Medicine

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

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

LINKS

www.aaha.org

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

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

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host Dr. Andy Roark. Guys, I am here with one of my dear good friends Dr. Jessica Vogelsang. She is amazing. She is one of those people who really makes me think we are talking about Is it time to decenter the veterinarian from veterinary care?

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

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

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

Dr. Andy Roark: Welcome to the podcast. Dr. Jessica Vogelsang, how are you?

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

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

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

mean when you say that? 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Andy Roark: Yeah, 

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

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

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

Dr. Jessica Vogelsang: Who created that 

Dr. Andy Roark: I agree. I agree.

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

Dr. Andy Roark: Oh, 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Andy Roark: Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Jessica Vogelsang: at aaha.org

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

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

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

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

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

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

LINKS

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

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

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

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

EPISODE TRANSCRIPT

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

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

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

So, I think a lot of people are going to love this episode. Let’s get into it.

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

Dr. Andy Roark: Welcome to the podcast, Vicki O’Grain, how are you?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Vicky Ograin: I hope so.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LINKS

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

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

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

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

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

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

ABOUT OUR GUEST

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

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

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

EPISODE TRANSCRIPT

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

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

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

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

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

Dr. Andy Roark: Welcome back to the podcast, Dr. David Dycus how are you, my friend?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Andy Roark: And it pops back in?

Dr. David Dycus: Yep, exactly.

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

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

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

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

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

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

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

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

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

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

Dr. Andy Roark: Okay.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. David Dycus: Thank you. 

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

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

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

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

Tyler Grogan, CVT and Creative Marketing Director at Uncharted Veterinary Conference, is on the podcast today to discuss transitioning out of practice and what it means to walk away from what you consider your “life’s work.” In this episode of the Cone of Shame Veterinary Podcast, Dr. Andy Roark and Tyler share personal experiences and reflections on leaving clinical veterinary work, struggling with identity, and redefining success. They also dive into the emotional complexities veterinary professionals face when stepping away from practice. This episode provides valuable insight for those looking to transition into new roles while staying connected to the veterinary profession.

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

LINKS

Tyler Grogan on LinkedIn: https://www.linkedin.com/in/tyler-grogan-63247a192/

Uncharted Veterinary Conference & Community: https://www.unchartedvet.com

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Tyler Grogan is a Certified Veterinary Technician with experience in specialty, emergency and general practice. She currently serves as the Creative Marketing Director for the Uncharted Veterinary Conference where she focuses on brand building, marketing, storytelling across multiple digital platforms, and exploring new ways to elevate the client experience.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host. Dr. Andy Roark. Guys, I am here with my friend Tyler Grogan. She is a CVT and she works for me at the Uncharted Veterinary Conference and we are talking about what happens when you are done with your life’s work. And so Tyler’s got a great question here that came from one of our community members in Uncharted.

And it’s, it’s a really good philosophic discussion about phases of our life and what happens when we don’t want to do the thing that we’ve been doing in the past. And the guilt that a lot of people wrestle with when they say, I, I want to leave. I want to change. I want to. to try something different, but I feel like I’m giving up on the legacy I’ve been trying to build, or I feel like I’m quitting on a field that I was called to.

And anyway, we get into all of that. This is a really interesting conversation. I hope you guys will enjoy it. Let’s get into it.

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

Dr. Andy Roark: Welcome to the podcast Tyler Grogan, CVT. How are you?

Tyler Grogan: I’m great. How are you Andy?

Dr. Andy Roark: I’m doing really well. It’s always good to see your smiling face, which I get to see quite regularly because we live in the same town and you, you work for me. And so that, that makes us see each other quite regularly. So for those who do not know you, you are the Creative Marketing Director at Uncharted Veterinary Conference.

What does that mean? What does that entail, Tyler? What does that mean?

Tyler Grogan: You know, I do a little bit of everything, Andy. A little bit of promoting our events and telling people what we’re doing over at Uncharted. I help out with our events when we put them on, creating stuff on our social media, all kinds of things like that, writing newsletters. So yeah. A little bit of everything. 

You’re 

Dr. Andy Roark: doing, you’re doing a bit of speaking these days and you are actually doing really good stuff. Now you’re blushing. You do really good. You do really good lectures. You do really great lectures on the customer experience, I think is sort of your area of expertise. I think it’s, it blends in with the marketing work that you do, but you do very cool stuff on engaging your clients as they come into the building.

You do work on queue theory, which is the science of getting people to enjoy waiting and lots of really interesting stuff. That I just, I love. I don’t think anybody else is talking about it. And so, anyway, you do, you do excellent work in a lot of different areas. And, you’re also writing a bit. And you wrote something that really, I thought was very interesting.

And I have not seen other people talking about it. And so let me pause here and just open sort of the floor to you for a second. Why don’t you sort of talk about the piece about the end of our life’s work.

Tyler Grogan: Sure. one of the things that I do over at Uncharted is our community newsletter. So every month our members get a newsletter from us. And a few months ago I was encouraged to write for it. So I started writing and

Dr. Andy Roark: You were volun-told, I think is the

Tyler Grogan: I, yes,

Dr. Andy Roark: I think is

Tyler Grogan: well, I wasn’t going to call you out on the podcast that you run, but yes, you volun-told me to write more.

So, I started writing these letters from the editor and every month go into the community and look for some things that people are doing and share kind of their wins and their trophies and also just see, you know, what everybody’s doing that’s great in their practices. And there was one post that came out this past month that I recognized someone was struggling with.

This idea of selling their practice or moving on from being a practice veterinarian to pursue other things and there was a kind of a feeling of guilt it seemed like in the post and that really struck me because I remember when I left practice and started working full time with uncharted. I had a really hard time dealing with the idea of not being a vet tech, not being the person on the floor handling the pets.

And what did that mean about my identity and my role in veterinary medicine? And so I could really resonate with perhaps what she was going through. So, it just gave me this thought of what does it mean when you’re done with what you considered was your life’s work? I mean, I’ve never been a business owner or a practice owner, so I can’t directly relate, but I can imagine dedicating your entire world to building this business.

And then considering walking away from that or working in it in a different way could be scary and a really big question to answer. So what do you do when you’re done with what you considered your life’s work?

Dr. Andy Roark: Yeah.

Tyler Grogan: So that’s where it came from.

Dr. Andy Roark: It’s I love that. I think that’s really interesting. And I, it’s funny, I get a lot of private phone calls about this. It’s not, you know, not, people don’t raise their hand at lectures or anything and ask me about it, but I get a lot of questions because I’ve done a lot of different things in my career, I think, and so people say, well, Andy’s, he has done things and then done different things, and, you know, when they’re kind of looking at ending a chapter, I get those phone calls sometimes, and it’s, it’s funny, I’ve thought, I’ve thought a lot about it, I think, I think there’s a couple pieces to this, I think that, I think you put your finger right on it at the beginning, Tyler, I think that, There’s a couple weird things about vet medicine that I don’t think other industries have and I think the identity aspect I don’t think happens so much in other other areas like I don’t know that people see themselves as a barista. 

Tyler Grogan: Like, I’m an insurance provider.

Dr. Andy Roark: exactly right. I mean, it totally, and like, I am actually blown away sometimes when I talk to people who are not remotely defined by their career. And I, I have tried hard to not let veterinarian define me as a person. But it’s a constant battle because it’s, it’s, I always say, it doesn’t define me.

And then I’ll meet new people. I’m like, Hi, I’m Andy. I’m a veterinarian. Because I know that they’re going to like that. It’s going to make them happy. And they’re going to want to know me. And like, I say it and it’s just. It reemphasizes this idea of like, this is who I am as a, as a person. And, and I don’t know the other, the other people have those, have those thoughts.

I think, I think also there’s the calling. And so, you know, I don’t know, I think there’s some, some vet techs that feel this way for sure, but I think it’s, it’s definitely heavy on the doctors. People say vet medicine is a calling. And if you buy into that, it really does feel like leaving is a failure of some great, like, spiritual call that you’ve had.

You know, you’re like, I was called to vet medicine. And I got tired of it and decided I was gonna go into, you know, into pharmaceutical sales. And it just feels awful. I’ve always kind of pushed back against that idea that, that medicine is a calling. And some people really don’t like when I say that because I speak so lovingly of that medicine.

But I could, two things can be true at the same time. You can really like that medicine and also say, I don’t, I don’t feel like it’s a calling. I feel like it’s a job and it’s something I’m happy to do while I’m doing it. But I think a lot of people really struggle with that.

Tyler Grogan: I completely agree with that. And you know, I was definitely one of those people, you know, walking out of practice. I felt like I suddenly wasn’t fulfilling some greater purpose. Like it almost felt like I was abandoning something that was bigger than me. And, I remember sitting with that for awhile and thinking about, okay, who was I before I worked in a veterinary practice?

And like, what are the things about me that define me beyond that, that title? And I’ve also had conversations with people that work in different, in veterinary medicine, but in different countries and their perspective on work in their life is such, it can be so different and their definition, they do really care and are very dedicated to this profession, but they’re also talking more about the things they do outside of that, like their role in their community. The things that they’re active within their community doing, maybe gardening and the local community garden, or, you know, the things that they do with their families or talking about their families.

And I think that there’s just kind of a different perspective and When I thought about this person that I, I know relatively well, thanks to Uncharted being such a tight knit community, I know her for who she is more than I, like, I’ve never worked with her in practice. So I know her as a person and the way that she, she has impacted me in my life,

as a person outside of veterinary practice. And so I think it’s really easy to forget that you have a purpose as a person outside of the context of the walls of a veterinary practice, like how you impact people is so much beyond, like it grows so far beyond that. And then the article that I wrote, I talk about, you know, Was your goal, what was your goal in starting this in this business or starting your practice?

Was it to create a space that you could have medicine be practiced in a way that you felt was good for the animals? Did you want to create an environment for people that also love to practice medicine and that they would want to stay and they would have a lifelong fulfilling career there because as you walk away from that that is still probably true.

You probably created exactly what you were aiming to create. And just because your hands on involvement may change, it doesn’t necessarily mean that it’s not part of who you are anymore. And so there was just so much to, to dig into there. And, and like I said, as a person she’s had a great impact on me in my life.

And so it was just really interesting to think about that. She didn’t see the impact she could have in the same way outside of her practice.

Dr. Andy Roark: Yeah, I think, I think you really put your finger right on it. I, I’m guilty of looking at things like a practice and saying, yes, this is the mark I will make on the world. You know, like, this will be my legacy. And, and you, you look at that and it, it feels like a tangible thing that you need to have.

Like, I need a gold watch from doing 30 years in this, you know, organization or whatever. And, as the world has changed the idea that any of us are going to stay in a job for 30 years is, you know, it’s not as common as it used to be. Now, if you, if you own the place, that can be a little bit different, but for most of us, you know, we’re getting more accustomed to the idea of having multiple jobs and not having one thing.

And so I, I think that that’s, that’s important for the changing state of the world. I think you’re spot on in this idea. A lot of us look at a thing and you say, I’m going to be a house call veterinarian and I’m going to serve this community and that will be my legacy. I am in it and I’m going to do it for the rest of my career.

And then you do it for 15 years and you say, well, I, I’m, I’m, I’m ready for something else. And. If you have tied your legacy to this house call business, walking away from it feels like quitting. It feels like abandoning the legacy that was so important to you. And so I, but I think that that’s a mental trap.

And I think you, you put your finger right on it. The idea that your practice or your time in practice is your legacy. It’s a mental fallacy. I think what’s exactly right, Tyler, is what you said of it is. Why did you start this practice? What did you hope to accomplish? What was your goal in starting it?

Because you can set down that practice and walk away and continue to pursue that goal. And thereby your legacy becomes, I want to have this supportive impact on my community. And I’m not going to do it with my house call practice. I’m going to do it in other ways. I’m going to go and partner up with another group of doctors and do something different, but I am still pursuing the goal and making that legacy true.

And now I’ll say I have served my community for 15 years as a house call veterinarian, and then for 10 more years as a co owner of the emergency hospital, and then blah, blah, blah. And you put together this really great resume, and I don’t know what great resume means in this context, but you put together this resume of continuing to pursue your goal, continuing to make a difference, even though the housecall vet chapter of your life has closed.

But I think, I think, if you don’t break the, what was the point with all of this? Was it really to have a big building and a sign that people recognize? Or was it to do something great? If, if you break that point out, I think that that’s really the key, and I think you can carry that key oftentimes into retirement.

I think a lot of people who are just like, you know, it’s not even about shutting down what I’m doing and doing something else. I think for a lot of people going into retirement, they really do kind of have to figure out what their why is and what pursuit of that why in a different way looks like. And it may just be being the most engaged grandparent that you can be.

That’s, that’s part of your legacy. It’s really, it’s probably, it’s probably one of the most important parts of your legacy.

Tyler Grogan: It’s so true. And I love what you said about, you know, this is a different way to serve your community because. We evolve, and I think this is something I’m, I’m learning more about myself, but we evolve as we age and get older, and our priorities shift, and the things that we care about shift, and then the beauty of veterinary medicine is that the people that come into practices are people that really care about what we do and there are people that by opening the door for them to have a different role in that space may give them the catalyst to do the next amazing thing that they’re going to do.

So, you know, stepping out of that role and allowing someone else to fulfill it or fulfill a different role within that community or that group of people, you know, it, it opens doors for everyone. And it also, you can shift and evolve and do different things. And you’re still growing and you’re still learning and you can still use it to, again, like you said, serve the same people, you know, still help the, if that was your goal from the beginning was to be someone that your community could rely on for the, this information and this care for their pets, it could be different.

It can just be different. Be something new and I think that that’s that’s so fun. I mean, I don’t get me wrong. You work with me you know well enough that I’m not always the most eager about change or uncertainty definitely uncertainty. So I might come off like I’m like change is great. Everything is super easy.

Like this is no problem. It’s definitely not and it’s not for me but it is, you know taking a step back and allowing yourself to have that perspective for a minute and just think okay, this could be really cool. This could be really fun. And the work that we do that we’re excited about is the work that makes the biggest impact.

You know, those are the things that really leave the mark or the things that you did when you were so in it and so in your flow and you were excited about it at the time. So it would almost be a disservice not to pursue what you’re excited about. Rather to stay in something that’s comfortable. So I have to remind myself of these things, like I said, on a regular and daily basis.

I think that it’s a good opportunity to step back and have a different perspective for a minute to let yourself not feel those feelings of, am I walking away from what my life was supposed to be? Because your life is so much more than just one thing.

Dr. Andy Roark: I think there’s also this, this idea. So part of it is, there’s this fear about the unknown. You know, you get quite comfortable in where we are. And that, and there, there’s fear about, about the unknown. Changing and moving in something else.

I think another way to kind of look at it is a lot of us have told ourselves that there is a finish line in our career. So when we say this is my life’s work and I’m going to walk away from this work, probably at some point we decided that this job, this, you know, a position, you know, whatever that was, that was the finish line.

I was like, I will get here and I will do this and my life will be a success. And then what always happens is you get there and you realize that it doesn’t make you a success in your own eyes. You know what I mean? Like you don’t feel any different about yourself now that you’ve been doing this for 20 years than you did when you did it for five years.

And you don’t feel any different about yourself now that you have this, I don’t know, this academic position at the vet school than you did when you were grinding it out in private practice. Like those that we tell ourselves this is going to transform me or this is going to make my life meaningful or this is going to, at least for me, it’s always been like I’m going to do this thing.

I’m going to accomplish this thing. I’m going to build this thing. And then I will have certifiable proof that I have been successful or I’ve made the impact that I wanted to make. And that, that, that transformation has never happened for me, and so I think that, that happens to a lot of us. I, you know, I heard a, a phrase, and I, I say this all the time, and you’ve probably heard me say it a million times, but, you know, Life is what you experience.

It’s not what you accomplish, it’s what you experience. And so, every day that we’re out there, In practice, your life is what you’re focusing on. It is on the actual doing of the work. And so I think it’s easy to say, Oh, no, I’m leaving my life’s work behind. And I say, well, but that’s that’s a thing that you did.

It’s not, one, it’s not who you are, and also, two, it’s not what your life was like as an experience. It was not, it was not the the process of being, if you will. And so I, I think that, that that’s sort of a construct that people kind of get, get sort of tied up in. And so I, I, that was just sort of the, the a big part of it for me is if you can get your head around the idea that your life is not anything that you leave behind, but is instead is the The sum of the experiences that you have along the way and when I say experiences I don’t mean like going on vacation stuff like that.

I mean, the experience I have if you and I are hanging out together and we’re riding a bus And i’m looking at my phone the whole time and scrolling on instagram. That’s my experience right like my life is a bus ride looking instagram And if I don’t have my phone in my hands and i’m talking to you about you know, what, what the end of a career looks like or what career change looks like and we’re having this, this back and forth discussion that’s, that’s, that’s really interesting and engaging and you and I are building our relationship and we’re thinking about things in different ways.

That’s my experience. That’s my life. And those are two wildly different experiences on the same bus ride. But that’s what your life becomes at the end of the day. Did you scroll Instagram all day? Because that’s the life you’re leading or did you engage with other people and talk to them about what’s important to them and feel like you grew the social fabric around you and you made these stronger relationships that, that they’re going to continue to, to be able to take joy in.

I just really think that, that life is the experience. I think that that can help you feel that your life is rolling on, even though you’ve left this big part of you behind. I think the last thing for me. I don’t know if it’s a good story or not, but it’s definitely something that happened in my life and it really affected me.

It’s just so silly when it’s just a simple conversation and the other person doesn’t even remember. But when I was in vet school, and all the way up until vet school, I really enjoyed watching movies. I was a movie fan. I just, I really, I just liked movies. I liked getting lost in the story and just watching movies.

Tyler Grogan: I’ve heard you nerd out about Star Wars a couple of times, so I had an idea.

Dr. Andy Roark: I just watched a bunch of movies. I watched a little art house stuff. I watched all kinds of stuff. I just, I really like movies a lot. And then Alison my wife, was pregnant. And and so we were heading for our first child, and I was at the end of vet school. And my mother in law, was talking to me about something and I said something like, Oh, you know, I don’t know these movies are coming out or there was a movie, you know, the release date was like the next year or something.

And I said something to her. And she said, well, you’re not going to have any time to watch movies after this. And she kind of laughed at me. And I, I remember being, angry, like really angry, like, how dare you, you know what I mean? I think I was probably afraid, like, because you don’t know what’s gonna happen when you have a baby.

And I was like, is this, is this gonna be the end of my movie watching? Like, it really scared me in that, like, I, I imagined something I love being just taken away from me. And I was like, oh crap. And then we had the baby. And the truth, Tyler, after that is, I just, I didn’t watch movies. But also, it was, I didn’t really want to watch movies. The truth is, I just wanted to go to bed. I was exhausted all the time.

Tyler Grogan: I can imagine.

Dr. Andy Roark: You know what I mean? And like, so it just, I, it just didn’t occur to me. And then we had, we just had other stuff going on. And it wasn’t like I was pining to watch movies and not getting to. It was, I just, that phase of my life of my, my girlfriend slash Fiancee slash new bride and I hanging out watching movies and going on dates like that that that we did that and it was great. But then that sort of phase of our life came to an end and then we had kids and things and it was hard to get out to the movie theater and it just so But I didn’t pine for it, it just kind of, that, that chapter ended.

And that was the first time I, I sort of started to realize and recognize, like, sometimes you have chapters in your life, and those chapters just kind of close. I saw, I saw this post in social media one time, it was this person, and I’m not, I’m still not exactly sure if they were in good faith or bad faith, but basically they were someone in their 20s, and they were asking the question of, hey, people who are 30 and older, what do you live for?

Like, you’re past your prime in every meaningful way. I know! They were like, you’re past your prime in every meaningful way. And again, how ridiculous was this? It was a person in their, probably late teens, early 20s, saying people over the age of 30, not 90, 30. And, again, I wasn’t sure if this person was in good faith or bad faith, but I was just kind of like, I can’t, the idea this person would say to someone in their 30s or 40s or 50s or whatever Why do you keep living?

You, all, the best stuff is behind you. I, I, and here I am with my young family, like, living the most rewarding phase of my life. So far, at that time. You know what I mean? And and the fact that this person who’s 21 who’s like, Psh, now that I can go to the bars, I guess there’s nothing left. And I’m like, you have no idea how you’re going to feel in five years.

You have no idea what you’re going to want in 10 years. You just, you don’t know. And the things that I enjoy doing, I get up early and go to the gym now, and I get teased about it. But, I did not want to get up early and go to the gym in my 20s. But now, I love it. It’s great. And if you told me that when I was 30, I would have said, You’re crazy.

Leave me alone so I can sleep because my child is distracted. It’s amazing. All that to say, it’s through these sort of a couple of experiences that I really came to believe. There are chapters in our life, and you might really, really want things for a certain amount of time in your life. And then that chapter comes to an end by external circumstances.

You just get older, and you tend to feel differently about things when you’re in different phases of your life. Yeah. And the idea that you would feel guilty because what you want in this new chapter of your life is not what you wanted in your previous chapter of your life. I think that’s, I think that’s sad.

And that, that whole chapter of your life thing, it has made me so much more open to change. And so much more I don’t know, just, just flexible when I look ahead and I say, Oh my gosh, the city of Greenville where we live. It’s beautiful. It’s booming, Tyler. Like, there’s people moving here all day, every day.

It’s, it’s gone from a town to being a tiny city, and like, it does not look like it’s slowing down. And I can go, boy, am I gonna wanna be here in ten years? And the truth is, I have no idea. In ten years, my kids will have moved out hopefully. And, you know, they might be, they might be starting families, and like, maybe I wanna be where they are.

Who, who knows? Maybe it won’t be a sad thing. I, I don’t know how I’m gonna feel. When we get to that point, but I talk about this because that, that, that phases of life, those chapters of life, I think that’s so vital to growing and being happy in different phases. And so when someone says to me, how do I put my life’s work behind me?

One, I go back to your point, which is, I think you should tease out the original goal and I think you could probably continue that goal and you will continue your life’s work even as you leave the thing behind. And then number two, I would say. You have chapters and phases in your life. And if a, there’s nothing sadder than someone who has gone on to the next chapter, but is too afraid to turn the page.

And it’s just, it just, it chains them down. And they’re not happy and they don’t enjoy these things they’ve made for themselves. And they feel like because they don’t enjoy them now, they must have been untruthful in the past. And that’s just not true. It’s just We change, and we grow, and we evolve, and these phases, I just think that they’re very, very real.

And so, anyway, for anyone who’s feeling sort of guilty out there about moving into a new phase, I don’t, I don’t, that, the phases of life has helped me a lot, just to say, Yep, I’ve done this, I was in practice full time for this amount of time, and then I did relief work, and I did that, and then I was the parent of two kids.

You know, babies and toddlers. And I, I did that. I’m not, I’m not there anymore. And when I see parents who were in that phase, I look back with nostalgia, but I ain’t confused. My, my teenagers are very, very different, and I do not have toddler problems anymore. I did that, and I empathize. And I, and again, I’m not interested in going back, but it was very rewarding when I was there.

Tyler Grogan: I think that that’s a really good point in comparing it. I mean, I have not been a parent, but I have seen, kind of, people go through the different phases of their child’s lives and how their lives evolve and change, and it’s so true that it’s a good comparison to make. And I’ll just, you know, say that, in terms of a career example, you know, if you had told me that you’d introduced me on a podcast one day, like first, let’s start there.

But second that I’d be, have just got back talking to people about queue theory and queue management. I would have laughed in your face because I would have said, how in the world does that even happen? Like, tell me how that world unfolds because I don’t understand. 

Dr. Andy Roark: You just came back from lecturing in Canada, like you were

in another country. International speaker coming back for a podcast.

Tyler Grogan: I’m working on them, inviting me to be, you know, a dual citizen. So, you know, because the mountains are amazing, but yes, so very fortunate to have had those opportunities, but you know, it’s because of random other parts of my life that those things that even came to be, that was just because of someone I knew that was outside of veterinary medicine, that it came to be, that that would be how I would start to speak.

So, you know, things happen that. You don’t expect they change the chapters of your life open and close. And I think you just have to, you know, walk into those moments and say, this is a good thing. Like, even if it feels scary right now I met, I’ve met so many veterinary professionals and especially technicians, but they’re like, I can’t, I don’t know anything else.

I don’t know how to do anything else. Everything you do in practice is transferable to life or to other careers. And you can do anything that you believe in yourself that you can, that you want to do. And so much of what we do is goes beyond the walls of the veterinary practice. So when you’re faced with that moment where you’re not sure you’re ready to walk away from being in practice or, or whatever it is, whatever part of your career, you’re ready to walk into practice.

If you’re not sure if it feels like the thing that excites you the most then go for it. You can totally you can do it. So I’m, very grateful for our community for being so vulnerable and honest with each other because it really allows us to have these conversations and you know to close i’ll say that this person received so much support and options and you know offers for people to call to talk it out people that have been in similar situations or maybe are also in a similar place. And it was followed by a post somewhat by someone else that’s working on post retirement writing stories about their life in practice.

And it’s been a great memory kind of jogging exercise for them. So I’m really grateful for our community for providing these conversations for us. Cause I mean, it’s, it’s inspiring to watch for sure.

Dr. Andy Roark: No, I agree. Tyler, thanks so much for being here. Where can people, where can they find you? And then where can they learn more about the Uncharted Veterinary Conference and Community?

Tyler Grogan: You could find me on LinkedIn or, you know, in the Uncharted Community. I’m usually most active there. Uncharted. If you’re not familiar, we we are at unchartedvet.com we put on virtual events and we also do lots of other things, and we have a podcast as well. So if you’re interested in that and uncharted @unchartedvet is where we’re at on social, so check us out.

Dr. Andy Roark: Sounds good. Thanks for being here, Tyler. Guys, thanks for listening, everybody. Take care of yourselves. I’ll talk to you later on.

And that’s what I got. Guys, thanks for being here. Thanks to Tyler Grogan for joining us. I hope you got something out of this episode. This is one of those episodes that I really, I’ve very much enjoyed thinking about when I recorded it. I have enjoyed thinking about it since then. I hope, guys find, find some value in it, or at least to stimulate some thought and discussion. So anyway, Take care of yourselves, everybody. I’ll talk to you later on. 

The DermVet, Dr. Ashley Bourgeois returns to help us navigate canine allergies. In this episode of The Cone of Shame Veterinary Podcast, Dr. Andy Roark welcomes board-certified veterinary dermatologist Dr. Ashley Bourgeois to discuss managing difficult canine allergy cases that don’t respond well to Apoquel or Cytopoint. Dr. Bourgeois offers practical advice on identifying hidden infections in claw folds, using consistent treatment regimens, and when to consider alternatives like skin biopsies or recognizing allergy mimickers such as autoimmune diseases or lymphoma. Tune in for insights on allergy testing, immunotherapy, and effective long-term strategies for managing atopic dermatitis. Gang, let’s get into this episode!

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

LINKS

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

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

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

Exam Room Communication Toolkit: https://drandyroark.com/exam-room-communication-toolkit/

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

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

ABOUT OUR GUEST

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

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a good one here. I am with my friend Dr. Ashley Bourgeois she is a veterinary dermatologist, and we are talking about allergies when Apoquel doesn’t work. That’s right, if you’ve been in practice for a while, you’ve seen those cases roll in, and you’re like, Oh, we tried Apoquel, we tried Cytopoint, and we’re still, we’ve still got an itchy dog and I talked with Ashley here. She’s got all kinds of pearls and insights and we walked through what do you do with these cases? is a fantastic episode. I hope you’re gonna get a ton out of it I got a ton out of listening to Ashley break it down, And so anyway, let’s get into it.

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

Dr. Andy Roark: Welcome to the podcast, Dr. Ashley Bourgeois how are you?

Dr. Ashley Bourgeois: I am doing so good. We are actually going to talk about one of my favorite topics today. So I’m just so excited to go through this journey with you today. 

Dr. Andy Roark: I love when I have brilliant people on the podcast, and I take them problems, and they’re like, this is one of my favorite things to talk about. 

Dr. Ashley Bourgeois: But I’m a dermatologist I like, I could say that about any topic, but this is such a common issue. I can’t wait to shed some light onto it.

Dr. Andy Roark: Oh, yeah, what we want to talk about today, and sort of what I went to you with, is, Ashley, what are your, what are your tips and tricks for treating the canine allergy patient who’s getting Apoquel or Cytopoint and it’s still not cutting it? And so I’m thinking of the case, let’s say we’ve sent home flea and tick preventative and we have, you know, tried to, treat these allergies in the classic way, and they’re getting Apoquel or Cytopoint, things like that.

And we’re still having issues. I think a lot of times people kind of look at their hands and go, Oh boy, you know, what do we need to do here? What do we need to do here? I’ll tell you. I always have a panic moment at, at that, at that, at that point. Not that I don’t have other tools, but it’s almost like, oh, my go-to move isn’t working.

And and I, I need to, I need to walk this back or, or try to approach this differently. So let me just pause there and kind of turn it over to you and say, how often do you see. Allergy cases that make their way to you that are getting sort of what you consider to be quality Sort of top line therapy and you’re still seeing breakthroughs.

Dr. Ashley Bourgeois: Yeah. I think it’s a bit of a double edged sword because let’s say it’s typical for me to get that history where the client comes in and says that, right. But I’d say the two things I see, if that is not true, let’s say like the client comes in with that impression, maybe the veterinarian has that impression.

But I kind of get to the point where I’m not really sure that’s true. I’d say there’s two, two fold one for sure. Flare factors. So like things aren’t infection aren’t controlled. So we see oftentimes where if they do break out with Malassezia or a pyoderma, you know, interdigital spaces, claw folds, claw folds are huge.

When I lecture about cytology, it’s one of the best things you could be doing. Is getting a toothpick, scraping material out of that claw fold. If you have a dog that’s looking and chewing their paws incessantly, but when you look at the paws, they don’t look that bad. Check those claw folds. Malassezia, infection, bacteria really like to hide in there, and they can look pretty darn normal, and then all of a sudden you’ll find a bunch of stuff hiding there.

Dr. Andy Roark: You’re not seeing you’re not seeing kind of pus crusty stuff around the the edges there? You’re not seeing hair loss anything like that?

Dr. Ashley Bourgeois: You can be, you don’t have to. I mean, especially if they have long coats. Like a lot of times I have pictures where they look totally normal. You flip back the claw fold and there is stuff in there or you flip back the claw fold. You don’t see too much, but then when you get a sample, there’s actually quite a bit of infection that’s hiding in that tissue.

So they don’t have to necessarily be lesional, but I always check those areas. I’d say the second kind of, it didn’t work, but actually I think it maybe could, is not consistent. So, Apoquel is a great tool, and I think as a general practitioner, you probably get away a little bit more with, Oh, let’s just do two weeks and you can stop.

But when you keep doing the two weeks and stop, two weeks and stop, two weeks and stop, and the dog keeps breaking out, then they come to us and I’ll say, well, have you just given it consistently? And they’ll say, no, I’m like, well, you might be a dog that just needs it consistently. So I think those are probably the more common things I see.

Now there can be true statements to that. I’ve certainly had cases that don’t respond. You know, I am managing the infections. I have them on the flea control. We’ve done the diet trials. Like they truly are atopic. I don’t have a flare factor present and they’re just not responding. No medication is a hundred percent.

So certainly there are some difficult cases. And that’s when I start thinking of either alternatives or I’d say the flip side is, is it actually allergies? Because sometimes we have allergy mimickers that can present as well. 

Dr. Andy Roark: Okay. Tell me tell me more about that. What what are your what are your top allergy mimickers?

Dr. Ashley Bourgeois: So I would say some of the main mimickers we think of are either like autoimmune or neoplastic. I think when we talk about, say, like, pymphagus, right? Because that’s the one people always think of. They think, oh, it has to be the dog coming in where the nose is completely crusted and depigmented and their paw pads are completely crusted.

But if you think about it, pyoderma, what does that look like? It can be colorette, scaly, but it can also be crusty. So when you get some of these pymphagus cases that their mucous membranes aren’t affected, you know, they are just kind of crusty throughout the trunk. And we don’t do cytology. We don’t identify like, oh, there’s not an infection causing that.

They actually can look a lot like allergies. And then I would say one of the other big ones, and it’s going to sound crazy, but it’s so true. And we see this a lot is skin lymphoma. Skin lymphoma can do anything from being detrimental. You know, completely eating away the skin ulcerative. They look awful to a focal area of erythema and scaling.

I mean, it really can be pretty mild in some of these early cases. And a lot of times our till for that is it has started when they’re older and they haven’t really had a history of dermatologic issues in the past.

Dr. Andy Roark: Okay, so old dog with a lesion and that’s, that’s not, not normal for this dog. You would have like cutaneous lymphoma on your, on your list. Are you going to see anything on that with, with cytology, like just regular skin cytology? Are you going to pick anything up or no?

Dr. Ashley Bourgeois: You can. So a lot of times you will pick up these neoplastic cells. And what I try to tell general veterinarians, because some of them will be like, well, I don’t feel comfortable saying that. Yeah. 

Dr. Andy Roark: Oh, I definitely don’t want to say that.

Like, 

I’m like, ooh, we need to send this out and get, get a second, get a second opinion on this.

Dr. Ashley Bourgeois: and you totally could. And what I would tell you as a dermatologist is, I don’t really care if you would say, Oh, I’m Andy Roark. And I feel like this looks like cutaneous lymphoma. Like what I care about is that you can say that’s weird, right? Because if you can even say that’s weird, like that happens to me all the time, you know, I’m a dermatologist, but I’ll look at something.

I’m like, well, that’s weird. Okay. But at least I know my next step should be, well, you know, I can’t, I shouldn’t probably refer, I mean, I could refer to someone else, but it should be me, but you would refer or you’d biopsy. Right? So like you could at least say, okay, well maybe we don’t just throw apoquel at this case.

So to me, there’s a ton of value in that, even if you’re not confident to say. This is an autoimmune disease. You can say, well, there’s not bacteria here. That’s pretty weird. So now what do I think about in this case?

Dr. Andy Roark: Have you got any pearls for me on skin biopsies? I mean, they’re pretty, they’re pretty straightforward. I do love, I love a, I love a punch biopsy. It makes me feel so cultured. I don’t know. It works well. It tends to go well. I know what I’m doing. But I, if, if another doctor turned to me and said, Andy, I hey, you got any concerns about me biopsying this weird spot?

Is there anything that should be on my radar, or should I say, no, go for it?

Dr. Ashley Bourgeois: Yeah, I’d say multiple things. I would collect cytology first because if it’s severely infected, you’re probably better off trying to treat that infection first, because if there’s just a rip roaring bacterial folliculitis, you’re going to get a biopsy that says there’s a bacterial folliculitis. And that’s not going to be that helpful.

You know, other basic stuff is if there’s diffuse lesions, you know, you should be getting multiple sites. You should not just be taking one site if there is diffuse. And it’s not just like a mass you’re taking off. You do not want to sterilely prep them. So I think surgeons probably lose their mind when they walk by a dermatologist biopsying them.

Right. Cause we want the crests. Like sometimes that’s how you get your diagnosis. So we are almost never sterilely prepping unless we’re removing a nodule or mass, but. Or we’re doing a tissue culture, but for just a run of the mill histopathology, we’re actually getting the crust. We’re getting the nasty stuff with it.

And then just making sure that you’re getting bigger punches. So we shouldn’t really be taking two millimeter punches. Like we should be doing more like eight millimeter punches if we’re doing diffuse disease.

Dr. Andy Roark: Not sterilely prepping the area feels like sacrilege. But I mean, I know, I know I’m supposed to do it, but I feel people looking at me like, are you just gonna, you’re just gonna. Do it like that and yeah,

Dr. Ashley Bourgeois: Just come spend a day in derm. Like, I mean, we are just like, you know, crust and nasty and like I said, the surgeons probably lose their mind because we’re just like not sterilely prepping. And I will tell you, I biopsy all the time. I’ve just done derm now for like 13 years. None have ever been like, Oh my God, you cause this patient to be septic

cause he took a skin biopsy. Right. Cause I’ve done cytology. If there’s infection, I’m probably going to treat them anyway. But you’ll, you’ll be 

okay. 

Dr. Andy Roark: That totally makes sense. 

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let’s get back into this episode. 

Dr. Andy Roark: We’ve laid down a lot a lot of different possibilities here, but we’ve got something. We feel like it’s it should be resolving and it’s not we’re digging in the nail beds Which I think is a beautiful little pearl i’m going to put in my pocket and keep for sure we’ll move towards skin biopsy thing things like that. Are there are there anything that that pet owners should be aware of is there anything that I should

you say to them about where this treatment path might go so that they’re prepped?

Dr. Ashley Bourgeois: Yeah. I mean, usually when I’m giving, so let’s assume it is an allergic case, right? Like it’s not a mimicker. It’s truly an allergic case. That’s like not responding. I certainly talked to owners about, I kind of break it into two options. If I’m managing atopic dermatitis, one is symptom treatment.

And I break that into infection control because we know. We have to control the infection or the itch won’t fully resolve. And then my second kind of symptom control category is the allergic itch itself. And when I do that for dogs, I write Apoquel, cytopoint, cyclosporine and steroids. The reason being, apoquel and cytopoint have been amazing tools for us, you know, you can certainly use them together, you can do all sorts of things, but again, no medication is 100%, so we certainly have cases that do not respond.

They’re allergic, they’re not a mimicker, we’re managing infection, they don’t respond. And you cannot forget about those other possibilities. And I would say I still have cases that respond better to cyclosporine. It’s a more broad spectrum anti inflammatory. It’s certainly something, especially with our crazy pododermis titus cases, things like that, where they can still respond the best.

So just because they don’t respond to apoquel or cytopoint, you know, they’re allergic doesn’t mean you have no option. And then sometimes we do end up with steroids. Like we try not to. You know, but again, if the reality is they didn’t respond to anything else, then we got to still provide comfort. And then I’m also pushing my second category of managing allergies is pushing allergy testing and immunotherapy, especially if they’re a younger, middle aged dog, right?

If they’re not responding to apoquel cytopoint, like what is the next 10 years look like for that dog? We’re going to have a better chance to desensitize them earlier in the disease process if we can.

Dr. Andy Roark: so I got a couple questions here. So when we’re talking about apoquel cytopoint, cyclosporine, steroids What are your feelings about overlapping these? Are you trying to kind of? say we’re not getting the results that we want. Are we adding in something else with the idea that we may keep all the things?

Or are you going to add in something else and maybe wean off of one of our earlier treatments? Are you, so yeah, talk, talk to me about that is, I don’t want to end up, you know, throwing everything in the kitchen sink at this problem, especially if we’re not getting results. But I always wonder, you know, if I take this dog off of Apoquel to try something else, am I gonna, am I gonna make things worse?

How do you sort of assess what to do with that crossroads?

Dr. Ashley Bourgeois: Yeah, it is a very good question. I’m very individual in the case, but I agree with you. So if I started a dog on let’s say we, for that particular case, we started with Apoquel. They recheck with me and let’s say like, they’re like kind of better, but it’s not a hundred percent better, and I want to try Cytopoint.

I usually have them still give a few days of Apoquel initially. After I give the Cytopoint, a lot of the studies show within three days is when you usually get that response, like a bit over half within a day, see a response. The nice thing about Apoquel is you can start, stop it, right? So I usually say, give it a few days.

If you’re starting to notice the pet’s doing really well, try to stop it and let’s see what happens. So I give them the freedom to do that. If we’re starting something like Cyclosporin, if they were on Apoquel, you can very safely bridge the gap. Like, you can keep them on Apoquel because cyclosporine doesn’t act really quickly, right?

It can take a few weeks, a month to work. So you can still safely keep them on Apoquel in that time if you need to. A lot of times I am using like low dose steroid as I’m bridging them to the cyclosporine as a way to provide some comfort. But that’s why the rechecks are important, right? Cause I want to check in and if the dog’s doing awesome, I’m with you.

I want to try to take things away. Like I already have a lot of my patients on a lot of things. I always want to try to take things away, but I also want to see them, evaluate them to make sure they’ve responded the way that I want.

Dr. Andy Roark: How often do you recheck these types of cases, Ashley? Are you getting them every week or is it a sort of a longer, do you have a tapering where you’re like, I’ll see you in a week and then two weeks and then it’s to go from there? Like, how, how is that?

Dr. Ashley Bourgeois: Yeah, I mean, we actually don’t usually see them back within a week, unless it’s like a rip roaring crazy ear or, you know, like, I think you’ve got some terrible autoimmune disease and I’m just treating the infection to know when to biopsy you, but for an allergy case, at least for me, I would say pretty typical is like, I try something, have them come back three weeks, maybe four weeks.

A lot of that’s very dependent on infection. But if it’s just your response to a medication, yeah. Then usually if I’m going to start on Apoquel, you know, I may do the twice daily for 14 days and then drop down. But I always tell people to let me know if things are not improving and we could try to get them in sooner.

But I give them a bit of time and just don’t want to frustrate the owner if I’m trying to jump the gun a bit quickly and see them that soon. So I would say usually like three weeks is fairly typical, maybe four if we’re not dealing with a bunch of infection.

Dr. Andy Roark: I know that you’re a big fan of allergy testing and immunotherapy in cats. How big are you on this, in our canine patients? So, just, just in us talking, you know, we’ve got a pretty good list of medications that we go through, and then you kind of felt like you added on allergy testing immunotherapy as a sort of like, man, if there’s nothing, if that doesn’t work.

Then, then let’s talk about this. Is that, is that really how you kind of feel or should we be thinking about immunotherapy earlier in our canine patients?

Dr. Ashley Bourgeois: Ooh, I’m really glad you’re asking us to differentiate this cause I’m going to not want to give that impression. I am an advocate to allergy tests whenever the owner is willing. So I love a dog that comes in. It doesn’t happen often, but I love a dog that comes in. They’re doing well on their symptomatic treatment, whether it’s cytopoint cyclosporine, whichever one is working for them.

And they are coming because they, they know it’s a young dog. They want to try to minimize drugs long time, and they want to allergy test them. That is actually most of our dreams as a dermatologist. It doesn’t happen very often. Usually it’s, Oh, this worked. And until it did it, and now you should go see them.

But we absolutely, if owners are willing, we are a hundred percent. So happy to allergy test them at a, at a young age, or even when they’re symptomatically doing well, just to see if we can get ahead of it. Remember, this is a progressive disease. So just because they’re doing great on apoquel when they’re three years old, doesn’t mean when they’re eight years old, they’ll necessarily be controlled.

We know that there’s a progression to it, and that’s what I try to explain to owners, too, is if they’re proactive, it gives us the best chance to try to keep that in control.

Dr. Andy Roark: How do you talk about immunotherapy compared to, you know, medical management in a way that sets good expectations? Like, I guess my idea is if I said to the owner as well, I can do this cytopoint injection or we can do allergy testing and then maybe immunotherapy, which is its own set of injections.

What do you want to do? How do you, how do you sort of explain that in the way the owner says, okay, I understand the investment immunotherapy and I would, I’m going to invest my time and energy there now instead of just taking the, the short term medical fix.

Dr. Ashley Bourgeois: Yeah, to me, it’s not necessarily an or, right? It’s almost an and, because the reality is if I allergy test them, Most of the time they’re on some sort of symptom control while we are giving that time to work. So I really try to have them think more of longevity marathon, you know, rather than like the sprint, the comfort now both are really important, but if we are trying to get ahead of the longterm aspect of this disease, none of us have a crystal ball, you know, if you knew that dog would just get cytopoint and be great the rest of its life with no progression of disease, Cool.

But we don’t know that. So ultimately I really tried to break down kind of that longterm aspect. And let me tell you this, not all of my clients allergy test. I have plenty that don’t, I mean, we love it, but we have to meet that owner where they’re at. And I know I can still help them even if that’s not the route they’re going to go.

But to me, what I tell them is these things can make them comfortable. It can still be tools in our toolbox. What I can do is try to identify what they’re allergic to, put it in a bottle, give it to them in small amounts, and basically see if I can teach their immune system to not react the way it’s reacting.

But that takes time and every response is different.

Dr. Andy Roark: No, that, that totally makes sense. Are there any final pearls, any last words of wisdom for people who are looking at some of these more challenging allergy cases?

Dr. Ashley Bourgeois: I would say for sure, like, control the controllable is one thing I like to say. So I know we have talked about this when we’ve discussed cats, but controlling the controllable means don’t forget the other things, right? The flea control, you know, being able to bathe these pets if they’re able to. There’s a reason you always hear dermatologists talk about multimodal therapy.

This is actually a very complex disease. We think of it being simple, right? Allergies, they’re itchy. You know, you know, we, you and I were talking about how we’re getting to be the older ones now. But when we first started practicing, we didn’t have apoquel or cytopoint. You know, that came out at the end of my residency.

So I did my years with not those tools. And so, you know, those things are, have been amazing. And I hope we keep getting lots of tools. But the reality is like we say multimodal because it’s a complex disease. They’re itchy. They’re skin barrier defects, right? Like. There is an abnormal immune system, their microbiome, we’re starting to learn more about.

So that’s why you often see dermatologists do all the things bathing and, you know, skin support and things like that. So definitely control the things that we can control because there’s a lot that we can’t control. And then certainly like going back to your point, if you are able to, I know not everyone has a dermatologist by them, try to refer them earlier.

You know, it is just nice to start with these cases before it’s been, Oh, well, now we’re eight and we have a methicillin resistant staph pyoderma, and we have to get through that and spend all the money there. And then we’re like, Oh yeah, we also could do this. And we’ve lost all those years to maybe get ahead of it.

Dr. Andy Roark: And the owners are tired and, you know, and they’re frustrated and they’re like, I just don’t want to deal with this anymore.

Dr. Ashley Bourgeois: Yeah. I mean, we set aside that time, right? Like we are usually setting aside longer appointment times. We don’t have the emergency hit by car trying to rush in the same day. So don’t get me wrong, like we’re busy and I know a lot of us have waiting lists. But ultimately like that is what we’re experts in and we have a better success rate if we kind of start managing them earlier.

I think people think I’ve heard even some of my local vets be like, well, they’re not bad enough. I’m like, I can see things besides train wrecks all day. I’m so happy to see the one year old boxer that wants to allergy tests, like bring them on. So I would definitely say like get to know your local dermatologist if you can, and do not be afraid to refer them earlier in the disease process.

Dr. Andy Roark: Dr. Ashley Bourgeois thank you so much for being here. Where can people find you online?

Dr. Ashley Bourgeois: Yeah. Everything I do is under the Derm vet. So I have a podcast that I put weekly tips on, and then a lot of social media that I put under the Derm vet, including cases and just day to day clinical tips. I really like to keep things real life for you guys, and hopefully you guys find that information helpful.

Dr. Andy Roark: That’s fantastic. Thanks so much for being here. Guys, thanks for listening everybody. Take care of yourselves. I’ll talk to you later on.

Dr. Andy Roark: and that’s what I got for you guys. I hope you enjoyed it I hope you got something out of it. Thanks to Ashley for being here. Thanks to you guys for being here. Take care I’ll talk to you guys later on

Dr. Chris Pachel joins us to discuss the complexities of integrating behavior health into veterinary practice. In this episode of the Cone of Shame Veterinary Podcast, Dr. Andy Roark and Dr. Chris Pachel dive into the challenges veterinarians face when addressing behavioral issues within the constraints of typical appointment times. Dr. Pachel shares insights on effective communication strategies, the importance of proper training for veterinary staff in handling behavioral consultations, and the potential benefits of leveraging telehealth for behavioral management. The conversation highlights the need for practical approaches to behavioral health in veterinary settings, emphasizing efficient client education and the strategic use of support staff.

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

LINKS

Dr. Chris Pachel: www.drpachel.com

Uncharted Team Leads Summit: www.unchartedvet.com/tls2024

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Chris Pachel is a board-certified veterinary behaviorist and is the owner and lead clinician at the Animal Behavior Clinic in Portland, Oregon. Dr. Pachel lectures extensively worldwide, teaches courses at multiple veterinary schools in the United States, and has authored numerous articles and book chapters for veterinarians and pet owners. He is a sought-after expert witness for legal cases and serves on the Editorial Advisory Board for dvm360. He is also a Vice-president of Veterinary Behavior for Instinct Dog Behavior and Training, as well as co-owner of Instinct Portland, which opened in the fall of 2020.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Same Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with veterinary behaviorist Dr. Chris Pachel, and we are talking about actually getting behavior appointments done in vet practice.

Look, we all know that doing behavior in our appointments is important. Pet owners are interested in behavior, and they have tons of behavior questions and challenges. And, if you’ve done any work in behavior, you know that it takes time. It is not a magic wand.

You can’t give a behavior pill and just script it out and send it home. It is a process of working with people and giving them our time and focus and attention. And guys, a lot of us are shorthanded. A lot of us are really busy. We are trying to juggle a lot of things. So, oftentimes, People bring their pets in for one thing, and then, oh, surprise, here’s a big behavior issue right on top of it.

And I expect you to deal with both of them in this 20 minute appointment that we have. . This is going to be a good one. Let’s get into it.

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

Dr. Andy Roark: Welcome to the podcast, Dr. Christopher Pachel how are you?

Dr. Chris Pachel: I am doing fantastic, Andy. Thanks for having me on.

Dr. Andy Roark: I always enjoy having you on. I really, I’m glad you made it. For those who don’t know you, you are a Veterinary Behaviorist in Portland, Oregon. You are, you’re a busy guy. You have a lot of things going on. A couple of the things I will pull from the pile are you were at the Animal Behavior Clinic. You were also at Instinct Dog Training.

You have done a number of podcasts with me. You were lecturing. You were just, you were very, very busy. And so I appreciate you making time for me.

Dr. Chris Pachel: No, absolutely. The opportunity like this to really have a conversation with someone like yourself, to get into some of these meaty topics that we can cover in these little bite sized snippets. Ah, man, I’ll make time for that in my schedule every day.

Dr. Andy Roark: I always appreciate your perspective. I think you do a really good job. You’re, you’re a thinker. You, you are philosophic in your views and then also you take that philosophy and you translate it into very pragmatic action steps of what people can do or, or what we can say or how conversations can go smoothly.

And so I, I, I love to think about the implications of things and then, okay, what are we going to do about it? And I think you do that really well. And so that’s, that’s what I want to kind of come to you today with. I want to talk to you about behavior, animal behavior, behavior training in veterinary practices.

I love having you on the podcast. You and I have talked through a number of different cases at this point, I will tell you when I am out in the world and I’m sure other people in the vet profession will agree to this. The number one behavior, or the number one thing I get asked about, you know, when people are like, Hey, can I ask you a question?

Behavior is number, is number one. How do I get my pet to stop doing this? How do I get my pet to start, stop jumping up on the countertop, stealing food, barking at the window, yanking me down when we go for walks? It’s the, the percentage of behavior. It’s probably 50 50 behavior and everything else.

Really? And people, they want to talk about their pets. They want to get into behavior. Where the rubber meets the road in practice is, you know, we have 20 minute appointments often. And people, we are shorthanded. There’s a labor shortage. We are trying to go fast and get things done. And so there’s great demand for behavior and behavior services from the pet owners.

We also know that keeping pets out of shelter oftentimes depending, depends on, you know, having having some behavior services and helping them And at the same time, I think a lot of veterinarians and vet professionals wonder, do we have time to have these conversations and how do we do this?

It’s, it’s, it seems like it’s challenging to bill for, you know, clients want to come and have an appointment. And they want to talk to us for an hour and a half, but they don’t want to pay for an hour and a half Of veterinary in time. And so anyway, I just kind of just dumped a lot on you here. Chris, can you just speak at a high level?

Do you see this stress as someone in the veterinary behavior world? Do you see the conflict between vets trying to support people and then also? Let’s be honest some challenging logistics in getting behavior done in the way We were taught in vet school that behavior needs to be done

Dr. Chris Pachel: yeah, it’s absolutely one of the most common questions that I get when I am lecturing at veterinary conferences or I’m doing vet to vet consults with practitioners who are trying to get advice on how to handle a particular case. There’s that sort of that underlying theme of, but how do I actually put this information into common practice?

It’s going to take me forever. I can’t block my schedule. You know, I, you know, I can wait, make way more revenue for myself and my team if I’m doing dentistry procedures or surgeries or other diagnostics. And so how do I, how do I do that? And I think sometimes we, we kind of, if it’s still appropriate to say, throw the baby out with the bath water to some degree, right?

Where we’re, we’re, we’re trying to say, you know, gosh, if I can’t do a two hour behavior consult, then I just can’t do behavior. And, you know, in some ways I think about it almost the same way as saying, you know what, I was in general practice for a number of years. I didn’t do a TPLO myself. I, I didn’t do total hip replacements.

I, I didn’t do intradermal allergy testing of dogs. I, there were a lot of advanced procedures that I didn’t do, but I still had to have a basic understanding of when and if those procedures were appropriate. How to talk to a client about how to choose between their available options. And even from the standpoint of saying, if I, you know, saw that dog let’s say it’s a hind limb lameness, for example, cruciate until proven otherwise sort of an idea.

And I don’t have time to evaluate that dog today. It’s not an acute injury. I can say, cool, we’re going to schedule you to come back on Tuesday. It’s going to take about two hours for the sedation and the radiographs. We do it all the time where we delay the diagnostic or the conversation until we have a window to actually perform the service.

And I think sometimes one of the easiest things to do if we have an interest in really diving into that conversation is say, that’s a great question. It’s gonna take more time than I have available. So let’s see you back on Tuesday. Let’s do it. It’ll take us about an hour to run through the details.

I’ll have some questions. I’ll share my perspective. We can troubleshoot and figure out what’s the best option for going forward. I’ll see you at nine a. m. You know, we can do that in that little snippet that we have at the end of an appointment and still provide that service for the client.

Dr. Andy Roark: I I tell this story sometimes. I went to a physical therapist one time because my my foot was, was bothering me. But also my shoulder was bothering me because I am a master’s athlete. And so, so I, I go in and the person’s like, Great, you’re here for your foot? And I was like, Yeah, my shoulder also hurts.

And she just didn’t miss a beat. And she said, Which one do you want to work on today? And I thought, wow! You could do that? You could just ask which one of these do you want to do? And so, I picked one, but I just, I’ve always remembered that in the vet world I’ve been like, oh well we better go fast then.

And that just did not seem to cross her mind. She was like no. Which, what’s the focus for today? And we can work on the other one next week or make another appointment and I just when you say that it’s so funny I think a lot of us don’t really feel like we have permission to just punt somebody until later in the week.,

Dr. Chris Pachel: Yes, and what I love about that is for that individual who responded in that way to you, they heard your concern and they provided you with a solution and the power of choice and agency to choose your own adventure.

Dr. Andy Roark: It was, it was, it was really well done. It was just, and it was so casual too. It wasn’t like, Hey, look, I’m really sorry about this. It was just great. Which one? So I, I, I think that there’s a, I do think that there’s a lot to that. I, I think that feeling empowered to say, this is gonna take, I really like the wording that you used.

This is gonna take more time than what we have for today, let’s get back in. It’s probably going to take about an hour, but let’s really go through this. I think that you can, I think that you can communicate real value there. I think if the doctor says to you, I, I want to spend enough time with you to really get this problem worked out, and I would not be helping you if I don’t give you that, that amount of time.

I think it makes them feel seen and taken seriously, and, and I, I suspect it conveys value to them. I, I really like that a lot. You know, I, I’m always I’m a big advocate for technician and technician utilization. I, I really, I I think we can use our technicians more than we do. What I see in technicians and support staff really is a desire to learn and develop, you know, not, not everybody, but there is, there’s a hunger for, for knowledge and to be valuable and useful to the pets and the pet owners.

And so I, I look at this and I, and I wonder about technician and support staff. Utilization in these cases. Now, I, I know that there’s, there’s different degrees where we have, you know, some behavioral cases may be pretty complicated. They may have medical components wrapped into them, things like that.

But the vast majority of behavioral questions that we get about, you know, litter boxes, things like that. I feel like that’s things that, that can be delegated whether, whether it’s done by the technician in the appointment or whether we allow technicians to have technician appointments to address things like this.

I know I’m starting to see a move in our profession towards more technician appointments, more technicians working independently. What do you think of when you hear that, Chris? Do you think that things like that are possible? Have you seen technicians taking the lead on behavior cases in practices in a way that makes sense?

Dr. Chris Pachel: Absolutely. And especially in the general practice setting around behavior, the ability to go in and to learn how and to practice taking a good history, where we can ask those questions. Where, you know, let’s say it’s the cat that’s eliminating outside of the litter box. There’s a list of pretty standard questions

that we should know the answers to before we recommend a particular treatment. Simply saying, oh your cat’s peeing outside the box, add a box. Or try a different litter. It’s sort of like saying, oh I’ve got a cat who’s, you know, peeing excessively, here’s some insulin, try that first. We would never do that.

We need the diagnostic information to actually know what the solution to the identified problem is, even at a working diagnosis level and a technician who’s been trained in that area who has a, you know, a foundational knowledge and behavior can do a lot of that heavy lifting and in some of those cases do all of the lifting to really help those clients understand, you know, again, is this something that needs to be approached from a medical side of things?

And, you know, maybe they get that history for that cat who’s peeing outside the box. And in asking some of the routine questions, we also identify the fact that the cat is not jumping up on the furniture the way that it used to. And it’s a nine year old and this is a new onset problem. And awesome.

That dog or that cat likely needs to be evaluated by the veterinary team and there’s probably some diagnostics. Awesome. That didn’t necessarily need the veterinarian to spend 20 minutes gathering the history to be able to determine that that’s the next step. The technician is going to be able to say, okay, I can identify what is quote unquote behavior only and what needs the veterinary lens.

Go for it.

Dr. Andy Roark: Yeah, I, I, I really like that idea of, of the, the history leading into the conversations that we, that we want to have and having my technicians train so that they have the history and then, I don’t want to make it into a, into a, into an algorithm necessarily, but if the answer to this question is yes, then this is kind of the path that we start to go down.

Do you have favorite training resources? So, you know, I think a lot of times. A lot of times we throw our assistants and our technicians kind of into the room and we’re like, here’s the history. Anything that’s weird, just ask them more questions. do you, how do you get your staff up to the point where they can have these conversations?

I’ve seen, I’ll be honest with you, I’ve seen a lot of practices where where everybody’s kind of freestyling, you know what I mean? And you’re getting markedly different behavioral information from the different people that you see in the practice. I don’t want that. How do you, how do I get my people on the same page?

What does that sort of training and support of the team look like?

Dr. Chris Pachel: Yeah, I think one of the easiest places to start is to use a hand, a standardized history form, you know, and those are available through out, you know, and essentially any of the, the textbooks that we have, the, the handbooks that we have for behavior problems of companion animals, they include a history form that you can use to start with in, in the back of that.

And I think the reason I often start with one of those standardized forms is if you’re just on the early side of learning how to do this. You’re going to miss stuff. Of course you are. Unless we have that standardized checklist to follow and whether that’s something that we’re working through with the client in real time or whether it’s something that we’re asking them to fill out before they come in, it’s something that, for example, even when I look at a history form that for my practices, I think it’s five or six pages long by the time it spits all that data, not six pages of text.

But but but looking all that I can review that efficiently, usually in about 6 to 8 minutes. and verbalize my diagnostic plan, the additional questions that I need answered. I can verbalize that over and include, you know, if this, then this, or if we see this, this is going to redirect them to medical, or these are the things that we can recommend from a training standpoint.

So from a doctor, I could do six of those in an hour with a skilled training team and technician team who can implement a lot of that. Now, I say that knowing that the general practice cases, at least there are more of the straightforward cases that would apply for something like that. By the time we get to the point where they’re being referred over to a veterinary behaviors, there’s probably more layers that require the clinician to be involved.

But at an intake level of basically saying, is there something that we can do here before we consider referral to a veterinary behaviorist, or as a way of setting them up with the right trainer who’s going to be able to coach them on the implementation of skills knowing that if we’re going down, let’s say, a separation anxiety pathway versus a leash reactive dog pathway, we may have different trainers that we use based on their skill set and the actual problems that they like to work on.

But we can do all of that intake efficiently in the veterinary practice.

Dr. Andy Roark: Talk to me about the potential in telemedicine that you see. Do you think it’s going to be possible that we’re going to be able to have our, our, you know, our, our our behavior specialists in our, in our practice, whoever that, that may be. I mean, are they going to be able to just do a Zoom call with this client instead of having them come in repeatedly?

Is that, is that way more limited than people think? Help me, help me see what you see in your crystal ball.

Dr. Chris Pachel: I. Love. I love telehealth for behavior. I really, really do. And especially when we’re working with a veterinary team that does have hands on to the limit of safety with or without sedation, but we have that team that has the ability to have that established veterinary patient client relationship. I love coming into that conversation as a consulting specialist to say, let me ask a few of the questions that maybe you just didn’t know to ask.

And then let’s give you some some more guidance as to what we can do next and how that works and in real time, then be able to talk through medication options, perhaps even some of the diagnostic testing that we can do to really tease out some of those differentials that might not have been ruled out yet.

I love being able to do that. Truthfully, it’s one of my favorite things on my schedule most days. Not only from the standpoint of being able to reach patients that I otherwise wouldn’t reach, but more importantly for me, if I’m working through that primary care veterinarian, part of my education is to the veterinarian themselves to try to expand their knowledge base.

So the next time around they can perhaps get just a little bit farther with that case before they need to reach for me. So I’m trying to on board a more robust toolbox for them in the process of helping this single patient that’s in front of them so that they don’t have that same level of dependence on me for every single case that comes through.

Dr. Andy Roark: How do you differentiate behavior and training, Chris? I find myself using them largely interchangeably, but I feel like behavior is sort of very much in the veterinary medicine realm, and training may be a bit different. You know, there’s just a huge amount of overlap there. When I think of training, I think of puppy classes at Petco, or people out in a field really working with schutzendogs.

Not to, make it negative, but that feels different than hey, I’m the veterinary and let’s, let’s do a behavior appointment. Those feel very different to me, but do you, do you see them as being different? If so, how, how do you separate them?

Dr. Chris Pachel: So it the lines are blurry. That’s the short answer to that question, because it’s really hard sometimes to know kind of where one begins and one ends. Even we could go as far as to say that almost everything that we see is behavior, right? Movement patterns, ingestive behaviors, where the animal is looking or what they’re responding to.

It’s all behavior. What we do about it and the tools that are in our toolbox to really tease out why behavior is showing up the way that it that it is or how we’re going to modify that, that’s where those roles really start to differentiate themselves. Meaning if I’ve got a naive puppy or a dog that is

newly out of the shelter and doesn’t have its basic cues of sit, come, down, stay you know, things like that. Training is perfect for that. Those dogs don’t necessarily need a behavior assessment or a veterinarian to be involved. However, when we’re doing an assessment where there’s a behavior change, or where there’s any level of suspicion that there might be an underlying medical component.

And whether that’s gastrointestinal sensitivity, whether that’s recurrent itch issues that’s creating a level of irritability, whether it’s airway problems that’s impacting a dog’s ability to sleep restfully overnight, or whether we’re looking at actually prescribing for behavioral interventions, those are all within the purview of the veterinarian and absolutely need that medical lens and that medical knowledge.

The behavior modification piece kind of straddles between there where we’re saying I’ve got a dog who’s doing one thing or a cat who’s behaving in a certain way, assuming that we’ve ruled out or addressed any underlying medical issues, how can I apply the science of behavior change to manage that environment to coach the owner on how to utilize reinforcement based training to modify that and to build a better set of coping skills for that animal who’s doing the best they can, but they might be acting in an unsafe or unproductive way.

And that’s where the behavior consultants and a lot of the behavior professionals come into play. Not in isolation, but in my opinion, in collaboration with the veterinary team. So I don’t have to coach the veterinarian on how to do all the little micromanagement of individual training or behavior modification sessions, but that I also have that veterinary team who understands what underlying medical issues may be showing up with a change in appetite,

or a difference in behavior or a new onset aggression or a disruption in sleep wake cycle. That’s where the differentiation really comes into play for me.

Dr. Andy Roark: No, that, that makes sense. The last question I have for you, when you look into your crystal ball, And you look five years into the future and you’re thinking about artificial intelligence and you’re thinking about, you know, cloud based practice management software and corporate consolidation, all these kinds of things.

What changes do you see coming down the pipeline in the way that we engage with behavior cases?

Dr. Chris Pachel: Yeah, I think there’s a, there’s a couple of intersections here that are really meaningful for me. I personally don’t want to give up any of my client time to AI. I really don’t. I love being able to spend that time to really observe the animal, to ask the questions that I need answered, to be able to do that.

And I like looking at the history data in real time and assimilating my own thoughts about what that, what that might mean. Where I really struggle and where a lot of my colleagues who practice behavior really struggle is getting it all documented efficiently in a way that actually then makes a meaningful list of recommendations to clients.

And that’s truthfully where I use AI in my practice is not necessarily to generate my differential lists. I’m not asking it to assess my history forms. I’m basically saying, Hey, distill this down in my brain. Let me run through the education. But if there’s a little recording playing in the background that can pair that down into an actionable bullet point list.

Oh, man, I’m a happy camper. That is exactly what I’m looking for. So capture my words, put them on paper and assimilated into action items. That’s where I use AI. And that’s where I think, you know, if I could wave my magic wand. getting that dialed in so that I can walk out of an hour long appointment and just check the box and say, yep, captured it.

That’s what I want.

Dr. Andy Roark: It’s done and they’ve got good resources to go home with. I like it. I like where your head’s at. That’s wonderful. Dr. Chris Pachel thank you so much for being here. Where can people find you online? Where can they keep up with all of the adventures you’re having?

Dr. Chris Pachel: Yeah, the easiest place to find me is on my website, which is drpachel.Com, so d r p a c h e l. com. And if you go to that main landing page, there’ll be links there to all of the different projects, the things we’re doing at Animal Behavior Clinic, the things we’re doing at Instinct Dog Behavior and Training.

There’s a link there to my media pages, which will take you to podcast recordings like this one, as well as any other things that I’m involved with. You can keep tabs on me there. It also takes you to my socials on the business side, too. So everything is linked from drpachel.com

Dr. Andy Roark: Outstanding. Thanks for being here, Chris. Thanks for being here, everybody. Take care of yourselves, gang. See you later.

And that’s what I got. Guys, thanks for being here. Thanks to Chris Pachel for being here. Take care of yourselves, everybody. Be well. I’ll talk to you later on.