Just like people, pets can develop arthritis from injury or age-related changes. Arthritis in dog and cats can cause discomfort and pain, slowing an animal down, making them seem older and less able to enjoy their favorite activities. In this episode, veterinarian and Certified Canine Rehabilitation Practitioner, Dr. Jennifer Fletcher, discusses:
- How to recognize signs of arthritis in dogs and cats
- How your veterinarian might diagnose arthritis
- What treatment options are available.
Dr. Jennifer Fletcher, Certified Canine Rehabilitation Veterinarian
[00:01:04] Dr. Lancellotti: Welcome, everyone, to today’s episode of Your Vet Wants You To Know, in which we’ll be talking about arthritis- a very common condition seen in dogs and cats. Today, I have with me a special guest, Dr. Jennifer Fletcher, who is going to be talking about this disease, the different options that we have available for treating these pets, and helping them get a little bit more mobile in life. Welcome, Dr. Fletcher.
[00:01:29] Dr. Fletcher: Thank you for having me.
[00:01:31] Dr. Lancellotti: Tell me a little bit about your background and what got you interested in canine rehabilitation and physical therapy.
[00:01:39] Dr. Fletcher: What really made me find the physical therapy rehab bug was having knee surgery during sophomore year of vet school and did not receive good therapy afterwards. And I went to my surgeon, and he said, “You may just never run well again.” That, to me, was not the goal of having surgery. So, I rehabbed myself. Then, in practice, I wanted better for my patients. I realized that there’s a whole world of rehabilitation out there, and as soon as I could, I dove right in.
[00:02:10] Dr. Lancellotti: That’s awesome. How frustrating that must have been for you- to go through that surgery, wanting to be able to recover and get back to physical activity, and hearing that maybe that’s not in the cards for you.
[00:02:23] Dr. Fletcher: Right. I even said to my surgeon, “My goal is to be able to run comfortably. I’m not out to win marathons, but I want to do it recreationally in races.” But he didn’t recognize that, so I was frustrated, and that pushed me to ask every owner I see in rehab, “What is your goal?” What do they want to get out of it?
[00:02:43] Dr. Lancellotti: Yeah, absolutely. What is it that you’re doing to try and maintain the pet’s quality of life? Tell me a little bit about the training that goes into specializing in rehabilitation.
[00:02:56] Dr. Fletcher: After becoming a veterinarian, a physical therapist, or a certified veterinary technician, you can apply to one of the rehab schools. I went to the Canine Rehabilitation Institute, which partners with Colorado State University- which is my alma mater twice over. It took me about a year to complete (January through October), and it consisted of three trips to about five day courses, and then also a 40-hour internship, each course having an exam. Then, you had to pass your internship as well. So depending on how quickly you can get your travels done and the courses, it could be six months to a year of additional training outside your vet program. So, I’ve been doing this since 2017.
[00:03:46] Dr. Lancellotti: Okay. So a lot of extra training on getting to understand the process of arthritis and how to start making these pets feel better.
Why do pets get arthritis?
Dr. Lancelltti: Let’s talk a little bit about arthritis itself. Briefly describe to pet owners what arthritis is and what’s happening inside the animal’s body.
[00:04:04] Dr. Fletcher: By definition, arthritis is just inflammation in a joint. A joint is where two bones meet (ending in cartilage), and they are surrounded by this tissue membrane called the joint capsule. Within the joint is joint fluid and that’s the oil that keeps the joint moving. Arthritis is quite complex when you flush it out. It’s inflammation in the joint, but it also affects the cartilage, the bone underneath the cartilage, the tendons or ligaments that may be involved in the joint. The joint fluid itself changes drastically when there’s arthritis present, and so does the lining of the joint capsule. A lot of doctors and such always focus on the bones and the cartilage, but it’s the joint capsule that undergoes a lot of change. I tell owners that it’s kind of like the engine of a car. Whether your car gets really old, you have a bad part (a screw or a belt or something), or you don’t get your oil changed, over time, the engine doesn’t work as well anymore. Things get sticky. And that’s essentially what arthritis is. It’s a broken engine, if you will.
[00:05:17] Dr. Lancellotti: I love that analogy. That’s really good.
How can you tell if your dog has arthritis?
Dr. Lancellotti: So, what do you think a pet owner might notice, at home, if their dog is starting to develop arthritis? Or what if they have a cat that is developing arthritis? What are those first clues that they might pick up on?
[00:05:33] Dr. Fletcher: They’ll tell me that their pet seems to be slowing down. They just don’t get up as fast as they used to, they take a while to lay down, they take a while to sit down, they have trouble going up the stairs, they go slower on walks, or they don’t want to walk as long as they used to (if it’s a dog). They just feel like it’s due to age and not necessarily arthritis or the pain from arthritis, but it’s causing these pets to have trouble just doing some basic movements that maybe they used to do more readily.
[00:06:07] Dr. Lancellotti: So overall, they’re just getting a little bit slower. Maybe they seem a little bit sore- not quite as active and energetic and bubbly as they used to be.
How can you tell if a cat has arthritis?
[00:06:16] Dr. Fletcher: Cats can be a little bit tricky- true throughout veterinary medicine. Most cats aren’t walked and they’re just generally a sedentary species, but cats will show great hesitation to jump onto surfaces or they’ll miss the jump completely. They’ll start hiding more, their appetite can decrease, or even litter box problems can be a manifestation of arthritis. If the box is not in their correct location, it takes too much movement to go get to it, or it’s too high sided that it’s painful to get into the box itself. Any older cat that actually has litter box problems, I start to think maybe this cat has arthritis.
[00:07:01] Dr. Lancellotti: Yeah. If it’s a little tough for them to get their legs up and over the side of the box, that could cause some reluctance to go in there and use it normally.
How is arthritis diagnosed in dogs?
Dr. Lancellotti: If the pet is experiencing some of these signs, what might a veterinarian discuss with a pet owner in terms of diagnosing arthritis?
[00:07:17] Dr. Fletcher: Diagnosis for me starts with my physical exam or I do my rehabilitation exam. They’re slightly different, but you feel the bones and the joints of the pet to determine if there’s any abnormal thickening or swelling in the joints. We then assess the range of motion- how much flexion or extension the pet has in the joint. There are normal ranges, at least for dogs, not necessarily for cats, because they’re a little bendy. But in the rehab world, we do have a normal set of ‘range of motion’ degrees, so I will measure that in a rehab exam. If a dog has 140 degrees of extension in one of its knees, that’s about 20 degrees off of what I consider normal for most dogs, so that would lend me to think that there could be something wrong. Or if I’m doing that range of motion and the pet is painful in any part of that range of motion, that will help me diagnose there’s a problem within that joint. Then, once the painful area or the thickened joint or the decreased range of motion is detected, we then go on to usually take an x-ray. That’s what I have at my facility. We can look at the bones to see if there’s any abnormal flecks or swelling within the joint that you can see on these x-rays. If needed, I can always refer to a specialist that may have a cat scan or an MRI, if it’s just not making sense between a normal x-ray and a painful patient.
[00:08:50] Dr. Lancellotti: So if it’s not super clear, there are some more advanced options available. But generally, an x-ray is something that’s really helpful in giving you that diagnosis.
How are cats diagnosed with arthritis?
[00:09:01] Dr. Fletcher: Ha! Cats. Again, cats are a little tricky. I actually did a clinical trial for arthritis and had to do so many orthopedic exams on them- flex and extend the joints, feel for thickening, swelling, pain, etc. Acting normal doesn’t always mean that there’s not a problem. Sometimes, you go a little bit based off of history with an owner. If they’re not jumping up as well anymore, then I go, “Okay, this is probably a hind-end problem. I’ll look at the lower back, the hips, the knees, and the ankles of the cat on an x-ray, just knowing there still could be arthritis present.
[00:09:43] Dr. Lancellotti: Yeah, cats definitely have a way of making it difficult for us to tell exactly what’s going on with them. They do their best to try and hide their diseases and their clinical signs.
Omega3 Fatty Acids for Arthritis in Dogs
Dr. Lancellotti: Once we’ve gotten the answer (and we know we’re dealing with arthritis), talk a little bit about some of the common ways to relieve the pain from arthritis, as well as some of the benefits and risks associated with them.
[00:10:08] Dr. Fletcher: I categorize the treatment of arthritis into two categories- traditional and non-traditional. Traditional methods of managing arthritis can start at the supplement, or what we call nutraceuticals. These are usually supplements using natural products to increase the joint’s health, and/or decrease inflammation of arthritis. These products would include things like omega 3 fatty acids, the glucosamine chondroitin sulfate products. I’m going to throw CBD in this category, just because it has not been regulated into a drug in any sort of way. But for the most part, omega 3 fatty acids are the most effective in decreasing joint inflammations (as far as the nutraceutical category goes). I tend to recommend dog and cat specific brands, because certain companies tend to make them in a higher concentration, and pets need a higher concentration than humans do in order to achieve the anti-inflammatory dose. Most dogs and cats need 30 to 40 milligrams per pound of omega threes to decrease joint inflammation. So if you take your average 75 pound Labrador, you’ll need at least 2,600 milligrams of omega fatty acids for that pet. Some dogs don’t tolerate the taste of human products (the fishy smell/taste), so the dog and cat specific products tend to be more palatable. I also recommend more of a small-fish source omega fatty acid (anchovy or sardine based oil).
Glucosamine chondroitin for Arthritis in Dogs
Dr. Lancellotti: Talk a little bit about glucosamine chondroitin, because I know a lot of pet owners will reach for that also.
[00:12:14] Dr. Fletcher: Yeah. These supplements have their place as well, but they don’t do anything necessarily for inflammation. They keep the joint fluid fluid-y, they prevent it from getting sticky, and glucosamine chondroitin sulfate are the building blocks of joint fluid. So if you continue to feed that into the body, then the joints use that to make sure that joint fluid remains healthy. Some pet-specific companies out there have been adding some natural anti-inflammatory ingredients to their glucosamine chondroitin products. So I think they have their place, as far as joint supplements. I still recommend And once again, I usually go towards certain companies that are pet specific, knowing that studies have done on those products.
CBD for Arthritis in Dogs
[00:13:00] Dr. Lancellotti: Perfect. You mentioned CBD. I know this is a hot topic in veterinary medicine. Tell me about the evidence-based research that’s been done using CBD for arthritis.
[00:13:14] Dr. Fletcher: Currently, there is only one study that has been done and it was at Cornell University. They had various ways of determining whether or not the owners felt that the patient’s arthritis had improved, as well as the veterinarians. The summary of the study is that they feel that the dose of two milligrams per kilogram helped. They’re exploring other doses for sure, as well as the side effects. I think it will have its place in arthritis management, but just not yet. There’s so much variability from product to product and there’s no current regulation to know if what you’re getting is correct.
[00:13:54] Dr. Lancellotti: Yeah. I agree. I think it will be very exciting to see more studies come out, giving us more data for this, so that we can confidently recommend certain formulations or certain products to help, without worrying about the risk associated with it.
[00:14:12] Dr. Fletcher: Agreed.
Medications for Dogs with Arthritis
[00:14:13] Dr. Lancellotti: Moving on from our nutraceuticals- tell me a little bit about common prescription treatments.
[00:14:18] Dr. Fletcher: When we talk about medications, the gold standard is the non-steroidal anti-inflammatory category (NSAIDs). There are more side effects associated with them. They are either metabolized by the liver or the kidneys. Therefor, we do blood monitoring frequently, if these patients are on them long-term. Most of these side effects are rare. The most common side effect I see in the NSAID category is GI upset (vomiting, diarrhea, descreased appetite, etc). And not every NSAID is created equal, so if one patient has a side effect on one particular brand, it is worth exploring different brands because they may handle a different brand better.
Medications for Cats with Arthritis
Dr. Fletcher: For cats, this is another tough category because their livers do not function like dogs. They do not handle the NSAIDs well with their kidneys either, so there isn’t currently a non steroidal anti inflammatory medication labeled for long-term use in cats. We have only one labeled for 3 days after surgery (soft-tissue or orthopedic).
[00:15:27] Dr. Lancellotti: Oh, I feel like cats are getting left out here too. They’re getting left out of the dermatology world as far as treatment of allergies and they’re getting left out with the arthritis too. Hopefully, within the next few years, we’ll have an update- and we can say some phenomenal new therapy has come on the market for cats and has changed their lives. That would be wonderful.
Gabapentin for Pets with Arthritis
Dr. Lancellotti: It sounds like there are a lot of different options with different medications to decrease inflammation. What about for pain? Are there different options that target just pain?
[00:15:59] Dr. Fletcher: Yes, there are. Sometimes in some of our older and more chronic arthritis patients, they need the multimodal approach. We use an anti-inflammatory. The most commonly used chronic pain medication for dogs and cats right now is Gabapentin. It is definitely the newest, hottest drug out there for use in chronic pain. It works in conjunction with the anti-inflammatory, so there’s no contraindication to using them together. It has a wide dosing range and it’s relatively safe. The most common side effect of this is sedation. And we even use it for some “spicy” cats. If they’re too stressed during their visits, we’ll actually use a higher dose of Gabapentin because we want that sedative effect for them. Then, there’s a closely related drug called Amantadine. It doesn’t have as wide of a dosing range, but it also attacks a different receptor from Gabapentin, working well for chronic pain. That’s the one I tend to reach for if a patient doesn’t tolerate Gabapentin. Tramadol has been used, traditionally, but it’s fallen out of favor recently. For cats, however, it’s a great option. They do have the receptor that Tramadol works against. The only downside is a very bitter taste, so we either have to hide it or formulate it so that they don’t want to spit it out, or start foaming at the mouth.
Weight Loss for Arthritis
[00:17:31] Dr. Lancellotti: What about other things that aren’t necessarily medications? Are there ways that the pet owner can address the arthritis and get the animal feeling better without necessarily using medications?
[00:17:46] Dr. Fletcher: This is another huge category- possibly, my favorite one to talk about. The number one way to actually help with arthritis pain in pets is weight loss, or just having them at an appropriate body condition. So if they’re already there, keep them there. If they are overweight, then we got to get the weight off. It is, by far, the best thing that you can do for your pets. Basically, weight loss is about calories, not necessarily about exercise. Making sure their diet is appropriate for the life stage, their calorie amount is low enough to achieve weight loss. And once again, this is best to do through your veterinarian for guidance.
Cheddar lost how much weight??
Dr. Fletcher: The best story I have about a weight loss win was this dog named Cheddar. He was a yellow lab who was I hate to use the word, but he was fat. I love Cheddar, but he got chubby. He had severely arthritic knees, and he stood like he was a cowboy who had just gotten off a horse. They were just widespread, outturned, and they were just so thickened. So, he was your average sized lab, but he was 116 lbs.
[00:18:58] Dr. Lancellotti: Oh my gosh.
[00:18:59] Dr. Fletcher: He was so overweight and he limped all the time. You could see him struggling in the exam room on our slippery floors. The owner said he wouldn’t go upstairs anymore. She and I had a good heart to heart. I said, “We need to get him to around 80 lbs. A year went by, and he came at his next appointment and he was 85 pounds.
[00:19:20] Dr. Lancellotti: Wow. That’s incredible.
[00:19:25] Dr. Fletcher: She did it! I asked her, “How’d you do it?” She’s like, “I really strictly controlled what he ate.” I asked, “How does he feel?” and she said, “He feels fantastic. He doesn’t limp anymore. He goes back up the stairs. He acts like a new dog.”
[00:19:42] Dr. Lancellotti: Oh, that’s amazing. That must’ve felt so good for her as the owner to see her dog get his life back, but also for you as a veterinarian to see what a big difference you made by taking the time and having that conversation with that owner. That’s got to be a huge amount of work for her to put in, but what a pay off!
[00:20:01] Dr. Fletcher: What a payoff! He didn’t need to be on meds anymore. It was amazing and the smile on my face was huge.
[00:20:09] Dr. Lancellotti: That’s great. Oh, that’s so wonderful. So get those pounds off, for sure!
Rehabilitation for Dogs and Cats with Arthritis
[00:20:14] Dr. Fletcher: Yes! But besides weight loss, there’s this whole category of complimentary or alternative medicine. But through rehab and what I do, I use a lot of these different modalities. There’s something called low-level laser therapy (or cold laser therapy), and this is the use of light at certain frequencies to increase blood flow to an area. This has shown to decrease inflammation and pain, and aid in healing. If there’s actual injury to that area. We use this alone, or we can use this in conjunction with medication, rehab therapy, and the nutraceuticals. We don’t put the laser over an area of cancer, pregnancy, eyes, or the thyroid- things like that. There are certain areas we don’t want to increase blood flow, so if a patient does have a known cancer or something, then that’s out for them at that time. We use low-level laser as a part of rehab, and not only is it for dogs, but it’s for cats as well. Basically, we do everything your physical therapist would do for your pet. We’ll do laser therapy. We use tens (electrodes on your muscles and do little slow twitches). You’d be surprised. You would think it’d be something that they would absolutely hate, but they love it once they realize what’s going on?
[00:21:30] Dr. Lancellotti: Yeah. It feels great.
[00:21:31] Dr. Fletcher: It feels fantastic. We have some dogs who sit in our laps and get all ready for us. We do joint mobilizations. Think of what a chiropractor does- high grade mobilizations. We treat their pain and they feel more like moving around, so then we create an individualized therapeutic exercise program. We’ll get them an underwater treadmill (heated), so these pets actually have kind of like a spa day. But they walk in the underwater treadmill to help decrease the gravity on their bodies and help them walk better. Some of these old guys that I’ll see until 14-15 years of age- we’ve given them 2-3 years that they wouldn’t have had.
[00:22:13] Dr. Lancellotti: I love the concept of rehab. It’s always fascinating to see these really dramatic miraculous recoveries when an animal has had a trauma or injury or something. But I have to tell you- those older animals, who just come in once or twice a week for maintenance rehab, just to help them feel a little bit better- it was so nice bonding with that pet. Those owners would come in and they’d say, “Oh, yeah. We need some rehab. I can tell. As soon as we leave, they’re feeling so much younger, and by the end of the week, we know it’s time to come see you guys again.” It really makes a huge difference in these animals’ qualities of life.
[00:22:50] Dr. Fletcher: It does. Actually, an owner of mine wrote a children’s book that she wants to get published called “Sadie’s Spa Day.” It talks about her going to our office and going through her rehab day- because that’s what she calls it.
[00:23:02] Dr. Lancellotti: That’s adorable. I would love to read “Sadie’s Spa Day,” for sure.
[00:23:08] Dr. Fletcher: It’s so cute. I love it.
Acupuncture for Dogs with Arthritis
[00:23:11] Dr. Lancellotti: We did a lot of acupuncture when I used to work at the rehab facility. Is that something that your practice does as well? And what does that entail for pets with arthritis?
[00:23:21] Dr. Fletcher: We currently don’t offer it. We did for a short time, and then our veterinarian that did it left. It’s on my plan. For training, it usually it takes a year or two for each of these certifications. I’m kind of lining them up! But acupuncture has been around for 2000 years and it has helped immensely. It is non-painful and these dogs and cats and bunnies tolerate it quite well (maybe more so than humans, because they don’t even know that it’s a needle being used).
Platelet Rich Plasma and Stem Cell Therapy
Dr. Fletcher: Then, there’s this whole regenerative medicine part of arthritis management. We do platelet rich plasma injections. We’ll do stem cell injections. Basically, platelet rich plasma is a part of the blood that you can extract from a pet’s normal blood sample. We have a certain kit that we use to extract the red blood cells off. And it’s patient’s blood, so there are no side effects. Then, we inject it into the affected joint (knees, wrists, elbows, hips, shoulders). It can help these pets for 6-9 months (I would say) on average. Some pets get a little bit more or less, but we’ll repeat those injections, depending on how bad the arthritis is in the joint- usually, 2-3 injections spaced out by two weeks. Then, that pet will get maybe 6-9 to maybe even 12 months of relief in that joint.
[00:24:48] Dr. Lancellotti: Wow. That’s a significant period of time.
[00:24:51] Dr. Fletcher: It is. We do a little twilight anesthesia, so they’re just kind of drifting off to sleep. Then, it’s a quick injection. In humans, they don’t anesthetize you, but in veterinary medicine, we need to so they can sit still. But it’s a quick procedure in my office and they go home that day.
[00:25:10] Dr. Lancellotti: Wow. That’s cool.
[00:25:11] Dr. Fletcher: Yeah. And then we also do stem cell. This is a little bit more expensive than PRP injections. We’ll take fat cells from the patient, and then we’ll inject those stem cells into the joint, in hopes that they will become integrated into the cartilage and the joint capsule, and help repair some of the damage.
[00:25:29] Dr. Lancellotti: Interesting. So, there are a lot of different options out there- lots of different things for pet owners to consider and talk to their veterinarian about.
[00:25:36] Dr. Fletcher: For sure.
Further Resources for Canine Arthritis
[00:25:38] Dr. Lancellotti: What are some of the big takeaway points that you want pet owners to remember?
[00:25:42] Dr. Fletcher: Recognition or signs of arthritis may not be what you think they are. If you have any concerns about your pet just not acting like they did when they were 6 (and now they’re 10), bring that up to your veterinarian. See if they can find any problems in any of their joints. That may be the reason why they’re acting this way. Secondly, the most effective and least expensive way to prevent arthritis is to keep them at a lean body weight. Because you feed them less food, you’re not buying as much. Then, later in life, you’re not spending money on medications, vet visits, joint supplements, blood work to monitor all these medications, or rehab, etc. So if we can prevent them from getting that way, we can actually prevent arthritis.
[00:26:34] Dr. Lancellotti: But if they wind up gaining weight, then we want them to be like Cheddar and lose all of that weight.
[00:26:39] Dr. Fletcher: Absolutely. 31 pounds. He lost a whole dog.
[00:26:45] Dr. Lancellotti: That’s great. This has been really helpful, as far as walking through arthritis and what options are available. Thank you so much. I really hope pet owners will use this information to make a difference in their pets lives and get them moving again.
[00:27:04] Dr. Fletcher: Thank you for having me and being able to spread the word about how many things that we can do for these pets.
[00:27:09] Dr. Lancellotti: Yeah, absolutely. There are a lot of great resources that Dr. Fletcher has provided for listeners. Lots of links!
- University of Tennessee CCRP program- utvetce.com
- CARE – canine arthritis resources and education; caninearthritis.org
Many family veterinarians are comfortable managing pets with arthritis, but if you want to find a rehabilitation therapist near you, you can go onto the resources page of the website so you can consult with someone who has advanced training.
Dr. Fletcher's Favorite Rehab Patient
Dr. Lancellotti: Dr. Fletcher has provided me with some really awesome images of one of her favorite patients that she’s treated in rehab over the years. Dr. Fletcher, would you like to share with the listeners who that is?
[00:28:15] Dr. Fletcher: Yes. Probably the most unique patient I have treated in rehab is a goat. She was paralyzed. We didn’t know why, but I treat so many paralyzed cats and dogs in rehab, and I’ve gotten most of them walking again- I would say close to 90%. So I worked on Vindaloo, my 9-month-old boar goat friend, and she was the sweetest thing ever. She enjoyed marshmallows and Cheerios, and she would “bah” at you if you did not give them to her quickly enough. It’s fun. It keeps me on my toes.
Scratching the Itch
[00:28:57] Dr. Lancellotti: I end every episode with the ‘Scratching The Itch’ segment, which is a segment that highlights something- either a human interest story, a product, or a website that either provides relief or just makes you feel good. Hence, ‘scratching the itch.’ The goat definitely made me feel good, but do you have anything else that you would like to highlight on the Scratching The Itch segment today?
[00:29:25] Dr. Fletcher: I would love to highlight a product called the Help ‘Em Up Harness. This is the most common product I recommend to my pet owners. It’s mostly for dogs, unless you have a rather large cat or the small harness might fit them. But it’s an ergonomically correct harness that can go around the chest, and also around the hindquarters with handles. It’s a help for their dog, but it’s also a help to them, in actually lifting dogs in and out of the car, getting them up and moving. Or if they’re paralyzed in any sort of way in rehab, it helps them through their therapeutic exercises. These are so well-made that the pets can actually live in them if they need to. And I’ve had some owners go out and get some copycats and they just don’t work as well. They’re a fantastic company out of Colorado, which is where my heart lives (after living there for 10 years). They have fantastic customer service too, in addition to their amazing products.
[00:30:22] Dr. Lancellotti: I agree 100 % with you. When I was working in rehab, we constantly recommended the Help ‘Em Up Harness and it was a game changer. Especially for those bigger dogs, where they’re a challenge to actually lift. It really makes such a huge difference for people being able to get them up, so that they can get moving on their own.
[00:30:57] Dr. Fletcher: Absolutely. I totally agree.
[00:30:59] Dr. Lancellotti: Again, thank you so much, Dr. Fletcher, for coming on and for taking time out of your day to talk to everybody. I really hope people get a lot of good information out of this.
[00:31:08] Dr. Fletcher: Thank you so much. I had so much fun talking with you.
[00:31:11] Dr. Lancellotti: Excellent. For all of our listeners, I look forward to your next visit with Your Vet Wants You To Know.
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