Medicine

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.

This week on the Cone of Shame Veterinary Podcast, board certified behaviorist, Dr. Leanne Lilly, joins Dr. Andy Roark to discuss the link between stress and the GI tract. Together they talk through treating the behavior case of Calix, a calico feline that will not stop defecating outside the litter box. 

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 you ad free by Hill’s Pet Nutrition.

LINKS

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

Hill’s Prescription Diet GI Biome Feline:  https://www.hillspet.com/cat-food/pd-gastrointestinal-biome-feline-dry?cq_src=google_ads&cq_cmp=12261618915&cq_con=112560660650&cq_term=hills%20gastrointestinal%20biome%20cat%20food&cq_med=&cq_plac=&cq_net=g&cq_plt=gp&gad_source=1&gclid=CjwKCAiAloavBhBOEiwAbtAJO4TWaZ1xA4C5UP3CsqjqQHBL83bRYKlyAemu_QdHIECeeuC-GdSKPhoC6M8QAvD_BwE&gclsrc=aw.ds

Leanne Lilly LinkedIn: https://www.linkedin.com/in/mleannelilly

TVP Article: https://todaysveterinarypractice.com/nutrition/feline-stress-nutrition/

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

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

ABOUT OUR GUEST

Dr. Lilly is an Assistant Professor and the service head for the Behavioral Medicine Service at The Ohio State University’s Veterinary Medical Center. She received her DVM from the University of Wisconsin-Madison in 2011 and spent 4 years in the trenches of general practice. She completed a specialty internship in Behavior Medicine at the University of Pennsylvania. She followed that with a Behavioral Medicine Residency at The Ohio State University, where she then joined the faculty, teaching residents and veterinary students. She serves on the Ohio Veterinary Medical Association’s Behavior Education Committee, the ACVB’s exam committee, Low Stress reviewer for VIN through Cattle Dog Publishing. She has appeared in a webisode of Animal Planet’s Life at Vet U, over 75 print, and live interviews. She is Fear Free Elite and Shelter, Low Stress Handling Silver, and Feline Friendly Certified. When not working she enjoys kitten cuddles and landscaping.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host Dr. Andy Roark. Guys, I got a good one for you today. We are talking about stressing cats. We have a cat named Calix that is defecating outside the litter box when mom travels. It seems to have a stress component, but it needs to get sorted out.

And so I have Dr. Leanne Lilly here with me to help sort that out. She is a boarded, veterinary behaviorist. She is on the faculty at the Ohio State University. She is a great person to talk to. I really enjoy her. We get into a GI brain interface. We get into the biome. We get into stress management.

We talk a lot about expectation setting with pet owners, which honestly, that’s… that was great. That was a really neat little pearl that I put in my pocket, and I’m gonna, I’m gonna set some expectations with pet owners a little bit differently. I think that was really good for me. Anyway, you’ll hear it. You can decide if it’s good for you, but I loved it. 

This episode is made possible ad free by our friends at Hills Pet Nutrition. If you have not checked out their learning platform, it’s called Hills Veterinary Academy. I’ll put a link in the show notes.

It is a fantastic place to get your learn on. Guys, let’s get into this episode.

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

Dr. Andy Roark: Welcome to the podcast, Dr. Leanne Lilly. How are you?

Dr. Leanne Lilly: I’m doing well, thank you.

Dr. Andy Roark: I’m so glad that you’re here. Thank you for coming on. For those who don’t know you, you are a board certified veterinary behaviorist. You are an assistant professor of clinical, how do you say it, assistant professor clinical for behavioral medicine at the College of Vet Medicine at the Ohio State University is?

Dr. Leanne Lilly: Yeah, yeah, we usually leave out the College of Veterinary Medicine as it’s sort of implied, because that is the most long and gamely title that I think I’ve come across. I mean, it sounds really important, right? So many words, but yes. 

Dr. Andy Roark: I imagine the old cop shows where they would like whip their badge out and you have one, but then when you whip it out, it just folds and folds and folds as your title keeps wrapping down. I love that you were here. You are… first of all you are fascinating for a lot of reasons.

You are so focused in Low Stress Handling. You’re fear free elite certified. You have done so much with stress management in shelter pets. You have a lot of expertise and experience in the field of stress management, I would say. So, how did you get into that?

Was it a conscious decision? Is that something that has evolved over time? How did you just sort of decide to be the stress doctor?

Dr. Leanne Lilly: Yeah, so it’s a little bit of both. The sort of long version goes all the way back to when I was eight. And I was not one of those people who knew they wanted to be a vet when they were a kid because I’m actually a needle phobe. But I had a dog who had seizures most often during thunderstorms. And so that sort of jump started my foray into the brain.

And then in vet school, in undergrad, actually, I did an undergrad in Biopsychology. So I studied the brain and behavior and neurotransmitters. Yeah. Then I went to vet school and then because of that background, I started collecting all these patients who were nervous in the hospital or hard to handle in the hospital or had anxiety components at home because it was very comfortable reading about a medication and say, okay, well, what does it do?

What does it bind to? Who does it talk to? Is that going to be helpful in this symptomatology? And as I collected more cases, then of course I got to the end of my knowledge base. And then said, okay, there has to be someone who knows more about this than I do. Who are those people? which is when I discovered the diplomats of the American College of Veterinary Behavior.

I did a specialty internship and that sort of blossomed me further into that. And then I said, yes, this is absolutely what I want to do with my life. I went into residency and then I just hung on to academia because I love that ability to keep expanding the knowledge base both for myself and for my students.

And it gives me the opportunity to do things like. Study how behavior changes and how stress management and teach stress management. So that’s kind of how I got here. 

Dr. Andy Roark: That’s amazing. I have got a case that I think you are uniquely qualified to, to talk about. Maybe not uniquely, you’re super qualified, not uniquely qualified, but super qualified to talk about. I’ve got this case. Can I bounce it off of you? Is that okay?

Dr. Leanne Lilly: Absolutely. 

Dr. Andy Roark: Alright, cool., I have a two and a half year old female spayed domestic shorthair named Calix.

She’s a calico, and she… 

Dr. Leanne Lilly: Spicy. 

Dr. Andy Roark: Yes, a little bit, a little, a little bit she, you know, the technician’s face doesn’t necessarily light up when she comes into the hospital, but she’s a sweetie in her way, in her special way. She is here because she’s driving mom nuts with pooping outside the litter box.

And,  what happens is, it’s, it’s mom travels, mom travels for work, she goes away, and everything is fine, and then she goes away, or, boyfriend comes over and stays for a weekend, or some other, you know, sort of small thing, maybe some furniture gets moved. And now we’re backed up pooping out of the box again, and she’s going back to the doctor, and they’re doing a workup for GI stuff.

She’s had an internal medicine workup. There’s really nothing significant that they can find. They’ve scoped the cat and it’s sort of vague. It’s maybe it’s IBS, maybe it’s not, you know, we can’t really tell. A lot of sort of vague, vague symptoms and signs, and words like that being thrown around.

And so she’s really frustrated. 

Dr. Leanne Lilly: Nobody likes to clean up extra cat poop. 

Dr. Andy Roark: Exactly. And, the thing that she’s really grabbed on to is this “it’s when I travel.” And again, a lot of people will have the cats and they’re like, oh she’s punishing me. And we know that that’s not real. But it’s, that type of vibe that she’s, you know, she’s like, definitely seems correlated to my behaviors and me doing these things that she doesn’t like.

And so anyway, I’m talking with her. I want to do right by this owner. I want to try to fix this problem. I want to make sure this cat doesn’t get vilified, not that mom would try to do that, but you know what I mean? Like, I want to, I want right by her as well. So, let me just, Ask you about that and sort of lay it out and say, I’m looking at this case.

I’m kind of walking into it. Dr. Lilly, how do you treat that?

Dr. Leanne Lilly: Yeah. So taking a good history and finding out and confirming that this really does happen with these changes in the environment, changes in the schedule, changes in routine does very much make me think that this is stress related. And, I think what gets tricky about that is simply because we’ve identified it as a stress related problem doesn’t mean that there isn’t also a GI component to that stress related problem, because every time we look at it, the GI brain axis gets more complicated and more interesting, and it talks to each other bidirectionally.

So the stress can influence the GI tract and the GI tract can influence the stress. And so maybe what we’re having is the stress impacts the GI tract and then we get a vicious cycle until mom returns. And then if mom is stressed, now we have more stress at home. So that can become really overwhelming for everybody in the household really quickly.

And certainly anytime there’s a change in stool, you want to do your due diligence and make sure nothing has changed because just because the last fecal was normal doesn’t mean this fecal is normal. But if you’re going through that cycle, and we’re not getting what we need, then focusing on either the GI brain interface or the brain side may be very helpful in helping Calix and this owner get to a much better place in that regard. 

Dr. Andy Roark: I love the conversation, the GI brain interface, this is actually an area that I just sort of became aware of in the last year. And it’s rather amazing to look at what we can do with GI health, to have effects on other parts of the body. And so, I like this.

Mom does not want to pay for any more fecals. And again, I get it, and we’re always like, hey, just because it was normal last night. I, I get it, she’s at that point. And so, all of that makes sense, all of that tracks. The cycle of the stress buildup, things like that.

Where do you start to intervene? First of all, let me ask you about sort of getting this back on the rails. We have this cat. And, she’s defecating outside the box and mom is bringing her in yet again. What are your sort of pearls? What are your favorite things for trying to get these stress cases kind of calm back down and back on the rails?

Because let’s be honest, coming into the vet clinic is not helping this stress level that we have. Help me first to stabilize and then long term management.

Dr. Leanne Lilly: Sure, so some of those stabilizing is. It’s going to end up being client education and client management, right? The cat is not doing this for spite, the cat is doing this because it’s profoundly stressed out. It doesn’t seem like it, but take it as a compliment. Your cat loves you that much, and that can help reframe things and calm things down so that you have the bandwidth to then start doing an intervention at the cat level.

And then I really want to think about, is this cat’s GI tract working as perfectly as it could? Either all the time or during stress and then how can we support that stress. So that might include things like diet specifically for the GI tract because stress changes the microbiome. Even if we don’t get diarrhea, stress changes the microbiome.

Stress can certainly also decrease the rest of the health function and lead to additional non positive things. So hairballs, upchuck, this idea potentially of Pandora’s Syndrome launched by Tony Buffington. So we also want to look at that stress side and that, depending on the client, depending on the cat, that might be nutritional management of stress.

Things like supplements and probiotics and the generally recognized as safe type of products and diets that are specifically for stress, you might think about how do we combine those two things. We might reach for medications. I find a lot of people are hesitant to do that. For all the reasons that make perfect sense, is the medication safe?

There’s a, there’s actually just a stigma about behavior ,and psychiatric modifying medications. And how easy is it to get it into the cat? You know, we have a shortage of highly palatable flavored medications that are for stress. By which I mean we don’t currently have any FDA labeled ones except for Pregabalin, which is brand new.

So, if we can get something into the cat that the cat likes to eat, and it’s easy for the client, and it helps address either the GI side or the brain side or both, that sounds and feels like maybe we could have one stop shopping in a slam dunk for this case. 

Dr. Andy Roark: When you start to look at this, and that definitely makes sense as far as, a one stop shop, let’s be honest, convenience in cat medication is a, it’s a big driver, I don’t, I, I think convenient sounds like the wrong word, but it’s…

Dr. Leanne Lilly: Adherence, right? Can they actually do it? 

Dr. Andy Roark: Yeah, and again I tend to choose positive, uh, thoughts about, you know, pet owners when they come in and so everybody’s doing their best and it just, it’s easier just to

Dr. Leanne Lilly: But can we make it easier for them? 

Dr. Andy Roark: Exactly. Do you find that pet owners are kind of open to these types of conversations around nutrition? Do you think you get buy in? Are they like, yes, I like this, or are they sort of skeptical? that yet another food is going to help. In this case, you know, with Calix, they did some diet trials with internal medicine.

Now, granted, it’s not what we’re talking about, but I don’t know the pet owner necessarily differentiates what we’re talking about from the diet trials that she did before. What is that conversation like?

Dr. Leanne Lilly: Yeah. So I think buy-in has probably been better in the last couple of years as the idea that your GI tract influences your body has become more public knowledge, in the human side. But I think even without that, it’s about getting specific about. Why this particular diet in this sense, and recognizing that the hard work that they did to go through other diets and notice what those diets did and didn’t do.

So if you’ve done a hypoallergenic diet trial, say we tried a hypoallergenic diet. That diet, you know, it’s designed to keep the immune system from flaring up in response to the food. And the great news is your cat doesn’t need that highly expensive hypoallergenic diet. And that means that we have other options.

The diet that we’re talking about is potentially designed for whether we talk about a calming diet or a microbiome diet, right? Getting down into these about what it’s designed to do and how it does that and why that’s specific to Calix and why that may specifically help Calix in terms of the signs that we’re seeing.

If you have personal experience with those, I think that’s really helpful. If you have little samples in the room and you say, Hey, we can even just see which one Calix likes to eat. Cause guess what? None of these do any good in the dish. They have to get into the cat, right? Those things can really help buy-in.

And if you set them down and the cat’s like, I am absolutely going to gobble that up in the exam room. And normally Calix doesn’t eat in the exam room unless you whip out the high value churro. You’re like, aha. All right. Now we’re starting to look at easy and potentially successful. So I think those conversations really are about bringing the client along for the details rather than glossing over them to try and help them meet you in the middle, right?

We have all this stuff in our heads that we know about these things and why those two things are different and why this food is different from that food and why a novel protein is different from a hydrolyzed diet. And it’s really our job to bring the clients along in that information journey in a way that they understand.

So that also means being willing to stop, pause and say, what do you know about or what was your experience with? Or have you heard of the term GI brain axis, right? And see where they are and then try to find the stepping stones to bring them along so that what your thought process is actually makes sense to them.

Dr. Andy Roark: What does the client experience if we lean into like a biome diet or into a stress diet, something like that? There’s a lot of, there’s a lot of nutraceuticals in the world that have been sold to people and pets and some of them are amazing and they work really well and a lot of them people are like, I don’t really know if they helped or not.

If I want to set expectations for these types of diets and stress management cases, is this going to be a fairly stark change in the patient? Is this something where they’re probably going to see real improvement in a short period of time? Is this going to be a two week process of kind of re-regulation like what are they going to expect to see when they get back home?

And I know it’s very case specific individual specific But just how do you set their expectations of I fed this 20 minutes after I got home and it isn’t working. Yeah

Dr. Leanne Lilly: Sure. So some of that depends on which diet you’re using and the case, and where your target and your stress points are. So for Calix, for example, if the stool gets a little bit soft every time we defecate outside the box because the boyfriend came over or we moved the furniture or we traveled, then we may actually see clinical improvement, at least in the stool quality within 24 hours, which to my end, that’s great.

The cat may still be defecating outside the box, but for the client, that means they’re not picking up gross poop anymore. Now they’re picking up solid poop. And so you can highlight that as right. Here’s your little ray of sunshine about that. Now, in terms of whether or not from a GI brain access, that’s sufficient on its own to help the cat manage in the stressful situation. You won’t know until the next stressful situation. And so I think that is a client expectation that you have to manage. I think the other thing is putting some objectives on that, right? It’s the last time Calix’s mom traveled for four days, we had 27 incidents of poop.

That’s a lot of poop. Traveled for four days. We had four poops. Back at having diary had four poops outside the box, and the next time they travel, we have one poop outside the box, right? That’s improvement. And so we need to try and get those objective measures so we can have those good conversations because the client goal is always zero, and sometimes it takes us some finagling to get there.

And so we want to be able to say, Hey, we took five steps forward, and it was amazing. I understand your goal is zero. We’re going to keep working towards that. So those types of details and adjusting those inside the case, I think, is really helpful for both the client and for you, right? If you know that objectively, then when they come back in for the recheck, you’d be like, Ah, four poops last time, like on average a poop per day out of the box.

Next time, we only had one out of the litter box. Maybe it was on the last day. Maybe it wasn’t. Doesn’t matter, right? We’re making progress. So those types of things can help both the client. As well as you for your management because then you don’t have to guess. 

Dr. Andy Roark: That is exceptional expectation setting. I think it means, it means, because you’re exactly right. Their expectation is zero. I will feed them this food ,and I will have no more problems. I think saying zero is our goal and know that it may take some time to get there. There are intermediate improvements that we’re probably going to see before we get there.

I just think that that’s really smart communication. That’s fantastic. All right, great. I really enjoy talking with you. I could sit here and ask you a million questions about the GI brain interface and just I, this is an area I’m still really, truly, deeply interested in and I want to keep learning about.

If someone is into, if someone’s really into this conversation and they’re like, I want to learn more about biome, I want to learn more about the GI brain interface and stress management, what are your favorite resources? Where do you send people?

Dr. Leanne Lilly: Yeah. So it depends a little on whether they’re looking for client side or, you know, white paper side. White paper side, of course, I’m biased to my colleagues, no offense to anybody else doing wonderful research out there. It’s just that I got to see it develop on both sides. So I’m like, Ooh, it’s shiny.

So we actually have some pretty good papers on this coming out through JAVMA in the last couple of years. So that’s actually relatively readily accessible, for the veterinary community, 

 More research is coming out every day. So, ask me again in six months, I’ll probably have more places to look.

Dr. Andy Roark: I’ll link up some articles and everything for people in the show notes, things like that. What did you like for client facing? 

Dr. Leanne Lilly: For client facing things get a little bit messier, because it’s such a novel field. And so they change a little bit. Veterinary partner has a couple of handouts about. Basic urine and defecation outside the litter box and that it’s not for spite and those types of things.

And I think that can be really helpful if it comes from multiple places. They have some supporting documentation about IBD. We have a handout, it should be available on the Indoor Pet Initiative that’s called IBS. It’s about stress with a little apostrophe ignoring the A, because I’m a literary nerd, and I think that that’s really helpful as a bite size piece of information to give people or to think about, okay, here’s how someone else talked about this.

How might I reframe that for my specific client? Cause nothing is one size fits all. 

Dr. Andy Roark: Yeah, absolutely. Leanne, where can people find you online if they want to kind of follow your work and what you’re up to?

Dr. Leanne Lilly: Yeah, so I have a LinkedIn page. It’s just my name, M. Leanne Lily, and then the clinic web page does a pretty good job of keeping things up to date and posted for resources at the vet.osu.edu/behavior page. So those are pretty good places to find out what I’m up to. 

Dr. Andy Roark: That sounds fantastic. Awesome. I will put links to all that sort of stuff. Thank you so much for being here. Gang, thanks for tuning in, everybody. I hope you found something helpful and useful that you can put into practice. So, I have to go see Kalix and get this sorted out. So, thanks a lot, everybody.

Dr. Leanne Lilly: Thanks, Andy. 

Dr. Andy Roark: And that’s it. That’s what I got for you. I hope you enjoyed it. Thanks to Dr. Leanne Lilly for being here. Thanks to Hills Pet Nutrition for making this episode possible. As I said, if you haven’t checked out the Hills Veterinary Academy, take a look at it. It’s a great site. It’s a great resource. Um, yeah, I just, um, I’m a big fan.

Anyway, I hope you guys will have a look. Take care of yourselves, everybody. I’ll talk to you next week. Bye bye.

Dr. Christopher Pachel joins Dr. Andy Roark on the Cone of Shame podcast to discuss the intriguing case of Caliente, a seven-year-old calico cat exhibiting inappropriate urination. Despite the pet owners attributing the behavior to behavioral issues, the duo explores the underlying medical complexities. Tune in as they expertly navigate this conversation by validating the pet owners while shedding light on potential medical conditions driving Caliente’s actions.

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

LINKS

Dr. Christopher Pachel: www.DrPachel.com

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

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

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Come to Shame veterinary podcast. I am your host Dr. Andrew Roark. Guys, I got a great How do you treat that episode today? I am here with vet behaviorist, Dr. Christopher Pachel. He is a boy. He is fun. He has got, he’s just, he’s got such great energy and I love how he talks about what he says and how he says it.

It’s one of, this is one of those conversations where you hear just, he’s just pearls, he’s just scattering pearls everywhere. And it’s just, you could hear him in the exam room having these conversations. And I was just like, I’m writing that line down. Ooh, I could hear me saying that and I just got so many things that I would actually say to a pet owner.

Such a good conversation. So much fun. We are talking about medical conditions that masquerade as behavior problems. So this is a behavior consult that’s not. it’s anyway, it just, I love his perspective on this. Really good conversation. I think this is good stuff to file away. Anybody who likes behavior is going to love this episode.

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, Dr. Christopher Pachel. How are you?

Dr. Chris Pachel: I am doing fantastic, Dr. Roark. How are you today? 

Dr. Andy Roark: I Man, I’m so good. I’m so glad that you’re here. You and I have sort of circled around the same circles for a long time. We’ve got a lot of mutual friends. And we only got to meet recently, and you are so fun. I really– Every time I talk to you, I leave with a smile on my face. I caught up with you and we started to sort of talk shop a bit in Orlando early this year and you were laying out a couple of lectures and I was like, Oh man, this is really interesting stuff.

And so I’m so glad you made time to be on the podcast. For those who don’t know you, you are a boarded veterinary behaviorist and lecturer. I have a case that I wanted to run by you if that’s okay. right. He’s making the anticipatory evil genius finger sign.

Alright, here we go. I have got a seven year old female spayed calico cat named Caliente, who goes by Callie for short. And she is urinating inappropriately. And this is not Unusual for her this has kind of been going on and on the owners are not really big on diagnostics they have said no she is spicy It is the spiciness that is causing Caliente to pee outside of the box and they seem pretty adamant about it I am as this problem persists, I am less and less okay with this, but, I’m going to have to wade in and talk to these people.

Their position is, she’s seven years old and has always been spicy and this, she’s just doing this because she’s unhappy. And so I just wanted to kind of run that back to you a little bit and say, When you get these cases that people say, this is a behavioral case or this is anxiety, things like that.

How straight away do you buy that? And what landmines do I need to look out for in these presentations?

Dr. Chris Pachel: That’s such a great question. And that scenario is so incredibly common where an owner comes in with a I almost said a premonition. That’s not exactly right, right? But that’s sort of a a pre existing idea about what’s going on here. And I find that for a lot of clients. So when that happens, even as they’re giving me the answers to my question, I can almost feel them trying to lead the responses into a different direction where everything comes back to, you know, her emotionality.

She’s got big feelings. She’s really spiteful. So therefore, yeah. That becomes the explanation for a lot of things. And so when I recognize that as a bit of a tip off, my first response is typically to say, you know, it sounds like, you know, your Cali or Caliente, you know, her really, well.

And I’m excited to get to know her right alongside you. I’ve got some additional questions for you to really be able to, make sure that if this is a behavior issue, we really figure out what we’re going to do about it and how we do that. In the meantime, I’m also going to be listening for other things that could actually be there because of an underlying medical issue that might not be all that obvious right at first glance. So if it’s okay with you, let’s dive into some of those questions and let’s see where the conversation takes

Dr. Andy Roark: Oh, I love that from a conversational standpoint just the opening up of you are clearly in tune with her. You are– this is great. I am so glad you are here. I really like that approach and then just introducing the idea there may be other things go off, Chris. That’s really a really nice introduction. I like this opening the conversation.

So great, so you start to put those things forward, what are we talking about here when we see these things coming in? So talk to me a little bit about the medical conditions that manifest as behavior, if you don’t mind. 

Dr. Chris Pachel: absolutely. So there’s a number of them that I would say we see with increased frequency compared to others. And certainly in a case like this, where the primary concern is elimination outside of the litter box, you know, certainly, you know, we might tease that out. Are we talking about stool?

Are we talking about urine? And we might go down that systems based approach. They’re really wanting to, I guess, in the ideal world where everything is convenient and nothing costs Money we’d be able to get those diagnostics to rule those things out. But my clients have the same sort of pushback that yours do and that everybody listening to the podcast, you know, it, isn’t necessarily convenient.

Maybe Caliente has different ideas about how she wants to donate a urine sample today, and so we’re flying blind a little bit with our diagnostics. So all of that to say, I’m looking for underlying, you know, issues relative to the urinary tract. So anything that’s creating you know, increase urine volume or urgency and whether that’s a urinary tract infection or stones or even some of the other systems and that’s perhaps some of the endocrine disorders like hyperthyroidism or diabetes that may impact urine volume or the overall patterns for elimination.

And then we broaden it even further to say, is there anything that might be causing discomfort? And especially when we think about a seven year old cat, we say, oh, well, she’s young and healthy. Therefore, it’s probably unlikely that it’s a medical issue. And yet, the more we learn about cats and things like osteoarthritis, the more we start to recognize some of those patterns that even for a cat who is urinating outside of the litter box, that can be discomfort, right?

She has to crouch, she has to posture. She has to walk on, you know, a shifting stand, sort of a surface that can cause discomfort for some cats. We also find in those cats where discomfort is an issue, even sometimes seeing a differential response between urination and defecation, knowing that the physical posture that cat needs to assume for those two elimination events is actually different.

And we can see a lot of specificity of one patter over the other.

So I’m looking for all of those things within my clinical history, within my observation, and certainly within my physical exam.

Dr. Andy Roark: I talked to a dog owner this morning who came in and the present presenting complaint was He’s an old dog. He’s a Westie and 17 year old Westie and he said oh, you know, his biggest problem is that he holds his urine. We have to really convince him to go and my immediate question was around mobility and pain and things like that.

Chris, can you talk a little bit about the interface between pain, discomfort and behavioral presentations? Just, I know that’s sort of a broad topic, but how often do you see this? How often do things make their way to the behaviorist and you’re still, and you’re still thinking about pain or discomfort?

Dr. Chris Pachel: I would say pain and discomfort is probably the most common underlying issue that has not been fully recognized or addressed in our patient population at the behavior clinic. And obviously that can come from a variety of different places, whether it’s a, You know, untreated allergies, and we’re creating itch and pruritus and discomfort in that direction, whether it is low grade chronic, you know, IBD, IBS type signs, and we’re seeing that, that visceral discomfort associated with gastrointestinal disorders, or whether we’re talking musculoskeletal issues, maybe it’s the partially torn cruciate, maybe it’s LS disease, or maybe it’s a type of discomfort.

You know, an old so as injury or who knows what it is, but you know, we see it over and over again, either as a direct cause of behavior change, you know, perhaps it’s that you know, like the dog you were just describing, maybe it’s a dog who’s now reluctant to go down the stairs when they go out into the backyard because They’re physically unable to do so comfortably.

And so we see that direct sort of cause and effect. I am uncomfortable, therefore I won’t do the stairs, or therefore I won’t go into the litter box and eliminate. So it’s a very direct correlation. And in other cases, it’s much more indirect, where we see, especially with some of the emotional disorders, or some of the emotional patterns, where we may see an animal who’s more irritable, maybe is not sleeping as well as a result of that discomfort.

And so now we’re dealing with more of the chronic effects of sleep deprivation and that effect on cognition and that again, irritability or altering threshold. So we may now have an animal who’s always been, let’s say a little bit sensitive to a particular stimuli or a particular set of circumstances.

And now we get almost a new on chronic presentation for that animal. Because they’re not as physically comfortable, which means they don’t have the same level of tolerance or resilience or threshold as they previously did when all systems were go.

Dr. Andy Roark: you’re, kind of blowing my mind. So orthopedics is something I got my head around a long time ago. Like I just, I’ve seen a lot of inappropriate urination, elimination because of back pain because of hip pains, you know, you see the creaky pets that are having, I get that one, but the untreated allergies presenting as behavior and like IBD as a behavior issue, that’s kind of shocking to me.

I get the sleep disorder as well. It’s kind of funny. I, it’s not one that I originally comes to, or immediately comes to my mind, but talk to me a little bit about that. What, is it like when the case presents for untreated allergies at the behaviorist?

Dr. Chris Pachel: Yeah. So what we’re looking for usually in a case like that is, you know, any little tip off. So if we’re going down the allergy perspective, for example, we may see that pruritus or itchiness, or if the owner is interacting physically with that animal, we may see avoidance or an animal who is, you know, shifting their body in response to manipulation in some ways.

We may see cases where, you know, even while we’re interacting with them, the animal pauses in the middle of a social interaction to itch or scratch or rub on the carpet or something along those lines enough to just sort of prompt the question of, do you see this at home? If so, how often? And, you know, and oftentimes again, owners have had it.

You know, they’ve had the observations, but I’ve never quite made the connection, certainly to that being a primary issue, or it impacting the other issue that they’re presenting the animal for. And that irritability is a huge piece of that.

Dr. Andy Roark: Hey guys, you know, probably the number one plea for help that I get from medical directors, from practice managers, from practice owners, from lead technicians, and especially lead CSRs is, “Hey, Andy, help me, help my staff to deal with angry and complaining clients. They need ways to help these people because angry clients, complaining clients, they need help is what they need. And, our people aren’t empowered or they aren’t trained in how to do that.”

And so why isn’t there more training for this? Why aren’t there more resources that make teams good at dealing with angry and complaining clients?

Well, the number one reason really is, the way that feels natural for your team, the skills that they have that they would bring into the situation, they’re different in every practice. So there’s not a bullet pointed. This is how you do it way. Which is why I end up in this place where people are like, “Andy How do I do this?”

Listen, I made a course it’s called ‘Charming the Angry Client’ and it is my course meant for teams or groups to work together on all about dealing with angry and complaining clients.

I use what’s called the Davidow model of organizational response, which is a super peer reviewed, empirically tested way, of addressing angry and complaining clients. And, I break it up into pieces so that it’s easy to digest. You can scatter it across a number of meetings, it is made to be watched with a couple people together. And then there’s discussion questions about how do we do this in our practice? What does this look like for us? What, when, think about a time that this happened and we saw it. How did we handle it?

Ooh, I also put a bunch of, example videos in there of me being an angry client. So I, I will just give it to ya. As here’s Andy with his pet, and he is upset, and then you can pause it, and then you can talk about right there, “What would we do with this? How would we handle this, guys?” And it is a great, low stakes way of getting your team to talk about what they would actually do.

Guys, there’s nothing more powerful than your team. Talking about what they would actually do and comparing notes, sitting and getting lectured at is nothing close to your team, whether it’s just your CSRs, whether it’s four of your technicians working together, whether it’s a whole staff meeting and a manager or owner or medical director leading the meeting and being the facilitator guys, I put a whole facilitator guide in there too. There is a whole hour long broken up in a module section on how to run an active training program using this course.

And that’s all laid out there and how I do it, how I work with big groups, how it works, small groups, all that information is there. Anyway, it’s called Charming the Angry Client. It is on the Dr. Andy Roark website. I’ll put links directly to it in the show notes. Guys, I hope you will enjoy it.

I think it’s really valuable. It is, honestly the most popular course I have ever put online. Grab yourself a copy. I hope you’ll get a lot out of it.

Let’s get back to this episode.

 I, I have felt less than. Sometimes, Chris, when I, you know, when I say to someone let’s, you know what, let’s try an anti inflammatory medication for a little bit and, let’s see what impact this has. I, I don’t know if that makes sense why I say I feel less than, but something, they come in and they have a question and I’m not, you know, I’m kind of feeling something or it’s a cat and I’m trying to do orthopedic exam and it’s not going very well, you know, something like that.

And I feel like I’m maybe faking it in a way of going. Ah, you know, well, maybe can we try this other thing first? How do you so when I sort of say that to you, you know what I mean? And you’ve got IBD you’ve got allergies or things like that one Is that sort of empiric treatment for the things that we’re seeing in the exam room when they present for behavior?

Is that a problem in your mind? And if so, or if not, then how do you usually layer those things together? In my mind, I’ve always thought, I don’t want to start going heavy on behavior stuff while I’m also introducing, An apparent treatment for a potential medical condition because then I’m not gonna really know what’s working or things.

And so I kind of send them away with empty handed from a behavior standpoint. And I’ll be honest. I kind of questioned myself and go, Andy, are you taking the easy way out? Because it’s a whole lot easier for me to treat IBD or you know, or especially orthopedic pain, things like that. That’s a whole lot easier for me to cut a script than it is for me to wade into that behavior conversation.

So I’ve always questioned myself and say, Andy, are you taking the easy, are you kicking this down the, kicking this down the path here? What do you think about those sort of thought, thoughts when I sort of put them out to you?

Dr. Chris Pachel: Yeah, I think what I’m having the conversation with that owner, I may say something along the lines of, you know, this sure looks like a behavior change and what you’re describing is consistent with a behavior change. Absolutely. Without question. You know, Cali better than I do. And sometimes, you know, some of these issues can be hard to detect, even in people who really care about their animals and are paying very close attention.

We know that from some of the studies, and I may go into a lot or a little bit of this depth when I’m talking with the client, but we know that for some of the studies, even when we have an underlying gastrointestinal issue, for example, they may not show any clinical signs until we run the diagnostics.

And so, you know, I’ve got this little inkling in the back of my mind that really wants me to make sure that there’s not something underlying this because, truthfully, if it is a pain related issue, I want your pet to be as comfortable as possible. So are you open to trialing this? As kind of a diagnostic challenge, we can go down this process, and if we do an anti inflammatory, or if we’re talking about GI disease, maybe we do a trial with a hypoallergenic diet for a period of time, and we say, let’s ask the question and answer it if we do this change And the behavior of your pet changes in response to That’s a pretty darn good confirmation that there’s something going on that we probably should take a closer look for And if it doesn’t Well, cool, then we got great information from that as well.

So we’re getting some information either way I really just want to make sure your pet’s as healthy as we think they are Before we go down the pathway of other interventions.

Dr. Andy Roark: I’m sure this really ties tightly to what the other condition is when I ask you this question. How long do you start to go down this alternative pathway? And, look for results before you say, okay, this is not what I thought it was going to be. I don’t know if I’m saying that very well.

I think, what I’m kind of digging for is, so let’s just say it’s allergies. Do you give the expectation to clients that We’re going to do this and in 48 hours this behavior should be gone, you know, or significantly reduced. And my thought too is in some cases there are– I just think about my own life and there have been things that have ailments or injuries that I’ve had and it’s caused me to sort of change my behavior and then the injury gets better and my behavior doesn’t change.

Let’s just say that, say for example, say I start sort of leaning on my, I lean on my left leg because my right hip bothers me. And then after a while, I just get used to standing on my left leg. And so if you take away the pain in my right hip, I’m still going to stand on my left leg. And you would say, well, Andy’s still standing on his left leg.

So clearly that wasn’t the answer. Does that make sense? Like, like how strongly do you, and I also know that when I said that, when I sent the pet owner home, they’re going to watch this pet like a hawk. They’re going to be like, is he fixed yet? Is he fixed yet? And so, how do you help? Yeah, exactly. help. What should I expect starting to have some of these therapies where there is behavioral symptoms from underlying conditions?

And what sort of expectations should I set with the pet owner?

Dr. Chris Pachel: Yeah, I think there’s two things that really stand out for me. One is If I’m going down that pathway of, let’s say, let’s go back to that allergy dog that’s with me in the consult room, for example, and I’ve recognized that they look a little itchy. I don’t know if that’s related to the medical issue or excuse me to the behavioral issue or not, but I want to make sure that the client knows what we’re monitoring.

So it’s not just, did we cure the behavior issue and it completely resolved? I’m trying in most cases to identify one or two observations that I can allow the client to look for that would suggest You know if we go down that pathway of an anti itch treatment of some case or something that’s affecting the GI tract Am I looking for changes in the frequency of itching, scratching, or licking on the GI side?

Am I watching for any changes in stool quality or the number of bowel movements per day? Something that is easily identifiable for the owner and that usually stems from something that I’ve heard or observed in either the client’s history or in watching their animal or asking some of these questions.

So I’m trying to find a couple of markers versus just saying, well, let’s try this food and see if he or she gets better and the client goes home and they’re expecting a miracle. They didn’t get a miracle. And so they report back not didn’t work. So part of it is trying to be very specific to the best of my ability in that moment.

What do I think we can monitor for even before we get to the big picture behavior issue? The second side of that is also If there is something where we have an interplay between medical and behavior, let’s say, for example, I’ve got a cat very much like Caliente, the one we were talking about earlier, let’s say the issue was not urination outside the box, but maybe this was a cat has a new onset of reacting aggressively when she’s picked up by the kids or by a visitor in that particular scenario.

I may say, well, you know what? You know, sure, we can try a pain medication trial, and let’s monitor for gait, let’s monitor for movement up and down stairs, let’s monitor for ease of jumping on and off surfaces. I want to watch those things more so than just whether or not she’s more tolerant of being picked up, because If she has had an experience over the last day, week, month, or year where being picked up causes physical discomfort and we now have an emotional response to that, just making her feel better in this moment physically

isn’t automatically going to change that learned behavior or those sensitizing events that she’s experienced in the past. So I want to watch for signs that the intervention is making a difference on that underlying medical issue but I also want to make sure that i’ve set that stage for the owner to say “Hey, And if the behavior issue persists, it could mean that this is not in fact related to that medical issue, or we got two problems going on here.

We have a medical issue that started this whole process, but now she’s learned some stuff. She’s had some experiences, and we need to circle back around and actually address the emotional or learned component as well.”

Dr. Andy Roark: You know, two things I noticed in my conversation with you, and I had this impression when you and I first talked. Well, it’s three things, I would say. You do a phenomenal job of validating the pet owners. I, just, I love how you do that, and you are so on their side as you’re having these conversations.

I just think that’s exceptional. I really love how you set expectations as well. And just as a behaviorist, that has to be, it has to be a tool in your toolbox. You like, you have to, write in behaviors and, also manage many. I’m sorry. you have to reign in expectations and really sort of help them to understand what success looks like and what is reasonable.

And you just do that so well. And then, and the third thing I would just say about you that I love how you share what you say and how you say it because when I hear you say it out loud I just can a hundred percent internalize that and go. Yeah, that sounds good. I could see me saying that or I can see me saying some version of that. So I just wanted to say I just love how you do that.

Dr. Chris Pachel: Thank you.

Dr. Andy Roark: When you look at these cases of medical conditions that are sort of masquerading as behavior, kind of what we’ve been talking about, are there significant pitfalls that you see general practitioners falling into that can either be rare mistakes that are catastrophic? You make them or common mistakes where they show up in your clinic and you say, Ooh, I wish.

I wish this last doctor had asked this question. Are there consistent little blind spots or problem areas that we need to be aware of in these types of cases?

Dr. Chris Pachel: You know, I think this is actually something I was chatting with some folks about in Columbus this last weekend when I was lecturing at Midwest conference event conference as well. And we’re having some examples there where we make assumptions too soon, like when we’re busy in the clinic, right?

That client comes in, that animal comes in, we do a quick physical exam. We either find something or we don’t, we ask three or four questions and we get sort of that clinical picture. And You know, for example, it may be that dog who comes in. It’s a four year old Labrador. It’s gained some weight. It’s a little lethargic and, you know, and our brain is like, okay, well, it’s hypothyroid.

I’m just going to test the thyroid and let’s just see what happens, right? So we sort of make the assumption based on what’s most likely. And that is a part of our differential diagnosis, right? We are ranking the probability of those things. With that being said, I find there’s so many cases where we test the thyroid and it’s not a hypothyroid dog, then what?

And I think in many cases we sort of either lose the, skill set over time, or maybe don’t leverage that skill set of really running through that scheme of what are the developmental issues, what are the anomaly issues, what are the metabolic issues, and really running that comprehensive differential is to say, what else could this be?

So that I can run that process down because a lot of these cases, you know, whether I’m talking about dogs or cats or any other species, once we get a couple of questions and we tease out exactly what are we working with in terms of a data set or a breed or a signalman, when we identify what that medical issue is, oftentimes we, you know, we kind of go, well, yeah, that actually makes a lot of sense.

Now that I know all the pieces, Okay. But if we’re not looking at that sort of broad lens of what are all the things that could be, we’re going to miss some stuff. And I get it. I totally understand when we’re super busy, we’re in, clinic, we have to be efficient. So we have to think about that. But I think that the biggest mistake, if there is one here, is If it’s not what you thought it was at first, what else do you think it could be?

Before we go to the next assumption, really, what does it look like to really tease that out? How would we get that client on board for running some diagnostics? How do we rank or triage those recommendations in? You know, I almost said in the worst case scenario, but maybe it’s the best case scenario. If you’re not sure, reach out to a specialist.

So many of the folks like the veterinary behaviorist, like, like in my college, You know, we’re happy to hop on the phone call to be able to say, tell me about the case you’re navigating. Let me see if anything lands differently for my ear or my eye than what you considered, and let’s see if we can work it up together.

Dr. Andy Roark: Outstanding. Dr. Christopher Pachel thank you so much for being here. Where can people find you? Where, I know you’re, traveling, you’re lecturing if people are like, I wanna learn more from him. Where can they find you?

Dr. Chris Pachel: That’s a great question. So, the easiest place to track me down is on the website drpachel.com. So, D R P A C H E L dot com. And from there, you can link into any one of the different avenues, whether you’re trying to find me at the animal behavior clinic or at instinct, dog behavior and training, or if you want to link to any of the podcasts like this one that will end up being linked on that site, all of that is there in addition to webinars and travel schedules and all of that.

So that is the one stop shop that will get you to all the things that I do.

Dr. Andy Roark: That’s phenomenal. Thanks so much 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. I hope you enjoyed it. I hope you got something out of it. Thanks to Christopher for being here what he’s super fun. I just I really enjoy him. Gang take a look at his website check out what he’s doing. Anyway, take care of yourselves everybody. Have a great rest of your week. I’ll see you later on.