Ashley Bourgeois, DVM, DACVD: On the behavioral side, have you noticed or had dogs where you’re managing their behavior or they’re referred to you where you’ve noticed adverse effects from things like treatment of atopic dermatitis? They are trying to keep them in the bathtub even though the dog hates it and we’re not working with them. Or the dermatologist says wipe the paws once a day and they’re pinning their dog down and trying to do it, and it’s not going well. Or we have them on 5 oral medications, and the dog won’t take it. Have you had experience where you’ve been able to make behavioral modifications, or you’ve seen that in relation to how many therapies we have to use in these allergic dogs?
Christopher Pachel, DVM, DACVB, CABC: Oh, yes.
Ashley Bourgeois, DVM, DACVD: You’re like, “What are you doing to my client?”
Christopher Pachel, DVM, DACVB, CABC: I get it, because there are so many clients who have been given a recommendation, whether that’s for giving the medication, doing the bath, doing whatever. Maybe they didn’t recognize it was going to be difficult. They’re going home and doing the best they can, giving it the old college try, so to speak. I’m not faulting the clients or the veterinarians necessarily, but now we’re in a situation where accomplishing that goal and achieving success is coming at a cost. We may be conditioning a certain level of defensiveness, potentially in some cases even damaging the trust relationship that exists between the owner and the animal.
I love being able to troubleshoot that. Sometimes we get enough notice that we can do that preemptively, but in many cases we don’t. I’m smiling because just this morning I was watching a video that one of our clients at the Animal Behavior Clinic sent who’s been working with one of my team members as well as my technician—she’s been working with a clicker training, marking program. She’s got 2 dogs, one who would benefit from topical therapy in his feet and will not tolerate it. It was creating some stressors. She taught, utilizing reinforcement-based methodology, taught them both because it worked better to have both dogs at the same time. They’re now taking turns stepping up and putting their feet inside a little bucket and then stepping out while they get a reinforcement. It’s the most amazing video to see. We will be sharing it at some point very soon on our social media as well in the Animal Behavior Clinic.
Ashley Bourgeois, DVM, DACVD: I want to see this.
Christopher Pachel, DVM, DACVB, CABC: You’re going to love it. It’s that sort of stuff where we can say, “You’re in the midst of it. You can’t do the therapy that’s been asked of you.” Then we just have to start with what’s doable, so let’s start where we are. Let’s move it forward, and eventually we’ll catch up to that recommendation. Maybe it’s tomorrow, maybe it’s next week. The allergies are still going to be there. We either put in the work now to catch up with them, or a month from now we’re still going to be navigating the same problem, not making any headway. So, let’s dig in.
Ashley Bourgeois, DVM, DACVD: Yes. That’s where the check-in is important too because you’re right, you can ask all the questions, and sometimes as clients come in for their initial examination, especially right now when they are waiting a long time to see a veterinarian with how busy most of us are. Say they make it to my door, and then they’re in. They’re committed. They’ve made it. They’re at their appointment they’ve been waiting for, and then suddenly, I spew off 10 things they should do. They’re like, “Yes, I’m here. This is why I waited.” Then real life happens. Suddenly, we’re at home, and our kids are running around, or we go back to traveling, or the dog hates it and we didn’t think they would. That’s why the rechecks and check-ins are really important.
For us, we always look over the discharge instructions. “Are you doing this? Are you wiping the paws once a day?” That’s where you can pick up on those things like, “Oh no, they hate it,” or “No, bathing didn’t go well because of this reason.” Where if we just see them and don’t really check in, it just keeps being copied-pasted, copied-pasted on the discharge instructions. You find out a year later that they’ve never bought a new thing of wipes or a new bottle of shampoo. Well, that doesn’t make any sense and they go, “Oh, I don’t do it.”
Checking in is important, and we forget about that. We get them through the bad flare, and they’re all excited. But that maintenance and those rechecks, we need good rechecks. We want the good rechecks where they’re coming in because they understand what we we’re looking for, but also so we can tweak those things. Bathing is not realistic for you now, maybe there’s someone at home who’s ill, maybe you are traveling. You’re going on a 3-week vacation when that happens again, and you can’t ask the dog sitter to do that. But you can when you come back.
That’s where those rechecks and seeing where they are at that point can be important. I have a client where they’re recovering from surgery, themselves. They say, “I usually could bathe my dog once a week, but for 6 weeks I’m having back surgery, and I can’t.” Maybe then it’s realistic that the daughter could use a wipe. So check in to see if it’s possible, how the dog’s reacting to it. Maybe we didn’t think it was going to be a problem, but it actually is. All those things can be important because we’re both in specialties that manage chronic issues; tweaking, pivoting, and changing is just a way of life in our specialties. We have to make sure we’re having that conversation with the owners.
Christopher Pachel, DVM, DACVB, CABC: I love that check-in piece too because sometimes what we’ve asked them to do may have been more than what was needed. Let’s say we’ve asked them to give a medication or do a wipe twice a day, and they come back for the recheck and we’re like, “How are the twice-a-day wipes going?” And they just nod because they’re embarrassed to say, “I haven’t been doing it. Only been doing once a day, doctor.” Quite honestly, if you’re looking at the dog and the dog looks great, well guess what? Once a day is plenty. I don’t need to send that client away still carrying that guilt of not doing twice-a-day therapy when in fact, once a day is good enough.
I’d rather be able to say, “Out of 14 doses, how many are you missing?” Something that almost makes the assumption that they’re missing at least 1. I’d rather have a client push back and say, “No, we get all of them.” Cool. If I make it comfortable for them to say, “Yes, we usually miss about 3 out of 14.” Cool. Awesome. We’re getting 11 out of 14, and this is what that progress looks like. Now we’re just talking data points. There isn’t baggage, there’s not could of, should of, would of. It’s none of that stuff. It’s an accurate medical record with updated recommendations for what needs to happen for the patient. That goes so far to then not only guiding our knowledge basis as clinicians, but also creating trust-based communications with our clients as well.
Ashley Bourgeois, DVM, DACVD: Absolutely. I’ve had that happen where a client comes in, and the dog looks great. They’re like, “Oh, but you said bathe twice a week. I’ve only been doing it once a week.” I’m like, “OK. Clearly that’s OK because they’re doing well. Let’s just change what’s written because it’s not what we need. Maybe we can go even lower because they’re doing so well. Maybe we can’t go lower when they’re looking great, but here’s why.” When I look in the history, spring is always a tough time. Bathing once a week is going to keep the pollens off the skin and help minimize infection. Let’s get through that season. I like to tell owners, “If the dog can prove it to me—they’re doing great right now—but I need him to prove that he can do this well for 3 more months before we can consider lowering things.” The last thing we want is to finally get through this bad pyoderma, and we get so overzealous and excited that we stop everything, and then we’re back to where we were 2 weeks later. Sometimes, I tell owners, “Fluffy really needs to prove to me that we can sustain this longer before we can pull back.” Then they get it. They’re like, “Why are you having me do this, they’re fine?” Well, they’re fine, but we haven’t seen that length of time that makes me very confident we can reduce things. We don’t want to keep sliding backward every time you see me because we start taking things away.
Transcripts edited for clarity.