Wellness

Dr. Margie Sherk is on this Hall of Fame podcast to talk about those easily forgotten holiday dangers that we (and cat owners) need to keep in mind.

LINKS

It’s All Fun and Games – How to Play, Engage with and Reward Your Team: unchartedvet.com/product/its-all-fun-and-games/

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Two weeks before graduating from OVC in 1982, Margie Scherk packed all of her worldly belongings into her rusty, yellow Honda Civic named Jaundice and drove west to take her last two weeks of school at WCVM. Moving to a place she could see the mountains and ocean every day, she opened Cats Only Veterinary Clinic in 1982, at that time the second feline specific clinic in Canada. The first time they became available to sit, she sat and passed ABVP Feline boards in 1995.

Since 2008 she has been teaching, writing and editing exclusively. This takes her around the world where, like a locum, she gets to see how other people practice, only in this case, under some very different circumstances and in different cultures. She is the North American editor of the Journal of Feline Medicine and Surgery, serves on a whole bunch of committees on national, international and feline projects. As a break, she loves to cook.

SHOW TRANSCRIPT

Dr. Andy Roark (00:08):

Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host Dr. Andrew Roark. Guys, I got a great one for you. This is a hall of fame episode. This is me and my friend cat whisperer extraordinaire, Dr. Margie Sherk. And we are talking about cat holiday dangers and how we keep our kitty cats safe and sound during the holidays. And what conversations we have with pet owners and what things we need to look out for that maybe we’re not already looking out for. Quick, to the point, super useful. Let’s get into this episode.

Dr. Andy Roark (00:59):

(singing).

Dr. Andy Roark (00:59):

Dr. Margie Sherk, welcome, welcome. Thanks for coming back.

Dr. Margie Sherk (01:03):

Hey, pleasure. Lot of times gone by since we last spoke.

Dr. Andy Roark (01:08):

It’s been minutes since we recorded our previous episode. And in 2020 minutes are like day.

Dr. Margie Sherk (01:15):

Wasn’t it though. I mean, March I came back from… My last trip was to Germany and I came back three days early because of COVID. Got home on the 13th of March. Haven’t been anywhere since. And the month of March, even though that was only the 13th, was the longest month of my life. Oh my goodness.

Dr. Andy Roark (01:37):

One of my favorite memes was during the election here in the states. After the polls had closed and the counting was going on, and it was like Friday, and I saw this meme that said, “From the year that brought you four months of April comes Tuesday part three.” And I was like, “That’s so fun and that’s so true.”

Dr. Margie Sherk (01:59):

Oh my goodness. One good thing about this year, I’m learning patience.

Dr. Andy Roark (02:07):

Yeah. In new and significant ways. I’m also learning how to teach a nine year old math so that’s a skill I didn’t have. When I learned math at no point did my teacher say, “You need to learn this so that you can teach your own child during a pandemic.” That was new to me.

Dr. Margie Sherk (02:22):

Oh my goodness. I am so, so many things I’m grateful for, but I’m very grateful for the fact that my kids are well and gone and out of the house. I don’t know how you could have to work from home, teach your kids when we don’t know how to teach. I honest to goodness… Or I mean, I know how to teach, but I don’t know how to, relatively, I don’t know how teach that material.

Dr. Andy Roark (02:46):

Yeah.

Dr. Margie Sherk (02:46):

And I don’t think if I had a three year old I don’t think they’d want to be learning veterinary medicine.

Dr. Andy Roark (02:52):

No. “Let’s talk about sterile cystitis.” “Not again, mom. Not again.” Got it.

Dr. Margie Sherk (02:57):

“Today we’re going to learn how to place an E tube.”

Dr. Andy Roark (02:59):

She’s like, “When will I use this in the third grade?” I want to talk to you today. I want to run through Christmas risks for cats. This is great material just for me to have on top of mind. And honestly, this is great stuff to communicate to pet owners. So this is going to help me make a social media post for my practice. It’s going to help me make handouts for my clients and give me things to mention in the exam room that are interesting and topical that the pet owners will like. But lets you and me real fast, we’re getting in the month of December, what do I need to be looking out for? What are risks to cats associated with the holiday season that may not be present the rest of the year? So as people unpack their decorations, what dastardly, devious, diabolical things are they getting out?

Dr. Margie Sherk (03:52):

That’s a lot of D’s there.

Dr. Andy Roark (03:53):

It’s a lot. I was like, “I’m onto this now. I’m going to keep going as long as I can.”

Dr. Margie Sherk (03:59):

So I mean, the most obvious one is tinsel. And it’s been literally decades since I’ve had tinsel on trees. You just can’t have tinsel on trees because not only is it dangling and shiny and appealing and moves and a cat wants to bat at it, but of course if caught can be a linear foreign body, which can slice, literally slice, the intestines open in a cat and cause… It’s totally unnecessarily so sadly no tinsel.

Dr. Margie Sherk (04:29):

Other hanging decorations. Hang them up high enough that a cat can’t get to them. And for heavens sakes, make sure you attach your tree to the wall in some way shape or form because should kitty decide that it’s a cat tree rather than just a Christmas tree, this whole thing can come tumbling down and glass ornaments break. And you don’t want those glass ornaments to break. You also don’t want them slicing Kitty’s paw or being ingested in any way. So angel hair also a problem because that can cause, that fluffy white stuff, if they get that cloud on the barbs of their tongue they can’t get it off. And just like tinsel they have to swallow it and that could cause an obstruction.

Dr. Andy Roark (05:13):

When you say angel hair you’re talking about the fake snow stuff that people put around the bottom of their tree?

Dr. Margie Sherk (05:17):

No. No, I’m talking about that stringy, it’s almost like fiberglass or something. It’s that white, fluffy… It is like snow, but it’s not the snow that you spray on. Sorry. Maybe you were talking about same.

Dr. Andy Roark (05:30):

Yeah, yeah.

Dr. Margie Sherk (05:32):

But the nice puffy, marshmallowy kind of snow. Yeah.

Dr. Andy Roark (05:36):

Yeah. Okay. Perfect. I know what you’re talking about now. Okay. Yeah. I had no idea that was called angel hair, but that makes a ton of sense.

Dr. Margie Sherk (05:43):

Yeah.

Dr. Andy Roark (05:43):

Okay, cool. So angel hair, I got to tell you that I had no idea. That totally makes sense.

Dr. Margie Sherk (05:48):

Then also Christmas lights. Of course, with Christmas lights we’re talking electrical and that’s always an issue if they could bite the electrical and then get a horrible burn on their tongues and some sloughing there. They could also get caught up in them in the wires so supervise your cat when that’s on. Battery powered lights would be better at least in as far as not getting caught in cords, but there’s still the electrical. Snow globes, a real problem. We don’t think of snow globes as being, if they break, because snow globes are filled with ethylene glycol. [crosstalk 00:06:27].

Dr. Andy Roark (06:26):

What? Is that true? I had no idea.

Dr. Margie Sherk (06:28):

Didn’t know that, right?

Dr. Andy Roark (06:30):

I didn’t. In all seriousness-

Dr. Margie Sherk (06:31):

I thought it was just water.

Dr. Andy Roark (06:31):

… you said, “Snow globes,” I was like, “You got me here.”

Dr. Margie Sherk (06:37):

[crosstalk 00:06:37]. And there’s ethylene glycol in snow globes. I mean, I don’t know if it’s in all snow globes, but of course that is deadly, absolutely deadly, so that’s an important thing too. And then if we’ve got kitty Christmas presents under the tree, probably not a good idea to be putting the catnip filled presents under the Christmas tree where kitty’s going to want to dig through the wrapping and all that kind of stuff.

Dr. Andy Roark (07:09):

Hey guys, I just want to jump in real fast with a quick announcement. On December the 12th, that is right around the corner, that’s this weekend as this podcast is coming out, the one and only Jenn Galvin is doing her workshop called It’s All Fun and Games: How to Play, Engage With and Reward Your Team. I saw Jenn this last weekend at the Uncharted Practice Owner Summit. I can’t say enough good things about her. She is truly amazing. She runs a great practice. This is going to be super valuable, useful workshop. It is from 4:00 to 6:00 PM Eastern time, 1:00 to 3:00 PM Pacific. That is, again, on December the 12th. It is free for uncharted members. It is $99 to the public. Don’t miss out on this great workshop and this great opportunity. I hope to see you guys there.

Dr. Margie Sherk (07:59):

One of the things too that when we think about cooking, there’s a lot of cooking that goes around holidays. And who knows what it’s going to be like during this pandemic where everything’s sort of dialed down smaller because we’re not having people over, public service announcement, we aren’t having people over. But even so we may be cooking, well, we will be cooking fancier and for those of us who have the ability to do so. So we need to be careful of strings on roasts, strings on ham, birds, that sort of thing because that can also be, like tinsel, can be awfully tasty. And if they’re getting into too much fat it’s not going to give them pancreatitis, but it can certainly give them a day or two of a pretty upset tummy.

Dr. Andy Roark (08:49):

Yeah.

Dr. Margie Sherk (08:52):

Poinsettias have gotten a really bad rap. Poinsettias actually aren’t, well, strictly speaking, yes, they are toxic in that you get drooly and feel kind of crummy after eating them. They may be vomiting, a little bit of drooling, maybe some diarrhea, maybe even conjunctivitis, but the reality is poinsettias aren’t going to kill anybody. It’s a really, really mild, a really mild thing. They can get dermal irritation, just some itchiness from them. But really, I mean, when I had my practice, every Christmas I would buy these huge, from a charity, I would buy these huge poinsettias and we’d have about 20 of these things out on the floor and I was never worried about them with either the clinic cats or the patients.

Dr. Andy Roark (09:41):

What do you say to the pet owner who calls in a panic and she says, “My cat just ate, I saw her eating flowers off the poinsettia.” Do you just sort of run them through that? Is there a point where you say, “Okay, bring her in if this happens.” Do you just say, “It’s going to be fine?” Walk me through that conversation really quickly if you don’t mind.

Dr. Margie Sherk (10:01):

Yeah, sure. I mean, it’s a really low level of toxicity. And if the kitty were vomiting and more than once and continuously vomiting, then might be a good idea to bring kitty in and to give them an antiemetic. Give them an antiemetic and maybe some fluids, subcu fluids, because of the electrolytes and water that they’ve lost, but really that’s it. It’s much less dangerous than lilies. Of course, amaryllis are lilies. And I have them in my house, but they stay in the living room and the living room has glass doors and the doors stay shut unless we’re in there, then the cats can be in there. So lilies. There’s other types of lilies that people like. Even those alstroemeria that you see in bouquets really commonly, those are also lilies. And when we’re talking lilies now we’re talking acute kidney injury, just like as we are with the snow globe ethylene glycol thing.

Dr. Margie Sherk (11:06):

Christmas holly, holly is really dangerous. As well as you can also get the mechanical injury from the spiny leaves because that can really slice their tongues. And then there’s other plants too like, let me think here. Oh, well mistletoe can be toxic too. You think about the Druids and how they used to always look for mistletoe and I think it has some hallucinogenic property. That’s what that’s about. But with mistletoe, certainly you European mistletoe tends to be more toxic than the American varieties, but people plant things that aren’t necessarily native to their region.

Dr. Andy Roark (11:47):

Sure, sure, sure.

Dr. Margie Sherk (11:48):

And that can cause collapse, hypotension, ataxia, really seizures, even death. So it’s pretty wild what it can cause. And then, lastly, around Christmas what I want to think about too is stress. Stress, stress, stress, and anxiety. I mean, there’s all kinds of stuff happening. Just think about it. Thanksgiving, Christmas, everybody looks forward to them. And within about how long, how many minutes, is the family fighting or arguing? [inaudible 00:12:20]. And there’s more people there. I mean, again, that’s one probably really good thing with the pandemic, for the cats, is there’s fewer people coming over.

Dr. Andy Roark (12:27):

Yep, yep.

Dr. Margie Sherk (12:28):

But we’re kind of wound up. We need to get our presents mailed off, we’re decorating the house, we’re doing all this stuff that we may be feeling financially stressed. And so we pass on all this stress and that may be a time where some pheromones might be, if you don’t already have them in place, you might want some pheromones. You want to make sure that the cats can get away, that they can always get to a peaceful place where they’re not pestered without having to… So they can take care of themselves that way.

Dr. Andy Roark (13:00):

That makes total sense. Is there anything else in the kitchen that people might need a quick reminder on, that pet owners should be reminded of? I love the string. I think that’s a big one to call out. Any other ingredients that come out? Are people doing funky things with xylitol now that I’m not aware of? Anything like that?

Dr. Margie Sherk (13:21):

Yeah, I don’t know about xylitol. I mean, cats do, at least my cats, love peanut butter. And we only use peanut butter that’s peanuts and that’s not any of the processed peanut butters that may have xylitol, which certainly is toxic. But thanks for this prod, for this leading question. That’s awesome.

Dr. Andy Roark (13:41):

Yeah. Well, you are a cook. You’re a chef.

Dr. Margie Sherk (13:44):

Yeah, [crosstalk 00:13:44].

Dr. Andy Roark (13:44):

I know it’s a passion of yours. I’m like if anybody’s going to unpack this well it’s going to be Margie.

Dr. Margie Sherk (13:50):

Oh, I love cooking. Although I’m getting a little bit sick of it with the pandemic because it’s like gardening and cooking. What else [inaudible 00:14:02]? Anyways, I can never retire. I don’t know, I’ll probably poke my eyes out. But okay, so onions and garlic. I mean, my kitchen is a super toxic place for cats because pretty much every meal has onions and garlic in it. Especially, onions are an issue for cats. So that could be in gravy if you’re giving them a little bit of turkey, give them the turkey, but no gravy.

Dr. Margie Sherk (14:26):

And then raisins and grapes. I’m just about done assembling all my ingredients to make chocolate bark. And with that I have dark cabou chocolate and there’s some raisins in it. There’s nuts in it. There’s ginger in it. There’s mango in it. There’s dried cherries. And well, pretty much all those things could be problematic. Or at least I should say the raisins and the chocolate could definitely be problematic. Cats aren’t usually really big on chocolate, but if a raisin hits the floor they might just investigate it. And one raisin isn’t going to likely do anything, but if they decide that this is a good thing and they bat them around, that could be a problem.

Dr. Andy Roark (15:06):

That sounds great. I feel good. I feel like I got a lot to talk to my clients about. I think I got some great stuff for some client handouts. This is super good. Any last tips, tricks, pearls, anything about the holiday that the veterinarian with the cat love should have in mind that you can think of?

Dr. Margie Sherk (15:25):

Well, I mean, we love our cats and we love, certainly this year if the numbers don’t lie, we’re loving our alcohol and we might want for ourselves to relax a bit have a nice glass of something, maybe it would be a toddy or something. Whatever it is, cider, don’t give your cat any of that. Cats don’t have the alcohol dehydrogenase they need to break down the alcohol in their livers, so please don’t let your cats drink from your whatever lovely thing you’re enjoying, no matter how much you love your cat.

Dr. Andy Roark (15:57):

That sound great.

Dr. Margie Sherk (15:58):

Give them some [crosstalk 00:15:58] instead.

Dr. Andy Roark (15:59):

That’s a good one to leave on. Margie, thank you for being here. I really appreciate, always appreciate your time. I hope that you will come back and talk with us again.

Dr. Margie Sherk (16:07):

Anytime. Would love it. Love seeing your friendly face.

Dr. Andy Roark (16:09):

Thanks my friend.

Dr. Margie Sherk (16:10):

Okay. Take care.

Dr. Andy Roark (16:11):

Take care of bye-bye.

Dr. Margie Sherk (16:12):

Bye.

Dr. Andy Roark (16:13):

And that is our episode. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. As always, if you did go ahead and leave us an honest review on iTunes or wherever you get your podcast. That is how people find the podcast. It always means the world to me. It’s a nice thing that you can do. It really makes my day. That’s it guys. Otherwise, I hope you’re enjoying the holiday season. Take care of yourselves. I’ll see you soon. Bye.

Josh Vaisman, cofounder of Flourish Veterinary Consulting, and Dr. Andy Roark discuss what it means to have a positive workplace, where most veterinary practices go wrong and what we can actually do to make our practices more enjoyable places to work.

LINKS

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Josh Vaisman believes all veterinary professionals deserve to feel fulfilled by their work, each and every day. Through his company, Flourish Veterinary Consulting, he combines more than 20 years of veterinary experience, a master’s in applied Positive Psychology & Coaching Psychology, and education in Positive Leadership and Positive Organizational Scholarship and a passion for guiding leaders to cultivate work environments in which people can thrive.

Fun fact – Josh is also an avid beekeeper who teaches beginning beekeepers how to tend to their buzzing buddies.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

SHOW TRANSCRIPT

Dr. Andy Roark:

Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I love this episode. I am so happy with it. I am so excited about it. Josh Vaisman, this is my first time really getting to sit down and do anything with him. And man did I enjoy the heck out of it. I’m getting that guy back on the podcast for sure, because I could have talked to him all day. It was a fantastic conversation about what it means to have a positive workplace and to feel good about going to work. We talked about how some practices put numbers ahead of people and how that manifests and how that looks and how we do that differently. We talk about having compassion for the people we work with and still holding people accountable, and how you can do that. It just takes some balance. But man, such a good conversation. Guys, I’m not going to delay any longer. Let’s get into this episode.

Kelsey Beth Carpenter:

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

Dr. Andy Roark:

Welcome to the podcast. Josh Vaisman, thanks for being here.

Josh Vaisman:

Oh gosh, Andy, thanks for having me. I’m super excited to chat with you today.

Dr. Andy Roark:

My pleasure. So I met you at the first event I had been to in two years when I went back to Vegas for Western. And I had lunch with you because of our mutual friend, Dr. Phil Richmond. And man, we had a great conversation and I really loved talking with you and I wanted to have you on and talk some more. So thanks for making time.

Josh Vaisman:

Oh gosh, yeah. I appreciate the opportunity, and shout out to Phil. Phil is such a wonderful guy and he’s the ultimate connector in the veterinary community.

Dr. Andy Roark:

Yeah. If you don’t know Dr. Phil Richmond, you’re missing out. He’s doing so much for mental health in vet medicine and he’s out there just … He’s one of those guys that doesn’t make a big show about it and just does the work that helps other people. And yeah, I have so much love in my heart for that guy.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

All right. Cool. Why don’t we just start a little bit with your background. Can you tell me a little bit about … So you are the owner and founder of Flourish Veterinary Consulting. Tell us a little bit about positive psychology and coaching psychology and what you do.

Josh Vaisman:

Absolutely. So Flourish was started with the goal of taking, what does the science tell us contributes to human thriving, specifically in an organizational context. So what are the kinds of things that seem to allow people to really thrive and get a sense of fulfillment in their work from a scientific evidence-based perspective. And then we try and bring that to the veterinary space in really tangible and digestible ways, so that we can empower leaders to cultivate that kind of environment in a veterinary hospital. And that’s the basic gist of it. So for me personally, how my journey got started on that, I’ve worked in the veterinary space since the late ’90s. I’ve done just about every role in a hospital, except be a full DVM. I like to joke I was once the right hand of a veterinarian for about two months when she broke her wrist.

Josh Vaisman:

And I did all her medical records and pretty much everything that required her right hand. But I found myself stumbling into practice management and ownership. And I did that in a couple small animal hospitals over several years, and went through a pretty significant bout of occupational burnout. I mean, depression level kind of burnout. Crying in my kitchen over scrambled eggs one morning for no apparent reason, as my shocked wife looked on and couldn’t figure out what was happening to me.

Dr. Andy Roark:

Yeah.

Josh Vaisman:

And going through all that, I had two realizations. One of them community based and one of them personally based. On a personal level, I recognized that I was, pardon my French, a shitty leader. I did not lead in the best possible ways. I had allowed myself to get into the habit of putting numbers ahead of people. And I don’t think that numbers are the leading indicators that we really should be after, I think people are what make things happen. And when you care for people, they care for outcomes. But I didn’t do a good job of that. And then on a community level, I realized that the veterinary space, we’ve gotten really damn good at taking care of others and not quite as good at taking care of ourselves and each other.

Josh Vaisman:

And I felt like there’s got to be a better way to do this wonderful, worthy work that we do so that it actually contributes to our individual and collective fulfillment instead of our depletion. And so that led me to go back to school and pursue a master’s in applied positive psychology and coaching psychology, because I really feel like that is the prism of science that can help us get there.

Dr. Andy Roark:

Yeah. So the challenge of separating care for people from care from numbers, I think that that’s something that a lot of people don’t really appreciate or recognize. I don’t know how much you see it until you’re in a leadership role. And then a lot of people go, oh, yeah, obviously you care for people and not for numbers. And I don’t know that people really appreciate how strong there is a push to manage numbers. And let’s be honest, numbers are easy to manage, people are hard to manage. You know what I mean?

Josh Vaisman:

Yes.

Dr. Andy Roark:

And there’s all these phrases like, if you can’t measure it, you can’t manage it. And we need to make this objective so that we can look and have a dashboard and see how we’re doing, because it’s easy to lie to ourselves. And man, it is easy to get sucked into that vortex of looking at these numbers. And so when I hear that, I think most of us wrestle with that. I would say in my career, I’ve done a pendulum swing a number of times. And I think that’s probably what most of us do is where we get really focused on our people and taking care of our people and then we start to say, oh, I’m getting close to not making payroll. Or there starts to be behavioral issues and you go, okay, we need to quantify this so that we can really track it or we can start to have very specific conversations with people.

Dr. Andy Roark:

And so then we start to track numbers and look at people clocking in and clocking out on time and absenteeism and things like that. And those are very valid reasons to get into looking at these numbers, but the staff sees that as well. And it’s just funny how our mind shifts over time and then it shifts back. So first of all, validate that struggle. Let me begin with that.

Josh Vaisman:

Yes.

Dr. Andy Roark:

Let’s talk about positivity and positive work cultures in vet medicine. So what do you see when you look at most veterinary practices? Do most practices do a pretty good job, a pretty bad job? Just give me a picture of the general landscape. When you look at your average vet practice, what are the things that you feel like most of them do right and what are the things that most of them do wrong?

Josh Vaisman:

Yeah, that’s a really great question, Andy. And I do want to validate that struggle, because that struggle is real and it can feel like it’s pulling you in two diametrical directions. I think there’s an opportunity to navigate the space between both.

Dr. Andy Roark:

Yeah.

Josh Vaisman:

And I think that that’s what the hospitals that do this well, that’s what they do. They honor and recognize that there are pulls and pressures from both sides, and that we can find a way to live in a both and world instead of an either or. And the hospitals that have an opportunity to do better, which I would venture to say is probably the majority of practices, do find themselves being pulled in one direction or the other and really struggling with that. A positive environment. When I use that word, positive, I recognize that that word can be a little bit loaded.

Dr. Andy Roark:

Yeah, totally. It’s a fluffy, fuzzy word that means a lot of things. And it’s gotten a lot of use recently and that always makes me go, all right. The meaning of this is really getting distorted probably.

Josh Vaisman:

Yes. Yes. Distorted is a great word to describe that. Yeah. So when I’m talking about positive, I’m not talking about ice cream and sprinkles every day at work. I’m not talking about this fluffy, everybody is best friends and we all hug it out all day long and it’s kumbaya and roasted marshmallows. That is not a positive environment, that’s an apathetic environment. That’s an environment of learned helplessness, that’s an environment that is not fulfilling. When we think about things like meaningfulness and impact and contribution and fulfillment, we don’t imagine scenarios that were full of joy from beginning to end. We imagined scenarios that had challenges, that were difficult, that we overcame and that there was maybe an environment of support or help in. And I think that’s what the practices that do this well recognize.

Josh Vaisman:

One of the things that I talk about, at Flourish, we have a leadership framework. We call it the four Ps of positive leadership. It’s something we’ve been working on for several years. We’re actually writing a book about it for AHA Press right now. And there’s these four pillars. And one of the pillars that we talk about is the progress pillar. And the progress pillar is really what we think of as the connective tissue of the entire framework. I often, when I’m standing in front of large audiences of hospital owners and practice managers and medical directors and I talk about leadership, I say, really, I don’t have to talk to you for two hours or four hours or six hours here, I can sum it up in two sentences. Other people matter, leadership is relationships. If you can really, truly embody and embrace those two statements, other people matter, leadership is relationships, then you’ll be an excellent leader.

Josh Vaisman:

And that’s what it really boils down to. But that can also be taken to that pendulum swing that you referred to. That can be taken to the extreme side of, I will solve all your problems. I’ll cuddle you, I’ll take care of everything for you. And that’s actually antithesis to positive leadership. If you’re the kind of leader who finds that, A, everybody seems to dump all their problems on your lap, or B, you take on everybody’s problems. That’s not an effective way to cultivate an environment that contributes to professional fulfillment, because that’s an environment of learned helplessness. We have to create leadership through partnership. A partnership in where, Andy, I care about your success and I care about you as a person. And I care enough to give you the kindness of helping you be the best version of who you can be.

Josh Vaisman:

And sometimes that means calling out your strengths and where you’re kicking butt and where you’re doing great. And sometimes that means we’ve got to have these difficult conversations where you’re falling a bit short of my expectations, because that’s the kind thing to do. Sometimes we think of positive environments as the nice environment, where everything is nice and we never say anything bad. But actually, a positive environment, a positive culture, positive leadership is about kindness. And kindness sometimes means calling people out when they’re falling short.

Dr. Andy Roark:

Yeah. No, I like this a lot. So the big thing as we talk about the struggle that a lot of people have of say measuring numbers versus the compassionate relationships. And I look at this and I say, okay, other people matter, leading is relationships. I get that. I think the part that people have to wrestle a little bit to get their head around, and I had to wrestle with this for a long time.

Josh Vaisman:

Sure.

Dr. Andy Roark:

Accountability is still a thing.

Josh Vaisman:

Yes.

Dr. Andy Roark:

You know what I mean? And I think that’s the biggest mistake I see people make. Is they’re like, okay, got it. Relationships matter, people matter, I got it. So what I’m hearing is, I just take care of people and I make people happy. And I’m like, no.

Josh Vaisman:

No.

Dr. Andy Roark:

That’s flawed. And I think that that’s an important point, because that is the difference between sunshine and rainbows, a bunch of fluffy, fuzzy garbage. That’s not true. And people getting walked on and people not having personal boundaries. I think responsibility and accountability are things that we have to bake into being compassionate.

Josh Vaisman:

Yes.

Dr. Andy Roark:

And you can do that. But to me, that is the middle path. That is the path that I think a lot of people struggle with. And so I very much like how you talk about relationships matter. And I agree with that as well. And I’ll say, relationships matter and relationships are built on trust, and trust matters.

Josh Vaisman:

Yes.

Dr. Andy Roark:

At the same time, anyone who’s ever worked at a business where people are not held accountable, or forget a business, a family. If you got people in your family who are not held accountable, you know what I mean? And who other people are just determined to make happy, those people are maddening. And I don’t have any of those people in family or extended family at all, ever. But you see those people … I make a joke, but you see people out in the world all the time who have never been held accountable and they’re not happy people.

Josh Vaisman:

Correct.

Dr. Andy Roark:

And you don’t want to spend a lot of time with them. And so that brings me to the other part of navigating this path, it’s balance, which means you do want to be compassionate to this person. But it is also your job as a leader to be compassionate to everybody else in the clinic as well.

Josh Vaisman:

Correct.

Dr. Andy Roark:

And so if you are being a pushover and other people are picking up the slack because you’re not holding this person accountable, you know what I mean? Or you are not telling them the truth and giving them honest feedback and saying, hey, you’re kicking butt in these ways, but you’re not kicking butt in these ways and it’s causing frustration to Pam, then you are not being compassionate to Pam.

Josh Vaisman:

Yeah. Yeah, I totally agree.

Dr. Andy Roark:

I like that. I suspect it probably threw some people for a loop when you said, oh, we’ve got donuts in the break room and sprinkles, and that’s learned helplessness. Unpack that a little bit more for me. When you say learned helplessness in the vet world, what does that look like?

Josh Vaisman:

Yeah. I want to talk a little bit about learned helplessness and this idea that we can learn to be helpless. Oftentimes, it’s subversive and it’s not something that’s necessarily overtly conscious. But we have to realize, people, all of us, every human being, we’re driven by a lot of basic psychological needs. And when those needs are unmet, that’s when we get these deleterious effects. These problems in a team environment or the problems that you hear about at the front versus the back and all that kind of stuff. To me, whenever I hear problems in a team environment, what I hear is there are needs in this environment that are being unmet. One of those basic needs is the need for autonomy. Every single one of us needs to feel like we are in some way, shape or form the captain of our own lives. That we have a voice and a say in the direction that our life is going.

Josh Vaisman:

When you have a team environment where somebody in leadership is the be all end all, whether that’s intentional or not. And I want to clarify something by the way, Andy. I’ve had the opportunity over the last several years to meet and interact with thousands of people in leadership positions in veterinary medicine. I can tell you with complete confidence, I’ll take this to my grave, I can count on one hand the number of actually bad human beings in leadership in vet med.

Dr. Andy Roark:

Yeah.

Josh Vaisman:

Most of the people, the vast majority of people in veterinary medicine who are in leadership positions truly want to do the best they can for and by the people that they serve. They want to create this kind environment where people feel happiness at work and fulfillment and all that kind of stuff. It’s just that nobody’s really ever taught us how to do that. And so what we do is we revert to what we know. Okay, I need to take care of people and make them happy, so bring me all your problems. I’ll solve everything for you. Or, ooh, I’m in the leadership position now, so I’ve got to be the person who’s the strongest and has all the answers and knows all the right things to do. And I can’t ever show any weakness in my armor.

Josh Vaisman:

All of that creates an environment that tells people two things, you can’t ever be wrong, so get somebody who can be right. And if you can’t ever be wrong, you can’t ever lean into the discomfort of trying new things and learning and growing and innovating and creating. And so essentially you have to put on this facade of everything is always good and right all the time. That’s impossible.

Dr. Andy Roark:

Yeah.

Josh Vaisman:

But people lose the sense of empowerment. If you work for a leader who either expects everything to be right or takes all your problems on, you have lost control over the environment. You have given that control to somebody else or they have taken it from you, which means you don’t feel a sense of autonomy. You don’t feel like you’re the captain there. That human need is unmet, you’re going to try and find it somewhere else. And most of the time in this environment of learned helplessness, that’s the whispers and complaints in the corners. Most of the time, that sense of empowerment and control is ruminating with somebody else on the team who gets it.

Dr. Andy Roark:

Yeah. No, that definitely makes sense. I hadn’t thought about the whispers and complaints as being a manifestation of autonomy. I think a lot about personal agency as a requirement. I think that that’s pretty much the same thing as what you’re talking about with autonomy. I don’t think that people can be happy when they don’t feel like they have some control. Right?

Josh Vaisman:

Yeah.

Dr. Andy Roark:

Imagine playing a video game where everything was so on rails that you just, you couldn’t mess up. And you go, how fun is that?

Josh Vaisman:

Right.

Dr. Andy Roark:

That’s some people’s jobs. And people say, well, my job is not a video game. And I say, well, there should be similarities. It should be challenging. It should be engaging. It should change. It should give you a feeling of accomplishment. That’s why people play video games, is to immediately have that engagement, that challenge, that quick hit of accomplishment. People aren’t too hard to figure out what entertains them in one way or entertains them in another way or what engages them in one way and engage them in another. So yeah, I think that that’s funny. The thought of, I’m the leader, I’m going to make this perfect to the point that my people don’t feel like they have any autonomy. I hadn’t really thought about that. I did think, when you were talking about the leader that doesn’t let people fail or that is there to solve problems, is the old Karpman drama triangle. The hero, villain, victim triangle.

Josh Vaisman:

I don’t remember that, please.

Dr. Andy Roark:

Oh, you don’t. Oh, yeah, okay.

Josh Vaisman:

I love Karpman though.

Dr. Andy Roark:

All right, so here we go. The drama triangle is the hero, villain, victim triangle.

Josh Vaisman:

Okay.

Dr. Andy Roark:

And what it says is generally when we have conflict, we tend to have three roles. We tend to have the victim who is the person who has been wronged. And we have the villain, who’s the person who did the despicable deed. And then there’s the hero, who is the person who comes in and saves the victim, punishes the villain, writes the wrong and rides off into the sunset. And that is the drama triangle. And think about your vet practice, think about the victim and the villain who the victim comes and complains about. And then they want you to be the hero.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

And the takeaway from the Karpman drama triangle and the thing I always hammer on people is, you don’t want to be the hero. Don’t be the hero. Because we have these people who are like, you know what, I am a professional hero. All day long, I’m a hero. And the problem with it is it makes you feel good. You’re like, yeah, I righted 10 wrongs today. And you’re like, you shouldn’t have had to write any wrongs, you should have done your regular job that you want to do and that you need to do. But you didn’t, you were protecting the victim all day. And so it really comes down to, don’t be the hero. Make the victim be the hero, empower the victim to be their own hero.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

And now you’ve got people who have some agency. They’ve got some autonomy, they’ve got tools in the toolbox to fix their problem, and they can fix their problem and navigate the course without having you to be involved. Of course, there’s problems that come up that need to go up the chain, but that’s not most of the problems most of us deal with all day.

Josh Vaisman:

Yeah. I love that. The drama triangle. That’s awesome. The hero and the victim and the-

Dr. Andy Roark:

I use it all the time.

Josh Vaisman:

Yeah. Oh, that’s awesome. See, I think that what we can also do to add to that is, we can shift our mindset around what it means to be the heroic leader. And see, I think that you’re right. I think that so many of us in this space, we try to be the superhero. The one who sweeps in and punishes the wrong doer and saves the one who’s been victimized. You’re right. I mean, it does feel good when you make that contribution to people’s lives. And it’s incredibly exhausting to be the hero all day, every day, and it’s disempowering to the people around you. You’re right, it removes any sense of agency. And when we lose agency, when we lose a sense of autonomy, we invariably become disengaged. We become demotivated. And that’s the opposite of what we’re trying to accomplish.

Josh Vaisman:

So what I think we can do is we can shift the mindset. We can create a new way of thinking of what the hero can be. The hero, rather than being the lifesaver, can be the kind of partner who sits down with people and says, I hear you. This is a struggle. I see how this is affecting you. How can we solve this together? And truly embrace that together part and be the partner. The person who can empathize, who can offer support and tools when people don’t feel like they have all that resources, and enable a sense of agency and autonomy. So they can actually, instead of being the victim, they can play a role as a hero as well.

Dr. Andy Roark:

Oh yeah. It’s the difference between trying to be Harry Potter and being Albus Dumbledore. Be Albus Dumbledore.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

Mentor Harry Potter to handle his own problems.

Josh Vaisman:

Yes.

Dr. Andy Roark:

Be Yoda, not Luke Skywalker. That’s where you’re doing the most good in the world. Right?

Josh Vaisman:

Totally.

Dr. Andy Roark:

I really like the idea that part of being a leader, part of being a business owner, because business owners are leaders, part of being a manager is growing people. And part of that is just because I find that deeply rewarding, to see people grow. And this is a big part of making people more competent, is not fighting their battles for them. God, this is the hardest part of being a parent. I totally want to fight my kids battles for them. That’s not my job and that’s not the best thing for my kids in the long term. But boy, those are hard muscles to work. No one teaches you how to coach. They think they teach you how to fix problems, they don’t teach you how to coach. And man, I think that that is one of the most undervalued skills that is out there.

Josh Vaisman:

Yeah. I totally agree. And that’s one of the biggest questions that I get. When I talk about these kinds of concepts, I think that it actually resonates with a lot of people. I think that actually the preference would be for most leaders is to have an empowered team that solves problems, that innovates and creates, that overcomes and is resilient, and that the leader is supporting in a supporting role instead of an overarching role. But then what they invariably ask is, well, okay, this sounds great, Josh, but I have no fricking clue how to do it. How do I do it? And you touched on that word. I think the very best leaders are leaders who coach up or coach out. But coaching is always essential to it, but coaching is an acquired skill and it’s not something that most of us naturally possess.

Josh Vaisman:

And so how do you do that? How do you have those kinds of conversations? See, I think when we get caught up in the day-to-day fires and we feel like it’s the 476 complaint that’s come through our door that day and I’ve still got a checklist of 74 items to get done by 6:00 and it’s already 4:00 PM and somebody comes in and complains about somebody, it’s really easy to fall into that habit of like, all right, Andy, I’ve heard what you’ve said about Diane and I’m going to fix it. And then just let Andy go. A coaching response would be, okay, Andy, I heard what you said about Diane and I can see how it’s affecting you. I’m curious, if you were in my shoes, what would you do?

Dr. Andy Roark:

Yeah. What options do you think that we have going forward?

Josh Vaisman:

Yeah. Coaches ask questions.

Dr. Andy Roark:

Yeah. What do you think we could do to prevent this from happening in the future? There’s three pieces of this, I think. So not knowing what to say, I think that’s the first one. Right?

Josh Vaisman:

Yeah.

Dr. Andy Roark:

So how do you coach, how do you ask those questions so that they figure out. When they come to you and they say, well, this is the problem. And you say, all right, what have you done to try to address the problem?

Josh Vaisman:

Yeah.

Dr. Andy Roark:

So the first one is they don’t know what to say. I would say the second thing that I see a lot is this … And this comes from me. It’s this twisted self identity leader thing.

Josh Vaisman:

Yes.

Dr. Andy Roark:

Where you are the leader and in order to be a good leader, you have to have the answer or you’re supposed to fix the problem. I do a little bit on this in one of my lectures and I put up a picture of General George Patton. And I’m like, I thought that this is what leadership looked like. And when you were a good leader, people didn’t question you because they trusted you. And they were like, oh, Andy knows the answer and he’s the boss, he’s a great boss. And so the great boss knows what the answer is and so we’re just going to do the answer. And I found that that does not exist outside the military. And if your people don’t question you, that’s a terrible thing-

Josh Vaisman:

Andy-

Dr. Andy Roark:

… because it means they trust you.

Josh Vaisman:

… I feel personally attacked right now. I mean, you have completely hit a nerve with me. That’s entirely the kind of leader that I was. I thought that I had to be George Patton.

Dr. Andy Roark:

I’m with you.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

Yeah. Oh yeah. So then my next slide is Kermit the Frog. I’m like, this is what a leader looks like. It’s like, Kermit gets questioned constantly about everything. And you know why? It’s because people trust him enough to tell him what they think.

Josh Vaisman:

Exactly.

Dr. Andy Roark:

And they think that he’s trying to do the best thing and he’s worth engaging with.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

And the George Patton to Kermit the Frog leadership shift, dang, that’s hard. And it’s hard because I’m naturally Muppet. And so just owning that and feeling okay about it and being like, this is a good identity for a leader, is to be questioned continuously from people who are good at their job and who care. And they ask you because they care. And to be criticized because people feel safe enough around you to say, hey, I’m not sure that this is the best thing, or you should think about this. The self identity thing is a thing, I think, that holds a lot of us back. And the last thing that I think holds a lot of us back too is, like so many things in leadership, what is easiest in the short term is detrimental in the long term.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

And so, I’ll just fix it. You know what I mean? You got a problem, just tell me and I will go talk to the other person or I will send the email or I will call the pet owner and I’ll just do it. And today, that is by far the easiest thing to do to move forward.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

The problem is, in the long term, I haven’t grown this person at all and I’m just going to end up doing this again and again. And so when you zoom out for three to five years, you’re going to say, that was a terrible idea. You could have had that person trained and empowered in the first six months. And then you would’ve had three and a half years of not having to deal with this crap. But you did what was easy in the moment and you paid for it in the long term. And so those are the three things that I see.

Josh Vaisman:

Oh, no., I think that’s incredibly insightful. I’m really grateful to hear that perspective from you, because I think you’re really spot on. You talked about the two additional things beyond what we were talking about, this idea of identity, self-identifying as a leader and the [inaudible 00:28:28] approach. And then you talked about what I heard as the urgency of the immediate and the urgency of the immediate seems to take over. And I’d really love to talk about those two things from a little bit of an evidence-based perspective. So there’s a researcher out of Wharton business school named Adam Grant, who I totally nerd boy over. I always like to joke, one of my claims to fame is I’ve gotten Adam Grant to exchange emails with me twice. So I feel pretty good about myself.

Dr. Andy Roark:

Well, give and take, [inaudible 00:29:01].

Josh Vaisman:

Yes. A little give and take. Excellent pun.

Dr. Andy Roark:

Thank you.

Josh Vaisman:

There’s going to be like three really nerdy listeners who are going to get that.

Dr. Andy Roark:

They’ll be like, wow. God. Okay.

Josh Vaisman:

Phil is going to be one of them, by the way.

Dr. Andy Roark:

Phil, that pun was for you, buddy.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

All right. Hey guys, I just want to jump in real fast and let you know that registration for the April 2022 Uncharted Veterinary Conference is open. We are live and back together in person. Again, downtown Greenville, April 21st through the 23rd 2022, because it is the five-year anniversary of Uncharted. That’s right, in 2017 we kicked off the first Uncharted Veterinary Conference. Single best live event I’ve ever been to in my life. I got to tell you. I mean, I was among the people who cried when it was over, because it was that amazing and awesome. Guys, if you have not been to Uncharted, you’ve never seen anything like it. It is truly a special, wonderful event. Yeah, it’s hard to explain. It is all about running smoother, more efficient, more enjoyable practices. That is what this conference is all about.

Dr. Andy Roark:

It’s about getting things done and enjoying the process of doing them. Gang, if you are not an Uncharted member, you’ll need to be one to be able to come. This is a member only conference. There’s only 150 spots. The reasons for that are plentiful, but mostly they involve the fact that Uncharted is a conference that never ends. There is stuff that goes on before the conference, there’s stuff that goes on after the conference. It’s just unlike anything else that’s out there. If you’re like, this is crazy talk. What is he talking about? Head over to unchartedvet.com and learn more. Guys, I would love to see you in April. Do not miss your chance to get your membership and get your spot. Like I said, there’s only 150. Guys, I can’t remember the last time I was this fired up about a live event. It’s going to phenomenal. And I would love to see you there. Now, let’s get back into this episode.

Josh Vaisman:

One of the things that Adam Grant is really passionate about, which is one of the reasons why I totally adore the man, is this idea of psychological safety. And you talked about that a little bit, you talked about the safety. That as leaders, if we put on the persona of being George Patton, what we’ve essentially done is created an environment through messaging that says we only tolerate perfection here. And if you can’t be perfect, keep it to yourself. The problem is, no human being is perfect, we’re all fallible. We all fall short. We all stumble. Nobody has all the answers and all the skills and talents. The only way that we can achieve the higher purpose of our work together is if we do it together. Collectively we are so much more resilient, more creative, more innovative, more able to accomplish things than we are as individuals.

Josh Vaisman:

But the leader sets the tone for that. And psychological safety is essentially this concept of in a team that it is safe. It is safe to say, hey, you know what, Andy, the way you did that, I’m not sure that was the right way. And I know that you’re not going to lash out at me or freak out or I’m going to get punished in some way, that we can actually have that conversation. So Adam Grant did some work in the Gates Foundation. He’s friends with Melinda Gates. And so they wanted to see what they could do to enhance psychological safety in the Gates Foundation. One of the typical approaches is we train managers on that and we tell them, okay, you know what, maybe you need to go have these vulnerable open-ended conversations.

Josh Vaisman:

And certainly, when they go through that training and then they go try it, when you measure psychological safety scores a week out, two weeks out, you do see an improvement. But the improvement doesn’t last because more often than not what happens is these managers say, okay, I’m going to have this vulnerable conversation. And then they get feedback that they don’t like or they don’t agree with. And then they’re like-

Dr. Andy Roark:

They’re telling me the truth, damn them for that.

Josh Vaisman:

Yeah. Damn them for that or this is the total waste of my time, and then they stop doing it. So they tried something a little bit different inspired by … Oh gosh, who’s the late night host who does the mean tweets thing.

Dr. Andy Roark:

Oh, Jimmy Kimmel.

Josh Vaisman:

Jimmy Kimmel. Yeah. So they had executives, including Melinda, who’s at the very top of this huge organization, do mean tweets videos. Where they took feedback that they had received and then on video they talked about it through the mean tweets kind of approach, but then also talked about what they learned from that feedback and how that feedback was valuable to them. And then they talked a little bit about constructive feedback that they’d gotten in the past and the value they got from that. They did not see the same immediate boost to psychological safety scores that they saw with that initial training. However, a year later they saw significantly higher psychological safety scores than they saw with the initial training. You see, doing this kind of thing, being the vulnerable leader, the kind of leader who says, this is not an environment of perfection, this is an environment of growth. This is where we learn and I have to learn too. And this is some constructive criticism that I’ve gotten and this is what I’ve learned from it.

Josh Vaisman:

This is what I’m trying to work on now and I’d really love to hear from you all now how I can be better here, starts to create that kind of environment long term. Which then leads to that second point you made, the urgency of the immediate. We do, we get caught up in the urgency of the immediate and we lose the capacity to think in long term. But the truth is, and there’s some really vibrant research on this too, when we put an immediate, sometimes painful but intentional investment into the long term. For example, in this particular piece of research I’m thinking about, where they implemented one-on-one programs that were nothing to do with performance evaluations, they were all about the employee. Where do you need more autonomy? Where do you need more support? How are you doing? What are you struggling with? How can I help you? Kind of meetings one-on-one with direct reports for a minimum of one hour a month.

Josh Vaisman:

So most of these teams, we’re talking like five, six, seven, eight people that the manager is sitting down with for an hour every month. To most managers, you share that and they hear, wait, you want me to work another full day just to sit down with my team and talk about these things? They did that for 18 months and they saw a double digit percentage increase in productivity and job satisfaction. They saw reduction in turnover, retention rates went up, all of this kind of stuff happened. And at the end of it, they asked the managers qualitatively, how did this impact your time doing this an hour per direct report every month? Did you find that you had to work more to get that done? Did you find that it didn’t really impact your time? Or did you find that actually it increased the amount of time you had available? The average response from these managers, I found I had an extra seven hours every month to get my work done.

Dr. Andy Roark:

Yeah. We do a lot of that stuff. So I run a group called Uncharted, and so we do conferences and we have an online community and stuff. And one of the struggles for me personally, when getting Uncharted up and going, was there are things like that that I just believed deeply in that I would say to people. And I would say, hey, we’re going to talk about having effective one-on-one, so we’re going to talk about getting your leadership team on the same page with you. And we’re going to talk about strategic planning and we’re going to talk about these different things. And the pushback from so many people is, I don’t have time to do strategic planning and I don’t have time to do one-on-ones.

Dr. Andy Roark:

And God, that’s probably the biggest trap that I see. Is there are some of these things that are so transformational and people go, I don’t have the time to do it. And I’m like, but if you did it, you would have the time. You know what I mean? It would open up so many other things. And it’s that first painful thing. So just the path of what’s easy and convenient right now in the short term hurts the long term. That is the greatest trap in life, is how many things are easy now. Think about how much we use social media. I’ve got five minutes to kill. The easiest thing for me possibly is pop out Instagram and scroll through it. But then the problem is, I got five minutes to kill again and again and again. You look at the end of the week and I “killed” three hours over the course of the week.

Dr. Andy Roark:

You know what I mean? And had I popped my Kindle app open, I could have read 10 chapters of something actually meaningful and that helps me be a better person, however I want to be, or that I would remember. Instagram is just like, what did you look at today? I have no idea. There was dancing, there were people jumping and then they were in a different outfit than they were before.

Josh Vaisman:

There were kittens.

Dr. Andy Roark:

There were kittens. Yeah, exactly. Yeah. Or it’s like, there was that dog running in circles. That’s the most memorable thing I saw. But yeah, it’s that way. But it’s not like the one-on-one and stuff like that, it’s really trying hard to cajole people to do the thing that’s not easiest in the moment.

Josh Vaisman:

Especially when you don’t get that immediate feedback of the value of it. When it doesn’t feel like it’s making a difference now, it’s really easy to let go and lose motivation for those things. We did some work with the hospital. We started working with them about a year ago now and they came to us … Large practice, over 150 employees. They came to us for a lot of the same reasons that a lot of folks are coming to us these days. We’re struggling, we’re overworked, we’re under-resourced, we can’t find help, the caseloads are through the roof. It’s insane, what do we do? People are leaving and we need to help them. And so we conducted a large discovery process. We did some wide sweeping surveys and really touched base with the team and the leadership to get a good idea of what was going on. And it’s interesting, one of the clear themes that emerged through this process was people really crying out for connection.

Josh Vaisman:

We feel disconnected, we feel so overwhelmed by the work that we’ve lost touch with each other and we just need to touch base. So that screams for one of these effective one-on-one programs that you’re referring to. But of course, you can’t really go to a team like that and say, okay, here’s what we’re going to do. We’re going to cut out seven hours once a month where you’re all going to meet and sit down. That felt like way too much for them, a quantum leap. So we thought, well, gosh, how could we do this incrementally? And this is what they came up with, which I thought was genius. They said, hey, what if we just recruited people to conduct these mini check-ins and we’ll make it no more than 10 minutes once a month. We’ll divide the team up so that everybody has no more than five or six people they got to check in with and we’ll create a standard framework for how this is going to work.

Josh Vaisman:

We’ll create a small committee, we’ll put these three people in charge of overseeing a program and being of support. And we did, we implemented that. We did a coach the coaches kind of training and I sat down with these … By the way, 34 people in the hospital volunteered to conduct check-ins, which was amazing.

Dr. Andy Roark:

Yeah, that’s great.

Josh Vaisman:

And we just trained them on coaching concepts and how do you conduct a check-in from a coaching perspective and talked to people in that way. And then we implemented that program. Eight months later, we redid the surveys and we looked at some of the quantitative scores. And one of these things was a measurement on just the team’s self-perception of resiliency. We saw those resiliency scores. So we divide them into categories of how we view people in terms of their perception of their resiliency. I feel like I’m doing pretty good despite the challenges I face or I’m struggling or I’m just getting by. We saw the low end of that. The people who said they were really struggling at the beginning of our work with them was at 12%. Eight months later, we had cut it down to 4%.

Josh Vaisman:

The people who were in those, I feel like I’m actually doing pretty good despite the challenges I’m facing, went up by 17%. All by just doing this little check-in intervention. And that was through a period of time that by the way I think you would agree as somebody who’s in practice. From last October to this October, have things gotten easier in veterinary medicine?

Dr. Andy Roark:

Yeah. Not remarkably, no.

Josh Vaisman:

Yeah. So I mean, that I feel like is a tangible in our profession. Something that shows that this stuff, it really does matter. Putting a small, incremental investment now into a long term relationship with your team will pay dividends.

Dr. Andy Roark:

Yeah. No, I like that a lot. Two comments I think that I want to make. The first one is maybe a little dicey here, so I’m going to be careful how I say this. I think that one of the mantras I hear on social media that always makes me cringe a little bit, I think that there’s this idea that’s out there that I’m tired. Let me start with a caveat. I think a lot of us struggle to understand how we really feel and what we really need. I think most of us don’t really know. If I said I’m not happy right now and you said, Andy, what do you need? I don’t think I can tell you like … I’m not going to be able to list three things that I need.

Dr. Andy Roark:

That’s not the case for me at the moment, but there have been times I’ve been unhappy and if you said, what do you need to be happy? I’d be like, if I knew that, I would’ve done the thing that I needed to be happy and this would’ve been over. And so I think a lot of us struggle with that sometimes. We know that we don’t feel good or we know that we’re not enjoying our work like we used to, or we know that we seem tired. And it just seems like that part of that is a human condition, it always comes in waves. But I think we’re generally pretty craptacular at putting our finger right on what we need. And so I see a lot of narratives that say, we need more time off, we need to rest more, we need to relax more.

Dr. Andy Roark:

And again, I don’t know the specific circumstances, it’s very context specific. So in some cases that may be true. I think for most of us who say we’re tired, it’s probably not really about the hours that we’re working. It may not even be with the speed with which we’re working. It’s often something else about how we feel about our work, how we feel about how other people see our work, our appreciation level. A lot of it is, we feel like how successful we are. We’ve all done things before where we’re like, I’m doing this and I suck at it and it’s terrible, versus I’m doing this and I’m doing a thing and I’m great at it. And I’m scoring points and people are like, damn, you’re killing it, buddy.

Dr. Andy Roark:

You know what I mean? And I’m like, I can do this all day. Because I feel like I’m doing a good job and there’s this rewarding thing and I’m getting positive feedback. And so when you talk about moving to these types of check-ins, things like that where we connect with each other, I think for most of us, finding things like that really does so much good. And again, I’m not trying to downplay other people’s concerns when they say, oh, I need time off or I need to rest. That may very well be true. But I think for our profession as a whole, I think most of us really do benefit by thinking more deeply about, how do we connect? What makes us feel appreciated? What do we need to have psychological safety here? And things like that.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

I like Adam Grant’s stuff for sure. I really think the power of vulnerability and leadership is really important. And I think it’s really scary for a lot of people. They go, I don’t know how to be vulnerable because I don’t want to lose credibility. And so there is this thing too of like, I don’t want to see my boss as a crying, sobbing mess.

Josh Vaisman:

Correct.

Dr. Andy Roark:

Not as a regular thing anyway.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

But generally, I do like to feel like my boss is confident and still being open. And so there’s a balance in this. I think for a lot of people who have maybe not led with vulnerability or never been comfortable with before, I think right now is a really good opportunity. And I’m curious what you think of this, but as far as trying out vulnerability and flexing the leadership muscle, I think a lot of people right now are dealing with tired teams.

Josh Vaisman:

Yes.

Dr. Andy Roark:

And I think a lot of people are starting to see some maybe negativity in their practices that didn’t use to be there. Maybe not overt, but maybe just some eye rolling, maybe just some snarkiness. And it comes from fatigue, I think. And I think those types of problems are the best time to flex your vulnerability muscles as a leader. And you can go to the team and you can say, guys, I’m noticing that we’re not getting along as well as we used to and I don’t know what to do about it. And honestly, I know that I’m having some grumpy days as well and sometimes I’m not the nicest person to be around, but I don’t want to be that way and I don’t want our team to be that way. And I want to talk to you guys about why this is happening and mostly more importantly, what can we do to write the ship? What can we do to get along better and to feel more supportive of each other? And I like that as a 101 level vulnerability conversation.

Josh Vaisman:

Totally.

Dr. Andy Roark:

But just saying, I don’t know what to do and I own the fact that I’m probably part of this problem. I’m sure I’m part of the problem, but I don’t want to be and I want to work with you guys to figure out what we can do.

Josh Vaisman:

Yeah.

Dr. Andy Roark:

I just feel like a lot of practices are struggling with that problem right now and I really think that vulnerability is the key. You might be able to roll out some appreciation program like, guys, this is what we’re going to do. We’re going to have smile books and-

Josh Vaisman:

Smile books.

Dr. Andy Roark:

But yeah, you may have a great thing, I don’t. I got to go to my people and say, I don’t know what to do.

Josh Vaisman:

No, I love that.

Dr. Andy Roark:

But I love you guys and I want to be happy here. And I know you want to be happy here.

Josh Vaisman:

I’m listening to you describe this opportunity for vulnerability and how you would talk to your team, and I’m thinking to myself, I think I’m going to send Andy my book manuscript and just have him revise it. I mean, that is spot on what positive leadership is about. I think one of the challenges that people have … because you’re right. Again, this is like what we were talking about at the beginning of this conversation, that sort of being pulled in two directions. And it’s really easy to teeter-totter between the two poles, the extremes. And I think there’s an opportunity in between, the both and. That’s where that both and lives. That tensional space in between two polls is where often the most vibrant and effective approaches live.

Josh Vaisman:

And what you just shared was between the approach of action and vulnerability. See, I think that a lot of us, when we hear talk about vulnerability, we hear what Brene Brown talks about, we hear what you’re talking about, what I’m talking about, a lot of us can’t help but hear only the vulnerability piece. And that feels like, well, I can’t show a kink in my armor, I’m the leader. They won’t believe I’m credible. They won’t follow me anymore. It’s not vulnerability by itself. You can’t stop at vulnerability.

Dr. Andy Roark:

Yeah, quite.

Josh Vaisman:

There also has to be action. And that’s what you just said. It’s vulnerability to sit down with your team and say, guys, listen, things are not going well right now. And we are overwhelmed and I’m probably just as guilty of the shitty attitude as I’m seeing around us. And that’s not okay, I don’t want it to be this way. We got to be better together because we’re in this together. That’s vulnerability. But if you stop just there and that’s all you ever do, yes, the team will eventually see you as the person who doesn’t know what they’re doing and doesn’t have the answers. And why would I trust that person?

Dr. Andy Roark:

Right.

Josh Vaisman:

What you just did was, you followed it up with, okay, let’s talk about why we think this is happening. And perhaps more importantly, what we can do about it together.

Dr. Andy Roark:

Right.

Josh Vaisman:

Because we are in this situation and scenario, these are the tools and resources we have, things are not going to just change on their own. Caseloads, they’re not going away.

Dr. Andy Roark:

Right.

Josh Vaisman:

The staffing shortages that we have, it’s not like Santa Claus is going to deliver a whole bunch of veterinarians and technicians.

Dr. Andy Roark:

Yeah.

Josh Vaisman:

That’s not going to change. So given that we’re here together and we want it to be better, what can we do?

Dr. Andy Roark:

Yeah. That’s right. I think this is such a good workout tryout for a vulnerable approach, because it does lend itself to, what are we going to do going forward? And that’s why I said, why is this happening? More importantly, what are we doing in the future? I think a lot of people get tied up in dissecting what’s going on. And really, the truth is, what’s done is done. It doesn’t matter why we felt crappy two weeks ago, what matters is how we’re going to feel two weeks from now.

Josh Vaisman:

You just touched on something that is very, very important to me. It’s not a mindset that I always had. I had to develop this mindset. But when we get fixated on dissecting the problems, what we’re doing is we’re trying to make things better by eliminating. And eliminating problems never contributes to innovation, to new ways of doing, being, or feeling or any of that. To loosely steal Dr. Martin Seligman’s words, the absence of mental illness is not necessarily mental wellness. Often, when I talk about this leadership stuff, I paint a picture. Just imagine the scenario, you go to bed tonight and a miracle happens. And overnight all veterinary debt disappears, everybody in this space gets triple the pay, you never have to work a minute over 35 hours a week, you never get double booked and every client also got triple pay.

Josh Vaisman:

And so that means that every client is now ready to say yes to all your recommendations. Glorious scenario. Sounds amazing. And I watch people’s eyes light up. And then on next slide I say, do you think in this miracle scenario that everybody in veterinary medicine with a snap of a finger would be happy and fulfilled? And everybody in the room shakes their head, no.

Dr. Andy Roark:

No way.

Josh Vaisman:

Because we all know that elimination of problems is an important thing, we have to work on that stuff. But elimination of problems alone does not create fulfillment. Fulfillment is cultivated by adding things into the environment. And that’s what you’re trying to do with that conversation, that vulnerable conversation with your team. You’re looking at the problems, you’re honoring that, you’re giving them the space to share and looking what we can add to make the best of the situation we have.

Dr. Andy Roark:

Yeah. Josh, I love that. I want to unpack that more with you. I think we’re going to be out of time for now. So will you come back and talk with me more about that in the future?

Josh Vaisman:

I’d love to. Andy, this is a joy for me, to chat with somebody like you, who just clearly gets this.

Dr. Andy Roark:

Oh, thanks. I enjoyed this as well. Where can people find you online? Where can they learn more about Flourish Veterinary Consulting?

Josh Vaisman:

Yeah. So our website is just flourish.vet, F-L-O-U-R-I-S-H.vet. You can find me on LinkedIn, I’m pretty active on there. We’re on Facebook as well. And then just at various conferences and things around the country.

Dr. Andy Roark:

Awesome. Thanks, Josh.

Josh Vaisman:

Thank you, Andy, appreciate you.

Dr. Andy Roark:

And that is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. I hope you’re like, ah, I see why Andy said at the very beginning that this was a good episode, because it was. I really enjoyed it. Guys, if you enjoyed it, leave me an honest review wherever you get your podcast. That’s a nice thing that you can do and it means the world to me. Other than that, guys, I don’t have anything else for you. Have a wonderful day. I hope this gave you some really good food for thought. Hope you’re enjoying your holidays. Take care. Be well, bye.

Description: Dr. Andy Roark has a tough case! A rambunctious 3 month old tabby kitten won’t stop attacking his owner! He stalks her, pounces on her ankles from under the bed and rabbit kicks her hand when he gets the chance. It may sound funny, but his owner is fragile and can’t have this keep happening. Luckly, Ingrid Johnson, a feline behavior expert, is here to talk through the case and how she would tackle it.

LINKS

WORKSHOP: It’s All Fun and Games – How to Play, Engage with and Reward Your Team: unchartedvet.com/product/its-all-fun-and-games/

Fundamentally Feline: www.fundamentallyfeline.com/

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Ingrid Johnson is a Certified Cat Behavior Consultant (CCBC) through The International Association of Animal Behavior Consultants (IAABC). 
Ingrid owns and operates Fundamentally Feline, providing in home consults for locals and virtual consultations worldwide for clients experiencing behavior challenges with their cat(s). In addition to behavior consults, Ingrid also offers medicating consultations to help clients overcome, or get ahead of, medicating challenges. Prevention and training, the best medicine! She makes her own line of feline foraging toys, scratching posts, vertical space, and litter boxes. She lectures nationwide on cat behavior at veterinary conferences such as AAFP, VMX, ACVC and the like. She is employed at Paws Whiskers and Claws, a feline only veterinary hospital, as a tech, groomer, and office manager and has been working exclusively with cats since 1999.

In the Fall of 2016 a paper she co-authored, Food puzzles for cats: Feeding for physical and emotional well-being, was published in the JFMS (Journal of Feline Medicine and Surgery) and to compliment it she co-developed FoodPuzzlesforCats.com. To date it is the most popular and widely downloaded paper in the history of the journal! Ingrid’s home, cats, and environmental enrichment expertise has been featured on Animal Planet’s Cats101 show and featured in numerous publications including the website WebMD. She has created a series of educational How-To videos of her own, viewable on Fundamentally Feline’s website and YouTube channel. Ingrid regularly interviews and offers her expertise for various media outlets. She is Co-Director of Paw Project-Georgia, working towards ending the cruel practice of de-clawing cats. 

Cat Fancy magazine’s 2008 “Home Issue” showcased her feline friendly accommodations and the aesthetically pleasing ways you can provide for your cats innate basic needs while still having a home the humans can enjoy. Ingrid is a huge advocate for enrichment and is determined to thwart the belief that one’s home will look unsightly in efforts to provide it. 

Ingrid shares her home with husband Jake, five rescue cats, and Sebastian, a rescued Great Pyrenees Dog. Follow Fundamentally Feline on Facebook, Twitter, Instagram and You Tube!

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

SHOW TRANSCRIPT

Dr. Andy Roark:

Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a fun one today, got a good one today, got a useful one today. My friend Ingrid Johnson, feline behavior expert, is back with me to talk about a tough case. I’ve got a rambunctious kitten that’s pouncing on his demure owner, who doesn’t handle being scratched and bitten very well for legitimate reasons. Is this just what it means to have a kitten? Is there any way these two can live together? What other pieces of advice that I can give her that are going to be helpful? Let’s get into this episode.

Kelsey Beth Carpenter:

This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:

Welcome, Ingrid Johnson. Good to see you again.

Ingrid Johnson:

Hi, there. Thanks for having me back.

Dr. Andy Roark:

Always, I love having you on the podcast and I appreciate you being here. I love talking cat behavior with you. You are super fun to chat with and I always learn stuff when we talk, so yeah.

Ingrid Johnson:

I always have a good time. I love doing these, so thank you.

Dr. Andy Roark:

Well, I’ve got one for you. I want to ask you about a case that I’ve got and I’ve got this very nice lady. She is a librarian. She is just a very demure, quiet lady that I think the world of. And she has a three-month-old male tabby cat and she brings him in to see me. And I think he’s very fun. We have a lot of fun in the exam room. He chases cotton balls. You know what I mean? And bats things around and I love a cat that loves the little toy fishing line and he goes right after it.

Dr. Andy Roark:

Anyway, at home, he’s a predator. He attacks from under the bed skirt. He grabs and he alligator rolls. He invites her to pet his tummy and then he grabs her and then he just bunny kicks the crap out of her with his back feet.

Ingrid Johnson:

Classic.

Dr. Andy Roark:

He comes off the top rope with a flying elbow. He’s a one cat professional wrestling company. And his mother, she doesn’t want to participate in his WWE fantasy. And she’s asking me, “What do I with this? Yeah, what do I do with this?” And she holds out her hands and she’s got little kitten needle teeth. It’s KNT. It’s a disease that I think we should write more of the awareness of the KNT and the PNT, the puppy needle teeth and the kitten needle teeth. And so I feel bad and for her, she’s a little bit older person and she’s got some concerns about getting bitten, honestly. So yeah, that’s a lot to drop on you but help me out. How do you treat this case? Where should I get started trying to help this person?

Ingrid Johnson:

How much time you got, Andy?

Dr. Andy Roark:

Yeah, yes.

Ingrid Johnson:

Well, my very first and foremost suggestion, if the client is willing, is to get another kitten.

Dr. Andy Roark:

What? Really?

Ingrid Johnson:

ASAP.

Dr. Andy Roark:

You’re like, “You know what? I know this is terrible. Let’s double it.” And that will-

Ingrid Johnson:

Had we gotten a pair of babies from the get go, this behavior may not be happening at all. It might. Some cats will still do that but it’s just that they need an outlet for their predatory aggression. They’re practicing their hunting instincts and their killing blows and they [inaudible 00:03:57] practice on something. And well, when mom moves across the living room floor, she’s prey and it’s really fun to bust out from under the bed skirt and attack the prey. And then she probably vocalizes, which is very exciting because now we’re screaming and squealing just like real prey.

Dr. Andy Roark:

Yeah, that makes a lot of sense. You look at the kittens and you see them doing these things and they’re clearly hardwired. It’s actually fascinating to watch. It’s evolution and-

Ingrid Johnson:

At its finest.

Dr. Andy Roark:

And yeah, exactly, at its finest of, this was baked in and it totally is. So okay, that does make some sense. And it- [crosstalk 00:04:39]

Ingrid Johnson:

Have a pair, they do this to each other and then the human hands are reserved for love and affection. But since they don’t have an outlet for it, anything’s fair game in the house and it could be the family dog, too.

Dr. Andy Roark:

Is there an age range on that or is there a place where you say, “As a kitten, it’s really good, but if there was an older cat I wouldn’t do it or at some point, it becomes more of a headache to introduce another cat”? Any considerations like that or is that-

Ingrid Johnson:

Oh, absolutely.

Dr. Andy Roark:

A go-to whenever you see this?

Ingrid Johnson:

That’s a great question. So their early socialization period, that’s sealed in pretty early. I mean, by nine weeks of age, they’ve learned a lot of their social skills and their ability to interact with other cats and what we call bite inhibition. So when you start getting into six, eight, nine months and that cat’s lived alone all of those months, it can be very difficult to introduce a new kitty because their instinct is oftentimes to be aggressive towards that cat. They don’t know how to cat. Now there’s exceptions to every rule, right? I mean, there’s totally exceptions to this rule but as a whole, the older the cat gets and the longer they’re raised as a “only child,” the harder it can be to ever bring in another cat. So, it’s not too late at three to four months. I would give it a whirl and I would get another male.

Dr. Andy Roark:

Okay. Tell me about that a little bit. Why do you say another male, I mean, if I’m going to neuter and spay both cats?

Ingrid Johnson:

Yeah. Male cats like to engage in physical rough house play really well into their teens. And again, while there’s exceptions to every rule, you get a little female kitten, she’s going to give him a run for his money for a while. But once they hit two to three years of age and they’re in social maturity, she’s going to be a like, “Really rather sit and watch the birds out the window and play with the feline flyer. We’re not wrestling anymore. That’s dumb,” so the physical rough house starts to subside more in the females. Doesn’t mean she can’t hold her own with him, but she’s just not going to give him as much of a run for his money as another boy would for 15 years.

Dr. Andy Roark:

Yeah. No, my wife and I had that dynamic. I get that. All right. What else? I get that. That’s been my experience as well.

Ingrid Johnson:

Crosses many species.

Dr. Andy Roark:

Yeah, so that’s number one, is another cat. Moving on, number two.

Ingrid Johnson:

Moving on to they don’t want another cat.

Dr. Andy Roark:

Right. So yeah, I don’t know. Honestly, I think you make a good value proposition. Especially at three months of age, that seems pretty reasonable to put forward, but whether she takes it or whether she doesn’t, I’m assuming there’s probably some other things I want to start to unpack as well.

Ingrid Johnson:

Yeah, absolutely. Well, we do have to make sure that we are reserving our hands and feet only for affection. A lot of people have created this behavior because when they’re six weeks, it’s super cute when they are ferocious little adorable fuzzballs attacking your hands. But as this client and many others may start learning, they are carnivores with sharp teeth and claws and when they’re 12 pounds and don’t know when too much is enough, then it really hurts. So, it’s really, really, really important that we focus on a lot of interactive play here and reserve hands for only affection. And I will say, and this is pretty difficult homework assignment when you’ve got a baby, and this is probably my second least favorite homework assignment to recommend. I have clients stop touching their cat for a couple of weeks. They can train. They can play. They can use their food puzzles. They can do all kinds of fun activities with their cat, but no petting. And when they start to introduce petting again, we’re going to just stick to the head, neck, cheek and chin, and we’re going to only give them a couple little scratches and strokes and immediately stop and always leave them longing for more affection so we don’t push them to the point where they roll over and grab our forearm and bunny kick our forearm.

Dr. Andy Roark:

Gotcha. Okay, I had to sit with that. I don’t know that I, as a full grown man, have the willpower to not… I was like, “Wow.”

Ingrid Johnson:

[inaudible 00:08:33].

Dr. Andy Roark:

I know. I love to pet a kitten. But no, it makes some sense. Okay, cool. That definitely makes sense. I really like the idea of reserving hands for affection. Yeah, that definitely does make some sense. I imagine in practice, once you come up with some workarounds and you have some things to play with them, you know what I mean? Some toys, if you’re doing things like that, that it is feasible to do for sure. But honestly, I could a hundred percent. Now for the client that I’m talking about, this seems very reasonable. You know what I mean? Because she’s not a rowdy cat owner. She wants a little companion. And I think that that is something. She might jump at the chance to be like, “Yep, sounds great. I’m on board. I’m just going to do some head petting and that will be that.” So, okay, I do like that a lot.

Dr. Andy Roark:

So we’ve talked about getting another kitten, reserving hands. We’ve talked about using toys and things like that and again, just starting to reintroduce petting to make sure that everybody’s on the same page, yeah. What else?

Ingrid Johnson:

And again, I mean, this is a predatory behavior, right? So this is just cats being cats, practicing how to be a grown up cat. So, that means just amplifying these suggestions times a hundred. So, getting on a play and feed schedule would be really important so we get an outlet for predatory aggression prior to a meal, our “kill.” So playing before you feed, really important. I feel like we talk about that almost every time we chat, but that’s okay because everyone needs to [inaudible 00:10:07].

Dr. Andy Roark:

But it’s good and people need to hear it and honestly, I need to keep hearing it because it’s one of those things that diffuses out of my brain over time. But yeah, it makes a ton of sense and it’s just a good recommendation [inaudible 00:10:20].

Dr. Andy Roark:

Hey guys, I just want to jump in with one quick update, something I want to put on your radar. On December the 12th, we are doing our last Uncharted workshop of the year. It’s called It’s All Fun and Games, How to Play, Engage, and Reward Your Team. And if you hear that and you’re like, “Oh man, I would like to play, engage and reward my team. That sounds like a fun thing for me to do at the end of the year. I would like to have that positivity in my practice right now. I would like people to be happy at work and to feel like we want to take care of them. That’s what I want.” Well then guys, don’t miss this workshop. It is coming up fast so you’re going to have to jump on it. Like I said, it’s December the 12th. It is from 4:00 to 6:00 PM Eastern time, 1:00 to 3:00 PM Pacific time. It is free to Uncharted members. It is $99 to the public.

Dr. Andy Roark:

If you’re looking at your CE budget and you’re like, “I got some money left in my CE budget,” you should be an Uncharted member. You should. I mean, duh, you should be an Uncharted member. You should go ahead and get your membership and then come to this for free. And it’s going to be great. Guys, Uncharted really is a smoother, simpler, faster, better way to run your practice and run your career. You are the average of the people you spend time with. Come and spend time with us. This is going to be a fantastic year coming up. You should be a part of it. Unchartedvet.com. I’ll put a link in the show notes. Now, let’s give back into this episode.

Ingrid Johnson:

And then I think we have to really focus here on interrupting and redirecting the behavior. And sometimes we don’t have to do much to interrupt the behavior. We could simply just redirect, but that means we have to set ourselves up for success all over the home. And so the families have to equip themselves with interactive wand toys or some of those nice long kick pillows. If you guys are familiar with kick pillows, they basically serve the purpose of the forearm that the kitties, grabbing and kicking. When cats kick that forearm, what they’re doing is mimicking eviscerating their prey. We call it bunny kicking for a reason, right? They catch a rabbit. It’s a rather elongated body and they have to kick the stomach of the rabbit and slice it open. And then boom, now we have our meal prepared for us. So they’re just-

Dr. Andy Roark:

That’s not at all why I thought it was called bunny kicking. I thought it was called of bunny kicking because bunnies kick with both feet as they run happily through the field in the sunshine amongst the flowers, Ingrid, not because their guts are being torn out for a meal.

Ingrid Johnson:

Well [crosstalk 00:12:48]-

Dr. Andy Roark:

In your horror world, that’s what it’s called bunny kicking for.

Ingrid Johnson:

Are we going to wait to air this for next Halloween?

Dr. Andy Roark:

Exactly, we’re going to hold on to this now for a year. Okay, so first of all, I’m going to have to google bunny kicking [crosstalk 00:13:03].

Ingrid Johnson:

Okay, maybe some of it is about bunnies jumping through fields.

Dr. Andy Roark:

I don’t know. I’m like, “God, I feel naive. I feel like my rosy world view is a lie right now,” is what I think. Okay, [crosstalk 00:13:14] Kick pillows, I love it. I’m sorry. I did not mean to derail us with that but I was reeling. So, okay. So kick pillows, I do love it. I mean that makes a ton of sense, to give them other things to attack on.

Ingrid Johnson:

Yeah [crosstalk 00:13:28] insert appropriate.

Dr. Andy Roark:

Yeah, totally. Let me make some suggestions and you tell me. You give me a thumbs or thumbs down. It seems like probably when we talk about puppies as well, a variety of toys are good to have, different toys for different purposes, different needs that they have. Then also, probably each individual is going to have types of toys that they tend to like and resonate with. Is that true?

Ingrid Johnson:

Absolutely, 100%. Cats can be very predatory, prey-specific. And so they might only like birds and they might only like things that fly. They might only like snakes things, things that slither and they want to play with strings and shoelaces but they might be non-discerning and just go for everything you get. But I think we all have to accept. For some reason, people don’t accept this as much with cat toys as with dog toys. You’re going to waste some money on some stuff the cat’s not going to be more motivated to chase and that’s okay.

Dr. Andy Roark:

Yes, we see that a lot, too. People are like, “I got her toys and she just didn’t do anything so I stopped buying them.” And I’m like, “I need you to go back to the store.”

Ingrid Johnson:

Yeah, exactly. You just haven’t found the thing yet that gets them going. And also we need to learn how to play with our cats. We’ve got to evoke that prey drive. Move away from them, evoke chase. Hide behind the leg of a chair and writhe around in pain and scooch under some tissue paper and really give this guy a chance to pounce and kill stuff. Not just laser pointers because laser pointers offer no satisfaction, nothing tangible to kill.

Dr. Andy Roark:

Right, a lot of chasing and then no satisfaction. Can you talk me through a couple things about talking to pet owners about interruption and redirection? And I feel like the stakes are a little bit high here because I think that people can grab onto interrupting and redirecting and make this a traumatic experience for the cat. And correct me if you don’t think I’m right, but in my experience, I’ve had concerns in the last couple of years of like, “Oh man, I think people get a little carried away with this,” or they end up making the cat really frustrated or evoking bad behaviors through their attempt to interrupt. Can you help me to coach people with that?

Ingrid Johnson:

Well, what we want to do is not instill fear. So, I once learned from another behaviorist and I’ll snag it and reiterate it here. We want a yuck response. So if we do something to correct a behavior or stop a behavior and they run a [inaudible 00:15:51] for three hours, we’ve instilled fear and that cat might now start to fear us and we’re not fixing anything. We’re just terrifying them.

Dr. Andy Roark:

Right, it sounds like we’re creating more problems. We get some anxious behaviors, litter box problems, things like that. That’s exactly what I’m not-

Ingrid Johnson:

Exactly. And I’m not a fan of the water bottles, but just as an example, some cats, you spray them with water and batting at the stream. They could care less. Well, that’s just play so you’re also not doing anything effective there. So punishment really isn’t effective for most species most of the time, right? So when we’re doing things like spraying them with air and spraying them with water or doing any of these scary things that we think are somehow scolding them or correcting them, we’re often just terrifying them and then we’re not giving them an appropriate outlet for the behavior. So people often say, “Well, why are we trying to play with them with a feather toy when they have just attacked my foot? We’re rewarding them for attacking the foot.” I’m like, “We’re not rewarding them. We’re giving them an appropriate outlet for this energy and that’s what we have to overcome.”

Dr. Andy Roark:

Yeah, that’s so insightful because I hear that exact thing. Is this is rewarding? And people have this justice thing about it like, “You don’t get toys when you bite me.” And I go, “We have to reframe this in your mind.” I think that’s really helpful. Awesome. That is super useful. So we’ve talked about getting another kitten, reserving hands for affection, play before feeding, timing, things like that, and then finally, interruption and distraction. I feel like this is pretty good little set of tools. Is there anything else I want to touch on?

Ingrid Johnson:

I think one of the other things I want to mention is, and I know this is really, really hard for people, but freeze and try not to react because say the kitty attacks the ankles and you pull away. Well, that’s what a prey does so we’re going to want to dig in harder. So, freeze and be so boring like a tree that we eventually just give up and walk away because the foot is no fun. And same thing with any of our body parts. If we get a little bit of a finger nibbling or anything, we want to make sure that we don’t vocalize and scream and squeal like prey.

Dr. Andy Roark:

I’m sorry. I made a face at you. I didn’t mean to. I felt myself making a face because I was imagining this tabby cat just attached to my arm and me trying to keep a straight face. And I felt my face bending into this redness of hidden pain like, “Ooh, that feels uncomfortable but I’m freezing.”

Ingrid Johnson:

I have had some people successfully booby trap themselves. They’ll wrap their arm in something yucky or one little trick is crazy, but double-sided sticky tape all over the bottoms of your pants or some rain boots or some just crappy boots that you don’t care about. And when the cat dives at your ankles, they get a whole bunch of sticky tape, which is really unpleasant. So, you got to keep the tape fresh. That’s a lot of tape on your boots and jeans.

Dr. Andy Roark:

That’s a heck of a project. When people get really inspired and you’re like, “How much time did you spend on this project?” And they’re like, “Way too much.” That’s this. That’s sticky tape pants.

Ingrid Johnson:

Yeah, that’s pretty creative but we try not to have to get there. And if you just get two kittens, oftentimes you don’t have this problem.

Dr. Andy Roark:

Yeah, you know what? Coming all the way back around the end. I’m like, “Yeah, two kittens sounds a whole lot more reasonable now than…” It’s like, “I think this might be what you need.” That’s awesome.

Ingrid Johnson:

Honestly, we feel so strongly about it at our office. I mean, we talk to everybody that walks in the door with a single kitten that they need another kitten. They’re social species. They should have friends. They don’t usually get to go outside like dogs, so they need a buddy. And if you don’t want to get two, get an adult that hates other cats. We’ve got to stop the cycle.

Dr. Andy Roark:

Yeah, gotcha. I love it. No, I think that’s fantastic, Ingrid. Thank you so much. I got a lot to think about that. It’s really good advice for me to able to give to my client. And man, I always appreciate your insight. Where can people find you? I know you’re doing some lecturing out in the world these days, which I think is super great because I love when you get to lecture. You are amazing and you help people and you have a ton of insight. Where can people find you? Where can they learn more?

Ingrid Johnson:

So many places. So, fundamentallyfeline.com and I offer behavior consults, medicating consults and vertical space design consults, so feel free to utilize us however they’d like. And of course Facebook, Instagram, Twitter, and YouTube. And occasionally you might see me lecturing for, I don’t know, a couple random companies, Royal Canin, et cetera.

Dr. Andy Roark:

Good deal. Awesome. Thanks for being here.

Ingrid Johnson:

Thank you.

Dr. Andy Roark:

And that is our episode. Guys, I hope you enjoyed. I hope you something out of it. I always enjoy having Ingrid on. She’s great and she gives super practical, to-the-point advice that I find myself using in the exam room, so thank you to Ingrid, again, for being here. Guys, check her out at fundamentallyfeline.com. I put links to all her stuff down in the show notes and in her bio, so have a look at that. Guys, if you did enjoy it, if you got something out of it, leave me an honest review wherever you get podcasts. It really does mean a lot. It lets me know what kinds of episodes you guys like to hear and it’s how people find the show. So anyway, guys, we’re in the holiday season. I hope you’re having a great one. Guys, take care. Be well. I’ll talk to you soon. Bye.

In this episode, Dr. Andy Roark talks to the VetGirl herself, Dr. Justine Lee about how SHE treats pancreatitis. We’ve got a tiny dog who ate half a heavenly ham. How do YOU treat that?

LINKS

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

VetGirl: vetgirlontherun.com/

ABOUT OUR GUEST

Dr. Justine Lee DVM, DACVECC, DABT lectures throughout the world on emergency, critical care, and toxicology, and was honored to receive the Speaker of the Year Award at the North American Veterinary Conference (2016, 2015, 2011) and Association des Médecines Vétérinaires du Québec (2012). Dr. Lee was the co-host veterinary analyst on Nat Geo Wild‘s Animal ER LIVE, and was the former contributor/blogger to Prevention magazine, PetMD: The Daily Vet, Pet Health Network and Voyce. She has been featured on NBC Weekend Today, Rachael Ray, WCCO, MPR, and various other TV and radio engagements. Dr. Lee is a part-time criticalist at Animal Emergency & Referral Center, a specialty referral hospital in the Twin Cities, MN.

VETgirl was the brainchild of Dr. Justine Lee. Years ago, while frantically studying for her board examination(s), she decided to take some time out to relieve some stress (aka “panic) by running. While pounding the pavement, she thought, “Why can’t I listen to this stuff on my Walkman while I exercise?” (She is old, and this was pre-Ipod days). Since sleeping on top of her textbooks didn’t appear to osmotically work, she decided that this “listen and learn” modality would truly be the best way to “take it all” in while frantically multi-tasking. And that’s when she teamed up with techno-saavy Dr. Pachtinger to create VETgirl.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

SHOW TRANSCRIPT

Dr. Andy Roark:

Welcome, welcome, welcome to The Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I’m pulling out one of my favorites, the vet girl herself, the one and only, the amazing Dr. Justine Lee, in this hall of fame episode, talking about how she treats pancreatitis.

Dr. Andy Roark:

Guys, it’s the holiday season. We’re going to see some upset stomachs. What happens when they’re bad? What happens when we go all the way to the pancreatitis? Are there any tips, tricks, or hacks that you or I could pick up? Let’s find out from Dr. Justine Lee.

Kelsey Beth Carpenter:

This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:

Welcome back, Dr. Justine Lee. Thanks for being here.

Dr. Justine Lee:

Thanks so much for having me on.

Dr. Andy Roark:

Oh, my pleasure. I always enjoy it. I have got a quick case. This is a classic, but every now and then it’s good to through the classics and make sure that we’re not missing anything, that I am doing gold standard of care today as it was years ago, so let me make sure I’m up to date and I got my bases covered. You ready?

Dr. Justine Lee:

Ready.

Dr. Andy Roark:

I have a four-year old male neutered Yorkie named Lancelot. He is quite a character. As we got ready for the Thanksgiving holiday, Lancelot got loose from mom when her friends were over, and into the big red cooler that was holding the honey baked ham for dinner. They found Lancelot standing on top of the tinfoil and grazing on the ham itself. Just so you know, they saved the ham.

Dr. Andy Roark:

They cut off the part that he ate, and so the ham’s okay other than the portion that Lancelot ate, but he did eat a hunk of hunk of ham. It’s been about two days. Lancelot, on examination, he’s got a painful belly, he’s trembling, which might just be Yorkie at the vet clinic, but it might be something more. He’s vomiting and he’s having bloody diarrhea. Just walk through this case with me real fast. I want to make sure I’m going to nail it. How do you treat that, Justine?

Dr. Justine Lee:

Sure. You know, we were just joking before whether or not to make it a Schnauzer, but I will say one of the top breeds that I end up seeing for pancreatitis, of course during Thanksgiving and during Christmastime, is actually the Yorkshire Terrier. A lot of people forget this is one of the top three breeds besides Miniature Schnauzers and Shetland Sheepdogs that are really at risk for pancreatitis, and unfortunately, I see pretty severe pancreatitis in Yorkies.

Dr. Justine Lee:

Now, with pancreatitis, it can range from the mild case that goes home with sub-Q fluids and an injection of Maropitant and some bland food, to the life threatening, acute, necrotizing pancreatitis that can be fatal, and I’ve seen the whole gamut.

Dr. Justine Lee:

I will say most of them oftentimes need to be hospitalized for one to two days, depending on how severe it is, and I’m also going to just get on my soapbox and say when in doubt, in this scenario, really important that we educate our pet owners. As soon as their dog eats anything, even if they don’t think it’s poisonous, it’s always important to call the ASPCA Animal Poison Control Center because simply inducing vomiting two days ago, as soon as they saw him standing on the cooler eating it, could have prevented the problem to begin with, right?

Dr. Andy Roark:

Yeah.

Dr. Justine Lee:

Preventative medicine, again, so important. In this scenario, because the dog already ate it, I’m going to say the mainstay therapy is always just a handful of things, and I say this with a poison patient too. I joke when people ask me for advice. My answer is always symptomatic supportive care, fluid therapy for perfusion and hydration. It’s gastrointestinal support. It’s analgesia. It’s neurologic supports, cardiovascular support, and a couple of miscellaneous things, but I always joke that’s my answer to vet med.

Dr. Justine Lee:

In this scenario, depending on what we find on physical exam, depending on how severe this dog’s abdominal pain is, my general philosophy is treat each pet the way you would if it was your own pet, so if you didn’t get a veterinary discount, would you spend $1000 in diagnostics or $1000 on treatment? Just focus it on treatment and work with the pet owner that way. I would say definitely warranted, appropriate to get a CBC, a chemistry, potentially an ultrasound, depending on how severe it is, obviously starting with some survey rads if you don’t have ultrasound.

Dr. Justine Lee:

If the owner has financial limitations, you can even consider doing a CPL or a canine pancreas specific lipase test, if you don’t have the ability to do ultrasound, but really treating the symptoms. In this scenario, I oftentimes will use IV fluids. I don’t care what kind of bag of fluids you reach for, saline, LRS, P-Lyte, whatever’s going to perfuse that patient.

Dr. Justine Lee:

Provided that patient doesn’t have cardiopulmonary disease, I usually use 2 1/2, three times maintenance. I know that that dog is probably pretty nauseous, so whatever you’re favorite antiemetic is. I use Maropitant. Some type of analgesic. My go to for visceral pain is Buprenorphine, but obviously we want to treat that dog’s signs of shock first, depending on how shocked they are, so I’m going to say fluid therapy, antiemetics, Buprenorphine for pain control. I will say that I have moved away from using Metronidazole for every bloody diarrhea case.

Dr. Andy Roark:

Talk to me more about that. Yeah.

Dr. Justine Lee:

Yeah, there have been a couple of recent studies that came out basically saying it doesn’t help decrease the severity of it too, too much, and most owners don’t medicate this super bitter pill twice a day for the two to three weeks that they’re supposed to, right, so as part of antiemetic [crobiol 00:06:15] stewardship, I’m going to advocate for a high fiber diet instead, once the dog is doing well enough to take enteral feeding.

Dr. Justine Lee:

Sometimes just probiotics will help, so honestly I’ve moved away from using Metronidazole in a lot of these cases, and really again, just symptomatic supportive care, resting the gut. If I think it’s a dog that is really severely affected, sometimes in the critical care, ICU setting, I may put in a nasogastric tube the following day so I can evacuate the gastric juices and potentially start enteral feeding.

Dr. Justine Lee:

But I think the biggest update with pancreatitis nowadays is years ago, we used to starve dogs, right? We wouldn’t show them any food, we wouldn’t let them smell food. Now what we’ve discovered is more of what we’re doing with cats, which is once you control that nausea, it is okay to actually start potentially feeding these guys with a feeding tube.

Dr. Justine Lee:

But the big mistake I see, vets like to feed too quickly, and my general philosophy is do not feed until all the homeostatic, physiological parameters are normal. If their blood pressure isn’t normal, their heart rate’s not normal, they don’t have gut sounds, if they’re still cold, if they’re still nauseous, they do not get nutrition. You’ve got to fix all that stuff first and then we’ll feed them later.

Dr. Andy Roark:

Hey guys. I just want to jump in real quick with a couple quick updates. Did I mention they’re quick? Because this is the quickness. Quickly, what do we got going on? Over on the Uncharted Veterinary Podcast, Stephanie Goss and I are talking about Dr. Fragile. No, Dr. Sensitive, that’s her name, Dr. Sensitive, who cannot take any type of criticism from the staff without getting real upset.

Dr. Andy Roark:

How do we talk to that doctor? Is that okay? Is that how we can run a practice? I think it’s probably not. What do we do about it? Check out the Uncharted Veterinary Podcast this week, because that’s when we break it down. I’ll put a link down in the show notes. Also on the Uncharted side of the house, on December 12th, we have a brand spanking new workshop. It is from the one and only Jen Galvin. It’s called It’s All Fun and Games: How to Play, Engage With, and Reward Your Team.

Dr. Andy Roark:

If you’re like hey, I wish my team was happier. I wish we knew each other. I wish we had some team building. I wish I knew how to make people laugh and smile, and enjoy being here. I’d like a workshop on how to play and engage with my team. Yeah, that’s what we’re doing. It is $99 to the public. It is free to Uncharted members. Link in the show notes. We would love to see you there. Guys, let’s get back into this episode.

Dr. Andy Roark:

Can you, and the answer may be no, but can you help me set expectations for the pet owners? Are there things in the diagnostics and the presenting examination that are going to help me say to them, look, we’re probably going to need an ultrasound? You know what I mean? We’re going to need an ultrasound. This is going to be a multi-day hospitalization.

Dr. Andy Roark:

Is there anything like that that I can be looking at where I am to get some idea of severity? I have been practicing a dozen years. I have messed them up probably every way you can mess it up. I have sent them home too early, I have kept them too long. I have done all those things. Anything that I can look at early on to judge severity and try to set expectations for the clients?

Dr. Justine Lee:

Great question. Without pulling the acute necrotizing pancreatitis paper, I can say yes, there probably are some. Clinically, I would say if it’s a Yorkshire Terrier, or a dog with a lot of co-morbidities, they have heart disease, they have diabetes, they’re azotemic, they have acute kidney injury, they have signs of MODS, multi-organ dysfunction, their prognosis is probably worse.

Dr. Justine Lee:

I’m going to say clinically, if they have ascites, if they have evidence of a really severe peritonitis that’s causing some effusion. That’s a patient I would really recommend referring for an ultrasound, referring for 24-hour care. For me I’m going to say any concurrent co-morbidity, any evidence of multi-organ dysfunction, any ascites, would be big red flags where I would warn the owner that the hospitalization’s going to be longer. It’s going to be more costly.

Dr. Justine Lee:

With my multi-organ dysfunction, a lot of people think ah, I never see MODS in general practice. You do. If you see a bad parvo, you see a bad heatstroke, they’re azotemic, you think it’s pre-renal, they’re vomiting, they’re [sloughing 00:10:38] their gut, they have GI failure, they’re slightly tachypneic, it could be lung failure, they’re coagulopathic, so any kind of sign like that usually means it’s pretty severe or it’s leaning towards acute necrotizing pancreatitis.

Dr. Andy Roark:

Got you. Any last pearls, words of wisdom on these types of cases? Anything that you see GPs miss or wish that we would, as a group, lean harder into?

Dr. Justine Lee:

Yeah, I guess just what I mentioned before. Don’t blow off the Yorkshire Terrier.

Dr. Andy Roark:

Yeah, that’s a good one.

Dr. Justine Lee:

They’re definitely one of the top three breeds for pancreatitis. The second thing is don’t spend all the money on diagnostics. When they have financial limitations, focus on that symptomatic supportive care. In full disclosure, I don’t do a lot of CPLs except when an owner has financial limitations and can’t afford a $500 ultrasound, right? You have to be careful interpreting it. If it’s negative, I believe it rules out pancreatitis. But if it’s positive, it could be GI lympho, it could be a GI foreign body.

Dr. Justine Lee:

There’s a lot of positives that I can see with CPLs, so just interpret it carefully and when in doubt, appropriate pet owner education. Now is a great time for people to embrace the opportunity on social media to say keep turkey fat, the string that goes around a turkey, don’t feed turkey bones, or things like that. Taking time to help educate your pet owners, especially those three breeds at risk, the Yorkshire Terrier, the Schnauzer, and the Shetland Sheepdog.

Dr. Andy Roark:

Cool. Thanks, Justine. Always appreciate your insight. I really do. Thanks for being here.

Dr. Justine Lee:

Thank you so much. So fun to talk to you.

Dr. Andy Roark:

And that is our episode. That’s what we got for you, guys. I hope it was useful. I hope it’s going to make the holidays a little bit better for somebody out there who heard it and goes ooh, that was a good refresher right before I needed it. That’s what I hope when I make these episodes, guys. If this was helpful, you can give me a big Thanksgiving helping of review, of podcast review, wherever you get your podcasts.

Dr. Andy Roark:

I love it when people write honest reviews of the podcast on iTunes or wherever they get their podcasts. It’s how people find the show. It means the world to me. Yeah, that’s it. That’s all I ask. All I want for Christmas is your podcast review. That’s it, that’s all, so I mean, you could be Santa for me any time, any place.

Dr. Andy Roark:

That’s all you got to do. Anyway, guys, in all seriousness, I am thankful for this profession. I’m thankful that I get to talk to you guys every week. I’m thankful that I get to talk to people like Justine Lee. I’m thankful that I have a job where lifelong learning is a thing I get to do. Anyway, happy holidays to everybody. Take care of yourselves. Bye.

This week on the Cone of Shame Veterinary Podcast, Dr. Andy Roark talks with his dear friend, the dynamic and shining star that is veterinary nutritionist Dr. Jackie Parr. They discuss that young dog diarrhea that just. wont. resolve. How do YOU treat that???

LINKS

PRACTICE OWNER SUMMIT: www.unchartedvet.com/pos2021

It’s All Fun & Games Workshop: unchartedvet.com/upcoming-events/

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Jackie Parr BScH, DVM, MSc, Dip ACVN

When Bruno the chocolate lab was found after 27 days in the bottom of an abandoned well, Dr. Jackie Parr was one of the people he desperately needed.

Refeeding syndrome, muscle loss, dangerously fluctuating electrolyte levels and more were all part of a language Dr. Parr intimately understood. After 14 years of specialized veterinary nutritional study, Bruno was exactly the kind of patient she had been preparing for.

And that’s how it’s always been for Dr. Jackie Parr: complete emersion in the science of veterinary nutrition as a means to an important end – for all the Bruno’s of the world.

A Board Certified Veterinary Nutritionist TM, and festooned with veterinary and academic designations that speak to a passion for science and animal care that borders on obsession, Dr. Parr is among the elite where animal nutrition is concerned. A natural educator, Dr. Parr is widely sought after in professional veterinarian circles as both a public speaker, and as a specialist for consults on the most unique and emergent nutritional cases. She is a passionate nutrition advocate and an accessible expert with feet planted firmly in both the academic and practical worlds of specialized nutritional medicine.

For more information: www.kibblequeen.com

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

SHOW TRANSCRIPT

Dr. Andy Roark:

Welcome. Welcome. Welcome to the Cone of Shame Veterinary Podcast. Guys, Thanksgiving season is upon us regardless of what the radio station might tell you. I have a radio station I wake up to in the morning and I kid you not, the day after Halloween, I woke up to Mariah Carey singing, All I want for Christmas is you. I love the holidays. I got to tell you, it was not a pleasant morning experience. I have changed radio stations and first of all, I feel it’s disrespectful to my favorite holiday, which is American Thanksgiving. I have to say American because Canadians have some other date that they do. If you’re Canadian and you have an extra seat at your table, just saying, it’s my favorite holiday, if I could hit it twice in a year, I would do that.

Dr. Andy Roark:

Just putting it out there, there’s a hole in my schedule. It’s true. All right. The other thing is it makes me feel like I’m immediately behind [inaudible 00:01:08]. And I wonder if other people feel that way. I’m like, I woke up. It’s like, “All I want for Christmas.”, and I was like “I have done nothing to prepare for the holidays.” It’s two months away. I shouldn’t have to have that anxiety in my life. I don’t need that stress. Anyway, we’re doing Thanksgiving here in the Cone of Shame podcast. We’re going to do one of the Hall of fame episodes, Make this diarrhea stop. And let’s be honest. There’s going to be a lot of calls in the next 30 days and beyond, about upset tummies in pets. A quick reminder, quick refresher, quick piece of advice, this is great for paraprofessionals, your front desk people can definitely just get some tools in their pockets that they can have in case they get those phone calls. So, anyway, guys, without further ado, let’s get into this episode.

Kelsey Beth Carpenter:

This is your show. We’re glad you’re here. We want to help you and your veterinary career. Welcome to The Cone of Shame with Dr. Andy Rourke.

Dr. Andy Roark:

Hey guys. I am here today with my good friend, Dr. Jackie Parr. Jackie, thanks for being with me today.

Dr. Jackie Parr:

I am so excited to be here today. We’re going to chat about one of my favorite topics.

Dr. Andy Roark:

Yeah, well, I love talking to you. You and I have done a lot of work together. We lectured a lot together on increasing nutritional recommendations and clients listening to our nutritional recommendations, all over North America you and I have talked. So I love working with you. I will never forget our trip to the hockey game in Winnipeg and [crosstalk 00:02:57] I forgot my coat and I had to run. I had to physically run from the cab to the hockey stadium and sprint back out after it was over.

Dr. Jackie Parr:

And I think one of the best things is, we had done nutrition all day. We had given this great bootcamp and then we ate hockey arena food for dinner. And so we had pizza and French fries. We were like, “Okay, well this is just our moderation. We’re good. We’re good.”.

Dr. Andy Roark:

Yeah. That’s exactly it. We did everything that we recommended not to let a pet do.

Dr. Jackie Parr:

Not to do. Not to do.

Dr. Andy Roark:

So great. All right. I got a case and I’m wondering if you can help me out with it.

Dr. Jackie Parr:

I would love to.

Dr. Andy Roark:

All right, cool. So I have a puppy, a Labrador retriever puppy. He’s six months old and intact, and he has been having liquid diarrhea for the last three days. Now I’ve seen this dog a couple of times before. He’s bad about just eating things he shouldn’t, socks, underwear, raw hides. He always throws them back up and then he has diarrhea for a couple of days and it gets better and the owners want to pull their hair out. But this is not getting better and the owners are here and I’m getting ready to go into this room. I don’t know. I’m thinking, do I treat this, do I need to antibiotic for this dog? You know what I mean? Can I treat this conservatively? Jackie Parr, how do you treat that?

Dr. Jackie Parr:

This is a great one and the perfect breed, right? You’re going to see a Labrador in here that’s had this history of eating all these wonderful things, but now there’s this issue where this is just lasting a little bit longer than it should. So we’ve always thought that his dog had a bit of a steel stomach, it just sort of got through it on its own. How are we going to approach this, given that the owners are getting a bit worried? I love to take it back to basics.

Dr. Jackie Parr:

These clients, you’ve probably coached them in the past about putting stuff up so that we’re not getting these dietary indiscretions, but let’s just go back to basics and let’s just get a really good history, because I would hate to miss something that can point us in the right direction here, taking a few minutes for them to, one, let’s just get a good diet history and then, two, I want to get a good poop history. And I know that may sound really funny, we know its liquid diarrhea, but you can actually get some really good information, really delving into the poop. And I tell you, the owners then feel hurt. Because they’ve been picking it up or trying to wash it away with a bucket and they want to to tell you what’s going on. So I, I think that’s where it starts.

Dr. Andy Roark:

I picture them talking to a sketch artist and I’m drawing and then I turn it around and go, “Does this look like the poop?”.

Dr. Jackie Parr:

Is this the poop?

Dr. Andy Roark:

So, all right, let’s start at the other end of the pet. What constitutes a good history for you? So for my technicians that are going in the room, they’re going to set me up for success. What questions are they asking? What are they looking for specifically?

Dr. Jackie Parr:

Absolutely. And as a nutritionist, diet history comes to mind first for me in general practice, you guys are so good about asking about dewormings, potential for some sort of infectious disease, those sorts of things. So I think, GPs, you are experts there. For me, when I look at that diet history, it’s really about trying to figure out what does a day in the life of this dog look like. And has there been any changes recently? One of my colleagues at the university of Guelph has done some really amazing work, talking about how an open-ended question can get you a whole bunch of diet history really quickly, versus sort of starting with what food are you feeding? What treats are you feeding? And then you have to keep funneling in and you just feel like you’re asking questions for 15 minutes and we don’t have that kind of time. So how can we be efficient? And so the question he developed through his research was, “Tell me everything that this pup is eating, starting first thing in the morning, up until it goes to bed.”. Just get a day in the life of this pup, just to start with. That could give us some really good info.

Dr. Andy Roark:

Great.

Dr. Jackie Parr:

Great place to start.

Dr. Andy Roark:

Perfect. And then let’s go to the other end, what are you asking them about poop?

Dr. Jackie Parr:

Poop. Excellent. So for this particular case, one of the things that I love to have ready in an exam room would be my dog and cat fecal score charts, affectionately known as poop charts.

Dr. Andy Roark:

Gotcha.

Dr. Jackie Parr:

I love these tools because a picture literally does say a thousand words. How you were joking about the sketch artist earlier, literally we just want to give them a realistic photo and have them say, “It’s been in this range.”. That can give us so much information. It also avoids the inevitable, them describing the poop as food before your lunch break type of thing. So super helpful because there’s always certain foods that they just start throwing out there and we just don’t want to be a part of that.

Dr. Andy Roark:

Right.

Dr. Jackie Parr:

So I think this is a really great tool to get everybody on the same page.

Dr. Andy Roark:

Hey guys, just going to jump in real fast with a couple quick announcements. December 2nd, through the 4th in Greenville, South Carolina, in person, the uncharted practice owner summit. If you are a practice owner, you do not want to miss this. This is about coming together with only other veterinary practice owners and working on your business. It is going to be collaborative. It is going to be inspiring. It is going to be fun. It’s going to be motivational. If you’re like, “I feel like my work is kind of a drag right now and I’m feeling heavy shoulders from carrying the load.”, it’s time for you to get reconnected, reignited, re inspired. Come down to Greenville, South Carolina, work with other vet practice owners. We are going to be doing all sorts of stuff. We are going to be building the conference for you at the conference.

Dr. Andy Roark:

It is a summit, which means it is going to be very much about what you want and what you are struggling with and what you want to talk about. I’m going to be doing a couple of different workshops there. I’ve got one on your leadership stories. The stories you tell as a leader. And man, I got to say I did this back at our culture conference and I really liked it. And I think it’s going to be even better in person. So I’m excited to talk about stories and using stories to motivate and inspire and lead your team. And then also I’m going to be talking about leading tired teams and I some of you have tired teams. That’s what we’re going to be talking about. So anyway, that’s what I’m talking about. There’s Stephanie Goss going to be there doing some stuff. We’re going to be doing a lot of discussions, that round tables things like that. It’s going to be super engaging.

Dr. Andy Roark:

I’d love to have you there. So anyway, registration closes on November the 15th. You need to get on the horse and grab it. I’ll put the link in the show notes for everybody else, guys, I am super pumped about this. On December the 12th, we have an online workshop. It is all fun and games, how to play, engage, and reward your team. Doesn’t that sound fun? Isn’t it awesome to have a workshop about, “Hey, here’s how to play with your team. Here’s how to make your practice fun. Here’s how to get people to stop being grumpy, and just to feel like there’s something worth smiling about at their job again. How do you play? We need to, we need to do more play in practice.”. And so guys, that’s what it’s all about is from 4:00 to 6:00 PM Eastern time, 1:00 to 3:00 PM Pacific time, that is free to uncharted members. It is $99 to the public. And man, I would love to see you guys there. All right, without further ado, let’s get into this episode again, back into it. Yes. We’re going back. All right. That’s it. We’re going back.

Dr. Andy Roark:

So we go through the food history. There’s no obvious dietary and discretion that they are telling me about, right?

Dr. Jackie Parr:

Yes.

Dr. Andy Roark:

We know this dog is trolling. He’s he’s going to be a wonderful dog, right now he is a naughty Labrador retriever. You know, he is the Labrador phase that everyone forgets about when they think about Labrador retrievers.

Dr. Jackie Parr:

Yeah.

Dr. Andy Roark:

So he’s that guy. They don’t know of anything that he’s eaten. I’m not picking up a whole lot of obvious dietary indiscretion. He’s just got diarrhea and it’s not going away. They point to liquid to slightly chunky on the chart.

Dr. Jackie Parr:

Yeah.

Dr. Andy Roark:

I’m going to put a disclaimer on this episode, if poop descriptions gross you out, skip on over to [crosstalk 00:11:20] my favorite murder podcast.

Dr. Jackie Parr:

That’s awesome. So we’ve got that information. The other thing that I would really pay attention to here when I’m looking at diet history is a few of my physical exam findings. So I want to make sure this isn’t the start of something else that’s going to be a challenge. So can I just verify that this puppy is growing properly? So we’ve had a couple of episodes of intermittent diarrhea that have gone away. I don’t want to miss something that’s a bit more concerning, so can I just quickly validate I’m happy with the growth of this puppy. So a good way to do that is to do a body condition score. Labradors of course, we’re often worried they’re going to get a bit too chunky. And if they do start to pack on the pounds, that sets them up for lifelong obesity. And so we want to make sure that we’re in the right plane of nutrition here.

Dr. Jackie Parr:

The other thing is that there’s some really amazing tools out there for tracking growth that I would love to tell people about because sometimes a diarrhea case that starts off, just being a few times here and there linked to dietary and discretion, you eventually do find a medical problem down the road, right? And if they’re not growing properly, that can be a sign that something else is going on and you can go looking further. So we’ll give people the link. There are puppy growth curves that have been created by the Waltham center. And literally all you need to do is take the puppy’s age and their weight and you start plotting them. So this like when your girls went to the pediatrician, they probably got plotted on growth curves, right? You would know what percentile your girls were growing on when they were little and it’s the exact same thing with a puppy.

Dr. Jackie Parr:

So you just track them on that and make sure they’re not falling down a growth curve, because that would mean this puppy’s probably not growing properly. Or if they grow up a growth curve that I’m thinking about maybe this puppy’s getting way too many calories and it’s growing too quickly. So that would be my third check for this case, is can I just verify that I think this puppy is growing appropriately at six months of age? It’s in peak growth. We should be seeing a good, straightforward growth curve. It shouldn’t be jumping around a whole bunch.

Dr. Andy Roark:

If this puppy’s falling off the growth curve, what are the top things that pop into your mind?

Dr. Jackie Parr:

So if they’re starting to fall off the growth curve, I’m at least doing basic blood work to look for any sort of organ dysfunctions, those sorts of things. I’m making sure that I’m doing x-rays, making sure there’s no sort of foreign body that he’s ingested in the past that’s really been lingering in there if he hasn’t had x-rays done before and then based on some of that preliminary workup, if necessary, I’m going to go to the next step, with things, further workup if I start to notice some things on my initial blood work.

Dr. Andy Roark:

Gotcha. That’s beautiful. So jumping back to it, let’s say this guy seems to be growing fairly normally he’s just got diarrhea.

Dr. Jackie Parr:

Yes. Given it’s a Lab puppy, sometimes we’re really quick to say let’s change the diet, let’s change the diet and let’s put them on something for like GI. But what I like to start with, is I really look at the treat and the human food history, because especially in a Lab puppy, we know at this stage, this guy is busy, right? He is getting into everything, as you said, this is the stage people block out when they start to think about the history of their puppy. He’s probably been getting cogs, he’s been getting things to chew on, they’ve been doing training classes, he’s probably been getting a lot of stuff there. I want to see how much of his diet is really being made up of all these extra goodies that he’s been getting.

Dr. Jackie Parr:

And if I can just take him back to basics and just get him back to his large breed puppy diet, I may actually be able to calm things down. This may be one of those situations where he has just been overloaded just to keep him busy, that his system can’t handle it. Right? He just can’t handle it. And so if we’re noticing that type of history, that’s why the good diet history is so important. Because if you start saying, we need to cut out treats because he’s got diarrhea and you didn’t get the diet history up front, you often are met with a little bit of reluctance, like, “Oh, we’re not feeding him that many treats.”. But if you have the history ahead of time, you can say, look, this is still too much for a puppy this age. This is just too much. Can we talk about what we can do to just try to quiet things down?

Dr. Andy Roark:

Yeah. Lovely. Cool.

Dr. Jackie Parr:

That would be sort of first stage there.

Dr. Andy Roark:

Okay. Sweet. So maybe set them up. Talk about the diet history.

Dr. Jackie Parr:

Yeah.

Dr. Andy Roark:

How do we get them back on track to send them out the door?

Dr. Jackie Parr:

Absolutely. So what I would say to them is I really want them to feel confident that we’re going to support them through this. And so what I would say to them is I’m going to send you home with this poop chart. And one of my great technicians or client customer service staff is going to touch base with you in the next 24 to 48 hours to get another poop score. If you’re concerned, you contact us in the meantime, but if things are going well, we’re just going to reach out. We’re going to put a reminder in touch base with you. We just want to make sure we’re moving in the right direction. And the reason I love the poop charts is there is the whole description from liquid to sort of liquidy and chunky to sort of getting cow patty like, and as long as they’re moving in the right direction, we’re starting to make some progress.

Dr. Jackie Parr:

And so I find this can help prevent frustration because you don’t want them thinking it’s going to be a normal sport tomorrow, right? Like this is going maybe take a few days for it to calm down, but we want to be there. We want to be checking in to make sure it’s not getting worse. Cause we don’t want this puppy getting dehydrated and then he needs to be hospitalized. Right?

Dr. Andy Roark:

Right. Yeah.

Dr. Jackie Parr:

So that check in, I think is important.

Dr. Andy Roark:

Perfect.

Dr. Jackie Parr:

And say to them, if it worsens on the chart, then you need to come see us again. Cause we’re going to have to do some more work. Yeah.

Dr. Andy Roark:

Yeah. I like it. I like talking to them about getting a long term solution. I feel like that helps buy us some time in some patience, as opposed to saying, I’m just going to medicate this and I’ll see you back in four to six weeks when this happens again. I think people are willing to walk with us if we explain that we’re trying to address the underlying cause.

Dr. Jackie Parr:

Exactly.

Dr. Andy Roark:

Perfect.

Dr. Jackie Parr:

Exactly.

Dr. Andy Roark:

Well, Jackie, I think this has been great. This is good. Giving me what I need to go in there and get started and get going. We will put a link to the growth curves that you like down in the description for the podcast. So people can click there if they don’t have a ready supply of poop charts.

Dr. Jackie Parr:

Yes.

Dr. Andy Roark:

Do you have a source?

Dr. Jackie Parr:

Yes. Royal Canin can absolutely supply you with poop charts. So they’ve got some great charts for both dogs and cats, because obviously they’re a little bit different, right? Fecal consistency’s a bit different, so great opportunity to get some resources there.

Dr. Andy Roark:

Perfect. And so they’ll go to website Royal Canin .com .ca.?

Dr. Jackie Parr:

I’ll send you a link so they can just download them.

Dr. Andy Roark:

Just straight to it. Oh.

Dr. Jackie Parr:

You can just straight download off of this podcast, your very own poop chart.

Dr. Andy Roark:

I love it so much. Perfect. So I will put that link in the description. Jackie Parr, where can people find you? You are the Kibble Queen on social media. What’s the best place for them to reach out to you?

Dr. Jackie Parr:

They should definitely check out my website. So www.kibblequeen.com. I have tons of resources up there for people. So follow me there. And I would say I’m most frequently on Instagram these days. I just really enjoy Instagram. It just fills my feed with lots of great animal photos. So I’m the Kibble Queen on Instagram as well.

Dr. Andy Roark:

Awesome. Guys, thanks so much for tuning in. We will see you soon. Thanks again, Jackie.

Dr. Jackie Parr:

Thank you.

Dr. Andy Roark:

And that is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. I love the episode. It’s just good, good stuff from the vault. Anyway, guys, if you got some out of the episode, write me an honest review on iTunes or wherever get your podcast. It really does help. It’s how people find the podcast. Anyway, gang, take care of yourselves, have a great month of November and beyond, whenever you’re listening to this and I’ll talk to you next week.

Dr. Tina Wismer (Senior Director of the ASPCA Animal Poison Control Center) and Dr. Andy Roark discuss the rising rates of Maijuana toxicity in dogs, the cause, and the staples of effective treatment.

LINKS

PRACTICE OWNER SUMMIT: www.unchartedvet.com/pos2021

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: 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.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

SHOW TRANSCRIPT

Dr. Andy Roark:

Welcome, welcome, welcome to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. I am back today with my friend, Dr. Tina Wismer. She is the senior director of the ASPCA Animal Poison Control Center. We talk about rising rates of marijuana toxicity. I saw one of these last week. The numbers are up, and that’s tied to legalization of marijuana, and just an increased prevalence in it, in daily life of many people. And we want to run through it, and then get into the staples of therapies. Make sure you’re up to date on everything you need, what to expect, what to tell people if they’re calling and asking about it, and just generally, what do you need to know, in a short little bite sized bundle. That’s what we got. 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 Dr. Tina Wismer, thanks for being here again.

Dr. Tina Wismer:

Thanks for inviting me.

Dr. Andy Roark:

Oh, it’s always my pleasure, I love to have you. You are the senior director of toxicology at ASPCA Animal Poison Control, for those who don’t know. You’ve been a regular guest on The Cone of Shame. I think this is our fourth episode together, out of a hundred, basically. We have a hundred and a couple, so you’re 4% of the podcast history.

Dr. Tina Wismer:

Woo hoo.

Dr. Andy Roark:

Right here.

Dr. Andy Roark:

Well, I wanted to jump on and talk to you today about, I was always looking at trends and what’s common. What are we seeing in the exam rooms today? And that’s what I’d like to bring you in and talk about on the podcast. Let’s talk a bit about legalization of marijuana across the country, and this has sort of been weird state by state creep. But I wanted to talk to you, as it becomes more normalized and legal, and we’vve got CBD dispensaries and things like that. Are we seeing fall outs of that, from a toxin basis, from an emergency medicine basis?

Dr. Tina Wismer:

Certainly. We have seen an increase in marijuana cases, just about every year, since legalization started. And I can tell you like between 2018 and 2020, the number of cases reported to animal poison control has more than doubled.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

And we certainly don’t get all of them that are reported. I think part of it has to do with it being legal, and people are more likely to admit it. Yep, my dog got into marijuana. Right, there’s less of a stigma.

Dr. Andy Roark:

Well, let’s unpack that for a second. Do you think that these are new cases, meaning marijuana is more common and they’re more often getting it, or do you think that we’ve always been seeing marijuana toxicity cases, but people just didn’t admit it, and so we were having these kind of veiled conversations or veterinarians were treating unknown toxins. So yeah, help me with that a little bit.

Dr. Tina Wismer:

Sure. I think it’s a little bit of that. I definitely think that it’s more easily available. So as you said, there’s, dispensaries in, I shouldn’t say on every corner, but it seems like driving down the highway with all the billboards, that they’re on every corner.

Dr. Andy Roark:

Yeah.

Dr. Tina Wismer:

And I think that with less stigma, more people are willing to have it out in the open, and also that we’re dealing more with concentrated forms of THC now. A lot of the edibles have very high amounts of THC.

Dr. Andy Roark:

Okay, so let’s talk about that a little bit. It makes sense. Now that there’s dispensaries out in the open, and they’re selling a variety of products, hyper concentrated products, are they common? I mean, what percentage of toxin cases with marijuana do you think we’re seeing, that are this more processed, more potent version?

Dr. Tina Wismer:

So with cats, we’re still seeing a lot of plant material. Cats get into the baggie or cats eat the joints and become symptomatic. Dogs, it’s all about the edibles and especially because a lot of edibles contain chocolate, then we have to think about treating both chocolate and THC toxicosis.

Dr. Andy Roark:

So for those of us who are not in marijuana legal states, can you give us a quick breakdown of edibles, kind of what they are. Are these gummy products, chocolate products, anything that you can imagine? Are there trends and variables? Yeah. If you’re somewhere like South Carolina, it does not have legal marijuana. So yeah. I, I wonder if veterinarians there would be as familiar with the packaging of marijuana as in other states.

Dr. Tina Wismer:

Right? So you still can buy plant material, but you mentioned some of the things. You can get gummies, you can get brownies, you can get chocolate bars. You can get oil, which is a concentrated THC product. You can get wax, which is an even more concentrated THC product, and it does, it looks very waxy. All of these can be either ingested or smoked, and dogs seem to love them.

Dr. Andy Roark:

Well, I’m resisting their urge to drive this conversation more deeply into wax and how it’s used, because that’s not what we’re here for. I’m going to have to do some Googling after we get off the podcast. Okay.

Dr. Tina Wismer:

And one of the issues is that when people buy a brownie, or a chocolate bar, it’s considered to be multi dose. The typical THC dose for people is 10 milligrams, but a lot of these chocolate bars have like 180 milligrams. You’re just supposed to take a bite of it.

Dr. Andy Roark:

That’s terrible. Let’s let me jump in here for a second, that’s awful. The idea that I’m going to take a bite of a chocolate bar and stop, it’s not going to happen, makers of THC products, you need to be more responsible.

Dr. Tina Wismer:

Right, and dogs certainly don’t stop either. Right?

Dr. Andy Roark:

So what me and Labrador retrievers have in common is, we’re not stopping when we get a brownie, like we’re going to, we’re eating. The serving size is how big the pan is, and everybody should be open about that.

Dr. Andy Roark:

Hey guys, I just want to jump in real quick with some housekeeping wanted to let you know what’s going on. The big thing is December 2nd through the 4th in Greenville, South Carolina, in person, the practice owner summit is going on. This is uncharted practice owner summit. It is a gathering of practice owners. It is only open to practice owners. That’s not business owners, that’s practice owners. It is going to be a summit, which means there is going to be some workshops. There are going to be some hands on working groups, and it’s going to be a lot of discussion. It’s going to be a lot of collaborative problem solving and talking about your practice and working on your practice. So if you want to get re-energized, if you want to get re-motivated, if you want to connect with other people who are practice owners, talk about a real benefit.

Dr. Andy Roark:

We talk about knowledge is power and that’s true, but relationships are power as well. And, and the great thing about the uncharted, especially the summits, we really lean into the relationship. So come surround yourself with people who do what you do. Surround yourself with people who understand the struggles that you have, and get re inspired and re-motivated and reinvigorated. Get yourself a new lifeline or two, or three, or five, or twin, or 20 people who are there to help you and support you. That’s what we’re doing. Anyway, link in the show notes. I would love to see you there, registration closes on November the 15th. If you have friends who are practice owners, don’t let them miss out, put this on their radar. Be like, Hey, you need to look at this, it is really going to be awesome, and God, it’s going to feel good to get back together in person and see these smiling faces. Anyway, guys, take care and let’s get back into this episode.

Dr. Tina Wismer:

Our typical marijuana dog presents to you with the triad of classic signs. It is ataxic. It is hyper aesthetic ,and it’s dribbling urine, classic triad. Now we do have other dogs, about 25%, become a little more agitated, instead of lethargic.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

But yeah, the classic triad.

Dr. Andy Roark:

It’s still a mixed bag. I’m assuming as far as what type of report you’re going to get from the pet owner. Yeah. So when marijuana’s legal, I’m sure you’re more likely to hear, yes. This is what happened. Are there common cover stories for nonlegal states that’s code for like my dog ate my stash.

Dr. Tina Wismer:

Right, typically its the neighbors threw it over the fence, and we’re like really. As one of my coworkers says, junkies don’t share. So it’s not uncommon that we’ll get, oh, it’s the neighbors marijuana. Okay, that’s fine. I don’t really care.

Dr. Andy Roark:

At this point, I jump in and help the high school kid out. I’m like, look, this happens all the time. Neighbors are always throwing marijuana into other people’s yards, and it just happens every day.

Dr. Tina Wismer:

Yes. Now, one of the weird things that does happen, so I have to mention it, and it’s kind of gross, is that people who do edibles, the metabolites that are passed in the stool are active. So we have dogs that will go to the park, or out hiking, and they eat human stool, and they get marijuana toxicosis.

Dr. Andy Roark:

That’s the case I would get, I would 100% get the hikers who come in with their dogs, stumbling around like I’m-. So like you’re a hiker, I’m sure that your nature interests extend to marijuana. And they would be like, no. I would only find out after the dog had thoroughly licked my face for like 10, that’s when I would make the discovery.

Dr. Tina Wismer:

Nice.

Dr. Andy Roark:

So, okay. Clinical science presentation, what’s my diagnostic workup on this dog?

Dr. Tina Wismer:

So we really don’t have any good diagnostic tools. The over the counter tests, the urine tests, really with dogs give false negatives, because dogs make different metabolites than people do. So typically we treat based on history and clinical signs.

Dr. Andy Roark:

So are you saying those tests are without value, meaning that they’re almost always going to be negative? Or do you mean that when there’s an error, it’s negative?

Dr. Tina Wismer:

They’re almost always negative.

Dr. Andy Roark:

All right.

Dr. Tina Wismer:

The time it can be positive is when they eat human stool, because that’s the metabolite that they’re testing for.

Dr. Andy Roark:

Okay, so that’s a test specifically for that type of ingestion, let’s write that down, you don’t know when you’re going to need that. That’s a pearl that maybe we’re going to need to break out.

Dr. Tina Wismer:

Definitely. So, we used to always joke about treating these guys with Pink Floyd and Doritos, that’s how you treat a [inaudible 00:11:21]. Forget about them in the back, don’t worry about it, but it’s changed with dogs that get into edibles,

Dr. Andy Roark:

Right.

Dr. Tina Wismer:

Because of the huge amount of THC, we can now see some of these dogs becoming severely hypotensive and comatose.

Dr. Andy Roark:

It seems like now, especially with being out in the open, is probably more likely that you can actually get some information about how much was consumed, in a way that you probably couldn’t in the past. Is that true, and how is that useful?

Dr. Tina Wismer:

Yes. So people will tell you, oh, he ate a brownie that was four doses, or they ate a chocolate bar that was 16 doses. So you can at least get an idea of how much did they ingest? Yes, this is going to be a serious problem. Or, if it’s just one human dose, many times you can monitor them at home. If they can walk around, they respond to their name, they can eat, they can stay home, but if they can’t ambulate, they need to come in and see you.

Dr. Andy Roark:

Okay, all right. What kind of timeline are we talking about usually before we’re going to see significant clinical signs?

Dr. Tina Wismer:

Sure, so signs can start within about 30 to 60 minutes after ingestion, and one of the other differences with dogs that get into edibles, is that they can actually be symptomatic for up to three days, post ingestion.

Dr. Andy Roark:

Okay, that seems important for setting expectations.

Dr. Tina Wismer:

It does. Now, if the dog is recovering and it’s able to get up and it’s still just stumbling, then yeah, we can send it home. But the dogs that are comatose, we treat with lipids. So they get the intravenous lipid infusion.

Dr. Andy Roark:

Okay, talk to me more about that. I’ve never given a dog intravenous lipid infusion.

Dr. Tina Wismer:

Sure, so this is a 20% lipid solution that you can use for partial parental nutrition, and it’s been used in toxicology for fat soluble toxins. So THC is highly fat soluble, highly lipid soluble. So the thought is, that the lipids bind the THC so it can’t get to the receptors and the CNS, and then it’s metabolized and removed from the body. Dosing wise, it’s nice because with 20% solution, you can actually give it through a peripheral vein. You can use your cephalic vein. You don’t need a central line.

Dr. Andy Roark:

All right.

Dr. Tina Wismer:

You give an initial bolus, one and a half mills per kilo, followed by a constant rate infusion of 0.25 mills per kilo, per minute, for about 30 to 60 minutes, and then you stop it. You wait for about four to six hours. If the animal is still symptomatic, you draw a blood sample. If it’s like PMIC, you have to wait. But if the serum is clear, then you can go ahead and re dose your lipids.

Dr. Andy Roark:

Okay, given that dogs can show signs for three days, is there a window in which I would give this and not give it? So saying for example, the pet owner is like, hey, I work 12 hour shifts, and I’m pretty sure he ate it the moment I left the house and now it’s been 16 hours. Is there a window where you go, okay this window has closed.

Dr. Tina Wismer:

Yeah. So the dogs that need lipids are the ones that are comatose or hypotensive. If they don’t hit that point within the first 12 to 18 hours, they’re not going to. They’re just going to be sedated and wobbly and we can typically monitor those at home, but yeah, the other ones will come to you pretty quickly. You give them lipids, and then they recover.

Dr. Andy Roark:

Okay, are there any sort of side effects of lipid treatment that we should be aware of? Is this one of those supportive measures that may have its own sort of fall outs?

Dr. Tina Wismer:

It does, right, because as we know nothing we do as benign. With lipids, there is an increased risk of pancreatitis, and we can see some elevated liver values. The biggest risk is if you have given other medications to treat other clinical signs, if those medications are also lipid soluble, it could take them away. So not in this, in marijuana toxicosis typically, we’re not using any other additional medications, but let’s say you had a dog that got into amphetamines, it ate the child’s ADHD medication.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

It’s very agitated. You give it acepromazine, calms it down. Well, if we gave lipids to animal, it would scoop up the acepromazine first and we would see our animal become agitated again from the amphetamines.

Dr. Andy Roark:

Gotcha, okay, any interactions that we tend to see with medications we’d use for supportive care of GI symptoms. So let’s say that we’ve got, our chocolate dogs, things like that, and we’re worried about having diarrhea, having vomiting. Are there medications that I might normally reach for, that I don’t want to reach for, if I’m doing lipid therapy?

Dr. Tina Wismer:

So it can inhibit things like serenia, things that are going to act within the CNS, but things that you are given orally, like your proton pump inhibitors or things like that, it has minimal effects.

Dr. Andy Roark:

Is there benefits of inducing vomiting, or things like activated charcoal? Are there places for either of those?

Dr. Tina Wismer:

That’s a great question. So marijuana is actually a antiedemic. You think about people who are undergoing chemotherapy, they use THC to help decrease the nausea. So getting these guys to vomit, can be difficult. If you are going to induce vomiting, we have best effects using something that acts locally like peroxide, apomorphine, and those new ropinirole eye drops to induce vomiting, don’t seem to work. Charcoal, we rarely give it with marijuana, unless it’s a huge dose and we’re worried about signs and we couldn’t induce vomiting.

Dr. Andy Roark:

Gotcha, okay. Well that makes sense. Are there common mistakes that you see practitioners making, that you would warn against?

Dr. Tina Wismer:

I think the thing is that with our supportive care, we need to make sure that these guys stay warm, because they can get quite cold. And if they’re cold, we’re going to see decreased metabolism. So they’ll be with you longer, so keep them warm.

Dr. Andy Roark:

Yeah. That totally makes sense, that’s super helpful. Awesome. Well, Tina, where can people find you and learn more about ASPCA poison control?

Dr. Tina Wismer:

ASPCA.org, and we’ve got articles about treating many different toxins on there, including marijuana.

Dr. Andy Roark:

Thanks again for being here. I really appreciate your time.

Dr. Tina Wismer:

You’re welcome.

Dr. Andy Roark:

And that is our show. That’s what we got for you. I hope it was useful. I hope it was helpful. Guys, it was good to get little refreshers, quick to the point, super useful, knowledge lumps that we can just pop in our mouth on the way to work. It’s a little knowledge lump for you. If I ever have a candy, I’m going to call it a knowledge lump, and how can I fail? I think that’s amazing. Anyway, guys, I’d love to see you, if you’re a practice owner. I’d love to see you in December at our practice owner summit, for uncharted. Remember registration closes on the 15th of November, link in the show notes. Everybody else, I’d love to see you when I get to see you.

Dr. Andy Roark:

I hope life treating you well. And I hope you are-. God, I hope you’re not already hearing Christmas music because I am, the day after Halloween, my radio station I listen to in the morning. When the alarm comes on, it switched to the Christmas station and I just can’t handle it. I hope that you’re not dealing with the stress, but if you are, let’s stick together. We’ll get through this, ultimately one way or another. We’ll survive the holiday music in November trend. So anyway, that’s enough of that. That’s a whole nother podcast. Guys, take care of yourselves. I’ll see you later. Bye.