula for everybody but thought it might be worth sharing. Did anybody have a similar experience?

At February 29, 2012 4:51 PM, Anonymous michael said...

i am 48 and had both my knees replaced 5 months ago. I have suffered with needing a replacement for 25 years after complications with ulceratjve colitis. They kept saying I was to young. after being on and off crutches all these years (yes crutches) they were that bad. finally could no longer walk without crutches and severe pain all the time. for the past 6 weeks I have been able to go hiking in the woods. sometimes as much as 3 hours. even on back to back days. they are still healing. still hurt a little on outside of knee. took a bad fall off a dtool while working on ceiling 2 weeks ago. A m not sure if I damaged the right knee or not. it is healing on its own so i hope it will be ok. After all this I feel 30 years younger on my new knees. Some range of motion is lost forevermore. but it feels so good to walk around without pain. I can even keep up hiking with my teenagers. TKR..GOOD STUFF

At March 30, 2014 11:06 PM, Anonymous Anonymous said...

I am a 67 y/o tennis star wannabe. I had both knees scoped, once for R and twice for L. Started twice a year hylauronic acid injections 5+ yrs ago with good results. Pain relief was very good but not complete. I still had to ice half the times I played especially if it was more than three sets. Tylenol and Advil were my constant companion. I could no longer ride a bike due to decreased ROM in my right knee.

Last June after my bilateral twice a year Synvisc injection with the orthopaedist for the last 20 yrs, I decided to get a 2nd opinion. The guy looks at the x-rays. He then asked me about my lifestyle accommodations. Then he asked when I would like to schedule replacement surgery. The idea was not even on my radar because I was feeling so good with with the injections. He would not do the surgery. He would refer me to his former partner who had done,he said, "over 8000". I occasionally played with two guys for whom he had done replacements. One, I could almost beat in singles and he is five years my senior! He has locally been my mentor! "If you do the rehab you can come back!" I really appreciate your blog. I have found little support for tennis playing, doubles, let alone singles among the medical staff yet there are growing anecdotal reports that suggest the components are strong enough. I just read an interview with Billie Jean King and her success 2+ yrs later. As you have written and she strongly concurred, you have to do the rehab.

I am half way there: R knee, 20 Dec 2013; now L knee, 24 Mar 2014. PT says I am way ahead of the rehab curve for the R one. ROM is about 130 degrees now. Leg strength is adequate to support me for the L. I did have some IT band pain about week 5-6, but it was manageable. I had dealt with it most of the summer of 2011! Otherwise I had little post-op pain. No narcotics after I left the hospital. L one has been a little more sore. I have taken at least on narcotic pill at night since I came home. I am again grateful for your 2, 5, and 10 year follow up.

I would add that I had a R shoulder rotator cuff repair in 2006. I was in a sling 24/7 for 3 months. That helped to mentally prepare me for the pain and torture (PT) of my knee rehab so far!

Would you share with me how long it took before you did not think about your knees on the court? What you, your PT, or trainers gave you for goals to start back on the court? How long after you started hitting before you felt confident to start playing and with your movement on the court?

Sorry, I could not get this sent through your blog, but feel free to add it to the contributions.

Geoff Wagner

Sent from my iPad
George Pollock

8:22 PM (2 hours ago)

to Geoff's
Hi Geoff,

Thank you for your email and congratulations on your knee replacements, the second barely a week ago! This means you are smack dab at the time where what you do determines your overall success: rehab. I cannot emphasize enough how important it is that you give it everything you got in rehab. That's what I did and that's how I got to where I am today, running full out on the court and not even thinking about it. But, honestly, it took me a long time, not until after my 5-year exam, before I became a believer and fully realized that my knees were as good or better than players in my age bracket. I just had my 10-year exam and my orthopedic surgeon pronounced them "beautiful;" and sent my on my way. I just wrote about it on my blog.. These next few weeks are critical. If you work as hard as you possibly can, you can have the same outcome as mine. I'll be thinking of you.


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