12/11 - 12/12 Hershey - Dental Update

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Doug N Libby

Member Since 2012
11/14 Hershey

HAPPY WEDNESDAY!!!

It's been a whirlwind around here with everyone running in different directions, Operation Christmas Child activities and even FINALLY got a day to visit Sammy! Just really STARTING on Christmas activities today - feeling a little panic at the lateness of the hour...The tree is up and has lights (usually done the weekend after Thanksgiving, so we have time to enjoy it) but probably won't get ornaments until tomorrow.

DENTAL TOMORROW: Anyhoo - I was mainly popping in to ask y'all to remember Hershey tomorrow as he goes in for his first dental procedure and to share my conversation with our new vet, who will be doing the dental. We haven't actually met Dr. Hoover; you may recall we were referred to him by the local vet we had chosen but they couldn't handle Hershey's dental. The office person, Priscilla, called with a reminder for tomorrow and I told her I had a few questions I was going to call them with after lunch. After the first question, she got Dr. Hoover on the phone. (Score 1 point for the practice!) He was very friendly and acted like he had all day to talk to me! (Getting better!) I said, NO Convenia - to which he said, he doesn't like it, either. I said, NO NSAID's - NO Metacam/Meloxicam - to which he said, I'm with ya' - I don't like those, either. (Yippee!) They'll sedate/exam him and call with recommendations to discuss. They do digital images before and after the procedure and are happy to show them/discuss them with us. (He said a lot of people don't want to see them. Can't imagine - anyhoo...) Dental charting - yes; All post-ops included in procedure $. Variety of medication/anesthesia options depending on the situation - what he needs done, how he reacts, pain level. Will discuss more tomorrow.

So, while I'm still nervous about the whole thing, speaking with him put me more at ease. When I got off the phone, Joseph said, "Could you have asked him ANY more questions???" :lol:

We've been gone a lot lately and had an alarm clock mishap (maybe two?) which has wreaked havoc with Hershey's shot times and BG. Bless his heart, he's so forgiving, but I always feel bad for him. He saw :mrgreen: on 12/8, but his shot times went out the window 12/9 and 12/10, so little wonder he saw (351) in the wee hours of this morning. :YMSIGH: Tomorrow will be the last monkey wrench...until Christmas. But, overall he looks good and seems to feel good. He's currently under Jessica's blanket, asleep on the futon. Wish I could join him.

Again, THANK YOU!!! to everyone for patiently answering my questions about dental procedures and how to find a new vet!

I hope all is well with you today. Thanks for visiting; I've missed y'all!

Libby (& Hershey, too!)

12/11/12:
AMPS (218) +11.25 - Shot .5u at 10:45am + 1/8th tsp Miralax
+2.5 (266) - fed
+5.25 (247)

PMPS (232) +12 - Shot .5u + 1/8th tsp Miralax
+1 (252) - fed - took food up at midnight
+10 (85) - out the door to the vet for check-up/dental

Dr. Hoover said he stayed around (180) for the procedure. Not sure if they gave him anything, but
+17.42 (349) - fed baby food

PMPS (368) +20.25 - Shot .5u at 7:00pm + 1/8th tsp Miralax
+3.5 (288) - going to offer more food
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Hope everything goes smoothly tomorrow. Dr Hoover sounds really cool. Are you expecting any extractions?
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Good dental vines coming your way!!! I have no experience with any of it. ((((Libby))))
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

- Thanks, Tara. Yes, we're expecting extractions because of the resorptive lesions. I've been talking to Hershey about going, asking him to give Dr. Hoover a chance. We'll see how that goes. My kitties usually listen about as well as my kids. ;-)

- Thanks, Melissa. I've never taken a cat for dental, so that's adding to the butterflies. Still kicking myself for not realizing kitties needed dental attention until I read it here. Now, it seems like a no-brainer. :YMSIGH: Thanks for the hug, too - always welcome!
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Owie! Well, make sure the toof fairy leaves Hershey a lil something extra. We'll be thinking of you tomorrow.
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Sending perfect dental vines to Hershey for tomorrow and wishes for a fast recovery.
The Dental Specialist we went to in January really helped to put my mind at ease. It's always scary, but having a good doctor helps a lot.
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

I am glad that the doctor was helpful and courteous. We will pray for Hershey for a smooth procedure and a quick recovery.

It must be scary. I never took my cat for a dental so I will soon as well.
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Paws crossed for everything to go smoothly tomorrow. Anesthesia and fluids can cause BGs to drop so you might want to remind them to check Hersey. He's going to do fine.
Liz
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Sending good dental vines for tomorrow.

A couple of reminders:
  • You might want to have some baby food on hand if Hershey's mouth is tender. Gabby has eaten her usual food after extractions but not all cats will.
  • Get a BG when you get home. It will give you a comparison for your PMPS test so you'll know if numbers are dropping. You may need to reduce the dose in the evening or even skip depending on what the numbers tell you.
  • Anesthesia lowers BG and makes kitties hungry. However, is also slows the GI track. Feed small amounts to make sure you don't have a scarf-and-barf.
  • If the vet gives Hershey an antibiotic, you may want to get a probiotic in case Hershey is prone to diarrhea with ABs.
  • Most of us ask for bupe (buprenorphine) to manage pain due to extractions. Some cats become agitated when given a narcotic. A quiet, dimly lit room will help.
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Sending perfect dental vines for you and Hershey tomorrow. Ours is next week, so I'm reading everyone else's experiences. nailbite_smile nailbite_smile

This vet sounds like a real winner! Neko approves of anyone with a name like Dr. Hoover. :lol: I think seeing the digital pictures would be cool too. Did the vet say what if any insulin to give in the morning? Mine said 1/4 dose and since that's too small to measure, I'm probably going to skip. But she does get to have her first breakfast in the morning. Some vets say no food after midnight.
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Hi Libby,
We are adding our good dental vines to the chorus. I hope Hershey will come through with flying colors.

Hugs and scritches,

Ella & Rusty
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Some more good dental vines for Hershey tomorrow and hugs to you Libby :YMHUG: :YMHUG:
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

Hi Libby! Sending mega, big, enormous happy dental vines to Hershey and calm, comforting vines to you. :YMHUG: :YMHUG:
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

I don't think I've posted in Hershey's condo before, but wanted to stop by and let you know I'm praying for a successful dental today. Furball has a dental scheduled for tomorrow.
 
Re: 12/11 Hershey AMPS(218) Dental TOMORROW!

HAPPY FURSDAY!!!

OREO: Oreo and Hershey went for their check-ups this morning with the new vet. Oreo immediately exited his carrier and started sniffing around the room. By the time the nurse came in, he had jumped on the counter and was climbing into the sink. Dr. Hoover did a quick once over on Oreo and said he looked good and didn't need any shots. He does have some plaque, but nothing urgent. Weight: 12-lb, so holding his ideal weight. Surprising because he's been eating ALL of his food and then getting into Hershey's. :roll:

HERSHEY WEIGHT/DIABETES: Yesterday, I had told Dr. Hoover that Hershey has trouble holding his 12-lb ideal weight and stays closer to 11.5, but that I haven't weighed him in awhile. Yepperz - 11.5-lb today. Dr. Hoover said we're doing an excellent job taking care of Hershey and managing his diabetes. They are repeating some of the BW done at the ER because he hasn't had a thyroid check since 11/11 and apparently that one test is almost as expensive as the larger package of BW. They're also doing a urinalysis. Made me feel better since I had to ask for his last UR to be done and even then the vet acted like she didn't know why I wanted one. :YMSIGH: Dr. Hoover was surprised that we stay on top of his BG and are comfortable with him below 100. He said he's had a few patients say they'll home test, but it never lasts long. Hershey was (252) at PM +1 - midnight, when we had to take up his food. At PM +10, 7:45am when we left for the vet's, he was (85). They planned to give something if he stayed that low, but he was (157) when they called to let us know they had done the oral exam. Dr. Hoover thought maybe if he went that low on .5u that he may no longer need insulin. We explained that skipping, or even delaying a shot, can lead to 300+.

EXTRACTIONS: So, now we're just waiting for the call to go get our boy! They gave us a high and low estimate, so we wouldn't be completely shocked when we go to pay. We do know that they will be extracting his cheek teeth and two left canines (stage 4 disease). He'll be left with his 12 incisors and 2 right canines.

RABIES SHOT: OH! We also learned that this vet only gives the 1-year rabies vaccine because there is some concern that the 3-yr vaccine may be to blame for a cancer that develops at the injection site (can't recall what she called it). Have you ever heard that?? That was concerning to me since our kitties usually get the 3-yr vaccine...
 
Re: 12/11 - 12/12 Hershey DENTAL!

Thank y'all for coming by to wish Hershey well!

- Tara - Hadn't thought about the toof fairy for Hershey, but definitely planning to break out the automatic shut-off heating pad for him to recuperate on. Even letting him have my favorite chair (which he thinks is his anyway. ;-) )

- Hey, Dyana - You're right, knowing Dr. Hoover is a specialist X18 years did really put my mind at ease. Still didn't like leaving without him, though :sad:

- Hey, Catherine - Thanks for the prayers. I hope all goes well for Lovey, too, that you find a great doctor to do the dental!

- Hey, Liz - Thanks for the reminder. They mentioned regular testing for his BG, which put me more at ease, too. I'm thinking I may just skip tonight's shot, too, just to be on the safe side, especially since his shot time is 10:45. Maybe we just all need a good night's sleep.

- Hey, Sienne - Thanks for the reminders. I have one jar of baby food set on GO! and according to the calories in it, he can have 2-1/2 jars, if he wants it. I also have 3 varieties of Wellness, including that high-smelling Turkey & Salmon. I just noticed last night that it WAY higher in calories and I haven't been adjusting portions accordingly! :o Dr. Hoover did mention buprenex and sending him home with a fentanyl patch. I'm trying to figure out now how to keep Oreo away from him. I guess I could close him up in my room...we'll see.

- Hey, Wendy - Oh, I hope your dental goes well!! :lol: I hadn't even thought about Dr. Hoover's name! :lol: He did say originally say to take up food at midnight. After learning Hershey's diabetic, he said to give him 1/2 insulin and 1/2 food at shot time. But, since working at OCC moved shot time to 10:45, I just took the food up at midnight. I think the midnight is just an extra precaution, like in people, to reduce the chance of complications. i guess it also depends on what time they're doing the procedure? Dr. Hoover said he only does two dentals a day and always does the older one first. Guess there are perks to age ;-)
 
Re: 12/11 - 12/12 Hershey DENTAL!

Libby - now I know you have a really good vet. Read Dr. Lisa's page on vaccines. I have a hard time finding a vet who stocks the Purevax rabies vaccine. Mine referred me to another vet 1/2 hour away. Until I found this site and did some reading, Neko had been getting the 3 year vaccine too. :sad:

Best of luck Hershey - you are going to get totally spoiled when you get home!
 
Re: 12/11 - 12/12 Hershey DENTAL!

Well, Joseph is outside with Doug, Jessica is at school and Hershey is at the vet. My quiet kitty, Oreo, is MEOWING for me to play fetch with him. Guess he thinks I'm okay...if I'm the ONLY choice...


- Hey, Devon - Thanks for thinking of us

- Hey, Ella - Hershey especially thanks you for the scritches! I'll pass them along when I pick him up :smile:

- Hey, Rhiannon - Thanks. I'll be glad when we get the call to come get him. We decorated the tree (finally!) and now I have to find another distraction...

- Hey, Jane - Thanks!

- Hey, Julie - Yes, ma'am on the winner vet. He was so nice on the phone and equally nice in person. So far, so good :-D

- Hey, Pam - Thanks!

- Hey, Deborah - Thanks!

- Hey, Amy - Thanks for the prayers.

- Hey, Michelle - Thanks!

- Hey, Carla - Thanks for coming over and for the prayers. I hope Furball's dental goes GREAT!


Thanks, again for stopping by and sending prayers and well wishes! It really means a lot to feel like you're surrounded by friends who understand!! :YMHUG: :YMHUG:
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

- Wendy - Guess I missed that part of the vaccine information. I'll definitely go back and re-read it.


***HOME from the vet! They started on him about 10am and at 2:06pm, I got the call that he was awake enough to come home - YIPPEE SKIPPY!!!!!!

Dr. Hoover said he stayed around (180) for the procedure. Not sure if they gave him anything, but
+17.42 (349). Guess we won't be skipping tonight's shot, too. In fact, sounds like a good time to go back to the 7/7 shot time.

INSULIN/METER: Dr. Hoover isn't familiar with Levemir (only uses Lantus) but wrote the prescription for Levemir. He also isn't familiar with ReliOn meters, so asked me to bring mine in. (I had taken it with us this morning, but we got to talking about teeth and never went back.) I don't know how he checked it out, but returned it to me with his approval.

LABS/X-RAYS: At our former vet, I always felt like I had to explain WHY I wanted copies of whatever was done. I asked today and he said it was a great idea to have a baseline handy should we need to take him to the ER. He showed the X-rays and pictures taken before and after and offered to email me a copy!

GLUCOSE in URINE: He said it is unusual to find a diabetic cat with NO glucose in his urine. He said that means he's either really well regulated or doesn't need insulin. When I told him we saw (351) 12/10 PM, he said he must be really well regulated.

EATING: We got home almost 2 hours ago and Hershey was STARVING! He has since eaten almost a jar of baby food and looks like he could eat me because I'm rationing it out every little while!

POST-OP: He was sent home with one dose of buprenex for later tonight and a fentanyl patch to be removed in 4 - 5 days.

:-D :-D "Assessment: Hershey did great for his examination today. You are doing a fabulous job regulating his diabetes!" And on his discharge summary: "Thank you for entrusting us with Hershey's care today. He was a trooper!" I've got to say this was great to hear/read, especially when the last vet always complained how hard he was to handle. At our former vet's, it took two people to get his weight. Today, the tech did it in the room with us - not a kitty peep to be heard.

QUESTION: Oreo has been hissing at Hershey since we got home. That's just not like Oreo. I know Hershey probably smells funny and maybe Oreo knows he's a little under the weather - unsteady on his feet, a little glassy-eyed, etc. My question is - will Oreo recognize he can more easily dominate Hershey/bully him now or will he mellow?

THANK YOU for holding our hand through this!!!!!!
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

QUESTION: Oreo has been hissing at Hershey since we got home. That's just not like Oreo. I know Hershey probably smells funny and maybe Oreo knows he's a little under the weather - unsteady on his feet, a little glassy-eyed, etc. My question is - will Oreo recognize he can more easily dominate Hershey/bully him now or will he mellow

When Bob and Mullet were with me, this happened every time one of them went to the vet. The one that came home had "vet scent" on him, and the other would hiss and spit like a tough guy. Occasionally Mullet would whap Bob, no matter which one was just home from the vet. But Mullet in general had a bad attitude most days (there's a reason I usually refer to him as my grumpy ole orinch boy). It never went beyond the hissy/spitty "greeting" though, Libby. For the most part, the cat just coming back home would remain away from the other one.
Oreo probably smells "weirdness" on Hersh, and can tell he's stoned. But if they don't normally get aggressive with each other, this will probably pass by tomorrow. Just spend a little time with just Oreo so he doesn't feel like you're paying too much attention to the "stinky one". :lol: A couple times I would take a towel, rub down the one that had been to the vet, and then rub down the one who hadn't. So they could share the scent.
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

I'm glad Hershey is home and the dental went well. I've had the hissing thing happen too when I've brought one of my cats home from the vet. The other cats just don't like the smell. I agree with Carl that it should pass by tomorrow. Sending prayers for a quick recovery for Hershey.
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

what a wonderful report - that's fantastic that the vet was open to what you're doing. maybe his other clients don't stick with hometesting because they didn't find FDMB to coach and support them. let that vet know we're here!

so glad Hershey's doing ok!
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

I'm glad the dental went well, today :) and :YMHUG: I know you're glad he's home.

I have heard of the rubbing a towel on one and then the other and back and forth to spread the scent around. I think that's a good idea.

I only get the one year live virus vaccines. Once, years ago, both of my cats had lumps about a month after they received their vaccines... and the lumps (located at the back of their necks/scruff area) eventually and very very very slowly went away (but it was very scary). I call ahead now to "order" the one year live vaccine or just insist on it. I also watch the vet closely and talk about it and make sure that they give the vaccines in the legs, not the scruff.
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

Yay! I'm glad to hear everything went well and you are pleased with the care. That is such a relief. :-D :-D :-D Maybe keep Oreo in another room if he starts to act aggressive. Hersey will back to normal tomorrow.
Liz
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

Wonderful report - yay for a successful dental! I get some of that funny hissy fit stuff, too, when one of my herd returns from the vet. It's as if the siblings don't recognize him/her, but it is usually very short-lived. Have a relaxing evening, guys!!
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

I'm glad all went well and it sounds like the vet is a keeper.

Did the vet give you instructions re. getting the patch off? I've had experience with it being hard to get off. You can use mineral or vegetable oil or Avon Skin so Soft to remove it. Also, don't let the grandkids handle the patch.
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

- Hey, Carl - Good idea about the towel. I tried it; neither of them liked being rubbed with it. The hissing did stop...briefly. :YMSIGH: Yepperz, stoned is a good description. I'm used to one hissing if the other has been to the vet - well, it's usually Hershey doing the hissing no matter which went to the vet. But, they BOTH went to the vet today. Maybe the anesthesia left a different scent?

- Thanks, Carla. I do hope the hissing is gone by the morning. Hershey seems to have enough to deal with without his little brother acting up.

- Julie - I mentioned being part of an online group, maybe I should email about it so he can read it when he gets a chance. It is nice to feel like we have a little vetty support!

- Dyana - Those vaccine site lumps do sound scary! Glad they went away. I'm not sure where they injected, guess that's a question to ask.

- Liz - I've been trying to keep the boys separated, but it isn't working as well as I'd like. I keep trying to bring Hershey into the living room - covered an auto shut-off heating pad with a towel and put in his favorite chair. He walks into the other room. :YMSIGH: Each one seems to find a reason to walk past the other. Now, Oreo is sleeping next to Jessica, maybe he'll be over it when he wakes.

- Amy - Thanks, hoping the evening gets more relaxing. We'll see...

- Sienne - No, they didn't give us directions for the patch removal. The tech said it was like removing a band-aid. She said we could either bring him in for removal or do it at home. Thanks for the ideas for removal! Dreading it actually. Jessica said, "EW! It's like removing a band-aid from a hairy man!!" :lol: :lol:
 
Re: 12/11 - 12/12 Hershey - Home & QUESTION

Oh yeah, both went...in that case, the towel isn't likely to do the trick, duh! Maybe not a different scent from the anesthesia? Maybe his mouth or breath just smell different? Or Oreo might smell a hint of blood from Hershey's mouth? More than likely, Oreo feels an "advantage" because he knows Hershey is a little "off" due to the pain meds.

Jessica said, "EW! It's like removing a band-aid from a hairy man!!" :lol: :lol:

Jessica, it's even worse....He's covered in hair....imagine pulling a 12 x 12 sticky icky patch off a really hairy backed man.... :lol: :lol: :lol: Sleep well and try to keep that image out of your head! :lol: :lol: :lol:
 
UPDATE:

Hershey doesn't want to make use of the heating pad or even be in the living room with the rest of us. I tried removing the heating pad/towel from his chair to see if that was the problem. I did get him to lay in the chair as long as I kept my hand on him, not applying pressure, just touching him. As soon as I removed my hand, he got up.

He retreated to the dining room, to the feeding mat. He has happily eaten everything I offered, so that part is good. He's drinking a lot - maybe it feels good to his mouth? When he's not drinking, he's just staring at the water bowl. Maybe having medication-induced visions?

Well, Oreo is awake now and the hissing continues... :YMSIGH:

PMPS (368) +20.25 - Shot .5u at 7:00pm + 1/8th tsp Miralax
+3.5 (288) - going to offer more food
 
So glad Hershey is home and all went well :-D I know how relieved you must feel cat_pet_icon
Your vet sounds wonderful! Once Hershey isn't zoned out, he will probably give Oreo a whack, and order will be restored :lol:
 
I'm glad all went well with Hershey's dental. I hope aired will settle down more....poor Hershey!

Sending healing vines...I hope he is 100% tomorrow but great he is eating.
 
Aw, I hope the hissing settles soon. I wouldn't be surprised if Hershey is have some "visions" right now! Hopefully things will be much more normal tomorrow.

With regards to the pepcid I mentioned in Trix's condo...I think the stomach acid is the result of an empty tummy, because like Hershey, any time she does the spit up thing, it's close to meal time - I think the acid overtakes since there is no food in the belly, so I'm inclined to think it's pretty much your thought about them being hungry. Our GA, Mario, would do the same thing when he got older, too. Our vet told us to give him Pepcid at night (1/4 of a 10mg basic tablet - no fancy extras). I need to schedule a check up for Trix anyway, but I'm going to start giving her some pepcid in the meantime.

Feel better and settle in Hershey - and Oreo!
 
Doug N Libby said:
Yeah, thanks for that Carl - I'll never get THAT image out of my head!!! :lol:

You're welcome. Happy to serve.... :lol:

The patch, that's a pain med too? When Bob was on bupe, he didn't really want to be messed with either. At that point, he couldn't move around all that much or that well, but when I'd get close to him, he'd try to move to the other end of the sofa or bed. I think he just felt like "please leave me alone?"
 
Wonderful update Libby :-D And it sounds like your vet's a winner! Good job Hershey on having an appy after all that work.
I agree with Jane
Once Hershey isn't zoned out, he will probably give Oreo a whack, and order will be restored :lol:
:lol:
Good luck getting Carl's dreamy vision outta your head tonight :lol:
 
YAY for a happy dental report! I knew he'd come through with flying colors! (same with you!!!! ;-) ) Scritches to the good boy!!!
 
- Thanks, Jane. I look forward to Hershey feeling well enough to give Oreo a good whack. ;-)

- Thanks, Marje. I was all prepared for him to not want to eat. Instead, he was almost knocking me down to get to the food!

- Thanks for the pepcid info, Amy. I forgot to mention it to the vet today, but that sounds like it just might help Hershey.

- Carl - Trying to give Hershey some space, but it's such a cold night, I felt certain he'd at least want to be in the warmest room. But, what do I know? :roll:

- Thanks, Kim. Yeah, pretty sure Carl's image will give me nightmares... :lol:

- Michelle - I'll be sure to tell Oreo you said no more hissing. Jessica covered his eyes to carry him past Hershey and put him to bed by her door. Haven't seen Oreo in the last few minutes, so maybe he stayed there. He often will, if she's in her room.

- Thanks, Deborah. I'm looking forward to Hershey welcoming scritches, again. I am pleased with how well today went, though. Couldn't have asked for better communication from the vet's office and it looks like they took good care of Hershey. Can't ask for more than that. :smile:


**I'm going to try to test Hershey once more, leave a little food out and head to bed. He's been less than cooperative about testing tonight. I've been getting Doug to do it, for fear of hurting Hershey. But, Doug is asleep so guess I'll give it a whirl.

THANKS, again, for all the visits, prayers, well wishes and hugs!!!! Y'all are THE BEST!!!!
 
- Carl - Trying to give Hershey some space, but it's such a cold night, I felt certain he'd at least want to be in the warmest room. But, what do I know? :roll:
Libby,
You have three grown-up children and have been married for a long time....
You should know the secret to success....
Reverse psychology! ;-)
 
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