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A New Treatment for Canine Idiopathic Epilepsy: Pexion

A New Treatment for Canine Idiopathic Epilepsy: Pexion

We recently wrote about canine idiopathic epilepsy, a form of epilepsy where the cause remains unknown. Today we are looking at a new treatment; Pexion.

The severity of epilepsy can vary greatly between individual sufferers. Some dogs may experience a single, isolated seizure, whilst other can experience multiple seizures every week.

Recently Boehringer Ingelheim has announced their latest product for the treatment of canine epilepsy, Pexion® (Pexion) an alternative to the traditional phenobarbital or potassium bromide treatments given to epileptic dogs.

Are you using Pexion?

If you’re dog has been prescribed Pexion, let us know how your dog is getting on in the comments below. Join the discussion on how other dog owners are getting on with Pexion and keep the community updated with your progress. 

What Is Pexion?

Unlike other treatments for canine epilepsy, Pexion contains the active ingredient Imepitoin. Imepitoin acts in a similar manner to previous anti-epileptic medicines, potassium bromide and phenobarbital, in that it works to suppress electrical activity in the brain.

Imepitoin partially activates GABA receptors, which are responsible for reducing electrical activity between nerve cells. This partial activation of the GABA receptors is believed to reduce electrical activity and help prevent seizures. Specifically, Imepitoin also has a weak blocking effect on calcium channels that allow electrical signals to be propagated along nerve cells.

See here for more information about Pexion 

Does Pexion Work?

A study conducted on Pexion during its development compared it to the traditional anti-epileptic medicine phenobarbital. A 20 week study of 226 dogs taking the medications found Pexion matched phenobarbital in efficacy, reducing the occurence of seizures by around 50%. 1

Is Pexion a Better Alternative?

The Pexion study showed that it had an effectiveness equivalent to phenobarbital, however, Pexion may be considered a better alternative as it has less severe side effects.

Unlike phenobarbital, Pexion does not pose a hepatotoxicity risk (liver toxicity). This means the regular testing required to ensure that a dog’s liver remains healthy is not needed whilst being given Pexion.

Treating the Epileptic Dog

It is commonly cited that around 0.5 to 5% of dogs suffer from some form of epilepsy, the severity varying between breeds and individuals. In dogs where seizures occur infrequently  owners may consider not using any medication at all, avoiding the side effects associated with anti-epileptic medications.

In dogs where seizures occur more freqently, such as once a month or more, treatment should be considered.

The introduction of Pexion gives owners and vets a greater choice when it comes to treatment, but does not replace phenobarbital and potassium bromide.

Owners should consult their vet and explore all the possibilities when dealing with an epileptic dog.

Seizure Types That Require Immediate Veterinary Assistance

Cluster seizures – When multiple seizures occur in one 24 hour period
Status epilepticus – A persistent epileptic state that lasts for longer than 5 minutes

For more information about epilepsy, such as the causes, what to do during a seizure and more, see this article.

Disclaimer: This article was written as a response to the release of Pexion and as a follow up to a previous article concerning idiopathic epilepsy. I am not affiliated with the product (Pexion) or the manufacturer (Boehringer). 

Image Credit: Onkel_wart

About James Watts

BSc Bioveterinary Science. Editor of PetSci. When I'm not writing, learning, discussing, or reading about animals, you know it's the weekend!


  1. I have now stopped Pexion and put Ziggy on Epiphen. Since we stopped it he hasn’t had a single seizure so far(5 days).The effect of Pexion was horrendous as the fits increased every time we increased it, culminating in 4 seizures in 12 hrs even after rectal valium. He also became more paranoid and jumpy with each increase.Before he started on Pexion he only has single seizures, but as soon as he was on Pexion he started having clusters of 2 seizures every time. I also heard of a lady last week who ended up having her dog put to sleep because it had 30 seizures in a day on Pexion. One thing I would say to everyone who’s dog is on Pexion is, if the seizures get too bad just stop giving it (you can do that with Pexion) and the seizures will reduce straight away. I know of only a couple of dogs who Pexion has worked for. Don’t be afraid to stop it. I just knew if I didn’t stop it after the 4 seizures he might go into status.

    • Dear Faye,
      I posted last week recommending that when changing medication you do it slowly, even pexion. My dog Izzy had 30 seizures a day after stopping the pexion and not having other meds in her system. She had the 30 seizures twice about a week apart and both times the vets had to keep her over night and sedated her. After the second time the vets couldn’t control the seizures and she was put to sleep. Good luck with your dog, hope you never have to make that next step.

      • Sorry Amanda but you are wrong. .you can just stop pexion overnight. ..I did that too and saved my dogs life I believe. ..It even states it in the pexion information that it needs no withdrawal

        • Dear Alison
          All dogs are different and 3 dogs mine included have passed away as a result of stopping pexion and not having something else in place. Thats why you should take your vets advice as they take into account each animals health and age. I repeat, every dog is different and one method worked across the board it would make matters easy for all involved.
          Whatever works best for your dog is best for you. Wishing luck always as epilepsy is the most horrific illness to witness.
          Amanda x

          • One think I know for sure is that each dog reacts differently to anti epileptics and most vets believe it’s through trial and error to find what works best for your dog. It certainly needs lot of patience, time and luck…

    • Hi Faye

      My dog Dillon was on epiphen for 2 years (max dose 240mg per day) at first on epiphen he looked as if he was drunk he could hardly stand, this stopped after 2 weeks and he has only had 2 seizures since, but epiphen can effect the liver, which it did. He needed blood tests regularly then it became monthly, 2 hours before and after food to test his levels. We moved him to pexion (weaning him off epiphen, which will take 3 months) because his liver could have failed . He was put on pexion because it says it does not effect the liver and he has been on it ( 400mg per day) for 2 weeks, his initial wobbly legs have stopped, he does seem to drink more (but epiphen also made him drink a lot)

      Dillon never had many seizures but on seizing he was always alert to his surroundings, I just held him till they passed. He has only had 1 cluster in 4 years ( this is why he was put on epiphen.)

      I hope epiphen works for you , but please have his blood tested and look for the signs off liver problems, goog luck.

  2. Amanda, I think you were just unfortunate when stopping the Pexion that there were so many fits. I know several people who have just stopped Pexion with no ill effects, like myself, so generally speaking it is ok to just stop Pexion as it is not an addictive drug like the other AED’s. Also the info on Pexion says you can just stop it, but I guess like everything there are exceptions and I think unfortunately your dog was one of those, so sorry. Faye x

  3. Yes, sorry Amanda I agree with Faye, I think that you were just unfortunate… the drug Pexion does not react to being stopped suddenly as it does not stay in the system, that is why they state that there is no withdrawal, aside from that I would NEVER EVER recommend using this drug, it almost made me come to the decision to have my boy PTS until I saw this forum and saw what others were also suffering, I am so sorry for your loss x

    • As we have all agreed, each dog reacts differently to each medicine and it is only by trial an error that we may find something that helps our dog. I would not put my dog on any medicine if she/he was having less than 3 fits a month, manage the fits with natural remedies as I did with Izzy. Good luck to everyone on this site I wish you all the best of luck, love and strength.
      Amanda x

  4. My JRT, Trooper, has now been on Pexion for 6 months. He has fewer side effects than on phenobarbitol and we don’t have to put him through the regular blood tests.
    Pexion works for him, he has fewer seizures, 6 weeks between the last 2 rather than 3 weeks with pheno.
    He has put on little weight and he’s no longer as keen to go on walks, he’d rather stay home, but apart from that, he’s very much the same old dog…. It seems experience vary to great degree with regards Pexion, but for Trooper, it works!

  5. My four year old Rhodesian Ridgeback commenced with seizures 7 months ago, he was prescribed Pexion. Seizures continued once every three weeks or so until a massive 8 seizures in one evening resulting in our taking him to the Vet Hospital to see a specialist,
    we nearly lost him, he is now on epiphen and is back to his pre-seizure self.

    He had an MRI scan and spinal tap to get to this stage , I would suggest that everyone considers the advise of a specialist before embarking on any drugs. I know that different dogs react to different things but do not accept that on- going seizures are a fact of life for your dog – they deserve the best….

    • Hi Annemarie

      How did you get your dog off the Pexion? Was it gradually or immediate? What sort of dose was he on? Did you wait until epiphen levels were at a certain level? Sorry for all the questions, I’m desperate to get my dog off Pexion (he’s on epihen as well now) but every time I try to reduce the Pexion, even really slightly, he starts fitting. I’m so scared it’ll be too late soon. Any insight you can give would be massively welcome
      Thanks, Natalie

      • Hi Natalie
        You do not need to wean off Pexion you can just stop giving it, thank goodness. That is what I did with my dog and I know others that have done that too, it states it in their literature that there is no weaning needed. I doubt that the reduction in the Pexion is causing the increased seizures, maybe the pb levels need checking? Good luck and kind regards, Alison

        • Hi Alison
          Thanks for the reply. I know the literature states there’s no weaning off, that’s what’s so frustrating. His pb levels are within therapeutic range (24.4 two weeks ago) but the specialist says we still can’t continue with the Pexion reduction because of the frequency/severity of the seizures etc. They say next step will have to be upping the pb again to aim for a level of about 30 and also bringing in Kbr, waiting until Kbr levels are high enough and THEN attempting another reduction in Pexion, which will be at least another 2-3 months down the line apparently.

          It’s so maddening because my gut instinct is that it’s the Pexion that’s complicating/increasing seizures. Still, it’s heartening to see that you and others have managed to get off the Pexion and are having much better situations for their dogs. Quick question, was your dog on Pexion as a first (and mono) drug and then you switched to pb or had he been on any other drugs before Pexion? Wishing you all the very best, Natalie

          • Hi Natalie
            After going through 3 months of hell with Pexion I think your gut instinct is boy was already on pheno and potassium bromide although we did start to reduce the pheno when he was on the Pexion… they kept telling me to up the dose of Pexion more and more until it reached the max, my dog was not my dog any more and was some phycotic crazy animal.. after continued seizures 3 days running I took the decision myself to just stop the Pexion, was the best decision I ever Ummed and arrhed over, I couldn’t have taken another couple of months of what we had at the time..why not up the pb a little and stop the pexion after 2 weeks and see what happens? The pb will be in the system by then and if needs be you could adjust or add another aed? Just a thought… good luck! xx

          • Thanks Alison, your thoughts are good ones and I think that’s kind of the route I was considering. Am going to speak to the neurologist today and see what sort of increase of the pb to look at, wait a couple weeks and just start reducing the Pexion again and see where we are. Am really pleased you had such a good outcome, everything crossed it carries on well for you and your boy xx

      • If you ask your vet about the valium protocol, it’s basically using the pessaries and tablets then try reducing the pexion half a tablet each week. Look back on this comments list. You can also go on for more information, buy do it slowly with your vets help. Good luck, love Amanda. Xx

        • Hi Amanda
          Thanks very much for this – I didn’t know about the valium protocol. I’ll speak to the specialist/vet in the morning and see if this is something we could get going on asap. I’ll have a look at the site too – many thanks, Natalie xx

        • Can I just say that the valium protocol is used solely for when your dog has a seizure (not always pessaries, we have liquid valium for rectal use) it has nothing to do with the use of Pexion or any other aed. You do not need to wean off Pexion, it even states that in their literature.. I stopped overnight and had immediate positive effects and know of many others that have done the same thing… take a look at the facebook page canine epilepsy, there are a few of us on there that have done just that x

  6. My 7 YO dog started fitting in Jan 2014, started on Pexion 400mg, fitted again, increased to 500mg, fitted again, so this week and upped to 700mg. Waiting to see if he is stabalised. He has side effects of excessive hunger, thirst, slightly ataxic on back legs and much more sleepy in the evening. Hoping the side effects reduce and the frequency stops.

  7. My dog has been on Pexion since August. He had a fit as we swapped from bromide to Pexion the nothing until January of this year. He then had another fit mid February and another 9 days later. My vet suggested upping his Pexion to 600mg in the morning and 400mg in the evening, he did have 400mg morning and night. Hopefully this will stop the fits again.

    • elizabeth hilton

      Hello wendy,

      My collie is 13 and has been on pexion 600mg since august. I took her to the vet yesterday for a six month check up and she was very pleased with her. I suggested weaning Maddie off the pexion, but the vet did not advise that. Maddie has had very few fits since being on pexion, she does not drink so much and only side effect I can detect is she is more agitated and has tremor in front leg. She still chases balls and has 6 mile walks every day. Maddie does not need regular blood tests as pexion doesn’t involve the liver, but oddly there are only 4 dogs on this drug in the whole practice. Most are still on bromide/phenobarb. I know pexion is still a very new drug and many vets are still wary of it and its possible side effects. Good luck to all of you who have tried it on your pets.


      • Murphy has obviously had another fit whilst I was at work today. That’s 3 now in the last month. He only had two all last year. Not sure what to do now! I’m just waiting to hear back from the vet to see whether to up his meds again.

  8. Someone has just told me that Pexion has to be given exactly 12 hours apart, is this the case. I’ve been giving it to Murphy about 13/14 hours apart for the whole time he’s been on it. I was just told twice a day on an empty stomach so he has it an hour before food.

    • Hi our beagle snoopy is on pexion he has half a tablet morn an eve approximately 13/14 hours apart or sometimes even longer depending on when we r home from work etc… Also he has his after he has his breakfast as we weren’t told otherwise…. We were just advised to try and keep as regular as possible ….. Hope Murphy is ok xx

      • Going through a bit of a bad patch with fits at the moment, he has had four so far this year, the last three have each been about two weeks apart. Just trying to work out why. I know this is nothing for some people, but I don’t know what has made him fit like this.

        We’ve upped his dose to 600mg twice a day. Fingers crossed this will work for him. He was doing so well, he only had two fits all last year.

  9. Hi there
    My dog blue has been on pexion for 10.days now when he first started he was on
    400mg in the morning and 400mg at night I gave him first dose at 9pm at 1am he
    Got up for toilet and could not walk he kept falling over as if he was drunk this
    Continued till 7am I phoned vets at 9am to tell him he halfed the dose right away
    He has just had another fit. I am not conviced so far by this drug as he is very sleepy and keeps walking into things also ticked his pupils are very large. And the thirst and
    Hunger is terrible. He is also on epilease epiphen and keppra. I am desperate now
    For any suggestions now as my poor dog does not seem to get any better even being on all these

  10. bailey 1.3 years old great dane 10.5 stone
    started having seizers 6 weeks ago 1 a week then a group of 4 2 weeks ago .
    next next day started on pexion 2x 400mg twice daily
    no side affects no seizers
    now a very happy dog again

    Hi everyone,
    I haven’t posted for a while but have been following posts.

    Jack was doing well on the Pexion until the start of the year and then the seizures started to increase. Finally we were getting to the stage he was having 4 a month so I took him to see the vet yesterday and she has just got back to me.
    She contacted the makers of Pexion and they have now discovered that if a dog was on KBr (potassium bromide) prior to starting Pexion then he/she should remain on it. We have now resumed KBr so hopefully once Jack’s dose builds up to a therapeutic level we should see a reduction in his seizures. We withdrew the KBr in August after weaning off PB so it would have been in his system for a few months so this is probably why the seizures didn’t increase immediately.
    On a positive note, Jack’s seizures are very short, about 1-2 mins in length followed by 5-10 mins pacing before he makes a complete recovery. The vet hadn’t seen Jack since he has been weaned off the Pb and she was amazed by his altered behaviour. He is so much happier now, his tail was wagging and although he was very excited he was much happier about having his booster.
    I hope everyone is having a happy, seizure-free day.
    Kind regards,

    • That’s really interesting, Murphy was on bromide from last January until August when I swapped him onto Pexion. He only had two fits all last year, but since this January he has already had four, three of which have been in the last month.

      We’ve upped his Pexion, but will see what happens.

      • I forgot to say that we increased Jack’s dose of Pexion from 1000mg x 2 up to the maximum dose for his weight (38kg) which is 1200mg x 2 in mid January and it made no difference to the frequency of his seizures.
        I think the makers of Pexion have only just become aware of this as most dogs that started on Pexion last April/May are only now having issues if they have spent months weaning off PB and KBr.
        I’ll be interested to see what your vet says.
        My vet is also considering referring Jack to a neurologist.
        Kind regards,

        • Murphy isn’t on the highest dose, he is 26kg and is on 600mg twice a day. Vet is going to call m tomorrow to discuss this. The highest dose he can have is 800mg twice a day. I am tempted to leave him on the Pexion and see how he goes if we increase, but am now worried that the Bromide mixes with the Pexion and causes a problem.

          Did your vet say why you shouldn’t use Pexion after Bromide?


          • Sorry, Wendy, I didn’t think to ask the reason why but I’ll wait to see if anyone else has any questions and I’ll email my vet to ask her to contact them again for answers.

          • Wendy,
            After reading your last post I’ve just read my original post and I don’t think I made it clear that Jack is still on the max dose of Pexion but we have added 325mg x 2 of KBr to it. Sorry to cause confusion.

          • Aaahhhhh! Ok, I got the impression that they couldn’t take Pexion if they had originally been on Bromide. So do the makers say that Pexion doesn’t work so well if your dog was originally on Bromide?

          • Hi Wendy,
            Yes, I think that is the gist of it. My vet said that any of her clients’ dogs switching to Pexion in future would have to also continue with the KBr too if already taking it. Those just on Pheno won’t be affected. I don’t know about any other AEDs as I don’t know if my vet uses any others.
            I will try to get answers – just didn’t think when she phoned earlier.

          • Sorry thats not true for Izzy, she couldnt take the bromide anymore as it gave her pancreatitus so it was withdrawn and that was when we heard about pexion so Izzy was on pexion and being weenex off the epiphen.
            Amanda xx

      I didn’t make it clear above that Jack is continuing with the max dose of Pexion but we have added 325mg x 2 of KBr to it.
      What I should have said is that if dogs have been on KBr prior to starting Pexion they should take both Pexion and KBr together rather than withdraw the KBr.
      Sorry for the confusion.
      If anyone has any questions I will get back to my vet and ask her to contact the makers for answers.

  12. I’ve just phoned my vet and asked him to check this out and find out why they say this.

  13. my boy was on both pheno and Kbr when trying Pexion… we had a terrible time as described earlier. The problem with using new drugs is that they cannot give you all the answers… Pexion was only ever trialled on dogs on no other AEDS and was not recommended for dogs with clusters as had not been tested either (not mentioned to my vet when starting us on it). Most people I know with dogs that didn’t cluster started to after starting Pexion, very few people have had results with this drug. The manufacturers representatives here in spain just tell you that the dose is not high enough, my dog ended up on such a high dose it almost killed him

  14. Millie is almost 8 years old and is a Springer Spaniel. She was diagnosed with epilepsy in February 2012. She has been on Epiphen with her dose continually increasing to 120mg x 2 per day. We tried her on potassium bromide but she had terrible side effects including chronic diarrohea so it had to be stopped. Her liver enzymes have increased every time her bloods have been checked so the vet recommended we introduced pexion. She is still on 90mg of Ephiphen x 2 per day. She was only on Pexion for 5 days when she had a cluster of fits so then had Keppra for 3 days. Her most recent fit lasted about 6.5 minutes and she took about 45 minute to really recover. She is due have her liver enzymes checked again next week. I know I have to wait to see what happens but I find ‘waiting to see’ very difficult and I find her fits heart-breaking to watch. We are due to go away on holiday in a few weeks and I really don’t want to leave her.

    • If you read back on earlier comments, it seems that dogs that have been on other medicines don’t take to pexion very well. Ask your vet to read this sites comments. Good luck. Amanda xx

    • Hi, not sure if your dog had clusters before Pexion? But it is not recommended for dogs that cluster – mine does but still they recommended it to me.. he had a dreadful 3 months resulting in him almost being PTS!! In all the groups and people I speak to I have only come across one person that has had success with Pexion they will keep telling you to put up the dose… we reached max and my dog had terrible hallucinations and side effects unheard of….
      It was never trialled on dogs taking any other medication either, so the side effects cannot be guaranteed, I have known people who’s dogs had been on no other medication, had never had a cluster seizure UNTIL they were on

    • Hi, not sure if your dog had clusters before Pexion? But it is not recommended for dogs that cluster – mine does but still they recommended it to me.. he had a dreadful 3 months resulting in him almost being PTS!! In all the groups and people I speak to I have only come across one person that has had success with Pexion they will keep telling you to put up the dose… we reached max and my dog had terrible hallucinations and side effects unheard of….
      It was never trialled on dogs taking any other medication either, so the side effects cannot be guaranteed, I have known people who’s dogs had been on no other medication, had never had a cluster seizure UNTIL they were on this drug.. I would urge you to take your dog off Pexion and find another AED to try alongside normal treatment, there are lots of tried and tested drugs out there to use besides this, I know lots of people have success with Keppra alongside pheno and potassium bromide, not sure what your dog is already on? Good luck whatever you decide

      • Please read from the beginning of all these comments, but also check other canine epilipsy sights, I found s lot of useful info about diet and natural remedies. My research also found that there are 2 main types of idiopathic epilipsy- a brain scan will show if there are any reason fir fitting, those that are undiagnosed with underlying issues are idiopathic. This group seems to be split in two, aggressive and non-aggressive. The aggressive strain takes the dogs before they reach 5 or 6 its as if the fits are learned behaviour that gets out of hand ( there is nothing you can do to stop this so dont blame yourself for not doing your best for your beloved pet. The second passive epilepsy is treatable with drugs or natural methods. I think more research needs to be done by vets, if they pooled information online and listened to owners stories and stop treating our pets like guinea pigs.
        Amanda x

      • Thank you both for your comments. Millie didn’t have clusters as such although she has been known to have a fit in the evening and take a shorter fit in the morning. When she first had fits she would be really aggressive when she came round which was out of character and frightening. However the epiphen has stopped that. I am planning to let our vet see the comments here. Millie is still on ephiphen and pexion and takes Urilin. She is licking her lips a lot (and anything else!) and is starving all the time. She is really cuddly and doesn’t want to walk more than 15-20 minutes. I think even the vet doesn’t know what to do anymore…

  15. Amália Maria Nunes

    I apologize for my bad English. I’m desperate. My 9 year old boxer is taking phenobarbital since january and 10 days ago I (and a Vet) introduce the Pexion. Since 4 days ago has had partial seizures of 10 in 10 minutes, or less. Insted of improving is getting worse.
    I’ m slowly withdraw Pexion, but is no information on Pexion site. She continues to take the pheno and I wanted to finish faster the weaning (?) process. I’m full of fear to withdraw all at once. Please, someone help me.

  16. You can stop the Pexion, you dont have to wean her off that.

    • I would suggest you read earlier postings on this forum. Dogs that have previously been managed on pheno and bromide and then put on pexion need to reduce the pexion slowly and increase other meds. Have you tried Keppra? Please be careful and when your dog is having fits one after the other use an icepack on the head and neck as the fits cause heat which can lead to more fits. I would also recommend reading on canine epilepsy websites, the Americans are using many natural remedies that can be used alongside medicines given by vets. Good luck.

  17. Amália Maria Nunes

    I will read carefully every post. I do not know if there Keppra in Portugal. I will ask the Vet. Potassium Bromide does not exist, the sale was proihbited. She continues with parcial seizures. I’m slowly reduce Pexion. Thank you for important advices.

    • When your dog has a seizure have small towels handy and cover your dogs face sit at its back and be as quiet and calm as you can. If you can get Bachs rescue remedy also called Five flower oil from a chemist or online herbal website, put 4 or 5 drops where you put flea treatment on the neck when you see signs of fit coming. The oil helps calm the dog. Ice packs keep temperature down. If you can get Skulcap and Valerian tablets from http://www.petdrugsonline, I dont know how far they ship to. Hope you are able to find something that helps.

  18. Our border collie (between 7 – 8 years old) had a cluster of seizures (5 in less than 24 hours) without any prior attacks seen. After the fifth he was totally disorientated and confused. He was originally put onto Epiphen tablets of the lowest dosage. These seizures then stopped. 18 months on and though still no seizures the vet was getting concerned about an increase of liver enzymes in his blood and recommended that we went on to Pexion. We started his full dose of Pexion (400mg) tablets immediately and started to reduce the Epiphen. We did not notice any side effects from the Pexion and some two months on his epiphen is almost three quarters less. He will be off epiphen completely by early May. Once he had got over the initial fits (which took about two weeks) he is as lively and ‘normal’ as any other border collie and so far no more fits. When he is off the Epiphen completely we will have a further blood test done, but so far very pleased with the new drug Pexion.

    • Thanks for that, it is nice to hear a more positive response. We are due to reduce Millie’s Epiphen again tomorrow and I do feel a bit apprehensive. Even on 120mg of epiphen twice a day, Millie still has fits about every 4-5 weeks, so she would be due to fit around next week anyway. Her liver enzymes have reduced already since we first reduced her epiphen which is good news. Fingers crossed!

      Good Luck!


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