Fall Creek Vet Blog

Fall Creek Vet Blog

The Move Is On!

After several fits and starts, lots of ups and downs, and some hints dropped along the way, we have big news to unveil:  WE ARE MOVING! 

When Fall Creek Veterinary Medical Center opened 8 ½ years ago, our current facility was bright, new, and completely met our needs.  You don’t have to have been here that long ago to realize that it is no longer the case.  Our caseload has grown from zero to over 3200 active clients.  Our staff has quintupled.  And we now have two full-time doctors working nearly at capacity.  We have two examination rooms that don’t meet the needs of our patients or clients, and are substantially limited in grooming (with several weeks waiting time during some seasons).  We also have limited hospitalization and boarding space.  Our lobby often overflows and it seems like we are always asking people’s patience.  You have all been very understanding when we have shuffled you around and made you wait longer than you should.

The opportunity to build a free-standing facility became available as land exactly 100 yards east of our current building became available.  Today we closed the purchase of the land, a bit over two acres, and our new home will be started within the next two weeks, at 9667 Geist Crossing Drive, the access road that connects 96th Street and Olio Road. 

Here are a few questions you may have:

Q: How big will the building be?
A:  We will expand from 1968 square feet to nearly 6800.  (Yes, that’s nearly 3 ½ times bigger than we are now!)

Q: When will the move happen?
A:  We anticipate a winter 2016 move-in.  We will stay fully operational during the move, with (hopefully) only limited periods where we might not be able to do so, and then just for parts of a day.  We will hope for good weather and a fast start to construction.

Q:  Can we see pictures or floorplans?
A:  We will keep a steady stream of updates, plans, and photos coming as construction commences and progresses on our Facebook page.  Please follow us there if you don’t already.  We’ll also have some drawings and blueprints to share at our office during construction.

Q:  What will be different?
A:  In addition to added space in general, we will be able to offer separate feline and canine wards,  a fenced-in area to walk dogs, including new cat condos for boarding, room for two groomers to work every day, five exam rooms, separate areas for canine and feline patients to check in in the reception area, a “mini-arcade” to occupy kids during visits, a large consultation room to visit your pet in the hospital or to have a more private place to discuss things with the doctor or staff, and an isolation ward for sick, contagious patients.

Q:  So what will be the same?
A:  For better or worse, we’ll still be “us.”  Our doctors and staff won’t change.  Our philosophy of practice won’t change.  The same desire to know you and your pet, the warm connections we have shared over the years, the attention you and your pet have come to expect will be the same.  There’s never been a desire to be the largest practice in town…just to do the best we can to be your pets’ family doctors.  Now you just won’t have to wait so long for an examination room to open up!

Q:  Will there be a celebration or open house after the new location opens?
A:  Yes, stay tuned!

Q:  “How much is this gonna cost me?”
A:  This is a pretty darn legitimate question to ask…as much as a new building will be pleasant for you and your pet, you ought to know if it’s going to be built by charging you more.  It was important to me that we not build unless and until the practice could support it without raising fees.  I’m glad to say that our clients have been so good to write nice online reviews on sites like Google and Yelp and, most importantly, to refer friends and neighbors to us, we have no need to increase them.  The tremendous growth in the number of clients and patients we have seen completely supports the construction.  So, absent the changes that come when drug or supply costs, for example, go up or down for us, you will see no change in the fees for our services in the new building in 2016.

We all appreciate the privilege you give us daily to be part of your lives and your pets’ lives.  Without your trust and kindness over the years, we would never pursue this.  It’s our hope that you will love our new space as much as we will.   Thank you again for your partnership with us.


Dental Health for Your Pet

(This blog written by Dr. Aaron Luth, Associate Veterinarian.) 
 
At Fall Creek VMC we commonly get asked questions about what pet owners can do to clean their pets’ teeth at home. Before this question can be addressed, it is important to know that by taking prophylactic measures at home to clean teeth, and by doing routine oral cleanings under anesthesia, we are working to eliminate periodontal disease, so called “periodontitis”. This is the number one oral disease in dogs and cats, the end-stage of which is loss of teeth. Periodontal disease is disease of all of the structures of the periodontium, a collective group of anatomical structures that includes the teeth, the bones of the jaws that hold the teeth, the periodontal ligaments (which help hold the tooth roots in place), and the gums. The root of all periodontal disease (pun intended) is the buildup of dental plaque and subsequent dental calculus. Plaque is the grey-brown accumulation of bacteria, salivary glycoproteins, lipid, carbohydrates, and inorganic minerals (calcium carbonate, phosphates). Once this material mineralizes it is known as dental calculus. This material adheres to the teeth and must be mechanically removed. The buildup of plaque and calculus results in the gum disease gingivitis and eventually gingival recession, a painful process by which the gums recede and expose the sensitive roots of the teeth. This is a self-perpetuating process that can be very painful and affect your pet’s overall health. 
 
It is important to realize that by taking prophylactic measures at home, we are not going to completely prevent the inevitable buildup of dental plaque and calculus. Instead, our goal is to minimize the rate at which it accumulates, and thereby reduce the number of anesthetic events required to clean the teeth on a regular basis. The rate at which dental tartar and plaque accumulate on our pet’s teeth is dependent on several factors. In dogs, the size of the animal has as much to do with the rate of accumulation as much as anything, as smaller breeds typically accumulate tartar faster than larger breeds. Dachshunds, Yorkies, Shih-Tzus, Pomeranians, Chihuahuas, and Miniature Pinschers seem to build up residues the fastest. There are many options available for home dental care for both cats and dogs that we may provide to our pets. Any of these may be used alone or in combination with other measures. We typically recommend products that are approved by the Veterinary Oral Health Council (VOHC). This is a panel of veterinarians that rate products based on their efficacy, active ingredients, and margin of safety related to their regular use. The best measures that we can take include daily teeth brushing, enzyme-impregnated rawhide chews, regular application of gingival antimicrobial solutions, prescription dental diets, and oral rinses that can be added to the water bowl. Products approved by the VOHC can be found at the following link: 
 
www.vohc.org/accepted_products.htm

Summer's End Updates

Yesterday I removed a rose branch that was trapped between the upper premolars in an otherwise cheerful (if now foul-breathed) young dog...one of the easier thing to resolve in the course of a busy day. I was less interested in the "why" question (why in the world would any dog think a rose bush seems a good thing to chew up?) and more reflective of what a crazy summer this has been. Of course, having endured a winter that made us all feel a little tougher (and, perhaps, a little bitter), many pf us quietly felt we wouldn't complain about too much heat, or too many stretched of dry weather or the mischief of dogs who dig after moles or chew on the roses. We were rewarded with an oddly cool summer, lots of rain, tick, and mosquitoes galore, and, as it winds down, the heat we had expected in late June. So forgive me if I am late to the game with some updates that I meant to have out well before Labor Day. It's just that I can't wrap my brain around the idea that it's the end of a summer that seems like it has just started. 
 
Most of you know that Dr. Aaron Luth joined our practice as a full-time Associate Veterinarian in early June. Thanks for the warm welcome you have offered him...he hit the ground running and is already busy seeing patients and performing surgical procedures. It has been a huge help to have him here-some of the challenges that come with a packed-full appointment schedule have been alleviated.
 
With Dr. Luth's arrival, we are also able to have a slight extension of our practice hours, with the office open until 7 PM on Tuesdays, starting September 2nd. This means we will have three nights a week where we will be open until 7 PM (Monday, Tuesday, and Thursday), as well as the usual Saturday mornings, and until 6 PM on Wednesday and Friday. We do continue to find limitations with space, though. Even with greater appointment availability, we are still limited by the number of exam rooms, a frustrating problem. 
 
While not yet able to officially announce anything, we are quite optimistic that we will be transitioning to a much larger, free-standing hospital site very close to our current location within the next 18 months. STAY TUNED, and thanks for your patience during this time of transition. 
 
As an early reminder (because these spots have been booking up the last two times we have offered it), we will have a Fall Dental Health Special again this October. All dental cleanings (including anesthesia, the ultrasonic scaling, and polishing) will be offered at a 10 percent discount during October. Please call or e-mail our office with questions or to schedule an appointment. 
 
Finally, we get occasional calls about possible adverse effects from some of the preventative medications we use for heartworm and flea control. Social media (and sometimes news reports) may mention sudden death in a dog or cat one or more days after taking an oral preventative. We appreciate it that you contact us for details...we want to be your source for information on these types of reports. We have ourselves researched the reports and feel comfortable saying that there appears to be no relationship between the very sad loss of a pet and giving a dose of the preventative medication before it. Pathologists who did post-mortem examinations found a variety of problems, non related to others and with no apparent linkage to the preventative medication. Those of you who have been around a while have heard me say this a lot: Any animal's body can respond to whatever is taken into it in almost any way it chooses to do so. ANYTHING has the potential to cause some kind of adverse reaction... the same thing is true in human beings. That said, we see no evidence to cause worry about the preventative medications we currently offer and recommend. Rest assured that we will absolutely make you aware if such a genuine concern arises. These are the same products we use on our own pets, so we share your desires to be sure they are effective AND SAFE. Please enjoy the Labor Day weekend, even as we a bid a too-quick goodbye to Summer 2014. The office will be closed on Monday (though staff as always will be in to care for our boarders), and we look forward to your comments and questions. Thank you for sharing the care of your pets with us...it is a privilege!
 
Warmly, 
 
Jerry Risser, DVM, for all of us at Fall Creek Veterinary Medical Center

NOW is always the best time to help your fat cat shape up!

The New Year provides an annual, if somewhat contrived, opportunity to "fix ourselves.” For many of us, that may mean tackling weight-loss efforts from the unwanted baggage of too much holiday cheer (and for many, the "holiday” baggage began loading itself about January 15th of last year). While we’re at it, we may cast a glance at our pets as well. Cats in particular are often overweight, because many live fairly sedentary lives indoors, with daily "exercise” marked by following the sunbeams from couch to recliner for naps. So what do we feed these felines to get them to lose weight?

A fat cat is not like a fat dog

Traditionally, we have treated a fat cat like a small dog when it comes to nutrition. This is to say, we often have fed low-fat, high-fiber foods to both species to try to decrease caloric intake while still allowing them to get the sense of a full tummy (and, therefore, keep them from harassing us with hungry meows). Many a fat cat has indeed lost weight this way. But there are some concerns. Cats are considered true carnivores (meat-eaters) as opposed to dogs who are omnivores (meat- and plant-eaters). Their need for carbohydrates is much lower than that of dogs; meat products by themselves are often adequate. A fairly recent theory that holds a lot of credence in my opinion is that the increased incidence of diabetes mellitus (high blood sugar) in cats has arisen because we have overfed high carbohydrate foods to cats. The pancreas, which produces insulin, essentially "wears out” from the workload, and then stops producing insulin. Insulin, which is necessary to transport glucose (sugar) into most body cells, is deficient in most diabetic animals.

Healthy fat cat weight loss to prevent diabetes

As a result, a new approach to weight management in cats, that de-emphasizes high-fiber (and, therefore, high-carbohydrate) foods in favor of higher protein and fat diets have been developed, both to manage diabetes and as a possible weight-loss diet in cats. Its similarity to the "Adkins Diet” in people has led to this nutritional approach being called the "Catkins Diet.” Some cats have done well in their weight loss with these diets, and some diabetic animals have been able to discontinue insulin eventually. The two most well-researched diets are Royal Canin Calorie Control CC High Protein, Hills Prescription M/D and Purina Prescription DM.

So which diet is the right one for your fat cat? I wish it were easy to decree a simple answer. Humans have no greater clarity: try Googling "diet book” on Amazon.com sometime if you want a "right” answer. Some cats seem to do well with one approach, others the opposite. It is worth a good chat with your veterinarian to decide how to proceed, and how to monitor success or lack thereof. Keep in mind that weight loss is almost never an emergency (cats don’t have to fit into a bathing suit or attend their twentieth class reunion next week), and too much caloric restriction too fast can lead to big problems. That said, excessive weight can lead to a host of medical problems, and most cats in America are overweight.

Dr. Risser's Column Archives

December 2011

December 2011 Column

Merry Christmas! We hope you and your pets are all enjoying a wonderful holiday season this year! On behalf of myse;f and the staff, I want to thank you all for a terrific 2011. It has been a privilege to work with so many dedicated pet families and welcoming new pets and people to the practice. We also have felt the sadness of the loss of some dearly-loved companions over the past year. I continue to appreciate my staff, a team of people who care deeply about keeping animals safe and healthy and caring about the humans to whom the animals are attached.
It has been a financially-challenging year for many. We have worked to hold down expenses here to be able to keep our fees for office visits, vaccinations, and elective surgeries unchanged. Additionally, though we feel some constraints in our current facility, we plan to stay put for the next few years as we prepare to expand. Fortunately, there is still ample space to do so in the immediate vicinity of our current office. Until then, we appreciate your patience at especially busy times. This should allow us to keep professional fees reasonable during a very slow economic recovery.
Holiday Tips: Preventing Christmas Dramas in Dogs And Cats
--Toxic Plants?
Poinsettias, despite a long run on the “toxic plant” list, are actually, at worst, just irritating to the mouths of dogs and cats. “Mistletoe” can originate from a variety of plant sources, some innocent, others potential neurotoxins, so it may be best to stay “under the mistletoe” and keep it away from pets.
--Tinsel (and other bad stringy things…
Cats in particular seem to love to swallow the “icicles” and other stands of tinsel, leading to a possibly awful (and potentially fatal) “linear foreign body,” which can catch in the GI tract, leading to bunching of intestine as the body tries in vain to move the string or ribbon through. Dogs may actually swallow whole strands of lights. While all electrical cords have the potential to cause painful electrical burns to the mouths of wayward puppies and kittens (and not a few adolescent-behaving adults), the flashy lights seems to shout “come hither” more than other cords.
--Food and Drink
While we humans will likely indulge in impressive displays of eating, we should be careful of feeding rich foods, like turkey and ham, to some pets who can become quite ill from them. Dogs in particular can develop acute pancreatitis from rich and fatty. foods to which they are unaccustomed. Xylitol, an artificial sweetener found primarily in sugar-free chewing gum, is toxic to animals. Chocolate also has the potential, at high doses and especially in concentrated forms like bakers’ chocolate, to be toxic to animals. It causes gastrointestinal upset initially and can lead to elevated heart rates and even seizures. By the way, if you (or a guest—think about that especially annoying in-law) think that it is fun to watch the cat stagger after a few sips of liqueur or “smart” eggnog, remember the danger to pets that comes from ingesting alcoholic beverages.
--Escape
Lots of doors fly open this time of year with the arrival and departure of guests (only Santa uses the chimney) and the risk of pets getting out is significant. Be sure that your pet is microchipped and that it has been registered. We can help answer questions about both
--Cold Weather
Be sure that outdoor pets have access to fresh (and unfrozen) water and shelter from the wind. Give your car hood a “thump” if it has been parked outside to shake loose any kitties that have found your engine to be a warm napping place. Fan belt injuries can be disastrous. Finally, the ethylene glycol found in anti-freeze is a potent toxin to pets that like to lick the sweet, syrupy fluid from the garage floor or driveway. It causes potentially-irreversible kidney failure. Incidentally, if your pet is involved in any holiday drama, we will be here regular hours throughout the holidays (including 8 to 12 on the Saturdays of Christmas Eve and New Year’s Eve and the Mondays after both holidays).
April 2010

Arthritis & Fatty Acid Supplements

A new article in the Journal of the American Veterinary Medical Association reports that pets taking supplements containing Omega-3 fatty acids, found in fish oils, get noticeable anti-inflammatory benefits from them. We have used these supplements for years for itchy, allergic pets (cross-reference the Happy Spring note above), where they help prevent the production of itchy substances (like the advanced biochemistry?).

Newer evidence, confirmed by this report, shows that the need for anti-inflammatory medication like Rimadyl or Deramaxx is lessened (lower dose or less frequent need for administration). So these supplements may mean less medication for your pet.

Omega-3 fatty acids come in various forms, including liquid you can put on food and chewables. Please contact our office for recommendations.

The Hills company makes a food called J/D ("Joint Diet") that includes glucosamine and also large amounts of Omega-3 fatty acids. This has been a good option for those wishing to have a "one-stop shop" for these nutritional supplements already in a diet. More information can be found via this link.

Top 10 Dog Breeds (AKC Registration) in the USA in 2009

  1. Labrador Retriever
  2. German Shepherd
  3. Golden Retriever
  4. Yorkshire Terrier
  5. Beagle
  6. Boxer
  7. Bulldog
  8. Dachshund
  9. Poodle
  10. Shih tzu

Bulldogs, French Bulldogs, Cavalier King Charles Spaniels, and Havanese have made the biggest leaps in popularity in the last decade.

Source: DVM Newsmagazine, March 2010

January 2009

Dr. Risser's Column: January 2009

Hello from All of Us at Fall Creek Veterinary Medical Center!

We hope you and your pets had a safe and happy holiday season and are enduring the January chill well. The bitter temperatures can be dangerous for humans and animals alike. For outdoor pets, be sure that they are given shelter from the wind and plenty of clean, unfrozen water. Better yet, just bring them inside until it warms. Some dogs may be reluctant to go outside, especially if they get snow between their toes in extremely cold temperatures. If your dog needs a sweater, go for it. I admit to some skepticism with snow boots, but some report good success. Road salt can be an irritant for animals that come in contact with it; a foot rinse after a walk may be a good idea.

Aches and pains go up in arthritic pets, just as they can in people, during cold weather. Some of them may require additional medication for discomfort; please let us know if your pet is among those seeming less comfortable.

Finally, if you park outside, “thump” your hood before starting your car on cold mornings. Cats often snuggle near the engine for warmth, and fan-belt and other injuries can seriously injure or kill them.

A reminder that February is “Pet Dental Health Month,” and we will again be discounting dental prophylactic procedures (cleanings) by 15 percent during the entire month to reflect the importance of good dental health care in dogs and cats. There has been a great response so far, but there are still spots available to schedule your pet. We will gladly provide a treatment plan at your request to let you know of anticipated fees. At times of financial uncertainty, every bit helps, and we hope this allows more people to be able to afford this preventative care procedure.

Speaking of these “interesting” financial times, it is curious to me that my Bioethics coursework will find me taking “Ethical Theory” this semester. I admit to initially being less-than-thrilled to take this course, but the way a recession seems to “smoke out” the unethical behavior of so many recently has piqued my interest. I will let those interested know how the course plays out.

Two last updates from the new product front: We now have in stock a medication called Cerenia, a tablet that can be given to prevent motion sickness vomiting in dogs and cats. If this tends to be a struggle for you and your pet, please phone or e-mail us and we can fill you in on it. And for cats that may be taking Lysine, an amino acid that has been helpful with chronic eye infections caused by some viruses, it will soon be available in a chewable treat form (that, supposedly, even cats who are notoriously finicky will enjoy). We will let those interested know more soon.

Do stay toasty, try to consider the cold weather “character-building,” and we will look forward to seeing you and your furry family member soon.

December 2008

Dr. Risser's Column: December 2008

Merry Christmas to all our furry patients and their families! We hope this busy time has been also a happy one for you as well. We are all well here at Fall Creek Veterinary as we celebrate our second holiday season since the practice opened. We are truly thankful for all of you who have made us part of your pets’ health care. For many, 2008 was a year for new pets, whether puppies, kittens, or adopted adult animals. For some, it was a year of sadness in losing a good friend. The holidays can be challenging times for people in the latter category, as with any loss, so please contact us if we may be of any help. We have all been through similar times.

A few quick updates here. I am looking forward to my year ahead as President of the Central Indiana Veterinary Medical Association, which allows some great opportunities to meet with veterinarians and technicians throughout greater Indianapolis. I still hope to take the next course in Bioethics this Spring, a real thriller called “Ethical Theory.” Hold on to your seats as I fill you in on that one.

We will again “celebrate” (if that is the right word) Dental Health Month in February of this year. The entire month, we will be taking 15 percent off the base cost of dental prophylaxis and cleaning. If your pet has had a dental procedure recommended recently (or, in some cases, not-so-recently), this may be a great time to schedule it at a time after the post-Christmas bill-paying blues have hit. Please contact the office if you would like to schedule; a limited number of slots will be available for this popular promotion for better dental health for pets.

For those of you with a son or daughter who will be entering the 8th or 9th grade in the Fall of 2009, Purdue University is offering its third annual “Boiler Vet Camp” from June 7 to 13, 2009. It is a week for those interested in a career in veterinary medicine to spend a week on campus, living and experiencing the veterinary school. If interested, check out the link: here. April 9th is Open House at the School of Veterinary Medicine for the future veterinarians out there.

Finally, a few thoughts on a common group of disorders that cause seizures in companion animals (thanks to Bridgette for the idea). Seizural disorders in animals look a lot like they do in people; grand mal seizures are the type most would recognize; animals convulse (all their muscles contracting at once, often associated with simultaneous urinating and defecating) for what seems like an eternity, but is often more like 60 seconds or so. Some give a few warnings: a so-called “aura” may precede a seizure, where animals seem more agitated or act more strangely than usual. After a seizure, most recover quickly, though may be tired or a bit wobbly for several minutes in the “post-ictal” phase. Some animals may have petit mal seizures, where they do not convulse, but may have “star-gazing” or “fly-snapping” behaviors. These types of seizures may progress to grand mal types.

Causes of seizures are many. In young animals, we attribute many of them to “idiopathic epilepsy,” where the first word says it all—we just plain don’t know what causes them. It is called a “rule-out” diagnosis, because other disorders, including liver and kidney disease, some toxins, electrolyte and blood sugar disorders must be eliminated first. Bloodwork often does this. In older dogs and cats (maybe 6 years or older) we may add some more “Organic brain disease” causes, including tumors. Interestingly, there are some statistical links now being drawn between hypothyroidism (low thyroid hormone levels) in dogs with epilepsy, and allergies to some food proteins in both dogs and cats. Some find seizures may happen when pets are in more stressful circumstances. Most, for whatever reason, seem to happen when people are home to see them happen. Some medications may make seizures more likely.

I usually encourage people with seizuring pets to have an exam done after the first seizure. Unless it was a status epilepticus episode, where a dog or cat convulsed for over 15 minutes, or part of a “cluster” of seizures, where several seizures occurred in a matter of hours, bloodwork may be optional, as is starting medication. In the case of the two events I mentioned, these are true emergencies and need to be addressed quickly. Dogs and cats that have been seizuring for an extended period may cause life-threatening increases in their body temperature and have irreversible brain damage from swelling in the central nervous system.

Epileptics, if they are so-diagnosed, are often given anticonvulsant drugs if they have more than one seizure in a 30-day period, or if they have status or cluster seizures. These medications may vary, but all require close monitoring to avoid toxicity and side-effects. The goal of anti-convulsants is not to “cure” epilepsy or even prevent all future seizures, but to “raise the threshold” for their occurrence. Good information in the recently-published veterinary literature is coming out on options for alternative medications or “add-on” drugs for pets that cannot handle the more commonly-used approaches. This has been very helpful in more difficult cases.

Seizures are one of the most unnerving events pet owners can live through with their companions, so I get lots of calls and questions about them. First, they are not painful, though I suspect dogs and cats are tired after an extended “workout” of having all their muscles contracting! Second, there are suspicions of a genetic link, since certain breeds seem to have higher rates of epilepsy than others; breeding pets with epilepsy is not recommended. Finally, I have never heard of an animal swallowing his or her tongue during a seizure, so, for goodness’ sake, DO NOT reach your hand into your seizuring Rottweiler’s mouth to “save” the tongue—you’ll be the one going to the ER.

A great link from the University of Missouri on seizures is: here. Also look on our website’s “Links” page, especially veterinarypartner.com, one of my personal favorites; seems to avoid a lot of the “crazies” you may find on some sites.

With that, I wish you all again a delightful Christmas season, a wonderful 2009, and the heartfelt gratitude of all of us here for the opportunity to care for your pet this year.

October 2008

Dr. Risser's Column: October 2008

Happy October to all the pets and their people out there!

We hope you are all enjoying what has been a long and beautiful fall so far, after a really pleasant summer. Here at Fall Creek Veterinary we tend to get a bit busier in October, as people prepare their dogs and cats for the winter ahead and the inevitable busy-ness of the holidays, and fight the (hopefully) last battles against fleas and ticks until spring. For a lot of you (pets and people included), this has been an incredibly intense allergy season. I can't remember a time when I've treated more dogs and cats for allergies, or that allergic animals have had such an intense reaction as we have seen this late summer/ early fall. A human allergist friend of mine says research suggests global warming may be a cause, with larger crops of pollen-producing plants its product. So put me in a small category of people who are rooting for an early hard freeze. I'm willing to sacrifice my still-abundant tomato crop at home for a bit of itching-relief for my patients.

Atopy, or atopic dermatitis is the name we give environmental allergies in dogs and cats. They are triggered by things like pollens, molds, and even housedust or housedust mites. Many are seasonal (like when ragweed is pollinating, or maple trees are budding in the spring), though some are year-round. Most animals have very itchy skin, often especially on their feet, their sides (flanks), and ears. Some will show the respiratory signs that many people do, like sneezing, itchy eyes, and even snoring. A lot of dogs, in particular, will scratch so badly that they get skin infections, and that can make them itchier still.

In many cases, we diagnose these allergies based on the symptoms they show and, often, if they have a previous history of the problem at a similar time of year. For severe sufferers, especially those that are miserable all year long, we may advise allergy testing. Traditionally, this was done by having a dermatologist give a series of injections under the top layer of the skin and looking for a reaction, a process called "intradermal skin testing." This is still a very good method. But blood testing for environmental allergens, done by a commercial laboratory that tailors the test to a specific region of the country, can be extremely effective, too. Please let us know if you have questions about these tests; many of you may have already run them on your pet, and are giving allergy injections to "hyposensitize" them to some allergens.

Food proteins, like beef, chicken, and wheat, can also cause allergies. I am, personally, not a fan of blood tests for food allergies, and usually find we have to feed a different protein source or another type of hypoallergenic diet to help these animals. They can be tricky to separate from atopy, and some animals have both. Those are challenging, but we do manage them.

Most pets just plain need some relief from the itch, and there are ways we can help that. The goal of this is to provide the most relief during the season pets are affected, while still being cautious in the approach we take to avoid side effects. Some things, like oatmeal shampoos in cool water (I am a big fan of the shampoo, Epi-soothe), offer at leat 24 hours of relief. Antihistamines, like Benadryl, can help some animals, are really safe, inexpensive, and easy to get, but often don't provide enough relief. For long-term allergies, supplementing with fatty acid, "fish oil" capsules may also help. Infections may require antibiotics or anti-yeast medication. Many animals receive so-called "cortisone" or "steroid" medications, which can be really useful, but have the risk of side-effects. I use these, but am big on using them judiciouly. A newer approach is a medication called Atopica that has less side-effects for most and may be a good option for chronic sufferers.

If your pet suffers none of this, then you've already tuned out and you can be especially thankful for your good fortune. At my house, one of the dogs began in August chewing herself like a pork loin roast and the other licked her feet until the constant sloshing drove my wife to expel her from our room. Both are better now with treatment, but I fully understand the frustration that allergies can cause the human companions of affected pets. Please don't hesitate to phone or e-mail if you have questions or thoughts about allergies in your dog or cat. I'll be busily preparing a "Welcome" sign for Jack Frost.

Do remember to get your boarding reservations for the holidays in to us early, as we always have a "full house" then. Also, grooming appointments also fill up quickly this time of year.

We want to offer our best wishes to Kim, who served as our morning receptionist from the beginning of the practice, who was married this past weekend and will be moving with new husband, Ben, to West Virginia after returning from her honeymoon. We will miss her.

Finally, I will be out of the office at the end of next week to take my next installment of courses for my bioethics degree up at Trinity in Deerfield, IL. So far, in my "free time," I have read the bulk of 2600 pages and will write a total of 10 papers. My 5-year old son was up with me at 6 AM this week to "help" compose one of them. The results were poor (I rewrote my scattered thoughts) but will love the memory of him by my side, offering running commentary, and the dogs at my feet as I slurped coffee over the laptop. It seemed to make all the appointments and surgeries I saw that day even a little more enjoyable. In my absence, a couple of friends and colleagues will be here to care for your pets, including Dr. Jodi Hubner, who many remember from her time at Log Cabin Animal Hospital. I appreciate the opportunity they are giving me to keep broadening horizons in veterinary medicine and bioethics. I'll keep you posted on what I am learning.

As always, I continue to treasure the opportunity to care for your pets. Every day offers new challenges but great joys. I get to do the best job in the world with a delightful group of pets and people, and I hope you all enjoy a long and comfortable (if somewhat allergenic) fall.

June 2008

Dr. Risser's Column: June 2008

We hope that you and your animal pals are enjoying a wonderful summer. It has been a terrific summer here at Fall Creek Veterinary, with the chance to see a lot of new faces (many attached to adorable puppies and kittens). A new (human) face on our staff here is Colleen Grafton, a student at Mount Vernon High School, who is enjoying her job caring for our boarders and hospitalized patients.

A Sunday trip to the "Dental ER" with my 5-year old son last week (following a spectacular trip over his bicycle handlebars and a lost baby tooth) offered me a reminder about the importance of available emergency medical services, and the value of planning ahead for the hopefully unnecessary but often inevitable veterinary ER visit your pet may experience. We are fortunate (both as pet owners and busy veterinarians) to have 24-hour hospitals on Indianapolis's north side. During the early days in this practice, I would often work a shift or two at one of them myself. The popular Discovery Channel show Emergency Vets has give a lot of people a look into the world of animal emergency clinics (alas, minus the tense narration and dramatic music of the show; many a time I would have loved that backdrop versus explaining a case to worried families, with instead only old Duran Duran songs playing on the speakers ovehead).

It used to be typical for veterinarians to "cover call" and see weekend/ holiday/ late night emergencies on their own. In rural areas, this is often still the case. But as regular hours of operation for many practices have expanded to accomodate busy people who work or have children active in activities, the level of general practitioners to be on-call "24/7," mentally sharp, and not grouchy with family and staff has gotten challenging. I did it myself for the first 14 years I practiced, until realizing that my patients may not get the optimal level of care if I show up at the office, alone at 3:15 AM, compared to seeing a veterinarian at a fully-staffed emergency clinic. We are also fortunate to now have board-certified criticalists here, which raises the standard of care even more. These are smart people (I consult with them relentlessly), and are certainly good at navigating difficult emergency cases and, often, improving the outcome in the critical initial stages of care.

Some common questions about veterinary emergencies:

1. When is it an emergency that needs to be seen and when am I just being paranoid?
Sometimes, the answer is clear. A dog hit by a car that is in shock and bleeding clearly needs care. A cat is a life-threatening asthmatic crisis is the same. Most of the rest lies within a gray area. For some people, anything that has them concerned enough to make them think about going to the emergency clinic will benefit from, at least, the peace-of-mind that comes from an exam. Significant pain that seems unable to be controlled at home, or pets that are showing quick deterioration from whatever symptoms they are showing are best off being seen sooner rather than later. If you think there may be a possible problem while our office is still open, phone or e-mail us to clarify if and when you may need emergency care after hours. Finally, some of the listing on our "Links" page (among them healthypet.com and veterinarypartner.com) have some good advice as well, that may help you decide if immediate care or "wait-and-see" is more appropriate for your pet.

2. Where should I go?
At face value, this would seem an easy answer: Go to the closest emergency clinic. We have listings of up to 5 locations within 15 to 30 minutes of most of our clients. But what if the closest location has an emergency surgical patient on the table and 5 other animals in the lobby waiting to be seen? It then would seem, for all but the most life-threatening acute emergencies, that an additional 15-minute drive, where there may be no such wait makes more sense; calling ahead to see what the wait could be (as well as preparing the staff for your arrival) is a good idea. For what it's worth, I would be happy to give you my own personal take on the local emergency options, to see what might be the best match for your pet. A lot of factors come into play, going beyond the scope of this newsletter. I would recommend keeping the phone number of one or two emergency clinics easily accessible (we can give you a handy refrigerator magnet if you want, too).

3. Do I have the option to transfer care when Fall Creek's office reopens?
Absolutely. If your pet requires additional hospitalized care, and your pet is stable enough for transport, you should have the option to transfer him or her back to our office. Please contact me if you want to know if this is a good option. In some cases, it may be appropriate to continue care with one of the specialists affiliated with the emergency clinic. But remember, the option is always yours when it comes to your pet's care.

4. Why are Emergency clinics so *#%! expensive?
Several answers fit here. Among them, emergency clinics have a lot of overhead expenses, including equipment for intensive care and in-house lab testing (outside labs close on weekends and holidays), high staff costs (try hiring for positions that include overnights, weekends, and holidays), and maintaining a facility that may see a zillion emergencies or nothing at all on any given day. Also, there is the old-fashioned economics of supply and demand, meaning that prices can be higher when you're the only show in town. That said, we do have more than one option in town, and having a bit of friendly competition is a good thing. For the increasing number of our clients that have been purchasing pet insurance policies, since all medical and veterinary costs seem to grow rapidly, it is important to know the level of coverage provided for emergency care. This can make a huge difference if your pet requires emergency care.

As always, please get in touch with us with any questions or comments. Have a wonderful, "emergency-free" rest of your summer!

April 2008

Dr. Risser's Column: April 2008

Happy Spring to our patients and their humans!

After what seems like an unusually long and ugly winter (rain/ ice/ and an inch of snow every 3rd day), it is wonderful to see Spring landing so rapidly upon us. We hope you and your pets are able to enjoy the nicer days (more walks and frisbee for the dogs, watching the returning birds from Florida outside sun-soaked windowsills for indoor kitties). Do remember that heartworm preventatives should be given to dogs and even cats, especially important now that our mosquito populations are on the increase. Also, fleas and ticks start in earnest by the beginning of May, so I usually recommend starting things like Frontline and Advantage by May 1st.

We are all well here at the office. Jamie, our outpatient technical/ nursing staff leader, will be holding our next PUPPY PARTY Saturday morning, APRIL 19th, from 10 AM to Noon. The inaugural event was great fun for all, and the video can be seen by clicking on the "Puppy Party" button to the left. All puppies between 8 and 16 weeks old and their people are invited, and feel free to invite friends with puppies as well. It will be free, and treats will be provided for humans and canines alike. Please RSVP to Jamie, jamie@fallcreekvet.com or phone 336-8900.

I (Dr. Risser) completed the next course in the pursuit of my Masters in Bioethics degree earlier this month, addressing reproductive and genetic ethics. I also had a chance to lecture on ethics to students in the veterinary technician program at International Business College. As always, time away from the practice is filled with children, dogs, yardwork/landscaping, and efforts to cycle when the opportunity arises.

Last month, I listed my top picks for flea/ tick/ heartworm preventatives and wanted to offer a few other recommendations for this month. This month's category is one near and dear to me: urine/ pet stain eliminators for the carpet. If anyone would be so deceived as to believe that my pets are free of behavioral and housesoiling issues, they clearly don't know my life or remember the old example of the cobbler whose children have holes in their shoes. Yes, we have one dog who will urinate on the living room floor if the planets are not correctly aligned to make the oudoors completely appealing, and both dogs have been participants in a semi-annual "Diarrhea Fest." So, yep, I have learned a lot about carpet odor/ stain eliminators over the years. This is also relevant to people who have cats who have had issues with urine marking; removing the smell of these spots is pivitol to preventing further episodes.

First, the initial treatment should involve use of an "enzymatic" solution that uses harmless bacterial enzymes to break down the organic matter and urea in urine and fecal matter. The key to successfully using these products is to saturate the entire area, keep it covered with moistened towels or cloths for at least 12 hours (and preferably 24), and to repeat frequently until the odor is much diminished. Do not use any disinfectants to the site for a day before or after treating as this will also kill off the "good" bacteria in the product and inactivate it. While there are a few good choices, we carry one called Unique Pet Stain and Odor Eliminator here. As with anything used on your carpets, read the directions on the bottle completely before using the product.

After the initial treatment, a follow-up stain and odor eliminator may be used to get the remaining inorganic odors and stains out. One product we have found effective is called Equilizer, and it is also available here as well.

Keep in mind that these are some of the most frustrating stains and smells with which we deal in our carpets. If you hire a carpet cleaning company to come out, be sure you mention the pet stain/ odor issues you have. Because these issues are so difficult, many will not guarantee that they can remove them. If the company does so, verify that the guarantee lasts a few days after treatment; many stains can "wick up" from the carpet padding after seemingly being eliminated initially.

As always, we are here to answer any questions you may have about your pet (or, apparently, about bioethical or carpet care issues as well). Thank you for the privilege and opportunity to care for your pets!

Next month's recommended list (if you can contain your curiosity long enough) will be for the following:

  • Dental Care treats/ chews
  • Shampoos for normal skin

We continue to feel privileged to care for your pets, and want to be available to address any concerns or questions you have. Please phone or e-mail anytime.

March 2008

Dr. Risser's Column: March 2008

March 1st marks the first anniversary of the opening of Fall Creek Veterinary Medical Center! It has been a entirely enjoyable, often challenging, and thoroughly rewarding year. Many thanks to all of you and your pets that have offered us such a great start, and thanks to my staff who “make it all go.” We have made many new animal friends over this year and said goodbye to a few dear pets who have passed away. In it all, we are excited about the possibilities for our second year, and continue to appreciate the comments you send our way and your referrals of friends and neighbors.

The Recommended List

With spring finally approaching, we will be seeing nature coming alive again. But hyacinths also herald mosquitoes, warm days for roses also nurture fleas and ticks. Petunias and parasites, unfortunately, must coexist during warmer days. Some of the following will be my own recommendations for anti-parasitic products for cats and dogs, among the growing number of options out there.

I would love to do a “Dr. Risser Recommends…” list that includes my exquisite tastes in literature, film, and fine wine, but that makes several invalid assumptions:

  1. I have any real knowledge of any of those things whatsoever, much less good taste.
  2. My opinion counts for anything that anyone would care about.
  3. I have left the house or the practice long enough to experience anything cultured anyway.
  4. My ego, bruised by three preschoolers that can outsmart me daily, is strong enough to even recommend anything of substance.

So, instead, here’s the less cultured, but utterly practical, list of what I like best among what is out there. Keep in mind that we continue to stock some other products (also listed) if your personal favorite isn’t listed.

Heartworm Preventative:

Interceptor is my top pick for dogs. While Heartgard is a close second, I like the fact that Interceptor has broader protection against the intestinal parasites, particularly whipworms. With a lot of the neighborhoods in the general vicinity of the practice arising from reclaimed farmland, whipworms may be a greater threat here than in some other areas. I also recommend giving prevention year ‘round now, with unpredictable winter temperatures (blame global warming if you will) offering some threat for infection with heartworm and intestinal parasites even in otherwise “cold” months. We also stock Revolution (a topical which also treats fleas and ticks) and Sentinel (basically Interceptor with a “flea birth control” drug added).

Heartgard (oral) or Revolution (topical) are my top picks for heartworm prevention in cats. We truly don’t know the full incidence of heartworm disease in cats (they can be quite difficult to diagnose), but know that there have been many confirmed cases in Indiana.

Revolution has the benefit of also treating fleas, ticks, and ear mites, but is more expensive. Please contact the office for advice on heartworm preventatives in cats, including your own cat’s risk factors.

Flea/ Tick Preventative/ Treatment

Frontline remains my top pick for control of fleas and ticks on dogs and cats. It is applied topically, is very safe for pets and human family members, and is effective for a month. It has the added benefit of being waterproof, so swimming pets will continue to be protected. We also carry:

Advantage, very good in its own right, which is effective against fleas, but not ticks. Again, Revolution will also cover fleas and ticks when applied correctly.

Next month’s recommended list (if you can contain your curiosity long enough) will be for the following:

  • Urine/ Pet Stain eliminators for carpet
  • Dental Care treats/ chews
  • Shampoos for “normal” skin

We continue to feel privileged to care for your pets, and want to be available to address any concerns or questions you have. Please phone or e-mail anytime.

December 2007

Dr. Risser's Column: December 2007

Most everyone knows that pets make poor gifts; yet each April, many puppies (and kittens) that were so joyously greeted at the holidays get dropped off at shelters or rescues. The reasons are many: Too expensive to keep, too much energy, too destructive, too hard to train, too much shedding, too much barking. Essentially, too much puppy (or kitty).

Getting a pet should be a decision one arrives at after considerable thought & research; definitely not easy to keep in mind when faced with large-eyed faces and wagging tails at the local shelter or pet shop. There are many, many details to take into consideration. Do you live in a 3-bedroom house with a couple of fenced acres, or a 1-bedroom apartment that has a weight (or breed) restriction on what sort of dog you can have? Before you begin your breed search, have in mind a particular size and temperament of dog that you will be comfortable handling. Are you a bit of a couch potato, or do you jog or walk regularly around your neighborhood or on trails, even in inclement weather? Dogs have been bred for generations for certain characteristics, like a strong herding instinct, or chasing game for miles. Those breeds will need an outlet for the instincts that have been bred into them, like agility classes or another hobby. Have you the time & patience required to obedience and house-train a puppy, or would you prefer to adopt an older, somewhat more settled dog? Even older dogs that come from shelters or rescues will often need obedience or settling training done to resolve the problems that often send them to the shelters or rescues in the first place.

Another consideration is cost of care; it’s a common euphemism in the pet care field that the most expensive years of a pet’s life are the first, and the last. After a puppy is selected and settled, the real care starts. Giant breeds need more food than a smaller breed with less growing to do. Puppy vaccines, training, and spay or neuter follow one upon the other for at least the first 6 months. Training should be continued and advanced as your dog gets older to keep in practice and prevent boredom.

As expensive and time-consuming puppies and kittens may be, with the proper effort as younglings we can help them become a truly pleasant companion for life. If you are considering adding a new canine or feline member to your family this holiday season, please feel free to call our office for some advice or help with choosing a breed that should work well with your situation.

July 2007

Dr. Risser's Column: July 2007

Geist area homeowners have grown accustomed to the presence of “adorable” wildlife that calls our wooded and ravine terrain their home as well. From the bunnies and deer that find my perennials irresistible to the raccoons that have affection for the garbage cans, I join my neighbors in dealing with issues stemming from co-existence with wild animals. As a veterinarian, I have long dealt with interactions between pets and wildlife, often including fights involving some combination of dogs, coyotes, cats, and possums (the last of which are surprisingly nasty creatures). But now we have another issue that is present locally. A disease called “leptospirosis” has re-emerged. This bacterial disease, which can cause fatal kidney and liver failure in dogs, was relatively common years ago, but then largely disappeared from Indiana. In the past year in particular, I have personally diagnosed it in dogs in the area. It is spread through contact with urine from infected animals, most often wildlife like raccoons, opossums, skunks, squirrels, and deer. The contaminated urine, though often found in puddles or other standing water, can also penetrate the soil, where Leptospira bacteria can survive for several months. Humans can also contract the disease.

Fortunately, there is a vaccine available for dogs to prevent leptospirosis. Most veterinarians offer it as an option for their patients. Because there are several strains, or “serovars,” of Leptospira, of which two are especially prevalent in Indiana, it is important to be sure the vaccine contains the appropriate serovars.

It is also worth noting that not every dog is at risk for contracting leptospirosis. As with decisions about any vaccination, your veterinarian will help you decide the appropriateness of giving the vaccine to your dog and discuss any possible risks associated with it.

Since I live in the Geist area and, like most of you, have encroached on the turf of a bevy of wild critters, I have a fair bit of concern about diseases that can spread between them and my pets. So my brave warrior dogs, who have just cornered a possum on the deck (and who is himself playing dead, of course), will be getting their Leptospirosis booster right on schedule again this year.

June 2007

Dr. Risser's Column: June 2007

Occasionally I check out the bumpy and pock-marked backyard, victims of the countless moles that call the underground world of my beloved grassy yard home. The neighbors try assorted efforts to banish them (often in vain or, worse, into my yard), but I get incredibly nervous when I hear of anyone using rodent poisons to try to kill moles or other rodents. The recent pet food recalls and tragic poisonings of dogs and cats created some confusion about rodenticides, as such poisons are called. The chemical found in the contaminated food was sometimes called, by the media, a rodenticide, for which it, in fact, is used in Asia, though not typically in North America. This chemical, which works by causing kidney failure, can be distinguished from the “anticoagulant” rodenticides used here. These poisons, by contrast, are extremely potent and effective at blocking the normal blood clotting mechanisms in the body. Unfortunately, they are also readily available in homes and yards, and their sweet taste is appealing to dogs and cats. While dogs are more likely to directly eat the poison itself, cats more commonly indirectly take it in by eating a rodent that has itself eaten the rodenticide. This can make it extremely difficult to even know if a cat has been poisoned until he or she is showing symptoms.

Symptoms of toxicity with anticoagulant rodenticides come from their effects on blocking the body’s production of Vitamin K, a vital part of the so-called clotting cascade. As Vitamin K levels drop over a few days following ingestion of the poison, “routine” knocks and bumps cause an animal’s body to start bleeding uncontrollably. Initial signs can be bruising on large areas of the skin, gums, or eyes. Some animals have nosebleeds or vomit blood. Untreated, animals that are showing symptoms will die. Even with aggressive treatment, if diagnosed too late in the course of the illness, many animals do not survive.

Important considerations with animals that have, or may have, ingested rodenticides is EARLY and AGGRESSIVE treatment. Even a very small amount of poison can be fatal. The first goal of treatment is removal of any rodenticide that is still in the animal’s stomach, if it was recently eaten, by inducing vomiting. Contact your veterinarian for recommendations on how to best do so. Further treatment often involves administering activated charcoal or other toxin adsorbents, and starting Vitamin K therapy. Vitamin K usually starts as an injection, followed by at least 4 weeks of daily oral medication. Even animals suspected of ingesting anticoagulant rodenticides should be treated prophylactically.

Animals already displaying clinical signs may require intensive care and blood transfusions. These animals should be minimally-handled to avoid further trauma that could start an additional bleeding episode. These are challenging and often sad cases.

If you have pets, or know of animals that have access to your home or property, be extremely cautious with rodent poisons, or avoid them altogether. Take any possible exposure very seriously. For my part, I’ll just continue, grudgingly, to view my mole-riddled yard as a current fact of life.

May 2007

Dr. Risser's Column: May 2007

I have a couple of pictures of myself as an idealistic 9-year old with my Cocker Spaniel, Jodi, who had the profound gift of patience to allow me to do checkups on her, discuss her medical conditions, in great detail and dreadful terminology, with her, and write reports summarizing my findings. With a twinkle in my eye as I carried out my “duties”, I knew I would become a veterinarian. I would save the animal world.

Like other idealists, I grew up, but, perhaps, not completely. My dreams became a little smaller (which was good, after all), but I still felt called to take a few risks to live out, in some way, what I felt called to do. Some risks are bad. I have been abundantly capable of making bad choices that have led to deep regret. Others are good. Marriage and children are astonishingly risky, but have been joyful for me. In the Fall, I decided to take another risk and start my very own small animal practice. Like much of life, the journey is sometimes more telling than the final result. Here are a few musings gleaned from the process, and some stories to accompany them.

I have been incredibly fortunate in my career to work with impeccable colleagues, from whom I have learned a lot. The decision to “do it on my own” offered challenges as well as opportunities. As I was planning and designing and financing the clinic, I also lived the life of a “relief veterinarian.” This meant that I would fill in for other doctors who might be on vacation or recovering from surgery, for example, and work in a variety of practices. This meant some very long days, several overnight emergency stints, and a lot of driving. It also offers the chance to meet many other veterinarians, see new and different protocols and facilities, and work with some terrific staff people. With a new facility under construction and new accounts being set up for drugs and supplies, my cell phone became my business and personal lifeline while I was working at various practices. Many a good-natured technician would roll his or her eyes every time my “pants rang.” Truthfully, I am happy for the fact that I could do relief work. It can be a great exercise in grace to work with other practitioners and a diverse group of clients, and to realize that we share a lot of similar joys and frustrations. I am less likely to be judgmental about other veterinarians today than a year ago.

Days when I wasn’t doing relief work, I would be home with my three children, the computer, some blueprints, and the ubiquitous cell phone. One memorable scene occurred when I was deep in discussion with a possible receptionist candidate on the phone. My potty-training 3-year old shouted from the top of the stairs, “Daddy, WIPE ME!” Maintaining professionalism is strained anytime after one shouts back to a pre-schooler, “You’re a big boy! Do it yourself and I’ll check you when you think you’re done!” I somehow suspected that Andrew Carnegie had no such conversations while building his empire.

Hiring staff was the single most important thing I would do. It was, in a lot of ways, the most stressful. Lacking an office, it meant setting up interviews across Indianapolis. As the sole member of the “Human Resources Department,” I got to make initial calls, do interviews, call references, negotiate rates of pay, and call the people that I had to pass on. I was impressed and thrilled with the quality of applicants I got (and, obviously, excited about the people who came aboard), though it will be some time before I feel like starting every interview with the words, “Venti, no room for cream.”

Construction was quick and, generally, painless, though our opening received multiple delays from successive snowstorms. Computer training happened in a building with no ceiling or heat some days. The phone number assigned to us proved to be wrong, after it appeared in the phone book. One phone book lost our ad altogether. Our address proved to be wrong, with the town incorrectly identified. And our first few clients were an amazing patient bunch, helping us through computer curiosities and delays in medication arriving.

We are one month into the new practice, and the routine is becoming smoother. We have already shared laughter and tears with people and their pets. I still sometimes walk through this place with a sense of wonder, where a dirt floor stood four months ago, I have the sounds of dogs, cats, children, groomer’s clippers, surgical monitors, and phones. This continues to be an amazing adventure and a remarkable way to make a living.

And sometimes in the mirror I can catch a little bit of that twinkle again, and I think I may have a chance of helping save a little piece of the world.