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Andy Roark DVM MS

Veterinary Cardiology Myths, Legends and Fears

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Veterinary cardiologist extraordinaire Dr. Kristin MacDonald teams up with Dr. Andy Roark to debunk the myths and unravel the legends swirling around cardiology. From heart attacks in dogs to the controversies surrounding grain-free diets, they dissect it all. Tune in as they sift through the maze of modern ideas floating on the internet, separating fact from fiction, and shedding light on what holds true in the world of pet heart health.

This episode is brought to you by CEVA Animal Health!

Important Safety Information: Do not administer in conjunction with non-steroidal anti-inflammatory drugs (NSAIDs) in dogs with renal insufficiency. Do not use in dogs with hypoadrenocorticism (Addison’s disease), hyperkalemia or hyponatremia. Do not use in dogs with known hypersensitivity to ACE inhibitors or spironolactone. The safety and effectiveness of concurrent therapy of Cardalis™ with pimobendan has not been evaluated. The safety of Cardalis™ has not been evaluated in pregnant, lactating, breeding, or growing dogs. Cardalis™ administration should begin after pulmonary edema is stabilized. Regular monitoring of renal function and serum potassium levels is recommended. Common side effects from a field study include anorexia, vomiting, lethargy, diarrhea and renal insufficiency.

LINKS

Cardalis Resources and App

CEVA Connect

Upcoming Webinar (Free RACE CE)

Dr. Andy Roark Resources 

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course

Dr. Andy Roark Charming the Angry Client Team Training Course

Dr. Andy Roark Swag

ABOUT OUR GUEST

Dr. Kristin MacDonald earned her doctorate of veterinary medicine in 1998 from Auburn University, and then completed an internship in small animal medicine and surgery at Michigan State University in 1999. She finished a residency in veterinary cardiology at University of California, Davis in 2001 and became a board certified veterinary cardiologist in the American College of Veterinary Internal Medicine in 2002.  She continued her education by earning a PhD at UC Davis Comparative Pathology graduate group in September 2005 on hypertrophic cardiomyopathy in Maine Coon cats, and the effects of ACE inhibitors.  Dr. MacDonald taught on faculty at UC Davis for a year, and then became the clinical cardiologist at the VCA Animal Care Center of Sonoma County in Rohnert Park, CA, where she continues to have a busy cardiology practice. She has been an active author of book chapters for highly respected textbooks, served as section editor for Handbook of Small Animal Practice, published a multitude of original research papers, and is coauthor of The Textbook of Feline Cardiology, the only text of its kind available.  Dr. MacDonald has participated in clinical trials involving treatment of canine congestive heart failure, and enjoys being the lecturer for the VCA Cardiology Series in the United States. Living in Sonoma County, she enjoys spending time outdoors hiking, skiing, and being mom of two daughters, two Tonkinese cats and a Labrador Retriever.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I am here with veterinary cardiologist, Dr. Kristin MacDonald. Today we are talking about cardiology myths. We are walking through a little bit about heart murmurs, a lot about heart failure, a lot about communicating the heart failure to clients, a lot about managing heart failure. We talk a bit about Spironolactone and why it has become so popular in cardiology and it’s all sort of presented in the format of myths and legends that I have heard and mostly I’ve seen online with pet owner groups, things like that, pet owner discussions, and I’m just putting that out to her and seeing how she communicates about these things and really what the truth is. So anyway, this is a super fun episode. It is a great bite-sized chunk episode. We just clip from one subject to the next subject to the next subject. It’ll definitely hold your attention. You’re definitely going to pick up some pearls along the way. Kristin is amazing, was so glad to have her. Guys, this episode is brought to you by Ceva Animal Health. 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. Kristin McDonald. How are you?

Dr. Kristin MacDonald:
I’m great. How are you, Andy?

Dr. Andy Roark:
I am so great. I am so glad that you are here. I have been looking forward to getting to sit down and talk with you a bit. For those who do not know you, you are a clinical cardiologist at VCA Animal Care Center in Sonoma, California. You are a huge outdoorsman, which I love, and you live in a beautiful place for it. You are also have two daughters just like I do, and you are teaching one of them to drive just like I am. I feel like we’re living parallel lives except for the whole cardiology thing. You are also a lecturer. You are doing VCA lecture series all across the United States. People can find you all over the place in your presentations. So yeah, thank you. Thank you so much for making time to be here. I’ve got a fun game and it is, I wanted to share with you some cardiology myths. I want to make some bold statements and I want you to shoot ’em down. So yeah, I want to go ahead and lay out some things that I am starting to hear or things that have kind of floated around the internet and I just want you to weigh in on some of the modern cardiology legends. Is that okay?

Dr. Kristin MacDonald:
That sounds great.

Dr. Andy Roark:
Alright, great. So first thing I’m going to start with is talk to me a bit about pet owners that are concerned about their dog having a heart attack. And so I see a lot in people. I’ve heard people say that dogs don’t have heart attacks. They’re like, dogs have heart attacks. I’m like, well, they do. And then people talk about heart failure and they’ll use heart attack interchangeably. Like, oh, well the doctor says he’s going to have a heart attack, and I’m like, nobody did that. Talk to me a bit about heart attacks in dogs and that terminology, if you don’t mind.

Dr. Kristin MacDonald:
Well, most clients actually equate heart disease in dogs to what they might suffer in human cardiology, which is a heart attack and it really is not the same thing. So dogs have a lot of different heart diseases, some that are in common with people, but they don’t have coronary artery disease and atherosclerosis. And I’m guessing it’s because we probably feed them better than we eat ourselves. Looking at my diet lately of lots of pastries and french fries on vacation, my dog eating way better than me. So there are certain things that may look like a heart attack that they may clinging to in severe forms. Their pet might be short of breath or breathing hard or coughing or collapsing. And so those things look like a heart attack, but it’s actually a very different process to a severe process. So we try to explain the actual heart disease that we think is going on with their pets so they can better understand it.

Dr. Andy Roark:
A couple of years ago, the grain-free heart disease was everywhere. It was huge thing. It blew up. There was much conversation about grain-free diets and their interaction with heart disease and things like that. That seems to have quieted way down. We don’t hear a whole lot about grain-free diet associated dilated cardiomyopathy anymore. Is that over? Is grain-free diet, heart disease a thing of the past?

Dr. Kristin MacDonald:
It is not over. It’s just not front and center on people’s minds. And unfortunately there are still cases of this. This was first described back in 2018 when we started seeing dogs that weren’t supposed to have dilated cardiomyopathy like little dogs that never get that disease. And we were looking at common threads and sure enough it was these grain-free diets that seemed to be emerging as this common factor. So there was this frenzy of learning and reporting to the FDA, which was a very arduous process for clients. It could take 30 minutes for them to have to fill out all this information and there gets to be fatigue in the process and fatigue with investigators. So there’s still ongoing active research, but I think that maybe the word has gotten out and maybe there’s been some reformulation of different diets, but there’s also very sneaky ways that companies are sorting the term grain free. And so they may call it grain friendly, but they still may have the same potentially toxic ingredients. We’re learning that it’s the legume family like peas and so they might call it green friendly where it’s more approachable. They still kept the peas in it. So we still are finding dogs with this and they can die from it. Changing the diet and treating for heart disease in these dogs can make a dramatic improvement in their outcomes. So it’s still around.

Dr. Andy Roark:
I can’t fathom. I’ve seen grain friendly and I’m like, oh, clearly they have addressed the concerns. But you say, but not necessarily.

Dr. Kristin MacDonald:
You have to look at now. It’s harder. You can’t just look at the title of the diet. You actually have to look at the ingredients list. It’s very complicated.

Dr. Andy Roark:
Oh man, I’m going to have to sit with that. That’s amazing. Talk to me about having seizures with heart problems. So I’ve had pet owners, I’ve seen posts on the internet where pet owners are like, yeah, my dog have heart disease and now he has seizures. How do you talk to people about seizures when their dog has heart disease?

Dr. Kristin MacDonald:
This is something or

Dr. Andy Roark:
Perception of seizures. Yeah.

Dr. Kristin MacDonald:
Oh, yes. This is something. Now full disclosure, I’m married to a veterinary neurologist, so this is a sensitive subject here. And we also happen to work in the same practice. So we’re often jockeying for whose case is this?

Dr. Andy Roark:
Well, hold on to jump in. Your father is also a veterinary dermatologist. Is that true’s like Oh, Thanksgiving’s at your house? Yeah.

Dr. Kristin MacDonald:
There was one actual Ettinger textbook that the three of us all had chapters in it and the table of contents had us in sequential order.

Dr. Andy Roark:
That’s got to be a record. That has to be a record. That’s super cool. Okay, I’m sorry. I didn’t mean to interrupt.

Dr. Kristin MacDonald:
So back to every time an animal has something where it looks like they collapse, they may lose consciousness, they may have some tonic CLO movement. They almost always call it a seizure, and it’s very difficult even in the best trained eyes and education to differentiate them. I’ve actually seen a dog in the ICU with an EKG on that went into horrible vtac, collapsed and fainted, and then had myoclonic movements that looked exactly like a seizure. But I had the EKG on and he had minimal blood flow and it was syncope. So of course an untrained client would think it’s seizure, but you’ve got to think twice about that and it’s hard for the GP because they’ve got to decide completely different directions to go, is this a really malignant cardiac event, cardiac or is this neurologic? Who do I send this to or what treatment should I start?
So it can be tricky because they can have similar appearances, but there’s a few things that I’m going to look for. I’m going to look at is there an inciting cause for syncope? It might be that it’s excitable or exertion related or triggered by a cough, or maybe it’s a small breed dog with chronic respiratory clinical signs in murmurs where for seizure it may be more likely at night when they’re resting and they may have different behaviors before and after, but it can be super tricky. But generally when a client says it’s a seizure, I would urge you guys to dig in deeper, get a little more info, look at your patient signalman and decide which direction should we go. And if there’s any questions, I’d be dialing up your favorite cardiologist or neurologist and tell them about it. Ask for a video.

Dr. Andy Roark:
Yeah. Well, I love the video suggestion, and this is always interesting because it really is the clinical history and asking the questions and kind of digging in. Do you still put halter monitors on dogs that you are playing around with syncope? Is that still a standard of care that you reach

Dr. Kristin MacDonald:
For? Oh yes. So for sure the first thing we’re going to start with is in my cardiology practice is we’re going to do a really comprehensive echocardiogram. We’re going to look for pulmonary hypertension, especially in small breed dogs, really common cause of syncope we’re going to have an EKG on, but you never luck into that aha moment. That’s when we really lean on the Holter monitor where we may place it for a day or even up to seven days to try to document arrhythmia and maybe we can catch the event and actually show whether it is from an arrhythmia or not, and then that will implicate your treatment because we have many great drugs out there, anti-arrhythmic meds, or even pacemakers we’ll use in dogs to really cure the problem.

Dr. Andy Roark:
Yeah, there’s a lot of conversation when I look online and I look at pet owners that are talking about their pets with heart disease and things like that. There’s a lot of fear. So one of the questions I’ve honestly seen online is people say, my dog has a heart murmur. Does that mean he’s going to die? Again, I think I bring this up because I think all of us in vet practice, we see heart murmurs all the time and we know that, but I think sometimes we take it for granted that the pet owners, they’re going to understand when we don’t act like it’s a big deal, so they’re going to understand it’s not a big deal. But I don’t think that’s necessarily true. How do you talk to pet owners about heart disease, about their heart murmur, which can hit them like a hammer when they go, what do you mean my little dog has a heart? What do you mean her heart has a valve that’s not working the way it should? What is that conversation like with you?

Dr. Kristin MacDonald:
Well, actually you catch it first, so I feel for you very much because you’re the revealer. And then I have clients that come in and they’re on the ledge. They are holding their breath, they are wringing their hands. You can see every bit of body language is fear. The dog’s not afraid, the cat’s not afraid as much, but the client’s terrified. So I love it when I can come back into the room after we’ve done our workup literally 25 minutes later and say, one of my first things is we’re okay here. And so it’s really disgusting that a murmur doesn’t mean your dog is going to die. And in fact, the odds are greatly in your dogs or your cat’s favor that they’re going to be okay. But this can get worse over time. And if we’re talking about the number one cause of murmurs in dogs, it’s going to be mitral valve disease, which yes, this can get worse over years of life, but again, if you’re a betting person, two thirds of dogs are going to live full lives with mitral valve disease. So it’s kind of giving them a little bit of reassurance and also committing them to the fact that things can go wrong and we need to stay on top of this. And that means we need to proactively prospectively watch these dogs and really monitor them to know when do we need to get worried and when do we need to start medications because certainly heart disease is not always benign and it can really progress to become problematic.

Dr. Andy Roark:
How do you handle the pet owners who, I mean again, so we talked about heart murmurs. When we start talking about heart failure, I have had clients come up to me or people who aren’t my clients, they talk to another vet and it’s almost like they have a question they’re embarrassed to ask their vet. So they say heart failure, that means he’s going to die, right? Heart failure is you can’t live if your heart fails and he’s in heart failure, does that mean he’s dying? And so unpack that for me.

Dr. Kristin MacDonald:
I literally had that happen to me last week. I kid you not right before this podcast. I was like, oh, this is it. This is definitely a myth that we need to dispel that heart failure is concerning. It’s a scary word because oh, it’s terrifying. This is a big deal. I mean, this is not a benign process typically, but it doesn’t mean your dog is dying on the floor in front of us. It means that your dog has severe heart disease severe enough that it cannot function properly, such that fluid will build up in the lungs or in the abdomen, or maybe they have really low blood flow so that they’re really tired going on walks or they’re coughing and breathing hard in that yes, heart failure, there are medications do help it just in people and think they may relate to that. They know like, oh, I have a lot of clients that go, well, I have heart failure.
I’m on that med. And so it almost makes them a little more comfortable to know we can treat this. But yes, overall there is a accelerated time course compared to people that can live with heart failure for 10 years, 20 years in dogs. I mean, it’s sad about most dogs with mitral valve disease and heart failure may live on average a year. Then again, we have some great success stories for longer and for dilated neuropathy, it’s even shorter. So there is this, in my approach, it’s an honest, gentle preparation for them so that we’re not sugarcoating things. We’re not trying to diverge from the truth, but we’re trying to support them, trying support and let them know what might happen, what it might look like. They always want to know what’s it going to look like, what’s the end going to look like? And I think it’s really helpful to discuss what it could be like with breathing difficulty that maybe it’s a phone call, kind of things are getting worse or maybe it’s a crisis and you need to get help urgently.

Dr. Andy Roark:
Do you think that you can have those honest conversations about what heart failure looks like and then still have sort of a voice of optimism?

Dr. Kristin MacDonald:
Yeah, absolutely. I think that I try to talk about that this is treatable and kind of a plan for what this looks like, but then we do have to talk about when things don’t go right. But also the fact that even if we have a dog that represents with heart failure, it doesn’t mean that we can’t make more adjustments and get more quality time. And I also think it helps with buy-in for medications because in veterinary medicine we don’t have so much success or there’s not as much availability of valve replacement. So really the mainstay of treatment cross country is medical therapy. And so if they know this is a deadly disease and we worry most about how they feel that medications are going to help deliver that improvement as best as we can, and we need them to be compliant and follow up and know what to look for that are concerns to let us know so we can be proactive.

Dr. Andy Roark:
Okay. Well, speaking of medical therapy, one of the things that I have seen in the last 16 months I have never seen since I was in vet school and learned about spironolactone, I have not put much thought into spironolactone until about 16 months ago when I started to really hear an uptick about conversations about Spironolactone. And so the debate that I’ve seen online, which is actually again, this isn’t pet owner for, but it’s interesting, but people are like, if you’ve got Lasix that’s so much stronger, you don’t need spironolactone if you got Lasix. And so let me put that to you as a potential myth that’s out there. How do you feel about that?

Dr. Kristin MacDonald:
I too was educated that it’s a weak diuretic. And really at that time until about a year and a half ago, I’ve been waiting for the data. I like data. I think it’s reassuring. It helps me to know is this worth it or not? And so we’re looking at effects within oftentimes like mitral valve disease and heart failure. And really we’re thinking about spironolactone is not a diuretic. We’re thinking about it kind of like an ACE inhibitor where it’s more of a renin, angiotensin, aldosterone system blocker. So it’s blocking aldosterone receptors. And so we think of it more in that neurohormonal antagonism rather than its effect on increasing urinary output. And there are definitely benefits that have been shown when you add spironolactone to benazepril that these dogs, they had a lot longer time before heart failure worsened and they lived longer and they had less time to what they call at all cause removal or all cause problems. So it’s very safe and effective and we’re learning that it’s not all about just how much urination they’re going to have in diuresis to have an actual benefit. But again, it’s not a one or the other. The beautiful part is that we can use multiple medications at each, have their own job to cumulatively get the benefit.

Dr. Andy Roark:
Well, tell me more about that. Talk to me a bit about quad therapy. So I’m hearing the term quad therapy in our cardiac cases and things. Can you define that for me, is what that means to you and then start to make the case for a quad therapy approach?

Dr. Kristin MacDonald:
Yeah, when I think we all talked about triple therapy, when PMO Bendin became available, we had of course our standard puric amide loop diuretic pulls the fluid from the lungs. We’ve got ACE inhibitors which are blocking the conversion of angiotensin one to two. And earlier studies showed improvement in heart failure class and double survival time. So that was back in the eighties to nineties. Then came pob Bendin, this revolutionary drug that has honestly changed the face of cardiology. It’s made us have a lot more fun and a lot better outcomes.

Dr. Andy Roark:
It should be in the water,

Dr. Kristin MacDonald:
A lot of happy, happy dogs and clients with this drug being an inod dilator. So what we’re looking at is I describe it to owners as this is the one that helps the heart function better and dilates vessels both going out the body and back to the lungs. So this really helps heart failure, many causes. And of course that one demonstrated again, improvement in survival, time and time to heart failure, recurrence, all of that is really something we’re looking for. So now comes on the scene spironolactone, and we just had this best clinical trial that I kind of honestly was waiting for. And what that is looking at is blocking aldosterone receptors with spironolactone and what aldosterone, it’s a toxic neuro hormone. And unfortunately when dogs or cats are placed on ACE inhibitors, we want to believe that there will be less angiotensin too made, which then lessens production of aldosterone. Well, that’s logical, but the body has different workarounds. And so about 40 to 50% of animals people, they have this aldosterone breakthrough where we still have elevated toxic aldosterone circulating in the body that’s wreaking havoc on the cardiovascular system. So we’re looking at now blocking both the ACE system and aldosterone, and I think of it as kind of like peanut butter and jelly, or actually it’d be more like chocolate and peanut butter. For me, the perfect combination really for more comprehensive blockade.

Dr. Andy Roark:
Is it hard to get clients to buy into quad therapy? I mean, we’re talking about giving a number of different medications. If some were to make the case and they were like, it’s better to do fewer things the client will actually do. How do you feel about that?

Dr. Kristin MacDonald:
Very

Dr. Andy Roark:
Tricky. Shoot that down for me if you can.

Dr. Kristin MacDonald:
It’s a tricky, tricky thing. And unfortunately a lot of these dogs are coming to me and have never even seen POB bendin yet. And so they may be on no medications and they come in for a little cough, they think they’ve got kemal cough, things are great, and then I’m telling them their dog is congestive heart failure and may live for a year. This is a lot to handle. So then we start talking about quad therapy, four different drugs. And some clients will get worried like, well, is it safe? Is it toxic drugs might be toxic? Well, yes, we do have to follow kidney values and all, but they are very safe. But then comes the reality of implementation. So how compliant might a client be able to be with four different medications given often twice a day? And unfortunately, doctors, they want to believe they have the perfect pupils that will do everything perfectly.
But I think we may be perfect cases that humans are going to mess up and they’re going to be busy and going to a lot of other stuff on their plate looking at a lot of clients say they cannot handle giving more than three meds. They say, I can’t even do two meds a day. And about 30% said they could give at most three meds a day and that they couldn’t handle more. So I often look at, there’s a nice combination tablet where we have both the NPR and Spironolactone and one tablet given once a day. And so I don’t sneak it in. I just say, well, we’ve got three medications your pet’s going to go home on little. And I sort of say, by the way, one of them happens to have a two in one, so it makes it a little easier for them to handle.
And it’s even easier if they’ve already come in on PMO bendin for preclinical, say, heart enlargement. And then I say, well, we’re just going to add two more medications that are going to help the heart failure part of things. But it’s very tricky. The other part is will the pet take the medication? Maybe the client is absolutely on board. They are dependable. They know they’ve been educated to say, this is how your dog is going to have a good life and live longer, but we have to give the med or it’s not going to work well talking pet language. Your dog or cat may not agree with that, so we’ve got to make sure they know how to give the med. Maybe they may need reminders or training on that. So there’s some great apps out there. I mean there’s apps for everything these days. But I do love the Cardis app because it helps them monitor breathing rights and it has medication reminders and you can have multiple pets. And I do have families that have three animals and heart failure all at once. So just giving them the tools to help them with the delivery.

Dr. Andy Roark:
I love it. Dr. Krista McDonald, thank you so much for being here. You are so wonderful. Where can people learn more from you? Where can they find you online or in the future?

Dr. Kristin MacDonald:
I might be a bit of a dinosaur, but I have a LinkedIn. I don’t check it that much, but really VCA Animal Care Center of Sonoma and LinkedIn. But overall, I also go incognito because online I have a Facebook that’s my own personal Facebook with last namely. Oh, okay. Yeah. But probably through VCA. I am actually going to have a really fun time weekend before school starts. My daughters and I are going to go to Vet Girl U down in Scottsdale at the Princess, and we’re going to have a great time with my mom-in-Law. Oh man. Yeah, you guys should check it out.

Dr. Andy Roark:
Yes, vet Girl u Justine Lee and Garrett Pater are good friends of mine’s founder of Night Girl. Just wonderful people. They’ve got a great event. They have a great culture. I think the world of them. That’s fantastic. Yeah. Awesome. Thank you. Thank you guys. Take care of yourselves, everybody. I’ll talk to you soon. Thank you. 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. Real quick before you go, I got to give you a fast heads up. I have a Ray CE webinar coming right at you very soon. It is called The Practical Guide to the Mitral Valve Patient. This is with my friend Dr. Natalie Marks. It is on November 29th at 4:00 PM Eastern. That’s 1:00 PM Pacific. It’s sponsored by Ceva Animal Health. Guys. I’ve worked with Natalie many times. She’s been on this podcast many times. She’s absolutely great, super practical, a really wonderful doctor to learn from. This is going to be packed full of pearls, like I said, free hour race, ce. Jump in and grab it. Link is in the show notes. Get on it fast because this is going to pass us by real quick. Anyway, coming at you. I’d love to see you there, and that’s what I got for you today. Take care of yourselves, everybody. See you later.

HDYTT: Anesthesia on a Full Belly

by

Veterinary Anesthesia Nerd Tasha McNerney joins Dr. Andy Roark on the podcast to unravel the intricacies of anesthesia on a full stomach. They explore navigating emergencies when surgeries can’t be postponed, highlight crucial factors in devising meticulous anesthetic plans, and dissect the risks tied to regurgitation during anesthesia.

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

LINKS

Veterinary Anesthesia Nerds Symposium 2024

Veterinary Anesthesia Nerds Facebook Page

Veterinary Anesthesia Nerds

Canine Cardiology Webinar (Free RACE CE)

Dr. Andy Roark Resources 

Dr. Andy Roark Swag

REFERENCES

AD Galatos, D Raptopoulos. Gastro-oesophageal reflux during anesthesia in the dog: the effect of age, positioning and type of surgical procedure. Vet Record, 137, 1995: 513-516

DV Wilson, AT Evans, WA Mauer. Influence of metoclopramide on gastroesophageal reflux in anesthetized dogs. AJVR, 67, 2006:26-31

AC Zacuto, et al. The influence of esomeprazole and cisapride on gastroesophageal reflux during anesthesia in dogs. J Vet Intern Med, 26, 2012:518-525

ABOUT OUR GUEST

Tasha McNerney is a Certified Veterinary Technician from Pennsylvania where she works as a educational consultant and relief anesthesia technician. Tasha is the founder of the Veterinary Anesthesia Nerds, while also a Certified Veterinary Pain Practitioner and board member of the International Veterinary Academy of Pain Management (IVAPM) to educate the public about animal pain awareness. In fact, Tasha was the thought leader behind the now celebrated “Animal Pain Awareness Month” within the veterinary industry. Tasha became a veterinary technician specialist in anesthesia in 2015. Tasha loves to lecture on various anesthesia and pain management topics around the globe and was previously named VMX Speaker of the Year.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. I’m here with my dear friend, Tasha McNerney. She’s the original anesthesia nerd. Boy, this is a great conversation. Get ready to jot down some notes. I don’t care how much experience you have with surgery and anesthesia, you are going to get some pearls today because Tasha is laying them down thick. This is a great conversation about going to anesthesia when we have a pet with a full belly, and it’s going to happen. It’s just pets don’t always plan to have surgery later in the day when they decide whether or not they’re going to eat. And so this is a thing that we have to deal with. But God, I took so much away from this conversation. It’s a great one, gang. 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. How are you my friend?

Tasha McNerney:
I’m good. Thanks for having me again.

Dr. Andy Roark:
Always. I love having you on here. I just be honest. You and I have been talking for like an hour and we finally had to press record and do this episode, but you are a joy. For those of you who are watching on YouTube, it’s Halloween, just so you know. That’s why-

Tasha McNerney:
That’s why I am dressed like this.

Dr. Andy Roark:
Yes, and for those of you who are not watching on YouTube, Tasha is dressed as, do you want to tell ’em what you’re dressed as?

Tasha McNerney:
Yes. So for all of the Swifties out there, if you’ve ever seen the Shake It Off music video, I am the cheerleader section, the cheerleader, Taylor Swift. So shout out to all the Swifties out there. Not going to lie. I am a Reputation girly way more than a 1989 girly. I know that’s controversial. Oh wow. But the reputation costume that I really would want to have, I need some serious time to work on that. So maybe next year we’ll go a Reputation based costume.

Dr. Andy Roark:
Okay. Well, I mean Taylor has a deep catalog. I think we can just year after year, we can

Tasha McNerney:
Just keep

Dr. Andy Roark:
Going. Just keep going. Alright. I love this. For those who don’t know you, you are Tasha McNerney. You are CVPP which is a certified veterinary pain practitioner. You are a VTS, veterinary technician specialty in anesthesia. You are the founder of the Veterinary Anesthesia Nerds, which was originally a Facebook group, still a Facebook group. However, you have moved way beyond that. You guys have, you’ve had a conference for a number of years. I have heard wonderful things about it. It is all about anesthesia. It has a heavy emphasis on vet techs, which I love, but it’s open to everybody. You guys are doing your next one in San Diego in April, is that correct? April 24?

Tasha McNerney:
That’s correct. Yes. We’re doing April, 2024 and we’re bringing back, we’ve taken a hiatus over the last couple of years with just everything going on and moving in jobs and et cetera. And now we are back and we have some fantastic speakers, not only Darcy and Steven, just wonderful in their own right, but also two great anesthesiologists. Kristen Messenger and Mike Barletta are going to be speaking with us as well. We’re going to get really in depth, really high level anesthesia, new concepts, deep dives into drug pharmacology. But my favorite thing that we do at the conference is the hands-on lab going over head to toe, regional anesthesia, ultrasound guided blocks, different nerve blocks and local anesthetic techniques. So I love that.

Dr. Andy Roark:
I love how you do this. I think the future of learning is this type of really hands-on deep dive when you get together and just really do it. It’s not sitting in a lecture and looking at slides. It is doing the cadaver labs and really doing the skills. Anyway, I love how you guys roll. Also, I love San Diego. It’s a wonderful place to be. You guys are at the Hyatt, which is right on the water and absolutely gorgeous. It’s just, anyway, for anybody who’s looking around and going, man, that sounds amazing. Registration is open. I’ll put a link in.

Tasha McNerney:
Registration is open. Yeah, I can send you the link and we can put it up there. Registration is open. The cool thing about this conference is that we have looked at the data and we know that after a certain amount of time, listen, we all just start to tune out and sitting in a lecture hall for eight hours straight is just a lot. So our lectures are actually from 8:00 AM till 1:00 PM and then our expectation is you’re going to spend the afternoon going out and exploring San Diego. We are really trying to do that work-life balance thing because we want you to actually enjoy your conference and not just see the inside of a conference room. We want you to go outside and explore some stuff. We might be even doing a nerd’s hike where we hike the beach, but also talk about, I don’t know, drug pharmacology as one does.

Dr. Andy Roark:
Totally. So if your boss is like, what will you do in the afternoons? You’re like, I will talk about drug pharmacology. You will while you walk on the beach.

Tasha McNerney:
We will. Sure.

Dr. Andy Roark:
Yeah. Sounds great. Cool. You came to my mind recently because I saw this case and it’s a big dog. I can’t remember exactly what time. It wasn’t a great dane, but I think it was a big shepherd. It was a big shepherd. I remember the hair. I remember hair everywhere. It was definitely a lot of hair. It was a big shepherd. And I saw this dog back after a neuter and it had just blown up. And so this dog had the biggest, most awful scrotal hematoma I had ever seen, like necrotic skin. It was God awful. And I was like, okay, we’ve got to fix this. This dog needs a scrotal ablation. And they brought him in first thing in the morning, and of course I said to them, has he had breakfast? And they were like, oh yeah, he ate everything. And so I thought, you know what?
We need to, we’ll sort this out, but I want to talk to Tasha about anesthesia on a full belly. And also I was like, Thanksgiving’s coming up. I think that’s a good Thanksgiving talk. Is anesthesia on a full belly when I have a full belly, when the patient has a full belly? How does that go? So let me just pause there and we can get into specifics if we want. We can use my one-year-old German Shepherd if we want to, but generally, let me just open the conversation. Tasha, talk to me a bit about putting pets under anesthesia when they have a full belly because it’s going to happen. Ultimately dogs don’t like skip breakfast so they can get hit by a car. That’s not how it works. And so anyway, just start with me a high level. How much of a concern should this be?

Tasha McNerney:
First off, it is a concern. We do know that anytime that our patients do have stomach contents, we are at increased risk for vomiting, but more importantly, regurgitation. And that’s what we really worry about. We definitely don’t want them vomiting. We don’t want ’em feeling nauseous, but we don’t want regurgitation under anesthesia. We know that not only can that cause a problem to the mucosa of the esophagus, but also increases anytime there’s stomach contents, that’s going to increase our chance for a potential of airway, stomach contents, getting into the airway basically. Now you’re mentioning that this patient is going under, is going to go under anesthesia. So let’s just say that when we talk about this from an anesthetic standpoint, the good thing is that we are going to have our airway protected because we’re going to intubate this patient. So having an endotracheal tube in place, having a good seal on that endotracheal tube, testing it to make sure using your capnograph to check to make sure that that seal is appropriate, that is going to help that. If the patient does develop any kind of esophageal reflux under anesthesia, then that airway is going to be protected. So I will say that in this case, if you have a patient come in, whether they be an emergency patient or something like this, where we’re going to do procedure this afternoon and the patient has eaten, then we want to make sure that we are looking at drug choices and setting the patient up for success. There’s nothing we can do to get rid of those stomach contents.
We want to make sure that we are just giving them the safest option possible. And this is why in anesthesia land, we will always advocate for full anesthesia where we can intubate the patient and have control of that airway versus heavy sedation where we might not have control of that airway. And should that patient have esophageal reflux or regurgitation, sorry, that becomes a more dangerous situation.

Dr. Andy Roark:
Let’s just say I’ve got a dog or a cat comes in with some sort of a laceration it, something that needs to be treated, things like that, and you ask the question, when was the last time that your pet ate? And they say, oh, fairly recently. You would actually factor that into is this a heavy sedation case or is this a full anesthesia case? Is that correct?

Tasha McNerney:
That’s correct, yes. And again, that’s going to influence the drugs that we choose. Now, all of our opioids that we are going to utilize and we utilize a lot of opioids, especially if you’re going to surgery with a patient, we know that our full opioids, things like morphine or hydromorphone are going to cause more nausea, more vomiting and more regurgitation, opioids in themselves. Also blunt the protective airway reflexes. There are other drugs that can cause this as well, which are things like anticholinergic. So if you use atropine during your procedure or ace promazine or inhalant anesthetics, and I think sometimes people forget that inhalant anesthetics in themselves can cause nausea, vomiting, blunting that esophageal sphincter tone. So that is something to keep in mind as well. So if you’re going to be utilizing those drugs, absolutely we should have a protected airway and that means intubation of our patient with a good fitting seal that we can verify either with your manometer to check to make sure that your endotracheal tube is holding to the correct pressure or you’re washing your capnograph to make sure you’re getting those nice plateaus. And then we’re not getting any leaking around our airway. We want to make sure that that airway is protected. No stomach contents or regurg can get down into that airway.

Dr. Andy Roark:
I have a RACE CE webinar coming right at you very soon. It is called the Practical Guide to the Mitral Valve Patient. This is with my friend Dr. Natalie Marks. It is on November 29th at 4:00 PM Eastern. That’s 1:00 PM Pacific. It is sponsored by Ceva Animal Health. Guys, I’ve worked with Natalie many times. She’s been on this podcast many times. She’s absolutely great. Super practical, a really wonderful doctor to learn from. This is going to be packed full of pearls, like I said, free hour RACE CE. Jump in and grab it. Link is in the show notes. Get on it fast because this is going to pass us by real quick. Anyway, coming at you. I’d love to see you there. Let’s get back into this episode.
Talk to me a little bit about the approach that some people have of, Hey, this pet’s got a full stomach. We’re just going to use our opioids, we’re going to use morphine, we’re going to use hydromorphine. They’re almost certainly going to throw up, and then we’ll go ahead and do our procedure. You pointed out some things to be concerned about or at least pay attention to with our opioids. Do you hate that approach? Are you okay with that approach? Talk to me a little bit about how you feel about that.

Tasha McNerney:
Yeah, so interestingly enough, my husband, who I should let people know, my husband works in vet med, so when I say I was talking with my husband about something similar to this, he was like, but I would want to give them hydro and dexmed. Then I know they’re going to throw up all their stomach contents.

Dr. Andy Roark:
Yeah.

Tasha McNerney:
Potentially. Yes, potentially that’s true. And this is again, where I have to say every single patient is going to be treated differently because if you said to me, I have a laceration repair on this bulldog, French bulldog, Boston Terrier, boxer, anything, brachycephalic, again, because of their body confirmation, just because of the breed, I know that they are already at a higher risk of vomiting, regurgitation under anesthesia. So if we heavily, heavily sedate them with something like an opioid plus minus dexmedetomidine, even acepromazine, then what I worry about is if my team isn’t on top of it, could they potentially be vomiting but then not be in a position I’m talking about with their body. If they’re on the side, they’re vomiting or if they vomit up and then immediately fall over, we’re not ready with intubation to protect their airway. There is a chance that some stomach contents could get into their airway, and we are at greater risk of aspiration pneumonia. So if this is a brachycephalic breed, I will really try to avoid making them vomit before I am ready because I don’t want them potentially getting anything into their airway.

Dr. Andy Roark:
Yeah, that absolutely makes sense. And as you’re sort of laying this out, I was like, yeah, this is the stuff of nightmares. Yeah, that totally makes sense. So looking at brachiocephalic breeds things like that’s going to specifically or that’s going to increase your concern?

Tasha McNerney:
Yes, 100%. So if this was a shepherd that came in, and again, every patient is an individual. So if you said to me, Tasha, I can’t even get a catheter in without giving this patient some sedation, then again, what we have to look at is what’s the procedure that’s about to be performed? How heavy of analgesia and sedation do I need for this patient? So if I have a shepherd that is in for a scrotal ablation, I know that they have eaten within the past couple of hours, then we have to look at can I get a catheter in? If I can get a catheter in, then we can give our drugs IV. And we know by giving our drugs IV opioids, IV dexmedetomidine IV, we can lessen the overall amount that we’re giving and then that will lessen the side effects. And we usually don’t tend to see if we have given something like hydromorphone or buprenorphine IV, we don’t tend to see the same amount of nausea, vomiting, et cetera, that we will with an IM or subcutaneous injection.
So if I can get IV in, that’s preferred. However, if you say to me, absolutely, this dog is going to need some sedation before we place a catheter because it’s extremely fearful and reactive, then okay, let’s do that. Now, my drug choices might be a little different. Maybe I might choose something like buprenorphine or butorphanol as my opioid plus minus a dexmedetomidine or acepromazine. Again, depending on the patient’s, ASA status health status. So I might give that as an IM injection just to sedate the patient enough to do an IV catheter. And I know there’s people out there saying, Tasha, you just said butorphanol. Butorphanol is not a potent analgesic. I worry if I give butorphanol, then can I still give an opioid? Yes, butorphanol as far as its analgesic properties, pretty short acting. So let’s say you gave that patient butorphanol as a sedative because we don’t want to give it morphine or hydromorphone.
I don’t want it to be vomiting all over. So let’s give it a little butorphanol, less likely to vomit and then say the time goes by, you can always top off with IV hydromorphone or IV buprenorphine. Okay, yes, some of the receptors are going to be taken up with the butorphanol, however, not all of them are. So layer in your other opioids, once you get that IV catheter in place, our other opioids like hydro are going to be fast acting. If you have fentanyl at your practice, you could consider that as well of the opioids. Morphine is going to be the one that causes the most vomiting and of the pure MU opioids, methadone is going to be the one that causes the least amount of vomiting. If you have access to methadone, again, for a GI case or something, that’s usually what I’m going to go towards. However, if you’re at a practice that doesn’t have any MU opioids, then you have to use what you have on the shelf, and that’s when I start to look at things like butorphanol and then follow it up with longer lasting, higher level analgesia with buprenorphine.

Dr. Andy Roark:
Okay. No, that totally makes sense. And yeah, I’ve got to tell you, starting off with a buprenorphine or sort of a partial agonist and then adding in more of a pure agonist, that’s not a tool I really have in my toolbox. I have to sit with that. So is that a fairly common procedure? Are there things that you should be concerned about? Do you see, I don’t know. When you start with something that’s sedative and then you add an IV pure opioid on top of it, so start with buprenorphine and then add in some hydromorphone IV. Again, I just don’t have a lot of experience with that combination in my hands. Is there anything I should be looking out for or anything that I want to pay attention to?

Tasha McNerney:
Yeah, no problem. So I’ll just clarify that. If I was going to do this where I needed a sedative at first, I would be using butorphanol, not necessarily buprenorphine. Buprenorphine in itself of the opioids is not going to cause a lot of good sedation. So if I’m looking at a patient where I just need some sedation to get me through to get a catheter in place butorphanol is where, that’s where you want to go. Again, if I’ve used butorphanol say 45 minutes to an hour beforehand, and now I’m about to induce anesthesia and I need some analgesia and I’m about to give hydromorphone, yes, you potentially could not see as strong effects with your hydromorphone. However, as with any anesthetic or any analgesic protocol, it’s not all about the opioids. We want to make sure that we’re using a multimodal protocol so that way if there are some receptors that aren’t able to be taken up with the hydro and those MU receptors aren’t able to be fully agonized with our hydro, well that’s okay because guess what?
We’re also adding in things like maybe a Lidocaine CRI. We’re using regional anesthesia to our fullest extent. We’re adding in dexmedetomidine together with opioids, a really wonderful sedative analgesic combination. I think, again, if anybody’s ever heard me speak how much I love dexmedetomidine, and even the addition of half a mic to one mic per KG IV dexmedetomidine is going to provide additional synergistic analgesia. So I think that if you are at all worried that maybe my hydro is not going to work as well because an hour ago I gave butorphanol, that’s fine. Again, you’re going to do a multimodal protocol. We’re not always just going to rely on our opioids, and if we look at some of the evidences from human medicine, it really is about playing with and being very careful with or targeting our opioids, maybe even reducing our opioids and increasing some of these adjuncts like dexmedetomidine lidocaine, regional blocks, et cetera.

Dr. Andy Roark:
Is there any chance that you’re going to see a bounce phenomenon? So you use Butorphanol, which has got a pretty short half-life, and I give my hydromorphone, am I going to see increased effects from the hydromorphone after the butorphanol wears off, or is that not going to happen?

Tasha McNerney:
No, not usually, or at least we don’t seem to appreciate that again, because usually these patients are now under the effects of inhalant anesthesia.

Dr. Andy Roark:
Okay, so we’ve talked about choosing our opioids and what that looks like. Talk to me a little bit about GI protectants, things like that.

Tasha McNerney:
Yes, excellent. Because again, if I have a patient that came in and they needed an emergency surgery, let’s say they have a fracture or whatever, they have the laceration repair, they have eaten. I’ve chosen the most appropriate opioid. We have a catheter in. Now, another thing that’s going to be important, again, because we know that these drugs that we’re using like opioids, like inhaling anesthetics, are going to blunt those reflexes and they are going to decrease the sphincter tone or esophageal sphincter tone. Then we want to make sure that we are putting GI protectants in, and this is things like pantoprazole, omeprazole, metoclopramide, not only the bolus of metoclopramide, but also then a CRI of metoclopramide. So things like this, if I know that patient is going to surgery and they’re going to get opioids and inhaling anesthetics, I know that they’ve eaten in the last four hours, I’m going to my clinician and I’m saying, okay, also before we get started with inhalant anesthesia, once we get that catheter in, how do you feel about pantoprazole?
How do you feel about maybe some cisapride omeprazole? Do you want me to start a reglan CRI? Things like that. We do have some evidence that doing these things is going to decrease the amount of esophageal reflux under anesthesia. Then another thing that I want people to know is if you as the anesthesia technician are with a patient and they’re under anesthesia and you notice that they do have regurgitation either coming out of their mouth, coming out of their nose, et cetera, that’s really important to note. You want to let your clinician know that because that pH of those gastric contents that are coming up, that’s acidic. So we risk damaging the mucosal layer of the esophagus. So not only do we want to make sure we alert our clinician, write it down on our anesthetic record, but also it’s going to be important to not only have your suction ready, but you’re going to want to lavage that.
Now, there was a study looking at whether or not just plain saline versus saline with diluted bicarbonate was better to reduce that pH in the mucosa, and they did find that if you’re going to lavage the esophagus, then you want to make sure that you’re using saline with diluted bicarbonate in it to neutralize that pH, and then you have your suction ready, suctioning all of that out. Also, one thing that you want to note is, again, on your anesthetic record, we want to make sure that we know that this patient did have some regurgitation intraoperatively, because then I might want to talk to my clinician about whether or not this patient should be started on something like sucralfate once they have their swallow reflex back.

Dr. Andy Roark:
Yeah. Alright. That totally makes sense. Great. I feel good about this. Is there any other things I need to look out for? Any words of wisdom, pieces of advice?

Tasha McNerney:
No. Well, interestingly enough, the patients that do have the highest amount of regurgitation under anesthesia are orthopedic patients. So again, if your patient is a orthopedic fracture repair, then they actually already have a higher incidence of having that regurgitation, so be prepared with your GI protectants.

Dr. Andy Roark:
Why do you think that is?

Tasha McNerney:
I don’t know, but it was a really interesting study. I can send you the paper if you want to put it in the show notes. Yeah, sure. Send. But they look like they saw that orthopedic patients actually had a 25% chance greater incidence of esophageal reflux and regurgitation than the other patient populations. It’s very strange. Oh,

Dr. Andy Roark:
That’s fascinating. Cool.

Tasha McNerney:
And again, again, so brachycephalic already have an increased risk of regurgitation under anesthesia, so make sure you are protecting their airway at all costs.

Dr. Andy Roark:
Yes, I love it. Awesome. Thank you so much for talking through this with me. I have a page and a half of notes from a 15 minute conversation, absolutely enjoyable. I really appreciate your time. I will put links to the anesthesia nerds conference up. Tasha, where can people find you online?

Tasha McNerney:
Yeah, we are on the veterinary anesthesia nerd, so veterinary anesthesia nerds.com is the website for all of our information where you can find all of us speaking. And if you really want to get involved in the chat where our chat is mainly going over cases still as a Facebook group, but a very active Facebook group. We are looking to move off of Facebook in the near future and just be located on our website. But for now, you can find us on Facebook, you can find us on Instagram, and come see us in person in San Diego.

Dr. Andy Roark:
That sounds awesome. Awesome. Thanks so much for being here, guys. Thanks for tuning in. I hope you learned something. I hope you took something in the way. Take care of yourselves, everybody.

Tasha McNerney:
Bye.

Dr. Andy Roark:
And that’s it. That’s our episode. That’s what I got for you. Thanks, Tasha, for being here. Guys, thanks to you for tuning in and listening. Take care of yourselves, everybody. We’ll talk to you soon.

An Honest Look at What We’re Thankful For

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I’ve seen more than a few shocked faces as I, the guy known for holding the torch of positivity in veterinary medicine, tell people that “life is suffering.” If you’ve listened to my podcasts or read my articles, you’ve heard me tell people that medicine (and management) is simply picking your poison over and over again. One of my favorite quotes centers on the idea that no one, and I mean no one, can escape pain, uncertainty, and hard work. Not exactly the mantra that people expect from the smiling, laughing guy who loves his job.

I think that there is a perception that being positive (or grateful) is about fooling yourself. It’s about refusing to see challenges and hardships, or at least to discount the impact these difficulties have on us. I do think there is power in “choosing happy” and I reject the idea that looking on the bright side always constitutes “toxic positivity.” That idea is simply a cudgel the cynical like to wield against the optimistic.

The healthiest view of the world I have found is a balance between optimism and a pragmatic, honest look at the challenges we are destined to face in this life.

Pretending that hardship isn’t all around us or that the world is fair doesn’t make much sense. Neither does wallowing in the knowledge that we have very limited control over much of our lives and death comes for us all. A balance between these mindsets, however, can be a thing of beauty.

As I reflect on what I’m thankful for this holiday season, my list looks different than it has in the past. Yes, I’m thankful for my family and interpersonal relationships, and I’m optimistic about my chances of deepening and strengthening those bonds in the coming year. I’m thankful for our profession and to have work that I find meaningful and rewarding. I think veterinary medicine has a bright future, and I’m genuinely excited to see where it is going.

At the same time, my list is balanced by a more clear-eyed perspective on how fragile life can be, and a knowledge that hardships inevitably await us all on the road ahead. I’m grateful that my family is healthy. That gratitude is deepened, not diminished, by the fact that one year ago my wife was beginning radiation therapy for breast cancer. I am proud of what my business has done and is doing, and that pride is stronger because we have faced setbacks, suffered failures, and navigated uncertainty. I cherish the laughter around me, because I have seen a lot of tears.

Today, I am more grateful for what I have than ever before. It’s a deep, rich gratitude that I think comes not from blocking out everything but the positive, but by truly seeing the difficulties, learning to accept them, and then looking towards the future with an intentional and dedicated optimism.

My wife is healthy. My children are safe. My job is rewarding. My business is a success in the ways that truly matter. I feel thankfulness for these truths in my bones because I know they are not guaranteed.

What are you thankful for?

Building Your Personal Board of Directors

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Dr. Addie Reinhard joins Dr. Andy Roark on the podcast to delve into the pivotal topic of mentorship in the veterinary field. They explore the significance of crafting a personal board of mentors, offering insights on being an effective mentee and navigating the terrain of feedback. Tune in as they unravel strategies for identifying the ideal mentors and uncover best practices in fostering these invaluable professional relationships.

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

LINKS

Mentorvet.com

MentorVet Facebook and Instagram

MentorVet LinkedIn

Dr. Andy Roark Resources 

Dr. Andy Roark Webinars

Dr. Andy Roark Swag

ABOUT OUR GUEST

Dr. Addie Reinhard is a veterinary wellbeing researcher. Her research focuses on developing and evaluating innovative interventions to support mental health and wellbeing within the veterinary profession. She is the Founder and CEO of MentorVet, an evidence-based mentorship and professional development program for recent veterinary graduates. She is on the research team for the next phase of the Merck Animal Health Veterinary Wellbeing Study. In 2021, she completed a master’s degree in Community and Leadership Development and a Graduate Certificate in College Teaching and Learning from the University of Kentucky and holds a certificate in Veterinary Human Support from the University of Tennessee. She is also a certified QPR instructor.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary podcast. I’m your host, Dr. Andy Roark. I got a great one today. I am here with my good friend, Dr. Addie Reinhard. She is amazing. If you’re not familiar with her, her work with MentorVet, you’re in for a real treat. Addie and I have, we’ve become good friends in the last year. She’s just a absolutely wonderful person, one of my favorite people to spend time with. I got so much out of this conversation with her. She’s got so much insight into mentorship and into building relationships. And guys, I genuinely think that the interpersonal relationships we have are probably the most important thing when we decide whether or not we are happy with our life. I really think that those relationships, they matter more than anything as far as satisfaction. I can tell you from personal experience, I don’t think there’s anything that matters more in our careers and getting doors open for us to go and do things, to grow, to learn, to try new things than the people that we know who are willing to give us opportunities and to help us out and to give us advice, and to invest some time into us.
And I just believe that deeply. And so Addie is just such a wonderful person to talk to and she’s got so much information to share. So anyway, I hope you guys will enjoy this episode. I think it’s a great one. 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. Addie Reinhard. How are you?

Dr. Addie Reinhard:
Hey, doing well. How are you?

Dr. Andy Roark:
Doing great. Thanks for being here. I always love to visit with you.

Dr. Addie Reinhard:
Yeah, it’s always a good time. Lots of laughs usually.

Dr. Andy Roark:
Yeah, usually. For those who don’t know you, you are a veterinarian. You are the founder and CEO of MentorVet. And so MentorVet, actually I’ll let you take it. Why don’t you quickly lay down what MentorVet does?

Dr. Addie Reinhard:
Yeah, so I practiced small animal for about four years, got burnt out a few times, had some great mentors to help me through that. And really recognized how powerful good mentorship and support is really at all stages of your career, but particularly for me in the transition to practice. And so really fell to calling to be able to want to give back to others through creating structures for mentorship. So founded MentorVet, the entity, after spending two years at University of Kentucky doing some research on veterinary wellbeing and more importantly, what can we do about it. So at MentorVet, we create evidence-based programming to support the individuals in the veterinary profession to give them the skills and tools and support structure that they need to help themselves and help others in the field with the ultimate goal of creating a healthier profession for everybody involved.
I love it. You are amazing. I love the work that you do. I really enjoy getting to hang out with you. You and I got to visit in Austin, Texas at the NAVC Hive event, and we basically spent three days together, just so fun talking about the world and eating a lot of brisket and tacos. We had a lot of brisket and tacos. Alright, I want to talk to you. So I want to talk to you. I have a mentorship sort of idea theme that I’m playing around with. I was talking to a very smart veterinarian just like a week or two ago, and she is high up in one of the big vet clinic hospital organizations. And so one of the corporate groups, and she was talking to me about what she thinks the key to success for doctor leaders is. And she said, you need to build your board and build your bench.
And so build your board and build your bench. And so building your board is what you call our, I mean how do you call it a reverse? It’s not reverse mentorship, but it’s basically seeking out mentors, your own professional development mentors. And then your bench is basically developing people around you and being the mentor for others. And I thought that that was really interesting. I just like that phrasing of build your board, build your bench. And so I wanted to talk to you a bit about the building your board part. I know I could talk to you all day about building your bench and you obviously have so much experience mentoring young doctors and things like that. But I want to talk more about this as a later career veterinarian, what mentorship looks like and why more people don’t seem to prioritize it. So lemme just pause here for a second and say, when I talk to you about later career veterinarians, people who have been a vet for at least five years, maybe 10 plus years, do you think those people have a focus on mentorship? Do you think that, I know we’re speaking in broad terms, do they seek out mentorship or is there a general consensus I’m kind of perceiving, which is I’m too old to be mentored. Mentorship is sort of for younger people. What do you think?
Yeah, I think there is a common belief that mentorship is usually reserved for early career individuals, but I think it should be for everyone. And it’s funny you say that because when I ask this question to groups and audiences when I ask who here has a mentor? And usually less than a quarter of people or maybe a third of people raise their hand. So I think we are not leveraging mentorship. We could be, and I think mentorship can be very powerful and it’s how I’ve gotten to where I am in what I’m doing with mentor ed. I wouldn’t be here without all the mentors along the way believing in me when I didn’t even believe in myself and opening doors for me and supporting the work that I do and making me think differently about the world and the things that we were doing and challenging my beliefs on things and getting me to expand my horizons on things. So I think that mentorship is appropriate for all career stages, especially mid-career vets. And I would agree that I don’t think it’s being used nearly as much as it could be.

Dr. Andy Roark:
Wait, so just to be clear, you’re saying a quarter to a third of veterinarians raise their hand saying they have a mentor like one and that’s all that there is really? That’s staggering to me.

Dr. Addie Reinhard:
It’s sad and I don’t know, I think

Dr. Andy Roark:
I’ve got five mentors, I have mentors, people have pairs of shoes, I’ve

Dr. Addie Reinhard:
Got too many, maybe I’m going to have to get rid of one.

Dr. Andy Roark:
Exactly right. I’m sorry Andy

Dr. Addie Reinhard:
Going to have to get you as a mentor.

Dr. Andy Roark:
The tribe has spoken and you put my torch out and then I have to leave the Addie Reinhard mentor party.

Dr. Addie Reinhard:
But yeah, I mean it’s surprising to me because I do have, and I look at mentorship, so mentorship can be a few different things. It can be something where you’re getting support with medical decisions, but professional development has been such an important aspect of my own mentorship and being able to talk with people who both have walked the route you’re walking or are currently walking the route that you are walking can be so helpful to get through the day.

Dr. Andy Roark:
Oh no, no doubt. I mean you were one of my mentors, and I’ll just say this and people don’t think, but I mean people can’t see us. I am markedly older than you were one of my, I called you when I was laying face down trying to make a conference happen that refused to actually happen. And I was like, I don’t know where to go from here. And so I called you because I knew that you have experience in these types of things and the events and running teams and I was just like, I need someone who is not as emotionally invested in this as I am to just look at this for me please and tell me what I’m missing. And it is hugely helpful, but I think that whole, it goes one direction of the older to the younger, I think that that’s such a mistake.
It’s just it’s not true. So I don’t know, how did you get started? I don’t know if you want to tell a story of mentorship opening doors for you as said as you got going, how did this make a difference for you? How did you decide that this mentorship building, this personal board of directors was worth your time? Because I got to tell you, honestly, I don’t know, it’s hard for me to think of anybody that is as good as you are at making people want to support them. Well, but you draw people’s sweet, is it? I don’t know, it’s like, I dunno anyone who just tricks other people into,

Dr. Addie Reinhard:
I dunno, anyone who needs so much.

Dr. Andy Roark:
Exactly. You suck resources from so many people. It’s amazing. How do you do it? How do you do

Dr. Addie Reinhard:
It? How do you do it? How do you get people to help you? So there’s a few things that I think as a mentee and having the mindset that there’s always something to learn from somebody, there’s always something to learn from anybody. And going through life with that mindset and being very curious about what you can learn opens a lot of doors for good connection. Because if you enter in with humility and knowing that I don’t know all the answers. I don’t know all the answers, and being willing to be taught, be teachable. And I think so many times if we’re stuck in, I think especially in my early career, I think about the way that I learned things in school. And if I had come into practice and said, Nope, I’m not going to do it that way. This is how I learned in school, then those people are going to have a harder time mentoring me versus if I’m willing to learn, okay, you’ve been in practice for 20, 30 years, tell me why are you doing it this way?
Oh, okay, well I learned it this way. I don’t know if this is better or worse or just different, but let’s compare notes and see and maybe I can learn a few things from you and maybe you can learn a few things from me. So I think being teachable is one. I would say being proactive is the other. So many people are not proactive about mentorship. So proactive about developing your connections, developing your taking time to chat with people, just making time in your day to reach out and say, Hey, I’ve got a question. Or Hey, can I bounce some things off of you? And the proactivity and actually taking the effort to set up intentional time to talk to somebody about challenges that you’re facing makes them want to help you because they see that you’re making an effort. So being teachable, being proactive and entering in with that mindset of always learning and growing. I’m trying to think of other things that I do. Awesome, but

Dr. Andy Roark:
Well no, I want to start to unpack some of this stuff, right, because I don’t know that people know necessarily what you mean when you say you need to be teachable. But I will tell you had a lot of people reach out to me over the years and ask me for advice, which I am, I’m happy to share, and then they tell me why I’m wrong and I’m like, you don’t have to do what I say, but you know what I mean. It’s amazing how many people, I don’t know if it’s insecurity of I don’t want to take advice from somebody. And again, I’m not saying I’m right, but it’s interesting how many people will ask you what you would do and then instead of saying, well why do you say that or Tell me more about that or help me understand why, that’s where you would go. They go, that won’t work because of this or it won’t work because of that. And I think it’s an interesting mentality, but I’ve seen it again and again over the years and I think it’s people who want to be mentored but that make it really hard to do it. Do you agree with that?

Dr. Addie Reinhard:
Yeah, I do. And I think you have to come into a conversation being willing to listen. There’s a lot of things that my mentors tell me that are total crap that I’m not going to do.

Dr. Andy Roark:
Thank you. I appreciate that.

Dr. Addie Reinhard:
Some of the advice that you’ve given me is just total crap. I believe it, but a lot of it is really good. And so maybe this is number three of being discerning about what you’re going to take with you and what you’re going to leave behind and being grateful for all of the knowledge that is given regardless because they don’t know what’s going to be appropriate to your situation, but you do. So listening, having an open mind and taking the nuggets that do apply to your situation and using those and then discarding the rest and still showing appreciation for all of it, I think is one of the ways that you can be really a good mentee or learner from other people. Because again, I’ve heard even today we had an advisory board meeting for MentorVet, so it’s like my 10 11 mentors that I’ve chosen to help me and MentorVet grow. And during the meeting some of our advisory board members say some stuff that I don’t really necessarily agree with and yet I will sit and I will listen to their point of view and their perspective, take notes and again, take what applies and then discard the rest. But they don’t need to know that they have a bad

Dr. Andy Roark:
Idea. Oh yeah, no, I am so proud to unveil the biggest project I have ever worked on. This is a partnership with NA VC’s, VetFolio and Uncharted, which is the veterinary conference that I started and run for 15 years. I have worked with people on being effective as communicators and making their practice better places to be. Now I am so thrilled to be launching the Leadership Essentials certificate with Uncharted and these are the seven courses that I believe really believe anyone who’s leading other people in vet medicine should have. This is vision and value setting. This is basic strategic planning. It is understanding different communication styles, and I have my friend Stephanie Goss helping teach that session. It is getting the team to buy in to new ideas and initiatives. It is how to coach and give feedback. It is how to set priorities. It is how to delegate effectively.
It is how to do time management. It is the talks and the stories that I am probably most well known for giving. My red.talk is in here and my GPA talk is in here. Everything about the North stars, everything that I lay out where I’m like, this is just so essential to managing people. It’s the trust game. It is everything about building and maintaining trust with your team. I think that this is something that I would recommend for anyone who is a practice owner, definitely who’s becoming a new practice owner. It’s for anybody who has especially gotten promoted up into management. It is huge for our team leads. We take people who are CSRs, we take people who are technicians and we make them lead techs or lead CSRs and we give them zero leadership or management training. There’s no excuse for that anymore. This is on demand whenever you want.
It’s broken up, it’s eight hours, it’s got race ce, it has the uncharted VetFolio certificate with it. It is there. It is accessible. I really hope that people will take this and put it to work. I went really hard on this. It has been years in the making and refining to get this content down. So it is really for everybody who is leading and managing other people in vet medicine. I hope you’ll check it out. I’m so proud of it. I’m so glad to be partnering with NABC on it. Anyway, guys, I’ll put links in this show note. I hope you’ll have a look. Let’s get back into this episode.
Well, I mean I really love that idea of being grateful for all of it and then taking the parts that you need in going on. I think that’s really insightful. I think the specificity is really important. I think one of the things in mentorship that is hard is when you look at someone and you say, I feel like I could learn from you, but I don’t really know what I need or I don’t really know how I think I have always struggled in approaching people that I just admire, but I’m like, I don’t know how you can help me. People that I admire who I know have insight on a specific headache that I’m wrestling with, that’s easy. I reached out to Justine Lee, Dr. Justine Lee, who’s the founder of Vet Girl yesterday, and I was like, Hey, I got this thing I’m kind of rolling around.
It was the online education stuff and I was like, I haven’t talked to Justine in a year since it’s before the pandemic, but she’s great. But I just said, Hey, this is basically what I’m looking for. Would you have 10 minutes to kick this around with me? And she made 10 minutes happen yesterday afternoon and we just kicked it back and forth real fast and that was that. But I wouldn’t feel comfortable reaching out Justin and being like, Hey, let’s just chat. You’re awesome. I’d like to just chat with you. It was having that problem that opened that door. Do you think that that’s true too, or do you feel like you can strike up those relationships without having a specific headache that you’re actually motivated to deal with?

Dr. Addie Reinhard:
I think there has to be a little bit of both. I think the relationship building piece, and I will say there’s a difference between that flash mentorship, the one time conversation with somebody versus the long-term mentoring relationship, which both can be used honestly, when I go to conferences, I’m having flash mentorship moments, the entire conference I’m sitting down for two, three hours talking to somebody about issues and their life and my life and learning things along the way. But I think for a long-term mentoring relationship, the aspects of building the relationship outside of just every time there’s a fire, I’m talking to you, but sometimes just talking to you when there’s not a fire and just catching up and saying hello and celebrating the wins too and the good things that happen. And I think that aspect of relationship building becomes important. And especially if we’re talking about mentors outside of the clinic and hospital setting too.
And I think that would be something that I would encourage everyone to consider. If you’re looking for mentorship, look for it both in your hospital or your clinic or your organization and look for another mentor outside of your hospital or clinic or organization because that’s going to be a little bit safer space to talk about some of the stuff that you’re facing. Then if you’re having a conflict with a coworker, maybe your boss Ash mentor is not the best person to be the first person to bring this up with. Maybe you need to process some of this stuff in a safe space outside of the workplace. So really thinking about that external mentor and the external mentors is one that that’s more important on the relationship building side of things. And honestly, a lot of my mentors, I would call friends as well. Oh

Dr. Andy Roark:
Yeah. I think it’s really hard to tease ’em apart. I kind of feel silly calling some of my friends mentors. You know what I mean? I was just going to say it could be

Dr. Addie Reinhard:
Both. We can be friends and mentors,

Dr. Andy Roark:
Andy. We can be friends and mentors. I always going to say, one of my mentors, he runs a comedy theater, an improv comedy theater, and he’s my friend, he’s younger than me, I know him from comedy. But we have lunch once a month and just compare notes on how the comedy theater is going and how my business is going. And there’s actually a lot of weird similarities between getting people to come together and perform on a comedy stage and getting people to come together and perform on a veterinary CE stage. It’s kind of weird and kind of awesome. But I just say that one to sort of validate the idea of having people outside of vet medicine that you can learn from. I tell you, I had significant career epiphanies talking to that guy and been like, oh my God, I have been looking at this the wrong way. And just, I don’t know that I would even have those epiphanies if it was vet medicine. I think it would be too close to make it pop out. But it is sort of weird to think of those people as mentors. But I don’t know. I would definitely say he’s definitely on my board of directors. Like I said, we do our monthly lunch, we talk about life and what’s going on, and I have gotten a ton out of that relationship.

Dr. Addie Reinhard:
I love the finding somebody outside of the field because I was just thinking about some of my friends who have supported me in various things that I had no clue what was going on, tech stuff for it, kind of things that can be really beneficial. And like you said, getting that external framework, that was probably the most valuable thing I gained from my master’s program is just a lot of people from different disciplines coming together and I learned new frameworks, new ways to think about the world. So yeah, encourage anybody to look outside of the field too for mentors.

Dr. Andy Roark:
What does a mentor conversation sound like for you? And I know that’s a weird question to ask, but I think a lot of people, they don’t know how to get started with a relationship like this. They don’t know how to ask someone how to ask someone for guidance in a way that doesn’t feel weird or seem weird. No one’s taught most of us how to get insight out of other people without it feeling strange. There’s a lot of people I know who do podcasts, and the reason I think they do a podcast is because they’re too self-conscious to just talk to people without headphones and a microphone. So you just say to somebody, Hey, would you be on my podcast? And then you ask them the questions that you want to ask them, but you feel safe because you have a reason to ask them. And I’m like,

Dr. Addie Reinhard:
Are you saying this from personal experience?

Dr. Andy Roark:
No, listen, I don’t listen. I can’t. Maybe

Dr. Addie Reinhard:
Is this a,

Dr. Andy Roark:
I mean, there are definitely people out there that I’m like, this person is amazing and I don’t know how to be their friend. And so this is a gateway to me having a conversation with them that has absolutely happened. I can come up with a list of people in vet medicine I admire, who I have admired from afar, but I had no reason to talk to them except that they then published something or I read something and I was like, aha, this is my chance to be this person’s friend. And so I do it. But I don’t know, it’s weird, especially if there’s a significant difference in where you are in your career and things like that. I think one of the biggest mistakes people make with mentorship and sort of just full, the biggest mistake they make with mentorship is they think that the mentor is supposed to reach out or the mentor is supposed to make it happen.
I was like, the mentor has the least to gain in this relationship. I mean, I know that mentors get a lot out of it, but I’m not walking around looking for people to try to give advice to. And I don’t think other people are either. You know what I mean? I feel like it has to be driven by the person who wants to grow and develop and knows what they’re trying to do. But I feel like it’s often framed as mentors need to recruit mentees, and you hear, come to our hospital and we’ll mentor you. And it’s trying to plug them into that system as opposed to saying to the person, where are you trying to go? What are you trying to do? So yeah, I don’t know. I dunno if that resonates at all if you feel that way, but I think a lot of people just, I don’t know that they know what the conversation sounds like.

Dr. Addie Reinhard:
Yeah, I think you make a lot of good points. And typically when I’m looking at a mentoring relationship, a lot of it kind of evolves naturally just because I’m genuinely interested in learning more about the individual and their career. So oftentimes a mentoring relationship might just start off with me learning more about where you’ve been in your career. What are some of the challenges that you faced along the way? How did you overcome those challenges? And I will typically, and it is something that we teach our mentees going through a lot of our mentee training and the MentorVet program is just be proactive. And like you said, set up those meetings, set your own goals for what you want the mentoring relationship to look like. And if you come at a situation with, and usually if I have a challenge, I will just lay it out on the table and say, Hey, here’s what I’m going through.
Have you experienced anything like this before? Make it a conversation. What would you suggest? How have you navigated similar things in the past? But I think a lot of times that initial and it’s scary, right? Reaching out to somebody that you think would be a good mentor for you and making that initial connection and contact, but just look at it as getting coffee with somebody, just learning about them, getting to know them a little bit more. And then maybe not on the first meeting disclosing all your challenges and stressors, but maybe on the second or third meeting after the trust is built a little bit and you kind of see that it’s a good fit because not every mentor mentee is going to be a good fit. So you might meet with this person one time and be like, we didn’t really connect. And I’ve met with quite a few people who I’m sure are phenomenal mentors to other people, but maybe we just didn’t really have that spark of connection that will create a successful relationship.
So it’s funny, there’s a lot of parallels to dating here. It’s kind of weird, but when you think about dating people, not every person that you go on a date with is going to be somebody that you want to marry for the rest of your life. And same thing with mentors. Not every mentor that you meet is somebody that you want to be your mentor forever, but being willing to meet people and trying to find people that fit your personality, that have similar shared experiences and some differing experiences as well to broaden your perspective. Yeah.

Dr. Andy Roark:
How often does that happen, do you think? I was having that thought as well as there are some people I reach out to who I know are brilliant and they’re super smart and they’ve been very successful. And I talk to them and after the conversation is over, I’m like, I don’t know that they know they saw me or that, you know what I mean? It was like, I hear what they’re saying. Or maybe just the fundamental way that they think is not in alignment with mine. I’ve seen that a lot with doctors where there are brilliant doctors out there and I will talk to them about a case and they’re like, oh, well I would just do this and this is why. And I’m like, I would never do that. I mean, I’m sure they’re right, but their thought process is absolutely not one that I would take. And so it’s hard for me to say, ah, I’m going to learn from this person and you and I are not wired closely enough alike to make this easy. I feel like good mentorship should be easy. Do you want to put a ballpark percentage on? What percentage of people are you like, no, I appreciate you, but this is not going to be a good fit.

Dr. Addie Reinhard:
So some statistics from our platform of how, and this is finding people who we think would be a good fit or people are self-selecting mentors, the proportion of relationships that are probably first time successful right off the bat, maybe a third of those relationships really spark and turn into something longer lasting. And I would say the same thing. So when we first started doing programming, I pretty much was the paired mentor for everyone going through our program. And I would say about a third of the people I reached out to as a mentor and said, Hey, I’m your mentor. Let’s meet. And they never contacted me. A third of them, we met one time and then they’re like, I’m fine. I don’t need any support. I’m like, cool. And then a third of them are people that I still sometimes chat with today. I met with one of my mentees who I mentored two years ago for monthly for about six months.
And she reached out to me and said, Hey, I need some support. Can I chat with you? And we met for an hour today and it was great. And it was like, oh, we just picked up where we left off. So I would say about a third of the time, and it’s funny because I was thinking as you were thinking about, or as you were saying, the thing about doctors and not agreeing, there was this relief that I would always ask for some support from in my early career. And every time I would ask her advice, she would give me what she would do in the situation. And I’d leave the conversation being like, I’m not going to do any of that. And then it got to the point where I was like, wait, why am I even asking her for her advice on this? Because we’re fundamentally different on how we practice. So again, I would say about a third at the time.

Dr. Andy Roark:
Yeah, that totally makes sense. That tracks. Addie, you are amazing. Thank you so much for being here. Where can people learn more about MentorVet?

Dr. Addie Reinhard:
Yeah, so check us out on Instagram at MentorVet or on LinkedIn as well as Facebook. We are at MentorVet one on Facebook because turns out there is an old organization that was Mentorship for Veterans that currently is the at MentorVet on Facebook. But you can also follow me personally on LinkedIn. I post a lot of stuff around my journey through entrepreneurship and mentorship and all the things. And also at our website, MentorVet.net

Dr. Andy Roark:
Outstanding. I’ll put links in the show notes to that. And thanks for being here guys. Thanks for tuning in and listening. Take care of yourselves, everybody. And that is our episode, guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Addie for being here. So enjoy her. Check out MentorVet, if you’re not familiar with it. It’s a great organization. Addie’s doing really wonderful things over there. Guys. Take care of yourselves. Be well everybody. Talk to you later. Bye.

Those You Know, But Don’t Know

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When I used to drop my kids off at daycare, my primary focus was ejecting the children from my car so I could get on to my mile long to-do list. Screeching tires, flying gravel and… was that a little girl wearing a halloween costume in March? I passed through the parking lot as quickly as possible.

From an efficiency standpoint, this was great. I was knocking things off the list and making stuff happen! From a relationship-with-daycare-workers-and-other-parents, it was pretty bad.

Relationships are funny and fickle things. You can’t put them on a checklist and mark them off. You can’t show up, say a compliment and walk away. No matter how charming you are or how much corporate communication training you’ve had, building relationships takes time. It requires doing the work to know another person. Putting in the time of simply being together. There are no shortcuts.

I spent years as a veterinarian ducking into and out of exam rooms like a game show contestant navigating an obstacle course. I took great care of pet owners and pushed appointments quickly and efficiently. But at the end of the day, when my technicians would go home, I had no idea where they went. I didn’t know what they did, or who met them when they got home.

I knew the people I worked with, but I didn’t really KNOW them. I knew their competencies and behaviors. I knew their quirks and what made them laugh. I didn’t know, however, what they cared about, how they thought, or what they aspired to become in the future. I didn’t know what they wanted to accomplish before they died, what their most meaningful life experience had been, or what made them proud at the end of the day.

I regret not knowing those things. 

I think a lot of us believe we don’t have better relationships with the people around us because we don’t have time to build those relationships. I’m not so sure that’s true. Recently I’ve been pondering the idea that maybe it’s not time that holds us back. Maybe it’s a lack of curiosity. Maybe we forget to wonder about people we see everyday. Or maybe we’re just too shy to ask people about themselves.

In my experience, most people are thrilled to have someone want to know more about them. They smile and open up. They feel special and seen. Asking deeper questions so we can better know others isn’t a weird thing in practice. Instead it’s usually a path to deeper, more trusting relationships. 

Who do you know, but don’t really know? What could you ask them today to start to make that journey?

Mastering Weight Management

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Dr. Taryn Pestalozzi, DVM, residency-trained in Nutrition, joins the podcast to talk about how she approaches difficult pet weight-loss conversations. Dr. Pestalozzi and Dr. Roark discuss the case of an obese Labrador Retriever named Greta, and how best to handle her care. As a veterinarian who practiced in GP for 7 years before running the Healthy Weight Clinic during her internship at Kansas State University’s Veterinary Health Center, Dr. Pestalozzi has fantastic and practical insight on how to motivate pet owners to make real changes for the sake of their best friends.

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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. 

Hill’s Veterinary Academy: https://na.hillsvna.com/

Hill’s Body Fat Index Tool

World Small Animal Veterinary Association Nutrition Toolkit

Association for Pet Obesity Prevention

Pet Nutrition Alliance Calorie Calculator

Ohio State RER Calculator

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Taryn Pestalozzi received her bachelor’s degree from Smith College in 2008, before graduating with her DVM from Oregon State University in 2013. Dr. Pestalozzi was a general practitioner in the Portland, OR metropolitan area for 7 years before completing a clinical nutrition internship at Kansas State University’s Veterinary Health Center, where she managed the Healthy Weight Clinic. Dr. Pestalozzi recently completed her clinical nutrition residency at UC Davis Veterinary Medical Teaching Hospital.

EPISODE TRANSCRIPT

Dr. Andy Roark (00:07):
Hello and welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one for you. Today is on mastering weight Management. This is super mega practical, what to say and how to say it. Podcast, I have got Dr. Taryn Pestalozzi here. She is residency trained in nutrition. She’s a joy to talk to. She is super practical and pragmatic, which I really love. She’s got great advice for setting up these weight management conversations in a way that actually get results and help us convince pet owners to make the steps they need to make to take care of their pets. Anyway, you are going to probably get some affirmation for things that you do out of this, you are also going to get some tips and tricks for things that you don’t do or ways to have these conversations that you haven’t had.

(00:55):
I am really big on this. I love it when we get insights on things that we do a lot of because little tweaks in those behaviors make a huge difference because we do ’em all the time. And so anyway, this episode is really good and it’s really useful. I think you guys are going to really, really like it. I have to say thanks to my friends at Hill’s Pet Nutrition for making this episode possible ad free. And I also have to say thanks to ’em for their Hill’s Veterinary Academy. Guys, if you have not checked out the Hill’s Veterinary Academy, it is a fantastic learning platform that Hill’s is putting out and they are steadily growing and expanding and it is packed full of good stuff for training your team. It’s got free RACE CE in there. There’s so much that’s going on and they’re really putting a lot of effort into it. So anyway, if you are not familiar with the Hill’s Veterinary Academy, I’m going to put a link down in the show notes. You can give it a Google if you want to go that way, but check it out. Go see what they’re doing. This is really just a neat little gift through our profession. So anyway guys, that’s enough of that. Let’s get into this episode.

Kelsey Beth Carpenter (01:55):
(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 (02:12):
Welcome to the podcast, Dr. Taryn Pestalozzi. How are you?

Dr. Taryn Pestalozzi (02:16):
Good. Thanks for having me.

Dr. Andy Roark (02:17):
Oh, I am so glad that you’re here. I am looking forward to this. So, what I wanted to talk to you about today, so when you did your internship, you did your internship at Kansas State and you ran the healthy weight clinic there and I see a lot of very heavy pets. I saw a cat that was rapidly gaining weight last week and it bothers and this is a passion of yours. It’s something you have a lot of experience in. I just want to run through a healthy weight campaign with you today and just be like, alright, tighten. Let’s tighten the bolts down here and I want to make sure that I’m running a program and then I can carry this out and I want to get weight off of pets and so are you okay to run through a case with me and just start to finish and get me set for success?

Dr. Taryn Pestalozzi (03:22):
That sounds great. Let’s do it.

Dr. Andy Roark (03:24):
Let’s do it. I have got a 100 pound female spayed chocolate Labrador named Greta. So Greta is eight years old and those hips ain’t what they used to be. Sure not. And I can see it. I can see that the muscle mass in her back legs is not what it used to be. And owners are not reporting mobility issues. She’s not, her gait doesn’t appear to be, you don’t see her walking going, oh boy, but she’s eight and I can see that when I look into my future scope where I look ahead a year or two. And so this dog is probably 20 pounds overweight. I think she should be, honestly, if I’m really serious, she should probably be a 75 pound lab, but she’s a hundred. I could be okay. I think if she’s 80, I have to see it. You know what I mean? And you go,

(04:23):
I think 80 is about right. I have to see it, but I need some help in this. And I think that I can get the owners motivated, they love this dog. I think I can make a solid pitch for the lack of mobility that’s coming down the pipes and I want to really push and so I have not gone into this room yet, but I want you to help me. That’s how the table is set. Taryn, how do you treat this case? Where’s your head at when you’re standing outside this door to the exam room getting ready to go in?

Dr. Taryn Pestalozzi (04:55):
So I think the first thing is maybe keeping in mind maybe these owners haven’t come to see you for this problem. They’ve brought Greta in for her annual exam. Yeah, she’s in needs. So it can sometimes take people off guard when you bring up a topic and you get really fixated on that that they weren’t really coming to talk about. So first thing I think is to not forget your primary reason for the appointment. And if you need to schedule a follow-up to actually spend more time talking about the weight loss, do that. But then also consider asking permission to talk about her weight. Be thoughtful with your language. Don’t use fat humor. There was a consensus statement that came out of the UK between medical professionals and the human medical side and patients from obesity programs that talked about what kind of conversations and language are useful. So some of those tips are coming from that consensus statement sort of extrapolated that to our veterinary friends. So just be mindful that as you go into have this conversation.

Dr. Andy Roark (05:53):
Okay, talk to me a little bit about asking permission, right? Give me some language. I know we’ve had a lot of doctors who, and there’s a lot of technicians that are coming in and taking a history and they know that I’m going to come in and talk about the weight and it would be helpful to me if they could open this conversation up. So give me an example of what that, asking permission, I get the concept, what does that sound like?

Dr. Taryn Pestalozzi (06:12):
Yeah, I would start with an open-ended question probably. So asking the client how do they feel Greta’s doing overall? Do they have an idea of where they think she is in terms of weight? Do they think she’s a healthy weight? Do they have any concerns that she might be over or underweight? And that lets you also assess maybe where they’re at with that topic and then ask them, do you mind if we spend some more time talking about this today? I think I have some concerns.

Dr. Andy Roark (06:40):
I really like that question of do you have any concerns about her being over or underweight? It feels like a standard sort of form question and it’s not a judgment question. It feels like I’m taking a history or I’m filling out my form and it helps me know really quickly do they see it or are they blind to it? And we’ve seen, I mean I literally had a case just like this one chocolate lab a hundred pounds and the owners just could not see it. And I was showing them the body condition out and they didn’t get, that was rare. Definitely happened. I still remember it. They were just like, Nope, she looks like a five of nine to us and I’m just going, we’re not looking at the same things.

Dr. Taryn Pestalozzi (07:19):
Yup.

Dr. Andy Roark (07:19):
Anyway, a great question. Alright, I love it, Taryn. That’s super helpful. Alright, great. So I get get this conversation, get permission to talk to them about it. I like it. Let’s say that they’re like, sure we’re here for our annual exam, wellness, yup, we’ll totally talk about it. Where do you start to go from there?

Dr. Taryn Pestalozzi (07:39):
Yeah. Next would, as part of my exam I do a body condition score assessment on Greta and I think most of us are familiar with the body condition score concept. There’s a couple of different scale systems out there, so there’s a five point scale, there’s a nine point scale in the nutrition world, we tend to go with that nine point scale and if you need a resource in your clinic, the world’s mono, that association has some nice non-branded charts that you can use, but there’s lots of them available and I keep a copy in my exam room laminated and I actually pull it out and I look at it while I do my body condition score because the more you actually read through the definitions of what each of the points on the scale mean, the more consistent you will get. And also if you have your support staff and the other clinicians in your hospital all using that same tool and actually looking at it, you’re going to be more consistent across your whole clinic so that you start building a more reliable history as you’re seeing patients.

Dr. Andy Roark (08:35):
I tend to run into not opposition to this conversation, but just a level of passiveness that they don’t argue with you. They’re not like, no, we’re not going to do a weight loss program. But non-committal I think is how I would

Dr. Taryn Pestalozzi (08:57):
Yeah

Dr. Andy Roark (08:57):
And again, I’m going to lean into the hips in this case and try to make a real quality of life point here, but as I try to motivate for action and try to push through that non-committal place to get them on board with taking action, how can you support me there?

Dr. Taryn Pestalozzi (09:18):
Yeah

Dr. Andy Roark (09:18):
How do you do that?

Dr. Taryn Pestalozzi (09:20):
I think it’s common for a lot of us to maybe focus on those negative outcomes that we are sort of foreseeing in the future. And there’s certainly clients that might need that, right? They maybe need you to really kind of hone in on those negative potential outcomes because they might not budge without it. But going back to that consensus statement in human medicine, it’s actually more effective a lot of times to focus on positive outcomes of weight loss rather than the negative potential consequences of being overweight or obese. So I hear from clients all the time, even with minimal, it’s pretty small amounts of weight loss. They’re acting so much younger, I can see they look thinner. I’m getting compliments on how they look. I’ve had to make their harness smaller. And so really focusing on what the benefits are and what they might see as that progress happens, I think is often more motivating.

Dr. Andy Roark (10:14):
I like that. So what your counsel here would be in the case of a dog that’s overweight and a senior pet is maybe don’t, ooh, she’s getting older, but instead talk about what we could accomplish and she could have the best years of her life. I mean there’s quite possible we could turn back the wheel of time a couple of years and you would see her

Dr. Taryn Pestalozzi (10:35):
Sure, let’s give her the best quality of life where we can as long as possible. And to do that, let’s really focus on getting her down to a lean ideal body condition so that she can be mobile as long as possible and do the things that she loves.

Dr. Andy Roark (10:47):
I’d much rather have the positive conversation than the negative one. No one wants to go tell someone, I’m really worried your dog is going to get worse and have hard time getting up. And that’s not a fun conversation.

Dr. Taryn Pestalozzi (11:00):
No, it’s not at all.

Dr. Andy Roark (11:00):
Appreciate this perspective. I like this so motivating from here to hear to action. I do like that. Any other advice for trying to get buy-in and build momentum?

Dr. Taryn Pestalozzi (11:11):
I think it’s important to try to get all of the humans in the household on the same page. There’s always going to be that person who maybe causes lack of compliance, sneaking treats or they don’t see the importance of the plan. So trying to get everybody involved in that conversation and on the same page is always a good idea if you can, it’s not always possible, but I think that’s going to be helpful for your success.

Dr. Andy Roark (11:40):
What does that look like when you go into the exam room? Because it’s always like my husband does and he’s not there.

Dr. Taryn Pestalozzi (11:50):
They throw each other under the bus. Right?

Dr. Andy Roark (11:52):
Business. That’s totally true. It could a hundred percent not just because they say it’s the person who’s not there. That doesn’t mean that really is.

Dr. Taryn Pestalozzi (12:00):
Sure. I’ve had clients pull me aside, tell me to kind of tell on their spouse or their partner. So I think if you can have ’em both in the same room, maybe you do have schedule a follow-up appointment and ask if they can both be there or I’ll be there. But otherwise, I mean I’ve had clients ask me to write letters to their significant others on letterhead to tell them they need to stop feeding the pet. I haven’t had that as much since I came to nutrition, but I was a GP for seven years before I did nutrition, so I definitely got that apps that several times

Dr. Andy Roark (12:31):
Oh that’s so funny. Alright.

(12:33):
Got it.

Dr. Taryn Pestalozzi (12:34):
I mean you kind of have to play it by ear, but I think trying to get buy-in from everybody is useful.

Dr. Andy Roark (12:39):
Oh, I love it. I just wondered if you had some special tool like I video myself and text it to them. I don’t know. I don’t know. I was just curious if you had any tools for wrangling people in.

Dr. Taryn Pestalozzi (12:48):
Yeah, we do the best we can.

Dr. Andy Roark (12:49):
I love it. This feels so daunting. 25 pounds is a lot. I mean 20 pounds, it’s a lot. 20 pounds per person is a lot and a person weighs more than a hundred pounds. Generally it’s a lot to lose. We’re talking 25%, 20, 25% of this pet’s entire body weight. How do set, it’s not going to be done in a week. This is going to be a process. How do I set expectations so that the clients are not like we’re going to try hard for five days and then I don’t see any changes I’m giving up, help me set us up for success in this and what’s going to be a marathon?

Dr. Taryn Pestalozzi (13:33):
Yeah, I think that’s a really good question, a thing to consider. So there’s a few things. First, the Association for Pet Obesity Prevention puts out annual reports that do surveys of both veterinary clinics and pet owners. And on the most recent data from 2022, they reported on average maybe 30 to 40% of pet owners who had tried a weight loss plan either reported their pet was not successful or they even gained weight. So trying to mitigate that is going to be helpful for long-term compliance. So the first thing is being specific in your recommendations so that you are setting them up for hopefully success right away and not sort of initial lack of weight loss, ribbon weight gain. We can’t always prevent that. So I do warn owners this is a process, it’s going to take us a while. We might backslide occasionally, but we will hopefully be moving forward the majority of the time. I think the second thing is coming up with a timeline. If Greta is a hundred pounds, let’s say that she is, I don’t know, 20% overweight, so she’d be a seven out of nine. For example, if our goal’s a five, so she’s actually 20 to 30% overweight as a seven out of nine. So then we can say, okay, well she’s 20 to 30% overweight and she loses on average 1% per week, which would be the bottom of our target range, then it’s going to take us at least 20 to 30 weeks to get her down to ideal weight. And that’s on an ideal sort of situation. It often takes longer. So giving them a timeline of what to expect I think is helpful.

(15:12):
Then the last thing is just really monitoring so that you can be making adjustments to the plan. I normally see these patients ideally every two to three weeks, or if I’m not seeing ’em in person, I’m at least doing a virtual check-in appointment. I’ll have them weigh them on their own and send me the wait before the appointment and then we can spend maybe five to 10 minutes on the phone or on a video call having that conversation of what’s next, what adjustments do we do or not need to do, what do we need to troubleshoot? And that way we’re keeping progress moving forward hopefully and not running into plateaus that just continue on and on and on.

Dr. Andy Roark (15:48):
Yeah. Okay. I got a couple of questions, so I really like this. So tell me what a specific recommendation sounds like when you say that. How far down the rabbit hole are you going as far as the specificity of what you’re giving to?

Dr. Taryn Pestalozzi (16:03):
Yeah, well, I mean as a GP was totally guilty of this, and I know lots of other practitioners do this too, of they’re overweight to say, oh, just drop their food a quarter of a cup, right? Yeah.

(16:14):
And we go, okay, great. We’ll see you in six months for your net set of vaccines, have a good life, whatever. And instead, what really we should be doing is giving a specific feeding amount. So the first thing is, as much as we can getting an accurate assessment of how much the pet is currently eating, so all the food they’re getting, any treats, any foods they’re going to use to give medications, which often clients forget to include in that history when you ask. And from there, I normally would drop their intake probably 20% initially if, I don’t know if they’re the kind of client who says, oh, well I feed the green bag, it’s really expensive so I know it’s good quality and I just fill the bowl up every two days. Well then I would start for a dog with their resting energy requirement and if they’re a cat, I’d start at 80% of the resting energy requirement.

(17:02):
There’s two methods, so a lot of nutritionists will use an estimated ideal weight to do those calculations and that’s great. That’s how I did it when I ran the Healthy Weight Clinic at K State for that year, and it’s definitely a successful method. That’s also what AHA has in their weight management guidelines. At Davis, we do things a little bit different. We use their current weight, not an estimated ideal weight. We want to use a true number and not an estimate to make all of our calculations. Both methods work really, you’re just picking a starting point and you’re adjusting from that starting point. The other thing we do is we recommend they weigh their food in grams, or if it’s canned food, then at least an easy fraction of a can because we want to be as accurate as we can so that we can make small adjustments as we go.

Dr. Andy Roark (17:46):
Okay. Yeah, that totally makes sense to me. I like the timeline idea as well. I think that’s part of the recommendation. It’s funny when you say 1% per week, I go, okay, well that’s six months, which feels very different. And just saying out loud, this is minimum of six months, just so you know,.

Dr. Taryn Pestalozzi (18:05):
That’s like best case scenario. If there is six out of nine, I can probably get them down to ideal and figure out what it takes to keep them there in about six months. If they’re seven or above, realistically you’re talking more like nine to 12 months or more.

Dr. Andy Roark (18:19):
Yeah.

Dr. Taryn Pestalozzi (18:20):
They’re that 11 out of nine, maybe you’re talking 18 months. So it’s not a short process. It does take a dedicated owner and that’s why you have to be their cheerleader and positive reinforcement of the owner. You’re doing a great job. I’m seeing improvement. Let’s keep going. We give prizes. When they reach their target weight.

Dr. Andy Roark (18:38):
What kind of prizes do you give?

Dr. Taryn Pestalozzi (18:40):
Well, at Kansas we took a photo of them and we were going to make, this was right as I was leaving, we were going to make a wall of fame. So I dunno if that or wall of success kind of oncology departments like to do with their pets finished chemo and then I would give them slow feed bowls or leashes or frisbees, that kind of stuff. If we had plants who are really hesitant to weigh their pet’s, weigh their food, we actually had some gram scales and we would just give them one

Dr. Andy Roark (19:07):
Wow.

Dr. Taryn Pestalozzi (19:07):
Say, can you please just do it? I didn’t do that for everybody, but it was like I was getting a lot of pushback. Yeah.

Dr. Andy Roark (19:13):
Well it shows how serious you are about it, for sure.

Dr. Taryn Pestalozzi (19:16):
Yeah.

Dr. Andy Roark (19:17):
Talk to me a little bit about what these, so I really like sort of the monitoring part. Talk to me a little bit about what these monitoring recheck appointments look like. So you’re like, yeah, we see ’em back two to three weeks. First let’s talk in person. But I think the virtual is, there’s a lot of opportunity there, but just if you have them sort come back into the clinic, what does that recheck look like? I know everybody’s busy, you know what I mean?

Dr. Taryn Pestalozzi (19:37):
Sure, yeah.

Dr. Andy Roark (19:37):
So we’re trying squeeze it in. What does that experience for the clients look like?

Dr. Taryn Pestalozzi (19:42):
So it can be a quick appointment. So my sort of rule of thumb is if I’ve made any changes to their plan, I try to see them back in two to three weeks. If we haven’t made any changes, I push it out like a three to four weeks. So on average every three weeks or so, and it could be probably at the most a 15 minute appointment if you are sort of efficient in how you’re running it, if you’re leveraging your support staff so you could have your support staff go in and body condition that animal if you’ve gotten everybody well trained and on the same book in that regard, get a weight and take a little bit of a diet history. How have things been going? Are you feeding them out? We talked about last time, have you run into challenges? What sort of troubleshooting?

(20:21):
I mean, I think the classic example I give to students is they come in and they haven’t lost any weight and it’s December and you find out that, oh, the in-laws are in town visiting for the holidays and they’ve been feeding the dog a ton of milk bones, so maybe we don’t need to make a change that visit. Maybe we just need to send the in-laws home and get back on track. But if they have kind of lost in that one to two-ish percent percent of body weight per week, then great, we don’t make any changes. We see you again in a few weeks, reassess. If they have not lost as quickly as we’d like or they’ve gained weight, then I’d probably drop them about 10% of their daily caloric intake.

Dr. Andy Roark (21:03):
Okay.

Dr. Taryn Pestalozzi (21:03):
They’re losing too fast, then I’d up ’em 10% and I’d see ’em again in two to three weeks and we’d reassess at that point. And I keep in mind treats. So we plan for treats in our plans. Yeah,

Dr. Andy Roark (21:14):
Gotcha. Talk to me about what losing too fast looks like. So that’s what I was going to start to poke you about a little bit was like when they come back in two to three weeks, what are we looking for? And definitely, I like the idea that we’re going to put ’em on a scale. We’re going to put ’em on the same scale they used last time, so we get some consistency and then if we’re not seeing any weight loss at all, we’re going to start to adjust. And that all tracks to me, when do I have to start worrying like, oh, we’re falling like a stone? Because I suspect that pet owners are probably pretty psyched. They’re like, this is great. We’re making real headway. Greta’s not really thrilled, but the pet owners, I could see them being on board. What am I looking out for there?

Dr. Taryn Pestalozzi (21:56):
Yeah, I mean I’ve had that happen. It’s less common than you might think, but I mean, I’ve had dogs that got boarded when they were sort of starting their plan and they lost like five, 6% in a short period of time, like 10 days. And so our concern there is two things for both species we’re concerned about lack of muscle, muscle losing lean muscle. You mentioned Greta, you were concerned about the muscle in her hind end. So that’s great. I would encourage everybody to actually record a muscle condition score every visit. It doesn’t have to have a number. The world’s Monolo Bed Association actually doesn’t use a numerical scale. It’s just normal or mild, moderate or severe atrophy. And then I’d also be concerned maybe in our cat patients about something like hepatic lipidosis, but that takes a lot. It takes very dramatic sort of extended in tants or hypoxia to get hepatic. So I don’t get too worried about it. But certainly for our cat patients, if I’m starting a new plan, I am really conscious of how I tell owners to transition ’em onto a new food and give them criteria for when they would need to call us. If they’re not eating the new food or they’re not doing well,

Dr. Andy Roark (23:04):
How does the virtual check-in visit work? Because if they’re not there and you don’t have your scale, what is that experience like for the pet owner?

Dr. Taryn Pestalozzi (23:11):
Yeah, I mean it’s a pretty similar, I think outline to how the appointment runs. But what I do is I made a little handout for my owners that shows them some specific photos. I want them to take the photo from the side, a photo from above, and then one of their face if you want to use the body fat index tool from Hill’s and University of Tennessee, I’d also take a picture from behind them staring at their butt. And that lets me just assess roughly their body condition or their body fat index. And then I have the owners weigh them and I just tell ’em, find a consistent way to weigh them, whatever that is. They’re coming to your clinic just for a quick swing by the lobby scale. Or if they have a scale at home, they can get an infant scale or even a floor scale for a big dog relatively inexpensively online. And so they just email me in advance their weight, they send me their photos. I can do the math that I need to do right before the appointment, and then it takes 10 minutes or less to have that conversation about do we need to troubleshoot anything? How fast or how slow were you losing weight? And what adjustments do we need to make?

Dr. Andy Roark (24:14):
Got it. Perfect. That totally makes sense. Good deal. I like this. This seems good. Are there, so we’ve got a plan, we’ve got some good motivators, we’ve got specific recommendations. We’ve got a follow-up plan. I really like the ongoing monitoring. That makes a ton of sense. I a hundred percent see how I can lean on my technicians to help me with this and to run this program. That’s a big deal to me. I really like nutrition for technicians and they can make my job really easy and we can make a real impact together. But anyway, so I like all this. Is there any final pearls pieces that I want to make sure that I’m not forgetting

Dr. Taryn Pestalozzi (24:54):
And I maybe skipped over it? So in our specific recommendations,

Dr. Andy Roark (24:58):
mm-hmm

Dr. Taryn Pestalozzi (24:58):
the majority of these patients should be on a therapeutic, a prescription weight loss diet because if we start restricting their calories, especially if they get below RER or even 1.2 times RER, if we’re talking about dogs, we can cause nutritional deficiencies if we feed a non-therapeutic diet for a long time because those therapeutic diets are fortified with extra protein and vitamins and minerals to account for the lower calorie intake that those pets are having. They also help them with stain full, so satiety, if they’re canned diets, they have a lot of moisture. If they’re kibble, they might be what they call air puffed, so bigger kibbles to take up more volume. And then they also often are high in fiber to help them feel full. So you really should be using a diet like that if you’re going to institute a weight loss plan unless you’re doing small amounts of weight loss and you’re being very conservative with how fast you push them.

Dr. Andy Roark (25:50):
Okay. Define RER for me real quick.

Dr. Taryn Pestalozzi (25:53):
Resting Energy Requirements, and there’s a couple ways you can calculate it. I’m going to give some resources I think at the end that we’ll show you how to do all the calculations and walk you through how to do a plan like this.

Dr. Andy Roark (26:05):
Cool. I love it. And then I want to dig into this a little bit. I think that’s a great point about moving to therapeutic D because one of the pushbacks I always get is, well, I can just, there’s a light version of what they eat. Can I just use the light food? And I want to be supportive of pet owners and kind meet ’em where they are. And at the same time, I do feel like I’m only going to get one good shot. Often it’s one good shot, they’re going to make an attempt and if it doesn’t go anywhere, they’re going to kind of say, well, I guess she’s just a big girl and that’s what she’s going to be. And that’s that. So break that down for me a little bit as far as where your lines are when you’re like, no, it’s time to go to the therapeutic diet. I want to be confident when I make that recommendation to switch to a therapeutic diet and say, yes, this is the play we need to make. Where are your lines? Can you solidify that for me a little bit?

Dr. Taryn Pestalozzi (27:04):
It’s never wrong to pick a therapeutic diet for weight loss unless they have comorbidities that require other nutritional strategies. And there is not a commercially available combination diet. So there are combination joint support and weight loss diets. They’re a combination hydrolyzed and weight loss diets, et cetera. So it’s not wrong if you can find an option to do that other than it’s more expensive, I think that’s always the safe way to go. If I had a patient that did have other comorbidities, that’s the time to talk to a nutritionist or at least call the vet consult line for one of the therapeutic companies to talk to them about the case because maybe that pet really needs a homecooked diet to be able to accomplish weight loss and safely manage their other disease. But if I was going to go with a light or weight management diet over the counter, I’d be looking at patients that are maybe a six out of nine,

(28:02):
Or they have a calorie intake that’s already quite high. So if they’re eating 1.6, I’m talking about a dog right now, 1.6, 1.8 times their resting energy requirement, then I can probably reduce them at least for a while on their normal food and be safe. If they’re starting below that, which often these obese pets are, they have slow metabolisms, most of them. So if they’re starting at 1.2 or one times their resting energy requirement, then it’s not safe because I’m going to have to be cutting them back over this six to nine to 12 month process. We’re going to be making gradual reductions most likely. So we’re going to reach a point where it’s not safe for them to eat a regular diet over the counter. And I think that’s another takeaway is to talk to owners about the fact that this diet is not as short-term diet. Most of these pets have a low metabolic requirement, even once they’re at ideal body condition, so they really should be on a weight loss diet long term. I own one of these dogs, she’s on a weight loss diet for life unless I have to make a switch for another reason.

Dr. Andy Roark (29:05):
Gotcha. That makes sense. Yeah, that’s wonderful. Any other pearls I should pick up here at the very end?

Dr. Taryn Pestalozzi (29:12):
I mean, I think we’ve talked about a lot of them. It’s really about pick a starting point, monitor,

Dr. Andy Roark (29:17):
Yeah.

Dr. Taryn Pestalozzi (29:18):
Make adjustments, be a cheerleader. Those are the keys that people miss and that are what actually result in success. And I mean, we had roughly a 75 to 80% success rate and healthy weight clinic at Kansas when I was there. And most of the cases that weren’t successful, we had lack of compliance or we lost a follow-up. So I think if you work the plan so to speak, you can help a lot of these pets. And there’s like 60% of both dogs and cats that are overweight or obese currently. So this is the case you see every day.

Dr. Andy Roark (29:49):
Oh, I mean, yeah, the overweight Labrador people were like, oh, that’s really a novel case. Sandy, you haven’t seen that before. Yeah. That’s awesome. You’ve given me a number of resources. I’m going to be linking like crazy in the show notes, which I always love. People love having a list of resources. Any other that you would recommend if somebody’s just like, I love this, I love what you’re talking about. Where do you refer people who are nutrition geeks? They’re just like, yeah,

Dr. Taryn Pestalozzi (30:16):
Anymore. I’ve got a few. So the first one that will really walk you through this step-by-step is that 2014 aha weight management guidelines. There is a later like an updated version, but the 2014 as well. The meat and potatoes of this topic is the world’s model of that association has a nutrition toolkit. So that’s where you can get your body condition, your muscle condition, other resources for your support staff. Pet Nutrition Alliance does have a little online calculator you can use. I think they may have updated the website recently, so I’m not sure how they’ve changed it. And then Hill has the Bed Academy with some cece type videos about weight loss. They also have the quick reco tool that can help you initially make a plan. And then if you want more about the stats from that recent annual survey, the Association for Pet Obesity Prevention website has the results of all of the surveys, but the most recent being 2022 and they’ve got good infographics and stuff.

Dr. Andy Roark (31:12):
That’s amazing. I’ll link up to all that stuff. Dr. Taryn Peal, thank you so much for being here. I so enjoy you.

Dr. Taryn Pestalozzi (31:19):
Great, thanks. It was so nice talking about it. This was a topic that I really like.

Dr. Andy Roark (31:23):
Well, yeah, it’s obvious. That’s why I had to have you. Anyway, guys, thanks for tuning in. Everybody take care of yourselves. And that’s it, guys. That’s what I got for you. I hope you enjoyed it. I hope you got something out of it. Thanks so much to Taryn for being here. I really enjoy her. I really enjoy talking with her about weight management. It’s a thing that we talk about a lot, but man, when you find someone who is really passionate about this subject and who has had a job, just having these conversations, these are important, and just because we have ’em a lot doesn’t mean that we shouldn’t take them seriously and really think about how we get better. In fact, it’s the conversations we have a lot that we should really focus on because that’s where we can make a real difference for the clients and the pets that we see.

(32:09):
I mean, I dunno. I think a lot of times in education there’s this push to find these unique things that rarely happen and to be aware of them, and that’s okay. I really think that finding the things that happen commonly and deciding that we’re going to be amazing at them, I think that’s how we really make an impact on the world through veterinary care. Anyway, that’s just how I feel. Guys, if you have not checked at the Hill’s Veterinary Academy, you should take a look. Go and check it out. It is their learning library, it’s their Learning academy. There’s so many resources there. It is a great, great, great source of knowledge on all things nutrition. I’ll put links down in the show notes, go and check it out. Thanks to Hill’s for making this episode possible, guys. Take care of yourselves. I’ll talk to you later.