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Dr.Fiona
Dr.Fiona, Cat Veterinarian
Category: Cat
Satisfied Customers: 6273
Experience:  16 years experience as a companion animal veterinarian in British Columbia, California and Ontario
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Hello Dr. Fiona, its Paula the other side of Niagara Falls !

Customer Question

Hello Dr. Fiona, it's Paula "the other side of Niagara Falls"! Your knowledge/compassion were vital to my surviving ups & downs, from beginning (mid-2008) to end (March 2009) w/ Mr. Pie, gone 18 months/forever missed.

Once again, I need help with a kitty baby: Daisy...8 yr old female, DSH, grey tiger (brindle). 09/10/2010 @ NFVS (Vet Oncologists). Blood/urine/pathology reports not complete. Aspirated several nodes, physical exam, 103.8 temp, CXR, abdominal u/s: multiple enlarged lymph nodes. Dr. initially said Leukemia but after a quick consult w/ same oncologist who worked w/ Mr. Pie, diagnosis leaning towards (Stage 3) Lymphoma. Keeping over weekend. I agreed to starting chemo: IV Vincristine, Prednisone, anti-nausea med (I forgot which one).

Dr. F, you know me - I researched this to the wee hours this morning, soaking up lots of info to understand what I'm dealing with & ask the right questions. (Sorry for the long lead-in).

Shouldn't they be able to pin-point a more specific diagnosis (lymphoma/lymphosarcoma vs lymphocytic leukema?) Lymphoma recognized as highly malignant/most common form of cancer(?) Identified as one of the most responsive to treatment but data on prognoses isn't heartening. Long-term treatment/chemo protocol results: 5-7 months, maybe 9-12-18 mos. Without treatment, her life expectancy is 4-8 weeks from time of diagnosis!

Ah Dr. F, I don't even know what I'm asking. Once again I'm faced with what-ifs & quality-of-life issues while drowning in the inevitable. I need your clear thinking and some {{hugs}} for Daisy!
Most Sincerely,
Paula Courchaine
Jacksonville, FL
Submitted: 4 years ago.
Category: Cat
Expert:  Dr.Fiona replied 4 years ago.
Paula,

Sorry for the delay - I was out at work and just walked through the door!

Let me send this right away so you know I am here.... then I'll be back....

Fiona
Expert:  Dr.Fiona replied 4 years ago.
Paula,

First up, <<<hugs>>> and ~~~head scritches~~~ to Daisy! I hope that she starts feeling better soon!

So, the histopathology reports on the lymph node aspirates are not back yet?

Was the anti-nausea med perhaps called Cerenia?

When the results come in, can you get a copy to me (by taking a photo and attaching, or scanning and attaching)?

I will be in and out all weekend, so I may not be online when you reply, but I won't be far away!

Fiona
Customer: replied 4 years ago.

Fiona, thank you...thank you...thank you...

 

Sorry for the delay. I was on the other side of the house getting Mom up and going! I'm behind on everything....sixes and sevens today!

 

No results from lymph node aspirates yet. I don't know if they sent fine needle aspirates or tissue biopsy. I was puzzled why they're looking for Feline Leukemia as there's no way Daisy would have contracted it, but in a head-slapping moment I remembered we had a flea infestation last year & several kitties had scratch-scabs behind & underneath their necks. All were treated with Revolution (for 6 months). No more fleas & no more problems. But I forgot FelV can be contracted from air-borne parasites!

 

As soon as the results come in, I'll send them to you.

 

It goes without saying that I feel better knowing you're "here" with us!

 

Paula

Customer: replied 4 years ago.

Fiona, I'll be out for a few hours, but I'll be checking in later. Thank you...as always

 

Paula

 

PS: Darn it! I lost the information I once had about our different cultures and hope to find it again.

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,

Just missed you - I was out with the children at the park for a few minutes. We're heading to the library soon but will be back in a couple of hours.

Any time we see a kitty with what we think may be lymphoma, we always wonder if it might be triggered by Feline Leukemia, as that is a virus that CAN cause cancer.


So, we always test for Feline leukemia, starting usually with a simple ELISA test on a drop of blood.

Here is more about these tests and what they mean:

http://www.neighborhoodcats.org/info/releasing.htm

http://www.acfacat.com/felv.htm

http://www.winnfelinehealth.org/Pages/FeLV_Web.pdf




Feline leukemia (FeLV) is a devastating virus for which there is no cure once cats are exposed. Transmission occurs through infected saliva; bites by or sharing bowls with infected cats may infect other cats within the household.


Symptoms are numerous including fever, frequent infections, weight loss, depression, decreased appetite, and swollen lymph nodes.


Prevalence of the disease is worldwide with locally high numbers of incidence possible in infected groups of feral cats.


Blood tests can identify infection… but there are different kinds of infections!




When you or I get sick with the flu what happens is: healthy --> sick --> mount immune response --> healthy.


Unfortunately, it is not that simple with FeLV! Instead of the two possibilities (healthy or sick), there are four possible outcomes for cats with FeLV.


OUTCOME 1: IMMUNITY (40% of cats). The cat may be sick for a few days, but then recovers.


OUTCOME 2: INFECTION (30% of cats)– The cat is sick, seems to get better, but the virus is still there, and in weeks to years the cat gets sick again and dies.


OUTCOME 3: LATENCY (28% of cats) The cat has FeLV in the body but it is hard to detect as it hides in the cells, and may lead to cancer. This can only be detected by a special test called PCR. So, this is what they may be wanting to do with Daisy. it is also a blood test, but results take longer (a week for us up here in Canada).


OUTCOME 4: IMMUNE CARRIER (1-2% of cats) - The cat has FeLV, but is not affected by it, BUT can still pass it on to other cats.




Unfortunately, there is no cure for Feline Leukemia and the only thing we can do is provide supportive care, giving antibiotics for bacterial infections and treating the symptoms.


Here are websites with more information:




So, the fact that Daisy has these large lymph nodes which are suspected of being possible lymphoma, which *can* be caused by FeLV is why they want to test for this. There is no cure, but knowing her status would help to let us know about her prognosis and other treatment options.

Must go before the library closes!

bye for now,

Fiona

PS don't bother hitting "accept" at this point, as I'm sure we will be talking more!

Dr.Fiona, Cat Veterinarian
Category: Cat
Satisfied Customers: 6273
Experience: 16 years experience as a companion animal veterinarian in British Columbia, California and Ontario
Dr.Fiona and other Cat Specialists are ready to help you
Customer: replied 4 years ago.

 

Fiona,

 

Wow, we're two very busy ladies! Thanks for the websites (even if it means more homework for me) :-) I most likely won't get to them until some time tomorrow, though and I do want to absorb what I can.

 

You mentioned the ELISA test, my brain cells woke up, the lightbulb came on, and I remembered what my NY vet said 25 yrs ago when Kitty Bones tested "positive" for FelV. I was stunned because I knew he was never outdoors or exposed to any other kitties. ELISA was the test that showed Bones had been exposed to the virus some time in the past (pointing to the trauma he suffered as a result of that one-time, horrible flea infestation I had in my home when I lived in NC)....but his body rejected it.

 

Based on what you've told me, Kitty Bones was in the 40% Immunity group. I can only pray for a more positive outcome for my Daisy. It's hitting my husband Ron very hard because Daisy is "Daddy's girl". The hussy!

 

Not grasping at straws...... but isn't it the job of our lymph nodes to fight infection, or inflammation, or anything the body sees as an invader? And don't they accomplish this by absorbing the enemy, kicking the snot out of it and rendering the body fit again? And don't the lymph nodes become enlarged and painful during this process? (Mine do)!

 

Ah, you see where I'm going with this... Is there some flicker of hope that this could be what's happening? Daisy has never lost weight or her appetite. In fact, my vet calls her a "little tank" because while slender and sleek, she feels like a 12 lb bowling ball. Even my father calls her a 12-lb "pipe cleaner"!

 

Ok, it's time to give my body some physical and mental down time for the greater good. Let's see - chocolate, or floating in the pool.....chocolate, or floating in the pool....why not both!

 

Paula

 

 

Expert:  Dr.Fiona replied 4 years ago.
BOTH chocolate and floating in the pool sounds like the only option! ;-)

Yes, lymph nodes get enlarged and even tender when fighting infection.

For example, in dogs or cats with really bad dental disease, I will often find that their submandibular lymph nodes are enlarged. The rest of the lymph nodes will be normal.

So, if we find a generalized lymphadenopathy (meaning that all of the lymph nodes are enlarged) we start thinking of a disease that affects the whole body.

Depending on the other symptoms and the blood tests, we look for hints as to what that infection or inflammation might be. There are other possibilities for why Daisy is sick.... but lymphoma is unfortunately the most common disease that would explain her symptoms.

The test results should help to pin-point it better. Fingers crossed - hope for the best, XXXXX XXXXX for the worst!

I am off to bed now...

let me know the moment you get any results!

Fiona
Customer: replied 4 years ago.

Good Morning! Oh No....I think I inadvertently hit some button and I'm not sure if I ended our session. I hope not! I'm trying to print out our question/answer data for my file and to research the websites you listed, but it just prints out a blank screen!

 

Talked to technician this morning...Daisy doing great. Chatty, eating/drinking very well; peeing good, poop still very hard (she's on iv fluids) so I asked they find out why. Daisy is not on any anti-emetics...she didn't need it! You go, DaisyGirl!

 

There's a Dr. Meinkoff at Colorado State who is supposedly one of the premier cytology specialists. That's where Daisy's samples were sent.

 

And yes, they did send him everything, including the fine needle aspirate samples - NOT a biopsy tissue sample. I'm disappointed because I thought a biopsy tissue sample would tell more than a fine needle aspirate. (?)

 

Gotta make brunch for Mom and Ron. Going to visit Daisy this afternoon (hoping to run into Dr. Paula (!) Levine). She'll be there but no set time.

 

Enjoy the day!

 

Paula

 

 

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,
I just wanted to let you know that you didn't end our chat - I can still reply!

We are going out apple picking today, even though it rained a lot overnight and is rather wet. It will still be fun!

I'm glad Daisy is doing well, that's really good news. I'm sure the aspirate will be fine for diagnosis, and much safer (as with an internal biopsy you always worry a bit about unseen bleeding).

Let me know how the visit goes!

Fiona
Customer: replied 4 years ago.

Fiona,

 

Saw Daisy for 2 hrs today. Within less than 60 seconds she was chatting & rolling on the floor for scratchies! She thinks her front leg wrapping is an annoyance though! We couldn't believe how normal she seemed. The tech said she's been alert & sits on her princess pillow & talks to anyone going by her cage. She's eating & drinking & 'out-putting' & has no fever or weight loss. Oh, and THE SWELLING HAS GONE DOWN IN ALL BUT ONE OF THE LYMPH NODES.

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I saw her still shaking her head & asked that her ears be thoroughly checked as she's prone to yeast build-up (NOT ear mites). Her ears were clean but she usually has it farther in the ear canal & I want to make sure it's not causing any problems.

 

Dr. Levine called me later at home....

(1) FelV and HIV tests: Negative

(2) Initial blood work results: Almost normal

(3) Daisy's recovery: Remarkable

(3) Still waiting for cytology results from the aspirates

(4) Setting up consult w/ oncologist Thursday for prognosis/treatment options once the report comes in from Colorado

 

I asked why she was still sure we're dealing with Lymphoma with these test results & how well she's responding. Her reply was "Because she responded to the chemo". "We didn't anticipate her response being this remarkable".

 

I don't know why but I was put off by the "because she responded to the chemo" answer. Besides not really telling me anything, I thought it was flippant. But I may be over reacting. BotXXXXX XXXXXne is her response to just one chemo treatment is very much in her favor and (knock on wood) she never got nauseous and didn't lose her appetite. And she has the techs feeding her by hand. That's my Daisy!

 

I'll have lots of questions for my friend (the oncologist) Dr. Schmidt on Thursday. I'll get a copy of the results we have so far for you. As soon as I get a copy of the cytology report I'll sent it to you

 

I'm in a good place today. I have no reason to not hope she may be part of that small percentage who respond favorably with an 80 to 90% long-term remission rate of 20+ months. If anyone can, it's my feisty little Daisy girl.

 

Gotta go. Mad Men is on. Time to get my night shirt on and my feet up. Talk to you soon.

 

Paula

 

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,
WOW - that is great news that Daisy is doing so well! What a smart kitty she is!

Does she come home soon?

I hope you are enjoying your Mad Men. :-)

Fiona
Customer: replied 4 years ago.

Fiona,

 

I can pick her up tomorrow....make that today, since it's 3:15am! l have to continue her Prednisone but I was so excited over that little bit of good news that I didn't think to ask why she continues taking it!

 

Will keep you posted.

 

Paula

Expert:  Dr.Fiona replied 4 years ago.
Paula,
I hope you managed to get some sleep last night - 3:15am?! Ouch!

I wonder if the prednisone is part of her chemotherapy treatment. There are many protocols that include prednisone pills as part of the therapy. For example, the COP protocol uses the drugs Cyclophosphamide, vincristine (brand name: Oncovin, hence the O in the acronym) and Prednisone.

You can read more about it here:

http://www.marvistavet.com/html/feline_lymphoma.html

http://maxshouse.com/Oncology/feline_lymphoma_and_leukemias.htm


I am sure Daisy will be happy to be home. And, hopefully, the aspirate results will be in soon. Although the vet who gave you the "because she responded to the chemo" answer was neither sensitive, compassionate nor helpful....I see what she means. If Daisy had a raging infection causing her lymph nodes to be enlarged, then the chemotherapy treatment would have made her worse. Instead, she felt better afterwards. That does support this being the right treatment, which does support this likely being lymphoma, unfortunately.



The main thing is that Daisy FEELS better.
That is fantastic! I am always delighted when my feline patients are eating and head-butting for attention. That tells me better than any lab test that they are feeling good! :-)

Just a few more hours until she is home!

Fiona
Customer: replied 4 years ago.

Fiona,

 

Sleep? Oh yeah, the stuff I don't get enough of. As in head-on-the-pillow at 4am. Head-off-the-pillow at 8am...get Mom up & ready for the home health care RN by 8:45am; get her breakfast & meds ready by 9:40am; duck into my "office" to finish my own work before 11:30am; get dressed & out the door by 11:50am (!) for my own 12:30pm dr. apt.; meet with the vet/pick up Daisy at 3:15pm; back home by 5pm; get mom's dinner & meds together by 5:30pm; & finally, back to my computer at....6:40pm. And I don't even have kids! :-D

 

Back to Daisy....thanks for the add'l websites. Marvistavet was one of the websites I'd found that gave me really good data. (All great minds runs alike)! It was straightforward & informative. I was interested in all data, including remission/survival rates for cats w/Lymphoma. It is my belief that the more "pluses" Daisy has in her "Plus Column", the better her chance of falling into the 30-40% category for remission lasting 2 years or longer. Her results so far are more promising than anyone imagined.

 

Based on initial assessments, Prednisone therapy was started (5mg twice/daily) as well as Vincristine injection (0.5 mg / kg IV) for chemo induction & a Dexamethasone injection. Prednisone continuing at home until we see oncologist on Thursday.

 

I do have preliminary report/assessment and labs and by tomorrow I'll have the CXR and U/S reports faxed to me. Then I'll send it all to you. Labs really are remarkable for being unremarkable!

 

So Daisy's home - taking all of about 15 minutes before reclaiming her Daddy's lap and kitty kisses.

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As for me, I'm retiring my brain cells for the evening. I'm so glad you've got my back. Goodnight my friend.

 

Paula

 

 

 

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,
Oh, I am so glad that Daisy is home! I am so happy she is doing well - really, that is so wonderful!

Your day sounds totally crazy! Is every day that intense? Wow! I feel tired just reading it!

I will be around, on and off tomorrow, but then I work 10 hour days on Wed, Thurs and Fri, so I might be quite late replying on those days. I hope you all have a good night's sleep tonight - I am sure you all deserve it!

Fiona
Customer: replied 4 years ago.

.......>>>>on rollar skates>>>>>...... getting ready to take Mom to followup cardio apt., then to drug store, then Hobby Lobby for a dry-erase board (to help her with memory notes), then the credit union for some $$, then home. Hopefully, the info from the vet specialists will be faxed to me by then.

 

Daisy "quiet" last night. Not usual feisty noisy self as during the day. Weird thing though.....she was curled up on my lap about 10pm when I felt an extreme body vibration (only way to explain it) in her shoulder blades, chest, front legs area. It stopped a few seconds, then start again, repeatedly for about 5 minutes. Never saw this before. Lasted only a few minutes until she lay beside me on her blanket and stretched out on her side and quieted down. I came "this close" to taking her to the animal ER. Hmmm...

 

Like you, I won't be back on until later tonight.

 

Paula

Customer: replied 4 years ago.

Fiona,

 

Oops, sorry....'scuse me while I look up lymphadenopathy. Be back later.

 

Paula

Customer: replied 4 years ago.

Fiona,

 

I know you won't be here until later, but I wanted to synopsize what I've got so far.

 

As soon as I get some real computer time this evening....translation: not running back forth doing laundry....I'll scan additional hard data to you. Just please remind me how I get it through to you as a reply or attachment. (brain freeze....I can't remember).

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Radiology and Ultrasound Reports......

 

Radiology Report - (Views: Lateral and VD thorax and abdomen)

 

Findings:

Thoracic:

1) Cardiac silhouette

2) Lung Fields

3) No pleural effusion

4) Enlarged sternal lymph nodes seen on lateral projection

 

Abdomen:

1) Markedly enlarged sub-lumbar lymph nodes

2) Ingesta in stomach

3) Formed poop in colon

4) Enlarged inguinal lymph nodes visible

 

Asesment:

Sternal, inguinal, and sub-lumbar lymphadenopathy

 

Recommendation:

Abdominal ultrasound (results follow)

Lymph node aspirate and cytology

 

Ultrasound Report

Liver/Gall Bladder: Normal - Gall bladder normal, proximal bile duct enlargement

Liver homogenous and uniform

Spleen: Abnormal - Homogenous but diffusely and uniformly moderately

enlarged

Right Kidney: Normal - Normal appearance and architecture (4.07cm in size)

Left Kidney: Normal - Normal appearance and architecture (3.47cm in size)

Urinary Bladder: Normal

Adrenals: (Left): Not Seen

(Right): Not Seen

GI: Normal

Pancreas: Normal

Lymph Nodes: Abnormal - Bilaterally markedly enlarged sub-lumbar lymph nodes

Prostate/Uterus: Not Seen

Other: (Free fluid) Not Seen

Diagnosis & Recommendations

Sub-lumbar lymphadenopathy and splenomegaly

Sorry, off to the laundry room. More stuff (labs) later.

Paula

 

 

 

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,

Ok, well, so far there is nothing abnormal apart from all her lymph nodes being enlarged, and her spleen being moderately enlarged. So, that is good!

I sure hope you get those aspirate results back soon... but it does fit with lymphoma given that all her lymph nodes seem to be affected.

The muscle tremour thing she did might have been as simple as exhaustion. Being hospitalized is very tiring - for humans and animals alike! Poor Daisy would have been checked on so often she could not have gotten much sleep. So, it may just be that she was so tired she had a little muscle spasm. Hopefully, as she relaxes at home she will be better rested and that won't happen again!




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Hope that works for you! Fiona

Customer: replied 4 years ago.

Fiona,

 

Wow, that's a boatload of information! You're up late too, I see. Still doing laundry here. <sigh>

 

Just a few more runs to the laundry room and I'll be at the computer 'for the duration'. I want to get the labs to you tonight so you'll have them for tomorrow. Yipes, it IS tomorrow!

 

The PARR results aren't back from Colorado U but Dr. Meinkoff's cytology report confirms Lymphoma. I asked them to fax me the report but they had a problem on their end (MY fax is working) and I didn't get it.

 

More later. Paula

 

Customer: replied 4 years ago.

Fiona

 

4:35am.. reading test results but eyeballs are crossing. As in the other labs, test results were almost all in the middle of the ranges. Almost. In the following, I've only shown tests with results either out of range, or very close to the low or high end. The number in parenthesis is the range:

 

Superchem:

AST/SGOT = 94 (10-100); ALT/SGPT = 21 (10-100); Alkaline Phosphtase = 5 (6-102); GGTP <5 (1-10); Total Bilirubin = 0.1 (0.1-0.4); Calcium = 10.4 (8.2-10.8); Amylast = 1099 (100-1200); CPK = 416 (56-529);

 

CBC:

Hemoglobin = 8.7 (9.3-15.9); Hematocrit = 28.7 (29-48); RBC = 5.66 (5.92-9.93); MCHC = 30.3 (30-38); Platelet Count = 64 (200-500) (Note: platelet clumps prevented precise results); Bands = 0 (0-3); Lymphocytes = 41 (20-45); Monocytes = 4 (1-4); Eosinophils = 4 (2-12); Basophils = 1 (0-1); Absolute Bands = 0 (0-150); FeLV Antigen = Negative; FIV Antibody = Negative

 

Urinalysis:

Specific Gravity = 1.06 (1.015-1.060); pH = 7 (5.5-7.0); WBC = 0-1 (0-3); RBC = 0-1 (0-3); Squamous Epithelia = 0-1 (0-3);

 

T4:

T4 = 1.4 (0.8-4.0)

 

CBC - LaserCyte

HCT = 14.6 (30.0-45.0); HGB = 9.6 (9.0-15.1); MCH = 30.9 (12.0-20.0); MCHC = 0 (29.0-37.5); RDW = 20.8 (17.3-22.0); Platelets = 1315 (175-600) Note: MCHC out of reportable range

 

I hope I covered enough ground and this gives you what you need. I wish I had the darn cytology report for specifics but I'll get it tomorrow when I'm there. Wish us luck. It's 5:09am and I'm thinking that what's left in the dryer...can stay in the dryer!

 

Paula

Expert:  Dr.Fiona replied 4 years ago.
Paula,
Oh, you poor thing - I hope you got some sleep!

I just got home from work and have to grab some food, then will be back at the computer. It sounds like you are really catching this early with Daisy, which is fantastic!

:-)

Fiona
Customer: replied 4 years ago.

Fiona,

 

To bed 6:40am>>>"twilight sleep">>>up 8:24am.

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Met w/ Mr. Pie's oncologist and I was glad I spent those hours this morning absorbed in the never ending proliferation of LSA research and data on the web. I'm ok with the fact that when dealing with feline cancer, the only guarantee is.....there is no guarantee!

 

Informative, methodical consult about Daisy's condition, test results, protocol direction, remission possibilities and "what-if's". Tons of "pluses" in Daisy's favor.... and a few "minuses".

 

Once again, I have a feline with "unusual" morphology and "bizzare" pleomorphism. While histiocytic neoplasia couldn't be ruled out, Daisy's "dramatic response" to vincristine and prednisone and her "near complete remission" strongly suggests lymphoma. PARR is still pending. Daisy doesn't need to have any more tests at this point.

 

Her overall successful remission rate is approximately 80%. Average survival is 9 months but with her negative FeLV status, overall health and good body condition, response to chemo, etc. "suggests the possibility of a longer survival time". Odds are in her favor and Dr. S put her above the curve at 12 mos.

 

Using Tuft's "CHOP" chemotherapy protocol Vincristine, Cytoxan, Adriamycin, Prednisone (incl weekly labs).....

 

WK 1: V

WK 2: V

WK 3: V, C

WK 4: V

WK 5: V

WK 6: V, C

WK 7:

WK 8: X-RAYS/ ULTRASOUND

WK 9:

WK 10: A

WK 11: A

WK 12: A

WK 13: A

WK 14: A

WK 15: A

 

We're both in a good place about this. Dr. S. understands that as long as expectations for long-term remission are realistic and remain in Daisy's favor, we'll fight the fight for and with her. If she begins adversely reacting to protocol and changing it would be too stressful and her QOL is in jeopardy, we won't continue.

 

Tonight, she was her usual feisty self and even hissed at Frankie - so for now, all is well in Courchaine-land!

 

I think I've covered everything. I'll let you know when the PARR results come in.

 

Paula

.

 

 

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,
I am running out the door to go to work and will be back in about 10 hours... I wish I had time to go over this more carefully right now. But I just don't! I'm sorry!

I will be back tonight to help you further!

Glad to hear that Daisy is feeling well enough to put Frankie in his place! ;-)


Fiona
Customer: replied 4 years ago.

Fiona - roller skates would help!

 

I wish I could do a better job of synchronozing our on-line availability for a real-time exchange of information but more often than not, my down time is usually in the wee hours of the morning when nothing or no one is competing for my time.

 

Relevant>>> I bought a book by the Alzheimer's Assoc. called "The 36-hour Day" (for Alzheimer's caregivers) but haven't had time to read it. I took it in my bathroom the other evening but fell asleep sitting up....until Mousie jumped in my lap!

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No problem about reviewing the test results and planned treatment protocol later. And having sorted through it, please let me know if the following has any bearing......

 

Somebody (most probably Daisy) threw up on the bed this morning some time after she ate. At least she picked Ron's side.

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Both Daisy and Mattie sleeping on the bed. In case it was Daisy, I sorted through the yuck with my finger to feel for pieces of a Prednisone pill. Ron had already gone to work so I didn't know if he gave her a pill this morning, was it in her regular food or a treat, etc. Unfortunately what was left was "smooshie" with no discernable tiny hard pieces I would recognize as a pill.

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I put the ejecta (I love that word!) in a sealed pleastic storage bag and put it in the fridge. Don't have any idea if it's viable for any testing, but I've got it just in case. Am keeping an eye on Daisy, but she's not lethargic - just in her normal sleepy-eyed curled up position.

 

As always, our thanks....

 

Paula

 

 

Customer: replied 4 years ago.

Fiona

 

Would forget my head if it wasn't fastened to my shoulders. (One of Mom's favorite expressions to me when I was growing up)!

 

Here's the 9/14/2010 Diagnostic Cytology Report from J. H. Meinkoth DVM, PhD Dip. ACVP (Clinical Pathology), Oklahoma State University Departmentof Veterinary Pathobiology.....

 

Cytologic Description

4 slides examined - well made, markedly high cellularity, containing population of discrete cells characterized by a marked predominantly (exact words) of large, atypical cells and variable numbers of remnant small lymphocytes. On one slide, small lymphocytes predominate, but they're in vast minority on other slides. The atypical cells are extremely pleomorphic, generally 20-25 um diameter, with a low number of much larger cells. Nuclei are extremely pleomorphic ranging from round to indented to polylobated (monocytoid) with chromatin that varies from smooth to reticular. Most cells do not have prominent nucleoli, although a minority does. Cytoplasm is moderate and varies from deeply basophilic to light grey-blue. Many cells contain numerous clear cytoplasmic vacuoles. Scattered erythrophagocytic cells and cell containing iron pigment are seen. Mitotic figures numerous.

 

Cytologic Diagnosis

Hematopoietic neoplasia, probably lymphoma

 

Comments

Slides indicate a hematopoietic (round cell) neoplasm effacing the samples node(s). Morphology is unusual and most likely lymphoma with pleomorphic morphology. A histiocytic origin is also possible given the morphology of the cells.

 

Naturally I dog-earred the medical dictionary for terminology I didn't understand. Can anyone tell me why they don't say "many-formed" instead of Pleomorphic? Ahh, just wonderin'.

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Time to give my stiff neck a break. Other than did she (or not) throw up, Daisy did very well today: laying in her favorite sun-spot on the dining room carpet

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....big kitty-stretch when you talk to her....pupils now a normal slit instead of the size of moth balls!

 

I'll try to get back on-line around 10pm....or whenever my head stops spinning

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.

 

 

 

 

Expert:  Dr.Fiona replied 4 years ago.
Hey Paula!

I had a totally packed day at work... and then on top of that had a dog come in who had cut his foot and lacerated 2 arteries in the process! Ai yi yi! Needless to say, I was home very late tonight!

Well, it looks like the results confirm lymphoma and her treatment plan looks excellent. The fact that she has been started to quickly on treatment, AND that Daisy has responded so very well is really encouraging.

The vomiting could easily be just a hairball, or it could be some nausea from being on the prednisone (which can happen in some cats). However, I would not read too much into one event of vomiting. It's good to take note of it, so if it happens every day, we know when it started, but I would not worry about it. Also, there's no testing that could be done on it... so feel free to toss that out (so nobody wonders in a week what on earth that is!). ;-)


Daisy really is an incredibly lucky cat to have you as her caregiver! It sounds like she is on the right track with her care!

I will have to get that book you mentioned as my mother in law was just diagnosed with very early Alzheimer's disease. She lives in Ottawa, which is about a 6h drive from us, but it would be good for us to know what to expect, and what we can do to support the people who will be her primary care-givers. Any other books you can recommend?

I hope you get to have some sleep at some point, Paula! I have no idea how you function and are coherent on the amount of sleep you get!

((HUGS))

Fiona
Customer: replied 4 years ago.

Fiona,

 

So who says I'm coherent?....

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Oh, poor baby.... I hope he's ok. I'm first in line to give doggy smoochies!

 

So sorry about mother-in-law. It will be a very long journey (for everybody) from now on. That they've diagnosed her early is a huge positive. Everyone's different, but with Mom's severe renal impairment, she's limited to one drug vs. the usual multi-drug treatment. When limited to one-drug treatment, the best is Namenda. It has the least side effects of all. Before she gets to the moderate stages, there will be more strides in Alzeimers research and better more effective meds.

 

There's many forms of dementia of which Alzeimers is just one. Mom has Alzheimer's Dementia. In 1996 she was diagnosed w/severe depression and anxiety (my step-dad died Nov 1995). What no one knew until 2007 was the depression had masked early on-set Alzheimers! By 2007 she was in "moderate" stages of the disease until being reassessed as "past moderate" a month ago. To confirm her diagnosis, she should be evaluated/tested by a Neuropsychologist. They do a 4 to 6 hour test/evaluation that will be conclusive for the disease. For help, the Alzeimers Assoc on line is an unending source of information and assistance, including help for the caregivers, especially if it's family. If Eldersource.com is available in her area, definitely use them. Also go to any one-day seminars or conferences usually done by local Alzeimers and/or elder source groups, including the VA for assistance for veterans and their families. Hope that helps.

 

I want to make sure you're compensated for helping me so far, yet leave our lines of communications open for Daisy updates, etc. How do I do that since this will be, I'm sure, a long-term discussion process.

 

I'm definitely headed off-line for now. If anything changes, I'll hoist up the SOS flag post-haste.

 

Ditto {{Hugs}} - Paula

 

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,

Our doggie patient with the cut foot arteries did very well - largely due to being a very good patient! He's a Golden Retriever, and very calm and obedient. He came in squirting blood all over the place, but sat and gave me his paw without fussing so that I could put a pressure bandage on it right away. Then he gave me a dog-kiss - awww! I'm sure he will heal up well from his surgery.

Thanks for the resources regarding Alzeimer's. I'll look into those! My husband and I are a bit out-of-the-loop about what is going on, and what medication she is on as we were in France when she was diagnosed. My M-I-L has had chronic depression, and I am not sure what lead to her being checked for alzeimer's or who (ie what medical specialist) made the diagnosis.

You already "accepted" my answer, at which point part of your deposit gets transferred to me, so don't worry about that! :-)


Ok, I must go find some coffee and take my dog out for a run!
bye for now,
Fiona
Customer: replied 4 years ago.

Fiona

 

Ohhhh, I'm so glad that "goldie" (your blood-squirting canine patient) will be ok. What wonderful dogs they are. Actually, what wonderful creatures all animals are!

 

Wow, your M-I-L diagnosed w/depression and now Alz. She's very lucky someone recognized it early. Mom lived on her own from 1995 - 2007. Everyone attributed her oddities to laziness, eccentricity, depression, etc. When I took over her checkbook in 2004, no one knew just how bad things really were: buying 3 dustpans "because they were on sale"; buying many, many flats of flowers and never planting them (they all died); buying mail-order items & throwing them away instead of returning if she didn't like it; writing checks/not listing them; one $ amount written/different $ amount in the check box; $ amount in check register not matching bank statements; etc. (You get the picture). I mentioned all this to her primary care physician and her psychiarist and they both said it was depression and some age-related mild cognitive impairment .

Note: "mild cognitive impairment" - MCI- be wary when a doctor says those words.

 

Fast forward to April 2007 - Mom hospitalized w/heart problems - I visited late after noon - Mom in bed/just ate - peas all over her bed & on floor - I jokingly said "I know you had peas for dinner, they're all over your bed & on the floor". Her answer was an agitated "I did not pee on the floor". I didn't understand her reaction but said "oh, you must have had peas for supper, I can see them on the bed & the floor." She got terribly aggitated, started picking & pulling at her sheets & wiping away imaginary things and kept saying "I didn't pee on the floor". I ran for her RN to observe Mom while this was going on. The RN watched her 20 sec. then called the on-call neurosurgeon to see her, stat. His assessment of her behavior (including what I've been seeing over the past few years) was mild cognitive impairment!

 

July 2007: I took her to a Neuropsychologist specializing in identifying Alzheimers and Dementia disorders. Mom had a 5-6 hr session (questions, testing, drawings, written and oral responses, etc). That's when the actual diagnosis was made: Moderate stage Alzeimer's-Dementia. I would not have a diagnosis done by anyone other than a PhD qualitife Neuropsychologist.

\

Sorry to be so verbose, but I hope it gives you some info and insight. Any time you want to talk about it, Customer likes aol and is always available.

 

BTW, is there a rate scale they use to determine compensation? I just want to make sure you're treated fairly. That's my nature.

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Daisy now on half dose (2.5mg) Prednisone twice/daily. So far....so good.

 

Paula

 

 

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,

It sounds like Daisy is heading in the right direction! :-)

Thanks for all the info on Alzeimer's - very helpful! Now I know what questions to ask my sister-in-law about what the qualifications were of the person who evaluated my MIL and what stage she is at.

In terms of compensation, you can see how the experts are compensated here:
http://ww2.justanswer.com/expert-compensation-overview

I am a stage 4 expert. :-)


I am taking the children to Telling Tales today (http://tellingtales.org/) , so I had better get going now...

bye for now,
Fiona

Customer: replied 4 years ago.

Fiona

 

Stage 4? Sorry, but you're way beyond that. They need Stage 5"for people like you who have the kinds of qualificiations you can't pidgeonhole or put on paper - because it's from the heart. So there!

 

Out for groceries. Taking Mom with me. It will be good for her - she needs to be outside.

 

Have a great time at Telling Tales today. Hope the weather's nice. It's awesome today......86 degrees, sunny, slight breeze.

 

I'll be in touch.

 

Paula

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,
Aww - thanks for the compliment! :-) It is rewarding for me emotionally to know that I can help people who love their animal companions. Last year, when we were in France, that was such a mental life saver for me since I was unable to practice!



We had a wonderful day! It was sunny and about 75'F and just perfect! The children had so much fun - which meant that my husband and I also had a fun day!

I hope that your trip to the grocery store went well? I must get those little face-painted, ice-cream covered, muddy-kneed children of mine off to bed now....

bye for now,
Fiona
Customer: replied 4 years ago.

Fiona

 

Other than my wallet being hundreds of dollars lighter,

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our grocery shopping trip was amazing. To see Mom wheel herself around the store without her oxygen was something I didn't think I'd every see. The bakery department lady who always asks about Mom was there today and asked me how she was. I said "ask her yourself... she's over in the sitting area by the grocery carts". She threw her arms in the air, ran from behind the bakery counter, past the pharmacy and over to the waiting area. By the time I walked by, I saw her hold out her hand to introduce herself to Mom, then lean over to give her a big hug. They were chatting away, and Mom was beaming from ear to ear! ==== Priceless!

 

Doing some typing for hubby (translation...unpaid personal assistant!) but taking a break at 10pm to watch Mad Men on AMC, then back to the typing.

 

Daisy doing pretty darn good. I picked up kitten dry food and a few tiny cans of Fancy Feast for her. The oncologist said it will be a better source of nutrition during chemo. We've been keeping an eye on her poops and it's been perfectly normal.

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Yea! She usually leaves cow flops, and has since she was born.

 

Have a great eveing (when it's quieter)

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Paula

 

 

Expert:  Dr.Fiona replied 4 years ago.
Paula,

That's great that you had such a positive trip out with your mom - so good for both of you (ignore the wallet ;-) ).

Glad to hear Daisy likes her kitten food. Low carbs and high protein are the current recommendations for diet when fighting cancers!

I am off to bed - a busy day tomorrow, so I won't be around, I'm afraid....

bye for now,
Fiona
Customer: replied 3 years ago.

Dr. Fiona - sorry, first I've had some "free" time. The latest on Daisy...

 

Scheduled for chemo #3 (Vincristine & Cytoxin) Thurs 9/23 but she was very lethargic, not eating/drinking 36 hrs prior so I took her early as I was concerned re: kidneys (pee was tangerine color/very strong smelling); dehydration; constipation (stuggling to go), sleeping all the time, etc.

 

Initial exam: fever 104.3; marked reduction in size of peripheral lymph nodes; slightly palpable submandibular & right prescapular lymph node; mild dehydration; wgt decrease (4.68kg to 4.46kg). No chemo. Keeping overnight.

 

CBC/PCV/TP/serum chem profile/Ec8: mildly progressive anemia (PCV = 22%, 6.0) - all else normal. Lateral abdominal radiograph: mod. amt of firm stool; IV fluids, famotidine, Timentin, lactulose, lactulose enemas; (PCV/TP: PCV 16%, 5.2); lateral radiograph: colon empty; eating/drinking. Fever improved (102.2); hydrated, BAR and eating. Wgt increased to 4/68kg

 

Assessment

T-cell lymphoma: near complete remission.

Constipation w/subsequent anorexia & dehydration; consider Vincristine induced.

Fever: improving.

Anemia: likely anemia of chronic disease & dilutional secondary to chemotherapy.

 

Week-end Home Instructions/Treatment(Fri 9/24)

Delayed chemo this week

Lactulose to help with constipation

Clavamox to treat any infection associated with the constipation

Tentative treatment plan to be administered as planned following this delay

Anemia worsened but transfusion not required. Should improve over weekend

Overall remission rate expected to be approx 80%. Overall avg survival rate: 9 mos however negative FelV status, body condition and response to chemo still suggests possibility of longer survival time.

Next chemo & CBC: Tues 9/28

 

PARR results: T-cell lymphoma (multicentric/nodal). Near complete remission after Vincristine #2

 

Saturday 9/25

Daisy is back to being lethargic(!). Very quiet/off to quiet area/sleeping all the time. She's drinking but not interested in eating. I'm giving her 2.5mg Prednisone twice/daily; l ml Lactulose every 12 hrs; and 1ml Clavamox every 12 hrs. I've tried premium canned chicken & broth, baby food, tuna, Fancy Feast - not interested. She took some licks of tapioca pudding (one of her favorites), a few licks of whipped cream (another favorite) and a few licks of tuna liquid (water - not oil). Even tried Pedialyte - no way! She did take some licks of strawberry Ensure. I saw her pee twice Saturday. No poop that I saw, but I was out for over 3 hours. Is this to be expected because of the antibiotic? They said she'd eat like a pig when she got home, but that ain't happening! It's been 24 hrs since she came home.....should I be worried?

 

Paula

 

 

Expert:  Dr.Fiona replied 3 years ago.
Good morning Paula,

I just woke up - let me grab my coffee and then I'll be right back....
Expert:  Dr.Fiona replied 3 years ago.
Ok!

So... I don't want you to panic, but yes, this is rather concerning....

It sounds like Daisy was eating well and feeling much better when she came home on Friday, and it worries me that she has deteriorated. I am concerned that her fever may be up again. That may be the reason she won't eat.

Can you get her in to the referral centre where they do her chemo? I would really like a vet to examine her, check her temperature and check her hydration. She may need some fluids given under the skin, and she may need something to get her fever down (perhaps an additional antibiotic).

Let me know if you cannot get her in to see a vet, but I really do think she needs to see one this morning!

Fiona
Customer: replied 3 years ago.

Dr. Fiona -

 

So sorry to bother you so early, especially on a Sunday - but I'm glad you got your coffee!

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I just woke up myself (slept (?) on a leather couch in family room.) Poor Ron is so worried about his Daisy girl he snored (all night) in decibles rivaling a rock concert.

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He woke up to find Daisy behind our bedroom door to the screened lanai area. When a kittly does that, my red flag antennea are busy.

 

I gave her a 2.5mg Prednisone tablet and 1.25ml Clavamox. Tried a tasty, ham/ham gravy baby food (in tiny jar) at room temp but still not interested. I touched it to her nose so she'd lick it off, but she didn't act like she was interested. I again tried the premium chicken/broth microwaved to take the chill off - still not interested. So I took the Clavamox dropper, filled it w/the chicken broth and got it down her throat - about 3ml worth. She didn't fight me at all.

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She jumped off bed and wobbled over to her "hidey-hole" behind the door. That's when I saw that her back legs seemed weak.

 

Oh yes, I'm taking her right back to NFVS (No. Florida Vet Spec) Oncology group. They're now open 24/7. There's also an animal ER next door. I'm calling Dr. Schmidt's after hours emer. cell # XXXXX he'll know her status and that I'm taking back.

 

Time for her 1ml Lactulose (stool softener) - given at least 30 minutes after Prednisone and Clavamox.

 

I think you're right. She's getting dehydrated again. And although Clavamox is the normal industry standard antibiotic, I want to see something a little stronger to knock any infection out quicker. She can't be be debililtated from a long, drawn out treatment. And I now I'll request she wait longer than next Tuesday for her next chemo treatment.

 

I also want a more specific/definitive reason for this or any "infection" . And I want her to stay there for close observation/monitoring 24/7.... notating results to be 100% sure her fever goes down and stays down - she's eating - drinking - peeing - pooping - more lively - interactive - talkative - etc.

 

Wish us luck. I'm wearing my Daisy earrings today! Gotta get there and back before 2:30pm,,,,company coming for Ron's birthday (actual date is tomorrow) - but how often do you celetrate 74 years!

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I'll write back when I have more info. Take care....

 

Paula

 

 

 

 

Customer: replied 3 years ago.

Oh Fiona, it's 1:35pm.....our Daisy-girl left us at 1:00pm.

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Dr. Schmidt came in as we were waiting for Daisy's test results. A few minutes later he came out and the only way I can explain it is he looked extremely sad and a little ill..

 

I asked how she was and I didn't write anything down when he started talking so I might not have the terminology right. Basically a blast off or a blast of cells erupted into full blown leukemia (???) and was already in her spleen.

 

I knew then that we wanted no more chemo so I asked what could we do to make her comfortable at home for whatever time she has left and he said... she will be gone before the end of the day.

 

Ron and I were not prepared for this and I almost lost it. I asked if we could stay with her a while and then we will let her go. He asked did I mean for him to prepare her and bring her to us and I said yes. It is destroying me, but...yes. He brought her to us in a nice room and we held her, talked to her, fussed over her, kissed her head and nose and cheeks, and held her paws for 30 minutes. She was quiet but alert, and even "aah-aah'ed" for us a couple of times. Or she'd open her mouth to "talk" but you only heard a very faint sound, or none at all. I took several pictures with my cell phone and she looks so alert and "normal". I have to figure how to get them off my phone album and into my computer.

 

When it was time, Dr. Schmidt injected her sleeping med very slowly. She was wide eyed, awake, very comfortable, and no signs of stress as I held her in my arms. But it's funny....when he injected the euthanasia med, I never felt her "go". Her head still rested comfortably on my forearm and her eyes were still open. She never went "limp". I kissed her eyes closed and handed her to Dr. Schmidt. When he picked her up in her blanket, I could see she was limp. I have always felt the souls of my kitties as they left to go over the Rainbow Bridge. But I never felt Daisy's. And I don't know if I'm happy or sad about that.

 

Oh God Fiona, I hurt so very bad. It's Mr. Pie all over again. All the other kitties are very quiet. I'll talk again later.

 

Paula

Expert:  Dr.Fiona replied 3 years ago.
Paula....

Noooooooooooooooo! I am in shock! If I feel this shocked and saddened by this loss, it is hard for me to imagine what it must be like for you... I'm so very very sorry to hear of this terrible and sudden loss of Daisy.

For her to have taken such a fast and dramatic change in direction must make it even more difficult to bear as you had no warning....

(((HUGS)))

I really wish there were something I could do to take away your pain, but I cannot... just know that I understand and am so very sorry that you are facing this.

It sounds like it was peaceful at the end, and that her spirit stayed in her body and with you until the moment Dr. Schmidt picked her up and broke the spell, releasing her spirit to move on. It sounds like Daisy knew you needed her to stay as long as possible, before she moved on to play with Mr. Pie... which is surely where she is now.

My most sincere condolences, Paula, on your loss of Daisy... my heart goes out to you!

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Fiona
Customer: replied 3 years ago.

Fiona -

 

I am amazed and humbled at your perception of my love for Daisy. As if you were there, your description of what occurred perfectly captured my last moments with her.

 

She never did close her eyes or let her head roll to the side or fall limp in my arms.... as if her magnificent spirit kept us bound together until she felt my release - and knew it was ok for her to move on. This classy little girl quietly slipped over the Rainbow Bridge with her last breath inside me - leaving behind a healing balm she knew my soul would need.

 

Ah Daze......

 

I'm trying to upload her picture for you. Please don't go too far way because I'm sure I'll need your knowledge and compassion again one day.

 

With heartfelt thanks....Paula

 

Customer: replied 3 years ago.

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Customer: replied 3 years ago.

Fiona

 

I hope I did this right. Sent 1st one without notation. It's "Daisy - Then"

 

This one is "Daisy - Now" (or was)

 

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Expert:  Dr.Fiona replied 3 years ago.
Paula,
Thank you for sharing your photos of Daisy - even "now" she looks like a kitten! She just has such a dear, sweet little face. Her personality just shines through - she looks as though she is about to take a step towards you to head butt you and ask for a scratch. What a beautiful little spirit she is!

Any time you need me, I'll be around. Just bookmark my profile ( here ) and you can contact me through that. As long as you put my name in the first line, then others should leave it for me to pick up. If you do it through my profile, then an email is sent to my home address to alert me.

If you have an urgent question, you may just want to post it on the boards to be picked up as quickly as possible since now that I am back at work, I am not online quite so often as I was last year.


Thank you again for sharing the photos of Daisy. I feel like I know her....

((HUGS))

Fiona
Customer: replied 3 years ago.

Fiona

 

Your words were the inspiration for my tribute to Daisy....

 

Expert:  Dr.Fiona replied 3 years ago.
Paula,

It is you who are inspiring - I wish all people loved their animal companions as much as you love yours!

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