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Web DVM https://web-dvm.net Health, advice, and information online community for dog and cat lovers. Sat, 23 Dec 2023 18:12:39 +0000 en-US hourly 1 https://wordpress.org/?v=6.2.4 https://web-dvm.net/wp-content/uploads/2014/10/Web-DVM-Logo-150x150.jpg Web DVM https://web-dvm.net 32 32 Beware of hidden holiday dangers to your pets https://web-dvm.net/beware-of-hidden-holiday-dangers-to-your-pets/ https://web-dvm.net/beware-of-hidden-holiday-dangers-to-your-pets/#respond Sat, 23 Dec 2023 18:12:39 +0000 https://web-dvm.net/?p=9010 You’re in full swing of the holiday season and while we want you to enjoy it you and you family might not realize the hazards that are around for your pets. In fact, the ASPCA Pet Poison Helpline gets more calls about potential poisonings at this time of the year than any other. So, what […]

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You’re in full swing of the holiday season and while we want you to enjoy it you and you family might not realize the hazards that are around for your pets. In fact, the ASPCA Pet Poison Helpline gets more calls about potential poisonings at this time of the year than any other. So, what should you be on the lookout for?

Food

Onions and garlic: Whether they’re fresh, cooked or in powdered form, these can be dangerous for your dogs and cats. They can injure their red blood cells and cause anemia and a list of symptoms like lethargy and vomiting.

Fatty meats: You may be tempted to feed your pet some meat, but if it’s fatty, it can cause an upset stomach and a potentially life-threatening, painful disease called pancreatitis. The most common symptoms of pancreatitis in dogs include vomiting, restlessness, and shaking and abdominal pain. In cats, the symptoms include a decreased appetite, vomiting and weight loss.

Bones: After you cook meat, the bones inside can splinter easily. This can cause blockages or lacerations in their gastrointestinal tracts. Veterinarians say that a lot of the time, pets get these foods from the trash. Best thing to do is to keep your trash in a bin under the sink or in the garage.

Under the Christmas tree

Presents: Food wrapped up as presents are a major danger, especially chocolate and candies that have the artificial sweetener xylitol. It can make dogs vomit, have an abnormal heart rate, or even have seizures.

Christmas tree water: Water that’s been sitting in the stand can be contaminated with fertilizer or just bacteria from sitting there for so long, making your pet sick.

Plants

Poinsettias: The milky white sap found in poinsettias contains chemicals that can cause an upset stomach and irritation to the mouth, especially in cats.

Holly: When holly is ingested, it can cause gastrointestinal upset and spiny leaves can create irritation to your pet’s mouth.

Mistletoe: If accidentally ingested, mistletoe can result in gastrointestinal irritation, causing vomiting and abdominal pain for your pet. Large amounts of it can cause abnormal heart rate, low blood pressure, seizures, and in some cases, death.

Lilies: These can be toxic to both cats and dogs, however, the effects are much more severe in cats. Cats who ingest lilies can be at risk for renal failure and death without treatment. If dogs ingest lilies, they don’t develop renal failure but may experience gastrointestinal upset. Lily toxicity signs vary but can include; decreased activity, lethargy, drooling, vomiting, decreased appetite, a change in thirst (either increased or decreased), and a change in urination (increased or decreased).

Purses

Medication: If you’re having a party, your guests may come in and drop their purses on the ground but that’s bad for your pet. They could swallow unknown medication that’s in there. The Pet Poison Helpline says animals ingesting human medications is one of their most common calls.

Gum: Another thing that might be in guests’ purses is gum. A lot of gums and sugar-free treats have the ingredient, xylitol in it. It can kill your dog within hours. Symptoms of xylitol poisoning in dogs include vomiting, low blood sugar, decreased activity, weakness, staggering, incoordination, collapse and seizures. Create a space, like a table or blocked-off room, for people to set down their bags, especially if your pet will be roaming the party.

If you do think your pet has ingested something toxic, you can call your local vet hospital or one of these lines that are open 24/7:
Pet Poison Helpline – 855-764-7661.
ASPCA Animal Poison Control Center – 888-426-4435.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of his top selling memoir The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to this writing this blog, Dr. Welton also hosts the popular Space Coast Pet Podcast.  He is the CEO and chief attending veterinary of Premier Veterinary Care in Viera, FL.  

 

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Try to give your dog the [right] time of day https://web-dvm.net/try-to-give-your-dog-the-right-time-of-day/ https://web-dvm.net/try-to-give-your-dog-the-right-time-of-day/#respond Sat, 18 Mar 2023 21:17:04 +0000 https://web-dvm.net/?p=8988 Some animals are nocturnal by nature, that is, they are most active at night, such as opossums and raccoons.  Other animal like humans, are diurnal by nature, that is, they are most active during the day.  Like the wolf ancestors that they descended from, dogs are neither nocturnal nor diurnal, but crepuscular. Crepuscular animals are […]

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Dogs are crepuscular animals

Some animals are nocturnal by nature, that is, they are most active at night, such as opossums and raccoons.  Other animal like humans, are diurnal by nature, that is, they are most active during the day.  Like the wolf ancestors that they descended from, dogs are neither nocturnal nor diurnal, but crepuscular.

Crepuscular animals are most active in twilight, which is the periods of the day around dusk and dawn.  Also like wolves, to accommodate their lower light preference, they have even evolved a special reflective region of the retina that enhances vision in a lower light setting.  This is why the eyes of wolves and dogs can seem to glow in low light when just small amounts of light reflect off the eyes.

Dogs can be incredibly adaptable and can seem to conform to human preferences in many aspects of life, including the periods when we tend to be most active.  And while it is a dog’s general preference to be the most active in during the twilight periods of the day, it is not necessarily bad for the dog to be active alongside their humans when we generally choose to be the most active.  However, it is wise to always be cognizant of the dog’s innate preference for a crepuscular existence and at least try to meet them part of the way.

From a training perspective, a dog is going to be the most alert, mentally acute, and receptive to learning during the twilight periods of the day.  Therefore, you should aim to plan training sessions around dawn or dusk.  This will enable your dog to get the most out of training sessions and optimally learn.

While for many of us, dawn is a bit on the early side to get up and walk our dogs and play with them, but you should not too much time elapse from dawn to start engaging with your dog.  By their nature, they crave to be most active when the sun is lower, so a good compromise is to be certain let them out and engage with them no later than 60 to 90 minutes after dawn.  While it will be brighter than sunrise, the sun will still be lower in the sky and your dog will far more relish play than he would with the sun much higher in the sky and brighter later in the day.

On the flip side, don’t try to keep your dog active late into the evening, as the dog’s mind and body are seeking rest and winding down the farther they get from dusk.  At the same time, it is good policy to let them out to potty late enough that they will not have to go in the middle of the night, so a good rule of thumb is to have their final walk and potty outside 60 to 90 minutes after dusk.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of his top selling memoir The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to this writing this blog, Dr. Welton also hosts the popular Space Coast Pet Podcast.  He is the CEO and chief attending veterinary of Premier Veterinary Care in Viera, FL.  

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Why parasite screening in pets is more important now than ever! https://web-dvm.net/why-parasite-screening-in-pets-is-more-important-now-than-ever/ https://web-dvm.net/why-parasite-screening-in-pets-is-more-important-now-than-ever/#respond Tue, 10 May 2022 15:50:39 +0000 https://web-dvm.net/?p=8928 It has always been astounding to me the number of pet owners who decline stool parasite screening as a regular component of the well visit. Statistically I have found that 48 percent of pet owners decline yearly parasite screening despite my assertions that these parasites can be monsters within that not only chip away at […]

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Hookworm in Dogs

It has always been astounding to me the number of pet owners who decline stool parasite screening as a regular component of the well visit. Statistically I have found that 48 percent of pet owners decline yearly parasite screening despite my assertions that these parasites can be monsters within that not only chip away at the health of the actual patient but could put the human family at risk as well. From a medical perspective , routine parasite screening has always been an essential component to maintaining the health of the animal patient and the human family he resides with . However, now with the emergence of resistant parasites, routine parasite screening has never been more important.

What we refer to using the term “resistant parasite” , is the emergence of parasites that are no longer eradicated using our traditional anti-parasite medications. That is, they have gained genetic resistance to the effectiveness of parasite medications that have previously been effective in treating parasites for years.

Particularly concerning are resistant strains of hookworm that we have been encountering starting here in my home state of Florida, but now spreading throughout the southeastern United States; and it is predicted that eventually those strains will be nationwide. In light of the emergence of these resistant hookworm strain, we find ourselves having to get creative with anti-parasitic cocktails in order to successfully treat them. There is even a strain that infects primarily greyhounds for which there is actually no effective treatment.

So why should pet owners be concerned about this? Hookworm is well-documented to chip away at the health of the Patient either with direct irritation of the bowel and malabsorptive syndrome , but when subclinical (meaning no direct GI symptoms), is known to chip away at the health of the patient by zapping its nutrients and reducing the effectiveness of his immune system. On the human side, hookworm can infect a person and reach a larval stage that can migrate through the skin and cause severe itchiness, discomfort and cause spider web looking lesions on the skin. These type of larvae are called cutaneous larval migrans. I have a family member who contracted this from his puppy that was infected with hookworm and it took several rounds of medication and weeks of discomfort to rid himself of the parasite.

There is also an emergence of resistant strains of giardia, a protozoal parasite that also primarily infects the gut. While giardia remains species specific and the canine and feline versions do not appear to currently have the ability to infect people, the ability for an organism to jump species often starts with the emergence of strains resistant to medication that would normally successfully treat them.

Thankfully, we have new technology at our disposal to not only highly accurately identify the presence of parasites , but can also identify resistant strains. Traditionally, most stool tests relied on a technique where ultimately the main diagnosis is obtained by a technician literally looking under a microscope and looking for eggs produced by certain worm parasites and cysts produced by certain protozoal parasites. These tests had uncomfortably high rates of false negative as high as 25%, but also did not enable us to identify specific strains of parasites. This still served us pretty well given that resistant strains of parasite are only a recent phenomenon, but now knowing that they are among us it is important to know if we are dealing with a resistant strain right out of the gate.

Specifically, instead of relying on the human element of visually searching for parasite components, we now have gastrointestinal PCR testing at our disposal that takes a human element out of the testing and makes it highly accurate. PCR identifies DNA signatures from the individual parasites present in the stool and not only finds the organism but tells us the exact strains so that we know if a patient is infected with a resistant strain; and can therefore get aggressive with the treatment immediately . It costs a bit more than traditional stool parasite screening, but in my opinion given the potential health benefits of catching these parasites strains before they wreak havoc on the health of the patient or put the human family at risk , are priceless.

I recommend that the next time your pet has a yearly well visit , ask your vet about GI PCR parasite testing instead of traditional diagnostic techniques. For a slight uptick in cost you will receive a high level of diagnostic accuracy never-before-seen and if positive, be armed with knowing the exact strain of parasite and therefore the best way to treat it.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to being passionate about integrative veterinary medicine for which he is a globally recognized expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , general partner of Grant Animal Clinic, and runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care.  Dr. Welton fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

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FDA Expands Diets Linked To Deadly Heart Disease In Dogs https://web-dvm.net/fda-expands-diets-linked-to-deadly-heart-disease-in-dogs/ https://web-dvm.net/fda-expands-diets-linked-to-deadly-heart-disease-in-dogs/#respond Wed, 19 Jan 2022 11:44:25 +0000 https://web-dvm.net/?p=8899 In 2019 the FDA looked into specifically grain free dog diets that were observed to be linked to the deadly heart disease, Dilated Cardiomyopathy, aka, DCM. DCM previously had been a very genetically linked disease unique to only a few mostly giant breeds of dogs, namely Doberman Pinschers, Great Danes, and occasionally German Shepherds. Cardiologists […]

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Diets Linked to Deadly Dilated Cardiomyopathy in Dogs

In 2019 the FDA looked into specifically grain free dog diets that were observed to be linked to the deadly heart disease, Dilated Cardiomyopathy, aka, DCM. DCM previously had been a very genetically linked disease unique to only a few mostly giant breeds of dogs, namely Doberman Pinschers, Great Danes, and occasionally German Shepherds. Cardiologists in the Baltimore area raised the alarm when they started seeing DCM cases seemingly linked to specific grain free diets and petitioned the FDA to look into the matter.

That list initially was populated with 16 specific diets, but a recent update from the AVMA (American Veterinary Medical Association) working in conjunction with the FDA, according to an article in the Journal of the American Veterinary Association (JAVMA), FDA and AVMA have further expanded the list to now include not just specifically grain free diets, but what they term BEG diets.

BEG stands for Boutique style, Exotic proteins and other ingredients, and Grain free. Boutique style diets are generally niche diets, very small companies that generally do not follow mainstream quality control protocols, such as published feeding trials, AAFCO (American Association of Feed Control Officials) certification, and staffing at least 1 veterinary clinical nutritionist. They commonly use terminology on their labels that realistically have no tangible meaning in the pet food industry, such as “all natural,” “holistic,” and “home made.” Exotic proteins and other ingredients refers to the raw diets and uncommonly used protein sources, such as quail, ostrich, rabbit, and kangaroo. The FDA also saw a particular spike in the incidence of DCM in boutique style diets with lentils, sweet potato, and peas.

The mechanism by which these diets cause DCM is not fully understood, but the FDA currently has observed that these diets seem to generally be deficient in B vitamins, cofactors that are integral to integration of taurine in cardiac muscle metabolism. Taurine is an amino acid that is essential to cardiac muscle function and the maintenance of cardiac muscle health. The best way to avoid these diets? Easy, ask your veterinarian. Contrary to common misinformation spread in grooming, breeder, and other non-medical pet industry circles, veterinarians are not only trained in veterinary nutrition, but also engage in ongoing nutritional continuing education.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to being passionate about integrative veterinary medicine for which he is a globally recognized expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , general partner of Grant Animal Clinic, and runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care.  Dr. Welton fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

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FIP – Feline Infectious Peritonitis – May No Longer Be A Death Sentence For Cats https://web-dvm.net/fip-feline-infectious-peritonitis-may-no-longer-be-a-death-sentence-for-cats/ https://web-dvm.net/fip-feline-infectious-peritonitis-may-no-longer-be-a-death-sentence-for-cats/#respond Sat, 05 Jun 2021 19:48:00 +0000 https://web-dvm.net/?p=8873 Long considered an imminently fatal infectious disease in cats, feline infectious peritonitis, aka., FIP, may now be treatable in some cats infected with the disease. This comes, unfortunately, with one giant caveat: the antiviral agents that seem to have some efficacy in treating the disease, GS-441524 and GC376, are not FDA approved, still held up […]

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There may now be viable treatment for cats with FIP.

Long considered an imminently fatal infectious disease in cats, feline infectious peritonitis, aka., FIP, may now be treatable in some cats infected with the disease. This comes, unfortunately, with one giant caveat: the antiviral agents that seem to have some efficacy in treating the disease, GS-441524 and GC376, are not FDA approved, still held up in clinical trials.

In desperation fueled by a combination of hope that treatment exists and despair that cat owners’ FIP infected cats cannot get it, cat owners are turning to black market sources to obtain the drugs to treat their beloved feline family members. Within the past four years, antiviral agents GS-441524 (patented by Gilead Sciences) and GC376 (patented by Kansas State University) have been shown to reverse the progression of FIP in clinical trials involving several dozen infected cats. The agents interfere with the virus’s ability to hijack the body’s immune system. While they are not available on the open pharmaceutical market, in China, where cat ownership is becoming increasingly popular and cases of FIP are on the rise, entrepreneurs have begun producing versions of these antivirals and some are making their way to cat owners around the world, including the US.

FIP was first identified as a clinical infectious disease in the 1950s. It has since become one of the most the most researched infectious disease of cats. FIP is triggered by mutations that occur in a common and generally mild feline coronavirus that infects the small intestine. These mutations allow feline coronavirus to escape epithelial cells in the lower intestine and infect a primary immune system cell, a type of white blood cell called the macrophage. This new macrophage-infecting virus is known as FIP virus.

About 10% of cats exposed to this mutant variant go on to develop FIP after a subclinical period ranging from a few days to a year or longer. FIP is imminently fatal in all cases if left to run its normal course. FIP is regarded as the leading cause of death among young cats from foster/rescues, shelters, and catteries.

There are two forms of FIP, known as the wet and dry forms. In wet form FIP, in my experience the more common form, fluid resulting from inflammation accumulates in body cavities, most commonly in the abdomen or around the lungs. In dry FIP form, the cat develops tumor-like lesions on organs of the abdomen, lungs, eyes and/or brain. Early clinical signs of FIP include fever, loss of appetite, weight loss and depression. Case progression will depend on which form, and which organs are primarily affected and include: distended/fluid fill abdomen, incoordination, seizure, clouding of the the eyes, and labored breathing.

FIP can be difficult to diagnose, especially in dry form, which can present similarly to toxoplasmosis, certain fungal infections, or lymphoma. A positive FIP test does not necessarily distinguish between a cat that has been exposed to a general feline coronavirus or the deadly FIP variant. However, a negative test would definitively rule it out, but this is rare since it is generally accepted that 80% or more cats have been exposed to feline coronavirus. Given this lack of definitive ability to distinguish between feline coronavirus and FIP, final diagnosis is often based on history, presenting clinical signs, and other supportive lab data.

Many cats with FIP are euthanized. Others are given symptomatic treatment with the faint hope that the immune system ultimately win out over the virus (in 19 years of practice, I have never seen this happen. When I first graduated veterinary school in 2002, the immune messenger molecule, interferon, was being tried, as it had previously shown the ability to boost the body’s immune system against certain viruses. It would ultimately show little benefit for FIP cats.

The names GS and GC that precede each FIP drug are derrived from small molecules that easily pass from the bloodstream into infected cells. Once inside infected cells, they target specific viral proteins that control viral replication. GS inhibits the formation of viral RNA early on and GC inhibits the formation of mature viral proteins at a later stage. In trials so far, GS has been shown to be the more effective.

Although no GC or GS FIP drugs have been approved for use in China, the companies that make these drugs are apparently under no meaningful legal restraints in manufacturing them and selling them. “Brands” that have been identified as legitimate drugs that deliver on the content and efficacy of the drugs have been identified by FIP social media groups: Mutian II, Mark’s, Andy’s and Shire to name a few. Treatments are purchased through intermediaries on the internet, often for thousands of dollars.

The potential problems with this are clearly glaring. With no official governing body overseeing the collection of money, one may just be putting money out into cyberspace never to be seen again. If one is lucky and product actually does arrive, with no government oversight proving quality control and integrity of ingredients, processing etc., one may not know what one is administering to one’s cat.

Still, many view these circumstances and unknowns as having nothing to lose with an otherwise terminally ill patient. I have three veterinary colleagues have not only gone along with their client purchases of these agents for their FIP infected cats, but aided them in the administration. All three colleagues have reported a 100% success rate thus far.

Where this leaves the veterinary practitioner is a very gray area. Being complicit in the administration of an unapproved drug to a patient is a potentially serious offense that risks one’s veterinary and DEA licenses, thus potentially risking one’s ability to practice medicine and prescribe medication, respectively.

I have only recently learned of these new treatments for FIP and have yet to be presented with a case of FIP to have this discussion with clients. My stance for now will be to inform clients of the existence of these drugs and leave it to them to decide if they are prepared to personally take the risks of lost money, bogus product, and understand that I cannot in any way legally assist in the administration of the drug.

My hope is that the current US GS and GC patents will make it out of FDA clinical trials and get approval status in the near future. After a whole career of advising owners of their cats’ FIP diagnosis and grave prognosis, it is exciting to know that any day now, there may be approved and effective treatment available for this horrible disease.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to being passionate about integrative veterinary medicine for which he is a globally recognized expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , general partner of Grant Animal Clinic, and runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care.  Dr. Welton fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

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Choosing The Right Surgical Repair For Dog Cranial Cruciate Ligament (CCL) Tears OF the Knee https://web-dvm.net/choosing-the-right-surgical-repair-for-dog-cranial-cruciate-ligament-ccl-tears-of-the-knee/ https://web-dvm.net/choosing-the-right-surgical-repair-for-dog-cranial-cruciate-ligament-ccl-tears-of-the-knee/#respond Fri, 21 May 2021 16:42:59 +0000 https://web-dvm.net/?p=8861 The cranial cruciate ligament (CCL) is the major stabilizing ligament that lies deep within the knee joint in dogs and serves a similar function as the anterior cruciate ligament (ACL) in people.  Rupture or tear of this ligament is a very common injury in the hind extremities of dogs.  Rupture of the CCL causes a […]

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The cranial cruciate ligament (CCL) is the major stabilizing ligament that lies deep within the knee joint in dogs and serves a similar function as the anterior cruciate ligament (ACL) in people.  Rupture or tear of this ligament is a very common injury in the hind extremities of dogs.  Rupture of the CCL causes a forward thrust, also known as a sheer force, of the tibia when the dog is in motion or even just standing while weight bearing.  The image below illustrates the nature and consequence of rupture of the CCL.

Cranial Cruciate Ligament Tear of the Dog Knee

The sheer force causes inflammation and pain within the joint and causes significant lameness in the affected limb.  CCL rupture will not heal without surgical stabilization.  The longer a dog lives with a CCL tear, constantly shifting weight to the non-injured limb, it increases the chance of CCL tear in the opposite limb.

There are three main methods by which dog knees with torn CCL’s are surgically stabilized.  One approach involves running a suture between focal points of the femur and tibia.  Suture procedures still have their place in CCL repair, but it is widely accepted that suture based CCL repair is not as effective for dogs over 35-38 pounds.  My own preference for suture procedure for surgical stabilization is the arthrex tighrope suture procedure for CCL tears in smaller dogs generally south of 35 pounds.

Arthrex tightrope for surgical repair of cranial cruciate ligament (CCL) tear in dogs.

Larger breed dogs will tend to place a great deal of force across the knee joint that sometimes leads to suture failure.  Also, certain large breed dogs are born with steep tibial head angles (called tibial slope – more on this below) that predispose the dog to the injury in the first place, that will subsequently fight against the suture for the  life of the dog.  Thus, procedures called osteotomies are generally the preferred method of repairing CCL injuries in large breed dogs.  Osteotomy refers to procedures that require the cutting and altering of long bone structures.

In the 1990’s, a procedure was developed by an Oregon based veterinarian called the tibial plateau leveling osteotomy, aka, TPLO.  The procedure involves cutting a wedge of bone out of the head of the tibia, rotating it a predetermined number of degrees, and plating in place.  This changes the physics of the knee by altering the angle of the surface of the head of the tibia (aka, tibial plateau), whereby the sheer force created by the injury is converted into a compressive force oriented toward the vertical axis of the femur.  The resulting compressive force is not painful for the dog and successfully stabilizes the knee when the dog is weight bearing or in motion (stay tuned for more on the compressive force, as this is an important consideration).  The subsequent reduction of the tibial slope accomplished by the TPLO also accounts for the aforementioned certain breeds that have steep tibial slope angles that predispose to CCL injury.  The x-rays below show pre and post operative TPLO images.

Tibial Plateau Leveling Osteotomy for surgical repair of cranial cruciate ligament (CCL) tear in dogs.

Although the procedure was invented in the United States, TPLO at first gained more momentum in Europe as the procedure of choice for CCL tear in medium to large breed dogs.  It started to gain momentum in the US in the early 2000’s and has generally currently become the CCL repair method of choice among veterinary colleges and the majority of veterinary surgeons.  Many even hold it as the procedure of choice even for small and toy breed dogs. But hold that thought, there is much more to come!

In 2005, a procedure known as the Tibial Tuberosity Advancement (TTA) was developed in Switzerland where the top part of the tibia, called the tibial tuberosity, is cut and advanced forward.  The result is two fold:

1.) The advancement increases tension on the very thick and strong patellar tendon that runs over the knee cap and inserts at the head of the tibia.  This increased tension on the patellar tendon stops the sheer force created by the CCL tear.

2.) The advancement of the tibial tuberosity lengthens the patellar tendon thereby decreasing its angle relative to the tibial slope (the portion of the tibia that articulates with the femur within the knee joint).  The result is that the deep tibial slope angles are to some degree functionally reduced without the necessarily having to change the angle by cutting such a large wedge of bone as is the case with TPLO.  Overall, TTA was considered by many veterinary surgeons to be less invasive and found that patients were quicker to weight bearing and experienced less complications.  What’s more, the procedure had a shorter learning curve than TPLO, so veterinarians without residency training were able to quickly gain proficiency with the procedure.

Below is the post operative TTA x-ray:

Tibial Tuberosity Advancement (TTA) for surgical repair of cranial cruciate ligament (CCL) tear in dogs.

I am not really certain why veterinary colleges never really embraced the TTA as a mainstream CCL repair procedure performed at veterinary college teaching hospitals.  Despite the European veterinary community making a significant transition away from TPLO to TTA after its inception in 2005, while many private US veterinary surgeons were adopting TTA as their go to procedure, US based veterinary schools stuck with TPLO.

Enter the Modified Maquet Procedure, aka, MMP, developed in England and first introduced in the US in 2014.  The MMP procedure utilizes the same principles as the TTA, however, with less cumbersome hardware, smaller incision, and shorter surgical time.  The wedge that is placed within the bone does not require multiple screws to be placed into the bone as the TTA and TPLO hardware does.  Once placed, it simply requires the placement of one single pin and staple that effectively hold the hardware in place.  What’s more, the MMP wedge is made of a porous titanium alloy that allows bone to grow through it.  This results in much faster recovery times of 4-6 weeks (as opposed to TPLO and TTA that are 10-12 weeks).  See the images below for a post operative MMP x-ray and an image of the actual hardware used in the procedure:

Modified Maquet Procedure (MMP) for surgical repair of cranial cruciate ligament (CCL) tear in dogs.
Modified Maquet Procedure Hardware.

Let’s return to TPLO for one moment before I close.  Remember I wrote about converting the sheer force into a compressive force?  No, it is not painful and, yes, it stabilizes the knee, but it is not without consequence.  Over time that compressive force leads to earlier stage degenerative joint disease of knees surgically repaired via TPLO as compared to TTA and MMP; in my experience in dealing with degenerative joint issues in dogs’ senior years that have had past CCL surgical repair.  Also, look back at the TPLO x-ray and observe the metal structures across the surface of the leg….those are skin staples necessary to close the skin and give you an idea of the size of the incision.  That represents an 8-10 inch incision versus MMP that requires typically no more than a 3-4 inch incision.

This is not to say that TPLO does not necessarily have its place in some cases.  Before deciding on which procedure to move forward with, it is imperative to measure the tibial slope angle.  The reason for this is that occasionally, dogs that suffer CCL tear have done so due to an inherrited excessively steep tibial slope angle that causes excessive forward thrust of the tibia and stresses the CCL.  While the MMP functionally overcomes many cases of excessively steep tibial slope, I generally will not recommend MMP for patients with tibial slopes of 28 degrees or higher.  Dogs with slopes above this threshold should have TPLO done, as it more aggressively addresses reduction of the tibial slope angle.  Luckily, tibial slopes of 28 degrees or higher has only represented a very small percentage of my cases, so MMP remains the appropriate surgical repair for the vast majority of my patients that present with CCL tear.  

I am enjoying quicker return to function, by far faster recovery times, and excellent results with the MMP procedure for repair of the CCL in dogs that I have been performing the surgery for since completing the training in 2017.  The standard TTA and TPLO remain good procedures especially in the hands of an experienced veterinary surgeon, but in my view, MMP is currently the best CCL repair procedure for most dogs over 38 pounds that have suffered CCL tears.

Related: The benefits of Modified Machet Procedure (MMP) over TPLO surgery for CCL tears in dogs

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of The Man In The White Coat: A Veterinarian’s Tail Of Love.   Dr. Welton is the CEO and senior attending veterinarian of Premier Veterinary Care in Viera, Florida.  In addition to blogging, he is also the host of the popular Space Coast Pet Podcast.

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The COVID-19 Pet Paradigm Shift https://web-dvm.net/the-covid-19-pet-paradigm-shift/ https://web-dvm.net/the-covid-19-pet-paradigm-shift/#respond Tue, 27 Apr 2021 17:06:36 +0000 https://web-dvm.net/?p=8855 In the past year of the pandemic, I have witnessed a remarkable shift in the increased number of people who own pets, in addition to family’s and individuals’ view of the importance of pets in their lives. During a time when human contact was so limited for so many, it was often pets that provided […]

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Pets in the age of COVID-19

In the past year of the pandemic, I have witnessed a remarkable shift in the increased number of people who own pets, in addition to family’s and individuals’ view of the importance of pets in their lives. During a time when human contact was so limited for so many, it was often pets that provided the companionship and physical contact that is so crucial to our emotional well being. This was especially true of those at most risk of death or serious complication from COVID-19, either seniors or people of all ages that lived with co-morbidities that were the most restricted from human contact.

In some states and cities that took the most restrictive measures and for those whose jobs were not considered essential and were at home furloughed or let go, their dogs were their only means to simply leave the house for weeks to months; given the one exception for pets to be exercised and allowed to eliminate outside. Thus, in so many ways, pets provided not only the basic human need for companionship, but a justifiable reason to simply step outside of the home.

As previously mentioned, the number of pets owned by people has increased dramatically in the past year. Given so much free time for many people to finally take the plunge to raise that new puppy or kitten, new pet numbers surged this year. In my county, there were reports of hours long lines at the shelter with people (properly donning masks and socially distanced of course) waiting for the opportunity to adopt a new pet.

All of the above took the veterinary profession by storm with surges of new patients many clinics (both of mine included) unprepared with too few doctors and support staff to handle the capacity. We are currently faced with a veterinary industry growth that new graduate numbers, both doctors and technicians, are not keeping up with the demand for more of them. Subsequently, most clinics are running with doctor and staff deficiencies.

On one hand we are all grateful that while much of the general work force has faced so much economic hardship that we enjoy very strong job security, on the other hand, we are looking at a veterinary medical force that is increasingly overworked and overwhelmed. Add in most clinics offering curbside service only while our populace still struggles to get vaccination numbers to the extent that COVID-19 herd immunity is achieved, and that is the perfect recipe for mental and physical exhaustion at the end of each work day.

We are faced with the juxtaposition that most of us are thrilled that people are seeing the value of pets as family members at no greater time in history and please that people are seeing the value of their veterinary health professionals like no other time in history; with the back drop of also hoping that there can one day be a better balance where we can enjoy the enhanced love of pets paradigm that COVID-19 brought us, have good employment security, but once again perhaps occasionally have a moment to breathe at work.

At any rate, enjoy your new found appreciation of pets and may that never end. While the veterinary profession struggles to catch up, please also be patient. We want nothing more than to get your pet in to be seen, but please always understand that during these exceptionally busy times, we must prioritize those whose lives are most at risk.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to being passionate about integrative veterinary medicine for which he is a globally recognized expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , general partner of Grant Animal Clinic, and runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care.  Dr. Welton fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

 

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Recognizing Warning Signs Of An Aggressive Puppy https://web-dvm.net/recognizing-warning-signs-of-an-aggressive-puppy/ https://web-dvm.net/recognizing-warning-signs-of-an-aggressive-puppy/#respond Tue, 30 Mar 2021 11:49:27 +0000 https://web-dvm.net/?p=8851 Puppies are commonly “mouthy” and nibble on an owner’s hands as you play with them and sometimes they will make little growls as they do so, even accidentally break skin if one is not careful. To some degree, this can be normal, as this is behavior they exhibit with one another’s littermates in a litter […]

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Recognizing aggression in puppies

Puppies are commonly “mouthy” and nibble on an owner’s hands as you play with them and sometimes they will make little growls as they do so, even accidentally break skin if one is not careful. To some degree, this can be normal, as this is behavior they exhibit with one another’s littermates in a litter setting. It is still not necessarily appropriate to get to a certain level and there are proven methods to redirect excessive rough play, but that is not the scope of this article. This article is to help puppy owners recognize and head off true puppy aggression.

It is uncommon for puppies to be truly aggressive, which is why outright aggressive behavior exhibited by puppies can be particularly concerning. Although there are breeds where aggression is more common, make no mistake, aggression is not breed specific.

Case in point, 2 months ago I was about to examine what seemed to be a very friendly 14 week old Labrador Retriever puppy whose demeanor abruptly changed once my technician applied standard gentle restraint for the examination. The puppy’s turn was so sudden, my technician was caught by surprise when the puppy went to bite her face. Seeing this coming, I grabbed the puppy’s muzzle who then proceeded to clamp down on my thumb with its canine tooth puncturing through my nail and refusing to let go, having to pry its jaws open to get her to let go. She tried to clap down again but I pulled away in time, my technician now having the puppy firmly in control.

Most dog oriented people know that Labs are well known for their gentle demeanors, consistently rated as being among the safest breeds to have with children. Yet this puppy was very much an exception to this rule. Let my experience be a lesson to you and do not take breed for granted.

So how to we differentiate normal puppy nipping and teething behavior from aggression? A good starting point is to watch your puppy’s behavior around areas where there is food. Early signs of aggression in puppies include being possessive over toys and food.

Is your puppy protective of his food bowl? Does he growl or snarl as you walk by the food bowl while eating? Does he growl or snap when you reach for the food bowl, even if it’s empty? Does he snatch treats or food out of your hand when not offered? Does your puppy lunge, growl, or snap as you attempt to retrieve a dropped piece of food? Is he protective of the trash recepticle?

Does your puppy assert a claim to any specific piece of furniture in certain rooms of the house, such as a particular chair, couch, or bed? Is your puppy unusually possessive of toys or other items, especially items that may belong to your children?

How does the puppy act when someone, especially someone he does not know, walks into the house or enters a room? Does the puppy react differently when an unfamiliar child comes to the house or bark excessively? 

Does the puppy exhibit an unusually high prey drive by chasing and nipping at anything that is moving? Does he over-react aggressively to playful teasing, sudden movements, awakening from a deep sleep, or being corrected? Is he resentful of being touched? Is there aggressive behavior such as growling and biting when the puppy is picked up?

Also, watch how your puppy reacts to other dogs and puppies. Be sure to watch for signs of a dominant puppy. Does your puppy try to dominate other puppies or adult dogs? That type of early aggression needs to be curbed immediately with training.

If any of the above circumstances resonate with your puppy, my first advice to you is to seek consultation with your veterinarian. Many veterinarians, myself included, are not trainers or behaviorists, but many of us have our pulse on the most effective trainers and the ones that locally have appropriate methods and good reputations.

What prompted me to write this article was a client I saw just yesterday that adopted a beautiful 12 week old mixed breed puppy from a rescue. She had recently lost a very gentle a friendly dog and was ready to open her heart to a new puppy. However, she was dismayed to learn that the puppy quickly began to exhibit troubling aggression and when attempting to correct and redirect, the puppy would worsen. She showed me the many puncture wounds on her hands and ankles from the puppy.

As I examined the puppy, he did not show us any bit of aggression, but behavior in a clinic setting can be very different from behavior at home…and of course, I know this owner to be credible and the bite wounds on her were unmistakable.

I will give you the same advice I gave my client: TAKE ACTION AS QUICKLY AS POSSIBLE. The sooner there is intervention, the higher the likelihood that the situation can be resolved. Conversely, the longer the aggression goes unchecked, the more ingrained the behavior becomes, and the more difficult it becomes to reverse it.

It is possible to modify or change your puppy’s inappropriate behavior by consulting with a responsible dog trainer who applies positive reinforcement, punishment-free training methods. The trainer must have experience working with aggressive dogs. Often, something as simple as strong human leadership and basic obedience training can turn things around.

I am fortunate where I practice to have a local Barkbusters dog behavior therapist. Barkbusters is a company that originated in Australia that started a central training program in the US that standardizes their therapists’ approach. To see if there is a local Barkbusters therapist in your area, you can visit their site at Barkbusters.com and type in your zip code. For my international readers, there are also Barkbusters therapy programs in the UK, Canada, New Zealand, and Japan.

Whether its Barkbusters or another good training option in your area, seek help for your puppy’s aggressive behavior before tragedy occurs for the human family, the puppy, or both. Even if your aggressive puppy is a small breed, I would implore you to still take action to resolve the aggression. Some of the the worst injuries I have seen have come from small breed dogs, especially to children: lips bitten off, parts of ears bitten off, permanent nerve damage from bites, etc.

Lastly, do not ever be convinced to try to medicate away a puppy’s aggression. Most tricyclic and SSRI anti-depressant medications can actually worsen aggression and make the situation more dangerous. There are circumstances where behavior modification aids such as these are appropriate, but aggression is absolutely not one of them. Natural calming aids like pheromone therapy may be helpful but only in combination with a comprehensive training program.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to being passionate about integrative veterinary medicine for which he is a globally recognized expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , general partner of Grant Animal Clinic, and runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care.  Dr. Welton fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

 

 

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In Dogs, Cats Senior Age is Not a Disease! https://web-dvm.net/in-dogs-cats-senior-age-is-not-a-disease/ https://web-dvm.net/in-dogs-cats-senior-age-is-not-a-disease/#comments Mon, 25 Jan 2021 14:35:40 +0000 https://web-dvm.net/?p=8845 Maybe I am getting impatient as I get on in years of practice, getting older and crotchety myself, or perhaps it is just that after 19 years of hearing the same reservations from pet owners and having the same talk with them to alleviate their reservations over and over and over and over again…that I […]

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Maybe I am getting impatient as I get on in years of practice, getting older and crotchety myself, or perhaps it is just that after 19 years of hearing the same reservations from pet owners and having the same talk with them to alleviate their reservations over and over and over and over again…that I am just sick of it. Whatever the case, it simply grates on me when I recommend a routine procedure or diagnostic that involves sedation or anesthesia in a senior aged pet that I get the question, “isn’t he too old?”

Ironically this question seems to come most commonly from senior aged people when I recommend a dental procedure, biopsy, colonoscopy, or a whole slew of other diagnostics and procedures that require anesthesia or sedation. They have these instant reservations about a necessary procedure that I am recommending but they have none when it comes to their own procedures that their doctors may recommend. Their logic is like, “Sure I’ll go in for my own colonoscopy despite my advanced age, but my senior dog will die if he does the same.” I wonder how it became a mainstream belief that senior aged dogs are far more likely to die under anesthesia than a senior aged person.

Not to be an ageist, as there are plenty of young people that have the same irrational fears that their senior pet will die if put under anesthesia to the extent that they would preferably let their pet live with a painful or otherwise debilitating condition out of fear of anesthesia.

Case in point, I had a Golden Retriever patient that had a lipoma, a benign tumor that sometimes can become intrusive as they grow large in some patients. When I first noted that the lipoma was getting uncomfortably large to the extent that it was make the dog walk funny and I subsequently recommended surgical removal of the tumor, the dog was just shy of 10 years of age. The owner declined out of fear that the dog was too old to survive the anesthesia, even though he had no cardiovascular or lung issues and his blood work was perfect.

The owner let this thing grow for another 2 years when just shy of 12 years of age and it was literally the size of a watermelon. Between the general arthritis the dog now had and this massive lipoma weighing him down and restricting his movement, the dog could barely get up.

Having no other choice at this point, the owner finally agreed to have the procedure done with euthanasia being her only other alternative. By virtue of waiting for it to get this bad, the owner actually ended up increasing the risk because the surgical time was to be 4-5 times longer than had she done it when I originally made the recommendation 2 years earlier.

Thankfully everything went well and the dog made a full recovery and regained a great deal of mobility back. The tumor ended up weighing 13 pounds.

It is even more frustrating when owners decline much needed dental work on pets. These can be an especially hard sell because in addition to the fear of anesthesia in a senior pet, we also have to contend with pet owners often not taking taking dental health as seriously as they should.

I had an Italian Greyhound patient’s owner put off much needed dentistry for 3 years out of fear of anesthesia. She finally scheduled it when the dog presented looking like an aardvark because the front part of it muzzle was sagging from all of the jaw bone that had rotted out and he could no longer eat. I ended up having to perform an hour and a half worth of oral surgery to extract a full mouth of rotten teeth and surgically reconstruct the upper jaw and leave in a feeding tube for 2 weeks for the owner to feed the dog through while the dog’s mouth healed.

Please be aware, age is not a disease in and of itself. Age is stage of life where we tend to see more disease and it is incumbent upon the veterinarian to rule out underlying disease that may increase the risk of anesthesia prior to a procedure. This starts with a simple physical examination, senior blood work to start, and may also include chest x-rays and an EKG if we suspect any anomalies. Even if there is an underlying condition that may increase risk, we can often adjust our anesthesia/sedation protocols to mitigate that risk.

The reality is that the greater body of anesthetic procedures and diagnostics that we perform in veterinary medicine are in senior aged pets. That is when chronic ailments and injuries tend to be statistically more likely to occur, just as it is in people. If many of them died as the result of anesthesia, that would not reflect well on our profession. The truth is, the vast majority of our senior pets do fine with anesthesia, with anesthesia related death rare with statistical probability rivaling that of anesthesia in people.

What finally prompted this article was a patient I saw yesterday. An otherwise healthy 11 year old Cocker Spaniel presented for a routine well visit and I diagnosed advanced stage dental disease. The teeth were so bad that I saw root exposure with pus and blood at the gum line and the dog was clearly painful for the oral exam.

I naturally recommended a dental ASAP and I was immediately shut down by the owner when I told her the tech would print her out an estimate for cost and she said, “Don’t bother, there is no way I’m doing it, she is too old.” I had a take a few deep breaths as I was feeling my blood rise and I shared with her that the worst pain I have ever felt in my life, even more than the two times I broke my collar bone, was dental pain.

I also told her that living with that level of dental disease would weaken her dog’s immune system, make her more susceptible to cancer, and significantly increase her risk of developing kidney failure. She said nothing just shook her head. I then said that I would have the tech get the estimate anyway, in case she had a change of heart, then proceeded to give myself a time out before I saw my next patient.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to being passionate about integrative veterinary medicine for which he is a globally recognized expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , general partner of Grant Animal Clinic, and runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care.  Dr. Welton fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

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Beware of Your Dog Ingesting This https://web-dvm.net/beware-of-your-dog-ingesting-this/ https://web-dvm.net/beware-of-your-dog-ingesting-this/#respond Sun, 03 Jan 2021 02:26:45 +0000 https://web-dvm.net/?p=8838 You may not recognize what this is but it is a component to common dog toys, specifically the ones that squeak – pictured here is the squeaker within the toy. They can be particularly dangerous because some dogs become obsessed with getting to the source of the noise made by squeaky toys and proceed to […]

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Squeaker in Dog Toys Common Foreign Body Obstruction

You may not recognize what this is but it is a component to common dog toys, specifically the ones that squeak – pictured here is the squeaker within the toy. They can be particularly dangerous because some dogs become obsessed with getting to the source of the noise made by squeaky toys and proceed to tear them out. If they are swallowed, they pose a risk of causing a GI obstruction.

I lost count in my career of how many squeakers I have surgically removed from the guts of dogs. I bring it up today because it is the holiday season and toys in our pets’ stockings are common, most especially squeaky toys….and case in point, I just recently removed one from the colon of a Doberman Pinscher that got stuck.

I am not necessarily saying that we should deny our dogs the joy of a squeaky toy, just saying that we should be careful. If your dog enjoys squeaky toys, you may safely allow him to indulge keeping in mind the following guidelines:

  • If your dog is especially obssessed with squeaky toys and/or has an especially strong bite that makes quick work of such toys, perhaps he is not a good candidate for such a toy.
  • Purchase an appropriate sized toy. For example, don’t buy a toy breed sized toy for a Pit Bull.
  • Inspect the toys frequently, discard and replace as soon as you see damage.

It amazing how much damage and how often I have seen such a fun and seemingly innocuous item can cause. Let your dog have fun, but exercise caution and good discretion and your dog will not likely end up in my operating room.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. He is the author of The Man In The White Coat: A Veterinarian’s Tail Of Love. In addition to being passionate about integrative veterinary medicine for which he is a globally recognized expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , general partner of Grant Animal Clinic, and runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care.  Dr. Welton fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

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