Summer is on the way and that means – allergies! Watch the replay of this awesome webinar with the veterinary dermatologist, Dr. Galia Scheinberg as she gives us some of her pearls of wisdom in managing allergic dogs. Thanks to our friends at Purina for sponsoring this webinar!
About Andy Roark DVM MS
The $45,000 Cat and How We Should Talk About the Cost of Owning Pets
A new survey from Synchrony (Parent Company of CareCredit & Pets Best Pet Insurance) indicates that the lifetime cost of care ranges from $20K-$55K for dogs and $15K-$45K for cats! Also, most pet owners have no idea that this is the case. 4 our of 5 pet owners will face unexpected veterinary bills. What does this mean for veterinary professionals, who often bear the brunt of pet owner anger when financial limitations to care arise?
In this episode, Dr. Andy Roark is joined by Jonathan Wainberg (Synchrony General Manager & Senior Vice President, Pet) to discuss the findings of the study, what is realistic when it comes to setting pet owner expectations for the cost of pet ownership, and how to have financial conversations that encourage financial planning on the part of pet owners.
You can also listen to this episode on Apple Podcasts, Google Podcasts, Soundcloud, YouTube, or wherever you get your podcasts!
LINKS
Synchrony Study Reveals Pet Owners Spend as Much as $55,000 during a Pet’s Lifetime
https://www.carecredit.com/pressrelease/lifetime-of-care-study/
Language of Veterinary Care (AVMA Membership Required):
https://www.synchrony.com/groundbreaking-new-language-of-veterinary-care-research.html
CareCredit: https://www.carecredit.com/providers/
What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Jonathan Wainberg (General Manager, Senior Vice President, Pet – Synchrony) brings over 15 years of financial services expertise, and a record of commercial ingenuity, market expansion and energetic leadership driving revenue growth to his role as CareCredit’s General Manager, Senior Vice President, Pet.
In this newly established vertical, Jonathan will lead CareCredit’s expansion of the veterinarian credit business, pet insurance and additional market adjacencies.
Prior to this, Jonathan served as SVP, General Manager GAP. He joined Synchrony following a 15-year tenure with GE Capital, where he was the Senior Managing Director, Global Sales for Industrial Finance in London. He was a key member of the senior leadership team building a new captive finance business for the reorganized and streamlined GE Capital.
Jonathan developed the strategy and led the efforts that allowed GE to provide financing support to global customers in new markets, surpassing sales targets by more than 30%. With on-the-ground roles in the US, Europe and Asia, he’s managed teams around the world and delivered complex strategies in more than 50 countries.
Earlier, Jonathan joined GE Capital in Corporate Finance in New York, ultimately becomingManaging Director, responsible for the Eastern US, Canada and private equity firms, in 2012. As Managing Director, Jonathan originated, structured and negotiated leveraged loans and highly structured financings for leveraged buyouts, re-financings, expansions and restructurings of middle market and large cap retail companies. He was a top individual sales contributor from 2007-2010.
Jonathan has an MBA from Georgetown University and a BA in History with a concentration in Marketing from Concordia University in Montreal, Canada. He began his career in the executive training program at Macy’s in New York, where he also had various merchant/management roles.
Jonathan is a native of Canada, with a dual US-Canada citizenship. He has traveled to over 85 counties, enjoys entertaining, wine and playing with his energetic 2-year-old son. While based in Costa Mesa, Jonathan currently resides in Bal Harbour, Florida with his wife and son, Jonathan will relocate to Southern California soon.
EPISODE TRANSCRIPT
Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a good one for you today. I am talking about the cost of having a pet. This is a topic that I think is super important. I think we need to be more upfront about what it really costs to have a pet, so that pet owners have realistic expectations going in. I don’t think any of us like surprising pet owners with what it costs, but the only way to avoid that is for them to have that knowledge, hopefully, before we come into hard money conversations.
Dr. Andy Roark:
So that is what I aspire to. That’s what I would like to see more of is a more open dialogue about what pet ownership really costs. CareCredit and their parent company, Synchrony, have released the results from a survey that they did. It’s 1,200 pet owners talking about what does it really cost to have a dog or cat for the life of that pet? That is what we were breaking down today.
Dr. Andy Roark:
It’s me and Jonathan Wainberg, who is the general manager and senior VP for Synchrony, which is CareCredit and Pets Best Pet Insurance. So anyway, good episode, good insight, really thoughtful discussion. Guys, let’s get into this.
Dr. Andy Roark:
This episode of the Cone of Shame Veterinary Podcast is made possible ad free by CareCredit.
Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast, Jonathan Wainberg. How are you?
Jonathan Wainberg:
I’m doing great. Thanks for having me.
Dr. Andy Roark:
Oh man, it’s my pleasure. For those who don’t know you, you are the general manager, senior vice president for Synchrony, which is a company that is over CareCredit, which pretty much everybody in the vet profession knows, and also Pets Best Pet Insurance. So you guys, you do a lot of things with the financial side of money. And so I was thrilled to be able to have you on the podcast.
Jonathan Wainberg:
Yeah, great to be here. Synchrony is a large financial institution. We’re actually a bank and we specialize in consumer finance. And one of our divisions is Synchrony Health and Wellness, which is really the part of this that Pet CareCredit resides in. And like you said, everyone knows CareCredit in the veterinary profession, and CareCredit is really the largest elective healthcare solution for consumers in the US. And just over three years ago, we made the decision to expand our veterinary finance specialty by purchasing Pets Best. And so it’s been just over three years and it’s been a great acquisition and shows our commitment to this space.
Dr. Andy Roark:
Yeah, you guys are really kind of leading the way in helping pet owners afford pet care, really. When we talk about what options are out there and what support there are for them, you guys are kind of, you’re an 800-pound gorilla in that space, which is good. It’s an important space.
Jonathan Wainberg:
Yeah. Listen, I think we’ve been in this business a long time. CareCredit is celebrating its 35th anniversary this year, and we’ve been in the veterinary space for approximately 27 years. And so when you’ve been around that long, people know you and trust you for generations, whether it’d be someone who’s been caring for their pet and using their card over the course of a lifetime of their pet family members, or for that matter if it’s their first time, or over the various lives of your pets.
Jonathan Wainberg:
And then I think the other thing is we’re a work hard that is not just limited to the veterinary channel. You can use it for human health as well. And so it’s very often that someone takes out CareCredit for perhaps something in the dentistry field like orthodontistry for your child. And then you find out, “Oh, this also works in the vet channel.” And so you have that cross-utility.
Jonathan Wainberg:
And so that has enabled us to build a good business. And in my case, provide a great alternative for helping pet parents afford some of those costs that come along in the veterinary channel.
Dr. Andy Roark:
I want to get into some research that you guys put out earlier this year and you guys have a study and it was on pet owners spending. And the title is Synchrony study reveals pet owners spend as much as $55,000 during a pet’s lifetime. And I want to talk to you about this because the study itself is really interesting. I want to lay down the methodology you guys use because I think it’s really well done. I think the findings, I was surprised by the findings to be honest.
Dr. Andy Roark:
And they make sense to me, but even I was sort of backed up a little bit by the numbers that you guys put down. I’ve been thinking a lot about this because we’re seeing changes in vet medicine and we’ve got a lot of student debt for veterinarians and we’re seeing veterinarian salaries rising, which is good. And we’re seeing technician support staff salaries rising, which is good and it needs to happen.
Dr. Andy Roark:
But you can’t look at those things and not also look at where does this money sort of come from and what does this ultimately mean and kind of look down the chain at the pet owner and think, what is care for or what does affordability and access to that medicine look like?
Dr. Andy Roark:
And that’s been a head space that I’ve been playing in a lot. I don’t pet owners largely have an idea of what the financial commitment is to having a pet. And I think that as medicine costs go up and food costs go up and inflation and all those sorts of things, I think it’s less and less true.
Dr. Andy Roark:
I was playing around with my own dog and he’s a three-year-old totally healthy dog. And I started running the numbers and I was like if I just did the basic wellness care on him and nothing bad happened to him, no hotspots, no allergy stuff, no ear infections, nothing, just basic parasiticides. If I said grocery store dog food, I’m still at a thousand dollars plus in maintaining a goofy, totally healthy dog. I don’t think that people recognize that. Do you agree?
Jonathan Wainberg:
Oh, I absolutely agree. I think the study, which we commissioned, which we call the lifetime of care because that’s what we’re trying to ascertain, is what does that cost? And I think there’s several points you hit on which make a ton of sense. I think the first thing is like you, as an expert in this field, and someone who’s in the profession yourself, you don’t realize what you’re spending because you don’t look at it in a one by sample, even if you had a dog that required or a pet that required maybe more care and more medical care than the average.
Jonathan Wainberg:
It’s done in chunks, so you don’t realize how it adds up. And then you see this number that we came up with, not we came up with, that we surveyed 1,200 pet owners and a hundred veterinarians, is as much as $55,000. And that’s a really big number because it’s not all in one shot, number one. Number two, to your point that saying that most people don’t realize it. Our study showed that nearly half of pet parents underestimate that cost of what you’re going to be spending on your pet.
Jonathan Wainberg:
And so you can really see that you’re not alone. And you’re probably on the higher echelon of people that understand this profession, understand the cost. I agree with you a hundred percent. There’s a major issue with veterinarians and student debt and with vet techs. And it’s great to see that hopefully not the debt going up, but the salaries going up and their ability to manage that. That’s a problem in our profession.
Jonathan Wainberg:
And it’s hard because you know better than me as someone really deeply into the profession, the passion that people have for this and the choices that you make. But what I’d say is that the vet industry is no different than things we’re seeing across the economy now, and we’re seeing inflation. And there’s a lot of inflation in the cost of care for the animals, some of it to make up perhaps for the human resources cost. But a lot of it ever also has to do with the demand that veterinarians are under with so many more people having pets and the ability really, it’s the competition numbers.
Dr. Andy Roark:
Yeah. I agree with that. So, let’s lay down some numbers here. The lifetime cost of care, according to the survey, comes down to $20,000 to $55,000 for dogs and $15,000 to $45,000 for cats. And I thought it was also really fascinating looking at just the first year of life, $1,300 to $2,800 for dog owners and $960 to $2,500 for cat owners in the first year alone.
Jonathan Wainberg:
Yeah. And that’s the first year. And I think what we’re seeing is in the first year you’re going to have startup costs. I think everyone kind of understands that and is prepared to some degree, but it’s the stuff that comes later. And even those startup costs are more than you think. Just acquiring a dog and these sort of things that you capture. So yes, the first year expenses, obviously getting the pet, vaccinating it, home proofing it, training it, et cetera. Those are big. But when you start thinking about some of these annual costs, they add up very quickly.
Dr. Andy Roark:
Yeah. I see frustration from veterinarians about financial conversations, because these are not fun conversations and pet owners get emotional about them. I see a lot of frustration from pet owners. I saw an interaction on the internet today and social media is a cess pool. But I was looking and someone had posted and said how dare these veterinarians charge this money for my pet and they couldn’t do it. And someone else had written back and said, “It’s not their responsibility to pay for your pet. You had a responsibility when you took this pet.”
Dr. Andy Roark:
And I don’t endorse communicating that way online at all. I do understand the sentiment of both parties, both the person who’s like, “I was surprised they didn’t have the money, and this is heartbreaking and I’m upset.” And I also understand the pushback from the veterinary professional, who was like, “Hey man, we deal with this all day every day. And we don’t have the resources to just take care of this and absorb the costs ourselves. Even though we would love to, you have some responsibility here as well.”
Jonathan Wainberg:
That is absolutely right. And that’s why with this study and with the kind of financial solutions that we have out in the market, we think it addresses both things. Number one, the study of a lifetime of care is to really educate prospective pet parents about what they can expect in expenses over for caring so that they can prepare themselves financially.
Jonathan Wainberg:
When you bring a pet into your family, there’s responsibility that you need to have before. We think that those costs make sense, and it’s really worth it. We’re not trying to scare anyone. A couple times, people have asked me, “Well, are you trying to scare people from getting pets?” “Absolutely not. It’s the greatest thing to have a pet in your family, but we want you to be prepared before.”
Jonathan Wainberg:
And then on the other part of it with taking it from the veterinarian side, we know that these are not easy cost to absorb. And so what CareCredit tries to do is be able to provide solutions, whether it’d be the CareCredit card, or whether it’d be Pets Best Insurance that allows pet parents to prepare for those expenses, whether expected or unexpected and what we’re hoping is that they are expected, in a meaningful manner. And so that when something happens, they have that ability and the wherewithal to take care of that pet in the manner that it should be responsibly, and then also have great compliance to care because that’s everything.
Jonathan Wainberg:
And I’m sure you know and I’ve heard some of your other podcast that a pet that is taken to the vet more often is able to get their normal checkups and compliance of care is going to be a healthier pet. It’s probably going to be a less expensive pet to, for lack of a better word, maintain over its lifetime.
Dr. Andy Roark:
Yeah. I think you hit on a controversial point. But you and I are in the same camp here. I wish these numbers weren’t true. I wish that it didn’t cost $25,000 to $55,000 to have a dog or $15,000 to $45,000 to have a cat. If I had a magic wand, I would make that not true. I would make it cost a thousand dollars over the lifetime of a pet. And I would go ahead and wipe out that veterinary student debt, and pay the tax a living wage. I would do all those things.
Dr. Andy Roark:
But I think a lot of people say, they look at these numbers and I’ve gotten push back on this because my thought was for a long time, we should tell people it costs a thousand dollars a year to have a healthy dog. And people are like, “What? Why would … Like that’s just off putting?” And I’m like, “That’s true.”
Dr. Andy Roark:
And it’s kind of like when we go in the exam room and we make recommendations, if you don’t tell people the truth, then they can’t make an educated decision. If I don’t say, “Hey, look, this is what it costs to treat heartworm disease. And this is the prevalence in our area. And your pet could die from heartworm disease. Do they really have the information they need to decide whether or not they want to make that purchase? And people say that’s sort of hard. And I sort of say, “Well, I want to give them the truth and help them to make the best decision.”
Dr. Andy Roark:
And I think that these numbers kind of fall into that same category of, “I wish this wasn’t the case. I wish I could tell you that heartworms aren’t going to hurt your dog, and that you can just give your dog some Benadryl for allergies and they’ll be fine.” But that’s not true. And the same thing is to say, to not set the expectation of this is what it costs, I don’t think that’s productive in the long term.
Dr. Andy Roark:
When we talk about angry clients, one of my favorite sayings is people don’t get mad about what you give to them. They get mad about the difference between what they got and what they expected to get. And so I think that even just setting the expectations, if people expect, “Yep, I am making this commitment and yep, it’s going to be expensive,” those conversations are a whole lot easier than then just being blissfully naive about what medicine costs. And they walk in with $300 and get their doors blown off.
Jonathan Wainberg:
Yeah. I think it’s important that we get through them in multiple channels. Obviously, the veterinary profession is going to be the one that … I hate to say the word bears the burden of this, but that’s the truth because you guys are the most trusted in the industry. Yeah, we could publicize these stats and go out there, but we’re never going to reach the 30 million US households, is what our study shows will face an unexpected pet expense.
Jonathan Wainberg:
There’s no way we’re going to get them. So you guys on the frontline are the ones that are going to have to bear of that. But also it’s the shelters that need to be kind of telling people, “Hey, it’s great that you’re adopting this pet. We love that you’re taking it,” but hey, with that comes a responsibility, same thing with breeders and just the general industry as a whole.
Jonathan Wainberg:
And that’s why we did our part to message this study. This isn’t a commercial for CareCredit or Pets Best. Really, but we would make it a lot sexier, yeah, exactly. Maybe we would have the Bruno Mars sing the results. But I think it’s something that we want to get out there because we know that this is such a critical part of the industry.
Jonathan Wainberg:
And what we’re trying to do at the end of the day is yeah, sure, we’re in the business of providing healthcare and financial solutions in the healthcare space. But what would be much better for everyone is if they know beforehand what they’re getting into and are able to prepare for it in an orderly manner so that they’re not surprised and have to make tough decisions like, “Hey, do I have to pay this bill or make my car payment?” We don’t want anyone to be in that position.
Dr. Andy Roark:
Yeah. I completely agree. The first time you end up at the emergency clinic and it’s $1,500, $2,000. That’s just like people’s heads explode. They hadn’t seen it coming. So that brings us to the actionable part of this. And actually, this is what I really want to talk with you about. What does a world look like where expectations like this are set? What do we do as medical professionals to try to bring this awareness to pet owners?
Jonathan Wainberg:
Listen, you have to hit people in on it in a, “Don’t hit anyone. This isn’t the Oscars.” You need to explain to people as much as possible and it has to be multiple times, especially for those first time pet owners. I think, we try as best as we can at whether it’d be pet adoption or that first puppy visit with the vet to talk about … That’s a great place to talk about pet insurance because you’re also getting the pet insurance at the best time for your dog or cat, because that’s when it’s going to be the most cost efficient if there’s not going to be preexisting conditions. And your premiums, you’ll get in at the right time. That’s just the way it works. The younger pet is going to be more affordable.
Jonathan Wainberg:
And so that’s one of the things where we at Pets Best try to certainly get adoption, and I think I’d say across the industry in that space. And in CareCredit also, we try to make it easier, as easy as we can because we don’t want you guys having that conversation. You’re so busy as it is, right? So we develop QR codes. We develop tags that say, “Hey, have this. We have educational videos.” But at the end of the day, there’s only so much that could be done virtually without that human touch. And you are the ones in the practice that are dealing with that kind of stressed out pet owner who is having to make that decision.
Jonathan Wainberg:
And yes, there’s certainly a lot of education we could do beforehand. But I think ultimately, there’s only so much that you can do to prepare someone for what is an unfortunate surprise when it comes to costs. And if you think about it in the US, it’s not like we’re much better in human health. People are not prepared for that. So I’d like to say, it’s something that’s unique to the pet industry. But the truth is it isn’t, and it just makes it harder because pets don’t speak and can’t tell you how they feel.
Jonathan Wainberg:
And so they can’t … Your guys are trying to translate two things, not just the cost, but how do you know that pet is feeling that way? And is this going to work or is this not going to work without being able to communicate verbally?
Dr. Andy Roark:
Right. And I think you make a good point about the vet professionals bearing the brunt, because I would add to that and say the emotional brunt of like, “I have to stand in the exam room and talk to people about the hard decisions they’re making and what things cost. And I don’t like that. And my technicians don’t want to bear that.” There’s an emotional toll, especially when you talk about, it’s not convenience euthanasia but financial euthanasia, things like that where people are … I mean, that takes a toll on me as well.
Dr. Andy Roark:
And so things that we can do to reduce that, the number of times I have those interactions, I’m all about that. I don’t think that there’s a magic formula that makes financial conversations go away. I do think that there are things that we can do systematically that reduce the number of hard conversations that we have in a sort of multimodal approach. And I think that we should be looking at those things.
Dr. Andy Roark:
When I look at this, I think that you’re right too. I don’t know what a high level spreading of this message looks like. Is it the AVMA’s place to sort of say to people, “Hey, by the way …” I don’t know that they would go for that. I don’t think that’s really the image that they want to have, but I do think it might help.
Dr. Andy Roark:
But I mean, is it time to come up with a graceful way to talk about financial planning for your pet at the puppy visits? Should we have resources when new clients come in and just sort of say, “Hey, these are things that we mention to people and try to start to put forward right from the very beginning”? And these can’t be one time conversations. People come in, they’ve got a new puppy, a new kitten, they get a whole folder. They get a whole truckload of information and they don’t retain 90% of it.
Dr. Andy Roark:
It needs to be a consistent message of, “Hey, this is important. Hey, you need to be thinking about that.” And I think that that’s an area that we as a profession, we have to work on like how do we communicate that? What do we say? How do we talk about in a way that normalizes the financial conversation around veterinary medicine?
Dr. Andy Roark:
Because I love the reputation that veterinarians have and sort of the James Herriot culture that we have, but it’s a double edged sword. And the downside to people saying, “Oh, the veterinarians, I love you guys. You have the biggest hearts. You’re the kindest people,” is that that can set us up to be the bad guy when we’re not able to deliver what this person wants just because we love pets. And I think a lot of us see that of, we enjoy the benefits of that reputation, but then we also take a beating from it.
Dr. Andy Roark:
My brother’s a lawyer and no one’s like, “I can’t believe that you charge for your services.” He’s a lawyer. They totally believe he charges for services. And I’m not saying that we should be lawyers, but I do think … No one’s advocating that.
Dr. Andy Roark:
But I do think that there is a middle path of saying we do care and we are compassionate. And you need to be aware that this is the landscape that you deal in, and that these are your options. Also, if you are breaking the news about what medicine costs to a pet owner at the time that they need financial resources, that’s a nightmare conversation. If they can get that message before they need it, then at least it’s not new information. They come in going, “Oh my gosh, I don’t know how I’m going to pay for this.” That’s a whole lot easier conversation than, “I can’t believe that this is what the bill is. This is outrageous.”
Jonathan Wainberg:
Yeah. I think two answers on that. On the languages and the do’s and don’ts as it comes to financial, we did do something with the AVMA to train veterinarians. And we do spend a lot of time because it isn’t … First of all, it isn’t a natural thing. They’re not trained to be in a business. Yeah, some of the office managers perhaps, but they’re doing something that they’re passionate about and it is hard to kind remove yourself and go back to the bottom line. So, I’m empathetic to the veterinarian who is looking at that pet and trying to figure out any which way to get them that care, even at their personal expense.
Jonathan Wainberg:
Now, with that said, the profession, as you said, as much debt as people are in and as much as we think that that cost of healthcare for our pets is high, it really probably isn’t at the level where it should be. And that’s where we as CareCredit want to be able to help. We want to take that conversation away by saying, “Okay.” And we will serve to some degree, I don’t want to say the bad guy in that space, but we’re the bank. That’s what we’re prepared to do. We’re the one who’s going to be able to lend the money. And we’re the ones that are able to have that harder conversation.
Jonathan Wainberg:
And what we try to do is take that as much as we can that conversation away from the vet by somebody’s self-service tools that we’ve developed. But also as a veterinarian shouldn’t be having receivables on their account from Dave Jones’s poodle, right? It should be … No one wins with that, right? And so that’s something that we got to, as a profession, kind of get away from because it just doesn’t make sense for anyone in the whole ecosystem.
Dr. Andy Roark:
Yeah. I agree. So I’m going to put a link to the survey in the show notes so everybody can see that. Definitely, it’s very brief. It’s well put together. You guys check it out. It’s a lot of food for thought. Jonathan, where else would you send people? So if some people are sort of sitting and processing this and they want to increase the financial education that they’re able to provide to clients, things like that, what resources would you point them to?
Jonathan Wainberg:
I think on the carecredit.com site, we have a lot of learning and knowledge that can talk about that. And I think that’s something that you will get on that page. We have a special page that talks about that and talks about various expenses and costs that you have. You’re going to put a link into the lifetime of care study so that the people are prepared. We did a language of financial expenses with AVMA and those tools are available as well.
Jonathan Wainberg:
And I’d say if you’re someone who already accepts CareCredit and wants to learn more, we have resources and training available for all our providers in that provider network, and anything we can do in that space. Costs are going up. In 2020, they said there was $104 billion spent in the pet industry in the US. 2021, I just saw it came out at $123 billion. It’s almost 20% up. It’s going one direction.
Jonathan Wainberg:
And whether it’d be … It’s not just inflation, a lot of it is population, and that’s great. And a lot of it is also people investing more in their pet. We talk about the humanization of pets, but people are treating them at a different level of treatment in that family than they did in the past. And so people, it’s great to see that. But with that cost go up and you’re seeing that overall in our studies’ results.
Dr. Andy Roark:
Yeah, exactly. And well in the study, it says 7 out of 10 pet owners consider their pet as part of the family, just to your point. So anyway, I’m going to go ahead. I’ll put links to the survey in the show notes. I’ll also put links to CareCredit, and then I’ll also pull up the language of financial expenses that I think that’s a great resource. I’ll link all that stuff in the show notes. Jonathan, thank you so much for being here. I really appreciate your time.
Jonathan Wainberg:
Oh, no. It’s a delight.
Dr. Andy Roark:
And that is our episode. Guys, I hope you liked it. I hope you got something out of it. I hope it gave you something to think about. I think this stuff is really important. And again, it feels icky sometimes to talk about the numbers and talk about what pets really cost. But guys, we got to be honest with people and they need to know what they’re getting into. And so we need to start thinking about how to make pet owners more aware, just so they know what they’re signing up for. I think it’s only fair.
Dr. Andy Roark:
So guys, that’s it. That’s what I got. Thanks again to CareCredit for making this episode possible ad free. Guys, take care of yourselves. Talk to you later on. Bye.
Dentistry Pain Control When Cost is A Challenge
Dental procedures are expensive, and pain control is non-negotiable. How do we do right by our patients while working within the budgets of pet owners? The original anesthesia nerd Tasha McNerney is on the podcast today with FANTASTIC advice on how to do exceptional pain control without breaking the client bank! Let’s get into this episode!
You can also listen to this episode on Apple Podcasts, Google Podcasts, Soundcloud, YouTube, or wherever you get your podcasts!
LINKS
International Veterinary Academy of Pain Management: https://ivapm.org/
Book: Small Animal Regional Anesthesia
https://www.amazon.com/Small-Animal-Regional-Anesthesia-Analgesia/dp/0813819946/ref=sr_1_1?keywords=small+animal+regional+anesthesia+and+analgesia&qid=1649161001&s=books&sprefix=small+animal+regional+anesthesia%2Cstripbooks%2C97&sr=1-1
The Uncharted Veterinary Podcast
https://unchartedvet.com/uncharted-veterinary-podcast/
Retain Your Team: Languages of Appreciation in your Workplace
https://unchartedvet.com/product/appreciation-languages-101/
Creating Content that Clients Crave
https://unchartedvet.com/product/creating-content-that-clients-crave/
What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Tasha McNerney obtained her CVT in 2005 and has worked clinically in the areas of anesthesia and surgery ever since. Tasha obtained her CVPP (certified veterinary pain practitioner) designation in 2013 and became a veterinary technician specialist in anesthesia in 2015.
Tasha has been a featured speaker on various anesthesia and pain management topics at several international veterinary conferences. Tasha is the author of many articles and blogs on anesthesia and pain management related topics.
In 2013 Tasha created the Facebook group Veterinary Anesthesia Nerds, which has over 65,000 members taking part in education and exchange of ideas from all over the world!
Tasha is crazy and bought a 1920’s fixer upper and is now obsessed with home improvement tutorials on YouTube. She lives in Philadelphia with her husband, son, one perfect cat, and one jerk cat. Trust me that cat is a jerk.
EPISODE TRANSCRIPT
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Welcome, welcome, welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with my good, dear, awesome friend, the one and only Tasha McNerney, a.k.a. the original anesthesia nerd. She’s a VTS in anesthesia, she is a fantastic lecturer, she is hilarious, she is one of my favorite people to talk to. And her last episode with me when she was on the podcast, we talked about analgesia for blocked cats. And it was very popular, because it was very good.
Dr. Andy Roark:
Guys, this is an equally good one. Dentistry pain control when cost is a challenge. That’s right. Money is a real thing and pet owners struggle with it. And also pain is a real thing, and pets getting dental procedures struggle with it. Let’s talk about cost effective management for that 11-year-old Yorkie who’s got trench mouth and whose owner has a fixed income. Guys, this is a great episode. I hope you’ll get a ton out of it. Let’s get into it.
Kelsey Beth Carpenter:
(Singing) This is your show, we’re glad you’re here, we want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast, Tasha McNerney. Thanks for being back with me.
Tasha McNerney:
No problem, thanks for having me. I love talking about anesthesia stuff.
Dr. Andy Roark:
You are so amazing. You and I have been friends a long time. How good of friends are we? The last text message you sent, do you remember it?
Tasha McNerney:
Oh yeah. I have to share this with the world. This is amazing.
Dr. Andy Roark:
I was just minding my business, then I got a text from you that said, “If you call this phone number, they will play Hall & Oates music.” And I did. And it’s real. There’s a-
Tasha McNerney:
It’s real.
Dr. Andy Roark:
It’s a real phone number that you just call.
Tasha McNerney:
And it’s Callin’ Oates, so you can call in and hear whatever song you want from Hall & Oates.
Dr. Andy Roark:
Callin’ Oates. But for those of you at home who are just like, I don’t believe this is true. It’s 719-26-62837. That’s 719-26-OATES. And if you call that phone number, they’ll be putting Hall & Oates. That’s the type of communications I get from you. And that’s why we’re such good friends.
Dr. Andy Roark:
The other reason we’re such good friends is because you’re brilliant. And because you are a VTS in anesthesia and because you are super down to earth, real world, you have worked in private practice almost your whole career. You did some lab animal stuff for a little while, but for the most part, you have been a private practice teacher and technician. And so you know how it really is. So anyway, I have a case that I would like your very specific set of skills on, if you don’t mind.
Tasha McNerney:
I can do it. Let’s go.
Dr. Andy Roark:
Yeah. They can’t see you nodding your head on the podcast.
Tasha McNerney:
I was trying to think of like have fun like Liam Neeson taking jokes to put in there, but I really couldn’t come up with anything.
Dr. Andy Roark:
That’s what I was going on. See-
Tasha McNerney:
I was like, “Oh, what?” I was trying to think about Taken 3, which actually my husband and I were surprised that they made a Taken 3. Like how many times can you get taken before you know you’re going to be took? I don’t just think … And I love Liam Neeson, but I feel like he really should have been more prepared for this.
Dr. Andy Roark:
Well, I agree. One of my favorite pieces of business management advice is if there’s something that you’re surprised by again and again, at some point you’re not surprised by is your business model. And I would say that to Liam Neeson. You need to take care of this and stop acting surprise when people take your children.
Dr. Andy Roark:
Let’s do this medical thing. I have got an 11-year-old female spayed Yorkshire Terrier named Tinkerbell. She is very loved by her elderly owner. And you can imagine her. She is your older Yorkie, she’s just … Look at her, look at her in your mind’s eye. She’s trembling, and she has trench mouth. She has a nasty, funky mouth that cannot be ignored. Mom loves her to pieces and has really been afraid of anesthesia for a long time, which is why we’re kind of in a hole here as far as her dental health and things like that.
Dr. Andy Roark:
Mom’s also on a fixed income. And so she has limited resources to spend here. So I have a significant dental procedure in front of me. And I want to make sure that Tinkerbell is comfortable. Pain management is going to be really important for me and I’m working under financial constraints. And so let me put it to you like that and say, “Tasha McNerney, how do you treat this?”
Tasha McNerney:
Yeah, this is a good one because I feel like this happens all the time in private practice. In fact, it happens at university level too in their dentistry departments. It happens all over because people are scared of anesthesia and I totally get it. If you were, I mean, I knock on wood have only had a couple of anesthetic experiences in my life, but I have to tell you, even though I know so much about anesthesia and very comfortable with it. It’s scary, right?
Dr. Andy Roark:
Yeah. I get it.
Tasha McNerney:
For this patient in particular, we have to look at, if our finances are really limited and we know we’re about to do multiple extractions, how can we provide the best experience for this patient and make sure analgesia is taken care of without breaking the bank. And there’s some ways that we can do that certainly. I think one of the first things is you have to look at what’s in your anesthesia, your analgesia spice rack at your clinic.
Tasha McNerney:
So if you have options, that’s going to be a little bit easier. Certainly, we can say, “I, Tasha McNerney, as anesthesia nerd, I love fentanyl and I love methadone. Those are really great analgesic opioids that I can choose for my patients. But if I’m looking at it purely from a cost perspective, then I have to maybe look at, “Oh, could I potentially utilize something like hydromorphone instead for this patient?” That’s going to be a little more cost effective of all my pure mu opioids. And yeah, hydromorphone would be a really good opioid for this patient.
Tasha McNerney:
Now let’s say in clinic, you don’t have access to any pure mu opioids. Either your clinic doesn’t utilize them or buprenorphine is maybe the strongest opioid you have. Well, that’s fine too. If buprenorphine is the strongest opioid you have on your shelf, then let’s use that. But from a cost perspective, yes, I would maybe not utilize the methadone in this patient because I know dollar per mil is going to be more expensive than something like hydro.
Tasha McNerney:
So let’s just say I’m utilizing hydro for this patient. And now, I don’t want to just give a huge walking dose of hydro to this patient. I don’t know what other comorbid disease it has, but if it’s an 11-year-old Yorkie that has a really, really diseased mouth, we know that it probably has some degree of infection going on, inflammation going on. Let’s just hope that it doesn’t have any cardiac issues going on.
Tasha McNerney:
Well, maybe we have an echo in the previous past, but because we are financially limited, probably you don’t. If you have the ability to, if the dog is amenable to it, I would suggest that your staff at least get a pre-op ECG and blood pressure on this patient. Any of those things that you can get beforehand are going to make it a lot easier for you intraoperatively and how to manage that case.
Tasha McNerney:
So if you notice that this patient’s normal resting heart rate is 162, or if you notice that it’s 82, that’s going to kind of guide where you’re going to go with your drug selection, your inhalant, maybe your blood pressure support, et cetera. Also, if you know any murmurs or anything like that, again, all of these things are just really nice to know before we start layering in a bunch of drugs.
Tasha McNerney:
If it is a smaller Yorkie, 11 years old, I feel like I say this a lot. I love dexmedetomidine, but this is probably not the dogs that I would go dexmedetomidine with only because I hate to be a breedist. But if it potentially has any cardiac or mitral valve disease underlying that we don’t know about because we haven’t followed it or got an echo, I don’t want to make things worse with dexmedetomidine.
Tasha McNerney:
So this is probably not a dog I’m going to hit with dexmedetomidine, which from a cost perspective that’s okay because dexmedetomidine, again, one of our more expensive dollar per mil drugs. So I’m probably going to go with something a little bit more cost effective, maybe a small dose of midazolam for this patient followed by my induction agent.
Tasha McNerney:
Now, we have a couple choices for induction agent. You can have alfaxalone. I know a lot of clinics are utilizing alfaxalone, or you can utilize propofol, which a lot of clinics are using propofol. Both really great drugs and both have a pretty nice safety profile when utilized correctly in the correct dose mg/mL. However, there are some studies, there were some claims that alfaxalone is going to be better as far as apnea or hypertension.
Tasha McNerney:
But what we found is that there really isn’t that much of a difference between alfaxalone and propofol when it comes to overall hypertension, if you’re using it within the dose range. So again, because of a cost per mil for this patient in particular, I’m trying to be cognizant of cost. I would probably choose the propofol, and be as low with my dose. Just get them induced and then get them on inhalant.
Tasha McNerney:
Now this patient in particular, we know has a trench mouth and it’s going to be a lot of extractions. This is where your local blocks, right? So if bupivacaine, lidocaine things that are very cost effective, this is where your analgesia heavy lifting is going to be done with the local blocks. So instead of putting this patient on maybe an expensive fentanyl CRI or something like that, you can do local blocks or four-point local blocks in the mouth and that’s going to cover everything.
Tasha McNerney:
So if you had to do even full mouth extractions on this patient, if you’re doing both of the mandibular and maxillary blocks that you should be doing on these patients, and let’s say your practice doesn’t even have bupivacaine, you only have lidocaine, great, utilize your lidocaine. That’s going to give you a couple hours of pain free. You’re then going to be able to keep your inhalant turned down.
Tasha McNerney:
And when you can keep your inhalant down and your oxygen down, that’s going to be cost effective for you as a clinic. So anytime you don’t have to have cranking high levels of oxygen, high level of inhalant, that’s going to be better overall, not only for our patient, but for our finances.
Tasha McNerney:
And then intraoperatively, if you feel like this patient still needs a little bit of bump of something and this patient is not a hypertrophic cardiomyopathy cat, we know it’s a little Yorkie, this is where a low dose ketamine CRI can be really nice for MAC reduction. Again, to keep your inhalant low, ketamine is very, very cost effective. So, a little bit of ketamine can go a very long way.
Tasha McNerney:
You can put your ketamine either into a bag and run it on a pump or into a syringe and run it on a syringe pump. But you can do a low dose ketamine CRI to reduce your inhalant, increase your analgesia. So those two things together, local blocks, low dose ketamine CRI, very, very cheap but very, very effective when it comes to analgesia and reducing the amount of inhalants.
Tasha McNerney:
And then as the patient’s waking up, then it’s kind of dealer’s choice how they do under anesthesia, and what their blood work shows, whether or not the clinician wants to add in the nonsteroidal anti-inflammatory.
Dr. Andy Roark:
Okay. I like it.
Dr. Andy Roark:
Hey, everybody. I just want to jump in real quick with a couple of updates. This week over on the Uncharted Veterinary Podcast, which is the other podcast I do with the one and only Stephanie Goss, I’m not on that episode. Stephanie Goss is talking about information security. Are you storing data in your practice like you’re supposed to? Guys, this is not an area where you want to get burned. If you are not up to date or you’re kind of feeling like, “Ooh, I should probably listen to that,” head over to the Uncharted Veterinary Podcast and check it out.
Dr. Andy Roark:
Uncharted Workshops coming at you, guys, on May the 21st, which is just a couple of days after this episode comes out at 2:00 PM Eastern, 11:00 AM Pacific. Stephanie Goss, she is teaching our workshop, retain your team, speak the languages of appreciation in your workplace. Guys, you’re trying to get your team motivated. You’re trying to keep morale up. You’re trying to keep people engaged. You want your team to stick around to enjoy the work that they’re doing and to feel like they matter to you and to the patients.
Dr. Andy Roark:
Guys, are you talking about appreciation in your workplace? Are you doing it effectively? If not, jump in. This is a little bit higher level. We had an entry level appreciation workshop. This is a bit more down into the nitty-gritty. I think people can get a lot out of it. It is $99 to the public. It is free to our Uncharted members. I’ll put a link down in the show notes below.
Dr. Andy Roark:
On June the 8th, my friend, Bill Schroeder, veterinary marketing specialist, CEO of InTouch veterinary marketing, he is going to be doing his lectures. It’s not lectures, a workshop, called Creating Content That Clients Crave. This is all about you spending your time smartly to make resources that educate clients, that answer questions, that protect your reputation, that do all of the things that you wish you had content for but you just don’t have all the time in the world to make.
Dr. Andy Roark:
Most of us are spending too much time doing things like posting stupid social media stuff. Guys, it’s time to get a strategy. It’s time to get smart about how we communicate digitally. Bill Schroeder is the guy to do that. It is $99 to the public. It is free for Uncharted members. Guys, both of those things are coming up. I’m going to put links of both of them in the show notes. Let’s get back into this episode.
Dr. Andy Roark:
Give me give me any pearls you have, any words or advice on the ketamine CRI. I know there’s a lot of people out there who kind of draw back a little bit from CRIs. I think it’s still one of those things. It’s become a lot more common, but I still think a lot of practices are just intimidated. When you say CRI, I think a lot of technicians, a lot of doctors kind of go, “I don’t know, it’s kind of scary.” Make it seem less scary to me.
Tasha McNerney:
Oh, sure. So I think when most of us when we think of CRIs, we think back to when we were in vet school or tech school and we were at universities. And we were seeing these animals that are on what we call like the tree of life, where they’re on multiple CRIs because their state is so critical that they have to be on fentanyl and lidocaine, and dopamine and norepi and something else and plasma. So, we’re not talking about that.
Tasha McNerney:
We’re just talking about adding in a little bit of extra pain control to make the procedure go smoother overall. And the only reason I’m talking specifically about ketamine in this one is because if we look at overall cost effectiveness, now I could say that a lidocaine CRI would also be a very cost effective. But for this patient in particular, I think a ketamine CRI is a nice adjunct analgesia-wise. Cost per mil, very, very effective. And it doesn’t require that you have to have a syringe pump.
Tasha McNerney:
So most of the time, they’re also thinking, “Oh, well. I don’t have a syringe pump. I only have my regular Baxter pump. I can’t run something as fancy as a constant rate infusion.” But you can add a small amount of ketamine to a 250 or a 500 ml bag of saline and figure out the math. I know the math is intimidating, but don’t worry. There’s lots of CRI calculators online that can help you with this.
Tasha McNerney:
The International Veterinary Academy of Pain Management or ivapm.org, if you go to their website or even the website on your phone, they have CRI calculators where you just punch in the patient’s current weight and what dose you want the CRI to be run at, and they’ll give you the mils or volume per hour that you should put into your Baxter pump.
Tasha McNerney:
So, don’t feel like you have to have a syringe pump in order to make this work. You don’t. You can just have, as long as you have some ketamine, a bag of saline and a Baxter pump, we can run this into our patient. And we’re just talking a low dose ketamine. So, low dose ketamine is also different because I know sometimes people kind of like, ugh, cringe a little bit with just the thought of ketamine because we have these ideas of 10 years ago when we were using much higher doses of ketamine. And we know that higher doses of ketamine, higher doses really of anything are going to cause higher incidences of side effects.
Tasha McNerney:
But in ketamine in particular, ketamine, once you get into the higher dosing range, it goes from analgesic to anesthetic and it has more of these central effects that we see. And I think that people were, and rightly so, I think a cat in a really high dose of ketamine can be kind of scary thing to watch, and they usually don’t have the best recoveries. That’s where that ketamine crazies saying came from, was really high dose of ketamine.
Tasha McNerney:
When I’m talking high dose, I’m talking about like 15 to 20 mg/kg, so like these big doses of ketamine, which we don’t tend to use anymore. And when we’re talking about analgesic doses of ketamine, we’re talking about 1 mg/kg make, 2 mg/kg maybe, so smaller, smaller doses. We’re not seeing the same type of side effects we used to in the past.
Dr. Andy Roark:
If I have doctors or technicians that want to brush up on their dental blocks, do you have resources you would point people to that say this is a good review of your blocks?
Tasha McNerney:
Yes. So for dental blocks in particular, I am a book reader. So if you like to read books, and actually if you’re interested in local blocks in general, there’s a really good textbook of regional anesthesia in the small animal patient. And I believe it is by Campoy and Read, Campoy out of Cornell. And I’m pretty sure that I got my copy on Amazon, but it goes through every single local block that you could think of from epidurals, to ring blocks if you had to take a toe off of a patient, to sacrococcygeal blocks if you had to do a tail amputation, to all of the dental blocks.
Tasha McNerney:
And there’s a bunch of different dental blocks that we can utilize. And I think there’s also a really cool thing about dental blocks that we also sometimes don’t think about, is that they don’t actually only have to be for dentistry. So sometimes, we will utilize an infraorbital block bilaterally if we have to go in and take a tumor off the nose, or if we have to do a rhinoscopy or something like that. So, they’re not just for dentistry.
Tasha McNerney:
I always tell people that, again, local blocks are going to do a lot of your analgesia heavy lifting during the surgery because we could just put our patients on 5% ISO and kick back and they’re not going to move. But that’s not really balanced anesthesia or analgesia. We want to make sure that we don’t have the patient on 5% ISO, that we have them on low ISO, and we’re doing a lot of local blocks to take care of those pain signals going to the brain.
Tasha McNerney:
And if you can utilize a local block for every single patient, whether it’d be a tooth extraction or a radius-ulnar fracture that’s coming in, to a skin incision, laceration repair, so there’s a local block for everything. And if we’re talking about lidocaine in particular, it’s very, very, very cheap way to provide pain management.
Dr. Andy Roark:
Perfect. That’s fantastic. I will put links to the book and then also to the CRI calculators down in the show notes. Tasha, thank you so much for being here and doing this with me. Where can people find you online? Where can they follow all the stuff that you’re doing? Because you’re doing a lot of things.
Tasha McNerney:
Yeah. We are doing a lot of things. So, I am most active on the Facebook group, Veterinary Anesthesia Nerds, and also on our website. So if you ever have any questions, hit me up on Anesthesia Nerds or send us an email through the website. Also, the Veterinary Anesthesia Nerds are kind of like going on tour together. All three of us administrators are … I know. We are going to all be present at the Fetch Conference that’s happening in Charlotte, North Carolina.
Tasha McNerney:
And then we’re also going to be present at the one that’s going to be in San Diego this year. So kind of East Coast, West Coast opportunities to do some stuff and talk about how we can elevate the standard of care for anesthesia patients.
Dr. Andy Roark:
Veterinary Anesthesia Nerds coast to coast is what I’m hearing. So good. Awesome. Well guys, thanks so much for being here. Tasha, thanks so much for being here. I always appreciate your time.
Tasha McNerney:
Yeah. Thanks so much for having me.
Dr. Andy Roark:
And that’s our episode. Guys, I hope you enjoyed it. I hope you got a ton out of it. If you did, please feel free to leave an honest review wherever you get your podcast. It really makes a difference to me. It’s how people find us. It’s the nicest thing that you can do when it only takes a moment. Gang, that’s all I got. Take care of yourselves. Be well. I’ll talk to you soon. Bye.
New Heart Murmur in a Cat Scheduled for a Dental (HDYTT)
Dr. Anna McManamey joins the podcast to discuss heart murmurs in cats. Alabaster is a 4 year old MN domestic shorthair who is in for his first dental cleaning. On physical examination, Alabaster has a grade 2-3/6 systolic murmur. Dr. Mac breaks down what her concerns are, the risk factors and next steps to take. Let’s get into it!
You can also listen to this episode on Apple Podcasts, Google Podcasts, Soundcloud, YouTube, or wherever you get your podcasts!
LINKS
Retain Your Team: Speak the Languages of Appreciation in Your Workplace – May 21, 2022: https://unchartedvet.com/product/appreciation-languages-101/
What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. McManamey (aka Dr. Mac) is a veterinary cardiologist. She received her degree of veterinary medicine from the University of Missouri. She then completed a rotating internship at the Ohio State University followed by an emergency and critical care internship at North Carolina State University. She finished her cardiology residency at North Carolina State University and became an ACVIM diplomate in 2021. Dr. Mac is currently an assistant clinical professor at Purdue University in Indiana. Cardiology is her favorite subject because it can be made as simple or as complex as needed. Furthermore, every animal has a heart and that means Dr. Mac gets to work with all kinds of species. Her areas of interest within cardiology are echocardiogram, congenital heart disease and interventional procedures, as well as emergency management of cardiac disease. She has a very supportive and patient husband along with three canine fur-children, one of which had a patent ductus arteriosus (of course).
EPISODE TRANSCRIPT
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Welcome everybody to The Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark guys I got a great medical episode today with the one and only doctor Mac, Dr. Anna McManamey is on the podcast and she’s been on before. I met her, just, we just sat down next to each other at the VMX conference. And I started talking to her and she was delightful and awesome.
Dr. Andy Roark:
And I learned so much just sitting next to her. I was like, “You have to be on a podcast.” And this is her second appearance on the podcast. She is really great. You guys are going to get some great pearls in a short amount of time. We are talking about a four year old male neuter, domestic short hair who has a systolic murmur. Who’s in for a dental. What do you do with that? Do you do that case? Is that going to be okay? What precautions do we need to take? How concerned should we be. Guys you’ve seen this case. You don’t want to miss this. Let’s get into this episode.
Kelsey Beth Carpenter:
(singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast. Welcome back to the podcast, Dr. Mac. Thanks for being here.
Dr. Anna McManamey:
Thank you for having me.
Dr. Andy Roark:
Oh man. I enjoy having you on the podcast. I’m so glad you’re back. I have a, well, let me pause and introduce you to those who don’t know you are a professor of cardiology at Purdue’s College of Veterinary Medicine and a lecturer and a genuinely wonderful smart person and a great darn teacher. And so that’s why I hope that you would be able to help me out with this case.
Dr. Anna McManamey:
Happy to be here. It sounds so fancy when you say it that way.
Dr. Andy Roark:
I know. Yeah, I get introduced and people are, this is Andy and he has this big title and I’m like, that sounds really fancy
Dr. Anna McManamey:
I don’t know if I’m qualified. Yeah. Obvious.
Dr. Andy Roark:
I know. I’m like, boy, I hope they don’t ask me hard questions.
Dr. Anna McManamey:
Yeah. Yeah.
Dr. Andy Roark:
Because I can’t justify this.
Dr. Anna McManamey:
Yeah, I’m a newbie cardiologist, but I’m enthusiastic so.
Dr. Andy Roark:
No, you’re I think you’re amazing. I love having you on the podcast. I have a kitty cat that I need help with. I, and again, maybe this is just my personal bias maybe it’s just the ratio of dogs to cats that we tend to see in practice. Maybe it’s just sort of the secret of nature of cats. Maybe it’s that cats are a little bit harder to physically examine than dogs sometimes. I don’t feel like I find a lot of heart murmurs in cats relative to heart murmurs in dogs. But I got one, I have a four year old male neuter, domestic short hair named Alabaster who came in for a dental cleaning and he’s got a heart murmur. He’s got a grade two, maybe a grade three. I’m not the best at nailing. Exactly. He’s in the grade two, three range.
Dr. Andy Roark:
Yeah, just a systolic heart murmur. No complaints from the owners. He doesn’t seem to be coughing or anything. They said, I asked them, “Is he coughing?” And they’re like, “Not more than usual.” And so that usual, okay. Yeah. So it’s that?.Yeah. So I’m looking at this cat one is anesthesia patient, but then also number two is just a general maintenance of a fairly young cat that I had not heard a heart murmur in before. Dr Mac, how do you treat that? Where do you go with this case?
Dr. Anna McManamey:
Yeah, I think that’s a great question. This is a very common scenario of why a lot of cats come to see me honestly. I think you hit a lot of good points right off the bat. Cats are sneaky. Cats they hide their disease. They don’t usually act sick even when they are sick. And then there’s a very frustrating, I guess, ratio of the number of cats that have heart murmurs that actually have heart disease and vice versa. So when you hear a murmur in a cat, I’d say it’s a 50, 50 chance that they have structural heart disease. So still-
Dr. Andy Roark:
Okay.
Dr. Anna McManamey:
… a reasonable chance that they do have that structural heart disease that you need to further investigate before putting them under an anesthesia where they’re going to get fluids as part of their anesthetic protocol. So in cats, a murmur usually is from some type of outflow tract obstruction. So whether that’s like an HOCM, so hypertrophic obstructive cardiomyopathy. Or some type of less pathologic form, a dynamic right ventricular tract obstruction. But usually that’s where we see these murmurs in these younger cats, mitral valve disease really isn’t common in cats.
Dr. Anna McManamey:
It happens in really older cats like geriatric kind of cats. But in this young of an animal, I think it’s very appropriate. It’s a male cat, it’s a middle aged cat, domestic short hair. Those are animals that are predisposed to HCM and structural heart disease. So what are you going to do with it? Well, I think if this were a dog, the answer would be easy. Take a set of baseline chest X-rays, know what you’re dealing with. Unfortunately in cats because their heart disease, they get most commonly is a hypertrophic cardiomyopathy. It’s a concentric thickening of the ventricle. So the ventricle thickens inward. And so taking X-rays on a cat, their heart can look miraculously normal, even if they have significant disease. So I say that an X-ray is helpful for ruling out severe, severe heart disease, maybe. But honestly, if you see a big heart, they probably have heart disease. If you see a normal looking heart, they still could have heart disease.
Dr. Andy Roark:
So 50, 50 chance they could have like
Dr. Anna McManamey:
Yeah. It’s frustrating, right? Because you got this cat-
Dr. Andy Roark:
Yeah, that’s not-
Dr. Anna McManamey:
… you want to do the dental. It’s asymptomatic.
Dr. Andy Roark:
It’s much less helpful than I thought.
Dr. Anna McManamey:
Yeah. I know. So I still think X-rays are okay. I think that again, if you see a big heart on X-rays, then I’d say, well, you probably do have heart disease. If I see a normal heart on x-rays, it just doesn’t rule out heart disease. So X-rays not wrong to do the other thing that’s growing in popularity that I actually really like is something called the BNP. So it’s just a B-type natriuretic peptide. So this is a biomarker. It is very, very specific for the heart. And what it tells us is if the heart is stretched. So it doesn’t tell us what the heart disease is. It doesn’t matter if it’s even primary heart disease, it could be like in an older cat could be hyperthyroid heart disease, could be systemic hypertensive heart disease. But what it tells us is the ventricles are under some type of duress.
Dr. Anna McManamey:
They’re either having a pressure overload or a volume overload something’s going on. And this is a blood test. It’s usually always going to be sent out like IDEX is the one that owns this test currently. So it’s going to be a turnaround. So it’s not going to be same day results, but it’s a simple blood test. You can do it with their pre anesthetic blood work for example. It goes out the range for cats is pretty tight. It’s about zero to a hundred kind of picomole per decaliter is the range. And usually if it’s in that range, I don’t worry at all about any type of structural heart disease.
Dr. Anna McManamey:
If it’s outside that range, it’s a pretty sensitive test. So you might get cats that have false positives, meaning it’s a little bit outside the range, but their hearts look very normal echocardiographically, but that’s a good screening test. In my opinion, it’s better than maybe even X-rays just because again, you can have pretty severe heart disease, but a normal heart on X-rays. So the BNP, in my opinion is the cheat man’s echo. And if you can’t get to cardiologist right away, or you don’t have the money to get to a cardiologist, then a BNP is a very appropriate screening tool. And I’m looking for that number to be higher than a hundred.
Dr. Andy Roark:
Do you add that in as a routine screening test for patients you’re planning to put under anesthesia? Is it that level of screening tool utility or are you still thinking mostly patients have… I have questions or concerns about I add this on to. I’m just curious.
Dr. Anna McManamey:
Yeah. Yeah.
Dr. Andy Roark:
Are you just sending these out all day or is this a targeted?
Dr. Anna McManamey:
I know. This is a slippery slope. I’m definitely in the case.
Dr. Andy Roark:
You’re a cardiologist too. You’re like, “You’re asking the wrong guy, uh.”
Dr. Anna McManamey:
But I do. I think I realize that not everyone can come see me. Right. I mean, we see-
Dr. Andy Roark:
Sure, totally.
Dr. Anna McManamey:
It’s going to sound really bad when I tell you how many cases I see a day, it’s not enough, but I don’t have enough time to see all these cats. And so what are we going to do in the meantime? But I do think that the BNP in the cat, not so much the dog but in the cat, I think it’s appropriate to start screening cats, just like you do for hyperthyroidism.
Dr. Anna McManamey:
There’s enough cats that don’t have heart murmurs that have heart disease. And so wouldn’t it be nice if we could catch them earlier to just let the client know what’s going on with their pet, what they need to watch out for with their pet. Is there any medication their pet should be on before congestive heart failure or something happens? So I might make some people mad when I say that, but I do. I think it’s-
Dr. Andy Roark:
No, no.
Dr. Anna McManamey:
I think it’s a good enough test that it might be worth doing more often.
Dr. Andy Roark:
I mean, at what age do you start to think about screening for things like this? Right? Because it is a measurement of sort of the state of the heart.
Dr. Anna McManamey:
Yeah.
Dr. Andy Roark:
So it seems like screening kittens is probably not going to be super productive or really insightful for the future. But I mean, are you talking about five year old cats? Are you talking about eight year olds? Is this a senior wellness type of screen in your mind?
Dr. Anna McManamey:
Yeah.
Dr. Andy Roark:
I’m just curious kind of, when you look in your crystal ball, kind of where do you see that going or how do you use that tool in your toolbox?
Dr. Anna McManamey:
Yeah, first of all, highly recommend a crystal ball to every veterinarian because they do come in a very, very handy.
Dr. Andy Roark:
Well mine has been craptastic for the last three, four years. It’s just boy.
Dr. Anna McManamey:
God, I wish I had one of those. But, yeah, I think that’s a great question. So I would say if you look at HCM, hypertrophic cardiomyopathy as a model of heart disease, because it’s the most common heart disease we see in cats, it’s usually around five to eight years of age where that kind of takes its peak effect in cats. However, we see some cats as young as three. So I think five seems like a magic number for me.
Dr. Andy Roark:
Okay.
Dr. Anna McManamey:
I think maybe three is a little early, but you could catch some that are starting to show signs earlier, but I’d say it’s early as five, but I think kind of that eight years of age, when you’re starting to screen for hyperthyroidism, it’s probably appropriate to be doing the same for the heart.
Dr. Andy Roark:
All right guys, I want to jump in here with a couple quick updates. First of all, the uncharted veterinary conference was last week in a Greenville, South Carolina it was amazing. We will have a virtual conference in the back half of this year. It’ll be in October. It is our GSD for Get Stuff Done Shorthanded that’s right. Get Stuff Done Shorthanded is going to be a virtual conference, which means you can join it anywhere. It will be in October more details coming soon. Registration is not yet open, but go ahead and get fired up. This is a great way to see what Uncharted is all about. See is it really different from everything else like people say it is. Yeah, you can come and see just how that works online. And then if you love it, we’ll see you in person April next year in Greenville, South Carolina, or if you’re a practice owner, we’ll see you in person in December for our practice owner summit.
Dr. Andy Roark:
Gang, if you can’t wait that long and you know you can’t wait that long, we have a couple of workshops coming up. We have retained your team, speak the languages of appreciation in your workplace. That is with Dr. Tracy Sands. It is on May 21st. It is all about showing your team appreciation. You know they’re tired, you know they’re overwhelmed, you know that they want to feel appreciated for their work. Are you doing it right? Are you showing them appreciation? There are simple things that you can do that really make a difference. Guys, this is, as I said, May 21st, 2:00 PM Eastern, 11:00 AM Pacific time. It is $99 to the public. It is free for Uncharted members. Jump on a, get registered, come and be there. This one is actually already filling up. It’s a month away and the spots are largely taken. So jump in there and grab a spot while you can.
Dr. Andy Roark:
On June 8th, my friend, Bill Schroeder, founder and CEO of InTouch Veterinary Communications is doing his workshop, creating content that clients crave. This is all about making information in a way that clients will want to consume it. If you’re tired of trying to educate in the exam room, if you want some backup, if you want some help, if you’re like, I don’t have enough time to communicate everything, I need to communicate. Jump in on this webinar or it’s a workshop you’re actually going to work on the thing. That’s the difference in a workshop and a webinar. We do the thing and uncharted. June the 8th, 7:00 PM Eastern, 4:00 PM Pacific time. This is $99 to the public, free for Uncharted members. You can hit the link in the show notes and get registered for that as well. Guys, that’s enough for me. Let’s get back into this episode.
Dr. Andy Roark:
Talk to me a little bit about blood pressure in these cats. Is that going to be an insightful tool when I’ve got this sort of heart murmur? Yeah. I mean, is that something? It didn’t come immediately to hand, I guess when we talked about chest X-rays, when we talked about the BNP.
Dr. Anna McManamey:
Yeah.
Dr. Andy Roark:
Is there real value in trying to get this cat calmed down in a nice secluded place and try to get a good blood pressure and what can I gain from that?
Dr. Anna McManamey:
Yeah, that’s a great question. So I usually will reserve the blood pressure. I think it’s a very important test, but I usually will keep it for a little bit later in the lifespan of a cat. So it’s unlikely that the cat at this age at five years of age is going to have systemic hypertension. However-
Dr. Andy Roark:
Okay.
Dr. Anna McManamey:
… that’s a very cheap, very accessible test to do, because again, if your BNP is high, you’re kind of obligated to check a systemic blood pressure and to check a thyroid level. Again, even though it’s unlikely in a cat that young, if those two diseases are present, whether that’s systemic hypertension or hyperthyroidism, both of those conditions cause a thick left ventricle, would cause an elevated BNP. So definitely has its place again in that age range, I’d be less suspicious of it, but totally appropriate to do.
Dr. Andy Roark:
Okay. Let’s talk about management of heart disease in cats. And I think that’s something that probably compliance and adherence are often a bit of a challenge. It’s hard, especially if we have ongoing medications for these cats. How do you introduce the idea of long term medication to pet owners? What sort of pearls of advice do you have for setting pet owners for success?
Dr. Anna McManamey:
Yeah, it’s a great question. And I think with cats, it’s just a whole nother level of difficulty than compared to dogs.
Dr. Andy Roark:
Yeah.
Dr. Anna McManamey:
You’ll get the occasional cat that just eats everything you put in front of them, but that’s not always going to be the case. So the good news is that cats with heart disease, again, HCM being the most common, really the only medication that we routinely recommend in these guys before congestive heart failure happens is a blood thinner and Plavix clopidogrel, we do think is probably better than just Aspirin for preventing that thromboembolic event. That’s that big scary thing that we really want to be able to just let clients know their cat has a risk for it. I would say a lot of ATEs aortic thromboembolism that I see, unfortunately it’s the first time the owner ever knew their cat had disease.
Dr. Anna McManamey:
So that’s the one that we’re trying to protect them with. And so really the left atrium has to be big for them to be at that risk. In most cases, I’ll say less than less than 5% of cats that have ATEs have a normal left atrium size. So most of the time their left atrium’s big. If they have a high BNP if I would say probably at least over 200 BNP range, if we echo them and they have a big left atrium, blood thinner is what we’re prioritizing in terms of treatment.
Dr. Andy Roark:
Okay.
Dr. Anna McManamey:
It’s a once a day therapy, it’s a small pill. So those things are in our favor.
Dr. Andy Roark:
Yep.
Dr. Anna McManamey:
Once heart failure happens, congestive failure happens, then it’s really Furosemide and they’re Plavix plus or minus an ACE inhibitor. We don’t have that same evidence that it has to have that ACE inhibitor to have a better prognosis once congestive heart failure happens like we do in dogs. Does it make sense that they would do better? Yeah, it makes sense, but we don’t have that exact evidence. So if congestive heart failure happens and I have a cat that the client can’t medicate, well, I’m just going to prioritize what I need to give them. And that’s their Lasix, which is a small pill and that’s their Plavix or some type of blood thinner to try to reduce that risk of an ATE.
Dr. Anna McManamey:
I have cats that are on injectable drugs. They’re on injectable Lasix because the owner can’t medicate them. So it’s kind of like a diabetic cat in that stance. So we’re just giving injections of Lasix twice a day, instead of giving oral medications. And you can coat the meds in some butter, you can coat them in cottage cheese, those kinds of tricks. But unfortunately, at least not yet are transdermal medications. I think that would be a godsend if we could get some bioavailable, transdermal Plavix or transdermal Lasix, something like that for these kind of cats. Yeah.
Dr. Andy Roark:
Okay. I was going to say no success in that regard so far.
Dr. Anna McManamey:
Not yet. Not yet
Dr. Andy Roark:
So I’ve heard people mention Pimobendan and cats.
Dr. Anna McManamey:
Yeah.
Dr. Andy Roark:
Is that-
Dr. Anna McManamey:
That’s yeah.
Dr. Andy Roark:
That’s kind of one of those back alley hey.
Dr. Anna McManamey:
Yeah. I was listening to-
Dr. Andy Roark:
Animal vet, come here.
Dr. Anna McManamey:
… one of your podcasts with Dr. Journey and she was… It’s the religion debate. Right. So-
Dr. Andy Roark:
Yeah.
Dr. Anna McManamey:
Yeah. So I would say that for the asymptomatic cat. So the cat that’s not in congestive heart failure. There’s probably no cardiologist that’s going to recommend Pimobendan in those cats.
Dr. Andy Roark:
Okay.
Dr. Anna McManamey:
So different than dogs. If there is a cat with congestive heart failure, some cardiologists might start Pimobendan in those cats. The rule for me is if there is a murmur, don’t give the Pimobendan because Pimobendan worsens dynamic obstruction. So if you already have a heart murmur, odds are it’s dynamic obstruction, giving Pimobendan will worsen that obstruction. So that’s kind of my general rule. If there’s a murmur and heart failure in a cat, just don’t give Pimo just stick with your Lasix, your Plavix plus, or minus your ACE inhibitor.
Dr. Andy Roark:
That’s super useful. Thank you for walking through this with me. Are there any final pearls or words of wisdom or pitfalls I should look out for just in general dealing with heart disease in a cat?
Dr. Anna McManamey:
Yeah. I think something that you actually mentioned in part of the history was coughing in cats. Coughing in the cat, rarely is from heart disease. Rarely is from congestive heart failure. I’d say the only times they see cats coughing with congestive heart failure is if they have a significant amount of plural effusion or a significant amount of pericardial fusion, which are both presentations of left sided congestive heart failure in the cat. So the coughing cat with a murmur to me, I actually move heart failure way down on my list and prioritize other things.
Dr. Anna McManamey:
The other little tidbit I’ll leave you with is if you’re in the ER setting and you tap a cat’s chest, do a thoracentesis and you just want to know, is this heart failure or not? You can run that sample on a BNP test. So you don’t even have to use the blood.
Dr. Andy Roark:
Really?
Dr. Anna McManamey:
And there’s these BNP tests, the B-type natriuretic peptide tests that are snap tests that are available for the ER setting. It just tells you, is it normal? Is it abnormal? That’s of same day test. It’s snap it’s eight minutes, but you can run that on blood serum or the plural effusion and you actually get a pretty good result with that.
Dr. Andy Roark:
That is super useful. Awesome. Thank you. Thank you. Thanks for sharing. I’ll tell you real quick. I remember being a first year veterinarian and I had a cat that had a chest full of fluid and I was going to tap it and the owner was there and I was getting ready to do it. And he said, “How many of these have you done before?” I was like, “I wish you hadn’t asked me that.” And then I was like, “I’m going to be honest,” and I’m like, “none but I’ve read about them.” And he was like, “I!s there someone else who could do this? And I had to go get… And I did, I went. The most humbling experience but-
Dr. Anna McManamey:
Oh my gosh. That’s-
Dr. Andy Roark:
I guess-
Dr. Anna McManamey:
That still happens to me. They’re like, “How many have you done?” And the devil on my shoulder wants to say, “Whether it’s one or a hundred, I’m all you got so you might as well.”
Dr. Andy Roark:
Yeah. Yeah, exactly. Right. Yeah. And just for me, I worked in a big practice. There were literally a dozen other vets. And they were like, “Why don’t you get somebody else junior?”
Dr. Anna McManamey:
It’s humbling.
Dr. Andy Roark:
Whenever I start to tap a cats chest I think how many of these have I done? It’s like, oh, a dozen. Okay. But, oh man, that’s funny. But yeah. Well the other thing too, you, how many of you done, you did a rotating internship, you did an emergency critical care internship, and then you did a residency. There’s probably not a whole lot that you haven’t done once-
Dr. Anna McManamey:
At least once so yeah.
Dr. Andy Roark:
… already so. At least.
Dr. Anna McManamey:
But it is. It’s always a little humbling and you’re kind of, eh, how do I answer that?
Dr. Andy Roark:
I’ve been doing vet medicine for 13 years and I am humbled every day and then I go in there and go, ah, oh, well, I love it. Yeah, I think if it wasn’t that way, I think it might get boring.
Dr. Anna McManamey:
Yeah I agree.
Dr. Andy Roark:
And that medicine’s a lot of things.
Dr. Anna McManamey:
Never boring.
Dr. Andy Roark:
Borings not one of them. Thank you, my friend. Thanks for being here.
Dr. Anna McManamey:
My pleasure. Thank you.
Dr. Andy Roark:
And that’s our episode, guys. I hope you enjoyed it. I hope you got turned out of it. If you did, please feel free to go leave us an honest review, wherever you get your podcast. It really makes a difference to me. It’s how people find us. It’s the nicest thing that you can do and it only takes a moment. Gang, that’s all I got. Take care of yourselves. Be well. I’ll talk to you soon. Bye.
Management of Acute Pain in Cats – New Consensus Guidelines
Dr. Sheila Robertson is board certified in anesthesia and in animal welfare in the USA and Europe and serves as the senior medical director at Lap of Love Pet Hospice. Today, she joins Dr. Andy Roark to discuss a recent research publication on which she is an author: the 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. This is a great episode for anyone interested in getting our feline patients better pain control and generally better experiences in the veterinary clinic.
You can also listen to this episode on Apple Podcasts, Google Podcasts, Soundcloud, YouTube, or wherever you get your podcasts!
LINKS
2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats:
https://journals.sagepub.com/doi/metrics/10.1177/1098612X211066268
Feline Grimace Scale (Website & App):
https://www.felinegrimacescale.com/
AAFP Feline Friendly Handling Guidelines:
https://catvets.com/guidelines/practice-guidelines/handling-guidelines
Retain Your Team – Speak the Languages of Appreciation in Your Workplace: https://unchartedvet.com/product/appreciation-languages-101/
Creating Content Clients Crave: https://unchartedvet.com/product/creating-content-that-clients-crave/
What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. Sheila Robertson graduated from the University of Glasgow in Scotland in 1980. After some time in mixed animal practice, she spent a year as a surgery intern followed by specialized training in anesthesia and analgesia at Bristol University (United Kingdom). While at Bristol she also completed her PhD investigating the physiologic effects of different anesthetic protocols in horses. She is board certified in anesthesia and in animal welfare in the USA and Europe and holds a certificate in small animal acupuncture. She has been a faculty member at the University of Saskatchewan, Michigan State University, and the University of Florida. Her research interests have focused on the recognition and alleviation of acute pain in cats, horses and even iguanas, topics she has published widely on.
She spent 2 years as an assistant director in the division of Animal Welfare at the American Veterinary Medical Association. In 2014 she completed her graduate certificate in Shelter Medicine at the University of Florida. In 2019 she received her certification as a Traditional Chinese Veterinary Medicine Palliative and End-of-Life practitioner by the Chi Institute of Chinese Medicine. Currently she is the senior medical director of Lap of Love Veterinary Hospice, a large network of veterinarians dedicated to end-of-life care and in-home euthanasia throughout the USA. Dr Robertson is also a courtesy Professor in the Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida. She continues to volunteer at community cat clinics and High-Volume High Quality Spay and Neuter Programs.
EPISODE TRANSCRIPT
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andrew Roark.
Dr. Andy Roark:
Guys, I am here today with the one and only Dr. Sheila Robertson. She was on the faculty at the University of Florida when I was there. She is board certified in anesthesia and animal welfare in both the USA and in Europe. She is absolutely brilliant and amazing. And she has got some new research out. She is an author on the 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. And I wanted to talk to her about acute pain and pain management in cats. And man, we get into it.
Dr. Andy Roark:
She’s super excited about the Feline Grimace Scale and the Feline Grimace Scale app, which I was unaware of. And so man, new tool in my toolbox.
Dr. Andy Roark:
Guys, this is a great episode. We really get into it later on talking about, the back half of the podcast, we get a lot into action steps and what we can be doing in the practices. That makes me super happy. Anyway, all-around great conversation. I hope you enjoy it. Let’s get into this episode.
Kelsey Beth Carpenter:
(singing) This is your show, we’re glad you’re here, we want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast Dr. Sheila Robertson. Thanks for being here.
Dr. Shelia Robertson:
Oh, thanks for inviting me. I listen in a lot. Never thought I’d be a guest.
Dr. Andy Roark:
Right. I have known you for some time now. You were on the faculty at the University of Florida when I was there. You were running my anesthesia rotation when I went through. And that was the first time I got to spend time with you. I’ve seen you lecture dozens of times since then all over the world.
Dr. Andy Roark:
You are the senior medical director at Lap of Love Pet Hospice, which is a group that was founded by some of my classmates and dear friends and they’re a great group. And gosh, you’re just everywhere. You work with the global pain council for WSAVA, which is the World Small Animal Veterinary Association. And you publish all over the place. And that’s honestly what I wanted to talk to you about today is a study that you have put out with a group of collaborators, it’s the 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats.
Dr. Andy Roark:
And so this just came out in January. I think you were doing some speaking about it at the VMX Conference in Orlando. And I saw, I think you were on the agenda there talking about it, and I am a huge advocate for better care for cats and I think pain management in cats is something that we have not traditionally done as well as we should as a profession. And so I look at this and I say, “This is something that I would like to understand more.” And I’m always checking myself and trying to make sure that I’m practicing good medicine that I’m up to the current standards and things like that. So that is how I know you and kind of what I wanted to talk to you about today.
Dr. Shelia Robertson:
Yeah. Just so everybody knows what these are consensus guidelines.
Dr. Andy Roark:
Okay.
Dr. Shelia Robertson:
And ISFM stands for the International Society of Feline Medicine. So these are global. We wanted them to be able to be used around the world. Where access to different drugs and different types of therapy can be very different. So we wanted to make them global. And the group that put them together is Paulo Stegall originally from Brazil now working in Hong Kong. Myself, Brad Simon, who’s at Texas A & M, and then we have Leon Warren from Australia, was on them. And then Yael Shilo-Benjamini. She is actually based in Israel, did her training here in the US, and then Sam Taylor, who is a specialist, internal medicine and feline person in the UK.
Dr. Shelia Robertson:
So we got that group together and decided that it was time to really focus on cats and give them an entire paper to themselves, not kind of tagged onto the back of a dog paper. So these are completely feline only acute pain management guidelines.
Dr. Andy Roark:
So, let’s start at a high level. What are the objectives of the guidelines when you set out? So what were you trying to accomplish when you guys went to work on this?
Dr. Shelia Robertson:
Yeah. Well, so it almost like I can tell that you might have read them because one of the opening statements says, “Pain has traditionally been under recognized in cats.” And obviously if you under recognize it, that by default, means it’s undertreated, right? And we also know that pain assessment tools aren’t widely implemented. And so cats are very different from dogs.
Dr. Shelia Robertson:
I mean, cats are so good at hiding everything from people. And they’re not as demonstrative when they’re in trouble and we know that from other diseases. And so we wanted to raise awareness of the fact that they will be as painful as dogs after the same types of procedures or trauma, but there are lots of data to show that they’re not treated as well. People are, “Oh, I’m afraid to give a cat this,” because they have unique metabolism compared to dogs as well.
Dr. Shelia Robertson:
So the object was to really let people know that there are some very easy-to-use pain recognition tools out there that are now apps that you can put on a smartphone. And what does pain look like? And once you know what it looks like, you can actually score it. Because my philosophy is that we have an outcome measure for just about everything we do, right?
Dr. Shelia Robertson:
Say a cat comes in with a fever, like a very high temperature. So you can try and figure out was causing it. You treat it, but your resolution is, the temperature comes down, right.
Dr. Andy Roark:
Right.
Dr. Shelia Robertson:
If they’re diabetic, we follow their blood glucose. If have renal disease, we follow their blood work or SDMA. So what are people using as an outcome measure to say that they treated in pain effectively?
Dr. Andy Roark:
Yeah. It’s very little.
Dr. Shelia Robertson:
Other than I just think the cat looks better?
Dr. Andy Roark:
Right. Or, the cat seems more fractious and anxious next time it comes in and you think, “Oh, well maybe we didn’t do as good a job last time as we could have.”
Dr. Shelia Robertson:
Yeah. Yeah. And so we spent quite a bit of time putting in really nice real life images that each of us had of what feline pain looks like and how to examine a cat and recognize pain. And we did quite a lot on talking about the Feline Grimace Scale.
Dr. Andy Roark:
Yeah.
Dr. Shelia Robertson:
Which I like for a lot of quick assessments because it’s basically, you look at the face and they’re scored from zero to 10. Now that is now an app that can be downloaded on a smartphone. And yeah, it’s at the app store and everybody in the world has a smartphone. So you can download that app and use it cage-side to start scoring. You look at the pictures and you score their facial expression and it can tell you. And then if you instigate treatment, if you chose the right drug and did the right thing and things are better, the score goes down, right?
Dr. Andy Roark:
Yeah. I’ll put links to the app and also to the paper in the show notes so people can grab it.
Dr. Andy Roark:
So how widespread do you think that monitoring of pain in feline patients is in vet practices? Do you see practices that are doing good monitoring sort of patient care? And, I think a lot of us do a good job of recording hydration status, recording temperatures. Coming through and just checking on general wellbeing. Do our patients have food? Do they have water? Things like that.
Dr. Andy Roark:
Do you see a lot of practices that are doing an adequate, I’m just going to set the bar at adequate, do you see practices that are doing an adequate job of pain monitoring?
Dr. Shelia Robertson:
So I would say a lot of people using good protocols, but they’re not actually assessing how effective their protocols are. There was a paper just published very recently from a large number of veterinarians. And it was based in Australia and only 15% actually use a validated pain tool to assess pain in their patient population.
Dr. Andy Roark:
Right.
Dr. Shelia Robertson:
So they’re just doing it based on, well, I know if the cat is okay or not, right? It’s almost like you look at the cat and you guess that it’s temperature’s okay, but you don’t actually take the temperature.
Dr. Andy Roark:
Right? No, that definitely makes sense. Do you see good systems that people put in place? In your mind, when you see this, is this something that is hospital-wide, is this support staff technicians that are going by and sort of checking on this? Is it doctors? How sort of frequent in your mind does a monitoring system like this check-in on the patient? Is this an hourly check postsurgery? Help me dig into the specifics a little bit. I guess what I’m trying to do is really imagine this in my practice and what it could look like?
Dr. Shelia Robertson:
So when I was working in referral practice, so university practices, so we were getting pretty complex cases. And basically, my wing men and women are the anesthesia technicians, right? And I think that we need to empower technicians a lot more than we do, because if you think of yourself every day, Andy, you are probably in the surgery room or your surgeons are in the surgery room, doing surgery. The anesthesia techs admit the cat. It has an exam by a doctor and they often examine it. You check it over, you decide on a protocol, and they get it ready. So they’ve spent more time with the cat than you. So they know its personality, how it reacted to things. And then they take it to recovery. And they are really the advocate for that cat because they know how it was behaving before.
Dr. Shelia Robertson:
And obviously, if it’s now still nice and friendly and wants to play, everything went well. But if it’s not, they could come to you and say, “I don’t think this cat is doing very well.” And you might say, “Well, that’s your opinion. Let me look.” And so if you have a validated pain scoring tool, it’s no longer someone’s opinion, right? It’s well, here’s the temperature and here is its blood glucose level, here’s its pain score. So it gives them a lot more to advocate with and for everyone to focus on trying to get that score down.
Dr. Shelia Robertson:
And I think that is important because it empowers them. And there is a lot of what I know. I have pictures that I sometimes show when I go and visit hospitals, I’ll see notices on the front of a cat cage and it says, “Will bite,” and I’m like, “Why?” Does it bite because it’s painful. And if I ask, they go, “No, it’s just a evil cat.” And I’m like, “Well maybe it’s very anxious. Maybe it’s very afraid. Maybe it’s very painful.” So there is a lot of labeling and bias goes on and then people call it the diva cat, it’ll flinch if you just touch it. But to the cat, that pain is real and it will escalate with each visit if we don’t do the right things. And then we can talk later about the connection between fear and anxiety and pain because that’s more of a connection than we ever thought.
Dr. Andy Roark:
Yeah. So let’s go ahead and start to unpack that a little bit. So I, 100% resonate with what you’re saying about, “Oh, will bite. It’s a bad cat. She’s she’s evil.” Diagnosis, evil.
Dr. Andy Roark:
Why do you think that we don’t commonly make that distinction? Is it a lack of knowledge on our part? Is it a lack of understanding of anxiety, behavior, stress, or things like that? Why don’t we do a better job of understanding sort of why we get the reactions that we do from cats?
Dr. Shelia Robertson:
I mean, I think we’re all we’re moving in the right direction. And of course, there’s been a huge initiative for feeling friendly, cat-friendly practices. Lots of people understand how difficult it is to get a cat and a carrier and then drive it. A lot of them are motion sick and people don’t realize that, yet there are drugs we could give them to make them feel better. They could be dispensed with antiemetics before their next visit. And then a lot of people are using Gabapentin to sedate them. But remember that’s an anti-anxiety drug as well. And I think cats are, they don’t like change, but the biggest thing is they get very, very stressed when they don’t have control over their environment.
Dr. Shelia Robertson:
And they don’t get the same, I think, reassurance from having the owner there. A dog is with its owner and it obeys commands. I know we have difficult dogs to deal with but I think it’s more common in the cat. The cat really does not like a new environment and that new environment is extremely threatening to them when they don’t have control. And the control they have, in most threatening environments, is escape, right? And they don’t have that at your clinic. And then if they don’t live or haven’t been exposed to dogs and there are dogs barking and dogs smell, that’s very distressing to them.
Dr. Shelia Robertson:
So certainly understanding what an anxious, fearful cat looks like and what a painful cat looks like is important. But often they’re both. They can be painful and anxious and fearful and all of that is subversive and unpleasant. So we need to deal with all of it.
Dr. Andy Roark:
Yeah. So it sounds more like a holistic kind of generalized approach as far as low-stress handling. How we’re housing cats, things like that.
Dr. Andy Roark:
All right guys. This is when I jump in here with a couple of quick updates. First of all, the Uncharted Veterinary Vonference was last week in Greenville, South Carolina. It was amazing. We will have a virtual conference in the back half of this year. It’ll be in October. It is our GSD for Get Stuff Done Shorthanded.
Dr. Andy Roark:
That’s right. Get stuff Done shorthanded is going to be a virtual conference, which means you can join it anywhere. It will be in October more details coming soon. Registration is not yet open, but go ahead and get fired up. This is a great way to see what Unchartered is all about. See is it really different from everything else? Like people say it is, yeah. You can come and see just how that works online.
Dr. Andy Roark:
And then, if you love it, we’ll see you in person April next year in Greenville, South Carolina. Or, if you’re a practice owner, we’ll see you in person in December for our Practice Owner Summit.
Dr. Andy Roark:
Gang, if you can’t wait that long, and you know you can’t wait that long. We have a couple of workshops coming up. We have Retain Your Team. Speak the languages of appreciation in your workplace that is with Dr. Tracy Sands. It is on May 21st. It is all about showing your team appreciation. You know, they’re tired, you know they’re overwhelmed. You know that they want to feel appreciated for their work. Are you doing it right? Are you showing them appreciation? There are simple things that you can do that really make a difference. Guys, this is, as I said, May 21st 2:00 PM, Eastern, 11:00 AM Pacific time. It is $99 to the public. It is free for Uncharted members. Jump on, get registered, come and be there. This one is actually already filling up. It’s a month away and the spots are largely taken. So jump in there and grab a spot while you can.
Dr. Andy Roark:
On June the eighth, my friend, Bill Schroeder, founder and CEO of InTouch Veterinary Communications is doing his workshop, Creating Content that Clients Crave. This is all about making information in a way that clients will want to consume it. If you are tired of trying to educate in the exam room, if you want some backup, if you want some help, if you’re like, “I don’t have enough time to communicate everything, I need to communicate,” jump in on this webinar or, it’s a workshop, you’re actually going to work on the thing. That’s the difference in a workshop in a webinar, we do the thing, in Uncharted. June the eighth 7:00 PM, Eastern, 4:00 PM Pacific time. This is $99 to the public. Free for Uncharted members. You can hit the link in the show notes and get registered for that as well.
Dr. Andy Roark:
Guys, that’s enough for me. Let’s get back into this episode.
Dr. Andy Roark:
What do you think are the keys for sort of implementing this in practices? From the things that you see, what are the most important changes that sort of make you try to get practices up to speed? Are there approaches that seem to be particularly successful in getting the team on board and actually making changes?
Dr. Shelia Robertson:
Well, I think the AAFP has some very, very good courses that anyone can take. I mean, from veterinarians, technicians, and nurses, all the way down to anybody that even works in your clinic, and at very reasonable cost, can get certified or take a training course in how to handle cats and recognize, what they’re likely to do.
Dr. Shelia Robertson:
So I think the feline-friendly practice program is phenomenal and it’s coming up on its 10-year anniversary this year. And I think that’s made a huge difference to how we understand cats and allows people to work through learning about those things.
Dr. Shelia Robertson:
I think we all understand the exam room should be a little bit different. Using pheromones to calm animals or cats down. Owners can have a Feliway wipe in the carrier before they even come. And again, doing a cat exam, you can do a little bit, you can’t force it, right. You’ve just got to take your time. And I think the pre-visit Gabapentin, which is what most people use, some use Trazodone, but I think the pre-visit Gabapentin has been very, very successful for a lot of people.
Dr. Andy Roark:
Yeah. That’s a trend I definitely would like to see continue to spread. I’m amazed at how many practices do not have pre-visit Gabapentin or another sedative, anti-anxiety medicine pickup. It’s such an easy trick and pet owners appreciate it and it makes such a difference when people come in.
Dr. Shelia Robertson:
Yeah. And the stress itself can actually make you make a wrong diagnosis, right? They’re hypertensive, but they’re not really, it’s white coat hypertension, their blood glucose through the roof, because they’re so stressed out, and yet that could lead you down the wrong path with a diagnosis.
Dr. Andy Roark:
Yeah. What do you see as the biggest pushback that people run into as they start to improve their feline patient monitoring, things like that? Where, where are the pain points? Say that I wanted to advance this in my own practice as a veterinarian, where do people run into roadblocks?
Dr. Shelia Robertson:
I’ll be honest. I think a lot of people say, “Well, we know what a comfortable cat looks like.” And I thought I did until, I mean years and years ago started creating the Glasgow Acute Pain and validating that scale, which is more than just the face. The face is included, but it’s also palpation and so on. And I think what has been overlooked if a cat is sitting at the back of the cage, quiet and not moving, people have assumed it’s okay. And that’s actually the cat that I would now look at.
Dr. Shelia Robertson:
That would be a red flag because they’re at the back of the cage because they’re trying to hide and they haven’t been given a safe place to hide. Because that’s one of their coping mechanisms, right? They don’t have a box to hide in and they’re not moving because they’re painful and they’re not doing normal behaviors like getting up and having a nice stretch because their incision on their abdomen really hurts or they’re not grooming themselves because they hurt.
Dr. Shelia Robertson:
And then pain can make them nauseous as well and then they don’t want to eat in your clinic. I mean, a lot of them are just very suspicious of everything at the clinic. But use pheromones in their cage. And we do what’s called spot cleaning, which I learned from doing shelter work. Is that if it’s their own cage they will have taken the time to mark it and put their cheek pheromones on it.
Dr. Shelia Robertson:
All you need to do when you tidy up is just take anything that’s soiled, leave everything else because they’ve marked it and they’ve said, “This is my safe place.” So all I ever do now is clean up totally soiled articles in a cat cage and then give them a new towel that has been sprayed and left to air for 15 minutes with Feliway to put it in for security.
Dr. Shelia Robertson:
And again, noise, and partially covering the cage, and having the staff all know how to approach a cat, that not every interaction with the clinic should be for something to be done. I actually advise people when a cat is staying for several days that you should prescribe non-medical treatment. So the cat doesn’t anticipate that every time someone’s at the front of the cage, it’s going to be a pill. It’s going to be they’re going to do something to you. And we have good data, from again, from shelter medicine, showing that if you come up to the cage and just stroke the cat, pet the cat, and just have a safe interaction with it that doesn’t involve anything unpleasant, then everything’s much, much better.
Dr. Shelia Robertson:
It would take five minutes extra each day, or you could have volunteers obviously, that know that they’re going to not get hurt, open up and just speak to the cat and stroke it or get out a brush and brush it to help it because even that in itself releases endorphins and it is a good thing to do. But every single interaction usually is a medical interaction and they anticipate it, right?
Dr. Andy Roark:
Yeah.
Dr. Shelia Robertson:
I would too.
Dr. Andy Roark:
That makes perfect… Oh, absolutely. Sure, every time the door opens something bad happens and I get poked with a needle or grabbed by my neck or whatever, exactly. That doesn’t take long to leave a lasting impression about what’s going to happen.
Dr. Shelia Robertson:
So this not this like positive reinforcement that nothing bad’s going to happen. I’m going to groom you or I’m going to give you just a little bit of really super nutritious food, like a little piece of the tubes of Churu, which all the cats love. And they’re like, “Oh, okay. That was okay.” And then it was a predictable, positive interaction and I think they need, they need more of that. And I know everybody is busy. And then to have the time to do that before a treatment and then immediately after their treatment as well, if they’re getting an injection or something’s being done, would, I think, help lot.
Dr. Andy Roark:
Yeah. That makes a lot of sense. I mean, everybody’s busy at the same time. I mean what are the benefits to patient care? What are the benefits to reducing risk of cat bites and things like that by creating a better experience?
Dr. Shelia Robertson:
Well, yeah, I mean, there is good data to show that feline-friendly, trained practices have lower incidents of bite. Well, fewer people in the practice have a cat bite, and you know that can take someone out for days, right?
Dr. Andy Roark:
Yeah.
Dr. Shelia Robertson:
If they’re a surgeon they’re out for days. All has to be reported to HR and it’s horrible. So we know that cat bites can be reduced when people understand cats. And the other thing is a cat that is being totally defensive. You can’t nurse it, right? So the actual care of the cat is suboptimal. But if they’re very relaxed and feel secure, you can actually nurse them and take care of them.
Dr. Shelia Robertson:
They will want to eat, they won’t have GI stasis because they’re so fearful, which then in itself leads to all sorts of other problems. Hypertension, right? Is it real or is it that they’re terrified of being in their cage? So there’s just so much to understanding normal cat behavior and how to make it a better or experience.
Dr. Andy Roark:
No, that’s actually, that’s really great. That’s actually really useful. I’m going to sit with that. I like this a lot. Prescription snuggles, I think that’s fantastic. That makes me happy.
Dr. Shelia Robertson:
Yeah.
Dr. Andy Roark:
Let’s jump back for one second. So let’s say that I have that cat that’s just sitting at the back of the cage. So, I’ve got a patient, they had a fairly routine surgical procedure we’re going to say. Now they’re just sitting at the back of the cage and I’m hearing your voice in my mind saying, “You know, that cat at the back of the cage, that may be your painful patient.”
Dr. Andy Roark:
Can you walk me through just step-by-step? How would you assess pain in this cat. You talked about patient and things like that, but just run me through kind of what is your thought process as you are looking through the front of the cage and you see this cat looking back at you from the back?
Dr. Shelia Robertson:
Yep. So when we assess pain, we have two parts. We observe them only and we try and do that without them sort of knowing we’re there. So not right in their face, but just kind of have a look at them in the cage. So that’s going to let us see what their spontaneous pain behaviors are.
Dr. Shelia Robertson:
Now a spontaneous pain behavior in a cat is sitting still doing nothing but hunched up. That’s a pain behavior, but because it’s not throwing themselves around and wailing like a dog. It’s often ignored as an actual pain behavior.
Dr. Shelia Robertson:
And then we have what we call evoked pain behavior. So that’s when we have done the observation and then we actually interact and touch the wound. Sometimes that’s possible. Sometimes it’s not.
Dr. Shelia Robertson:
So for the cat, that’s sitting at the back of the cage, I would be, if I’ve downloaded, which probably everyone hopefully will do after this podcast, download the Feline Grimace Scale onto my iPhone. I’m going to pull it up. And I’m going to look at the cat’s face and start scoring it.
Dr. Shelia Robertson:
So we look at their ears, we look at their eye position, we look at their whiskers, we look at their muzzle, because it’s called the Grimace Scale for a reason, right?
Dr. Shelia Robertson:
When you’re painful, you kind of go, eh, and when you are a cat that makes your whiskers move, right? And your whole jaw and muzzle changes.
Dr. Shelia Robertson:
And then the other thing, which isn’t actually the face, but it’s the position of the head in relation to the cat shoulders.
Dr. Shelia Robertson:
So cats that are painful will just kind of drop their head down like this. But when they’re happy, their head is up, above their shoulders.
Dr. Shelia Robertson:
So those are the five things that you look at, and each is scored zero, one, or two. So you can have zero for the happiest, I’m doing great cat, and 10, yikes. Something’s really wrong. And round about four or five, we would say this cat needs rescue or needs to be looked at. What’s wrong?
Dr. Shelia Robertson:
Now the ear positions for pain and stress and fear are similar, right? So a cat that’s very fearful. Their ears go kind of flat. And so does a cat in pain. So we need to kind of figure out, and that’s why your nurses and technicians know when they come in for an elective procedure, they’re very unlikely to be painful, right?
Dr. Shelia Robertson:
So you do a baseline score. Now a baseline cat could score two for flat ears because is afraid. So what we’re looking at is differences in that score after the only thing you did before and after is do the surgery, right? So you’re looking for the pain scale or their score not to go up. You’re looking for it to the same. Maybe the flat ears. I’m still a little anxious, but not to go up.
Dr. Shelia Robertson:
And if you take care of anxiety, it’ll go down, right. It’ll be even better.
Dr. Andy Roark:
Yeah.
Dr. Shelia Robertson:
Right. If you take care of that. So that would be the first thing is look at their face. And then we look at posture. But I think people are finding the Feline Grimace Scale does correlate well with the Glasgow Acute Scale, which takes a little longer to do because then you interact with the cat. You touch it and stroke. Does it do the usual greet you? Does it not want to let you near it? Because that’s a bad sign. Do you hold their head, you should be able to touch around and palpate a wound gently if your pain management is adequate or good.
Dr. Andy Roark:
Okay.
Dr. Shelia Robertson:
Without them trying to turn around and nail you, they may flinch a little bit. And it also helps you look and see if your protocols are working most of the time and what I can do, even at feral cat clinics. I can go into one of those clinics, do the facial scale and show that their protocol works for most cats, like 96%. But there’ll always be a few that fall between the cracks, even with the same protocol. And that’s genetics, every cat’s different. It may have had previous pain. So it may already have come in with chronic pain that we don’t know about and we’ve added acute pain because we neutered it. But if I went into clinic and we’re rescuing, 50% of the time your protocol needs to be reworked, right?
Dr. Andy Roark:
Yeah. No, that totally makes sense. All that makes sense. I love the idea of a baseline score and it’s so simple it makes a ton of sense and it simply didn’t occur to me to do a baseline pain score on a cat. You go, “Well, you just came from home, the baseline score’s going to be 0. Well, no, we need to start looking at signs of stress.
Dr. Shelia Robertson:
And, the great thing about if you want to talk about continuing continuity of care when they go home before the owner leaves, they can download the Feline Grimace Scale app onto their phone, right? Or you can give them as part of their, like here. They could even do it at home before they leave to come in. Score their cat and then they can be monitoring the cat at home after a surgical procedure. And you know, you can say, “Well, if you score them with this app and their score goes back up to seven, you need to call us.” And it could be that the cat is getting more painful. Often it’s like, “Well you gave me those meds, but I can’t get her to take them,” right? And that’s why she’s painful. So it helps with the continuation of care at home.
Dr. Andy Roark:
Yeah. And so the app is approachable for vet owners.
Dr. Shelia Robertson:
Yeah. It’s free. It’s one of the number one medical download apps at the moment and it’s for Apple and for the other.
Dr. Andy Roark:
For Android, yeah.
Dr. Shelia Robertson:
It’s IOS and Android and Android. Yep. And it’s free. Yep.
Dr. Andy Roark:
Perfect.
Dr. Andy Roark:
Well, that’s awesome. I’m going to put a link down in the show notes. I’m going to link to the study so that people can download and have that as well. I’ll put a link to the AAFP courses for feline handling.
Dr. Shelia Robertson:
Yep.
Dr. Andy Roark:
Are there any other resources that you would recommend for my cat warriors who want to make sure they’re doing good pain control and learning what they can to be the best advocate for our feline patients?
Dr. Shelia Robertson:
Yeah. Well the good thing about the Feline Grimace Score, other than the app, they have their own website. And it’s now, the actual tool is in multiple different languages. So it’s in Spanish, it’s in lots of different languages because a lot of us have clients or people in our practice that English isn’t their first language. So that’s very positive.
Dr. Shelia Robertson:
And then the other thing, in there, they’re upgrading it more and more. So the really good thing about the Feline Grimace Scale, or tool, is that there is the app, but there’s their own website. And if you go to their website, it’s felinegrimacescale.com. You can get it in multiple different languages, the scale. It’s in Spanish, it’s in Portuguese, it’s in French, and so on. And on that website, they’re updating it all the time. What you can do, or your staff can do, is you can go in and score a cat and see how you compare to an expert that has scored that.
Dr. Andy Roark:
That’s cool.
Dr. Shelia Robertson:
So they’re doing it as a training center, right? You can go in, test yourself. Can I actually score a cat? And the answer is after a few minutes of training, owners can score a cat’s facial expression, whether it’s painful or not.
Dr. Andy Roark:
That’s awesome. That sounds like such a fun thing to do with the team. To say, “We’re going to do this together and everybody gets to do their scores and then we’re going to see what the experts come back at.” That’s really cool.
Dr. Shelia Robertson:
Yep. And then what I would remind people is, if you have a clipboard or you have an electronic, whatever you do for your postop monitoring, you’re probably going to put how much fluid they’ve had or are still having. If they ate. What their temperature is. What their pulse respiration is. Just add a line and put Feline Grimace Score. What was it?
Dr. Andy Roark:
Yeah, that’s awesome. I really appreciate it. That this has been wonderful. Thanks so much for… Thanks for all that you do for our patients. Thanks for taking time to be with us. Thanks for all the research resources. Like I said, I’ll link those down the show notes. I really appreciate you. Thank you for doing this.
Dr. Shelia Robertson:
Well, and I’m going to thank you for getting it out to the masses because that’s what we need. It’s the getting it out there and getting people just to say, “Yeah, wow, this is kind of cool.” And like I always have said, empowering our technicians and nurses that work with us, our support staff, because they’re with the patient more than we are usually.
Dr. Andy Roark:
Yeah. I completely agree. Awesome. Well thank you so much guys. Take care everybody.
Dr. Shelia Robertson:
Thank you.
Dr. Andy Roark:
And that is our episode guys. That’s what I got for you. I hope you did enjoy it. I hope you got something out of it. If you did, the kindest thing you can do for me is go in, leave an honest review wherever you get your podcast. If you didn’t enjoy it, then the kindest thing you can do is just not leave a review until next week when we have a whole new episode that you might like, and then if you do like it, then you can go leave an honest review. And that would be great as well.
Dr. Andy Roark:
So guys, that’s all I got take care of yourselves. Be well, I’ll talk to you soon.
The Expanding Labrador & Nutrition Resources for Clients (HDYTT)
This episode is made possible ad-free with the support of the Purina Institute!
Charlie, the 2 year-old labrador has crept from 76 lbs to 84 lbs over the last 6 months. We need to do something about this, and Charlie’s owners don’t seem super motivated to intervene. They’re good people, and they will listen if we can just communicate the right message in the right way.
Dr. Shelly Adrian, US Ambassador for the Purina Institute, joins Dr. Andy Roark to discuss this oh-so-common case and some resources that veterinary teams can use to have these conversations more effectively. Let’s get into this episode!
This podcast was brought to you ad-free by the Purina Institute.
LINKS
Purina Institute CentreSquare: www.purinainstitute.com/centresquare
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Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr Shelly Adrian received her DVM from Kansas State University College of Veterinary Medicine in 2007. She went on to a rigorous one-year private practice internship, mainly focused on Emergency Medicine, at the Pet Emergency & Specialty Center in San Diego, CA.
Dr Adrian remained with that clinic for an additional 2 years as an emergency veterinarian. In 2010, she entered general practice in San Diego, and continues to practice in coastal San Diego. Shelly’s areas of interest include nutrition, internal medicine, and emergency medicine. In 2015, Shelly joined Nestle Purina Pet Care as a Veterinary Communications Manager and was named a Senior Veterinary Communications Manager in 2019. Her current responsibilities include supporting several veterinary schools as well as providing education on behalf of the veterinary sales team. Shelly also took on the role of US Ambassador for the Purina Institute in 2021 and works to further communication to the veterinary community regarding the science behind nutrition.
Shelly resides with her physicist husband in San Diego and has three dogs: a 77-pound “greyhound-lookin’ thing” named Nutmeg, a young “Monkey” golden retriever mix, who she found on Petfinder.com, and their newest puppy “Walnut”.
EPISODE TRANSCRIPT
Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a good one for you today. I am here with my friend, Dr. Shelly Adrian. She is a veterinarian, a member of Uncharted, which is how I got to know her. She is also the U.S. Ambassador for the Purina Institute and I am talking to her about a case that you have seen, yes, you have.
Dr. Andy Roark:
It’s the young Labrador who is not wildly overweight yet, but we’re seeing it creep up. In this case, we’re talking about Charlie, the two-year-old Labrador retriever whose weight has crept from 76 to 84 pounds. And whose owners don’t seem super motivated to get involved with it. They’re like, “Oh, Charlie loves food.”
Dr. Andy Roark:
Listen, this is about team training is what it is. It’s about communicating effectively, it is about supporting our team as they have these conversations, it’s about veterinarians getting the same story and resources to back that story up from multiple team members. And so guys, Shelly is amazing at this really good conversation about how to approach this super common case. And let’s be honest, super important, right? We know that we expand pet’s lifespans when we manage their weight.
Dr. Andy Roark:
How do we do it? And the resources that Shelly brings to the table really fantastic. If you want your team to do better jobs, talking about nutrition, this is a great episode to get into and to share with them. Guys without further ado, we’re going to jump into this episode, which has been brought to you ad free by the Purina Institute. Let’s get into it.
Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast, Dr. Shelly Adrian. Thank you so much for being here.
Dr. Shelly Adrian:
Thanks for having me, Andy.
Dr. Andy Roark:
It’s my pleasure. You and I have known each other for years. You are an Uncharted member and so that’s where we met back in the day, hanging out at those conferences and I’ve always enjoyed you very much. And I love to see you at our gatherings and our get together. You are a practicing vet in San Diego, and you are also the U.S. Ambassador for the Purina Institute. And I bring that up because it’s central to the conversation that I want to have with you today.
Dr. Andy Roark:
When we last spoke, you were telling me about one of your cases and we were talking about the hard conversation of getting pets to actually lose weight. I had a case yesterday and it was a 10 year old Yorkshire Terrier with collapsing trachea. And it came in and the owners were super nice. They were really great people, but they came in and they’re like the medications aren’t working anymore.
Dr. Andy Roark:
“I’ve been trying to medically manage this case and the medications aren’t working anymore.” And he’s just coughing all the time and whatever. And that little booger had gained a pound since the last time I saw him. And he’s only 10 pounds now. So even from nine to 10 pounds and they’re like, “He’s coughing all the time.” And I’m like, “Yeah, I suspect.”
Dr. Andy Roark:
And I know I talked with them about weight management and stuff before, and I went through like, “What are you feeding?” And it was this again, they’re wonderful people. And they clearly love this dog, but the list of things that they feed to this dog just kept going and it kept going. And there were pates and there were extra things that they were cooking and there were just these things.
Dr. Andy Roark:
And I’m like, this is a hard conversation. And it was a hard conversation, even though I’m like, here’s this glaring medical issue, right? It’s not like, Hey, it would be good if he lost weight. He’s like, no, you came here because he’s coughing and this is getting worse. And I’m like, we’ve got a pressing medical reason for him to lose weight and that’s still a hard conversation. And so that was just yesterday that I had that happen.
Dr. Andy Roark:
And then I step back and I really look at what we do for pets and what matters for pets. And when we think about the things that really affect the life of our patients, the two biggest ones in my mind are weight management, nutrition, and dental health, right? If you think about the goal for me is to increase the life span of the patients that I see, those are the ones I want to get right.
Dr. Andy Roark:
And then the last thing I’ll pull into this is the classic golden retriever study of dogs that are of an ideal body weight, or slightly thinner, live on average two years longer than those that are even slightly overweight. And so we know the importance of this conversation, but it is really hard to get traction on this conversation.
Dr. Andy Roark:
I know that people have a lot of frustration with this. So anyway, go back to our conversation and you and I were talking and you brought up, you were talking about resources that were there and then you had a case of how you would put those resources into use. And I want to unpack that with you today, if you’re okay with that.
Dr. Shelly Adrian:
Yeah, absolutely. And that nutrition conversation is vital, right? Nutrition is considered the fifth vital assessment. We know we have to have that conversation. We know our owners want to have that conversation with us, but…
Dr. Andy Roark:
Yeah.
Dr. Shelly Adrian:
Regardless of whether it’s a weight topic or what they’re currently feeding topic, it can feel very difficult and delicate and uncomfortable for us to have that conversation.
Dr. Andy Roark:
Well, there’s a couple pieces to it, right? There’s the denial piece when they… I never forget. I saw the most morbidly obese pet I’ve ever seen in my entire career. And I showed the pet owners, the body condition score chart, and I was like, which one do you think your dog is? And they pointed right at five out of nine. And I was like, which dog are you looking at?
Dr. Shelly Adrian:
I would say it by nine plus.
Dr. Andy Roark:
Yeah. But it was just like, there is that denial part of it and then there’s the food is love part of it. They have to believe that this is worth it, or it’s just so easy to fall off the wagon so it’s such a struggle.
Dr. Andy Roark:
But let me go ahead and open this up for you a little bit. Why don’t you just tell the story? Why don’t you tell the story that you were telling me before about the two-year-old Labrador?
Dr. Shelly Adrian:
Luckily, I saw this patient before it was in the situation that your York, he was in the other day, but…
Dr. Andy Roark:
Yeah.
Dr. Shelly Adrian:
Very classic patient that we see, I saw her in June 2021, for the one moment we were allowing clients in the exam rooms, Charlie, two-year-old female sped, Labrador was just there for healthy pet, no concerns, vaccines, except I had a concern when she came in, she weighed 84 pounds and previously she had weighed 76 pounds and the owner again, the denial part, right? The owner didn’t realize that those extra pounds can slip on you over six months. I think you’ve all experienced that. So I had to bring up a topic that the owner wasn’t prepared to talk about and draw her attention to a problem that she wasn’t aware Charlie had.
Dr. Andy Roark:
Yeah.
Dr. Shelly Adrian:
So I was able to use this new resource, this online toolkit that’s available to us from the Purina Institute and I had some secret knowledge of this toolkit. And what I was able to do was pull up a video for the owner on how to conduct a body condition assessment on your own pet.
Dr. Shelly Adrian:
And while I went to go get Charlie’s vaccines and vaccinate her, I was able to play that video in the exam room for Charlie’s owner to watch. And then when I came back, we talked about, what did she think Charlie’s body condition score was now being a typical owner after watching the video, she thought Charlie was a five out of nine.
Dr. Andy Roark:
Yeah.
Dr. Shelly Adrian:
Difficult. Right?
Dr. Andy Roark:
Yeah.
Dr. Shelly Adrian:
But on that same website, instead of having to open up a completely new tab and go to a new resource, I was able to pull up the body condition, score chart, and talk with her about what I was looking at when I’m judging Charlie’s body condition and showed her why instead of a five, I would actually grade Charlie at a six. And you’re right, I was able then very quickly to link to a resource that talks about that retriever study.
Dr. Shelly Adrian:
And it was perfect because Charlie is a retriever. And what they found was that paired litter mates who were just slightly heavier, typically those dogs were six and a half out of nine versus four and a half out of nine lived two years shorter than they’re lean lit made. So we have that conversation, we talked about Charlie’s ideal body, weight and body condition.
Dr. Shelly Adrian:
And I was able to print out a body condition score chart to send home with Charlie’s mom was able to print out a brief, or actually I emailed it to her after the exam. And it went through those key bullet points of why it’s important to have my pet at an ideal body condition. And most importantly, to help me feel comfortable having this conversation, it links published data.
Dr. Shelly Adrian:
So this is not just Dr. Shelly Adrian saying this isn’t just random veterinarian saying this. This is based on scientific data, not mentioning any type of specific product or biased in any way. It’s just based on scientific data. And then the cool part is, I just saw Charlie again, six months later, and guess who’s back down to her original body weight. So, how often does it happen and where that weight conversation works the first time?
Dr. Andy Roark:
Yeah. You won. You actually did the thing and got the pounds back off, as opposed to, all the other cases where you see the two-year-old and they’ve gained six pounds, and then next time you see them, they’ve gained another pound and then three more pounds. And now they’re 93 pounds and that’s where they’re just going to live for a while. You actually move the needle.
Dr. Andy Roark:
I want to unpack with you a little bit workflow, right? And one of the things that I think a lot about these days is how we do education in a way that actually reaches people. Some of the pushback that I get because I teach a lot about exam room communication, how we build relationship and how we build trust.
Dr. Andy Roark:
And people are always talking to me about time. Andy, we’re super busy, we’ve got people waiting, we’ve got all of these things and it’s so easy to push nutrition off of your plate and just say, this is not the most pressing thing. They didn’t ask me about nutrition. We can talk about it next time because the dog is still going to be a little bit heavy then and we can do it then.
Dr. Andy Roark:
And I want to be gentle and kind to my colleagues and stand in the exam room. I run behind schedule as well. I know how it goes at the same time when people press me on it and say, well, what do we do?
Dr. Andy Roark:
I really love the idea of using videos and using resources and things that we have in the clinic to let clients work or educate or to support the things that we’re saying when we’re not in the exam room. And so as you say, Hey, I ducked off to do these other things and I showed them this video, and when I came back, we talked more.
Dr. Andy Roark:
That is multitasking, right? That’s an efficient use of time. I’m going to hand you this while I go get these other things going and you’re going to stay engaged and we’re going to advance conversation while I’m in the back, drawing up, setting up [inaudible 00:11:20] getting my next appointment, ready, whatever the things that I’m doing, walk me through that workflow.
Dr. Andy Roark:
Like what exactly does that look like? Are you using tablet computers? I just want to start at the base level. I think I know other people really just want to visualize what this system looks like to get this education into the sessions.
Dr. Shelly Adrian:
That’s a great question and I’m just like you, I’m almost always running behind in the clinic. There’s so much information I want to convey to the owners and we have such a short period of time with them and it’s all critical, right? And I would argue you’re absolutely right that some of the most overlooked conversations are some of the most important and dental disease and nutrition are the top two because all of our patients have to eat.
Dr. Shelly Adrian:
And all of our patients at one time had teeth. So it’s really important that we never leave those pieces out. As far as workflow goes, it can vary from clinic to clinic the way my clinic works, we do have computers in the exam room that I can use. We could use a tablet if we chose to on that same resource, that online toolkit, I can email things.
Dr. Shelly Adrian:
And I did email something after the fact, it was really easy to just click a link and send that email to the owner. There are even additional resources that I could use to train my staff with videos or with reading. So the workflow, again, idea to save us time, to get us quick information, when we’re in the exam room too, what I find is a big area sometimes with nutrition conversations is when we look up good science backed conversation, we pull up some 12 page document that might take us an hour to read, right? And sometimes I just need the quick key messages.
Dr. Shelly Adrian:
I just want the bullet points. What do I need to say? What is the most important information to convey in less than five minutes? And so the nice addition to this tool is every piece of content has a reader watch time, so I can even filter. If I’ve got less than five minutes, what can I use to convey this information and go.
Dr. Andy Roark:
That’s super cool. Yeah. We need to be realistic about what people are going to actually do. Like sending them home with a multi chapter reading assignment is wishful thinking. And it’s just… I liken what we do to auto mechanic sometimes. And not in all cases I know people don’t like that, but for me, it’s the easiest thing that I can imagine that is expensive. It can get expensive real fast.
Dr. Andy Roark:
And personally, I’m not a car guy. I don’t know all that much. I want to be a good car owner. Obviously I want to have a car that works and have a nice long life from a car and I don’t know what I need and I don’t know what I don’t know.
Dr. Andy Roark:
And so when I think about education, I think a lot about my experience with an auto mechanic and stuff like that. And if I go to the auto mechanic and they give me a 10 page document to read with the specs of engine care, it’s not going to happen and you know what’s not going to happen. You and I were talking before, as we were making this COVID pandemic spike, my kids have been doing virtual school for a while.
Dr. Andy Roark:
Everybody around me is sick. Yeah. And it’s like, we are all busy and we’re all stressed. And so just meeting people where they are and being realistic and just giving them the actual information that they’re going to use to make a decision and then giving the pathway to where they can go deeper if they want, right?
Dr. Andy Roark:
I think that’s probably the key with a lot of the clients and trying to educate us. We all have those clients who are sponges. They want to read all the things, they want the 12 page document, and they want to see the original sources. It’s a beautiful thing to be able to give people the executive summary and then have it link deeper, have the ability to go deeper to what they want.
Dr. Andy Roark:
But I think a lot of times we jump to the full Monty and people are not ready for that. And it just goes into their email and it just sits in their inbox for a long time because they didn’t delete it because they mean to read it. They just never do.
Dr. Andy Roark:
And so that’s super interest to me just short my time and have stuff that’s top level. And what… Can I ask you some more questions about the training stuff because that’s really intriguing. I’m a super big advocate for tech training for helping people grow and develop inside the practices.
Dr. Andy Roark:
I like people to be learning new things. I want to learn new things and so I’m always interested in what training resources and stuff are there, can you lay out what’s there and what might be beneficial to practices?
Dr. Shelly Adrian:
I thought that might pique your interest. Yeah.
Dr. Andy Roark:
Yeah. I love it.
Dr. Shelly Adrian:
And that’s the neat thing like you said, some folks want those key bullet points, those key messages and that’s all they need to know. I don’t know what a carburetor is. I’m never going to read further about what a carburetor is, I just hope that it works. Sometimes I really do want to read deeper into what makes a large breed puppy food different than a regular puppy food, right?
Dr. Shelly Adrian:
And so do my technicians because let’s be honest, they might be the ones having the conversation about large breed puppy food versus regular puppy food. So what we can utilize on that center square toolkit, there are videos, there are right ups again with those key bullet points, but then linking to deeper, more science getting into that nitty gritty, that nerdy part.
Dr. Shelly Adrian:
And again, always based on published data, the videos are really cool though and I pull those up frequently just for myself. If I have a few minutes to inhale my lunch, most of the videos are less than five minutes long and they’re recorded by board certified veterinary nutritionists. These are nutritionist that do not work for Purina.
Dr. Shelly Adrian:
So this is not Purina centric at all, and they have really helpful videos about how to fit that nutrition conversation into a short exam. How to have a conversation with an owner who comes in with recommendations for foods, perhaps from a breeder or a shelter that maybe we don’t agree with those recommendations for that pet, the importance of a nutrition conversation.
Dr. Shelly Adrian:
They hit all of those difficult topics and give their pearls and their best practices because they’re having those conversations too, right? So listening to their perspective on it just while I’m inhaling my food, watching that quick video is not only helpful for me, but for my staff as well. And then if they want to dig deeper, they can look below the video and it will link them to some of the deeper information on that same topic.
Dr. Andy Roark:
That’s awesome. I really like it a lot. Can you help me with… So the last part of this for me, that I find is a hurdle to really leveraging resources effectively is what I say in the exam room. Can you help me with some conversation stuff just to set this up to then refer them to some resources and things like that?
Dr. Andy Roark:
You have a lot of experience with this. How do you broach the conversation of either, Hey, I’m going to leave you with this video or I want to send you with more information and I’m going to send this as a link or I’m going to print this off.
Dr. Andy Roark:
What strategically do you do to set up the conversation so it doesn’t sound like, Hey, I know we didn’t talk about this, but here’s bunch of links because that’s not going to go anywhere either way, so you’re naturally a very warm and charismatic person.
Dr. Andy Roark:
How do you lead into this conversation to get people to actually click the links and to feel like, yes, this is not homework for me, this is a value add to my exam.
Dr. Shelly Adrian:
That’s a good question and you’re right. We don’t want to information dump or sometimes we do want information dump, but we know that’s not effective.
Dr. Andy Roark:
Right. Always want to information dump.
Dr. Shelly Adrian:
But yeah. So, I think a part of it is going back to the idea that we’re on the same team.
Dr. Andy Roark:
Yeah.
Dr. Shelly Adrian:
We both want what’s best for their pets health and going back to the idea that food is love, I almost by nutrition to be a topic that usually does peak owner’s interests and as opposed to my car’s carburetor…
Dr. Andy Roark:
Yeah.
Dr. Shelly Adrian:
That the nutrition piece is something they want to eat. So, when I bring up the nutrition conversation, which I always at least mention a piece of nutrition in the exam room, we always talk about what food they’re currently eating the body condition score. So as I go back to that, Hey, remember we talked about, your dog is eating X, Y, Z. The reason I like X, Y, Z food for fluffy is, and then if you want to read more up on that, say, for example, I’m seeing a geriatric cat, this is another true life example, geriatric cat named Angelina 17 years old.
Dr. Shelly Adrian:
It was healthy but she was getting to that where she’s getting leaner and thinner and losing that lean body mass. So we talked about the food she was eating, which was good. But what I said for her is, Hey, I want to focus a little bit more on getting more water into her, help with her kidney function and just for geriatric cat in general, and getting some extra protein into her for that lean body mass.
Dr. Shelly Adrian:
So, if you want to read further on why I’m making that recommendation, I have this link for you. In the meantime, here are some solutions as far as getting more water into her and getting more protein into her. Does that make sense?
Dr. Andy Roark:
Yeah, I like that a lot of, Hey, if you want to get deeper into why I’m making this recommendation, that’s the words that I like, I’m going to put that into my little quiver of arrows for the exam room, because that makes sense for me as well.
Dr. Andy Roark:
So no, I like that a lot. That really makes sense. One of the things I think is true with nutrition, right? I think it is true of people in general, but I think it’s also especially true of people with pets. I think we also want to have control in our lives. I think we all want to believe that we have some control and we want believe that we can keep ourselves.
Dr. Andy Roark:
And I think this is obviously COVID thoughts with Andy. We all want to believe that we can keep ourselves and our family safe, including our pets and nutrition is a thing that we have great control over for our pets. It is a thing where we can make this purchase and we can decide what they get. And this is an aspect of their life that we can control, which is why people talk to us about their pets stool all the time.
Dr. Andy Roark:
Because they’re like, they can see it and it’s there and I can adjust what’s going in, the front side and effect what’s going on the backside and this is control I definitely have. And so I do think that in that mindset, nutrition is really easy to talk about and I do find that pet owners are generally psyched to get a recommendation, to start to Wade into it.
Dr. Andy Roark:
There’s also some research that came out and I’m not going to try to quote the staff because they’ll be off, but I was actually surprised by the high percentage of pet owners who say that they want nutritional recommendations from the doctors and they want to talk about nutrition. I think a lot of us go, they made a choice and this is bringing up old stuff but the research doesn’t, that’s not true.
Dr. Shelly Adrian:
You’re right. And I’m super nerd. I actually do know this stuff.
Dr. Andy Roark:
So I thought, I’m going to toss this out there at half date and I’m going to let Shelly just finish cooking it for me.
Dr. Shelly Adrian:
And I think it’s really important for us to keep this in mind because again, I’m in San Diego. I have had the challenging nutrition conversations and I know what it’s like…
Dr. Andy Roark:
Oh, I’m sure yeah.
Dr. Shelly Adrian:
Talking and you feel like you’re talking to Rick wall, but they hear you. 83% of owners trust their veterinary professional when it comes to nutrition advice, however, less than 25% perceive that they’re getting that nutrition conversation when they go to the vet.
Dr. Shelly Adrian:
So it’s a real… That’s why I think it’s important to have those additional resources say, Hey, if you want to read more, because if they have those, whether it’s an email or a video, we showed them or a printout that we leave them going home with, now they know they’ve had that nutrition conversation, right?
Dr. Shelly Adrian:
So now they’re going to see, yes, I got this recommendation from my vet, whether it was about body condition, score, specific diet, hydration, and whatever, the aspect of nutrition that conversation you’ve had, they know they had that conversation with you and that just builds to a better relationship overall, right?
Dr. Andy Roark:
Yeah. I agree. I want to leave you with a bonus round here and you can take either of these two questions. You can either leave me with your favorite Pearl for getting nutritional compliance, getting people on board, getting people to make changes that you think that most GPS or technicians miss, or you can give me the biggest pitfall that you see in these conversations that most of us fall into. Which one do you want to do? You can take either one yeah, I know.
Dr. Shelly Adrian:
I think the biggest pitfall that I see from my colleagues is shying away from the nutrition conversation. And there are lots of reasons why we might not feel comfortable having it. We might not be fully up on the science ourselves, right? So if we get questioned, we’re not sure that we can justify the recommendation we’re giving, or we don’t know how to have that conversation.
Dr. Shelly Adrian:
But I challenge you to take the conversation back because as we already discussed, the owners want it. If they don’t get the information from their vet professional, they’re going to get it from somewhere. And we have tools available to us that are backed by science. So if you take a step back and you just approach it as a teammate with the owner, right, we’re part of a team to keep this pet healthy.
Dr. Shelly Adrian:
And what does the published data say about this pet’s nutrition? And if we just go back to what our resources and our published data give us, it can take some of the emotion out of it and it makes it less difficult. So I challenge you, especially those times where you really don’t want to have the conversation, do it.
Dr. Shelly Adrian:
Have the conversation backed by science, give a specific diet recommendation every time whether it’s stay on this food, it’s great, I love it. Or I recommend X diet because this is Y.
Dr. Andy Roark:
Yeah.
Dr. Shelly Adrian:
And back up, site your source back up your reasoning.
Dr. Andy Roark:
Yeah. What’s the easiest way or the best way for people to engage with Purina Institute and Center Square? I’m going to put links in the show notes for everybody who wants to click through. But yeah, if people are out there and they’re listen to, as they drive in and they’re like, Hey, I want to look around, I want to see this thing. How would you advise them to get started?
Dr. Shelly Adrian:
Perfect. Yeah. The Purina Institute is the scientific arm of Purina, and the goal of the Purina Institute is twofold. In general, is to generate and communicate scientific content on companion animal nutrition, but also to help us take that conversation back to help us have these difficult nutrition conversations. So if you just go to the website, Purina institute.com, there’s a wealth of information there.
Dr. Shelly Adrian:
If you want to get real nerdy on it, you can, whatever the topic may be. The nerdy shell, you had to come out but there’s a label at the top called Center Square and if you just tap on that, you can search the wealth of resources. I encourage you to play with it, whether it’s veterinarian, technician, receptionist, there’s content there that can help you have those nutrition conversations because we all do.
Dr. Andy Roark:
Yeah. Awesome. Thanks so much for being here. I really appreciate you. Appreciate your time.
Dr. Shelly Adrian:
Thanks for the Sandy.
Dr. Andy Roark:
And that is our episode. Thanks again to the Purina Institute for making this possible guys, thank you for tuning in and checking it out as always, if you like the episode and you feel like leaving us an honest review, wherever you get your podcast, that means the world to me.
Dr. Andy Roark:
I really do appreciate it. Also, remember that we are now on YouTube. So if you like watching podcasts or watching the conversation, check us out there. Anyway, gang take care of yourselves. Be well, talk to you later. Bye.
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