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Medicine

New Veterinary Business Models to Keep Pet Care Affordable

June 23, 2022 by Andy Roark DVM MS

Dr. Bob Lester believes owning pets shouldn’t be a luxury that few people can afford. The veterinary profession needs to think creatively about how to keep medicine accessible to pet owners across socioeconomic groups. In this episode, Dr. Lester joins Dr. Andy Roark to discuss his recent article which outlines 15 new business models our profession might approach to help pets get the care they need.

Cone Of Shame Veterinary Podcast · COS – 144 – New Veterinary Buisness Models To Keep Pet Casre Affordable

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


LINKS

Tear Down the Wall (Original Article):

Tear Down the Wall

Wellhaven Pet Health: https://wellhaven.com/

Uncharted Veterinary Podcast: https://unchartedvet.com/blog/

NEW Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark


ABOUT OUR GUEST

Dr. Bob Lester remains as passionate about the veterinary profession as the day he entered veterinary school (sometime last century). He is a firm believer in the veterinary profession’s double bottom line proposition of doing well by doing good.

Dr. Lester is a graduate of Oregon State and Washington State University’s College of Veterinary Medicine and completed the American Association of Veterinary Medical Colleges Leadership Academy.

He spent his early career as a small-town mixed animal practice owner before joining the founding leadership team at Banfield Pet Hospitals. At Banfield, he held positions in medicine, operations, franchising, human resources, and professional relations. After a rewarding career at Banfield/Mars Inc., he left as Vice President of Professional Relations to help found the Lincoln Memorial University College of Veterinary Medicine where he served as Assistant Dean. Dr. Lester’s LMU-CVM team pioneered a novel community-based clinical education program and developed the professional skills curriculum including instruction in communication, leadership, teamwork, and practice management.

Bob is now a co-founder, Chief Medical Officer, and member of the Board of Directors for WellHaven Pet Health, a family of companion animal practices that believes in caring for the caregivers so that they can care for others. WellHaven Pet Hospitals are both new build full-service AAHA/Fear Free hospitals, acquired and joint venture affiliate practices.

Bob was a two-time gubernatorial appointee and Chair of the Oregon Veterinary Medical Examining Board. He was the state delegate to the American Association of Veterinary State Boards. He served as a site team member for the AVMA Council on Education, and on the Job Analysis Task Force for the International Council for Veterinary Assessment. Dr. Lester authors the column “Creative Disruption” for Today’s Veterinary Business.

In addition to his board position at WellHaven Pet Health, he serves as a board member and Treasurer of Pet Peace of Mind a non-profit which keeps hospice patients together with their pets through the end of life. He also serves as Vice President of the board of the North American Veterinary Community, and on the advisory boards of easyvetclinic, Pet Desk, AirVet, and the LMU College of Veterinary Medicine.

Dr. Lester’s interests include all things veterinary, writing, start-ups, speaking, business and leadership development, the human-animal bond, and giving back to the profession that has done so much for him and others.

His family includes his wife Crystal, two amazing daughters McKenzie and Paige, and two rescue Yorkie’s Jessie and Woody.


EPISODE TRANSCRIPT

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

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with my friend, Dr. Bob Lester. We are talking about paradigm-shifting ways, business model-changing ways to keep pet care affordable for pet owners. And so, we start to just unpack some ideas. What could the future look like? What are some things that we might see going forward?

Dr. Andy Roark:
I know this will get some people fired up. We do talk about changing the way that we leverage nurses in our profession. We talk about employer subsidized care. We talk about government subsidized care. We talk about tax benefits for pet owners. It’s really all over the place, as far as, what are things that we could possibly unpack as a profession to make sure that pet care stays affordable for pet owners?

Dr. Andy Roark:
While we take care of ourselves, while we address the student debt issue for veterinarians, while we lift up our support staff and pay them a living wage. Guys, super thought-provoking episode. Dr. Lester is always awesome. 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 back to the podcast, Dr. Bob Lester. Thanks for being here.

Dr. Bob Lester:
Great to be here, Andy. Always fun to catch up with you.

Dr. Andy Roark:
Man, I was thinking earlier. I don’t think I’ve invited anybody on the podcast as often as I have invited you. You are one of my favorite thinkers. I read your stuff whenever it comes out in Today’s Veterinary Business. I like your perspective and I like to hear your thoughts on things. Thanks for making time for me.

Dr. Bob Lester:
I am honored. Likewise, I listen to you on my walk virtually every morning.

Dr. Andy Roark:
For those who don’t know, you are a co-founder, chief medical officer at WellHaven Pet Health.

Dr. Bob Lester:
Correct.

Dr. Andy Roark:
You are also, because you have so much free time, the president-elect of NAVC.

Dr. Bob Lester:
Yes, indeed.

Dr. Andy Roark:
And you are a regular columnist in Today’s Veterinary Business, so you stay busy.

Dr. Bob Lester:
As we all do in this profession.

Dr. Andy Roark:
I wanted to talk to you about … You wrote an article called Tear Down the Wall in February’s Today’s Veterinary Business magazine. The premise was, “More pets from lower-income households and their owners will reap the benefits, if we are imaginative about how we deliver veterinary care.” And so, I want to talk to you, because this is a big thing in my mind these days.

Dr. Andy Roark:
I am looking a lot at accessibility and affordability of vet care. I’m looking at the marketplace. I see salaries for veterinarians going up, which is good given student debt. I see salaries for support staff going up, which is way overdue and needs to happen. I see more and more specialists. I went to a CE event last night, which was great. It’s the third specialty clinic in our area, where we had one forever.

Dr. Andy Roark:
All of a sudden, we just bang, bang. We’ve got two more now. And I’m going, “Wow. Specialty care is coming up.” At some point, how does this not trickle down to the pet owners in a way that makes us inaccessible? You look at shortage of veterinarians. Classic supply and demand says, “Well, there’s not enough supply.” And so, the demand goes up and the prices go up, which is going to attract more people to vet medicine.

Dr. Andy Roark:
But we’ve got this ethical ceiling that most of us see. Where you go, “I don’t want prices to go up to make what we do inaccessible to a lot of people.” And so, that’s where my head has been these days. I’m really thinking a lot about, how do we do this? How do we keep our profession financially viable, and meet the needs of our people, and not burn them out as they’re overworked and overstressed? And at the same time, keep our services available where people can have pets? Because I don’t think any of us want pets to be a luxury item.

Dr. Bob Lester:
I think you’ve summed up the issue well. As further backdrop, I think we have to acknowledge that the profession is in a time of abundance. So much is going on. Pet numbers are up. Pet spending is up. Pet lifespans are up. Euthanasia is down. America’s love affair with the pet has never been stronger.

Dr. Andy Roark:
Yep.

Dr. Bob Lester:
However, against a backdrop of a workforce shortage. The supply and demand mismatch, as you pointed out. What are we going to do? Our teams deserve more money. They deserve flexible schedules. They deserve better benefits. To meet that, recognizing that we’ve never had more pricing power with the increase in demand, fees go up and up and up.

Dr. Bob Lester:
Good, as you point out, that people within our profession are certainly earning that and deserve that and more. Bad, in that it continues to raise that barrier of care. How can we help those somewhere near half the pets in the US that won’t see a veterinarian this year? While maintaining quality care and taking care of our teams and our doctors, their compensation needs and benefits and flexibility, wellness and life needs and all of those things?

Dr. Bob Lester:
It always comes down to raising fees as a result. I think we need to be looking at different models. From the traditional model that we all grew up on. We love it. The James Herriot, “All creatures, great and small. All things to all people,” has got to change to, “Some creatures, great and small. Some things to some people.” So that we can become more efficient, help more pets, continue to compensate and treat our team members well, while delivering a broader service to more people.

Dr. Andy Roark:
I completely agree. Somebody was talking to me recently about the future of vet medicine. And I said, “I think the future is shattered.” Meaning, you’re going to see a wide variety of different kinds of practices. You’re going to see high volume, low cost practices. Or limited services practices, or mobile practices, or white glove practices.

Dr. Andy Roark:
I don’t think that’s bad at all. I think that’s what needs to happen. But we cannot have everybody doing all things and pulling our hair out about, “How do we practice the gold standard of care and also be accessible to every pet owner?” That’s a losing proposition for us as individuals and practices.

Dr. Bob Lester:
We’re singing from the same sheet. Our consumers have changed. Millennials and Gen Zs are the dominant consumer now. Their needs are different. Their expectations are higher. Their bond is stronger. Our workforce has changed. Our workforce isn’t willing to be on call every other week. Work six days a week, take one week of vacation. All of that has changed, so we have to change the model.

Dr. Bob Lester:
Change is always painful, but it’s necessary. That doesn’t mean we completely walk away from that primary care, great citizen, great person there in each community that is there to be the quarterback. To be the general practitioner, the primary care provider, that knows you and your pets. However, there are other models as well to take on some of the other needs. In some cases, in a more efficient manner.

Dr. Andy Roark:
I agree. I also really like the way you laid this out. I don’t think there’s a silver bullet. I don’t think you think that either. It’s a multimodal approach. It’s not, “Hey. We’re going to do this one thing and the problem’s going to go away.” It’s like, “No. I think we need to approach it from a variety of different aspects.”

Dr. Andy Roark:
How do you want to start to lay this out? Because I want to talk to you about some of the options that you and I both see, as far as how we can get this job done or what the future might look like. Do you have favorites? Do you have things that you think should happen first? Do you have things that you think we are closer to that might be easier to implement?

Dr. Bob Lester:
Definitely have favorites. As you point out, it’s an, “And.” There isn’t a silver bullet. We have to do this and that and the other. As we specifically look at some of the new models that are out there and emerging, there’s several that I find really appealing. The idea of nurse-driven care.

Dr. Bob Lester:
We’ve got States in which the Practice Act reads that under indirect supervision, our veterinary technician nurses can do virtually anything but diagnose, prescribe, and do surgery. Why not have one veterinarian oversee five or six limited care run by nurses? We’re seeing those pop up in a number of states now.

Dr. Bob Lester:
I think that’s one model that has a lot of potential to better utilize our teams, better empower veterinarian technician nurses, offer higher compensation, and treat more pets at a lower price point. It’s not, “All things to all creatures,” but it is, “Some to some,” and will help break down those barriers to care.

Dr. Andy Roark:
For me, I think that’s a big one as well. I know it’s a controversial idea.

Dr. Bob Lester:
Yes.

Dr. Andy Roark:
I think people can get really fired up about it. But as I look at this and I say, “We don’t have enough veterinarians.” We also have a problem attracting, especially, credentialed or licensed technicians. I was talking to someone just a while ago, who’s very big into technician regulations and things like that at the state-level. She was saying, “When you look at what unlicensed technicians make relative to licensed technicians, in a lot of cases, it’s hard to make the case that they should go and they should get that education.”

Dr. Andy Roark:
The other thing is that when you go … This person teaches at the tech college, where you have technician programs. She says, “We have these people come in, and they look at our program. They look at the average salary of credentialed techs. And it’s $30,000.” Something like that. And then, they look next to it, and there’s an ultrasound technician for human healthcare and it’s $70,000.

Dr. Andy Roark:
They go, “That’s a big difference for a similar length of program.” I go, “How do we make this competitive for them?” There’s a way to do it. And I think nuance is important. But that may be the win-win. Empowering credentialed technicians. You’ve got to have a licensing program. Because we’re not talking about taking people off the street, training them in-house, and having them do significant procedures.

Dr. Bob Lester:
Right.

Dr. Andy Roark:
But that may be the win-win of it. It gives the technicians things to aspire to, to grow new skills. A way to justify salary that makes our profession attractive to them. And it also reduces the burden of overload on veterinarians. Because I don’t see anybody turning on the spigot to release a bunch of new veterinarians soon.

Dr. Bob Lester:
No. That’s a 6, 8, 10-year fix. I’m encouraged over COVID. I think we have finally seen our profession take some significant steps towards embracing team healthcare delivery. Our profession’s roots have always been one doctor, one exam room, one truck, one stable. Whatever it might be.

Dr. Bob Lester:
We’re the fiercely independent John Wayne out there doing everything ourselves. We shoot every film, chart every chart, fill every pill bottle. And it’s silly. No other healthcare profession does that. COVID and the mismatch in supply and demand is really driving veterinarians, in some cases for the first time, to delegate and really take advantage and leverage and empower and honor their teams.

Dr. Andy Roark:
I think that’s true. I think that dentists have it right. I think the dental model with the dental hygienist carrying a lot of the weight, doing a lot of the heavy lifting, making a good living for themselves. And then, also, you are efficiently moving a dentist through that office. I go, “Man. I think those guys have a lot figured out.”

Dr. Andy Roark:
I wonder how much of this transition … Because I think you and I are on the same page. The opportunity for this to take root, I think it happens a lot in our education systems. I’m seeing some movement in that direction of starting to talk more about, “When you’re a doctor, this is how you interface with a team.” And, “Hey, doctors. Here’s how you leverage the technicians.”

Dr. Andy Roark:
I don’t think it used to be taught that way. I remember going through vet school back in the day. It was very much you were trained as the technician. That was part of the training process, is you were trained how to do everything. I get that. The doctors should be able to do everything. But I think you should be able to do it, and then be trained how to utilize and leverage your technicians so you don’t have to.

Dr. Bob Lester:
Exactly. It’s part of our education. We should be training side by-side veterinary students with tech students. That only takes place in two or three schools today in the human model. You certainly see them training side-by-side. Veterinarians need to remember their job is diagnose, prescribe, and surgery. Everything else, we can delegate.

Dr. Andy Roark:
What do you think about the potential of more non-profit practices?

Dr. Bob Lester:
I like the move. The shelter world has an interesting business model. They essentially were set up to put themselves out of business. Let’s place every pet in a home, and once they’re all placed … What is it the shelter will do? Well, we’re not there yet.

Dr. Andy Roark:
Right.

Dr. Bob Lester:
But in the case of dog overpopulation, we’ve largely turned the corner. We’re making big strides with cats. The shelter world has such a great reputation, does such wonderful things. However, as their primary mission in placing homeless pets begins to wane, they’re taking on new things. From forensics to wildlife to community education to community veterinary care. To fill that niche that you and I aren’t filling, because people don’t have $60, $70, $80, $90 for an office call to come in.

Dr. Bob Lester:
I’m really encouraged by what they’re doing. They’re picking up a segment of the population that traditional veterinary medicine has been poor to serve. And that’s not a blame thing. We can’t do it for free. With the benefits of pet ownership, comes the responsibility of paying for good care for that pet. For those that can’t afford the traditional, this gives them one more lower cost alternative to get good basic care.

Dr. Andy Roark:
It’s funny. I always joke that we can beat ourselves up no matter how well we’re doing. You can beat yourself up for working too much and you can beat yourself up for not working enough. It seems like a lot of us jump back and forth. When we talk about non-profits or we talk about shelter, medicine, things like that … And I get it. I’m not criticizing.

Dr. Andy Roark:
But veterinarians can jump really fast from, “We are overwhelmed and people can’t afford our services.” And then, they flip to the other side and go, “How dare these shelters do medicine there and take this clientele?” And I go, “We’ve got to pick our poison here.” Do we want to have the accessibility in our own practices? Or are we okay to let that part of the market go, so that we can focus on our target clientele and still feel good about it?

Dr. Bob Lester:
And still partner with those shelters. They’re still placing pets. Those pets are going to need a veterinarian. In many cases, it’s going to be you or I. As veterinarians, I think we’re silly not to be best friends with our rescues, our shelters, and do all we can to help them and be thankful if they can take care of some of the pets that we’re unable to.

Dr. Andy Roark:
I think that’s interesting. I see a niche I had for non-shelter, purpose-driven, non-profit practices. I think that there are people out there who want to live their values and believe in accessibility. I could 100% see non-profit practices being set up for the purpose of providing care for people who couldn’t otherwise get it. And it just being a very intentional decision of, “This is the market that we’re going to serve.”

Dr. Bob Lester:
We’re in, again, this period of abundance in our profession. There is certainly more business than they can handle. The challenge is, “Can we get people in there to take care of that?” In the shelter world, in the non-profit model that we’re talking about, they have an enormous recruiting advantage.

Dr. Bob Lester:
You can go to that student that’s two or $300,000 in debt, have them go to work for a qualified non-profit for 10 years, and erase the debt. They may not be able to pay what a traditional for-profit is, but if they invest 10 years … To your point, it’s mission, it’s hard, it’s purpose. It feels right. And at 10 years into it, my debt disappears. That’s tremendous. That’s a win-win.

Dr. Andy Roark:
I agree. Hey, everybody. I just want to jump in real quick with a couple of updates. Gang, before I do though, I’ve got to give a shout out. I’ve got to give some love to Banfield. The pet hospital. Guys, they have stepped up and supported us in getting transcripts for both this podcast and The Cone of Shame Veterinary Podcast, which is the other podcast that I host.

Dr. Andy Roark:
They do it to increase accessibility and inclusion in our profession. That is a big point for them right now. It’s something that they are doing for our whole profession and industry. They stepped up and put their money where their mouth was and said, “How can we help you?” I said, “Hey. This is a thing that people have asked for.” And it’s a big lift for us. Banfield said, “We got you, buddy.”

Dr. Andy Roark:
They have made this happen. If you want transcripts for our podcast, we’ve got them. Head over to unchartedvet.com. You can see all of our podcasts and you can see transcripts for those. Feel free to share them. Help us get the word out. But I’ve just got to give some love to Banfield. Because they didn’t have to do that, but they did. And it is awesome. Thanks to them.

Dr. Andy Roark:
Over at Uncharted Online on June 29th at 8:30 PM, Eastern Time, 5:30 Pacific. That is PM, not AM. We’re not doing a 5:30 AM Pacific thing. Guys, over at Uncharted Online. You can join from anywhere. My friend, the one and only practice management goddess, Stephanie Goss, is doing her Teamwork Mind Meld: Setting Expectations for Team Communication.

Dr. Andy Roark:
Guys, do your teams struggle from a lack of accountability? You’re like, “People don’t do what they say they’re going to do. People don’t follow up the way that they should. People don’t communicate in a way that stuff actually gets done. They are making assumptions about what is going to happen that are not realistic, and it is continuing to cause problems between the team and management.” Guys, I see this all the time.

Dr. Andy Roark:
Stephanie Goss’s workshop is all about setting expectations for how the team is going to communicate. Just think about how much you need that. This is a two-hour actual workshop. Come with your camera. Come ready to talk about your practice. This is going to be stuff that you can take home and plug right into what you’re doing and actually make a difference in the way your practice functions. To take this back and engage it with your team in a way that’s going to make a difference. Guys, I hope you’ll check it out.

Dr. Andy Roark:
Stephanie Goss is amazing. Uncharted workshops. They’re uniformly pretty freaking fantastic. I do love them. I’ll put a link to that down in the show notes. Guys, as you might have heard, my brand new Exam Room Communication Training Course, it launched on June the 7th. It is my 17 tips, tools, tricks, and hacks to make you and/or your team more effective in the exam room. Guys, this is the stuff that I lecture on all over the world. It is my absolute best material. I wanted to make it available to everybody.

Dr. Andy Roark:
I have people who always come up to me after my talks and say, “That was great. How do I teach my staff to do that?” I’ve got you now, buddy. I’ve got you covered. Because you can take this to your team. It is 100% module. It is broken up into five-minute modules that you can drop into your staff meetings. Tag it onto the end of a team training meeting. You can do it in the morning huddle. You can go through. Everything stands alone, so you can pick the things that you like. Skip the ones that you don’t.

Dr. Andy Roark:
You can look and say, “We need this the most in our practice. Let’s do this.” Guys, the course pays for itself. If there’s one thing that you take and you give to your team and they go, “Light bulb moment,” it is the fact that it’s made to go back to your team and be interactive, which means everything comes with discussion questions. You can say to your team, “How do we do this? What does this look like in our practice? How could we do this better? What opportunities do we have for improvement here?”

Dr. Andy Roark:
I give you those suggested wordings and questions to ask, so that you can get your team to engage. Guys, I’m super proud of this. I’m super happy. For the first 30 days, so until July the 8th, it’s $100 off. It is a launch special. I don’t want this to slip past you. If you’re like, “I want to try that out.” Grab it now. Grab it while it’s got $100 off. I will put a link in this show notes. But guys, I hope you love it and you enjoy it.

Dr. Andy Roark:
And if you haven’t checked out my Charming the Angry Client course, it’s built in a similar model. It’s been very popular. People who have had it can tell you about what it’s like. You feel free to ask, because it has gotten very good reviews. A lot of people have gotten a lot of mileage out of this. But guys, I want you to be able to train your team. Specifically, your team. Not some generic team.

Dr. Andy Roark:
I want you to train your team in a way that’s going to work in your practice. This is why I made this tool, so it can get taken and used as you want to use it. So it supports your culture and your practice and the way that you guys work. Anyway, I hope you’ll check it out. Like I said, I’m over the moon that it has launched. Boy, it’s been a lot of work for me and my team, but I think it’s going to be totally worth it for those of you who check it out. All right. Let’s get into this episode.

Dr. Andy Roark:
Let’s talk a little bit about support coming from outside the industry. You were one of the first people that I had heard talk about employer subsidized care. I think that’s an interesting idea. Can you lay out the thought process there and what that would look like?

Dr. Bob Lester:
We talk about the workforce shortage within the veterinary profession. It’s certainly a big issue. Approaching a crisis issue. However, there’s a workforce shortage across many segments of society. Those employers are looking to attract and retain good talent. They’re looking at their benefit offerings. Well, two-thirds of Americans own a pet. We’re crazy about our pets.

Dr. Bob Lester:
If you could go to work for one employer that offered you some a pet subsidy, whether it’s through a wellness plan or pet insurance, or whatever it might be … That might be a deciding factor in you taking that job or not. We’re seeing more and more that employers outside of the veterinary world are offering benefits within their offerings to their employees to help better care for their pets.

Dr. Andy Roark:
That’s my favorite. The employers pick up the tab? I like that. That still seems really good to me. It’s interesting. Have you seen evidence of that happening?

Dr. Bob Lester:
In fact, I had a neighbor the other day telling me that their employer offered a specific pet insurance company. I’ve forgotten which one it was, but they were asking me about pet insurance. “Hey. My employer subsidizes this. What do you think? Is that a good deal?” And that was just a completely unsolicited person telling me about it. Anecdotally, I’m certainly seeing more and more of it.

Dr. Andy Roark:
I think that’s interesting. I had Dr. Michael Blackwell on the podcast a while back. We didn’t really get much into aligned care, but that’s his baby. You put that forward as something that you’re positive about.

Dr. Bob Lester:
What Dr. Blackwell is doing is so noble. He no doubt described it better than I could, but working again to help people that are underserved today. He’s brought quite a collaboration of people together and spent the last number of years on it. Noble effort, and one more, “And,” as we look at, “How can we knock down barriers to care?”

Dr. Andy Roark:
His premise, when I was talking about … I don’t want to misstate how he was working with it. He was working with a number of local groups to assess the need in underserved communities and things like that. I’m trying to remember where. It was almost a political action committee that he was working on.

Dr. Bob Lester:
My expertise is limited as well. My recollection and my last reading on it. He was taking an approach, at least my interpretation, as they’ve done in human care. Looking at all the different providers out there that could help subsidize. How could he pull those similar groups together with an aim towards veterinary care as opposed to human healthcare?

Dr. Andy Roark:
It was the idea of … There are so many health benefits to owning a pet that this is worth subsidizing from a human public health perspective. That was how he was approaching it. I like that case a lot. I think that’s the type of innovative thinking, kind of like what we were talking about. With employers outside the profession looking for ways to attract employees.

Dr. Andy Roark:
You say, “Well, let’s take a look at this.” And I think that was really the core of his insight and his genius is to say, “We know the benefits of healthcare that people get from having pets. At some level, it’s worth subsidizing pet care for the health benefits that people get from them.” I think that’s a really interesting approach and argument. I hope he finds success and gets traction making that pitch.

Dr. Bob Lester:
I think it’s brilliant. If you own pets, you’re less likely to be obese. You have lower blood pressure. You’re less likely to have a heart attack. Your children have fewer allergies. Your emotional wellbeing is stronger. The savings in human healthcare, which is what? 20% of GDP. It’s huge. Just a rounding error of savings by having pets in your household to human healthcare could really reverberate through the vet profession, once that’s widely recognized.

Dr. Andy Roark:
Talk about those sorts of benefits. You had the idea of pet ownership as tax savings. Talk about how those connect.

Dr. Bob Lester:
Same concept, and not my idea. I think there was actually legislation introduced in California, a number of years ago. It went nowhere and its time may not have come. But again, when you look at the savings in human healthcare to families that own pets. By having fewer medical needs for two-legged animals, I think there’s a big case to be made that by having a pet you save money on the human side.

Dr. Bob Lester:
Hopefully, we’ll see that in our lifetime. We’re certainly seeing more and more data to that. Just looking at HABRI and what Dr. Blackwell and others are doing. It’s a potential big win for pet society and our profession.

Dr. Andy Roark:
It would be pretty nice if you could write off your bad dog who eats socks. That would help me out. That would help me out a lot. It’s funny how our relationship with pets continues to grow and change. We talk about the health benefits and things like that. People’s level of connectedness with their pets. I look at the interface of technology with this.

Dr. Andy Roark:
We talk about the insight into our pets that we’ve had before that we never used to have. My technician that I work with has a water bowl that’s got a microchip scanner on it and a scale built into it. It’s called a Felaqua. She gets updates on her phone when her cats drink water and how much water they have drank today. She loves it. She’s always sharing with me.

Dr. Andy Roark:
She’s funny. She has a pirate theme among her cats. She has all pirate names for her cats. She named the water bowl, “The Sea.” And so, she gets alerts that say things like, “Anne Bonny drank one ounce from The Sea.” She just laughs and laughs every time.

Dr. Bob Lester:
That whole concept, I think of as a connected pet. In our lifetimes, I think that’s also going to lower barriers to care. Imagine sensors in the water. The scale, the food, the litter box. Cameras in your home that can pick up gaits and activity and facial expressions indicating pain. Wearables.

Dr. Bob Lester:
Connect all that data together along with what we see through virtual or physical exams, client observations, and all those millions of data points coming in filtered through some form of artificial intelligence. I think, in our lifetime, we’re going to see some big changes in how we practice medicine. And once again, the opportunity to lower barriers to care to help more pets.

Dr. Andy Roark:
I had Dr. Sheila Robertson on just a little while ago. She was talking about the new international guidelines in feline pain management. They were using the Feline Grimace Scale, and they have an app that goes with it. That’s educational for pet owners, to help them figure things out.

Dr. Andy Roark:
I think about that app and I think about Google photos that I have and what it can do, which is ridiculous, as far as processing images and facial recognition stuff. And I go, “How long is it until we do shoot a video of a pet?” Or we do take a photo of a pet and it automatically runs a Feline Grimace Scale on our cat and says, “This is concerning.” Why wouldn’t we go that way?

Dr. Bob Lester:
Yep.

Dr. Andy Roark:
I think that’s really interesting.

Dr. Bob Lester:
It’s exciting. And that dovetails into the whole idea around telehealth. Again, sometimes controversial. But can we remotely reach out and help more pets at a different price point? Well, in my mind, we can and we should. We’re moving in that direction slowly, but we’re moving that way.

Dr. Andy Roark:
I think the staffing shortage is the biggest thing that’s screwing us up there. You know what I mean? The very understandable pushback that we get when we talk about telehealth is that people say, “Look, I’m in the exam room more than I want to be.” Stepping out of the exam room to do telehealth, especially if I don’t have high demand for it right now from clients, it doesn’t make financial sense.

Dr. Andy Roark:
I could be in the exam room putting hands on pets and actually staying really busy. Financially, at present, that makes a lot more sense. I think that there’s a tipping point. There are some practices that are starting to do more telehealth. The model that I’ve seen that’s really cool … I actually had one of the co-owners and the virtual manager at Adobe Animal Hospital on the podcast recently.

Dr. Andy Roark:
They were talking about their hospital. And so, what they’ve done is they’ve started having some people work from home. And so, part of their workforces work from home, and they have a chat set up through their website. When people go to the website, it says, “Would you like to talk to somebody?” They made the point that you can have a CSR working from home.

Dr. Bob Lester:
Got you.

Dr. Andy Roark:
They can chat with three people instead of talking on the phone to one. And then, they had a doctor set up that they could kick questions over to as a virtual visit and say, “Well, would you like to see our doctor virtually?” They could just kick over there. They’re also a big enough hospital that they could keep that doctor busy with scheduled virtual appointments. And then, also picking up stuff coming in through the chat.

Dr. Andy Roark:
And I go, “Well, that makes a ton of sense.” It also drives a lot of their other business, because they only work with their own clients. And then, they’re often bringing these people in. And so, they’ve got this flywheel, where this thing makes sense and feeds a lot of other things going on in their practice. I say, there’s insight there. As far as how this tool fits in with the other things that we’re doing.

Dr. Bob Lester:
Without a doubt. The opportunity to delegate to your team … In that case, CSRs. Or in many cases, nurses, before it gets to the doctor to triage. And then, the efficiencies around asynchronous. So much can be done through telehealth when you have a minute.

Dr. Bob Lester:
They send us a message, a picture, whatever it might be, between appointments or at home in your bunny slippers. Taking care of those cases, that can bring huge efficiencies to a practice. But again, to your point that we’re so understaffed now. It’s difficult to go in and disrupt existing workflows when we’re all running at 110% already.

Dr. Andy Roark:
Yes, it is. Change takes effort. Even delegation takes effort. I’ve been talking to people a lot about this recently. We struggle to hire or we struggle to delegate. And then, I have people who actually do hire. They do delegate or they’re trying to make change.

Dr. Andy Roark:
We’re doing that in my business right now. Trying to do some significant change in our workflows and the way we do things. Man, it’s a ton of work. Because basically, you’re doing your whole workflow, while you’re training someone else to also do the job that you could just do faster yourself.

Dr. Bob Lester:
Yep.

Dr. Andy Roark:
But that’s the short view. And so, I think a lot of times … You’re right. When we are just barely keeping our nose out of the water, it’s really hard to consider making a shift in our workflow, in our processes, and trying new things. You go, “I’m working too hard to experiment.”

Dr. Bob Lester:
You got to slow down to go faster. And that’s a tough sell.

Dr. Andy Roark:
It is a tough sell. Well, Bob, thanks so much for being on. I always appreciate your time and coming and talking with me about these things. I get fired up and I really appreciate your perspective on the industry. I like how you think outside the box. Where can people find you? Where can they learn more about WellHaven and what you’re doing?

Dr. Bob Lester:
They can learn more about WellHaven at our website, wellhaven.com. I can be reached through LinkedIn. Or if someone wants to email me directly, I can be reached at bob.lesterdvm@wellhaven.com.

Dr. Andy Roark:
All right. Thank you, sir.

Dr. Bob Lester:
Great talking with you, Andy.

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. If you’re checking us out on YouTube, hit that subscribe button. If you’re listening on podcast, guys, leave us an honest review wherever you get your podcast. It’s really the nicest thing you can do. It’s how people find us. It makes my day when it happens. Gang, take care of yourselves. Be well. Talk to you later. Bye.

Filed Under: Podcast Tagged With: Life With Clients, Medicine, Team Culture, Wellness

What Do Veterinary Practices Need to Start & Stop Doing?

June 17, 2022 by Andy Roark DVM MS

Dr. Adam Little joins us to discuss what veterinary practices need to start doing and stop doing to adapt to a changing world. He and Dr. Andy Roark discuss everything from remote work to the challenges of recruiting and hiring in a super-tight labor market. If you like big ideas and inspiration for a bright future, this is the episode for you!

Cone Of Shame Veterinary Podcast · COS – 143 – What Do Veterinary Practices Need To Start & Stop Doing?

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


LINKS

GoFetch: https://www.gofetch.ca/

NEW Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark


ABOUT OUR GUEST

Dr. Adam Little works at the intersection of accelerating technologies and veterinary medicine. His career has spanned areas of focus ranging from artificial intelligence to telemedicine to connected devices. He is the co-founder and Chief Medical Officer of GoFetch where his team is building a new subscription care model focused on making local vet care more accessible and affordable.

Prior to co-founding GoFetch, he served as the first ever Director of Innovation & Entrepreneurship for Texas A&M College of Veterinary Medicine where he spearheaded such initiatives as the Veterinary Innovation Summit and the Veterinary Entrepreneurship Academy.

Dr. Little holds a Doctor of Veterinary Medicine degree from the Ontario Veterinary College He is a past Board member of the Ontario Veterinary Medical Association, Veterinarians without Borders and the Vet Futures Commission


EPISODE TRANSCRIPT

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

Andy Roark:
Hey, everybody. Welcome to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I have a fun episode today with Dr. Adam Little. This guy is super innovative, he is an idea guy, I’m going to get into his bio in a second when he comes on the podcast. If you like to be excited about vet medicine, if you like to think about hospitals and where they’re going and what the future looks like, this is a great episode. But you can hear he gets me fired up and we geek out about the future and what is possible and what is defining hospitals today and what will define them in the future. If you like new ideas, if you like rolling around and looking at where we are and where we’re going, man, you’re going to enjoy this episode. Let’s get into it.

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

Andy Roark:
Welcome to the podcast my friend, Dr. Adam Little. How are you?

Adam Little:
Great, Andy. Nice to be with you.

Andy Roark:
Man, it’s good to see you again. It has been too long.

Adam Little:
Very much so. Yeah, it’s great to reconnect and chat a bit and hope you and everybody in the Uncharted community are doing well.

Andy Roark:
Yeah, yeah. Well, I speak for me, yeah, it’s going very well. I’ve known you since vet school. You have a DVM. You are a veterinarian. You’ve done work with artificial intelligence. You were the first ever director of innovation and entrepreneurship for Texas A&M’s College of Vet Medicine. You also spearheaded initiatives like the Veterinary Innovation Summit, which is still going on, and also the Veterinary Entrepreneurship Academy. And now you are the co-founder of GoFetch. Why don’t you give me a quick rundown on what that is?

Adam Little:
Yeah, for sure. What we’re trying to do at GoFetch is bring a subscription model to vet practices that helps clients afford and access care and combine some of the best parts of traditional wellness plans, savings and loyalty accounts and financing in a much simpler and easier to implement model that any practice can offer to their clients. Practically speaking, what that means is that a pet owner signs up, they pay a subscription fee to us, we manage that responsibility, and then they get benefits that are delivered by our practice partners. Things like access to visits, 24/7 support, they have access to interest free financing for big and unexpected bills. Then the ability to accumulate and save up rewards that act like a pet savings account or the ability to actually donate those rewards to help pets in need.
One of the really neat things that we do is we have this community based component of our program, where we build a fund that practices can have access to and actually use to support low income pets and families in their community. People who just can’t afford care at all that are coming in and saying, “My pet needs essential support right now and I just can’t afford it.” What we’re really trying to do it at a high level, is create a more sustainable, profitable model for practices that really focuses on eliminating cost from the care that’s provided. Yeah, that’s what we’re working on.

Andy Roark:
That’s awesome, man. That’s really, really cool. I invited you to be here because, coming into 2022, I reached out at the beginning of 2022 and I was trying to peer into my crystal ball for the year and I was like, “Hmm, where is this year going?” You’re such an innovative thinker and you’ve got your finger on the pulse in technology and a lot of communication things and just in the way that practices grow and evolve and your work with the Veterinary Innovation Summit, you are really tapped into new and interesting things.
And so I reached out to you at the beginning of the year and said, “Hey, you want to come on and do some future casting with me?” And you said, “I’m a bit busy. We’re having a baby and it’s going to have to wait a little while.” So we had to put it off, but I still want to go, even though it’s not the first of the year, I still want to see your vision for the future. Let’s do a little exercise called start, stop, continue. The way I want to do it is, I want you to pick some things and tell me what you think veterinary practices need to start doing, tell me what you think they need to stop doing, and tell me what you think they’d like to continue and let’s kick those ideas back and forth a little bit.

Adam Little:
Yeah, that sounds great. I think to level set all three of those categories, practices are at a very interesting junction point because in many ways we’re coming out of what has been, in some ways as many practices still going through it, but a very challenging, disruptive time for how veterinary practices serve their clients. It meant that things that maybe practices could have put off or thought more about down the road, things like telemedicine, things like in-home delivery of medications and food, these just became almost necessities. There’s a huge accelerant that required practices to move at a pace that I think traditionally they would’ve been less comfortable with.
Now we’re dealing with a little bit of the fallout of some of these things where people now, I think their relationships with their pets continue to deepen and for many practices they’re just overextended in that capacity. They’ve been through the wringer where they’ve had this boomerang effect of, hey, we went to longer appointment times or curbside. How do we come back to that? What are the best practices that we’re still trying to absorb? When really trying to maintain a staff that is increasingly burnt out and overextended. So that’s a really challenging position to be in.
So what do I see to continue in for the next couple of years and what does that mean for practices in terms of the actions that they can start taking now? One of the first ones that comes to mind is we need to find ways to better augment your team. What I mean by that is your clinic is likely to continue to have clients that have higher expectations, they’re looking for more engagement, they’re asking more of you and it’s going to be increasingly difficult for practices to wear all the hats that they have as a small business to serve those clients. There’s a couple different ways that I think you can break that down.
The first is really understanding what your team’s core focus is for your community and for your clients. It might mean that there’s opportunities for you to start doing things to support some of the less critical interactions by technology or partnering with other providers to help really extend the support of your team. So I’ll give you a specific example. I think this idea that clients are going to continue to want help 24/7 is here to stay. I think that there’s a lot of value in really trying to figure out what is the connectivity and the continuity of care, so that if you have a client that’s messaging you after hours, when you do see them in person, you’re building upon that interaction, you’re actually able to drive, ideally, a more compliant and efficient visit.
However, you can’t just put your team on call 24/7, that’s not realistic. One of the things that you need to think about is how do we augment our team in particular during those periods where we know it’s going to be difficult for our team to provide those services? We’ve seen an explosion now of these teletriage and other services that can plug into your practice to provide general advice and initial access to support. Not necessarily with the intention of replacing the need for the visit, but really acting as a more accessible, easier touchpoint so that when your team gets involved, you can really focus in on elevating the care as needed, without sacrificing that always on availability.
So, I think that’s one to consider. What does that look like when your clients need support, but you can’t be the people to provide it?

Andy Roark:
Yeah. So this is mostly probably clients outside the building type support, right? I mean, accessibility, things like that. Scheduling, phone support, advice. Yeah, okay. Yeah, I get that. I believe that’s true. I also think the other thing that supports that, I think the laborer push for more flexible work hours and then also work from home. I think also both of those things feed into this new model of, hey, you can provide support from outside the clinic in a way that’s valuable. No, I agree with that.

Adam Little:
That’s a really important point because I think this is maybe there’s a bit of a misconception about the type of support you can provide. There’s clearly a portion of the profession that gets, I think, reasonably, and rightfully so, nervous about the idea of, is this other vets or medical professionals that are informing my clients? Where do I get looped in? There’s varied levels of comfort of it.
But what we’re really talking about is there’s a huge segment of tasks that have nothing to do necessarily with that high end medical advice or case management that are required to power the client experience that you depend on. And to your point, Andy, about the recruitment piece, if you’re a practice that has the option for hybrid work environments, where you can actually create an opportunity for staff members to add value to your practice, help to take on some of those tasks and really offset that workload for your in clinic team, it’s a huge way to recruit a completely different pool of individuals. They’re more attractive jobs in many ways, they’re more flexible, it’s a great balance for folks and it ends up becoming a huge differentiator between you and other clinics.
And so I think that’s another piece of this, where if you can go as a practice to say we’re going to hire for a client representative, or we’re going to hire for a manager and there is a remote or flexible work component, that already puts you in a very small percentage of practices that offer that type of working environment, which people now are increasingly coming to expect. And I think it actually broadens the applicant pool beyond the traditional types of people that would work in vet clinics. People that come from client service backgrounds or other areas that now are saying, “Wait a second. I don’t have maybe as much veterinary experience, but this job sounds really interesting.” So I think those two go hand in hand.

Andy Roark:
Yeah. No, I think that makes total sense. Yeah. That fits for me.

Adam Little:
I think, to pull in that thread a little bit more, for you to take advantage or even create those opportunities in the first place, you need to have hospital systems and processes that people remotely can plug into.

Andy Roark:
Yeah.

Adam Little:
So if you’re a practice that is paper based, or you have hospital systems that mean that you have to be on premises to even log in and get basic information, there isn’t the ability to communicate with your team in a remote way, you’re not going to be set up to take advantage of some of these new opportunities. And so maybe another start doing is really optimizing for your team, how they can function together, both in person and remotely, by using things like Slack or some of these other tools but really focusing on what are the two or three key tasks and workflows that we need to optimize these tools around so that whether you are the front desk person, that’s at the other side of the building, you’re a vet that’s stepped out for a break or you’re a remote team member. You can still actively participate and contribute to these practices.
And I think what we’re finding is the same sort of basic infrastructure of remote first businesses that they just needed to have in order to function. Our company is completely remote, we have an office that people can kind of go into what they want, but these tools aren’t kind of optional add-ons, they are the infrastructure of our entire business. We couldn’t do what we do without them. And I think what’s happening is, if you can bring that layer in that thinking to a vet clinic, wow, that’s a really powerful one two punch because you have all the benefits of working and the purpose of a practice bond with the flexibility and connectivity of those remote first companies. And I think that can be really powerful for practices.

Andy Roark:
Yeah, I agree with that. You kind of blew my mind there for a second because you’re right. How many of our practices have we had this old school way of doing things and we’ve kind of added to it, augmented it, we kind of dipped our toe into some electronic record stuff, but we’ve still got half of our paper stuff. And the idea of stepping back and looking at your practice with fresh eyes and going, “Okay. Let’s look 10 years down the road, what base model do we want to be built on?” Right?
Because that’s what we’re talking about. And you don’t want to switch your PIM systems around, you don’t want to keep jumping from one thing to another. And so I think that there’s a lot of wisdom in stepping back and saying, “All right. How do we lay the groundwork so that we know that accessing from outside the building, or allowing other people to come in virtually and interface with our team, that’s going to be important.” Man, laying that groundwork as opposed to waiting until you get to a place where you really need to have that sort of flexibility, and you don’t have it? That’s insightful.

Adam Little:
Yeah. I think the other thing too is, it’s been really easy for a very long time for practices to say things like, “Well, our clients don’t want these things. They don’t need it.” There really hasn’t been maybe the internal push within the profession to accelerate towards these new ways of working. But for the first time ever, you’re seeing associates and new staff members that are saying, “Look, if your practice works like this, I’m not going to work for you.” If you’re a practice that doesn’t have access to these tools, you’re a practice that’s going to make me all of a sudden write my records, or you’re even a practice now that doesn’t have some of these cloud based systems. You’re seeing that because there’s so much more technology and it’s so much more in your face. People are developing relationships and getting exposed to these tools far earlier in their career.
And so they’re going to these employers and saying, “These are the tools that I work with. This is what I want to do. Oh, you don’t have them? Well, that’s another cognitive kind of load that I’m going to have to bring on to this practice, because I’m going to have to have a completely different way of doing things.” And for certain team members, if they’re already really used to it, they’re not going to want to go back, right?

Andy Roark:
Yeah.

Adam Little:
It’s kind of the equivalent of being an accountant and then there’s one accounting shop that uses Microsoft Excel and another one that uses Tickertape and you’ve grown up in the school of Excel, you’re not going to go work at the Tickertape office. And in fact, your mindset is that business is not long for this world. And so it’s not just practically speaking what the day to day work looks like, but what is the signal that you’re sending to your team, to potential new applicants and to your clients about the type of practice that you are going to become and where you’re investing your time and energy. Because we don’t have the luxury now, I think, of just putting our heads in the sand and it’s really beginning to shape the types of people you can recruit and the types of people that want to stay and work in your clinics.

Andy Roark:
Yeah. I agree. I think one of the things that’s really interesting is I think a lot of us like to believe that we’re going to have a lot more runway than we do. You know what I mean? Five years ago, I mean people working outside the clinic, I don’t know. And if people start getting excited about it, then maybe I’ll get on board. Well, all of a sudden, consumer technology shifts so it shows up in other industries and six months later, pet owners are like, “Oh, I’m very used to communicating this way. And now I 100% want a text driven, chat driven interface.”
And you’re right about other veterinarians coming in as well. I think a lot of us thought that this would be a slow march towards accessibility and it has not been, it has kind of been flipped a switch and very quickly you look outdated or you feel outdated.

Adam Little:
And I think it’s okay to understand and take a step back and be like, it makes sense that veterinarians would feel that way because for the longest time, the career arc of a veterinary profession was very well defined from the earliest days that you decided to be a vet. And so you can develop this mental model that you really kept from vet school, from volunteering to vet school, to your first days in practice. And it’s natural to be like, this is the kind of almost reliability and I want that plan. And I think Mike Tyson said, “Everybody has a plan until you get punched in the mouth.” And I think for a lot of people COVID was that punch in the mouth and they’re realizing, geez, my transition plan is 10 years of maybe waiting out these changes so I don’t have to make them to my practice and I can transition, or sell, or go to… That doesn’t exist anymore.
And I think the other thing is that, the pet owners don’t have to ask for your permission, right? Pet owners today are voting with their wallets and their decisions and where they’re going for information. And so they’re not necessarily considering when they’re pet’s sick or when you’re unavailable. I wonder what Dr. Smith is going to think about this if I go to this vet or I’d buy this product here? They’re just saying what’s quicker, easier, better for me and the same way that I think we’d all do in our other lives.
So I think this is often times like a really helpful mental model where it’s like, if you were a client in your own practice, can you put yourselves in those shoes? How would you actually feel? Because when we go to our dentist, or our therapist, or any other medical profession, we have no problem highlighting all the reasons it can be frustrating or difficult. But when our clients raise those similar concerns, we can really easily justify why they are maybe not realistic or what have you. And so that’s that balance, I think, is really difficult to really navigate sometimes.

Andy Roark:
Yeah. No, I agree with that. Yeah. It’s hard to look at yourself with fresh eyes and to detach yourself and say, “If I wasn’t me and I didn’t know anything about that medicine, how would I feel about this? And would I be okay?” And you go, honestly, probably not. I would probably complain.

Adam Little:
Yeah. It’s really challenging but I think one of the solutions to this is to broaden that applicant pool and bring in people that maybe can help you see that from another perspective.
I think one of the things that I never see practices doing, and I don’t understand why, why not recruit from your clients? Every practice is having difficulty recruiting for, in particular, support staff roles and those sorts of client facing roles in particular. They have lots of high turnover, they have people that maybe don’t have the experience, they tend to be more transient positions. You have thousands of people a year that love your business to a certain degree and want to see you succeed and they don’t even know that you’re hiring. They have no visibility to where you are in the life of your business. And you can imagine what that might look differently if you did little things like had a careers page on your website, on the bottom of your email templates, we are hiring for these positions, and really starting to engage, even if it’s only a couple of people, it really broadens, again, that visibility to the type of clinic that you’re becoming and bringing in some of those fresh perspectives, at a time when I think staffing is challenging.

Andy Roark:
Yeah. I agree with that. With the staffing challenges, I think a lot about having a developmental pipeline, being more important now than in the past. Meaning, if you know you can’t just grab a trained technician or assistant or even veterinarian off the road, can you start the development process much earlier and try to groom people who can come up and either take those positions, or you can groom them to come up and take the workload off of the people that you have. Meaning, bring that person up so that you reduce the communication workload, say, on the veterinarian so the veterinarian has more time to do the clinical things that you can’t delegate away from them.

Adam Little:
Yeah. It’s a really interesting point of one that I think will actually end up being a much bigger issue than people realize, because if you take that point and you extrapolate out, what you’re seeing is exactly that. In particular, a lot of the larger corporate groups are saying, “Wait a second. We need to lock in these graduates far earlier than their final year. We need to lock them in first year. We need to lock them in when they’re interested in even becoming a vet in the first place.” And so what you end up having is this sort of downward pressure where at the earliest stages of veterinary education, it’s like the recruiting for the NCAA, right? If you’re a promising basketball player on your age 10? You’re in this pipeline.
I wonder what that will do for higher education where a significant part of that individual’s development is going to be tied to that process. They’re going to supply you with resources and mentorship and financial relief, they’re going to fast track you to positions in their organization, and they’re going to give you those remote opportunities. And I think it’s going to be increasingly difficult for your independent practice to sort of say, “Let’s get the talent to come to me” because they are so many further steps ahead of where you normally interact.
So I think to your point, what are the strengths and the unfair advantages that an independent practice has in a world like that? And I think it’s things like authenticity and community and personal relationships and maybe different outcomes in terms of career trajectory. But you certainly need to be investing in that because otherwise that pool… You go back, how many new grads are there this year? It’s not 100, 120. It might be 10. And the others are already spoken for in their second and third year, which is a very different shift for practices.

Andy Roark:
Yeah. Yeah. Oh, I completely agree. Yeah. I agree with you. I’m a big fan of the independent practices. I think culture, having core values, a purpose that you serve, everybody wants to have a good place to work. I definitely think that there’s ways these little guys compete. But to your point, yes. Why wouldn’t we see recruiting earlier in the vet training pathway than we have in the past?
I had Lance Roasa, who’s a vet and a lawyer, on not long ago and we were talking about signing bonuses. So signing bonuses have really taken off and new grad salaries are going up. And he really made the point that we call them signing bonuses, but they’re not. They’re retention bonuses. Meaning, you come in and then you stay for three years or four years or whatever, and then you’ll get this money. And if you don’t, then you have to give it back or if they’re smart, they get it prorated. But they have to give it back.
And so, yes. When you think about it and you say, “How do you go to a second year vet student and recruit that person?” Well, if you’re willing to do something like retention bonuses and things like that, there’s a lot of tricks in your bag that you can actually use to make this type of recruiting work. And so I would not be surprised to see more and more of that. That’s definitely a shift.
So then again, it goes back to the pipeline question of how do you get in? How do you start mentoring? How do you start building relationships? How do you stay involved? And I look at the vet schools and I look at the technician schools because I feel like for a lot of places, that’s a lot easier. But they’re looking for preceptorships at the tech schools and you say, we are a hospital that likes to teach and we have a good culture and we’re willing to take some people on and we do it in an organized way. Again, it’s the long game and it’s definitely not guaranteed. I see a lot of people who are like, “I had three externs and none of them came here!” And I go, well, that is part of the deal. But yeah, it’s fishing.
Hey everybody, I just want to jump in real quick with a couple of updates. Gang, before I do, though, I got to get a shout out, I got to get some love to Banfield the Pet Hospital. Guys, they have stepped up and supported us in getting transcripts for both this podcast and the Cone of Shame Veterinary Podcast, which is the other podcast that I host. They do it to increase accessibility and inclusion in our profession. That is a big point for them right now. It’s something that they are doing for our whole profession industry and they stepped up and put their money where their mouth was and said, “How can we help you?” And I said, “Hey, this is a thing that people have asked for and it’s a big lift for us.” And Banfield said, “We got you, buddy.” And they have made this happen. So if you want transcripts for our podcast, we got them. Head over to unchartedvet.com, you can see all of our podcasts and you can see transcripts for those. They are feel free to share them and help us get the word out but I just got to give some love to Banfield because they didn’t have to do that, but they did and it is awesome, so thanks to them.
Over at Uncharted Online on June 29th at 8:30PM, Eastern time, 5.30PM Pacific. That is PM, not AM. We’re not doing 5:30AM Pacific thing. Guys, over at Uncharted Online, so you can join from anywhere, my friend, the one and only practice management goddess, Stephanie Goss is doing her teamwork, mind meld. Setting expectations for team communication. Guys, do your teams struggle from a lack of accountability? You’re like, people don’t do what they say they’re going to do. And people don’t follow up the way that they should. And people don’t communicate in a way that stuff actually gets done. And they are making assumptions about what is going to happen. That they’re not realistic and it is continuing to cause problems between the team and management.
Guys, I see this all the time. Stephanie Goss’ workshop is all about setting expectations for how the team is going to communicate. Just think about how much you need that. Gang, this is a two hour actual workshop. Come with your camera. Come ready to talk about your practice. So this is going to be stuff that you can take home and plug right into what you are doing and actually make a difference in the way your practice functions and to take this back and engage it with your team in a way that’s going to make a difference. Guys, I hope you’ll check it out, Stephanie Goss is amazing. Uncharted workshops are uniformly pretty freaking and fantastic. I do love them. I’ll put a link to that down in the show notes.
Guys, as you might have heard my brand new exam room communication training course, it launched on June 7th. It is my 17 tips, tools, tricks, and hats to make you and or your team more effective in the exam room. Guys, this is the stuff that I lecture on all over the world. It’s my absolute best material. I wanted to make it available to everybody. I have people who always come up to me after my talks and say, “That was great! How do I teach my staff to do that?” I got you now, buddy. I’ve got you covered because you can take this to your team. It is 100% module. It is broken up into five minute modules that you can drop into your staff meetings, tag it onto the end of a team training meeting. You can do it in the morning huddle. You can go through and everything stands alone so you can pick the things that you like, skip the ones that you don’t. You can look and say, we need this the most in our practice. Let’s do this.
Guys, the course pays for itself. If there’s one thing that you take and you give to your team and they go, “Oh! Light bulb moment!” The fact that it’s made to go back to your team and be interactive, which means everything comes with discussion questions so you can say to your team, how do we do this? What does this look like in our practice? How could we do this better? What opportunities do we have for improvement here? And I give you those suggested wordings and questions to ask so that you can get your team to engage.
Guys, I’m super proud of this. I’m super happy. For the first 30 days, so until July 8th, it’s a $100 off. It’s a launch special. I don’t want to slip past you. If you’re like, “I want to try that out!” Grab it. Grab it now. Grab it while it’s got a $100 off. I’ll put a link in this show notes. Guys, I hope you love it and you enjoy it.
And if you haven’t checked out my charmingly angry client course, it’s built in a similar model. It’s been very, very popular. People who have had it can tell you about what it’s like, feel free to ask because it has gotten very good reviews and a lot of people have gotten a lot of mileage out of this. But guys, I want you to be able to train your team, specifically your team, not some generic team. I want you to train your team in a way that’s going to work in your practice. And this is why I made this tool, so it can get taken and used as you want to use it so it supports your culture and your practice and the way that you guys work. Anyway, I hope you’ll check it out. Like I said, I’m over the moon that is launched and boy, it’s been a lot of work for me and my team, but I think it’s going to be totally worth it for those of you who check it out.
All right, let’s get into this episode.

Adam Little:
And then the other point that you raise is, okay, you have that person. How do you allow them to develop their career and themselves in their jobs, in your community? And I think this is again where it’s a bit of a mind shift, but traditionally, you have these very kind of almost like rigid identifiers for roles and practices, right? So you have a registered veterinary technician, you have a veterinarian, you have… And the reality is, it’s much more of a fluid spectrum where, depending on your experience and your interest, there’s a huge gradient in terms of a registered veterinary technician that specializes in surgery and supporting the surgical services of a practice versus an entry level one. And I think what people are going to want is, they’re going to want to see from employers a much clearer map of how they can advance themselves, how they can make more money, how they can take more accountability and ownership by staying with you. And this is where there’s an opportunity to carve out and actually be a lot more nimble as an independent practice, because you can develop levels yourself.
And this is some of the best practices that we’ve even heard in the Uncharted community where, I think, when I look at the practices in that community that are really successful, one of the things that they pay in particular attention to is really clearly lying out this is the expectations for you, but more importantly, this is where we think we can get you to and why, when we make decisions, your role looks like this.
I think one of the things about the culture, which can really kind of get away from you, is that without those clear expectations, without opportunities for advancement and without a transparent set of rules and guides and opportunities, the ambiguity can really paralyze people or get your good people to leave are frustration. And the practices on Uncharted, that I think are fantastic, are the ones that are like, “We’ve introduced three levels of technicians and this is the hours of the work that you need to do.” And those are the types of people they’re going to stay with you because they want to grow and they see that you have an opportunity to do that with them.

Andy Roark:
Especially for the technician levels, pay scales, things like that. There’s a nice wage transparency that comes with it. But you can also sort of gamify your training and your development and you say, “This is what you need to get to the next level and this is how you get rewarded when you get there.” And I think it makes a lot of sense.
I really like your point, even with doctors, one of the things, when we talk about change and evolution, one of the things that’s really important is that people need to be able to see themselves in the future that you’re creating. They need to know that there’s a place for them there. If they can’t see themselves in where you’re going, that’s very demotivating. And so when I come to you and I say, “Adam, this is what I’m really excited about.” And you say, “Andy, I could see you doing more and more of that and ultimately moving in this direction”. I think that’s really powerful.
I was up at a practice in New York, it was outside of Syracuse, and they were breaking ground on a huge rehabilitation facility behind the vet clinic. And they had had some technicians who 10 years ago, just twisted arms to get a little closet at the back of the building where they could do rehab stuff and they loved it and they advocated for it and they built that business up. And they got an aquatic treadmill and they’re doing a lot of rehab. And they finally grew that thing up to where the owners were like, “Look, we’re going to build you the real deal.” And they’re building a new building just for rehab. But again, they had this person who drove the bus and she was super motivated and they continued to say to her, “Hey, we’re growing this with you. We want you here and we can see this is where this goes.” And they delivered on what they said and now they’re going to lead the whole area in this niche of medicine. They’re really doing impressive things.

Adam Little:
That’s such an interesting story because there’s so many takeaways that are weaved into that for this conversation. So one is, you had somebody with enormous pride in themselves and their work and the opportunities to do that. And I think that’s a really undervalued aspect of this entire thing. If you have a team that wakes up every day and they really truly believe that their work is meaningful and they can be proud of their team and their output and the clinic and they’re standing within the community, I think regardless of all the future stuff that’s going to come out there, that is such an important element of being on that right trajectory.
The second thing is, in your example, they found a way to make strides so that this big monolithic building wasn’t something that might happen in the future. Okay, we’re going to start with this service. We’re going to get this cause. So we’re going to keep pushing forward. And then they had a really aspirational, this is where we want to get to.
And I think that is a really difficult thing in life to pull off, where you have a lot of conviction on the vision and a lot of clarity on what the first steps are in the milestones to get to that vision. So they’re like, we want to build the rebound center, we’re going to knock it out of the park with a little bit of space, we’re going to build this service up, we’re going to train people. It requires such a unique individual and the right conditions in that environment in order to move that forward, and I think that’s part of this for the practices. Are you creating the environment and the conditions to allow people and ideas like that to propagate? Or are you actively discouraging those types of people and ideas from joining your practice?

Andy Roark:
Yeah. No, I think you’re right and then that sort of encouragement. So it was funny, what I was talking to this person about, her question from me was, how do I streamline the process of getting our surgeries to make the recommendation for physical therapy and to educate the clients about what that looks like? How do I interface with that? So that every time we have a surgery go out, they get this information, they understand what we could do. And I was like, that’s the level this person is thinking at is, we’re here. We’ve got this service. It’s growing. How do I continue to integrate it into what we’re doing? And to have that coming from the technician level? That’s amazing.
But the other part of it is, that would scare the hell out of a lot of practice owners. You know what I mean? A lot of people would be like, “Whoa, whoa, whoa. You’re pushing hard here.” This practice had not done that. They had listened to this person and supported and tried to work with her and figure out, okay, we see where you’re going. How do we do this? And what does this look like? And they’ve got this video monitor in the waiting room that looks really good. It was a vertical one, so it’s four feet tall, two feet wide, kind of cool. And they’ve got rehab videos that are playing in the waiting room, so when clients are in the waiting room, they’re watching this stuff. But that was all technician driven. It was technician driven and owner facilitated and supported. As I say, it was impressive.

Adam Little:
Yeah. There’s kind of an interesting parallel between startups and that experience where, oftentimes the people that are closest to the customer, the closest to the user when you’re building something, they have such powerful insights because they can see what they’re reacting to and how they’re learning. And in practices, that’s usually not the owner, it’s usually not the manager, it’s usually the front desk staff. So how are you empowering those people to have a meaningful voice and actually, more importantly, take that step further and take actions that are in the best interest of those individuals?
To your point about how do you kind of get that information in? I think a lot of times this is one of the biggest challenges for practices. They spend a lot of time on the setup of something, but they’re not really thinking from the perspective of, an owner might need to know about this six or seven times. And if they only come in twice a year, that means that I need to tell them every single time that they’re in, for three years in order to actually make that decision, plus the nature of their pets and their care and where they’re at financially.
And so if you have a practice that’s reluctant that first time to talk about rehab, they’re never going to cross that threshold where they’ve hit somebody enough times to make that top of mind so you have to be creative. You have to say, is there ways that we can expose people to what we’re offering, that isn’t hanging on the recommendation of an individual face to face conversation. The videos are a great touch. Surfacing up those patient stories, the newsletters, all those things that are just maybe not where they make the decision, but they build a bit of a foundation that when that recommendation ultimately might be reinforced or come from the vet, they’re like, “Huh, this isn’t the first time I’ve heard about this. I saw those writing room videos. I saw that patient. I saw that cute thing on Facebook.” You’re just pulling that last push to get them over the edge as opposed to beginning it from a cold start which is really hard for practices in general, I find,

Andy Roark:
Oh, I completely agree. But the idea when you look at how crowded the media environment is and how much messaging pet owners receive from Google ads, on social media, from TV ads, from all these places. The idea that they’re going to roll into the vet clinic, I’m going to see them once a year, I’m going to say this is what you need to do, and it’s going to cut through all that noise. That’s really hard.
I think we have so many things that we talk about exactly one time. A new puppy comes in and we talk about pet insurance, or we talk about dental care, or we talk about whatever it is. We talk about weight control and feeding a good diet. And then we’re done and we don’t talk about a diet again, and we don’t talk about weight control, and we don’t talk about dental health, and we don’t talk about any of these things. And it’s sort of like we know that if you want to get someone to commit to letting you clean their pet’s teeth, they can’t learn about dental cleanings the day that you recommend them. They really need to have heard this seven times before, probably in different ways, in conversations with the doctor, with the tech. They probably need to read something about it, see videos on what it is, get a newsletter. Just this multimodal education.

Adam Little:
I think the examples that you shared really amplify this problem which is that I feel like practices are really just receiving. They’re like this is a new priority of the month, this is a new priority. There are so many things that now I’m expected to do which means that, what do I actually stand for? What’s the one thing that people respond for me for?
And I think that the start doing thing I also encourage. Practices need to be polarizing in the sense that you need to have something that when a friend is talking to a friend, they’re like where do you take your pet? I go to this clinic because of X. And really focus on that because otherwise you’re swimming in a seat of priorities. All these topics are important for pet health, which means that none of them are important for pet health, because none of them are actually receiving the focus and attention they deserve.
And on the flip side, I think that people are going to gravitate towards businesses that carve out positions on things and for pets, I think that there’s such an opportunity there to say we are great at this, we’re going to make this a priority. It might mean that we’re not the best vet for you, and that’s okay. But as a result, the things that we’re going to do, we’re going to do very well. We’re going to reinforce them and we’re going to start to see the fruits of that labor. And that’s why I think you’re seeing some of these new practices come out with like membership models where they’re like, we know that for us, as a clinic, we have a commitment to this client or to this patient over the lifetime of that pet. And we want to work with people that are going to make that commitment to us. So we have a business model and a care model that allows us to go deeper for your pet’s needs, allows us to be more supportive and as a result, it means that we can’t take on thousands of new clients. But for the clients that we do have, this is what we’re going to do.
And the other thing too, is it gives permission to your staff to say no. And I think that’s where things get really important where, if you stand for something and you create that culture, it allows your staff to confidently say, “This is what we’re going to do and this is what we’re not going to do” as opposed to, I think what’s happening right now, where there’s more than ever before, there’s more to keep up and you’re kind of like where are the priorities? Where is our focus?

Andy Roark:
Yeah. It’s the all things to all people problem, right? The best ex the best example of this, just to validate your point here, I was working at this practice in Florida and I was working with one of their technicians and she was in charge of their marketing and she was trying to figure out sort of what the brand messaging of the practice would be. And it was a feline only practice and so I was talking to her and we were talking about their approach to low stress handling, and they were very into that.
And so we were talking and she was walking me through what appointments are like and I said, “Well, you know what happens when you have a stressful patient coming in, or a cat that you think might be high stress or high anxiety and stuff?” And she said, “Well, we have these calming packages that the owners come and pick up”. And it’s a towel and it’s the Feliway and it’s Gabapentin, or whatever it was. And I said to her, “What happens if the pet owner doesn’t make time to come in and get that, or doesn’t want to come in and get it?” And she said, “Well, then they’re not a good client for our practice.” Or they’re not a good fit for our practice. And I remember that and I was like, man, they’ve got it. I can’t believe we’re talking about your brand message, you’ve got this nailed down.

Adam Little:
Exactly.

Andy Roark:
And it wasn’t like we also do these other things, but they were like, no. We are a low stress practice and we want cats to be happy coming to the vet and if you’re not on a board, then you’re not the right client for us. And I thought not only is that a powerful message for attracting clients but Adam, isn’t that the place you’d want to work?

Adam Little:
100%. In some ways it’s this simple but powerful concept because you’re just like there is no negotiation. This is how we treat our patients. And if you’re a client, you’re either going to be, wow, that’s fantastic. I am anxious about my pet. My pet does get stressed. But if you’re saying, well, my pet isn’t like that, I don’t care, then they’re opting out, right? It’s such a powerful thing to find those moments where you’re like, no, this is who we are. And let’s double down on that and make sure it’s part of each interaction that we have.
And to your point about recruitment, these are the things that I think the next generation of veterinarians wants to hear, right? That’s fantastic. Things that used to be optional, that are now required and now are almost baked into the DNA of the practice. Pain management is another one. There’s a bunch of these medical things that you have saw. Well, maybe we’ll do it, maybe we’ll not, to it’s required, to no, actually we have a really strong reaction when you go against what we believe is true. And I think that’s a really powerful trend for practices to continue to explore.

Andy Roark:
Yeah. I completely agree. Picking your values, picking the thing that you stand for and saying these are our people and this is what we believe. Again, I don’t think you can pick every aspect of medicine and say we stand strongly on all of these things. I think you need to figure out what you’re really about.
Adam Little, thank you so much for being here, my friend. Where can people find you online? Where can they learn more about GoFetch?

Adam Little:
Yeah, so check out GoFetch.ca. They can reach me at Adam@GoFetch.ca or Twitter @exponentialvetand. I’m happy to connect with anybody.

Andy Roark:
Good. Thanks for being here.

Adam Little:
Thanks, man.

Andy Roark:
And that is our episode, that’s what we got guys. I hope you enjoyed it. Dr. Adam Little is amazing. Taking time out of his busy GoFetch, running, iddy biddy baby raising schedule. I appreciate it. Anyway. I appreciate that guy. He’s super fun to talk to.
Anyway, gang, if you enjoyed this, if you’re watching a YouTube, hit that subscribe button. If you’re listening on your podcast, go ahead and give us an honest review wherever you get your podcast from, it makes a big difference to me. So anyway, gang. Take care of yourselves. Be well, talk to you later. Bye.

Filed Under: Podcast Tagged With: Medicine, Team Culture

Mystery Toxicosis! Chlorfenapyr in Dogs (HDYTT)

June 8, 2022 by Andy Roark DVM MS

Dr. Tina Wismer, Senior Director of ASPCA Pet Poison Control Center joins Dr. Andy Roark to talk about a scary case. Vomiting, fever, muscle tremors, and a stiff gait…. what could be the cause??

Chlorfenapyr is a chemical used in some pest control sprays, and it can be a fatal toxin for pets. Dr. Wismer discusses the risks and how to treat these cases if/when we see them.

Cone Of Shame Veterinary Podcast · COS – 142 – Mystery Toxicosis! Chlorfenapyr In Dogs (HDYTT)

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


LINKS

ASPCA Animal Poison Control: https://www.aspca.org/pet-care/animal-poison-control

NEW Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark


ABOUT OUR GUEST

Tina Wismer, DVM, MS, DABVT, DABT, is the Senior Director of the ASPCA Animal Poison Control Center. She earned her undergraduate degree from Ohio’s University of Findlay and received her DVM from Purdue University. Dr. Wismer worked in both small animal and emergency practice before joining the ASPCA Animal Poison Control Center in 1998. Dr. Wismer is a Diplomate of the American Board of Toxicology and the American Board of Veterinary Toxicology. She is an adjunct instructor at the University of Illinois, a visiting professor at St. Matthews University (Grand Cayman), a consultant for VIN (Veterinary Information Network) and a Master Gardener.


EPISODE TRANSCRIPT

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

Dr. Andrew Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andrew Roark. Guys, I’ve got a fun toxicology case for you today. What’s going on with this trembling, shaking dog? Why did its two housemates die suddenly? What are we going to do about it? How concerned do we need to be in the future? Are we having good conversations with pet owners about what to do when they have the insect home protection guy come into their house? 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. Andrew Roark:
Welcome to the podcast. Dr. Tina Wismer, thanks for being here.

Dr. Tina Wismer:
Thank you for inviting me.

Dr. Andrew Roark:
My absolute pleasure. I love having you on here. You’ve been on a number of times. You’re at my go to for toxicity questions that I have when I’m losing sleep about my patients eating things, you are the person that I reach out to. For those who do not know you, Dr. Tina Wismer is the senior director of the ASPCA Animal Poison Control Center. Thanks for being here.

Dr. Tina Wismer:
Thank you for inviting me.

Dr. Andrew Roark:
I think… Yeah. Sorry. I keep thanking you.

Dr. Tina Wismer:
I think we already did that. That’s okay.

Dr. Andrew Roark:
We did that already. Okay. I’m sorry. Let’s move on to the next session. I invited you here because I saw an article. It was actually in today’s Veterinary Nurse Magazine, which is a great magazine. They do good work. I enjoy a lot of stuff. They had a case that scared the willies out of me. I wanted to get some more information on it, and get your thoughts on, one, treatment of this thing. But then two, also, what are the risks and how likely am I to have to deal with it, and just get a more clear view of it. The case that they talk about, that I want to put to you presented like this, there is a pet owner and she went to school for the day. She came home and her three dogs were acting normally. She has a Labrador, she has a Chihuahua, and she has a Jack Russell, so big dog and two little dogs. They’re all acting normally.

Dr. Andrew Roark:
Then she takes them for a walk. When she comes back, it’s been about two hours since she got home. The big dog is acting normal, but the two small dogs are not. They are panting and they have both vomited multiple times. Then they had a stiff gait in their hind end, as they walked around. The vomitus was described as frothy fluid with a red tinge. Then about one hour after they started showing signs, both of the small dogs had died. The bigger dog was starting to show the same signs, the stiff gait, mostly it was the panting and appeared to be in distress. This dog was rushed into emergency care and was thankfully saved. The diagnosis that was given was chlorfenapyr poisoning. I just want to start to talk about that and what that means. Starting at the high level, what is chlorfenapyr?

Dr. Tina Wismer:
Chlorfenapyr is an insecticide. It is labeled for use on both agricultural products and for in the household.

Dr. Andrew Roark:
Okay. We most commonly see this where? I mean, I guess, how do companion animal vets tend see this? How is this used in our households? Is this something that people go down to Home Depot and pick up, and they’re just sort of spraying around the house? It sounds like this is sort of the next level up from that.

Dr. Tina Wismer:
Right. This can only be used by licensed pest control operators. This would be the company that you would pay to come in and spray your house for termites, or if you had a severe roach infestation. You’re not going to be able to go to Home Depot or Walmart and buy this yourself.

Dr. Andrew Roark:
Okay. How often does this happen? I mean, I get my house sprayed for termites, because I live in the woods. Is this a common occurrence? Is it fairly uncommon? How concerned about this type of toxicity should I be?

Dr. Tina Wismer:
Sure. Fortunately, it’s pretty rare. This product has been on the market since about 2001. We see the occasional animal that gets exposed and has problems, but it’s not very common.

Dr. Andrew Roark:
Well, why do we think it’s uncommon? Is this type of chemical not used really widely by the guys who are spraying? Is it dose dependent, and so most pets don’t reach a dose that is going to cause clinical signs? Were all three of these dogs just the weird cases that had a reaction? Yeah. What’s your take on why we don’t see this more commonly?

Dr. Tina Wismer:
Right. Number one, I don’t think it’s very commonly used as compared to our other like pyrethrin-based products, which we know are quite safe around mammals. I also think that most people remove their animals from the household when this person is coming over to spray. All of our cases have been animals that were inside the household when the spraying was occurring.

Dr. Andrew Roark:
Okay. Is there anything that, on the surface level, I could see or I could advise pet owners to see? If pet owners call me and they say, “Hey, I’m getting ready to get my house sprayed. Is there anything I should be looking for in the pest control guys?” Because I have gotten those questions a number of times, is there any red flags or anything that I should just put out to them and say, “Hey, here’s something to look out for.”

Dr. Tina Wismer:
Right. Most pest control operators will give you the name of the product that they’re using, things like EPA registration numbers. You can check and see how safe is this to use around pets. Also, the most important thing, remove them from the environment.

Dr. Andrew Roark:
Yeah, no matter what.

Dr. Tina Wismer:
Yeah. Don’t bring them back until you can’t smell the product anymore.

Dr. Andrew Roark:
Okay. That’s a good rule. If you can’t smell it, then it’s probably okay. Am I paraphrasing that appropriately?

Dr. Tina Wismer:
Yes, yes.

Dr. Andrew Roark:
Awesome. All right. Sweet. Okay. What do we tend to see on clinical presentation in these dogs? I told you, the pet owner said that she saw, what other signs do we see beyond that? Are there things that we’re going to find on admission to the hospital that maybe the pet owner would not have seen?

Dr. Tina Wismer:
Yeah. These guys tend to have pretty impressive tremors, muscle tremors. Then we get secondary hyperthermia, your body temperature goes up.

Dr. Andrew Roark:
Got it.

Dr. Tina Wismer:
Some of these guys will also develop pulmonary edema.

Dr. Andrew Roark:
What temperature levels are you talking about when you say the temperature goes up, because I see a lot of nervous dogs that come in at 102.5. Is that what we’re talking about? Are we talking about 104, 105?

Dr. Tina Wismer:
We’re talking, these guys can present at like 107 or 108.

Dr. Andrew Roark:
Okay.

Dr. Tina Wismer:
So badness. Bad.

Dr. Andrew Roark:
Yeah, badness. All right. That’s super helpful. Okay. That way I won’t be like, “Oh my God, he’s 103, is this [inaudible 00:07:28]. Have you had-

Dr. Tina Wismer:
No, not chlorfenapyr.

Dr. Andrew Roark:
What other presentations… Clearly we’ve got muscle fasciculation, stiff gait, vomiting, panting, things like that. This is going to look like a toxicity of some point. What else looks this way? What are my other differentials that I want to separate this from?

Dr. Tina Wismer:
Sure. The one thing this looks very common or very similar to is hops toxicosis. If you’re home brewing beer, dogs that get into the hop pellets or they get into the hops flowers that are in your compost pile will present the same way. They’ll be extremely hyperthermic, they’ll be panting.

Dr. Andrew Roark:
Okay. That’s a question I don’t have in my repertoire for pet owners. “Have you been brewing beer?”

Dr. Tina Wismer:
Perfect.

Dr. Andrew Roark:
No, yeah.

Dr. Tina Wismer:
It’s pretty popular now.

Dr. Andrew Roark:
I mean, yes in way, but if I… “Have you…” Okay. People, yeah. That’s going to get me some weird looks from people when I… “Quick,” as I race them the back, “have you brewed any beer? Tell me now.”

Dr. Tina Wismer:
“If so, can you bring me some?” Exactly.

Dr. Andrew Roark:
Exactly. “If not, that’s good. If yes, that’s all so good because I’m going to need one.” Okay. My main differential is hops from beer brewing. “Have you had any insecticide sprayed? You don’t brew beer, do ya?” Those are two good questions. Okay. Basically same muscle fasciculations, high body temperature, vomiting, things like that, I’m going to see in both of those cases.

Dr. Tina Wismer:
Yes.

Dr. Andrew Roark:
What am I going to see on my diagnostic tests? Is there anything I’m going to see on the blood work that’s going to tip me off, either that I’m looking at these two, either hops or chlorfenapyr, or that’s going to differentiate them? Am I going to see on radiographs? Walk me through my diagnostics, if you don’t mind.

Dr. Tina Wismer:
Yeah. On blood work, you’re really not going to see anything initially, everything’s going to be normal. As the process goes on, things like CK are going to rise because you’ve got a lot of muscle activity. Then we can potentially see coagulopathies because of high body temperature, DIC. But nothing initially, it’s going be completely normal. Radiographs, once again, also going to look pretty benign.

Dr. Andrew Roark:
The main way I’m hearing from you is clinical history is your guiding light.

Dr. Tina Wismer:
History.

Dr. Andrew Roark:
That’s going to make it or break it.

Dr. Tina Wismer:
Yes.

Dr. Andrew Roark:
When the pet owner says to you, “Yeah. We had the guy in to spray the house today while I was at work.” How big of a blaring siren is that for you? Is that a big, red flashing, “This is an emergency.” Or is that kind of a, “Hmm, we’re definitely going to need to look into… We’re going to need to take this seriously.” Yeah. How many alarm fire is this for you?

Dr. Tina Wismer:
Right. With most insecticides that are contacted by the inhalation route, we’re going to see signs within a couple of hours, so we’re going to also ask about timeframe. But if we’ve got clinical signs that fit, we’ve got tremors, we’ve got hypothermia, then, yes, this is your nine-alarm fire.

Dr. Andrew Roark:
Yeah. Okay. I wasn’t sure how many alarms we could have. I thought five was the most.

Dr. Tina Wismer:
I don’t know. I just make that up.

Dr. Andrew Roark:
But maybe nine, if it’s a nine-alarm, I’m like, “That’s bigger fire than I had even thought.” I love it. I got it.

Dr. Tina Wismer:
Infinity, I don’t know.

Dr. Andrew Roark:
Yeah, exactly. I’m just going to be honest, my knowledge of the alarm system that firemen used is very limited. When you said nine, I was like, “Holy crap.”

Dr. Tina Wismer:
Zero. Zero, I have no idea. Zero. Zero knowledge.

Dr. Andrew Roark:
Okay. Yeah, there’s got to be a better medical way of describing this than in a fire alarm categories. Okay. All right. Moving on. I get the point. I get the point. We’re not sleeping on this.

Dr. Tina Wismer:
No.

Dr. Andrew Roark:
We’re not going to sleep on this. How do we treat it? This dog presents and I need to take action, what are my main concerns as I do this? How am I going to treat this?

Dr. Tina Wismer:
Sure. We want to get our body temperature down. You’re going to use things like IV fluids, wet the fur, a cool fan. Then for vomiting, pick your favorite antiemetic. For tremors, you’re going to use methocarbamol. You’re great. Muscle relaxant. Then, these guys actually respond pretty well to lipids.

Dr. Andrew Roark:
Okay. Tell me more about that. They respond pretty well to lipids.

Dr. Tina Wismer:
Sure.

Dr. Andrew Roark:
Walk me through that. That’s not something I reach for a whole lot.

Dr. Tina Wismer:
Sure. When we’re talking about lipids, we’re talking about the 20% solution that you use for partial parenteral nutrition, right?

Dr. Andrew Roark:
Okay.

Dr. Tina Wismer:
You’re feeding them through the vein. The thought is that we have certain toxins, including chlorfenapyr, that are highly lipid soluble. The thought is, if we give dogs lipids, we’re going to bind the toxin within the bloodstream and therefore it can’t get out and it can’t affect the receptors and cause clinical signs.

Dr. Andrew Roark:
Okay. Talk to me about a dosing regime and a timeframe for this, if you don’t mind.

Dr. Tina Wismer:
Sure. We start out with a bolus of about one and a half mils per kilo. You can give that over about 20 to 30 minutes. Then we drop down to a constant rate infusion of 0.5 mils per kilo per minute, and we’re going to do that for another 30 to 60 minutes. Right?

Dr. Andrew Roark:
Okay.

Dr. Tina Wismer:
The big thing is, if you’ve got a small dog we don’t want to volume overload, so make sure you go on the low end. Then we’re going to stop our constant rate infusion for about four hours. We’re going to then check and see if we’re lipemic. If we’re lipemic, we’re going to hold off. But if we’re no longer lipemic and our animal is still symptomatic, then they get another dose of lipids.

Dr. Andrew Roark:
What kind of timeframe am I looking for to see a change, or ideally, a resolution of symptoms? If I’m seeing muscle fasciculations and things like that, and I start to give some lipids and things, is this a 30 minutes in and I start to see improvements? Is this a longer play? Is this magic where you start to… It’s like deworming… or blood transfusion in a hookworm puppy where they just open their eyes and feel better? What are we talking about?

Dr. Tina Wismer:
Sure. With something like chlorfenapyr, typically it just takes like one dose of lipids. Usually by the time we finish that one to two hour timeframe, they’re much better. If we’re using lipids to treat something like marijuana or avermectins, things like ivermectin or Moxidectin, then you may need to give multiple doses of lipids before we see an improvement.

Dr. Andrew Roark:
Okay. Then what is the ultimate official cause of death in these cases?

Dr. Tina Wismer:
They can either die from severe hypothermia, or they can die from pulmonary edema.

Dr. Andrew Roark:
Okay. I’m assuming I’m going to pay special attention to lung sounds, things like that, as we’re treating and just try to manage to that.

Dr. Tina Wismer:
Exactly, yes.

Dr. Andrew Roark:
Okay. All right. Any other pearls of wisdom for me? Any words of advice as I would wade into something like this? Any mistakes I really want to avoid making?

Dr. Tina Wismer:
I think the important thing is to keep a pretty close eye on these guys for the first couple of hours that you have them. If they’re going to die, they tend to die pretty quickly.

Dr. Andrew Roark:
Okay.

Dr. Tina Wismer:
If we can get that temperature back down quickly, then they do well. Otherwise, then we have to manage DIC, and no one wants to do that. Just, let’s take-

Dr. Andrew Roark:
No, yeah. Let’s not do that. Awesome. Dr. Wismer, thank you so much for being here. Tina, I appreciate you so much. I really appreciate your time.

Dr. Tina Wismer:
Thanks for inviting me.

Dr. Andrew Roark:
That is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. If you’re watching on YouTube, hit that Like and Subscribe button. If you’re checking out the podcast, the nicest thing you can do is leave an honest review wherever you get your podcast, it’s how people find the show. Means the world to me. Guys, thank you so much for being here. I hope you learned something. I hope you enjoyed your time with me. I hope see you again soon. Take care of yourselves, all right? Be well. Bye.

Filed Under: Podcast Tagged With: Medicine

A Practical Guide to Caring for Geriatric Dogs

May 26, 2022 by Andy Roark DVM MS

Dr. Mary Gardner’s new book, It’s Never Long Enough: A practical guide to caring for your geriatric dog, is a wonderful collection of stories, lessons learned, and practical approaches from a career serving pets at the ends of their lives. Dr. Gardner discusses the writing of the book, her next book on cats, the chapters she’s most proud of, and some of the stories that she shares in her texts. Whether you are a pet owner with a geriatric dog, or a medical professional who wants to exponentially increase the number of tips and tricks you have to offer pet owners, this book is worth unpacking.

Cone Of Shame Veterinary Podcast · COS 140 A Practical Guide To Caring For Geriatric Dogs

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


LINKS

Buy the Book: DrMaryGardner.com/books

Dr. Mary Gardner on Facebook: https://www.facebook.com/drmarygardner

The Uncharted Veterinary Podcast

https://unchartedvet.com/uncharted-veterinary-podcast/

Retain Your Team: Languages of Appreciation in your Workplace

Retain Your Team: Speak the Languages of Appreciation in Your Workplace

Creating Content that Clients Crave

Creating Content that Clients Crave

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark


ABOUT OUR GUEST

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 250 veterinarians around the country dedicated to veterinary hospice and euthanasia in the home.

Dr. Gardner and Lap of Love have been featured in Entrepreneur Magazine, The New York Times, the Associated Press, The Doctors and numerous professional veterinary publications. She 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

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

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with one of my good friends. We went to vet school together. Gosh. She’s done so much for our profession. She is one of the funniest, most fun people that I have met in my life. Dr. Mary Gardner is here on the podcast.

Dr. Andy Roark:
We are talking about her new book, It’s Never Long Enough: A Practical Guide for Caring for Your Geriatric Dog. She has a practical guide for caring for your geriatric cat coming out later this year. Man, she tells stories from the book and you will see why she’s amazing.

Dr. Andy Roark:
Honestly, guys, I’m to going to sit down and read this book, because she sold me on it. What she’s doing is just awesome. It’s hard to believe that somebody could talk about geriatric care and end of life care and make it uplifting and fun and interesting. She crushes it. Anyway, guys, I’ll show you. 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. Mary Gardner. How are you?

Dr. Mary Gardner:
I’m good, Andy. How are you?

Dr. Andy Roark:
Man, I’m good. It’s good to see you again.

Dr. Mary Gardner:
I know. Listen, we go way back.

Dr. Andy Roark:
Yes. We do. I had that thought getting ready for this. I was like, we have to be careful or this going to become one of those, “Remember in vet school,” episodes.

Dr. Mary Gardner:
I know.

Dr. Andy Roark:
I’m not going to let that happen, but we could totally do that.

Dr. Mary Gardner:
Okay. We won’t. But it’s like 18 years now or something ridiculous from when we first met.

Dr. Andy Roark:
It is. It’s amazing. Time flies by. Look at us.

Dr. Mary Gardner:
I know.

Dr. Andy Roark:
We’re in vastly different places than when we met. You are, for those who don’t know, one of the co-founders of Lap of Love. That hospice. You are an entrepreneur. You do a lot of different things. You are a wonderful lecturer and really funny person and a light in veterinary medicine. You’re also an author. You have a new book out.

Dr. Mary Gardner:
I do.

Dr. Andy Roark:
It’s called, It’s Never Long Enough: A Practical Guide to Caring for Your Geriatric Dog. What is that like?

Dr. Mary Gardner:
It’s a lot of work, let me tell you, but it’s something I’ve wanted to write for many years. Because doing end of life care … You see some hot messes. You see some jalopies. Having the lens of being able to go to somebody’s homes, I saw so many families struggle with their older pets and not know how to practically care for them in the home. Whether they were seen by their veterinarian or not for their last year of life, which is a sad statistic in itself.

Dr. Mary Gardner:
A lot of us vets focus just on the medicine and don’t know … What’s the best harness to recommend? What about all the booties that are available? What do you do when the dog is pooping all over the house? How do you clean it? And so, the families were lacking that practical home care. Just doing hospice. That’s a big part of hospice, is the environmental setup. Along with palliative care.

Dr. Mary Gardner:
I just have been wanting to write this for the pet owner for a long time. We helped write a textbook for veterinarians, but I just wanted something for the pet owners. However, it’s really good for everybody. Technicians. Veterinarians. It’s pretty comprehensive. I started it probably over three years ago and it’s 500 pages. It’s pretty long.

Dr. Andy Roark:
It’s called It’s Never Long Enough. That’s the story of you writing the book.

Dr. Mary Gardner:
I had to stop. It was horrible.

Dr. Andy Roark:
It’s 500 pages. It’s a 500-page book. This is not a pamphlet that you put out.

Dr. Mary Gardner:
No.

Dr. Andy Roark:
First of all, it’s a real book. You can get it on Amazon. I’ll put links in the show notes. There’s nothing second tier about this. It is 100% gold star all the way.

Dr. Mary Gardner:
It’s a real thing. There’s 250 pictures and it’s all color.

Dr. Andy Roark:
Wow.

Dr. Mary Gardner:
I didn’t want to be … I wanted it to be gold standard. There you go.

Dr. Andy Roark:
No. I say that jokingly, but I say that fully impressed with what you’ve put together. It’s amazing. And so, let’s be honest. How many of us wish that we had time to walk through with pet owners and talk about these things?

Dr. Andy Roark:
We know that pet owners have tons of questions, but just basic things are, “What am I looking for in a harness?” They don’t even know to ask about a harness. They don’t know what they don’t know. They don’t know that’s a thing that they should even consider.

Dr. Andy Roark:
And so, when they don’t even know what questions to ask us, how can we support them? I think that it’s amazing that you took your knowledge from going into people’s homes. From work and doing hospice care for … What? You guys started Lap of Love in 2009?

Dr. Mary Gardner:

  1. Yes.

Dr. Andy Roark:
12 years. 13 years, at this point?

Dr. Mary Gardner:
13 years. It’s crazy.

Dr. Andy Roark:
That’s been what you do. It’s been your passion. 13 years of being in people’s homes. You said, “This is what I see people struggling with.” Or, “This is the things that I wish I could tell them or that they have asked along the way.” This is an amazing resource. Because most of us, we love to have those quality of life conversations. Ways to help pet owners.

Dr. Andy Roark:
But most of us don’t have time to really unpack those sorts of things. I don’t know. I tell you. I’m one of those people where … When I have a complex problem or I have something that’s significant in my life, I like to read about it. I’m a reader. Give me a book to sit down with and get what I need. That’s how I learn.

Dr. Mary Gardner:
I could see you doing that.

Dr. Andy Roark:
100%. I have the most eclectic book collection from different passing fancies in my life.

Dr. Mary Gardner:
That’s awesome. Listen, I had to recently clear out my book shelves. I was getting a little analysis paralysis. I dumped about 100 books recently, but I’m like you too. I just take little bits and I’m a little sponge.

Dr. Andy Roark:
I need to purge books. I still have all of our books from vet school.

Dr. Mary Gardner:
Listen, I threw out a lot. There’s a few I kept. Internal Medicine. Dermatology.

Dr. Andy Roark:
I’m going to go back and be like, “Let’s check back in 2006. See what Internal Medicine standards were there.” Why do I have that? I don’t know, but I do.

Dr. Mary Gardner:
I don’t know. Exactly. I love it.

Dr. Andy Roark:
Let’s start to unpack this a little bit. When you sat down to write this book, were there major things? You were like, “These are the takeaways that I really want to hammer home.”

Dr. Andy Roark:
Or were there objectives that you had in creating the book? Where you’re like, “I really want pet owners to understand these concepts.” Or, “These are areas that I don’t feel they’re getting from conversations they’re having with vets now.”

Dr. Mary Gardner:
I think a little bit of all of that. There’s repetitive conversations I would have in the homes over and over and over again. So I’m like, “Okay. Definitely, have that.” But one thing I wanted to do is not create a book about all the diseases a pet gets.

Dr. Andy Roark:
Right.

Dr. Mary Gardner:
In this case, it’s dogs. I’m working on the cat book. That’ll be out this summer. But I didn’t want just, “Diabetes …” The list of all the diseases. I wanted to focus on the ailments that they struggle with and how to help them. For instance, mobility, which is the number one issue I see in older dogs. And so, whether they’ve got arthritis or a disc issue or DM. Or whatever it may be.

Dr. Mary Gardner:
My girl, Sam, she had cancer in her spinal cord. Random. And so, no matter what the problem is, or the disease is, rather … The problem is they can’t move. They can’t get up and down well. How do we help support the family? How do we set up the home to do that?

Dr. Mary Gardner:
Same thing with incontinence. Whether it’s because you’ve got diabetes or just a bad sphincter. How do we keep pets clean and keep the home sane? Because it’s not easy when you have an in incontinent pet. Number one or number two. So I wanted to focus a portion of the book on just the ailments.

Dr. Mary Gardner:
And then, for the dog, there were though a few diseases that I just wanted to shout out that really are very geriatric-focused. For instance, Lar Par is one that just needed a chapter. Probably, because I had a dog with Lar Par, so I had to give it a little nod.

Dr. Andy Roark:
Sure. No. I get that. I love that you think of it that way. It’s so easy for us as doctors to look at disease and to classify it as disease symptoms. When you were saying that, I was like, “I would totally do that.” You know what I mean? I’m an explainer. And so, I would want them to understand the mechanisms of diabetes and what this means and blah, blah, blah.

Dr. Andy Roark:
The truth is, they don’t care. Their doctor is working with them to manage it. They don’t need to understand the pathology. They need to understand the symptoms and managing. Basically, home nursing care, in a lot of ways.

Dr. Mary Gardner:
That’s it.

Dr. Andy Roark:
That makes a ton of sense.

Dr. Mary Gardner:
Right? The dogs are there panting and pacing. Is it because they’re on steroids or they’ve got a cognitive dysfunction? How do we settle them down? How do we keep them sane and us sane? And so, it is a lot of a lot of nursing care. I’ve learned so much from families over the years.

Dr. Mary Gardner:
They taught me a lot of home hacks. I’m like, “I never would’ve thought of that.” They’re just amazing. I put so much into that book. I mentioned over 200 pictures. They’re all from the families I learned from. And so, they were all so happy to be a part of this book too and have their pets help others along the way.

Dr. Andy Roark:
I bet those were wonderful phone calls or emails to send, when you’re like, “Hey. I’m writing a book to help pet owners and I have pictures of your pet from back in the day. Can I use this as an example of someone who figured a thing out that was going to be helpful?” I bet they loved it.

Dr. Mary Gardner:
They were like, “I have more,” Andy. They were loving it. And so, this is when I lecture to veterinarians and I say, “Our websites. Look at your website. It’s all puppies, kittens, and adults. You have no geriatric old dogs or cats on your website. You need to have some education on your website about how to manage these symptoms.”

Dr. Mary Gardner:
Trust me. Your pet owners will send their pictures in, will send the videos in. All that stuff. I remember this one woman. Her dog, Merdog … I wanted to show her kitchen. She had all the bath mats in the kitchen and they were matched up so that the patterns were matching of all the bath mats that she had.

Dr. Andy Roark:
That’s amazing.

Dr. Mary Gardner:
She tried to do it cute. And so, I said, “Hey. Can I share this picture in the book?” And so, she’s like, “But look at my countertop. It’s so dirty.” I’m like, “Nobody’s looking at your countertop. They’re looking at Merdog and all his bath mats.” It was great.

Dr. Andy Roark:
That’s awesome. That’s really, really great. What did you learn doing the dog book that you’re going to do differently in the cat book? Because of …

Dr. Mary Gardner:
Try to keep it under 175,000 words?

Dr. Andy Roark:
Yeah.

Dr. Mary Gardner:
I wanted to have stories in it too, because so many people will remember more things about a story and connect with stories. I wanted to have a lot of stories. And I think I’ve helped more dogs than I have cats. Just like us. In GP too, you’ll see 30% cats. Or whatever the statistic is.

Dr. Mary Gardner:
And so, I’m finding it harder to go back in the history of my brain for some of those cat stories. Not that I want to. I want to have more cat stories. I probably won’t do too much different. I actually started this book with both species in mind. I was building it with both. The publishers that I was talking to, they all said, “You’ve got to split it up.”

Dr. Mary Gardner:
I was almost done with it and they’re like, “You’ve got to split it.” Then, I took about five months to take out the cats. I can now put the cats back in. They just said, “They’re different species.” The owners are different. The families are different. There’s more cat owners out there. I think we focus so much on dog stuff. I hope they’ll appreciate it, if you will.

Dr. Mary Gardner:
The sad part is, a lot of research has been done in dogs more than cats. I’m struggling to find some of that. I’ll just have to say, “This is the stuff that’s been done on dogs, but we haven’t done the same research on longevity and things like that.” But I hope that it’s going to be just as helpful for them as it is for the doggies.

Dr. Andy Roark:
I think there’s truth to that. Of splitting them out versus putting them together. Just in the way that dog owners and cat owners are very different people. I think that they’ll probably find it more accessible if they say, “No. This is a cat book,” or, “This is a dog book,” as opposed to rolling them together.

Dr. Mary Gardner:
There’s the first section of the book. Because it’s broken into four parts. The first part is all about aging. And so, why does a big dog not have as long of a lifespan as a little dog? What are the things that we could do to help extend their lifespan? Things like that.

Dr. Mary Gardner:
But for cats, they’re very similar. Usually the same size. And so, it’ll be a little bit shorter. But there’s still so many things that we could do to help keep our pets living a lot longer. Even some of the ways that we memorialize our pets. It can be very similar, but there’s also differences in how we may do that.

Dr. Andy Roark:
Hey, everybody. I just want to jump in real quick with a couple of updates. This week, over on the Uncharted Veterinary Podcast, which is the other podcast I do with the one and only Stephanie Goss … I’m not on that episode. Stephanie Goss is talking about information security. Are you storing data in your practice like you’re supposed to? Guys, this is not an area where you want to get burned.

Dr. Andy Roark:
If you are not up-to-date or you’re feeling like, “I should probably listen to that,” head over to the Uncharted Veterinary Podcast and check it out. Uncharted workshops coming at you guys. On May the 21st, which is just a couple of days after this episode comes out. At 2:00 PM Eastern, 11:00 AM Pacific, Stephanie Goss, she is teaching our workshop, Retain your Team: Speak the Languages of Appreciation in Your Workplace.

Dr. Andy Roark:
Guys, you’re trying to get your team motivated. You’re trying to keep morale up. You’re trying to keep people engaged. You want your team to stick around, to enjoy the work that they’re doing, and to feel they matter to you and to the patients. Guys, are you talking about appreciation in your workplace? Are you doing it effectively?

Dr. Andy Roark:
If not, jump in. This is a little bit higher level. We had an entry-level appreciation workshop. This is a bit more down into the nitty gritty. I think people are going to get lot out of it. It is $99 to the public. It is free to our Uncharted members. I’ll put a link down in this show notes below.

Dr. Andy Roark:
On June the 8th, my friend Bill Schroeder, veterinary marketing specialist, CEO of InTouch Veterinary Marketing, he is going to be doing his lectures … It’s not lectures. It’s a workshop called Creating Content that Clients Crave. This is all about you spending your time smartly to make resources that educate clients, that answer questions, that protect your reputation. That do all of the things that you wish you had content for, but you just don’t have all the time in the world to make.

Dr. Andy Roark:
Most of us are spending too much time doing things like posting stupid social media stuff. Guys, it’s time to get a strategy. It’s time to get smart about how we communicate digitally. Bill Schroeder is the guy to do that. It is $99 to the public. It is free for Uncharted members. Guys, both of those things are coming up. I’m going to put links to both of them in the show notes.

Dr. Andy Roark:
Let’s get back into this episode. Can you talk a little bit about that? That’s one of the things that you talk a lot about. And I always take notes. Whether they’re mental or physical notes. But when we talk about honoring pets and memorializing pets, this is something that you think a lot about. I really like the way that you think about it.

Dr. Andy Roark:
When you start to approach a conversation with a pet or about memorializing their pets, or they say, “Hey. I really want to remember my pet.” Or, “I want to honor my pet’s memory.” How do you approach that conversation? What are the things that you think are important as far as talking to pet owners about after their pet has passed and the memories of their pets?

Dr. Mary Gardner:
Such a good question, Andy. The first and most important thing I think as veterinarian professionals is to not judge. I’ll lecture to clinicians and say … Even when the receptionist is on the phone saying, “Do you want his ashes back or not?” Actually, just saying it that way, I don’t like. Because that is, “Do you want his ashes back or not?”

Dr. Mary Gardner:
It’s almost like saying not getting ashes back means you love them less. That is further from the truth. There are plenty of us that may not want the ashes back of our pet. So I’ll say, “Instead of saying that, you should say, would you the crematory to spread the ashes for you? Or would you them back in an urn?” And so, there’s no judgment.

Dr. Mary Gardner:
First off, most important. No judgment. Because what you would do or I would do is totally different. It doesn’t equate to the love of our pet, but I love to have all the options. Because I think a lot of people are scared to ask. Because they may think we’re judging. And that’s not true either.

Dr. Mary Gardner:
We’re so set on just the ashes, but there is a lot more that we can do. From of course, the paw prints or the fur clipping. I just like to not even offer it. I’ll just do things. I just do the paw print. I don’t say, “Do you want one?” Because somebody may say no. I’ve got in the book 75 different ways to memorialize your pet.

Dr. Andy Roark:
That’s amazing. That’s amazing.

Dr. Mary Gardner:
I talk about diamonds. I just got a diamond made out my pet’s ashes, because I had to try it out. That’s my excuse. Had to do that. I also think that sometimes we may hear something unusual, and we think that’s a little crazy. But it’s not. If somebody wants to dehydrate their cat, you should know where that’s at and how they can do it. I have learned where that’s at.

Dr. Andy Roark:
Hold on, I’m acting like, “Yeah.” I’m sorry. I can’t keep this up. I’m sorry.

Dr. Mary Gardner:
No.

Dr. Andy Roark:
Why would someone want to dehydrate their cat? Is that a thing?

Dr. Mary Gardner:
Listen, I have no idea. But you know what? I’m also not a hunter. I have no idea why somebody would want it to put a dead deer on their wall, but they do.

Dr. Andy Roark:
Okay.

Dr. Mary Gardner:
And that’s something you killed.

Dr. Andy Roark:
Have you had someone who wanted to dehydrate their cat?

Dr. Mary Gardner:
Yes. We’ve had …

Dr. Andy Roark:
Or did you make that up?

Dr. Mary Gardner:
I love your face.

Dr. Andy Roark:
I’m sorry. I’m trying to … I’m not judging. I’m trying to understand. Again, I’m not …

Dr. Mary Gardner:
No. You’re having a natural reaction between two professionals.

Dr. Andy Roark:
Totally.

Dr. Mary Gardner:
Wait. Hold on. I have just made Andy Roark quiet.

Dr. Andy Roark:
This is the face I would make if the pet owner asked me to dehydrate their cat. I would be like, “Act normal, Andy,” but I wouldn’t know how to roll with that.

Dr. Mary Gardner:
Okay. Well, that’s why you get my book. Chapter 39.

Dr. Andy Roark:
I now feel a strong motivation to sit down and really pour over this.

Dr. Mary Gardner:
That was an extreme in some ways. But some people want the canine teeth and we’re like, “God. That’s a mini surgery to take those out.” It’s not even just that extreme. The physical memorial items. But even maybe during the euthanasia. That is the funeral for the majority of our families.

Dr. Mary Gardner:
Although we are performing the death part of it, that is the funeral. Let’s make it really good. If a family wants to play harp music, let them play harp music. If the family wants to take pictures, let them take pictures. I have been on videos before.

Dr. Mary Gardner:
A lot of veterinarians freak out over that, because they don’t want somebody video taping them doing something. But I will do it. I’m fine with that, if that’s what the family wants to do, is memorialize this. I love … My favorite thing, Andy, is bucket lists. I love them.

Dr. Andy Roark:
Okay.

Dr. Mary Gardner:
I think having a bucket list is so nice, because it helps us do the things that we wish we would do before they would die. And then, taking pictures during those moments. Having professional photo shoots and things like that can really be very helpful. We don’t have to think about the creepy dehydrated cat. Maybe an actual photo shoot with them before they’re dehydrated.

Dr. Andy Roark:
Before. Yes. Before. Yes.

Dr. Mary Gardner:
Before. I just think … It’s not only important not to judge, but this isn’t about you. It’s not about us.

Dr. Andy Roark:
I think that’s totally important. You and I sort of laugh about it. But in another way, you go, “It’s not my thing. And this is not my tradition.” It’s not how I see the world or something I’m familiar with, but that doesn’t make it wrong. I’m not the arbiter of what is …

Dr. Mary Gardner:
What is correct.

Dr. Andy Roark:
What is an end of life ritual? I don’t decide that.

Dr. Mary Gardner:
No. What I love is being a part of all those different rituals. I’ve been at Jewish funerals. The family is Jewish and they’re, [Hebrew 00:22:03]. They’re doing their prayer over it. I’ve been at American-Indian. There’s just such amazing prayers and rituals. I’ve been at atheist. I’ve been a part of every single kind. Buddhist.

Dr. Mary Gardner:
It’s just so cool to see the respect that they have for their pet that they would do for their own family member. It’s just amazing. I did a Facebook Live the other day on pet hospice for pet owners. I had about a half an hour of questions afterwards. I was like, “Ask me anything.” Which could be scary, but …

Dr. Andy Roark:
Sure.

Dr. Mary Gardner:
Somebody wanted to know how long can they keep their pet after it’s passed. And so, a lot of veterinarians would be like, “Instantly, it needs to go in the freezer.” That’s actually not the case. I said, “It’s okay. If you want to keep your pet for a day or two, let me tell you what will happen just so you’re prepared. Let me tell you what rigor mortis happens and when it goes away.”

Dr. Mary Gardner:
How to keep them clean. We’ve got to be in an air conditioned location. Stuff like that. The guy was so thankful. He’s like, “I just want one more night with him in my house.” That’s okay. And I told them the story about … I let my girl Sam go last year. I did it at night. It was eight o’clock at night. I just wrapped her up in a blanket.

Dr. Mary Gardner:
Her little head was still out of the blanket. And I brought her the next day to the crematory myself. 18 hours later, she’s getting cremated. But it’s not like they explode or anything. It’s just so not normal for us to think about. But if a pet dies in their sleep, or dies when you’re not home, they’re there sometimes for 12 hours.

Dr. Andy Roark:
No. That does make sense. When you think about rituals that people have … You talked about a bunch of very different experiences. A big diversity of experiences. You’re not imagining being the veterinarian who’s there and participating.

Dr. Andy Roark:
Do you have any advice for me about when people have rituals that are not your rituals? They have a cultural ritual or a prayer ritual or something. You go, “I don’t know anything about this.” Any advice for me? Because I want to go in and be supportive. But I don’t know exactly what I’m walking into or what my place is. Help me navigate those waters a little bit.

Dr. Mary Gardner:
Well, the great thing about you, Andy, is that you actually are very humble. That’s the first thing to do is just be humble. Ask questions. Be respectful of it. Small things that you may not think of like not walking over the pet’s body. A lot of people may just do that. They’ll step over the pet and I’m like, “You can’t do that.” What if this was grandma? You would not do that.

Dr. Mary Gardner:
And then, just simply asking the questions. Or, “How can I help?” I said this earlier. It’s not about what I would do. I told you this once, Andy, and I think you liked my little joke I said once. True story. I had a vet student come up to me and she said, “I’m an atheist. What should I tell a family if they asked me if my dog goes to the rainbow bridge?”

Dr. Andy Roark:
Wow.

Dr. Mary Gardner:
And so, I said, “Okay. Well, so let me just confirm this.” Because I’m not an atheist. With a name like Mary … I have been to church. I said, “Just to confirm. As an atheist, you don’t believe in heaven. Right?”

Dr. Mary Gardner:
And so, she goes, “Correct.” I said, “All right. If a family is asking you, “Does my dog go to heaven?” Most chances are, they’re not atheist. They just want the answer to be yes.”

Dr. Andy Roark:
Yes. Just say yes.

Dr. Mary Gardner:
Just say freaking yes people. Who cares if you’re an atheist? Just say yes. It’s going to make them feel okay. And it really doesn’t matter if you lie and go to hell, because you don’t believe in hell either.

Dr. Andy Roark:
There’s no downside for you. Just tell them.

Dr. Mary Gardner:
There’s no downside.

Dr. Andy Roark:
Tell them what they need to hear.

Dr. Mary Gardner:
If you want me to hold the incense? I will do it. Whatever you need me to do. I just can’t sing very well. It’s just being open-minded. I also like to … For those of you who know me in person like you do. I’m literally big.

Dr. Andy Roark:
You are.

Dr. Mary Gardner:
I’m 6’1″. I’m very energetic. I have to shut that down a little bit and be small and be respectful of space and also be respectful of silence. I think so many of us get in these awkward situations where we want to fill the silence with noise and chatter. And if they’re doing a prayer, or they’ve got their eyes closed, just shut up. Just be quiet.

Dr. Mary Gardner:
I know that a lot of people will say, “Ask them how they got their pet’s name and stuff like that.” The last five minutes you have with your pet, you want with your pet. You don’t want to be talking about nonsense to somebody else. I’m just a little fly on the wall. I explain the medical part of it.

Dr. Mary Gardner:
And I say, “If there’s any other way that you want to honor your pet or any other rituals, I’m here to support you. Just tell me what I need to do.” They’re all so happy that I offer that. Sometimes they’re like, “Nope. We’re fine.” Or they’ve asked me to read a poem. My Lord. I’ve cried so many times reading poems.

Dr. Andy Roark:
Gosh.

Dr. Mary Gardner:
That’s the other thing. People say, “Can we cry during euthanasia?” I’m like, “Yes.” It’s silly to try to hold that in. But you’ll learn a lot from the family. That way, the next time, it’s not a total shock or surprise.

Dr. Andy Roark:
Tell me about a time that you had a hospice experience with a family. You went into a home and you had something that sort of changed your perspective. Was there something that you can remember that really just shook the way that you think about what you do?

Dr. Mary Gardner:
I think, when I first started doing this, I was still a younger vet. I started doing this two years out of vet school. And so, we go in so much with caring … Or sorry. Curing. Curing and all the stuff that goes involved. But I remember, Andy. Andy. Ha. Andy was the dog’s name.

Dr. Andy Roark:
This does not end well for Andy. That’s the thing.

Dr. Mary Gardner:
No.

Dr. Andy Roark:
Okay.

Dr. Mary Gardner:
But I remember Andy and he wasn’t eating very well. This was when I lived in Southern California. Andy had seen every single specialist. And I thought to myself … I had a moment of almost imposter syndrome where I was like, “What am I, DVM-only, no extra letters after my name, going to help with this family?”

Dr. Mary Gardner:
I walked into Andy’s house and she handed me this huge stack of medical records and everything. I realized she didn’t need me to read all that. She just wanted to show me that she was trying and that she cared. I just put that aside and I just said, “What are you struggling with?” And it just really helped me shift to know that I have to ask first. What’s the biggest problem are they dealing with?

Dr. Mary Gardner:
Because we could go through all the inappetence or with the disease. She just said, “He’s not sleeping with me at night. And I want that again.” Just to shift, to make sure, “What is important to you?” We could look at their disgusting teeth and talk about doing a dental exam. But if they’re not sleeping at night at all, you’ve got to address that first.

Dr. Mary Gardner:
And so, I think that pet Andy made me remember. You’ve got to start off with what’s most important. What’s our goals of care? Sometimes it’s not just about the physical exam. Andy, by the way, he was a spicy dog. I actually couldn’t touch Andy at all. And I said, “That’s okay. That’s fine.”

Dr. Mary Gardner:
Because when Andy doesn’t care that I’m here, and he lets me touch him, then we know that it’s definitely time. He’s a sassafras and that’s okay. And so, it just made me aware that we could do so much with specialty and all that stuff. But having this conversation with the family of what are their goals of care. She actually was one that wanted to know about diamonds with the ashes afterwards.

Dr. Andy Roark:
Okay.

Dr. Mary Gardner:
And I’m like, “I’ve got to look up what’s the best diamond company to do.” It can be so simple. Hospice and end of life care. It doesn’t have to be … So many people freak out over it and are just so focused on the diagnosis and the curing. But it’s just about caring. I loved Andy. He’s in my book too. So many are there.

Dr. Mary Gardner:
I remember this other one, Bogie. He’s in there too. I saw him December 10th for hospice. He had lymphoma. And the family’s big concern was should they put him on the Christmas card or not? Because he’s always on the Christmas card. I said, “Absolutely. I don’t know if he’ll be here for Christmas, but let’s get him on the Christmas card anyway.”

Dr. Mary Gardner:
We let him go New Year’s Eve, so he made it through Christmas. But to them, it was so important. And I said, “All right. I want you going every day to the beach.” Because he loved the beach. Since he can still go, take videos. They would send me videos. It meant so much.

Dr. Mary Gardner:
It is about smelling the roses at the end. We can sometimes forget that. A lot of people think hospice is prolonging suffering and it certainly is not. It is about making sure that they live before they die and they live well.

Dr. Andy Roark:
Dr. Mary Gardner, you are amazing. Thank you for being here. Where can people find you online and where can they get your book?

Dr. Mary Gardner:
Dr. Mary Gardner website, drmarygardner.com. That’s also all my social. Instagram and things like that. My book is available on all the online retailers. Books-A-Million, Barnes & Noble, and Amazon. It is hard cover, soft cover, and also on Kindle if somebody wants to do it that way too. I invested in all the ways.

Dr. Andy Roark:
I was going to say. I saw it’s free on Kindle Unlimited if you have that service. It’s one of the things that’s in there. I’m like, “Oh, man. Nice.”

Dr. Mary Gardner:
Look at that.

Dr. Andy Roark:
Awesome.

Dr. Mary Gardner:
There you go.

Dr. Andy Roark:
Well, thank you. Thank you for being here.

Dr. Mary Gardner:
Thank you, Andy, for having me. It’s really nice to know my classmate is supportive of what we’re all doing. You’re doing awesome things too. Go Gators.

Dr. Andy Roark:
Go Gators. That’s our episode, guys. That’s what I got for you. Thanks again to Dr. Mary Gardner for being here. Guys, I put links in the show notes to her book and to her social media pages. Man, I hope that you guys got as much out of it as I did. Check her book out.

Dr. Andy Roark:
Also, if you were like, “Man, that’s a great podcast …” Do me a favor and leave me an honest review. It’s how people find the show. It means the world to me. Wherever you get your podcasts, that’s the place to drop it. Gang, take care of yourselves. Be well.

Dr. Andy Roark:
Remember to enjoy practice. That’s what I took away from my conversation with Mary. People are interesting and people are good. We’re in a neat place where we get to support people at important moments of their life. That’s a good thing. That’s a purposeful thing. Anyway, guys, take care of yourselves. I’ll see you later.

Filed Under: Podcast Tagged With: Medicine

The $45,000 Cat and How We Should Talk About the Cost of Owning Pets

May 23, 2022 by Andy Roark DVM MS

A new survey from Synchrony (Parent Company of CareCredit & Pets Best Pet Insurance) indicates that the lifetime cost of care ranges from $20K-$55K for dogs and $15K-$45K for cats! Also, most pet owners have no idea that this is the case. 4 our of 5 pet owners will face unexpected veterinary bills. What does this mean for veterinary professionals, who often bear the brunt of pet owner anger when financial limitations to care arise?

In this episode, Dr. Andy Roark is joined by Jonathan Wainberg (Synchrony General Manager & Senior Vice President, Pet) to discuss the findings of the study, what is realistic when it comes to setting pet owner expectations for the cost of pet ownership, and how to have financial conversations that encourage financial planning on the part of pet owners.

Cone Of Shame Veterinary Podcast · COS 137 New Heart Murmur In A Cat Scheduled For A Dental (HDYTT)

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

LINKS

Synchrony Study Reveals Pet Owners Spend as Much as $55,000 during a Pet’s Lifetime
https://www.carecredit.com/pressrelease/lifetime-of-care-study/

Language of Veterinary Care (AVMA Membership Required):
https://www.synchrony.com/groundbreaking-new-language-of-veterinary-care-research.html

CareCredit: https://www.carecredit.com/providers/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Jonathan Wainberg (General Manager, Senior Vice President, Pet – Synchrony) brings over 15 years of financial services expertise, and a record of commercial ingenuity, market expansion and energetic leadership driving revenue growth to his role as CareCredit’s General Manager, Senior Vice President, Pet.

In this newly established vertical, Jonathan will lead CareCredit’s expansion of the veterinarian credit business, pet insurance and additional market adjacencies.

Prior to this, Jonathan served as SVP, General Manager GAP. He joined Synchrony following a 15-year tenure with GE Capital, where he was the Senior Managing Director, Global Sales for Industrial Finance in London. He was a key member of the senior leadership team building a new captive finance business for the reorganized and streamlined GE Capital.

Jonathan developed the strategy and led the efforts that allowed GE to provide financing support to global customers in new markets, surpassing sales targets by more than 30%. With on-the-ground roles in the US, Europe and Asia, he’s managed teams around the world and delivered complex strategies in more than 50 countries.

Earlier, Jonathan joined GE Capital in Corporate Finance in New York, ultimately becomingManaging Director, responsible for the Eastern US, Canada and private equity firms, in 2012. As Managing Director, Jonathan originated, structured and negotiated leveraged loans and highly structured financings for leveraged buyouts, re-financings, expansions and restructurings of middle market and large cap retail companies. He was a top individual sales contributor from 2007-2010.

Jonathan has an MBA from Georgetown University and a BA in History with a concentration in Marketing from Concordia University in Montreal, Canada. He began his career in the executive training program at Macy’s in New York, where he also had various merchant/management roles.
Jonathan is a native of Canada, with a dual US-Canada citizenship. He has traveled to over 85 counties, enjoys entertaining, wine and playing with his energetic 2-year-old son. While based in Costa Mesa, Jonathan currently resides in Bal Harbour, Florida with his wife and son, Jonathan will relocate to Southern California soon.


EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a good one for you today. I am talking about the cost of having a pet. This is a topic that I think is super important. I think we need to be more upfront about what it really costs to have a pet, so that pet owners have realistic expectations going in. I don’t think any of us like surprising pet owners with what it costs, but the only way to avoid that is for them to have that knowledge, hopefully, before we come into hard money conversations.

Dr. Andy Roark:
So that is what I aspire to. That’s what I would like to see more of is a more open dialogue about what pet ownership really costs. CareCredit and their parent company, Synchrony, have released the results from a survey that they did. It’s 1,200 pet owners talking about what does it really cost to have a dog or cat for the life of that pet? That is what we were breaking down today.

Dr. Andy Roark:
It’s me and Jonathan Wainberg, who is the general manager and senior VP for Synchrony, which is CareCredit and Pets Best Pet Insurance. So anyway, good episode, good insight, really thoughtful discussion. Guys, let’s get into this.

Dr. Andy Roark:
This episode of the Cone of Shame Veterinary Podcast is made possible ad free by CareCredit.

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, Jonathan Wainberg. How are you?

Jonathan Wainberg:
I’m doing great. Thanks for having me.

Dr. Andy Roark:
Oh man, it’s my pleasure. For those who don’t know you, you are the general manager, senior vice president for Synchrony, which is a company that is over CareCredit, which pretty much everybody in the vet profession knows, and also Pets Best Pet Insurance. So you guys, you do a lot of things with the financial side of money. And so I was thrilled to be able to have you on the podcast.

Jonathan Wainberg:
Yeah, great to be here. Synchrony is a large financial institution. We’re actually a bank and we specialize in consumer finance. And one of our divisions is Synchrony Health and Wellness, which is really the part of this that Pet CareCredit resides in. And like you said, everyone knows CareCredit in the veterinary profession, and CareCredit is really the largest elective healthcare solution for consumers in the US. And just over three years ago, we made the decision to expand our veterinary finance specialty by purchasing Pets Best. And so it’s been just over three years and it’s been a great acquisition and shows our commitment to this space.

Dr. Andy Roark:
Yeah, you guys are really kind of leading the way in helping pet owners afford pet care, really. When we talk about what options are out there and what support there are for them, you guys are kind of, you’re an 800-pound gorilla in that space, which is good. It’s an important space.

Jonathan Wainberg:
Yeah. Listen, I think we’ve been in this business a long time. CareCredit is celebrating its 35th anniversary this year, and we’ve been in the veterinary space for approximately 27 years. And so when you’ve been around that long, people know you and trust you for generations, whether it’d be someone who’s been caring for their pet and using their card over the course of a lifetime of their pet family members, or for that matter if it’s their first time, or over the various lives of your pets.

Jonathan Wainberg:
And then I think the other thing is we’re a work hard that is not just limited to the veterinary channel. You can use it for human health as well. And so it’s very often that someone takes out CareCredit for perhaps something in the dentistry field like orthodontistry for your child. And then you find out, “Oh, this also works in the vet channel.” And so you have that cross-utility.

Jonathan Wainberg:
And so that has enabled us to build a good business. And in my case, provide a great alternative for helping pet parents afford some of those costs that come along in the veterinary channel.

Dr. Andy Roark:
I want to get into some research that you guys put out earlier this year and you guys have a study and it was on pet owners spending. And the title is Synchrony study reveals pet owners spend as much as $55,000 during a pet’s lifetime. And I want to talk to you about this because the study itself is really interesting. I want to lay down the methodology you guys use because I think it’s really well done. I think the findings, I was surprised by the findings to be honest.

Dr. Andy Roark:
And they make sense to me, but even I was sort of backed up a little bit by the numbers that you guys put down. I’ve been thinking a lot about this because we’re seeing changes in vet medicine and we’ve got a lot of student debt for veterinarians and we’re seeing veterinarian salaries rising, which is good. And we’re seeing technician support staff salaries rising, which is good and it needs to happen.

Dr. Andy Roark:
But you can’t look at those things and not also look at where does this money sort of come from and what does this ultimately mean and kind of look down the chain at the pet owner and think, what is care for or what does affordability and access to that medicine look like?

Dr. Andy Roark:
And that’s been a head space that I’ve been playing in a lot. I don’t pet owners largely have an idea of what the financial commitment is to having a pet. And I think that as medicine costs go up and food costs go up and inflation and all those sorts of things, I think it’s less and less true.

Dr. Andy Roark:
I was playing around with my own dog and he’s a three-year-old totally healthy dog. And I started running the numbers and I was like if I just did the basic wellness care on him and nothing bad happened to him, no hotspots, no allergy stuff, no ear infections, nothing, just basic parasiticides. If I said grocery store dog food, I’m still at a thousand dollars plus in maintaining a goofy, totally healthy dog. I don’t think that people recognize that. Do you agree?

Jonathan Wainberg:
Oh, I absolutely agree. I think the study, which we commissioned, which we call the lifetime of care because that’s what we’re trying to ascertain, is what does that cost? And I think there’s several points you hit on which make a ton of sense. I think the first thing is like you, as an expert in this field, and someone who’s in the profession yourself, you don’t realize what you’re spending because you don’t look at it in a one by sample, even if you had a dog that required or a pet that required maybe more care and more medical care than the average.

Jonathan Wainberg:
It’s done in chunks, so you don’t realize how it adds up. And then you see this number that we came up with, not we came up with, that we surveyed 1,200 pet owners and a hundred veterinarians, is as much as $55,000. And that’s a really big number because it’s not all in one shot, number one. Number two, to your point that saying that most people don’t realize it. Our study showed that nearly half of pet parents underestimate that cost of what you’re going to be spending on your pet.

Jonathan Wainberg:
And so you can really see that you’re not alone. And you’re probably on the higher echelon of people that understand this profession, understand the cost. I agree with you a hundred percent. There’s a major issue with veterinarians and student debt and with vet techs. And it’s great to see that hopefully not the debt going up, but the salaries going up and their ability to manage that. That’s a problem in our profession.

Jonathan Wainberg:
And it’s hard because you know better than me as someone really deeply into the profession, the passion that people have for this and the choices that you make. But what I’d say is that the vet industry is no different than things we’re seeing across the economy now, and we’re seeing inflation. And there’s a lot of inflation in the cost of care for the animals, some of it to make up perhaps for the human resources cost. But a lot of it ever also has to do with the demand that veterinarians are under with so many more people having pets and the ability really, it’s the competition numbers.

Dr. Andy Roark:
Yeah. I agree with that. So, let’s lay down some numbers here. The lifetime cost of care, according to the survey, comes down to $20,000 to $55,000 for dogs and $15,000 to $45,000 for cats. And I thought it was also really fascinating looking at just the first year of life, $1,300 to $2,800 for dog owners and $960 to $2,500 for cat owners in the first year alone.

Jonathan Wainberg:
Yeah. And that’s the first year. And I think what we’re seeing is in the first year you’re going to have startup costs. I think everyone kind of understands that and is prepared to some degree, but it’s the stuff that comes later. And even those startup costs are more than you think. Just acquiring a dog and these sort of things that you capture. So yes, the first year expenses, obviously getting the pet, vaccinating it, home proofing it, training it, et cetera. Those are big. But when you start thinking about some of these annual costs, they add up very quickly.

Dr. Andy Roark:
Yeah. I see frustration from veterinarians about financial conversations, because these are not fun conversations and pet owners get emotional about them. I see a lot of frustration from pet owners. I saw an interaction on the internet today and social media is a cess pool. But I was looking and someone had posted and said how dare these veterinarians charge this money for my pet and they couldn’t do it. And someone else had written back and said, “It’s not their responsibility to pay for your pet. You had a responsibility when you took this pet.”

Dr. Andy Roark:
And I don’t endorse communicating that way online at all. I do understand the sentiment of both parties, both the person who’s like, “I was surprised they didn’t have the money, and this is heartbreaking and I’m upset.” And I also understand the pushback from the veterinary professional, who was like, “Hey man, we deal with this all day every day. And we don’t have the resources to just take care of this and absorb the costs ourselves. Even though we would love to, you have some responsibility here as well.”

Jonathan Wainberg:
That is absolutely right. And that’s why with this study and with the kind of financial solutions that we have out in the market, we think it addresses both things. Number one, the study of a lifetime of care is to really educate prospective pet parents about what they can expect in expenses over for caring so that they can prepare themselves financially.

Jonathan Wainberg:
When you bring a pet into your family, there’s responsibility that you need to have before. We think that those costs make sense, and it’s really worth it. We’re not trying to scare anyone. A couple times, people have asked me, “Well, are you trying to scare people from getting pets?” “Absolutely not. It’s the greatest thing to have a pet in your family, but we want you to be prepared before.”

Jonathan Wainberg:
And then on the other part of it with taking it from the veterinarian side, we know that these are not easy cost to absorb. And so what CareCredit tries to do is be able to provide solutions, whether it’d be the CareCredit card, or whether it’d be Pets Best Insurance that allows pet parents to prepare for those expenses, whether expected or unexpected and what we’re hoping is that they are expected, in a meaningful manner. And so that when something happens, they have that ability and the wherewithal to take care of that pet in the manner that it should be responsibly, and then also have great compliance to care because that’s everything.

Jonathan Wainberg:
And I’m sure you know and I’ve heard some of your other podcast that a pet that is taken to the vet more often is able to get their normal checkups and compliance of care is going to be a healthier pet. It’s probably going to be a less expensive pet to, for lack of a better word, maintain over its lifetime.

Dr. Andy Roark:
Yeah. I think you hit on a controversial point. But you and I are in the same camp here. I wish these numbers weren’t true. I wish that it didn’t cost $25,000 to $55,000 to have a dog or $15,000 to $45,000 to have a cat. If I had a magic wand, I would make that not true. I would make it cost a thousand dollars over the lifetime of a pet. And I would go ahead and wipe out that veterinary student debt, and pay the tax a living wage. I would do all those things.

Dr. Andy Roark:
But I think a lot of people say, they look at these numbers and I’ve gotten push back on this because my thought was for a long time, we should tell people it costs a thousand dollars a year to have a healthy dog. And people are like, “What? Why would … Like that’s just off putting?” And I’m like, “That’s true.”

Dr. Andy Roark:
And it’s kind of like when we go in the exam room and we make recommendations, if you don’t tell people the truth, then they can’t make an educated decision. If I don’t say, “Hey, look, this is what it costs to treat heartworm disease. And this is the prevalence in our area. And your pet could die from heartworm disease. Do they really have the information they need to decide whether or not they want to make that purchase? And people say that’s sort of hard. And I sort of say, “Well, I want to give them the truth and help them to make the best decision.”

Dr. Andy Roark:
And I think that these numbers kind of fall into that same category of, “I wish this wasn’t the case. I wish I could tell you that heartworms aren’t going to hurt your dog, and that you can just give your dog some Benadryl for allergies and they’ll be fine.” But that’s not true. And the same thing is to say, to not set the expectation of this is what it costs, I don’t think that’s productive in the long term.

Dr. Andy Roark:
When we talk about angry clients, one of my favorite sayings is people don’t get mad about what you give to them. They get mad about the difference between what they got and what they expected to get. And so I think that even just setting the expectations, if people expect, “Yep, I am making this commitment and yep, it’s going to be expensive,” those conversations are a whole lot easier than then just being blissfully naive about what medicine costs. And they walk in with $300 and get their doors blown off.

Jonathan Wainberg:
Yeah. I think it’s important that we get through them in multiple channels. Obviously, the veterinary profession is going to be the one that … I hate to say the word bears the burden of this, but that’s the truth because you guys are the most trusted in the industry. Yeah, we could publicize these stats and go out there, but we’re never going to reach the 30 million US households, is what our study shows will face an unexpected pet expense.

Jonathan Wainberg:
There’s no way we’re going to get them. So you guys on the frontline are the ones that are going to have to bear of that. But also it’s the shelters that need to be kind of telling people, “Hey, it’s great that you’re adopting this pet. We love that you’re taking it,” but hey, with that comes a responsibility, same thing with breeders and just the general industry as a whole.

Jonathan Wainberg:
And that’s why we did our part to message this study. This isn’t a commercial for CareCredit or Pets Best. Really, but we would make it a lot sexier, yeah, exactly. Maybe we would have the Bruno Mars sing the results. But I think it’s something that we want to get out there because we know that this is such a critical part of the industry.

Jonathan Wainberg:
And what we’re trying to do at the end of the day is yeah, sure, we’re in the business of providing healthcare and financial solutions in the healthcare space. But what would be much better for everyone is if they know beforehand what they’re getting into and are able to prepare for it in an orderly manner so that they’re not surprised and have to make tough decisions like, “Hey, do I have to pay this bill or make my car payment?” We don’t want anyone to be in that position.

Dr. Andy Roark:
Yeah. I completely agree. The first time you end up at the emergency clinic and it’s $1,500, $2,000. That’s just like people’s heads explode. They hadn’t seen it coming. So that brings us to the actionable part of this. And actually, this is what I really want to talk with you about. What does a world look like where expectations like this are set? What do we do as medical professionals to try to bring this awareness to pet owners?

Jonathan Wainberg:
Listen, you have to hit people in on it in a, “Don’t hit anyone. This isn’t the Oscars.” You need to explain to people as much as possible and it has to be multiple times, especially for those first time pet owners. I think, we try as best as we can at whether it’d be pet adoption or that first puppy visit with the vet to talk about … That’s a great place to talk about pet insurance because you’re also getting the pet insurance at the best time for your dog or cat, because that’s when it’s going to be the most cost efficient if there’s not going to be preexisting conditions. And your premiums, you’ll get in at the right time. That’s just the way it works. The younger pet is going to be more affordable.

Jonathan Wainberg:
And so that’s one of the things where we at Pets Best try to certainly get adoption, and I think I’d say across the industry in that space. And in CareCredit also, we try to make it easier, as easy as we can because we don’t want you guys having that conversation. You’re so busy as it is, right? So we develop QR codes. We develop tags that say, “Hey, have this. We have educational videos.” But at the end of the day, there’s only so much that could be done virtually without that human touch. And you are the ones in the practice that are dealing with that kind of stressed out pet owner who is having to make that decision.

Jonathan Wainberg:
And yes, there’s certainly a lot of education we could do beforehand. But I think ultimately, there’s only so much that you can do to prepare someone for what is an unfortunate surprise when it comes to costs. And if you think about it in the US, it’s not like we’re much better in human health. People are not prepared for that. So I’d like to say, it’s something that’s unique to the pet industry. But the truth is it isn’t, and it just makes it harder because pets don’t speak and can’t tell you how they feel.

Jonathan Wainberg:
And so they can’t … Your guys are trying to translate two things, not just the cost, but how do you know that pet is feeling that way? And is this going to work or is this not going to work without being able to communicate verbally?

Dr. Andy Roark:
Right. And I think you make a good point about the vet professionals bearing the brunt, because I would add to that and say the emotional brunt of like, “I have to stand in the exam room and talk to people about the hard decisions they’re making and what things cost. And I don’t like that. And my technicians don’t want to bear that.” There’s an emotional toll, especially when you talk about, it’s not convenience euthanasia but financial euthanasia, things like that where people are … I mean, that takes a toll on me as well.

Dr. Andy Roark:
And so things that we can do to reduce that, the number of times I have those interactions, I’m all about that. I don’t think that there’s a magic formula that makes financial conversations go away. I do think that there are things that we can do systematically that reduce the number of hard conversations that we have in a sort of multimodal approach. And I think that we should be looking at those things.

Dr. Andy Roark:
When I look at this, I think that you’re right too. I don’t know what a high level spreading of this message looks like. Is it the AVMA’s place to sort of say to people, “Hey, by the way …” I don’t know that they would go for that. I don’t think that’s really the image that they want to have, but I do think it might help.

Dr. Andy Roark:
But I mean, is it time to come up with a graceful way to talk about financial planning for your pet at the puppy visits? Should we have resources when new clients come in and just sort of say, “Hey, these are things that we mention to people and try to start to put forward right from the very beginning”? And these can’t be one time conversations. People come in, they’ve got a new puppy, a new kitten, they get a whole folder. They get a whole truckload of information and they don’t retain 90% of it.

Dr. Andy Roark:
It needs to be a consistent message of, “Hey, this is important. Hey, you need to be thinking about that.” And I think that that’s an area that we as a profession, we have to work on like how do we communicate that? What do we say? How do we talk about in a way that normalizes the financial conversation around veterinary medicine?

Dr. Andy Roark:
Because I love the reputation that veterinarians have and sort of the James Herriot culture that we have, but it’s a double edged sword. And the downside to people saying, “Oh, the veterinarians, I love you guys. You have the biggest hearts. You’re the kindest people,” is that that can set us up to be the bad guy when we’re not able to deliver what this person wants just because we love pets. And I think a lot of us see that of, we enjoy the benefits of that reputation, but then we also take a beating from it.

Dr. Andy Roark:
My brother’s a lawyer and no one’s like, “I can’t believe that you charge for your services.” He’s a lawyer. They totally believe he charges for services. And I’m not saying that we should be lawyers, but I do think … No one’s advocating that.

Dr. Andy Roark:
But I do think that there is a middle path of saying we do care and we are compassionate. And you need to be aware that this is the landscape that you deal in, and that these are your options. Also, if you are breaking the news about what medicine costs to a pet owner at the time that they need financial resources, that’s a nightmare conversation. If they can get that message before they need it, then at least it’s not new information. They come in going, “Oh my gosh, I don’t know how I’m going to pay for this.” That’s a whole lot easier conversation than, “I can’t believe that this is what the bill is. This is outrageous.”

Jonathan Wainberg:
Yeah. I think two answers on that. On the languages and the do’s and don’ts as it comes to financial, we did do something with the AVMA to train veterinarians. And we do spend a lot of time because it isn’t … First of all, it isn’t a natural thing. They’re not trained to be in a business. Yeah, some of the office managers perhaps, but they’re doing something that they’re passionate about and it is hard to kind remove yourself and go back to the bottom line. So, I’m empathetic to the veterinarian who is looking at that pet and trying to figure out any which way to get them that care, even at their personal expense.

Jonathan Wainberg:
Now, with that said, the profession, as you said, as much debt as people are in and as much as we think that that cost of healthcare for our pets is high, it really probably isn’t at the level where it should be. And that’s where we as CareCredit want to be able to help. We want to take that conversation away by saying, “Okay.” And we will serve to some degree, I don’t want to say the bad guy in that space, but we’re the bank. That’s what we’re prepared to do. We’re the one who’s going to be able to lend the money. And we’re the ones that are able to have that harder conversation.

Jonathan Wainberg:
And what we try to do is take that as much as we can that conversation away from the vet by somebody’s self-service tools that we’ve developed. But also as a veterinarian shouldn’t be having receivables on their account from Dave Jones’s poodle, right? It should be … No one wins with that, right? And so that’s something that we got to, as a profession, kind of get away from because it just doesn’t make sense for anyone in the whole ecosystem.

Dr. Andy Roark:
Yeah. I agree. So I’m going to put a link to the survey in the show notes so everybody can see that. Definitely, it’s very brief. It’s well put together. You guys check it out. It’s a lot of food for thought. Jonathan, where else would you send people? So if some people are sort of sitting and processing this and they want to increase the financial education that they’re able to provide to clients, things like that, what resources would you point them to?

Jonathan Wainberg:
I think on the carecredit.com site, we have a lot of learning and knowledge that can talk about that. And I think that’s something that you will get on that page. We have a special page that talks about that and talks about various expenses and costs that you have. You’re going to put a link into the lifetime of care study so that the people are prepared. We did a language of financial expenses with AVMA and those tools are available as well.

Jonathan Wainberg:
And I’d say if you’re someone who already accepts CareCredit and wants to learn more, we have resources and training available for all our providers in that provider network, and anything we can do in that space. Costs are going up. In 2020, they said there was $104 billion spent in the pet industry in the US. 2021, I just saw it came out at $123 billion. It’s almost 20% up. It’s going one direction.

Jonathan Wainberg:
And whether it’d be … It’s not just inflation, a lot of it is population, and that’s great. And a lot of it is also people investing more in their pet. We talk about the humanization of pets, but people are treating them at a different level of treatment in that family than they did in the past. And so people, it’s great to see that. But with that cost go up and you’re seeing that overall in our studies’ results.

Dr. Andy Roark:
Yeah, exactly. And well in the study, it says 7 out of 10 pet owners consider their pet as part of the family, just to your point. So anyway, I’m going to go ahead. I’ll put links to the survey in the show notes. I’ll also put links to CareCredit, and then I’ll also pull up the language of financial expenses that I think that’s a great resource. I’ll link all that stuff in the show notes. Jonathan, thank you so much for being here. I really appreciate your time.

Jonathan Wainberg:
Oh, no. It’s a delight.

Dr. Andy Roark:
And that is our episode. Guys, I hope you liked it. I hope you got something out of it. I hope it gave you something to think about. I think this stuff is really important. And again, it feels icky sometimes to talk about the numbers and talk about what pets really cost. But guys, we got to be honest with people and they need to know what they’re getting into. And so we need to start thinking about how to make pet owners more aware, just so they know what they’re signing up for. I think it’s only fair.

Dr. Andy Roark:
So guys, that’s it. That’s what I got. Thanks again to CareCredit for making this episode possible ad free. Guys, take care of yourselves. Talk to you later on. Bye.

Filed Under: Podcast Tagged With: Life With Clients, Medicine

Dentistry Pain Control When Cost is A Challenge

May 18, 2022 by Andy Roark DVM MS

Dental procedures are expensive, and pain control is non-negotiable. How do we do right by our patients while working within the budgets of pet owners? The original anesthesia nerd Tasha McNerney is on the podcast today with FANTASTIC advice on how to do exceptional pain control without breaking the client bank! Let’s get into this episode!

Cone Of Shame Veterinary Podcast · COS 138 Dentistry Pain Control When Cost Is A Challenge

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

LINKS

International Veterinary Academy of Pain Management: https://ivapm.org/

Book: Small Animal Regional Anesthesia
https://www.amazon.com/Small-Animal-Regional-Anesthesia-Analgesia/dp/0813819946/ref=sr_1_1?keywords=small+animal+regional+anesthesia+and+analgesia&qid=1649161001&s=books&sprefix=small+animal+regional+anesthesia%2Cstripbooks%2C97&sr=1-1

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

Retain Your Team: Languages of Appreciation in your Workplace
https://unchartedvet.com/product/appreciation-languages-101/

Creating Content that Clients Crave
https://unchartedvet.com/product/creating-content-that-clients-crave/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Tasha McNerney obtained her CVT in 2005 and has worked clinically in the areas of anesthesia and surgery ever since. Tasha obtained her CVPP (certified veterinary pain practitioner) designation in 2013 and became a veterinary technician specialist in anesthesia in 2015.

Tasha has been a featured speaker on various anesthesia and pain management topics at several international veterinary conferences. Tasha is the author of many articles and blogs on anesthesia and pain management related topics.

In 2013 Tasha created the Facebook group Veterinary Anesthesia Nerds, which has over 65,000 members taking part in education and exchange of ideas from all over the world!

Tasha is crazy and bought a 1920’s fixer upper and is now obsessed with home improvement tutorials on YouTube. She lives in Philadelphia with her husband, son, one perfect cat, and one jerk cat. Trust me that cat is a jerk.


EPISODE TRANSCRIPT

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

Dr. Andy Roark:
Welcome, welcome, welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with my good, dear, awesome friend, the one and only Tasha McNerney, a.k.a. the original anesthesia nerd. She’s a VTS in anesthesia, she is a fantastic lecturer, she is hilarious, she is one of my favorite people to talk to. And her last episode with me when she was on the podcast, we talked about analgesia for blocked cats. And it was very popular, because it was very good.

Dr. Andy Roark:
Guys, this is an equally good one. Dentistry pain control when cost is a challenge. That’s right. Money is a real thing and pet owners struggle with it. And also pain is a real thing, and pets getting dental procedures struggle with it. Let’s talk about cost effective management for that 11-year-old Yorkie who’s got trench mouth and whose owner has a fixed income. Guys, this is a great episode. I hope you’ll get a ton out of it. Let’s get into it.

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

Dr. Andy Roark:
Welcome to the podcast, Tasha McNerney. Thanks for being back with me.

Tasha McNerney:
No problem, thanks for having me. I love talking about anesthesia stuff.

Dr. Andy Roark:
You are so amazing. You and I have been friends a long time. How good of friends are we? The last text message you sent, do you remember it?

Tasha McNerney:
Oh yeah. I have to share this with the world. This is amazing.

Dr. Andy Roark:
I was just minding my business, then I got a text from you that said, “If you call this phone number, they will play Hall & Oates music.” And I did. And it’s real. There’s a-

Tasha McNerney:
It’s real.

Dr. Andy Roark:
It’s a real phone number that you just call.

Tasha McNerney:
And it’s Callin’ Oates, so you can call in and hear whatever song you want from Hall & Oates.

Dr. Andy Roark:
Callin’ Oates. But for those of you at home who are just like, I don’t believe this is true. It’s 719-26-62837. That’s 719-26-OATES. And if you call that phone number, they’ll be putting Hall & Oates. That’s the type of communications I get from you. And that’s why we’re such good friends.

Dr. Andy Roark:
The other reason we’re such good friends is because you’re brilliant. And because you are a VTS in anesthesia and because you are super down to earth, real world, you have worked in private practice almost your whole career. You did some lab animal stuff for a little while, but for the most part, you have been a private practice teacher and technician. And so you know how it really is. So anyway, I have a case that I would like your very specific set of skills on, if you don’t mind.

Tasha McNerney:
I can do it. Let’s go.

Dr. Andy Roark:
Yeah. They can’t see you nodding your head on the podcast.

Tasha McNerney:
I was trying to think of like have fun like Liam Neeson taking jokes to put in there, but I really couldn’t come up with anything.

Dr. Andy Roark:
That’s what I was going on. See-

Tasha McNerney:
I was like, “Oh, what?” I was trying to think about Taken 3, which actually my husband and I were surprised that they made a Taken 3. Like how many times can you get taken before you know you’re going to be took? I don’t just think … And I love Liam Neeson, but I feel like he really should have been more prepared for this.

Dr. Andy Roark:
Well, I agree. One of my favorite pieces of business management advice is if there’s something that you’re surprised by again and again, at some point you’re not surprised by is your business model. And I would say that to Liam Neeson. You need to take care of this and stop acting surprise when people take your children.

Dr. Andy Roark:
Let’s do this medical thing. I have got an 11-year-old female spayed Yorkshire Terrier named Tinkerbell. She is very loved by her elderly owner. And you can imagine her. She is your older Yorkie, she’s just … Look at her, look at her in your mind’s eye. She’s trembling, and she has trench mouth. She has a nasty, funky mouth that cannot be ignored. Mom loves her to pieces and has really been afraid of anesthesia for a long time, which is why we’re kind of in a hole here as far as her dental health and things like that.

Dr. Andy Roark:
Mom’s also on a fixed income. And so she has limited resources to spend here. So I have a significant dental procedure in front of me. And I want to make sure that Tinkerbell is comfortable. Pain management is going to be really important for me and I’m working under financial constraints. And so let me put it to you like that and say, “Tasha McNerney, how do you treat this?”

Tasha McNerney:
Yeah, this is a good one because I feel like this happens all the time in private practice. In fact, it happens at university level too in their dentistry departments. It happens all over because people are scared of anesthesia and I totally get it. If you were, I mean, I knock on wood have only had a couple of anesthetic experiences in my life, but I have to tell you, even though I know so much about anesthesia and very comfortable with it. It’s scary, right?

Dr. Andy Roark:
Yeah. I get it.

Tasha McNerney:
For this patient in particular, we have to look at, if our finances are really limited and we know we’re about to do multiple extractions, how can we provide the best experience for this patient and make sure analgesia is taken care of without breaking the bank. And there’s some ways that we can do that certainly. I think one of the first things is you have to look at what’s in your anesthesia, your analgesia spice rack at your clinic.

Tasha McNerney:
So if you have options, that’s going to be a little bit easier. Certainly, we can say, “I, Tasha McNerney, as anesthesia nerd, I love fentanyl and I love methadone. Those are really great analgesic opioids that I can choose for my patients. But if I’m looking at it purely from a cost perspective, then I have to maybe look at, “Oh, could I potentially utilize something like hydromorphone instead for this patient?” That’s going to be a little more cost effective of all my pure mu opioids. And yeah, hydromorphone would be a really good opioid for this patient.

Tasha McNerney:
Now let’s say in clinic, you don’t have access to any pure mu opioids. Either your clinic doesn’t utilize them or buprenorphine is maybe the strongest opioid you have. Well, that’s fine too. If buprenorphine is the strongest opioid you have on your shelf, then let’s use that. But from a cost perspective, yes, I would maybe not utilize the methadone in this patient because I know dollar per mil is going to be more expensive than something like hydro.

Tasha McNerney:
So let’s just say I’m utilizing hydro for this patient. And now, I don’t want to just give a huge walking dose of hydro to this patient. I don’t know what other comorbid disease it has, but if it’s an 11-year-old Yorkie that has a really, really diseased mouth, we know that it probably has some degree of infection going on, inflammation going on. Let’s just hope that it doesn’t have any cardiac issues going on.

Tasha McNerney:
Well, maybe we have an echo in the previous past, but because we are financially limited, probably you don’t. If you have the ability to, if the dog is amenable to it, I would suggest that your staff at least get a pre-op ECG and blood pressure on this patient. Any of those things that you can get beforehand are going to make it a lot easier for you intraoperatively and how to manage that case.

Tasha McNerney:
So if you notice that this patient’s normal resting heart rate is 162, or if you notice that it’s 82, that’s going to kind of guide where you’re going to go with your drug selection, your inhalant, maybe your blood pressure support, et cetera. Also, if you know any murmurs or anything like that, again, all of these things are just really nice to know before we start layering in a bunch of drugs.

Tasha McNerney:
If it is a smaller Yorkie, 11 years old, I feel like I say this a lot. I love dexmedetomidine, but this is probably not the dogs that I would go dexmedetomidine with only because I hate to be a breedist. But if it potentially has any cardiac or mitral valve disease underlying that we don’t know about because we haven’t followed it or got an echo, I don’t want to make things worse with dexmedetomidine.

Tasha McNerney:
So this is probably not a dog I’m going to hit with dexmedetomidine, which from a cost perspective that’s okay because dexmedetomidine, again, one of our more expensive dollar per mil drugs. So I’m probably going to go with something a little bit more cost effective, maybe a small dose of midazolam for this patient followed by my induction agent.

Tasha McNerney:
Now, we have a couple choices for induction agent. You can have alfaxalone. I know a lot of clinics are utilizing alfaxalone, or you can utilize propofol, which a lot of clinics are using propofol. Both really great drugs and both have a pretty nice safety profile when utilized correctly in the correct dose mg/mL. However, there are some studies, there were some claims that alfaxalone is going to be better as far as apnea or hypertension.

Tasha McNerney:
But what we found is that there really isn’t that much of a difference between alfaxalone and propofol when it comes to overall hypertension, if you’re using it within the dose range. So again, because of a cost per mil for this patient in particular, I’m trying to be cognizant of cost. I would probably choose the propofol, and be as low with my dose. Just get them induced and then get them on inhalant.

Tasha McNerney:
Now this patient in particular, we know has a trench mouth and it’s going to be a lot of extractions. This is where your local blocks, right? So if bupivacaine, lidocaine things that are very cost effective, this is where your analgesia heavy lifting is going to be done with the local blocks. So instead of putting this patient on maybe an expensive fentanyl CRI or something like that, you can do local blocks or four-point local blocks in the mouth and that’s going to cover everything.

Tasha McNerney:
So if you had to do even full mouth extractions on this patient, if you’re doing both of the mandibular and maxillary blocks that you should be doing on these patients, and let’s say your practice doesn’t even have bupivacaine, you only have lidocaine, great, utilize your lidocaine. That’s going to give you a couple hours of pain free. You’re then going to be able to keep your inhalant turned down.

Tasha McNerney:
And when you can keep your inhalant down and your oxygen down, that’s going to be cost effective for you as a clinic. So anytime you don’t have to have cranking high levels of oxygen, high level of inhalant, that’s going to be better overall, not only for our patient, but for our finances.

Tasha McNerney:
And then intraoperatively, if you feel like this patient still needs a little bit of bump of something and this patient is not a hypertrophic cardiomyopathy cat, we know it’s a little Yorkie, this is where a low dose ketamine CRI can be really nice for MAC reduction. Again, to keep your inhalant low, ketamine is very, very cost effective. So, a little bit of ketamine can go a very long way.

Tasha McNerney:
You can put your ketamine either into a bag and run it on a pump or into a syringe and run it on a syringe pump. But you can do a low dose ketamine CRI to reduce your inhalant, increase your analgesia. So those two things together, local blocks, low dose ketamine CRI, very, very cheap but very, very effective when it comes to analgesia and reducing the amount of inhalants.

Tasha McNerney:
And then as the patient’s waking up, then it’s kind of dealer’s choice how they do under anesthesia, and what their blood work shows, whether or not the clinician wants to add in the nonsteroidal anti-inflammatory.

Dr. Andy Roark:
Okay. I like it.

Dr. Andy Roark:
Hey, everybody. I just want to jump in real quick with a couple of updates. This week over on the Uncharted Veterinary Podcast, which is the other podcast I do with the one and only Stephanie Goss, I’m not on that episode. Stephanie Goss is talking about information security. Are you storing data in your practice like you’re supposed to? Guys, this is not an area where you want to get burned. If you are not up to date or you’re kind of feeling like, “Ooh, I should probably listen to that,” head over to the Uncharted Veterinary Podcast and check it out.

Dr. Andy Roark:
Uncharted Workshops coming at you, guys, on May the 21st, which is just a couple of days after this episode comes out at 2:00 PM Eastern, 11:00 AM Pacific. Stephanie Goss, she is teaching our workshop, retain your team, speak the languages of appreciation in your workplace. Guys, you’re trying to get your team motivated. You’re trying to keep morale up. You’re trying to keep people engaged. You want your team to stick around to enjoy the work that they’re doing and to feel like they matter to you and to the patients.

Dr. Andy Roark:
Guys, are you talking about appreciation in your workplace? Are you doing it effectively? If not, jump in. This is a little bit higher level. We had an entry level appreciation workshop. This is a bit more down into the nitty-gritty. I think people can get a lot out of it. It is $99 to the public. It is free to our Uncharted members. I’ll put a link down in the show notes below.

Dr. Andy Roark:
On June the 8th, my friend, Bill Schroeder, veterinary marketing specialist, CEO of InTouch veterinary marketing, he is going to be doing his lectures. It’s not lectures, a workshop, called Creating Content That Clients Crave. This is all about you spending your time smartly to make resources that educate clients, that answer questions, that protect your reputation, that do all of the things that you wish you had content for but you just don’t have all the time in the world to make.

Dr. Andy Roark:
Most of us are spending too much time doing things like posting stupid social media stuff. Guys, it’s time to get a strategy. It’s time to get smart about how we communicate digitally. Bill Schroeder is the guy to do that. It is $99 to the public. It is free for Uncharted members. Guys, both of those things are coming up. I’m going to put links of both of them in the show notes. Let’s get back into this episode.

Dr. Andy Roark:
Give me give me any pearls you have, any words or advice on the ketamine CRI. I know there’s a lot of people out there who kind of draw back a little bit from CRIs. I think it’s still one of those things. It’s become a lot more common, but I still think a lot of practices are just intimidated. When you say CRI, I think a lot of technicians, a lot of doctors kind of go, “I don’t know, it’s kind of scary.” Make it seem less scary to me.

Tasha McNerney:
Oh, sure. So I think when most of us when we think of CRIs, we think back to when we were in vet school or tech school and we were at universities. And we were seeing these animals that are on what we call like the tree of life, where they’re on multiple CRIs because their state is so critical that they have to be on fentanyl and lidocaine, and dopamine and norepi and something else and plasma. So, we’re not talking about that.

Tasha McNerney:
We’re just talking about adding in a little bit of extra pain control to make the procedure go smoother overall. And the only reason I’m talking specifically about ketamine in this one is because if we look at overall cost effectiveness, now I could say that a lidocaine CRI would also be a very cost effective. But for this patient in particular, I think a ketamine CRI is a nice adjunct analgesia-wise. Cost per mil, very, very effective. And it doesn’t require that you have to have a syringe pump.

Tasha McNerney:
So most of the time, they’re also thinking, “Oh, well. I don’t have a syringe pump. I only have my regular Baxter pump. I can’t run something as fancy as a constant rate infusion.” But you can add a small amount of ketamine to a 250 or a 500 ml bag of saline and figure out the math. I know the math is intimidating, but don’t worry. There’s lots of CRI calculators online that can help you with this.

Tasha McNerney:
The International Veterinary Academy of Pain Management or ivapm.org, if you go to their website or even the website on your phone, they have CRI calculators where you just punch in the patient’s current weight and what dose you want the CRI to be run at, and they’ll give you the mils or volume per hour that you should put into your Baxter pump.

Tasha McNerney:
So, don’t feel like you have to have a syringe pump in order to make this work. You don’t. You can just have, as long as you have some ketamine, a bag of saline and a Baxter pump, we can run this into our patient. And we’re just talking a low dose ketamine. So, low dose ketamine is also different because I know sometimes people kind of like, ugh, cringe a little bit with just the thought of ketamine because we have these ideas of 10 years ago when we were using much higher doses of ketamine. And we know that higher doses of ketamine, higher doses really of anything are going to cause higher incidences of side effects.

Tasha McNerney:
But in ketamine in particular, ketamine, once you get into the higher dosing range, it goes from analgesic to anesthetic and it has more of these central effects that we see. And I think that people were, and rightly so, I think a cat in a really high dose of ketamine can be kind of scary thing to watch, and they usually don’t have the best recoveries. That’s where that ketamine crazies saying came from, was really high dose of ketamine.

Tasha McNerney:
When I’m talking high dose, I’m talking about like 15 to 20 mg/kg, so like these big doses of ketamine, which we don’t tend to use anymore. And when we’re talking about analgesic doses of ketamine, we’re talking about 1 mg/kg make, 2 mg/kg maybe, so smaller, smaller doses. We’re not seeing the same type of side effects we used to in the past.

Dr. Andy Roark:
If I have doctors or technicians that want to brush up on their dental blocks, do you have resources you would point people to that say this is a good review of your blocks?

Tasha McNerney:
Yes. So for dental blocks in particular, I am a book reader. So if you like to read books, and actually if you’re interested in local blocks in general, there’s a really good textbook of regional anesthesia in the small animal patient. And I believe it is by Campoy and Read, Campoy out of Cornell. And I’m pretty sure that I got my copy on Amazon, but it goes through every single local block that you could think of from epidurals, to ring blocks if you had to take a toe off of a patient, to sacrococcygeal blocks if you had to do a tail amputation, to all of the dental blocks.

Tasha McNerney:
And there’s a bunch of different dental blocks that we can utilize. And I think there’s also a really cool thing about dental blocks that we also sometimes don’t think about, is that they don’t actually only have to be for dentistry. So sometimes, we will utilize an infraorbital block bilaterally if we have to go in and take a tumor off the nose, or if we have to do a rhinoscopy or something like that. So, they’re not just for dentistry.

Tasha McNerney:
I always tell people that, again, local blocks are going to do a lot of your analgesia heavy lifting during the surgery because we could just put our patients on 5% ISO and kick back and they’re not going to move. But that’s not really balanced anesthesia or analgesia. We want to make sure that we don’t have the patient on 5% ISO, that we have them on low ISO, and we’re doing a lot of local blocks to take care of those pain signals going to the brain.

Tasha McNerney:
And if you can utilize a local block for every single patient, whether it’d be a tooth extraction or a radius-ulnar fracture that’s coming in, to a skin incision, laceration repair, so there’s a local block for everything. And if we’re talking about lidocaine in particular, it’s very, very, very cheap way to provide pain management.

Dr. Andy Roark:
Perfect. That’s fantastic. I will put links to the book and then also to the CRI calculators down in the show notes. Tasha, thank you so much for being here and doing this with me. Where can people find you online? Where can they follow all the stuff that you’re doing? Because you’re doing a lot of things.

Tasha McNerney:
Yeah. We are doing a lot of things. So, I am most active on the Facebook group, Veterinary Anesthesia Nerds, and also on our website. So if you ever have any questions, hit me up on Anesthesia Nerds or send us an email through the website. Also, the Veterinary Anesthesia Nerds are kind of like going on tour together. All three of us administrators are … I know. We are going to all be present at the Fetch Conference that’s happening in Charlotte, North Carolina.

Tasha McNerney:
And then we’re also going to be present at the one that’s going to be in San Diego this year. So kind of East Coast, West Coast opportunities to do some stuff and talk about how we can elevate the standard of care for anesthesia patients.

Dr. Andy Roark:
Veterinary Anesthesia Nerds coast to coast is what I’m hearing. So good. Awesome. Well guys, thanks so much for being here. Tasha, thanks so much for being here. I always appreciate your time.

Tasha McNerney:
Yeah. Thanks so much for having me.

Dr. Andy Roark:
And that’s our episode. Guys, I hope you enjoyed it. I hope you got a ton out of it. If you did, please feel free to leave an honest review wherever you get your podcast. It really makes a difference to me. It’s how people find us. It’s the nicest thing that you can do when it only takes a moment. Gang, that’s all I got. Take care of yourselves. Be well. I’ll talk to you soon. Bye.

Filed Under: Podcast Tagged With: Medicine

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