{"version":"1.0.0","segments":[{"startTime":0.0,"endTime":7.44,"body":"Welcome to the Dermvet Podcast. I'm Dr. Ashley Bujwa, a board certified veterinary dermatologist"},{"startTime":7.44,"endTime":13.28,"body":"practicing in Portland, Oregon with animal dermatology clinics. I'm also a mom of two just"},{"startTime":13.28,"endTime":21.2,"body":"trying to find the balance like everyone else. Let's learn to ditch the itch, cytology, everything,"},{"startTime":21.2,"endTime":28.32,"body":"and make Derm more fun than frustrating. I love being able to have my friends on the podcast."},{"startTime":28.32,"endTime":34.64,"body":"I'm very excited today to welcome my good friend Dr. Gary Marshall to the Dermvet Podcast."},{"startTime":34.64,"endTime":41.36,"body":"He has an over quarter century experience being a feline practitioner. He practices at"},{"startTime":41.36,"endTime":47.28,"body":"island cats veterinary hospital near the Seattle, Washington area, and he is currently the clinical"},{"startTime":47.28,"endTime":52.64,"body":"director of student development. He's also very involved in organized veterinary medicine currently"},{"startTime":52.64,"endTime":58.56,"body":"running for ABA and A. Vice President and has recently received Washington State University's"},{"startTime":58.56,"endTime":64.96,"body":"Distinguished Alumni Award. I was so excited to have Gary on today to talk about cats to get the"},{"startTime":64.96,"endTime":70.64,"body":"side of the practitioner who just deals with cats on what's realistic on how you can manage these"},{"startTime":70.64,"endTime":76.4,"body":"cats, how to medicate these cats. Of course, I can speak from a dermatologist lens, but I love to have"},{"startTime":76.4,"endTime":81.92,"body":"other people on the podcast to compare notes and just to see how things may be a bit different."},{"startTime":81.92,"endTime":85.92,"body":"So I really hope you enjoyed this episode of the Dermvet Podcast."},{"startTime":85.92,"endTime":91.28,"body":"Well, welcome everyone to another episode of the Dermvet Podcast. I am always excited to have"},{"startTime":91.28,"endTime":95.68,"body":"guests on and it's just been thrilling to have more and more people back on the podcast as I get to"},{"startTime":95.68,"endTime":101.52,"body":"more interview type episodes. But today is especially exciting because I have one of my really good"},{"startTime":101.52,"endTime":109.12,"body":"friends Dr. Gary Marshall on the podcast today. Just a dear friend has been really supportive of my"},{"startTime":109.12,"endTime":115.52,"body":"career and my family and I am just really excited to have a cat bet on. I know before we got on,"},{"startTime":115.52,"endTime":121.84,"body":"you said, oh, I'm just a cat bet. Listen, cat, feline veterinarians, you guys are tough and a different"},{"startTime":121.84,"endTime":127.92,"body":"breed. I mean, it is not easy to become so specialized in handling cats. So I am very excited to have"},{"startTime":127.92,"endTime":132.8,"body":"you on the podcast today and learn from you and discuss things and hopefully teach other general"},{"startTime":132.8,"endTime":136.8,"body":"practitioners how to manage these cats a bit better. So thank you so much for being on the podcast"},{"startTime":136.8,"endTime":143.76,"body":"today. I am thrilled to be here Ashley. It's always fun to see you and especially to talk about cats."},{"startTime":143.76,"endTime":152.16,"body":"Cats, they are their own breed for sure isn't that true, their own species. Well, let's just kind of,"},{"startTime":152.16,"endTime":155.76,"body":"you know, obviously don't be asking me about like fluted or anything crazy because"},{"startTime":155.76,"endTime":162.0,"body":"I have no idea. But if we just talk about skin disease and cats, because I know you're still seeing"},{"startTime":162.0,"endTime":168.48,"body":"a significant amount of dermatologic disease, even specializing in cats, what do you feel like the"},{"startTime":168.48,"endTime":173.84,"body":"most common things you see if you thought, okay, the top two to three things I see as far as B-line"},{"startTime":173.84,"endTime":183.12,"body":"dermatology? Probably the top three are all people with concerns about itchiness in their cats."},{"startTime":183.12,"endTime":190.0,"body":"Different forms of itchiness either they are like really itching and bothering the owners because"},{"startTime":190.0,"endTime":194.48,"body":"they're sitting there are the owners are worried about them or that they've just got patchy hair"},{"startTime":194.48,"endTime":199.76,"body":"loss or scabs or those types of things and that probably is leading to itchiness even though they're"},{"startTime":199.76,"endTime":204.56,"body":"not as concerned about that just day in and day out. And do you feel like there's certain patterns"},{"startTime":204.56,"endTime":210.96,"body":"of itchiness you see because what's always tough and I find this especially true for cats is they can"},{"startTime":210.96,"endTime":216.8,"body":"show their itch in so many different ways. So if you think about a cat coming in a typical like"},{"startTime":216.8,"endTime":221.76,"body":"clinical presentation or distribution you see what do you feel like you're not shocked to see"},{"startTime":221.76,"endTime":230.32,"body":"come in your exam room? Oh yeah well with cats there's nothing super typical right? I loved your"},{"startTime":230.32,"endTime":235.84,"body":"podcast a couple weeks ago about like the whole thing revolved around it depends because that's"},{"startTime":235.84,"endTime":242.56,"body":"so true it was great. And we bonded on that. We bonded on that didn't we when you were doing cat"},{"startTime":242.56,"endTime":248.0,"body":"class in you you say it depends for cats too I think that really is something simple that can hold"},{"startTime":248.0,"endTime":253.44,"body":"true for most aspects of veterinary medicine. I'm running out of itchiness stickers but even in"},{"startTime":253.44,"endTime":258.0,"body":"Texas this last weekend I was people were like up on the podium we're talking about itch"},{"startTime":258.0,"endTime":262.48,"body":"depends and I would walk up and give them a sticker it was great because that's all the time. I"},{"startTime":262.48,"endTime":269.2,"body":"I would say though when I have a cat come into the to the room I'm my brain is going to engage"},{"startTime":269.2,"endTime":275.84,"body":"a little bit differently if it's bilateral or if it's unilateral or or focalized in one area of"},{"startTime":275.84,"endTime":282.24,"body":"the cat and then we start thinking about okay what's gonna what's going on that would lead to these"},{"startTime":282.24,"endTime":288.88,"body":"different patterns even though there could be you know five different bilaterally symmetric"},{"startTime":288.88,"endTime":294.88,"body":"problems and they could all look different on different cats. And do you feel like you see a lot more"},{"startTime":294.88,"endTime":299.36,"body":"like trunkal disease or like when I think about cats who come to see me which is definitely going to"},{"startTime":299.36,"endTime":304.0,"body":"be a bit different than what you would see more commonly like I would say like ball belly cats"},{"startTime":304.0,"endTime":311.28,"body":"you know like ball belly cats we see a lot of kind of the rump like back half of the body having"},{"startTime":311.28,"endTime":316.56,"body":"less hair on it is something we see more commonly facial excoriations scratching towards the face"},{"startTime":316.56,"endTime":321.44,"body":"is something we see fairly commonly do you feel like that mimics what you see in general practice"},{"startTime":321.44,"endTime":327.68,"body":"or do you feel like it's different. No I think I see all those definitely the ball belly that the"},{"startTime":327.68,"endTime":333.28,"body":"owners like that we find on a clinical exam that's not brought in for that and then we have to discuss"},{"startTime":333.28,"endTime":344.64,"body":"that the the rump the ears face I also the ones that probably puzzle me the most is just patchy limbs"},{"startTime":344.64,"endTime":350.8,"body":"and I don't have a good like oh it's patchy limbs that means this is what it is and this is what I'm"},{"startTime":350.8,"endTime":357.44,"body":"going to do because they're those are all a little bit different and so those are definitely a is it"},{"startTime":357.44,"endTime":364.08,"body":"bilaterally on the limbs or is it just one limb or those types of things that make me fine tune"},{"startTime":364.08,"endTime":369.2,"body":"kind of my next steps. And I love the fact that you keep bringing up like bilateral versus like a"},{"startTime":369.2,"endTime":374.72,"body":"focal area because I've heard you mentioned that a couple times and it is so important you know I am"},{"startTime":374.72,"endTime":379.2,"body":"typically going to see a my practice is probably going to be more like a symmetrical or bilateral"},{"startTime":379.2,"endTime":384.0,"body":"distribution of these signs because you know most of the time and not always they're referred to me"},{"startTime":384.0,"endTime":389.12,"body":"because there's a suspicion of allergic dermatitis of some degree you know for those of you who don't"},{"startTime":389.12,"endTime":394.64,"body":"know if we talk about environmental allergies and cats it's a really annoying name it's feline"},{"startTime":394.64,"endTime":400.4,"body":"atopic skin syndrome just because of the different ways they manifest it that is kind of where we"},{"startTime":400.4,"endTime":406.08,"body":"have landed which is a bit of a mouthful but essentially I'm usually getting referred cats to work"},{"startTime":406.08,"endTime":412.0,"body":"up that I compare sites things of that nature but when we talk about certain things like just going"},{"startTime":412.0,"endTime":418.24,"body":"after one limb or just having patchy alopecia on one limb or you know a focal area on the belly"},{"startTime":418.24,"endTime":425.28,"body":"there are other things besides allergies that can cause hair loss in itch and cats right like a"},{"startTime":425.28,"endTime":430.32,"body":"urinary tract infection right you probably see that I like hardly ever see that because usually"},{"startTime":430.32,"endTime":434.24,"body":"the primaries ruled it out but is that something you see say like a bald belly cat and it's a certain"},{"startTime":434.24,"endTime":439.6,"body":"distribution that you have seen like a urinary tract infection or fluted or anything like that cause"},{"startTime":439.6,"endTime":447.12,"body":"those issues it's it's on the list definitely especially if it's like I think that they're just"},{"startTime":447.12,"endTime":454.56,"body":"turning to one side and looking one side of their belly or one side of their flank we also think we"},{"startTime":454.56,"endTime":460.8,"body":"can't rule out bilateral as you know if they're arthritic and they only want to turn one way you"},{"startTime":460.8,"endTime":465.84,"body":"know they're just they're just doing more on one side than then both sides even though both sides"},{"startTime":465.84,"endTime":478.4,"body":"probably do itch just as much and and I as far as like a just one spot we don't see what we think of"},{"startTime":478.4,"endTime":484.16,"body":"as hot spots and cats very much I don't you probably do because they they come to you more than they do"},{"startTime":484.16,"endTime":489.92,"body":"me but it's something that has to be on the on the list of is this cat just going at this one spot"},{"startTime":489.92,"endTime":494.32,"body":"because there's something about that particular spot as opposed to a systemic type thing"},{"startTime":494.32,"endTime":500.64,"body":"and other things that I that I hate having on that list and some of these cats that are really"},{"startTime":500.64,"endTime":505.92,"body":"aggressive like it looks like a hot spot is like a hyperesthesia thing because those are so challenging"},{"startTime":505.92,"endTime":511.2,"body":"and they're more you know potentially neuro or internal medicine than actually skin disease but"},{"startTime":511.2,"endTime":515.92,"body":"that's where it's affected the most yeah I've seen videos of cats with hyperesthesia syndrome and"},{"startTime":515.92,"endTime":521.2,"body":"it is awful in fact when I do some lecturing with darker pockel or friend who's a behavior is like he"},{"startTime":521.2,"endTime":525.28,"body":"has some videos of that and they have discussions between neuro behavior internal medicine and"},{"startTime":525.28,"endTime":529.92,"body":"those are ones where if I'm suspecting it when they come in to see me I'm like oh like I don't know"},{"startTime":529.92,"endTime":534.8,"body":"that you're in the right place because I don't even know really what to do with that um but I like"},{"startTime":534.8,"endTime":539.12,"body":"something else you mentioned that if they folk you mentioned feline arthritis and I think feline"},{"startTime":539.12,"endTime":543.84,"body":"arthritis is gained a lot more attention right in the last like year or two because of slenceia coming"},{"startTime":543.84,"endTime":550.16,"body":"out but they can also chew and like I think we see this a bit more with dogs that would probably be like"},{"startTime":550.16,"endTime":556.8,"body":"my interpretation but recognizing feline osteoarthritis a bit more now like if they have a certain limb"},{"startTime":556.8,"endTime":562.72,"body":"that's really arthritic they could chew like really bother a spot from that I don't feel like we see"},{"startTime":562.72,"endTime":569.12,"body":"that as much in cats for you know behavior reasons if they're going after one spot like on the limb"},{"startTime":569.12,"endTime":574.0,"body":"I feel like that I'd be doing x-rays or you know talking to their primary veterinarian to see if we"},{"startTime":574.0,"endTime":578.48,"body":"need to work up that limb further rather than just assume we throw them on steroids would you agree"},{"startTime":578.48,"endTime":586.08,"body":"with that? Yes but a lot of times I mean we don't we we can't just like take an x-ray and say this is"},{"startTime":586.08,"endTime":592.4,"body":"arthritis or not because there's such a wide range of what that x-ray might look like um and you know"},{"startTime":592.4,"endTime":596.96,"body":"I'm kind of I'm kind of old school and I kind of just made it up as I went along so a lot of my"},{"startTime":598.08,"endTime":604.24,"body":"focus on these is gonna end up being response to therapy but if it's arthritis versus itchy"},{"startTime":604.24,"endTime":607.68,"body":"you know you put them on steroids they're probably going to feel better in either one of those so"},{"startTime":607.68,"endTime":614.32,"body":"so sometimes it's a it helps you as kind of a means to an end but it doesn't help you get closer to"},{"startTime":614.32,"endTime":621.04,"body":"the to the answer unless they're limping and cats are so good at hiding anything from us um so"},{"startTime":621.04,"endTime":626.4,"body":"then it comes down to education and a conversation because those owners are going to be such a good"},{"startTime":626.4,"endTime":633.12,"body":"resource if you say no I'm trying to figure out if this cat is itchy or if it's sore somewhere and"},{"startTime":633.12,"endTime":638.8,"body":"and letting the owner know like what this might look like a little bit differently at home versus"},{"startTime":638.8,"endTime":644.16,"body":"obviously in the clinic so we can use them to help us figure out what's going on a little bit better"},{"startTime":644.16,"endTime":649.68,"body":"than we can just do in the clinic and that is so important I mean cats in particular like history is"},{"startTime":649.68,"endTime":657.28,"body":"so important in pretty much any aspect it is so important to really take the time to ask a cat owner"},{"startTime":657.28,"endTime":663.36,"body":"these questions because cats are tricky like you mentioned and I obviously don't see ball belly cats"},{"startTime":663.36,"endTime":669.6,"body":"as a specialist on an annual exam like they're coming because that's there but I hear many of my"},{"startTime":669.6,"endTime":674.56,"body":"friends who are practitioners mentioned oh yeah we're doing they're like I'll do an annual exam"},{"startTime":674.56,"endTime":681.36,"body":"owners won't even notice that there's a ball belly because cats are by nature groomers and so what is"},{"startTime":681.36,"endTime":685.76,"body":"over grooming is always a really difficult question to have if there is multiple cats in the household"},{"startTime":685.76,"endTime":689.12,"body":"sometimes it's helpful because you can say like oh do they groom more than your other cat"},{"startTime":689.12,"endTime":694.88,"body":"but where do you draw the line right to decipher what's too much grooming versus not if you're not"},{"startTime":694.88,"endTime":699.28,"body":"looking for that knowing it can be a clinical symptom of something that's tough"},{"startTime":700.56,"endTime":706.96,"body":"that's so let's get the truth all the time every day yeah so let's focus a bit on cat allergies"},{"startTime":706.96,"endTime":711.6,"body":"because you know predominantly that's what we're going to see a lot of these cats for and we're"},{"startTime":711.6,"endTime":716.88,"body":"both in the Pacific Northwest you know you being in your the Seattle area me being in Portland"},{"startTime":716.88,"endTime":723.04,"body":"and so we're in a pretty high allergenic areas you know we deal with things like not just pollen"},{"startTime":723.04,"endTime":729.36,"body":"but molds because of the moisture and then ectoparasides obviously do you have the same struggle so"},{"startTime":729.36,"endTime":734.16,"body":"when I think of cats and allergies I'm like you know for the love of goodness please please please please"},{"startTime":734.16,"endTime":740.64,"body":"before you refer them to me have them on an isoxazling just please because then if they're better"},{"startTime":740.64,"endTime":745.36,"body":"cool they don't have to spend the money to see me and if they're not better or they're only partially"},{"startTime":745.36,"endTime":751.76,"body":"better cool you've just taken a very easy step away that I have to start out with that owner"},{"startTime":751.76,"endTime":756.16,"body":"do you feel like you see the same like a lot of these cats with flea bite hypersensitivity that you can"},{"startTime":756.16,"endTime":764.0,"body":"manage with flea control yeah it practicing on Mercer Island we don't let fleas come across the bridge"},{"startTime":764.0,"endTime":771.6,"body":"on to Mercer Island so we don't have to worry about it as much but lucky lucky right if only yeah"},{"startTime":771.6,"endTime":781.6,"body":"now we a good chunk of my patients are indoor only they are and the clients that that they live with"},{"startTime":782.56,"endTime":790.48,"body":"don't have a lot of dogs with them so I don't see day in day out a lot of what I think is flea allergy"},{"startTime":790.48,"endTime":797.2,"body":"dermatitis but you have trained me well and so the other local dermatologist that is like if we're"},{"startTime":797.2,"endTime":801.6,"body":"gonna work this thing up further I don't think this is fleas but we're gonna use this otherwise"},{"startTime":801.6,"endTime":806.0,"body":"I'm gonna get scolded when you go to the to the dermatologist because we we haven't been doing this"},{"startTime":806.0,"endTime":816.64,"body":"consistently and but I there's some definitely but not a ton of those cases that they get back to me"},{"startTime":816.64,"endTime":821.2,"body":"and say oh we don't need to do anything anymore and now that I've been you know using whatever"},{"startTime":821.2,"endTime":829.52,"body":"everything's fine I just don't see that that much with my particular patient base and it's always"},{"startTime":829.52,"endTime":833.44,"body":"important to realize that locations can be different right even being the Pacific Northwest maybe"},{"startTime":833.44,"endTime":838.56,"body":"having that kind of island in that area is a bit more protected and even when I lecture you know"},{"startTime":838.56,"endTime":842.96,"body":"people in like high desert climates were like nope we actually really don't have to worry about that"},{"startTime":842.96,"endTime":848.72,"body":"but I think you can on something really important like I am not I I try to be really real life and"},{"startTime":848.72,"endTime":855.2,"body":"realistic and yeah you know I'm not one to be like if you have an indoor cat and they're not itchy at all"},{"startTime":855.2,"endTime":862.0,"body":"like yeah flea controls great but it's more of their symptomatic right like of course it's also"},{"startTime":862.0,"endTime":866.24,"body":"nice in general but if they can't because of cost or whatever and they're a normal cat living their"},{"startTime":866.24,"endTime":871.6,"body":"life and they're happy like I don't know if I'm losing sleep over that but the ones that are going to"},{"startTime":871.6,"endTime":876.64,"body":"get to the point where they're like we are itchy you know we're uncomfortable things aren't working"},{"startTime":876.64,"endTime":880.88,"body":"especially if you're like giving a serenade injection and they're not fully responding or you know"},{"startTime":880.88,"endTime":885.76,"body":"you could kind of control it like that for a bit and now they're not really getting that length"},{"startTime":885.76,"endTime":892.24,"body":"of time or duration that they once did it is just one of those things that I always say is an easy win"},{"startTime":892.24,"endTime":898.24,"body":"like if we can give them an easy win and we don't have to medicate their cats orally or beyond"},{"startTime":898.24,"endTime":904.32,"body":"medications or it just takes that step away from me when they come to see me that I can say oh you're"},{"startTime":904.32,"endTime":910.08,"body":"on revolution plus credele overvecto you know whichever now they're next car combo like you're on one"},{"startTime":910.08,"endTime":913.84,"body":"of those you've been consistent and I would say the other thing is making sure everyone in the"},{"startTime":913.84,"endTime":919.36,"body":"household is so the dogs in the cats because I have had many a cat where because they're an indoor cat"},{"startTime":919.36,"endTime":925.44,"body":"either they're not on flea prevention the dog is we just put the cat they get better but I actually"},{"startTime":925.44,"endTime":931.68,"body":"had situations where the cat was because they were itchy so like the primary that had said hey they're"},{"startTime":931.68,"endTime":938.0,"body":"itchy let's get them on flea control but the dog wasn't and so then I'll say well so it's the dog's"},{"startTime":938.0,"endTime":943.92,"body":"we I don't blame the dog right but before I'm like before we allergy test and spend thousands of"},{"startTime":943.92,"endTime":950.08,"body":"dollars on all this stuff like let's just again easy win and I have absolutely had cats were just"},{"startTime":950.08,"endTime":955.12,"body":"putting the dog on flea control helps and what's important to realize about like do pairs like"},{"startTime":955.12,"endTime":959.76,"body":"control it's not a force field right like everyone's like oh but they self-dipit like it's not a"},{"startTime":959.76,"endTime":965.2,"body":"force field around them where like fleas can't come within three feet you're just really trying to"},{"startTime":965.2,"endTime":970.32,"body":"minimize the population that that pet could be exposed to with a fast speed of kill product"},{"startTime":970.32,"endTime":974.72,"body":"and that's why it's really important to have them all on it yeah but then when they come in to see"},{"startTime":974.72,"endTime":979.76,"body":"me I can say okay that's controlled because we do see cats with multiple allergies and sometimes"},{"startTime":979.76,"endTime":986.16,"body":"that's a hard part too people really want to see is with dogs and cats well we put them on flea"},{"startTime":986.16,"endTime":992.8,"body":"prevention they didn't 100% get better so we stopped uh yeah what if flea in environmental then"},{"startTime":992.8,"endTime":999.68,"body":"it's like well if flea prevention controls you know 40% of it and it's not fully controlled but"},{"startTime":999.68,"endTime":1004.96,"body":"that's controlled like maybe we will be more successful with immunotherapy maybe a topical"},{"startTime":1004.96,"endTime":1008.8,"body":"will work better and we don't need steroids so that's kind of the hard thing too or these cats"},{"startTime":1008.8,"endTime":1015.68,"body":"with multiple allergies yeah yeah one point that came up to me in there that isn't necessarily"},{"startTime":1015.68,"endTime":1022.48,"body":"those derm patients but when when I am talking about flea control with my clients they're saying"},{"startTime":1022.48,"endTime":1029.12,"body":"well I don't see any fleas it's like you know cat even if they're not itchy cats can harbor some"},{"startTime":1029.12,"endTime":1034.8,"body":"fleas but also I really think that cats are just so good at grooming that they can slurp up all the"},{"startTime":1034.8,"endTime":1040.0,"body":"evidence so even if you're flea combing them everything else so I tell owners not being able to"},{"startTime":1040.0,"endTime":1045.92,"body":"find anything does not mean you don't have fleas in your house and so I use that as a as a statement"},{"startTime":1045.92,"endTime":1052.08,"body":"to try to convince them to but it's important um especially you know with kids others in the house"},{"startTime":1052.08,"endTime":1058.16,"body":"you know that everybody needs to be treated if there's any suspicion at all so yeah what do you"},{"startTime":1058.16,"endTime":1062.32,"body":"think about food so let's say you have a cat that you're potentially going to do like a diet trial on"},{"startTime":1062.32,"endTime":1068.96,"body":"you know cats can be exceptionally difficult with diet trials what kind of tips or success or things"},{"startTime":1068.96,"endTime":1074.0,"body":"do you if you're going to have that conversation with an owner lean on or there's certain diets that"},{"startTime":1074.0,"endTime":1079.12,"body":"you really enjoy or like for these cats that use respect to food allergy yeah that's that's a"},{"startTime":1079.12,"endTime":1089.84,"body":"really good one I because cats are picky um I guess my go to is is really decreasing variables as much"},{"startTime":1089.84,"endTime":1094.24,"body":"as possible so if they're on all sorts of treats and all sorts of other stuff and they're on can"},{"startTime":1094.24,"endTime":1100.32,"body":"food and dry food and all this I try to really convince them it's like we're gonna do one thing"},{"startTime":1100.32,"endTime":1106.72,"body":"and maybe your cat's not gonna love this the most but if it eats it gains it maintains its weight"},{"startTime":1107.6,"endTime":1112.08,"body":"we're not gonna we're not gonna worry about all these other things for a period of time"},{"startTime":1112.08,"endTime":1118.8,"body":"and that first thing that I can usually get cats to go for and the people is getting a bag of a"},{"startTime":1118.8,"endTime":1126.08,"body":"hydrolyzed protein dry food I hope there's some hydrolyzed protein can foods coming out that a cat will"},{"startTime":1126.08,"endTime":1132.32,"body":"eat but so far that's like a zero like so I don't even try with the can ones even though they say"},{"startTime":1132.32,"endTime":1140.16,"body":"my cat loves can food but the hydrolyzed protein dry and maybe you can alter my recommendations but I"},{"startTime":1140.16,"endTime":1147.04,"body":"say if if you go through a bag and your cat eats it and your cat's not better by the end of that bag"},{"startTime":1147.04,"endTime":1151.04,"body":"it's like we got to look at other stuff but if you give me that length of time and we'll commit to"},{"startTime":1151.04,"endTime":1156.96,"body":"this one bag then I think we can really decide where we go from there and then I'll try to introduce"},{"startTime":1156.96,"endTime":1165.52,"body":"some limited ingredient single protein can foods or other stuff to that if we get that far."},{"startTime":1165.52,"endTime":1169.44,"body":"I think that's fair and again I think what we have to always recognize and I'm always respectful"},{"startTime":1169.44,"endTime":1174.48,"body":"of this is clients who are just seeing you day to day and you guys are starting this are gonna"},{"startTime":1174.48,"endTime":1179.36,"body":"we're gonna see different types of clients like predominantly right like I have the people who are"},{"startTime":1179.36,"endTime":1187.76,"body":"kind of like simple things are not working so I love hydrolyzed personally and so what we tend to"},{"startTime":1187.76,"endTime":1192.0,"body":"see with cats with food allergies a lot of facial pridest it doesn't have to be I've certainly had cats"},{"startTime":1192.0,"endTime":1197.36,"body":"who don't but that is just with the studies show can be a little bit more common and there's a"},{"startTime":1197.36,"endTime":1205.92,"body":"couple hydrolyzed so I mean these ZD can and I don't personally use a lot of ZD just based on some of"},{"startTime":1205.92,"endTime":1211.44,"body":"the chicken allergies we know can flare with that but just to recognize that that is there and then"},{"startTime":1211.44,"endTime":1217.28,"body":"blue hf has a canned version I've had a lot of cats not like it but I've had some really like it so"},{"startTime":1217.28,"endTime":1224.08,"body":"again what I have learned about food I can have my favorites but in the end you can't tell me one"},{"startTime":1224.08,"endTime":1229.36,"body":"diet that works for every single cat that every single cat will eat that every single owner is"},{"startTime":1229.36,"endTime":1235.68,"body":"happy to feed like that is just the reality with food food is love people have opinions on it"},{"startTime":1235.92,"endTime":1241.68,"body":"so I tried to be really open but I also will be very informative if you've gotten to me and I'm"},{"startTime":1241.68,"endTime":1245.84,"body":"worried about a food allergy like we can't just say oh but I don't feed chicken so they're not food"},{"startTime":1245.84,"endTime":1252.32,"body":"allergic like yes I do use a lot of the hydrolyzed diets but I always ask owners like I go eight weeks"},{"startTime":1252.32,"endTime":1257.04,"body":"so kind of depends on the size of the cat out of 22 pound cat in the clinic yesterday so he probably"},{"startTime":1257.04,"endTime":1262.24,"body":"gets served by a food pretty fast but it always depends on you right like so I say eight weeks and"},{"startTime":1262.24,"endTime":1268.16,"body":"then I ask them like are you fine with just kibble what's your comfort level with this food you know"},{"startTime":1268.16,"endTime":1272.96,"body":"can do you have to have a can well then maybe we do just need to do novel protein right off the get go"},{"startTime":1272.96,"endTime":1278.4,"body":"so those are kind of the conversations that I have with them but it just depends on the owner"},{"startTime":1278.4,"endTime":1282.64,"body":"and what they're willing to do and if it's just overwhelming and they're gonna like half commit"},{"startTime":1282.64,"endTime":1288.64,"body":"to a diet trial I just tell them to wait till they can fully commit because I might only get one or"},{"startTime":1288.64,"endTime":1294.48,"body":"two chances at a diet trial and if they're like well but Graham is coming over and she's still always"},{"startTime":1294.48,"endTime":1299.12,"body":"gonna give this you know they're spending two weeks with us and like then we wait till two weeks"},{"startTime":1299.12,"endTime":1303.76,"body":"we wait till they're gone because it is a diagnostic test and I think it's really important for people"},{"startTime":1303.76,"endTime":1309.44,"body":"to recognize that and use that wording with owners too like I tell them like this trial is a"},{"startTime":1309.44,"endTime":1315.84,"body":"diagnostic test so we want to do it correctly because at the end of it our goal is to hear yes or"},{"startTime":1315.84,"endTime":1322.0,"body":"no your cat is food allergic or not and if it has not helped us at all then we get to move on with"},{"startTime":1322.0,"endTime":1328.64,"body":"confidence and realize we're not missing something but I think that helps owners realize why it is so"},{"startTime":1328.64,"endTime":1334.16,"body":"strict because it's a diagnostic test and then we can always pivot long term if we find out the"},{"startTime":1334.16,"endTime":1338.88,"body":"the cat is food allergic and maybe they have different desires like of what they want to feed their cat"},{"startTime":1338.88,"endTime":1344.88,"body":"yeah I think that's important because I I do a lot of that the same and I you know I tell my clients"},{"startTime":1344.88,"endTime":1349.6,"body":"a lot of times I'm pretty simple there's a couple things I want to know first and for me to"},{"startTime":1349.6,"endTime":1355.68,"body":"know these things sometimes it's a test sometimes it's a trial sometimes with it's with a drug sometimes"},{"startTime":1355.68,"endTime":1363.6,"body":"with it's with food but like you said it's like if we can't do this thing for this long now then"},{"startTime":1363.6,"endTime":1368.4,"body":"we're gonna wait because I'm not gonna learn anything and then we'll it'll be just I I won't be"},{"startTime":1368.4,"endTime":1374.4,"body":"any closer to being able to help you if we don't aren't able to commit to it for whatever period to"},{"startTime":1374.4,"endTime":1380.88,"body":"perfect definitely now let's move on to that bugger that is feel any two-pick skin syndrome so when"},{"startTime":1380.88,"endTime":1385.52,"body":"we talk about these cats that you are suspecting there's an environmental allergy what does that"},{"startTime":1385.52,"endTime":1391.76,"body":"conversation look like as far as the treatment options you know again totally respecting that I'm"},{"startTime":1391.76,"endTime":1396.08,"body":"gonna have a different kind of clientele conversation and I think that would be expected or else"},{"startTime":1396.08,"endTime":1401.12,"body":"my primary events are gonna love you know sending me cases if we're not having different conversations"},{"startTime":1401.12,"endTime":1406.0,"body":"so what does that look like if you kind of come to the conclusion that a cat is environmentally allergic"},{"startTime":1406.0,"endTime":1412.16,"body":"yeah I that's that's a good one because like we've talked about they're all so different"},{"startTime":1412.16,"endTime":1419.6,"body":"and sometimes we have like for myself with being in practice for 25 years and we have you know the"},{"startTime":1419.6,"endTime":1425.04,"body":"grandkids of some of my original clients or no clients of mine that we have we have we're in it for"},{"startTime":1425.04,"endTime":1430.24,"body":"the long game so we're able to piece together a little bit more probably than you are with some of"},{"startTime":1430.24,"endTime":1436.8,"body":"these histories and stuff that maybe it's seasonal maybe it's never happened until right now and we"},{"startTime":1436.8,"endTime":1441.44,"body":"try to kind of figure out what may have changed to initiate that whether it's environmental or something"},{"startTime":1441.44,"endTime":1450.08,"body":"else chemical or something in in the home so that will play a role in getting to that point"},{"startTime":1450.08,"endTime":1458.88,"body":"and then I also try to weigh what's the the urgency in the panic of the client whether you know it's"},{"startTime":1458.88,"endTime":1463.84,"body":"mild no big deal we want to really really learn and we want to know exactly what's going on and how we"},{"startTime":1463.84,"endTime":1470.64,"body":"step into that in the diagnostic process or it's like I can't sleep my cats you know June a new hole"},{"startTime":1470.64,"endTime":1477.44,"body":"in its leg or something like that and then in those patients I will jump more to a what is it"},{"startTime":1477.44,"endTime":1483.68,"body":"going to take to prove that we can stop this problem and I will usually go to steroids on that"},{"startTime":1483.68,"endTime":1490.48,"body":"or something like that first as opposed to you know atopica or something that is non-steroidal and just"},{"startTime":1490.48,"endTime":1497.6,"body":"to get that do we get relief or not because I learn a lot from that and as opposed to you I do have a"},{"startTime":1497.6,"endTime":1503.92,"body":"favorite injectable steroid I like to use in those particular situations because a lot of my clients"},{"startTime":1503.92,"endTime":1509.84,"body":"are like you want me to give this pylp this frequently for this long it's and it's not then I'm"},{"startTime":1510.48,"endTime":1514.8,"body":"again it comes back to that can we get this done and am I going to be certain with the answer to the"},{"startTime":1514.8,"endTime":1521.6,"body":"question that I want and for me in that initial one a little injectable triumson alone is my favorite."},{"startTime":1521.6,"endTime":1526.56,"body":"Yeah and just to loop back to that when you say opposed to me so before you're and I hopped on or"},{"startTime":1526.56,"endTime":1532.96,"body":"even when we when I first asked you like Dr. Marshall please be on my podcast you said well just"},{"startTime":1532.96,"endTime":1536.72,"body":"don't like shape me about steroids and cats I'm like I use a ton of steroids and cats I think we"},{"startTime":1536.72,"endTime":1545.6,"body":"have to be realistic there is not much unlabeled for cats and you can you do steroids are a great"},{"startTime":1545.6,"endTime":1552.4,"body":"tool they can be a bad tool too right but they are a great tool and the reason that Dr. Marshall is"},{"startTime":1552.4,"endTime":1557.52,"body":"mentioning like opposed to me I don't use a lot of injectable steroids but that does not mean I have"},{"startTime":1557.52,"endTime":1562.64,"body":"any shame in a general practitioner doing it the reason that I don't is because the cats who just get like"},{"startTime":1563.2,"endTime":1568.24,"body":"one or two triumson alone injections a year or one depot a year and they're hunky-dory the rest of the"},{"startTime":1568.24,"endTime":1575.12,"body":"year are not the ones I am seeing like I am seeing the ones that we were on depot and now we it only"},{"startTime":1575.12,"endTime":1579.28,"body":"last a few weeks you know like we are to the point where that is not going to be the solution and the"},{"startTime":1579.28,"endTime":1584.72,"body":"reason we will lean more towards an oral steroid and yes everything you're saying about the"},{"startTime":1584.72,"endTime":1590.8,"body":"complications of giving cats oral steroids is so true and I will work so diligently with owners"},{"startTime":1590.8,"endTime":1595.28,"body":"whether it is we need a compound liquid doing need to you know we we don't just say give this if"},{"startTime":1595.28,"endTime":1600.4,"body":"it's difficult but it's because I'm usually having to use them more consistently like a pimpicus cat"},{"startTime":1600.4,"endTime":1605.36,"body":"or a really bad allergy cat and so then if I can get them to the point where they're more on like"},{"startTime":1605.36,"endTime":1611.92,"body":"every other day steroid and we're controlled I personally see like less like diabetes or other"},{"startTime":1611.92,"endTime":1617.44,"body":"issues so there is no shame for me because I think if I was in general practice and I just had to give"},{"startTime":1617.44,"endTime":1622.32,"body":"a steroid you know shot and that made their life easier in the owner kind of knows the risk which"},{"startTime":1622.32,"endTime":1626.56,"body":"honestly a lot of times cats handle them okay we think of the terrible stories that happen though right"},{"startTime":1626.56,"endTime":1632.16,"body":"we have to make these cats comfortable like we don't want to be so afraid I see that all the time"},{"startTime":1632.16,"endTime":1637.12,"body":"with feline otitis I know we're gonna talk briefly about that where I always get asked like what"},{"startTime":1637.12,"endTime":1640.24,"body":"can you put in there what can you put in there what can you put in there and we all know they're"},{"startTime":1640.24,"endTime":1645.6,"body":"ain't much right that's on label for cats but if we are so afraid to treat that year you know it's"},{"startTime":1645.6,"endTime":1651.36,"body":"also not good for that year like a multi-drug resistance pseudomonas that we're not treating"},{"startTime":1651.36,"endTime":1656.88,"body":"is also not good for that middle year so to your point like yes we have to be like thoughtful and"},{"startTime":1656.88,"endTime":1662.16,"body":"we're gonna have different ways that we handle that but I just want people to have the comfort to know"},{"startTime":1662.16,"endTime":1668.0,"body":"like cats are difficult and we have to provide a good quality of life for that we don't want to"},{"startTime":1668.0,"endTime":1672.88,"body":"abuse them and not use them appropriately but they can be wonderful tools to make these cats"},{"startTime":1672.88,"endTime":1680.16,"body":"comfortable yeah I love steroids listen I do steroid trials sometimes too like I've had some"},{"startTime":1680.16,"endTime":1685.52,"body":"cats where I'm like I'm pretty sure you're allergic but like psychogenic alopecia is extremely rare"},{"startTime":1685.52,"endTime":1690.16,"body":"but like I mean so if I give you steroids and I know you got better then it's not psychogenic"},{"startTime":1690.16,"endTime":1694.72,"body":"alopecia but if I'm like tried my third or fourth type of steroid and you're not responding maybe"},{"startTime":1694.72,"endTime":1699.92,"body":"I'm questioning myself a bit more so I do think like there's an appropriate way to do that but you"},{"startTime":1699.92,"endTime":1704.88,"body":"also have to educate the owner right like well I need to know if there's a response and then we'll"},{"startTime":1704.88,"endTime":1709.44,"body":"move on from there and then you mentioned a tope because let's talk a little bit about that so with"},{"startTime":1709.44,"endTime":1714.32,"body":"a topical topic I kind of say both tell me about that when you're starting cats and eggs I believe"},{"startTime":1714.32,"endTime":1723.44,"body":"we've had conversations where you primarily use the capsules is that correct yeah I the liquid"},{"startTime":1723.44,"endTime":1731.76,"body":"even though it's labeled for cats is just nasty I I think I have one out of a few dozen patients that"},{"startTime":1731.76,"endTime":1735.52,"body":"would actually take the liquid just because they they went to that because they couldn't get the"},{"startTime":1735.52,"endTime":1748.4,"body":"capsule in but I really really like the the capsule and if not every client can get it in but I"},{"startTime":1749.2,"endTime":1755.2,"body":"will see usually it's one that I've seen that it that the steroids will really benefit it and then"},{"startTime":1755.2,"endTime":1763.36,"body":"I'll put them on atopica and for a long more a longer term I don't want to put them on steroids forever"},{"startTime":1763.36,"endTime":1772.96,"body":"so let's try this instead and I get wonderful results if they truly are an atopic cat and"},{"startTime":1775.52,"endTime":1782.0,"body":"so I I we're having a little bit more trouble getting it on some of the online ones to order it for"},{"startTime":1782.0,"endTime":1788.0,"body":"people because and the my clinic as far as being able to inventory it now they'd say I don't want"},{"startTime":1788.0,"endTime":1795.36,"body":"to spend all this money to have this stuff on my shelf and so some of the some of the online pharmacies"},{"startTime":1795.36,"endTime":1800.88,"body":"veterinary ones specifically are like that's not a cat drug you can't order it for your clients even if"},{"startTime":1800.88,"endTime":1805.44,"body":"we say you know it's okay off label that we've just seen a trend in this in the last literally the"},{"startTime":1805.44,"endTime":1809.84,"body":"last month or so so I don't know if any of your listeners are going through any of that"},{"startTime":1809.84,"endTime":1817.92,"body":"but I don't have a workaround for that just yet and if you're having trouble getting it just look"},{"startTime":1817.92,"endTime":1822.48,"body":"for another source I guess look for another pharmacy yeah it's interesting we haven't had that"},{"startTime":1822.48,"endTime":1828.72,"body":"issue but again we're using probably a lot and I use the liquid orcapsules I ask owners I and I tell"},{"startTime":1828.72,"endTime":1834.4,"body":"them the liquid is bitter but I still have had owners that are successful with it and I in the capsules"},{"startTime":1834.4,"endTime":1839.84,"body":"not tiny so you know I kind of give them the option either way and I just say the starting point"},{"startTime":1839.84,"endTime":1845.28,"body":"we could always move but it is on label for cats liquid version and it really can be a great"},{"startTime":1845.28,"endTime":1849.92,"body":"tool for these cats as long as they tolerate it and it's effective the dosing being five to ten"},{"startTime":1849.92,"endTime":1855.28,"body":"makes per gig which a lot of cats like the labeled kind of serengyocene the liquids is seven"},{"startTime":1855.28,"endTime":1860.32,"body":"milligram per kilogram dosing so you can kind of vary from that one trick I have had with some of the"},{"startTime":1860.32,"endTime":1864.96,"body":"liquid if they won't take the capsule and it was gone for a while but slowly come back is there is"},{"startTime":1864.96,"endTime":1873.68,"body":"it's off label what's hardly anything's not in cats but cyclovance which is a non-flavored liquid"},{"startTime":1873.68,"endTime":1880.56,"body":"that verbat has it's on label for dogs with allergic dermatitis but and I write anything if I"},{"startTime":1880.56,"endTime":1884.72,"body":"use apical and cats that like a tell-lone just off label but we actually had some we've had"},{"startTime":1884.72,"endTime":1890.48,"body":"some fair success with it so it's non-flavored and some cats will take it really well but you just"},{"startTime":1890.48,"endTime":1894.56,"body":"have again have to let them know that it's off label for them but we not gonna would haven't seen"},{"startTime":1894.56,"endTime":1899.36,"body":"a lot of indications beyond just like normal cyclospor inside effects like vomiting and things of"},{"startTime":1899.36,"endTime":1906.4,"body":"that nature and then yeah go ahead I was gonna say one one thing and maybe you have some advice on"},{"startTime":1906.4,"endTime":1912.56,"body":"this is if I am starting them on atopika and it's the the capsules pretty much any cat I'll start"},{"startTime":1912.56,"endTime":1917.28,"body":"on 25 milligram and if it works great then I'll just say let's try the 10 milligram because you really"},{"startTime":1917.28,"endTime":1922.8,"body":"only have you know you can't break it in half you can't change the dose so you're either going one or"},{"startTime":1922.8,"endTime":1929.36,"body":"the other so I'll usually go with a two week or four week supply of the higher dose and see how"},{"startTime":1929.36,"endTime":1933.68,"body":"they're working and then see if we can get her way with the lower dose and sometimes we can't we"},{"startTime":1933.68,"endTime":1941.28,"body":"go back up to the 25 yeah I just I dose it out so it usually is a 10 or 25 unless you have a huge cat"},{"startTime":1942.16,"endTime":1946.24,"body":"just based on the limitations with the capsules I have occasionally had cats who are fairly big where"},{"startTime":1946.24,"endTime":1951.84,"body":"we almost have to do both like it like they need like 35 milligrams but I think in general you're"},{"startTime":1951.84,"endTime":1957.44,"body":"gonna get a large population of cats with that and then what are your feelings on allergy testing"},{"startTime":1957.44,"endTime":1961.68,"body":"and cats is it something you recommend is it something you've seen success with do you do it on"},{"startTime":1961.68,"endTime":1968.8,"body":"yourself or do you refer them out for that I don't deal with it and I will if they're if they're I"},{"startTime":1968.8,"endTime":1973.76,"body":"tell them there are some options that I haven't had cases that have been really helpful to the"},{"startTime":1973.76,"endTime":1980.56,"body":"options that we can still do after that and if they're really in into like I want to find this out I"},{"startTime":1980.56,"endTime":1985.28,"body":"want to do the you know hyposensitization or whatever will refer them we have dermatologist here that"},{"startTime":1985.28,"endTime":1992.56,"body":"will that will do that and yeah I don't exactly know what they're doing I just get a report back this"},{"startTime":1992.56,"endTime":1997.36,"body":"is there allergic to this that and the other thing and it's like that's fine I'll help you with whatever"},{"startTime":1997.36,"endTime":2003.2,"body":"you want us to do after that and that's not something that I've tried to fill my brain with how that all"},{"startTime":2003.2,"endTime":2008.32,"body":"works and because a change is two and each one's a little different and how they do it and so it's"},{"startTime":2008.32,"endTime":2014.16,"body":"like I trust them and we'll just go with whatever they decide but that's very few I a couple cats a"},{"startTime":2014.16,"endTime":2020.16,"body":"year I think and I think that's told again realistic you know I don't I think if it's something that"},{"startTime":2020.16,"endTime":2024.0,"body":"you're not confident in how to do it I think it's a really easy thing sometimes for people to say"},{"startTime":2024.0,"endTime":2029.2,"body":"well we'll just do an allergy test but I actually love I'd prefer and then if you're not comfortable"},{"startTime":2029.2,"endTime":2033.84,"body":"then we know therapy are describing that to your owners like I'd prefer owner you know just to say"},{"startTime":2033.84,"endTime":2038.08,"body":"well this is not hitting your goals or your cat's not responding then we should refer you"},{"startTime":2038.08,"endTime":2042.96,"body":"because dermatology is something that can be easy right we're not like doing a crazy surgery most"},{"startTime":2042.96,"endTime":2049.44,"body":"of us so like it's pretty easy to do it within your practice but I always encourage like if you're"},{"startTime":2049.44,"endTime":2056.48,"body":"going to do immunotherapy either really know how to do it or refer out for it and we have to be careful"},{"startTime":2056.48,"endTime":2061.68,"body":"because allergy testing it's so easy for people to get caught in the weeds with that and say but"},{"startTime":2061.68,"endTime":2066.8,"body":"this and they want to tear up their yards and you know it's it's not a test we do diagnostically it's"},{"startTime":2066.8,"endTime":2073.68,"body":"one to guide or immunotherapy so but I will tell you I have had cats who do extremely well with"},{"startTime":2073.68,"endTime":2078.88,"body":"immunotherapy and when we are limited on what we have available for cats or they don't want to take"},{"startTime":2078.88,"endTime":2084.8,"body":"oral medications the owners that are willing to do it it's not that it's 100% successful but it"},{"startTime":2084.8,"endTime":2090.32,"body":"often can allow me to lower the dose of e-topica or just use it seasonally or I've absolutely had cats"},{"startTime":2090.32,"endTime":2095.28,"body":"that fully respond so if you are in a situation where they can't they can't medicate or it's not working"},{"startTime":2095.28,"endTime":2100.8,"body":"I love referring because those are the cats that we might have the ability to help in a different way"},{"startTime":2100.8,"endTime":2106.64,"body":"and I'll tell you Ash you probably a lot of that is not just that I don't want to invest the bandwidth"},{"startTime":2106.64,"endTime":2116.0,"body":"in it to figure it out and to manage those issues it's more the that I want somebody else to have"},{"startTime":2116.0,"endTime":2122.96,"body":"those conversations with these clients because it's a lot and that's kind of the in the last few"},{"startTime":2122.96,"endTime":2127.28,"body":"years I finally said we finally said not doing international health certificates anymore it's like"},{"startTime":2127.28,"endTime":2132.56,"body":"we can do them maybe we're supposed to do them but it's just a pain in the neck and there's other people"},{"startTime":2132.56,"endTime":2138.0,"body":"that that's their business so we're going to refer them to that because they take up too much time"},{"startTime":2138.0,"endTime":2142.32,"body":"and we we're plenty busy anyway and if there's somebody else that that's all they do and that's what"},{"startTime":2142.32,"endTime":2147.12,"body":"they focus on they're going to be better for those clients and vice versa. I think that is great I"},{"startTime":2147.12,"endTime":2152.24,"body":"mean I think we have to protect our bandwidth to some point like I said like I would much rather you"},{"startTime":2152.24,"endTime":2157.2,"body":"say hey there is a possibility to do like allergy shots we're going to send you to someone who wants"},{"startTime":2157.2,"endTime":2162.0,"body":"to do them like I honestly think I I hear all the time like I didn't even know you existed as a"},{"startTime":2162.0,"endTime":2166.88,"body":"veterinary dermatologist like I think the people who are going to start to really actually consider"},{"startTime":2166.88,"endTime":2171.04,"body":"that they are going to probably I mean I can ask questions by clients where I'm like I don't really"},{"startTime":2171.04,"endTime":2177.04,"body":"know the answer to that like I may have to investigate for you so I I think that's great you want"},{"startTime":2177.04,"endTime":2181.28,"body":"to talk about bandwidth anything that's not skin and ears I'm like we're going to have to ask your"},{"startTime":2181.28,"endTime":2188.0,"body":"primary vet because I don't my dog has a primary vet because I don't I don't know what to do you know"},{"startTime":2188.0,"endTime":2193.36,"body":"I can't give her a dental I can't like the primary vet or he's the important she's also like oh well"},{"startTime":2193.36,"endTime":2197.76,"body":"you know we could just you know I could help you get the vaccines are I'm like no I need you to listen"},{"startTime":2197.76,"endTime":2204.56,"body":"to her I need you to palpate her like I need some like I can I got her allergies don't worry about that"},{"startTime":2204.56,"endTime":2209.76,"body":"but like beyond that like I am helpless you like to have to know everything you guys do is mind"},{"startTime":2209.76,"endTime":2215.52,"body":"boggling to me and so I love that that if you're just like you know there's these options but I'm"},{"startTime":2215.52,"endTime":2220.56,"body":"not just the right person for that that I mean that's how we work collaboratively right like that's"},{"startTime":2220.56,"endTime":2225.84,"body":"why I do all this specialized training to know how to handle those patients for you but also like"},{"startTime":2225.84,"endTime":2230.72,"body":"you are the pet's advocate as a general practitioner to be able to say there's other options but that"},{"startTime":2230.72,"endTime":2234.96,"body":"I'm not the one to do it like you should go see someone who who has really learned how to do it"},{"startTime":2234.96,"endTime":2240.16,"body":"so we can give you the best chance to respond and then the last thing I do want to ask you about"},{"startTime":2240.16,"endTime":2245.92,"body":"this has been so wonderful I know we could chat forever um let's talk about ears and cats kind of as"},{"startTime":2245.92,"endTime":2250.16,"body":"our closer because I do think that's difficult and we get asked a lot about and I've had I've had"},{"startTime":2250.16,"endTime":2254.56,"body":"Dr. Diesel a dermatologist in Texas and I'm a few years ago we talked about catatitis in the"},{"startTime":2254.56,"endTime":2258.96,"body":"podcast but it is really tough like what do you feel like the most common things if you see a cat"},{"startTime":2258.96,"endTime":2264.56,"body":"with an ear infection that you're using or are you flushing cat ears I know that's always scary"},{"startTime":2264.56,"endTime":2272.48,"body":"for people what do you what do you see in your practice yeah this um I don't love this topic because"},{"startTime":2272.48,"endTime":2279.92,"body":"they're no one loves this topic Gary no one loves this topic and it's and and then it's even when"},{"startTime":2279.92,"endTime":2283.84,"body":"you find out what then what the heck are you going to do about it because the ears are uncomfortable"},{"startTime":2283.84,"endTime":2290.24,"body":"and you got to put stuff in the ears maybe maybe you don't maybe there's other ways um but cats hate"},{"startTime":2290.24,"endTime":2297.44,"body":"it people hate doing it they're usually not nobody is usually able to do it well enough um at home"},{"startTime":2297.44,"endTime":2303.68,"body":"to manage the problems completely topically I feel um and so it's it's it's it's frustrating and"},{"startTime":2303.68,"endTime":2312.88,"body":"and they they they come back again and um and so this is one where I will sort of claim that"},{"startTime":2312.88,"endTime":2319.28,"body":"and and usually we're seeing mixed things right we're seeing yeast and we're seeing bacteria"},{"startTime":2319.84,"endTime":2324.32,"body":"and there's probably an allergic component all that kind of stuff and the products that I have"},{"startTime":2324.32,"endTime":2328.48,"body":"on my shelf are they're going to have antibiotics in it they're going to have antifungals and they're"},{"startTime":2328.48,"endTime":2334.88,"body":"going to have a steroid is opposed to just a one a one item just the antibiotic or just an"},{"startTime":2334.88,"endTime":2339.68,"body":"antifungal that I'm putting in ears because because I want them to be soothed a little bit too and"},{"startTime":2339.68,"endTime":2343.36,"body":"and maybe I just don't have enough experience by doing it just by myself with all the different"},{"startTime":2343.92,"endTime":2352.88,"body":"plethora of products out there um and if possible I try to manage as much as I can"},{"startTime":2352.88,"endTime":2362.08,"body":"systemically so I've I've found if I see bacteria in there and it smells like bacteria is just a nasty"},{"startTime":2362.08,"endTime":2372.08,"body":"ear infection I think I get so much better benefit by a proper um oral antibiotic than I do with with"},{"startTime":2372.08,"endTime":2377.12,"body":"topical stuff in those years a lot of times you have to do both but I so those are the ones I like"},{"startTime":2377.12,"endTime":2383.52,"body":"to be able to make a big benefit on are the ones that are stinky gross nasty lots of bacteria it's"},{"startTime":2383.52,"endTime":2389.68,"body":"going to have other stuff too but um and getting if we get a culture we um can put it on an"},{"startTime":2389.68,"endTime":2395.36,"body":"antibiotic and I see those feel better so much better and a lot of times even you know once they get"},{"startTime":2395.36,"endTime":2400.64,"body":"get rid of the infection a lot of times the yeast takes care of itself I think on some of those"},{"startTime":2400.64,"endTime":2405.68,"body":"if we're cleaning them occasionally um but maybe I'm maybe maybe you'll tell me I'm doing it all wrong"},{"startTime":2405.68,"endTime":2410.88,"body":"I mean I look at this but that's just what I'm looking at too it's just always different I'm never"},{"startTime":2410.88,"endTime":2415.12,"body":"here to tell anyone they're doing something wrong because again I'm we are seeing different clientele's"},{"startTime":2415.12,"endTime":2421.76,"body":"and different reasons right I would say to briefly end on v line a to otitis um for me so I do"},{"startTime":2421.76,"endTime":2426.0,"body":"successfully get a lot of ownership to topical therapy again I am probably seeing a different form of"},{"startTime":2426.0,"endTime":2432.0,"body":"clientele and I will always respect that um so don't get me wrong I've cat I have cats that that's not"},{"startTime":2432.0,"endTime":2438.16,"body":"the case but I I'd say in general the ones who come to CS like it's it's an option um we know trezziderm"},{"startTime":2438.16,"endTime":2444.16,"body":"is historically the one that's labeled in the US in other countries syrian is labeled for cats um but"},{"startTime":2444.16,"endTime":2449.84,"body":"then you really don't have a ton of options in general most of us find things like betrall pretty safe"},{"startTime":2449.84,"endTime":2454.0,"body":"so you'll see a lot of people compound different formulations and you can talk to compounding"},{"startTime":2454.0,"endTime":2458.8,"body":"pharmacies about like betrall dexaline betrall dexconify of course you could use betrall odic but there's"},{"startTime":2458.8,"endTime":2465.52,"body":"no steroid in it which to your point a lot of times can help with comfort um so but I've had wicked"},{"startTime":2465.52,"endTime":2470.08,"body":"nasty ear infections that we have to reach for you know other things like momentum x pose dex and"},{"startTime":2470.08,"endTime":2475.52,"body":"that can be scary but again a really nasty like pseudomonas is also scary for the middle ear"},{"startTime":2475.52,"endTime":2481.04,"body":"my biggest thing I would kind of end on talking about feline otitis is please find out why it's there"},{"startTime":2481.92,"endTime":2489.52,"body":"I would say more often than not I actually see feline otitis from an ear mass they can get it"},{"startTime":2489.52,"endTime":2495.6,"body":"with their allergies for sure I've seen it we see it with food allergy things like that um but they"},{"startTime":2495.6,"endTime":2499.36,"body":"don't tend to break out with otitis as much as dog dogs like you know allergies it's like ear"},{"startTime":2499.36,"endTime":2505.04,"body":"infections all day long again not that it can't happen but often as we clear out that debris and"},{"startTime":2505.04,"endTime":2510.24,"body":"we look again all of a sudden there's a mass hanging out there or we'll we'll send them for CT"},{"startTime":2510.24,"endTime":2515.04,"body":"so especially if you're having a unilateral otitis or no tightest situation where one ear keeps being"},{"startTime":2515.04,"endTime":2520.08,"body":"significantly worse and the other just got a little bit of infection just keep on keep in mind"},{"startTime":2520.08,"endTime":2526.32,"body":"that we do see out on cats because then if they go to VO or surgery they often can do really well"},{"startTime":2526.32,"endTime":2532.16,"body":"whenever we treat near infection we just want to know why it's there but yeah cats are limiting so"},{"startTime":2532.16,"endTime":2536.24,"body":"if you have one you absolutely cannot touch and you culture and you feel like you get some good"},{"startTime":2536.24,"endTime":2540.72,"body":"systemic options like I'm definitely not here to say that's wrong because there are cases where"},{"startTime":2540.72,"endTime":2545.44,"body":"that can happen I've had dogs where they can't touch their ear and we have to reach for things like"},{"startTime":2545.44,"endTime":2550.32,"body":"systemics even though we prefer not to so I think that's that's just real like medicine you know"},{"startTime":2550.32,"endTime":2554.8,"body":"that we have to help these pets you know we can try to give them tools of how to do things"},{"startTime":2554.8,"endTime":2559.76,"body":"but in the end if they just cannot do it and they can't bring them into you every day to put"},{"startTime":2559.76,"endTime":2564.64,"body":"ear drops in for them like I just am not one to say well we got zero options for you then"},{"startTime":2564.64,"endTime":2569.28,"body":"it can be frustrating but we still have to help them yeah make their pet feel better the best we can"},{"startTime":2569.28,"endTime":2575.36,"body":"and I love me a good polyp those are so satisfying oh man I ending on a funny note so I have this"},{"startTime":2575.36,"endTime":2580.64,"body":"we're older and keep trying to get in to see me I just yesterday I had a second cancellation for"},{"startTime":2580.64,"endTime":2587.68,"body":"it's like a eight-month-old cat that has this a polyp and the second cancellation of can't catch cat"},{"startTime":2587.68,"endTime":2593.36,"body":"like for the appointment and so there's our ass like our staff like what do we do the staff's"},{"startTime":2593.36,"endTime":2597.36,"body":"like well we haven't seen them so like you need to talk to primary vet but you know like here's some"},{"startTime":2597.36,"endTime":2600.32,"body":"don't try to catch them right one is time for the appointment you know or like get them"},{"startTime":2600.32,"endTime":2605.2,"body":"desensitized the carrier so it's interesting because it's always like mostly young cats and then it's"},{"startTime":2605.2,"endTime":2611.52,"body":"always like a bit of a squirrely situation yeah cats I know right in that we could end right there"},{"startTime":2611.52,"endTime":2617.2,"body":"oh cats it depends well with that dog to Marshall I just want to thank you so much for being on"},{"startTime":2617.2,"endTime":2622.96,"body":"the podcast just really good insight I think it's always nice to have people who you know"},{"startTime":2622.96,"endTime":2626.96,"body":"the cats are difficult but I love having general practitioners on too because I think it's great for"},{"startTime":2626.96,"endTime":2631.44,"body":"our practitioners out there listening to the podcast or technicians you just to see that there"},{"startTime":2631.44,"endTime":2637.04,"body":"are some differences but ways that we can really help these cats whether it's referral or just learning"},{"startTime":2637.04,"endTime":2641.2,"body":"or kind of using someone with a lot of experience like yourself so thank you so much for being on"},{"startTime":2641.2,"endTime":2645.84,"body":"the Dermvet podcast it's been an honor so I was great to talk with you I hope that some of it was"},{"startTime":2645.84,"endTime":2652.08,"body":"a little helpful well thank you so much Dr Marshall for being on the podcast today it was so awesome"},{"startTime":2652.08,"endTime":2657.84,"body":"just to be able to see different insight from a v-line practitioner some things we may do"},{"startTime":2657.84,"endTime":2662.88,"body":"similarly and differently I think what it really comes down to is we have to make sure"},{"startTime":2662.88,"endTime":2668.72,"body":"with the limited options we do have with cats that we ask owners involve them what can they do"},{"startTime":2668.72,"endTime":2674.08,"body":"what their expectations are and don't give up and it's okay to use steroids and cats I think that's"},{"startTime":2674.08,"endTime":2679.6,"body":"the other thing of course we have to be aware of their side effects but these cats also deserve"},{"startTime":2679.6,"endTime":2686.32,"body":"to have treatment so I hope you enjoyed listening just to our discussion our conversation as always"},{"startTime":2686.32,"endTime":2691.04,"body":"please rate the podcast if it's something that you love that you find enjoyable and that you learn"},{"startTime":2691.04,"endTime":2696.16,"body":"from so I can keep getting really good dermatology education out to you"}]}