Does your cat run and hide when it’s time to take medicine?

Cats are usually difficult when it comes to taking medicine, leaving owners throwing their hands up in frustration and cats leery of coming out of hiding. Here are some alternatives to forcing a pill down Fluffy’s throat.

You can try Pill Pockets that are specially made for cats. It is basically a cat treat shaped like a pocket where you place the pill in order to disguise it from Fluffy. This will work with some cats and others will simply eat the treat and spit out a half dissolved pill. What can we say, a cat knows what it likes and will not be tricked…….or do we have more tricks up our sleeves?

For cats with impeccable taste, you can go to a local compounding pharmacy where the pills can be turned into a chicken or tuna flavored liquid that can be mixed into Fluffy’s food……yes, as easy as eating cake! For those do-it-yourself people, you can crush the pill and mix it in Fluffy’s tuna for the same affect—as long as tuna (or beef broth) is OK with Fluffy’s Doctor, of course!  Learn more from Prescription Lab Compounding Pharmacy

Last but not least, some medications can be given transdermally, (rubbed into the skin). Fluffy can get his/her medicine while receiving love from you, how awesome is that?! It is true; a spoonful of love helps the medicine go down!

For more tips and tricks on medicating cats, contact  us @ 520-886-1125

“Despite the ever-increasing emotional bond we have with our pets, research shows pets are getting less preventive healthcare,” says Dr. Rene A. Carlson, president of the American Veterinary Medical Association (AVMA). “Consequently, illnesses that are totally preventable, such as dental infections, intestinal worms and heartworms, ear infections and diabetes, are on the increase. … we encourage pet owners to bring their pets into their veterinarian for regular checkups.”

Pets are going to the veterinarian 25% less often than before.  Why?

The economy has a lot to do with it.  Less discretionary income puts pet care lower on the list of things we need to spend money on.  Sometimes we just don’t have the extra cash or credit for pet emergencies, let alone wellness visitis.  And, payment arrangements are hard to find at Veterinary offices.  So, here are some other options:

  • Pet Health Insurance.  The same way it helps us get health care, it can help you afford pet care. Check out this site for comparison shopping the most reliable Pet Insurance Companies:  Trupanion.com
  • Apply for Care Credit– a line of credit for medical expenses.
  • Seek out Veterinarians who accept Care Credit
  • Seek out Veterinarians who offer monthly payments on Annual Wellness Packages–  dividing the expected expenses over the course of the year can sure make optimal pet care more affordable!
  • Look for Vets who offer in-house Medical Savings Plans– let your vet help you save by putting money in your pet’s account for wellness or urgent care.
  • Ask your Vet if they offerFrequent Flyer Discounts” for pets that come in more than once a year

Internet sources encourage owners to self-diagnose and even try treating at home.  While the internet has lots of good information, there is a lot of misinformation out there, too.  Make sure you  are getting medical information from a veterinary source, not just anyone. Here are some reliable sources for veterinary information:  Veterinary Partner  and   AAHA Healthy Pet.   Avoid putting off a vet visit based on “wait and see” advice from the internet.  Illnesses are almost always less expensive to treat and have better outcomes when treated earlier than later.  And, always remember, there is no substitute for your veterinarian’s hands-on examination and their advice based on personal knowledge of your pet!

3 Year Vaccination rotations are becoming more popular, so owners are choosing to forego the annual health exams.  Many people don’t realize that the Veterinary Exam is the Most Important Part of their pet’s “vaccination visit”.  Of course, every pet needs appropriate vaccinations based on life risk assessments (which your vet can help you figure out), but it’s the up-to-date exchange of knowledge and the physical exam that let you and your pet’s doctor keep him in top form– not just the vaccines.

As more cats are staying indoors, owners are abandoning annual health check ups for their cats, being under the mistaken impression that their indoor cat is “safe” from disease.  It is true that indoor cats are unlikely to get contagious diseases and suffer less traumatic injury than outdoor cats.  But, indoor cats are more prone to metabolic disease, obesity, and diabetes than their more active outdoor counterparts.  The fabulous thing is that medical advances in the last several years are helping cats with metabolic diseases and diabetes, even renal failure, live up 2 or more years longer than before!  It’s worth checking it out!

Tips for getting your cat to the vet with a minimum of stress (to both you and your cat)

  • Train your cat to enjoy his carrier.  Click here
  • Spray Feliway in the carrier 15 minutes before putting your kitty inside.  Tabby finds Happiness with Feliway– from youtube
  • Put a towel or sweatshirt with your scent on it in the carrier for kitty to hide in.
  • Ask your veterinarian for anti-anxiety medication to give before the trip
  • Choose a Veterinarian with some of these cat friendly features

Time constraints make it difficult to get in to the vet during regular “Doctor Office Hours”.

  • Look for a Vet that allows Drop Off Appointments.  Drop your pet off while you go to work or run other errands.  Your Vet or Vet Tech can call you with physical exam findings and  recommendations.  You can make treatment decisions and pick your pet up on the way home!
  • Look for Veterinary clinics with extended hours.

Just as for humans, an ounce of prevention (and a few dollars intermittently) is worth a pound (and big bucks) of cure for pets.

Pets should have regular checkups throughout their lives just like people.  Human physicians recommend annual exams for children and adults starting at middle age, annual blood testing starting at middle age, and some specialized tests as we advance in age (prostate cancer testing, breast cancer screening, colonoscopy).    Likewise, Puppies and Kittens should have monthly exams until 4 months of age (equate that to children at age 11).  Pets age 4-8 (equate to human ages 40-65) should have at least 1 exam every year.  Twice yearly exams for middle aged pets would be entirely reasonable.  That would be like a middle aged human getting an exam and wellness testing every 3 years.  Senior pets over the age of 8 should be examined every 6 months with an annual wellness blood and urine screen.

Sure, you will pay for 1 or 2 vet visits a year, but you will get your money’s worth!  Your vet will be able to detect problems that you can’t at home.  You can implement lifestyle, diet, or exercise changes to turn around some illnesses or slow down the progression of chronic disease, giving your family more great quality time with your pet.

Our rapidly changing ,constantly moving society will always present challenges to the things we want to do.  When you are feeling challenged about bringing your pet into your Veterinarian, call them.  Your family Vet probably has some ways to make the experience easier and better.   As our pets give us unconditional love, we need to give it back in comfort and quality of life.   Don’t let preventable disease steal precious years from your bond with your Pet Friend Forever.

Part of every examination prior to vaccines includes a “Life Risk Assessment”.  Our technicians and Doctors evaluate each pet’s risk of contagious disease prior to making vaccine recommendations.  Some vaccines should be given to every pet.  Other vaccines are only needed by pets that experience higher risk of contagious disease, such as trips to the dog park, groomer’s or boarding kennel.

Pets that stay at home or only go on leash walks without a lot of contact with other animals may only need some vaccines every 3 years, according to new recommendations made by the American Animal Hospital Association (AAHA) and the American Veterinary Medical Association (AVMA).

The veterinarian who knows your pet, your family and  lifestyle is the best person to make recommendations regarding the vaccines that are best for your pets.  If you take your pets to a discount vaccination clinic, you will not get advice about which vaccines are uniquely suited for your pet since all animals are treated the same at most vaccination clinics.  They will not recommend 3 year vaccines for pets (that would cut into their profits).  They will not recommend specialized vaccines based on your pets lifestyle (like rattlesnake vaccine for hunting dogs or periodontal vaccine for dogs prone to dental disease) because they do not take the time to perform a Life Risk Assessment or a complete physical exam.  They may even insist that your pet have non-core vaccines that he/ she doesn’t need because that’s what corporate says they have to do.

The best place for vaccinations for your pet is still with your family veterinarian.  Sure, you may have to pay $ 40- $50 for an exam with the vaccines, but you may not have to pay for vaccines that your pet doesn’t need.  Meanwhile, for your investment,  your pet will be getting the physical exam, individualized health recommendations, and better health care that are the Really Important things!

  • Baseline for comparison in times of illness
  • Early disease detection and correction avoids crises

Adult Wellness Screening is a valuable tool for keeping your beloved furry family member healthy– especially since they don’t tell us when they feel “off” all the time.  Adult Wellness Screening involves a small blood sampling to briefly evaluate a pet’s blood sugar, liver enzymes, kidney values and a Complete blood count. 

Baseline Values-  Armed with your pet’s “normal” values, your veterinarian can make faster, better medical decisions for your pet if he gets sick. 

Early Illness Detection-  Catching disease in early stages allows you and your veterinarian to make small changes in your pet’s  lifestyle to slow down the progression of disease or turn around early disease.  During early stages of disease, nutritional management and supplements have the greatest impact– the greatest protective and therapeutic value.  Learing about issues early on and making small changes earlier in the state of a disease can save hundreds and thousands of dollars as well as emotional heart ache during a crisis.

During Wellness Screening in apparently “healthy” patients, we have found pets with early degenerative liver disease that we have arrested by prescribing liver antioxidant supplements.  We have identified signs that led us to diagnosing Tick Fever, Valley Fever and Heartworm disease so we could treat these patients before they experienced life-threatening symptoms!  We are often able to uncover early kidney disease in cats, allowing us to make diet changes and add supplements to their diets that allow them to live for years more before needing medication! 

In our experience, 4 out of 10 pets show evidence of subtle abnormalities in their Adult Wellness Screens by age 6. 

An Adult Wellness Screening should be done once yearly on pets between the age of 4 and 8.  After all, this is middle-aged– equivalent to a human of 40 – 65 years.  Remembering that dogs and cats age approximately 5 “years” to our one year during middle age, checking a blood profile once every 5 years doesn’t seem so unreasonable.

Current Lifestage Guidelines for Dogs and Cats*

  • Veterinary Exam every 6 months (Remember, pets in mid-life age about 5 years to every human 1 year)
  • Vaccinations as needed  (Based on Life Risk Assessment)
  • Fecal sample for Internal Parasite testing
  • Contagious Disease Testing  (Based on Life Risk Assessment)
  • Wellness Blood testing once a year

We, at Cimarron, are advocates of preventive medicine because we have seen the huge improvement in our patients’ lives– longer lives, more active lives, thanks to the discoveries that we have made during routine wellness screening in our apparently healthy patients.  We hope that Wellness Screening can help your pet live longer and happier, too!

* Compilation of recommendations made by

  • American Animal Hospital Association
  • American Veterinary Medical Association
  • American Heartworm Association
  • Council on Animal Parasite Control

 

 WHAT IS IT?

Valley Fever (VF) is a very serious and potentially fatal disease of animals who live in Desert Southwest- Arizona, Southern California, Southern New Mexico and Southeastern Texas. We see it quite frequently in Tucson.

Valley Fever is caused by a fungus, called Coccidioides immitis, that lives in the soil as spores. Animals become exposed to the fungus by inhaling the spores from the soil either directly (snarfing around in the dirt) or indirectly (dust storms and construction). Nearly every animal that lives in the Desert Southwest for any length of time becomes exposed. Fortunately, most animals’ immune systems fight the fungus and never develop signs of the disease. If an animal’s immune system is not as strong as it should be, or the animal is exposed to a lot of Coccidioides spores, (like hunting dogs, dogs who dig, and animals living near new constructions sites), he/she may develop signs of VF. 

SIGNS:

 “Just Ain’t Doin’ Right” is one of the most common signs of valley fever. This is probably due to the waxing and waning fevers and the fugus’ tremendous draw on the body’s immune system defenses.

 Pulmonary (early) Form: Classic signs of VF in dogs include a harsh, dry cough, decreased appetite, and fever. As the disease progresses, the cough may resolve and signs of dissemination (spread around the body) may develop

 Disseminated Form: Coccidioides can spred to almost all organs causing related signs of disease:

Bone

Lameness/ limping

Spine

Decreased jumping, back pain

Brain

Seizures

Liver

Poor appetite, vomiting

Eyes

Sudden Blindness

Kidneys (rare)

Increased drinking/ urination

 DIAGNOSIS:

  Because the signs of Valley Fever can mimic those of nearly any disease, a blood test must be performed to accurately diagnose the disease. Depending on a patient’s clinical signs, radiographs or other tests may also be recommended. The Valley Fever Center for Excellence at the University of Arizona  is currently promoting several novel methods of diagnosis that may prove helpful in the future as well!

  TREATMENT:

Most patients CAN be cured with long term therapy and committment to veterinary monitoring.

   Treatment involves giving medication daily. Fluconazole is the most widely used medication currently, however, due to suspected resistance of Coccidioides, newer medciations are available and some are in the process of clinical trials!  The length of time that an animal must be treated is variable (usually a minimum of 1 year), depending on the severity of disease and the pet’s individual response to treatment. The response to treatment is determined by monitoring blood tests and/ or radiographs every few months.

Depending on a patient’s signs, surgery may be needed to improve a patient’s response to therapy.  For instance, sexually intact pets should be spayed or neutered as the fungus loves to “hide out” in reproductive tissue.

 It is critical to continue medication until your veterinarian saysthat it is safe to stop medication.

Stopping medication prematurely will only result in relapse of signs later and may induce a chronic, incurable infection

 Your veterinarian will use the data from blood tests, radiographs and physical exams, as well as  information provided by rapidly changing, late-breaking research to help determine when it is safe to discontinue medication.

 ** Even after a patient is “cured”, according to his clinical signs and bloodwork, relapses or re-infection may occur. It may, therefore, be recommended that a pet’s blood be rechecked at intervals for several years after recovery.

  Early detection can save a pet’s life.

 If your pet has any signs that might suggest Valley Fever and he has been living in or passed through the United States Desert Southwest,  please do not hesitate to have him examined and tested by your veterinarian!

 Learn More from the University of Arizona Valley Fever Center for Excellence

 

 

 

 

 

 

 

 

 

 

 

Tips:

  • Put the kitty in YOUR space– up on a table/ counter/ washing machine
  • Have a second person help keep kitty in one place if you are inexperienced
  • Practice gently pinching the toe tips, pulling the covering sheath of skin up the leg away from nail tip to “uncover” the nail
  • Regardless of type of trimmer you use, trim off only the “hook” of the nail, avoiding the pink quick in the nail– that’s where the blood vessel and nerve live.

Arm yourself with the right equipment: 

 

We are so excited to have our new Digital Dental X-ray machine up and running!  It’s been a long-time dream of  Dr. Bohnke’s to be able to provide the level of dental care that dental x-rays allow!  Most dental disease occurs below the gum line.  A lot of that is completely invisible to the naked eye.  (Ever had (or had a friend who had) a toothache but the dentist couldn’t tell what tooth was involved just by looking?)

Dental readiographs show us  root infections, bone loss and tumors that we might not be able to determine just by looking at and probing the teeth. Without dental x-rays, infected teeth may be left in the mouth, even after a thorough dental treatment!  Cats develop painful resorptive dental lesions, similar to cavities, below the gumline.  The only treatment for this condition is extraction of the painful tooth.  If we can’t see the lesion, don’t know it’s there, because we haven’t taken radiographs, we could leave our patients in pain!

Dental Rads also tell us when we DON’T have to pull a tooth.  Tooth tip fractures are common.  If the pulp cavity of the tooth is exposed, the tooth should be either capped or extracted.  If the pulp cavity is not affected, the tooth can stay in place and just be “watched”.

The widened pulp cavity and dark area under the root of the fractured upper canine tooth told us this tooth was infected and needed to be extracted. The gums around this tooth looked normal.Being able to take radiographs of the inside of the mouth let’s us know whether oral masses are affecting the dental or boney structures of the jaw.  And, they are a lot more easiy interpreted than whole skull rads– with far greater detail.

We have also used our dental x-ray machine to radiograph pocket pet parts!  It’s a quick way to get a detail x-ray– as many as we need, given rats’ and guinea pigs’ tendency to wiggle– without anesthetizing the patient or having to do a whole body x-ray!   This image shows a guinea pig’s fractured elbow!

 

Our pets don’t always tell us that their teeth hurt, or which teeth hurt, but radiographs can!

For the best dental care, the most complete treatment, insist on dental radiographs every time your pet is anesthetized for dental work.

We’ve rolled out our Discount Spay and Neuter options to allow pet owners with financial constraints a better choice than the local Discount Spay-neuter clinics for their pet’s surgery.

Our BASIC CARE PACKAGE provides services comparable to Discount Clinics, but with SOME EXTRA BENEFITS:

  • Your pet is at a full service hospital.  In case anything goes wrong during surgery, we can deal with it!
  • You will have full support of our staff, available by phone day or night, should you have questions or concerns after surgery!  Even our after hours calls are taken by veteirnary emergency trained staff! (Not just an answering machine– or go to the emergency room as at discount clinics)
  • Pets will receive 3-4 Pain injections (not just one)  during their stay and have the option to take home pain medications after surgery.  (Would you want an ovariohysterectomy

    Local Discount clinic surgery

    or castration without pain control at home?!?) 
  •  Surgeries are performed in a sterile surgical suite– our Doctor is fully dressed in sterile surgical attire- discount or not! 
  • Patients will be attended by a dedicated Certified Veterinary Technician from anesthetic induction to recovery.

For Pet Parents wanting optimal anesthetic safety for their pets, we still  offer the ULTIMATE PATIENT CARE PACKAGE which includes all of the above PLUS:

  • Pre-Anesthetic Bloodworkensures there is no hidden infection or organ compromise that will affect anesthetic/ surgical safety, and allows the

    Surgery at Cimarron

    Doctor to make individual adjustments in your pet’s drug plan.
  • Intravenous catheter and fluids- provide immediate venous access for emergency in case they are needed. The fluids help to maintain healthy organ function throughout and after surgery. They also help organs metabolize sedatives and anesthetic medications faster, returning your pet to “normal” behaviors sooner.
  • Advanced Electronic Anesthetic Monitoring- Using EKG, Pulse oximeter, Blood pressure monitor, Respiratory monitor and Core Termperature we can customize a patient’s anesthesic level based on subtle
    changes, minimizing the amount of anesthetic needed. These monitors also allow us to detect problems before they become anesthetic crises.
  •  Proactive Pain Medication- Pets receive both a pain/ sedative injection and an anti-inflammatory injection before surgery, a pain injection during surgery, and another if they need it after surgery. They also receive pain medication to go home. We also offer a post op Cold Laser therapy treatment to minimize swelling and desensitize nerves in the area of surgery. 
  •  We believe that pets deserve the safest surgical options.  They should not just survive surgery, but survive it Well– with a minimum of physiologic stress and pain. 

    But, we also understand that many of our clients have financial constraints. 

    ** We would rather pets were neutered and spayed, rather than not, just because of monetary issues.  Also, we would rather have our patients’ surgeries done in a sterile surgical suite, with skilled anesthesia nurses in constant attendance, proactive pain management, and after care support should they need it! 

    Contact Us today for an $Estimate!

More cats are owned than dogs, yet there are 60% fewer cat visits to the vet every year.  But, they need the highly tunes sleuthing and observation skills of a veterinarian at least as much as dogs do.  Cats are both predator and prey animals in the wild.  This makes them unique masters of hiding signs of illness and weakness.  Vet check ups every 6 months to a year help identify health problems sooner, keeping your kitty active and happy longer!

CIMARRON ANNOUNCES NEW FELINE FRIENDLY INITIATIVE!

Studies say #1 reason cats don’t come to the vet:   it’s stressful to them and their people!  Boy Howdy!  Ever noticed how fast a cat can run under a bed when you get the carrier out of the garage?  Then, if you can reach them, they have to be dragged out and stuffed into the carrier.  Straight out of the cartoon when the cat spreads his legs across the doorway…  Then, if you’ve been able to successfully stuff scratching, hissing kitty into the carrier, you have to endure the excruciating, guilt building yowling all the way to the vet.  Then, there are the dogs and other cats in the waiting room– not friends!  Then the veterinary nurse drags you out of the only safe haven you have (hey!  how’d this dread carrier suddenly become the best thing around?) to stuff a thermometer up your tookus (that’s cat French).  The room smells like all the other scared animals. The steel table, no place to hide cuz they keep dragging you around.  Poking , prodding, stabbing.  Thank goodness, the carrier door is open! Kitty can slither into it faster at the vet’s office than anywhere! The hideous yowling all the way back home.  Once kitty is home, his cat-mates hate him all over again because he smells funny, so he hides under the bed for the next 12 hours.

Studies also say that when we emotionally bond with our cats, it’s more intensely than with out dogs!  (Swear, I didn’t make it up!)  It’s no wonder we dread the trip to the vet with our precious, beloved pussy cats so much that we just don’t do it and hope OUR cat doesn’t get sick.

Cimarron’s New Kitty Sensitive Solutions:

  * Tips for Travel Training cats and kittens  check it out!       Cat Carrier Training

* Medications to help the travel anxiety— ask for a dose when you schedule your appointment. Pick it up ahead and administer an hour before the trip

   * Happy Kitty Pheromone diffusers in the cat room to help reduce anxiety.  Also on sale so you can pre-treat that carrier!

   * Move directly into your exam room to avoid other animals and give kitty a chance to come out of carrier and explore a little before all of the necessary evils.

   * Fleece lined exam tables.

* More onwer comfort care allowed.

The American Association of Feline Practitioners  video on How Cat Sensitive Practices like Cimarron make the vet visit easier!

     #2 Reason to not bring cats to the vet:  She’s never sick.

Cats are largely indoor pets, so people figure thaey don’t need vaccinations, adn simce cats are so good at hiding signs of illness, it’s easy to tnik that a cat is “fine”– unitl she’s in medical crisis.  so, why put us all through all that stress and expense?  Did you know that indoor cats are actually more prone to dental disease, obesity, diabetes mellitus, pancreatitis, osteoarthritis, urinary tract disorders and behavioral conditions than outdoor cats?

The best news is that medical advances in feline medicine in the past 5-7 years have given us treatments for these diseases in cats!  Many of the treatments are simple food additives.  Even treating diabetes is no longer the horror that it used to be!  Newer feline pain medications keep you cat spry and active!  A little treatment can give you back the playful, spunky kitten you once knew!

Cats should be seen once to twice yearly by their veterinarian, just like dogs,  even if they are indoors only. Veterinary Wellness exams and wellness testing can detect disease conditions early.  And early intervention is the key to a longer,  more comfortable life with fewer expensive, emotionally racking crises along the way!

We are here to do whatever we can to help you take the terror (for both you and your family felid) out of Kitty’s trip to the Vet!    

 

 

The human medical field calls it “Concierge medicine”, “boutique medicine” ,” executive health”, “VIP”, “platinum services”, “signature”, “medallion”.  In Veterinary Medicine, we call it customer service.    In a nutshell, human physicians are deciding to get out of the Insurance rat race that forces them to triple book and spend only 7 minutes with each patient.  Many are deciding to spend quality time with their patients, examining all their body parts, discussing not just the complaint of the day, but wellness, nutrition, exercise, behavioral concerns, and quality of life.  They are trimming their patient bases down from 2500 patients to 500 to allow the personalized attention, comprehensive screening and customized health plans they want to provide.  Many advertise in-office blood draws and lab testing and rapid turn around times of lab results.   In order to still make the salaries they want, though, physicians have to compaensate for fewer patients by charging all the remaining patients a “retainer” or service priviledge fee of anywhere from $1500 – $5000 a year.  Mind you, that only gets you the above services.  Patients still have to pay thier office visit co-pays and submit to their insurance companies for any testing/ treatments performed.

I find it amusing that we, at Cimarron Animal Hosptial ,provide all these services Everyday, to Every patient!   At Cimarron Animal Hospital, we schedule most patients 20 minutes of Doctor time.  The Doctor performs a comprehensive exam on every pet, regardless of the complaint.   (When was the last time a physician looked in your ears when you went in complaining of a hang nail?)  The Doctor discusses diet, exercise, weight management, and behavior issues as they apply.  Our veterinarians consider the whole pet, performing a lifestyle risk assessment and providing an Individualized Medical Plan for every patient!   We provide a VIP waiting room– sodas and water for the people, water and treats for the pets!  That’s part of the service every day, for everyone– no extra charge!  Our goal is to return every client phone call before the end of the work day.  The Doctor or Nurse will call you about lab results, treatment plans, etc.  Our after hours calls are taken by a Veterinary Emergency Service– you talk directly to skilled veterinary staff 24 hours a day!  Your pet gets blood and urine samples collected and many tests run right in the office!  Test results are usually available in 10 minutes to  24- 72 hours (not weeks from now)!   That’s just part of our Great Client Service! 

Can you imagine if vets started charging clients $1500/ year for the first pet  ($1000/ additional pets) just to do what we do every day?  Wow!

Our physician couterparts think it’s a special service to advertise that they ” are always learning about the latest innovations in healthcare that enables us to detect diseases at their earliest stage.”  That’s what veterinarians have been doing forever!

At least human physicians are learning what veterinarians have always practiced– good customer service makes customers happy.  Too bad they think we should be so beholden to them that they feel they should be paid $1500 or more a year for what veterinarians do for the cost of an office call!  (Or, maybe we vets ought to wise up and start charging for the priviledge of personal service?!?  Good grief, what would the world come to?!?)