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Olecranon Fracture Posts

Arm strength exercises after elbow fracture – TitaniumGeek

I think the hardest part after fracturing my olecranon SEVEN months and THREE weeks ago, was not the injury itself, which was annoying, but the residual weakness. This weakness has not merely affected my arm, but also my chest and back. ONE month after having had my metal work removed, it’s finally safe to start rebuilding the muscles on my right arm and shoulder. This was MUCH harder than I expected!

Regaining arm strength after elbow fracture

Firstly, the important thing to realise is that, dus to the significant lack of use as the olecranon fracture healed, the power/strength in your tricep muscle, heck the whole arm, will have been utterly decimated. That is NOT an exaggeration. It was only in the last week or so before I went in for the second operation that I was finally beginning able to put on a seated, when in the passenger seat without difficulty, or pain. I still remain shocked that of my day-to-day activities, the passenger seat belt has remained the most difficult. Possibility as I can’t compensate really. Lying down remains an annoyance, but I have compensated with my LEFT arm/just drop onto the bed. But there hasn’t been anything other than to pull the Seat belt carefully and slowly.

Going back to the gym

Just let me reiterate. The power in my RIGHT arm has been decimated. Doing arm extension reps with the gym machines – which are good for initial rehab, as they isolate the desired muscle of the user – I am able to pull against 20kg of weight with my LEFT arm without straining too much. With my RIGHT, 2kg is passable, 4kg is an unacceptable strain on my elbow.
I’m reasonably confident that at 6 months post fracture, you would be looking at a force of approximately 80Nm going through the fracture in order to displace it. Obviously, normal bone can support greater forces, but there is no weak point in an undamaged/fully remodelled bone in order to allow the force to propagate out of, and create a new fracture.
80Nm is going to translate to 80kg of weight, applied to the fracture, which is a sizeable amount of weight, but using levers, such as on a gym machine, that would be quite easily generated, but with a lesser actual weight in the machine.
I can’t put this strongly enough, you should start at the lowest weight possible, and then work up, when starting to rebuild your strength.
I remain surprised how… Much strain… I felt trying with 4kg weight after trying to extend the 2kg weight. It certainly wasn’t a pain, but it too much for my arm generally to take.

Regime

In spite of being surprised how much strength I’d lost. I have also been very impressed with how quickly things are beginning to return.
Doing simple arm extension exercises, 20reps at 2kg, 3 times a day, after 3 days I was able to add in 10reps of 4kg without significant difficulty, although discomfort was apparent at the end of the 10 reps.

Start of tricep extension

End of tricep extension

I was very lucky to find a machine – a TechnoGym model – using ropes/cords attached to the weights. This gives more free movement, akin to using free weights, but at the same time provides more stability and safety of the injured arm than simple triceps extension exercises using a hand weight

Whole limb work out

The same rope/weight machine also allows for seated rows, and Ab/Aduction exercises. When initially doing physiotherapy, abduction  and Adduction exercises were highlighted as very important.

Abduction of LEFT arm

Adduction/internal rotation of LEFT arm

Adduction and abduction exercises are very important to keeping the shoulder muscles in good condition. But even with effective physiotherapy, it’s likely, as I’ve found, that your shoulder muscles will have weakend slightly. Maintaining deltoid and rotator cuff muscles are crucial to preventing developing other issues, such as shoulder impingement and rotator cuff dysfunction.

I have been able to feel my LEFT shoulder movements, when using the weights, are not as smooth as my RIGHT shoulder, so large movements, involving many muscles groups, as with the above abduction exercises will hopeful be effective in addressing this – only time will tell!

Back to the back

The muscles of to my back, particularly trapezius and lat. dorsi, which help you do things like rowing and pull ups have also weakened. Seated rows, have been effective at rebuilding those muscles. But in order to prevent in an imbalance occurring I use my affected LEFT arm individually, at 2kg and then increase to 4kh the weight, and use both arms. Exercises like this are not about straining and moving iron, just about slowly and carefully rebuilding strength. I know in time, it WILL come, but the loss of arm strength, and inability to slam the seated row backwards with a large weight is quite…difficulty at times,es, given I used to row competitively at Uni!

Seated row

Conclusion

Arm strength exercises after elbow fracture are a vital part of returning to full health after a fractured olecranon. The difficulty is that progress is VERY slow, but will be even slowly if you try to rush things. I have found  I was particularly grumpy coming back from the gym only able to move 2kg.

I think I was partially ashamed. BUT by keeping at it, keeping up the small weight reps, I’ve begun to see an improvement.

Some days things are harder than others, tell someone about it, don’t just grit your teeth. My girlfriend was much more helpful when she understood how…weak and annoyed I felt. But also be careful…

Even at 4 weeks post op, I’m not 100% healed, the wounds are closed… And look very healthy… But

But imperative to still be careful – esp if like me the stitches are dissolvable, as they will take 8-12 weeks to be completely resolve, and can be a potential source of weakness to the wound if you happen to trip…

Trip and open wound!

I’ll be honest, I was terrified I’d done something to the fracture, it was a good blow, falling onto soft ground, but still went with a thump. The opening was RIGHT OVER THE FRACTURE SITE #terror! But a couple of steristrips to close the wound and everything seems ok. Still have full range of movement, and no pain when going to back to the gym, but still, had an hour or so of real worry – and now a bruise on my scar!

Top tip: post-op, when being discharged, ask the nurses if can you have some spare steri-strips…just in case 😉

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Comments

  1. I thought I’d revisit this post and update on my progress. It is now 15 months since my accident and I’ve been on the waiting list for plate removal for nearly 9 months (one cancelled op). My next op is scheduled for 12 December.

    Not a great deal of progress for me since last time, I can flex the arm OK but adding any kind of load to the tendon which runs around the back of the elbow causes pain.

    I’ll post some more updates next month after the op.

    Cheers all,

    Henry

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  3. Hi, I have just discovered this group and it has been so encouraging. I slipped on ice on January 2 this year and completely smashed my left elbow and “log split” my humerus. Am plated, pinned and wired and at 10 week appt was told that bones have started healing and all metalwork will be with me forever. Can’t believe how incredibly painful it has been and how it has affected everyday living. Fortunately I’m right handed. Have been told I can now start weight bearing and possibly drive in a couple of weeks. I am so frustrated that I keep being told I will not regain full movement so I am doing 4 Half hour physio sessions a day by myself but it is such slow progress. My flexion just isn’t moving and twisting the hand is still very painful but my extension is improving. What I have discovered though is that my shoulder and back are now bad as well and I haven’t had a physio appt since to find out the best way of improving it, My wrist was similar but I have managed to find some exercises to improve that. I want to be able to wake up a) not in pain b) able to sleep normally and c) feel vaguely normal. By the way I have just started using a 1 kg weight to try and improve strength in that arm.

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    • A, B, and C will come. You are still very early in your recovery process. I fractured in January, and I don’t think it wasnt until July-August I actually felt well again

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  4. arabafenicesarda - March 14, 2017 at 9:05 pm - Reply

    I definitely cannot post pictures. It would be really good for others to see it the pic with broken olecranon, the one with the wires and the one of today with all healed.

    I have 99% extension and maybe 85% there on the flexion, do you have any good exercise for flexion?

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  5. arabafenicesarda - March 14, 2017 at 7:40 pm - Reply

    I had my last visit today and even got pics of my xrays…..it’s all good and back to normal wooo hooooo :))

    The extension is 99% (I will get it to 100) and the flexion is maybe 80% (ditto).

    I wish I could post pics here, you can see the olecranon hanging off the back of the arm on the first one, the second one has two pins and a figure of 8 wire, the third one done today shows the ulna back in one piece.

    Wires were removed two weeks ago, surgery to put them in was 9.07.16 and fracture was 31.05.16.

    Hope my story helps someone regain trust. I felt devastated and was afraid not to come back to normal, but I am!!

    Keep the physio going and exercise regularly. For my first two months after surgery I did exercise every two hours.

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    • I’ll have to take a look at the comments plugin, you should be able to post the picture

      I’m glad things have worked out for you.

      The surgeon puts us back together, put it is the physio that gets us going again!

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  6. This is useful information and a great read, thank you.
    I fell off my mountain bike onto the pavement after our ride heading to brunch (avoiding a car and speed bump, my pedal caught the kerb and spat me off)
    Also of a medic background, am now 12 weeks post surgery with a swanky titanium plate and have a reasonable amount of flexion and extension thanks to acupuncture and fabulous physio who allows me to wail in pain yet on my instruction ignores me and carries on regardless. We’re achieving. I spent a lot of time coercing my elbow to flex and extend, self care eg, putting moisturiser on and plaiting my hair helped immensely. I can do a few seconds of straight arm plank now and run upstairs ‘on all 4’s’ like an animal to help with extension and strength (OK Consultant doesn’t know about this…).
    Housework has helped. Swimming has been marvellous, I’m over a mile now and no pain.
    Normally I run but the vibration through my fracture from foot pounding was far too much so I’ve done some interesting rehab to keep me going (https://thisgirlcanrun.wordpress.com/). Probably won’t be doing the Brighton Marathon this year but I am back out there now.
    Not sure if I will retain the plate, I’m convinced it is stopping full extension – however I’ll keep working at it and see what the xrays reveal in 2 weeks time.

    What flexion and extension have you achieved now?

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  7. Ouch Henry – welcome to the olecranon club

    Sadly almost 18 months on my elbow is still rubbish. Painful and stiff and I now have ossified bone that has grown at the back of the scar so it feels like I still have the cast on which is not nice

    I think that at the age of 64 and having severe rheumatoid and osteoporosis things are not going to improve, only get worse

    I keep trying to use my arm and even have some baby hedgehogs I am bottle feeding and they wriggle a lot

    Good luck Henry you are young so hopefully you will recover fully but you cannot rush this particular fracture it seems

    Keep us postede

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  8. This is a great source of info, I thought I’d share my story in case it helps others at all.

    I fractured the Olecranon in my left arm when I came off my bike at 20mph going over a speed bump, which I failed to see. As an additional complication I broke my collarbone on the same side. I am 31 years old.

    The Olecranon was so far displaced that my tricep was visibly higher up my arm because the bone was no longer attached. The Xray showed a 1.5-2″ gap where the bone used to be.

    Both injuries were very painful. I was operated on within 7 hours of falling off, and had the full plate and screws treatment for the olecranon (as opposed to wires). The collarbone was also reasonably far displaced and one end was poking into my skin, causing ‘tenting’. They decided not to operate on this and hope for a natural healing.

    I went back to work after 3 weeks (signed off for 6 weeks). I work at a computer all day and honestly 3 weeks was too soon. I returned full time at 4 weeks. At 6 weeks, I had another set of Xrays and it appeared the Olecranon had healed correctly, but the collarbone nowhere near. They operated next day and installed a plate and screws in the collarbone. Initially they said I might need a bone graft, but it turned out that wasn’t required.

    I took another 4 weeks off work (signed off for 6-8 weeks). Almost 3 months after the accident I am back to work full time and writing this post. I had further Xrays of the collarbone at 6 weeks post op and they showed it had healed perfectly. The collarbone pain reduce rapidly to almost zero in the 6 weeks after the operation. The incision was quite large and I have lost feeling in the skin around that area.

    The Olecranon break has been by far the worst injury. Straightening the elbow was very difficult in the early days. I managed to avoid a plaster cast and only had a sling, so I got things moving early on. I can straighten and flex the elbow fairly well with what looks like only a few degrees of lost movement.

    I am left with one major problem, and that is a lot of pain in the back of the elbow when using the tricep. I would say it is almost unusable, for example I cannot lift more than about half a kilo upwards from behind my head, the pain is too great. On a day to day (desk bound) basis the issue is easily tolerated. However, at the gym it makes most of the machines very difficult to use on anything other than the lowest setting. I am hopeful this might improve. The consultant seemed to think it may be interference between the metal plate and scar tissue/tendon attachment points. He said I could consider having it removed after a year if the problem persists. I was warned that arthritis may occur due to the lining of joint being damaged.

    Overall this has been the most horrific injury I have ever suffered. I am back on the bike and have managed 20 lengths in the pool (breast stroke is more painful than the crawl). I desperate to make a full recovery but it seems this may be many more months in the making, if I’m lucky.

    Good luck everyone.

    Henry

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    • The plate should come out Henry

      50% of olecranon injuries do get RADIOGRAPHICALLY detectable arthritis, but only 20% of those have any symptoms, so don’t fret about that

      As the elbow is not a weight bearing joint, risks of OA are low anyway

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  9. Hi James.

    Thank you so much for posting this. I fell off my bike on 7th May 2016 and broke my elbow it’s Ben the most painful bone I’ve ever broke.

    Anyway had one operation when I had the accident and getting ready to have my 2ndin the middle of September. To have the wires and two pins removed.

    Please can anyone give me confidence im such a worrier with operations.

    Also my shoulder has got very stiff they said they thought I had frozen shoulder too but after to consultant checking it he does not think I have that.

    I do hope I get my mussels stronger in my arm. It’s so very sore.

    I wish you all well

    Sharon.

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    • Hi Sharon

      Dont worry at all. My pins came out, and was basically given a sympathy bandage. I was fine within 1 week max, the wound was a little sore by that was it.

      You’ll see go increase in range of movement in before too long given you just have pins.

      The hard bit is putting the metal work in. Getting it out is easy

      The muscle strengthening does take quite a while. I really think it was at least a year before I was back to full strength – but I was able to completely the monkey bars on tough mudder a few weeks ago, which I’ve never done before

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  10. Yvonne Moore - June 9, 2016 at 8:07 pm - Reply

    One year next week for my right olecranon/ORIF fiasco! I still have pain. bone chips where the wires were dragged out of my arm, nerve damage along scar, ulnar nerve damage and thickening seen this week on ultrasound.

    Also nearly lost the use of my right hand from ulnar nerve damage and now have acute tenosynovitis in my right hand from a rheumatoid flare – my physio thinks as a body response to all the rubbish it has put up with over the last year

    I still cannot hold a mug or cut food up – so no where near getting back to things like the cross trainer

    I have done all the exercises I can but my triceps are nowhere to be seen but a tiny biceps improvement

    Obviously I am a 64 year old woman with rheumatoid and severe osteoporosis but my elbow is not recovering in ways the orthopods said it would despite these conditions

    The olecranon must be the worst bone to break as it has the potential to cause so many problems down the road

    Good luck to everyone with their recovery and I hope you all do better than I have

    Best wishes

    Yvonne

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  11. I’m about a year on from fracturing my elbow and stumbled across this post because my left arm is extremely weak and I feel as though I should try to build a little strength so at least I can do a push up again! The thing I notice most is pushing my daughter in her pram causes a decent amount of pain especially over uneven paths where my arms are absorbing shocks. I’ve not cycled since my fracture.

    The thing that’s weirdest for me is that because I’ve not regained full extension (especially compared to my right where there was about 5 degrees of over extension) exercises like push ups (or a similar action of pushing) where you might start or finish by locking your arm feel totally weird.

    Have you recovered full extension? How has having the metal removed affected that for you? Are you right or left handed?

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    • I’m about 2 degrees off full extension. I saw a big improvement after the metal was removed.

      Assuming you’ve only got wires, they should be removed. Plates *can* come out, but that depends on the severity of the fracture.

      I’m RIGHT handed and it was the RIGHT arm broken

      It felt so much better after the metal work was removed.

      A good tip is hanging from a pull up bar. Don’t do pull ups. Just hang, and try to increase duration.

      I could only do about 5-10 secs. Now limited by grip strength to about 60secs. But also able to pull ups as well bow

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      • That’s a funny coincidence, I was just looking at pull up bars on Amazon…

        That must have been awful with it being your dominant side breaking and losing strength. It’s my non-dominant side that was broken which is ‘good’ in a way as it was easy to continue normal life shortly after the fracture. Part of me wonders if I’d have tried harder at some of the exercises and recovery in general if it had been my right elbow – probably but still not sure I’d want it that way around!

        Embarrassingly I can’t for the life of me remember what metal I have – I think a pin and some wires. I was discharged from the fracture clinic approximately 6 months after the accident and it seemed to me the idea was the metal would be a permanent fixture. The under-extension is not causing any issues – eyeballing it now I’d say I’m somewhere between 5-12 deg without stretching – so I’m not too worried about the metal staying in.

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        • That’s a good outcome then. Pins and rods usually come out at the 9-18month stage.

          Crucial word is usually. There is no “always”in medicine.

          Recovery having the out takes about 2-3 DAYS, it’s a doddle. Only thing I’d say is don’t get lost to follow up. The point is in many, but not all cases, simple pins and rods try to work themselves out and you have to have them removed then.

          My rods were pushing, but not much. My issue is I’m like with girl with the pea under 15 mattresses, I could tell, so they had to come out.

          Glad your progress has been good

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  12. Yvonne Moore - April 11, 2016 at 7:58 pm - Reply

    Ulna nerve severed!

    My surgeon insisted the wires had to stay in for a year and refused to see me

    My wonderful shoulder surgeon intervened and arranged both wire removal surgeries

    The one in February was fun as I had developed LBBB querie heart attack plus failed neck fusion

    My lovely pain consultant did nerve blocks for a ’40 minute op’ that took two and a half hours as the wires were stuck and bone had grown round them

    I was on morphine and high as a kite making useful comments about how quick operations were on Holby City!

    My hand surgeon mentioned decompression but not keen in having this scar opened again

    I can see from your fall that these scars are fragile

    I am pleased that you are doing well

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    • Ok, depending on how far up the cut in the nerve is, make sure you work EVERYTHING above it that the ulna nerve supplies.

      So assuming you are able, find a way to make triceps contract. Using the nerve MIGHT help.

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      • Yvonne Moore - April 13, 2016 at 6:54 am - Reply

        Hi James
        I showed your reply to my wonderful physio
        He traced the ulna nerve
        There is an area at the elbow he can feel a problem and then that tracks to where the rod punctured
        This is just over a third of the way between the elbow and little finger side of the wrist and there is a sore lump

        My biceps are doing ok – small but he found them

        My triceps have vanished

        He said this could take months

        He awaits seeing the nerve tests and taking to my surgeon but I have got to keep doing what movement I can

        I cannot do the gripping paper test between the fingers test still and my hand is clawing again

        My surgeon suggested Vaughan Jackson syndrome as well

        This contrasts how a younger healthier male with stronger bones – you compares to a 63 year old female with severe osteoporosis and end stage rheumatoid

        We both fell on our olecranon but mine is causing huge problems

        Just texting this has set up throbbing

        I remain inspired by you to keep trying to exercise so a big thank you James

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        • The triceps muscles do recover. Mine were completely shot as were most of my shoulder muscles. But after a year I was able to do A SINGLE press up.

          We don’t use triceps as much as bicep, so we have to actively work it.

          You’ll get there, just had a bit of a detour

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  13. Yvonne Moore - April 11, 2016 at 7:04 pm - Reply

    Hi James
    As you know I broke mine in June
    Had one wire removed in October
    Then the other long wire penetrated bone muscle and ulnar nerve
    Had emergency surgery in February then the next week emergency admission for IV clindamycin for a nasty infection
    Have not gained the nerve back and await nerve conduction tests in a few days
    I have not come out of this well
    Like you say the shoulder and back get affected
    My muscles have gone!

    So avoid being 63 with rheumatoid and osteoporosis!!

    I remain inspired by your progress

    Yvonne

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  14. Hey James,

    Thanks for putting together your story of the recovery from an ORIF. Unfortunately I am going through the same ordeal on my right elbow. 4 weeks post bike crash and 3 weeks post surgery, I am far from getting my elbow to straighten. Have had one rehab session so far and it was painful but encouraging. How long post surgery were you able to start training on the turbo. Appreciate a response.

    Cheers

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    • I was on the turbo after the cast came off, so 2 weeks post op. Then when I had confidence to actually climb on the bike, so about 4-5 weeks post injury

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      • Thanks for the prompt response.
        Were you able to put any weight on your healing arm or did you just ride with a single arm on the bars?
        More than a year after the injury, have you regained all the strength in your right arm?

        Cheers.

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        • Yes. I’m doing quite well now. Pull ups no issue now ?

          If you do EVERYTHING the physio says. Eat well, and get your heart pumping, even just walking helps the healing. It took months before I can put weight through it properly. It’s all about pain.

          I’d hold the bar and take the weight on the broken arm, but would only be able to hold for 5 secs, and SLOWLY, as you heal, you build up how long you can hold for. I was cycling outside in June after fracture in Jan

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          • Thanks for the reply. I am looking at a long road to recovery. I haven’t had a chance to get back on the turbo yet but I may give it a try in a week or so after consulting with my therapist.
            Cheers.

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  15. Thanks for the comments, Jim. I found your site inspiring and informational after skimming a few entries. I love all kinds of cycling. I too had ORIF to repair my wrist, it folded back from a nasty fall. I too am a recipient of a Ti metal plate with 8 screws holding it all together. Speedy recovery to you and Yvonne too ;o), cheers.

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  16. Hi James
    Great to see you progress so far
    It is a worry about falling again

    I broke mine 8 weeks today and am 7 weeks post op

    Have got some movement but not yet seen a physio yet!

    Keep up the good work

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    • If you can’t get referred to physio, I’d pay for a one off session immediately. I was in physio Exactly 2 weeks post op the day after plaster came off. Great physio is the reason I think I have such a good range of movement now.

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    • Biggest thing from the physio is instructions and knowledge. Even paying for one session should help rehab amazingly.

      I’ve tried to write what my physio showed me, but everyone will need slightly different advice

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      • Thanks James
        The surgeon forgot to do a referral!
        An appointment came today for 24 August so no further forward

        I will get on to it tomorrow

        My problem is naff shoulder, wrists and neck from severe rheumatoid so any physio is going to require imagination!!
        My husband laughed when I showed him your ball exercises

        I could never throw a ball anyway so he thought it a huge joke!!

        You take care and have a speedy recovery

        Yvonne

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