Understanding the Widespread Implications of Trauma: Insights from Dr. Linda Randall and Dr. Kathie Nurena

Episode Transcript
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Speaker 1 (00:02):
This is a must listen episode as I have the honor of
chatting with both Dr LindaRandall and Dr Kathy Nurena.
With Linda's background as aveterinarian and Kathy's
background as a medical doctor,we have a unique and insightful
conversation around the topic oftrauma in both dogs and people.
Linda focuses on the behavioralaspects of training in dog

(00:23):
sports and is a board certifiedcompanion animal veterinarian
and also owns One Smart Dog, afull service training and
behavior facility in Ohio.
She brings positivereinforcement handling to junior
handlers who excel under hertutelage.
A proponent and practitioner ofthe Lima methodology, linda
brings multiple fields ofexpertise to the work of

(00:44):
trauma-informed care.
Kathy graduated from the AlbertEinstein College of Medicine and
completed her family medicineresidency at Stanford Hospital.
She is now faculty at thatprogram.
With an interest in socialdeterminants of health and
scholarly activity.
She also graduated from KarimPryor Academy and earned her
certified nosework instructorcertification.

(01:06):
Kathy helped organize the firstinterdisciplinary conference
for animal control officers,department of Children and
Family, social Workers and otherprofessionals in Connecticut
when cross reporting of childabuse and animal abuse became a
law in that state.
Kathy has long appreciated howthe principles of learning
theory and the positivereinforcement principles she is
learning in animal training wererelevant to her work with human

(01:29):
learners, and perhaps some ofthe theories in the medical
literature may be useful toanimal trainers.
And if you are enjoying thebitey end of the dog, you can
support the podcast by going toaggressivedogcom, where there is
a variety of resources to learnmore about helping dogs with
aggression issues, including theupcoming aggression and dogs
conference happening fromSeptember 29 through October 1,

(01:50):
2023 in Chicago, illinois, withboth in-person and online
options.
You can also learn more aboutthe Gression and Dogs Master
Course, which is the mostcomprehensive course available
anywhere in the world forlearning how to work with and
help dogs with aggression issues.
Hey, everyone, welcome back tothe Bitey End of the Dog.

(02:11):
This week I am surrounded bydoctors, so we have Dr Kathy
Norena and Dr Linda Randell.
We are going to be jumping intothe human and the animal side
of the equation.
We've been doing a lot of thatthis year in our episodes and if
you've listened to some of theseason openers as well as some
of the upcoming episodes, Ithink you're going to see that

(02:32):
general theme.
So I'm actually really gladwe're talking about this and I'm
really happy to have these twospecial people on.
So welcome to the show Kathyand Linda.

Speaker 2 (02:42):
Thank you, it's great being here.

Speaker 1 (02:44):
It's so great to have you both here and I kind of
want to dive right in.
We were kind of chatting aroundtopics of what to talk about,
but obviously trauma issomething both of you focus on.
You've talked about it inprevious conference appearances.
I've definitely taken aninterest in it myself,
especially in the last couple ofyears, with working aggression
cases especially.

(03:05):
So let's first kind of definethat.
I think it's important thatwe're on the same page of that
word trauma or the topic oftrauma.
What does it mean?
Maybe, kathy, we'll start fromyou, from the human side of
things, how you would definethat.

Speaker 3 (03:19):
I think it's interesting when you try to
define something, you can go tothat dictionary definition of
trauma and they really have twodefinitions.
They talk about a deeplydistressing or disturbing
experience and the emotionalshock that follows, but they
also talk about a medicaldefinition of injury to tissue
caused by an extrinsic agent.

(03:41):
Right, it's important whenyou're talking with human
medical doctors, what type oftrauma are you talking about?
I don't know if, linda, if youwant to talk about a definition
of trauma and then kind ofevolve into that more emotional
aspect of trauma.

Speaker 2 (03:56):
Yeah, I am an English literature major, so I always
go back and say, well, where didit come from and how did it get
to be what it is today?
And just, it comes from a Greekword meaning wound, and of
course originally it was tissue.
And it wasn't until we evolvedin our knowledge of what could

(04:20):
actually be wounded, that itdidn't have to be a solid thing,
that we started using the wordtrauma to mean something.
It could be psychic, it couldbe emotional, it could be tissue
, it just could be anything.
And I think that that'sinteresting because along the

(04:40):
way wound came along for theride.
So we can be wounded, and wecan be wounded emotionally, and
it can be something acute orchronic.
So that's where, that's how Ilook at trauma, and I think all
of those applications apply toany species and to plants.

Speaker 1 (05:03):
Interesting and we were talking about emotions of
Kathy.
You want to expand on that aswell, the emotional side of it.

Speaker 3 (05:09):
Yeah, for that I really went to SAMHSA or the
Substance Abuse and MentalHealth Services Administration
definition of trauma becausesome of the movement coming out
of there for healthprofessionals is coming from
SAMHSA and they define trauma asan event or circumstance that
results in physical, emotionaland or life-threatening harm and

(05:31):
that these events orcircumstances have lasting
adverse effects on theindividual, whether it's mental
health, physical health,emotional health, social
well-being or spiritualwell-being.
So I think they spent a lot oftime summing that up and I think
that's a good definition towork with.

Speaker 1 (05:49):
That's a really good definition and I think it's
important to recognize that wedon't always see it.
So when we hear, like Linda wasmentioning wound, right, we can
kind of picture that in ourmind of when somebody suffers an
injury, of wound externally.
But I think it's an appropriateword to help us understand also
that it can happen internally,right, in the sense of it gives

(06:11):
us a picture to wrap our headaround that it's not just some
disorder or some simple thing,right, it's an actual injury.
So do you want to expand on theemotions aspect as well, linda?

Speaker 2 (06:21):
Well, actually I'd like to maybe I guess this
really is emotion, but I'd liketo shift it just a little bit,
because when we're talking abouttrauma because in the end Kathy
and I talk a lot about trauma,informed care so I'd like to
just say that in animals we callit trauma, assumed care, and

(06:46):
that is something that I thinkis extremely reasonable.
And you know, sometimes when wename something we aren't as
reasonable as we thought we werebeing.
But I think that's true Because, unlike people, people may not
tell you, but sometimes peopledo know what traumatized them.
Sometimes they don't, sometimesthey don't even know that they

(07:10):
had stacked on traumas as achild and that's why they are
the way they are as an adult.
And when we look at most of thestudies, interestingly we've
been done in cats but on what'shappening pre and immediately
postnatally and what triggersand what stacking happens then,

(07:33):
and then they follow the catsthrough and find that later on
in life the kittens that werestacked end up having what we
would call trauma or an affectof trauma.
So and that would be somethingthat maybe would be back to what
you were saying emotional atthat point, psychic or

(07:56):
psychological it's aninteresting thing that is not as
well studied in animals,because of the difficulty, of
course, of knowing these things,and so we make so many
assumptions in animals.
But, kathy, you make a lot ofassumptions with people too,
correct?

Speaker 3 (08:12):
I think we do right Heuristics or mental shortcuts
to.
You have limited amount of timewith people and you have to
make certain assumptions, and Ithink that's where this movement
or this concept of traumainformed care is coming from.
It was really interesting to dosome more reading about it and
where it came from, and a lot ofit came from some of the

(08:35):
substance abuse and mentalhealth services work with women
who were surviving domesticviolence, intimate partner
violence, those type of issues,and when they sought healthcare
they were actually gettingretraumatized because of the way
healthcare systems areestablished.

(08:56):
So just trying to make peoplesensitive to our actions have
consequences and if you'retalking about unseen trauma, you
may not realize that whatyou're doing is doing more harm
to this person, this patient infront of you.
For healthcare professionals,doctors, nurse practitioners,
all that so many of them went into healthcare to help people

(09:19):
and the last thing they want todo is retraumatize someone.

Speaker 2 (09:23):
Which does bring us around.
I think very nicely to a coupleof things.
One is, if we're going todefine trauma and we're talking
about trauma-informed care, howare we defining informed?
It sounds like we all mightknow what the word informed
means, but do we really?
Or how are we using it?
How is it segwayed into wherewe are now?

(09:44):
And so when we're informed, Ithink of it as we're basing our
opinions and our way of movingin the world on reliable
information and that we areknowledgeable and educated, that
we're, let's say, you can sayyou're an informed consumer, or

(10:04):
you're an informed doctor, oryou're an informed animal
trainer.
You know what's going on, yourely on evidence-based practices
, and so that's how I look atthe informed.
And do you have anything to addto that, kathy?

Speaker 3 (10:22):
Well, I think I've been very struck when you
started using that termtrauma-assumed care, because
they liken it to universalprecautions.
I don't know if you know whatthat are, but if you're drawing
blood on someone, you put gloveson for everyone and just assume
everyone may have an infectiousdisease, or you don't want to
transmit what's on your skin tothe patient, so you just use

(10:43):
universal precautions, and Ithink the same can be assumed
with trauma.
You don't have to know aperson's ACE score, their
adverse childhood experiencescore right, because you're not
trying to judge.
Is this person in front of me?
Do they need specialconsideration?
Do they need extra kindness oravoid re-traumatizing them?
Because you don't want to judgea score?

(11:03):
Is it three worse than a fourin some circumstances?
But if you assume thateverybody's experienced trauma
or has the potential to hurtfrom trauma, it's a little bit
more helpful and kind toeverybody.

Speaker 1 (11:20):
I'd love to just to distinguish those a little bit
more, because in my mind I waskind of assuming which is
another assumption of the wordassume, but so informed meaning
the person.
With humans, they can oftencommunicate their emotions.
So we're making informeddecisions based on what they're
telling us, versus with animals,we can only assume it, we don't

(11:40):
know for sure because theycan't tell us their experiences.
Is that the right distinctionor am I off there?

Speaker 2 (11:46):
I think it's the right distinction, but perhaps
we need to refine our language alittle bit.
And one would be to say I stillthink the word assumed in both
cases is correct.
We have more information frompeople if they're willing to
give it.
So therefore, there are otherassumptions that we may need to
make, but we don't want to dothe book by its cover idea of

(12:10):
this person walks in off thestreet.
Well, they're homeless.
And if they're homeless, allthese other things must also be
true.
So there's, there's a lot there,and we can also read body
language, and so it there's alot with animals.
I think just flip it a littlebit that we're going to make

(12:32):
more assumptions because we haveless information.
But they do give us informationif we know how to read it.
And so there you get more intothe skill of I'm going to call
it animal practitioner I don'tmean veterinary and practitioner
of the small P, just saying theperson who is there in front of

(12:54):
the animal doing training,working with, helping to
mitigate circumstances that givethis animal the feelings that
it's got.
So it does come into a bit of agray area, but I do think that,
just in general talk, generalcircumstances, using trauma

(13:15):
assumed with animals gives usthe leeway that the animal needs
to be given.
Yes In order to work with themappropriately.
So, language does matter.

Speaker 1 (13:27):
Yes, very happy you made that clarity for me,
because I think it's importantAgain to have more clear
definitions of what we'retalking about, which kind of
leads me to the next question isabout diagnostics or diagnosing
trauma.
So as trainers and consultants,I actually try to dissuade
people from using diagnosis assomething they would do as a

(13:49):
trainer.
That's more for medicalprofessionals or veterinarians
to diagnose a particular issue.
So, for instance, cathy, youmight diagnose somebody through
assessment as having trauma orpost-traumatic stress disorder
or some of the technical termswe might use to label trauma.
And I would love to hear alsoyour thoughts, linda too, on the

(14:10):
diagnosis or what you use todiagnose trauma and animal.
So does that kind of make sense?
What are the diagnostic factorsand is it a diagnosis when you
do label an animal or human withtrauma?

Speaker 3 (14:24):
That's, I think, a big question and we certainly
have diagnostic criteria forlabeling someone with, say, ptsd
post-traumatic stress disorder.
There's certain criteria inwhat's now the DSM-5, diagnostic
Statistic Manual for Psychiatryand PTSD was a relatively new

(14:44):
addition.
It wasn't in the first coupleof additions of that.
So we're really starting thatevolution of understanding of
what that is.
What I think is interesting withthis trauma-informed care
approach to healthcare is itreally can be for all healthcare
teams.
It can be for a primary careoffice that is seeing a patient

(15:05):
for the first time and you maynot know what their background
is.
And one of the tenets oftrauma-informed care is
trustworthiness.
A person may not trust you inthat first visit, in that second
, in that third visit, and itmay not be till over time where
you start to piece together abigger history or a bigger

(15:25):
picture of this patient.
So it isn't necessarily todiagnose them with a diagnosis
from the DSM-5, with apsychiatric diagnosis, but it's
how do you care for people in anenvironment that allows them
their optimal health?
I don't know if that makessense.
Whatever, it is your sugar'snot well controlled for a

(15:47):
diabetic, which is a little bitmore of a straightforward
diagnosis, and they're havingtrouble controlling their sugars
?
What other factors may beplaying into it?
But you're still treating thediabetes, but with consideration
that there's probably a lotmore going on under the surface
than we realize.

Speaker 1 (16:06):
Interesting.
What about you, Linda?

Speaker 2 (16:08):
Well, the first thought that came to my mind is
the fact that trauma isn't adisease, so we don't really
diagnose it in a literal senseor in a technical sense of the
word diagnosing it.
So, really, that's all I haveto say about that section of it
is but the theory or the path bywhich you might get to.

(16:32):
Well, maybe there's more traumahere than we think.
That can be something that canfollow a logical diagnostic tree
, so to speak, only if you canget the information, because
otherwise we're right back fullcircle to what we're assuming
may have happened and we may betotally wrong.

(16:53):
And I think that happens tochildren a lot, and it happens
to women probably, I would say,more than men.
Just like, if we're going totake it into the animal world
and trust me, I am not makingcomparisons here between
children and women and theanimals that I'm going to
mention I'm just saying thatwithin the animal world, we

(17:17):
might say that an animal thatwas captured in the wild, with
people chasing after them withjeeps and shooting them with
tranquilizer guns and all ofthat, had a traumatic incident.
What happens after thattraumatic incident can take a
lot of different ways and thatone incident may be just that

(17:42):
incident in that animal's life,depending upon especially if it
was a predator or a prey animalin the first place.
But if they keep happening andkeep stacking, then we can start
down our tree.
Well, this happened, and ifthis had happened, the corollary
would be we might have gonethis way, but that's not what

(18:02):
happened and we have knowledgeof that.
So I'm just taking an incidentwhere we can take a starting
place and move through it and 10years later, when that animal
is in a zoo somewhere and has astereotypic behaviors, we may be
able to trace it through thatwith diagnostics.
Otherwise we're saying, well,this animal was caught in this

(18:25):
country this way and now it'sacting this way.
I bet that was the cause.
It may not have been.
So it gets so complicated.

Speaker 1 (18:33):
It is complicated and I'm glad we're kind of working
through these nuances because wehear those stories.
Somebody, like a client, mightsay, oh, I think a man used to
beat him or something like that.
And so we're signing what wewould assume are traumatic
incidents or pass to the animalsthat we have no history on.
We just make those assumptions.
And so what do you look for?

(18:54):
If you're going to say this dogis experiencing trauma or this
cat is experiencing trauma, whatdoes it look like when you make
that statement Okay, this dogis.
Is it because of experiencesyou've witnessed?
And then you see the future,behavior change and responses or
is it?
Could it be something where wedon't know the past but we see
potentially what we think istrauma affecting the animal?

Speaker 2 (19:16):
Well, this is a place and Kathy just jumped in any
time, if you know, where wereally have to step back and
look at it as ABA.
I mean, we need to look atwhat's in front of us and we
have to treat that.
And then, as we know morewhether about the animal or

(19:38):
somebody comes forward and saysI know for a fact that this
happened, any knowledge that wecan gain that's more factual, we
can add it in and we can adjustaccordingly.
But with I would say probably90, 95% of the animals in front
of us that we're trying to help,that we want to label as being

(20:01):
traumatized, the animal is bestserved by us being our best
diagnostic selves, by just goingback to the basic ABCs.
Every behavior has a reason tobe in existence with that animal
and just because you see thesame behavior in different

(20:22):
species or in differentindividuals of a certain species
, does not mean that that animalis getting the same consequence
out of that behavior that wehave.
So we treat them as individualsand we just keep going back to
the foundation.
But we do that as doctors aswell.
We have to keep going back,which is how they discovered

(20:43):
which we talked a little bitabout before Pandora syndrome
and cats.

Speaker 3 (20:48):
Yeah, this is a great place for Pandora syndrome.
Yeah, to explain that becauseit's very interesting.

Speaker 2 (20:55):
And for years, decades, cats would come in,
especially to a veterinaryhospital, because they're
keeping all the records.
So we've had 2000 cats and ofthose, such and such a
percentage has had come in withliver disease or urinary tract
problems a huge one urinarytract problems and cats of all

(21:15):
sorts of different kinds.
And as they tracked those andstarted putting them into a
database Dr Tony Buffington isthe person who really came up
with this it turned out thesecats all went back to having
environmental issues and whatwe're going to call.

(21:37):
They call it a disease ofanxiety, stress and anxiety, and
you could relay all of thesesymptoms back to that.
And so it started treating theenvironment and not the disease
or the problem that the cat wasbeing presented for.
They would treat it was abacterial infection.

(21:57):
I'm not saying they didn'ttreat it, they did treat it.
But the cause of it was notjust bacteria, it was stress and
anxiety.
So that's become interesting anda huge, more recent part of
that is treating the client.
So now we have to treat theperson as well, because who's
got to change the environmentand how do they have to change

(22:20):
their life?
And the clients get stressedand they get anxious and they're
calling you up.
They've got a cat with achronic condition that's got
this fancy name, pandorasyndrome, and they're picturing
that they opened the box, thatall of these things came out of
that just, and now they've got asick cat.
So they feel guilty and oftenneed to seek counseling on that

(22:44):
issue.
So it is a very interestingproblem.
We haven't identified, as faras I know, anything like that
specifically in dogs.
However, we do know, just likewith people, that stress, that
stress, anxiety, depression,trauma can stack on itself and
then cause liver disease, cancer, all sorts of things that are

(23:08):
based on environment.

Speaker 1 (23:12):
Yeah.
So to jump back into the humanside of things, kathy, maybe you
can tell us about what you lookfor in somebody that might be
experiencing, or has had, traumaor is experiencing now in terms
of what it looks like.
So if we had our operationaleyes, as they say, what does it
look like for you?
Or let's say, you havesomething that it can't even
tell you much about it?
Are you looking for somephysiological signs, physical

(23:35):
side behaviors?

Speaker 3 (23:37):
And I think it's a really interesting question
because there are so manystories of people who've gone to
the doctor and had somethingphysically wrong with them, but
their symptoms were attributedto stress or anxiety.
So it's often always adiagnosis of exclusion.
Or maybe the degree of symptomsthat they experience will be

(23:58):
exacerbated by stress, bycortisol levels.
I mean, some of the studieslook at cortisol levels when
people are responding to stress.
So you're really looking for asimilar, I think, to what Linda
talks about in Pandora'ssyndrome.
Are people coming in?
Are there symptoms in line withwhat they're presenting with?

(24:20):
It's like we know appendicitisis very painful.
Is someone having stomachissues?
That seem what doctors call?
And this is, I think, why weneed trauma-informed care, maybe
out of proportion.
Their symptoms are out ofproportion to their exam.
And it isn't out of proportionto the exam, it's just the way
that they are presenting.
But how do we get to that rootcause of what's making it so

(24:43):
painful?
Let's say, a painful abdomen.
You will look at differentthings.
Is it a urine infection?
Is there some type of bowel orgut disease?
What else might be going on?
But it's a really fine line tosay that, oh, this is stress.
But if you're sensitive to thecommunity that you're in and how

(25:03):
much stress or how many ofthose adverse childhood
experiences the community hasexperienced in general, you may
be more sensitive to how youapproach each patient you know
with their symptoms,understanding that it can be
very painful.
Whatever you know symptomyou're experiencing and it's not
out of proportion to your examor your diagnosis.

(25:25):
That's kind of a preconceivednotion that the provider would
bring there and that that isn'tfostering trustworthiness or
collaboration that you reallyneed in your doctor-patient
relationship or yourprovider-patient relationship to
get to better health.

Speaker 2 (25:42):
So, which is where, I would think, then one health
comes in and that we're takingall of this and trying to make
it more congruent.
So veterinary students arespending time at hospitals and
medical students are spendingtime with veterinarians, and

(26:02):
especially at universities.
You see a lot of sort of crossthere to see how all of this
works in the differentcommunities.
And then we have Align Care andStreet veterinarians and
Spectrum of Care, which I wouldsay right now are the three
biggest things that I wanted tosay on the horizon.

(26:24):
But they're not on the horizon.
They've been around for alittle bit, but they're really
coming into their own now.
And here you are taking care ofeither a bonded family, which
would be Align Care, so you'vegot people who don't have the
income or the wherewithal, can'tget to the veterinarians, that
kind of thing.
They give money to people totake them to their family

(26:48):
veterinarian, take the pet totheir family veterinarian and
get care.
So Align Care is working thatway, whereas the street
veterinarians are going right onthe street and are really
taking care of people that arehomeless and taking care of the
pets.
No judgment, and the peopledon't have to come up with any

(27:09):
money.
So they aren't getting vouchers, like a lot of the Align Care
people are, and that has beenfantastic, and often the animals
are what are keeping the peoplestable and sometimes even just
basically alive, because theyhave to care for this animal,
they want to, they love thisanimal, and so they're going to

(27:30):
get up in the morning to providesome kind of care food, water
for their pet, and then thespectrum of care is taking it
and Ohio State University is atthe forefront of this, so I'm
pretty involved in followingthis through is where they're
saying it's not just thediagnosis and it's not just how

(27:53):
much money you can.
I don't want to say throw at it,but some people that's what
they're doing.
Oh yeah, I can do that.
So here's $20,000 to do.
Some of these things arecosting that kind of money, but
it's not always the goldstandard and a lot of it ends up
being caring for the people.
So spectrum of care is givingveterinary students now a lot of

(28:16):
information right from theget-go on how to care for the
people in front of you so thatthey and you can care for the
animal in front of you, knowingthat there are ways around doing
an MRI, there are ways arounddoing some of the more expensive
things and it's not less care,it's not inadequate care, it is

(28:37):
different care.
It's very, very exciting.
Those three things.
They have my heart.

Speaker 1 (28:45):
Yeah, and I love that because it's making it
accessible to so many peoplethat don't have access to that
kind of care, and doing it in acreative way too.
So it sounds like it's verysupportive for that sort of
triad that veterinarians, thepet guardians and then the
animals themselves so brilliant.
So, I want to dive into thattoo.
So there's a lot my head'sgoing around a lot of different

(29:08):
questions right now and I don'tknow where to start because it's
all trauma informed care though.

Speaker 2 (29:14):
It's all under umbrella.
We really haven't diverged this.
It's such a big umbrella andthat, if I may, would bring us
back to that.
So would bring us back aroundto are we over using the word
trauma?
I mean, what are we?
Are we trivializing somethingthat shouldn't be trivialized,
because it is so major in oursociety and it is even more

(29:37):
major in the western societiesthan it is in some others, and
others also have treasuredanimals more within their
culture than we have in westernsociety.

Speaker 1 (29:52):
Because I think that people latch on to that right.
They in a sense of it I don'tknow what the right word I'm
looking for, but it almost helpsyou feel like you're being more
of a rescuer or you're helpingyour dog more If you can say
they've been traumatized orthey're experiencing trauma, so
it allows you, as the person, tofeel better about it.

(30:12):
So I want to wrap my headaround.
Maybe we use a story or yourexperience.
Both of you can maybe just talkabout where you've seen a dog
or you've worked with a dog,that you're saying this dog has
experienced trauma and this iswhy and this is what it looks
like.
Can you maybe walk us through acase of that, just so we have
the listeners kind of have apretty clear picture of okay, oh

(30:34):
, that's what they're talkingabout when they say trauma.
And again, it's another broadquestion, but I think that'll
help if we have a visualizedwhat it looks like Behavior,
physiological, whatever you wantto throw at it.
But what would it look like foryou?
Or maybe a story you have?

Speaker 2 (30:48):
Yeah, there are so many.
Sometimes I have trouble.
Well, actually I was just goingto say choosing, but the word
that came to my mind wasactually sleeping, because
that's how many we can see.
And one of the reasons that theprofession is known for the
high rate of suicide, addiction,depression and what have you as

(31:08):
far as that is because we seeit so often and I see it from
both ends.
I had a client who would come inscratching all the time, and so
I'm thinking of scabies, I'mthinking of this thing, and
she's scratching.
Her dog is not scratching, butshe brings her dog in to be

(31:30):
looked at for some reason.
That isn't real to me, it isreal to her.
So I'm not saying it's not real, but the dog does not have the
issue she brings the dog in forbecause really she's coming in
because of her and she wants toshow me everything that's wrong
with her, but she's relating itto the dog so by proxy kind of

(31:57):
situation, well, eventuallyshe's treating this dog with
everything she can think of forthese symptoms that she actually
has.
I saw that dog over a number ofyears and that dog became what
I'm going to call traumatized,because it was constantly
getting medications and peoplewere coming into our apartment

(32:21):
because she called the firedepartment over certain things,
whoever it is that she feltcould come in and help her with
whatever that was.
But it was always put on thedog.
So the dog's always beingshunted, playing noises,
everything and the dog finallystarted acting poorly.
In her description he's actingpoorly towards me, which she

(32:43):
would always say to me.
Well, he was biting her and shedidn't understand why.
And I did talk to her doctor.
I called her doctor and ofcourse they couldn't talk to me,
but I could say what I had tosay and see if I could get her
some help on that end.
She never did, as far as I know, really get any help on that

(33:05):
end.
But that to me was constanttrauma, possibly small T trauma
individually, but over five orsix years it added up and it was
to the point where I just Iwanted the dog I hate to say it
to be quote taken away from her.
But she couldn't have the dog.
This was her life.
So what do you do with thesetwo beings and you can't take?

(33:30):
The dog is the one that needsto be removed from the
environment, but you can't dothat to the person.

Speaker 1 (33:36):
Yeah, yes, such an interesting case and interesting
dynamic there.
I want to dive more into that,but I'm going to take a short
break to hear a word from oursponsors and we'll come right
back to that.
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(33:58):
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Alright, we're back here withKathy and Linda.
We were talking just before thebreak about an interesting case
Linda was sharing with aparticular client and their dog
and how the dog was.
I think you mentioned likeshort T, low T, can you?

(37:57):
Just because that wasn't a termfamiliar to that.
So the micro traumas, I guessadding up was there a
terminology use.

Speaker 2 (38:04):
Yes, small T trauma.
That's that's yeah, the small Ttraumas are the small things
that in and of themselves mightbe I don't want to say
insignificant, but you get overthem and maybe you think about
them every once in a while, butthey don't affect your life.
But as you get more of thesesmall T traumas and they start

(38:26):
layering on themselves, so youget small T, small T, small T
and over here might be a littlesmall T and over here, but
eventually your world is small Ttrauma which then becomes a big
T trauma and it's actually, asyou were saying before, a
diagnosable that this person hasbeen traumatized.

(38:47):
And this I think the instancethat Kathy correct me if I'm
wrong on this that I think mightbe most relatable to people
would be some of the PTSD'swhere it's not the big ID that
just blows up all the Humveesaround you and you make it
through and but you see carnageeverywhere and we say, oh, big T

(39:08):
trauma you should have, butit's the little ones where
you're stuck somewhere, thinkingsomething's going to happen to
you.
You know, yesterday this convoywas attacked at this place and
you're going through it.
Nothing happens, but over timethose smaller ones just add up
and they don't have to bewartime things.

(39:29):
It's just that.
That's the visual, I think yeahyou can take with you.
Yeah, and you can relate it tobeing a diverse in a country
that doesn't have a lot ofdiversity.
And there are a lot ofcountries in the world where
have been isolated enough,either because that's what they
wanted to be as a people or forother reasons, and then you

(39:51):
start bringing people in thatdon't look like them, don't act
like them, and those people keepgetting small T traumas.

Speaker 1 (39:59):
I'm so glad you brought that up.
Yeah, it's something we don'tthink about often.
We usually when sociallytrainers.
We think about trauma as likesome big, significant event that
was just startling and justawful for the dog versus the
smaller traumas.
So, yeah, such an importantpoint to make.

Speaker 3 (40:16):
Yeah, yeah.

Speaker 1 (40:17):
Yeah, kathy, I would love to also hear your thoughts
too on how we can start helpingyou, know, and your work with
people.
So let's kind of dive into thatnext.
You know, we talked about, kindof what it looks like, some of
the aspects.
Sometimes it manifests asaggression, right?
So of course this is aaggression podcast, but
sometimes it manifests as that.
But let's talk about what yourexperiences in terms of helping

(40:38):
people.

Speaker 3 (40:40):
So I think that's the most exciting thing I'm finding
now as we explore this, becauseyou can get consumed in the
literature about adversechildhood experiences, the
negative impact that has on yourhealth, but seeing some of the
studies come out there's onecalled hope healthy outcomes
from positive experiences.
It's out of Tufts University.

(41:00):
I think one of their studieswas a kind of a review on
resilience that came out in 2017.
I believe it was from theAcademy of Pediatrics in their
journal.
So it's nice to see that we'removing to well, what can we do?
Because you don't want to getstuck in that kind of
helplessness.
All of these things happen andnow we're stuck, but what can

(41:21):
you do to move forward?
And looking at some of thethings that they're studying and
right now it seems like they'redoing kind of analysis of
surveys and things like that butit does seem like you can have
healthy outcomes from positiveexperiences.
Positive experiences, whetherit's on an individual level or a
community level, can reallyhelp build resilience in people,

(41:41):
in those children that haveexperienced it, and that is
really the most exciting thingI've seen in a while.

Speaker 1 (41:49):
It sounds very interesting.
Could you give us an example ofwhat that might look like or an
exercise you might incorporatein your work?

Speaker 3 (41:56):
Yeah, and I think this goes to someone I wanted to
mention, or a profession Iwanted to mention that Linda and
I found when we were looking atthings like Align Care and all
of that.
But there are veterinary socialworkers, which is a relatively
new field of social work to helppeople and you see it, and we
have an emergency vet near me,so they might be helpful.
But I've also had patientswho've come who needed time off

(42:18):
work to grieve a pet and washappy to be their doctor,
because I get it and I think notthat it matters what I think,
but it's very legitimate grief.
So what they're looking at isthey're looking at how do you
build relationships, how do youbuild safe, equitable, stable
environments, how do you havesocial and civic engagement and
how do you have emotional growth, and those are very variable.

(42:42):
It depends a little bit on, Ithink, communities and your
resources and what can you do tohelp foster positivity.
And one of the things that thisgroup did was their logo was
designed by high school studentsin kind of a higher risk
category, if I'm rememberingcorrectly, but it was just the

(43:02):
right people that you wantdesigning your logo.
That is beautiful and you'reputting a good face forward and
doing good communityrelationships at the same time.
So I think it may be a littlebit on more of a community level
than in the doctor's office.
When Linda and I were talkingwith one of the veterinary
social workers she spoke into alot of doctors.
But it's hard to change bigsystems, it's hard to change big

(43:26):
organizations.
But what little changes can youmake to kind of approximate or
to get there?
So I think there'll be thingsin the community and it's going
to be partnerships.

Speaker 1 (43:39):
Yeah, yeah, and I'm gonna also ask Linda two part
question, so to follow up onwhat was just asked.
But also real quick side note,isn't you're?
So you're part of Ohio StateUniversity, right?
And so are they the ones thathave honoring the bond?
They have a support network, Ibelieve or am I off by one
university, because you hadmentioned that social workers,

(44:00):
veterinary social workers, but Iknow.

Speaker 2 (44:01):
I was the University of Tennessee.
Okay that's where theveterinary social work comes out
.
I don't think honoring.
If so, then I better.

Speaker 1 (44:16):
You know it's a grief support type of initiative and
I think it's for eithereuthanasia or behavior
euthanasia support as well, andI think they have a good
resource.
I think it is all has to lookit up.

Speaker 2 (44:28):
I'll link to it in the show notes when I do find it
Well, have to find out moreabout it.
It hasn't been something that'sbeen.

Speaker 1 (44:35):
Yeah, it's not very well known and I it's still
there, but I yeah it's a greatresource for anybody because as
they have some good articles inthere as well.
So, going to the animal side ofthe equation, we're kind of
talking about how to help, whatcan we do to help the animals.
So you mentioned again we'relooking at informed care.
So we got this sort of trifectaof the vet, the patient and

(44:57):
then the patient's guardian.
But if we're going to focusright now just on the animals
for right now, and then I'mgoing to go full circle and go
back to the informed care aswell.
But what do you do for theanimals, like the dogs or the
cats that have experiencedtrauma and you're going to give,
let's say, a client, whetherit's a training client or a
veterinary client?
What do you?
What do you?
Some of your first steps there?
So do you have a general planin place for that kind of thing?

Speaker 2 (45:21):
You know, quite honestly, I try to go in without
a general plan because I Reallytry to take a deep breath, do
my yoga breaths before I go inand go in with a clean kind of
space within me, becauseeverything is so different when

(45:42):
we're dealing with that animaland we have to take so much time
and Patience and just watch andobserve and ask questions of
the animal.
I mean, as we always say, train, ask the question, the dog will
answer Me one way or another.
However, it is the formation ofthat question of course isn't

(46:04):
literal, because that's whereit's going to be.
And at the same time, I Believeso much in video.
I don't feel I do it enough,because what I want to be saying
is, when I leave that room, Iwant to be able to Somehow take
the human part of the equationwith me.
Often you can't I mean, we'redealing with this often you

(46:27):
can't just say, oh, leave yourdog here because we're going to
go here.
You've got a traumatized animaland sometimes that's not
happening.
But I want to be able to saylet's slow this down a bit and
see what happened here.
And so I do go in saying, if Ican only get their caretaker To
see what I'm seeing.
I think that's.

(46:47):
I've got tears in my eyes.
I just feel it.
Just I feel so strongly aboutit that I, if I could just get
them to see it, then I thinkthat we would be halfway there,
because this dog does need tohave choice.
But the people need to havechoice and often they walk in
and the veterinarian and I get alot of people are coming to me

(47:10):
as a trainer and as aveterinarian, and we're looking
at medication and we're lookingat all of these different
aspects, and so I Want to openthe door for them not to feel
guilty about where their dog is.
Is or not to feel guilty thatthey rescued a dog, that they
were going to give this?

(47:31):
You know they have dreams ofthis great home too, and now
they're afraid they're not goingto be able to provide A safe
environment for their family orfor the dog.
In answer to your question, Ireally try not to go in with a
plan.
I try to come out with a plan,though, and as small as it may

(47:54):
be.
Several of my criteria are thatI have some small points for
the dog to try to move themforward, but I also have small
points for the client to try tomove them forward, and they may
have nothing to do with eachother and that's the hard part
in order to move the personforward.

(48:15):
It may be totally separate fromhow I want to move the dog.

Speaker 1 (48:20):
That's deep Thoughts.
Yeah, and Kathy, I think what'sthat to that?
Yeah.

Speaker 3 (48:24):
I, I was just thinking and, lindon, I haven't
discussed this.
Really we talk a lot kind ofoffline but I think Not being
necessarily scripted when you goin with your plan.
Is trauma informed or you know,trauma assumed care?
Because it's going to depend alittle bit on what this person
has heard before from whetherother trainers or other doctors.

(48:46):
You know how many people online.
Yeah, have you know, seen theorthopedist and the woman?
The first thing they hear forher knee pain is you have to
lose weight.
I mean, you can re traumatize.
And the part that I reallyhadn't thought of before is when
they talk about trauma,informed care, it's supposed to
really benefit Not just thepatient but your colleagues and

(49:07):
everyone that you're workingwith.
And our front staff Is oftenscripted.
You know, business people willhave you script this so that
everyone's saying the same thingand no one deviates, and that's
really hard to do gently andWith consideration to the person
you're speaking with.
So I think there is value Innot necessarily having a plan or

(49:30):
an agenda when you go in,because I think the scripting
may be hurting more than it'shelping when we're talking about
this topic.
I'm sure there's a lot of otherbusiness reasons why they want
to do that.

Speaker 2 (49:41):
Oh yeah but yes, so unlike.
Kathy, I own my own businessand Two businesses and so, yeah,
definitely scripting helps, butthere are times and then you
have to have the right people inthe right place.

Speaker 1 (49:55):
Oh, there's so much I want to dive into right now.
I guess you guys are bringingup somebody good points and
you're so right.
I think we have to be socareful about not re
traumatizing someone, or eventhe animals in our care, or
they're putting them Intosituations that can do you know
how important is it right.

Speaker 2 (50:12):
You know, we say with medication I'm sorry, just got
me excited here, I'm just goingto jump right in and interrupt
you for a second is to say We'vegotten aggressive dogs, say and
we need to sort of Tamp thosebig feelings down a little bit
so that Complimental learningstate, great.
What's the first thing we sayas a veterinarian?

(50:33):
Well, we have to draw bloodbecause we need to know where
this 10 year old dog is, becauseI'm putting him on this
medication.
And what if he's got a badliver?
What if, what if, what if?
And there we are, are we goingto re traumatize this dog?
And that's exactly what's goingto happen.
Either we're going to bemuscling him, and there are some

(50:54):
places that still get out whatwe always used to call the
rabies pole, all those thingsthat can happen, even if we had
to give an injection ofsomething to sedate them in
order to be able to draw theblood.
We have to say how important isit that we get this blood?
What is more important?
So we come up with what's moreimportant, and that's helping

(51:16):
the dog and not getting theblood.
But then what do we do?
We have to pull out our piece ofpaper that says would you sign
off here saying that I am goingto give this dog this that could
affect his liver and if he hasliver disease I'm not
responsible.
And there you are, and that'sbasically what we end up doing,
in a nicer way than I just saidit, I hope.

(51:38):
But, um, but in a gentle way,to say I think this is important
for your dog.
I want you to know the risks ofthis medication, but I think
it's worth taking because thoserisks are low.
The risk of your dog gettingworse are high.
The risk of behavioraleuthanasia is higher.

(52:00):
So, this is what we need to do.

Speaker 1 (52:02):
It's it's those, those nuances right, that that
we have to learn and add to ourPractitioner toolbox in terms of
navigating those nuances right?
Because what I'm thinking froma trainer or consultant lens, so
not from, necessarily, you know, a doctor or veterinarian lens
is is when I'm working with ananimal in a context or
environment which might I canset things up as perfectly as

(52:25):
possible distance, duration,intensity, pay attention to all
those variables we do intraining.
Put just by virtue of puttingthat dog in that environment,
and less we're careful we mightnot recognize we could re
traumatize that animal in thatspace, even if all the other
variables look like the goldstandard, you know, high-value
reinforcers, setting theenvironment well, and we might

(52:45):
not even see those things comein to play until later.
Because sometimes that's howtrauma works, right, it's not an
immediate Response, right,sometimes it is, sometimes it's
obvious.
But it's not always.
So yeah, it's kind of like Ilove how we're kind of putting
this all full circle on, kind ofit's all you know, piecing
these little pieces of thepuzzle together.

(53:05):
So I want to jump a little bitfurther in the last few minutes
that we have to Jump into moreof the informed care topic.
You know, I know we've covereda lot, but let's talk about that
, some more of thistrauma-informed trauma, assumed
care that we've been talkingabout.
Any other thoughts orstrategies that's kind of based
on what we've been talking aboutthat you want to throw out
there.
Maybe, kathy, you want to startwith that.

Speaker 3 (53:27):
I think the conversation that we just had
around kind of informed consentspeaks.
When we talk about definition,the challenge of being informed,
and which is why I really dolike the trauma assumed care,
it's a big topic.
And how do you initiate that inorganizations where there's
high staff turnover?
The front desk person may not,you know, may rotate through

(53:48):
various offices or things likethat.
So I don't have great answerson how to implement it
Successfully.
But I think it does take thatone champion, that one person
who just really appreciates thevalue of that, to talk about it.
Linda and I often, when we firstmet, would talk about how dog
training impacted our kind ofapproach to medicine, medicine

(54:11):
or change or leadership, andit's might be just break it down
into small pieces and do alittle bit.
And what's really interestingand Makes me keep trying to
figure out how to implement it,is that kindness, that
compassion, the considerationthat you give to the patient or
the client.
It also translates into carefor colleagues and co-workers as

(54:35):
well.
You're not just treating thepatient, but you know the person
who answers the phone, theperson who's going to cover your
call on a Thursday night,everyone, everyone.
Linda was mentioning, you knowthe high rate of suicide and
depression, with veterinariansand so many people in.
In one of our talks or one ofour conversations we talked
about shelter workers andburnout and Animal trainers and

(54:58):
people who are in givingprofessions.
They're, they're all reallygiving professions and the
burnout there.
And if we were all a little bitmore Aware of the possibility
that there might be some traumaor something deeper, that right,
that old saying you don't knowwhat someone's going through and
just assumed the best inyourself and in the skills that
you have to navigate that, itwould probably be better for

(55:21):
everybody and then you mayretain that front desk person a
little bit longer and you mayget that continuity that family
medicine really likes, not justwith patients but with staff,
because there's nothing nicerthan calling the office and
knowing who you're speaking towhen you're making the
appointment or asking for arefill.
That continuity, that staff,everyone could really benefit

(55:41):
from that.

Speaker 1 (55:43):
And it's contagious that empathy right.
Right.
Any thoughts Linda?

Speaker 2 (55:51):
I have so many thoughts.

Speaker 1 (55:53):
Let's hear them all.

Speaker 2 (55:56):
I'm thinking of global care and and however well
I feel during the day when I'mtrying to care for pets, I'm
trying to care for the people,care for my staff and care for
myself, and, of course, myself-care always goes down.

(56:18):
You know, you get less sleepybecause you're doing all of this
other care, and I think thatwhen we're working in
trauma-informed care, that oneof the best things that we can
do is know that we can only workwithin our own Environment, in

(56:38):
our own small area.
We can't then translate that,as people in this profession we
often do, is well, just sort ofsaying, well, I should have done
this, I should have done that,and I know that I shouldn't have
held that dog down in order toDraw his blood and to be
forgiving to ourselves as we tryto be to other people.

(57:00):
But given that the other thingthat was going through my mind I
graduated in 83 82 people keeptelling me I'm trying to.
I always get it wrong, and I'vebeen called on it so many times
anyway, from veterinary schooland when I ended up, 10 years

(57:21):
later, opening, I was in a dairypractice and I even now am
involved with some of therobotic milking and positive
reinforcement with dairy cows.
So, in any case, when I openedmy own practice, I was a woman
in a male-dominated, you knowprofession and I was also one of
very, very few blackveterinarians in the state of

(57:44):
Ohio, never mind in the country,and the KKK had a rally and I
ended up having to have policeprotection for quite a while and
One night I was sleeping my Ihad an apartment attached to my
veterinary hospital and I, after12 years, I decided that wasn't

(58:05):
such a great idea, but in anycase, at this point that's where
I was and all sorts of thingswere happening around me.
And one night the police camein my door with all their lights
, their guns drawn and there wassleep in my bed and I said you
know what's?
What's going on?
And they looked at me and theysaid, oh, you're here, you're

(58:29):
okay.
And I said, yes, they said wegot a report, you were dead, and
I thought, okay, so all thelights are off, the doors closed
.
How would anybody know if I wasdead.
So obviously, you know, inretrospect they probably got a
report now fake report fromsomebody saying that somebody

(58:50):
had killed me and and it went inand so I.
I Lived my life in thatcommunity in a very defensive
way for a long time.
It was very hard, and so I thinkof that whenever I I'm
approaching People who come inwho are unsure of why they're

(59:12):
there to see me with their dogfor a behavior issue and I find
a medical issue.
Often it's pain and and I tryto be really careful with how I
talk to them, because Last nightthe police could have, you know
, broken into their apartmentand said you know, we thought
you were dead I'm getting offtopic here but that's what you

(59:34):
were.
There isn't any answer reallyto how we should move forward in
this.
We each have to take it withinour own selves and Do the best
we can with it, but keeping inmind that we have a goal.
We're not just amorphouslydoing the best we can and oh, I
tried.
I don't mean that at all.

(59:54):
I mean a very factual Almost,as if you have a training plan.
I'm going to go this step inthis step, so I train my staff
and I surround myself withpeople who are supportive of me
and of my goals, and I try tobring other people in, as a
matter of fact, people who wouldleave me and say no, and Word

(01:00:15):
is going to be touching my dog,because they came in not knowing
they had I was a blackveterinarian, and then they
grabbed their dog and they runout the door and then, three
years later, that same person iscalling me because they're
trying to get somebody to lookat their dog for certain reasons
that only I could handle, andmy goal at that point was to say

(01:00:35):
, of course, come on in and moreor less Over, treat them with
kindness and if they can'tafford it, I would give them a
free exam.
All because of what happenedbefore that.
You know I want to be MichelleObama.
You know I want to take thehigh road, and by taking the
high road I'm hoping to helpmore people who are feeling

(01:00:58):
traumatized and taking it out onpeople like me or or people and
their animals around them, andso that's how I approach it, how
I approach the world, and thatdidn't answer your question at
all.

Speaker 1 (01:01:11):
It's the story I wanted to tell it actually tied
in everything beautifully, and Ithink, first, I'm glad the
police report was Incorrect, solet's just put that out there.
But no, really, I mean you'reyou're speaking about so many
things that have.
Also, we were talking abouttying this season together,
about how our past experiencescan shape us to actually be

(01:01:36):
kinder human beings because ofour understanding of those
moments, those traumatic,stressful, difficult moments in
our lives and our experiencesthat make us empathetic to the
people that we're going to endup dealing with, sometimes that
might have their own traumas,their own hate, their own
Experiences, because of theirexperiences right, that's the
way they're treating us at thatmoment.

(01:01:57):
But also the animals too.
I think it's also come fullcircle to help us understand the
animals in our care and thetraumas they might have
experienced, and that they'rebarking and lunging and snarling
and stopping at us is not to betaken personally, right and, of
course, the resiliency thatyou've built and it shows
clearly.
So so thank you for sharingthat story, because I think it's

(01:02:19):
it's a wonderful way to Reallyround out this whole season as
well as what we've been talkingabout.
So, so, speaking of ripples, youknow you had both kind of
mentioned.
Now we're making these smallchanges, but I think you both
are making Incredible waves bycreating these small ripples,
because we need to talk aboutthis more right.
We need to talk about traumaand understanding it and being

(01:02:40):
empathetic to those that wemight see in our care for those
that have experienced trauma intheir lives.
So thank you both for doingthat.
I do want to give you a moment,though, of course, to talk
about where can people find moreabout this, so what you're
working on, and if they want tolearn more about you and the
work you're doing.
So maybe, kathy, you want tostart.

Speaker 3 (01:02:59):
Well, I'm working at Stanford Hospital and a family
medicine residency trainingprogram, so that's the medical
side of it.
I also teach at Port Chesterobedience training club doing
nose work, so it's really fun tobe able to do some dog training
.
And so much of what I learnedabout teaching I've learned from
positive reinforcement dogtrainers, so it's been great and

(01:03:20):
I love how animals have made mea better teacher.
And then Linda and I will betalking at APDT in October right
, wonderful.

Speaker 2 (01:03:30):
Yeah, and in October and look probably in early 2024
for a series that we're puttingtogether interviews on Trauma,
informed care with people thatyou might not expect that their
professions or what they dowould lead to that, and so we've
got a whole list.

(01:03:50):
They are that we're going to beworking on.

Speaker 1 (01:03:54):
Wonderful, wonderful, and I'll be sure to link to all
of your the things you weretalking about in the show notes
and if you have informationabout what you just mentioned
there, I can add that if by thetime this episode comes out.

Speaker 2 (01:04:05):
So Well, and you know , oh, I'm sorry, just one thing,
and just to say that in thepast, just to mention what we've
already done, looking at theconvergence, the chat Talk that
we did, I think we'll givepeople more in depth into the
science of trauma.
And that because that'sbasically what that was about.

(01:04:26):
Yes and then also looking intoour talk from the lemonade
conference where we went on onfrom that and to some other
things, and then I did afour-hour webinar on kids race
and positive reinforcement thatcan be found on the heart
collective, which was very, veryinteresting.

Speaker 1 (01:04:47):
Wonderful, wonderful.
And again I'm gonna link to allthat in the show notes so
everybody listening in check outall of their work.
Kathy and Linda, thank you somuch for coming on.
This has been wonderfulchatting with you both.

Speaker 3 (01:04:58):
Thank you for having us, yeah.

Speaker 2 (01:05:00):
Thank you.
Thank you so much I.

Speaker 1 (01:05:03):
Can't thank Linda and Kathy enough for sharing their
expertise and knowledge aboutboth dogs and their people.
It's so crucial for ourcommunity to be able to discuss
trauma and, while it can oftenbe a difficult topic to have
conversations about, I'm so gladto have amazing professionals
like Linda and Kathy in ourcorner.
And don't forget to head onover to aggressive dog comm for

(01:05:25):
more information about helpingdogs with aggression From the
aggression in dogs master courseto webinars from world-renowned
experts and even an annualconference.
We have both options for petpros and pet owners to learn
more about aggression in dogs.
We also have the help for dogswith aggression bonus episodes
that you can subscribe to.
These are solo shows where Iwalk you through how to work

(01:05:47):
with a variety of types ofaggression, such as resource
guarding, dog-to-dog aggression,territorial aggression,
fear-based aggression in much,much more.
You can find a link tosubscribe in the show notes or
by hitting the subscribe buttonif you're listening in on Apple
podcasts.
Thanks for listening and staywell, my friends.

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