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Articles, Videos, & Training on Pets & Veterinary Medicine

Andy Roark DVM MS

Optimism & The Long(er) Nosed Frenchie

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As someone who posts a ton of veterinary photos and videos online, I find brachycephalic pets to be a bit of a tricky fish. On the one hand, I often see brachycephalic (aka “smooshed-faced”) pets with absolutely wonderful personalities and are a joy to be around. These include brachycephalic dog breeds like pugs, Frenchies, and bulldogs as well as cat breeds like Persians, Himalayans, and Burmese. I love these pets as individuals, and I celebrate the joy they bring to their families.

At the same time, breeding trends that have pushed these guys to have shorter and shorter noses have also led to more and more health concerns (Here’s some very good data if you are interested). For this reason, I generally don’t post pictures of these breeds on my social media feeds. My thought here is not that I want to boycott or shame anyone. It’s simply that I don’t want to encourage people to seek out or request traits in pets that are physically detrimental to those pets’ health.

Simply put, I think breeders will always breed what consumers want to buy. I don’t think it’s contradictory to love an individual pet and want the best for him or her and also refrain from publicly celebrating a trend you don’t want to perpetuate. That’s been my position on the brachycephalics for years now.

Well, the other day I saw my first long(er) nosed Frenchie! He didn’t have medial patellar luxations, his back wasn’t painful, and he didn’t make any abnormal noises when he breathed. I told the owner “This is exceptional! I love his little snout!” She said she knew she wanted a Frenchie and found a breeder who was actively working to breed length back into the nose and focused on making the healthiest Frenchies possible.

This little dog made my day. Not just because he was wonderful to interact with, but because he reminded me that sometimes we can make changes for the better. Sometimes we can raise awareness of issues and pet owners will listen. Sometimes we can communicate productively and collaboratively with breeders to make the world a healthier place. Sometimes we can push a pendulum that has swung too far back in the other direction.

I don’t mean this post to be about what kinds of dogs people should like, where they should get them, or how they should spend their money. I mean it to be about recognizing that things can change, and negative trends can be reversed if people want them to be. I left my appointment feeling optimistic and a renewed belief that while it might sometimes feel like everything naturally slides towards getting worse, this isn’t actually true. 

Cynicism seems to be in style these days, but I don’t believe the world is bending inevitably towards darkness. Instead, I think the world is just messy. Some parts of our lives and jobs will get worse, and some parts will get better, and some parts will get worse and then better. Remembering that it’s possible for tides to turn is the first step in developing a rosier view of our futures.

A Comedian Walks into an Emergency Room

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Dr. Matt Asciutto explores the power of comedy in veterinary medicine as he applies the “yes, and” principle from his improv comedy background to enhance client and team interactions. Dr. Roark shares how humor has shaped his approach to the profession. Together, they discuss how comedy can bring light to even the darkest moments in veterinary practice, ultimately making them more effective veterinarians. Join them on this episode of the Cone of Shame podcast as they share laughs and insights in a conversation filled with humor and heart.

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

LINKS

Matt Asciutto Website: www.MattAsciutto.com

Podcast: www.thegreatestprofession.com

Related Article: https://drandyroark.com/the-open-mic/

Leadership Essentials Certificate: https://unchartedvet.com/certificates/

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

Charming the Angry Client Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: https://drandyroark.com/store/

ABOUT OUR GUEST

Matt Asciutto spent many years performing improv comedy, designing polymers, and teaching MCAT for Kaplan before pursuing an incredibly sensible career in veterinary medicine. 

A 2017 graduate of the College of Veterinary Medicine at The University of Tennessee, Dr. Asciutto has been working as a full-time emergency relief veterinarian since 2018, working for over 35 hospitals and traveling across 6 states to get there. 

When he isn’t working, Matt can be found making good use of his National Parks Annual Pass, incessantly bothering his fiancé with opinions about everything, and collecting an unreasonable number of guitars and surfboards. These days he spends far too much time attempting to start a de novo practice in Fort Collins, CO, editing his upcoming book, or endlessly droning on about his podcast: The Greatest 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 a great one today with Dr. Matthew Asciutto. This is real fun. And so we start off talking about his career as a relief, a traveling relief emergency veterinarian. And what that’s like. And that kind of dovetails into sort of his backstory with improv comedy.

And so then we sort of started to start talking about what– how improv comedy sort of actually works in practice. And, the lessons he learned from that and what he takes into his emergency practice today. And it’s just, it’s a really, very fun look at practice in general, and we talk a bit about comedy and humor.

Not homedy. We talk about comedy and humor. Anyway, guys, if you like to laugh, that is amazing. If you like to imagine interesting professions where, I don’t know, maybe you do emergency in the middle of a metropolitan area, and then next week you’re in the middle of nowhere yeah, this is a great episode.

Guys, 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. Matthew Asciutto. How are you?

Dr. Matt Asciutto: I’m doing all right. Thanks for having me

Dr. Andy Roark: Man, I’m, so glad you’re here. I I love getting to know you this year. We, you know, I’ve gotten to talk a number of times and I you fall into that camp of people where I’m like, I, this is someone I just enjoy talking to and I feel awkward just calling him like when I’m walking my dog And so I’m just gonna send him an email and say can I podcast with you?

And then that will let me that will let me have the conversation I want. For those who don’t know you for the last six years you have been a traveling ER relief veterinarian So you have a company called Bendel Vet and you fly is a base. It’s all over the U.S. Right you?

Dr. Matt Asciutto: Yeah. Right now it’s mostly North Carolina, Virginia. And then I was doing like kind of all over.

Dr. Andy Roark: but you live in Colorado. You’re in 

Fort Collins. 

Dr. Matt Asciutto: Yeah. Yeah. Yeah. And I’ve never practiced here. I am licensed in Colorado. practiced in the state.

Dr. Andy Roark: You’ve never practiced in the state you live in. That’s fun. That’s interesting. You are, but you will, because you are starting your own emergency clinic in Fort Collins. You want to tell me about that real quick?

Dr. Matt Asciutto: Yeah. I mean, the idea is that basically all these things that I’ve learned from all these hospitals and traveling around, I’m like, well, we can do it better. And at some point I decided, I guess I have to actually try. Yeah.

Dr. Andy Roark: I will tell you, true story, that’s how I the Uncharted Veterinary Conference, is I, for like 15 years, I spoke at conferences all over the world, and I felt like some of them were amazing. And I would sit on the plane and I would be like, Why was that so amazing? Like, what did they do? What were the circumstances that made that amazing?

And other times, I would fly away and I was like, Oh, 

Dr. Matt Asciutto: Right.

Dr. Andy Roark: I wish I could have that four days back. That was rare. That was rare, but, you could definitely, just in all candor, you could, like, some events you just go, that was incredible. I mean, it’s like in life, where you’ve gone to some parties and you’ve been like, that was a great party, and you’ve been to other parties, you’re like, I’m, it’s 8 30.

I’m ready to leave. so, 

Dr. Matt Asciutto: There’s like certain weddings like that in my life where I’m just like, that was fantastic. I’m going to remember that moment forever. And then others were like, what happened?

Dr. Andy Roark: Yes, and it doesn’t, it does not correlate to the wedding spend. I think that’s really important to note. I have been to, I have, one of my favorite weddings was in someone’s backyard and it slapped. It was just a great time. And I have been to crazy over the top mega weddings and been like, oh, you know, 

Dr. Matt Asciutto: Yeah. 

Dr. Andy Roark: that was a thing.

Dr. Matt Asciutto: Yeah. And similarly, I mean, when I’m thinking about all these, you know, hospitals, one with the fancy toys and all that kind of stuff, there’s pieces of it that are great. And then there’s pieces of it that are not so great. And you can take all those little things.

And if you, I don’t know, if you think that you have enough of a point of view, trying to institute it yourself seems to be the thing to do so I’m doing it.

Dr. Andy Roark: I think that’s always been my position with relief vets in general. Like, if you see yourself as a possible practice owner in the future, start up, starting up a practice, go and be a relief vet for a year or two. And, you just see how everybody does it. And you very quickly will be like, I like that PIM system.

I do not like this PIM system. I like that approach in the exam room or like the, or the way they leverage their technicians and not the way they do it. It’s just, if you just go to vet school and then you go to one place, that’s kind of all, you know, just, but that, that sample platter of being able to go and look at how different people do things.

I mean, so in, in the practices that you’ve called on as an, as a relief emergency vet, How much variability have you seen in, in how these places run? Is it, night and day, they’re different countries, or is it like, no, you know, it’s a 10 percent grade?

Dr. Matt Asciutto: I would say it’s kind of more the former than the latter. I do think that there is, you know, there’s commonality, right? There’s common experience that we all have, especially when it comes to ER, right? Oh, it’s busy and we feel like we can’t see everything. And we’re questioning whether or not we’re doing the right medicine at the right time for these people in front of us.

Yeah. You and the rest of us, we all feel that way. Right? But the cool thing, I mean, the way that I did it is I just sort of said, yes to whatever opportunity came in front of me. And that was everything from, you know, high level specialty ERs in the middle of, you know, metropolitan areas to like overnight only ERs kind of in the middle of nowhere and then kind of everything in between.

Which then allows you to see, okay, well, what is the, what am I, what is required of me as a veterinarian? What is the expectation of the person across the way? And what’s the relationship to the referring community? All that stuff. Who are these people here? Every, everything ends up being kind of different in those ways.

Dr. Andy Roark: Okay. So, so going into the metropolitan area ER and then out into the sort of middle of nowhere ER,

do you think that having those two distinctly different experiences was, is that a plus for you? Was that a net neutral or was that like a detriment where you were like, man, it was just a different world and things that I had learned didn’t carry over?

Like, so yeah. So tell me on the idea that this was, it sounds like it was positive. Tell me on the idea that what you learned in. You know, downtown Chicago was helped you in easily South Carolina.

Dr. Matt Asciutto: Yeah, I think that what you see in real time is, you know, this thing that’s being thrown around now is this like spectrum of care and things like that. But, you know, when I’m downtown, if I’m, you know, outside of Washington, D. C. I’m going to be elevating to the specialists for every small thing, right? And there is this sort of downside that exists in that, which is then you kind of, I don’t know, you lose confidence in yourself a little bit.

When you constantly have to sort of refer up and out, right? Whereas when you’re in the middle of nowhere and the nearest surgeon is three hours away. You’re like, well, I guess I’m the surgeon, right? And I can use everything that I’ve seen from the people who, you know, have all the letters who go to all the big conferences.

I can use all of that as best, you know, as best as I can to these, other locations, right? And so for me, it’s kind of a, it’s a big, it’s a About application of that spectrum, but it’s also about like, Hey, look, I can do this too. And then, you know, by doing the things you sort of say, oh, okay, I can do it.

I’d never want to do it again. Right.

Dr. Andy Roark: so no, I love it. So it’s funny I don’t I’m gonna get myself in trouble here, but I don’t mean to but it’s almost like so I started practicing in DC outside of Washington DC and there very much was this belief that I could punt so Easily like there was just six other referral places around us And I can that was some of the culture too is you just punt it up You know, it was funny that the culture was very much like yeah, sure Just send it up And, if you don’t watch out, you can be, you can fall into this mindset of like the kid who defers to the grownups in the room, you mean?

Of like, Oh yeah, you know, we’re gonna, we’re gonna, I’m going to get, I’m going to appeal to an authority figure here. I’m going to get a grownup as opposed to when you’re out in the middle of nowhere, that’s it. It’s like, there are no grownups. You better figure out your own problems. And again, I don’t mean to push that too, far, but I will tell you that the veterinarians that I have seen,

seen who are just, I mean, kind of James Harriet style. they’re all the rural veterinarians. And, like, I’ve heard that again and again, as the people, they’re like, yeah, I can, I’ll totally do these surgeries or those surgeries. And I’ll say, how did you kind of get started doing that?

And they were like, well, there was no other option. And I told people I’m not the right guy, but I’m the only guy you got. Do you still want to do this?

Dr. Matt Asciutto: Right. That’s exactly it. It becomes out of necessity and same with working overnights. Even if you are in the middle of kind of a, like, Hey, there is a specialty hospital, even that you’re working in it for whatever reason you can’t call people in, it’s like, it’s just you. And I started doing relief so early in my career.

I had so much of the. Am I doing this right? Like there’s, I need somebody to tell me that I’m doing it right. But in doing overnights, you’re just like, I guess it’s me. Like, there are no other people that I can talk to. So I have to make this decision. 

Dr. Andy Roark: Yeah. Unless someone comes back and tells you didn’t do it right, you’re like, I guess I pulled that off.

Dr. Matt Asciutto: Right. Exactly. Yeah. And then there’s the comfort of like, if you are in one of these specialty hospitals, you can then ask in the morning, am I a moron? Did I do this right? Would you have done something different?

Dr. Andy Roark: Exactly right! When the internist comes in, oh, that would be hard for me. Every morning, I’d be like, oh. I would want to know, but also I would just not want to know. But I would want to know.

Dr. Matt Asciutto: Which is why, honestly, I approach it that way. I mean, this is sort of the benefit of then adding levity and humor and the things that you do, right? If I come in and be like, hi, am I an idiot? Did I do something? But I’m, you know, tongue in cheek. I’m saying this, right? I mean, the idea is it’s like, I’m approachable.

I’m not taking myself too seriously in this moment. I want to know. And also you’ve been there as an internist, you know what it’s like to be the, you know, intern or somebody early on in your career who has no idea what they’re doing. Who just has to do something.

Dr. Andy Roark: Well, I love I think you’re spot on like that is really how you get coached is if you put out the vibe of I’m, not taking myself too seriously like generally or genuinely, what do you think? You know, what are you going to do with this? And what should I have maybe consider what should I consider next time?

But again that I do like that No, i’m Like, I’m an idiot. just lay it on me. What should I do? but they’ll laugh, and then they’ll give you honest feedback as opposed to, you know it’s hard when you’re a specialist and there’s a GP that hands you a case and you’re looking at it and you’re like, Do I tell them that this was not what I would have done?

Do I just smile and roll with it? And, you kind of take that off their shoulders of like, Alright, lay it on me. What, how would you approach this differently?

Dr. Matt Asciutto: Yeah. Yeah. Cause they’re human beings and it’s always awkward to tell somebody else, Hey, you did something wrong or, Hey, you got kale in your teeth. Right. It’s just like, these are awkward things, but if I ask you, Hey, do I have kale in my teeth?

Dr. Andy Roark: Yeah. I have a hundred percent said to my technicians. Look, if I ever look stupid, like I’ve got like a booger or like, like just, I expect, just tell me to please just tell me. And I just, I was like, that’s like ground rules. If I ever come to work at your practice on day one, I’ll be like, look, I don’t take myself very seriously. If I’m doing something dumb or I’m wearing something dumb, it’s probably not intentional. Just tell me. 

Dr. Matt Asciutto: Yes, which is how I as a relief vet have approached and I feel like found my place within, honestly, the industry, but within these jobs, you come in and you’re immediately the guest and as long as I come in sort of, like that. And yeah, a little lower in the shoulders and be like, Hey, I’m just a moron vet who’s doing my best.

You know what I mean? Like if I’m doing something silly, just tell me if I’m doing something that seems crazy, just tell me. And I think it’s helped me a lot.

Dr. Andy Roark: Well, I think that’s so important too. And so let me just say here, I don’t know of anyone who’s had a better background pre veterinary training to be able to just go into radically different hospitals and just, “yes, and” your way into what they’re doing. And so can you speak for that for a second?

So you, it’s not, okay. I do improv, like there’s a local improv theater. I make drunk people laugh on Friday nights. Like you have done real improv. Like tell me a little bit about your background with improv. And so talk to me about that and kind of the timeline between improv comedy and then veterinary medicine.

Dr. Matt Asciutto: Yeah. I mean, I will say that a lot of real improv is entertaining drunk people on Friday nights.

Dr. Andy Roark: Yeah, no, you don’t get away from that. 

Dr. Matt Asciutto: Most of it. Yeah, exactly. Whether or not you’re doing it in like the theater or the comedy sports type. Yeah. It’s just drunk people on Fridays. Yeah. When I. I mean, truly, I started doing it in high school because people forced me to do it.

I had friends who would literally carry me to improv practice and we had a little high school team and it was a national comedy theater was the name of the group in San Diego. And they made me do it until one day I said, please stop carrying me. It’s embarrassing. I’ll go myself but that was most of that was probably junior.

No, that was sophomore year all the way through. And I don’t. I don’t know. You have no concept of that. But what it was, it something that kind of became a part of me? And so when I went to college, I felt like something was missing and I ended up auditioning for the same team, but the professional team that was there.

So National Comedy Theater in San Diego. This is, gosh, I guess 2003, 2004, whatever. And I stayed doing that. They hired me. They like, they said, sure, why not? Come on board. And I ended up, through the following seven years, doing improv with them for I started teaching at the high school league. I started, you know, being the person who was there to teach improv fridays and Saturday nights. And that was just my gig until we left for Chicago just as a kind of a life choice. And I’d realized actually, no backing up a little bit. I did. They gave– I had an opportunity to teach at an arts Academy. I was a teaching artist. That was an improv comedy, teaching artists as an arts Academy.

I’m trying to teach these kids how to do kind of more advanced improv. But I was just the fool who was, you know, doing the sportscaster games on a Friday night in front of drunk people. So I actually read all of the books, you know, truth and comedy and impro by Keith Johnstone and all that stuff.

I, to try to figure out what am I going to teach these kids. And so when later on we moved to Chicago, I thought I should probably figure out if I was right. So all of the places, so ImprovOlympic and Second City, which are kind of these Just major institutions in for, yeah. 

Dr. Andy Roark: Yeah, they’re legendary. 

Dr. Matt Asciutto: You know, they all have training programs as a part of them. And so I went into those training programs and I, you know, I have almost a, you know, seven years or whatever of improv experience behind me plus high school. And I come in and I’m immediately humbled by it. I thought I knew, but I guess I didn’t. And I thought I read this book the way that it was supposed to be, but then there’s all this nuance to it.

So then I spent the next, you know, probably year for both of those going through the training programs. And then I got into the house teams and you know, you kind of end up in this world where now you’re doing improv both in those institutions as well as around the city. And so it was phenomenal.

Then I decided to go to vet school. So I guess I actually got my master’s degree in chemistry or I was pursuing it kind of during that time as well. And so that was probably three years of doing improv in Chicago before leaving to Tennessee. My partner at the time got into vet school and then the year after that, I’m just like, well, I guess I’ll apply to, and that’s the timeline.

Dr. Andy Roark: Hey guys, did you know that I have another podcast? I am the host of the Uncharted Veterinary Podcast with my dear friend, practice management goddess, Stephanie Goss. We have been answering questions for years. We started a year before Cone of Shame. We take questions from our mailbag. We have listeners who write to us and they tell us about what’s going on in their practice and we try to answer their questions and they are all about communication, leadership, management, things like that. It’s about working with clients. It’s about working with staff.

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

I hope that you’ll check it out and enjoy it and love it. I just love making it. So Let’s get back into this episode. 

So, talk to me about improv when you’re walking into these practices, right? So it seemed to me very much the story, what I heard you say was I kind of show up and then sort of “yes, and” my way into it. I was like, Oh, this is what we’re doing here. Okay.

Dr. Matt Asciutto: That’s exactly right. 

Dr. Andy Roark: Gonna to do it.

Dr. Matt Asciutto: improv is all about the, all right, here we are. I’m going to agree to the circumstance, to agree the situation that we’re in, and I’m going to, you know, interact, right? I’m not going to be like, oh no, that’s not how I do it. I don’t, you know, I come into a practice like I don’t use cornerstone.

I have my own PIMS. You could never do it. So you have to sort of say, okay, what is going on here? And then how do I exist within this world that you’ve created? And that’s, I mean, that’s just improv.

Dr. Andy Roark: It was funny. I had a client today in the practice. And so I was talking to my technician. He was just kind of flustered and he was like, I’m not getting a straight answer, I’m not getting straight answers out of her. And I’m trying to remember what was going on with the dog. It was a senior dog, but it was like she he was going in and he was asking her questions like, is he peeing in the house?

And she says, well, he was, but then I got pee pads and now he just pees on them. So I guess not. And he was, yeah. He was really bothered by that. He was like, that’s not a straight answer. And I was like, look, you just, you’re going to have to roll with this. Like, you’re just going to have to nod your head.

But she gave about six answers like that. And he was just tied in knots. And I went in and I sat down and she was like, you know, that technician, I think my boy’s really taken to him. He’s genuinely a wonderful person. I came back out and said, well, you want to really be confused. She likes you a lot. But

Dr. Matt Asciutto: That’s amazing.

Dr. Andy Roark: It’s just like, I just, you like, you have to go in and just listen to the person and just kind of accept their worldview and then being like, okay, this is how we’re talking and this is what we’re doing. And I’m going to ask a lot of very specific questions before we go forward.

Dr. Matt Asciutto: Yeah. I, and I think that you’re right. I mean, especially with client communication, the other way that people talk about it is, you know, meeting people where they are and all that, but there is almost this kind of nuance that maybe you as also an improviser can see, which is that’s a bit that person’s doing right.

Dr. Andy Roark: Yeah.

Dr. Matt Asciutto: Like in any other circumstance, if you as a character were just to be like, I’m going to answer your question, but in like this most circuitous way possible, that is now a bit. And that’s the game. And one of the things that we kind of talked about in, you know, in, in Chicago, I guess this is like in the IO thing, but what is the game of the scene?

What is the game of this, you know, long form thing that we’re doing? We always come back to that. So, so yeah, you, as a doctor, if you were to want to, right. You could also do some things like we’re going to do medicine in this hospital, not necessarily in this room, but definitely within these walls. Sorry.

Dr. Andy Roark: That’s funny but I’d never thought of that. Every, like every, exam room is basically a scene and every, interaction is a bit, and it’s just, you know, like you’ll, have those clients and they will speak to you like their cat is their child and I’m not going to correct them and I’m not, you know, like I’m, I was like, all right, we’re doing cats as children.

That’s the game of the scene. All right. Well, let’s get them in here. All right. Are you saving for college? Cause that’s going to come at ya. 

Dr. Matt Asciutto: That is so powerful because those things, if you can acknowledge just that little bit that they’re offering you, right, like they say, this cat is my child and then they just kind of keep doing it, it’s like fantastic. Now we have a whole list of exactly like saving for college cat toys or baby toys baby Bjorn carrying the cat around in the baby Bjorn, like, you know, all of these things you can now sprinkle in and that becomes now again, this bit that you’re doing with the client.

But really what it is. I’m listening to you, right? I’m here for you. We’re here together as two human beings talking, and now we can then make some recommendations about medicine, you know?

Dr. Andy Roark: You know, I, really, I love that you say this, right. And so, so one of the things I’ve been thinking a lot about, I’m just going to ask you about one of the things I’ve been thinking a lot about, Matthew, is like, there, there’s humor is so valuable in practice and the ability to smile and find humor in, in just sort of talking to people.

To me, it’s absolutely mission critical. It’s the only way I get through the day is just, it’s just, you know, Finding the humor, but yet, but you have to find a positive humor. I was looking at some social media stuff recently. And so there’s all these veterinarians that are sort of on Instagram and things like that.

And I wouldn’t throw any shade or anything at all, but those platforms have really morphed in my opinion to reward bad behavior in a lot of ways and the comedy, the humor in the vet space that seems to do well is generally kind of cutting humor. It’s about you know, I mean, it’s about sort of boy The clients are dumb or boy that the if it’s from technicians, it’s like boy the doctors are dumb and you know, and it’s just There’s just kind of a lot of that sort of honest kind of eye roll sort of humor. At least I see my impression is that is what gets rewarded on those platforms You And I just want to ask you, when you look at humor and sort of how we use it in practice, to you, is there a good humor and a bad humor?

Is there, sort of a line between them? How does, when does, humor kind of go bad in practice or do you think it can?

Dr. Matt Asciutto: I mean, I think it definitely can. I think that, And maybe this is just my style of humor that, so I don’t mean to maybe overstep in terms of what humor is overall, but I do feel like when we, as team members within a, within any situation, but you know, as veterinarians in a client veterinary relationship or whatever, or even just sort of who your techs are and who you are, I think that the humor that we should be using is like collaborative we’re in this together type of humor, if we’re ever going to make fun of something I was actually just talking to a friend of mine yesterday who’s an oncologist, and he was just like, we were talking about how frustrating certain mast cell tumors can be, right?

And it’s like, that’s funny. That’s a funny bit. That’s not at anyone’s expense. That is, you know, there’s something about that. But it’s like, we are in this together. We have this common experience and we’re in this together. And there’s not really an other, right? And I do think that works in my opinion.

I think that’s the humor that we should be using if, at all possible within these situations, as opposed to putting other people down.

Dr. Andy Roark: No, I think that’s, I think you just gave me a really good rule of thumb. That, that, that humor with when there’s an other, when there’s an outside, I think if you’re punching with your humor, I think that’s probably bad. So yeah, that makes a lot of sense. I think it’s a really good answer.

Dr. Matt Asciutto: Right? We all really want to use it. And there is something that’s kind of funny about the like metronidazole on the shelf, just like beckoning you like and you’re just like, ah, I can’t, you know, and you have this like weird push pull relationship, like that’s funny.

Right?

Dr. Andy Roark: That’s so funny.

Dr. Matt Asciutto: But it’s not like, Oh, people who use metronidazole are, you know, behind the times or whatever. Right. Like that’s a judgment based other type of thing. And I just don’t think that’s, I think that in the moment it can be funny, but it may be depending on how you do it, but I just don’t think it’s useful.

It’s not useful humor.

Dr. Andy Roark: No, but, oh man, that’s such a perfect example of metronidazole beckoning to you from the shelf because, like, it resonates and, like, ah, my favorite humor is sort of inside humor. I don’t mean to make people feel excluded, but the best stuff is the stuff that’s really niche. And so that, the metronidazole calling to you from the shelf.

Like I feel that so much. I was literally in the radiograph room today and we were going to do a system in this cat that was peeing outside the litter box. And of course the cat comes in, his bladder is tiny. There’s no urine. And the technician looks at me and goes, well, what do you want to do?

And I was like, I know what old school Andy would want to do. And that’s sent him home with antibiotics and sent him home, which like, nope, that’s not what we do. That’s what, 1999 Andy would have a hundred percent been on board with. We’re not doing that anymore. 

Dr. Matt Asciutto: Yeah. And then you have like this thing that now, for me, it’s in those moments where you’re kind of outside of yourself a little bit, where now you can laugh on this, at this little tiny bit that, that shows up in your mind, right? Like old school, Andy hops on your shelf and is now, you know, be like, ah, do it, man. Just get just a little Convenia. Just a little Convenia.

Dr. Andy Roark: Just do a little convenia, this won’t hurt anything. Just, just, try it. Just try it and see how it feels.

Dr. Matt Asciutto: Right.

Dr. Andy Roark: No, that’s terrible. 

Dr. Matt Asciutto: but I do think that, you know, when you look at, I’ve actually been thinking about humor kind of a lot over this past, you know, six months or a year or so and how I particularly use it, but it really is, it’s like finding these small moments of connection that then can be something else that I think there’s a lot of power in that.

And then, and those things, you know, you can take a euthanasia. And maybe you’re not like guffawing, right? No one is feeling what’s happening in there, but there’s smiling. There’s even chuckling. There’s like, Hey, this is actually a good human moment. And it can just come from these little things.

Like, someone said to me the other day, and this was just horrible news that I had given them. And they said something along the lines of you know, I’m speechless. And that never happens. Like, I’m never speechless. Right. Which by the way, that was her offer. She was the client.

Dr. Andy Roark: Yeah. She’s given you a lot to work with.

Dr. Matt Asciutto: right? And it’s not, you know, you don’t come in and be like, I know I could tell this whole time you’ve been talking or whatever, like that’s me against her. But just this idea of, Hey, being speechless. And that’s something that never happens is something that you can kind of work with and it’s an opening, right?

And that’s an opening for humor. And I think things like that are present and can allow us to connect even more, even in bad situations.

Dr. Andy Roark: Yeah, no, I think that’s true. Gallows humor. Emergency veterinarians are notorious for, I don’t want to say notorious, are known for some gallows humor. Do you ascribe to the idea that again, not, it’s not hurting to others, but do you ascribe to the idea that a shared laugh, if it’s a dark laugh, is a good thing?

Or do you think that there are things about gallows humor that maybe don’t have a place in vet medicine?

Dr. Matt Asciutto: Oh, I feel like if we are laughing and it’s together, that it’s okay. I’m sure that there’s a line here and I’m not going to be able to come up with it. 

Dr. Andy Roark: Exactly, right! I don’t know what the line is but I feel like there’s a line. There has got to be a line and at the same time

Dr. Matt Asciutto: We’ll find it. Yeah. Yeah.

Dr. Andy Roark: (Laughter) Unfortunately, we’ll know it when we’re well past it and we’re like, oh that was the line.

Dr. Matt Asciutto: Right. And like, you know, something small you know, I know this is, I don’t know, this sounds terrible, but like when it’s a really bad you know, a night and there’s like a lot of euthanasias or, you know, and then there’s like this really critical case that I have to kind of take care of, I might say just to myself and around something along the lines of like, Well, I got to go murder this dog real quick, but then I’ll be back and we’ll do it.

Right? And it’s not like for me, it’s not obviously, you know, I’m not, I’m going to take this seriously. It’s not, but in that way, for me, it sort of does take away the heaviness of it. Right? I’m obviously not committing murder, but it’s like, I just takes the moment. Cause then I’m going to be able to come back and sort of say, okay, cool, like now this is what we have to do to the dog and oxygen. This is what we have to do with this one. Who’s bleeding out, et cetera.

Dr. Andy Roark: Well, yeah, I think I think you’re spot on. I think a lot of people would sort of say, you know, humor like that, it, it, breaks that tension that we all carry. And if you can just set that weight down for a second and everybody sort of laughs, then you can, then you can pick that weight back up and maybe move forward in a way that it doesn’t, drag you down the way that not setting the weight down does. So anyway, I think that’s great. 

Dr. Matt Asciutto: Right. I think light stuff is a way to do that. Like for me it’s, I use a lot of silly language, like Okie dokey and you know, stuff like that. Like if something comes in and it’s, you know, oh we gotta do this and you know, heart failure cases are like this that are really bad, right? It’s like, okay, there are okie dokie, like here we go.

Or you know, little things that are. Obviously, they don’t take track from anything, but they’re definitely unexpected that then does break that tension, which then allows us to focus, right? It’s on purpose. I don’t want us to feel like we’re balancing plates on top of sticks the whole time. We’re never going to be able to do our job effectively.

But if we can just kind of be like, Oh, now I’m out of this cycle. Now I can focus on, you know, doing CPR and chest compressions and whatever that might be.

Dr. Andy Roark: Oh man, Dr. Matt Asciutto, thanks so much for being here. Where can people find you online? Ooh, have you got a webpage for Inkwell or anything like that?

Dr. Matt Asciutto: Not yet, but I will have a webpage that is fully functional in mid June for Inkwell, which is my new veterinary practice. You can find me on thegreatestprofession.com. I have a podcast that’s basically about the human behind the professional. So thegreatestprofession.com and also MattAsciutto.com.

Dr. Andy Roark: Awesome. Well, I’ll put links in the show notes. Thanks so much for being here guys. Thanks for tuning in. Take care of yourselves, everybody.

And that’s it. That’s what I got for you guys. I hope you enjoy it. I hope you got something out of it. Thanks to Matt for being here guys. Thanks for coming along and laughing. If you are thinking about improv comedy, you’re like I might like to do that. I strongly encourage you. I love it. I have so much fun with it.

It gives me something to do. That’s not vet medicine. It gives me a friend group that’s not related to vet medicine. It just makes me so much better in the exam room. It makes me better to work with. It makes me a better spouse and father. All of those things really do come out of skills from learning to think on your feet, to talk to other people, to listen really intently.

So anyway, I’m just, I’ll always be an advocate for improv comedy. If you’re thinking about it, find an improv theater near you, take some classes. Sometimes they have just one or two day weekend intensives. Think about it. Anyway, I would really encourage anybody who’s in vet medicine. Just think about it.

Take care of yourselves guys. I’ll talk to you later. Bye.

Lessons Learned Around Caregiver Burden

by

Dr. Ashley Bourgeois joins us for a candid discussion about caregiver fatigue and its wide-ranging effects on individuals. Dr. Andy Roark and Dr. Bourgeois share how the lessons they’ve learned have impacted their careers. 

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

LINKS

Dr. Ashley Bourgeois: https://thedermvet.com/about

Dr. Ashley Bourgeois on Instagram: https://www.instagram.com/thedermvet/

Dr. Ashley Bourgeois on LinkedIn: https://www.linkedin.com/in/ashley-bourgeois-dvm-dip-acvd-9169208/

Leadership Essentials Certificate: https://unchartedvet.com/certificates/

Uncharted on the Road: https://unchartedvet.com/on-the-road/

Charming the Angry Client Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: https://drandyroark.com/store/

ABOUT OUR GUEST

Dr. Ashley Bourgeois is a board-certified veterinary dermatologist passionate about providing practical knowledge to general practitioners to help itchy pets! She completed her bachelor’s degree at Iowa State University and graduated from the University of Missouri’s College of Veterinary Medicine in 2010. She then completed a one-year small animal internship at Purdue University. Upon finishing her internship, she accepted a residency position with the Animal Dermatology Clinic’s Tustin, California location in 2011. She became a Diplomate of the American College of Veterinary Dermatology in 2014. Dr. Bourgeois moved to Portland, Oregon in 2016 to help expand the company. She is an owner within the company and on the board of directors. She has a strong interest in autoimmune skin diseases, allergies, cytology, and otology. In her leisure, Dr. Bourgeois enjoys outdoor activities, traveling, and watching sports. She and her husband stay busy with their daughter, son, and rescue Lab/Boxer/Pit mix. Dr. Bourgeois is passionate about educating veterinarians in dermatology and work/life integration through her podcast, lecturing, and social media presence (The Derm Vet).

EPISODE TRANSCRIPT

Dr Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Me and my allergies are here.

With the one and only Dr. Ashley Bourgeois, she is amazing. I tell a story about this episode when we get started. This is on caregiver fatigue and Ashley’s had a lot going on in her life and she talked candidly about that on this episode, which is really fascinating. And basically we were talking about what does hardship do to our ability to empathize?

What does having our own hardship teach us about being better caregivers? Caregivers, how do we let the personal burdens that we carry spill over into our professional life? How much is just unavoidable? We can’t we’re not two different people we’re not a we’re not a professional human being in a personal life human being and the two don’t intermingle That’s not realistic either.

And so we talk a lot about just about about carrying weights. We talk a lot about carrying weights in this episode. We talk about Ashley’s son’s battle with leukemia. We talk a bit about my wife’s battle with breast cancer. We talk about this at the end. And in both cases, things look good.

I don’t want you to think this is a sad episode. It’s definitely not. This is a life lessons learned episode. And I think it’s a really good one. I hope you guys will enjoy it. Let’s get into it.

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

Dr Andy Roark: Welcome to the podcast, Dr. Ashley Bourgeois:. Thanks for being here.

Dr. Ashley Bourgeois: Thank you so much for having me. I’m so excited.

Dr Andy Roark: You can’t still be excited. you’re on this podcast. I’ve had you so many times on the podcast because you’re just, you’re so lovely. And I always just enjoy you. And it’s funny the last time that you were on the podcast, you know, we were going along and we were talking and you were talking about fluorescent light energy FLE and that was just as I really appreciate it was something I reached out to you about and then You know at the end of the episode I’m always fascinated in what people like you who are doing so many things I’m always interested in what you’re interested in, you know, and so it what are the things I’ve learned in running a podcast is The best podcasts don’t come from me having an idea and reaching out to people.

They come from hearing people talking and saying, well that’s something that person has going on in their life, or that’s something they have real expertise or real passion about. And I’d much rather engage people in what they’re passionate about because you just learn so much more and you can just tell that it’s what, it’s sort of, I don’t know, it’s, where they’re heads at and kind of, kind of what their experience has been.

And so I was talking to you last time we were together and I said, you know, are there things that are on your radar or things that you wanted to talk about? And you kind of caught me off guard. Cause you said, well, you know, I’d be interested in talking about caregiver burden. And I thought that was really I thought that was really interesting ’cause you and I have known each other since vet school and so, I’m not gonna tell your story, but you have had you’ve had a tough road in a lot of ways, and I don’t know, most people probably don’t know that about you because they see you lecturing at, you know, you’re at all the conferences.

You, you’re traveling, you’re speaking. You’re just so well regarded. You’re writing. I’d love to have you as a guest on here and you, just do so many things, but you know, as one of your friends, I, have, I’ve. You know, known about your journey and sort of watched your journey for years. And I don’t know that most people understand sort of the weight that you kind of carry.

And so when you sort of start to talk about caregiver burden, let me just sort of pause here and kind of open it up to you and sort of say, tell me a little bit about kind of what you mean by that. And also what, what makes you say that as something that, I don’t know, that you think needs sort of more attention.

What does that look like in your eyes?

Dr. Ashley Bourgeois: Definitely. I think the idea with caregiver burden, we have to realize does we extrapolate that term from human medicine. That is something that is actually really well researched in human medicine and what caregiver burden means. It means is when you are the person that’s not necessarily getting diagnosed or going through the treatment, but you are the person that has to take care of someone going through that.

And traditionally, actually, so what has done a lot of kind of initial research into this dealing with allergic pets, and it’s something I’ve lectured on. Just through my relationship of kind of teaching about allergies and dogs. And then, you know, we’re going to talk about some of the journeys that we’ve had personally.

But when you start to talk about caregiver burden, we think about it in a different way compared to when we have to go through it. So in human medicine, we often think about this with say that your parent is elderly and you have to take care of them or if you have a child who is sick or a spouse who is sick, someone that you have to, you know, drive to the appointments, you have to advocate for them when they’re not feeling well, you have to pick up medications at the pharmacy.

Obviously there’s financial burdens associated with that. So once you really experienced having to go through that yourself, whether it is for a pet, a human. You start to realize all the different aspects that are there. It’s not just when someone’s in the exam room with you, there are so many different layers that we have to deal with when we are a caregiver for a pet, a person, whatever that looks like.

Dr Andy Roark: Well, you see it in You see it in some of the elderly pets for sure, right? You see it as far as you know, this pet has 16 different medications and a routine they have to have at the end of the day and there’s all of that sort of stuff and I think that’s I think we’ve all seen patients like that, but I think those people are sort of on the outliers.

I, I think, one of the things that I was really interested in is, you know, we look at a lot of mental health and wellness stuff in vet medicine, and people say, you know, vet medicine is so hard, vet medicine is so hard. It is a challenging profession, that’s true. But when you look at mental health, wellness, you look at depression, things like that, most of the time, Most of the underlying factors that are really, most of those conditions are multifactorial.

You know, we look at it and there’s generally an acute cause or there’s an acute pain, something that’s particularly challenging for people, but it’s usually layered on top of a number of other sort of burdens that they’re carrying in their life. And so, you know, when you look at depression, yes, professional stress is on the list, but it’s generally added on along with relationship stress, you know, medical concerns, you know, illnesses of self or others, family problems you know, genetic predisposition, all of these sorts of things.

And so when you and I started talking about caregiver burden, I think that it’s, I’m always interested in talking about what else is going on with people kind of in the background and how these things kind of layer. And so, you know, we’ve seen people. and they’re having a hard day.

So, for example, I had this client that came in and she had this golden retriever that had been hit by a car. And so I go in and see her, and it’s her and like five kids and this golden retriever, and I said to her look, you know this, back leg is broken. You know, we’re going to need to, it’s orthopedic surgery is the answer, you know, and it’s going to be 4 or 5,000, something like that.

And she just absolutely came apart. And she said, can I talk to you in the hall? And so I said, yeah. And so we stepped out into the hall and she said, listen, my husband walked out on our family. And he had all the bank accounts in his name and someone from our church gave the kids this dog as, you know, as a, to, to help them during this hard time.

And I’m the one who hit it with the car and just like, Oh my God, it was the, and I was just like the load that she was carrying sort of, behind the scenes. And yes, this dog was devastating, but it had to be a culmination of all these other things that she had on her shoulders. And like when she laid that out, you just go, Oh, I’ve got, we’ve got to figure out how to help you.

 but a lot of us would just see someone coming apart and think it was about the money or something like that. And you just go, Oh man, people have a lot going on that we just can’t see. And I think that’s really important to remember.

Dr. Ashley Bourgeois: It is really important to remember, and when I, you know, discuss this topic, I like to think of all the roles that all of us have. So you know, I can speak as a mom of two young kids. You know, when you have kids and you don’t have to have kids, there’s lots of other ways you can be taking care of someone.

You could have a brother or sister who needs help. But when I just think about beyond some of the issues we dealt with our son’s health issues, you know, chauffeur, not sleeping well, you know, then having, you know, both being working parents, we all hold so many titles. You know, we, a lot of us identify as veterinarians and that is really important to us.

And it’s super important to me. I mean, that’s a huge part of my identity. But there are times where that’s not as important as being a mom. That’s times where that’s not as important as being a wife or, you know, having a parent who’s going through something or having to be a friend. But we only see people in that exam room for a finite amount of time.

And at that point in time, we really often just see them as a pet owner. And there could be so many other things going on in the background, you know, especially if you are dealing with something really traumatic in your life, like your owner was. You know, but sometimes it’s also hard to find that line of boundaries and empathy.

And that can be extremely difficult because of course we are in a challenging profession. And I can speak as a dermatologist. I think there’s some things that we obviously have a little bit easier because most of our things are not life threatening, but we’re dealing with a lot of chronic issues that add up and are expensive and are frustrating.

So it is, it can be difficult to find that line of protecting your own mental health, but being empathetic to others. Especially when you often don’t have the full story, not everyone’s as forthcoming of information like your own or what.

Dr Andy Roark: Yeah. So, you, I think, the way I remember it, and correct me if I’m wrong, I think you were at a speaking engagement when you learned that your son had cancer. Is that true?

Dr. Ashley Bourgeois: So I was at our veterinary dermatology conference. And what’s interesting about that is I was about to speak like in an hour. I was supposed to give an abstract and this was the first conference. And if you know, I know, you know, a lot of dermatologists. We are a pretty close knit group. We’re kind of a medium sized specialty.

Most of us are kind of weird, right? And I’m including myself in that top tier. We’re kind of weird. We’re kind of funky, but we talk a lot because that’s what we do all day, every day with our clients. So we’re a pretty tight knit group. And so we, this is the first conference in 2022 we had since COVID in person.

So we’re all so excited, right? We are in new Orleans. We are having a ball. We are. We are, you know, cheersing. We were having a good time. And I had found out second day into our conference, that our son was severely anemic. So luckily I didn’t find out about his diagnosis until I got home, but we found out he was severely anemic in that he needed a blood transfusion.

Which there’s lots of reasons kids need blood transfusions, but it’s scary and you have no idea why. So I pretty much had to drop everything. And what I’ll say about our community is pretty much everyone rallied around me because I just said, I just found out my son needs a blood transfusion. I am going home.

And you know, between the people, someone spoke for me, they got me into my hotel room and got me on a plane as fast as they could. And then I went straight to the hospital from the airport. And then the next morning is when we found out that our, at the time, three year old son had leukemia.

Dr Andy Roark: Yeah. Oh, man. When you sort of go through this and you’re learning these things about your son and your family, and you’re sort of coming back together what was your sort of thought about the arrangement of your life, right? So you’re a specialist, you, you’ve got all these things.

I love the fact that you’re sort of able to say, guys, I’m leaving and I, you know, and I just, and you just go. I think a lot of people who’ve had those sorts of realizations have that experience. I found out my wife had breast cancer. I was just like, all right I’m gonna go for a walk.

And no one had a problem with that. No one had a problem with that. And so it is, but I think everyone sort of has that sort of lightning strike moment. 

I was sort of secondary in that this was my wife’s diagnosis. But at the beginning, you know, we didn’t know really anything about it.

And so there was this great uncertainty and wait. And it was funny, but we came back to sort of together. And we talked about it and so she sort of said, this is a diagnosis and things like that. And I said, okay, well, what are you going to do? And she’s like, well, I’m going to go to work. And I was like, okay, well, I, me too.

and we went back to work and people asked me about it. And my sort of thought was like, I didn’t know what else to do. 

Hey guys on Uncharted, April is this weekend in my hometown Greenville, South Carolina guys. I am looking forward to diving into all kinds of topics on marketing and strategy and growing practices and streamlining communication with pet owners and with our team. Anyway, this is, um, this is the flagship conference of Uncharted. 

It is the first conference we ever did. It is an absolutely magical experience. I am so sorry if you’re not going to be there. Uh, It’s it’s. It’s awesome. But don’t worry. I didn’t, I didn’t jump on here. Uh, to tell you bad things. I jumped on here to tell you good things. We’ve got tons of stuff coming down the pipelines at Uncharted, head over to The vet.com/events to see all the stuff we have coming. 

If you live in Atlanta the Uncharted team, including me will be there next month. We will be there in May. We are doing our leadership essential certificate together in person. It’s going to be amazing. You should come, you should bring your leadership team. You should bring your team, lead your head, CSR, your head technician, uh, your, uh, your, your veterinarian, your associate vet, who might want to be a medical director. 

One day, you guys should come together. You should get all the information downloaded into your brains at one time. That’s in Atlanta in may. We’ll be doing that again in Minneapolis, in June. And so come and see me. I’d love to meet you in person. It’s going to be small, intimate, boutique, deep training on everything. 

You know, you need to have to lead and manage other people. So it is our leadership essentials program. It’s going to be incredible guys. Back half of the year, we’ve got our virtual summits coming up. We’ve got our practice owner summit at the end of the year. I just uncharteredvet.com/events. You’ll see all the chefs coming down the pipelines. 

You don’t want to miss it. All right, let’s get back into this episode. 

Dr Andy Roark: And so let me ask you that. And again, I know this may sound strange, but I’m always curious. How did you reconcile sort of the rest of your day with this thing that’s going on at home?

Did you want it to be, did you want to be away from work or did you want to go right back to it? How did you sort of square those things in your mind?

Dr. Ashley Bourgeois: Yeah, that’s a really great question, and I think the first important thing to realize it is that it is different for everybody. So, and it’s hard when you get connected to people who, so for leukemia is one of the top pediatric cancer. So it’s kind of interesting. I didn’t know anything about it, but then as you start telling people, you find a friend of a friend, you have, right.

Like you get all of a sudden these indirect connections and you get in these groups and you know, all these things, but then you realize everyone does things differently. Like the pediatric leukemia journey, at least the one that my son is currently on. Is about two and a half years of treatment. And so there are some people who completely just quit working for those two and a half years.

So what I ended up doing is there’s all these in right, kind of similar, probably to your journey. You went from knowing nothing about something to all of a sudden, almost being like a layman expert right now, like anyone who connected with the thing, be like, here’s this phase, here’s this phase, here’s this phase.

Here’s when they lose their hair. Here’s when they do this. But you don’t know any of that. Like I’m not trained in that. And so what I did was pretty much like that Saturday, we found out the first month is the induction phase, at least for what our son deal or dealt with is the most, one of the most intense.

And so he ended up going on steroids twice daily. And then a bunch of different lumbar punctures and chemo rounds that he has to go through. And so I essentially just took those initial, like that initial month, and a half off. He also ended up throwing like a clot in his arm. And so we had to give him heparin injections.

There was just a lot going on. And I very much identify with work. So it was hard, but not hard because I knew in that time, like if I was at work and our son ended up gaining a bunch of weight, couldn’t walk cause they get neuropathies from the chemo and they’re, you know, he’s three and he gained like eight pounds, which is a lot for a three year old just from all the steroid weight.

And I was like, if I’m in an exam room and someone’s mad, cause I won’t refill Apoquel, like I am not in that mindset. Like I am not there. Now I was still doing some stuff like podcasts or things I could control. Like I’d be like, this is a bad day. I’m not going to do it. But I wasn’t in the clinic for about a month and a half because I just had to, I couldn’t control that.

And I love being in the clinic, but I was still doing little things like interviews, podcasts, content. But when I needed it, when I knew I could be like, okay, I like to you, your point. A lot of walking. My dog got walked a lot during that month. But I wasn’t in the clinic cause I knew I couldn’t, I just couldn’t mentally be there.

But after that month and a half, I was also very much ready to go back. So probably a middle ground where I kind of got through that initial time, but then I needed to get my mind off of it.

Dr Andy Roark: Well, that makes sense. I really like your example of like, if a client was gonna get mad about Apoquel.

Dr. Ashley Bourgeois: I was like, I can’t.

Dr Andy Roark: Well, and I was, that’s what, that’s where I kinda wanna go with this, is started to talk to you about sort of the experience of working with people when you’re carrying a burden and working with people with the idea that they might be carrying a burden.

I, it was funny, I tell this story sometimes now because so, so. My wife came to where I was and just to talk to me in person was just like, Hey, this is the diagnosis. and, we decided that we would come back to work. She was like, well, I gotta go, I gotta go teach. And I was like, okay.

And again, everybody handles. Things are on the way and so I went back to my team and I was like, I have to go for a walk. And so I went for a walk and I walked down main street and I went to this coffee shop. And so I was like, I, you know, it’s been a hard morning. I think I would like a bougie coffee.

And so I, walked into the coffee shop and the guy was behind the counter and he had this big smile on his face and he was like, Hey man, how’s your day going? And I was just standing there and I thought I just found out my wife has cancer. How’s your day going? and of course I didn’t say that but I’ve never forgotten that and just and having that internal thought of it ain’t the best and so of course I said something like, you know, one one step at a time and then I sort of placed my order But, I’ve never had such clarity in my life that people, they’d have no idea what you’re going through.

And I have been that happy guy to be like, hey buddy, how’s everything going? And I’m sure that there is a heavy weight that other people carry. I was texting with somebody. last week, and she said, oh, I just got terrible news about my father having metastatic cancer, and I was like, oh, and I kind of carried on with the conversation thinking that she had gotten that news in the last couple of weeks, and it was like, oh, no, it’s been less than an hour, Andy, and I was like, oh, no, I’m so sorry.

But even like, I just, you don’t process and you don’t know that people are carrying sort of a burden like this. And you look at them, you, I don’t know, I always kind of imagined that you would know, but you, I don’t think that you do. And so, I just, that whole ownership of the idea that people don’t, They’re going to continue to have their own things and they’re not going to know about your things.

I don’t know. I think that’s important. I think that was sort of an eye opening realization for me. And the other thing I wanted to ask you about with this is just and it makes sense also that you would take time off. Like, I was mad for a while. Like, you know what I mean? Like, I did not want to hear.

about how other people were having a tough day because, you know, because traffic was bad. I was like, are you kidding me right now? Are you kidding me right now? And so I think that was something that I had to kind of manage was just not having a lot of patience for things that seem trivial in the light of kind of this weight that I was kind of holding.

And again, I know people have a lot worse things than I had, you know, and so I don’t know. So does any of that sort of resonate with you when you think about it? Did you feel that? I don’t know. Did you feel that? Were you frustrated with other people? Did you have less patience at least initially?

Dr. Ashley Bourgeois: You know, it’s funny as it would be very situational for me. So like, to your point, that’s kind of why I ended up taking that month off, right? Because if it was someone I know coming in saying like, Oh, I just want the antibiotic skin without cytology. I’d been like, I’m sure I would have been fine and faked my way through it, but I just didn’t need to, right?

Like I didn’t need to. I had a supportive company. We could figure it out. I didn’t need to, but where I kind of ran into were a couple things. I can be a deflector, meaning people be, I’m a very positive person for the most part. So when people, right, everyone saw, I left the meeting early. So everyone’s like, let’s go get drinks.

I’m like, I’m on my way home for some reason. My son needs a blood transfusion. I don’t know why they were still all at the conference when I found out, but I didn’t want to like call and tell everyone, like, let’s let everyone know. I’m not there cause my son has cancer. So, you know, for me, everyone was calling to check in when they got back.

I didn’t know exact cause. With our son, he couldn’t go to school for about a year. So there’s about a year because he was so immunosuppressed. He couldn’t. So basically, my husband and I kind of divided and conquered. We’re very fortunate. We could do that. So, you know, I was down to two days a week in the clinic.

He was kind of down to two, he’s an engineer. He was down to two days a week in the office. And then the fifth day we’d kind of like. Divide and conquer whatever needed to happen. And in that time period, there’s lots of appointments happening and he had to have a few more blood transfusions, bone marrow you know, ask for things like that.

So there were times that people would call and because I think I tend to be a positive person, I would just like, well, we’re very, we’re really lucky because we, you know, we caught it early. We’re very lucky because we have supportive jobs. So I would, and people would be like, You can be lucky. It could still really suck.

Like you have a child with cancer, like it’s okay to say it sucks. And I’m like, yeah, it does. But then you end up in this weird competition. Right? So like I was connected to people I knew who’s my son is what’s called standard risk with kind of medium risk. And I got connected to people who had children with high risk.

So they were having a different protocol. I ran into a lot of people, even in the last year when he’s been on maintenance now for a year and, you know. See, fairly normal kid. If you saw him, you would not know. He just got a haircut again, like, he’s crazy, he’s about to turn five, his birthday’s coming up.

Like, you would not look at him and know he’s still going through chemo. Like, he’s been pretty good for, I mean, we still have our challenges, but he’s been pretty good for about a year since he hit maintenance. But a lot of times when I talk to people, they’ll have something hard going on in their life.

And they’ll say, here’s my hard thing, but it’s nothing compared to what you’re going through. I’m like, I don’t need that anymore. Like, yes, I appreciate you want to say that, but I still want to be here for you as a friend. And I don’t have this magic. You know, trump card because I have a child with cancer.

That means you can’t go through something hard. So that’s what I’ve had to kind of explain to my friends is I love that you want to be appreciative and supportive, but like, I still want to hear about your hard stuff, but I think that is very different for people. I know people who can’t do that. They can’t.

But I’m a very external person. I’m a verbal person. I’m an external person, like to my husband’s dismay sometimes, but I’m a chatter like I want to talk through things like if you have a problem, like I want to be able to sit there and talk to you about it. And I’m okay to not be like, well, Like I, I remember my friend, his dog slipped his disc and he was like, Oh, but it’s nothing.

I’m like, no, that’s terrible. It’s terrible that you have to go to acute surgery with your dog. You know, do we have to be in a competition? But I think that is very individual on a person because I know people who kind of have to seclude themselves when they’re going through something like this.

But I’m such an external person, I almost craved not hearing about other people’s bad things, but I craved to know what was going on in the world because I knew the world didn’t stop just because I was going through something.

Dr Andy Roark: It seems like there’s sort of a switch that some people go through and maybe others don’t. There’s a part, I think. I mean, everyone’s different, as you say, but there’s a part when we’re sort of carrying a burden or we have something that happens that’s significant in our lives, where I think, it’s justifiable to look around and say, this isn’t fair.

You know, this isn’t fair. Why is this happening to me? I don’t think anyone would fault people for having those thoughts. And I think that’s justifiable. I think it’s justifiable. for a while and then I think one of the transitions that happens or it doesn’t happen is The feelings that we have of having carried this burden.

They can either transition into empathy for other people or They stay as this sort of source of frustration. You know what I mean? It feels like at some point we have the potential to make the choice. I’ve had this hardship. I had this thing that happened to me that really sucks.

And so I don’t want to hear about other people’s complaining or I’ve had this hardship. I’ve had this burden, had this bad thing that happens to me. And so I understand that other people are also struggling and I’m going to be more empathetic than I would have earlier because now I’ve, I know, that things can suck, you know, does that make sense, I guess, that sort of dichotomy of perspectives and I just, you so exemplify the second one to me and all the times I’ve talked with you and of, being someone who has never seemed angry to me, who has never seemed you have never, and let it make you sort of angry or, you know, or bitter, but in fact, it’s the opposite where you just seem you’re, you just seem so much more empathetic and more open and you’re the first one to say things like, well, we don’t know what that person’s dealing with, you know, and stuff like that.

And it’s just, I don’t know. Do you, did you. Did you feel like you had a transition in that way? Do you feel like you just from the very beginning you always sort of had This rise in empathy. Did you ever have the I don’t want to hear about your crap kind of phase or was that not a thing for you?

Dr. Ashley Bourgeois: Yeah, I don’t want to paint a picture that like the day after we found out I was just like, all’s good. 

Dr Andy Roark: Yeah, mother teresa, like 

Dr. Ashley Bourgeois: Right, no, I don’t want to paint a fake picture. I definitely I went through grief like anybody else. You know, I definitely went through like, why or. You know, cause when we found out we had a couple of people tell us like he looked pale and you know, I would joke about it.

Like, I’d be like, we’re not exactly the tannest of people. Right? Like I’m Norwegian German. Like, so I don’t want to definitely give a false impression that it was just like, Oh, he’s got cancer. No big deal. Not at all. But I think that you, I mean, there would be good and bad days, right? There’d be days where I would be like, Well, why?

And our son has had a couple of medical issues, like he was born with a congenital heart defect. I like to call him our English Bulldog. He is just our daughter, nothing. She’s like had nothing. Our son has been to the Children’s Hospital for a heart procedure when he was 13 days old, tubes put in his ears when he was, you know, 10 months old and now cancer.

So he saw like the Children’s Hospital for three different diagnoses before he was even like when he was three. But I think I’m also just very trusting in like medicine. So the good news is as soon we had, I will say the way that our initial oncologist told us, was wonderful. And I’ve been in situations like when we initially got told about our son’s heart defect, the communication bedside manner was not wonderful.

And that was way different as far as how I processed it. But the oncologist we had was wonderful. It was very like, here’s what we’re dealing with. Here’s exactly, I mean, there’s a roadmap. Here’s exactly what it is. Here’s the things we need to do. But then she also, and we’re very fortunate, like pediatric leukemia, the type he has is like a 90 to 95 percent cure rate.

So it’s like, this is going to be a sucky road and I’m so sorry. You have to go through this, but I just want you to know there’s plenty of options. So I think I was able to also, I’m kind of a. Tell me what needs to be done and it will happen. That is just, that is me to like a fault. Sometimes my husband would be like, we don’t have to just do everything cause you can. But so I was like, I went through grief. I went through uncertainty, right? Cause I didn’t know what our world was going to look like. He has a port in. So anytime he gets a fever, which kids, right. They always get fevers. He has to go to the hospital. Cause they have to do blood cultures just to rule out sepsis.

So it was here’s all these uncertain things. But there is a roadmap and an endpoint and I can just, I’m just, my personality can be like, tell me what needs to be done and it will happen. That can also be a fault because sometimes I have a hard time like just relaxing or, you know, being like trusting and not having to be on so much.

So I definitely had my doubts. But I just want everyone to know whatever you’re going through, like there’s not a right or wrong. Like I definitely had things I probably didn’t handle as well, but it’s just like how I identified with it. And I just tend to be very trusting in like the research and science.

And once they said, you know, there’s, a, really high chance for a cure rate, then I just had some peace with that.

Dr Andy Roark: What are some of the things that changed in your perspective or in the way that you practice based on the experience that you had? So, I mean, I can’t imagine having this experience and you get this diagnosis and it’s not delivered well, and there’s a lack of bedside manager manner.

And then you go and you have this other diagnosis and this person delivers it well and things like, surely you took things away from that, sort of influenced you and how you communicate and how you practice medicine. Like, are there things that stand out in your mind?

Dr. Ashley Bourgeois: Oh, you bet. I mean, for sure. We just had a situation where we had to ask to not see someone anymore because even two years in, when we were seeing a certain person, we didn’t have the best feeling. And that includes my husband who is like, I’m pretty nice and patient. He is like a saint compared to me. So when he was I don’t know, I was like, Oh, that’s it.

Like we need to probably just advocate that we don’t feel good about seeing that person. So I took a lot away from that delivery. Making sure, so, you know, when we were talking before we hop on, like if someone’s a couple of minutes late, of course I have boundaries, but often I understand I have been panicked because I’m a couple of minutes late for an appointment.

You know, I have been like, I cannot go to everything. I’m the more medical minded person in our family. I can’t go to every single appointment for our son over two and a half years. Like it is not like my husband’s job is a bit more flexible than mine. Like we have to balance that, you know, if he gets a fever, we have to drop everything and run in, that’s a little bit easier for his schedule.

So if someone says like, Oh, my wife sent me a list of questions, you know, historically it would be like, well, why, doesn’t she come in now? I’m like, okay, great. Show me the list of questions. You know, okay, great. Can you FaceTime them? Can you put them on speaker? Like when, you know, I used to be annoyed at people would be like, Oh, they’re on speakerphone.

And now I’m like, cool, great. Put them on. I’m on FaceTime a lot. Like, I’m just like, 

Dr Andy Roark: I’m glad we made this happen. Yeah. That’s great. 

Dr. Ashley Bourgeois: It just saves a lot of frustration. Cause I don’t know, to your point, I have no idea if they just had. A child that was diagnosed with something. I have no idea if the wife is the breadwinner of the family And she needs to go be the one that’s working. I don’t know that now.

I have a lot of clients who confide a lot in me because it’s dermatologists We get to know our clients a lot pretty well but I don’t know that so if I can reasonably make it happen without breaking a boundary and it’s not just because i’m stubborn In saying, well, it’s just the way that it should be.

Then I will try my best to accommodate it. Now I will have boundaries if they’re like 25 minutes late for the 30 minute appointment and they’re like, you have to see me this second. Of course I have boundaries, but I really, tried to just think about how I have felt in those situations. I also, almost every single exam.

I, even if it’s a happy, you’re doing great. You’re just here for blood work. I almost always end with what questions do you have for me? Because so many situations and I’m, you know, my texts will be like, cause I’m a talker, like you’re a couple minutes late, but I kind of know where I can make it up in my schedule at this point, practicing so long, but I like to ask that cause I’ve written so many situations in the last few years where we’ve seen many people and you just know the ones that, you know, Make you feel rushed, you know that just make you feel like oh I’m just checking off the box and moving on and of course if I like know that they’ve been taking too much time I can Say, okay.

Well great. I’m gonna do this if you have any other questions, like, you know, we can set another appointment But even if it’s just I could get in and out fast just having that question and oftentimes it’s oh not really or something quick I just feel like people feel like, Hey, you appreciated my time that I just paid you for.

So I really try to be thoughtful of that because I’ve had so many situations where they just run out and I have, like two questions I want to ask them and I never got that opportunity.

Dr Andy Roark: Yeah. Well, actually, I know people are going to want to know, how’s Carson doing now?

Dr. Ashley Bourgeois: He is doing great. He is so currently he’s about to turn five. And he has been in school now for a year and as it stands now, things go well. You know, he’s still on chemo every single day. But as it stands now in July, he is supposed to finish treatment. So my hope is he starts kindergarten this fall.

As a normal boy that gets to put all this behind him. And then we’ll just kind of keep every step of the journey, checking and making sure things stay in check. But so far, so good.

Dr Andy Roark: That’s awesome. Allison’s now well over a year post treatment. Everything is going well also. So, yeah. Some bright skies ahead. Ashley, thank you so much for being here. Where can people find you online? You have such a wonderful online presence. You do so much stuff on Instagram and just, you make educational videos and you’re just, I don’t know, you’re such a great online presence.

Where can people find you?

Dr. Ashley Bourgeois: Yeah. I mean, I try to keep things simple. Everything’s under the DERM VET, which includes, you know, some motivational stuff, some parent stuff, but mostly dermatology education, the idea just to make it really tangible and easy for general practitioners to learn. And then. You know, my own podcast, the DermVet podcast.

And I just really appreciate you having me on and being open to having this discussion. I know it’s not easy for everyone to share journeys like we feel comfortable with, but I hope people can take some stuff away from it. Cause we are a really great community, but we have things that we have to navigate as well.

Dr Andy Roark: Oh, thanks so much for being here. Guys, thanks for tuning in and listening. Take care of yourselves, everybody. 

And that’s it. That’s what I got for you guys. Thanks for being here. Thanks so much to Ashley for being here and sharing her story and providing her perspective and everyone has a.

Their own personal journey and there’s no one way to feel about things but I just– I really feel like talking to people who have had experiences in practice in life and kind of understanding what their perspective was. I think it’s, I think it’s helpful in getting her own ideas straight in her own minds and kind of parsing to her own feelings So I really appreciate her coming here and just sort of sharing of herself . Anyway guys, take care of yourselves.

Be well everybody. I’ll talk to you later on. Okay. Bye

HDYTT: Feline Stress and Inappropriate Defecation

by

This week on the Cone of Shame Veterinary Podcast, board certified behaviorist, Dr. Leanne Lilly, joins Dr. Andy Roark to discuss the link between stress and the GI tract. Together they talk through treating the behavior case of Calix, a calico feline that will not stop defecating outside the litter box. 

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

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This episode is brought you ad free by Hill’s Pet Nutrition.

LINKS

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

Hill’s Prescription Diet GI Biome Feline:  https://www.hillspet.com/cat-food/pd-gastrointestinal-biome-feline-dry?cq_src=google_ads&cq_cmp=12261618915&cq_con=112560660650&cq_term=hills%20gastrointestinal%20biome%20cat%20food&cq_med=&cq_plac=&cq_net=g&cq_plt=gp&gad_source=1&gclid=CjwKCAiAloavBhBOEiwAbtAJO4TWaZ1xA4C5UP3CsqjqQHBL83bRYKlyAemu_QdHIECeeuC-GdSKPhoC6M8QAvD_BwE&gclsrc=aw.ds

Leanne Lilly LinkedIn: https://www.linkedin.com/in/mleannelilly

TVP Article: https://todaysveterinarypractice.com/nutrition/feline-stress-nutrition/

Charming the Angry Client Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: https://drandyroark.com/store/

ABOUT OUR GUEST

Dr. Lilly is an Assistant Professor and the service head for the Behavioral Medicine Service at The Ohio State University’s Veterinary Medical Center. She received her DVM from the University of Wisconsin-Madison in 2011 and spent 4 years in the trenches of general practice. She completed a specialty internship in Behavior Medicine at the University of Pennsylvania. She followed that with a Behavioral Medicine Residency at The Ohio State University, where she then joined the faculty, teaching residents and veterinary students. She serves on the Ohio Veterinary Medical Association’s Behavior Education Committee, the ACVB’s exam committee, Low Stress reviewer for VIN through Cattle Dog Publishing. She has appeared in a webisode of Animal Planet’s Life at Vet U, over 75 print, and live interviews. She is Fear Free Elite and Shelter, Low Stress Handling Silver, and Feline Friendly Certified. When not working she enjoys kitten cuddles and landscaping.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host Dr. Andy Roark. Guys, I got a good one for you today. We are talking about stressing cats. We have a cat named Calix that is defecating outside the litter box when mom travels. It seems to have a stress component, but it needs to get sorted out.

And so I have Dr. Leanne Lilly here with me to help sort that out. She is a boarded, veterinary behaviorist. She is on the faculty at the Ohio State University. She is a great person to talk to. I really enjoy her. We get into a GI brain interface. We get into the biome. We get into stress management.

We talk a lot about expectation setting with pet owners, which honestly, that’s… that was great. That was a really neat little pearl that I put in my pocket, and I’m gonna, I’m gonna set some expectations with pet owners a little bit differently. I think that was really good for me. Anyway, you’ll hear it. You can decide if it’s good for you, but I loved it. 

This episode is made possible ad free by our friends at Hills Pet Nutrition. If you have not checked out their learning platform, it’s called Hills Veterinary Academy. I’ll put a link in the show notes.

It is a fantastic place to get your learn on. Guys, 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. Leanne Lilly. How are you?

Dr. Leanne Lilly: I’m doing well, thank you.

Dr. Andy Roark: I’m so glad that you’re here. Thank you for coming on. For those who don’t know you, you are a board certified veterinary behaviorist. You are an assistant professor of clinical, how do you say it, assistant professor clinical for behavioral medicine at the College of Vet Medicine at the Ohio State University is?

Dr. Leanne Lilly: Yeah, yeah, we usually leave out the College of Veterinary Medicine as it’s sort of implied, because that is the most long and gamely title that I think I’ve come across. I mean, it sounds really important, right? So many words, but yes. 

Dr. Andy Roark: I imagine the old cop shows where they would like whip their badge out and you have one, but then when you whip it out, it just folds and folds and folds as your title keeps wrapping down. I love that you were here. You are… first of all you are fascinating for a lot of reasons.

You are so focused in Low Stress Handling. You’re fear free elite certified. You have done so much with stress management in shelter pets. You have a lot of expertise and experience in the field of stress management, I would say. So, how did you get into that?

Was it a conscious decision? Is that something that has evolved over time? How did you just sort of decide to be the stress doctor?

Dr. Leanne Lilly: Yeah, so it’s a little bit of both. The sort of long version goes all the way back to when I was eight. And I was not one of those people who knew they wanted to be a vet when they were a kid because I’m actually a needle phobe. But I had a dog who had seizures most often during thunderstorms. And so that sort of jump started my foray into the brain.

And then in vet school, in undergrad, actually, I did an undergrad in Biopsychology. So I studied the brain and behavior and neurotransmitters. Yeah. Then I went to vet school and then because of that background, I started collecting all these patients who were nervous in the hospital or hard to handle in the hospital or had anxiety components at home because it was very comfortable reading about a medication and say, okay, well, what does it do?

What does it bind to? Who does it talk to? Is that going to be helpful in this symptomatology? And as I collected more cases, then of course I got to the end of my knowledge base. And then said, okay, there has to be someone who knows more about this than I do. Who are those people? which is when I discovered the diplomats of the American College of Veterinary Behavior.

I did a specialty internship and that sort of blossomed me further into that. And then I said, yes, this is absolutely what I want to do with my life. I went into residency and then I just hung on to academia because I love that ability to keep expanding the knowledge base both for myself and for my students.

And it gives me the opportunity to do things like. Study how behavior changes and how stress management and teach stress management. So that’s kind of how I got here. 

Dr. Andy Roark: That’s amazing. I have got a case that I think you are uniquely qualified to, to talk about. Maybe not uniquely, you’re super qualified, not uniquely qualified, but super qualified to talk about. I’ve got this case. Can I bounce it off of you? Is that okay?

Dr. Leanne Lilly: Absolutely. 

Dr. Andy Roark: Alright, cool., I have a two and a half year old female spayed domestic shorthair named Calix.

She’s a calico, and she… 

Dr. Leanne Lilly: Spicy. 

Dr. Andy Roark: Yes, a little bit, a little, a little bit she, you know, the technician’s face doesn’t necessarily light up when she comes into the hospital, but she’s a sweetie in her way, in her special way. She is here because she’s driving mom nuts with pooping outside the litter box.

And,  what happens is, it’s, it’s mom travels, mom travels for work, she goes away, and everything is fine, and then she goes away, or, boyfriend comes over and stays for a weekend, or some other, you know, sort of small thing, maybe some furniture gets moved. And now we’re backed up pooping out of the box again, and she’s going back to the doctor, and they’re doing a workup for GI stuff.

She’s had an internal medicine workup. There’s really nothing significant that they can find. They’ve scoped the cat and it’s sort of vague. It’s maybe it’s IBS, maybe it’s not, you know, we can’t really tell. A lot of sort of vague, vague symptoms and signs, and words like that being thrown around.

And so she’s really frustrated. 

Dr. Leanne Lilly: Nobody likes to clean up extra cat poop. 

Dr. Andy Roark: Exactly. And, the thing that she’s really grabbed on to is this “it’s when I travel.” And again, a lot of people will have the cats and they’re like, oh she’s punishing me. And we know that that’s not real. But it’s, that type of vibe that she’s, you know, she’s like, definitely seems correlated to my behaviors and me doing these things that she doesn’t like.

And so anyway, I’m talking with her. I want to do right by this owner. I want to try to fix this problem. I want to make sure this cat doesn’t get vilified, not that mom would try to do that, but you know what I mean? Like, I want to, I want right by her as well. So, let me just, Ask you about that and sort of lay it out and say, I’m looking at this case.

I’m kind of walking into it. Dr. Lilly, how do you treat that?

Dr. Leanne Lilly: Yeah. So taking a good history and finding out and confirming that this really does happen with these changes in the environment, changes in the schedule, changes in routine does very much make me think that this is stress related. And, I think what gets tricky about that is simply because we’ve identified it as a stress related problem doesn’t mean that there isn’t also a GI component to that stress related problem, because every time we look at it, the GI brain axis gets more complicated and more interesting, and it talks to each other bidirectionally.

So the stress can influence the GI tract and the GI tract can influence the stress. And so maybe what we’re having is the stress impacts the GI tract and then we get a vicious cycle until mom returns. And then if mom is stressed, now we have more stress at home. So that can become really overwhelming for everybody in the household really quickly.

And certainly anytime there’s a change in stool, you want to do your due diligence and make sure nothing has changed because just because the last fecal was normal doesn’t mean this fecal is normal. But if you’re going through that cycle, and we’re not getting what we need, then focusing on either the GI brain interface or the brain side may be very helpful in helping Calix and this owner get to a much better place in that regard. 

Dr. Andy Roark: I love the conversation, the GI brain interface, this is actually an area that I just sort of became aware of in the last year. And it’s rather amazing to look at what we can do with GI health, to have effects on other parts of the body. And so, I like this.

Mom does not want to pay for any more fecals. And again, I get it, and we’re always like, hey, just because it was normal last night. I, I get it, she’s at that point. And so, all of that makes sense, all of that tracks. The cycle of the stress buildup, things like that.

Where do you start to intervene? First of all, let me ask you about sort of getting this back on the rails. We have this cat. And, she’s defecating outside the box and mom is bringing her in yet again. What are your sort of pearls? What are your favorite things for trying to get these stress cases kind of calm back down and back on the rails?

Because let’s be honest, coming into the vet clinic is not helping this stress level that we have. Help me first to stabilize and then long term management.

Dr. Leanne Lilly: Sure, so some of those stabilizing is. It’s going to end up being client education and client management, right? The cat is not doing this for spite, the cat is doing this because it’s profoundly stressed out. It doesn’t seem like it, but take it as a compliment. Your cat loves you that much, and that can help reframe things and calm things down so that you have the bandwidth to then start doing an intervention at the cat level.

And then I really want to think about, is this cat’s GI tract working as perfectly as it could? Either all the time or during stress and then how can we support that stress. So that might include things like diet specifically for the GI tract because stress changes the microbiome. Even if we don’t get diarrhea, stress changes the microbiome.

Stress can certainly also decrease the rest of the health function and lead to additional non positive things. So hairballs, upchuck, this idea potentially of Pandora’s Syndrome launched by Tony Buffington. So we also want to look at that stress side and that, depending on the client, depending on the cat, that might be nutritional management of stress.

Things like supplements and probiotics and the generally recognized as safe type of products and diets that are specifically for stress, you might think about how do we combine those two things. We might reach for medications. I find a lot of people are hesitant to do that. For all the reasons that make perfect sense, is the medication safe?

There’s a, there’s actually just a stigma about behavior ,and psychiatric modifying medications. And how easy is it to get it into the cat? You know, we have a shortage of highly palatable flavored medications that are for stress. By which I mean we don’t currently have any FDA labeled ones except for Pregabalin, which is brand new.

So, if we can get something into the cat that the cat likes to eat, and it’s easy for the client, and it helps address either the GI side or the brain side or both, that sounds and feels like maybe we could have one stop shopping in a slam dunk for this case. 

Dr. Andy Roark: When you start to look at this, and that definitely makes sense as far as, a one stop shop, let’s be honest, convenience in cat medication is a, it’s a big driver, I don’t, I, I think convenient sounds like the wrong word, but it’s…

Dr. Leanne Lilly: Adherence, right? Can they actually do it? 

Dr. Andy Roark: Yeah, and again I tend to choose positive, uh, thoughts about, you know, pet owners when they come in and so everybody’s doing their best and it just, it’s easier just to

Dr. Leanne Lilly: But can we make it easier for them? 

Dr. Andy Roark: Exactly. Do you find that pet owners are kind of open to these types of conversations around nutrition? Do you think you get buy in? Are they like, yes, I like this, or are they sort of skeptical? that yet another food is going to help. In this case, you know, with Calix, they did some diet trials with internal medicine.

Now, granted, it’s not what we’re talking about, but I don’t know the pet owner necessarily differentiates what we’re talking about from the diet trials that she did before. What is that conversation like?

Dr. Leanne Lilly: Yeah. So I think buy-in has probably been better in the last couple of years as the idea that your GI tract influences your body has become more public knowledge, in the human side. But I think even without that, it’s about getting specific about. Why this particular diet in this sense, and recognizing that the hard work that they did to go through other diets and notice what those diets did and didn’t do.

So if you’ve done a hypoallergenic diet trial, say we tried a hypoallergenic diet. That diet, you know, it’s designed to keep the immune system from flaring up in response to the food. And the great news is your cat doesn’t need that highly expensive hypoallergenic diet. And that means that we have other options.

The diet that we’re talking about is potentially designed for whether we talk about a calming diet or a microbiome diet, right? Getting down into these about what it’s designed to do and how it does that and why that’s specific to Calix and why that may specifically help Calix in terms of the signs that we’re seeing.

If you have personal experience with those, I think that’s really helpful. If you have little samples in the room and you say, Hey, we can even just see which one Calix likes to eat. Cause guess what? None of these do any good in the dish. They have to get into the cat, right? Those things can really help buy-in.

And if you set them down and the cat’s like, I am absolutely going to gobble that up in the exam room. And normally Calix doesn’t eat in the exam room unless you whip out the high value churro. You’re like, aha. All right. Now we’re starting to look at easy and potentially successful. So I think those conversations really are about bringing the client along for the details rather than glossing over them to try and help them meet you in the middle, right?

We have all this stuff in our heads that we know about these things and why those two things are different and why this food is different from that food and why a novel protein is different from a hydrolyzed diet. And it’s really our job to bring the clients along in that information journey in a way that they understand.

So that also means being willing to stop, pause and say, what do you know about or what was your experience with? Or have you heard of the term GI brain axis, right? And see where they are and then try to find the stepping stones to bring them along so that what your thought process is actually makes sense to them.

Dr. Andy Roark: What does the client experience if we lean into like a biome diet or into a stress diet, something like that? There’s a lot of, there’s a lot of nutraceuticals in the world that have been sold to people and pets and some of them are amazing and they work really well and a lot of them people are like, I don’t really know if they helped or not.

If I want to set expectations for these types of diets and stress management cases, is this going to be a fairly stark change in the patient? Is this something where they’re probably going to see real improvement in a short period of time? Is this going to be a two week process of kind of re-regulation like what are they going to expect to see when they get back home?

And I know it’s very case specific individual specific But just how do you set their expectations of I fed this 20 minutes after I got home and it isn’t working. Yeah

Dr. Leanne Lilly: Sure. So some of that depends on which diet you’re using and the case, and where your target and your stress points are. So for Calix, for example, if the stool gets a little bit soft every time we defecate outside the box because the boyfriend came over or we moved the furniture or we traveled, then we may actually see clinical improvement, at least in the stool quality within 24 hours, which to my end, that’s great.

The cat may still be defecating outside the box, but for the client, that means they’re not picking up gross poop anymore. Now they’re picking up solid poop. And so you can highlight that as right. Here’s your little ray of sunshine about that. Now, in terms of whether or not from a GI brain access, that’s sufficient on its own to help the cat manage in the stressful situation. You won’t know until the next stressful situation. And so I think that is a client expectation that you have to manage. I think the other thing is putting some objectives on that, right? It’s the last time Calix’s mom traveled for four days, we had 27 incidents of poop.

That’s a lot of poop. Traveled for four days. We had four poops. Back at having diary had four poops outside the box, and the next time they travel, we have one poop outside the box, right? That’s improvement. And so we need to try and get those objective measures so we can have those good conversations because the client goal is always zero, and sometimes it takes us some finagling to get there.

And so we want to be able to say, Hey, we took five steps forward, and it was amazing. I understand your goal is zero. We’re going to keep working towards that. So those types of details and adjusting those inside the case, I think, is really helpful for both the client and for you, right? If you know that objectively, then when they come back in for the recheck, you’d be like, Ah, four poops last time, like on average a poop per day out of the box.

Next time, we only had one out of the litter box. Maybe it was on the last day. Maybe it wasn’t. Doesn’t matter, right? We’re making progress. So those types of things can help both the client. As well as you for your management because then you don’t have to guess. 

Dr. Andy Roark: That is exceptional expectation setting. I think it means, it means, because you’re exactly right. Their expectation is zero. I will feed them this food ,and I will have no more problems. I think saying zero is our goal and know that it may take some time to get there. There are intermediate improvements that we’re probably going to see before we get there.

I just think that that’s really smart communication. That’s fantastic. All right, great. I really enjoy talking with you. I could sit here and ask you a million questions about the GI brain interface and just I, this is an area I’m still really, truly, deeply interested in and I want to keep learning about.

If someone is into, if someone’s really into this conversation and they’re like, I want to learn more about biome, I want to learn more about the GI brain interface and stress management, what are your favorite resources? Where do you send people?

Dr. Leanne Lilly: Yeah. So it depends a little on whether they’re looking for client side or, you know, white paper side. White paper side, of course, I’m biased to my colleagues, no offense to anybody else doing wonderful research out there. It’s just that I got to see it develop on both sides. So I’m like, Ooh, it’s shiny.

So we actually have some pretty good papers on this coming out through JAVMA in the last couple of years. So that’s actually relatively readily accessible, for the veterinary community, 

 More research is coming out every day. So, ask me again in six months, I’ll probably have more places to look.

Dr. Andy Roark: I’ll link up some articles and everything for people in the show notes, things like that. What did you like for client facing? 

Dr. Leanne Lilly: For client facing things get a little bit messier, because it’s such a novel field. And so they change a little bit. Veterinary partner has a couple of handouts about. Basic urine and defecation outside the litter box and that it’s not for spite and those types of things.

And I think that can be really helpful if it comes from multiple places. They have some supporting documentation about IBD. We have a handout, it should be available on the Indoor Pet Initiative that’s called IBS. It’s about stress with a little apostrophe ignoring the A, because I’m a literary nerd, and I think that that’s really helpful as a bite size piece of information to give people or to think about, okay, here’s how someone else talked about this.

How might I reframe that for my specific client? Cause nothing is one size fits all. 

Dr. Andy Roark: Yeah, absolutely. Leanne, where can people find you online if they want to kind of follow your work and what you’re up to?

Dr. Leanne Lilly: Yeah, so I have a LinkedIn page. It’s just my name, M. Leanne Lily, and then the clinic web page does a pretty good job of keeping things up to date and posted for resources at the vet.osu.edu/behavior page. So those are pretty good places to find out what I’m up to. 

Dr. Andy Roark: That sounds fantastic. Awesome. I will put links to all that sort of stuff. Thank you so much for being here. Gang, thanks for tuning in, everybody. I hope you found something helpful and useful that you can put into practice. So, I have to go see Kalix and get this sorted out. So, thanks a lot, everybody.

Dr. Leanne Lilly: Thanks, Andy. 

Dr. Andy Roark: And that’s it. That’s what I got for you. I hope you enjoyed it. Thanks to Dr. Leanne Lilly for being here. Thanks to Hills Pet Nutrition for making this episode possible. As I said, if you haven’t checked out the Hills Veterinary Academy, take a look at it. It’s a great site. It’s a great resource. Um, yeah, I just, um, I’m a big fan.

Anyway, I hope you guys will have a look. Take care of yourselves, everybody. I’ll talk to you next week. Bye bye.

Our Lives Outside Vet Medicine

by

Kelsey Carpenter reflects on her journey outside of veterinary medicine and how it changed her perspective on success. Together, Kelsey Carpenter and Dr. Andy Roark discuss the many opportunities for growth that exist outside of our careers and how they both found joy in climbing their second mountains. 

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

LINKS

Kelsey Beth Carpenter on Instagram: https://www.instagram.com/kelseybethcarpenter/

Uncharted on the Road: https://unchartedvet.com/on-the-road/

Charming the Angry Client Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: https://drandyroark.com/store/

ABOUT OUR GUEST

Kelsey Beth Carpenter is a Registered Veterinary Technician, social media manager, singer/songwriter, speaker/performer, and content creator. Kelsey has enjoyed working in emergency hospitals across California for over a decade. At her most recent clinic, she fell in love with the open hospital concept, and is passionate about teaching others how to implement this structure in their own practices. Kelsey also works as the Social Media Manager for DrAndyRoark.com, a Content Specialist for the Uncharted Veterinary Conferences and Community, and the manager of her own growing brand, previously under the name Vet Tech Kelsey. With a background in the arts, Kelsey is passionate about the power of creativity, the importance of humor, and the magic that happens when art and science overlap. In her free time (what’s that?), she can be found hiking, writing goofy songs about Veterinary Medicine, and dressing up her Chihuahua even though she swore she would never be “that person”.

EPISODE TRANSCRIPT

Dr Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host Dr. Andy Roark, guys I am here with the one and only Kelsey Beth Carpenter, formerly Vet Tech Kelsey. I wanted to talk to her about a little bit of what’s going on in her life And she dropped the bomb on me at the beginning that she’s not Vet Tech Kelsey anymore and we talked about why that was and then we talked about having one foot in the grave outside of that medicine and what that looks like and it was a really great conversation about how we define ourselves in medicine, how we fall deeply passionately in love with medicine and sometimes we can fall back out of love and that’s not bad and honestly for a lot of us it is not bad. For a lot of us, it is destined to happen. We are going to fall back out of love with vet medicine. That’s not failure, that’s just part of the process. So anyway that’s what we’re talking about today is, finding that balance, identifying ourselves as someone who’s a side of vet medicine, who’s who does vet medicine, but not, maybe it is that medicine.

We, we talk a lot about that. We talk about it from a social media sort of public figure standpoint. And then we talk about it from the practice standpoint and just how we set up our friendships and our relationships and how we feel about the fact that sometimes we’re more into our profession than other times.

So anyway, that’s it. That’s the conversation and it is a really good one. Kelsey is amazing. Guys, I hope you enjoy it. Let’s get into it.

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

Dr Andy Roark: Welcome to the podcast, Kelsey Beth Carpenter RVT. How are you?

Kelsey Beth Carpenter: I’m pretty darn good. How are you, Dr. Andy Roark?

Dr Andy Roark: I am good. Thanks for coming on and chatting with me. I always enjoy having you on the podcast. I always enjoy our talks in general. for those who don’t know you, you are you often go by Vet Tech Kelsey in the online world and you have, you’ve worked with me for, we’re getting close to 10 years at this point,

Kelsey Beth Carpenter: Too long.

Dr Andy Roark: Too long. Yeah. Yeah.

Kelsey Beth Carpenter: No, you know what? This is a side note, but I actually got rid of the Vettech Kelsey name recently. I went back to my name.

Dr Andy Roark: Did you really?

Kelsey Beth Carpenter: And I just felt like it was like, kind of, you know what? I don’t want to pigeonhole myself into being all about vet medicine all the time. I just want to be Kelsey Beth Carpenter, who’s also an RVT and also does other stuff. You know?

Dr Andy Roark: What’s the process for backing out of an internet name? Like if I if, Dr. Sue Cancer Vet wanted to give that up, like what kind of process would she have to go through? Is there paperwork?

Kelsey Beth Carpenter: I’m claiming that name immediately.

Dr Andy Roark: Yeah, oh yeah!

Kelsey Beth Carpenter: I’m now Dr. Sue Cancer Vet. me up. 

Kelsey Beth Carpenter, Cancer Vet. None of that is true. Okay. wait, so, so why did you make that decision? So you were like, hey, I’ve been doing, I’ve been Kelsey Beth Carpenter on Instagram and Facebook and like, got YouTube videos and people know me. And then you just, like, you just didn’t want to do, are you trying to do other things?

Did you feel like you were tied to that medicine in an unhealthy way? Like, what was the process for that?

I think it was just there was a period of my life where vet medicine was my entire life, for I think everyone’s gone through some period with vet meds their whole life. Now my life has changed and there’s other things going on And I was feeling like I had pigeonholed myself into Only being able to show up on social media as vet tech whereas be able to share other parts of my life and not feel like Being a Vet Tech is my entire identity, it’s only part my identity.

And I think like the, as silly as it is, the handle you use on social media does kind of represent a little bit of what you’re doing. And I was like, I’m going back to my name. Cause I feel like I have more, I’ve given myself permission to be more than just a Vet Tech. I can be a Vet Tech in other things.

Dr Andy Roark: Yeah. It’s funny how we sort of define ourselves, you know, and like how we look at ourselves. And yeah, I thought about that a lot with, sort of, Dr. Andy Roark, sort of as a brand. I was at the VMX conference, this was years ago, and I was sitting there with this guy who was a mentor of mine, and he was just a guy I really respect a lot.

And he’s just, he’s done all the things in vet medicine. And, you know, we were there and we’re at this conference and there were just people streaming by and everything, and we were sort of talking and he said, you know, Andy, I’m gonna be done soon. And I was like, what does that look like?

And he’s like, I’m just going to go play music. We’re just going to go play music. And I was like, really? So it’s like, you’re not going to, are you going to come back here? And he was like, no, man, when I’m out. And he said, all this is fake. And I said, what do you mean? It’s all fake.

And he was like, you know, you see these conferences, you see all the hustle and bustle and everybody, you know, tells you that you’re greater. Everybody tells you that you, your work really matters and things like that. But if you disappeared. Everything would just keep, it would just keep rolling and so he was like, I’m going to be done and I’m, you’re not going to see me anymore.

I’m going to, I’m going to be with my family. I’ll be with my grandkids. I’m going to play my music and that’s what I’m going to, what I’m going to be. And I’ve never forgotten him saying, This is all fake. And it was really fascinating. ’cause I thought a lot about that because, you know, in my career I’ve hustled so hard for so long to, to be, Hey, I hate to say that

you try to be relevant. You know what I mean? But I have, I’ve just, I didn’t, there was a time, to your point earlier when almost my entire friend group was in vet medicine. Like, you know what I mean? Almost my entire friend group and for him to be like, this is all fake. And like, they would, if you dipped out, they would have another doctor in a week, you know what I mean?

They would. I don’t, I didn’t see it as cynical when he said it, you know what I mean? But I did, kind of feel as honest. Yeah, it was funny. I said that to someone else and she was like, well, our relationship is not fake. And I think that’s very true too. And so, But I do think that you can balance those things of saying I love what I do in vet medicine and I love the relationships I have with people and also this would all go on without me and you know what I mean?

It’s not going to stop without me and so I shouldn’t stop without it. You know what I mean? Meaning I, I should be able to go and do the things I want to do. So that was that. 

Kelsey Beth Carpenter: I partially agree and partially disagree only because I very much disappeared for a good while there. When I first developed my fibromyalgia and I was really sick, I pretty much disappeared. And even now I rarely post on social media anymore. And yet I still have maintained numerous of My connections, people that I did not know before I was Vet tech Kelsey on social media.

But I think what it came down to was I like the perspective of sort of, If no one knew me anymore, if everyone forgot about me, what would I want to be doing? And I think what I would want to be doing is I still would want to have one very firm foot in Vet Med and posting about Vet Med, but I also would want to be talking about other things as well.

If no one was listening to anything I’m posting, what do I want to post? And that’s what it came down to for me, I think.

Dr Andy Roark: I like that question of, you know, if no one else was watching, what would I want to be doing? I think that, I think if you can get into that headspace and then you make the decision that I would want to do vet medicine, I think that’s a really powerful thing because it’s, a difference in, in feeling like you made a choice versus you had no choice.

You were, you were stuck in the web. You were tied into what was going on. I do think that’s really true. One of the things that I think freed me up a lot in my career is having a couple of friends who just left vet medicine and then came back, later on. So, I had two people come to mind, the first one is like the speaking stuff that I do.

I always felt like I was on the hamster wheel. And if I stopped, you know, going to conferences or writing or doing these things, then everything would fall apart in that regard. And that would just, that door would slam in my face and I would not be able to do it. And then Sean McVeigh who’s a practice management speaker and a really dynamic speaker.

He was one of the best known speakers in practice management for years and years. And then he decided that he was going to only work for one company basically at their events. And he left and he just only spoke with him and he was gone for like five years and I had numerous times I thought along the way, wow, Sean has gone off.

He’s doing this other thing. If he wanted to come back, would people be happy to see him? Would opportunities exist for him? And the answer was, absolutely. Like, at least as many opportunities as you had before. I think people would be like, wow, you’ve taken, you’ve gone away, you’ve done some things, you’ve refreshed yourself, and now you’re coming back with new ideas and perspectives and things like that.

And you’ve chosen to do this. I think it would be, I think it’d be even more You know, opportunities for him and I don’t know that if I did not see him sort of go through that. And say, wow, you really can put things down and walk away and come back and they’ll still be there. I don’t know that I would have been able to make that choice from a practice standpoint.

I had more than one friend who was a practicing veterinarian who left and went into industry, whether it was pharma or diagnostics or whatever. And they would go and they would do work in industry as a technical services vet, which is, which has got their hands in the profession, but it’s not in the exam room seeing appointments is a different thing.

but I had a couple of friends who would go and they did it for three or five years and then they decided they wanted to own their own practice and went back and fired it back up. And I just, those people, I’m so glad I had those interactions with those people because I didn’t. I don’t know that I really believed that you could just put it down until I saw them, you know, and that that was a big thing in my life.

Kelsey Beth Carpenter: Yeah. I don’t know if all industries are that way, but that’s been my experience is that Vet Med will always make space for me. And I think that’s the case for everyone.

Dr. Andy Roark: Hey guys, you know, probably the number one plea for help that I get from medical directors, from practice managers, from practice owners, from lead technicians, and especially lead CSRs is, “Hey, Andy, help me, help my staff to deal with angry and complaining clients. They need ways to help these people because angry clients, complaining clients, they need help is what they need. And, our people aren’t empowered or they aren’t trained in how to do that.”

And so why isn’t there more training for this? Why aren’t there more resources that make teams good at dealing with angry and complaining clients?

Well, the number one reason really is, the way that feels natural for your team, the skills that they have that they would bring into the situation, they’re different in every practice. So there’s not a bullet pointed. This is how you do it way.

Which is why I end up in this place where people are like, “Andy How do I do this?” 

Listen, I made a course it’s called ‘Charming the Angry Client’ and it is my course meant for teams or groups to work together on all about dealing with angry and complaining clients.

I use what’s called the Davidow model of organizational response, which is a super peer reviewed, empirically tested way of addressing angry and complaining clients. 

And, I break it up into pieces so that it’s easy to digest. You can scatter it across a number of meetings, it is made to be watched with a couple people together. And then there’s discussion questions about how do we do this in our practice? What does this look like for us? What, when, think about a time that this happened and we saw it. How did we handle it?

Ooh, I also put a bunch of example videos in there of me being an angry client. So I will just give it to ya. As here’s Andy with his pet, and he is upset, and then you can pause it, and then you can talk about right there, “What would we do with this? How would we handle this, guys?” And it is a great, low stakes way of getting your team to talk about what they would actually do.

Guys, there’s nothing more powerful than your team. Talking about what they would actually do and comparing notes, sitting and getting lectured at is nothing close to your team, whether it’s just your CSRs, whether it’s four of your technicians working together, whether it’s a whole staff meeting and a manager or owner or medical director leading the meeting and being the facilitator guys, I put a whole facilitator guide in there too. There is a whole hour long broken up in a module section on how to run an active training program using this course.

And that’s all laid out there and how I do it, how I work with big groups, how it works, small groups, all that information is there. Anyway, it’s called Charming the Angry Client. It is on the Dr. Andy Roark website. I’ll put links directly to it in the show notes. Guys, I hope you will enjoy it.

I think it’s really valuable. It is honestly the most popular course I have ever put online. Grab yourself a copy. I hope you’ll get a lot out of it.

Let’s get back to this episode. 

Kelsey Beth Carpenter: Yeah. I don’t know if all industries are that way, but that’s been my experience is that Vet Med will always make space for me. And I think that’s the case for everyone.

Dr Andy Roark: I think our industry is weird. I don’t think people are like, if I quit waiting tables, are they ever gonna let me back into Olive Garden? I don’t know, you know, I don’t, I can’t, so I’ll walk that back and say other industries I think they have like advanced training. I think there’s, I think there’s probably some truth to that and I think it would be really hard to go to vet school and then immediately leave because you haven’t like, you know, trained that knowledge into muscle memory.

I think that would be very hard. But I suspect that the other I think, a lot of people struggle just to get off the treadmill in general, you know what I mean? So my wife is a college professor and she’s amazing. She’s absolutely amazing. And she has always wanted to work. Her career has always been important and like I’ve always supported her in that regard because she’s amazing.

And also, especially in academia, she’s gone through, she’s gotten tenure, all of, she’s done all the things. And so, but, I do think that there’s definitely a piece of it where she feels very much like she has sunk so much into this. I don’t know that she feels freedom to be like, nah, I think I’m gonna, I think I’m gonna take a couple years off.

I don’t know that those cards are open to podcast here talking about self identity.

Kelsey Beth Carpenter: I loved that episode. I loved that episode. And I cracked up out loud multiple times.

Dr Andy Roark: She is amazing. She left two tenure track jobs.

Kelsey Beth Carpenter:Yep. Incredible. 

Dr Andy Roark: I’m like, just the, God, the guts that she has is just amazing, like she is inspiring to me.

Kelsey Beth Carpenter: Yep. But I think that’s exactly, it is, it’s often not the experiences I’ve had in vet med that make me the best technician, like it’s my experiences outside of veterinary medicine that give me perspective that is valuable within veterinary medicine. And I think, like Dr. Sarah Boston is like a perfect example of that.

She’s got all this experience outside of veterinary medicine as well. And it makes her that much more incredible of a doctor. I mean, you too, like a lot of the stuff you talk about, you’re not just reading veterinary books or veterinary articles or going and doing veterinary things. Like a lot of the value you bring to veterinary medicine is from your experiences outside of it.

Dr Andy Roark: Well, thanks for saying that. But I think, you’re spot on too, in that, like, I mean, just, think about for a second, what really makes people into the people that they are, it’s just like, I think. I think things like maybe getting married but I think experience is like having children and, like, that will teach you a new level of organization that I don’t know, you know, otherwise for me, improv comedy was such a massive impact on my skills and approach to the exam room.

I mean, it’s just, I can’t explain how much I got from doing this weird hobby. And bringing it back into the medical realm, but it’s just the way I listen to people, the way I talk to people, the way that I look at problems and without panicking, you know, things like that. It’s just all that stuff came from telling jokes with other people on a stage.

And it’s hard to convince people of that sometimes. I really learned this. I mean, how many of us picked up projects and learned? Patience from painting, you know what I mean? Just being like, well, I used to be, I used to be so much more high, you know, high strung. And I learned that, you know, or we learn to meditate or we get to do yoga and we bring this back as part of our practice and mindfulness in the practice.

And again, it doesn’t have to be about wellness, but really anything in the way that you organize your thoughts, the way you treat people, all that stuff comes from outside of practice. I think when you get into practice and, you go in. You go to the same building every day, you punch the same clock every day, you talk to the same people every day, the pet owners rotate through the same rooms in front of you every day.

I do think it’s easy to get stale. I really think that perspective, I mean, it’s the same thing with international travel. You know, people go and travel to different cultures. It’ll change your life. It’ll change your perspective. But you’ll bring that stuff back in, like, I don’t know, maybe you’ll look at people and their relationships with their pets a little bit differently.

Maybe you’ll see cultural differences a little differently than you did before. But I think that whole stepping outside of vet medicine, I think that makes a ton of sense. But I think it’s, I think it’s wildly underrated.

Kelsey Beth Carpenter: Yeah, I think it was, I think one of the biggest lessons I’ve taken in recent years was that one of the things I would do differently if I had to go back is not dive quite so deep into veterinary medicine in the beginning. Because it was so exciting. We love it so much. It’s so easy to just commit your entire life.

But when I was single. I didn’t have any kids. Like I could just commit all this time to veterinary medicine. And that’s great. But it then limited how much I was growing in other ways 

Dr Andy Roark: Yeah, but could you do that though? Like could you because I again I fall hard like when I fall hard. Like when I got into improv, I was all into improv until my wife was like we have children. And you need to come home. Like you can’t be a Can’t be, at bars every night making people laugh.

I was like, I get it. Like, but you know what I mean? Like, yeah. when you get into vet medicine and it’s all new and it’s exciting and the people are new and excited. Like, I, I don’t, I, I would never have the discipline to not fall in love with something at the beginning. I think. I think that, I think the thing that I have had to learn in my life is that you can fall in love with the thing and then slowly kind of fall back out of it, but not all the way out of it.

Like, you can, you know what I mean? You can be all about dance class and then, just decide you’re going to dance once a week, you know, and that’s going to be fine. And it doesn’t have to go anywhere. I think that’s, I think that’s fine. I think a lot of us. feel like if we’re not as in love with the thing or we’re not as invested or involved or putting the time into the thing as we did in the past, that means that we’re burning out or that we’re failing or that we’re not as committed as we used to be.

I think that’s just a weird way of thinking about it.

Kelsey Beth Carpenter: Oh, I think about,now these days, I think about it like a relationship. You get in a relationship, you may fall very hard, but you don’t want to cut off every other part of your life because the second you get in a fight in that relationship You have nothing else to turn to and that’s when you hit a low spot. And so if you keep your friendships and your hobbies and all these things your life is more diverse. If one thing goes wrong in your relationship, you still have all these other positive things and same with vet med You’re gonna have a bad day in vet med. But if you have an improv class coming up There’s still something positive to bring you up. If you have a bad day in improv, you might have a good day in vet medicine. You know, like just not putting All the way there.

It helped me love veterinary medicine more, I feel like. 

Dr Andy Roark: Yeah. Oh, it’s not putting all your eggs in one basket. It’s not like this thing defines me. I think that’s really interesting. It’s interesting that you made that sort of adjustment on social media and kind of opened the, you know, opened, open yourself back up that way. But I do think that it’s funny.

There’s such sort of an arms race of who’s the biggest Doctor of the doctors, you know what I mean? Like I’m more doctory than you are. And that’s why I’m going to, I don’t know. That’s why my opinion should matter more and that’s, I don’t know. It’s funny. I actually just, I just talked to a specialist and this person was, you know, boarded and just this incredible pedigree.

And it was funny because we were literally talking about still this person feeling intimidated by people who were I don’t know, the farther, farther along in the hierarchy, you know what I mean, of their specialty and being like, I don’t know, it’s intimidating to deal with them, but I’m like, you have all the degrees and they were like, yeah, but still, you know, it’s intimidating.

And it’s just funny that like, we get into this race of like, I’m more into it than you are. I think that’s true for any hobby. You know what I mean? if you, my wife used to work at a scuba store, like, doing scuba dive rentals and stuff. And she would talk about these people who would come in.

I don’t know if they actually did any scuba diving or not, but they owned all the equipment and they talked about it constantly, but it was like, I have no idea that people actually went scuba diving or not, but they were like, Boy, they would sit in the scuba store and just tell stories and talk about the latest equipment, you know, and I go, I guess I, I see that in vet medicine too, if that makes sense.

Kelsey Beth Carpenter: I think one of the biggest pieces of wisdom that I’ve gained in my 30s has been that growing up, I wanted the biggest life I could make. I wanted to be famous. I wanted to be the best at everything. I wanted to have everything. I wanted to do everything. I wanted to, like, you know, I wanted it all. And I think in my 30s is when I realized, like, I don’t want that at all.

I think I thought I was supposed to want that and now you know, what I really want is a very small, very joy filled, very simple life. I just want to fill my life with things that make me happy And I don’t that means I don’t have to be the best at them like I can be a vet tech and be enjoying myself in whatever capacity I am a vet tech, and I don’t have to be the best vet tech to like completely enjoy it in some ways.

We were just talking before we started recording about, you know, starting new hobbies and being bad at them. Like in some ways it’s more enjoyable to not be the best and to stop running that race. Like it makes life more fun and more free. And yeah, I just want a very quiet, simple, just happy life now.

Dr Andy Roark: Yeah. I think most of us run into that probably in our thirties. It happened for me in my thirties. Right, right, right when I turned 40. That’s when I slammed into it. There’s this guy, he’s a columnist. His name is David Brooks, and he’s got a book. It’s called The Second Mountain, and I really liked it.

I thought it was really good, I thought it was a good idea. It’s not a great book, but it’s a good idea. And so, basically, his idea, Kelsey, is like, is to He says that when we’re brought up, we’re shown the first mountain. And this first mountain is the type of material success that you’re talking about.

it’s attention, it’s wealth, it’s, you know, career success. it’s what, whatever the thing is in your mind, that is the big, flashy, glamorous thing that you think you need to have. And we all charge and start climbing this mountain. And at one point, one of two things happens to us. We either just kind of Don’t get there and we’re like, well, this sucks, you know, like this or You do get there you climb to the top of that mountain or up near the top of that mountain. But in either case regardless of who you are at some point you realize This isn’t what it’s all about and like it doesn’t really matter.

I don’t I wish there was a way for people to recognize that mountain

Is– it just doesn’t matter without spending 30 years of their life trying to climb it. I don’t know that there is you tell people but like anyway I had like I had to burn out and just be like this is terrible and I’m running on this treadmill and like It’s just not rewarding and I don’t know what I got from our work.

Kelsey Beth Carpenter: I remember you telling a story about how one of the things that you thought you wanted, or that you were supposed to want, was to open your own practice. And it was your wife who talked the sense into you and said, It’s the middle of the afternoon and you’re hanging out in the pool. you want to get rid of that? That you’re not happy with that life?

Dr Andy Roark: I felt, yeah, I felt like I was supposed to own a business that had a big, that had employees and had a big building around it. And yeah, I had a great thing going and all I could think of was like, yeah, but this isn’t the, this isn’t the mountain that I had decided was so great.

So anyway, in the book, he said, he says the second mountain is, this is, interconnectivity. After you try to climb the first mountain, you realize that what really matters is how you’re connected to other people and the relationships that you have. So anyway, I’ve always, it’s stuck with me forever, but I really liked that a lot, but, well, Kelsey, I really appreciate you being here.

Thanks for talking through with me about, you know, getting out of that medicine and what it means to be in vet medicine versus what it means to be a person as like, I don’t know touching that medicine adjacent to that medicine. I don’t know.

Kelsey Beth Carpenter: I don’t know. Doing the wave into vet medicine.

Dr Andy Roark: Doing it, and then it comes back. Yeah, it comes back the other way. That’s it. All right. Thanks for being here, Kelsey. Thanks for listening to everybody. Take care of yourselves. And that’s what I got for you guys. That’s the episode. Thanks so much to Kelsey Beth Carpenter for being here. I hope you enjoyed it. If you did leave us an honest review, wherever you get your podcast or send it to a friend, help us get people to know the podcast exists. That’s all I’m asking.

So anyway, gang, take care of yourselves. Talk to you later. Bye.

On A Mission to Get Birds Better Care

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Dr. Nick Kirk teams up with Dr. Andy Roark on this week’s episode of the Cone of Shame Podcast to discuss how he turned his passion into a unique business. Together, they dive into Dr. Nick Kirk’s journey to board certification, his business partnership with a technician, and his mission to share knowledge in avian veterinary medicine.

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

LINKS

Migratory Avian Services: https://migratoryavianservices.com/

Association of Avian Veterinarians: https://www.aav.org/

American Board of Veterinary Practitioners: https://abvp.com/

Uncharted on the Road: https://unchartedvet.com/on-the-road/

Charming the Angry Client Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: https://drandyroark.com/store/

ABOUT OUR GUEST

Dr. Nick Kirk grew up in the Middle Tennessee area, and is a Nashville native. He received his B.S. in Biology with Minors in Chemistry and Music at Belmont University in 2012. After undergrad, he went to the University of Tennessee College of Veterinary Medicine where he graduated with his Doctorate in Veterinary Medicine in 2016. He then went straight into emergency medicine for two years until receiving advice to move to Utah for further avian and exotic training. He then started an ABVP-Avian Residency program at his clinic under the mentorship of Dr. Scott Echols. During this time in Utah he worked in private practice, with three separate facilities (including an all avian AZA facility) as their primary care veterinarian, participated in research, gave national and international presentations, and also picked up relief at a local emergency clinic. After finishing his residency, Dr. Kirk returned to Nashville and passed his boards for specialization. At this time, he continued traveling back and forth to Utah for work and also founded Migratory Avian Services.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one. I’m here with Dr. Nick Kirk. He’s a boarded exotics veterinarian. He is the owner, co owner of Migratory Avian Services.

Guys, I talked to him about how he followed his passion and made his career into, kind of what he wanted to be. And it’s just, it’s a great story. It’s an inspiring story. I love the business model that he’s got. I love that he’s working with general practice hospitals and providing avian services through them and doing training for their staff.

I think that’s fascinating and, and just, just really, really interesting stuff. Neat guy, really cool business that he’s doing. 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. Nick Kirk. How are you? 

Dr. Nick Kirk: I’m doing great. How are you Andy? 

Dr. Andy Roark: I’m doing really good, man. It’s good to have you on the podcast. I love you being here. You are such an interesting guy. You and I met very recently just kind of by chance and I heard what you were doing and I was immediately interested. So for those who don’t know you are the owner of Migratory Avian Services Why don’t you just talk a little bit about what that is and kind of what your business model is. 

Dr. Nick Kirk: Sure. Absolutely. So Migratory Avian Services. I am partial owner in the practice Um, it’s one of the LLC’s that I am am an owner of but Migratory Avian Services is a service that goes around to dog and cat clinics and offers Um, specialty avian services because I’m a boarded avian vet Um, but also exotic services clients in the area around nashville that um, will provide extra services that they can’t offer.

I just, I really just love this immediately and it’s because like, I, so I’m a herp[etology] guy, like I a snake reptile or a reptile know, amphibian guy sort of by training and I, went to graduate school before in the vet school and I with with, mostly with snakes in my graduate training.

And I, so I’m a big, I’m a big herp[etology] fan. I think birds are awesome, and I do not feel particularly comfortable with them and so, but I want to make sure that pet owners of exotic pets have access to great care, and vets are being asked to know how to do so many things. I love that migratory avian services, you’ve come up with this idea of being able to move around and support general practices in brick and mortar facilities so that they could provide some of these services so they can support those pet owners.

I just think, I feel like you kind of came up with a neat way to sort of scale yourself of being able to move around and support these different groups. Because we always hear, you know, dog and cat owners come in and I’ll talk to veterinarians and I’ll say, well, do they have exotics? And they’re like, no, they, and I’ll say, how do you know?

And they’re like, well, they didn’t. They didn’t say so, but the truth is they’ve got, you know, I’ve got a bird at home or whatever, but they’ve got no signs that it’s the appropriate to bring the bird to their general practice vet. And so I just, I think that there’s a need for the type of services that you provide.

And I just, I think your business model is really interesting. How did you decide to start this? So tell me sort of starting from the beginning. Let’s step further back. Talk to me a little about your training. When did you decide to be bored in an exotics with something you always knew you wanted to do?

How did you make that happen? Because there’s a lot of people, I think, who have sort of passions that they maybe feel like they didn’t get to pursue, or they may want to in the future. 

Dr. Nick Kirk: Sure. Absolutely. Um a lot of what was really into early on Um, even before vet school, uh, I was trying to decide going to go into like avian research or was vet school the appropriate path um got into vet school and realized very quickly that there is not a lot of Great avenues for people who Not just want to study exotics, but avian specific.

Um, I got really in depth in the community really fast, but the big thing that we’re trying to do with migratory avian services is provide services to not just clients, but education to um, clinicians around the area that will benefit if they’re trying to see avian and exotic animals. Um, give them an idea or at least some tools in their tool belt even if it’s not the specialty that we offer um, to have these patients be better cared for as opposed to kind of the um, the uh, that a lot of clinicians use that was just throwing in reflux system at a bird or, um, a bunny or or something like that, and actually offering more specific, uh, specimen care. 

Dr. Andy Roark: Talk to me about what that looks like. So, so you’re, again, this, I really this holistic support of the general practitioners in the area. Talk, talk to me about, like, what are those resources? What does that training look like, Nick? Like, do you go in and kind of do lunch and learns with, practices?

Like, like, and again, if I wanted to, I guess what I’m thinking is if I wanted to get my team up to snuff as far as just basic training, Basic exotic animal handling things like that. What does training for that look like? What do you think that people? What is reasonable to provide to a staff like what is was the staff’s kind of reaction to that. 

Dr. Nick Kirk: That’s a really good question. Um, a lot of the offerings that I– right now, since we’re a more new veterinary practice, it’s one on one with doctors. But when I worked in emergency medicine, which is what I did before uh, I. program. I did a lot of training for staff things like that.

And then once I got into my residency, I had staff that was a little bit more trained, but I still worked with emergency practice. Um, when I was in Utah as well as Moving back here to Nashville after I got my specialty and being able to do hands-on training and things like that is one of the most paramount.

But we are currently working on CE’s not just from the doctor side, but also the technician side with um, my nurse, uh, there, 

Dr. Andy Roark: That’s really cool. I love that you’re putting this with the education together to go along with the mission. Talk to me a little bit. So you have one technician, also the co owner of your practice, right, Devin? I’m always interested in technician owners.

I think that’s great. I love that. How did you decide– tell me about the birth of Migratory Aviation Services. How did you decide to go into business with your technician? What was the thought process there? 

Dr. Nick Kirk: There were a lot of thoughts that went into it. One of the main ones was how we work together from a doctor and technician standpoint. One thing that she is super valuable for is her attention to detail. I’d say she’s more of a type A person, I’m more of a type B. I roll with the punches, but she’s more of a structured person.

But when I think about how our practice works, we really work hand in hand and having her be a part of the business, as opposed to just being a paid employee was really important to me because I think from everything that I’ve learned as a veterinarian for, you know, the the almost 10 years now after graduation um, is the veterinary team is truly a team.

And if it’s going to be a small practice, then everyone should benefit from the success.

Dr. Andy Roark: No, that totally makes sense. I really like that. I just think that’s interesting, especially talking about the education and things. And I also love, it totally makes sense, you know, when you’ve got this partnership of skill sets. And as someone who benefits from having a type A person as a partner, I like, I love that.

A hundred percent that makes sense to me. 

I am so proud to unveil the biggest project I have ever worked on. This is a partnership with NAVC’s Vetfolio and Uncharted, which is the veterinary conference that I started and run. For 15 years, I have worked with people on being effective as communicators and making their practice better places to be.

Now, I am so thrilled to be launching the Leadership Essentials Certificate with Uncharted and Vetfolio. Guys, these are the seven courses that I believe, really believe anyone who’s leading other people in vet medicine should have. This is vision and value setting. This is basic strategic planning. It is understanding different communication styles, and I have my friend, Stephanie Goss, uh, helping teach that session is, uh, getting the team to buy in to new ideas and initiatives.

It is how to coach and give feedback. It is how to set priorities. It is how to delegate effectively. It is how to do time management. It is the talks and the stories that I am probably most well known for giving. My red dot talk is in here. My GPA talk is in here. Everything about the north stars, everything that I Layout where I’m like, this is just so essential to managing people.

It’s the trust game. It is everything about building and maintaining trust with your team. I think that this is something that I would recommend for anyone who is a practice owner. Uh, it’s anyone who’s definitely who’s becoming a new practice owner. It is for anybody who has especially gotten promoted up into management.

It is huge for our team leads. We take people who are CSRs, we take people who are technicians, and we make them lead techs or lead CSRs, and we give them zero leadership or management training. There’s no excuse for that anymore. This is, this is on demand whenever you want. It’s broken up. It’s eight hours.

It’s got race CE. It has the Uncharted Vetfolio certificate with it. It is there, it is accessible. I really hope that people will take this and put it to work. I went really hard on this. It has been years in the making and refining to get this content down and right. So it is really for everybody who is leading and managing other people in vet medicine. I hope you will check it out.

I’m so proud of it. I’m so glad to be partnering with NAVC on it. Anyway, guys, I’ll put links in the show notes. I hope you’ll have a look. Let’s get back into this episode

let me step back here and ask you your general perception here. So when you start thinking about the care that veterinary medicine in general provides for avian patients, and again, I know this is, I’m sure the answer is regional. What is your general take on education that we have for doctors, for technicians, exotics, avians?

Do you, are we in the dark ages? Do you feel like most bird owners can probably get competent care? Like, where do you think we are? Is it, is, yeah, I just, I’m interested in a general temperature check from you. Are you going are you going to clutch your forehead like your migraine has appeared?

Or, are you okay with where we are? 

Dr. Nick Kirk: That’s a really good question. Um, and the true answer is that there is a whole lot of difference between the practitioners. There are tons of. Non Avian Boarded Certified Practitioners that can provide um, great avian care some, just like anything else, Boarded Avian Practitioners who may not be completely on the cutting edge, like, For example, myself and my residency with Dr. Scott Echols. Um, we are very intertwined with doing advanced imaging and things like that. That’s not very common within the avian world. But as far as general care, I think that a lot of people, and I’ve heard this from multiple clients when I moved back to Nashville, I heard that there are practitioners who won’t even take the bird out of the cage and do a complete physical exam.

And that worries me a lot. And I want our avian patients to have as good of care as our dog and cat patients. And that’s one of my main goals.

Dr. Andy Roark: I think that’s a very, like, it’s a simple, clean goal. I want our avian patients to have the same care level as our dog and cat patients. That makes sense to me. I want to ask you this on two different levels. So part of it is as I look at you and I look at what you do And again, I see an obvious deficiency in my own game here and I go, okay there’s actually really two different levels that I’m interested in here.

The first one, I’m curious in how you, Nick Kirk, decided to go in this direction. Like what does it look like to move from emergency medicine. I don’t, I’m curious when you got into your residency, how you had positioned yourself to be able to make that transition. I’m sure other people would want to know that.

And then I think I’m gonna ask you that first, but then know that I’m going to come back around. I’m going to ask you as a general practitioner who would be interested in sort of trying to raise his game. how, can a practice that doesn’t have access to you say like what are some of the basic steps they start to take?

So let’s start with you specifically. So Nick, how, did you, open this door to kind of start moving down this sort of very specific path that you’re on. 

Dr. Nick Kirk: So, I really started with doing networking through different organizations. So AAV was my big one, the Association of Avian Veterinarians, but I been involved with ARAV and then, which is the Reptile Association and AEMV. Which is the exotic small mammal association. But my main one was AAV.

I started to go to conferences during vet school. I hadn’t missed one for a long time. I missed one this past year, but that’s okay. But the reason I got super involved, is not just because I was interested in avian medicine, but also the research aspects of it and furthering medicine in that, in those cases, which led me to trying to do a specialty and things like that.

And I’ll circle back to that, but I did actually start my residency program when I was in Utah at a private clinic through ABVP. So the American Board of Veterinarian Practitioners. And once that residency was started, I was able to get boarded through that program, but the whole reason got into that was to really dig down deep and join these people that I’ve read books from, read papers from, and everything to try and forward medicine, not just for the specialists, but for everybody else.

And, you know, we need to make the general practitioner, if they want to see birds, feel more comfortable with it, as opposed to, oh, I hear this a lot from practitioners. Oh, we’re going to pick up this bird and it’s going to pass away in our hands. 

(laughter) 

Dr. Andy Roark: Yeah, I hear that. I may have made that joke. I may have made that joke. Yeah, I get that. No, but you’re right. That totally resonates. 

Dr. Nick Kirk: Yep. Well, and I mean, like, the easiest part is starting your physical exam with just a general visual exam. Before you even pick up that bird. But there are so are out now, um, including AAV, the, um, the avian, uh, association is providing, um, opportunities for to have Not specialist level uh, introduction, but, general practitioner introduction programs that they offer. 

Dr. Andy Roark: So you’re in general practice in Utah, and you’re starting your board with ABVP. So you’re in Utah, and you’re, yeah, you’re in Utah, and you’re starting your you know, boarded process through ABVP, and are you seeing a ton of exotics at this time? Are you it was it, were you in a hospital that had a large exotics department that, or you know, or are there doctors. Is that sort of comes from? 

Dr. Nick Kirk: It was. So, um, one of my mentors, Brian Speer who’s actually in California, runs an all avian vet practice, medical center for birds. I did an externship during vet school with him. And then he connected me with Dr. Scott Echols, which uh, was my mentor for the residency program. And essentially it was like, Hey, if you want to be an expert on birds, go work with him and,

I did the interview process and everything worked out and then I did the footwork to create the residency and everything that went out for that as far as like, uh, sitting for boards and meeting the qualifications. 

Dr. Andy Roark: That’s fantastic. I know, I love that you found this thing and you made it your own. I just, I love that vet medicine is a house with a million rooms and like you have, you’ve found your way. I love how you’re sort of sharing your knowledge out across practices. I just think it’s a neat business model.

I love that you’re a partner with your technician. I just, I, there’s just so many things about what you’re doing. I just think it’s really refreshing. I am so optimistic about the future of vet medicine, but I, Nick, I really think that you’re making your way in a way that’s just, sort of inspiring in all honesty.

So I love that you’re doing that. Thanks for the resources. I really everything up in the show notes. I always want to support people who want to start raising their game and practice. 

Where can people find migratory avian services? Where can they find out more about you? 

Dr. Nick Kirk: Um, migratory avian services is available online.. We have a website, migratoryavianservices.com. We’re on all the socials, you know, um, like Instagram, or Facebook, the same. We can uh, absolutely reach out to folks. I am super into people being willing to shout out, but um, as far digitally reaching out, I’m definitely into that as well.

So, I would rather see the community grow with better knowledge than us just trying to keep specialists and general practitioners separate.

Dr. Andy Roark: That’s awesome. Thanks for being here, guys. Thanks for listening, everybody. Take care of yourselves. 

And that’s it guys. That’s our show. That’s what I got for you. I hope you enjoyed it. I hope you got something out of it. Thanks Nick for being her. Gang, take care of yourselves everybody. I’ll talk to you later on.