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But can’t he just die in his sleep…..?

This week my Granny died, which was sad for us all but she was very old, had had a wonderful life and her family was with her at the end. She had been in a home for some time and was cared for very well. When she became sick and bedbound, the doctors and nurses worked together to keep her comfortable and pain free, until she slipped away in her sleep. I am lucky in that she was the first person I knew well who has died and this experience has made me understand why many people hope this is how their pets will go. However, to die in their sleep is rarely a pleasant or pain free experience for our animals. Domino sleepingAlthough, just like people, our pets are living longer and healthier lives, inevitably there comes a time when their age catches up with them and illnesses develop. Advances in veterinary care mean we can do a lot for them but eventually we won’t be able to keep up with their problems. If they were people we would put them in wheelchairs or place them in a home where their needs could be catered for, for example being assisted to the toilet or spoon fed but this isn’t practical, or in most cases fair, to a pet who won’t understand what is happening (there are many people who would argue this is no kind of life for a person either but that is a whole other debate). For a pet, when they can no longer get up and out to do their toilet or feed themselves properly, or when their illnesses or pain can no longer be controlled with medication, this is the time as owners we should objectively assess their quality of life and decide whether it is fair to let them continue. Also, just as important is your quality of life, it is hard work caring for any pet, let alone an elderly one who may be incontinent or senile. The vast majority of pets who reach the end of their natural lives are euthanased by their vet. This is inevitably a sad experience for their owners (and us) but is far preferable than allowing them to slip away on their own. Many people hope this will happen, having probably experienced death this way with people as I recently did myself, but it is very different for animals. Bodies are designed for living and will go on doing so regardless of how painful or unpleasant it becomes for the individual. When people die in their sleep they are usually heavily medicated and cared for to ensure they are not in any pain or dehydrated but this doesn’t happen for our pets. If an animal dies this way, they have usually suffered to a large extent; likely being dehydrated, malnourished and in pain. Although from the outside they might look peaceful, they are anything but; it is simply all their exhausted body can manage. This is why when our pets become infirm and their quality of life declines to a point where living is a struggle and not the joy it should be, by far the kindest and most humane thing we can do as owners and vets is to euthanase them in a painless and peaceful way. I often say it is the one big advantages we have over human medicine; we can stop the suffering before it becomes too great. Although it may seem daunting your vet will talk you through the procedure and make sure you are happy with the process and your decision. You will be able to stay with your pet if you want to and most vets will come to your home if your request it. Euthanasia means ‘a peaceful death’ and as a pet owner it is the final act of kindness you can bestow upon your companion. If you are worried that your pet may be ill, talk to your vet. Try our Interactive Symptom Guide to check any symptoms they are displaying and help decide how soon you'll need to visit your vet.
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Colic: Part 2: Medical Colics

In my last piece, I looked at how the vet will examine a horse with colic. Following this, and using all the information from the history and workup, he or she has to decide if the colic is Medical or Surgical. The terms are more or less self-explanatory: a medical colic can be managed with drugs, while a surgical colic needs emergency surgery. As a rule of thumb, 9/10 colics are medical, and can almost always be managed on the yard. So, here are the common causes of colic that we see in the UK1 : 1) Spasmodic Colic. This is probably the commonest, and perhaps the least understood; I estimate about 80% of Medical colics are Spasmodic. Spasmodic colic can be caused by a stressful event, mild dehydration, or be genuinely idiopathic (i.e. we don't know what causes it!). It can also be caused by severe tapeworm burdens. In a Spasmodic Colic, a section of the gut goes into a spasm, preventing anything from moving past it. It can be acutely painful, but usually responds really well to management with drugs. For any horse that has two or more bouts of spasmodic colic, I'd always recommend a tapeworm blood test to make sure it isn't part of the problem! 2) Impaction Colic. This is more common in some management systems - it is pretty rare, for example, in horses who live on grass. In these cases, the food in the large intestine dries out a bit too much, and turns into a putty-like material. It then gets stuck, typically at one of the 180- degree turns in the Large Colon. It's also strongly associated with moderate dehydration - as a horse gets dehydrated, he will move water out of the gut in order to keep up his circulating blood volume. This is a clever trick, meaning a horse can survive levels of dehydration that would kill a human. However, if the water isn't replaced, and he's been eating dry hay, his gut contents can become so dry they cause an impaction. This is why, many years ago, bran mash and Epsom salts were fed after hard work - both are good ways of rehydrating the colon and Caecum contents. 3) Gut displacements and entraptions. These are a bit of a mixture - some are medical, some are surgical, some look surgical but aren't, and some can be fixed medically but keep coming back so surgery is eventually needed. What many people don't realise is that the guts are in constant motion. Occasionally, a loop of intestine goes "wandering around" inside the abdomen, and gets stuck behind something else (for example, into a little gap between the spleen and the kidney). These can often only be diagnosed by rectal exam, and can feel really confusing, where nothing seems to be exactly where it should be! Each case has to be treated on its merits, and many can be resolved by lunging - presumably because jiggling everything around helps the intestines to fall back into their proper places! Personally, however, my inclination is generally to refer the horse as a possible surgical case, because it's amazing how often a trip in the box fixes a displacement or entraption. Of course, if they can't be rapidly resolved, they need to have surgery to put everything back, before any permanent damage is done. 4) Sand colic - I've only rarely seen these; they're normally caused by the horse drinking from sandy water. Over time, sand builds up in the intestines, causing irritation and sometimes an impaction. Management usually revolves around maintaining gut motion with laxatives and pain relief; however, surgery is sometimes needed to evacuate the sand and debris from the gut. 5) Inflammatory diseases, e.g. peritonitis or anterior enteritis. I'm including these here because they're not strictly surgical. However, they can be really hard to differentiate from surgical cases, and they're usually only diagnosed after referral, with the advanced techniques available at a referral hospital. 6) Other medical causes, e.g. diarrhoea, or stomach ulcers, can also cause a "Medical" colic; however, these cases require the underlying disease to be treated, at which point the colic symptoms will resolve themselves. Treatment for medical colics is focused around pain relief and maintaining hydration. Spasmodic colics especially respond very well to a mixture of hyoscine and a pain-killer, which relaxes the spasming gut segment, allowing normal gut movement to be re-established. Using a painkiller (e.g. injectable bute) can also be a really useful diagnostic test for whether a horse needs surgery - one of the standard guidelines is that a horse with a heart rate over 60 beats per minutes, 30 minutes after intravenous bute, is usually a surgical case. The other painkiller (flunixin meglumine) is almost never used, unless surgery is definitely not an option. This is because it is too powerful! Even horses with dead bowel can look bright, healthy and well, until the flunixin wears off. At that point, they crash, and are often too far gone to be saved. [caption id="attachment_2632" align="alignright" width="300" caption="Equipment for the medical treatment of colic"]Equipment for the medical treatment of colic[/caption] For impactions, rehydrating the gut contents is vital, but pain relief is also really important. In these cases, Epsom salts and water by stomach tube are really useful. There is some controversy over the use of liquid paraffin in impaction colics. If the horse later has to go to surgery, the presence of liquid paraffin in the gut can cause major headaches for the surgeons; on the other hand, it can be a marvellous lubricant to help move things along. Personally, I tend to give any impaction colic a bucket by stomach tube containing a mixture of water, electrolytes and Epsom salts; and if I'm sure it's not surgical, I'll add in a litre or two of liquid paraffin as well. Liquid paraffin is horrible stuff to work with, and if all you've got to give it with is cold water, it's not easy to mix in; I like to mix the water and electrolyte tablets or sachets together first in a bucket, then add the paraffin. The tube is passed down the nose and (hopefully first time!) into the gullet (if it goes into the wind pipe, start again...), and down all the way into the stomach. To check it's in the right place, I always feel for it passing down the throat, listen for air moving as the horse breathes, and then suck on it to see if I get lots of air back (means I'm in the airways) or nothing (means I'm in the gullet) or, worst of all, a mouthful of stomach contents. This means the tube is in the stomach, which is great, but it tastes truly vile! Once I've carried out all those tests, I'll pour in a tiny amount of clean water, just to be sure - if the horse coughs, it means the tube is in the windpipe despite all my tests, but it's not the disaster it would be if I'd poured in a couple of gallons of liquid... To get this lot into a horse, some people use stirrup pumps - they're a bit like bicycle pumps, and attach to the end of the stomach tube. This is used to pump fluid from the bucket down the tube - they're great if you've got them, although you have to be careful not to overfill the stomach. However, most of us still use syphons and funnels. The tallest person present (usually me...) attaches a funnel to the top of the tube, then fills the funnel from the bucket. They then hold the funnel as high as they can, so the liquid runs down the tube into the horse's stomach. You then repeat this until either the bucket is empty or the funnel stops running, which normally means the stomach is full. It's messy, and can be physically pretty hard work, but it’s a vital part of treating an impaction colic. Personally, I quite often use it to rehydrate the gut of any severe medical colic, because anything that causes gut stasis can lead to a secondary impaction if you're not careful. I'd normally treat a definitely diagnosed impaction with injectable bute for pain relief. There is some evidence to suggest that the use of anti-spasm drugs like Buscopan can help to encourage normal gut action, even though they are designed to work as gut relaxants, but I think that particular debate is still open. To maintain hydration, some vets also like to start a drip line for intravenous fluids. This won't help the gut (any excess fluid will be excreted by the kidneys before it gets there), but it can help to support the circulation of the horse. Personally, my thinking is that most colics that are so severely dehydrated that they need a drip are either surgical or have another, underlying disease; however, there are always exceptions! Chronic, ongoing colics can be a nightmare to manage - they're typically low grade, spasmodic colics, or mild impactions. In these cases, a more thorough examination (including blood tests) is indicated, to try and rule out any underlying disease. Chronic impaction problems tend to be management related, and can usually be resolved with minor tweaks to management. However, your vet will often want to check your horse's teeth - this is because dental problems can result in poorly chewed food, which can make impactions more likely. My experience with the chronic spasmodic colics is that if there's no other underlying cause found, they can occasionally respond nicely to a course of probiotics. I had an incredibly frustrating case once of a horse that had repeated bouts of colic, that we never got to the bottom of. I was being called out every few weeks (and the yard was nearly thirty miles from the practice, which made each visit something of a nightmare!). Eventually I suggested we try a month's course of probiotics... and the next time I saw the horse was nine months later for annual vaccination. Any further colic episodes, I asked? No, they replied - nothing since we started the probiotics. Although it isn't a cure-all, it can apparently help in some cases! Of course, not all colics are medical - about 10% require surgical management. In the third and final piece of this series, I will look at the indications for surgery, the types of colic needing surgery, and then I'll go through what happens when your horse is referred to an equine hospital for emergency surgery. 1 This is based on my clinical experience in the Midlands, Wales and the South West of England. In some parts of the country, other causes will be more common - for example, on the South Coast, Sand Colic is more common. However, it seems to be fairly rare in most areas, so I'm not going to cover it in great detail. If you are worried your horse or pony may be suffering from colic, talk to your vet, or check the symptoms using our Interactive Equine Symptom Guide to help assess how urgent the problem may be.
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Keep Your Rabbits Gnashers Gnawing Gnaturally!

Bunnies cropThe most common cause of illness in rabbits is poor dental health, they suffer terribly with their teeth and problems can become so severe, it is not unusual for bunnies to be euthansed because of them. However, the news is not all bad because it is actually very easy to keep a rabbits gnashers gnawing gnaturally! Rabbits have teeth that grow all the time and are kept short by both a natural diet of tough, woody grasses and also by the upper and lower sets grinding on each other. However, since bunnies have been domesticated their diets can be very different from the wild, often consisting of more soft rabbit food and vegetables than hay and grass, and this is what causes the problems. Firstly, because the teeth aren’t worn down by these softer foods and secondly because they can become calcium deficient; leading to the jaw bones softening, the teeth shifting and no longer being in alignment with each other. This problem is particularly prevalent when the rabbit is fed the muesli type diets, which they tend to selectively eat by picking out their favourite bits and so they don’t get a balanced diet. When they over-grow, the molar teeth can develop sharp spikes that dig into the sides of the mouth or tongue and cause a lot of pain. The incisor teeth can become extremely long and curl out of the mouth (which makes them easy to spot) or, worse, into it and dig into the flesh and bone. Again this is very painful and makes it almost impossible for the rabbit to eat. Also, the roots of the teeth can become impacted because of the back pressure and as well as being very sore, can also become infected; causing nasty abscesses which can be extremely difficult to treat. Spotting dental problems is not always easy because rabbits will hide when they are poorly but checking their weight regularly, examining their mouths and carefully monitoring their appetite are all good ways of picking up on issues. To check your bunny’s mouth, hold them on your lap and gently lift their lips up to have a look at the incisor teeth. These should be smooth, even and short. It is more or less impossible to check the molar teeth without a special scope but by feeling along the upper and lower jaw bones you can pick up abscesses and swellings. If you are at all concerned you should take your rabbit to your vet. The treatment of over-grown teeth can be a challenge and once they have developed them, many bunnies need to go in regularly for them to be trimmed, which can require an anaesthetic. Over-long incisors can be removed, which is a good idea because it solves the problem and the rabbit will still be able to eat without problems. However, by far the best thing is prevention rather than cure and this is done very easily by making sure your bunny’s diet is as similar as possible to that of their wild cousins; lots and lots and lots of chewy hay and grass!
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Colic: Part 1: Diagnosis and Workup

Horse colic examination and anatomy
When talking about colic, it's important to have some idea of what the various parts of the equine gut are... So, here we go: Stomach - quite small, and hidden away deep up in the ribcage. Small intestine - this is very long, but quite narrow (perhaps 1 or 2 inches across). It is all coiled up throughout the abdomen. Large intestine - this is divided into three parts: The Caecum is a large sac perhaps four or five feet long, pointing forward, and can be heard on the right flank. Generally, it makes a loud gurgling noise every 20 to 30 seconds in a normal, healthy horse. The Large Colon makes up a double U shape, lying on the bottom of the abdomen. It can be up to a foot across, but at each end is a sharp 180-degree bend; the bend near the pelvis (the pelvic flexure) is especially narrow. The Small Colon runs from the large colon down to the rectum, along the top of the abdominal space.
It's something all horse owners dread - colic. However, colic is a symptom, not a disease in its own right, and has a wide range of different causes. This is the first in a three-part series where I'll be looking at colic in horses - its diagnosis and treatment, and what happens if your horse has to be referred for surgery. Put simply, all colic is, is abdominal pain. However, before you're tempted to dismiss it as a stomach ache, it's worth remembering that the horse's intestines are as complicated as a major chemical factory! Anything that causes disruption to their function is potentially life-threatening. Occasionally, colic pain comes from a non-intestinal source, e.g. Liver disease (think ragwort poisoning, or liver fluke), or a kidney issue. In mares, it can also be caused by certain disorders of the reproductive tract. However, the vast majority are due to disease, damage or malfunction of the intestines. If you call your vet and tell them that your horse has colic, they'll treat it as an emergency, because it can be. They'll generally take a bit of history from you, a quick description of what the horse is doing at the moment, and then they'll head out to examine the horse. Most vets will also give instructions for what to do while you're waiting; it's important to do what they say, not what someone else on the yard suggests. This is because they may have an idea what sort of colic your horse has, and will try to tailor their instructions to the specific case. For example, some forms of colic respond well to being trotted around on the lunge; however, that can worsen other types. When they arrive, the vet will want to establish three things: Firstly, does the horse actually have colic? I've been called out to "colic" cases that proved to be laminitis; to a mare foaling down; once even to a tired (but perfectly healthy) horse sleeping in his stable! Secondly, assuming it is a colic, is it a Medical or a Surgical Colic? (I'll talk more about this distinction in a minute). Third and finally, can they make a specific diagnosis of what kind of colic it is? Every vet will have their own routine, but my workup goes something like this: What's the horse's behaviour like? Is he alert, or dull and unresponsive? Is he thrashing about, or just looking at his flanks occasionally? Generally, a quieter horse is likely to have a milder colic, unless he or she is so toxic that they are depressed or spaced out. One exception is that some spasmodic colics are incredibly painful - however, the pain usually comes in waves. Are there any droppings in the stable? Hard, dry lumps of faeces is suggestive of an impaction, or blockage; while very runny faeces or diarrhoea may suggest colic secondary to an infection, e.g. Salmonella. Then I'll start my examination: Mucous membranes (gums are usually most accessible and reliable) - what colour are they, what is the refill time, are they tacky? The normal colour is described as being "salmon pink", and if you press with a finger for a moment, the colour should fade to white, then return within 2 seconds. They should also be nice and moist to the touch. If they are red, or purple, or the colour doesn't fade, it is highly suggestive of toxic shock (like septicaemia). This is a marker of a really, really severe injury to the gut wall, that’s allowing bacterial toxins to enter the circulation. If the refill time is greater than 2 seconds, or the membranes are tacky or dry, it suggests dehydration and/or shock. Heart rate - how fast, is the rhythm good? As a (very rough and ready!) general rule, a heart rate under 60 beats per minute implies a Medical colic, while over 80 suggests a Surgical case. If there's an abnormality in the rhythm, it can mean heart disease as well, or severe toxic shock. Gut sounds - what do the guts sound like in all 4 quadrants? This is where you'll see your vet putting a stethoscope to the horse's flanks, listening to the guts. The normal, healthy gut makes a wide range of bubbling, gurgling noises (the sort that anywhere else you would associate with really cheap plumbing!). The bottom left is the left Large Colon, bottom right is the right Large Colon and perhaps some Caecum, the top right is the base of the Caecum, and the top left is mainly small intestine. This is one of the most useful tests we can do - reduced sounds mean the guts are "slowing down" - this can mean an impaction or blockage, but it can also mean a serious disease e.g. a twisted gut. Increased sounds is generally a good sign, as it usually means a Spasmodic colic. Finally, I'd want to take the temperature (a horse with a fever is likely to have another disease, e.g. Salmonella, that is the underlying cause of the colic), and then, if at all possible, do a rectal exam. People get very excited about this, and it's one of the standard jokes about vets, but I'd like to go on record and say that I doubt anyone actually enjoys rectalling a horse! Apart from anything else, it's dangerous to the vet, and uncomfortable to the horse... However, it can provide more information than almost any other test. What we're feeling for is anything unusual: is the large colon a normal size and texture? How about the Caecum? Can you feel the small intestine? Usually, the small intestine is almost impossible to feel - it just slithers out of the way. If, however, you can feel thick, swollen loops of intestines (they feel a bit like black pudding, or really thick, soft sausages, if you're interested!), it is an indication of a complete blockage in the small intestine, which needs emergency colic surgery. On the other hand, if you feel a doughy, squishy mass in the colon, that means the horse has an impaction. Sometimes, if there is doubt about whether food is passing from the stomach or not, the vet will pass a stomach tube and see how full the stomach is. This looks really easy in theory - you pass a tube up the horse's nose, he swallows it, and then you syphon out the stomach. If you get lots, it's too full, if not, it's fine. However, not all horses are quite so easy! Some horses are really difficult to get to swallow the tube, and it can take several attempts to make sure it's not in the windpipe (which would be a disaster). Also, the equine stomach is, as one equine surgeon I know once put it, "a fantastic organ - it can be completely dilated (full), and you'll get nothing out of it until you move the tube half an inch, then it all comes spurting out". However, if there's any doubt, it can be a great tool to ensure that there isn't a rapidly life- threatening blockage; it can also be emergency first aid to prevent the horse's stomach rupturing in a severe surgical colic. The vet will also sometimes take blood samples - we tend to hold onto these in case they're needed, but the main things we're looking for are: 1) Evidence of dehydration - the blood tests will allow us to quantify the degree of dehydration, making it easier to plan a course of treatment. 2) Evidence of infection - if the white cell count is significantly abnormal, it suggests there may be something else causing the colic that we might need to look into. 3) Liver and kidney function - sometimes liver or kidney disease can present as colic 4) MOST IMPORTANTLY - Fibrinogen levels. Fibrinogen is a substance that can be used to assess inflammation and tissue damage - a high Fib level in a colic case is very suggestive that the gut integrity is damaged, and that surgical intervention may be needed. There's one other sample that can be very useful, especially as a "rule out" test if the clinical findings are contradictory or unclear. This is a peritoneal tap. This test carries some risk, but sometimes it's the best way to find out what's going on inside the abdomen. The belly of the horse is clipped, and prepared so make it as sterile as possible - we don't want to risk introducing infection. The area is numbed with local anaesthetic, and then either a small incision is made with a scalpel and a blunt cannula inserted or (more usually) a small sterile needle is VERY CAREFULY inserted through the abdominal wall. The fluid that comes out is collected in a sterile sample pot for examination. The risk, of course, is that damage is done to the intestines; however, we're very careful to avoid them as far as possible, and instead to collect the fluid that surrounds the intestines, the peritoneal fluid. In the lab, the numbers of cells can be counted to assess if there's infection in the belly (peritonitis); however, in the field we can tell three things: 1) The tap fluid is clear (you can read text through it) yellowish - this suggests that the abdomen is basically OK, and means that in the absence of any other findings, the case can be managed medically. 2) The tap is cloudy, reddish or umber in colour - this means severe damage to the gut walls and/or peritonitis (infection in the abdominal cavity). This horse needs urgent referral for investigation at a hospital. 3) The tap contains gut contents (green or brown, lumpy) - sadly, this means that the intestines have ruptured; the horse is highly unlikely to survive. Alternatively, this may mean that the needle has gone into a part of the intestines, so if I get this, I'll usually repeat the tap a few inches away, to make sure. If the needle has damaged the intestine, it's not a disaster, but it is something to be avoided if possible. So, using all the information from our history and workup, the vet has to decide if the colic is Medical or Surgical. The terms are more or less self-explanatory: a medical colic can be managed with drugs, while a surgical colic needs emergency surgery. As a rule of thumb, 9/10 colics are medical, and can almost always be managed on the yard. In my next blog, I'll be looking at these Medical colics, their causes and treatment. If you are worried your horse or pony may be suffering from colic, talk to your vet, or check the symptoms using our Interactive Equine Symptom Guide to help assess how urgent the problem may be.
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Cruelty to animals: as important as cruelty to humans?

The so-called "Canadian cannibal porn star", Luke Magnotta has finally been apprehended. His actions to date provide a classic case study of the reasons why society needs to make tackling animal cruelty a far higher priority. Magnotta began by torturing and killing animals, and now he's doing the same to humans: if his attacks on animals had been dealt with effectively, he might never have become a murderer. Cruelty to animals is important to many of us because of the simple fact that animals are sentient beings: to us, it's a given that animals should not be allowed to suffer. Unfortunately, there are many in society who disagree: animals rank low on the scale of importance. If it came to a vote, it's likely that "animal lovers" would be in a minority. As a result, calls for greater attention to animal welfare often go unheard: human concerns trump animal welfare issues. This can be frustrating for those who are passionate about animal welfare, but rather than just moaning about it, perhaps we can use these facts to our best possible advantage, by seeking out reasons why the human race can benefit from improving animal welfare. The link between animal abuse and physical abuse of other humans in the same household is now well established: in a study of shelters for victims of domestic violence, more than 85 percent of those interviewed reported incidents of cruelty to animals. Nowadays, whenever vets see cases of “non-accidental injury” in pets, we know that there’s a serious risk that humans in the same household could be at risk of physical violence. In some parts of the world, vets are legally obliged to report such incidents to social services authorities. The reason for this link is thought to be a phenomenon known as the “erosion of empathy”. Most humans feel some empathy towards animals: we have an innate sense that it's wrong to cause them to suffer. The problem starts when individuals take that relatively small step of deliberately causing pain to an animal. Once this moral hurdle has been stepped over, it's much easier to go on to cause pain to humans. Researchers believe that some people develop “impaired systems of empathy” which can lead to increasing levels of cruelty to both animals and humans. Many serial killers start their murderous careers by killing animals: Jeffrey Dahmer impaled the heads of cats and dogs on sticks. The self-named Crossbow Cannibal from Bradford was reported to keep large lizards which he fed on live rodents. And now there's Luke Magnotta: six months ago, videos were circulated of a live kitten being fed to a snake. The Sun newspaper tracked down Magnotta as the likely culprit but could not definitively prove his involvement. Nonetheless, they informed London police of their concerns. Despite these events, Magnotta was not apprehended. For the sake of humans, as well as for the animals themselves, isn't it time that society started to take animal cruelty more seriously?
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