March 2, 2023 — Dr. Kelly Diehl sits down with Dr. Lauren Trepanier, Professor of Internal Medicine and the Assistant Dean for Clinical and Translational Research at the University of Wisconsin-Madison, to discuss what is known - and what isn't - about the link between environmental toxins and pollutants and cancer development in dogs and cats. The pair take a deep dive into the current literature and Dr. Trepanier discusses her research projects focused on answering these questions.
0:00:10.1 Dr. Kelly Diehl: Welcome to Fresh Scoop, Episode 54, Environmental toxins, Cancer and Pets. I'm your host, Dr. Kelly Diehl, Morris Animal Foundation Senior Director of Science Communication. And today we'll talk to Dr. Lauren Trepanier. Dr. Trepanier is a professor of Internal Medicine and the Assistant Dean for Clinical and Translational Research at the University of Wisconsin-Madison. Welcome Lauren.
0:00:35.1 Dr. Lauren Trepanier: Hey, Kelly, it's so nice to be here.
0:00:38.2 DD: And I'm so... Thanks so much for joining me. Before we get started, I always ask everyone to talk a little bit about yourself, what led you to become a veterinarian and then specialize.
0:00:50.0 DT: Well, I guess I became a veterinarian because my dad didn't want me to major in art and science was the other thing that I loved, and I thought the pre-meds were too intense, and so I went with veterinary medicine. So, I wasn't one of those kids that wanted to be a vet since I was three years old. However, once I started working for a vet, I realized that it really was for me. I got interested in internal medicine because in my fourth year of vet school I worked with some internists at Cornell who were just really impressive and seemed to see the whole animal in all its problems and address all the problems comprehensively, and I have enjoyed being an internist because I really like working with animals that have more than one problem where you have to be really attentive to how you address each problem.
0:01:44.7 DD: Yeah, I think internal medicine as another fellow internist, I always thought it was... I know there are people listening who are other specialists, but I felt it really encompassed a lot of different disciplines, and it was a big puzzle that always needed to be solved.
0:02:04.7 DT: And you're not making animals bleed by cutting into them, which was also a plus for me.
0:02:10.3 DD: Yeah, I was not really a surgical type either. So, you start out as an internist, and that's how we met many, many years ago when we were very small children, [laughter] but what got you interested in looking at environmental toxins and cancer?
0:02:30.6 DT: Well, it's been a little bit of a windy road because I'm not an oncologist, I'm an internist, but I was very interested in pharmacology and drugs as an internist because of all the different medications that we use, how they work, what their side effects are, and then I became interested in why certain animals get adverse drug reactions like drug allergies, and so I studied actually sulfonamide drug allergy for many years in both dogs and people, and I was studying how the drug was broken down in the body by different individual people or individual dogs, and studying a drug allergy is kind of really a narrow focus, and I wanted to work on something that was a little bit more common and had a higher impact, and some of the same pathways that break down drugs that you take also break down environmental chemicals that you're exposed to. So, we started looking at differences in the way people and dogs break down environmental chemicals, and we've morphed into looking at differences between people and dogs and how they're exposed to environmental chemicals, particularly in the household.
0:03:43.2 DD: And I wanted to... because we've heard about this stuff for a long time, and I think people have recognized a little bit that you can get exposed to something and then develop cancer, but just for fun, can you talk a little bit, if you know it, about the history of people kind of starting to put together, Oh, if I get exposed to this, this cancer can develop. When did that first start?
0:04:09.6 DT: Well, probably, I mean, I actually don't know the history of when specific thing started, but with the onset of industrialization, most studies of, say, leukemia or bladder cancer were based on workplace accidents or workplace exposures that were really high. So, for example, there are dye workers work with certain chemicals called arylamines, and they had a higher instance of bladder cancer, so it was sort of found out accidentally by people that were working with these chemicals. And then things like arsenic and water, we know that it causes bladder cancer because when there's well water contamination or industrial accidents, we know that there's clusters of bladder cancer. And then of course, people have looked at smoking for a long time, and initially there was really a push against releasing information that smoking cause lung cancer, but we know, of course, now that it does. More recent studies, instead of looking at smoking or environmental exposures and environmental disasters are focusing on lower dose exposures to chemicals that we encounter in our daily lives.
0:05:25.5 DD: Okay. because I think people probably know... It seems like people have known for a long time about radiation exposure. I know we've all heard Madam Curie carried radium around her pocket, which was probably not a good idea.
0:05:36.7 DT: And put it next to her bed.
0:05:38.2 DD: Yeah, yeah. And then the women, I think who used to paint the dial, so that's like 100 years ago now. And I know people have been advanced, and I think it's a real buzz word out there. I think people are worried now and more in tune with it. I know you can't answer this completely because we don't know, but how do... What do we know about the mechanisms of how certain exposures lead to cancer?
0:06:06.1 DT: So, it varies by the exposure, of course, but if we're talking about environmental chemicals or something like radon, so radon actually causes point mutations in DNA, so it causes ionizing radiation, it causes a damage to DNA, and then when those cells try to divide, they can do it in abnormal way because their DNA is damaged. Some chemicals do the same thing, things like benzene, which is found in occupational exposures, but also is in indoor air, will actually affect whether a gene is turned on or off by changing the control part of the gene, and if a gene that controls cell cycle or how cells multiply is turned on abnormally, then that can drive cancer. And then there's other chemicals, like a lot of the chemicals that are in cigarette smoke, which will actually stick to DNA and cause the mutation. So, most of the ways that environmental chemicals cause cancer is by either changing the gene itself or changing whether the gene gets turned on or off.
0:07:25.8 DD: Okay, now this ties in with what you just talked about with your research is why doesn't it happen to everyone, because I've always heard the saying, having a sister-in-law who smokes, they'll say, almost everyone who gets lung cancer is a smoker, but not every smoker gets lung cancer, so what do we know about differences in people and animals maybe and exposures?
0:07:48.9 DT: So, there's a lot of data on this in people because the chemicals say... I mean, cigarette smoke is very complex chemical mixture, hundreds of chemicals, but the primary carcinogens in tobacco smoke, we know how the body breaks them down, and we also know that some people's bodies are very efficient at that. And some people's bodies are very poor, so if you have a protective enzyme that's supposed to break down chemicals when you inhale cigarette smoke and that enzyme is not working very well, then that chemical is going to stick around longer in your body and have a greater chance of damaging your DNA. So, differences in your ability to break down the chemicals is a major source of variability between people, and then differences in your ability to repair DNA once the damage occurs. Those are two major areas that determine your susceptibility to certain chemicals even if you're exposed to a higher amount.
0:08:50.8 DD: Okay, and that sounds like some of that is genetically determined. Yes, it's just part of your...
0:08:56.9 DT: Yes. It's primarily genetically determined.
0:09:01.2 DD: Okay, so and I think I wanted to talk a little bit because we get this... This is one of the most common questions we get at the Foundation is, my dog or cat was exposed to this. A lot of times somebody has lost an animal to cancer, and they ask us when they make a donation, did I do something wrong? Or maybe we had this happen in my house, X, Y, Z is that what caused my animal's cancer? And what do we actually know? I know there's a lot of guesswork, but what do we know about certain toxins and cancer in animals?
0:09:35.9 DT: Well, very little, because there hasn't been very much work done on it. I'm on Facebook groups for bladder cancer and lymphoma, because we recruit dogs into our studies, and there's a lot of misinformation out there. I completely empathize with owners of dogs that are diagnosed with cancer because you want to know why so that you can prevent it, and when you're worried, you're more likely to sort of believe anything that you hear. In people, we know that smoking causes lung cancer. We know that processed or grilled meats cause colon cancer, we know that alcoholism can lead to stomach cancer, we know tanning beds lead to melanoma, and then we know about certain workplace exposures like benzene and leukemia and water pollution and bladder cancer. So, there's a bunch of things. Most of the studies that have been done in dogs have said, okay, this is a risk factor for this cancer in people, is it a risk factor for this cancer in dogs? And Larry Glickman and Deborah Knapp from Purdue University did some really nice early work with herbicides and bladder cancer and found that if an owner reported that they used herbicide or weed killers, that there was a higher likelihood that their dog would be a bladder cancer case.
0:11:03.8 DT: But there hasn't been actually a ton of other work, some earlier work in dogs looked at lymphoma and Roundup, which is a weed killer that defoliates your lawn if you're trying to replace grass with something else and found an association between lymphoma in dogs and Roundup and it was countered by another group of scientists, but they worked for industry funding institutes, and now we know that Roundup has been associated with non-Hodgkin lymphoma in people, in fact, there's a multi-billion dollar lawsuit associated with it. So, there is evidence that herbicides lead to certain cancers in people, bladder cancer and lymphoma among them, and we also have circumstantial evidence that that is true in dogs as well, but there's been a lot less work done in dogs and virtually nothing done in cats about environmental cancers.
0:12:10.7 DD: Okay. Yeah, because I was going to ask you about cats, because I've seen written... People talking about cats grooming behaviors. Because they groom a lot and development of oral squamous cell carcinoma, which we know is linked to chewing tobacco in people. So people made those leaps. Well, cats in a house with a smoker might be grooming themselves more, but we really don't know that. We don't really know that for sure, do we?
0:12:40.9 DT: Well, I don't study cats, so I'm actually looking right now to see if there was a... because I know that there have been one or two papers in cats that have shown association with cats and specific environmental exposures, but it's not something that I study directly.
0:13:03.6 DD: So, we really... So, cats even worse than dogs, we just don't know, and they're really different too in a lot of their metabolic processes, right?
0:13:12.7 DT: Yeah, so we know less about their exposures, and we know even less about variability between cats and their ability to neutralize chemicals from the environment.
0:13:23.3 DD: As you said, a lot of blanks right now, and I think you could probably relate to, and everyone listening is sometimes we're asking people to recall with a lot of retrospective studies out there, which I think inherently have some issues, right?
0:13:46.4 DT: Yeah, so if you ask the owner of a dog with bladder cancer compared to an owner of a dog who's a healthy control of the same breed and sex, did you use weed killers? Are there smokers in the house? Things like that, the owner of the dog with cancer is more likely to recall exposures because they've been thinking about it, they've been putting it through their mind, and they've been asking. They've been reading and asking, whereas an owner of a healthy dog, probably hasn't thought about it very much, and we've used questionnaires in our studies, and I've realized that a lot of people don't know what kind of water is in their house, what kind of filtration unit they have. They may not know whether they have a deck made out of treated lumber, and they definitely don't know what is being put on their lawn if they have a commercial product, a commercial person come in because, for example, weed and feed is used by a lot of commercial lawn care companies, that is a fertilizer, but it also has an herbicide in it. So, people usually don't know whether weed killers are being used or what... They definitely don't know what the chemical names are, which I don't blame them because it's not something that the person is talking to them about.
0:15:01.6 DD: And I think even the people applying it sometimes. My husband is a great one to chase people in the neighborhood, especially when our neighbors are spraying something to go over and say, do you know what is in this? Do you have the MDSD paperwork? And sometimes they don't even really know exactly what's there.
0:15:24.7 DT: And they should know because they should have protective clothing on.
0:15:27.1 DD: Yeah. Exactly, exactly. And they're like, well, you just told us. So, I think, yeah, there's multiple areas there where that can be really difficult for folks. So, let's talk about your work, because this is an approach to getting at these questions that is not dependent on people remembering or even knowing exposure that could have even happened years before, so what are some of the studies that you've done? We'll look back first. And then what did you find?
0:15:58.7 DT: So, we're focusing on lymphoma and bladder cancer in dogs because they are very common, they typically lead to euthanasia, and they are very similar to those cancers in people. So, for bladder cancer, we started out asking the question, do dogs in a household get exposed to the same chemicals as their owner? And so we looked at 42 healthy dogs and their owners, and we measured a bunch of chemicals in their urine that have been associated with bladder cancer in people in particular arsenic, which is a heavy metal that can contaminate ground water, but it also could be found in household dust and acrolein. So acrolein is an air pollutant, particularly an indoor air that's generated from, frighteningly enough, from fried foods. And so we found that these chemicals were readily detected in the urine of healthy people and dogs, that they were up to six times higher in dogs than their owners, and some of that could be related to the dogs being smaller, but it really didn't correlate with body size, and so it may have more to do with dogs grooming behavior and licking their paws and their fur and things and being closer to the ground. We also found that if a dog had high levels, it predicted high levels in the owner, which suggested that there's shared sources, this probably isn't food, because these dogs are mostly eating commercial dog food and their owners were not.
0:17:35.2 DT: And the last thing we found is that between 3% and 7% of the people and dogs in our study had levels of these chemicals that we found were high enough to damage DNA in urinary cells. So, we know that dogs and people are exposed to the same chemicals, the sources are probably similar, and that they can reach DNA damaging levels in otherwise healthy individuals.
0:18:04.8 DD: Okay. Did you ever follow these people to see and dogs to see if they ever developed cancer eventually, or was this sort of like a snapshot?
0:18:12.5 DT: It was a snapshot, and part of the reason for that is that the lag time for bladder cancer development in people is 30 years.
0:18:19.5 DD: Oh, okay.
0:18:20.4 DT: So, I'll be dead by then. And the lag time for dogs, we don't really know, but it's definitely not just a few years. So, because of those data we're now directly measuring arsenic and acrolein. So, arsenic found in water and dust, acrolein found in the air, and also herbicides, weed killers in the urine of dogs with bladder cancer as well as their owners, and then match dogs of the same breed and sex and age that don't have bladder cancer and their owners. And this study is funded by the AKC Canine Health Foundation as well as by UW, and we're measuring also chemicals in the household. So, household dust, tap water and indoor air, and that study is just finishing up, in fact, we will get our final data analysis next month, so I'm very excited about that.
0:19:18.3 DD: That's going to be cool. So were these... I guess what's the geographic distribution of the dogs, was it more widespread or local?
0:19:28.0 DT: We've drawn from all over the country. We have actually geographic maps of the percentage of dogs that are from each state, and I think we've drawn from 27 states for the bladder cancer study, so for both cases and controls, so it's a pretty wide breadth, but it's not... It does depend on whether people are... Whether their veterinarian tells them about the study. So, our study is advertised by Antech in association with a BRAF test, which veterinarians send in to confirm that there's DNA damage in the urine consistent with bladder cancer. So, whether a case comes to us, depending on whether the owner can afford to do that test, whether the veterinarian tells them about it, and then whether they're willing to collect urine and samples around the house. And we are missing a whole slice of people of lower socio-economic strata who can't afford to go to the vet or can't afford specific diagnostics. So that is a constraint.
0:20:39.7 DD: But it sounds like... If I'm correct... Wow, I hate to say it, we probably all fry food, right? So, we're probably... But arsenic's pretty widely distributed, right? It's not... Or are there pockets, or is it more likely in one area versus another?
0:20:56.0 DT: There's definitely hotspots where a lot of wells are affected where they have higher arsenic in them. I mean, it is screened for in municipal water, but there are other chemicals, chlorination breakdown products that are found in municipal water. But for arsenic it's mostly in well water if people haven't had their wells checked.
0:21:17.1 DD: Okay. Okay. Well, that's good to know. Well, we'd actually talked about this, but I wanted to ask you maybe to dive a little deeper into how dogs and humans respond when they're exposed to chemicals. Like is it always similar or how maybe they differ a bit, or can you make pretty strong associations between them?
0:21:42.1 DT: Can I go back to our lymphoma studies first and then...
0:21:44.3 DD: Oh yes, please do. Sorry, I took a dive that way. But yes, go back to your lymphoma studies.
0:21:48.0 DT: So, in addition to bladder cancer, we're looking at lymphoma, a cancer of lymph glands typically seen as enlarged lymph nodes under the jaw or in front of the shoulders. And we focus on two breeds that are at high risk of lymphoma, the boxer dog, which tends to get T-cell lymphoma, which is more aggressive and tends to occur at an earlier age. And golden retrievers who get both B-cell and T-cell lymphoma at a very high incidence relative to other breeds. And we've done ecologic studies. In other words, we look at where these dogs live and we found that Boxers with lymphoma are more likely live in counties that had higher human health risks from air pollution, higher ozone levels, which is a marker of air pollution and higher human health risk from what we call volatile organic compounds or VOCs, including one that's found in diesel exhaust called butadiene and one that's off gas from paints and panelings and medium density fiber board, which is formaldehyde.
0:22:58.1 DT: So that's looking at where do you live and what's in the air where you live. And we're now directly measuring these volatile organic compounds in collaboration with the CDC, which can measure a whole range of VOC metabolites in dog urine. And we're looking at Boxers with lymphoma and matched healthy controls as well as Golden Retrievers with lymphoma and match healthy controls. And in both of those groups we're also looking at specific herbicides and we're partnering with the Morris Animal Foundation Golden Retriever Lifetime Study, which is an invaluable resource to look at these chemical exposures not only at the time of diagnosis, but in the year prior to diagnosis. And we're looking to see whether there is early DNA damage that can be seen in the blood in association with chemical exposures as long as a year before actually lymphoma develops. And so that might help us screen high risk animals or understand what chemical exposures are actually doing, if we can actually document that there's DNA damage.
0:24:08.9 DD: Okay. Yeah, no, I think that... Yeah, I mean the GRL... The Golden Retriever Lifetime Study, I always want to say GRLS, but the Golden Retriever Lifetime Study I think provides that because that's one thing you were talking about, we were talking about recall bias, right? And one of the things we hope to eliminate with the Golden Retriever Lifetime Study is because you're asking people all the time the same questions over and over again that we would be able to capture those... They can't think back and go, yes, it was this exposure because we know what that was. We know what the folks answered many, many years before and we ask a lot of detailed environmental questions. So yeah, I am hoping it'll be a really good resource for people moving forward for long time because we'll have a sense of what these guys were exposed to.
0:24:55.7 DT: Yeah, I mean it is actually a very brilliant study design and I tell that to everyone that will listen to me, not just people from Morris Animal Foundation.
0:25:08.8 DD: Well, yeah, it's a bear sometimes, but it gets around. Like people ask us, and just for the folks who are on here, we've talked about this in a couple of our blog posts, but we ask really detailed questions about exposure to what's your primary cooking fuel, which now with the whole gas stove thing will be really interesting because at the time it's like, Oh, that seems like stupid or boring or what flooring are they exposed to? So, it's not just like, do you spray pesticides? There's all these other questions that I think sometimes perplex people when they have to fill them out now they get it. But it's going to provide ,I think some great data, these questions that seem a little offbeat to folks.
0:25:52.9 DD: So, you kind of answered this already, and maybe I'm going to retract my question about, do animals handle things similarly? And reframe it as, do you think animals are good models for people cancer? And are there difference like maybe cancer? Yes. Certain cancers, maybe others no, what do you think?
0:26:14.2 DT: Well, you start with whether the cancer looks similar under the microscope between dogs and people. So that's very true for bladder cancer. It's very similar to the more aggressive form of human bladder cancer. And it's very true for non-Hodgkin lymphoma in people and multicentric lymphoma in dogs. And primary lung cancers are similar and things like that. So, there are parallels. We ask ourselves, is this a cancer that's common in dogs so that it would actually help us understand it in people. And so, because bladder cancer and lymphoma are so common in dogs and occur at a relatively younger age, so in an accelerated timeline, they can be a good model. Now, of course, dogs have inbred lines, which people tend not to have.
0:27:05.3 DT: And dogs obviously don't metabolize chemicals exactly the way people do, but there's surprising similarities in, let's say an enzyme in people breaks down this chemical. It often also breaks down the same chemical in dogs. We don't have the same comparisons for cats. So, I think they are good models and unfortunately they're often overlooked as a sort of a dirty model or a complex model because like people, they're heterogeneous individuals, they're not an inbred strain and they don't live in a controlled environment, but that's also makes them a very good model for people. So, they're a very good compliment to these very elegant, controlled mouse studies, which can get at specifically whether a chemical is actually causing something because you're giving the chemical to the mouse. But those very controlled exposures in inbred mice don't always extrapolate to people. Whereas I strongly feel, and many veterinarians do as well, that spontaneous diseases in animals that share environments with people are a very valuable model.
0:28:25.9 DD: Yeah, I think I would agree with that. It seems like at least with dogs, people are getting more on board, with dogs as a model. So, it'd be interesting to see. And that brings me to something I wanted to ask you, which is... Yeah, we've talked a lot about what we now know, but what are some of those big unknown questions we still don't know about exposure in cancer?
0:28:50.7 DT: Well, we don't ask people to walk around with monitors on all the time to know what they're exposed to. I mean, in the workplaces environment we do, if someone works in a radiology suite, they have a monitor on. But from day to day we don't have people do that. And we certainly don't do it for their dogs. So, the big question is, what are the cumulative effects of chronic low doses of exposures in the household environment? That's primarily where our pets live. And it's also where people spend a lot of their time. It may not be all their time, most of their time if they have a job that they drive to. And that is a long day. But it's certainly a significant portion of their day. We also don't know the important timeframes for exposure.
0:29:38.4 DT: So, when we're measuring chemicals in the urine of a dog that was just diagnosed with cancer, is that the important time point or was it 10 years ago or five years ago? Or was it when they were in utero as puppies? We don't really know very much about that. And in studies of cancers in people, particularly childhood cancers, they focus on the mother's exposures, not the child's... Well, they look at both, but they look at the mother's exposures because it's important for in utero. We have very limited ways to do that in veterinary medicine.
0:30:21.1 DD: Yeah.
0:30:22.3 DT: What'e the low dose, and what's the timeframe that's important.
0:30:26.9 DD: Okay. Yeah. That makes sense because maybe it's an exposure at a certain time that sets the snowball in motion. So, as we wrap up Lauren, what's kind of your take home message for people who are listening and worried like we all are, about our pets and ourselves and our kids and exposures? What's some commonsense sort of things we should do?
0:30:53.7 DT: It's kind of rough because a lot of things we know we're supposed to do, and we still don't do them. Like people still smoke and they still go out in the sun without sunscreen on and things, but I mean, we do know that tobacco smoke leads to lung cancer. We know it exacerbates asthma in children. And we know that it has a lot of chemicals that have been associated with lymphoma and bladder cancer. So, if you have young children or you have pets in the house, quitting all tobacco smoking in the house and asking other people not to smoke in your house is important. And that includes people who are coming into your house having smoked a cigarette outside because they have chemical carcinogens on their clothing. And then they're sitting on your couch, so they're still bringing chemical carcinogens into your house.
0:31:46.8 DT: I think we have enough data to say that you should not be using weed killers on your lawn, that it is not worth having a perfect lawn. So, advocate for that in your neighborhood. If you have a homeowner's association, advocate for... maybe if they're very strict about it, just requiring it in the front lawns but not the back lawns and just letting your dog run free in the back lawn. When you walk your dog avoid pristine parks or lawns with no weeds because you know that those have been treated with herbicides. And again, Roundup, which is one of the most common herbicides out there, has been associated with lymphoma in people. And 2,4-D, which is the weed killer that's put in like weed and feed because it doesn't kill the grass, has also been associated with both bladder cancer and lymphoma.
0:32:38.7 DT: So, stop worrying about a perfect lawn, get rid of weed killers and then consider install... So, if you have a dog that's a breed that's at high risk of bladder cancer, like a Scottish Terrier or West Highland White, consider installing a water filtration unit and you're going to want one that filters arsenic, particularly if you have well water and chemicals called total trihalomethanes or TTHMs. Those are breakdown products of chlorine. We need chlorine so that we don't have cholera in our water sources, but sometimes the breakdown products can build up and can lead to bladder cancer. And again, if you have a high-risk breed of dog for bladder cancer, don't let them swim in chlorinated pools, because again, that's a source of these chlorination breakdown products. And then Larry Glickman at Purdue did a very nice study to show that even in a dog that's at high risk for bladder cancer, like a Scottish Terrier, having owner's feed green leafy vegetables and we want to use organic because there can be pesticide residues on vegetables, and maintain lean body weight, can actually decrease the risk of bladder cancer.
0:33:58.6 DT: And the body weight is not a 100% clear, but a lot of these chemicals that are harmful in the environment build up in body fat. They're fat loving or lipophilic and so they concentrate in fat and then so they continually kind of enter the bloodstream from your fat stores. And so, maintaining a lean body weight obviously has many health benefits, but it in dogs that are high risk for cancer, particularly bladder cancer, it may have a benefit even in a high-risk dog.
0:34:28.8 DD: Okay. Those are all good things. I am very guilty as far as getting... I don't get uptight about my lawn, but I do get uptight about weeds in my garden. And so, I have been sorely tempted to use some of these products, but I just dig them out now. Whereas I will be the first to admit I used to love Roundup, judiciously applied, but still, but we completely stopped several years ago in our house.
0:34:57.0 DT: Yeah. When I just strip an area now, I just cover it with newspaper and rocks and let the grass die and dig it out. It's not good.
0:35:09.6 DD: Yeah, no, no, it isn't. And it's probably better for all of us. Well, that does it for this episode of Fresh Scoop. And once again, thanks to Dr. Lauren Trepanier. It always is helpful to have good friends that you can arm twist into coming on. So, thanks Lauren. [laughter]
0:35:26.3 DT: Oh, that's been really fun, Kelly. No arm twisting required.
0:35:31.3 DD: [laughter] So everyone will be back again next month with another episode. We hope you'll find just as informative and because we know the science of animal health is ever changing and we need cutting edge research information, whether we're treating patients as veterinary caregivers or if we're pet parents. And that's why we're here, of course. And you can find us on iTunes, Spotify, Google Podcast and Stitcher. And if you like today's episode, we'd sure you appreciate it if you can take a moment to rate us, because that helps others find our podcast. Obviously, to learn more about more Morris Animal Foundation's work, go to more 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, we're still on Twitter, and Instagram. And I'm Dr. Kelly Diehl. We'll talk soon.