Andy Roark DVM MS

Dr. Katie Kling joins Dr. Andy Roark on the Cone of Shame Podcast to discuss the importance of working with pet owners on dental disease prevention without risking their human animal bond in the process. Together they go over what to do when pet owners bring in their favorite dental products and how we as veterinary professionals can guide them to the right resources.

This episode is brought to you by Hill’s Pet Nutrition and the Hill’s Veterinary Academy

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

The Hill’s Veterinary Academy is a one site solution for educating the entire veterinary team. On the HVA, you can find FREE RACE CE from leading specialists and experts, patient-centric education beyond nutrition and flexible, on-demand content that fits your schedule. 

More information on Hill’s Prescription Diet t/d

Continuing Education on Gaining Dental Home Care Compliance

The Veterinary Dental Forum

The Veterinary Oral Health Council

Veterinary Oral Health Council Seal of Acceptance

ABOUT OUR GUEST

Dr. Katie Kling graduated from Ross University School of Veterinary Medicine in 2008 and spent the first 7 years of her career in general practice in Cincinnati, Ohio and College Station, Texas prior to completing her dental residency at the University of Illinois in 2019. She stayed on at the University as an Assistant Professor until 2021 at which time she joined the Veterinary Dental Center in Aurora, IL where she now practices as a part of a dedicated dentistry team.  She is happy to serve on the AVDC Diversity, Equity, and Inclusion Committee and the AVDC Exam Committee.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I had a great one here with Dr. Katie Kling. Gang, we are doing a ‘How Do You Treat That’ episode with a three year old chihuahua who’s starting to get dental tartar. And mom loves chihuahuas and has had them in the past and they all had trench mouth and she’s like what can I do?

She’s got some products she bought off of instagram that she’s rolling in with. This is a great conversation. I get Katie to help me to talk to this person, to lay down for me her thoughts on supplements on nutrition for dental health, on what ages we start to have these conversations and things like that.

We talk about toothbrushing. We talk about relative importance of toothbrushing versus like dental chews and diets and things like that. And it is really a very cool conversation to sort out kind of the, all the different stuff that people can do. And I’ll be honest, like there are so many products around dentistry.

A lot of them I’ve never seen before and pet owners are coming in with stuff. I just never heard of this stuff and there’s nothing, authoritative behind it. I want tips on how to talk to them, how to guide them, things like that. So anyway, this is a really good, really practical episode for maintaining dental health. I hope you guys will like it a lot. This episode is brought to you ad-free by Hill’s Pet Nutrition. Guys, if you have not checked out Hill’s Veterinary Academy for your learning needs, I highly recommend that you do. I’m going to put a link down in the show notes. I mention it when we talk about resources as well, but Hill’s Veterinary Academy is a great place to get some continuing education on dentistry, especially on nutrition.

Go check it out. Have a look. Guys, let’s get into this episode. 

Kelsey Beth Carpenter: 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. Katie Kling. How are you?

Dr. Katie Kling: Great. Great. Thanks for having me.

Dr. Andy Roark: I am so thrilled to have you. I love having you on the show. You are one of those people who is amazing because you are a boarded veterinary dentist. You’re a specialist. You have a deep wealth of information and knowledge, and also, you were a general practice doctor for like eight years when you graduated, you went straight into practice, you did that for a while, and then you transitioned over and went back and got your residency, and so you walk in both worlds.

Dr. Katie Kling: Yeah. Thanks. Thanks, Andy. I agree. I have a huge respect for general practice. I think that’s really where a lot of the most important things happen in caring for our pets and that’s a huge vantage point to be in. So I loved general practice. And I think a lot of good dentistry, important dentistry happens at that level too.

Dr. Andy Roark: I’m always interested. I always have to start this conversation when I talk to people who have had a journey like yours, because I think vet medicine is amazing in that you can change up what you do. It’s a– it’s a house with a million rooms. And so, what was it that motivated you after being in general practice for eight years?

How did you decide to go back and become a specialist?

Dr. Katie Kling: Yeah, great point. So yeah, I think a lot of us jump around a little bit or try out different things. And, you know, when I was at U of I, I would say the students like it’s not like everything advances at the same level. So even if you’re not specializing officially, you’re still sort of developing your special interests or your special skill set.

And I think when I worked in practice and worked with multiple colleagues, three or four colleagues, you know, it’s like, okay, Carrie’s good at ultrasound. I’m going to be faster at this surgery. And, and you still, in my experience, at least. Bounce things off of each other and specialize in your own way.

So, definitely I think that starting out in that practice, I felt very hesitant about dentistry, spent a lot of CE and then kind of swung the other way to where I developed a special interest. So I think all of us that like, you know, we’ve been in practice a similar amount of time, you look for the next challenge, the next thing to take on and, and dentistry became that for me.

Dr. Andy Roark: Yeah that’s awesome. I love the fact that it was something that you were not particularly good at or you just felt sort of uncertain about and through sort of learning more about it, you’re like, I really like this and you just kept going. I think that’s great. All right. I have a case that I want to talk with you about a little bit today.

Is that okay?

Dr. Katie Kling: That sounds great.

Dr. Andy Roark: Alright, sweet. I have a three year old female spayed chihuahua named Cece. And so, Cece’s a young chihuahua, and she is here with her mom. And, uh, her mom is her person. Her, she’s one of those chihuahuas, her body has kind of formed to match her mother’s like armpit, you know what I mean? So as she’s being held, her back end just fits right there. Uh, that’s, she doesn’t touch the ground a lot. She lives, lives on mom’s arm. And so anyway, that’s Cece. 

Now, I can talk to mom and Cece’s at three years old. She’s already getting some of the tartar that you can see on the outsides of her upper canines, you know, just along the gum line. She doesn’t have gingivitis, anything like that, but she’s getting that.

You can start to see it accumulating. And so I’m doing my physical exam and I just say to mom. Hey, come and have a look at this. You can see we’re starting to get some dental tartar here. And I was just sort of starting to set the stage to talk to her about this and about, you know, our chihuahuas are just classic sort of dental, dental dogs that we have to keep up with.

And I really hit a nerve because mom has had chihuahuas before and she was one of those Chihuahua owners that had this old Chihuahua that had a horrible trench mouth and it was going to be a lot of money to do anything about it. And she was like, Oh, but she’s so old, you know? And it was, it was really that case.

And ultimately I don’t think she did anything about the mouth and of course, you know, her dog ultimately was put to sleep. And in this conversation, it becomes clear that she’s got a lot of guilt. She’s got a lot of guilt that her dog had terrible dental disease and had it for years at the end of her life and she either I don’t know if she’s able to financially afford it if she was it was if it was the risk of you know of putting her under anesthesia.

It’s always hard to tease those things apart about what’s really motivating people. But she definitely had a lot of guilt, and so, when I pointed this out to her in this three year old dog, she was kind of upset, like, what am I supposed to do? And I sort of uncovered that it came from that sort of hardship in the past.

And so, what I want to talk to you about is this. So, I’ve got Cece. She’s young. We’re just starting to see some accumulation of dental tartar. Mom is very aware of this. She’s got, Sparkle Rinse. Sparkle Rinse is an all natural dog mouthwash that she’s pretty excited about. I don’t, this is voodoo. I think it’s got lemon juice in it and, wishes is what I can tell. The primary ingredients are thoughts and prayers for healthy teeth.

Um, Anyway, that’s what she’s got. Katie, how do you treat this? Where do I try to take this conversation? What do you say to the owner of this, you know, relatively young dog, to help sort of get her on the right path? And what tools are even in my toolbox?

Dr. Katie Kling: Great point. Great scenario. I think we’re all familiar with this patient and this owner, right? And then you brought up a couple of different things that I think we all see, right? This is a, this is maybe from a medical standpoint, if we just had the dog in front of us, we kind of all know what to do.

We, we all know the steps. We know what’s going on. We know what this dog is prone to. And so this shifts into like maybe a little bit of a medical challenge, but primarily communication challenge here, and I think we have a lot tied up in this, right? We have this, there’s typically some guilt tied up in dentistry. They feel like they’re bad owners or they’re neglecting something or, the dental health maybe reflects the care of the patient overall, and then also a hesitancy to want to have, you know, I think the, the implicit thing is, is there’s also the fear of anesthesia, probably. And so all those things go into this where we’re coming in and they’re defensive, right? So, so straight off the bat, and then they brought in this product that we’re like, uh, we’ve never heard of this product. Um, and they feel great about it, and so I think, there’s varying opinions on how to approach this. But my opinion is that we want to be on the same side as our clients.

So our clients are at the very least good clients because they’re in front of us. The worst clients have not even shown up to us in the first place. So they’re, they’re trying to do the right thing. And we want to educate if they want to be educated. And so I think laying the groundwork, that’s like, Hey, you want to take care of Cece’s mouth? Me too! We’re on the same page. You brought this product to me. You’re interested in home care. Me too. So let’s figure out where we have common ground and then to alleviate them of that guilt. What I’ll say is, hey, your breed is a chihuahua. You’ve fallen in love with chihuahuas. You’ve always had chihuahuas.

So let’s talk about what we need to think about, in having a chihuahua in addition to all the good things that come with chihuahuas and, and obviously you’re a dedicated mom. So how do we sort of open them up to let them know that we’re on their side? We’re not here to scare them. You know, this, this in my opinion, outdated way of saying, Oh, wow, these are really bad. Or, or did you know this can seed to the liver or cause heart disease or things like that, where we used to try these threats, which it’s like, okay, if you look at the research, the incidence of cardiac disease and liver disease is very rare. That’s not really the highest risk. I think the highest risk is that we could miss providing an even more comfortable and healthier mouth for your pet. And most of our clients are at that level. They’re like, I do want to do the best thing for Cece. and we can share those.

So I can say, I’m on the same page as you. How do we make things easy on Cece when we know Cece is at such a higher risk of dental disease. I usually, depending on how interested people are in talking about dentistry or not, I will sometimes just bring it all down to just dental disease. So you fall in love with a small breed dog, they have a high rate of dental disease.

So, let’s talk about what that looks like. 

Dr. Andy Roark: Yeah, I really like that opening a lot. I know at some point she’s going well, I have friends and their dogs don’t need dental cleanings every six months. And you know and, and their Labrador was 12 years old and barely had anything eating on his teeth and no one said anything about him and I go, okay, let’s validate the scenery here.

You’re not in crazy town, but this is, you have picked this wonderful little dog and every dog has their little eccentricities and dental diseases is part of this. I really liked that a lot. Let’s start to talk a little bit about, let’s talk a little bit about this mouthwash. There are so many products that are out there and I swear.

I do Instagram. I don’t do a lot of social videos, but I do, I do do Instagram. I had it off my phone for like two years and I put it back on and I do Instagram. And man, they hit me with great targeted marketing. Like they know my stupid sense of humor, um, and just hit me with these weird products that I’m like, okay, that’s pretty great.

And I know that pet owners are out there looking at, you know, you start looking at dog Instagram feeds and all of a sudden you’re getting all kinds of stuff. And like, I used to feel like if you had a product that just flat out didn’t work, nobody was ever going to hear about it, you know, and that’s not the case anymore because you can, you can target ads and you can, you know, sell just absolute snake oil. And so I’ve got these people and they’re coming in and some of them seem really compelling ads and things like that. What does that conversation look like for you today, given that at least it feels like there’s so many more products being put in front of better owners and the marketing around these products is pretty darn slick.

Help me with that part of the conversation.

Dr. Katie Kling: Yeah, I agree. They’re just swamped with all this information. And some of it, I’m trying to, to kind of come at it from, from what their angle is. So like, let’s say someone’s like, I’m spending all this money on these products and I can’t keep up with this. You know, that comes down to something that’s pretty simple, which is the bottom line is that toothbrushing works and toothbrushing is pretty inexpensive.

But it’s time consuming. And so then we look at these products to say what other products work besides toothbrushing and to try to sort that out. So I’ll typically if they bring in a product I haven’t heard of, or I’m unfamiliar with, or doesn’t have any studies behind, then I’ll, I’ll take a look at the product for them.

I want to look and make sure it doesn’t have xylitol or a whole lot of alcohol or things like that, that we would not expect to be in them. But like you said, anything’s out there. And then from there, if they’re interested, I introduced the idea of a group of products that have been studied, by something that’s not sponsored, like you said.

So for humans, we have the ADA that we can trust and can find on our toothpaste or our toothbrushes. And then the dog version of that is the VOHC.org . So that’s the Veterinary Oral Health Council. And that is the same  premise, which is to say, Hey, I’m a vet, I’m going to make my recommendations as research based recommendations.

And these are products that have been through the same standard research and have proven that they help with either plaque, tartar or gingivitis or halitosis. And this is how we can tell that they work. Could there be other products out there that work that haven’t been through this testing? Sure.

But if you want to spend your money on something that has proven to work that’s where you would look. When they evaluated toothbrushing in a whole group of beagles with just saline, right? So no product, that was effective in reducing gingivitis and plaque. And so we look at these other products as sort of supplemental or more inviting or, or more appealing or more user friendly, right?

Maybe Cece’s mom is 85 and she’s not going to be Chasing her chihuahua around with a toothbrush. Similarly, I will say, my pet owners who are holding down their pet to brush their teeth. It’s like well, that’s gonna happen once like my goal is not to disrupt your bond with your pet, right?

Dr. Andy Roark: Yeah. So two questions here. First, I just got to know, have you actually seen, are there actually pet products with alcohol or xylitol in them?

Dr. Katie Kling: Yes, so I have seen xylitol and I think what was it? Well, I’ve been in practice same amount of time as you, but I think that they, justified that it was a small enough amount. But yeah, isn’t that shocking?

Dr. Andy Roark: Well, the alcohol for, I was like, I could see, you know, dental products being like, sure, we’ll just put some alcohol in there. That’ll, that’ll do it. Okay. I was just curious. Okay. So, so that’s, that’s the first part. The other, talk to me a little bit about how much emphasis you put on tooth brushing versus, either supplements or dental nutrition, things like that.

I think a lot of us have kind of settled into this idea that like, we’re going to tell people they should brush their pet’s teeth, but we’ve kind of accepted that the chances of them actually doing it are low. And some of us have just given up even talking about it, but I always feel guilty.

I, and I always wonder a little bit if they go out and they’re like, you know what, I’m going to do the t/d diet or I’m going to do some dental chews, but I’m not going to brush my pet’s teeth. I always kind of wonder, are we spitting in the wind here or are we actually doing good?

Help, help me get my head around, are supplements comparable to teeth brushing? Is teeth brushing really? 85 percent of the battle and supplements are 10 percent of the battle, like, where, where are we? Can they put together a comparable dental plan if they’re like, I can’t brush this pet’s teeth? Do I need to just suck it up and really start trying to talk more directly to them about toothbrushing?

Help me, am I doing a good job? I guess, Katie, is what I’m kind of looking for here.

Dr. Katie Kling: Right. Um, so I agree. And I think, we as vets sort of get trained by our clients, right? You bring up toothbrushing, you get like, uh, or, just like when we bring up a dental procedure, right? We get that, like, kind of bad feedback that makes us, Maybe even subconsciously sometimes not want to bring it up the next time.

When I talk about tooth brushing, and sometimes I talk about tooth wiping instead, which if it’s more realistic for certain pets or certain owners. What I let the owner know, I want to know, where do you stand on that? Is that something that you’re planning on doing so that I can make my plan around that?

So I’m not going to tell you. You need to brush your teeth. And next time that I come in, I’m going to ask you how frequently are you brushing your dog’s teeth? I am going to tell you that the science says that tooth brushing every other day makes a big difference. Every day makes a huge difference once a week.

Not very much. So if you’re taking Cece to the groomer every six weeks, and she’s getting her teeth brushed, I’m gonna tell you, why don’t you stop doing that? That’s just like Cece torture, but it’s not having any benefit. Or, certainly if the mouth is painful and you’re introducing tooth brushing, it’s causing bleeding. You’ve just trained Cece that tooth brushing hurts. So I think that some people are gung ho. They’re like, my whole goal is keeping the teeth. My whole goal is not having what happened to my last dog happen to this dog. Then really, toothbrushing is a great concept, and then maybe you can supplement it with, you know, we, we talk about the t/d, which is great for chewing teeth if they’re chewing it right.

It’s plaque disruptive, just like chewing is. Um, and sometimes, you know, I keep it in my room, my exam room, because I want to see, I want to see how a dog chews. That food sometimes if they’ll chew it, or if they won’t like that can be useful information to know, and then when we think about other supplements, things that are really going to bind up the minerals that are in saliva that cause the plaque to calcify into calculus or tartar.

That can be helpful too. But tartar looks bad and, and really the bottom line is plaque is what’s causing that disease or causing the bone to want to recess away. So we can have, like you said, a lab come in who the owner perceives the teeth are really bad and we know we’re going to get them under, do full mouth rods and we’re going to clean the teeth and Maybe they won’t require any extractions versus our Chihuahua that has, like you said, just a little bit of tartar forming on the canines.

Well, chances are we get in there and one of those 42 teeth, even at two or three years of age or more than that, may already have advanced dental disease.

Dr. Andy Roark: Talk to me a little bit more about your chewing test. That’s not in my playbook. What does that look like? What are you looking for? So you, you give them t/d, which I love as an exam room treat. I like, I like the size, you know, I like the fact that it’s there and it makes the conversation about these, uh, these types of things easier, but you’re, you’re giving it to them and you’re seeing if they’ll chew it. Like what does that look like when you do it in the exam room and what are you looking for?

Dr. Katie Kling: Yeah, so and maybe that is getting off topic a little bit. I have some, I have some patients who come in where they do a little chatter after they chew or they’re hesitant to chew or the owners will say they’re chewing on one side. And so sometimes I can use that for an exaggerated to sort of show me, show me what they’re doing.

 I think also if, if I’m thinking about using a treat or a kibble or something like that with a dog as a part of their home care routine. I also want to see if they’re going to swallow that whole. Have you had those dachshunds swallow them whole before? I mean, just impressive. 

Dr. Andy Roark: It’s impressive.

Yeah. It’s a skill that I was like, I didn’t, it’s like a snake they just dislocate their jaw and kind of down. Yeah.

Dr. Katie Kling: Right. If you’re chewing a dental treat and you’re giving it one bite and swallowing it, that’s. I mean, but now the, they, they test a lot of those dental treats with beagles and they did go through them in like 15 to 40 seconds, and they’re still having benefit from them. So, but certainly they have to chew them somewhat.

Dr. Andy Roark: Talk to me about when you start to lean into nutrition for dental health. Is it pretty early in your, in your presentation? Is this something with Cece at age three?. Especially since mom is focused on it. I mean, she seems like a good candidate in my mind. Is this early in the game? Is it late in the game?

Are you talking to puppies about or a puppy of visits about it? When do you start to introduce this? And how do you kind of get the clients to start thinking about nutrition? I can tell you that sparkle rinse is probably a lot cheaper than a diet that we buy ongoing and ongoing. Talk to me about sort of how that presentation looks.

Dr. Katie Kling: Yeah, absolutely. So I think that we are looking at sort of trying to get multiple factors in there at 2 or 3 years of age, Cece needs needs a full assessment, right? She needs to go under. She needs to be probed. And we know that 80 percent or higher of dogs are going to have, are going to have dental disease at that age already.

And I think that in a really motivated owner, right? Some owners are motivated to say, I want my pet to be pain free and comfortable mouth. Great. We’re on the same page. Some owners want pain free, comfortable mouth, and to preserve as many teeth as possible. So now that is in a situation where I can’t do that alone without some home care.

And that’s when we pull up, I have them go home with that list, look through that and say, what is realistic for me? I think you’ll be hard pressed to find something better than, brushing once a day with with saline, I mean, I and and sometimes linking that with something that they’re that is positive for them.

So for chihuahuas, for in Cece’s case, right? We also have to take into account, their daily caloric needs. I don’t think any general practitioners going to be happy with me making recommendations to add these three treats. I’m adding 200 calories to their patients diet every day. So now they’re going to have the other the other situation.

In terms of, using a product to, as like a toothpaste, I think they want to think about that more in the sense of bribery. So if the pet likes the flavor of toothpaste, great, that’s an added bonus that they’re going to now have that positive link versus for us when we’re thinking about fluoride or preventing cavities, right?

The incidence of cavities in dogs is 6 percent of dogs will ever get a cavity and, and cats just simply don’t get cavities. So really it’s the mechanical disruption that we’re thinking about. So whether that’s done with tooth brushing or a diet or treats, those are, that’s all the angle of disrupting plaque by the natural way that they’re using their chewing teeth.

Dr. Andy Roark: Gotcha. What are your favorite resources if people are geeking out and they love, you know, dentistry? So, I’ve got to give a shout out to Hill’s Veterinary Academy as, you know, they, we work with them and they’ve, they’ve made this episode possible. What are the, what are some of the resources that you find a lot of value in or that you recommend to people who may be like you or like, hey, I’m in general practice and either I’m weak in dentistry or, this is an area that i’m starting to fall in love with and I would like to read more deeply. Where do you send people?

Dr. Katie Kling: Yeah, great point. So the dental forum is the ABDC’s national, forum. We have people internationally there too. So, and that’s held in the U. S. every year, once a year, usually in the fall. And there’s typically a lot of attendance by veterinarians who have a strong interest in dentistry and veterinary technicians who have a strong interest in dentistry or even specializing in dentistry.

There’s good anesthesia references or resources there too. And then there’s hands on labs, which. For me certainly coming right out of school, that was what I was looking for, right? Like, hands on, let me make my mistakes in a lab and kind of build my confidence that way. So, that would be the route I would go to in terms of making connections and then also just, just all of your, resources and hands on practice.

There is, you know, I don’t know how things are nationally, but around us, our general practitioners are still backed up with, with dentals. I don’t know if that’s ever going to go back to pre pandemic times or not. It’s just, there’s a huge demand for that in patients where people are alerted to that, that that’s going to make such a good, positive impact on their pets.

Dr. Andy Roark: I agree with that. I love the hands on learning idea I think that that is absolutely fantastic I’m such a big believer in you know There’s knowledge and there’s skill and like skill comes from actually doing the thing and so I just I love that. I’ll put links in the show notes.

Thanks so much for being here. Where can people find you online?

Dr. Katie Kling: Definitely Instagram and Facebook. I work at the veterinary dental center in Aurora, Illinois. Great team of dentists there. 

Dr. Andy Roark: I’ll put links to those accounts in the show notes. Katie, thank you so much for being here. Hey guys, thanks for tuning in and listen, everybody.

Dr. Katie Kling: Thank you.

And that’s it, guys. That’s what we got. I hope you enjoyed it. I hope you got a ton out of it. Thanks to Dr. Katie Kling for being here. That was a really fun conversation. Thanks, thanks, thanks to Hill’s Pet Nutrition for making this episode possible. Guys, again, if you haven’t checked out Hill’s Veterinary Academy, definitely do so.

I’ll put a link in the show notes. Also, if you have questions specifically about t/d or dental diets, things like that, through Hill’s Pet Nutrition, check out hillspet.com. I’ll put a link to that in the show notes as well. Guys. Take care of yourselves, everybody. Be well. I’ll talk to you soon.

Board-certified veterinary dermatologist, Dr. Ashley Bourgeois, joins Dr. Andy Roark to explore cutting-edge developments in veterinary dermatology. The focus is on Fluorescent Light Energy (FLE), also known as photobiomodulation (PBM), and its revolutionary applications in addressing diverse dermatological cases. Dr. Bourgeois demystifies the workings of this light energy, and provides insights into seamlessly integrating this innovative technology into veterinary practices.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Referenced Article: https://todaysveterinarynurse.com/dermatology/fluorescent-light-energy-therapy/

Phovia: https://www.phoviausa.com/

The DermVet: https://thedermvet.com/

Uncharted Veterinary Podcast: https://unchartedvet.com/uncharted-veterinary-podcast/

Uncharted Veterinary Conference

Dr. Andy Roark Charming the Angry Client Team Training Course

ABOUT OUR GUEST

Dr. Ashley Bourgeois is a board-certified veterinary dermatologist passionate about providing practical knowledge to general practitioners to help itchy pets! She completed her bachelor’s degree at Iowa State University and graduated from the University of Missouri’s College of Veterinary Medicine in 2010. She then completed a one-year small animal internship at Purdue University. Upon finishing her internship, she accepted a residency position with the Animal Dermatology Clinic’s Tustin, California location in 2011. She became a Diplomate of the American College of Veterinary Dermatology in 2014. Dr. Bourgeois moved to Portland, Oregon in 2016 to help expand the company. She is an owner within the company and on the board of directors. She has a strong interest in autoimmune skin diseases, allergies, cytology, and otology.

In her leisure, Dr. Bourgeois enjoys outdoor activities, traveling, and watching sports. She and her husband stay busy with their daughter, son, and rescue Lab/Boxer/Pit mix. Dr. Bourgeois is passionate about educating veterinarians in dermatology and work/life integration through her podcast, lecturing, and social media presence (The Derm Vet).

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 fun one here for you today. I’ve got my friend, Dr. Ashley Bourgeois here. She is a boarded dermatologist and this is a, this is what our conversations are like. I was reading through my magazines as, I explain in a moment and I found an article on fluorescent light energy in dermatology. And I was like, this feels like voodoo. This feels like just, just some hand waving medicine that gets recommended in drum circles. Like that’s what it sounds like to me and I texted her, I was like, “is this legit?” And she was like “Totally!”

And I was like, ou gotta be kidding me. And she said, yeah, I’ll tell you about it. And I said, great. Let’s, let’s turn the, let’s turn the microphones on. And so that’s what happened here. There’s not a sponsored episode at all. I just, it was something I am not familiar with. I’ve not gotten to use this and Ashley was great about running me through it. So anyway, if you are familiar with FLE or Phovia. is the brand name that she refers to then you’re going to learn about it here. But anyway super fun stuff. Gosh, what an amazing time to be alive. 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. Ashley Bourgeois. How are you?

Dr. Ashley Bourgeois: I’m so wonderful. How are you doing?

Dr. Andy Roark: Man, I’m good now that you’re here. It’s good to see your face again, old friend. For those who don’t know you, you are a boarded veterinary dermatologist. You practice at the Animal Dermatology Clinic in Portland. You do a bunch of stuff online and things like that, but that’s not where I know you from.

We met way back in vet school. When we were doing the VBMA stuff and have sort of kept in touch ever since. And I get to see you at conferences and you are just a, you are just a gift to our profession. And so I just, I love having you here and I really appreciate you taking time and I will say here’s.

Here’s a feather for your cap, when I was reading an article, and I was like, I don’t know what this is, I need to talk to someone who could explain this to me, you were the person I texted. I was like, I’m gonna ask Ashley, hey, is this legit? And I texted you, and that started our conversation that led to this podcast, so, I will get into what that means in a moment. How are you doing?

Dr. Ashley Bourgeois: Yeah, I’m doing well. It is. It’s really funny to think about when people ask me, like, oh, do you know Andy Roark? And like, I mean, I knew Andy Roark he was Andy Roark. I will say, you know, National VBMA, which when we were on the national board was young, right? VBMA was really just going.

I never had any doubt. Like when you started being well known. I’m like, that makes sense. So it’s really cool to surround yourself with people, right. That you either went to school with, or were involved in certain organizations. And as we were talking about before we started recording, we’re getting old now that we can start to say like back in my day, like, you know? Over a decade ago when we were on the VBMA together, it’s pretty, it’s a cool journey to really see people blossom.

Dr. Andy Roark: Oh, yeah, it absolutely is. It absolutely is. It’s funny how you, it’s a small profession and it’s funny people who hustle and do stuff tend to kind of turn up again and again and I really, I think you end up, you just, you sometimes you meet people early on and then they just never go away.

You’re just kind of around. And so that’s been great. But it has been wonderful watching your journey. I, texted you because, and let me just say it front, this is not a sponsored episode at all, or  anything like that. I was just, I was reading through my journals and I came across an article in Today’s Veterinary Nurse about using fluorescent light energy for dermatologic therapy.

And I texted you because this was kind of a new concept for me as far as in practice. And I’ll, be honest. It sounds like voodoo. I was like, yeah. Is this like, you know, is, this like, you know, using salt crystals you know, things like that? I texted you like is this legit? And you were like, yeah, it’s pretty legit, Andy.

And so I was like, okay, I’m sure I’m not the only person who’s not very familiar with FLE. Can you just give me, give me a primer, start at sort of a mile high, what is this? And then we’ll sort of dig into how is it useful in practice, potentially.

Dr. Ashley Bourgeois: Yeah, definitely. And I’ll say anything, anytime something comes out in dermatology, because we are very right. Product heavy specialty. The first thing is that sounds cool, but show me the research. So I think it’s pretty normal when you hear something that’s different that you want to say, but, prove it to me.

So you’ll hear it called a few different things. FLE, like you mentioned, you’ll hear it called photobiomodulation. And primarily the unit within the veterinary field is Phovia. And the idea behind this is that there’s actually a gel. So it’s not just a light. What’s really important is it’s a chromophore gel that you put on lesions, which we can talk about specifics.

And then the idea is that light unit is a blue light. But what’s important is when that light actually hits the chromophore gel, it creates almost a rainbow effect of different wavelengths and lights. And why that’s important is it kind of hits different layers of the skin, so different wavelengths go different depths.

But then each light, like there’s red, green, blue, each light actually has different benefits too. So whether it’s anti-inflammatory, it’s encouraging different growth factors, which can help with wound healing, or being antibacterial, you get kind of that cascade of events just by putting one light on it because of that gel.

And so it is a pretty interesting technique and they actually do have literature behind it for deep pyoderma, superficial pyoderma, even things like perianal fistulas. So I think it’s a pretty cool tool. Yeah.

Dr. Andy Roark: That’s so perianal fistulas have a personal place in my, and I don’t, it’s not in my heart. It’s the opposite of my heart.

Dr. Ashley Bourgeois: No, I don’t think anyone’s in love with the disease.

Dr. Andy Roark: No, it’s the opposite. If I had a hate organ, that’s where it would be, but yeah, that’s fascinating. So the gel itself, is something that come in and gets applied in the clinic just for the transmission of a light? It’s not something that you would continue to apply at home anything like that? There’s no benefit to that, correct?

Dr. Ashley Bourgeois: Yeah, correct. It’s like photo activated. So the way that we do it is usually the protocol is twice a week, but you can do it back to back. So what I usually do is if I know I just did a Phovia treatment, I think last week in the clinic for like a very focal pyoderma. And so we’ll put the gel on, well we’ll use chlorhexidine if it’s a pyoderma, wipe that off, put the gel on.

The light is, once you press the button, it goes for two minutes. So it goes for two minutes, super simple. And then the light goes off. Then what you can actually do, because we all know clients are busy, if we can make it less hectic for them to have to go back and forth to the clinic, you can do the second treatment in a row.

So then I just reapply the gel. You want to wipe it off. the stuff that’s already used up, reapply, and then you just do another treatment, and then I’ll have them come in once a week, depending on what I’m treating.

Dr. Andy Roark: Okay. So give me some, examples of the things that you would be treating. I mean, so is this, does this have post operative functions? I mean, I, is this is this classic, you know, like deep pyoderma? I, what, walk, me through this. It kind of sounds like kind of sounds Like, like too good to be true?

Like, you just use it on everything. Like allergies, limping, storm phobia. Like it sounds like there’s a lot. Hey, give me, start, to ratchet this down for me a little bit and say, okay, this is when you would start to kind of think about FLE.

Dr. Ashley Bourgeois: Yeah probably not storm phobia, probably not trying to get the light energy to the brain for like anxiety, but I, you know, I’d say a lot of skin applications, I’d say the limitation is if it’s a really diffuse disease, right? Like if I diffuse pyoderma, that’s probably not gonna be really realistic. So I do need it to be focal or multifocal in a realistic manner, like two to three lesions, whatever makes sense. 

I would say primarily, and as we’ve had this technology longer and longer, we’re finding more and stuff we can use it for. But I’d say where the most supportive things in the literature would be wound healing. So you certainly could use it post operatively.

I use it in things like I’ve had non healing wounds that get referred to me. So My first application of it was a benign mass that a primary vet had taken off, like the dorsal paw of a dog, and it just would not close. It had struggled for like six months. We cultured and did all the things we needed to do, but that had been done before too.

But when we treated the infection plus used Phovia, it was the first time that lesion ever fully resolved. So I’d say focal lesions like that, I’ve used it in acral lick lesions. because those are often infected and inflammatory. I’ve used it in focal deep pyoderma and focal superficial pyoderma. And there are actually our studies, true studies available showing that either you can use it as a sole therapy and something like a superficial pyoderma.

Again, if it’s more focal. Or you could use it with a deep pyoderma concurrently with an antibiotic. And with deep pyodermas, we often have to use several weeks of antibiotics. They were able to shorten the duration of antibiotic use by implementing something like FLE.

Dr. Andy Roark: Okay. Are there cases that you do not use this on? Something where you’re like, yeah, this either there’s contraindications or, yeah, or, concerns that you have? Anything that you would say, this is a case I would specifically not reach for?

Dr. Ashley Bourgeois: Yeah, so I would say that what I am cautious of, though, I’ll talk about a couple things that maybe it’s different is traditionally when it came out, we were really cautious of anything that could be cancer, like a neoplastic process, because you are encouraging growth factors. So if it was just like a nodule sitting there and I didn’t make sure it wasn’t a mast cell tumor, there was some uncertainty, like we could not make it worse.

But I actually have had colleagues, because in DERM, sometimes we are the Wild West, right? Like, we have lots of options, we deal with lots of things. I’ve had some colleagues actually use it on focal areas like skin lymphoma, and have seen results with it. So, we’re cautious of that. I think that’s one I’d still be a little bit, you know, weary of before I got more information, but hopefully we’ll see further studies and information come out as we have it longer.

Dr. Andy Roark: Gotcha. What you said, you know, you can do the treatment sort of back to back. What is the standard sort of treatment period? Is this a fairly short session? I guess what I’m, thinking about here when I think about like, laser therapy for joints, arthritis, things like that. is it that, that’s kind of what’s in my mind.

How comparable are those in the actual performing of the therapy?

Dr. Ashley Bourgeois: So I would say kind of depending on what you’re treating. If it’s a superficial pyoderma on average, I probably do it about, you know, three weeks and then I recheck them. And the nice thing about it is it’s something that you can train. I’m all about utilizing my assistants, my technicians. So this is something that once we have the treatment protocol set up, then they come in for treatments with them.

You know, they know how to do it. It’s very straightforward. So it’s something that we can actually have the staff do. It’s really good as far as utilizing their skills and their techniques. So I’ll usually have them do like three treatments and then we’ll recheck. That wound I was talking about that was non healing, I think we did that one for probably about like six weeks, but I was rechecking kind of every couple weeks in between.

So there’s not really a contraindication going too long. There’s even some that will use it for maintenance, like things for perianal fistulas, but it just depends on, you know, how convenient it is for the owner to come in for treatments and how much they’re willing to keep up with it.

Dr. Andy Roark: Do owners tend to get it, you think? I mean, I couldn’t, it kind of, I don’t know, it seems to me like it would be hit and miss. Like some owners would be like, that’s too, that’s woo woo You’re going to shine a special light on my pet and he’s going to get better. Versus others that are like, oh yeah, I am here for this, for this specific therapy. Yeah.

Dr. Ashley Bourgeois: I find it hit or miss. I mean, to be frank, I, mean, I think that’s true for anything that I do in dermatology. Some people really get it for some people if we’re already going to have to utilize something like say an antibiotic. You know, maybe cost is an issue, right? Because of course we have to charge for that service.

So, I have had some people, I am in Portland, Oregon. So some people are really excited about anything that’s not traditional. So, and I think there’s something to be said for that. I mean, I still have to use a lot of antibiotics and dermatology, but I’m totally game for anything that gives me the ability to be a steward of antimicrobials and try to use less or shorter durations.

So I would say it is hit or miss. Certainly I give estimates out for it and people don’t do it. But I think if you really explain it like, “Hey, there’s studies showing this can not only help with infection, but stimulate, you know, wound healing properties that we might be able to shorten the duration of antibiotics.”

A lot of people really do buy into that. If you can say that it truly has support behind it.

Dr. Andy Roark: Are there things that you wish you knew when you started playing around with FLE? Were there lessons you kind of learned along the way?

Dr. Ashley Bourgeois: I think just the confidence and actually recommending it, right? So very similar to you when things come out, you know, I’m, pretty cavalier. Like I, I’m always up for innovation and trying new things. I think that’s the beauty of veterinary medicine. I never want to be the person that’s just like, “Oh, well this has worked for 30 years. That’s what I’ll do.” Like, I always want to try new things because that’s the beauty of our specialty, but of course, like I’m like, there’s this cool way like we could try it. I don’t know. So I think the important thing is the studies right? To be able to say there are truly studies that show the benefit of this, but I also am totally fine if people say it’s not for them.

Like I, you practice long enough. You kind of, you know, you get used to like, that’s not for you. That’s okay.

Dr. Andy Roark: Hey guys, did you know that I have another podcast? I am the host of the Uncharted Veterinary Podcast with my dear friend, practice management goddess, Stephanie Goss. We, we have been answering questions for years. We started a year before Cone of Shame. I started doing the Uncharted Vet Podcast with Stephanie.

We take questions from our mailbag. We have listeners who write to us and they tell us about what’s going on in their practice and we try to answer their questions and they are all about. Communication, leadership, management, things like that. It’s about working with clients. It’s about working with staff.

It’s about working with your boss. It is about all of those sorts of things. We have everything from, trying to establish some trust in your team when you’re a brand new baby doctor, fresh out of vet school to, managing an employee with mental health issues to, how to. How to give notice without the guilt if you are in a place, you just can’t be there anymore. We’ve got all that stuff. We’ve got hiring, firing, working together, working with clients, reviewing your systems, getting your practice to run smoothly and efficiently, how to manage your time. All that stuff is there. Check it out. I said 250 episodes.

You can see what everyone is about, from the title because it’s what, it’s basically the question that we’re being asked. But anyway, it is a very popular podcast. I hope that you’ll check it out and enjoy it and love it. I just love making it. So anyway, I just want to tell you it’s there. Guys, let’s get back into this episode. 

Yeah. No, that totally makes sense to me. I’m with you too. It’s- I never want to be like, “that’s how we always did it”. And, at the same time, I take people’s trust in me really seriously, which means I don’t want to be in there like, “Hey, here’s some stuff. I just, I got it in the mail. I don’t know if it works.

It might be toxic. Let’s do it.” I, you know, I don’t want to be that too. So it’s it’s building that confidence, which is why I wanted to sort of talk to you about it and sort of say, okay, tell me about this as I, sort of look at it.

Dr. Ashley Bourgeois: And to your point real quick, it is totally fine to say stuff like that. Like I do get samples of stuff and I’m in Durham, right? So I have clients who’ve seen me for years and years and half the time, half the appointment is talking about like, what are your kids doing? So I will tell people like, there’s this new product out.

I don’t know much about it, but it’s supposed to do this. Or, you know, I saw some studies, just a couple of studies. So I’m really honest with owners. Like this is new. I don’t know much about it. I don’t have a lot of experience about it. Cause they appreciate that to your point.

Dr. Andy Roark: Yeah. when I’m thinking about sort of new derm therapies and new derm approaches, and you and I are talking here and it’s kind of, it’s still near the, first of the the first of the year, the beginning of 2024 setting FLA sort of stuff aside, what’s in derm right now that you’re excited about?

Like, what are you, what other tools are you looking at? I’m just fishing to be like, are there other things I should be really thinking about? But what are you Ashley interested in, excited about, optimistic about for the coming year?

Dr. Ashley Bourgeois: You know, I’m always optimistic that there is good research coming out just about learning more about what allergies really are. I think that in the last decade, we always think of itch, right? Like, Oh, they’re itchy. Stop the itch. And that’s so important, but I’m also really optimistic that there are being more studies looking at right?

Like when certain medications like apical and cytopoint came out, like they were not out when I started doing my residency. And it was kind of like now, you know, wow, they’ve been game changers, but I love also some of the attention that’s going into things like microbiome, like the differences in some of our allergies, right?

Like how come Westies are always little elephants? How come German Shepherds tend to have like ulcerative, crazy, nasty, like dermatitis, like there has to be phenotypic differences between some of these pets? So Itch is important. I think we’re going to continue to have more allergy medications that come out, which is great because we still have some cases that don’t respond to even the tools we have now.

You know, I always, we all cross our fingers more stuff for cats will come out. Like, I don’t think that will ever change.

Dr. Andy Roark: I know that’s exactly where my head was talk to me about allergies and cats.There’s such an opportunity there. I was really hoping you would have something you were like, oh, this is

Dr. Ashley Bourgeois: Everyone’s always like, you must know. Here’s the thing I’ll say about cats. There is a reason we don’t have as much, right? Like, of course, like, there’s, we see more dogs than cats, and you can get down to that. But the big thing is, think about the differences in cat allergies that we see. So, you see anything from an eosinophilic granuloma, Right.

To an indolent ulcer completely eating its lip to a cat who’s just itchy to feline asthma. Like there’s so many different presentations of allergies in cats. So of course, I don’t think it’s as easy to figure out and fine tune all of these things with cats because they have such wildly different presentations.

So there has to be some difference between the mechanism of action and pathophysiology of those diseases, right? So. We all want more stuff for cats. All I can tell you from the little I do know is it’s not for lack of effort from companies. It’s just that they can’t figure it out because cats are cats and they like to make our lives complicated.

Dr. Andy Roark: Yeah. No, they don’t. It sounds like there’s not going to be a cat allergy off switch that we can just find and flick. That would be nice.

Dr. Ashley Bourgeois: That would be so, even for us, people are like, Oh, but derm. I’m like, we have the same tools as you.

Dr. Andy Roark: Yeah, exactly right. There’s not a secret derm medicine cabinet that you guys aren’t aware of. Like we have the same stuff that you do. Oh man. Ashley Bourgeois, thank you so much for being here. What before, before I, yeah. I’ll let you go. So jumping back to FLE real quick. If people are interested in this, if they want to learn more, I will link the original article that I just was happened to be reading when I decided to text you.

What are the resources that you really like that you would kind of point people towards if they wanted to learn more?

Dr. Ashley Bourgeois: Yeah. Honestly, what’s a really good resource is just going to the Phovia website. Like if you just Google Phovia. I think it’s like Phovia.us or something like that. We could look it up. But the Veto Kenal True website has their literature. their actual research there, and it links it to, like, these have been published, like, in VetDerm and other places, too.

So they’ll actually have the true studies there, and you can look at how they design them, you can look at the results of that. So it is worth checking out, and I do think we’re going to see more to come.

Dr. Andy Roark: All right. Sounds good. I will link to that in the show notes as well. Ashley, you do as I said at the beginning a bunch of stuff on online. You, you’re always telling Derm stories and lessons and pearls sharing. And anyway, where can people find you online?

Dr. Ashley Bourgeois: Yeah, you know, I’m a simple person, so it’s all under the DermVet. On Instagram, on Facebook. And then I have my own podcast that is just Derm Nuggets tips. A mix of just me chatting in your ear for 15 minutes and then a mix of interviews with other dermatologists cause I truly am a believer that we all do things differently and that’s okay.

And we should learn from each other. So I love to hear about people who do things differently than I do, but I put everything under the DermVet cause you know, I’m a tired mom of two. And so I just keep it all under the same name for simplicity’s sake.

Dr. Andy Roark: I love it. I will link to all that stuff, including the podcast and the show notes as well. Ashley, thank you so much for being here, guys. Thanks so much for tuning in and listening. Take care of yourselves, everybody.

Dr. Ashley Bourgeois: Thank you.

Dr. Andy Roark: And that’s it. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. Thanks so much for being here. Thanks to Ashley for being here as well. Gang, take care of yourselves. Be well. I’ll talk to you later. Bye.