#106 - Dr. Kelly Ballantyne: Combating Caregiver Burden

We've said it before and we'll say it again- it's hard to care for individuals who need specialized care, and that includes pets with behavior challenges! In this episode, Board Certified Veterinary Behaviorist Dr. Kelly Ballantyne provides tips for combating caregiver burden, discusses the link between pain and behavior, and gives up-to-date information on anti-anxiety medication for adolescent animals. 

You can find the full episode show notes here.

Transcript

[00:00:00] Kelly: client communication is something I'm super passionate about. I realized like these, Clients were in dire straits and I needed to bring out as many skills as I could to help serve them.

So things like asking open ended questions instead of yes, no questions. You know, I really want to hear their story and. And I also want to get their opinion on everything, both on, like, why they think what's going on is going on, and what they think about what I'm proposing in terms of trying to address it. you know, using reflective listening where somebody asks you a question and you either repeat those words right back at them or you interpret what they say and repeat your interpretation back to them. That one is one that I talk to like veterinary students in my residence about a lot and they feel like that's a skill that like when you first start practicing it, it feels so awkward, right?

I also use a lot of positive reinforcement with my clients. You know, like, I mean, we talk as pet professionals all the time about the importance of using positive reinforcement with the animals that we're working with, but that includes the humans and like praise is such a valuable social reinforcer for so many humans. Obviously, you know, what's reinforcing to everybody can be quite variable, but so many people really appreciate praise. No matter what is going on in the situation, I can always find something to reinforce the client for, even if they're doing something that I don't agree with, I can say, you know what, I can tell that you have been trying really hard to address this problem. 

[00:01:42] Allie: Welcome to Enrichment for the Real World, the podcast devoted to improving the quality of life of pets and their people through enrichment. We are your hosts, Allie Bender...

[00:02:00] Emily: ...and I'm Emily Strong...

[00:02:01] Allie: ...and we are here to challenge and expand your view of what enrichment is, what enrichment can be and what enrichment can do for you and the animals in your lives. Let's get started.  

Thank you for joining us for today's episode of Enrichment for the Real World, and I want to thank you for rating, reviewing, and subscribing wherever you listen to podcasts. The voice you heard at the beginning of today's episode was Dr. Kelly Ballantyne. Dr. Kelly Ballantyne is a board certified veterinary behaviorist and practice owner of Insight Animal Behavior Services in Chicago. Dr. Ballantyne earned her Doctor of Veterinary Medicine from the University of Illinois Urbana Champaign in 2005 and board certification through the American College of Veterinary Behaviorists in 2015.

In addition to her clinical work with dogs and cats, Dr. Ballantyne has co authored several peer reviewed publications and book chapters, including Noise Aversion, in the newest edition of Behavior Problems of the Dog and Cat, The Feline Dream Home in Decoding Your Cat and Social Behavior in the Upcoming Feline Behavior and Welfare Textbook.

She speaks nationally and internationally on companion animal behavioral issues and pet caregiver burden, and is the immediate past president of the American College of Veterinary Behaviorists. I am so excited for you to hear today's episode with Dr.

Kelly Ballantyne. I absolutely adore her. She is just our people. And I know that our team loves working with her and her team so much Because of how much she cares about the client experience and cares equally for the humans involved with the pet behavior issues that she's dealing with. And that's ultimately how we can help pets and their people live harmoniously, is by caring equally about all species involved. In this episode, you're going to hear Emily and Kelly talk about supporting clients through caregiver burden, the link between pain and behavior, anti anxiety meds in adolescent animals, and Emily and Dr. B's spicy PSA. Alright, here it is, today's episode, Dr. Kelly Ballantyne Combating Caregiver Burden. 

[00:04:17] Emily: All right. Tell us your name, your pronouns and your pets.

[00:04:21] Kelly: Yeah, so my name is Dr. Kelly Ballantyne. Pronouns are she, her. And my pets are my two cats. They're one and a half years old now. And their names are Pippet and Towie. And so they're named after two different kinds of birds.

[00:04:36] Emily: That is so cute. Okay. I need to know which birds they're named after because when I heard Towie, I was like, Oh, do you have a kitty with extra toes? But no, it's about birds.

[00:04:46] Kelly: It is about birds.

Yeah, yeah. 

So,

so, um, Pippet is named after the American Pippet, which is actually, it's a bird that's around here in Chicago. It comes in um, usually in the fall and winter and leaves around the spring. And then Towie there's a ton of different kinds of Towies he's named after a spotted Towie because he has a spot on his chin. So, Yeah. And they're both named after birds that are named after the sounds that they make. So I love when birds are named after the sounds that they make. 

[00:05:17] Emily: yes, me too. That is delightful. I love birds, but I don't have as much knowledge of like native bird species in places that I haven't lived. And so I enjoyed learning that today because now I have to go look those birds up.

[00:05:32] Kelly: Oh, they're so cute. 

[00:05:33] Emily: Of course they are. They're birbs. All birbs are cute. 

[00:05:36] Kelly: Yes, they are. 

[00:05:36] Emily: All right. Well, tell us your story and how you got to where you are.

[00:05:39] Kelly: Oh, yeah. So, I was one of those kids that wanted to be a veterinarian from the time I think I knew what a veterinarian was. I would estimate that somewhere around four or five because we had pets and so I'd go with my mom to the vet with our pets. I made that decision at five years of age and I never really considered other options for a career for better or worse. And yeah, so I, I went to undergrad at University of Illinois in Urbana Champaign. I went to veterinary school there. And then once I was done with veterinary school, I moved back to Chicago cause that's where all my family is from. And I started working as a general practitioner. So like primary care vet, seeing dogs and cats doing all of the things that vets do. During my work as a primary care vet, I realized how many of my clients had questions about their pet's behavior. And I had no training in behavior when I was in vet school. So, I really had no idea how to help these clients. Like, all of my knowledge was basically based on What I knew from my own pets, which I didn't even know if that was correct.

So I started reading up on a lot of the veterinary behavior texts. And I would say, like, Sharon Crowell Davis and Sophia Yin were some of my very early influencers. And I got hooked. Like, I just got so engaged in learning about how animals learn, and I then, like, started looking into how I could do this more and implement it more in my practice, and then ended up pursuing a residency in animal behavior or veterinary behavior.

Dr. Sirabasi was my mentor. So, as part of a residency in veterinary behavior, You work under a mentor who is already board certified in that specialty, so yes, he was kind enough to mentor me through my residency.

[00:07:34] Emily: I've been following the research you've been involved with since long before we met and our company started collaborating. So I was super excited when we started working together because The first papers that I'd seen from you were where you had collaborated with Dr. Surabasi. And so the thing I love and admire so much about Insight is your commitment to best practices, whether we're talking about research based approaches to behavior change or client care or communication strategies. I just deeply admire and appreciate that striving for excellence that we consistently see from y'all.

And as you know, we already had Valerie on the podcast to talk about what she does for Insight and the importance of client support and emotional CPR. But one of the other ways I've seen this show up is how good y'all are at validating the client's experience. And as you know, because you and I have discussed this before, I think a skill that everyone in every healthcare, caregiver, or teaching profession could stand to learn is how to say something like, your experience is valid and I believe you.

The data doesn't support your explanation for what's happening to you, but that just means that we need to keep looking for the explanation. So let's do that together. Because I think, I mean, I've had a lot of experiences personally being gaslit by healthcare professionals or veterinary professionals or, I mean, veterinarians are healthcare, human healthcare professionals or veterinary healthcare professionals.

And I've seen that happen a lot to clients that I've worked with as well. So I think it's super important for clients whose pets have severe and complicated special needs to, to like. For the person or the people who are helping them to to say, like, I believe your experience and let's look for why this is actually happening.

Right? Because I think that's 1 of the top stresses of taking care of their pet and trying to keep everyone safe is that. They're also being inundated with constant gaslighting and criticism and unsolicited advice from friends, family, neighbors, the internet, right? Everybody. So that's why I'd like to start today. What client communication techniques do you use that results in so many of your clients feeling seen, heard, supported and validated?

[00:09:59] Kelly: Oh, yes. So I would say, so client communication is something I'm super passionate about. It's also something that I spent a lot of time studying during my residency because I realized like these, Clients were in dire straits and I needed to bring out as many skills as I could to help serve them.

So the techniques that I would say I use most often in my client interactions are things like asking open ended questions instead of yes, no questions. You know, I really want to hear their story and. And I also want to get their opinion on everything, both on, like, why they think what's going on is going on, and what they think about what I'm proposing in terms of trying to address it. So I love open ended questions. I also do a lot of active listening. So that's doing stuff like, you know, using reflective listening where somebody asks you a question and you either repeat those words right back at them or you interpret what they say and repeat your interpretation back to them. That one is one that I talk to like veterinary students in my residence about a lot and they feel like that's a skill that like when you first start practicing it, it feels so awkward, right?

And you like read about it and you're like, What? You're going to just repeat back what this person said? But that is a really good way to show somebody that you actually listened to what they said. So I love that. And then I also, I also use a lot of positive reinforcement with my clients. You know, like, I mean, we talk as pet professionals all the time about the importance of using positive reinforcement with the animals that we're working with, but that includes the humans and like praise is such a valuable social reinforcer for so many humans. Obviously, you know, what's reinforcing to everybody can be quite variable, but so many people really appreciate praise. No matter what is going on in the situation, I can always find something to reinforce the client for, even if they're doing something that I don't agree with, I can say, you know what, I can tell that you have been trying really hard to address this problem. So, so that one is one that I think you can utilize anywhere and it's going to go a long way.

[00:12:25] Emily: For sure. I think I am, I'm very much similar to you in that when I first started learning about active listening, the, the suggestions didn't feel natural to me. So the, the way that I kind of modified it to make it fit for like my personality and my style and everything is to say, okay, so what I'm hearing is, and then I'll sort of like recap or summarize what.

I think that they said to me, and then I'll ask them, is that accurate? Did I hear you correctly? And then that way they have a, like, they can either say like, Oh my gosh, yes, that's it. Or they can be like, well, this other thing. Right. So I think you hit on something really important, which is like, learn the skills.

And then the way that people recommend delivering those skills may not actually feel natural to you, but you can take those concepts and sort of like morph them into something that does kind of flow naturally for you. And the other thing that you said that I really kind of wanted to, like, pull out and emphasize is that when, when clients are doing stuff that is like, Painful to us to see that they're doing.

It can be really hard to think of things to praise them for. And, but you are right. That praise is so important. I read a paper one time. Maybe I'll, I'll be able to fish it up for the, the show notes. Maybe not. We'll see. But it was, it was, it was profoundly impactful for me because it said that they were looking at people who had been.

Isolated or ostracized and they had the same types of changes in their brain. That people who had experienced physical abuse had so like that, like feeling alone or ostracized or rejected as is as hard for humans. I mean, again, there's outliers, but in general, our species finds isolation and, you know, being cut off incredibly aversive.

And so like, that is such a struggle sometimes when a client is coming to you, just dumping all of this stuff on your lap that you're like, Oh my God, it is, it is physically painful for me to hear you telling me what you've been doing with your pet. But so my life hack for that is I praise them for telling me.

What they've been doing. I'm like, wow, thank you so much for sharing all of that because that had to be so hard and I, I really appreciate you sharing that with me because we, now we've got something to work with and we've got somewhere to go from here. And so like, that's my other sort of like, I know I'm supposed to, I mean, not, you know what I mean by supposed to, but like.

I know that the most beneficial thing would to positively reinforce my client through praise, and I'm having a really hard time finding something to praise, but I can at least praise their communication, their honesty, because that's important. If I don't know that they're doing those things, we're going to be much less impactful than if.

I, and then if they actually tell me what they've been doing, right?

[00:15:24] Kelly: Exactly. Yes. I love that, Emily, so much. Right? Like, thank you for sharing. Thank you for being open with me and, and acknowledging how hard it is to share that information too. Right? I mean, because that's the thing, these clients are coming in. I know a lot of our clients are always worried about being judged. And they're coming in feeling embarrassed about what's going on. They might be feeling shame, like there's all of this heavy stuff that's happening. So yeah, that is so amazing that you could be like, yes, thank you so much for just sharing, acknowledging the effort, because it is a huge effort.

[00:15:59] Emily: yes, it is. And I mean, and it's not it's not disingenuous either, right? Like I, I am actually grateful when people like share information with me, even if it's hard to hear, it's like, okay, now we have something to work with because I know what's going on. So it's a good way to like, be genuine. And also find something, find a, find a place to start, right?

Yeah. So I have a follow up question to all of this. I know that you have done some research involved with caregiver burden and the pet owner experience. So can you talk more about that research that you did and what y'all found in, in that process?

[00:16:37] Kelly: Yes, absolutely. So we've actually done a couple of projects on that now. So the first one was a project that I started while I was in my residency, and I was working with my friend and colleague, Kristen Bowler. So Kristen is a licensed clinical social worker. She also has a certificate in veterinary social work. And as part of her veterinary social work certificate, she was sitting in on consults with me during a part of my residency. And it sparked a lot of conversations between her and I about the human aspect of all of, of the work that we do and how, how these clients are, are living in these experiences. Not so ironically, I guess, or not unexpectedly. Also, Kristen and I both at that time had dogs with serious behavioral challenges, so we were like living it as well, and we were just really curious on, you know, what, what is The experience of people that are living with dogs and cats with significant behavioral changes.

We knew what our experiences were. We had a glimpse into the experiences of our clients, but we just wanted to get kind of like a, a broader view. And so, that 1st study that we did was a. survey. It was a qualitative survey. So we were basically asking a bunch of open ended questions to, and, and we, we cast a pretty wide net in terms of who we sent the survey out to. And and then we did this what's called a thematic analysis where we were basically going through the data set and finding common themes throughout that data set. And What we found was that, you know, there were, there was a, you know, a lot of people were feeling like very mixed emotions.

Like, there was so much love in this survey. People kept talking about how much they loved their pets, how strongly they were bonded to their pets, but also talking about the negative emotions they experienced, like fear and frustration and anxiety and worry about the future, also feeling distance from family members and friends because of what was going on with their pet and just feeling isolated.

And so that I don't know that survey. It was really, it was just, it was so important to me because it kind of showed everybody like what we were experiencing in the console. And I, I just wanted to make sure we got that information out there, because I know that there are other people. That are having those same experiences and feeling so alone.

So I was really hoping, you know, maybe just knowing that like, this is a normal experience and that a lot of other people are experiencing it. Well, that might help. So that was that was study number 1. and then the next study we did was with my resident, Dr. Kristin Koontz and we, at that point, there had been a validated survey looking at what's called caregiver burden and we were able to utilize that survey to assess caregiver burden in our pet owners and the clients that were coming in to see us for their pets behavioral issues. And so caregiver burden is, is pretty similar to, like, what we were looking at in that 1st study. It kind of encompasses. What the pet or what the caregiver experiences when caring for an ill individual. And this has been mostly looked at in the human side of things. People may be caring for an elderly parent or a child with serious disabilities, but it has been utilized more and more in the veterinary. Field as well. So there have been a lot of studies done by the time we started on people going to general practices and taking their care of their, their pet to like a dermatologist or cardiologist, but nothing had been done in the behavior space yet. So we wanted to see if we got similar results or different results from the other veterinary. Clients, 

[00:20:28] Emily: I love that you have been researching this and like really focusing on it because I mean, it's certainly better now than when I started out as a behavior consultant. But even now, I don't think there's enough emphasis on the client's experience. And so often we're, we're looking at the, Our job as like, how can we help the, the, the pet and what do we have to get these dang humans to do to reach our goal?

And really like, they're the ones who live with the animal. It's their lives, their money, their time, their career, sometimes their reputation and even like their financial wellbeing is at stake. And so like. obviously, I'm in this profession because I love animals. I love non humans, but really, it's the humans who have so much invested into this.

I mean, the animals have everything to lose, right? But to overlook the fact that the, the humans have, like, are, are like the big, big stakeholders. Is, is such an important part of our job that I think is, is could use more focus and support. Right. So, so I love that you're doing that research. What would you say are some of the biggest takeaways from your findings that professionals can kind of like, Apply to their, to what they do, right, uh, behavior professionals what can they take away from the research that you've done and, and, and utilize to improve their, their outcomes.

[00:21:58] Kelly: yeah. 1 of the key takeaways from that study is that the majority of our page or our clients experienced caregiver burden and experienced it at a higher level than. the veterinary clients in the other studies. So they were more impacted by caregiver burden, which I'm sure is no surprise to you or to like many of the people in your audience.

We know a lot of these clients are really struggling, so they are impacted significantly. Those impacts have been associated with other issues such as anxiety and depression and reduced quality of life. In the pet owner, so that's something that we need to be cognizant of. But we are not mental health professionals for humans.

Right? So, like, we, we, we have to make sure that we stay within our lane when it comes to that. If we recognize that caregiver burden is present in the clients that we're working with, you know, referral out to a human mental health professional is helpful asking them if they have that kind of support. is extremely helpful because I have asked that question many times and often I will have clients that say, Oh, I'm, I'm good.

I'm working, you know, with a therapist. Or they might say, Oh, you know what, thank you so much for checking in with me on that. I would love, you know, a referral or, you know what, I'm good, but thank you. Like everybody's always appreciative. So, so that's, that's that, but definitely referral to a mental health professional can be helpful. And then the the recommendations for how, like, we as prep professionals can, can deal with caregiver burden, if we notice it is keep your training plan simple or your treatment plan simple, because often these clients are very overwhelmed their ability to. Implement your suggestions is going to be challenged work collaboratively with the client on those treatment plans.

Like, you don't want to just be very directive and say, do this and this and this and this. You need to get their feedback and use positive reinforcement, you know, when you notice that they're doing something really great, those are all things that could be really helpful when caregiver burden is recognized.

I think. All that being said too, I think screening for caregiver burden is really important. You don't know if it's there if you don't look for it, but there are these surveys um, they're called instruments, you know, where we can actually assess um, how somebody is feeling in terms of caregiver burden. I believe that we have that on our website. website, and I can send you the link so you can put it in the show notes. But it is a very brief survey, and you know, we have it as part of our intake paperwork pretty easy and quick to fill out.

[00:24:37] Emily: I, I love that idea. And we're absolutely going to steal that form from you because I mean, a lot of times, like, my. Historically, when I was seeing clients, I was doing that assessment, but in a much more loosey goosey way of like just asking the client how they're feeling, asking them, I would do, I am like, and I still encourage my team to do these check ins with clients where we'll give them a plan and then we'll say.

You know, as you get into this plan, let's check in and see how you're feeling. If you feel like you could do this every day for a year, that means that we're like in a pretty good place because this fits in your lifestyle. If the idea of doing it every day for a year makes you die a little bit on the inside, let's adjust the plan because we.

Don't want it to feel burdensome or too hard to do. So like I ha we have these kind of like loosey goosey ways of checking with clients and seeing how they're feeling. But I love having something that's like simple, fast and structured so that we can just sort of like very quickly and, and almost like proactively get.

Get up to speed on where our clients are at emotionally and, and just, you know, cognitively,

[00:25:48] Kelly: Yeah, yeah, absolutely, and

I feel like I actually just pulled up the the survey just to like point out a couple of the questions, but some of them I think are really Interesting. And there are things that like, I'm sure like you've always wondered, you know, when you've been working with a client, but it's like, you know, are you afraid of what the future holds for your pet?

And people answer on a scale of like never to nearly always, or like, do you feel embarrassed about your pet's behavior? Also do you feel like you'll be unable to care for your pet much longer? Right? Like, these are also just questions that we, Really need to know the answers to and I think just sometimes we ask them as you said and like kind of a roundabout way, but this has it nice and structured and then you get a you get a, like, you'll add up the answers to the questions and you get a score and then that's it.

score shows us where they fall on, like, the caregiver burden scale. So, if the score is under 17, that's considered a normal amount of burden because, let's face it, like caring for another living being carries some amount of burden. But then there's mild, moderate, and severe categories as well.

[00:26:55] Emily: yeah, that's lovely. I'm, I'm really happy that you shared that tool with us because yeah, I think that it's just a very important thing to like check in with clients and be like, how bad is it for you right now? What's going on with you? And I think it's also really good for the clients because I have been in situations.

Where I've had like pretty severe caregiver burden or, you know, caregiver fatigue, but because I was just sort of in it and it's just all day, every day, and it just becomes life, I would not realize how bad I was impacted until somebody either pointed it out to me or. I would like find myself having an absolute meltdown about things that were just like, not that big of a deal.

Right. And then I'm like, Oh, okay. Something's not right here. I need to check in with myself. And, and so I do think that that is also helpful for the clients because I think a lot of times when you're in the thick of it, you also lose perspective on your own. Level of caregiver burden. So, so yeah, I love that tool.

Thank you for sharing that. 

Okay. I want to, I want to shift topics a little bit. Although I do think that these two things are, are related. You've done a lot of work looking at the relationship between pain and behavior issues in dogs and I know that there are a lot of situations where pain can be really hard to detect.

And so like, I have had several, several cases with several clients where The, the level of fatigue that they were feeling was directly related to how much effort they had been putting in and how like little yield they were getting from that labor. Right. And then we would find out like, Oh, look, pain, health issue.

And then like, everything would be easier. Right. So I do think these two things are related. But but like, I think we're, we're just starting to develop an awareness of how often animals with maladaptive behaviors are experiencing some kind of pain somewhere. So can you talk more about how you and your team help clients to identify potential pain in their pets?

[00:29:04] Kelly: Yes. Some of that is Based on the patient's history, what they're presenting to us for. So some red flags for me are animals that respond by growling, snapping, swatting, or biting when they're approached when resting. And so, I mean, I would say that that, that that might Be a valid reaction to being woken up from sleep anyway, right?

Like, no animal really enjoys being disrupted when they're resting, but a lot of dogs and cats are very tolerant of it and won't necessarily bite their humans for that infraction. So, if they, if somebody is getting hurt, because they're approaching their pet while they're resting, then that's a big red flag for me.

Another 1 is a change. Or an intensification of behavior after the pet is socially mature. So over, you know, three years of age and dogs and probably one to two years of aging cats, most of the time, you know, we're, we're seeing young animals. If they're, if they're struggling with fear and anxiety, that usually starts pretty early on and then it just progresses from there. But we certainly see a number of dogs and cats that present to us that we're. Pretty normal, you know, quote unquote normal for most of their lives. And then all of a sudden, as a 5 year old, they're starting with new issues, or maybe they didn't like something and they kind of would grumble about it. But now all of a sudden they're biting.

So if it's a big change in behavior and a socially mature animal, that's a big red flag for me as well. Noise sensitivity that starts later in life is a red flag for pain. And trying to think if there's, so those are the things that would come up in the behavior history. And then what we generally do, I mean, we are, we are, In contact with our clients for extended periods of time, during our appointments, we get to see the animals move around quite a bit.

Definitely much longer than I did when I was in primary care practice. Uh, So we're constantly watching how these animals move, how they move into and out of like, spaces. Sit in down positions. If they're jumping up on the furniture, what does that look like? If they're getting out of the car, what does that look like?

So we're, we're kind of constantly assessing their gate and their posture when they're standing or where they're at rest and also just trying to like, look at their muscle mass and does everything look symmetrical or just like 1 leg really, really small. Skinny. So those are all of the ways or all of the tools we pull out to try to assess for pain and the animals that we're working with.

[00:31:46] Emily: Do you ever encounter situations where there's not like necessarily overt signs of pain, like the stuff that you described, but there's just something like, you know, they ain't doing right. And there's just something fishy. I like, so for example, I had a client with a great Dane who had no, Real overt signs of pain, like no muscle wasting, no limping, no, anything like that.

I don't remember his exact behavioral repertoire, but there was something they, I mean, obviously they called me in for some behavior issue. I just don't remember what it was, but the reason that he stands out for me, even though I've forgotten why I was working with him is because the one thing that he did that was fishy to me was that whenever he was resting his back, The skin on his back would twitch like hyperesthesia in cats, and that was the only sign that there may be something funky going on with him medically.

So in a situation like that where it's not overt signs of pain, but you're like something right here, right? How do you navigate that with clients? And. And also how can, because you can do, you can have different conversations with clients than we, you know, just behavior consultants or trainers can have.

So, how do you navigate that as a veterinarian? And what advice do you have for us to navigate those situations where it's like, look, there's something fishy here. I, it's not, it's not obviously pain, but like, do dogs have hyperesthesia? Come on. Right. So, yeah. So those are my questions. 

[00:33:23] Kelly: yeah, yeah, and we definitely, I mean, we definitely see those dogs and cats quite frequently where it's just this odd thing. I was actually just talking to another vet about 1 of her patients that was doing something like, just. weird stuff, right? Like that's just not normal. So depending on what's going on with the case, what I might do is say, you know what, this is weird, but it is, it is not a top priority.

So we're going to like put a pin in it. We're going to see if that changes with the rest of our treatment plan, and if it doesn't, or if it becomes worse, we're going to readdress it, or if it is like a significant issue, and maybe it doesn't fit with pain completely. Um, But we're worried that that might be a component just doing like, a therapeutic trial with pain medications is a really good diagnostic test. Because if that animals issue that we're twitching when they're sleeping goes away because you put them on an anti inflammatory drug, you're pretty sure that there's a pain component there. So yeah, I love therapeutic trials. And we're always like, we're going to just see what happens. We're going to do this. We're going to pick a drug that's safe for that animal, depending on what else is going on with them. And we're going to give it for, you know, an extended period of time, usually four weeks in our practice. To see, so we have enough time to see if there's a substantial change.

[00:34:45] Emily: love that. I've had that experience for myself where I, I had, I was my, got my fifth diagnosis because my body's just special. And they were like, okay, so try this supplement. And I tried it and like, I, I was, I was doing data collection, but it was, I was like, well, I didn't really have a good baseline. I don't actually know if this is a thing.

And so then I got off of it and I got much worse. And I was like, okay, no, no, that was the thing that was doing right. So like I, I am a big fan of those therapeutic trials because I, I've personally experienced how helpful they can be as behavior consultants. So what we typically do is we'll say. To the client, this is the specific thing to communicate to your vet.

So what you need to be very clear, like when you talk to your vet, tell your vet that when your Dane is asleep he gets these, his skin twitches down his back, like hyperesthesia in cats. Okay. Let's, let's practice that. Let's make sure that you're sending this clear communication to your vet. Let's pretend I'm your vet.

You tell me what you would tell your vet, right? So we. We rehearsed it. And we also communicate. We also will try to like send vets a communication directly not knowing that vet clinics are busy and not expecting a response. All of you know, all of that. We get it. And Those things work, sometimes , and sometimes even with all of the, the measures that we're taking there's just a communication breakdown.

So then it's like, okay, well we need to stay in our lane, but we also feel like our hands are a little bit tied because. The things that we're trying, the methods that we're trying to like, get that information to the veterinary and just aren't landing. Right. So I know that you and I have discussed this before about like, this is a known issue in the industry and we want to work to improve that.

But for the benefit of our listeners do you have any suggestions for how behavior professionals can circumnavigate or not circumnavigate, but how they can just navigate those issues where there's a communication breakdown. We're not sure that the vet is getting the information they need to do the diagnostics they need to do.

Like how, how do you suggest that we do that while staying in our

[00:37:05] Kelly: Yes. So, I think one getting video of what like short, short, short videos of whatever it is that the client is concerned about is super helpful. So the veterinarian can see exactly. What it is, because sometimes, you know, I know I've gotten videos where it's like, Oh, the dog is reverse sneezing, but the client thought their dog was dying.

And I can quickly look at a video and I was like, Oh, don't worry about that. But in other cases, the client might say like, Oh, this is what's happening. And then I look at the video and I'm like, Oh. Okay, that gives me a ton of information. I have all of these differential diagnoses for that problem now, and we could do XYZ to look into it.

So video would be super helpful. I also think, and this is honestly an issue that I run into a lot, is that with some of these issues, you know, like maybe it's something that's happening in a lot of dogs, but it normally doesn't cause a problem. But in the dogs that you and I are working with, because they also have all of this stress from their behavioral issues, and they might have other medical issues that are going on, like every little thing that gets piled on top of the other thing just makes the whole thing worse. picture worse. And if this is a thing that is getting in the way of progress, if your rational treatment plan isn't working because there's this like potentially undiagnosed medical condition, I think relaying that to the veterinarian is super helpful as well. Saying like, These clients are really dedicated.

They are, you know, they are working hard. They're doing all of the things like this normally works. Most of my, the dogs that I'm working with are responding in like this number of weeks and this dog is just not responding as expected. You know, I'm really concerned that there's an underlying physical issue 

[00:38:50] Emily: I think one of the things that we run into is that we'll, we'll have the client communicate to the vet and we will try to communicate to the vet and there's receptionists are doing their job, which is protecting the veterinarian's time as they rightfully should.

No hate, love, love our receptionists. However, one of the things that we've run into a few times is that the message doesn't get to the vet unfiltered, it gets filtered through the front desk. And and so that's kind of, been a sort of a hang up for us. And one of the ways that we have navigated that is talking to the client about like, Hey, your vet is awesome that we're not in any way, implying that your vet is not a good vet and also nobody can be an expert in everything. So how would you feel about like us referring you to this other vet just to deal with this one specific thing because we know they have, you know, expertise in this area, you can continue going to your primary vet for everything else.

But can we work with this? And then we'll refer them to a client where we do have good communication with the veterinarians and the whole team, the vet techs and the receptionist, everybody. So that's kind of how we navigate those issues where like the communication is just not happening because it's being filtered through the front desk.

And again, No hate, like that's their job. But sometimes that can cause, you know, some logistical issues. So that's how we're handling it. But do you have other recommendations or additional recommendations in addition to like having that conversation about referring to a vet that we do have good communication skills with?

Is there another way that we as professionals can help advocate for our client while being respectful of the vet clinics sort of structure and process?

[00:40:37] Kelly: Yes. One of my recommendations would be to also have that client like schedule an actual appointment with their veterinarian to have this discussion. And If, if it's a possibility for, you know, you as the behavior consultant to attend that, appointment as well so everybody can be on the same page.

That can be super helpful because you're right, like a lot of that information gets filtered through the front desk or it might get filtered through the veterinary technicians. It might never meet that or, you know, reach that veterinarian. And I was just talking with some friends of mine from vet school a couple of weeks ago and. Everybody is overwhelmed and overworked and like, there's so little time and so also when, when veterinarians are getting communications from their clients or like, if they're in appointments, they're going to be prioritizing their time and their energy on the people that are actually like, in the room.

in front of them in an appointment. So I think that's also a really good way to get in front of the veterinarian. It's just like schedule an appointment. You're going to have to pay for it. The client's going to have to pay for it. But like, then you could actually have that conversation rather than doing it in this kind of like circuitous way.

Now that's not always, you know, that's not always going to work for everybody. So I think your other recommendation of Having that, you know, if you have a network of other veterinarians that you work with in the area that, you know, are specialized in that specific issue, or, you know, are really, you know, really up on their pain management, or, you know, really good with rehabilitation therapy, or, you know, whatever it is, you know, just getting a 2nd opinion is fine. Like, we, as veterinarians, know people are going to get 2nd opinions. Like, that's okay.

[00:42:20] Emily: Awesome. That's wonderful. Thank you. Thank you for having that conversation because it's something that is really complicated and everybody's, everybody's position is valid, right? But it can be hard managing the communication among like multiple parties. It's almost like behavior consultants almost also have to have Like project management skills to like, you know, oversee the support team and make sure everybody's on the same page and like, we're all drawing from the same pool of information.

Yeah, yeah. So I really appreciate your input on that because, because that is something that I think a lot of us struggle with from time to time. Okay, so, another thing that I, I feel like we have conversations with clients about on a somewhat regular basis is when we as behavior professionals see a younger dog, either a puppy or an adolescent dog who is struggling more than we usually Is typical for their developmental period, right?

We anticipate that most puppies are going to have a little bit of separation related behaviors because they're social species and they've had their whole life in the litter and that's different than a puppy causing self harm when their, their family goes to the bathroom. Right? Or like we see, you know, a six month old dog who is already has multiple bites under their belt.

Right. So like, okay. you know, like, yes, adolescents are mouthy. Yes. Puppies don't like to be left alone. And, but we do see some individuals that are struggling beyond what we feel is within normal limits for their developmental period. Right. So a lot of times we will see when we have clients like that, which Pet Harmony gets a lot of those because we kind of have that reputation for taking the kind of like hard cases.

And so we get a lot of referrals from other professionals that are like this puppy ain't right. Go to Pet Harmony. And and so a lot of times we find ourselves having conversations with clients like it would be a good idea to get a veterinary behaviorist on board your support team so that we can explore like, you know, maybe some neurochemical imbalances or some health issues or something that's contributing to your puppy or your adolescence issues.

And we're, we're, we're prepared for this to be a hard conversation because a lot of people, I think historically, like we've all been told, like, Oh my God, you don't put a young, young puppy on, on medication. That's just, that's just terrible. You don't do that. And I'm very sympathetic to that because I think, you know, we humans have a legacy of using medication to suppress behavior or just to sort of like.

Dial somebody down or put them in a corner. You know what I mean? Like, we do have an ugly history with the, the misuse of psychopharmaceuticals. So I'm, I'm really sympathetic to people's icky feelings about that. But unlike with, you know, adult dogs where we do have the luxury of like, let's try these other things first and meds if, if, you know, You as a client decide that this is really the last resort for you, and you're finally willing to to pull the trigger on this.

We do feel a little more urgency when these puppies are young, you know, still in their developmental periods, because there is a window of time. so first of all, I think, can you elaborate more on why I'm saying there's a more, it's more time sensitive for our listeners. Because I, you are definitely the person to talk about that, not me.

But then after you kind of like explain that, can you talk about how we can help our clients navigate those feelings so that we can get them to a veterinary behaviorist? And within a like timely fashion,

[00:46:02] Kelly: Yes, absolutely. So, the, the window of time question, I think, all relates to behavioral development and how Plastic or changeable young brains are and I think like the, perhaps the simplest way to think about it is that these animals having been only on the planet for what, like, 3 months, 4 months, 6 months, their lived experience is so small. So every experience carries a lot of weight if they have trauma. Within their early life, that is going to have a much bigger impact on their behavior long term, not only because they just haven't had a lot of experience. So then they learn, like, ooh, encountering a person outside is terrible, but also because their brains are just still developing and forming and the, the connections that are being made, the pathways that are being made in these different brain regions.

Transcribed At that point are forming, and they can become like, solidified at that time. So, it is a very, very sensitive time in development. Scary experiences that happen then are just going to. You know, be much more impactful. 

[00:47:18] Emily: Okay. So yes, it is. It's very impactful. I had heard somewhere and I, and I don't know, I don't remember where I heard this. So I can't do sort of like an epistemological investigation of, of how solid this information is. But someone somewhere told me that the earlier we get a puppy on psychopharmaceuticals or, you know, behavior modification, medication, whatever we want to call it the more likely they will not need it for the rest of their lives, the more likely that we'll be able to eventually wean them off of it. So I think that's sort of like the thing in my head that makes me feel a sense of urgency. How valid is that, that piece of information.

[00:48:01] Kelly: Yes, that is absolutely valid, and I think it also applies to adult dogs, but absolutely to young dogs. Again, they have this very short amount of lived experience, and if that experience continues to be fear and anxiety and distress, that is going to stick with them, and the problem is just going to keep getting worse. They are not going to grow out of it. This is not just a phase. So if we do get treatment and earlier, we're probably going to need fewer meds. We're probably going to get a faster resolution. We're going to get better learning because in the end, these drugs that we are using, the psychopharmaceuticals that we're using, they impact the parts of the brain that both mediate our emotions like fear and anxiety.

And when I talk about are, I mean, like, animals so they impact the parts of the brain that mediate emotions, but they also impact the parts of the brain that mediate learning. So they're going to improve that puppy or kittens ability to learn different and more adaptable coping skills. So yes, to earlier treatment, as soon as you recognize a problem, get them on appropriate anxiety support and you had brought up something when we started this particular topic in terms of, like, seeing those puppies that are .

Just a little bit different. And there actually is some data on this. So there have been a couple of studies one that was looking at just puppy behavior in a general veterinary practice. And what was the most interesting thing for me that came out of that study is about, I think it was about 10 percent of the puppies were outliers. So they were either more avoidant or they were more active in the exam room. They panted more. And then that veterinary behaviorist did a follow up study with some of those dogs, like, 18 months later, and many of them had behavior problems at that point. So puppies don't grow out of it and. Some of them are a little different and we can identify that early. That study was done with puppies at like 8 to 16 weeks of age. 

There was another study that was done looking at separation distress in puppies, and they did videos to look at just what do puppies do when they're home alone? They did have some were created, some weren't. And again, about 10 percent of those puppies Were different, most of the puppies got quieter and more restful over this series of videos that were done and 10 percent of them did not. They just kept being vocal and they got more vocal. So if we identify them early, we need to intervene with treatment early and not be scared about using meds in young dogs. 

I think some of the hesitation not only comes from stigmas around psychopharmaceuticals, but also, honestly, a lot of the studies that have been done on these psychopharmaceuticals, like Reconcile and Clomacom, they were only done in dogs six months of age and older. So that also means the product label, the medication label, says for use in dogs six months of age and older. So, like, I treat dogs younger than six months with SSRIs and TCAs and all of the, you know, the psychopharmaceuticals, but I can understand why veterinarians are hesitant because of that as well.

[00:51:25] Emily: Yeah, I mean, it's so complicated because there's, yes, the, the. the harmful legacy of the misuse of these medications in the past. There's the, the language on the labels because of, I mean, rightfully so careful language based on like, we can only cite our sources for this age. I think another one too, is that people There's, there's a sort of grief that happens when you get this cute and cuddly puppy. And then like, now you have this puppy who's on medication, like capital O, capital N or M. I mean, you know what I mean? Like, I think that is part of it too. At least what we see in our clients is like, Oh, great. I have a puppy who needs drugs. Like, Oh, I have Cujo. Right. And so I think there's also that like social stigma.

And the conversation that I have with. with clients often about around that particular part of it is you, you don't owe anybody an explanation for why you're doing what you're doing. You don't even have to tell them about medications. Like we are more protected with HIPAA laws in terms of like legally, nobody can ask us what medications we're on or what our diagnoses are.

And so like, if we treat ourselves humans that way, then. We can advocate for our pets in the same way, even though HIPAA does not protect nonhumans, you don't owe anybody your animal's diagnosis or what medications they're on. And, and I think that's really hard. A lot of people are socially conditioned to just like to help answer whatever questions get asked.

And And so like, that's one thing that I coached my clients on is like, you don't have to answer those questions. You also don't have to be mean or rude to your family about it. Like there are ways that you can navigate that conversation, but like, you don't owe anybody that information and, and it's okay.

And, and also I think we have this impulse of like, well, we just need to educate them. But another component of that is, first of all, asking clients who are emotionally distressed to educate people about something is, is, really asking a lot of them. 

And secondly, unsolicited advice is its own form of violence, right? So like, we're not going to return violence with violence. Like they didn't ask to be educated. And so like asking our clients to intrude on their lives is not acceptable just because they're intruding on our clients lives, right? So there's a lot of complicated social stuff that goes into that as well, that we have to help our clients navigate and, and be like, okay, listen, like this is going to come up and here's how you can handle it. And here's like, here's what you, how you can handle this in a way that sets Compassionate boundaries and advocates for your pet without engaging in conflict with the people who care about you. Right? So I definitely think that that's, that's part of it too. But I, I did want to ask you for your input about how we can help our clients Come to terms with this with, while staying in our lane, right?

Because I know we have a tendency as a profession to try to, to like explain why the medications are important. And in doing so, we can maybe like step out of our lane and start talking about things that are like, really not in our wheelhouse. So how do you recommend that we handle this discussion with clients and, and sort of, veer them towards VBs while staying in our lane?

[00:54:49] Kelly: So, I think you can, you can have that conversation and say, you know, it's my understanding that medications can be really helpful and that you know, usually the earlier condition is treated, you know, the better the prognosis. So I think that that is staying well within your lane, sharing that kind of information. The only time I honestly get upset is when A non veterinarian recommends a specific medication to, to one of to one of my clients or, you know, anybody because the choice of medication requires a lot of thought and consideration and knowledge of the animal's physical health and a whole myriad of things.

So, I get real spicy when I hear somebody recommended a specific medication. But just saying, you know what, anti anxiety medications might be really helpful here. You should, you know, reach out to your vet or, you know, consider consulting with a vet behaviorist. That is totally okay. Absolutely.

[00:55:54] Emily: Lovely. Yeah. I'm just going to add to your spice and I'm just going to say it flat out. Hey colleagues, super not okay to be like recommending specific meds, but also things that make me spicy. And I'm not even a veterinarian, but I get like my hackles go up. Like, please don't. Tell clients to increase or decrease the dose. Please don't tell clients that their animals should be discontinued. The medication, like all of that, like super not your wheelhouse. Even if you have been nerdy and read textbooks and really understand the pharmacokinetics of all of these medications still super not your wheelhouse. I'm just, I'm just going to pick. I'm just going to pick fights here and be like, y'all. We got to stop that no touchy.

[00:56:37] Kelly: Thank you so much for saying that, Emily, because yes, that is awesome. Not okay. Oh, my goodness. Yes, we have enough trouble with clients changing the dose of the medication without telling us first.

[00:56:49] Emily: We have a little meme that we share with our, with our pet pro community that's lighthearted and loving, but it's like really sparkly and shiny. It says the shiny is not for you. Put the shiny down. And I feel like this applies that that meme applies here.

So, so, okay. So we can, so we can definitely say like, hey you know, anti anxiety medications might be really helpful. Let's talk about, you know, veterinary behaviorists, you know, let's collaborate. Do you have any specific recommendations for how we talk about like how we navigate the conversation of like, ah, but puppy, my puppy, I don't want to put my puppy on meds.

In addition to what I told you that we already do with our clients, is there anything additionally that you would recommend for navigating that conversation with our clients about like their icky feelings about it being a puppy or an adolescent dog?

[00:57:41] Kelly: I would share that. Yeah, the medications are another tool that we could add to our toolbox that can improve this puppy's ability to learn, help them learn new coping skills. Also, like, we could get a faster resolution. If you know, we could potentially get a faster resolution if we have the benefit of medication and. Medications have the potential of alleviating not only the puppy's distress, but also their distress.

[00:58:14] Emily: Yes. I just like felt myself exhale when you said that, like, yes, helping clients understand that it's going to make their own life easier. It's going to alleviate some of that caregiver burden. That's the sweet spot. Yeah. Love that. Thank you. Yeah. All right. At the end of every interview, I, I have the same set of questions. I like to ask everybody. The first of those being what are our observable goals and actionable items that people can take away from this discussion?

[00:58:43] Kelly: They can start screening for caregiver burden and their clients. Because if you know that that's present, that can help you adjust your treatment plans accordingly. And I think it also helps to just set expectations. We also talked about staying in the lane in terms of medications. Please do not make specific recommendations about types of medications, dose adjustments or discontinuation. Ooh, what else? Oh, and then you know, how physical health issues and behavioral issues are just intertwined and that we just need to make sure that that patient or your, you know, your, the dog that you're working with, that their physical health needs are being addressed. Adequately,

[00:59:33] Emily: Beautiful. Thank you. What is one thing you wish people knew about either this topic, your profession or enrichment, your choice?

[00:59:41] Kelly: I thought about my answers for this question, the answer that I had in my head has gone away. So I guess what I would say is that. I wish that people would recognize more that we can't separate behavior from the rest of the body, that we can't just stick them into separate buckets, because as living organisms, all of our systems, including our brain, which is driving behavior, right, are intertwined. So we can't just say, oh, this is a behavioral issue, or this is a physical health issue. Thank you. They're gonna, they're gonna be enmeshed. And that's why it's so important that we always make sure that physical health needs are being met.

[01:00:30] Emily: Again, for the people in the back, like, yes, absolutely. I mean, that's the, that's the whole thing. Like the reason that we love looking at behavior through an enrichment lens is because it helps, it helps facilitate that sort of like holistic or global view of like, what is like behavior in context. Right. So yes, you're speaking to my soul here. What is one thing you'd love to see improved in your field? 

[01:00:58] Kelly: Accessibility. 

[01:00:59] Emily: I love that companies or organizations like EasePetVet are trying to sort of like make it more like financially accessible. And I think that's an awesome, you know, that's an awesome thing. But like part of accessibility is just like, are there enough VBs to go around? And the answer is no. The answer is no. 

[01:01:17] Kelly: No, No, there aren't. And now some of them are retiring. Like, it's, oh my gosh, it's a whole thing.

[01:01:24] Emily: I spoke to Debbie Martin for the podcast a few days ago and she told me that there are only like 30 something veterinary technicians who specialize in behavior. And I was like, wow, there's even fewer of you than there are VBs. Like we need more. We need people who care about the intersection between veterinary medicine and behavior enough to do that. For a living. Awesome. Okay. What do you love about what you do?

[01:01:47] Kelly: I honestly love interacting with the people. Which is not something that I thought I would, like, when I went into this field, I was all about the animals. I was an animal loving kid. I wanted all of the animals. And as I do this more, I just really, I love interacting with humans. Humans are so interesting, right? Like, They're always keeping me on my toes. And we see, I don't know, we just see so many really lovely humans in our practice. Like not only is, are the humans on my team amazing? Like I love working with them, but also the clients that we get to interact with on a day to day basis. They love their animals so much. so much. They are so dedicated and like, they are so compassionate. It's just, it's, that's what I love about it.

[01:02:36] Emily: Me too. I, so here's the thing. I know there's so many people in this field who are like, I don't love humans. I love animals. And I would like to reframe that. I think. A lot of the, a lot of the people who say that have been deeply wounded by humans, but the thing about humans that's so incredible is that we have enormous capacity, not just for harm, but also for good. Right. And so like, yes, we do have enormous capacity for harm. And that does hurt us. But when you can, you know, Shift your perspective from focusing on the ways that humans cause harm to focusing on the ways that humans are just animals too. And we're just like bumbling around, trying our best, making mistakes, being quirky, having all our little neuro types, all our little brains work the the just different ways. Like we're really, we're really just kind of precious. Like I'm a fan of humans. I mean, I'm not a fan of every human, right? But I am a fan of humans. I think like, you know, when we can look at us as a, as a species of learners, we're really delightful. All right. What are you currently working on? If people want to work more with or learn from you, where can they find you?

[01:03:51] Kelly: We're working on a couple of different projects with my 2 residents. 1 of them is a continuation of the caregiver burden research. And then the other 1, we're actually exploring this phenomenon called burden transfer. So, that's when you're working with clients that have high caregiver burden that can get passed on to you. to the veterinarians and the veterinary team. I'm also assuming it happens to behavior consultants and trainers. Although that hasn't been investigated yet. So I'm really interested in the outcome of that study.

So we're looking at that how burden transfer impacts veterinary behaviorists and residents. And then you know, I'm, I'm working at Insight Animal Behavior. So I do behavior consults for dogs and cats and Yeah, I also do vet to vet consults with primary care veterinarians all around the country. And honestly, it can't, it is a service that can be used around the world. And yeah, that keeps me busy. So, in terms of where people can find us, we, our website is insightful animals. com. And then we are also on Instagram and Facebook at insightful animals.

[01:04:57] Emily: I love all of that. I have a follow up question for you, which I normally don't at this stage of the interview. But, but now you've got me thinking, okay, so how is caregiver transfer related to secondary traumatic stress disorder? Or is it? Are those two totally different things? Or what's the relationship there? 

[01:05:15] Kelly: I don't know. That's a great question. I don't know if burden transfer, if they, like, there's been a study to investigate how burden transfer and secondary traumatic stress are related. Burden transfer tends to be related to client behaviors, including there's like a whole acronym for it, but it's stuff like excessive communications and confrontational behaviors and, you know, doing things like researching your treatment plan and going on Google or social media. So it like looks at like how all of those things might impact the veterinarian or the support team. And also it looks at not only like how often does that happen in your day to day job, but what is your reaction to those things? And that's the really Interesting stuff, and that's where like interventions can be most effective. Because we can change how we react to those behaviors.

[01:06:14] Emily: Yes. Yes. Okay. That is fascinating. I cannot wait for that paper to come out because I am, I'm really intrigued by this concept. And I think it's going to be hugely helpful for immediately in the, in the, in the short term, it's going to be immediately helpful for the veterinary community and also in the longterm. I look forward to seeing how this also impacts behavior professionals. So, yeah. Beautiful. Thank you so much for spending time with me today and chatting. It's been lovely and informative and I really appreciate you.

[01:06:47] Kelly: I really appreciate the invite and the opportunity to be on your podcast, and it's been delightful to talk to you as always, Emily.

[01:06:55] Allie: Okay, how good was that episode? I know that you adore Kelly as much as I do after listening to that. I am so happy that we got to ask her especially about anti anxiety meds on adolescent brains because that is something that we have to navigate quite a bit and I'm so, so happy to have an expert talking about that subject.

Next week we will be talking about, I didn't put that in my thing. I don't know what we're talking about. How to better support clients.\  

If you're anything like me, you listened to a podcast episode, and the little gremlin toddler in your brain is like, the world needs to know this! So, if that's you right now, and while you were listening to this episode, you thought of someone who could benefit from it, go ahead and text them the link to this right now. I'm tasking you with being an enrichment ambassador so that together we can improve the quality of life for pets and their people.

Thank you for listening. You can find us at petharmonytraining.com and @petharmonytraining on Facebook and Instagram, and also @petharmonypro on Instagram for those of you who are behavioral professionals. As always links to everything we discussed in this episode are in the show notes and a reminder to please rate, review and subscribe wherever you listen to podcasts a special thank you to Ellen Yoakum for editing this episode, our intro music is from Penguin Music on Pixabay.

Thank you for listening and happy training.