PaulaM
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Post by PaulaM on Mar 29, 2015 14:40:07 GMT -7
Well if you increased Tramadol yesterday because of pain, doesn't make a lot of sense to stop the Metacam tomorrow. Maybe get with your vet for a more days of metacam, then stop metacam. Have a plan with your vet to back off or stop tramadol and gabapentin. Some vets do taper pain meds depending how long the dog was on the meds and some do not taper. Always good to check with your vet.
The true test of whether there is painful inflammation still is the stop of meds. Pain meds are stopped (backed off) and the Metacam is stopped for the clearest, truest and fasted test. You at home will be observing for any hint of pain to report to the vet so that Metacam and pain meds can be used for a bit longer. A vet is just making a guess that all the swelling might be gone... only the stop of all the meds tells the true story. If there is no pain on the stop, then no meds at all are needed.... just the finish of crate rest to let the disc heal.
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Post by Nancy & Maisy on Mar 29, 2015 19:53:57 GMT -7
Thanks, Paula! I'll talk with the vet tomorrow and come up with a plan.
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Post by Nancy & Maisy on Mar 30, 2015 22:39:28 GMT -7
Mo has had a foul smelling poop 2 nights in a row. It seems to me that I read a caution about this on the site, but I can't remember where I read it and can't find it. I just read about each of his meds again and didn't see anything. Any concerns?
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Marjorie
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Post by Marjorie on Mar 31, 2015 5:18:54 GMT -7
The concern would be with loose stool or diarrhea, which is a side effect of the Metacam. Is the stool still formed or is it loose? No dark or bright red blood?
What had the vet said about continuing all meds due to the fact that Mowlgi still had pain a few days ago? Is she still on all meds, including Pepcid AC 2x/day?
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Post by Nancy & Maisy on Mar 31, 2015 6:13:36 GMT -7
Yes, still on meds including the Pepcid. We finished our vet prescribed week long course of [finished] Metacam last night. The vet said to slowly decrease the pain meds and let him know if Mo seems to be in pain. I've written back asking for more specific instructions than to "slowly decrease the meds".
No blood in his stool; just stinky and formed.
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PaulaM
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Post by PaulaM on Mar 31, 2015 8:10:25 GMT -7
Do let us know how many mgs and how often to give is what the vet is Rxing for the "slowly decrease the meds" Good to hear stools are formed. #2 picture is the ideal poop as it is firm and feels like Play-Doh when pressed. What you do not want to see is #6 or #7. Has there been any change in diet that may be the reason for stinky stool: dairy products of any kind, change in kibble product, using canned food? Change in Mowigi's appetite, not wanting to eat as much?
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Post by Nancy & Maisy on Mar 31, 2015 8:52:49 GMT -7
Looks like pic 2. No appetite change; voracious as always. Dietary changes:, added 1 Composure/day and the Vetri Disc, sweet potato chews I made for him (by dehydrating them in the oven), peanut butter (wrapping his meds in a little so it goes down easily). That's about it.
Will let you know what the vet says.
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Post by Nancy & Maisy on Mar 31, 2015 18:24:35 GMT -7
I sent a meds tapering plan to the vet and he replied and said "I like the plan. Very safe tapering schedule to avoid side effects, good job."
Today: Stop Metacam Reduce Tram to 12.5 q8h Gabapentin to 100 mg q12h
Tomorrow: Tram 12.5 mg q12h Gabapentin 100 mg q24h
I started the 12.5 of Tram with his 2nd dose today. We'll see how it goes. We're watching him carefully for signs of pain. I still have some Metacam if it's needed.
As far as the Pepcid goes, I'm thinking I'll keep him on it in case we need to start the Metacam again in the next day or two???
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PaulaM
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Post by PaulaM on Mar 31, 2015 19:00:54 GMT -7
Got our fingers crossed you will not see any pain as the pain meds are tapered down.
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Post by Nancy & Maisy on Mar 31, 2015 19:18:45 GMT -7
As for the Pepcid, I'm thinking I'll keep him on it in case I need to start the Metacam again in the next couple of days. What do you think?
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PaulaM
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Post by PaulaM on Mar 31, 2015 20:00:47 GMT -7
Pepcid AC is active within 30-60 minutes of giving it and is active for 12 hours or so. So unless you are seeing signs of not wanting to eat, vomit, diarreah now that Metacam has stopped, he probably does not need it.
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Post by Nancy & Maisy on Mar 31, 2015 22:47:30 GMT -7
I'm glad I gave the Pepcid tonight because he's not ready to taper, as you thought (me, too really). Just before tonight's reduced Tram, I was trying to put on his little fleece coat and he let me know in no uncertain terms that I wasn't to touch his left flank area or his belly on that side. He flung his head around and growled. I just wrote to the vet and let him know that I gave the Metacam and upped the Tram to 25 mg. Tomorrow I'll go back to the
[22 lbs.] 37.5 mgs Tram [how many times per day?] 100 Gabapentin [how many times per day?] and will keep giving the Metacam.[mgs? frequency?]
I asked the vet to let me know when he'd like me to try stopping it again and tapering. I mentioned that I read here that it can take up to 30 days. Other than that area being painful, Mo was in great spirits tonight. He enjoyed being less dopey from the meds and the attention he got as I cleaned his ears and wiped him down with a watermelon scented dog wipe. Good appetite, walking, peeing and pooping well on potty breaks. It's hard to keep a young dog quiet and resting and I'm doing my very best for him.
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Marjorie
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Post by Marjorie on Apr 1, 2015 6:06:47 GMT -7
Good job on advocating for more time on all meds with your vet, Nancy. It's not uncommon for the first tapering to still show signs of pain. Hopefully, the next taper will be pain free. Is it very cold where you live that he needs to wear a coat when going out for potty for a few minutes? My concern is that it may be more movement than necessary putting a coat on him, unless it's the kind that just drapes over him and fastens at the neck and belly. If it's the kind his legs have to go into openings, I'd consider taking him out for a quick potty without it. Though last night it was a good test in that it made you aware of his pain. Keep up the good work with him.
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Post by Nancy & Maisy on Apr 1, 2015 11:22:47 GMT -7
Thanks, Marjorie. It's not very cold here in Seattle; rather nice, actually, but he's a shorthair and I just leave his fleece jacket on him all the time since he's cool from not moving around much. I washed one and was putting on a clean one last night. These have no leg holes and just wrap around him and fasten with belly straps. My husband made them! He loves Mo so much. Do any of you have concerns about using these NSAIDS with the risk to the kidneys? I asked the vet and he said there's always a risk to the kidneys with Metacam. Since Mo's pain is localized to his left hind end and he is perky and doing well otherwise, I'm going to try Traumeel for him and see how that goes for him. I'm not sure it would be effective for a dog in deep and more generalized pain, but I think in Mo's case it's worth a try. I'm reading that it works as well as Rimadyl in dogs with advanced arthritis and has good anti inflammatory effects. I ordered some and will start it Friday when it arrives. I just let the vet know what I'm thinking and we'll see what he has to say.
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Post by Linda Stowe on Apr 1, 2015 12:08:37 GMT -7
Nancy, as your vet said there is always a risk with NSAIDS and for any other med your dog is given. Dogs should always have a blood test before taking a steroid or an NSAID and if on it for a longer term, done again to check kidney and liver function.
As for the Traumeel it can be used for inflammation but for IVDD the stronger meds are needed because they cross the blood/brain barrier to reach the disc. Traumeel is a Homeopathic pain reliever for minor pain. Most supplements and homeopathic pills will not cross the blood/brain barrier.
Let us know what your vet says.
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Post by Nancy & Maisy on Apr 1, 2015 20:59:32 GMT -7
This morning Dr. Hicks emailed and said that ultimately, he recommends and MRI for Mo; to see what we're up against and for diagnostic and prognostic purposes. I'm all for it, except for the fact that I've read here that the back is at risk under general anesthesia. I've asked him about that and asked what they can do to mitigate the risk to Mo. What's your opinion? I certainly don't want to cause further injury to his spine with an MRI. If there is a way to support the spine during the MRI... can they use supports or something?
At our appointment, the doc said that an MRI wasn't indicated, but now he feels it is because Mo is still showing signs of pain. My questions center around whether it's better to just continue conservative treatment and forego the MRI, since that's what we'd do regardless of the MRI results (I would think)or is it better to find out exactly what's going on with his spine? When I write it out here, it helps to process things. I would think it's better to forego the MRI if it's risky. His treatment won't change and from what I understand, it's possible that his spine could be further injured during an MRI and general anesthesia. It seems as though the vet may be expecting a faster healing for Mo, when I would expect that he needs a full 8 weeks of rest to see real results. The vet's literature sent home with me recommends 4 weeks of crate rest (although he didn't say a thing to me when I told him I'd do 8 weeks), which makes me think they don't quite get it. I like and respect this vet, but not everyone has the knowledge that's here on this forum. He also recommended that I let Mo walk more on his potty breaks to prevent muscle atrophy and also said that he could rest outside his crate so he could have time with me. So, I'm thinking that the MRI rec might fall into the same category as those recommendations. What do you all think?
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PaulaM
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Post by PaulaM on Apr 1, 2015 22:11:49 GMT -7
Nancy, Mogli has only been on metacam since 3/23 (10 days) now. Vets do need to be careful in support of the spine during an MRI which requires anesthesia. I'm most assured that Dr. Hicks would know the proper way to support Mo's back.
If there is not a suspicion of something else besides the disc episode going on, if surgery is not a consideration for your family, if pain is under control, if there are no sudden neuro diminishments then knowing exactly which disc via an MRI picture would not change the current course of treatment-- 100% strict rest. Metacam can take from 7 to 30 days to completely get the swelling down. It is prudent to stop the metacam and pain meds to verify if all the swelling is gone. No one wants to be using metacam any longer past the benefit period. Do not be dismayed that the first round of metacam did not get all the swelling down. A vet has to make a guess when to stop the medication that is the only way to test if it needs to be used a bit longer or ready to stop permanently.
I have my fingers crossed that ultimately Mo will not need an MRI/surgey but will find that conservative treatment will get the job done
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Post by Nancy & Maisy on Apr 5, 2015 14:19:31 GMT -7
Before our progress report, a question: I gave Mo a chew treat; a Kong double chew. They're soft rawhide treats. Is it okay for a non cervical dog to chew vigorously? They seem like a life saver in terms of keeping him occupied and happy for part of the day, but I don't want to aggravate his back issues.
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PaulaM
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Post by PaulaM on Apr 5, 2015 15:13:11 GMT -7
If the chewing is causing his back to move, then the vertebrae are pushing on the weak early healing disc. That deafeats the principle of 100% STRICT crate rest 24/7 Sounds like there is more movement than a little bit of jaw action
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Post by Nancy & Maisy on Apr 5, 2015 17:25:25 GMT -7
Thanks. I thought better of it after giving it to him and decided to ask. No more chew treats. Poor guy is so bored and unhappy. I'm trying to find things to brighten his day. He didn't like being in the stroller the one time I tried it, so it's hard to give him a change of pace.
Meds update: my vet has me pretty confused, between him wanting the meds stopped and wanting an MRI. I last heard from him on Thursday. He said I was welcome to continue conservative treatment, but that when a dog continues to have pain beyond 1-2 weeks, he recommends an MRI for diagnostic/prognostic purposes. Then he went on to say that he thought it was probably best to stop the meds and see where Mo is at. So I stopped the Metacam and Gabapentin on Friday and the Tram Friday night. I've been giving Mo Traumeel because I want him to have some sort of pain reliever on board. What I'm seeing is that he appears generally comfortable (no trembling, shaking, contractions, groaning when picked up, panting, whining, etc.) But he still growls at us occasionally when we unsnap his harness (front right side of his body) and he's still protective of his flanks. This tells me that the swelling is not gone. Mo is a very happy little guy and he played and romped and ran despite his pain and this is why it took us so long to figure out that he was in pain prior to starting his crate rest. What I'm seeing is that not much has changed, except that he is no longer grunting when he's picked up to go potty.
What I'm thinking is that I will email the vet tonight and explain this to him and ask for more Metacam, tho' I hate giving it to Mo after all I've read about it. It seems like a pretty dangerous drug and I wish that there was something safer. I called the ER vet and got a
new short prescription of Tram and am giving that again. THey would only give me a weekend script because the chart says to stop meds if possible.
I'm not sure if Gabapentin is necessary. I don't see any signs of nerve pain; no licking, etc., but I can't be certain he doesn't have any. I am also going to tell the vet that I feel an MRI may be a great thing, but AFTER Mo completes his crate rest. I don't see the need now to risk further injury to his bulging disc by transporting him and putting him through the procedure at this time.
Thoughts?
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PaulaM
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Post by PaulaM on Apr 5, 2015 18:17:02 GMT -7
Your regular vet may not feel comfortable in treating with conservative treatment. It can take anywhere from 7-30 days on Metacam before all the swelling is gone. At marked periods Metacam (including Traumeel) should be stopped as well as all pain meds in order to have a clear picture on the state of swelling. Traumeel, muddies the waters in a test of stopping pain meds and Metacam. It is important for you to have a good understanding how IVDD meds work so you can be confident when to advocate for things. Two very important pages explaing pain meds and anti-inflammatories www.dodgerslist.com/literature/healingpain.htmwww.dodgerslist.com/literature/healingsweling.htmSnapping at you or protective of his flanks can be either pain or possibly learned/expected pain. I would stop traumeel at the next time you stop metacam and pain meds, observe for more than one sign of pain as two or more help to confirm pain: shivering, trembling, yelping when picked up or moved, reluctant to move much in crate such as shift positions or slow to move, tight tense tummy, can't find a comfortable position, Arched back. Not their normal perky selves. Safety in use of meds comes from two avenues. The vet uses meds in a safe manner such as calling for a blood test to confirm organ health. The owner must be up to speed on each med their dog is on.... what side effects to monitor for. The FDA has a very good flyer to help you know about NSAIDs: www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm196295.htm and you can also read more about Metacam at the Mar Vista Vet web page: www.marvistavet.com/html/pharmacy_center.htmlGabapentin is used not just for neurpathic pain but in conjuction with Tramadol for over all better control of pain. At the end of conservative treatment and Mowgli has healed his disc and is in no pain, then an MRI will not be of value.... Mowgli would have healed, would not need surgery. These two pages will help you sort out ideas about surgery: www.dodgerslist.com/literature/healingsurgery.htmwww.dodgerslist.com/literature/surgery.htm
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Post by Nancy & Maisy on Apr 5, 2015 19:45:35 GMT -7
Thank you for the links, Paula. I've read them, but it's always good to read again.
Wouldn't an MRI show how many discs are calcifying and give us an idea of what we're looking at?
Sorry, I should have specified; I'm not talking about my regular vet. I'm talking about the neurologist.
Guess I screwed up with the Traumeel. I'll stop it and see what I see. Like I said, the only sign of pain we're seeing is the growling at the harness snap and protective of his flank area. Otherwise, he seems pain free BUT besides the couple of times that he yelped prior to crate rest, these are the only symptoms we've ever seen with this little guy. Makes it kind of hard to tell what's going on.
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Post by Deleted on Apr 5, 2015 23:42:19 GMT -7
Calcification will show up on an xray, and it is the vertebra (bones) that calcify. MRI's show the disc, which is a substance between the vertebra, and will show how far out it has been pushed and the amount it is pressing on the spinal cord. The disc cannot be shown on xrays as it is not bone. MRI's are not as good at picking up bones, it picks up other things much better.
My dog had xrays which showed no calcification, all the vertebra in perfect alignment, etc. An MRI showed a very significant disc extrusion, much more than one would expect to see, based on how good the xrays were and how functional she was, and how mild the symptoms were. But it has allowed us to understand the level of pain that she is in, and explain that pain, to know exactly what we are dealing with, where the injury has occurred. etc. I do not regret having an MRI, it has explained so much for me, and I do not believe it made things worse for my dog. She was no different before or after it and not in any more pain. But everyone is different, and it is a large expense.
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Marjorie
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Post by Marjorie on Apr 6, 2015 4:47:03 GMT -7
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Post by Nancy & Maisy on Apr 6, 2015 23:04:16 GMT -7
Thanks, Marjorie, it's good to re-read these. I understand your points about the MRI and this was why I expressed confusion about our neurologist recommending one for Mo.
Mo has been off the Metacam, tram and gabapentin for 3 days and the traumeel for 1. He seems comfortable and has shown no signs of pain at all today. He's no longer groaning when he's picked up to go potty. I lightly touched him on his hind end in different spots earlier and he didn't react. So far, so good. I'll continue to watch, of course.
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Marjorie
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Post by Marjorie on Apr 7, 2015 11:25:25 GMT -7
Good news on no signs of pain, Nancy. Fingers crossed that no pain returns over the next couple of days proving that swelling is gone and all that will be needed is the continuation of the strict 8 weeks of crate rest.
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Post by Nancy & Maisy on Apr 18, 2015 14:25:42 GMT -7
Sorry for the long pause between updates. My female doxie is just being diagnosed with hip dysplasia and I've been preoccupied and busy with that. She's one and a half. I've found a HD board to join.
Update: 4 weeks of crate rest today and Mo is doing well. He's being a real trooper and is accepting of his crate rest; pretty amazing for a 3 year old. He is off all pain meds (for about 5 days). After my last post he began growling when his flank area was touched so I consulted with the vet and let him know that I started the Traumeel again. We discussed the possible need to discontinue the Traumeel and start a 2nd round of Metacam. I stopped the Traumeel about 5 days ago, following vet's instructions to allow a 48 hour wash out and he called the Metacam into my regular vet for me to pick up. Well, in the meantime our weather has warmed and we've removed Mo's fleece jacket. Since jacket has been off - no growling. It appears he's more nervous about us undoing the Velcro fasteners than being in pain. Since the coat has been off I've been able to touch him anywhere with little or no reaction and absolutely no growling. He will sometimes turn and look when touched on the left side flank, but that's the only thing I'm seeing. No other signs of pain. We plan to complete our next 4 weeks of 24/7 crate rest.
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Post by Nancy & Maisy on May 8, 2015 12:36:31 GMT -7
Mr. Mo has been doing so well, then last night I reached under his belly to fasten his jacket strap (still chilly nights here) and he yelped. It was a true yelp, not a grunt or low growl. I took a moment to clear the disappointment that rushed through me, then let him walk one step out of his crate and tried it again. No yelping and I was able to touch him all over his underside with no reaction. Absolutely no other signs of pain, but this was the case when I first noticed symptoms 7 weeks ago; very occasional yelping and nothing else. My neuro is not in his office today. I've emailed him to let him know, but he wont' be back til Monday. I made their 1st available appointment for a recheck - it's not until Tues at 10 am. I'm concerned we have a recurrence of swelling. They can't prescribe more Metacam without Dr. Hicks unless I take Mo in thru ER before then. Or, I suppose I could take him in to the regular vet. Maybe I'll just call them and see if she'll prescribe? Or do you think I should wait until we see Dr. Hicks? It's a tough call with Mo. This is the only sign of pain he's ever shown and it's so sporadic. I'm not sure what to do. Please give me your opinion. Thanks!
I have a call into our regular vet to talk with her. Mo has been off of Metacam since mid April; I don't think the regular vet's office carries Metacam and my pharmacy doesn't (just called and asked). I just want to double check with you all that it would be okay to switch to Rimadyl if she prescribes it. He has had no NSAID or pain meds since on or around 4/13/15. I know I've read here that there's a 4-7 day wash out period but just want to double check.
Added a few minutes later: I just found that I still have at least 6 daily doses of Metacam left in the bottle. I was checking for Pepcid AC in the medicine cabinet and came across the Metacam. If the vet will agree, I'll start him back on it today, along with his Pepcid 30 minutes prior. I also have Tram and Gabapentin on hand.
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Post by Nancy & Maisy on May 8, 2015 13:12:34 GMT -7
I have a call into our regular vet to talk with her. Mo has been off of Metacam since mid April; I don't think the regular vet's office carries Metacam and my pharmacy doesn't (just called and asked). I just want to double check with you all that it would be okay to switch to Rimadyl if she prescribes it. He has had no NSAID or pain meds since on or around 4/13/15. I know I've read here that there's a 7 day wash out period but just want to double check.
Added a few minutes later: I just found that I still have at least 6 daily doses of Metacam left in the bottle. I was checking for Pepcid AC in the medicine cabinet and came across the Metacam. If the vet will agree, I'll start him back on it today, along with his Pepcid 30 minutes prior. I also have Tram and Gabapentin on hand.
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PaulaM
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Post by PaulaM on May 8, 2015 13:20:51 GMT -7
Nancy, he's been off of all meds since Aprl 18?
Has Mo been too active in his crate or at potty times that might explain the painful yelp? This is really tough to know what is going on... expectation of learned pain, a pinch putting on jacket or the healing disc had too much movement and a little tear to the forming scar tissue???
Since you are not seeing any other signs of pain and no more yelps, I might be inclined to observe until you are seeing signs that it is necessary to get him checked out at ER if it would happen before Dr. Hicks returns on Monday. Please do let us know how things go and what you observe.
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