Medicine

As the gold standard of care (and price of medicine) go higher and higher, is it time to get serious about formalizing a spectrum of care approach? Dr. Emily M. Tincher, Senior Director of Veterinary Relations at Nationwide Pet Insurance, joins the podcast to talk about combining evidence-based medicine and advanced client communication strategies to protect and improve accessibility and affordability of veterinary care.

This episode of the Cone of Shame is made possible ad-free by Nationwide Pet Insurance!

LINKS

Nationwide Spectrum of Care Page: www.spectrum-of-care.com

Nationwide Veterinary Analytics: https://www.petinsurance.com/veterinarians/research/

JAVMA spectrum of care publications:
https://avmajournals.avma.org/view/journals/javma/259/7/javma.259.7.712.xml

Preparing Veterinary Students… Spectrum of Care: https://avmajournals.avma.org/view/journals/javma/259/5/javma.259.5.463.xml

Vetsuccess Industry Tracker: https://vetsuccess.com/resources/veterinary-industry-tracker/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Emily M. Tincher is a collaborative and data-driven leader who advocates for a pet-parent centered approach to communication and medicine through spectrum of care approaches. She is a second-generation veterinarian and a 2016 Auburn University’s College of Veterinary Medicine graduate. Emily has practiced clinically in small animal emergency and general practice.

As the Senior Director of Veterinary Relations at Nationwide Pet, she oversees operations and strategy in the veterinary space, including industry relationships and outreach to veterinary students, veterinarians, and veterinary teams. Emily serves on the AVMA Early Career Development Committee and is President of the Board of Directors for the Veterinary Leadership Institute.

Outside of veterinary medicine, Emily enjoys traveling with her husband Kyle, competing with her horse (Blue) in the sport of Eventing, and endlessly spoiling her two perfect dogs (Tuxedo and Cricket) and rotten orange tabby (Exploding Poptart).

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome, everybody, to the Cone Of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. I’m here with my good friend, Dr. Emily Tincher. She is talking with me about Spectrum of Care. She talks a lot about Spectrum of Care. I ask her hard questions about what does Spectrum of Care look like? How is it different from we’ve done in the past? How do we balance making care accessible with advocating for what’s best for pets?
Those things can be challenging when we want to make sure care is affordable. And at the same time, we want to make sure we’re still pushing to do the most good that we can do in the world for the pets. And it’s just, I don’t know, it’s really interesting conversation. Guys, I enjoyed the heck out of this. I hope you’ll enjoy it too. This episode is made possible ad free by our friends at Nationwide Pet Insurance. Gang, let’s get into this episode.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Emily Tincher. Thanks for being here.

Dr. Emily M. Tincher:
Thank you so much for having me.

Dr. Andy Roark:
It’s my pleasure. Is this your first time on the podcast? I think it is.

Dr. Emily M. Tincher:
It is my first time on the podcast, yes.

Dr. Andy Roark:
That’s amazing to me. You’re a good friend of mine and have been for a long time. I think the world of you and I have known you for years and years. We met way back in the day. I think I had graduated from vet school and you were a vet student. I may be just being very generous to myself in my age.
But we met through the VBMA, which is the student business group. And then, I’ve stayed involved in that as a national advisor for years. And you have stayed involved in well. For those who don’t know, you are the senior director of vet relations at Nationwide Pet Insurance. You are doing a bunch of stuff. Got your hands all over these white papers that have been coming out from Nationwide. They’ve got, just a variety of topics.
It’s different cancer rates according to dog breeds. There’s some senior pet stuff that’s come out. You guys have some new stuff coming out. I think about brachycephalic pets pretty soon. And you’ve just got all this research stuff coming now. And then you are lecturing all over the place on Spectrum of Care, which is an interest of mine and we’ve talked a lot about that. And so yeah, that’s what I wanted to talk to you about today. But it’s surprising to me that I haven’t had you on the podcast before. That’s an oversight on my part. How’s it been?

Dr. Emily M. Tincher:
Well, I’m just so excited to be here now. I know we’ve been grateful to just like a bad penny I guess. I keep showing up. From starting as a vet student at Auburn, came in and lectured to our VBMA. And then yeah, we were involved when I was on the national VBMA board and was an advisor with you before I step back now as a founding and platinum sponsor of the VBMA that Nationwide is. And so, get to remain involved just in a different way now building curriculum part.

Dr. Andy Roark:
Oh, yeah. I forgot you were at Auburn.

Dr. Emily M. Tincher:
[inaudible 00:03:19] at Auburn [inaudible 00:03:20].

Dr. Andy Roark:
I forgot you were at Auburn. You get to do really cool stuff. Yeah, you still go to the vet schools. You guys have some student development programs going on. You get some programs through the vb, a brown Spectrum of Care. You’re getting to do cool stuff, Emily.

Dr. Emily M. Tincher:
We do cool.

Dr. Andy Roark:
That’s super awesome.

Dr. Emily M. Tincher:
We spoke at every vet school this year about Spectrum of Care between the spring semester and the fall, which was a lot of fun to get their feedback. And hear the students’ interest in just trying to find ways to meet pet families where they are. And asking questions about how does evidence-based medicine fit in and how do we navigate all the challenges with providing the care that we recommend. Oh, it’s just been, it’s really cool. I’m excited to get into it with you.

Dr. Andy Roark:
All right. Let’s start to talk about Spectrum of Care in general. Just go ahead in your own words, define the term Spectrum of Care for me. And that just to get us on the same page of this general topic.

Dr. Emily M. Tincher:
Yeah. We did not come up with this definition for the record of Spectrum of Care at Nationwide. We used a published definition that came from a couple of JAVMA publications, that Spectrum of Care is providing a range of diagnostic and treatment options for pet families across basic to advance that meet their needs and their goals with relation to their values and their resources. Of course, including finances being one of the main ones. But that acknowledging that there are many different ways to treat everything from wellness to most conditions that we see in practice.

Dr. Andy Roark:
Okay. Talk to me a bit about how you see Spectrum of Care as a rising topic and trend in vet medicine. What is the integration of Spectrum of Care look like compared to what vet medicine has looked like in the past? A lot of times we talk about Spectrum of Care and a lot of people like, “That’s what we’ve always done.” Help me get my head around how this vision of the future with Spectrum of Care looks different from what we’ve historically done.

Dr. Emily M. Tincher:
In many ways it doesn’t necessarily look different from Vet Med of many years past. I’m a second generation veterinarian. My parents are both vets and I grew up in their rural practice that they owned in Kentucky. And watching them practice across all the range of socioeconomic statuses of the pet families that they served, I really saw that you can do a lot with a little. And you can also offer people the opportunity to refer or to have advanced level care if that’s what they’re seeking and have the resources to support.
What I think is really important and a critical component of offering a Spectrum of Care is making sure that we integrate the evidence-based medicine that’s available, knowing there’s not as much as we would like in veterinary medicine with pet family centered communication. And so, we could talk a little bit about some exciting research that we completed this year at Nationwide in partnership with my genomics advisors that work towards communicating in a pet family centered way.
I think there are many people that are practicing a Spectrum of Care right now. What I think is often not discussed is how to do that as a vet student and a new graduate. When I watched my parents growing up, they practiced the Spectrum of Care. They just, they maybe didn’t have a term to call it that, but they practiced the Spectrum of Care.

Dr. Andy Roark:
They didn’t have a marketing slogan for it. Yeah.

Dr. Emily M. Tincher:
Right. It’s helpful though to have a term and to have definitions that we can all get behind and work towards. I think the pendulum is swung with academia to where, for quite some time, we were focused on excitingly and fairly the increased specialization. And it took I think a little bit of time for our profession to notice that there were some challenges associated with the awesome education that specialists can provide.
And we need them very much. But sometimes there is a little bit of an oversight or a lot of an oversight on but what does it look like when people can’t or don’t want to pursue the most advanced level of care? Especially as we have new diagnostics, we have new drugs that are awesome, allow us to do more than we ever have in the past.

Dr. Andy Roark:
Sure.

Dr. Emily M. Tincher:
They also cost more. And that’s not necessarily veterinary medicine. I think one of the greatest challenges that we see is that veterinary medicine, the advanced level of care getting more expensive. And if we can only think that you deserve to own a pet if you provide that advanced level of care that pets are a luxury, we’re in trouble.
Not only is it unrealistic, but pet families are not considering what their vet thinks before they go get a pet. We want to serve the diverse population of pet families that are out there that do have over 50 million owned US cats and dogs. Then we are going to have to meet them where they’re at a little bit with what their goals are and what their needs are.

Dr. Andy Roark:
Yeah, okay. That’s a lot to unpack and I like it. First of all, let me say, I think you really put your finger on how I feel about this. Because I like to ask questions that I struggle to answer myself because I’m like, “Oh, maybe Emily will have a better answer than I do.” I think when you talked about a pendulum, I think that’s where I am as well.
And so, when we talk about Spectrum of Care and giving people options, I think a lot of people go, “Well we’ve given options forever.” I think that you’re exactly right, is when we zoom in on how we train new graduates and an increasingly high gold standard of care. To me, that’s the pendulum swing of, I love that we have pushed towards increasing our capabilities and what we can do and how we educate our doctors.
And at some point, I do think it’s time to swing back a little bit the other way and say, “And just because theoretically we can do something doesn’t mean that that’s going to be the best course of action for this individual pet owner.” I also, from a wellness standpoint, think that if we set ourselves up as doctors as I’m only a good doctor if I get people to do the highest technical standard of care possible, I don’t think that’s realistic. And that may sound foolish, but I know young doctors who grade themselves that way.
They’re like, “Well, I couldn’t get this person to do a TPLO.” And I go, well, why did you think you had that? All you can do is recommend and advocate and you’re not going to be able to magically enable people to give their pet of TPLO. You’re going to have to talk about medical management sometimes. And that’s not ideal. That’s not what we aim for, but it’s not a failure on your part if that’s just not in the cards with this patient.
And real skill as a doctor comes from being able to look at that and saying, “Okay. What other cards do we have to play here to get the best outcome possible in this case?” I really like that a lot. I think that I want to ask…

Dr. Emily M. Tincher:
There’s a small piece I want to dive into that you just mentioned there that it may not be ideal if a pet family doesn’t choose a TPLO. Well, I mean there’s some great evidence base that I’d love to that that example you brought up is one where we do have great evidence-based medicine. That there are other options like a lateral suture, for example, that can have a very similar outcome to a TPLO or a TTA referral historically, usually to see a board certified surgeon.
Now, the best possible outcome may be to go see a surgeon with the lowest chances of complications. However, talking to pet families about their options, that range of basic to intermediate options, my definition that I’m trying to use more and more is that the ideal or best outcome, the medical component is included, but that the best outcome is the best outcome for the family.
If for them, they’re anxious about surgery, about anesthesia, even if it’s not just about costs, maybe there’s a comorbidity for the pet. It might be that basic care is the best for that particular family for multiple reasons in addition to finances. Or it may be that if your practice offers that more intermediate approach of a lateral suture, which not everyone has that skillset, the ability to perform that surgery. That’s in addition to meeting that family where they’re at with their goal to stay with you as a general practitioner can help keep the revenue within your practice if you have the ability to perform that surgery.

Dr. Andy Roark:
Well, I’d also would add to that too, when we think about what is success. I like to take the long view on these things as well and say trust in the relationship is also a factor of success for me as well. I definitely seen people go in and aggressively advocate for a path of care and get it done. And then that client will do it. And then they go home and they’re like, “I’m not going back to that person. I felt pressured. This isn’t what… In hindsight, I felt pressured into this course of action. I didn’t want to do it and I don’t really like that veterinarian.”
And so I’d say, well, now we won the battle but lost the war. Especially if those people are reluctant to go back to a veterinarian and it affects care in the future. And so, I always try to say that the outcome for me is not the best outcome today. It’s the best outcome over the life of the pet and the life of multiple pets underneath one client.
I want to dive in a little bit and take apart some of the stuff that you said earlier because I think that this is an interesting way that you’ve built this up when you talk about spectrum care. You talked about evidence-based medicine and then you talked about communication. And sounds like you’re putting those two things together.
And so, you threw around the term evidence-based medicine and then when we talked about the TPLO, you got to unpacked it a little bit. Talk to me about those two things. We’re going to start with evidence-based medicine, then I’m going to talk to you about the communication. We can get into the genomics research and stuff like that as well.
Just unpack that for me. When you say evidence-based medicine, this is a phrase I’ve heard for the last couple decades is thrown around. I think when I talk about Spectrum of Care and look at Spectrum of Care, one of the things I really struggle with is what is good medicine? And what is an acceptable standard?
And I think a lot of us have a certain level of fear because we talk about malpractice. Malpractice is failing to meet the standard of care, which is not written down anywhere. It’s a concept that lives in the minds of the people who will be reviewing your work. And I think that that is a scary idea. And so, help me get my head around what is evidence-based medicine? What is actually out there that’s useful? And what do you see as the future of this and its impact on our profession?

Dr. Emily M. Tincher:
Yeah, I think it’s a great point to bring up. And it’s a common challenge that we have been discussing, not alone certainly, with other organizations to say, “What does it mean to uphold a standard of care, which is what we are legally and ethically required to uphold as veterinarians.” Everything that is above the standard of care, can fit into a Spectrum of Care that range from basic to advanced.
But yeah, how do you know what meets the basic needs? What is the minimum for any particular thing that you are seeing for the day, whether it’s well care or whether it’s something with a sickness or an injury? Well, it’s great when we have evidence-based medicine, i.e. there are some actual research studies, ideally publications that allow us to say, “We know that this particular condition has this particular outcome with this particular treatment in some cohort of dogs.”
Now, sometimes we have that and I think a parvo is one that I love considering for a Spectrum of Care. Say, okay, it’s a pretty common challenge that we have to treat in veterinary medicine. And there is, we have a advanced level protocol of hospitalization that typically has about a 90% success rate. And then we have an intermediate level option for pet families with other components to consider having to come back and forth to the practice every day to meet the Colorado State protocol for outpatient management.
That particular protocol has an 80% success rate. Eight in 10 dogs will do well with outpatient management versus nine in 10 with hospitalization. And the difference in costs is drastic. It’s often thousands of dollars. Talking to pet families about their odds, the pros and cons of the decision that they make. And having the confidence to make those recommendations. I think all of us as applied scientists feel better about knowing what the options are and recommending them in a way that can address the concerns any particular pet family has, when we have that evidence-based component to lean upon.
You mentioned some of the white papers that we’ve published. We are trying to add to that with our over 40 years of experience in pet health and over 1.1 million pets insured at Nationwide, we have a lot of data. And so we’re trying to analyze that data. We have a dedicated pet health analytics and insights team led by our chief veterinary officer, Dr. Jules Benson, where we are trying to add to that, but it’s a mammoth task. Leaning on evidence-based medicine is huge for Spectrum of Care, knowing we aren’t going to have all the information that we want most of the time.

Dr. Andy Roark:
Yeah, I love it. I would really love to continue to see these types of publications. Get the data out so you can publish something. I think the parvo is a great example. I’m really glad you brought that up. I mean just to be able to even just to know, hey, 90% success rate this way, 80% this way. You can have really clear conversations. You can have a clear thought in your mind about how you feel about what you’re advocating.
And I don’t know. There’s that, I remember earlier in my career saying, “Okay, I’m going to make sure that I document that these people declined hospitalization.” And that’s still good practice, but I felt a certain fear or moral weight of like, “Oh, I don’t know what’s going to happen when they take this pet and they leave. And am I impressing on them enough the dangers of leaving?”
You go, “Okay. Well, now I have some things to fall back on and some guidance where I can say they’re not going to be able to hospitalize.” And we can have this with our conversation. And they also know the choice that they’re making and I can give them that clarity. I think that’s beautiful.
Talk to me a bit about the communication part of this. And so, part of it is having a knowledge of what are options, what are inside our Spectrum of Care? What is between the gold standard and acceptable standard, what are our options in there? And then communicating those. Talk to me a little bit about your ideas about what good Spectrum of Care communication looks like.

Dr. Emily M. Tincher:
Yeah. It’s a great question and I’m going to answer it in a couple of parts. One being some of the really cool research that we completed this summer with Nationwide and partnering with Mind Genomics Advisors. And then the second one being piloting out that research and getting feedback from vet healthcare teams and feedback from vet students with our college program.
Part one is what does it look like to communicate with pet families in a pet family centered way. Avoiding judgment and trying to actively be sure that we are understanding what their goals and their values are as well as their resources. The finances component that we sometimes focus on can feel negative to pet families, depending on how we represent things. Not in a way that I think we mean for it to.

Dr. Andy Roark:
Sure.

Dr. Emily M. Tincher:
But I’ve had a pet family say to me that, “It felt like I was talking to my vet about and they seemed like a used car salesman.” I was like, “No vet wants to sound like that.” I’m confident that none of us want to come off that way, but I can understand it. It is important to have those financial discussions.
How do we that? And how do we shortcut the communications to get to the point of what do pet families really value? What are they looking for from us? And what are they looking for from veterinary healthcare? We try to identify that with a process that Mind Genomics has used mostly in human medicine to understand what are the subconscious drivers behind the choices that we make?
And I won’t go through the process for how we did it right now since it gets a little nerdy. But the output is that we identified three different viewpoints. Through instead of going through typical survey methods, they use a mixture of multiple types of sciences. Behavioral science is a big one that they lean upon. Even some food science ideas are included.
But getting to the idea of, “Okay, there are three categories of…” And we built messaging surrounding Spectrum of Care and how pet family, how specifically pet parents would respond to 36 different messages. And the end, we have three viewpoints.
The first one is one that’s focused on two things, optionality. They’re looking for their vet healthcare team to talk to them about the options available to them. And they’re looking to have a strong focus on what the evidence-based component, what the outcome for their pet’s health is going to be.
Second one is highly focused on a mixture of they’re cost conscious. But also, what does it look like to feel clinical empathy from their vet healthcare team that feel like they’re the best pet owner they possibly can be, while acknowledging that this group is pretty cost conscious. They’re looking for ways to either they’re unable or unwilling, they’ve got multiple priorities going on. They’re looking for different ways to have the best possible value for any plans that we present to them.
And the last one is a group that’s highly focused on how can we integrate our recommendations with their schedules in a convenience? How can we make the medications that we recommend or the follow-up schedule that we recommend as easy as possible for their schedule? While still all three groups seem very focused on what’s good for their pet, but that shows up in different ways for them.
The top finding that we have from this research is that, which leads to the implementation of this, everyone hates having the most expensive option offered first. I’m going to just let that sink in for a moment because that is how most of us are trained to present options to pet families.
And by considering that. But with that finding as a top finding, when we asked pet families how do they want us to engage in communication with them, with that as a top finding. We went back to the research and said, “Okay. Well, the interesting thing about the order that we present our recommendations in is that the first option,” and this is again, not research that we came up with but is well represented in a Spectrum of Care publication, Brown et al. if anyone wants to go look for more information, about the order that you represent, things is pretty cognitively biased.
There’s a ton of research in human healthcare that the first option presented is usually the one that people choose. But that does not mean people are later happy with that choice. Going back to your observation earlier that sometimes we do eventually get people to agree to the most advanced option. And they say yes to it, but later, they may not come back. They may reflect on that and say, “It wasn’t exactly what I wanted or needed for my family.”
The recommendation that we are going with, again with published research supporting it, is to instead use our research and we have a tool that will be releasing early next year that will help with this. To use our research to instead recommend the option that you think will fit best with the pet family first, make sure they have three options and then check in. And say, “Okay, which one do you think is the best fit based on this conversation that we’re having?”
And finally, be sure, of course, that you document that you have discussed all three options and why the pet family has chosen that option. To get back to the fear that you mentioned earlier of how do we make sure that we feel comfortable with the idea of a Spectrum of Care? Well, documentation is a very important part of that.

Dr. Andy Roark:
Yeah. This gets into the weeds pretty quick.

Dr. Emily M. Tincher:
It does.

Dr. Andy Roark:
I think the obvious places where this gets pretty hairy is how do you know which is the best fit for the pet parents? And so again, we’ve talked for a long time about not X-raying people’s wallets or guessing as to what they’re able or available to do.
And we all have pretty good research that also says people are not as transparent as they like to think that they are. People don’t tend to know what you’re thinking. And so, I guess that would be my first question is how do you know what fits well with the parents?
Then the other thing I would say is how does this interface with the idea that vet professionals have a responsibility to advocate for what’s best for the pet? And as opposed to making things easy on the pet owner. I think some of it comes down to what are your goals in the room? Yeah. And so, I guess I put that back to you. I know it’s a lot to unpack, but what does that look like? And to me, this is really where things get difficult to parse apart.

Dr. Emily M. Tincher:
How do you know what pet family’s goals are and their resources are?

Dr. Andy Roark:
Yeah, exactly.

Dr. Emily M. Tincher:
Yeah. It’s I mean in some way, we have to have a conversation. And no amount of research or tool that we can provide will be able to magically tell us, you still, every pet family’s going to be a little bit different. Have to have that conversation. Which begins, it’s not for the veterinarian to have, it’s for the whole healthcare team to have. Which is what I love about the resources that you put together is acknowledging that everyone has a massive role in these conversations. And from technicians and CSRs and then the vet is the final link in that team.
Is the research that we have can help shortcut that by asking a few questions. And a process that says, “Okay. In general, most of the time these are, people fit into one of three categories based on a couple of questions that we ask.” And what’s really important about that research is that we also ask the demographics associated with it.
Sometimes, there have been previous conversations around assuming that various socioeconomic levels or anyone with a different family or racial or ethnic background might have certain ways that they interact with their pet. And not only is that biased and ethically wrong, it’s also not founded in the research.
It’s almost a even split, whether you’re looking at age, income level, familial status, education level. Almost a even split across those three viewpoints, which is great. It was certainly what you hope to find is great justification for saying, “You can’t look at someone and just imagine what they might value. You have to have the conversation.”
And our process helps I think shorten that conversation. But it’s still, whether it’s a major life event has just happened, of course, we’ve had vet healthcare teams. We have people tell us, they do tell us things all the time. We’re such a trusted profession that I’m so grateful to be part of that people feel comfortable. Even as a ER vet, they’ve never met me before, feel comfortable telling me that they’ve just lost their husband, that their house just burned down. That they are going on vacation and therefore things are… Or they just got back from vacation yesterday. And so that’s uncomfortable to admit that that’s why your finances are tough, but it’s real life.
Having that conversation and asking, asking in a way that’s collaborative is I think step one, even though knowing it can be uncomfortable but it’s more uncomfortable. And cut to your second part of your question, doesn’t help pets get any care. If we only recommend something that’s not possible for the pet family, they’re getting nothing. If they walk away and say no or they say yes, but they never come back to see us again, in my opinion, that’s worse for the pet long term.

Dr. Andy Roark:
I really like that. That’s really good examples. What it sounds like you’re saying, I guess how it strikes me is this is what we’ve always done. In a lot of ways, it’s about building a trusting relationship and having good communication.
And I go back to relationship. It’s as you say this, I think about how transparent people have been in the past with me about what’s possible and where they are. And they go, “Oh.” I think probably a lot of us are doing this in a common sense way. I can say my take in the exam room is if there’s something that, based on our conversation, I think is the best fit for them, I generally say, “Based on our conversation, this is what I think is probably going to be the best fit for us.” And then I’ll say, “Alternatively, more aggressively, blank, or more conservatively, blank.”
And I give them those options. But it’s always been, I very much am aware and take advantage of the fact that the first thing that I say is going to have extra weight. Which is why I try to do the best job of saying, “This is what I recommend.” I think big things for me are just the basics. Blocking and tackling of exam room communication, which is open-ended questions.
Listen to people, ask to learn, not to respond. Try to understand where they’re coming from. Ask them some lead in questions about how do you feel about this? Or what would you think about this? Or what are your concerns? Or what are your goals for today? And things like that. And just try to extract those bits of information. But I think those are really good examples of what it looks like to listen to a person and then make a good recommendation based on your understanding of what they’ve shared with us.
I’ve always thought that it was cringe-worthy when, the idea being that a veterinarian would go into an exam room and listen to a person talk about how they just lost their car because it got repossessed. And then they turn around and make this recommendation, which is, “Well, here’s what we need to do.” And they give this very high price thing. And then offer some lower cost alternatives. That was like, “Didn’t you hear what I said when I talked about losing my car?”
And I just think that’s just basic common sense of being a good person and building a relationship. And playing against the long term. The goal is not to work today to is build a relationship with this pet owner that’s going to get them on board with taking care of their pet and communicating with me as a healthcare provider for the long term. I think you really answered that well. That makes a lot of sense.

Dr. Emily M. Tincher:
I think it’s more important than ever to have, I love the way you described, it’s a lot of core communication skills that they’re not new, but they are really important. But it’s more important than ever to employ them in a non-judgmental way.
I think we still have, estimates vary, but if you look at the access to care coalitions research, at least 50% of US-owned cats and dogs don’t see a veterinarian on an annual basis. And if you look at our partners at Vet Success who analyze on and sit on a very cool, free weekly tracker that the number of vet visits is going down. But the revenue and income associated with them is going up.
It’s getting more expensive to provide care. And that has implications for the pet families that we serve. It’s a challenging problem for sure, but it’s not sustainable, for us as a profession, to have fewer and fewer people coming in and bring their pets in. Nor is it serving the basic needs. I think we can all agree that pets deserve some amount of basic healthcare. Right now, we’re, staffing challenges notwithstanding, already not serving about 50% of the US-owned cats and dogs out there.

Dr. Andy Roark:
Yeah. Emily Tincher, you’re amazing. Thank you so much for being here and talking through this with me. You’ve thrown out a lot of resources, you have a lot of things going on. What are your favorite resources right now? What are the things that you want people to be most aware of?

Dr. Emily M. Tincher:
That’s a great question. One of the things that you could do to find our white papers. We talked a little bit about some of the evidence-based medicine we’re putting out into the world is petinsurance.com/petdata is where you can find them. We have a new Spectrum of Care website that will be launching in January, so stay tuned for that.
But you can also follow Jules or I on LinkedIn. And then, as far as additional resources for you’re just interested in Spectrum of Care, the Brown et al. paper that I mentioned, as well as England et al., which is published from the Ohio State, who are absolutely leading in a Spectrum of Care in education, are some great places to just to get started if you want to learn more about the topic itself.

Dr. Andy Roark:
Yeah, guys, I’ll put links in the show notes to all those things so you can just check them out there. Emily, thanks again for being here. Everybody, take care of yourself.

Dr. Emily M. Tincher:
Thanks for having me.

Dr. Andy Roark:
And that is our episode, guys. That’s what I got for you. I hope you enjoyed it. I hope you got something out of it. Thanks again to Nationwide for making this episode possible. Gang, take care of yourselves. Be well. Talk to you soon.

Dr. Traci Zager joins the podcast to talk about the role pets can play in domestic violence and keeping people in dangerous places. She discusses how animal abuse and domestic abuse are often linked, the Purple Leash Project and how initiatives like these can aid people seeking shelter from domestic violence. She talks about what every veterinary professional should know, and how we can use our knowledge and skills to make a difference in our own communities.

This episode has been made possible ad-free by Purina Pro Plan Veterinary Diets!

LINKS

The Purple Leash Project: https://redrover.org/the-purple-leash-project/

Red Rover: https://redrover.org/

OVMA Education Resources (Animal Abuse): https://www.ohiovma.org/veterinarians/resources/abuse.html

Safe Place For Pets: https://www.safeplacepets.org/

National Link Coalition: https://nationallinkcoalition.org/

Domestic Violence Hotline: 800-799-7233

ABOUT OUR GUEST

Dr. Traci Zager received her B.S. in Biology with Chemistry minor from California University of Pennsylvania. She then completed her MBA from Youngstown State University and her Doctorate of Veterinary Medicine from The Ohio State University. After graduation, she worked as a small animal and exotics veterinarian in Northeast Ohio before joining Nestlé Purina PetCare as a full time Veterinary Communications Manager in 2021.

In addition to small animal medicine and nutrition, Traci has special interests in companion animal behavior and education. She currently teaches courses online to veterinary technician students at her Alma Mater CalU of PA, as well as continuing to practice small animal/exotics medicine on the weekend.

Dr. Zager also served on the Animal Abuse Reporting Taskforce for the Ohio VMA, which helped to create educational materials on abuse reporting for Ohio Veterinarians. This taskforce was so important because legislation was recently passed to make Ohio a mandatory reporting state for all veterinarians. Dr. Zager also occasionally helps her local AWL with abuse cases.

Fun fact: Dr. Traci Zager is a new mom of a beautiful little boy named Jameson Henry Zager!

EPISODE TRANSCRIPT

Dr. Andy Roark:
This episode is made possible by Purina Pro Plan veterinary diets. Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I got a great episode today. Have a bit of a heavy episode today, I have to give out trigger warning. This is an episode about domestic violence and also it touches on animal abuse. And so we’re talking about the Purple Leash Project. We’re talking about fighting back and making a difference in ways that vet professionals can get involved. I’m very happy to have this conversation and I learned a lot in this conversation and it’s good.
It’s motivating me to take some action and to get more educated and to look at how I can support. But if domestic violence, if animal abuse are triggers for you, this might be an episode to skip or to check out the transcripts. We do have transcripts of our podcasts thanks to Banfield Vet Hospital. They made transcripts possible in an effort to help increase inclusivity and accessibility in our profession, which is a super awesome thing that they do. And we’ll have links to that in the show notes and over on the website. And yeah, that’s it. So guys, good episode coming up. I hope you’ll enjoy it. I got a lot out of it, I hope you all too. Let’s get into it.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Traci Zager. Thanks for being here.

Dr. Traci Zager:
Hi, thank you so much for having me. How are you today?

Dr. Andy Roark:
I’m good. I am good. I’m super good for a Monday. It’s been a wild day back in the office as you know, but man Fall is here, did the pumpkin patch thing with the kids over the weekend. You’ve got, you’re not there yet, but you’re going to be there. Tracy has, she has a five month old little boy, her first. Just back from maternity. The excitement is just coming. How is the walking going at your house?

Dr. Traci Zager:
Oh my gosh, he’s doing great. He’s running around in his little walker and chasing the dogs and we went apple picking. We went to an orchard recently and he got to help us pick some apples and sit around some pumpkins, which was fun. But yeah, he’s not quite old enough to pick his own pumpkin or apples yet, but we’ll get there.

Dr. Andy Roark:
But you got that Halloween baby pumpkin picture, didn’t you?

Dr. Traci Zager:
Oh, we’re going to, We got one with a pumpkin, but we haven’t gotten one with him in a pumpkin yet.

Dr. Andy Roark:
Oh yeah. The opportunities are endless. Good timing, good timing on that. Everyone should plan their pregnancy around photo ops, I think. And you just nailed it. Well done. Alright. For those who don’t know you, you are a veterinarian communication manager with Purina. You are a practicing veterinarian. You do small animal and exotic in Northeast Ohio. And you are here talking with me about the Purple Leash Project, which I am super pumped about. I’m really glad that you’re here. This is something I think more people should know about and I appreciate you making time to be here. So thanks a lot for that. Do you want to go ahead and kick us off and just give a mile high view on what the heck is the Purple Leash Project and why is it important?

Dr. Traci Zager:
Absolutely. So the Purple Leash Project is a partnership between Purina and Red Rover. Essentially what they do is they provide grants to domestic violence shelters to help them become pet friendly. The biggest problem that we know that a lot of these survivors face is that they have to make the choice of whether to stay in an abusive relationship to protect their pets or leave their pets behind and escape. And that’s not something that we want them to have to choose. We want them to be able to take their whole family with them. So we know also just how often this is happening that it’s just really important that we provide these grants and help these domestic violence shelters to become more pet friendly so they can take them with them.

Dr. Andy Roark:
Can you tell us a little bit about Red Rover? That’s a group that I only learned about through you and I don’t know if other people are really familiar. So tell me a little bit about that.

Dr. Traci Zager:
Yeah, so Red Rover is like a Red Cross for pets. They provide housing and relief for people and pets in crisis situations.

Dr. Andy Roark:
Tell me a little bit more about why having pet-friendly shelters is so important and the impact on survivors. So just you unpack it a little bit, but give me a clear picture of the prevalence of this and that reality.

Dr. Traci Zager:
Yeah, so one in three women and one in four men will experience domestic abuse or domestic violence at some point in their lives. And so with it being that prevalent, we also know how many people have pets and that’s a huge part of their life. It’s a huge part of their family and that human animal bond is just so important. And we know 48% of people that are trying to escape a situation like that, delay their escape in order to help escape with their pets. So we don’t want them to have to wait to get out of these situations. We want them to be able to get out as soon as possible. The other thing is we know a lot of abusers will threaten their pets or even threaten to kill their pets if they try to leave. So having a way for them to escape and know that their pet is safe as well is going to help them recover and help their mental health as well. If they’re worried about what’s going on with their pet and their abuser as they try to escape, they’re never going to be fully free.

Dr. Andy Roark:
Okay. Can you tell me a little bit about where the veterinarian starts to interface with this? So let’s talk, I hate to go too much here, but I think it’s important, let’s talk a bit about animal abuse as it relates to domestic abuse, and then start to unpack what is the role of the veterinarian here? What should we be looking out for in our practices? How do we start to perceive these situations?

Dr. Traci Zager:
Yeah. So the role of the veterinarian is way more than I think a lot of us consider on a day to day basis. So the link between domestic violence, elder abuse, child abuse, it’s just so prevalent, and it’s part of that cycle of violence that we think about so frequently. If one population of vulnerable individuals like pets are likely to be harmed by an abuser, then other vulnerable populations are likely to be abused as well. So we think of domestic violence and we think of child a abuse and neglect as well. And we also know just how often when things are being investigated, another type of abuse or violence is uncovered.
So on the National Link Coalition’s website, they detail a statistic that I find just really powerful. So in an investigation of homes that were suspected of child abuse, they range between 60 and 88% of those homes also having animal abuse found. And so it’s happening as a coincidence really commonly. And we as veterinarians, if we’ve always been mandatory reporters of child abuse and domestic violence, that’s always been a thing. But not every state has some sort of legislature or laws around being a mandatory reporter for animal abuse, which I find crazy. And so when we report a suspected animal abuse, we may be saving other vulnerable populations within that household. We might be leading investigators to find child abuse or domestic violence and helping to save those individuals as well.

Dr. Andy Roark:
Yeah, we have a broad swath of people in the vet profession that listen to the podcast and everything. So just to run to this quickly, what are telltale signs? What are the flags that we’re looking for where we may be potentially looking at animal abuse? Can you run me through those?

Dr. Traci Zager:
Absolutely. So there’s a range of different types of abuse that you could see, whether that’s neglect or hoarding, intentional abuse or non-accidental injury or organized abuse, which is things like animal fighting. The biggest red flags I would say, I have seen in practice is when the injuries don’t match up to the history. So if an animal is hit by a car, they’re not going to have bilateral rib fractures and a hind limb that’s potentially fractured in multiple places. They’re not going to have fractures that are healing in different or in different states of healing. So looking at all of those red flags, when the history of what they’re saying happened and what the injury pattern you’re seeing is, they’re not matching up, those are the biggest ones that I would say.

Dr. Andy Roark:
Walk me out of this situation. So you’ve given me this place and let’s just say that I’ve got a pet in and a history of injuries. And they go, “Gosh, this pet seems accident prone.” And I’m looking at him going, “These stories don’t match up.” And I thought your fractures at different stages of healing. That makes a lot of sense. I can imagine me being in this room and not wanting to believe what I’m looking at, can you help me get my head around of steps that I might take from there? We started to talk about reporting it and honest to say I’m not exactly sure where I would report it. Can you help me parse out where I would go from here?

Dr. Traci Zager:
Yeah, absolutely. And this is where I really got into this space and how I became so passionate about it is because I was in your situation. I was in the room with a client and things weren’t adding up and I needed to figure out what to do next. And I felt like there were just, I didn’t know where to look. I didn’t know what resources were out there and I didn’t know who to ask. We’re all afraid that we’re wrong, we’re veterinarians. We’re really, really good at being right and we really don’t want to be wrong about something so serious. And so a lot of people that I talked to as I was working through this, didn’t want to make reports or didn’t want to ask those tough questions in the room because they didn’t want to suffer the embarrassment or the potential consequences of being wrong about that or being wrong in that thinking.
So I think if you’re noticing anything, you are the one who’s most qualified to make that determination of whether or not the history and what you’re finding on your physical exam is matching up. Police don’t know how to do that as well. Lawyers don’t know how to do that. Veterinarians are really on the front line of trying to figure out, is this a non-accidental injury? Is this abuse or is it not? And I think that’s the first step in this thinking is realizing that you’re the expert as a veterinarian or a veterinary technician. You’re the one who understands how these injuries happen and you’re the one who knows what to look for on an exam. In those instances where maybe you’re not sure, this is where it’s a really good idea to have that relationship with these reporting organizations before you ever need to make a report.
So you want to feel comfortable enough to call and say, “Hey, maybe I’m not a hundred percent sure, but this is what I’m seeing. What should I do next? And how can I help you in the steps going forward?” And they are more than happy to help you with that. So you don’t have to be a hundred percent right, you don’t have to be a hundred percent sure, but if you think it’s happening, you should make a report if you have any sort of reason, reasonable suspicion. And those reporting partners vary based on where you live. And the National Link Coalition’s website has a directory based on your county. So you can look up exactly who to report to. They’ll give you the organization’s name and phone number, maybe even their email and their address on that website. So you can write that information down and have it available to you before you ever need it.
And I would really recommend to any veterinarians listening, make those relationships now. Call them, tell them that this is what you’re thinking about, that you’re not a hundred percent sure about what to do. But you do want to reach out and have those relationships so that if you’re not sure you still feel comfortable calling and talking to someone. Because what happens after you make the report, you’re not the police, you’re not the lawyer, you’re not doing anything else. You’re just giving them your opinion and stating that you think something might be happening. You’re giving them your objective exam findings and what happens after that is totally not up to you. You don’t have to worry about all that.

Dr. Andy Roark:
This is really helpful and I totally hear what you’re saying about going and having those relationships. So, for me right now, say I’m not looking at anything particularly that I’m concerned about, but I see what you’re saying and I go, “I don’t have those relationships.” So I’m going to put the link to the National Link Coalition down in the show notes. It’s definitely something, I’m going to just take a look at to have that information.
Do we as doctors, reach out to groups now and say, “I’m not looking at anything. I just wanted to say hi and introduce myself.” Is that what we have in mind or are you more, When you say have a relationship, do you mean mostly know who you would contact if and when you needed to? If we are reaching out now, what am I saying? Because I don’t want this to be awkward, but in the same way, I think this is important. And so I’m really navigating this weirdness of I couldn’t live with myself if I didn’t say something and someone was negativity affected. And so I’m going to push myself to go ahead and get my ducks in a road just so I can be there if someone ever needs me.

Dr. Traci Zager:
Yeah, I think both. So it’s okay if it’s awkward. It doesn’t have to be, but it’s okay if it is, to just reach out and say hi and just say, “Hey, I’m a local veterinarian. I was just doing some research on the connection between animal abuse and domestic violence and child abuse. I think it’s really important that I just reach out and say hello. And that way we can get to know each other a little bit.” I think it’s also really helpful, they can potentially educate your clinic. So depending on the organization you’re reaching out to, they deal with this more than you do. They might be able to come in and say, “Hey, let’s do a 30 minute talk where I tell you more about how to investigate these things and determine whether or not you do have something going on in your clinic or what to look for, or I can just meet with you for lunch and we can feel more comfortable talking to each other and know what we’re looking for on both ends.”

Dr. Andy Roark:
Yeah, that makes a lot of sense. What happens, Tracy, when you call these places? I imagine me putting in this phone call going, “I don’t really know.” And then there’s helicopters and people crashing through windows and things like that. I know that’s not, but what should my expectation be if I reach out to a group or support network and say, “Hey, I’m looking at this, but I don’t really know.” What is that set in motion?

Dr. Traci Zager:
Yeah, so they might ask you for your exam findings. So they might just say, “Can you just let me know what you found on your exam? Give me some objectives, some objective information that I can look through and help you to determine if there’s something going on.” They might say, let’s say if it’s a hoarding case. So I had a hoarding situation with one of my clients where I determined that that was what was going on, and all I did was help her find resources and help. So as soon as I contacted our local anal welfare league, it’s not like they came out with handcuffs and put her in the back of a squad car. So they sent somebody to the house, they helped her rehome a lot of these animals. They helped her get the animals out and find new homes and get veterinary care.
They educated her. It wasn’t a situation where she ended up going to jail. They just provided her with the resources she needed to get out of this situation. And 90% of the time that’s what happens. So there’s education, there’s some sort of intervention where the pet is helped, the owner is helped. They want these pets to stay with their owners. So if it’s a neglect or they didn’t know better type of a situation, they educate them, they help them remediate the situation, and then they move on and continue with just welfare checks on that animal.
If it’s a really bad situation like we’re concerned about a non-accidental injury or intentional abuse, they might do a welfare check. They might also consider bringing police along, things like that, just to see what’s going on in the house. They might investigate if there’s been any reports of things like domestic violence or child abuse in that home before they do that welfare check. And again, after that, after the veterinarian has made the report, nine times out of 10, they don’t need anything else from you. You make your report, you get concerned. You might be able to call and ask what happened later on, but you don’t have to be involved in anything else after that.

Dr. Andy Roark:
Okay. That makes sense. And you’re clearly really passionate about this, and this is something that I know that you were really interested in before you went to Purina. How did Purina decide to get involved in the Purple Leash and how did that get started?

Dr. Traci Zager:
Yeah. So I know that there was, I don’t know a hundred percent sure, Andy, how it first started at the very beginning, I do know that the partnership between Purina and Red Rover started in 2019, and that was really when the whole grants and all of that started. I do know as well that in general, Purina got started in this space because we really care about the human animal bond. We care about keeping pets and people together. And this is one of those situations where people are having to make really, really difficult decisions to leave their pets behind in scary situations, and we don’t want them to have to make that choice.

Dr. Andy Roark:
That makes total sense. Talk to me a little bit about how veterinarians and the public can support Purple Leash. How do they engage in what happens?

Dr. Traci Zager:
Yeah, so the most obvious way that veterinarians could be a participant in Purple Leash Project is to make a donation. So on the website, you can make a donation and they’ll send you one of these beautiful purples leashes. They have really nice cushy hand grips, and they’re very nice leashes, but they have walk heel together on them, which is really cute. It really symbolizes that bond. And the purple is obviously a nod to domestic violence awareness, which is the purple ribbon.

Dr. Andy Roark:
Yeah, I love it. What else should people know about Purple Leash Project, Red Rover any final words, anything like that? This has been super helpful and insightful. I really appreciate you talking through with me. So but Final Pearls.

Dr. Traci Zager:
Yeah, so I think one of the biggest one really is that the goal for the Purple Leash Project is to make 25% of domestic violence shelters pet friendly by 2025. So that’s our big goal. That’s what our we’re striving for as far as the Purple Leash Project goes. And then as far as the veterinarian’s role in all of this, just know that by listening to this podcast and by going into your exam rooms with this in the back of your mind and seeing your clients and their relationships with each other and their pets through this lens, that’s really half the battle, is being willing to think about it, being willing to educate yourself about it, and then putting it into practice when you go in and do your exams.

Dr. Andy Roark:
Oh, Tracy Geiger, thank you so much for being here. Thanks for the work that you do. Thanks for telling me about it, guys. Thanks for listening today. I’m going to put links to all of these resources to Purple Leash Project, to the National Link Coalition, to Red Rover, all those sorts and stuff. I’ll hook you guys up in the show notes. Okay and take care of yourselves, be well, do good work alright, see you later. And that is our episode, guys. I hope you enjoyed it. I hope you got something out of it. As always, it feels good to make a difference. Share these links. Think about getting involved and helping out. And I’m going to do the same, but guys, yeah, sometimes we forget how lucky we are and we forget what other people are facing. And most times we don’t have any idea what’s going on in the houses of the people and the pets that we take care of and stuff. Anyway, gang, be well. Take care of yourselves. I’ll talk to you later.

Dr. Amy Pike joins the podcast to discuss behavior screening in general practice! Dr. Pike was recommended by multiple listeners to the podcast because of her lecture The 6 M’s of Treating and Behavior Disorder in Practice. One listener even said the lecture helped their practice become better equipped to handle or rear behavior cases!

The 6 M’s are:

1) Medical Rule Out

2) Mental Enrichment

3) Management

4) Modification of behavior

5 Medications and Products

6) Monitor and Modify the Plan

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

LINKS

Links to Amazon.com are affiliate links and help support the show. (They’re also much smaller than normal links and easier to copy when typing up show notes!)

Kong Products: https://www.kongcompany.com/

Doc & Phoebe’s Indoor Hunting Cat Feeder: https://amzn.to/3R9Dnr2

Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Canine and Feline Behavior – https://amzn.to/3R6Vhuj

Decoding Your Cat: https://amzn.to/3wrD4Qe

Decoding Your Dog: https://amzn.to/3pKVA2p

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

What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Pike is a native Arizonan and graduated from Colorado State University’s school of veterinary medicine in 2003. Working as an Army veterinarian after graduation and taking care of the Military Working Dogs returning from deployment spurred her interests in behavior medicine. Dr. Pike completed a Residency program and became board certified in 2015. She is owner of the Animal Behavior Wellness Center and was recently named one of the “Top Veterinarians of Northern Virginia” by NoVa Magazine for the sixth year in a row.

Dr. Pike speaks all over the world about veterinary behavior medicine, she has been published in numerous veterinary journals, she has conducted and published two scientific research studies, and is a contributing author in five clinical text books. She mentors 4 clinical behavior residents and is a clinical instructor for E-training for dogs and the Masters Program in Applied Animal Behavior at Virginia Tech. She is an advisory board member for Royal Canin, Fear Free, and the Animal Welfare League of Arlington, and is a consultant for Chewy, Inc. In her (fairly non-existent) spare time, she enjoys gardening and hanging out with her active-duty Army husband of 20 years, their 14 yr old daughter, and 9 yr old son, and their menagerie- Dobby (6 yr old Devon Rex), Ike (4 yr old Giant Schnauzer), Scooby (2 yr old, Mini schnauzer), Ginny (10 month old Airedale), Prickles (1 yr old Hedge Hog) and Pavlov (16 week old Indian Ringneck Parakeet).

EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great episode today for anybody in the vet practice and, honestly, it’s probably pretty great for pet owners, who are interested in behavior, to hear as well. Gang, Dr. Amy Pike is here talking about the 6 M’s that she uses to treat any behavior disorder in practice. And guys, this is so packed full of pearls. It’s like a pearl bag that’s one size too small for all the pearls. That’s what it’s like, it is. This is a great one. It’s short and to the point. It’s about 25 minutes of our interview. Man, you’re going to get something out of this. I can’t wait for you to hear it. Let’s get into this episode.

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

Dr. Andy Roark:
Welcome Dr. Amy Pike. Thanks for being here.

Dr. Amy Pike:
Yeah, thanks for having me. I appreciate it.

Dr. Andy Roark:
Oh man, it is an honor to have you here. You are here because I asked the world on social media, “What is the best lecture that you have seen as a veterinary professional? Who’s the person who gave a lecture that really you thought was amazing? And what did they talk about?” And you got one of the nods, a significant nod. The feedback was something along the lines of, “Dr. Amy Pike’s lecture helped me change the way that I screen behavior cases and how we treat these pets. And it made a big difference in our hospital.” And I thought, “Man.” No pressure, Amy. Holy moly.

Dr. Amy Pike:
I know, right. I know. Can I retire now?

Dr. Andy Roark:
Yes, you should be-

Dr. Amy Pike:
Is that it, I’m at the pinnacle?

Dr. Andy Roark:
Just drop the veterinary mike and take the rest of the night off because you crushed it. You are, for people who don’t know you, you are a boarded veterinary behaviorist. You have worked as an army veterinarian, and you worked with military working dogs. You have been named one of the top veterinarians of Northern Virginia by Nova Magazine for six years in a row. You actually own your own hospital, correct? The Animal Behavior Wellness Center. And that is in Northern Virginia.

Dr. Amy Pike:
Yeah, we have two locations, one in Northern Virginia, one in Central in Richmond.

Dr. Andy Roark:
Oh, very nice. And then you have residents of your own now, is that true?

Dr. Amy Pike:
We do, I have little minions, four of them.

Dr. Andy Roark:
You’re taking over this profession. I love it. Well, thank you so much for being here. I just wanted to come in… So that was the guidance that I got was, “You got to talk to Amy Pike about the way that she screens behavior in these animals.” And so I don’t have a specific case that I want to put on you, but help me get into that headspace. Yeah, walk me through, how should I be looking at this in practice, Amy?

Dr. Amy Pike:
Yeah, so I went to Colorado State. And any of you who have seen Mike Lappin lecture, he was one of my professors. And he likes to bring things into these little algorithms of, “If this, then that,” kind of thing. And that’s really where I wanted to come at this from, because not every clinician has an interest in behavior. Nor have they had any behavior, potentially, even in school, or in continuing education. And so any behavior case, no matter whether it be the worst aggression you’ve ever seen, or a puppy that’s peeing in the house and hasn’t been potty trained, how do you just start from the beginning and work through any case? And that’s where I came at this from.

Dr. Andy Roark:
All right, let’s do it. Run me through your Mike Lappin style algorithm. I’m fired up now.

Dr. Amy Pike:
Yeah, so I call it the 6 M’s. So the first M would be medical rule outs. So behavior is very much a rule out diagnosis. So that’s why any behavior case should come to see their veterinarian first and foremost. Because that little puppy peeing in the house, maybe it’s not house soiling because it is not yet house trained, it’s got a urinary tract infection. So we want to make sure that we rule out any sort of medical concern. And that, of course, includes doing our medical due diligence as veterinarians, doing your full physical exam. Orthopedic, neurologic, especially because pain can be a huge contribution to behavior concerns. And then CBC chemistry, urinalysis, and a thyroid panel. So that’s where I start with any behavior issue.

Dr. Andy Roark:
I love it. That is super commonsensical in a way, though I always struggle with. When you’re at a party and people are like, “Hey my cat’s peeing outside the box.” Let’s make sure this isn’t a medical issue is a great… “See you on Monday,” that’s how you answer that piece of advice. I love it.

Dr. Amy Pike:
Yeah, make an appointment with your vet.

Dr. Andy Roark:
Yeah. Thanks. Oh, I love it. All right, great. So I’m 100% on board with the first one. First M is medical rule up. Okay, what’s number two?

Dr. Amy Pike:
Yeah, so second M can be… Well, I interchange the next two. So we’ll go with mental enrichment. So mental enrichment is all about stimulating a brain, basically. And so we want to make sure that these pets have enough opportunities to do their normal behavioral repertoires. So cats love to hunt, so we want to make sure that cats have the ability to be able to hunt, to climb vertical spaces, to get away from other cats in their territory.

Dr. Amy Pike:
We want to make sure that dogs, especially dogs of working lines and working breeds have enough stimulation that they’re going to be tired. And I hear trainers all the time say, “Oh, you need to exercise that dog. Oh, you need to exercise them. Exercise is like the end all, be all.” But, let’s say, you have a dog that has leash reactivity and it can’t handle seeing other dogs on leash. Well, exercise is not going to be good for that dog. Taking it out on a leash walk, where it’s exposed to all of its triggers, is not going to be any good. So how do the owners go about actually tiring that pet out? And the easiest way is just through mental stimulation. You can do trick training. You can do nose work, where you hide pieces of treats all throughout the house and they have to find it. If you’ve ever seen a puppy after puppy class, they are exhausted. But they romp and play with their friend for 45 minutes, and they’re not necessarily tired after that. They’re raring to go for another round. So you have to stimulate that brain.

Dr. Andy Roark:
That’s awesome. So hold on, I’m going to be honest here and say you blew my mind. Which, again, it seems super simple when you say it. And I’m like, “I have always been one of those exercise, exercise veterinarians.” Just because a tired dog is a good dog. I see understimulation as a problem in a lot of pets that I see. Anyway, and I am that person too. I am that person who’s like, “If I don’t get out and exercise, I start getting stir crazy.”

Dr. Amy Pike:
But if you think about it, Andy, from your perspective, if you go out and, let’s say, go for a run. You’re training your body to be a better runner. So if we take that border collie out for a run, they’re just going to be a better runner. They’re going to need more and more and more and more. And so, really, that’s a self-licking ice cream cone, so to speak. We actually need to tire that brain out a little bit better.

Dr. Andy Roark:
Well, I really like this a lot, and I want to unpack this. Because you’re right, I have literally had clients who are like, “I took him and then I started exercising and walking and running. And that was great for a couple weeks. And then he got in shape and, now, I’m in as much trouble as I was in before.” And so this is a new concept or idea for me. So give me some guidelines here about these mental workouts. What are you looking for? If a client says to me, “Yeah, first of all, I can’t out-exercise my husky. I break way before she does.” What kind of guidance do you have here? Help me get an idea in my head of how to do this and what guidance to give.

Dr. Amy Pike:
Yeah, it can be as just as easy as not feeding the dog out of a bowl, or a cat. So make them work for that food. Put it in puzzle toys, hide it. We call these adventure boxes. We take all the Amazon boxes and put kibble inside of one. And then put another one in there, put some toilet paper or paper towels, put some more kibble in there. So the dog actually has to go through that. So rather than your Labrador taking 0.2 seconds to hoover up its food, maybe it’ll take 10 to 20 minutes. And that 10 to 20 minutes is actually exhausting because they really have to think about it.

Dr. Amy Pike:
I, now, as a veterinarian, not when I was in general practice, but now as a veterinarian, I have very much a desk job. Because I can’t move for most of my patients because they will try and eat me, should I do make any sort of motion. But I’m exhausted at the end of the day. I haven’t done anything physical, it’s because my brain’s been working the whole time. So that’s one easy way. Even just 10 to 15 minutes of running through there, sit down, shake, touch, whatever tricks that they know, or teaching them a new trick, can be just as mentally stimulating. My kids love to hide the feeder toys for the cat all around the house. They fill these little mice up every night and they hide them all over the house. And the cat has to hunt all night. And it’s not up waking me up in the middle of the night saying, “When’s food coming?” But it’s actually getting some mental stimulation, and performing some of those normal behaviors that it would otherwise.

Dr. Andy Roark:
I love this. And I love your example of the Amazon boxes and things like that. I’m 100% running through, in my mind, how to put this together. Are there toys that you like specifically for dogs and cats? Are there certain brands that you’re like, “Yeah, that’s what I recommend,” or things like that to help get people started?

Dr. Amy Pike:
Yeah, there are so many your head would spin. There’s some really good enrichment social media Facebook groups out there. But one of my favorites for cats is the Doc & Phoebe’s mice. Those are what my cats love to find. And then, really, for dogs, I do a lot of DIY for dogs. Because I have pretty destructive dogs so I’m going to make something that they can destroy. But they are a lot of good… KONG makes a bunch, not even just your normal KONG that you stuff, but the one that has a little hole in the side. I think it’s called the KONG Wobbler, where you can manipulate it and topple that food out.

Dr. Andy Roark:
So I’m a big KONG guy. I looked over to the side, I used to have a shelf of KONG, this kind of display. But my Goldendoodle has just been helping himself for the last couple of months. And by the time I find it, it’s too late.

Dr. Amy Pike:
He’s like, “Hey, I need enrichment, Dad.”

Dr. Andy Roark:
Oh, he’s smart. He waits for me to leave, and then he just helps himself. But my nephew, who’s 2-years-old, came to visit a little while ago. And he found those big KONG Wobblers, and there was two of them. And that kid just toddled through the house, holding these two KONG Wobblers that were as big as him. It was absolutely awesome. So anyway, all right, cool. I’ll stick some links in the show notes, at least for KONG stuff and for the Doc & Phoebe. All right, cool. So we’ve got medical rule out, we got mental enrichment, where are we going from here?

Dr. Amy Pike:
The third one’s going to be management. So management is just like staunching the bleeding, wait, put a tourniquet on, or put a bandage on something. Maybe we don’t have time to explore that wound a little further, but we need to stop that bleeding immediately. So management is what’s going to do that for behavior. So we are going to try and avoid the triggers, so whatever that trigger may be. So, let’s say, the dog is leash reactive to other dogs. All right, we’re going to avoid leash walks as much as possible. Or we’re going to take the dog to a remote trail. Or, during COVID, it was nice because the schools were empty, people could go to the school grounds and walk around. Church parking lots are a really good place. Business centers that are empty and void of employees right now also make great areas. So that’s just going to prevent the practice of that problematic behavior.

Dr. Amy Pike:
So number one, we know practice makes perfect. So if we stop the practice of that behavior, the dog’s not going to get any sort of reinforcement or punishment for it. But it will allow us then to be able to train something in the future, which we’ll talk about. But the other thing too is, especially with aggression, because that’s the number one thing that I see as a behaviorist, it’s going to keep everybody safe. And if we can keep everyone safe, then we can keep that pet in the home until we’re able to implement treatment. Because behavior treatment isn’t an overnight thing. I know owners obviously come in and they want the magic wand, but it doesn’t happen. And it’s going to take some time. So we are going to have to implement management in the meantime.

Dr. Andy Roark:
That totally makes sense. So, basically, what I’m hearing when you say management is, let’s not let these problems detonate. And just put ourselves in a safe place while we work on the mechanism behind the scenes. Is that pretty accurate?

Dr. Amy Pike:
Exactly, yeah.

Dr. Andy Roark:
Okay, cool. Great, I like that. What does that look like in things like house soiling in cats or things like that? I see that in dogs, and I think dog triggers seem to be much more known and recognized. And cat triggers, I’m not saying they’re not there, I’m saying pet owners often don’t see them or get them. And then I get a lot of, “I don’t know why he’s doing this.” Help me with that.

Dr. Amy Pike:
Yeah, so one of the things, obviously, the owner’s going to want to stop the urination or defecation on their carpet. So if we maybe just confine that cat to a bathroom with its own litter box; food; and water, or a basement maybe that’s unfinished. Somewhere where, even if the behavior happens, it’s not going to be as detrimental to the oriental rug or something like that. But also, inner cat aggression is a big component, whether it be obvious or subtle, in a multi cat household. So separating all the cats until we figure out what the root cause is for the elimination. But that would be one other way that we can go about that.

Dr. Andy Roark:
That’s awesome. Okay, that totally makes sense. Great, I’m on board with management. Where are we going from here?

Dr. Amy Pike:
Excellent. So the next one would be modification of behavior. So this is teaching either the animal an alternate behavior to the one that we don’t want. Let’s say, dog is jumping on guests. All right, we’re going to teach it to sit down for attention instead. Or if we’re talking about something that is fear, anxiety, or stress related, we’re going to desensitize them and counter condition them to that trigger. So this is all the training aspect of what I do. I equate it to the therapy in humans. It’s like you have to put in the work. And this is the work that’s going to take the time in order to teach those different behaviors.

Dr. Andy Roark:
Perfect. I’m making copious notes over here. This is really good, yeah. All right, that’s wonderful.

Dr. Andy Roark:
Guys, I just got to jump in here real fast and give a quick shout out to Banfield the Pet Hospital. Guys, we have transcripts for this podcast. That’s right, at drandyroark.com you can find transcripts to all of the Cone of Shame Veterinary Podcast episodes. Banfield has sponsored that, they have made it possible to increase accessibility and inclusivity in our profession. I’m so grateful to them for that. We could not do it without them. Gang, I hope you’ll take advantage of this resource. Feel free to check it out. It’s not hard to find. We try to make it super easy to find. Anyway, I just got to say thanks to those guys. And I want you guys to know that those transcripts are there, if you need them. Gang, let’s get back into this episode.

Dr. Andy Roark:
Is there anything that we need to set… Help me, when we start talking about modification of behavior, what expectations do you try to put into the mind of the pet owner? Because this is a lot of work. It’s easy to be like, “We’re just going to alternate your dog’s behavior so he doesn’t jump up on people when they come to the house.” And they’re like, “Great, that sounds like a busy day.” And it’s like, “Oh no, no. Oh, no.” Help me with that. How do you do that?

Dr. Amy Pike:
Well, and I always tell people too, I’m obviously busy, I have a family practice and everything. And so if management can solve a lot of your issues, let’s say, it is this jumping dog. And you just say, “Hey, I’m going to just put the dog away when I let people in and then it can’t jump on people.” If that’s all you want to do, that’s fine. I am totally cool with that.

Dr. Amy Pike:
But if you do want to do the modification of the behavior, then we are going to have to train that. It’s going to take consistency. It’s going to take using positive reinforcement based training. So making sure we reward that pet for that alternate behavior. And really, honestly, even if it’s something as simple as jumping up, we could probably teach that in one session. But getting the consistency under our belts is going to be the key. And that may take weeks to months, depending on how long this animal has been doing this behavior. If this has been seven years running and, now, we’re trying to change it, it’s going to take a little bit longer. Because there’s a lot of reinforcement history there. But if this is a new puppy, that’s going to be simple.

Dr. Andy Roark:
Okay, I like that. That makes sense. I’m totally on board with this. I love the way this program is coming together. So number five?

Dr. Amy Pike:
Yeah. So number five would be medication and products. And that’s if it is something that’s fear, anxiety, and stress related. So the house soiling puppy that we’ve ruled out medical, that is just a puppy that has never had potty training before, that’s not going to need medication and products. So I’m talking about dogs and cats with anxiety disorders. And so this can be anything from our nutraceuticals like ANXITANE and Zylkene. Am I allowed to say brand names?

Dr. Andy Roark:
Yeah, absolutely. Yeah, you can definitely, yeah. Yeah, totally. Yep. No, no, you’re all good.

Dr. Amy Pike:
Good. And then we can use the pheromones, like ADAPTIL and FELIWAY, all the way up to our psychotropic medications. And we have a few that are FDA approved in dogs. We’ve got Reconcile and Clomicalm, which are FDA approved for separation anxiety in dogs. We’ve got SILEO gel, which is approved for noise and storm phobias. We’ve got Enalapril, which can be hard to find, but it is approved for cognitive dysfunction in dogs. And hopefully in the next year or so we will get Pexion, which is a benzodiazepine that is approved for noise phobias as well. But other than that, we’re using everything off label in our veterinary patients. And we use all of the same psychotropic medication that they do in human medicine now. So we have lots and lots of options moving forward.

Dr. Andy Roark:
Talk to me about the timing of this. So when we’re laying out this program, number four modification of behavior, comes before number five, which is medication. Is that how it goes in practice? So I know there’s some difference here in behaviorists and how they do it. I’m really interested in this of when do I introduce medication? I think I’ve been guilty, earlier in my career, of sitting on medication too long when, had I introduced it earlier on with the training, I could have been more successful. And so I’m still parsing that. Can you comment a little bit on the timing of those things together?

Dr. Amy Pike:
Absolutely. That can be a little bit tricky. So the reason that I have it in this order in my talk is because there are some behaviors that aren’t going to need medication and products. And so, of course, I didn’t want to put that first. But for the cases that typically see me, I’m not seeing the jumping dog at the door, because I’m seeing the aggressive dog at the door. And for the most part, if the animal cannot be kept under a threshold, meaning the owners can’t manage the environment appropriately… Maybe they live in an apartment and the dog has to go outside to potty, and they’re leash reactive to every dog. Or they’re reactive to strangers, and they also live in an apartment and have to take the elevator 13 floors with other people, I am likely going to have to need some sort of medication in order to keep that animal under threshold.

Dr. Amy Pike:
Because nobody can learn when they’re highly aroused. So if you are stressed, learning doesn’t take place. And if the animal is reacting, nothing is happening between those ears except fight or flight. And so we need to make sure that those medications get on board, sooner rather than later, because, otherwise, they’re just going to spin their wheels with training and get frustrated.

Dr. Andy Roark:
Okay. All right. Can I ask you about a specific case that this could have come together?

Dr. Amy Pike:
Yeah, of course.

Dr. Andy Roark:
Okay, so this is interesting, and it’s a case that bothered me a lot because I didn’t feel like I had good tools in my toolbox to deal with it. Or maybe I didn’t process it, at the time. Because you’re in the exam room, the person’s laying out… I had a case… It’s been some time ago now, so I feel comfortable telling you about it. But, basically, it was a person who had an 11-month-old German shepherd in an apartment complex. And the dog was barking continuously and the neighbors were complaining. And I talked about exercising the dog a lot, which I think is true. Can you talk to me a little bit about that? And, of course, the owner said, she said, “I want medications for this dog.” And I did not like that. But now that I’m listening to you, I’m going, “Well, is this dog hyper stimulated because it’s being crated. And how do you train this dog that’s having this reaction?” Anyway, yeah, help me just process that, as I think back.

Dr. Amy Pike:
Yeah, I think the trouble with barking is they’re going to have to take a little bit deeper detailed history because barking has so many motivations. But, regardless, if it is pretty much all daytime hours, there’s probably a some sort of noise stimulus. That they’re hearing other things outside. Potentially, separation anxiety. And like you said, if we are unable… If that dog cannot even focus on owner trying to give it a treat when it’s quiet, and it just continually is barking, it is going to need medication.

Dr. Andy Roark:
Okay, that helps.

Dr. Amy Pike:
Now, of course, I’m going to do management, mental enrichment, all that stuff at the same time. As I tell my owners, it’s never medication in a vacuum. But the medication is going to allow us to be able to proceed in a much better fashion, and much faster.

Dr. Andy Roark:
Well, I come out of this interview thinking about that case. And thinking about mental enrichment is definitely the tool that I wish I’d had handy in my pocket, that I could have brought in as well as the exercise stuff that I talked about. Because that dog does need exercise. But that was maybe another thing. So anyway, that’s super helpful for me. I’m sure I’m not the only one who’s listening to this, who’s running back through their own cases and going, “I could have taken that one a different way.” Anyway, well, that’s why we do these. All right, perfect. And then that brings us to number six, what have you got?

Dr. Amy Pike:
Yeah. And number six is monitor and modify the plan. Because there is no behavior plan that goes out the door that’s perfect, especially when it comes to medication and behavior modification. Well, actually, I should take that back. Every single one of these things. Because no matter what I give owners, they could come back to me and be like, “I can’t crate that dog. Number one, it’s panicked.” Okay, we’re going to have to work on crate training. Or, “I can’t hold the dog back when people are coming to the door because it then redirects and bites at me.” All right, well, that’s something we’re going to have to modify.

Dr. Amy Pike:
So no plan that goes out that door is going to be perfect from the get-go. And so it’s very, very key. Behavior cases are probably some of the most intense as far as follow up is concerned. Because we need to be in regular touch with these owners to make sure that they are on track, and that everything is proceeding as we want it to be. And certainly with medications. Yes, we pick medications based off of what clinical signs we’re seeing, what neurotransmitters we want to target, et cetera. But it’s up to that brain, ultimately, whether they respond to it or not. And so I can pick the greatest medication based on the textbook chapter. If that dog hasn’t read the textbook chapter, then I’m going to have to alter that.

Dr. Andy Roark:
That totally makes sense. Well, great, this is super helpful. I love these six steps. This has been really helpful. I’ve taken away a couple of real nuggets and pearls today, so I call that a huge win. I want to ask you something now that may seem a little bit off topic in the moment. But I’ve been sitting with this since about halfway through our conversation. You are about the most laid back animal behaviorist that I have ever talked to. As far as your ability to be like, “We’ll see what happens.” And when you say, “Hey, if you want to put your dog away, instead of the dog who jumps up, you just want to put him away, that’s fine.” And I’m like, “Wow.” Legitimately, I had people who are animal behaviorists who are like, “Nope, we’re going to fix this.” And you’re like, “Well, find what works.”

Dr. Amy Pike:
I’m a realist. I am very much a realist. And, again, I’m also a client, to a certain degree. I have pets. They’re not all perfect. Certainly, my children are not perfect. And so you have to roll with the punches. And if management is all you can handle, have at it. Management and mental enrichment, I’m good with you.

Dr. Andy Roark:
Well, so two things. Number one, you and I talked about our kids before we started recording. And so you have a 14 and 9-year-old. I have a 9 and 11-year-old… Or a 14 and 11-year-old. It changes your perspective a little bit about what’s really important. You’re like, “Look, just get through the day.” And so I love that.

Dr. Amy Pike:
Exactly, let’s get through the day.

Dr. Andy Roark:
Look, we’re all just holding it together. Just let’s make it work. But, anyway, I think it’s really refreshing. I think a lot of us, as veterinarians, feel like we’re not getting it right. Or we didn’t 100% fix this. Or we’re not fixing it as fast as we should. And I just want to tell you, I really like your perspective. And I think that you make me feel much more competent, with a more laid-back attitude of, “You know what? We’re going to work on this, and some of it’s not going to work. And we’re going to keep adjusting.” But, anyway, I’m struck by that, talking to you. I think it’s really awesome. Actually, let me ask you this real quick. Do you have favorite behavior resources out there? So if you’re a veterinarian or a technician and you’re like, “This is my jam.” Where do you send people to?

Dr. Amy Pike:
Yeah, even if it’s not your jam, if you want more resources just for clients, the Five-Minute Vet Consult, Canine and Feline behavior one, is one of my favorites. I give it to all my students when they come on rotation. I love Decoding Your Cat and Decoding Your Dog by the American College of Veterinary Behaviorists. Might see a chapter in one of the books by yours truly. And those are great for clients too. I love being able to put those into puppy and kitten packs. If I were in general practice, that’s what I would do. I would put one of those books in every single one of my puppy and kitten packs and send those home with owners. Because that is going to be an invaluable resource for the life of that animal.

Dr. Andy Roark:
Those are great. I’ll put links to all that stuff in the show notes. Those are great books, Decoding Your Dog and Decoding Your Cat. And 100% written for pet owners as well. Really good call, really great recommendation. Amy, where can people find you online? Where can they learn more about your practice, things like that?

Dr. Amy Pike:
Yeah, well you can find me at our website at abwellnesscenter.com. And our Facebook page is the same AB Wellness Center. And we put lots of resources up there, lots of success stores from our patients, good ideas for management. We have a fun little post recently of a dog with his nice little bandana that says, “Don’t touch me,” so advertising his management to others. So we love that type of stuff.

Dr. Andy Roark:
I wish I had a bandana that said, “Don’t talk to me,” sometimes.

Dr. Amy Pike:
That’s what I said too. Yeah, leave. No hugs.

Dr. Andy Roark:
That’s so great, thank you. No hugs. Thank you so much for being here. You were really wonderful. Guys, everybody take care of yourselves. Thanks for listening. I will talk to you next week.

Dr. Andy Roark:
And that’s it, guys. That’s what we got. Thank you so much Dr. Amy Pike for being here. Gang, I love this. I love talking about this stuff. I love learning. I love getting better. If you want to get your team on board with episodes like this, just share it with them. It’s available on YouTube, if you have people who like to go and watch the podcast on YouTube. It’s wherever you get your podcasts. You can tell Amazon Alexa to play the latest Cone of Shame Veterinary Podcast and she’ll do it. And so you got that going for you. It’s easy to bring the team in.

Dr. Andy Roark:
Also, if you want to work with your team on making good recommendations and communicating more effectively with pet owners, I got you there too. You can head over to drandyroark.com and click on our store. And I have a course, which is my Exam Room Communication course for teams. It is my best advice and practices for training teams to work with pet owners. Check it out. Man, it’s my best resource that I could possibly make to help teams work better in the exam room. I hope that you’ll find something valuable in it. And that you and your team can get something out of it. I bet you can. Anyway, guys, take care of yourselves. Be well. I’ll talk to you soon.