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Hemangiosarcoma presumptive diagnosis

LilF

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Jan 3, 2021
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236
@Dr. Sue @Dr. Jeff @Dr. Sara @Dr. Jean and any others......This is difficult to post because there is so much to include. My dog Gabby 14 y/o shar pei mix had some inappetence recently along with a bout of vomiting and a bout of diarrhea. Happened over a few days. I had her blood taken the week before this occurred and even posted some of the results in one of my posts. After the symptoms above I asked my vet to do blood again, just 7 days later. He called and said her hematocrit took a nosedive from the blood taken the week before when she was symptom free. He assumed she was losing blood. I took her for xrays to my acupuncture vet and she was not definitive so I went to the hospital with Gabby and they did an ultrasound. The differential is metastatic neoplasia. Kidneys also had numerous heteroechoic masses/nodules in the cortical region. (largest 5.1x3cm right and 3.4x3.2 left) Spleen contained numerous heteroechoic nodules and masses (largest 6.5 x 3.8cm) Small intestinal wall was mildly thickened as it was before because she has protein losing enteropathy which I had under control
This came out of left field. In Feb 2020 she had an ultrasound recheck for some incidental findings of nodules on the spleen when she had her thyroid tumor removed. As advised I came back in 3 months and they said "don't worry, no need to come back, they are benign and won't grow"

Currently they assume her inappetence, lethargy were due to a possible bleed. We have the Yunnan Baiyou and I am aware of the U of Penn study on the mushrooms. I wonder if her Protein Enteropathy Diet I have home cooked for her was unbalanced. I think it is. I need to balance what she gets.

She also had acupuncture on Aug 12th. Within a week a HUGE lipoma, now 8 cm grew. Perhaps it is something else but he did pull out fat. then in October I think she went to a new acupuncturist who is certified (the first was not), Gabby got laser acupuncture and a Max's concentrated formula for the lipoma but I think it was too strong as she got sick after 2 days of it (to be fair I also had given her cooked bison liver which was new and was giving her a new renal supplement which may have had blood thinning ingredients like Ginko) Shortly after that , Gabby vomited and felt sick previously attributed to a doggie virus but maybe it was a bleed (I believe acupuncture should be stopped. I am not an expert but what I have heard is it can stimulate a cancer to grow. )So after this is when symptoms started to appear. I blame myself and my gut said "how does one know if an animal, esp an old one has a simmering cancer---best not to do acupuncture" I did not listen to my gut.

So, any suggestions besides what I already mentioned? Yes, I know, happiness etc... I also appreciate no comments on how old she is. It is like with old PEOPLE, age is no reason not to treat them. I want to know ways to lengthen her lifespan. I have known about Yunnan for 10 years and now using it. I had it in my "pharmacy". I ordered turkey tail mushrooms today and plan to give the 100 mg/kg dose to her as used in the study. I am not using the I'M Yunity which was used in the study but will use another brand that is organic.

I do not want to hear to make her comfortable as this is not my direction. Yes, she has always had a good life and now is no different. I would like suggestions. I understand Omega 3's and turmeric are out as they may thin the blood and cause a bleed. I understand certain things are contraindicated to use with the Yunnan.

Are there any holistic actions besides happiness, exercise (there will be no sun here for a while), snuffle mat. I could use ideas on diet. Her Protein losing problem makes fat a bad option since this problem requires lower fat. Cancer cells don't use fat so I feel my hands are somewhat tied. I wish the conventional vet I had who found my OTHER dog's splenic tumor had not retired. He saved JJ, the other dog's life simply by finding it by palpation. He was a gifted vet. Gabby's problem should have been found as I was ALWAYS at the vets getting blood or alternative treatments. I feel I need to move fast. Thanks
 

Dr. Sara

Veterinarian
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Dec 30, 2018
Messages
266
Dear Lil,
First, do not blame yourself in any way. You have done the best you could do, promptly.

Second, the spleen nodules may have looked benign and stable in May 2020. That doesn't prevent an evil nodule growing quickly after that, despite all your good care. I have had this happen with my own personal dog; life happens, and we can't predict what or why, we can only do our best, as you are doing.

Change and add therapies gradually so you know what is affecting Gabby positively, and what is affecting her adversely. Allow at least a few days between each change.

Acupuncture can help dogs with cancer. I would not give acupuncture right beside a tumor, though I can and do give acupuncture to dogs with splenic and adrenal cancers.
Certification is a good thing, but not every vet who could be certified bothers to complete it. I took the IVAS courses, and passed both the practical and written exams. I never got certified as I am self-employed.

Do you have a Happy Light, or other full spectrum light? These are fantastic for improving mood, and you can have them on while you and Gabby are doing other things. Don't use it too close to bedtime, as some people can have trouble sleeping if they get a lot of 'sun' late in the day.

The lipoma is not significant to address unless it is bothering Gabby. It may represent an exteriorization of disease, and as such, you don't want to direct therapy toward it.

Are you working with a homeopath to determine a whole body homeopathic medicine to boost Gabby's internal resistance? I have seen both constitutional homeopathic prescribing and cancer directed prescribing (such as Ramakrishnan's method) yield good results.
Take care, and keep us posted,
Dr. Sara
 

LilF

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Jan 3, 2021
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236
Dr. Sara, thank you and sorry to hear this about your dog as well.... It is overwhelming now to broach a novel therapy I have no sense about really. So do you do homeopathy and/or do I look for someone who specifically has treated this with homeopathy successfully or does this idea of "specialty" not apply. I guess I wondered if there were some homeopaths who maybe have a knack for knowing what formulas might balance her out. I am worried about time it takes to get all this going... They said that they thought this happened over the past month or so. I ask myself what was going on over the past month. Today she did not get her walk due to the weather. I played with her inside and she liked it a lot. But I am starting to cry some as this sinks in. I don't know where to start with the homeopathy or who has had good results with a similar situation. I am not working with a homeopath right now but I want to. Do they all do this Ramakrishnan method or is that a specialty? Thank you!
 

Dr. Sara

Veterinarian
HA! Faculty
Joined
Dec 30, 2018
Messages
266
A skilled homeopath can treat any disease; different homeopaths may use different methods. Homeopaths use the method that works best in their hands. Look for a homeopath with whom you and Gabby have a good rapport, and follow their advice. I mentioned the different methods to illustrate that there may be different approaches.
Try to stay positive - Gabby is living in the moment, and that is a useful lesson for all of us.
Love her, enjoy her life, and stay proactive.
Dr. Sara
 

LilF

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Jan 3, 2021
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236
Dr. Sara, I was hoping you do phone consults but I guess that is not an option :-( I am scrambling on a number of fronts on her behalf. I do feel good I have SOMEthing going with the mushrooms and Yunnan. I talked to the vet this morning who does Chinese herbs and see her later this week. I DO want to give homeopathy a shot. I am frustrated with my internet service as I race to put things in place. It is off most days for 8 hours at a time. The weather is an obstacle to her walks but I will do the best I can. I want Gabby to exceed all expectations like some animals (and people) I read about on the internet. That will take some research but I feel hopeful . I need to get her on the optimal diet and don't think she can eat more fat vs protein to starve the cancer as is recommended in the keto diet, because of her PLE. I will keep you all posted. Thank you for the support in both information and understanding.
 

AlysonR

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Jun 21, 2020
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57
I *highly* recommend Dr.Sagrera of Natural Pet Care (Natural Pet Care - Metairie / New Orleans, Louisiana - Dr. Adriana Sagrera, DVM). While she was unable to cure Magic (the bleeding just kept recurring), she did do an amazing job of quite literally bringing Magic back from certain death several times, and Magic had many, really good days before she died. Dr. Sagrera will not give up until you do, or your dog does! That is what she told me, and I truly believe it. When I finally decided it was time for Magic to "change addresses" (as they say in Hawaii), it was definitely a decision between just the two of us. Dr. Sagrera would have kept going with us. She does not charge a great deal. She could certainly charge more. And she will be there for you on weekends, after hours, whatever it takes. She also is completely on board with using yunnan baiyao and turkey tail mushroom. Give her a call -- and impress upon the staff how urgent the matter is. The woman I talked to actually gave me *her* appointment for her somewhat less ill cat! A more dedicated crew you will not find. (I will say, please don't overexercise your dog if the homeopathy makes her feel a lot better -- which it just may well. That was the one thing I wish I'd held back on, as I do believe that was one of the reasons the bleeding kept returning.) I wish you all the best.

I noticed you have trouble with internet, so here's the information:
Phone: 504-834-2023

Hours:

Sunday/Monday: Closed
Tuesday/Thursday: 9:30 AM – 7 PM
Wednesday/Friday: 9:30 AM – 5:30 PM
Saturday: 10 AM – 4 PM

We are closed the second and last Saturday of every month.
 

LilF

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Jan 3, 2021
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236
@AlysonR I just read your post and called Dr. Sagrera. She cannot get me in till Dec 18th. While we were on the phone the Appt we were discussing to make was Dec 14th but in the process it was taken so now it is the 18th. I pleaded with them that this developed quickly and is urgent. They put me on a cancellation list. I said I hope she is still with us by then :-(. I do need support for things that come up with someone "available." like you say. You also mentioned exercise.... This was a big question I have... Gabby does like to walk, is this a bad idea? The weather is now cold and I took her yesterday and she slept for 2 hours after we got back, before dinner. Recalling a few days ago we had an hour walk and she was pretty good wanting to go even more. The weather was snowy. But I noticed a bit after we got home she had turned and did not want her food and seemed more lethargic. I pet her and she rebounded the next morning again. Last night I had this very question about exercise which is typically good for cancer, so for you to mention it as a possible concern, makes me want to investigate this more. Oh, I do hope her walks are not taken from her. She gets depressed not going. Doesn't the Yunnan prevent the bleeding? Is this what is happening. Nobody at the hospital told me she should not jump on the sofa but I learned that this is not good so I put a few cushions there so she could step up. The hospital really gave me no lifestyle cautions like I think they should have. Gabby likes to jump up when she sees people she loves. I also need suggestions for diet. Did Magic have metastatic process with the hemangiosarcoma? I am sorry she "changed addresses" but sounds like you have some consolation that you made her days more better than more worse. I appreciate you taking the time to write your post more than you know. Thank you for giving me some hope with something I can do.
 

AlysonR

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Jun 21, 2020
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57
The yunnan baiyao helps stop the bleeding, but it depends on how bad the bleeding is, and it also depends on what else is going on with the blood. Yes, Magic's spleenic hemangiosarcoma had (apparently) metastasized to the liver. I wanted to keep her walks going, and there were days when she could walk two miles. But just as the doc says to keep your dog quiet after they've had surgery, I think it's prudent to do the same when your dog has a bleeding tumor. One thought is to take Gabby to some place to mosey about. Does she like to go in the car? Some place new to sniff around for a bit, keeping the walk slow and not too long, might be OK (but don't quote me, because I really don't know). Shopping centers (if you're near one), different neighborhoods, just starting the walk where you normally would have had to turn back might be fun for her. Of course, carry her in and out of the car. You could do some fun clicker training with her. For my dog who had to be treated for heartworm, I taught him to lie down and push a small ball to me, which I would then push back to him. If he stood up, the game stopped. He enjoyed it quite a bit, and it was a nightly ritual.

I don't have any suggestions for diet, other than to go very light on the carbs, which is something you're probably already doing. Keep it well balanced, though, and listen to your dog. If she turns her nose up at something, it's time to try something else. Magic *LOVED* Weruva "Paw Lickin' Chicken" (anathema here since it's canned, but she really did absolutely love it, and the only 'problem' with it is it isn't fresh). If your dog likes chicken, and you have access to pasture raised chicken, that might be an enticement. Freeze-dried liver is fun for the snuffle mat.

If it gets close to Dec. 10th and your pup is still hanging in there and you haven't gotten an earlier appt., contact me via this forum. Maybe we can switch appts. with Dr. Sagrera, as the 18th is plenty soon enough for my dog.
 

heart500

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Aug 2, 2017
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38
My heart goes out to you Lil, and your beloved Gabby. In January of 2019, my 12 year old Shih Tzu, Joli, who has always been fed raw, had an ultrasound and was diagnosed presumptively with hemangiosarcoma with two nodules on her spleen. She was started on Yunnan Bail and Turkey Tail. We had an ultrasound every four months and after a year, both nodules had increased in size and a third appeared. Joli was scheduled for a splenectomy at the end of February 2020 and had a good recovery and follow-up appointment the day before everything shut down in March 2020. Biopsies determined that the nodules were two different malignancies but not hemangiosarcoma. Joli is now 14. In the ensuring 21 months, she has gone totally blind, hearing is diminished and the most recent ultrasound three months ago, showed her right adrenal gland and kidney have shrunk. That said, we enjoy every precious day. Holistic vet placed her on four supplements and her BEAM is excellent. Appetite undiminished, enjoys her daily walks (a bit slower and shorter in distance), significant snoozing and enjoys the company of her three Shih Tzu sisters; age 11, and the two littles at age 4. They keep her young and interested in what's going on. Joli gracefully passed on her pack leadership to the 11 year old and is enjoying being a senior with no responsibility but to enjoy her life. I'm unclear as to why Gabby can't have the fat in her raw? At a farm, I purchase a variety of frozen raw proteins ground with bones and organs. I rotate this with Answers Fermented Dog Food and have recently added Mercola's Dehydrated Dog Food into the mix. She eats a large variety of fresh fruit and steamed veggies and appears younger than her years. I am blessed with the counsel of both a wonderful holistic vet and homeopathic vet. The great thing about homeopathic vets is that they don't have to be local and will work with you via phone. Instead of acupuncture, why not try acupressure yourself? T-touch is also a great modality which you can do. Joli always gets some kind of massage upon retiring for the night and before getting out of bed in the morning. It creates intimacy and makes her feel good. Maybe that would serve Gabby as well? There are videos on YouTube that can guide you. I also found the FB group called 'Hemangiosarcoma Diet & Supplement Protocols for dogs - A holistic Approach' full of compassionate, experienced, knowledgeable people who are tireless advocates. Worth joining when facing this dreaded disease. Wishing you both the best. Please provide updates.
 

LilF

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Jan 3, 2021
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236
@AlysonR I just got a call from Dr. Sagrera's office and we are in now Dec 4th.... This is great news!! To all happen in one day.... I will scramble to put the records together....Yes, we go to the park to sniff but she still likes to go on the trails. Just about 10 days ago she was wildly excited to see the horses there. I hope she can feel some of that again... After I sent the prior post, I took her up the street in the sunshine. She walked slowly. It seems I am hand feeding her, otherwise she looks at the bowl like it is going to bite her :) I give her organic turkey chunks to get her interested. Then I take her favorite cookies, no carbs, and make like an Hors douvres (spelling?) with her food which is fresh and wet. The treats are baked and she likes too many of them. Mercola beef and bison bites, I hope they don't have those toxic glycation end products from too high heat.... but she loves them. I try to use as few supplements as possible. I give her the Yunnan and Mushrooms and enzymes to digest her food. I also, for the past year, use L glutamine in her food twice a day for her gut problem. I just started to put in the Meal Mix from Mercola for the vitamins etc... Don't want to make her aversive with too much. Thank you for the generous offer of switching appointments. I did not see Gabby smile today even though she saw someone that she hasn't seen in months. I take her in the car a lot with me. Sounds like you really did great things with Magic that were fun and btw, I love her name.... Will keep you posted
 

AlysonR

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Yay! So happy you got the earlier appt. I sincerely believe if anyone can help Gabby, it's Dr. Sagrera.

I hand fed Magic a *lot*, but I'd been hand feeding her since I brought her into the house (3 months after I "met" her, so I didn't find it unusual. Do whatever it takes.
 

LilF

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Jan 3, 2021
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236
@heart500 You have been through so much with Joli but sounds like you found the right things to do. What supplements seem to give Joli back her zest? Can you share who your holistic vet is. I am in Ohio and pretty much have had to do phone consultations. So yes, happy to explain about the "fat" issue with Gabby. Back about a year ago, her albumin got real low. So I was told to feed her low fat diet. I cooked for her, bison, squash and for the past 5 months, added Open Farm Gently Cooked Turkey . I also add greens and some supplements. So she cannot eat fat for that reason. I always fed her raw until the Protein Losing Enteropathy gut problem, i.e. leaky gut kind of thing... I do not know if she can eat raw---it sure would be easier on ME. Today cooked up 4 lbs of meat and 8 turkey breasts. I added some bison kidney, somewhat cooked and she got sick after that, but I was also giving her a chinese herbal for 2 days prior so not sure what brought on the inappetence and nausea. I thought cancer dogs were supposed to eat cooked food for ease of digestion. I read in Dr. Demian Dressler's The Dog Cancer Survival Guide which I had had on my shelf for years now, that things should be cooked. My own holistic vet calls this "dead food." So I am confused as to what she can and should eat. I thought the bison kidney was too rich for her maybe. I put off feeding time because I get anxious about her eating. I have prepared meals for an hour only to throw them away once in a while. I am not on Facebook anymore but maybe should sign up again. I talked to a vet today who agreed with me that the laser acupuncture she got may have exacerbated this all. But I dont blame the vet who is certified. How was she to know. Seems things started to emerge then thinking it was a doggie virus. But her BEAM had been good up until Thanksgiving time really. Now it is noticeably different day to day. I am supposed to exude happiness but it is crushing. Yours with Joli is a success story and she made it to 14. that is such a testament to the possibilities and your determination and patience. Gabby had identified nodules on the spleen in 2020. They said not to come back for another recheck as they won't grow. Never even occurred to me she had a problem until recently and I constantly monitor everything. I will check out the accupressure modality. It would not stimulate the cancer would it? You were lucky Joli's masses did not metastasize. Again, I did not see this coming with Gabby, not in a million years. I have caught EVERY issue both dogs have had that would have killed them in the past 3 years. I missed this one, but think it came on in a months time according to the internal med Dr. She is my "favorite" dog.. Everyone since I got her at 2 has said the very same word to describe her... "She is so sweet." Thanks for the ideas and the success story of Joli. Bless your heart and hers.
 

LilF

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Jan 3, 2021
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236
Yay! So happy you got the earlier appt. I sincerely believe if anyone can help Gabby, it's Dr. Sagrera.

I hand fed Magic a *lot*, but I'd been hand feeding her since I brought her into the house (3 months after I "met" her, so I didn't find it unusual. Do whatever it takes.
I KNOW!!!! Thanks for being in my corner!!!
 

LilF

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236
I just tried to feed Gabby her dinner and all she wanted was some turkey pieces and took her Yunnan pills. I spend HOURS preparing meat in bulk every few days and HOURS daily putting the meals together with fresh veggies and other toppings like maybe fish etc... So she would not eat the meal I spent over an hour making. The kitchen is a mess three times per day. (she has to have a little meal first thing in the morning to prevent the bilous vomiting) Am I supposed to put dinner in the fridge and give it to her tomorrow? Am I supposed to feed her all the turkey for dinner I made for a week for their pills . I am tired of throwing away grass fed meats. The time I spend on the feeding is hours a day. Mostly it is too late to prepare a meal for myself. She had 2 very short walks today, each about .5 miles or less. Is the Yunnan making her not want to eat. Feeding raw was EASY. I just ordered some grass fed steaks for her in case she is tired of the ground bison. Why is her appetite like this. She doesn't even look at her food bowl. It is like running a hospice here with the other dog senile, slow and stubborn. I have been preparing these meals like this for a long time but I do not like throwing away a full meal and should recycle it tomorrow whether it tastes good or not.
 

lizkunz

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I really sympathize with you. Maybe in a pinch you could look at Cornucopia canned food. It might be more appealing and give you a break now and then. All Natural Organic Dog Food. I wish you and Gabby well.
 

LilF

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Jan 3, 2021
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236
@lizkunz Hi Liz, I will check the pet food store, something different for her. Thanks for your suggestion and kind words. I took Gabby to the park today, she does seem to want to follow other dogs and gets excited. We were out about 50 minutes. I tried to do more sniffing and less walking but she did want to walk. When it was time to get back in the car she did not want to go home, wanted to KEEP GOING. I always feel bad to deny her longer but it was dark and raining the whole time. Unfortunately she did not want to take her thyroid pill this morning so I put it in a syringe with water and put it in her mouth. Gabby has never liked me doing anything in her mouth. She is so smart.... I had it in my hand and she seemed to know exactly what was coming and ran the other way. I had the syringe hidden but she is sooooo smart , she knew. I had to chuckle. But I had to be firm and do it. She did not want much to eat today and I did not even put supplements in her food, including no Yunnan Baiyou. Maybe it is upsetting her stomach. I tried to even feed her in a different bowl with the different foods in separate bowls for her to choose from. She ate a few pieces of turkey and thought the walk would make her appetite better but did not really. I was researching last night supplements to stop the angiogenesis of cancer and feel like her failure to take things is not good. I can even mix parsley in her food but she is not interested right now. I wanted to give her melatonin but how many supplements can she take? I am seeing the acupuncture, chinese medicine vet tomorrow but will not have her do any acupuncture. I talked to a holistic vet over the phone and she did agree that it could have worsened the cancer but probably did not initiate it. Gabby got a lot worse after the laser acupuncture. But who knew?? I do not like the cerenia but do not know how to fix her lack of appetite but that is probably what all vets recommend. She did have some diarrhea today. Very frustrating. I was preparing records for the homeopathic doctor today and saw Gabby had an ultrasound in January of 2021 and none of this was evident but her nodules noted in 2020 had grown some. Wish they would have suggested removal at that time to save her life. Anyway, if anyone has suggestions as to how to get her to eat.. or the cerenia . Maybe the homeopath will be able to work some "magic" (That's a pun for Alyson :) ) for her appetite. Will check out the canned food... and hope for an easy day of food prep---Oh one last thing... Gabby always gets a cookie after her meal... can you believe she was wild for those still? one after the other, did not get tired of eating THOSE....
 

lizkunz

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Another thing I thought of is a Vitamin B12 shot. That seemed to help my picky dog. Also, look at the supplement by VETClassics, CAS options. soft chews, that provides Immune & Antioxidant Support.

I see I didn't provide the link for Cornucopia: Cornucopia Pet Foods - The Power of Preventative Nutrition

Look at the Clear Consience line of treats and gravy. The gravy might entice her, and their treats might provide her with extra nutrition. There was an empower hour on this:

07/05/2021 Empower Hour! Digestion & Microbiome

I wish you and Gabby the best. Maybe use music to promote happiness and wellbeing?
 

LilF

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Jan 3, 2021
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236
@lizkunz This is a great idea about the B12 shot, I didn't think of it. She goes today to the vet. It has helped in the past when the other dog wasn't keen about eating. You actually did send a link with the first post. This latest link is a bit different but I am going to dive into it to see what might fit. I want to have something on hand to entice her. Wish I knew about this several months ago when I was working on her Protein Losing Enteropathy and wanted to balance it with a commercial food. The one I used was not organic . Gabby is also mostly deaf since her thyroid surgery 2 years ago. Sad because we did a lot of things with oral prompting that she had fun with. Right now I am having trouble getting her to take her thyroid pill. I put it in a syringe and went to put it in her mouth and she is too fast and won't take it. I thought I could do it fast like the other day but because she is so smart she figured it out. I will look into all the things you mentioned. I have heard of CAS options maybe 10 years ago from a vet on a radio show and I remember the name but didn't know what it was....so I will check that out too. Thank you for the ideas I can use today and the ones to look into the next few days. I hope she turns around and starts to accept some food. She DID take her thyroid last night with a piece of food. I don't think the Meal Mix I was using for a few days agreed with her. When I think about the first time I gave it to her she ALSO got diarrhea from it so no more of that stuff.
 

lizkunz

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There are two Empower Hours by Dr. Ihor Basko, one on Mushrooms and one on Nutrition. They might be of interest to you. I think Dr. Basko helped formulate some of the VetClassics line including CAS options. Good luck today with Gabby at the vet.
 

AlysonR

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Jun 21, 2020
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57
When you're putting together the records for the homeopathic vet, the main things to focus on are the changes that have occurred with her illness (e.g, things she ate happily before but won't eat now; maybe she would never go out in the rain before, but now she doesn't seem bothered by it, or maybe she used to like to sleep on soft surfaces but now prefers a bare floor...) and the things that are unique to her (for Magic, it was her persistence). Of course, if she's grown pickier, that's a sign. Wanting, say, turkey, but not beef, would be something interesting. There are others here that can give you a much better idea of the sorts of things you should focus on. While medical records are important, current symptoms are, too. Certainly Dr. Sagrera will want to know how her other issues have affected her behavior. She may also have suggestions for how to simplify meal preparation. For Magic, there were a couple of supplements Dr. Sagrera prescribed. The big thing was the homeopathy, though. Be careful how you handle the remedy. Let Dr. Sagrera know you are new to homeopathy and need to know things like "how to dose" and "where to store" the remedy. All the best, and remember, even the best food in the world won't help Gabby if she doesn't eat it. Better to feed her something she's willing to eat. Also, ask Dr. Sagrera how much exercise is OK. I didn't, and I should have.
 

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