Medicine

Penn Vet Transitions to Fully Integrated Curriculum

March 21, 2024 by Andy Roark DVM MS

Dr. Amy Durham, Professor and Assistant Dean at the University of Pennsylvania, joins Dr. Andy Roark on the Cone of Shame podcast to discuss PennVet’s new active learning and learner centered curriculum. Together they dive into the driving factors behind this decision and what it’s meant to students, faculty and the veterinary industry.

Cone Of Shame Veterinary Podcast · COS – 260 – Penn Vet Transitions To Fully Integrated Curriculum

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

LINKS

PennVet Article on Curriculum: https://www.vet.upenn.edu/about/news-room/bellwether/bellwether-magazine/bellwether-spring-2023/educating-a-21st-century-veterinarian

AAHA Article on Curriculum: Penn Vet transitions from discipline-based to fully integrated curriculum (aaha.org)

Today’s Veterinary Business Article: https://todaysveterinarybusiness.com/penn-vet-curriculum-121823/?oly_enc_id=5467B7086134E1Y

Competency-Based Veterinary Education: https://www.aavmc.org/programs/cbve/

Uncharted Veterinary Conference: https://unchartedvet.com/uvc-april-2024/

Uncharted on the Road: https://unchartedvet.com/on-the-road/

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

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

ABOUT OUR GUEST

Dr. Amy Durham is a Professor of Anatomic Pathology and Assistant Dean for Education at the University of Pennsylvania School of Veterinary Medicine. She went to Penn for vet school (class of 2005), did a residency in anatomic pathology at Penn, and then have stayed as a faculty member in the Department of Pathobiology. She became the assistant Dean for Education a couple of years ago, and is currently completing an MSEd in medical education.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one. I am here with Dr. Amy Durham, Assistant Dean for Education at Penn’s Veterinary School, and we are talking about the curriculum transformation that they are currently going through. I am a, I’m an education nerd for those who don’t know.

I am married to a college professor who has a love of pedagogy, which is the science of teaching. My conference, Uncharted Veterinary Conference is an active learning, learner centered conference. It is all about hands-on learning and education. I just, I really dig this stuff. I really think that there are ways that we can dig in to train skills as well as knowledge.

And so I was really geeked out when I started reading about what Penn was doing. There’s a number of other vet schools that are rolling out similar curriculums. And I am just, I’m really happy and fascinated. I think the way that we educate doctors for a lot of schools has become outdated. It’s just– It doesn’t make sense in the modern world, the way that we educate and I am so happy to see people shifting what they were doing, being honest about where we are and the resources that people have and training in a way that’s going to make doctors successful and comfortable and competent as fast as possible. I just, I love this mentality. So anyway, I get in with Amy. We talk about what Penn is doing, why they’re doing it this way. I asked them about the transition and what that experience is like where it goes and just really start to dig into what they’re trying to accomplish. So I very much enjoyed this conversation.

Amy’s wonderful. I hope you guys will enjoy it. Let’s get into this episode.

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

Dr. Andy Roark: Welcome to the podcast, Dr. Amy Durham. Thanks for being here.

Dr. Amy Durham: Thanks for having me, Dr. Roark. It’s great to see you.

Dr. Andy Roark: It is great to see you. It’s my pleasure. For those who don’t know you, you are an anatomic pathologist by training. You are also wearing the hat of assistant dean for education at University of Penn’s College of Veterinary Medicine, and I became aware of you because I started seeing articles about the fully integrated curriculum that Penn’s vet school is transitioning to. And I wanted to know more about it because I’m a bit of an education nerd. And so that’s why I reached out to you. So thanks for making time.

Dr. Amy Durham: Absolutely.

Dr. Andy Roark: I started seeing this just a couple of months ago and sort of the announcement was Penn vet is transitioning to a fully integrated curriculum.

Can you go ahead and just, mile high layout? What does that mean? What does this general transformation look like?

Dr. Amy Durham: Yeah.

Okay. So I’m going to start to do this from the mile high version. So essentially we redesigned our entire four year curriculum and we had a couple of principles in mind when we did this, that one of them was this backward design principle. So what are the, you know, knowledge, skills, and values that we want the day one veterinarian to have when they graduate?

And then we just sort of went backwards from there and designed the curriculum. The other goal we really wanted to do is have the core curriculum, so that preclinical curriculum to be two years so that we get our students into the clinics in their third and fourth years. And so, yeah, so that’s how we sort of started out with those principles and a small, what we called curriculum redesign team was born in 2018 and we started to work.

Pretty early on, we knew we wanted to do this backward design, we knew we wanted to use competency based veterinary education as a guiding principle and we knew we wanted to have more learner centered versus teacher centered educational experiences. So these are context rich, application based experiences and integrated as you mentioned curriculum. And so the way we integrated was we how’s best to describe this? So essentially the first year is the animal and health. And so the, ologies that we do or the disciplines that we integrate together are things like anatomy and histology and physiology.

And those are integrated into what some people call systems based, but we, you know, we sort of do it like a block system. Or process based and so in any given process or system, the students are exposed to the anatomy, the histology and the physiology kind of concurrently or in an integrated way.

And they’re also sort of linked into context. And so we’ll start to introduce disease in the first year, but only as by example. And then in the second year, the same, it’s a mirror image of our first year, but now we’re focused on the animal in disease. And so, things like the diagnosis and treatment of diseases.

And so those would be courses in the traditional curricula, those courses would be things like pathology. We had something called medicine and surgery and the different sort of microbiology, parasitology, those types of things. And so those are really how it’s structured at a very high level.

Dr. Andy Roark: Okay. Talk to me a little bit about learner centered education versus teacher centered education. So you use those terms, but specifically what is, what do they look like?

Dr. Amy Durham: So, in the, sort of traditional sense of the teacher centered, you can see me standing up in a big classroom, Right?

I’ve got I’m on a podium. Students are sort of in the stadium in front of me, and there’s the screen, and I’m delivering a PowerPoint presentation and delivering content. And so we still have to do that.

To a certain extent, we can’t completely. We have not completely gone away from that. But what we’ve tried to do is integrate sort of more learner centered activities. So try to do more small group activities, more lab based activities. Even when we are lecturing per se, like, we want to, we do things where we stop and we quiz or poll students, we bring them in and sort of make it, make them sort of the center of the learning experience, not the professor standing in the front of the classroom.

Dr. Andy Roark: That totally makes sense. Can you tell me a little bit, I want to get into backward design, because I love this approach to creating doctors. This makes so much sense to me. I just beat my employees over the head with the phrase, what does done look like? What does success look like?

And I know they are saying, sick of hearing me say that because I say it, you know, daily. What does done look like? What does success look like here? And it’s because I just so deeply believe in this sort of backward design or what are we trying to produce? Can you lay down a little bit either the specifics or the general process that took you to deciding what a done, complete competent doctor looks like?

Because I think that’s really a point of debate for a lot of us.

Dr. Amy Durham: Yeah. I mean, we really used the CBVE this competency based veteran education that the AVMC has, and you can go onto their website and see. And we use their in concept, use their domains and competencies underneath those they have what we would call illustrative sub competencies, and then you can take it a step further to integrate something called entrustable professional activities. So those are the things that you can watch them do. And then if they can do that, you can entrust them to do them independently. And that means they’re competent and ready to go into practice. And so we really relied on the hard work of this group that are continuing to meet, like, you know, in iterations.

As are again, like I said, is one of our guiding principles. And then we but, of course, we also had to rely on our professors. I mean, every university has its unique personality, and it’s built on their history and the people that make up that place. And so we relied on our professors to do an exercise of really evaluating what they teach in the legacy curriculum and really looking at it and saying, Is this core?

Do I need– is this core knowledge? You know, And that’s a hard exercise because, you know, we’re content experts. Like I could lecture for days on the thing that I love, right.

But it’s probably not what it’s probably not the level of detail that our students need to have in sort of this core, preclinical curriculum and the same thing is true as we get into the second, the third and fourth years in their clinic years.

So it’s a hard exercise and honestly it’s not done. We, I mean this is, it’s a process that just sort of needs to keep going and be reevaluated routinely to say are we producing what we feel are those day one ready veterinarians and importantly, have we given them, and this is another principle that we used of understanding, do they know how to access information, right? So that they’re lifelong learners because you’re never done, right? Like, I’m back in school now myself. Like, you’re just never done. And so, you know, we create, we created this curriculum sort of based on the just in time principle, not the just in case. So don’t just go ahead and memorize a bunch of things just in case you need it.

At some point, know how to access and critically evaluate the information to sort of practice this evidence based medicine so that you, when you need it, when you’re in clinics and you know, oh gosh, I need to go get this information and you know how to get that information and apply it just in time for that patient.

Dr. Andy Roark: Hey guys, did you know that I have another podcast? I am the host of the Uncharted Veterinary Podcast with my dear friend, practice management goddess, Stephanie Goss. We have been answering questions for years. We started a year before Cone of Shame. I started doing the Uncharted Vet Podcast with Stephanie.

We take questions from our mailbag. We have listeners who write to us and they tell us about what’s going on in their practice and we try to answer their questions and they are all about. Communication, leadership, management, things like that. It’s about working with clients. It’s about working with staff.

If you are in a place, you just can’t be there anymore. We’ve got all that stuff. We’ve got hiring, firing, working together, working with clients, reviewing your systems, getting your practice to run smoothly and efficiently, and how to manage your time. All that stuff is there. Check it out. I said 250 episodes.

You can see what everyone is about, from the title because it’s what, it’s basically the question that we’re being asked. But anyway, it is a very popular podcast. I hope that you’ll check it out and enjoy it and love it. I just love making it. So anyway, I just want to tell you it’s there guys. Let’s get back into this episode.

Andy Roark: This type of just in time education, as opposed to just in case, I really think that this is where education, not just in our field, but across, like, higher learning is going. We live in the age of artificial intelligence, like the computing power that we can bring to bear. We have more power in our pocket, in our cell phone, than veterinarians a hundred years ago had in a whole library.

They did not own the knowledge that we can pull up in 30 seconds online. And so at some point that has to fundamentally change how we educate because at some point if we’re just hammering facts into someone’s head that they could access in 20 seconds online, are we really training them as opposed to training them how to interpret information and recognize what is important and make decisions and make priority. So I really like this emphasis on just in time over. Just in case. Do you agree that there is sort of a societal shift in education in this direction? I mean, do you think that fundamentally with the technology we have this is where our skill based learning is going?

Dr. Amy Durham: You know, I don’t think we have a choice, right? I mean, I think, so I have a 14 year old son, and the way he learns is just not how I learned it. The way our students, our current students who are in their, typically in their 20s, the way they learn and access information is not how I learned and accessed information when I was going through school.

And so I think we have to meet our learners where they’re at and recognize that the amount of information that is out there, I think there’s something like the stat is the doubling time of biomedical information is just, it’s measured in like, you know, months and years versus decades at this point.

So there’s simply just no way that you can put all that information in your head. Like it’s just not, it’s just not possible. And so, yeah.

I think you’re absolutely right in higher education in general. But I would even say, you know, just education across the board, teaching people how to critically think, critically evaluate how to sort of have what we’ve called, like, productive skepticism for about what you read especially important for doctors is how to tolerate ambiguity so all of these things, this is how we are trying to embed into this new curriculum, these sort of values.

Dr. Andy Roark: Penn has a phenomenal reputation, and I know that because all of my friends who went to Penn tell me that they have one.

Dr. Amy Durham: Oh, gosh.

Dr. Andy Roark: but they, I know, but no, but they do, Penn, has a phenomenal reputation. When you talk about assessing the success of graduates to continue to kind of update and tinker with the curriculum going forward, what does that assessment look like in your mind?

How do you know when you have produced a successful graduate or not?

Dr. Amy Durham: That’s a great question. And so we, and you’ve always, we’ve always had to do this. All schools have always had to do a sort of a program assessment and outcomes assessment. It’s part of our accreditation process. And when you build a new curriculum, especially one that is very new, is this one, you want to make sure that.

You haven’t lost something in the translation and so we’ll do our continual, the things that we’ve always done for our curricular assessment and our outcomes assessment. So things like as basic as looking at NAVLE scores, right? Like that’s a metric, but also we do exit interviews with our vet students.

We interview employers around the area that hire our students to sort of see where they’re at. We go back to our students a couple of years later after they graduate and ask them a series of questions. But in this new curriculum, we’re introducing some other elements to our assessment, which is that we have always asked students, you know, for evaluations for the coursework and the professors.

But this time around, we’re also adding in surveys of our professors. So what did they think of the new classes? Because their opinions are really important. And we’ve also created focus groups. So 1st and 2nd year vet students sit in on like five or six student, you know, per focus group and they just give them lunch.

And we talk. And I mean, we I’m not in the room because I would sort of buy us a conversation. But they sort of talk to our administrative folks and have the conversation about what’s working and what’s not. And that information has really helped us sort of in real time make edits to this unfolding new curriculum.

So yeah, there’s a lot of ways to do this, and I think there’s no, there’s no one right recipe. And I think different schools probably have different ways of doing it. But in general, we have to continually evaluate. and one of the ways we want to do that too is by doing research, like asking, you know, research questions on the new curriculum and, publishing that data so that other schools can learn from it too.

Dr. Andy Roark: Talk to me about how other schools are changing because as you know, I was interested, I said because of its storied history, Penn really stood out to me when I started looking at who was integrating and changing up their curriculum. But there are, especially with the newer schools that are opening up, there’s a lot of them, especially ones that do some of their clinical training offsite and things like that.

These are newer models that we’ve seen for a while now, but a lot of them are leaning into very different models of education. Can you speak, and I know your specific interest is in Penn, and you’re sort of head down working on that, but do you see a trend in upgrading a move towards sort of a fully integrated curriculum across other vet schools?

Is this something that you think is moving very rapidly? is it kind of very piecemeal? What are your thoughts about education of veterinarians across the United States and Canada at large?

Dr. Amy Durham: You know, I don’t want to speak too much for other schools, but I can tell you just, you know, and working with other people from across the United States. And I would say that many, if not most, veterinary schools are, have undergone or are undergoing or plan to undergo some degree of curricular redesign at this stage.

So, you know, in general, I think change in academia is kind of like steering a cruise ship, like it usually takes a really long time. So I think maybe we’re seeing kind of a trend where this is accelerating and probably for the same reasons that we’ve talked about where we see, we have a different student population, we know more about adult learning theory, we know how to, sort of engage our learners better.

And so I think Penn is not, you know, Penn’s– The new curriculum is unique to Penn and what I’ve just described, but the idea of curricular change is certainly widespread throughout veterinary education.

Dr. Andy Roark: You mentioned sort of this transition. This is not a flip the switch. All right guys, on Monday when the students show up, we’re going to be doing it differently. What, how long does a transition like this take? What does that look? Is it rolled out in pieces? Surely it’s not summer break and we’re coming back with a whole new style.

What is that?

Dr. Amy Durham: It requires a lot of patience from our faculty and our students. So and I have to say everybody has been on board and been just amazing. But Yeah.

So essentially it’s got launched. The new curriculum got launched in 2022. And so as we stand here right now, we’ve got two classes in the new curriculum and we’ve got two classes in the legacy curriculum.

And so it’s, there’s times where I was teaching in the old curriculum and then I would turn around and then teach in the new curriculum. And I’m certainly not unique. A lot of our professors have had to do that. And so it’s. It’s been an all hands on deck and total buy in, and our faculty really embraced it and have done an amazing job and are currently, you know, working really hard to continue that transition.

Dr. Andy Roark: How do you square the experience of having the legacy students? You’ve got two classes of legacy students, and you’ve got two that you’re doing this new thing. And I’m sure the feelings are mixed. I’m a change junkie. I like to try new things. I like to push and evolve and, I don’t know. I just, I really, enjoy that sort of evolution things.

And so I think whenever I start rolling out a new thing, I am very excited for the people who are doing that, and I think I feel a little bit sorry for the people who are doing the old thing. Do you have thoughts like that, where you, because you see these, the legacy students, do you have thoughts of, Oh boy, I can’t, I’m so glad we’re transitioning to this? Are there things that you miss in the legacy way, where you say, It sure was a lot easier when we had, you know, in the Legacy way. I wonder if we’ll go back to that. What, how do you square having those two different experiences going on at the same time?

Dr. Amy Durham: Yeah, I mean, it’s real, it’s real. for the students that are in the legacy curriculum, I say to myself, I was a part of the legacy curriculum and I turned out just fine, right? or at least I hope I did. So, you know, I think they are getting a stellar education and they are going to graduate as stellar veterinarians.

And I think And both and I am excited for our new curricular students because it’s but they also they’re faced with some challenges too right? This is there’s hiccups in the rollout and they’ve got to roll with it. And they have been great and provided really important feedback, but also just, given us the grace to mess up and try to fix it. And so I think Yeah. I think, I mean, I love change too, but not everybody does. And so it’s taken, you know, we’ve had to sort of meet in the middle and sort of come together and I think it’s going well, but Yeah.

For sure there’s, this is not just, you know, like you said, flip a switch and everything’s done.

Dr. Andy Roark: Yeah. Well, this is, this has sort of been your baby along with the team I know you work with. And you’ve put so much into this. When you think about this transition, what is most important to you? I mean, what are, what do you feel that you desperately want to get right here? Like, what would make this a success, in your eyes?

Dr. Amy Durham: Oh, what does done look like? Right? There’s so many ways I could answer that question. I think–

Dr. Andy Roark: I just mean for you personally, yeah. I mean, you, as a person who has invested so much themselves, like, it’s, not, I just not even about the, curriculum overall, but, you, Amy, like, what do you want to get out of this?

Dr. Amy Durham: so. One of the things that I love, I’m a pathologist, which means like I sort of feel like I straddle between clinical medicine and sort of biomedical sciences. And one of the things that I’ve really loved about this new curriculum is how we’ve, you know, in the clinics, in practice, you talk about interprofessional clinic teams, right?

You’re sort of the doctor and the clinic staff. We’ve sort of modeled that kind of by accident with our interdisciplinary teaching teams. So not interprofessional, but interdisciplinary. So when we have these block courses, we have our basic scientists pair up with our clinicians to create this curriculum, and one of the things that I have been so, that I’ve loved to sit back and watch happen is sort of, even though we’ve all worked with each other in some way or another for you decades, in some cases, there’s this deeper level of respect that we have for what we all bring to the table in educating our, veterinary students that I’ve really enjoyed watching happen.

And then I also feel like in a way we’ve sort of modeled that idea that you can sort of have these teams come in and work really well together, even if they come from different disciplines or different skill sets. And so that’s sort of one of those, I don’t know, almost like it’s an emerging theme that’s come out of this curricular redesign process that I’ve really enjoyed.

Dr. Andy Roark: That’s awesome. Dr. Amy Durham, thank you so much for being here. If people have questions for you, if there are other institutions that are looking at transitioning their curriculum how can people reach out? How can they get in touch with you?

Dr. Amy Durham: I, you? can find me on, you can email me. I’m on the website. Please just email me. I’d love to answer any questions.

Dr. Andy Roark: That sounds amazing. Thanks so much for being here. Guys, thanks for tuning in. Take care of yourselves, everybody.

And that’s it guys. That’s what I got for you. Thanks so much for being here. Thanks to Dr. Amy Durham for making time to talk about what Penn is doing. Big big love for those guys and encouragement for them and the journey that they’re on. And I’m just, I’m so glad that they’re putting the effort in.

I think it’s going to be great for our profession. I think it’s gonna be great for Penn grads. And just, anyway, I’m all optimism about this type of transition in our profession. I think it’s great to be in vet medicine. I love it. I love a lot about where we’re going And this just makes me super happy guys.

Take care of yourselves. I’ll see you later on.

Lar Par, GOLPP and Our Missed Opportunities

February 15, 2024 by Andy Roark DVM MS

On this week’s episode, Dr. Andy Roark is joined by Dr. Mary Gardner to discuss one of her personal passion projects, raising awareness about geriatric onset laryngeal paralysis and polyneuropathy (GOLPP) in senior dogs. Dr. Mary Gardner shares her experience with the disease and how that’s led to her commitment to educating both pet owners and veterinary professionals on various treatment options.

Cone Of Shame Veterinary Podcast · COS – 255 – Lar Par, GOLPP And Our Missed Opportunities

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

LINKS

All About GOLPP Website

Dr. Mary Gardner on Instagram

Uncharted Roadshow in Atlanta

2024 Uncharted Veterinary Conference

Charming the Angry Client Course

ABOUT OUR GUEST

There is nothing better to Dr. Mary Gardner than a dog with a grey muzzle or skinny old cat! Her professional goal is to increase awareness and medical care for the geriatric veterinary patient and to help make the final life stage to be as peaceful as possible, surrounded with dignity and support for all involved.

A University of Florida graduate (AND ANDY’S CLASSMATE!), she discovered her niche in end-of-life care and is the co-founder and CIO of Lap of Love which has over 350 veterinarians around the country dedicated to veterinary hospice and euthanasia in the home.

Dr. Gardner is co-author of the textbook “The Treatment and Care of the Veterinary Patient”, co-author of a children’s activity book focused on saying goodbye to a dog called “Forever Friend”, and the author of a book dedicated to pet owners “It’s Never Long Enough: A practical guide to caring for your geriatric dog”. Dr. Gardner also won VMX Small Animal Speaker of the year in 2020!

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host Dr. Andy Roark. Guys, I am here with one of my best friends in the world, Dr. Mary Gardner. I love her to pieces. We went to vet school at Florida together. You’ll hear us talk about that a little bit. She has a passion project that she is working on.

It’s around laryngeal paralysis and GOLPP in senior pets. Some of you might remember Mary Gardner. She is the founder of Lap of Love pet hospice. She is a she is a hospice care veterinarian. She is a amazing lecturer. If you ever get a chance to see her speak, you should. You’re going to look and you’re going to be like, man, she’s doing three hours on end of life care.

That sounds really down. It won’t be, it will be riveting and you will learn an absolute ton from someone who is super easy to relate to someone who will make you laugh and smile and feel good about the work that we do. That’s Mary Gardner. So anyway, she is amazing. I am thrilled to be talking to her about this project that she’s fired up about that.

Honestly, when I first heard about it, I was like, why are we talking about that? Boy, she makes a good case. This is going to be great. 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. Mary Gardner, thanks for being back.

Dr. Mary Gardner: Hi, Andy. I know. I think this is like our third or something like that.

Dr. Andy Roark: It’s tough being up there. Like, you’re definitely up there at the top of the people that I’ve had on the podcast again and again. It’s just because I love you to pieces,

Dr. Mary Gardner: I know

Dr. Andy Roark: We’ve known each other forever. And every time I talk to you I get excited about what you’re doing and what you’re excited about and we just kind of feed off of that. And this was no, exception. So, you and I were together in Orlando in January, and I had looked at the program, and there was, Mary Gardner is doing a LARPAR surgery lab, and I’m like, either that’s a typo, or Mary Gardner is blossoming late in her career in ways that I did not anticipate and I talked to you and you were like I am doing the laryngeal paralysis workshop. And when I talked to you later I was like how was it and you were like I want six hours instead of four and I was like I like we have to talk about this this is not it would be like if I came to you and I was like I’m into Turkish baking and I love it.

I’m like, I just, it, talk to me about laryngeal paralysis and your love affair with this kind of odd medical condition.

Dr. Mary Gardner: It is. I know. And I always say like, I love it, but it’s weird to say that you love a disease, right? I hate it. I wish it wasn’t a disease, but you, I love it. It’s like, it’s just something that came into my, life personally and also professionally. My Doberman, you know, Duncan, he’s always a topic of many conversations, but he, when he was about 9 or 10, more, like 10, he started to clear his throat.

So he just was doing it. Which, you know, I’m like, Oh my God, that’s my Doberman coughing. I instantly went to DCM heart disease, you know, and

Dr. Andy Roark: It’s a dark, the dark place we go. Oh my god.

Dr. Mary Gardner: Right. He could have just had a little acid reflux. No, I went straight to stage 20 heart disease. I already went there. So, so I, bring him to the cardiologist. Like, I don’t even touch my stethoscope. I’m like, you’re going to the cardiologist, buddy. Right. And they’re like, no,

Dr. Andy Roark: We turn into, it’s when we turn into needy pet owners. We’re like, Oh my God!

Dr. Mary Gardner: Totally.

Dr. Andy Roark: Someone listened to this chest.

Dr. Mary Gardner: Exactly. Cause I can’t. And so I brought him in the right. No, he’s actually totally fine. And I’m like, he’s doing this weird clearing his throat. It’s not a reverse sneeze. It’s, you know, and so, turns out that then he was diagnosed with laryngeal paralysis and this is probably, gosh, I, should look at the exact dates, but it’s probably around 2014, 2015 or something like that.

Right. And yeah, probably around that. And so it was then a decision. Do I wait for him to get? worse and then end up in an emergency situation, which is what we see so much. Or do I consider or do I consider euthanasia before he gets that bad? And then, or do I consider doing the surgical option, which is the tieback.

And for me, it, he wasn’t so bad, like his breathing wasn’t horrific. It started over the next few months. So I can then see his breathing when he was sleeping. It was, you know, a little snoring, but it was like, and I’m like, nope, that’s, he’s not going to live like that. Right? So no doubt in my mind, I was going for the tie back and

Dr. Andy Roark: 10 year old Doberman, right?

Dr. Mary Gardner: 10 year old Doberman.

Yes. Yes. This, and that’s a very good point.

Dr. Andy Roark: This is an old, this is an old big

Dr. Mary Gardner: Is an old man.

Dr. Andy Roark: For a big dog, this is an old man. All right, I just wanted to flesh that out.

Dr. Mary Gardner: Totally. And he, I actually used this story in one of my lectures. And so I’m sort of doing parallel conversations here with you. So actually years later, I was telling the same story to a group of veterinarians and it was in Texas.

And I didn’t say it was my dog, I just said it was a 10 year old Doberman who here would even discuss tie-back surgery and only 2 people in a room of 80 raised their hands. So I’m like, no, let me repeat that. Like who here would just, talk, like give it as the option. And again, only two people.

And I said, why not? And they said, He’s an old dog and the risk of aspiration pneumonia is too high. And it just boggled my mind at that time that nobody would even consider it. And it was something that I had done. And then of course the reveal was it was my dog that I’m having this conversation about.

So back to 2014, I absolutely did the tie back. And during post surgery, he actually did have aspiration pneumonia because he vomited. From like morphine or whatever they had given him. So this is again, 2014 and so that, that is a risk, but he survived it and he was fine and he did great. Andy, like he was fine years, you know, a year or two later, I started to see then this neuropathy happened in the, in his backend.

And I was doing you know, I was researching all of this and that’s when I learned more about GOLPP than just LARPAR. And so he’s the thing that started my he, him having it is the reason why I love it so much because it was such a big a part of my life and treatment with him. He ended up dying of DCM years later.

So he did get DCM, but that’s why he passed.

Dr. Andy Roark: How did you feel about that? Are you like, it’s a heartbreak, or are you like, I called it. I called it really early. I was

Dr. Mary Gardner: So long ago.

Dr. Andy Roark: I had,

Dr. Mary Gardner: No,

Dr. Andy Roark: Long ago, I knew this was gonna happen.

Dr. Mary Gardner: I know. You know, it’s one of the things, you love a certain breed and you know what it comes with, right? Like, so I know, but he was 13. So I got, like, almost 3 years after a tieback with him where so many people would have, It would have been a few months and then I would have had to euthanize him.

So, that’s how it started.

Dr. Andy Roark: Well, you know, I love that you tell this story and you and I have talked about this before with your work with Lap of Love Pet Hospice and things and you and I are both we’re both on the advisory board for the Gray Muzzle Organization it says this is a group that we both care about and it’s glad we get to do this stuff together I saw this case and it was a dog had a splenic mass and he’s my neighbor’s dog.

His name is Copper. And he’s like a ten, ten and a half year old sort of coon hound dog. Not a small dog. And so I had that talk with him. You know what I mean? When you’re like, well, you know, it’s probably two thirds chance it’s going to be malignant and one third it’s benign. And, you know, this is kind of how it goes.

And, you know, kind of what do you want to do? And I guess I was kind of trying to cushion the blow. You know, if they were going to say, well, you didn’t do it and they were like, no, he’s been a great dog. We’re gonna do this thing and sure enough. It’s benign. They take it out That dog is stealing food from me at cookouts like he sees me.

He’s like that guy’s a sucker You know what I mean? And like he tell you but like boy, I mean you start thinking about you like a couple of years you know sometimes I wrote an article about it, and I called it, Sometimes It’s Worth the Risk. And it’s like, sometimes we go with it, and it’s just, sometimes it’s just worth it.

And,

Dr. Mary Gardner: It’s worth it.

Dr. Andy Roark: I think it’s easy to, like, write that off, and like, I think we kind of guard ourselves by being a little dark or cynical. But man, sometimes it’s totally worth it. Okay, so you go through this

Dr. Mary Gardner: Now, hold on. On that, I’m sorry to Like, at what point is it not worth it, right? Like, is it six months? Is it a year? If you think about chemo, how many times do we do chemo and it’s just to get a few months or you amputate a dog with osteosarcoma, like that’s to relieve the pain, but you’re not taking away his cancer.

And so is that worth it? Right? And the one thing I just say, while I’m just honest is no judgment because there’s not one right answer. So it’s okay not to, but what I don’t want to do is, you know, everyone says old age is not a disease, but old age is not an excuse. And so, like, It doesn’t mean just because he was 10 that we shouldn’t do it because if he had six great months of breathing okay but then got hit by a car or something like that.

I’d still be happy I did it

Dr. Andy Roark: I love that. I just, I think that’s an important point. I’m just glad, I was just glad to see that. I love that you had a sort of happy outcome of saying, he’s ten. Well, I mean, that’s why I sort of set it up as a ten year old Doberman, and then you go, Oh, well, we’re gonna do this thing. It’s not a small undertaking.

And then three more years, and, you know, it’s that quality of life, quantity of life thing, too, where, it’s not that he stayed alive for three years, it’s that he

Dr. Mary Gardner: He was good. Yeah, right.

Dr. Andy Roark: Sleep, and breathe, and like, that’s a significant difference. So anyway. So, so I love that.

So you go have this experience. Alright. So, so I’m looking at this. You know, I know you’re interested in quality of life. I know you’re interested in seeing your pets. So you go through this experience yourself. And then talk to me a little bit about the realization you sort of had or sort of your experience around this where you started to feel like this is something that needs more light on it.

Because that’s kind of what I got from you at VMX when you were talking about doing this workshop and things. So, so help, me get my head around like. The need you saw in the larger profession or what that kind of looks like.

Dr. Mary Gardner: Yeah. Well, I think because we laugh a lot of them and I go euthanize so many animals in their home So many are because of because of mobility issues and so many are middle sized dogs. So 60, 70, 80 pound dogs, like that’s our bread and butter, let’s say, right? It’s mobility issues, you know, large, medium, large dogs and so many I’d go to and now they’re not in the emergency situation, right?

Which what is what GP normally sees is that the dog is under emergency, but here’s a dog that has bilateral muscle atrophy. They’ve got weakness. It’s clearly neurological on the back end. They’re saying, yeah, he’s, kind of snoring more. He’s having some breathing, you know, struggling and his bark has changed.

And I’m like, this is freaking LARPAR. Like, and, I was just seeing it so much, but nobody ever talked to them about it.

Dr. Andy Roark: Yeah.

Dr. Mary Gardner: And then again, at the same time, I had this, you know, lecture in, in Texas where everybody’s like, it’s too old of a dog. We wouldn’t do it. And it, was just like. But we can help so many and the families want to do it.

So it was probably in 2020, maybe I I did a Facebook live with this surgeon, Dr. Bryden Stanley, who is the, like the godmother of GOLPP. And we did it for like, it was an hour long conversation. I just, I asked her everything, meds, da, and thousands of people have watched it. Hundreds of people reach out to me and these are pet owners and they send me videos of their dog and they’re like, my vet doesn’t know what it is or my, he, you know, they, say, don’t do the risk, but I think I want to do the surgery.

And you know, it’s, I of course always walk a very fine line to never throw any vet under the bus, but I always say, go, just go to a surgeon and get, you know, here’s the statistics because now I know the statistics really well. And so it’s just. Now my passion project to educate everybody in the veterinary field about it.

And I love it. So, you know, when we went to vet school, it was called idiopathic laryngeal paralysis.

And we didn’t know that actually there was a connection to the polyneuropathy. And this is where I think if a pet does even go for the tie back surgery, they need care with their veterinarian and rehab and stuff like that, because it’s more than just a tie back, it’s a whole like.

You know, big thing, and that’s where GOLPP, so that’s geriatric onset poly laryngeal paralysis and polyneuropathy has came, has come in, and that’s, so Dr. Stanley is the one who found that connection.

Dr. Andy Roark: Let’s go ahead and start to talk about let’s start to talk about GOLPP a little bit here because when we started talking about the tieback and managing these cases, you know you do not fancy yourself a surgeon unless things have radically changed

Dr. Mary Gardner: No, I’ve not blossomed, no.

Dr. Andy Roark: I was say I was like, wow, it just, you do a lot of things, you do a lot of interesting things. Surgery was not one of them that I had on my bingo card for you, but, given that you’re very interested in this, topic of like, so, so talk to me about the interface here. So, so without making this into a surgery podcast,

Dr. Mary Gardner: Oh god no, which it won’t be,

Dr. Andy Roark: Yeah, which is why the blind leading the blind in, in that regard.

Hey guys, I just want to talk to you real quick about the Uncharted Roadshow in Atlanta. I am going to be there with Stephanie Goss and Maria Parita and Tyler Grogan and we are going to be doing the Uncharted Leadership Essentials Certificate. That is, uh, it is two days, it is 14 hours of race CE. You heard that right, it’s packed in there.

It is workshop style CE. We will be doing understanding the trust economy. We’ll be doing strategic planning, vision and values. We’ll be doing communication styles, feedback and coaching, achieving team buy in, setting priorities, getting priorities done. That means holding people accountable and setting timelines and deadlines.

We’re going to be doing all of that stuff. You are going to be, uh, drinking from the fire hose and it is all about you actually getting the skills. As I said, it is very, very, very very hands on, you are not going to be sitting and getting lectured at. You are going to learn, you are going to be a different and better leader when you leave than when you arrived.

That is a Sunday and a Monday in May, as I said the 5th and 6th in Atlanta. Grab yourself a spot, they are going to sell out, um, I would love to see you there. Alright, let’s get back into this episode.

Dr. Andy Roark: So talk to me a bit about, GOLPP. Talk to me about, surgery as a tool. And if surgery is a tool, Mary, what are the sort of the other tools in the toolbox? What does this overall management of this condition look like in your mind when it’s done exceptionally well?

Dr. Mary Gardner: Oh God, this is the most amazing question. Okay, so,

Dr. Andy Roark: Why, thank you! know, I work hard.

I take notes ahead of time. Like I prep,

Dr. Mary Gardner: I love Prepping.

So, well actually, you know, let’s step back. I think about Duncan and his clearing of his throat, right? Everybody assumes that’s like a tickle in his larynx or something like that. That was actually because he was having, you know, regurge. So, so, you know, like almost like acid reflux.

Because that comes oftentimes in parallel with, GOLPP, with the laryngeal paralysis. So basically and this is definitely not surgery, definitely not a anatomy class here, but the a laryngeal nerve actually is what the problem is with the larynx. But it’s also all kind of connected to the esophagus.

And so they will have esophageal mobility issues. And that’s why they’ll have little acid reflux. Some of them so much that they vomit often or regurge often. And so it’s not just from the surgery or the tieback that they could have aspiration. It’s because of their vomiting. Like that’s why, because they may vomit or have that regurge or they eat too fast and they have a tieback or drink too fast.

But it’s a risk factor even for dogs that don’t have a tieback. And I don’t think people understand that we have to actually help them with their regurg also because it’s gonna, it’s gonna happen. And then what, what also happens is that they will get a polyneuropathy, neuropathy. So their back end is going to start to toe drag, get weak, all those things.

So historically, when we in GP get a LARPAR case in, it’s on emergency, right? So we are just hoping that they can breathe. We’re not doing a full neurological exam. And half these dogs are like, You know, basically unconscious. Anyway, we give him some ace. So you’re not doing a good neurological exam. So we never actually knew that the polyneuropathy was, there.

And but many already started to have a little, you know, CP deficits and things like that. So, Dr. Bryden was actually doing research on the esophageal problem with, larpar. So that’s what she was studying. And when she had all these dogs coming in that were in her case, she was doing a full neurological exam.

And she’s like, wow, all these dogs also have polyneuropathy, you know, this neuropathy in the back end. So it was because she was able to do a really good full exam is how she made this connection to it all. So really the optimal thing if you’ve got a breathing disorder is to do the tie back and a problem is that there’s not, it could be expensive for a family, there may not be a surgeon locally, there may not be a surgeon eight hours from them, right?

And so that’s, also an issue. It also may be an emergent situation where it could be something that we need to do in a day or two and not wait for five weeks to get to see the surgeon that, you know, the boarded surgeon. So then, so, so all these things are, happening of course, so regardless of surgical intervention, you will, you need to manage the esophageal problem and you also need to manage that, polyneuropathy.

And it’s no NSAIDs, it’s nothing like that. It’s, it is, you know, physical therapy is the biggest help and then environmental management and harnesses and stuff like that. So that, like in in a high level nutshell is, GOLPP and. with the surgery. So many people are nervous about recommending it because of the risk.

However, the risk that here’s the big thing is that anesthesia for the surgery is very important. Technically, this isn’t a, this isn’t a difficult surgery on the pet, right? You’re not going into the, a spay is worse, right? You’re good. It’s a soft tissue. It’s a tiny little incision. It’s soft tissue.

It’s in the neck. It’s two stitches. Close it, you know, for the tie back, then you’ve got some skin, you know, whatever sutures, an ice pack. It doesn’t need morphine. It doesn’t need all these things that, this is why there was so much aspiration after surgery is because we were over anesthetizing them. So that’s why for this workshop I did at VMX we had Sheilah Robertson, our good, you know, friend talk about anesthesia.

And, it’s only about 8 percent of a risk factor for aspiration pneumonia. And I always say it’s a hundred percent risk for asphyxiation, so I would much rather take an eight percent risk than a hundred percent risk. But and they might be a it might be a 14 year old lab. Do you do it?

Guess what? If you get six more months, like it doesn’t matter if they don’t want to do it or they want to do it, but I don’t think we should make that decision for our families. And I’ve done studies, I’ve done surveys of over 800 families and about half and half did the tie back and didn’t. And it’s about 50 percent did not get the advice of their, from their veterinarian about the tie back.

They found it on their own. And we absolutely should give the option for those families. But anyway, so that’s where I get so kind of worked up on it is because there are people that are not getting this information and they would do the tieback or then they need to learn about physical therapy and, knowing how, to, how should your dog eat?

You know, should it be a raised bowl or not? All these things.

Dr. Andy Roark: Talk, talk to me a little bit. I know we don’t have a ton of time.

Dr. Mary Gardner: I know. Sorry.

Dr. Andy Roark: But if, no, I love it. If, I was talking to a pet owner and I was like, “Hey, you know, this is, an option. This is what I’m seeing. This is kind of how it progresses. You know, there is surgical intervention.”

We sort of gracefully talk about that and kind of, you know, what does that look like for you? Is that something we want to explore a little bit? And they said, well, okay. So what is our life like? After the surgery. Talk to me a little bit about in sort of those terms sort of at the high level.

Frame up for me what the commitment for physical therapy and the environmental management would look like. How much do you share with the pet owners kind of in the moment of what that looks like?

Dr. Mary Gardner: Yeah. You know, it’s funny is, I think we recommend amputation of an osteosarc way more than we recommend a tieback, right? And,

Dr. Andy Roark: Probably true.

Dr. Mary Gardner: right, yet

Dr. Andy Roark: Oh.

Dr. Mary Gardner: You manage a hundred pound Rottweiler that’s just had his leg amputated, that’s difficult. Like, that’s a lot of care at home, where this is not so much.

So, there’s should we change the feeding and water habits? Yes, we need to slow them down. So there’s slow, waters water bowls. Should they feed raised bowls? Actually not a raised bowl. They should be on an incline. So that way they’re slow. That’s how they should be fed because it’s gravity, right?

Like all these things, it’s, not just a raised bowl. That doesn’t do anything. We need to get them on an incline. And then. And, you know, talk to the owner that probably the vast majority of pets will have a neuropathy, start of a neuropathy at least within a year from diagnosis. Duncan took a little longer because I think I noticed him sooner.

I was like, whoa, that’s a cough, right? Owners don’t think, we, I went a little crazy. So, within the year, you’re going to have a 60, 70 pound dog that may have trouble walking. And that means yoga mats around your house. Here’s the help them up harness. Here’s some physical therapy exercises. And it’s probably about 18 to two years out that they live, but it’s, because we’re already starting at 12.

The average pet is getting it done at 12. So you’re talking about labs that are probably going to die towards 14. Regardless, there’s a million other things that they might be getting also, so I don’t think, but the neuropathy does become a big issue and I think it’s very important to talk to owners whether or not they do the tieback that because they may have a dog that has some respiratory issues, but it’s okay. They’re managing it well. They’re in air conditioning. They’re in a cold area. They don’t, you know, exert themselves. They’re a couch potato and you know, they’re, it’s not that bad, but they’re going to get the neuropathy also. And that’s where it starts to be a caregiver burden. And it was for, I wouldn’t say a burden.

I would do it all day long for Duncan. And I just, I can’t tell you any, how many hundreds of people have emailed me about this. It’s crazy.

Dr. Andy Roark: Oh, I’m sure. I think that, I’m trying to think back to where my sort of ideas around this procedure come from? I feel like, and you, were there, we were there together in the same class, but I feel like the whole aspiration pneumonia was beaten pretty soundly into me. I don’t know if it was, I think it was one of those things where like, if I saw a test question that had laryngeal tieback, the question was going to be, or the answer was going to be aspiration pneumonia.

You know what I mean? Like it was, that it

Dr. Mary Gardner: and it was 30 percent risk then, but that’s because of like the anesthesia that they’re doing back then, right? So we could do it so much better, so much more simple. We don’t need massive pain. They don’t need to be on morphine. It’s, not that bad, right? So it’s better to have them alert and not, you know, all drugged up.

So I think you’re right. That was 100 percent when me and you were in it it,that’s what we were taught.

Dr. Andy Roark: Well, I was trying to remember why I had that thought, because I’ll be honest, like, it’s just not, it’s not a procedure that’s really kind of been on my radar. I haven’t looked at a dog that’s struggling and been like, well, I’m not gonna say anything. But I’m like, why isn’t this, why didn’t this come to my hand faster?

As I, I think that when we were going through it, the risk really was taught as being quite high. And I was like, boy, this is kind of a last resort, is how I had it filed in my mind. I think you, I’m glad you’re talking about this. I know you and I had talked earlier and you said that you’re going pretty.

pretty hard on this. You’re putting together. Talk to me about the website that you’re sort of putting together. You sort of mentioned that you were sort of putting together resources and you wanted to make this really accessible. what’s your plan with that?

Dr. Mary Gardner: it is just my passion plan. So I’ve got, it’s been totally self funded. It’s called all, all about GOLPP. So, allaboutgolpp.com and it’s for both the pet parents and the veterinarians out there. So I wanted it to be like a one stop shop of education. For the pet owners. So what is it?

What are risk factors? You know, medications. Cause there’s doxepin discussion. Like, should we use that? and, no, don’t waste your time on that. You know, things, like that. I’ve also got a veterinary section. So it’s got how to diagnose what are the signs. non surgical options. And then there’s a whole set of resources.

So there’s handouts for veterinarians. We’ve got history handout. We’ve got an oral exam handout for them. We’ve got client education handouts, all free on the website. And then the biggest thing is just these rehab videos that I made with Dr. Carolina Medina. If you remember her from UF and the acupuncture service.

And so we made about 11 different rehab videos for just exercises at home that aren’t a big struggle for, it’s not like go run agility. This is, you know, the cookie stretch and the incline stand, you know, stuff like that. So, it’s got all the resources and lists of the boarded veterinarians out there, the list of the rehab facilities.

And yeah, so it’s just, my goal is that it’s the one stop shop for people to get educated on both, pets and vets, both pet owners and vets.

Dr. Andy Roark: You know, it’s funny. I, as I’ve come along in my life, I have come to really appreciate stories and examples that illustrate who people are. And so I always think it’s this beautiful thing. If you can reach into your pocket and kind of pull out a story or an example about someone who sort of encapsulates who they are and.

One of my favorite stories about you is this one, where it’s like, you’re the person who gets excited about something that they care about, and you don’t post it on Facebook, like, you’re like, nope, we’re, and you make, you launch an empire and crusade, and you’re building, there’s gonna be a GOLPP app, that you’re gonna, like, that

Dr. Mary Gardner: Wait, yes. I would love that. Yes.

Dr. Andy Roark: I see you running across a professional sporting event with like a banner behind you before security tackles you that says “Ask your vet about GOLPP.” I mean, it’s just,

Dr. Mary Gardner: I like that.

Dr. Andy Roark: You get these passion projects and

Dr. Mary Gardner: I do.

Dr. Andy Roark: And you go with them and you do such great stuff. And I don’t think you get enough credit for all the work that you do for our profession.

But anyway, I, love you buddy. I’m so glad you do this.

Dr. Mary Gardner: I love you too.

Dr. Andy Roark: I really appreciate you coming and sharing with us. So cool. Mary Gardner, besides the website

Dr. Mary Gardner: Oh God,

Dr. Andy Roark: and all the resources, where can people find you online if they want to follow your, if they want to follow your adventures, where can they find you?

Dr. Mary Gardner: So my, personal adventures are at Dr. Mary Gardner. So Dr. Mary Gardner, and I’m on Instagram and Facebook and I, you know, my shenanigans are out there and I will post about this in a couple of weeks when I’m you know, ready to, but it’s it’s been fun. So you can follow me there.

Dr. Andy Roark: Very nice. Cool. Take care, everybody. We’ll talk to you later.

Dr. Mary Gardner: Bye.

Dr. Andy Roark: And that’s what I got guys. That’s that’s my talk with Mary Gardner. Thank you to her for being here. Thank you to you for also being here.

Thank you to me for I’m here as well. Like we all need praise sometimes like we all want to feel appreciated and so i’m appreciating myself. Anyway, guys, if you enjoyed the podcast send it to your friends if you’re like, I don’t have any friends to send it to but I want but I really liked it you can just go and leave me an honest review wherever you get your podcast that’s super helpful as well Anyway, that’s enough. That’s enough of this. Let me let you go so you can get out there and do good in the world. All right. I’ll see you guys soon. Bye

Dental Dialogues: A Guide to Oral Care Conversations

February 12, 2024 by Andy Roark DVM MS

Dr. Katie Kling joins Dr. Andy Roark on the Cone of Shame Podcast to discuss the importance of working with pet owners on dental disease prevention without risking their human animal bond in the process. Together they go over what to do when pet owners bring in their favorite dental products and how we as veterinary professionals can guide them to the right resources.

Cone Of Shame Veterinary Podcast · 254 – Dental Dialogues: A Guide to Oral Care Conversations

This episode is brought to you by Hill’s Pet Nutrition and the Hill’s Veterinary Academy

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

LINKS

The Hill’s Veterinary Academy is a one site solution for educating the entire veterinary team. On the HVA, you can find FREE RACE CE from leading specialists and experts, patient-centric education beyond nutrition and flexible, on-demand content that fits your schedule.

More information on Hill’s Prescription Diet t/d

Continuing Education on Gaining Dental Home Care Compliance

The Veterinary Dental Forum

The Veterinary Oral Health Council

Veterinary Oral Health Council Seal of Acceptance

ABOUT OUR GUEST

Dr. Katie Kling graduated from Ross University School of Veterinary Medicine in 2008 and spent the first 7 years of her career in general practice in Cincinnati, Ohio and College Station, Texas prior to completing her dental residency at the University of Illinois in 2019. She stayed on at the University as an Assistant Professor until 2021 at which time she joined the Veterinary Dental Center in Aurora, IL where she now practices as a part of a dedicated dentistry team. She is happy to serve on the AVDC Diversity, Equity, and Inclusion Committee and the AVDC Exam Committee.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I had a great one here with Dr. Katie Kling. Gang, we are doing a ‘How Do You Treat That’ episode with a three year old chihuahua who’s starting to get dental tartar. And mom loves chihuahuas and has had them in the past and they all had trench mouth and she’s like what can I do?

She’s got some products she bought off of instagram that she’s rolling in with. This is a great conversation. I get Katie to help me to talk to this person, to lay down for me her thoughts on supplements on nutrition for dental health, on what ages we start to have these conversations and things like that.

We talk about toothbrushing. We talk about relative importance of toothbrushing versus like dental chews and diets and things like that. And it is really a very cool conversation to sort out kind of the, all the different stuff that people can do. And I’ll be honest, like there are so many products around dentistry.

A lot of them I’ve never seen before and pet owners are coming in with stuff. I just never heard of this stuff and there’s nothing, authoritative behind it. I want tips on how to talk to them, how to guide them, things like that. So anyway, this is a really good, really practical episode for maintaining dental health. I hope you guys will like it a lot. This episode is brought to you ad-free by Hill’s Pet Nutrition. Guys, if you have not checked out Hill’s Veterinary Academy for your learning needs, I highly recommend that you do. I’m going to put a link down in the show notes. I mention it when we talk about resources as well, but Hill’s Veterinary Academy is a great place to get some continuing education on dentistry, especially on nutrition.

Go check it out. Have a look. Guys, let’s get into this episode.

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

Dr. Andy Roark: Welcome to the podcast, Dr. Katie Kling. How are you?

Dr. Katie Kling: Great. Great. Thanks for having me.

Dr. Andy Roark: I am so thrilled to have you. I love having you on the show. You are one of those people who is amazing because you are a boarded veterinary dentist. You’re a specialist. You have a deep wealth of information and knowledge, and also, you were a general practice doctor for like eight years when you graduated, you went straight into practice, you did that for a while, and then you transitioned over and went back and got your residency, and so you walk in both worlds.

Dr. Katie Kling: Yeah. Thanks. Thanks, Andy. I agree. I have a huge respect for general practice. I think that’s really where a lot of the most important things happen in caring for our pets and that’s a huge vantage point to be in. So I loved general practice. And I think a lot of good dentistry, important dentistry happens at that level too.

Dr. Andy Roark: I’m always interested. I always have to start this conversation when I talk to people who have had a journey like yours, because I think vet medicine is amazing in that you can change up what you do. It’s a– it’s a house with a million rooms. And so, what was it that motivated you after being in general practice for eight years?

How did you decide to go back and become a specialist?

Dr. Katie Kling: Yeah, great point. So yeah, I think a lot of us jump around a little bit or try out different things. And, you know, when I was at U of I, I would say the students like it’s not like everything advances at the same level. So even if you’re not specializing officially, you’re still sort of developing your special interests or your special skill set.

And I think when I worked in practice and worked with multiple colleagues, three or four colleagues, you know, it’s like, okay, Carrie’s good at ultrasound. I’m going to be faster at this surgery. And, and you still, in my experience, at least. Bounce things off of each other and specialize in your own way.

So, definitely I think that starting out in that practice, I felt very hesitant about dentistry, spent a lot of CE and then kind of swung the other way to where I developed a special interest. So I think all of us that like, you know, we’ve been in practice a similar amount of time, you look for the next challenge, the next thing to take on and, and dentistry became that for me.

Dr. Andy Roark: Yeah that’s awesome. I love the fact that it was something that you were not particularly good at or you just felt sort of uncertain about and through sort of learning more about it, you’re like, I really like this and you just kept going. I think that’s great. All right. I have a case that I want to talk with you about a little bit today.

Is that okay?

Dr. Katie Kling: That sounds great.

Dr. Andy Roark: Alright, sweet. I have a three year old female spayed chihuahua named Cece. And so, Cece’s a young chihuahua, and she is here with her mom. And, uh, her mom is her person. Her, she’s one of those chihuahuas, her body has kind of formed to match her mother’s like armpit, you know what I mean? So as she’s being held, her back end just fits right there. Uh, that’s, she doesn’t touch the ground a lot. She lives, lives on mom’s arm. And so anyway, that’s Cece.

Now, I can talk to mom and Cece’s at three years old. She’s already getting some of the tartar that you can see on the outsides of her upper canines, you know, just along the gum line. She doesn’t have gingivitis, anything like that, but she’s getting that.

You can start to see it accumulating. And so I’m doing my physical exam and I just say to mom. Hey, come and have a look at this. You can see we’re starting to get some dental tartar here. And I was just sort of starting to set the stage to talk to her about this and about, you know, our chihuahuas are just classic sort of dental, dental dogs that we have to keep up with.

And I really hit a nerve because mom has had chihuahuas before and she was one of those Chihuahua owners that had this old Chihuahua that had a horrible trench mouth and it was going to be a lot of money to do anything about it. And she was like, Oh, but she’s so old, you know? And it was, it was really that case.

And ultimately I don’t think she did anything about the mouth and of course, you know, her dog ultimately was put to sleep. And in this conversation, it becomes clear that she’s got a lot of guilt. She’s got a lot of guilt that her dog had terrible dental disease and had it for years at the end of her life and she either I don’t know if she’s able to financially afford it if she was it was if it was the risk of you know of putting her under anesthesia.

It’s always hard to tease those things apart about what’s really motivating people. But she definitely had a lot of guilt, and so, when I pointed this out to her in this three year old dog, she was kind of upset, like, what am I supposed to do? And I sort of uncovered that it came from that sort of hardship in the past.

And so, what I want to talk to you about is this. So, I’ve got Cece. She’s young. We’re just starting to see some accumulation of dental tartar. Mom is very aware of this. She’s got, Sparkle Rinse. Sparkle Rinse is an all natural dog mouthwash that she’s pretty excited about. I don’t, this is voodoo. I think it’s got lemon juice in it and, wishes is what I can tell. The primary ingredients are thoughts and prayers for healthy teeth.

Um, Anyway, that’s what she’s got. Katie, how do you treat this? Where do I try to take this conversation? What do you say to the owner of this, you know, relatively young dog, to help sort of get her on the right path? And what tools are even in my toolbox?

Dr. Katie Kling: Great point. Great scenario. I think we’re all familiar with this patient and this owner, right? And then you brought up a couple of different things that I think we all see, right? This is a, this is maybe from a medical standpoint, if we just had the dog in front of us, we kind of all know what to do.

We, we all know the steps. We know what’s going on. We know what this dog is prone to. And so this shifts into like maybe a little bit of a medical challenge, but primarily communication challenge here, and I think we have a lot tied up in this, right? We have this, there’s typically some guilt tied up in dentistry. They feel like they’re bad owners or they’re neglecting something or, the dental health maybe reflects the care of the patient overall, and then also a hesitancy to want to have, you know, I think the, the implicit thing is, is there’s also the fear of anesthesia, probably. And so all those things go into this where we’re coming in and they’re defensive, right? So, so straight off the bat, and then they brought in this product that we’re like, uh, we’ve never heard of this product. Um, and they feel great about it, and so I think, there’s varying opinions on how to approach this. But my opinion is that we want to be on the same side as our clients.

So our clients are at the very least good clients because they’re in front of us. The worst clients have not even shown up to us in the first place. So they’re, they’re trying to do the right thing. And we want to educate if they want to be educated. And so I think laying the groundwork, that’s like, Hey, you want to take care of Cece’s mouth? Me too! We’re on the same page. You brought this product to me. You’re interested in home care. Me too. So let’s figure out where we have common ground and then to alleviate them of that guilt. What I’ll say is, hey, your breed is a chihuahua. You’ve fallen in love with chihuahuas. You’ve always had chihuahuas.

So let’s talk about what we need to think about, in having a chihuahua in addition to all the good things that come with chihuahuas and, and obviously you’re a dedicated mom. So how do we sort of open them up to let them know that we’re on their side? We’re not here to scare them. You know, this, this in my opinion, outdated way of saying, Oh, wow, these are really bad. Or, or did you know this can seed to the liver or cause heart disease or things like that, where we used to try these threats, which it’s like, okay, if you look at the research, the incidence of cardiac disease and liver disease is very rare. That’s not really the highest risk. I think the highest risk is that we could miss providing an even more comfortable and healthier mouth for your pet. And most of our clients are at that level. They’re like, I do want to do the best thing for Cece. and we can share those.

So I can say, I’m on the same page as you. How do we make things easy on Cece when we know Cece is at such a higher risk of dental disease. I usually, depending on how interested people are in talking about dentistry or not, I will sometimes just bring it all down to just dental disease. So you fall in love with a small breed dog, they have a high rate of dental disease.

So, let’s talk about what that looks like.

Dr. Andy Roark: Yeah, I really like that opening a lot. I know at some point she’s going well, I have friends and their dogs don’t need dental cleanings every six months. And you know and, and their Labrador was 12 years old and barely had anything eating on his teeth and no one said anything about him and I go, okay, let’s validate the scenery here.

You’re not in crazy town, but this is, you have picked this wonderful little dog and every dog has their little eccentricities and dental diseases is part of this. I really liked that a lot. Let’s start to talk a little bit about, let’s talk a little bit about this mouthwash. There are so many products that are out there and I swear.

I do Instagram. I don’t do a lot of social videos, but I do, I do do Instagram. I had it off my phone for like two years and I put it back on and I do Instagram. And man, they hit me with great targeted marketing. Like they know my stupid sense of humor, um, and just hit me with these weird products that I’m like, okay, that’s pretty great.

And I know that pet owners are out there looking at, you know, you start looking at dog Instagram feeds and all of a sudden you’re getting all kinds of stuff. And like, I used to feel like if you had a product that just flat out didn’t work, nobody was ever going to hear about it, you know, and that’s not the case anymore because you can, you can target ads and you can, you know, sell just absolute snake oil. And so I’ve got these people and they’re coming in and some of them seem really compelling ads and things like that. What does that conversation look like for you today, given that at least it feels like there’s so many more products being put in front of better owners and the marketing around these products is pretty darn slick.

Help me with that part of the conversation.

Dr. Katie Kling: Yeah, I agree. They’re just swamped with all this information. And some of it, I’m trying to, to kind of come at it from, from what their angle is. So like, let’s say someone’s like, I’m spending all this money on these products and I can’t keep up with this. You know, that comes down to something that’s pretty simple, which is the bottom line is that toothbrushing works and toothbrushing is pretty inexpensive.

But it’s time consuming. And so then we look at these products to say what other products work besides toothbrushing and to try to sort that out. So I’ll typically if they bring in a product I haven’t heard of, or I’m unfamiliar with, or doesn’t have any studies behind, then I’ll, I’ll take a look at the product for them.

I want to look and make sure it doesn’t have xylitol or a whole lot of alcohol or things like that, that we would not expect to be in them. But like you said, anything’s out there. And then from there, if they’re interested, I introduced the idea of a group of products that have been studied, by something that’s not sponsored, like you said.

So for humans, we have the ADA that we can trust and can find on our toothpaste or our toothbrushes. And then the dog version of that is the VOHC.org . So that’s the Veterinary Oral Health Council. And that is the same premise, which is to say, Hey, I’m a vet, I’m going to make my recommendations as research based recommendations.

And these are products that have been through the same standard research and have proven that they help with either plaque, tartar or gingivitis or halitosis. And this is how we can tell that they work. Could there be other products out there that work that haven’t been through this testing? Sure.

But if you want to spend your money on something that has proven to work that’s where you would look. When they evaluated toothbrushing in a whole group of beagles with just saline, right? So no product, that was effective in reducing gingivitis and plaque. And so we look at these other products as sort of supplemental or more inviting or, or more appealing or more user friendly, right?

Maybe Cece’s mom is 85 and she’s not going to be Chasing her chihuahua around with a toothbrush. Similarly, I will say, my pet owners who are holding down their pet to brush their teeth. It’s like well, that’s gonna happen once like my goal is not to disrupt your bond with your pet, right?

Dr. Andy Roark: Yeah. So two questions here. First, I just got to know, have you actually seen, are there actually pet products with alcohol or xylitol in them?

Dr. Katie Kling: Yes, so I have seen xylitol and I think what was it? Well, I’ve been in practice same amount of time as you, but I think that they, justified that it was a small enough amount. But yeah, isn’t that shocking?

Dr. Andy Roark: Well, the alcohol for, I was like, I could see, you know, dental products being like, sure, we’ll just put some alcohol in there. That’ll, that’ll do it. Okay. I was just curious. Okay. So, so that’s, that’s the first part. The other, talk to me a little bit about how much emphasis you put on tooth brushing versus, either supplements or dental nutrition, things like that.

I think a lot of us have kind of settled into this idea that like, we’re going to tell people they should brush their pet’s teeth, but we’ve kind of accepted that the chances of them actually doing it are low. And some of us have just given up even talking about it, but I always feel guilty.

I, and I always wonder a little bit if they go out and they’re like, you know what, I’m going to do the t/d diet or I’m going to do some dental chews, but I’m not going to brush my pet’s teeth. I always kind of wonder, are we spitting in the wind here or are we actually doing good?

Help, help me get my head around, are supplements comparable to teeth brushing? Is teeth brushing really? 85 percent of the battle and supplements are 10 percent of the battle, like, where, where are we? Can they put together a comparable dental plan if they’re like, I can’t brush this pet’s teeth? Do I need to just suck it up and really start trying to talk more directly to them about toothbrushing?

Help me, am I doing a good job? I guess, Katie, is what I’m kind of looking for here.

Dr. Katie Kling: Right. Um, so I agree. And I think, we as vets sort of get trained by our clients, right? You bring up toothbrushing, you get like, uh, or, just like when we bring up a dental procedure, right? We get that, like, kind of bad feedback that makes us, Maybe even subconsciously sometimes not want to bring it up the next time.

When I talk about tooth brushing, and sometimes I talk about tooth wiping instead, which if it’s more realistic for certain pets or certain owners. What I let the owner know, I want to know, where do you stand on that? Is that something that you’re planning on doing so that I can make my plan around that?

So I’m not going to tell you. You need to brush your teeth. And next time that I come in, I’m going to ask you how frequently are you brushing your dog’s teeth? I am going to tell you that the science says that tooth brushing every other day makes a big difference. Every day makes a huge difference once a week.

Not very much. So if you’re taking Cece to the groomer every six weeks, and she’s getting her teeth brushed, I’m gonna tell you, why don’t you stop doing that? That’s just like Cece torture, but it’s not having any benefit. Or, certainly if the mouth is painful and you’re introducing tooth brushing, it’s causing bleeding. You’ve just trained Cece that tooth brushing hurts. So I think that some people are gung ho. They’re like, my whole goal is keeping the teeth. My whole goal is not having what happened to my last dog happen to this dog. Then really, toothbrushing is a great concept, and then maybe you can supplement it with, you know, we, we talk about the t/d, which is great for chewing teeth if they’re chewing it right.

It’s plaque disruptive, just like chewing is. Um, and sometimes, you know, I keep it in my room, my exam room, because I want to see, I want to see how a dog chews. That food sometimes if they’ll chew it, or if they won’t like that can be useful information to know, and then when we think about other supplements, things that are really going to bind up the minerals that are in saliva that cause the plaque to calcify into calculus or tartar.

That can be helpful too. But tartar looks bad and, and really the bottom line is plaque is what’s causing that disease or causing the bone to want to recess away. So we can have, like you said, a lab come in who the owner perceives the teeth are really bad and we know we’re going to get them under, do full mouth rods and we’re going to clean the teeth and Maybe they won’t require any extractions versus our Chihuahua that has, like you said, just a little bit of tartar forming on the canines.

Well, chances are we get in there and one of those 42 teeth, even at two or three years of age or more than that, may already have advanced dental disease.

Dr. Andy Roark: Talk to me a little bit more about your chewing test. That’s not in my playbook. What does that look like? What are you looking for? So you, you give them t/d, which I love as an exam room treat. I like, I like the size, you know, I like the fact that it’s there and it makes the conversation about these, uh, these types of things easier, but you’re, you’re giving it to them and you’re seeing if they’ll chew it. Like what does that look like when you do it in the exam room and what are you looking for?

Dr. Katie Kling: Yeah, so and maybe that is getting off topic a little bit. I have some, I have some patients who come in where they do a little chatter after they chew or they’re hesitant to chew or the owners will say they’re chewing on one side. And so sometimes I can use that for an exaggerated to sort of show me, show me what they’re doing.

I think also if, if I’m thinking about using a treat or a kibble or something like that with a dog as a part of their home care routine. I also want to see if they’re going to swallow that whole. Have you had those dachshunds swallow them whole before? I mean, just impressive.

Dr. Andy Roark: It’s impressive.

Yeah. It’s a skill that I was like, I didn’t, it’s like a snake they just dislocate their jaw and kind of down. Yeah.

Dr. Katie Kling: Right. If you’re chewing a dental treat and you’re giving it one bite and swallowing it, that’s. I mean, but now the, they, they test a lot of those dental treats with beagles and they did go through them in like 15 to 40 seconds, and they’re still having benefit from them. So, but certainly they have to chew them somewhat.

Dr. Andy Roark: Talk to me about when you start to lean into nutrition for dental health. Is it pretty early in your, in your presentation? Is this something with Cece at age three?. Especially since mom is focused on it. I mean, she seems like a good candidate in my mind. Is this early in the game? Is it late in the game?

Are you talking to puppies about or a puppy of visits about it? When do you start to introduce this? And how do you kind of get the clients to start thinking about nutrition? I can tell you that sparkle rinse is probably a lot cheaper than a diet that we buy ongoing and ongoing. Talk to me about sort of how that presentation looks.

Dr. Katie Kling: Yeah, absolutely. So I think that we are looking at sort of trying to get multiple factors in there at 2 or 3 years of age, Cece needs needs a full assessment, right? She needs to go under. She needs to be probed. And we know that 80 percent or higher of dogs are going to have, are going to have dental disease at that age already.

And I think that in a really motivated owner, right? Some owners are motivated to say, I want my pet to be pain free and comfortable mouth. Great. We’re on the same page. Some owners want pain free, comfortable mouth, and to preserve as many teeth as possible. So now that is in a situation where I can’t do that alone without some home care.

And that’s when we pull up, I have them go home with that list, look through that and say, what is realistic for me? I think you’ll be hard pressed to find something better than, brushing once a day with with saline, I mean, I and and sometimes linking that with something that they’re that is positive for them.

So for chihuahuas, for in Cece’s case, right? We also have to take into account, their daily caloric needs. I don’t think any general practitioners going to be happy with me making recommendations to add these three treats. I’m adding 200 calories to their patients diet every day. So now they’re going to have the other the other situation.

In terms of, using a product to, as like a toothpaste, I think they want to think about that more in the sense of bribery. So if the pet likes the flavor of toothpaste, great, that’s an added bonus that they’re going to now have that positive link versus for us when we’re thinking about fluoride or preventing cavities, right?

The incidence of cavities in dogs is 6 percent of dogs will ever get a cavity and, and cats just simply don’t get cavities. So really it’s the mechanical disruption that we’re thinking about. So whether that’s done with tooth brushing or a diet or treats, those are, that’s all the angle of disrupting plaque by the natural way that they’re using their chewing teeth.

Dr. Andy Roark: Gotcha. What are your favorite resources if people are geeking out and they love, you know, dentistry? So, I’ve got to give a shout out to Hill’s Veterinary Academy as, you know, they, we work with them and they’ve, they’ve made this episode possible. What are the, what are some of the resources that you find a lot of value in or that you recommend to people who may be like you or like, hey, I’m in general practice and either I’m weak in dentistry or, this is an area that i’m starting to fall in love with and I would like to read more deeply. Where do you send people?

Dr. Katie Kling: Yeah, great point. So the dental forum is the ABDC’s national, forum. We have people internationally there too. So, and that’s held in the U. S. every year, once a year, usually in the fall. And there’s typically a lot of attendance by veterinarians who have a strong interest in dentistry and veterinary technicians who have a strong interest in dentistry or even specializing in dentistry.

There’s good anesthesia references or resources there too. And then there’s hands on labs, which. For me certainly coming right out of school, that was what I was looking for, right? Like, hands on, let me make my mistakes in a lab and kind of build my confidence that way. So, that would be the route I would go to in terms of making connections and then also just, just all of your, resources and hands on practice.

There is, you know, I don’t know how things are nationally, but around us, our general practitioners are still backed up with, with dentals. I don’t know if that’s ever going to go back to pre pandemic times or not. It’s just, there’s a huge demand for that in patients where people are alerted to that, that that’s going to make such a good, positive impact on their pets.

Dr. Andy Roark: I agree with that. I love the hands on learning idea I think that that is absolutely fantastic I’m such a big believer in you know There’s knowledge and there’s skill and like skill comes from actually doing the thing and so I just I love that. I’ll put links in the show notes.

Thanks so much for being here. Where can people find you online?

Dr. Katie Kling: Definitely Instagram and Facebook. I work at the veterinary dental center in Aurora, Illinois. Great team of dentists there.

Dr. Andy Roark: I’ll put links to those accounts in the show notes. Katie, thank you so much for being here. Hey guys, thanks for tuning in and listen, everybody.

Dr. Katie Kling: Thank you.

And that’s it, guys. That’s what we got. I hope you enjoyed it. I hope you got a ton out of it. Thanks to Dr. Katie Kling for being here. That was a really fun conversation. Thanks, thanks, thanks to Hill’s Pet Nutrition for making this episode possible. Guys, again, if you haven’t checked out Hill’s Veterinary Academy, definitely do so.

I’ll put a link in the show notes. Also, if you have questions specifically about t/d or dental diets, things like that, through Hill’s Pet Nutrition, check out hillspet.com. I’ll put a link to that in the show notes as well. Guys. Take care of yourselves, everybody. Be well. I’ll talk to you soon.

Using Fluorescent Light Energy for Dermatologic Therapy

February 8, 2024 by Andy Roark DVM MS

Board-certified veterinary dermatologist, Dr. Ashley Bourgeois, joins Dr. Andy Roark to explore cutting-edge developments in veterinary dermatology. The focus is on Fluorescent Light Energy (FLE), also known as photobiomodulation (PBM), and its revolutionary applications in addressing diverse dermatological cases. Dr. Bourgeois demystifies the workings of this light energy, and provides insights into seamlessly integrating this innovative technology into veterinary practices.

Cone Of Shame Veterinary Podcast · 253 – Using Fluorescent Light Energy For Dermatologic Therapy

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

LINKS

Referenced Article: https://todaysveterinarynurse.com/dermatology/fluorescent-light-energy-therapy/

Phovia: https://www.phoviausa.com/

The DermVet: https://thedermvet.com/

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

Uncharted Veterinary Conference

Dr. Andy Roark Charming the Angry Client Team Training Course

ABOUT OUR GUEST

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

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

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome, everybody to the Cone of Shame veterinary Podcast! I am your host, Dr. Andy Roark. Guys, I got a fun one here for you today. I’ve got my friend, Dr. Ashley Bourgeois here. She is a boarded dermatologist and this is a, this is what our conversations are like. I was reading through my magazines as, I explain in a moment and I found an article on fluorescent light energy in dermatology. And I was like, this feels like voodoo. This feels like just, just some hand waving medicine that gets recommended in drum circles. Like that’s what it sounds like to me and I texted her, I was like, “is this legit?” And she was like “Totally!”

And I was like, ou gotta be kidding me. And she said, yeah, I’ll tell you about it. And I said, great. Let’s, let’s turn the, let’s turn the microphones on. And so that’s what happened here. There’s not a sponsored episode at all. I just, it was something I am not familiar with. I’ve not gotten to use this and Ashley was great about running me through it. So anyway, if you are familiar with FLE or Phovia. is the brand name that she refers to then you’re going to learn about it here. But anyway super fun stuff. Gosh, what an amazing time to be alive. 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. Ashley Bourgeois. How are you?

Dr. Ashley Bourgeois: I’m so wonderful. How are you doing?

Dr. Andy Roark: Man, I’m good now that you’re here. It’s good to see your face again, old friend. For those who don’t know you, you are a boarded veterinary dermatologist. You practice at the Animal Dermatology Clinic in Portland. You do a bunch of stuff online and things like that, but that’s not where I know you from.

We met way back in vet school. When we were doing the VBMA stuff and have sort of kept in touch ever since. And I get to see you at conferences and you are just a, you are just a gift to our profession. And so I just, I love having you here and I really appreciate you taking time and I will say here’s.

Here’s a feather for your cap, when I was reading an article, and I was like, I don’t know what this is, I need to talk to someone who could explain this to me, you were the person I texted. I was like, I’m gonna ask Ashley, hey, is this legit? And I texted you, and that started our conversation that led to this podcast, so, I will get into what that means in a moment. How are you doing?

Dr. Ashley Bourgeois: Yeah, I’m doing well. It is. It’s really funny to think about when people ask me, like, oh, do you know Andy Roark? And like, I mean, I knew Andy Roark he was Andy Roark. I will say, you know, National VBMA, which when we were on the national board was young, right? VBMA was really just going.

I never had any doubt. Like when you started being well known. I’m like, that makes sense. So it’s really cool to surround yourself with people, right. That you either went to school with, or were involved in certain organizations. And as we were talking about before we started recording, we’re getting old now that we can start to say like back in my day, like, you know? Over a decade ago when we were on the VBMA together, it’s pretty, it’s a cool journey to really see people blossom.

Dr. Andy Roark: Oh, yeah, it absolutely is. It absolutely is. It’s funny how you, it’s a small profession and it’s funny people who hustle and do stuff tend to kind of turn up again and again and I really, I think you end up, you just, you sometimes you meet people early on and then they just never go away.

You’re just kind of around. And so that’s been great. But it has been wonderful watching your journey. I, texted you because, and let me just say it front, this is not a sponsored episode at all, or anything like that. I was just, I was reading through my journals and I came across an article in Today’s Veterinary Nurse about using fluorescent light energy for dermatologic therapy.

And I texted you because this was kind of a new concept for me as far as in practice. And I’ll, be honest. It sounds like voodoo. I was like, yeah. Is this like, you know, is, this like, you know, using salt crystals you know, things like that? I texted you like is this legit? And you were like, yeah, it’s pretty legit, Andy.

And so I was like, okay, I’m sure I’m not the only person who’s not very familiar with FLE. Can you just give me, give me a primer, start at sort of a mile high, what is this? And then we’ll sort of dig into how is it useful in practice, potentially.

Dr. Ashley Bourgeois: Yeah, definitely. And I’ll say anything, anytime something comes out in dermatology, because we are very right. Product heavy specialty. The first thing is that sounds cool, but show me the research. So I think it’s pretty normal when you hear something that’s different that you want to say, but, prove it to me.

So you’ll hear it called a few different things. FLE, like you mentioned, you’ll hear it called photobiomodulation. And primarily the unit within the veterinary field is Phovia. And the idea behind this is that there’s actually a gel. So it’s not just a light. What’s really important is it’s a chromophore gel that you put on lesions, which we can talk about specifics.

And then the idea is that light unit is a blue light. But what’s important is when that light actually hits the chromophore gel, it creates almost a rainbow effect of different wavelengths and lights. And why that’s important is it kind of hits different layers of the skin, so different wavelengths go different depths.

But then each light, like there’s red, green, blue, each light actually has different benefits too. So whether it’s anti-inflammatory, it’s encouraging different growth factors, which can help with wound healing, or being antibacterial, you get kind of that cascade of events just by putting one light on it because of that gel.

And so it is a pretty interesting technique and they actually do have literature behind it for deep pyoderma, superficial pyoderma, even things like perianal fistulas. So I think it’s a pretty cool tool. Yeah.

Dr. Andy Roark: That’s so perianal fistulas have a personal place in my, and I don’t, it’s not in my heart. It’s the opposite of my heart.

Dr. Ashley Bourgeois: No, I don’t think anyone’s in love with the disease.

Dr. Andy Roark: No, it’s the opposite. If I had a hate organ, that’s where it would be, but yeah, that’s fascinating. So the gel itself, is something that come in and gets applied in the clinic just for the transmission of a light? It’s not something that you would continue to apply at home anything like that? There’s no benefit to that, correct?

Dr. Ashley Bourgeois: Yeah, correct. It’s like photo activated. So the way that we do it is usually the protocol is twice a week, but you can do it back to back. So what I usually do is if I know I just did a Phovia treatment, I think last week in the clinic for like a very focal pyoderma. And so we’ll put the gel on, well we’ll use chlorhexidine if it’s a pyoderma, wipe that off, put the gel on.

The light is, once you press the button, it goes for two minutes. So it goes for two minutes, super simple. And then the light goes off. Then what you can actually do, because we all know clients are busy, if we can make it less hectic for them to have to go back and forth to the clinic, you can do the second treatment in a row.

So then I just reapply the gel. You want to wipe it off. the stuff that’s already used up, reapply, and then you just do another treatment, and then I’ll have them come in once a week, depending on what I’m treating.

Dr. Andy Roark: Okay. So give me some, examples of the things that you would be treating. I mean, so is this, does this have post operative functions? I mean, I, is this is this classic, you know, like deep pyoderma? I, what, walk, me through this. It kind of sounds like kind of sounds Like, like too good to be true?

Like, you just use it on everything. Like allergies, limping, storm phobia. Like it sounds like there’s a lot. Hey, give me, start, to ratchet this down for me a little bit and say, okay, this is when you would start to kind of think about FLE.

Dr. Ashley Bourgeois: Yeah probably not storm phobia, probably not trying to get the light energy to the brain for like anxiety, but I, you know, I’d say a lot of skin applications, I’d say the limitation is if it’s a really diffuse disease, right? Like if I diffuse pyoderma, that’s probably not gonna be really realistic. So I do need it to be focal or multifocal in a realistic manner, like two to three lesions, whatever makes sense.

I would say primarily, and as we’ve had this technology longer and longer, we’re finding more and stuff we can use it for. But I’d say where the most supportive things in the literature would be wound healing. So you certainly could use it post operatively.

I use it in things like I’ve had non healing wounds that get referred to me. So My first application of it was a benign mass that a primary vet had taken off, like the dorsal paw of a dog, and it just would not close. It had struggled for like six months. We cultured and did all the things we needed to do, but that had been done before too.

But when we treated the infection plus used Phovia, it was the first time that lesion ever fully resolved. So I’d say focal lesions like that, I’ve used it in acral lick lesions. because those are often infected and inflammatory. I’ve used it in focal deep pyoderma and focal superficial pyoderma. And there are actually our studies, true studies available showing that either you can use it as a sole therapy and something like a superficial pyoderma.

Again, if it’s more focal. Or you could use it with a deep pyoderma concurrently with an antibiotic. And with deep pyodermas, we often have to use several weeks of antibiotics. They were able to shorten the duration of antibiotic use by implementing something like FLE.

Dr. Andy Roark: Okay. Are there cases that you do not use this on? Something where you’re like, yeah, this either there’s contraindications or, yeah, or, concerns that you have? Anything that you would say, this is a case I would specifically not reach for?

Dr. Ashley Bourgeois: Yeah, so I would say that what I am cautious of, though, I’ll talk about a couple things that maybe it’s different is traditionally when it came out, we were really cautious of anything that could be cancer, like a neoplastic process, because you are encouraging growth factors. So if it was just like a nodule sitting there and I didn’t make sure it wasn’t a mast cell tumor, there was some uncertainty, like we could not make it worse.

But I actually have had colleagues, because in DERM, sometimes we are the Wild West, right? Like, we have lots of options, we deal with lots of things. I’ve had some colleagues actually use it on focal areas like skin lymphoma, and have seen results with it. So, we’re cautious of that. I think that’s one I’d still be a little bit, you know, weary of before I got more information, but hopefully we’ll see further studies and information come out as we have it longer.

Dr. Andy Roark: Gotcha. What you said, you know, you can do the treatment sort of back to back. What is the standard sort of treatment period? Is this a fairly short session? I guess what I’m, thinking about here when I think about like, laser therapy for joints, arthritis, things like that. is it that, that’s kind of what’s in my mind.

How comparable are those in the actual performing of the therapy?

Dr. Ashley Bourgeois: So I would say kind of depending on what you’re treating. If it’s a superficial pyoderma on average, I probably do it about, you know, three weeks and then I recheck them. And the nice thing about it is it’s something that you can train. I’m all about utilizing my assistants, my technicians. So this is something that once we have the treatment protocol set up, then they come in for treatments with them.

You know, they know how to do it. It’s very straightforward. So it’s something that we can actually have the staff do. It’s really good as far as utilizing their skills and their techniques. So I’ll usually have them do like three treatments and then we’ll recheck. That wound I was talking about that was non healing, I think we did that one for probably about like six weeks, but I was rechecking kind of every couple weeks in between.

So there’s not really a contraindication going too long. There’s even some that will use it for maintenance, like things for perianal fistulas, but it just depends on, you know, how convenient it is for the owner to come in for treatments and how much they’re willing to keep up with it.

Dr. Andy Roark: Do owners tend to get it, you think? I mean, I couldn’t, it kind of, I don’t know, it seems to me like it would be hit and miss. Like some owners would be like, that’s too, that’s woo woo You’re going to shine a special light on my pet and he’s going to get better. Versus others that are like, oh yeah, I am here for this, for this specific therapy. Yeah.

Dr. Ashley Bourgeois: I find it hit or miss. I mean, to be frank, I, mean, I think that’s true for anything that I do in dermatology. Some people really get it for some people if we’re already going to have to utilize something like say an antibiotic. You know, maybe cost is an issue, right? Because of course we have to charge for that service.

So, I have had some people, I am in Portland, Oregon. So some people are really excited about anything that’s not traditional. So, and I think there’s something to be said for that. I mean, I still have to use a lot of antibiotics and dermatology, but I’m totally game for anything that gives me the ability to be a steward of antimicrobials and try to use less or shorter durations.

So I would say it is hit or miss. Certainly I give estimates out for it and people don’t do it. But I think if you really explain it like, “Hey, there’s studies showing this can not only help with infection, but stimulate, you know, wound healing properties that we might be able to shorten the duration of antibiotics.”

A lot of people really do buy into that. If you can say that it truly has support behind it.

Dr. Andy Roark: Are there things that you wish you knew when you started playing around with FLE? Were there lessons you kind of learned along the way?

Dr. Ashley Bourgeois: I think just the confidence and actually recommending it, right? So very similar to you when things come out, you know, I’m, pretty cavalier. Like I, I’m always up for innovation and trying new things. I think that’s the beauty of veterinary medicine. I never want to be the person that’s just like, “Oh, well this has worked for 30 years. That’s what I’ll do.” Like, I always want to try new things because that’s the beauty of our specialty, but of course, like I’m like, there’s this cool way like we could try it. I don’t know. So I think the important thing is the studies right? To be able to say there are truly studies that show the benefit of this, but I also am totally fine if people say it’s not for them.

Like I, you practice long enough. You kind of, you know, you get used to like, that’s not for you. That’s okay.

Dr. Andy Roark: Hey guys, did you know that I have another podcast? I am the host of the Uncharted Veterinary Podcast with my dear friend, practice management goddess, Stephanie Goss. We, we have been answering questions for years. We started a year before Cone of Shame. I started doing the Uncharted Vet Podcast with Stephanie.

It’s about working with your boss. It is about all of those sorts of things. We have everything from, trying to establish some trust in your team when you’re a brand new baby doctor, fresh out of vet school to, managing an employee with mental health issues to, how to. How to give notice without the guilt if you are in a place, you just can’t be there anymore. We’ve got all that stuff. We’ve got hiring, firing, working together, working with clients, reviewing your systems, getting your practice to run smoothly and efficiently, how to manage your time. All that stuff is there. Check it out. I said 250 episodes.

Yeah. No, that totally makes sense to me. I’m with you too. It’s- I never want to be like, “that’s how we always did it”. And, at the same time, I take people’s trust in me really seriously, which means I don’t want to be in there like, “Hey, here’s some stuff. I just, I got it in the mail. I don’t know if it works.

It might be toxic. Let’s do it.” I, you know, I don’t want to be that too. So it’s it’s building that confidence, which is why I wanted to sort of talk to you about it and sort of say, okay, tell me about this as I, sort of look at it.

Dr. Ashley Bourgeois: And to your point real quick, it is totally fine to say stuff like that. Like I do get samples of stuff and I’m in Durham, right? So I have clients who’ve seen me for years and years and half the time, half the appointment is talking about like, what are your kids doing? So I will tell people like, there’s this new product out.

I don’t know much about it, but it’s supposed to do this. Or, you know, I saw some studies, just a couple of studies. So I’m really honest with owners. Like this is new. I don’t know much about it. I don’t have a lot of experience about it. Cause they appreciate that to your point.

Dr. Andy Roark: Yeah. when I’m thinking about sort of new derm therapies and new derm approaches, and you and I are talking here and it’s kind of, it’s still near the, first of the the first of the year, the beginning of 2024 setting FLA sort of stuff aside, what’s in derm right now that you’re excited about?

Like, what are you, what other tools are you looking at? I’m just fishing to be like, are there other things I should be really thinking about? But what are you Ashley interested in, excited about, optimistic about for the coming year?

Dr. Ashley Bourgeois: You know, I’m always optimistic that there is good research coming out just about learning more about what allergies really are. I think that in the last decade, we always think of itch, right? Like, Oh, they’re itchy. Stop the itch. And that’s so important, but I’m also really optimistic that there are being more studies looking at right?

Like when certain medications like apical and cytopoint came out, like they were not out when I started doing my residency. And it was kind of like now, you know, wow, they’ve been game changers, but I love also some of the attention that’s going into things like microbiome, like the differences in some of our allergies, right?

Like how come Westies are always little elephants? How come German Shepherds tend to have like ulcerative, crazy, nasty, like dermatitis, like there has to be phenotypic differences between some of these pets? So Itch is important. I think we’re going to continue to have more allergy medications that come out, which is great because we still have some cases that don’t respond to even the tools we have now.

You know, I always, we all cross our fingers more stuff for cats will come out. Like, I don’t think that will ever change.

Dr. Andy Roark: I know that’s exactly where my head was talk to me about allergies and cats.There’s such an opportunity there. I was really hoping you would have something you were like, oh, this is

Dr. Ashley Bourgeois: Everyone’s always like, you must know. Here’s the thing I’ll say about cats. There is a reason we don’t have as much, right? Like, of course, like, there’s, we see more dogs than cats, and you can get down to that. But the big thing is, think about the differences in cat allergies that we see. So, you see anything from an eosinophilic granuloma, Right.

To an indolent ulcer completely eating its lip to a cat who’s just itchy to feline asthma. Like there’s so many different presentations of allergies in cats. So of course, I don’t think it’s as easy to figure out and fine tune all of these things with cats because they have such wildly different presentations.

So there has to be some difference between the mechanism of action and pathophysiology of those diseases, right? So. We all want more stuff for cats. All I can tell you from the little I do know is it’s not for lack of effort from companies. It’s just that they can’t figure it out because cats are cats and they like to make our lives complicated.

Dr. Andy Roark: Yeah. No, they don’t. It sounds like there’s not going to be a cat allergy off switch that we can just find and flick. That would be nice.

Dr. Ashley Bourgeois: That would be so, even for us, people are like, Oh, but derm. I’m like, we have the same tools as you.

Dr. Andy Roark: Yeah, exactly right. There’s not a secret derm medicine cabinet that you guys aren’t aware of. Like we have the same stuff that you do. Oh man. Ashley Bourgeois, thank you so much for being here. What before, before I, yeah. I’ll let you go. So jumping back to FLE real quick. If people are interested in this, if they want to learn more, I will link the original article that I just was happened to be reading when I decided to text you.

What are the resources that you really like that you would kind of point people towards if they wanted to learn more?

Dr. Ashley Bourgeois: Yeah. Honestly, what’s a really good resource is just going to the Phovia website. Like if you just Google Phovia. I think it’s like Phovia.us or something like that. We could look it up. But the Veto Kenal True website has their literature. their actual research there, and it links it to, like, these have been published, like, in VetDerm and other places, too.

So they’ll actually have the true studies there, and you can look at how they design them, you can look at the results of that. So it is worth checking out, and I do think we’re going to see more to come.

Dr. Andy Roark: All right. Sounds good. I will link to that in the show notes as well. Ashley, you do as I said at the beginning a bunch of stuff on online. You, you’re always telling Derm stories and lessons and pearls sharing. And anyway, where can people find you online?

Dr. Ashley Bourgeois: Yeah, you know, I’m a simple person, so it’s all under the DermVet. On Instagram, on Facebook. And then I have my own podcast that is just Derm Nuggets tips. A mix of just me chatting in your ear for 15 minutes and then a mix of interviews with other dermatologists cause I truly am a believer that we all do things differently and that’s okay.

And we should learn from each other. So I love to hear about people who do things differently than I do, but I put everything under the DermVet cause you know, I’m a tired mom of two. And so I just keep it all under the same name for simplicity’s sake.

Dr. Andy Roark: I love it. I will link to all that stuff, including the podcast and the show notes as well. Ashley, thank you so much for being here, guys. Thanks so much for tuning in and listening. Take care of yourselves, everybody.

Dr. Ashley Bourgeois: Thank you.

Dr. Andy Roark: 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 so much for being here. Thanks to Ashley for being here as well. Gang, take care of yourselves. Be well. I’ll talk to you later. Bye.

A Pentobarbital Problem: Post-Euthanasia Risks are Real

January 25, 2024 by Andy Roark DVM MS

In this episode of the Cone of Shame Veterinary Podcast, host Dr. Andy Roark discusses the post-euthanasia risks associated with pentobarbital injection. Dr. Warren Hess, the first author on a notable paper in JAVMA on the subject offers valuable insight as their conversation dives into the environmental and legal implications veterinarians may face after performing euthanasia using pentobarbital. Dr. Hess emphasizes the importance of understanding the drug’s impact beyond the act of euthanasia, addressing issues such as liability, rendering, and potential impacts on food and feed. The conversation explores the need for better education among veterinarians and clients, and the importance of documentation to protect practitioners. Dr. Hess also mentions ongoing efforts by the AVMA to provide resources and education on this critical topic for veterinary professionals.

Cone Of Shame Veterinary Podcast · COS – 251 – A Pentobarbital Problem – Post – Euthanasia Risks Are Real

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

LINKS

Article Referenced: https://avmajournals.avma.org/view/journals/javma/261/11/javma.23.03.0161.xml

AVMA Axon: https://axon.avma.org/

2024 Uncharted Veterinary Conference: https://unchartedvet.com/uncharted-veterinary-conference-2024/

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

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

ABOUT OUR GUEST

Dr. Hess is an associate director in the American Veterinary Medical Association’s (AVMA) Division of Animal and Public Health and as AVMA’s Disaster Coordinator. He provides technical and scientific expertise to the Committee on Environmental Issues (CEI) , the Aquatic Veterinary Medicine Committee (AqVMC), the Council on Veterinary Service (CoVS), and the Committee on Disaster and Emergency Issues (CDEI).

Dr. Hess graduated from Colorado State University in 1989. He worked in small animal practice with an emphasis on birds and other exotic animals until 2004 when he began working for the Utah Department of Agriculture and Food (UDAF) where he served as a field veterinarian, assistant state veterinarian and 18 months as acting state veterinarian. He began working at the AVMA in 2016.

Dr. Hess became involved early in his career with organized veterinary medicine and was elected president of the Utah Veterinary Medical Association (UVMA) in 2000. Dr. Hess has led several state and national organizations including serving as president of the National Alliance of Animal and Agricultural Emergency Programs (NASAAEP). Dr. Hess was voted Veterinarian of the Year in 2014 by the UVMA. He was the recipient of the NASAAEP Service Award in 2017 and the American Veterinary Medical Foundation (AVMF) Paws Up Award in 2018. He is married to his high school sweetheart (Lori), and together they have 5 children and 14 grandchildren.

Dr. Hess has enjoyed the companionship of horses, dogs, various birds, and marine fish. He enjoys fishing, rowing/kayaking, and motorcycles and has completed a motorcycle trip from his home state of Utah to Alaska and back with his 87-year-old father in tow.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with Dr. Warren Hess. He’s the first author on an interesting paper that I saw in JAVMA. It was about pentobarbital and what happens after the injection. And I’ll, be honest, it was something I was not really aware of. I genuinely don’t really think about what happens after we perform euthanasia. And it turns out there’s a number of things we need to at least have some eyes on. There’s some liability for veterinarians. There are there are some environmental impacts.

There are impacts around rendering and feed and food. And it’s just, it was something I had not really considered in a long time. And so it was a really good refresh. So anyway, this is a short conversation where we get right into it and just talk about what do veterinarians need to know?

What do they need to remember? What should we be talking to pet owners and animal owners about before we do euthanasias using pentobarbital? So anyway, that’s what it is. 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. Warren Hess. How are you?

Dr. Warren Hess: I’m great, Andy. Thanks for having me.

Dr. Andy Roark: I am very excited that you are here. For those who don’t know you, you are a veterinarian. You are also the American Veterinary Medical Association’s Disaster Coordinator, which I think is the best title you could possibly have. You are also an associate director in the AVMA’s Division of Animal and Public Health.

And I just became aware of some of your work quite recently. I was actually reading through the JAVMA issue that came out earlier this year. And you were the first author on a paper called Survey of Veterinarians Who Use Pentobarbital for Euthanasia Suggests Knowledge Gaps Regarding Animal Disposal.

It was actually an interesting survey that you did about what veterinarians know and don’t know, about what happens with animal disposal after we use pentobarbital. And it was funny because I looked at this and I thought I would check every “no, I am unaware box” on the whole survey. And so I actually found this survey quite interesting.

One, in what veterinarians know and don’t know, but also in the like, why would we do this survey? What are we supposed to know? What is important to know about animal disposal when we use pentobarbital and drugs like that? So let me just start at a really high level and just say, when I looked at this article at first, I was like, I had no idea that there was anything I need to be concerned about in this regard.

Why should we be aware? What should we know?

Dr. Warren Hess: Andy, you’re similar to most of us, I think, especially if we come from a small animal background, which, I do. We go through vet school, we’re taught pentobarbital is one of the choice agents for euthanasia and we’re taught how to use it but we’re not really taught much more than that.

And what we’re learning about pentobarbital is, it doesn’t break down very well after it’s injected into the body for, euthanasia purposes. And that can create quite a bit of a problem, the scope of the problem is multifactorial.

Dr. Andy Roark: Okay.

Dr. Warren Hess: It ranges from issues with traces of pentobarbital ending up food and feed through a variety of processes. It impacts renders and it also impacts scavenger animals that might get access to a carcass or animal remains.

And it also impacts the environment, when pentobarbital leeches out of animal remains into the ground it can reach waterways. It can impact microbial life in, the surrounding area, and it can get into waterways and impact aquatic life as well.

Dr. Andy Roark: What motivated you to start to do this survey and look at this? Do you get the impression that it is an increasing problem? Is it something that has just been around and you feel like it’s lingering without getting any attention or unawareness? But what made you decide that this was the thing that you were gonna look into?

Dr. Warren Hess: Back in 2018, there were a couple of incidents where pentobarbital was detected in pet food.

And that started a discussion between AVMA and the FDA about why was that happening and what could we do to bring better awareness to, not just veterinarians, but other industry professionals out there as well.

Dr. Andy Roark: How does that happen? how do we end up with pentobarbital in pet food?

Dr. Warren Hess: The FDA would probably be the best one that answer that accurately but my understanding is that there were two different scenarios. One where there was enough pentobarbital in some meat products that were used for pet food that it actually impacted the animals that were consuming it.

Dr. Andy Roark: Okay.

Dr. Warren Hess: The other scenario was and I don’t even recall what organization it was, but after that event happened where animals where their health was impacted. An organization just grabbed some pet food off the shelf and ran had a lab run pentobarbital levels and detected it in those products even though it wasn’t causing clinical signs in animals. So that, brings up the issue that, probably rendering products were involved and the more sensitive our tests become, the easier it is to just pick up minute amounts of pentobarbital. And, any amount of pentobarbital in a food or feed product is what FDA considers an adulteration, and would be cause for a recall.

Dr. Andy Roark: Are there guidelines or precautions that veterinarians should be taking when they use pentobarbital that you think that veterinarians don’t know or they’re not aware of?

Dr. Warren Hess: The first thing I would say is that veterinarians should understand that their responsibility about the drug, pentobarbital, that they use doesn’t end when they inject it. Their responsibility continues for any impacts that occur from that animal after it leaves their clinic or after they leave the farm or anything like that. That would be the first thing to be aware of. There have been veterinarians that have been prosecuted for the impacts that pentobarbital had on protected species of animals that ended up having access to those animal remains and being impacted by it.

Dr. Andy Roark: There were veterinarians that were prosecuted because, I’m guessing you’re saying are we talking about endangered species or protected species scavenged something? What does that look like?

Dr. Warren Hess: Yes. They euthanize a horse, for example, and leave it with the owner to take care of. And the owner doesn’t take care of it, just leaves it out in the field. And eagles or something like that come along and feed on it and either die or are severely impacted from the pentobarbital that they’re getting from the meat that they’re eating.

Dr. Andy Roark: I’m looking at my career and I’m going, “where did I mess this up?” And so the first thing I say, do I have concerns if I’m using cremation service, something like that?

So your standard small animal veterinary and, we’ve got pets, we’ve got, we’re going to, we do our injection, we send the pet off to be cremated. Is there anything that I should be thinking about that? Is, should I give that a second thought or is that an acceptable disposal that does, is not gonna have any problems?

Dr. Warren Hess: As far as we know, cremation is probably one of the best ways to dispose of animal remains that have been euthanized with pentobarbital. There really hasn’t been a lot of study. Along that line, but the temperatures that the cremation services reach to cremate animals should degrade the pentobarbital.

Dr. Andy Roark: Hey guys, is your clinic slowing down? Are you having more open appointments than you had in the past? Are you wondering a little bit about what you need to do to get clients to, one, come into the building, and then, two, listen to your doctors and your staff when they get there? Well, you, my friend, might need to head over to the Uncharted conference in April.

That’s right! It’s in Greenville, South Carolina. It is April 18th through the 20th. This is the granddaddy of the Uncharted Veterinary Conferences. This is the one that we started with. This is our marketing and strategy conference back to our roots. I love this stuff! The theme of this conference is ‘Standing Out In A Sea Of Noise’

It is all about strategic communication. It is about getting heard. This is going to be a lot about your brand identity is understanding the modern consumer who is getting more price conscious because things are getting more expensive. We are going to need to up our marketing game, our communication game, our client bonding game, our trust building game, we’re going to have to turn the volume over on that stuff.

Guys, we didn’t have to do that for the last couple of years. People have been coming in, the pandemic was a surge in business. A lot of us are trying to keep our head above water. It’s not going to be that way going forward. It’s time to re-engage with our clients in a motivating, educating way to get them coming back into the building.

Guys, Uncharted is not a bunch of lectures. You are not going to come here and sit in lectures. You are going to work on your business at this conference. You are going to be surrounded by butt-kicking, positive people who love vet medicine, who love pet owners, and who want to create a great experience and make a wonderful place for, pets to get the care that they need.

They want to have a positive workplace. They want to have a place where people smile when they come to work and they’re working on making that happen. And so if that sounds like you, or if you want to be surrounded by those people, you got to come to the April conference. Also, this is the last time for a while that the April Uncharted conference is going to be in Greenville, South Carolina.

This is our birthplace. It’s our home base. It’s our nest, this is kind of a big deal for me. At least I, you know, I, I have loved this conference in Greenville. I still love it in Greenville. I think Greenville will always be our home, but guys, we’re spreading our wings. We are going to be moving out and doing new things and going to new places.

And it is going to be amazing. But if you want the original Uncharted experience, if you are like, man, I’ve heard so many people talk about Uncharted in downtown Greenville and how the conference just fits into that community and how amazing it is, this is your chance. You want to be here. Also, if you have been an Uncharted member, if you’ve come to our conferences before, if you loved it, you always thought there’d be a chance to come back to the old Westin Poinsett and downtown Greenville you should grab a spot.

I think that there will probably be a chance in the future, but it won’t be for a while. I think there’s going to be a lot of people coming back because they want to do it one more time at the Westin before we move on and check out some new places and do some new stuff.

So I do expect this event will sell out. Guys, go ahead, head over to UnchartedVet.com and grab your registration spot right now. I’ll put a link down in the show notes. Again, you do not want to miss it. This is an investment in yourself and in your practice and your future. It is an investment in skills that you will have and use again and again, and it’s an investment in connections.

You are the average of the people you spend time with and you’re about to be surrounded and spend time with some really amazing people. Anyway, let’s get back into this episode.

Do you think that veterinarians need to not allow pet owners to take the body of pets’ home? Or do you think that we should not allow, say farms to dispose of bodies without some sort of supervision or some sort of a waiver or, what does that look like? Are we going to not yield access back to pet owners after they have this drug in the body?

Or are we going to legally protect ourselves? What does that look like in your mind?

Dr. Warren Hess: AVMA hasn’t come out with a position on that. My personal opinion is that I hope we don’t get to the point where people are afraid to send animals home, or leave animals at a farm, but hopefully better education, better awareness by the veterinarians, better education to the clients, and maybe some forethought about how things are going to happen rather than an afterthought of, “now that we’ve euthanized this animal, what are we going to do?” Because you want, you hopefully want with forethought, you can plan ahead and, let people know what really needs to happen if the animal’s not going to go for, stay with the veterinarian under their control and that probably will solve a lot of problems. Certainly, the number one message that’s out there that not all veterinarians apparently are aware of is that pentobarbital should not be utilized in animals that are going to go for intended for food or feed products. So that means either directly to a to be processed for meat or to go to a renderer and have rendering products. It’s a big issue right now in the rendering industry and a lot of people that deal with cattle and horses know that there’s been a major shift in the rendering industry over the past five or six years. And it’s much more difficult to a lot of renders will not even pick up horses anymore.

So that’s really limiting the options for horse carcass disposal, and some renderers won’t even pick up cattle anymore off of farms. The only products that they will pick up are from slaughterhouses. They’ll pick up unused product from slaughterhouses. And that’s all they’ll do because it costs tens of thousands of dollars to do a cleanup in a rendering facility once pentobarbital has been detected.

And most renderers are now, because of this issue, most of them are routinely scanning doing spot tests for pentobarbital residues in their products.

Dr. Andy Roark: Do you think there’s fallout for veterinarians if you’re called out to the farm and you’re going to put cattle down or something and they go, oh, no, we’re not rendering this and then they change their mind or you’re like, is there anything that we need to do to protect ourselves is this going to come back on me when I go and I do a euthanasia and I, this is not what I thought was going to happen and maybe the story that I get is not accurate or the intentions change after I leave, do I need to cover myself in this significant way

Dr. Warren Hess: I’m not a lawyer, right? But my, my suggestion would be to document. Document your discussion, what you talked about with the owner. Make sure it’s in the record and that way you’ve probably protected yourself as best you can.

Dr. Andy Roark: if, I have a just a, dog or a cat come in and they come in for a euthanasia appointment or I go and I do a house call and I’ve had plenty of clients who say, I have a spot in the yard where I’m going to bury, Capsy and that’s, it’s her spot. I, do you have concerns about that other than maybe to talk about?

I don’t know, proper burying techniques where we’re not going to have problems with scavengers, things like that. I don’t mean to be morbid, but, those are the ones that I have done. I’ve a hundred percent used pentobarbital to put pets to sleep and the owner said, you know what? I, want to, bury, I want to bury her out by the, by the tree.

Yeah. Do, does that, does my approach to that need to change? Do I need to be having a different conversation?

Dr. Warren Hess: I, think there needs to be, there should be a conversation now that stresses the importance of the drug that was used the ramifications on if, if that carcass is accessed and also just be paying attention to what the regulations are in their location obviously a lot of these regulations are local they fluctuate from city to city, so it’s really difficult for veterinarians to know what those regulations are going to be, but if there’s shallow water tables that, leaching of that pentobarbital can certainly impact It’s not going to be treated by water treatment plants, and it’s not and it can, if it’s not going to a water plant, but going directly to a stream or something like that, it can impact the aquatic life there.

Dr. Andy Roark: If there are veterinarians out there who are just sitting and processing this and they would say, I’d like to think a little bit more about this, what resources do the AVMA have? What, would you recommend for people who wanted to learn a little bit more and, maybe start to process but what exactly they’re going to say or how this might affect the way that they practice. Where would you send them?

Dr. Warren Hess: AVMA is in the process of developing some resources, Andy, I wish I wish I could point you to an exact spot right now, but what I would say is be looking for information on AVMA’s website concerning this in the coming six months. And also, our digital education platform, which is called Axon we’ll be developing a, a webinar for veterinarians and, further education about this, expanding on what we’ve discussed today, pointing them to local resources. If you have specific questions about handling pentobarbital in larger animals certainly check with your state veterinarian, they might be a great first point of contact to understand if there’s any developing legislation in the state around this or anything like that.

Dr. Andy Roark: Good. All right, that sounds good. Dr. Warren Hess, thanks so much for being here today. I really appreciate your time. Guys, thanks for tuning in. I will put a link to the original JAVMA article in the show notes. I’ll also link up to Axon the educational portal for AVMA and hopefully you guys will be aware when they release new information there.

Dr. Warren Hess: Thanks, Andy.

Dr. Andy Roark: Hey, thanks a lot. Thanks everybody. Talk to you later.

And that’s it guys that’s what I got for you. Thanks for being here. Thanks to Dr. Warren Hess. I hope you guys learned something from this. I hope you got something to think about I’ve been thinking about a little bit since the interview and just going, you know How would I say this and when pet owners want to take their pets home to bury them at home? What’s my communication strategy going to be? So I’ve been rolling it around. It’s definitely been a good conversation for thought provoking purposes Anyway guys, thanks for being here. Take care of yourselves everybody. I’ll talk to you later.

Understanding the Role of Nutrition and the Microbiome in Overall Pet Health

December 18, 2023 by Andy Roark DVM MS

Dr. Caroline Mansfield, registered specialist in internal medicine and honorary research professorial fellow at the University of Queensland and clinician at James Cook University, joins Dr. Andy Roark to discuss the role of the gut microbiome in the health and disease of dogs and cats. Caroline provides an overview of the importance of the microbiome in general pet health, the impact of antimicrobials, and her thoughts on what future research in this area might find.

Cone Of Shame Veterinary Podcast · COS – 244 – Understanding the Role of Nutrition and the Microbiome in Overall Pet Health

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ABOUT OUR GUEST

Professor Caroline Mansfield is a registered specialist in small animal medicine and is recognised as an international leader in veterinary internal medicine, as evidenced by frequent invitations to present at international conferences, requests to provide expert opinions and current and previous roles in the profession. She is a past Board member and President of the Australian and New Zealand College of Veterinary Scientists and has been a member of the Board of Examiners for the National Veterinary Examination. Her expertise is recognized outside of the sphere of clinical veterinary medicine by participating in the peer review process for Australian Research Council Discovery Early Career Researcher awards (DECRA) and Discovery projects from 2015 to present. She is currently Chief Editor for the Australian Veterinary Practitioner, on the Editorial Board for Animals, a member of the Purina Institute advisory group and received the 2019 Award for Scientific Excellence from the Australian Small Animal Veterinarians. She is currently an honorary research professorial fellow at the University of Queensland and clinician at James Cook University, located in tropical far north Queensland. Her research is focused on the interaction of the gut microbiome in the health and disease of dogs and cats, and the role diet and environment play in this. She also researches in areas of clinical gastroenterology that can result in tangible improvement in the health and welfare of our pets. She has published over 90 peer-reviewed papers plus multiple textbook chapters and conference presentations. To date, she has supervised over 30 post-graduate students and clinical residents to successful completion.

EPISODE TRANSCRIPT

Dr. Andy Roark (00:07):
Hello and welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one today. I am here with Dr. Caroline Mansfield. She does a lot of things that I will talk to you about when she comes onto the podcast, but her main emphasis is in research on the interaction of the gut microbiome in health and disease in dogs and cats. And so I think she’s fascinating. I think gut microbiome research is fascinating. I am really amazed and odd as you will hear about what we are learning about gut health and how gut health interacts with health in the rest of the bodies and how basically every organ system can be tied back in some way, shape or form, probably to the microbiome and into gut health. And so anyway, we start talking about cognitive dysfunction and the role that the microbiome plays in that we start talking about where prevention and treatment of a variety of the illnesses might go in the future and what research in gut microbiome looks like in that.

(01:08):
If you just don’t know much about sort of the gut microbiome research and why people are talking about it and why it’s becoming a big deal in nutrition in general animal health, this is a great episode. I talked to her a little bit about the wellness industry and about the noise that’s generally around nutrition and things like this and how to kind of separate out what is worth talking about and what is not, and try to get our head straight so that we can be a valuable resource when we talk to pet owners. So anyway, it is a sprawling conversation about a topic that I think is incredible, and so you’ll hear my wonder and excitement when you get into this episode. I hope you’ll like it a lot. I have been thinking a lot about this episode since we did it. Anyway, that’s enough. Let’s get into this episode with Dr. Caroline Mansfield. Also, I got to say thanks to Purina Institute, they are making this episode possible ad free for you guys, and so shout out to them. Let’s get into it.

Kelsey Beth Carpenter (02:01):
(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 (02:17):
Welcome to the podcast, Dr. Caroline Mansfield. Thank you for being here.

Dr. Caroline Mansfield (02:22):
Oh, thank you. You’re welcome.

Dr. Andy Roark (02:23):
Oh, it is a pleasure to have you here. You had to get up really early for this podcast. I really appreciate it. You are. For those who don’t know, a registered specialist in internal medicine, you are a past board member and president of the Australian and New Zealand College of Veterinary Specialists. You are the chief editor for the Australian Veterinary Practitioner. I could just keep going and going have, but you have over 90 peer reviewed publications. My wife is a college professor. I don’t know if people know how amazing that is, that incredible amount of work. You have supervised over 30 graduate students. You have done absolutely incredible things. And so I really just, I appreciate making time to be here. I want to talk with you about nutrition and there was something I was really sort laxing philosophical about as I was sort of preparing for our time together and I was thinking about having you come on and stuff like that.

(03:20):
And so I’ve got this idea that we do not look at life and especially at medicine with the wonder that it deserves. And so I look around at our world and just simple concepts like our physiology, our immune system. It is absolutely astonishing that we have this system that works as well as it does. And I just think about so much of what we do in medicine and we just take it as, oh yeah, well, we have this and we know that and we know that the body works this way in that way, but I really don’t think that we just look at life with the wonder that it deserves. And so your research really focuses on the interaction of the gut microbiome in health and disease in dogs and cats. And so I’m thinking about this idea that the gut microbiome has this role that is so large and sort of ubiquitous through our body and through health in dogs and cats, but also in humans. And I don’t know that people really process what that means. And so let me just sort of open up here at just a high level paint for me sort a picture of how you look at the gut microbiome and its role in healthcare in general, if you don’t mind.

Dr. Caroline Mansfield (04:38):
Sure. I guess it’s kind of interesting that you talk about that wonder and that excitement about medicine and physiology. I feel super excited every time I learn something new about the microbiome or the way that it interacts with the body. I think it’s incredibly fascinating area. It’s probably like having a whole other organism within an organism. So it has an interaction with virtually every organ system is affected by the gut. And the gut is from an immune perspective, is probably one of the most important interfaces with the environment. The gut is usually where we are exposed to multiple antigens on a daily basis. So the gut microbiome influences that immunity, that immune system. It influences the way the brain develops as a child or as a puppy or a kitten influences behavior. It influences kidney disease, influences development of uroliths. It’s fascinating all of the interactions that it potentially has.

(05:54):
And probably what’s even more fascinating is that we didn’t understand how much was there because we didn’t have the technology to identify all of the organisms that were in the gut microbiome until recently. And even now, I still think we’re a little bit limited in how we understand or basic in how we understand because I think each bacteria has the capacity to have different functions. And so there’s this kind of redundancy or fail safe system. So it’s not enough just to know what bacteria are there, it’s what they’re doing, whether they have their buddies there to help them or not. It’s justs just super fascinating.

Dr. Andy Roark (06:35):
I completely agree, and I appreciate you saying that this is fairly new in coming to light because it does feel fairly new. We didn’t have this sort of insight when I was in veterinary school. And so I’m seeing this sort of research coming out and I, I’m trying to get my sort of hands around it and I’m thinking about it in a lot of different ways. So first it’s just my basic understanding of the physiology and how this affects my patients. But then also we start to get into therapeutics. We start talking about wellness care, and then we also start talking about addressing disease states. If you’re talking to, I don’t know, just say a doctor who didn’t have a robust understanding of this coming out of vet school and has been sort of trying to catch up, how do you help veterinarians, veterinary technicians, nurses, how do you help them think about this microbiome just at a systemic level if they say to you, this is all really new to me and I’m trying to get my head around it so I can start to understand and start to talk in a way that’s helpful for my patients.

(07:29):
Where do you start?

Dr. Caroline Mansfield (07:31):
I guess, I don’t know. Well, it’s a little bit lyrical. I sort of talk about the fact that the microbiome, it’s not equally divided. It’s not good or bad, but to have a really healthy community, just like a healthy human community, you need diversity and you need the bacteria or the participants in that community are doing different functions and they’re all contributing together to work towards a particular goal. So I guess the things that we need to be thinking about is that when we talking about nutrition, we can talk about basic nutritional requirements like protein and carbohydrates and fat and so on, but we also need to be aware that any diet that we feed affects that community. And so if we want to enhance a particular function, I’m really loathed to talk too much about particular bacterial species because I think I was alluding to before, particular bacterial strains or species will only be effective if other bacterial strains are present.

(08:40):
And they do have a redundancy in their roles. And so I think it’s better to think about the functionality. And so most diets provide some kind of prebiotics, which it’s kind of like a fertilizer, I guess, to promote growth and diversity of that microbiome. And we also have the capacity to influence it positively by using prebiotics or what post-biotics, which are probably the new emerging fields. So those are the metabolites that bacteria produce, but we also have the capacity to do it a lot of harm. So I think particularly with the use of antimicrobials indiscriminately, we often think, well, we’re treating that urinary tract infection or we’re treating that ear infection or pyoderma, but we’re not doing absolutely no harm to the animal and the animal’s microbiome when we use those antimicrobials,

Dr. Andy Roark (09:45):
When we disrupt that way, when we use systemic antibiotics for cystitis or for, that’s the classic one, is we better safe than sorry. And so we use antibiotics when we have cystitis or even a pyoderma that we could maybe treat topically and we don’t. Talk to me a little bit about the recovery period. How does that manifest clinically? What does the fallout that we see?

Dr. Caroline Mansfield (10:10):
So I think that’s a really good question, and I wish there was a really simple answer, but there’s probably not because each individual microbiome is going to respond really quite differently. And even within an individual there, microbiome might respond differently at different times. I use the analogy of an elastic band. And so if you’ve got a really healthy, fresh, new elastic band and you stretch it, so you give it se antimicrobial, so you disrupt it, you give it for a short period of time and then you release it, the elastic band’s going to go back to normal pretty quickly. But the more that you stretch it, or if it’s an old elastic band or it’s a little bit sick when you stretch it, it just doesn’t go back as normal the next time. So it is highly individualized, and I think we probably don’t, A lot of the analysis that’s been done, a lot of the studies that have been done, the way that the microbiome has assessed probably doesn’t completely answer that question because it doesn’t completely answer the functional capacity. But we know that, for example, metronidazole has impacts for a very long time. We’re talking weeks to months after it’s been discontinued, but again, it’s really highly individual. Some animals will revert back to normal more quickly and some will take longer.

Dr. Andy Roark (11:30):
I think about sort of looking at diets this way and sort of processing what the microbiome means to overall animal health. And we’ve already got people, we’ve had pet owners for decades now who have been very attuned to what their pets are eating. They are very interested in the nutrition and what they feed their pets. It’s something that pet owners can see. They have a feeling of control about what they feed. I can also see this being an area for a lot of confusion. I can see a lot of people trying to do what’s best for their pets and kind of heading off in a sort of misguided directions. Let’s start to take this focus on the microbiome into a more sort of practical clinical conversation. How do we start to advise pet owners on diet selection and what’s important and what are sort of the pitfalls that we might fall in or areas where we might see pet owners kind of going off in a way that’s not productive?

Dr. Caroline Mansfield (12:26):
Yeah, I guess part of the problem with, part of the problem with the microbiome or it’s I guess the downside for its increasing popularity is that there’s a lot of increasing noise around about it and a lot of noise about how to manipulate it. And that kind of corresponds with, I guess that sort of whole wellness industry that I think is being translated into the veterinary pet owners. They take themselves very seriously. I think we have, the advantage with pet food though is that we can control what they eat to a certain degree. And I think as long as it’s a well-balanced diet, I mean it’s been proven and the dog is healthy or the cat is healthy, there’s probably not a lot of benefit in manipulating the microbiome in those animals. So the times, I guess when we start to think about it are once they’ve actually developed disease and particularly gut disease, that’s probably more when we know that manipulating the microbiome is likely to be effective. And also there’s some emerging things that are happening like with cognitive dysfunction in dogs and epilepsy and manipulating the microbiome in those may be beneficial. And I guess also when we think about it with some conditions like hepatic encephalopathy or liver failure, we’ve been manipulating the microbiome for half a century with lactulose, but we didn’t really aware that’s why we were doing it. So I don’t know that I’ve actually answered your question very well though.

Dr. Andy Roark (14:09):
No, no, I think you did. I knew exactly where I was going is the wellness industry is definitely spilling over into pet health, and this is when we start talking about gut microbiome. I hear this in the wellness industry all the time of people talking about protecting yourself against Alzheimer’s, people getting joint health from the supplements that we take and things like that. And there are supplements that are hugely valuable and wonderful, and there’s a lot that’s not. But I think you put your finger right on it. When I said I anticipate the noise of this, I hear a lot, and I don’t mean to start a controversy about this, but there’s a lot of people who put forward raw foods or things like that specifically because they say, oh, the microbiome is important and this is a more robust way to increase diversity in the microbiome and things like that.

(14:57):
And again, I’m not trying to start the raw food, not raw food debate at all, but there are a lot of people who have strong opinions. And so I think I just want to be, I appreciate you answering in sort of an even-handed way. Really what I was looking for is I want to have productive conversations about this and not just jump to conclusions or overstate what is available and what patterns need to look for in their food. So I think you asked it well, are there, the second part of my question was really how does this go off the rails? Are there areas of misunderstanding that you see where either doctors or pet owners, I don’t know, they take part truths or they have common misunderstandings or things that kind of derail these conversations?

Dr. Caroline Mansfield (15:50):
I think personally and probably in my experience not so much. I mean, I think I’m privileged that I work in a referral population. So normally the people are coming to me for advice, and so usually are quite happy to take advice. It’s interesting that there are some people that are very resistant to some diet regimes, but when you start talking about manipulating the microbiome and that there are other ways to do that, so we can use prebiotics, we can use fiber, we can use, probably not so much postbiotics anymore at this stage. They’re not really developed, but we can use probiotics to a certain extent. I find that people are really quite willing to take that on board. They’re probably not, if they’re very set in their ideas about what they want to feed their animal. And I do come across those people. They have really strong beliefs. I tend not to try and work against them. I tend to try and work with them and just to make sure that the diet is appropriate for the animal if it’s not what else they need to have to make that appropriate or if we can help in any way. But I tend to find if I’ll alienate them if I tell them that I disagree with ’em or I think that their diet choice is wrong and then you lose them.

Dr. Andy Roark (17:21):
Right, yeah.I think we’ve all kind had to do that math at some point and to say, is this the hill I want to die on, or do I want to continue on so that that’s right. We can work on the future. Yeah,

Dr. Caroline Mansfield (17:32):
Pick your battles.

Dr. Andy Roark (17:34):
Yeah, definitely. Talk to me a little bit about where you see this field going. I got to tell you, going back to the statement of wonder I had at the beginning, when we start talking about the microbiome and its impacts on cognitive dysfunction, that’s magical to me. That is so beyond what we ever used to think. And the idea that there’s something we can do for cognitive decline or things like that is amazing. Where do you see this sort of research going? How do you see the science here manifesting out into healthcare into actually treating dogs and cats in the future? What’s this going to look like?

Dr. Caroline Mansfield (18:17):
So what I’d love it to look like, so there’s a few things in the human field. So there’s something that was called the American Gut Project. It’s a bit of a misnomer because they do get samples from around the world, but where they’re basically screening people and looking for, I guess if there’s geographical differences, seasonal differences and so on. And we don’t really know that that well in dogs yet, partly because of the costs of sequencing. So a lot of it has been done with the method called 16S, which takes the ribosomal RNA gene that’s ubiquitous in bacteria, and then it amplifies that, and then you get your sequencing data, but it does miss a lot of stuff. It doesn’t go down to a species level, and there’s just a lot of noise that surrounds 16S. So using different methodologies is really expensive.

(19:20):
It’s coming down in price now, so it’s probably more useful, but it’s still expensive. So where I would love to see it is I’d love to see similar situations in veterinary medicine where we’re actually tracking it. We track cohorts of animals across the world, different breeds, and we then are able to also track their health. And so we can actually see whether there’s a preceding marker or a flag or a change in the microbiome that actually precedes the development of any clinical disease. And to me, that’s where the magic would really happen. So if we could have it as part of our health check and we go, well, hang on, we’re seeing this shift in the microbiome, and that suggests to me that if we can intervene here, we may prolong or prevent the development of this particular disease. That’s where I think the real magic is going to come. But that’s a long way away because we need to be tracking these animals and we need to be doing all of those and correlating them to the diseases. But you talked about cognitive dysfunction. One of the cognitive dysfunction can’t talk properly. I’m getting too excited. One of the really interesting things with Alzheimer’s disease is they have actually shown that changes in the microbiome proceed any detectable change by one to two years in people. So I know like, wow, isn’t that amazing?

Dr. Andy Roark (20:49):
Well, think about, I mean, that is amazing. One of the things that we have going for us in veterinary medicine is our patient’s lifespan are much shorter, which is bad, but the beautiful part is starting to gain that type of whole lifespan knowledge. We can do it much faster than if you were following cohorts of people that started in their twenties and age into their eighties and nineties. So anyway, this is super exciting. If people want to learn more, do you have favorite resources? Are there places that you would send veterinarians, nurses, even engaged pet owners? What do you like for general educational growth in this topic?

Dr. Caroline Mansfield (21:29):
Yeah, so the problem is that there is so much information coming out. So if you put microbiome in, you’ll have 25,000 hits. So sometimes I think there’s almost, there is almost too much information. I do find the Purina Institute Center Square, they’ve got a lot of really good resources. They’ve recently had a microbiome forum, which I think it may still be available online and the recording, which don’t quote me on that. So I think that breaks it down and it also breaks it down quite nicely into bite-sized pieces that are good for speaking to clients about particular conditions as well. So I think those resources are really good for more general nutrition. I think the WSAVA, the World Small Animal Veterinary Association has some amazing resources. So nutritional toolkits and diet history forms. They also run some modules on nutrition, which are free, which I think are really useful for techs and new grads to do as well. And then I guess it kind of depends on what condition you’re talking about, then you kind of go more specific websites. But I think those are probably good places to start.

Dr. Andy Roark (22:55):
I love that. I’ll put links to the Purinas Institute Center Square in the show notes. If the Microbiome Forum is still up, I’ll link to that as well in the notes. And then the WSAVA, I’ll definitely link to that. And their nutrition toolkits are excellent and their nutrition modules as well. So I’ll put links to all that stuff. Caroline, thank you so much for being here. I thoroughly enjoy talking with you. Where can people find you online if they’re interested in you and your work and just kind want to keep up with you?

Dr. Caroline Mansfield (23:24):
So at the moment, I’m working at James Cook University, which is in far north tropical Queensland. So JCU Vet, it’s probably the best link for that. It’s a pretty cool place to be. It’s just right near the Barrier Reef and get to go snorkeling and hop up and see some crocodiles. It’s pretty cool.

Dr. Andy Roark (23:47):
That’s amazing. Oh man, thank you so much for making time and being here. I really appreciate you.

Dr. Caroline Mansfield (23:51):
No worries.

Dr. Andy Roark (23:51):
Guys, thanks for tuning in today. Everybody take care of yourselves. Thanks for being here. 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. Thank you so much to Dr. Mansfield. She got up before six o’clock in the morning, her time to do this podcast, and that was wonderful. Thanks to Purina Institute for making this episode possible. Thanks to you guys for being here. And yeah, that’s it. That’s all the thanks. That’s the thank and night. Thanks to me for also being here. Thanks to my dog Skipper who came and sat with me when I did the podcast, thanks to my mom and my dad. And I’m just going to fade out. I’m just going to fade out on that. And that’s where we’re going to end the episode. Thanks so much everybody. Take care of yourselves. Be well. Bye.

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