Another serious issue regarding scam rescue animals is health concerns, especially if animals come from distant sources. Veterinarian Dr. John Kable has encountered numerous rescue dogs whose owners have paid $400 for shipping before finding that many of the dogs were not spayed/neutered, or received appropriate or any core vaccinations. Heartworm disease is very common, according to Kable. He also shared reports that animals from Michigan have been diagnosed with lead toxicity and other heavy metal toxicities from the Flint, Michigan, water quality crisis. Fungal, tick and other vector-carried diseases common in other regions of the country are challenging to diagnose rapidly. In addition, regional parasitic diseases can also be carried in by out-of-area rescue animals. Kable adds that dogs that travel and come into contact with other dogs are sources for the two types of canine influenza and other respiratory diseases.