Lab Retriever, Male, 6 years. Right undescended testicular tumour and atrophied right testicle removed 5 days ago. Greyish-white, large sized and multi-nodular suggested Sertoli cell tumour. To wait for histopathology on malignancy or no malignancy of cells.
The owner asked about post-op management.
This depended on blood test results. Significant findings are:
1. No disorders of liver and kidney function. Glucose is normal.
2. Haematology: Low haemoglobin and red cell count. Low PCV. Very low platelets count. Platelet clumping noted.
Urine results
1. pH=7.0, SG 1.027.
2. Abnormal findings: Protein 2+, Glucose 1+, Blood 4+, WCC >2250/uL, RBC 900/uL, epithelial cells 1053/uL. Bacteria 3+
Bad infection of bladder, prostate (painful and enlarged during rectal palpation), kidney localised as total blood WCC OK. Had been given IV Vit K1 in drip earlier.
Advice:
1. Had been fed meat, rice 1X/day in the past. Very thin. Increase to 2x/day
2. Good quality premium dog food dry to be added. 1 egg/day for 14 days.
3. Antibiotics for next 14 - 20 days. UTI + prostatitis + bone marrow depression.
4. Review in 14 days.
Thursday, August 12, 2010
Wednesday, August 11, 2010
Rotting flesh smell of right ear in 12-year-old Shih Tzu
Surprisingly, a young couple brought in a Shih Tzu with multiple warts. One big bleeding wart on the left ear.
"My vet does not do surgery on weekends, so we come to see you." the busy couple has only 6.30pm to 7 pm to see me. But today is Wednesday.
This is the second case of a dog owner who had been to the vet for the past few years with ear infections, so stinking but no cure. I inserted a cotton bud which came out of the vertical ear canal with bright yellow pus and strong stink.
"My vet would clean the ears and in bad smell, give an injection. We spent a lot of money over the last 4 years. The dog keeps shaking his head daily."
"How long the smell return?" I asked. "Is it over 2 weeks."
"No," the wife said. "A few days."
"A solution will be ear surgery." I got the Sheltie inside for them to see the surgery which was done as it is hard for the couple to visualise the procedure. I showed the horizontal canal opening. The Sheltie's left ear was operated some 8 days ago and the ear canal was clear. No head shaking. However, there was still some pain in the ear canal as the Sheltie moved away as I touched the opening of the horizontal ear canal.
1. Clipped bald
2. Take blood and urine for tests.
3. Irrigate ears
4. Electosurgery to remove warts. Count the number of warts. Marker pen.
5. Goes home with antibiotics for 14 days.
6. 10 days later, right ear canal wall opened up.
"My vet does not do surgery on weekends, so we come to see you." the busy couple has only 6.30pm to 7 pm to see me. But today is Wednesday.
This is the second case of a dog owner who had been to the vet for the past few years with ear infections, so stinking but no cure. I inserted a cotton bud which came out of the vertical ear canal with bright yellow pus and strong stink.
"My vet would clean the ears and in bad smell, give an injection. We spent a lot of money over the last 4 years. The dog keeps shaking his head daily."
"How long the smell return?" I asked. "Is it over 2 weeks."
"No," the wife said. "A few days."
"A solution will be ear surgery." I got the Sheltie inside for them to see the surgery which was done as it is hard for the couple to visualise the procedure. I showed the horizontal canal opening. The Sheltie's left ear was operated some 8 days ago and the ear canal was clear. No head shaking. However, there was still some pain in the ear canal as the Sheltie moved away as I touched the opening of the horizontal ear canal.
1. Clipped bald
2. Take blood and urine for tests.
3. Irrigate ears
4. Electosurgery to remove warts. Count the number of warts. Marker pen.
5. Goes home with antibiotics for 14 days.
6. 10 days later, right ear canal wall opened up.
Omega 3 and Omega 6 oil for cat with recurring mouth ulcers
Stray cat now adopted by a young couple. His ulcers at the "adenoid" areas have healed 80%. Given canned food only. He had suffered a chronic disease, leading to "indolent ulcers" of the mouth and a high eosinophil count.
He likes the Omega 3 and Omega 6 oil 1 ml 2x/day. If his immune system is back to normal, I presume that he will no longer have oral ulcers and drool. He will not need anti-inflam steroids. Too early to know. Wait and see.
He likes the Omega 3 and Omega 6 oil 1 ml 2x/day. If his immune system is back to normal, I presume that he will no longer have oral ulcers and drool. He will not need anti-inflam steroids. Too early to know. Wait and see.
157. Ear surgery Sheltie 11 years old
Sheltie, Female, 11 years. Head shaking and rubbing daily
"The vet advises me to keep the ears dry," the lady was often given this advice from several vets in a big practice she was referred to by her family vet. "How do I keep the ears dry? Her left " In fact, I did give such advices too by asking the owner to plug the ear opening with a piece of cloth during bath time.
The Sheltie's ears were full of dry crusts, as in a scabies mite infestation. Her eyelids were scratched bald.
I examined the dog's ears.
"Every time I see the vets, I am asked to keep the ears dry."
"The vet advises me to keep the ears dry," the lady was often given this advice from several vets in a big practice she was referred to by her family vet. "How do I keep the ears dry? Her left " In fact, I did give such advices too by asking the owner to plug the ear opening with a piece of cloth during bath time.
The Sheltie's ears were full of dry crusts, as in a scabies mite infestation. Her eyelids were scratched bald.
I examined the dog's ears.
"Every time I see the vets, I am asked to keep the ears dry."
156. Tumours in older male dogs
On Aug 11, 2010. I reviewed the 3 cases to find whether they are linked to the male gender. Dogs over 6 years of age are more likely to develop tumours than younger ones. The following three cases are recorded to educate dog owners and help veterinary students in their studies.
1. Maltese, Male Dog, 18 years old
Circum-anal tumour above anus
One testicular tumour 3.5 cm x 2.5 cm x 2.0 cm was sent to the Laboratory for histopathology.
Due to economic reasons, I submitted the testicular tumour and not the other normal sized testicle.
Result: Malignant tumour compatible with a seminoma.
Interstitial Cell Tumours and Seminomas are reported to produce estrogen. Dog has a very good coat. Could it be due to excessive estrogen production?
The circum-anal tumour is more common in male, non-neutered dogs.
2. Labrador Retriever, Male Dog, 6 years.
Retained or undescended left testicle grew explosively to half the size of a tennis ball while the right testicle was shrunken (atrophied). Sent both for histopathology. The dog goes home tomorrow (5th day after neutering). Blood tests and histopathology in progress.
From the appearance, the testicular tumour is a Sertoli cell tumour. Sertoli cell tumours tend to grow very large. They are firm, white or greyish and multinodular. The rate of metastasis is reported to be less than 10%. Early removal will give the dog good chances of survival. I believe that this 6-year-old dog's testicular tumour had been detected at an early stage* by the father or family member. If the histopathology results show a diffuse subtype as contrasted to the intratubular subtype. We have to wait and see. A young lady owner is concerned.
* Around 1/3 of dogs with Sertoli cell tumours show signs of hyperestrogenism (feminization, gynecomastia, atrophy of the contralateral testicle, squamous metaplasia of the prostate and prostatitis, symmetrical alopecia from genital area to cranio-dorsally and bone marrow atrophy.
In bone marrow atrophy - initial transient increase in granulocytes and neutrophils followed by leucopenia, thrombocytopenia and non-regenerative anaemia and granulocytopenia. Death from overwhelming bacterial infections and bleeding.
This Labrador Retriever had atrophy of the contralateral testicle, prostatitis (ping-pong ball sized prostate and pain on digital rectal examination, takes a long time to pee). Will wait for blood test results.
A good report on testicular tumour is at: www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php
3. Miniature Schnauzer, Male Dog, 11 years.
Bad breath complaint in Jun 2010. I had excised large cheek tumour in Jun 2010. Extracted 15 teeth and dental scaling done. The case is recorded at:
toapayohvets.com/surgery/20100618cheek_tumour_old_dog_electrosurgery
_ToaPayohVets.htm
Some pictures are shown as follows:
"There is a white lump in the same area of his previous tumour," the young lady said today. "He would not allow me to open his mouth. I saw it when he yawned." The dog would not permit me and my assistant Mr Saw to open his mouth too. He jerked away suddenly when I gripped his upper jaw. No point fighting and getting bitten. I will sedate and check mouth and teeth. Recurrence of oral tumour likely. Did not send the previous tumour for histopathology to reduce the veterinary costs for the owner.
The dog had no fever but vomited and had diarrhoea 4 X yesterday. The dog will be treated for gastroenteritis first before any exploration of the mouth.
"Oral tumours are associated with the many years of poor dental hygiene," I said to the young and slim lady who does sales. "My advice to neuter him is not to prevent recurrence as this oral tumour. I have not heard of any scientific studies regarding neutering and oral tumours. However, any dog over 6 years of age is likely to develop tumours. Since your dog has a large cheek tumour, I advised neutering to prevent testicular tumours.
"it is well known that neutering of the male dogs do prevent or lower the incidence of circum-anal tumours and the development of testicular tumours in testicle that have not come down from the body into the scrotal bag."
I doubt that this young lady know what I am talking about. I elaborated: "Since this dog has developed such a large oral tumour, it is best to remove his testicles in case he develops testicular tumour. I am not guaranteeing that castration will prevent recurrence of the oral gum tumour and mouth ulcers."
The dog was warded, given the IV drip and medication for diarrhoea and vomiting.
I checked the anaesthetic records for the Jun 2010 cheek tumour (4.5 cm x 4.5 cm x 0.8cm) excised by electro-surgery for reference. Blood test normal results.
BW 12.3 kg
Domitor 0.2 ml IV
Zoletil 100 0.1 ml IV. Body tremors started. Gave Atropine 0.5 ml IV. Tremors stopped. Surgery done. Antisedan 0.2 ml IV. Dog woke up fast.
CONCLUSION
3 male dogs had tumours.
Case 1 - Maltese not neutered. Malignant Seminoma and Circum-Anal tumour. During his old age, he developed testicular tumour (malignant) seminoma and circum-anal tumour. Both were removed and the dog had no anaesthetic problems although he was 18 years old. I used isoflurane gas only. Neutering would have prevented such tumours from developing.
Case 2 - Labrador Retriever not neutered. Testicular Tumour. Surprisingly, at 6 years of age, he developed the testicular tumour so rapidly. Testicular tumours usually happens in dogs of 10 years. Studies have associated testicular tumours may form in undescended tumours (cryptorchidism) in man and male dogs.
Case 3 - Miniature Schnauzer not neutered. Oral tumour was large. Oral tumours develop due to poor oral hygiene in dogs and man, according to several medical reports. There is no association with neutering or no neutering. Teeth cleaning every alternate daily and yearly dental check up most important for your dog if you want to prevent oral tumours from developing in your dog.
goto:
http://www.asiahomes.com/angelfire/20100657testicular_tumours_oral_old_dogs_male_singapore_ToaPayohVets.htm
Latest info at www.toapayohvets.com
1. Maltese, Male Dog, 18 years old
Circum-anal tumour above anus
One testicular tumour 3.5 cm x 2.5 cm x 2.0 cm was sent to the Laboratory for histopathology.
Due to economic reasons, I submitted the testicular tumour and not the other normal sized testicle.
Result: Malignant tumour compatible with a seminoma.
Interstitial Cell Tumours and Seminomas are reported to produce estrogen. Dog has a very good coat. Could it be due to excessive estrogen production?
The circum-anal tumour is more common in male, non-neutered dogs.
2. Labrador Retriever, Male Dog, 6 years.
Retained or undescended left testicle grew explosively to half the size of a tennis ball while the right testicle was shrunken (atrophied). Sent both for histopathology. The dog goes home tomorrow (5th day after neutering). Blood tests and histopathology in progress.
From the appearance, the testicular tumour is a Sertoli cell tumour. Sertoli cell tumours tend to grow very large. They are firm, white or greyish and multinodular. The rate of metastasis is reported to be less than 10%. Early removal will give the dog good chances of survival. I believe that this 6-year-old dog's testicular tumour had been detected at an early stage* by the father or family member. If the histopathology results show a diffuse subtype as contrasted to the intratubular subtype. We have to wait and see. A young lady owner is concerned.
* Around 1/3 of dogs with Sertoli cell tumours show signs of hyperestrogenism (feminization, gynecomastia, atrophy of the contralateral testicle, squamous metaplasia of the prostate and prostatitis, symmetrical alopecia from genital area to cranio-dorsally and bone marrow atrophy.
In bone marrow atrophy - initial transient increase in granulocytes and neutrophils followed by leucopenia, thrombocytopenia and non-regenerative anaemia and granulocytopenia. Death from overwhelming bacterial infections and bleeding.
This Labrador Retriever had atrophy of the contralateral testicle, prostatitis (ping-pong ball sized prostate and pain on digital rectal examination, takes a long time to pee). Will wait for blood test results.
A good report on testicular tumour is at: www.vet.uga.edu/vpp/clerk_anat/sabatino/index.php
3. Miniature Schnauzer, Male Dog, 11 years.
Bad breath complaint in Jun 2010. I had excised large cheek tumour in Jun 2010. Extracted 15 teeth and dental scaling done. The case is recorded at:
toapayohvets.com/surgery/20100618cheek_tumour_old_dog_electrosurgery
_ToaPayohVets.htm
Some pictures are shown as follows:
"There is a white lump in the same area of his previous tumour," the young lady said today. "He would not allow me to open his mouth. I saw it when he yawned." The dog would not permit me and my assistant Mr Saw to open his mouth too. He jerked away suddenly when I gripped his upper jaw. No point fighting and getting bitten. I will sedate and check mouth and teeth. Recurrence of oral tumour likely. Did not send the previous tumour for histopathology to reduce the veterinary costs for the owner.
The dog had no fever but vomited and had diarrhoea 4 X yesterday. The dog will be treated for gastroenteritis first before any exploration of the mouth.
"Oral tumours are associated with the many years of poor dental hygiene," I said to the young and slim lady who does sales. "My advice to neuter him is not to prevent recurrence as this oral tumour. I have not heard of any scientific studies regarding neutering and oral tumours. However, any dog over 6 years of age is likely to develop tumours. Since your dog has a large cheek tumour, I advised neutering to prevent testicular tumours.
"it is well known that neutering of the male dogs do prevent or lower the incidence of circum-anal tumours and the development of testicular tumours in testicle that have not come down from the body into the scrotal bag."
I doubt that this young lady know what I am talking about. I elaborated: "Since this dog has developed such a large oral tumour, it is best to remove his testicles in case he develops testicular tumour. I am not guaranteeing that castration will prevent recurrence of the oral gum tumour and mouth ulcers."
The dog was warded, given the IV drip and medication for diarrhoea and vomiting.
I checked the anaesthetic records for the Jun 2010 cheek tumour (4.5 cm x 4.5 cm x 0.8cm) excised by electro-surgery for reference. Blood test normal results.
BW 12.3 kg
Domitor 0.2 ml IV
Zoletil 100 0.1 ml IV. Body tremors started. Gave Atropine 0.5 ml IV. Tremors stopped. Surgery done. Antisedan 0.2 ml IV. Dog woke up fast.
CONCLUSION
3 male dogs had tumours.
Case 1 - Maltese not neutered. Malignant Seminoma and Circum-Anal tumour. During his old age, he developed testicular tumour (malignant) seminoma and circum-anal tumour. Both were removed and the dog had no anaesthetic problems although he was 18 years old. I used isoflurane gas only. Neutering would have prevented such tumours from developing.
Case 2 - Labrador Retriever not neutered. Testicular Tumour. Surprisingly, at 6 years of age, he developed the testicular tumour so rapidly. Testicular tumours usually happens in dogs of 10 years. Studies have associated testicular tumours may form in undescended tumours (cryptorchidism) in man and male dogs.
Case 3 - Miniature Schnauzer not neutered. Oral tumour was large. Oral tumours develop due to poor oral hygiene in dogs and man, according to several medical reports. There is no association with neutering or no neutering. Teeth cleaning every alternate daily and yearly dental check up most important for your dog if you want to prevent oral tumours from developing in your dog.
goto:
http://www.asiahomes.com/angelfire/20100657testicular_tumours_oral_old_dogs_male_singapore_ToaPayohVets.htm
Latest info at www.toapayohvets.com
Tuesday, August 10, 2010
Faucitis stray cat
August 10, 2010 review of eosinophilia in a stray cat.
Salivation is the presenting sign. Ulcers in fauces and lower tongue 2 weeks ago. Treated and went home. Came back again as the cat started to salivate.
Ulcers at fauces reduced by 80% today. Cat gentle but dislikes mouth being opened. Wanted to scratch intern Ms Lai. Will the condition relapses? Is there a permanent cure? Not according to the cat experts.
August 10, 2010 review of a cat with urine all over his body.
Urinary incontinence and cystitis. Treated. Thick yellow urine. OK now. Goes home.
August 10, 2010 review of a black cat with red blood. Only 1.5 years old. Why he passes red blood? FLUTD with unknown cause usually. Treated, bladder irrigation 2 days. OK. Goes home. Neuter first.
Salivation is the presenting sign. Ulcers in fauces and lower tongue 2 weeks ago. Treated and went home. Came back again as the cat started to salivate.
Ulcers at fauces reduced by 80% today. Cat gentle but dislikes mouth being opened. Wanted to scratch intern Ms Lai. Will the condition relapses? Is there a permanent cure? Not according to the cat experts.
August 10, 2010 review of a cat with urine all over his body.
Urinary incontinence and cystitis. Treated. Thick yellow urine. OK now. Goes home.
August 10, 2010 review of a black cat with red blood. Only 1.5 years old. Why he passes red blood? FLUTD with unknown cause usually. Treated, bladder irrigation 2 days. OK. Goes home. Neuter first.
154. Undescended testicular tumour
Aug 10,2010 report
REVIEW OF A CASE OF A TESTICULAR TUMOUR
DAY 3 AFTER NEUTER
Labrador Retriever, Male, 6 years, 17 kg.
A very thin gentle dog. Poor bodily condition and anaemic. High anaesthetic risk but surgery was necessary.
Complaint 2 days ago: Large lump in the left inguinal area
Noted: Preputial opening black and much swollen. Squatted and took over 1 minute to pee (suspect urethral obstruction, cystitis or prostrate enlargement/inflamation, tumour)
Blood test: Anaemia. Low haemoglobin, red blood cells and platelets. Kidneys and livers OK. No diabetes.
Urine analysis: Wait for lab results.
Urine dipstick by intern Ms Lai who collected urine today and wrote the following: No blood. Protein 1000 mg/dl, Glucose 100 mg/dl, pH 7.0 - 7.5, SG 1.015, leucocytes 500 WBC/ul
IV drip + Vit K1 in slow IV 2 hours
Isoflurane gas mask, neutered 2 days ago.
Prostate as large as a ping pong ball (digital rectal palpation while at the end of neuter anaesthesia) and dog reacted in pain.
Undescended testicular tumour, 4"X3" with multiple yellow nodules. Descended testicle appeared shrunkened and 1/3 normal size. Both sent to the laboratory for histopathology.
"Has the testicular tumour spread inside the body?" the father asked me. "It is hard to say without further tests, scans and X-rays." I replied. "Is it a testicular cancer? I had to wait for lab report.
Undescended testicle may develop into testicular tumour in man and dog. "Have you heard of Lance Armstrong who suffered the same condition as your Labrador?" I asked the father. "No," he said.
I am glad that this dog can now pee at one go. Will review tomorrow.
I gave him an anti-androgenic injection (Tardak). After 24 hours, at 5.30 pm today, Aug 10, 2010, he could just pee normally in one go in less than a few seconds.
Aug 10, 2010
HISTOPATHOLOGY RESULTS
A testicular tumour - sertoli cell tumour.
Comment from the histopathologist: A second interstitial (Leydig) cell tumour component cannot be excluded in this tumour. Most primary testicular neoplasm in the dog are benign. The rare malignant Seretoli cell tumour has no good cytological or histological markers of malignancy. The only way to determine malignancy is to identify metastases in lymphatics, spermatic cord, lymph node or distant sites. Pl correlate with clinical features.
Aug 10, 2010
URINE ANALYSIS
pH = 7.0, SG 1.027
Abnormal findings:
Prortein 2+, glucose+, blood 4+
White Blood cells >2250/uL, red blood cells 900/uL, epithelial cells 1053/uL, bacteria 3+
nephritis? + cystitis + prostatitis
Aug 10, 2010
BLOOD TEST
Total White cell count normal with neutrophils 82% (absolute 7.96), lymphocytes 12% (absolute 1.17), monocytes 5% (absolute 0.45), eosinophils 0.5% (absolute 0.05), basophil 0.4% (absolute 0.04)
but there is bone marrow depression as evident by:
Low platelets 90 (200-500)
Low haemoglobin
Low red cell count
Aug 17, 2010
Phoned owner to check on dog and post lab reports.
1. Yes, can take out the e-collar as it is one week.
2. "The dog no longer limps. We thought he had hip problems," the owner said. "It is the pain in the undescended testicular tumour as the cells are getting necrotic and dying.
3. "Does he attract other dogs to go near him when you took him out for walk?" I asked. "Many dogs would look at home or go near him," he said. "That is the result of excessive female hormone production - estrogen that caused him to be attracted by other dogs. Now, he should be getting less attention as he longer secretes the female sex hormones."
REVIEW OF A CASE OF A TESTICULAR TUMOUR
DAY 3 AFTER NEUTER
Labrador Retriever, Male, 6 years, 17 kg.
A very thin gentle dog. Poor bodily condition and anaemic. High anaesthetic risk but surgery was necessary.
Complaint 2 days ago: Large lump in the left inguinal area
Noted: Preputial opening black and much swollen. Squatted and took over 1 minute to pee (suspect urethral obstruction, cystitis or prostrate enlargement/inflamation, tumour)
Blood test: Anaemia. Low haemoglobin, red blood cells and platelets. Kidneys and livers OK. No diabetes.
Urine analysis: Wait for lab results.
Urine dipstick by intern Ms Lai who collected urine today and wrote the following: No blood. Protein 1000 mg/dl, Glucose 100 mg/dl, pH 7.0 - 7.5, SG 1.015, leucocytes 500 WBC/ul
IV drip + Vit K1 in slow IV 2 hours
Isoflurane gas mask, neutered 2 days ago.
Prostate as large as a ping pong ball (digital rectal palpation while at the end of neuter anaesthesia) and dog reacted in pain.
Undescended testicular tumour, 4"X3" with multiple yellow nodules. Descended testicle appeared shrunkened and 1/3 normal size. Both sent to the laboratory for histopathology.
"Has the testicular tumour spread inside the body?" the father asked me. "It is hard to say without further tests, scans and X-rays." I replied. "Is it a testicular cancer? I had to wait for lab report.
Undescended testicle may develop into testicular tumour in man and dog. "Have you heard of Lance Armstrong who suffered the same condition as your Labrador?" I asked the father. "No," he said.
I am glad that this dog can now pee at one go. Will review tomorrow.
I gave him an anti-androgenic injection (Tardak). After 24 hours, at 5.30 pm today, Aug 10, 2010, he could just pee normally in one go in less than a few seconds.
Aug 10, 2010
HISTOPATHOLOGY RESULTS
A testicular tumour - sertoli cell tumour.
Comment from the histopathologist: A second interstitial (Leydig) cell tumour component cannot be excluded in this tumour. Most primary testicular neoplasm in the dog are benign. The rare malignant Seretoli cell tumour has no good cytological or histological markers of malignancy. The only way to determine malignancy is to identify metastases in lymphatics, spermatic cord, lymph node or distant sites. Pl correlate with clinical features.
Aug 10, 2010
URINE ANALYSIS
pH = 7.0, SG 1.027
Abnormal findings:
Prortein 2+, glucose+, blood 4+
White Blood cells >2250/uL, red blood cells 900/uL, epithelial cells 1053/uL, bacteria 3+
nephritis? + cystitis + prostatitis
Aug 10, 2010
BLOOD TEST
Total White cell count normal with neutrophils 82% (absolute 7.96), lymphocytes 12% (absolute 1.17), monocytes 5% (absolute 0.45), eosinophils 0.5% (absolute 0.05), basophil 0.4% (absolute 0.04)
but there is bone marrow depression as evident by:
Low platelets 90 (200-500)
Low haemoglobin
Low red cell count
Aug 17, 2010
Phoned owner to check on dog and post lab reports.
1. Yes, can take out the e-collar as it is one week.
2. "The dog no longer limps. We thought he had hip problems," the owner said. "It is the pain in the undescended testicular tumour as the cells are getting necrotic and dying.
3. "Does he attract other dogs to go near him when you took him out for walk?" I asked. "Many dogs would look at home or go near him," he said. "That is the result of excessive female hormone production - estrogen that caused him to be attracted by other dogs. Now, he should be getting less attention as he longer secretes the female sex hormones."
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