Medicine

Dr. Taryn Pestalozzi, DVM, residency-trained in Nutrition, joins the podcast to talk about how she approaches difficult pet weight-loss conversations. Dr. Pestalozzi and Dr. Roark discuss the case of an obese Labrador Retriever named Greta, and how best to handle her care. As a veterinarian who practiced in GP for 7 years before running the Healthy Weight Clinic during her internship at Kansas State University’s Veterinary Health Center, Dr. Pestalozzi has fantastic and practical insight on how to motivate pet owners to make real changes for the sake of their best friends.

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LINKS

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

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Hill’s Body Fat Index Tool

World Small Animal Veterinary Association Nutrition Toolkit

Association for Pet Obesity Prevention

Pet Nutrition Alliance Calorie Calculator

Ohio State RER Calculator

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Taryn Pestalozzi received her bachelor’s degree from Smith College in 2008, before graduating with her DVM from Oregon State University in 2013. Dr. Pestalozzi was a general practitioner in the Portland, OR metropolitan area for 7 years before completing a clinical nutrition internship at Kansas State University’s Veterinary Health Center, where she managed the Healthy Weight Clinic. Dr. Pestalozzi recently completed her clinical nutrition residency at UC Davis Veterinary Medical Teaching Hospital.

EPISODE TRANSCRIPT

Dr. Andy Roark (00:07):
Hello and welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one for you. Today is on mastering weight Management. This is super mega practical, what to say and how to say it. Podcast, I have got Dr. Taryn Pestalozzi here. She is residency trained in nutrition. She’s a joy to talk to. She is super practical and pragmatic, which I really love. She’s got great advice for setting up these weight management conversations in a way that actually get results and help us convince pet owners to make the steps they need to make to take care of their pets. Anyway, you are going to probably get some affirmation for things that you do out of this, you are also going to get some tips and tricks for things that you don’t do or ways to have these conversations that you haven’t had.

(00:55):
I am really big on this. I love it when we get insights on things that we do a lot of because little tweaks in those behaviors make a huge difference because we do ’em all the time. And so anyway, this episode is really good and it’s really useful. I think you guys are going to really, really like it. I have to say thanks to my friends at Hill’s Pet Nutrition for making this episode possible ad free. And I also have to say thanks to ’em for their Hill’s Veterinary Academy. Guys, if you have not checked out the Hill’s Veterinary Academy, it is a fantastic learning platform that Hill’s is putting out and they are steadily growing and expanding and it is packed full of good stuff for training your team. It’s got free RACE CE in there. There’s so much that’s going on and they’re really putting a lot of effort into it. So anyway, if you are not familiar with the Hill’s Veterinary Academy, I’m going to put a link down in the show notes. You can give it a Google if you want to go that way, but check it out. Go see what they’re doing. This is really just a neat little gift through our profession. So anyway guys, that’s enough of that. Let’s get into this episode.

Kelsey Beth Carpenter (01:55):
(singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark (02:12):
Welcome to the podcast, Dr. Taryn Pestalozzi. How are you?

Dr. Taryn Pestalozzi (02:16):
Good. Thanks for having me.

Dr. Andy Roark (02:17):
Oh, I am so glad that you’re here. I am looking forward to this. So, what I wanted to talk to you about today, so when you did your internship, you did your internship at Kansas State and you ran the healthy weight clinic there and I see a lot of very heavy pets. I saw a cat that was rapidly gaining weight last week and it bothers and this is a passion of yours. It’s something you have a lot of experience in. I just want to run through a healthy weight campaign with you today and just be like, alright, tighten. Let’s tighten the bolts down here and I want to make sure that I’m running a program and then I can carry this out and I want to get weight off of pets and so are you okay to run through a case with me and just start to finish and get me set for success?

Dr. Taryn Pestalozzi (03:22):
That sounds great. Let’s do it.

Dr. Andy Roark (03:24):
Let’s do it. I have got a 100 pound female spayed chocolate Labrador named Greta. So Greta is eight years old and those hips ain’t what they used to be. Sure not. And I can see it. I can see that the muscle mass in her back legs is not what it used to be. And owners are not reporting mobility issues. She’s not, her gait doesn’t appear to be, you don’t see her walking going, oh boy, but she’s eight and I can see that when I look into my future scope where I look ahead a year or two. And so this dog is probably 20 pounds overweight. I think she should be, honestly, if I’m really serious, she should probably be a 75 pound lab, but she’s a hundred. I could be okay. I think if she’s 80, I have to see it. You know what I mean? And you go,

(04:23):
I think 80 is about right. I have to see it, but I need some help in this. And I think that I can get the owners motivated, they love this dog. I think I can make a solid pitch for the lack of mobility that’s coming down the pipes and I want to really push and so I have not gone into this room yet, but I want you to help me. That’s how the table is set. Taryn, how do you treat this case? Where’s your head at when you’re standing outside this door to the exam room getting ready to go in?

Dr. Taryn Pestalozzi (04:55):
So I think the first thing is maybe keeping in mind maybe these owners haven’t come to see you for this problem. They’ve brought Greta in for her annual exam. Yeah, she’s in needs. So it can sometimes take people off guard when you bring up a topic and you get really fixated on that that they weren’t really coming to talk about. So first thing I think is to not forget your primary reason for the appointment. And if you need to schedule a follow-up to actually spend more time talking about the weight loss, do that. But then also consider asking permission to talk about her weight. Be thoughtful with your language. Don’t use fat humor. There was a consensus statement that came out of the UK between medical professionals and the human medical side and patients from obesity programs that talked about what kind of conversations and language are useful. So some of those tips are coming from that consensus statement sort of extrapolated that to our veterinary friends. So just be mindful that as you go into have this conversation.

Dr. Andy Roark (05:53):
Okay, talk to me a little bit about asking permission, right? Give me some language. I know we’ve had a lot of doctors who, and there’s a lot of technicians that are coming in and taking a history and they know that I’m going to come in and talk about the weight and it would be helpful to me if they could open this conversation up. So give me an example of what that, asking permission, I get the concept, what does that sound like?

Dr. Taryn Pestalozzi (06:12):
Yeah, I would start with an open-ended question probably. So asking the client how do they feel Greta’s doing overall? Do they have an idea of where they think she is in terms of weight? Do they think she’s a healthy weight? Do they have any concerns that she might be over or underweight? And that lets you also assess maybe where they’re at with that topic and then ask them, do you mind if we spend some more time talking about this today? I think I have some concerns.

Dr. Andy Roark (06:40):
I really like that question of do you have any concerns about her being over or underweight? It feels like a standard sort of form question and it’s not a judgment question. It feels like I’m taking a history or I’m filling out my form and it helps me know really quickly do they see it or are they blind to it? And we’ve seen, I mean I literally had a case just like this one chocolate lab a hundred pounds and the owners just could not see it. And I was showing them the body condition out and they didn’t get, that was rare. Definitely happened. I still remember it. They were just like, Nope, she looks like a five of nine to us and I’m just going, we’re not looking at the same things.

Dr. Taryn Pestalozzi (07:19):
Yup.

Dr. Andy Roark (07:19):
Anyway, a great question. Alright, I love it, Taryn. That’s super helpful. Alright, great. So I get get this conversation, get permission to talk to them about it. I like it. Let’s say that they’re like, sure we’re here for our annual exam, wellness, yup, we’ll totally talk about it. Where do you start to go from there?

Dr. Taryn Pestalozzi (07:39):
Yeah. Next would, as part of my exam I do a body condition score assessment on Greta and I think most of us are familiar with the body condition score concept. There’s a couple of different scale systems out there, so there’s a five point scale, there’s a nine point scale in the nutrition world, we tend to go with that nine point scale and if you need a resource in your clinic, the world’s mono, that association has some nice non-branded charts that you can use, but there’s lots of them available and I keep a copy in my exam room laminated and I actually pull it out and I look at it while I do my body condition score because the more you actually read through the definitions of what each of the points on the scale mean, the more consistent you will get. And also if you have your support staff and the other clinicians in your hospital all using that same tool and actually looking at it, you’re going to be more consistent across your whole clinic so that you start building a more reliable history as you’re seeing patients.

Dr. Andy Roark (08:35):
I tend to run into not opposition to this conversation, but just a level of passiveness that they don’t argue with you. They’re not like, no, we’re not going to do a weight loss program. But non-committal I think is how I would

Dr. Taryn Pestalozzi (08:57):
Yeah

Dr. Andy Roark (08:57):
And again, I’m going to lean into the hips in this case and try to make a real quality of life point here, but as I try to motivate for action and try to push through that non-committal place to get them on board with taking action, how can you support me there?

Dr. Taryn Pestalozzi (09:18):
Yeah

Dr. Andy Roark (09:18):
How do you do that?

Dr. Taryn Pestalozzi (09:20):
I think it’s common for a lot of us to maybe focus on those negative outcomes that we are sort of foreseeing in the future. And there’s certainly clients that might need that, right? They maybe need you to really kind of hone in on those negative potential outcomes because they might not budge without it. But going back to that consensus statement in human medicine, it’s actually more effective a lot of times to focus on positive outcomes of weight loss rather than the negative potential consequences of being overweight or obese. So I hear from clients all the time, even with minimal, it’s pretty small amounts of weight loss. They’re acting so much younger, I can see they look thinner. I’m getting compliments on how they look. I’ve had to make their harness smaller. And so really focusing on what the benefits are and what they might see as that progress happens, I think is often more motivating.

Dr. Andy Roark (10:14):
I like that. So what your counsel here would be in the case of a dog that’s overweight and a senior pet is maybe don’t, ooh, she’s getting older, but instead talk about what we could accomplish and she could have the best years of her life. I mean there’s quite possible we could turn back the wheel of time a couple of years and you would see her

Dr. Taryn Pestalozzi (10:35):
Sure, let’s give her the best quality of life where we can as long as possible. And to do that, let’s really focus on getting her down to a lean ideal body condition so that she can be mobile as long as possible and do the things that she loves.

Dr. Andy Roark (10:47):
I’d much rather have the positive conversation than the negative one. No one wants to go tell someone, I’m really worried your dog is going to get worse and have hard time getting up. And that’s not a fun conversation.

Dr. Taryn Pestalozzi (11:00):
No, it’s not at all.

Dr. Andy Roark (11:00):
Appreciate this perspective. I like this so motivating from here to hear to action. I do like that. Any other advice for trying to get buy-in and build momentum?

Dr. Taryn Pestalozzi (11:11):
I think it’s important to try to get all of the humans in the household on the same page. There’s always going to be that person who maybe causes lack of compliance, sneaking treats or they don’t see the importance of the plan. So trying to get everybody involved in that conversation and on the same page is always a good idea if you can, it’s not always possible, but I think that’s going to be helpful for your success.

Dr. Andy Roark (11:40):
What does that look like when you go into the exam room? Because it’s always like my husband does and he’s not there.

Dr. Taryn Pestalozzi (11:50):
They throw each other under the bus. Right?

Dr. Andy Roark (11:52):
Business. That’s totally true. It could a hundred percent not just because they say it’s the person who’s not there. That doesn’t mean that really is.

Dr. Taryn Pestalozzi (12:00):
Sure. I’ve had clients pull me aside, tell me to kind of tell on their spouse or their partner. So I think if you can have ’em both in the same room, maybe you do have schedule a follow-up appointment and ask if they can both be there or I’ll be there. But otherwise, I mean I’ve had clients ask me to write letters to their significant others on letterhead to tell them they need to stop feeding the pet. I haven’t had that as much since I came to nutrition, but I was a GP for seven years before I did nutrition, so I definitely got that apps that several times

Dr. Andy Roark (12:31):
Oh that’s so funny. Alright.

(12:33):
Got it.

Dr. Taryn Pestalozzi (12:34):
I mean you kind of have to play it by ear, but I think trying to get buy-in from everybody is useful.

Dr. Andy Roark (12:39):
Oh, I love it. I just wondered if you had some special tool like I video myself and text it to them. I don’t know. I don’t know. I was just curious if you had any tools for wrangling people in.

Dr. Taryn Pestalozzi (12:48):
Yeah, we do the best we can.

Dr. Andy Roark (12:49):
I love it. This feels so daunting. 25 pounds is a lot. I mean 20 pounds, it’s a lot. 20 pounds per person is a lot and a person weighs more than a hundred pounds. Generally it’s a lot to lose. We’re talking 25%, 20, 25% of this pet’s entire body weight. How do set, it’s not going to be done in a week. This is going to be a process. How do I set expectations so that the clients are not like we’re going to try hard for five days and then I don’t see any changes I’m giving up, help me set us up for success in this and what’s going to be a marathon?

Dr. Taryn Pestalozzi (13:33):
Yeah, I think that’s a really good question, a thing to consider. So there’s a few things. First, the Association for Pet Obesity Prevention puts out annual reports that do surveys of both veterinary clinics and pet owners. And on the most recent data from 2022, they reported on average maybe 30 to 40% of pet owners who had tried a weight loss plan either reported their pet was not successful or they even gained weight. So trying to mitigate that is going to be helpful for long-term compliance. So the first thing is being specific in your recommendations so that you are setting them up for hopefully success right away and not sort of initial lack of weight loss, ribbon weight gain. We can’t always prevent that. So I do warn owners this is a process, it’s going to take us a while. We might backslide occasionally, but we will hopefully be moving forward the majority of the time. I think the second thing is coming up with a timeline. If Greta is a hundred pounds, let’s say that she is, I don’t know, 20% overweight, so she’d be a seven out of nine. For example, if our goal’s a five, so she’s actually 20 to 30% overweight as a seven out of nine. So then we can say, okay, well she’s 20 to 30% overweight and she loses on average 1% per week, which would be the bottom of our target range, then it’s going to take us at least 20 to 30 weeks to get her down to ideal weight. And that’s on an ideal sort of situation. It often takes longer. So giving them a timeline of what to expect I think is helpful.

(15:12):
Then the last thing is just really monitoring so that you can be making adjustments to the plan. I normally see these patients ideally every two to three weeks, or if I’m not seeing ’em in person, I’m at least doing a virtual check-in appointment. I’ll have them weigh them on their own and send me the wait before the appointment and then we can spend maybe five to 10 minutes on the phone or on a video call having that conversation of what’s next, what adjustments do we do or not need to do, what do we need to troubleshoot? And that way we’re keeping progress moving forward hopefully and not running into plateaus that just continue on and on and on.

Dr. Andy Roark (15:48):
Yeah. Okay. I got a couple of questions, so I really like this. So tell me what a specific recommendation sounds like when you say that. How far down the rabbit hole are you going as far as the specificity of what you’re giving to?

Dr. Taryn Pestalozzi (16:03):
Yeah, well, I mean as a GP was totally guilty of this, and I know lots of other practitioners do this too, of they’re overweight to say, oh, just drop their food a quarter of a cup, right? Yeah.

(16:14):
And we go, okay, great. We’ll see you in six months for your net set of vaccines, have a good life, whatever. And instead, what really we should be doing is giving a specific feeding amount. So the first thing is, as much as we can getting an accurate assessment of how much the pet is currently eating, so all the food they’re getting, any treats, any foods they’re going to use to give medications, which often clients forget to include in that history when you ask. And from there, I normally would drop their intake probably 20% initially if, I don’t know if they’re the kind of client who says, oh, well I feed the green bag, it’s really expensive so I know it’s good quality and I just fill the bowl up every two days. Well then I would start for a dog with their resting energy requirement and if they’re a cat, I’d start at 80% of the resting energy requirement.

(17:02):
There’s two methods, so a lot of nutritionists will use an estimated ideal weight to do those calculations and that’s great. That’s how I did it when I ran the Healthy Weight Clinic at K State for that year, and it’s definitely a successful method. That’s also what AHA has in their weight management guidelines. At Davis, we do things a little bit different. We use their current weight, not an estimated ideal weight. We want to use a true number and not an estimate to make all of our calculations. Both methods work really, you’re just picking a starting point and you’re adjusting from that starting point. The other thing we do is we recommend they weigh their food in grams, or if it’s canned food, then at least an easy fraction of a can because we want to be as accurate as we can so that we can make small adjustments as we go.

Dr. Andy Roark (17:46):
Okay. Yeah, that totally makes sense to me. I like the timeline idea as well. I think that’s part of the recommendation. It’s funny when you say 1% per week, I go, okay, well that’s six months, which feels very different. And just saying out loud, this is minimum of six months, just so you know,.

Dr. Taryn Pestalozzi (18:05):
That’s like best case scenario. If there is six out of nine, I can probably get them down to ideal and figure out what it takes to keep them there in about six months. If they’re seven or above, realistically you’re talking more like nine to 12 months or more.

Dr. Andy Roark (18:19):
Yeah.

Dr. Taryn Pestalozzi (18:20):
They’re that 11 out of nine, maybe you’re talking 18 months. So it’s not a short process. It does take a dedicated owner and that’s why you have to be their cheerleader and positive reinforcement of the owner. You’re doing a great job. I’m seeing improvement. Let’s keep going. We give prizes. When they reach their target weight.

Dr. Andy Roark (18:38):
What kind of prizes do you give?

Dr. Taryn Pestalozzi (18:40):
Well, at Kansas we took a photo of them and we were going to make, this was right as I was leaving, we were going to make a wall of fame. So I dunno if that or wall of success kind of oncology departments like to do with their pets finished chemo and then I would give them slow feed bowls or leashes or frisbees, that kind of stuff. If we had plants who are really hesitant to weigh their pet’s, weigh their food, we actually had some gram scales and we would just give them one

Dr. Andy Roark (19:07):
Wow.

Dr. Taryn Pestalozzi (19:07):
Say, can you please just do it? I didn’t do that for everybody, but it was like I was getting a lot of pushback. Yeah.

Dr. Andy Roark (19:13):
Well it shows how serious you are about it, for sure.

Dr. Taryn Pestalozzi (19:16):
Yeah.

Dr. Andy Roark (19:17):
Talk to me a little bit about what these, so I really like sort of the monitoring part. Talk to me a little bit about what these monitoring recheck appointments look like. So you’re like, yeah, we see ’em back two to three weeks. First let’s talk in person. But I think the virtual is, there’s a lot of opportunity there, but just if you have them sort come back into the clinic, what does that recheck look like? I know everybody’s busy, you know what I mean?

Dr. Taryn Pestalozzi (19:37):
Sure, yeah.

Dr. Andy Roark (19:37):
So we’re trying squeeze it in. What does that experience for the clients look like?

Dr. Taryn Pestalozzi (19:42):
So it can be a quick appointment. So my sort of rule of thumb is if I’ve made any changes to their plan, I try to see them back in two to three weeks. If we haven’t made any changes, I push it out like a three to four weeks. So on average every three weeks or so, and it could be probably at the most a 15 minute appointment if you are sort of efficient in how you’re running it, if you’re leveraging your support staff so you could have your support staff go in and body condition that animal if you’ve gotten everybody well trained and on the same book in that regard, get a weight and take a little bit of a diet history. How have things been going? Are you feeding them out? We talked about last time, have you run into challenges? What sort of troubleshooting?

(20:21):
I mean, I think the classic example I give to students is they come in and they haven’t lost any weight and it’s December and you find out that, oh, the in-laws are in town visiting for the holidays and they’ve been feeding the dog a ton of milk bones, so maybe we don’t need to make a change that visit. Maybe we just need to send the in-laws home and get back on track. But if they have kind of lost in that one to two-ish percent percent of body weight per week, then great, we don’t make any changes. We see you again in a few weeks, reassess. If they have not lost as quickly as we’d like or they’ve gained weight, then I’d probably drop them about 10% of their daily caloric intake.

Dr. Andy Roark (21:03):
Okay.

Dr. Taryn Pestalozzi (21:03):
They’re losing too fast, then I’d up ’em 10% and I’d see ’em again in two to three weeks and we’d reassess at that point. And I keep in mind treats. So we plan for treats in our plans. Yeah,

Dr. Andy Roark (21:14):
Gotcha. Talk to me about what losing too fast looks like. So that’s what I was going to start to poke you about a little bit was like when they come back in two to three weeks, what are we looking for? And definitely, I like the idea that we’re going to put ’em on a scale. We’re going to put ’em on the same scale they used last time, so we get some consistency and then if we’re not seeing any weight loss at all, we’re going to start to adjust. And that all tracks to me, when do I have to start worrying like, oh, we’re falling like a stone? Because I suspect that pet owners are probably pretty psyched. They’re like, this is great. We’re making real headway. Greta’s not really thrilled, but the pet owners, I could see them being on board. What am I looking out for there?

Dr. Taryn Pestalozzi (21:56):
Yeah, I mean I’ve had that happen. It’s less common than you might think, but I mean, I’ve had dogs that got boarded when they were sort of starting their plan and they lost like five, 6% in a short period of time, like 10 days. And so our concern there is two things for both species we’re concerned about lack of muscle, muscle losing lean muscle. You mentioned Greta, you were concerned about the muscle in her hind end. So that’s great. I would encourage everybody to actually record a muscle condition score every visit. It doesn’t have to have a number. The world’s Monolo Bed Association actually doesn’t use a numerical scale. It’s just normal or mild, moderate or severe atrophy. And then I’d also be concerned maybe in our cat patients about something like hepatic lipidosis, but that takes a lot. It takes very dramatic sort of extended in tants or hypoxia to get hepatic. So I don’t get too worried about it. But certainly for our cat patients, if I’m starting a new plan, I am really conscious of how I tell owners to transition ’em onto a new food and give them criteria for when they would need to call us. If they’re not eating the new food or they’re not doing well,

Dr. Andy Roark (23:04):
How does the virtual check-in visit work? Because if they’re not there and you don’t have your scale, what is that experience like for the pet owner?

Dr. Taryn Pestalozzi (23:11):
Yeah, I mean it’s a pretty similar, I think outline to how the appointment runs. But what I do is I made a little handout for my owners that shows them some specific photos. I want them to take the photo from the side, a photo from above, and then one of their face if you want to use the body fat index tool from Hill’s and University of Tennessee, I’d also take a picture from behind them staring at their butt. And that lets me just assess roughly their body condition or their body fat index. And then I have the owners weigh them and I just tell ’em, find a consistent way to weigh them, whatever that is. They’re coming to your clinic just for a quick swing by the lobby scale. Or if they have a scale at home, they can get an infant scale or even a floor scale for a big dog relatively inexpensively online. And so they just email me in advance their weight, they send me their photos. I can do the math that I need to do right before the appointment, and then it takes 10 minutes or less to have that conversation about do we need to troubleshoot anything? How fast or how slow were you losing weight? And what adjustments do we need to make?

Dr. Andy Roark (24:14):
Got it. Perfect. That totally makes sense. Good deal. I like this. This seems good. Are there, so we’ve got a plan, we’ve got some good motivators, we’ve got specific recommendations. We’ve got a follow-up plan. I really like the ongoing monitoring. That makes a ton of sense. I a hundred percent see how I can lean on my technicians to help me with this and to run this program. That’s a big deal to me. I really like nutrition for technicians and they can make my job really easy and we can make a real impact together. But anyway, so I like all this. Is there any final pearls pieces that I want to make sure that I’m not forgetting

Dr. Taryn Pestalozzi (24:54):
And I maybe skipped over it? So in our specific recommendations,

Dr. Andy Roark (24:58):
mm-hmm

Dr. Taryn Pestalozzi (24:58):
the majority of these patients should be on a therapeutic, a prescription weight loss diet because if we start restricting their calories, especially if they get below RER or even 1.2 times RER, if we’re talking about dogs, we can cause nutritional deficiencies if we feed a non-therapeutic diet for a long time because those therapeutic diets are fortified with extra protein and vitamins and minerals to account for the lower calorie intake that those pets are having. They also help them with stain full, so satiety, if they’re canned diets, they have a lot of moisture. If they’re kibble, they might be what they call air puffed, so bigger kibbles to take up more volume. And then they also often are high in fiber to help them feel full. So you really should be using a diet like that if you’re going to institute a weight loss plan unless you’re doing small amounts of weight loss and you’re being very conservative with how fast you push them.

Dr. Andy Roark (25:50):
Okay. Define RER for me real quick.

Dr. Taryn Pestalozzi (25:53):
Resting Energy Requirements, and there’s a couple ways you can calculate it. I’m going to give some resources I think at the end that we’ll show you how to do all the calculations and walk you through how to do a plan like this.

Dr. Andy Roark (26:05):
Cool. I love it. And then I want to dig into this a little bit. I think that’s a great point about moving to therapeutic D because one of the pushbacks I always get is, well, I can just, there’s a light version of what they eat. Can I just use the light food? And I want to be supportive of pet owners and kind meet ’em where they are. And at the same time, I do feel like I’m only going to get one good shot. Often it’s one good shot, they’re going to make an attempt and if it doesn’t go anywhere, they’re going to kind of say, well, I guess she’s just a big girl and that’s what she’s going to be. And that’s that. So break that down for me a little bit as far as where your lines are when you’re like, no, it’s time to go to the therapeutic diet. I want to be confident when I make that recommendation to switch to a therapeutic diet and say, yes, this is the play we need to make. Where are your lines? Can you solidify that for me a little bit?

Dr. Taryn Pestalozzi (27:04):
It’s never wrong to pick a therapeutic diet for weight loss unless they have comorbidities that require other nutritional strategies. And there is not a commercially available combination diet. So there are combination joint support and weight loss diets. They’re a combination hydrolyzed and weight loss diets, et cetera. So it’s not wrong if you can find an option to do that other than it’s more expensive, I think that’s always the safe way to go. If I had a patient that did have other comorbidities, that’s the time to talk to a nutritionist or at least call the vet consult line for one of the therapeutic companies to talk to them about the case because maybe that pet really needs a homecooked diet to be able to accomplish weight loss and safely manage their other disease. But if I was going to go with a light or weight management diet over the counter, I’d be looking at patients that are maybe a six out of nine,

(28:02):
Or they have a calorie intake that’s already quite high. So if they’re eating 1.6, I’m talking about a dog right now, 1.6, 1.8 times their resting energy requirement, then I can probably reduce them at least for a while on their normal food and be safe. If they’re starting below that, which often these obese pets are, they have slow metabolisms, most of them. So if they’re starting at 1.2 or one times their resting energy requirement, then it’s not safe because I’m going to have to be cutting them back over this six to nine to 12 month process. We’re going to be making gradual reductions most likely. So we’re going to reach a point where it’s not safe for them to eat a regular diet over the counter. And I think that’s another takeaway is to talk to owners about the fact that this diet is not as short-term diet. Most of these pets have a low metabolic requirement, even once they’re at ideal body condition, so they really should be on a weight loss diet long term. I own one of these dogs, she’s on a weight loss diet for life unless I have to make a switch for another reason.

Dr. Andy Roark (29:05):
Gotcha. That makes sense. Yeah, that’s wonderful. Any other pearls I should pick up here at the very end?

Dr. Taryn Pestalozzi (29:12):
I mean, I think we’ve talked about a lot of them. It’s really about pick a starting point, monitor,

Dr. Andy Roark (29:17):
Yeah.

Dr. Taryn Pestalozzi (29:18):
Make adjustments, be a cheerleader. Those are the keys that people miss and that are what actually result in success. And I mean, we had roughly a 75 to 80% success rate and healthy weight clinic at Kansas when I was there. And most of the cases that weren’t successful, we had lack of compliance or we lost a follow-up. So I think if you work the plan so to speak, you can help a lot of these pets. And there’s like 60% of both dogs and cats that are overweight or obese currently. So this is the case you see every day.

Dr. Andy Roark (29:49):
Oh, I mean, yeah, the overweight Labrador people were like, oh, that’s really a novel case. Sandy, you haven’t seen that before. Yeah. That’s awesome. You’ve given me a number of resources. I’m going to be linking like crazy in the show notes, which I always love. People love having a list of resources. Any other that you would recommend if somebody’s just like, I love this, I love what you’re talking about. Where do you refer people who are nutrition geeks? They’re just like, yeah,

Dr. Taryn Pestalozzi (30:16):
Anymore. I’ve got a few. So the first one that will really walk you through this step-by-step is that 2014 aha weight management guidelines. There is a later like an updated version, but the 2014 as well. The meat and potatoes of this topic is the world’s model of that association has a nutrition toolkit. So that’s where you can get your body condition, your muscle condition, other resources for your support staff. Pet Nutrition Alliance does have a little online calculator you can use. I think they may have updated the website recently, so I’m not sure how they’ve changed it. And then Hill has the Bed Academy with some cece type videos about weight loss. They also have the quick reco tool that can help you initially make a plan. And then if you want more about the stats from that recent annual survey, the Association for Pet Obesity Prevention website has the results of all of the surveys, but the most recent being 2022 and they’ve got good infographics and stuff.

Dr. Andy Roark (31:12):
That’s amazing. I’ll link up to all that stuff. Dr. Taryn Peal, thank you so much for being here. I so enjoy you.

Dr. Taryn Pestalozzi (31:19):
Great, thanks. It was so nice talking about it. This was a topic that I really like.

Dr. Andy Roark (31:23):
Well, yeah, it’s obvious. That’s why I had to have you. Anyway, guys, thanks for tuning in. Everybody take care of yourselves. And that’s it, guys. That’s what I got for you. I hope you enjoyed it. I hope you got something out of it. Thanks so much to Taryn for being here. I really enjoy her. I really enjoy talking with her about weight management. It’s a thing that we talk about a lot, but man, when you find someone who is really passionate about this subject and who has had a job, just having these conversations, these are important, and just because we have ’em a lot doesn’t mean that we shouldn’t take them seriously and really think about how we get better. In fact, it’s the conversations we have a lot that we should really focus on because that’s where we can make a real difference for the clients and the pets that we see.

(32:09):
I mean, I dunno. I think a lot of times in education there’s this push to find these unique things that rarely happen and to be aware of them, and that’s okay. I really think that finding the things that happen commonly and deciding that we’re going to be amazing at them, I think that’s how we really make an impact on the world through veterinary care. Anyway, that’s just how I feel. Guys, if you have not checked at the Hill’s Veterinary Academy, you should take a look. Go and check it out. It is their learning library, it’s their Learning academy. There’s so many resources there. It is a great, great, great source of knowledge on all things nutrition. I’ll put links down in the show notes, go and check it out. Thanks to Hill’s for making this episode possible, guys. Take care of yourselves. I’ll talk to you later.

Dr. Dycus, Chief of Orthopedics at the Nexus Veterinary Bone and Joint Center and founder of Ortho Vet Consulting, shares invaluable insights into orthopedic examinations for both dogs and cats. He discusses the importance of video documentation for evaluating mobility issues, offering indispensable guidance to veterinarians and pet owners alike.

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

LINKS

Dr. David Dycus’s website

Dr. David Dycus on Instagram

Dr. David Dycus on Facebook

C.A.M. (resource for pet owners)

C.A.R.E. (resource for pet owners)

Dr. Andy Roark Resources 

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course

Dr. Andy Roark Charming the Angry Client Team Training Course

Dr. Andy Roark Swag

ABOUT OUR GUEST

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

Dr. Dycus is frequently asked to lecture locally, nationally, and internationally. He has given over 200 continuing education lectures and taught over 125 laboratories. He has published numerous research articles and authored or co-authored several book chapters. He is the co-editor of the textbook: Complications in Canine Cranial Cruciate Ligament Surgery. He was named by DVM360.com as one of the 10 veterinarians to watch in 2018. Dr. Dycus is a frequent contributor for updates in orthopedics to several veterinary websites and magazines. Dr. Dycus has also been featured on Sirius XMs Doctor Radio’s segment on Pet Health and Orthopedics. His passion for teaching has allowed Dr. Dycus to become a laboratory instructor for the CBLO, TPLO, extra-capsular stabilization, medial patella luxation, angular limb deformity, and fracture repair. He is on faculty for AO (Arbeitsgemeinschaft für Osteosynthesefragen), and he is an orthopedic consultant for VIN (Veterinary Information Network). 

Along with being a scientific reviewer for multiple journals, he serves on the editorial review board and is the associate editor (orthopedics) for Veterinary Surgery, the official publication of the American and European Colleges of Veterinary Surgeons. He has previously held an appointment on the research committee for the American College of Veterinary Surgeons. Currently Dr. Dycus is on the Board of Trustees for the American College of Veterinary Surgeons, is a council member for the Association for Veterinary Orthopedic Research and Education (AVORE), and is on the education committee for AO North America. Dr. Dycus became a certified canine rehabilitation practitioner through the University of Tennessee in 2015. He is the director and chief of orthopedic surgery at Nexus Veterinary Bone and Joint Center where he has a focus on total joint replacement, complex and minimally invasive fracture repair as well as angular limb deformity correction, 3D implant printing, and arthroscopy. In addition, he is the medical director for Nexus Veterinary Specialists located in Baltimore, Maryland. He is the founder of Ortho Vet Consulting, an educational consulting and orthopedic coaching service as well as the co-founder of the Veterinary Sports Medicine and Rehabilitation Institute (VSMRI).

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome, everybody, to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I’m here with my good friend, Dr. David Dycus. He’s an orthopedist. He lectures all over the world. He does a ton of things, which I’ll lay out here in a moment. Man, I always enjoy him. He is so useful. He’s such a wealth of knowledge and just super practical clinical knowledge. And guys, we are in the orthopedic exam today. And gosh, he just makes pearls of wisdom rain from above in this episode. It makes me so happy.
My face, I wish you could have seen my face when we get into talking about how to ask pet owners to take videos of their limping pet, and he’s like, “Yeah. This is my wishlist for how to film and what to get them to do.” And I’m like, “Man, if I was a pet owner, I would love this. I would feel empowered. I would feel like I have got some homework to do. I feel like my vet cares.” And then as the vet, I’m like, “Yeah. This is super helpful.” And it’s just a way… It’s like sometimes you struggle to ask for what you really need because you don’t exactly know how to articulate, “Hey. This is what makes a good video that’s actually going to make my life easier and not just give me more to do in my day.” And so anyway, that’s just one part of what he lays down. But man, that was probably my favorite part and we do it for dogs and cats.
At first we start off, we’re talking a lot about dogs. We very much get into cats and how cats are different and ways of diagnosing cats differently, and just, anyway, boy, the amount of knowledge packed into this episode is just absolutely over the top. So anyway, if you ever see limping animals, limping dogs or cats, this episode’s for you. Let’s get into it.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. David Dycus. Thanks for being back on the show.

Dr. David Dycus:
Hey. Thanks for having me. It’s great like always to be back.

Dr. Andy Roark:
Oh, man. I so enjoy having you on here. You have been… I think I have you on about once a year. I should probably do more than that, but you are perennial here. I always enjoy the heck out of you. For those who don’t know you, you are a board certified veterinary surgeon. You have a sole focus in orthopedics, so you’re always in talking about limps and joints and aches and pains and corrective procedures and things like that. You are the chief of orthopedics at Nexus Veterinary Bone and Joint Center. And you also are the founder and owner of your own consulting firm, which is Ortho Vet Consulting.
So you are awesome. I love talking to you about these things. You have a passion for canine working dogs. And so it’s just something that I’ve always been interested in and it fits with your orthopedic interest. And I’ve had you on talking about osteoarthritis many times in the past and things like that. And so let’s go on. I want to just talk with you today. I’m interested in. I had just a flurry of questions recently about limping dogs and mobility. From those, do you think it’s torn? Is it partially torn? Do I need to come in? Do I need to do a surgery? Should I wait and see? And it’s just a lot of those sort of nuanced questions. And so I wanted to bring you in to kind of help me brush up a bit on identifying mobility and pain issues and just examination and then even pre-examination. Are there things I should be asking before from the pet owner? Are there things I should be looking at before I put the hands on the beast? Anything like that?
So let me just start it at a high level and sort of say when somebody comes to you and says, “Hey. Could you take a look at this limping dog?” where do you even start to process this in your mind?

Dr. David Dycus:
So I think first thing is going to be listening to the owners and gathering as much information as you can, because in a lot of situations when the dog or even the cat is in the veterinary hospital, they’re amped up. And so sometimes some of the things that the owners say are happening, you watch the dog walk, for example, and you’re like, “Well, I don’t see anything,” and you’re thinking the owner’s crazy or the dog’s getting better. So I always question them about how long it’s been going on, where they see the issues most. And I try to keep most things open-ended so I don’t persuade them one way or the other or they answer something the way I want them to.
I want them to tell me are they predominantly seeing stiffness upon rising and then the dog works out of it and looks beautiful? Or are they seeing something that the dog is stiff and then it stays consistent? Is it something that started out very intermittent and has now progressively gotten worse? Or are they actually seeing maybe some behavioral type changes? Maybe the dog’s sitting down on walks or maybe they’ve noticed that, “Usually he beats me up the stairs and hops on the bed at night, and now we’re kind of waiting on him to come up the stairs and then I’m having to bend over and help him up into the bed.” So they may notice some not necessarily limping, but they may notice some changes. And if it’s a cat, for example, perhaps they have stopped wanting to jump up onto the counter or they get up and find themselves, but then they start meowing or seeking out somebody to help them get down off of a surface because they don’t want to jump down. So I think certainly listening to the owners is a huge, huge one.

Dr. Andy Roark:
Do you have any slick sort of Jedi questions that you feel draw histories out naturally? Or do you sort of do a 20 questions like, “Hey. I’m going to ask you a bunch of questions,” and then just kind of go through a checklist in your mind? How does that sound when you’re trying to draw this out and without leading them too much?

Dr. David Dycus:
Yeah. I think sometimes when the owners come to see me, they’ve been to their regular veterinarian and they’ve maybe got an idea of what’s going on.
So they start telling me things that they think I want to hear, things they’ve looked up on the internet to try to persuade me in that direction. And so I say, “Listen. Let’s start at the very beginning.” I’ll say, “Why are we here?” “Well, my veterinarian…” and I say, “Well, no, no. What did you see at home when you first noticed something that was wrong?” And, “What changed your thought as to why you thought your dog needed to see a veterinarian?” And then they’ll say, “Well, he was limping.” “Okay. Well, how long ago was he limping?” “Well, a few months ago.” And then I say, “Okay. Well, has he just been limping the same way the whole time? Or did you notice something before?” And then they start thinking and they’re like, “Well, there was a few months ago where maybe he seemed like he slept wrong on his leg for a few days and then it went away. We didn’t think anything of it.” So that’s a huge important thing, especially when it comes to cruciate ligament disease.
Or I’ll say, “Well, are there certain times of the day where you notice the issue more?” I don’t want to say, “Are they stiff when they get up in the morning?” I just want to say, “Are there certain times of the day where you see it? Or are there certain activities that you notice the issue more more than others?” And if they’ve been on any sort of medications, say, “Well, did it help?” And they’re like, “Well, no. He’s still limping.” I’m like, “Well, did you notice any change at all for the better or just zero change?” And they’re like, “Well, maybe it helped a little bit,” because I think some of those things are very, very important.
And many a times they’ll say, “Well, I’ve got a video. Do you want to see it?” And I’m always like, “Yes. Absolutely.” And more times than not, it’s probably not even really focused on the dog and helpful, but I do think it’s important because sometimes you can see some things that the owner’s trying to describe, and I’m sitting there thinking, “What are they talking about?” They’ll say, “Well, he’s dragging his nails.” And we all think, “Oh, it’s got to be neurologic.” And I’m looking, and they’ll say, “We’ve got video.” And I’m watching the video, and it’s like, “Well, the dog doesn’t have a neurologic gait. The dog’s just too painful, so it can’t actually flex the knee or the hip enough to clear the paw and the nails are catching. And so it’s not neurologic. It’s actually orthopedic.”
So many a times, my technician will come in and she’ll be like, “Well, the owner says he’s dragging his feet.” And I’m like, “Oh. Well, this might not be orthopedic.” And so we have to be careful about the terms that we perceive in our brain that we hear without actually seeing. So I think the history is critical and then videos if they have them, and then before you even touch the animal, you have to watch them move.

Dr. Andy Roark:
Okay. Hold on. So I’m going to unpack this a little bit. Okay. Because like I said, I’ve just had a pile of these recently and, pat myself on the back, I have done a good job of saying, “Hey. Why don’t you get a video of it before you come in?” And that has been really helpful. However, David, I get it and they bring the video in and oftentimes, they’re holding the leash and they’re filming from behind or, as you said, there’s a variation in quality of the video and things like that.
Are there certain types of videos, are there shots that you’re looking for? Can I give them a little bit more coaching to get a better video? Because a lot of times, they love the idea of filming it, you know what I mean, and bring it with us so we can see what it looks like. And especially if I say, “Oh, often they’ll hide it when they come into the vet, so I really want you to get this video,” they feel like they’re hands-on, they’re part of what we’re doing, they’re on the diagnostic team. Do you give them any sort of guidance in how to get a good orthopedic video that’s going to help us look at lameness?

Dr. David Dycus:
Yeah. We try to. And for me, it’s actually, if I get the opportunity to tell them to get video before they come in, then my wishlist of videos would be someone else is walking the dog and someone is filming, so it’s not the same person walking and filming. The first thing I would like to see is the dog lying down and getting up to a walk and see what happens. That’s video one. Video two would be the dog just standing before walking. And then the next set of videos would be one video of the dog walking away from the camera, a video of the dog walking towards the camera and a video on both the left and the right side of the dog walking. And ultimately, if I can get even more videos, I would want those same series, but with the dog trotting, so the trotting towards me or the camera, trotting away from the camera, trotting a view on the left side and a view on the right side.
That would be my ultimate wishlist if I could have those videos because I think that would certainly help pinpoint a number of things. You’re able to see how does the dog look when it rises and then starts walking, how does the dog look when it’s standing. Some dogs will offload a limb at a stance, but then the minute they start walking, they’re engaging and using it, and that tells me things versus if the dog is offloading and then takes off walking and is limping. And then for some animals when they have a more mild issue, it’s easier to detect at the trot than it is the walk, because it’s a lot harder for them to hide things at the trot than it is the walk.

Dr. Andy Roark:
Hey, guys. I just want to jump in real quick and let you know about some great continuing education I have coming your way. Guys, I’ve partnered with Nationwide to put together a series of webinars that are 100% free to you. They have [inaudible 00:11:18]. They are good to go. And they are going to be, first of all, just genuinely entertaining and fascinating. The first thing I got coming for you is on October the 31st, that is on Halloween, with me. I am doing a webinar that is on a topic that I love and I care about. It’s keeping care accessible in veterinary hospitals, strategies for affordability and sustainability. This is me talking about exam room communication. It’s talking to people about money. It’s working with clients who have financial limitations. You get to hear me do my thing. I’m super excited about it. It’s at 3:00 PM Eastern, noon Pacific on October the 31st. Registration is open. I’ll put links to all of these down in the show notes.
The second one is coming up on November the 14th with my good friend, Dr. Emily Tincher. She’s been on the podcast a number of times. I love having her here. She’s such a fun, interesting person who’s a deep thinker. And so anyway, she is doing a webinar called Clinical Empathy: The Exam Room Skill that Can Transform Your Team. I’ve had Emily on the podcast before talking about clinical empathy. This is a really good skill building webinar. This is great for your support staff, as well as your doctors, but your team leads especially, but your technicians, your assistants, your CSRs, all of this, it’s such a great communication content. I think you’re going to really like it. So anyway, that is on November the 14th. It is at 3:00 PM Eastern, noon Pacific.
And then the last one in the series is on December 13th. It is with Dr. Simon Platt. It is called Head Cases: A Spectrum of Care Approach to Neurology in General Practice. So if you’re a neurology buff, if you like seizures, not like it, if you like knowing about seizures, if you like neurophysical exam, tips, tricks and hacks, things like that, this is going to be a great webinar. So again, this is on December 13th. It’s at 1:00 PM Eastern. That’s 10:00 AM Pacific Time. Gang, I would love to see you there. Links to all this stuff in the show notes. Go ahead and grab a spot. I’ll see you there. Let’s get back into this episode.
Is this the same wishlist that you have for cats? Or do you tailor your instructions? I know. It’s really hard, but that’s why. It feels to me like the videos of cats are so much more valuable, because they just… It’s so limited in what I can kind of get and use in the exam room, and so I want to do this just well. But yeah, do you tailor those? Is your wishlist still the same and you just say, “I know this could be challenging.”? How do you advise the cat owners?

Dr. David Dycus:
Yeah. So for the cat, I want the owner filming the cat just walking around, engaging its normal environment. And then if they can encourage the cat to play, so if they have a toy they can toss and the cat will go after, I want to see that. I want them to try to encourage the cat to jump up onto a surface, whether it’s a chair or a counter. And then I also want them to encourage the cat to jump off of a surface, an elevated surface, whether it’s a chair or a counter. And then even better if it’s a home that has stairs, if they can encourage the cat to either go up or down the stairs. Those things I think are very helpful, because the cat’s going to be very, very different to detect some things and especially in the hospital.
In most situations the owner has spent all morning trying to get the cat in the carrier to get to you, and then all of a sudden when they’re there in the hospital, the cat doesn’t want to come out of the carrier. And so we take them out of the carrier and I’ll put the carrier at one end of the room and I’ll put the cat at the other and I’ll watch what happens, and the cat walks with a crouched, light gait, well guess what? Every cat walks with a crouched, light gait in the hospital. So that doesn’t really help. But a limping cat’s a big deal. If you have a cat that’s you watching and that you’re like, “That cat looks like it’s limping,” that’s a big issue that needs to be dealt with. But if they can get me videos of just the cat in its normal environment, how it’s interacting, especially with stairs and jumping, that’s also going to be very helpful.

Dr. Andy Roark:
You just made my day. This is absolutely worth the cost of admission just to go through these videos with you. I freaking love this. Okay. Great. So we’ve got our videos. Let’s move into the exam room. So you said even before the examination, just try to watch the pet. And so we talked a little bit about the cat and separating from the carrier and things like that. How do you try to do this in the vet clinic? I have done everything from go just big and have people, “Let’s go outside together and we’ll go and leash it up and go,” to just trying to maneuver in the exam room or things like that. Yeah. Tell me kind of what you’re trying to accomplish before you start your exam with the patient.

Dr. David Dycus:
So I’ll start with the cat. As we said earlier, I want to watch the cat first walk and then I want to see how the cat’s going to engage in terms of jumping up and jumping down. And so what I’ll do is I’ll put the carrier on an elevated surface to see if I can encourage the cat to jump up. And then I’ll reverse rolls. I’ll put the carrier on the ground and the cat on an elevated surface to see if the cat will jump down, because jumping up or having trouble or refusing makes me start to think hind limb issues versus not wanting to jump off or hesitating. That makes me start thinking front limb issues. And for example, cats commonly suffer from elbow osteoarthritis. And so if they do jump down, they’re going to try to get their front legs unloaded as quickly as possible, so they’ll kind of slam their back legs down, so it won’t be a very nice elegant landing.
But for the dog, I really think if the dog’s coming in for limping or weakness or a mobility related issue, we really need to watch them walk in more than just the exam room, because the exam rooms usually just aren’t big enough to pick these things up. But while I’m talking to the owner, I’m going to watch what the dog’s doing. In other words, sometimes I’m staring at the dog while I’m talking to the owner and I’m looking to see if the dog’s standing, does the dog revert and start to offload a limb, or does the dog immediately go to sit down and doesn’t want to stand up, and how does their sit look or when they go to lie down, how does their lie look? And before I ever put hands on them, we’re going to watch them walk.
And so I think watching them walk towards you, watching them walk away from you, if a big enough area, watching them walk on the left and the right and then repeating the process for the trot is very important, but that means you have to have space for this. And so sometimes that can be a hallway. Sometimes it’s the outside in the parking lot. Sometimes it’s on the sidewalk. Sometimes it might be in a grassy area. I tell people, “If you’re going to remodel a hospital or if you’re going to build a hospital, architects love to design beautiful, elegant floorings, but many a times they’re not practical for our patients.” They’re slippery. And if we’ve got a neurologically or orthopedically compromised patient, there’s got to be good footing. And so if your hospital has slippery flooring, you got to move it somewhere where there’s better traction or get a bunch of yoga mats and line your hallway just for your gait evaluation so they have traction, then they’re not sliding because it makes it really challenging if the floors are slippery.

Dr. Andy Roark:
Got you. That totally makes sense. All right. So let’s start to move into our physical exam. And I’ve asked you about this before in the past, but walk through… Primary objectives in our physical examination. How do you start this out?

Dr. David Dycus:
So I think it’s dealer’s choice, and when we talk about dogs, for example, it’s dealer’s choice if you want to have them standing or lying down. I do think it creates a bit more stress in some of the animals if we try to force them in lateral recumbency for an exam. And so if I have a dog that’s relatively submissive and immediately rolls over to their back and is submitting, then I’ll just say, “Okay. Our technician will give them belly rubs and I’ll do the exam with them lying down.” But usually I want to have them standing up. And this isn’t the time where we’re going to try to perfect our wrestling skills.
The exam should be done the same way every time. For me, that means I start at the toes and I work my way up and I do the affected leg last. And so let’s say for example, it’s a right hind limb. Well, I’m going to do the left front leg first, and then I’m going to do the left hind limb, and then I’m going to do the right front leg, and then I’m going to do the right back leg. So that way if I hit an area that’s uncomfortable on the affected limb, I need to know how is this dog’s body language, because in some situations we’re not necessarily looking for pain per se. We’re sometimes looking more for tension or resistance or spasm to manipulation. And so I read a lot of body language. And so if I manipulate, say, the shoulder on the left side in a certain way, but then I manipulate the shoulder on the right side and the dog’s panting and it stops panting or kind of looks back at me or starts licking its lips, those are signs to me that the dog could be uncomfortable.
And I also rely on the feedback from my team. If my technician, say, holding the dog and she says, “Hey. This dog’s kind of pushing into me, kind of trying to get away from you,” that tells me that what I hit is likely an area of discomfort. And I’m notorious for palpating one limb that’s the affected limb last. And I don’t get a whole lot. And so I go back to the contralateral limb and I kind of dig in a little bit deeper and then I go back. And I’m notorious for going back and forth, just sometimes looking for those subtleties, especially if it just doesn’t jump out at you, “Hey. The dog’s legs dangling because it’s got a broken tibia.” Sometimes it can be tricky. And where it gets tricky is with a lot of the soft tissue injuries. That’s where it gets really challenging and where you have to hone in and look for those body language changes when you’re manipulating the animal.

Dr. Andy Roark:
Got you. All right. All that totally makes sense. Where do you see people making mistakes here, David? What sort of pitfalls do I have to look out for?

Dr. David Dycus:
I think people try to rush things. I think they try to quickly run joints through range of motion and then say, “Well, I could do it, didn’t bother the dog.” I also think sometimes our manipulations aren’t as calculated as they should be. Many a times we go just to grab the dog and then the dog tenses up. And I think the prime example there is if we’re checking for cranial drawer. What I see notoriously in notes coming in probably in the last five years is, “Well, full orthopedic exam not completed because the animal was too tense without sedation.” But unless the dog’s actively really trying to eat you, you can usually get instability if your motions are a bit more calculated. We don’t go home after work to pet our animals and we grab them in the position where we’re going to check cranial drawer. I mean, it’s super awkward position for a dog. And so if you go in with a really tight, quick grip, the dog’s going to tense down. And once they tense down, then it’s a fight of will and the dog’s going to win every time.
And so I think if you go very light touches. So for me, what I like to do is just even before I start manipulating them, I’ll run my hands down their back kind of lightly, so they’re getting that very light touch. And then I’ll run my hands down the front legs and run my hands down the back leg, just very light touch so the dog knows I’m there. And then I’ll sometimes kind of rub the medial and lateral side of the leg just very lightly before I even pick up the toe. And then if they start kind of pulling or fighting with me, I’ll let the leg go down for a minute, so I’ll give them a break, and then will re-pick up the process.
So I think if we’re focusing strictly on the orthopedic exam for an orthopedic ailment, it makes sense to slow the exam down. Now if you’re doing a quick orthopedic check, say, on a wellness exam with no complaints, you can get through it pretty quickly. I mean, probably three minutes, you can cover the entire orthopedic exam. But I do think you need to slow down. I think you need to make very calculated movements. We need to avoid quick grips. And then for example, what I find for… Again, going back to the knee, what a lot of people tend to do is when they try to check cranial drawer, they like to kind of pick the leg up, which means the hips flexed a little bit, and they try to check cranial drawer, which I find is very challenging. So actually what I’ll do is I’ll pick the leg up, I’ll extend the hip back a little bit. And that’ll release some of the tension that makes checking both cranial drawer and, for me, tibial thrust much easier.
And then when we talk about hip extension, a lot of people like to try to go to hip extension and then it’s tight and they’re like, “Oh, well, they’re resisting hip extension.” Well, if I walked up behind you and I shoved you down to touch your toes and you couldn’t bend your knees, you’re going to be like, “Ow,” and you’re going to be like, “Well, you’re tight.” Well, we kind of have to work into that. So when I go to hip extension, I’m going very slowly and I can feel that tightness and then I’m just going to push through it as we’re stretching. I’m basically doing a controlled stretch. And I find that many a times dogs when they come in, they’ve got hip pain, well, they don’t really have hip pain. It’s just they were tight and somebody tried to check their hip extension really quickly rather than kind of stretching it out.
And don’t get tunnel vision. For example, if the dog is tight with hip extension, it might not be the hip, because a dog with groin pain or a dog with tarsal pain or a dog with lower back pain or a dog with stifle pain, they’ll sometimes offload the limb and then they’re going to be compensating, which means that their hip’s going to be a bit more flexed, so they can centerline the limb a little bit, which means over time their hip’s going to get tight. And so it’s equivalent if I told you to bend over and walk bent over for weeks at a time and then stand up straight, you’re going to be really tight. So it’s the same thing. So we have to think about, “Okay. If I’m getting pain at the hock, but they’re tight on hip extension and ruling out what’s the primary issue versus the secondary issue, and the news flash is many a times in a skeletally mature dog with an acute lameness, it doesn’t matter really how bad the hips look. It’s usually not the hips that are causing the issue.

Dr. Andy Roark:
No. This is fantastic. I really, really appreciate it. David, where can people… Do you have any favorite resources that you like to refer people to?

Dr. David Dycus:
Yeah. So I’m going to give myself a shameless plug first, and then I’m going to provide other resources.

Dr. Andy Roark:
Do it.

Dr. David Dycus:
So first off would be my own website. It’s drdavid dycus.com, and my Instagram is ortho_vet and my Facebook is Dr. David Dycus. Now, resources for clients are a big deal for me, and we see many patients with osteoarthritis. And so there are two resources I’ll send clients to to learn more about how we manage osteoarthritis over the long term. One is called CAM. That’s Canine Arthritis Management. It’s a group based out of the UK. And the other is CARE, Canine Arthritis Resources and Education. And that’s based in the US. If you just Google Canine Arthritis Management or Canine Arthritis Resources and Education, you’ll probably be able to find both of those websites very easily. And that’s sort of my go-to for sending clients for OA management, so that way they can learn, “Here’s what things are going to be looking like for the rest of the dog’s life,” in a very client friendly language so they know what we’re going to be doing.

Dr. Andy Roark:
That’s fantastic. I’ll put links to all that stuff. I’ll link to David’s stuff and I’ll link to his socials and then also to the other resources as well. So I’ll put all this stuff in the show notes for you guys. David, thank you so much for being here. I always appreciate your time and insight. Gang, thanks for tuning in and listening. Take care of yourselves.

Dr. David Dycus:
Thank you. Was a pleasure.

Dr. Andy Roark:
And that’s it. Guys, that’s the episode. That’s what I got for you. Thanks to Dr. David Dycus for being here. Thanks to you guys for listening. If you found this podcast helpful, leave me an honest review wherever you get your podcast. It’s how people find the show. It means the world to me. I really do appreciate it. Anyway, guys, take care of yourselves. I’ll talk to you later on. Bye.

Dr. Lisa Radosta, veterinary behavior specialist, joins the podcast to scatter a PILE of knowledge pearls upon us! This is a wonderful discussion of inter-cat aggression and what vet professionals and clients can do to maximize their chances of success.

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

LINKS

Dr. Radosta Links: https://linktr.ee/drradostadogresources

Florida Veterinary Behavior Service: https://flvetbehavior.com/

Dr. Lisa Radosta Homepage: https://drlisaradosta.com/

Solensia (Zoetis)

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Lisa Radosta graduated from the University of Florida College of Veterinary Medicine in 2000. She completed a residency in Behavioral Medicine at the University of Pennsylvania. During her residency, she was awarded the American College of Veterinary Behaviorists Resident research award two years in a row. 

Dr. Radosta is the owner of Florida Veterinary Behavior Service, a specialty behavior practice in southeast Florida and co-owns Dog Nerds, an online educational resource for owners whose pets have behavior disorders.

She is a sought after speaker nationally and internationally. She is a coauthor of several books including: Behavior Problems of the Dog and Cat, 4th edition and From Fearful to Fear Free. She is a contributing author for Blackwell’s Five Minute Veterinary Consult, Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Canine and Feline Behavior, Decoding your Cat, Canine and Feline Behavior for Veterinary Technicians and Nurses and Feline and Small Animal Pediatrics. Her new textbook, Handbook of Behavior Problems of the Dog and Cat, 4th Edition is due out May, 2023.

She has published research articles in the Journal of Applied Animal Behavior Science, Journal of Veterinary Behavior and The Veterinary Journal and written review articles for Advances in Small Animal Medicine and Surgery, Compendium, NAVC, Veterinary Team Brief, Clinician’s Brief and AAHA Newstat. She has served on the Fear Free Executive Council and the AAHA Behavior Management Task Force.

She has been interviewed for many publications including Cat Fancy, Dog Fancy, Palm Beach Post, NAVC Clinician’s Brief, Sun Sentinel, WebMD, AAHA trends, Real Simple, Good News for Pets, Catster, DVM 360 and AAHA News Stat. She has appeared on Lifetime television, Laurie Live, local news in southeast Florida, Mitch Wilder’s Amazing Pet Discoveries, Nat Geo Wild, Animal Planet, Steve Dale’s Pet Talk and Dogs, CNBC and Cats and Scapegoats.  

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with a one and only Dr. Lisa Radosta. We are having a conversation about multi-cat aggression, or inner-cat aggression, I should say, but yeah, we start breaking it down. I asked her to set up a little case with three cats, and then just kind of open it to her, and, again, I love having Dr. Radosta on the program. She is so fun, and she tells great stories, and she’s just a wealth of information, and, man, she’s linking to all kinds of resources in this podcast. I’ll put them all in the show notes. Definitely hit the notes, take a look at all the stuff that’s there, but, man, this is a great episode. Let’s get into it.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Lisa Radosta. Thanks for being here.

Dr. Lisa Radosta:
Thank you for having me.

Dr. Andy Roark:
I always enjoy having you here. You have been a regular in the podcast. You are, for people who don’t know you, you are a boarded veterinary behaviorist. You are the owner of Florida Veterinary Behavior Service. You are an author of so many things From Fearful to Fear Free was just one of your books. You’ve written for the clinical handbooks. You have so much that you put out, and you’re such a source of wisdom. I so enjoy our conversations. So I wanted to come to you with a case, and I’ll sort of lay it out, but I want to get a general refresher on this topic, because I’ve seen it recently, and I want to make sure that my game is on point here.
So I’ve got a client, and she has three cats, and they are getting in fights, and so one of the cats is newish, but she has these three cats, and I just wanted to go ahead and start to get your take on apartment living, three cats, newish cat is not getting along; it’s not all-out war, and it’s just kind of one of those things where they’re having fights, but why I say the cat’s newish is because it wasn’t like, “Here’s the new cat, and it’s World War III.” It has been, at first, it was okay, and then it was not, and then it kind of was okay for a while, and just every now and then, they’re getting into it, and so can we talk a little bit about inner-cat aggression? Is that okay?

Dr. Lisa Radosta:
Yeah, let’s do it.

Dr. Andy Roark:
All right, three cats. Is that normal? Does that change how we approach this, as opposed to two cats? Let’s just start there.

Dr. Lisa Radosta:
Look, it makes it more complicated, but it doesn’t change our approach. So, number one, well, here’s generally going to happen, at least in my experience, is they’re going to bring you one cat, and they’re going to say Fluffy-

Dr. Andy Roark:
The culprit, the villain.

Dr. Lisa Radosta:
The villain. It’s always, “Fluffy X, Y, Z.” So you have to try, and I remember sitting with this elderly man. Sometimes you sit with these older people, and they are just a hoot. He was just a hoot, and every time he roadblocked me, he would do it with a big smile on his face. So then, with a big smile on my face, I would explain to him why he’s wrong. It was just a fun appointment. It was an inter-cat aggression appointment, but anyway, so they have these ideas. So the first thing I say is, “Okay, well, here’s the thing. It takes two to tango, and, most likely, at least in my experience, if you have arguments, both cats are involved. If there’s three cats arguing, three cats are involved.”
So here’s what they’ll say, “Well, when I put Cat 1 up, nobody argues, and everybody gets along. It must be Cat one,” and I say, “Well, Cat 1 changes the dynamic enough, but Cat 1 may not be the person, the cat, who’s causing the problem,” all right? So that’s the first thing, is we say, “Okay, just so you know, Ms. Jones, I’m going to need to see all the cats,” and the first step in every behavior appointment, I do not care what the presenting complaint is, I do care, but not for this talk, is to work the cat out. Cats don’t tell us when they’re sick, so you’re going to have to get a needle out, you’re going to have to draw some blood, you may have to take some x-rays, send them to… What is it? The Zoetis Solensia website, where they show the cats jumping. Love this website. I don’t know if I’m allowed to say products, but I do love that site, because the clients then can see, and one client videoed her cat doing every single activity, sent them to me so I could see it.
It was kind of fun, but anyway, the point is, I look for pain, I look for systemic disease, because maybe these cats were getting along in the beginning; somebody’s sick, someone’s irritable, someone’s acting differently. So everybody’s going to need a workup, okay? A lot of clients will push back and say, “I’m sure, I’m sure, I’m sure,” and I just tell them about my experience. “I’ve been sure, and then I treated a case through about eight months, and I couldn’t resolve the case, and you know why? Because as a doctor, I didn’t push hard enough for that lady to bring in her other cat, because the other cat needed a workup, too. So I’m going to you the best I can give you, and that’s everybody coming in, everybody getting a workup.”
So that’s the first step. Clients will bring you, because they bring their phone, videos and pictures. This is what I love. Do you ever watch the home improvement shows? And you know when they pull back the big barrier, and they see the house, and the person goes, “Oh, God!” Right? This is it. So then, they pull out their phone, she pulls out her phone, and I say, “Okay, show me the pictures.” This just happened to me, because she was sure she brought me the aggressor. I’m like, “Okay,” and so then the first picture is both cats sitting in a meatloaf position, so everybody’s defensive, both of them in a bright room, widely dilated pupils, and I went, “Oh, my God,” and she goes, “What?” And I go, “They’re both scared!” And she goes, “No!” I’m like, “Yes!” And she goes, “I can’t believe it!” I’m like, “Yes!” So then she [inaudible 00:06:11]

Dr. Andy Roark:
You were practicing a soap opera. I would just come and watch you work.

Dr. Lisa Radosta:
It is. So then she flips to the next one. I’m like, “Oh, that tail,” and this is a video, “That tail’s thumping. That cat’s agitated.” She goes, “It is?” I’m like, “Yes, it is.” So once you see the pictures, if you know anything about body language, and you might have a technician, a nurse, a doctor’s assistant, who knows a lot about body language, right? Once you start showing the client, “There’s the proof. That’s the radiograph, okay? That’s the MRI,” you’re showing the proof on her phone that everybody’s involved. Now, she’s coming in, right? So that’s step one.

Dr. Andy Roark:
Yep. Do you have resources you really love for body language for pet owners who want to learn more about it?

Dr. Lisa Radosta:
So if you go to my profile on Instagram or Facebook, you go to the profile, there’s Linktrees. There’s a Linktree for cat resources, a Linktree for dog resources, a Linktree for vets. So then you will see I update that all the time. I grab stuff from all over the place and stick it onto that Linktree. So there’s everything, from body language, to carrier training, everything. Yeah. Yeah.

Dr. Andy Roark:
Love it.

Dr. Lisa Radosta:
So yeah, the thing is, we want to educate people. We want to be preventative. I know we’re talking about treating, but what people need to know is about 50% of cats show some sort of conflict when they fight. So that’s the number one statistic we want to put into our veterinary brains. Cat is coming into you, first appointment, you’ve never seen this cat, just adopted into a family of a current client who has cats. You want her to know 50% of cats have an argument, and I want to tell you what an argument looks like: ears back, tail thumping, hissing. Because what they’ll say is they weren’t swatting, they weren’t biting, they weren’t chasing. That’s good, but that’s end of that spectrum. At the beginning of the conflict is ears back, tail thumping, hissing.
So when you see that, think of that as conflict. That means you don’t want to go farther with the introduction. What they need to know is 35% of those cats are still fighting at least once a week a year later. So we have to, as vets, go, “Here’s the thing: if you saw any of those signs, we got to go super, super slow. Maybe you need a cat trainer, right? Maybe you need to follow this handout that I’ve written for you, or that I have. Our new textbook has a handout in it for introduction. Actually, I think it’s on my website. So follow that exactly, because if you start the cats off right, the likelihood they’re going to be here in a year for fighting is a lot lower.

Dr. Andy Roark:
Yeah. No, that makes sense.
Hey guys, I just want to jump in real quick and let you know I have a secret. I have something that is coming for you that is really wonderful. As you know, I love to have fun, I love to facilitate teams learning together, and laughing together, and getting to know each other, I like to make things that are kind of zany and off the wall that will bring joy into practice, and, guys, my team has been working so hard on something very special for you. It’s not a webinar, it’s not a conference, it’s not an event, it’s not a summit, it’s not a training program; it is something entirely different, and so I just want to give you a quick heads up that there’s something exciting coming down the pipes. If you want to get the inside scoop, you can hunt around the DrAndyRoark.com website, or some of my emails, and see if you can find the question marks.
Look for some question marks, and that will link you up to some information, and some clues, and you can start to make your way towards figuring out and finding out what I got for you, but anyway, it’s going to be something really fun, and really exciting, and I can’t wait to share more with you soon. Now, let’s get back into this episode.
Okay. I love the idea of getting in the phones, I love the videos, I love working with the cats, things like that. How do you start to… You and I talked in the past about it, and you had made a distinction between the two different drivers of cat aggression. Do you want to start there as far as how you weighed into these?

Dr. Lisa Radosta:
Yeah, so you’ve got the cat who a new cat’s introduced into the home, and there’s conflict, and that conflict could be over anything. It could be one cat is fearful, it could be one cat is not well, one or more, it could be that the resources in the house aren’t plentiful enough, et cetera, et cetera, and the way we educate those clients looks really different than the way we educate the second group of clients. Those are clients whose cats, these are often littermates, not always, but often, that get along really well. I mean, they sleep in a pile of cats, which is one of the ways we figure out if cats are actually BFFs, and then they’re in a situation where one cat gets really scared, and redirects aggressively toward the other, and the relationship is forever changed. When I see that second group of cats, at least, in my practice, way better prognosis, because a couple of reasons. They had a good relationship prior. They had something to go back to, right? And also because usually clients get them to us pretty quickly because they’re shocked at what’s happening. It feels urgent because of the change in the behavior.

Dr. Andy Roark:
Yeah. No, that makes sense. Okay, so we talked about, I love the idea of setting the expectation, “This is going to take time, this is going to be a process.” Is there anything else you do to sort of set up expectations like that at the beginning?

Dr. Lisa Radosta:
Yeah. So one of the first things we do is educate. Here’s how cats live. If you ever had a barn, or barn cat, which I did, you pour out the food, and the cats come together, right? But then the cats scatter, and you notice the ones that are hanging out together look the same, bunch of ginger cats, bunch of tuxedo cats. Why is that? Because cats live in matrilineal colonies. So I tell the client, “Look, the moms, and the sisters, and the aunts, and the grandmas, they all live together, and they take care of each other’s babies, but God help you if you’re another cat, and you’re not related, and you try to come into that group, because they’re going to be aggressive toward you. So let’s normalize that what your cats are doing normal, right? Let’s also normalize that they’re not sisters, they’re not family, they’re roommates, but you did not ask them if they wanted a roommate. You just got another cat, right?” So let’s first empathize for the kitties. That’s the first thing.
The second thing, it depends on the situation. If the situation’s really bad, so if I say seek and destroy, cat sees other cat, goes after it, then I’m going to explain to them that this is going to be a challenge. “These are ways we can treat this. We can separate. We could separate forever. You could live with your cats separated. That is the cheapest thing to do. That is what your cats want, and you will divide your time, and your cats’ time will be divided. Number two, we can medicate and manage them. They can be together when you’re there to interrupt them. All across the board, of course, we’re going to do environmental enrichment, that’s a given, and then the third option is to do behavior modification with a cat trainer.
That’s going to be done virtually almost 100% of the time. That is going to be six months of your time. We’re going to meet every two weeks, and I just want you to know that, a lot of times, after six to eight months, the cats relapse and have a fight. So I want you to think about this as marriage counseling. I don’t know if you’ve ever been to any sort of relationship counseling. It’s just how I talk to people, and you don’t have to tell me that you have, but what I can tell you is that that’s not a fix. Sometimes those people are triggered again, and they fight again, right? So your cats are going to be in that situation, too. So whatever you do is up to you. I’m here to be a part of the solution. Here’s the options.”

Dr. Andy Roark:
Yeah, that makes sense. I always ask about environmental enrichment, because I think it’s so useful, and it’s so often overlooked by pet owners, and it does so much for the quality of life of cats. What are your go-tos for feline environmental enrichment? What do you love?

Dr. Lisa Radosta:
There’s a book called The Indoor Cat, which is a great, great book that is all about enrichment. That’s all that the authors write about in that book. So I tell clients to get that. Of course, I send them to our resources, but here’s the troubleshooting point, because I think the veterinarians and the veterinary nurses and technicians listening to this podcast have a lot of knowledge. Where’s the troubleshooting? When you say, “I want you to enrich the environment,” first of all, I was shocked when I got a follower on Instagram who DM’d me to say, “What is enrichment?” I had done like five posts on enrichment. “What is it?” So watch your lingo. People don’t know what that means. Okay, does your cat have stuff to do?
And then here’s the next thing they say, “Yes, my cat’s got a toy box full of toys. My cat doesn’t need anything,” and I say, “Okay. You’ve got to break through that challenge. That challenge is coming. So either you break through it by getting ahead of it,” which is what I try to do to say, “One thing we need to do is enrich your cat’s environment. Enrichment is giving your cat stuff to do and engaging all five senses, and I know, because you’re here, that you’re an amazing pet parent, and I know, because your butt is in that seat, that you got a full toy box full of cat toys, and I also know that my husband is going to walk into my closet tomorrow and say I have enough black high heel shoes, and he will be wrong, right? Because he will think I’m plenty and rich, but shoe-wise, I’m not, and your cat isn’t either.” So that is the way I talk to them, and they’ve got a smile on their faces. Now, they’re like, “Oh, that’s funny.”
So then we talk about the five senses, and we talk about rotation. Your cat is so smart, and he’s got the same toys in front of him every day. That is no fun, right? So we’re going to rotate; three toys in the drawer, bring out three new toys every day. Plus, there’s the toys that he has in his box. I tell them my three-step process for finding what your cat loves. Number one, you go on to whatever your search engine is, you Google, let’s say, “Cat toys,” and you just spend an hour shopping. You spend your budget for that month, and then you get those in the mail, and then you log, with your pen and paper, on your phone, what your cat played with, and you write down the exact characteristics in detail. Month two, spend your budget on only toys that have those exact characteristics. Repeat. By month three, you will have what your cat likes, and go forward from there, rotating and keeping it new and fresh for him.

Dr. Andy Roark:
Yeah. Oh, I love it. That’s amazing. Are there any common pitfalls that you see? Are there any mistakes that I should look out for, anywhere that I mess this up, or make my life harder?

Dr. Lisa Radosta:
Yeah, I mean, the clients, every part of our job, they push the limits too soon. I didn’t give all the cephalexin. I don’t even think we used cephalexin. You could tell me, because I don’t do skin anymore, but I didn’t give all the antibiotic. “My dog looked pretty good,” right?

Dr. Andy Roark:
It’s good enough we stop, yeah.

Dr. Lisa Radosta:
It’s good enough we stopped. So what we’re going to see is the cats are going to fine behind the closed. So the client’s going to call you, or email, or text you, and say, “I opened the door. I just wanted to see,” but the problem is, and this is what I have to explain to them, “The problem is that one negative, it takes me 1,000 positives to outweigh that one negative. So you can’t break the rules, and we did it this time, we’re going to let it go, but you can’t break them in the future. “

Dr. Andy Roark:
Yeah, that makes total sense. Oh, man. Dr. Lisa Radosta, you are amazing. Thank you so much for being here and talking through this with me. I always enjoy our time together. I have got a ton of links I’m going to be putting down in the show notes so that people can go and find. Let’s go ahead. I’m going to put you a link to your website. Are there any other resources? Talk a little bit about your social medias. Clearly, you’re active on Instagram. Where can people find you?

Dr. Lisa Radosta:
Yeah, @DrLisaRadosta is where you’ll find me, and we post on everything behavior in little digestible bites; dogs, cats. We’re living and breathing it, and I love it.

Dr. Andy Roark:
Sounds great. I will add those links as well. Guys, thanks for being here. Take care of yourselves, everybody.
And that is it, guys. That’s what we got for you. I hope you enjoyed it. I hope you got something out of the episode. Thanks so much to Dr. Lisa Radosta for being here. Thanks to you for being here and listening. Yeah, if you like the podcast, do me a favor, leave me an honest review wherever you get your podcasts. It means the world to me. Anyway, that’s all I got. Gang, take care of yourselves. Be well. I’ll talk to you soon.