Our Own Bienville AMC Veterinarian Elected To American Heartworm Society Board

beinville-dr-dukeDr. Chris Duke of Bienville Animal Medical Center in Ocean Springs, MS was recently elected to the Board of Directors of the American Heartworm Society.  The board is composed of representatives from academia, industry and veterinary practice.  Dr. Duke was elected to a three-year term on the board as an at-large member at the American Heartworm Society Triennial Symposium in New Orleans in September.

Dr. Duke, co-owner of Bienville Animal Medical Center, is a 33-year veteran of veterinary practice and has been heavily involved in professional, church and civic organizations for many years.  He is also a member of the American Society of Veterinary Journalists and writes weekly columns and blogs on veterinary-related topics.

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Is There A Correlation Between Gulf Hurricanes And Heartworm Cases In Dogs?

At first glance, I know that you’re wondering….say what?  I thought that the problem with heartworm disease was that a larval-carrying mosquito bit a vulnerable dog (not on a preventive), and that was the way the process started.  What does wind and water have to do with this?  Aside from maybe a bit of heat and humidity and a transfer vector, what else does dirofilaria immitus need to thrive?

At the recent Triennial Symposium of the American Heartworm Society in New Orleans, Dr. Clarke Atkins, DVM, DACVIM (SAIM, Cardiology), addressed this seemingly off-beat topic.  After communicating with inland veterinarians in places like Shreveport, LA and Oxford, MS, Dr. Atkins found that positive diagnoses of heartworms and adulticide treatments became more prevalent in the year after hurricanes affected the gulf.  The core question of course is why?

According to Dr. Atkins, as we as coast people know, when there is a shake-up of our structures, like homes, fences and neighborhoods from damages, pets roam free.  Atkins called it post-storm “chaos”.  Dogs went free, and in the case of Katrina, many were rescued and relocated to inland shelters.  From that point, many were vaccinated, heartworm tested, dewormed and adopted out.  It is estimated that 250,000 dogs from the greater New Orleans area and up to 100,000 from South Mississippi were processed in this manner.  Of course, many dogs were found to be heartworm positive-so we’ll call this pre-existing disease.

Then, Dr. Atkins cites the point that refugia-native animal populations- contribute to the problems well.  In the Mississippi delta, other canine and canine-type hosts (wolves, coyotes, wild dogs, etc.) also enhance the spread of the disease.  Once again, just as with unprotected domestic dogs, these hosts are just as dangerous as any to propagating more potential for the spread of heartworm disease.

Then there’s water.  This is not to blame our coastal flooding but waters to our north.  The increased rain from the hurricanes contributes to not only standing water problems, but even significant rises in lake levels.  After the storm-laden hurricane season of 2005, Lake Sardis near Oxford even rose to record levels after Katrina, Rita and other named storms from that year.  Do mosquitoes love standing water?  Oh yeah.  There’s your connection.

Dr. Atkins had a chart that showed the lag effect of positive heartworm cases diagnosed after Hurricanes Elena (1985), Georges (1998), Lili (2002), Ivan (2004), Katrina (2005), Gustav (2008), and Isaac (2012).  The same chart showed the quiescent periods of lower heartworm diagnostic rates in the times when we had no hurricanes in the previous year.  Although there was a question as to whether the “delta” should be singled out as a local hotbed for heartworms, I personally think that the three main reasons Atkins cited stand on their merits whether we focus on that specific area of Mississippi or use broader parameters.

So what about the people who adopted and had these dogs treated?  Should pet owners in Massachusetts or Pennsylvania be concerned that the risk of heartworm disease goes up in their region once these dogs are transferred up?  Dr. Atkins says yes, because the presence of a heartworm positive dog greatly increases the potential for the disease, especially if the area is vulnerable (mosquitoes present and unprotected dogs).  That statement really re-framed my thinking, as for years I have always held that without the bite of a vector-host (mosquito), direct communicability of heartworms from dog-to-dog was never believed to be a problem.  My thinking has indeed expanded on this subject.

I guess this old dog needed to learn a new trick.

Have a great week with your pets!

Dr. Chris Duke

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Kidneys – Most Vital Organs

Often times in veterinary practice, pet owners ask me about the most common reasons that we lose pets.   Certainly, being hit by an automobile takes the lives of many pets.  So also are attacks by other animals (and occasionally man).  Yet, I often surprise pet owners when asked about the most common natural causes of pet death.  Sure, the answer may lie in heart disease topics.  Yet, kidney failure is right up there with the heart when it comes to veterinary cases.

Particularly in cats, kidneys are the #1 cause of natural death by organ failure.  This often happens in conjunction with tissue aging, or as a nephrologist might say, “loss of functional nephrons”, or cells of the kidney.  Yet, these paired organs, which much rid the body of excess internal fluid waste can cause a problem in the prime of life from other causes.  For example, poisonings and infectious disease can also lead to loss of functional kidney tissue.  Occasionally, the tissue may turn upon itself in the unusual circumstance of autoimmune disease.

For the most part, we as veterinarians try to actively treat the entire spectrum of kidney diseases when we are faced with the challenge.  Commonly, we utilize intravenous fluids to not only rehydrate the dehydrated pets, but to also re-activate dry, dormant tissues of the kidney.  In the case of infectious disease, we commonly use antibiotics systemically, as long as they are kidney-friendly in nature.  We also control symptoms such as nausea, anorexia and diarrhea, which can often accompany kidney disease.

Once the patient can get to the point of eating food voluntarily, kidney tissue is further spared by using a special diet like the k/d food.  One such food is the k/d food (a.k.a. “kidney diet”) from Hill’s.  Veterinarians often request that blood tests, which were used to diagnose the case originally are repeated once the therapy progresses.  In that manner, improvement can be measured.  Unfortunately, not all kidney case treatments are successful.

The cases such as the aforementioned, brought on by failing kidneys from old age and poisonings causing irreparable damage often yield a poor prognosis.  Try as we may, veterinarians must prepare pet owners properly for these tragic outcomes.  Transplantation is impractical in veterinary medicine at this time because of lack of donation banks and also because many canine and feline patients are at such a high risk for the procedure by the time the patients are presented and diagnosed.   Some veterinary teaching hospitals have succeeded in transplantation on selected patients and at a great economic expense.

The truth to the matter is that when it comes to kidney treatments in pets, there needs to be clear communication between the pet owner and the veterinarian.  Owners need to be cognizant of the risks inherent to these cases, and veterinarians need to be cautious about outcome.  Establishment of a proper diagnosis and prognosis is the key in the client-veterinary relationship while the storm of pet kidney disease is being weathered.

One way to stay ahead of kidney disease is through blood and urine testing, especially once your dog or cat reaches senior age (over 7 years of age).  In that manner, early detection of kidney disease may take place, and kidney-sparing measures instituted.  Ask your veterinarian to explain the laboratory results, and if your pet seems to be at risk for kidney disease.

We all want the same thing:  A long, quality life for your beloved pet.

Have a great week with your pets!

Dr. Chris Duke

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So What Do You Do With Your Pets If A Hurricane Comes Our Way?

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As I compose this column, there have already been seven named storms (one is still active), and several “invests” that our local weather personalities have pointed out to us as potential threats.   This is not unusual for late August and early September on the Coast, as there is a spike in potential tropical storm and hurricane activity every year at this time.  I have been asked at least once daily by someone locally the central question about what to do with beloved pets should we get one of those nasty storms in the northern Gulf threatening us.  So here is my simple answer:

If at all possible, when you evacuate, take you pets with you.  You may think it strange that a veterinarian who runs a boarding kennel as well might give this advice, but I’ll enumerate five reasons why it’s the best answer.

  • If flood waters or excessive winds threaten your home and the people in your family, they also threaten animals. Those of us who weathered Katrina know firsthand about folks who stayed at home and had tragic losses.  We also know how well-meaning people may had left pets in their garages or sheds only to let them meet a demise that many didn’t see coming.
  • Realistically, there are not enough pet kennels or other animal shelters on the coast to house all the pets that might have a need. On top of that, some veterinary clinics and kennels have even shied away from boarding during hurricanes because of liability issues.
  • There is no guarantee that a veterinary clinic or kennel building will still be standing after a hurricane. Sure, we were fortunate here at Bienville AMC with Katrina, in that our building sustained very minimal wind damage and was above the flood line.  However, less than a half a mile away from us, an associated tornado severely damaged the former Ocean Springs High School and local businesses around it.  One of the saddest signs I saw after Katrina was a posted sign on the front door of a colleague’s flooded out clinic that read “I am so sorry, but the pets here all perished because of the flood waters.”   Just because our clinic has weathered several storms over the years, there is never a guarantee that all will be well.
  • There are more pet-friendly hotels than ever before that want to help. Frankly, it’s getting to the point that the more common way to ask the question is “you do take pets here, don’t you?”.  Certainly I would call or reserve on-line ahead to be sure you and your pets can be accommodated.  Of course, if you evacuate to the home of a family member inland, that it always a good option as well.  If you do hit the road, remember to also take your pet foods, medicines, and vaccination records for proof if you go to a hotel or out-of-town kennel.
  • Who knows how long you will be away, or when the veterinary clinic or kennel will re-open. This may sound like a minor point, but it is quite emotional to some pet owners.  After Katrina, cell and land line communications were down for days.  Even though we had re-opened and were operating with a skeleton crew (whoever we could get back to work), many clients couldn’t get through to us.  Some clients didn’t return for their beloved pets until weeks later.  And from our perspective, even though we re-opened for business fairly quickly, that extra day we were closed seemed like an eternity for a few local people.

So there you have it.  I was trying to count the number of named storms I had witnessed since I began practice 33 years ago.  While I lost count, the five or six memorable ones always bring me back to this same advice.  If you love ‘em, take ‘em with you!

Dr. Chris Duke

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A News Flash: Labs Eat a Lot (But There’s Scientific Evidence Why!)

Labrador retrievers.  They are playful, active and energetic dogs for sure.  If their owners claim that they beg for food a lot, well, they must be quite astute.  Researchers in the U.K. and England have linked a gene alteration specific to these dogs that proves that they possess food-motivated behavior.  The variation occurs frequently in Labradors chosen as assistance dogs.

This study was published in the May 3 issue of Cell Metabolism, and reported by the E-newsletter Newstat.

Starting with an initial group of 15 obese and 18 lean Labrador retrievers, the researchers selected three obesity-related genes to examine, all of which are known to affect weight in humans.  The first analysis turned up a variation in a gene called POMC.

In more of the obese dogs, a section od DNA was scrambled at the end of the gene.  This deletion was predicted to hinder the ability to predict a dog’s ability to produce neuropeptides B-MSH and B-Endorphin, which are usually involved in switching off hunger after a meal.

In a larger sample of 310 Labrador retrievers, the researchers discovered a host of canine behaviors associated with the POMC deletion.  Not all labs with the DNA variation were obese (as some were obese without the having the mutation), but in general the deletion was associated with greater weight.

Additionally, according to an owner survey, affected dogs were more food-motivated: they begged their owners for more food more frequently, and paid more attention at human mealtimes, and scavenged for scraps more often.

On average, the POMC deletion was associated with a 4.6 pound weight increase in the affected dogs.

“We’ve found something in about a quarter of pet Labradors that fits with the hardwired biological reason for the food-obsessed behavior reported by pet owners”, said Eleanor Raffan, PhD, from the University of Cambridge and one of the study’s authors.  Yet, the POMC deletion was present in 76 % of assistance dogs.  “We had no reason to believe that assistance dogs would be a different cohort”, says Raffan.  “It was surprising.  It’s possible that these dogs are more food-motivated and therefore are more likely to be selected for assistance-dog breeding programs, which historically train using food rewards”.

So there you have it.  As an owner of two labs that are not service dogs, I can tell you that I highly suspect the gene variation in Jake and Flo.  Those two will knock the doors down twice daily when they think the grub is overdue.  Food-motivated?  That’s an understatement!

Dr. Chris Duke

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An 83 Year-Old Man Looks To Graduate Veterinary Technician School…And That’s Not All!

Occasionally a human-interest story from within your profession grabs your attention.  In this case, reading about this special man touched not only my mind, but my heart.  I thought I’d share this story with local readers, because it is special on many levels:

This month in Suffolk County New York, Leonard Marino will be graduating with his veterinary technician degree from Suffolk County Community College.  As reported recently by trade journal DVM 360, this amazing man will work in his son Dominic’s veterinary practice as a certified veterinary technician soon.  The twist?  Leonard Marino is Dr. Leonard Marino, a retired pediatrician since 1995.

The elder Dr. Marino has not been resting on his laurels since medical practice retirement.  He had practiced pediatric medicine in Plainview, New York for 31 years, beginning in 1964.  Soon after retirement, he began working in his son’s practice, Long Island Veterinary Specialists (LIVS) for a time, helping edit the practice’s newsletter and assisting in surgery.  He still serves as editor of the practice’s newsletter.  His interest in better understanding the technical content of the newsletters, coupled with a desire to work more closely with his son led him to pursue the veterinary technician option.  Says Dr. Leonard Marino “initially I was in the on-line training classes, but switched to the in-person classes.  I missed that hands-on element that I used to feel in pediatrics.”

The younger Dr. Dominic Marino (DVM, DACVS, DACCT, CCRP) is not only the hospital chief of staff, but performs a lot of surgery in the practice.  The elder Dr. Marino says that his favorite part of working with his son is the time in surgery.  He helps by setting up the drapes and equipment, use the suction and cautery, and assist directly in the procedures.  He also helps post-operatively in these surgeries.  In all, he says that he has assisted his son in over 500 hip replacement surgeries.

Dr. Leonard Marino has no plans for slowing down after he picking up his diploma as a veterinary technician.  He plans to continue assisting his son in surgeries and editing the practice newsletter for years to come-or as long as he is able.

After all, Marino shares, ”my father lived to be 100, so I have some time left in this profession.”

Have a great week with your pets!

Dr. Chris Duke

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Corticosteroids In Veterinary Practice? Think “CIA”

It really depends on who you talk to.  The use of corticosteroids in veterinary medicine can be a blessing or a curse.  A wise old veterinarian once shared with me that “although antibiotics may be the heart of your practice, steroids are its soul”.  But we also must heed the lyrics of Barry White when he once shared “too much of anything isn’t good for you baby”.  Perhaps the answer lies in-between:  judicious situational usage is the key when discussing corticosteroids.

In the trade journal DVM 360 this past month, Daniel Fletcher, PhD, DVM, DACVECC shared with us that the acronym “CIA” was an easy way to justify the use of corticosteroids in the veterinary patient.  For definition purposes, think of any anti-inflammatory drug ending in –one, like dexamethasone, prednisone, prednisolone, triamcinolone and the like (but not hormones or anabolics like testosterone).  With this in mind, what is the “CIA” advice about?  Let’s take a look:

C-Cancer.  We all know that although corticosteroids don’t kill cancer cells, they serve many ancillary purposes in the cancer patient.  They help with associated secondary inflammation, can stimulate the appetite in the anorexic patient, and give a sense of well-being through at least palliative therapy.  Even when chemotherapy is in play, corticosteroids have a role in the overall treatment plan.

I-Immune-mediated disease.  Corticosteroids are at the heart of the treatment on immune-mediated thrombocytopenia, autoimmune hemolytic anemia and the autoimmune skin diseases.  No ifs ands or buts on this.

A-Actually, Fletcher calls them the “Five A’s”.  Atopy, asthma, anaphylactic shock, Addison’s disease and allergies.   I’ll say that whenever confronted with any of these five situations, I have reached for corticosteroids in the past.  However, on that last “a”, there are more alternatives as opposed to corticosteroids in recent years.  Some of these newer antihistamines have changed the game regarding the use of so many corticosteroids on “itchy skin”.  The often-reported side-effects, like drinking excessive water and excessive urination can discourage pet owners and veterinarians alike from choosing this option so quickly.  So have innovative diets, like Hill’s Derm-Defense food, a new player in specific realm of canine atopy.

Beyond these categories, veterinarians have to be careful in situations like gastroenteritis, trauma, back problems and heat stroke.  Many veterinarians are on the fence when corticosteroid usage is discussed when treating snake bites.  While many have justified the use of corticosteroids in many of these emergency-type situations, longer-term repercussions, like immunosuppression must be thought through.

In my experience, the benefits versus the risk in an individual situation must be weighed out.  In my 33 years of practice, I have seen some wonderful results as a result of corticosteroid usage.  However, I have seen a few disasters as well.   Most importantly, the choice to use corticosteroids in marginal situations must be offered and accepted as part of the therapy by the pet owner.  In that manner, the veterinarian and the pet owner are in partnership on the decision as whether to treat the pet with or without corticosteroids.

The bottom line?  Begin with “CIA” in mind!

Have a great week with your pets!

Dr. Chris Duke

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Let’s Talk Turtles…….

I don’t know about you, but for the past month and a half, turtles have been just about everywhere around here.  My dogs can’t take a walk without sniffing them out and yes, even putting one in their mouths when I’m not looking.  These mainly land-based creatures have their pick on where to go and roam, and that includes neighborhood streets and driveways.  I’ve even heard some of these turtles wandering up driveways into garages lately.

Our most common turtles are the genus Terrapine, and they commonly come out of their hibernation in mid-to-late March around here and begin their feeding and mating once the average temperature goes above 65 degrees.   They feed on anything they find, including snails, grubs, fallen fruit, caterpillars and other worms.  Our garbage remains are not out of the question!

Once the mating begins each Spring, the average egg clutch varies from one to seven per female turtle.  The gestation period is about two months.  Our common local box turtle will stay active all through warm weather, until they have to seek hibernation accommodations by burrowing underground once Jack Frost announces his presence.

little turtle walk ahead, just a few days old

I have always referred to turtles as amphibians, but there is a lifestyle preference of some of these shelled creatures verses others.  Our box turtles prefer land, but tortoises of course are truly amphibious.  I recently came up on a two-foot tortoise in my neighborhood, just a few blocks up from the bayou.  Both tortoises and turtles as a group live long lives, and tortoises live longer than other turtles, according to Thomas H. Boyer, DVM, DABVT who practices in san Diego, CA..  He has studied chelonians, or painted turtles, and has evidence that most of them live 50-100 years.

Says Boyer “I’ve seen several desert tortoises that were in their eighties.  All the desert tortoises I’ve seen that were really old lived in a yard with Bermuda grass, which has a nutritional profile similar to what they eat in the wild.  Conversely, the most common health issue in them is poor nutrition”.  Boer added that most turtles tend to not die of old age, but from man and other predators.

Along with dogs, coyotes, wolves and foxes, large birds and snakes can also prey on turtles.  As well-intended as man may be, turtles die from getting in the wrong place at the wrong time (like a street or driveway), and tortoises get hurt by way of fishing nets, fishing lines or fish hooks.  One of the saddest moments I had this Spring was when I accidently crushed a turtle with my truck tire only because the poor thing chose the cool shade d my tire as his resting place.

As independent as turtles are, many turtles die in captivity when they are removed from their natural habitat.  So, while well-intended, many attempts at keeping box turtles as pets fail because of variables that differ from their true homes.

Dr. Chris Duke

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10 Reasons Why Joint Damage Can Get Worse Without Attention

Anterior Cruciate Ligament

We see it just about every week in practice:  A hurt shoulder, hip, knee, elbow or ankle.  Most joint injuries are sprains, thank goodness.  Yet, dislocations, fractures or ligament tears that affect joints have a need to be surgically repaired within a reasonable amount of time.  Dr. Phil Zeltzman, DVM, DACVS, CVJ recently wrote in our trade journal Veterinary Practice News that untreated joint damage like those mentioned above can really hurt pets when surgery is put off too long.  These reasons included:

  • Pain. Simply stated, although a pet with, let’s say a torn ACL of the knee, may have acute pain at first, chronic pain stays around.  This will probably lead to a permanent limp and hesitance to ever try and put the affected leg down properly.
  • Degenerative joint disease. This is a common sequel of non-surgical intervention.  The aforementioned chronic disease tends to compound negatively this effect on the joint.
  • Decreased range of motion. One may rationalize that this may not mean much to a couch-potato dog, but it sure will determine the activity level of an active family pet or a working dog.
  • Muscle atrophy. After weeks of damage, anyone can see the muscle atrophy on the affected limb of a dog.  It becomes easily visual after awhile, and this is muscle often never recovered back.
  • Exercise intolerance. These pets seldom want to walk or run as they used to, because of chronic pain.  Particularly in working dogs, this is critical.  This also commonly leads to:
  • Weight gain. A consequence of many of the above changes is decreased activity, which invariably causes weight gain.  Unless the pet owner decreases the food intake to match the decrease in activity, weight gain is inevitable.
  • Contralateral limb damage. We’ve seen it many times in practice.  One limb is damaged, so the opposite limb must compensate to bear the load.  The common result?  Yet another joint damaged on the opposite leg. We can at least limit the damage to one leg if we can tackle the problem head-on in the beginning.
  • Other injuries on the same leg. For example, meniscal tears on knees after the initial ACL rupture.  The medial meniscus often times give way once the damage from the ACL tear sets in awhile.
  • Distant problems. The changes in gait problems and posture can affect all three other limbs, as well as the spine.  Weight shifting and compensation (as mentioned in #8) can indeed cause a cascade of other orthopedic events for years after the injury.

Now I know that just after injuries happen, we in general practice try to alleviate pain and inflammation initially.  Optimally, surgical repair of joints in pets is optimal one to two weeks after initial injury.  However, I always caution pet owners that putting off surgery to repair affected joints too long may not only cause the 10 things that Dr. Zeltzman mentioned, but my #11:  That the pet may give up trying to use the affected limb for good because of the psychological acceptance that they cannot rehabilitate the limb anymore.

That’s a premise true in pets and people, amen?

Dr. Chris Duke

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DNA Testing in Dogs: Does It Have A Place?

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About once a month, I get asked a question by a client that isn’t really clinical, but just interesting.  Pertaining to mixed-breed dogs in particular, is sending in hair, saliva or blood samples useful in determining the breed mix in a certain dog?  Up until now, I’ve been ambivalent on the subject, and given such responses as “does it really matter?”, or “if you want to spend money on it, go ahead-but it makes no difference to me”.  But a new company is rolling out a testing service on both mixed and pure-bred dogs with a different perspective.

 

Embark (gotta love the “bark” part of the name), is making available a saliva submission test to see not only the genetic makeup of a said dog, but also look at breed markers to establish risk against certain congenital or developmental conditions.  According to GenomeWeb and reported this past in the Brakke Animal Health e-Newsletter, the Embark DNA test will not only serve as mechanism with which to assess breed origin and ancestry, but also define disease risk and heritable traits of the dogs tested.

 

If we think through on this rationale, we would be better equipped to make hardline recommendation on spay/neuter, let’s say as opposed to allowing for breeding in a given individual dog.  Furthermore, specific blood tests and/or imaging could be done on a regular basis to track any suspicions that might have been raised by certain heritable diseases in a given blood line.  The Golden Retriever project based at Texas A & M, for example is one such program, monitoring cancer incidences reported by pet owners over a span of years.   More and more breeds, I believe will have similar organized programs in the future, with regular testing, bloodwork and imaging protocols.

 

The goal, of course, is to have dogs that live longer, fuller lives as a result of genetic selection and preventive medicine.

 

The Embark testing service will not be for everyone, as the stated cost of their DNA testing program is $199.  This is a significantly higher cost as opposed to the first generation DNA testing services for dogs that only stated percentages of purebred traits from submitted samples, and according to some consumers were questionable in their results. For client convenience, the service includes a mobile app, and the service should be available to the pet-owning public soon.  My understanding is that once the sample is mailed in, results will be reported to the pet owner within four weeks.

 

The service should be available directly to the pet-owning public soon, according to their website www.embarkvet.com..   As a veterinarian, I would like to be aware of such test results so that I can help follow-through on the necessary medical recommendations for the pet afterwards.  As always, we need to work in partnership with dog owners to achieve the desired full, long life everyone wants!

 

Have a great week with your pets!

 

Dr. Chris Duke

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