Veterinarians Mark 250 Years Of Care
How did veterinary medicine start, and how has it evolved over the last 250 years? We speak to local vets, Dr. Katy Allen and Dr. Michael Mansfield about the history of the practice, and the varying specialties that are now offered.
Dr. Katy Allen, local veterinarian, and owner of Canterbury Tails Veterinary Services.
Dr. Michael Mansfield, emergency clinician at the Pet Emergency and Specialty Center in San Diego.
This is a rush transcript created by a contractor for KPBS to improve accessibility for the deaf and hard-of-hearing. Please refer to the media file as the formal record of this interview. Opinions expressed by guests during interviews reflect the guest’s individual views and do not necessarily represent those of KPBS staff, members or its sponsors.
CAVANAUGH: As America still struggles with the issue of how all its human residents should be getting their healthcare, the world of veterinary medicine is celebrating a mile stone this year. 2011 markings the 200 and 50th world anniversary of formal veterinary medical education. Advances in the treatment of animals have been amazing in recent years, and the life span of pets has increased dramatically, but there are still a lot of people who because of their budget or their convictions just don't take their pets to the doctor. We're about to find out what they're missing. I'd like to welcome my guests. Katie Allen is a local veterinarian, owner of Canterbury Tails veterinary services. Katie, welcome back.
ALLEN: Thank you so much, Maureen, nice to be here.
CAVANAUGH: Doctor Michael Mansfield is emergency clinician at the pet emergency and specialty center in San Diego. Michael mansion field, welcome.
MANSFIELD: Thank you, good morning.
CAVANAUGH: Now, we invite our listeners to join the conversation. Do you have questions about how advances in veterinary care could help your pet? When do you think vets could do differently that would help pets and their humans? Give us a call with your questions and your comments. The number here is 1-888-895-5727. That's 1-888-895-5727 KPBS. Well, Katie, to falls to you to give us a little history lesson here. How did veterinary medicine start.
ALLEN: Well, quite annoyingly, it was the French that got it started. The first formal veterinary school was in Leone in France, and they first got to students in, I think, 1761, which makes this the two helped and 50th anniversary, and it was really -- they were all horse doctors.
ALLEN: It was mostly horses that they were dealing with, you know you used horses for farm working for charming into battle, which obviously the English won most of those. But --
CAVANAUGH: But who's keeping score?
ALLEN: Who's keeping score? Not me. Action core. But farm working transport,ering. So that's how it started. And it was very -- it was very basic stuff. Mostly dealing with injuries, lamenesses, pretty much horses spend most of their time getting lame, and veterinarians spend most of their time trying to make them sound again. And that's where it started. It then sort of spread, they they Italy took up the role, and they got more interested in food animal immediate, they were seeing how people were relying on animals more for food, and so they got a little bit more involved in that. It also grew needing veterinarians to work on diseases that people were catching from animals. They weren't interested so much in animals being sick, but that humans were catching diseases from them. And so that's where it all began.
CAVANAUGH: Now, I'm wondering, one of the ideas that really caught up on among people who wanted to get involved in this new specialty was that of compare to know anatomy, that people could actually learn something about human physiology from studying the physiology of and the sickness of animals.
ALLEN: Well, yes, because it would be a lot easier to be looking at animals rather than cutting up people.
ALLEN: And there are lots of similarities, there are also as you learn more about veterinary medicine, a lot of defenses. But they were just sort of into the basics, how does blood flow around the body?
ALLEN: Very basic stuff, which is the same between species.
CAVANAUGH: Well, when did they start to treat primarily cats and dogs.
ALLEN: Primarily, not for a long time. In England, you started to see veterinarians specializing, sort of, maybe in dogs and cats, beginning in about the 1850s of so sort of midVictorian era when people started to have pets of not the way we think of them as members of the family, but none the less, they would have outside cats and dogs also would be outside, but -- so people -- veterinarians would start to in the cities being more interested in being able to look after dogs and the cas. It moved very, very slowly from then. And even between the war, when World War II obviously, things grew a lot bit, but still veterinarians were very much food animal vet their -- food animal doctors. It was a reserved occupation in World War II, you didn't have to go and fight if you were a vet their yen because you were needed for the food supply of the country.
CAVANAUGH: That's fascinating.
ALLEN: . You were involve definitely very important from that perspective, after world war two, things then started to change eight-bit. Of and pet medicine started to be -- to grow very, very slowly. Probably in the last 20-year, it is just taken off.
CAVANAUGH: I'm speaking with doctor Katie Allen, she's the owner of Canterbury tails veterinary services. And doctor Michael Mansfield is also my guest, he's emergency clinician at the pet emergency and specialty center in San Diego. And we're talking today in honor of the 200 and 50th anniversary of formal vet their medical education. And before we bring this right up to the modern day, I know that, Katie, you have actually looked at some of the prescriptions, or the treatment methods of veterinary medicine in the past. Tell us a little wit about that.
ALLEN: It's really very Amyselfing, if you read old textbooks, it's wonderful, some of the things they used to do. The names of the diseases were so fun and interesting of there'd be dropsy and black leg and glanders, and all sorts of weird names. It's lovely. The treatments, a lot of things would be treated with arsenic, strychnine, turpentine. You'd be asked to drink turpentine. And lots of the immediates looked really good, you'd be treating topically, that is, on the surface of the skin with different tinctures, gentian violet, purple stuff. And even today, if you're a horse veterinarian, you'll know that your clients love sprays that are blue and purple to put on their horses, they feel like it's really working if it's a cool color like that.
CAVANAUGH: That's interesting. So some things are a hold over from this somewhat ancient past?
ALLEN: Yes! Yes!
CAVANAUGH: Now, as I say, doctor Mansfield, I want to bring this story up to our modern day because you deal with emergency situations when it comes to largely pets that are brought into -- so what do you dos an emergency clinician?
MANSFIELD: Well, basically, we do the same things as a human ER doctor would do. And I get that question a lot. People just don't understand what kind of emergencies animals would have. But they're typically the same ones that people would have. Of you see a lot of vehicular trauma, we see congestive heart failures, seizures, those are some of the major things we see animals coming 234 very sick with fevers. We see a lot of rattle snake bites out where I practice. So those are the different types of things we deal with at every shift that we work.
CAVANAUGH: I think people are probably amazed too at how similar some of the emergency treatments are for animals as opposed to humans, like when an animal arrives with an emergency in your clinic, what do you do? How do you evaluate them? What are your treatments like?
MANSFIELD: Well, we always triage our clients. So the most ill ones get seen first. But if they come in in a state of shock, we place an intravenous catheter, we start fluids right away, we assess their blood pressure. Their vital signs.
CAVANAUGH: Just like me, right? It's the same thing.
MANSFIELD: Uh-huh. I would say it's probably about 80 percent the same as human medicine. It's just that 20 percent that's critical. What is different is a substantial difference.
CAVANAUGH: Exactly. We're taking your calls at 1-888-895-5727 if you'd like to join the conversation. John is on the line from San Diego. Good morning, John, welcome to These Days. John, are you with us? Good morning. Okay. We will check back and see if we can -- if we can get our calls in. Michael, I'm wondering, what -- do you find that many emergency clinicians need to be board certified the or are not port certified?
MANSFIELD: Well, I think the vast majority of emergency doctors, veterinary emergency doctors in this country are not board certified. I think that pursuing board special -- a board specialty is something that is becoming more and more popular over the last few years. And I think that -- I mean, it would be impossible to staff every emergency veterinary clinic with a boarded specialist. So right now the clinic where we working we have two of them, and they do make sure that everything is [CHECK AUDIO] in terms of how we practice medicine in our clinic.
CAVANAUGH: Great. Right, I just wanted to get that out of the way. John is on the line with us now from San Diego. We're taking your calls at 1-888-895-5727. Good morning, John.
NEW SPEAKER: Morning. You know, you had started the show you have with a question of why people may not be bringing in their animals to see their vets or why they might be reluctant. And I know from my past experience, I bring my pets in, and I have often a lot of vets giving me or trying to sell me products that my pets don't need. And sometimes there's food that -- or other products that they may be selling at the vettednary clinic that may not be the best for my animal. And have a lot of byproducts, and I think there's a distrust among people in believing what their vets -- their vets tell them, thinking that they're gonna be going in to the clinic just for a simple thing, and then, you know, coming out spending hundreds of dollars.
CAVANAUGH: Right. Let me get a response to that, John. And thank you for the question. Katie, how do you deal with that issue of trust between a veterinarian and patients so to speak?
ALLEN: It can be a big issue. And I hear what he said. I think a part of it is we're not good enough, you're not doing a good enough job of educating people about what is available, and why we're recommending it. Certainly there are lots of different ways you can go, when you own a pet. And you can do the bear minimum, which is maybe vaccines and spay neuter and food and shelter. And it's perfectly fine. But there is always more that can be done, and there are other people on the other end of spectrum that want absolutely everything possible to be done. So it's -- it's our job to offer what's available but not in a way that makes people feel pressured to do all that extra, or make them feel like they're bad pet owners if they don't do it. But if you don't offer what's available, then somebody else will be angry at you for not letting you know that that was available. So I think it's more in the way that it's presented as options that are there for you, and then educate the person well enough to let them make the choice. But I would, sort of in our defense, say in general veterinarians adopt enter their field to make money. With our degree of education, we could be making so much more in other professional fields. And we've elected to do this because it's what we want to do.
CAVANAUGH: Do you run up against that as well, Michael, with people who, you know, you have an animal in an emergency situation, there are a whole host of things that you might be able to offer to the pet owner as -- but is there that idea that you're not forcing people to do things, but at the same time you would to let them know that these options are available?
MANSFIELD: Certainly. I try to hard -- I mean, I sympathize with my clients, and I do try hard to explain to them when an animal comes in injured what we can probably get away with doing, in trying to treat and help their animal, and what we should ideally do to minimize complications and risks and those sorts of things. So I do -- I do try to explain to my clients what I think is absolutely necessary and what we should try to do in order to avoid problems. In some cases, there aren't good options, and we do have to talk about euthanasia. But I always try to let people know what, you know, I try to give them plan A, plan B, plan C, and help them decide based on what they can do, what might be the best route for their animal.
CAVANAUGH: Katie, how much training does a vet need.
ALLEN: Well, you have your under graduate degree, so you're four years there in school, then it's four years of veterinary school, and that's eight years in college. Then if you want to specialize, you've got a year's internship, maybe a three-year residence, so that's a lot of time getting an expensive education, not earning any money while you're there, and so yes, we do have to charge for our services. But I would encourage the gentleman that called to find a veterinarian that he does trust. Just like with any profession, you find depend and bad. You also might find someone who's good, but just not someone that you click with. Of so there's plenty of us around. Shop around and find someone that you really to trust and you can discuss those issues with.
CAVANAUGH: We're taking your calls at 1-888-895-5727. Of we're gonna get in one more call benefit the break. Carol is calling us from San Diego. Good morning, carol. Welcome to These Days. Of.
NEW SPEAKER: Hi. Can you hear me?
NEW SPEAKER: Okay. I'm in my car. It's really difficult because of the advances in veterinary medicine to -- determine how far you should go in keeping a pet alive with a chronic disease like diabetes or cancer or -- kidney disease or something like that.
NEW SPEAKER: You can spend a fortunate keeping an animal alive, and they do become part of your family, and it's become, you know, like they are like a child am well. And so you feel compelled to try to save them, but you can run up thousands and thousands of dollars in vet bills doing that. And I don't know that veterinary pet insurance is a good but. I don't know if that's a worthwhile thing to do for pets, the pros and cons about that. So it's really hard.
NEW SPEAKER: Because with people, you do. If it's a relative or your parents or something, you do go ahead and try to save them as much as possible.
CAVANAUGH: But the question is whether or not to do that for your pet even though your pet is part of your family. Katy, we did a whole show on this.
CAVANAUGH: Somewhat recently about when basically when to say goodbye to a beloved pet. And I guess, you know, it just doesn't get, it doesn't get any easier. What's the vet's role in all of that?
ALLEN: The vet's role is to be able to take a step back and look at it somewhat logically. Some people are so involved that they [CHECK AUDIO] but there is no light at the end of the tunnel. But then also our view is a little bit skewed because I see illness and suffering and death every day, and so when someone comes in with a terminally ill patient, I'm kind of done. And I almost want for them to say let's be done, let's do it. Because I can't take anymore.
CAVANAUGH: Right, right. You know what lies ahead.
ALLEN: Yeah, exactly, I know what lies ahead. So it is very difficult, but yes, owning a pet and keeping them alive through a long illness is very expensive. So many you need to decide are you that kind of a person? Do you want to do that? Or do you notment to? And sort of have that philosophy in place before it happens.
CAVANAUGH: We have to take a short break. And when we return, we will continue to take your calls as we celebrate 250 years of formal veterinary medical education. 1-888-895-5727. You're listening to These Days on KPBS.
I'm Maureen Cavanaugh, you're listening to These Days on KPBS. My gets are doctor Katie Allen, doctor Michael Mansfield, both veterinarians here in San Diego, and we're talking about a world event this year that marks the 200 and 50th world anniversary, really, of veterinarians. And we're taking your calls at 1-888-895-5727. Katy, do you still encounter an attitude among some people that basically pets don't need to go to the doctor and.
ALLEN: I do. I see it a lot. And the way I come across it, is I see the end result on it. I'll see someone who's come in, and they have been trying to treat their animals for days, weeks or even months and they finally bring it in, and it's in the most dreadful state. Of there are still people who try to [CHECK AUDIO] and it's rather sad, they're often spent money on useless treatments and then when they come to me, they can't afford what it is they actually need. It's more of a rural sort of attitude. But not always.
CAVANAUGH: Do you encounter any of that in emergency medical care for pets, Michael?
MANSFIELD: Uh-huh. And it is unfortunate, because sometimes if people would have just brought their pets in earlier, we could have nipped something in it the bud before it became a crisis situation. So, you know, I do think that taking your pets to the vet, even for routine yearly checkups is extremely important. Animals are really good at hiding illness. And especially as they get older, you know, more things can go on with them, and it's best to discover it early in the course of disease rather than late in the -- stage of disease, when you need to see me at tree in the morning.
MANSFIELD: Because usual he your pet's not doing so well at that point.
CAVANAUGH: Exactly. Are there any free clinics for pets here in San Diego? I know that there are some spay neuter, like a spay/neuter truck that goes around every now and then, but anything like that for people who basically are having a hard time?
ALLEN: There's nothing -- there's nothing regular. There are some people that will put on a fair, you know, a health fair, and there might be free vaccinations and free dewormings. I've gone to a couple of those. There is the spay truck that goes around. But there's -- really is not a lot. There are rescue organizations, there are some organizations that will donate money towards the care of a pet. They have to deal with the person who owns the pet, and the veterinary hospital they have gone to. And maybe they'll give you, you know, 50 bucks, a hundred bucks.
ALLEN: O there are different organizes but there's nothing formal set up.
CAVANAUGH: And what about the second half of the -- our caller, carol's question, about health insurance? Pet health insurance. Is that worthwhile?
MANSFIELD: I think it depends on the policy. That's something that the weigher really needs to investigate. Just like human health insurance, it doesn't cover pre-existing conditions in most cases. There are deductibles, and there's usually lifetime limits on what can be spent on the animal of so it's something you really need to instigate as to whether it might be something worth pursuing if are your pet or not.
ALLEN: Yeah, some of them are very good about paying for wellness stuff. And they'll pay for heart worm test and vaccines, and nearly blood work to a certain degree so you can catch things of so if you start when you have a puppy or a kitty and look and make sure they've got good preventive care coverage.
CAVANAUGH: Okay. I'm sorry, go ahead.
MANSFIELD: The one thing with pet insurance is that most people should realize that you're still responsible for the cost up front. The insurance company later reimburses you. It's not like human health coverage where the cost is taken care of.
CAVANAUGH: Ah, that's a good point. Okay. We're taking your calls at 1-888-895-5727. Jeff is on the line from El Centro. Good morning, Jeff, welcome to These Days.
NEW SPEAKER: Hi.
NEW SPEAKER: Yeah, I've got a strong farm down here in El Centro, and I have some feed chickens, dogs, cats, and all that, every once in a while, I run into a situation where I've got an animal that I have to put down. And I've never taken any of my sheep to a vet just because of cost prohibit it. Do you consider using ether as a humane way of putting down an animal?
MANSFIELD: Well, first of all, ether is extremely flammable. Of so that's very dangerous. Second of all, that's not considered a humane way. The EVA, the American veterinary medical association lists the only way of humanely euthanizing an animals an injection of barbiturates, which is how veterinarians do put down animals. Also euthanizing your own pets is considered veterinary medicine without a license, so there's some legal issues there as well.
CAVANAUGH: So basically, it's not something that people should do.
ALLEN: That would be the bottom line, yes.
CAVANAUGH: Okay. Thank you for the call, Jeff. Nate is calling from Escondido. Good morning, Nate, welcome to These Days.
NEW SPEAKER: Hi there. Yeah, you had a caller, a gentleman earlier in which the topic was the mistrust of people, pet owners, who bring their -- who are reluctant to bring their pets to the veterinarian.
NEW SPEAKER: And I think that one of your guests there really kind of side stepped, unintentionally, what he was trying to address that needs to be restated. Start with just two examples. And the first is that when you take your pet to the vet and you look on the shelves at what they're offering to sell you for nutrition for your pet, if you know anything about nutrition you would say I think that this veterinarian is more interested in making a sale than they are actually providing good nutrition. Very specifically, hills, there's no business having those on your shelves of the contents are just -- well, they're not good. Secondly, over 21 years, had a cat who recently died, 21 years old. Every time we took that cat to the vet, it was misdiagnosed. And the last example was the cat was diagnosed as having high blood pressure when in fact it didn't. And as a result, we were giving this cat high blood pressure medicine and driving it nuts. And doing great damage to its kidneys and liver. And so I had taken the cat back to.
NEW SPEAKER: Three different veterinarians and said, can you duplicate the blood pressure reading? And none of them could. Two of them couldn't even -- the technician was not even physically able to do --
CAVANAUGH: Nate, I'm gonna have to stop you there, because we're gonna have to move on. But I will take your questions and address them. What about -- are veterinarians a step behind this nutritional curve when it comes to what they're offering for pets to eat, like Hills and things of that nature?
ALLEN: I think it could be argued that a lot of veterinarians might not be, yes, up to speed with that. Yeah, Hills, is -- it's a lot easier if you have, there are several veterinary diet manufacturers, there's rural cane an, and hills, and a few others, and they do make special prescription diets. And so it is easy, if you've got, say, a cat who's got kidney disease, and you have a diet that's made with the right low protein and everything, it's much easier for the client and the veterinarian to say, I know this is the right diet for your pet. Run with it. Where's if your going to try to do the absolute best, maybe do home cooking, maybe look around at rural alternatives. That takes a lot more time and effort. So I think maybe veterinarians are stopping the ones that they know, it's going to be good enough. It's gone fulfill the need, but maybe if the owners are more invested in doing a bit more nutritional research on their own, they certainly could do that.
CAVANAUGH: It's finding that middle ground between the people who want to do everything and the people who want to do nothing that you were talking about. Of.
CAVANAUGH: Before. And also, not to minimize our caller's about the misdiagnosis of his cat, but 21 years old? I mean, that's -- that's a pretty good lifetime for a cat, right?
ALLEN: Yes. If this was a misdiagnosis, then they must have found a veterinarian to know that the current diagnose ease were wrong, [CHECK AUDIO] blood pressure measurement on a cat is extremely difficult. The minute it comes into your clinic, the blood pressure goes way up.
CAVANAUGH: I see.
ALLEN: So that particular thing is very difficult. But yes, you're going to, thought like in human immediate, you're not gonna get it right the first time always, and sometimes it can take several efforts to get it right.
CAVANAUGH: Now, yeah, go ahead.
MANSFIELD: I wanted to clarify a point too, and I think this addresses one of the caller's concerns as well. My role as an emergency veterinarian is not to talk about nutrition, is not to talk about flee control. That's the last thing in the world I want to do when your animals, you know, been recently hit by a car, is having some other major problem. So that's not something I deal with or emergency vets deal with. Upon we're purely there to address your animal's emergency, and that's that.
CAVANAUGH: Right. Exactly right. Now, let me ask you, since I harped on that -- the age of that cat, have pets reached their optimal ages yet? I mean, when I was growing up, a cat who was 15 or 16 years old was just ancient. Right? And now I mean, you know, early twenties, you know, somewhat -- that happens somewhat often.
ALLEN: Yes, it's not as unusual anymore. I don't know -- I don't know what their potential is. That's an interesting question. But certainly when I do get the 21-year -- years old, you can tell from a hundred charts that they're 21. You dent need to see them fat and healthy, they're fairly skinny and they look like they're, you know, been --
CAVANAUGH: They've lived.
ALLEN: They've lived. They've definitely lived of that's an interesting question. But yes, and that's really happened in the past 20 years or so, I think.
CAVANAUGH: Let's take another call. Gale is calling us from Tecate. Good morning, gale, welcome to These Days.
NEW SPEAKER: Good morning, this is it a subject very dear to my heart. I work as a volunteer with an organization, a nonprofit that we help people get their animals spayed and neutered, and at low cost or for free. And we also help with veterinary bills. One of the things this I've come across, and it's -- it seems to be coming more and more the case is an extreme difference in prices. I had a lady that I talked to last week who quoted for spaying a small dog under 40 pounds $465. We were able to get her into a low cost spay neuter clinic at the county rate of $65. So when people have a puppy, that I want to get it spayed or neutered, they want to do the benefit for their animal, they call around, they get a quote like this, and they give up. And then the question arises of, okay, my animal has a broken leg or my animal has a huge skin problem, or whatever. They're afraid to go to the vet. I mean, I've heard people tell me they were quoted a thousand dollars to cure their dog of diarrhea. Oh, we have to keep it in for a couple of days of we have to run these tests of sometimes you see these things that are outrageous.
CAVANAUGH: Gale, let me get a response. I'm wondering issue either Katie or Michael, are there any standards when it comes to how much veterinarians are going to be charging for certain procedures?
ALLEN: No, there are no standards. Everybody works it out to what it costs you in the way of over head and supplies and support staff. And to have the electricity on and all of that stuff. And then a profit so that, you know, you have a roof over your own head. So when you call around for quotes, you might get a very variable quote, but that $460 pre[CHECK AUDIO] blood working intravenous catheter with fluids, pain medication to go home as well as the surgery. And the $65.01 was probably just knock it out and spay it, and wake it up and send it home. And then what we need to do as -- we need to offer -- tell people this is -- this is the Cadillac version, this is the WB version, there may be something in between. What would you like? What are the relative pros and cons? What are the risks of taking, you know, the cheaper version? And give people options. And also people need to realize owning a pet costs money. And if you can't afford at least the basics, you probably shouldn't be owning a pet. You don't have to be able to afford the fancy. But you need to be able to afford the basics.
CAVANAUGH: I'm wondering, Michael, are people sort of staggered? They'll brush into your office bringing you a pet who's in dire need of treatment, and then the pet is saved, he's treated, and then they're told how much it is. What kind of sticker shock do you get?
MANSFIELD: Well, we try to avoid any sort of sticker shock by trying to tell people up front and present them with estimates as to how much things will be. But, you know, there have been a lot of advancements in veterinary medicine. And a lot of the stuff that we use is the same stuff that's used in human hospitals in terms of anesthesia, etc. And the newer stuff, which is a lot safer is also unfortunately a lot more expensive. And just in the case of a spay, I mean, that's -- a hysterectomy, if you go and look how much a human -- that would cost for a human, the fact that we could do that for just a few hundred dollars in veterinary medicine is actually a pretty amazing feet of that's a major abdominal surgery. And we're doing it for a few hundred dollars. So I think people need to also keep in mind that relative dollars. Things, and veterinarians are actually still, compared to human medicine, just a small fraction of the cost.
CAVANAUGH: Right. Exactly. And I think your point is very well made, Katie, to shop around. If you don't, if you're not happy with what you're hearing from one veterinarian, there are others that you can call that maybe you can work with a little bit.
CAVANAUGH: I don't want to let this whole subject pass without noting a big change that's happened in veterinarians themselves during this 250 years that they have gone operating. And that is the fact that the profession is, is it fair to say, demonstrated by women now?
ALLEN: It is. Obviously the first veterinary class ever was all men, and it remained that way until about, I think the first woman veterinarian that graduated was about 1903, I think. And now this class that went to UC Davis, they'll graduate in 2000 friendship, and of 134 graduates, 25 will be men.
CAVANAUGH: Oh, my, oh, my. Yes. The times they are a'changing.
ALLEN: Times change.
CAVANAUGH: Well, I want to thank you both so much for speaking with us today. Congratulations.
ALLEN: Thank you.
MANSFIELD: Thank you.
CAVANAUGH: 250. Doctor Katy Allen and doctor Michael Mansfield 678 if you would like to comment please go on-line, KPBS.org/thesedays.