National ProZinc Shortage - Is the PZI Generic Okay for your Diabetic Cat??

Trouble in Diabetesville
Shortage of ProZinc causes a scramble for feline insulin. 

Update - As of September 12th, ProZinc is available again in limited supplies. 

I own a busy cat practice, and we have a lot of diabetic cats in the practice.  Most diabetic cats require insulin injections to achieve good control of their diabetes.  Years ago, most veterinarians administered a type of insulin called protamine zinc insulin (PZI).  This insulin was derived mainly from cattle.  It was 90% beef, 10% pork in origin.  Cats respond well to bovine insulin, because the molecular structure of feline insulin most closely resembles bovine insulin; they differ by only one amino acid.  When recombinant human insulin became available, the demand for PZI insulin in humans disappeared, and it was not feasible for companies to continue to produce PZI insulin solely for use in domestic animals.  Veterinarians began using recombinant human insulin to treat diabetic cats.

Currently, there are several types of insulin products available for cats with diabetes.  Every practitioner has their own personal favorite.  Some people use insulin glargine (brand  name Lantus), while others prefer  a type called protamine  zinc insulin.  When Lantus became available, there were high hopes that this relatively long-acting insulin could be given only once daily.  Alas, this turned  out to not be the case.  Cats on Lantus still require twice daily insulin.

                The  insulin  I’ve been prescribing  in the last few years is a type called ProZinc.  I like it because  it’s the only insulin approved by the FDA specifically for use in cats.  It is recombinant human insulin; as noted above, they don’t make insulin of animal origin anymore.   If a client comes to my practice  with a cat that has previously been diagnosed as diabetic and is already receiving Lantus insulin, I won’t switch them to ProZinc. Lantus is fine.  But for newly diagnosed diabetic cats, ProZinc is what I’ve been prescribing.  Their diabetes  usually comes under control fairly quickly, with most cats requiring somewhere  between 1 and 4 units twice daily.  

                Lately, it’s been difficult managing all of the diabetic  cats  in my practice, because  there is a nationwide shortage of ProZinc insulin.  This is due to a shortage of the ingredient protamine, a protein that slows down the absorption of the insulin, increasing its duration of action.

                Initially, when I ran  out of ProZinc, I called some referral centers and they were kind  enough to either sell me a few bottles, or to let my clients go there with a prescription and pick up a bottle.  Then I called some veterinary pharmacies.  They had a few bottles, but of course, they were affected by the shortage as well.  A few tried to gouge me, asking an outrageous  price for a bottle.   I’ve made note of those pharmacies and have vowed never to deal with them again. 

                Now, it seems there’s not a bottle of  ProZinc to be had anywhere.  I’ve spoken with some veterinary pharmacies that have the ability to compound their own generic protamine zinc insulin (PZI).  They tell me that it’s the same potency as ProZinc, so it’s not necessary to re-regulate the diabetes.  Cats receiving  3 units of ProZinc twice daily should receive 3 units of generic PZI twice daily.  

                I’m always  leery of these claims, because you never know if the generic is as good as the brand, and small differences in potency  can have significant consequences.  To re-regulate  all of the diabetics in my practice would be a nightmare.  I’ve spoken to the pharmacist at the pharmacy that is offering the generic PZI, and he told me he’s sold many bottles during the shortage, and has not had any vet inform him of any problems.  So I’m going to trust the generic PZI for now.  The good news is that ProZinc should be back on the market in mid-September, according to our distributor.  Until then, fingers crossed that no problems arise with the generic.
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No Holding Back: Top Nine Things that Cat Owners May Not Want to Hear from their Cat Veterinarian

As a cat veterinarian for over 20 years, I’ve noticed a few common themes to some of the questions and comments I get in the examination room.  Cat owners are amazing people.  They love their babies.  They want to protect their babies.  They want to know what the heck is up with their babies?!  It is an ongoing struggle trying to understand and communicate with feline creatures.  I decided to collect some common questions/comments and address them all in a blog post that I think my veterinary colleagues might relate to as much as my readers can.  I hope you can appreciate my tongue-in-cheek tone to some of these issues.  (Vets and Techs, did I miss any?  Let us know in comments.)

No Holding Back: Top Nine Things that Cat Owners May Not Want to Hear from their Cat Veterinarian

1. They don’t teach us mindreading in vet school
Your cat always sleeps on the couch.  Today you found her sleeping on the chair.  This is highly unusual behavior.  I mean, she ALWAYS sleeps on the couch, on that blanket that you put there specifically for her.  I understand this. No, really, I understand.   On physical health examination, though, she checks out fine.  Totally healthy. Why did she suddenly start sleeping on the chair?  I don’t know.  I just don’t know. No veterinarian will know.

2. Spite is a human emotion, not a feline one.

She didn’t pee on your bed to spite you.  It’s either a medical problem, marking behavior, or inappropriate elimination.  Bring her in, and we’ll rule out a medical cause.  Then I’ll ask you a bunch of questions to figure out whether it’s marking, or whether it’s inappropriate elimination.  Then I’ll give you some tried-and-true suggestions as to how to fix the problem.  That’s kinda what I do.

Russian Blue

3. Your cat is not a Russian Blue... She’s an American Gray. 

Yes, I know, she looks just like a Russian Blue in the breed book.  I know.   Still… you found her near the dumpster in your apartment complex.  Expensive purebred Russian Blues don’t just appear near a dumpster as kittens that need to be rescued.

(2b: No, your cat is not a Maine Coon.  It’s a domestic longhair. Sorry.)

4. Your cat was not abused as a kitten.  

I know she runs under the bed every time you take out the Dirt Devil.  This does not mean she was beaten with a Dirt Devil as a kitten.  It means the Dirt Devil is 4 times her size and makes a terrifyingly loud noise when you turn it on.

5. It’s not a hairball

Yes, cats get hairballs now and then.  But your cat has been vomiting five times a day for the past two weeks.  The first vomit had a little hair in it. The last 23 vomits did not.  Your now-dehydrated, debilitated, underweight cat does not have hairballs.  Don’t wait until vomit number 23 to bring him in.

P.S.  Cats don’t “cough up” a hairball.  Hairballs live in the stomach. Cats vomit up hairballs.  Coughing means there’s a lung problem.  Your cat is coughing? It’s NOT hairballs. Bring him in.

6. It’s not worms

Your 13 year old cat is eating voraciously and is losing weight.   You’re thinking it must be worms.  Your cat lives totally indoors; where would it get worms?   Now you’re thinking of going to PetCo to purchase an over-the-counter dewormer.  Um, don’t.  Your cat has hyperthyroidism.  Bring it in, for heaven’s sake, before he goes into heart failure.

7. Your breeder may or may not know what s/he is talking about. 
Sorry, but four years undergrad and four intensive years of vet school means that a veterinarian knows more about feline health than your breeder. I’m sure your breeder is a wonderful person.  However, unless there’s a D.V.M. after his/her name, you really should listen to the veterinarian, not the breeder.

8. Yes, your cat still needs vaccines even if your cat is totally indoors.

I address this one at least once a day, every day.  Here’s a whole blog post explaining why: Why We Vaccinate (Even Indoor Cats)

9. Just because your cat seems fine doesn’t mean you can skip bringing him to the vet for years.

You seem shocked when I point out that your cat is missing half of his teeth.  I ask if they were extracted during a previous dental procedure.  Oh, he’s never had a dental procedure?  Well, I guess the teeth rotted out of his head.  You say that he never showed any sign that his teeth were bothering him?  Hey, remember five months ago, when he got all finicky and stopped eating dry food, and demanded only wet food?  That wasn’t finicky.  It hurts to crunch dry food when your teeth are rotting out of your head.  How were you supposed to know?  You’re not. It’s my job to tell you.  But I can’t, unless you bring him in. Every six months, for life.

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Exceeding Expectations

As a veterinary practice owner, I’m constantly trying to find that happy balance between being a veterinarian, and being a businessman.  If I had my druthers, I would love to just practice veterinary medicine and devote myself 100% to the cats, and not have to worry about hiring and firing and inventory and revenue and  marketing.  But I’m also a control freak and I like to be in charge of my own life, and the only way you can really do this is to be your own boss.

Whenever I read business magazines, they’re always talking about “exceeding your customers expectations” as the key to a successful business.  It’s a phrase that’s been overused to the point where it’s become a groan-inducing cliché.  I always felt that this phrase didn’t apply to veterinary medicine the way it applies to other businesses, like a bank or a restaurant or the air conditioner repair guy.  With veterinary medicine, the expectations are already set very high: you’re expected to be able to diagnose what is wrong with the patient, and then prescribe the appropriate treatment so that the cat hopefully gets better.  Clients don’t come in thinking you’ll have no clue what might be wrong with their cat, and then are pleasantly surprised that you figured it out.  It doesn’t work that way in veterinary medicine.  Usually, the exceeding of the expectations occurs at the front desk, where the receptionist goes out of their way to fit you into a busy schedule, or in the treatment room, where the technician agrees to cut all 50 tablets into quarters to make it easier for the client.  When it comes to the medical part, the expectation, especially at a feline specialty practice, is that you’re the experts.  If you can’t figure it out, then no one can.  It’s a heavy responsibility, but it’s what vets (the motivated ones, anyway) thrive on.

Last week, however, we had two instances where expectations were exceeded, but this time, the expectations happened to be mine, and the exceeders were some members of my staff.  Perhaps it’s cheesy to toot our own horn, but what happened last week was cool, and it’s my blog, so I’m sharing.

The first incident had to do with a four year-old cat named Fig.  This cat came in for a little lethargy and some weight loss.  The weight loss was minor; less than a pound.  My doctor, Victoria Sheheri, did a very thorough examination on the cat, and thought she felt something odd in the abdomen, perhaps a small nodule or mass somewhere.  It was very subtle.  The odds of a cat this young having something worrisome like a tumor is pretty slim, especially with pretty mild, ambiguous signs like lethargy and a tiny bit of weight loss.  This little nodule could easily have been a little piece of poop that she was feeling. But something didn’t feel right to her, and she suggested that Fig undergo an abdominal ultrasound just to make sure it was nothing significant.  Fig’s owner agreed to the procedure.   A few days later, an ultrasound was performed by Dr. Patrick Hopper, an internist who travels from hospital to hospital, performing ultrasound (and/or endoscopy) for clinics in the area.  He, too, performed a very thorough ultrasound, and he located a nodule in the pancreas.  It was about the size of a chick pea.  “Good call”, he said, referring to Dr. Sheheri’s ability to feel this little thing.

In order to figure out what this nodule was, you would typically have to perform surgery to biopsy or remove the nodule, an invasive and expensive procedure.  But I thought the nodule looked pretty discreet and well-circumscribed, and I asked Dr. Hopper if he could insert a needle in there and get a sample for cytology.  He seemed skeptical, but I’ve seen him do this many times before, and I kinda pushed a little for him to try.  He managed, with ultrasound guidance, to place a needle right in the center of this tiny nodule, and then aspirated some material from the nodule into the hub of the needle, and then onto a microscope slide.  He did this three (!) times, and we got six good slides.  We woke Fig up and sent him home a few hours later.  The next day, the cytology report revealed the nodule to be a pancreatic carcinoma.

We reported the results to the owner, who naturally was distraught at the news.  We recommended that she consult with a surgeon to see if this could be removed. She met with Dr. Andrew Kyles, an excellent board-certified surgeon at Blue Pearl Veterinary Partners, and Fig is now scheduled for surgery later this week.
I don’t know if Fig’s owner ever stopped to think about whether we “exceeded her expectations” or not.  Her cat wasn’t quite right, and we figured out why.  This was her expectation, and we met it.  However, MY expectations were GREATLY exceeded. As a practice owner, I would not expect one of my doctors to ever detect such a small nodule during a physical exam.  The nodule was in the body of the pancreas.  It could easily be missed, or felt and dismissed as probably being a little piece of stool.  After all, who would expect a four year old cat to have a pancreatic tumor?  I’m impressed with, and proud of, my doctor.  As an internist, I know how difficult it is to clearly identify a small nodule in the pancreas, and then be able to zero in on it and non-invasively obtain a good-quality sample of it, for analysis.  Again, my expectations were exceeded by the people I hire.   Dr. Kyles, the surgeon scheduled to tackle this mass on Thursday, said the same.  “You guys did a very good work-up”, he said.  High praise from a guy who works for a center whose job is to work-up cases that other vets can’t totally get a grip on.

The second incident occurred last Saturday.  We had a cat boarding with us named Cosmo.  He is an elderly cat – three  months shy of his 18th birthday – and he’s been  coming to our hospital for years.  He has a number of illness – inflammatory bowel disease, chronic  renal failure, and occasional unexplained  seizures, previous bout of pancreatitis  – and he’s been negotiating them very impressively.

Cosmo was boarding at our hospital while his owners were out of town.  Cosmo receives several medications daily, and that’s a big reason why many of our clients board their cats with us rather  than have a cat sitter come into their home to care for the cat.  They don’t want to burden the sitter with having to give so many medications.

When Cosmo boards, he gives the technicians a little sass.  He figures he’s been around for almost 18 years; he’s earned  the right to be grumpy.   So he gives a little attitude when you change his litter box.  He gives some ‘tude when you try to give him his meds.   On Saturday,  I  normally have a slew of appointments back to back, straight  through to 1:30.  Surprisingly, my appointments came to an abrupt end at 12:30.  But my technician, Rita, filled in my 12:30 appointment slot with Cosmo.  I asked what was going on.  She told me that this morning, he didn’t give her much grief about being fed and medicated.  She just let her do whatever needed to be done.  She also thought he was maybe breathing a little funny.

I put Cosmo on the scale.  He had lost 3 ounces; nothing significant.  I checked out his breathing.  Rita noticed that his nostrils were flaring a little when he breathed.  I could see his respiratory rate was a little more rapid than normal.  I listened to his heart and lungs, and they sounded fine.  I looked at his eyes.  Uh oh… the whites of his eyes looked yellow.  Jaundice.  His gums were yellow as well.  I felt his abdomen, and his liver felt a little enlarged.

Sometimes when a cat is anemic, they will be jaundiced and they will breathe a little rapidly, due to low levels of oxygen in the blood from the anemia.  So I checked his red cell count. It was normal.  I took an x-ray of his lungs.  The lungs looked fine.  I realized that his rapid breathing was probably due to pain.  The presence of jaundice, a history of a previous bout of pancreatitis, and a breathing pattern suggestive of pain, I suspected Cosmo was having an acute flare-up of his pancreatitis.  I contacted the owners and explained what was going on.  They were due back in town the following day, but they agreed to let us do whatever we felt was necessary to get him through this.  I started him on intravenous fluids and pain medications.  Right at that time, Dr. Sheheri arrived at the hospital.  I work on Saturday from 10 to 2; she works from 2 to 6.  I explained what was going on with Cosmo. She was going to keep a close eye on him throughout the day.

Around 6:00 p.m., Dr. Sheheri called and let me know that Cosmo hadn’t really improved; he actually looked a little worse, and she was concerned about leaving him unattended for the night.  She felt that he needed closer monitoring.  I agreed, and was going to come to the hospital and arrange for his transport to Blue Pearl.  Before I could even offer, Dr. Sheheri said that she could load him up in his carrier and take him there by cab, after getting the green light from the client.   Cosmo arrived at Blue Pearl about 30 minutes later.  They have a highly skilled team of intensive-care doctors, and they looked after him that weekend, until his owner could arrive back in town.

As the practice owner, I was pleased at the way everything was handled logistically.  A boarder became sick while boarding, appropriate treatment and diagnostics were performed, and proper round-the-clock care was arranged for when it was  clear that the patient wasn’t doing  as well as expected.   The part that exceeded my expectations was my technician Rita noticing that something was off with Cosmo.  Saturdays are busy, and she is the only technician on duty that day.  The boarding ward was full, and she had to make sure all the cats were fed and medicated, their bedding changed, and their litter boxes clean, before appointment begin.  A grumpy cat in the boarding ward can slow things down and make the day more difficult.  It would have been easy to say, “wow, Cosmo is being behaved this morning”, and  just clean cage, feed him, and then move on to the next boarder, without thinking about it.  But Rita is not like that.  Rita gets to know every cat who is boarding.  My office is down the hall from the boarding ward.  On weekdays, when I’m in my office and Rita is taking care of the boarders, I can hear her having long detailed conversations with each cat in the ward.  She talks to them. She notices what they like and what they dislike.  She knows it’s stressful for the cats to be away from their family, so she tries to make them as welcome and comfortable as possible.  So rather than just dismiss Cosmo’s lack of “attitude” as just being non-grumpy that day, she KNEW that this was abnormal for him.  And she did something about it.   If a grumpy cat isn’t acting grumpy when you’re trying to clean his cage, that makes  your life easier, and I think most people would just be thankful for this making the day easier, and then go on to the next cage.  But to notice, and to care, and to add him to the appointment schedule was very proactive, and I think this is a pretty clear case of “exceeding their expectations”.

My staff and I spend our time always trying to exceed our clients’ expectations.  Most of the time, I’m sure we do.  Every now and then, perhaps we don’t.  But my staff always exceeds MY expectations, and these are merely two examples.   It makes coming to work an adventure every day.

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My Travels in China: Shanghai Day 4


Dr. Arnold Plotnick of Manhattan Cat Specialists, loves to travel and loves cats.  So off he went... East... way way East... to China.  Over the course of the next few weeks, we will share the cultural and kitty cat highlights of Dr. Plotnick's trip.

(Continued from Day 3, pt 2)

Our last full day in Shanghai begins in Pudong, the neighborhood across the Huangpu River, where all the fancy skyscrapers are.  We decided that we weren’t going to spend lots of money going to the observation decks of all these gargantuan skyscrapers.  I live in NYC; I’d been to the World Trade Center observation deck a few times in the past, and the Empire State Building, and I’ve been in the CN tower in Toronto.

They all start to feel the same after a while.  But I certainly do like staring up at them from below.  The three biggies are the Oriental Pearl Tower, a huge space-age monstrosity.

There’s also the Shanghai World Financial Center, which  looks like a giant bottle-opener.  It has the world’s highest observation deck, on the 100th floor.

You can see, right next to it, a nicer-looking (in my opinion) building, the Jin Mao Tower.  Apparently, the Cloud Nine Bar on the 87thfloor is a very cool place to have a drink and enjoy the view, but it was 9:00 a.m.; perhaps a little early to have a drink.  (Or perhaps not).

Across the street from these impressive buildings was a lovely little park, where you can look up in the  sky all around you and feel really, well, puny.

Everyone around me was staring up at the buildings. In fact, some of the people were staring for hours, not moving.

I tried talking to a family visiting Shanghai, but they seemed kinda stiff.

After the skyscrapers, I suggested we go back to the French Concession, by way of  Jing’An Park.

The other day, we went to the Jing’An temple across the street from the park, but  didn’t spend much time in the park itself, and the park is really supposed to be lovely, and  you can see, it certainly is.

It’s another one of those parks where the locals like to just relax and be locals, like these two guys playing checkers.

We moseyed through Jing’An  Park, and then hit the French Concession, once again enjoying the shops and stores

and architecture.

As we continued walking, I saw a sign for a place called the K Wah Center, and I remembered that Mark had printed out, from the internet, a listing for a wildly popular restaurant called Spicy Joint, and I recalled the address being the K Wah Center.  After a little searching, I found it.  It was worth it; the food was cheap, and delicious. Even though I’m not a big fan  of spicy duck head

and mustard beef throat.

After lunch, as we left the French Concession, I encountered a very sweet tomcat at a fruit shop.

Alas, this was to be the last cat of the trip.

Our last park of the trip was Fuxing Park. It’s a beautiful park, designed in the French style, with a center lake, fountains, covered pavilions, and flower beds.

Early morning, the park fills with dancers,

card players,

mahjong enthusiasts, and tai chi practitioners.  There’s also a very cool, tall granite statue of Marx and Engels

We casually wandered back to the  hotel, by way of the big pedestrian shopping street, East Nanjing Road.

We did some last minute shopping, bringing back boxes of snacks and a few final souvenirs from our trip.

For our last dinner, we hit Xintiandi again, the beautiful plaza filled with lovely upscale restaurants and bars.

Tired of Chinese food by now, we opted for Fountain, an American-style restaurant.

All I wanted at this point was a sandwich and fries.  Ahhh…comfort food at last.

And thus ends my fabulous trip to China.  Thank you to everyone who was kind enough to read my blog.  I wish I could have shown you as many photos of  cats as I did on my Istanbul trip, but alas, China wasn’t teeming with cats the way Istanbul (and Greece, which I visited two years before that) was.  Not sure where my next adventure will be, but you can bet I’ll have my camera handy, eager to snap pics of kitties who cross my path.

THE END (until the next trip, perhaps Scandinavia?)

Previous Posts
Beijing - Day 1Day 2 Part 1Day 2 Part 2Day 3Day 4 Part 1Day 4 Part 2Day 5Day 6
Shanghai - Day 1 part 1Day 1 part 2Day 2Day 3 part 1, day 3 part 2, day 4

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My Travels in China: Shanghai Day 3 (part 2)

My Travels in China: Shanghai Day 3 (part 2)

Dr. Arnold Plotnick of Manhattan Cat Specialists, loves to travel and loves cats.  So off he went... East... way way East... to China.  Over the course of the next few weeks, we will share the cultural and kitty cat highlights of Dr. Plotnick's trip.

(Continued from Day 3, pt 1)

The Yu Yuan Bazaar is the city's largest Flea Market

Its narrow lanes are dotted with over 100 shops 
as well as teahouses, wine houses, snack bars, restaurants, a lotus pond

a zigzag bridge,

as well as China’s oldest teahouse.  The Yu Yuan bazaar and garden is the most popular tourist attraction in Shanghai and is always very crowded.

The Yuyuan Garden, adjacent to the bazaar, is exceptionally beautiful. The garden was finished in 1577 by a government officer of the Ming Dynasty (1368-1644) named Pan Yunduan. Yu in Chinese means pleasing and satisfying, and this garden was specially built for Pan's parents as a place for them to enjoy a tranquil and happy time in their old age.

In the 400 years of its existence, Yuyuan Garden had undergone many changes.. During the late Ming Dynasty, it became very dilapidated with the decline of Pan's family. In 1760, some rich merchants bought Yuyuan Garden and spent more than 20 years reconstructing the buildings. During the Opium War of the 19th century, Yuyuan Garden was severely damaged. The Yuyuan Garden you see today is the result of a five year restoration project which began in 1956. The garden was open to the public in September, 1961. You can see how lovely the gardens are

There are lots of bridges, pavilions, and ponds.  Mark tossed a few pieces of bread into the koi pond, and started a koi stampede!

So far, it hadn’t been a very feline filled day. I did see this cat sleeping in the doorway of a shop nearby the bazaar, 
and I managed to get a nice close-up of her sleeping.

However, as we left the bazaar and gardens, and headed back to our hotel, I hit paydirt!  I came across the cutest cat of the whole trip, an adorable calico kitten outside a shop, resting on a cardboard box

Look how cute she is!  She let me pick her up

and snuggle with her a little

I put her back down, and gave her one more pat to say goodbye, but she got frisky and wanted to play

She was the most adorable thing.  I wish I could have taken her back with me.
After freshening up at the hotel, we strolled the Bund walkway, going south this time, to another “lifestyle hub”, as they call them in Shanghai.  This one is called Cool Docks.  It’s similar to Xintiandi, but not as fully developed yet.  It’s basically a contemporary shopping/dining complex with a central plaza and fountain.

Its first wave of venues included a Starbucks, a Greek terrace restaurant called Mythos, several independent cafés, a gay club and a tattoo parlour. While some (including the aforementioned Stillers and Kebabs on the Grille) continue to do well, others have closed down or relocated, so it’s still in a state of flux.  But it was a fun place to visit, as you can see. 

We moseyed back north on the Bund walkway,

and enjoyed the skyscrapers across the Huangpu at dusk.
We spotted the Bund Bull,

and of course, I had to pose for a crude photo.

Hey, I’m a vet. I’m posing with a statue of an animal.  Cut me a break.

We then went to Lost Heaven for dinner.  It’s the same restaurant we went to on our first night in Shanghai.  I know it seems crazy to go to the same restaurant  twice when you’re visiting a foreign city, but the food and the atmosphere was so wonderful, and there were  so many  other things on the menu we wanted to try, we figured what the heck.  And once again, it was great.
We went back to the hotel for a little disco nap, but we slept a little longer than we had anticipated, and woke up at midnight.  Since it was our next-to-last evening in Shanghai, we still wanted to go out with a bang, so we got dressed quickly and headed to MJ Club, for their “Heaven” dance party.

The place was hopping.
We danced and drank until about 2:30 before calling it a night. 
Tomorrow is our last full day.  Hopefully I’ll see a few more cats before I leave.

CHECK BACK SOON, Dr. Plotnick's China Travelog continues.

Previous Posts
Beijing - Day 1, Day 2 Part 1, Day 2 Part 2, Day 3, Day 4 Part 1Day 4 Part 2, Day 5, Day 6
Shanghai - Day 1 part 1, Day 1 part 2, Day 2, Day 3 part 1

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