We are totally buggin' out on today's episode! In keeping with our theme of unappetizing subjects, Dr. J and Mia discuss fleas, ticks, and answer a listener question about sarcoptic mange.
We go into different types of preventatives and treatment options, and also include a warning for all of the pet parents with both dogs and cats at home.
And since they are plentiful, we'll be exploring other parasites in a follow-up to this episode.
Click to jump to conversation topic:
- 01:55 There are basically two things that fleas could get endorsed for on LinkedIn
- 02:39 If you have dogs and cats at home, please be extra careful with your preventatives
- 06:03 Different preventative options for dogs and cats
- 06:46 Steps you can take when applying a topical preventative with kids in the house and lots of things to consider when choosing a preventative
- 08:42 The flea collars of today are not your mama's flea collars
- 09:57 Some of the older fipronil-based solutions have decreased efficacy
- 11:11 Not too many "natural" options for preventatives, but a few flea-fighting solutions for the home
- 12:20 Garlic is not a good solution for treating parasites
- 14:39 Mia explains that she should probably have to wear her own cone of shame
- 16:27 If you find fleas, what should you do first, besides panic
- 18:42 We move on to ticks and Mia admits to learning about Lyme disease from watching The Real World and is not ashamed
- 21:15 Some tips for finding ticks on your pets
- 24:30 Dr. J answers a listener question about sarcoptic mange, and its recurrence on her dog
- 27:49 What the heck is sarcoptic mange
Full Paws & Play podcast transcript:
Mia: Welcome back to episode three of Paws & Play. I'm Mia and I'm here with Dr. J. How you doing?
Dr. J: I'm doing great Mia. Thanks for asking. How are you?
Mia: I am doing pretty great. Despite us going into yet another unappetizing topic, as we tend to do.
Dr. J: Oh I thought you were going to say despite going back into winter number three in the Pacific Northwest.
Mia: Actually the sun finally came out here. It looked like it was about to pour and then it came back out. Is it not so good over where you are?
Dr. J: Yeah it's just quite overcast. Ready for the good weather to set in permanently for a few months.
Mia: Ah, yes. I've had quite the start/stop battle with my lawn thanks to this weather. You know, what the weather does not stop? Parasites.
Dr. J: It's true! That is a good segue!
Mia: So, you know, fleas are one of the trickiest little (buggers) to deal with. Thankfully I haven't — I'm knocking on all of the wood everywhere — I haven't had to deal with it myself, but it seems like it is something that kind of takes over not only your pet, but your life.
Dr. J: And your home. Yeah. I mean there's two things that fleas do really well. One is suck blood and the other is reproduce. I mean they are just, they're experts at both and, so once fleas get hold and get established in your household, um, they can be really, they can be tricky and take a while to completely eradicate. So they really are truly best prevented.
Mia: So let's talk about that because there are a lot of flea treatments out there and a lot of preventives but not all are created equal. And there are some important things to be aware of when it comes to flea preventatives and using it on your dogs and cats and making sure not to use the dogs medication on your cats.
Dr. J: Yeah. And I'm happy that you're bringing this up at the outset because it really is a very important thing to get in the ears and the and the, the mindset of people who have cats because every year in the spring, summer, fall, E.R.s and general practice vet hospitals all around the country get in cats that, people in effort to try and save money, buy a dog product or maybe they don't read the label or they haven't sitting around for their dogs.
They take a dog product that has as an active ingredient, either a pyrethrin or one of the permethrin based compounds that are really good at killing fleas, but they're not very selective, in that they can also cause neurologic problems in mammals, in cats and dogs. And the concentration of the pyrethrin typically in the products for dogs are too high for cats to be able to process and handle safely.
Even if you're only giving them a fraction of a portion of the tube on their back. So all these hospitals will get a lot of cats coming in, twitching, having very severe whole body muscle tremors as a result of pyrethrin and permethrin toxicity and it can cause lasting neurologic damage.
It's very distressing and given that a lot of people are using a dog product that they've bought at the supermarket or Walmart or something like that, in an effort to save money, they wind up having to spend an awful lot more to treat the results of pyrethrin and permethrin toxicity in their cats. And so it can be really devastating on multiple levels.
So you always, always, always want to read labels. Fortunately, I think a few years back, the EPA required the dog-only products to have a little warning on it that says, "Not for use on cats", but really just make a really concerted effort to not use a dog-specific product on your cats.
And really ideally you should be getting your parasite preventatives from your veterinarian. Because they are the best ones able to guide you into a safe and effective whole home, all pet, parasite prevention program to keep fleas and other parasites out of your house.
Mia: So like, like a bundled kind of a preventative, not just fleas, but ticks and mites.
Dr. J: Yeah, ideally, if you're going to be spending the money on something to keep parasites out of your house, the more bang for your buck you get in terms of the number of parasites it'll keep off your pets and out of your home, the better typically.
And I think that what happens is a lot of people get the over the counter flea medication because they can get it without a prescription. If it's just fleas and it's a topical, a lot of those are now not necessary to have a prescription.
And so it can be less expensive because you don't have to necessarily go to the vet, pay for a vet exam if you haven't had one within the last six or 12 months. But really you may as well be getting the most mileage out of this stuff that you're using and ensuring that it's safe. So yes, ideally a sort of combination product under the guidance of a veterinarian.
Mia: Can we talk about some of the different types available? So there's chewables, that's what Marshall gets. He used to get the topical. There are collars. I have to assume that there is a difference in effectiveness from one to the other. And I know for me personally I wanted to go to a chewable because I was afraid of kind of getting it in the wrong place and having it rub off.
Dr. J: And there are a lot of considerations when figuring out what product, and/or products, are going to be most effective and, logistically the best in your home and with your pets and with your family. I've got two young daughters and so I really, even though a lot of the topical stuff is relatively safe around kids, it was just one thing I didn't want to have to think of.
So with, you know, with my dog, with Wendy, we do an oral pill that takes care of fleas, ticks and heartworms. And then with our cat, really just because of getting all of this stuff, even though he's indoor only, I want to have him on heartworm preventative because that can be devastating in cats and untreatable. I wanted to protect against fleas so we have him on a topical.
But I would apply it to him after the girls would go to bed. So by the time they woke up they can be petting him perfectly fine. So there's lots of things to take into consideration, you know, even what type of pets you have in the house, you know, going back to the pyrethrin thing, if you've got a cat in the house, even if you're using a safe labeled pyrethrin based product on your dog, if your cat and your dog are friendly, which a lot of the times they are, your cat may be grooming that off of your dog and so they can suffer the risks of pyrethrin toxicity even though you've used the product appropriately.
So there's a lot of things to consider, you know, do you want to be dealing with a topical that you've got to, like you said, part of the fur, make sure you're getting it on the coat. Do they do a lot of swimming? Do they get frequent baths? Are you worried about bathing it off? Do they have the food hypersensitivity? So are they allergic to maybe one of the proteins that's in one of the tubal tablets and therefore they need a topical product? Or is it the speed of kill.
Mia: Oh gosh I hadn't even thought about that.
Dr. J: Again, this is the reason why these are decisions to be made with your veterinarian as opposed to the, you know, the employee or the pet store, the cashier at the Walmart or anything like that. Or even if the human pharmacies start getting into this market, the pharmacists at the CVS or the Walgreens or whatever it might be.
We vets and our teams know this stuff and we think about these aspects of it and it really is all about efficacy and safety, because parasites can cause not just the discomfort and be a nuisance to our cats and dogs, but they can also cause disease and sometimes very significant disease and some of the diseases can be transmissible to people so they can be zoonotic. So these really are important decisions and, and really should be made under the guidance of your veterinarian
Mia: So, you know, I brought up flea collars before and I just, in the past what I've seen, it looks like it, it doesn't work very well. You mentioned one to me a little bit ago that you said that is actually pretty good.
Dr. J: Yeah, I mean, so the flea collars of like when we were growing up, you know, like our parents and grandparents, flea colors, maybe not grandparents, but our parent's flea collars, not that they wore them themselves but, they really weren't very effective and they were pretty nasty chemicals and they smelled to high heaven and you didn't want to be anywhere around them. You certainly didn't want to touch them. And if a kid touched and put it in their mouth, you know, their fingers in their mouth that, that can be problematic.
Bayer came out with the Seresto collar, I think, probably like three, four or five years ago maybe. And that's a really effective flea collar. And it's waterproof so it can be worn in the water and it's safe to touch. I think they actually even say like if a toddler would it chew on it, it will be perfectly safe. I don't know that I'd necessarily, you know, go around testing that, but...
Mia: Throw it in the freezer and use it as a teething ring? No fleas!
Dr. J: No fleas, no problem. No teeth. So there are, you know, every formulation is possible, so you've got an effective flea collar if that's the way you want to go. You've got highly effective chewables that can protect against fleas as well as multiple other parasites and are quick acting and they last for a month, sometimes even longer. And then you've got the topicals, which, still there are some really good topicals out there.
Unfortunately in clinical practiceI was definitely seeing some decreased efficacy of the Fipronil based ones. So the Frontline, and the generic of Frontline.
It's been out for, gosh, I think 20 plus years, and when it came out it revolutionize the market. Like it was literally a godsend for flea control at the time. I was a technician, veterinary nurse down in Gainesville, Florida, and it was like the quality of life of pets and the people that had them just went up astronomically when Fipronil came out, when Frontline first came out.
But I think over the years there's been some resistance perhaps developed to it, or people just aren't applying as well because the topicals can be a little bit tricky. Like you said, are you getting it on the fur, are you getting it on the coat? Are you releasing the pressure on the tube before you pulled the tube away from the skin and therefore sucking some of it back up and under-dosing them,
Mia: Can they rub it off too?
Dr. J: Sure they can and they can turn around and groom it off. You know what I mean? Cats in particular are really quite agile and bendable. So they can turn around, even if you think you're getting it completely on the back of their shoulder blades or the back of their neck, they could probably still groom a decent amount off. They wouldn't be too thrilled to do it, I would imagine, but that can decrease the dose that they're getting as well.
Mia: Yeah. Everywhere I look, people are looking for natural remedies. In my head. I don't know if there are preventatives that would be natural. It seems like it would have to be some kind of after the fact. Right. But yeah, can you speak to that a little because obviously if there are natural ways to do things, um, I'd love to hear about them.
Dr. J: As far as natural is concerned, I mean one of the things you could do is, fleas love a sandy, dirty, dry, hot environment. So if your backyard is all dug up and dirt and sand and it's hot and stuff, putting down a surface, grass or something like that, is going to decrease their ability to cultivate there, if you will.
In the home, doing a lot of vacuuming. There is a product, I think it's still out, called Fleabusters, which is a boric acid based product that you could put on the floor and in the carpets and it's meant to be able to stay down and be safe. And that can help decrease the populations in the home. But when people typically talk about the natural remedies for fleas, they're talking about garlic which just really isn't very effective.
And honestly, garlic and in higher doses can actually cause anemia. So low red blood cell count because it can destroy red blood cells both in cats and dogs — although cats tend to be a little bit more sensitive.
But if you've got a cat that's got chronic renal failure, who potentially already has anemia because of the role the kidneys play in creating blood cells, and then you give them garlic to try and keep fleas away, the garlic may be destroying more of the few red blood cells they have remaining. And then the fleas that are gonna survive are gonna suck and eat more of their blood, worsening their anemia. So garlic really isn't anything that I recommend people do.
You can use diatomaceous earth in the environment, and that can help in some cases. Again, boric acid we talked about. There are some beneficial nematodes, or worms, that you can have out in the yard that can eat flea eggs and flea larva, so those things can help.
But as far as like an actual, legitimate, effective flea preventative program — really it's the medications that are the best. There are a bunch and really kind of runs the range. So really go that way, especially with pets that have flea allergic dermatitis — cats and dogs that are allergic to flea saliva.
I mean, some of these guys it's heartbreaking because they're so allergic that literally the saliva from one flea can set them off to the point where, I've literally seen cats scratch their skin open and be bleeding just from the reaction to flea saliva. And these guys really need quick, effective, safe flea prevention.
And really, it's also one thing that I think unfortunately a lot of people don't realize, is we're even talking indoor-only cats because fleas don't know boundaries. They're not stopped by the front doors or screens or whatever.
Mia: There's no bouncers.
Dr. J: Wouldn't that be great though? I mean, I guess in effect, the effect of parasite preventatives, the flea preventatives are your bouncer. So there you go. Even if the fleas can afford the cover charge, they ain't getting in.
Really, every pet in the home has to be on safe, effective flea prevention for it to be effective because literally one missing link, and it's oftentimes the indoor-only cat, it just allows a flea population to perpetuate and just keep growing and causing problems, including with people. So you really need to be on top of it.
Mia: I should probably bow my head in shame a little bit. I bought Mazel heartworm medication, but —I'm pretty sure it's gotta be a topical. Does that sound right?
Dr. J: I mean, so, Revolution and Advantage multi.
Mia: I got him the Revolution, yes.
Dr. J: They're both topical heartworm preventatives for cats and they're great because they get fleas, they prevent heartworm and they also take care of some intestinal parasites. So again, lots of bang for the buck.
Mia: Yes, well, I bought it. I haven't used it yet.
Dr. J: Your vet didn't tell you it's actually most effective if you take it out of the box and apply it to the cat? It's not just a proximity thing?
Mia: I mean, it may have been mentioned. But I don't know, I'm just like, afraid of not putting it in the right place. And again, having him groom it off of himself or rub up against Marshall.
Dr. J: I mean it's a possibility. In terms of probability, it's probably fairly low. But you know, they really are important to use and do. You just take time and try and part their fur, and if you need multiple sets of hands, you just enlist the troops and get 'er done.
Mia: Well, I guess I'll do that tonight and I'll report back on how that goes.
So, let's say that you have done the comb and yep, there's fleas. What's the first thing to do? Because obviously panic is probably about to set in. You're probably looking around the house thinking, "Oh God, am I gonna have to get rid of everything?" Where to start?
Dr. J: I would say that the first thing to do ideally, is call your vet and get an effective treatment for them. Ideally you've been to the vet in the last six to twelve months with your pet and they can just prescribe something and send something home once you've shown them that, yeah, it's fleas.
Because there are things that can start killing fleas very quickly, like within a half an hour and some even faster.
So you want to start killing those adult fleas, but unfortunately that's not the only component because in any sort of flea environment it's only about, I think it's roughly five to ten percent of the flea population or burden is on the pets. So the other ninety, ninety-five percent is actually in the environment. So in your carpets, on your furniture, in your bed, in the dog bed and the cat bed in the form of eggs and larva.
And like I said, they just reproduce like it's going out of style. And so there's a lot more generations waiting to sort of come up and take the place of the adult fleas that you're killing. So environmentally there are some safe and effective knockout sprays that can help to eradicate the environmental load, but vacuuming is hugely important.
And actually even oftentimes I recommend pretreating carpets with Borax, which you can just get in the laundry detergent aisle at the supermarket. That's boric acid, and if you put it down and let it sit for a couple hours, the little flea larva that are crawling around looking for flea dirt, the dried blood to eat, will eat the boric acid and destroy their gut. So when you vacuum them up, you're vacuuming up dead larva. And so when you then take the vacuum outside and change your empty the bag, you're not likely to reinfect. But vacuuming, you know, furniture, everything.
Mia: I was going to ask, like, you keep the vacuum after?
Dr. J: Well you gotta keep the vacuum. I mean some of those are really expensive, like the good ones, like those awesome Dyson vacuums and stuff. Yeah, you keep it. But, you know, you take it outside to either empty or changing the bag and you can even put, you know, a little bit of Borax in the vacuum bag, you know, so that any larva that get in there would also potentially be killed by that. But yeah, you want to just take it outside and, and change it out there.
Mia: All right, well I'm glad that we don't have to get rid of our vacuum cleaners. Uh, let's move along to ticks because it seems as though they are on the rise. I first learned about Lyme disease and ticks from watching the Real World.
Dr. J: Oh, you just admitted to that. Edit that part out. No, just kidding
Mia: You know what? I am what I am.
Dr. J: Right, right. Everyone's got their guilty pleasures.
Mia: I mean I was a hardcore Real World watcher since season one. We didn't have cable so I would stay up all night and watch the reruns at my grandparent's place when I slept over. But Irene from, I believe actually it was Real World Seattle, I'm going to have to go back and check on this*, but I just saw that she has like a whole Lyme disease awareness campaign going on right now. Seems like exactly the right time to be having it, too, because of all the warnings coming out.
*My brain is like a pop culture steel trap. Irene was, indeed, on The Real World Seattle.
Dr. J: Well yeah, there was that recent CDC report that talked about, you know, the, the incidents and prevalence of a lot of tick-borne diseases has really skyrocketed. Now. Part of that is going to be because we're, we're probably better at testing both in the veterinary world and perhaps even in the human medical world, but also, I mean, you know, climate is changing and the environments, you know, the boundaries of tick habitats are, are, are growing and we're spending more time in wooded areas and you know, around, you know, areas that ticks are. So. Yeah, I mean it's, and, and they really are. I mean it ticks are very problematic both for, for people and for, and for pets.
Mia: I mean, you know, obviously everybody says, okay, well look for ticks after you, you go out into the woods or you know, whatever on yourself and your, your dog or cats. Um, and honestly I don't know that I would be able to, to tell on, on myself, but like digging through fur and stuff like that has to be harder. So I just am wondering if there are any tips for, for doing that search because I mean Marshall has short hair so I think maybe it would be easier maybe on him, but I can't imagine trying to go through a long haired dogs for trying to search for the ticks.
Dr. J: It can be really difficult. I mean you can use the same flea comb, you know, you can use a flea comb like, you use for fleas to hopefully try and catch them and see them. And parting the fur and stuff and looking on their belly where typically there's less fur cover, you know, in their armpits and stuff. I mean, oftentimes ticks will migrate to those areas, especially the armpits or up, like behind the ears to attach, but when they first get on him, you know, it can be anywhere on their body.
You know, unfortunately a lot of people realize ticks only once they've kind of latched on and started taking a blood meal again, they feed off of your, you know, your pet's blood. And so there a little, you know, they start getting engorged, they're filling with blood and so they become that much more obvious because before a blood meal, some ticks are really quite small, but then they expand, you know, significantly as they start taking blood and, and that's when they start transmitting disease, um, is when they've been taking blood meals.
So just really checking regularly. But again, it underscores the importance of having them on a tick preventative, especially if you live in an area where ticks are a problem. But again, those boundaries have expanded. I mean, we never used to really have, and I didn't grow up here in the Pacific Northwest, but in the Pacific Northwest, in Western Oregon and Washington, there really was never a huge tick problem in a lot of areas. Well, that's changed now, so there's a lot more tick-borne disease being diagnosed out here and a lot more people, finding ticks even in and around Portland.
So fortunately, again, a lot of these combination medications, especially the newer, what are called isoxazoline compounds, like a Nexguard, Simperica and Bravecto, you know, they are really good at killing a fleas and ticks
Mia: Let's say that you haven't been able to catch it and you notice after the tick has had a good meal. What next? Is Lyme disease something that also comes up in pets?
Dr. J: Yeah. Oh yeah. It's a big thing for dogs. I mean, especially back on the east coast, and there can be some significant complications with Lyme disease in dogs just as there are in people. I mean, from Lyme arthritis, to kidney damage. So again, it underscores the importance of prevention and checking.
But if you find a tick, bring him to the vet to have it removed to have it identified because certain diseases are more likely transmitted by certain types of ticks. So trying to identify it if you can. Ideally try to make sure that all the mouth parts are removed when the tick is removed, and then potentially getting on prophylactic antibiotics depending on the vet's judgment and what they're seeing, to try and help minimize the risk of Lyme disease.
And there is a Lyme vaccine as well for dogs that are at risk. So dogs that spend a lot of time in the woods or go hunting or do a lot of camping. So it is quite a big thing. But then there's other tick-borne diseases like Rocky Mountain spotted fever, and Ehrlichia and such, that there isn't necessarily a vaccine for. So again, trying to prevent them.
There are tests to diagnose it, but trying to just keep ticks off of your pets is an important part. And part of that is even just keeping the tall grass away from your home. Mowing your yard and not having a lot of log piles and stuff like that.
Mia: We're short on time today, but we'll be picking up this conversation again later. But I definitely want to make sure that we get to one of our listeners' questions. So Cindy in Tampa, thank you for sending in your question.
Cindy said, "Hi — it seems as though as soon as I get my dog cured of sarcoptic mange through meds and baths he gets another batch of it." They live in an apartment complex, and she's wondering if it lies dormant in the grass and dirt and jumps on him when he goes to the bathroom or — what's going on?
Dr. J: Yeah. Interesting. So thank you very much for sending that in Cindy. And I'm, and I'm sorry to hear of your cycle with sarcoptic mange in your dog. It can be quite frustrating.
So the sarcoptic mange mite can survive in the environment for a variable amount of time. It depends on the environmental conditions, but anywhere from a week probably is the most likely, but potentially up to a couple or a few weeks. Oftentimes though it's that we haven't fully eradicated it because sarcoptic mange can be difficult, especially historically, to fully eradicate and get off of a dog. It sounds like we might be doing some topical and maybe some oral medications. It's interesting that we're talking about this because the three isoxazoline medications, so Simparica, Nexguard, and Bravecto that I mentioned, those actually have been shown to be very effective against sarcoptic mange as well.
Um, and those are oral medications that are given monthly, although the Bravecto is every three months and really is quite effective at killing the mites. And then they're also preventative. So talk to your vet about having your dog on that, one of those medications in particular, chronically throughout the year. I mean, if you're in Tampa, you're in flea central. That's literally where the pharma companies do their flea efficacy testing, is in Tampa. So, I feel for you down there with the fleas and apparently the mites, too.
So talking to your vet about having them on maybe one of those products in particular throughout the year to help make sure that fleas and ticks aren't a problem and also that sarcoptic mange is not a problem, would be very, very helpful. And also keep in mind sarcoptic mange is zoonotic, so it can be transmitted to people and caused problems in people. So again, be careful what you do.
And then speaking about in-contact, really to be most effective, because sarcoptic mange can be, like if you've got other dogs in the home, they can just, to some degree, be passing it back and forth. So all in-contact dogs really should be on treatment and preventative.
Now, living in an apartment complex that is going to be difficult because you have very little control over what your neighbors do, but letting them know and talking to them. I mean, you don't want to be the ostracized person in the apartment complex who is out there avidly promoting parasite prevention — though we should be, because that can also help with the flea problem — but really trying to get all in-contact dogs on preventative treatment, that should hopefully solve the problem for you.
And working very closely with your veterinarian to ensure that, through skin scrapings and such, your dog is truly free of sarcoptic mange, but then staying on a preventative that would help to keep it that way.
Mia: Can you actually tell me what sarcoptic mange is? I've heard of mange before, but I haven't really done a deep dive thankfully because I haven't had to. You said it's a mite?
Dr. J: Yeah. It's a parasitic mite that lives actually sort of deep in the follicles in the skin of dogs and their host.
The other common mite in dogs is demodectic mange, so the demodectic mite. And they're very different. The sarcoptic mite can actually be quite a bit more difficult to find on a skin scrape because they do tend to live deep, but they can wreak some pretty significant havoc and cause some extremely intense itchiness in animals affected by it.
But again, fortunately because we've got these isoxazoline compounds that are effective, if they're itchy because of fleas, that's going to solve your problem. If they're itchy because of sarcoptic mange, that's gonna solve your problem. And if it doesn't solve your problem with itch, then you really start looking at the allergies. So it can kind of also be diagnostic from that standpoint, as well as therapeutic.
So fortunately things have gotten a little bit better or a lot a bit better actually for pets and people who love and have them, in that we've got more effective preventatives and treatments.
Mia: So I'm just curious, since this is something that can be zoonotic and passed between humans and dogs, do you think that there's any possibility that Cindy and her dog could be passing things back and forth?
Dr. J: It's probably not the most probable scenario. I think potentially one of the most probable scenarios is that, depending on what the medication protocols have been, that maybe it hasn't been fully eradicated yet, just because it can be so difficult to find on skin scrapings. So maybe it hasn't been found, but it's still there. And then when the medication stops, it just flares back up (because it hasn't actually been cured).
I think that's a distinct possibility, but it is also possible that there's reinfection from the environment, and whether that's from her, or from any of the other pets in the apartment complex, or in her apartment, it is certainly possible.
Hopefully this works. I mean, hopefully this is not what she's already doing and then therefore it's not gonna be of any help. But Cindy, if you're listening and you're not already talking to your vet about being on something like Nexgaurd, Simparica or Bravecto for the sarcoptic mange treatment at least, and then longterm for prevention and flea and tick control, it will be worthwhile having that conversation.
Those medications can be a little bit more expensive, but really they're worth it, especially because they can save rechecks on skin scrapes and the secondary effects of sarcoptic mange.
Mia: Right, over time it ends up saving you money. It's so hard to think in those terms, but really.
Well Dr. J, I think that's all we have time for today, but we will definitely be picking this back up shortly. And as always, I appreciate your time and all your valuable information.
Dr. J: I appreciate you getting this out there and it's always fun to chat.