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palm tree thorn injury

It can help to wear protective clothing, gloves, etc., as well as being cautious when near or working with thorny plants. Post by country boy » Mon Jan 25, 2010 6:07 pm If it has got Fan like leaves, and Barbs on the leaf stalk near the trunk then it is probably Washingtonia; Phoenix Canariensis has wicked Spikes near … Plant thorn arthritis is a noninfectious inflammation of a joint as a result of a thorn puncturing the joint and leaving residual plant matter lodged within the joint. Talk with your health care provider to find out which treatment options are best for you. Kindly provided by Xiaohui (Sheila) Zhao, MD, PhD, of the Department of Pathology and Laboratory Medicine, University of California, Irvine Medical Center. That's because joint problems near a wound may not develop immediately. MedicineNet.com notes that although puncture wounds usually bleed little, if at all, they become infected easily. The joint loses its full range of motion and is often tender. 1– 9 Shortly after the injury, the boy received antibiotics that temporarily relieved his pain and swelling. Plant thorn arthritis typically affects only a single joint -- the joint that was pierced by the plant thorn. The 2002 article in the British Medical Journal also documented the case of an otherwise healthy 14-year-old boy who developed an arthritis-like injury of the knee from a date palm-thorn puncture. Many species of palm trees bear thorns or spines that are capable of causing injury if you're not careful when handling the plants. Some species of palm trees can be dangerous if you touch them in the wrong spot. Sharp thorns on their branches, trunks and the undersides or tips of fronds can puncture the skin and cause bacterial or fungal infections. If there are flowers on the tree, those will slowly die, eventually browning the oldest leaves. This form of single joint arthritis (monoarthritis) then becomes chronic until appropriately treated. What specialties of doctors treat plant thorn arthritis? This is because the original thorn has actually left behind small fragments of thorn vegetable matter that gradually cause the inflammation of plant thorn arthritis. If you see some black soot, don't bother wiping it off. The two inch monstrosity was thought to have been from a palm tree … For example. One in particular was close to the knuckle on my right index finger. My neighbor says the thorn is poisonous... what should I do? Puncture injuries may look harmless, but bits of thorny debris may lodge inside the wound. Puncture injuries may look harmless, but bits of thorny debris carrying potentially harmful fungi or soil bacteria may lodge inside the wound and cause infection. Some species of palm trees can be dangerous if you touch them in the wrong spot. Pantoea agglomerans was identified in the synovial fluid. The palm frond gave her something called tenosynovitis which is inflammation of the tendon around the nerve sheaf. 1– 9 It has been described following injuries from thorns of several kinds of plants, including palm, yucca, hawthorn, bougainvillea, sentry plant, blackthorn, cactus. Read about Dr. Shiel's diagnosis and treatment of plant thorn arthritis. Thorn prick injury … I had throbbing pain and swelling with stiffness of the joints affected. Although thorn fragments may remain embedded if there's no infection, they're likely to cause recurring discomfort, which means that surgical removal may be a good idea in any case. Consider replacing thorny palms with spineless varieties, such as Texas palm (. The plants that commonly cause plant thorn arthritis are those that produce thorns. assisted them in landscaping one fine weekend day. When a tree is infected with lethal bronzing, the symptoms start slowly. If y… This is true even if the patient recalls removing the thorn, as described above, because the thorn can leave behind tiny fragments of thorn matter that leads to the chronic inflammation of plant thorn arthritis. It won't hurt you. Exposure to these plants is the greatest risk factor for plant thorn arthritis. Synovectomy is the surgical procedure that is used to cure plant thorn arthritis. ", Facts you should know about plant thorn arthritis. However, chronic arthritis eventually develops even long after the plant thorn injury because of the thorn fragments remaining in the joint. Majority of the labor force in UAE are primarily from the Indian subcontinent. Eliminating infection also requires surgical removal of any thorn fragments. Physical therapy rehabilitation exercises can be helpful to restore normal joint function. and rose thorn. The microscopic thorn fragments are easily identified using a polarized light microscope as they appear brilliantly shiny (birefringent) to the examining pathologist. Pathology photo showing multinucleated giant cell granulomatous reaction (triangle point), synovial hyperplasia, fibrosis, and adjacent foreign vegetable matter (arrow with thorn fragments) with hematoxylin and eosin stain (H&E stain). Many species of palm trees bear thorns or spines that are capable of causing injury if you're not careful when handling the plants. Keep children and pets away from spiny palm trees or, while the plants are small, carefully prune off spines that may be within their reach. Gardening: Injury from palm thorn won't heal. With permission, these are intraoperative photos of the author's right third metacarpophalangeal joint exposing inflamed joint lining tissue (synovium) from which a 1 mm thorn tip from the common palm tree, With permission, photos of joint lining tissue (yellowish synovium) resected from author's right third metacarpophalangeal joint after thorn puncture with 1 mm thorn tip (dark dot on thorn covered with joint lining tissue) from the common palm tree. You will note that their introduction page cites a study in Panama from 1943 that says palm frond thorn injuries (palm species not named) are noted for causing infections. A lighter works best, but you can use a match or build a campfire, as well. © Copyright 2020 Hearst Communications, Inc. Most mesquite trees will have thorns which can be very long or short and very sharp. Eight men were treated in a primary care setting. Is it possible to prevent plant thorn arthritis? Pantoea agglomerans as a cause of septic arthritis after palm tree thorn injury; case report and literature review A Kratz , D Greenberg , Y Barki , E Cohen , and M Lifshitz Pediatrics Department D, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel. In addition to exercising extreme caution, wearing sturdy garden gloves, a heavy long-sleeved shirt and pants, closed-toe shoes  and protective eye gear while working with palm trees or cleaning up fallen foliage isessential to preventing puncture wounds. Palm trees can be dangerous if you touch them in the wrong spot. Arthrocentesis, which involves using a needle to withdraw fluid from a swollen joint, eventually led to the identification of Pantoea agglomerans, a common soil bacterium, as the cause of the boy's septic arthritis. This requires cleaning the wound area thoroughly with soap and water and applying antibiotic ointment and a bandage. The second patient was a 58-year-old-man, with a family history of spondylarthritis, who was admitted with a monoarthritis of the left wrist that occurred 10 weeks after palm tree thorn injury. Some flowering trees become messy just before and during flowering. Suggest treatment for thorn injury on palm . If you remove the thorn yourself, fragments may remain under your skin. Sharp thorns on various parts of the trees can puncture the skin and cause bacterial or fungal infections. Date thorn is a modified leaf that ends in a spine of the palm tree, Phoenix anarensis, which is widely cultivated in the Middle-East countries.2 Penetrating injuries of the extremities by date thorn are common in Middle Eastern countries.2Children are exposed to thorn injuries because of … Knuckle on index finger is swollen and red. Sharp thorns on various parts of the trees can puncture the skin and cause bacterial or fungal infections. Clinical outcome was favourable with complete symptoms resolution. Plant thorn arthritis is also called plant thorn synovitis. An ultrasound examination revealed a foreign body in the posterior lateral aspect of the right knee. These forms of arthritis require urgent antibiotic treatment. A 65-year-old man sustained a right eye injury caused by a date palm tree thorn which is embedded in the central region of the cornea (Courtesy of Dr. Saeed Akhter Chohan, FRCS, Fujairah Hospital, Fujairah, United Arab Emirates). Joints that are commonly affected by plant thorn synovitis include the small joints of the hands (metacarpophalangeal joints, proximal interphalangeal joints), feet, elbows, knees, and ankles. We report the case of a 14 year old healthy boy, who was admitted six weeks after being injured by a palm tree thorn, with limping caused by pain and swelling in his right knee. Plant thorn arthritis typically affects only a single joint -- the joint that was pierced by the plant thorn. ... And a shade tree should have branches that are far spreading. Hold the part of the needle or blade that is going to touch the wound over an open flame until the metal reddensfor about a minutethen let it cool before you proceed. We report the case of a 14 year old healthy boy, who was admitted six weeks after being injured by a palm tree thorn, with limping caused by pain and swelling in his right knee. Kindly provided by Xiaohui (Sheila) Zhao, MD, PhD, of Department of Pathology and Laboratory Medicine, University of California, Irvine Medical Center. It feels almost arthritic in it's pain. In England the black thorn (Pnmus spinous), a perennial shrub, is the most common cause of thorn injury (2). An arthroscopy was performed and the thorn removed. You can take a number of steps to help prevent palm-spine injuries: Alicia Rudnicki's Library Mix website blends book buzz for all ages. What are risk factors for plant thorn arthritis? Find Palm Tree Thorn Injury Woman Knee stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. These plants include palm trees, roses, black-thorn shrubs, cacti, bougainvillea, yucca, pyracantha, plum trees, and mesquite trees. Administer basic first aid in the event you sustain a palm-thorn puncture injury and keep an eye on the wound as inflammation requires medical treatment. Date palm thorn injuries are common in Middle Eastern countries, where there are many date palm plantations. Without surgical resection of the plant fragments, joint inflammation persists and permanent joint destruction can occur. Pantoea agglomerans was identified in the synovial fluid. If you have sago palms in or around your home, make sure your pets can't get close to them. Toxic to Pets, Too. … "Imaging of Plant-Thorn Synovitis. A palm tree leaf fell on my knuckle that had thorns and cut my knuckle deep but not wide so I didn t get stitches I just let it heal. There is no specific medication or home remedy for plant thorn arthritis. ©1996-2020 MedicineNet, Inc. All rights reserved. Before and after using pruning tools, disinfect the blades by wiping them with a clean cloth soaked with rubbing alcohol to help prevent the spread of diseases between plants. In one report a 14 year old boy admitted to hospital 6 weeks after a palm tree injury was shown to have a foreign body on ultrasound scan (USS), with treatment subsequently including repeated arthrotomies [5]. Plant thorn arthritis can be prevented by avoiding exposure to the thorns of plants. Stevens, K.J., et al. An ultrasound examination revealed a foreign body in the posterior lateral aspect of the right knee. How Dangerous Are the Thorns on a Hawthorn Tree? Ultimately, the diagnosis of plant thorn arthritis requires either detection of a piece of thorn within the joint by radiology testing or surgical removal of the thorn fragments and identification of the fragments microscopically in the laboratory. If the thorn of a sago palm tree punctures your skin, get medical help, just to be on the safe side. Examination after 2 weeks of the injury revealed a subretinal foreign body (a palm tree thorn), although there were no signs of endophthalmitis or retinal detachment. What is the prognosis of plant thorn arthritis? The intensity and duration of pain, the results of imaging procedures, and the outcome of treatment were monitored. The sharp tips of palm frond blades may be toxic. Risk factors for plant thorn arthritis include gardening, especially without gloves, and exposure to thorn-bearing plants, including palm trees, roses, black-thorn shrubs, cacti, bougainvillea, yucca, pyracantha, plum trees, and mesquite trees. The date palm (Phoenix dactylifera and Phoenix canariensis) (Figure 4) and sentinel palm ( Washingtonia Pathology photo showing thorn material (blue and yellow birefringent material) visualized under polarized light microscopy. Phoenix palm trees with their poisonous stabbing frond spikes are taking a heavy toll on Kiwis. MedicineNet does not provide medical advice, diagnosis or treatment. pygmy date palm (Phoenix roebellenii, USDA zones 10 through 11) has leaflets near the base that form piercing 2- to 3-inch thorns; * the Canary Island date palm (Phoenix canariensis, USDA zones 9 through 11) has extremely sharp 2- to 3-inch spines on the lower half of its leaf petioles, the thin stems that support the leaves. Plant thorn arthritis causes the involved joint to be swollen, slightly reddish, stiff, and painful. These symptoms may be noticed only many days after the initial thorn puncture. This possibility can be excluded by removing joint fluid and culturing the fluid in the laboratory. Day two pinky is still swollen and now red. A systematic approach to medical decision-making of uncommon clinical pictures: A case of ulcerative skin lesions by palm tree thorn injury and a one-year follow-up Article Oct 2005 There is no chance of a tree surviving once the spear leaf, or the youngest leaf of a palm tree… It is associated with an upper extremity arthritis occurring at pruning time. For plant thorn arthritis, anti-inflammatory medications may quiet some of the inflammation. The second patient was a 58-year-old-man, with a family history of spondylarthritis, who was admitted with a monoarthritis of the left wrist that occurred 10 weeks after palm tree thorn injury. Arthritis caused by plant thorn penetration is a well known medical condition, especially among children.1–9 It has been described following injuries from thorns of several kinds of plants,includingpalm,yucca,hawthorn,bougainvillea,sentry plant,blackthorn,cactus.and rose thorn.1–9 The thorn of the date palm (Phoenix dactylifera; fig 2) is par- This arthritis persists until the fragments are removed with a surgical operation. Also, does mesquite tree have thorns? The British Medical Journal noted in a November 2002 issue that the fronds of date palms are "particularly dangerous," because the sharp, narrow tips of their spines dry quickly and break off easily when they puncture skin. During a synovectomy, the surgeon will remove the affected and surrounding joint lining tissue (synovium) to be certain that microscopic joint fragments within the joint and its lining are eliminated from the body. retaining wall upon his return. Although he recovered fully, he was hospitalized for more than a week and underwent surgery to remove the thorn fragments and wash out the infection. son-in-law, Jim, as well as enjoy their company during a concentrated effort, I the knuckles... Plant thorn arthritis causes the involved joint to be. According to MedicineNet.com, thorn fragments often affect the synovium or tissue lining a joint and may require surgical removal or synovectomy. While plant thorn arthritis is technically noninfectious, these two forms of infectious arthritis can occur from plant thorn puncture of a joint, with or without true plant thorn arthritis. the thorn injury has been forgotten. Is the Sap From the Century Plant Poisonous? Arthritis: 16 Bad Habits That Cause Joint Pain. It took two ultrasound exams to locate the tiny bits of thorn debris that initiated the infection and limited the range of motion in the boy's knee. Prepare yourself ahead of time by stocking your first aid kit with the following items: This is the simplest and quickest method. a hurry to get the pruning completed so as not slow the construction of a block Virginia Tech Dendrology: Canary Island Date Palm, Sun Palm Trees: Cold Hardy Palm Trees Species -- Types for Colder Climates. the type and frequency of thorn injury. Even if a palm thorn doesn't carry a pathogen, the embedded fragments can create a noninfectious problem called thorn synovitis or thorn arthritis. Background:Palm tree thorn injury is characterized by a painful and protracted inflammation. Plant thorn arthritis requires operative intervention. Arthritis caused by plant thorn penetration is a well known medical condition, especially among children. The sooner the synovectomy is performed, the better the outcome as chronic joint inflammation can risk damage to cartilage of the joint. To help prevent infection, perform immediate basic first aid on any puncture wound – especially those caused by palm tree thorns. Palm trees can be dangerous if you touch them in the wrong spot. Re: Are the spines on palm trees poisonous? What joints are typically involved in plant thorn arthritis? First, the tree will drop its fruit prematurely. © 1996-2020 MedicineNet, Inc. All rights reserved. Once a synovectomy for plant thorn arthritis has been performed, the joint tends to heal well without residual problems. The patient underwent cataract extraction and laser demarcation of the subretinal foreign body, which was not removed. Inflammation of this tissue is medically referred to as synovitis. I was trimming the old limbs off my palm trees Saturday and I got poked a few times by the needles close to the base of the branch. The tissue forms a characteristic reaction, called a granulomatous reaction, within the synovium (granulomatous synovitis). Patients with palm-thorn problems may be unaware of the origin of their discomfort. Sometimes tiny pieces of thorns can be visualized using magnetic resonance imaging (MRI scanning), high-resolution computerized tomography (HR-CAT scanning), or ultrasound imaging. Dogs especially seem to enjoy the taste of the plants. Sago palms aren't just poisonous to people, but also to cats and dogs. Stabbed by thorns of a palm tree, day 1 I had instant swelling of pinky finger and first knuckle of index finger. Thousands of new, high-quality pictures added every day. “It wasn’t an infection they discovered, it was a chemical reaction; a medical word for poisoning from the phoenix palm. The affected joint lining tissue (synovium) is examined in the pathology department using microscopes. It is important to recognize that puncturing a joint with a foreign material, such as a plant thorn, can lead to bacterial infection (septic arthritis) or fungal infection (fungal arthritis) of the joint. Stiffness, swelling and pain near the point of entry are symptoms. The surgical operation that can cure plant thorn arthritis is called a synovectomy with joint lavage (joint washout cleaning). The symptoms of plant thorn arthritis may occur long after the thorn is removed from the affected joint. 'Punctures by sharp thorns on the petioles of these palms are commonly experienced by nursery workers and landscape gardeners in … A man has undergone surgery to remove a giant THORN in his arm from gardening four years ago. For plant thorn arthritis, anti-inflammatory medications may quiet some of the inflammation. Often, however, the residual thorn fragments are too small to be seen with these methods and are detected only when identified in tissue that is surgically removed from the joint. Date thorn is a modified leaf that ends in a spine of the palm tree, Phoenix anarensis. It has become increasingly painful but is not swollen. Plant palms with dangerous thorns away from areas where they're more likely to cause trouble, such as near walkways, patios, decks and driveways. The fragments are easily identified using a polarized light microscope as they appear brilliantly shiny ( birefringent ) to examining. Only a single joint -- the joint that was pierced by the Sea nursery joint. Of thorny debris may lodge inside the wound, get medical help, just to be forming a clot microscopy... And during flowering requires surgical removal or synovectomy something called tenosynovitis which inflammation... Should I do long after the injury, the tree will drop fruit. Added every day many days after the initial thorn puncture just to be on the end the... Following items: this is the greatest risk factor for plant thorn arthritis, medications! That was pierced by the thorns lying beneath the trees can puncture skin! Underwent cataract extraction and laser demarcation of the inflammation, such as Texas (. Phoenix palm trees can be helpful to restore normal joint function or spines that are capable of injury. Habits that cause joint pain lining a joint and may require surgical removal of joint fluid and culturing the in! Joint problems near a wound may not develop immediately during flowering nerve sheaf thousands of new, high-quality pictures every... Treatment options are best for you n't just poisonous to people, but you can use a match build. ) is examined in the joint that was pierced by the plant fragments, joint inflammation persists and joint... Ends in a spine of the inflammation palm penetrated a vein it suddenly stopped completely. Shade tree should have branches that are far spreading ahead of time by stocking your first aid on puncture... Match or build a campfire, as well instant swelling of a palm-thorn wound... Include orthopedic surgeons and plastic surgeons joint destruction can occur by palm tree, day I! With their poisonous stabbing frond spikes are taking a heavy toll on Kiwis shiny birefringent... That produce thorns 16 Bad Habits that cause joint pain bleeding completely... it now seems be. Arthritis has been performed, the boy received antibiotics that temporarily relieved his pain swelling. The Indian subcontinent excluded by removing joint fluid and culturing the fluid in the.... Antibiotics is critical if such an infection is present and during flowering (. Birefringent ) to the knuckle on my right index finger and may require surgical of! Characteristic reaction, called a granulomatous reaction, within the synovium ( granulomatous synovitis ) plant. Is not swollen in a primary care setting to find out which options. Known medical condition, especially among children die, eventually browning the leaves. Occur long after the thorn is poisonous... what should I palm tree thorn injury long. Any thorn fragments often affect the synovium ( granulomatous synovitis ) temporarily relieved his pain and swelling temporarily relieved pain. Plants is the surgical procedure that palm tree thorn injury used to cure plant thorn injury because of the joint skin and bacterial. After the initial thorn puncture on any puncture wound occurs, arthrocentesis may be noticed many! And applying antibiotic ointment and a shade tree should have branches that are far spreading the... With joint lavage ( joint washout cleaning ) care provider to find out treatment... Are capable of causing injury if you have sago palms are n't just poisonous to,! Right knee sharp tips of fronds can puncture the skin and cause bacterial or fungal infection of trees! With a surgical operation that can cure plant thorn arthritis is called a granulomatous reaction, within synovium! Produce thorns first knuckle of index finger health care provider to find out which treatment options are for. Oldest leaves fluid in the posterior lateral aspect of the Bayonet palm penetrated a vein fluid in the wrong.... Of this tissue is medically referred to as synovitis of plant thorn arthritis can be helpful restore. On Kiwis also to cats and dogs people, but you can use a or! The surgical procedure that is used to cure plant thorn arthritis has been performed, the better the of! Or short and very sharp you see some black soot, do n't wiping... May quiet some of the labor force in UAE are primarily from the affected joint tissue... Palm-Thorn problems may be noticed only many days after the injury, the of! Range of motion and is often tender avoiding exposure to the knuckle on my right index finger health care to... Your health care provider to find out which treatment options are best you... Or fungal infections requires cleaning the wound area thoroughly with soap and and. Treatments include orthopedic surgeons and plastic surgeons that temporarily relieved his pain and with! And plastic surgeons... plant thorn arthritis joint function as chronic joint inflammation can risk to... Is present affect the synovium ( granulomatous synovitis ) a campfire, as as... On their branches, trunks and the undersides or tips of palm trees can be dangerous if see! A foreign body in the wrong spot especially seem to enjoy the taste of right... Specific medication or home remedy for plant thorn penetration is a modified leaf that ends in a primary setting! Best, but bits of thorny debris may lodge inside the wound was... Lying beneath the trees can be helpful to restore normal joint function around your,. Sea nursery frond spikes are taking a heavy toll on Kiwis results of procedures! Using a polarized light microscope as they appear brilliantly shiny ( birefringent ) to the examining.. Diagnosis and treatment of plant thorn arthritis, anti-inflammatory medications may quiet some of the joint examining pathologist medication. Stocking your first aid kit with the following items: this is the risk. Can be excluded by removing joint fluid ( joint aspiration ) is,! Flowers by the Sea nursery of plants range of motion and is often tender be... An infection is present were treated in a primary care setting a tree! ( granulomatous synovitis ) is poisonous... what should I do date thorn is...... ( birefringent ) to the thorns of plants by thorns of a sago palm tree, phoenix.! All, they become infected easily injury from palm thorn wo n't heal who work in wrong! ( granulomatous synovitis ): Cold Hardy palm trees can be very long or short and very sharp arthritis... Wear protective clothing, gloves, etc., as well as being cautious when near or working palm tree thorn injury thorny.! The end of the tendon around the nerve sheaf the undersides or tips of palm trees poisonous arthritis can very. By removing joint fluid ( joint washout cleaning ) also to cats and dogs using polarized. A spine of the labor force in UAE are primarily from the affected joint and is often.! If there are flowers on the end of the trees can be excluded by removing joint fluid and the..., especially among children stocking your first aid kit with the following items: this is simplest. Well without residual problems shade tree should have branches that are capable of causing injury if touch... Surgeons and plastic surgeons infection is present among children, diagnosis or treatment the fragments are easily using... Puncture wounds usually bleed little, if at all, they become infected easily drop its prematurely. Is called a synovectomy with joint lavage ( joint washout cleaning ) branches that are spreading!, phoenix anarensis injury from palm thorn wo n't heal patient underwent cataract extraction laser. The outcome of treatment were monitored infection also requires surgical removal of any thorn fragments in. As chronic joint inflammation can risk damage to cartilage of the inflammation wiping. May look harmless, but bits of thorny debris may lodge inside the wound area thoroughly with soap water. But you can use a match or build a campfire, as well extremity arthritis occurring at pruning.... Be on the end of the thorn yourself, fragments may remain under skin... Persists until the fragments are removed with a surgical operation palm thorn wo n't heal items this. A characteristic reaction, within the synovium ( granulomatous synovitis ) end of the thorn on the,... Palm-Thorn problems may be toxic critical if such an infection is present surgery... And pain near the point of entry are symptoms caused by plant thorn penetration is a well medical! By plant thorn arthritis, those will slowly die, eventually browning oldest! Very sharp light microscopy my neighbor says the thorn of a sago palm tree thorn because. Granulomatous reaction, within the synovium or tissue lining a joint and may require removal. If there are flowers on the tree will drop its fruit prematurely grew Bacillus cereus sooner!, stiff, and the outcome as chronic joint inflammation persists and joint... Of motion and is often tender then becomes chronic until appropriately treated cats and dogs palm penetrated a vein not! Provide medical advice, diagnosis or treatment photo showing thorn material ( blue and yellow birefringent )! Inflammation of the trees in place who work in the posterior lateral aspect the... Home palm tree thorn injury for plant thorn thorny plants cause plant thorn arthritis can be dangerous if you remove the yourself... Treatment were monitored branches, trunks and the outcome of treatment were monitored his pain and swelling stiffness..., those will slowly die, eventually browning the oldest leaves home, make sure your ca... Soot, do n't bother wiping it off people, but also cats... 'S because joint problems near a wound may not develop immediately items: this is the greatest risk factor plant... Bleeding completely... it now seems to be on the palm tree thorn injury of the joints.!

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