Myasthenia Gravis

In this episode of VetLife, Dr. Cliff Redford shares personal experiences from a recent trip to the Quebec mountains and transitions into discussing important health topics for dogs, including heat stroke and sunburn. He emphasizes the risks associated with sun exposure for various dog breeds and provides preventive measures. The conversation then shifts to myasthenia gravis, an autoimmune disease affecting dogs, where Dr. Redford explains its implications, treatment options, and the importance of careful management. The episode concludes with a discussion on vaccination concerns for dogs with autoimmune conditions, highlighting the need for individualized veterinary advice.

First, if you haven't watched my film and live in Canada (or have one of those VPN things), you can watch it here:

https://youtu.be/oMUx3yuyznc?si=oagpg7bGnpbuyXlJ

Be sure to follow me on Instagram @drcliffworldwidevet.com and on Twitter at @drcliff_vet
Listener questions, episode suggestions, or if you have a good idea for a guest, email me at dr.redford@vet905.com
Additional information can be found at drcliff.ca

Transcript

Dr. Cliff Redford (00:08)

Hey everyone, welcome to another episode of VetLife with me, Dr. Cliff. It is ⁓ Monday, June 23rd. So I'm recording this a day before it ⁓ comes out. Why did I leave it at the last minute? Because this weekend, this past weekend, my lovely wife and I were up in the Quebec mountains. Why you did not ask? Because she was ⁓ racing a half Ironman. Only a half, ladies and gentlemen, only a half.

she has done a full, has a full iron man in five weeks in Ottawa, the capital city of Canada. No, is not Toronto. ⁓ like they said in the Canadian bacon movie with Tom, not Tom. Jesus. With John Candy, John Candy and a whole bunch of other guys. ⁓ I highly recommend you guys check out Canadian bacon. very, very, very funny.

⁓ but, yeah, we were, we were up in, ⁓ up in the mountains and I was cheering her on and being a support crew and Thalia was with me and Bo was staying with, ⁓ his brothers, Nicholas and Brandon and, ⁓ Lana Poppy as always was with her favorite aunt Sarah. ⁓ I encourage any of you guys to like check out, check out a triathlon.

Not, necessarily compete, but I mean, it'd be weird if you just went and watched, but anyways, like it's so inspiring seeing all these people from, you know, ages of 18 up to there was a, there was a woman who crossed the finish line at like seven and a half hours. was 80 years old. ⁓ and, and she was faster than probably 15 % of the people who are racing. ⁓

Yeah, it's so inspiring seeing these people. ⁓ Obviously most of them are incredibly fit, which in itself is inspiring, but there are some people that you never would have thought were fit enough to do these races. And so a half Ironman is, let me see if I can, I'm not going to try and do it in Imperial. It'll be metric. It's 1900 meters swim. So almost two kilometers swim followed by a 90 kilometer bike.

followed by a half marathon, 21.3 kilometers. And a full Ironman again for Vaso in five weeks is double that. So her one Ironman took her 16 hours. ⁓ This half took her seven and a half. Her record is just sub seven. But the course was super hilly and it was so hot. Quite a few people pulled out from, from sort of heat stroke, I guess.

But, uh, it was a great time. It was a great time. So today we're going to talk about, uh, two things. We're going to talk about heat stroke. Uh, there you go. That was a unintended segue. We're going to talk about heat stroke and sunburn in primarily dogs. Uh, and we're going to, I'm going to answer a, uh, a viewer email, a listener's email, but a condition called myasthenia gravis. So as far as, let's talk about the, sunstroke first. Um,

the, or sun burns, I should say. So this Friday, for those of you in Canada, this Friday, ⁓ on the morning show, so June 27th on the morning show on global between nine and 10 AM is my semi-regular, ⁓ segment, Cliff's notes with Dr. Cliff. And we're going to be talking about summer safety. And I kind of reached out to him and said, Hey, could we avoid talking about the standard stuff like fleas and ticks and.

allergies and whatnot, and actually talk about sunburns. Now, one of the reasons I recommended this is I had already done up the notes because I was in a, ⁓ I think I'm in Time magazine coming up. ⁓ have a PR person now who's helping me get onto podcasts and getting into getting, getting quotes and articles and various science journals or ⁓ animal health pieces.

Um, and, uh, yeah, this one, uh, I got interviewed by, uh, someone from time magazine. So I think they have an online version that's going to be talking about this. So I already had the notes. So when the time comes, uh, everyone can check it out on my, Instagram. Uh, so what do I got here? So I basically talked about how all breeds of dogs are susceptible to sunburn. However, the lighter or thinner the fur, the more risk they're at breeds such as boxers.

Westies, Greyhounds, Pitbulls, Dalmatians, French Bulldogs, they're all at a higher risk. Hairless dogs and those with pink noses and ears or light colored eyes are highly susceptible. So just like, just like people, the more fair you are, the lighter your skin, the lighter your eyes, ⁓ the more at risk you are for melanoma, for skin cancer and for sunburns, ⁓ because you don't have as much, ⁓ melanin. You don't have as much pigment to your skin.

⁓ so just like in people, UV radiation from the sun damages the top layer of skin cells, causes redness, heat and pain, and can eventually lead to skin cancer. Common areas affected include the tips of the ears, the bridge of the nose, the groin and the lips. Do not forget if your dog has recently had surgery or their fur has been clipped to reveal the skin, those areas must also be protected. The signs of sunburn include much like in people, bright red skin,

The affected area may appear dry and scaly. Sunburns can be painful, so pay attention if your dog seems sensitive to a particular area being touched or brushed. To prevent sunburn in your dog, keep them at a direct sunlight during peak hours, which is basically 10 a.m. to 3 p.m. Cover their skin with a damp shirt, damp just so that they stay cool, which will keep them cool and protected. Consider using a dog safe sunblock.

for added protection. you cannot use human sunblock. Even a lot of the baby sunblocks are not appropriate. If they carry, if they contain in them zinc oxide or para amino benzoic acid, which is called PABBA, P-A-B-A. These can be toxic to dogs if they're adjusted. So you got to get something just like your regular pet supply store will have something that's dog and lick friendly.

If your dog is showing signs of sunburn, focus on cooling off the affected area with a cold damp cloth or a cooling bath. Soothing products containing coconut oil or aloe vera can be applied, but if the burn seems severe enough, you got to contact your veterinarian and we will prescribe some local medications and or pain relieving medications. Now, as far as things like melanoma tumors, I mean, you got to watch out for them. They show up quite quickly.

They show up as roundish or spherical ish growths that are often a dark red to even a black. They can be all straighted. can bleed. They basically look nasty. ⁓ now they can show up anywhere, but common areas are along the lips, the tips of the ears or the bridge of the nose. we actually call these places MC junctions, mucocutaneous junctions. So mucoid.

tissue is like the lips, let's say, it's like a specialized moist tissue. ⁓ and then cutaneous is skin. So where the skin meets the mucoid special tissue, that's an MC junction. MC junctions are susceptible to a lot of things, including a little cold sores in people, and autoimmune conditions and, certain types of tumors like melanoma.

Can show up there. the reason is, is right in that MC junction, the immune system is let's say weak, essentially. ⁓ certain immune cells are unable to get there like T killer cells, which is what kills off cancer cells. T killer cells have trouble getting into the MC junction. ⁓ viruses can hide right in the MC junction, herpes simplex virus causing cold sores. that's why it happens in that area, but.

now melanoma, if caught quickly in cats or dogs, has a very high success rate. I've only seen it five or six times in my career, several times, several times on the tips of the ears in white cats that like to sunbathe. and we had to unfortunately remove the pinnas of the ears, ⁓ essentially like cropping the ears sort of, ⁓ or shortening their ears, but they did great. I recently saw one in an old beagle.

right on his, right on her lip. ⁓ And ⁓ we removed it and she did great. removed it successfully. There is a type of a different type of melanoma that can show up in the gums underneath the lip. it has nothing to do with sun, sun sort of damage or sunburns, but of course, ⁓ and unfortunately those have a much more severe prognosis, but.

Keep your cats and dogs and especially your dogs when they go outside as much as they do, keep them safe from the sun and enjoy the summer. This would be a good time for a commercial if we had one, we don't, but there you go. While I pull up this this email talking about Myasenia Gravis, I got to say I'm having such a good time editing my book. I have a deadline June 30th, so basically one week, not even.

this weekend, ⁓ and then July 1st is Canada day. So I'm sure it will be July 2nd then, but, my editor kind of said, yeah, I'll be ready to, to review it soon. ⁓ do one more editing. ⁓ I want to make sure you clean it up as much as possible as far as punctuation. And I moved some stuff around, ⁓ and I gotta say, it's a good book. I I've, I've lived the experiences.

I've written about it many times in journal and then onto the pages of my computer. ⁓ And then I've edited it and edited it and edited it, reread it and edited it. So this is probably my 10th time experiencing the words either in my head or on the page. And I'm still enjoying it. So I hope you guys do too. Only a short 14 or 15 months away before it gets.

out there in the public, it'll, it'll come upon us very quickly, but I am enjoying it. All right. So this email is from a wonderful woman named Simone. no, I've already talked to her. We've sort of dealt with a lot of issues and I've helped her reach out to her, ⁓ her specialty team that's working with this case, but I'm going to read this email. It's a long one. So stay with me here. ⁓ okay. She says, hi, Dr. Redford.

Hi Simone. I spoke with Megan a few days ago and she was kind enough to pass on some information to you about my dog, Alika. I very much appreciate the opportunity to be able to ask a couple of questions of you. I'm aware that you can't provide medical advice per se without seeing my dog, but I'm casting a bit of a wide net, collecting information from frustrated sources in an effort to make some decisions about her care given her history. I like my veterinarian and they've provided good care over the course of me having Alika.

That was a great start to this email. She's looking for advice. She's not looking to step on toes. She's not looking for a new vet. She actually offered after I spoke to her to pay me or to make a donation. I asked her to make a donation to her local animal charity, but I did not require any payment other than I asked her to check out the podcast, which she said she would. ⁓ Okay. So Alika is a nine-year-old pot cake from.

Mexico, pot cakes. Those are so cute. Pot cakes are basically medium size, usually brown, short-haired street dogs. ⁓ And people joke that they're called pot cakes when they come from Jamaica. That has something to do with marijuana. That is not the case because you can get pot cakes all over the Caribbean and in Mexico, all over the place. And it's basically people would feed these street dogs out of giant pots. ⁓ And they would be like a buffet.

⁓ so they started calling them pot cakes. I adopted her through a rescue organization here in Ontario. I got her in 2018 when it was deemed she was about two years old. She's been fully vaccinated at that time spayed and was considered in very good health. In 2020, after many weeks of treatment for various symptoms, she ended up in a merge with pneumonia due to ongoing bouts of regurgitation and painful esophagitis.

She was referred to internal medicine and the focus was on her mega esophagus. So her esophagus had become weak and, and was dilating out two, three times the size that normally should. A new vet at my regular clinic had suggested that this may be myasthenia gravis. I'm going to call that MG from now on. After hearing me discussing a leka's mega esophagus while paying at the front desk, this comment stuck with me. I learned that MG

was not very common. ⁓ but I asked the internal medicine vet and emerge about it at a follow-up. She was of the opinion that MG was unlikely, but I pushed her for the titer test to at least rule it out. I had no real answers at the moment. So I thought, why not? I should note that I do understand that MG is not common and it's a tough and expensive to diagnose, but it came back positive for focal myasthenia gravis. It seems only the esophagus was impacted.

Alika was never prescribed. Pyrodostage ⁓ mean. ⁓ That's the drug. this point, been, I do know of this drug. just have trouble saying it. ⁓ I'm sure I'm missing the accent somewhere. The emphasis on a certain syllable. At this point, I've been doing upright feedings and treating the esophagitis for a few weeks and Alika's symptoms improved greatly.

I fed her GI canned food meatballs and Knox blocks jello squares to keep her hydrated. Water was difficult for a short time. I'm happy to report she was deemed in remission about eight months after a diagnosis and the megasophagus has also resolved. Okay. So let's talk about MG, myosinogravus. Now I learned some, things about this. I did not know they could go into remission.

I also did not know about focal myasthenia gravis. So myasthenia gravis is kind of like an autoimmune disease and it's damaged to certain neurons. It's damaged to certain neurons at the junction points between one neuron and another. So think of a neuron like an electrical cord and these junctions are kind of like, where you plug one cord into an extension cord. That spot that you plug is a junction from one

neuron to another and it's where the electrical signal passes. So I always use this electrical cord as an analogy. Now, instead of having the metal prongs that sort of communicate ⁓ in the outlet or in the plug, ⁓ we have these spaces and there's a chemical between one space and another between these two neurons called neurotransmitters and it transmit neuron signals.

And in this case, the, in myasthenia gravis, and in these neurons, the neurotransmitter is acetylcholine. So acetylcholine just transfers the electrical signal sort of, from one neuron to another. Now, unfortunately with myasthenia gravis, the body starts attacking, ⁓ the tips of the neurons. And so it damages the edges of these neurons.

at these junction points. so acetylcholine has trouble crossing over because the, if acetylcholine is like a boat, the port, the landing point for the boat is damaged. And what ends up happening is then there's this chemical called acetylcholinesterase. And when it ends in the, the suffix, when it ends in the suffix,ase, A-S-E, it's generally an enzyme.

Lipid is fat, lipase is the enzyme that deals with fat. so acetylcholine is a neurotransmitter and the body has to clear that acetylcholine and it uses a neurotransmitter called, or uses an enzyme called acetylcholinesterase. And the way this, ⁓ periodo, pyridostigamine, P-Y-R-I-D-O-S-T-I-G-M-I-N-E, pyridostigamine, ⁓ the way this drug works is it.

⁓ Basically giving acetylcholine more time to find neuron, neuron sections that work. Okay. ⁓ so that's how, that's how this, disease happens. And they, these neurons with acetylcholine are typically, ⁓ motor neurons. So they, they deal with muscle function, muscle strength.

So I've only seen Messenia Gravis maybe three times. ⁓ And yes, I've always seen it with megaesophagus because it weakens and damages the swallowing muscles. But I also would see sort of weakness of the legs, weakness of the neck, ⁓ even breathing difficulties. And we treat with this drug as well as with corticosteroids to reduce the immune system.

to stop the damage to the, to the neurons, cause it is an autoimmune disease. But after researching, what I found out is there's actually multiple types of Gravis. There is a progressive type that is usually very quickly fatal. There is one that affects the entire body. And that's the one that I am used to. And then there's focal myasthenia gravis where it only affects neurons of one section. And in Alika's case, it was the muscles dealing with swallowing and megasophagous.

And then the last one, and I did know about this is a tumor, what's called a thymoma, a tumor of the thymus gland, which is in the chest. So when you diagnose Gravis, you should be ⁓ doing chest x-rays and or ultrasound to look for a mass just to be safe. So with myasthenia gravis, the main concern is swallowing because what ends up happening is they start to inhale.

their food and their water, and it goes down the wrong pipe, essentially. Um, and they can, many of them, unfortunately, uh, pass away due to repeated bouts of aspiration pneumonia. And one of the things they'll do is they will get these special chairs that look like high chairs for children. They'll get these special chairs that the animal sits on, or the dog sits on, and it keeps them vertical. And then you can feed them with this chair.

⁓ and it allows gravity to, to help bring the food down into the stomach past the barely functioning, if functioning at all, esophagus. So there's a very, ⁓ Cliff's notes with Dr. Cliff version of myasthenia gravis. So, ⁓ all right, back to the email. since all this happened, I've been doing annual titers instead of her core boosters, including LEPTO as per discussions with my vet.

And the reason is vaccines don't cause this disease, but if you have an autoimmune condition, ⁓ you do not want to stimulate the immune system. And that's what vaccines do. So she held immunity for everything up until last year when her titers showed no immunity for Leptosporosis. I should mention that I live in a condo in the city and Alika is never off-leash because of this. So basically she's not at risk for, or she's very, very low risk for developing Leptosporosis.

I don't take her dog to dog parks, but we do long walks on a leash. I don't take her up North anymore. She has many enrichment toys and sees two other dogs occasionally who are fully vaccinated. In short, I'm very careful with her and have curbed my behavior to keep her safe, but I know well that risks still exist to some degree. This year, however, her titers, not surprisingly, again showed no leptoimmunity, but also no distemper immunity. And she's right on the cusp for rabies protection.

So leptospirosis, we see it a lot in various animals. I won't get into it, but it's ⁓ easily treatable. Distemper, especially in the GTA and the Toronto area, which is where this woman's from. We do see a lot of distemper in raccoons. And if your dog contracts distemper and doesn't have vaccines, ⁓ doesn't have protection, it's a very, difficult disease to treat.

and often leaves them debilitated for the rest of their lives. And then rabies is rabies. That's pretty serious, obviously. ⁓ So she's losing her rabies ⁓ protection as far as titers. Here's my thinking. I can't protect her a hundred percent, but I can definitely take steps to mitigate exposure, especially for lepto and distemper with my vet about this. talked to my vet about this. No, sorry. If she was to somehow get one of these, although both are awful, successful treatment might be possible.

The lack of rabies protection is really concerning to me. had a long discussion with my vet about this and he was very helpful. While he can't tell me which decision to make, we discussed the potential risks of not vaccinating versus vaccinating. I'm concerned of course about a flare up of MG that might be even more severe and that's a possibility. So with these autoimmune conditions, they are idiopathic, meaning idiopathy, to be

afflicted with being an idiot, lack of knowledge, it's a Greek word. Idiopathic diseases, meaning we don't fully understand them, why they occur, which means they can come and go, or they can have varying, variabilities. So if a leak or were to have a flare up, it might be quite different the next time around. So she goes on to say, but not vaccinating, especially for rabies is exceedingly worrisome. I know rabies is not endemic here and cases are very low.

But again, if there was ever a possibility she was exposed, that would be it for her. I do know of another dog in remission for MG. She has also made a full recovery. She has a dog from the same rescue organization as Alika and a few years older. Her owner boosted her last year for rabies and she was fine. This is encouraging. Every single dog is going to be different though in this situation. So this is the reason I'm reaching out to you. While I'm aware every dog is different and the data available is anecdotal at best.

trying to gather information about other dogs experiences being vaccinated or boosted when in remission for MG. My vet has indicated that if I decided to boost her, we would do one booster at a time. It would likely treat with a steroid and antihistamine prior to mitigate against a potential adverse reaction. In your experience have dogs with an MG history tolerated boosters well. My vet did speak to a neurologist about their experience with MG.

And while he also indicated that the data available around vaccines launching a flare of MG was largely anecdotal, he felt most MG dogs tolerated them well, save for a handful exceptions that couldn't be reliably linked to vaccinations. My understanding was that actual data linking vaccines to an auto-mute flare up is more linked to disease involving red blood cells and platelets. We don't really know. That's the problem, but ⁓

because the red blood cell, like if you have an autoimmune condition of red blood cells and platelets, ⁓ like hemolytic anemia or ⁓ thrombocytopenia, ⁓ red blood cells and platelets, while not directly involved in the immune system, they're not white blood cells, for example, they are adjacent. They are immune system adjacent. They're created in the bone marrow, which is where white blood cells are created.

Yes, you could say that they would be more susceptible to an immune system flare up, a stimulation of the immune system resulting in an autoimmune disease flare up. ⁓ But ⁓ regardless, all autoimmune conditions have to be treated somewhat the same in the sense of you want to reduce these sort of over-stimulations. Now the thing is diseases can also stimulate the immune system.

resulting in a flare up if your animal has an autoimmune condition. Stress can do it. There's so many different things. So it's very, very tricky. All right. So she finally goes on to say, in short, what has your experience been with vaccinating dogs and remission for MG? I would like nothing more than to once again, fully vaccinate my dog or at least revaccinate for rabies for obvious reasons. It's a difficult decision. I do have her full file if you require it. I've attached one of the 10,000 photos I have of Alika. She's a great dog.

Dr. Redford, appreciate your time very much. Very grateful for the opportunity to run this by you. Thank you and kind regards, Simone. ⁓ Wonderful email, Simone. And I'm to put this photo up on my Instagram of this. my God. This dog's so cute. He's like, ⁓ she is like this sort of chocolate brown, even a mochaccino color. And then even, you know, like under her neck, her muzzle, her feet.

all have ⁓ the whipped cream color of a mochaccino cappuccino and she's sitting up on a couch and she's got her front legs crossed and she's sort of staring at the camera with a slight tilt to her head. It's very, very nice. ⁓ Very nice photo. Very sweet dog, obviously. ⁓ So let's see. Let me get my first quick reply here.

⁓ I said, hello, Simone, thank you for reaching out. You've done a great job managing this disease. A few things, likely not new info for you. MG is an autoimmune disease. MG has a component to it that is idiopathic, which means everything has to be taken with a grain of salt. Every patient is different. I've had a handful of patients with MG, but I've never heard of them going into remission, especially without prescription treatment.

Is it possible the test was a false positive? Something to ask the neurologist. I'm glad you tested every dog I've seen with Megasophagus had MG. ⁓ So again, I wasn't realized remission was possible and I've since then done some research and yes it is. ⁓ And she confirmed that she spoke to the neurologist. So it seems like this great group of veterinarians and this amazing owner are working together.

Because, okay, so then I go on and say, because it is an autoimmune disease, anything that affects the immune system, whether it is good or bad, can cause a flare up. If the leaker was my dog, so here's how I get around the, I'm giving advice. This is what you should do. Not that it's really a big deal. ⁓ Yes, I haven't seen the dog, but I'm just talking about a disease in particular. But if you want to, you know, if you want to worry that somebody is going to be litigious or another veterinarian is going to put in a complaint.

Hey, he's making, Dr. Cliff's making, giving medical advice without seeing the patient. ⁓ Yes, they would be right. That is considered unprofessional. It's kind of a little different if you're just giving advice versus stealing the client from them. ⁓ I'm not really worried about any of this. Veterinarians are cool and they appreciate, most veterinarians appreciate like a second or a third, third opinion. But anyways, either way.

To get around that, I would just say if this is what I would do if this was my dog. If Alika was my dog, I would only give rabies and I would follow the AHA, American Animal Hospital Association protocol such that eventually the rabies protection lasts three years. Titus are great, but some people within the Ministry of Health do not recognize them. And if Alika were to ever bite someone, and since she arguably has neurological symptoms, the Ministry of Health may demand she be euthanized and tested for rabies.

I know this sounds extreme. I'm unfortunately speaking from experience. I had a patient 20 plus years ago, this gorgeous boxer cross who was dealing with a brain tumor and she was seizureing and they were going to euthanize her. Like in a few days kind of thing, she ended up while having a seizure, mom was trying to basically pull her tongue out of her mouth, which she didn't really need to do, but she thought she was doing the right thing.

And she got, bit basically. I mean, she wasn't, it wasn't a purposeful bite, but she got injured and it broke the skin on her hand. Now, normally the woman said, I would not have gone to the doctors. It's not a big deal, but she was six months pregnant, seven months pregnant. So she just happened to have an appointment with her doctor the next day. She mentioned the wound. Unfortunately, as soon as a doctor learns that you've been bitten by a dog or cat or animal, they have to call public health.

That's the rule. They can't, they can't avoid it. Public health then reaches out to the veterinarian, which was me and said, is this dog vaccinated up to date on rabies? And at the time the dog was not. We were dealing with this disease slowly over months. So we stopped worrying about rabies. I said, no, unfortunately the dog is three months overdue for rabies. And then they said, is this dog showing any neurological signs? And this is when the shit hit the fan. I guess we're opening up Pandora's box.

could, because the dog was showing neurological signs. And I tried to say, look, this dog's got a brain tumor, da, da, da, da, da, da, da, da, da, da,

came back negative, everything was fine, but it was just, it made a difficult situation even more difficult. ⁓ So, I've seen this happen. and then I actually wrote, I'm sorry, I actually wrote, had a similar case 20 years ago regarding a dog with a brain tumor, da da da da da. So, and then I asked her, does this help? If it is okay, I'd like to read this on my podcast. She said, great. And so she basically thanked me for my time. ⁓

Thank me for the kind words that I said about her. ⁓ and basically said, yeah, she's leaning towards just rabies. and yeah, she, she went on to say she spoke to a neurologist, ⁓ and that they are confident that she has my senior Gravis that Alika has it. ⁓ and she basically said, yeah, I can go into remission. So, ⁓ thank you very much, Simone. First of all,

Great job taking care of Alika. Great job summarizing things. ⁓ Thank you for allowing me to share this and giving me the opportunity to do some research and learn more about this disease. ⁓ So it was, ⁓ it was, it was fascinating. So that is my, my, my asthenia gravis. That's a tongue, tongue twister. The acetylcholine is having trouble reaching the tip of my tongue to, ⁓

to twist up that word, myasenia gravis, MG, and megasophagus, and a little bit about autoimmune diseases and rabies. So in the end though, speak to your veterinarian, regardless of what the disease is, especially with these autoimmune conditions, do not take my advice without talking to your veterinarian. He or she trumps what I have to say. Are we going to stop using that word? I mean, Trump was always...

You know, ⁓ it takes precedence, right? It takes precedence. It's the powerful one. If you play euchre, the, the top card is the Trump card. what other card games use trumps? but I guess there's at least half of the population. It sounds like more than half of the U S population now, would rather we not use that, that word, ⁓ especially in reverence, you know, ⁓ this trumps that as in this is more important than that.

Anyways, I am getting off on a tangent here. That's not, that's not what this is about maybe, but hey, being a veterinarian and the life of a veterinarian, and this is vet life with Dr. Cliff, vet life isn't just talking about animal stuff. You can talk about politics too. Anyways, everyone, thank you so much for listening. Please send in your emails. If you've got a question or comment about the show, if you want to tell me that I talk too much or I need to allow the.

guest to talk more, not in a situation like today. ⁓ I love constructive criticism. love deconstruct, destructive criticism because I think it's funny that you think I give a darn about, ⁓ some trolls opinion. but send it in anyways, and I'll, I'll make fun of you while you make fun of me. That's fine. but also if there's medical conditions, I'm, happy to answer them. I don't have to read them on the podcast. will always get your permission first, or maybe you could put that in the,

in the header, but you can find me at dr.redfordatvet905.com, instagram at drcliffworldwidevet, so drcliffworldwidevet. 15 months from now, keep your eye out for Far and Wild, the Adventures of the Worldwide Vet. That is the name of the book. ⁓ And ⁓ stay tuned and we'll talk to you guys soon. Thanks.