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Kionna | 10 months ago
Dog Having Seizures And All Her Lab Results Came Back Normal. He Always Go Back To …

Dog having seizures and all her lab results came back normal. He always go back to normal after. She is eating, playing, barking.
Just don’t know what to do.

1 Response

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  1. Krista Magnifico

    Hello.

    I have lots of information on seizures on my blog. Please go to kmdvm.blogspot.com and from there search seizures. Depending on how many your dog has had you might need a medication like keepra for this

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Brandis | 11 months ago
I Came Across Your Video Of How To Pickup A Dog With IVDD And Paralysis, Is …

I came across your video of how to pickup a dog with IVDD and paralysis, is there one for dogs with the issue in their hind legs vs neck? Unfortunately, surgery is not in our budget and I’m really struggling to make sure he’s comfortable when taking him to use the bathroom/rotate him. So just looking for how to support him and keep him as comfortable as possible.

1 Response

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  1. Krista Magnifico

    Hello

    I’m sorry to hear about your dog. I have a lot of information on my blog and YouTube channel. Go there. See if that helps. If you have a specific question come back and ask. I’ll do my best to help.

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Frederick | 11 months ago
This Post Is Specifically For Dr. Krista Magnifico, However Anyone Is Welcome To Chime In If …

This post is specifically for Dr. Krista Magnifico, however anyone is welcome to chime in if you feel you can contribute.

On the evening of Monday, 11/20, our strictly indoor 8yo cat Louie had an accident at home. We aren’t entirely sure what happened, but we observed him jump down from the couch and race across the room, knocking his water bowl over in the process in a way that suggested he was spooked or startled, possibly by an outside noise.

That night he loafed a bit more than usual, but we didn’t think anything of it.

The next day (Tuesday) we noticed he had a noticeable limp in one of his hind legs. He had a slight sprain about six months prior in one of his front legs, and all he was prescribed was rest, so we figured this required the same since he bounced back from that sprain in under a week.

By Tuesday night it was noticeably worse and now both legs were effected, and he was extremely lethargic and kept hiding. We made sure he was comfortable and made plans to take him to a vet the following morning. The next day he was MUCH worse, now dragging his entire body by his front legs with hardly any rear leg movement, and his tail was partially limp as well. Both still had movement, but something was clearly very wrong.

We found a vet who did a quick half assed exam and wouldn’t take x-rays even though we asked for them. She did labwork and prescribed pain meds and said it was likely just a bad fall and he just needed to rest. She told us to follow up with her when we felt it was necessary.

By the next day, Thursday, his rear legs and tail showed absolutely no movement, and he was completely dragging himself with his front legs. And since it was Thanksgiving, everyone was closed, and we don’t have the means to pay for a 24hr emergency facility.

We called the vet back as soon as they opened Friday morning and scheduled the follow-up the same day. We waited in a small room while they took him into another room for a second exam, and when she came back she said his blood work was fine but she recommended putting him down asap because he had developed some sort of neurological issue, likely a slipped disc with his spine. I inquired about treatment options but apparently I didn’t look rich enough, because she just dismissed it as “probably too expensive” and suggested taking him home for some goodbye time, followed by making arrangements.

On Wednesday it was “probably a sprain, just let him rest” and 48 hours later she’s telling us to kill him. Economic Euthanasia in action. Are there treatments? Yes. Can you afford them? No. So fuck you and fuck your cat.

I immediately reached out to another facility for a second opinion. The prognosis was poor, but I was told that there was a chance he could recover with enough rest, attention, love and patience. As long as his appetite remained and he still wanted water, I could let him rest, do physical therapy, pursue acupuncture, etc….and just give him time. He said it could be 50/50 but gave no guarantees. What mattered was he didn’t take away our hope. We were told he wasn’t necessarily in pain, so it wasn’t inhumane to give him a fighting chance. So that’s what we did. The biggest problem was the paralysis meant he couldn’t use his box, so he had to be manually expressed for all his bathroom needs. I could NOT get the hang of it and was incredibly worried about a rupture or blockage. But he had developed incontinence, so even though I wasn’t able to remove his waste myself, it would come out on its own over time. I had to clean a lot of messes as well as clean his backside often, but at least it was coming out one way or another.

Still, he wasn’t examined to my satisfaction, and I wanted to find a vet who took his case more seriously and could actually provide some sort of treatment. After a little research I found one, and they did a FULL neurological exam, asked for his whole story, listened, didn’t rush, and told me how to proceed and what to expect. The did a complimentary ultrasound, two full x-ray sessions and only charged me for one because they did the second just to rule something out, and all in all were angels on earth. They said red light / laser therapy might help, but again couldn’t offer any guarantees. They unit they had on hand was a “Class IV” which is apparently really powerful and efficient, so we began treatment with that immediately, twice weekly.

That was two weeks ago, and as of today it’s now the start of week four. It’s been three full weeks since this all started. Over the last couple weeks, he started showing signs of movement in his right leg. Then his left. Bit by bit. As of today, HE CAN WALK, but only on his “hocks”. His front paws / legs are still fine, and he’s capable of making his way around the house on his own. However he’s still incontinent, and he still isn’t using his box. I’ve been doing my best to clean up after him with warm water and wet wipes (for cats), but he’s starting to develop sores by his anus due to constant over grooming. Apparently I haven’t been doing a well enough job keeping him clean.

We were prescribed a medication called Amoxicillin and Clavulanate Potassium on 12/11 which we were told to give twice daily, 12 hours apart. So we gave him his first dose that night, and twice the next day. He didn’t take well to it and developed horrible diarrhea and vomited a few times as well. Despite this, he still has his appetite and he’s still drinking water. He’s not hiding or showing signs of pain or distress. He still purrs and wants attention, and even wants to play. He just walks on his hocks and can’t use his box. He was also prescribed another medication for nerve pain which was mixed with (I believe) Almond Oil? But he immediately began drooling profusely and had an incredibly adverse reaction to it, and he hated me for the next two days and even became fearful, which was difficult to deal with. Apparently there’s a similar option available in pill / powder form, but our vet won’t prescribe it because apparently it’s too strong for his size.

What all can we do from here on out to help him regain his independence on the bathroom front? What treatments / medications / additional measures would you recommend?

We were told if he were to make a recovery it would take anywhere from 4, 8, or even 12 weeks or more. It’s been three full weeks and he IS walking again (on his hocks), but the bathroom issue is our biggest concern. We’ve laid towels down everywhere but we can’t live like this forever….but at the same time we don’t consider this issue alone to be sufficient reason to end his life. We love him, and he’s family. We’re in it for the long haul.

We were told an MRI to pinpoint the exact spot of his injury would be upwards of 4k and corrective surgery, if it’s a slipped disc, would be 8k – 11k.

We can’t fucking afford any of that, and its safe to say MOST people can’t. What an absolutely predatory situation to be in.

Any advice on how best to proceed from here would be sincerely appreciated. We’re open to anything which has ever shown proven results. Thank you for taking the time to read this. Being concise isn’t among my strong suites.

2 Responses

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  1. Krista Magnifico

    Hello,
    I’m sorry to hear about all of the issues you have had with your cat and the ability to find meaningful help. I know how hard it can be.
    I think that a few things need to be discussed.
    1. I feel it is really important that you talk to the vets who failed you and your cat. Here’s why. You and your cat are still alive and I fear too many others would not have had the same fate. If you don’t tell that to these vets they will keep on writing off pets and breaking their humans hearts. I honestly don’t know why we just don’t help people and stop killing pets we refuse to help.
    2. Keep practicing palapating your cat so you can monitor urine and fecal output.
    3. It sounds like this might be Ivdd in your cat. Which would also mean it can improve and your cat might regain function. For these cases I recommend cage rest and at home physical therapy. Try to keep massaging the legs and work on strengthening and supporting the body.
    4. Keep your cat in a safe place. No jumping or falling. That’s why we call it strict cage rest.
    5. I do think that these guys do have enough quality of life to stay with their family. If they can eat, drink, urinate and defecate and you can provide them a happy life then it’s ok they aren’t perfect.

    PS if he’s struggling with the box put a small amount of litter on a puppy pad. That might help.

  2. Frederick Post author

    1. I have absolutely already been planning on doing so with at least the first initial office which was so quick to suggest euthanasia. She really was SO QUICK to give up on us. I’ve had the thought of sharpening his claws once he’s fully healed, going back there and just throwing him at her face.

    2. I’m doing my best to stay on top of it. He’s not plugged up on either end, that’s for sure. He’s fully incontinent. I just hope he regains his independence at some point, because this is so frustrating. Keeping him and our home clean feels like a full time job in itself at this point.

    3. Is Ivdd different from a slipped disc? I’ve googled it but there’s so much information, some of which is a little conflicting. Initially I was told surgery would be 8-11k (on top of a 4k MRI), but a quick search online suggests surgery for Ivdd runs anywhere from $1500 to 4k. We can’t swing 4k, but we could scrounge up a grand and a half if it meant giving him his best chance at a full recovery. If you have any recommendations for a spot in California we could turn to, we’re open to it.

    We haven’t been keeping him in a cage, as he doesn’t take to it well at all. It stresses him out a great deal, and the third vet that actually bothered treating him said that reducing his stress would play a substantial role in his chances of recovering. But we don’t have any stairs and he’s not able to jump. He can make his way onto the bed using his front lets, and we put pillows and comforters all around the base of the bed so when he heads down, he lands on something soft even though it’s only about two feet high.

    I’ve been massaging his legs a bit and doing bicycle riding motions from time to time for as long as he’ll put up with it (which isn’t long). I also purchased this from Amazon and have been using it along his spine and the base of his tail.

    https://www.amazon.com/dp/B0BR3PSMW1?psc=1&ref=ppx_yo2ov_dt_b_product_details

    If you would recommend a different variant which you’re more familiar with, please let me know and I can return the above and buy your recommendation. Louie is also currently receiving a much more powerful version of this twice weekly with a class IV unit.

    4. He’s not able to independently get onto anything high. The most would be the bed, and we’ve made sure he can get back down comfortably.

    5. His appetite and interest in water have yet to waver. Any recommendations on the puppy pad front? Perhaps something with pheromones or other such attractant? You’re suggesting the pad and litter combination will help re-associate him with the idea of peeing where there’s litter, which might encourage him to start using the box again after a few successful puppy pad uses?

    Lastly, he was prescribed gabapentin about two weeks ago for potential nerve pain, but he had an incredibly adverse reaction with severe drooling and agitation. It was in liquid form in some sort of almond oil, which he HATES. It’s not something I’m comfortable giving him regularly based on the severity of his reaction. I was told there is a pill form, but our vet won’t prescribe it because it’s too much for Louie’s size, and apparently California law has some kind of regulations about allowing the pills to be opened with readjusted doses, so I can’t just half the powder from each pill. If you have any advice for alternatives on this front or how best to proceed, any suggestions at all, that would be extremely helpful.

    They’re also reluctant to give him any anti-inflammatory medication because it’s apparently terrible for the kidneys. I believe it was called an “NSAID”.

    He doesn’t seem to be in any obvious pain or distress, but he’s also a cat and they’re notorious for hiding their discomfort, as you full well know.

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Jessica Gallison | 12 months ago
Dog Vomiting Mucus And Blood

Dog vomiting mucus and blood

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  1. Krista Magnifico

    Hello,
    If you have a question about your pet please add it to the questions page, and give as much information and detail as able. We will try to help

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Frederick | 12 months ago
Our Cat Was Recently Paralyzed Following A Stupid Preventable Accident At Home Where He Got Spooked, …

Our cat was recently paralyzed following a stupid preventable accident at home where he got spooked, jumped off a couch and landed wrong. Now he’s largely immobile. He can get around in short spurts using his front legs, but his hind legs and tail are limp. This has all occurred within the span of a week. Last Monday, 11/20, he was fine. He developed a slight limp on Tuesday, was clearly worse on Wednesday, and fully paralyzed by Thursday, which was Thanksgiving. Friday was when I returned to the initial vet we saw Wednesday for a follow up who recommended putting him down due to the time and potential cost for care, and we got the second opinion elsewhere within an hour that same day.

So the first vet immediately suggesting putting him down, and the second opinion vet offered more hope and said he might be able to bounce back and recover, but it would take a while. Anywhere from 4-12 weeks before showing any improvement. I’m going to do all I can within our means to save him if it’s possible. But I have concerns surrounding his bathroom needs, and potential pain I may be unaware of. Both offices ruled out “FATE” and neither feel it’s heart disease, heart failure, or a clot. Both feel it’s a slipped disc in his spine.

As a result of all this, he can’t use his litter box himself, and I need to learn how to “express” his urine and other end myself while searching for how we’ll be proceeding with his future care.

He’s been having urine incontinence the last few days, regularly leaking a bit when laying down (he’s always laying down now, but you get the point). I need to know if this is only possible or a thing when his bladder is uncomfortably full, or if it can happen regardless of the contents of his bladder, because I’ve found contrasting opinions. Some sources say it’s only leaking because it’s about to rupture and emergency care is needed, and other sources claim it can leak regardless of how much urine is in his bladder at any given time. It can leak when there’s a little or a lot. I don’t know what to put any stock in. I do know that shortly after expressing urine yesterday, we got a lot out….enough to make us think he must be empty or nearly empty, but shortly after he was still leaking a bit, which makes me think this is just something that we will have to deal with in general even if his bladder isn’t full.

The last thing I want is for it to rupture, and I’m finding removing / expressing his urine to be incredibly difficult. I’ve watched a dozen videos demonstrating it on youtube and read guides with photos featuring hand placement, and it’s just not coming easy or naturally at all. He’s a big boi….a little over 18lbs, so he’s a chonk. That’s making finding his bladder especially difficult.

I was able to successfully get a lot out yesterday, and he hasn’t had any water since. But he has had one of those treats that’s kind of like paste in a push up tube, and a small bowl of wet food. I know cats also develop urine from the liquid from their food.

I’m going to be “expressing” him at least once a day. I’ve been told it should be done up to three times a day, but I’m just not there yet, and he’s so uncomfortable I don’t want to put him through that more than necessary. When he drinks water it’s not all that much, maybe half an inch from a small bowl.

Lastly, I’m curious to know if he’s in more pain than I know or realize. We all know cats are great at hiding and masking pain, but at the same time they still do vocalize when they’re uncomfortable, or in distress. I can pick him up without him yowling or making noise, but he tends to complain the most when picking him up just to move him back onto a towel I’ve been keeping under him due to the incontinence.

I’ve read that when cats are in a fair amount of pain, they lose their appetite and stop drinking. Our guy is still doing both, and seems to enjoy both. He doesn’t randomly vocalize or cry or yowl. He’ll protest a bit when I shift him from spot to spot when changing towels, but that’s all.

Any help / thoughts / guidance / advice would be very much appreciate. And if anyone here can recommend a neurology clinic or hospital or other facility that treats cats without RAPING US FINANCIALLY that would be wonderful, because my God has this been frustrating. These people want upwards of 4k for an MRI. It’s positively unreal.

Thank you.

1 Response

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  1. Krista Magnifico

    Hello,
    I’m sorry to hear about your kitty. I really feel like this is best managed by trying to find someone locally who can help you monitor the size of your cats bladder and show you how to safely empty it. Also I think it is helpful to provide a place where he can rest to see if the injury improves. Have you asked your vet if they know of someone who has experience with this? Or reach out on social media or through a local rescue.
    I hope he is feeling better soon Good luck.

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Karen | 12 months ago
My 10 Week Beagle Pup Kiwi Was Diagnosed With Strangles. She Was Put On Clavamox And Prednisone. …

My 10 week beagle pup Kiwi was diagnosed with strangles. She was put on Clavamox and prednisone. I saw a lot of improvement fairly quickly with the swelling and now she is drinking again and is playful and no longer lethargic. My question is regarding the length of the prednisone treatment. She is on 5mg twice a day for 3 days and then 2.5 twice a day for 3 days and then 2.5 once a day for 4 days. I had never heard of this before she became sick and so I have been doing a lot of reading. Everything I have seen so far suggests a much longer course of steroid therapy. I am somewhat uncomfortable about beginning the taper so soon as she still has some swelling on the face and lymph nodes. Should the dosage remain the same until symptoms resolve and then begin to taper?

1 Response

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  1. Krista Magnifico

    Hello,

    I’m so glad to hear your pup is doing better. I think this question is best directed to the vet who prescribed it.

    No one can provide a better answer than they can.

    Good luck!!

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Rance | 1 year ago
My Rescue Dog Copper He Is Amazing, Protective And Overall A Huge Part Of My Familys …

My rescue dog Copper he is amazing, protective and overall a huge part of my familys life. He looks like he has dachshund in hin the length reminds me. Recently we started seeing a limp in his back left leg. He has not been hurt at all. I thought maybe a sprain from playing he does get wild with the neighbors bigger pup. So we gradually notice it getting worse over the week hes limping and the muscle has all gone. I have been walking him maybe gain some back he wont even put pressure on his back leg. Its been a couple weeks and we come home and there is blood comong from his genital when the part comes out. It seems as if he has no control o er it anymore. My heart is hurting and i dont want to put him down he is only 2 years old but he seems missreable. He does not speak it (cry) but the look in his eyes tells me everything i need to know. I do not have the money now to go to vet and pay 1,000 tell i get a new job. Please anyone if you have been through anything similar or any home remedies to ease him.

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  1. Krista Magnifico

    Hello
    I’m sorry to hear about your pup. It really sounds like he needs to be seen by a veterinarian. For cases like these I tell clients to please pay the cost of rhe exam and then we can at least get some idea of what’s going on. In some cases I try an antibiotic and pain medication and then have people save up for an X-ray.
    But a limp is not a reason to put a dog to sleep. The only time I might discuss lameness and euthanasia is if I am worried about cancer. But your dog is very young for this.

    Start with a phone call to a vet for an appointment and go from there.

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Aby | 1 year ago
I Think My Dog Has IVDD, She Is In Pain In Her Neck And When She …

I think my dog has IVDD, she is in pain in her neck and when she walks she keeps her head down and her neck muscles are twitching, i would like to know what to do in this situation to give her relief what medicine are safe for her, specially in my situation and where i live. i couldn’t afford it.

1 Response

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  1. Krista Magnifico

    Hello,

    If you go to my blog at kmdvm.blogspot.Com you can search Ivdd in the search field and read about the cases I have worked with.

    I cannot over emphasize how important it is to see a veterinarian. You will not be able to acquire the medications needed to adequately control the pain without a vets assistance.

    I hope your pup is feeling better soon.

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Alexandra | 1 year ago
** Cat Who Is Veracious Around Feeding Time Help** Hello! I Have 3 Cats That Are Patients There. …

** cat who is veracious around feeding time help**

Hello! I have 3 cats that are patients there. I have had 2 cats, Blink and Havoc for about 5 years now. They are biological brothers. They have always shared everything and we never really had any problems with food or their weight.

About 2 months ago, we adopted a blind cat, Gemma who is about a year old. Her foster said that she would free feed her at her house and that she never really had any aggression with food. I’m not sure what happened because once we adopted her and brought her back here, she has became very veracious with her food. Our solution now is to feed her the dry food in a separate room (we feed her according to the package instructions) because if we do not, she will race through eating her food so she can start trying to eat the boys food as well.

With wet food, I monitor them and am constantly shooing her away so the boys can finish their food as she always inhales her food super quickly.

When we separate her, she will cry until we open the door and then she comes running full speed to the food bowl.

I’ve never really seen anything like it! She is so sweet and other than that there really is no issues I’m just looking for advice if there is anything I can do to make feeding time not so chaotic.

I want her to feel secure that she will always be fed but I can’t leave food out because I don’t want my other cats to eat hers.

I guess my question is, is this a behavior that can be changed or do we just work with it the way we are now? She seems to have a lot of anxiety around food and I’m sure being blind doesn’t help so I wasn’t sure what else we can do.

Thank you!

2 Responses

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  1. Laura

    In all seriousness, get her bloodwork done. A cat that crazy about food might have a thyroid or other medical issue.

    You’ll probably have to separate to feed for a long while yet. If she starts to calm down about it, maybe you’d be able to try feeding in like…a dog crate, perhaps. In the same room, so she can smell their food. It’s a good test while allowing them the ability to eat their own food peacefully.

    You can also try bowls which only open for the right collar. Amazon sells them, but they are NOT cheap: https://www.amazon.com/Sure-Petcare-SureFlap-Selective-Automatic-Stress-Free/dp/B00O0UIPTY/ref=sr_1_17?crid=O9337BSZVCPE&keywords=cat%2Bautomatic%2Bopen%2Band%2Bclose%2Bbowls&qid=1695900727&sprefix=automatic%2Bopen%2Bcat%2B%2Caps%2C57&sr=8-17&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0&th=1

  2. Shiria

    I have those bowls that only open for the right cat. Expensive but so worth it…
    One of mine needs to take medication twice a day but doesn’t take treats and both are very slow eaters. So I either had to seperate them the whole day, or she wasn’t getting her medication.

    As Laura says, get her checked up and if everything is fine, maybe try feeding her more?
    I have learned that kittens and young cats can eat as much as they want, so they can learn that there is always enough food. This way they get calmer with food later on. Also – young cats burn a lot of more energy than older ones. Some can eat more than double the recommended account and still not get fat.
    Also maybe feed more wet food. It has more volume than dry food, while having less calories. this way she feels full faster. You can also add a bit of water for more volume. A friend of mine added special food cellulose for more volume for her cat.

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Roxy | 1 year ago
Suspected IVDD: My 14 Yr Old Jack Russell Has Been Experiencing Some Severe What Looks To Be …

Suspected IVDD: my 14 yr old Jack Russell has been experiencing some severe what looks to be muscle spasms. Took her into the vet and was told she may have joint pain or a neurological nerve pain. They sent me home with pain meds gabapentin, anti inflammatory carprofen and vitamin antinol to see if she got better. It was four days and she didn’t really seem to get better.

Then she seemed like she was developing some sort of serve cough. Took her back to the vet and they said she has some bacterial respiratory infection (also took X-rays) but I suspected kennel cough which they could not tell me 100% for sure, so was sent home with antibiotics. She is up on her vaccines and the only place she has been is at the vet because we don’t have any other dogs around us at home and haven’t been taking her for any walks due to her pain.

It’s been 5 days now and the cough is getting better. However, she is having muscle flares up everyday, multiple times a day. She is panting a lot and seems to be in a lot of pain. The meds don’t seem to be helping a whole lot.

She can still walk but is wobbly. Her legs tremble. I can see her legs are very stiff. Her back looks a little raised. She is still going to the bathroom on her own, but is wobbly.

I’ve put some paw grips on her feet since we have tile floors and some more rugs around the house. I’ve also tried to give her messages which she sometimes allowed me but she’s a Jack Russell and they have their own kind of personality.

What should I do? Any advice? I hate seeing her in so much pain.

4 Responses

Comments

  1. Krista Magnifico

    Hello,

    I think it sounds like you are worried and unsure about your pets condition. In cases like this I recommend two things:
    1: ask your vet to help clarify and solidify your pets condition. Just explain that you are worried and want to make sure you are doing everything you can.
    2. Ask friends and family for help in finding a vet they trust and call them for a second opinion.

    I would also ask about more pain management help, like robaxin or even something stronger, and make sure you are following the very strict cage rest guidelines. These guys just stay in a cage to rest for 6-8 weeks. They only go out for bathroom breaks.

    Also you can follow dodgers list in facebook. They are helpful.

    Good luck.

  2. Roxy Post author

    I’ve switched vets three different times in the last couple of years. Every time I go to the vet there is just really no real solution given other than meds and then come out with a minimum $300-500 or more bill. Tests look normal and basically just have to deal with the problem on my own. To me there are not many vets that are really trying to help or maybe they can’t help. (Have not done an MRI yet, it’s so expensive).

    My dog also has a very stubborn personality. She wants to do what she wants to do. She doesn’t do well with crating. She can be aggressive at times and want to bite. Regardless of her pain, she wants to walk around and “be nosey.” She has to know what’s going on and what we are doing. She has to be around us at all times. I feel like I have to be stationary in order for her to relax. She only eats on her time and if she likes the food (changed food so many times due to refusing to eat). It gets hard with giving her meds when she’s so picky.

    She is currently on Methocarbamol muscle relaxer and seems to help only for a couple of hours if that.

    I’ve been trying to switch her from carprofen to prednisolone but vet said there should be a 3 day wash out period. I feel like I just can’t wait 3 days with her in so much pain without having an anti inflammatory.

    I am lost and cry for her everyday.

    1. Roxy Post author

      My dog actually had a seizure tonight, so we took her to the emergency room. After some tests, it looks like she has low calcium which may have caused the seizure and the leg tremors and muscle spasms. The ER vet doesn’t think her symptoms are associated with IVDD. We are keeping her overnight at the ER while they are administering calcium. She is to be transferred to internal medicine tomorrow to find out the cause or more information. Any thoughts/advice?