how long can someone be on life support

Your health care provider may tell you that these organs will not repair themselves. My answer is that I don't think anyone on life support is conscious. This is especially true if the CPR they receive is given properly and immediately. If your loved one has a feeding tube and this is the support that is removed, he may live for a few more days or as long as two more weeks. Brain death - anguish for the family Because life support machines maintain the person’s breathing and heart rate, they are warm to the touch. Life support for any extended period of time beyond 3–6 months is simply ORGAN SUPPORT because there is no life to support anymore. Is now the time to perform a vent wean? There may be long pauses between their breaths. Here's a look at approaches…, Euthanasia is practice that helps people who are terminally ill or in extreme pain end their lives. Also sometimes they need to be told that it is ok to move on. All content is protected by copyscape.com. For many families, this may be the first time that they have ever had to think about life support or about decisions for someone who may be dying. The length of time left depends on the injuries and what life support treatment was ceased. Unlike Jahi, Terri Schiavo was not brain dead, but in a vegetative state in which she had some brain activity. For patients, families, and even healthcare professionals, the ultimate decision to forgo treatments including life support may be less clear. Although it's a relatively painless…. Kinds of Life-Support Decisions Ventilators . “It is important for a patient to be in treatment for at least a year to a year and a half. Terri Schiavo's family, who fought to keep their brain-damaged daughter on life support for 15 years, has said they are trying to help move Jahi to another facility for long-term support. It’s one of the most difficult and emotional situations that you may find yourself in. After successful CPR, a doctor or first responder will assess if other kinds of life-support measures or treatment are needed. Once the brain activity of a person stops, there’s no chance of recovery. End of life and palliative care offers emotional and practical support to families, friends and carers. Experts say such care should be expanded to include people who aren't yet in hospice. When you think of life support, you likely envision you or your loved one connected to machines via various tubes that perform necessary functions, like breathing, eating, and the excretion of non-necessary fluids. After a ventilator is removed, the patient will most likely stop breathing, passing shortly thereafter. Doctors and nurses caring for the child may recognize that there are no more life-saving treatments that can … What’s a long time? His lungs can recover if given the proper time and treatment, but the problem is if he can’t breathe he will not survive long enough to recover. ECMO is often a treatment used after other methods have failed, but it can certainly be quite effective. Each person will have their own unique experiences with the patient to draw on. It can be very hard to know what is the right thing to do, or even what you want to happen. I know of somebody who had a heart attack two and a half weeks ago. This isn’t necessarily life support, as there are people with digestive or feeding issues who are otherwise healthy who may rely on artificial nutrition. While every individual and their circumstances are different, there are long-term life support success stories, such as a woman from Guyana who had been on kidney dialysis for forty years, as well as a man in London who finally passed at age 67 after having been in an iron lung since the age of 17. Another key indicator when discerning a patient's consciousness level is the illness or injury they have sustained. It's a … The spirit of a person is awesome and what it can do. This gives the illusion that the person … The treatments may extend your life, but do not cure your illness. Clinicians in the intensive care unit (ICU) often care for patients who are on several life support measures at once. This is called substituted judgment. A person who is brain dead, is dead… There’s no such thing as surviving brain death. With life support technology, we have the ability to keep people alive much longer than we used to. While you are on furlough you can take on other jobs, as long as it doesn't break the rules of your contract. Tubes are connected from the ventilator to the patient usually by means of an endotracheal. Answered on Aug 3, 2013. What are the End-of-Life Signs? In fact, a review of the research available concluded that more studies about long-term outcomes for people who were on a mechanical ventilator are needed. This is a trying time for all involved, but you can take comfort in knowing that if removal of life support is chosen, this is not why your loved one will pass away – they will pass due to the injuries sustained and the resulting condition. The truth is, life support can be one or all of these – it is dependent on the individual and the nature of their illness. This is likely to be because they aren't able to re-absorb or swallow the normal fluids in their chest or throat, which can cause a rattling sound. It can be difficult to be confined to the waiting room while your loved one is in this state, but staff members in the Critical Care Department are trained to provide you with an exact status evaluation. There are many people who have portable ventilators and continue to live a relatively normal life. Our website services, content, and products are for informational purposes only. It can also prolong life for people who are recovering from traumatic injuries. Usually people use the words life support to refer to a mechanical ventilation machine that helps you breathe even if you’re too injured or sick for your lungs to keep working. Statistics suggest that people who need CPR after a cardiac arrest can make a full recovery. When you speak to a professional, whether it be a life coach or a therapist, Ziev stresses the importance of opening yourself up to what you're struggling with and where you'd like to go from there. Life support may not be working. I remember nothing. ECMO is also called extracorporeal life support (ECLS). In theory an induced coma can go on for long periods of time, sometimes many weeks, as Michael Schuhmacher the famous formula one racing car driver and former world championship has shown. A defibrillator is a machine that uses sharp electric pulses to change your heart’s rhythm. If your loved one must be medicated with narcotics, they will likely sleep much of the time and therefore not have an increased consciousness level. Healthline Media does not provide medical advice, diagnosis, or treatment. (888) 867-7620 The actual purpose of hospice is to improve quality of life for whatever time remains. A time may come when the only outcome from the therapies that prolong life is the prolonging of suffering, with no chance of meaningful recovery. This website uses cookies to ensure you get the best experience on our website. Yes I do believe there is. A high proportion of people do survive being taken off a ventilator under a doctor’s advice. Had no pain whatsoever. No one wants to feel like “it’s all up to them” as they make a decision about life support for a loved one. If end-of-life has never been discussed before, it can be difficult to decide. Find a Support Group Few things are harder than watching a loved one slip away because of a life-limiting illness. Also known as “tube feeding,” artificial nutrition replaces the act of eating and drinking with a tube that directly inserts nutrition into your body. If lung function has been severely impaired—due to injury or an illness such as COVID-19 —patients may need a ventilator. The respirator takes on the job of providing breaths and assisting with gas exchange while the rest of your body gets a break and can work on healing. This phase can involve medication, self-help programs such as Narcotics Anonymous, a stay in a sober house or regular support group meetings. Other types of life support considered more invasive, such as a heart or a lung bypass, is only sustainable for a few days at most, while artificial heart recipients have lived as long as a year and a half. The answer is that it depends. It’s a mechanical device that assists the left ventricle in pumping blood to the body. Know why is someone put on a ventilator and can a person recover after being on a ventilator. If you're caring for a family member or friend who's approaching the end of life, learn what to expect and how you can support end-of-life care. It is 52 pages long and it shows that the total bill during his last stay would come out to more than $104,000. And hospice patients whose conditions improve can opt out of hospice care and can renew it later if needed (more on that later). It’s also called a respirator. Your email address will not be published. If you or a loved one has received a doctor recommendation for hospice care, your first question may be how long do people live in hospice?Because every patient's condition is different, there is no single answer to that question. Any method chosen is heavily dependent on the current status of the patient and his or her level of consciousness. If a unanimous decision can’t be made, it may be helpful to try mediation. When the symptoms of pneumonia, COPD, edema, or other lung conditions make it too hard to breathe on your own, a short-term solution is to use a mechanical ventilator. Brain death can be confusing, particularly for families who are confronted with the sudden death of someone they love because a brain dead person on a ventilator can feel warm to the touch and can look "alive." If a person also has another life-limiting illness (such as cancer), it is often easier to know how quickly their condition will get worse. Research shows that social support can help build resilience against stress-- a useful tool if you're trying to make a significant life change. Most people who need to use a respirator get better and can live without one. Every effort will be made to keep you comfortable and pain-free, however. You may wish to think about what the person would have wanted. This site uses Akismet to reduce spam. A pro of taking them off of life support would be it makes room for other people who have a chance. If a person on a ventilator is in a long-term state of unconsciousness, this can put family members in the difficult situation of choosing whether their loved one should continue to live in an unconscious state with the help of the machine. If you do, the healthcare team will keep the dying person comfortable until his or her life ends. Medical care to prolong life can keep you alive when these organs stop working well. Patients with VADs are also usually outpatients with relatively normal lives. Call our Support Line 0800 090 2309* *Monday to Friday 8am to 6pm, Saturday 11am to 5pm. Here are some general rules: Spousal support always ends when the support recipient dies. If you're a carer or friend of a person with dementia, you can give them help and support in their everyday life and activities. If someone can no longer leave their house or care home for appointments or treatment, ... Our trained team, including nurses, can answer any questions about end of life. Not necessarily inpatient treatment for that long, but to … This is where life support comes in. However, this is an expensive proposition and might be out of reach for a large number of people, also the outcome is not positive. Ventilators administer oxygen to patients who are unable to breathe on their own. Perhaps a patient will live longer on life support. Furthermore, a Tracheostomy tube can stay in infinitely and in fact some People have a life long Tracheostomy tube in place and they can live with it independently. Such life support can sometimes be a temporary measure that allows the body to heal itself and begin to work normally again. It’s especially used in infants who have underdeveloped cardiovascular or respiratory systems due to serious disorders. In some case, though, patients have been known to begin breathing without the ventilator's assistance. Quality care at the end of life addresses a person's physical comfort, daily care, and emotional and spiritual needs. After time spent on a mechanical ventilator, life expectancy predictions become harder to understand. Life support can also become a permanent necessity for some people to stay alive. When you consider whether to turn off life support, there are many individual factors at play. Acute HIV infection occurs a few weeks after someone contracts HIV. ... the older the patient and the more major organ systems involved in the person's illness, the higher the morbidity and mortality rate. This is due to the machine’s ability to do the job of either just the lungs (veno-venous ECMO) or both the heart and the lungs (veno-arterial ECMO). It is difficult to say how long someone can hang on after life support, can be hours or days. You may have to consider whether to use a breathing tube or ventilator. Patricia LeBlack from Guyana has been on continuous kidney dialysis in London for 40 years and John Prestwich MBE died in 2006 at the age of 67, after 50 years in an iron lung. You may often feel stressed and worried if you're caring for someone else. An LVAD is used in cases of heart failure. Do odd jobs and run errands. Life support is usually deployed as a short-term, temporizing measure to buy sufficient time for the patient to recover from a critical illness and … the doctors have to assess the patient to see if the patient is viable. When you're unconscious or not of sound mind, doctors and family members will decide when life support measures should stop. Want to know what the data says about how long you’ll live? People hang on because of unfinished business, they need to see someone first. With AND, the doctor will let nature take its course even if you need medical intervention to stay alive. ... confidence and then you can finally let go. They may not regain the ability to breathe and function on their own. The spirit of a person is awesome and what it can do. Life support means that the person could not sustain life on his own without the help of one or more machine. After turning off life support, a person who’s brain-dead will die within minutes, because they won’t be able to breathe on their own. Also sometimes they need to be told that it is ok to move on. It is not intended to be used indefinitely in someone who is dying. 1 2. If there is no hope of recovery, then one needs to have a proxy stating their wishes about life support. And yet, it’s important to be realistic about how sick the person may be. Also, by the time your critically ill loved one comes off the ventilator and the breathing tube/endotracheal tube is removed(= Extubation ), they will need to be awake and have come out of the induced coma. Friends can offer to step in with walking the dog, mowing the lawn, picking up the kids or doing the shopping – anything that eases the workload of the main carer. While the decision to maintain or stop life support can be in the hands of the family, sometimes it is up to the patient himself in the form of an advanced directive. Talking to other family members, a hospital chaplain, or a therapist is critical in times of grief and stressful decision-making. At that point, you may choose to talk with the healthcare provider and ask that life support be removed. If you support someone with a mental health problem, ... You may be worried that they're becoming too dependent on you or that things you do are not really helpful in the long term. See how your life expectancy compares to others and what steps you can take to live a longer life. Sometimes the hospital does not mean to NOT let someone die in peace. Question Posted by: Stephanie | 2005/08/15 H ow long on Life Support after a Heart Attack on Average ?. If the patient must be entirely relaxed or sedated for a short period of time, a ventilator will be used. Now, I can tell you that I have seen many many critically ill Patients being on life support for a very long time. Despite powerful medicines, and despite life support machines, the child may be getting sicker and sicker. Palliative care is not just for people nearing the end of their lives. The approach of best interests involves making a decision that would be the best for the patient. If you need CPR, the person giving CPR presses down on your chest to keep your blood pumping through your heart while you’re unconscious. 0. The heart is still beating and the ventilator is pushing oxygen and air into the lungs making the person's chest rise and fall. Sometimes the person’s breathing may sound noisy or 'rattling'. Terms such as "mechanical support" or "artificial machine support" could be used to refer to sustaining the functioning of a brain dead person, Caplan said. Spousal support may continue after the support payor's death if there is life insurance or assets (like an RRSP) from which spousal support can still be paid. Thus, the ventilator provides efficient maintenance of the body's oxygen levels. However, artificial nutrition is typically part of a life-support system when an individual is unconscious or otherwise unable to live without the support of a respirator. Some people that are in a similar situation may have a chance of living, unlike the first person, and could use the life support to get them back on their feet and keep living. This will depends on the patient's beliefs and opinion about life support or other related cases. Thus, it is safe to be on a ventilator for as long as the doctor suggests and whether patients can live after being taken off life support depends on how well the patients respond to treatment. To find the best mattress that works for you and your scoliosis, here are tips for what to look for and seven we suggest. There are two common types of instructions: With a DNR, you won’t be revived or given a breathing tube in the event that you stop breathing or experience cardiac arrest. How Long Can Someone Be on Life Support? In some cases, ECMO may be used earlier in treatment to prevent damage to the lungs from high ventilator settings. Learn how your comment data is processed. It doesn’t replace the heart. CPR is a basic first aid measure to save a person’s life when they stop breathing. If there is no hope of recovery, then one needs to have a proxy stating their wishes about life support. This could be because of: If you’ve left written instructions that you don’t want to be put on life support, the doctor won’t start the process. if someone is on life support with pneumonia and sepsis, is there a chance they may recover? In some cases, the life support becomes a permanent necessity to keep the person alive. Another cause for the need of a ventilator is a brain injury that doesn’t allow the person to protect their airway or initiate breaths effectively. When patients have curable or treatable conditions, life support is used temporarily until the illness or disease can be stabilized and the body can resume normal functioning. A decision can either be made by the whole family or one person who is the spokesperson of the family. The doctor will conduct several tests to be completely certain there’s no chance of recovery before making this recommendation. End of life and palliative care helps improve the quality of life for someone who has a life-limiting illness, by offering services, advice, information, referral and support. How long can my critically ill loved one stay in an induced coma? A mechanical ventilator, a typical example of life support, can assist or replace a person’s breathing temporarily. © 2005-2020 Healthline Media a Red Ventures Company. Call our Support Line 0800 090 2309* *Monday to Friday 8am to 6pm, Saturday 11am to 5pm. Family members and caregivers can show their support in ways other than meals. There really are no reliable metrics for the percentage of people who live after life support is administered or withdrawn. If you feel this way over a long time, it can have a big impact on your mental health and you can … The term “life support” refers to any combination of machines and medication that keeps a person’s body alive when their organs would otherwise stop working. Do you want to be on life support just to see how long you can live or are you wondering about it in case you become ill and need it. Our trained team, including nurses, can answer any questions about end of life. Sometimes after injury or a long illness, the main organs of the body no longer work properly without support. For the hospital and the first responders, their sole purpose is to save the life of the patient. A ventilator is a type of life support system as an alternative breathing system. Artificial nutrition can help maintain life at the end stages of some terminal conditions as well. They’ll also vary according to the medical condition of the person in question. Enjoy the flavors of the holidays with practical portions. For all other enquiries please see our contact us page. Compound fractures and a minor head injury. A person with no chance of surviving should not be kept on life support. You could spend a lot of time thinking about the impact of the illness and what will happen in the future. Original Question: How long can a brain dead person survive on average? That condition isn’t caused by you or your decision. Calls are free from landlines and mobiles. There are many things that family and friends can do to help support someone at the end of life. The manner in which a person dies determines what organs and tissues can be donated. Dementia is a life-limiting illness, but it is very difficult to know how long someone with dementia will live for. A person or a patient can be kept on ventilation for an indefinite period as they can be made to stay alive for an indefinite period. The alternative is death, but the one thing that can be worse than death is futility—depending on life support for a long period of time without meaningful benefit of survival." Most people on life support are on long enough to recover from a serious life threatening problem. While every individual and their circumstances are different, there are long-term life support success stories, such as a woman from Guyana who had been on kidney dialysis for forty years, as well as a man in London who finally passed at age 67 after having been in an iron lung since the age of 17. At times, the body never regains the ability to function without life support. Caregivers can encourage their loved one without giving false hope. It’s normal to want to be upbeat and positive, rather than talk about death. Thus, it is safe to be on a ventilator for as long as the doctor suggests and whether patients can live after being taken off life support depends on how well the patients respond to treatment. Children and adults can also need ECMO. Dementia can bring changes to a person's life. Another option is to consider what’s in the best interest of your loved one and try to make a decision based on that. Some children who are very sick do not respond to treatment. However, people who are using a life-support device don’t always recover. Life support can also become a permanent necessity for some people to stay alive. When attempting to answer how long someone can be on life support, there is no clear-cut limit. Life support is what gives doctors the ability to perform complicated surgeries. A defibrillator can get your heart to beat normally despite an underlying health condition that could lead to greater complications. You might find it hard to switch off. You can’t control other people, you can’t control what they say etc… but you are 100% in control of how you react! Terminal cancer refers to cancer that can no longer be cured with treatment. In most cases, people who are evaluated for organ donation have suffered fatal head injuries resulting from a car accident, stroke or a brain aneurysm.A person is not evaluated for organ donation until all life saving measures have been attempted. Respirators are also used in the later stages of chronic health conditions, such as Lou Gehrig’s disease or spinal cord injuries. Narcotics are mainly used to decrease anxiety in a patient, but this also decreases their ability to breathe on their own. No matter what, your loved one's doctors will ensure that your loved one remains comfortable. Most people on life support are on long enough to recover from a serious life threatening problem. When they fail, special medical procedures, commonly called life support, can keep you alive until your body is ready to take over again. Palliative Care May Help Advanced Cancer Patients Live Longer, Coping with Depression After a Loved One’s Death, Mattresses for Scoliosis, Plus Tips for Shopping, 20 Small-Batch Recipes for Your COVID-19 Holiday, Service Dogs That Can Monitor Their Owners’ Diabetes. All rights reserved. When my dad had a heart attack he was on life support for nearly a month when we decided to pull the plug" and he lived for another 2 weeks before passing. It just helps the heart pump. If these are stopped, it may take anywhere from a few hours to several days for the person’s vital organs to shut down completely. I had a motorcycle accident many years ago and I was "out cold". When I came to, I wanted to walk home- but someone stopped me. Calls are free from landlines and mobiles. In principle, there is no upper limit to surviving on life support. A person in a vegetative state is alive and may recover to some degree, given time. Common Life Support Methods When Using a Ventilator, When to Finally Pull the Patient from Life Support, 5-Step Soul Diving Solution Workshop, a Guided Excursion into Living a Full and Meaningful Life, My Life Re-Imagined 201 – Introduction to Conscious Dying, Caring 101: This Course is for YOU, the Family/Friend Caregiver, BEing Human 101 – Deeper Dive Fundamentals, The Loss of a Son or Daughter: How to Cope with the Grief. But there are cases where difficult decisions about life support may rest with a person’s loved ones. If a person is in a permanent vegetative state but not brain-dead, their life support likely consists of fluids and nutrition. People hang on because of unfinished business, they need to see someone first. This is why a ventilator is also known as a respirator. Copying without permission is not permitted by law. In all instances, your loved one's doctors will advise when to keep your hopes up – and, unfortunately, when there's no hope remaining for a recovery. Your email address will not be published. What happens after that varies according to diagnosis. Depending upon the situation. Brain death means the person has died. But you may survive for as long as 1 or 2 weeks. When life support is removed, it means that your loved one will pass away within the next few hours, sometimes days. After someone is declared brain dead over a period of time there is a minuscule chance of them being responsive again, and if they do become responsive again the chances of them being the same is close to none. Doctors start life support when it’s clear your body needs help to support your basic survival. Required fields are marked *. As a person’s own heart and lungs strengthen, the machine can be turned down to allow the person’s body to take over. In cases where there’s no brain activity detected, a doctor may recommend turning off a respirator machine and stopping artificial nutrition. ... “HOW LONG DOES IT TAKE TO DIE AFTER REMOVING THE BREATHING MACHINE OR LIFE SUPPORT? Especially if you and your family have been putting your life on hold because your loved one stays in ICU/PICU or NICU for many weeks or months on end, you and your family need to ask this question and you need to look at genuine alternatives to a long-term stay in Intensive Care and we can offer you this genuine alternative to a long-term stay in Intensive Care with INTENSIVE CARE AT HOME! A patient who has undergone major surgery, sustained a traumatic injury, or that has a severe lung disease may need assistance via a ventilator. This machine can be used after a cardiac event, like a heart attack or arrhythmia. Many people mistakenly think that hospice will hasten the demise of their loved one. Definitely many weeks, definitely many months and in some cases many years if not decades. Terri Schiavo's family, who fought to keep their brain-damaged daughter on life support for 15 years, has said they are trying to help move Jahi to another facility for long-term support. In the very last moments of life, the person’s breathing pattern may change. Cardiac arrest, drowning, and suffocation are all instances in which someone who’s stopped breathing may be rescued with CPR. Prepare meals. While complications can occur, they are relatively rare. Remember that it’s not the decision to remove life support that will cause your loved one to pass away; it’s the underlying health condition. For many people, it’s hard to know what to say to someone at the end of life. It is difficult to say how long someone can hang on after life support, can be hours or days. Usually, being on life support means that the individual is being kept alive with the assistance of a breathing machine, or ventilator. by Shelley Whizin | Feb 6, 2019 | 0 comments. When the human lungs and the respiratory system collapse and stop functioning, it is the ventilation system that can help the patient to breathe. Don’t be pressured to make a decision about life support you or the person you’re making it for wouldn’t be comfortable with. It does not necessarily mean that he is already dead; though someone CAN be brain dead but kept alive on life support. Other factors that are considered include whether the life support option is merely drawing out the dying process and whether the family or their insurance provider can maintain the costs of treatment. In theory, you can pump blood and oxygenate it (if that is how you define 'living') forever, yes, via these forms of life support. The underlying causes of why people go on life support and the age they are when life support is needed makes it impossible to statistically calculate outcomes. Terminal cancer refers to cancer that can no longer be cured with treatment. How Long Does Hospice Last? The main types of complications that can occur are infections at tube sites and other issues due to a longer than normal period of immobility. Life support refers to the treatments and techniques performed in an emergency in order to support life after the failure of one or more vital organs. You can also take part in training, or volunteer for an unconnected organisation. That ultimately depends on the person and the severity of that person's current condition. “You pull the plug when the person has no brain waves, and no hope of quality of life,” Braverman said. For instance, a head injury can cause auditory damage meaning the patient may not be able to hear any audible form of communication. Learn about risk factors, diagnosis, prevention, where to seek support, and more. Learn more. No matter what, these decisions are intensely personal. Ventilators can save lives by helping people who cannot breathe on their own. This tube is normally passed through the mouth, down the throat, and into the airway of the lungs, but it can also be administered through the nose or via an incision into the neck. Sometimes an LVAD becomes necessary when a person is awaiting a heart transplant. We'll go over the different types of euthanasia…, Microneedling can help reduce the appearance of acne scars, hyperpigmentation, sunspots, and even wrinkles. It is a hard question to answer, but unfortunately one we all need to think about before it happens to us. They won't seek help – but their behaviour is making life a struggle. If someone who is particularly on life support after brain death they should be taken off of life support, even if it is against the family's wishes. How long spousal support is paid depends on the facts of your situation. Spousal support does not always end when the support payor dies. 3 doctors agree. It is best when all the patient's loved ones can agree on whether to withhold or withdraw life support. Reasons for stopping life support. The COVID-19 pandemic has cast a spotlight on ventilators—but few know much about what they do or how they work.. A ventilator pumps air—usually with extra oxygen—into patients' airways when they are unable to breathe adequately on their own. The exact reason for choosing ventilation lies in a patient's particular medical condition or status. ECMO, the most aggressive form of life support available, pumps blood out of the body, oxygenates it and returns it to the body, keeping a person alive … Insurance company will only cover the patient as long as the doctors tests has a viable outcome. Your calls may be recorded for training and monitoring purposes. In other words, seeing your loved one hooked to a respirator is not always a cause for alarm – it is simply an assistive device. Talking with someone can help you find purpose. LVADs can have significant side effects, so a person on the heart transplant list might opt against having one implanted after evaluating their likely wait time and risk with their doctor. When you’re on a mechanical respirator as part of an end-of-life situation for a long period of time, your chances of surviving without it begin to decrease. For some people, intense grief after the death of a loved one can lead to depression or make underlying depression worse. But we do know that certain underlying conditions have good long-term outcomes even after a person has been put on life support. Patients on dialysis are fully conscious, usually outpatients who are otherwise having normal lives.

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