August 12, 2022 – Drs. Kelly Diehl and Felix Duerr discuss the ins and outs of osteoarthritis in dogs and cats. Dr. Duerr shares his experiences treating this very common disease of older pets and discusses the latest information on treatment of osteoarthritis in pets, including his cutting-edge research projects.
Resources:
https://www.youtube.com/watch?v=d-UwRLoS30E&list=PLrCRNwka1UgRgs8z7vKQarpPWmRZE7m3q&index=3
0:00:10.3 Dr. Kelly Diehl: Welcome to Fresh Scoop Episode 47. New thoughts on osteoarthritis in dogs and cats. I'm your host, Dr. Kelly Diehl, Morris Animal Foundation, Senior Director of Science and Communication. And today, we have the pleasure of speaking with Dr. Felix Duerr. Dr. Duerr is Associate Professor of Small Animal Orthopedics at Colorado State University. So welcome, Felix.
0:00:34.3 Dr. Felix Duerr: Yeah. Thank you very much, Kelly, it's a pleasure being here.
0:00:37.2 DD: Before we get started, I always ask everybody this, can you tell us a bit about yourself and what first led you to become a veterinarian? And then what led you to specialize in surgery?
0:00:50.7 DD: Oh yeah, that's super easy to answer there, because my dad is a veterinarian. And I remember that there was one night when a crocodile swallowed a screwdriver, and my dad's like, "You guys should all come." And then he put some two by fours in the crocodile's mouth and jumped in there and pulled out the screwdriver. And that's why I became a veterinarian, and that actually is a true story.
[laughter]
0:01:15.6 DD: I didn't think you had a lot of crocodiles because you were in Germany, or were you someplace else?
0:01:18.9 DD: It was from a circus. That's true. It's a few years ago, yes. [laughter]
0:01:23.5 DD: Wow, wow, that's pretty... I don't think I have ever heard a story, an origin story for us veterinarians that was quite so dramatic. So, you take the prize for that. Most of them are like, well, I always wanted to be a vet from when I was a little kid, but never did it involve a reptile [laughter] and a screwdriver.
[laughter]
0:01:43.7 DD: Yeah I know. On a more serious note, I think that I was always intrigued by... I do love horses, so we do have horses for fun. I always was intrigued by surgery, by fixing these fractures, and that was something that I was very, very motivated by. And yeah, I guess it is kind of interesting that now I actually don't do any surgery anymore. So, but two and a half years ago, we changed the program at Colorado State University into a surgical program and an orthopedic medicine program. And that actually results from all the challenges we have faced with treating dogs with arthritis. So, while I still love fixing things and I do miss the fractures and having that immediate gratification, I think arthritis also poses a really substantial challenge to us. And that's, I guess, what I'm intrigued by right now.
0:02:42.8 DD: Oh, great. And that's a great lead into obviously our talk today, which is about osteoarthritis. And I have a favor to ask you, can you do... Talk to us about the definitions, because I think sometimes we use the term arthritis when we mean osteoarthritis. But there are different kinds of arthritis. Can you help sort through those, as far as terminology?
0:03:06.0 DD: Yeah, of course. So, I guess arthritis in general, I mean most people, when they hear arthritis or osteoarthritis, they think of a cartilage problem and that's true. The cartilage is definitely a big problem, but it's not just a problem of the cartilage. So, arthritis also affects the surrounding tissues like the joint capsule, the ligaments, the muscle, and the underlying bone, which, all of these play a big role in the pathophysiology and the pain that happens with it. As far as what type of arthritis, so to me, the easiest way to explain that is that we have some that we call primary arthritis and secondary arthritis, and primary arthritis really is what in people we consider wear and tear. So, you know everybody that has done marathons or even when you just have regular activity in people, that is the most common form of arthritis. And then there's other types of arthritis like rheumatoid arthritis, where there's an underlying problem. In dogs, the most common things that we see is that there is some developmental problem. So, people always know about hip dysplasia, and most people know about elbow dysplasia as well, and that's how we think about it in dogs.
0:04:33.4 DD: So, in dogs we don't see a lot of primary osteoarthritis, the majority of what we see, at least what we think we see, is secondary osteoarthritis. So, when we see a dog that has hip osteoarthritis, we think the dog probably has hip dysplasia, or that's what started it, same with elbows. If we think about arthritis in the knee, then we think this dog most likely has cruciate disease or an ACL tear. So that's kind of the way to think about it. So, the big deal with arthritis, and that's something that I think most people have heard before, but it's important to reiterate that, is that cartilage doesn't really have any good blood supply so it can't heal. So, when you cut your skin, not a big deal, it heals back in two weeks, but when you cut your cartilage, then it can't really heal. And so, the cartilage that you're walking on right now is the cartilage you'll be walking around on for the next few years. So, it's really important to take care of that cartilage, and the same is true in dogs. And that's why this is such a big problem.
0:05:47.3 DD: Before I ask you my next question, I may put you on the spot a little bit. What about cats? Because they've been, I hate to date myself, but when I went through vet school, people said, "Oh, cats don't even really get arthritis." And we know that is wrong, wrong, wrong. Is theirs a primary or a secondary?
0:06:08.5 DD: Yeah, it's a great question, and I think you have a really good point there so that, this has shifted a lot. So, we did in the beginning, people were thinking that cats just don't really have these problems, and that is because a lot of cats don't show the symptoms as... Or maybe they are not as obvious to us as owners or veterinarians as in dogs. And the other part of that is, it's also not that easy to do an orthopedic exam on a cat as it is on a dog, right? So, but now we know that a lot of cats have arthritis, and I think because there is so much arthritis, actually, I think that there is a little bit more of an argument to be made that they have more primary osteoarthritis, because that's when you... And people in general practice knew this all the time, because when you do those cat o-grams the big... the X-rays that take everything, I mean, they would see arthritis they would even be like, there wasn't a big surprise when the academic researchers said, "Oh look, there is actually a lot of arthritis in cats." Everybody was like, "I kind of knew that." So no, I think it's a great point.
0:07:16.6 DD: Oh, great. Tell us, I don't know that we know this for the exact point you just talked about of the actual incidence of osteoarthritis in dogs and cats, because at least what I read, it's changing. Can you pipe in on that?
0:07:32.7 DD: Oh, for sure. Yeah. Actually, we just had a discussion about that yesterday because there was just recently a new study on exactly that topic. So, it's very interesting. When you look back at all of the previous literature, most of them would always quote that 20% of dogs over one year of age are affected by osteoarthritis. And that came from a really old survey that was there from 1996, only 200 veterinarians, it wasn't even published, but yet everybody propagated that. Then there is a group in the UK that has done some fantastic work on this topic, and they've looked at the veterinary data bases, now keep in mind that that's probably underestimating that because it relies on people actually writing that down. They looked at the one-year period prevalence or how many dogs in that one year were diagnosed with that, and their numbers showed like somewhere between 2% and somewhere 8% or so, if I remember that correctly. The dog that had the most osteoarthritis, you can guess which one, I know Kelly... golden retrievers. And so, then a recent group, they looked at 500 dogs and they reported a prevalence of 38%. So, I think that all of that data suggests, and that's the same. We know that in people, it's about 30 million adults in the US, we know that this is a substantial problem no matter with which number you want to go.
0:09:15.1 DD: Yeah, that sounds great. I think cats are a little harder though. I've seen a pretty high percentage, but it gets back to what you said, we used to do a lot of those x-rays. You are, were like, yeah, just get the whole cat on the plate. And I think we see it, but is it causing signs? Which I wanted to get into next, because I think what we... To talk about signs in cats and dogs, because I think there are some classic signs, there are some signs we're recognizing now that maybe are osteoarthritis and the cats are really different, as one of mine has popped into our podcast here. [chuckle] So talk a little bit about the signs, cats versus dogs and maybe common signs and maybe more subtle signs.
0:10:00.9 DD: Yeah. Well, let's start with the cats because I have a tendency... We just see a lot of dogs and I have a tendency to not focus on the cats as much. So, I want to change that, and so we're going to start with the cats. So, cats are, actually, what we see a lot is that people are reporting that their cats are not jumping as much, you can also see problems getting into the litter box, cat trees or something where so they don't spend as much time on it, maybe they're not as playful. And so, I think we don't see as much this lameness that we see in dogs, it's more the subtle signs. And I think that speaks to what we talked about it before. In dogs, we do... I definitely see the same thing where they just slow down and are just not as active and maybe not wanting to go as far, and in general, that is one of the things that we have to make sure we realize, that there's a difference in slowing down because of age and slowing down because of arthritis getting worse.
0:11:13.2 DD: And when we see these puppies with bilateral elbow dysplasia and hip dysplasia, they are crazy, they run around because they are just able to compensate for that a little bit more with their willingness to just work through that pain. And when they get a little bit older, those stimuli are probably, the arthritis gets worse, and maybe there is a little bit more life experience on, "okay, well, I've seen about 500 bunnies, so maybe I'll let that one slide." So that's something to keep in mind for us when we look at our pets, that when they slow down, there might be a reason for that. In dogs however, we also see a lot of just trouble getting up. People frequently report not wanting to jump back into the car or not just getting back in on the bed, at the dog park, maybe not playing as much as the other dogs do, being kind of dragging on the leash. But also, the unilateral lameness, that can also be due to arthritis, and we do see that quite a lot that one side is worse than the other, and there is also secondary things that can happen when dogs have arthritis. So, lots of different presentations, but basically any of those that show a decrease in mobility, that's probably something where we could fit arthritis in.
0:12:44.5 DD: Okay, and I... My next question is another big kind of categories, which is the treatment. There are lots of individual options, but maybe talking about sort of the general categories rather than getting into the specifics, because I know there's just a lot of stuff out there.
0:13:06.7 DD: Yeah, that's very true. I think as far as if we are talking just big categories, I think the first one is, to me, that's super important is weight management. We do know that weight has a huge impact on dogs, no matter whether they have arthritis or whether they are healthy. If they're healthy, they should be of an appropriate weight because it will reduce the amount of wear and tear on their joints, and if they have arthritis, we know that it will slow the progression and it will also help with the pain associated with it. That is kind of really an interesting argument and people always get a little confused by that, but we do know that it helps with their mobility when they lose weight. So, it's either prevention, which is one of the things that we have not really focused enough on in veterinary medicine, or treatment. So that is the number one thing, and it also is one of the least expensive things to do. And it ties very well into the second one, and that is regular activity, because weight management can be accomplished by appropriate nutrition and then an appropriate exercise.
0:14:26.9 DD: So, when we have dogs that are overweight and have arthritis in many joints, it can be very difficult for these dogs to go to a more active lifestyle, because people say, "Yeah, my dog doesn't want to walk." And that's where some of the physical therapy can be fantastic, so that's where we frequently use underwater treadmill because you can get them to strengthen and lose weight, and then you break that cycle, but at the earlier stages, if we can take our dogs for more frequent walks that they can tolerate and avoid the high-impact activities, so that weekend warrior... the other thing that people always talk about, so where we don't do anything with them during five or six days during the week and then we take them to the dog park forever, or maybe go climb a 14er with them, that's not good for arthritis. That is going to create more of an inflammation and that's going to worsen things. So, we want to have ideally regular controlled activity. That would be the best way to go.
0:15:43.4 DD: Okay. That's a question I think I got a lot in practice too, when people would start out, like you're going, "Okay, they need to lose weight, they probably have some arthritis." and they would go, "Well, what is okay? What's too much?" And so, I think you gave some good suggestions on that. Let's pick our next favorite category of treatment. [laughter]
0:16:08.7 DD: Yeah, and on that question, I think that we do want to try to avoid these setbacks. To me, that's always the best guidance for owners, is if your dog is much worse after you have basically done some of this forced activity, then it was just too much. You want to really gradually increase that and increase the amount of walking that you do.
0:16:35.6 DD: Yeah, so my next favorite is probably nutrition. So that's where the weight loss can be complex. Honestly, we run into this, we want to make sure that the dogs are getting an appropriate nutrition as far as nutrients go, but that they are not getting too many calories, so that we are accomplishing this weight loss. And this can be definitely requiring input of a nutritionist because there are some tricks that you can do to accomplish that when some dogs are just not losing any weight, but there's also other parts that play a role into this. For example, one of our favorite treatments is omega-3 fatty acids, and so with that specifically the things that we look for, their abbreviations are EPA and DHA, that is something that you can see on a lot of the diets. They actually spell that out because everybody knows that in the veterinary world that that's the one that we're actually looking for, and it's been shown in several studies that these are beneficial.
0:17:49.5 DD: It's not a magic cure. None of these things are a magic cure, it's just we try to do everything that we can, and that can also be included in some of the diets, but the problem is, you again, got to watch the caloric intake, so that's where sometimes we don't use omega-3 fatty acids, if the dogs are too overweight, but rather do a weight management protocol first. And so that's something to really talk about on individual cases.
0:18:16.8 DD: But my other favorite that I definitely need to talk about is NSAIDs. So, when we talk about NSAIDs, non-seroidal anti-inflammatory drugs, those are... There's a lot of them out there, and those are a fantastic option. Those are pain medications, anti-inflammatories that help with the pain associated with arthritis. They work really quick, and they are very safe. Now, when I say very safe, it's a drug and it comes with potential side effects, so we're going to monitor for that, we're going to make sure we dose it correctly, but if you are looking for one thing that probably has the biggest impact on these dogs that you can make happen by tomorrow, that is giving an NSAID.
0:19:06.2 DD: And I do think that this is really important because with that, that goes back to the dogs that are not wanting to walk because of pain, we can address that and that can then address the inability to lose weight, and then that can happen over a longer period of time. So, I know they get some of the... When you search on the internet, there is a little bit of negative press about NSAIDs, but they really are a fantastic option, and as long as we do it at the right dose, monitor their blood work, the chances that something happens that is a severe side effect is so low that I think it's worthwhile taking that risk and there's newer options that we can use that may be a little bit safer, so they're really are a mainstay of our therapy.
0:19:58.0 DD: Anything. What else do you see that sometimes you might add in? Maybe talk a little bit more about the physical therapy options or the exercise options that are now available for folks.
0:20:13.4 DD: Yeah. And we do have a long list of things that we consider, there's lots of... There is other things that are... Injections that we can do under the skin that can help. There is joint supplements, there is joint injections where we inject directly into the joint. There is all sorts of new modalities that we try anything from shockwave to laser therapy, physical therapy. Lots of studies out there and lots of modalities that we try. I guess what I want to make sure is that we balance this with the potential harm, right? So, when I look at any of the treatments, for example, magnetic fields are something that we get asked about a lot, and that to me has a very low risk. That is fine, right?
0:21:16.8 DD: It may not do much, but it has a very low risk of harming the patient. And so as long as we disclose the cost and the evidence behind it, that's all fine with me. So, there are some other treatments that are way more invasive and, where we don't really know, is this justified? So, when people are looking at those options out there, joint supplements is a great example. It's a very controversial topic in people and in dogs. And I think that we are unable to identify minor changes in our patients. So, meaning that let's say the joint supplements in relationship to an NSAID maybe have a tenth of the effect. And kind of almost impossible to identify that in our studies. And since there are some studies that show that they have a benefit, I'm totally fine with giving them. Some other people say, "Well, that's just wasted money." And yes, if people are really cost concerned, then maybe that's not something that we should prioritize.
0:22:30.4 DD: Yeah. And actually, that's a good lead into your Foundation grant, which I wanted to ask you about. And tell us a little bit about your grant that was funded through Morris, and a little bit about your methods and what you were measuring.
0:22:46.4 DD: Yeah. So, about this Foundation grant. So, the idea here really is to use a new idea when it comes to intra-articular injections. So, when we do joint injections, lots of people have probably heard about stem cell therapy, that's been the hype for a while. The idea was that we would inject stem cells into the joint and they would then regenerate that cartilage. Looking back at what we talked about in the beginning was that cartilage doesn't really heal like skin does, and if stem cells could do that, they could just suddenly smoothen your joint. That would be fantastic. Well, we do know that that unfortunately is not the case. And because of that, people are looking for other solutions. So, what do we have? Well, we have, for example, steroids. When we inject steroids into the joint, they usually help quiet down that joint, and most people and animals experience some degree of short-term benefit from that.
0:24:00.4 DD: And then when we think about other regenerative medicine options, probably PRP, platelet rich plasma. So, it's a commonly performed procedure that has the same idea of creating some benefit that helps the cartilage regenerate, but it's also in many studies been shown that this also is not the magic bullet. And so, the idea with gene therapy is that we are going to change a little bit of what the joints are, what the joint itself, what the cells in the joint are doing. And so that was kind of the idea behind this. And this is really kudos to Lori Goodrich, who has done a lot of work in horses with this. And now she said, "Well, let's go look at this in dogs as well."
0:24:58.2 DD: And then Ah Young Kim is the resident that did this project and her explanation of this, I love. So basically, what she said is that "I think of the cell as the computer and the computer then, or the cell in this case, then produces certain... Spits out certain documents. And we want those documents to tell the joint, Hey. To be a healthy joint. And what gene therapy does is gene therapy, basically programs a USB stick to put out those beneficial documents that tell the joint to be a good joint.” And that's what this grant is about. So basically, the name of it is the inter-articular gene transfer Interleukin-10 - development of a new strategy for the treatment of canine osteoarthritis. So that's the idea to figure out well, how can we most efficiently do this? So, what are the... What is the correct USB stick that we need to use for that?
0:26:15.7 DD: And can you remind everyone what IL-10 is and what it does and why you would want to put it in there? [chuckle] Or get them to make it. Get them to make it, right. Give them the instructions.
0:26:30.7 DD: [chuckle] Yeah, exactly. So that's why I try to go on the document side of it, because it always confuses everyone when we throw around these names. So, IL-10, that stands for interleukin 10, and that is one of the most important anti-inflammatory cytokines, or the mediators in osteoarthritis. So, that's why we would like to basically have more of that to keep the joint healthy. So that's the idea of this. So basically, if we can program the cell to be like, "Yes, put out more of this", then the joint will be having less inflammation and therefore be a healthier joint.
0:27:17.9 DD: And what do you think... It's kind of self-evident, but what do you hope with your research... What outcomes are you looking at, and what do you hope you'll find with this?
0:27:29.8 DD: Yeah, so I think this is kind of... This initial study is really just to identify exactly how can we do this most efficiently. So, there is a lot involved in this as far as which vectors should be used, to basically designing the ideal USB stick and the program that gets them transferred into the cells. So that's, this is really the basic research right now, and this is not actually using any live animals. So that's where we are just hoping to do our work so that the next part of this, where we use this in live animals, will be giving us the best chance to have a successful outcome in that next phase.
0:28:19.8 DD: Okay, and that... I was going to, maybe, think about that is, is that kind of where you're heading? What you would do next after your stuff is done, if it looks promising? Are you thinking clinical trial?
0:28:32.0 DD: Yeah, for sure. I think there is already a couple reports of this being used in clinical trials. I think they're... Yes, that is, to me, the ideal way to study this. Because a clinical trial is something that can be representing what actually happens in real life. Versus when you do everything just in the lab, there are a lot of factors that we don't account for. But before we do a clinical trial, we want to make sure that the patients that we are enrolling have a great chance of benefiting from this. This is where we did this study first. So, I think that's the way we at CSU think of clinical trials. We look at, "Well, is this product something that is likely going to help the animals?" And if that is the case, then we set up a clinical trial where we then try to confirm that. So, the benefit is that the individual patient that enrolls in that clinical trial hopefully benefits from it, if we have correctly guessed on this. And they get free treatment.
0:29:52.6 DD: And frequently, we also, as our control group, we use something that is an established method. And so, then we know, "Is this better than the established method." So, on this one here, for example... I didn't talk about hyaluronic acid when we talked about joint injection first. That's a very established injectate in people and also in dogs, and it's very benign. And that could be one set up, where you compare this to hyaluronic acid, which we've done with stem cells, for example. Because to me, as a dog owner, I would like to know if I can spend $80 on a treatment that's off the shelf and safe versus $3000 on, for example, stem cells, how much better are they? And if they're not any better or if they're just a tiny bit better, then why a. spend that additional money, and when we talk about stem cell there's the whole issue of sometimes you have to get those from the dog itself, so then it means two procedures and some risks associated with that, so...
0:31:00.2 DD: Yeah, I was going to ask you too. This is a little diversion, but reading the veterinary literature, I know that any kind of pain management trial, there are some... They're tough to run. What are some of the challenges? Mostly, I'm thinking placebo effect, okay. And I've read in people and in animals, right, that that can be really strong in pain and drug trials. What's been your experience? And can you comment on that?
0:31:37.8 DD: Yeah, well, Kelly, how long is this podcast because caregiver placebo is one of my favorite topics.
[laughter]
0:31:48.6 DD: You're going to have to... I'm going to put you on the spot to be quick for our audience, just to kind of give them a taste of "This is a big thing."
0:31:58.6 DD: Right. Okay, well, in people, it's pretty easy because when you believe in something very strongly... So, if you have arthritis and you believe in whatever it may be, pick acupuncture, and then you go to an acupuncturist, you will get better because you are strongly believing in it. Now when we do clinical trials, the dogs have no clue why they're coming in, right? But the owners do. And so, we ask the owners to judge their dog's status after an injection. That is called the caregiver placebo effect. And in fact, that's also for veterinarians. So, a fantastic study done a few years ago showed that that caregiver placebo effect in veterinarians, in dog owners, is somewhere between 40 to 60%. So what that means is that when you know as a dog owner or as a veterinarian that that dog may have not received any treatment, in 40-60%, you will think that dog got better without there actually being a real improvement. And this was done with gait analysis, objective gait analysis and all sorts of things.
0:33:14.4 DD: So, this is really important, because when you actually, as an owner you're trying to do the best for your dog, and you go see your veterinarian or your physical therapist, or whoever you're going to see, and you're paying for it, your caregiver placebo effect is probably going to be higher than 60%. So, we're really not great at judging this, this is why we are using objective outcome measures, so the gold standard is still objective gait analysis where they walk over a walkway and we measure exactly how much forces they put on each leg, but that only captures a really tiny time period, that's why we also use things like activity collars. But you're 100% right, it is tough to judge pain, arthritis does definitely have its up and downs in a day or even over a week, so it's very difficult to do.
0:34:11.0 DD: And I'm going to point everyone... I'm going to put this in the show notes, but Felix did a TED talk for us, right? [chuckle] And I'm going to... I'm not going to... I don't want to give anything away, but you guys need to watch it because there's a little piece about this, isn't there? I don't, like I said...
0:34:27.3 DD: There sure is. Yes.
0:34:28.4 DD: It's a teaser for everyone, but I don't want to give it away. But thanks for addressing that. I think it's a huge problem for veterinarians. I know that also as a pet parent, like you said, you're wanting to be doing the right thing, so you tend to be optimistic. As a owner of a nine and a half-year-old Labrador who occasionally gets a little gimpy, we're always like, "Did that medication work? Is she better today?" And you can be optimistic. I tend to be pessimistic because I'm just a veterinarian, but my husband will be like, "Wow, that worked great," and I'm like, "Well, did it really?" So, it's even within our family, right? It can be tough kind of assessing that. So, I wanted to ask you, not just your Morris grant, but what other projects, what are you working on right now?
0:35:15.6 DD: Yeah, we're working on some pretty exciting things. So one area that we work on is just exactly that problem on trying to improve outcome measures, so how can we get better on that, how can we study this better, because I think the dogs are a fantastic clinical model for people as well, so I think that we can do a little bit better still on this, because it will help a lot of dogs and then helping people with arthritis, I love that idea too. The other things, just projects, is we're doing some work with CBD, which is a big interest area right now for a lot of people, and then we're doing some work with orthotics and prosthetics, which is also quite fun, then we are doing some more work with joint supplements, and then we are also looking at a joint injectate right now, and then the last thing that we're just starting is looking at shockwave for arthritis as well. So, a lot of exciting things.
0:36:25.5 DD: Cool. So, we're getting low on time though, this was so much fun. I wanted to ask you if you had one message to give everyone in the audience, which is everyone from veterinarians to just dog and cat owners about this topic, what do you think you would want people to remember?
0:36:44.3 DD: Yeah, it's definitely the weight. I think that we are very bad at judging weight as dog owners, we're very bad at discussing weight as veterinarians, and yet it probably has the biggest impact, so that's probably number one. The other part, prevention. There are still a lot of people that haven't heard of some of the options for early treatment, for example in dogs with hip dysplasia, and I feel that we are... because dogs are so amazing at hiding their pain, we're not treating them early enough, so I do think that a greater focus on the prevention, meaning having regular exams and evaluations, is a fantastic idea.
0:37:30.9 DD: Okay. And I'm going to add in there too, remember cats get arthritis.
0:37:36.6 DD: [chuckle] Remember cats get arthritis, and nutrition is really important. Yes, those are four good points.
0:37:42.2 DD: Points. Those are great points. Well, thanks so much, and that does it for this episode of Fresh Scoop, and once again, thank you to Felix for joining us today. That was really fun. We'll be back with another episode, obviously, next month, that we hope you'll find just as informative because we know the science of animal health is ever-changing. And all of us need cutting edge research information to give our pets and patients the best possible care, and that's why we're here. You can find us as always on iTunes, Spotify, Google Podcast and Stitcher, and if you liked today's episode, please take a moment to rate us. We've been moving up, yay, in the podcast score, and we all need a good science out there, and we hope that we do that on this podcast. To learn more obviously about Morris Animal Foundation's work, again, go to morrisanimalfoundation.org, and there you'll see just how we bridge science and resources to advance the health of animals. You can also follow us on Facebook, Twitter, and Instagram. I am Dr. Kelly Diehl, and we'll talk soon.
