Neonatal Knowledge with Dr. Michelle Kutzler

Join us for a discussion about practical assessments and interventions for newborn small ruminants with Dr. Michelle Kutzler of Oregon State University.  

In this episode we review Apgar scoring as an assessment tool for newborn lambs and their need for intervention after birth as well as a technique for assisting lambs that struggle with the transition of birth called the Madigan Squeeze. This technique was popularized in horses but has also been used in cattle.

Developing a modified Apgar scoring system for newborn lambs:
https://pubmed.ncbi.nlm.nih.gov/32827990/

Resuscitation compression for newborn sheep:
https://pubmed.ncbi.nlm.nih.gov/33358064/

Dr. Kutzler's work is funded, in part, by the Oregon Sheep Commission:
https://oregonsheepcommission.com/

Learn more about Dr. Michelle Kutzler and her work:
https://anrs.oregonstate.edu/users/michelle-kutzler

If your company or organization would like to sponsor an episode or if you have questions about today's show, email Office@AASRP.org

Transcript

0:39

Hello, and welcome back to Baws and Bleats. Today we are talking to Dr. Michelle Kutzler, who is a professor at Oregon State University. Dr. Kutzler and I have sat on the board of directors for the AASRP together for the last few years, and she is currently the treasurer of our organization. It's great to see you, Dr. Kutzler. Thanks for chatting with us. Oh, thank you so much, Sarah. It's been my pleasure. I, I have been, Waiting an opportunity to, to speak on your podcast. I feel like I'm one of precious few people who've had the honor. Well, I don't know about that, but it worked out really well, actually. So I always love hearing everybody's history, kind of like where you, where you went to school, how you got here. Just kind of give us a little background about yourself before we jump into the papers. For sure. So I'm originally from Washington state. So I grew up on a hobby farm in West Seattle Washington and went to veterinary school at Washington State University. We didn't have any small ruminants growing up. But Since I, I became a veterinarian. I have had lots of came lids and still have llamas and alpacas now, and have served on a number of national organizations for llamas and alpacas over the years. So again, not necessarily associated with our topic of today, but I have been a long time a small room minute. Owner at least for over 20 years. Awesome. Awesome. And so Dr. Cutler teaches and does research primarily in the field of theriogenology, which is the fancy word of saying reproduction. But also does a fair amount of advising both undergrads and graduates. So you have your own animals, but you do a lot at Oregon State with animals but you don't not work in a vet school, correct? It's Right. So I work in the I, when I started at Oregon State, I worked in the College of Veterinary Medicine. I worked there for eight years and I've been in the College of Agricultural Sciences since 2010. And I teach predominantly reproduction classes an equine reproduction class, calving school. I teach the reproduction sections of our sheep and goat production class and our beef production class and a companion animal production class. And, you know, you're getting the idea that there's a common theme here with reproduction. Nice. Yep. So I, I mean, I grew up on the west side of the mountains where there's no veterinary school, but but my, my heart was always to become a veterinarian. So I lived in Pullman for seven years while I was in veterinary school in undergrad. Nice. Awesome. All right, so let's jump in today. We're actually going to be talking about two different papers that Dr. Kutzler was involved with and published. The first one was published in 2020 and it's entitled developing a modified Apgar score system for newborn lambs. The second paper was published in 2021 and it is titled resuscitation compression for newborn sheep. I'm going to try not to jump between the two papers, even though I know I'm going to want to and just do one at a time. So can you give us a little bit of background? We were kind of talking about this before we started recording, but kind of how these papers came about and like, what was your your ideas that kind of first got you going. And I know you were working with a graduate student on this at the time. So you want to just give us a little background? Yeah, absolutely. So the, the, I would say brainchild of this project is actually Dr. Tasman Flores. She's now a practicing veterinarian in Oregon. But she came to me with a question about using The Madigan squeeze technique on lambs. So the, and here we are jumping between papers, like we said, we weren't going to. But this is a, a method of and inducing a, a sleep like state in a newborn animal to overcome some of the neurohormone suppression that happens and, and increase their, their viability afterwards. So, so Dr. Flora was very interested in this topic and since it hadn't been done in sheep I was supportive and I, and I would be remiss if I didn't make a shout out to the Oregon Sheep Commission because nobody can do any research, no matter how big or small without some funding. And the Oregon Sheep Commission is the one who provided us with the funding for this. And also our, our co author on the paper Mary Smallman, she was the the sheet manager at the time. And, and you know, there was a lot of samples that have to be collected data points in the middle of the night when lambs are being born. And so we couldn't have done that without her help too, but getting back to kind of the project. So in order for us to test this, this, this method to see if this method would work in, in sheep we needed to first establish some, some normals. And that led us to our, our first paper is developing a modified APGAR score for lambs. And I I am going to guess that most of the audience has heard of APGAR scoring before. APGAR is an acronym. It stands for Appearance, Pulse, Grimace. Attitude and respiration. And those terms make a lot of sense when you think about it used for humans. But we had to modify like the grimace response, you know, for animals so that it fits in. Fun fact the, we use the APGAR as kind of an acronym, but APGAR was actually named from Virginia APGAR, who was a, a human. OB GYN nurse and wanted to, again, measure some of these viability parameters in newborn humans and so we think of it as being an acronym for APGAR, but it actually came from her last name, APGAR. That was so fascinating. It actually says she's a human OB anesthesiologist. Oh, there you go. Sorry. Thank you. Thank you for correcting me. But, yeah, that was fascinating to know. I mean, there, I mean, I'm sure maybe if you haven't had a baby or you're not a grandma or an aunt, you may not have heard of Afgar. I hadn't heard of it till I had kids. But yeah, so it's kind of, for those of you who aren't familiar, like the second a baby is born, they get an Afgar score. They look at like Michelle, Dr. Ketzer said, appearance, pulse, grimace, attitude. Attitude and respiration, and baby, like my, my daughter was born with a very bad APGAR score, but then they keep doing it every few minutes, and I mean, she was fine, hers came up quickly, but it's a way to like instantly kind of tell if, if these babies need more help. Which would be awesome for our animal species. And, and what they've, they've shown. So this, this of course holds true with, with humans, but in other species where Apgar scoring has been done, so horses, cows swine and dogs they found that low Apgar scores are highly correlated with higher neonatal mortality. And so as a veterinarian, you know, anything that we can do to prevent mortality, we're all for. And, and, and for our clients, anything they can do to prevent mortality, they're all for too. Now Often, we as veterinarians maybe aren't there when the offspring are born, or maybe our producers aren't even there when they're born. So being able to do that initial assessment might not be possible, but one of the things that we, and I feel like I'm jumping around, but one of the things that we did with our test is we looked at it. at within five minutes of birth. So that's kind of similar to what they do with people. And then we did it at 15 minutes, which like with people, they usually do it, like you said, every, about every five minutes until they have a, like a normal score. But then we also did it at one hour because we're like, well, what's more realistic, you know, if, if, if, if. You're going to be there every five minutes looking for lamb Apgar scores. And we found that there was no difference in Apgar score between, like those significant difference between those time points. So you can still get really meaningful. So that, that lamb that has a bad Apgar score at 60 minutes, it, You had a bad APGAR score at birth, but also the mama had a good APGAR score at 60 minutes. They had a good APGAR score at birth as well. I feel like a baby that's born and looks horrible and then the mom licks it and stimulates it. Like that should up their Apgar score, but you're saying, no, they're pretty similar. Well, so all of our lambs were, were kept with their mom. So they once we knew they were lambing, we, we kind of isolated them into a a pen, but we have these, and I'm sure a lot of producers have these too, but these kind of like a temporary wood fences. They're kind of like they're on a hinge and they're, you know, so that you can make them into an owl or. And then that way, if the ewe is, you know, laying in one area, we could just kind of like move this fence around her and we don't have to move her at all. She's still in like her safe environment but we can keep, you know, her and her lambs in an area where some other ewe is not going to try to get in there and like, you know, take a lamb or, or you just get up, get up all up in her business. And, and so the lambs that. All, all of the lambs were cared for by their mothers in exactly the same way as what I'm trying to say. So there wasn't any, we didn't try to deprive any like maternal stimulation or, or increase any sort of maternal stimulation either. Okay. Okay. And I feel like as I was reading this, I was kind of like, you know, so say as a vet, you're there helping assisting in birth. You know, we all kind of do this in the back of our mind, right? You're like, Oh, take a piece of straw and stimulate the respiration. That one's not breathing enough. You know, I put your hand on the chest. How's the heart rate? You know, I feel like we kind of yeah. probably do this sort of in our minds, but I think having numbers next to anything is always super important, right? Like knowing exactly like where a pulse is, where a respiration is. I mean, it's just, you know, better for the whole situation, even though I'm like, I kind of do that. I have a feeling for that. So, so you mentioned like using a straw in the nostril to kind of stimulate a respiration. So that was one of the modifications that we did for the Grimace response. And so in, you know, for, and I should probably take a step back, you know, regardless of the Apgar scoring method of the species is used there are three essentially, like categories under each of the criteria, and the categories are either 0, 1, or 2 points, and since there are 5 criteria there's the highest APGAR score is a 10, and a Of course, the lowest half bar score would be zero. But, but lambs that didn't have you know, any response at all to a straw up the nose. And I, I'm sure if you've delivered enough lambs, you've probably seen some that, that don't, you know, they're just kind of hanging there with their tongue and fluid running out of their mouth and, and don't do anything. And then some that just maybe you know, barely shook their head, but then didn't like try to sneeze or, you know, do anything else, then that would have been a score of one. So, so we, we came up with these parameters by observing lots of lambs ahead of time. And then once we set the criteria, then that's how we did the scoring after that. Okay. So just give us a little brief kind of what you looked at to score each thing. So like and in the table, one of the paper, when you guys read it, you'll see this. But if you just want to kind of give us a brief little for appearance, we were looking at this kind of Yeah, exactly. So, so appearance, we're using mucus membrane color and, and so, I mean, we, we, we typically use gums and of course it's a little bit, you know, if you've got a, you know, dark faced animal sometimes their gums, you know, kind of look a little bit more muddy. So you have to know what, what, you know, normal, like, appearance would look like. But we, you know, pink would be a score of two. That's what you desire. And if it's like really muddy or what we call here cyanotic, then that would have been a score of, of zero. And then somewhere between that pink and cyanotic what we call just pale would have been a score of one. For P that's actually pulse. So we just measured pulse. And again, we had to determine what what we were going to call normal, because there is a pretty wide variation in the literature, what a normal pulse is for a newborn lamb. And so again, we just took data from our own animals to make a normal range and we determined that if it was less than a hundred that that was going to be a score of zero. And of course, you know, we had some that were much lower than a hundred and if it was greater than 175, then that was going to be a score of two and then between 100 and 175, that's a score of one. I already mentioned grimace, that was the straw on the nose. Attitude this is response to croup or low, you know, loin stimulation. So this would again be like the mother, you know, nuzzling the, the back or, or, or pawing the back or doing something to stimulate the lamb to, you know, rise or move. And if there was no response, they got zero. If they, if they try to stand that was two, but if they just kind of, you know, made a a, not a great effort, then that was a score of one. And the last one, R is resp, is respiration. And and some abgar scores, they actually measure the number of breaths per minute, but in our setting we used a pulse oximeter right on the lamb's ear in order to get a idea of what the oxygen saturation was. We felt that that was a, a more reliable way to measure respiration. And so for lambs with a oxygen saturation of less than 45%, that was zero. That's obviously pretty desaturated. And then if it was over 65%, then we call that two, and then between 45 and 65 is zero. Is a one. And I know I'm just jumping forward between papers and you said we weren't gonna do that, but when we did the neonatal compression test we, we weren't looking necessarily for lambs that had Apgar scores of 10 or even eight. We used three and a half as a. And there were a lot of lambs that had an APGAR score of less than 3. 5. So it, it seems like, you know, oh, they're all should be 10s or 8s or something, but, but, That that's not what we found and and using these criteria. Interesting. Yeah, I found that interesting. I just wanna back up just a little bit. So they literally use those, those oxygen saturation things that like people use in the hospital, the finger ones that you just pinch that now when you take your kids to the doctor that they put on them and old people and everywhere. So those are super easy to come by as, you know, field veterinarian, something like that is super exciting for me as one more tool that I can add to my tool chest to help monitor not even just lambs, like animals in respiratory distress, just in general. I mean, I don't know what I'd do if it was low. I sound like I carry oxygen, but it would be good to know. You can use it as a response to treatment though. I mean, and that's, you know, what we're, what we're looking at is if they had a. you know, low oxygen saturation. How are they responding now to our resuscitation efforts? Right, right, right. So all right. So what else, what else is in this paper? I mean, it's just, it's just a lot of talking about that and like realizing that, you know, maybe a lot of our lambs need help, you know, a lot more than we think, and maybe we could save a lot more than we normally do. Do you. I assume all these moms and everything like have good nutrition, you know, had a good, you know, like they are like normal, healthy, not parasitized. I mean, we do our best, I think, to find a flock of sheep that has no parasites is a, is a unicorn. But you know, definitely, you know, we keep our especially our late gestation ewes in the barn actually during the winter because it's, it's quite wet in western Oregon and there's a greater risk that they can get infected. You know, succumb to some other problems being you know, out in the mud all the time, but then of course there's trade offs because if they're in the barn, then, you know, there's perhaps the increased risk for, you know, parasitism because they, you know, they're you're all in the barn. But so, but they were all of the ewes they were all polype ewes and they were all, you know, managed the same way. This all took place over one season. So this wasn't a, like a combination of. You know, multiple years of, of data at all. Do you have any, and I know this is an out of the blue question, do you have any idea for this flock what their normal percent of loss is? So our, our, I don't remember off the top of my head. I know that we did look it up. But we actually have a very low loss rate. I think we're currently doing a pregnancy toxemia study right now. And last year out of over a hundred years that we had lamb, we only had You know, one you that actually was down with pregnancy toxemia. So we're, you're part of it. The benefit is that it's, you know, teaching institutions. So we have a lot of student labor that can catch animals, you know, quickly. And and, you know, we keep our, our, our late, later gestation animals indoors. So we, you know, have eyeballs on them a better But our, our, you know, we have, we have hot boxes for, you know, any lambs that are, that are cold and lots of frozen colostrum. So we, we, we really rarely lose lambs cause we get really aggressive and, you know, keeping them, keeping them alive. Okay. Okay. Just curious, you know, because there are some flocks that like probably, you know, A large portion of them have bad at first, right? Well, and here in the Willamette Valley the grassy capital of the world, I should say there are a lot of sheep that run on, on grassy pastures and are lambing you know outside during the winter, you know, when it's raining horizontally for days on end and the lambs, you know, they survive, okay, so what else before we move on to the really fun paper? Okay. Should we take away from this one? Yeah, so I had, I had mentioned before that, that when we Looked at. the APGAR scores over time, that when we compared singletons at those three time points, five minutes, 15 minutes and an hour and, and twins, there was no difference. We did see a slight improvement in APGAR scores in, in triplets. And, you know, one could, could argue that that last lamb being born, you know, may have more hypoxemia because of its place in the birth order. But we, we compared the length of delivery and we did that for twins and triplets and then twins and triplets combined, where the average, like, You know, length between lambs for twins was about 26 minutes. I'm reading here the paper and, and, you know, 15 minutes for triplets. I found that there was no effect on delivery interval. So, I mean, the idea that, you know, maybe they have you know, longer, interval and that was causing it. So that didn't, that was, did not make an effect. There was also no significant difference between birth order, at least with respect to twin lambs. So first and second. But one of the things that was of interest is that there was an effect of sex. And so even though there wasn't a difference in birth order, birth weight. So birth weight itself didn't correlate with Apgar score. For females they tended to have a higher attitude. All right. That's the, that's the rump stimulation compared to other compared to males or compared to the other categories. So, so there was an effect or a difference that we saw with females. And we also saw that, that. females in, I mean, in our group of animals had a tendency to stand faster than males. And, and that's kind of interesting too, because I don't think that we pay a lot of attention to that. If they're all market lambs, it doesn't really matter if they're, you know ram lamb or you lamb. But you know, if you might want to not discount those little ram lambs, if they're not standing up right away, they might need some intervention. Cause it, you know, there could be a problem. All right. Those are very interesting. Were any of them assisted births? Yeah. So that, that included the ones that were assisted. And I, I can't remember how many that there were, but there really weren't that many that, that that had that other than just, you know, like gentle guidance, it wasn't a dystocia that required a veterinary and we didn't include any animals like that. Okay. Okay. Good to know. I just wanted like one like kind of concluding thing about APGAR scoring is that if you, if you don't measure it, we won't know, right? That's the thing. So, and, and it's really easy to train your, producers, you know, how to do this APGAR scoring. And if they find that the lamb has a low APGAR score then, then, you know, hopefully they can like put that little piece of information away and, and provide, you know, maybe additional colostrum to that one or additional, like you know, warmth, you know, some additional support to keep that lamb from dying, because again, there's a strong correlation with low outpour scores and neonatal mortality. So rather than just coming back and finding that, you know, one of the three lambs dead and say, well, you know, what was I going to do with that third lamb anyway? You know, you can so you could keep that lamb alive and then have to figure out what you're going to do with that third lamb. Right. She worked hard to grow that baby. All right. Well, that, that, yeah, I love that paper. I, I think it's very applicable, which is what we're going for here. Okay, so we're gonna move on to the second paper. So many of you in the vet community will have heard about What's called the Madigan squeeze which is named after the veterinarian that kind of invented it. I know I see it I was telling Michelle mentioned all over the vet to vet groups talking about it primarily in foals and calves. So it was very fascinated. I guess I hadn't even crossed my mind to apply it to small ruminants. And now that I will be Avgar scoring every baby that I see I will be, I'll have my little rope ready. And so the AVGAR score was like, because you wanted to do this, but you needed a way to measure so that, that makes sense. So I think you've already given us a good background of kind of how this came about. So let's just kind of jump into the materials and methods and And you know, how this went and yeah, it's a really fascinating paper. So go ahead. Sure. So I know that we probably messed some people up when we called it resuscitation compression because I think a lot of people know it as a Matican squeeze or a neonatal squeeze. But those terms are really I didn't feel, particularly helpful. And you know, what we, what we were looking for was a way to you know, resuscitate these low Apgar limp lambs, and we were doing it by compression. So that's why we, we are trying to coin this term resuscitation compression instead of like the, you know, the Madigan squeeze, but it is essentially the same term. the same thing. And I don't know whether it's necessary to, to take a step back, but what happens when the animal is squeezed particularly around their thorax is it induces a release of excitatory neurohormones. So during the in utero period, neurohormones are Suppressed so that the fetus isn't moving around so much. I mean, of course, if you were to do an ultrasound, you'd probably see the fetus move, but, but you don't want it to be kicking and flailing, especially during the delivery process. You want it to remain as motionless as, as possible. And, and that squeezing that's happening. In the uterine body vagina as the animal is being born. That is essentially what we're mimicking, that thoracic squeeze with these, with these ropes. And, and again, this, this method of neonatal resuscitation compression was first you know, very well demonstrated in foals. And you know, we, we. We kind of, you know, collectively call these dummy foals because they are typically non responsive. They don't, they have, don't have a suckle reflex. They may not be able to walk around. They may just stand with a sawhorse stance, staring at the wall as though they're, they're blind. And if they have the squeeze technique done, then they now completely wake up and are moving around without any impairment and finding the udder and nursing. So it's just incredible if you have an opportunity to watch one of these YouTube videos with foals because it, it, it's, it's so. effective, you just don't believe your eyes that this could actually be happening. Well, this technique has been done before in cattle as well. And so we thought, well why not in sheep? And again, like I said, the brain, the real brains behind this was Dr. Tasman Flora, who just graduated from Oregon State University Veterinary School this year in 2024. So In this project, we had three main groups. We had the control group, which we didn't do anything with. So we, I mean, we still, like, measure the APGAR score, and we recorded the time to stand and the time to suckle, but we didn't apply any sort of compressions or touch by us at all. That was our, our control group. We had a placebo group, where we put the ropes on, but we did not tighten the ropes. So that way they still had the ropes on them, if it was just some sort of like just a pressure point thing that would have worked out in the, the, Like the placebo group and then for the actual treatment group, we applied the ropes and then we we had a little weight that you can determine how much pressure or force you're putting on. So we identified that about one pound of pressure applied to the ropes was sufficient. I mean, we obviously don't want to break the ribs, you know, crush their chest at all. They still have to breathe while this is happening. But we wanted it to be of a sufficient force to, to essentially induce sleep. And, and that's exactly what happened. So in one of the videos, you can see the lamb is standing we apply the ropes and, and then start, you know, pulling back on the rope to apply some pressure, some, some force, and the lamb just crumbles, like it just like falls asleep. And we maintained that hold for five minutes. Now, someone said, why five minutes? You know, why not one minute or 10 minutes? So that was, that was a little bit arbitrary, but again. wanting to be long enough that if we were going to see an effect that should be there. And then at the end of five minutes, we took off the ropes and usually the lamb was already starting to wake up and trying to run away as the tension was coming off the ropes. But if they were still laying down, we would just scratch their wool over their rump and then they would jump up and In these three different, like, groups, we had lambs that had normal APGAR scores. Again, we set kind of a low APGAR score threshold as being less than 3. So, so over 3. 5, and then, and then in that, if you call them the normal LAMs, those are LAMs that, that stood and nursed without any sort of delay. We had another group where they had a normal APGAR score, so greater than 3. 5, but had a delay in standing and nursing. So they hadn't nursed yet. And again, I think this is, you know, maybe a lot of, I guess Problems that, that people might run into, that the lamb is born, everything seems fine, but it just doesn't wanna stand in nurse or, or, or you can hold it up but it won't suckle or, you know, so these are some of the problems. And then our last group was those that had a low Apgar score, less than 3.5, and also, you know, had a delay in standing in nursing. And, and the real exciting thing that we found is that for the animals. that were normal to start off with. So it had an APGAR score that was normal, stood and nursed just fine. There was no adverse effects of the treatment at all on them. So it didn't, it didn't impair their ability to continue to thrive interfere with the bond with you at all for the ones that had a delay in standing and suckling with a normal APGAR score or those that had a delay in standing and suckling. a normal APGAR score we saw an increase in the time it took for them, or sorry a delay then say like that they stood and nursed faster. And really, the, the, you know, most exciting were those lambs that either couldn't stay standing on their own or couldn't couldn't stand and suckle on their own after the squeeze, they were able to stand and suckle on their own and and and that's, you know, that that that was huge. So again, you get back to these situations where you may be a you. lamb's out in the field and the lamb is, you know, dull well, this is another technique that you can use to help to help revive it in order to get it to start suckling on its own. So I just, for those of you who have never heard of this Madigan squeeze before, it sounds like voodoo and it feels like voodoo. But it is amazing. You can definitely look it up on YouTube, but I will. In the podcast notes, put the links to Michelle's videos that they made Dr. Kutzler's during the that are associated with this paper. So you can kind of watch how they, how they do it and how quickly they, they respond. I'd like to joke with my clients that we're making the animals Christians because they're being born again, because that's really like what it's like, like you are almost like redoing. their birthing process for them. So for those of you who have never heard of it, I know this sounds like out of the blue craziness, but it's definitely been circling around in the veterinary community for a while. I feel like people I talked to, a lot of the horse owners more about it than other species. Like, I think it's slowly trickling into the ruminant community. But multiple people that I've talked to non vets in the horse world had heard of it. So I think that's, that's super interesting, but if you haven't seen it watch a video, watch the one that's attached to this podcast. So sorry to interrupt you, Michelle. I just wanted to make sure that we are not insane. And, and the rope that we use, I mean, it was just a soft cotton like one inch diameter rope and it just needs to be long enough in order to do those two essentially half hitches over the Like the thoracic spine, that's where the compression kind of is, is, is cinched down. I think, I want to say ours was like seven or eight feet long, but it, you know, we bought it from just a local hardware store and it, it, you know, wrapped right, right up real easily into a Ziploc bag that we kept, you know, kept in the barn. So it was, you know, Really easy to, like, throw, you know, in on your, like, your lambing supply card or, you know, in your, in your truck if you have to and just to, just to mention that, you know, if you are using something like this for horses, you're going to need to scale down a little bit the size of the the rope for the lamb just because they're, they're more petite compared to a foal. Do you think you could use baling twine? You know, we actually thought of that because, you know, what does everybody always have around is, is baling twine. You need, because you have to, you know, apply this, like a, a substantial amount of pressure, I, I think that I would worry that the baling twine might, might, I don't know, cut in a little bit more rather than, than apply the compression that we were thinking of, but, but maybe you could take three pieces of baling twine and braid them together and get the same, you know, get the same thing, but I think a single piece of baling twine would, would not be as effective because of how it would kind of dig into the skin rather than, you know, stay on the top. Yeah, yeah, yeah. Yeah. Okay, what else? What was significant? Well, like, as I mentioned before, so after compression, you know, there was a reduction in the time to stand and, and to suckle and, and, you know, that's, of course, when it comes to, survivability. If they can't stand and suckle, then they're not going to survive or it's going to be really labor intensive for the, the owner. And and then I guess the other, you know, main thing was that let's say you're not sure whether this lamb needs to be squeezed or not. You know, you, you're not sure whether, you know, which one of the three of these lambs has already stood and nursed, we found that there is no adverse effects of applying this technique to normal lambs. So there's essentially no reason why not to do it if you have one that is slow to stand and suckle. And, and there's lots of reasons for, for doing this. Yeah, that's, that's a good, really good point. Yeah. Have you tried it on a camelid? Nope. I haven't tried it on a camelid yet. We you know, we don't have enough in my own farm to, to you know, have it be of, any sort of meaningful study and, and at our sheep center you know, all we have are geldings for, you know, for guards, so and, you know, someone. You know, could ask, well, what about, you know, adult animals? I mean you know, certainly, you know, when you use, you have pregnancy toxemia or something, there are some mentation problems too. You know, would this be something that you could actually use on, on older animals with impaired mental mentation to, you know, after you've like corrected their metabolic state, they still have some lingering mentation problems. So that's a, I think it's a great, a great question. I just. Don't know the answer to that. But, but again, I, there won't, wouldn't be any, any harm in trying if you were, if you were out on the farm and, And I think it's a lot more humane than, than trying to, you know, get into them with a, you know, a hot shot or something like that too. When you know, if they're having impairmentation you know, shocking them isn't going to make them any better. I mean, even, you know, before we started recording, we were talking about how just like pressure, like the weighted blankets and all of that. The human world's realizing how calming it could be, you know, you think of the dogs with the Thunder jackets now that are kind of a big thing, my thought would be, what if we're like asking a very stressful thing of our pet, of our small ruminants, you know, like you've never been to a show and you're sleeping at the show for the first night, you know, with some sort of little like. Weighted blankets, some sort of little compression thing, like help them be calmer and like happier, you know, and just, not go off feed and like all the things, like who knows, like I think we're just tipping, starting on the iceberg here. And, and, and for the lamb project, you know, of course, we want them to to fall asleep, but we also want them to wake up right away so that that way you can get busy. We want you to get up and we want you to start nursing. And so you can have a little, a little nappy poo to, to you shake off all of those residual neurohormones from delivery, but, but then we want you to get up. Right, right. And one of the places that we take advantage of those neurohormones is when we do things to young animals, like disbudding or, you know, stuff like that, that might be painful. So they're good also. But, yeah, I wonder if you could swaddle lambs or kids and take advantage of the somnolescence that you get. When you have to do a painful procedure like, you know, disc butting or tail docking or what have you, that's a great idea. Have to, have to do that one. I mean, you can even start with something simple, like giving a shot, you know, like something that's not as painful, but is painful. Maybe while they're asleep, they get their, their selenium injections or whatever. Yeah. At least out here, we do selenium injections. Yeah, oh no, we do in Oregon too, for sure. In fact Dr. Oldfield, who are, are one of our buildings is named after, is, we, we call him Mr. Selenium because he did a lot of the, the pioneering selenium research in livestock. Nice. Nice. Okay. Anything else like from this paper that that we're not, we're not getting or that you feel like we skimmed over? No, I, I think that that, that was it. Like I said, you know, I mean, that, you know, the biggest take home messages is just really that it's that this is perfectly, perfectly safe. And you know, if you, Misjudged, you know, who needed it and you, you, you did it to an animal that didn't need to, to have this done, there was no harm. And then of course, the, the fact that, you know, it, it, it does wake those animals up and then they stay awake and continue to search and nurse, which is, is really a you know, the main factor for, you know, survivability and these lambs. Yeah, awesome. Awesome. So as always in the podcast notes, I'll have where you can find these papers how you can ask Dr. Kutzler the million questions you're going to have after you listen to this podcast so, my final question that I always like to ask what do you see as the next big problem that researchers need to think about and address in the small ruminant world? Oh, that's a good one. So you know, we're right now we're doing a a vitamin D supplementation project and use and pregnant use in the Pacific Northwest we have Many, many gray days during the fall and winter. And even though we don't really think of like vitamin D deficiency, and she. I mean, this of course is when we're asking them to be pregnant and, and deliver healthy lambs. And sure enough the sheep in our area are vitamin D deficient. So, so we are, you know, currently doing a study looking at supplementing just giving injections like at a time of ultrasound and then at a time of, you know, crutching essentially. So two time points during the winter, but when when use would be already handled to see if this improves their, their pregnancy performance, decreasing either pregnancy toxemia or increases the birth weight of the lamb or their ability to care for the lamb. So we'll see. We'll hopefully have some results from that this spring because we're, we're starting this project on the ewes that are being bred right now. Oh, that'll be interesting too. We also have no sunshine here in Buffalo. That would be awesome. It's our nightly routine at our house. Everybody gets vitamin D before bed in the winter. And maybe I need to add the small ruminants in my life. Awesome. I look forward to that. Well, thank you so much, Dr. Kutzler for joining us today on Boz and Bleeds, the American association of small ruminant practitioners podcast. And we will see you next time. Thanks.