{"version":"1.0.0","segments":[{"startTime":0.0,"endTime":4.72,"body":"Well, welcome to another episode of the Dermvet podcast."},{"startTime":4.72,"endTime":10.76,"body":"I am really excited because I got asked to put together a new Dermatology lecture for"},{"startTime":10.76,"endTime":16.54,"body":"the World Congress of Veterinary Dermatology, which you've heard me talk a bit about."},{"startTime":16.54,"endTime":19.28,"body":"It's in Boston, this July."},{"startTime":19.28,"endTime":24.92,"body":"It happens every four years where all the veterinary dermatologists in the world come together"},{"startTime":24.92,"endTime":31.04,"body":"for one meeting and we are so excited to have it, you know, close to us in the United States,"},{"startTime":31.04,"endTime":35.96,"body":"but just so excited after not having in 2020 to finally have all the veterinary dermatologist"},{"startTime":35.96,"endTime":40.88,"body":"in general practitioners, technicians, anyone that's really interested in Durham, this"},{"startTime":40.88,"endTime":43.2,"body":"is definitely the place to be."},{"startTime":43.2,"endTime":47.44,"body":"This is the first time I have been asked to speak at one of the veterinary Dermatology"},{"startTime":47.44,"endTime":51.32,"body":"conferences beyond abstract presentations."},{"startTime":51.32,"endTime":55.4,"body":"And I wanted to give a glimpse into a lecture that I'm currently putting together that I'm"},{"startTime":55.4,"endTime":57.24,"body":"really excited about."},{"startTime":57.24,"endTime":62.48,"body":"I was asked to put together a lecture about, you know, kind of Dermatology on a budget,"},{"startTime":62.48,"endTime":67.8,"body":"which can be really daunting because as we know with these long term diseases, it can"},{"startTime":67.8,"endTime":71.64,"body":"be expensive and it can be really frustrating."},{"startTime":71.64,"endTime":75.84,"body":"And it's great when you have an owner who can do everything you feel like necessary, but"},{"startTime":75.84,"endTime":78.32,"body":"that's just not the real world that we live in."},{"startTime":78.32,"endTime":83.36,"body":"We have to be willing to provide different access to care points and just make sure that"},{"startTime":83.36,"endTime":90.64,"body":"we can do our best to use our mind and really utilize the tools we have in an efficient way,"},{"startTime":90.64,"endTime":92.96,"body":"cost wise and time wise."},{"startTime":92.96,"endTime":97.72,"body":"So I came up with what I hope comes across as kind of clever because I'm really excited"},{"startTime":97.72,"endTime":104.08,"body":"about an acronym to consider how and the way that I'm kind of titling this lecture,"},{"startTime":104.08,"endTime":107.56,"body":"how to make Dermatology cheaper."},{"startTime":107.56,"endTime":113.28,"body":"With that, the cheap portion of that stands for psychology because you know, I always have"},{"startTime":113.28,"endTime":119.36,"body":"to have that in there somewhere, history, examination, assessment and plan."},{"startTime":119.36,"endTime":123.84,"body":"That doesn't mean I'm necessarily giving you tools to make Dermatology free."},{"startTime":123.84,"endTime":128.96,"body":"Of course, we have to know our worth, but I'm just wanting you to really think about and"},{"startTime":128.96,"endTime":135.76,"body":"consider how we're using the tools we have to be diligent about the workup of that pet"},{"startTime":135.76,"endTime":137.36,"body":"for the owner."},{"startTime":137.36,"endTime":143.84,"body":"Because it is great to have certain protocols in place, but I don't think you should scrape"},{"startTime":143.84,"endTime":145.36,"body":"Pluck smear every single case."},{"startTime":145.36,"endTime":149.12,"body":"Of course, I think if you don't know what's going on, you should go back to the basics."},{"startTime":149.12,"endTime":155.2,"body":"I talk about that a lot, but to be upfront, I do not do skin scrapings on every case."},{"startTime":155.2,"endTime":158.88,"body":"If I don't think it's my, I'm not going to skin scrape."},{"startTime":158.88,"endTime":164.0,"body":"Of course, as you gain more experience working up Dermatology cases, you get more comfortable"},{"startTime":164.0,"endTime":169.16,"body":"with that, but I just want you to know, like I'm satelaging almost everything."},{"startTime":169.16,"endTime":170.48,"body":"I'm not skin scraping everything."},{"startTime":170.48,"endTime":172.04,"body":"I'm not treco-gramming everything."},{"startTime":172.04,"endTime":177.12,"body":"I'm not, you know, ringworm testing everything because I really want to be efficient with"},{"startTime":177.12,"endTime":178.6,"body":"my client's money."},{"startTime":178.6,"endTime":183.84,"body":"So having protocols like doing certain tests again, it's great to try to standardize that"},{"startTime":183.84,"endTime":189.76,"body":"to some degree, but we have to make sure we're really thinking about how we're utilizing"},{"startTime":189.76,"endTime":194.36,"body":"the cost and owner is giving us to take care of their pet."},{"startTime":194.36,"endTime":197.12,"body":"So cheap is a way that I can kind of get my mind around."},{"startTime":197.12,"endTime":201.6,"body":"If I have a case, then maybe there is some cost consciousness."},{"startTime":201.6,"endTime":209.28,"body":"What can I really maximize with that money to get me to hopefully a really great long term"},{"startTime":209.28,"endTime":214.8,"body":"plan, whether it's future diagnostics, we'll save up for and prioritizing those or the treatment"},{"startTime":214.8,"endTime":217.44,"body":"I think is really going to make sense for that pet."},{"startTime":217.44,"endTime":219.64,"body":"So let's go through this cheap protocol."},{"startTime":219.64,"endTime":224.64,"body":"Of course, satology, the C is first or else I probably would have put that a little bit later"},{"startTime":224.64,"endTime":231.04,"body":"on, but satology, you know, as I always say, is our minimum database in dermatology."},{"startTime":231.04,"endTime":236.6,"body":"It is so important and I know the cost of satology can add up when you're repeating it a lot."},{"startTime":236.6,"endTime":244.16,"body":"When you think about the information we get from other tests that maybe cost more, satology,"},{"startTime":244.16,"endTime":250.0,"body":"I feel like is one of the best bangs we were buck as far as an actual diagnostic test because"},{"startTime":250.0,"endTime":252.12,"body":"we can rule out certain things, right?"},{"startTime":252.12,"endTime":257.36,"body":"If we see a dog with skin lesions that are scaly and really itchy, you know, I always say"},{"startTime":257.36,"endTime":259.24,"body":"you can't smell yeast and diagnose it."},{"startTime":259.24,"endTime":260.72,"body":"We have to find it."},{"startTime":260.72,"endTime":266.2,"body":"If you put the cost and the satology to look under the microscope for that pet and we find"},{"startTime":266.2,"endTime":271.36,"body":"a lot of malcezia, we can potentially save the cost of a bacterial culture and sensitivity"},{"startTime":271.36,"endTime":275.2,"body":"that doesn't need to happen and we know that's more expensive."},{"startTime":275.2,"endTime":280.12,"body":"If we see that there's not much bacteria but there's a bunch of inflammatory cells, he"},{"startTime":280.12,"endTime":285.64,"body":"has biopsies not cheap, but if we prioritize that as the next step because we do think it's"},{"startTime":285.64,"endTime":291.04,"body":"an autoimmune disease, then that's still going to save the owner some cost."},{"startTime":291.04,"endTime":295.72,"body":"So, satology really, if you think about it can tell you inflammation, if there's infection"},{"startTime":295.72,"endTime":300.24,"body":"or not, you can even get hints of other diseases like acantholytic carotenicides with"},{"startTime":300.24,"endTime":305.72,"body":"pimpagas, dermatophyte spores, you know, we don't see it on all ringworm cases but occasionally"},{"startTime":305.72,"endTime":310.6,"body":"we do and that can give us an indication of what's going on, neoplastic cells."},{"startTime":310.6,"endTime":314.5,"body":"There's so many different things that can tell us, you know, if you're suspecting dermatophyte"},{"startTime":314.5,"endTime":321.24,"body":"of course doing a fungal PCR or DTM, those are helpful, but it's really only giving you"},{"startTime":321.24,"endTime":327.64,"body":"a yes or no on one disease process versus satology being able to tell you so much."},{"startTime":327.64,"endTime":333.16,"body":"So, really collecting satology as your baseline is going to be more cost effective for that"},{"startTime":333.16,"endTime":339.2,"body":"owner so we can either guide them to the test that makes sense for their pet or start appropriate"},{"startTime":339.2,"endTime":340.2,"body":"treatment."},{"startTime":340.2,"endTime":343.76,"body":"You know, I don't like antibiotic roulette none of us do."},{"startTime":343.76,"endTime":348.84,"body":"So if I know that I've had cases where they've just been on azolept or azolept or azole"},{"startTime":348.84,"endTime":353.48,"body":"because it's assumed it's yeast, but when we run a satology we see like, oh, actually"},{"startTime":353.48,"endTime":359.44,"body":"we have a lot of bacteria, all the money that owners put towards something like yeast treatment"},{"startTime":359.44,"endTime":363.92,"body":"and repeat veterinary visits could have just gone into a culture which would make more"},{"startTime":363.92,"endTime":364.92,"body":"sense."},{"startTime":364.92,"endTime":369.32,"body":"So that's why satology really is something that can help make dermatology a bit cheaper."},{"startTime":369.32,"endTime":375.88,"body":"If you train yourself how to, you know, examine it, there's lots of digital satology machines"},{"startTime":375.88,"endTime":380.48,"body":"that are out now as well like, DrewView, Bysometica or the images, Bysoleta."},{"startTime":380.48,"endTime":384.6,"body":"So there's lots of opportunities to get help with satology if you don't feel comfortable"},{"startTime":384.6,"endTime":386.28,"body":"as well."},{"startTime":386.28,"endTime":391.08,"body":"Then we break into the other things that require you to use your mind."},{"startTime":391.08,"endTime":396.12,"body":"So history that would be the age of cheap history is one of those valuable diagnostic tools"},{"startTime":396.12,"endTime":398.6,"body":"we have in dermatology as well."},{"startTime":398.6,"endTime":404.2,"body":"It can give a ton of information that sometimes is even more valuable than the exam itself because"},{"startTime":404.2,"endTime":407.28,"body":"you're just finding things out like is it seasonal?"},{"startTime":407.28,"endTime":410.28,"body":"Well, but seasonal then obviously we don't need to do a diet trial."},{"startTime":410.28,"endTime":414.56,"body":"It's a lot of a similar to pet, but you just want to make sure you take the time to record"},{"startTime":414.56,"endTime":419.96,"body":"and evaluate that thorough history of those intake forms if that makes sense."},{"startTime":419.96,"endTime":424.2,"body":"Really spending the time during that exam which by the time the owners in the room with"},{"startTime":424.2,"endTime":426.96,"body":"you they've accepted that fee."},{"startTime":426.96,"endTime":433.92,"body":"So at that point taking the time to get a really good history can be so beneficial in assuring"},{"startTime":433.92,"endTime":437.6,"body":"that we do know the next steps of what we need to do."},{"startTime":437.6,"endTime":440.32,"body":"Do they have GI histories?"},{"startTime":440.32,"endTime":442.24,"body":"Are the other pets affected?"},{"startTime":442.24,"endTime":444.08,"body":"Is everyone on Ectoparasite control?"},{"startTime":444.08,"endTime":446.12,"body":"Do we have other systemic signs that are present?"},{"startTime":446.12,"endTime":450.72,"body":"If you have an older dog who's all of a sudden broken out with pyadurma, but you also find"},{"startTime":450.72,"endTime":453.88,"body":"out they became P-U-P-D around the same time."},{"startTime":453.88,"endTime":458.04,"body":"Maybe we were prioritizing a cushing's test rather than putting the money into allergy"},{"startTime":458.04,"endTime":459.72,"body":"medications."},{"startTime":459.72,"endTime":464.28,"body":"So there's certain indicators that can really help you in a history with your differential"},{"startTime":464.28,"endTime":465.28,"body":"list."},{"startTime":465.28,"endTime":469.16,"body":"Just like back in vet school we're all creating a differential list when we evaluate these"},{"startTime":469.16,"endTime":470.16,"body":"pets."},{"startTime":470.16,"endTime":473.76,"body":"You know you're just doing it quicker in your head as you're gaining the information."},{"startTime":473.76,"endTime":478.88,"body":"My differential list is like shifting positions as I'm talking to the owner depending"},{"startTime":478.88,"endTime":480.6,"body":"on what they're telling me."},{"startTime":480.6,"endTime":484.24,"body":"You know did they first break out with parietists when they were two?"},{"startTime":484.24,"endTime":488.48,"body":"Well then I'm going to have a different differential list and if they say oh no but they never"},{"startTime":488.48,"endTime":492.28,"body":"had a sign or history of parietas until they were 12."},{"startTime":492.28,"endTime":498.16,"body":"So that history is extremely extremely valuable in trying to really prioritize what you were"},{"startTime":498.16,"endTime":502.04,"body":"spending your clients money on when working out their pet."},{"startTime":502.04,"endTime":509.04,"body":"The E and sheep examination do not overlook the importance of your examination."},{"startTime":509.04,"endTime":514.12,"body":"A couple things that I would really really try to emphasize for you."},{"startTime":514.12,"endTime":518.2,"body":"Yes it's important to focus on what the owner comes in concerned about but please try to"},{"startTime":518.2,"endTime":522.24,"body":"do your best to still do a full dermatologic examination."},{"startTime":522.24,"endTime":527.44,"body":"They come in concerned about one lesion and it's an epidermal cholera and they think it's"},{"startTime":527.44,"endTime":529.2,"body":"going to be ringworm."},{"startTime":529.2,"endTime":532.48,"body":"You know it's probably back to olfoliculitis then the question is why."},{"startTime":532.48,"endTime":535.28,"body":"You know they're like oh they've never really bothered anything else."},{"startTime":535.28,"endTime":540.08,"body":"You look in their paws are really red, their axillary region is really red and that could"},{"startTime":540.08,"endTime":543.48,"body":"suggest that you might have an allergic pet."},{"startTime":543.48,"endTime":547.6,"body":"They just might not have thought about the fact that yes of course the dog looks as"},{"startTime":547.6,"endTime":552.08,"body":"paws all the time."},{"startTime":552.08,"endTime":556.44,"body":"These are still things that we can pick up on that can give us an indication of what"},{"startTime":556.44,"endTime":561.2,"body":"could be the primary cause especially true for things like ears right."},{"startTime":561.2,"endTime":565.48,"body":"Owners always come in oh the ears are infected and that's what they're worried about and"},{"startTime":565.48,"endTime":569.64,"body":"that makes sense because ears are really annoying if you deal with a pet with you know ear"},{"startTime":569.64,"endTime":573.56,"body":"disease it's painful it's uncomfortable there's an odor to it."},{"startTime":573.56,"endTime":578.04,"body":"So owners come in and say I'll just have an ear infection if you just focus on the ear"},{"startTime":578.04,"endTime":583.12,"body":"infection and don't look at the rest of the pet you may miss some clues that could really"},{"startTime":583.12,"endTime":588.92,"body":"tell you the reason why that's happening and when we talk about making dermatology cheaper"},{"startTime":588.92,"endTime":592.32,"body":"you have to think about the long term implications of that as well."},{"startTime":592.32,"endTime":597.64,"body":"Every veterinary visit every test we run every medication is another cost to that owner."},{"startTime":597.64,"endTime":603.0,"body":"So taking the time to do a thorough examination allows it so we figure out the primary cause"},{"startTime":603.0,"endTime":608.32,"body":"we educate that owner on the primary cause so hopefully we can save those repeat visits"},{"startTime":608.32,"endTime":612.92,"body":"as much as possible because they're not just getting infected all the time because the primary"},{"startTime":612.92,"endTime":617.24,"body":"causes not controlled that's also going to be beneficial."},{"startTime":617.24,"endTime":622.24,"body":"So examination again something that we want to take the time pick up on things like distribution"},{"startTime":622.24,"endTime":626.72,"body":"of lesions if you have a dog that comes in their nasal planums completely deep pigmented"},{"startTime":626.72,"endTime":632.6,"body":"and swollen side of point injections probably not the best use of that owners finances"},{"startTime":632.6,"endTime":637.44,"body":"unless they also have signs of allergic disease and they're uncomfortable because ultimately"},{"startTime":637.44,"endTime":643.64,"body":"we probably need to figure out what autoimmune or deep infectious or plastic disease process"},{"startTime":643.64,"endTime":645.04,"body":"that's there."},{"startTime":645.04,"endTime":650.68,"body":"So we want to be using that examination and those distribution of lesions to really prioritize"},{"startTime":650.68,"endTime":655.04,"body":"the things that we want to spend the clients money on."},{"startTime":655.04,"endTime":659.92,"body":"The A of cheap assessment so again this is kind of pulling all those little things that"},{"startTime":659.92,"endTime":661.76,"body":"we just talked about together."},{"startTime":661.76,"endTime":667.08,"body":"We put that piece of the puzzle in place and see what we think is the best use of that"},{"startTime":667.08,"endTime":668.4,"body":"owners money."},{"startTime":668.4,"endTime":674.64,"body":"So the psychology, the history, the examination that's only decide now what are the next steps?"},{"startTime":674.64,"endTime":678.36,"body":"You know are we at a point we feel comfortable starting a treatment plan is this an allergic"},{"startTime":678.36,"endTime":679.36,"body":"dog?"},{"startTime":679.36,"endTime":683.92,"body":"We are going to do infection control in apaquil is the pieces of the puzzle not really"},{"startTime":683.92,"endTime":686.64,"body":"looking like it's something like an allergic pet."},{"startTime":686.64,"endTime":691.8,"body":"Do we need to say for biopsy is it worthwhile to do something like a fungal PCR?"},{"startTime":691.8,"endTime":695.48,"body":"So those are the things that we want to make sure we're really taking the time to assess."},{"startTime":695.48,"endTime":700.28,"body":"Again the protocols are great but we want to really think like do I really think this"},{"startTime":700.28,"endTime":707.2,"body":"pet has means and I should spend the owners money on a trichogram or a skin's grade."},{"startTime":707.2,"endTime":712.96,"body":"You know do I really think this pet could have to amount of itosis or am I just checking"},{"startTime":712.96,"endTime":716.08,"body":"something off the list to do?"},{"startTime":716.08,"endTime":720.56,"body":"You know those are the things I want to you need to do the beginning of your career maybe"},{"startTime":720.56,"endTime":724.72,"body":"but as you get more educated you really want to think about the test that should be necessary"},{"startTime":724.72,"endTime":729.36,"body":"for that pet based on your examination your history and your psychology because this is"},{"startTime":729.36,"endTime":734.52,"body":"the point where you're coming together and saying okay you know I think this is more auto"},{"startTime":734.52,"endTime":735.52,"body":"immune."},{"startTime":735.52,"endTime":739.2,"body":"I don't necessarily need to spend the money on fungal culture versus doing the exact same"},{"startTime":739.2,"endTime":741.2,"body":"test on every single pet."},{"startTime":741.2,"endTime":745.68,"body":"So again with experience in just seeing these cases and of course I've had cases that I"},{"startTime":745.68,"endTime":749.64,"body":"don't think it's something, I don't think it's dramatic, I don't do it and then they come"},{"startTime":749.64,"endTime":753.32,"body":"back in the lesions of change or progressed a bit and that's okay."},{"startTime":753.32,"endTime":757.52,"body":"You know of course we want to be complete and what we think is necessary but sometimes"},{"startTime":757.52,"endTime":759.92,"body":"lesions change."},{"startTime":759.92,"endTime":763.96,"body":"Sometimes the history changes sometimes it seems straightforward and it's not and"},{"startTime":763.96,"endTime":768.96,"body":"that's okay too that's kind of part of the evolution of dealing with the skin diseases"},{"startTime":768.96,"endTime":773.36,"body":"that can change that can progress sometimes you clear up the infection and all of a sudden"},{"startTime":773.36,"endTime":779.04,"body":"something's really obvious so don't be afraid to prioritize but also to come back and"},{"startTime":779.04,"endTime":784.16,"body":"be like oh maybe I should have done this because sometimes that happens in these cases."},{"startTime":784.16,"endTime":786.76,"body":"Then finally we're going to put together the plan."},{"startTime":786.76,"endTime":790.64,"body":"So after we've made our assessment the plan is going to be split to me into kind of two"},{"startTime":790.64,"endTime":791.64,"body":"categories."},{"startTime":791.64,"endTime":796.2,"body":"The diagnostics like what further diagnostics do we need to do maybe the owner cannot"},{"startTime":796.2,"endTime":801.36,"body":"necessarily afford it today but we can educate the owner on why we should do that in the"},{"startTime":801.36,"endTime":802.36,"body":"future."},{"startTime":802.36,"endTime":807.84,"body":"So a dog that has a pyadurma that you're worried could have thyroid disease maybe they"},{"startTime":807.84,"endTime":812.0,"body":"can't test the thyroid that day because they just need to focus on treating the infection"},{"startTime":812.0,"endTime":817.96,"body":"with their finances but maybe in a month you know we could work up to testing for thyroid"},{"startTime":817.96,"endTime":822.76,"body":"and we just educate them that we feel like that's the best next step to working up their"},{"startTime":822.76,"endTime":824.44,"body":"pets disease."},{"startTime":824.44,"endTime":828.28,"body":"The other category obviously being treatment so what are we going to spend the money on"},{"startTime":828.28,"endTime":830.08,"body":"for treatment."},{"startTime":830.08,"endTime":833.56,"body":"And sometimes when we look at treatment we have to think about what's needed then and what's"},{"startTime":833.56,"endTime":836.6,"body":"the long term future for this pet would cost."},{"startTime":836.6,"endTime":841.58,"body":"For example if I have an owner who says apacryl is just too expensive I can't do it that is"},{"startTime":841.58,"endTime":845.8,"body":"true for some owners I will completely respect that but some owners if you really stick"},{"startTime":845.8,"endTime":850.4,"body":"a step back and say okay I understand you've been through a lot so many different visits"},{"startTime":850.4,"endTime":852.44,"body":"so many different infections."},{"startTime":852.44,"endTime":857.6,"body":"If we look at the cost of apacryl per month long term for your say non seasonal allergic"},{"startTime":857.6,"endTime":864.0,"body":"pet and say they can't dollar a gtast the diet they can't do a diatriil if we look at the"},{"startTime":864.0,"endTime":870.44,"body":"cost of that if your pet successfully is managed with that treatment in the long run and"},{"startTime":870.44,"endTime":875.8,"body":"instead of seeing me once a month and having to do zytology and treat infection what if they"},{"startTime":875.8,"endTime":879.72,"body":"only break out twice a year you know versus all the time."},{"startTime":879.72,"endTime":885.64,"body":"If those repeat cost of the veterinary visit the zytology that antimicrobials if those are"},{"startTime":885.64,"endTime":890.24,"body":"also not cheap if we are not having to spend the money on that as much sometimes it's more"},{"startTime":890.24,"endTime":894.0,"body":"cost effective for the owner and they just didn't think about that."},{"startTime":894.0,"endTime":897.64,"body":"So we have to look at yes as medication per month we have to make sure it's somewhat fits"},{"startTime":897.64,"endTime":902.56,"body":"within the budget but also explain you know versus on their medications if one's well"},{"startTime":902.56,"endTime":907.16,"body":"tolerated and maybe more expensive but you know we don't have to monitor as much lab work"},{"startTime":907.16,"endTime":912.0,"body":"or the pet won't break out as much as they don't want to come spend the cost to see me as"},{"startTime":912.0,"endTime":916.8,"body":"often maybe it's actually more cost effective in the long run for that pet."},{"startTime":916.8,"endTime":923.44,"body":"So we have to look at the acute cost but also the long term cost for that pet and that's"},{"startTime":923.44,"endTime":926.24,"body":"where we just have to really decide what makes sense."},{"startTime":926.24,"endTime":932.32,"body":"So I love allergy testing but if an owner says that it's not realistic for them to be able"},{"startTime":932.32,"endTime":937.12,"body":"to put the cost in allergy testing because remember we allergy test to put them on immunotherapy"},{"startTime":937.12,"endTime":938.12,"body":"therapy."},{"startTime":938.12,"endTime":942.96,"body":"So if they can't commit to immunotherapy or finances are tight and you know for something"},{"startTime":942.96,"endTime":947.0,"body":"that they're not sure how well it's going to work until they put a year of time into it"},{"startTime":947.0,"endTime":951.16,"body":"that's not the right decision but I'm not going to push them to allergy testing."},{"startTime":951.16,"endTime":955.2,"body":"We might educate on it in case in the future that becomes an option but we're going to"},{"startTime":955.2,"endTime":959.92,"body":"focus on the things that we actually can do to symptomatically help that pet and then"},{"startTime":959.92,"endTime":965.2,"body":"over time I'll keep coming back to it if it does become a realistic option for the owner."},{"startTime":965.2,"endTime":970.84,"body":"When we start getting into resistant infections you know of course culture and certain antibiotics"},{"startTime":970.84,"endTime":975.84,"body":"those can add up to those cost effective options we always can consider for things like"},{"startTime":975.84,"endTime":978.92,"body":"a resistance to superficial pyiderma."},{"startTime":978.92,"endTime":983.12,"body":"Topicals you know if I have a pet who's not responding owner can afford a culture you know"},{"startTime":983.12,"endTime":989.16,"body":"they could really get strung on you know every day every other day for accident bathing"},{"startTime":989.16,"endTime":993.96,"body":"the loop bleached the loop bleached is very cheap it's time consuming and owners have to"},{"startTime":993.96,"endTime":998.84,"body":"you know be careful about staining things but it's very cheap so there are ways we can try"},{"startTime":998.84,"endTime":1003.64,"body":"and even these difficult situations to make sure it's cost effective for the owner."},{"startTime":1003.64,"endTime":1009.4,"body":"So that is a little snippet into what I'll be speaking of in a longer format when I'm"},{"startTime":1009.4,"endTime":1013.64,"body":"at the World Congress of Veterinary Nermontology in Boston and July."},{"startTime":1013.64,"endTime":1021.64,"body":"How to make dermatology cheaper cheap being cytology history examination assessment implant."},{"startTime":1021.64,"endTime":1026.12,"body":"So if you want to hear more expanded version of that I have one more talk I'm doing and"},{"startTime":1026.12,"endTime":1031.2,"body":"also so many other wonderful talks are being given you know at the World Congress of Veterinary"},{"startTime":1031.2,"endTime":1032.2,"body":"Nermontology."},{"startTime":1032.2,"endTime":1038.88,"body":"I really encourage you to meet in Boston meet all your fellow term nerd friends in Boston"},{"startTime":1038.88,"endTime":1042.72,"body":"and come just get some of the best education you're going to get when it comes to veterinary"},{"startTime":1042.72,"endTime":1046.68,"body":"dermatology and I hope to see you all there and see you hopefully at my lecture."},{"startTime":1046.68,"endTime":1056.68,"body":"[BLANK_AUDIO]"}]}