Episode 160: Repro Vet FAQs

Dr. Julia Zuercher, a veterinarian with a focus on reproductive medicine, joins us to discuss some of the most frequently asked questions she receives from her clients. Tune in and learn about progesterone, neonatal care, vaccines, and more!

Transcript

Nicole Engleman 00:04

Welcome to the Good Dog Pod. Join us every other Wednesday when we discuss all things dogs, from health and veterinary care, to training and behavior science, as well as the ins and outs of Good Dog and how our platform can help you successfully run your breeding program. Follow us and join Good Dog’s mission to build a better world for dogs and the people who love them. 

Dr. Nate Ritter 00:28

Hi, everyone, and welcome back to another episode of The Good Dog Pod where we discuss all things related to canine health and research, how Good Dog helps breeders run their breeding programs and so much more. I'm Dr. Nate Ritter, the staff veterinarian here at Good Dog and your host for this week's episode. I'm really excited to introduce the topic of today's podcast client frequently asked questions, a little more freeform than usual but basically we will be covering some questions and discussions repro focus veterinarians commonly have with their clients. I'm joined this week by Dr. Julia Zuercher. Dr. Zuercher  is a small animal veterinarian based outside of Charlotte, North Carolina. She works in general practice at the animal hospital Statesville with a focus on reproductive medicine. Dr. Zuercher has PennHIP certified and enjoys working together with her clients to improve their breeding programs. Dr. Zuercher has been engaged with the purpose bred dog community since she was a student at the Virginia Maryland College of Veterinary Medicine, and was a proud AKC veterinary outreach scholar during that time. She was heavily involved with the Theriogenology service at VMCVM and worked with the Department to research the validity and reliability of a common in house progesterone machine. In 2021. Dr. Zuercher was named NANDI scholar by the Theriogenology Foundation, an award for graduating veterinary students who have demonstrated superior potential for future clinical and scholarly excellence and leadership in Theriogenology. In her free time Dr. Zuercher enjoys gardening, baking and spending time with her German Shorthaired Pointer, Heidi. Dr. Zuercher Welcome to the Good Dog Pod.

Dr. Julia Zuercher  01:50

Thanks for having me.

Dr. Nate Ritter  01:51

Yeah, thanks for being with us. So our questions today they're grouped by topic. These topics include progesterone, health testing, neonatal care, and vaccines. All topics I'm sure our audience will be interested in. Why don't we start with progesterone, it's a topic with special interest to you. I'm considering your publication that we referenced in the introduction. The paper is titled Comparison of a point of care analyzer with chemiluminescent immunoassay for serum progesterone measurement in breeding management of the bitch. Should anyone be interested in looking that up? But starting with our questions? Are all machines the same? Is it just about the speed of the test, you know, in house versus sending it out? But what are your thoughts? 

Dr. Julia Zuercher  02:31

So great question. And you know, all these topics that we're talking about today could very much be a whole podcast in of themselves. So we're kind of skimming the surface on some of this, but try to keep it useful to our listeners. What do you need to know? What are the take home points from these things? So the bottom line is no, not all the machines are the same. And this is a common question and a common discussion that I have with a lot of my breeder clients. Progesterone is a very conserved molecule, which means it's stable. And testing in theory, the value is going to be the same, should be the same one way or another. But there are various different literal ways that we test them that vary. And so the gold standard, what we know is reliable and accurate that value is what it is, is the Immulite. And that is either a giant tabletop analyzer that some clinics have, or what we call the attic, send out test which any vet can order, because it goes through the lab just like they normally do. That test, we know is going to be accurate, we know that that value, if we tested it again, and again, would keep coming up the same. Because it's a sundown test, unless you have the tabletop analyzer, we don't get those test results back until the next morning. And so a lot of various groups have started trying to come up with tests that get results faster, which I'm all for, because you know, as well as I do when the cycle starts, and we're managing things, things move quickly. And it's nice to be able to have these results faster to make these decisions. The problem is the testing methods differ with how they are actually tested. And so some of the values are not really useful clinically in terms of what we get. And so our analyzer or the paper that we were analyzing was the IDEXX catalyst, which is a common test because a lot of vets already have the equipment to be able to do it. The big pro is that you get results in 20 minutes or less, which is great. I would love to be able to make my decisions that quickly with my breeding bitches. The downside was we found that the way the test worked, if the number was below a two nanograms per mil, the value was actually decently comparable. We could trust it. But above a two it turned into how I phrase predictably unpredictable, we know that it's going to be off. But we don't know how much we don't know how we can account for it, you know, it may just jump dramatically and make it look like we missed the timing, it may look like we stalled, but actually she ovulated like there can be some variation to that. And the whole reason that we did this research when I was at Virginia Tech for vet school was because we were getting a lot of bitches referred to the Theriogenology service up there for infertility. And it was actually just that they'd been timed on this in house catalyst. And as soon as we timed them on a different machine, they got pregnant. And this was happening again and again, and made us look into, okay, what are these testing methods? And how do they compare themselves? So that's a long answer to know not all the machines are the same. It's comparing apples and oranges between tests because on one analyzer, things may be higher or lower versus another. And so it's also really hard to jump between analyzers to get a reliable result. If you're doing timing, I recommend sticking with the same analyzer so that you can monitor that trend versus hopping around and you don't know what she's doing. 

Dr. Nate Ritter  06:19

Yeah, absolutely. And not just true progesterone, right. I think we have plenty of cases where the machines differ from hospital to hospital when you're running CBC’s, or Chem’s or what have you. So definitely important to keep in mind and sound advice. And very, very interesting. kind of piggybacking off of that, what if you need to do another progesterone, but the analyzer at the studs vet is different kind of if your hand is forced, how do you handle that?

Dr. Julia Zuercher  06:42

So in the real world, what does reliability mean for you and your cycle? If you're traveling to the stud, and you have to get a progesterone at a different vet, a lot of that depends on how much error you can afford to have. If you're doing a natural breeding, and you're driving to the stud and they're doing it themselves, then you can afford a little bit of inaccuracy because fresh semen is going to last for seven to 10 days in the reproductive tract, you have a little bit of wiggle room, whether she completely ovulated that day, or whether it was the next day. But for instance, if you're doing a frozen semen breeding, and you are using the last of a 30 year old, frozen stud, which we've been in that situation before, once you saw that semen it lasts for six hours, so your timing better be accurate, you do not have room for error. And so how this all applies to you is where you are in terms of what you're doing that cycle, how much error can you afford to have. And that helps you choose whether you can do it in house or whether you need to do something else, that's going to be more accurate. And if you're going to the stud's vet to pull a final progesterone, you can always call ahead and see what analyzer they use. And if it's one that your vet doesn't use, or you can't find a middle ground, you can always opt for the send out even for the whole cycle because that is going to be accurate, the lab that you send it to is the same. And so you know that you're comparing to the same machine the whole way. If that's going to be a situation, you know, you're gonna find yourself in.

Dr. Nate Ritter  08:21

Yeah, absolutely. I mean, you've referenced accuracy a couple of times, I was wondering if you could explain the difference between precision and accuracy and why we might care about that.

Dr. Julia Zuercher  08:31

Yeah. So accuracy is how close the value is to what the real value is. So if it's accurate, it is what we want it to be. If it's precise, it's repeatable, you keep getting the same value over and over again, and it's the same and you can have one without the other, you can be repeatably wrong. But you need to know what the factors are that you are testing for. And again, just helps you understand what you're doing and how this may impact you long term of the cycle.

Dr. Nate Ritter  09:06

Yeah, absolutely. And like you mentioned, that can have an impact on whatever method you may be choosing. So if you could expound on that a little bit. What does that mean for a breeder and their bitch, you know, different methods that they might be pursuing? 

Dr. Julia Zuercher  09:19

Yeah, so this is where it might hospital in a lot of other clinics. You'll sit down with that before the cycle and talk through what is the plan for the cycle and that's, Are you doing a natural breeding? Are we doing a side by side collection? Are we getting semen shipped? Is it frozen? How many readings are we doing? What is the stud's quality? Do either dogs have fertility concerns? You know all these things play a role in how we make our decisions about timing for breeding and again, helps us decide the wiggle room we have for error whether we need 100% accuracy or whether we can afford to have a little bit more?

Dr. Nate Ritter  10:04

Yeah, makes sense. Great. So onto you know, these topics are a little bit disparate, but health testing another very, very important. I'm sure you've had this conversation and readers may fear bad results when they have either their events or their study tested, and how do we, you know, empower them and make this recommendation still, when the unknown is unknown. 

Dr. Julia Zuercher  10:26

I feel like the big scary thing with health testing is that everyone's afraid that they can't breed a dog. And that the result is going to say no, and I don't look at health testing as a pass fail, I don't think inherently you could fail health testing. And I think once you phrase it this way, it kind of helps make it less scary and helps make it more of a puzzle piece. You know, so many breeds already have such small gene pools, you can't afford to toss a dog out of the gene pool. And especially, I'm not going to throw a dog out for like one issue, unless it's a very severe issue or something. I mean, for the most part, you have to look at the dog as a whole. And so when I think of health testing, I think of what strengths does this dog have, what weaknesses does this dog have? And how can we pick a stud or a bitch or whatever side you're on to help compensate? You know, she's got bad hips, okay, maybe we pick a stud with better hips. It's never about how we throw a dog out. It's just helping us fit the puzzle pieces together to help empower breeding programs and get what you're breeding for or against.

Dr. Nate Ritter  11:36

Yeah, definitely a tool in your toolbox, if you will. Speaking of health testing, specifically, kind of two general categories, phenotypic and genetic testing, can you talk about the difference between the two of those?

Dr. Julia Zuercher  11:49

Yeah, so phenotypes are what the dog actually has versus genotypes is what genes they may carry. So they may not show those things, but they may have that in their genetic makeup. And so all genetic tests rely on literally looking at the genes that the dog has. And that can be blood or cheek swab, or you know, whatever tests you're doing may require different things, versus phenotypic testing or things like your eyes, or cardiac or hips, elbows, thyroid, things that show you what the dog is in that moment. And so, every breed is different in what problems they have in the breed and what things we need to test for. And so some breeds have genetic things. Some breeds have phenotypic things, some dogs have both, my breed has both. And so it's knowing again, what you're testing for, and what issues are in the breed. And, you know, Good Dog has their list of recommended testing, same with breed clubs and the OFA as well. It's not always cut and dry. What test a breed needs. You know, not every breed needs hips, for example. And not every breed needs Von Willebrand or concern for, you know, disc disease or dwarfism or other things. And so, I encourage everyone to look at what their breed actually needs, I find that a lot of breeders are going with the genetic panels, and that alone counts as health testing, and some breeds it does. But a lot of breeds, there are other things we need to test for, like those phenotypic things that the genetics aren't going to show us. We have to do those other tests, whether it's X rays, or an echocardiogram or having an ophthalmologist look at the eyes to see what is going on with that job. 

Dr. Nate Ritter  13:40

Definitely, you need that full picture. And a lot of those tests, you know, you need to repeat those tests, because things may come up later that weren't appreciated earlier. So really, the more that you can do, the better. Like you said, putting those puzzle pieces together, leaning on different resources, your veterinarian, your breed club, OFA, mentors, communities such as Good Dog reaching out to ensure you know, you're doing things that you shouldn't be doing. A specific test, you know, hip dysplasia, testing, they're kind of two ways to approach that. And you know, as we referenced earlier, you are PennHIP certified. Just very cool. Was wondering if you could explain or, you know, a brief overview of PennHIP versus OFA hip testing, we get this question, as I'm sure you can imagine a lot. 

Dr. Julia Zuercher  14:23

Yeah, and again, this is one of those prime examples of things we're talking about today. That could be a topic in and of itself, and I think has been, if I remember correctly, so PennHIP is sort of a more thorough hip evaluation, it's 3 x rays, and you get a numerical value assigned to your dog and their hips, each hip, for how much laxity there is. So each breed is separated out to determine a breed average and what the range is for that breed. The scores range from zero, which is no laxity, that's the dream, you're never gonna get it. And, and one, which is 100% laxity, they're terrible. Hopefully we don't get that. And you want to be somewhere in the middle. And what that number is depends on your breed. And that's part of what the PennHIP report will tell you. And hopefully what your vet will go through with you if you do that. OFA will recognize PennHIP, but it's different than obviously the tried and true, but what they hit, which is just that one classic OFA x-ray, that is one of the three that we send to PennHIP. So you're double dipping, we have some breeders have us send both, but it's just one as opposed to those additional 2 x-rays. OFA is great. I'm a huge proponent of any testing is better than no testing. But the biggest con of OFA is that it's a subjective measurement. So the radiologists look at it, they say, excellent, good, fair, you know, dysplastic, how dysplastic you know all those things. And it can be really hard to make decisions off that alone. Because you don't necessarily have the guidance to pair those dogs as opposed to PennHIP, it's this dog is this number, if we breed to this number or less we'll start to shrink down that range will start to get those values better. And there have actually been studies that show that if you use PennHIP values to breed for better hips, you will achieve that significantly faster than using OFA alone just because of that actual numerical value versus the subjective measure. So pros and cons to both, you know, again, always a proponent of something, but PennHIP is going to be more thorough and get you more information. And if that's something you're dealing with, with your breed or with your breeding program itself, it's going to help you make improvements a lot faster. 

Dr. Nate Ritter  16:51

Yeah, great overview. Moving on, yet again, neonatal care. And this is I'm sure you can imagine, repetitive here, obviously, these are the frequently asked questions. So no surprise that you're seeing these often. But why is monitoring weight essential with neonates?

Dr. Julia Zuercher  17:08

Yeah, so as our listeners know, when puppies take a turn, it happens quickly. And it can be very serious, very suddenly. Tracking weights, I recommend my clients do it twice a day, especially those first two weeks, tracking weights, helps you see who's gaining weight, who's not, who's losing weight, who's plateauing. And that can actually help you intervene faster before the puppy actually starts having issues, which is nice, especially when time is essential to have a heads up that there may be an issue. Puppies are supposed to, you know, in an ideal world gain about 10% a day of their body weight. And so especially if they're continuing to not gain if they're losing, by monitoring, you can catch that faster. Versus if you're going off of when they look like they're growing, which I get with big litters and you know, everything else going on in life, it can be hard to catch it until they are actively having issues and then that's an emergency situation.

Dr. Nate Ritter  18:09

Absolutely. If we need to supplement milk, can you kind of talk about the different options there tube feeding, bottle feeding, syringing? 

Dr. Julia Zuercher  18:17

Yeah, so one common thing that we get is either mom can't nurse puppies or puppies not latching or puppies failing to thrive or fading or you know something, and we have to intervene. Feeding is one of the biggest things. And there are pros and cons to everything. So the concern with puppies and milk is aspiration. And that's that the puppy basically inhales some of the milk it goes to the lungs and it can lead to aspiration pneumonia, which can compound anything else that we're dealing with with that puppy. And so my recommendations for this is tube feeding is best because you know, it's going to the stomach. I know it freaks a lot of people out and I walk people through it all the time. As long as you're in the stomach and we show you how to confirm that with either the way you're pulling back on the syringe or you know getting milk or getting air you know, things like that appear in the lungs. As long as you know you're in the stomach, then you're far enough down the tracks that the puppy can't inhale that milk. So I know it can be scary for some people, but that's going to be your most surefire way. If you choose bottle feeding, you know tube feeding is carried on with equipment, things like that. Then I recommend the premature nipples like the preemie nipples, because they're going to have a slower flow. Because again, if there's too much too quickly in that puppy's mouth, it can then go into the airway and cause issues. I tend to advise against syringe feeding at all possible again, because you're just ending up flooding that mouth with milk, you're gonna be at higher risk of aspirating and you're gonna potentially run into those other complications. So multiple ways to go about everything, but again, it's planning ahead and trying to get ahead of what issues you could run into on top of everything else you're doing. 

Dr. Nate Ritter  20:06

Definitely, and make sure to work with your veterinarian, you referenced showing clients how to do this appropriately. I think that's key. There's certainly a lot of content, whether it be online or what have you, that you know, may show you but definitely work with your veterinarian to ensure you're doing that appropriately. The three H's of critical puppies, hypothermia, hyperglycemia, and hypovolemia, could you speak to those and why they are so critical? 

Dr. Julia Zuercher  20:29

Yeah, so there are basically three things that take puppies out. And it's being too cold, their blood sugar tanking, and getting dehydrated. And so these are all things on my radar when I have a critical neonate brought to me is what we do with this. So I'll start with temperature, puppies run warmer than even adult dogs. And they need to be kept warm, and they can't regulate their own body temperature for the first couple of weeks of their life. So there's a fine line, obviously, between getting them too warm and cooking them, versus making sure that they're where they need to be. One of my catchphrases that we have at work whenever we deal with neonatal emergencies is a puppy isn't dead until it's cold and dead, because it's amazing how many puppies are cold, and basically it's the body shuts down. And once you rewarm them, it starts to function again. And so we don't make any decisions until the puppies' temperatures are above 98 degrees. 98 is the minimum temperature that puppies need to be able to have the GI movement, have stuff move through their system. And so you know, if they're not nursing, but also they're cold, then I don't necessarily care that they're not nursing, because no way of getting them milk is going to get them the nutrients they need. So that's always one big thing on our radars. Okay, let's get them up to temperature. The next biggest thing is blood sugar. You know, puppies feed all the time, they're constantly nursing with mom, they have to feed, you know, at least every couple hours. And if they aren't nursing, if they're, you know, failing to thrive, things like that, then their blood sugar can tank really quickly. And we can just see that again, the body can start to shut down. Sometimes we get seizures, sometimes we get other things. But again, we need that blood sugar to come up. And so that's one thing that I'm always going to be checking for is where are we? do we need to give basically sugar IV, do we need to give it across the gums? Do we need to tube feed? What do we need to do based on how the puppy's doing to get that blood sugar back up. And then the last big thing that takes puppies out is dehydration. So puppies, again, because they can't control anything else, they also can't necessarily regulate blood volume as well. And so they're very sensitive to getting dehydrated. And so with that, you know, obviously we supplement fluids either tube feeding depending on how they're doing versus giving under the skin or in the bone or you know, various methods depending on how severe the puppy is. The biggest thing for people who give fluids at home is puppies don't absorb fluids under the skin the same way that adult dogs do. And so you know, adult dogs, you may give this giant bolus to and they have the camel hump and it goes away after a couple hours, puppies can't handle that much. And so they're not going to be able to absorb that to the same extent. So comparatively, the amount of fluids that you give a puppy is significantly less. So for instance, it's like a mil per amp, which sounds like nothing but also puppies are tiny, and they're going to absorb that. So it's not going to be the same giant bolus as you'd give an adult dog.

Dr. Nate Ritter  23:28

Yeah, definitely. And once again, you know, work with your veterinarian there to ensure you're administering that appropriately administering the right amount. Should you have an issue? What should you do on the way to the vet, obviously, every second counts. So what are your recommendations there?

Dr. Julia Zuercher  23:41

Yeah. So you know, I get that not everybody is comfortable with neonates, some schools don't really teach a lot of neonatology. And honestly, some of my breeders and breeders in general, have more experience with neonates, then some of our colleagues. And so I know that it's not necessarily uncommon to have a heck of a drive to get where you need to be to the vet that's going to help you out. And so I have a lot of clients that say, hey, we're on the way, you know, what do you want me to do and they haven't, you know, an hour drive or whatnot to get there. The biggest thing again, because we're dealing with those three things, the low body temperature, low blood sugar and dehydration, what I want to do is prep them ahead of time, and then try to get ahead of the curve. So, you know, bring the puppy on a heating pad, have them wrapped in lots of clothes. If the puppy is still nursing, bring mom and the rest of the puppies so that they can continue to nurse and get the sugar they need. Make sure that if you don't have somebody to watch mom and the puppies, that you bring them with you because it's not uncommon at the ER to have a wait. You don't want the rest of the puppies to not be getting the milk that they need and their blood sugar tank and all those things. And so it's planning ahead either having somebody watch mom and puppies bringing the whole group with you, making sure there's a little warm everyone. We have a puppy warmer incubator at our hospital that will be for the rest of the litter if you need to bring them. I know not everyone does bring a heating pad to put under whatever you have as your basket to try to help keep puppies warm, put towels in the dryer, you know all these things. And again, because of blood sugar, what can we do to keep that up? I always recommend having Karo corn syrup on hand, you can wipe a big swipe full on the puppy's gums, they start to absorb the sugar through the membranes. And at least we can again, get ahead of the curve that way. So basically, try to keep them warm, give them some sugar, bring all that stuff with you. And make sure you're also watching the rest of the litter have a game plan for the rest of the litter to make sure everybody's okay.

Dr. Nate Ritter  25:40

Great. Be prepared to talk with your medical team to make sure if the worst happens that you can do your best to try and rectify that. Our final topic is vaccines.  To start with, how many DHPP shots does a pup need? You know, I think a lot of people think about it in terms of the number of vaccines and not necessarily the timing. But you and I both know that's not the case. 

Dr. Julia Zuercher  26:03

Yeah. And again, all of these could be their own separate topic, I have to laugh this is like whack a mole-ing various, so it's like the speed roller coaster of puppy care. So yes, for vaccines, I always get that question in terms of like total number. And it's not the simple not so simple answer is two vaccines, two to four weeks apart after mom's antibodies have waned, which we'll come to in a minute. So I almost compare it sometimes like jumping on a trampoline. When you get that first vaccine going fine. And then somebody jumps at the same time as you do and you spike up, that's what that second vaccine does. It really just brings up that immune response for that puppy to make sure that it's actually working. And so timing really is essential. In terms of after mom's immunity wanes. So puppies get some immunity through the placenta and through mom's milk that help them in their early days of life trie to fight off anything that they could be exposed to. With time, that wanes and it depends on the puppy when that is, you know, how much did mom have that she was able to transfer? How much of that colostrum did the puppy get in that timeframe. If some puppies that could wane as early as like six weeks, if they didn't really nurse on mom, some puppies that could wane like 12 plus weeks. And we don't know when that puppy is going to have that issue. And so there are two ways to go about that. One is nomographs, I believe University of Wisconsin is the main go to for that, that you can pull blood on mom at least two weeks prior to her whelping to see when will her immunity wane in the puppies. And when exactly do you need to do those two vaccines and they will get that for you. That's nice, obviously, because it takes a lot of the guesswork out. But there's still a lot of caveats. Again, that's a whole conversation of how that works in the first place. And what you need to do from there. The other way, which is what a lot of people do is booster every two to four weeks from the time they're six to eight weeks until they're, you know, 18 weeks or so, 16-18 weeks, trying to catch that timeframe. So those vaccines, say the puppy's immunity doesn't wane until they're closer to 12 weeks, then that six week shot isn't really going to do anything for that puppy. But if the puppy's immunity is waning at six weeks, we are protecting that. And so that's why those boosters happen along the way trying to catch when that decrease is going to occur. And so without having the demographic without doing the titers on mom, it's a little bit of a guessing game. And that's why there are those repeated boosters. So I would say minimally, I would do one like 12 weeks and 16 weeks. But if there's any question of when else we need to do these vaccines, two to four weeks along the way.

Dr. Nate Ritter  28:53

Great. Yeah, a really good explanation. I think a lot of people get confused with that. Not all vaccines are made equally, if you can kind of expand on that a little bit.

Dr. Julia Zuercher  29:04

Yeah, so vaccines vary in terms of how well the puppies' body will respond to it both in terms of mounting an immune response. And also, you know, possible complications from the vaccine, you know, all these other things. And so not all vaccines are made equally. And honestly, some vaccines are better than others, they're going to be more reliable in terms of how they work for the puppy. They might be pure, they may have fewer additives in it that could cause a reaction. You know, it's not uncommon to see 30 different distemper/Parvo varieties, right. But the reason there's so many different varieties is because they're all slightly different, you know, what ingredients are in it, how well it works, how well it's been studied, all those things. And so it's not just about getting puppies vaccinated. I mean, obviously, that's part of it, but it's getting them vaccinated quality vaccines. The other big caveat is the handling, you know, the purest vaccine in the world isn't going to do anything if it gets above a certain temperature. And so it's really essential that it stays below a certain temperature for all the handling, never gets the chance to warm up, you know, nothing that's going to inactivate it along the way. And so that's where, you know, for instance, practice five vaccines, you know, you'll get like the what, like 15, way, I don't even know half of what's in it sometimes. And then also, has it been kept cold the whole time? I don't know. Versus, Look, I get that giving vaccines is not necessarily rocket science. We dispense vaccines to our breeder clients all the time. If you want to do it, that's fine to do with a quality vaccine. And so if there's any concern about what vaccine you're using, you know, how you well you think it's working, how reliable you think the source is for that, talk to your vet, they'll be happy to give you recommendations of you know, hey, I like this one over this one, I would do this. Maybe they can dispense it for you. I don't know where you are. But those can all be options just to make sure that puppies are getting the vaccines they need when they get them.

Dr. Nate Ritter  31:05

Yeah, really, really good recommendations. That is all we've got for today. Thank you so much for taking the time to tune into this week's episode. We would also like to thank Dr. Zuercher for her time and willingness to educate our community. We hope this information was helpful. And yeah, we appreciate you tuning in and we'll see you back here for our next episode. Thank you for listening to the Good Dog Pod. We'll be back in two weeks with another episode so be sure to subscribe to the Good Dog Pod on your favorite podcast platform.