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Andy Roark DVM MS

When Vet Techs Consider Leaving the Field

by

Dave Cowan and Jeff Backus, Emergency & Critical Care Veterinary Technician Specialists and the hosts of the Vet Tech Cafe podcast, join Dr. Andy Roark to talk about when veterinary technicians consider leaving vet medicine.

Both Dave and Jeff were considering walking away from vet medicine when they met and decided to start their own podcast. Since then, they’ve learned lessons and gained insight on how to keep technicians engaged with vet medicine (and also when it’s just better to go ahead and leave).

Let’s get into it!

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

LINKS


Vet Tech Cafe Podcast Homepage

Dr. Andy Roark on Vet Tech Cafe

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUESTS

Dave Cowan BA, CVT, VTS(ECC) has been in the veterinary field for over 25 years.  He has worked for an educational farm, the Animal Rescue League, general practice and emergency/specialty practices  In 2013, Dave passed the Academy of Veterinary Emergency and Critical Care Technician (AVECCT) exam and became a Veterinary Technician Specialist (VTS) in Emergency and Critical Care.  He moved to North Carolina in 2016 and has spent time as a technician supervisor, an education and training coordinator, and was lead instructor for a Veterinary Technician Program. In 2019, Dave co-founded the Vet Tech Cafe Podcast with Jeff Backus.  The podcast tackles difficult issues that veterinary technicians face as well as highlighting some of the many career opportunities available to technicians. Dave joined Action Vet Tech Services in 2020 and now works relief shifts at various practices both ER/referral and GP while also providing CE and training opportunities 

Dave has served on the New Hampshire Veterinary Technician board as the head of the credentials committee.  He has been the chairperson of the AVECCTN credentials committee and is now one of the Members at Large on the AVECCTN Board.  Dave lives in Hillsborough NC on a farm with his partner Robyn and her daughter Ruby. They have many animals to care for including goats, horses, chickens, and a donkey to go along with 2 dogs, and 2 cats., I have a one year old daughter.

Jeff Backus started as a veterinary assistant in general practice in 1995 and began working in ECC in 2004. He became an RVT in 2009 and VTS(ECC) in 2013. Jeff also taught veterinary technician education for 7 years. He has been on the Board of Directors for the California RVT Association for 8 years, serving as President position from 2020-2022, and is now past President. After 4 years in academia at Tufts University, he relocated back to Southern California with his wife and began working for the ASPCA Animal Poison Control Center. He is also a frequent lecturer and speaker with a focus on toxicology. He co-founded the Vet Tech Café podcast with Dave Cowan in 2019, talking about issues that face the veterinary technician profession with leaders in the field, and all of the amazing opportunities of the veterinary technician profession.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast, I am your host, Dr. Andy Roark. Guys, I got two friends in today, Dave Cowan and Jeff Backus, they are the host of the Vet Tech Cafe Podcast, we talk about that a little bit getting started. And we come in and I started to talk to them, I want to talk to them about lessons learned from their years of interviewing mostly veterinary technicians and we immediately found the path that I was really interested in, which was when they talked about when they met each other and were both basically burned out and thinking about leaving that medicine. And I said, “man, is that common, do I hear that from technicians, including boarded technicians like they are, I just hear this a lot of, I reached this point and I was thinking about leaving the profession, I was ready to get out.”
And so we stopped there and just started to unpack the lessons they have learned about when we reached the point of thinking about leaving the profession. And so we get into that, we talk about headspace, we talk about all the people that they’ve interviewed, and what lessons they’ve learned, and what keeps them engaged and things like that. But it is really an interesting conversation, it’s a lot about technicians specifically, but it’s also a lot just about burnout, it’s about the stresses of our profession, and it’s about the idea that just because you have done something, it doesn’t mean that you have to do it forever. Just because you’ve been in that medicine for 10 years, that doesn’t necessarily mean that you have to continue practicing as you did for the rest of your career. I think a lot of times we put that weight on ourself, but it’s not real, we make it in our own minds. So anyway, that’s the episode, that’s what we’re here talking about, so guys, let’s get into this.

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, Dave Cowan and Jeff Backus, how are you guys?

Dave Cowan:
We’re doing great, how are you doing?

Jeff Backus:
Yeah, doing well.

Dr. Andy Roark:
I’m doing really well, I’m glad that we could sit down and talk. For those who do not know you, you are both veterinary technicians, you both have veterinary technician specialties in emergency and critical care. And I met you as you two are the host of a podcast called Vet Tech Cafe, and you invited me to be on a year ago and I just had the most lovely time.

Dave Cowan:
Yeah, it was great, we enjoyed talking to you.

Dr. Andy Roark:
It was really good. I felt very honored because it is very rare to have a veterinarian on the podcast-

Dave Cowan:
That’s true.

Dr. Andy Roark:
… As you guys-

Jeff Backus:
That’s true.

Dr. Andy Roark:
… Tend to talk to technicians, so that was quite an honor for me. But I enjoyed the conversation so much, I thought it’s been a year since I came and met with you guys. And so I wanted to talk a little bit about your podcast, I want to talk mostly about the veterinary technician space and culture and things like that.
And I want to talk about that because it was funny when we were here doing the soundcheck, getting ready for the podcast, our producer said, “so you guys you are techs, you work with techs, you also do the podcast, it’s like you guys are putting on the cape and going and doing the thing.” And I thought that was funny, but let me go ahead and just start this out, let’s talk a little bit about Vet Tech Cafe and what it is before we start to get into what it means for technicians. So what was the vision for your podcast when you got started?

Jeff Backus:
Honestly, Dave and I met when we were doing our specialty certification several years ago and we were at Ivex in-

Dave Cowan:
2019.

Jeff Backus:
… Twenty eight-

Dave Cowan:
2019.

Jeff Backus:
… 2019 in DC, we were sharing an Airbnb and we were just hanging out one night after lectures and we were both in the same like, do we want to keep doing this or do we want to get out of med headspace? We were both not in a great spot in veterinary medicine and then we started talking about this podcast, somehow the conversation shifted to that and got us really thinking about all the cool things and cool people we knew that were doing these cool things and that reinvigorated us. And we talked for a couple of hours and then the next day we were like, “so are we doing this?” And now almost four years later, here we are.

Dave Cowan:
And it was more about the fact that we were frustrated, we’re like, “is there something we could do that’s different?” Because all we knew was clinic work, because we worked on the floor for 20 some odd years and we were both frustrated in our jobs and frustrated with where our career was stuck and we said, “there’s got to be something else out there.” And it shifted to a talk about a podcast, I don’t exactly remember how we shifted to that, but we said, “there’s nothing really in the podcast space for technicians, there’s a lot for the field, there’s a lot for veterinarians, but nothing really specifically for us,” and we’re like, “we should probably do that.”

Dr. Andy Roark:
I love that you did it. I think there’s a lot of people out there doing really good stuff at this, specifically the thing I liked about the way you set it up, it’s what I started trying to do with here with the Cone of Shame, was there were people out there I wanted to talk to and give a platform to. And so it wasn’t that you guys set out, or at least not since I became aware of you, it wasn’t that you were like, “we want people to hear us,” it was more like, “we’d like to talk to these other people and learn from them.” And I just think that it’s almost like a service position in that way of trying to shine the light on what others are doing. I think you do that really well, I encourage people to take a look at your podcast and look at the episodes you have.
It’s fascinating to hear you talk about that, about how you met. And so now I get to talk to some of the most successful people in the world in either in our industry and the proportion of highly successful technicians that tell me, “I don’t want to do this anymore,” or that they went through that period, it’s enormous. It is usually after we turn the microphone off or whatever, they’ll be like, “God, I was so burned out two years ago, I was trying to get… Or they’ll be like, “I’m thinking about doing something different,” and it seems to be such a widespread problem of people just getting tired of the technician role and burning out.
I’ve also had people who have come to me and asked the same questions that you were asking each other, which is, “what else is there?” Or say, “I’m in my forties, I’m into my fifties, my body’s not holding up like it used to. I have this background, I have this experience, I may have this advanced training, but I don’t know if I can keep doing that.” Talk to me a little bit, so when I say that, do you think that your position of, do we want to get out of the industry, do you think that that’s common?

Dave Cowan:
Very common.

Jeff Backus:
Yeah, very common. When we started, I was living in New England, my wife had just graduated vet school, was doing a couple of internships in Rhode Island and I was working at Tufts University. And working in academia darn near broke me and I was ready to get out, I was ready to go pour beer to brewery, that was going to be my next step. And we were coming back home to California and we had started this podcast, which frankly for me, I have found so reinvigorating for this career, hearing from people that found their niche and found what they love to do and they’ve carved out a path and a career for themselves.
Because like Dave was just saying, we’re ECC techs, that’s what we’re boarded in and sure you can move around to other ERs or ICUs or maybe even move into different departments in the hospital, but you’re still in the hospital. It was a little bit of a narrow focus, but with all of these guests that we’ve talked to, and we have learned so much about so many things that we didn’t even know existed after 20 some years in the field. So it’s been really, really reinvigorating for my career especially.

Dr. Andy Roark:
Yeah.

Dave Cowan:
You don’t know this, but Jeff and I are both extreme introverts and when we said we’re going to start a podcast, my partner, she’s like, “the guy who doesn’t want to talk to anyone’s going to have a podcast?” I’m like, “yeah, this is different.” And the fact that we can do that and talk to these people and bring their stories to our listeners, that’s amazing because we’ve gotten feedback from a lot of people saying, “I want to try that, I want to do that,” and going down that path of saying, “I’m tired of doing this too, so what else can I do?” So I think a lot of our listeners listen to us because they want to figure out something different to do, which was the whole point of starting the thing, right?

Jeff Backus:
Yeah. And there really is a lot you can do as a veterinary technician, under the umbrella of veterinary medicine, there are a lot of roles and careers inside and outside of the clinic that are out there. I think now in 2023 with remote jobs, there’s more than there’s ever been, but a lot of us just don’t know how to find it or don’t know what those jobs are. And so talking to some of these people that figured it out and are doing it, it’s awesome to listen to, from my perspective.

Dr. Andy Roark:
Taking a step back from the path, which is looking at alternate ways to practice, if someone came to you now in the position that you were in when you started and they were like, “man, I’m thinking about getting out of the profession, just leaving vet med in general, I’m not sure if I want to, but really, that’s where I am.” Based on your experience and then also the hundreds of people that you’ve talked to, what kind of roadmap would you build for somebody like that? Give me a quick action step, give me a treatment plan for someone who’s there.
And again, you don’t exactly know what’s going to work and what’s going to be different, but if they came to you and said, “I need a treatment plan, what are the steps, things like that.” And so let’s start with headspace, is what I like to talk about, it’s just before we get into what would you do, just philosophically, what have you come to believe about when you’re ready to leave? Where would you try to get them in their head to look at the profession or look at the options? Would you be optimistic? Would you tell them, “no, this may be unavoidable?” What would you try to get them to visualize for themselves?

Dave Cowan:
Well, first thing is, do you want to be in this field? That’s my first question, figure out why did you get into this field in the beginning and then find out is that still true? And I’m going to refer back to something you told us when you were on the show, find out what you love to do and find ways to do more of it. If working on the floor is not what you want to do, figure out where you can go from there and figure out what it is that you like doing in this field and figure out ways to do more of it. And the other part is that, is this field isn’t for everyone, so if you’re two, three years in it and you’re burnt out already, maybe this isn’t the field for you. For Jeff and I-

Jeff Backus:
And that’s okay.

Dave Cowan:
… Yeah, that’s perfectly fine. Don’t stay in it if you’re going to be miserable because we’ve got plenty of miserable people in this field that we don’t-

Dr. Andy Roark:
We’ve got enough miserable people.

Dave Cowan:
… Yeah, we’ve got enough miserable people, we don’t need to add to it, and just figure out what you like to do and find ways to do that.

Dr. Andy Roark:
It’s fascinating to me that you just own it like, “this might not be the place for you.” I think that’s true, I love the candor in just saying that, why do you want to be here, I think that’s good.

Jeff Backus:
And I think on our side of the spectrum too, our schooling, if you go the traditional AVMA route, it’s only two years, yes, there’s some student debt associated with that, but there are so many assistants that come into the field that haven’t gone through the educational path. So I don’t feel like they have the burden of the undergrad and the four years of vet school and the level of debt associated with that. So it’s a little bit easier to exit if so desired.
But I think to Dave’s point is, you work in a clinic for a little while, maybe that becomes stagnant, maybe it doesn’t interest you any longer. Or sometimes people just get promoted to supervisory or managerial roles that they’re not thriving in that they don’t love just because they were the most senior person there and that’s taking away from their love of the job. And so it’s like Dave said, getting back to what drew you to it in the first place, it’s like if you want to be on the floor, just be on the floor and take yourself out of those other roles. Or if you don’t want to be on the floor anymore, then what about being on the floor that you like, and what kind of things can you do with that that are just no longer on the floor anymore?

Dr. Andy Roark:
There’s this narrative that the career path, especially for paraprofessionals, but even for doctors, but definitely for paraprofessionals, the career path is upward into management. And you’re like, “why would that be true necessarily?” The thing that makes you a great practitioner on the floor, that doesn’t prepare you to manage other people in my experience, and you said that this is what you wanted to do.
I think one of the biggest challenges for technicians, and it is also true for doctors, I think both are opening up now, but it used to be, it was a hard development ceiling at the clinic level of, well, you’re a new tech and now you’re an experienced tech, and-

Dave Cowan:
And that’s it.

Dr. Andy Roark:
… That’s the end of … yeah, that’s it, and next step, management.

Dave Cowan:
Congratulations, you made it.

Dr. Andy Roark:
You made it, exactly right. So first of all, actually let me pause here and just so say, because you’re both in emergency critical care, do you think emergency critical care is worse as far as people burning out or over a certain period of time they go, “I don’t want to do this?” I’ve always wondered if the lifestyle that’s usually associated with it, if that puts more stresses on people or if you disagree?

Jeff Backus:
I would say I agree, I think each individual facet, each specialty deals with its own things that make it more difficult than others in certain areas. But I will say for emergency and ICU, the off hours, I will say I did overnights exclusively for 15 years and the toll it takes is not worth the $2 an hour shift differential.
But also, I think the level of the cases and the frequent interaction with futile care and just cases that we know are not going to end well and still pouring everything that we’ve got and such a high volume of those cases, I think it takes a little bit more toll. That being said, for internal medicine techs, I imagine the chronicity of some of those cases and just the slow linear progression takes the same kind of toll in a different way on them. And same thing too with general practice, I think it’s much the same, it’s just in a little bit different way.

Dave Cowan:
Yeah, I’ve worked in general practice and I’ve worked in emergency, and when I made that switch to emergency, I looked back at some of my colleagues that were still in general practice and the things that they were complaining about, for a lack of a better term, I’m like, “I don’t even care about that stuff anymore, it’s just a different mindset in emergency.” So like Jeff said, there’s stresses on every department of this field that I think sometimes people go to ER because they like the chaos, they like constantly having stuff to do and constantly be moving and the critical nature of it.
But other people like the, I don’t want to say relaxed, that’s probably not the right term, but the more steady pace or scheduled thing of working in general practice, where Jeff and I enjoy the ones where we have to think about things and use our brains and be active in the treatment of these cases. But I think every department in this field has its own stressors that are pushing people out of the field really.

Dr. Andy Roark:
Coming up on November the 14th with my good friend Dr. Emily Tincher, she’s been on the podcast a number of times, I love having her here, she is such a fun, interesting person who’s a deep thinker. And so anyway, she is doing a webinar called Clinical Empathy: The Exam Room Skill That Can Transform Your Team. I’ve had Emily on the podcast before talking about Clinical Empathy, this is a really good skill building webinar, this is great for your support staff as well as your doctors, but your team leads especially, but your technicians, your assistants, your CSRs, all of this is just is such a great communication content, I think you’re going to really like it. So anyway, that is on November the 14th, it is at 3:00 PM eastern noon Pacific.
And then the last one in the series is on December 13th, it is with Dr. Simon Platt, it is called, Head Cases: A Spectrum of Care Approach to Neurology in General Practice. So if you’re a neurology buff, if you like seizures, not like seizures, if you like knowing about seizures, if you like neurophysical exam tips, tricks and hacks, things like that, this is going to be a great webinar. So again, this is on December 13th, it’s at 1:00 PM Eastern, that’s 10:00 AM Pacific Time. Gang, I would love to see there, the links to all this stuff are in the show notes, go ahead and grab a spot, I’ll see you there. Let’s get back into this episode.
Well, going back to our treatment plan for I’m not sure I want to do this anymore, so we talked a bit about headspace, recognize why you want to be here, I think that’s great remembering your why point. Let’s move into other action steps, so once you come to that place and you are sure you do the reflection, and I talk to a lot of people who say, “I do really love it, I’m just unhappy, Verizon Wireless is not calling out to me, I’m not purpose driven to be a cell phone salesperson, but the benefits are not bad and it’s close to my house and I’m honestly thinking about going there.” So help me start to walk towards understanding what my options are.

Dave Cowan:
Well, as the three of us know, this is a very small field, everybody knows somebody. If there’s something that you want to do, there’s probably somebody you know or somebody that you are in direct contact with that has experience in that department or the field, you just have to talk to people, you have to network. And we talk about this on the podcast a lot, is that when we first started out, social media was not a thing, and now social media is very wide and it’s got its pros and cons. But one of the pros is that we can network with people that we would never have contact with years ago, there’s ways to find those career opportunities just by scrolling through social media.

Dr. Andy Roark:
Yeah, I think that’s a great point.

Jeff Backus:
And I think too, in some ways in this field, a lot of times we have almost an adversarial relationship with our management team and depending on what that structure is. But I think if you are seriously contemplating leaving your clinic or changing jobs or whatever it is, I think an honest conversation with management and actually involving them is really important because just don’t look at it as just their manager and you’re going to get fired or whatever, but they might actually be a resource to help network like Dave’s talked.
I would hope that that person actually wants to see you succeed, and maybe that’s not always the case, but they might have suggestions for you or this conversation of, “what do you like specifically about being here and your job here? Can we help do more of that and take away some of what you don’t like so that you feel more valued here or you start to enjoy your job more?” And again, I realize maybe that’s just rose colored glasses, but I think at some point, you have to have those conversations with the people that are responsible for the work that you do in your clinic because otherwise, it’s just going to be the same old thing.

Dr. Andy Roark:
I love these points, I think this is excellent. So I started thinking about thinking about this, so I want to start with David’s point, but, boy, 20 years ago, the idea of technicians networking was just dumb. And I would say that to people and they would just look at me like, what are you talking about? I think Jeff’s point of social media coming up is a huge one, it’s been particularly huge for technicians because there are so many groups of technicians online, things like that. None of that stuff used to exist, all the practices were very siloed and the practices would even try to keep the techs away from other techs because you didn’t want them to jump ship and-

Jeff Backus:
You didn’t want them to compare notes.

Dr. Andy Roark:
… You didn’t want them to compare notes, you didn’t want them to jump ship and go to the place down the road. And so you’re like, “you know what, I keep my people here and their people can be over there.” That’s an old school mentality that has nicely gone away, but I think social media opened up a lot for that. And there’s been so many technicians like yourself who have said things like, “you should go to CE.” And again, that’s another massive opportunity that just wasn’t there that long ago, there just wasn’t a lot of tech CE and now there’s so many more options, so I really do love that.
To Jeff’s point about talking to management, there’s two pieces to it, the first is, I’m a big believer in Brene Brown’s saying that, “clear as kind.” Which is, if you’re seriously thinking about bailing, if you seriously think, I can’t keep doing this, is it kind to the place that you work to not say anything until you’re totally toast and then just to give them your two weeks notice and be gone? Is it kind to go get another job and being like, “all right, well, I give my two weeks because I’m already set up there.” That’s not kind, kind is saying, “I just want you to know where I’m at and this is what I’m starting to feel and I’m looking for some opportunities to do some different things, try to maybe get to do more of the things that I’m really excited about, or I’m wondering if you guys have ideas for advancement for me or what my career development might look like.”
And savvy leaders, they’ll make something, I’ve done that with my people a number of times as they come and they’re like, “look, this is what I’m looking for,” and I go, “well, I don’t want this person to leave, let’s figure out how to create some opportunities for them to see if we can keep them here.” And then going originally back to the candor of like maybe this isn’t the right place for you, I wrote an article, it’s probably been over a year ago, but it was called Fare Thee Truly Well, and this is from the other side, is from the management leadership side.
But I don’t think a lot of people can do this, but I have met more and more people who said, “I hire these people and I want to train them and I want to grow them, and I do that in the full knowledge that they might outgrow my practice. They might come along and get skills and knowledge and grow until there’s really not much else here for them to do and they’re going to go somewhere else. And rather than resent that, rather than try to not let that happen, I’m just going to accept that that is going to happen, I’m going to continue to grow and develop people because it’s morally right and teaching is what I love to do and I’m going to believe that karma is out there and that good things will come back to me from growing people and even facilitating them going on to the next adventure.”
But I’ve met enough of those people over the years and people who have worked for those people and then gone on that really, when you start thinking about what’s important in life and the type of employer you want to be, I think that there’s a lot to that. But it’s not a mindset that comes naturally to people, people, they generally want to, if they have talented people that work for them, they want to keep those people and of course they do.

Jeff Backus:
And it’s very easy from that managerial perspective to become defensive and take it personally that this person is not happy in their role and they’re not being fulfilled. And so you have to lay down that armor a little bit and just be like, “look, we can do this, but let’s just have a couple of conversations and involve some other people here about this,” because probably that’s not the only person in the clinic that feels that way and it’s not going to be the only person down the road that feels that way and so got to find solutions.

Dr. Andy Roark:
I heard some terminology recently, someone told to me, I can’t remember where it comes from, but basically they were like, “there’s a couple of different types of really high-flyers in a business, there’s your superstars and there’s your rock stars. And your rock stars are people who are good at what they do and they like coming out and playing the song. And your superstars are the ones who, they are going somewhere, meaning that they’re doing new things, they are trying new things and they are soaring. And the superstars are great, they are self-driven, they know where they want to be, they want to grow. But the downside to superstars is they’re probably going to leave, they’re probably going to come and they’re going to leave.”
And I just thought it was really interesting the idea of just owning that to say and there are some people who are not interested in going on, they want to be very good at what they do and they want to remain challenged. And as long as they feel like they are good and they are challenged in their work and they do good jobs, they’re totally fine to punch the clock for 25 years and do it. And it’s not a bad thing, it’s not a knock, but for those people who are superstars and feel like, “I’m really internally driven, I want to keep trying new things, I get bored easily,” that can just be a different environment.
And so it was funny because the point of the article was, you want to have a mixture of rock stars and superstars, is you really don’t want everybody who’s gunning and trying to be a high-flyer like a couple of those people because they push everything forward. But it’s also really good to have people who are happy to be challenged in the way they were, so anyway, I thought that was really interesting.
What are your favorite resources for technicians? So obviously you guys have a podcast, it’s called Vet Tech Cafe, it’s an excellent podcast, as I said, I really like it, I really enjoy it, it is a lot of technician guests and talking to them about their careers and lessons that they learned and things like that. Are there other resources that you like for technicians?

Dave Cowan:
In terms of podcasting or-

Dr. Andy Roark:
No-

Dave Cowan:
… Just in general?

Dr. Andy Roark:
… I was more thinking, well, in terms of our action plan of trying to figure out where you want to go, what you want your career to be like. Just in general, if somebody said, “God, I’m feeling stagnant, not necessarily that I’m looking to go somewhere different or do something different, but I want something that’s going to make me not feel stagnant.”

Dave Cowan:
I would advocate for CE and it used to be a very commonplace thing where everyone had this CE allowance where they could go to conferences, they could go to different CE. And many years ago, one of the stipulations that I had with some of my CE was that if you’re going to go learn something, come back and teach it. And I really enjoyed that and I think that’s probably what got me on my path to enjoying teaching and enjoying doing CE and things like that.
But just going out and networking with other people and getting some continuing education, a lot of times you’ll go there and you may not learn anything new, but the experience of being there, like we have this post-conference invigoration always when we come back we’re like, “I learned this thing, we’re going to do this on our practice,” and we get back and a lot of times the people that we work with are like, “we’re not going to do that.” But if you come back invigorated and you can bring that to management and say, “we learned how to do this one little thing with these types of cases, can we try and incorporate that?” And I feel like people that get stuck and stagnant and burned out and leave is because they’re doing the same thing over and over and over again.
And back to Jeff’s point about finding other things to do in your practice, it’s a little bit more relevant to an ER referral practice because there are different departments. I feel like for me, the reason that I’ve stayed in this field so long is that I’ve done different things, I haven’t been doing the one thing for 25 years, I’ve been doing different things. And I feel like if you go to CE, you’ll learn about something and maybe that inspires you to try a different way or even move to a different department in your hospital to entertain your mind and make you more useful and get you thinking instead of just doing the same thing over and over again.
I feel like that’s one of the things that I would recommend for people, is to educate yourself, there’s a vast amount of knowledge and we are never going to learn all of it in this field and I think sometimes people don’t realize that, that there’s no limit to what we can learn here. And I found that the more that I educated myself, the more that I went to CE, the more invigorated I was to stay in the field.

Dr. Andy Roark:
I love it. Guys, I’m going to put links to the Vet Tech Cafe in the show notes, I’ll put a link to the episode that I did with you guys a year ago, if you want to hear us, flip it around and go the other way, they can check that out. Thank you both so much for being here, guys, thanks for tuning in and listening, take care of yourselves everybody.


And that is the episode, that’s what I got for you guys, I hope you enjoyed it. Thanks again to Dave and Jeff for coming on, gang, check out their podcast about Tech Cafe, I said I’ll put links into it down in the show notes. If you are enjoying this podcast, one of the nice things you can do is leave me an honest review wherever you get your podcast, it always means the world to me, it’s how people find the show, it’s super important, so like and share the episodes if you enjoy them. Guys, take care of yourselves out there, be well everybody, talk to you soon, bye.

The Correlation Between Struggle, Perception, and Success

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I Have No Idea What to Write

First, I struggled to come up with something to write about today. Then, I struggled with the realization that I was struggling. “Why is this so hard?” I thought. “Surely I should be better at coming up with things to say at this point.”

It’s not easy to write something new every week, or to say things that will be valuable to [at least some of] those who read it. I was lamenting this fact as I walked my dog this morning, and I was honestly beating myself up a bit. At some point, challenges can start to feel like failure and I was reaching that point.

When I got home, I mentioned to my wife, a college professor who is fascinated by how people learn, that I was having a hard time getting anything good on paper. I told her I was feeling a bit stuck and demoralized.

In response, she shared with me that one characteristic that correlates with academic success in students is how they perceive struggles like the one I was facing. Students who believe that struggle is a sign of weakness are less likely to be successful academically than students who believe struggle is part of learning and improvement. The ability to frame struggle as progress (and not as a sign of impending failure) makes a big difference in how we think we are doing. How we think we are doing, interestingly, tends to correlate with where we actually end up. 

As I sat down to write to you today, I had two thoughts. The first was that I’m glad I wrestled to come up with what to say. The struggle was part of the process. Without the frustration, I would not have learned the lesson that I want to share today.

The second thought I had was “I bet I’m not alone.” I suspect that everyone has something with which they are struggling. Whether it’s working up a tough case or juggling family schedules, I think everyone faces challenges pretty much continuously in one way or another. We all toil and feel frustration.

My hope for today is simply to ask the question “How are you looking at the struggle?” Are you seeing the hard work you are putting in as the required path to improvement and ultimate success? Or are you internalizing it as a sign that you are weak, unprepared or failing?

We can choose how we perceive hardships. The middle of success often feels like failure. Maybe the struggles you are facing are not red flags and stop lights. Maybe those struggles are the rocky path you are simply required to climb to reach your goals.

Identifying Mobility and Pain Issues on Examination (and Even Before)

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Dr. Dycus, Chief of Orthopedics at the Nexus Veterinary Bone and Joint Center and founder of Ortho Vet Consulting, shares invaluable insights into orthopedic examinations for both dogs and cats. He discusses the importance of video documentation for evaluating mobility issues, offering indispensable guidance to veterinarians and pet owners alike.

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

LINKS

Dr. David Dycus’s website

Dr. David Dycus on Instagram

Dr. David Dycus on Facebook

C.A.M. (resource for pet owners)

C.A.R.E. (resource for pet owners)

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. Dycus attended Mississippi State University’s College of Veterinary Medicine for his veterinary degree, Auburn University for a small animal rotating internship, and Mississippi State for a combined surgical residency and Masters degree.

Dr. Dycus is frequently asked to lecture locally, nationally, and internationally. He has given over 200 continuing education lectures and taught over 125 laboratories. He has published numerous research articles and authored or co-authored several book chapters. He is the co-editor of the textbook: Complications in Canine Cranial Cruciate Ligament Surgery. He was named by DVM360.com as one of the 10 veterinarians to watch in 2018. Dr. Dycus is a frequent contributor for updates in orthopedics to several veterinary websites and magazines. Dr. Dycus has also been featured on Sirius XMs Doctor Radio’s segment on Pet Health and Orthopedics. His passion for teaching has allowed Dr. Dycus to become a laboratory instructor for the CBLO, TPLO, extra-capsular stabilization, medial patella luxation, angular limb deformity, and fracture repair. He is on faculty for AO (Arbeitsgemeinschaft für Osteosynthesefragen), and he is an orthopedic consultant for VIN (Veterinary Information Network). 

Along with being a scientific reviewer for multiple journals, he serves on the editorial review board and is the associate editor (orthopedics) for Veterinary Surgery, the official publication of the American and European Colleges of Veterinary Surgeons. He has previously held an appointment on the research committee for the American College of Veterinary Surgeons. Currently Dr. Dycus is on the Board of Trustees for the American College of Veterinary Surgeons, is a council member for the Association for Veterinary Orthopedic Research and Education (AVORE), and is on the education committee for AO North America. Dr. Dycus became a certified canine rehabilitation practitioner through the University of Tennessee in 2015. He is the director and chief of orthopedic surgery at Nexus Veterinary Bone and Joint Center where he has a focus on total joint replacement, complex and minimally invasive fracture repair as well as angular limb deformity correction, 3D implant printing, and arthroscopy. In addition, he is the medical director for Nexus Veterinary Specialists located in Baltimore, Maryland. He is the founder of Ortho Vet Consulting, an educational consulting and orthopedic coaching service as well as the co-founder of the Veterinary Sports Medicine and Rehabilitation Institute (VSMRI).

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome, everybody, to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I’m here with my good friend, Dr. David Dycus. He’s an orthopedist. He lectures all over the world. He does a ton of things, which I’ll lay out here in a moment. Man, I always enjoy him. He is so useful. He’s such a wealth of knowledge and just super practical clinical knowledge. And guys, we are in the orthopedic exam today. And gosh, he just makes pearls of wisdom rain from above in this episode. It makes me so happy.
My face, I wish you could have seen my face when we get into talking about how to ask pet owners to take videos of their limping pet, and he’s like, “Yeah. This is my wishlist for how to film and what to get them to do.” And I’m like, “Man, if I was a pet owner, I would love this. I would feel empowered. I would feel like I have got some homework to do. I feel like my vet cares.” And then as the vet, I’m like, “Yeah. This is super helpful.” And it’s just a way… It’s like sometimes you struggle to ask for what you really need because you don’t exactly know how to articulate, “Hey. This is what makes a good video that’s actually going to make my life easier and not just give me more to do in my day.” And so anyway, that’s just one part of what he lays down. But man, that was probably my favorite part and we do it for dogs and cats.
At first we start off, we’re talking a lot about dogs. We very much get into cats and how cats are different and ways of diagnosing cats differently, and just, anyway, boy, the amount of knowledge packed into this episode is just absolutely over the top. So anyway, if you ever see limping animals, limping dogs or cats, this episode’s for you. 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. David Dycus. Thanks for being back on the show.

Dr. David Dycus:
Hey. Thanks for having me. It’s great like always to be back.

Dr. Andy Roark:
Oh, man. I so enjoy having you on here. You have been… I think I have you on about once a year. I should probably do more than that, but you are perennial here. I always enjoy the heck out of you. For those who don’t know you, you are a board certified veterinary surgeon. You have a sole focus in orthopedics, so you’re always in talking about limps and joints and aches and pains and corrective procedures and things like that. You are the chief of orthopedics at Nexus Veterinary Bone and Joint Center. And you also are the founder and owner of your own consulting firm, which is Ortho Vet Consulting.
So you are awesome. I love talking to you about these things. You have a passion for canine working dogs. And so it’s just something that I’ve always been interested in and it fits with your orthopedic interest. And I’ve had you on talking about osteoarthritis many times in the past and things like that. And so let’s go on. I want to just talk with you today. I’m interested in. I had just a flurry of questions recently about limping dogs and mobility. From those, do you think it’s torn? Is it partially torn? Do I need to come in? Do I need to do a surgery? Should I wait and see? And it’s just a lot of those sort of nuanced questions. And so I wanted to bring you in to kind of help me brush up a bit on identifying mobility and pain issues and just examination and then even pre-examination. Are there things I should be asking before from the pet owner? Are there things I should be looking at before I put the hands on the beast? Anything like that?
So let me just start it at a high level and sort of say when somebody comes to you and says, “Hey. Could you take a look at this limping dog?” where do you even start to process this in your mind?

Dr. David Dycus:
So I think first thing is going to be listening to the owners and gathering as much information as you can, because in a lot of situations when the dog or even the cat is in the veterinary hospital, they’re amped up. And so sometimes some of the things that the owners say are happening, you watch the dog walk, for example, and you’re like, “Well, I don’t see anything,” and you’re thinking the owner’s crazy or the dog’s getting better. So I always question them about how long it’s been going on, where they see the issues most. And I try to keep most things open-ended so I don’t persuade them one way or the other or they answer something the way I want them to.
I want them to tell me are they predominantly seeing stiffness upon rising and then the dog works out of it and looks beautiful? Or are they seeing something that the dog is stiff and then it stays consistent? Is it something that started out very intermittent and has now progressively gotten worse? Or are they actually seeing maybe some behavioral type changes? Maybe the dog’s sitting down on walks or maybe they’ve noticed that, “Usually he beats me up the stairs and hops on the bed at night, and now we’re kind of waiting on him to come up the stairs and then I’m having to bend over and help him up into the bed.” So they may notice some not necessarily limping, but they may notice some changes. And if it’s a cat, for example, perhaps they have stopped wanting to jump up onto the counter or they get up and find themselves, but then they start meowing or seeking out somebody to help them get down off of a surface because they don’t want to jump down. So I think certainly listening to the owners is a huge, huge one.

Dr. Andy Roark:
Do you have any slick sort of Jedi questions that you feel draw histories out naturally? Or do you sort of do a 20 questions like, “Hey. I’m going to ask you a bunch of questions,” and then just kind of go through a checklist in your mind? How does that sound when you’re trying to draw this out and without leading them too much?

Dr. David Dycus:
Yeah. I think sometimes when the owners come to see me, they’ve been to their regular veterinarian and they’ve maybe got an idea of what’s going on.
So they start telling me things that they think I want to hear, things they’ve looked up on the internet to try to persuade me in that direction. And so I say, “Listen. Let’s start at the very beginning.” I’ll say, “Why are we here?” “Well, my veterinarian…” and I say, “Well, no, no. What did you see at home when you first noticed something that was wrong?” And, “What changed your thought as to why you thought your dog needed to see a veterinarian?” And then they’ll say, “Well, he was limping.” “Okay. Well, how long ago was he limping?” “Well, a few months ago.” And then I say, “Okay. Well, has he just been limping the same way the whole time? Or did you notice something before?” And then they start thinking and they’re like, “Well, there was a few months ago where maybe he seemed like he slept wrong on his leg for a few days and then it went away. We didn’t think anything of it.” So that’s a huge important thing, especially when it comes to cruciate ligament disease.
Or I’ll say, “Well, are there certain times of the day where you notice the issue more?” I don’t want to say, “Are they stiff when they get up in the morning?” I just want to say, “Are there certain times of the day where you see it? Or are there certain activities that you notice the issue more more than others?” And if they’ve been on any sort of medications, say, “Well, did it help?” And they’re like, “Well, no. He’s still limping.” I’m like, “Well, did you notice any change at all for the better or just zero change?” And they’re like, “Well, maybe it helped a little bit,” because I think some of those things are very, very important.
And many a times they’ll say, “Well, I’ve got a video. Do you want to see it?” And I’m always like, “Yes. Absolutely.” And more times than not, it’s probably not even really focused on the dog and helpful, but I do think it’s important because sometimes you can see some things that the owner’s trying to describe, and I’m sitting there thinking, “What are they talking about?” They’ll say, “Well, he’s dragging his nails.” And we all think, “Oh, it’s got to be neurologic.” And I’m looking, and they’ll say, “We’ve got video.” And I’m watching the video, and it’s like, “Well, the dog doesn’t have a neurologic gait. The dog’s just too painful, so it can’t actually flex the knee or the hip enough to clear the paw and the nails are catching. And so it’s not neurologic. It’s actually orthopedic.”
So many a times, my technician will come in and she’ll be like, “Well, the owner says he’s dragging his feet.” And I’m like, “Oh. Well, this might not be orthopedic.” And so we have to be careful about the terms that we perceive in our brain that we hear without actually seeing. So I think the history is critical and then videos if they have them, and then before you even touch the animal, you have to watch them move.

Dr. Andy Roark:
Okay. Hold on. So I’m going to unpack this a little bit. Okay. Because like I said, I’ve just had a pile of these recently and, pat myself on the back, I have done a good job of saying, “Hey. Why don’t you get a video of it before you come in?” And that has been really helpful. However, David, I get it and they bring the video in and oftentimes, they’re holding the leash and they’re filming from behind or, as you said, there’s a variation in quality of the video and things like that.
Are there certain types of videos, are there shots that you’re looking for? Can I give them a little bit more coaching to get a better video? Because a lot of times, they love the idea of filming it, you know what I mean, and bring it with us so we can see what it looks like. And especially if I say, “Oh, often they’ll hide it when they come into the vet, so I really want you to get this video,” they feel like they’re hands-on, they’re part of what we’re doing, they’re on the diagnostic team. Do you give them any sort of guidance in how to get a good orthopedic video that’s going to help us look at lameness?

Dr. David Dycus:
Yeah. We try to. And for me, it’s actually, if I get the opportunity to tell them to get video before they come in, then my wishlist of videos would be someone else is walking the dog and someone is filming, so it’s not the same person walking and filming. The first thing I would like to see is the dog lying down and getting up to a walk and see what happens. That’s video one. Video two would be the dog just standing before walking. And then the next set of videos would be one video of the dog walking away from the camera, a video of the dog walking towards the camera and a video on both the left and the right side of the dog walking. And ultimately, if I can get even more videos, I would want those same series, but with the dog trotting, so the trotting towards me or the camera, trotting away from the camera, trotting a view on the left side and a view on the right side.
That would be my ultimate wishlist if I could have those videos because I think that would certainly help pinpoint a number of things. You’re able to see how does the dog look when it rises and then starts walking, how does the dog look when it’s standing. Some dogs will offload a limb at a stance, but then the minute they start walking, they’re engaging and using it, and that tells me things versus if the dog is offloading and then takes off walking and is limping. And then for some animals when they have a more mild issue, it’s easier to detect at the trot than it is the walk, because it’s a lot harder for them to hide things at the trot than it is the walk.

Dr. Andy Roark:
Hey, guys. I just want to jump in real quick and let you know about some great continuing education I have coming your way. Guys, I’ve partnered with Nationwide to put together a series of webinars that are 100% free to you. They have [inaudible 00:11:18]. They are good to go. And they are going to be, first of all, just genuinely entertaining and fascinating. The first thing I got coming for you is on October the 31st, that is on Halloween, with me. I am doing a webinar that is on a topic that I love and I care about. It’s keeping care accessible in veterinary hospitals, strategies for affordability and sustainability. This is me talking about exam room communication. It’s talking to people about money. It’s working with clients who have financial limitations. You get to hear me do my thing. I’m super excited about it. It’s at 3:00 PM Eastern, noon Pacific on October the 31st. Registration is open. I’ll put links to all of these down in the show notes.
The second one is coming up on November the 14th with my good friend, Dr. Emily Tincher. She’s been on the podcast a number of times. I love having her here. She’s such a fun, interesting person who’s a deep thinker. And so anyway, she is doing a webinar called Clinical Empathy: The Exam Room Skill that Can Transform Your Team. I’ve had Emily on the podcast before talking about clinical empathy. This is a really good skill building webinar. This is great for your support staff, as well as your doctors, but your team leads especially, but your technicians, your assistants, your CSRs, all of this, it’s such a great communication content. I think you’re going to really like it. So anyway, that is on November the 14th. It is at 3:00 PM Eastern, noon Pacific.
And then the last one in the series is on December 13th. It is with Dr. Simon Platt. It is called Head Cases: A Spectrum of Care Approach to Neurology in General Practice. So if you’re a neurology buff, if you like seizures, not like it, if you like knowing about seizures, if you like neurophysical exam, tips, tricks and hacks, things like that, this is going to be a great webinar. So again, this is on December 13th. It’s at 1:00 PM Eastern. That’s 10:00 AM Pacific Time. Gang, I would love to see you there. Links to all this stuff in the show notes. Go ahead and grab a spot. I’ll see you there. Let’s get back into this episode.
Is this the same wishlist that you have for cats? Or do you tailor your instructions? I know. It’s really hard, but that’s why. It feels to me like the videos of cats are so much more valuable, because they just… It’s so limited in what I can kind of get and use in the exam room, and so I want to do this just well. But yeah, do you tailor those? Is your wishlist still the same and you just say, “I know this could be challenging.”? How do you advise the cat owners?

Dr. David Dycus:
Yeah. So for the cat, I want the owner filming the cat just walking around, engaging its normal environment. And then if they can encourage the cat to play, so if they have a toy they can toss and the cat will go after, I want to see that. I want them to try to encourage the cat to jump up onto a surface, whether it’s a chair or a counter. And then I also want them to encourage the cat to jump off of a surface, an elevated surface, whether it’s a chair or a counter. And then even better if it’s a home that has stairs, if they can encourage the cat to either go up or down the stairs. Those things I think are very helpful, because the cat’s going to be very, very different to detect some things and especially in the hospital.
In most situations the owner has spent all morning trying to get the cat in the carrier to get to you, and then all of a sudden when they’re there in the hospital, the cat doesn’t want to come out of the carrier. And so we take them out of the carrier and I’ll put the carrier at one end of the room and I’ll put the cat at the other and I’ll watch what happens, and the cat walks with a crouched, light gait, well guess what? Every cat walks with a crouched, light gait in the hospital. So that doesn’t really help. But a limping cat’s a big deal. If you have a cat that’s you watching and that you’re like, “That cat looks like it’s limping,” that’s a big issue that needs to be dealt with. But if they can get me videos of just the cat in its normal environment, how it’s interacting, especially with stairs and jumping, that’s also going to be very helpful.

Dr. Andy Roark:
You just made my day. This is absolutely worth the cost of admission just to go through these videos with you. I freaking love this. Okay. Great. So we’ve got our videos. Let’s move into the exam room. So you said even before the examination, just try to watch the pet. And so we talked a little bit about the cat and separating from the carrier and things like that. How do you try to do this in the vet clinic? I have done everything from go just big and have people, “Let’s go outside together and we’ll go and leash it up and go,” to just trying to maneuver in the exam room or things like that. Yeah. Tell me kind of what you’re trying to accomplish before you start your exam with the patient.

Dr. David Dycus:
So I’ll start with the cat. As we said earlier, I want to watch the cat first walk and then I want to see how the cat’s going to engage in terms of jumping up and jumping down. And so what I’ll do is I’ll put the carrier on an elevated surface to see if I can encourage the cat to jump up. And then I’ll reverse rolls. I’ll put the carrier on the ground and the cat on an elevated surface to see if the cat will jump down, because jumping up or having trouble or refusing makes me start to think hind limb issues versus not wanting to jump off or hesitating. That makes me start thinking front limb issues. And for example, cats commonly suffer from elbow osteoarthritis. And so if they do jump down, they’re going to try to get their front legs unloaded as quickly as possible, so they’ll kind of slam their back legs down, so it won’t be a very nice elegant landing.
But for the dog, I really think if the dog’s coming in for limping or weakness or a mobility related issue, we really need to watch them walk in more than just the exam room, because the exam rooms usually just aren’t big enough to pick these things up. But while I’m talking to the owner, I’m going to watch what the dog’s doing. In other words, sometimes I’m staring at the dog while I’m talking to the owner and I’m looking to see if the dog’s standing, does the dog revert and start to offload a limb, or does the dog immediately go to sit down and doesn’t want to stand up, and how does their sit look or when they go to lie down, how does their lie look? And before I ever put hands on them, we’re going to watch them walk.
And so I think watching them walk towards you, watching them walk away from you, if a big enough area, watching them walk on the left and the right and then repeating the process for the trot is very important, but that means you have to have space for this. And so sometimes that can be a hallway. Sometimes it’s the outside in the parking lot. Sometimes it’s on the sidewalk. Sometimes it might be in a grassy area. I tell people, “If you’re going to remodel a hospital or if you’re going to build a hospital, architects love to design beautiful, elegant floorings, but many a times they’re not practical for our patients.” They’re slippery. And if we’ve got a neurologically or orthopedically compromised patient, there’s got to be good footing. And so if your hospital has slippery flooring, you got to move it somewhere where there’s better traction or get a bunch of yoga mats and line your hallway just for your gait evaluation so they have traction, then they’re not sliding because it makes it really challenging if the floors are slippery.

Dr. Andy Roark:
Got you. That totally makes sense. All right. So let’s start to move into our physical exam. And I’ve asked you about this before in the past, but walk through… Primary objectives in our physical examination. How do you start this out?

Dr. David Dycus:
So I think it’s dealer’s choice, and when we talk about dogs, for example, it’s dealer’s choice if you want to have them standing or lying down. I do think it creates a bit more stress in some of the animals if we try to force them in lateral recumbency for an exam. And so if I have a dog that’s relatively submissive and immediately rolls over to their back and is submitting, then I’ll just say, “Okay. Our technician will give them belly rubs and I’ll do the exam with them lying down.” But usually I want to have them standing up. And this isn’t the time where we’re going to try to perfect our wrestling skills.
The exam should be done the same way every time. For me, that means I start at the toes and I work my way up and I do the affected leg last. And so let’s say for example, it’s a right hind limb. Well, I’m going to do the left front leg first, and then I’m going to do the left hind limb, and then I’m going to do the right front leg, and then I’m going to do the right back leg. So that way if I hit an area that’s uncomfortable on the affected limb, I need to know how is this dog’s body language, because in some situations we’re not necessarily looking for pain per se. We’re sometimes looking more for tension or resistance or spasm to manipulation. And so I read a lot of body language. And so if I manipulate, say, the shoulder on the left side in a certain way, but then I manipulate the shoulder on the right side and the dog’s panting and it stops panting or kind of looks back at me or starts licking its lips, those are signs to me that the dog could be uncomfortable.
And I also rely on the feedback from my team. If my technician, say, holding the dog and she says, “Hey. This dog’s kind of pushing into me, kind of trying to get away from you,” that tells me that what I hit is likely an area of discomfort. And I’m notorious for palpating one limb that’s the affected limb last. And I don’t get a whole lot. And so I go back to the contralateral limb and I kind of dig in a little bit deeper and then I go back. And I’m notorious for going back and forth, just sometimes looking for those subtleties, especially if it just doesn’t jump out at you, “Hey. The dog’s legs dangling because it’s got a broken tibia.” Sometimes it can be tricky. And where it gets tricky is with a lot of the soft tissue injuries. That’s where it gets really challenging and where you have to hone in and look for those body language changes when you’re manipulating the animal.

Dr. Andy Roark:
Got you. All right. All that totally makes sense. Where do you see people making mistakes here, David? What sort of pitfalls do I have to look out for?

Dr. David Dycus:
I think people try to rush things. I think they try to quickly run joints through range of motion and then say, “Well, I could do it, didn’t bother the dog.” I also think sometimes our manipulations aren’t as calculated as they should be. Many a times we go just to grab the dog and then the dog tenses up. And I think the prime example there is if we’re checking for cranial drawer. What I see notoriously in notes coming in probably in the last five years is, “Well, full orthopedic exam not completed because the animal was too tense without sedation.” But unless the dog’s actively really trying to eat you, you can usually get instability if your motions are a bit more calculated. We don’t go home after work to pet our animals and we grab them in the position where we’re going to check cranial drawer. I mean, it’s super awkward position for a dog. And so if you go in with a really tight, quick grip, the dog’s going to tense down. And once they tense down, then it’s a fight of will and the dog’s going to win every time.
And so I think if you go very light touches. So for me, what I like to do is just even before I start manipulating them, I’ll run my hands down their back kind of lightly, so they’re getting that very light touch. And then I’ll run my hands down the front legs and run my hands down the back leg, just very light touch so the dog knows I’m there. And then I’ll sometimes kind of rub the medial and lateral side of the leg just very lightly before I even pick up the toe. And then if they start kind of pulling or fighting with me, I’ll let the leg go down for a minute, so I’ll give them a break, and then will re-pick up the process.
So I think if we’re focusing strictly on the orthopedic exam for an orthopedic ailment, it makes sense to slow the exam down. Now if you’re doing a quick orthopedic check, say, on a wellness exam with no complaints, you can get through it pretty quickly. I mean, probably three minutes, you can cover the entire orthopedic exam. But I do think you need to slow down. I think you need to make very calculated movements. We need to avoid quick grips. And then for example, what I find for… Again, going back to the knee, what a lot of people tend to do is when they try to check cranial drawer, they like to kind of pick the leg up, which means the hips flexed a little bit, and they try to check cranial drawer, which I find is very challenging. So actually what I’ll do is I’ll pick the leg up, I’ll extend the hip back a little bit. And that’ll release some of the tension that makes checking both cranial drawer and, for me, tibial thrust much easier.
And then when we talk about hip extension, a lot of people like to try to go to hip extension and then it’s tight and they’re like, “Oh, well, they’re resisting hip extension.” Well, if I walked up behind you and I shoved you down to touch your toes and you couldn’t bend your knees, you’re going to be like, “Ow,” and you’re going to be like, “Well, you’re tight.” Well, we kind of have to work into that. So when I go to hip extension, I’m going very slowly and I can feel that tightness and then I’m just going to push through it as we’re stretching. I’m basically doing a controlled stretch. And I find that many a times dogs when they come in, they’ve got hip pain, well, they don’t really have hip pain. It’s just they were tight and somebody tried to check their hip extension really quickly rather than kind of stretching it out.
And don’t get tunnel vision. For example, if the dog is tight with hip extension, it might not be the hip, because a dog with groin pain or a dog with tarsal pain or a dog with lower back pain or a dog with stifle pain, they’ll sometimes offload the limb and then they’re going to be compensating, which means that their hip’s going to be a bit more flexed, so they can centerline the limb a little bit, which means over time their hip’s going to get tight. And so it’s equivalent if I told you to bend over and walk bent over for weeks at a time and then stand up straight, you’re going to be really tight. So it’s the same thing. So we have to think about, “Okay. If I’m getting pain at the hock, but they’re tight on hip extension and ruling out what’s the primary issue versus the secondary issue, and the news flash is many a times in a skeletally mature dog with an acute lameness, it doesn’t matter really how bad the hips look. It’s usually not the hips that are causing the issue.

Dr. Andy Roark:
No. This is fantastic. I really, really appreciate it. David, where can people… Do you have any favorite resources that you like to refer people to?

Dr. David Dycus:
Yeah. So I’m going to give myself a shameless plug first, and then I’m going to provide other resources.

Dr. Andy Roark:
Do it.

Dr. David Dycus:
So first off would be my own website. It’s drdavid dycus.com, and my Instagram is ortho_vet and my Facebook is Dr. David Dycus. Now, resources for clients are a big deal for me, and we see many patients with osteoarthritis. And so there are two resources I’ll send clients to to learn more about how we manage osteoarthritis over the long term. One is called CAM. That’s Canine Arthritis Management. It’s a group based out of the UK. And the other is CARE, Canine Arthritis Resources and Education. And that’s based in the US. If you just Google Canine Arthritis Management or Canine Arthritis Resources and Education, you’ll probably be able to find both of those websites very easily. And that’s sort of my go-to for sending clients for OA management, so that way they can learn, “Here’s what things are going to be looking like for the rest of the dog’s life,” in a very client friendly language so they know what we’re going to be doing.

Dr. Andy Roark:
That’s fantastic. I’ll put links to all that stuff. I’ll link to David’s stuff and I’ll link to his socials and then also to the other resources as well. So I’ll put all this stuff in the show notes for you guys. David, thank you so much for being here. I always appreciate your time and insight. Gang, thanks for tuning in and listening. Take care of yourselves.

Dr. David Dycus:
Thank you. Was a pleasure.

Dr. Andy Roark:
And that’s it. Guys, that’s the episode. That’s what I got for you. Thanks to Dr. David Dycus for being here. Thanks to you guys for listening. If you found this podcast helpful, leave me an honest review wherever you get your podcast. It’s how people find the show. It means the world to me. I really do appreciate it. Anyway, guys, take care of yourselves. I’ll talk to you later on. Bye.

Sometimes It’s Worth The Risk

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A few months ago, I got a text from one of my neighbors. Her husband was traveling and their senior dog had collapsed and wouldn’t eat or move around. I was home when it happened and decided to walk down the street to see what was going on.

When I got to her house, you can imagine what I found. Copper, their beloved 10-ish year old hound mix, was laying sternal on the floor, panting. His gums were pale and his heart rate was elevated. His abdomen felt markedly distended.

I told Copper’s owner that I was worried about a splenic tumor (or some other internal bleeding issue) and that he should get some imaging done ASAP. She took Copper into the vet clinic.

The next day, I got another call. It was as I’d feared: Copper had a splenic tumor and secondary bleeding. His owners were asking for advice about whether or not to take Copper to surgery.

Like most veterinarians, I’ve gotten this question many times in my career, and my answer is always highly context-dependent. I generally talk to pet owners about the chances of the tumor being malignant and having already spread being around 70% versus a 30% chance of it being benign. I tell them what to expect from surgical recovery and talk about the price of the procedure. I also talk about life expectancy in the best case scenario and also in the worst. After all of that, I end with some version of the statement “I don’t think there’s a right or wrong answer.”

I hate to say it, but I think I’ve gotten accustomed to people either looking at all of these factors in a senior pet and then deciding not to go to surgery, or deciding that they will go to surgery and then finding out that the mass their pooch developed was malignant and has spread. I am supportive of either decision, but I think I’ve subconsciously come to expect that this will end badly.

I was fully prepared to be supportive of my neighbors’ decision to pass on surgery when they decided they were “going for it.” I don’t know why this caught me off guard. My neighbors are great pet owners and lovely people. Their young kids love Copper, and he has been a faithful companion for years. “Okay,” I said. “Let’s do it.”

Last night I visited my neighbors’ house for a cookout. The husband had recently… (I kid you not)… jumped out of his car while traveling, stopped a car jacking, wrestled the criminal to the ground, and handed him over to the police. He was being honored with a service award and our neighborhood was coming to congratulate him.

Right there in the middle of the cookout was Copper. He was bright, active and energetic. He asked me very politely for a tortilla chip and I absolutely did not give him one (regardless of what witnesses at the event might say). Copper played with the kids, demanded to be petted by anyone sitting down with a free hand, and made lots of friends. He was right back to his energetic old self. It was wonderful.

I have been reflecting on my reaction to Copper since I was there. Over the years, I think I kind of gave up on dogs with splenic masses coming back and having wonderful times after their diagnoses. I had convinced myself that, even though the statistics said these dogs could have benign lesions, most of the cases would turn out poorly, and I did that so I wouldn’t be so sad when people decided not to go to surgery or when the surgeries didn’t go well.

Copper is a reminder to me that sometimes things work out. Sometimes you go to surgery on a senior patient, everything goes splendidly and you get more time with a wonderful four-legged soul. He is a symbol for me that it’s worth hoping and it’s worth trying. 

From now on, when I talk about the decision to go to surgery on a senior patient, I’ll still paint an honest picture of the situation, but I will have to mention Copper and how well he recovered. I’ll have to give that head nod to hope and optimism. I’ll have to remember that sometimes trying is worth the risk.

A Profession in Crisis? Far From It.

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Dr. Eleanor Green, Founding Dean at Lyon College School of Veterinary Medicine, joins the podcast to discuss her recent article on the narrative that veterinary medicine is a profession in crisis.

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

LINKS

Article: A profession in Crisis? Far From it

Dr. Eleanor Green on LinkedIn

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. Eleanor Green holds the Carl B. King deanship of Texas A&M University College of Veterinary Medicine & Biomedical Sciences. She is a Diplomate of ACVIM and ABVP. She received a BS in Animal Science from the University of Florida and a DVM from Auburn University.

She established a veterinary practice in Mississippi as partner/owner. She became a founding faculty member of the College of Veterinary Medicine at Mississippi State University. Her academic appointments have included: equine faculty member at University of Missouri; head of Department of Large Animal Clinical Sciences and director of large animal hospital at the University of Tennessee; chair of Department of Large Animal Clinical Sciences and Chief of Staff of large animal hospital at the University of Florida. She served as president of three national organizations: American Association of Equine Practitioners, American Board of Veterinary Practitioners, American Association of Veterinary Clinicians.

Her awards include: 2004 Award of Distinction from UF College of Agriculture and Life Sciences, 2011 Wilford S. Bailey Distinguished Alumni Award from Auburn, 2012 Women‘s Progress Award for Administration and 2015 Distinguished Achievement Award for Administration at Texas A&M, and induction into the National Cowgirl Hall of Fame in 2013.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark, as I am here with the one and only Dr. Eleanor Green. Eleanor is someone that I have admired my entire career just because she has done so many things and we get into that right at the very beginning and start to lay down what her bio is. Guys, I am a perpetual optimist. I am. I love vet medicine. I am big on the future of vet medicine. I know it’s hard, and you guys have all heard me talk about the challenges of vet medicine. I still love it and I still think it’s great, and I still think it’s sad that oftentimes I feel like we focus on the downsides and not enough on the upsides of what makes it really good. And if you feel that way, this is a great conversation.
So at first we kind of start off talking at a high level, but then Eleanor just starts to kind of unpack her ideas and we get kind of down the rabbit hole a little bit. And she’s so inspiring. We were talking after the podcast was over, and I wish this was on the podcast. So when she was the dean at Texas A&M’s College of Vet Medicine, she asked her incoming students or her students, it was like a sample of 500 vet students. She said, “Raise your hand if you were discouraged from becoming a veterinarian.” And 495 of the 500 students raised their hands. And she asked, “Who discouraged you?” And they said, “Other veterinarians.” And I get it. Again, this should not be a path that you undertake lightly, but in another way, as someone who just loves our profession and what we do, I go, man, I want to spread the positivity. I want to spread the light. I want to change the story a little bit and be more honest about the balance of good and bad, and how darn rewarding this profession can be. So anyway, that’s what we get into in this conversation, guys. I hope you will enjoy it. Let’s get into this episode.

Kelsey Beth Carpenter:
(singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:
Welcome to the podcast Dr. Eleanor Green. Thank you for being here.

Dr. Eleanor Green:
Yeah, thank you for having me. This will be fun today.

Dr. Andy Roark:
Oh man, what a treat for me. I have always admired you. You are on the faculty at the University of Florida when I was a vet student there. I have seen your career from afar. You’re a veterinarian, you have been in private practice, you’ve been in academia. You were the dean at Texas A&M’s College of Veterinarian Medicine. You’ve had a consulting career. You are now the founding dean at Lyon College School of Veterinary Medicine, and I got the opportunity to talk with you. What I want to talk to you about was you’re also writing articles, and I saw one of your pieces that just spoke to me immediately and it was titled A Profession in Crisis, I think Not. And I, as a fan of optimism and positivity and a lover of vet medicine, I wanted to talk to you kind of about where your head was in that regard and what inspired you to write the article.

Dr. Eleanor Green:
Well, thank you, Andy. Again, it must be mutual admiration, because I’m so pleased with everything that you’re doing in the profession. It’s always great to see a good University of Florida graduate get out there and affect the practice of veterinary medicine and the whole profession just like you are. So the article, we have all looked around and seen headlines, and these headlines are dominated by descriptions of challenges. In fact, veterinary medicine has been called a profession in crisis. And I am not saying that we shouldn’t look at our challenges, try to make our profession better and tackle each one individually and appropriately. But I think there’s so much sensationalism about the negativity of this profession that I think it’s having an adverse effect on the profession. And that worries me, because I think this is one of the most fulfilling professions that’s out there.
It’s still highly ranked. Veterinarians are looked at more favorably than medical doctors and they’re seen to be more compassionate and understanding and approachable and so many of the things, and they’re seen as contributing to society. And so I think that we really need to take a hard look at that as veterinarians because I think we’re hurting the profession by being so focused in sensationalizing the negativity.

Dr. Andy Roark:
Yeah, one of my favorite pieces of advice that I’ve gotten in my life is your life is what you focus on. And so if you walk around looking at the negativity and you just focus on it, that’s what your life is going to be. And again, you can say that without discounting real problems and real struggles that people have, but I think that that’s really important. When you think about education, so you come out of being the dean at Texas A&M, you’re the founding dean at a new school. Talk to me about with the mindset that you hope to instill in vet students, what does that look like and how do you go about trying to set a mentality that says, “Yes, this is challenging, you’re about to do a hard job, but it’s a great job.” How do you put that together?

Dr. Eleanor Green:
Well, I think we certainly need to get to vet students early on, and maybe day one, and I don’t know if you remember this, but at University of Florida, the first day of the freshman year at the University of Florida College of Veterinary Medicine, we had a session that was co-sponsored with the Florida Veterinary Medical Association that brought in some veterinarians from different walks of professional life. And we certainly handpicked them to be the ones who are the very enthusiastic lovers of this profession. And we had them talk to the students. And so there was a purpose of that, and one is welcoming them to a wonderful profession, showing them and showcasing some veterinarians who have had unbelievable careers and throughout their profession, they’re still enormously fulfilled in all walks of life. And the other thing was to open their eyes to the many opportunities in veterinary medicine are out there, because so many of us think of veterinary medicine as just taking care of pets.
And that’s enormously important. I don’t want to minimize that at all, but veterinarians can do almost anything. And so I think that we need to make sure that students know that. I think the other thing that we need to let them know is that the education can be taxing because of so much volume, and that we’re here to help them. We’ve got support for them, we’ve got peer support, we’ve got counselors, we’ve got all kinds of ways that if they’re having any struggles, we are there for them. And there are actually a lot of programs that are going on now beyond veterinary school that can provide a lot of support for veterinarians who are struggling.

Dr. Andy Roark:
What do you see as the main pitfalls as trying to drag our mentality out of the profession and crisis and start to look at things as, I don’t know, to look at things in a more balanced way? What sort of holds people back?

Dr. Eleanor Green:
Well, let me just tell you what veterinarians have been telling me. I polled a bunch of veterinarians and have been doing this for quite some time. This is not official. I haven’t sent out a form. I’ve just talked to people and I’ve asked them several questions. I’ve said, what do you like most about this profession? What do you like the least? And if you could change one thing, what would it be? And I also asked them if they would encourage or discourage others from becoming veterinarians. And there were common themes across the first three questions. One is they were committed to the human-animal bond and they were very fulfilled by being part of a happiness that animals bring to people. They love that. They love taking care of animals and taking care of their clients as well. We talk about some people have criticized the profession that all they care about is animals, but their people with every animal.
That’s not what I found. They love taking care of the clients and their needs also. And really what they love is the experiencing the happy outcomes. They love it when things go well. They also enjoyed variety in the practice. Never a dull moment. It’s just not going and doing the same thing every day. And here’s another one that really keeps you stimulated, they love the intrigue of the mystery of unraveling the cases. Isn’t that neat? And they also, this is going to be surprising for some who are critical of perhaps the new graduates, but the veterinarians of all ages appreciated the work ethic within the profession.

Dr. Andy Roark:
Yeah, I think that that’s true. That resonates with me.

Dr. Eleanor Green:
Yeah, it does with me too. And then here’s one that I really, really love. A striking component was that the empathy was plentiful within the veterinary medicine, in a world where many have lost empathy. I think we ought to say that one again. Empathy is plentiful in our profession in a world where many have lost empathy. Now if that’s not a reason to join this profession, I don’t know what is.

Dr. Andy Roark:
Yeah, I love it. One of the big pieces of advice that I offer to vet students these days, and it’s sort of come to me in just in the last year or two, is I think you have to enjoy the mundane. And what I mean is it’s just going into the room and doing the wellness appointment and you got to enjoy that path and you have to enjoy that person and just genuinely take pleasure in helping them and sort of being there and being present. But I really do think if you focus down on those things, it’s a really good job. It’s a hard job. I am not one of the people who enjoys the mystery. I one who I enjoy fixing the problem. I will tell you just for me, the ability to put hands on a pet and fix the problem to make this animal comfortable, send this person away with one less problem than they had when they came in. That’s it for me. I guess probably I was just never the sharpest clinicians, but I was always, I very much prefer to know what the answer is and be able to do it as opposed to trying to figure it out. But that’s [inaudible 00:10:10].

Dr. Eleanor Green:
You sound like a surgeon.

Dr. Andy Roark:
I do.

Dr. Eleanor Green:
[inaudible 00:10:13] move on.

Dr. Andy Roark:
I had this thought. It’s funny, I was telling someone recently, there’s two kinds of doctors, the doctor that looks at the vomiting cat and says, “Boy, I need to know why that cat’s vomiting.” And there’s the other kind that looks at the vomiting cat and says, “I need to know how to make that cat stop vomiting.” And I’m definitely the latter of the two, which is how do I make it stop vomiting?

Dr. Eleanor Green:
Yeah. Interestingly, I started out in surgery. Everybody in my family’s a human surgeon and I thought that’s what I wanted to do. And I did. I love surgery, and this is a number of years ago, I was very frustrated by not knowing what was going on in the whole animal. I ended up in internal medicine and music play because I’m one of those ones that loves the mystery and loves the unraveling and loves the critical care and the adjusting this and that happens, but it’s a different mentality. But back to why veterinary medicine’s so intriguing and appealing is that there’s something for everyone regardless of your way of thinking.

Dr. Andy Roark:
Yeah. I love one of the questions you asked, you said, “If you could change one thing in medicine, what would it be?” Let me ask you that question, Eleanor, if you could change one thing in that medicine, what would you change?

Dr. Eleanor Green:
If I could change one thing about this profession or the veterinarians within it, I would never want to give up the traditionalism and the dedication, but I would want to add a lot more interest in the future and receptivity to the innovations in a changing world that’s actually changing at an exponential rate. And somehow we seem reluctant not only organizationally, but sometimes individually to be receptive to the new things that are possible in our profession. That’s the one thing I would love to change.

Dr. Andy Roark:
That’s a great answer.
Hey guys, I have some huge news for my technicians out there, guys. I am speaking at the NAVC Vet Nurse+Tech HiVE event in Austin, Texas. This is October 16th through the 18th. It is live in person in Austin, Texas. It is 25 bucks to register, but I got you hooked up. There’s a promo code, it’s just Andy, promo code, Andy, and you get in for $15, $15 registration for the event. I’m going to be there. I have my friend Meg Pearson who’s an improv comedian, an actress. You will recognize her from some of my funny videos. She is hilarious. She’s going to be role-playing with me. I’ve got four sessions. We are going to do what to say and how to say it when talking to difficult clients, when talking up to management, when talking to doctors and when talking to colleagues.
And so all of those challenging conversations, we are going to be not just talking through how to do it, but I’m going to try to do it for you and show you what it looks like. And I promise we are going to laugh and have a lot of fun, but it’s going to be a great time. I’d love to see you there. Remember promo code, Andy, get 10 bucks off. Come out and see me. Also, if you are a technician, team lead. If you’re any type of team lead, come and see me at the Uncharted Team Lead Summit. This is a one-day virtual summit. It’s only for team leads. Guys, we put team leads up there and we want them to lead and motivate and manage and take care of problems and take care of patients. And also we hold them accountable to management, but then also they’re accountable to the people that they’re leading.
And we don’t give them any leadership training or support. Guys, it’s time for that to be over. Unchartered is dedicated to making team leads successful. It’s a new world, it’s a team game. We need to be investing into our leads and that’s what we want to do. So if you are a team lead, come and check out our virtual summit. It’s November the 8th. I’ll put a link in the show notes over to Uncharted. One day virtual, check it out, work with other team leads. I promise you’re going to get a ton out of it. Let’s get back into this episode.
I’ve heard you speak passionately about Lyons and what you sort of envisioned there and how it’s ideally going to be a different sort of education model and things like that. Can you talk a little bit as you talk about innovation and openness to change and things, can you tell me a little bit about how you envision education and vet school and kind where it’s going?

Dr. Eleanor Green:
Yeah, I will. I want to talk about Lyon, but even before I do that, I want to throw out one thing. Adaptability. When we were on the Veterinary Futures Commission, we were looking at core competencies and what should they be for the future. And the one new core competency we added was adaptability. And that’s something else I’ve gotten intrigued with. I actually lecture on this, but there’s a thing called adaptability quotient, which actually has been shown now to Trump EQ and IQ. And it is the success of businesses, it’s the success of individuals of the future. And so I think one thing that we need to do at Lyon is make sure that we’re recruiting for adaptability, but in addition to that, adaptability is trainable. So we are training for adaptability, and then within practices I would say not only recruit and retain for, but also evaluate for.
And I think that’s going to change this big stumbling block for our professionals as we enter the future. Now back to Lyon. One thing that I’m pretty excited about and the reason that I’m the dean at Lyon is that they have given me pretty much a blank slate within reason to create a veterinary education model of the future. What’s that going to look like? I’m going to get a lot of people together to add to some opinions that I have because I’m always very open to the opinions of others. So we haven’t shaped it finally. But in essence, what I want to do conceptually is I want to create a community of collaborators, not a community of competitors. I want to make learning fun and create lifelong learners who are curious and who love the process rather than who are struggling and taken down by memorizing a thousand things for anatomy. Medical information doubles every 73 days with a half life of 18 to 24 months. We are not going to have them memorize everything they need to know. We can’t. So what we need to do is we need to expose them, teach them how to access information and how to use it and how interpret it and how to apply it. That’s the future. And then the other piece of that, and pardon me for going on, I could do this for three [inaudible 00:16:31].

Dr. Andy Roark:
No, I love it.

Dr. Eleanor Green:
Is that I’ve seen some struggles in higher education about what do we do about AI and ChatGPT, because there’s certainly some detrimental parts and potential for cheating. And there are some that were trying to fence students away from that. I want to block down all those fences and I want us to teach students how to use AI and how to use ChatGPT and how to use it ethically and what are some of the pitfalls. That’s their life. We can’t keep it from them. We have to teach them how to use it. So things like that. There’s more, I mean, simulation, I think we’ve got to minimize the use of live animals in teaching until they get to patients. So I think they need to get really good. We’ve got wonderful simulations today, and so I’d love to have an experiential and simulation-based learning center in a collaborative way. I think we need to share, I don’t think we need to recreate all the wheels we need to share with other schools, and not just schools, but industry. And there are a lot of people out there doing wonderful things that we ought to bring in to our educational process. So like I said, I could go on and on. I’ll stop there and I can crank back up anytime you want.

Dr. Andy Roark:
No, I love it. I love where your head’s at. I love the collaborative approach. All of this just resonates with me so much, as far as ChatGPT and artificial intelligence. We’re not putting the genie back in the bottle. The best thing we can do is train practitioners to utilize the tools that they have. And as you said, in an ethical and helpful way, I love where your head’s at. I want to ask you to back up for a second a little bit. I’m going to go back to adaptability, because I think that’s really interesting about adaptability quotient, and kind of how this is such an important strength. Can you give me an example of what adaptability looks like in the clinic? Help me understand what that looks like in a doctor or in a technician that I see on the floor.

Dr. Eleanor Green:
Well, adaptability or curious, they use the challenge of change as opportunity and they use that for excitement to move forward and do something good. They’re risk-takers. They want to try the new things. They don’t say no. They say, “Let me think about it.” So they consider new things, or they say yes to new things, and say, “Yes, let’s try it.” And then if it doesn’t work, that’s great. All you’ve done is made yourself better by finding something that didn’t work. And I think they’re team players, they tend to collaborate more with others. They’re inspirational for others. So that’s what an adaptable person looks like, and that’s what an adaptable business looks like as well.

Dr. Andy Roark:
No, that absolutely makes sense. So when you kind of look into your crystal ball and you sort of see the profession and where it’s going, what are you most excited about outside of the vet schools? Are there things, when you look five years into the future, how do you see our profession functioning differently than it does today?

Dr. Eleanor Green:
Well, this is another dream. I don’t know if this is a dream I’ll fulfill. Maybe I will. I hope I will. I would love to create a hospital the future, as a functioning hospital, but also a demonstration hospital, because there are so many great things available to us today that in your end, busy life and you’re trying to look at the bottom line and what’s the return on investment and how can any patients that I see, it’s hard to raise your head up and look at what’s possible and what could be implemented new. Telemedicine’s one great example of that, that’s just one tiny example. A digital health is another. How do we integrate and provide connected care? But wouldn’t it be fun to create one hospital that has the technologies that are available to us today to provide connected care, integrated care, and again, I’d love to do that where you get veterinarians who are operating in that sphere, but we also have companies and other people with new things, who can bring those new things to this hospital and sort of demonstrate what they have out there.
And that is going to accelerate growth of some of our startup companies, or quite frankly, struggling with adoption. They’ve got a great product and it’s just hard to get people to adopt it. And yet we don’t have time in practice to try everything that comes along. And so if we can find a place where we can be the ones who are trying some of these things and then saying, “You’re going to love this.” We’ll work on this one a little more, but wouldn’t that be fun? And wouldn’t that be a great facility to have in association with a vet school?

Dr. Andy Roark:
Yeah. Oh, I love this vision, like I said, I’m sort of a Chinese junkie. And so all of this gets me super excited. Do you think we’re coming to a place of a bit of reset? So what I mean when I say that is there’s a traditional vet practice, which is what pops into your mind when you think of a vet practice. And I think that people have done a good job, really. They’ve tried to upgrade different pieces, but it’s almost kind of patchwork. We had the traditional model and we’ve kind of slapped a patch on it. At some point in my career, I’ve looked at different projects. I’ve run our programs or businesses, and I keep upgrading. And at some point I finally stop and just reset. I go, look, this is all built on an old operating system. I’m going to shut it all down for a moment and then start absolutely brand new, fresh. Do you see something like that coming in our profession as technology continues to advance?

Dr. Eleanor Green:
I do. And I think it is going to be technology driven. And just one tiny example, and this is an asset, not a criticism in any way, but PIM systems. Early on, they were very competitive and they still are somewhat, and they wanted to fence in again their system. But they’ve got, I think the PIM system that will win the future is the one that’s integratable and interoperative, and that’s in the end, that’s going to win. And right now, the ones that are winning or have been winning is the ones that feel like they hoard, you have to use me. And that’s not the last. So that’s going to be a big change, I think.

Dr. Andy Roark:
Well, I think you’re right too. And I also think as there’s these other companies that come up with new technologies that are really good and that people want to use, I think that the PIM system that wins is the one that allows that kind of integration and lets you pull these new things in and use them. Because you can see in practices where they say, “Well, I’ve got this classic system and it doesn’t use the interesting thing that my friends are using in their practice. And we’re not able to do that.” And I think you’re probably spot on. It goes back to your point about adaptability, doesn’t it?

Dr. Eleanor Green:
It really does. And there are some examples of that already with cloud, those that didn’t have the cloud, now they do have the cloud. There’s a lot of migration towards the cloud. Just one tiny example of that. People are going to go where it’s better. And I want to tell you one example, and this was a number of years ago, the principle applies, but this is a time ago. I know there were some concerns about we couldn’t get anybody to buy my practice. So this is again, a number of years ago, and I was at this meeting and it was the AVMA and the AAVMC, and they had student reps there. And this was a very loudly expressed concern. Nobody will buy my practice, et cetera.
So I went and sat with the students and I said, “Say, tell me about that.” And they said, “Oh, yeah. Well, here’s the thing. We don’t mind buying a practice, but it’s antiquated. The equipment’s outdated. It just doesn’t even have digital records. It’s still all paper, medical record system. What is there to buy?” I know that’s outdated. Most people don’t do that anymore, but when are the ones today going to be outdated and not going to be sold because they’re so much more, and I think we need to be mindful of that.

Dr. Andy Roark:
Yeah. No, I think that’s a great point. I love where your head’s at. I love your positivity about the future. I love your optimism about technology. It’s so refreshing, and you and I are so in alignment in that regard. Dr. Green, where can people find you online? Where can they learn more? I love that you’re writing. But yeah, where can people who want to see more about your adventures kind of find you?

Dr. Eleanor Green:
Well, I’m on LinkedIn, so you can find me there. And I’d love to link up. I link up with several every day. My email address is dreleanorgreen@gmail.com. That’s all lowercase, no dots. And it’s D-R-E-L-E-A-N-O-R-G-R-E-E-N@gmail.com.

Dr. Andy Roark:
Perfect.

Dr. Eleanor Green:
Yeah, that’s the main two. I’m on Facebook, but I would say go to LinkedIn rather than Facebook.

Dr. Andy Roark:
It’s amazing how often guests are on LinkedIn and not the other social media, so it definitely seems to be a common place where we can find people today. Anyway, thank you so much for being here. Gang, thanks a lot for tuning in. I hope you enjoyed it. Take care of yourselves, everybody.
And that’s what I got for you. That’s it. I hope you guys enjoyed it. Thanks to Dr. Eleanor Green for being here. I can’t wait to see how her new deanship goes and the start of her new vet school. I am absolutely rooting for her and the vision that she sort of has for education in the future. Anyway, guys, thanks for being here. If you enjoyed the podcast, leave us an honest review wherever you get your podcast. It means the world to me. It’s how people find us, and I hope to talk to you again in the future. Take care of yourselves, everybody. I will talk to you soon. Bye.

NOMV: From Facebook Group to Industry Power

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Dr. Shannon Emmons, practice owner and member of the NOMV board of directors, joins Dr. Andy Roark to discuss the rapid growth of Not One More Vet (NOMV) and the mental health and wellness programs they have been developing.

This episode is brought to you ad-free by CEVA Animal Health!

LINKS

NOMV.org

Race Around the World

NOMV Lifeboat

NOMV Anti Cyber-Harassment

NOMV CLEAR Blueprint

NOMV Advocates Program

NOMV Gala

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

Shannon Emmons DVM is a graduate of Atlantic Veterinary Class of 2017. She is a small animal veterinarian practicing in southern Maine and the owner of Eliot Veterinary Hospital.

Shannon first got involved with NOMV after her own mental health struggles and worked to start the NOMV Ambassadors Committee. She is the Education Committee Co-Chair and a member of NOMV Seacoast. Shannon joined the NOMV Board of Directors in 2023.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinarinary podcast. I am your host, Dr. Andy Roark. Guys, I got a good one today. I am here with Dr. Shannon Emon. Shannon is a, she is a practice owner and a practicing veterinarian in Maine and she is a member of the board of directors for Not One More Vet or NOMV as they’re commonly known. She’s here today talking about and all of the initiatives they have rolling out and boy, they have a lot of ’em. If you are still thinking of NOMV as a Facebook group, this is going to be a big fun episode for you because they have a ton of initiatives that are coming out and we hit some of the highlights, not nearly all the stuff they have going on, but I’m really interested in what do we do about supporting mental health and wellness in the vet profession?
And they are putting their money where their mouth is, they are doing the work. They have a lot of programs coming out, is a really interesting download on all things non being what they have going on. Guys, this episode is made possible and brought to you ad free by my friends at Ceva Animal Health. They are partnering with NOMV on their Healing Broken Hearts Initiative. This is a joint wellness program they have with where they are giving 5% of Cardis sales to NOMV Card is a drug for heart failure. If you’re unfamiliar with it, I’ll put a link in the show notes to a previous episode that we’ve done on Cardis and what it is. But yeah, it’s thanks to them for one, for doing the work and supporting NOMV and thanks to them for supporting this episode and making it possible. Guys, let’s get into this.

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. Shannon Emmons. How are you?

Dr. Shannon Emmons:
I am good, Andy. How are you?

Dr. Andy Roark:
I am so good. I feel like we almost could have done this podcast in person. For those who don’t know you, you are a practice owner in Maine. What part of Maine do you live in?

Dr. Shannon Emmons:
Southern Maine. Yeah, let’s… you won’t know where I’m from.

Dr. Andy Roark:
It’s not Bar Harbor in Maine. I that’s, that’s where I was. I just got back last night. I did the family vacation. We went to Bangor and then a Bar Harbor and then up to Nova Scotia and PEI, which is where you went to vet school.

Dr. Shannon Emmons:
That’s where I went to vet school!

Dr. Andy Roark:
School. I know. And so I was just like, I was looking at your bio and I’m like, gosh, Shannon, she’s like Visa. She’s everywhere I want to be. And so anyway, it’s a joy and a pleasure to have you on the podcast. You are a practicing vet. As I said before, you’re on the board of directors at NOMV, which is Not One More Veterinarian. And I wanted to get you on today to talk a bit about NOMV, there’s not many organizations that I have seen that have grown as fast or has branched out as much as Novi has. And I don’t know that a lot of people understand what all Novi is doing right now. And so just to kind of set the scene, my first interaction with the, Not One More Vet group was a Facebook group, which was great, but it was a very big, very raucous Facebook group about mental health and wellness in veterinarians. And that’s kind of how it imprinted in my mind. And I was just kind of shocked recently at how inaccurate that is as far as the depiction of NOMV. So lemme just pause here and ask you, why don’t you give us a little bit of background about NOMV and your path to the board of directors?

Dr. Shannon Emmons:
Sounds good. So NOMV started in 2014 after the death of Dr. Sophia Yin. Nicole MacArthur, who is a vet, was really blown away that we as a profession have such a high rate of suicide. And she said, if I don’t know about this, I’m sure there are other people who don’t, and how can we get resources to everyone or just check in on everybody. So the Facebook forum started and I graduated in 2017 and it was cool to watch because as I joined the Facebook forum, I was seeing the need for, we were doing GoFundMe for fellow vets to try and raise money for their inpatient therapy or they needed help and then it got nonprofit status and it just blew up. And even since I’ve been involved, I started working with Novi in 2021. We’ve put on a couple of huge new programs in addition to a lot of already existing programs that we’ve been able to continue to grow.
So I started after my own mental health crisis, I had a friend reach out and say, Hey, I want to figure out how we can get NOMV locally. And I was like, that’s great. I could have used someone locally. And so I talked to Carrie Journey and she said, Hey, we’re already working on that. So I joined as part of what’s called the ambassadors program, and we started making local chapters. So there are NOMVa chapters popping up all over the us. We have one in Canada now and we have one in Brazil. So that was kind of my baby for a while, was getting that up and running. And it then led me to the education committee,

Dr. Andy Roark:
Which I want to jump in here. So tell me more about that. What does a local Novi chapter actually look like? So I’m a veterinarian. I’m here in South Carolina. If there was a local Novi chapter, what does that mean? Do they have meetings? Is it a meetup? Help me get my head around what practically is that?

Dr. Shannon Emmons:
So it’s whatever the community needs really. We have guidelines for what you can and can’t do in terms of you can’t talk badly about people or something like that. But we have groups that do. Texas is our definitely by far biggest chapter. Mallory Preston, who’s in charge of that, has really done a lot of webinars and Texas is a huge state, so they’re not meeting in person a lot though they have, they’re doing a lot of webinars, meetings with local people and whether that’s educational or whether that’s walking through a guided meditation, our chapter, so I helped formed NOMV New England. We are helping with the NOMV Gala, which is going to be in Boston in October. So we’re doing some CE there. We’re going to be doing an outreach event there. And we’re also helping with the five K in. And we did a veterinary appreciation event. And all of the chapters have really made their own takes with it, which is really great to see because it could be as simple as just getting people together for coffee or going for a walk, or it can be a big organization, however people want to do it, what the need is in their community. But the big thing is that there are people available locally if somebody needs help.

Dr. Andy Roark:
Yeah, I love that. I’ve always felt like when you’re trying to run something that’s a national program, getting people who are inspired on the ground and giving them the autonomy to do the things that they’re excited about or they see a need for, I think that’s wildly underrated as far as how to set up an organization. I’ve always seen it be very successful and it just for something like nabe where you obviously have people who care a lot about mental health and wellness, giving them a platform and just sort of saying, Hey, figure out what’s going to be helpful for the people in your area and make it happen. I think I love that flexibility. I think a lot of times you can come up with things that are prescribed that don’t really meet the needs of individuals. They might work in one place, but it’s not what other people are really looking for.

Dr. Shannon Emmons:
It’s been great to see people be able to do what their community needs and get the help into their communities, whatever that may be. And they’re at local conferences, meeting vets in their area, they’re doing local events, and it’s been great to just build that community from an organization that was largely virtual. And that’s like what you said, people know Novi for the forums, but they don’t realize just how much else there is to Novi and the help that’s available rather than just the Facebook groups, which are great. And we’ve expanded off of them. There’s the support staff group as well. And I think one thing I would love for everyone to know is we are not just for vets, we’re for everyone in the vet profession.

Dr. Andy Roark:
That was a big point of growth for you guys for a long time. It was just veterinarians and it was kind of a pain point. There was support staff and paraprofessionals and things. Yeah. So when did you guys start having groups for the support staff?

Dr. Shannon Emmons:
I will be honest, I’m not sure exactly the year on that, but I believe it was just a couple of years after everything got going because we really needed support staff to have help too. I mean, everyone in this profession has a hard time. We all have our different battles we have to deal with on a day-to-day basis. So making sure, and then students too, we branched out to vet students because and vet tech students, it’s not easy to go through vet school or tech school and to make sure those people have support as well was something that we decided also needed to be taken care of.

Dr. Andy Roark:
About how many chapters are there now? So switching back to the ambassadors, what are we talking about?

Dr. Shannon Emmons:
I believe there are nine now. So it’s always a little bit of a process just because we have to go through volunteer onboarding just so that we make sure people are adhering to Avi’s guidelines in terms of talking about suicide in a healthy way, making sure people are Q P R trained, which is the suicide prevention training. So anybody who gets involved with NABI has to go through that process. So we really just launched the chapters about a year ago and we’re excited that, I mean, Brazil is awesome. We’ve already got an international chapter, which is incredible and we keep having people apply too. It’s just a little bit to get them up and running. So I think that’s our big pausing point right now. But we keep getting the interest and we keep getting the people who are, like you said, really excited and really want to do things in their

Dr. Andy Roark:
Communities. How can people find out about chapters around them if people are interested in trying to get their own chapter going or getting involved with the Ambassador program? And how would you advise people to get involved?

Dr. Shannon Emmons:
So there’s, NOMV.org is going to be our best resource for all things. And there’s a list of our chapters and each chapter has a Facebook group, which is not necessarily a private Facebook group, I should say, a Facebook page where they post whatever they want to, whether it’s ways to support one another, local events that they’re doing. And then each chapter also has their own email address. So right now I’d say go to the page, see if there’s anyone local and if there’s not, that can be you. Yeah,

Dr. Andy Roark:
I love it. Cool. Talk to me about the things that you guys have started expanded out into. So I talked to Brian Bwin on the podcast not long ago about the non-clear blueprint, which I think is fascinating for workplace wellness. It’s a great program I’ve thought a lot about since I had him on to talk with him. But yeah, lay out some of the other things that you guys are doing.

Dr. Shannon Emmons:
So yeah, clear is amazing and has been really exciting in the past year since we started that. Another one that’s newer is called Lifeboat. It’s an anonymous peer-to-peer support group. So for the people who don’t like the Facebook forums or aren’t on social media, it allows them that same one-on-one support and mentorship and can get them in touch with the help that they need. And it’s completely anonymous. So that’s been a really great new program that we’ve gotten a lot of use of. And I know one of our former board members just mentioned she was at a conference I think two days ago and someone said Lifeboat saved their life because somebody was able to get the help that they needed.

Dr. Andy Roark:
So is this sort of a standalone webpage as well? I guess

Dr. Shannon Emmons:
It’s on the Novi website, but then you get iNOMVted into, we’re very careful about anonymity. We’re very careful about who gets into veterinary things. You hate to think about it, but the public can hold things against us in ways we don’t necessarily always expect. So we’re very careful about who can get in and who can be involved. But they get in, they’re assigned a person. If you want to be somebody’s mentor support, you can also enroll for lifeboat. And there’s resources in there on how to talk to people about certain subjects and what to do if this is happening. And it gives you the resources to be able to help. And we know that I’m not a mental health professional, I’m a veterinarian. So there is always that if you don’t know what to do, there’s always a way to find the help that you need, whatever that may be. And lifeboat gives a lot of opportunities for education in that regard. But again, if you need the help, you can get in there, get matched with somebody, and then start talking.

Dr. Andy Roark:
Okay. You said the public can hold things against us. Tell me a little bit more about what you mean about that, because I’m curious about the challenges that Naves faced. Obviously it’s a delicate balance when you’re trying to help veterinarians who are in practice facing mental health struggles and things, but beyond that, tell me what you meant when you said that.

Dr. Shannon Emmons:
So I’ll talk about another program while I’m talking about this, but we just recently formed the Anti Cyber Harassment Task Force in light of M V M C had the huge cyber bullying attack last year where they took an owner’s surrender in and it ended up going all over the world. It ended up being

Dr. Andy Roark:
The huge thing. Yeah, that was a nightmare.

Dr. Shannon Emmons:
So I’m local to them, and so I was really invested and rare breed, who owns M V M C said, what can we do to make sure this never happens again? Or at least if it happens again, we had the resources, how do we get people the resources? So we’ve had to be careful with that too, because we don’t want the general public who could potentially come back and use this stuff against us to have access to the resources. We’re trying to offer veterinarians, veterinary practice owners to combat cyber harassment. So there’s always and there Facebook groups that are attacking vets and there are always those groups that just have to be the negative in the world and start stuff that is so inappropriate. It’s great. You’d be blown away by the stuff that we do with sometimes.

Dr. Andy Roark:
No, I can imagine. I’ve been around the old social media internet world for a while. I can imagine. So I’m curious, so when you think about the future, do you think about health and wellness in vet medicine? How optimistic or pessimistic are you when you look at this? Do you feel good about the progress we’ve made in the last 10 years? Do you feel like we have big challenges ahead? Talk to me a little bit about, because you get up every day and you go into practice and you do your stuff and you step up and you’re set an ambassador for your region and you’re on the board of directors at NOMV. Talk to me a little bit about the headspace that you get in when you think about where things are going as far as mental health and wellness in the vet profession.

Dr. Shannon Emmons:
I think we have dueling pros and cons and it’s hard to say just kind of how things are going to go because I think we as a society are starting to value mental health more, which is amazing. People are talking about it. There’s less of a stigma. People are asking for mental health days off. People are asking for the time that they need, whatever it may be. But then we get the pushback too from business owners of like, Ugh, they’re complaining about having to work 40 hours a week or whatever it may be. So there’s that kind of push and pull. And then there’s the lack of veterinary professionals. I think the shortages that we’re all dealing with. I mean, I’ve been hiring for an associate for a year and a half, and I know clinics that have been hiring for years. And if you look in our area, everyone’s hiring for a vet, everyone’s hiring for techs.
And that I think is hard because those of us who are still here are taking on all that extra burden. And as you know with Covid, it didn’t get easier. We saw that huge increase in pet adoption rate and where did all of the vet staff go? So that’s my biggest concern. But I think that as NOMV continues to grow and we continue to make these programs that make Vet Bed more sustainable, the more we talk about it, the more we make people aware of ways that they can get the help and they don’t need to suffer through a bad job or they don’t need to worry about cyber harassment if we can take some of the load off. We’re trying our best to do that from every angle.

Dr. Andy Roark:
Yeah. What are you most excited about when you look at NBE and you look at all the things that are coming out in the next, say five years, you’re looking ahead and you go, this makes me smile, or this makes me happy, or this makes me feel really positive.

Dr. Shannon Emmons:
We’re planning a Novi conference. It’s in our five year plan to have a Novi conference, and we’re going to do a little baby conference at our gala this fall. So it’d be nice to just dip our toes in the water, but I would love for us to have a way to get people the mental health resources, like come to this conference, we’re going to make it mental health friendly. We’ll probably do half days and then take it easy the rest of the day. It’s still very early in the works. We have no concrete plans, but I am really looking forward to that and just meeting the people in our veterinary community. Every time I speak, every time I go to a conference on behalf of nafi, hearing how much we’ve done for people, it means that what we’re doing is important and it’s helping and it just definitely makes me want to keep doing what I’m doing.

Dr. Andy Roark:
Yeah, that’s fantastic. Real quick, I’m going to let you shout out any other programs you guys have coming up. Anything else that you’re working on that you feel like people should know that either has come out recently from NOMV or is in the pipelines that people should be looking for?

Dr. Shannon Emmons:
I think the big thing that’s coming up that I would like people to know about is our race around the world, which is virtual, but we also have an in-person option this year. So it’s during the month of September and we are just promoting Novi and General Public awareness, making sure people know what we are and do it with exercising, which is good for our mental health. And it’s one of our biggest fundraisers for the year too. So you can join as an individual virtually in person. You can start a team. My clinic competes with a clinic up the street every year and we’re already trash talking one another, get a little competition going, it’s all in good fun, but it’s whatever you want it to be. But I’m really excited that we have the in-person race, which is going to be at our gala in Boston on October 7th, and we have Temple Grandin coming to that. So that’s very exciting and we’d want to thank everyone who helps our organization on a day-to-day. Siva in particular is currently running Healing Broken Hearts program where they’re donating 5% of car Dallas sales, which we super appreciate and we have so many other great sponsors who help us to do our work on a day-to-day basis because without them, we would not be able to do so much of what we do.

Dr. Andy Roark:
That’s fantastic. I’m going to put links in the show notes to all the stuff we’ve talked about. I’ll mention the Clear blueprint Brian was on recently talking about it. I’ll put links to information on that as well. novi.org where you can find the Ambassador program information, all the things that we talked about, the lifeboat links, I’ll put all that stuff in the show notes so everybody has it. Are there any other links, Shannon, or resources that you think people should make sure to check out or be aware of?

Dr. Shannon Emmons:
Novi List is on the website, so basically anything I’m saying to you can get from the website, but Novi List is kind of like Angie’s List, but for veterinary professionals. So if somebody has a therapist locally that they’ve really liked or a lawyer they’ve locally really liked, it’s a great way to find local resources. I’ll send you to the link to the Race Around the world, sign up and to our gala registration.

Dr. Andy Roark:
Sounds great. I’ll put all that stuff into the show note. Dr. Shannon Emmons, thank you so much for being here, guys. Thanks for tuning in and listening. Take care of yourselves, everybody. And that’s it. That’s our episode. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. Thanks to Shannon for being here. Thanks to Novi for all the work they’re doing for our profession. Thanks to Siva Animal Health for making this episode ad free and for their Healing Broken Hearts initiative gang, take care of yourselves. Be well. I’ll talk to you soon. Bye.