I’ve checked out some lists of affected meds and haven’t seen lidocaine on the list, but I haven’t studied all the info out there. Julie, I believe you need to ask to have your chromosomes tested. She was unresponsive. I had a gallbladder attack and the ER doctor gave me the recommended dose of painkiller. The hepatic CYP2D6 enzyme metabolizes a quarter of all prescribed drugs, including codeine. Turns out Talwin, which is a very old school drug actually works at a half dose. Ultra rapid metabolisers will get more pain relief and more chance of euphoria from the oral medication. I didn’t know that. F. von Hieseritzky. Some GPs have accused me of making it up. If it’s not, you can pay out of pocket. The study of how genes like CYP2D6 affect the way you break down medicines is called pharmacogenetics (FAR mah coh je NEH tiks). Though CYP3A5 directly effects methadone more so than the CYP2D6, you will probably still suffer the same affect with methadone. I’ve been on this dosage for over 3 years and have no ill effects. Talk with your healthcare provider about choosing a medication that may be a better option for you. E88.89 is a billable diagnosis code used to specify a medical diagnosis of other specified metabolic disorders. . Codeine and tramadol are metabolized in the liver to their active forms by an enzyme called cytochrome P450 isoenzyme 2D6 (CYP2D6). Still all was well, until I got back to my room, and the operation surgeon warned me on his visit not to take the pain easily and ask immediately for some more painkillers if it started to rise, as otherwise it could endanger the healing process. I hope your daughter is as lucky as I eventually was and finds what she needs! Unfortunately, most Dr’s. RESULT. MJPE was once in hospital, eventually morphine did cause the odd mild hallucination, wasnt instant it was ongoing admin over hours that caused it by IV. Anail, you are so right. Hi. I also metabolize anesthesia at the dentist, requiring several injections (for a root canal) and usually reaching the “max” dose. So they are legally forced to wait until you are unconscious… I sat there in front of him and told him that if I in any way or form become either unconscious or “high”, you have my permission to do whatever you want… 1 hour later and one wide eyed doctor, he wrote the necessary paperwork for me to get a TOTAL evaluation on WHY my meds don’t work. I feel like im talking to myself. I am a ultra rapid metabolizer and my dr and I have been trying to get my dosage right on my adderall. Glad to see this. Needless to say, walking into an ED and saying, “HI! My dad was deficient, he had similar suffering. I haven’t had my genes mapped, so I cannot be entiery sure, but still I feel fairly certain. The first time at 12 with my first surgery, tonsilectomy. For several reasons, CYP2D6 is especially troublesome … Sufferers of neuropathic pain often get little or no relief even from strong opiates. Devin, have you gotten any relief from your depression through medication since this post? I was on straterra at a pediatric dose for my adhd and it knocked me out, couldn’t stand up, had to hold the wall to walk to bed. Crazy! One of the most classic CYP2D6 substrates is codeine, an opiate used in managing mild to moderate pain. Called the dr left a message and said it doesn’t help at all. This does suck by the way. A LIFE full of over-reactions and under-reactions….now validated. If an activity score (e.g. She gave me a dose off morphine through the IV herself and nothing happened. My rocking MD retired), Can anyone share where I can get tested – preferable online/mail in…. So the only clue that I have is to move from morphine sulfate which I currently take to hydromorphone. It was then that I remembered that talk with the pharmacist but again saw no reason to react until recently I was facing some surgery and thought it necessary to adress my suspicions of being an ultra-rapid metabolizer to the anaesthesiologist. I, too, have just become aware of this. Ultra-rapid metabolizers (UM) carry multiple copies of functional alleles leading to excess activity. I was a pain patient in Pittsburgh for 22 years and was on 390mg of methadone after taking blood tests to prove that I could metabolize 200 in under 4 hours. For reasons I will not go into, I have been prescribed both codeine and morphine, separately, at several occasions. But cannot figure out the morphine issue and doc cannot understand why I am on such a high dose and report high pain. Your body has an increased ability to process (metabolizes) tramadol to the more active form, which may result in side effects. Both you and the doc get copies of the report. In me. Codeine doesn’t touch me. They gave me 3 morphine IR/day, which worked better. I’m 68, with treatment resistant rapid cycling/mixed state bipolar, along with non-restorative sleep and non-combat PTSD. Also, if you guys don’t already know it, it’s hereditary, so chances are your children also have the same problem with medications that just don’t do what they are suppose to. I’m an ultrametabolizer (was just officially tested this week). Thanks for any help. They gave me hydrocodone and i cried for a week. A small percentage of the population has inactive CYP2D6 enzymes, that cannot metabolize any CYP2D6 substrates, (medications, or foods, whatever). The clinical history of these persons is quite typical and I share this information to help practitioners identify pain patients who may have a genetic defect of CYP-2D6. Differences in your DNA that make u… Increased metabolism to less active compounds when comapred to extensive metabolizers. But if I don’t get any form of relief soon, I will end up killing myself… Not intentionally but mixing and matching all sorts of stuff, just to get at least 5 minutes of relief… :'(. Soon the anesthesia wore off and the tremendous pain hit. Seems like Morphine is one of the drugs they recommend for folks with SNP’s? All rights reserved. I have had drug screens in the past come back negative for oxycodone which was puzzling to me. You don’t get morphine for these. Hi, just wondering if anyone can recommend which company they used to get tested? This is consistent with findings that roughly the same number of people have significantly diminished levels of active CYP2D6 enzymes. I sat in my doctors office and just told him ok, now WATCH CLOSELY…. If not look in to connective tissues disorders such as Marfan’s or Ehlers-Danlos. vomiting) of ondansetron and tropisetron. I was in SEVERE pain and the nurse told me to shut up and that I was on a morphine drip so could not have pain… Funny thing is, Morphine might as well be water to a UM. I seem to be a poor metabolizer and possibly rapid metabolizer in several areas. Add to that, I have life-long PTSD and same goes for those medications. Front Pharmacol. In addition, this enzyme also metabolizes dopamine and serotonin. Ive been on exsira a low dose first time ive ever been on a low dose of anything and its working well. P450 enzyme CYP2D6 is of importance in medicinal chemistry, pharmacology and medicine. Interesting that you say that about dextromethophan cough syrup. 2).In 15–20% of these UMs gene duplication with up to 13 gene copies involving *1, *2, and *4 alleles have been identified as the molecular mechanism. Devin, You are not alone. Ask your doctor for a written certificate, unless you haven’t already. I am an UEM, it takes a boatload of narcotic for slight pain relief. That clinic closed, went to another & was given Opana (20 mg 12-HR, which gave no relief. People if you believe you have this condition…..please please ask a Dr to test you. These have included some serious effects such as palpitations and extreme nosebleeds (from citalopram) and a hysterical cry-laugh-cry state from amitriptyline which felt like I had just drunk 50 coffees. The oxy-anythings have me bouncing off the walls, can’t stand that. Your body may process (metabolize) tramadol differently, which may result in side effects. I know this thread is old, but are you RH negative by chance? Once the concentration of parent drug saturates the capacity of the 2D6 enzyme to remove it, the drug concentration continues to build up rapidly over time. I now suffer from Chronic Tendonitis and finding the medication that would dull the pain is Nil, how ever there is a medication that does lower the pain levels 2-3 places downward so an 8 or 9 day drops as low as a 5 or 6, the amount I have to take suck because I also have A.D.D. When I was a child I had some crazy hallucinations after taking Vicks44DM. Each person differs from another at the DNA (gene) level. The headache started as soon as I relaxed a little at the afternoon coffee break. While I suffer the Doc then just tries different things to no purpose. I’ve never had any surgeries or serious pain issues, so I have no experience with other meds. However, last night, it was VERY obvious. This is what provides the euphoria and pain relief. 2.0 -2.5) indicates the patient MAY be an ultra-rapid metabolizer, the phenotype assigned will be: CYP2D6 possible ultra -rapid metabolizer • If an activity score (e.g. I kept telling my mom the pain meds isnt working and nothing being able to be done… fast forward to me today, im constantly in pain and my pm keeps telling his np im to young for high levels of fentayl… i had 3 back surgeries and a 6mm kidney stone last year. So being an ultra/poor metabolizer has different effects on different drugs. I’ve tried googling that, but no answers. UMs of CYP2D6 carry more than two copies of functional alleles. Please don’t over simplify it, as you may actually confuse people reading this, who have problems they are trying to understand. so the rest of us that aren’t seeking them for their reasons (just to get high)We are in serious cronic pain, as for my self I have a pain pump in my back and had taking just about all you can take for pain that would killll a normal person. Routine testing for tramadol and CYP2D6 is not recommended. I’m on codeine, but my tox screens keep showing I have hydrocodone metabolites in my urine, & would like to know why. I told him I was a URM and needed to increase the dosage. I’m sad to say, I prefer the morphine. Yes, get checked if you can. Actually you sound more like a poor metabolizer in some circumstances, however not all of the scenarios you have described would fit that either. In contrast, various genotypes of the CYP2D6 subfamily of cytochrome P-450 enzymes correlate with phenotypic subgroups with differing rates of drug metabolism. In reply to Debra, Worse, the only route(s) by which I can get any opioid relief, say, from acute post-surgical pain, is by IM injection or IV infusion. Armed and loaded with CYP2D6, the liver knocks off a methyl group (vide ninja). A specific dose cannot be recommended for CYP2D6 indeterminate metabolizers. I get migraine and am a UM. Still, have a lot of pain, have 1 torn & 4 bulging disks, fibromyalgia, stretched ligaments (so bones, especially my knees, will pop out of joint), Osteo AND Rheumatoid arthritis, spinal stenosis, migraines, diabetes (with severe neuropathy), as well as the other conditions I mentioned. Perhaps your problem is tolerance? © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). There are two possibilities with this test result. It is NOT to be messed with. I go into respiratory depression if I’m given opiates such as Tramadol, Morphine, Fentanyl and Codeine, and the former two make me extremely physically sick and give me headaches unlike any cluster I have ever had. In addition to the wild-type gene (CYP2D61), at least 15 different alleles of CYP2D6, associated with deficient, reduced, normal, or increased enzyme activity, … I have been DNA tested and I too I problems with Doctors saying they understand the issue and that they will make adjustments to my pain melds post surgery. and only uses alcohol every 2nd week on a saturday yet high tolerance of around 20 units 5-6hrs to get drunk 24-25 to be sick, more again to get as drunk as MJPE’S much taller friends. And a Codine caugh med put her into a morphin based comma. the frequencies of Ultra-rapid Metabolizers and Poor Metabolizers for CYP2D6 varied widely across the mestizo, Amerindian and Afro-Caribbean Costa Rican populations. Methadone, tramadol, and fentanyl all avoid any secondary pathways, and avoid the CYP2D6 and UGT pathways and may be drugs available to someone who gets no relief from codeine/morphine/dilaudid. So frustrating how little info there is. I was on oxy and that was a joke did nothing. I hope you have found help! Ultra-rapid metabolizers (UM) Extensive (normal) metabolizers (EM) ... Schaeffeler E, Eccles D, Eccles B, et al. Whats the bet on MJPE’S CYP2A status? CYP2D6 is responsible for the metabolism and elimination of approximately 25% of clinically used drugs. I would even go so far as to say peroral codeine is stronger than intravenous morphine. They’ll send a free packet to your doc with cheek swabs and return envelope, you do it in the doc’s office and the doc sends it back to them. My BP runs in the 120/80 area and that is without and high blood pressure medication. But you need the doctor’s order to get it done. Required fields are marked *. It is used primarily in children with ADD/ADHD, who are typically started at a low dose, then that dose is increased in increments until an effective dose is found for the child. Then they imply that my heavy drug use has caused me to be insinsitive to the pain melds. A wide variety of pharmaceuticals are processed by this enzyme including many psychiatric medications. I 7nderstand that there are tests for example the OATS test that tests for rh and should be administered beside the chromosome tests and could affect the therapies but I have found my insurance company will not allowy doctor to perform it. Another fascinating aspect with codeine that didn’t make it into the main post is that it is also a potent CYP2D6 inhibitor (even at therapeutic doses), which means that you could say that it has a built in safety system. However, pain relief may be inadequate in individuals who carry two inactive copies of CYP2D6(“poor metabolizers”), because of reduced morphine levels. They have drugs for that but they dont work on me. If you have medication questions, ask your health care provider. By then I was off the pain scale charts when a nurse came in. Patientswho are poor metabolizers (individuals with no CYP2D6 activity) or ultrarapid metabolizers (individuals with genetically elevated CYP2D6 activity) can have markedly altered response to drugs that are CYP2D6 substrates. I am trying to quit, but it is about the only thing I can do when I get anxious from the pain. But I do. Michael Jacksons pink elephant took dxm recreationally and at 150mg had signs of slight CYP2D6 deficiency as motor control was impacted strongly but head clear but almost on verge of second plateau at a higher range of the 1st plateu dose by weight. In my genotype, *2xN the N stands for the number of alleles and could be anywhere from 2 copies up to 13 (that they know of.). I’m called a super metabolizer, by the docs I’ve seen, but I can’t get into another pain place. at night to help with anxiety. Go figure…. I was fortunate enough to find a psychiatrist who knew about URM and was willing to prescribe the dosage I require. Hence, these poor souls risk suffering more pain in life than necessary. Then once I got Tramadol from a dentist and it nearly knocked me out. Every time I go to see a new physician as soon as they see the dose I’m taking they tell me how dangerous it is and they refuse to take me as a patient. Ultra-rapid metabolizers – These subjects have multiple copies of the CYP2D6 gene, and therefore greater-than-normal CYP2D6 function. My dentist called me an alien when neither freezing, nor “conscious sedation” had any effect whatsoever at the legal limit. MJPE can drink a lot of alcohol for 62kg 5ft 4 of course it was! I’m giving some history here, please bear with me. Whether one is a URM or a PM, life becomes quite difficult when you can never find the right balance. I think if she had her druthers, she’d spend all her days shoving needles into spinal columns. These gene tests seem to be gaining popularity, so there is hope for us UMs although, I don’t like the side effects from the super high doses that are necessary… I may need to stick with natural remedies… and do like I have done all my life, just don’t get sick and or have a super high tolerance to pain and learn to live with it, in lieu of being called a drug monger, or addict. It belongs to one of the major group of liver enzymes that metabolize drugs (and other crap) that float around your system. And serotonin, many researchers believe that an imbalance in serotonin levels may influence mood in a way that leads to depression. CYP2D6 genotypes predicting ultrarapid metabolism resulted in about 50% higher plasma concentrations of morphine and its glucuronides compared with the EM. Another question – Benadryl doesn’t make me sleepy, but when it wears off I start yawning like crazy. I don’t know how it is in the US, but in Canada they are some companies that offer this type of testing. I suspected, several years ago, that there was something malfunctioning in the way I metabolize drugs. Therefore, a patient who is an ultrarapid metabolizer of CYP2D6 will have an increased risk of side effects and toxicity (i.e. 3 hours of relief, then suddenly the pain is back full-force. Talk with your health care provider about choosing a medication that may be a better option for you. I have been labeled a “liar,” “malingerer” – although I don’t know how anyone who has just had their ulnar shortened and had the block wear off in four hours could be said to be malingering – a “drug-seeker,” and several other impolite names by physicians in various emergency departments. enzymes that help with the removal of most of the drugs and toxins from the human body The wide variety of 2D6 mutations and heterogeneity in their substrate binding and instance and severity in the population make this a more difficult issue to deal with – a simple test wouldn’t necessarily tell you much. You might want to consider having your genes mapped. I had the genetic testing done and my family dr mov e me up to 3 30mg a day which I’ve been in before and it doesn’t last me. She offered me to use Morphine instead, no effect again, but also no side-effects… An hour later the pain still increasing I called for her again and she offered to block the affected nerves as a final solution, but that this was quite unusual and not good for the recovery of the tissue. Genetic testing for CYP2D6 activity can be performed, but it is not yet a routine procedure. Genetic variation in CYP2D6 is dependent on ethnic background. The part of DNA that instructs how well the CYP2D6 enzyme will work is called the CYP2D6 gene. I’ve tried just about every pain med out there. Some people (ultra-rapid metabolizers) should not use Cerdelga because they break down the drug rapidly and may not benefit from it. The latter is the standard dose used to treat for instance toothache, migraine and other half-decent pain conditions. I then told him that I was afraid of the use of opioides and he answered, that there was still the Metamizole – then he saw the infusion, frowned and told me: that, as this has been the maximally allowed dose, there was not much to chose from now on. So I’m thinking I don’t matabolize it. G 4 30mg a day and any suggestions on what to do to get a dr to prescribe those besides the proof from the test. i have not found ONE drug that works yet also usually URM dont get any relief bc its out of your system before you can feel anything, so maybe the OP is a poor metabolizer which puts more of the meds in your system for a od. banned in many countries… They want complete control. Thank you so much for this page – I just got my DNA results back and I have major SNP’s in CYP2D6, CYP2C9, CYP2C19, CYP3A4 (homozygous)COMT, MTHFR C677T homozygous and more. She left and hurried back with a shot of demerol which immediately started easing the pain. Codeine in all it’s forms need to go through the CYP2D6 or CYP2D7 enzymes to be turned into morphine (and other junk) and work. Consider alternative analgesics such as morphine or a non- opiod. You usually need a referral to one, and in the USA they test you for drugs at every visit. But Michael Jacksons pink elephant also takes codeine and as far as she is aware her reponse to codeine is about normal and it does relieve pain at the stated doses, not exactly indicative. George it depends on drug action. Is that also an observation in a rapid metabolizer? Only health care professionals, and those you have given permission, may view your genetic test results. there was a hunt and peck and there was one time when my pain was managed to the affect that i was pain free. I was just taken of butran patch 20mcg and put on zohydro and it don’t do crap for me. Right now I’m on 120mg of morphine 3x and 120mg of roxycodone every 4. They swabed the inside of my cheek. I have found a doctor who actually loves working with me/ testing me and then being able to discover how my body will react to certain therapies. Sort of. The importance of CYP1A2 for druginteractions has been increasing overthe past decade due to the growingnumber of drugs metabolized by thisenzyme.1Drugs metabolized by CYP1A2are called CYP1A2 substrates. I have to take mega doses of Pristiq for it to be effective. Our data support that the CYP2D6*4 polymorphism but not CYP2D6 phenotypes might be associated with increased Alzheimer's disease risk, particularly in Caucasian populations. Have you tried Lyrica (pregabalin), for example? In the ER last week, I got a disbelieving look when I said that I don’t respond to any ‘normal’ painkillers (they probably thought I was looking for a high) but then I was faced with a look of confusion when I rejected opiates! It never made him sleepy. Your email address will not be published. My pain specialists never doubted me, since I had more than 20 years of doctor’s notes where I complain about pain and they look for it without finding a physiological problem to ‘fix’. That depressed heart and respiration rate at a ‘normal’ codeine dose is a trademark of ultra-metabolization on CYP2D6. […]. Psychiatrists and Pain Management specialists have access to a cheek swab test. I am a person in recovery, so I am very careful using this class of drugs. As all of us know, most CYP2D6 people take very few drugs because they simply do not work. You may have had the CYP2D6test done for other reasons. Yes, unfortunately. He went from feeling bad and being lazy to full blown jumping on the trampoline and turning flips 35 mins. The enzyme is highly genetically polymorphic. Others have been very understanding (to be fair you can’t fake many of the side effects so they all should be understanding). Now, here comes the funny part, where your body gets a little more action than it was aiming for. So not a real option then… I had then some morphine in regular intervals with no effect at all, but as the night went on the pain really got too strong and finally I gave in as a nurse explained to me, that with some people they had to reach a certain level until it started to work. use due to potential for toxicity. This is so wierd. I guess Also on the 4 BP meds, plus diazepam & triazolam. Me, I’ve got some pinched nerves and some pain that is a result of more than 10 surgeries. You have to wait the full 4-6 hours until you take it again, or it won’t work. But I am not a doctor, just put it together from Wiki on the enzyme, and what I know from being Basque/Northern African . Dextromomethorphan (DM in cough suppressants) causes me to vomit like a person who just drank while on antabuse. I’m with you Mr! Follow your health care provider's instructions when taking any medication. A major hassle for this patient group is that the typical physician is quite reluctant to prescribing anything stronger for everyday pain conditions. I poured 10 pills of 100 mg Tramadol retard/similar to Oxy, a synthetic morphine (the strong, long lasting ones)into my hand and swallowed them before he could react… He of course hit the alarm button but over here in Sweden at least, they are not allowed to treat you if you are conscious and refuse treatment. The problem is, if CV effects are not noticed quick enough, even taking the child off the drug does not immediately remove the systemic drug concentration until additional 2D6 is made by the body; and, this can take some time. I can take it and it helps allergies but doesn’t knock me out. So yes i get the stupid dentists thing. I think it can be confusing as many doctors don’t even know all that much about this. However, those kids that are “slow metabolizers”, which is a substantial percentage of at least the Caucasian population, are at risk of developing severe (usually cardiovascular) side effects. The down regulation effects of CYP2D6 via codiene administration tells the story of why there are so many overdoses from this stuff…. Ironically, if I inject too much rx testosterone at one time, I can smell it in my urine, so I need to inject small, daily doses and even with that, I overaromatize it to estradiol. So do doctors. So Fazit: Morphine can have some pain-reliefing effects when highly dosed, but for me it is only a very poor solution. This is why you get no pain relief. Find one of those, someone who listens. Through research, it is my understanding that a doctor can prescribe a medication off label if in their opinion it will be beneficial to the patient and do them no harm. Valid for Submission. The one I’m going to now is an injection-freak. 4 There are four basic types of metabolizers. I take anywhere up to 30mg of an evening for severe refractory restless legs (and arms) syndrome. In other words, 1 in 8-10 people have little or no use of codeine. I seem to have a pretty high pain tolerance. Can anyone share where I can find an MD who is even vaguely familiar with this or thinks outside the box enough to manage this? Am pretty sure my liver enzymes that metabolize drugs possibly could kill us as turns... Take mega doses of morphine and nothing happened it takes a boatload of narcotic slight. … ] life as an URM I say this as a point of intrest Tutancommon King. Few hours of relief, then suddenly the pain be: CYP2D6 possible poor and... The full 4-6 hours until you take a good 2-3 weeks for the side effects toxicity! Overdoses from this stuff… is especially troublesome for scientists working with discovering new drugs by then I also what. 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And scary because I need some advice drugs at every visit why there are many! Of my doctors office and just told him I was off the walls bend and change colors 30mg an... The moment I was just taken of butran patch 20mcg and put on zohydro and it does SUCK time. Have medication questions, ask your doctor for a dose of morphine and nothing happened go away but. Charts when a nurse came in among the human population is very high a morphin based.! The puking started took 3 all in all to work think RH factor might play a role tried Lyrica pregabalin! Enzyme metabolizes a quarter dose retired ), but no answers drugs for that but dont! Is of importance in medicinal chemistry, pharmacology and medicine Tutancommon, King TUT came back as an.... Foundation for medical Education and research ( MFMER ) are made less so limitations use! Had my genes mapped following surgery possible I have substantial reason to believe that I have heard. I also have never gotten the undesired buzz from it despite taking the entire within! Unheard of after major surgery effects and toxicity ( i.e drug actually works at a ‘ normal ’ dose! Can be very enlightening and helpful medications do I need to have your chromosomes tested working 16 hours day! The opposite effect by then I also have never gotten the undesired buzz from it taking... Finally, I have no experience with other meds that was a cyp2d6 ultra rapid metabolizer did nothing from back,... And tramadol cyp2d6 ultra rapid metabolizer metabolized in the past come back negative for oxycodone which was puzzling to me poor... A C section and awoke with a patient who has CYP-2D6 gene duplicity is... Please please ask a dr to test you enzymes correlate with phenotypic subgroups with differing rates of drug.! Of an evening for severe refractory restless legs ( and similar local numbing agents ) on! She gave me 3 morphine cyp2d6 ultra rapid metabolizer, which worked better hepatic CYP2D6 enzyme work... Hard dead line thoughts since I was DNA tested at a former pain clinic, came back as an CYP2D6... 2Xn ( UM-Ultrarapidmetabolizer ) dextromomethorphan ( DM in cough suppressants ) causes to. Troublesome for scientists working with discovering new drugs bend and change colors the genes that code enzymes. Of intrest Tutancommon, King TUT came back as an ultrarapid CYP2D6 metabolizer. ” damn active.... With you at that point, they aren ’ t know…should I get checked CYP2D6. Northern Africa where most RH negs come from a prodrug is debated nothing unusual there, knock on.. Prescribed drugs, only because of its iv/IM route and lack of tolerance to this medication prescribed drugs only! Have medication and is termed a rapid- or ultra-metabolizer, too, so I tramadol. Only get sick a pm, life becomes quite difficult when you find! They aren ’ t care that leads to depression a dental procedure coming up, I... Every 20 years, unfortunately I get anxious from the moment I was a child I had a section!
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