Board-certified veterinary dermatologist, Dr. Ashley Bourgeois, joins Dr. Andy Roark to explore cutting-edge developments in veterinary dermatology. The focus is on Fluorescent Light Energy (FLE), also known as photobiomodulation (PBM), and its revolutionary applications in addressing diverse dermatological cases. Dr. Bourgeois demystifies the workings of this light energy, and provides insights into seamlessly integrating this innovative technology into veterinary practices.
Referenced Article: https://todaysveterinarynurse.com/dermatology/fluorescent-light-energy-therapy/
The DermVet: https://thedermvet.com/
Uncharted Veterinary Podcast: https://unchartedvet.com/uncharted-veterinary-podcast/
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).
Dr. Andy Roark: Welcome, everybody to the Cone of Shame veterinary Podcast! I am your host, Dr. Andy Roark. Guys, I got a fun one here for you today. I’ve got my friend, Dr. Ashley Bourgeois here. She is a boarded dermatologist and this is a, this is what our conversations are like. I was reading through my magazines as, I explain in a moment and I found an article on fluorescent light energy in dermatology. And I was like, this feels like voodoo. This feels like just, just some hand waving medicine that gets recommended in drum circles. Like that’s what it sounds like to me and I texted her, I was like, “is this legit?” And she was like “Totally!”
And I was like, ou gotta be kidding me. And she said, yeah, I’ll tell you about it. And I said, great. Let’s, let’s turn the, let’s turn the microphones on. And so that’s what happened here. There’s not a sponsored episode at all. I just, it was something I am not familiar with. I’ve not gotten to use this and Ashley was great about running me through it. So anyway, if you are familiar with FLE or Phovia. is the brand name that she refers to then you’re going to learn about it here. But anyway super fun stuff. Gosh, what an amazing time to be alive. Let’s get into this episode.
Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Ashley Bourgeois. How are you?
Dr. Ashley Bourgeois: I’m so wonderful. How are you doing?
Dr. Andy Roark: Man, I’m good now that you’re here. It’s good to see your face again, old friend. For those who don’t know you, you are a boarded veterinary dermatologist. You practice at the Animal Dermatology Clinic in Portland. You do a bunch of stuff online and things like that, but that’s not where I know you from.
We met way back in vet school. When we were doing the VBMA stuff and have sort of kept in touch ever since. And I get to see you at conferences and you are just a, you are just a gift to our profession. And so I just, I love having you here and I really appreciate you taking time and I will say here’s.
Here’s a feather for your cap, when I was reading an article, and I was like, I don’t know what this is, I need to talk to someone who could explain this to me, you were the person I texted. I was like, I’m gonna ask Ashley, hey, is this legit? And I texted you, and that started our conversation that led to this podcast, so, I will get into what that means in a moment. How are you doing?
Dr. Ashley Bourgeois: Yeah, I’m doing well. It is. It’s really funny to think about when people ask me, like, oh, do you know Andy Roark? And like, I mean, I knew Andy Roark he was Andy Roark. I will say, you know, National VBMA, which when we were on the national board was young, right? VBMA was really just going.
I never had any doubt. Like when you started being well known. I’m like, that makes sense. So it’s really cool to surround yourself with people, right. That you either went to school with, or were involved in certain organizations. And as we were talking about before we started recording, we’re getting old now that we can start to say like back in my day, like, you know? Over a decade ago when we were on the VBMA together, it’s pretty, it’s a cool journey to really see people blossom.
Dr. Andy Roark: Oh, yeah, it absolutely is. It absolutely is. It’s funny how you, it’s a small profession and it’s funny people who hustle and do stuff tend to kind of turn up again and again and I really, I think you end up, you just, you sometimes you meet people early on and then they just never go away.
You’re just kind of around. And so that’s been great. But it has been wonderful watching your journey. I, texted you because, and let me just say it front, this is not a sponsored episode at all, or anything like that. I was just, I was reading through my journals and I came across an article in Today’s Veterinary Nurse about using fluorescent light energy for dermatologic therapy.
And I texted you because this was kind of a new concept for me as far as in practice. And I’ll, be honest. It sounds like voodoo. I was like, yeah. Is this like, you know, is, this like, you know, using salt crystals you know, things like that? I texted you like is this legit? And you were like, yeah, it’s pretty legit, Andy.
And so I was like, okay, I’m sure I’m not the only person who’s not very familiar with FLE. Can you just give me, give me a primer, start at sort of a mile high, what is this? And then we’ll sort of dig into how is it useful in practice, potentially.
Dr. Ashley Bourgeois: Yeah, definitely. And I’ll say anything, anytime something comes out in dermatology, because we are very right. Product heavy specialty. The first thing is that sounds cool, but show me the research. So I think it’s pretty normal when you hear something that’s different that you want to say, but, prove it to me.
So you’ll hear it called a few different things. FLE, like you mentioned, you’ll hear it called photobiomodulation. And primarily the unit within the veterinary field is Phovia. And the idea behind this is that there’s actually a gel. So it’s not just a light. What’s really important is it’s a chromophore gel that you put on lesions, which we can talk about specifics.
And then the idea is that light unit is a blue light. But what’s important is when that light actually hits the chromophore gel, it creates almost a rainbow effect of different wavelengths and lights. And why that’s important is it kind of hits different layers of the skin, so different wavelengths go different depths.
But then each light, like there’s red, green, blue, each light actually has different benefits too. So whether it’s anti-inflammatory, it’s encouraging different growth factors, which can help with wound healing, or being antibacterial, you get kind of that cascade of events just by putting one light on it because of that gel.
And so it is a pretty interesting technique and they actually do have literature behind it for deep pyoderma, superficial pyoderma, even things like perianal fistulas. So I think it’s a pretty cool tool. Yeah.
Dr. Andy Roark: That’s so perianal fistulas have a personal place in my, and I don’t, it’s not in my heart. It’s the opposite of my heart.
Dr. Ashley Bourgeois: No, I don’t think anyone’s in love with the disease.
Dr. Andy Roark: No, it’s the opposite. If I had a hate organ, that’s where it would be, but yeah, that’s fascinating. So the gel itself, is something that come in and gets applied in the clinic just for the transmission of a light? It’s not something that you would continue to apply at home anything like that? There’s no benefit to that, correct?
Dr. Ashley Bourgeois: Yeah, correct. It’s like photo activated. So the way that we do it is usually the protocol is twice a week, but you can do it back to back. So what I usually do is if I know I just did a Phovia treatment, I think last week in the clinic for like a very focal pyoderma. And so we’ll put the gel on, well we’ll use chlorhexidine if it’s a pyoderma, wipe that off, put the gel on.
The light is, once you press the button, it goes for two minutes. So it goes for two minutes, super simple. And then the light goes off. Then what you can actually do, because we all know clients are busy, if we can make it less hectic for them to have to go back and forth to the clinic, you can do the second treatment in a row.
So then I just reapply the gel. You want to wipe it off. the stuff that’s already used up, reapply, and then you just do another treatment, and then I’ll have them come in once a week, depending on what I’m treating.
Dr. Andy Roark: Okay. So give me some, examples of the things that you would be treating. I mean, so is this, does this have post operative functions? I mean, I, is this is this classic, you know, like deep pyoderma? I, what, walk, me through this. It kind of sounds like kind of sounds Like, like too good to be true?
Like, you just use it on everything. Like allergies, limping, storm phobia. Like it sounds like there’s a lot. Hey, give me, start, to ratchet this down for me a little bit and say, okay, this is when you would start to kind of think about FLE.
Dr. Ashley Bourgeois: Yeah probably not storm phobia, probably not trying to get the light energy to the brain for like anxiety, but I, you know, I’d say a lot of skin applications, I’d say the limitation is if it’s a really diffuse disease, right? Like if I diffuse pyoderma, that’s probably not gonna be really realistic. So I do need it to be focal or multifocal in a realistic manner, like two to three lesions, whatever makes sense.
I would say primarily, and as we’ve had this technology longer and longer, we’re finding more and stuff we can use it for. But I’d say where the most supportive things in the literature would be wound healing. So you certainly could use it post operatively.
I use it in things like I’ve had non healing wounds that get referred to me. So My first application of it was a benign mass that a primary vet had taken off, like the dorsal paw of a dog, and it just would not close. It had struggled for like six months. We cultured and did all the things we needed to do, but that had been done before too.
But when we treated the infection plus used Phovia, it was the first time that lesion ever fully resolved. So I’d say focal lesions like that, I’ve used it in acral lick lesions. because those are often infected and inflammatory. I’ve used it in focal deep pyoderma and focal superficial pyoderma. And there are actually our studies, true studies available showing that either you can use it as a sole therapy and something like a superficial pyoderma.
Again, if it’s more focal. Or you could use it with a deep pyoderma concurrently with an antibiotic. And with deep pyodermas, we often have to use several weeks of antibiotics. They were able to shorten the duration of antibiotic use by implementing something like FLE.
Dr. Andy Roark: Okay. Are there cases that you do not use this on? Something where you’re like, yeah, this either there’s contraindications or, yeah, or, concerns that you have? Anything that you would say, this is a case I would specifically not reach for?
Dr. Ashley Bourgeois: Yeah, so I would say that what I am cautious of, though, I’ll talk about a couple things that maybe it’s different is traditionally when it came out, we were really cautious of anything that could be cancer, like a neoplastic process, because you are encouraging growth factors. So if it was just like a nodule sitting there and I didn’t make sure it wasn’t a mast cell tumor, there was some uncertainty, like we could not make it worse.
But I actually have had colleagues, because in DERM, sometimes we are the Wild West, right? Like, we have lots of options, we deal with lots of things. I’ve had some colleagues actually use it on focal areas like skin lymphoma, and have seen results with it. So, we’re cautious of that. I think that’s one I’d still be a little bit, you know, weary of before I got more information, but hopefully we’ll see further studies and information come out as we have it longer.
Dr. Andy Roark: Gotcha. What you said, you know, you can do the treatment sort of back to back. What is the standard sort of treatment period? Is this a fairly short session? I guess what I’m, thinking about here when I think about like, laser therapy for joints, arthritis, things like that. is it that, that’s kind of what’s in my mind.
How comparable are those in the actual performing of the therapy?
Dr. Ashley Bourgeois: So I would say kind of depending on what you’re treating. If it’s a superficial pyoderma on average, I probably do it about, you know, three weeks and then I recheck them. And the nice thing about it is it’s something that you can train. I’m all about utilizing my assistants, my technicians. So this is something that once we have the treatment protocol set up, then they come in for treatments with them.
You know, they know how to do it. It’s very straightforward. So it’s something that we can actually have the staff do. It’s really good as far as utilizing their skills and their techniques. So I’ll usually have them do like three treatments and then we’ll recheck. That wound I was talking about that was non healing, I think we did that one for probably about like six weeks, but I was rechecking kind of every couple weeks in between.
So there’s not really a contraindication going too long. There’s even some that will use it for maintenance, like things for perianal fistulas, but it just depends on, you know, how convenient it is for the owner to come in for treatments and how much they’re willing to keep up with it.
Dr. Andy Roark: Do owners tend to get it, you think? I mean, I couldn’t, it kind of, I don’t know, it seems to me like it would be hit and miss. Like some owners would be like, that’s too, that’s woo woo You’re going to shine a special light on my pet and he’s going to get better. Versus others that are like, oh yeah, I am here for this, for this specific therapy. Yeah.
Dr. Ashley Bourgeois: I find it hit or miss. I mean, to be frank, I, mean, I think that’s true for anything that I do in dermatology. Some people really get it for some people if we’re already going to have to utilize something like say an antibiotic. You know, maybe cost is an issue, right? Because of course we have to charge for that service.
So, I have had some people, I am in Portland, Oregon. So some people are really excited about anything that’s not traditional. So, and I think there’s something to be said for that. I mean, I still have to use a lot of antibiotics and dermatology, but I’m totally game for anything that gives me the ability to be a steward of antimicrobials and try to use less or shorter durations.
So I would say it is hit or miss. Certainly I give estimates out for it and people don’t do it. But I think if you really explain it like, “Hey, there’s studies showing this can not only help with infection, but stimulate, you know, wound healing properties that we might be able to shorten the duration of antibiotics.”
A lot of people really do buy into that. If you can say that it truly has support behind it.
Dr. Andy Roark: Are there things that you wish you knew when you started playing around with FLE? Were there lessons you kind of learned along the way?
Dr. Ashley Bourgeois: I think just the confidence and actually recommending it, right? So very similar to you when things come out, you know, I’m, pretty cavalier. Like I, I’m always up for innovation and trying new things. I think that’s the beauty of veterinary medicine. I never want to be the person that’s just like, “Oh, well this has worked for 30 years. That’s what I’ll do.” Like, I always want to try new things because that’s the beauty of our specialty, but of course, like I’m like, there’s this cool way like we could try it. I don’t know. So I think the important thing is the studies right? To be able to say there are truly studies that show the benefit of this, but I also am totally fine if people say it’s not for them.
Like I, you practice long enough. You kind of, you know, you get used to like, that’s not for you. That’s okay.
Dr. Andy Roark: Hey guys, did you know that I have another podcast? I am the host of the Uncharted Veterinary Podcast with my dear friend, practice management goddess, Stephanie Goss. We, we have been answering questions for years. We started a year before Cone of Shame. I started doing the Uncharted Vet Podcast with Stephanie.
We take questions from our mailbag. We have listeners who write to us and they tell us about what’s going on in their practice and we try to answer their questions and they are all about. Communication, leadership, management, things like that. It’s about working with clients. It’s about working with staff.
It’s about working with your boss. It is about all of those sorts of things. We have everything from, trying to establish some trust in your team when you’re a brand new baby doctor, fresh out of vet school to, managing an employee with mental health issues to, how to. How to give notice without the guilt if you are in a place, you just can’t be there anymore. We’ve got all that stuff. We’ve got hiring, firing, working together, working with clients, reviewing your systems, getting your practice to run smoothly and efficiently, how to manage your time. All that stuff is there. Check it out. I said 250 episodes.
You can see what everyone is about, from the title because it’s what, it’s basically the question that we’re being asked. But anyway, it is a very popular podcast. I hope that you’ll check it out and enjoy it and love it. I just love making it. So anyway, I just want to tell you it’s there. Guys, let’s get back into this episode.
Yeah. No, that totally makes sense to me. I’m with you too. It’s- I never want to be like, “that’s how we always did it”. And, at the same time, I take people’s trust in me really seriously, which means I don’t want to be in there like, “Hey, here’s some stuff. I just, I got it in the mail. I don’t know if it works.
It might be toxic. Let’s do it.” I, you know, I don’t want to be that too. So it’s it’s building that confidence, which is why I wanted to sort of talk to you about it and sort of say, okay, tell me about this as I, sort of look at it.
Dr. Ashley Bourgeois: And to your point real quick, it is totally fine to say stuff like that. Like I do get samples of stuff and I’m in Durham, right? So I have clients who’ve seen me for years and years and half the time, half the appointment is talking about like, what are your kids doing? So I will tell people like, there’s this new product out.
I don’t know much about it, but it’s supposed to do this. Or, you know, I saw some studies, just a couple of studies. So I’m really honest with owners. Like this is new. I don’t know much about it. I don’t have a lot of experience about it. Cause they appreciate that to your point.
Dr. Andy Roark: Yeah. when I’m thinking about sort of new derm therapies and new derm approaches, and you and I are talking here and it’s kind of, it’s still near the, first of the the first of the year, the beginning of 2024 setting FLA sort of stuff aside, what’s in derm right now that you’re excited about?
Like, what are you, what other tools are you looking at? I’m just fishing to be like, are there other things I should be really thinking about? But what are you Ashley interested in, excited about, optimistic about for the coming year?
Dr. Ashley Bourgeois: You know, I’m always optimistic that there is good research coming out just about learning more about what allergies really are. I think that in the last decade, we always think of itch, right? Like, Oh, they’re itchy. Stop the itch. And that’s so important, but I’m also really optimistic that there are being more studies looking at right?
Like when certain medications like apical and cytopoint came out, like they were not out when I started doing my residency. And it was kind of like now, you know, wow, they’ve been game changers, but I love also some of the attention that’s going into things like microbiome, like the differences in some of our allergies, right?
Like how come Westies are always little elephants? How come German Shepherds tend to have like ulcerative, crazy, nasty, like dermatitis, like there has to be phenotypic differences between some of these pets? So Itch is important. I think we’re going to continue to have more allergy medications that come out, which is great because we still have some cases that don’t respond to even the tools we have now.
You know, I always, we all cross our fingers more stuff for cats will come out. Like, I don’t think that will ever change.
Dr. Andy Roark: I know that’s exactly where my head was talk to me about allergies and cats.There’s such an opportunity there. I was really hoping you would have something you were like, oh, this is
Dr. Ashley Bourgeois: Everyone’s always like, you must know. Here’s the thing I’ll say about cats. There is a reason we don’t have as much, right? Like, of course, like, there’s, we see more dogs than cats, and you can get down to that. But the big thing is, think about the differences in cat allergies that we see. So, you see anything from an eosinophilic granuloma, Right.
To an indolent ulcer completely eating its lip to a cat who’s just itchy to feline asthma. Like there’s so many different presentations of allergies in cats. So of course, I don’t think it’s as easy to figure out and fine tune all of these things with cats because they have such wildly different presentations.
So there has to be some difference between the mechanism of action and pathophysiology of those diseases, right? So. We all want more stuff for cats. All I can tell you from the little I do know is it’s not for lack of effort from companies. It’s just that they can’t figure it out because cats are cats and they like to make our lives complicated.
Dr. Andy Roark: Yeah. No, they don’t. It sounds like there’s not going to be a cat allergy off switch that we can just find and flick. That would be nice.
Dr. Ashley Bourgeois: That would be so, even for us, people are like, Oh, but derm. I’m like, we have the same tools as you.
Dr. Andy Roark: Yeah, exactly right. There’s not a secret derm medicine cabinet that you guys aren’t aware of. Like we have the same stuff that you do. Oh man. Ashley Bourgeois, thank you so much for being here. What before, before I, yeah. I’ll let you go. So jumping back to FLE real quick. If people are interested in this, if they want to learn more, I will link the original article that I just was happened to be reading when I decided to text you.
What are the resources that you really like that you would kind of point people towards if they wanted to learn more?
Dr. Ashley Bourgeois: Yeah. Honestly, what’s a really good resource is just going to the Phovia website. Like if you just Google Phovia. I think it’s like Phovia.us or something like that. We could look it up. But the Veto Kenal True website has their literature. their actual research there, and it links it to, like, these have been published, like, in VetDerm and other places, too.
So they’ll actually have the true studies there, and you can look at how they design them, you can look at the results of that. So it is worth checking out, and I do think we’re going to see more to come.
Dr. Andy Roark: All right. Sounds good. I will link to that in the show notes as well. Ashley, you do as I said at the beginning a bunch of stuff on online. You, you’re always telling Derm stories and lessons and pearls sharing. And anyway, where can people find you online?
Dr. Ashley Bourgeois: Yeah, you know, I’m a simple person, so it’s all under the DermVet. On Instagram, on Facebook. And then I have my own podcast that is just Derm Nuggets tips. A mix of just me chatting in your ear for 15 minutes and then a mix of interviews with other dermatologists cause I truly am a believer that we all do things differently and that’s okay.
And we should learn from each other. So I love to hear about people who do things differently than I do, but I put everything under the DermVet cause you know, I’m a tired mom of two. And so I just keep it all under the same name for simplicity’s sake.
Dr. Andy Roark: I love it. I will link to all that stuff, including the podcast and the show notes as well. Ashley, thank you so much for being here, guys. Thanks so much for tuning in and listening. Take care of yourselves, everybody.
Dr. Ashley Bourgeois: Thank you.
Dr. Andy Roark: And that’s it. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. Thanks so much for being here. Thanks to Ashley for being here as well. Gang, take care of yourselves. Be well. I’ll talk to you later. Bye.