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Animal Rehabilitation Unity Discussion – Live

 

Danielle Anderson (DA): Good morning, everybody. I am really, really excited to do this because, you know, for those of you who do know or don’t know, there’s a lot of discussion in veterinary medicine, not even veterinary medicine, in animal rehabilitation, about unifying all the different professions that perform animal rehabilitation.

And I wanted to bring some calm discussion on what unity can look like. So, I brought four different people to discuss this: myself, Deanna Rogers, Jenn Panko and Dr. Narda Robinson.

I’ll introduce myself first. I graduated from the Ontario Veterinary College in Canada in 2002. I did my Bachelor of Science prior to that. I practiced in small animal medicine until I stopped and did rehab full-time a few years ago.

But I started doing rehab in 2012. I added acupuncture to that. In 2016, I finished my certification.

So, I now own a referral-only pain management and rehab practice in Ontario. I have myself, I have a part-time DVM rehab vet as well, I have two CCRP technicians, I have a Chi acupuncturist who works for me as well that graduated from Mexico.

And then I have about five assistants that help us out throughout the day, whether that’s helping with water treadmill or answering phones or communicating with clients, that we’ve trained. So, at least, they have the background of why we’re using some of the modalities. And if we need them to sit with a patient, at least they’re kind of aware of things to worry about and things to watch for. But we’re always in the building with them.

My technicians are amazing and all my associates are amazing. So, that’s kind of how my practice works.

We are referral-only because I felt like – So, I was a general practitioner for many, many, many years – I guess if you consider 18 years many, many. And I know what it’s like, as a veterinarian, to have a patient doing things that you have no idea what’s going on.

And to earn trust of other veterinarians and other practitioners, I wanted to make sure that they knew exactly what was happening. In order for that to happen, I wanted to have a referral on file. So, we will not see them without that. Unless for some reason, they are moving to the area, they haven’t seen anyone and something major is going on. And then I will help them find a local veterinary for general practice.

But since we don’t do general practice, I make sure that they have something somewhere to take care of that patient. I think that’s it for me.

And we actually won’t book them–We used to, but we won’t book them appointments now until we have full medical records, x-rays, if they’re done, anything that we can potentially have on file. Because I feel like that even when clients leave and go to another practice, it’s required by law for us to send that information. And I think for client care, it’s super important.

So, when I talk about unity in rehab, that’s one of the biggest things that I try and emphasize and I think is super, super important, whether it’s PTs and vets working together, technicians and vets working together, chiros and vets working together; whatever the professions are, I think it’s imperative to have all of that information. Because clients are wonderful, but do they always remember the details of things that are going on or that are said?

And so, I think that’s where I’m coming from, from my perspective, and that’s my background. So, Deanna, do you want to introduce yourself?

Deanna Rogers (DR): Sure, yeah. I’m Deanna Rogers and I’m a human-trained physical therapist that also does animals. And I graduated from PT school in 1985 from Texas Women’s University in Houston. Got a Master’s degree.

My human practice, I did till 2011, and all of my human practice was in geriatrics. I was board certified as a geriatric PT.

I started working with animals in 2004, working through getting my Canine Rehabilitation Certification and worked with a group of folks to get our Practice Act changed in Colorado. And so, then I officially started my animal PT business in 2008 and became full-time there in 2011.

So, I have a mobile practice and I go to people’s homes and treat their pets there. I also spent about seven, eight years also working at a rehab clinic, that was an ER and rehab clinic, which was wonderful.

So, as for me, being in Colorado, we do have to get what’s called Veterinary Medical Clearance, which is like a referral. So, I definitely have to have that. And because I’m a one-man show, so to speak, I don’t have technicians or assistants or whatever – And therefore I’m pretty much on my own – I do a lot of communicating with the other members of that animal’s veterinary health care, and particularly in the way of communicating notes and what I’m doing in rehab, and the rehab plan development and that type of thing.

So, collaboration for me is critical. It’s kind of my lifeline, since I’m out there on my own. I really value having that interaction with the other members of that animal’s team.

DA: Do you want to go next, Jenn?

Jenn Panko (JP): Sure.

DA: We’ll kind of work our way around.

JP: Hi, everyone.

I have a small animal rehab facility in British Columbia that I moved across Canada to work at, and I was so excited to move here. I love it.

I was from Ontario, like Danielle, and I worked there for about a year. And then I went on maternity leave. And when I returned, I purchased it, which was exciting. And I was going to collaborate. I was going to do all these great things.

Fortunately for the veterinarian that I worked closely with, he was able to buy another practice, which didn’t stress me out at all. We were still going to collaborate. It was going to be fine. And now he’s gone; I took it so hard.

But the village has stepped up. So, I have Dr. Susan Calverley, who is a rehab vet, a CCRT. She also does amazing work with OrthoPets. She is my out-of-the-box thinker. So, if you’re old, if you’re complicated, if there is no solution, guess what? Susan’s got one. So, she shows up and she makes it happen.

And then I also have Dr. David Lane in Squamish who’s a boarded sports med vet who will see anything for me.

So, I am maybe not the best businessperson, but I do have a good business model in the sense of everybody has a good veterinary patient care relationship-type thing. If they come and see me and I don’t feel like the diagnosis is sufficient for a technician to be treating – And I have learned more about that since I’ve been in this situation – I send back to the family vet. I also will send directly to Dave. I will send to Susan as well, keeping the family that involved, of course.

It’s so weird. You think as you gained experience, you would know more, but it’s more like I know more about what I don’t know, which is great, and a very good skill as a technician.

DA: And as a veterinarian, just saying.

JP: Right, like it’s just that thing of I get texts being like, “Are you on your own? Oh my gosh, it must be so amazing.” And I’m like, “I’m not on my own. I wouldn’t want to be on my own. I can’t be on my own. The thought of being on my own gives me a complete crisis.”

So, the village has stepped up. And for that I’m so grateful. I would love to add to my team. I haven’t met anybody that has wanted to be on my team, which isn’t a reflection on me. It’s a shortage of the people available at this point. But that being said, I am so lucky to have who I have and I’m also so lucky that I have the trust of the community.

So, the other thing that I do: So, say you’re a general family veterinarian and you send a patient to me and I don’t feel they’re suitable for rehab, guess what? I’d spend probably an hour with your client, and I don’t charge them.

Which is shocking. There’s always like, “What?” But my feeling is I send it back to you, I send it to Dr. Lane, I sent it to Dr. Susan, we refer to surgery, neuro, etc., whatever that looks like for that pet.

If it’s meant for me to treat as a technician, it will come back to me. If it’s not, it won’t. But those people will hopefully tell other people about me. So, I call it the boomerang effect.

Could I charge those clients? Yes, they value my time. They appreciate it, all that stuff. I am just very focused, as a technician, in staying in my lane. And my lane in British Columbia is not diagnosis, it’s not prescription, it’s not stepping out of the role of treating what it has been sent for.

So, that’s how I stay in my lane. I don’t know if it’s the right answer, but that’s my comfort zone.

Previously, I did work with three human physical therapists in Ontario at a referral hospital. I also did work in a sports medicine practice with a lovely veterinarian.

And what else have I done? Oh, I started the program at the University of Guelph. I forget about that one all the time.

And unfortunately, in that situation I was on my own. The surgeon was across the parking lot, I guess, and he was available as much as possible. And everything came with a vet diagnosis, referral, all that stuff, but I did not have the opportunity to collaborate. And I really struggled in that specific environment with big, complex cases, not having anybody to really bounce ideas off of on a regular basis.

I mean, it’s not that there weren’t people there, there were. They just weren’t available to me to the degree that I like. Like Dr. Lane, as much as I see him – maybe twice a year – he is a message away and I can SOS him and say, “Hey, it ain’t right.”

I also have learned, as I’ve gotten a little bit older, that there are minimal rehab emergencies. So, if something isn’t right, I don’t have to do anything that day. There is nothing my laser is going to do today or that I’m going to do today that is going to affect the outcome, unless it’s an emergency case, which it needs to be going to see someone else anyway.

So, I think that age, experience, all that stuff, has kind of calmed me down about it all and made me a more objective, reasonable practitioner.

As for unity…

DA: Did you also think, though, that Tara’s Facebook site, that we started supporting one another and all of these other online resources where we can text each other and we can shoot a message to someone and say, “Hey, like what do you think because this case is like not doing better” or “It’s kind of way out of my comfort zone” or whatever, that it makes things easier?

Would that have helped when you were at OVC to be able to say, “Hey, can you kind of help me out? I’m going to send you some videos and pictures and stuff and see what you think?”

JP: Yeah, maybe. It might have. My time there was limited. So, I was hired as the rehab tech. But I was often in the general practice doing general practice stuff.

And I am someone that thrives in the discussion/collaboration mode. So, for me, there was no one to celebrate with. There was the students and they, I mean, they were along for the ride, they were all about it. So, I mean, that portion was fantastic. But I also struggled coming out of Mississauga, Oakville, where I was, where it was a ‘Yes’ environment, and we could see anything, to suddenly we weren’t taking referrals. We were only seeing in house patients.

I went from being the ‘Yes’ girl in Ontario to the ‘No’ girl, and it really made me struggle.

So, I think that I am in a good environment. The village – Oh, gosh, the village. I can’t even take good enough things about them – has supported me and kept me going. And thank gosh, they have, because I don’t think without them, I would have kept going because I didn’t think it was ethically right. Yeah.

But as for unity, I know that’s what we’re kind of headed towards. My view is everybody has a place on the team. Anybody who wants to work with me, anybody who’s interested in doing what I’m doing is a valuable resource. And it comes down to, unfortunately, business model, right? What can we make work?

So, for me, a business model is, “What can you bring to the practice?” You can make as much money out of my practice as you want, if you can help me make that money as well. And it’s not all about money – Believe me, I’m still paying for the thing – but it is about being successful together.

DA: Yeah, and you know what? And you’ve proven and there’s lots of technician-owned businesses and PT-owned businesses, direct access isn’t, you know, we don’t have to be there watching –

DA: – watching over your momma’s head and going, “Jenn, don’t do that,” because I think your training and your knowledge comes into that and you’re like, “Something’s not right here. I’m going to seek some other advice.”

So, I think the legislation that’s coming forward in multiple places about direct access isn’t necessary, but some sort of regulation or collaboration is necessary. That’s my thought on that.

JP: I had some discussions this week about assuming everyone has integrity, right?

DA: Yes.

JP: Assuming that we all want the best thing. I’m not out there saying I’m a surgeon or a chiropractor or anything that I’m not. I’m not buying expensive modalities that I don’t know how to use. I’m not recommending things that don’t make sense.

So, I think that having a genuine trust between ourselves is the first step to presenting that to the community. So, checking in and saying, “Hey, this is what I’ve experienced” or “Hey, I saw a case like this once and it didn’t go so well.”

I have Trina Legg out on the Island (Vancouver), is a lovely technician that does rehab. Her and I go back and forth about cases all day. She’s like, “What do you got?” I’m like, “Hmm, what do you got?” And it’s fun, right?

For me, it’s that collaboration. And with these Covid times, it has slowed us down and made us look at things a bit differently and how we do things. I’m so lucky that I have a porch that is in front of the practice that I can do gym stuff on and meet with the clients and develop those relationships.

I think that mentally, if I was just taking dogs out of cars all day and not having client relationships, I would really wilt as an extreme extrovert; let’s just call it what it is.

I value that time in the gym. And when somebody says to me, “I want gym time”, I’m like, “Yes, this is my people. These are my people.” So, I thrive in the gym environment. If I had the chance, I would hire someone to run the water treadmill and I would do all the other things because that’s what I want to be doing.

Right now, I’m doing it all; toilet paper to vacuuming, to changing filters, even my son vacuums.

DA: Narda, you want to introduce yourself? Your background is varied because you come from a human perspective and a DVM perspective, right?

Narda Robinson (NR): Right.

DA: You want to talk about yourself.

NR: Sure. Sure. Yeah, I graduated from Osteopathic Medical School back in 1988 and then shortly thereafter, I got my medical acupuncture training. And then by ’97, I graduated from vet school at Colorado State University and started their first acupuncture program. And then stayed there for the next 20 years teaching scientifically based integrative medicine.

So, that was until about 2016. And now, I just solely run the educational institution, CuraCore Vet and then the human part is CuraCore Med.

And that’s how I met you, as you know, Danielle. You took our Medical Acupuncture for Veterinarians course and then became an instructor shortly thereafter. You’re one of the most favorite instructors, now you teach in our rehab course, the MOVE course.

And I met Deanna back in the early to mid-2000s because Deanna has lots of great stories about that. Deanna was there at the beginning of the dialogue between physical therapists and the Veterinary Medical Board in Colorado.

And so, I got to meet Deanna and also Carrie; used to be Adamson. Now, it’s Carrie Adrian.

And so, from the veterinary side, I worked with the Colorado Veterinary Medical Association. And then it was an arduous task for several years, but it culminated in the provision of a model of collaboration between physical therapists and veterinarians, that I’m learning now, a lot of other states are trying to emulate or derive their own laws from.

But I think there always needs to be ongoing communication. And accountability and transparency are very important to me. And if whatever the profession, I want to know, what is your background? What are your hours of training? What are your hours of safety?

Because if you are asking to add something to your scope of practice and wanting to perform that on patients, I think that you need to have a fundamental understanding of what’s going on there. You know, you’re jumping into maybe another species. So, from human to vet or from vet to human.

I know, when I did wildlife rehabilitation before I went to vet school, I was a volunteer and I started working with the wildlife there under the supervision of the veterinarian, because they asked me to do acupuncture, they knew that I was an osteopathic physician and did medical acupuncture.

And I love the results, but I didn’t want to, just for the rest of my life, have to have a veterinarian supervising me. So, that’s why I decided to go to vet school. I love animals. I never want to hurt anybody. I never want anybody else to hurt anybody.

And so, with the work that I did with a physical therapist, I had also, previously to that, worked on scope of practice issues with animal chiropractors. And I just learned last night that there are human acupuncturists trying to gain access to animal treatment in one of the neighboring states.

And so this is an ongoing issue. And I agree that it’s nice to have conceptual unity, but I also think that it’s important for people to be able to back up what they’re doing and to verbalize to me and to animal owners and to the legislature and to anybody, what do you know and how is this going to apply?

And like Deanna has always said that she values knowing your field, but also knowing your limitations. And I think that that is an issue that comes up. Because when I was working under veterinary supervision, before vet school, I had no even conceivable knowledge of what I didn’t know, because I didn’t go to vet school.

And I had lots of human knowledge, but as they say, cats are not small dogs. Well, cats and dogs are not small humans. And it’s easy to not know that. And I see people getting defensive about that. But you don’t know what you don’t know, as has been said in the past.

So, the more dialogue, the more honesty, the more willing to come to the table and not just run away because your feelings get hurt, but it’s like, “Let’s have an honest discussion.” So, that’s my perspective.

DA: Yeah, and I mean, I get my feelings hurt a lot, because I’m a sensitive introvert and it’s easy for me to just go, “I don’t know if I want to get out there anymore.”

I get so excited. I get so excited to think of the potential for unity and all of us coming together and really working together and referring to one another.

And I’ll text my human PT, because she’s a CCRP as well. And I’ll say, “Okay, I need another opinion” or “Can I ask you something about, like legislation and what your knowledge base is and what you’ve learned and where you think your deficits are.”

And I think it’s good to have those conversations. But then sometimes I feel like everyone – And I’m not saying PTs only or vets only – everyone just kind of gets on this like, “I don’t need anybody else” and that doesn’t get us anywhere.

When I was legitimately the most excited was, we did a bit of a rehab course on ortho conditions and then on neuro conditions for veterinarians through CuraCore a few weeks ago. And that’s when I met Deanna and I was a little like – And this is me being honest – I was like, “Is this a good idea? Who’s this Deanna person?”

DR: Who is that person?

DR: And I didn’t know that though.

DA: “What’s that about?”

DR: I didn’t know she was hesitant. I didn’t find out about that till day before yesterday.

DA: Yeah. Oh, right. But I’m like, you’re so, first of all, you’re so lovely and so open and so willing to talk about things. And multiple times, I remember when we were going through things, you’d be like, “Oh, I didn’t know that.” And if you’re watching her, she’s writing stuff down all the time.

DR: And you see me doing that here.

DA: I know. I know she’s like, “I need my pencil and I need paper. And I need to write something down.”

And watching her teach, I learned things. And I think, again, it doesn’t matter, you’ve been doing this for a very, very long time now. So, I think, even you going, “Oh, I didn’t know that.” And I’m like, “Wow, you have so much knowledge about things that I didn’t know about.” This is what unity was.

And I came off of that week and I was like, “Yes. Like, let’s do this.” And then I went to the unity discussion and I was like, “I feel like there’s just so much anger and it kind of hurts my heart a little.”

And so, I feel like, did I go into it with an open mind? No, I did not. And we all have our own baggage that we’re kind of dealing with. But I feel like listening to you guys talk about what happened in Colorado and then teaching with you a few weeks ago, I was like, “Yeah, there’s so much we can do. So, how do we get this accomplished?” I guess, is our is our next goal.

What does unity mean? And, you know, I said it before, but definitely accountability. And I know that that touches on legislation. And I know worldwide, it’s different everywhere. But if we can get some sort of standard of practice to say, direct supervision isn’t necessary. We don’t need vets standing over, if we can guarantee that someone is regulating medical records, someone is regulating biosecurity, someone is regulating all of these things, and medical records are going back and forth between practitioners, because to me, that’s essential for patient care.

I know there’s a lot of comparisons to human side of things, but man, I mean, I’ve gone through the human side of things – from a personal perspective; with myself, with my mom – and it was not something that I would ever want to mirror in veterinary medicine. Veterinary medicine isn’t meant to be like that, so disconnected.

And I know there’s comments about human side of things and interprofessional collaboration and stuff, but maybe that’s in certain places, but definitely that is not something that I experienced when my mom was in the hospital.

DR: And I think… Well, go ahead.

DA: No, no, you talk.

DR: Well, I think the human medical field, in some areas, it can be a template for what we might like to do, but also a template for what we don’t want to do. So, yeah, I get that.

And the other thing I want to point out is, you can’t have collaboration without communication, but you can have communication without collaboration. So, I think both of those things are so critically important. Because even though, for example, I’ll be sending notes to the vets and whatnot about what I’m doing, most of the time, I don’t hear anything back from the vets.

And I understand. I mean, they’re not going to have time to go and read my notes every time I see somebody, but they know that it’s there in the record if they need it.

Now, if I need their input or have a question or problem or concern, there are some vets who are great about getting back with me right away, others don’t get back with me, but they get with the owner. So, they’ll go that way. And some just don’t communicate at all.

And if that ends up being the case, if there’s like a family vet and then a vet that comes in, does acupuncture, whatever, if I’m worried about the patient and I can’t get a communication with the vet that’s made the referral to me, then I will pull in even, in a stronger fashion, another vet that can help me with a particular problem if it’s a time-sensitive issue.

And I try not to step on people’s toes, but I have to be that pet’s advocate and that client’s advocate and have to do that.

But that whole working together, I’m like you, Jenn, I mean, I just love it. And I’ve been that way from the get-go, even in my human practice. I was the only PT working in this nursing home, which I love, love, loved. And my boss at the time, the administrator of the nursing home, absolutely wonderful, got me connected with the therapy department at the local hospital.

So, I had their Assistant Director, she would come and do case reviews with me every month and I could go to their lunch and in-services and just stayed connected that way. Learned so much just being around a lot of people and getting their ideas about treatments. And I’m still doing that, even with all these years of practice. Because I mean, there’s so much that I don’t know.

And like you said, even the things we learned from the course that we taught. I mean, just because I might be an instructor does not mean I know everything. And how I practiced today was different than I practiced six months ago and how I’m going to practice six months down the road. It’s just a work in progress.

NR: Yeah. And I mean, just who you are. I mean, I hope people can get who you are, like just your demeanor, your cautiousness, your care and love for the profession.

And you told me the other day, too, that you would attend your human patient’s doctor’s visits, so you could learn more. And that that further built the collaboration.

And you are as careful and methodical, and I know maybe you don’t like this word, the reliable piece or something that you got the award for eventually.

DR: Oh.

NR: Dependable.

DR: Dependable.

NR: Yeah, dependable. But just you’re so easy to work with and you’re so honest. But then, in the mid-2000s, after we worked out all that legislation and I had a case at Colorado State where the client was heavily demanding physical therapy and acupuncture from me, but then that’s when I got permission from the hospital director, the first time ever, that any physical therapist, at least in the small animal world, came to treat an animal. And I still show that video to this day.

Because you’re – what I love and why I wanted you as part of our rehabilitation course is because you think about that individual, who they are today, who they’re going to be long term, what the client’s needs are, what the client can perform.

You don’t push things. You know, it’s obviously not one of these kind of assembly-line kind of rehab things, that was one of the inspirations that made me want to start the CuraCore rehab course, because I want to express this patient-tailored, specific diagnosis, lots of hands-on, bring in the osteopathic piece, the myofascial piece, the physical therapy piece, everything, acupuncture, integrative, massage.

And it’s just like you showed so much, just, care and compassion that that’s just the embodiment of what I would want to see this profession going toward.

DR: Well, and also, too, like in your video, too, there’s times that I’m sitting there with you while you’re doing the acupuncture.

NR: Right.

DR: Because I’m like, “Teach me about this.” I mean, I don’t do acupuncture and I don’t do dry needling and there’s so much I don’t even know and understand about acupuncture. So, I’m like a little sponge and it’s like, you know, “Tell me how this works and to see it with my own eyes” and all that was just so exciting.

And I think, too, the owner really appreciates it. She just felt supported on so many levels. And she knew this was kind of an experiment for us as well. And she was trusting enough, as was little CeCe, to let us work with her and do that.

So, yeah, and like you said, I forgot about it. Yes, I did go with some of my human patients. When I was working the nursing home, I would go with them to their doctor’s appointments, particularly their orthopedic and neuro appointments. Because I just wanted to learn from these physicians in the community and how they operate and be there as an advocate for my senior patient and just developed some really nice relationships with the physicians in the community.

And the medical director at our nursing home, we did care conferences every week, alternating patients through there. So, that team approach was just ingrained in me from day one in how I worked with my human patients. And I love it.

One of the things that I really miss, not being at the rehab clinic, was there were such a lovely group of people there that I continue to interact with and learn from, even to this day, even though I’m not physically there working with them anymore. We have these connections that we can keep forever and learn from.

DA: So, I mean, I know what I learned in vet school about rehab, which was nothing. It’s like nothing. And you even a couple of years ago, I remember talking to a vet student. I was like, “How is that going? Like are they introducing that?” Knowing that we have this facility now at the Ontario Veterinary College with a swimming pool and a water treadmill and a boarded rehab person and all of these things that she does acupuncture.

And they said, “We got one slide in ortho in our lectures and that was it.” And I was like, “That’s weird.”

But it’s not across universities, right? So, MSU has a great rehab program, CSU, and Narda, you can maybe tell me more about how that works there. And University of Tennessee; they have this incorporated into their program. Whether or not that every vet student is exposed to it or not, I don’t know.

But I had a vet student with me this past week and she was blown away by not only what she thought rehab was, because she said they got about 20 minutes. So, I guess it’s getting better. 20 minutes on, “Rehab and swimming is great for arthritis and cruciate and all these other things” is what she was told. And I was like, “Okay, so let’s talk about that.”

And there’s still a huge gap of knowledge. But again, does it depend on university?

So, these vets, students that I met at MSU, their knowledge of rehab and physical medicine and all of these other things is way more than the other students graduating.

So, I feel like I don’t know what techs get. And is that depending on where they graduate from, Jenn? Like I know Northern has a rehab program – I don’t know who teaches it – but Sheridan does not. And again, there’s tech schools everywhere. And just PTs don’t get animal rehab in the regular program, I’m assuming, Deanna.

DR: No, I think they might have a little bit now in some of them. But again, it’s very small. So, in Colorado, we came up with these minimum criteria you have to meet for educational hours and topics, as well as clinical hours and topics, before you could even consider practicing on animals.

Because we wanted to emphasize, just because you’re a human-trained PT does not mean you can automatically go and treat animals. And that, too, has been what also the animal special interest group with the American Physical Therapy Association has worked on, as well as it doesn’t work that way. You get your human PT license and then you can go and hang your shingle to work on animals. It just doesn’t work that way. It’s not the best thing for consumer safety. You need extra training for that.

DA: And I want to give an example, because, you know, I think there’s been a couple of times where I have such great relationship with the referring vets that refer to us. They were like, “We haven’t seen this dog in like a year. It’s senior. It’s weak on the hind end. The owners don’t want to do medications. Can I just send the referral off to you?” And I’ve gone, “Whatever. Sure. I’m a vet. I can see this.”

And it comes over and then I’m like, “Something’s not right.” And I do a physical exam and it’s got a basketball in its abdomen. So, the bleeding hemangiosarcoma is probably why it was a little bit weaker in its hind end.

And so, my fear without referral from a veterinarian. So, had they seen that dog and then referred it, they probably would have caught that first, right?

So, without referral from a veterinarian, who’s done a proper physical exam and evaluated that patient, that is my fear, going to a non-DVM who may not pick those things up. Is it a real fear? I don’t know.

Jenn, do you see anything that, like you always get medical records and everything else? You said you get diagnosis.

JP: Yeah, it varies. And honestly, I’m on it. And if it smells like anything other than straight out success to me, it’s out the door. And that’s not me being – Sometimes, I’ve had the like, “You know this?” And I’m like, “Oh, I do know this. Oh, I know it.”

But it doesn’t serve anybody for me to know more than I should as a technician. So, I don’t pride myself on that.

I also think that from the student standpoint that you were talking about, mentors are key. And I do not mentor anyone right now. No fault of this little person. But he keeps me very busy. And I have said no to mentoring because I would be an awful mentor at this point in my life. I don’t have that to give. I just don’t.

You saw me cut up a caramel apple during our discussion. Yes, that is where I’m at. Yeah. Like I’m awesome. I’m the best ever.

DA: Yeah, but you’re managing a lot. You’re managing a business. You’re managing a child. Right?

JP: Yeah.

DA: You’re right.

JP: Stuff’s going on.

DA: There’s only so much you can do.

JP: And I do here. Like monitoring, mentor. No, moderating – That’s the word I’m looking for the English language – the unity group at the moment, what I am seeing is, yes, there is that fear. Yes, there is that territorial stuff going on. There’s a lot going on in that group.

But I do think it does come from a common place of caring about our professions, about our patients and actually about each other in a very weird relationship kind of way. I’m not saying it’s the ideal relationship, but I do think that people genuinely care about what we’re doing and this topic or they wouldn’t get so fired up.

So, hopefully, every day will get a little easier. I have a little notebook of, like, “It’s going to be better today.” And it will. It has to get better.

It’s not sustainable the way it is. And it’s not sustainable to keep lobbying the way that we have and it’s not working. And I was serious when I said, “If you keep hitting a wall, stop driving your car into it. We’ve got to take a detour.”

And I’m not saying we won’t get to the same answer; we just might need to take a different approach. And I’m not saying my approach is right. I don’t know. I’m a technician that’s looking to collaborate with anybody who will collaborate with me. Like I feel like a homeless little puppy at times. I’m like, “Please pick me. Come work with me.” But I do think there’s a lot of potential for all of this. So, that’s kind of where I was coming at today.

DR: And I don’t know; I’ll be honest with you, I mean, I hear this concept of unity or unity discussion or whatever, and all I’m relating to is what I do in my small world here in Colorado. I don’t really know what you all are talking about.

I don’t even know if that’s a topic for this particular discussion, but anyway, I just wanted to put that out there that maybe we need some clarity on that. Because that’s such a broad term; unity, unity discussion. And if there are folks listening, maybe they need to know if there’s something specific you’re referring to.

DA: I think that’s the problem. Nobody seems to know what exactly we’re talking about.

JP: Our work group has a meeting scheduled soon, and I think that’s where we’re getting started. As with everything, I think everybody wants their piece of the pie. They also want their voice heard right now. And they’d like answers right now.

Because let’s face it, we all come from fast moving practices, right? “I really want that animal diagnosed right now, so I can start.”

It’s not necessarily how it works. Sometimes, it’s a few weeks. And that is probably what’s going to happen with this is I think it will be a little slower than we’d like. But hopefully, we can keep the momentum going, because I think it’s valuable stuff. There wouldn’t be this many people involved and this many different side conversations happening if it wasn’t necessary.

And I do think the IADRPT is a perfect organization to come up with a global document for all of us to take to whoever’s legislating us and try and improve things.

And I think that’s where it will end up going. I can’t speak on behalf of them. I can’t speak on behalf of the working committee at this point at all. But my vision would be a document that I could say, “This is what animal rehab looks like. This is what everyone brings to the table, and this is what’s the special skill.”

So, when I say, “Hey, you should go see Deanna because she’s a PT.” That’s documented as to why you’re going to see that PT. So, not only for each other, but for our clients. “You should see a physical therapist instead of Jenn Panko because she can do these things.” “You need to go see Dr. Danielle because she can get you that pain management that your pet needs.” “Hey, I know your pet needs these things, and this is who’s going to be the best person for you.”

And I honestly wish we all had baseball trading cards of what we did, and I could just pass them out. I could be like, “Hey, go see Number 17, she’s got what you need.”

NR: Okay. So, what is the goal of unity, Danielle? Answer Deanna’s question about what this is about.

DA: Yeah, I mean, this today is – Again, I felt like four different perspectives coming at this is better than – I felt anxious and bombarded when we were trying to discuss it in the unity stuff.

And I feel like I’ve worked and talked to all three of you. And I feel like you’re kind of like – I feel like we can at least bring some different perspectives out there and say, “What is our ideal of unity?”

My idea of unity would be, again, communication about every aspect of these patients. And I don’t think that’s an unrealistic expectation. I know in human medicine there’s direct access for PTs, but there’s so much disconnect in human medicine between professionals. Like my mom’s endocrinologist does not talk to my mom’s cardiologist who does not talk to whoever. It just doesn’t happen. They send the reports off to their GP, maybe.

But I feel like in vet medicine, we are trained. We are trained in everything. We are trained to be that neurologist, orthopedist, surgeon, internal medicine person. Do we still refer out to boarded specialists? Yes, we do. And we should. But we are multifaceted trained in those things.

And so, I feel like in vet medicine, it’s not the same. And in Canada – Let’s use Canada as an example, because that’s where I am – I feel like there’s a lot of waiting around. There’s a lot of disconnect with medical professionals. And our health care is paid for. So, people don’t see the worth there.

And veterinary medicine doesn’t operate like that. Veterinary medicine, if we treated animals like people are treated in the medical profession sometimes, I’m like we would never have any patients and clients coming in the door.

They want value and they want to feel valued and they want their pet to feel like they’re doing the best thing possible. And these are members of their family. And I think we can just do better.

So, I do believe unity means collaboration and medical record transfer. And yeah, I’m on the phone going, “Okay, well…” And yes, these are other veterinarians. So, I get there’s people that don’t agree that that’s interprofessional collaboration, but I would have no problem as a GP.

So, let’s back my education up 10 years, when I’m not rehab certified. If I was educated and went, “Okay, this PT is doing a great job. I’m going to refer off to her. I’m going to make sure she knows what she’s doing. I’m going to send her the medical records, so she has all of the information.”

Or I’m going to tell my client, “You know what? Before I refer you off, can you just come in for a physical, so I can make sure that the weakness isn’t caused by cardiac or by cancer or by something else that we’re missing. And then I’m going to send you to the PT for all the things that you want.” I mean, that’s my ideal, right? Or the technician, right?

I just feel like if you don’t have all the answers, that’s where mistakes are going to get made. And that is not in the best interest of the patient.

So, having something that just has a nice little framework on what unity might look like. So, then I can go to my College, who’s trying to make legislative changes that just don’t seem in the best interests of anyone, the PTs, the vets, definitely not the patients.

Direct access isn’t the answer. And there aren’t enough veterinarians who want to even have to deal with any of it. They’re overwhelmed in regular practice as it is. They don’t want to have to oversee a rehab tech or a PT, I think.

And, you know, someone – I can’t remember who it was. Maybe it was Karen Atlas – brought up some of the legislation with calling them assistants. Look, that doesn’t do anybody any good either. They’re not assistants. They have a vast education on physical therapy. So, let’s not devalue anyone.

Let’s all talk. Let’s all communicate. Let’s get something in place that we can now go, “I can go to the CVO and say, “Hey, this is how it could work and should work” and maybe then they’ll listen, because they want information, but they’re not really communicating with anyone who knows anything before they’re trying to set up these legislations. Not in our area. Again, that’s different globally. But anyways, I just rambled. I’m sorry.

NR: Well, Danielle, there’s that liability piece, too, right? Is it that if you refer, then you are liable, no matter what?

DA: Yeah. So, if I refer to a non-DVM and something goes wrong, it’s my license that they can go after.

DR: Is that in your Practice Act or…?

DA: Yeah, that’s our College.

DR: Oh, okay.

NR: So, the College is your regulatory body.

DA: Correct. Yeah.

DR: Oh, got you.

DA: And so, legally, the College will not let me practice, Deanna, in anything other than an accredited veterinary hospital. So, I could not work for you. You could work for me, under my license. But anything you do, I’m still liable for.

The Canadian Physical Therapy Association in Canada does not regulate any physical therapy on animals by PTs. So, again, no one’s regulating that.

Technicians, if they’re registered, Jenn, you may know a little bit about that, but I believe the OAVT (Ontario Association of Veterinary Technicians,) you can complain to the OAVT and say, “Hey, this technician is doing something that’s really, really sketchy.”

But again, no one’s really going into their business and saying, “Hey, are you properly cleaning in between patients? What are you doing with all your needles? Do you have proper medical records?”

For me to open my practice, first of all, they didn’t even have – I mean, Ontario is pretty extensive on what they require for a vet hospital to open, and they didn’t even have anything for a rehab facility. So, we have to apply as a regular hospital with –

And mobile stuff as well. So, there’s MAV grads and rehab grads that want to do mobile practice, they have to have an inspection of their car and their house, because that’s they’re kind of stationary point.

I know someone who had a palliative care practice and she had to move. She got divorced. She moved two doors down and they charged her and said, “You have to re-accredit your stationary place.” She’s like, “I’m literally two doors down. Nothing else has changed.” But the address changed, which means she has to re-accredit her whole practice.

DR: Wow.

DA: And so, we’re under such strict guidelines that this came up in the unity discussion. I can’t go to an agility meet unless I have a mobile license. And to get that mobile license, I have to have oxygen and surgical packs and all these other crap in my car that I don’t need to have.

The CVO (College of Veterinarians Ontario,) is understanding that things are changing, and so they are they are starting to be a little bit better about going, “Okay. Well, we’ll waive those, but you still have to apply.”

And it’s a process. And we seem to be the only ones being regulated in Ontario, possibly across Canada, as far as when we were doing rehab.”

And so, yeah.

NR: Very uneven.

DA: And as a technician, it’s even more complicated. And I don’t know if it’s like that out there in B.C., Jenn, but I mean, they can practice in Ontario without being registered. They could go through their whole program and not take our exam. So, if they aren’t registered, no one’s regulating them, right?

JP: If I want to make a bucket of money, I’d grab my dog gym equipment, go to all the competition and be a one-hit wonder.

Ethically, I would never do that. It’s completely out of my comfort zone. It’s completely disrespectful to the veterinarians that work with those pets. It is completely disrespectful to the client. They don’t know that. They think they would love it. They would all show up and line up and sign up and get their time and hand me their cash h. And it would be like, “Wow, this is great.” Not great.

Because (a) I know the process of rehab. I know the process of fitness, all those things. Giving a random laser wand, if you need that, you need more than me, you need Dr. Lane, you need something else. You don’t need Jenn Panko.

DA: Oh, Jenn. 

JP: And yes, I could do that. But it just puts a bad name on it. And it’s hard because other places do it and other people do it. And why is Jenn Panko not out there promoting her business? Does she not like the agility people? What’s the issue? Why is she not coming to the shows on the weekend?

Because it’s a lawsuit waiting to happen.

NR: So, I just received a comment from one of our live viewers directly. Very good input there, Jenn. I am glad that you’re following your heart and your mind and your ethics.

So, yeah, what is missing in this discussion perhaps is like the consumers or the clients.

DA: Yeah.

NR: And so, I’ll just do my piece and then listen to you guys. But that is what the Practice Acts are all about. That’s what the vet boards are about, is consumer protection and public health, animal welfare and everything. But I know when we were dealing with the chiropractors wanting to carve out chiropractic or manipulation from veterinary medicine and all this stuff, talking to the regulators, their concern was consumer protection, most of all. It wasn’t really animal welfare, animal health, this, that and the other.

And so, I think that a lot of what drives the impetus to change laws, because I know the Veterinary Medical Board, they were tired of hearing complaints like, “Why can’t I see my physical therapist,” blah, blah, blah, blah, blah.

And so, their desire to have some kind of working model that we could collaborate and that everybody would be more than happy with that was because it was bugging them to have to deal with this repeatedly.

So, from my piece, what do I want for clients? I want somebody that will make a good, solid diagnosis, use their hands. So, I think that the veterinarians, they need better information on how to do a myofascial complete diagnosis, feeling the animal, not watching them walk and assuming it’s something surgical.

I want clients to have non-surgical options. I see rehab as not post-surgery rehab, but you had something happen to you. Let’s see what we can do before surgery. I’m very non-surgical myself, as you know.

And so, just listening to you guys. I mean, you know, and then I love my clients and I love my patients, whatever the species. So, I care for them and I want to protect them, and I want to protect them from harm when I see that being a possibility.

And so, I know that I tend to be outspoken and want to have this accountability and transparency, but it comes from that position of not wanting harm and caring for people. So, wondering if you guys could talk about where the client fits in and all this.

DR: Yeah, I agree with that as well. And when in Colorado, we started the process of working on our Practice Act changes, we had a consumer advocate with us from the get-go, that was Connie.

And I remember many times meeting with the vet board, staying true and just stating out loud, “This is all for – I see everybody’s laughing – This is all for protection of the animals and the consumers.”

DA: All right, just a little inappropriate.

DR: Oh, no, no, no.

NR: One of Danielle’s dogs gave us a rare glimpse of the opposite end of the spectrum. Anyway, go on, Deanna.

DR: And Narda and I were talking the other day about when we started this process in Colorado, to get the Practice Act changed, the way it happened was I met with the Colorado Vet Board, with Connie joining me as a consumer advocate, to talk to them about, “Hey, I’m a PT. I’m seeing a few patients here without direct supervision because I need to do these case studies for my Canine Rehab Certification Program. Is this going to be okay or am I going to get a cease-and-desist letter?”

So, we went over all my communication processes and Connie spoke on my behalf as well. And they said, “No, what you’re doing is fine.”

I know that if there was an issue, I wouldn’t have had a legal leg to stand on, but I wanted to just put it all out there, “This is what I’m doing.”

But from that first conversation, the board members were saying, “We are hearing more and more that the consumer wants animal rehab. We’re also hearing about it, that they want chiropractic services,” which really at that point was very concerning to them. And they said, “Maybe we need to start dealing with this now, particularly with animal physical therapy, because you’re sitting here in front of us talking to us about it.”

They’re the ones that opened the door, as far as trying to get something figured out, how we can do this, so that human trained PTs could do animal physical therapy. And so, I just remember driving home from that meeting and Connie and I were so elated and shocked and just never even expected that to come out of this first visit.

But through that whole process, which took us three years, the big motivating factor was animal and consumer safety throughout the whole process. And I so much appreciated that that board and the Colorado Veterinary Medical Association just staying so true to that while we were coming up with the proper legislation.

NR: Well, and as you and I have talked before, that was kind of, it was made so much more blend-able and “easy,” because – And easy in quotes, I guess – but because of who you are and what Carrie brought to the table as well. And then she went on to get her PhD from CSU.

DR: It’s true. Yeah.

NR: But I think that our vision also had to extend, not only from the creme de la creme, which were you and Carrie Adrian, but also anybody else. So, it has to be everybody has to meet this minimum amount.

DR: Minimum, right. Right.

NR: Yeah.

DR: Right. Exactly. You’re right. And we all we’re putting our heads together, figuring out what should this be, the minimum criteria, again, with consumer and animal safety in mind.

Which brings me – I never answered your question, like you mentioned, Danielle, about the dog with the abdomen mass. Would that be picked up?

As therapists, we are trained to look for red flags. And even though I get a referral from a vet, which means in Colorado, they have to have a veterinary-client-patient relationship and have to have seen the animal within the past year.

I never assume, even if they saw the vet last week, that they’re free and clear. I still will take on the responsibility of assessing them at every visit about what is going on as the whole patient, within my skill set, to do so.

And there may be times that things just don’t seem right and I can’t even put my finger on it, but rest assured, then I would be contacting the veterinarian.

And even if I can just relay what I’m finding with my hands or clinical symptoms I’m seeing, the two of us can help then maybe put together, “All right, do we need to get the dog back in to be examined?” and all those kinds of things. So, that’s how that kind of process would work out.

And I’ve had dogs who I’ve seen, who the vet just saw them the week before, and I may catch something. Also because I’m in their home, animals, I think, also may behave differently than they do in the clinic setting. And so, sometimes I can pick up on stuff maybe that you don’t see in the clinic.

NR: Right.

DA: And like you said, it’s a different lens, right?

DR: And that’s right.

DA: And I’ve had clients before, they’re like, “Well, how come my vet didn’t catch that?” And I’m like, “It’s a different way of looking at things and different way of looking at patients. And the training we get allows us to find those things.”

And so, even having the vet student that I had last week, she’s like the way that I examine these patients, the way that we look for gait abnormalities and all these other things is not something that she was taught, but she was so excited about.

And so, I think for us, all of our professions, none of us know everything. And it’s to continue to teach PT students what options are out there and have them go ahead.

If they think that this is an option – I mean, yes, it’s nice to spend a week with a veterinarian, like is required in Laurie’s course, but maybe a little bit longer.

I know my week that I spent doing rehab for my CCRP externship, it wasn’t enough, right? Like one week was not enough to see what I needed to see, moving forward and really perfect my skills and my techniques and my exams.

And so, I think we just need to keep teaching one another and getting to the students and saying, “Hey, great. I’m glad that OVC has prepared you for your NAVLE and I hope you rock it. I hope you go in there and you just rock that NAVLE.

“But after that, let’s talk about other ways to maybe examine these patients and talk about the psoas – Which a lot of them still don’t know what that is – and let’s talk about what other potential causes are, from a myofascial standpoint, not just a, is it a cruciate? Is it not a cruciate?”

Because we had this discussion a lot last week; just because it comes in and its lame on that hind, it does not mean it’s a cruciate tear. And what is an atypical cruciate?”

I’ve had that discussion where I’m like, “Well, really, what is it? Because then if it’s atypical, is it actually a cruciate?”

So, these things need to – It’s just about education. And we can easily say, “You know what? These vets don’t know anything. So, we just need to take this over.”

But I think it’s not about that. It’s about educating them. And I think, you know, I send my report off to the referring vet and they’re like, “Oh, I didn’t know that” or “I wish I had that.”

And don’t ask me about any new advances in ophthalmology, like I’d be like, “Er, I haven’t done ophthalmology in a very long time.”

DR: Yeah.

DA: Again, it’s all about knowing what we know and knowing what we don’t know.

DR: That’s right. And being comfortable with that and, yeah, communicating that as well. And not only to our other people in the team, but the pet owner and whatnot.

DA: Yes.

NR: Right. And I think that the clients, back to them, I mean, they need to know there are options. They need to know that there are non-surgical options for the putative cruciate issue, which might not be that at all, and then even spinal cord injury and intervertebral disc disease, all these things that they don’t have to choose between a very invasive surgery and euthanasia or sticking their animal in a small cage for six or eight weeks or whatever.

So, I think that that is imperative, too, because that will drive the veterinarians to learn more about this.

And just one piece, before we wrap up whenever we do, that I think that in addition to the indirect supervision, if that could be worked out, then a big missing piece that we can now see a remedy for are telecommunications. And so, whether we’re going to FaceTime or Zoom or whatever. That I think that sending a video of the animal, as they are, back to the vet, just short, whatever.

Let them see it or let them, if they’re interested, they can talk to the client, they can see the animal, they can watch you do the treatment.

I mean, it’s really fascinating to see what’s going on. And I think that veterinarians would learn by that visual piece.

And I know how diligent you are about your record keeping and all the details, Deanna. And that is important. And that’s what’s required by our arrangement and legality.

But if they could see you work, I mean, that is just such a model for just focused engagement on the patient. And also is a model for how veterinarians that are burnt out, depressed, whatever, with corporate or other practice that they see the animal for five or 10 or 15 minutes, that’s what we’re showing them, is that you can have a life that is happy and very patient-centered, bond-centered practices. And you spend an hour with your patients and you’re happy at the end of the day, not burnt out.

DR: Yeah, yeah.

DA: You’re right. We need to educate owners; like that’s a big thing.

DR: Yeah.

DA: Educate owners as to the differences between going to a place that does not have a certified person. I think if you have a PT or a tech or DVM or whatever and they’ve gone through the rehab certification and they’re educated, then that is very different from going to a pool, who claims to do rehab or even going to a chiropractor who is doing rehab without any training.

And I think that is the key. And doing part of the course is not the same as finishing that course and writing your exams. And I think people don’t understand that difference.

So, do I believe that they need to have access to as much as possible? Absolutely, but educated access.

DR: Well, and from the liability perspective here in the States and Colorado, I’m liable. If the vet sends me someone, I’m the one that needs to be responsible for the liability. And I’m happy to take on that responsibility. And I should take on that responsibility.

And if I have clients who are pursuing services, like you say, maybe with uncertified folks or whatnot, there may be times when I’m like, “Okay, could I join you for that visit, so I can see what that person’s doing and learn from that person, what services they’re providing and that kind of thing.”

And sometimes it works out really well. I get a whole nother person I can add to my toolbox.

And so, yeah, it’s just a lot of collaborating. But the liability issues, I think, certainly I can see why, that’s complicated in Canada. Oh, my goodness.

DA: Yes.

DR: Oh, my goodness.

DA: Yes, it is.

Jenn, do you have anything to add to that, before we wrap up?

JP: I actually have to go take my little person to school and go proctor the vet tech student’s large animal exam, which is so much fun. It’s practical.

But I did have a hairbrained-Jenn-Panko idea, and I really think that our profession could benefit from this. I think that I need to start lobbying – Let’s call it lobbying – for networking opportunities at conferences. And I mean speed-dating style.

Because listen, I don’t know, Narda, I don’t know, Deanna. I learned a lot from this conversation right here, while I was cutting up an apple, getting a pillow put on my face and having a wrestling match with my child.

So, imagine meeting people that we see on the internet that are giving opinions, all sorts of stuff, meeting them in person and having those conversations. I feel like these groups or even discussion groups could be so important.

So, that was what I took from this. So, I thank you all for including me in it.

DR: Nice to meet you.

JP: And I appreciate the opportunity to just chat with you all. And I’m thinking of ways to improve unity, starting with either, I mean, it’s Covid time. So, maybe it does need to be online, but maybe we need to have a little meetings and get to know each other, instead of posture against each other.

Something to think about. I will roll it around in my little brain.

Thank you so much. Take care.

DA: Thank you, Jenn. Thank you, Deanna. Thank you, Narda. And everyone, have a wonderful, wonderful weekend.

NR: Thanks.

DR: Thanks, everybody.

NR: Thank you.