Medicine

Dr. Kris Otteman joins us to discuss the critical topic of recognizing and reporting animal abuse within veterinary practices. On this episode of the Cone of Shame Veterinary Podcast, Dr. Andy Roark and Dr. Otteman emphasize the importance of practical, action-oriented approaches to identifying signs of abuse and neglect. Dr. Otteman provides guidance on documentation, communication with authorities, and navigating the complexities of suspected abuse cases. Veterinarians and veterinary staff will learn valuable insights on how to be effective advocates for animal victims while maintaining their professional roles. This episode is essential for anyone in the veterinary field committed to protecting animal welfare.

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

LINKS

Victim to Verdict: https://www.victim2verdict.com/

Animal Legal Defense Fund: https://www.aldf.org/

Victim to Verdict Instagram: https://www.instagram.com/victim2verdict/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

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ABOUT OUR GUEST

Dr. Kris Otteman’s journey into veterinary forensics began as a teenager in Klamath Falls, where she first reported the neglect of a donkey she discovered while riding her horse through the woods. This early experience ignited a passion that would define her illustrious career. With 34 years of veterinary and leadership experience, Dr. Otteman now serves as the President of Victim to Verdict LLC and forensic veterinary consultant to the Animal Legal Defense Fund.

A pioneer in veterinary medicine, she co-founded Banfield, The Pet Hospital, and played a crucial role in developing the nation’s first shelter teaching hospital at the Oregon Humane Society which provides care for over 12,000 shelter pets annually. Dr. Otteman’s expertise in veterinary forensics has led to significant advancements in animal cruelty investigations, and she has shared her knowledge as a courtesy faculty member at Oregon State University, University of Florida Maples Center for Forensic Medicine, and through numerous national and international presentations.

Dr. Otteman’s dedication to animal welfare extends beyond her professional achievements. She has served on multiple boards, including the Oregon Veterinary Medical Licensing Board, Banfield Charitable Trust, and is the current board president of the International Veterinary Forensic Sciences Association. Her contributions to veterinary education and animal welfare have earned her the prestigious OSU/CVM Alumni Fellow award. Residing in Washington with her family, Dr. Otteman continues to inspire and lead with her unwavering commitment to improving the lives of animals.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I have a really good episode today. This is Dr. Kris Otteman is with me, and we are talking practically about spotting animal abuse in our practice. I know that doesn’t sound super fun. I know that doesn’t sound super rosy.

Guys, first of all Dr. Otteman is a fantastic communicator around this topic. She keeps it really clinical. She keeps it super practical and and action oriented. I took so many notes from such a short podcast. It’s amazing. She gets right into it. She presents this information in a really non emotional, as unupsetting as possible way.

And just. Oh, it’s so so valuable. I’m really proud of this episode. Guys, I hope you’ll take a moment and and listen to it maybe get your team to listen to it. If not consider taking the information here digesting it presenting it to your people. Just because guys we need more awareness about what to do when we see animal abuse in our in our hospitals. And honestly, we need to know what animal abuse in our hospitals looks like. So, anyway, great episode.

Super useful. I promise it’s worth your time. I promise it is going to do the best job it can possibly do of not being heavy and not bringing you down, but really giving you good tools that are going to make you feel empowered. So anyway, that’s what we’re doing today. Let’s get into it. 

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

Dr. Andy Roark: Welcome to the podcast. Dr. Kris Otteman. How are you?

Dr. Kris Otteman: I’m well, Andy. Thank you. How are you? 

Dr. Andy Roark: I am, I’m great. I’m, I’m so glad to have you here. You are such an interesting person. You have had such a rich career. You’ve done so many things. You, You recently wrapped up doing some work on the master’s program at the University of Florida. Go Gators!

You are on the faculty at Oregon State University’s College of Vet Medicine. You are the author of a rather interesting book that we’re going to talk about today. You are the author of Animal Cruelty Investigations, A Collaborative Approach from Victim to Verdict, and, and it’s, it’s, it’s pretty, it’s pretty intense title, pretty intense title.

You came onto my radar when one of my good friends, Dr. Caitlin DeWilde, who writes for Today’s Veterinary Business, and she she has a business called the Social DVM, and she’s just very, very sharp. She just reached out to me, and she was like, You need to talk to Kris Otteman. She is, she’s fascinating.

The work she’s doing is really, really important. And people just have no idea about what animal abuse looks like when it comes into vet practices. And so I, I just want to start there and kind of open up is that? Is that true? Do you believe that most veterinarians and vet teams don’t know what they’re looking at when animal abuse cases or animal cruelty cases come into the practice?

Dr. Kris Otteman: You know, I think so, like thinking back when I first got out of vet school, I felt really armed with all these diagnostic and treatment tools and enthusiasm, but I, it was not on my radar to think about someone intentionally, especially intentionally neglecting or abusing an animal. And then, fast forward all these years, we’re really still not structured to teach a format in vet school or even post doc to clinicians to help us understand how to recognize, report, and be a voice for the animal victim.

So yeah, I do think, I look back, I know it was walking right by me in the exam room or I did large animal, even like out in the field. But I didn’t. I didn’t, it did not come onto my radar in terms of how to affect a change and help, you know, other doctors and vet teams address this for our communities.

Dr. Andy Roark: I tend to be, I don’t know, I don’t like to say naive, but I, I tend to look for the best in people and just kind of assume the best. I’m, I am confident. I just don’t have thoughts about animal abuse or neglect come into my mind, I don’t think, unless there’s something extreme that happens, you know what I mean?

It’s just, it’s not something that I have It’s, it’s not in my search image and when you’ve been talking about this and looking at your book I’m confident that I, that I have missed, I’ve missed some tricks. Can we start at sort of a high level and just as, as someone who is probably not looking for these things, help me get my head around, just to start with, what, help me, help me understand sort of the, the problem and then kind of what I should be looking for.

Dr. Kris Otteman: Right. That’s a great question. You know, I’m definitely a rose colored glasses person like you, Andy, tend to like just be looking for the bad actor or thinking, oh, you know, this is bad. I just never, operate that way. And so this has been really interesting from my perspective to put it under that lens of vet med as something just to keep on my rule out list.

So I, what I would say is, you know, veterinarians and vet staff are going to get these cases kind of three main ways. It’s going to be part of your regular job if you’re in animal control or maybe an animal shelter where I practiced for many years, because it’s just going to be part of your job to work these out.

The second way you’re going to get it is some detective, law enforcement, prosecutor, somebody’s going to call you and say, Hey, Andy, I hear you’re a vet in the community. I’ve got this case. Would you look at the records? Would you look at the animal? What, what do you think? That may catch us completely off guard.

I would say it usually does in the cases, even in the last week that I’ve worked on, those have come that way. And the veterinarians are completely wait, what you want me to look at what, and then the, the. The third way that these come up is just recognizing it, like, you know, just those times in, in your career when you, maybe you’re in an exam room, and someone’s telling you how this cat got injured, and you’re thinking, I’m not sure if I’m really being a critical thinker here.

Does that, story match that finding? So, you know, if like blunt force trauma and maybe you do x rays and you see repetitive, repetitive injury pattern, for example, you’re like, yeah, that, you know, that doesn’t really add up that, Oh, I was just trying to bathe the cat or something like. Don’t ever bathe a cat, we all know that.

But, yeah, so that’s kind of what I, I think about the three ways you get it and how it can catch us off guard, for sure.

Dr. Andy Roark: Yeah. I, I actually had one of those cases, number two, where the detectives reach out and say, hey, you know, you’re a veterinarian and they wanted me to do a, a necropsy. And I ended up sort of being involved in this case. Of course, I, I just happened to be working that night when they came in and, and like now I’m, now I’m sort of in this, but I felt wholly unprepared and I didn’t know, you know, I, I answered their questions and, and sort of worked up the cases.

I wouldn’t work up a case, but it was It was definitely kind of, just kind of jarring it and really kind of out of the blue. Kris, when, when people are presented with these sorts of cases, so, let, let, let’s start with the, you know, with the, with the shelter or animal control, you know, work, things like that.

Or if a detective sort of comes in with an animal or something, what are the types of things that, that I should sort of be looking for? What am I trying to document here? What are the, what are the findings that are important for me to pay attention? Cause again, a lot of times this, this just isn’t on my radar.

Dr. Kris Otteman: Yeah, I, I think that’s great. I mean, kudos to you for stepping up and taking the case because it does, it does kind of jar you, like you said. It makes you feel a little unease. Like, what’s the difference? And the way I like to explain it is we, as veterinarians and vet teams, we have a great toolbox, right?

We know how to methodically look at things and document our findings. And an animal cruelty case or a suspected case, it’s really just including a little more detail. So we’re going to take more photos. We’re going to write down more notes, communication notes about what the person that presented the animal or the detective said.

So getting started, it’s just important to know I already have those tools as a vet. I, I know I can just work through this methodically and thoroughly. I’m just going to do an different, a little bit of different documentation. For a real practical example, if you get a live animal in and you think it may have been in a part of a case, you’re going to take what we call five view photos.

So you’re just going to go click, click, click. You’re going to get front, back, sides, and top of the dog or cat so that you can identify it. and document how it looked when you got it. That’s something we wouldn’t normally do in clinical practice. We would just click the BAR box, right? Or, or, whatever.

So, yeah, I think just, just knowing some of the tips that have that are available. And that’s one of the reasons I wanted to write the book and put these protocols in the back about just those specific things that differentiate a physical exam from a forensic exam. Because I know veterinarians, we want to do the best we can and we want the tools, right?

And we’re always learning. We have to be always learning. So, yeah, I think that’s how I approach it.

Dr. Andy Roark: That, that, that’s super helpful. Again, like the five for you photos totally makes sense. Not on, not on my radar. That was just, I guess, I hadn’t, I didn’t think of it. Now you say that I’m like, Oh, yeah, obviously that make, that’s gonna be helpful or useful, but I, it was not something I had, I had considered for. 

Dr. Kris Otteman: No, me neither. No, that’s totally normal. Or like the other photography thing we tell is like far, mid, and close up. So like if you see a dog with maybe an injured eye, you’re going to document, Oh, the dog’s back here. I can see it’s Lulu. Oh, now I can see I’m looking at the eye. Oh, now I’m close up so I can see the injury.

We don’t do that in practice, but that’s incredibly helpful in a forensic report because it shows yes, that was the animal and yes, this was my medical finding. So, It isn’t really any different. I think the documentation is the big difference. But I would say that the CSI effect has been difficult for our profession because everybody thinks this is all about blood spatter, projectile angle, DNA interpretation, and I just like to say, you know what, Doctors, we can do this because we’re going to use our clinical skills and just know some of the basic things that will help us through.

We don’t have to be like, you know, on Bones or something.

Dr. Andy Roark: know it probably sounds bad, but like the the far medium close photos totally make sense again I don’t think that would occur to me in practice I would be the doofus who gets pictures up close documenting the wound and then someone would say that’s not our dog and I would say of course it is you think I’m lying and like I just it completely makes sense.

It was just the idea that it would, that it would not be the pet. That just never occurred to me.

Dr. Kris Otteman: Yeah. Yeah. You wouldn’t, you know, I mean, we get those on our texts all the time at home at night, right? Hey, Andy, what is this on my dog? And it’s like this little photo on your iPhone and you’re like, where is it on the dog? I don’t know. It looks like, but yeah, so it’s just a different, it’s looking at it through a different lens, it’s slightlydifferent. 

Stephanie Goss: Hey, Cone of Shame listeners. . This is Stephanie Goss. Co-host of the Uncharted podcasts with Dr. Andy work. And I’m jumping in here for a second, because one of the number one things. That people ask Andy and I, and all of our colleagues on the Uncharted team about when we go to other conferences we go to events is. Hey, how do I teach my team? 

How to handle conflict? We get asked that by other leaders. All the time. And I get asked by fellow technicians, fellow CSR’s, kennel support members. Hey, how do I get better at talking through conflict with other people on my team. Because conflict is a part of life. And the reality is it is a. A big part of life in general that we don’t talk about. 

And so our team decided it was time. Past time to tackle conflict head-on and so our Uncharted the team has been working hard on a new certificate for veterinary medicine and Andy and I are so excited to say that it is almost here now. Now, I’m going rogue and jumping in here with y’all, but I can’t entirely entirely spill the beans. 

I can tell you that the Uncharted team has put together and awesome certificate on the foundations of how we as people handle conflict and how to get better at it. And so if you want to learn how to talk better to other people on your team. If you want to learn how to handle conflict, even in your personal life. Head over to Uncharted.com/conflict Our team has put a mailing list together. 

Sign up for this mailing list, it’s different than the Dr. Andy mailing list. This one will get you all of the details as soon as they are ready to drop for the certificate. And were not going to want to miss out. It almost ready. And now, 

back to the podcast. 

Dr. Andy Roark: for the third type of case that comes in, the one that we recognize walking into the exam door we’ve got, let’s, let’s take your cat, for example, and they say, oh, you know, I was bathing the cat or whatever, and I’m doing x rays, and this cat’s got multiple healing, and Orthopedic wounds things like that, and I think this is not, this is not right at all.

What, what does that reporting process look like, Kris? Like, where, where do I, where do I go with this idea? Which, of course, I would probably still question myself. I’d probably be like, ah, it doesn’t look good. It doesn’t look right. What are, what are the steps that I can take?

Dr. Kris Otteman: Yeah, that, that’s just, that is the most common feeling I think that we have as colleagues is like, what do I do? So the first thing is just get that basic training on knowing how to document, just photos, documenting, communication And then be prepared by knowing who in your jurisdiction you report to.

Now this can be a little tricky because it’s different based on county and state that you live in. But a really quick easy way is to go to the Animal Legal Defense Fund website, click on your state, look at your jurisdiction, ask around in your area, who do I report suspected animal abuse to? And then you can also find out, am I a required reporter?

Because in most states in the United States now, veterinarians are required to report suspected animal abuse. And so, and we’re also in many states we are not subject to civil or criminal liability when we report in good faith. So, those are important things to know. Go look and find your laws.

Understand who to report for, report to. It’s usually okay to just call local law enforcement and they will guide you. Oh, you know, they might say in some jurisdictions you need to call the local animal control. You need to call this humane society. They have sworn officers or we will take the case. So, you can always start with law enforcement.

Dr. Andy Roark: So. I’m just sort of thinking through what this actually would look like going down in the practice. So I’ve got the cat. I’ve done my documentation. I’ve called, you know, the person in my area that I’m supposed to call. Or I’ve called law enforcement and communicated this. So now I’m hanging up the phone.

I’m still in the clinic and I’ve still got the cat and the person is presumably still waiting in the exam room is so like, where do I, where do I go from this? Do you, do you go in and you say to the person, Hey, I have these suspicions or I’m going to have to hold on to your animal. Do you, do you generally go on and let them take the pet and know that law enforcement is going to follow up with them?

Like I, I don’t mean to be naive, but honestly I, I have

Dr. Kris Otteman: Yeah, absolutely, absolutely. This is a super common and excellent question. You know, I think it is a lot about judgment. How is it going in that relationship in the room? In this scenario, many times the person presenting the injured pet, it’s typically a cat or a small dog, the person that did the abuse is likely not there.

And so the veterinarian and technician can have an opportunity to say, tell me more about how you think this happened. Who, who could have had access to your kitty today or in the last few days? Have you noticed any other injuries in the last few months? So you can do a little bit more of your own basically interview in terms of getting clinical information that’s relevant to what you’re seeing.

If you really think, especially if the animal is in urgent, you know, an urgent situation and really needing to be kept, then of course, do whatever you can do to keep the animal in the hospital. Maybe the client goes home, signs a release for care while you wait for law enforcement to come on the scene.

And then really, it’s important for the veterinarian to understand we are not the investigator and we are not the judge and jury. We are the expert that can tell the story for the animal in terms of what this could have been like for the animal, how it could have hurt. or not what the injuries are.

Are they permanent? Are they fatal? And so on. But then the investigator will come to us and say, Okay, Andy, show me your report. What did you hear? What did you see? And then they need, they will take it from there.

Dr. Andy Roark: So, Kris, the way this sounds to me, and again, it is, I think, I think it sort of clicked into my mind here, basically what you’re saying is, I’m going to work this case up like another case. I’m going to go back and say, you know, let’s, let’s go back into the history. And that, that’s really kind of, kind of, at least, at least how I kind of hear it is, what else could have happened?

Is there other people who could have been there? You know, things, things like that of, of, in, in my mind, you know, I don’t know, I’m always, I’m not, I don’t see myself as an interrogator, I don’t see myself as an investigator, but I can take a pretty darn good clinical history, and I definitely am good at looking at diagnostics, going back to the owner and saying, well, what I’m seeing here is not lining up with these things, let’s, let’s talk more, let’s go more deeply into possible causes of what could be going on here, and I think that those are muscles that I already have.

That I, that I, I think I can lean into, and that also doesn’t feel out of character for me. So I go, okay, I can go back into this, I can continue to document, I can look for, you know, continue my diagnostic workup, quite honestly, is sort of how I would, how I would sort of frame it.

Dr. Kris Otteman: Yeah, I think that’s framed exactly right because we aren’t expected and we should not step into the role of law enforcement or investigator, right? We’re not trying to get a confession in the exam room. We’re really just trying to, exactly like you said, suss out that history a little bit more you.

Because that will lead us to maybe further diagnostics, more notes in our report, and it will help shed light on whether or not this could have been an accident or it was intentional. So, that’s a really great way to explain it.

Dr. Andy Roark: Well, I really like the fact that you pointed out the person who is doing animal abuse is probably not the person in the exam room. And I think that that helps me to go, okay, I feel more comfortable continuing, you know, the history taking and going back and talking to this person. And it helps, I think it would help me in the moment to say, well, this is probably the person who’s in this room.

Wow. My initial reaction should be that person should die. It should not, that’s not, that’s not, that’s not where we are. You know what I mean? It’s probably, probably not them. You know what I mean? Let’s not make assumptions. Let’s continue to do our workup. Get our, get our story, get our history, document, document, document.

I, I think that all, you’ve made this much more accessible to me in my mind. So this is really helpful. So at this point, we’ve done our diagnostics, we’ve communicated with the appropriate person. I’m going to go ahead and definitely link up the Animal Legal Defense Fund website in the show notes so people can check that.

I need to go check that because I don’t know who my person is. And so this has been hugely valuable. The, the idea The, the five, the five view photos, the, the far, medium, and close photos, like very, very, very useful information. I feel like at this point we’ve got law enforcement involved. I’m gathering as much information as I can.

I actually feel like I can be a good supporter of this pet and an advocate for this pet. And I’m not in over my head. I, I feel like I know, I know what I’m doing and I’m not, you know, acting. I’m not, I’m not turning into Supercop. Like that, that’s, I, I feel like I’m in a 

Dr. Kris Otteman: Right. Yeah. And you can write up a summary and give it to whoever’s going to be taking it off your hands and and feel good about that contribution and then they’ll take it from there. So, that’s huge. 

Dr. Andy Roark: Kris, is there anything else I should have top of mind here? Because I feel like we’ve walked through this pretty well. I’m going to put a link to your book in the show notes so people can check it out. But any, anything in the process that we haven’t talked about that, that I should, I should make sure that I keep top of mind.

Dr. Kris Otteman: I think as far as the process goes, it’s always just great to not only have a lifeline to who you’re going to report to, but is there somebody in the profession or a colleague that you would want to talk through? Just like doctor to doctor, we talk about internal medicine cases, or derm, or ortho, or whatever.

Is there somebody else in your community? You want to call Kris, call Kris, call somebody to just say, Hey, I’m seeing this. What are the other tips that I need to be thinking about to get through this and come up with a succinct report? We don’t want to leave cliffhangers in our report, but we don’t want to make accusations that are not founded.

It’s not our job. We want to be thorough. We want to be, you know, helpful, but not retaliatory or judgmental. So it is a tricky walk. I would say, you know, looking at the resources that you mentioned, one of the things that, that I did with my colleagues is take a lot of the book and create an online asynchronous course for people who are interested for vets, vet techs, law enforcement, just to get some of these basics, having, you know, who do you call?

How do you do this? Having a policy in your practice that upholds reporting. Because you would be surprised, some practices have a policy that says we won’t report because we don’t know for sure. And that’s, that’s the opposite way we want to go. But yeah, look at, look at the course, look at the book, look at Animal Legal Defense Fund, our website, Victim to Verdict

has some good resources and links that would help. And of course I’m always available to colleagues around the country. Love to help our profession and the animals that we love and help us be the voice.

Dr. Andy Roark: Kris, you are so great. Thank you for what you do for our profession. Thanks for what you do for the pets. I am going to link up Victim to Verdict website as well. The, the, the online course, things like that. Guys, take a look at this stuff. Check it out. It’s something that we should all be up on and just be, at least have in our search image.

So, Kris, thank you so much for being here. You’re just, just amazing. Guys, thanks for tuning in. Take care of yourselves, everybody! 

Dr. Kris Otteman: You’re welcome. Thank you. Thank you, Andy.

Dr. Andy Roark: And that’s what we got for you guys.

Thanks for being here. Thanks to Kris for being here. Thanks for sticking with me. This is super important. It was really good to get this information out to people and it’s just I mean I was really honest in the podcast to say I didn’t know a lot of this stuff. That’s just I have some sort of rose colored glasses. I tend to think the best about people and I just don’t tend to look at people and think that they could be animal abusers or that their pets could be abused.

I don’t want to live in that world where that’s the first thing that I think. But I think it’s good to have it lurking in the back of my mind. And I think in the future, you know, pay attention and make sure if something does come through my doors, I want to catch it. And I want to say something about it and I want to put a stop to it.

And that’s inspiring to me. So anyway, guys, take care of yourselves. Be well. I’ll talk to you later on.

Dr. Jessica Vogelsang, Chief Medical Officer at the American Animal Hospital Association (AAHA), joins us to discuss the evolving role of veterinarians in modern veterinary practices. Dr. Vogelsang introduces the concept of “decentering” the veterinarian to create a more team-based approach that places the patient at the heart of care, similar to patient-centered models in human medicine. She explains how this shift can improve efficiency and client satisfaction by empowering veterinary technicians and support staff to handle many tasks traditionally managed by DVMs. Together, Dr. Andy Roark and Dr. Vogelsang explore the barriers to this model, including liability concerns and the importance of training and trust in a collaborative practice. This thought-provoking conversation is a must-listen for anyone interested in the future of veterinary medicine and the evolving dynamics within the field.

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

LINKS

www.aaha.org

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Jessica Vogelsang is a noted veterinarian, internationally recognized speaker, and bestselling author of All Dogs Go to Kevin. She serves as the Chief Medical Officer at AAHA and is the founder of Pawcurious Media, established in 2009. An early adopter in utilizing the internet for veterinary purposes, she successfully built an online community, influencing hundreds of thousands of pet owners globally. Her achievements include launching several veterinary brands and founding the Veterinary Telemedicine community during the COVID-19 pandemic. Besides her role at AAHA, she is an active board member of the Mark Morris Institute and the Veterinary Virtual Care Association.

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 one of my dear good friends Dr. Jessica Vogelsang. She is amazing. She is one of those people who really makes me think we are talking about Is it time to decenter the veterinarian from veterinary care?

Don’t have an aneurysm. Just it’s a very provocative title. It is A very good grounded discussion that’s probably not going to panic anybody, but it is a good place to start thinking about what care should look like in the future and the role of veterinarians going forward. So anyway, I really enjoy this.

I hope you guys are going to get it and get a lot of it. It’s just really smart to start thinking about what practice going forward will look like. I think there’s some really good practical actionable tips in here. Yeah, I hope you guys will enjoy it. I’m going to stop talking now and let you guys get into the episode.

Kelsey Beth Carpenter: 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. Jessica Vogelsang, how are you?

Dr. Jessica Vogelsang: Hello. Hello, I’m good. How are you?

Dr. Andy Roark: I am good. It’s good to have you back on the podcast. The last time you were here, we were talking about the retention study from the American Animal Hospital Association. For those who don’t know you, you are the Chief Medical Officer at the American Animal Hospital Association, but we’re not talking about AAHA stuff specifically today. You and I have just been kicking around some ideas recently and I said, what are you excited to talk about? And one of the ideas that you had that you’ve been thinking about that immediately got me interested and excited was the idea that may be time decenter the DVM from the delivery of veterinary services.

Did I quote you correctly on that? Do you believe that it might be time to decenter? What do you even

mean when you say that? 

Dr. Jessica Vogelsang: when you think about models of care, right, who is the primary decision maker who directs the whole cycle of care in human medicine, they’ve gotten away from this sort of physician centered care and they talk about patient centered care. And so the patient is at the center of the wheel and there’s all these different little hub and spokes.

You have your nursing care your doctors, your specialists, and they all coordinate together to funnel into this patient. And in veterinary medicine, I think we, we think we work that way, but in actuality, we don’t, we’re still very DVM centered. And really what actually represented this for me and got me thinking about it was I was looking at something actually about telehealth and VCPR.

And there was a diagram about how you know, care is delivered to patients, but it’s still the vet at the center of it. And the patient was kind of off on the side. It’s oh, they’re talking to this person, they’re talking to that person, but why is it the patient? at the center. And so it started this whole sort of rabbit hole that I went down asking questions about, do we actually perform team based medicine in veterinary medicine?

So you can look at it in different ways. There’s, it’s all going at the same thing. But in order to provide really patient centered care, you need a team based approach, which involves the veterinarian sort of decentering themselves from being the one and only person through which all information and decisions are funneled.

And that’s It’s very hard for many, many reasons as I’ve been learning over the last year, but it’s an important conversation for us to have.

Dr. Andy Roark: When we start to talk about this and the idea that it is possible to have the patient in the center of the, of the spoken wheel, if you will, it seems like there’s pretty fundamental changes there. So before I start to ask too many questions about this, can you paint me a picture, Jessica, of what this might actually look like in practice?

What would the experience be like in an imaginary vet hospital that has this decenter DVM approach? In which they have the pain. The administration in the center of the wheel. How does that even look?

Dr. Jessica Vogelsang: There’s sort of different layers of the onion, right? Like part of it is just what happens inside the clinic. Part of it is, are you plugged into the community, right? To, to other people who have a stake in this person and their family and their lives. But inside the clinic itself, really in terms of workflow at its most basic level, it is a veterinarian doing the things for which a DVM is required.

So diagnosing, prescribing, prognosing, performing surgery, and your team does really, everything else. That is it at its most fundamental core. That is the core of workplace efficiency. Leveraging your technicians, as a profession, I think that’s been our first sort of dig into exploring this is in the conversation surrounding technician utilization.

Okay. Well, what does that mean? It means that the technician does everything that they’re legally allowed to do, depending on your state practice act. And then the veterinarian just does the stuff that, that they need to do. And even that one little thing, you immediately run into a brick wall.

It’s how do I trust that they’re going to do it? Why do we have veterinarians out there writing prescriptions? Do they need to actually be like, they need to be the one to determine what the prescription is, but they, do they need to be the one to enter it into the record? Do they need to be the one to like count out the pills?

And some people say, yes, some people say no. So how do you even begin to have those conversations about truly understanding? roles and responsibilities. How do you delegate? And, once you decide, yes, I know that this is what this person should do. Do I trust them to do it? And if not, why not?

Who’s responsible for determining if that person has the right skill sets? who’s liable if they don’t do it right. There’s a lot of things that separate how veterinary medicine works from human medicine. So it’s not like you can just go up to a vet and say, just trust him. It’s fine. But it’s worth going down that hole and trying to play it out.

I mean, there are clinics that function that way. I was talking with Mark Thompson. He’s the president of AAHA this year and he, I think he sees 50 patients a day and I couldn’t get my head around that 50 patients a day. He works from nine to five and everybody leaves on time. I think his technician to DVM ratio is, is something It’s like eight to one or something. And don’t quote me on that, but it’s, it’s, Because he leverages every one of their health, but it’s taken him 25 years of practice. To get to that workflow and he knows that he’s certainly the exception, but that’s what we’re shooting for 

Dr. Andy Roark: would you say I think that the sort of stereotypical dentist, human dentist, is kind of an example of what this might look like. There’s, when we talk about decentering the DVM, there’s always this question I think that comes into people’s minds, and I think that’s why they react really strongly to this is, how decentered are we talking about?

Is it the veteran, is that guy a veteran, a dentist dental hygienist relationship, or is it there’s a vet in a building, two cities away, and a technician here with a pet, and that’s how decentered the veterinarian is.

Dr. Jessica Vogelsang: That’s why it gets scary, right? And we’re not talking about like direct versus indirect supervision, anything like that. Like certainly you still like the veterinarian has oversight of what’s happening. And so it’s not about lack of oversight, right? It’s not about taking decisions away that the veterinarian is legally obligated to make, but it’s about when you’re at the center, everything goes through you.

Everything. Does everything need to go through you? Certainly a lot of stuff needs to, but does everything, do you need to be the one to go through follow up instructions? Do you need to be the one, like I said, to like count out the individual pills and check off that it was filled, right? Like I, it, there, there’s a happy medium in there somewhere.

And I think we haven’t quite figured out what that is. So that’s what I mean by by de-centered. And when decisions are being made, are we taking into account all of the other factors? When you talk about patient centered veterinary medicine, so it’s not just about who’s making the decisions, but what are they thinking about when they make the decisions?

So you know, as a veterinarian, as veterinarians, we’re trained oftentimes to look at the patient in front of us and recommend things that have, that are in the best interest medically of the patient. But all of the conversations that we’re having now around spectrum of care, contextualized care requires you to take a little bit more of a step back and to say, there are other confounding layering factors on there about finances, about accessibility is the client able to do the things that, that you’re recommending just physically or mentally.

And so can you leverage your team to help have some of those conversations and have some understanding so that you’re making recommendations that are really family centered it’s complex and you are never going to be able to get to that model.

If you’re the one who has to make every little decision, like it’s exhausting. 

Dr. Andy Roark: Yeah, 

Dr. Jessica Vogelsang: It’s not going to work.

Dr. Andy Roark: It’s not feasible, it’s not sustainable. Do you think that pet owners are open to this type of practice, or do you think, and again, I know we’re speaking in about broad generalities here, but whenever I bring this, because I, I, you and I are pretty much in alignment, I think, based on this conversation of how I think practices should run and what they look like in the future and what makes sense.

One of the big, biggest pieces of pushback that I receive is, pet owners won’t allow that. They want to talk to the veterinarian. They want to know what the veterinarian thinks. They want

Dr. Jessica Vogelsang: Who created that 

Dr. Andy Roark: I agree. I agree.

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Dr. Jessica Vogelsang: My first day in the clinic, I was a brand new grad, so I had practiced for exactly zero hours at that time. And I show up and my mentor’s there. And what does he do? So the first thing that happens is my name tag isn’t printed yet. So my name tag still has my maiden name and says student of veterinary medicine.

Dr. Andy Roark: Oh, 

Dr. Jessica Vogelsang: thing he does is say, wear that. I’m like, that’s not gonna help.

Dr. Andy Roark: That’s a terrible idea. Oh,

Dr. Jessica Vogelsang: He introduced me as the brand new grad who didn’t know anything. So of course they’re going to want to talk to him. You have set the expectation that this person doesn’t know what they’re doing.

And it’s the same with your staff. How are we introducing our technicians, and our front desk staff is this is the person who knows so much more about financial plans than I do. This is our absolute maestro at dental care. This is our technician who does this day in, day out.

She is going to teach you everything you need to know. there is zero pushback about taking advice from someone. If you let the client know, this is who I trust. And this is who you should trust too. That’s it. That’s it. It’s about trust. So when you look at some of the surveys out there about telehealth, people are complaining about going to Dr. Google and all that kind of stuff. They’re not going there because they like Dr. Google more. They’re going there because you’ve been inaccessible for the most part. And so we know that the studies have proven in human medicine and veterinary medicine, people preferentially that their number one most trusted source of information is their vet in the vet clinic.

Number two is any vet. And number three is the random public. If you make yourself and by proxy your team accessible, that’s who they’re gonna go to first. I see no barriers there other than the ones that we’ve created ourselves.

Dr. Andy Roark: I like that a lot. I think your statement about how we introduce our support team is, I think you’re spot on. I don’t think that’s ever been more relevant. The thought that was sort of in my mind is we sort of talk about these decentering the vet and what that looks like. I always sort of swing back and forth.

I don’t think I’m indecisive, but I think I tend to lean one way and then evaluate my views and then kind of went lean back the other way and it’s for a long time and always said it said, you know We really need to sort of decentralize the vet. We really need to vet medicine as a team game and I still do believe that as I look around the world I can’t help but notice influencer culture really growing and spreading like crazy. And whether you’re into TikTok or Instagram, or whether you’re just watching on TV, I mean, I’ll give you an example. We have Snoop Dogg at the Olympics right now, as we’re recording this, he’s…

Dr. Jessica Vogelsang: Who had that on their bingo card 10 years ago? 

Dr. Andy Roark: No, not at all. Not at all. And. Even more shockingly, he’s crushing it. People love him. People who you wouldn’t think love him.

My mom loves him. And boy, she didn’t like him when I played his music in the 90s. was not about it at all. 

Dr. Jessica Vogelsang: and, the man knows more about dressage than I do.

Dr. Andy Roark: Yeah, his coverage amazing. But so all that to say, I promise there’s a point here. The point here is We have this influencer culture where people are going and they’re saying, Oh this individual is great. I really like them. I really like what they have to say. And that’s all TikTok things are these short sort of video clips of people talking to the camera and stuff like that.

We see people building these audiences. We see them building credibility. We know that TikTok has surpassed Google In the first place that young people go to find information, which blows my mind. They search TikTok And and so i’m looking at and I go, okay if this is how the world is going and people are leaning more and more into what do these, I don’t know, famous figures these people I pseudo know, what do they say, what do they think?

I can’t help but wonder a little bit, are we shooting ourselves in the foot if we move veterinarians out of the public spotlight? Does that make sense?

Dr. Jessica Vogelsang: I want to be really, really careful when I say decentering. Again, it doesn’t mean that you’re not present in a way that you were before. Like one, it’s about efficiency, but two really decentering also has to do with, with your prioritization and decision making.

It’s about making decisions that are truly driven by the needs and priorities of the patient rather than necessarily just what you think. And so When a client comes in and they have all this stuff they found on TikTok, you have to take that into account in your conversations, which is really hard for people.

So again, it is centering them in here. They went and did that for a reason. There’s some reason that they came in thinking that raw food’s the way to go. Or, and if you immediately discount that and say, that’s stupid and I know better that then they’re going to shut down. Because you have to center them as the person who knows themselves and their pet best. they may not know the medicine the best but they know their lives best. And so really to me, that’s what centering means. So it doesn’t matter what you would do in that situation. And that’s why it’s always funny when someone asks, what would you do? It doesn’t necessarily always really matter what I would do because I’m not you.

And I have different resources and needs and priorities. To me, that’s really what about the centering means. And so I think the reason that people love influencers so much is that influencers are really, really good at centering the viewer in those conversations. I know this is what you care about, and here’s my thoughts on it.

And you don’t have to play the same game or be on TikTok. You just have to take the same approach. I know this is what you care about. this is my recommendation. And again, you don’t have to be the only one having that conversation. I guarantee that there are probably 75 percent of your clinic who’s more adept at TikTok and knows these influencers more than you do.

Dr. Andy Roark: I think you totally blew my mind. What I thought you were going to say was if we introduce our and we endorse them, you can have the veterinarian being this influencer type figure, the person who, you know who has the relationship, but then delegates effectively to the team and does so by bringing up their status in the eyes of the pet owner.

And you can still have this almost like a PR, veterinary centered experience. And that’s what I thought you were going to go. You did not go there. You completely flipped it on its head and I really love your answer much more than what I was thinking you were probably going to say.

And the idea of the idea that influencers do a great job because they center the viewer, meaning they create this content that makes the viewer feel seen and feel special and feel important. I think that’s probably the answer. And so I, think it’s. Suddenly, it makes a lot of sense going back to sort of the original idea of the patient slash client as the center of the care wheel, as opposed to the veterinarian center of the care wheel.

I, I think what does our engagement with the public, what is our marketing, what is our public relations, what does that stuff look like if we put Patient slash client in the center of everything and we make this client based care environment. I think that’s, I think that’s a really good answer.

I’m gonna, I have to sit with that as far as what it looks like. But

Dr. Jessica Vogelsang: Can you write that down for me? You just explained it really well.

Dr. Andy Roark: I’m still processing. I’m like, Oh I thought I think that your take on it is, is really, I think that’s really good. I’m really going to sit and think with that. It’s I think you’re probably spot on.

I think that you can 100 percent lean into everything that we’ve been talking about, about decentering the veterinarian and still creating the experience. That the pet owner is looking for. I think it’s quite possible that the pet owner thinks that they want the veterinarian’s attention. The truth is the pet owner wants to feel seen and heard and listened to.

They want to feel reassured and safe, and if we create that experience for them, then magically, direct face time with the veterinarian for an extended period of time becomes a lot less important. I think if you ask them what they want, they’re going to tell you, I want an hour with the veterinarian.

I don’t think that they really do. And I think if you show them a healthy alternative they’ll just let that idea go.

Dr. Jessica Vogelsang: Well, and to take it even a step further, I would say what they really want is to know that they did the right thing at the end of the day.

Dr. Andy Roark: Yeah.

Dr. Jessica Vogelsang: It is not about, I want you to fix this. I want to know that I did the right thing by coming to you. I want to know that I did the right thing by following your recommendations.

Dr. Andy Roark: Yeah. No, I, I think you’re, I think you’re right. I think there’s a big validation component. And I think if they could probably receive that validation from the team. Then that would relieve that tension or that feeling of, I need more time with the veterinarian. I think in order for them to receive that validation, we have to do a good job of giving our team a reputation of setting them up for success in the pet owner’s eyes, for making them for making the pet owner feel like our team is a worthy source of validation.

You know what I mean? I, I want to be validated by an expert and if I don’t believe you’re an expert then your validation doesn’t mean that much to me but if I do believe you are an expert, you’re knowledgeable, you’re someone that I respect, then that validation is great. I think we have to make sure that our team falls into that expert category in order all of this to work.

Dr. Jessica Vogelsang: This reference is going to be, like, super dated by the time this comes out, but, Simone Biles, greatest of all time, bowed to Rebecca Andrade when she won the gold medal. Yeah, you’re the greatest, but also, like, in this, somebody else did really, really exceptional. It doesn’t take anything away from you to acknowledge that to celebrate it in front of the world.

Actually, it makes you stronger. It makes the entire world stronger. Sportive gymnastics stronger. It makes the entire profession stronger for us to have that message. Like when you come into the clinic, yeah. Like, look, I’m great. I know you love me. And also this team that I work with every day is also amazing.

It wouldn’t work with them if they didn’t. We are here to make sure you leave feeling like you did the right thing.

Dr. Andy Roark: What do you think is the main driver of pushback against this? Because this is not a new concept, the idea of, using our technicians like dentists use their hygienists. None of this is new. I think that perspectives are changing. I think that there are significant incentives for us to get more efficient today than there were 10 years ago.

There’s still pushback. Where do you think that pushback primarily comes from?

Dr. Jessica Vogelsang: Yeah. It’s interesting, you know, depending on who you ask. And when we were working on the technician utilization guidelines, the technicians were saying, why don’t you trust us? It’s that you don’t think we know how to do a good job. And the veterinarian said, well, no, it’s, not that it’s, I’m worried about liability.

So I think a lot of it is about the perception of whose responsibility is it to ensure that this person. is actually doing those things that you’re delegating to them and that they’re trained appropriately to do so. that was sort of like an aha moment for me where I know for me as an associate, cause it’s happened to me, it’s happened to a lot of my colleagues, you’re an associate.

I know that I’m working with this credential technician and that I’m being told that they’re trained in order to do X, Y, Z. But if something goes off the rails, I’m still the one who’s going to be liable in court, my license is online. That makes it really, really hard. If I don’t truly believe in my heart of hearts that you’ve seen this and that you know how to do it.

And it’s not the same on the human side. If you go into the hospital and the nurse pulls up the wrong medication and administers it to you and something bad happens, it’s the hospital who carries the liability. So I think there’s some fundamental ways that we address that, that’s like legal and that’s all this other stuff and that’s cultural.

That it’s gonna take us a while to untangle. But that’s real, like that fear is real. So I get why it’s really hard for for veterinarians. Especially when you’re not the one who, has oversight as to how the rest of the team is being trained, And so it’s going to take some time.

It’s certainly not a matter of just flipping it off and on switch, right? It’s a lot of teamwork. It’s a lot of transparency in terms of very specific core competencies, that It’s really great conversations that organizations are having right now. There, there’s different levels of assistants and technicians and registered technicians, all the way up to specialists.

What does that mean? What exactly are those skillsets and how have they been validated? And I think, as we build those out and everybody has a much clearer understanding of what they are, that’s going to make it easier for us to trust and to delegate, but it’s going to take some time

Dr. Andy Roark: Dr. Jessica Vogel saying, thanks for being here. Where can people find you online? Where can they see what you’re up to with the American Animal Hospital Association?

Dr. Jessica Vogelsang: at aaha.org

Dr. Andy Roark: awesome. Thank you so much. Guys, thanks for tuning in and listening. I hope you had I hope you had fun. I hope you got some good ideas to roll around like I did. Take care of yourselves, everybody. 

And that’s what I got. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Dr. Jessica Vogelsang from the American Animal Hospital Association for being here and kicking ideas back and forth with me. She is, she’s amazing. I just so enjoy her. I so enjoy you as well.

Thanks for tuning in. Take care of yourselves, everybody. I’ll talk to you soon.

Vicky Ograin, RVT and VTS in Nutrition, joins us to discuss the evolving role of veterinary technicians. In this episode of The Cone of Shame Veterinary Podcast, Dr. Andy Roark and Vicky explore how vet techs are being increasingly empowered and better utilized in clinics, supported by organizations like NAVTA and social media. They also highlight the Veterinary Nutritional Advocate Certificate, a free program that enhances nutrition knowledge and patient care. Listen in to learn how veterinary technicians can use these tools to advance their careers and make a bigger impact in the clinic!

This episode is brought to you by Hill’s Pet Nutrition!

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

LINKS

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

Academy of Veterinary Nutrition Techs: https://nutritiontechs.com/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Vicky received her technician degree from Los Angeles Pierce College. She served in private practice for many years in California, and then 22 years ago began a career with Hill’s Pet Nutrition, where she is a Scientific Communication Senior Specialist, in the US Professional Veterinary Affairs department. She focuses on education for technicians and the health care team as well as strategy for veterinary technicians in tech schools and graduates. 

In 2007, she completed a Bachelor of Science and in 2008, she completed a Masters, both in Business Administration. Vicky obtained her Veterinary Technician Specialty (VTS) in nutrition in June 2013.  Vicky speaks nationally and internationally and is a published author.

EPISODE TRANSCRIPT

Dr. Andy Roark: This episode is made possible ad free by Hills Pet Nutrition. Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a fan-freaking-tastic, technician-tastic, episode for you today. I am here with the one and only Vicky O’Grain and we are talking about all, well, honestly, we’re talking about all things technician.

We’re talking about technician utilization. We talk about where the technician job is going, what the future of being a technician maybe looks like. If you are a tech or a vet assistant this is going to be a super uplifting make you smile sort of episode and also we talk about the

Veterinary nutritional advocate certificate. Guys, this is free training program is made possible by hills pet nutrition. It is an excellent resource for our support staff and we’re going to talk all about that as well. So we got some educational opportunities. We’ve got some really cool stuff in the growth and development frame of practice and we’re just talking generally about our love for technicians and we talk a little bit about what tech week means to us at the end.

So, I think a lot of people are going to love this episode. 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, Vicki O’Grain, how are you?

Vicky Ograin: I am awesome. How are you today?

Dr. Andy Roark: Oh man, I am so good. I am so good. I’m just gonna, I’m not gonna hold it together very long. I’m just gonna stop and gush at you for a moment. I am so glad that you’re here. I am honored to have you here. For those who don’t know you, you are a champion, you are a torchbearer,

for veterinary technicians and you make my heart glad you have been a veterinary technician for four years for a while you are an RVT. You are a veterinary technician specialist, a VTS in nutrition. You also went ahead and got your MBA. You have been ride or die with NAVTA the North American Veterinary Technician Association group for a long time. You were the president I think 20 2013 2015 somewhere in there.

You’ve had some past president duties. You’re the chair of the CE committee there now. Like, you are ride or die Veterinary technician and you have been an educator and a supporter for so long and I am just so grateful for what you do. And I just I think the world of you. I’m so glad you’re here.

You are also right now working as the The Scientific communication Senior specialist at Hills Pet Nutrition. And yeah. And so again, using that educational muscle to

make that profession better. I wanted you to come in and I wanted to talk to you. I saw, you’ve sort of been involved in the Veterinary Nutritional Advocate Certificate this is a new program that’s coming out, but I wanted to stop and before I get into that, I want to zoom out a little bit and just get your perspective on the landscape here.

It is my impression that Veterinary Technicians and Veterinary Assistants. I’m very optimistic about the future for vet techs and vet assistants. My impression is that over the last couple of years things have been improving in a lot of ways for vet techs and vet assistants. I feel like they’re being more empowered.

I feel like they’re being better utilized. I feel like they’re being paid better and again, I know I’m speaking in broad generalities. There’s people out there who are like, nope. Nope. Nope, but across the board my impression is that this this profession is quite really starting to come up. I think that there’s a lot of room for growth in the future.

Do you share this positive impression that I have that things are moving in the right direction in a way that they didn’t for a long time?

Vicky Ograin: Yeah. Yeah. Thank you for that question. And you’re right. I’ve been around a long time and, way back in the day, we were told things were going to get better, but I do feel that they are getting better now and when we got our veterinary technician specialist, NAVTA has our certified vet assistants.

There’s other programs that have vet assistant programs. So I do think that things are better. I think that we’re doing a better job of advocating for ourselves. Certainly, we got in this profession because we love animals, whether we’re a vet tech or a veterinarian. But for us, vet techs, we got in this profession because we love animals and we want to help them and so to me that’s one of the things that’s always been so important to me is really advocating for my patient and putting myself out there and saying Hey, I want to learn more.

I want to do more. I want to help my patients and luckily, I worked at a clinic where they were open to me doing that. And now with Hills it’s even more impactful because I’m able to influence so many more technicians, healthcare teams to really make sure that they feel empowered and have an understanding.

So I do hope I’m optimistic that things will get better.

Dr. Andy Roark: Where do you think that empowerment comes from? Because I get that impression as well, is that the technician voice is much bigger than it used to be. I think NAVTA has had a hand in that. I think having an organization that people are a part of is definitely beneficial. I’m looking a lot at social media.

I really think social media opened up a lot of pathways for people to have a voice when they wouldn’t have necessarily had a voice before. I don’t, do you agree with that? Are there other things you think that have made that voice more prominent for technicians?

Vicky Ograin: Yeah, I think you’re absolutely right. When I started just a few years ago, there really was no social media. it was word of mouth. You talk to other technicians in your clinic, you went to conferences, that was really your only avenue. But now that we have social media and we have some amazing technicians out there who really are advocating for us.

And it’s, I think that’s helping us feel more empowered because, you know, we’re able to talk to each other in a social media aspect, and tell our stories and then someone else will come along and go, my gosh that’s resonating with me. That’s exactly how I feel. And I think we feel seen more.

I mean, I worked in a clinic where, you know, I was the only credential technician at the time that I was working there. And I worked with, some amazing assistants, but I was the only credential tech. And so for me, I didn’t have really any other credential techs to really talk to and get feedback from and know what I’m going through.

That’s one of the things I love at Hills. We employ so many credential vet techs, and I have this amazing group of people now that I can talk to and we can, commiserate, so to speak, and realize that, oh, wait a minute, you’re going through the same thing. How can we help each other? So I think that community.

But social media apps, I agreed, absolutely has helped things so much more, and it’s allowed us to be seen, empowered, and feel that we have a voice and coming up with solutions.

Dr. Andy Roark: I think for a long time people struggled with knowing how to utilize credential technicians. I don’t know if you agree with that, but I also think when social media, when people are able to talk across practices and say, well this is what I get to do and this is what I get to do. I think that’s, I think that’s eye opening in a lot of ways.

I saw, it was funny, I saw a conversation recently a practice owner brought it up to me and there are practices out there that have decided that they are, they don’t want to do nail trims anymore. And that’s what they have decided. And they say, we don’t, we don’t want to do this.

We feel like it’s stressful for our staff or they’re too shorthanded. Whatever the reasons are. And I’m not saying we should do them or not do nail trims. However, I saw a conversation from so many different clinics and people say, well, we also made this choice. And other people said, we talked about it and we decided not to do this.

But that type of just having the conversation and saying, Hey, did you know, it’s not illegal to not do nail trims? I thought that was, I thought that was something that never used to happen. And so my position on technicians and vet assistants is I see a bright future for them. I think that the future has to come from them being utilized and empowered.

Like we, they have to have tangible skills. They have to be able to help deliver services to the pets and to the pet owners. I think that they and the rest of us need to work on a sort of I want to make sure they get the respect that they deserve. I think having pet owners believe the veterinarian is the only one who knows what’s going on and these other people are helpers.

I, that’s not accurate. It’s not honest and it undermines our technicians to really help us and to wanting to take burdens off of the veterinarians if people see value in the text. They’re more willing to have the phone call with the technicians. And then it also helps the pet owners feel better about the services they’re delivering.

And it also feels good to be appreciated and to feel valued. And so anyway, I, I’m looking at those types of skills and that kind of brings us around to the certificate that I kind of wanted to talk about a little bit today, the Veterinary Nutrition Advocate Certificate. And so that’s for me, I look at things like that and I’m like, yes, that is the type of tangible knowledge that can make my techs and my assistants better in the exam room.

It can make a more value to my practice and to my patients. And so can you talk at a high level, just start out high level about what is the certificate? Tell, just get me started on what the nuts and bolts sort of look like.

Vicky Ograin: Yeah. So first off, just to let you know this was a program that was around a while ago and the decision was made to discontinue it. And so I, after talking to a lot of technicians and educators, realized that it needed to come back. And so, I kind of became the champion for it. And it’s been great that Hills was like, very supportive in saying, No, actually, you’re right.

We do need to bring this back. And so what it is, it’s a multi level, certificate program. So it’s level one wellness. So you learn about basic nutrition and then it goes into level one, two and three therapeutic, where you learn about disease processes. Now, originally we were going to do words like, bronze, platinum, whatever, right?

Well what we realized is this is actually an evergreen program and that the plan is to add more. So the hope is we’ll add more modules for wellness. So then there’ll be level two wellness and level four therapeutic. Okay. So the hope is that as technicians and really anybody, veterinarians, healthcare team, really anyone can take this program.

It’s a free program. And so anyone’s welcome to take it as you complete each of the modules within that level, you get your certificate. And then hopefully, I’ll see out on social media where people like, well, I’m level two, I’m level three. Ooh, we’ve got level four now, I’m really excited about that part of it because I know us technicians, we like having that extra credential.

And so this gives them that opportunity. I know vets and vet assistants like that as well. But the good thing is it’s really teaching them sort of a foundation of nutrition and then helping them. I think when you have that foundation, it’s going to help you have those conversations with the pet parent.

Because if we’re not talking to the pet parent, they’re going to go to the internet, and the internet is not going to give them necessarily accurate information, and ultimately, which is what I always go back to, the one that’s going to suffer in this situation if they get the wrong information is the pet.

And so if we can educate and get the right information out there, we’re going to help our patients, and to me that’s what it’s all about.

Dr. Andy Roark: One of the questions I always ask when I start to look at programs or I’m thinking about investing into training or things like that is, what does success look like? And so, Vicki, when you think about this and you think about someone in the practice whether it’s a sister or a tech or even a doctor taking this, what does success look like in this program?

What is this person able to come out and do? What is the impact that they’re able to have in the practice? 

Vicky Ograin: I want to use myself as an example because I did do this program, a similar version of this program through Hills many years ago when I was in practice. And it allowed me to understand more about nutrition to form my love for nutrition, realizing that really every patient, every pet can really benefit from good nutrition.

And by having that understanding, I really felt empowered to be able to then go to the owner, the veterinarian that I was working for at the time and say, I’ve learned all this really amazing information. I feel I can bring value to the clinic. I’d like, I literally named myself the nutritional counselor, which was the name of the program at that time.

I’d like to be the official nutritional counselor. The old ask for what you want. So that’s what I did. And the owner who was a businessman was like, fine. Okay. If she wants to go be the nutritional counselor. He didn’t care by doing that. I helped my patients, but I also, we saw the value of the revenue that was coming in was going up because we were doing a lot more nutrition. For me,

it empowered me to feel like I was being more utilized as a technician because now I was having extra special things that I was doing. I started training other people in the clinic to also be nutritional counselors because I’m not there every minute, right? And so that gave the other technicians or the other assistants, I was the only credential tech, but the other assistants in the practice, it gave them a feeling of worth that they were now providing great services for the patients, but also for the practice, job security.

That also ended up becoming my true love of nutrition, which is when I wanted to get my VTS and nutrition. So I actually helped start The Academy because by now I’ve got this absolute passion for nutrition. And as I was transitioning and thinking what was the next step in my career, that was when In my mind, I thought working for a pet food company would be an amazing opportunity.

Hills was a company I always had worked with and thought they were an amazing science based company. And so I applied and as a good, I’m just a vet tech mentality, I thought they would never hire me. But they did, because they saw the value and the enthusiasm that I brought to the table. And I’m now in an education role, which, and so when you think about it, that isn’t going to happen for everyone, right?

But to me, I think it allows you to really feel more empowered in the clinic, be able to be more utilized. And then maybe you could be like me and, and end up getting a VTS in nutrition, end up doing some really amazing things. So to me I think it’s. It’s all about career development, personal development, but also helping your patients.

Dr. Andy Roark: I think from a career standpoint, one of the things that we see with the high turnover rate that we have for support staff in vet medicine is stagnation is the enemy. Having people who feel like they’re stuck, they’re doing the same thing that they’ve been doing, they don’t see a path forward.

I think, it’s funny, I had a conversation about this recently with Stephanie Goss, who’s a practice manager. I think that. In the past, the pathway that was laid down was, you’re gonna be an assistant, and then you’re gonna be a technician, and then if you’re really good, you’ll be a manager. Which makes no sense at all!

If you’re really good at this, we’re gonna make you stop doing it, and let you manage other people, which is a totally different job. But it was like, It was this path that led from the floor into management, which, and there’s so many really good people who say, I, pardon me, I never said that I wanted to be a manager.

That has never been something I’ve asked for. All of my effort has gone into patient care. This assumption that I would be excited to move up to management is ridiculous. How do we keep those people on the floor? We have to continue to let them learn and grow and develop. And it just, I think these things are really important.

I love the way that you talk about, about, these, the modules and wellness and therapeutic splitting them apart. Because as I think about this, recently I’ve worked with technicians that had a real impact on the way that I was talking to pet owners. And so it was last week I had a diabetic cat and I was going through and we were talking about glucose levels and things like that, and where this is on four units of insulin.

And, we’re working through this and everything. And it was my technician who was like, Dr. Roark, she’s not on a diabetic diet. And I was like, oh, and she had picked that up from the history and again, I’ve got three cases going and again, I’ll just be honest, I’m a human being and you don’t, I’d like to say I never miss anything.

I miss stuff all the time. I’m very happy for my techs to help me not drop balls. And it was just one of those things where she had the knowledge, she was paying attention. She saw an opportunity and said, we’re not doing anything nutritionally for this pet. And we were able to go back in and talk about

patient care and hopefully, get this dose of insulin down, which is going to save the pet owner most likely money and effort and time and get some weight off the cat and all of these sort of benefits. But like she brought that, that therapeutic part to the table. The other part, is in the wellness part,

and we talk about keeping pets healthy. I think we’re seeing a shift in human medicine from in the past, human medicine has really been focused on, you know, fixing broken people and I’m hoping that we’re seeing a shift towards a focus on wellness and maintaining people so that we’re not fixing them after they’re broken, but we’re laying down patterns that keep them healthy. And I just think that there’s so much opportunity there people love their pets.

They want their cats to live to be 25 years old. I’m not convinced we can’t make that happen.

Vicky Ograin: I hope so.

Dr. Andy Roark: So, what, how do you find people doing learnings like this? How, how does that work? Are most people sitting down? Are they doing it as an intensive download? Is it an ongoing approach that people take and they do a certain module every X amount of time?

Do you have thoughts on, as I’m trying to get my staff trained and get them up to be maximally effective, what is, what does training and implementation look like in your mind?

Vicky Ograin: I think it’s going to be different for everyone, but one of the things that’s really great, and I realize you’re in a clinic and you already have your technicians, but this is a great opportunity for vet tech students. And so they’re in that point where they’re learning, they need to understand nutrition for the VTNE, things like that.

My hope is for them, it would be an immersive experience where they really immerse themselves, do the modules in succession. Some of the instructors may even be assigning certain modules to them if, if that’s something the school has embraced. But I think for technicians out in practice, we’re so busy.

And so to me, I’m the type that I get excited about something and you might as well, just the weekend’s over. I’m just going to sit 

here and read modules because I’m not that crazy person that loves CE but some others it may be more important, they’ve got family and the kids and it’s ball games and things.

So maybe they could do a module on their phone while they’re at the ball game, watching the kids. They’re pretty easy to do. They’re mobile friendly. So you can do them on an iPad or a tablet, a phone, certainly a computer. And so they really can be done at your convenience. You don’t necessarily have to just be like the crazy person I am and basically put myself into a room for the weekend and completely immerse myself.

But you can if you want. And certainly there’s going to be certain people that are going to do that. We’ve already seen I mean this program has actually only been up and running at this point for three weeks And we’ve already seen over a hundred. I think it’s 130 people have already completed the different levels which is pretty amazing when you think that it we really haven’t done a lot of advertising of it yet Because it’s still very new. It’s been out on social media, and it’s been a lot of word of mouth. And so, it just shows me that this really was needed. And, to me, those are the people like me who just sat down and did the modules because they were so excited about it. But certainly could be either way.

Dr. Andy Roark: So I’m going to switch gears here for a second. I want to go back to sort of the optimism at the beginning of seeing a sort of a bright future for technicians. And I really want to pick up on what you’re talking about, the education and things like that. And you’re so involved with technicians.

I always like to ask people like you and say, tell me what you see as far as technician utilization that you’re excited about. Like, how are practices using technicians, how are technicians using these skills in a way that you think might spread that we might see in practices across the country in the future?

Vicky Ograin: I mean, we could certainly do better, but I do think that a lot of the clinics are utilizing their technicians more, but I think sometimes for us as well, we need to speak up. I think sometimes we sit in the back and we think that they’re going to let us do stuff. We need to advocate for ourselves.

And I think that’s something that a lot of technicians of today are doing, which I think is why we’re seeing more technician utilization. Also working with amazing veterinarians like you. I mean, you’re such a great technician advocate. We, and that’s, I think something that makes us feel really great as technicians, because ultimately at the end of the day, we are a team.

And that’s the way I always think about it, I can’t do my job without you, but I feel you shouldn’t do your job without me. And so when we’re working as a team, you’re doing your doctoring, I’m doing my technician type stuff. That’s when you really have a great cohesive clinic and you’re able to get the tests done, bring in the revenue, which of course always makes everybody happy.

But honestly, I think that’s what we need to be doing more of. Maybe more team building, maybe getting the vets and the techs together, getting us to realize that we really do need each other. And then I do think that we need to, I mean, that’s, I think why I was able to do so much and became the nutritional counselor at my clinic because I asked for it.

And I never really, I’m always in all these years, I’ve still been very enthusiastic for this profession. I think it’s an amazing profession, whether you’re a vet tech or a veterinarian, obviously as a vet tech. I think being a vet tech is such an amazing profession. But I do think that sometimes we need to kind of advocate for ourselves.

I know that can be hard, continuing education, making sure that we’re keeping up bringing in those new skills. I used to meet with my vet every year and tell them, this is what I’ve done this year, this is what I proposed to do. And then I would check in with them the next year and say, this is what I did of these things, that we talked about, and this was, this wasn’t like a formal review.

I just put it together. It’s funny. Now that I work in corporate America, we have official reviews, but back then we didn’t. But I knew enough to know that if I was going to advocate for myself, if I was going to be able to take on more skills, I needed to show him what I was doing, how I was accomplishing that, the CE that I was doing to learn more, all those kind of things, I think.

And I think a lot of our technicians these days are really doing that. And the vet assistants that decide to go on and become, I’m hearing so many more that do decide to go on and become a vet tech because they’ve got those great skills, but they need the knowledge. And then they’re in a great position because they also can advocate for themselves as well.

Dr. Andy Roark: I love your point about sort of team building. There’s research on the human side of medicine when they look at nurses for humans. And a lot of job satisfaction, a lot of feeling utilized and meaningful in their work comes down to, do you know the doctors, do the doctors know you, do you trust the doctors, do the doctors trust you?

And it really is that, and I really think that it’s been damaging to some degree to have these silos of the doctors. Talk to the doctors, and the techs talk to the techs, and the doctors have a medical director, and the techs have a manager, and I understand why it’s that way, and I understand there’s logistical challenges.

I think that you can definitely segment those groups in a way that prevents them from working collaboratively, from the doctors not knowing the techs as well as they should, and that makes trust building harder for the technicians. I think that you’re so right in that there are things that we should be doing as far as giving techs opportunity.

And I always say to technicians like, if you get a chance to run the staff meeting, to do some training for the other team, jump on it, because part of that is your ability to show your knowledge and to build trust in the doctors and in the organization. I just, I, I don’t know. I think that you’re spot on.

I also just, I really want to agree with you here on the advocacy part because there’s this thing that I’ve seen. I’ve seen it again and again in the last couple of years. It’s almost this problem with your really competent people is that the doctors and the managers, they tend to be focused on the people on the team who are struggling.

You know what I mean? People that, I don’t mean struggling in a bad way, but they’re brand new, they’re being onboarded. The new people, they need support, they need help, and so they get a lot of attention. And at some point, you can be so competent that you just get ignored. It’s because they’re like, everyone’s, they’re completely comfortable, they’re like, they know you got your stuff locked down.

But the downside of that is you honestly get ignored. It doesn’t come out of a bad place. It’s not that people don’t appreciate you. The analogy I use, and I don’t mean to be disrespectful, I remember when I, when my kids were younger and I had an older kid who knew what she was doing and she could put her own shoes on and stuff like that.

And I have a younger kid and my older kid at some point would get frustrated and be like, Why aren’t you engaging with me? And I’m like, because you’re the big kid, and you can do these things, I just need you to handle your own stuff, and let me deal with the little kid. And, that’s okay in the short term, that shouldn’t be how the relationship goes.

And so I really do think that, especially if you’re bumping up against the top of what you’re allowed to do. I think reminding people that you’re there, showing interest in wanting to grow and wanting to develop, being clear about where you want to go. I think that’s another thing that technicians have not done traditionally, which is why I think a lot of them get fast tracked into management of we don’t know what else to do with you, but we’re going to, we trust you and so we’re going to move you up.

I think if people had a little bit more insight into these are the types of opportunities that I’m looking for. I think that they could, I think a lot of, savvy doctors and managers and owners who want to keep the techs would be happy to try to support them and where they want to go. But I think it does put some of that ownership back on the tech stuff. Where do you want to go and what do you want to do?

Vicky Ograin: Exactly. It needs to be your passion. to me, it’s no different than going to tech school or veterinary school, it’s, it’s another level and it’s absolutely worth it.

Dr. Andy Roark: This episode is coming out on national veterinary technician week. And I just wanted to pause for a second and say to you, what does tech week mean to you?

Vicky Ograin: It’s so funny to me and I really, I love this question because to me, it’s the week to celebrate vet techs. You know, there’s so much that we do. You’re on the floor, you’re saving animals. There’s times that you forget all the things that we really do for this profession. And other members of the healthcare team are just as valuable.

Our veterinarians, our assistants our, CSRs, to me, this is our one week where we really get a focus on vet techs and all the things that we bring to the practice. And so to me, it’s the week to celebrate us. And to me, as simple as just saying, thank you. This doesn’t have to be about big parties.

We love that, right? Don’t get me wrong. But, to me, I always love that tech week when I have anybody, a family member, friends, family, veterinarians that I work with, other technicians, we love saying it to each other, that just thank me for being a tech and for all the patients that I’ve helped. It just, it fuels my heart.

And makes me feel so good. I’m so happy that NAVTA started this. And so it’s the 31st year this year. And so we’ve had 31 years of really celebrating vet techs. And so I really hope that all the vet techs out there really are feeling proud of all the things that they do and all the patients that they’ve helped and hopefully that will fuel you as you are helping those patients and making them giving them a better life.

Dr. Andy Roark: Thank you. Thank you so much for being here. I’ll put a link in the show notes to the Veterinary Nutritional Advocate Certificate. Again, it’s a free program. It’s a great resource. I will link that up. Vicki, what are your favorite resources for technician support staff that just that love to learn and that want to make sure that they’re continuing to grow? 

Vicky Ograin: Absolutely. And one thing if I could mention that I forgot to mention before, is the Veterinary Nutritional Advocate Program is RACE approved. So they will get race CE, which is obviously important for our credential tax. But I also think another really great resource is NAVTA. So, as you mentioned, I’m the CE chair, so I must

shout out to NAVTA we’ve got some really great resources. We are doing webinars monthly. They’re free for members, not too expensive if you’re not a member, but obviously there’s benefits to being a member. There are also some really great certificate programs that are on the NAVTA website as well. So I think that those are really good.

A lot of those are free resources as well. And then when we look at Hills, we have our VNA program, but on our Hills Veterinary Academy, we also have some other CE opportunities. And so I always encourage everyone to look at all the different offerings that we have. They’re all free, most of them are RACE CE.

So those are really great resources. And then for anyone who might be interested in getting a VTS in nutrition, the Academy of Veterinary Nutrition Technicians, or nutritiontechs.com is a really great resource to find out more about that. It’s not for everyone. We’re a small group, but we’re a mighty group and we all love nutrition.

So if you have an interest in, In another academy, certainly the NAVTA website, has all the links to all the different academies so you can find out more which ones are offered and find out more about them.

Obviously, I think nutrition is the best, but all of them are really important and as we say in nutrition, all the academies for the most part include nutrition because we feed all the patients. So it always comes back to nutrition, right? So I think those are some great resources. 

Dr. Andy Roark: Well, I will put links to all that stuff in this show notes. Thank you, Vicki, for being here. Guys, thanks for tuning in. Happy Vet Tech Week, everybody. Take care of yourselves.

Vicky Ograin: you. Happy Vet Tech Week. Thank you.

Dr. Andy Roark: And that’s what we got. Guys, thanks for being here. Thanks to Hills Pet Nutrition for making this episode possible, ad free. Thanks so much to Vicki O’Grain for, one, for just being a wonderful person to talk to. Two, for being a torchbearer for veterinary technicians for many, many years. For just advocating continuously.

For being positive about being a technician and and that role. And just, tirelessly working to make make life for vet techs better. And anyway, she is an absolute joy. She is a gift to our profession. So I was so happy she was here. Gang, take care of yourselves, everybody. I will talk to you later on.

Dr. David Dycus provides a practical, in-depth look at managing canine hip dysplasia, from early diagnosis to surgical interventions in this episode of Cone of Shame Veterinary Podcast. Dr. Andy Roark sits down with . Dr. Dycus to discuss the various treatment options, including juvenile pubic symphysiodesis (JPS), pelvic osteotomies, and total hip replacements. He explains the importance of early detection, especially in breeds predisposed to hip dysplasia, and breaks down when and why certain surgical options are recommended. This episode is essential for veterinary professionals looking to better understand orthopedic surgery decisions and help guide pet owners through difficult choices. 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

Dr. David Dycus: https://drdaviddycus.com/

Dr. David Dycus on Instagram: https://www.instagram.com/ortho_vet/

Dr. Andy Roark Resources: https://linktr.ee/DrAndyRoark

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: https://drandyroark.com/store

ABOUT OUR GUEST

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

Dr. Dycus is frequently asked to lecture locally, nationally, and internationally. He has given over 250 continuing education lectures and taught over 150 laboratories. He has published numerous research articles and authored or co-authored several book chapters. He is the co-editor of the textbook: Complications in Canine Cranial Cruciate Ligament Surgery. In 2023 Dr. Dycus received the Veterinary Hero’s Award in surgery by DVM360 and was named by DVM360.com as one of the 10 veterinarians to watch in 2018. Dr. Dycus is a frequent contributor for updates in orthopedics to several veterinary websites and magazines. Dr. Dycus has also been featured on Sirius XMs Doctor Radio’s segment on Pet Health and Orthopedics. His passion for teaching has allowed Dr. Dycus to become a laboratory instructor for the CBLO, TPLO, extra-capsular stabilization, medial patella luxation, angular limb deformity, and fracture repair. He is on faculty for AO (Arbeitsgemeinschaft für Osteosynthesefragen), and he is an orthopedic consultant for VIN (Veterinary Information Network). 

Dr. Dycus became a certified canine rehabilitation practitioner through the University of Tennessee in 2015. He is the founder and surgeon at Fusion Veterinary Orthopedics where he has a focus on total joint replacement, complex and minimally invasive fracture repair as well as angular limb deformity correction, 3D implant printing, and arthroscopy. In addition, he is the founder of Ortho Vet Consulting, an educational consulting and orthopedic coaching service.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one for you with my good friend, Dr. David Dycus. Dr. Dycus is an orthopedic veterinary surgeon. And if you haven’t heard him on the podcast before, you’ve been missing out. He is just a fantastic resource on all things orthopedics.

And today we’re talking about hip dysplasia. Guys we see hip dysplasia, we wrestle with hip dysplasia. I wanted a very fast download on the surgical options for hip dysplasia and when they’re appropriate, meaning when in the lifespan of the dog and yeah and what they entail and just just get me up to speed on our surgical options here, Dr.

Dycus. And he did and it was great and it’s not what I was taught in vet school 15 years ago. There has been a number of advancements and of course there has, that’s great. But it is really good. He makes a lot of points and I go, Oh yeah, that totally makes sense. Anyway, this was a fantastic conversation.

This is going to affect how I talk about hip dysplasia in the exam room. I hope it’ll make that impact for you as well. Let’s get into it.

Kelsey Beth Carpenter: 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 back to the podcast, Dr. David Dycus how are you, my friend?

Dr. David Dycus: Oh, I’m fantastic. Thanks for having me back again.

Dr. Andy Roark: Man, it is always my pleasure. I so enjoy having you in the podcast and getting to talk to you and learn from you. You are a very, very smart guy. You’re also a very, very busy guy. You are, for those who don’t know, you are a lecturer. I’ve seen you lecture all over the place. You write a ton.

You are also the founder and owner of OrthoVet Consulting. And, because you don’t have enough going on, your new venture is a surgery specialty hospital outside of Washington, D.C. It is Fusion Veterinary Orthopedics. Which when are you set to open?

Dr. David Dycus: Hopefully, we’re going to be opening in mid October of 2024. So, not far. Things are moving quick.

Dr. Andy Roark: You are right there just staring at the finish line from where we are. I appreciate the heck out of you being here. One of the things that I always like to talk to you about when we get together and we’ve got orthopedics on the table, I always like to keep this thing super practical and I want to keep growing my own skills in the exam room and making sure that I’m giving pet owners the advice that’s going to help them.

And I have had a string recently of hip dysplasia cases. I have got a couple variants. I’ve got the German Shepherd puppy that’s vocalizing when I stretch his hips out, which maybe it’s just behavior. Maybe he’s just tired of being handled. But I’m concerned. And then I’ve got obviously the older dogs that are having a lot of hip dysplasia.

They’re just very minimal muscle mass in the back end and sort of everything in between. And so I’m looking at these patients. I’m thinking about what we can do for them. And today, what I really wanted to do was get a rundown with you of hip dysplasia, surgery options, what are my options for trying to surgically intervene in these hip dysplasia cases?

And then also, when is it appropriate? Because I know that there are some cases that we say earlier in life is I would probably go for this and later in life we’re going to go for that. And so I was wondering if you could help me just as an overview, what are my options for surgery and when would I put these options into play?

Dr. David Dycus: Great questions. And a lot of it is going to depend on the age of the dog, the clinical signs they’re having, the breed. And so what I like to think about is if we’re going to think surgery, we’re going to put them in the category of potentially hip joint improvement in terms of the anatomy.

Versus moving more towards a salvage option which would be doing something more definitive to the actual joint itself. And what I mean by that is we can take the improvement in the hip joints category and there’s usually two surgical procedures that we would put into that category. One is what’s called a JPS.

And we all call it a JPS because it stands for juvenile pubic symphysiodesis, so it’s just easier to say JPS. And then the other would be either a triple or double pelvic osteotomy. And so the reasoning age comes into play and breed is the cutoff points for these two procedures are very, very different.

So with a JPS and the whole theory here is with hip dysplasia, there’s laxity of the hip joint. So when the animal is trying to walk and when the leg is in the air, the femoral head is subluxating from the acetabulum. And then when the foot strikes the ground, it causes the femoral head to crash back into the acetabulum.

And that creates. Abnormal wear and tear on the cartilage, which we all know will lead to arthritic changes. And so, in dogs with hip laxity that are very, very young, we can do things to try to improve the coverage of the femoral head and the acetabulum. And so, a JPS would come into play in dogs at around 16 weeks of age.

One has to have a very high suspicion of a dog with hip dysplasia at four months of age. Because these are usually still bouncing, happy, go puppies. And so, in these situations, we usually look more towards breeds that are tend to be predisposed. So we think German Shepherds, we think Rottweilers, we think Labradors, we think Golden Retrievers, Newfoundlands.

And in these dogs, if they come from a line that has dogs that have previously had hip dysplasia, or perhaps there’s poor breeding practices. Somebody says, Hey, I’ve got this beautiful German shepherd. Somebody in the Walmart parking lot was selling puppies and we, we picked one up.

What do you think, to me, my, my bells are going off. Oh, there’s probably some backyard breeding going on. And, and in that case, a JPS, we make a little incision just above the pubis. And we actually prematurely fuse the cranial part of the pubis. And when we do that, as the animal’s growing, it actually pushes the acetabulum outward and over.

So it actually covers over the femoral head as they’re developing. But if we wait until after, say, 18 weeks of age, then the degree of coverage there isn’t going to be enough to really help us. And the whole goal. Is to try to improve the coverage to minimize changes to the cartilage and thus minimize arthritic changes in life. And if one is astute enough, they could do an exam in a puppy and every puppy squirmy, so you try to extend their hips and every puppy is going to squirm like. It’s bothersome to them, but the reality is many times they’re just not used to being held that way. So what I would recommend an individual do would be to check what’s called an Ortolani, which is a test to check for laxity of the hips.

And that’s done by basically putting a hand sort of on the dorsum of the dog and then taking the other hand at the knee and you sort of push up on the femur And then that will cause the femoral head to subluxate. And then you start to pull the leg away a little bit. And that would cause the catastrophic reduction.

So you’re listening for a thud or a click or a

Dr. Andy Roark: And it pops back in?

Dr. David Dycus: Yep, exactly.

Dr. Andy Roark: How does the dog react to this?

Dr. David Dycus: So in some situations, if the hips are really lax, they usually don’t even react at all. The challenge though is if there’s mild laxity, they could have some muscle strength that could prevent you from being able to get a positive Ortolani when they’re awake.

And so in a otherwise healthy dog that’s there for, say, a routine vaccine visit, I’m going to look at the breed of the dog. I’m going to, And if it’s negative and the breeding of the dog has been very, very good meaning that it comes from a reputable breeder and, and, you know, the, all the due diligence has been done then we might not jump to saying, okay, let’s sedate just to make sure we, we don’t get an Ortolani.

But if I have a dog that we’re just not sure about the breeding principles or I’m not sure if I’m getting an Ortolani or there’s a little bit of discomfort on hip extension, then I might say, okay, it might be worth doing a quick sedation just to check for hip laxity and at the same time get hip x rays.

And we want to get well positioned hip x rays, but we have to remember that when we do that. We put them on their back, we pull their legs down and that actually forces the femoral head into the acetabulum So if there’s mild laxity there, you might miss it and so one of the cool things that people can do and I think the training is free is Become pin hip certified and if you’re pin hip certified What you could do is take the pin hip radiographs and that gives us what’s called a distraction index, which is, tells us the degree of laxity.

And if that distraction index is above say 0. 3 or is on the upper end for that particular breed, then you could do a JPS. You could say, okay, we’ve got a German Shepherd. We believe breeding was good. But when I was manipulating their hips, they were a little more squirmy than I thought they should be on hip extension.

Or I was trying to do an Ortolani and I thought I got it, but the dog was also a little bit reactive, which they, I wouldn’t have expected them to be. So we talked to the owner about sedating. We check Ortolani when they’re sedated, we get our well positioned hip radiographs, and then we do a pin hip. And if the pin hip number is higher than it should be, we can say, okay, we need to do a JPS.

And, for that to take place, we really have to start this thought process of looking into these dogs when they’re very young.

Dr. Andy Roark: Like when they’re a fetus. Like three weeks before they’re born, we should start talking to the client about, do you, okay. I’m

Dr. David Dycus: so what I would say is, think about when they’re coming in for that. I don’t know, was it 12, 13, 14 week vaccine appointment? Make that, and I think that usually correlates to when they’re getting the rabies vaccine, maybe make that visit where you check hip extension, check Ortolani.

Dr. Andy Roark: Okay.

Dr. David Dycus: And you don’t have to do that in a dachshund, or in a greyhound if anybody’s ever actually seen a greyhound puppy.

But, in a German Shepherd, in a Labrador, in a Golden Retriever, absolutely I think it’s worthwhile to check. And then the other one that would be super easy is the dog’s actually having an issue. And so the owner brings them to you, he’s really slow to get up or, he tries to jump on the sofa, but he can’t, or he refuses.

Then that obviously would warrant a more in depth workup, but you can do some slight screening at that visit that really shouldn’t take a lot of time. But if some of your little red flags go off, then it says, okay. We’re not going to do this at today’s visit, but let’s get you in maybe next week and let’s get this kind of figured out just so we can be safe.

Dr. Andy Roark: Do you do a lot of these procedures, David? I mean, in all seriousness, it’s just, I was gonna say, it seems like such a specific case. I, when you said, hey, this pet’s coming in he’s really slow to get up. He’s not, his litter mates are behaving and he’s not, to me, I go, okay, that would be the type of flag where I go, oh, we’ve got someone who’s attuned to what’s going on.

They’ve got a basis for comparison to other dogs. It’s terrifying, I think, to have that conversation with a 12 week old puppy’s owner and say, we’re talking about a permanent alteration of your dog because I’m, I’m worried about what this is going to happen.

And it just, there’s, there seems like there’s so much pressure to say, well, let’s wait and see how it goes. And again I’m really checking myself here. I think your idea of checking Ortolani, I think that’s a real pearl for me to take away and go, I think I can get into that. The reminder at that 12 week visit, I think I can see me really starting to lean into that and to really dig into that orthopedic history there.

I think that makes a lot of sense. I, it, the whole thing, I’ll be honest, my, my hands are sweating because I’m like, oh man, that, that recommendation, unless the owner comes to me and says, I’m concerned because of what I’m seeing that feels like such a hard call to make of, let’s go for it.

That, that’s, I don’t know. I would struggle with that. 

Dr. David Dycus: And I think you just hit the nail on the head. And you hit the nail on the head on the fact that why many of us don’t do many of these procedures is because they get missed. Because it’s not on our radar. And we also don’t want to be Debbie Downer to the clients that have a bouncing puppy. 

Dr. Andy Roark: And the puppies often, they’re squirming. They’re wiggling. I’ll put a puppy’s hips in extension and they go, Ah! And I’ll go, is, are you just, are you doing that because it hurts? Or are you just doing that because you’re tired of this guy giving you this weird petting?

Yeah, and I don’t know. A lot of times, I’m I have to do it a couple of times and try to interpret what’s going on. Yeah.

Dr. David Dycus: yeah and I think once you, palpate enough puppies, you get kind of used to what squirminess versus wait a minute, this is a little bit more, but the way I look at it is, you know, yes, you might have to be the deliverer of bad news, but in theory, if we could do a JPS. There may be the need to do nothing more later in life.

So it’s like, we could have this conversation now, or I ignore it, and then you guys come back in when the dog’s two or three, and now we got to start having a discussion on how we’re gonna manage this for life. Are we now having to be committed to something like a total hip replacement, or you know, and I always think back to myself, well gosh, if we had been more proactive, could we not even be in this boat?

And it’s the same way I approached the whole aspect of osteoarthritis. If we could just be more proactive at recognizing and bringing in the discussion before we get to the point of them having clinical signs, I think we can be a lot better at managing the, the long term aspect of things.

Dr. Andy Roark: Yeah. That, that totally makes sense. I think you’re spot on. I appreciate you speaking to that. But, you know, I remember being taught JPS in vet school and that was always my thought was, am I ever going to have the confidence to say, let’s do it? And I think your point of looking back and saying, could we have prevented this?

Could we have taken action earlier? I, ah, yeah. It’s it’s tough. Talk to me a little bit about the pelvic osteotomy. So if we’re talking about less than 18 weeks here, for the JPS, what kind of window are we looking at there?

Dr. David Dycus: Usually those are going to be the dogs that we didn’t really pay attention to when they were 12, 13 weeks old. And then the clients start to notice an issue at, seven, eight, nine, 10, 11, 12 months of age. And these are dogs that actually have clinical signs. A JPS is more of a prophylactic type procedure.

Whereas a pelvic osteotomy is you realize that there’s now clinical signs. There’s pain on hip manipulation. There’s radiographic evidence of hip laxity, but there’s no arthritic changes to the hips at this point. Then you would say, okay, sometime around that eight to 12 month time frame, we’re going to actually go in and make two to three different incisions in the pelvis, cut the bone in two to three different places.

And we’re actually going to physically move the pelvis so that the acetabulum rotates over the femoral head. So you’re basically doing what a JPS would have done, but now the animal is at a point where a JPS wouldn’t be effective. So now you have to physically cut the bone and move it and put a bone plate on there.

And, the challenge here, and I remember during my residency in the first few years out in practice, I would do these pelvic osteotomies, but then as I was out longer, I would see these dogs years and years later, and They would still develop pretty horrendous arthritic changes. And now the owner’s like, okay, now what do we do?

You know, you said we were going to do this and it should help. And yeah, it helped for, X number of years, but now they’ve got arthritic changes. So now we’re back to what we’ll talk about in a moment on the salvage aspect of things. And so. a lot of us from a surgeon standpoint that deal with, patients with hip dysplasia, many of us don’t do mini pelvic osteotomies anymore because as we’ll talk about in a moment, we’ve got some other options available to us.

But the key finding of a pelvic osteotomy is that they have to have clinical signs. So she would never do it in a dog that does not have hip pain. So you would never do it as more of a prophylactic thing like you would a JPS. And they also cannot have radiographic evidence of arthritic changes. And the challenge is most of them at that point, if you really start scrutinizing a radiograph have arthritic changes.

They’re just not jumping out at you like when we think about looking at a radiograph and going, oh gosh Those hips look horrible, you know, you may glance at these and be like, oh the hips look fine But if you really start scrutinizing it, you’ll see some changes associated with arthritic changes.

Dr. Andy Roark: Yeah that definitely feels like you’re threading the needle. You need clinical signs, but not radiographic changes, and it feels like you’re really trying to hit a certain window. Okay so talk to me about these alternatives.

Dr. David Dycus: So once we’ve moved out of those categories, we’re left with what we consider our salvage procedures and and the two there would be a femoral head and neck ostectomy or the so called fho and then the other would be a total hip replacement and I feel like where we can bring in those procedures could really be in the young, the middle, and the older parts of life, but there’s going to be different criteria associated with that.

I will say that I always, from an FHO standpoint, put that at the very end of the list, the very last thing I would ever do to a dog. And, I feel like many a times veterinarians dog comes in, say at the age of one and a half or two, and they’ve got hip pain and they take an X ray and they’re like, Oh, they’re, they’ve got hip laxity, they’ve got arthritic changes, let’s do an FHO.

I would reserve an FHO for the absolute last quality of life is absolutely suffering standpoint before I would consider it and a total hip replacement would have to be totally out of the question. 

Dr. Andy Roark: Tell me more about that, right? Like I’m with you. I’ve sort of seen the FHO higher on the list. It’s something, it can be fairly cost effective for pet owners. People go, well, we can make this pain go away right now. Break that down for me a little bit more as to why it’s so far down the list and the total hip has to be off the table.

Dr. David Dycus: Yeah. So the reasoning for that. So number one before the advent of hip replacements and people, they would lop off your femoral head and they’d do an FHO. And it left people permanently crippled for the rest of their lives. They had that 100 percent of people had to walk with a cane afterwards.

And in dogs, yes, there are studies that would say, Hey, dogs seem to do well after an FHO, but their owner perceived versus the reality. But what I will say is after an FHO hip extension, Is restricted in every single case and hip extension is critical to limb function. Maintenance of range of motion is critical to limb function.

So will it relieve the discomfort of the femoral head on the acetabulum? Yes. But what we’re forgetting is that we also typically have a lot of scar tissue around the hip. And in fact, after an FHO, you’re relying on scar tissue around the hip to develop. All of those things are inhibiting range of motion.

And so we don’t take in the soft tissue, the muscular aspect of things following an FHO and the pain associated with those soft tissues. And so the other excuse where people will say, well, it’s cheaper. The actual process of doing an FHO is cheaper. But as I said, Maintenance of range of motion is critical, and so for me, if I were to agree to do an FHO, I require the owners to enroll their pets into a formalized rehabilitation program that starts at about five days out from surgery, because the whole goal there is they’re starting to work on hip extension.

And getting hip extension and I’m sure many of us have done an FHO and the little dog comes in at two weeks for suture removal and the leg is held in a flex position and you try to move the hip and it doesn’t move and at that point we’re so far behind the eight ball we’ll never get normal hip extension back but what I found is if FHO enroll them into a formal rehab program and we do that for up to about 12 weeks We can get the hip extension range close to the normal range not normal But close to the normal range so that we can have the best outcome as possible. But on the cost front if you take in the cost of surgery plus the cost of rehab When we did a price comparison, it actually came out to be 30 more expensive to do that over a total hip replacement. 

Dr. Andy Roark: And you’ve got 12 weeks of work, right? Like the owners have to be committed to this. It doesn’t do itself.

Dr. David Dycus: If we’re wanting to achieve what I would consider to be an appropriate outcome, keeping the pets pain at the forefront and limb function then yeah, absolutely.

And then people will like to say, well, we’re going to rely on the owners to do some stretching at home. The problem is, is that the owners can do that, but they’re not going to be able to push the hip into extension to the amount that’s needed to really improve it. Because they’re worried about hurting their pet whereas the rehab therapist knows how much to push on the tissues and how to get the tissues to respond and react Because the thing that we always forget about is we look at a radiograph and we say, okay the disease ball’s gone And now they’re going to feel better, but we’re not thinking about what does that feel like on the soft tissues when the animal’s walking yes, they’re out there running, but if you look at them run, they’re not really extending their hip It’s just sort of a long for the right so their actual gait and function is not normal and they’re just compensating because they likely are uncomfortable.

Dr. Andy Roark: Yeah, that totally makes sense. All right. This is that you broke that down really nicely. That all makes sense to me. Talk, talk to me about the total hip now. What can we do with total hip replacements that we weren’t able to do 10 years ago?

Dr. David Dycus: Yeah, we can put a total hip in the smallest of small dogs and cats all the way up to the largest of large dogs. And the interesting thing is, is years ago, we used to say, Okay, we have to use a total hip at the very end point. We got to do all these things and then do a total hip replacement. And then we would take the eight year old German Shepherd that’s had trouble for the last four years, we would put a total hip in them, and then all of a sudden this dog is out in the backyard running again, going on hikes with the owner, and the owner’s this is a new dog.

And so then we thought, Why are we making them go through all of this to give them a happy hip? And it was because we thought they’ll outlive their implants. We would have to come back and do it later, but we were basing those decisions on what they do in people, but people live 70, 80, 90 years. So what we’ve discovered is because dogs don’t live 70, 80, 90 years, we could put a hip replacement in a young dog and that hip replacement will be good for the life of the dog.

And so in the way I do this is the way I look at this. Is if I have a six or seven or eight month old dog come into me, that’s an excruciating pain. I’m sure we’ve all seen those. They’re hunched in the back. They’re extended in their hocks. They don’t want to walk. You try to move the hips. They’re screaming.

You try to get x rays. You can’t really get x rays. You put them under heavy anesthesia. You get x rays. And then it just looks like the ball of the femur has never even communicated with the acetabulum. They are in opposite territories. We call those luxoid hips. So in those dogs, what I look at is saying this dog needs a total hip now.

And so the youngest we’ve done is six, seven months of age. Ideally, the time frame would be like 10 to 12 months of age. But if I have a dog that is, say, two or three, And we’ve never seen an issue. The dog has been great and then all of a sudden comes up acutely lame And then we take x rays of the hips and the hips look bad I’m, probably not going to jump to a total hip replacement in that dog because number one, we have to remember that dogs with hip dysplasia and hip OA don’t come up acutely lame So we got to make sure they didn’t tear their cruciate ligament first but if I truly think it’s the hip then I’m going to say, okay, this dog’s had hip arthritis, but now they’re painful.

Why are they painful? likely because they’re in an arthritic flare up. So I’m going to do things to get the flare up under control. And if that’s successful, then we’re going to ride that wave. But if it’s not successful or they, have a repeat flare up kind of over and over and over rather than reinventing the wheel then we’ll say okay We’ll probably move to a hip replacement at this point. So, I sort of you know again on the total hip thing Look at the breed look at the age look at the clinical signs look at what’s been done and that’s why if I had the eight or nine month old dog with really severe hip pain.

I’m not going to do pelvic osteotomy. I’m just going to put a total hip in them because if I do a pelvic osteotomy, they might feel good, but then there’s a chance I might have to put a total hip in them when they’re four, five, six, seven years of age. And it’s why do two surgeries when we can just do one surgery?

And so that’s sort of where my thought process has gone for the surgical aspect of things, but I really think we have to look at the patient in front of us, look at the age, look at the clinical signs, look at the radiographic findings and then we also need to have a discussion with the owners as far as what expectations are, what are their financial means, you know, if an owner is strapped for cash I’m not going to say, well, let’s do an F.

H. O. I’m going to say, let’s take your funds and let’s do all these things from a conservative standpoint to get your pet more comfortable and improve range of motion and then we’ll keep doing these things. As needed, but if we hit a point where that’s not becoming effective, then we might have to say, okay, have we been able to save up over time for total hip?

If we’ve been able to throw some money into a savings account for that, or are we at a point where we need to do an FHO? But rather than doing that FHO on the front end, because I don’t want to cripple that dog, when they’re two rather than doing some other things to improve hip extension.

Because what I will say is the young dog that comes in with the acute lameness, that’s not a cruciate tear, that has hip pain, that’s in an OA flare up, we can usually get that OA flare up under control and get them right back to doing the things that they were doing before they started limping without doing an FHO.

Dr. Andy Roark: Yeah, David. Would you be up for coming back and talking about conservative management for a hip dysplasia?

Dr. David Dycus: Yeah. Any time. Absolutely.

Dr. Andy Roark: Wow, we’re gonna make that happen. David, you’re amazing. Thank you so much for being here and walking me through this. I just, I’ve got so many notes. I came out when the total hip replacement was the, it was the last thing.

You know, it was like, oh, if all else fails, we can replace the hip. And so this is such a perspective shift. I just, it makes tons of sense. I really appreciate it. David, where can people find you online? Where can they learn more about you and what you’re up to?

Dr. David Dycus: Absolutely. So for the those on social media, my Instagram is Ortho_Vet. My Facebook is Dr. David Dycus. You can check out my website at www.drdavidycus.com. And then for the new hospital Instagram and, and Facebook are both Fusion Vet Ortho.

Dr. Andy Roark: David, thanks for being here. Guys, thanks for tuning in. Take care of yourselves, everybody. I’ll talk to you soon.

Dr. David Dycus: Thank you. 

Dr. Andy Roark: And that’s what I got. Thanks to Dr. David Dycus for being here, guys. I hope you learned something. Do not worry. I got David immediately scheduled and we knocked out the episode on managing medically Hip dysplasia. And so that is going to be coming down the pipe. Stay tuned to the Conor Shane Veterinary Podcast.

I’ll probably sped it out a little bit, like I love this stuff. I’m super excited about it. I think there’s people who generally like to kind of mix things up a little bit. In the next couple of weeks I’ll drop that episode. I can go ahead and tell you right now is real good. If you enjoyed this episode, you’re going to enjoy that one and it’s coming soon.

Anyway, thanks to David for being here. Guys, if this episode was good for you, if it was helpful, please leave me an honest review wherever you get your podcasts or comments below. Text it over to your friends. Make sure the other doctors get to see it. You know, we’re always trying to help people. I just, I love making stuff like this.

I started this podcast so that I could continue to learn and boy, have I gotten a lot out of it. So anyway, gang, take care of yourselves. I’ll talk to you later on.