Ever wondered how trauma transcends species boundaries, impacting both humans and dogs alike? Here's your chance to unravel this complex topic with us and our esteemed guests, Dr. Linda Randall, a seasoned veterinarian, and Dr. Kathie Nurena, a medical doctor with a wealth of knowledge. Together, we'll explore the multifaceted nature of trauma, the invisible scars it leaves, and how understanding it as a 'wound' can illuminate its impact.
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ABOUT LINDA:
Linda Randall, DVM is a Board Certified Companion Animal Veterinarian focused on the behavioral aspects of training in dog sports. She also brings positive reinforcement handling to junior handlers, who excel under her tutelage. A proponent and practitioner of the LIMA methodology, Linda brings multiple fields of expertise to the work of trauma informed care. She is certified in Living and Learning with Animals (LLA), Tag Teach (Level 3), and is also a KPA-CTP of distinction.
Linda is a past president of the Ohio Veterinary Medical Licensing Board, past president of the Board of the Medina Battered Women’s Shelter, and currently heads the Leadership Medina County Agriculture Day, where she emphasizes farms working with increasingly positive reinforcement handling and care with beef and dairy cattle. She was recognized by The Ohio State University College of Veterinary Medicine as an Outstanding Alumni 2022, and Medina County’s Outstanding Leader, 2022.
Linda owns a full-service training facility in Seville OH, One Smart Dog. You can reach her at: 330-958-9224, 1smartdog.LR@gmail.com,
ABOUT KATHIE:
Kathie Nurena is a doctor and a dog trainer. She graduated for Albert Einstein College of Medicine in 1999. She completed her Family Medicine Residency at Stamford Hospital. She is now faculty at that program, with an interest in social determinants of health and scholarly activity. She also graduated from Karen Pryor Academy (KPA-CTP) and earned her Certified Nose Work Instructor (CNWI) certification. She currently teaches nosework classes at Port Chester Obedience Training Club. She is a member of APDT and IAABC.
Kathie helped organize the first interdisciplinary conference for animal control officers, Department of Children and Families social workers, and other professionals in Connecticut, when cross reporting of child abuse and animal abuse became a law in that state.
She has long appreciated how the principles of learning theory and the positive reinforcement principles she learning in animal training were relevant to her work with human learners. And, perhaps, some of the theories in the medical literature may be useful to animal trainers.
Ever wondered how trauma transcends species boundaries, impacting both humans and dogs alike? Here's your chance to unravel this complex topic with us and our esteemed guests, Dr. Linda Randall, a seasoned veterinarian, and Dr. Kathie Nurena, a medical doctor with a wealth of knowledge. Together, we'll explore the multifaceted nature of trauma, the invisible scars it leaves, and how understanding it as a 'wound' can illuminate its impact.
The Aggression in Dogs Conference
The Bitey End of the Dog Bonus Episodes
The Aggression in Dogs Master Course and Expert Webinar Bundle --- LIMITED TIME SPECIAL OFFER
ABOUT LINDA:
Linda Randall, DVM is a Board Certified Companion Animal Veterinarian focused on the behavioral aspects of training in dog sports. She also brings positive reinforcement handling to junior handlers, who excel under her tutelage. A proponent and practitioner of the LIMA methodology, Linda brings multiple fields of expertise to the work of trauma informed care. She is certified in Living and Learning with Animals (LLA), Tag Teach (Level 3), and is also a KPA-CTP of distinction.
Linda is a past president of the Ohio Veterinary Medical Licensing Board, past president of the Board of the Medina Battered Women’s Shelter, and currently heads the Leadership Medina County Agriculture Day, where she emphasizes farms working with increasingly positive reinforcement handling and care with beef and dairy cattle. She was recognized by The Ohio State University College of Veterinary Medicine as an Outstanding Alumni 2022, and Medina County’s Outstanding Leader, 2022.
Linda owns a full-service training facility in Seville OH, One Smart Dog. You can reach her at: 330-958-9224, 1smartdog.LR@gmail.com,
ABOUT KATHIE:
Kathie Nurena is a doctor and a dog trainer. She graduated for Albert Einstein College of Medicine in 1999. She completed her Family Medicine Residency at Stamford Hospital. She is now faculty at that program, with an interest in social determinants of health and scholarly activity. She also graduated from Karen Pryor Academy (KPA-CTP) and earned her Certified Nose Work Instructor (CNWI) certification. She currently teaches nosework classes at Port Chester Obedience Training Club. She is a member of APDT and IAABC.
Kathie helped organize the first interdisciplinary conference for animal control officers, Department of Children and Families social workers, and other professionals in Connecticut, when cross reporting of child abuse and animal abuse became a law in that state.
She has long appreciated how the principles of learning theory and the positive reinforcement principles she learning in animal training were relevant to her work with human learners. And, perhaps, some of the theories in the medical literature may be useful to animal trainers.
This is a must listen episode as I have the honor of chatting with both Dr Linda Randall and Dr Kathy Nurena. With Linda's background as a veterinarian and Kathy's background as a medical doctor, we have a unique and insightful conversation around the topic of trauma in both dogs and people. Linda focuses on the behavioral aspects of training in dog sports and is a board certified companion animal veterinarian and also owns One Smart Dog, a full service training and behavior facility in Ohio. She brings positive reinforcement handling to junior handlers who excel under her tutelage. A proponent and practitioner of the Lima methodology, linda brings multiple fields of expertise to the work of trauma-informed care.
Speaker 1:Kathy graduated from the Albert Einstein College of Medicine and completed her family medicine residency at Stanford Hospital. She is now faculty at that program. With an interest in social determinants of health and scholarly activity. She also graduated from Karim Pryor Academy and earned her certified nosework instructor certification. Kathy helped organize the first interdisciplinary conference for animal control officers, department of Children and Family, social Workers and other professionals in Connecticut when cross reporting of child abuse and animal abuse became a law in that state. Kathy has long appreciated how the principles of learning theory and the positive reinforcement principles she is learning in animal training were relevant to her work with human learners, and perhaps some of the theories in the medical literature may be useful to animal trainers. And if you are enjoying the bitey end of the dog, you can support the podcast by going to aggressivedogcom, where there is a variety of resources to learn more about helping dogs with aggression issues, including the upcoming aggression and dogs conference happening from September 29 through October 1, 2023 in Chicago, illinois, with both in-person and online options. You can also learn more about the Gression and Dogs Master Course, which is the most comprehensive course available anywhere in the world for learning how to work with and help dogs with aggression issues.
Speaker 1:Hey, everyone, welcome back to the Bitey End of the Dog. This week I am surrounded by doctors, so we have Dr Kathy Norena and Dr Linda Randell. We are going to be jumping into the human and the animal side of the equation. We've been doing a lot of that this year in our episodes and if you've listened to some of the season openers as well as some of the upcoming episodes, I think you're going to see that general theme. So I'm actually really glad we're talking about this and I'm really happy to have these two special people on. So welcome to the show Kathy and Linda.
Speaker 2:Thank you, it's great being here.
Speaker 1:It's so great to have you both here and I kind of want to dive right in. We were kind of chatting around topics of what to talk about, but obviously trauma is something both of you focus on. You've talked about it in previous conference appearances. I've definitely taken an interest in it myself, especially in the last couple of years, with working aggression cases especially. So let's first kind of define that. I think it's important that we're on the same page of that word trauma or the topic of trauma. What does it mean? Maybe, kathy, we'll start from you, from the human side of things, how you would define that.
Speaker 3:I think it's interesting when you try to define something, you can go to that dictionary definition of trauma and they really have two definitions. They talk about a deeply distressing or disturbing experience and the emotional shock that follows, but they also talk about a medical definition of injury to tissue caused by an extrinsic agent. Right, it's important when you're talking with human medical doctors, what type of trauma are you talking about? I don't know if, linda, if you want to talk about a definition of trauma and then kind of evolve into that more emotional aspect of trauma.
Speaker 2:Yeah, I am an English literature major, so I always go back and say, well, where did it come from and how did it get to be what it is today? And just, it comes from a Greek word meaning wound, and of course originally it was tissue. And it wasn't until we evolved in our knowledge of what could actually be wounded, that it didn't have to be a solid thing, that we started using the word trauma to mean something. It could be psychic, it could be emotional, it could be tissue, it just could be anything. And I think that that's interesting because along the way wound came along for the ride. So we can be wounded, and we can be wounded emotionally, and it can be something acute or chronic. So that's where, that's how I look at trauma, and I think all of those applications apply to any species and to plants.
Speaker 1:Interesting and we were talking about emotions of Kathy. You want to expand on that as well, the emotional side of it.
Speaker 3:Yeah, for that I really went to SAMHSA or the Substance Abuse and Mental Health Services Administration definition of trauma because some of the movement coming out of there for health professionals is coming from SAMHSA and they define trauma as an event or circumstance that results in physical, emotional and or life-threatening harm and that these events or circumstances have lasting adverse effects on the individual, whether it's mental health, physical health, emotional health, social well-being or spiritual well-being. So I think they spent a lot of time summing that up and I think that's a good definition to work with.
Speaker 1:That's a really good definition and I think it's important to recognize that we don't always see it. So when we hear, like Linda was mentioning wound, right, we can kind of picture that in our mind of when somebody suffers an injury, of wound externally. But I think it's an appropriate word to help us understand also that it can happen internally, right, in the sense of it gives us a picture to wrap our head around that it's not just some disorder or some simple thing, right, it's an actual injury. So do you want to expand on the emotions aspect as well, linda?
Speaker 2:Well, actually I'd like to maybe I guess this really is emotion, but I'd like to shift it just a little bit, because when we're talking about trauma because in the end Kathy and I talk a lot about trauma, informed care so I'd like to just say that in animals we call it trauma, assumed care, and that is something that I think is extremely reasonable.
Speaker 2:And you know, sometimes when we name something we aren't as reasonable as we thought we were being. But I think that's true Because, unlike people, people may not tell you, but sometimes people do know what traumatized them. Sometimes they don't, sometimes they don't even know that they had stacked on traumas as a child and that's why they are the way they are as an adult. And when we look at most of the studies, interestingly we've been done in cats but on what's happening pre and immediately postnatally and what triggers and what stacking happens then, and then they follow the cats through and find that later on in life the kittens that were stacked end up having what we would call trauma or an affect of trauma. So and that would be something that maybe would be back to what you were saying emotional at that point, psychic or psychological it's an interesting thing that is not as well studied in animals, because of the difficulty, of course, of knowing these things, and so we make so many assumptions in animals. But, kathy, you make a lot of assumptions with people too, correct?
Speaker 3:I think we do right Heuristics or mental shortcuts to. You have limited amount of time with people and you have to make certain assumptions, and I think that's where this movement or this concept of trauma informed care is coming from. It was really interesting to do some more reading about it and where it came from, and a lot of it came from some of the substance abuse and mental health services work with women who were surviving domestic violence, intimate partner violence, those type of issues, and when they sought healthcare they were actually getting retraumatized because of the way healthcare systems are established. So just trying to make people sensitive to our actions have consequences and if you're talking about unseen trauma, you may not realize that what you're doing is doing more harm to this person, this patient in front of you. For healthcare professionals, doctors, nurse practitioners, all that so many of them went in to healthcare to help people and the last thing they want to do is retraumatize someone.
Speaker 2:Which does bring us around. I think very nicely to a couple of things. One is, if we're going to define trauma and we're talking about trauma-informed care, how are we defining informed? It sounds like we all might know what the word informed means, but do we really? Or how are we using it? How is it segwayed into where we are now? And so when we're informed, I think of it as we're basing our opinions and our way of moving in the world on reliable information and that we are knowledgeable and educated, that we're, let's say, you can say you're an informed consumer, or you're an informed doctor, or you're an informed animal trainer. You know what's going on, you rely on evidence-based practices, and so that's how I look at the informed. And do you have anything to add to that, kathy?
Speaker 3:Well, I think I've been very struck when you started using that term trauma-assumed care, because they liken it to universal precautions. I don't know if you know what that are, but if you're drawing blood on someone, you put gloves on for everyone and just assume everyone may have an infectious disease, or you don't want to transmit what's on your skin to the patient, so you just use universal precautions, and I think the same can be assumed with trauma. You don't have to know a person's ACE score, their adverse childhood experience score right, because you're not trying to judge. Is this person in front of me? Do they need special consideration? Do they need extra kindness or avoid re-traumatizing them? Because you don't want to judge a score? Is it three worse than a four in some circumstances? But if you assume that everybody's experienced trauma or has the potential to hurt from trauma, it's a little bit more helpful and kind to everybody.
Speaker 1:I'd love to just to distinguish those a little bit more, because in my mind I was kind of assuming which is another assumption of the word assume, but so informed meaning the person. With humans, they can often communicate their emotions. So we're making informed decisions based on what they're telling us, versus with animals, we can only assume it, we don't know for sure because they can't tell us their experiences. Is that the right distinction or am I off there?
Speaker 2:I think it's the right distinction, but perhaps we need to refine our language a little bit. And one would be to say I still think the word assumed in both cases is correct. We have more information from people if they're willing to give it. So therefore, there are other assumptions that we may need to make, but we don't want to do the book by its cover idea of this person walks in off the street. Well, they're homeless. And if they're homeless, all these other things must also be true.
Speaker 2:So there's, there's a lot there, and we can also read body language, and so it there's a lot with animals. I think just flip it a little bit that we're going to make more assumptions because we have less information. But they do give us information if we know how to read it. And so there you get more into the skill of I'm going to call it animal practitioner I don't mean veterinary and practitioner of the small P, just saying the person who is there in front of the animal doing training, working with, helping to mitigate circumstances that give this animal the feelings that it's got. So it does come into a bit of a gray area, but I do think that, just in general talk, general circumstances, using trauma assumed with animals gives us the leeway that the animal needs to be given.
Speaker 2:Yes In order to work with them appropriately. So, language does matter.
Speaker 1:Yes, very happy you made that clarity for me, because I think it's important Again to have more clear definitions of what we're talking about, which kind of leads me to the next question is about diagnostics or diagnosing trauma. So as trainers and consultants, I actually try to dissuade people from using diagnosis as something they would do as a trainer. That's more for medical professionals or veterinarians to diagnose a particular issue. So, for instance, cathy, you might diagnose somebody through assessment as having trauma or post-traumatic stress disorder or some of the technical terms we might use to label trauma. And I would love to hear also your thoughts, linda too, on the diagnosis or what you use to diagnose trauma and animal. So does that kind of make sense? What are the diagnostic factors and is it a diagnosis when you do label an animal or human with trauma?
Speaker 3:That's, I think, a big question and we certainly have diagnostic criteria for labeling someone with, say, ptsd post-traumatic stress disorder. There's certain criteria in what's now the DSM-5, diagnostic Statistic Manual for Psychiatry and PTSD was a relatively new addition. It wasn't in the first couple of additions of that. So we're really starting that evolution of understanding of what that is.
Speaker 3:What I think is interesting with this trauma-informed care approach to healthcare is it really can be for all healthcare teams. It can be for a primary care office that is seeing a patient for the first time and you may not know what their background is. And one of the tenets of trauma-informed care is trustworthiness. A person may not trust you in that first visit, in that second, in that third visit, and it may not be till over time where you start to piece together a bigger history or a bigger picture of this patient. So it isn't necessarily to diagnose them with a diagnosis from the DSM-5, with a psychiatric diagnosis, but it's how do you care for people in an environment that allows them their optimal health? I don't know if that makes sense. Whatever, it is your sugar's not well controlled for a diabetic, which is a little bit more of a straightforward diagnosis, and they're having trouble controlling their sugars? What other factors may be playing into it? But you're still treating the diabetes, but with consideration that there's probably a lot more going on under the surface than we realize.
Speaker 1:Interesting. What about you, Linda?
Speaker 2:Well, the first thought that came to my mind is the fact that trauma isn't a disease, so we don't really diagnose it in a literal sense or in a technical sense of the word diagnosing it. So, really, that's all I have to say about that section of it is but the theory or the path by which you might get to.
Speaker 2:Well, maybe there's more trauma here than we think. That can be something that can follow a logical diagnostic tree, so to speak, only if you can get the information, because otherwise we're right back full circle to what we're assuming may have happened and we may be totally wrong. And I think that happens to children a lot, and it happens to women probably, I would say, more than men. Just like, if we're going to take it into the animal world and trust me, I am not making comparisons here between children and women and the animals that I'm going to mention I'm just saying that within the animal world, we might say that an animal that was captured in the wild, with people chasing after them with jeeps and shooting them with tranquilizer guns and all of that, had a traumatic incident.
Speaker 2:What happens after that traumatic incident can take a lot of different ways and that one incident may be just that incident in that animal's life, depending upon especially if it was a predator or a prey animal in the first place. But if they keep happening and keep stacking, then we can start down our tree. Well, this happened, and if this had happened, the corollary would be we might have gone this way, but that's not what happened and we have knowledge of that. So I'm just taking an incident where we can take a starting place and move through it and 10 years later, when that animal is in a zoo somewhere and has a stereotypic behaviors, we may be able to trace it through that with diagnostics. Otherwise we're saying, well, this animal was caught in this country this way and now it's acting this way. I bet that was the cause. It may not have been.
Speaker 2:So it gets so complicated.
Speaker 1:It is complicated and I'm glad we're kind of working through these nuances because we hear those stories. Somebody, like a client, might say, oh, I think a man used to beat him or something like that. And so we're signing what we would assume are traumatic incidents or pass to the animals that we have no history on. We just make those assumptions. And so what do you look for? If you're going to say this dog is experiencing trauma or this cat is experiencing trauma, what does it look like when you make that statement Okay, this dog is. Is it because of experiences you've witnessed? And then you see the future, behavior change and responses or is it? Could it be something where we don't know the past but we see potentially what we think is trauma affecting the animal?
Speaker 2:Well, this is a place and Kathy just jumped in any time, if you know, where we really have to step back and look at it as ABA.
Speaker 2:I mean, we need to look at what's in front of us and we have to treat that.
Speaker 2:And then, as we know more whether about the animal or somebody comes forward and says I know for a fact that this happened, any knowledge that we can gain that's more factual, we can add it in and we can adjust accordingly. But with I would say probably 90, 95% of the animals in front of us that we're trying to help, that we want to label as being traumatized, the animal is best served by us being our best diagnostic selves, by just going back to the basic ABCs. Every behavior has a reason to be in existence with that animal and just because you see the same behavior in different species or in different individuals of a certain species, does not mean that that animal is getting the same consequence out of that behavior that we have. So we treat them as individuals and we just keep going back to the foundation. But we do that as doctors as well. We have to keep going back, which is how they discovered which we talked a little bit about before Pandora syndrome and cats.
Speaker 3:Yeah, this is a great place for Pandora syndrome. Yeah, to explain that because it's very interesting.
Speaker 2:And for years, decades, cats would come in, especially to a veterinary hospital, because they're keeping all the records. So we've had 2000 cats and of those, such and such a percentage has had come in with liver disease or urinary tract problems a huge one urinary tract problems and cats of all sorts of different kinds. And as they tracked those and started putting them into a database Dr Tony Buffington is the person who really came up with this it turned out these cats all went back to having environmental issues and what we're going to call. They call it a disease of anxiety, stress and anxiety, and you could relay all of these symptoms back to that. And so it started treating the environment and not the disease or the problem that the cat was being presented for. They would treat it was a bacterial infection. I'm not saying they didn't treat it, they did treat it. But the cause of it was not just bacteria, it was stress and anxiety.
Speaker 2:So that's become interesting and a huge, more recent part of that is treating the client. So now we have to treat the person as well, because who's got to change the environment and how do they have to change their life? And the clients get stressed and they get anxious and they're calling you up. They've got a cat with a chronic condition that's got this fancy name, pandora syndrome, and they're picturing that they opened the box, that all of these things came out of that just, and now they've got a sick cat. So they feel guilty and often need to seek counseling on that issue. So it is a very interesting problem. We haven't identified, as far as I know, anything like that specifically in dogs. However, we do know, just like with people, that stress, that stress, anxiety, depression, trauma can stack on itself and then cause liver disease, cancer, all sorts of things that are based on environment.
Speaker 1:Yeah. So to jump back into the human side of things, kathy, maybe you can tell us about what you look for in somebody that might be experiencing, or has had, trauma or is experiencing now in terms of what it looks like. So if we had our operational eyes, as they say, what does it look like for you? Or let's say, you have something that it can't even tell you much about it? Are you looking for some physiological signs, physical side behaviors?
Speaker 3:And I think it's a really interesting question because there are so many stories of people who've gone to the doctor and had something physically wrong with them, but their symptoms were attributed to stress or anxiety. So it's often always a diagnosis of exclusion. Or maybe the degree of symptoms that they experience will be exacerbated by stress, by cortisol levels. I mean, some of the studies look at cortisol levels when people are responding to stress. So you're really looking for a similar, I think, to what Linda talks about in Pandora's syndrome. Are people coming in? Are there symptoms in line with what they're presenting with? It's like we know appendicitis is very painful. Is someone having stomach issues? That seem what doctors call?
Speaker 3:And this is, I think, why we need trauma-informed care, maybe out of proportion. Their symptoms are out of proportion to their exam. And it isn't out of proportion to the exam, it's just the way that they are presenting. But how do we get to that root cause of what's making it so painful? Let's say, a painful abdomen.
Speaker 3:You will look at different things. Is it a urine infection? Is there some type of bowel or gut disease? What else might be going on? But it's a really fine line to say that, oh, this is stress. But if you're sensitive to the community that you're in and how much stress or how many of those adverse childhood experiences the community has experienced in general, you may be more sensitive to how you approach each patient you know with their symptoms, understanding that it can be very painful. Whatever you know symptom you're experiencing and it's not out of proportion to your exam or your diagnosis. That's kind of a preconceived notion that the provider would bring there and that that isn't fostering trustworthiness or collaboration that you really need in your doctor-patient relationship or your provider-patient relationship to get to better health.
Speaker 2:So, which is where, I would think, then one health comes in and that we're taking all of this and trying to make it more congruent. So veterinary students are spending time at hospitals and medical students are spending time with veterinarians, and especially at universities. You see a lot of sort of cross there to see how all of this works in the different communities. And then we have Align Care and Street veterinarians and Spectrum of Care, which I would say right now are the three biggest things that I wanted to say on the horizon. But they're not on the horizon. They've been around for a little bit, but they're really coming into their own now.
Speaker 2:And here you are taking care of either a bonded family, which would be Align Care, so you've got people who don't have the income or the wherewithal, can't get to the veterinarians, that kind of thing. They give money to people to take them to their family veterinarian, take the pet to their family veterinarian and get care. So Align Care is working that way, whereas the street veterinarians are going right on the street and are really taking care of people that are homeless and taking care of the pets. No judgment, and the people don't have to come up with any money. So they aren't getting vouchers, like a lot of the Align Care people are, and that has been fantastic, and often the animals are what are keeping the people stable and sometimes even just basically alive, because they have to care for this animal, they want to, they love this animal, and so they're going to get up in the morning to provide some kind of care food, water for their pet, and then the spectrum of care is taking it and Ohio State University is at the forefront of this, so I'm pretty involved in following this through is where they're saying it's not just the diagnosis and it's not just how much money you can.
Speaker 2:I don't want to say throw at it, but some people that's what they're doing. Oh yeah, I can do that. So here's $20,000 to do. Some of these things are costing that kind of money, but it's not always the gold standard and a lot of it ends up being caring for the people. So spectrum of care is giving veterinary students now a lot of information right from the get-go on how to care for the people in front of you so that they and you can care for the animal in front of you, knowing that there are ways around doing an MRI, there are ways around doing some of the more expensive things and it's not less care, it's not inadequate care, it is different care. It's very, very exciting. Those three things. They have my heart.
Speaker 1:Yeah, and I love that because it's making it accessible to so many people that don't have access to that kind of care, and doing it in a creative way too. So it sounds like it's very supportive for that sort of triad that veterinarians, the pet guardians and then the animals themselves so brilliant. So, I want to dive into that too. So there's a lot my head's going around a lot of different questions right now and I don't know where to start because it's all trauma informed care though.
Speaker 2:It's all under umbrella. We really haven't diverged this. It's such a big umbrella and that, if I may, would bring us back to that. So would bring us back around to are we over using the word trauma? I mean, what are we? Are we trivializing something that shouldn't be trivialized, because it is so major in our society and it is even more major in the western societies than it is in some others, and others also have treasured animals more within their culture than we have in western society.
Speaker 1:Because I think that people latch on to that right. They in a sense of it I don't know what the right word I'm looking for, but it almost helps you feel like you're being more of a rescuer or you're helping your dog more If you can say they've been traumatized or they're experiencing trauma, so it allows you, as the person, to feel better about it. So I want to wrap my head around. Maybe we use a story or your experience. Both of you can maybe just talk about where you've seen a dog or you've worked with a dog, that you're saying this dog has experienced trauma and this is why and this is what it looks like. Can you maybe walk us through a case of that, just so we have the listeners kind of have a pretty clear picture of okay, oh, that's what they're talking about when they say trauma.
Speaker 1:And again, it's another broad question, but I think that'll help if we have a visualized what it looks like Behavior, physiological, whatever you want to throw at it. But what would it look like for you? Or maybe a story you have?
Speaker 2:Yeah, there are so many. Sometimes I have trouble. Well, actually I was just going to say choosing, but the word that came to my mind was actually sleeping, because that's how many we can see. And one of the reasons that the profession is known for the high rate of suicide, addiction, depression and what have you as far as that is because we see it so often and I see it from both ends.
Speaker 2:I had a client who would come in scratching all the time, and so I'm thinking of scabies, I'm thinking of this thing, and she's scratching. Her dog is not scratching, but she brings her dog in to be looked at for some reason. That isn't real to me, it is real to her. So I'm not saying it's not real, but the dog does not have the issue she brings the dog in for because really she's coming in because of her and she wants to show me everything that's wrong with her, but she's relating it to the dog so by proxy kind of situation, well, eventually she's treating this dog with everything she can think of for these symptoms that she actually has.
Speaker 2:I saw that dog over a number of years and that dog became what I'm going to call traumatized, because it was constantly getting medications and people were coming into our apartment because she called the fire department over certain things, whoever it is that she felt could come in and help her with whatever that was. But it was always put on the dog. So the dog's always being shunted, playing noises, everything and the dog finally started acting poorly. In her description he's acting poorly towards me, which she would always say to me. Well, he was biting her and she didn't understand why.
Speaker 2:And I did talk to her doctor. I called her doctor and of course they couldn't talk to me, but I could say what I had to say and see if I could get her some help on that end. She never did, as far as I know, really get any help on that end. But that to me was constant trauma, possibly small T trauma individually, but over five or six years it added up and it was to the point where I just I wanted the dog I hate to say it to be quote taken away from her. But she couldn't have the dog. This was her life. So what do you do with these two beings and you can't take? The dog is the one that needs to be removed from the environment, but you can't do that to the person.
Speaker 1:Yeah, yes, such an interesting case and interesting dynamic there. I want to dive more into that, but I'm going to take a short break to hear a word from our sponsors and we'll come right back to that. Hey guys, thanks for tuning in and I hope you are enjoying this episode. I have a very special offer that I'm announcing just before the aggression and dogs conference this year. You've heard me talk about the aggression and dogs master course on this podcast and for a limited time, to celebrate the fourth annual aggression and dogs conference, I'm going to be launching a bundle offer that includes the course and all 19 webinars available on aggressive dogcom. Yes, that's all of the webinars. The webinars alone would typically cost more than $580 to purchase together, but I'm including them for free in this special bundle deal with the aggression and dogs master course. Just some of the topics for the webinars include how to break up a dog fight, assessing canine posture and movement, the genetics of aggression, dog to cat aggression, dog to child, directed aggression, and treat and retreat with some of the most respected behavior pros in our field, including Suzanne Clodier, grisha Stewart, dr Amy Cook, Dr Christina Spalding, laura Monaco-Tarelli, jen Shryock, trish McMillan and Dr Jessica Heckman, just to name a few. You're going to receive all 19 webinars, the master course, live group, mentor sessions with me and access to the private Facebook group a value of over $2,700, all for just the price of the master course, which is $495. There's only going to be 50 bundles available in this offer and I'm going to drop a link to the bundle in the show notes for this episode. The offer is going to expire on October 8th 2023. That's October 8th 2023, which is just one week after the conference, though the bundle typically sells out quickly, so please take advantage. If you are interested, head on over to the show notes for this episode in the podcast platform you're listening to and click on the aggression and dogs master course and expert webinar bundle link. I also want to take a moment to support Sintor Pangal, who's going to be speaking at the aggression and dogs conference.
Speaker 1:This year, sintor shared the story of an organization doing truly amazing work to help animals. Charlie's Animal Rescue Center, c-a-r-e, or CARE for short, is an animal shelter providing timely medical aid to injured and ill animals of the streets in Bangalore City. They aim to provide life-saving veterinary care, on par with private veterinary setups, to all animals, irrespective of their ownership status. Care has a rescue helpline, animal ambulance services and a fully equipped veterinary trauma care unit. Care strives to provide dignity to animals who are old, blind, paraplegic and suffering from chronic diseases, and allow them to live out their lives at the shelter in a safe and peaceful environment. Care is home to many dogs, cats, rabbits, ducks, hens, pigs, skinny pigs, birds and even terrapins. No animal left behind is their main model. Apart from rescue and shelter services, care also provides adoption services, humane education in schools, animal cruelty prevention and control, and volunteering opportunities.
Speaker 1:You have to check out their Instagram channel, where you can see all the wonderful work they are doing to care for and save dogs and animals and needs. Their Instagram handle is charliesanimalrescuecenter and that center is spelled C-E-N-T-R-E, so it's charliesanimalrescuecentercom. You've got to check out their Instagram accounts. Really wonderful work they're doing. Please consider donating to this wonderful cause. You can do that directly through their website at charlies-carecom. I'm going to be sure to drop a link in the show notes for both their Instagram and a way to donate. Alright, we're back here with Kathy and Linda. We were talking just before the break about an interesting case Linda was sharing with a particular client and their dog and how the dog was. I think you mentioned like short T, low T, can you? Just because that wasn't a term familiar to that. So the micro traumas, I guess adding up was there a terminology use.
Speaker 2:Yes, small T trauma.
Speaker 2:That's that's yeah, the small T traumas are the small things that in and of themselves might be I don't want to say insignificant, but you get over them and maybe you think about them every once in a while, but they don't affect your life.
Speaker 2:But as you get more of these small T traumas and they start layering on themselves, so you get small T, small T, small T and over here might be a little small T and over here, but eventually your world is small T trauma which then becomes a big T trauma and it's actually, as you were saying before, a diagnosable that this person has been traumatized. And this I think the instance that Kathy correct me if I'm wrong on this that I think might be most relatable to people would be some of the PTSD's where it's not the big ID that just blows up all the Humvees around you and you make it through and but you see carnage everywhere and we say, oh, big T trauma you should have, but it's the little ones where you're stuck somewhere, thinking something's going to happen to you. You know, yesterday this convoy was attacked at this place and you're going through it. Nothing happens, but over time those smaller ones just add up and they don't have to be wartime things. It's just that. That's the visual, I think yeah you can take with you.
Speaker 2:Yeah, and you can relate it to being a diverse in a country that doesn't have a lot of diversity. And there are a lot of countries in the world where have been isolated enough, either because that's what they wanted to be as a people or for other reasons, and then you start bringing people in that don't look like them, don't act like them, and those people keep getting small T traumas.
Speaker 1:I'm so glad you brought that up. Yeah, it's something we don't think about often. We usually when socially trainers. We think about trauma as like some big, significant event that was just startling and just awful for the dog versus the smaller traumas. So, yeah, such an important point to make.
Speaker 3:Yeah, yeah.
Speaker 1:Yeah, kathy, I would love to also hear your thoughts too on how we can start helping you, know, and your work with people. So let's kind of dive into that next. You know, we talked about, kind of what it looks like, some of the aspects. Sometimes it manifests as aggression, right? So of course this is a aggression podcast, but sometimes it manifests as that. But let's talk about what your experiences in terms of helping people.
Speaker 3:So I think that's the most exciting thing I'm finding now as we explore this, because you can get consumed in the literature about adverse childhood experiences, the negative impact that has on your health, but seeing some of the studies come out there's one called hope healthy outcomes from positive experiences. It's out of Tufts University. I think one of their studies was a kind of a review on resilience that came out in 2017. I believe it was from the Academy of Pediatrics in their journal.
Speaker 3:So it's nice to see that we're moving to well, what can we do? Because you don't want to get stuck in that kind of helplessness. All of these things happen and now we're stuck, but what can you do to move forward? And looking at some of the things that they're studying and right now it seems like they're doing kind of analysis of surveys and things like that but it does seem like you can have healthy outcomes from positive experiences. Positive experiences, whether it's on an individual level or a community level, can really help build resilience in people, in those children that have experienced it, and that is really the most exciting thing I've seen in a while.
Speaker 1:It sounds very interesting. Could you give us an example of what that might look like or an exercise you might incorporate in your work?
Speaker 3:Yeah, and I think this goes to someone I wanted to mention, or a profession I wanted to mention that Linda and I found when we were looking at things like Align Care and all of that. But there are veterinary social workers, which is a relatively new field of social work to help people and you see it, and we have an emergency vet near me, so they might be helpful. But I've also had patients who've come who needed time off work to grieve a pet and was happy to be their doctor, because I get it and I think not that it matters what I think, but it's very legitimate grief. So what they're looking at is they're looking at how do you build relationships, how do you build safe, equitable, stable environments, how do you have social and civic engagement and how do you have emotional growth, and those are very variable. It depends a little bit on, I think, communities and your resources and what can you do to help foster positivity.
Speaker 3:And one of the things that this group did was their logo was designed by high school students in kind of a higher risk category, if I'm remembering correctly, but it was just the right people that you want designing your logo. That is beautiful and you're putting a good face forward and doing good community relationships at the same time. So I think it may be a little bit on more of a community level than in the doctor's office. When Linda and I were talking with one of the veterinary social workers she spoke into a lot of doctors. But it's hard to change big systems, it's hard to change big organizations. But what little changes can you make to kind of approximate or to get there? So I think there'll be things in the community and it's going to be partnerships.
Speaker 1:Yeah, yeah, and I'm gonna also ask Linda two part question, so to follow up on what was just asked. But also real quick side note, isn't you're? So you're part of Ohio State University, right? And so are they the ones that have honoring the bond? They have a support network, I believe or am I off by one university, because you had mentioned that social workers, veterinary social workers, but I know.
Speaker 2:I was the University of Tennessee. Okay that's where the veterinary social work comes out. I don't think honoring. If so, then I better.
Speaker 1:You know it's a grief support type of initiative and I think it's for either euthanasia or behavior euthanasia support as well, and I think they have a good resource. I think it is all has to look it up.
Speaker 2:I'll link to it in the show notes when I do find it Well, have to find out more about it. It hasn't been something that's been.
Speaker 1:Yeah, it's not very well known and I it's still there, but I yeah it's a great resource for anybody because as they have some good articles in there as well. So, going to the animal side of the equation, we're kind of talking about how to help, what can we do to help the animals. So you mentioned again we're looking at informed care. So we got this sort of trifecta of the vet, the patient and then the patient's guardian. But if we're going to focus right now just on the animals for right now, and then I'm going to go full circle and go back to the informed care as well. But what do you do for the animals, like the dogs or the cats that have experienced trauma and you're going to give, let's say, a client, whether it's a training client or a veterinary client? What do you? What do you? Some of your first steps there? So do you have a general plan in place for that kind of thing?
Speaker 2:You know, quite honestly, I try to go in without a general plan because I Really try to take a deep breath, do my yoga breaths before I go in and go in with a clean kind of space within me, because everything is so different when we're dealing with that animal and we have to take so much time and Patience and just watch and observe and ask questions of the animal. I mean, as we always say, train, ask the question, the dog will answer Me one way or another. However, it is the formation of that question of course isn't literal, because that's where it's going to be. And at the same time, I Believe so much in video. I don't feel I do it enough, because what I want to be saying is, when I leave that room, I want to be able to Somehow take the human part of the equation with me.
Speaker 2:Often you can't I mean, we're dealing with this often you can't just say, oh, leave your dog here because we're going to go here. You've got a traumatized animal and sometimes that's not happening. But I want to be able to say let's slow this down a bit and see what happened here. And so I do go in saying, if I can only get their caretaker To see what I'm seeing. I think that's. I've got tears in my eyes. I just feel it. Just I feel so strongly about it that I, if I could just get them to see it, then I think that we would be halfway there, because this dog does need to have choice.
Speaker 2:But the people need to have choice and often they walk in and the veterinarian and I get a lot of people are coming to me as a trainer and as a veterinarian, and we're looking at medication and we're looking at all of these different aspects, and so I Want to open the door for them not to feel guilty about where their dog is.
Speaker 2:Is or not to feel guilty that they rescued a dog, that they were going to give this? You know they have dreams of this great home too, and now they're afraid they're not going to be able to provide A safe environment for their family or for the dog. In answer to your question, I really try not to go in with a plan. I try to come out with a plan, though, and as small as it may be. Several of my criteria are that I have some small points for the dog to try to move them forward, but I also have small points for the client to try to move them forward, and they may have nothing to do with each other and that's the hard part in order to move the person forward. It may be totally separate from how I want to move the dog.
Speaker 1:That's deep Thoughts. Yeah, and Kathy, I think what's that to that? Yeah.
Speaker 3:I, I was just thinking and, lindon, I haven't discussed this. Really we talk a lot kind of offline but I think Not being necessarily scripted when you go in with your plan. Is trauma informed or you know, trauma assumed care? Because it's going to depend a little bit on what this person has heard before from whether other trainers or other doctors. You know how many people online.
Speaker 3:Yeah, have you know, seen the orthopedist and the woman? The first thing they hear for her knee pain is you have to lose weight. I mean, you can re traumatize. And the part that I really hadn't thought of before is when they talk about trauma, informed care, it's supposed to really benefit Not just the patient but your colleagues and everyone that you're working with. And our front staff Is often scripted. You know, business people will have you script this so that everyone's saying the same thing and no one deviates, and that's really hard to do gently and With consideration to the person you're speaking with. So I think there is value In not necessarily having a plan or an agenda when you go in, because I think the scripting may be hurting more than it's helping when we're talking about this topic. I'm sure there's a lot of other business reasons why they want to do that.
Speaker 2:Oh yeah but yes, so unlike. Kathy, I own my own business and Two businesses and so, yeah, definitely scripting helps, but there are times and then you have to have the right people in the right place.
Speaker 1:Oh, there's so much I want to dive into right now. I guess you guys are bringing up somebody good points and you're so right. I think we have to be so careful about not re traumatizing someone, or even the animals in our care, or they're putting them Into situations that can do you know how important is it right.
Speaker 2:You know, we say with medication I'm sorry, just got me excited here, I'm just going to jump right in and interrupt you for a second is to say We've gotten aggressive dogs, say and we need to sort of Tamp those big feelings down a little bit so that Complimental learning state, great. What's the first thing we say as a veterinarian? Well, we have to draw blood because we need to know where this 10 year old dog is, because I'm putting him on this medication. And what if he's got a bad liver? What if, what if, what if? And there we are, are we going to re traumatize this dog? And that's exactly what's going to happen.
Speaker 2:Either we're going to be muscling him, and there are some places that still get out what we always used to call the rabies pole, all those things that can happen, even if we had to give an injection of something to sedate them in order to be able to draw the blood. We have to say how important is it that we get this blood? What is more important? So we come up with what's more important, and that's helping the dog and not getting the blood. But then what do we do?
Speaker 2:We have to pull out our piece of paper that says would you sign off here saying that I am going to give this dog this that could affect his liver and if he has liver disease I'm not responsible. And there you are, and that's basically what we end up doing, in a nicer way than I just said it, I hope. But, um, but in a gentle way, to say I think this is important for your dog. I want you to know the risks of this medication, but I think it's worth taking because those risks are low. The risk of your dog getting worse are high. The risk of behavioral euthanasia is higher.
Speaker 2:So, this is what we need to do.
Speaker 1:It's it's those, those nuances right, that that we have to learn and add to our Practitioner toolbox in terms of navigating those nuances right? Because what I'm thinking from a trainer or consultant lens, so not from, necessarily, you know, a doctor or veterinarian lens is is when I'm working with an animal in a context or environment which might I can set things up as perfectly as possible distance, duration, intensity, pay attention to all those variables we do in training. Put just by virtue of putting that dog in that environment, and less we're careful we might not recognize we could re traumatize that animal in that space, even if all the other variables look like the gold standard, you know, high-value reinforcers, setting the environment well, and we might not even see those things come in to play until later. Because sometimes that's how trauma works, right, it's not an immediate Response, right, sometimes it is, sometimes it's obvious. But it's not always.
Speaker 1:So yeah, it's kind of like I love how we're kind of putting this all full circle on, kind of it's all you know, piecing these little pieces of the puzzle together. So I want to jump a little bit further in the last few minutes that we have to Jump into more of the informed care topic. You know, I know we've covered a lot, but let's talk about that, some more of this trauma-informed trauma, assumed care that we've been talking about. Any other thoughts or strategies that's kind of based on what we've been talking about that you want to throw out there. Maybe, kathy, you want to start with that.
Speaker 3:I think the conversation that we just had around kind of informed consent speaks. When we talk about definition, the challenge of being informed, and which is why I really do like the trauma assumed care, it's a big topic. And how do you initiate that in organizations where there's high staff turnover? The front desk person may not, you know, may rotate through various offices or things like that. So I don't have great answers on how to implement it Successfully. But I think it does take that one champion, that one person who just really appreciates the value of that, to talk about it.
Speaker 3:Linda and I often, when we first met, would talk about how dog training impacted our kind of approach to medicine, medicine or change or leadership, and it's might be just break it down into small pieces and do a little bit. And what's really interesting and Makes me keep trying to figure out how to implement it, is that kindness, that compassion, the consideration that you give to the patient or the client. It also translates into care for colleagues and co-workers as well. You're not just treating the patient, but you know the person who answers the phone, the person who's going to cover your call on a Thursday night, everyone, everyone. Linda was mentioning, you know the high rate of suicide and depression, with veterinarians and so many people in.
Speaker 3:In one of our talks or one of our conversations we talked about shelter workers and burnout and Animal trainers and people who are in giving professions. They're, they're all really giving professions and the burnout there. And if we were all a little bit more Aware of the possibility that there might be some trauma or something deeper, that right, that old saying you don't know what someone's going through and just assumed the best in yourself and in the skills that you have to navigate that, it would probably be better for everybody and then you may retain that front desk person a little bit longer and you may get that continuity that family medicine really likes, not just with patients but with staff, because there's nothing nicer than calling the office and knowing who you're speaking to when you're making the appointment or asking for a refill. That continuity, that staff, everyone could really benefit from that.
Speaker 1:And it's contagious that empathy right. Right. Any thoughts Linda?
Speaker 2:I have so many thoughts.
Speaker 1:Let's hear them all.
Speaker 2:I'm thinking of global care and and however well I feel during the day when I'm trying to care for pets, I'm trying to care for the people, care for my staff and care for myself, and, of course, my self-care always goes down. You know, you get less sleepy because you're doing all of this other care, and I think that when we're working in trauma-informed care, that one of the best things that we can do is know that we can only work within our own Environment, in our own small area. We can't then translate that, as people in this profession we often do, is well, just sort of saying, well, I should have done this, I should have done that, and I know that I shouldn't have held that dog down in order to Draw his blood and to be forgiving to ourselves as we try to be to other people. But given that the other thing that was going through my mind I graduated in 83 82 people keep telling me I'm trying to.
Speaker 2:I always get it wrong, and I've been called on it so many times anyway, from veterinary school and when I ended up, 10 years later, opening, I was in a dairy practice and I even now am involved with some of the robotic milking and positive reinforcement with dairy cows. So, in any case, when I opened my own practice, I was a woman in a male-dominated, you know profession and I was also one of very, very few black veterinarians in the state of Ohio, never mind in the country, and the KKK had a rally and I ended up having to have police protection for quite a while and One night I was sleeping my I had an apartment attached to my veterinary hospital and I, after 12 years, I decided that wasn't such a great idea, but in any case, at this point that's where I was and all sorts of things were happening around me. And one night the police came in my door with all their lights, their guns drawn and there was sleep in my bed and I said you know what's? What's going on? And they looked at me and they said, oh, you're here, you're okay. And I said, yes, they said we got a report, you were dead, and I thought, okay, so all the lights are off, the doors closed. How would anybody know if I was dead. So obviously, you know, in retrospect they probably got a report now fake report from somebody saying that somebody had killed me and and it went in and so I. I Lived my life in that community in a very defensive way for a long time.
Speaker 2:It was very hard, and so I think of that whenever I I'm approaching People who come in who are unsure of why they're there to see me with their dog for a behavior issue and I find a medical issue. Often it's pain and and I try to be really careful with how I talk to them, because Last night the police could have, you know, broken into their apartment and said you know, we thought you were dead I'm getting off topic here but that's what you were. There isn't any answer really to how we should move forward in this. We each have to take it within our own selves and Do the best we can with it, but keeping in mind that we have a goal. We're not just amorphously doing the best we can and oh, I tried. I don't mean that at all. I mean a very factual Almost, as if you have a training plan.
Speaker 2:I'm going to go this step in this step, so I train my staff and I surround myself with people who are supportive of me and of my goals, and I try to bring other people in, as a matter of fact, people who would leave me and say no, and Word is going to be touching my dog, because they came in not knowing they had I was a black veterinarian, and then they grabbed their dog and they run out the door and then, three years later, that same person is calling me because they're trying to get somebody to look at their dog for certain reasons that only I could handle, and my goal at that point was to say, of course, come on in and more or less Over, treat them with kindness and if they can't afford it, I would give them a free exam.
Speaker 2:All because of what happened before that. You know I want to be Michelle Obama. You know I want to take the high road, and by taking the high road I'm hoping to help more people who are feeling traumatized and taking it out on people like me or or people and their animals around them, and so that's how I approach it, how I approach the world, and that didn't answer your question at all.
Speaker 1:It's the story I wanted to tell it actually tied in everything beautifully, and I think, first, I'm glad the police report was Incorrect, so let's just put that out there. But no, really, I mean you're you're speaking about so many things that have. Also, we were talking about tying this season together, about how our past experiences can shape us to actually be kinder human beings because of our understanding of those moments, those traumatic, stressful, difficult moments in our lives and our experiences that make us empathetic to the people that we're going to end up dealing with, sometimes that might have their own traumas, their own hate, their own Experiences, because of their experiences right, that's the way they're treating us at that moment. But also the animals too. I think it's also come full circle to help us understand the animals in our care and the traumas they might have experienced, and that they're barking and lunging and snarling and stopping at us is not to be taken personally, right and, of course, the resiliency that you've built and it shows clearly. So so thank you for sharing that story, because I think it's it's a wonderful way to Really round out this whole season as well as what we've been talking about.
Speaker 1:So, so, speaking of ripples, you know you had both kind of mentioned. Now we're making these small changes, but I think you both are making Incredible waves by creating these small ripples, because we need to talk about this more right. We need to talk about trauma and understanding it and being empathetic to those that we might see in our care for those that have experienced trauma in their lives. So thank you both for doing that. I do want to give you a moment, though, of course, to talk about where can people find more about this, so what you're working on, and if they want to learn more about you and the work you're doing. So maybe, kathy, you want to start.
Speaker 3:Well, I'm working at Stanford Hospital and a family medicine residency training program, so that's the medical side of it. I also teach at Port Chester obedience training club doing nose work, so it's really fun to be able to do some dog training. And so much of what I learned about teaching I've learned from positive reinforcement dog trainers, so it's been great and I love how animals have made me a better teacher. And then Linda and I will be talking at APDT in October right, wonderful.
Speaker 2:Yeah, and in October and look probably in early 2024 for a series that we're putting together interviews on Trauma, informed care with people that you might not expect that their professions or what they do would lead to that, and so we've got a whole list. They are that we're going to be working on.
Speaker 1:Wonderful, wonderful, and I'll be sure to link to all of your the things you were talking about in the show notes and if you have information about what you just mentioned there, I can add that if by the time this episode comes out.
Speaker 2:So Well, and you know, oh, I'm sorry, just one thing, and just to say that in the past, just to mention what we've already done, looking at the convergence, the chat Talk that we did, I think we'll give people more in depth into the science of trauma. And that because that's basically what that was about.
Speaker 2:Yes and then also looking into our talk from the lemonade conference where we went on on from that and to some other things, and then I did a four-hour webinar on kids race and positive reinforcement that can be found on the heart collective, which was very, very interesting.
Speaker 1:Wonderful, wonderful. And again I'm gonna link to all that in the show notes so everybody listening in check out all of their work. Kathy and Linda, thank you so much for coming on. This has been wonderful chatting with you both.
Speaker 3:Thank you for having us, yeah.
Speaker 2:Thank you. Thank you so much I.
Speaker 1:Can't thank Linda and Kathy enough for sharing their expertise and knowledge about both dogs and their people. It's so crucial for our community to be able to discuss trauma and, while it can often be a difficult topic to have conversations about, I'm so glad to have amazing professionals like Linda and Kathy in our corner. And don't forget to head on over to aggressive dog comm for more information about helping dogs with aggression From the aggression in dogs master course to webinars from world-renowned experts and even an annual conference. We have both options for pet pros and pet owners to learn more about aggression in dogs. We also have the help for dogs with aggression bonus episodes that you can subscribe to. These are solo shows where I walk you through how to work with a variety of types of aggression, such as resource guarding, dog-to-dog aggression, territorial aggression, fear-based aggression in much, much more. You can find a link to subscribe in the show notes or by hitting the subscribe button if you're listening in on Apple podcasts. Thanks for listening and stay well, my friends.