https://www.cancer.org/cancer/cancer-basics/lymph-nodes-and-cancer.html. Lymphadenopathy. Omicron vs. Delta: How the 2 COVID-19 Variants Compare. Lymph fluid is a clear or slightly yellowish fluid made up of white blood cells, proteins and fats. When people talk about swollen glands, they're usually referring to their lymph nodesthe small, bean-shaped structures that are part of your body's immune system. The doctor who spoke with sister station WBAL said she doesnt want this to lead to hesitancy or fear about the vaccine or mammograms it is about having the knowledge about what to possibly expect. Though they may not be a common sign of COVID-19, it's still possible for them to happen. As with most vaccines, it triggers an immune response, so your body is better prepared to fight if you are exposed to the virus. That means if you have strep throat, you may develop swollen lymph nodes in your neck. Swollen lymph nodes can be the result of your body responding to infections. I found this related article online: See a healthcare provider right away if you have large lymph nodes in multiple areas of your body. If infection is the cause of your swollen lymph nodes and isn't treated, an abscess may form. Summary. 2023 Healthline Media LLC. If you have a large, swollen area but youre not feeling sick and you didnt recently have a cold, flu or other infection, see your healthcare provider. How long did this last for others? They went in for evaluation and had scans and biopsies only to find out everything was fine. Axillary Lymph Node Swelling After COVID-19 Booster Vaccination: Japanese Case Report and Literature Review In Vivo. GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Chapter 5 ultrasound characteristics of benign vs malignant cervical lymph nodes. This makes lymph nodes swell and feel tender. After review of the CT scan, the ENT ordered a biopsy of the node. One study found up to 1 in 3 people experienced lymph-node swelling after their vaccine. They can last for a couple of weeks. Cancer in your lymph nodes may point to lymphoma or another blood cancer, or may be a cancer that has spread from another site. a speedy recovery. Lymph nodes and cancer. Please include the articles headline. Scientists believe this may be because the vaccine evokes a strong immune response from your body. If an infection causes swollen lymph nodes, treatment depends on the cause. GoodRx is not offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Contacting a doctor. By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx. The mediastinum of your body is a space that keeps your lungs and other chest structures (e.g., heart, esophagus, windpipe) separate. You may have a more serious condition that needs proper diagnosis and treatment. Based on the source of the cancer cells and how far away that is from the swollen nodes, your doctor will recommend a treatment plan. Take an over-the-counter pain reliever. WHAT WE ACTUALLY FOUNWAD S THAT FOR SOME PATIENTS THEY PERSISTED IN BEING ENLARGED BONEYD THE THREE-MONTH MARK. If your doctor thinks your swollen lymph nodes could be cancer, tests and imaging can confirm the diagnosis or point to something else. When I informed the doctor the antibiotic had no effect, he ordered a CT scan and referred me to an ENT. So experts made recommendations to address this issue. The study showed that . When your body is fighting off an infection, you may get swollen lymph nodestechnically called lymphadenopathyin that part of your body, Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo, told Health. A LARGE LIVE KNOWNS AFTER GETTING THE VACCINE IS A NORMAL AND NOT UNEXPECDTE IMMUNE RESPONSE, BUT NOW IN SOME CASES, CTDOSOR DOING ULTRASOUNDS ARE SEEING THE LARGER LYMPH NODES PERSIST FOR MONTHS LONGER THAN INITLLIAY PREDICTED. They faced large medical bills and dealt with emotional stress and anxiety. Lymph nodes are checkpoints for infection. Swollen nodes that are close to your collarbone or the lower part of your neck when you're over 40 are more likely to be cancer. Australia may need to move 'quickly' on teen booster shots, but older groups remain the priority, Four numbers give us clues about when Australia's COVID wave may peak, Timely reminder: How to respond if you test positive to COVID-19. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. ", American Cancer Society: "Lymph Nodes and Cancer. These are wide-ranging and may include: These conditions will require more aggressive treatments over a longer period of time. Interested in more discussions like this? (2017). Now, youll enjoy a streamlined experience created specifically for healthcare providers. Complete your request online or contact us by phone. COVID illness can lead to lymph-node swelling, especially swollen neck lymph nodes. Here are some tips from the guidelines: If you need a mammogram or any other imaging studies of your head and neck, get it done before your COVID vaccine. You may have swollen lymph nodes under your jaw and in your groin too. Despite getting mRNA vaccines for his first two doses, this was the first time he'd experienced painful lymph nodes. It's possible to experience swollen glands as part of COVID-19and there has been research to back up this connection. Depending on the amount of swelling, some people may notice their lymph nodes are larger, and these lymph . The swelling in these pea- or bean-sized lymph nodes are one of your bodys natural reactions to illness or infection. You also have lymph nodes throughout your body that you cant feel. If theyre enlarged with no obvious cause, see your healthcare provider to rule out something more serious. When lymph nodes detect a virus or bacteria, they start pumping out white blood cells to fight off infection. Merck Manual Professional Version. We acknowledge Aboriginal and Torres Strait Islander peoples as the First Australians and Traditional Custodians of the lands where we live, learn, and work. And those swollen lymph nodes. Realizing this is an older post but Im also looking for info on post-Covid lymph node issues. Association of mediastinal lymphadenopathy with COVID-19 prognosis. There are memory cells that, when confronted with a particular pathogenmonths or even decades down the track, can mount an immune response. If you can't come up with an explanation, it may be time to get checked out. National cabinet encourages wearing masks to combat COVID-19. Swollen lymph nodes are a common and harmless reaction to many vaccines, including vaccination for COVID-19. And most of the time, you have a virus so theres no treatment truly needed and it will just run its course. A scan called FDG-PET, which stands for fluorodeoxyglucose with positron emission tomography, can help find lymphoma and other cancers. Go to the Ear, Nose & Throat (ENT) Support Group. And the swelling should go away within a couple of weeks. "In general, most GPswill be reassuring you if you've just had a vaccination, and we'd give you up to a month to let it go down.". Click or tap here to report it. I'm not going to do this at this point. Kelly Clarkson's Home Collection Is Up to 74% Off During Way Day Deals, The Best Wayfair Way Day Deals 2023 Starting at $30, Wayfair's Way Day Sale Includes Up to 60% Off Outdoor Furniture Here's What to Shop ASAP, Amazon Has So Many Good Mother's Day Gifts on Sale Right Now. Papadakis MA, et al., eds. Your healthcare provider may examine your swollen lymph nodes to determine whats causing the swelling. They'll take either a sample of cells from a node, typically using a needle, or remove a whole node. The swelling tends to reduce over time. When aCOVID vaccine is injected into your arm muscle, your body starts building SARS-CoV-2 virus spike proteins. Those bumps on your neck are swollen lymph nodes. This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. There has been a lot of research about swollen lymph nodes in the mediastinum(aka, mediastinal lymph nodes). Other symptoms are also a reason to make an appointment: Your doctor will probably try to rule out reasons other than cancer first. You should see your doctor if your lymph nodes appear abnormal.". Don't Delay Your Mammogram After Getting the COVID-19 Vaccine, 16 Surprising Cancer Symptoms Everyone Should Know, What To Do About Swollen Glands in the Neck, 8 Illnesses That Cause Flu-Like Symptoms That Arent the Flu. So why doesa COVID booster generatemore lymph nodeswelling than either of the first two doses? Both are rare causes of swollen lymph nodes. Overall, when it comes to swollen lymph nodesespecially those that have stayed around for a whileDr. Mullen said theyre still learning about who is most affected by enlarged lymph nodes that persist after vaccination and for how long. health information, we will treat all of that information as protected health Anecdotal reports are surfacing that some people are developing tinnitus days after receiving one of the COVID vaccines. If you think you have swollen glands at any time, you'll want to see a healthcare provider as soon as possible. An increasing number of men with prostate cancer are choosing active surveillance over surgery or radiation, a new study shows. Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Motrin) help relieve discomfort and may temporarily bring down swelling. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. That's in contrast to less than one in 100 after their first or second shot. "I could feel real tension in my armpit. "Our immune system has a spectacular number of different subsets [of cells], and they all work together," Dr Groom said. Lymphadenopathy in COVID-19 vaccine recipients: Diagnostic dilemma in oncology patients. "Sometimes with other vaccines, occasionally we will see swollen lymph nodes . But you can develop painful swollen lymph nodes in your armpits too. I have a walnut size swollen thing near Adams apple, two doctors say, there is a syst near by which is filled with fluid, put me on antibiotic and neproxcin , not working and waiting to see ENT.It came on ten days ago. All rights reserved. If these tests don't show another cause and the swollen nodes don't go away in 3-4 weeks, your doctor will probably do a biopsy. If you are having difficulty accessing this website, please call or email us at (855) 268-2822 or ada@goodrx.com so that we can provide you with the services you require through alternative means. Rarely, swollen lymph nodes are caused by cancer. She noted, the swelling is almost always on the same side where they were vaccinated, and typically returns to normal about four weeks later. 6 weeks and decided to see my PC doc. 24/7 Streaming News Chicago Politics Local Impact Grants NASCAR Chicago Chicago Today The Food . (https://www.aafp.org/afp/2016/1201/p896.html), (https://pubmed.ncbi.nlm.nih.gov/30020622/). Common areas where you might notice swollen lymph nodes include your neck, under your chin, in your armpits and in your groin. "It's like many things with COVID: If someone notices swollen glandsregardlessit would be critical to have them assessed to make sure it's not of concern," Dr. Russo said. Other white blood cells stimulated in the presence of spike proteins are "effector" cells. Radiologist discusses persistent enlarged lymph nodes months after COVID-19 vaccinations, Doctor explains it shouldnt cause mammogram, vaccine hesitancy, West Columbia Riverwalk closed due to flooding, Man injured after Saturday morning shooting, Lexington County detectives investigating, Police: Sumter drivers advised to avoid area due to fallen tree. 2022;79:104039. doi:10.1016/j.amsu.2022.104039, Soares L, Rebelo Matos A, Mello Vieira M, Cruz R, Caixas U. Generalized lymphadenopathy as the first manifestation of systemic lupus erythematosus. Even if they remain swollen. KAI: THEY STTAR LEARNING ABOUT WHO IS MOST AFFECTED BY A LARGE LIVE NODES THAT PERSIST AFTER VACCINATION AND FO RHOW LONG. Therefore, breast oncologists will have to consider this side-effect of COVID-19 vaccination when diagnosing breast tumors. https://www.healthline.com/health/swollen-lymph-nodes-under-jaw-covid. While Mr Nevill's lymph nodes didn't swell up, people have reported lumps appearing in their armpit some as big as an orange. These are the most common symptoms of COVID, according to the CDC: Fever or chills Cough Shortness of breath or difficulty breathing Fatigue Muscle. Pancreatic Cancer May be Caused by This Killer Protein, What to Know About Cancer in the Lymph Nodes of Your Neck, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT. The COVID vaccine can cause swollen neck lymph nodes. What are some ways to try to minimize neuropathy during chemo? Is a High MCV (Mean Corpuscular Volume) an Indicator of Cancer? This is known as generalized lymphadenopathy, which can happen with inflammatory or infectious diseases. You may be able to move them slightly with your fingers. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. There are more than 600 small, kidney bean-shaped lymph nodes in clusters throughout your body -- under your neck, in your armpits and groin, and in the middle of your chest and belly. Typically, lymph nodes stay swollen for about 2 weeks or so. It could be something like chickenpox, HIV, or a cancer such as leukemia or lymphoma. Your lymphatic system is a network of organs, vessels and lymph nodes situated throughout your body. You may be wondering if COVID-19a SARS-CoV-2 infectionmight cause swollen glands like other infections (e.g., colds, the flu, and even ear infections) do. doi:10.7759/cureus.30089. swollen ankles and feet dry and itchy skin weight loss or poor appetite Diabetes extreme thirst without reason numbness or tingling in your hands or feet intense hunger continued fatigue frequent. The TGAsafety report statesswollen or sore lymph nodes is a normal and known side effect of vaccines, and that it's a sign your immune system is being stimulated. Swollen Lymph Nodes in Other Areas or Multiple Areas at Once. They typically occur under the arm where the shot was given. I had the biopsy, and they found no cancer, thankfully. DR. MULNLI EMPHASIZES THAT SHOULDOT N STOP PEOPLE FROM GETTING THEIR REGARUL MAMMOGRAM SCREENINGS BUT IT IS IMPORTANT TO BE AWE,AR ESPECIALLY AS MORE PEOPLE ARE GETTING THEIR BOOSTERS. Other less common causes of swollen lymph nodes include injury, AIDS and cancer thats spread from the lymph nodes to another part of your body. But it may take a few weeks longer to go away completely. Lymph-node swelling after COVID vaccination is fairly common. The Society of Breast Imaging reported that 11.6% of patients who received the Moderna COVID-19 vaccine had swollen lymph nodes after the first dose, and 16% after the second dose. COVID-19 Disclaimer:The information in this story is accurate as of press time. information is beneficial, we may combine your email and website usage information with "If you're really worried, you can seek treatment," Dr Price said. Matting (whether they feel joined or move together). However, the authors of those studies noted that the swollen lymph nodes appeared in seriously ill patients with COVID-19. In rare situations, swollen lymph nodes can point to cancer specifically, lymphoma (cancer of the lymphatic system). You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Lymph nodes are oval-shaped structures located throughout the body. 6 weeks and decided to see my", "Thank you. See additional information. Theyll evaluate your swollen lymph nodes for: The most common cause of lymph node swelling in your neck is an upper respiratory infection. "What we noticed is that lymph nodes actually were enlarged for a longer period of time," said Dr. Lisa Mullen, a radiologist at Johns Hopkins Medicine. American Cancer Society. But more often than not, minor infection or illness is the cause. The lymph nodes in your neck and other parts of your body can be swollen for years, but not be a sign of cancer. So, a person can have swollen glands (swollen lymph nodes) if they have COVID-19, based on research.. Mullen said it also could be a good idea to wait a couple of weeks between flu vaccine and booster. And other people found themselves with the opposite problem. 2022;37(22):e78. An abscess may require drainage and antibiotic treatment. That may not necessarily be the case. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. What Is Croup and Its Link to COVID-19 in Children? She referred me to ENT who Another study, published in June 2022, also described mediastinal lymphadenopathy as a "serious complication" in people with COVID-19. Case Presentation Case 1 A 47-year-old woman, generally in good health, presented to the Hematologic Clinic with a new non-painful left infraclavicular lump to rule out lymphoproliferative disease. More research is needed to, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Lymph nodes are small, round or bean-shaped clusters of cells. Request an appointment at MD Anderson online or by calling 1-877-632-6789. Now people can know when to get help, and providers can know when its safe to take a wait-and-see approach. It's wise to get yourself checked out if you think your lymph nodes are enlarged. When several areas of lymph nodes are swollen, that suggests the problem is throughout your body. In fact, research shows that when swollen lymph nodes are biopsied for cancer, they rarely turn out to be malignant (cancerous). Read ourfull coverage of the coronavirus pandemic. and i had one swell before i even started treatment. She visited 6 months before having her COVID-19 vaccination, and 7 days and 6 months after the first COVID-19 vaccination. Accessed Sept. 3, 2019. Since the swelling will often go away or another cause will be found while you're waiting to do a biopsy, the delay prevents people from getting procedures they don't need. You'll often have a good idea why a lymph node is swollen -- you've got a cold, your tooth is infected, or you have a cut that isn't healing well. The skin over them should not be red, irritated, or warm. Other infections and cancer also cause swollen lymph nodes. If you've notyet had your booster, there is one thing that may lower your chance of swelling once you do get that shot. Common areas where you might notice swollen lymph nodes include your neck, under your chin, in your armpits and in your groin. Here's what they think of a Voice to Parliament, Soccer spectator accused of punching out teeth of referee in 'outrageous attack' refused bail, MasterChef judge Jock Zonfrillo remembered for 'wicked sense of humour' as it happened, US authorities scramble to rescue First Republic Bank before markets open, Musician Broderick Smith dies peacefully at home, aged 75, after career spanning decades, A short history of the lowest-scoring matches in rugby league history. In February 2022, Radiology published the results of the largest study to date evaluating swollen lymph nodes after COVID-19 vaccination among patients receiving mammograms. WebMD does not provide medical advice, diagnosis or treatment. When I informed the doctor the antibiotic had no effect, he ordered a CT scan and referred me to an ENT. So which ones are best? When should you get a booster or vaccine? (2022). You may opt-out of email communications at any time by clicking on Swelling usually signals an infection of some kind, but it could also be from a condition like rheumatoid arthritis or . If you have a swollen lymph node on your neck or elsewhere for long periods of time, your first thought may be that you have cancer because swollen lymph nodes are sometimes linked with cancer. "What we noticed is that lymph nodes actually were enlarged for a longer period of time," said Dr. Lisa Mullen, a radiologist at Johns Hopkins Medicine. privacy practices. Apply a warm, wet compress, such as a washcloth dipped in hot water and wrung out, to the affected area. Lymphadenopathy. But if a swollen lymph node keeps getting bigger or doesn't resolve on its own within two weeks, get it checked out. Youll need further tests, like blood work, imaging scans or a biopsy. Atypical otolaryngologic manifestations of COVID-19: A review, Association of mediastinal lymphadenopathy with COVID-19 prognosis, Mediastinal lymphadenopathy in patients with severe COVID-19, Impact of mediastinal lymphadenopathy on the severity of COVID-19 pneumonia: a nationwide multicenter cohort study, Mediastinal lymphadenopathy: A serious complication in COVID-19 patients, Generalized lymphadenopathy as the first manifestation of systemic lupus erythematosus, Shortness of breath or difficulty breathing. If swollen lymph nodes are only found in one area of your body, its called localized swollen lymph nodes. McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. COLUMBIA, S.C. (WIS) - There is new insight on the COVID-19 vaccine and how it can impact your body. ", JAMA Oncology: "Lymph Nodes and Lymphadenopathy in Cancer. Many lymph nodes are located in your head and neck region. While its not always possible to determine the main reason, your lymph nodes can swell for various reasons. If your autoimmune condition is causing the symptoms, you may consider speaking to a physician about whether you need to change anything about your care plan, including medications. Swelling that may be the size of a pea or kidney bean, or even larger in the lymph nodes, Runny nose, sore throat, fever and other indications of an upper respiratory infection, General swelling of lymph nodes throughout your body. The swollen lymph node is only on the left side. Cleveland Clinic Community Care puts patients first by offering comprehensive, coordinated, personalized healthcare. Lymph nodes tend to become swollen in response to an infection, or other health condition. For example, two 2020 studies found that patients ended up with swollen lymph nodes in the mediastinum area. They contain lymphocytes (known as white blood cells) that help your body fight off infections and diseases. Last medically reviewed on April 3, 2023. Can COVID-19 Cause Swollen Lymph Nodes in the Neck? GoodRx provides no warranty for any information. Third day post chemo and terrible taste in my mouth. Since the COVID-19 vaccine rollout began, there has been knowledge of one possible side effect: enlarged lymph nodes and they might show up on a mammogram or ultrasound, but now doctors are noticing even more. So can other vaccines like HPV and influenza vaccines. Learn, A high MCV means your red blood cells are larger than normal. And you'll probably get a biopsy. This has been a problem throughout the pandemic. The Lancet Infectious Diseases. Welcome @subvet. All Rights Reserved. Learn what they looks like and when to see a. Often, swollen lymph nodes will be close to where the problem is. The studies above focused on swollen lymph nodes in the neck and surrounding the lungs. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.cancer.org/cancer/cancer-basics/lymph-nodes-and-cancer.html). Symptoms of COVID-19. Your lymph nodes, also called lymph glands, play a vital role in your body's ability to fight off infections. Swelling starts 2 to 4 days after vaccination and can last for several weeks. Most of the conditions that cause swollen lymph nodes, like common viral infections, arent serious. WE'V KNOWN SINCE THE COVID-19 VACCINEOLL RUT O BEGAN THAT ONE POSSIBLE SIDE EFFECT IS ENLARGED LYMPH NODES. I assume the white cells are still fighting the virus. Swollen lymph nodes usually just mean your body is working the way it's supposed to. If you have a history of cancer on one side of the body, be sure to get your COVID vaccine on the opposite side. DR. MULLINS SAYS IT IS A GOOD IDEA TO WAIT A COUPLE WEEKS BETWEEN THE FLU VACCINE AND THE BOOSTE. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our. Although swollen lymph nodes are sometimes linked to cancer, more often than not they are benign (not cancerous) and occur as the result of an illness or other health condition. Treatment for your swollen, noncancerous lymph nodes will depend on the cause. Dr. Dean said a small number of patients have reported swollen lymph nodes under the arm two-to-four days after vaccination, on average. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using theCDC,WHO, and their local public health department as resources. Mullen said they're still learning about who is most affected by enlarged lymph nodes that persist after vaccination and for how long. Swelling starts 2 to 4 days after vaccination and can last for several weeks. What we noticed is that lymph nodes actually were enlarged for a longer period of time, said Dr. Lisa Mullen, a radiologist at Johns Hopkins Medicine. 1998-2023 Mayo Foundation for Medical Education and Research. My lymph nodes werequite sore," Mr Nevill, from Melbourne, says. Notice a spelling or grammar error in this article? Other possible causes of swollen lymph nodes include: Other possible but rare causes include certain medications, such as the anti-seizure medication phenytoin (Dilantin) and preventive medications for malaria. 0 comments. Lymph nodes or lymph glands are (usually) small bean-shaped lumps of tissue found throughout your body and connectedin a network by lymph vessels. The site of the swollen lymph nodes may help identify the underlying cause. COVID-19 illness may cause swollen lymph nodes in the neck. I had the biopsy, and they found no cancer, thankfully.". Typically, it occurs in the neck or armpit region. They will go away on their own and rarely lead to any complications like infection. Infections that cause swollen lymph nodes include viral, bacterial, and fungal infections. When those effector cells encounter the booster-induced spike proteins, they spring into action, doing what they would do if confronted with the real virus: making more of themselves, churning outantibodies andclearing away the spike protein. There's no way to tell who will get painful lymph nodes in the days after their booster. Russo said, "it needs to be assessed to see what's going on.". The mRNA vaccines (Pfizer/BioNTech and the Moderna vaccines) are more likely to cause swollen lymph nodes, especially in the neck and armpit. We may be calling them back in to look at those and that may initiate that follow-up pathway, but even though that seems alarming, it really is not related to breast cancer and we just want to be as cautious as we can be, Mullen said. Both COVID illness and the COVID vaccine can lead to lymph-node swelling, especially in the neck. Swollen or painful lymph nodes are the most commonly reported adverse event following a COVID booster It's a normal response caused by immune cells that are activated by the vaccine Swollen lymph nodes may look pretty confronting, but most tend to subside within a week or two "I could feel real tension in my armpit.

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