This week we speak with the incredible Heart Doctor, Dr. Carley Saelinger about the physiological functions of the heart and all the intricacies of this organ. We learn about the symptoms, causes and medications for different diseases and more specifically about Pulmonary Hypertension, the one that stole our heart, Freddie.
Dr. Carley Saelinger
Transcript: Episode 14 of A Favor for Freddie with Dr. Carley Saelinger
Jyl- This weeks episode of A Favor for Freddie had some audio issues so some parts may be difficult to understand. That is why I typed up a transcript of the whole show. You can find it on our website under paw’dcasts, episode 14. And now, episode 14 with the incomparable, Dr. Carley.
Dr. Saelinger- My name is Carley Saelinger, so I’m veterinary but I have credentials from doing a residency uh and taking my ?? in cardiology. Some extra letters to to practice in our specialty and training.
Jyl- Well thank you very much for being here today, we really appreciate you.
Dr. Saelinger- Ah, you’re quite welcome.
Jyl- Let’s begin with a few questions on heart murmurs because we got quite a few on that. First of all, can you just begin with telling us a little bit about what that is?
Dr. Saelinger- Sure, so heart murmur, what they actually denote is fast blood flow in the heart. All blood flow in the heart in a person, or a dog, or a cat is approximately one meter per second. When it gets faster than that is when can hear an audible heart murmur. So, a heart murmur often in dogs is a sign that there is cardiac disease present because it means there is probably a valve that is leaking or a valve that doesn’t open well or a narrowing to that valve. By putting your thumb over a garden hose, if you put your thumb over it, you’ll feel the pressure build up behind and then the water shoots out quickly, which is the murmur that you hear and it’s almost always a sign of heart disease in dogs, not always, but in cats it can go either way, they can heart murmurs that are benign fast blood flow but also can be disease.
Jyl- So, a specific question that was asked was, I have a precious peke with a 4-5 grade heart murmur and is on 1.25 of Vetmedin or Pimobendan twice a day. She eats, sleeps well and goes outside. She gets regular check-ups and x-rays of her heart. Is there anything else we should be doing for her?
Dr. Saelinger- Sure, so first of all Pekingese, they’re one of my favorites. I love all dogs. Dogs are probably my favorite animal if you ask me, but I have a real particular place in my heart for dogs that have short little legs and short little faces, so Pekingese are high on my list and they are predisposed to two conditions, one is degenerative valve disease or mitral valve disease, chronic valvular insufficiency, that’s the most common heart disease that we see in small breed dogs and in dogs in general and it’s really the most studied. The second thing that they’re predisposed to is Pulmonary hypertension, it’s less common, but it’s common enough and Pimobendan can be used to treat both processes, but my guess is that common things happen commonly and Pimobendan is most often used before the onset of congestive heart failure and when there is heart failure in dogs with degenerative valve disease. When a dog has heart failure they need more drugs beyond Pimobendan to keep them stable, but what we know is when their heart gets to a level on echo where there is moderate enlargements or worse that this medicine Vetmedin or Pimobendan can actually slow down the progression, which is excellent to see. And then I think doing rechecks so Pimobendan, I would suspect that it was degenerative valve disease because if it was pulmonary hypertension there is other drugs that have a higher priority such as sildenafil therapy so again I would speculate again that it is valve disease and really just rechecking things every six months or so, whether it be with x-rays or echo to see is the heart getting bigger is there anything else that we need to do at that point and with that disease process you know dogs can live, it doesn’t have to be life limiting, that disease process is only life limiting if the pet develops congestive heart failure and in that scenario you know there are other drugs that are indicated and you know prognosis can change at that point. There are dogs who never get heart failure and live completely normal lives as well.
Jyl- Another question asked is, I have two 15-year olds with grade 4 heart murmurs, should they be on medication.
Dr. Saelinger- Sure, so 15 that’s excellent, so we got to do for upper teens, we gotta, we got to strive for even better than that. That’s really nice to hear. So, what I would say with those dogs is certainly, you know I don’t know what your availability is to having a cardiologist do an echo but that’s not always readily available and what I would say, what’s really important for a dog with a murmur, whether they’re 15 or 10 is for your primary vet to do blood work to make sure there is no metabolic condition, thyroid disease, anything else that can contribute to heart disease or make the disease progress faster as well as doing baseline x-rays to see, is the heart is enlarged. Pekingese and other what I call compact car dogs, like again the type of dogs that I like that are really smooshed down sometimes their heart will look quite big on x-rays when it’s not in reality so they can be a little more challenging than other dog breeds to really distinguish heart size on an x-ray alone. That being said sometimes there are features that are quite obvious to say wow this dog’s heart is moderately or severely enlarged, maybe we should start Pimobendan now, if we’re not doing an echo. The gold standard though for diagnosing whether a dog should get Pimobendan is an echocardiogram, but I also understand that that’s not always available or feasible for each person, so there are first things that can be done by at least looking at x-rays.
Jyl- So, this question is again about a Pekingese. About 4 years ago the vet said she could hear a heart murmur during one of her check-ups. She said it was between a 1 and 2 grade and to just monitor it if she got tired, etc. Her dog was around 9 or 10 at that time, so her first question would be what causes a heart murmur. I thought people/dogs were born with them. So now her dog is 13 and the vet said about a year ago that she was now at about a 3 on the heart murmur. She said her dogs still acts the same, naps as usual, gets bursts of energy, still enjoys walks, she’s still not on any meds and she has seen on some peke sights where there dogs are taking meds for heart murmurs. She’s wondering, again, if her dog should be on meds.
Dr. Saelinger- Ya, so I think in that case again the first step would be blood work and definitely x-ray, x-rays to evaluate heart size if it’s obvious that the heart is significantly enlarged than an echo might not necessarily be required to start Pimobendan cause again what we know is when, on echo, if there is mild enlargement of the bottom chamber, the left ventricle, in conjunction with moderate enlargement of the left atrium, the top chamber, or worse than that medicine slows progression. Again, it’s not always easy to tell from an x-ray but sometimes it can be very obvious where we can say, oh wow the heart is severely enlarged, if we get to that ??? to do. So that would be the step there and again, the heart murmur in that cause is from fast blood flow. So here is what’s happening, the valve that separates the top of the heart from the bottom on the left, called the mitral valve, is most likely sickened and weepy. The left ventricle has to generate a high pressure. 120, just like us. Blood pressure is 120 over 80 so they have to generate a high pressure to get blood out the aorta to the tip of the nose, to the tip of the tail. What happens is, when the aortic valve is open, when the heart is squeezing the mitral valve should be a tight tight seal. But in this disease process, it’s not and it’s allowing this high pressure blood to leak back into the atrium which is usually a low pressure system which that pressure gradient causes the fast blood flow and that’s the murmur that we are actually hearing.
Jyl- If your pet is on medication and they miss their dosing, what procedure should they follow?
Dr. Saelinger- Great question, so especially a drug like Pimobendan, if you miss a dose not the end of the world go ahead and just give the normal dose the next time, you don’t have to double up it really in the grand scheme of things won’t make or break you. Precision with medication becomes more significant when congestive heart failure is present and that’s when a dog requires a diuretic like furosemide also commonly called Lasix to clear extra fluid from the body. If someone misses one dose they’re usually okay, but some dogs are kind of teetering where they really need it every, you know 12 hours or every 8 hours where they could technically go into heart failure, I don’t see it happen commonly um so what I usually say if they’re in congestive heart failure and you missed your dose, as soon as you can, give it and if you see signs of fast breathing, go ahead and repeat a dose at that point.
Jyl- Have studies found grain-free dog food to be a cause of fluid around the heart?
Dr. Saelinger- Ah, good question. So, fluid around the heart, is sometimes a form of congestive heart failure. The most common form of fluid build-up in the body is usually in the lungs, with dogs but it can rarely happen around the heart, it can happen within the belly and around the lungs. In terms of grain-free diet, it’s not clear cut and it’s still under investigation with the FDA but what I can tell you, what we speculate is that these grain-free diets, and I always think that everything is done with good intentions, that’s my rule in life it has good intentions until proven otherwise. So, these high-end dog food companies were trying to create dog foods that were limited ingredients, you know, maybe less fillers more pure situation and again we see this where human medicine gets, trickles down to veterinary medicine where, you know carbs are eliminated and these things and the diets have more limited ingredients because that’s what we’re doing to people so let’s try to apply it for pets. And then not always does the great research and clinical trial happen that may need to go along with that. So, again probably with good intentions, many of these companies created grain-free diets. Instead of having traditional carbohydrates such as rice, they have alternative carbohydrates, particularly legumes like peas, garbanzo beans things of that nature where we think, again this is speculation we don’t know for sure because the clinical trials aren’t proven yet but what happens is, there is an amino acid called taurine in the food and in the body of dogs and what happens is, perhaps the precursors or building blocks to that taurine amino acid are not absorbed well, due to these alternative carbs. They’re interfering with the actual absorption, so then, the taurine levels in the dog aren’t as high as that amino acid is essential for heart muscle to function. So what we see is that the muscle of the heart, the left ventricle, is dilated and doesn’t squeeze well and in my experience, I’ve been doing cardiology 13 years in the last couple of years I can probably count on two hands, maybe 3 the amount of dogs where I was ?? diet was implicated and then where I had supplemented taurine and in half of the cases probably changed the diet some of us could change the diet due to allergies or other conditions and then watch the heart go from bad to good again and reverse so it can be, I think, a real component but again I can’t say for sure without the clinical trials and the verdict is still out in my opinion though I wouldn’t advise a grain-free diet unless necessary for other conditions in itself to supplement with an amino acid called, taurine.
Jyl- Actually, my next question it was uh, what are your thoughts and recommendations for diets for dogs? Do you have any specific that you like to follow?
Dr. Saelinger- So, I follow what are uh American college of veterinary internal medicine and specialty cardiology recommends to this point. So, again this is very researched and and the brands that we know that have not been implicated are what I call the old kinda corporate brands that have been around a long time. The Royal Canin, Eukenuba, Science Diet and Purina have been around forever and none of them have been implicated in this disease process. That being said, you know, there is probably fillers in there, whether or not they lead to other disease processes, cancer, etc. nobody knows. Um, but I feel they are safe for the heart, and that’s currently what our college recommends, as do I. Another more kinda local brand that is now more widely available is a diet called, Just food for Dogs, where there diet is formulated by veterinary nutritionists and it kinda looks like whole food for dogs like fresh human cooked foods that we could eat but it’s sound for dogs to eat as well so I also recommend that based on the region where I practice.
Jyl- Do you recommend any raw diets?
Dr. Saelinger- I don’t. I used to do a lot of emergency when I was a resident and have seen, unfortunately, e-coli toxicity from that, so I don’t.
Jyl- Okay. So are there any advancements from stem cell research for artificial valves.
Dr. Saelinger- To be honest with you, not that I am currently aware of, I know that they’ve done some research with DCM(Canine Dilated Cardiomyopathy) in dogs but to my knowledge right now, I don’t think there is anything that made progress in that department. I think really in terms of the valve issue that we speak of when it’s, when there is congestive heart failure, with medications dogs typically live a year to a year and a half, two years. I’ve had some dogs live 5/6 years; it just depends. There is however a surgical procedure where the valve is repaired, not replaced, in London, France and Japan, where they have in London and Japan a 90-92 % success rate and I’ve actually watched the surgery with the London team and I’ve had several cases in both locations with great success. Where those underwent, open heart surgery, cardiopulmonary bypass, that’s a big deal. And their teams are very well trained and very good at what they do and those dogs have all come back to the Los Angeles area and lived much longer than the couple of years that we typically see with congestive heart failure.
Jyl- Wow, that’s incredible.
Jyl- A Favor for Freddie was founded because we wanted to carry on the legacy of Freddie who had passed away from pulmonary hypertension. Can you talk a little bit about pulmonary hypertension?
Dr. Saelinger- Sure, so pulmonary hypertension is a disease process defined by high pressure in the vessels of the lungs. It’s not as common as degenerative valve disease, which we spoke quite a bit about, but it is fairly common. Meaning in my practice here in Los Angeles area, I see several cases a week. I mean I can count on one hand where I see much more the primary valve degeneration, but it is common and it is significant because the high pressures in the vessels of the lungs can cause the right heart to get large because it’s dealing with a higher pressure, so again if you put your thumb over a garden hose, you feel the pressure build up behind it and the higher the pressure is the more workload the heart has to do and it will become thicker and dilated because of that um which eventually sometimes can result in right side congestive heart failure. Commonly manifested as fluid in the belly, sometimes fluid around the lungs and just like you spoke about earlier, more rare, fluid around the heart. Um This disease process is a bit unpredictable unlike degenerative valve disease, there are dogs that will go on to do extremely well with medication and other ones who aren’t nearly as responsive. Most of them though have common clinical signs such as difficulty breathing, exercise intolerance, and sometimes fainting.
Jyl- Ya, that’s what Freddie was, um so are those the basic signs of this disease? Is that how you can test er, you can tell what it is?
Dr. Saelinger- Ya, so what will often come in is a pet will have trouble breathing or they’re fainting. That’s the most common reason we will see them and on x-rays the heart may or may not look enlarged, there may be abnormalities in the lungs themselves that isn’t from the common left heart failure that we see with valve disease but rather from pulmonary infiltrates from the high pressure, the vessels in the lungs. Meeting, you know, protein rich foods into the lungs that way or from sometimes clots. So pulmonary hypertension has several causes, we eliminate, you know, causes with a further workup but one of the more common causes is when the body has blood that’s sticky where the blood is getting stuck together forming clots these clots then travel in the vessels of the lungs and obstruct that, then cause the high pressure.
Jyl- Do you know any causes of this disease or is it just a wide range of it?
Dr. Saelinger- So, there are common causes, so whenever I see a patient with pulmonary hypertension, in addition to trying to get them treated and comfortable and taking medications, we say well what caused it? Cause what if we could treat the primary cause and make things better overall, so that’s just a really good question. So the common causes of pulmonary hypertension are they get high pressures passively when they have the common left heart valve problem, that’s usually a pretty easy fix because if we improve the left heart function, lower the pressure in the right side it will get better. Another major cause as I spoke a little bit about earlier is, clots. So again when the blood gets sticky if these clots then lodge in the vessels of the lungs, they cause high pressure there, so if we think there’s clots by running blood tests to say oh, okay, the blood is sticky. Well then what causes blood to get sticky? So, it leaves the data, a puzzle that you have to keep figuring out. Common causes of hyper coagulability or clot formation in pets include protein losing kidney disease, endocrine diseases such as Cushing’s where the body makes too many steroids, uh diabetes, things of that nature, so we go ahead and rule those things out with common blood tests and then unfortunately a less treatable option is something like cancer so cancer can mess everything up cause ?? inflammation that can cause clots and that becomes a little harder to treat. And then finally another common cause of pulmonary hypertension is having lung disease. So as I told you earlier, I love Pekingese but they are dogs that has an airways that are not so normal so they can have upper airway issues where, you know, kind of their smooshed face they don’t have the same passage of air as say a Labrador would and they can also have lower airway disease so the lower airways just aren’t as compliant, they collapse they get inflammation and that can ?? to high pressure in the lungs so a lot of small breed dogs not even if they’re smooshed face or not can also have lower airway disease which then causes secondary high pressure since the blood in the vessels of the lungs is trying to get to lungs that aren’t so normal anymore and that causes it. Then finally we say it’s idiopathic, we’ve done the full work-up looking at you know blood tests for clots, looking at the lungs and we didn’t find anything and in that sense we just still medicate but we don’t know the actual cause.
Jyl- Ya that’s that is what basically Freddie’s came down to and they couldn’t… you know they couldn’t…put him under to do more testing because he wasn’t stable enough to do that, is, have you come across that and were you able to find any underlying cause when that’s the case?
Dr. Saelinger- That’s a good question, I’m sorry you were faced with that situation, that’s a really tough one because you are right. There are some dogs that are just too unstable and, you know, doing testing can cause harm and that’s not what we want, we always have to look out for that pets best interest so…pulmonary hypertension, sometimes they can go under anesthesia and the oxygen that you give helps them but then they are very unstable when you wake them up and that’s why it is so risky so, in those cases where anesthesia is too risky, we run blood tests where we can say are there clots, um we say is there signs of endocrine diseases or kidney disease that can cause pulmonary hypertension another big one which I didn’t mention is heartworm disease it’s not as prevalent in southern California but there are many regions where heartworm disease is quite prevalent and is a cause of pulmonary hypertension, so there’s blood tests for that. Then finally abdominal ultrasound, it’s kind of like of a hunch for abnormal things and they’re more malicious things ?? cancer you know are there tumors present in the belly, what do the kidneys look like, what does the liver look like and that test itself because most often you have to place a dog on its back to look at those organs in detail can be difficult if there is respiratory compromise so again you can’t always do a full ultrasound even though it doesn’t require it, it just puts the pet in an uncomfortable position, it just depends.
Jyl- Janelle, what tests were they able to do on Freddie?
Janelle- It was just basically x-rays and bloodwork and echo.
Jyl- And nothing was found right?
Janelle- Pretty much, well the echo showed all the problems that he had and blood work, he was seen by an internist too in regards to his lungs, there was really nothing the internist found that was causing all the problems that he had. That’s why I was referred to the internist and the internist really couldn’t find anything on Freddie.
Dr. Saelinger- And that’s common, I would say I’m sorry you were in that situation, but you’re not alone. I would say 50% of the time, whether I can do the extensive workup with or without anesthesia doing all those blood tests and imaging, I often find nothing and given that Freddie was a Pekingese, my default would be, it’s probably airway disease it’s just the way they’re designed(?) it’s nothing you could have prevented or would have you know would have changed what you’d done in that moment.
Jyl- Is something like that uh…cause it just happens so quickly is it something that grows or is it something that just, one day you have it and that’s it.
Dr. Saelinger- That’s another great question, so it can be very acute so, I have seen patients develop pulmonary hypertension overnight because they’re hospitalized for left heart disease or other situations where I see a normal right heart and normal right heart pressure and then the next day everything changed. Very abnormal right heart, very high pressure, get treatment which is ? given Sildenafil and then the next day their heart looks like it never even happened. So, it is a dynamic process which is often more acute than the valve chronic disease process so it doesn’t always show up over a long period of time, it can but it’s variable.
Jyl- Oh, someone had a question about that uh, can pulmonary hypertension be caused by mesotheliomea, mesothelioma.
Dr. Saelinger- Sure, that’s an uncommon cancer and it’s often a cancer that we diagnose, unfortunately when a patient is deceased because it’s hard to get cell samples of that tumor because it doesn’t exfoliate well, meaning if you take a sample of the lungs, stick it with a needle, move it around the chest and you take that out that kind of cancer doesn’t shed it’s cells so well and when it does it’s kind of non-distinct so you can’t always diagnose it under a microscope, easily. Often you need a tru cut biopsy to do so and that’s hard to get in situations, it’s an invasive procedure sometimes to do. But I say it is a possible cause, it’s just not one we commonly see but it’s ??
Jyl- Janelle, did you have any further questions for Dr. Saelinger?
Janelle- Can you tell us about monitoring respiratory rates and how to do it and is it something that should be done on dogs with heart problems.
Dr. Saelinger- Oh that’s a great, useful question, so in terms of monitoring respiratory rates…any dog with murmur, it would be wonderful for owners at home to watch respiratory rates, so here’s the key. If you’re watching the respiratory rates you don’t want to do it all day. If they’re running around, nobody cares about it, what you want to do is you want to get it when they are in a deep, sound sleep. Meaning you can walk by them; they don’t know that you’re there. That’s when you should look at them and their breathing should be so slow that you’re having a hard time even seeing if they’re breathing, you’re like oh my god, there’s almost this brief reflex like, OH is my pet alive? That’s actually a good thing. Even though it startles me, like right now I have younger dogs, but I used to have older dogs, I would come home and be like, Dora, wake up! I almost want to shake her, but that’s actually a good thing because when dogs sleep, when cats sleep, when we sleep, our body will always conserve energy even if you don’t want to, it will conserve energy and you will breathe at the slowest rate possible. Now, if there’s a problem, if it’s pulmonary hypertension or left sided congestive heart failure, fluid in the lungs. Your body will then know that’s it not getting enough oxygen and the brain will signal the body to breathe faster so if there is a problem, the breathing could become fast and labored. So what we, I usually tell people to do is actually if you walk in and it literally looks like a dead dog sleeping you’re fine, that’s actually a great thing but if you see that their respiratory rate, consistently is greater than 30 breaths per minute while sound asleep that could indicate that there is a problem. Now that being said, if their breathing looks fast and then later, an hour later I would say check it again don’t march to the emergency room because I wouldn’t want you to have to go there when you don’t have to go there. But if it looks fast and then later it’s slow, it cancels out what you saw prior, don’t be worried about it. Because sometimes dogs will dream or they can sense you’re in the room, they have one eye open, they’re looking at you. You really can only assess it when they’re in a deep, sound sleep state. And if they can’t get into a deep, sound sleep state, that is an urgent problem where they will need to be seen.
Jyl- Is there anything we should be doing to protect our dog’s hearts?
Dr. Saelinger- Ya, I think seeing your regular vet once a year is always helpful because they do a good physical and 9 out of 10 times when a dog has heart problems, we’re going to hear it, we’re going to hear a heart murmur so that always helps, going once a year and getting full lab work done when they’re in their mid to old range just to make sure organ function is good, that’s a really nice preventative measure that any vet can do which is really, really helpful. Pulmonary hypertension doesn’t always result in murmurs, so they can for sure, but I would say maybe 50 percent of the time it might not so that can be a little more challenging. But in that sense, if there was significant pulmonary hypertension, most likely it would lead to problems like there is trouble breathing, fainting, exercise intolerance, which you probably would go to your vet at that point. I think doing your yearly eval when things are good, is important and then when you recognize problems than seeing your vet at that point, there is a lot of things that can be done, in that scenario. And then my other advice would be, let’s say your dog has heart disease like pulmonary hypertension, I think you do what you can do, you give the medications, you can know what averages are and you do the best you can. But I’m a big believer in life, that what you think about is what happens and you don’t want to be worried unless you have to and I always tell my clients, I usually know when to be worried, when things aren’t looking so well, I’m going to let them know that in the interim, be like the dog, live in the moment, enjoy every moment because you never know what can happen to your pet and some dogs do way better than the average so averages exist for a reason, that doesn’t mean your dog can’t do better. So, you can always be hope for what you want to happen. Not about what you’re worried about.
Jyl- That’s beautiful advice, thank you.
Jyl- And now for my kindness questions. Do you include kindness in your daily routine and how?
Dr. Saelinger- So when I’m seeing patients, I always, I’m a big believer...you treat others as you want to be treated and you put yourself in their shoes. So, I like to get really connected to my patients, but also their pet parents and know what’s going on with them and try to be mindful of their situation so I can be as helpful for them and honestly, I always try do at the end of the day, did I do the right thing today, did I treat someone how I want to be treated because veterinary medicine you know there’s lots of things to be done and not always all tests are indicators so I like to treat every owner with their pet as if it were my own, what would I do in a ?? because at the end of the day if there were extra tests that you didn’t need to do it’s extra stress for the pet and extra expenses for the owners. So, I always try to be mindful of that situation.
Jyl- If you could do one kind thing for any one person in the world, who would it be and what would it be?
Dr. Saelinger- Hmmm, I would say, it would be two people. It would be my mom and dad because they are just absolutely delightful. I live in California, my brother and his wife and his children live in Oregon. So, if I could, I would move them on the west coast so they could see their family here.
Jyl- Awww, that’s sweet.
Jyl- Thank you so much, Dr. Saelinger.
Janelle- Thank you so much and a lot of people are going to listen to this and be very appreciative of the information that you’ve given us.
Dr. Saelinger- Awww, my pleasure, it’s lovely to help dogs in any way possible, so I’m happy to help and if you guys, have questions in the future don’t hesitate to reach out to me.
Jyl- Awww thank you so much. Alright, you take care and thank you for stopping in the middle of your bike ride we appreciate you.
· Dr. Saelinger-You’re quite welcome, you ladies have a lovely day.
· Janelle- Just real quick…
· Jyl- I’m sorry, Janelle?
· Dr. Saelinger- Sure.
Janelle- Nigel is your Frenchie?
Dr. Saelinger- Yes! Janelle- Adorable. Dr. Saelinger- Ya, so I have 3 Frenchies that I’ve selected, so I used to always get English Bulldogs. I get all these rescue dogs. There’s a rescue in Los Angeles called Road Dogs that specializes with these dogs so, for years and years I collected English Bulldogs than I either downgraded or upgraded, I’m not sure yet to French Bulldogs but I realized, is they’re collectibles. So, I had two for a while Nigel and then Flakey and then just more recently I got another one called French Toast so, it escalated. Now there’s three of them. But they’re so much love? Fun?
Janelle- Very awesome. Thank you again, very much.
Jyl- Thank you Carley.
Dr. Saelinger- Oh you’re quite welcome
Jyl- Take care.
Dr. Saelinger- All right take care now.
Janelle- You too.
Jyl- K, bye.
Janelle- Bye bye.
Jyl- A Favor for Freddie is produced by me, Jyl. Music written and performed by Alex Guzman with additional lyrics by Jamie Chanel Guzman. Please subscribe, like and review us on Apple podcasts, Spotify, Stitcher or any of your favorite podcast platforms. Also, please follow us on Facebook, Instagram and Twitter. Until next week and Freddie, until forever.