Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: pinkmarshmallow on August 12, 2022, 03:15:14 PM
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Hi
At the moment I’m on 2mg Sandrena gel daily and on days 15-26 take 200mg Utrogestan tabs orally. Also 40mg Propranalol when I wake up with these horrible surges and take 30mg Citalopram to help with low mood (which I had before peri started). I’ve been on this a year now.
The cortisol surges wake me up every day around 5.30am and start from my feet up through to my chest in waves. They can be so intense it’s really getting me down. I’m hating going to sleep as I know I have to wake up to these surges.
My migraines (which I’ve had since puberty) I’m now 53, have got worse from day 20 through to the next cycle day 3. Can anyone advise me what I can ask my GP when I eventually get an appointment with her? Previously she hasn’t wanted to give me a thyroid blood test. I just don’t know where to go from here. Any advice would be helpful.
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I'm always going to be influenced by my own experiences here, but for me anything to do with cortisol surges at night or insomnia or early waking, has been due to estrogen - too much of it. Other people here have found it to be just not the right dose or type of it, for them, causing this.
I am perhaps a very unusual case as I've had severe high blood pressure caused (we think) by a reaction to estrogen. But along with that came anxiety, early waking, heart palpitations and more. It all got worse when estrogen increased and better when it decreased.
I suspect there are many more women with reactions to estrogen out there, but they just aren't getting recognised by doctors for some reason. They are being prescribed meds to deal, piecemeal, with the symptoms - like your propranolol - instead of trying to work out the root cause.
With your migraines, that would seem to be simpler - as it seems to correlate with when you take your utrogestan. Have you tried taking it vaginally instead of orally? You might not absorb it systemically then. The other option is to try going to a continuous regime, which would see you take utrogestan every day - but only 100mg of it.
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Hello. Cortisol surges would wake me anytime after 3.00 a.m. and left me terrified. My GP prescribed a betablocka, the same as you, to take in the evening to ease the early mornings surges. Does the Citalopram help?
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How much propranolol? I was on 80mg 3 times a day for a month followed by 40mg twice a day then dropped it down to 20mg at night.
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Wonder if you'd benefit from a change of antidepressant? I had cortisol surges waking me daily for many years, but citalopram stopped that for me.
Eventually it stopped working although I tried many times as it was something I really relied upon for a decent quality of life.
There are lots of different ADs to try but I'm sure you know that.
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pinkmarshmallow, your migraines sound like the menstrual type ie progesterone withdrawal so if possible, it would be better to avoid a cycle and take 100mg Utrogestan vaginally every other day (as the Newson clinic advocate) and avoid a bleed - I'm assuming you are post menopause. This equates to a more tolerable 50mg progesterone every day which I find more than enough but it's worth having an annual transvaginal scan to check the womb lining.
I take amiltrypline as a migraine preventative and so far I have not had any side effects. I started on 10mg daily and now increased to 30mg as recommended by the migraine specialist. Apparently amiltrypline is the best AD to use for migraine prevention so you might want to give it a try. If you find you still have morning anxiety/cortisol surges you can increase the dose up to 1mg per kilo of body weight.
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I think the poster takes Citalopram?
:thankyou: Mary G
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I'm always going to be influenced by my own experiences here, but for me anything to do with cortisol surges at night or insomnia or early waking, has been due to estrogen - too much of it. Other people here have found it to be just not the right dose or type of it, for them, causing this.
I am perhaps a very unusual case as I've had severe high blood pressure caused (we think) by a reaction to estrogen. But along with that came anxiety, early waking, heart palpitations and more. It all got worse when estrogen increased and better when it decreased.
I suspect there are many more women with reactions to estrogen out there, but they just aren't getting recognised by doctors for some reason. They are being prescribed meds to deal, piecemeal, with the symptoms - like your propranolol - instead of trying to work out the root cause.
This basically describes my response to the oestrogen element of HRT. For me it ended up creating a medical emergency.
I've found ditching the HRT, spending 3 years in weekly therapy, consulting a herbalist and having regular therapeutic massage sorted the cortisol issue. Sometimes I do still wake at dawn with that shocked back to life feeling, but I can orientate myself and drop back off pretty quickly.
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Gosh thanks so much for all of your advice!
I’m going to try taking Propranalol at night instead of the morning to see if it has any effect on the surges. If not, then I’ll reduce the Sandrena from 2mg back to 1mg and see if that works.
I have no idea whether the Citalopram is working, I presume it is helping me. I’ve had CBT therapy this year and am on the list for another block session in 14 weeks time.
Regarding my migraines, I’m still getting a withdrawal bleed on day 22 for 4/5 days but I will chat with my Dr about changing Utrogestan to 100mg a day orally or every other day vaginally. I hadn’t heard of taking it every other day. Thanks.
I’ll update you all. Feel this forum is such a life line x
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Morning. Don't stop the Citalopram. If may well be working 'in the background'.
Let us know how you get on.
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No I won’t stop the Citalopram as I could be a blubbering mess again once my 2 Uni kids go off in September! I’m hoping I’ll get through the whole thing much better than last year. I blame the perimenopause.
Anyway, took Propranalol last night - couldn’t get to sleep until at least 1.30am! Still woke at 5.50am with some surges. Will stick with it for a week and see.
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I'm afraid some people don't sleep if they take beta blockers at night time. I'm one of them! You might be the same. Whether it settles down I have no idea.
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Or U may have been waiting to see whether you went to sleep ::). It can have a sedative effect, however my friend becomes hyper and agitated with it!
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I’ll just chip in with my experience of cortisol surges, migraines etc. After many months of trying evorel patch & utrogestan I eventually abandoned it. The further I went up in the dose of estrogen the worse I felt. I was getting surges, early morning dizzies, daily migraines, bolting up awake in the night. I changed to evorel conti and am getting on much better. I feel much more stable. I think the thing I’ve learnt the most so far is that when it comes to migraines and other side effects…the most stable, drip feeding type of hrt works well for me.
How otherwise have you got on with your dose- have you seen the benefits? Have the surges started recently?
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That’s interesting as there’s not much difference between Evorel and Evorel Conti except for the progesterone 🤷♀️ I’d assume the adhesive in the patch and the estrogen and mechanism of delivery is the same… 🤔
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Or U may have been waiting to see whether you went to sleep ::). It can have a sedative effect, however my friend becomes hyper and agitated with it!
Exactly. Hyper and agitated = no sleep.
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Hi pink marshmallow
I had an awful time on HRT, and an absolutely hellish time when I came off. I had awful anxiety and early morning cortisol. I would physically be sick every morning it was that bad.
A couple of things that really helped were taking an antihistamine called phenergan before bed… it knocked me out and I didn’t wake up early and full of anxiety, and I changed from citalopram to venlafaxine.
I am one of those rare people that just can’t tolerate the HRT.
I used to suffer from awful migraines, since age 9. The one thing that has really helped with them was going gluten free. I originally did it for ibs reasons, but found it stopped them amazingly!
I really hope you find some sort of relief… it was an absolute nightmare for me, so I know how you are feeling x
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Suzysheep, if you found that anti-histamines helped you, the reason you couldn't tolerate estrogen would probably be histamine intolerance.
Estrogen increases histamine and histamine increases estrogen, in a feedback loop. Estrogen also down-regulates production of DAO, which is the enzyme that processes histamine and removes it.
Many women are bordering on histamine intolerance but are managing it most of the time without symptoms or only mild symptoms - but adding in estrogen tips them over the edge. Often it's possible for these women to have a low level of estrogen if they optimise everything else.
I have a friend who can't tolerate estrogen (not sure why) but found venlafaxine really useful for night sweats too.
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@joziel, I’m guessing the drip feeding of the norethisterone through the day is serving me better than the utrogestan. I always felt that the estrogen was “fighting back” on utrogestan. Weird, but glad it seems to be working better for me.
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Joziel, that’s really interesting, I didn’t know that. In the last couple of years I’ve become pretty intolerant to a lot of foods, maybe histamine plays a big part! Thank you for the info.x :)
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https://static1.squarespace.com/static/5a4269f28c56a85fe95206ea/t/5edcef82f510a4510b261e53/1591537538852/The+Menopause+Consultancy+-+Histamine+Factsheet+-+June+2020.pdf
This is very interesting!
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I’m so glad I’ve started this topic. It’s amazing how we’re all trying to cope in so many different ways. Still taking Propranolol at night - may be helping with surges? Though still waking at 5.50am. I’m speaking to a dr on Wednesday so hoping I can explain what I’m going through on the phone and where I go from here. I’m thinking of reducing Sandrena down to 1.5mg but then I’ve got to try and source 2 different boxes of sachets - 1mg and 0.5mg! So much anxiety with all of the phone calls too!
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It will take a couple of weeks for the Propranolol to settle at night. Do you drop back to sleep after 5.50? R U getting good quality sleep B4 then?
Could you alternate the Sandrena to cut down i.e. every other night ( I know nowt about HRT by the way).
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You folks in this thread, take a look at this other current thread that's running - all 17 pages of it ;D ;D ;D ;D ;D - which is basically a few of us trying to deal with similar issues recently, updating on our experiences: https://www.menopausematters.co.uk/forum/index.php/topic,62514.0.html
It would be good to have more voices in that thread. The thing is, we seem to have so many different threads about anxiety, cortisol, waking early, jumping out of sleep, heart palpitations, tachycardia, racing heart, heart beating hard, throbbing and pulsing/high blood pressure and a lot of night-time related stuff. And the risk is all this gets scattered over multiple different threads instead of the experiences brought together...
For me, none of this was happening before I started HRT - it has all started since HRT began. And I'm 99% sure it is/was the estrogen causing it. I have now stopped the estrogen (last week, 6 days ago) and I am still experiencing prolonged episodes of all this - although I am also starting to get long periods when it isn't happening and things are fine again. I'd be curious to know how your current experience/symptoms, compares with your symptoms prior to starting HRT. Is it possible this is being caused by the estrogen for you folks too?
I feel like there is some common cause(s) behind all this which relates to HRT. Clearly not all women experience HRT like this, but there seems to be a considerable subset of us which do. I would really like us to pool our collective experiences and try to figure things out(!), so do come and join that thread and then post regularly with updates as you think about things or try different stuff. Over time, we might find commonalities.
Because frankly doctors are RUBBISH at providing any understanding with these issues. They are all stumped when I talk to them about it, it's as if they've never heard of it before. Even menopause specialists. The only things they can suggest are increasing, decreasing or even stopping estrogen. Which we can really do by ourselves, if it's that simple. There is stuff going on here which they are not aware of as a group of symptoms.... OR - there is a difference between this so-called 'body identical' estrogen and what our own bodies make and many of our bodies don't like exogenous estrogen. (That means estrogen not coming from our body.)
Anyway, I am now waffling - but please do come join us on that other thread so we don't end up with 65000 different threads called 'anxiety' or 'heart palpitations' etc etc and can try to get everything in one place for future women to search for and find... :)
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Thanks CLKD - no I don’t sleep after 5.50am and not too bad sleep before then usually.
Joziel - will go over to the thread you’ve suggested now.
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Joziel, none of my anxiety or cortisol surges even existed before I used HRT. Once it was out of my system ( which was a hellish few months) it’s gone again.
I will look on the other thread x
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High and low cortisol have exactly the same symptoms!
So the only way to know is by doing saliva testing at 4 points during the day. The Dutch test also do a nighttime awaking saliva swab, so that’s useful for those who wake up in the night with these symptoms. It is expensive but has the added advantage of also doing DHea as well.
Another cheaper alternative is Zrt labs combined cortisol and Dhea test.
I’ve done these tests many times over the last six years and I now know that this is the only way you can tell what you are experiencing.
It’s such a shame that the nhs are not able to offer this simple and non intrusive test.
X
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Suzysheep, I'd be interested to know your entire story if you wouldn't mind telling it!? I just created a separate thread on the forum with a list of questions so we can start to pull together different women's experiences and I'd be really grateful if you could answer the questions there :)
I am just desperate to put all this together before I really am peri-menopausal and really do need estrogen and have to negotiate all this. Or deal with life without estrogen :(
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Hi
At the moment I’m on 2mg Sandrena gel daily and on days 15-26 take 200mg Utrogestan tabs orally. Also 40mg Propranalol when I wake up with these horrible surges and take 30mg Citalopram to help with low mood (which I had before peri started). I’ve been on this a year now.
The cortisol surges wake me up every day around 5.30am and start from my feet up through to my chest in waves. They can be so intense it’s really getting me down. I’m hating going to sleep as I know I have to wake up to these surges.
My migraines (which I’ve had since puberty) I’m now 53, have got worse from day 20 through to the next cycle day 3. Can anyone advise me what I can ask my GP when I eventually get an appointment with her? Previously she hasn’t wanted to give me a thyroid blood test. I just don’t know where to go from here. Any advice would be helpful.
Hi, to help with your migraines try this for three months to give it a fair chance of working for you: 400mg vitamin B2 and 400mg of magnesium powder. This is from the migraine society and my neurologist. I can tell you the b2 I’m using as it’s quite difficult to find a pill with that level of B2 (saves taking more than one pill a day).
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Hi pink marshmallow
I had an awful time on HRT, and an absolutely hellish time when I came off. I had awful anxiety and early morning cortisol. I would physically be sick every morning it was that bad.
A couple of things that really helped were taking an antihistamine called phenergan before bed… it knocked me out and I didn’t wake up early and full of anxiety, and I changed from citalopram to venlafaxine.
I am one of those rare people that just can’t tolerate the HRT.
I used to suffer from awful migraines, since age 9. The one thing that has really helped with them was going gluten free. I originally did it for ibs reasons, but found it stopped them amazingly!
I really hope you find some sort of relief… it was an absolute nightmare for me, so I know how you are feeling x
Hi, I’m really interested to hear that phenergan helped with your anxiety issues first thing in the morning. A mental health nurse has just prescribed this for me but I haven’t taken it yet as my sleep isn’t too bad most nights but my anxiety is bloody awful in the day! If it knocks it on the head from waking , it might be enough to start to reduce my anxiety through the day. Has it continued to work for you?
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I’m now 100mg Utrogesten every day and reduce Sandrena gel from 2mg to 1mg (starting to think that too much has been causing the cortisol surges). Still persevering with Propranolol at night although woke various times last night and then at 4.40 couldn’t get back off. I have noticed I’ve started to have dreams again. I’m also taking 345mg of magnesium glycinate (def helped with body twitches) but may take an antihistamine tonight to see if that helps with sleep. The dr I spoke to today was helpful and I’ve got a follow up phone chat with her next month.
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Hi pinkmarshmallow
The magnesium glycinate should help with your sleep ..its magnesium oxide that will help with migraines..I suffered with them for years till I found thise little beauty's....I also take feverfew ...a supplement I get from amazon ... take them both and I'm pretty much migraine free for years now ...I also have the surges in early morning when I open my eyes .. anxiety in waves from feet to chest! .. been taking antihistamine chloraphensmine as advised by one of the lovely ladies on here !.2 at night .. can take upto 4 a day if needed ...has made the world of difference in a week!...
Rk x
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Hi RainyKelly. Can I ask how much of the different magnesiums you take and also the amount of feverfew? Still not taken an antihistamine yet but my sleep has got worse over the past few days so thinking about that too. My surges are slightly not as strong as they had been may be from reducing the Sandrena gel. Who knows? Have a good day everyone
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Hi pinkmarshmallow ..
I take 2 glycinate 500mg at night to deal with anxiety...
I take 2 oxide 320 mg if I have a migraine head ...its a lot of mag in one day but it works for me with no side effects... and tbh I rarely get a bad head now and my anxiety is bothering me more lately so I stick to the glycinate religiously
And 2 feverfew ....100mg per tab
It's generally one a day ..but if your head is playing up take the 2 ..all trial and error and check with with any other meds your taking ..
.... the anthist has made a massive diff to my sleep and anxiety...I hope this helps
Rk
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Thank you Rainy Kelly for that. Have you or anyone had a nap in the afternoon and woken up with cortisol surges? It happened to me for the first time today. I thought the surges were highest in the morning. Surely by the afternoon they shouldn’t be around? Any advice would be appreciated
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I think there is something going on with some deeply primitive part of the brain in all this. Because a lot of us have issues at night and with sleeping/waking. Starting from sleep. I have palps that begin as I am losing consciousness(!). Others have cortisol on waking. It's all very weird.
It is also really hard to separate out what is peri-menopause/menopause and would be happening anyway even if people weren't on HRT - and what is caused by HRT.
The only way to know that would be to hang out on a group with a bunch of women going through these life phases who weren't taking HRT. And get a sense of how much these things happen for them. Because my hunch is that HRT is behind a lot of this. That's not to blame it, but to say that I think it's really crude at the moment and a lot of women's bodies need something more sophisticated.
Anyways, that's my waffle.
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Great idea. There is a Facebook page which I’ve found. I’ll ask on there.
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I completely agree and resonate with this Joziel.
I It’s a crude delivery, but how can we ever replicate our completely marvellous bodies!
I hang out with relatives and friends who are not on hrt and a lot are doing well.
But equally, the few women I know who are on hrt are doing well too!
Are they hiding stuff? I don’t know!
But on the surface at least, they are out and about and seem to have a life.
The primitive part of our brain is something we all hold within us.
Yes, I have felt this most strongly at night.
This overtime has shifted enormously!
Starting with night terrors, insomnia, but then progressing forward gradually to a greater acceptance of these mental symptoms.
Then came the physical symptoms, shaking, tremors and hallucinations. Not nice! But I suddenly realised that this was my body’s way of releasing trauma!
These mental and physical symptoms are gradually fading. Not fast enough I often think, but at the pace I now know is right for me.
X
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Hi all, I was interested to know what these surges felt like, I've been on hrt for over a month and last night I kept waking up non stop. So hard to explain what it felt like but I've had it before, feels like if I go to sleep something is going to happen like I stop breathing, get a surge like feeling in body and my heart races. It feels scary to sleep, could this be cortisol surges?
I hope everyone is ok on this menpause journey! I was thinking of trying accupincture as has always really helped with things in the past
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Hi joziel ...
I had the surges before Starting HRT ... had then for years and getting more frequent especially with mad hot flashes in the night .. I went on HRT in hope it would help ...so far ..im not sure ...but the antihistamines with the HRT patches have def made an improvrment to my mad waves of lunacy .. ( as I like to refer to them!) But def feeling like I'm not losing my mind the more I read that's its not just me whos body and mind is playing tricks :P
Also keeping a diary of food and drink ...can see a pattern of anxiety surging if I've had a coffee the day before! So stopped that and think it's helping too
RK
Rk
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Ansie, I had that a few times when I went really high with my estrogen - higher than my body liked. Could you be on too much estrogen?
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Hi Joziel thanks for your reply. That's interesting , I have no idea what's happening or what I'm doing ha ha, but I'm on a very low dose of estrogen at the mo. Yesterday I cried all day it was like an uncontrollable storm in my head! Wondering weather to try the combi patches, some people are saying they work for them. I hope you are getting on ok with it all
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In that case you might need more estrogen…
Confusingly too high and too low symptoms can look very similar.
I wouldn’t suggest switching to combi patches if you can avoid it as they contain a synthetic progestin and not the body identical progestin that is utrogestan…..
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Well I’ve stopped taking propranolol in the evenings and now back to the mornings. I had more interrupted sleep taking it at night. Also still getting surges in the morning. Tried Phenargen 35mg last night, knocked me out. Woke at 5.50am dragged myself to the loo and back into bed, fast asleep until the alarm went off! No surges or anxiety! This has not happened for a very long time! My Fitbit recorded that I’d only had 11 mins of deep sleep - that’s not good. I’ve felt so tired today, fed the dogs then slept on and off until 8.45am. Felt very heady today and have decided to half the dosage next time I take it. Had a migraine yesterday, need to buy some magnesium oxide
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Hi pink marshmallow .
Try the chlorapheamine antihist...get it over the counter too..far less heavy head than phenargans...that stuff is like a complete sedative the following day for me too! .taking 2 chlora at bed has been a life changer for me with the anxiety .. along with magnesium glycinate at night it will help with the headache too
Rk x
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Rainy Kelly could I ask what dose your chlorapheamine tablets are. I have some but they say just one to be taken. So maybe yours are a half dose?
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Hi Pmallow
Mine are 4mg upto 4 times a day ..I think piroton are one a day at a different dose...so 8mg at night .. maybe check dose if 16mg cut in half?
RK x
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Thank you x
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Please let me know if it helps
Rk x