All about ureteral stents

What is a stent?

Ureteral stents are soft, hollow, plastic tubes placed temporarily into the ureter to allow drainage around a stone or to speed healing after a stone surgery

Photograph of a ureteral stent
Photo of a ureteral stent next to a pen.

When are they needed?

Stents are used for various reasons in patients with kidney stones. They may be placed in patients to help reduce pain from a stone, when infection is present to allow drainage, or when a stone is preventing a kidney from working adequately. Stents are also commonly placed after surgeries for stones, as in ureteroscopy, to allow healing and prevent swelling of the ureter.

Illustration of a ureteral stent.

How is a stent placed?

Stents are placed during surgery by sliding them over a soft “guidewire” which is placed up the ureter, which is the tube draining the kidney. See a video below of a stent being placed.

How is a stent removed?

Stents can be removed in two different ways. Sometimes, a string is left attached to the end of the stent. This string is allowed to come out of the patient’s urethra, the tube where he or she urinates. The string can be used to pull on the stent and remove it. In cases where a string is not left attached, a small camera called a cystoscope is inserted into the patient’s urethra after numbing medication has usually been administered. The cystoscope is then advanced into the bladder and the stent is grasped with an instrument and removed. See our post on stent removal for a video and more details.

How long can a stent stay in?

In general, most stents should only remain in for no longer than 3 or so months. If a stent is left in too long, it can form stones directly on it, making removal difficult.

What are the symptoms of having a stent?

While some patients with stents have minimal discomfort related to them, other patients will report symptoms that can range from being annoying to being severe enough that the stent has to be removed. These symptoms can include:

  • Sensation of needing to urinate
  • Seeing blood in the urine
  • Bladder spasms
  • Burning sensation during urination
  • Pain in the back during urination or when moving
  • Pain in the bladder

Is there anything that can help reduce the discomfort of a stent?

Different medications may be given to help reduce the discomfort of a stent. The most effective appears to be those from the alpha blocker class of medications including tamsulosin (Flomax) and Alfuzosin (Uroxatral). Other types of medications commonly given for stent discomfort, such as oxybutynin (Ditropan) or phenazopyridine (Pyridium), do not appear to be successful at reducing stent related discomfort in placebo controlled studies.ย  Traditional pain medications are also less successful at reducing stent discomfort.

Hasn’t anyone come up with a better stent?

Research into improving stent designs will hopefully reduce the discomfort associated with them. Innovative stent designs currently being tested include stents embedded with medications to reduce discomfort and stents that dissolve by themselves.

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Jennifer saccenti

First off I am a 69 yr old female who is paralyzed on the left side from a stroke six years ago. I had pain n my stomach – nothing bad, fever and chills. My fingers were turning blue. My husband called 911. Fast forward Ct scan showed a large infected stone on my left kidney. Dr inserted a stent, no biggie. No pain, no blood just a slight discomfort in my stomach areAonce in awhile. Going for a follow up visit to the dr. Next week. In my life it seems the fun never ends. But I’m happy I wake up everyday to a supportive husband and family. Being paralyzed is worse than an infected kidney stone ๐Ÿ™€

Sara

God Bless you โค๏ธ

Terri Stiles

I’m so glad I looked this situation up. I had a scope last TH on my left side and a stent placed. I am feeling awful!! I have pain in my abdomen, back, and legs. I have serious bloating and nausea. I know it serves a purpose but this is awful. It’s all I can think about. I tried going to work yesterday. I work with elementary kiddos as a speech therapist with some challenging kids. I could not focus at all. I have called my doctor and he/they are not very concerned with how I feel. Supposed to get it out Monday which would be 12 days later. All I can do is take medicine and lay around. I was not warned about any of this at all. I sympathize with all of you! Take care~ Terri

Amy

Terri I just had mine place last Sunday. I have had the same trouble. I am so sorry you are going through this as well. Something that has REALLY helped me though is lemon essential oil in water and ensuring I am drinking a gallon of water a day. The back pain has decreased significantly. Hang in there. ๐Ÿ™‚

Tammy

Terri- I’m right there with you, it’s rediculous,my back is killing me! Mine was put in November 7th I have to wait until the 17th to get it removed

Teresa

Iโ€™ve had 2 stents pit on since August. They are a pain in my side!! I havenโ€™t been able to work because I had infection, pain, frequent urination, bleeding. Nothing about having a stent is comfortable. They need to figure out a better way. Finally will be having surgery to remove my stone because the stent hasnโ€™t helped. Frustrated is beyond an understatement. I canโ€™t go out since I need to be close to a toilet at all times. Good luck to anyone who needs it!

AJ and BH

ATTN: those suffering with severe pain and prolonged bleeding post STENT REMOVAL

Hey guys,

After going through some crazy things with my husband and his kidney stones, I thought I would post some further information.

So, my husband had been struggling for about a year with chronic pain. We have seen, in the toilet, he has peed out two very large stones; the largest one being just barely smaller than a tic tac. However, over the year some weeks he would be symptomatic, then he would be okay for a couple months, and then the symptoms would come back often just trying to pass the stones at home. One urologist said he wouldn’t do any interventions unless there was a blockage, but we finally got to a point where he was missing too much work and we had to do something, so we went for a second opinion after asking around for a while. FYI we work in a hospital and we are very well versed with medicine, so this helps a lot. I will also add that we are not impressed at all with the healthcare available here in central FL, north of Orlando.

So, our second opinion doctor explained that he would go up with the scope, laser the stone, and if he needed a uretal stent, he would place that as well, but he could not guarantee relief from pain since on the CT (cat scan) the stone wasn’t blocking anything, although it did show a large stone (12-15mm) in the left kidney (the symptomatic side) Well, my husband went to the OR and had the stone blasted and a stent placed. The doctor told us he wanted the stent out within a week, and he also explained that he gathered my husbands on-off symptoms were due to the stone attempting to leave the kidney causing the pain symptoms, then later it would regurgitate back into the kidney relieving symptomsโ€”hence the long-term on and off pain.

Immediately after stent placement, my husbands pain was severe, like a 15 on a scale of 10 in recovery. He also peed out clots and blood for approximately a day and a half. By day 2-3, the pain was around a 5-6 with pain medications, flomax, and over the counter Ura-calmโ€ฆso for him, tolerable.

The time came to remove the stent which was done in office with zero sedation or pain management, only some topical lidocaine. This is when things got terrible. The stent was removed and my husband remained in pain for SEVERAL days. This is when I found this wonderful website!

The first three days were terrible. Although my husbandโ€™s flank pain was essentially gone now, he was continuing to have either bladder or uretal spasms that would debilitate himโ€”pain worse than what we started this whole mess for in the first place. I think the second or third night he had one so bad that really scared me. I want to note that since we work in a hospital and see all of it, we basically do not go to the ER unless we are in fact dyingโ€ฆso we did not go there. We DID take a pain medicine (my husbands last one from stent placement) and more Ura-calm. The spasm lasted appx. 1-2 hours and it was after that we requested some more pain medicine from the urologist, who didnโ€™t really seem to be concerned. Time continued to go by with lots of pain and intermittent spasms, especially after urination. My husband described these spasms as shooting/sharp pain from more of the anterior flank abdomen portion all the way down to his testicle. I also want to note that my husband continued to urinate clots and blood for MORE THAN A WEEK post stent removal. The good thing about that was it was just clots, no active blood; however, it was still concerning and we were fairly certain the clots moving out was what was causing all the residual pain. Weโ€™ve gathered that perhaps he just had a raw spot or nik somewhere in his tract causing all these extra clots, but we knew no matter what there would be no more scopes going up his penis. (lol)

Anyway, with A LOT of rest, and I mean a LOTโ€”no lifting and no strenuous walking or standing for around 10 days, my baby finally started feeling a bit better. After about the first week, the pain and clots started backing off. The stent was removed 10/25 and he started feeling a lot better around 11/5 and this is also probably the first day there was NO blood clots at all. He did have one bad spasm yesterday morning early that lasted about 10-15 minutes, but quickly went away (Praise Jesus!).

Anyway, I just wanted to reach out because I was reading a lot about how bleeding isnโ€™t really normal, and pain isnโ€™t really normal POST stent removal, but my husband really did have a hard time with both those things. I realize some people probably think weโ€™re stupid for not being in the hospital or in the ER, but trust me, those places are no where near what they are cracked up to be, and would have done essentially nothing. In fact, I know what they would have done: Made us wait at least 5-6 hours before any treatment, given him one dose of pain medicine, send him to CT, tell him to follow up, and send us home or try to make him stay because his blood pressure was too high because his pain was too high, and I donโ€™t have patience for them anymore.

I hope this is comforting to some who may be struggling with this similar issue. I will say that it was very important when my husband was feeling under the weather that his movement was greatly restricted. We made sure that he was walking minimally, lifting minimally, and overall taking it VERY easy. And also, of course, as Iโ€™m sure you all know, a TON OF WATER. During this entire time my husband urinated nearly a gallon of urine a day.

Anyway, good luck guys! And this has made me realize what a terrible condition this is and I pray for all people suffering from these dreadful stones!

Thank you AJ and BH.
What a wonderful amount of information you have written and I can relate to it all. I have had an infected left kidney and they put a sten around the stone in it. I have had all the pain that goes with it and it is to be removed on Dec 4 under anesthesia.
After I got home from hospital, I was back in 2 days later with pancreatitis, and I am wondering if that was caused by the kidney problems as I don’t drink. I am so sick of it all as my own GP didn’t believe me that there was anything wrong with me and I wasn’t diagnosed until went to another doctor….

Susan M

Hi all,
I’m due for surgery on the 30th to remove one lousy stone that is causing a blockage so my right kidney is swollen. To say I’m scared is an understatement…the constant pain I’m reading about, time off from work. Does anyone here have a small child? I’m worried now I won’t be able to take care of her due to this pin that is upcoming. I

Mike C.

I had surgery this past Wed. I worried way too much compared to the actual process and the unknown. The pain that you feel when you get home and have to go to the bathroom is not fun. Stinging and burning feeling. But bearable. Today I’m removing the stent myself. I hope it goes well. Ready for the last 37 days to be behind me.

pauline

Hi susan,i have the same problem i am due to have a uretreaoscopy soon,i was terrified and i kept cancelling the procedure ,i then developed stone disease which caused me alot of pain and a temperature of 139 over five days,,i spent ten days in hospital and it made me realise how competant the health service is ,they do these operations all the time ,i was realy impressed with the care i got ,they practically saved my life,i have had some discomfort since i had the stent put in,but nothing major ,i have had to choose my priorities carefully when it comes to housework and such because i have been getting quite tired ,but i have been getting over a severe infection,dont be scared the procedure is pretty straight forward and alot safer than just letting it fester,hope this helps,lots of love and best wishes Xx

Jesicka

This fucking sucks the ER docter didnt tell or explain that he was
Even going to put a stent in my body or i would have not agreed to it.
This fucking sucks its irritating and i hate it.
Ps. I can also feel it this is my first.

Glynn

I feel better now that I am reading the experiences of others. I had my stent inserted 3 days ago and it has been agonizing each time I urinate. The pain goes down my leg and under my abdomen, pelvic area and testes. It is paralyzing at its worst. On a scale of 1 to 10, it is 10, being the most painful. My urine is bloody also. I spoke to my Doctor today and he told me what I am experiencing was normal. There is still a fairly large over 7mm stone which we are going to remove soon but for now, the stent has to remain to protect the kidney from distress. Let us hope medical science find a better less painful stent alternative soon.

crista

I had woke up one morning back in June went to the restroom and blood was flowing from me like a period. I rushed to the emergency room. They sent me back home said it was a bladder infection about 3 weeks later it happened again and I rushed to the hospital. They finally ran a CT scan and said I had kidney stones. After that I was sent to a Urologist he did a CT with contrast and found one stone left that would not pass it was 4mm, he was going to do the shockwave surgery but because of my size, he went with the laser and stent. I just had it done today and I am back at home. I was expecting it to be way more painful but the only thing is it is nagging pain and makes me feel like I need to pee all the time and when I do pee lots of blood and a few clots. I am supposed to have this thing in me for a month. I am hoping it does not get worst.I have never had an issue with my kidneys before and am afraid that these stones will come back.

Debbie

This is my 2nd stent. My 1st one was very painful. Couldn’t stand up straight, pain in both legs,pain in back. It was horrible. Went to Drs office to have it removed and he had one of his girls do it. It took 3 tries and I told the Dr. you do it or I will sue you. Never went back. New Dr is great. This one no pain.

Glenn

Hi all,

I just turned 25 years old, and I have had 4 kidney stones already (3 of them this year, each passing within just a few months of each other), but rather small ones varying from 1 mm to 5 mm. In case of the last three I had “minor problems” (still the worst pain I ever felt, hence the ” “) with them passing, just one or two days of heavy pain and then I peed them out and I almost didn’t feel them coming out because they were largely disintegrated.

However, I’ve experienced discomfort and sometimes pain for the last 3 weeks passing the latest one, which is the biggest being 5 mm. As it didn’t want to come out, my urologist suggested a surgery to remove it. After accepting reluctantly, it occured today. Turns out to have been the biggest mistake of my young life.

The stone was stuck just above my bladder according to the scan I took a few days ago. Between the scan and the surgery, I had my first two “real” days of the pain you are all familiar with, and wouldn’t wish on even your worst enemy (or maybe you do). But right after surgery, the surgeon told me he found NO stone. It just *POOF* vanished. Or it disintegrated again, or it got pushed back into my kidney (which he thought very unlikely as it was already stuck right above my bladder). Anyway, he went all the way up to my kidney to check, found nothing and so he placed a stent. And I regret it wholehartedly.

I hate myself for listening to my parents persuading me to do the surgery as I was afraid I would have more pain by doing the surgery than letting the stone pass on itself, even if it took 3 weeks already as most of the time I had no pain. Now, I pee pure blood and sharp needles. Right now, I don’t feel huge discomfort in my abdomen, but I believe that will change. And oh boy, I can stand there and watch while they remove it next week. One full week of agony awaits.

So, was this a mistake or a necessary evil? Because I hate myself for it as I still don’t know what happened to the stone itself. My respect and sympathies to all of you.

I have had stones for many years and was able to tolerate the issue,either by passing them or last resort the shock wave treatment. I need to have a large stone removed by lithotripsy. I can handle this as I had done before without any issues afterward. But a stent procedure while I am having this done scares me as I have heard many negative results with this stent inserted. Do I have to have this done?

JB

I was stented 3 weeks ago unfortunately have stones in both uretha so two stents, got the sensation to want to pee almost constantly when i do pee it burns like a bitch unless i drink pints of water and get a decent flow, but when i go and very little to pee it really does burn, still get blood when i do any physical work and have had the odd accident when not near enough to a toilet..I haven’t slept for more than 1 hour at a time for the past 3 weeks..had a ct scan to see if the stones have passed but fear they probably haven’t moved anywhen due to the stents holding them fast against the uretha wall (can’t really understand why they couldnt remove the stones when inserting the stents they have to go past the stone to stent you???? it all means another anesthetic more hospital bed time etc etc when I feel they could sort it all in one go right from the start….

BBrian Hatley

I got my first stent in 2004, after lithotripsy (12mm Stone). It was the absolute worst pain I have ever experienced in my life! I swore at that time Iโ€™d never have another. Iโ€™ve had 2 stones since then that they wanted me to have another stent put in and I refused, but this year I had a 20 mm stone in my urethra immediately after having a heart attack. Because of the blood thinners they had me on, it was going to be 6 weeks before they could bust it up with a laser, and get all of the fragments out. So, I agreed to have a stent put in while I was waiting to get the stone out. This stent, although extremely painful,was not as painful as my first one. About a week before the surgery was scheduled, the pain level rose great. When they were doing the surgery, they removed it, and it was covered in several new small stones. I ended up going through 3 stents over 4 months.
What I took out of this was, the second stent of my life was less painful than the first, and it is very worth it to save your kidney, even if you have it continuously for 4 months or longer.

C b chevy

I just had my surgery and had stone removed and stent put in. I tell ya itโ€™s the worst feeling in the world. Specially when itโ€™s your first ever surgery! Is there any pointers you guys have for comfort?

Elizabeth Bamford

I just had a 5 mm stone removed with a stint inserted afterwards for drainage.
I’m not going to sugarcoat coat how uncomfortable it is after surgery. You’ll have the constant feeling of having to urinate and burning. They actually gave me morphine and it didn’t touch the pain. Then I thought of AZO it’s an over the counter bladder infection medication. It has been a lifesaver no more burning or discomfort and as for the actual stint area pain they sent me home with Toridol and I have Norco 10/320. So between the AZO and the pain meds with rest and LOTS of fluids I’ve been comfortable. Now my concern is taking the stint out. Good luck and hope you have a speedy recovery.

Ebamford43

IF ALL OF YOU WOULD GET INTO NATURAL HEALTH AND HERBAL REMEDIES YOU COULD BENEFIT FROM NEVER HAVING TO GO THROUGH THIS OR THE PAIN…..IT DOES WORK AND I HAD MANY MAJOR SURGERIES IN THE PAST THAT BROUGHT ON MORE PROBLEMS AND SURGERY, BUT AFTER GOING TO MORE NATURAL HERBS AND MINIREALS I’VE HELPED MYSELF AND HAVEN’T HAD MAJOR PROBLEMS IN YEARS.

GOD BLESS YOU ALL, BUT I SURE WISH YOU’D GIVE GODS’ NATURAL MEDS A TRY….BLESSINGS & PEACE…

Cliff

Can your u elaborate on the natural meds?

Elle

Herbal remedies are what caused my stones. I still will always chose the natural route, but when taking herbal supplements we have to be very aware and respectful of how powerful they are. Just because something is natural does not mean they are weak or should be taken without Dr consult and significant research. Stones form for a variety of reasons and a healthy diet and “natural” remedies do not prevent you from stones in anyway. In fact, many healthy foods are so incredibly high in oxalate that you need to monitor and count out your portions very carefully. I will have a second surgery tomorrow to attempt to remove a 5mm stone and a stent will be placed. My first experience with a stent and I am terrified to say the least. I have a feeling my natural pain remedies will not be very effective this week, but hoping for the best.

Penny Oneill

Whar herbs menerals help thank blessings
U

Kay

Thanks for all the posts on here. Had my stent placed 5 days ago and really went into it blind. I was thinking that once the blockage was taken care of I would feel great! Still having discomfort and the only thing that really sounds good is a nap. Two more weeks of this? Ugh! Glad to know I’m not alone..

Robyn

I had my stones lasered 6 weeks ago. I had the stent out today – I’ve had nothing but pain and discomfort since it was inserted. I thought it was supposed to allow the stones to pass more easily. Since I had it out about 6 hours ago I have passed 10 quite large chunks of stone – I hadn’t noticed any pieces since I had the stent in. Has anyone else had this? I’m scared there might be chunks left that will give me pain as they pass. SO fas, no pain with the ones I’ve passed today.

Kimberly

I have had many stents put in But I don’t think I have ever had this much pain from one, Funny thing is it don’t hurts any where but my sternum, My a stomach is bloated and I feel horrible, I have had 17 surgeries not counting all the stones and stents, I have never felt this bad, I am so tired and sore, Almost feel like I should go have it checked to make sure everything is ok!!

Lulu

Hello All,

Just had my first surgical intervention with a stone (a little over 7mm) by a laser lithotripsy. Had the stent inserted on Thursday. I see so many different scenarios regarding how long the stent must remain. What normally determines the amount of time? The discomfort it causes is unbearable, I have the string at the end of mine and Iโ€™m ready to remove myself but figured that wouldnโ€™t be wise LOL. Iโ€™m hoping I only have to do 5-7 days. Well wishes to all and looking forward to your responses!

Bruno

I had laser lithotripsy on 10/10 to remove a 6mm. stone. Surgery went fine and Dr. inserted stent during surgery. I went home later that day. The stent was removed yesterday a week after surgery. I experienced two very painful spasms after the stent was removed. My wife called the Dr. to tell him about the pain I was having and he said it was normal to have pain but it would stop eventually and it did.Each spasm lasted about 30-45 minutes. It’s been almost 24 hrs. since last spasm and I am feeling no pain at all.

Chasity Bourda

I think stent’s are very uncomfortable

Jessica

I just got a stint in yesterday and I feel like I have to pee all the time and it’s a little sore down there but nothing like the pain I went to the ER.

Andrew

I just had a stent put in and not getting it removed for 7 days I’m in bad shape tight now

Kim

My husband just had one put in, we are day 4 post op…andhe is still in bed, on pain killers and passing a lot of blood. It is in for 2 weeks. It’s worse than we were expecting for sure!!

Julie Baptist

The best thing he could do is try and get up and move around if it is only for a few minutes. Best of luck to him.

Joel Paul

Having a stent can be quite agonising at first, however you will slowly get used to it as I did. Let me share my experience, after the surgery, it felt like crap trying to urinate, I always felt pain at my groin and kidneys right when I was about to empty my bladder while urinating. For the first few days you will feel a stinging sensation when you pee, and not to mention the frequent urgency to pee literally in intervals of twenty minutes.
However these symptoms will gradually subside as your body starts getting used to it, you to will learn how to live with a stent and will get used to it. Give it some days you will feel completely normal with it.
Keep in mind , that it will cause some discomfort when u walk too much , run or jump and don’t be surprised to see blood in your urine. Especially when you are doing some physical activity.
Also lot of water helps, keep your self well Hydrated, it takes away the discomfort of the stent.

Kim

How many days before you found it tolerable? My husband is day 4 post op…and not feeling any better than day 1. Still constant pain, lots of blood in the urine and can’t tolerate movement without it causing pain and more blood passing. Stent is to be in for 2 weeks ๐Ÿ™

Robyn

I’ve just had mine removed after 6 weeks – had pain and discomfort the whole time.

Peter

Had bilateral stents put in six weeks ago. Still have to laser the right kidney stone. Have had two lots of infection and pain all the time. Cannot sleep due to pain and passing blood most of the time.
Stents are a bitch.๐Ÿ˜‚

Melissa Gaydos

I believe I have the new Cadillac Model that desolves, but I will have to double check on that. 4:17am bladder spasms-shoke pain-body shakes-stomach heaves-puking.I guess It has been a day and a half, after pondering. How dose anyone get through this alone? Is the worst part over? I think I’m in for a fun 50th Birthday, exitting!

Brenda Baxter

What if I have a stone 11mm in size in the left kidney I have pain off and on mostly off but there is no obstruction I also have several stones in the right ureter that has been there 6 months or more and have not passed what should be done and should I be concerned

Julie Baptist

You should have them removed. I had no idea I had a stone in either of my kidneys. The stone in my left kidney killed the kidney. I just had the right stone removed. I went into renal failure that’s how I found out about my stones. So do yourself a favor and have them removed. Good luck to you.

Renee Blanchard

GET IT OUT! Just had a 5mm removed. Cystoscopy & ureteral stent in place. From the time I went to ER in pain & learned of the stone, I waited 2 months to go to the urologist who did the procedure. He said what he found when he went in was a 15mm mass of stone & infection that could have ruptured some wall, I forget, but it woulda been really bad. Only 2 months to go 5 to 15mm. Day 3 & totally uncomfortable.

Erin

I just had surgery to remove a 7mm stone today. This is my first ever stone (and hopefully my last because WOW that was the worst pain I’ve ever been in). They put a stent in and it will be removed in 3 days. I am bleeding like crazy and the pain is pretty bad, not close to the stone pain but still VERY uncomfortable. Every time I pee it burns, towards the end of uriniating it feels like I’m releasing an air bubble which sends horrible pain in my right side and my back on the right side. Is this going to last all 3 days? I’m not sure I can handle it on top of feeling like I need to pee every 5 minutes.

On the bright side my doctor told me he was going to knock me out when he removed it. I can’t believe people do it while you’re awake! That seems like torture.

Melissa Gaydos

Hope your feeling much better, young lady!! Im right behind you, get well!!????

L J

You can also remove your own ๐Ÿ™‚ I just did that yesterday. Doc gave me the option after surgery – wait a week and either come back to the office for removal or remove it yourself. She left a string taped down and when the day arrived (thankfully) I pulled the string slowly and out it came. Definitely uncomfortable, really weird, and way longer than I expected. but it’s out!

Monica

How did you feel once it was out? I just had my stones removed today (Tuesday) and they told me to pull the string and remove the stent on Thursday….I know itโ€™s going to hurt like a B when I pull it out but curious how it feels once itโ€™s all said and done ….

YOU SHOULD NOT HAVE PULLED IT OUT!!!!
IF SOMETHING IS WRONG BECAUSE OF THE TUBE OR ERROR ON THE SURGEONS BEHALF, YOU NOW ARE GOING TO MAKE IT NULL AND VOID TO GO AFTER THEM FOR MALPARACTICE OR DEFECT, BUT THE SANITATION OF THE AREA AND HANDLING IS CRITICAL TO YOUR HEALTH.
THE DOCTOR ISN’T RESPONSIBLE NOW AND THEY KNOW IT….

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