Monday, November 25, 2024

21 Widespread Dachshund Well being Points – YouDidWhatWithYourWiener.com


Each canine breed has a set of medical circumstances they’re liable to. The Dachshund breed isn’t exempt.

There are frequent Dachshund well being points that each proprietor ought to concentrate on to allow them to hold an eye fixed out for related indicators and signs.

This is not going to solely provide help to catch any points early, but it surely additionally offers you an inventory of choices to debate together with your veterinarian in case one thing appears “off” together with your canine.

Under are the highest 21 Dachshund well being points I’ve compiled from 10+ years of finding out the breed, having private expertise with over 100, and by studying from different Dachshund house owners.

A few of these well being points have an effect on Dachshunds due to genetics, some are orthopedic points associated to their measurement and form, and a few are age associated.

The Prime 5 Well being Points in Dachshunds

Under are the well being points you might be almost definitely to see in Dachshunds.

These are those I’ve personally encountered most and those that I see individuals in Dachshunds teams and boards asking about most frequently.

Again Issues

Dachshund again issues are the #1 commonest well being subject seen within the breed. 

One in 4 Dachshunds might expertise again points of their lifetime.

In Dachshunds, the vast majority of again issues are attributable to Intervertebral Disk Illness (IVDD)

IVDD is a genetic situation that causes a Dachshund’s spinal disks to harden, dry out, and calcify at a younger age.

In response to the College of California – Davis Faculty of Veterinary Medication (UC Davis), one of many premier analysis services for IVDD within the US:

“A Dachshund’s lengthy again and quick limbs (legs) is attributable to Chondrodysplasia (CDPA), generally known as the dwarfism, which interferes with the physique’s regular improvement of cartilage.”

Virtually all Dachshunds have at the very least one copy of the gene that causes IVDD as a result of it’s additionally what causes the unmistakable “lengthy and low” Dachshund look.

There could also be another genes concerned that haven’t been recognized but so, sadly, right now, there is no such thing as a dependable check for IVDD

One of the best factor you are able to do is hold your Dachshund at a wholesome weight, make sure that they get sufficient muscle-strengthening train, and memorize the warning indicators of a Dachshund again harm so you may catch and deal with it early.

Weight problems

The Dachshund is listed by Banfield Pet Hospital as one of many high 10 breeds at highest threat of weight problems. 

Some Dachshund house owners don’t contemplate pet weight problems a well being subject however the newest Affiliation for Pet Weight problems Survey reveals many pet dad and mom and veterinary professionals contemplate it a illness.

The issue is that a good portion of pet dad and mom don’t know what their Dachshund ought to weigh and fail to acknowledge once they might lose just a few kilos.

The identical examine above discovered that solely 39% of canine house owners contemplate their pet obese or overweight, which contrasts with quite a few stories indicating over 50% of canines and cats are obese.

Being severely obese can take years off your Dachshund’s life and result in a number of different well being points on this listing, together with arthritis, and a better threat when going below anesthesia.

It might probably additionally affect the frequency and severity of disk rupture attributable to Intervertebral Disk Illness (IVDD) as a result of the additional hanging weight places stress on the backbone. 

Cushing’s Illness (Hyperadrenocorticism)

Cushing’s Illness is precipitated when the adrenal glands produce an excessive amount of of a steroid hormone known as cortisone.

Cushing’s illness might be attributable to both a benign tumor on the pituitary gland or an adrenal gland tumor.

This hormone imbalance normally develops slowly, largely happens in previous age, and may simply be mistaken for indicators of growing old.

Signs embody extreme consuming, urination accidents in the home, hair loss, elevated urge for food, and weight acquire. 

All of these items might be signs of different points too however Cushing’s is the most typical trigger, particularly once they all current on the identical time.

Thankfully, Cushing’s is treatable with oral medicines or surgical procedure to take away the adrenal glands.

Dental Points

Dachshunds are predisposed to dental points as a result of their small measurement, and the chondrodysplasia talked about above, can lead to the crowding of enamel within the jaw.

When enamel are overcrowded, they’ll put strain on one another, inflicting microscopic cracks that then grow to be susceptible to periodontal illness.

Crowded enamel are additionally liable to lure meals, plaque, and calculus in between them, resulting in an infection and irritation.

One other Dachshund dental subject is damaged enamel.

Dachshunds are actually powerful chewers (significantly, attempt to discover a toy they’ll’t destroy) and chew down onerous.

This mostly ends in a cracked or damaged molar, however canine enamel can break off too. 

A damaged tooth usually causes ache and can should be eliminated.

You may assist hold your Dachshund’s enamel wholesome with a superb dwelling dental routine, which might embody brushing or cleansing your canine’s enamel with no toothbrush.

You might also need to contemplate the occasional anesthesia-free canine enamel cleansing from a licensed skilled to assist hold the buildup of tartar down.

In case your Dachshund’s enamel get actually soiled, otherwise you see indicators of an infection, they’ll possible require a radical cleansing, and x-ray, on the vet below anesthesia.

Pores and skin Points

Dachshunds are inclined to 3 main pores and skin circumstances – irritation and yeast overgrowth, dry, flaky pores and skin, and alopecia (baldness).

Yeast and flaky pores and skin

Yeast overgrowth on the pores and skin in canines might be attributable to meals or environmental allergy symptoms, hormonal imbalances, poor hygiene, immune system issues, antibiotic use, or extra moisture.

Dry, flaky pores and skin is most frequently attributable to bathing an excessive amount of, allergy symptoms, or genetics.

The signs of each might be related and embody itching and scratching, pores and skin redness and irritation, and, within the case of a yeast an infection, greasy or oily pores and skin and a foul odor.

When you suspect the reason for your canine’s pores and skin points is a yeast an infection, and common bathing and protecting the pores and skin dry doesn’t make it go away, then it’s finest to seek the advice of together with your vet to find out one of the best treatment.

That will embody switching your canine’s weight-reduction plan to keep away from allergens, medicated shampoos, topical lotions or ointments, and/or oral medicine reminiscent of antifungal medicine.

In case your Dachshund is merely itching because of dry, flaky pores and skin, you might need to attempt bathing them rather less (that is how usually you must bathe your Dachshund) and including omega-3 fish oils to their meals.

Altering your Dachshund’s weight-reduction plan, and utilizing these suggestions to assist forestall and handle frequent Dachshund pores and skin circumstances, might help.

Alopecia

Baldness in Dachshunds is primarily attributable to one thing known as colour dilution alopecia (CDA).

This situation is commonest in “dilute” colour Dachshunds like blue and isabella and is related to the genes that trigger this coloring.

Due to this, there isn’t a lot you are able to do besides handle signs and warmth regulation (with jackets, and so forth.).

Pinnal Alopecia – hair loss particularly on the ears – can also be frequent in Dachshunds and might be developed by any of them, no matter age or colour.

This situation might be mitigated by rubbing a pores and skin soothing balm or coconut oil on the ends of the ears.

Different Potential Well being Issues

Whereas a number of the well being points listed under are much less frequent in Dachshunds, all of them happen incessantly sufficient to say.

Meals Allergy symptoms

Meals allergy symptoms happen when the immune system reacts abnormally to a protein or different ingredient within the canine’s meals. 

Dachshunds, like every other breed, can develop meals allergy symptoms, and a few could also be extra liable to it than others.

Allergy symptoms is usually a downside on their very own however most usually exacerbate different points reminiscent of pores and skin points and gastrointestinal issues. 

Pet food allergy symptoms are additionally the most typical wrongdoer of ear infections, which might trigger a yeast overgrowth main to move shaking, scratching on the ears, and a foul odor.

Widespread meals allergens for canines embody beef, rooster, dairy, wheat, soy, and corn. 

When a canine is suspected of getting a meals allergy, your veterinarian might advocate an elimination weight-reduction plan, the place the canine is fed a particular weight-reduction plan consisting of novel proteins and carbohydrates for a number of weeks to see if the signs enhance. 

If the signs do enhance, the canine could also be allergic to a number of of the components of their earlier meals.

As soon as the allergen is recognized, you may swap to a pet food that doesn’t include the offending components, which can embody a uncooked weight-reduction plan, kibble with out that supply of protein, or a prescription pet food advisable by your veterinarian (I’m a proponent of attempting the previous two first).

Pes varus and pes valgus

Pes varus and pes valgus are each angular limb deformities that may happen in any breed, however are extra generally seen in achondroplastic, or dwarf, breeds reminiscent of Dachshunds.

These circumstances are attributable to uneven progress of a pair of bones (bones sitting side-by-side), whereby one bone stops rising prematurely, inflicting the paired bone (which continues to be rising) to bend and twist (supply)

Varus is a Latin time period which means bent inward whereas valgus is a Latin that denotes being bent outward.

Pes varus, also called “bow leggedness,” is a situation the place the legs bend outward on the knees, inflicting the ft to show inward

A Dachshund with pes varus is usually described as having a membership foot or as strolling like a cowboy.

Pes valgus is a situation the place the legs bend inward on the knees, inflicting the ft to show outward. 

This situation can also be typically known as a Queen Anne entrance (named for the furnishings type that was standard within the time of Queen Anne).

Each pes varus and pes valgus might be attributable to quite a lot of components, together with genetics, progress abnormalities, and trauma (like a fall or vigorously exercising a pet too quickly). 

Generally, these deformities usually are not sufficient to trigger an excessive amount of further stress on the joints and a Dachshund can reside usually.

But when the deformity is excessive sufficient to trigger ache, discomfort, and hassle strolling, a Dachshund might require orthopedic gadgets reminiscent of braces or splints, corrective surgical procedure, and/or bodily remedy.

Moreover, protecting your Dachshund at a wholesome weight and offering applicable train might help scale back the danger of orthopedic points like pes varus.

Diabetes

Dachshunds, like every other breed, can develop diabetes, and a few could also be extra liable to it than others.

In response to the American Kennel Membership (AKC), canines can undergo from two various kinds of diabetes.

Insulin-deficiency diabetes (kind 1 diabetes) happens when the canine’s pancreas is broken, or in any other case not functioning correctly, and isn’t producing sufficient insulin. 

That is the most typical kind of diabetes in canines and people with any such diabetes want each day pictures to exchange the lacking insulin. 

Insulin-resistance diabetes (kind 2 diabetes) happens when the pancreas is producing some insulin, however the canine’s physique isn’t using the insulin because it ought to. 

One of these diabetes can particularly happen in older, overweight canines.

Diabetes may cause a spread of signs reminiscent of elevated thirst and urination, elevated urge for food, weight reduction, lethargy and frequent urinary tract infections.

In case your Dachshund is recognized with diabetes, remedy might embody insulin injections, dietary modifications, and common blood glucose monitoring. 

Luxating Patella

The phrase “patella” refers back to the kneecap. “Luxating” means misplaced.

Subsequently, a luxating patella is an misplaced, or dislocated, kneecap.

Many canines, particularly small canines with bowed legs like Dachshunds, are liable to a luxating patella, as a result of the purpose of the patellar ligament attachment isn’t within the middle of the shin bone prefer it ought to be.

In canines with a luxating patella, the kneecap can transfer misplaced and catch (not transfer again into place) whereas strolling or exercising.

It might probably trigger ache and discomfort and trigger a Dachshund to skip, maintain one leg up within the air whereas transferring, or refuse to stroll.

If the situation is minor, it could not occur incessantly sufficient that one thing must be completed about it or bodily remedy could also be advisable to strengthen the encompassing muscular tissues and ligaments.

Whether it is impacting a canine’s high quality of life an excessive amount of, surgical procedure could also be advisable.

Hip Dysplasia

Individuals most frequently hear about hip dysplasia in reference to bigger breeds just like the German Shepherd, however Dachshunds can undergo from the situation too (though a number of veterinarians have instructed me that it’s uncommon).

Hip dysplasia is a genetic situation attributable to the irregular improvement of the hip joint, which can lead to the ball and socket not becoming collectively correctly.

Signs embody ache, stiffness, issue getting up or down, reluctance to climb stairs or leap, lameness, and issue strolling.

Nevertheless, some canines with hip dysplasia might not present any signs in any respect.

Remedy consists of weight administration, train modification, pain-managing medicines, joint dietary supplements, and surgical procedure.

Cancers/Tumors

Dachshunds have a higher-than-average threat of growing some cancers. 

This features a specific threat of growing mast cell tumors and squamous cell carcinoma.

Dachshunds may also develop different forms of cancers, together with testicular most cancers, lymphoma, osteosarcoma, Hemangiosarcoma, anal sac most cancers.

It’s necessary to examine your canine’s pores and skin recurrently for any irregular lumps on or simply below the pores and skin’s floor, together with on their ft, and to have your vet examine any lumps you discover.

Different indicators that your canine may need most cancers embody excessive losses in urge for food and/or vitality.

Cardiac Problems

Dachshunds can develop a number of forms of coronary heart issues, together with mitral valve illness (MVD), dilated cardiomyopathy (DCM), aortic stenosis (AS), and congestive coronary heart failure (CHF).

Out of that listing, I’ve personally identified just a few Dachshunds with congestive coronary heart failure however not the others.

Nevertheless, because it seems, congestive coronary heart failure is a blanket time period for a situation the place the center is unable to pump blood successfully, resulting in a buildup of fluid within the lungs and different organs. 

CHF might be attributable to quite a lot of underlying coronary heart circumstances, together with mitral valve illness (MVD), dilated cardiomyopathy (DCM), and different congenital coronary heart defects.

Signs of CHF in canines can embody coughing, issue respiration, decreased urge for food, lethargy, and weak point. 

When you suspect your Dachshund could also be affected by CHF, it’s necessary to seek the advice of with a veterinarian as quickly as doable for correct analysis and remedy.

Remedy for CHF in canines might embody medicines to assist handle signs and enhance coronary heart operate, reminiscent of diuretics to assist take away extra fluid, ACE inhibitors to assist dilate blood vessels and scale back blood strain, and/or optimistic inotropes to assist enhance coronary heart contractility.

Along with medicine, a veterinarian might advocate dietary modifications and train restrictions to assist handle the situation. 

Whereas CHF is usually a severe situation, with applicable remedy and administration, many canines with CHF can lead wholesome and energetic lives. 

Seizures

Dachshunds are liable to a number of neurologic issues, together with seizures and epilepsy.

As with people, seizures in canines are attributable to a misfiring of the mind or an imbalance of mind chemical substances.

Signs can embody freezing right into a inflexible place, jerking motions, tremors, imbalance, extreme sleeping, or weak point.

Throughout this irregular mind exercise, a Dachshund will primarily be unconscious however nonetheless awake. 

Their physique will act in unusual methods, they usually won’t be able to listen to or reply to you.

I skilled one Dachshund seizure in individual and the canine’s physique grew to become stiff, he received a vacant look in his eyes, and he stood in a single place swaying backwards and forwards somewhat.

I’ve heard of another Dachshunds urinating or defecating throughout a seizure.

I’ve been instructed that Dachshunds with the dapple gene are genetically liable to common seizures (the one I described above was dapple and so is Summit’s sibling, who’s dapple).

Wire-haired Dachshunds are inclined to a particular kind of epilepsy known as Lafora’s Illness (see under for extra).

In case your Dachshund has a seizure, the veterinarian will run exams. However do bear in mind that typically a definite trigger can’t be discovered.

Remedy for seizures consists of anti-seizure medicines, dietary modifications, environmental modifications like decreasing stress and triggers and various therapies reminiscent of acupuncture or CBD oil.

Lafora Illness

Lafora illness (LD) is an inherited, late onset, progressive myoclonic epilepsy.

It seems as temporary, shock-like jerks of a muscle or a gaggle of muscular tissues that normally solely lasts a second or two.

Any Dachshund can have it however there’s a excessive prevalence within the miniature Wirehaired Dachshund – as much as 20% of miniature wire hairs might be affected.

Eye Issues

Dachshunds are in danger for eye issues like cataracts, glaucoma, progressive retinal atrophy (PRA), and dry eye (generally known as KCS, or keratoconjunctivitis sicca).

A few of these eye points are extraordinarily painful or may cause blindness if not handled straight away.

Dry eye may cause itchy, or irritated eyes, eye redness, weepy eyes (discharge), or a cloudy look.

If one thing seems off together with your Dachshund’s eyes, otherwise you suppose they could be shedding their sight, see your veterinarian for analysis and remedy.

Dachshunds may also have cherry eye, which is a situation the place the gland that produces tears prolapses from its regular place, inflicting a crimson, swollen mass within the nook of the attention. 

Whereas this situation isn’t usually severe, it may trigger discomfort and require surgical procedure to appropriate.

I feel it’s additionally value mentioning that older canines can develop nuclear sclerosis (also called lenticular sclerosis) as a traditional growing old of the lens throughout the eye. 

It causes a canine’s eyes to have a hazy, blue, cloudy look to them and is usually confused with glaucoma.

Nevertheless nuclear sclerosis is usually not painful and doesn’t intrude with a canine’s sight.

Liver Illness

Dachshunds are liable to sure forms of liver illness, together with hepatic lipidosis (also called fatty liver illness) and portosystemic shunts (PSS).

Hepatic lipidosis is a situation the place fats accumulates within the liver, resulting in liver harm and potential liver failure. 

Dachshunds are significantly liable to this situation due to their predisposition to weight problems and since they’ve a genetic tendency to retailer fats of their liver. 

Signs of hepatic lipidosis in Dachshunds might embody lack of urge for food, weight reduction, vomiting, and jaundice.

Portosystemic shunts are a congenital situation the place blood move is diverted across the liver so it may’t successfully take away toxins from the bloodstream.

Signs of PSS in Dachshunds might embody poor progress, vomiting, lethargy, and seizures.

When you suspect your Dachshund could also be affected by liver illness, seek the advice of together with your veterinarian as quickly as doable for correct analysis and remedy. 

Remedy for liver illness in Dachshunds might embody dietary modifications, medicine, and/or surgical procedure.

Abdomen Points

It’s not unusual for Dachshund’s to expertise abdomen points.

Some are merely delicate to sure meals or abrupt meals modifications.

Others can undergo from gastroenteritis, a time period referring to abdomen points leading to irritation of the gastrointestinal tract, hemorrhagic gastroenteritis (HGE), and Inflammatory bowel illness (IBD).

Gastroenteritis has an underlying trigger reminiscent of parasites, dietary points, and so forth.

HGE can have related signs as gastroenteritis however has a extreme onset and no underlying trigger might be discovered.

The principle signs are bloody diarrhea and sudden onset.

IBD is a situation the place the liner of the abdomen and/or intestines turns into infected, resulting in signs reminiscent of vomiting, diarrhea, and weight reduction. 

Dachshunds, due to their propensity to chew, and typically chew issues that aren’t really meals, are liable to intestinal blockages requiring surgical procedure to take away (my first Dachshund Chester wanted this surgical procedure twice).

Signs of a GI overseas physique in Dachshunds might embody vomiting, diarrhea, belly ache, and lack of urge for food.

Dachshunds are a deep-chested breed so may also develop gastric dilatation-volvulus (GDV), also called bloat.

Bloat is a life-threatening situation the place the abdomen turns into distended and may twist, resulting in lowered blood move to the abdomen and different organs. 

Nevertheless, I’ve been instructed by a number of veterinarians that this situation may be very uncommon in Dachshunds, regardless of their deep chests (different breeds that generally get it have deep chests too).

Signs of GDV in Dachshunds might embody restlessness, panting, vomiting, and a distended stomach.

To assist forestall abdomen points in Dachshunds, it’s necessary to feed a high-quality weight-reduction plan, present common train (however not heavy train instantly after consuming), and supervise your canine to forestall them from consuming issues they shouldn’t.

Remedy for abdomen points might embody dietary modifications, medicine, and/or surgical procedure.

Immune System Problems

Dachshunds are liable to a number of forms of immune system issues, together with allergy symptoms, Immunodeficiency issues, and autoimmune illness.

Allergy symptoms have been coated above.

Immunodeficiency issues happen when the immune system is unable to operate correctly, resulting in elevated susceptibility to infections and different well being issues.

An autoimmune illness causes the immune system to assault the physique’s personal tissues and cells.

Dachshunds are liable to a number of forms of autoimmune ailments, together with immune-mediated hemolytic anemia, the place the immune system assaults the crimson blood cells, and autoimmune thyroiditis, the place the immune system assaults the thyroid gland.

When you suspect your Dachshund could also be affected by an immune system dysfunction, it’s necessary to seek the advice of with a veterinarian as quickly as doable for correct analysis and remedy. 

Remedy for immune system issues in Dachshunds might embody medicine, dietary modifications, and/or immune system modulators.

Dementia

Dementia, or canine cognitive dysfunction (CCD) syndrome, isn’t Dachshund-specific however it’s common. 

CCD is a progressive and irreversible neurodegenerative dysfunction that impacts the mind, resulting in modifications in conduct, reminiscence, and cognitive operate. 

CCD is often seen in older canines, and its signs might be much like these seen in human Alzheimer’s illness. 

The precise reason behind CCD isn’t absolutely understood, however it’s believed to be related to mind modifications reminiscent of beta-amyloid plaques, oxidative stress, and neuronal demise. 

Signs of CCD in canines can embody confusion, disorientation, modifications in sleep patterns, lack of curiosity in actions, and modifications in social conduct. 

There is no such thing as a identified treatment for CCD, however early detection and remedy might help handle the signs and gradual the development of the illness. 

Remedy might embody medicine, dietary modifications, and environmental modifications.

Sadly, I needed to put my first Dachshund to sleep because of his dementia. 

Hypothyroidism

Hypothyroidism is a situation the place the thyroid gland doesn’t produce sufficient thyroid hormone, which might result in quite a lot of well being points. 

Whereas any breed can develop hypothyroidism, some breeds, together with Dachshunds, could also be extra predisposed to this situation. 

Widespread signs of hypothyroidism in canines embody weight acquire, lethargy, hair loss, pores and skin points, and intolerance to chilly.

Younger dachshunds are likely to get this greater than older canines.

Hypothyroidism might be recognized by a blood check that measures the degrees of thyroid hormones within the bloodstream.

In case your Dachshund is recognized with hypothyroidism, remedy might embody medicine to complement the lacking thyroid hormone. 

With applicable remedy, most canines with hypothyroidism can lead wholesome and energetic lives.

Notice: Hypothyroidism and Cushing’s illness (described above) are each hormonal issues, however they’ve completely different underlying causes and signs.

Double Dapple Dachshund

A double dapple Dachshund is one which had two dapple dad and mom, which might occur on objective, could possibly be a results of unintentional breeding, or could possibly be a failure to well being check to verify neither Dachshund dad or mum is a hidden dapple.

Whereas double dapple isn’t a real well being situation in itself, a canine that has double dapple (merle) genes incessantly have extreme well being points.

Double Dapple Dachshunds are sometimes mistaken for piebald Dachshunds due to the numerous quantity of white on their physique, however there are a pair methods to inform them aside.

  • Piebalds solely have brown eyes. They’ll by no means have blue eyes, or one blue eye, or a blue tick in an eye fixed (supply). The American Kennel Membership (AKC) Dachshund breed normal additionally backs this up: “eyes are by no means partially or wholly blue as distinguished from the dapple sample.”
  • When you have a look at a piebald Dachshund head-on, the coloured areas will cowl each ears and be symmetrical – what you see on the left aspect you must see mirrored on the appropriate aspect.
  • The coloured patches on a piebald have easy, rounded edges. Double dapples can have jagged patches of colour.
  • Double dapples usually have “starburst eyes” – The pupil (black spot within the middle of the attention) can have spiked, jagged, or irregular edges – or misshapen eyes.

The most typical well being points in double dapple Dachshunds are malformed ears, malformed eyes, and deafness and blindness.

Nevertheless, they’ll even have inner deformities and well being points that may’t be seen.

Most double dapples might be noticed because of their coat sample and misshapen eyes however a genetic check may also affirm.

As a result of double dapple is genetic, nothing might be completed besides handle the signs.

Ultimate Ideas

Though this listing of Dachshund well being points could seem lengthy and scary, the vast majority of these listed are merely potentialities and never tremendous frequent.

Probably the most prevalent Dachshund well being issues – those I’ve seen most frequently over the past 10+ years, are again issues (IVDD), allergy symptoms, Cushing’s illness, seizures, enamel issues, pores and skin points, and weight problems.

Nevertheless, I wished to incorporate each well being situation I feel Dachshund house owners ought to concentrate on.

Crucial factor you are able to do to guard your Dachshund’s well being is to bear in mind, know your canine’s regular so you may rapidly detect any modifications, and see your veterinarian straight away if one thing appears off.

Moreover, working with a good breeder who screens their canines for genetic well being points might help scale back the danger of your Dachshund growing orthopedic circumstances or different genetic well being issues.

Notice: I’m not professional breeder or in opposition to rescue – I’m simply stating a truth

Every dog breed has a set of medical conditions they’re prone to and Dachshund breed is not exempt.

Here are 21 common Dachshund health issues that every owner should watch out for so they can spot associated signs and symptoms early.
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