Tanner is doing well

[dutchman]

As I said in the general healt forum I'm moving Tanner's folloups to this forum. Tanner is a lot more comfortable this morning. The rimadyl seems to starting to do it's job. For those of you who missed the basics in the general healt forum Tanner went to the vet yesterday because his back was very tight and his abdominals were rock hard. The vet did take x-rays and feels pretty confident it is a muscle and not spinal problem. I'm keeping an eye on him doing the toe test once or twice a day and looking for any other signs of a possible neurological problem.

That's all for now other than to than everyone for their support and rays. Tanner will continue on the rimadyl at least through Sunday. You can assume no news is good nes. I will post ASAP should we start to have any more problems.

One of the reasons for moving this thread here is to help alert everyone to the fact that it is possible for our little ones to be experiencing some back problems without them being neurological in nature. That is not to say we should ever just assume on our own that the problem is not spina related. It's always a good idea to seek out the advice of a good vet when a back problem is suspected.

Oh by the way we got lucky and the vet working yesterday (generally only one of the six vets works the two hour Sunday office hors) was teh orthapedic specialist that has previously treated Tanner for tight back muscles. Having the orthapedist on staff there is a second best to having a neurologist.

Tom and the boys (Frank, Tanner and Dester)

[lotsadox]

Thanks for the update, Tom. I'm glad to hear that Tanner is feeling better. You're so right about seeking help and not assuming anything. When Bandit had her first muscle spasms, I thought she was having gastric trouble and gave her something to ease that at midnight. Then when I took her in the next morning I found out it was muscles! Keep us updated and here's some more rayz from Texas :rayz: :rayz: :rayz: :rayz:

[Patt]

Thanks Tom for the update. I'm so glad Tanner is doing a little better today. Sending more healing rayz his way. :rayz: :rayz: :rayz: :rayz: :rayz: :rayz:

Patt :flower:

[Juneysmom]

I'm glad to hear that Tanner is doing much better. How old is he, again?

[minicooper]

I am so glad that Tanner is doing so well!

Good on you, Tom, for being so observant to any little change in behaviour, and getting him straight to the vet!

Please keep us posted!!

[TessieMom]

Glad to hear that Tanner is improving. We are sending more rays his way.

Rena and the Waco crew

[Mark]

that Tanner is better.

More Dachsie Healing RAYZ headed his way. :rayz: :rayz: :rayz: :rayz: :rayz: :rayz: :rayz:

[dutchman]

I'll be continuning to watch him closely. This evening just before he was due for his evening dose of meds (twice a day shooting for 12 hrs) he seemed to be getting rather stiff in the back again but has settled down and is relaxing after the meds. I'll see what he is like in the morning and call teh vet with an update. IF he is very tight in the morning again or tomorrow after work I may request a muscle r muscle relaxer. I wourl rather not use any other drugs while on the rimydal but also don't want him too uncomfortable. Still no sign of neurological involvement thank goodness.

Thanks again for all teh rays.

Tom and the boys (Frank, Tanner and Dexter)

[lotsadox]

It's good to hear that Tanner is relaxing after the meds. When they get that tension going in the back, it can be really scary. More rayz to help him get better. :rayz: :rayz: :rayz: :rayz:

[Meemoo]

in this...BUT acccupuncture does a WORLD of good. If you can find a holistic vet who does this, I'd highly recommend it. You can do a search on accupuncture and dogs and you'll come up with a wealth of information. Is Tanner on any supplements? Salmon oil is a NATURAL anti-inflammatory which would help. Glucosamine/Chondrotin and ester c are also very helpful. Please let me know if you need articles or information on these, as I do have them.

In the meantime..lots of COOL rays from the big apple (which is BAKING)

[dutchman]

Hi Loren,

Thank you for the suggestions. The idea of accupuncture is a good one. There are several practioners in the area. I know the CSU VTH has one and I believe there is vet in another small town 10-15 miles from here that also is a practioner. I don't want to introduce any new supplements while Tanner is on the rymadal. I don't want to risk mistaking any gastric problems that might develop with a new supplement as a bad side effect of the rymadal. I blend Avo-Derm and Avo Active Care for teh boys foods so he does get some Glucosamine/Chondrotin from the Active Care. I was giving the boys Ester-C for a little while but when my supply ran out I couldn't find it again in any of the local pet or feed stores. I didn't want to jsut start giving them human Exter-C w/o first investigating the recommend dosage for their little bodies. I know excessive C can produce some gastric problems on it's own. I'll have to look for the salmon oil. The boys love salmon meat so I suspect they would love the oil on their food. Do you get it at a healt food sop? Also what kind of doage would you recommend for a starter? Again I most likely won't introduce any new supplement while we are on our current round of meds.

Tom and the boys (Frank, Tanner and Dexter)

[Meemoo]

Tom:

First, I agree, no additional supplements etc until meds finish. I understand you giving avoderm which has gluc/chon but honestly, it isn't ENOUGH in the food for it to really be beneficial. You need to give additional for it to be helpful. As for ester C, human kind is just fine, in fact it is usually BETTER as it a more "Pure" if you will. (Same goes for glu/chon). I get my C from Duane Reade. For a dog that is healthy (exhibiting NO back problems) 500 mg (250 mg) each meal is a good dose. Easy on the tummy. For a dog with problems, you'd up that dose to bowel tolerance and then back off a bit.

Salmon oil...is a supplement IMO I wouldn't be without. It has many beneficial qualities. Helps coat, arthritis and other ailments. You can get this at a drug store or health food store. They usually come in BIG gel caps at 1000mg. I give one every other day. If your boys are fussy with pills, you could either (puncture the cap)..I wouldn't do this...messy OR purchase the liquid salmon oil which they have for pets called "grizzly salmon oil" It comes in a pump dispenser.

In any event, food (or supplements for thought)! :D

Keep us posted on Tanner's progress...see if you can find an accupuncturist, I think it would be helpful.

More rayz on the way!

[dutchman]

I'm waiting for a call back from our vet. When I went home for lunch today Tanner"s back started getting very tight again and his abdominals were also tightening up . I did ask if the did any referrals to the CSU accupuncurtist (SP) and found out Dr. suto the orthapedist we saw on Sunday does some himself. I'll ask about that as an option when he call and I see where he wants to go from here. He had discussed the possibility of a muscle releaxer drug if Tanner was still tense after a day or two.

I felt king of guilty putting hi back in the kennel and leaving him home when I headed back to work:( His back was tensing up and that's wehn he needs some comforting. He seems to relax when comforted but worries and just becomes even more tense when he is on his own. I guess he figures I won't let any thing too bad happen to him hen He is right next to me.

Tom

[Meemoo]

I know he's in good hands...or is it arms right now???:D

[dutchman]

That is the part that makes me feel bad. Tanner is home inhis kennel while I'm here at work witing for teh vet to call:( His brothers don'w seem as concerned about him (he's the alpha) as he is about them if they feel the least little bit under the weather.

Tom

[Meemoo]

I think we humans are more sad than the puppers...

[doxunzX3]

I hope Tanner is having a better day today. Keep us posted on his progress. You are so lucky to have a vet so quickly available to you.
I am sure he is getting the best treatment possible. After all his hooman is doing everything possible to help out his little doxie buddy. To bad we have to work for a living to pay for our doxies. But hey they are worth it.
Here's a few more rays from WI and hoping to her some good news on his progress.
:rayz: :rayz: :rayz: :rayz:
Oh don't forget to have a few winks and a good rest. That will help the most.
:snooze: :snoopy:

[dutchman]

Tanner was holding himsef rather rigid and shaking a bit when I got home from work tonight. I stopped off at the pharmacy to pickup his perscription. We now have a supply of methocarbamol 500MG tablets. He can have 1/4 of a tablet 2-3 times a day. It's a muscle relaxer. The label says it may cause drowisness and that he shouldn't operater heavy machinery:)



After he got his first dose he sat on my lap for about an hour then we got the boys dinner and he got this evenings dose of rimadyl. Dr. Suto is willing to give him aan accupuncture treatment if I decide I want to do that. He said he generally reserves accupuncture for chronic pain cases. He says many times dogs get nervious enough about coming into the office that he doesn't recommend the therapy for more minor cases. He will be out of the office next week but is working the late shift tomorow closing at 8:00 or should be available Thursday or Friday. I'll have to see how Tanner is doing at noon and or in the evening tomorrow. Dr. Suto says the ideal accupuncture treatment would be if you could find someone who did home visits. He is not aware of anyone in this immedate area that does that. He knows the CSU vet does not. It's nice to know my vet office with it's large staff is open to and pratices some of the alternative methods.

Thanks again for the rays,

Tom and the boys (Frank, Tanner and Dexter)

[Lauri Gengor]

Hope Tanner is doing better. I feel so bad when these little dogs have to fight something as this..but they are fighters! My two are a prime example.

Our healing rays to tanner:rayz: :rayz: :rayz: :rayz: and lots of prayers. Our fingers and paws are crossed for luck for you baby.


Lauri and the M&M crew...(Magic:angel: and Mistty:devil:

[Patt]

Tanner you get better!!!!! Sending more rayz :rayz: :rayz: :rayz: :rayz:

Patt

[Meemoo]

Interesting Tom that your vet doesn't think accupuncture is a wise idea for minor cases. There is a *TON* of info on the net about accupuncture being beneficial, and not just for major crises. Chief goes for accupuncture for "tune ups" if you will about once every 6 weeks. When he first had his "minor episode" he was going weekly for treatments. They have done nothing but help him. There have been occasions where Chief wouldn't relax for the needles to stay in, (he's too busy checking the surroundings out) that instead of the accupuncture, he gets injections of vitamin C instead.

More rayz from the big apple!

[dutchman]

I'm beginning to wonder how much of Tanner's tight back and tehn abdominals is mental and how much is an actual injury? First thing in the morning je seems just rine hardly a things wrong then as I start getting ready for work he starts to tighten up,. In the evening an hour os so after I get home settle down with him and comfort him a little he once again becomes confortable. Today at non (he knows I'm only home for a short time) he got very tight again.

I find myself debating should I call to see about an accupunture treatment today/tonight or not? I think another trip to the vet make just make him even more tense again. I'm thinking wait see how he is tonight and tomorrow morning then call to see if we can get in tomorrow or Friday.

By the way last night after we were all in the big bed together Frank and Dexter had a couple of second conflict (more vocal than any thing else) Dexter bailed out of bed. Tanner came charging out from under the covers all puffed up ready to take charge as shouse alpha and then had to check both boys over to make sure they were OK. Once he knew things were OK he was a little sore again but for those few minutes he was jsut fine.

Tom and the boys (Frank, Tanner and Dexter)

[TessieMom]

Sounds like you have a plan! I never will forget Tess when she hurt her paw (got lots of sympathy, until she forgot which one was hurt!). They do know how to work on HooPeople! Rena (the crew refused to acknowledge any part of the sympathy game)

[lotsadox]

When I first got Miller, Bogart suddenly was acting funny about going up and down stairs and seemed tense and a little uncomfortable so I put heat on his back and had the chiropractor come see all of them. He said that his back really wasn't irritated and we decided that maybe he just needed a little extra attention. It worked and he was fine so could be psychological.

[dutchman]

Tanner was so miserable when I got home again I decided to call the vet's office. We have an appoitment for 7:00 it's 5:40 ere in Colorado now. I think we are going to try accupuncture but Dr. Suto will have the final say on that. Since he is the most familar with Tanner's case and will be gone next week I also want to touch base with him.

When I get home from work Tanner once again had his adominals so contracted that it looked like he has been starved. I gave him another one of the new pills and held him for a while till he finally started to relax. Either the stress or the contracted adominals have him panting very hard when he is like that. You could also tell looking into his eyes that he was really hurting. He also wanted to be held cose with his face close t mine.

It's that being helpless when you know they are hurning and not really knowing what is going on that just eatsaway at you. I home the muscle relaxer is doing it's job when we get to the vet so he can get the accupncture without feeling too stresed. He is napping near my feet right now.

Tom

[Mark]

We're very saddened by your latest report. :(

Please continue to keep us posted. And here's an extra huge dose of Dachsie Healing RAYZ for your little boy :rayz: :rayz: :rayz: :rayz: :rayz: :rayz: :rayz: :rayz: :rayz:

[Meemoo]

feeling well. :crying: Accupuncture will help, it doesn't hurt at all and he will relax during the treatment. It is about 45 minutes or so they leave the needles in place. Frequently chief lies down during the session. When he gets home he is definitely more relaxed. If you do a search on google, dogs and accupuncture you will come up with many sites. There are some just about dachshunds as well. Give me till tomorrow, and I will post the links. I'd also give the Vitamin C, I posted a few weeks ago I believe, in this forum, an article on vitamin C and dachshunds back. Try to search for it. Again, I can find it and re-post if you like. I think *all* dachshunds should be on a maintenance dose of C along with a gluc/chon supplement and salmon oil -a natural anti-inflammatory.

If you are going to a holistic vet, I'm sure he can or will recommend chinese herbs. There are many of them for disc disease. They are helpful. I personally try to stay away from steroids unless they are really needed as their are side effects and after effects on the system. I will use them of course if necessary, but only after I have exhausted other treatment options.

Please keep us informed of Tanner's condition. Let me know if I can help you with some info.

Rayz from NYC

[TessieMom]

I am so sorry that he is doing worse. We are sending gigatons of those giant Texas healing rays and prayers as you are at the doctor's office with him now. Give him some love from my crew!

Rena and the Waco crew

[minicooper]

I'm sorry to hear that Tanner is still not well.

I hope, if they do the acupuncture, that you see some improvement.

We will send rayz from Oz

:rayz: :rayz: :rayz: :rayz: :rayz: :rayz:

Please keep us posted.

[Heide]

I am sorry to hear that Tanner is still not doing well.
I am sending more mega rayz for Tanner and you....:rayz: :rayz: :rayz: :rayz:
I hope that soon he will be feeling better.
We are here for you.
Please keep us posted.

[Heide]

Please post what the supplements all are that we should have our doxies on to help prevent back problems.
I would like to get all 3 of mine on that.
Thanks

[dutchman]

Hello all,

I wanted to get both the boys and myself fed after getting back from the vet before getting back online. Tanner did have his first ever accupuncture treatment. It must have taken somewhere between 20 and 30 minutes I didn't notice the exact time we got started. The majority of the needles were placed on either side of the spine along the lower back where the tension is. He also got a couple of neeles near teh shoulder blades, one in the top of his head and one very low in the hip but area. Most of the needles went in easy but one in particular took a few minues for the doctor to work in. Just before the theraphy itself got started tanner kind of climbed up against be burying his head between my arm and body. That actually ended up being an OK position to start the tretment. he ended up sitting patiently for most of the treatment. At one point he almost relaxed enough to go all the way down. I'm glad I had gien him the musle relaant at 5:00 otherwhise I fear he might have been too tense to get the needle in easily. It's hard to tell how much any good it did but time will tell. The good news was it only cost the price of a reegular offie visit $37.00. I expected it to cost more between the number of needlesthey used and the amount of vet time involved.

Right now Tanner is resting in the chair next to me. We will have to see what omorrow brings. I'm suppose to call the doctor with an update Friday so he can decide if he should see Tanner again before taking off for a week or if he doesn't see tanner he can update the notes in his file so who ever would be available to see Tanner next week will have all the current information.

We are taking things a day at a time. While the pain is no fun for Taner all we have to do is read of some of the problems others on the board are experiencing to consider ourselves lucky. Taner is eating af getting buy. At least this appears to be muscle rather than neurolgical in nature.

Tom and teh boys (Frank, Tanner and Dexter)

[TessieMom]

Sounds like it went well. Just have to get that boy a jaccuzi! I hope that he is feeling much better in the morning! It is not fair having all that tenseness!

Rena and the Waco crew

[Meemoo]

is your boy this morning? Anxiously awaiting good news.

[dutchman]

Tanner is rather tight again this mroning. He has a little extr reason to be tense look for mer detail in either the training or general healt forums latter today. Off to the vet with Dexter in a few minutes back latter.

Tom

[dutchman]

Tanner started getting tight in the back again this morning shortly after getting up for the day. Taking care of Dexter, see the thread in general health forum this morning I didn't have a lot of time to give Tanner. Last night when we got home from his accupuncture and had dinner and evening meds Tanner got the most relaxed I've seem him since this whole back tightness thing started. When Frank attacked Dexter Tanner came to full attention strutting and worrying jsut like any good little alpha member would. He helped me locate all of Dexter's injuries. I'm not sure if the extra activity was god or bad for him. I think he did feel a little streesed over the whole thing. He sometimes will spot thing between Frank and exter that I don't see and tell them to get apart but last night before the fight he was under the covers napping.

We will go today and tomorrow morning and see how things are going with Tanner then call Dr. Suto in the morning so he can decide if I should bring him in again tomorrow and also to make sure all the proper notes are made in his file in case one of the other vets needs to take a look at him next week while Dr. Suto is out.

Thanks again for all your rays and thoughts. Jsut being able to talk to people who understand is a big help.

Tom and the boys (Frank, Tanner and Dexter)

[crock]

Tom,
You know we are all here for you.
Char

[dutchman]

Hello all,

Tanner 's back actually started to appear to be relaxing more at noon yesterday. When I got home after work he appeard good enough and the abdominals while still not normal were a lot less tense. When I got home from work he took the treat I had given him at noon outside with him and did the dachsie streach while he ate it. The one whrer they put their legs out behind them but still stay on their toes. I figured if he can get into that position and stay there while eating the treat he must be feeling a little better. With the improvement I wnet ahead and ran with my club's Thursday eveing running group and then took the tight off from the computer.

This morning even his abdomainals are approaching normal. I've stopped giving him the muscle relaxant as of this mroning and I'll have to see what happens. No way to tell if it was the accupuncture , the drugs kicking in or what at this point but we don't care so long as he is feeling better and stays that way. I'll be calling the vet with an update soon so that his charts will be updated in case we have to see one of the other doctors next week. We will be cautious this weekend and keeping an eye on him. I'll as Dr. Suto this morning if I should consider cutting hi off the rimadyl after Sunday or if I should go ahead and ust the full 10 days supply we were given.

Perhaps Tanner being on the mend will help settle things between Trank and exter as Well. I know Frank has a lot of extra energy since he hasn't been able to play with Tanner. I will continue to try and restrict their play for at least a week after Tanner appears to be feeling better.

As you could tell from my post the episode with Frank and Dexter was the capper on what had already been a stress full week for me. Thank you all for your support.

Wish us luck,

Tom and the boys (Frank, Tanner and Dexter)

[doxunzX3]

Great News! So glad he is feeling better and hope he is feeling good as new soon!
One question, doesn't your vet recomend crate rest for a couple of weeks? Just wondering, because anytime my doxies have had a strain, or whatever with their back that is the first thing the vet suggests. I know that Tanner has had problems before and this might not apply. Just wondering? If it might not help, the hardest part for me was not to let them sleep with me. Those long little doggies love to jump off the bed. Even though I have a ramp.

[dutchman]

Crate rest with the back sprian is a suggestion. Tanner realy hasn't had a deire to be active so it's hasn't been much of an issue this week. This weekned and next week it may become one. He has been content to eith lay with me or fight nest to my feet. He also has been very good about letting me lower him from the bed. When he is healthy he always wants to be a jumper not wanting my help to put him dwon from the bed. I've needed short times where he had freedom to try and see how he progressing.

If this was a neurological rather than a muscualr problem the crate rest would be strictly inforced.

Tom and the boys (Frank, Tanner and Dexter)

[Lauri Gengor]

Dutch..we are glad Tanner is so much better and it sounds like the same theropy i had to put Magic through when she pulled a muscle..in her case it seems to be chest muscles since she has a slighty game right leg from a slipped disc. We shut her off in thier room and made sure she rested. We did not let her sleep with us. I got many dirty looks and alot of pouting but within a 2 to three week peroid she was fine.

Give tanner a big hug for us and keep us posted!


The M&M trio

[joeysmom]

Haven't seen an update on your boys in a while. Hope Tanner and Dexter are continuing to heal. I'm sure Frank is concerned too, maybe he will learn from his dad's example and find constructive ways to channel his energy and anxiety. Rays to your whole pack from me and JOEY in Seattle.

[Patt]

Hope all is going well for Tanner and the gang. Please give us an update when you can.

Sending positive thoughts and rayz :rayz: :rayz: :rayz: your way.

Patt

[dutchman]

Tanner made it through the day yesterday w/o any of the muscle relanants. I kept him on the rimadyl and he got his half tablet this morning. I plan on cutting hat back tomorrow perhaps a half tablet if all continues well. His adbonials did feel a little tnnse yesterday at noon but I am beginning to think part of his problem is mental . He has always had some minor seperation anxiety issues and I think muscle tenseness is just a new way this is showing up:( Last night I found Tanner growling at Frank as he came down the hall. Tanner had spotted the new box of treats that were sitting right next to the living room bed he was resting on and he was guarding them as his own private stash. I moved the treats to a netual up off the floor location. It's good to see that he was feeling well enough to be cllaiming something as his own. Oh Frank seemed to be respecting that Tanner was back to the house alpha position.

Dexter is healing from his wounds. The wound that looked th nasties the first night (the chest wound that looked like a hole the size of the end of my thumb) has closed and is now just a red las the edges of the wound have come back together on thwir own. Yesterday the hip puncture wound finallly closed over. I'm still keeping the sites clean with the badyne(SP) iodine scrub and applying neosporing twice a day. The mental healing may take slightly longer. He did spend most of last night sitting with me and went back to the big bed rather than his kennel when he came back in this morning. Hi is still a little more prone to retreating to his kennel.

Thanks for asking,

Tom and the boys (Frank, Tanner and Dexter)

[TessieMom]

Sounds like both boys are on the mend! More rays for a complete recovery by Tanner and Dexter. Glad that Frank has decided that he can't be alpha for now.

Rena and the Waco crew

[minicooper]

I am so glad to hear that both boys are on the road to recovery! :bounce:

[dutchman]

Hello all,

I was expecting to find a tense Tanner when I got home tonight. I ended up working through lunch to get a few things done then had a user with a tight deadline system crash jsut as I was getting ready to leave. Tried a few quick recovery steps then punted and started the rebuild. Got the basic configuration and apps they needed for their current project loaded. I left home at 7:00 this morning and got home a little after 8:00.

Tanner seems just fine. All three boys were very ready to go out and then got dinner. Tanner seems just fine. So does Dexter. Frank as usual is picking at his dinner claiming that I feed him too much. He is the only one that ever makes that complaint. Tanner sometimes including today won't eat his breakfast till I get home. Tonight he basically had two meals in one and still seems hungry.

Tom and teh boys (Frank, Tanner and Dexter)

[Patt]

Thanks for the update Tom, happy to hear all is going
well at your home tonight. Keep up the TLC. :bounce: :circle: :bounce:

Patt

[Lauri Gengor]

Im so glad Tanner is doing better...keep up the good work and a ton of dachi hugs to you!!



TheM&M crew

[Meemoo]

Are you continuing with accupuncture? For it be effective..you need to go for several times initially...

[dutchman]

The vet at our clinic that does the accupuncture is out this week. I'll have to decide if it's something we will continue or not.

On a side note took a dis of ice cream with me to the bedrom last night. At one point as I was getting close to the end of the dish both Frank and Dexter were coming up close to me while I laid on the bed eating it. Tanner made one big leap over me never touching me in order to make sure he was a barrier between Frank and Dexter. It looks like the little alpha is back on duty trying to keep everyone safe. I hadn't seen any danger signes but Tanner thought he did. Generally Frank and Tanner get to lick out the dish when it's empty and Dexter gets to lick the spoon.

Tom and the boys (Frank, Tanner and Dexter)

[Meemoo]

is Tanner today?

[dutchman]

Tanner is pretty good no drugs since yesterday noon or morning I can't remember which. He did seem a little tense as I left for work both morning and noon. I hope to keep him off the drugs and see how he does this weekend when I can spend mor time home with him.

Have you ever used the remiadies called Calms or Rescu Remady? I think part of Tanners problem is mental seperation anxiety problem. Someone at work has used both of these with one of their dogs who has anxiety problems with things like high winds. They werent too sure about what kind of dosage might be approprate for Tanner 12-13 pounds.

Tom

[lotsadox]

I use Rescue Remedy quite often or have in the past when I had dogs with anxiety problems. It worked quite well for me. It comes in a small bottle with a glass dropper. I just gave one dropper and then repeated as often as needed. My vet said it would hurt them to give it every hour if necessary, like 4th of July for my girl that was scared of fireworks.

[Heide]

glad to hear that Tanner is doing better.
Continueing to send rayz from us:rayz: :rayz: :rayz:

I wonder if I could give that to Maggie when she is freaked out by the storms here?

[Meemoo]

are bach flowers and they help with anxiety. You can get it at a GNC. It's a liquid tincture. Can't hurt at all..worth a shot.

Here's a link to the site for more information:

http://www.bachcentre.com/centre/38/rescue.htm