Medicine

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

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

LINKS

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

Sarah Parsons: www.vettechsarahparsons.com

Team Leads Summit: www.unchartedvet.com/tls2024

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

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

EPISODE TRANSCRIPT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yeah, 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So I definitely agree with that.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LINKS

The DermVet: https://thedermvet.com/

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

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

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

EPISODE TRANSCRIPT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Andy Roark: Yeah,

sure. 

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

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

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

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

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

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

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

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

Dr. Andy Roark: Just kind of along the front 

Dr. Ashley Bourgeois: gums?

Mm hmm.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

​

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where, where should I send them?

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

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

I’ll talk to you later on.

Alex Douzet, Co-Founder and CEO of Pumpkin® Pet Insurance, joins us to discuss the impact of pet insurance on client behaviors and the future of the pet industry. This week on the Cone of Shame Veterinary Podcast, Dr. Andy Roark and Alex Douzet dive into Pumpkin’s research with Zoetis revealing that Pumpkin-insured pets have more frequent vet visits and higher annual spending than uninsured pets. They explore the role of technology in veterinary practices, from digital check-ins to AI, and the potential benefits of corporate structures in enhancing clinic efficiency. Alex also shares insights from his Forbes article on emerging trends in pet healthcare. This episode is brought to you by Pumpkin Pet Insurance!

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

This episode is brought to you by Pumpkin Pet Insurance!

LINKS

Pumpkin Care for Veterinarians: https://www.pumpkin.care/for-veterinarians/

https://www.forbes.com/sites/forbesbusinesscouncil/2024/01/18/five-emerging-trends-in-pet-health-care-for-2024-and-beyond/?sh=1bdf73131430

https://www.avma.org/javma-news/2021-09-01/insured-pets-received-more-care-more-frequently

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

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

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Alex Douzet is the co-founder and CEO of Pumpkin®, the highest-rated pet insurance provider on Google as of January 2024, and one of the fastest growing pet insurance and wellness brands in the U.S. Pumpkin’s mission is to enable all cats and dogs to live their healthiest lives by removing the economic barriers that can prevent pet owners from providing their pets with veterinary care. 

Under Alex’s leadership, Pumpkin’s best-in-class insurance plans help make it easier for pet owners to provide their dogs and cats with advanced veterinary treatments, emergency care, and alternative or rehabilitative therapies if needed. Alex has also spearheaded a series of optional, non-insurance wellness products to help cover routine costs for essential preventive care, like vaccines and annual wellness visits.

Throughout his 20-year career as a serial entrepreneur, Alex has disrupted industries, scaled businesses, and built ‘people-first’ companies where employees grow and thrive. Prior to Pumpkin, he spent five years as CEO and Co-founder of Ollie, a next-gen, natural, and human-grade pet food brand.  Alex is also a competitive Triathlete and an 11X Ironman finisher. He is proud to have two rescue dogs: Belle, a 13-year-old Shar Pei Golden Retriever mix and Simon, a 6-year-old Dachshund mix.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Well, guys, I got a good one. Today, I am here with Alex Douzet . He is the CEO of Pumpkin. Alex is a tech entrepreneur, turned pet insurance CEO. He’s just got such an interesting perspective. I talked to him first about some research that Pumpkin put out with Zoetis on how they’re hoping to change the impact that having pet insurance has on pet owner behaviors at the vet clinic. We talk a bit about Pumpkin, what is different about, them and their perspective over there. 

And then we get into talking about one of Alex’s articles that was on Forbes. And I, he was, it was sort of talking about trends that are arising in the pet industry. We talk about artificial intelligence. We talk about telemedicine briefly. We talk about Gen Z pet owners and their interest in technology. 

And I got to tell you talking to a tech entrepreneur about young pet owners and what the future looks like for the way that we as veterinarians interact with those young pet owners. It’s it’s fascinating. Anyway, it was a great conversation. I think you guys will enjoy this episode. This episode is made possible by Pumpkin. Guys, 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 Alex Douzet, how are you?

Alex Douzet: I’m doing well. Thanks for having me.

Dr. Andy Roark: Well, it’s it is a it is a pleasure for those who don’t know you. You are the CEO of Pumpkin Pet Insurance. I first became aware of Pumpkin , when Pumpkin published some research in the AVMA News. And so it was an AVMA News article that came out. And I, I, I liked it and I sort of grabbed right onto it.

So, it’s, it’s been sort of anecdotally known, I’ve talked about it for a long time, that pets with pet insurance are more likely to come into the vet than pets that don’t have pet insurance and pets coming in with pet insurance are more likely to agree for for the services that we are recommending. And, and the Pumpkin research that sort of came out through the AVMA really backed that up And so what what you guys sort of showed was that Insured pets had 65 percent more hospital visits compared to uninsured pets and that they had a 72 percent higher annual spend compared to uninsured pets.

And both of those things have made sense and they sort of carried out some of, some of the ideas I had and sort of, sort of things that I’d seen in practice. But the thing that I really liked about it is when I’ve seen other, research on this. There’s always a bit of a sampling problem, right? When we look at insured pets, there’s this idea, you know, when you say, well, pets with pet insurance are more likely to come in more often.

I say, well, yeah, but the pet owners who are the people who get pet insurance are also likely to be the owners who bring people or bring their pets in. And so I, I liked in this research you had same, you, you compared Pets before they had pet insurance to pets after yeah, so you guys found a 22 percent Increase in the number of visits after getting pet insurance and a 43 percent increase in it in spending after getting pet insurance And so that that same pets pre and post that was not something I hadn’t seen before but I I really liked it Were you surprised by these results as you saw them or was this is this kind of what you expected?

Alex Douzet: I would say it’s both, you know, little surprised, but also what we were expecting. Cause we look, we started the Pumpkin with that promise of like enabling the best care possible for vets, right? And maybe just to answer your question better, you know, we kind of have to go back to the founding story of Pumpkin because it’s a little bit unique story, right?

We were founded with the support of a company you might have heard of called Zoetis, right? Zoetis is this little company in animal health that 

Dr. Andy Roark: They’re a boutique firm, I believe, yes.

Alex Douzet: Yeah, exactly. Like boutique very, very, very niche. Really wants to help their clients, the veterinarians, continue to do what they like to do, which is to save the life of pets, practice the best care possible.

And in 2018, 2019, when we started to think about the idea of doing pet insurance, we realized the pet insurance industry in the U.S. was relatively underpenetrated. Less than 2 percent of what we called medicalized pets. So, those are not just every pet in the U. S., but the ones that actually go see a vet.

Our estimation was about 100 million of the pets, right? There might be 165 million pets in the U. S., but like 100 million of them actually go see a vet at least like once every 18 to 24 months. Of those, only 2 percent had pet insurance. So we would look at that problem statement and say, what can we do to help that increase.

Because we’d seen market, more mature market, Sweden, the UK, with more than double digit penetration of pets with pet insurance. So what can we do? The idea came back to say, let’s create a pet insurance that is more pet centric, that is really focusing on enabling the best care possible. So to do that, you have to have great coverage.

You have to have like high annual limits, high reimbursement rates, but really, what you want to do is really partner and align with veterinarians to explain the value. I think one thing that we’d seen that was lacking in this country, unlike some European countries, was that the vet, as a community, was holding back from making a recommendation of the value of pet insurance.

So we figure like, okay we really need to like to do something there. And that’s where creating Pumpkin with the support of Zoetis made sense because what is in many cases is more than just pharmaceutical vendors to the vet industry. It’s really in many cases. We find them to be like the true partners to the veterinarians To practice better care so we then we figure okay, let’s we work together.

We create this great product. We can advocate a case, but we need to convince the community that it was a real benefit of pet insurance. We knew that pets with insurance will come more often, they’ll spend more, but we had to quantify this. And that’s where the story, the study you’re referring to came into place to really just prove the science behind it and say, hey, pets who have a great insurance product like Pumpkin will come more often. They’ll spend more with you, right?

Dr. Andy Roark: Yeah. Do you think that the way that vets talk about pet insurance in the States is the primary differentiator between the U. S. and the U.K.? So, I mean, I know that there’s been much greater uptake in other countries. Just sort of looking at it from your perspective, is it simply the way that vets in the states talk about pet insurance or are there other factors?

It seems like, I’ve always kind of imagined it’s more of a cultural, I don’t know if there’s some cultural component. What is your perspective?

Alex Douzet: I, I think there’s more than just one element. It’s, it’s a few elements. I think in the US you had a bit of a full start back in the days. I think the first real product that got some traction, you know, probably had some challenge from the product structure, the way it was structured and the way the reimbursement worked, and I think in many cases, it created what we call like a little bit of a buyer’s remorse. And that’s something that we spend a lot of time studying and really looked at, you know, it goes back to the DNA of the company and working with Zoetis and say, let’s make sure we do something that will never get the community to be upset. Right? And so we really looked at like, okay, why we need pet insurance and maybe the pet owners or customers, the veterinarians are just as important to us as the pet owners, right? It’s almost thinking about it like a two sided marketplace. Both sides need to be really happy with the equation. Otherwise, this work doesn’t takeoff. So we really focus on like creating a product that says there won’t be any kind of buyer’s remorse if the veterinarians makes a recommendation, advocate for the benefit of pet insurance. And say, look, this is a provider that we’ve had some good experience with. They deliver a good product, a good service. You should go check out pumpkin, right? That’s that’s how the experience works. So that’s I think important to also understand is like from our point of view from our research we looked at it, not every pet insurance is created equal And that’s actually a big part of what we do trying to work with the community and educating the community is like, don’t just advocate of like any pet insurance because like an insurance, you know, home insurance, car insurance, they are high end product and low end product, right?

And there’s no, what I would describe as like no magic math in insurance, meaning if something looks inexpensive, you get a quote for your dog or your cat. And you get a price that looks appealing, but low. It’s because the coverage is probably not that great. And that’s where this potential of buyer’s remorse exists, right?

Yeah, so so we were considering a developing pumpkin. With the goal in mind of like, really supporting the community enabling the best care possible. We had to look at all the scenarios and obviously looking at the situation where someone put hypothetically, you know, selecting a plan that is

 more on the lower hand in terms of coverage and reimbursement rate, they are still situation that could occur where this person could be faced by a recommendation from the veterinarians for treatment and then start to look at the math and say, well, a lot of it may not be reimbursed, and they may say no to the care in this example, or even worse, they may not even think about it consciously, go ahead and do it, and have a bad surprise post filing the claim.

They look at what they got reimbursed, and it’s probably, there’s probably a disconnect with the expectation. And I think that’s the thing that we were really conscious about that. Potentially, ultimately put us on the path to say the only way to solve for this is to create a more premium product with better coverage, higher, more generous annual limit, more generous reimbursement rate because we will avoid those situation and it ultimately prevent the buyer’s remorse and it will protect the community from having to deal with this.

And I think as a result, what we’ve seen over the past few years is that we get very strong reviews. I think when you, we Google for Pumpkin and you look at consumer reviews, you tend to see like very, very positive reviews. We get a lot of like positive comment and feedback from the clinics that we’ve been able to partner with and train them on the concept of an insurance and what we do particularly at Pumpkin.

Dr. Andy Roark: Yeah. You, you’ve got an article that came out earlier this year. It’s called Five Emerging Trends in Pet Healthcare for 2024 and Beyond. And I, and I, this is where I, I became aware of you. It’s, it’s, it’s good article. And so you’ve, you’ve got sort of five trends where you’re looking at the, at the sort of the pet health space.

And before I start, I want to ask you about a couple of them. But before I do, can you sort of lay out for me, like looking in your crystal ball in broad strokes, where do you sort of see the pet industry going in general? I mean, you talk in the article about a number of the forces that are sort of arising and converging.

Lay, lay that out for me, if you don’t mind.

Alex Douzet: Yeah. And to be honest for that, actually, I may have to like, take a step back of like how I got into this space cause my background 20 years ago was not in animal health. I’m a technology entrepreneur. My first company was a marketplace for jobs. You know, I was competing with the likes of the LinkedIn and of the world.

And I got into animal health through the first entry. My first entry was pet food. So in 2015, I came up with an idea for next gen of pet food product. Ultimately, the company and it like being called Ollie so human grade fresh product is only for dog that is custom tailored to their weight and attributes.

And it’s a point that we ship to people’s home, right? That’s how I got to learn this entire industry. The reason why I got into this is for two reasons. One because of my dog. My dog was the the inspiration. She was having some issue and I went to see a Veterinarian who educated me about the challenge I was facing with my dog and essentially what I learned there and gave me the inspiration to create that company the second thing is, was really really convincing because initially to be totally frank as an entrepreneur.

I was like I have no business being in this industry. Like, what do I know about pet food and manufacturing food? And so I was kind of like, am I over my skis here? Like, this is maybe a little bit too much, or maybe I shouldn’t go there. But ultimately what convinced me to do this was the secular trend.

The fact that the bond that exists between pet owners and pets is only getting stronger and stronger. You know, other people call that like the humanization of pets. And ultimately, what that translates into is the fact that over the last 10, 15 years, what we’ve seen is not every pet owner, but a strong group of pet owners and more and more of them are coming to market

are willing to invest in the care for their pet because they want to extend their life and the relationship that they have with their pets. And that is ultimately what I would call the secular trend that makes a product initially when I was in pet food work and succeed because again I was creating a premium product so you needed people to willing to pay for this to deliver a better experience for their pets.

And then ultimately in 2019 when I started to look at the pet insurance. I realize those trend applied as well to veterinary care and therefore pet insurance, right? And I think, you know, one thing I saw before 2014, the inflation rate, you know, what’s also called the vet CPI was pretty much 0 percent between like 2006 and 2014.

And then between 2014 and 2021, when we got it through covid It was on average 6%, so 3x the standard inflation. Since COVID, we see the inflation being at like 8, 9, sometimes 10%. So that creates a worry for a lot of people because like, hey, will the average consumer be able to continue to afford medicine?

And you have this force conflicting because you have more and more people adopting pets. Pets are taking a bigger part of our life. The good news is you have more and more people willing to invest in the care and are saying yes to new treatments or high end treatments. But at the same token, the overall cost is rising.

So this is creating creating like conflicting thoughts. And, and that’s where I decided to say, you know, it may be good for me to like write the story and, and try to do this like every year. You know, at the beginning of the year, like refreshing, like. What are my five year visions or what are the key trends that I see emerging?

Because one of the challenges that I see right now Because I, I go myself to a lot of clinics, you know, we have we have things that we partner all across the U. S. and I try to make sure I visit some of those clinics every year. I hear all the time, the biggest pain point is staffing, right? There’s a shortage of veterinarians, there’s a shortage of technicians, and that is in direct conflict with the demand.

The demand is rising, like adoptions keeps going up, pets are living longer, demand for vet services are not declining, they’re very resilient. Keeps increasing and supply demand is starting to get an imbalance. And so I quoted my story. I think the data was from IDEXX is that by 2030, there might be a 40 percent gap between the supply of people who can do the job and the demand for those services.

So something’s going to have to be there to increase the productivity.

Dr. Andy Roark: Yeah, you, you point to. You point to traditional telemedicine, which I, which I think was interesting as a possible way to, to increase increased capacity for, for vets. And I, I think that there’s, there’s some possibility there and I like, and you did a, you did a wonderful job of, painting a picture of what the future might be like.

You know, it was, it was very nuanced in not having a crystal ball, but also sort of the the convergent forces that you see. What I’d like, I’d like to you to sort of speak to here, if you don’t mind, you know, so you make a point, you know, the people are closer to their pets than they have been in the past.

And each generation is more tightly bound to their pets than they have been. And then, you know, and we see, I see increased willingness in In investing into pets as we go and then, you know, you as a tech entrepreneur, I know that you’re aware that, you know, our younger generations are also more comfortable with technology and they, they interface with the world through technology way more than previous generations do.

And so I know this is a large sort of conversation. We talk about AI and things, but you, you, you make, you make some references in the article to just things like digital self check in tools and patient intake kiosks and integrated CRM platforms, spanning every visit touch point. And like my eyes kind of got wide as I, I just like, this is really cool.

Can, can you speak? I know in just sort of broad brushstrokes. What does that interface with technology look like in 2030, say, as we’re going, if we continue to be shorthanded. I’m an optimist, Alex. I really, I think that we can solve so many problems with technology and with education. And I just, I am, I bet on, on vet medicine. I would like to see the future through your eyes, if that’s okay. What, show it, show it to me.

Alex Douzet: I mean, and look, as an entrepreneur, one of my motto is necessity is the mother of all invention, right? And so when I look at what I quote in the articles, this shortage of supply with this rising demand to me, that is the inevitable clash that’s going to force everybody to rethink the experience to say not going to suddenly manufacture more veterinarians or more technicians.

So we’re gonna have to find a way to increase productivity. And this is where technology does it. Every industry, if we look over the last 20, 30 years where technology came in, it created, if it was designed the right way, increase productivity in a tremendous way, right? Think about, like, the standard accountant that years ago was doing accounting on the paper ledger.

And now you’re introducing software that are doing accounting and A. I. These people are much more efficient and more productive, right? And the goal is not to necessarily use technology to replace the people that we see in the clinic. It’s to really give them like an exoskeleton to enhance them, so they become their co pilot.

So I think it’s got to be on two fronts. One is on the experience. You have this new generation coming in. They were born and raised on technology, right? They were born with this thing in their hands. That’s the native. I mean, it’s, it’s an unbelievable when you observe a young person and their approach to communication.

Texting is the first natural thing. Calling is not, you take someone who’s below the age of 25 and they’re like, they look, they look at you like you’re a deer in the headlight. If you say, well, you don’t call this person. Why don’t you call to make an appointment? They’re like, well, what can I go online to make an appointment?

What can I text? Make an appointment or what can I use an app to make an appointment, right? So from that standpoint, over the next 10 years, clinics gonna have to adjust to that way of doing where it will have to be self servicing tools and you can get productivity from that standpoint. So enabling appointments, booking through an online experience.

We are texting, self checking into a clinic through a kiosk. So you don’t, you need the app to like, find this person every single time. Maybe, maybe not me. I’ve seen some clinics today in the U. S. experiment with that, where the checking process is actually relatively seamless. You know, disappearing of like all the paperwork and it’s still like personally, I find this painful of mine when I walk into a clinic and I see, Oh, my God, you’re gonna make me fill up like this whole like intake form on paper.

Like, can you not be digitalized? That seems to be like such a low hanging fruit. Yeah. So things of that nature, and then we can go into the next phase, which is AI and how we can use AI to really enhance the productivity and really turn AI into a co pilot for both veterinarians and technicians.

Dr. Andy Roark: Yeah. think AI is going to take away a lot of the tedious work that we do in the practices. I think a lot of I think a lot of responding to emails and things is going to go away. I think the biggest opportunity for AI, I mean, I’m very biased as a veterinarian. I think medical record creation and management is going to be, Such a godsend, as far as AI, being able to make to make veterans faster, save them from spending time, you know, just documenting, documenting, documenting.

I think there is real opportunity there. You, you make the case in this article that you think corporation in veterinary medicine might be beneficial in increasing efficiency. Can you sort of talk to me a little bit about that and kind of what your, where your perspective is?

Alex Douzet: So promise, and I kind of go back to like first principles to, to build a thesis for this argument is most clinics are in world independence or relatively small business. Yeah. They may have three, four veterinarians working there. They may have, you know, 5, 000, 6, 000, 10 owners active who come regularly to practice.

In terms of revenue, we’re looking at maybe 3 to 4 million, right? So I put this under the category of a small business. To solve the problem that we discussed before, this requires investment in technology. And unfortunately there is a bit of a scale game there, right? So investing into a front end experience and then be a mobile first app to interact with the pet owners, digital kiosk, some of the things you may have to make a one time investments, but you can deploy that across many, many, pet owners, you’re going to get a better return on your investment.

And I think that’s where the corporatization comes in. Because if you are in continue to be just one man show as a, as a operation, there’s only so much you’re going to be able to invest. There’s just going to be natural boundaries in terms of resources that you have access to, to make those investments.

But if you’re looking at a broader group, the broader group can look at, Oh, we can make a one time investment that is meaningful, but we can deploy this across 10, 20, 30 clinics and get more efficiencies. And then at that point you standardize some of the more mundane processes, right? So that’s where I looked at it.

Now, it works great as an argument. The flip side of what I just said is the reality check. You know, today, you know, in the U S the, it’s roughly 40 percent of clinics or under the umbrella of a corporate, so that could be a large group, like an NVA, a VCA, or it could be let’s call it a private equity home group, and then 60 percent are still independent of the group of the 40%.

I would say there is underwhelming evidence that it’s actually working, right? I think what we’ve seen there is over the last 10 to 15 years, the message has been mostly join us, be you. But the challenge with that is ultimately you need to show an ability to create efficiencies, right? You know, how do you, what’s the point of like gathering 10, 20, 30, 50, 100 clinics If you can’t show any type of like standardization and any improvement.

And I think, you know, like you have to be able to look at both sides. Like you have to let the veterinarian decide how they want to practice medicine. I don’t think anybody loves being told how to practice medicine and having a top down approach. But on the flip side, on all the processes, standardizing, you know, practice management software checking processes, record keeping, all those things can be streamlined in the back end.

I think that’s probably where we see most of the corporation struggling in a big way in a way that was probably not expected, but they need to get there, right? Same, you know, like in one of your podcasts, because I do listen to your podcast, right? I listen to the one you made on the, on the wellness plan.

And I thought it was amazing and I thought it was a spot on, like every argument you made there was like spot on in the benefit of wellness plan. One of the reasons why we see such a low penetration of wellness plan in this country is mostly because all the companies will love to do it, completely struggle from a backend system and operation to implement the benefit of a wellness plan.

Dr. Andy Roark: Yeah. No, that well, thank, first of all, thank you for saying that, but I, I think I could, I, I could talk to you all day. This, this, I, I really enjoy your insight. I, I, I love your articles. I, I link it up and also the AVMA news piece down in the show notes so people can check that out. Alex, where can people find you online? Where can they learn more about Pumpkin Pet Insurance?

Alex Douzet: Yeah, I mean, super simple. You can find me on LinkedIn, you know, just just type my name and you’ll be one of the first thing that comes up. You Google my name, you’ll see all the story I write for Forbes, a contributor. You can find me on social media like X and Thread, and then, you know, you can just Google Pumpkin, Pumpkin Pet Insurance to learn more about us.Dr. Andy Roark: That’s that’s amazing. Thank you for being here guys. Thanks for tuning in and listening. Take care of yourselves everybody and that’s it that’s what I got for you guys, thanks for being here. Thanks to Alex for being here. I hope you enjoyed it. I put links in the show notes for everything that we talked about and mentioned check them out. I’ll see you guys later on take care of yourselves everybody!

Dr. Julie Levy returns to share an update on the black market FIP cure from one of the most popular episodes of 2022. In this episode of the Cone of Shame Podcast, Dr. Andy Roark and Dr. Julie Levy discuss recent updates on drug approvals for remdesivir as a treatment for FIP. They explore how clients can save the lives of their FIP-diagnosed cats, what veterinarians can do to monitor success, and which resources are available to help in the battle against FIP. Tune in for essential insights and practical advice on managing this challenging condition.

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

LINKS

FIP Warriors: https://fipwarriors.com/

Clinicians Brief Article: https://www.cliniciansbrief.com/article/feline-infectious-peritonitis-treatment-outcomes

Uncharted’s Conflict Management at HiVE: https://unchartedvet.com/conflict-management-training-navc-hive/

Black Market FIP Cure Podcast Original: https://drandyroark.com/cure-for-fip/

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. Julie Levy is the Fran Marino Distinguished Professor of Shelter Medicine Education at the University of Florida, where she focuses on the health and welfare of animals in shelters, feline infectious diseases, and humane alternatives for cat population control. She founded Operation Catnip, a nonprofit university-based community cat trap-neuter-return program that has spayed, neutered, and vaccinated more than 80,000 cats in Gainesville since 1998. In 2008, she joined Dr. Cynda Crawford to found Maddie’s Shelter Medicine Program at the College of Veterinary Medicine, an educational and discovery initiative with a global impact on the care of homeless animals. In 2014, she joined Dr. Kate Hurley to launch the Million Cat Challenge, a shelter-based campaign that saved more than 4.5 million cats in shelters across North America. In 2022, she helped launch Maddie’s Million Pet Challenge to create transformative “communities of practice” that deliver access to care through humane, community-centric programming—inside and outside of the shelter—to achieve the right outcome for every pet., Dr. Andy Roark is a practicing veterinarian, international speaker, author, and media personality. He is the founder of the Uncharted Veterinary Conference and DrAndyRoark.com. He has been an award-winning columnist for DVM360 and his popular Facebook page, website, and YouTube show reach millions of people every month.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am back with one of my veterinary idols, dr. Julie Levy. She means the world to me. I just, she’s so great for cats. She is so great for our profession. I just I, I’m always so happy when I get to talk to her.

 She was on about a year, year and a half ago, and she dropped the most popular Cone of Shame episode we’ve ever had. I mean, it was tens of thousands of plays. And it was all about a black market cure for FIP. And it’s been at least a year, year and a half since since we did that. And I want to get her back on and sort of talk about where we are today.

This is a great refresher on treatment of FIP. It’s also an interesting conversation about sort of where we are with access to the drugs and also what veterinarians are able to do and not do. And it turns out there’s a lot of things we’re really not all, we’re really not able to do but how do we support pet owners to get their cats taken care of and save lives?

That’s what we get into a really fun episode guys. Let’s get into this.

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. Julie Levy. Thank you for being here.

Dr. Julie Levy: Thank you, Andy. It’s so good to see you again.

Dr. Andy Roark: You, as well. So, you, it’s an absolute joy to have you on here for a couple of reasons. The first is you were the guest on the most popular podcast I’ve ever been a part of. We did a Black Market Cure for FIP. It’s been about a year, a year and a half, and it has outperformed anything else that I’ve ever done,

that I’ve ever made. It has been wildly popular. And so I’m, I’m really glad to have you back to talk a bit more about that. But, but on a personal note, you’re someone who I’ve, I’ve admired since my first days in veterinary school. For those who don’t know you, you are, I have to catch my breath the Fran Marino Distinguished Professor Shelter Medicine Education at the University of Florida.

You helped you, you started the shelter medicine program at University of Florida. You are the founder of Operation Catnip at the University of which I just, I cannot overstate how important that was to me. I graduated from veterinary school with so much more confidence in surgery than so many other veterinary school graduates because I got the opportunity to go on the weekends and and do spays and neuters and even just vaccinations.

That the practicing and the doing it. And so it’s a wonderful service. You guys have, I think spayed and neutered over 80,000 cats… 

Dr. Julie Levy: That’s right. 

Dr. Andy Roark: In and around Gainesville. It’s incredible. And, and it was so much hands on education and training for me. It just, it meant so much for my confidence and just, it was. It was something I always just really appreciated.

I just wanted to say that to you. How, what an impact it had for me personally. So thank, thank you for that.

Dr. Julie Levy: Thank you for saying that, Andy. And, and they still to this day are running Operation Catnip, spaying and neutering now about 9, 000 cats a year. And most of those are done by our veterinary students. So the UF students really have an opportunity for outstanding surgical experience.

Dr. Andy Roark: It was, it was a huge deal for me personally. And so I just, I love that you guys are still doing that. I wanted to, to have you back on just because of the reasons I said at the beginning. You came back into my orbit when I was talking to a veterinary student who was like, yeah, there’s this cure for FIP and you’re supposed to send pet owners to this Facebook group.

And that’s where I was like, that’s not right. And I talked to you and it totally was right. I was like, oh my goodness. And so we’ve gotten, I’ve gotten so many questions about this sort of episode and things like that. So I wanted to sort of circle back around. Let’s, let’s touch again on so treatment for FIP and kind of where we are and then I want to get into the legality of this and then finally into the role of the veterinary professional in helping make this care possible.

So if you don’t mind, give me, give me a high level overview of where are we with treatment of feline infectious peritonitis.

Dr. Julie Levy: Well, first off, who of us ever thought we could say cure and FIP in the same sentence? And I’m as shocked as anybody, and I’m always very skeptical of miracle cures that come along. We see them all the time. They never pan out. This one really did. Professor of mine at UC Davis Dr. Niels Peterson discovered antiviral drugs that cure FIP in most cats that are treated.

And it turns out that one of those drugs is Revdesivir, which later became the primary drug used for COVID, and then its related compound, which is known by an abbreviation called GS. Now, those drugs are bound up they’re not approved by FDA. In this country, well, Remdesivir now is approved for use in people, which means it’s also approved for use in animals.

And then GS, which is more popular and more affordable, is not approved in the U. S. and it is bound up by the intellectual property laws by patents. So when word got out that this, these compounds, especially GS, were available and were, effective in cats, cat owners themselves were the ones that really went out and found out where they could get it out of desperation, because like all of us, we’ve diagnosed FIP and very sadly told people that basically they could watch their kitten die.

And so these folks found out that they could go to Chinese. Chemical companies and they could order chemical grade G.S. and that was shipped illegally to the U. S. And little batches of unlabeled vials. And people started injecting it into their cats and, and saving their cats. 

So these cat owners found out that they’re, they could effectively treat cats and they started a group called FIP Warriors. And this is a Facebook group that anybody can go on and give information about their cat. They would ask for the medical records and the lab work.

And then they would give advice on how to treat the cat and where to get the drug. And this was all very kind of confusing and undercover for a while when it first came out. And then now there’s multiple papers that are published in the scientific literature about how to treat cats and how people are getting these drugs still not approved in the U. S. But still very effective and tens of thousands of cats have been treated internationally with about an 80 percent survival rate, a parent cure for these, these kitties that have what was used to be a fatal disease. And so now it’s very well organized. They have a lot of information and yet it’s an unapproved drug.

So veterinarians want to know, kind of, where they can play. In this, they don’t want to certainly should not order the drug themselves, prescribe the drug, or dispense the drug. And so the role that we found that most veterinarians are kind of comfortable with is making a diagnosis, teaching owners how to give injections and give pills.

And running lab work and giving supportive care, but then referring them to the Facebook page, which is the surprising thing that we never thought we would do as veterinarians is saying, go to FIP warriors, and they will give you an action plan for your cat. And then they will tell that person where they can meet someone to get some drug.

And this is the really shady part. Usually it’s like the other parts are shady at all, but this part’s like the most shady part, which is they usually say, you know, let’s meet at a closed gas station and somebody will meet you and give you unmarked files and you will get the money and you should go and check that in your cat.

And everybody I talk to and refer to the Facebook warriors page says, that’s exactly what happened. We met in an alley at night and they gave me drugs. And now my cat is alive.

Dr. Andy Roark: They gave me some Chinese pharmaceuticals and I paid in cash. And that’s what happens. And I just, I can’t believe we’re a part of this interaction in any way, shape or form. It’s, it’s amazing to me. Have it doesn’t sound like there’s been really any sort of progress made in increasing access or availability since you and I talked a year, year and a half ago. Is that true?

Dr. Julie Levy: It’s on a practical basis. That’s true. Legally. Remdesivir became fully approved for use in people, which then allows veterinarians to use it off label in cats. However, it’s not been available through veterinary distributors. Some folks have been able to get it from human hospitals. So a veterinarian can call up their human hospital and see if they will share some Remdesivir.

for a veterinary patient. We do that for all kinds of other drugs that we need occasionally that aren’t stocked by, by veterinary pharmacies. So, that is something that veterinarians can do and that would be totally legal. It’s just been a challenge to get access to the drug. Also, it’s several times more expensive. So we’re talking Many thousands of dollars rather than a few thousand dollars to treat a cat.

Dr. Andy Roark: Talk, talk to me a little bit about, so it’s, it’s really been fascinating. So there was an article in Clinician’s Brief that came out and they were talking about remdesivir and they were, they were quoting doses of, you know, 10 per kg. And so, but it was, it’s all this really weird. The language around all of this is really strange, and so shout out to Clinician’s Brief for sort of covering this and talking about it, which I appreciate, but it’s all still kind of strange.

Can you talk to me a little bit about the number jumbles that are out there? So it seems to me, when we look at remdesivir, we start to talk about the GS. There’s GS441524, which seems to be the, the go to treatment. But then if you get in there and people start, I don’t know if they’re throwing out on slang, but there’s somebody’s like talking about GS441 is that different?

Is that the same? And then there’s GC376, which is another thing. And so can you help me at least make some sense of this so that I. I don’t feel, I guess either foolish when I talk about it or when a, when a pet owner comes back with a very logical question of I’m seeing these other things, I have some bearing of even what that sort of means. Can you help me get my feet under me here?

Dr. Julie Levy: Absolutely, it is confusing. So remdesivir is the licensed drug. There is a pro drug of remdesivir called GS 441 blah blah blah and that is actually more effective we think than remdesivir is for FIP. And so GS and GS441 and GS, the long 441, are all the same thing. It’s just abbreviated as GS. That’s the most common drug that people are getting, not licensed.

Now GC is different. That is a drug that Dr. Peterson at UCD also discovered works against FIP. And that one is being moved through the FDA approval process by a drug company. That is developing it, and so eventually, maybe within a year or two, that drug will be legally available to veterinarians in the U.S.

Dr. Andy Roark: Okay, so that, that does, that does help me. 

Dr. Andy Roark: Hey guys, I just have to jump in with incredible news. I will be traveling with the Uncharted Veterinary Conference team. That includes Stephanie Goss and Maria Pirita we are going to Minneapolis for the NAVC HiVE conference that is there. This is on June 15th and 16th guys. We are doing a one day Uncharted conflict management training program. 

That’s right and it is included with the cost of HiVE. All you have to do is register for the HiVE conference that’s $99 for two days, one day, you can spend it with us, bring your team, send multiple people from your practice, put them together. We’ll put them at round tables. We will have them working together, talking about conflict management. 

We’re going to take them through a whole day. This is not a series of lectures. It’s not, they’re going to go to one and they’re going to do something else. Nope. Check the box register for the Uncharted event at HiVE. And you will spend the day with us. And I guess you’re never going to see an Uncharted event that is a day long. 

That is $99. Again, like this is the best price you will ever see on conflict management. So anyway, if you are anywhere near Minneapolis, June 15th and 16th, Come to the HiVE event it’s $99 and you get a day with Uncharted. If you register for it and the other day, you can use it HiVE and get their amazing CE for technicians and managers. Anyway I’ll put links in the show notes. 

You should learn more. I’m serious. If you were within hours of HiVE, there was never going to be a chance for you to sign up multiple team members come together. And do conflict management training as a group. This is a phenomenal opportunity, please don’t miss it. If you’re able to make it, it’s going to be great. 

Let’s get back into this episode. We’ve talked a little bit about, about what the veterinarian’s role is. It seems like it’s pretty darn hands off. There’s, there’s just not, there’s just not a lot to do here. We, you know, when I’m, when I’m checking blood work, things like that, Julie can you give me any guidance on kind of what I’m looking for here as opposed to just saying, here, take this blood work back to a Facebook like feels terrible.

Dr. Julie Levy: That feels weird. 

Dr. Andy Roark: Got like, yeah, it feels bad. Get, can, can you give me at least some, some buoys, you know, in the passageway that I can kind of mark where I’m going.

Dr. Julie Levy: So, it’s really interesting, because this group is very data driven. So they’ve collected tens of thousands of sets of data, and they’ve followed the cats over time, and notice which ones have relapses or don’t respond. What kinds of FIP need higher doses of drug. So kind of from a baseline, there’s a regular FIP, wet FIP, it’s probably the best one.

So that’s going to start off at about 10 milligrams per kilogram. And then higher doses right from the start for cats that have FeLV or cats that have neurologic or ocular sites because those are a little harder to get drugs into those sites, the CNS and the eyes. So right from the start they get a higher dose.

They also will start right from the start on injectable because that’s going to be more effective and better bioavailability. Then often, they will switch to pills when cats are more stable and they’re recovering because that’s a little less stress on the cat to get the pills rather than the injections, which are pretty stingy.

Now, the blood work that you’re going to follow, there’s a few things that really do usually start out abnormal and then normalize if the cat is responding. The most important one is the albumin to globulin ratio. Most cats with FIP, but not all, will have a very low albumin to globulin ratio. And as they’re responding to treatment, you just see that go back to normal.

Also, they often have a high white blood cell count, high neutrophil count low lymphocyte count, and they’re often anemic as well. And all of those in the responding cats just like track towards normal and they don’t stop treatment until they are solidly normal. So they might recommend extending treatment if the lab values are still abnormal.

Dr. Andy Roark: What, what’s the general, I know this is going to vary with, with the type of FIP and, and the specific kitten, what are we talking about from a timeline here? I mean, I know a lot of the research that was done we’re looking at, you know, six months out and things like that. If I want to try to set some expectations or even just kind of understand what sort of a process the pet owner is getting into, what is it?

What is a reasonable sort of ballpark timeline?

Dr. Julie Levy: So the current therapy is 84 days of daily medication, followed by 84 days of observation. And there’s some blood work that’s been, that is done during the observation period so that you can tell if a cat is falling back and needs to be restarted on medication. What we’ve learned over time is that the vast majority of cats that survive a week are going to live.

And so, and, and even really four days, if they’re still alive within four days of treatment, they often, most of them are going to go on and live. So, if you are on the fence or a client is on the fence about, is it worth it? How will I know if my cat will respond? That very early response is very predictive of how the cats would do.

So I would recommend for most people, like, give it a shot, give it a week, and see how the cat responds. And usually it’s dramatic. Like, it kind of defies logic that these cats can go from death’s door sometimes, unable to stand, unable to eat, and within a couple days, they’re already markedly improved.

Dr. Andy Roark: That’s phenomenal. Thank you so much, Julie, for being here and for talking through this stuff with me. I, I always love it. You are such a wealth of information. I just really appreciate your time. If there are people who want to learn more, are there, are there resources out there that you really recommend, places that you like?

Dr. Julie Levy: I, I, you know, I hate to be the person that says, go to Facebook, but FIP Warriors is an incredible source of information for cat owners to go to. Now there’s also a FIP Warriors for Veterinarians group and I like that one because that is only veterinarians talking to each other and reviewing lab work and and helping each other kind of navigate the guardrails of where they can practice.

So I recommend that one. We also have on our shelter medicine website, we have a whole section on research that we’ve done and clinical trials that are going on and there’s some also some links to websites that are specifically focused on the veterinary aspect of treating this for veterinarians.

Dr. Andy Roark: That sounds great. I’ll put links to all that down in the show notes and get everybody set up. Julie, thank you so much for all you do for cats. Thank you so much for what you do for vet students like myself back in the day. You are just a joy. Guys, thanks for listening to everybody. Take care of yourselves, gang.

Dr. Julie Levy: Thanks, Andy.

And that’s it. That’s what I got guys I hope you enjoyed it. I hope you got something out of it. If you did you share with your friends I I really I want I want to save cat lives and we do that with education. So feel free to pass this episode on to other people and just make sure that everybody’s kind of on the same page.

This is a really weird situation in my opinion, where the veterinarian’s hands are really tied. It’s still, it’s always going to feel really strange to me sending people to a Facebook group to get help, but it’s, it’s a hard pill for me to swallow, but, but I think that that’s where we are right now.

And so anyway make sure you help me spread the word. All right, guys, take care of yourselves. I’ll talk to you later. Bye. 

Dr. Amy Thomson joins us to explore non-anesthetic dentistry and client communication, tackling common fears about anesthesia and the importance of clear language in veterinary care. Learn from her expertise as she and Dr. Andy Roark discuss how to effectively manage cases like Nico, a Chihuahua with good teeth but bad breath on this week’s episode of the Cone of Shame Veterinary Podcast. Don’t miss these crucial insights that could transform your approach and elevate your practice. Let’s get started, gang!

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

LINKS

American Veterinary Dental College: https://avdc.org/

Veterinary Dental Forum: https://www.veterinarydentalforum.org/

Amy Thomson IG: https://www.instagram.com/toothy.thomson/

Referenced Obi Vet Course: https://obivet.com/product-category/certificates/

VetHive:https://www.vethive.com

Amy Thomson website: https://toothythomson.ca

ABOUT OUR GUEST

Dr. Amy Thomson, often known as “Toothy,” is passionate about teeth! However, it was not always this way—she started her career in small animal practice with very minimal dentistry knowledge. She was fortunate to have a great mentor in her first job, where she learned a lot and her desire to learn more grew. Once she attended her first Veterinary Dental Forum in 2013, she KNEW dentistry was her passion—and became affectionately known as “Toothy Thomson.”

With time and support from her family, friends, colleagues, and a big ‘shove’ from her mentor, she applied for a dentistry and oral surgery residency and was overjoyed when she matched at the University of Wisconsin-Madison. During her residency, her passion grew not only for dentistry but also for teaching. And because life is always full of surprises, Dr. Thomson found herself at a crossroads in 2020 in the early stages of the pandemic—so she started her own mobile dentistry practice!

In addition to working alongside small animal general practice teams, she also became very active online, sharing her knowledge. It has always been important for her to share as much as she can, given it took hundreds of hours and thousands of dollars to obtain the knowledge she did while in general practice. Knowledge she wants to see all veterinary teams have!

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host Dr. Andy Roark. Guys, I got it going for you today. I have got my friend Dr. Amy Thomson on. She is a boarded veterinary dentist. I am talking to her about a weird case of a little chihuahua whose teeth don’t look bad, but his breath is nasty.

He’s got gingivitis. Yep, we’re going to talk about some non anesthetic dentistry today and how we talk to pet owners about it. And also how do we deal with it when you’ve got this pet that’s got some nasty stuff lurking under the surface, but the teeth look good and the owners think that they’re that they’re golden.

Anyway, it’s a good case. 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. Amy Thomson. Thanks for being here.

Dr. Amy Thomson: Thanks for having me. I’m super excited to be here.

Dr. Andy Roark: It’s my pleasure. I, I’m so excited to have you here. For those who don’t know you, you are a boarded veterinary dentist. You and I met at the OVMA Convention in Ontario and you were speaking after me and we just started talking and I just I love your energy so much and like your passion for what you do just radiates through and so I really I wanted to spend more time with you and sort of talk with you and so I’m glad we were able to set this up.

Dr. Amy Thomson: It’s so, it’s so wonderful finding and getting to meet you in person and yeah, it was a, it was a great conference. I was super excited to be asked to be a part of it and then yeah, getting to connect with you and talk about teeth, which is my favorite thing to do. It’s pretty great.

Dr. Andy Roark: Yeah, see it’s I, I’ve got, I’ve got a tooth problem for you, actually, I want to, I want to bring up. So, I am looking at a five year old male neutered chihuahua named Nico. And so, Nico, Nico’s teeth, when I just looked in his mouth looked okay. But his breath stinks, and he’s got some gingivitis. And so, I started asking the owners about this, like, his breath, and what do you do for his dental health?

And they said, well, we’re very conscientious. Twice a year they do– they call it cosmetic dentistry. It’s anesthesia free dentistry and it sounds like they’ve been getting this service done for them. And now I’m, I’ve got Nico here and I’m, I’m looking at this dog and his, he’s got gingivitis and he’s got bad breath and I’m worried.

I’m going to, I’m going to, they’re going to let me do this. I’m really worried that it’s going to be a disaster when I get in there. And I’m hoping that you’ll talk, talk, you’d totally- don’t with me. Tell me I’m not, tell me I’m wrong. You’re supposed to “no it’s going to be fine.” 

Dr. Amy Thomson: No, I think you’re right. I’m worried. I’m worried about Nico’s now, for sure.

Dr. Andy Roark: So, so, tell, how do you treat this, Amy? Talk, talk me through this a little bit, like, where’s your head at when I bring you this case, and just sort of, start at a high level and let’s get down to kind of how I approach this, and, and how do I set expectations with the owners so I don’t get in a lot of trouble if I do come back to them with something they’re really not going to want to hear?

Dr. Amy Thomson: Yeah, yeah. So yeah, so this is always a challenging case and so I guess like taking it sort of back I think it’s really important to like meet these owners where they’re at. So they really care about oral health, which makes me happy And so I always try and start with acknowledging that. That like I’m very glad that you’re taking Nico’s oral health seriously and, you know, being proactive and having these anesthesia free cleanings done

obviously shows that, you know, you care and that you’re wanting to keep his mouth healthy. Unfortunately, this is not a great way to do it. And I’ll, and honest We, I’ve had this conversation and owners are like, what? Like we thought this was the right thing and all I’ll validate them and say, absolutely.

Like if I were in your shoes, based on the information that I see on the internet these seem great. It’s, they seem great because you see the before and after pictures and there’s all this calculus and then it’s all gone. The concern or the issue is unlike you and I that will sit still. Our pets rarely sit still and certainly not in a way that will allow us to do a deep clean underneath the gums and so Bringing it back to what I’m seeing in Nico’s mouth is despite the teeth looking quite clean I’m getting this smell and I’m seeing the gums are inflamed and those are my What I call my red flags when I look in the mouth to say that there’s there’s problems underneath The surface.

And so that bad breath or, you know, I sometimes joke about we like fancy doctor terms or halitosis. That’s actually volatile sulfur compounds and that’s the breakdown of tissue. That we’re smelling. So that sort of not like smells like canned dog food or whatever. We fed them, but that sort of unmistakable foul odor or halitosis is evidence that there’s disease and then the fact that his gums are diseased or at least inflamed says we’ve got inflammation there and so I can’t say I’m entirely surprised because if he’s been getting cleanings on the surface that we can see, but not deep under the gum.

There could be, you know, significant disease that we’re just not able to see when he’s awake.

Dr. Andy Roark: Do you tell pet owners that smell, that distinctive smell, is the breakdown of tissue? Do you tell them that?

Dr. Amy Thomson: Sometimes.

Dr. Andy Roark: That’s pretty intense. Like I, you kind of like, you’re kind of grossing me out like I’m–

Dr. Amy Thomson: I know it’s gross, but, but I also think it’s important I don’t see it as much anymore, but there used to be that like I haven’t been in general practice for a long time. It’s been eight, nine years. So I’m a little bit removed now, but I do remember when I was in and I would hear like, Oh yeah, they’ve got a little bit of doggy breath.

And, and I just think like we talked about when we met, it was like, I’m a big stickler for language and nomenclature and I don’t know, doggy breath sounds cute, but like what we’re smelling is, is evidence of disease. So, it a bit depends on the conversation I’m having with the owner, but I will acknowledge that like that smell that we’re smelling is indicating that there’s deeper disease going on.

Mm hmm.

Dr. Andy Roark: You, you are a stickler for language. Talk to me real quick, we’re just gonna take a little, a little side tangent here. You don’t like, you don’t like the term dental disease. You like the term periodontal disease.

Dr. Amy Thomson: I don’t

Dr. Andy Roark: Tell, tell me why that is. I, because I, like, I always say like, ’cause I, I feel like the pet owners get it when I say dental disease, but put push back on it.

Tell me, help me, help me understand.

Dr. Amy Thomson: I’m happy to So I recently put together a lecture for the veterinary dental forum called dentistry dirty words And so that’s top of the like one of the top of the list of the the words that I think are bad dirty words we should stop using and the reason being is that for me if I’m trying to like Understand communicating with owners if I say it’s dental disease, that means there’s a problem with the tooth And you, hopefully you, well maybe not hopefully, but I’ve heard this a lot and I get a lot of nods when I lecture of like who here has heard, you’ve made a recommendation, the teeth are quite bad, we need to get in and clean and probably extract, and then maybe we get a call back from the owner and be like don’t worry doc, the tooth fell out, we’re all good.

Dr. Andy Roark: Yeah, sure.

Dr. Amy Thomson: Yeah, so when we call it dental disease, it’s not, I don’t think it’s unrealistic for the owner to say, Oh, the tooth is a problem. The tooth is gone. The problem’s gone. Um, And so I do think using the appropriate term of periodontal disease and discussing that it’s the root surface of the tooth, but it’s also the gum, the bone and the ligament that are diseased to help understand why it’s so important to do the exam under anesthesia, to do the x rays, and then to make sure that we remove the tooth debride that area and close it up.

I do find, personally, I get more reception from owners of understanding the importance of say x rays or doing this under anesthesia kind of thing

Dr. Andy Roark: Do you think that fear of anesthesia is the number one reason that we tend to see these cosmetic dentistries coming in where the tooth root below the gingival line has not been taken care of? Is that, is that, is that, in your opinion, is that what really drives it?

Dr. Amy Thomson: Absolutely that’s been my experience both when I was a general practitioner now as a dentist oral surgeon taking referrals, and then I do a lot of like online education. And so you have to be careful with things online, like social media. There’s lots of people that will kind of chime in. And yeah, there is a, there is a huge fear of anesthesia.

And I think being fearful of anesthesia is, you know, important. I don’t, I’m not, I’m not here to say we shouldn’t be worried. I mean, I, I, I tell all of my owners, anesthesia is not a benign treatment. So there is always going to be a risk, albeit for most healthy patients, it’s, you know, less than 1%. And those that have comorbidities there’s lots of things that we can do as far as working up heart disease, kidney disease to make it as safe as possible.

And then we have. The wonderful people who are board certified anesthesiologists who can manage the higher risk anesthesia. So, I would say at least half, if not two thirds of my patients have kidney disease, heart disease, or sometimes both, yeah, but, but it is, owners are afraid, and I think that fear, I don’t think anyone’s doing it on purpose, but it’s almost like this fear mongering of like, you want clean teeth, which we talk about the importance of oral health, but you don’t want your pet to die, so here’s the solution.

The problem is that while we’re avoiding anesthesia, we’re not actually treating disease in their oral cavity and potentially we’re making it worse because the teeth look clean and so we’re not clued into the fact that actually below the gum line there’s problems.

Dr. Andy Roark: Hey guys, do you wish that your team was better at handling conflict management? Are you a leader, a medical director, a practice manager, a practice owner and associate vet that wants to not only be able to handle conflict really well in your team, but also to have the tools to train your people so that they have these conversations more gracefully with each other. 

Would you like to work at a place where we’re. We’re not sniping at each other. We’re getting along and communicating effectively. Guys, we can make that happen for you. I and the uncharted team will be at the hive event in Minneapolis is June 15th and 16th. We are having one day. Conflict management training program. 

So it will be, my team will be there is through uncharted. And so it is going to be one day of working with me and Stephanie Goss and Maria Pirita and we will be breaking down workshops on conflict management and you can drop in. You can get a day, you can spend the other day at the Hive conference. 

It is going to be an absolutely fantastic time, guys. Ah, I’m going to put a link in the show notes, head over there, check it out, grab your spot. This is not sit and be lectured at. This is round table workshop discussion format where you get your hands dirty. You get down to the weeds. We talk about what these tactics look like in our teams, in our practices. 

And we walk away at the end of the day with real skills to change the culture. In our practice guys, this is an investment in yourself is an investment in your team. It is an investment in your happiness and in your workplace. Do not miss the opportunity. It may not come around again. This is a great chance to work with us and to really stretch and expand your mind. 

And I promise you’re gonna have a great time, gang. Again, June 15th and 16th in Minneapolis. Hope to see you there. Let’s get back into this episode. 

Dr. Andy Roark: So, so, bringing this back to Nico. So, five years old seems young to me to have, especially, you know, when they’ve, they’ve, they have, they have been attentive in their way to his, to his oral health. I’m sort of surprised looking at this. Can you sort of lay down your approach to this case? So, I haven’t done any diagnostics here, but I’ve got Nico.

I’m trying to set expectations. How would, how would you approach this case from here? So walk me through kind of what your game plan would be, if you don’t mind.

Dr. Amy Thomson: Yeah, yeah, so again, I would acknowledge that, like, I think it’s great that they’re, like, taking an active approach and having his teeth cleaned. The concern is, is that despite the teeth looking clean and being free of plaque and calculus, there’s that, you know, bad breath, disease, I call it disease breath instead of doggy breath.

I don’t always maybe get as graphic as that.

Dr. Andy Roark: Yeah, exactly. Yeah 

Dr. Amy Thomson: and, and the fact that his gums either look a little bit darker pink or red, maybe a bit swollen. Definitely those are my two indications that there’s a deeper disease going on. And so the bet, I would explain to the owner, the only way to know the extent of this disease, unfortunately, is to do a tooth by tooth exam, just like our dentist does in our mouth, and take those x rays.

And then I’ll often joke around like, I wish we could do that awake, and he would just sit and go, ah, but unfortunately that’s going to require anesthesia. So I’d really like to get him scheduled in so we can get to the bottom of this, you know, bad breath, diseased breath, inflamed gums and figure out if this is, you know, hopefully we’re at a point where we’ve got a lot of buildup underneath the gum tissue that needs to be cleaned, but we don’t have significant bone or ligament loss or loss of those periodontal tissue structures where a deep cleaning is enough.

However, given his age and his size and potentially, you know, the smell or, or what you’re seeing we may find that, unfortunately, despite on the surface being clean, there’s been debris and disease underneath, and, and he may actually require extractions, but the only way to know for sure is to get those diagnostics, which, which will require anesthesia.

Dr. Andy Roark: Gotcha. Okay. Do you have any concerns about whenever I have these small dogs and I’m working in their mouth and I’m concerned about sort of significant, periodontal disease, things like that do you have any concerns about tooth extraction in tiny dogs, things like that? I mean, just if, if this has been going on and we’ve got significant dental disease when we get in there, I’m, I’m worried about breaking these little dogs, you know what I mean?

Like, like I’ve, I’ve seen these little jaw bones that have been sort of deteriorated. I’ve, I’ve seen them just snap and

Dr. Amy Thomson: Yeah. And they’re just like, they’re so little.

Dr. Andy Roark: So little and I don’t know. Is that fear completely un I can’t be, no it’s not completely unfounded, but like, is there, is there anything that I should be particularly aware of or anything that you can do to help me kind of protect myself if I do get in there and I find that the, there’s just been terrible deterioration of, of, of the jawbone, things like that.

Any tips or tricks for me? 

Dr. Amy Thomson: Not to get all nerdy, but there is publications to say that as our we bred dogs to get smaller and smaller, they don’t proportionally have smaller teeth. So smaller dogs actually have more of the volume in their jaw taken up by teeth. So that can create an issue when you have like a relatively big tooth.

I used to joke my little chichi, raisin nose. I used to joke. She was like the mask with the really big teeth, like the small little job, big teeth. And so it’s, it’s pretty common. So then if you imagine you have this really big tooth in this small jaw and then you start removing jaw, when you start to remove these teeth, you’re putting a fair amount of torque on the jaw to get this big tooth out.

And so, I think, And I will always say I said it a lot over OVMA is it’s important for you to be comfortable. So if you get into a mouth and you go this is way worse than what I thought Above all else do no harm like we take our oath is just let the owners know, you know, this is worse than what? We had thought and i’m concerned with the amount of bone loss and you know, the size of Nico. But there could be a risk that I could do some damage to his jaw.

And I just think it would be better in the hands of a colleague or, you know, perhaps we’ll do part of the work, but then come back because of course, depending on your clinic you may be scheduled for surgery and then in appointments. And the last thing you want to do with tooth extraction is try and rush.

Cause then I find when people rush, they get nervous. They use a bit more force. We’re more at risk to having problems happen. So I would just give everyone permission to say it’s okay to say like I’m not comfortable with this because you want to do what’s best for this pet. And then my little tip for that is I’m a huge huge fan of something called horizontal elevation.

So I find those that that had like a dentistry program in vet school or have gone to courses, I do find there’s a lot of what we call vertical elevation. So if this is like the tooth root, we put the instrument in down along it and we rotate which is, which is great. And one, technique in my toolbox.

The, so that’s vertical. It’s along the long axis. But horizontal, I find helpful in say like these big molars and these small dogs with the small jaw is if you actually say these are your two roots or two crown root segments, I put my winged elevator in between so perpendicular. And then when I rotate, I’m stretching the tooth against tooth and I’m putting less torque on the jaw while I support that jaw. And so, less likely not impossible but less likely to cause iatrogenic jaw fracture to that jaw because you’re not putting a ton of torque on that small jaw that’s potentially diseased.

Dr. Andy Roark: No, that totally makes sense. Okay, I feel like I got a plan here. I think I know how to approach this. Any last words of advice for me? Anything that you, that you could foresee that I would want to avoid as far as a pitfall or make sure that I do well?

Dr. Amy Thomson: I think you have a good plan. I just think like open communication and just like knowing that, you know, It’s very common for owners to feel like these anesthesia free cleanings are in their dog’s best interest because they’re scared of anesthesia And they know how important oral health is and probably at most of their pets visit The vet is talking about the importance of oral health So I think just letting them know that like we know they were doing what they felt was best and unfortunately There’s just not enough of us being able to be the voice out there to say that that these anesthesia free pains, while they avoid anesthesia very much limit in what we can do.

We can’t do diagnostics. We can’t do true, you know, therapeutic treatment. And so just talk to them about, you know, we may find that we have to extract multiple teeth from Nico, but he’s going to be healthier. And then when he comes back, I always tell owners, once he comes back at two weeks, I always see all my patients at two weeks, make sure they’re healing.

Then let’s talk about things that are going to be really helpful that you can be doing. So that we don’t kind of get into this situation in the future. There’s always a tooth brushing discussion and demo. And then we’ll talk about, you know, setting expectations for COHATs, or Comprehensive Oral Health Assessment and Treatment which is the cleaning the x rays under anesthesia.

And, and talk to them about what is realistic for them to feel comfortable doing, both from an anesthetic standpoint, overall pet health, cost and just sort of work together to make a plan. And, and let them know, you know, I’ll have recommendations, but this, this needs to be a team effort for Nico.

Dr. Andy Roark: Yeah, that totally makes sense. Thank you so much for being here. Amy, do you have any favorite resources for anybody if people are like man, this is my jam I love I love I love dental health. I mean you’re this is your passion. What are your favorite..

Dr. Amy Thomson: I love it. 

Dr. Andy Roark: Resources? 

Dr. Amy Thomson: Yeah,so, the veterinary dental forum that sort of like that was like Christmas for me and is every year I’ve been I don’t know. I think it’s like 11 years in a row now I’ve been, I’ve gone, or I’m coming up on my 11th forum. Lost track. But I went there early on in my career and it’s such an amazing weekend.

So it’s three full days of lectures. It’s broken up between sort of, beginner, intermediate, advanced. There’s practice management series. There’s technician series. And then there’s a bunch of wet labs and it’s just like a whole bunch of tooth nerds that are just real excited to talk about teeth.

And you can just really be immersed in that. And I always find like, even now I will, I will still learn things when I go. And, and it was interesting because when I was lecturing there last, last year I was also a moderator and, and hearing other diplomates talk about things that I talk about, you’re like, oh, it’s interesting they use that instrument a little bit differently.

So, it’s just like a huge wealth of knowledge. So if you’re available and can go, it’s normally in the fall, it moves around the continental U.S. It’s in Palm Springs this year at the end of September. So a pretty nice locale location. And, It’s a ton of CE. Definitely love that.

And then the AVDC website or the American Veteran Dental College has a lot of resources for ongoing CE and things like that. Which is really helpful if you’re looking for more. That’s sort of where I started many, many years ago, getting my education.

Dr. Andy Roark: That’s awesome. Well, thanks so much for sharing that. I’ll put links on the show notes guys. Thanks for being here. Amy. Thanks for being here. Take care of yourselves everybody. Yeah

And that’s what I got for you guys thanks for tuning in. I hope you enjoyed it. I hope you got something out of it. Thanks to Amy for being here and sharing her pearls of wisdom. Yeah, I really appreciate everybody’s time. I appreciate your time and her time and Dustin’s time who produces our episodes. It’s like don’t forget Dustin.

And so anyway, everyone is appreciated in the making of this episode. Anyway, guys, I’ve had enough. It’s been a day. I’m going home. Take care of yourselves, everybody.