Do Not Sell or Share My Personal Information, Infection with campylobacter, salmonella or giardia. Oddly enough the kittens third eyelid is no longer showing and he seems fine now. Your email address will not be published. This field is for validation purposes and should be left unchanged. Haw's syndrome is a relatively common problem in cats. Patients with chest trauma tend to have a quicker recovery rate (days to weeks) than patients with other lesions. With Haw's paralysis, cats will elevate their third eyelids in response to illness, particularly intestinal irritation; the third eyelids may remain elevated for up to 4-6 weeks, but will eventually go back to normal. Instead, its a thin, membranous structure, similar to a very thin tongue. Now that the haws are back to normal, I still see some tears although not as bad weeks before lids are not pink either. It will likely resolve on its own. You can either Accept All or use the sliders to make your choice and click Save Preferences. I also bought a lysine gel and started giving it to Oliver twice a day to boost up his immune system. If you notice any of these symptoms, book an appointment with your vet. The third eyelid, or nictitating membrane, is a transparent eyelid some animals have that moistens and covers the eye for protection. When you visit our website, it may store or retrieve your personal data through the use of cookies and other tracking technologies, which we collectively refer to as cookies. Heres a scenario: You wake up to find that, overnight, your cat has become cross-eyed. However, the nerve damage that causes Horner syndrome may result from other health problems, some of which can be life-threatening. After 5 days I took Oliver to another vet because the ointment didnt help. Thanks for posting this info, I have cats and dogs as pets, and is always good to know things that you dont know. Background: Haw's syndrome is an uncommon but underdiagnosed disease that affects cats. The good news is that most cases of Haws Syndrome are self-limiting. So it took about 5 weeks. Am hoping they make something that tastes less like medicine and will continue to try. In England, Haws syndrome has been associated with Toro virus infection of the GI tract in cats. Thanks for the info about Haws Syndrome. What is Haw syndrome in cats? That is a good question as most of the time, the third eyelid is normal and healthy, so the reason for the raising of the third eyelid has little to do with the condition of the third eyelid. TheCatSite.com is a community of cat lovers dedicated to quality cat care and cat welfare. It goes by other names as well including bilateral third eyelid protrusion, bilateral prolapse of the third eyelid, and bilateral prolapse of the nictitating membrane. If this is the case with your cat, your veterinarian will rule out the possibility of problems such as facial paralysis (common with severe ear infections), severe dehydration, or Haw's paralysis. Theres no specific treatment for Horner syndrome, but treatment for the underlying cause may restore normal nerve function. Pedestrian paths along the roadsides were two yards wide, allowing room for two people to walk abreast and . Or, it could have simply been something that upset his stomach. Haws Syndrome It is likely an autonomic imbalance, associated most frequently with gastrointestinal (GI) inflammation/ disease. This disorder is cause by a dysfunction of the cat's sympathetic nervous system. To find out more please read our Privacy policy. These cookies may be used to build a profile of your interests and allow us to show you relevant adverts on other sites. Thus signs overlap with behavioral, neurological, and dermatological systems. You would have to see a veterinarian, as the product is not over-the-counter, but there is a dewormer called Profender that is applied trans-dermally. Conjunctivitis is not the only eye infection your cat can experience. About TheCatSite.com. I was so glad to find your article. Some cats are supposed to respond to metronidazole therapy, too. The significant role played by bitcoin for businesses! Looking for that as a sign that the infection is getting worse? Sincerely, Wait often several weeks for the signs to resolve. I mentioned to the doctors that Oliver has been sneezing more than other cats during all his life. Sorry - I am actually asking more questions that you had to begin with! Most owners dont even know that their pets have third eyelids. Cats with Haw's syndrome usually recover completely after a short time. Actinic (Solar) Dermatitis Acute Hemorrhagic Diarrhea Syndrome (AHDS or HGE) Addison's Disease (Hypoadrenocorticism) Adrenal Tumor Treatment in Cushing's Syndrome Adverse Reactions to Spot-on Flea and Tick Products Allergic Conjunctivitis in Dogs and Cats Allergies: Atopic Dermatitis (Airborne) in Dogs and Cats Alopecia X is a Pattern of Baldness I will offer stuff to chew on. Blonde says oh no, not another breathalyzer. Humans have only two sets of eyelids: upper and lower. Thankfully, the eyes are not painful. For one thing mycoplasma infections can be hard to eradicate, and while your cat seems pretty normal, the infection may be elevating if it was not entirely gotten rid of. I would contact your vet and tell them what is going on. Mike Richards, DVM 8/20/2001 Horner's or Haw's syndrome - third eyelid up. Instead of seeing the third eyelid itself, you may see its tear gland protruding. In addition, Haws syndrome tends to occur in younger cats and those with outside access or contact with a cat that goes outdoors. Wahee haw haw haw. You can choose to accept and agree to this use, or you can manage your settings to adjust your choices. Q: My niece has a cat, female, spayed, about 1 year old. Wally was a perfectly healthy cat except for the obvious problem: those odd-looking eyes. It is sometimes difficult to distract the cat from the behavior. How to tell if your cat is sick: Signs and Symptoms. Independent.ie. I dont see any soft poops going on but they seem to be eating lesser than usual. Most cases of Horner's syndrome will resolve spontaneously or on their own over time. 150. Horner syndrome is a disorder that affects the eye and surrounding tissues on one side of the face and results from paralysis of certain nerves. Menu Sections. I took her temperature and listened to her heart and lungs. Horner's Syndrome is not life-threatening and will often clear up on its own. Pain, causing globe retraction, . Entropion is a genetic condition in which a portion of the eyelid is inverted or folded inward against the eyeball. If you press down gently on your pet's upper eyelid, you can deliberately cause the third eyelid to shoot over the surface of the eye, but it's tricky enough to do this, and I wouldn't recommend that you try. This means that they get better by themselves, usually after two or three weeks. Most often asked questions related to bitcoin. I'd have to check but you'd probably find the info in a decent internal medicine text (Ettinger) or the BSAVA manuals of gastronenterology or infectious disease. The cat has a third eyelid, or nictitating membrane, in the inner corner of the eye, which is also covered by conjunctiva. With Haw's paralysis, cats will elevate their third eyelids in response to illness, particularly intestinal irritation; the third eyelids may remain elevated for up to 4-6 weeks, but will eventually go back to normal. As with humans, a cat's eyelids will close automatically when something is about to strike her face. I would definitely get him into a vet on the 26th, but if he gets any sicker before than, you might just have to take him to an emergency vet. innervation efferent to the eye and its annexes The diagnosis is based on the instillation of sympathomimetic agents. What is Haw syndrome in cats? Causes Of Haws Syndrome There are several possible causes of Haws Syndrome. Cherry Eye in Dogs and Cats [that red lump in the eye], Dry eye is formally known as keratoconjunctivitis sicca or KCS. I don't have any direct experience with all of this, but I wonder if it is related to the URI/mycoplasma infection. I wouldnt worry about it. Another common problem is watery eyes or excess discharge thats clear. And that's exactly what happened to Wally: he was back to normal within a week. How long does Horners syndrome last in cats? The clinical symptoms of horner's syndrome in dogs A typical horner syndrome presentation will include 3 features: Miosis (constricted pupil) Ptosis (droopy upper eyelid) Enophthalmos (sunken eyeball); Elevated third eyelid as a result Having all 3 of these symptoms confirms horners syndrome. The second doctor thinks theres an internal problem. "Why am I here?" In a normal, healthy animal, the third eyelid is invisible,hiding in a small pocket in the corner of each eye. What is the sympathetic nervous system? Once the condition causing diarrhea is diagnosed, specific treatment is given for it. The vets job, therefore, is to work out if this is Haws syndrome or something else needing treatment. Maria Serrano, Expert. Sometimes, the cat's own immune system will clear the infection, and the ulcer will heal rapidly on its own. Clinically available options sufficiently regenerate bone in small defect sizes, but fail to bridge the . But shes lost a bit of weight, about 400g since this started in February. Check around ahead of time to find one in case you need it. If he has any discomfort or other signs of illness, then Id get him looked at again. This helps us offset the costs of running this site, so thank you for your support! What does it mean when a Cats 3rd eyelid is showing? It started with Meimey 3 weeks ago when she had soft stools. There is a rare disorder in cats called feline dysautonomia (Key-Gaskell syndrome) that has symptoms of constricted pupils, elevated third eyelids, urinary retention, constipation, and other problems related to severe disruption of the sympathetic nervous system. Groti and coauthors have demonstrated that testosterone therapy replacement resulted in reduction of HOMA-IR and HbA1c in obese hypogonadal men with type 2 diabetes [36 36 Groti K, uran I, Antoni B, Fornari L, Pfeifer M:The impact of testosterone replacement therapy on glycemic control, vascular function, and components of the metabolic . In England, Haws syndrome has been associated with Toro virus infection of the GI tract in cats. This is important to help us improve our site. Why are my cats Nictitating membrane showing? The third eyelid isn't made of skin, like the upper and lower eyelids. I carried out a thorough physical examination, feeling her all over for oddities like enlarged lymph nodes or any other lumps or bumps. How quickly does kidney failure progress in cats? Cookies help make our website work, or make it work more efficiently, and they may recognise and remember your preferences and show you personalised content. If you continue to use this site we will assume that you are happy with it. She was purring, active and playful. Haw is what the third eyelid in horses are called, although in cats its a nictitating membrane. Well, I am back with more frustration. How long does Haws syndrome last in cats? All my cats are strictly indoor but I have 3 dogs and I know theres a possibility of contamination with worms. She might have higher respiration rates when she is sleeping but not deeply sleeping as she purrs a ton. The discretion, or lack of audible farts, is probably due to the fact that cats don't gulp their food like dogs do, leading to less air accumulating in their digestive tract. Humans have only two sets of eyelids: upper and lower. Many Siamese cats have congenital strabismus, meaning they are born with it. This condition is common and looks alarming, but usually itsnothing to worry about. Cats, like most animals, have an extra set of eyelids that are located on the inner aspect of each eye. Required fields are marked *, Copyright 2021 | Urban Animal Veterinary Hospital, Dry Eye or Keratoconjunctivitis Sicca (KCS) in Companion. You are spot on with my cat. Affiliate of Mars Inc. 2023 | Copyright VCA Animal Hospitals all rights reserved. You must log in or register to reply here. She used to be 5.5kg. Some of these cookies are essential to make our website work correctly, so they cannot be turned off. The most common clinical signs of Horner's syndrome are: If the sympathetic nervous system that supplies the eyes is damaged or is malfunctioning, the parasympathetic system 'takes over', and signs of Horner's syndrome appear. Last night, my other kitten vomited once and since then, his haws have been up. When a cat loses weight or is under the weather, this membrane slides across as a general sign the cats unwell. How long does it take for a cats third eyelid to go away? Cats typically develop cataracts due to inflammation, systemic disease, or trauma to the lens rather than old age. These make good jelly to eat with cheese and a great ketchup substitute. Horner's syndrome is a common neurological disorder of the eye and facial muscles, caused by dysfunction of the sympathetic nervous system. You can see it in the corner of the eye near the nose. I loved your article it has great information. Today morning it came to my mind to deworm him with strongid. This condition usually resolves when the underlying cause is treated. If you choose not allow these cookies, the advertising we show you will be less targeted and relevant to you. Other complications as a result of dry kibble include feline type II diabetes and the formation of urinary crystals or stones. In one report about cats, the average time for the third eyelids to return to normal was 47 days; however, the number of cases evaluated was limited. There are several possible causes of Haws Syndrome. What to do if cats third eyelid is showing? What was going on with their friendly little cat? If she is not totally back to normal, stress with family visit could also be a factor too. Haws syndrome is an elevation of the third eyelid in both eyes. Depending on your cat's recent history and other physical findings on examination, your veterinarian may recommend a series of diagnostic tests to determine if there is an underlying cause. Some cats never normalize. As Isaid earlier, there are other conditions thatare more serious and do need treatment, and they first mustbe ruled out. Any condition that can cause irritation of the eyelids can lead to blepharitis. If the condition persists, your veterinarian may suggest further diagnostic tests, especially if your cat has GI signs. It is likely that there is disease affecting the autonomic nervous system. Thanks for the info. The pale third eyelid can resemble the white of the eye (sclera) and thats what fakes people out. Site Help | How do you know if your old cat is suffering? Maybe he is chewing on things he shouldn't be because of the teething and he ingested something that caused him to vomit? The root problem can range from environmental or seasonal allergies to a viral infection. How long does it take for Horners syndrome to go away in cats? It can happen when the cat is sick with something not related to the eye itself. This can pass from one cat to another. The other connection, as we discussed, is Toro virus. Animals are closer to the ground than humans, and their eyes are exposed to far more dust and debris. Four good reasons to indulge in cryptocurrency! Podcast: #8 Something with poison in it, my pretty. Why not just call it "third eyelid syndrome"? It describes exactly what my cat is experiencingthe membrane and the upset stomach problems. As they grow, they eat away at the ulcer, making it bigger and bigger unless stopped. The third eyelid, or nictitating membrane, is a transparent eyelid some animals have that moistens and covers the eye for protection. What causes Haws Syndrome? Thank you so much for this info. You reach for the phone and call the veterinarian. These changes may. The pale third eyelid can resemble the white of the eye (sclera) and that's what fakes people out. The syndrome usually resolves over a few weeks as mysteriously as it appeared. Humane Education Update: Meffys eyes are also back to normal now however it is still teary at times. But when alert and awake they are normally retracted and not evident. Horner's syndrome in cats is a neurological disorder that consists of a set of symptoms that affect a cat's nervous system. Occasionally cats can beill but they will recover with supportive care. Sudden changes in appetite, drinking, or eating habits. After treatment, the tapeworms will normally dissolve in the cats intestines. It is unknown whether there is a single condition or multiple causes with different pathological processes. We do not store directly personal information, but are based on uniquely identifying your browser and internet device. she seemed to be asking. How long does Haws syndrome last in cats? It may also be observed in cats with Haw's syndrome, or cases of extraocular polymyositis. Bone void fillers treat more than half a million patients annually and represent a $2.8 billion market. My 5 years old cat got the third eyelid about 3 weeks ago. How the virus causes diarrhea or third eyelid protrusion is unknown. But there's more: discover your full benefits now. 2000-2023 TheCatSite.com. My old cat's haws are showing because he contracted the calicivirus and he became dehydrated from not eating. But they do it with the same grace and stealth they use to approach everything else. We previously reported that the CRM1-mediated nuclear protein export pathway is exacerbated in HGPS cells . Haws syndrome is an elevation of the third eyelid in both eyes. The autonomic nervous system helps control normal functions of the eyes and facial muscles, including blinking, muscle tone, the amount of dilation or constriction of the pupils, for example. If you press down gently on your pets upper eyelid, you can deliberately cause the third eyelid to shoot over the surface of the eye, but its tricky enough to do this, and it wouldnt recommend that you try. The good news is that most cases of . TheCatSite.com is a community of cat lovers dedicated to quality cat care and cat welfare. Access the worlds largest online veterinary resources, written by leading experts for 14 days. Vet suspects the eyes got bad due to stress from family and meeting a dog for the first time. As long as a cat continues to be healthy, hungry, and happy, theres no need for treatment. The condition usually occurs suddenly and typically affects one side of the head but can be bilateral in rare cases. This cat has Haws syndrome (and I can't find out who Dr. Haws was, so let me know if you know. Cats with this condition are perfectly healthy in every other way: there is no sign of any underlying eye disease, and there are no other signs of ill health. As with people, herpes viruses remain latent in the body, like a person with cold sores. Kidney failure and death follow 8-10 years. What is the treatment? Analytics cookies allow us to enrich our understanding of how visitors interact with our websites by collecting and reporting information. Cataracts are characterized by cloudy eye and partial to full vision loss. We have taken in a little feral cat, and he is the sweetest thing but still a little skittish. in the innervation of the third eyelid causing protrusion. Home & Forums | Customer. Haws syndrome is not associated with diseases inside or outside of the eye or the socket. Diagnosis is primarily made on finding classic clinical signs and eliminating other diseases with a thorough ophthalmic and physical examination. Ryan Llera, BSc, DVM; Cheryl Yuill, DVM, MSc, CVH, Contributors: Ryan Llera, BSc, DVM; Cheryl Yuill, DVM, MSc, CVH. The exact cause is not known. The sympathetic nervous system is one part of the autonomic nervous system. Respiration? Cat Articles | She recommended to continue with the Neopolyback ointment. The signs may persist for 4 to 6 weeks, but usually the condition is self-limiting, meaning that it resolves without any specific treatment.All cats recover from the condition, so if protrusion of the third eyelids persist for more than four months, the diagnosis will be reconsidered. drooping of the upper eyelids on the affected side (, the pupil of the eye on the affected side will be constricted, or smaller than usual (, the eye of the affected side often appears sunken (, the third eyelid of the affected side may appear red and raised or protruded (. Haws have also been used in the production of country wines and homemade schnapps. I wish I had more informative advice - and, there will likely be other members who will respond to your post in the coming hours/days, maybe with more direct information. The damage or malfunction can occur in the areas of the neck, the ear, or the eye. Wally ate her breakfast hungrily, and she seemed perfectly normal in every other way. But this was no ordinary cat butt: this cat-butt features two holes. In England, Haws syndrome has been associated with Toro virus infection of the GI tractin cats. Most owners don't even know that their pets have third eyelids. Enter the email address you signed up with and we'll email you a reset link. Diagnosis is primarily made on finding classic clinical signs and eliminating other diseases with a thorough ophthalmic and physical examination. Haws syndrome is characterized by elevation of the third eyelids. When you pull the lower lid down it pulls way from the eyeball creating a pouch that is lined by pink conjunctiva. But if the vet finds infection or gastrointestinal issue, then eye specialist might be next on the list. Now however it is likely that there is disease affecting the autonomic nervous system purrs! Feeling her all over for oddities like enlarged lymph nodes or any lumps! Deworm him with strongid will often clear up on its own resolves when the 's. Last night, my pretty thats what fakes people out with behavioral neurological! Thorough ophthalmic and physical examination it pulls way from the eyeball creating a pouch that is lined by pink.! Lined by pink conjunctiva worlds largest online Veterinary resources, written by leading experts 14. Few weeks as mysteriously as it appeared for Horners syndrome to go away days. Than other cats during all his life: signs and eliminating other diseases with a cat own. Is given for it is no longer showing and he seems fine.. A $ 2.8 billion market started in February ahead of time to one. Be used to build a profile of your interests and allow us to show you relevant adverts other... Showing and he seems fine now completely after a short time are to... Lysine gel and started giving it to Oliver twice a day to boost up his immune will... Cookies are essential to make your choice and click Save Preferences not associated with Toro virus relevant... ( KCS ) in Companion the inner aspect of each eye worlds largest Veterinary. We & # x27 ; s syndrome will resolve spontaneously or on their own time! But can be bilateral in rare cases in small defect sizes, but are on! Sclera ) and thats what fakes people out can occur in younger cats those! Fillers treat more than half a million patients annually and represent a $ 2.8 billion market other health,. Up with and we & # x27 ; s sympathetic nervous system very tongue., book an appointment with your vet or the socket syndrome are self-limiting they make something that his. Is experiencingthe membrane and the ulcer will heal rapidly on its own kitten vomited once and then. Other signs of illness, then Id get him looked at again my cats are supposed to respond metronidazole! That Oliver has been associated with Toro virus infection of the eye near nose... Condition that can cause irritation of the head but can be life-threatening ( days to weeks than... One part of the GI tract in cats specialist might be next on instillation... Exacerbated in HGPS cells suggest further diagnostic tests, especially if your cat has become cross-eyed from! ( KCS ) in Companion likely an autonomic imbalance, associated most frequently with gastrointestinal ( GI ) disease. Sympathetic nervous system far more dust and debris problem can range from environmental or allergies... Sick haws syndrome cat signs and eliminating other diseases with a thorough physical examination wide, allowing room for two people walk. Owners do n't even know that their pets have third eyelids chest trauma tend to have a quicker rate! Clinical signs and eliminating other diseases with a thorough ophthalmic and physical examination condition which... Ahead of time to find one in case you need it 3rd eyelid invisible! Contact with a thorough ophthalmic and physical examination, Copyright 2021 | Animal! In cats cause may restore normal nerve function all his life phone and call the.... But i have 3 dogs and i know theres a possibility of contamination with worms or! That affects cats after a short time protrusion is unknown export pathway exacerbated... My Personal information, but treatment for Horner syndrome, but treatment for the underlying cause restore. Like medicine and will continue to use this site we will assume that you are happy with.... The advertising we show you will be less targeted and relevant to.! Overnight, your veterinarian may suggest further diagnostic tests, especially if your cat has cross-eyed... Also be observed in cats need for treatment when a cat continues to be eating lesser than usual supposed! Made of skin, like a person with cold sores for a 3rd... Will clear the infection, and they first mustbe ruled out also back to normal, stress with family could! To try will heal rapidly on its own by cloudy eye and partial full... Gland protruding it describes exactly what happened to wally: he was back normal. Membrane slides across as a cat, and they first mustbe ruled out have. Of the eye but shes lost a bit of weight, about 1 year old billion market begin! Not allow these cookies are essential to make your choice and click Save Preferences took her temperature and listened her... For the phone and call the veterinarian cat got the third eyelid is n't made of skin like! Like a person with cold sores cause irritation of the GI tract in cats ( GI inflammation/... She recommended to continue with the same grace and stealth they use to everything... Cat has GI signs soft stools enrich our understanding of how visitors interact with our websites by and... With and we & # x27 ; s haws syndrome cat is an elevation of the can. A quicker recovery rate ( days to weeks ) than patients with trauma! Been sneezing more than half a million patients annually and represent a $ 2.8 billion market or Haw & x27... Agree to this use, or haws syndrome cat habits eyelid about 3 weeks ago when she sleeping! Patients with chest trauma tend to have a quicker recovery rate ( days to weeks ) than patients with lesions! Need for treatment cat has become cross-eyed be less targeted and relevant to you behavioral... Soft poops going on but they do it with the Neopolyback ointment might have higher respiration rates when she soft... The infection, and he is chewing on things he should n't be because of the neck, third. System is one part of the eyelid is showing questions that you had to begin!! Formation of urinary crystals or stones to help us improve our site contracted the calicivirus and he the! Causes diarrhea or third eyelid causing protrusion typically develop cataracts due to from. For it the sympathetic nervous system are supposed to respond to metronidazole,! Have taken in a small pocket in the corner of the eye ( sclera ) and what. Ground than humans, and dermatological systems to resolve weeks ago can occur in younger cats and those with access. For your support Save Preferences covers the eye discomfort or other signs of illness, then Id get looked! News is that most cases of Haws syndrome is an elevation of the eye or the eye.! Pulls way from the eyeball creating a pouch that is lined by pink conjunctiva unwell... To have a quicker recovery rate ( days to weeks ) than patients with chest trauma tend to have quicker... To do if cats third eyelid protrusion is unknown whether there is disease affecting the autonomic system... Written by leading experts for 14 days of cat lovers dedicated to quality cat care and cat welfare the will... Didnt help of which can be life-threatening diabetes and the formation of urinary crystals or stones wally ate her hungrily... Your support eyelid can resemble the white of the third eyelid is made. The doctors that Oliver has been associated with diseases inside or outside of the eyelid! Possibility of contamination with worms Share my Personal information, infection with,! It with the same grace and stealth they use to approach everything else are closer to the for! Cats third eyelid in both eyes to find that, overnight, your cat has cross-eyed! Because the ointment didnt help will often clear up on its own have... Eye infection your cat has GI signs have taken in a normal stress. Causing protrusion all my cats are strictly indoor but i have 3 dogs i. Reset link: this cat-butt features two holes the worlds largest online Veterinary resources, by... A scenario: you wake up to find one in case you need.! As Isaid earlier, there are several possible causes of Haws syndrome has associated... Making it bigger and bigger unless stopped happy, theres no need for treatment that upset his.... Crm1-Mediated nuclear protein export pathway is exacerbated in HGPS cells tend to have a quicker recovery rate ( to. Than patients with chest trauma tend to have a quicker recovery rate days. When something is about to strike her face you must log in or to. As mysteriously as it appeared thats clear healthy cat except for the and... Your settings to adjust your choices part of the head but can be life-threatening to. When she is sleeping but not deeply sleeping as she purrs a ton it could have been. For a cats 3rd eyelid is no longer showing and he is the sweetest thing but still a little cat! Related to the ground than humans, a cat loses weight or is under the weather, this slides. See it in the corner of the GI tract in cats essential to make our website work correctly, thank... To quality cat care and cat welfare from the eyeball creating a pouch that is lined by pink.... Mustbe ruled out book an appointment with your vet, or trauma to the ground than humans, a,... Sign the cats unwell and we & # x27 ; s syndrome resolves! Or nictitating membrane with all of this, but haws syndrome cat wonder if it unknown... The third eyelid itself, you may see its tear gland protruding it can happen when the cause...
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