Deerfield Blog

Spring Showers bring Puppies and Kittens!


Spring is in full swing and with that comes one of the happiest times of the year: BABIES! Puppies and kittens to be more specific. With puppy and kitten season comes some very important questions about care and preventative health and wellness for the new furry friend. Below is detailed common puppy and kitten problems, vaccine protocols and other tips we can offer.


Puppies are weaned from mom around 6 – 8 weeks of age. Once they are weaned from mother’s milk and are no longer receiving her antibodies to protect them from harmful disease it is time for first vaccines. Puppies who are at least 6 – 8 weeks old should receive a DHPP booster (Distemper/hepatitis/parainfluenza/parvovirus). All of these diseases if contracted by a dog can potentially be fatal.

Distemper Virus is a severe potentially fatal disease characterized by a fever, nasal and eye discharge, depression, anorexia, sometimes dogs may get seizures or other neurological effects if the virus moves into the brain, it can also affect the enamel of the teeth and cause hardened paw pads. Mortality rate is about 50%

Hepaitits is a virus that infects the liver and causes acute liver failure, fever, neurological signs, anorexia, vomiting, diarrhea, abdominal pain, blue colored eyes and death in severe cases. The prognosis for hepatitis is poor. If the animal survives it will likely have permanent damage to the organ and require life long therapy.

Parainfluenza is a respiratory disease that causes coughing, gagging and retching at best. At its worst it can cause anorexia, lethargy difficulty breathing, pneumonia and death.

Parvovirus attacks the cells that line the gastrointestinal tract and cause severe lethargy, vomiting and diarrhea and death due to dehydration and the fact that the animal cannot absorb any of its nutrients.

Research and studies support that this vaccine is 90% protective against these diseases. That is an incredible reduction in the rate of disease. Therefore we recommend this vaccine for every dog as a core vaccine.

After the initial booster a puppy must receive a distemper booster (DHPP) every 2 – 4 weeks until he/she is 4 months of age. At that time the immune system is mature and will mount a long lasting immune response. Before the immune system is mature the protective length of a vaccine varies between 2 – 4 weeks before it wears off. This is why puppies must be boostered more frequently than adults.

If your puppy/dog is older and has never received any boosters, that’s ok, it’s never too late to start. Make an appointment today!


Kittens are weaned from mom around 6 – 8 weeks of age. Once they are weaned from mother’s milk and are no longer receiving her antibodies to protect them from harmful disease it is time for first vaccines. Kittens who are at least 6 – 8 weeks old should receive a FVRCP booster (Feline Viral Rhinotracheitis/calicivirus/panleukopenia virus) aka: feline distemper vaccine.

Feline Viral Rhinotracheitis is a severe upper respiratory infection that is difficult to cure since it is not bacterial in nature. Once contracted it is usually a life long struggle, the cats affected have nasal discharge, eye discharge, chronic severe coughing and sneezing and difficulty breathing.

Calicivirus is also an upper respiratory disease. It causes similar symptoms as rhinotracheitis except it also causes ulcerations in the mouth and on the tongue that can be very painful and cause the cat to have trouble eating.

Pnaleukopenia virus is the feline version of parvovirus. We also refer to it as fading kitten syndrome. Unlike their canine counterparts cats rarely vomit or have diarrhea, they just stop eating and waste away and eventually succumb to the illness

Due to the severe nature of these diseases we recommend this to every kitten/cat as a core vaccine. After the initial booster a kitten must receive a distemper booster (FVRCP) every 2 – 4 weeks until he/she is 4 months of age. Again, this is because the immune system is not fully matured until about 4 months of age thus a long lasting immune response cannot be mounted until that time.

If your kitten/cat is older and has never received any boosters, that’s ok, it’s never too late to start. Make an appointment today!


There is much controversy about the rabies vaccine today. Let us assure you that it is safe and it is necessary and it is the LAW. Rabies is fatal to any mammal that contracts the disease. There have been about 3 – 4 people in recorded history to have survived contracting the rabies virus and medical science currently does not know why those people survived. Despite popular belief rabies is not eradicated, there are still cases of rabies reported in the US. There are greater than 300 cases of feline rabies, 80 – 100 cases of canine rabies, and 1 – 3 cases of human rabies reported annually in the United States.

The most common rabies exposure to humans is through an infected dog. The most common rabies exposure to a dog is through wild life such as skunks, fox and raccoons.

There are other vaccines that we may or may not recommend depending on their life style, health and age but the previous vaccines are considered core and are recommended by most all veterinarians for most all puppies and kittens. If you have any further questions about vaccine protocols please call. If you have a new fur baby that needs vaccines please call to schedule an appointment today.


Veterinary Dental Health Month.

Feline premolars 2 resorbtion 352 264Dental Cleanings

“Periodontal disease is the most common clinical condition occurring in adult dogs and cats. By 3 years of age most dogs and cats have some evidence of periodontal disease” 1

Plaque is a soft, sticky, whitish mat-like film attached to the tooth surface that is formed by colonization of bacteria. Tooth brushing every day can remove plaque from the teeth. Tooth brushing is the gold standard of care to prevent gingivitis and gum disease in humans and pets.

For the busy house hold who does not have time to brush your pets teeth daily, don’t worry, we understand! There are plenty of other options to help prevent plaque and gingivitis for your pet. Here is a list of options to help prevent dental disease in your pet in order of effectiveness:

  1. Teeth brushing* Gold standard
    1. Many groomers also offer teeth brushing services!
  2. DentaHex Oral Care Chews for dogs OR CET Hextra treats for cats.
    1. Designed to take 1 – 20mins for complete consumption. This allows ample time for the enzymes in the treats to work their magic on the teeth. So to recap.
  3. Specially formulated diets such as T/D or Healthy Advantage Oral Care made by Hills (can also be used as treats!)
  4. Drinking water additives or mouth rinses
  5. Over the counter dental treats
    1. Only mildly helpful due to the speed they are consumed.

Gingivitis is the inflammation of the gum tissue. This can be caused by plaque and tartar build up around the gum line. If you have ever brushed yours or your pet’s teeth and noticed some blood in the saliva it was because of gingivitis. Gingivitis is the beginning of periodontal disease. Gingivitis can be prevented with good, at home dental care and attention.

Periodontitis is advanced gingivitis that threatens tooth viability.

Tartar/Calculus is hard yellowish to brownish-black deposit on teeth formed through mineralization of dead bacteria, dental plaque and the salts in salivary secretions. This when an anesthetized dental cleaning is warranted. No amount of brushing, flossing, special treats, foods or mouth washes will remove tartar and calculus. It is as hard as a rock and must be carefully and surgically scraped off with proper equipment so as to not damage the underlying tooth and enamel.

Periodontal Disease is graded 1 – 4. 1

Grade 1 – plaque and calculus are present causing gingivitis. Reversible with proper anesthetized veterinary dental cleaning

Grade 2 – Early periodontitis. Mild to moderate plaque and calculus, partial loss of gums and bone. Teeth may be able to be saved if treatment is pursued and quickly!

Grade 3 – Moderate periodontitis with moderate to significant plaque and calculus. Progressive destruction of the gum and bone. Teeth may need to be extracted. The pet’s mouth is sore and may cause eating or behavior problems.

Grade 4 – Advanced periodontitis with significant plaque and calculus. The pet’s mouth is painful and chronic bacterial infection is destroying the gum, teeth and bone. The bacteria can also spread to the blood stream and begin to colonize other organs such as kidneys, liver and heart. This is called bacterial translocation and endocarditis. Significant tooth loss is expected during a dental procedure.

If your veterinarian recommends a dental cleaning for your pet it is because we have found gingivitis, plaque and/or tartar and we are trying to prevent periodontitis and tooth loss. We want to intervene at grades 1 – 2 so we can prevent 3 and 4.

Do not be fooled by the “awake dental cleanings” that some facilities may offer. This type of dental cleaning is glorified teeth brushing. I think it is very helpful in prevention of dental disease but it does NOT replace a thorough veterinary oral exam and anesthetized dental cleaning procedure. For those owners who have reservations about general anesthesia we understand your concerns but we ask you not to worry. A veterinarian will not recommend a dental cleaning to you if they think there is a reason that your pet would not be a good anesthetic candidate.

resorptive disease 343 211

At Deerfield Veterinary Hospital we offer the highest standard of care for your pet’s dental experience. All pets are under general anesthesia so every individual tooth can be assessed properly. We have special dental radiology equipment so we can visualize tooth root and bones to help aid in the assessment of tooth viability. Once all the teeth are cleaned and assessed, we will surgically and carefully remove any teeth that need to be removed and close up the defects that are left behind to expedite recovery and facilitate a pain free healing process. We have the same dental equipment that you would find in your own human dental office. We also have continuous EKG monitoring, in house blood machines and a dedicated technician to be with your pet for not only the dental cleaning but all the way through recovery and waking. Your pet’s safety and quality of care is our number one concern.

If you have questions or concerns about your pet’s dental health please call to schedule an appointment for a veterinarian to evaluate him/her.


1 – American Veterinary Dental College


How To Protect Your Pets From Holiday Hazards

How To Protect Your Pets From Holiday Hazards

The holidays are often a time of coming together with friends and family to celebrate. Keeping your pets safe during the holiday season can be challenging with extra busy schedules and changing routines. The holidays usually increase the accessibility to “Human” food and drinks that may be hazardous to your pets.

Did you know that in addition to food dangers Christmas trees, lights, ornaments, wrapping paper, and other decorations all can also be hazardous to your dogs and cats? Not to worry, though. Below are some often overlooked simple techniques to better pet proof your home for the holidays. Awareness of these potential hazards will make it easier to prevent them as you go.

How to protect your pets from their new “Christmas Tree” toy.

If your dog or cat is fascinated with your Christmas tree and won’t leave it alone, you might consider placing it in a corner where they will have less access to it. If that isn’t an option or they still won’t leave it alone, you may want to place a small wind chime or a similar noise maker on the bottom of your tree so there will be an audible alarm when your pet goes for the tree. This will at least allow you to react quickly and better monitor their behavior so you can redirect them or just make sure they don’t damage the tree or hurt themselves.  Another idea is to place a pet playpen fence around your tree to block them from getting to the tree. This might be a good solution while you aren’t celebrating Christmas directly or are away from home with your pets home alone.

Consider not putting lights near the bottom of the tree within your pet’s reach. Dogs and cats have been known to chew  Christmas lights and electrical cords.

Pets occasionally eat tinsel which can cause intestinal blockages.  These situations usually require surgery to resolve.

Live Christmas trees present a different hazard than artificial trees in that they require water.  This standing water in the tree stand can be toxic as it often mixes with harmful sap or contains poisonous fertilizers.  To reduce this risk, cover the water reservoir. You can make a shroud out of aluminum foil and cover the reservoir like you would cover a bowl, taking care to work the foil tightly around the base of the tree.

Cats and dogs sometimes  view decorative ornaments as toys to be played with and chewed on. As you can imagine, this leads to choking, intestinal blockages, injured paws, and mouths.  Hang more pet-friendly ornaments on the bottom of the tree and put the more dangerous ones high up on the tree if possible.

Naughty kitty playing with a Christmas ornament under a tree

Poinsettia, holly, and mistletoe plants are considered poisonous to cats and dogs. Putting these plants up high out of your pets reach is suggested.

Remember dogs and cats have an amazing sense of smell. When you hang food decorations on your tree such as gingerbread ornaments or popcorn on a string, they will smell it and be attracted to it.

Has your dog or cat ever knocked something off a table with their tail or nose? Lit candles can easily cause a fire when knocked over so it’s a good idea to place them on high shelves out of reach of your pets.

Lastly, when wrapping gifts, keep in mind that dogs and some cats find the wrapping paper, bows, tape, and other wrapping decorations fun to chew on. As with the other Christmas decorations mentioned above, ingesting any of these items can lead to vomiting and/or intestinal blockages

With these tips and techniques in mind, you can make this the best holiday season ever for your entire family!

For more information on foods to protect your pets from this holiday season, check out our previous blog article on  holiday safety tips for pet owners.

All of us at Deerfield Vet want to wish you a very Merry Christmas and a Happy New Year! Thank you for making this another great year by allowing us the privilege of caring for your pets.


How To Tell If Your Pet Has Arthritis

How To Tell If Your Pet Has Arthritis

Did you realize that 62% of dogs between 8 and 13 years of age have arthritis?  And that 20% of all cats have x-ray evidence of arthritis?  Some orthopedists believe that  osteoarthritis disease (OAD) in dogs is caused by an anatomical defect that places abnormal stress on the joints.   Wear and tear arthritis tends to occur in cats much as it does in people.  No matter the cause of OAD, alleviating pain is the primary concern.  OAD pain signs can include limping, difficulty jumping, sitting or squatting to eliminate, stiffness, reluctance to navigate stairs and overall behavior change. If your pet is demonstrating any of these signs as it ages, it may be time for life improving OAD therapy.

Think of OAD therapy as a triangle.  Each leg of the triangle represents one mode of therapy:  chondroprotectants, NSAIDs (Non Steroidal Anti-Inflammatory Drugs) and adjuvant pain relievers.  The inner area encompassed by the triangle legs represents weight management which is often a too overlooked part of arthritis control.

Chondroprotectants are substances while help protect cartilage.  Joint fluid and cartilage act as shock absorbers for bones.  Chondroprotectants help maintain cartilage integrity and help increase joint fluid viscosity.  There is only one injectable FDA approved chondroprotectant.  All others are nutraceuticals such as glucosamine or dietary supplements some of which are incorporated into the food.  There is a wide variation of efficacy in these substances so please consult with your veterinarian about their use.

The next triangle leg is the NSAIDs- the largest group and mainstay of OAD treatment. NSAIDs block the cyclo-oxygenase (COX) pathway.  The COX pathway is responsible for prostaglandin production.  There are two primary COX pathways- COX 1 & COX 2. The COX 1 pathway synthesizes beneficial, “housekeeping” prostaglandins that aid in maintaining gastrointestinal mucosa, kidney blood flow and platelet aggregation which helps blood clot.  COX 1 is known as the “good COX”.  The COX 2 pathway produces inflammatory prostaglandins which cause inflammation and pain. Some inflammation is good and helps the body repair damage, but chronic inflammation isn’t beneficial to the body.  COX 2 is “the bad COX”. The newer, more potent NSAIDs inhibit the COX 2 pathway while mostly sparing the COX 1 pathway making these new class of drugs much safer.  Aspirin and corticosteroids work by inhibiting both the COX 1 and the COX 2 pathways. Aspirin’s action of interfering with gastric protection prostaglandins predisposes dogs and people to gastrointestinal ulceration. This side effect is rarely seen with the selective COX 2 inhibitor NSAIDs such as Rimadyl, Deramaxx, Metacam and Previcox. There are side effects associated with this group of drugs so your pet will need to have periodic, monitoring bloodwork done.  I also recommend doing baseline bloodwork prior to initiating therapy since often we are using these drugs in our older patients which may have other, underlying, hidden health issues.

A reminder note:  In general, NSAIDs are toxic to cats.  NSAIDs such as Tylenol (Acetaminophen) and Advil (Ibuprofen) can induce fatal liver failure in your cat. NEVER give your cat NSAIDs.

Senhor levando seu cachorro passearThe third leg of the OAD treatment triangle is pain relievers other than NSAIDS. Narcotic and narcotic-like drugs represent a large portion of this group.  These drugs make up the mainstay of OAD control for cats.  Unlike NSAIDs, narcotics can be used safely in cats under close supervision of a veterinarian. In canine patients, adding a narcotic or narcotic like drug into the treatment regimen along with the NSAIDs will allow us to use the lowest NSAID dose possible.  Lowering the NSAID dose reduces the potential side effects of the NSAID.  Moreover, many dogs with severe OAD require this multi-modal pain relief therapy to achieve pain control. A common drug now used to treat the pain of canine OAD is tramadol.  Many of you know this drug as Ultram.

Lastly, weight management is the overall key to controlling OAD. That is why it is represented as the center of the triangle.  Additional body weight stresses joints. A higher fiber, low fat diet will help your pet lose weight, decrease joint pain and hopefully decrease the overall doses of medication needed. Weight loss will also help your pet move more easily and this in turn will aid you with implementing a moderate exercise plan. Regular controlled exercise can improve joint mobility and strengthen supporting muscles which can improve your pet’s quality of life. Physical therapy is a new and upcoming area of treatment for patients with OAD.


My Dog Won’t Stop Scratching: Understanding Pet Allergies

My Dog Won’t Stop Scratching: Understanding Pet Allergies

Are Pet Allergies Causing Your Dog To Constantly Scratch And Chew Themselves?

Fall in the Ozarks brings less humidity, cooler weather, colored leaves, and unfortunately ragweed.  Fall means hay fever symptoms in people and allergic dermatitis in our pets. Unlike humans, most pets show signs of allergies through their skin. So, what are pet allergies? An allergy is a state of over-reactivity or hypersensitivity to an allergen. Most allergens are proteins. The allergen protein may be of insect, plant or animal origin.  Some allergens are inhaled, some allergens are ingested and some allergens cause contact irritation. No matter the route of exposure, the end result is an itchy dog if your pet suffers from allergies. The itching is caused by an overactive immune system reaction. This can sometimes happen with the first allergen exposure but often it requires multiple exposures to the offending allergen. An antibody in the blood called Immunoglobulin E (IgE) binds to the allergen protein.  This allergen-IgE complex then attaches to a Mast Cell. When attached to an allergen complex, Mast Cells break up and release potent inflammatory compounds such as histamine. This starts the inflammatory cascade and the allergic reaction. This allergic reaction can happen anywhere on the skin of your dog.  The medical term for this is allergic dermatitis or atopy.


There are numerous substances that can act as allergens. Flea saliva, tick saliva, tree pollens (cedar, oak, ash), flower pollens, grasses and weed pollens (ragweed), as well as molds, mildew, and house dust mites are the most common allergy offenders.  Some plant and animal proteins found in foods can cause allergies as well as some food additives.  The most common cause of allergies in our pets is fleas and the least common cause of allergies is food.  Up to 80% of our pets with allergic dermatitis are very allergic to fleas so flea control is absolutely essential in the allergic pet.


The most common sign of allergies is itching of the skin –either in one area or generalized over the body. Itchy signs can include chewing and licking of the feet, rubbing or pawing at the face or eyes, rubbing the head or ears along the carpet or sofa, rubbing the belly or rear on the floor, and redness of the skin in the affected areas.  Many pets will lick their armpits, thighs, belly or abdomen. Scratching at the ears or ear flicking and head shaking is also indicative of allergies. The constant scratching and licking can result in a secondary bacterial skin infection.  Other signs of allergies may also include reoccurring ear infections, full anal glands and anal gland infections.


Many dog breeds are predisposed to allergies.  Terrier breeds as a group are the most commonly affected dogs that we see in our practice. Schnauzers, Westies, Scottish, Cairn, Welsh, Fox, Boston and Jack Russell Terriers are just a few that can be afflicted with allergies.  Golden Retrievers, Labrador Retrievers, Boxers, Bulldogs, Shih Tzus, Cocker Spaniels, and Shepherds are also commonly affected breeds.   Most pets will start showing allergy signs between one and three years of age.  Initially, many allergies will occur seasonally when the allergen is at its peak.  But each year, the allergy season starts a little earlier and lasts a little longer and the allergies worsen. Eventually, with time, allergic dermatitis can become year-round.  Allergens such as house dust mites, molds and mildew are present any season and pets sensitive to these will suffer year-round.

Happy Puppy Dog Free From Allergy Symptoms

Happy Puppy Dog Free From Symptoms of Pet Allergies


The best way to treat allergies is to individualize the treatment to your pet and to treat that patient with the lowest dose or frequency of medication possible because allergies are a life long problem. Eventually, your pet may need medication daily to control its allergies so starting with lower dose therapy initially will be of benefit. Keep in mind that some animals will respond better to different aspects of the therapy than others and some therapies may not work at all.  Also remember that allergies are controlled and not cured. Seven possible allergy treatments include frequent bathing, antihistamine therapy, fatty acid supplementation, anti-inflammatory therapy, cyclosporine therapy, desensitization therapy, and/or food allergy trial.  And as mentioned earlier, flea and tick control is essential in the allergic patient.

Keep in mind that each allergy patient is different and each treatment will be individualized to that pet. Some therapies will work better than others for different pets. Above all, remember that allergies are controlled at best.  Allergies are not cured. Close communication with your veterinarian is essential in keeping your allergy pet as comfortable as possible.


Frequent bathing helps physically remove irritants that are on the surface of your pet’s skin.  Bathing also helps control and removes infection causing bacteria from the skin.  Some pets need be bathed weekly. It is very important to use a high-quality, hypoallergenic or medicated shampoo that will not dry out or irritate your pet’s skin when used regularly. Be sure to thoroughly rinse your pet after its bath. Your veterinarian will recommend the best shampoo and the best bathing schedule for your pet.  Consider having your long-haired pet’s coat shaved during allergy season to assist you in bathing.


Antihistamines work the same in our pets as they do in us.  By decreasing the release of inflammatory mediators, antihistamines help alleviate the symptoms of allergies.  As is the case with people, different antihistamines will affect our pets in different ways.  Some pets will become sleepy, others may become excitable, and some may show a decrease in appetite.  Despite these few side effects, antihistamines are relatively safe to use on a daily basis and are most effective when given prior to and regularly through the allergy season. The biggest benefit to using these medications is that it allows us to avoid using steroids or allows us to use a lower dose of steroids.


Fatty acids are compounds in the body that are used as building blocks to form compounds such as histamine and prostaglandins.  Histamines are compounds that can cause inflammation and allergies.  Supplementing the diet with a non-body source of fatty acids may actually help decrease the amount of inflammatory mediators produced by the body because the oral fatty acid gets metabolized into different, less potent inflammatory mediators. Fatty acid supplements work in about 30 % of our patients. It is believed that some antihistamines and fatty acids work synergistically to achieve an even greater effect.  Fatty acids also help moisturize and improve the condition of the hair coat which is important in our allergy patients.


Steroids are used when the above therapies are not effective or the allergies are so severe that the patient needs relief.  Steroids are often used to help a patient survive through allergy season until allergy testing and desensitization therapy can be initiated. Steroids basically turn off the over-reactive immune system. Steroids do have side effects some of which can be serious. The most common side effects are increased thirst and urination, increased appetite and weight gain.  Steroids also predispose pets to infections, especially bladder infections. Steroids can also interfere with your pet’s own hormonal regulation. There are short acting and long acting steroids. The severity of side effects is directly related to the potency of the steroid used.  There are two basic forms of steroids. There is an injectable form and a pill form.  The injectable form can last in your pet’s system for 2 to 3 months. The tablet form usually lasts for about a day.  It is safer for your pet to be on the oral tablets at a graduated, tapered dose.  The injectable form is used when your pet’s allergies are so severe that immediate relief is needed.  Steroid treatment is a serious therapy that requires close attention by your veterinarian.


This is the gold standard for a patient with allergic dermatitis.  Your pet may either be skin tested or have blood drawn for an allergy test.  The skin test involves injecting diluted allergens into your pet’s skin and looking for a flare skin reaction.  The blood test is done in a specialized laboratory. The test looks for blood levels of IgE in response to antigens. Most allergy testing is done in the winter when your pet is no longer receiving medications. Once it is determined what your pet is allergic to, an allergen-specific immune serum can be compounded.  This serum will have low levels of antigen that your pet will be exposed to by injections over a period of time – in effect desensitizing your pet to the allergens.  The exact mechanism of action of immunotherapy is still unknown in the dog but it is postulated that immunotherapy decreases the levels of IgE antibodies and increases the levels of IgG antibodies along with altering T-helper cell response.  Overall, desensitization improves allergy symptoms in about 50% of patients and the results can be very gratifying.


Cyclosporine is a chemotherapy drug. It has been altered and formulated into a low dose oral tablet called Atopica. Atopica is a potent immunosuppressor of T- helper cells and inhibits interleukin -2 which is an inflammatory mediator. These two actions help turn off the over reactive immune system response and provide relief for the allergy pet.  Atopica does not suppress cell- mediated immune responses and therefore overall doesn’t adversely affect the pet’s ability to fight infections.  It is only approved for use it dogs.


Is the newest generation anti-inflammatory medication used to control itching associated with allergic dermatitis? We have now treated over 80 patients at Deerfield in the past year with this new medication and have seen very positive results.  Apoquel targets the pet’s immune system. It specifically addresses that part of the immune system that is involved in the itch and inflammatory response.  Unlike


No amount of allergy treatment in the world will relieve your pet’s itching if your pet has fleas.  As stated earlier, 80% of our pets with allergies are also allergic to fleas.  It may take only one or two flea bites to cause an allergic reaction in your pet.  One flea is one flea too many for a pet with allergies.  Flea control is essential for an allergy patient.

We know it can be stressful to see your pet suffer. Feel free to contact us for further help and advise regarding your pet.

Got Questions? Just Ask. We’re here to help!