Life With Clients

Ron Sosa, a Certified Veterinary Practice Manager and advocate for neurodiversity, dives deep into the operational challenges and management strategies that can help create an inclusive environment. On this episode of the Cone of Shame Podcast, Dr. Andy Roark and Ron Sosa explore practical ways to manage workload effectively while being cognizant of the unique needs of neurodivergent staff. This episode is invaluable for anyone looking to enhance team dynamics and understand the nuances of neurodiversity in the workplace. Don’t miss these insights that aim to foster a supportive and efficient practice environment.

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

LINKS

Ron Sosa on LinkedIn: https://www.linkedin.com/in/ronald-sosa-cvpm-53453797/

Synaptic Neuro-inclusive Leadership: https://ronsosa84.wixsite.com/synaptic-leadership

Dr. Know-It-All Card Game: https://drandyroark.com/in-the-know/

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Ron is a Certified Veterinary Practice Manager and a former practice owner and business director for multisite animal hospitals. He also hold certificates in Neurodiversity, compassion fatigue, veterinary business leadership, and the human animal bond. He currently serves as the Executive Director for the Uncharted Veterinary Conference., Dr. Andy Roark is a practicing veterinarian in Greenville SC and the founder of the Uncharted Veterinary Conference. He has received the NAVC Practice Management Speaker of the Year Award three times, the WVC Practice Management Educator of the Year Award, the Outstanding Young Alumni Award from the University of Florida’s College of Veterinary Medicine, and the Veterinarian of the Year Award from the South Carolina Association of Veterinarians.

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 today with my good friend Ron Sosa. Ron is a Certified Vet Practice Manager and an educator and advocate on Neurodiversity in veterinary medicine and I give him kind of hard question. I think I talked to him about wanting to support neurodivergent team members and also being honest about the workload that we have in practices And the fact that people in practice might not even know this person is neurodivergent and can get frustrated with behaviors or struggles that they don’t understand.

How do we do those two things? How do we support and also manage the individual and the rest of the team as far as their expectations so that everybody gets along and feels good and the work that we have gets done.

And so anyway, we, we get pretty deep into some of the management struggles around neurodiversity and Ron is fantastic. So anyway, if you have someone on your team who you think might be neurodivergent or who has disclosed that they are neurodivergent, this is going to be a phenomenal episode just for helping you get your head around you know, how to be a good supporter and how to work effectively with these people.

And so anyway, it just. Great conversation. Ron is so wonderful and positive and helpful. And just, I feel like I took a lot away from this episode. I hope you will too. 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, Ron Sosa, how are you, my friend?

Ron Sosa: I’m good. How are you, Andy?

Dr. Andy Roark: I am really good. For those who don’t know you, you are the Executive Director of the Uncharted Veterinary Conference. You are a certified veterinary practice manager, and your career has taken an interesting turn in the last year or two.

Because you’ve been doing a lot of writing on neurodivergence and neurodiversity in veterinary medicine and you write about it from a management perspective, which of course aligns with the Uncharted focus of running smooth teams and practices. And it’s just been really fascinating to watch you grow.

You’re doing workshops in this space and things like that. And so yours has been a career that I just creatively has really blossomed and I’m just glad, you know, as a, as the founder of Uncharted to, to get to watch it up close, but but I’ve got. I’ve got something that I’ve been kind of rolling around and I thought that you were the perfect person to talk to about it.

And so let me, let me set the stage and then kind of, kind of bring you in here. So, you know, I read a lot about running effective teams in vet medicine, something I care a lot about and, you know, for a long time. I, you know, I’ve taught SMART goals as a tool in our toolbox. For those who aren’t familiar with SMART goals it’s just making goals that are Specific, Measurable, Achievable, Relevant, and Time-bound, meaning they have a deadline on them. And so it’s, it’s a, it’s a good way to sort of format your thoughts and make a structured goal that you can then check yourself against and make sure you’re actually doing what you intended to do and that you’re moving forward in the way that you set out to move.

And so anyway, this is sort of something that I’ve talked about for years and And kind of had it and used it. And then I saw a post from one of my friends. So Dr. Kate Boatwright is she’s writing a lot these days as well. And I think she’s, she’s pretty smart. I do enjoy her. I, she’s been on the podcast before.

And so she had this post recently about the fact that she had been teaching smart goals and someone really pushed back against her and said, boy, I really, I hate SMART goals. And she said, SMART goals the way it was put to her was, SMART goals don’t often work or don’t tend to work for people who are neurodiverse.

They just the, the format doesn’t, doesn’t make sense to them and there are better ways to format information and work with people who are neurodiverse. I know neurodiverse is a big bucket. But really, it was interesting to see this strong pushback against sort of a, a format that seemed pretty sort of common sense to me at this point.

And so I was thinking about that and I was thinking back to something that you wrote recently about time blindness and you talked about people who are neurodivergent in some instances might struggle with deadlines and just being sort of time unaware. And I thought, Hey, you know, I would like to know more about this.

And so I’ve talked a lot here, sort of setting up, setting up the the reason that we’re sort of talking. Ron, let me kind of hand this over to you. Can you talk to me a little bit about let’s start at a high level. As a CVPM, as someone who is focused on efficiency and operations, and someone who is really interested in being supportive of neurodivergence in our practices, can you talk to me a little bit about the challenges that neurodivergent people face from an operations standpoint in practice?

Ron Sosa: Yeah. I think the number one thing that gets spotted probably the most is just what you said. We talk about time blindness and time blindness is basically the inability to tell how long things take what time of day it is, how long you’ve been spending. Like think about our exam room common problems where you send a technician in and they’ve taken 30 minutes of the appointment getting a history, Any one of us can experience time blindness. So it’s like, I didn’t even realize it was in there or think of time. You drove home from work and had no idea how you got home. You know, it was that autopilot moment, right? That is time blindness where we just, our mind goes on the auto drive. We have no idea, a sense of time, how long things are taking, how long things are not taking.

We’re just doing the thing right in front of us.

Dr. Andy Roark: it’s just it’s to me. I always look at that. It’s kind of a good thing in practice, right? It means you’re fully engaged with with what you’re doing. So if I’m working on a team with someone who’s neurodiverse is How often is is things like time dialing this? How does that come into play?

Is this is this someone who is constantly? Unaware of time or like what does that look like in in in day to day practice and how I’m working with this person

Ron Sosa: Yeah. I would say that, you know, the neurotypical person, it probably happens to, you know, a few times a month, maybe, but for the neurodivergent person, we’ve got to be really, really careful. And so I would say that being somebody who didn’t, was late diagnosed, didn’t really understand myself. I would say I had been late.

Torn to the other side where I’ve been extremely overly conscious of my time. And so when I’m in an exam room, I’m going to get in and get out and getting a history, but for others, if they may not recognize how much 10 minutes is or five minutes, I do a lot for that. And so it happens all at the time.

They have no idea how long they’ve been shooting an x ray for, or taking care of a treatment on a pet or, you know, educating a client. It’s just. They have no concept of what 10 minutes feels like, because 10 minutes will feel like an eternity in one moment, and it’ll also feel like two seconds have gone by in another moment.

So there’s no consistency of what it feels like.

Dr. Andy Roark: I think a lot of people Probably feel a little bit, I don’t know, a little bit torn or a little bit trapped when we start talking about colleagues with neurodivergence because we have a very compassionate profession and I want to be compassionate and I want to set people up to succeed. And at the same time, nobody wants to be buried under work and not having appointments get seen and things like that.

Hey guys, communication is key to creating amazing experiences in the clinic. From the phones to the front desk, to the exam room. The way our teams interact with pet owners makes a difference. The team training bundle I have Dr. Andy wrote.com brings together my charming, the angry client and exam room communication toolkit courses to provide flexible on demand communication training for your veterinary practice. Check them out. 

These courses are made to be taken. in groups, they have discussion questions. They are all about taking these trainings and getting them to apply to your practice, your culture. And your clients, whether it’s handling angry clients. Or being effective in the exam room. We’ve got some great training resources that you can grab and drop and use pieces of. 

They’re all broken up into five minute modules to make it super easy for you to use what you want and skip over what you don’t want. Tag them onto the end of staff meetings, or just make a whole staff meeting out of the trainings. Anyway, super flexible. It’s Dr. Andy Roark.com/team training gang. 

Let’s get back into this episode. And so it’s funny when I look at this post about SMART goals and, and, and my friend is getting this pushback that says, you know, this, this doesn’t work, this doesn’t help. And then I see things about like time blindness and I go, okay, I see that and I want to be compassionate. And also I don’t know how, how we run an effective team if we can’t pay attention to time or set, you know, actionable goals and hold people accountable.

Dr. Andy Roark: And, and, and, and also I would never want to have a profession that wasn’t open to everyone. And there are neurodivergent people that, that we work with who are, who’ve been absolutely, absolutely wonderful to be around. And so let me, let me sort of give you that little bit of conundrum because I know it’s something that you.

that you think about and write about a lot is, Ronic, start to unpack for me a little bit about what it looks like to provide a supportive environment and to be open and I don’t know, welcoming of neurodivergent people in our teams and also not have the rest of the staff get frustrated because we say, well this person, we’ve told them what the goal is and they, they don’t, they don’t work to it or we’ve, you know, we’ve told them what our constraints are and they’re not being met.

How do you manage those things?

Ron Sosa: Yeah, I think first we’ve got to recognize the fact that we’ve built society around the average brain chemistry, right? So, When we think about, Oh, we’re frustrated because somebody hasn’t achieved their goals. It’s because we’re, we’re being very rigid and not thoughtful about how different brain brain chemistries work.

And so, you know, I think about the smart goal and there’s something called a demand avoid, avoidance. So once you tell me I have to do a thing, it is much harder for me to want to do the thing. Whereas if I was already going to do it and I was already committed myself to doing the thing, I could, I can easily get it done.

Also with ADHD, you have the. It’s either now or not now. And so I’m either going to do it right this moment, or I’m going to forget about it until the deadline comes. And I’m going to do it in the last 10 minutes. so I think that’s part of the issue with, with smart goals is it does not unnecessarily allow for the followup needed or consistency of followup needed or the understanding of sensory needs that would preclude from being able to achieve the smart goals.

Dr. Andy Roark: Talk, talk to me more about sensory needs to achieve a SMART goal. What do you mean when you say that?

Ron Sosa: Yeah. So sensory, obviously we have our five senses, you know, we’ve got sight, smell, taste, touch and hearing. And so with neurodivergent individuals, we have a heightened or desensitized sensory system. And so, you know, fluorescent lighting, I think affects most of us, but think about that lighting situation, how that flickering fluorescent ball would bother the normal person now times that by 10 or a hundred, and that’s overly affecting that person.

And so I have a sensory hypersensitivity. You know, like this, some people have the hypersensitivity to a certain smell or I always equate this with allergies when you talk about the allergy pet who has a threshold, right? They’re allergic to trees, grasses, molds, weeds, and something tips them over the edge and they have an allergy flare up, right?

So they could be allergic to 10 things, but that 11th thing pushes them over the edge. That’s how I think of sensory. We can be fine with some of our sensory inputs until you hit that 11 thing and it completely pours over and you get breakdowns. You get emotional dysregulation. You get the inability to effectively do a task.

You get all of that. Just kind of breakdown and shame kind of. Sets in because you can’t do the thing.

Dr. Andy Roark: Do you think that that usually presents in a way that people recognize it and say, Oh, well, this is sort of sensory overload, or does it present generally as this is this is a team member who’s struggling this person? I don’t understand why he’s so upset about having to work in the isolation room. And the reality is, this is a really hard environment for him.

Let’s just say. But I don’t, I mean, most of us, we’re busy, you know what I mean? And we try to, we try to pay attention to other people, but we’re generally focused on ourselves and what we’re doing. And so, yeah, talk to me a little bit about that, about, about the presentation to management or in the team where you say, okay, how do I, how do I recognize when a team member is struggling say from a conflict with neurodivergence, from sensory input overload, things like that.

Or do I, or do I just. Do I just approach this person as an individual who’s struggling and help me, help me sort of start to put one foot in front of the other to, to trying to, to, to work with this person effectively.

Ron Sosa: And I think as a leader, I want to treat, treat the person like a human being, but I want to be aware of the possibility of what they’re going through. And so, and the other problem is most people born in our age group are underdiagnosed, like. I wasn’t diagnosed with ADHD until I was in my late 20s. I got an autism diagnosis in my mid thirties, and so I had no clue I had these quote unquote sensory problems until I was more aware and educated myself as to what was going on.

So I think that just seeing someone struggling is. The leader’s job is to like, Hey, what’s going on? And they may have no clue that it’s today. It’s the, you know, the Parvo dog smell and the block cat smell, plus the lighting, plus the, the kennel saw or whatever the smells that are going on. They just don’t have a clue as why they’re necessarily overwhelmed.

And I think a lot of people can relate to that. Like, I just feel overwhelmed today and I have no idea why. I can do the same job yesterday and be completely fine. But today is overwhelming me and the caseload is not as high.

Dr. Andy Roark: That, that, okay. So that totally makes sense. And it also, it makes it easier for me to sort of approach people because you just approach them as, as people and say, okay, I see this person is struggling. Imagine, imagine for a sec, Ron, that you were coaching someone who was a manager in a hospital or a veterinarian, who was, who was a rule following person, you know what I mean, who is very much a process version of this is how we do it, and this is how we do it, and this is how we do it, and everyone, you need to get your job done, and again, I, I, those people can be really, really valuable in a, in a hospital.

I, I can imagine a situation where people who are process people or rule sort of following people might particularly struggle with working with someone who’s neurodiverse and who maybe struggles with this structure or this, I don’t you know, just, just, Has a, has a hard day for reasons that aren’t obvious to, to someone outside.

Co, coach this manager, this leader for me a little bit to help them get their head into the right place where they can start to, instead of saying, well, she’s not following the rules. She’s not, she didn’t, she didn’t do this thing. We had this clearly stated objective and she didn’t get to it. How do you, how do you start to change that person’s mindset?

And then how do you, how do you help them? To be more successful and also be more comfortable.

Ron Sosa: sure. I think, the answer I’ll give to anyone is I really feel like we need to go through some neurodiverse sensitivity training. And even if we don’t call it that, we need to just be able to understand that everybody’s brain chemistry works different. In fact, I would probably say the person who is your you know, High justice, you know, seeking person is probably on the neurodivergent spectrum themselves because most autistics need to follow the rules and neurodivergent as a whole have justice sensitivity where they have a complete sensitivity to Need to follow the rules, need to be fair.

We need to have the same setting applied to each person. And it’s just not the case. Like every individual is a person, every individual has their own strengths and weaknesses, and we just need to treat people like people. And that’s what I would probably talk to, you know, this leader or this person who is coming up to me about the need for justice, so to speak.

It’s be like, you know, I don’t treat everybody equally. I treat everybody fairly. And I think that really goes down to what is their strengths? What is their weaknesses? How can I help them? What supports have they already received? What supports can I already, can I give them next? You know, what are they, what do they think they need versus what do I think they need?

I think there’s a lot of questions to answer.

Dr. Andy Roark: yeah, I, I, I agree with that. So if you’re working with someone who’s a neurodiverse team member, are there questions that you can ask Ron that you think help to open that conversation up? You know, it’s, I’m imagining things like are there, are there Are there days that you have noticed that you particularly struggle?

Are there tasks that are I, you know, I, I’m, I’m kind of digging at, at those types of things. I want to ask some open ended questions to have this person sort of tell me how they’re feeling or, or what their struggles are or where they feel like they get lost or bogged down. 

Because if I don’t have that conversation, I don’t understand what the challenges are I can’t really support them. Have you heard questions that help sort of open those conversations up in a nonjudgmental way that allows us to support neurodivergent team members?

Ron Sosa: Yeah. I it’s, it’s hard because number one, I would say most don’t disclose their neurodivergence because of shame of their past or, you know, Shame of, will I even get the job if I do this or will I get fired if I, they think I can’t do my job. So there’s a lot of non disclosure that happens. And then what I don’t want to do is have leaders out in the vet clinics trying to diagnose their, their team.

Right. And so if we have somebody who has disclosed, then we can start to talk to them about their specifics. You know, what sensory things. have you had problems with what, what sensory things have you not had problems with? Like, I think we can very, we can ask very specific questions once we know that there’s disclosure, but if not, and we have those who have no idea that they are neurodivergent.

And so I think I have to try to go back to like treating the person like a person. And you and I have done the whole, you know, let’s just sit down and talk and see what’s bothering you. I see you’re struggling. I look, we go right to the behavior and not the person. Like this is what I’m seeing. You know, how can we work best together to achieve what it is we’re trying to achieve over here?

Dr. Andy Roark: No, that, that totally makes sense. Ron, thanks so much for just talking through this with me. I mean, this is I think you, You put this in great perspective. This is really helpful. It’s not, you know, it’s a lot of it’s just sort of a mindset change. And a lot of it’s just sort of trying to understand and go, Oh, people’s brains work very differently than mine.

And and we’re just gonna have to talk to people and try to meet them where they are and figure out you know, it’s not about right or wrong. It’s just about different and sort of come up with a solution that kind of works for everybody. Ron, you’re writing a lot on LinkedIn. Is there other places that people can find your work or should they be following you there?

Ron Sosa: Yeah. I just started writing on LinkedIn. I’ve never considered myself a writer. And then I just, Decided to write an article that I was feeling really passionate about and it’s kind of taken off. And so I will say I’m hopefully going to have a book published in the next year is the timeline, is my smart goal, so to speak. So maybe we’ll have it out by next April is the goal. But yeah, all my writing right now is usually two to five minute blog articles on LinkedIn.

Dr. Andy Roark: That’s outstanding. Thank you so much for being here, my friend. Guys, thanks for tuning in and listening. Take care of yourselves, everybody.

Ron Sosa: Yeah. 

Dr. Andy Roark: And that’s it guys. That’s what I got for you. I hope you enjoyed it. I hope you took something out of it. Thanks again to Ron for being here. Guys. If you enjoyed the episode, please leave me an honest review wherever you get your podcasts. It means the world to me. It’s how people find the show. Anyway, take care of yourselves, everybody.

I’ll talk to you later. Bye. 

Beloved influencer and LVT, Sarah Parsons joins us to talk about her journey building a brand online. Join Dr. Andy Roark and Sarah Parsons, LVT, on the Cone of Shame Veterinary Podcast as they dive into the world of brand building in veterinary medicine. Sarah, the creative force behind the popular @Wat_Really_Happens_at_The_Vet social media channels, shares her journey and insights on leveraging platforms like TikTok, Instagram, and Facebook to engage with veterinary professionals. This episode explores the importance of creating content that resonates with a professional audience, the dynamics of social media growth, and tips for veterinary technicians aspiring to establish their own unique brand.

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

LINKS

Sarah Parsons on Instagram: https://www.instagram.com/watreallyhappensatthevet/

Sarah Parsons: www.vettechsarahparsons.com

Team Leads Summit: www.unchartedvet.com/tls2024

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Sarah Parsons, LVT, is a distinguished social media Influencer within the veterinary community, renowned for her engaging portrayal as the “silly vet tech” Through vibrant videos showcasing life in Vet Med, Sarah inspires laughter and learning among Veterinary Professionals. She is deeply passionate about fostering a joyful and fulfilling workplace environment. Her dedication has led to being one of the co-founders of Camp VetMed. In addition to her impactful career, Sarah is a devoted mother to two boys. She resides on a ranch in Houston, Texas, where she cherishes outdoor activities, sports, and quality time with friends.

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 Sarah Parsons, LVT. For those you do not know her. Sarah is the creative force behind the What Really Happens at The Vet Instagram TikTok young person social media outlet that she runs. She’s an LVT and she makes really funny videos and content. We talked about in one of her videos about getting 48 million views and like she’s got a string of hits . If you want to find some stuff that is positive and funny check her stuff out. She’s really I– she she makes me laugh.

And so yeah, I was really glad that she was here. We were talking about brand building today. We’re gonna talk about what it means to build a brand in modern social media. And that’s really her interest is in video creation and in putting stuff out online and starting to build a following. And so I know a lot of people are interested in what it means to build a brand as a vet professional. Maybe specifically a veterinary technician and we, we get into that. And so she’s got some good advice. It’s been, it’s fun talking to her sort of about her journey. I think you guys will enjoy it. Let’s get into this episode.

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

Dr. Andy Roark: Welcome to the podcast, Sarah Parsons. Thanks for being here.

Sarah Parsons: Hello! Thank you for having me! Super excited! Aaaahhh!

Dr. Andy Roark: It’s my pleasure. For those who do not know you, you are the create, you are an LVT and the creative force behind the what really happens at the vet Instagram and TikTok channels. You are very funny. I genuinely really enjoy. I really enjoy your work.

Yeah, you have got, you have amassed a massive following. You are one of the most popular veterinary influencers that I see out there. I, you are definitely one of my favorites for reasons that we’ll talk about here in a moment when we get going. You are going to be speaking at the Uncharted Team Lead Summit with me in in September, September 17th.

Tickets are going to go on sale in July. It’s a virtual summit for Head technicians, head CSRs, things like that. Yeah, so, yeah, let’s go ahead. I want to go ahead and just sort of start off. I want to talk today about brand building, and it’s something that I think a lot of people are really interested in.

It’s sort of an interesting topic. I want to talk to you. Honestly, I sat down and I was, I was, you and I were going to do some work together in some other ways. And so I had a couple things I kind of wanted to do with you, but, but then I started, I was like, what is the one thing that I would honestly like to talk to Sarah about?

And it’s this. Yeah. So this is, this is my, my, my real topic about, I want to kind of look at, I want to look at building a brand. I want to look at building a brand as a technician or support staff member. I want to talk a little bit about modern social media. I want to talk about vets, the vet world on modern social media and stuff like that.

So let me, let’s go ahead and start off with your resume. Can you kind of lay down Where do you publish your content? You know, how long have you been doing it? Just give me a, give me a picture of the what really happens at the vet empire.

Sarah Parsons: Of course. So it’s, you know, I feel like it’s a lot more simple than really, you know, how it’s being portrayed. But I do post on I know.

Dr. Andy Roark: Roll with it. Just act you’re like as one influencer to another, like take yourself very seriously and with it and roll with.

Sarah Parsons: No, there’s really a lot more that actually goes on behind the scenes and what looks at it. Cause I think a lot of people say like, oh, she posts funny videos and like, and what?

That’s, you know, and basically that’s it. But there’s a whole lot more that goes into it. I do post videos. That’s, you know, my main platform, of course, is posting my social media videos. I post on TikTok and Instagram and Facebook, you know, cross, cross posts on most of those platforms and and everything.

And I post funny, silly, relatable videos about veterinary medicine. My handle is what really happens at the vet. I honestly thought that my main audience was going to be pet owners. So whenever I started that, that is kind of why the handle was what it was.

And that’s just kind of how I started and how my thought process was starting off. But I realized very quickly that my audience was mainly veterinary medicine, veterinary professionals. I’m talking veterinarians, vet techs, veterinary assistants, CSRs, practice managers, anyone in the veterinary professional field.

And the reason, you know, I think people resignated with these videos is because they’re so relatable to veterinary medicine. You know, if you know, you know, whenever I post my videos, I think pet owners, you know, You know, realize what’s going on in the videos, but veterinary professors are like, Oh my gosh.

Yes. That’s so true And I love posting those videos But it basically became this, you know, platform where I would be talking to other veterinary professionals and so it kind of grew from there and I, and I’ve wanted to expand and do more things other than just videos.

I started doing Project Golden Vet, which was me going and gifting these gifting free things to other, you know, hardworking, deserving clinics or, you know, in Vet Tech Week doing the same thing, you know, gifting things to other vet techs.

Dr. Andy Roark: So one of the things I think I like the most about you is when, when I look at a lot of your work, it a lot with me. Because I, I have had that same journey of talking to vet professionals. Cause I also, my original plan was to talk to pet owners. I just, it never sparked the same enjoyment for me as talking to other vet professionals. And no, no shade on, on pet owners. You know what I mean? But like, and, and again, I see a lot of people who really love talking directly to pet owners. And there are some great Adam Christman is, is an example.

Oh, he’s fabulous. He does great work owners. And there’s just, there’s, there’s lots of others, but he’s the first one that pops into my mind. And like, but he clearly loves it. And I just, I never got that excited about making pet education videos. I, did it, and I went through a phase where I alright, I’m gonna really try this.

And it just, it never lit my fire. Like talking to other vet professionals who get it and like having those sort of inside jokes. And so I I really love it. Talk to me about about the Golden Vet Program So I love this idea that that you that you sort of show up and you do something nice. What like what did that how did you get that idea that like you were gonna?

Presumably you just, this is always a fear that I have is I, I think, I think about half the vet clinics in America, probably someone in there knows who I am. Like that’s, but that’s it. Like tops like.

Sarah Parsons: Oh yeah, I could just say Andy Roark and immediately people would know who I’m talking about.

Dr. Andy Roark: but I, but I never, never that for granted or anything. And so it would, the idea of me walking into a vet clinic, like I’d have to be primed.

I would have to know that someone there knows me and, not going to just look like a weirdo. Like, like, how did this become a thing in your life? So it’s imagine coming being like, sir, I, you have an appointment, sir? I’m like, I would,

Sarah Parsons: I was afraid of that happening too, but I, I made it, there’s a, again, a whole lot of behind the scenes that went on to make sure that that didn’t happen because not everybody knows who I am. So yes, whenever I did Project Golden Vet and I think a lot of people thought I was crazy when I was like, yeah, I’m just going to go give free stuff to these clinics and just really contest.

And they’re like, okay, Sarah, great. Great. Like. How does this benefit you in any way? And I’m like, it doesn’t so what I would do, and I would work with like, I would get, donated items or sponsors and stuff. And I would I’m, I get this big basket of just stuff, gift cards and just stuff that veterinary professionals can use, like those little clippers off of Amazon and just a whole bunch of different items.

that veterinary professionals would use, and I made sure I said, to all these, you know, companies that I would work with, I said, I want everyone to have one. I’m talking from the veterinarians and practice managers all the way down to the janitor a clipper. 

Andy Roark: You get a clipper! You get a clipper.

Sarah Parsons: Exactly, you get a TV! And so, what I would do, and this is a kind of, you know, sneak peek as far as behind the scenes, what people don’t know what happens, is the way I would surprise them because it’s actually all those were genuine surprises Whenever I would go and I would film their actual responses actual reactions I would contact the practice manager first And I you know, I would honestly get on the phone call the clinic and pretend i’m someone else And I would like 

Dr. Andy Roark: Hello, I’m calling for Cheryl.

Sarah Parsons: Yeah. I would be like I just I had to get the practice manager on the phone somehow and then tell when I was like And I would tell them, I’d say, okay, is anyone else listening?

And they’d be like, no. And I’d be like, okay, not on speaker, like, and everything. And they’d be so weirded out until they found out why. And I’d be like, okay, cool. I’m actually Sarah. This is the reason I’m calling. And we would schedule a time, you know, the practice manager would help me schedule time, you know, for like a, quote, fake staff meeting.

And that’s whenever I would go and I would, you know, we’d provide lunch and I would go and surprise them during that time. The practice manager would be in on it. I would have another person come help me film and whatnot. And so that’s how I kind of, you know, got all that done. But it’s also when, you know, a lot of the clinics were nominated.

and the whole point of it was to also make sure that we feel appreciated in veterinary medicine and it’s important to get that on film, in my opinion, so that Everybody else knows that like, oh my gosh, we are appreciated as an industry.

like we’ve said, you know, before, it’s so hard in veterinary medicine. You get in this headspace of just, oh my gosh, depression, compassion fatigue, burnout. It’s just out the wazoo. So I think, movements like that and, you know, in videos and everything, anything I can is just so, so important to show veterinary medicine that, you know, it’s possible.

Yeah, 

Advertisement: Looking to protect your canine patients against parasites? Look no further than Simparicam Trio, chewable tablets. The first chewable to offer triple protection from heartworm disease, ticks and fleas, and roundworms and hookworms. It’s also FDA approved to block infections that may cause Lyme disease by killing deer ticks.

Use with caution in dogs with a history of seizures. Sarolaner belongs to the isoxazoline class, which has been associated with neurologic adverse reactions. The most common side effects were vomiting and diarrhea. Visit SimparicaTrioDVM. com for full prescribing information. 

Dr. Andy Roark: What do you think are the to sort of starting to build a brand as a technician? So let’s sort of talk about that a little bit because you’ve you kind of started into this and you were you enjoyed making videos and then my impression you for a bit in the past has been that it kind of um, I don’t think that you expected exactly what you got.

Talk to me a little bit about that. What is, what is, if someone came up to you and said I’m a technician, I’m interested in building my brand. First of all, what does that, what does that even mean to you? 

Sarah Parsons: Building a brand, in my opinion, this is just me personally building a brand is, I think having something that is unique to, something that’s unique that you can give people and you can show people and something that, exemplifies yourself. So in building a brand, I think you do have to find something that is unique.

And you know this as well with Uncharted. Uncharted is a very unique program. A lot of what you do, there’s uniqueness behind it. And whenever people say, Oh, I want to do social media videos. I want to make my own brand. I’m like, okay, well. What is it going to be? Oh, well, it’s just going to be some funny videos, maybe some educational videos and whatnot.

And I think you really have to narrow down your niche. And whenever you are building that brand to who you want your audience to be and who you are talking to, because if it’s just, again, you know, I thought it would be pet owners, but then it turned out to be veterinary professionals. Once I found that out, I kind of zeroed in on that and I was like, okay, there’s so much I could do with this.

And so those are my videos. I make silly, funny, relatable videos. No, they’re not really educational, but people can kind of understand that I know what I’m talking about whenever it comes to the industry, I guess. And building your brand, there’s, it’s not just making the videos.

It’s going out of your way to do what other people really haven’t done or figuring, I don’t know, it’s figuring out your own style, I guess, think 

Dr. Andy Roark: I think your own style is a big part of it. I i’m curious if this is true with you. I I never had a big plan And I think people ask me about like how i’m making a brand and like they’re scaffolding And it’s funny. Um You know, we had a huge discussion with, the team today about Game of Thrones, and we were, I don’t know, it totally got in talking about Game of Thrones.

we’re talking about George, George Martin who wrote Game of Thrones. He has this quote that I really like, though. He’s talking about other people writing books, and he said, he said, there’s two kinds of authors. architects And the architects are the people who scaffold everything. They have an, they have a plan.

They know what they’re building and they go in the building. And he said, I’m more of a gardener where I just plant things. And then, you know, see it see what grows here and I water it. And the other stuff just kind of dies. And I just kind of go, Oh, I just kind of go on. And I, I was much more of a gardener of

You’re just, and what I mean, I feel like that’s probably the path with you as well, at least, especially talking to vet professionals is like I cast some seeds talk to pet owners and like, it’s not that they didn’t grow, it’s just that they didn’t spark joy in my heart, you know what I mean?

And so I like, kind of, kind of let them wither in the sun and then kind of, kind kept watering the part that brought me joy. And it kind of, I don’t know, it went there. I think, I think a lot of it too. So I sort of look at your, your career and then, and then my own is like, you know, when I came, When I came up, really, started building a brand and things like that, Facebook was the only game, it was Facebook and Twitter.

And that like the only game in town, and, and I, I liked Facebook at the time, and kind of what it was, and, and it worked for me, and I liked to tell jokes, and Facebook was good for like, at the time, letting me, letting me do some, some writing in paragraph kind of format and things like that. And then now now the world has kind of changed and it’s just it’s not the same and that path isn’t necessarily open. But then here you come and you’re kind of making these these short 60 second videos And and they and they they work really well and you found you’ve sort of found this medium that works for you and it’s funny.

I I think it’s because of how sort of what i’ve done in the past I struggle to make things in 60 seconds that are really funny and sort of punchy. It’s just it’s not it’s not my art. And so when you’re saying you should You Find the thing, you know, find the thing that’s your thing or find your style. I think that that’s really true.

And and I think that, you know, sometimes your style matches up with platforms that are available really well. And sometimes I think it doesn’t. I think there’s probably some really amazing writers out there, but I think it’s probably much harder. to really build your brand. There’s just not as many opportunities and people just don’t read like they did 10, 20 years ago, you know?

Sarah Parsons: I can say that because my sister’s an author and she’s trying social media and it is a lot more of a struggle because she’s, you know, because again, people don’t read as many books as I think they used to. There’s still a, there’s still a niche for that. There’s still, you know, area, you know, for growth there.

But it, I think it’s a lot more difficult for her. And I think honestly, luck was on my side as well. Like, I don’t, I don’t chalk it up to like, Oh yes, this was a plan all the time. And I made myself the way it is. Like, I think a lot of it, like you said, was luck and just like, once something worked, then you zero in on that.

So I definitely agree with that.

Dr. Andy Roark: Well, it was definitely luck for me. I tell people that all the time, like I, you know, we, my wife and I had our first child in 2008 and that’s when I graduated from vet school. So I was a brand new vet with just wide eyes. And I got on Facebook to share pictures of my baby with my family and like all of these, and Facebook was just taking off and they were like, sure You’re come on.

And it was was no, like there was no money driving it. It was, there was no algorithm. It was just like, got. Whoever, posted in order it was there. And it was just, but it was, it was kind of this, this right place, right time. But I think that the opportunities keep opening up for people, but I, I don’t know.

I think you have to find your art. I think you have to find your style. I think that was, that was part of the thing for me. And I just kind of wanted to see how you feel at this is for, for me, I think one of the mistakes that I think a lot of people make in sort of Working online or trying to sort of build a brand or something like that.

Is that they, they really focus on trying to go viral. And I think what I did that worked well was I, I put that out of my mind. And I tried to find people who liked my specific goofy self. And, and tried to talk to them again and again and again. You know what I mean? And, and you, you, you zoom in on those people who go, Oh, I think she’s really funny.

And if, If someone likes your different types of dogs on the scale video, they’re probably going to like your you know, I don’t know Everyone Finds Underwear and Dogs like whatever, whatever the other, the things are, but like, I don’t know, I, I’m curious if you, I’m curious if you agree with that.

I’m curious if you have found that kind of zeroing in on what you enjoy and what you get feedback on has been beneficial over continuing just things. I don’t know. What do you think?

Sarah Parsons: Yes. No, I actually wholeheartedly agree with that because if your channel, whatever it is, for me, it was my, Tik mainly, for me, it was my channels. If you don’t have a purpose or something that you are adding value to your followers, your viewers, so if you’re just basing it off of like, I just want the video to go viral, then yes, I don’t think it’s going to work out very well if you’re just like, I want this one to go viral.

Like then if that’s the whole point, then it’s not going to, your, your channel has to have some sort of value to your viewers. So whether that, you know, means they’re coming to me because they are a self conscious veterinary technician that, you know, just needs those laughs or you’re a veterinarian that just, you know, wants to.

You know, find happiness at the end of the day, whatever, you know, those are, you know, the people that you’re finding. So you have to really focus on that and adding value to other people’s lives. 

I still actually remember one of your older videos and this is one of the ones that inspired me to do my channel. It was a technician talking to a pet owner and the technician says, you know, okay, so what’s wrong with, you know, Max today? And the owner says, Oh, you know, nothing that can, or sorry. No, he says, is there anything Max could have eaten or gotten into that you could think of? And the owner’s like, no, I really can’t think of anything.

Dr. Roark comes in. Okay. I hear, you know, Max hasn’t been eating. Oh, he ate an entire meatloaf. It I died because we all know that’s so relatable the vet techs go in and we’re like anything and then the veterinarian comes in and they Give you the life story and you’re like, well great I just you know, I look like I can’t get a history and everything But just the fact that it’s so relatable and so and I also love that You know, one of your ways your brand got built up is also, you know, advocating for the veterinary technicians and for education and everything.

So the fact that you add that value to people’s lives and that you have these all these other things to offer, people are curious. People click on your profile and they say, oh, what is Dr. Rourke about? Like, I like this video. What else do they have? So, yeah. In that, once that starts happening, then I feel like people have developed their own brand whenever they’re like, What else do you have?

Oh my gosh, I love their stuff. Let me follow them. Let me keep up with them.

Dr. Andy Roark: Yeah. Do you still think that consistency is the key in posting? So so let me so let me me give you a hard choice here. from like one to ten, ten is a maximum number Output of videos or content is maximum content output That’s low quality and one is minimum content output, but high, high, high quality.

Like you have really worked hard on this. Where are you on this, on this spectrum? Are you, are you team just fire, fire, fire, fire something will be good? Are you team don’t let it go until it’s perfect? Where are you in that spectrum?

Sarah Parsons: I’m more on the end of the higher quality, but also it’s important to be consistent. So, it is, I, there’s a both, but I would say let’s say a four. Because I’m more on the end of higher quality. If I don’t love a video that I, I’m about to post. I don’t post it. I’ve gone through and I’ve deleted drafts and I’ve been like, nope I’m not gonna post that one just cuz like if I haven’t posted it in like a week and it’s just still sitting there Then I’m like, I don’t and then it’s not gonna do well in my mind, you know And sometimes you know ones that you think are gonna go well, you know don’t and sometimes one that you’re like Okay, like the the black tongue bit video that I had talked to you about earlier the one that has 47 million views on Instagram, you know, was just like a, okay, you know, not one that I just, not one that I didn’t think would do well, but I’m like, okay, know, I’ll just post this one.

Dr. Andy Roark: I never would have thought that, you know what I mean? That, I was like, I would have been like, this is a fun little afternoon thing that I’m doing. But again, if you said to me, Andy, true or false, this video is going to get 47 million views. I would be like the odds are astronomically small but here we are. I’m with you like I I could never have looked at that and been like, yep this is viral sensation like I

Sarah Parsons: Right. I’m never that, you know, I’m never that way. I love to post videos and I’m never like, Oh, this one’s going to do so well. Like, but you never know, man. The algorithm works in mysterious ways sometimes.

Dr. Andy Roark: The more I love something, the more it is to die a horrible algorithm That’s what I’ve found. If I’m like, yeah, is it, it’s If I’m like, no, no, no, we’ll see what happens. 

Sarah Parsons, thanks so much for being here. Where can people find you online if they haven’t seen your 47 million view black tongue video. 

Sarah Parsons: I’m on TikTok, Instagram, and Facebook, my social media videos and my handle is at what really happens at the vet with what spelled W A T, so what really happens at the vet. And then my website’s vettechsarahparsons.com, so you can find me on any of those platforms.

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

And That’s it. That’s what we got guys. Thanks for tuning in Sarah. Thanks for being here Sarah will be speaking at the uncharted team lead summit on September the 18th. That is a virtual summit for team lead so if you’re a head technician if you are a head kennel technician if you are a If you are a lead CSR lead receptionist, check it out.

It’s a one day leadership communication summit. I think you’ll really enjoy it. Sarah will be there putting on a workshop. I’ll be there as well doing some stuff. It’ll be a good time. Anyway, take care of yourselves everybody. I’ll talk to you later.

Veterinary dermatologist Dr. Ashley Bourgeois returns to shed light on a topic often overlooked in veterinary care: dermatology issues in cats. Dr. Andy Roark and Dr. Bourgeois discuss the nuances of feline dermatology, emphasizing the challenges and underrepresentation of cats in dermatological care. They dive into common symptoms, diagnostic approaches, and effective treatments, providing valuable insights into managing allergies and skin conditions in cats. This conversation includes effective communication and expectation setting with clients in order to increase compliance. Tune in to another episode packed with practical advice and innovative solutions for veterinary professionals looking to enhance their dermatological care for feline patients. Gang, let’s get into this episode!

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

LINKS

The DermVet: https://thedermvet.com/

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

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

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

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I am here with veterinary dermatologist and good friend, Dr. Ashley Bourgeois. Ashley is on the podcast today. Guys, we are talking about our top tools for cats when it comes to dermatology cases. Guys, I don’t think cats get enough love

when we do allergy and derm workups, honestly, and so I want to talk about that with Ashley and we dive right into it. Gang, let’s help some itchy cats by getting 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 how are you, my friend?

Dr. Ashley Bourgeois: Dr. Andy Roark, I am so good. Very excited to be back on the podcast. 

Dr. Andy Roark: It’s great to have you here. For those who don’t know you, you are you are a longtime friend of mine. You are a veterinary dermatologist. You lecture all over the world on veterinary dermatology. You are at the Animal Dermatology Clinic in Portland, Oregon. You’ve been on the podcast many, many times.

You have, you’re a, you’ve got articles. You just, you just do a ton of stuff, Ashley. I wanted to ask you about something today and you’re always so gracious with your time. You know, it’s it’s summer as we’re recording this and I’m in the south and so summer means allergies and lots of ear infections and itchy skin and things like that.

And so I was wondering if If you would be up for talking with me a bit about the tools in our toolbox for dealing with dermatology problems in cats. I feel like derm and cats does not get a whole lot of spotlight, and I always like to kind of run back through the toolbox and make sure that I know what I can do, and make sure that I’m aware of all my options in trying to help out our cats because I don’t think know that they get as much care in dermatology as they probably should.

So, let me actually, let me just pause there and start with that. Do you agree with that? Do you think that cats are underrepresented in our dermatology caseload? Or do you think that they’re just less likely to manifest problems?

Dr. Ashley Bourgeois: totally think they’re underrepresented and I think there’s kind of a few different layers to that. Like I think one, owners don’t recognize it as readily, right? Like if a dog’s going to have an allergic flare, they’re going to slurp their paws next to you. A cat’s going to go hide and all of a sudden have a bald belly and cats are naturally groomers.

So it’s really easy for owners to think, well, they’re licking their belly, but that’s normal because they’re groomers. I also think just because we are more limited on what we have available for cats that, you know, we kind of want to give up on them a little bit easier. Like, well, sorry, that’s what I got and that’s it.

But there’s so many simple things that we can try to get these cats more comfortable and they deserve to be comfortable. You know, we should still be working with our cat clients. So that we can provide comfort for these itchy cats.

Dr. Andy Roark: Do you think we make assumptions about what cat clients are willing to do with their cats?

Dr. Ashley Bourgeois: Totally. I totally think that we make assumptions and sometimes they’re true,

Dr. Andy Roark: Yeah,

sure. 

Dr. Ashley Bourgeois: but there are really good about giving medications or doing the things with them.

Dr. Andy Roark: Start to unpack the toolbox for me a little bit. So, we, we’ve got allergies in cats. First of all most common presentations of allergies in cats. What are we talking about? Like, what do you think gets overlooked?

Dr. Ashley Bourgeois: Yeah. I would say that if we think about the most common things, bald belly cats are probably pretty high up there. So they just come in, they’re coming in for your wellness exam as a GP. And then you just look at them and start to notice they’re kind of thinning on their belly. And again, because they’re naturally groomers, owners don’t think much of it.

We also see a lot of head and neck itchiness. So they’ll kind of like really scratch their head and neck and they’ll have excoriations all over. And then of course the different representations of eosinophilic granuloma complex, which I think those are kind of tricky because the oral lesions, a lot of owners don’t look for unless they’re actually showing us symptoms.

So I always try to encourage vets to try to do oral exams and cats if they’re accepting of it, because you’ll be surprised what you can find.

Dr. Andy Roark: Yeah, it’s funny. I, I always do my absolute best to do oral exam on cats. I don’t ever think about it as an allergy check. But it makes, I mean, it, it totally makes sense.

Dr. Ashley Bourgeois: It doesn’t have to be crazy things. People think like the weird pictures of like this nasty eosinophilic granuloma we put up, but it’s very common just to find like really little rodent ulcers right here. So I’ll just, even if they won’t let me do full exam, I try to like lift their lips up and just see if there’s any like signs of a beginning of a rodent ulcer.

Because that’s gonna confirm to me that we probably have some sort of allergy going on.

Dr. Andy Roark: Just kind of along the front 

Dr. Ashley Bourgeois: gums?

Mm hmm.

Dr. Andy Roark: Okay. Yeah. That totally makes sense. Okay, so when you see that, you see the ball belly, you see sort of rodent ulcers, things like that. you’ve got some idea that we’ve got some sort of an allergy problem going on. Where do you start to go from there?

How do you, how do you sort of approach this?

Dr. Ashley Bourgeois: Can I tell you a secret for most dermatologists when we are talking about itchy cats? We are so excited if they just present to us on good quality flea control. That sounds incredibly simple, but I’ll tell you what, I think I diagnosed three flea allergic cats last week. So like we, yeah, we get them all the time and we’ll see kind of, you know, the exam like flea comb, no fleas and,

that’s our first step because to me flea, flea allergies are very common in cats. Even if they’re indoor, I have diagnosed them in indoor cats in Southern California, living on a high rise in Los Angeles. Like we see flea allergy fairly commonly. It’s called a cat flea, right? Like the flea wants to be on cats, but ultimately if they come in already on good, Isoxazoline flea preventions, what there’s quite a few options in cats.

If they come in on that and they’re still showing symptoms. It is just a huge step that I don’t have to waste the time and money and effort into for that initial exam. And that includes everyone in the household. That’s the other thing we see is like the itchy cat will be on flea control, but not the other animals in the household.

And I have actually had many cases where if we just treat all the other animals, that cat gets better.

Dr. Andy Roark: How did these cats present? Because, Ashley I would say, you know, when I look at cats and they’ve, and they have flea allergy stuff, it’s always that sort of racing stripe up the back, not always, but in my mind, it’s almost always that racing stripe, you know, the triangle above the tail and the dorsal aspect of the, of the lower back, Is that how these cats are presenting as well, or are you seeing I’m a little bit perplexed at, at flea allergy cats showing up with a dermatologist. I guess, being honest, I think that’s why I’m kind of asking this question.

Dr. Ashley Bourgeois: Yeah, all of the above. So racing stripe for sure. We like to say if a cat’s not wearing pants, meaning that they’re hairless, like on the caudal thighs, rump belly, I’ve had them just do the ball belly. I’ve had them completely be ripping their entire, I mean, I have videos of a case completely obliterating itself in the, in the clinic. Just completely hairless,

had came in on a flea collar, but not a good quality flea control. And then within two months, that cat was on nothing, but flea prevention and has been completely controlled now for three years, just on flea prevention. So they really can do present in a lot of ways, but yes, a lot of times if they have that racing stripe, if they don’t have hair towards the backend, you think of it.

But even if you have to remember two, cats like to get more than one allergy. So, even if you don’t get them fully under control by having them on good flea prevention, as a dermatologist, when I go to work that case up, I just can get that out of my mind that there’s even a component of it, right? Like if they’re food and flea, if I just know we’re on good flea prevention, I’ve crossed that bridge and we can focus on everything else versus they’re both of those, but we keep having to give them steroid injections because we don’t control one aspect of their disease.

Dr. Andy Roark: Right. Okay. That makes sense. So, flea medication seems like a great place to start.

Dr. Ashley Bourgeois: Yes, please. Please, please, please. We do. We see it quite often, which I think surprises a lot of people. But we actually get a ton of flea allergic cats in our clinic and we feel bad because they have to wait to see us. We’re more expensive and it’s something like pretty straightforward.

Dr. Andy Roark: What else do you like to go to?

Dr. Ashley Bourgeois: Yeah, so then I would say we assume they have good flea control, then we’re starting to think of, to me, kind of two things. Like one, how do we make them comfortable? And then two, how do we continue to work them up? So there are some important things to realize about feline allergies, one of them being distribution.

So there has been a study, a multicenter study, that showed if cats tend to scratch towards their head and neck pretty frequently, that they’re a bit more likely to have food allergy as a indication of their itchiness. So if they are really exhibiting that kind of head and neck itchiness, then, and I know they’re on good fleet control, then that’s usually my next step.

And you have to be really willing to work with clients over, you know, what they’ll feed, can they be strict if they have multiple cats, is that possible for them? And so then we kind of dive into that discussion. To rule out a food allergic component. Many cats don’t have abnormal gastrointestinal signs.

So even if they seem to be defecating normally, not really vomiting, they can still be extremely itchy from a food allergy. And so the, to me, if I can get any cat under control with flea control, indoor food, long term and not have to give them oral medications. You know, I’m very happy for that owner. Then assuming that portion we’ve got under control and we’re going to go down the feline atopic skin syndrome, which if you don’t know, that is the official name for environmental allergies and cats, which is kind of long and complicated, but it just is meant to be a representation of how crazy their allergies can present.

If you think about environmental allergies and cats, it can be anything from, I have a rodent ulcer eating my front lip, to I have asthma, to I get itchy all over my body. So they just present in so many different ways. Then we’re going to work on making them comfortable, but really be trying to drive them to allergy test and do immunotherapy.

Because that’s one of the main ways we can start limiting how many oral medications they can take longterm if we can help it.

Dr. Andy Roark: Jumping back real quick, I have always had the impression, I’ll just say, for me, it has been substantially harder to get cat owners to go in, in a way I believe, on on diet trials. Then it has been for dog owners. Have you seen that as well? I mean, I don’t know if it’s true or the perception is just oh, well she’s only gonna eat what she wants to eat or she has this specific food that she demands. I don’t tend to get that much pushback.

There may be pushback about price or things like that for dogs, but there’s I’ve, I’ve had such challenges in getting pet owners to buy in and do a food trial in cats. I’m assuming by the time, you know, if we have someone who’s come to the dermatologist, they’re probably more open to, to advice maybe than the general populace.

But have you found that to be true at all? And if so, how do you sort of approach that conversation of getting the owners to say, Okay, we’ll, we’ll try a different diet even though, even though, you know, Fluffy really loves her Frisky’s diet.

Dr. Ashley Bourgeois: Yeah. I think there’s probably some truth to that. I mean, I certainly have dog owners who are still hesitant or we get finicky dogs, but we know cats are kind of like little aliens, right? They kind of, They make the rule book and we’re just there to live in their world. So there’s a couple of tips I do.

One, I say like, what do they like? What do they need? I have my preferences on diets, but there are some limitations, right? Like Ultimino is great, but if they need a wet food that doesn’t have a wet food. So then I need to kind of consider other options of, okay, if we’re going to go novel protein, that’s fine, but then I have to know what they’ve been on so I can make sure it’s actually novel for them.

So I start out by asking like, what is it your cat does tend to prefer? Do they need a wet? Do they need a stew? Do they need a treat? Are they fine with just kibble? Are there other cats in the household that have nutritional needs and can you keep them strict? So, you know, if, if we can, ideally you just put all the cats in the household on it, but that’s not always the case.

If we have a cat who has renal disease that we can’t ignore just because we’re trying to do a diet trial and another cat. So then I just make sure one, we don’t have nutritional needs of another cat we have to consider. And then three, the way that I think I have a decent job, I still get people who won’t do it, but a decent job at getting people to do diet trials is I give them the end point.

I think we really need to focus on the fact that this is a diagnostic test. You know, if we just say, Oh, we’re just switching the food. I think people visualize forever, right? They visualize like, Oh, well now I have to buy this really expensive food. And the friskies is like my love language to the cat.

And you’re taking that away forever. And I’m like, I’m not, I need eight weeks. I need eight weeks. Because if the, if Fluffy is no better for this diet change, cool. I can feel comfortable knowing we’re not missing something. We move on from food. If we get through eight weeks and the diet has made a huge difference, that doesn’t mean we can’t feed anything else the rest of Fluffy’s life.

We just know what baseline looks like and then we can kind of add the other fun things back in and see what makes them flare and what doesn’t. So I think really giving a finite amount of time is super helpful.

Dr. Andy Roark: I really like that a lot. That’s it’s a much smaller ask to say we’re gonna do this for eight weeks and eight weeks It’s not an intimate substantial amount of time, but it feels like a Defined thing that okay, we’re gonna do this So my my dog is wearing the elizabethan collar right now cuz he got he got a he got his teeth cleaned and he got wart taken off of his leg and he will pull the stitches out immediately if he can and I feel bad for him. You know, he doesn’t understand.

He bangs it. He’s that dog that just refuses to acknowledge he’s wearing it. So he like hits, you know hits the doorframe and he’ll take you out, you know paste that thing into your shins and The fact that it’s going to be ten days makes it all Absolutely doable. If it was kind of like, let’s just see if this helps and maybe he’ll wear it forever, I would be, I would be out.

But knowing that we’re going to do this, I’m going at the end of this time, we will have accomplished something and that will be over. And so I love your point of we do this for eight weeks and then we’re going to know some things and we will have that information. I think that’s, that’s, that makes a lot of sense.

​

Dr. Andy Roark: Talk, talk to me a little bit, Ashley, about About comfort of the cats and specifically sort of itch control while this is going on So we’ve got this cat and they’re coming in and they’ve got the bald belly or they’ve got you know You know evidence of scratching around their neck and things like that and you say well, you know I want to try this diet trial or you know I think this may be feline atopic skin syndrome and and we’re gonna set you up for some allergy testing with the dermatologist. What are you doing for comfort for these cats,

while you’re doing this? Are you, are you doing anything or are you concerned that what you do is going to negate the efficacy? You know what I mean? If I, if I do a steroid injection and then send them out to do a diet trial, they’ll go, oh my gosh, she immediately is better. And I go, well, is she better?

Or are we still, are we riding out this, this other, you know, medication that I gave? Something like that. So help me sort of understand that.

Dr. Ashley Bourgeois: Yeah, I mean I still use a decent amount of steroids in cats to be honest because they get quick relief as long as they’re not a contraindication based on their other comorbidities. I don’t use a ton of injections, but a lot of that is just because by the time they come to me, they’ve kind of gone that route, right?

Like, they’re, they’re trying to get away from that, they can’t really do that as often. So I do tend to use a bit more oral steroids, and I work with owners to kind of get them to take that. But I still think they deserve to be comfortable. You can not send them out the door saying, here’s your bag of food.

See you in eight weeks. Like they’re going to call you in a week and be ticked off. So ultimately you still need to make them comfortable. When I started a steroid, I’ll tell owners, like if they’re great in a couple of days, this is steroid, not the food. But I, the way that we figure out if the food is helping is to get them off the steroid eventually.

And then a lot of the answers in the challenge, right? Because your two months, it’s a long time. You could switch seasons, like a lot of other things can happen. So when owners ask, well, how are we going to know? I’m like, well, no, because we’ll try to stop the steroid and we will try to ultimately challenge that diet.

I also just want to stress the importance of really the thing that only thing we have on label for cats for allergic itch is a topic and we still use a ton of cyclosporine in cats and it can work very, very well, I think some things that people forget is that you can use the capsules in cats. So the liquids on label, and that’s what’s kind of marketed for cats.

But I asked cat owners like what’s easier for you, a liquid or a capsules. You will be surprised how many cat owners actually will prefer capsules. Now they’re not the smallest capsules in the world. So we have to be honest about that. But the liquid has a bitter taste to it. So if I’m going to utilize cyclosporine, I kind of ask them for a starting point.

Like, which one do you think you’d be have more success with giving? And if that doesn’t work, we can go to the other one.

Dr. Andy Roark: Yeah. So, I really like what you’re doing here. The emphasis on the challenge makes a ton of sense to me. Because if you say, the emphasis is on the elimination part, then that’s always the question for me is, well, if I, if I send them home on steroids and then the, you know, it’s springtime and we, you know, very quickly, you know, things fall apart.

flare up. I can’t, you know, I’m all snotty and, and congested for seven days, 10 days, something like that. And then I kind of move on. You go, well, if it’s just the diet trial, I still question, you know, what, what did we actually learn here? I like the idea that the whole time you’re telling them, we are going to challenge

when we get to the end. I think that that’s I, I just, I like how you stage it and, and go ahead and set them up for that. I, I will say, I have been guilty in the past of saying, let’s try this other diet and we’ll do a sort of a diet trial, quote unquote, and let’s see how it goes. And then they say, well, it’s, you know, it’s great.

It’s working great. And I said, well, let’s just go on and not come back and done the trial or the challenge to actually say, oh, yep. When we. When we did challenge, we got this response and now we, now we know this. And so I, I like that you set that expectation at the very beginning. When we’re talking about sort of comfort and itch control and things like that, if the plan is to do some sort of allergy testing, things like that, talk to me a little bit about what is, what is safe for me to intervene with to sort of provide comfort before we do this allergy testing versus where am I potentially hampering the test?

Dr. Ashley Bourgeois: So that’s a really great question and something that’s very individual on the dermatologist. So one thing I would suggest is if you have a local dermatologist in your area that you’re going to be referring to checking in with them, I can give you kind of the general synopsis for me. You know, for if we’re going to serum test, so cats notoriously do not pop up their skin tests very well.

So it’s kind of hit or miss if dermatologists will skin test them. Something that we have been doing and is reported in the literature, but not everyone does is something called IV fluorescein. So you actually skin test a cat. You have to do it fairly quickly. So you have to have yourself or staff trained in it.

And then you actually give a little bit of IV fluorescein through a catheter, and then you read it with a black light and it enhances their positives. Now again, not everybody does that, but more and more people are starting to do that and we’ve had some pretty good success with that. There are some people that will prefer serum tests just because cats don’t tend to, again, pop up their positives.

Like dogs, like horses are like the best dogs are kind of next. And then cats like. Again, they like to be difficult. For a lot of the serum panels you and there’s pros and cons to all of them. They’re the steroids and cyclosporine, things like that don’t really have a huge effect on them. So I don’t personally get too worried if someone refers me to them and we’re just going to serum test for whatever reason.

I preferably try to do both. That’s an individual preference. If finances aren’t an issue, just to collect as much info as possible for my skin tests, they can’t be on steroids. So they would have to be off of steroids for at least a month, usually is our preference. So if they get a long acting injection, say like depo, right, that could actually be a few months because it’s in their system for a couple of months.

So cyclosporine though, if you are using off label Apoquil. You know, to our knowledge, there’s not a huge impact on skin testing. So steroids and then antihistamines, if you are using an antihistamine, depending on how long they’ve been on it, most of us say like one, two weeks, they need to be off of it before we can skin test.

There’s not a huge impact though on serum testing.

Dr. Andy Roark: There’s always been a bit of a question, I think, around serum testing. I, I think in, in just, and this is over the last year, 15 years or so. So, overall, you, you seem to be, to be positive on the, on the benefits of serum testing. And it sounds like, you know, depending on the panel that you choose, results and mileage may vary.

When I have pet owners that come to me and asking about serum testing, what kind of general guidance would you give to them as far as efficacy, a worthwhile investment, things like that?

Dr. Ashley Bourgeois: Yeah. So ultimately if you use some of the more like quality serum panels first of all, food’s not there. So there’s some interesting research being done in food, but we never suggest it as like a diagnostic test. So we don’t run food panels, but if you’re just looking at environmental, the couple of things I can tell you is one.

We utilize those results to help us formulate immunotherapy, but you still, it’s not a, Oh, that’s a high number. So that’s automatically what goes in. You’re still supposed to be evaluating like their history, their seasonality cross reaction. So there’s this weird art form that goes into it. And if you want to start a fight at a derm conference, ask about serum versus skin testing, because there’s a lot of opinions and there’s a lot that we just honestly are still discovering and don’t know, which is why I will try to do both,

if I can. Because I think there can be some different value in both of those tests. But another important thing to realize is please don’t allergy test them unless they are committed to immunotherapy because it’s not the cheapest test and we want to be able to utilize that information to help that pet.

And if that’s not going to be in their wheelhouse, the finances are better off with the symptomatic treatments because allergies are very expensive.

Dr. Andy Roark: Yeah, that, that totally makes sense. Help me set expectations around immunotherapy. So if I have a pet owner and they’re like Yeah, you know, I would consider immunotherapy. What does that, what does that involve? How do you talk to them about what they’re getting into?

Dr. Ashley Bourgeois: Yep. So for immunotherapy, I think it’s a great option in cats because a lot of cats are actually very accepting of injections, though there is sublingual forms, and I have some cats who do great on that as well. It’s just given more often than the injections are long term. I tell owners there’s about a 70 percent success rate, and that’s pretty consistent throughout the literature.

Now, when I say 70 percent success rate, that does not mean there’s a 70 percent chance or just off of everything, but there’s a 70 percent chance we’re going to see benefit. So benefit could be, okay, we were even on cyclosporine, you know, in all the things we’re still pretty itchy in a year. Oh, we need cyclosporine, but now we’re actually responding quite well with the addition of immunotherapy.

Or I’m a cat who used to break out with pyoderma. Yeah. Seven times a year. Now I really only break out like one time of year. So there’s a lot of different ways that we kind of judge benefit. I really like to simplify things for owners. So I like to tell owners, if we’re going to make this decision, an allergy test that I have a students, B and C students and F students and a student is within a year, that’s all you really need.

And that’s our dream for every patient. Like you you’re off the steroids. You’re off the cyclosporine. You know, if you’re just immunotherapy and flea control, That would be amazing and very safe. We get a lot of B and C students and B and C to me is I still need some help, but I am better. So I still need some cyclosporine maybe in the spring, but I am much better than I was when I was not on immunotherapy.

We do unfortunately have about 30 percent of F students. Like we put the time effort money into it and we just don’t see any benefit. And that’s really hard to ask an owner to commit to something for a year, year and a half. And there’s not a guarantee to work, but we do know cats tend to respond really well.

They tend to be very accepting of it. And that’s one of the only natural therapies we have to truly work with their immune system. So they don’t keep progressing their disease.

Dr. Andy Roark: Yeah, well, 30 percent is not an inconsequential number. I think you’re, I think you’re really smart to make sure we’re setting these expectations up front at the very beginning of, hey, you know, there’s almost a one in three chance that, that after a year and a half, we’re not going to, to see improvement here.

I could see that absolutely being quite frustrating, but at least going in, they have to know it’s an option on the table. I think, I think that’s I think that’s just smart communication. Ashley Boussois, thank you so much for being here. Where can people find you online? You do great social media stuff.

Where, where should I send them?

Dr. Ashley Bourgeois: Oh, thank you. I am simple. I keep everything under the derm fat. So I’m strongest on Instagram. I also have a weekly podcast that just goes over dermatology information. And then, as you said, I’ve been enjoying being back on the lecture circuit. So hopefully continuing to do lots of conferences in person.

Dr. Andy Roark: Thank you so much for being here. And guys, thanks for tuning in and listening. Take care of yourselves, everybody. And that’s what we got. Guys, thanks for being here. Thanks to Ashley for being here. If you enjoyed the podcast, share with your friends or leave me an honest review wherever you get your podcasts. It means the world to me. It’s how people find the show. So anyway, thanks for that. Take care of yourselves, everybody.

I’ll talk to you later on.