19 Cats And Counting

BIO:

Dr. Kelly Cairns graduated veterinary school from CSU in 2004, completed a small animal rotating internship at Cornell in 2005 and completed a small animal internal medicine residency at OSU in 2008, at which time she obtained Diplomate status. She enjoyed a rewarding clinical practice as an internist and medical director of a multi-specialty/ER hospital until joining Pathway Vet Alliance (now Thrive Pet Healthcare) in January of 2018. Dr. Cairns currently serves as Vice President of Medical Excellence and Education for over 400 hospitals in the Thrive Pet Healthcare family. She is also on the dvm360 editorial board and on the Chicago Veterinary Medical Association Board of Directors. She lectures nationally on profession-related wellness coaching topics as well as internal medicine.

Dr. Cairns provides coaching and resources to support the medical excellence, professional development and sustained happiness of veterinary healthcare team members. She is passionate about supporting the people in the veterinary profession on the front line who positively impact the lives of their patients and pet parents every day.
In her personal time Dr. Cairns is an avid runner and enjoys family life with her husband, two daughters, son, two cats and very sweet but poorly mannered lab mix.

Transcript:

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Announcer: This is Pet Life Radio.

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Announcer: Let's talk pets.

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Linda Hall: She's back.

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Linda Hall: She is the VP of Medical Excellence and Education for over 400 Thrive Pet Health Care Hospitals.

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Linda Hall: She's a smarty pants veterinarian, and God bless her, she graces us with her presence monthly.

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Linda Hall: She is here to talk this time about diabetes, and we see a lot of that with cats, so we know we wanna hear this.

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Linda Hall: We will be back with Dr.

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Linda Hall: Kelly Cairns as soon as we hear this word from our sponsor.

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Announcer: Let's Talk Pets on petliferadio.com.

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Linda Hall: Welcome back to 19 Cats and Counting.

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Linda Hall: I am your co-host, Linda Hall, here with my fabulous BFF business partner, work wife, I don't know, lots of good stuff, Rita Reimers.

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Rita Reimers: I am here and I'm excited to talk about this topic because I've had a few diabetic cats in my life.

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Rita Reimers: Right now I don't have one, knock wood, but you just never know, because I have so many seniors, right?

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Rita Reimers: So let's talk about what it is, how it comes about, how we spot it, how we treat it, all that good stuff.

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Linda Hall: Dr.

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Linda Hall: Kelly, thank you for being with us again.

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Linda Hall: We love you so much and appreciate you.

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Dr. Kelly Cairns: Ladies, it's Cat-er Friday.

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Dr. Kelly Cairns: Cat-er Friday.

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Dr. Kelly Cairns: I am so excited to be with you guys today.

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Dr. Kelly Cairns: And this is my favorite thing to do every month.

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Linda Hall: Oh, thank you.

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Linda Hall: You make us look smart.

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Rita Reimers: You make us look smart.

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Linda Hall: Yes, you do.

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Linda Hall: And we have learned so much that we pass on to clients and behavior.

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Linda Hall: And we're like, well, your cat's this old, it may be, and so is you.

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Linda Hall: And you know, we're regurgitating all this information.

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Linda Hall: So you are a wealth of knowledge for all of us.

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Linda Hall: So in my mind, and you can tell me if I'm wrong or not, as our cats get older, they're all doomed to certain things like thyroid, it's like people problems and diabetes.

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Linda Hall: Is that a fact as far as diabetes goes anyway?

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Dr. Kelly Cairns: We're not doomed.

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Dr. Kelly Cairns: Our kitties are going to be good.

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Dr. Kelly Cairns: And yes, it is true.

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Dr. Kelly Cairns: As cats get older, there are certain things that they may have risk factors where they could develop certain chronic conditions and absolutely diabetes mellitus or diabetes inability to regulate blood sugar is one of the most common things that we do see in middle age to older cats, along with, as you mentioned, hyperthyroidism or excessive functioning of the thyroid gland and also chronic age-related kidney disease.

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Dr. Kelly Cairns: But it's not a doomsday prophecy.

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Dr. Kelly Cairns: So we're going to talk about why it's not and how we can be proactive to figure out when it's happening and then make sure our kitties can feel good with that condition.

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Rita Reimers: Now, I've had some relatively young cats that had diabetes.

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Rita Reimers: My first cat, Nischia, way back in the, gosh, late 90s, I think it was, she had diabetes and it was not as well understood as it is now, but she was only six.

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Rita Reimers: And then she didn't live but a year after diagnosis because things weren't then what they're like now.

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Rita Reimers: Treatment's much better now.

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Linda Hall: What is the age?

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Linda Hall: You said middle to middle age, older age.

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Linda Hall: What is middle age for a cat?

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Dr. Kelly Cairns: 28, because they're all going to live to be 50.

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Rita Reimers: I agree with that.

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Dr. Kelly Cairns: So middle age, middle age in all seriousness in cats can be roughly defined as maybe about age seven or eight to maybe age 11 or 12.

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Rita Reimers: I see she was young, six.

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Dr. Kelly Cairns: Yeah, and then they get into the senior category of 12 to potentially 20 or 25, knock on wood.

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Dr. Kelly Cairns: So what might have happened with your kitty, and it's always hard to say, but what might have happened is that your kitty might have had one of the big types of diabetes that we call type one, which we can see earlier in age.

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Dr. Kelly Cairns: Cats are a little more likely to get what's called type two, which does develop more as they get older related to some risk factors that accumulate over time that we can talk about.

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Rita Reimers: One of the things I noticed about Mischief is she started smelling like rotten fruit.

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Rita Reimers: So that was my first indication that something was a miss.

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Rita Reimers: Yeah, she did.

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Rita Reimers: She smelled like rotten cantaloupe was awful.

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Dr. Kelly Cairns: Well, what you might have been smelling is something we call ketones.

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Dr. Kelly Cairns: So when any patient has diabetes and it's not regulated well and they're having what we call a crisis, the body will make these compounds called ketones in an effort to get energy.

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Dr. Kelly Cairns: Because when you have diabetes, you can't get that sugar in your bloodstream into your cells because to do that, you need a hormone called insulin.

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Dr. Kelly Cairns: And with diabetes, you don't have enough insulin or the insulin you have isn't working.

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Dr. Kelly Cairns: And so what can happen is the body's trying desperately to get energy for brain function.

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Dr. Kelly Cairns: And the body makes these things called ketones.

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Dr. Kelly Cairns: And interestingly, they smell kind of like that, but a little bit of trivia for you, some people can smell ketones and some people cannot at all.

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Dr. Kelly Cairns: I am one of those people that absolutely cannot smell them whatsoever.

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Rita Reimers: But I guess I can.

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Dr. Kelly Cairns: You can.

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Linda Hall: I guess so.

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Linda Hall: So what other signs other than our cats smelling like rotten cantaloupe?

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Dr. Kelly Cairns: It was really bad.

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Linda Hall: What are some of the other signs we should be looking for?

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Dr. Kelly Cairns: Okay, knowledge is power, right?

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Dr. Kelly Cairns: I always love it.

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Dr. Kelly Cairns: We can tell our kitty loving friends what to look for.

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Dr. Kelly Cairns: So because when you have diabetes, you cannot get that sugar into your cells because you don't have that hormone insulin.

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Dr. Kelly Cairns: You have way too much sugar floating around in the bloodstream and in the body.

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Dr. Kelly Cairns: And the most common symptoms for that will be increased thirst and or urination.

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Dr. Kelly Cairns: Usually the two of those go hand in hand.

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Dr. Kelly Cairns: You're peeing too much, so you get dehydrated, so you want to drink more.

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Dr. Kelly Cairns: Or you're drinking too much, so then you pee more because you're drinking more.

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Dr. Kelly Cairns: And we also can see a ravenous appetite with weight loss.

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Dr. Kelly Cairns: So there's not a lot of things that will cause that pattern.

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Dr. Kelly Cairns: Usually, you know, if I'm eating way, way too much, I'm probably going to pack on a few extra pounds.

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Dr. Kelly Cairns: But when we see a kitty that is eating a lot, seems starving, but losing weight, there's only a few things that cause that.

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Dr. Kelly Cairns: And definitely diabetes is one of the things on the shortlist because even though the kitty is eating, the body and the cells are not able to get that nutrient inside the cells.

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Dr. Kelly Cairns: Hence, the cat feels like it's starving, but it's losing weight.

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Rita Reimers: Yeah, that makes sense.

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Rita Reimers: That's what I saw with Miss Jeff and also with Mimi that we took in.

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Rita Reimers: Remember how tiny she was?

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Linda Hall: Yes.

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Linda Hall: And I was thinking about the peeing because I remember you saying to me when we got Mimi, we were told she's diabetic, she's on this dose.

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Linda Hall: It wasn't a very big dose.

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Linda Hall: And Rita's had experience with this.

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Linda Hall: And she said that seems like a small dose.

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Linda Hall: And then she said to me, this cat's peeing up oceans.

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Linda Hall: I don't think it's enough.

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Linda Hall: But I want to point out that she then made an appointment with a veterinarian.

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Linda Hall: She didn't say, oh, this cat's peeing.

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Linda Hall: This isn't enough.

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Linda Hall: I'll give her more.

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Linda Hall: She took her to the vet.

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Linda Hall: So you're giving us all this information to suspect, but we still don't want to self-treat, right?

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Linda Hall: We want to take her to the vet.

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Dr. Kelly Cairns: You bet.

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Dr. Kelly Cairns: You guys know well enough that everything always ends with, if you're concerned, see your veterinarian.

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Dr. Kelly Cairns: Now, here's the good news when you do that, is that your vet will, of course, ask a bunch of questions about thirst, urination, appetite, energy level, vomiting, diarrhea, all those things.

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Dr. Kelly Cairns: We're always going to ask you every time.

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Dr. Kelly Cairns: Your vet's going to do a great physical exam, and then your vet's going to do some basic diagnostic tests, blood and urine tests, to be able to see what's going on.

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Dr. Kelly Cairns: And the good news is that diabetes is pretty easy to diagnose with those routine tests.

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Dr. Kelly Cairns: So no test is perfect, and some things can be really hard to diagnose or require a lot more advanced testing.

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Dr. Kelly Cairns: Diabetes is one of those conditions that is actually pretty easy to be diagnosed with some pretty noninvasive routine blood and urine tests.

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Dr. Kelly Cairns: And those tests allow your veterinarian to also rule out other things that could be going on that can also cause increased thirst and urination or those other symptoms, like maybe chronic kidney disease or potentially other endocrine conditions like hyperthyroidism.

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Dr. Kelly Cairns: So the good news is when you get to your vet, your vet with those tests is going to be able to give you a wealth of information to let you know what you need to do.

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Rita Reimers: Is diabetes one of those diseases that comes with other diseases?

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Rita Reimers: Like, for example, I had a cat that had thyroid problems, and he went for that iodine treatment, you know?

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Rita Reimers: And my vet said, you know, he's going to get treated with this, but as soon as this is taken care of, he's going to have kidney issues because those things come together.

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Rita Reimers: Is that true with diabetes?

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Rita Reimers: Do other conditions come along with it?

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Dr. Kelly Cairns: Not necessarily.

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Dr. Kelly Cairns: We always can have an older kitty that might have different diseases existing at the same time that aren't intrinsically related to one another.

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Dr. Kelly Cairns: So a kitty with diabetes is not inherently at increased risk to get a bunch of other things.

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Dr. Kelly Cairns: It can absolutely be seen as a sole entity.

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Linda Hall: I'm glad you said, you know, we're not all doomed because probably half or better of my cats are riding right now between 10 and 15.

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Linda Hall: And so I'm on the lookout, right?

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Linda Hall: Like, what's coming?

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Linda Hall: What are we going to have to do?

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Linda Hall: So I suspect my cat has diabetes.

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Linda Hall: I take it in.

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Linda Hall: The vet says, yes, my cat has diabetes.

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Linda Hall: Now what?

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Linda Hall: Can I treat this at home?

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Linda Hall: Is the vet going to treat it?

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Linda Hall: Is this curable?

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Linda Hall: That's a lot of questions at once.

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Rita Reimers: No, that was my next question.

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Rita Reimers: Is this a forever disease or is it curable?

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Dr. Kelly Cairns: Yeah.

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Dr. Kelly Cairns: So the rule is that it is a generally a chronic condition that will require lifelong treatment, but we can unpack some nuances of that in just a little bit.

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Dr. Kelly Cairns: Now, the good news is, though, it is often very treatable for a very long time.

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Dr. Kelly Cairns: Yes, there's always the potential for complications.

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Dr. Kelly Cairns: There's always the potential for potentially life-threatening complications.

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Dr. Kelly Cairns: One of the things we worry about the most is when the diabetes is really unregulated, we can get something called DKA or diabetic ketoacidosis, which can make a kitty very sick.

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Dr. Kelly Cairns: Their bloodstream can get very low pH or what's called acidosis, and they will need to be treated in the hospital with IV treatments, intensive care, IV insulin.

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Dr. Kelly Cairns: But absolutely, if they recover from that acute crisis, which knock on wood in most instances they do, they can get back on track.

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Dr. Kelly Cairns: Okay, now where we worry a little bit more about diabetes being potentially difficult to regulate or potentially be more concerned for a poor long term prognosis might be if a kitty also has multiple other unrelated diseases, because now you're trying to balance multiple conditions where treating one could upset the apple cart for the other.

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Dr. Kelly Cairns: My own kitty Bean was an example of that, where I was able to manage his diabetes for quite a long time, but eventually he also had multiple other conditions, including hyperthyroidism, very advanced kidney failure, some heart issues, and then you're just managing multiple conditions in that kitty, which again may not be as easy or as favorable for long term, but there's still things we can do in that setting.

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Dr. Kelly Cairns: So bottom line is it is usually a lifelong condition that is chronically treated.

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Dr. Kelly Cairns: And we can definitely talk about the different things in the toolkit for treatment.

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Rita Reimers: Is there a way to avoid diabetes or the things we do that contribute to their potential for getting the disease?

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Dr. Kelly Cairns: I love you guys ask the most amazing questions that are so insightful.

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Dr. Kelly Cairns: So this is kind of cool.

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Dr. Kelly Cairns: You guys know I love it when cats are not small dogs.

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Dr. Kelly Cairns: So this is probably another example of that.

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Dr. Kelly Cairns: So in really broad strokes, there's two big types or classes of diabetes.

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Dr. Kelly Cairns: There's type one and type two.

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Dr. Kelly Cairns: And humans also have two general types as well as dogs.

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Dr. Kelly Cairns: So type one is that classic.

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Dr. Kelly Cairns: We don't really know why, but an animal is just not able to make insulin.

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Dr. Kelly Cairns: And so that is the insulin dependent diabetes.

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Dr. Kelly Cairns: They can be younger.

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Dr. Kelly Cairns: They can even be kids.

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Dr. Kelly Cairns: So people that will get a type one diabetes where it comes on when they're children.

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Dr. Kelly Cairns: And that condition is typically insulin forever, along with diet and other things.

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Dr. Kelly Cairns: Now dogs will get type one diabetes pretty frequently.

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Dr. Kelly Cairns: Cats can, but cats are more likely statistically to get type two diabetes, which is basically that over time, there's a variety of things that make them resistant to insulin.

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Dr. Kelly Cairns: And there are cells that make insulin in the pancreas are working so hard over time, going uphill in the snow, both ways that eventually cause the body's resistant to all the insulin that's being made, that those beta cells in the pancreas just frizzle out and take a permanent nap.

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Dr. Kelly Cairns: And so that absolutely can be caused and comes on by, or can be tipped into the edge for a cat to get that type two, if they have those risk factors.

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Dr. Kelly Cairns: So when you say there are things we can do to prevent it, or are things that we might be doing that are causing it, or are there risk factors?

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Dr. Kelly Cairns: The average cat that's getting type two diabetes, that is middle age to older, one of the biggest risk factors is obesity.

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Dr. Kelly Cairns: And also what they're eating tied to obesity, including excessive carbohydrates.

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Dr. Kelly Cairns: So there are absolutely things we can do for a patient that's at risk or what we call pre-diabetic for cats, just like we do for people that might be pre-diabetic.

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Dr. Kelly Cairns: And there's even when you see your vet as part of proactive wellness exams, remember part of that involves proactive diagnostic testing.

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Dr. Kelly Cairns: And there are for those kitties that might be at risk, some tests you can do just like people to see if they are pre-diabetic.

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Rita Reimers: So if you're feeding a grain free diet, are you pretty much assuring your cat will never get diabetes or is that not the case?

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Dr. Kelly Cairns: I want it to be that simple, but it's not that simple.

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Rita Reimers: Of course not.

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Dr. Kelly Cairns: There's no strong evidence that feeding a grain free diet is going to prevent diabetes.

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Dr. Kelly Cairns: And there are some potential long term risks for some kitties with a grain free diet.

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Dr. Kelly Cairns: So definitely if you're thinking about going grain free with any kitty, talk to your vet first just to make sure and get their recommendation.

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Dr. Kelly Cairns: Generally, we don't do diets preemptively to prevent diabetes in all cats.

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Dr. Kelly Cairns: But however, if we have a kitty that's pre-diabetic, your vet is going to be talking to you about dietary changes.

00:15:26.418 --> 00:15:35.818
Dr. Kelly Cairns: And the single biggest thing you can do to lessen the risk through the dietary change is less calories so that they lose weight.

00:15:35.938 --> 00:15:42.458
Dr. Kelly Cairns: And your vet's going to be talking to you about a lower carbohydrate, slightly higher protein diet.

00:15:43.298 --> 00:15:44.098
Linda Hall: Okay.

00:15:44.118 --> 00:15:46.098
Linda Hall: And I suppose choosing the right grains, too.

00:15:46.118 --> 00:15:47.358
Linda Hall: I mean, grain free doesn't...

00:15:47.378 --> 00:15:48.738
Linda Hall: There's crap grain, right?

00:15:48.758 --> 00:15:49.938
Linda Hall: Like, just like us.

00:15:49.958 --> 00:15:53.338
Rita Reimers: Well, let's get back to that after we have to take a little break.

00:15:53.598 --> 00:15:56.118
Rita Reimers: But when we get back, we ask her questions.

00:15:57.738 --> 00:15:58.638
Rita Reimers: We'll be right back.

00:16:01.218 --> 00:16:02.938
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00:16:02.958 --> 00:16:06.258
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00:16:07.458 --> 00:16:09.538
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00:16:09.738 --> 00:16:12.978
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00:16:31.478 --> 00:16:35.358
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00:16:35.838 --> 00:16:38.598
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00:16:38.918 --> 00:16:43.138
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00:17:07.718 --> 00:17:11.198
Rita Reimers: And we're back with 19 cats and counting the awesome Dr.

00:17:11.218 --> 00:17:12.058
Rita Reimers: Kelly Cairns.

00:17:12.378 --> 00:17:15.918
Rita Reimers: And of course Linda, my best friend and brother and I.

00:17:16.378 --> 00:17:19.078
Rita Reimers: You were just asking a question before we went to bed.

00:17:19.133 --> 00:17:20.513
Rita Reimers: I want to continue with that line.

00:17:20.573 --> 00:17:23.073
Linda Hall: So we were talking about green free, and that's been a whole thing.

00:17:23.093 --> 00:17:25.353
Linda Hall: There was a big green free kick, and then no greens are good.

00:17:25.373 --> 00:17:27.353
Linda Hall: But a green is not a green is not a green, right?

00:17:27.373 --> 00:17:33.413
Linda Hall: Just like we need carbs, or we can go into ketoacidosis, which some people shoot for, but it's not really great for our bodies.

00:17:33.833 --> 00:17:40.473
Linda Hall: But there's a difference between white flour and white sugar versus grape sand, whatever that are carbs.

00:17:40.493 --> 00:17:44.433
Rita Reimers: So people like me who break out from Celiac.

00:17:44.433 --> 00:17:45.153
Rita Reimers: Yes.

00:17:45.213 --> 00:17:45.733
Linda Hall: Yes.

00:17:45.873 --> 00:17:49.973
Linda Hall: So not all greens are better greens than others, right?

00:17:49.973 --> 00:17:51.593
Linda Hall: Are you getting what I'm putting down here?

00:17:52.113 --> 00:17:52.833
Dr. Kelly Cairns: Absolutely.

00:17:53.033 --> 00:17:54.893
Dr. Kelly Cairns: So carbs are not the enemy.

00:17:55.153 --> 00:18:00.153
Dr. Kelly Cairns: Carbs are amazingly helpful and useful to our body, but they are not all created equal.

00:18:00.553 --> 00:18:02.773
Dr. Kelly Cairns: So what you put in your body matters.

00:18:02.793 --> 00:18:09.113
Dr. Kelly Cairns: What your kitty puts into its body matters in terms of the types of carbohydrates and the types of greens.

00:18:09.133 --> 00:18:21.713
Dr. Kelly Cairns: So that's definitely for all cats, a conversation you have with your veterinarian about what are your cat's dietary needs related to how old it is, what its life stage is, what its environment's like, any underlying conditions.

00:18:21.993 --> 00:18:36.593
Dr. Kelly Cairns: And even in a cat that does have diabetes, if your veterinarian is saying that a low carb, slightly higher protein content diet might be right for your cat, your veterinarian is gonna be saying low carb and specific type of grain, not no carb.

00:18:36.613 --> 00:18:37.233
Rita Reimers: Not no carb.

00:18:37.373 --> 00:18:37.753
Rita Reimers: Yes.

00:18:38.333 --> 00:18:39.633
Linda Hall: So there's diet.

00:18:39.653 --> 00:18:41.113
Linda Hall: We also know there's shots.

00:18:41.133 --> 00:18:50.873
Linda Hall: And I have to say, we see clients that the cat gets diagnosed with something that's gonna take some maintenance at home and they get scared and they often euthanize or try to rehome.

00:18:50.893 --> 00:18:53.293
Linda Hall: We've actually taken in a diabetic cat for that reason.

00:18:53.893 --> 00:18:59.473
Linda Hall: So when I was staying at Rita's, I made her, and I didn't wanna do it, but I made her make me-

00:19:01.013 --> 00:19:03.433
Linda Hall: Give Mimi a shot.

00:19:03.453 --> 00:19:06.793
Linda Hall: And I'll tell you, I was a worked up nutcase.

00:19:06.833 --> 00:19:08.053
Rita Reimers: That's not as hard as you think.

00:19:08.073 --> 00:19:08.973
Linda Hall: I did not wanna do it.

00:19:09.333 --> 00:19:10.653
Linda Hall: It wasn't a big deal.

00:19:10.773 --> 00:19:11.913
Linda Hall: She didn't even look up.

00:19:11.933 --> 00:19:15.113
Linda Hall: She was eating her wet food and didn't even notice me doing it.

00:19:15.133 --> 00:19:16.893
Linda Hall: So what's involved?

00:19:16.933 --> 00:19:18.213
Linda Hall: How scary is it?

00:19:18.553 --> 00:19:21.513
Linda Hall: Everyone can do it or you need to have some training?

00:19:21.913 --> 00:19:22.613
Linda Hall: Talk to us.

00:19:22.873 --> 00:19:28.233
Dr. Kelly Cairns: Okay, so let's pick it up from, my cat has diabetes and I've been to the vet.

00:19:28.293 --> 00:19:29.653
Dr. Kelly Cairns: I have a diagnosis.

00:19:29.993 --> 00:19:30.953
Dr. Kelly Cairns: How are we treating?

00:19:31.133 --> 00:19:32.473
Dr. Kelly Cairns: So let me clarify.

00:19:32.493 --> 00:19:38.413
Dr. Kelly Cairns: If a kitty is pre-diabetic, your vet is probably gonna be talking to you about weight loss and also a different type of diet.

00:19:38.433 --> 00:19:40.233
Dr. Kelly Cairns: They may or may not have some other recommendations.

00:19:40.313 --> 00:19:41.953
Rita Reimers: Just like with people, right?

00:19:42.773 --> 00:19:43.873
Dr. Kelly Cairns: Absolutely, yep.

00:19:44.013 --> 00:19:58.853
Dr. Kelly Cairns: But once your kitty's been diagnosed with diabetes, most kitties, most kitties will still need, even though they are type two, they will still need insulin injections, either chronically, permanently, and or short term.

00:19:59.333 --> 00:20:02.233
Dr. Kelly Cairns: So that is, and we'll talk about the insulin.

00:20:02.793 --> 00:20:10.493
Dr. Kelly Cairns: Also then, your vet's gonna be talking to you about a permanent diet change for a diet that is lower in carbs and a little bit higher in protein.

00:20:10.693 --> 00:20:17.513
Dr. Kelly Cairns: The exact diet recommendation is gonna be really specific to your cat and what other conditions your cat may or may not have.

00:20:17.813 --> 00:20:21.753
Dr. Kelly Cairns: Now, there is a third, this is very exciting for me.

00:20:22.013 --> 00:20:29.713
Dr. Kelly Cairns: You guys know I've talked about some other things, like when we talked about arthritis and older cats, and, oh my gosh, we have this new class of medications.

00:20:30.033 --> 00:20:38.333
Dr. Kelly Cairns: Cilencia, yes, which is a mechanism of action or a class of drug that is never existed before for cats.

00:20:38.553 --> 00:20:55.093
Dr. Kelly Cairns: So we don't have major game changing tools in our medical toolkit as veterinary professionals very frequently, because medicine doesn't change that frequently, but for diabetes, it's been a really exciting year for us because we finally have something new we never had before.

00:20:56.973 --> 00:21:04.753
Dr. Kelly Cairns: So the old adage was oral medicines that people take, different oral hypoglycemic drugs that a lot of human diabetics will take.

00:21:05.153 --> 00:21:09.493
Dr. Kelly Cairns: The studies have not really shown they've been that effective for cats, and there's a lot of side effects.

00:21:09.513 --> 00:21:13.513
Dr. Kelly Cairns: So the old rule was always diet and insulin only full stop.

00:21:13.793 --> 00:21:25.833
Dr. Kelly Cairns: However, we do have a new class of medication that came from the human medical space where now we have a veterinary version, FDA approved for cats.

00:21:25.853 --> 00:21:27.653
Dr. Kelly Cairns: That's an oral medication.

00:21:28.153 --> 00:21:29.013
Dr. Kelly Cairns: One is a pill.

00:21:29.273 --> 00:21:34.393
Dr. Kelly Cairns: There's another one that's the same class that is a liquid for cats with diabetes.

00:21:34.633 --> 00:21:37.333
Dr. Kelly Cairns: And this may be a game changer.

00:21:37.733 --> 00:21:54.673
Dr. Kelly Cairns: I don't know that we think that it's always gonna replace insulin in all instances, but there are a subset of cats that are diagnosed with diabetes for which starting this oral medication may be just as good a choice as insulin instead of insulin.

00:21:54.773 --> 00:22:00.013
Dr. Kelly Cairns: Okay, so that's the first thing to know about in terms of the fact that we didn't have that a couple years ago.

00:22:00.333 --> 00:22:17.073
Dr. Kelly Cairns: Now, when your cat though needs insulin, which many cats do, the good news is that this is usually a very easy, non-scary thing, non-painful thing for you to do at home for your cat, most commonly twice a day.

00:22:17.873 --> 00:22:20.433
Dr. Kelly Cairns: It requires just a little bit of education.

00:22:20.753 --> 00:22:28.733
Dr. Kelly Cairns: When your cat's diagnosed with diabetes, I guarantee your veterinary office is going to have what I call the diabetes champion.

00:22:29.073 --> 00:22:34.553
Dr. Kelly Cairns: That person is probably going to be a veterinary technician because they're the superstars of the hospital.

00:22:34.573 --> 00:22:35.073
Dr. Kelly Cairns: They are.

00:22:35.093 --> 00:22:37.013
Linda Hall: So give them a little love when you go.

00:22:37.693 --> 00:22:39.393
Dr. Kelly Cairns: They're doing the heavy lift for us.

00:22:40.653 --> 00:23:00.013
Dr. Kelly Cairns: And I guarantee you that your veterinarian is going to have one or two diabetes champions, one of their amazing technicians who's going to go ahead and educate you and show you how to store the insulin, how to make sure that you're suspending it right, that it's not settling in the bottom, how you draw it up, how you give it.

00:23:00.373 --> 00:23:03.693
Dr. Kelly Cairns: They're going to be there for you every step of the way.

00:23:04.033 --> 00:23:28.433
Dr. Kelly Cairns: And as a board certified small animal internal medicine specialist who's treated a lot of cats with diabetes over the last 20 years, I will tell you that 98% of the time the kitty mom and dad and the kitty itself that's not so sure initially how this is going to go, feels very confident and comfortable with that kind of hand holding.

00:23:28.973 --> 00:23:32.313
Rita Reimers: I actually think shots are easier than giving a pill.

00:23:32.353 --> 00:23:33.173
Rita Reimers: That's just me.

00:23:33.993 --> 00:23:35.213
Rita Reimers: I do think they're easier.

00:23:35.373 --> 00:23:36.533
Linda Hall: Well, you don't have to.

00:23:36.553 --> 00:23:38.613
Linda Hall: I mean, it's, we're not putting something in a vein.

00:23:39.773 --> 00:23:40.693
Linda Hall: It's not even intramuscular, right?

00:23:40.973 --> 00:23:41.993
Linda Hall: Tenth the skin.

00:23:42.013 --> 00:23:46.833
Linda Hall: And yeah, I want to experience everything I can as talking to people and saying, well, you need to do this.

00:23:46.953 --> 00:23:48.373
Linda Hall: I want to have experienced it.

00:23:48.393 --> 00:23:52.233
Linda Hall: So that's why I forced myself to give this shot with Rita's nudging.

00:23:52.253 --> 00:23:53.833
Linda Hall: Had she not been there, I wouldn't have done it.

00:23:53.833 --> 00:23:55.233
Rita Reimers: Well, we still had pets sitting then.

00:23:55.253 --> 00:23:56.013
Rita Reimers: I don't remember.

00:23:56.073 --> 00:23:57.473
Linda Hall: No, we weren't pet sitting then.

00:23:57.493 --> 00:24:00.913
Linda Hall: We were just doing behavior, but I was just so freaked out.

00:24:00.913 --> 00:24:02.053
Linda Hall: And yeah, it was nothing.

00:24:03.093 --> 00:24:07.513
Rita Reimers: Can I ask a question about the pill, about the new oral medication?

00:24:08.093 --> 00:24:13.533
Rita Reimers: Way back, way, way, way back when I was a pet sitter, we did have one cat that used to try to bite me.

00:24:13.533 --> 00:24:17.013
Rita Reimers: Long story short, just when I would visit, we were doing a pill.

00:24:17.373 --> 00:24:21.033
Rita Reimers: So, but I remember her vet saying it wasn't as effective.

00:24:21.033 --> 00:24:22.733
Rita Reimers: So I'll have to look up what that was.

00:24:23.233 --> 00:24:33.593
Rita Reimers: But this new pill, is it only if the cat has been diagnosed diabetic, or does it help in a pre-diabetic situation to avoid the cat becoming diabetic?

00:24:33.993 --> 00:24:39.373
Dr. Kelly Cairns: This new class of medication, this oral medication is for a diagnosed diabetic cat.

00:24:39.533 --> 00:24:44.213
Rita Reimers: So there's nothing to give a pre-diabetic cat right now other than diet and weight loss.

00:24:44.813 --> 00:24:48.433
Dr. Kelly Cairns: Diet, weight loss, and exercise in most cases, yes.

00:24:48.753 --> 00:24:49.113
Rita Reimers: Yes.

00:24:50.773 --> 00:24:53.073
Linda Hall: So we should be keeping that up preemptively as well.

00:24:53.273 --> 00:24:57.793
Linda Hall: We're making sure that we can do everything we can to keep our cats eating the healthiest diet.

00:24:57.813 --> 00:24:58.493
Linda Hall: We should do that anyway.

00:24:58.833 --> 00:25:03.813
Linda Hall: And exercising and keeping all of this to prevent as much as possible.

00:25:03.833 --> 00:25:05.713
Linda Hall: I mean, I understand it's not a guarantee.

00:25:05.993 --> 00:25:10.753
Linda Hall: Even the healthiest, you see some healthy Olympian who has a heart attack, it happens, right?

00:25:10.773 --> 00:25:16.253
Linda Hall: So same thing with the diabetes, but there are things we can do that might stave off where there would have been.

00:25:16.693 --> 00:25:17.673
Linda Hall: Is that safe to say?

00:25:17.933 --> 00:25:19.253
Dr. Kelly Cairns: That is safe to say.

00:25:19.293 --> 00:25:19.713
Linda Hall: Yes.

00:25:19.953 --> 00:25:26.913
Dr. Kelly Cairns: Now, there are some cats that just like people might have some underlying genetic predisposition where they're going to get it no matter what.

00:25:27.133 --> 00:25:35.753
Dr. Kelly Cairns: For a lot of cats that get your type 2 diabetes, because they've been obese a long time, you absolutely can lessen the chance that's going to happen with what we've outlined.

00:25:37.253 --> 00:25:38.633
Rita Reimers: I have an obese cat.

00:25:38.673 --> 00:25:39.993
Rita Reimers: He's 16 pounds.

00:25:40.373 --> 00:25:41.553
Rita Reimers: He's healthy though.

00:25:41.573 --> 00:25:42.553
Rita Reimers: We've had all the blood work done.

00:25:42.913 --> 00:25:44.593
Rita Reimers: I just can't get him to lose weight.

00:25:45.053 --> 00:25:50.653
Rita Reimers: So if I see him starting to lose weight, now I'm like, okay, is it diabetes or is the weight loss?

00:25:50.673 --> 00:25:51.253
Rita Reimers: Well, that's right.

00:25:51.273 --> 00:25:52.593
Rita Reimers: I don't know, right?

00:25:52.853 --> 00:25:58.393
Rita Reimers: So when you do have a diabetic cat, they get diagnosed, you go home with your insulin, you've learned how to give it.

00:25:58.633 --> 00:26:03.713
Rita Reimers: That's not the end of the story, because a lot of times it takes some adjusting to get that insulin level right.

00:26:03.913 --> 00:26:08.913
Rita Reimers: So what are people looking for there to know that the insulin dose isn't quite right?

00:26:09.473 --> 00:26:12.573
Dr. Kelly Cairns: So the biggest thing we look at are what we call clinical symptoms.

00:26:12.593 --> 00:26:17.933
Dr. Kelly Cairns: So which would be the increased thirst, increased urination, excessive appetite with weight loss.

00:26:18.153 --> 00:26:20.013
Dr. Kelly Cairns: Those are symptoms of diabetes.

00:26:20.273 --> 00:26:33.573
Dr. Kelly Cairns: When we're regulating or treating a kitty, we want to see that those symptoms go away and their weight is stable, they're eating, but they're not ravenous and acting starving and that they're drinking and urinating normally, not excessively.

00:26:34.033 --> 00:26:35.853
Dr. Kelly Cairns: That's what we call clinical symptoms.

00:26:35.873 --> 00:26:36.553
Dr. Kelly Cairns: What are you seeing?

00:26:37.073 --> 00:26:51.413
Dr. Kelly Cairns: The other thing is going to be very strong and tight communication with your veterinarian and frequent re-checks, at least in the beginning, because the end all be all, just like with people, is to check their blood sugars.

00:26:51.693 --> 00:27:01.113
Dr. Kelly Cairns: So we do that through blood testing and there are some tests we do that can look at the average blood sugar over the prior several weeks or months.

00:27:01.513 --> 00:27:05.573
Dr. Kelly Cairns: And then we also do short-term testing, which is called a glucose curve.

00:27:06.033 --> 00:27:14.153
Dr. Kelly Cairns: So many of us know someone who has diabetes, a person, and we know that that person will prick their finger and check before they eat.

00:27:14.153 --> 00:27:24.113
Dr. Kelly Cairns: And now what's more common is that humans will actually have a constant monitor that's always monitoring with a little tiny sensor underneath their skin that doesn't hurt.

00:27:24.533 --> 00:27:27.673
Dr. Kelly Cairns: So with animals and kitties, it's the same thing.

00:27:27.913 --> 00:27:39.213
Dr. Kelly Cairns: We actually have technology that's being used more frequently now to do a little sensor that then can continuously monitor their sugar over a week period at home.

00:27:39.293 --> 00:27:41.173
Dr. Kelly Cairns: Your vet may want to put one of those on your kitty.

00:27:41.653 --> 00:28:00.733
Dr. Kelly Cairns: Or more commonly, we're doing a little tiny prick, a little tiny prick, usually on the ear, to get a drop of blood to check what's called a glucometer or a spot blood sugar reading every hour or two over the course of an entire day to look at the range of blood sugar levels.

00:28:01.093 --> 00:28:08.213
Dr. Kelly Cairns: And that is how your veterinarian is assessing, in addition to what you're telling them is going on at home, what needs to happen with the dose.

00:28:08.613 --> 00:28:18.333
Dr. Kelly Cairns: So the biggest thing I can ask folks to do is give your vet some grace, because we're just in it, just like you, rowing in the same direction.

00:28:18.553 --> 00:28:20.193
Dr. Kelly Cairns: We don't have a crystal ball.

00:28:20.473 --> 00:28:26.173
Dr. Kelly Cairns: And sometimes it can be a little frustrating because it can be time consuming to get things on track.

00:28:26.613 --> 00:28:32.113
Dr. Kelly Cairns: And so know that we don't want you to have to come into the hospital any more often than you have to.

00:28:32.313 --> 00:28:37.253
Dr. Kelly Cairns: But if we're asking you to do a check, it's because we think it's in your pet's best interest.

00:28:37.573 --> 00:28:44.793
Dr. Kelly Cairns: And then talk to your vet once things are regulated about the option of checking sugars at home.

00:28:45.493 --> 00:28:48.573
Dr. Kelly Cairns: Many, many folks will learn how to do that.

00:28:49.073 --> 00:28:57.593
Dr. Kelly Cairns: And then they're able to get readings for their veterinarian without having to come to the hospital, saving the time, saving the stress.

00:28:58.273 --> 00:29:07.093
Dr. Kelly Cairns: But if you're going to do that, you're never ever changing the dose of insulin at home without getting that green light from your vet.

00:29:07.113 --> 00:29:08.113
Rita Reimers: Yes, exactly.

00:29:08.193 --> 00:29:09.753
Dr. Kelly Cairns: Just doing the checks.

00:29:09.793 --> 00:29:14.953
Rita Reimers: Doing a blood, doing, sticking the blood, getting the blood draw, that's scarier to me than giving the shot.

00:29:14.973 --> 00:29:16.833
Rita Reimers: I'd rather take my cat to the vet for that.

00:29:17.013 --> 00:29:17.753
Rita Reimers: That's just me.

00:29:17.893 --> 00:29:19.153
Rita Reimers: I'll pay for a vet visit.

00:29:19.173 --> 00:29:20.973
Rita Reimers: You stick him with the, I don't want to do it.

00:29:20.993 --> 00:29:22.713
Linda Hall: We had to do that with Mimi, didn't we?

00:29:22.893 --> 00:29:24.333
Linda Hall: Didn't you have to get a monitor?

00:29:24.393 --> 00:29:26.173
Rita Reimers: I got a monitor, but she passed.

00:29:26.313 --> 00:29:27.813
Rita Reimers: No, I got a monitor, but she passed.

00:29:28.553 --> 00:29:29.993
Linda Hall: Because I was going to ask about that.

00:29:30.013 --> 00:29:35.833
Linda Hall: Yes, my son-in-law was diabetic, and so those constant finger sticks and switch fingers because it's calloused.

00:29:35.853 --> 00:29:40.073
Linda Hall: And so, yeah, I wondered if that was common thing at home to monitor as well.

00:29:41.053 --> 00:29:42.093
Dr. Kelly Cairns: Well, and this is the thing.

00:29:42.293 --> 00:29:46.973
Dr. Kelly Cairns: When you see your veterinarian, we're going to let you know what we think we need to do medically.

00:29:47.193 --> 00:29:53.533
Dr. Kelly Cairns: And then there might be like six ways to bake that cake or different things that you can do at home versus do in the hospital.

00:29:53.533 --> 00:30:00.633
Dr. Kelly Cairns: And I guarantee you, your veterinarian is going to work with you on the plan that feels most comfortable to you.

00:30:00.653 --> 00:30:04.633
Dr. Kelly Cairns: Because it can never be a one-size-fits-all approach to the point that you just raised.

00:30:04.833 --> 00:30:11.213
Dr. Kelly Cairns: There's some folks that actually want to do those blood sugar checks at home, and they really strongly feel passionate about that.

00:30:11.333 --> 00:30:12.873
Dr. Kelly Cairns: And it doesn't scare them.

00:30:12.873 --> 00:30:13.693
Dr. Kelly Cairns: And that's cool.

00:30:13.933 --> 00:30:17.633
Dr. Kelly Cairns: Then there's folks that say, uh-uh, uh, I want to go to the hospital for it.

00:30:17.653 --> 00:30:18.233
Dr. Kelly Cairns: And you know what?

00:30:18.473 --> 00:30:19.153
Dr. Kelly Cairns: That's cool.

00:30:19.413 --> 00:30:23.773
Dr. Kelly Cairns: So we're going to work on a plan that you feel comfortable with so that we can partner with you.

00:30:24.313 --> 00:30:26.573
Rita Reimers: Drawing blood is where I draw blood.

00:30:26.913 --> 00:30:31.833
Linda Hall: We had a pet sitter who would give shots in sub-queue and her visits.

00:30:32.293 --> 00:30:38.113
Linda Hall: But when her own cat got ill, her vet was trying to talk her into giving shots and she just couldn't do it.

00:30:38.133 --> 00:30:40.453
Linda Hall: It's like, this is my baby and I can't stick him.

00:30:40.473 --> 00:30:41.973
Linda Hall: And she said, I feel horrible.

00:30:41.993 --> 00:30:44.633
Linda Hall: And I said, your comfort level matters, right?

00:30:44.633 --> 00:30:48.593
Linda Hall: I mean, try and if you can do, but if you can't, you go to your vet.

00:30:49.053 --> 00:30:52.113
Linda Hall: There's no reason to carry that guilt, right?

00:30:52.813 --> 00:30:55.953
Dr. Kelly Cairns: It is a guilt-free zone at your veterinarian's office.

00:30:56.593 --> 00:30:57.493
Dr. Kelly Cairns: Here, here for you.

00:30:57.553 --> 00:31:04.333
Rita Reimers: Yeah, they'd rather you ask the question and get your cat the care that he needs than avoid and not do anything.

00:31:04.873 --> 00:31:06.393
Rita Reimers: We've got a few minutes left here.

00:31:06.413 --> 00:31:18.893
Rita Reimers: I want to make sure that we have talked about everything that, or as close as we can get to everything that a cat parent needs to know to recognize and get their diabetic cat treated as quickly as possible.

00:31:19.133 --> 00:31:25.873
Dr. Kelly Cairns: Well, you ladies know, I always like to leave y'all with a toolkit of what we, should we recap some take home points for Katie Levy?

00:31:25.893 --> 00:31:26.373
Rita Reimers: Yes, let's do.

00:31:27.093 --> 00:31:32.013
Dr. Kelly Cairns: Okay, so diabetes is when your cat is not able to make insulin.

00:31:32.053 --> 00:31:35.993
Dr. Kelly Cairns: So you can't get that sugar inside the cells where it's needed for energy.

00:31:36.393 --> 00:31:42.713
Dr. Kelly Cairns: The symptoms are increased thirst and urination, often increased appetite with weight loss.

00:31:43.153 --> 00:31:45.193
Dr. Kelly Cairns: It is very easy to diagnose.

00:31:45.493 --> 00:31:52.073
Dr. Kelly Cairns: So go to your veterinarian and we can even determine if your cat is pre-diabetic through routine testing.

00:31:52.093 --> 00:31:53.233
Dr. Kelly Cairns: So knowledge is power.

00:31:53.573 --> 00:32:10.473
Dr. Kelly Cairns: Do those recommended proactive preventive care, wellness, blood and urine tests that your vet recommends, even if your kitty's not showing any symptoms of illness, because a lot of times there's stuff in those tests that we can identify earlier than had we waited for symptoms.

00:32:11.073 --> 00:32:30.993
Dr. Kelly Cairns: Good news is many cats are treated and do well with a great quality of life for a very long time with diabetes, we're going to use diet, we're going to use insulin, we may as an alternate be using this brand new, very exciting oral medication for cats that didn't exist before, and you need to partner with your vet.

00:32:31.013 --> 00:32:35.793
Dr. Kelly Cairns: This is not like an infection where you get an antibiotic, buh-bye, see you in six months.

00:32:36.413 --> 00:32:42.953
Dr. Kelly Cairns: This is going to be a little bit of time, little bit of resources with a really great outcome partnering with your vet.

00:32:43.413 --> 00:32:43.933
Linda Hall: Sounds great.

00:32:43.953 --> 00:32:44.673
Linda Hall: That is so worth it.

00:32:45.113 --> 00:32:46.953
Dr. Kelly Cairns: Make sure your cat is not overweight.

00:32:46.973 --> 00:32:53.933
Dr. Kelly Cairns: Talk to your vet, because obesity does cause a lot of problems, including, but not limited to diabetes.

00:32:54.333 --> 00:32:57.553
Rita Reimers: That's a tough one, because our cats, you know, they're inside.

00:32:57.733 --> 00:32:59.593
Rita Reimers: This is bad.

00:32:59.633 --> 00:33:19.233
Dr. Kelly Cairns: Let me remind you, ladies, that I've got a cat who's sitting not too far away from me, who eats like a whiff of nothing and yet is about 22 pounds, and he's giant, and he's orange, and he's a male, and he still doesn't have diabetes, but I feel like it might be coming, and I'm trying to get him to lose weight.

00:33:19.553 --> 00:33:22.113
Dr. Kelly Cairns: I empathize with our kitty-loving friends on that one.

00:33:22.273 --> 00:33:24.073
Rita Reimers: That's why I'm with Peanut.

00:33:24.213 --> 00:33:30.393
Rita Reimers: He's 16 pounds, he's 15 years old, he's fine, but I know the day's coming.

00:33:30.653 --> 00:33:36.993
Linda Hall: The joke with Peanut is she named him Peanut when she got him because he was so tiny, and she changed it to Peanut Butter because he spread.

00:33:39.233 --> 00:33:40.313
Rita Reimers: And boy, did he.

00:33:42.173 --> 00:33:43.213
Rita Reimers: But he's still sweet.

00:33:43.893 --> 00:33:47.073
Rita Reimers: So thank you so much for all of this awesome information.

00:33:47.453 --> 00:33:52.853
Rita Reimers: Unfortunately, diabetes is a lot more prevalent than I wish it was, but now we know how to spot it.

00:33:53.393 --> 00:33:55.853
Rita Reimers: Go to your vet if you've got any concerns at all.

00:33:56.493 --> 00:33:58.893
Rita Reimers: I always tell people when they ask, should I take my cat to the vet?

00:33:58.913 --> 00:34:02.133
Rita Reimers: If you're asking that question, the answer is yes, you should.

00:34:02.853 --> 00:34:03.613
Rita Reimers: And of course-

00:34:03.873 --> 00:34:05.313
Dr. Kelly Cairns: You know how you can make it easier?

00:34:05.933 --> 00:34:19.473
Dr. Kelly Cairns: Is make it easier besides inventing the teleporter, which we haven't done yet, is find a veterinarian that has wellness care plans or membership plans where you have unlimited office visits for that member.

00:34:19.493 --> 00:34:21.173
Rita Reimers: Your company does that, right, Thrive?

00:34:21.353 --> 00:34:22.833
Dr. Kelly Cairns: We do, actually, we do.

00:34:22.853 --> 00:34:34.553
Dr. Kelly Cairns: And it's, boy, I take advantage of that as part of the Thrive community when I even have to have my animals seen by other veterinarians that aren't me, that I want to get their opinion on.

00:34:34.893 --> 00:34:42.093
Dr. Kelly Cairns: But a lot of those membership plans will also offer a discount for diagnostic testing, you know, like 10% off or something like that.

00:34:42.093 --> 00:34:42.773
Dr. Kelly Cairns: Ours does.

00:34:43.133 --> 00:34:48.933
Dr. Kelly Cairns: So that way, then, you know, you reap that benefit that more than pays for the membership plan.

00:34:48.953 --> 00:34:56.633
Dr. Kelly Cairns: But the biggest thing for me with this is that if you have a membership, there's, it decreases the barrier to entry to go in.

00:34:56.633 --> 00:34:58.153
Dr. Kelly Cairns: Yes, it's still a little time.

00:34:58.173 --> 00:35:02.193
Dr. Kelly Cairns: Hopefully your vet's close to you, but you know you can go in and get that exam.

00:35:02.373 --> 00:35:02.653
Linda Hall: Sure.

00:35:02.813 --> 00:35:05.973
Dr. Kelly Cairns: And you don't need to worry about, oh, how much is that gonna be?

00:35:06.073 --> 00:35:09.213
Linda Hall: I was thinking that I'd be much more, oh, let's go to the vet.

00:35:09.233 --> 00:35:11.413
Linda Hall: Then, oh, can we afford to go to the vet this week?

00:35:12.033 --> 00:35:21.773
Rita Reimers: Well, if you catch it early enough, you're gonna save a lot of money because you'll be treating something a lot sooner that could turn into a major, major issue if you let it go.

00:35:22.093 --> 00:35:23.913
Rita Reimers: Well, thank you again for being with us.

00:35:23.933 --> 00:35:27.913
Rita Reimers: I always look forward to our monthly visits with you, Dr.

00:35:27.933 --> 00:35:28.313
Rita Reimers: Kelly.

00:35:28.733 --> 00:35:31.213
Rita Reimers: And of course, Linda, I see you almost every day.

00:35:31.333 --> 00:35:33.373
Rita Reimers: I never get sick of seeing your beautiful face.

00:35:35.113 --> 00:35:42.053
Rita Reimers: And of course, Mark Winter, I have to thank you once again for this awesome opportunity to be part of the Pet Life Radio family.

00:35:42.233 --> 00:35:45.073
Rita Reimers: And just remember everyone, every day is Caturday.

00:35:45.533 --> 00:35:46.873
Rita Reimers: We'll see you next time.

00:35:47.673 --> 00:35:53.673
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