what is causing my breathlessness in morning? - AF Association

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what is causing my breathlessness in morning?

LKUK profile image
LKUK
76 Replies

I find myself very breathless in the mornings, after breakfast. Just walking 100m on the flat leaves me gasping for breath. Heart is pounding during this time. But later in the day this passes and I can walk around well (not as well as prior to AF but 30/45 mins on flat without too much breathlessness).

Any suggestions what might be causing this?

My Apple watch doesn’t log AF during the breathlessness, HR goes up to about 95, normally 60 at rest. Walking later in day my HR is usually 80.

I went into persistent AF last September (2021) had a successful CV in Nov and since have been in NSR. I’m on Diltizem and Flec 100 twice daily. Plus Apxiban.

76 Replies
DawnTX profile image
DawnTX

do you have sleep apnea by any chance? I am about to do a sleep study but until I get squared away I am not going to do it because I only sleep in two hour increments. I live with my cousin and he suggests that it may be sleep apnea. Evidently I snore like a train coming through the house. Upon waking my HR tends to be in the 120s

LKUK profile image
LKUK in reply to DawnTX

not sure. My partner has Apneaia - has had it for 20 years. He doesn’t think I have it, compared to his symptoms. But I do snore very loudly now and also awake every two to three hours. I’ll talk to my GP.

DawnTX profile image
DawnTX in reply to LKUK

it probably won’t hurt and if you haven’t had a study I’m not sure if they do it where you are but here they actually send you a home kit for a two night sleep study very simple nothing like the first one I had done years ago in a sleep lab.

I just thought I’d mention it because I know I have it and how high my HR is when I wake. Normally you would think that would be the best time to take it to get a low one. Best of luck. I did not know until reading on here have sleep apnea an a fib are so closely tied

jeanjeannie50 profile image
jeanjeannie50

I'm wondering what you eat for breakfast?

Jean

LKUK profile image
LKUK in reply to jeanjeannie50

hi I’ve tried a variety of options and for sure eating a lot makes it worse, especially carbs. But even yoghurt and fruit seems to trigger it. I’m on decaf coffee only. And it does seem to be eating that causes the breathing challenges. If I walk the dog before breakfast I am usually ok/okish.

jeanjeannie50 profile image
jeanjeannie50 in reply to LKUK

Yogurt made my stomach sore. I had no idea it was that until someone on this forum asked if I ate it? I thought I was being healthy. So stopped and the soreness went.

Are you eating flavoured yogurt because that sometimes has artificial additives in. They are a sure AF trigger for me.

I like to do long walks and found I couldn't take sandwiches to eat lunch time like other people or I'd feel like you do. Try eating a banana and a few mixed nuts for breakfast (I think Sainsburys are the best). Or you could always have your breakfast when you get home from walking your dog.

Jean

LKUK profile image
LKUK in reply to jeanjeannie50

thanks good idea. I’ll experiment a bit more.

CDreamer profile image
CDreamer in reply to LKUK

Eggs have the perfect combination of protein, fats and carbs - also satisfying and a myriad of ways to cook them.

NLGA profile image
NLGA in reply to LKUK

could it be white flour I used to get terrible acid reflux symptoms after any form of it

Auriculaire profile image
Auriculaire in reply to LKUK

Dairy can make asthma worse . Also walking straight after eating can be problematical anyway. Better to digest your food for 40 mins or so before setting out.

oscarfox49 profile image
oscarfox49

I have an almost identical experience. I am in permanent AF but take the dog for a 15 minute walk after breakfast each morning. My pulse goes very high and I feel breathless and extremely tired. It is a real struggle. I am on 80mg of Sotalol, apixaban, and 10mg of fluoxetine. By the afternoon I would not say I feel 'great' but I do a daily 45 minute walk in the forest which causes far fewer problems. My O2 levels are fine.

I conclude it is mainly the result of AF, coupled with low blood sugar in the morning. The doctor just takes my BP and pulse and says 'that's all fine' and the cardiologist didn't seem to want to know, apart from changing me from Sotalol. I have never had a 'stress test' under exercise and was told it wasn't necessary.

It will be interesting to see how many others have very similar symptoms under AF.

Ppiman profile image
Ppiman

I think that you might be best to ask a doctor's opinion. Shortness of breath (i.e. dyspnoea) can, but not by any means always, point to reduced oxygen levels. Do you have a pulse oximeter? That will show up this instantly and show if things improve as the day progresses.

If oxygen levels are low, then the reason might be that the heart is not pumping efficiently for some reason the Kardia cannot detect (it looks only for the presence or absence of a "P" wave, which is produced when the top of the heart, the atrium, is beating normally, signalling the lower chambers to beat. With this in place, it reports NSR even though some other heart issue might be present).

That the dyspnoea improves as the day wears on could also point to mild lung congestion or water retention. The cause might be COPD, asthma or something postural, that clears when the body is upright or with activity. I think diabetes is also a possible cause - and, amazingly, it can even be anxiety. Your snoring might suggest sleep apnoea as others have said. There are other forms of this that might cause morning congestion.

A doctor will know.

Steve

Hatten28 profile image
Hatten28 in reply to Ppiman

I am very interested in your comments as I have been getting increasingly breathless for a long time now, but only after exertion.

I have AF and type 2 diabetes, have put a stone of weight on since breaking my hip in March 2020.

Have not seen a cardiologist for 18 years, however on Monday this week I went for an echocardiogram which I am waiting for the results of.

My doctor did discover I had fluid around the heart some time ago which cleared the breathlessness to a degree after taking furosemide, which I am not taking at present just bendroflumethiazide.

At present I have an ongoing urine infection which turned to a kidney infection which I am still being treated for.

Getting pretty fed up with life in general would love to walk down our lane again it’s so pretty.

LKUK profile image
LKUK in reply to Hatten28

yes I can relate to the frustration of the debilitation. I was a committed walker and now struggle with not much at all. Interesting that you also find it improves later in the day.

I’m going to start checking my O2 levels as Ppiman suggests.

Ppiman profile image
Ppiman in reply to Hatten28

I get fed up with ailments. At 69, I feel like I’m creaking in too many places. A friend said get some WD40, but I reckon that’s short for winding down from 40! Feeling down is awful, and is something that descends without reason and lifts similarly. I put mine down to my awful sleep which often needs a tablet at 3am only to produce 2-3 hours of snooze.

Water retention is something I think is more common as we get older. I often wonder if my ankle has swollen at bedtime time but I doubt it has! I’m a terrible worrier where health is concerned. Diuretics help get rid of excess fluids but can upset electrolyte balance and bring on odd and severe side effects as a result, so need care. I think water retention is usually caused either by the heart not fully doing its job, or the kidneys, even the lungs.

Your echocardiogram will be very useful to your doctor. If it doesn’t show what is causing this, then maybe ask for an MRI scan? It’ll take a while on the NHS but is the gold standard for heart imaging, I gather.

Steve

irene75359 profile image
irene75359 in reply to Ppiman

We may have had this conversation before, but have you tried melatonin? My husband has huge problems sleeping and was getting quite low about it. For the past three nights he has been taking melatonin and has slept really well. I buy them from iHerb in the States for my grandson who is deaf and gets very frightened at night when he is not wearing his hearing aids. I should add that my daughter told her GP about her son's nightly dose of melatonin and he was in full agreement. If you wake during the night there are slow-release tablets available too.

Ppiman profile image
Ppiman in reply to irene75359

Thanks for that. I think you did mention it before. I didn’t try it as I get off to sleep easily and quickly which melatonin is supposed to be for. It’s the waking that is my issue, now made much worse thanks to nightly bathroom visits. I will give it a go though as it’s safe and your hubby seems to have done well with it. A recent study I read did show it not to be very effective but who knows?

Steve

LKUK profile image
LKUK in reply to Ppiman

thanks for that. Yes it is hard to stay positive when the changes all seem to be negative.

Hatten28 profile image
Hatten28 in reply to Ppiman

thank you for your response yesterday, today I visited the nurse for an inr

Check as I am taking antibiotics for a uti third lot so far.

After walking about 25 yards into the surgery, I was totally breathless so the nurse took my oxygen level which was 98 , feel very tired again and cannot understand why some days are worse than others, I was advised to go for a walk every day but sometimes I cannot get any enthusiasm for it.

Still waiting for a response from my doctor regarding my echocardiogram.

I don’t understand why I get so breathless if my oxygen level is so good.

Any ideas anyone?

Keep well all of you regards hatten

Ppiman profile image
Ppiman in reply to Hatten28

I guess you have had a blood test for anaemia, as that can, I gather cause breathlessness. Otherwise, I'd be asking my GP to check me over - but wait till your echo comes back as that might help your doctor diagnose it.

I was wondering whether the diltiazem might be responsible, though? If you are in NSR then this might be slowing your heart rate down too far or at least stopping it working as fast as the body demands when you go for a walk. Again - asking your doctor is the way forwards.

Steve

LKUK profile image
LKUK in reply to Ppiman

thanks - yes I will follow all of this up with my GP

LKUK profile image
LKUK in reply to Ppiman

sorry just realised you were responding to Hatten28 here. But I’m taking the advice too. And hoping Hatten28 gets some relief as it is awful to be so debilitated by the breathlessness.

Ppiman profile image
Ppiman in reply to LKUK

Doubly awful because of the fear it brings on!

Steve

LKUK profile image
LKUK in reply to Ppiman

yes that’s right. Fear and a bit of despair thinking life will always be so restrictive

Ppiman profile image
Ppiman in reply to LKUK

Yes, indeed. Exactly that.

Steve

Hatten28 profile image
Hatten28 in reply to Ppiman

Thank you, I don’t have swollen feet, just very occasionally in hot weather.

Today has been particularly bad, I will speak to my doctor about my various medications, but will wait for the results of my echocardiogram.

Lovely to have such helpful people on this site.

LKUK profile image
LKUK in reply to Hatten28

yes it is isn’t it!

LKUK profile image
LKUK in reply to Ppiman

thanks for that. Very helpful. I have been talking to my GP and am awaiting full blood tests. I am on a water tablet and do get swollen ankles still towards the end of the day (although it does depend on exercise level). I’ve put of weight despite eating better than I have in years. I have had asthma all my life and this breathlessness is not anything like the asthma breathlessness so I feel it is likely something else.

I will ask GP about an apena check.

Ppiman profile image
Ppiman in reply to LKUK

You’ll get there. The NHS makes it all so slow but the body is amazingly resilient.

My wife’s aunt ran the most successful diet club in the area for many hearts and struggled herself lifelong with her weight. Her method was so straightforward: stay with what you like but eat rather less of it each day. She said all crash and special diets were doomed but this one works. It’s slow but sure - much as the eight creeps on. Fluid retention will also cause weight gain of course, but that’s likely to send the weight swinging up and down, rather than steadily changing, I should think.

Steve

JOY2THEWORLD49 profile image
JOY2THEWORLD49 in reply to LKUK

Hi

Diltiazem may give you swollen feet.

Only once it happened on a very hot day and I drove 5-6 hours with stops.

I elevated my feet at night and in afternoons and it disappeared within a week overall incl the 3 days away.

UK and heat you need to keep hydrated.

Water pills take out important elements. Drink your made up electrolyte of

unflorinated water, squeeze orange, lemon or ....., add 1/4 tsp isodized salt and glucose to 1 litre of water. Drink 2-3 L of water each day. Do not count soup or liquid in meals.

Eat banana everyday and have an egg every day.

Drink water with unsalted nuts before your meal.

cheri. JOY

LKUK profile image
LKUK in reply to JOY2THEWORLD49

didn’t know water tabs stripped out electrolytes. I’ll look into making that up. Banana and nuts sounds a good plan for breakfast as well.

Speed profile image
Speed in reply to Ppiman

Nice response Steve. Well thought through, rational and well presented. 👍

Ppiman profile image
Ppiman

Thank you. You can tell I haven’t taken a sleeping tablet for three days!

Steve

Speed profile image
Speed in reply to Ppiman

I’ve just seen my response above and it was meant to be against your earlier post starting “I think that you might…”

I’ll repost correctly then delete this one so that the comment is more relevant to readers!

Ppiman profile image
Ppiman in reply to Speed

The threads do become complicated at times!

Steve

NLGA profile image
NLGA

have you had covid in the last 8 months to a year only I had covid in February and started with breathing problems and a racing heart in late March

This article may be of interest
Ppiman profile image
Ppiman in reply to NLGA

I think cardiology departments across the UK will confirm that’s true. My brother and his friend are conspiracy believers who think it’s all nonsense. Odd world, isn’t it - cynical beliefs borne of deep seated insecurity and a need to feel you know more than the experts, and all without ever studying - and fanned by social media.

(Sorry - I went on a a bit off topic there. It’s my high horse!).

Steve

LKUK profile image
LKUK in reply to Ppiman

yes I did have covid at Easter. Took me a long time to recover but the breathlessness is more recent. I got better in between.

NLGA profile image
NLGA in reply to LKUK

I was better for 7 weeks then I noticed it more and more ended up in hospital in June with a 178 heart rate . I couldn’t even walk up stairs even now I struggle more than before 8 months on

LKUK profile image
LKUK in reply to NLGA

that’s awful for you. Was it linked to covid?

Ppiman profile image
Ppiman in reply to LKUK

I’d ask for an echocardiogram maybe to see what’s what?

Steve

LKUK profile image
LKUK in reply to Ppiman

had one in June. Dilated right ventricle but good function. The mystery continues 😃

Ppiman profile image
Ppiman in reply to LKUK

That might be the problem though as it could reduce the output a bit. I have a sound heart I’m told but with left bundle branch block and I’m sure the fast rate atrial flutter I suffered with before my ablation in 2019 left it a bit weaker.

Steve

LKUK profile image
LKUK in reply to Ppiman

yes I wondered if the right ventricle was the cause. I’ll see what the bloods show.

Jalia profile image
Jalia

I can resonate with this and to lots of the replies you've received. Glad I'm not the only one!

My oxygen levels are normal, BP normal, bloods normal and diabetes test negative. No sleep apnea.

JOY2THEWORLD49 profile image
JOY2THEWORLD49

Hi

How much diltiazem?

Do you separate the flex... taking Diltiazem in morning and Flex at night?

Too much Diltiazem 180mg and I was light headed, I would not have driven a car or gone for walk. HR dropped 105 to 51 in two hours at first.

Twinked heart meds and controlled @ 120mg Diltiazem am and 2.5 Bisoprolol at night. Night HR has always stayed at 47.

I had more energy when HR controlled.

I dropped down to 110mg PRADAZA twice a day.

I keep TSH THYROID after THYROIDectomy & 12 lymph nodes removed at 2,0 TSH. On Synthroid 125mg and add 25mg one morning per week.

I was breathless on Metroprolol 186 avge day HR. Had to stop walking to regain energy. I had 2 x 2sec pauses during the night on 24 monitor. AF Rapid and persistent.

Sweating profusely.

DHB changed me finally to bisoprolol but HR 156 avge day. Not breathless. Uncontrolled. No more pauses.

It sounds like you go higher than 100.

Or it's the AF affecting you or Flec... is bothering you.

Breathlessness and loss of energy due to oxygen around your body are different.

Breathlessness is unable to breathe.

I tried to explain the difference to my specialist.

Some soul searching by you needs to be done to establish your cause. Metroprolol can cause breathlessness and interfere with breathing. Bisoprolol doesn't and is recommended to those with AF.

Search for your answers by keeping a notebook when you have your meds. Try walking 2 hours after taking diltiazem am only.

Take care, JOY. 73. (NZ)

LKUK profile image
LKUK in reply to JOY2THEWORLD49

thanks. I think the blood tests the GP has arranged are linked to the diltizem. So I should find out next week.

Auriculaire profile image
Auriculaire

I get more breathlessness now than I used to. It might be my asthma especially as in this season we have first ragweed then moulds both of which can cause problems . But I am not convinced it is just that. It does get better as the day goes on but comes back a bit in the evening.

Ppiman profile image
Ppiman in reply to Auriculaire

I was thinking that you could do a self test. If it’s your asthma, then taking a peak flow reading, followed by a puff or two of salbutamol, then another PF reading a few minutes later will show a real improvement and your breathlessness should improve. You don’t need the peak flow readings to do the test of course, but that would give objective confirmation.

Steve

LKUK profile image
LKUK in reply to Ppiman

thanks I have done this already. As someone with 50+ years of my asthma which often sees me in hospital I am in tune with that breathing challenge. I used my peak flow while very short of breath recently and it was fine. This breathless definitely feels like something else.

Ppiman profile image
Ppiman in reply to LKUK

It could also, I suppose, be some mild deterioration in the lungs (a kind of mild COPD from damaged alveoli) caused by the lifelong asthma; But, that said, I also feel a need to breathe more deeply at times and AF is rare with me, but ectopics and mild tachycardia are common. I suspect the heart just doesn't pump out as the body demands, myself. I wish I knew and I don;t want to dwell on it and become anxious, as is my won't. I sort of suspect the atrial flutter I had in 2019 has permanently and in some way affected "things" even if all scans seem "okay".

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

Thank you Steve. I have never had a peak flow meter! My asthma has waxed and waned throughout the period I have had it , It started as a result of meds - natch! I was one of the unfortunate few who develop asthma due to desensitisation jabs. That the doctor in ENT never warned when he proposed them as a solution to my cat fur allergy. Pretty bad - you can live with a runny nose but asthma can kill so I do not think I consented to the jabs fully informed. It is always bad at this time of year. The Ventolin helps and I am using the preventative inhaler twice a day. Usually once a day is enough and I have gone for long periods in the past not using it at all and been ok. I just tell myself I was like this last year and the year before and by Dec it will wear off!

LKUK profile image
LKUK in reply to Auriculaire

horrible that this has started for you. Do antihistamines help?

Auriculaire profile image
Auriculaire in reply to LKUK

Oh it started 30 years ago! One of the many reasons why I am so suspicious of drugs now. Our last cat died in April and we will not get another even though we are catlovers. I am also allergic to molds and a nasty plant that causes a lot of allergy here in France. It flowers from August through Sept so should be beginning to die down now. The falling leaves harbour molds so autumn is not a good time for me. I don't like taking antihistamines though I take Quercetin which has helped with hives.

Ppiman profile image
Ppiman in reply to Auriculaire

I used to work for Beecham Research Labs, now SmithKline and their division, called Bencard, used to sell the desensitising vaccines. Problems were unusual but I would be surprised if you weren't warned in the small and perhaps glossed over small print at least. That said, the usual problem with a course of desensitisation was some kind of anaphylactic response if there was to be one, otherwise the technique can be brilliantly useful. Most doctors would never prescribe it for a runny nose, though, so that seems unusual.

To "cause" asthma, too, would be unusual since asthma is a response to the body's IgE antibody mechanisms that go awry, much like, in its way - and much worse - the ARDS that unfortunate covid sufferers sometimes got and often never recovered from. Your asthma might have been waiting in the wings, as it were.

A PF meter can be very important if asthma is up and down, since it can show hidden or ignored deterioration like nothing else. Asthma can (rarely) become serious quite quickly and be ignored for too long. An evening peak flow, taken before any drugs, then a morning peak flow taken before any drugs, can reveal a deterioration that needs a rapid course of oral steroids and far more than the usual blue and brown puffers.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

What small print? The hospital doctor never showed me any small print. The jabs were given by my GP. The runny nose was like having a permanent cold. I was sent by my GP to ENT for allergy testing. My arm was scratched and various allergens were put on the scratches. They told me I was allergic to cat dander, house dust mites and some grass pollens and suggested a course of these jabs. There were supposed to be 18. After the 12th and 13th I had my first and second asthma attack. The GP said to stop the jabs and they had brought on the asthma attacks. I suppose my asthma might have been lurking - all my family have weak lungs maybe from growing up in a cotton mill town . But the jabs precipitated it. I had had hay fever as a child and teenager during grass pollen season with the usual sneezing , itchy eyes and runny nose. But I had never wheezed . The two years I had my cat before the rhinitis set in I never wheezed. I only wheezed after the jabs.

Ppiman profile image
Ppiman in reply to Auriculaire

It sounds like the jabs did it then. But the "small print" I was referring to was in the data sheets that the doctor will have had and should have told you about. Allergic reactions to provocation aren't all that uncommon I think although the product has long been discontinued owing to the cost. I've never heard of asthma being precipitated in this way, but anything is possible when the allergic response system is over responsive to challenge. It's an unpleasant condition, that's for sure.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

If available I now read every single letter of small print about any med I am given! I have to do it in French too! I got these jabs 31 years ago .

4chickens profile image
4chickens

I get very breathless to, I’m in Afl awaiting a convergent minimally invasive minimaze. It’s completely unpredictable sometimes I’m fine other times I’m gasping for breath after about 100 metres even if I stop and get my breath back as soon as I start to walk again it returns. It does appear to be more apparent after eating, went to see the gp who panicked did loads of blood tests including heart failure ones think it was bnp which was raised apparently meant to be under 100 but was 200 said wasn’t concerned as can go over 1000 . They increase my bisiprodol as heart rate was 111 but to be honest I haven’t noticed a difference. Think I’ve just got to hang in there until my surgery date.

LKUK profile image
LKUK in reply to 4chickens

hope your treatment helps out soon.

4chickens profile image
4chickens in reply to LKUK

thank you and I hope you get to the bottom of your breathlessness

Snowgirl65 profile image
Snowgirl65

I was just diagnosed with asthma. Could you possibly have a mild case of it? My recent scare happened while taking my normal walk around the neighborhood -- I was suddenly breathless and my heart felt it was beating out of my chest. Apparently, mine is allergic asthma triggered by seasonal pollen and mold. Could that possibly be your case as well?

LKUK profile image
LKUK in reply to Snowgirl65

thanks for this. I’ve had very bad asthma all my life, often hospitalised, so very used to the asthma symptoms I get. I’m certain the breathlessness isn’t asthma because it feels and behaves completely differently.

Snowgirl65 profile image
Snowgirl65 in reply to LKUK

I understand -- we each know our own bodies. But could it possibly be that certain conditions caused your asthma to have different symptoms? I recall having mild asthma decades ago, but feel that since I had Covid in December 2020, my respiratory system just isn't what it used to be and has caused my recent flare-up. I hope you find an answer soon -- take care.

LKUK profile image
LKUK in reply to Snowgirl65

covid certainly has changed things. And I do notice that type of shortness of breath sometimes too.

LKUK profile image
LKUK in reply to Snowgirl65

hope you keep well too.

LKUK profile image
LKUK

thanks for all the posts here - very helpful. And nice night to feel alone.

Afibflipper profile image
Afibflipper

I have the same issue and different on different days. Any incline have to keep stopping

I find if a meal has been too salty eg Chinese (may not necessarily taste to salty but they do use a lot - tends to give some water retention/BP raises can make me breathless

I stick to Decaf drinks only

Others mentioned, if I’ve eaten immediately before starting a walk, particularly a main meal I have problems

Maybe heart running a little faster or also the cold weather is bad for me and if windy it’s a non starter

LKUK profile image
LKUK in reply to Afibflipper

interesting about salt. I can monitor that more closely. Thanks

Afibflipper profile image
Afibflipper in reply to LKUK

yes apparently heart patients ne low salt diet - half the recommended amount of allowed amount - so I think we should be on something like (don’t quite me you’ll have to check) maybe 1.3G per day. Hope you find it helps

Pedroboy profile image
Pedroboy

have you had the vax plus boosters?

LKUK profile image
LKUK in reply to Pedroboy

yes I’ve had all the covid jabs, just had one last week plus flu jab.

Pedroboy profile image
Pedroboy in reply to LKUK

It's just that there have been reports of heart stress and breathlessness associated with those who may have had those jabs. Apparently the jabs hadn't been thoroughly tested...sorry to say.

LKUK profile image
LKUK in reply to Pedroboy

oh dear! Caught between the devil and the deep blue sea - don’t want to suffer covid.

Pedroboy profile image
Pedroboy in reply to LKUK

do as much as possible to raise you immune system strength. Increasedaily vitamin C, vitamin D (get plenty of sunshine on your skin, arms, body, without getting burned), and zinc. The zinc needs a quercitin to be absorbed into the cells. What's a quercitin? I think Tumeric is a quercitin, and maybe vitamin C, I'm not sure. Look it up. And I mean increased levels, well above Recommended Daily Intake (RDI), of these substances. Like I take between 5000-8000 mg Vit C daily, and I take about 35 mg zinc, and 60 ug (2,400 IU) vit D daily where the RDI is 90mg, 11 mg and 20ug (800 IU) respectively. And I'm not jabbed.

Taking this quantity might make for expensive urine, but it gives your body a fighting chance.

LKUK profile image
LKUK in reply to Pedroboy

thanks for this.

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