How long Shih Tzus actually live
The measured median age at death is 12.8 years, from 12,007 dogs of this breed. Breed standards usually quote 10 to 16 years, which describes the standard rather than what was recorded. 8
Every cost figure on this page is calculated across 12.8 years, so lifespan is the most load-bearing number here. It was measured in a UK population, and the American comparison sits below.
US life expectancy at birth for small purebred dogs was 13.53 years, from 13.3 million dogs at Banfield hospitals. That study grouped dogs by adult body size and states that differences between breeds within a size group were not captured, so this is not a US figure for shih tzus specifically. It is the American number for dogs of this size, set beside the British number for this breed.
12.8 years, measured
Not a breed-standard range. This is the median age at death recorded across 12,007 Shih Tzus in the largest study of canine longevity yet published.
Long enough that the routine costs, not the dramatic ones, make up most of what you will spend.
How often owners report nothing wrong at all
15.03% of 193 shih tzus in a US survey of 27,541 dogs had no medical condition reported by their owner at all. The purebred average was 22.3% and the mixed-breed average 20.7%. The range across the 25 breeds studied ran from 34.81% down to 8.81%.4
This is the mirror image of everything else on this page, and worth reading alongside it. Owner surveys miss things a vet would catch, so treat it as how often a problem was noticed rather than how often one existed.
Food, grooming and boarding are no longer typed in per breed. Food comes from the veterinary Resting Energy Requirement for a 9 to 16 pound dog, priced at 2026 US kibble rates with a 20% allowance for treats.12 Grooming assumes a silky coat on a small dog at national average prices. Boarding assumes eight nights a year, which is the most assumption-heavy figure here and will be wrong for anyone who travels a lot or never travels at all.
Figures on this page were last checked against their sources on August 16, 2026. Every one carries its study and the population it was measured in. How we calculate.
Health problems and what they cost
Every price here is American. Health figures lead with a US study wherever one exists, with British research alongside it, because several of the largest disorder studies in veterinary medicine are UK work and no US equivalent has been published. Where both appear, the American figure comes first. Why American data is so scarce.
Each row shows the figure exactly as the study measured it. We do not convert one kind of measurement into another, because a screening result, an owner survey and a clinical record answer different questions.
- Clinical records One-year prevalence in veterinary records for this breed. The strongest evidence available.
- Owner reported Prevalence among living surveyed dogs. Undercounts what owners do not notice, and is not lifetime risk.
- Screened dogs The share of dogs submitted to the OFA registry that evaluated abnormal. Submission is voluntary and skewed toward good stock, and a radiographic finding is not the same as needing treatment.
- All dogs Measured across the whole dog population, not this breed. Context only.
Health data from 5 peer-reviewed sources. Prices from 2 US sources. Full list below.
Periodontal disease
Most prevalent disorder in the breed. 229 of 2,423 dogs in a single year.
Anal sac impaction
Shih Tzus run at increased risk versus crossbreeds. Cheap individually, frequent enough to add up.
Skin disease
The integument is the most affected organ system in dogs, at 36.3%. Covers allergy, infection, lumps and wounds. An organ-system grouping that already contains the specific integument conditions listed separately. Shown for context and not added to any total, because that would count the same disease twice.
Digestive disease
Digestive tract problems affect roughly 30% of dogs in a year. An organ-system grouping that already contains the specific digestive conditions listed separately. Shown for context and not added to any total, because that would count the same disease twice.
Extracted teeth
No treatment-cost source matches this condition, so it is not priced.
Hip dysplasia
Radiographic hip evaluation. OFA grades submitted films; the figure below is the share graded dysplastic. 21.7% of 1,256 evaluated Shih Tzus were graded abnormal. Dogs are submitted voluntarily, mostly by breeders screening good stock, so the true rate in the breed is higher. Priced as a femoral head ostectomy, the usual choice for a dog this size. Femoral head ostectomy. Removes the femoral head and lets a false joint form. Usual choice for dogs under roughly 50 lb. Not every dysplastic dog needs surgery, and both hips roughly doubles it.
Dental calculus
No treatment-cost source matches this condition, so it is not priced.
Skin disease
The highest disorder group in this breed. No treatment-cost source matches this condition, so it is not priced.
Keratoconjunctivitis sicca (KCS)
No treatment-cost source matches this condition, so it is not priced.
Musculoskeletal disease
Joint and mobility problems affect roughly 15% of dogs in a year, rising steeply with age. An organ-system grouping that already contains the specific musculoskeletal conditions listed separately. Shown for context and not added to any total, because that would count the same disease twice.
Cataracts
No treatment-cost source matches this condition, so it is not priced.
Dental disease
Contains the periodontal figure above. No treatment-cost source matches this condition, so it is not priced.
Ear Infection
No treatment-cost source matches this condition, so it is not priced.
Seasonal allergies
No treatment-cost source matches this condition, so it is not priced.
Corneal ulcer
No treatment-cost source matches this condition, so it is not priced.
Umbilical hernia
Reported in 11.97% of Shih Tzus in a survey of 43,005 UK dogs across 192 breeds (95% CI 8.98 to 15.78%). Owner-reported, so it understates conditions owners do not recognize.
Murmur
No treatment-cost source matches this condition, so it is not priced.
Eye disease
Prominent eyes in a shallow socket. This grouping covers everything from dry eye to corneal injury. No treatment-cost source matches this condition, so it is not priced.
Elbow dysplasia
Often bilateral, which doubles the surgical cost. 10.8% of 167 evaluated Shih Tzus were graded abnormal. Dogs are submitted voluntarily, mostly by breeders screening good stock, so the true rate in the breed is higher. Arthroscopic treatment of elbow dysplasia. Often bilateral, which roughly doubles it.
Pruritis
No treatment-cost source matches this condition, so it is not priced.
Underbite
No treatment-cost source matches this condition, so it is not priced.
Ear disease
Third most recorded disorder. A grouping that covers several different conditions with very different costs. We show the rate and a representative treatment price, but do not put a single expected figure on it.
Skin cyst
Reported in 4.56% of Shih Tzus in a survey of 43,005 UK dogs across 192 breeds (95% CI 2.83 to 7.28%). Owner-reported, so it understates conditions owners do not recognize. No treatment-cost source matches this condition. Rather than price it using an unrelated procedure, we leave it unpriced.
Allergic skin disease
Reported in 2.56% of Shih Tzus in a survey of 43,005 UK dogs across 192 breeds (95% CI 1.35 to 4.8%). Owner-reported, so it understates conditions owners do not recognize.
Lipoma
Reported in 2.28% of Shih Tzus in a survey of 43,005 UK dogs across 192 breeds (95% CI 1.16 to 4.43%). Owner-reported, so it understates conditions owners do not recognize. No treatment-cost source matches this condition. Rather than price it using an unrelated procedure, we leave it unpriced.
Patellar luxation
Kneecap slips out of its groove. Mild grades are managed; severe grades are surgical. 2.2% of 3,378 evaluated Shih Tzus were graded abnormal. Dogs are submitted voluntarily, mostly by breeders screening good stock, so the true rate in the breed is higher. Per knee. A grade I in a small dog can be under $2,000; a grade IV in a large breed with both knees affected can exceed $6,000.
Unspecified Eye
Reported in 1.99% of Shih Tzus in a survey of 43,005 UK dogs across 192 breeds (95% CI 0.97 to 4.06%). Owner-reported, so it understates conditions owners do not recognize.
Intervertebral disc disease
Reported in 1.71% of Shih Tzus in a survey of 43,005 UK dogs across 192 breeds (95% CI 0.79 to 3.68%). Owner-reported, so it understates conditions owners do not recognize.
What you will actually pay
$38,107Across 12.8 years. About $2,651 a year after the first, which carries the purchase price and setup.
82% of that comes from measured prices. The rest is the puppy and retail assumptions you can adjust.
Where the money goes
The cost of owning the dog, year by year. Health spending is not included here: it is uncertain by nature and is set out separately above.
What makes up the total
- Puppy and setup$3,124
- Routine care$34,983
What to ask the breeder
Ask this breeder for certificates on hip dysplasia (22% of screened dogs abnormal), elbow dysplasia (11% of screened dogs abnormal). Those are the screenings where Shih Tzus score worst in the OFA registry, so they are the ones worth seeing paperwork for. A breeder who has done the testing will produce it without being pushed; one who has not will talk about how healthy their line is instead.
Where you live changes the number
Veterinary prices vary by more than half across the country. Everything above is a national average. Pick your state to see what it means for you.
What a Shih Tzu costs where you live
Average dog vet visit, $57 in West Virginia to $127 in Hawaii. Tap a state.
See all 51 in a table
| State | Avg visit | vs national | Lifetime here |
|---|---|---|---|
| Hawaii | $127 | +81% | $53,061 |
| Massachusetts | $99 | +41% | $45,695 |
| District of Columbia | $97 | +38% | $45,168 |
| California | $94 | +34% | $44,379 |
| Alaska | $84 | +20% | $41,748 |
| New York | $83 | +18% | $41,485 |
| Maryland | $79 | +13% | $40,433 |
| Vermont | $78 | +11% | $40,170 |
| New Jersey | $77 | +10% | $39,907 |
| Washington | $77 | +10% | $39,907 |
| Connecticut | $76 | +8% | $39,644 |
| New Hampshire | $76 | +8% | $39,644 |
| Rhode Island | $76 | +8% | $39,644 |
| Oregon | $75 | +7% | $39,381 |
| Maine | $74 | +5% | $39,118 |
| Arizona | $73 | +4% | $38,855 |
| Colorado | $72 | +3% | $38,591 |
| Florida | $70 | 0% | $38,065 |
| Montana | $70 | 0% | $38,065 |
| Utah | $70 | 0% | $38,065 |
| Delaware | $69 | -2% | $37,802 |
| Idaho | $69 | -2% | $37,802 |
| Nevada | $69 | -2% | $37,802 |
| Virginia | $69 | -2% | $37,802 |
| North Carolina | $66 | -6% | $37,013 |
| South Carolina | $66 | -6% | $37,013 |
| Wisconsin | $66 | -6% | $37,013 |
| Wyoming | $65 | -7% | $36,750 |
| Illinois | $64 | -9% | $36,487 |
| Minnesota | $64 | -9% | $36,487 |
| Nebraska | $64 | -9% | $36,487 |
| Ohio | $64 | -9% | $36,487 |
| Pennsylvania | $64 | -9% | $36,487 |
| Kentucky | $63 | -10% | $36,224 |
| Louisiana | $63 | -10% | $36,224 |
| New Mexico | $63 | -10% | $36,224 |
| South Dakota | $63 | -10% | $36,224 |
| Texas | $63 | -10% | $36,224 |
| Georgia | $62 | -12% | $35,961 |
| Indiana | $62 | -12% | $35,961 |
| North Dakota | $62 | -12% | $35,961 |
| Tennessee | $62 | -12% | $35,961 |
| Iowa | $61 | -13% | $35,698 |
| Michigan | $61 | -13% | $35,698 |
| Missouri | $60 | -14% | $35,435 |
| Alabama | $59 | -16% | $35,171 |
| Arkansas | $58 | -17% | $34,908 |
| Kansas | $58 | -17% | $34,908 |
| Oklahoma | $58 | -17% | $34,908 |
| Mississippi | $57 | -19% | $34,645 |
| West Virginia | $57 | -19% | $34,645 |
Source: 2025-2026 Synchrony Average Procedural Cost Study, ASQ360 Market Research, all 50 states and DC. We apply each state's index only to the veterinary share of the total. Food, grooming, boarding and the puppy price stay at the national figure, because a state's vet pricing says nothing about what a breeder or a bag of kibble costs there.
The number most owners get wrong
$598is what dog owners actually spend on veterinary care in a year, measured by the AVMA. Following the recommended schedule costs $1,301.
The gap is care that does not happen. Only 14% of dogs receive dental care at a vet's office, and 80% have periodontal disease by age three.
What veterinary care actually costs
Two measured figures that disagree, and the gap is the point.
The $703 gap is care that does not happen. We show the higher figure in the total for this breed, because it is what the recommended schedule costs. If you expect to spend closer to the average, the real total for a Shih Tzu is nearer $28,058.
Where the gap comes from
This is not owners being careless. It is the single largest difference between what veterinary medicine recommends and what actually happens, and dental care is most of it.
- 14%of dogs receive dental care at a veterinary office, in an AVMA owner survey, against a guideline of a cleaning under anaesthesia every year for small breeds and every one to two years for larger ones.
- Two thirdsof pet owners do not provide the dental care their veterinarian recommends, according to the AAHA.
- 80%of dogs have some periodontal disease by age three. It is the most commonly diagnosed condition in adult dogs, and most of it sits below the gumline where an owner cannot see it.
- Roughly a quarterof dog owners reported skipping veterinary visits altogether in the year the AVMA last measured it.
This matters for budgeting in an uncomfortable way. The lower figure is what people spend, not what a dog needs. A dental cleaning deferred is often a set of extractions later, which costs several times more and is not preventive care any insurer will cover.
How much of the total is sourced
82% of the $38,107 figure comes from measured prices: veterinary care from a 50-state cost study, and the lifespan it is spread over from a study of 584,734 dogs. The remaining 18%, about $6,978, is an observed market range for the puppy plus retail assumptions for supplies, a training course and boarding. Those are the numbers to adjust if your situation differs: plenty of people never board a dog.
Dental and visit statistics from the AVMA and the AAHA, 2026. Recommended care priced from the 2025-2026 Synchrony/CareCredit procedural cost study. Actual spending from the AVMA 2025 Pet Ownership and Demographic Sourcebook, self-reported by owners.
Insurance for a Shih Tzu
Coverage is protection against an uncommon large bill. It is not a way to save money on the care you already know is coming.
The bills it exists for
Documented conditions in this breed where a single episode runs into the thousands. We are not telling you how likely these are, because the prevalence evidence is not strong enough to carry that claim.
- Intervertebral disc disease$3,776–$10,168
- Elbow dysplasiaArthroscopic treatment of elbow dysplasia.$3,000–$5,000
- Patellar luxationPer knee.$1,000–$5,000
- Hip dysplasiaPriced as a femoral head ostectomy, the usual choice for a dog this size.$1,200–$3,500
What the tiers actually buy
Average US premiums for a dog, for the year ended December 2025.
- Accident onlyInjuries, not illness. Cheap because it covers far less.$190 a year
- Accident and illnessThe standard policy and the one most figures refer to. Up 11.5% on last year.$836 a year
- With embedded wellnessAdds routine care. Compare it against what routine care actually costs before assuming it saves money.$1,414 a year
What actually decides whether a claim is paid
Not the breed, and usually not the premium. Carrier terms verified August 2026; they change, and they vary by state.
- Hereditary and congenital conditions are usually covered
- This is the most common misconception about pet insurance. Every major US carrier covers inherited and congenital conditions on a standard accident-and-illness policy, provided they are not pre-existing. Trupanion covers them with no payout limit. Embrace covers them with no per-condition or per-incident limit at no extra cost, and states that its policies fully cover breed-specific conditions. Healthy Paws covers them too. Nationwide makes hereditary and congenital a coverage option you select rather than an automatic inclusion. Cheaper and accident-only policies sometimes exclude them entirely, so it is worth confirming in writing.
- Most pre-existing conditions are excluded
- Anything your dog has shown signs of before coverage began, or during the waiting period, is normally excluded. This, not heredity, is what actually stops most claims being paid. The detail varies more than people expect: several carriers will cover a condition they classify as curable once the dog has been symptom-free and treatment-free for a set period, commonly twelve months, subject to state rules and the policy wording. It is also why enrolling a healthy puppy costs less and excludes less than insuring a dog that already has a history.
- Orthopedic waiting periods vary a lot
- The clearest example of why the carrier matters more than the breed. Healthy Paws applies a 12-month waiting period to anything related to hip dysplasia, and will not cover it at all if the dog was enrolled at six years or older. Trupanion applies its standard 30-day illness waiting period. Some carriers will waive an orthopedic wait after a vet exam. For any breed with joint risk, this single clause can matter more than the premium.
- Standard waiting periods
- Typically 2 to 30 days for illness and 2 to 5 days for accidents. Trupanion is 5 days for injury and 30 for illness. Embrace is 14 days for illness. Nothing that appears during the wait is covered.
- Bilateral condition rule
- If one side of a paired body part was affected before coverage, many carriers exclude the other side too. Relevant for hips, elbows, knees, eyes and ears.
- Age at enrollment
- Premiums rise with age, some carriers cap new enrollment, and some restrict specific conditions for older enrollees. Healthy Paws requires enrollment before the 14th birthday and drops hip dysplasia cover from age six.
Premium range from NAPHIA industry data. Coverage terms from published carrier policies and independent reviews, checked 16 August 2026. We are not an insurance agency, we do not sell policies, and we make no recommendation. Terms vary by carrier and policy, and the exclusions in your own policy govern.
First year breakdown
| Item | What it covers | Cost |
|---|---|---|
| Puppy purchase | Observed market range, not an authoritative source | $1,750 |
| Vaccine series | Three rounds plus rabies | $235 |
| Spay or neuter | Includes anesthesia and monitoring | $471 |
| Supplies | Crate, harness, bedding, bowls | $420 |
| Food | About 1.1 cups daily at maturity, computed from body weight | $322 |
| Grooming | silky coat, small dog | $668 |
| Boarding | Eight nights a year at an average rate | $360 |
| Preventatives | Flea, tick, heartworm | $708 |
| Training class | Six week group course | $200 |
| Microchip | One time | $48 |
| First year total | $5,775 | |
Worth knowing
Ask this breeder for certificates on hip dysplasia (22% of screened dogs abnormal), elbow dysplasia (11% of screened dogs abnormal). Those are the screenings where Shih Tzus score worst in the OFA registry, so they are the ones worth seeing paperwork for. A breeder who has done the testing will produce it without being pushed; one who has not will talk about how healthy their line is instead.
Feeding an adult
At 13 lb, roughly 412 kcal a day, about 1.1 cups at 380 kcal per cup.
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Compare coverage for a Shih Tzu
Premiums run $190 to $1,414 a year. Routine care of roughly $1,301 a year is not covered by any standard policy, so compare on what happens when something expensive and unexpected occurs.
Shih Tzu vs other breeds
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The price
Shih Tzus are expensive to breed before they are expensive to own. Flat-faced breeds frequently need assisted mating and a planned cesarean section, because the puppies' heads are large relative to the mother's pelvis. Those costs are carried by a small litter and passed on in the purchase price. Expect $1,000 to $2,500 from a breeder who health tests. That figure is an observed market range rather than a sourced statistic, and it is the least reliable number on this page. Everything after the purchase is more predictable: about $2,651 a year in food, grooming, boarding, routine veterinary care, preventatives and dental.
The build
The shortened muzzle that defines the breed houses the same soft tissue a longer one would, with less room for it. That is why airway, skin fold and eye problems cluster in flat-faced dogs rather than appearing at random. Small breeds tend to live longer, which is the main reason their lifetime totals are not lower than they look. More years means more routine care, and crowded jaws make dental disease close to inevitable. On hips, 22% of Shih Tzus submitted to OFA were graded dysplastic, and 11% on elbows. Those are dogs a breeder chose to submit, so the rate across the breed is higher, and a radiographic grade is not the same as a dog that will need surgery. Cardiac screening flags 12% of evaluated dogs as abnormal, which is why a cardiac certificate is worth asking for in this breed.
Common questions
How much does a Shih Tzu cost?
A Shih Tzu puppy costs $1,000 to $2,500. The first year totals about $5,775 including vaccines, neutering and supplies, then roughly $2,651 a year after that. Across a median lifespan of 12.8 years that is about $38,107 to own. Health costs sit outside that figure and are listed separately, because the evidence is not strong enough to reduce them to one number.
What health problems do Shih Tzus have?
The most documented is periodontal disease: 10% were seen for it in a year of veterinary care. Treatment runs $246 to $663. Each figure on the page states the population it was measured in, because these are different kinds of measurement and are not interchangeable.
Is pet insurance worth it for a Shih Tzu?
A standard accident-and-illness policy averaged $836 a year in the latest published industry figures. Held flat, that is about $10,701 across 12.8 years, though real premiums rise with age and vary by carrier, state, deductible and reimbursement level, so treat it as a benchmark rather than a quote. Accident-only cover is cheaper at about $190 a year but pays nothing toward illness, and policies with a wellness rider reach $1,414 while mostly prepaying routine care you would buy anyway. Routine care of about $1,301 a year is not covered by any standard policy. Coverage is protection against an uncommon large bill, not a way to save money on predictable care. What decides whether a claim is paid is usually the policy mechanics rather than the breed: pre-existing conditions, waiting periods and bilateral rules.
Sources
Grade A is a peer-reviewed prevalence figure from a large primary-care population. Grade B needs a conversion or comes from a single market. Grade C and D are weaker and labeled wherever they appear.
- 1VetCompass Shih Tzu 2024Grade AData 2016Dale F, Brodbelt DC, West G, Church DB, Lee YH, O'Neill DG. Demography, common disorders and mortality of Shih Tzu dogs under primary veterinary care in the UK. Companion Animal Health and Genetics. 2024.2,423 Shih Tzus, 2016, median age 4.1 yrsView source
- 2Synchrony/CareCredit 2026Grade BData 2025-20262025-2026 Synchrony Average Procedural Cost Study for Veterinary Practices Across the United States, conducted by ASQ360 Market Research. Published by CareCredit.All 50 US states and the District of ColumbiaView source
- 3VetCompass 2014Grade AData 2013O'Neill DG, Church DB, McGreevy PD, Thomson PC, Brodbelt DC. Prevalence of disorders recorded in dogs attending primary-care veterinary practices in England. PLOS ONE. 2014;9(3):e90501.148,741 dogs across 93 UK clinics; 3,884 records reviewed in detailView source
- 4Dog Aging Project breeds 2023Grade BData 2019-2022Forsyth KK, McCoy BM, Schmid SM, Promislow DEL, Snyder-Mackler N, the DAP Consortium. Lifetime prevalence of owner-reported medical conditions in the 25 most common dog breeds in the Dog Aging Project pack. Frontiers in Veterinary Science. 2023;10:1140417.27,541 US companion dogs enrolled in the Dog Aging Project, owner reportedView source
- 5OFAGrade CData 1974-2026Orthopedic Foundation for Animals, Disease Statistics by Breed. Cumulative evaluations submitted to the OFA registry.US. Voluntarily submitted screening evaluations, not a random population sampleView source
- 6Orthopedic price guides 2026Grade CData 2026Published US veterinary price guides and specialist clinic fee pages for hip, elbow and patellar surgery, cross-checked across MetLife Pet Insurance, Lemonade, Vety, PetPlanWise, SustainableVet and SurgiPet. Retrieved 16 August 2026.US, general and referral practiceView source
- 7KC survey 2017Grade CData 2014Wiles BM, Llewellyn-Zaidi AM, Evans KM, O'Neill DG, Lewis TW. Large-scale survey to estimate the prevalence of disorders for 192 Kennel Club registered breeds. Canine Genetics and Epidemiology. 2017;4:8.43,005 UK dogs across 192 Kennel Club breeds, owner-reportedView source
- 8McMillan 2024Grade AData 2016-2020McMillan KM, Bielby J, Williams CL, Upjohn MM, Casey RA, Christley RM. Longevity of companion dog breeds: those at risk from early death. Scientific Reports. 2024;14:531.584,734 UK dogs including 284,734 deceased, across 155 breedsView source
- 9Dog Aging Project HLESGrade BData 2019-2025Dog Aging Project. Curated Data Summary Tables, Health and Life Experience Survey, 2025 release. Retrieved 17 August 2026.52,599 US dogs enrolled in the Dog Aging Project, owner reportedView source
- 10Banfield US life expectancyGrade AData 2013-2019Montoya M, Morrison JA, Arrignon F, Spofford N, Charles H, Hours M-A, Biourge V. Life expectancy tables for dogs and cats derived from clinical data. Frontiers in Veterinary Science. 2023;10:1082102.13,292,929 unique dogs at 1,152 Banfield hospitals across the USAView source
- 11AKC 2025 registrationsGrade AData 2025American Kennel Club. Most Popular Dog Breeds of 2025, from AKC registration statistics covering 202 recognized breeds.AKC registration statistics for the 2025 calendar yearView source
- 12Care cost model 2026Grade CData 2026The Breed Report care cost model. Food is computed from the veterinary Resting Energy Requirement, RER = 70 x (kg^0.75), times a 1.6 maintenance factor for a neutered adult, divided by kibble caloric density, priced at 2026 US retail. Grooming and boarding are computed from 2026 US national average prices by body size and coat type. Inputs and assumptions are published in full.Computed per breed from measured weight and coat typeView source
Each figure is shown as the study measured it, with the population beside it. We do not convert one kind of measurement into another. See the full method. Not veterinary advice.