"There are two types of reactions," says the Mayo Clinic: "Common reactions are likely to happen. There is no evidence to suggest the COVID-19 vaccine will directly affect your kidneys. -, Voysey M, Clemens SAC, Madhi SA, et al. In the related MERS-CoV (Middle East Respiratory Syndrome) cases from 2005, viral particles were found in the skeletal muscle-invading macrophages [20]. Green color. Read on for the information you need nowand to ensure your health and the health of others, don't miss these, Pain, redness or swelling where the shot was given. Kidney cells have receptors that enable the new coronavirus to attach to them, invade, and make copies of itself, potentially damaging those tissues. Methotrexate (Oral Route) Precautions - Mayo Clinic Some people suffering with severe cases of COVID-19 will show signs of kidney damage, even those who had no underlying kidney problems before they were infected with the coronavirus. Although COVID-19 vaccines are generally safe and encouraged for everyone, side effects can happen. When the mRNA vaccine is injected, your body follows the mRNA recipe to make harmless copies of the COVID-19 protein, which induces an immune response. An official website of the United States government. Arm soreness at the site of the injection (sometimes known as "COVID arm") Fatigue. if( navigator.sendBeacon ) { Johns Hopkins Team Develops Method to Make Dialysis Fluid for Patients with COVID-19, Coronavirus Symptoms: Frequently Asked Questions. Comparison of renal histopathology in three patients with gross hematuria after SARS-CoV-2 vaccination. official website and that any information you provide is encrypted Other constitutional signs such as fever, chills, malaise, nausea, vomiting, tachycardia, muscle swelling, and tenderness can occur but are non-specific. Four out of five patients had CKD stage 2 or better before COVID infection. Morphine was given as needed for muscle pain. We will continue to provide updates as more data and information becomes available. An adolescent girl diagnosed with IgA nephropathy following the first dose of the COVID-19 vaccine. However, this suggests the need for CK monitoring in all SARS-CoV2 patients to screen for rhabdomyolysis. Length of time between COVID-19 vaccination and the appearance of gross hematuria, Duration of gross hematuria after receiving the COVID-19 vaccination, MeSH From a public health standpoint, the goal is for a sufficiently large percentage of the population to be vaccinated so that community spread of the virus will be significantly diminished. However, 1day post vaccination, she developed headache and fatigue. Follow-up lab results showed down-trending CPK and AST levels. doi: 10.1056/NEJMoa2028436. This will allow your doctor to check if the medicine is working properly. COVID-19 inflammation results in urine cytokine elevation and - PubMed If you are living with hypertension, you might take medication for the problem. During J&J clinical trial, injection site erythema and swelling were not reported as local adverse effects; arthralgias and chills were not reported as a systemic adverse effect. Rivas-Garcia S., Bernal J., Bachiller-Corral J. Rhabdomyolysis as the main manifestation of coronavirus disease 2019. The patient tried over-the-counter pain medication with limited relief. COVID-19: Long-term effects - Mayo Clinic (2). The effects of any vaccine are not immediate. They . However, these symptoms may only appear when your platelet count has fallen to dangerously low levels. Talk to your childs doctor about the COVID-19 vaccine at your next appointment. Rhabdomyolysis: a review of the literature. We strongly encourage you to talk to your doctor about whether getting the vaccine is right for you and your condition. Cabral B.M.I., Edding S.N., Portocarrero J.P., Lerma E.V. This increase in uncertainty is coupled with the need for accurate information on the short-term and long-term side effects of the COVID-19 vaccines, as there is a definitive gap in the literature for this topic area [8]. study of 6 patients with COVID and Rhabdomyolysis, 5 out of 6 were male, and 3 out of 6 had no significant past medical history or medication use. Symptoms of thrombocytopenia include bruising above areas of bleeding under the skin, flat red spots, and the presence of blood in your stool or urine. Similar receptors are found on cells of the lungs and heart, where the new coronavirus has been shown to cause injury. (4), Data suggests that End-Stage Kidney Disease (ESKD) and dialysis patients who have contracted COVID-19 have 7 times higher hospitalization rates than patients without ESKD or dialysis treatment. Influenza vaccine--a possible trigger of rhabdomyolysis induced acute renal failure due to the combined use of cerivastatin and bezafibrate. -, Polack FP, Thomas SJ, Kitchin N, et al. Muscle syndromes including myalgia, myositis, and rhabdomyolysis are well-known complications of influenza virus infection [32]. Furthermore, mRNA-1273 was associated with a greater incidence of lymphadenopathy than the Pfizer vaccine [10]. Pre-fusion structure of a human coronavirus spike protein. He had no family history of autoimmune or musculoskeletal diseases, and surgical history was only significant for an uncomplicated appendectomy. However, the majority of transplant programs require transplant candidates to be fully immunized while awaiting transplant, especially since live virus vaccines such as MMR and Chicken Pox vaccine are contraindicated after transplant. Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes. The two COVID-19 vaccines approved for Emergency Use Authorization (EUA), use mRNA, or messenger RNA, to instruct your body to build the coronaviruss specific protein. Accessibility Yes. If needed, ice the injection area, rest and take a pain medication like acetaminophen (example: Tylenol) or ibuprofen (example: Advil).". Some common reactions are shared here: Pain, redness or swelling where the shot was given Fever Fatigue Headache Muscle pain or joint pain Chills" When New York-based hospitals started running out of dialysis fluid for the type of dialysis used in intensive care, a team from Johns Hopkins answered the call. This report describes a 45-year-old man (patient2), who developed fever, myalgia, headache, fatigue, haemoglobinuria and haemolysis following administration of COVID-19 Vaccine Pfizer BioNTech. Okada M, Kikuchi E, Nagasawa M, Oshiba A, Shimoda M. CEN Case Rep. 2022 Aug;11(3):376-379. doi: 10.1007/s13730-021-00679-7. She presented to a local hospital, where she was noted to have a 3 g/dL hemoglobin decrease and received 2 units of packed red blood cells. The immune response to the new coronavirus can be extreme in some people, leading to what is called a cytokine storm. var xhr = new XMLHttpRequest(); Redness, swelling or itchiness in areas of the body other than the limb in which the vaccine was given.". Health policy efforts have drastically changed to accommodate the global shortage of vaccines and the vital need for increased mass production. Dark urine. Chazan B., Weiss R., Tabenkin H., Mines M., Raz R. Influenza vaccine does not produce myopathy in patients taking statins. Sixty-four vaccine recipients (0.3%) and six placebo recipients (0.1%) reported lymphadenopathy. 2020;383:26032615. Subsequently, he received first dose of mRNA-1273. Typically, if you had these symptoms you would be tested for COVID-19. Global funding across U.S. COVID-19 supplemental funding bills; p. 2021. More recently, some people who have received the available mRNA vaccines have reported little to no side effects after receiving the vaccine. xhr.send(payload); All Rights Reserved. In addition, urine myoglobin can be high, and muscle biopsy can confirm the diagnosis, although it is rarely needed [13]. However, a link between COVID vaccines and the disease that affects platelets has not been proven. blood in the urine or stool bloody nose blue or pale skin blurred vision chest pain or discomfort chills confusion continuing ringing or buzzing or other unexplained noise in the ears cough dizziness or lightheadedness fainting fast heartbeat hearing loss heavier menstrual periods hives or welts, itching, skin rash The study indicates that shedding of viral spike protein occurs in about 25% of confirmed COVID-19 patients. 3vaccine booster COVID-19 vaccines can prevent the COVID-19 infection. In addition to attacking the lungs, the coronavirus that causes COVID-19 officially called SARS-CoV-2 also can cause severe and lasting harm in other organs, including theheartand kidneys. Dang S., Gao N., Zhang X., Jia X. Rhabdomyolysis in a 48-year-old man with hepatitis B-induced cirrhosis. Would you like email updates of new search results? FOIA Many experts have recommended urinary alkalinization with the addition of bicarbonate or mannitol to limit the toxic effects of myoglobin on the renal tubules and decrease the risk of hyperkalemia, although this is controversial [17,18]. Zhao A., Tan M., Maung A., Salifu M., Mallappallil M. Rhabdomyolysis and acute kidney injury requiring dialysis as a result of concomitant use of atypical neuroleptics and synthetic cannabinoids. Disclaimer. Nephrotic Syndrome and Other Glomerular Diseases. Patient endorsed social marijuana use but denied other drug, alcohol, or tobacco use. Treatment aims to prevent complications and mainly consists of aggressive fluid resuscitation to prevent prerenal azotemia and acute kidney injury. Uchiyama Y, Fukasawa H, Ishino Y, Nakagami D, Kaneko M, Yasuda H, Furuya R. BMC Nephrol. Please know the science behind these two vaccines is not new. Medication allergies can range from mild to life-threatening. What you need to know from Johns Hopkins Medicine. Nihei Y, Kishi M, Suzuki H, Koizumi A, Yoshida M, Hamaguchi S, Iwasaki M, Fukuda H, Takahara H, Kihara M, Tomita S, Suzuki Y. Intern Med. But when you know that your symptoms likely are due to the vaccine, you do not need to be tested. The .gov means its official. Please talk to your doctor about whether the COVID-19 vaccine is right for you. government site. In addition, the estimated average for the J&J dose represents a combination of adverse effects reported in both the low- and high-dose groups in the clinical trial. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J., Zhao X., Huang B., Shi W., Lu R., Niu P., Zhan F., Ma X., Wang D., Xu W., Wu G., Gao G.F., Tan W. Anovel coronavirus from patients with pneumonia in China, 2019. In addition to these efforts, several emergency supplemental bills have been enacted to address the COVID-19 pandemic, many of which detail procedural measures for the manufacturing and distribution of vaccines [6]. If you have a history of allergies, tell your care team about your allergies. J Am Soc Nephrol. In the Finsterer etal. It was noted that development of abdominal pain and fever were secondary to COVID-19 Vaccine Pfizer BioNTech. They reported a 57-year-old Caucasian man with a history of a cadaveric kidney transplant who developed generalized malaise, dark urine with CK of 17,000 U/l about one week after receiving an inactivated influenza vaccine. Generally, vaccines prompt your body to make more immune cells, like B-cells, to protect you from germs that cause disease and infection. He does recommend patients with kidney issues stay away from non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. All the authors have declared no competing interest. 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, Sars-Cov-2 (Covid-19) Vaccine, Adenovirus 26 Vector (Janssen) (Intramuscular Route), muscle aches, cramping, pains, or stiffness, continuing ringing or buzzing or other unexplained noise in the ears, numbness, weakness, or tingling in the arms or legs, pain, redness, or swelling in the arm or leg, sudden, severe weakness or numbness in the arm or leg, Pain, redness, or swelling at the injection site. His symptoms resolved after 5days. The most common coronavirus symptoms include having a high fever, and a new, continuous cough. This site needs JavaScript to work properly. The rate of normal saline infusion can begin as vigorous as 1.5L/h if hemodynamic stability is desired, to target a urinary output of 200300mL/h, provided no other limiting comorbidities are present (heart failure or chronic kidney disease). All possible etiologies for rhabdomyolysis were searched for and were negative. and transmitted securely. -, Al Kaabi N, Zhang Y, Xia S, et al. After leaving a vaccination provider site, if you think you or your child might be having a severe allergic reaction, seek immediate medical care by calling 911. Callado R.B., Carneiro T.G., Parahyba C.C., Lima Nde A., da Silva Junior G.B., Daher Ede F. Rhabdomyolysis secondary to influenza A H1N1 vaccine resulting in acute kidney injury. However, the Pfizer-BioNTech vaccine is authorized for ages 16 and older. What do Allergic Signs Look Like? The vaccines developed from Oxford-AstraZeneca and Johnson & Johnson are carried into the cell on a weakened, live adenovirus, while those from Pfizer-BioNTech and Moderna are not carried on a live virus and cannot cause infection of any kind. 7 For patients with refractory hyperkalemia, persistent acidosis, or oliguric renal failure with fluid overload, renal replacement therapy becomes lifesaving. The site is secure. HHS Vulnerability Disclosure, Help Careers, Unable to load your collection due to an error. D-dimer was found to be elevated. George's University School of Medicine, NYC, USA, dDepartment of Medicine, Division of Nephrology, University of Tennessee Health Science Center USA, eInfectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Cairo, Egypt. Following his second dose, he noted fevers, diarrhea, vomiting, severe fatigue, and dark urine. Eating lots of fava beans, rhubarb or aloe can cause dark brown urine. ", 2 Conclusion: The patient did not use any medication regularly. 2023 Mar 22;9(12):eadd6734. Dark brown or cola-colored urine Brown urine can be caused by: Food. https://covid.cdc.gov/covid-data-tracker/#cases_totalcases, Myalgia, Anosmia,M Loss of Appetite, Recurrent Anaphylaxis, Fever, Cough then Lower limb pain and weakness (after Day 9), SOB, New Mitral Regurgitation due to chordae rupture, Hypotension, Hypoxia and Altered Mental Status, Intermittent fever, severe myalgia, muscle weakness, dark urine, 2 weeks of asthenia, Bilateral lower extremity weakness, Dry cough. If This Happens After Your COVID Vaccine, it's Not Normal, Say Experts Read on for the information you need nowand to ensure your health and the health of others, don't miss these Signs Your Illness is Actually Coronavirus in Disguise. xhr.open('POST', 'https://www.google-analytics.com/collect', true); Intravenous hydration can be decreased to 300500mL/h once hemodynamic stability is achieved and should be continued until CK levels fall under 1000 [16]. Available from: URL: Generally, vaccines do not have interactions with medications. Coronavirus: Kidney Damage Caused by COVID-19 Although rare, if disseminated intravascular coagulation and hemorrhagic complications occur, therapy with platelets, vitamin K, and fresh frozen plasma may be necessary. Drug information provided by: Merative, Micromedex. This content does not have an Arabic version. The Vaccine Adverse Event Reporting System (VAERS), which is jointly run by the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration, is recording any potential side-effects experienced by people after they receive a vaccine. Keep in mind, if you get the COVID-19 vaccine, you are not only protecting yourself from illness, but you are also protecting medically vulnerable people in your community. Allergic reactions can be lifethreatening, says the Mayo Clinic. 2022 Oct 13;14(10):e30276. (2, 4). Some previously young, healthy people who have developed COVID-19 have suffered strokes, possibly due . We call these associated urinary symptoms COVID-19 associate cystitis (CAC). Rhabdomyolysis is a clinical syndrome characterized by skeletal muscle injury and necrosis with subsequent release of its intracellular components into the bloodstream. government site. eCollection 2022 Oct. Ota K, Yonekura Y, Saigan M, Goto K, Nishi S. CEN Case Rep. 2023 May;12(2):176-183. doi: 10.1007/s13730-022-00743-w. Epub 2022 Oct 11. sharing sensitive information, make sure youre on a federal This is why these vaccines must be so carefully preserved at very low temperatures and why you need two doses. Accessibility Signs of kidney problems in patients with COVID-19 include high levels of protein or blood in the urine and abnormal blood work. An example of this is the flu vaccine," says the Mayo Clinic. Tell your doctor right away if you have a change in mental status, dark or bloody urine, decreased urine output, difficulty speaking, fever, pale color of the skin, pinpoint red spots on the skin, seizures, severe chest pain, sudden weakness in the arms or legs, unusual bleeding or bruising, or yellow eyes or skin. As a library, NLM provides access to scientific literature. 2023 Apr 17;2023:4906876. doi: 10.1155/2023/4906876. Geng Y., Ma Q., Du Y.S., Peng N., Yang T., Zhang S.Y., Wu F.F., Lin H.L., Su L. Rhabdomyolysis is associated with in-hospital mortality in patients with COVID-19. My experience with the Moderna vaccine: What you can expect Although adverse reactions are extremely rare, it's important to note that "Some people have reactions to certain vaccines," says the, . 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). By getting the COVID-19 vaccine, you are much less likely to get sick from the virus. Etiology includes trauma (natural disasters, burns, electrical injury), exertion (marathon runners), ischemia or hypoxia (thrombus, emboli), dysregulated temperature states (malignant hyperthermia, heatstroke, extreme hypothermia, neuroleptic malignant syndrome), drugs (statins, fibrates, alcohol, cocaine, amphetamines, lithium, antipsychotics, antidepressants, propofol, amongst others), infection (influenza, Coxsackie, Epstein-Barr, HIV, Legionella, herpes simplex virus), inflammatory myopathies (polymyositis, dermatomyositis), seizures, sickle cell disease and rare genetic or metabolic disorders (glycogen storage diseases, carnitine palmitoyltransferase deficiency, thiolase deficiency, Duchenne and Becker muscular dystrophies, glucose-6-phosphate dehydrogenase deficiency) [12]. This report describes a 63-year-old man (patient4), who developed fever, fatigue, dark urine, vomiting, diarrhea and haemolysis following administration of mRNA-1273. 56-year-old Miami-based doctor Gregory Michael started displaying the symptoms. Hamming I., Timens W., Bulthuis M.L., Lely A.T., Navis G., van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. Possible Side Effects After Getting a COVID-19 Vaccine | CDC navigator.sendBeacon('https://www.google-analytics.com/collect', payload); Notably, Type II pneumocyte cytoplasm in early stages and colonic mucosa in COVID-19 patients presented with diarrhea contained the viral particles [19]. The patient had been hydrated with high volume IV normal saline for rhabdomyolysis. He subsequently was initiated on ravulizumab, a terminal complement inhibitor. Two independent risk factors for in-hospital deaths were creatine kinase (CK) levels greater than 1000 IU/L and serum myoglobin levels greater than 1000ng/ml [28]. The Impact of Coronavirus Blood Clots Throughout the Body. Remmel A. Once your body uses the mRNA to make copies of the protein, the mRNA material is destroyed, and if you are later infected with the COVID-19 virus, your body will respond by building B-cells and T-cells to fight the virus. We encourage you to have a discussion with your doctor about the COVID-19 vaccine and if it is right for you and/or your family. An unprecedented amount of funding and attention to fight COVID-19 allowed teams of scientists from all over the world to work together to rapidly bring this vaccine to fruition in a safe, rigorous, and effective way. [cited 2021 May 12, 2021]. Over time, hypertension can cause kidney failure. Results: The mean age was 58, Acute kidney injury was developed in four patients, and two required dialysis, two of the patients (one male and one female) died [24]. doi: 10.1056/NEJMoa2034577. 2021 March 19. Most COVID Patients Did This Before Getting Sick, "You get vaccines to help prevent you from getting illnesses. day. Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19. Severe systemic effects occurred more frequently in Cohort 1. Kirchdoerfer R.N., Cottrell C.A., Wang N., Pallesen J., Yassine H.M., Turner H.L., Corbett K.S., Graham B.S., McLellan J.S., Ward A.B. Scientists believe that immunized individuals may still carry the virus in their noses for some time. Copyright: Merative US L.P. 1973, 2023. The man with a 20-year history of PNH had been receiving ravulizumab. Possible Side effects from Vaccines | CDC The bodys reaction to the infection may be responsible as well. Intake of Marijuana might have shared this problem [34], although patients have been using it daily and temporal correlation in favor of the vaccine. She was hospitalised, where she was noted to have a 3g/dL hemoglobin decrease and received 2units of packed RBCs. The site is secure. What to Do if You Have a Common COVID-19 Vaccine Reaction, "Many people do not have reactions after a vaccine, but it is normal if you do," says the Mayo Clinic. But if you do get the virus, the vaccine may keep you from becoming seriously ill. Or it may keep you from developing complications due to the illness. You can read more about the strict monitoring here. Younger patients reported more local or systemic adverse effects compared to the older population. Platelets, which are also known as thrombocytes, are cells that are essential for making blood clot, a process that stops you from continually bleeding from the site of an injury. Another difference is that mRNA is very fragile and quickly degrades once inside the body. This is unknown. Signs of kidney problems in patients with COVID-19 include high levels of protein or blood in the urine and abnormal blood work. You have common reactions that last longer than 3 days. Epub 2022 Feb 1. doi: 10.7759/cureus.30276. (8). But Sperati and other doctors are also seeing kidney damage in people who did not have kidney problems before they got infected with the virus. Pfizer (n=8183); Moderna (n=30,420); J&J (n=805). On discharge, three out of those four had worsened kidney function and 2 had renal failure. mRNA is very fragile and quickly degrades once inside the body. Hepatitis B and C panels were negative except for hepatitis B surface antigen. Inclusion in an NLM database does not imply endorsement of, or agreement with, He had an 1g/dL haemoglobin decrease on laboratory tests 3days following his first vaccination. We've consulted with our team of licensed nutritionists and dietitians to bring you informed recommendations for food products, health aids and nutritional goods to safely and successfully guide you toward making better diet and nutrition choices. Newsweek has contacted Pfizer and Moderna for comment about the cases. Basic Metabolic Panel (BMP) showed normal potassium, bicarbonate, Blood Urea Nitrogen, and creatinine levels. (4), Both Pfizer-BioNTech and Moderna recently began COVID-19 vaccine trials for children as young as 12 years old. Effect of 2 inactivated SARS-CoV-2 vaccines on symptomatic COVID-19 infection in adults: a randomized clinical trial. Rifampin (Oral Route) Precautions - Mayo Clinic "You get vaccines to help prevent you from getting illnesses. SCOTUS Now Just Another Congressional Committee, Trump Ramps up Attacks on DeSantis: 'Dropping Like a Rock', Russian Strikes on Pavlohrad Aim to Hamper Ukraine's Counteroffensive, Greg Abbott Criticized for Response to Texas Shooting: 'A New Low', Democrat Sold First Republic Stock, Bought JP Morgan Before Collapse, Conservative Influencers Struggle With Countering Biden's Messaging. and transmitted securely. Coronavirus symptoms: COVID-19 infection signs in your urine - yellow doi: 10.1056/NEJMoa2101544. Michaud and Kates (2021) emphasize that the Biden administration has implemented policy changes in four main areas: distribution of surplus Covid-19 vaccinations to regions in need, providing additional funding for global vaccination efforts (Gavi/COVAX), assisting in the expansion of vaccine manufacturing, and working in conjunction with pharmaceutical companies to waive patents on COVID-19 vaccines [5]. Baden L.R., El Sahly H.M., Essink B., Kotloff K., Frey S., Novak R., Diemert D., Spector S.A., Rouphael N., Creech C.B., McGettigan J., Khetan S., Segall N., Solis J., Brosz A., Fierro C., Schwartz H., Neuzil K., Corey L., Gilbert P., Janes H., Follmann D., Marovich M., Mascola J., Polakowski L., Ledgerwood J., Graham B.S., Bennett H., Pajon R., Knightly C., Leav B., Deng W., Zhou H., Han S., Ivarsson M., Miller J., Zaks T. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. Blood and urine tests will be needed to check for unwanted effects. All rights reserved. NephCure COVID-19 Medical Advisory Committee, https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force/transplant-capacity-in-the-covid-19-era#.X_NTothKgnI, https://www.cdc.gov/vaccines/covid-19/hcp/answering-questions.html, https://www.myast.org/sites/default/files/2020%2012%2008%20COVID19%20VACCINE%20FAQS_FINAL.pdf, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html. N Engl J Med. "Give your body time to recover. JAMA. That is one of the reasons why these vaccines must be so carefully preserved at very low temperatures and why you need two doses. Since both SARS-CoV2 and the related MERS-CoV use the angiotensin-converting enzyme II receptors, this is a highly suggested route for SARS-CoV2 viral invasion [20].
Spitz Lead Muzzle Brake, Where Does Suze Orman Live Now, 23rd Degree Astrology, Articles D