Tuesdays with Tony – The Tale of Three Colics

Tuesdays with Tony – The Tale of Three Colics

This week I would like all of you to sit back and relax while I tell the story of Dr. Lacher’s Thanksgiving.  It’s a tale of joy and sadness.  It’s a tale of three colics with much in common with that other story about three things: Goldilocks and the Three Bears.

It started on Wednesday evening around 6pm.  A little peek into the lives of our veterinarians: most of you call about colics around 7-8am and 5-6pm when you head out to feed.  Matt, the 30 year old pony, had been normal at breakfast, but on arriving home from work, his owner found him down and rolling.  Dr. Lacher was leaving the clinic to head home, so she simply turned left instead of right and headed to Matt.

As she pulled up to the farm, Jane said, “Matt has lived here for the last ten years and has never had a sick day in all those years! I’m so worried!”

Dr. Lacher replied, “I will be honest, I’m very worried too, but let’s get Matt some sedation and pain relief and see what we have going on.”

Our Docs see a lot of colics.  Once you see your first 10-15 colics, you start to notice little things (and sometimes big things) the moment you pull in to a farm.  The horse has a pained look in his eye, there is sweat at the flanks, he isn’t just laying down, he’s going up and down repeatedly, and many more subtle signs tell our Docs that things are worse than they seem.

For Matt, it started with his history.  A thirty year-old horse with no history of colic suddenly colicing is very often bad.  Dr. Lacher noticed Matt had a sheen of sweat over his entire body as soon as she got close to him.  Added to that, Matt simply couldn’t get comfortable.  He wasn’t quietly laying down; he was up and down and up again in the 30 seconds it took to drive up the driveway.

“I’m giving Matt a large dose of sedation and a morphine-type drug for pain,” Dr. Lacher informed Jane. “Next, I’m going to draw a small amount of blood to run a lactate test.”

“We use lactate in the Emergency Department!” Jane replied.  Jane is the nurse you want to have if you ever end up in the Emergency Room.  She’s fantastic!

“Yep, we have been using it in horses in much the same way human doctors do for the past 6 years or so.  We want his number to be less than 3.0,” said Dr. Lacher.  Jane and Dr. Lacher stared at the lactate meter for the longest 13 seconds in history awaiting results.  The number loomed large at 7.2.

Dr. Lacher took a deep breath, “That’s not a good number.  Let’s see if we can figure out why it’s so high and then we can make decisions from there.”  Jane nodded her agreement.

After passing an NG tube in to Matt’s stomach, a rectal exam, and an abdominal ultrasound, it was determined Matt had a strangulating lipoma.  This is a fatty tumor that forms over many years.  One day all the forces of Mother Nature align and the tumor wraps around the small intestine and cuts off the blood supply.  The only cure is colic surgery and this is not one of the “easy” colic surgeries.  This one is long, very hard on the horse, and is often followed by a horrible bout of laminitis.

“I think there is only one decision I can make,” Jane stated.  “Matt has had a great retirement and a wonderful life.  I don’t want him to experience all that pain!”

So under a beautiful sky full of stars, Dr. Lacher and Jane walked Matt to the back field and said goodbye to him.  Jane told him how much he was loved and how much she appreciated all he had taught her daughter.  Dr. Lacher reflected on all the things these great old horses have contributed to the people around them as she drove home.

‘Twas the night before Thanksgiving and all through the house not a creature was stirring not even a mouse.  When what to my wondering ears should I hear but the sound of the BeeGees singing Staying Alive.  OK, I wasn’t actually there, but this is what I heard from one of the cats that lives at Dr. Lacher’s house.  Around 12:30am her phone rang with another colic.  This time it was, Zippy, a 28 year old Morgan with no history of colic.

“Uhoh,” said Dr. Lacher, “Here we go again.  I really worry about the old guys colicing!”

Weekend/Emergency Tech/Awesome Husband Justin replied, “So, where are we are heading to?”

This time as Dr. Lacher and Justin pulled up to the farm they saw a horse laying quietly on his side.  He was calm as Dr. Lacher put her stethoscope to his chest and abdomen.

“36,” Dr. Lacher stated matter-of-factly “and some gut sounds.”

“36 is good?” asked his owner, Linda.

“36 is very good!”  Dr. Lacher replied.  Turns out heart rate is one of those important things our Docs use to determine how bad your horse is actually colicing. Anything less than 48 is pretty darn good.  Anything over 60 is very worrisome to our Docs.  Dr. Lacher went on to explain that the fact that Zippy was laying quietly and willing to remain standing were good signs.  Zippy had a calm eye, some gut sounds, and wasn’t sweaty or agitated.  All really good signs.  His lacate was 1.8.  That’s really, really good.

Dr. Lacher put on the big, long sleeve and did a rectal exam.  “It’s one of the few ways we have to figure out what’s going on inside this big abdomen. And I’m happy to say that all his parts seem to be in the right places, though he does have a bit of an impaction in his large colon,” she reported.

Dr. Lacher gave Zippy some sedation, muscle relaxers, and pain relievers.  Then she and Justin tubed him with our scientifically formulated electrolyte mixture for colics.  This formula helps horses get water in to the GI tract which breaks up the impaction.  It also had just the right amount of sodium and potassium in there to correct deficiencies colicky horses often get.

“Call me if you need me or have ANY questions,” called Dr. Lacher as she and Justin headed home for a few hours of sleep.

Thanksgiving morning arrived quietly, for about 30 minutes.  Around 7:30am the BeeGees were at it again.  Stayin Alive could be heard coming from the house as Dr. Lacher and Justin fulfilled their horse feeding duties.  This time it was Stephanie calling about her horse, Blue.  He was uncomfortable and definitely not interested in breakfast.  Personally, I can’t imagine not being interested in food but horses are weird.

As Justin and Dr. Lacher pulled up to this colic Dr. Lacher said, “Oh we are going to be OK with this one.”

“How can you possibly know that?!?” exclaimed Justin.

“I just do,” was Dr. Lacher’s reply.

Allow me to explain what Dr. Lacher meant by “I just do.” Blue was standing in his stall, looking at his sides but not trying to lay down.  He had no hay, shavings, or grass on his sides or back, letting Dr. Lacher know he hadn’t been rolling much, if at all, before Stephanie found him acting colicky.  Blue also just plain didn’t look as painful as Matt, or even Zippy.  His eye was quieter, and while he was clearly uncomfortable, he just wasn’t as frantic as Matt.  Dr. Lacher did her exam on Blue and confirmed her suspicions.  Blue had a heart rate of 36, gut sounds all over his abdomen, and some gas on rectal palpation.

“Blue is going to be just fine.  He has a typical gas colic.  They do great with some sedation to relax them, Banamine to help with the pain, and a whole lot of fluids and electrolytes pumped in to help overhydrate them,” Dr. Lacher explained as Stayin’ Alive sounded from the truck.  It seemed the Thanksgiving weekend was going to be a long one.

The phone call was from Zippy’s owner.  He was still unhappy.  While he wasn’t as uncomfortable as the previous evening, he wasn’t interested in food and was laying down quietly.  After talking through the possibilities with Linda, Zippy got to go for a trailer ride to the Clinic.  I love when the horses come to the clinic so I can perform CAT scans on them!

Zippy was definitely uncomfortable when he stepped off the trailer at the clinic.  Dr. Lacher performed her usual exam on him and found his heart rate was a bit high at 48 beats per minute, and he didn’t have the greatest gut sounds.  She put that long glove on again and did a rectal exam.  Zippy’s impaction was softer but it was still there.

“Sometimes these impactions need a little bit more help.  Let’s get an IV catheter in Zippy and get him started on some fluids.  I’ll tube him with some more fluids too, just to make sure he is super hydrated,” said Dr. Lacher.

Zippy got started on IV fluids and got some more medication to help his pain.  Then Dr. Lacher pulled out her ultrasound machine.

“Because Zippy isn’t back to normal, I’m going to use the ultrasound to look inside his abdomen a different way and see if any of his small intestines are distended or if there’s free fluid,” Dr. Lacher explained.

Zippy’s ultrasound looked great.  His small intestine wasn’t distended and I could see it moving on the screen.  That was pretty cool.  There also wasn’t any free fluid around the intestines.  Dr. Lacher told us this would show up as black areas between the intestines.  She said Zippy’s large colon was also looking pretty darn normal.  While we were checking stuff, Zippy got another lactate.  We all breathed a sigh of relief when it was 2.6, a little higher, but still a pretty good number.

By late afternoon on Thanksgiving as I was finishing up the turkey bits Justin brought me, Zippy began looking for food in his stall.  This is a really good sign.  When colics start looking for food Dr. Lacher always gets really excited.  I thought poop was a better sign, but she says they can poop and still be colicing, and that looking for food usually means the colic is all better.  Zippy continued to be fed small amounts throughout the night and got to home on Friday morning.  I’m sure Linda was very happy to have him back!

I hope you have enjoyed my tale of three colics.  I learned a lot about what our Docs look for in a colic.  Heart rate seems like a really important clue.  If you want to learn how to take your horse’s heart rate, come on by the Clinic or ask us when we are out at your farm.  Our Docs and Technicians are always happy to teach!

Until next week,

Tonytony-colic-pic

Tuesdays with Tony – Evil Round Bales

Tuesdays with Tony – Evil Round Bales

Quick PSA about the Meet Tony Event this weekend:  Exercise for Equestrians.  You’ve got limited free time; learn how to make the time you do have to exercise count for all that it can! Come dressed to workout and Kevan will help you work on technique.  No, he will not be making anyone perform 50 Burpees or anything of that sort.  I will, likely, be lying in the aisle watching the goings on since I do NOT exercise.

Anywho, on to my life, which is really what’s important here.  Colic.  As far as I can tell, it’s what horses do when they are bored and seeking proof that their human is well trained to do their bidding.  My Docs, however, tell me it is largely due to the rather ridiculous system horses evolved to digest their food, combined with the rather ridiculous system humans have developed to house and feed said horses.  Also, cold weather.

We all know that horses have a crazy GI tract, and we can’t fix that.  What we can fix is what you humans do to that GI tract.  Start with feeding good stuff.  Need help figuring that part out?  Contact Beth at the Clinic.  She’s an expert.  She even has a certificate that says so from a leading feed manufacturer!  Between that certificate and over a decade in the feed industry, Beth has answers to your feed questions.  Beth tells me forage should form the foundation of the diet.  She tells me horses must eat more than the mouthful or so of grass that I eat and then puke up in some inappropriate place.  They need to eat 1.5-2% of their body weight in hay every day!  From there, supplement the gaps with as little concentrate as possible.  Again, Beth is our go to when it comes to nutrition.  Got questions? She’s got answers!

Moving on to the most common reason the Docs get called out this time of year: round bales of coastal hay.  The weather gets cool, the grass stops growing, and you humans remember that 1.5-2% body weight forage thing and put out a round bale.  Horses, being less intelligent than cats, get so excited about the hay, they gorge themselves to oblivion and get an ileal impaction.  How do you make sure this doesn’t happen?  Start with square bales.  Throw out 1 flake twice daily, then 2 flakes twice daily, and keep increasing the quantity until your horse is leaving some of the hay.  THEN you can put out the round bale.  Also add some peanut or alfalfa hay.  I realize most of our horses suffer from too many calories so alfalfa/peanut seems like a bad addition, but luckily adding 3-5 pounds of these hays per day can keep the GI tract moving in the right direction.  Other strategies than can help reduce the risk of coastal hay impactions are the addition of very wet, soaked beet pulp or alfalfa cubes (the minis work best) to the diet, and adding salt on very cold nights.

Trust me, my Docs don’t want to see you for a colic any more than you want to see them.  Let’s all do our part to keep those horses pooping as they were meant to be pooping!

-Tony

hay-rolls

Tuesdays with Tony – What’s with all the colics?

Tuesdays with Tony – What’s with all the colics?

Tony on benchMarch is almost over, and you've all heard the saying, "In like a lion, out like a lamb." Personally I prefer lions because they are really just big, less cuddly cats. Anyway, all this weather fluctuation has made for a bunch of colics!
   In horses, colic is just a general term for signs of GI pain. Colic may be due to an impaction, a twist (the fancy doctor word for this is volvulus), gas, stomach ulcers, or inflammation (doctor word enteritis). Colic may even be due to something non-GI like a urinary obstruction, although that is more of a cat thing. Luckily I haven't had the pleasure of experiencing one yet. 
   About 90% of the colics we see are termed "mild colics." Less than 10% of colics are severe or "surgical colics," so named because they would require surgery to correct. So what makes a colic a mild or severe one?
   In many cases, the answer is time. Most colics, when treated early with pain medication, laxatives, and electrolytes, will improve. There are some cases where a really big impaction will require rehydration with IV fluids to get it to pass. 
   When a mild colic is left untreated, it has the potential to become a bad colic. In the case of gas colics, the gas-filled intestine can float to the top and cause the large colon to twist. An impaction due to long-term dehydration can get worse and worse until it would need to be cut into and flushed out with a hose to get rid of it (yes, that is literally what they do during colic surgery). 
   Unfortunately, some horses are very stoic and don't tell you their belly hurts until it hurts really, really bad! Also, some people have jobs and can't stay home watching their horses all day to see if they colic. So if your horse colics at 8am and you don't get home until 5:30pm, it might already be a bad colic. 
   There is also something fat horses can get called a lipoma, basically a fatty tumor, that wraps itself around the small intestine and cuts off the blood supply. Nobody can do anything about that without surgery. Just one more reason I chose not to be a horse! 
   Luckily our docs are well trained to tell whether your horse has a mild colic or a bad colic, and they will know what to do either way! So the next time your horse has a bit of a bellyache, give us a call. The sooner the better! Odds are in your favor that it will be mild, but I wouldn't want to take my chances. Maybe that ball of yarn doesn't look so tasty after all...I'll just continue my nap. 
    Until next week, may the odds be ever in your favor!
  -Tony
The Naughty Pony October 2015

The Naughty Pony October 2015

Main Topic:
It’s almost hay season around here. Sure the weather is still warm but with the daylight decreasing our grass will slow down on growth over the next few weeks. This means our horses will need more hay. There’s good news and bad news on the hay front.

Good news: We have had more than enough rain this summer which means many pastures have done very well growing grass. You will be able to get by longer without hay as your horse grazes down what they have. This isn’t true for all situations, but check your pastures for actual grass and monitor how they are doing weekly. If you notice your horse starting to pull up grass by the roots, bare patches in your field, or weight loss in your horse it may be time to add more hay. Not sure what the right answer is for your horse? Have one of our amazing technicians: Beth, Charly, or Nancy come out and assess your pastures and feed program.

Bad news: We have had more than enough rain this summer which means farmers had to race against storms to try to get hay put up. Check with your regular hay supplier early to see what availability they have. Local hays may be difficult to get. Luckily farmers are farmers and they watch the weather more closely than Dr. Lacher (which is saying something since she has been known to check the radar every 5 minutes). So while hay may be a bit tougher to find most of them should be able to take care of their regular customers.

Coastal hay has a bad reputation when it comes to colic. Some of that is earned. Horses on lots of coastal and nothing else will often colic. Horses suddenly put on a round bale of coastal will colic (especially if this happens after 6pm on a weeknight or anytime on a weekend). Luckily there are easy ways to minimize your coastal hay colic risk.

Most important: gradually increase your horse’s hay. If your horse isn’t normally on hay during the summer now is the time to gradually start them on hay. Begin with 3-4 pounds of hay per day. Increase by about 1 pound weekly until your horse is leaving some hay behind. Once they are leaving hay you may put out a round roll of hay if that’s your feeding preference. Once your horse is on 8 pounds of coastal hay daily you should add in about 2 pounds of alfalfa or peanut hay daily. Alfalfa and peanut hays draw water in to the intestinal tract helping reduce the risk of colic.

Don’t feed coastal? We’ve got a plan for that too. Northern Grass and grass/alfalfa mix hays are excellent choices for many horses. Timothy, Orchard, and Brome hays are the most common grasses. You don’t have to worry about colics due to hay with these types of hays and they provide more nutrition than coastal hay. But they provide more nutrition than coastal hay and sometimes that’s too many calories. For the easy keeper or Insulin Resistant horse we don’t recommend more than 2-3 pounds of these hays per day added to a base of a coastal.

Want to get the most out of your hay dollar? Consider some type of feeding system. Slow feed hay nets come in sizes from a flake or two to an entire round roll. Hay nets have numerous benefits including slowing your horse down which makes your hay last longer, decreasing the calories they consume from hay, keeping them eating small amounts for longer, keeping their feet, manure, and urine out of the hay, and keeping them from stuffing their nose in the bale which often causes problems with allergies. We haven’t found a reason not to use these hay nets yet. One of our technicians, Nancy, began using them on her coastal round bale and got an addition 10 days out of the roll and her two older horses were able to stop taking medication for their heaves since they couldn’t stick their noses into the bale. If hay nets aren’t your thing check out YouTube for about a million different slow feed hay DIY options. Check out this one: https://www.youtube.com/watch?v=l7Ws8–3IOU for starters.

We are here to help you design the perfect nutritional system for your horse, your life, and your farm. Gives us call, e-mail, or text!

Erica’s Corner

For starters, I went and got married. It was a great day with everyone in costume, amazing cake (very important with my sweet tooth), and fantastic pizza from Villagios (also important). In typical Dr. Lacher fashion I did things a little weird. We took a bit of a honeymoon pre-wedding since Dr. Vurgason is expecting her first child any moment now. I asked Baby Vurgason to wait until after the wedding to appear but now we are ready and she can come any time!

I don’t know about you guys but I am officially ready for Fall! I love Summer but like all things we love too much is not a good thing. My horses are all hairy and need clipped but doing that while sweating is just no fun!

With the time change we are now relegated to riding in the very tiny area where I have some light. This always involves spooking at the imaginary dragons that live just outside the lit area. Good times!!! At least there is Pumpkin Spice everything to make it all better.

Tech Spot:

In this month’s Tech Corner, I’d like to talk about what tending to Coby’s wounds has taught us. Coby is the horse who fell through the floor of the horse trailer approximately 3 months ago. The bones were exposed on both hind legs and one tendon was torn.
The first thing we all learned is the importance of working with dedicated owners who are willing to devote the time and effort necessary for the patient to make a full recovery. This includes following the directions and time line set forth by your vet which is best determined by IMMEDIATE consultation with your vet. Coby’s owners did an excellent job! The second thing we learned is that good old well water does amazing things! Lots and lots of “shower effect” hosing of the wounds clean them quite nicely and helps reduce swelling and discomfort. We were able to experiment with amnion, provided by another client, and discovered that it does not attach to bone but loves granulation tissue. We also used a dressing called Cica care, which accelerated the healing process dramatically.
The bottom line is, if you’re going to have horses who are allowed to be out and act like horses, you are going to have wounds. Coby had severe wounds which had all of us holding our breath but with diligence, the right materials and guidance, MOST wounds that we see can heal nicely.

Events of the Month:

Open House 2015

Springhill Equine has had a very busy October…..hence the reason the Naughty Pony News Letter from October is late.

So if you have not already heard, the Open House on the 20th was a huge success! Thank you to all the Vendors and Contributors who helped to make it a great one! Thank you for all the participation from our clients!!

October 24th Dr Lacher and Justin Long shared a very special day with all of us! Congratulations and well wishes for a lifelong happiness together! It was a very unique event with all the costumes appropriate for Halloween right around the corner.

Dr Vurgason is impatiently waiting the arrival of her new baby girl. So she has been on maternity leave for a couple of weeks now. We will post some pictures of mom and baby when she arrives.

Upcoming Events:

November 17th @ 6:30pm
Hay Seminar
Please join us at our clinic 22837 NE 22nd Ave Newberry, Fl

Wellness 2016 Enrollment is HERE! You should have received the paperwork in the mail! If you did not. please call our office.

 

Tuesdays with Tony-Groundhog Day 2016

If I weren’t a cat I would send my most profound apologies for not getting Tuesdays with Tony written on Tuesday.  Luckily, as a cat, I don’t really care.  I have my reasons.  It has been a crazy week.  First there was rain, rain, rain and a temperature drop.  I hate rain.  I love to wander around my kingdom here at Springhill Equine and monitor all the activity.  I do not love getting wet thus when it rains I’m stuck inside.  The only joy on rainy days is making people repeatedly open the door just so I can see if it is still raining.

With all the rain and weather change, Dr. Lacher and Dr. Vurgason were kept busy seeing colicky horses.  People who study these things, they like the fancy title epidemiologist, say weather changes don’t cause colic.  I suppose they are correct in some ways.  Weather changes cause horses to get off their routine and routine changes make upset horse stomachs and upset horse stomachs make Springhill Equine come out for a visit.  That’s why our Docs recommend a little salt, some added water, and some alfalfa or peanut hay during dramatic weather changes.  It also helps to chase the horses around for a few minutes to get their gut moving.  Us cats are designed to sleep 18 hours daily.  It’s a benefit to being a top of the line predator.  Horses need to move around to keep their gut going.  What do they do on a rainy day? Stand under a tree or shelter and pout.

Monday was good.  The day was pretty. I got to sleep in the sun in the middle of the driveway and have people drive around me.  I greeted a few folks as they came in to the office.  I made my rounds of the property.  I liked Monday.

Tuesday was looking good.  The weather was nice.  We have a veterinary student, Bianca, who followed directions nicely and scratched all the places I wanted scratched.  Dr. Lacher was excited because she got to do a castration.  Then the neighbor drove by with a contraption and the day went down from there.  First, Renee wouldn’t let me go supervise the neighbor while he worked on the road with what she called a backhoe.  I feel this is the exact moment when things took a turn for the worse.  Because I wasn’t supervising the human, he cut our phone line.  This led to several moments of panic from Renee and Dr. Lacher.  Dr. Vurgason was having a great time celebrating her husband’s birthday at Disney so she was immune from all this.  Moments later I learned that someone called AT&T is a source of much yelling and screaming from the humans.  I don’t know much about this AT&T but I think they may be the spawn of Satan.  Luckily we have some great local people who are affiliated with this AT&T and they were able to temporarily fix our phone lines.

Whew what a week!  As a present to myself to recover from this week I’m going to allow folks to sign up for Wellness 2016 for one more week.  That’s right you have until February 10th to sign up! You won’t find a better deal for your horse.  I really don’t understand why everyone hasn’t signed up.

Tuesdays with Tony – Thanksgiving

Thanksgiving Day

Hello all….so last year at this time I was pondering what “I” would be doing for my Thanksgiving. The humans were around here discussing their plans for dinner with their family. So I decided to go on my own adventure. One of our clients came into the clinic with a trailer. I saw an open opportunity to make the great escape. After all the discussion about dinners, I wanted some turkey, giblets, mashed potatoes, and all the other wonderful food they were discussing. So, I hopped into the trailer in the stealth mode that I can do from time to time. I remained silent in the trailer, and then off we went. I was on my own holiday adventure and I was going to have me some turkey and not be stuck alone with my sister in the clinic. I arrived with all kinds of anticipation but I could not let the humans know I had made the great escape. I am sure they were extremely worried about me at the clinic but I did not care, I was going to have turkey dinner. I decided to make my grand appearance a day or so later and wow were they surprised to see me! They kept asking, “What I was doing here”? “How did you get here”? Silly humans and their questions…..a cat will never tell! So this year, unfortunately, they are onto me and I won’t be making the great escape again this year. Maybe someone can bring me a taste of turkey this year….If not, have a Happy Thanksgiving!

However, being inside for the weekend isn’t all bad. I sure would hate to be out and about with the cooler temperatures that have arrived in North Central Florida. I have seen and heard some strange things around the office about SALT and horses! Ya don’t say?? From what I understand, you add salt to the horse’s feed in the evenings (yuck not a cat thing) and according to Dr Lacher, this should stimulate them to drink more water because it makes them thirsty. The key thing here is keeping these guys and gals hydrated in the cooler temperatures so that you don’t have to call us out in the middle of the night because your horse is colicing. We have had several phone calls this past week with horses needing our help. I can get on board with the Docs recommendation to keep lots of food in front of the horses. Hay in particular but I’m not sure about that nasty stuff. The Docs say hay acts as an internal heater when the horses digest it and, if it is alfalfa or peanut hay, it keeps the poop moving. I can’t believe how difficult it is for horses to perform this basic operation: moving poop. So on really cold or wet nights throw an extra flake or two of hay to your horse, and they will stay toasty warm.

And now my feline opinion on blankets: I love them! Soft, warm, fluffy, great to curl up in, and purr. Yep, love blankets. Horses sometimes love blankets. Most horses handle our cold weather just fine. Older or fine haired horses may need blankets on the coldest nights. If they are shivering, our Docs recommend a blanket but if not then they are happy frolicking naked through the winter’s eve. Clipped horses definitely need blankets since not only have we taken off all their hair (appalling thought for a cat) but what little hair they have left doesn’t work like the natural stuff to block rain and wind.

I have generously closed the office Thursday and Friday for Thanksgiving. But Dr Lacher is still reachable at 352-474-5007 for emergencies.